Gabriella Hegyi

A systematic literature review of complementary and alternative medicine prevalence in EU

Background: Studies suggest that complementary and alternative medicine (CAM) is widely used in the European Union (EU). We systematically reviewed data, reporting research quality and the prevalence of CAM use by citizens in Europe; what it is used for, and why. Methods: We searched for general population surveys of CAM use by using Ovid MEDLINE (1948 to September 2010), Cochrane Library (1989 to September 2010), CINAHL (1989 to September 2010), EMBASE (1980 to September 2010), PsychINFO including PsychARTICLES (1989 to September 2010), Web of Science (1989 to September 2010), AMED (1985 to September 2010), and CISCOM (1989 to September 2010). Additional studies were identified through experts and grey literature. Cross-sectional, population-based or cohort studies reporting CAM use in any EU language were included. Data were extracted and reviewed by 2 authors using a pre-designed extraction protocol with quality assessment instrument. Results: 87 studies were included. Inter-rater reliability was good (kappa = 0.8). Study methodology and quality of reporting were poor. The prevalence of CAM use varied widely within and across EU countries (0.3–86%). Prevalence data demonstrated substantial heterogeneity unrelated to report quality; therefore, we were unable to pool data for meta-analysis; our report is narrative and based on descriptive statistics. Herbal medicine was most commonly reported. CAM users were mainly women. The most common reason for use was dissatisfaction with conventional care; CAM was widely used for musculoskeletal problems. Conclusion: CAM prevalence across the EU is problematic to estimate because studies are generally poor and heterogeneous. A consistent definition of CAM, a core set of CAMs with country-specific variations and a standardised reporting strategy to enhance the accuracy of data pooling would improve reporting quality.

Legal Status and Regulation of Complementary and Alternative Medicine in Europe

Objective: The study aims to review the legal and regulatory status of complementary and alternative medicine (CAM) in the 27 European Union (EU) member states and 12 associated states, and at the EU/European Economic Association (EEA) level. Methods: Contact was established with national Ministries of Health, Law or Education, members of national and European CAM associations, and CAMbrella partners. A literature search was performed in governmental and scientific/non-scientific websites as well as the EUROPA and EUR-lex websites/ databases to identify documents describing national CAM regulation and official EU law documents. Results: The 39 nations have all structured legislation and regulation differently: 17 have a general CAM legislation, 11 of these have a specific CAM law, and 6 have sections on CAM included in their general healthcare laws. Some countries only regulate specific CAM treatments. CAM medicinal products are subject to the same market authorization procedures as other medicinal products with the possible exception of documentation of efficacy. The directives, regulations and resolutions in the EU that may influence the professional practice of CAM will also affect the conditions under which patients are receiving CAM treatment(s) in Europe. Conclusion: There is an extraordinary diversity with regard to the regulation of CAM practice, but not CAM medicinal products. This will influence patients, practitioners and researchers when crossing European borders. Voluntary harmonization is possible within current legislation. Individual states within culturally similar regions should harmonize their CAM legislation and regulation. This can probably safeguard against inadequately justified over- or underregulation at the national level.

Hyperthermia versus Oncothermia: Cellular Effects in Complementary Cancer Therapy

Hyperthermia means overheating of the living object completely or partly. Hyperthermia, the procedure of raising the temperature of a part of or the whole body above normal for a defined period of time, is applied alone or as an adjunctive with various established cancer treatment modalities such as radiotherapy and chemotherapy. However, hyperthermia is not generally accepted as conventional therapy. The problem is its controversial performance. The controversy is originated from the complications of the deep heating and the focusing of the heat effect. The idea of oncothermia solves the selective deep action on nearly cellular resolution. We would like to demonstrate the force and perspectives of oncothermia, as a highly specialized hyperthermia in clinical oncology. Our aim is to prove the ability of oncothermia to be a candidate to become a widely accepted modality of the standard cancer care. We would like to show the proofs and the challenges of the hyperthermia and oncothermia applications to provide the presently available data and summarize the knowledge in the topic. Like many early stage therapies, oncothermia lacks adequate treatment experience and long-range, comprehensive statistics that can help us optimize its use for all indications.

