Global advances in integrative medicine and health最新文献

Background: In university and hospital workplace environments, high levels of stress coupled with physical and mental health issues are major drivers of employee health, healthcare costs, and workplace productivity. Workplace well-being programs can help employees manage stress and promote healthy behaviors. One approach to addressing stress and the physical and mental health of employees from a whole-person health perspective is integrative health and wellness coaching (IHWC). IHWC incorporates principles of motivational interviewing, positive psychology, transtheoretical model of behavior change and self-determination theory.

Objective: The purpose was to evaluate a novel IHWC program that included group coaching, individual coaching, and a post-program text message intervention to support the maintenance of program outcomes, at an East Coast university and its affiliated hospital.

Methods: The 12-week program consisted of 6 group sessions and 6 individual sessions followed by a randomized text message-based maintenance strategy between weeks 12 and 18. IHWC sessions were conducted by National Board-Certified Health and Wellness Coaches (NBC-HWC) and student trainees obtaining hours needed for eligibility for board certification (SHWC). Employee participants (n = 50) completed baseline and follow-up surveys at weeks 5, 12, 18, and 24. Outcomes included perceived stress measured by the Perceived Stress Scale (PSS-10), and mental and physical health measured by the Patient Reported Outcomes Measurement Information System (PROMIS-10).

Results: At baseline, employees in both the university and hospital setting reported moderate levels of stress, and perceived physical and mental health that were poorer than the national average. Multivariate analyses showed significant improvements in mental health, physical health, and stress scores from baseline to 12 weeks. Significant improvements endured at 18 and 24 weeks for physical health and stress, which were not enhanced by the text messaging intervention.

Conclusion: IHWC shows promise as an approach to support employees working in high stress environments.

Background: Complementary and Integrative Health (CIH) services are a national priority for the Department of Veterans Affairs (VA) healthcare system and can be effective in reducing chronic pain. Eligible VA patients can receive their CIH care through a VA clinic, or through community care (CC) funded by the VA. The present study compares the effectiveness of 3 CIH services (acupuncture, chiropractic, and medical massage therapy) delivered in direct care by VA vs CC providers at improving veterans' chronic pain.

Methods: Data were analyzed from the Complementary and Integrative Health Therapy Patient Experience Survey, a longitudinal, self-administered survey of CIH use and health outcomes. Mixed models were used to evaluate the relationship of higher CIH therapy visits delivered by the VA vs CC with pain interference and pain severity, using both raw counts of visits and clinically meaningful groupings of visits.

Results: Among veterans with chronic pain who engaged in CIH services, more CIH visits were associated with lower levels of pain severity and pain interference. VA acupuncture and chiropractic had a stronger beneficial relationship with pain than CC acupuncture and chiropractic, while CC medical massage therapy had a stronger beneficial relationship than VA medical massage.

Conclusions: CIH therapies delivered through the VA and through CC both offer potentially effective means of reducing chronic pain. Some therapies may be more effective when delivered through the VA vs CC, or may indicate lack of full implementation, but the limitations of observational data preclude any causal statements.

Introduction: Individuals with traumatic spinal cord injury (TSCI) are dissatisfied with their chronic pain management. A biopsychosocial approach has been proven to improve chronic pain. Guidelines are required to holistically manage chronic pain in the TSCI population.

Methods: A Delphi study was conducted to gain consensus on design principles for chronic pain in the TSCI population, for the Western Cape of South Africa. Purposive sampling was used to recruit first-line primary health care providers from primary health care settings in the Cape Metropolitan region. Participants were asked for consent on principles pertaining to the assessment, education and planning for chronic pain management, pharmacological and non-pharmacological therapy for neuropathic and nociceptive pain, as well as the monitoring of chronic pain and referral of resistant pain. For consensus analysis, a median of 3.24 or higher was considered in addition to two categories of consensus, namely weak consensus (50%-70%) and strong consensus (>70%).

Results: The first-line primary health care providers agreed on eighteen principles to guide chronic pain management in the TSCI population. Consensus could not be reached on the second to fourth line pharmacological management of neuropathic pain.

Conclusion: The agreed upon design principles may be considered as starting points for implementation at the primary health care level in the Western Cape of South Africa.

