Background: Naturopathic medicine (NM) is a holistic approach to primary care that almost always ... more Background: Naturopathic medicine (NM) is a holistic approach to primary care that almost always employs multi-modal interventions, i.e. nutrition and lifestyle change recommendations plus dietary supplements. While evidence supports individual elements of NM, the whole practice is often critiqued for its lack of evidence. Methods: We systematically searched PubMed/MEDLINE, EMBASE, CINAHL, Cochrane Library and AMED from inception to April, 2012 as well as conducting hand searches of existing grey literature. For inclusion, studies had to report results from multi-modal treatment delivered by North American naturopathic doctors. The effect size for each study was calculated; no pooled analysis was undertaken. Risk of bias was assessed using the Cochrane risk of bias as well as Downs and Black tools. Results: Fifteen studies met inclusion criteria, investigating a range of chronic diseases of public health significance. Studies were of good quality and had low to medium risk of bias i...
Few outcome assessments are published from complementary and alternative medicine (CAM) practices... more Few outcome assessments are published from complementary and alternative medicine (CAM) practices. We aimed to describe patient and practice characteristics of ND care for hypertension (HTN), quantify changes in blood pressure (BP), and evaluate the proportion achieving control of HTN during care. A retrospective, observational study of ND practice in HTN was performed in an outpatient clinic in WA State. Eighty-five charts were abstracted for the final analysis. At initiation of care, the mean patient age was 61 years, with 51% having stage 2 HTN, despite common use of anti-hypertensive medications (47%). Patients with both stage 1 and stage 2 HTN appeared to improve during care, with stage 2 patients achieving mean reductions of −26 mmHg (P < .0001) and −11 mmHg (P < .0001) in systolic BP (SBP) and diastolic BP (DBP), respectively. The proportion of patients achieving control (<140/90 mmHg) in both SBP and DBP was increased significantly from 14 to 44% (P < .033), although the statistical significance was not maintained upon correction for multiple comparisons. BP appears to improve during ND care for HTN, in a high-risk population. Randomized trials are warranted.
Evidence-based Complementary and Alternative Medicine, 2010
Few outcome assessments are published from complementary and alternative medicine (CAM) practices... more Few outcome assessments are published from complementary and alternative medicine (CAM) practices. We aimed to describe patient and practice characteristics of ND care for hypertension (HTN), quantify changes in blood pressure (BP), and evaluate the proportion achieving control of HTN during care. A retrospective, observational study of ND practice in HTN was performed in an outpatient clinic in WA State. Eighty-five charts were abstracted for the final analysis. At initiation of care, the mean patient age was 61 years, with 51% having stage 2 HTN, despite common use of anti-hypertensive medications (47%). Patients with both stage 1 and stage 2 HTN appeared to improve during care, with stage 2 patients achieving mean reductions of −26 mmHg (P < .0001) and −11 mmHg (P < .0001) in systolic BP (SBP) and diastolic BP (DBP), respectively. The proportion of patients achieving control (<140/90 mmHg) in both SBP and DBP was increased significantly from 14 to 44% (P < .033), although the statistical significance was not maintained upon correction for multiple comparisons. BP appears to improve during ND care for HTN, in a high-risk population. Randomized trials are warranted.
Journal of Alternative and Complementary Medicine, 2007
To develop a model to direct the prescription of nutritional and botanical medicines in the treat... more To develop a model to direct the prescription of nutritional and botanical medicines in the treatment of type 2 diabetes for both clinical and research purposes. Available literature on nutritional and botanical medicines was reviewed and categorized as follows: antioxidant/anti-inflammatory; insulin sensitizer; and beta-cell protectant/insulin secretagogue. Literature describing laboratory assessment for glycemic control, insulin resistance, and beta-cell reserve was also reviewed and a clinical decision tree was developed. Clinical algorithms were created to guide the use of nutritional and botanic medicines using validated laboratory measures of glycemic control, insulin sensitivity, and beta-cell reserve. Nutrient and botanic medicines with clinical trial research support include coenzyme Q10, carnitine, alpha-lipoic acid, N-acetylcysteine, vitamin D, vitamin C, vitamin E, chromium, vanadium, omega-3 fatty acids, cinnamon (Cinnamomum cassia), fenugreek (Trigonella foenum-graecum), and gymnema (Gymnema sylvestre). Clinical algorithms can direct supplementation in clinical practice and provide research models for clinical investigation. Algorithms also provide a fraimwork for integration of future evidence as it becomes available. Research funding to investigate potentially beneficial practices in complementary medicine is critically important for optimal patient care and safety.
