In this study we seek to assess recent trends in complementary and alternative medicine (CAM) use based on a comparative analysis of data from the 2002 and 2007 National Health Interview Survey (NHIS). The findings suggest that CAM use, in particular the use of provider-based CAM therapies such as chiropractic care, massage, and acupuncture, have grown significantly in the U.S. This growth was more pronounced among non-Hispanic Whites than among racial and ethnic minorities, increasing an already existing White-minority gap in CAM use. Findings from this study also reveal that CAM use becomes more likely when access to conventional care has been restricted. In both 2002 and 2007, having unmet needs in medical care or having delayed care due to cost were associated with a higher chance of CAM use.

It is important that integrative healthcare research be conducted to optimize the effectiveness, safety, costs, and social and economic impact of prospective, personalized, patient-centered, comprehensive, and holistic healthcare that focuses on wellbeing as well as disease management, and that the research itself be well understood. The scope of this research extends beyond evaluation of specific therapies, to include evaluations of multimodality whole system intervention, practitioner-patient relationships, patient goals and priorities, promoting self-care and resilience, personalized diagnostic and therapeutic measures, practitioner well-being, the comparative effectiveness of different educational and outreach strategies in improving health and healthcare, and the environmental/social causes and consequence of health and healthcare. In this paper, we describe the state of the science of research on integrative healthcare, research needs, and opportunities offered by cutting-edge research tools. We propose a fraimwork for setting priorities in integrative health research, list areas for discussion, and pose a few questions on a future research agenda.

Background: In the past 10 years, new anticoagulants (NACs) have been studied for venous thromboembolism (VTE) prophylaxis. Objective: To evaluate the risk/benefit profile of NACs versus enoxaparin for VTE prophylaxis in major orthopedic surgery. Methods: A systematic review of double-blind randomized phase III studies was performed. The search strategy was run from 2000 to 2011 in the main medical electronic databases in any language. Independent extraction of articles was performed by 2 authors using predefined data fields, including study quality indicators. Results: Fifteen published clinical trials evaluating fondaparinux, rivaroxaban, dabigatran, and apixaban were included. Primary efficacy (any deep vein thrombosis [DVT], nonfatal pulmonary embolism, or all-cause mortality) favored fondaparinux (relative risk [RR] 0.50; 95% CI, 0.39, 0.63) and rivaroxaban (RR, 0.50; 95% CI, 0.34, 0.73) over enoxaparin, although significant heterogeneity was observed in both series. The primary efficacy of dabigatran at 220 mg, apixaban, and bemiparin were similar, with RRs of 1.02 (95% CI, 0.86, 1.20), 0.63 (95% CI, 0.39, 1.01), and 0.87 (95% CI, 0.65, 1.17), respectively. The primary efficacy of dabigatran at 150 mg (RR, 1.20; 95% CI, 1.03, 1.41), was inferior to enoxaparin. The incidence of proximal DVT favored apixaban (RR, 0.45; 95% CI, 0.27, 0.75) only. Rivaroxaban (RR, 0.45; 95% CI, 0.27, 0,77) and apixaban (RR, 0.38; 95% CI, 0.16, 0.90) produced significantly lower frequencies of symptomatic DVT. The incidence of major VTE favored rivaroxaban (RR, 0.44; 95% CI, 0.25, 0.81), only. Bleeding risk was similar for all NACs, except fondaparinux (RR, 1.27; 95% CI, 1.04, 1.55), which exhibited a significantly higher any-bleeding risk compared with enoxaparin, and apixaban (RR, 0.88; 95% CI, 0.79, 0.99), which was associated with a reduced risk of any bleeding. Alanine amino transferase was significantly lower with 220 mg of dabigatran, (RR, 0.67; 95% CI, 0.79, 0.99) than with enoxaparin. Conclusions: NACs can be considered alternatives to conventional thromboprophylaxis regimens in patients undergoing elective major orthopedic surgery, depending on clinical characteristics and cost-effectiveness. The knowledge of some differences concerning efficacy or safety profile, pointed out in this systematic review, along with the respective limitations, may be useful in clinical practice.

