Global advances in integrative medicine and health最新文献

Background: Black women and Black femme-identifying individuals (referred to as womxn) have developed alternative health practices that support their well-being when navigating oppressive systems. Within the U.S. healthcare system, Black womxn are disproportionally impacted by inequities and discriminatory practices, leading to higher incidences of chronic conditions, limited healthcare access, and higher mortality rates. Integrative medicine has not yet adequately examined or incorporated healing modalities practiced by Black womxn and therefore has not investigated its potential to foster more inclusive care.

Objectives: This critical narrative review aims to explore the contributions of Black womxn to integrative medicine, identify components of Black feminist healing modalities, and discuss future directions for integrating these practices into integrative medicine.

Methods: A critical review was conducted using databases including PubMed, JSTOR, Taylor & Francis Online, and Sage to gather academic and praxis-focused sources. Books and films related to Black womxn healing practices were also examined. Sources were selected based on their focus on non-Western, alternative, and complementary therapies developed and practiced by Black womxn in the United States.

Results: We identified three key categories of Black feminist healing modalities: (1) Communal Care and Communication, which includes practices like storytelling, gossip, and community gathering to foster resilience; (2) Art as a Form of Cultural Strengthening, which emphasizes the use of creative expression for healing and resistance; and (3) Spirituality. These modalities provide tools for Black womxn to resist systemic oppression and promote well-being.

Conclusion: Black feminist healing modalities are crucial for creating inclusive models of care that address the specific health needs of marginalized communities. Incorporating these modalities into healthcare can contribute to health equity by offering culturally relevant and holistic approaches to health for Black womxn and other historically minoritized groups. Future research should focus on developing evidence-based practices for integrating these modalities into clinical settings.

Background: A confluence of factors is ushering forward growing opportunities for global-level reconsideration and expansion of foundational concepts of health. This process draws on dynamic and evolving contributions from Traditional, Complementary, and Integrative Medicine (TCIM) systems, Indigenous Knowledge systems, and existing biomedical models to center wholeness and balanced interconnection within individuals and between people and the planet as elements of an emergent collective redefinition of health. Purpose & Conclusions: This article threads US-based and global efforts in this emergence by showcasing the National Academy of Medicine Report, Achieving Whole Health: A New Approach for Veterans and the Nation, alongside an overview of several significant recent contributions to the global integration of TCIM into national health systems by the World Health Organization (WHO), briefly also highlighting examples of the range of country and state-wide integration. The opening of the first WHO Global Traditional Medicine Centre in India, the first Traditional Medicine Global Summit held in 2023, and the Summit's official meeting report: The Gujarat Declaration, are briefly explored as structures and experiences supporting enhanced collaboration and technical exchange as nations work to implement more expansive wholeness-based health concepts into national health systems. A discussion of the societal-level changes needed to implement such epistemic change is briefly explored, with emphasis on the need for equitable, cross-sectoral collaboration and visionary leadership in the development of new financial models to sustainably translate these emergent concepts of health into new healthcare delivery structures that center whole health and planetary health as part of the common good.

Background: Chronic low back pain is globally prevalent and associated with significant impairment in quality of life. Furthermore, people from historically marginalized communities are less likely to receive treatment, contributing to health inequities. Group mindfulness-based interventions improve pain and function, and virtual delivery has been demonstrated to be feasible. Little is known about how participants experience the virtual delivery of mindfulness-based interventions, especially participants from historically marginalized communities.

Objective: This study explored participant perspectives of a virtual mindfulness-based group medical visit for people with chronic low back pain.

Methods: Participants were recruited from the intervention arm of OPTIMUM, a study of virtual medical group visits using an adapted Mindfulness-Based Stress Reduction program for chronic low back pain. Semi-structured exit interviews were examined, and reflexive thematic analysis was used to compose key themes.

Results: Interviews from 59 participants (mean 56 years, 69.5% women; 45.8% Black or African American) were examined. Two major themes were derived from analysis. The first theme was 'effects of the external environment,' ie, the physical location from which the participant engaged with the session. The subthemes were comfort, social demands in the home setting, and sharing personal spaces. The second theme was 'navigating the virtual platform.' Subthemes were ease, struggle, and levels of support.

Conclusion: Patient experiences varied substantially during the virtual mindfulness-based group medical visit intervention and this variation was influenced by social determinants of health. The key themes bring attention to the effects of the external environment and the technology itself on participation for people from historically marginalized communities. Basic tenets of mindfulness, such as present state awareness and equanimity, can provide a structure within which to navigate virtual participation amid home environments. Future studies are needed to explore differences in virtual and in-person mindfulness programs and to adapt virtual mindfulness programs.

Clinicaltrialsgov id number: NCT04129450.

