Darshan H. Mehta

Herbal and Dietary Supplement Disclosure to Health Care Providers by Individuals with Chronic Conditions

BACKGROUND Very little is known about herbal and dietary supplement disclosure in adults with chronic medical conditions, especially on a national level. OBJECTIVE To examine herbal and dietary supplement disclosure to conventional health care providers by adults with chronic medical conditions. DESIGN Data on herbal and dietary supplement use (N = 5456 users) in the previous year were used from the 2002 National Health Interview Survey. Bi-variable analyses compared characteristics between herbal and dietary supplement disclosers and nondisclosers. Multivariable logistic regression identified independent correlates of herbal and dietary supplement disclosure. RESULTS Overall, only 33% of herbal and dietary supplement users reported disclosing use of herbal and dietary supplements to their conventional health care provider. Among herbal and dietary supplement users with chronic conditions, less than 51% disclosed use to their conventional health care provider. Hispanic (adjusted odds ratio and 95% confidence interval = 0.70 [0.52, 0.94]) and Asian American (adjusted odds ratio and 95% confidence interval = 0.54 [0.33, 0.89]) adults were much less likely than non-Hispanic white Americans to disclose herbal and dietary supplement use. Having less than a high school education (adjusted odds ratio and 95% confidence interval = 0.61 [0.45, 0.82]) and not having insurance (adjusted odds ratio and 95% confidence interval = 0.77 [0.59, 1.00]) were associated with being less likely to disclose herbal and dietary supplement use. CONCLUSION Herbal and dietary supplement disclosure rates are low, even among adults with chronic conditions. These findings raise concerns about the safety of herbal and dietary supplements in combination with allopathic care. Future studies should focus on educating physicians about crosscultural care as well as eliciting information about herbal and dietary supplement use.

Use of Complementary and Alternative Therapies by Asian Americans. Results from the National Health Interview Survey

Very little is known about complementary and alternative medicine (CAM) use in Asian Americans (AA), especially on a national level. To compare CAM use, reasons for use, and disclosure rates between Asian and non-Hispanic white Americans (NHW), and examine ethnic variations among AA. Data on CAM use in the past year (excluding prayer) were used from the 2002 National Health Interview Survey for 917 AA and 20,442 NHW. Compared with NHW, AA were as likely to use any CAM modality [42 vs. 38%; adjusted prevalence ratio = 1.09, 95% confidence interval (0.94, 1.27)]. Asian Americans were less likely than NHW to disclose the use of herbal medicines (16 vs. 34%, p < 0.001) and mind/body therapies (15 vs. 25%, p < 0.05). Mind/body therapies were used more often by Asian Indians (31%) than by Chinese (21%) and Filipinos (22%), whereas herbal medicines were used more often by Chinese (32%) than by Filipinos (26%) and Asian Indians (19%). Among AA, CAM use was associated with being female, having higher education, and having a chronic medical condition; foreign-birth was not associated with CAM use. Complementary and alternative medicine use is common among AA, and there are important ethnic variations in use. Asian Americans are less likely than NHW to disclose CAM use to conventional healthcare providers, suggesting that it is particularly important that physicians query AA patients about CAM use.

Relaxation Response and Resiliency Training and Its Effect on Healthcare Resource Utilization.

Background Poor psychological and physical resilience in response to stress drives a great deal of health care utilization. Mind-body interventions can reduce stress and build resiliency. The rationale for this study is therefore to estimate the effect of mind-body interventions on healthcare utilization. Objective Estimate the effect of mind body training, specifically, the Relaxation Response Resiliency Program (3RP) on healthcare utilization. Design Retrospective controlled cohort observational study. Setting: Major US Academic Health Network. Sample: All patients receiving 3RP at the MGH Benson-Henry Institute from 1/12/2006 to 7/1/2014 (n = 4452), controls (n = 13149) followed for a median of 4.2 years (.85–8.4 yrs). Measurements: Utilization as measured by billable encounters/year (be/yr) stratified by encounter type: clinical, imaging, laboratory and procedural, by class of chief complaint: e.g., Cardiovascular, and by site of care delivery, e.g., Emergency Department. Subgroup analysis by propensity score matched pre-intervention utilization rate. Results At one year, total utilization for the intervention group decreased by 43% [53.5 to 30.5 be/yr] (p <0.0001). Clinical encounters decreased by 41.9% [40 to 23.2 be/yr], imaging by 50.3% [11.5 to 5.7 be/yr], lab encounters by 43.5% [9.8 to 5.6], and procedures by 21.4% [2.2 to 1.7 be/yr], all p < 0.01. The intervention group’s Emergency department (ED) visits decreased from 3.6 to 1.7/year (p<0.0001) and Hospital and Urgent care visits converged with the controls. Subgroup analysis (identically matched initial utilization rates—Intervention group: high utilizing controls) showed the intervention group significantly reduced utilization relative to the control group by: 18.3% across all functional categories, 24.7% across all site categories and 25.3% across all clinical categories. Conclusion Mind body interventions such as 3RP have the potential to substantially reduce healthcare utilization at relatively low cost and thus can serve as key components in any population health and health care delivery system.

