Global advances in integrative medicine and health最新文献

Low back pain (LBP) is one of the leading causes of disability globally. The prevalence of chronic LBP has increased dramatically, and there is a need for conservative therapeutic interventions to support patients with chronic LBP. A 66-year-old female patient presented with severe low back pain and associated disability of 2 years' duration. The patient received 8 weeks of Ayurvedic treatment. The Oswestry Disability Index score and self-rated pain on a scale from zero to ten were used to assess disability and pain over time. The patient reported a considerable reduction in LBP over the course of the Ayurvedic intervention, and her disability score improved from 55% at the initial consultation to 20% at the end of treatment. This case report suggests the potential of an Ayurvedic approach as a complementary and alternative treatment method for chronic LBP. Larger, controlled interventional studies are needed to further evaluate the effectiveness of Ayurvedic protocols for the management of chronic LBP.

Background: Integrative health efforts typically offer clinical services of Western and non-Western origin in a biomedical context. Indigenous communities and other minoritized populations would benefit from improved equity efforts in integrative healthcare.

Objective: As an approach to improve healthcare for Kānaka 'Ōiwi (Native Hawaiians), we explore multi-eyed seeing, an elaboration on two-eyed seeing, emphasizing decolonialism and adaptive use of healing traditions from multiple cultural backgrounds. We also discuss the ways multi-eyed seeing may be used to address challenges to integrative health inequities.

Methods: Using the transformative paradigm and community-based participatory action research, we conducted 1 focus group and 38 in-depth interviews. Data were analyzed using grounded theory, a decolonial intersectionality method, ho'omana i nā leo (empowering the voices), and thematic analysis. To triangulate data, recruitment targeted 3 categories: mental and behavioral health providers who primarily serve Kānaka 'Ōiwi (n = 12), Kanaka 'Ōiwi clients who experienced depressive symptoms (n = 19), and Kanaka 'Ōiwi cultural leaders (n = 10).

Results: Three primary themes emerged, suggesting that multi-eyed seeing: 1) supports Indigenous wellbeing at multiple levels; 2) necessitates unique spaces for healthcare and healing; 3) may illuminate similarities across cultures and underlying mechanisms for healing and health. Findings also include 2 secondary themes, 1 describing the potential role of multi-eyed seeing in idiographic and transdiagnostic approaches to behavioral and integrative healthcare and another describing potential barriers to multi-eyed seeing.

Conclusions: By drawing upon strengths of Indigenous, Western, Eastern, and other pathways to wellbeing, a synergistic weaving may be stronger than the sum of its parts. At the levels of ontology, epistemology, axiology, and praxis, multi-eyed seeing provides approaches to equity in integrative healthcare. We offer critical reflections and analyses of the processes that may uplift the work of multi-eyed seeing as a decolonial approach and invite dialogue around this concept for future exploration.

Background: Myasthenia gravis (MG) is a rare autoimmune disease resulting in muscle weakness. Although pharmacologic treatments are typically effective at managing symptoms, prolonged use is associated with safety issues. Acupuncture treatment may have a significant positive effect in treating MG symptoms and may enhance the efficacy of medications.

Objective: The overall goal was to examine the feasibility and safety of a pilot randomized controlled trial of acupuncture treatment in individuals with MG.

Methods: Participants were randomized into 2 arms: (1) immediate start and (2) delayed start. Participants in the immediate start arm underwent twice weekly acupuncture for 12 weeks, whereas participants in the delayed start arm underwent a 12-week delay period, followed by twice weekly acupuncture for 12 weeks. A base treatment of 21 acupoints was used for all study participants. Acupuncturists made a Traditional Chinese Medicine differential diagnosis to determine whether the patient was yang deficient, yin deficient, or stagnation pronounced, and could add up to 9 additional acupoints. Participants received the same acupuncture protocol for all 24 treatments.

Results: Twenty-four individuals with MG were enrolled in the study. The average age of participants was 62 (SD = 13) with an average of 8 years (SD = 9) between diagnosis and enrollment. Seventeen of the 24 individuals who signed the consent form completed 100% of acupuncture treatment sessions and completed the full study. Only 17 adverse events were determined to be definitely or probably related to treatment, which were mostly mild site reactions. Barriers to participation included transportation issues, travel time, and the overall time commitment.

Conclusion: The results demonstrated that acupuncture treatment was overall feasible and safe in individuals with MG. Participants also self-reported improvements in MG symptoms. Next steps will include development of an efficacy RCT with a rigorous study design to examine the clinical significance and efficacy of acupuncture for MG.