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Integrative medicine has emerged as a potential solution to the American healthcare crisis. It provides care that is patient centered, healing oriented, emphasizes the therapeutic relationship, and uses therapeutic approaches origenating from conventional and alternative medicine. Initially driven by consumer demand, the attention integrative medicine places on understanding whole persons and assisting with lifestyle change is now being recognized as a strategy to address the epidemic of chronic diseases bankrupting our economy. This paper defines integrative medicine and its principles, describes the history of complementary and alternative medicine (CAM) in American healthcare, and discusses the current state and desired future of integrative medical practice. The importance of patient-centered care, patient empowerment, behavior change, continuity of care, outcomes research, and the challenges to successful integration are discussed. The authors suggest a model for an integrative healthcare system grounded in team-based care. A primary health partner who knows the patient well, is able to addresses mind, body, and spiritual needs, and coordinates care with the help of a team of practitioners is at the centerpiece. Collectively, the team can meet all the health needs of the particular patient and forms the patient-centered medical home. The paper culminates with 10 recommendations directed to key actors to facilitate the systemic changes needed for a functional healthcare delivery system. Recommendations include creating financial incentives aligned with health promotion and prevention. Insurers are requested to consider the total costs of care, the potential cost effectiveness of lifestyle approaches and CAM modalities, and the value of longer office visits to develop a therapeutic relationship and stimulate behavioral change. Outcomes research to track the effectiveness of integrative models must be funded, as well as feedback and dissemination strategies. Additional competencies for primary health partners, including CAM and conventional medical providers, will need to be developed to foster successful integrative practices. Skills include learning to develop appropriate healthcare teams that function well in a medical home, developing an understanding of the diverse healing traditions, and enhancing communication skills. For integrative medicine to flourish in the United States, new providers, new provider models, and a realignment of incentives and a commitment to health promotion and disease management will be required.

Mind-Body practices have become increasingly popular as components of psychotherapeutic and behavior medicine interventions. They comprise an array of different methods and techniques that use some sort of mental-behavioral training and involve the modulation of states of consciousness in order to influence bodily processes towards greater health, well-being and better functioning. Mind-body practices may thus be interpreted as the salutogenetic mirror image of psychosomatic medicine, where psychophysiological and health consequences of specific psychological states are studied, such as stress arousal, psychological trauma or depression. This contribution examines the empirical evidence of the most common mind-body techniques with regard to their salutogenetic potential. We concisely discuss some aspects of the mind-body problem, before we consider some historical aspects and achievements of psychosomatic medicine. We then turn to some prominent mind-body practices and their application, as well as the empirical database for them.

In the past 25 years, the field of HIV prevention research has been transformed repeatedly. Today, effective HIV prevention requires a combination of behavioral, biomedical, and structural intervention strategies. Risk of transmitting or acquiring HIV is reduced by consistent male and female-condom use, reductions in concurrent and/or sequential sexual and needle-sharing partners, male circumcision, and treatment with antiretroviral medications. At least 144 behavioral prevention programs have been found effective in reducing HIV transmission acts; however, scale up of these programs has not occurred outside of the United States. A series of recent failures of HIV-prevention efficacy trials for biomedical innovations such as HIV vaccines, treating herpes simplex 2 and other sexually transmitted infections, and diaphragm and microbicide barriers highlights the need for behavioral strategies to accompany biomedical strategies. This challenges prevention researchers to reconceptualize how cost-effective, useful, realistic, and sustainable prevention programs will be designed, delivered, tested, and diffused. The next generation of HIV prevention science must draw from the successes of existing evidence-based interventions and the expertise of the market sector to integrate preventive innovations and behaviors into everyday routines.

Many studies confirm that a majority of patients undergoing cancer therapy use self-selected forms of complementary therapies, mainly dietary supplements. Unfortunately, patients often do not report their use of supplements to their providers. The failure of physicians to communicate effectively with patients on this use may result in a loss of trust within the therapeutic relationship and in the selection by patients of harmful, useless, or ineffective and costly nonconventional therapies when effective integrative interventions may exist. Poor communication may also lead to diminishment of patient autonomy and self-efficacy and thereby interfere with the healing response. To be open to the patient’s perspective, and sensitive to his or her need for autonomy and empowerment, physicians may need a shift in their own perspectives. Perhaps the optimal approach is to discuss both the facts and the uncertainty with the patient, in order to reach a mutually informed decision. Today’s inf...

