Gurjeet S. Birdee

Factors Associated With Pediatric Use of Complementary and Alternative Medicine

BACKGROUND: Limited data are available on the use of complementary and alternative medicine (CAM) and factors associated with use among the pediatric population in the United States. METHODS: Using the 2007 National Health Interview Survey data among individuals <18 years of age (n = 9417), we compared CAM users (excluding those using vitamins and minerals) and non-CAM users. Using bivariable and multivariable logistic regression models, we examined independent associations of CAM use with sociodemographic factors, prescription medication use, delays in health care caused by access difficulties, and common medical conditions/symptoms. RESULTS: In an adjusted multivariable logistic model, CAM users were more likely than non-CAM users to be adolescents rather than infants or toddlers (adjusted odds ratio [aOR]: 1.61 [95% confidence interval (CI): 1.11–2.34]); live in the West (aOR: 2.05 [95% CI: 1.62–2.59]), Northeast (aOR: 1.36 [95% CI: 1.02–1.80]), or Midwest (aOR: 1.35 [95% CI: 1.04–1.74]) compared with those in the South; more likely to have a parent with a college education (aOR: 4.33 [95% CI: 2.92–6.42]); and more likely to use prescription medication (aOR: 1.51 [95% CI: 1.19–1.92]). Pediatric CAM users were more likely to have anxiety or stress (aOR: 2.54 [95% CI: 1.89–3.42]), dermatologic conditions (aOR: 1.35 [95% CI: 1.03–1.78]), musculoskeletal conditions (aOR: 1.94 [95% CI: 1.31–2.87]), and sinusitis (aOR: 1.54 [95% CI: 1.11–2.14]). Use of CAM by a parent was strongly associated with the childs use of CAM (aOR: 3.83 [95% CI: 3.04–4.84]). CONCLUSIONS: In 2007, pediatric CAM users were more likely to take prescription medications, have a parent who used CAM, and have chronic conditions such as anxiety or stress, musculoskeletal conditions, dermatologic conditions, or sinusitis. Research is required to guide pediatricians in making recommendations on CAM modalities for children including potential risks and/or benefits and interactions with conventional therapies.

Complementary and Alternative Medicine Therapies for Diabetes: A Clinical Review

C omplementary and alternative medicine (CAM) refers to a wide range of clinical therapies outside of conventional medicine.1 The term “complementary” refers to therapies that are used in conjunction with conventional medicine, whereas “alternative” medicine includes therapies that are used in place of conventional medicine. The term “integrative” medicine has been advocated by some CAM providers and researchers as representing a combination of conventional medicine, CAM, and evidence-based medicine.2 The National Center for Complementary and Alternative Medicine, a federal scientific agency for CAM research, categorizes CAM into five domains: biologically based practices, mind-body medicine, manipulation and body-based practices, energy medicine, and whole-medical systems (Table 1). Biologically based practices and mind-body medicine are the most common CAM modalities used and studied for the treatment of diabetes in the West and are the focus of this review. In the United States, CAM is frequently used by adults, with 40% reporting use in the past 12 months.3 An estimated 34% of adults with diabetes use some type of CAM therapy.4 The estimated out-of-pocket expense in 2007 on CAM therapies was

Use of Complementary and Alternative Medicine During Pregnancy and the Postpartum Period: An Analysis of the National Health Interview Survey

44 billion.5 Although some CAM therapies have been shown to affect glycemic control, the clinical efficacy and mechanism of many CAM therapies for diabetes is controversial, and safety issues are a concern. Adverse effects of many CAM therapies are not well documented. Because patients with diabetes often take multiple prescription medications, there exists the potential for herb-drug and herb-dietary supplement interactions, leading to adverse events.6,7 At least 63% of the general population do not disclose use of CAM therapies to their physicians.8 The purpose of this clinical review is to discuss selected CAM therapies frequently used for patients with diabetes and to provide a framework to advise patients on CAM use. INBRIEF More than …

Relationship between Physical Inactivity and Health Characteristics among Participants in an Employee Wellness Program

