Badri Rickhi

The embodied mind: A review on functional genomic and neurological correlates of mind-body therapies

HighlightsFunctional genomic and neurological correlates of mind‐body practices are reviewed.EEG and Neuroimaging correlates of mind‐body therapies and meditation are reviewed.Mechanisms of action by which mind‐body practices influence health outcomes are discussed &NA; A broad range of mind‐body therapies (MBTs) are used by the public today, and a growing body of clinical and basic sciences research has resulted in evidence‐based integration of many MBTs into clinical practice. Basic sciences research has identified some of the physiological correlates of MBT practices, leading to a better understanding of the processes by which emotional, cognitive and psychosocial factors can influence health outcomes and well‐being. In particular, results from functional genomics and neuroimaging describe some of the processes involved in the mind‐body connection and how these can influence health outcomes. Functional genomic and neurophysiological correlates of MBTs are reviewed, detailing studies showing changes in sympathetic nervous system activation of gene transcription factors involved in immune function and inflammation, electroencephalographic and neuroimaging studies on MBT practices, and persistent changes in neural function and morphology associated with these practices. While the broad diversity of study designs and MBTs studied presents a patchwork of results requiring further validation through replication and longitudinal studies, clear themes emerge for MBTs as immunomodulatory, with effects on leukocyte transcription and function related to inflammatory and innate immune responses, and neuromodulatory, with effects on brain function and morphology relevant for attention, learning, and emotion regulation. By detailing the potential mechanisms of action by which MBTs may influence health outcomes, the data generated by these studies have contributed significantly towards a better understanding of the biological mechanisms underlying MBTs.

Mental disorders and reasons for using complementary therapy.

Objective: To compare patients with and without mental disorders who seek services from a complementary therapy practitioner with regard to quality of life, reasons for seeking complementary therapies, complaints, and physical conditions. Method: We studied new patients who attended a complementary therapy clinic offering acupuncture treatment between July 1, 1993, and March 31, 1995. We collected data from a self-administered questionnaire and from a physician-conducted psychiatric assessment. Results: Of the 826 new patients at the clinic, 578 (70%) presented with a mental disorder. Patients with a mental disorder perceived their quality of life as poorer and reported greater levels of stress than did those without a mental disorder. However, the groups did not differ in their self-reported reasons for seeking complementary therapies, in their complaints, or in their physical conditions. Among patients with a mental disorder, the major reasons for choosing complementary therapies were personal preference, interest, or belief in complementary therapies (44.3%) and perceiving complementary therapies as a last resort (30.7%). Most patients with a mental disorder saw a complementary practitioner for musculoskeletal and connective-tissue disorders (44.1%), fatigue (26.6%), and headache (15.2%). The most frequent physical illnesses among patients with a mental disorder were diseases of the musculoskeletal system and connective tissue (42.6%). Conclusion: Like their counterparts without a mental disorder, individuals with a mental disorder use complementary therapies because of personal beliefs. The wide use of complementary therapies among individuals with a mental disorder may be ascribed to a poor quality of life and high levels of distress.

Reduced Health Resource Use After Acupuncture for Low-Back Pain

ObjectivesAcupuncture is commonly used to treat low-back pain (LBP) and clinical trials have demonstrated its efficacy. However, less is known about how the utilization of acupuncture impacts public health service utilization in the real world. This study investigates the association between acupuncture utilization for LBP and health care utilization by assessing whether patients who undergo acupuncture subsequently use fewer health care resources and whether those patients differ in their health care use from the general population with LBP.DesignThis study employed the design of a two-group pre/post secondary data analysis.Setting and SubjectsThere were two study populations. To identify patients who received acupuncture for LBP in 2000, patient charts at Alberta registered acupuncture clinics were reviewed. The comparison group was identified from the Alberta physician claims administrative database. Acupuncture group cases were matched with four comparison cases from the general population with LBP based on gender and age.Outcome MeasuresNumber of physician visits and physician service cost for LBP-related services for 1 year pre- and postacupuncture treatment period were calculated from the physician claims data for both study groups.ResultsFor the 201 cases and 804 controls, the mean age was 48 years and 54 % were female. The number of physician visits for the 1-year period postacupuncture decreased 49 % for the acupuncture group (p < 0.01) compared to the 1-year period preacupuncture. For the comparison there was a decrease of 2 % in physician visits (p = 0.59) for the same time periods. Corresponding to the decrease, physician services cost declined 37 % for the case group (p = 0.01) and 1 % for the comparison (p = 0.86).ConclusionsResults suggest that patients with LBP were less likely to visit physicians for LBP after acupuncture treatment. This led to reduced health services spending on LBP.