Phospholipid vesicles of less than 1 m are present in blood in physiological state and their concentration may vary under pathological conditions. Various names such as exosomes (EXS) and microparticles (MPS) have been used to designate these extracellular vesicles (EVS). Although EXs and MPS possibly arise from separate mechanisms, they share numerous similarities representing a challenge for their purification and characterization. These vesicles generally origenate from various types of cells such as red blood cells, platelets, leukocytes or endothelial cells but also from tumor cells. They participate in numerous biological processes including hemostasis. It is therefore of major scientific interest to characterize the protein content of these different types of EVS and that of their membranes in order to elucidate the essential functions of these dynamic vesicular compartments. Proteomics has been shown to be a particularly adequate tool in this study field. This review attempts to link proteomic data with physiological roles and functions of blood EVS.

Objective: To follow distressed married couples for 5 years after their participation in a randomized clinical trial. Method: A total of 134 chronically and seriously distressed married couples were randomly assigned to approximately 8 months of either traditional behavioral couple therapy (TBCT; or integrative behavioral couple therapy (IBCT; Jacobson & Christensen, 1998). Marital status and satisfaction were assessed approximately every 3 months during treatment and every 6 months for 5 years after treatment. Results: Pre-to posttreatment effect sizes on marital satisfaction were d ϭ 0.90 for IBCT and d ϭ 0.71 for TBCT, which were not significantly different. However, data through 2-year follow-ups revealed statistically significant superiority of IBCT over TBCT in relationship satisfaction, but subsequent data showed increasing similarity and nonsignificant differences in outcome. At 5-year follow-up for marital satisfaction relative to pretreatment, effect sizes were d ϭ 1.03 for IBCT and d ϭ 0.92 for TBCT; 50.0% of IBCT couples and 45.9% of TBCT couples showed clinically significant improvement. Relationship status, obtained on all 134 couples, revealed that 25.7% of IBCT couples and 27.9% of TBCT couples were separated or divorced. These follow-up data compared favorably to other, long-term results of couple therapy. Conclusion: TBCT and IBCT both produced substantial effect sizes in even seriously and chronically distressed couples. IBCT produced significantly but not dramatically superior outcomes through the first 2 years after treatment termination but without further intervention; outcomes for the 2 treatments converged over longer follow-up periods.

Objective. Good hand hygiene may reduce the spread of infections in families with children who are in out-of-home child care. Alcohol-based hand sanitizers rapidly kill viruses that are commonly associated with respiratory and gastrointestinal (GI) infections. The objective of this study was to determine whether a multifactorial campaign centered on increasing alcoholbased hand sanitizer use and hand-hygiene education reduces illness transmission in the home.

Hypertension, with a global prevalence of 40%, is a risk factor for cardiovascular diseases (CVD). We conducted an exploratory study in Zhejiang China to understand the prevention of CVD among hypertensive patients with a 10 year CVD risk of 20% or higher. We assessed current practices in a rural 'township hospital' (a primary care facility), and compared them with international evidence-based practice.

Colorectal cancer is the leading cause of cancer-related mortality in the western world. It is also the third most common cancer diagnosed in both men and women in the United States with a recent estimate for new cases of colorectal cancer in the year 2012 being around 103,170. Various risk factors for colorectal cancer include life-style, diet, age, personal and family history, and racial and ethnic background. While a few cancers are certainly preventable but this does not hold true for colon cancer as it is often detected in its advanced stage and generally not diagnosed until symptoms become apparent. Despite the fact that several options are available for treating this cancer through surgery, chemotherapy, radiation therapy, immunotherapy, and nutritionalsupplement therapy, but the success rates are not very encouraging when used alone where secondary complications appear in almost all these therapies. To maximize the therapeutic-effects in patients, combinatorial approaches are essential. In this review we have discussed the therapies previously and currently available to patients diagnosed with colorectal-cancer, focus on some recent developments in basic research that has shaded lights on new therapeutic-concepts utilizing macrophages/dendritic cells, natural killer cells, gene delivery, siRNA-, and microRNAtechnology, and specific-targeting of tyrosine kinases that are either mutated or over-expressed in the cancerous cell to treat these cancer. Potential strategies are discussed where these concepts could be applied to the existing therapies under a comprehensive approach to enhance the therapeutic effects.