Complementary and alternative medicine provision in Europe - first results approaching reality in an unclear field of practices

Background: The demand for complementary and alternative medicine (CAM) treatment in the European Union (EU) has led to an increase in the various CAM interventions available to the public. Our aim was to describe the CAM services available from both registered medical practitioners and registered non-medical practitioners. Methods: Our literature search comprised a PubMed search of any scientific publications, secondary references and so-called grey literature, a search of government websites and websites of CAM organisations to collect data in a systematic manner, and personal communications, e.g., via e-mail contact. Due to the different reliability of data sources, a classification was developed and implemented. This weighted database was condensed into tables and maps to display the provision of CAM disciplines by country, showing the distribution of CAM providers across countries. Results: Approximately 305,000 registered CAM providers can be identified in the EU (∼160,000 non-medical and ∼145,000 medical practitioners). Acupuncture (n = 96,380) is the most available therapeutic method for both medical (80,000) and non-medical (16,380) practitioners, followed by homeopathy (45,000 medical and 5,800 non-medical practitioners). Herbal medicine (29,000 practitioners) and reflexology (24,600 practitioners) are mainly provided by non-medical practitioners. Naturopathy (22,300) is dominated by 15,000 (mostly German) doctors. Anthroposophic medicine (4,500) and neural therapy (1,500) are practised by doctors only. Conclusion: CAM provision in the EU is maintained by approximately 305,000 registered medical doctors and non-medical practitioners, with a huge variability in its national regulatory management, which makes any direct comparison across the EU almost impossible. Harmonisation of legal status, teaching and certification of expertise for therapists would be of enormous value and should be developed.

A Pilot Feasibility Study of a Questionnaire to Determine European Union-Wide CAM Use

Background: No questionnaire specifically measuring the core components of complementary and alternative medicine (CAM) use has been validated for use across European Union (EU) countries. We aimed to determine the face validity, acceptability and the participants’ comprehension of a pre-existing questionnaire designed to measure ‘CAM use’, to provide a comparative, standardised questionnaire for use by health care providers, policy makers and purchasers throughout Europe. Methods: Established procedures were employed to translate the questionnaire into 4 EU languages. The translated questionnaires were piloted on 50 healthy adults from each country who may never have used CAM. 10 participants per country also took part in audio-recorded think aloud interviews about the questionnaire. The interviews were transcribed and analysed in the language in which they were conducted; findings were summarised in English. Questionnaire data were pooled across countries, and patterns of completion and missing data were analysed. Results: The questionnaire was translated into Italian, Spanish, Dutch and Romanian. The mean age of the participants was 43.6 years. 34% were male, 87.4% were either light or heavy CAM users, and 12.6% were non-users. Qualitative analysis identified common problems across countries including a ‘hard-to-read’ layout, misunderstood terminology and uncertainty in choosing response options. Quantitative analysis confirmed that a substantial minority of respondents failed to follow questionnaire instructions and that some questions had substantial rates of missing data. Conclusions: The I-CAM-Q has low face validity and low acceptability, and is likely to produce biased estimates of CAM use if applied in England, Romania, Italy, The Netherlands or Spain. Further work is required to develop the layout, terms, some response options and instructions for completion before it can be used across the EU.

Integrative versus Conventional Therapy of Chronic Otitis Media with Effusion and Adenoid Hypertrophy in Children: A Prospective Observational Study

Background: Chronic otitis media with effusion (COME) and adenoid hypertrophy (AH) are common entities in the pediatric population. The conventional treatment approach (conventional medicine; COM) involved mainly surgery after a period of close observation. In this study, we aimed to introduce an integrative, non-invasive approach (integrative medicine; IM) for COME, AH, and associated episodes of recurrent acute otitis media, and compared outcomes with conventional treatment. Methods: We conducted a prospective, non-randomized study in an integrative primary care pediatric practice and a conventional pediatric otolaryngological clinic, where treatment modality was determined by patient preference. Out of a total 101 patients aged 1-8 years, integrative therapy was chosen by 46, and conventional treatment by 55. All patients had COME and AH diagnosed by an otolaryngologist and had moderate to severe hearing impairment. COM treatment was based on close observation over time, nasal decongestants and surgical intervention. In contrast, the IM involved a complex personalized approach with non-invasive interventions, non-allopathic medications, diet and patient education. Results: The number of surgical interventions (adenoidectomy, pressure-equalization tube insertion, myringotomy) was significantly less in the IM cohort (1 of 28 vs. 15 of 35 in the COM group, p < 0.001). The frequency of antibiotic use was significantly less in the IM group (p < 0.001). The frequency of analgesic use was also significantly less in the IM group (p = 0.029). Improvement in tympanometric measures (normal A-type curve) was higher in IM patients compared to expected spontaneous remission during the observation period. Improvement in audiometric measures (intact hearing) of IM patients was also higher than expected compared to spontaneous remission during the observation period. Conclusion: Compared to conventional treatment, integrative treatment of patients with COME and AH showed significantly lower invasive surgical intervention rates and significantly decreased antibiotic and analgesic use. The integrative treatment was effective, safe and well tolerated.