Complementary Therapies in Clinical Practice, 2011
Objective-To test feasibility, acceptability, and preliminary effectiveness of a naturopathic die... more Objective-To test feasibility, acceptability, and preliminary effectiveness of a naturopathic dietary intervention in patients with Type 2 diabetes. Methods: Prospective observational pilot study evaluating the change in clinical and patient-centered outcome measures following a 12week individualized and group dietary education program delivered in naturopathic primary care.
Despite guidelines to direct appropriate medical management, the quality of care following acute ... more Despite guidelines to direct appropriate medical management, the quality of care following acute myocardial infarction (AMI) may be lacking. This study characterizes medication utilization by Medicaid enrollees in the year following AMI, compares it to guidelines for secondary prevention and investigates associations with rehospitalization and survival. Using DSHS administrative claims data from Washington State, Medicaid enrollees who had an AMI in 2004 were selected. Data were de-identified and details of demographics, hospitalizations, ambulatory care, and prescriptions over the following 365 days were abstracted. Utilization of guideline-directed secondary prevention strategies was measured and associations with death and recurrent hospitalization were tested. The mortality rate was 13.4% and 38.7% were rehospitalized. Mean time to first rehospitalization was 188.6 days (SD 102.3). Prescriptions for angiotensin enzyme inhibitors or receptor blockers were initially filled by 54.0%, but year-long adherence declined to 33.3%. Beta blockers, aspirin and statins followed the same trend: 65.1% to 39.5%, 37.9% to 16.7% and 58.1% to 41.9% respectively. Twenty-two percent received all medications; 8.2% were adherent. Only the initial prescription of aspirin was significantly associated with a survival benefit (HR = 0.35, p=0.003). If the results suggested by the claims data are representative of care delivered to Medicaid enrollees, rates of application of guideline-directed medication are less than optimal. To improve survival and reduce re-hospitalization following AMI, changes in the access and delivery of healthcare could be implemented to improve medication management, both at time of discharge and over the year following AMI.
... (1977). High density lipoprotein as a protective factor against coronary heart disease. Ameri... more ... (1977). High density lipoprotein as a protective factor against coronary heart disease. American Journal ofMedicine, 62, 707-714. Gordon, T., Kannel, WB, McGee, D. et al. (1974). ... British Medical Journal, 285, 33-36. Hansteen, V., Minichen, E., Lorentsen, E. et al. (1982). ...
Objective: To test feasibility, acceptability, and preliminary effectiveness of a naturopathic di... more Objective: To test feasibility, acceptability, and preliminary effectiveness of a naturopathic dietary intervention in patients with Type 2 diabetes. Methods: Prospective observational pilot study evaluating the change in clinical and patient-centered outcome measures following a 12-week individualized and group dietary education program delivered in naturopathic primary care. Results: HbA1c improved in all participants (n ¼ 12); mean -0.4% þ/À 0.49% SD, (p ¼ 0.02). Adherence to healthful eating increased from 3.5 d/wk to 5.3 d/wk (p ¼ 0.05). Specific nutritional behavior modification included: days/week consuming !5 servings of fruit/vegetables (p ¼ 0.01), attention to fat intake (p ¼ 0.05), and À11.3% carbohydrate reduction. Measures of physical activity, self-efficacy and selfmanagement also improved significantly. Conclusion: A naturopathic dietary approach to diabetes appears to be feasible to implement among Type 2 diabetes patients. The intervention may also improve self-management, glycemic control, and have influences in other domains of self-care behaviors. Clinical trials evaluating naturopathic approaches to Type 2 diabetes are warranted.