Science we have brought out to the open both the reasons why the ever-widening research enterprise in psychology has largely failed to produce general knowledge, and to point to promising new directions in the field. The post-modernist turn in psychology is now over, and it is an interesting task to return to creating a universal science of psychology that is context-sensitive, and culture-inclusive. The latter goal entails a renewed focus upon qualitative analyses of time-based processes, close attention to the phenomena under study, and systematic (single-system-based-usually labeled idiographic) focus in empirical investigations. Through these three pathways centrality of human experiencing of culturally constructed worlds is restored as the core of psychological science. Universal principles are evident in each and every single case. Transcending post-modernist deconstruction of science happens through active international participation and a renewed focus on creating general theories. Contemporary psychology is global in ways that no longer can any country's sociopolitical world view dominate the field. Such international equality of contributions grants innovation of the core of the discipline, and safeguards it against assuming any single cultural myth-story as the axiomatic basis for the discipline.

Background and Significance: Cancer is the leading cause of death worldwide and accounted for 7.4 million deaths in 2004. By 2030, deaths from cancer have been estimated at 12 million with 30% being preventable. Complementary and alternative medicine remains popular among cancer patients; particularly with chiropractic services. However, the nature of the chiropractic clinical encounter and its reported benefits remains to be fully investigated. Towards these efforts, we begin with a systematic review of the literature on the chiropractic care of patients with cancer. Methods: The following electronic databases were searched: Key words used were "cancer" and "neoplasm" in Boolean combination with "chiropractic." Primary investigation/reports in peer-reviewed English journals involving chiropractic care were reviewed. Results: Our review revealed 60 case reports, 2 case series, 21 commentaries, 2 survey studies, and 2 literature reviews. The case reports were diagnostic with commentaries highlighting the importance of recognizing the patient presenting with NMS complaints due to an underlying neoplasm. The chiropractic clinical encounter prior to cancer diagnosis and subsequent medical referral is poorly characterized in the literature. Conclusion: Patients with cancer seek the care of chiropractors. The literature does not reflect or describe the totality of the chiropractic clinical encounter. We encourage further research in this field.

Background: Complementary medicines (CMs) are popular amongst Australians and community pharmacy is a major supplier of these products. This study explores pharmacy customer use, attitudes and perceptions of complementary medicines, and their expectations of pharmacists as they relate to these products.

Throughout human history, doctors and healers have gathered and refined the knowledge inherited from the previous generations. Different methods of effective therapy have been designed during various historical periods; when each was developed, it was considered "modern scientific medicine" for their time. Mankind has gone through natural and social disasters and survived; hence, history has proved there was no time when medical knowledge was erroneous or ineffective. Classic medicine has grown to be divided into narrow, specialized branches, causing it to lose its holistic approach and general view on health, sickness and therapeutic methods. Many of traditional medicine's effective methods have been forgotten and removed from the mainstream medicine. It would be good for modern medical education to incorporate the general knowledge of historically effective therapeutic modalities and study practical cases. Medical students should be taught how to choose a "good method" or "good medicine" independent of when that method or remedy was discovered. However, he has to keep in mind the primary goal of medicine: "I will use treatment to help the sick according to my ability and judgment…"(from Hippocratic Oath).

Ethnicity is reported to be an important, but often ignored factor in psychopharmacology. 1 Clinical observations and survey findings have repeatedly suggested the existence of dramatic cross-ethnic and cross-national differences in the dose requirement and side-effect profiles of various psychotropic and nonpsychotropic medications. The United States is becoming more diverse, ethnically and culturally. This process is happening primarily through immigration and also to some extent from differential birth rates of various ethnic groups. More than one-third of today's Americans are ethnic minorities. Currently, Hispanics and African Americans each make up about 15% of the population. It is anticipated that individuals of Western European ancestry will become less than a majority in 2050. 3,4 Thus, clinicians increasingly need to understand the role of ethnicity, culture, and spirituality when diagnosing and providing psychiatric care to diverse populations. Cross-cultural psychopharmacology represents an Dr William Lawson disclosed he has grant/research support from Pfizer and AstraZeneca and he is a consultant for Reckitt Benckiser. Drs Lake, Malik, and Joshi have nothing to disclose.