YNSA permanent acupuncture of on quality of life in patients suffering from post-stroke syndrome

Objectives: The aim of our newer study involving more numbers of patient was to investigate whether permanent acupuncture, especially Yamamoto’s New Scalp Acupuncture (YNSA), and is of value in additional to standard post-stroke motor rehabilitation elevating QoL of patients with higher self-management. Design: A prospective, assessor-blinded randomized control trial was carried out in an outpatient stroke rehabilitation unit with day hospital service again enrolled 520 cases. After inclusion, patients were stratified into control group and acupuncture group, randomly. All of stratified patients participated in gymnastic exercises and conservative pharmacological treatment according western rehabiliation protocol. Outcome measures: The Barthel Index, the Rivermead Scale Index, the SP-36 questionnaire and the Visual Analogue Scale were used to follow the efficacy of treatment. Results: In the acupuncture group, all the sensory, motor, and functional scores improved significantly during the examination period until 3 years after injury. The Barthel Index is increased from 4±2 to 95±4 in the acupuncture group. This index also increased in the control group (from 4±2 to 75±4), but the changes were significantly less than in the acupuncture group. A significant spontaneous recovery during the 3-year follow-up was found, but the YNSA treatment facilitated the functional recovery not only in moving but generally in cognitive functions and memory. Improved moving function and more flexible joints and ligaments were observed in comparison to the patients’ condition prior to treatment. Conclusions: The data suggest that the YNSA acupuncture is a useful complementer method to treat residual symptomes of stroke patients and enhance their quality of life, to achieve higher self-management level. As soon as possible after stroke this method should be started if cardio-pulmonal condition of patient is ballanced and allowed it. This study was a reproduction of our earlier research with more participants to allowed us to prove advantages of early application of permanent acupuncture treatment *Correspondence to: Hegyi Gabriella, MD, PhD, Department of Complementary Medicine, Faculty of Health Sciences, University of Pécs, Pécs, Hungary, E-mail: drhegyi@hu.inter.net

Different Techniques of Acupuncture–Part of the Traditional Chinese Medicine and “Evidence Based Medicine”

Introduction: Dry needling: e.t. Acupuncture: is one of the most accepted CAM therapies, most well: known branch of the Traditional Chinese Medicine, which flows intensive research a few decades in the US, Europe, even in China. Is backed by proving research results of Evidence Based Medicine for properly as well. Objective: To summarize the newer understanding of the mechanism of action and indications with regard to harmonization and closer to the TCM/TCM tenets of contemporary classical Chinese medical applying for. Method: An international literature review, which called CAMbrella, the Pan: European Union project work package based on its research, which took part in the work of the Department of Complementary Medicine in, Health Science Faculty of Pecs University, as well. Results: Acupuncture and TCM, are one of the most researched area of non–conventional, complementary therapies. We have already demonstrated convincingly established by the management of the majority of acupuncture point physiological responses. The mediator neurohormonal transmitters are already known about now. 40 have been identified which are involved in induced “dry needling” effect. Discussion: The “Bridge” between the Eastern and Western medicine is the appropriate knowledge transfer, research and application. The performance of in: service training is a university competence. Evidence Based Medicine has an efficient and effective use based on the quality of training in: service training, which is conducted in some Universities for more decades. Further development of this training, quality education can only be realistic to achieve the goals (which effectively give rise to a dedicated TCM Confucius Institute Pecs University).

Newer application of Oncothermia to non-malignant diseases such as Dupuytren's contracture of the hand and chronic lower back pain lasting more than 4 weeks

Oncothermia (OTM) is based on electromagnetic interactions with the living matter. Its nano-targeting approach establishes a new paradigm. OTM could be applied not only to treat malignancies but it is feasible to apply for other diseases too. OTH is well proven method from the laboratory level to the clinical applications, promoting the natural processes, re-establishing of the synchronization between the cells. This approach allows therapy of some nonmalignant diseases too. Our objective is to use OTM for the irregularities of tissue-growth and for pain syndromes as well. OTM uses precisely tuned radiofrequency (RF) current flowing through the treated part of the body. We made extensive study, proving in details the applicability of the OTM for Dupuytrens contracture and chronic low back pain, in conjunction with permanent acupuncture method, a modified process of traditional Chinese Medicine (TCM). The synergy of the ancient and the state-of-art medical knowledges is the basic method of the present research. Our results with application of OTM for chronic low back pain and Dupuytren’s contracture shows definite improvements of the patients involved in the study. We measured the success with the Visual Analog Scale (VAS), with anecdotic quality of life (QoL), and the shortening of the of-work period due to the disease. We measured that VAS decreased significantly, the hand contracture became less rigid and less contracted. The QoL of patients improved and their complaints which blocked their regular activity has significantly reduced. OTM method was safe & no adverse effects were observed. Recognition of the distortions in the healthy tissue have some common principles and possibilities in TCM and OTM: both the methods recognize the loss of complexity of the living organization. Data of our 122 HEgYI, g., MATE, A., MOLNAR, I., SzOkE, H. ` ` 2 recent study verified the relevant end-points of our present study: the safety, the quality of life (QoL), the prolonged painless status of the patient.