Global advances in integrative medicine and health最新文献

Background: Mental health of emerging, young adults remains a concern, particularly in lower income groups who receive less mental healthcare. Mindfulness-based interventions yield mental health benefits and have been widely applied, though reach and accessibility remain limited. Poor mental health can negatively impact job performance, physical health, and life trajectories.

Objective: A mindfulness elective was offered through a year-long job training program serving diverse, low-income emerging adults. We investigated relevant outcomes in a mixed methods quasi-experimental study.

Methods: Pre-/post-elective surveys assessed mindfulness, mental health, and well-being using established measures. We analyzed within- and between-group differences comparing mindfulness vs control (Year 1) and 12-week vs 6-week (Year 2) participants using t-tests and mixed effects models. Focus groups were conducted and analyzed using codebook thematic analysis.

Results: Participants (n = 212) provided evaluation data. Over two years, 195 participated in a mindfulness elective (mean age = 22.3 [SD = 2.7] years; 47.2% female, 94.4% from racially and ethnically minoritized groups). In Year 1, mindfulness participants exhibited many pre-to-post improvements, including greater mindfulness (+8.4, 95% CI: 5.8, 11.0) and life satisfaction (+10.3, 95% CI: 7.0, 13.6) and lower stress (-8.2, 95% CI: -10.4, -5.9); no changes in controls were observed. In Year 2, mindfulness participants improved in mindfulness and life satisfaction plus self-compassion (12-week: +0.6, 95% CI: 0.4, 0.8; 6-week: +0.4, 95% CI: 0.1, 0.6), connectedness (12-week: +0.7, 95% CI: 0.5, 0.9; 6-week: +0.4, 95% CI: 0.2, 0.6), and mind-body connection (12-week: +1.8, 95% CI: 1.2, 2.4; 6-week: +0.6, 95% CI: 0.0, 1.3). Additional benefits were observed (eg, in stress, focus, emotional reactivity) but significance varied by elective length. Focus groups were generally concordant with quantitative results. Respondents described how the elective enabled self-care, supporting health and professional development.

Conclusions: Integrating mindfulness into job training for underserved emerging adults was well-received, effective, and supports mental health equity.

Background: Several clinical trials support the efficacy of Whole Systems Traditional Chinese Medicine (WS-TCM) modalities, including acupuncture, for improving outcomes among women undergoing in vitro fertilization (IVF), but few studies have described its real-world integration within an academic medical setting or its immediate effects on pain, stress, and anxiety.

Objective: To characterize the clinical delivery of WS-TCM and assess its effects on patient-reported outcomes (PROs) among patients receiving WS-TCM while undergoing IVF.

Methods: A retrospective review of patients who received ≥1 WS-TCM treatment associated with ≥1 embryo transfer at a single center was conducted. A linear mixed model adjusting for the random effect of patients seen over multiple treatments was used to calculate PRO changes among those with pre-treatment PROs ≥1 on a 0-10 numeric rating scale.

Results: 1896 WS-TCM treatments were provided during 202 embryo transfers among 146 patients. Patients (mean age 35.76 ± 4.37) were predominantly white (79.5%), and 26.7% had a documented mental health diagnosis. Of the 202 embryo transfers, 64.9% included pre-transfer treatment, 88.6% included day-of-transfer treatment, and 32.2% included post-transfer treatment. Patients reporting pre-treatment PROs ≥1 reported clinically significant mean [95% CI] reductions in pain (-1.38 [-1.70, -1.07]), stress (-2.11 [-2.47, -1.74]), and anxiety (-2.22 [-2.63, -1.81]) within a single treatment.

Conclusions: This study supports the integration of WS-TCM within IVF and its benefits for reducing acute pain, stress, and anxiety. WS-TCM may improve patient experiences and be a useful treatment for psychosocial concerns that often accompany IVF.

Background: Mindfulness training has been associated with improved health outcomes among family caregivers of people living with dementia, but access to training is limited, especially in rural areas. Moreover, mindfulness training that addresses the unique perspectives of African American families is needed.

Objectives: The study aimed to test the feasibility and acceptability of a theory-driven, telephone-delivered mindfulness intervention for caregivers of African Americans with moderate-to-severe dementia living in rural eastern North Carolina.

Methods: In this single-arm, multiple-methods study, pairs of informal caregivers attended an 8-week mindfulness training program involving weekly one-hour telephone-delivered sessions, and an online retreat. Feasibility outcomes included enrollment, retention, attendance, and acceptability. Exploratory pre-post endpoints related to our theoretical model included perceived caregiver burden (Zarit Burden Interview), uncertainty intolerance (Intolerance of Uncertainty Scale), and positive emotions (Meaning and Purpose Scale).