Objectives: Non-pharmacologic approaches are now considered best practice for the treatment of chronic pain. The purpose of this pilot study was to evaluate patient responses to a newly integrated clinic service called Mindful Awareness in Body-oriented Therapy (MABT) at a chronic pain clinic. MABT is designed to develop interoceptive sensibility for improved well-being and emotion regulation.

Methods: A one-group repeated measures design was used to examine MABT referral and delivery follow-through feasibility and change on health outcomes among chronic pain patients. Upon referral, participants were scheduled for the MABT program involving eight individual sessions with one of the clinic massage therapists trained in MABT. Measures were administered at baseline, post-intervention (3 months) and at 6 month follow-up). Outcome measures assessed physical and mental health distress, interoceptive awareness, and emotional well-being. Analyses included descriptive statistics and repeated measures ANOVA.

Results: Seventy patients were referred and 41 received at least one MABT session. Thirty patients (73%) completed the MABT intervention. Statistically and/or clinically significant improvements were identified for most subscales of the PROMIS-29 (the primary outcome), including Physical Function, Fatigue, Anxiety, Sleep Disturbance, Social Roles, and Pain Interference. Improvements in interoceptive sensibility and emotion regulation difficulties also demonstrated statistically significant and large effects.

Discussion: This pilot study demonstrates the feasibility of MABT referral and delivery follow-through when delivered in a real-life context. Significant improvements with large effects on outcomes in response to the MABT intervention program offers a promising non-pharmacological approach for chronic pain patients.

There are many known drivers of burnout and distress among physicians and other healthcare providers. Current conversations have not fully characterized the significant impact of workload increases alongside staffing shortages as drivers of moral distress and subsequent burnout. Together these factors pose a significant systemic threat to the workforce, and a personal threat to the individuals within it. Physicians are at high risk for moral distress because of work ethic and culture. The drive to do the right thing for the patient limits an ability to set boundaries around work. Moral distress is experienced when the needs of patients can't be met; this drives us to work even harder. Culturally, there has been limited opportunity to acknowledge this distress, so we haven't been able to deal with it outright. Financial pressures continue pressure health systems to drive productivity. Additional patient encounters drive more after visit work that requires time and attention. Simultaneously, the remaining physicians are further stretched as people burnout and leave. There are few groups of workers more mission-driven than primary care physicians. We are committed to doing the right thing for patients and our teams. If we can acknowledge and talk about moral distress as an indicator that we need to change the way we do things, we can use it as a tool to optimize patient care. The physician voice may help us move beyond the learned helplessness and shift to engagement in solutions. We propose three solutions: 1) acknowledge the presence of routinized stress injury that occurs in healthcare 2) leverage data on physician wellbeing to understand how to optimize care, and 3) foster connection and community. Fundamentally, when our healthcare workers feel seen, heard, and valued, they are healthier themselves, and better able to support the missions of the medical system.

Background: While specific elements of naturopathic medicine, such as botanical medicines and lifestyle interventions, have supporting evidence, there is limited quantitative data confirming its effectiveness as a comprehensive, whole-person medical approach for patients with metastatic colorectal cancer (CRC).

Objective: This study aims to retrospectively evaluate the integration of naturopathic modalities, including modulated electrohyperthermia (mEHT), into the standard of care for metastatic CRC. We compare survival outcomes between patients at the Integrated Health Clinic (IHC) and a matched control group from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database, a de-identified, publicly available cancer registry in the United States.

Methods: A retrospective chart review was conducted for 131 IHC patients diagnosed with stage IV CRC and treated with mEHT between 2010 and 2021. These patients were matched with 262 controls from the SEER database using propensity score matching. The primary outcome was overall survival, with time zero defined as the first IHC treatment date (with controls assigned the time zero of their matched IHC patient) to account for immortal time bias. Survival analysis was conducted using a Kaplan-Meier curve, log-rank test, and Cox proportional-hazards model.

Results: The overall survival analysis did not achieve a statistically significant difference (HR = .76; 95% CI: .57-1.01) between the IHC (median survival time: 29 month) and SEER groups (median survival time: 18 months). Incorporating time-varying effects, the hazard ratio (HR) for the IHC group compared to the SEER group was .63 (95% CI: .46-.86) for survival <36 months, indicating a lower hazard of early mortality in the IHC group. Moreover, IHC patients who initiated treatment within 90 days of diagnosis had significantly improved survival compared to their matched controls (HR = .45; 95% CI: .28-.70).

Conclusion: This study provides evidence that integrative naturopathic treatment, including mEHT, can significantly improve survival outcomes for CRC patients in the first 36 months post-treatment and when initiated within 90 days of diagnosis.