In this viewpoint, we discuss how culturally affirming, community-based interventions grounded in an integrative health equity framework are essential for the advancement of health equity for racial minorities and immigrant communities. Through a case study of Freedom Community Clinic and its initiatives, we demonstrate how culturally affirming, integrative healthcare models can further advance equitable outcomes in physical, mental, emotional, and spiritual health and well-being for individuals and communities. The current landscape of persistent health disparities, particularly in chronic disease and limited healthcare access for racial minorities and immigrant communities, highlights the systemic inequities embedded in current healthcare structures. An integrative health equity approach is critical for addressing these inequities by sharing access to the benefits of complementary and ancestral medicines, particularly as low-risk and low-cost interventions for chronic disease. Cultural humility is critical for informing the practice of integrative health, as many healing practices categorized within integrative health have roots in the cultural traditions of racial and ethnic minorities and immigrant communities. Growing evidence suggests that investments in interventions that strengthen social ties and community networks can positively influence population-level health outcomes, including health behaviors. Freedom Community Clinic exemplifies a culturally affirming, community-based approach to integrative health with its Whole-Person Healing to the People model, which integrates six core components: ancestral and Indigenous healing, Western medicine, community healing, culture, community engagement, and social justice. This example emphasizes how integrative health equity approaches can create paradigm shifts in how we understand and deliver care, moving beyond the confines of a fragmented healthcare system toward one that truly serves communities that are most in need. Freedom Community Clinic and its Whole-Person Healing to the People model offers a promising framework for how healthcare can be re-envisioned as a tool for social justice, providing opportunities for all individuals to achieve optimal health.

Background: Obesity is a medical condition characterized by the excessive accumulation of body fat, which adversely impacts health. It is primarily caused by a combination of overeating, physical inactivity, and genetic predisposition. In Ayurveda, obesity corresponds to conditions such as Sthaulya and Medoroga. Ayurvedic formulations like Vyoshadi Guggulu (VSG) and Vidanga Churna (VDC) are commonly prescribed for managing obesity despite limited scientific validation. This study aimed to evaluate the safety and efficacy of VSG and VDC in individuals with obesity.

Methods: A prospective, open-label, multicenter clinical study was conducted at 2 peripheral centres of the Central Council for Research in Ayurvedic Sciences (CCRAS). A total of 100 obese patients who met the selection criteria were recruited from outpatient departments and administered VSG (1 gm thrice daily after meals with lukewarm water) and VDC (3 gm twice daily after meals) for 12 weeks. Participants were followed up for an additional 2 weeks without medication.

Results: Statistically significant improvements were observed in key symptoms, including polyphagia, polydipsia, excessive sweating, excessive sleep, body fatigue, and dyspnea on exertion (DOE), which was initially reported by 36 participants but reduced markedly over the study period. While most participants had moderate physical activity capacity (Vyayama Shakti), some experienced exertional breathlessness, which improved with intervention. Significant reductions were also noted in BMI (P = 0.016), waist circumference (P = 0.043), and serum cholesterol levels (P = 0.002), with no adverse drug reactions reported.

Conclusion: This study demonstrates that the combination of VSG and VDC is effective and safe for managing obesity. Statistically significant improvements in anthropometric parameters and clinical symptoms highlight the potential of these Ayurvedic formulations as complementary therapies for obesity management.

Background: Integrated care interventions can improve patient outcomes and reduce the burden on acute health services, but need a strong evidence base to ensure their effectiveness. Understanding the meso and macro context in which care is delivered and determining whether patient needs are met are essential to successful implementation. Care coordination in New South Wales (NSW), Australia has evolved over time to meet the needs of an ageing population with chronic health conditions and multi-morbidity with the aim of reducing potentially preventable hospitalisations.

Objective: To examine how an integrated care coordination program was understood and implemented at state, district and clinician levels in NSW. The Integrated Care for People with Chronic Conditions (ICPCC) program was implemented statewide, however local implementation varied. Patients who were suitable for integrated care coordination were identified via a hospitalisation risk prediction algorithm and/or referrals from health professionals.

Methods: Understanding and implementation of ICPCC were assessed via interviews and a focus group with a range of health staff. Qualitative data were analysed using NVivo software and normalisation process theory.

Results: There was a strong sense of program coherence from management, clinicians and referrers. They viewed ICPCC as effective in coordinating care for patients at risk of hospitalisation and incorporating self-management at home. All health staff interviewed understood the program purpose and necessity, including the importance of achieving patient and systemic goals. Networking, linking services and program promotion were important, as was reporting on benefits. While the algorithm effectively identified previously hospitalised patients, it did not identify all suitable patients in the community with an increasing risk of requiring acute health care intervention. Referrals from health professionals familiar with patient needs and complexity were an important additional mechanism for patient selection.