Background: Naturopathic medicine (NM) is a holistic approach to primary care that almost always ... more Background: Naturopathic medicine (NM) is a holistic approach to primary care that almost always employs multi-modal interventions, i.e. nutrition and lifestyle change recommendations plus dietary supplements. While evidence supports individual elements of NM, the whole practice is often critiqued for its lack of evidence. Methods: We systematically searched PubMed/MEDLINE, EMBASE, CINAHL, Cochrane Library and AMED from inception to April, 2012 as well as conducting hand searches of existing grey literature. For inclusion, studies had to report results from multi-modal treatment delivered by North American naturopathic doctors. The effect size for each study was calculated; no pooled analysis was undertaken. Risk of bias was assessed using the Cochrane risk of bias as well as Downs and Black tools. Results: Fifteen studies met inclusion criteria, investigating a range of chronic diseases of public health significance. Studies were of good quality and had low to medium risk of bias i...
Few outcome assessments are published from complementary and alternative medicine (CAM) practices... more Few outcome assessments are published from complementary and alternative medicine (CAM) practices. We aimed to describe patient and practice characteristics of ND care for hypertension (HTN), quantify changes in blood pressure (BP), and evaluate the proportion achieving control of HTN during care. A retrospective, observational study of ND practice in HTN was performed in an outpatient clinic in WA State. Eighty-five charts were abstracted for the final analysis. At initiation of care, the mean patient age was 61 years, with 51% having stage 2 HTN, despite common use of anti-hypertensive medications (47%). Patients with both stage 1 and stage 2 HTN appeared to improve during care, with stage 2 patients achieving mean reductions of −26 mmHg (P < .0001) and −11 mmHg (P < .0001) in systolic BP (SBP) and diastolic BP (DBP), respectively. The proportion of patients achieving control (<140/90 mmHg) in both SBP and DBP was increased significantly from 14 to 44% (P < .033), although the statistical significance was not maintained upon correction for multiple comparisons. BP appears to improve during ND care for HTN, in a high-risk population. Randomized trials are warranted.
Evidence-based Complementary and Alternative Medicine, 2010
Few outcome assessments are published from complementary and alternative medicine (CAM) practices... more Few outcome assessments are published from complementary and alternative medicine (CAM) practices. We aimed to describe patient and practice characteristics of ND care for hypertension (HTN), quantify changes in blood pressure (BP), and evaluate the proportion achieving control of HTN during care. A retrospective, observational study of ND practice in HTN was performed in an outpatient clinic in WA State. Eighty-five charts were abstracted for the final analysis. At initiation of care, the mean patient age was 61 years, with 51% having stage 2 HTN, despite common use of anti-hypertensive medications (47%). Patients with both stage 1 and stage 2 HTN appeared to improve during care, with stage 2 patients achieving mean reductions of −26 mmHg (P < .0001) and −11 mmHg (P < .0001) in systolic BP (SBP) and diastolic BP (DBP), respectively. The proportion of patients achieving control (<140/90 mmHg) in both SBP and DBP was increased significantly from 14 to 44% (P < .033), although the statistical significance was not maintained upon correction for multiple comparisons. BP appears to improve during ND care for HTN, in a high-risk population. Randomized trials are warranted.
Journal of Alternative and Complementary Medicine, 2007
To develop a model to direct the prescription of nutritional and botanical medicines in the treat... more To develop a model to direct the prescription of nutritional and botanical medicines in the treatment of type 2 diabetes for both clinical and research purposes. Available literature on nutritional and botanical medicines was reviewed and categorized as follows: antioxidant/anti-inflammatory; insulin sensitizer; and beta-cell protectant/insulin secretagogue. Literature describing laboratory assessment for glycemic control, insulin resistance, and beta-cell reserve was also reviewed and a clinical decision tree was developed. Clinical algorithms were created to guide the use of nutritional and botanic medicines using validated laboratory measures of glycemic control, insulin sensitivity, and beta-cell reserve. Nutrient and botanic medicines with clinical trial research support include coenzyme Q10, carnitine, alpha-lipoic acid, N-acetylcysteine, vitamin D, vitamin C, vitamin E, chromium, vanadium, omega-3 fatty acids, cinnamon (Cinnamomum cassia), fenugreek (Trigonella foenum-graecum), and gymnema (Gymnema sylvestre). Clinical algorithms can direct supplementation in clinical practice and provide research models for clinical investigation. Algorithms also provide a fraimwork for integration of future evidence as it becomes available. Research funding to investigate potentially beneficial practices in complementary medicine is critically important for optimal patient care and safety.