INTRODUCTION Complementary and alternative medicine (CAM) is commonly used among women, but few national data exist regarding CAM use during pregnancy or the postnatal period. METHODS Data from the 2007 National Health Interview Survey were analyzed for women ages between the ages of 18 and 49 years who were pregnant or had children less than 1 year old. CAM use was identified based on standard definitions of CAM from the National Institutes of Healths National Center for Complementary and Alternative Medicine. CAM use among women who were pregnant or with a child less than 1 year was compared with the other similarly aged female responders. CAM use was examined among these women stratified by sociodemographics, health conditions, and conventional medicine use through bivariable and multivariable logistic regression models. RESULTS Among pregnant and postpartum women from the ages of 19 to 49 years in the United States, 37% of pregnant women and 28% of postpartum women reported using CAM in the last 12 months compared with 40% of nonpregnant/non-postpartum women. Mind-body practices were the most common CAM modality reported, with one out of four women reporting use. Biological therapies, excluding vitamins and minerals, during the postpartum period were used by only 8% of women. Using multivariable regression modeling, we report no significant difference in CAM use among pregnant compared with non-pregnant women (adjusted odds ratio [AOR], 0.88; [95% confidence interval 0.65-1.20]), but lower CAM use among postpartum women compared with non-pregnant women (AOR 0.67; [0.52-0.88]), while adjusting for sociodemographics. CONCLUSION CAM use among pregnancy similar to women who are not pregnant, while postpartum CAM use decreases. Further evaluation of CAM therapies among pregnant and postpartum women is necessary to determine the costs and benefits of integrative CAM therapies in conventional care.

Complementary Tools to Empower and Sustain Behavior Change: Motivational Interviewing and Mindfulness

Objective: To characterize factors associated with physical inactivity among employees with access to workplace wellness program. Methods: We examined data on physical inactivity, defined as exercise less than once a week, from the 2010 health risk assessment completed by employees at a major academic institution (N = 16,976). Results: Among employees, 18% of individuals reported physical activity less than once a week. Individuals who were physically inactive as compared with physically active reported higher prevalence of cardiovascular diseases (adjusted odds ratio [AOR], 1.36 [1.23 to 1.51]), fair or poor health status (AOR, 3.52 [2.97 to 4.17]), and absenteeism from work (AOR, 1.59 [1.41 to 1.79]). Overall, physically inactive employees as compared with physically active employees reported more interest in health education programs. Conclusion: Future research is needed to address barriers to physical inactivity to improve employee wellness and potentially lower health utility costs.

When conventional medical providers recommend unconventional medicine: results of a national study.

Improving health behaviors is fundamental to preventing and controlling chronic disease. Health care providers who have a patient-centered communication style and appropriate behavioral change tools can empower patients to engage in and sustain healthy behaviors. This review highlights motivational interviewing and mindfulness along with other evidence-based strategies for enhancing patient-centered communication and the behavior change process. Motivational interviewing and mindfulness are especially useful for empowering patients to set self-determined, or autonomous, goals for behavior change. This is important because autonomously motivated behavioral change is more sustainable. Additional strategies such as self-monitoring are discussed as useful for supporting the implementation and maintenance of goals. Thus, there is a need for health care providers to develop such tools to empower sustained behavior change. The additional support of a new role, a health coach who specializes in facilitating the process of health-related behavior change, may be required to substantially influence public health.

Cross-sectional analysis of health-related quality of life and elements of yoga practice.

I n 2007, 38% of Americans used complementary and alternative medicine (CAM). Rates of CAM use have increased since 2002, with mind-body therapies (MBT) composing 75% of this rise. Evidence to support the therapeutic use of MBT (including yoga, tai chi, qi gong, meditation, guided imagery, progressive muscle relaxation, and deep-breathing exercises) is growing. Little is known about the use of MBT by patients as a result of conventional medical provider recommendation. Our study objective was to compare patients using MBT as a result of conventional medical provider referral with those who self-referred for MBT.