Background: Several biomarkers, including C-reactive protein (CRP), ferritin, D-dimer, and Interleukin-6 (IL-6), are established predictors of disease severity and respiratory failure in patients with COVID-19.

Objective: In this randomised clinical study, we evaluated the efficiency of the combination of 2 variants' AFO-202 and N-163 strains of Aureobasidium pullulans produced 1,3-1,6 β-glucans in comparison with the control arm on these biomarkers in COVID-19 patients.

Methods: Forty RT-PCR positive COVID-19 patients were divided into 2 groups: control (n = 22) and standard treatment; ii. (n = 18) - Standard treatment + combination of AFO-202 and N-163 beta glucans for 15 days.

Results: IL-6 levels significantly decreased in the treatment group on day 7 (P = 0.03) but not by day 15 (P = 0.30). CRP levels in the treatment group decreased at day 7 (5.53 ± 8.21 mg/L) compared to baseline but showed no significant difference from the control group (4.91 ± 12.54 mg/L, P = 0.98). At day 15, CRP levels remained lower in the treatment group (5.42 ± 10.41 mg/L) but increased in the control group (14.0 ± 37.16 mg/L), with no significant difference (P = 0.52). Ferritin levels dropped significantly in the treatment group by day 15 (from 560.58 ± 537.30 ng/mL to 127.51 ± 215.91 ng/mL) but increased in the control (P = 0.98). D-dimer levels decreased in the treatment group by day 15 but were not significantly different from controls (P = 0.56).

Conclusion: These results indicate that while co-supplementation with AFO-202 and N-163 beta-glucans led to improvement in CRP, ferritin, and IL-6 levels in COVID-19 patients, only the reduction in IL-6 levels on day 7 reached statistical significance. Further long-term multicentric clinical research is warranted to validate the potential of these supplements as treatment adjuncts, for addressing inflammation in COVID-19, especially in vulnerable populations infected with emerging SARS-CoV-2 variants.

Background: Healthcare workers face an elevated risk of chronic stress and burnout, for which resiliency interventions are needed.

Methods: The Stress Management and Resiliency Training Program (SMART-3RP; 8 weekly 90-minute sessions) was offered to 254 hospital employees between 2/2021 and 1/2024. Participants were surveyed pre- and post-intervention for measures of resiliency, stress coping, positive affect, perceived stress, anxiety, and depression.

Results: The baseline sample was 84% female, 89.5% non-Hispanic, 71.3% White, and averaged 45 years of age (SD = 14.25). Baseline and follow-up survey completion rates were 71.3% (N = 181) and 35.8% (N = 91), respectively. Significant improvements were seen pre-post intervention for all measures (all ps <.001): resiliency (d = 0.57), stress coping (d = 1.1), positive affect (d = 0.83), perceived stress (d = -0.88), anxiety (d = -0.74), and depression (d = -0.43).

Conclusions: Alleviating employee stress is crucial for improving individual, clinical, and systems-level outcomes in hospitals. The SMART-3RP is a promising program that provides healthcare workers with resiliency and stress coping skills.

Background: More than 1 in 5 US adults live with mental illness. Novel therapies as complements to standard therapies are needed to improve patient well-being. Reiki is a biofield therapy that may improve well-being in mental health.

Objective: The primary aim of this study was to evaluate the feasibility of providing Reiki at a behavioral health clinic serving a low-income population. The secondary aim was to evaluate outcomes in terms of patients' symptoms, emotions, and feelings before and after Reiki.

Methods: This was a mixed-methods, feasibility pilot study with a pre-post experimental design. Reiki was offered to adult outpatients at a community behavioral health center in Rochester, Minnesota. Patients with a stable mental health diagnosis seen between July 22, 2021, and May 18, 2023, completed surveys before and after the Reiki intervention and provided qualitative feedback. Patients were asked to report their ratings of pain, anxiety, fatigue, and feelings (eg, happy, calm) on 0- to 10-point numeric rating scales. Data were analyzed with Wilcoxon signed rank tests.

Results: Among 91 patients who completed a Reiki session during the study period, 74 (81%) were women. Major depressive disorder (71%), posttraumatic stress disorder (47%), and generalized anxiety disorder (43%) were the most common diagnoses. The study was feasible in terms of recruitment, retention, data quality, acceptability, and fidelity of the intervention. Patient ratings of pain, fatigue, anxiety, stress, sadness, and agitation were significantly lower, and ratings of happiness, energy levels, relaxation, and calmness were significantly higher after a single Reiki session.

Conclusion: The results of this study suggest that Reiki is feasible and could be fit into the flow of clinical care in an outpatient behavioral health clinic. It improved positive emotions and feelings and decreased negative measures. Implementing Reiki in clinical practice should be further explored to improve mental health and well-being.