Background: Ayurveda Prakriti determines individuals' physical, physiological, and psychological features. Prana-the vital life energy-flows throughout the body and is intimately linked to the tridosha.

Objectives: This pilot study aims to explore the relationship between tridosha and the intensity and distribution of Pranic Energy Sensations (PES), along with physiological parameters and mental well-being.

Method: This single-arm pilot study was conducted at a Government Ayurveda Medical College, Mysuru, Karnataka, India, using convenience sampling. Data collection encompassed demographic details, the Dosha self-assessment questionnaire, Positive State of Mind Scale (PSOMS), and physiological parameters including Body Mass Index (BMI), Peak Expiratory Flow Rate (PEFR), oxygen saturation (SpO₂), and temperature. Following Sensitizing the Hands Practice (SHP) and Energising Prana Technique (EPT), the intensity and distribution of PES in the palms were recorded and analyzed.

Results: Ninety-one apparently healthy Ayurveda students with a mean age of 24.86 ± 2.32 years participated. Exploratory correlations suggested that PES intensity had a positive correlation with Body Vata (ρ = .224, P ≤ .05) and Pitta (r = .209, P ≤ .05). Mind Vata showed a negative correlation with Positive State of Mind (ρ = -.373, P ≤ .01). Body Vata also showed correlations with forehead temperature (pre: ρ = .282; post: ρ = .348, P ≤ .01), and Body Kapha with PEFR (ρ = .206, P ≤ .05). A small to moderate reduction in temperature was observed post-EPT.

Conclusion: This pilot study identified an association between higher PES intensity and Body Vata and Pitta dominance among Ayurveda students, suggesting a potential link between PES, Prakriti, physical parameters and psychological state. These findings align with Ayurvedic concepts connecting Vata and Prana, offering preliminary support for their relevance in biofield therapies. Further studies with control groups and objective validation are recommended.

Purpose: The purpose of this study was to understand homeless veterans' perspectives on the utility and impact of Battlefield Acupuncture (BFA).

Design: A qualitative study among veterans with chronic pain who were experiencing homelessness.

Methods and participants: A subset of twelve Veterans who participated in a in weekly BFA sessions for up to 12 weeks at one VA medical center participated in semi-structured interviews conducted between September 2022 and March 2023. Qualitative thematic analysis was used to analyze the data.

Results: The average number of BFA visits among participants was 10.8. Thematic analysis revealed three themes (1) Prior experiences with chronic pain, where Veterans often reported having pain for years with limited relief, (2) Appeal of a non-pharmacologic treatment, and (3) BFA had a positive impact on health and well-being. Overall, participants reported BFA to be a brief, convenient, and effective non-pharmacological treatment for their chronic pain. Many described how they had exhausted most other traditional treatments for their chronic pain and saw BFA as an acceptable and effective alternative treatment.

Conclusions: Our results indicated Veterans appreciated BFA as an alternative approach toward the treatment of their chronic pain beyond what is typically offered in conventional health care, the convenience of short appointment times, and accessible services. Our findings support the VA continuing to offer BFA as a Complementary and Integrative Health modality, particularly for high acuity populations like Veterans experiencing homelessness.

Background: Cost sharing, or the extent to which patients contribute to health care spending, has been linked to various outcomes. The relationship between cost sharing and acupuncture utilization is unclear.

Objectives: To measure the association between cost sharing (eg, copays, share of spending paid out of pocket, and consumer-driven health plans marked by high deductibles) and the use of in-network acupuncturists.

Methods: Our team used commercial insurance claims. The study sample included 105 501 individuals who visited an in-network acupuncturist between 2012 and 2021.

Results: In plans with less out-of-pocket spending overall, more members used an in-network acupuncturist. Plans with $0 copays and consumer-driven health plans had less acupuncture utilization compared to plans with higher copays and non-consumer driven health plans.

Conclusion: Cost sharing had an inconsistent impact on acupuncture utilization. Our findings suggest that access to in-network acupuncturists is more important than cost sharing when it comes to increasing acupuncture utilization.

Background: Pancreatoduodenectomy (PD) and distal pancreatectomy (DP) are painful procedures often accompanied by psychological distress. Music therapy interventions such as music-assisted relaxation and imagery (MARI) have demonstrated efficacy for acute pain but have not been examined within PD/DP. Gene expression mechanisms by which MARI may affect pain also remain poorly understood.

Objective: This study assessed the feasibility and acceptability of administering MARI, collecting dried blood spots (DBS), and collecting mobile-device patient-reported outcomes (MDPRO) among adults undergoing PD/DP.