Risk and Resilience Factors Associated with Resident Burnout

ObjectiveWe investigated hypothesized risk and resilience factors and their association with burnout in first year medicine and psychiatry residents at an urban teaching hospital in order to help guide the development of interventions targeted at reducing burnout.MethodsWe administered the Maslach Burnout Inventory (MBI), Perceived Stress Scale-10, Functional Assessment of Chronic Illness Therapy–Fatigue Scale, Penn State Worry Questionnaire, Patient Health Questionnaire-9 (depression symptoms), Revised Life Orientation Test (optimism), Self-Efficacy Questionnaire, Cognitive and Affective Mindfulness Scale, Interpersonal Reactivity Index Perspective-Taking Scale (empathy), and Measure of Current Status-Part A to first year medicine and psychiatry residents prior to initiation of clinical rotations in June.ResultsThe response rate was 91 % (68 of 75 residents). Nineteen respondents (28 %) met criteria for burnout as measured by the MBI. Residents with burnout scored higher on self-report measures assessing perceived stress (Cohen’s d = 0.97; p = 0.004), fatigue (d = 0.79; p = 0.018), worry (d = 0.88; p = 0.0009), and depression symptoms (d = 0.84; p = 0.035) and scored lower on questionnaires assessing mindfulness (d = −0.63; p = 0.029) and coping ability (d = −0.79; p = 0.003).ConclusionsIn a cross-sectional assessment using self-report measures, we found that nearly a third of first year residents prior to starting their internships experience burnout. They exhibit lower levels of mindfulness and coping skills and higher levels of depression symptoms, fatigue, worry, and stress. These preliminary findings should encourage programs to initiate and study curricula that combine mindfulness and self-awareness coping strategies to enhance or protect against burnout as well as cognitive behavioral coaching strategies to offset symptoms of burnout when present.

Resilient Warrior: A Stress Management Group to Improve Psychological Health in Service Members

Background: Many veterans deployed after 9/11/2001 are impacted by subthreshold levels of post-traumatic stress, anxiety, or other psychological health problems that may interfere with successful reintegration. Conventional treatments, including medication and trauma-focused individual psychotherapies, may not be optimally adapted, accepted, or effective to treat these subsyndromal symptoms. Methods: We developed “Resilient Warrior,” a 4-session, group-based, mind-body stress-management and resilience program targeted to build skills and assessed whether its format was accessible and acceptable, and potentially efficacious, to support resilience among service members. Results: From April 2014 to October 2014, 15 participants (53.3% women; mean age=36.6 y; SD=6.2) were surveyed for program acceptability and feasibility and completed self-reported psychological health outcomes before and after program participation. The majority (71.4%) of participants reported that the program included the right number of sessions, and all of them reported that it was helpful and relevant and that they would recommend it to others. While changes in self-reported resilience were only marginal, participation was associated with improvements in depressive symptoms, perceived stress, anxiety, and general sense of self efficacy. Conclusion: These pilot data provide preliminary support that “Resilient Warrior,” a group-based, stress reduction and resilience program, may improve psychological health in service members even when delivered in community settings. Randomized controlled trials with longer follow-up periods are needed to establish efficacy and effectiveness for this program.