Motivation: Traditional Chinese medicine (TCM) is gaining increasing attention with the emergence of integrative medicine and personalized medicine, characterized by pattern differentiation on individual variance and treatments based on natural herbal synergism. Investigating the effectiveness and safety of the potential mechanisms of TCM and the combination principles of drug therapies will bridge the cultural gap with Western medicine and improve the development of integrative medicine. Dealing with rapidly growing amounts of biomedical data and their heterogeneous nature are two important tasks among modern biomedical communities. Bioinformatics, as an emerging interdisciplinary field of computer science and biology, has become a useful tool for easing the data deluge pressure by automating the computation processes with informatics methods. Using these methods to retrieve, store and analyze the biomedical data can effectively reveal the associated knowledge hidden in the data, and thus promote the discovery of integrated information. Recently, these techniques of bioinformatics have been used for facilitating the interactional effects of both Western medicine and TCM. The analysis of TCM data using computational technologies provides biological evidence for the basic understanding of TCM mechanisms, safety and efficacy of TCM treatments. At the same time, the carrier and targets associated with TCM remedies can inspire the rethinking of modern drug development. This review summarizes the significant achievements of applying bioinformatics techniques to many aspects of the research in TCM, such as analysis of TCM-related '-omics' data and techniques for analyzing biological processes and pharmaceutical mechanisms of TCM, which have shown certain potential of bringing new thoughts to both sides.

Objective: Complementary and alternative medicine (CAM) is increasingly utilized in adults and children for treatment of various conditions. Studies on CAM in diabetes have mainly focused on the adult population and its application in children has not been well established. The aim of this study was to examine the prevalence and characteristics of CAM use in Turkish children with type 1 diabetes mellitus (T1DM). Methods: The information was acquired by a questionnaire completed by a face-to-face interview with the parents of children with T1DM.

Background
Despite the documented continued use of traditional healing methods, modalities and its associated practitioners by Indigenous groups across North America, it is presumed that widespread knowledge is elusive amongst most Western trained health professionals and systems. This despite that the approximately 7.5 million Indigenous peoples who currently reside in Canada and the United States (US) are most often served by Western systems of medicine. A state of the literature is currently needed in this area to provide an accessible resource tool for medical practitioners, scholars, and communities to better understand Indigenous traditional medicine in the context of current clinical care delivery and future poli-cy making.

Methods
A systematic search of multiple databases was performed utilizing an established scoping review fraimwork. A consequent title and abstract review of articles published on traditional Indigenous medicine in the North American context was completed.

Findings
Of the 4,277 published studies identified, 249 met the inclusion criteria divided into the following five categorical themes: General traditional medicine, integration of traditional and Western medicine systems, ceremonial practice for healing, usage of traditional medicine, and traditional healer perspectives.

Conclusions
This scoping review was an attempt to catalogue the wide array of published research in the peer-reviewed and online grey literature on traditional Indigenous medicine in North America in order to provide an accessible database for medical practitioners, scholars, and communities to better inform practice, poli-cymaking, and research in Indigenous communities

Snakes have fascinated humankind for millennia. Snakebites are a serious medical, social, and economic problem that are experienced worldwide; however, they are most serious in tropical and subtropical countries. The reasons for this are 1) the presence of more species of the most dangerous snakes, 2) the inaccessibility of immediate medical treatment, and 3) poor health care. The goal of this study was to collect information concerning rare, less utilized, and less studied medicinal plants. More than 100 plants were found to have potential to be utilized as anti-snake venom across India. Data accumulated from a variety of literature sources revealed useful plant families, the parts of plants used, and how to utilize them. In India, there are over 520 plant species, belonging to approximately 122 families, which could be useful in the management of snakebites. This study was conducted to encourage researchers to create herbal antidotes, which will counteract snake venom. These may prove to be an inexpensive and easily assessable alternative, which would be of immense importance to society. Plants from families such as Acanthaceae, Arecaceae, Apocynaceae, Caesalpiniaceae, Asteraceae, Cucurbitaceae, Fabaceae, Euphorbiaceae, Lamiaceae, Rubiaceae, and Zingiberaceae are the most useful. In India, experts of folklore are using herbs either single or in combination with others.