Reduced health resource use after acupuncture for low-back pain.

OBJECTIVES Acupuncture is commonly used to treat low-back pain (LBP) and clinical trials have demonstrated its efficacy. However, less is known about how the utilization of acupuncture impacts public health service utilization in the real world. This study investigates the association between acupuncture utilization for LBP and health care utilization by assessing whether patients who undergo acupuncture subsequently use fewer health care resources and whether those patients differ in their health care use from the general population with LBP. DESIGN This study employed the design of a two-group pre/post secondary data analysis. SETTING AND SUBJECTS There were two study populations. To identify patients who received acupuncture for LBP in 2000, patient charts at Alberta registered acupuncture clinics were reviewed. The comparison group was identified from the Alberta physician claims administrative database. Acupuncture group cases were matched with four comparison cases from the general population with LBP based on gender and age. OUTCOME MEASURES Number of physician visits and physician service cost for LBP-related services for 1 year pre- and postacupuncture treatment period were calculated from the physician claims data for both study groups. RESULTS For the 201 cases and 804 controls, the mean age was 48 years and 54% were female. The number of physician visits for the 1-year period postacupuncture decreased 49% for the acupuncture group (p<0.01) compared to the 1-year period preacupuncture. For the comparison there was a decrease of 2% in physician visits (p=0.59) for the same time periods. Corresponding to the decrease, physician services cost declined 37% for the case group (p=0.01) and 1% for the comparison (p=0.86). CONCLUSIONS Results suggest that patients with LBP were less likely to visit physicians for LBP after acupuncture treatment. This led to reduced health services spending on LBP.

A Spirituality Teaching Program for Depression: A Randomized Controlled Trial

Objective: This randomized controlled trial assessed the efficacy of a Spirituality Teaching Program to treat unipolar major depression. Method: A randomized controlled, assessor blinded trial design was used. A total of 84 individuals aged 18 years or older with unipolar major depression of mild to moderate severity were recruited in Calgary, Canada and randomized to two study arms: 1) Spirituality Teaching Program Group (8 week, home-based Spirituality Teaching Program); and 2) Waitlist Control Group (no intervention followed by Spirituality Teaching Program starting at week 9). Outcome measures (depression severity, response rate, remission rate) were assessed at baseline, 8, 16, and 24 weeks using the Hamilton Depression Rating Scale (HAM-D). Results: The two trial groups were similar in their demographic and disease characteristics at baseline. At the 8-week point, the change in depression severity was significantly different between the two groups (change in HAM-D score: 8.5 for the Spirituality Group and 2.3 for the Waitlist Control Group, p < 0.001). The Spirituality Teaching Program Group had significantly higher response (36% vs. 4.4%, p < 0.001) and remission rates (31% vs. 4.4%, p < 0.001) than the Waitlist Control Group. The benefits remained throughout the observation period for the Spirituality Teaching Program Group participants with response rates of 56.4% at 16 weeks and 58.9% at 24 weeks. Conclusion: The Spirituality Program significantly reduced depression severity and increased response and remission rates. This non-drug treatment program should be investigated further as a treatment option for depression.