Results: Seventy-eight percent of screened individuals enrolled, 86% completed the study, and 88% attended ≥6 sessions. Participants found the program valuable, especially via telephone. Perceived burden decreased from pre-to-post intervention (mean difference [MD] -2.7, (95% CI: -4.5, -1.3; Cohen's d -0.47) and positive emotions increased (MD 2.7, 95% CI 0.81, 4.5; d = 0.37). Both inhibitory (MD -1.0, 95% CI -1.8, -0.09; d = -0.28) and prospective (MD -1.2, 95% CI -2.7, 0.3; d = -0.20) intolerance of uncertainty were lower post-intervention.

Discussion: A telephone-delivered mindfulness training intervention was feasible and shows promise for reducing perceived burden among rural-dwelling informal caregivers of African Americans with dementia. Further testing in a randomized parallel-group trial comparing mindfulness training to a credible control intervention is warranted.

Trial registration: ClinicalTrials.gov NCT04058886.

Background: The integrative medicine (IM) clinic is an innovative care model that may increase access to guideline-concordant nonpharmacologic treatment use in healthcare delivery systems for prevalent conditions such as low back pain (LBP).

Objective: To describe the use and effectiveness of IM services for LBP in IM clinics.

Research design: Prospective cohort study.

Subjects: Adult patients with LBP enrolled at seventeen IM clinics.

Measures: Patterns of IM service use were assessed over 12 months. Changes in clinical outcomes were assessed between index visit and 12-month follow-up using linear mixed-effects models. Primary (pain interference, physical function) and secondary (pain intensity, anxiety, depression, fatigue, sleep disturbance, social participation) outcomes were obtained from the PROMIS-29 instrument.

Results: We identified 660 participants with LBP (mean age = 51.6 years, 75% female). Over the 12-month study period, common IM services were IM consults (56%), acupuncture (44%), chiropractic care (24%), physical therapy (19%), and massage (17%). Over two-thirds (70%) of participants received at least one guideline-concordant nonpharmacologic treatment. Participants with follow-up outcome data (n = 443, 67%) reported a modest reduction in pain interference with life activities in the short- and long-term (2-month mean difference [MD] = -1.47, 95%CI = -2.98, -0.64; 12-month MD = -1.98, 95%CI = -3.12, -0.88). By contrast, improvements in physical function were not statistically or clinically significant (2-month MD = 0.37, 95%CI = -0.28, 1.01; 12-month MD = 0.69, 95%CI = -0.31, 1.69). At 12 months, small improvements were observed on all secondary outcomes (pain intensity, anxiety, depression, and social participation) except fatigue and sleep disturbance.

Conclusions: Most patients with LBP receiving care at IM clinics received at least one guideline-recommended nonpharmacologic treatment. However, improvements on clinical outcomes were relatively small. Additional multi-site studies are needed to explore the optimal implementation approach.

Barriers to the use of integrative medicine modalities are complex, with associated disparities in awareness, access, and utilization within marginalized communities. This article details our experience in creating a virtual community designed to empower Hispanic women in the US to lead healthier lives through culturally aware health education in Spanish. Our digital health programs utilize a mind-body medicine approach to foster positive social connections and promote integrative health equity within the Hispanic community living in the US.

Background: People who undergo lumbar spine surgery experience variable pain, disability, and quality of life outcomes. Mindfulness-based interventions (MBIs) are recommended for chronic low back pain and may be an effective approach for surgical patients.

Objectives: Evaluate the feasibility and acceptability of a telehealth MBI following lumbar spine surgery and refine the intervention for optimal delivery.

Methods: This was a prospective, mixed-methods, single-arm cohort study with measurements preoperatively and 2 weeks and 3 months postoperatively. Participants were adults undergoing lumbar spine surgery for a degenerative condition at an academic medical center. A telehealth MBI was delivered one-on-one within 4 weeks after surgery and consisted of 8 weekly sessions modeled after Mindfulness-Based Cognitive Therapy for Chronic Pain. Outcomes were feasibility (enrollment rate, retention, session attendance, homework completion), acceptability (intervention satisfaction questionnaire and exit interview); and pre- to 3-month postoperative improvements in patient-reported disability, pain, and psychosocial factors including depression, anxiety, pain catastrophizing, kinesiophobia, self-efficacy, perceived stress, and dispositional mindfulness.

Results: Fifteen participants who received a laminectomy (n = 3) or fusion with (n = 9)/without (n = 3) laminectomy initiated the MBI. Enrollment (35%) and retention (80%) rates were lower than hypothesized, but participants had high levels of session attendance (80% completed) and home practice (median = 95% days assigned). The MBI was perceived as highly acceptable on the satisfaction questionnaire and exit interviews. Most participants reported improvements at or above established minimal clinically important differences for disability and pain at 3 months postoperatively and improvements in most psychosocial factors. Themes from exit interviews informed future modifications to the intervention.

Conclusions: Delivery of an 8-session, one-on-one, telehealth MBI to patients after lumbar spine surgery is feasible and acceptable and patients perceive meaningful benefits to their surgical recovery from the MBI. Results support fully powered randomized controlled trials to determine longer-term post-surgical effects of the MBI.

Background: Olfactory dysfunction (OD) is a common symptom in patients with coronavirus disease 2019 (COVID-19) with limited treatment options.

