George Lewith

Who Uses CAM? A Narrative Review of Demographic Characteristics and Health Factors Associated with CAM Use

Complementary and Alternative Medicines (CAM) are used by an extensive number of patients in the UK and elsewhere. In order to understand this pattern of behavior, it is helpful to examine the characteristics of people who use CAM. This narrative review collates and evaluates the evidence concerning the demographic characteristics and health status factors associated with CAM use in community-based non-clinical populations. A systematic literature search of computerized databases was conducted, and published research papers which present evidence concerning associations between CAM use and demographic and health characteristics are discussed and evaluated. The evidence suggests that people who use CAM tend to be female, of middle age and have more education. In terms of their health, CAM users tend to have more than one medical condition, but might not be more likely than non-users to have specific conditions such as cancer or to rate their own general health as poor. The multivariate studies that have been conducted suggest that both demographic and health characteristics contribute independently to CAM use. In conclusion, demographic characteristics and factors related to an individuals health status are associated with CAM use. Future research is needed to address methodological limitations in existing studies.

Homeopathy has clinical benefits in rheumatoid arthritis patients that are attributable to the consultation process but not the homeopathic remedy: a randomized controlled clinical trial

OBJECTIVESnTo assess whether any benefits from adjunctive homeopathic intervention in patients with RA are due to the homeopathic consultation, homeopathic remedies or both.nnnMETHODSnExploratory double-blind, randomized placebo-controlled trial conducted from January 2008 to July 2008, in patients with active stable RA receiving conventional therapy. Eighty-three participants from three secondary care UK outpatient clinics were randomized to 24 weeks of treatment with either homeopathic consultation (further randomized to individualized homeopathy, complex homeopathy or placebo) or non-homeopathic consultation (further randomized to complex homeopathy or placebo). Co-primary outcomes: ACR 20% improvement (ACR20) criteria and patient monthly global assessment (GA).nnnSECONDARY OUTCOMESn28-joint DAS (DAS-28), tender and swollen joint count, disease severity, pain, weekly patient and physician GA and pain, and inflammatory markers.nnnRESULTSnFifty-six completed treatment phase. No significant differences were observed for either primary outcome. There was no clear effect due to remedy type. Receiving a homeopathic consultation significantly improved DAS-28 [mean difference 0.623; 95% CI 0.1860, 1.060; P = 0.005; effect size (ES) 0.70], swollen joint count (mean difference 3.04; 95% CI 1.055, 5.030; P = 0.003; ES 0.83), current pain (mean difference 9.12; 95% CI 0.521, 17.718; P = 0.038; ES 0.48), weekly pain (mean difference 6.017; 95% CI 0.140, 11.894; P = 0.045; ES 0.30), weekly patient GA (mean difference 6.260; 95% CI 0.411, 12.169; P = 0.036; ES 0.31) and negative mood (mean difference - 4.497; 95% CI -8.071, -0.923; P = 0.015; ES 0.90).nnnCONCLUSIONnHomeopathic consultations but not homeopathic remedies are associated with clinically relevant benefits for patients with active but relatively stable RA.nnnTRIAL REGISTRATIONnCurrent controlled trials, http://www.controlled-trials.com/, ISRCTN09712705.

A qualitative analysis of patients' experiences of acupuncture: implications for understanding non-specific effects. Presented at EHPS and DHP conference 2008.

Background:This correlational study examined the value of the HAPA theory at predicting weight-loss in a weight-loss trial. n nMethods:Participants (N¼22) undergoing an 8-week weight-loss programme were recruited from aprivate hospital. Baseline questionnaires measured demographics, height, weight, self-efficacy,risk-perception, outcome-expectancies and intentions. n nFindings:Questionnaires at 4 and 8 weeks measured weight-loss behaviours – physical activity,dietary variables, effort and weight. The HAPA was able to significantly predict weight-loss(RAˆ2¼0.57,p¼0.027). Self-efficacy and risk-perceptions were significantly related to intention(r¼0.80,p50.001 andr¼�0.48,p50.01 respectively). Intentions were significantly related to weight-loss behaviour was significantly related toweight-loss (r¼0.73,p50.01). The study provides evidence for the predictive value of the HAPAat predicting weight-loss. n nDiscussion:Findings build on current knowledge of the cognitions and behaviours involved insuccessful weight-loss and may contribute to the development of interventions designed to increaseweight-loss in the overweight and clinically obese population.Background: Previous reports of this prospective study highlight the psychological benefits of a breast screening programme for younger women with a family history of breast cancer. The present paper identified risk factors for cancer worry in these women. Methods: 1286 women completed questionnaires one month prior to screening (T1), and one (T2)and six (T3) months after screening results. Breast cancer worry, perceived risk, cognitive appraisals, ncoping, and dispositional optimism were measured. nFindings: T1 cancer worry explained 56/61% and 54/57% of the variance in worry at T2 and T3 respectively. Other salient predictors included high perceived risk of breast cancer, appraisals of high relevance and threat associated with the family history, and low perceived ability to cope nemotionally. A false positive screening result, pessimistic personality, and religion/substance use coping predicted outcomes at T2 but not T3. Discussion: Interventions to ameliorate high levels of cancer worry and negative appraisals are needed.Background: Personal disclosures of patients may influence how they are evaluated by others. These evaluations may be influenced by the information the patient provides but also by the recipients needs. Methods: In an experimental study, healthy female participants (N = 61) listened to a female cancer patient’s testimonial (25 minutes) in which the patient told about either her negative emotions during radiation therapy or coping strategies she used. The dependent variable was participant’s evaluation of the patient. Findings: The results showed a main effect of condition, meaning that patients who told about their coping were perceived as more sympathetic, courageous and realistic. As indicated by a significant interaction, this effect was especially strong in participants with a strong inclination to compare themselves to others. Discussion: These data show that the personal information that patients provide to others influences how others perceive them. This may have consequences for the others’ motivation to provide social support.Background: Ovarian cancer is known as the “silent killer”. A prospective psychological evaluation study (PsyFOCS) is underway in partnership with the UK Familial Ovarian Cancer Screening Study, which aims to determine the clinical effectiveness of ovarian screening for high risk women. n nMethods: Prior to screening, 991 women completed the Illness Perception Questionnaire (adapted for ovarian cancer risk), Impact of Event Scale (IES), and Hospital Anxiety and Depression Scale. n nFindings: Over one third of women were moderately or highly distressed about their risk according to IES scores. Hierarchical multiple regression showed that negative emotional representations (p<.001), higher anxiety (p<.001), stronger ovarian cancer screening control beliefs (p<.01), and past ovarian cancer screening recall (p<.05) were associated with higher pre-screening distress. n nDiscussion: The association between ovarian cancer screening control beliefs and distress suggests that more distressed women may place greater faith in screening as a means of controlling genetic risk.