Preferred Models of Integrative Care

Introduction and ObjectivesThe opinions of healthcare providers play a crucial role in the debate around integrating complementary and alternative medicine (CAM) into the current healthcare system. The aim of this study is to explore the issue of CAM integration from the provider viewpoint by determining (a) what working relationship CAM practitioners and general practitioners (GPs) prefer or find acceptable, (b) whether there is agreement in the responses of CAM practitioners and GPs and (c) whether expressed opinions differ by CAM modalities.MethodsA cross-sectional random sample of CAM practitioners (acupuncturists, chiropractors, massage therapists, naturopaths, homeopaths and herbalists; n = 1112) and GPs (n = 413) from Alberta and British Columbia, Canada, were mailed a questionnaire at three timepoints in 2003. In total, 457 questionnaires were returned from CAM practitioners (41% response rate) and 85 from GPs (21% response rate). Participants were asked to rate four models of integration (independent model, collaborative model, supervised model, assimilation model) for six CAM therapies (acupuncture, chiropractic, massage therapy, naturopathy, homeopathy and herbology).ResultsThe collaborative model was rated as the most acceptable by all CAM practitioners and GPs, across all therapies. The least acceptable model, for both CAM practitioners and GPs, was the assimilation model. CAM practitioners and GPs disagreed on the acceptability of the independent model and the supervised model, and these differences were statistically significant.ConclusionA collaborative working relationship is preferred by both CAM practitioners and GPs. An integrative healthcare system would need to faciliate such working relations.

Towards Integration: Opinions of Health Policy Makers on Complementary and Alternative Medicine

BackgroundThis qualitative study describes what the integration of complementary and alternative medicine (CAM) means to healthcare policy makers in Canada and examines their recommendations and concerns with regard to the increased integration of CAM in the conventional healthcare system.MethodThe study employed face-to-face interviews with ten provincial government policy makers from Alberta and British Columbia, Canada. The interviews consisted of open-ended questions that focused on the barriers and solutions to the integration of CAM.ResultsContent analysis of the transcribed interviews revealed seven major themes. Participants highlighted the issues that need to be addressed for CAM integration to proceed: the prevention focus in CAM; economic issues; the need for scientific evidence; accreditation and education of CAM practitioners; professional boundary issues; the role of advocacy and strategic planning; and a suggested mechanism for CAM service delivery.Discussion and ConclusionThe findings indicate policy makers hold a positive view for the integration of CAM at the clinical and primary care level of practice. Policy makers support movement towards integrative health services, but emphasise that the issues of evidence-based CAM research, standards of accreditation and training for CAM practitioners, as well as the issue of who pays for these services, need to be addressed to ensure the improved health and well-being of Canadians.

P02.110. Recruitment experiences from piloting the LEAP project: an online spirituality based depression intervention for young adults

Methods This trial aimed to recruit adolescents suffering from mild to moderate unipolar depression. A multi-faceted recruitment strategy was used. Poor enrolment during the first 13 months (Phase I) prompted a review of eligibility criteria. Revised eligibility criteria included an age expansion from previously 13-18 to 13-24 and allowance of general, non-depression specific, counselling. An observational study was conducted to assess the impact of investing trial resources into the various recruitment sources pre (Phase I = 13 month) and post (Phase II = 10 months) eligibility change.

OA15.02. Quantitative findings from piloting the LEAP project: an online spirituality based depression intervention for young adults

Methods Participants were recruited using a convenience sampling strategy and invited to partake in an in-depth, semi-structured interview upon completion of the intervention. The LEAP Project intervention consists of eight modules (1) Consciousness and Self Acceptance, (2) Appreciation of Beauty & Creativity, (3). Mystery and Meaning, (4) Gratitude, (5) Compassion, (6) Acceptance, (7) Forgiveness, and (8) Celebration. Each is presented using video clips, music, visualizations, true stories and life practices. All interviews were digitally recorded and transcribed verbatim. Data were analyzed using a descriptive qualitative content analysis approach. Transcripts were read and re-read, and coded to preliminary categories and emerging themes of substantive meanings through an iterative process.