Objective: This pilot study aimed to investigate an acupuncture protocol in patients with COVID-19 related OD.

Methods: Thirty patients were randomized into 2 groups. The standard group was treated with budesonide nasal irrigation and olfactory training. The acupuncture group received ten sessions of acupuncture therapy in addition to the standard group treatment. Olfaction was assessed using the University of Pennsylvania Smell Identification Test, 10-point visual analog scale, and Sino-Nasal Outcome Test at baseline and after 3 months of treatment. Differences between study arms were compared using Fisher's exact and Wilcoxon rank sum tests.

Results: Eighteen of the 30 (60%) enrolled patients completed the study, including 11 (73%) in the standard and 7 (47%) in the acupuncture group. Reasons for participant drop-out included cost of travel and time constraints. There were no acupuncture complications.

Conclusions: Acupuncture as an adjunct therapy for COVID-19 related OD is well tolerated. Subsequent studies with larger sample sizes are needed to assess the effect of acupuncture on OD.

Background: The consequences of health disparities in underrepresented populations persist with increased disease burden and reduced access to care. Even with inclusion mandates, underserved populations are poorly represented across trials. This article describes recruitment and retention efforts of an underrepresented population in a large NIH-funded trial.

Methods: The BackInAction (BIA) study is a pragmatic, multi-site, three-arm, parallel-groups randomized controlled trial testing the effectiveness of acupuncture needling for reducing back pain-related disability among 800 older adults (≥65 years) with chronic low back pain. The Institute for Family Health (IFH), an FQHC in New York City, one of four BIA sites, provides primary care to largely underrepresented patients. The IFH recruitment goal was 123 participants. PCPs were oriented to trial referral, clinical research coordinators worked as navigators, and electronic health records (EHR) mechanisms were adapted to allow seamless communication between trial acupuncturists and the research team.

Results: IFH met its goal of 123 trial participants with sociodemographic (22.8% ≥ 75 yrs of age, 72.4% female, 59.4% reported having at least some college education, 62.6% reported an annual household income of less than $25 000) and ethnic/racial diversity (39.0% Hispanic, 35.6% Black, 22.0% White non-Hispanic, 26.8% Spanish-speaking). IFH study withdrawal rate was 12.2% with 18.7% missingness in follow-up data rates at the trial's 6-month primary endpoint.

Conclusion: The IFH site team successfully recruited and retained diverse participants through trusted connections with the study population, building on experience with acupuncture research, engaging PCPs, study team members, primary care clinical sites and EHR communication options.

Having validated instruments for the evaluation of lifestyles becomes a necessity for professional practice in terms of promoting the adoption of health-promoting behaviors in various aspects of daily life, such as social interactions, nutrition, physical activity, oral health, environmental health, mobility, and psychoactive substance use.

Objective: To evaluate the construct validity and reliability of the 'Lifestyle Questionnaire in the Colombian Population" over 18 years of age from the northeastern of Colombia.

Methodology: A psychometric study was conducted with the participation of 551 adults using the instrument proposed by the Pan American Health Organization (PAHO). A confirmatory analysis using the structural equation modeling (SEM) technique was carried out, in addition to an internal consistency analysis.

Results: The confirmatory factor analysis reports the same structure, with adequate goodness-of-fit indicators (X²/df = 2.10, CFI = .88, TLI = .87, RSMEA = .05, SRMR = .04). The reliability estimation of the test and its dimensions, with internal consistency coefficients Cronbach's α and McDonald's ω, reported optimal levels in the total test (ω = .93).

Conclusions: The instrument developed by PAHO showed adequate construct validity and reliability indicators for evaluating lifestyles in northeastern Colombian people over 18 years old.

Background: Family caregivers of individuals with Prader-Willi syndrome face significant challenges that affect their social, economic, personal, and emotional well-being. The mental health of these caregivers remains largely unexplored, particularly regarding their own premature death.

Objective: This study seeks to explicate how caregivers manage their responsibility of providing continuous specialized care for individuals with Prader-Willi syndrome. A mixed research approach was used to uncover depression, death anxiety, and anticipated fear of own death among caregivers of patients with SPW who access a foundation in the state of Hidalgo, Mexico.

Method: A mixed-methods approach was employed, using a sequential explanatory design. The quantitative sample included 15 volunteer participants between 35 and 66 years old, belonging to a foundation in Hidalgo, Mexico. Research instruments had an internal consistency of r = >0.70. Qualitative data was gathered through a focus group, using interpretive description to explore caregivers' emotional experiences.

Results: Statistical analyses, including Gamma and Kendall Tau tests, revealed significant correlations (P = 0.01) between caregivers' anticipated fear of death and the levels of death anxiety and depression. The qualitative findings yielded 3 principal themes: uncertainty about future self-sufficiency, fear of the future if they pass away, and the crucial role of community support.

Discussion and conclusion: This methodological mixed study reveals a correlation between anxiety about the future, fear of death, and the emotional need for support. Continual emotional support and counselling are crucial for caregivers responsible for PWS patients' care.