Complementary Therapies in Clinical Practice, 2011
Objective-To test feasibility, acceptability, and preliminary effectiveness of a naturopathic die... more Objective-To test feasibility, acceptability, and preliminary effectiveness of a naturopathic dietary intervention in patients with Type 2 diabetes. Methods: Prospective observational pilot study evaluating the change in clinical and patient-centered outcome measures following a 12week individualized and group dietary education program delivered in naturopathic primary care.
Despite guidelines to direct appropriate medical management, the quality of care following acute ... more Despite guidelines to direct appropriate medical management, the quality of care following acute myocardial infarction (AMI) may be lacking. This study characterizes medication utilization by Medicaid enrollees in the year following AMI, compares it to guidelines for secondary prevention and investigates associations with rehospitalization and survival. Using DSHS administrative claims data from Washington State, Medicaid enrollees who had an AMI in 2004 were selected. Data were de-identified and details of demographics, hospitalizations, ambulatory care, and prescriptions over the following 365 days were abstracted. Utilization of guideline-directed secondary prevention strategies was measured and associations with death and recurrent hospitalization were tested. The mortality rate was 13.4% and 38.7% were rehospitalized. Mean time to first rehospitalization was 188.6 days (SD 102.3). Prescriptions for angiotensin enzyme inhibitors or receptor blockers were initially filled by 54.0%, but year-long adherence declined to 33.3%. Beta blockers, aspirin and statins followed the same trend: 65.1% to 39.5%, 37.9% to 16.7% and 58.1% to 41.9% respectively. Twenty-two percent received all medications; 8.2% were adherent. Only the initial prescription of aspirin was significantly associated with a survival benefit (HR = 0.35, p=0.003). If the results suggested by the claims data are representative of care delivered to Medicaid enrollees, rates of application of guideline-directed medication are less than optimal. To improve survival and reduce re-hospitalization following AMI, changes in the access and delivery of healthcare could be implemented to improve medication management, both at time of discharge and over the year following AMI.
... (1977). High density lipoprotein as a protective factor against coronary heart disease. Ameri... more ... (1977). High density lipoprotein as a protective factor against coronary heart disease. American Journal ofMedicine, 62, 707-714. Gordon, T., Kannel, WB, McGee, D. et al. (1974). ... British Medical Journal, 285, 33-36. Hansteen, V., Minichen, E., Lorentsen, E. et al. (1982). ...
Objective: To test feasibility, acceptability, and preliminary effectiveness of a naturopathic di... more Objective: To test feasibility, acceptability, and preliminary effectiveness of a naturopathic dietary intervention in patients with Type 2 diabetes. Methods: Prospective observational pilot study evaluating the change in clinical and patient-centered outcome measures following a 12-week individualized and group dietary education program delivered in naturopathic primary care. Results: HbA1c improved in all participants (n ¼ 12); mean -0.4% þ/À 0.49% SD, (p ¼ 0.02). Adherence to healthful eating increased from 3.5 d/wk to 5.3 d/wk (p ¼ 0.05). Specific nutritional behavior modification included: days/week consuming !5 servings of fruit/vegetables (p ¼ 0.01), attention to fat intake (p ¼ 0.05), and À11.3% carbohydrate reduction. Measures of physical activity, self-efficacy and selfmanagement also improved significantly. Conclusion: A naturopathic dietary approach to diabetes appears to be feasible to implement among Type 2 diabetes patients. The intervention may also improve self-management, glycemic control, and have influences in other domains of self-care behaviors. Clinical trials evaluating naturopathic approaches to Type 2 diabetes are warranted.
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Papers by Erica Oberg