Methods: In this single-arm study, patients undergoing PD/DP received a live MARI intervention that was subsequently provided as a recording for use until discharge. DBS and numeric rating scale (NRS) measures of pain, stress, and anxiety were collected pre- (T0), post- (T1), and 15-minutes-post-MARI (T2). Participants were asked to complete MDPROs 3 times/day until discharge and participate in an interview post-discharge.

Results: Of 22 patients approached, 5 (22.7%) were enrolled (60% DP) with 80% completing all procedures. All participants completed the live MARI intervention, ≥1 NRS measure from T0-T2, ≥1 listen to the MARI recording, and ≥1 MDPRO survey. DBS sampling success was variable (9/15 [60%] across attempts). Qualitative data revealed three themes: (1) MARI was beneficial and useful throughout recovery; (2) MARI should be longer; and (3) need to improve blood sampling and mobile device procedures.

Conclusion: Preliminary findings support feasibility and acceptability of live MARI, continued MARI listening through discharge, and MDPRO collection within PD/DP. However, modifications are needed in future studies to improve blood sample collection.

Objectives: While Mindfulness-Based Interventions (MBIs) are evidenced to reduce common psychosocial symptoms experienced by people with cancer (PWC), few studies have tested their mechanisms. Additionally, studies have yet to assess sex assigned at birth as a moderator of the relationship between mindfulness and psychosocial symptoms through specified mediators. This study (1) explored the mediating role of rumination and experiential avoidance (EA) in the relationship between mindfulness and a range of psychosocial symptoms and (2) tested sex as a moderator of the mediation models.

Methods: This cross-sectional study assessed baseline data from 134 participants recruited for a mindfulness app clinical trial. Validated patient reported outcome measures of trait mindfulness, rumination, experiential avoidance, depression, anxiety, FCR, and fatigue were collected. Structural Equation Modelling was employed in R.

Results: Rumination was a significant partial mediator between mindfulness, depression and anxiety and FCR, but not fatigue. EA acted as a weak mediator from mindfulness to FCR only. Subgroup analyses found that rumination may be more important for females than males in the relationship between mindfulness and depression and anxiety.

Conclusions: Rumination may be a stronger mediator than EA for anxiety, depression and FCR, and this may be particularly important for females. Findings may help MBI researchers and developers target potentially relevant mediators to maximize robust study design and intervention efficacy.

Background: Posttraumatic stress disorder (PTSD) has higher prevalence in safety net settings, which also face structural barriers to the use of gold-standard, exposure-focused treatments. Somatic therapies (STs) are used to treat PTSD with a focus on sensations. STs may be a culturally relevant option not requiring exposure. They have not been rigorously studied.

Objective: Assess the acceptability of ST for patients with PTSD and staff in a safety net setting.

Methods: We conducted a qualitative study with interviews of patients and staff in a general internal medicine clinic within an urban safety net health system. Patients were eligible if they were seen between October 1^st, 2022 and October 31^st, 2023, had PTSD in their chart, had one past trauma-related visit with any psychotherapist, and were English-speaking. Staff were eligible if working in a patient-facing role for 6 months in primary care or integrated behavioral health. Transcripts were analyzed using the Consensual Qualitative Research approach.

Results: The 14 patients interviewed were diverse in terms of race and traumatic exposures, and most had a chronic pain condition. Childhood sexual abuse was the most common traumatic exposure disclosed. Analysis yielded five major themes: the somatic experience of PTSD, patient perspectives on exposure-based therapy, past experiences with mind and body practices, patient mind and body beliefs, and acceptability of ST. ST was congruent with many patients' lived experiences and their beliefs about mental health. Challenges faced in seeking care for PTSD, including negative past therapy experiences and poor access, promoted openness to ST.

Conclusion: Patients with PTSD and staff found ST acceptable. Further work is needed to develop somatic interventions for PTSD.

The Whole Well-Being Model offers a layered framework for understanding and supporting health across multiple levels, from individual experience to systems and the environment. As terms like whole health, whole person health, and integrative health gain traction, their overlapping use can create confusion. This model brings clarity by organizing existing domains, from integrative health to planetary health, into a coherent structure. It organizes these domains in a way that clarifies their connections and highlights their distinct contributions. It is rooted in the recognition that well-being does not happen in isolation and requires attention to both personal and systemic factors. The model was developed conceptually to help leaders, practitioners, and educators align strategies with a broader vision of human and planetary thriving. While not yet tested through formal feedback or empirical study, it is designed as a practical tool to inform design, collaboration, and innovation. This article introduces the model, explores its structure, and considers real-world applications. By linking individual needs with broader systems and environmental contexts, the Whole Well-Being Model supports more integrated and intentional approaches to advancing health.