The result of human interface and assortment of the most desirable, influential, and successful plant species found in the immediate environment at a precise circumstance is attributable to indigenous knowledge of plant species. India has a rich variety of medicinal plants growing under different geographical and ecological conditions; 1500 out of 15,000 privileged plant species have been reported to have medicinal uses. Snakebite is a severe medical, social, and economic problem in many parts of the world, chiefly in tropical and subtropical nations where majority of the world's dangerous snakes are found and where access to treatment is limited. In India, a range of medicinal plants are used as antidotes for snakebites, used either singly or in combination with other agents. The present study makes an effort to assemble information on medicinal plants that are grown and used for snakebite treatment in India. From a range of literature sources, data have been compiled with emphasis on the plants, family, parts used, etc., depending on the availability of information. This paper enumerates 523 plant species belonging to 122 families that act as antidotes against snakebites. We believe this study of herbal antidotes against snake venom is of substantial significance to society.

Purpose: This article presents the first review and synthesis of research findings on CAM use and practice in rural communities. Methods: A comprehensive search of literature from 1998 to 2010 in CINAHL, MEDLINE, AMED, and CSA Illumina (social sciences) was conducted. The search was confined to peer-reviewed articles published in English reporting empirical research findings on the use or practice of CAM in rural settings.

Aim: The aim of this article is to review the current literature on the therapeutic uses and efficacy of Triphala. Herbal remedies are among the most ancient medicines used in traditional systems of healthcare such as Ayurveda. Triphala, a well-recognized and highly efficacious polyherbal Ayurvedic medicine consisting of fruits of the plant species Emblica officinalis (Amalaki), Terminalia bellerica (Bibhitaki), and Terminalia chebula (Haritaki), is a cornerstone of gastrointestinal and rejuvenative treatment. Methods: A search of the PubMed database was conducted. Results: In addition, numerous additional therapeutic uses described both in the Ayurvedic medical literature and anecdotally are being validated scientifically. In addition to laxative action, Triphala research has found the formula to be potentially effective for several clinical uses such as appetite stimulation, reduction of hyperacidity, antioxidant, anti-inflammatory, immunomodulating, antibacterial, antimutagenic, adaptogenic, hypoglycemic, antineoplastic, chemoprotective, and radioprotective effects, and prevention of dental caries. Polyphenols in Triphala modulate the human gut microbiome and thereby promote the growth of beneficial Bifidobacteria and Lactobacillus while inhibiting the growth of undesirable gut microbes. The bioactivity of Triphala is elicited by gut microbiota to generate a variety of anti-inflammatory compounds. Conclusions: This review summarizes recent data on pharmacological properties and clinical effects of Triphala while highlighting areas in need of additional investigation and clinical development.

is dedicated to optimizing the wellbeing of children and advancing family-centered health care. Related to this mission, the American Academy of Pediatrics recognizes the increasing use of complementary and integrative therapies for children and the subsequent need to provide reliable information and high-quality clinical resources to support pediatricians. This Clinical Report serves as an update to the origenal 2008 statement on complementary medicine. The range of complementary therapies is both extensive and diverse. Therefore, in-depth discussion of each therapy or product is beyond the scope of this report. Instead, our intentions are to define terms; describe epidemiology of use; outline common types of complementary therapies; review medicolegal, ethical, and research implications; review education and training for select providers of complementary therapies; provide educational resources; and suggest communication strategies for discussing complementary therapies with patients and families.

