Global advances in integrative medicine and health最新文献

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.

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.