Conclusions: There was a shared sense of coherence and understanding of the ICPCC program among health staff at the three levels of implementation within NSW. The program played an important role in assisting patients with a range of chronic conditions to access and benefit from integrated care coordination, while increasing their capacity to self-manage at home. Program intake via hospitalisation risk prediction algorithm plus referrals from health professionals familiar with patient needs and complexity can effectively identify those who may benefit from integrated care coordination.

Introduction: This study aims to comprehensively evaluate health care access and utilization in rural Pakistan, shedding light on the multifaceted challenges and opportunities within the health care landscape. It explores the healthcare-seeking behaviours of individuals, particularly focusing on underserved populations.

Methods: The study employed a qualitative data collection method. Focus Group Discussions (FGDs) were conducted to gather qualitative insights. Data were analysed using thematic content analysis allowing for a comprehensive understanding of health care challenges.

Results: The study reveals significant findings, including limited healthcare-seeking behaviours due to financial constraints, lack of health insurance, and distrust in health care systems. Government health care facilities in rural areas were perceived as inadequate, with under-resourced staff and subpar quality of care. Participants expressed support for medical camps and educational sessions to address these issues.

Conclusion: This study provides critical insights into rural Pakistan's health care access and utilization challenges. Policymakers, health care practitioners, and community leaders can draw from these findings to formulate effective strategies for improving health care access and outcomes in underserved rural areas.

Mindfulness-Based Programs (MBPs) are increasingly being introduced into a range of mainstream contexts such as health care, education, criminal justice, workplace, community settings, and leadership. MBPs are available in some form in every continent, and in some countries have become established as part of standard care in publicly funded health care systems and routinely embedded into school curriculums. Efficacy and effectiveness research demonstrate gold standard evidence in some areas and significant promise in others, and cost-effectiveness evaluations are encouraging. However, understanding how to assess and ensure the fidelity of program delivery is at a germinal stage. Without clear, robust, and coordinated approaches to this issue within the international field, ongoing dissemination and implementation could be compromised by variable standards of teaching skill and adherence to program form. These issues are relevant in practice contexts where approaches to teacher training internationally need to adhere to commonly held principles, understandings, and standards. They are also relevant in research contexts where assessment of intervention fidelity needs to ensure that the variable of the teaching process and curriculum is addressed in the research design and conveyed to readers in the presentation of data. In this special collection, we bring together articles reporting on research and practice on MBP intervention fidelity in teacher training, implementation, and development of governance for the emerging mindfulness-based field. This paper introduces the special collection, summarizes the papers included, and offers an analysis of where we are now as a field and of what steps are needed to further our understanding on these issues. We hope to share current best practice and catalyse new understandings and directions of inquiry that will provide a compass to navigate forward and benefit this promising field.

Background: Underrepresentation of diverse populations in clinical trials poses challenges to equity and external validity in health care research. To successfully recruit underrepresented participants in pragmatic clinical trials, researchers must understand the perspectives and needs of individuals from diverse backgrounds who participate in research.

Objective: The purpose of this qualitative study was to gain an understanding of the needs and perspectives of participants of the OPTIMUM trial -- a pragmatic trial evaluating mindfulness-based stress reduction for chronic low back pain.

Methods: This qualitative study employed focus groups with participants from 3 clinical sites: Boston Medical Center, the University of North Carolina at Chapel Hill, and the University of Pittsburgh. Focus group discussions centered on participants' experiences, barriers, and facilitators to engagement in the OPTIMUM trial. Data were analyzed using thematic content analysis and the rapid qualitative analysis method, Lightning Reports, for real-time feedback integration into the trial process.

Results: Six focus groups were conducted with 46 participants, of whom 39.1% were first-time research participants and 56.5% identified as Black or African American. Qualitative analysis identified five key themes:1) The importance of providers in the recruitment of cLBP patients, (2) Motivators to participate and stay engaged in clinical research, (3) Participant lack of understanding of randomized control trials (RCTs) and general research processes, (4) Desire for social connection and community-building among participants, and (5) the Positive impact of regular study staff interaction.

Conclusion: Equity in RCTs requires intentional strategies to address barriers to participation and engagement faced by historically underrepresented populations. Engaging health care providers in recruitment, fostering positive interactions with study staff, and creating opportunities for social connection can improve recruitment, retention, and engagement. Incorporating community-engaged research methods and real-time feedback mechanisms can further support inclusivity and equity in pragmatic clinical trials.