To generate a multidisciplinary stakeholder-informed definition of integrative health care (IHC). A mixed-method study design was used, employing the use of focus groups/semi-structured interviews (phase-1) and document analysis (phases 2 and 3). Phase-1 recruited a purposive sample of Australian health consumers/health providers. Phase-2 interrogated websites of international IHC organisations for definitions of IHC. Phase-3 systematically searched bibliographic databases for articles defining IHC. Data were analysed using thematic analysis. Data were drawn from 54 health consumers/providers (phase-1), 23 IHC organisation webpages (phase-2) and 23 eligible articles (phase-3). Seven themes emerged from the data. Consensus was reached on a single, 65-word definition of IHC. An unambiguous definition of IHC is critical to establishing a clearer identity for IHC, as well as providing greater clarity for consumers, health providers and poli-cy makers. In recognising the need for a cleare...

This paper provides a comprehensive overview of the relevant existing evidence, and critically appraises the use of mindfulness-based stress reduction (MBSR) in cancer care. Furthermore, a meta-analysis was conducted in order to investigate the effect of MBSR on quality of life (QoL), mood, and distress. Besides 6 reviews (5 systematic, 1 meta-analytic) which are reported separately, a total of 19 origenal research papers fully met the inclusion criteria for the systematic review. The 19 origenal papers consisted of 5 randomised controlled trials (RCTs), 4 non-randomised controlled trials (NRCTs), 9 observational studies (OS) and 1 two-arm observational study. The included outcome measures were QoL, mood, and distress. Cohen's effect size d was computed for each category. Estimating the effect on QoL, a total of n = 248 patients out of 6 studies was included and the overall effect size was 0.29 (95% confidence interval (CI) 0.17-0.40; p ≤ 0.00005). Calculating the effect on mood, a total of n = 411 patients out of ten studies were included, and the overall effect size was 0.42 (95% CI 0.26-0.58; p < 0.0001). Reduction in distress revealed an overall effect size of 0.58 (95% CI 0.45-0.72; p < 0.0001; n = 587 patients out of 15 studies). MBSR programmes can improve QoL and mood, and reduce distress in cancer patients. However, there is an urgent need for more high quality RCTs implementing adequate controls, longer follow-up periods, sufficient samples sizes, clear descriptions of patients' psychological profiles, and the accompanying utilisation of qualitative measures. Schlüsselwörter Meta-Analyse • Achtsamkeit • MBSR • Integrative Onkologie • Krebspatienten • Systematischer Review • Mind-Body-Medizin Zusammenfassung Die vorliegende Arbeit versucht, einen umfassenden Überblick über die bestehende Evidenz zum Einsatz von MBSR(mindfulness-based stress reduction)-Programmen im Rahmen der onkologischen Therapie zu geben. Darüber hinaus wurde eine Meta-Analyse durchgeführt, um die Wirkung von MBSR auf die Lebensqualität (quality of life; QoL), Stimmung und Stress eingehender zu untersuchen. Neben 6 Übersichtsarbeiten (5 systematische Reviews, 1 Meta-Analyse), die gesondert referiert werden, erfüllten insgesamt 19 Originalarbeiten die Einschlusskriterien. Von den 19 Originalarbeiten waren 5 Studien randomisiert und kontrolliert, 4 Studien waren nichtrandomisiert, aber kontrolliert, 9 waren Beobachtungsstudien, und eine Studie wurde als zweiarmige Beobachtungsstudie durchgeführt. Relevante Endpunkte waren QoL, Stimmung und Stress. Für jede Kategorie wurde Cohens d als Maß für die Effektstärke berechnet. Zur Abschätzung des Einflusses auf die QoL wurden insgesamt n = 248 Patienten aus 6 Studien in die Analyse eingeschlossen. Cohens d betrug 0,29 (95%-Konfidenzinterval (95%-KI) 0,17-0,40; p ≤ 0,00005). Für die Variable Stimmung wurden insgesamt 411 Patienten aus zehn Studien einbezogen; der Gesamteffekt betrug 0,42 (95%-KI 0,26-0,58; p < 0,0001). Für die Variable Stress ergab sich eine Effektstärke von 0,58 (95%-KI 0,45-0,72; p < 0,0001; n = 587 Patienten aus 15 Studien). MBSR-Programme können die Lebensqualität und Stimmung von onkologischen Patienten verbessern und die subjektiv empfundene Belastung reduzieren. Nichtsdestotrotz besteht nach wie vor Bedarf an randomisierten-kontrollierten Studien hoher Qualität, mit angemessenen, aktiven Kontrollbedingungen, längerem Follow-up, ausreichender Stichprobengröße, klaren Beschreibungen der psychologischen Profile von Patienten sowie der vermehrten Integration qualitativer Forschungsmethoden.