The Effectiveness of a Brief Mind-Body Intervention for Treating Depression in Community Health Center Patients

Objective: The objective of this pilot study was to examine the effects of a brief, 6-week, 1.5-hour mind-body intervention for depression (MBID) in patients being treated for depression in 2 community health centers. Design: The MBID taught techniques such as meditation that elicit the relaxation response (RR) in combination with additional resiliency-enhancing components. Clinical outcomes of 24 depressed patients were measured pre-MBID, at completion of MBID, and 3 months post-MBID, using the Center for Epidemiological Studies Depression Scale (CES-D 10), Quality of Life Scale (QoL5), SF-12 Health Survey (SF-12), and Health-Promoting Lifestyle Profile-II (HPLP-II). Results: Significant post-treatment improvements were shown in depressive symptoms, spiritual growth, mental health, and quality of life, with a median CES-D 10 change from 17.5 (interquartile ratio [IQR] 13.3–22) to 12 (IQR 10–17.5; P<.001); a median HPLP-II Spiritual Growth subscale change from 2.0 (IQR 1.8–2.3) to 2.3 (IQR 2.0–3.0; P=.002) and a median HPLP-II Stress Management sub-scale change from 2.0 (IQR 1.8–2.4) to 2.4 (IQR 2.0–2.9; P=.027); significant improvement in median score on the QoL-5 from 53.3 (IQR 47.5–62.5) at baseline to 63.3 at endpoint (IQR 50–70; P=.008). Three-month follow-up data suggest that the improvement in outcomes were sustained 3 months after the intervention. Conclusions: Participation in a 6-week RR-based MBID is associated with an improvement in depression, spiritual growth, and mental health among depressed community health center patients.

A Case Report of Improvement in Crohn's Disease-related Symptoms Following Participation in a Comprehensive Mind-Body Program.

Stress is widely believed to play a role in the development and pathogenesis of inflammatory bowel disease (IBD), and several studies of mind-body programs have suggested benefits in this patient population. Here we describe a case report of a young man with a flare in Crohns disease—related symptoms that improved in response to a comprehensive, multimodal, mind-body program and the development of a novel IBD treatment center that incorporates mind-body approaches, nutrition, and other modalities to provide more holistic and patient-centered care for individuals with IBD.

P02.121. Psychological outcomes of a mind body program for successful aging

Purpose The biopsychosocial model of successful aging is aimed at developing a sense of well-being, high self-assessed quality of life, and a sense of personal fulfillment even in the context of illness and disability. The purpose of this study was to explore key outcomes of a new Successful Aging Mind Body program. We hypothesized the program would increase self-efficacy, which would lead to improved feelings of well-being.

Integrative Medicine and Cardiovascular Disorders

Integrative medicine (IM) has developed an increasingly significant role in health care worldwide, including cardiovascular diseases (CVD). This review describes the commonly used IM in CVD, with particular attention placed with dietary supplements and mind-body therapies. More rigorous research continues to be needed to determine the mechanisms and efficacy of IM cardiovascular morbidity and mortality. Health care providers will need to develop skills in open communication and nonjudgmental dialogue around IM use in discussing treatment plans with their patients.

Factors associated with complementary medicine use in pediatric musculoskeletal conditions: Results from a national survey

OBJECTIVES Complementary and alternative medicine (CAM) use is common in children, but its use has only been investigated in children with musculoskeletal conditions (MSK) to a limited extent. We aimed to characterize factors associated with CAM use in children with MSK conditions. METHODS Within the 2012 National Health Interview Survey dataset (including its child CAM supplement), we examined factors associated with CAM use in children with MSK conditions and performed an analysis examining the perceived usefulness of CAM therapies for MSK conditions. RESULTS Overall, there were 10,218 children in the dataset. 28.0% of children with MSK conditions used CAM, compared to 8.8% of children without MSK conditions. Gender (p=0.003), region (p=0.001), race (p=0.001), parental CAM use (p<0.001), education (<0.001), and having anxiety, stress or depression (p=0.030) were correlated with CAM use. Among 90 children who reported on CAM use, 89.7% said that CAM helped some or a great deal for their MSK condition. CONCLUSIONS Several factors, particularly parental education and parental CAM use, were associated with CAM use, and self-reported improvement rates were high. Interventional trials are needed to determine the efficacy of specific CAM therapies for treating different MSK conditions in children.