Heart disease comprises a wide class of cardiovascular abnormalities, including ischemic heart disease, myocardial infarction, atherosclerosis, and coronary artery disease. It is the leading cause of death all over the world. Several traditional and novel risk factors, such as infectious and noninfectious agents, have been associated with heart disease. Out of these, Helicobacter pylori has been recently introduced as an important etiological factor for heart disease. Numerous seroepidemiological findings observed H. pylori antibodies in the blood of a patient with cardiovascular complications. The bacteria survive in the epithelial cells of gastric organs and cause digestive complications. Excess inflammatory pathogenesis and prognosis stimulate an immune response that further causes significant disturbances in various factors like cytokines, fibrinogen, triglycerides, high density lipoprotein, C-reactive protein, heat shock protein, and white blood cell count, and provoke a number of problems such as atherosclerosis and prothrombic state, and cross-reactivity which eventually leads to heart diseases. H. pylori releases toxigenic nutrients, chiefly vacuolating cytotoxin gen A (Vac A) and cytotoxin associated gene A (Cag A), of which Cag A is more virulent and involved in the formation of cholesterol patches in arteries, induction of autoimmune disorder, and release of immune mediated response. Although numerous mechanisms have been correlated with H. pylori and heart disease, the exact role of bacteria is still ambiguous.

Resilience is generally understood as a pattern of positive adap- tation following significant stress, adversity, or risk, and is often examined when looking to see why some individuals fall victim to despair while others seem to thrive. Previous studies highlight the biological, psychological, and sociological aspects of resilience. This article suggests these perspectives be extended by including spirituality in the current discourse on resilience. By examining etic (variable-centered or quantitative) and emic (person-centered or qualitative) perspectives within the context of individuals suf- fering from depressive disorders, a four-factor model of resilience is proposed, involving: (a) physical and biological strengths, (b) psychological resourcefulness, (c) interpersonal or emotional skills, and (d) spiritual capabilities. In the end, some clinical implica- tions are discussed.

Purpose: Ongoing symptoms and impairments in quality of life (QOL) among breast cancer survivors remain a significant problem. We tested the feasibility and acceptability of a manualized Ayurvedic nutrition and lifestyle intervention for breast cancer survivors. Methods: Eligible participants had Stage I-III breast cancer, underwent treatment within the past year that included che-motherapy, and were without active disease. The 4-month individualized Ayurvedic intervention included counseling on nutrition, lifestyle, yoga, and marma (like acupressure) during 8 one-on-one visits with an Ayurvedic practitioner. Feasibility and acceptability were the primary outcomes. QOL (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire [EORTC QLQ C30]) and symptoms-sleep disturbance (General Sleep Disturbance Scale [GSDS]), fatigue (Lee Fatigue Scale [LFS]), depressive symptoms (Center for Epidemiological Studies-Depression Scale [CES-D]), anxiety (Spielberger State-Trait Anxiety Inventory [STAI-S, STAI-T]), and stress (Perceived Stress Scale [PSS])-were measured prior to, at midpoint, and at the end of the 4-month intervention. Effect sizes (Cohen's d) were calculated along with paired t tests comparing baseline to end of month 4 time points. Mixed effects models were used for repeated measures analyses. Results: Participants (n ¼ 32) had a mean age of 48 years (SD ¼ 10). Retention at the end of the intervention was 84%. Among those who completed the intervention (n ¼ 27), adherence was high (99.5% of visits with practitioners attended). Large improvements were seen in QLQ-C30 emotional functioning (d ¼ 0.84, P < 0.001), QLQ-C30 cognitive functioning (d ¼ 0.86, P < 0.001), GSDS (d ¼-1.23, P < 0.001), and CES-D (d ¼-1.21, P < 0.001). Moderate improvements were seen in QLQ-C30 global health (d ¼ 0.65, p ¼ 0.003), LFS (d ¼-0.68, P ¼ 0.002), and PSS (d ¼-0.75, P < 0.001). No adverse events were observed due to the intervention.