Feasibility and Safety of Intradialysis Yoga and Education in Maintenance Hemodialysis Patients

BackgroundMind-body practices such as yoga have been studied for their generally positive effects on health-related quality of life (HRQOL). The association between how a person practices yoga and the person’s HRQOL is not known.Materials and methodsYoga practitioners were sent invitations to participate in an online survey via email. Yoga characteristics, HRQOL, and other sociodemographics were collected. Analyses of data from 309 consenting responders evaluated associations between yoga practice characteristics (use of yoga tools, length of practice, location, method, etc.) and the 10-item PROMIS Global Health scale for both physical and mental health components.ResultsMultivariable regression models demonstrated higher mental health scores were associated with regular meditation practice, higher income, and the method of practicing in a community group class (versus one-on-one). Higher physical health scores were associated with length of lifetime practice, teacher status, Krishnamacharya yoga style, and practicing in a yoga school/studio (versus at home).ConclusionsMeditation practice in yoga is positively associated with mental health. Length of lifetime yoga practice was significantly associated with better physical health, suggesting yoga has a potential cumulative benefit over time. Different locations and methods of practice may be associated with varying effects on health outcomes. Comparative cross-sectional and longitudinal studies on the variations in yoga practice are needed to further characterize health benefits of yoga.

Yoga Combined With Health Education for Risk Reduction of Metabolic Syndrome: A Randomized Controlled Pilot Feasibility Study

OBJECTIVE Patients with end-stage renal disease on maintenance hemodialysis are much more sedentary than healthy individuals. The purpose of this study was to assess the feasibility and safety of a 12-week intradialysis yoga intervention versus a kidney education intervention on the promotion of physical activity. DESIGN AND METHODS We randomized participants by dialysis shift to either 12-week intradialysis yoga or an educational intervention. Intradialysis yoga was provided by yoga teachers to participants while receiving hemodialysis. Participants receiving the 12-week educational intervention received a modification of a previously developed comprehensive educational program for patients with kidney disease (Kidney School). The primary outcome for this study was feasibility based on recruitment and adherence to the interventions and safety of intradialysis yoga. Secondary outcomes were to determine the feasibility of administering questionnaires at baseline and 12 weeks including the Kidney Disease-Related Quality of Life-36. RESULTS Among 56 eligible patients who approached for the study, 31 (55%) were interested and consented to participation, with 18 assigned to intradialysis yoga and 13 to the educational program. A total of 5 participants withdrew from the pilot study, all from the intradialysis yoga group. Two of these participants reported no further interest in participation. Three withdrawn participants switched dialysis times and therefore could no longer receive intradialysis yoga. As a result, 13 of 18 (72%) and 13 of 13 (100%) participants completed 12-week intradialysis yoga and educational programs, respectively. There were no adverse events related to intradialysis yoga. Intervention participants practiced yoga for a median of 21 sessions (70% participation frequency), with 60% of participants practicing at least 2 times a week. Participants in the educational program completed a median of 30 sessions (83% participation frequency). Of participants who completed the study (n = 26), baseline and 12-week questionnaires were obtained from 85%. CONCLUSIONS Our pilot study of 12-week intradialysis yoga and 12-week educational intervention reached recruitment goals but with less than targeted completion and adherence to intervention rates. This study provided valuable feasibility data to increase follow-up and adherence for future clinical trials to compare efficacy.

Yoga for Risk Reduction of Metabolic Syndrome: Patient-Reported Outcomes from a Randomized Controlled Pilot Study.

Objective: The primary treatment for adults with risk factors for metabolic syndrome is lifestyle change, though adoption of traditional lifestyle programs is often limited. This pilot study tested the feasibility of conducting a randomized clinical trial comparing a novel targeted yoga program coupled to lifestyle education versus lifestyle education alone among adults with metabolic syndrome risk factors. Design and methods: Patients from primary care clinic were pre-screened electronically and further screened for metabolic syndrome. Consented participants were randomized to either a 12-week yoga program with lifestyle education or lifestyle education alone. Participants in the yoga arm received weekly 30 to 45 min of face-to-face yoga instruction, followed by 30 to 45 min of lifestyle education, and written instructions for home yoga practice and lifestyle changes. The lifestyle education was based on (EDU) the Group Lifestyle Balance Program that is adapted from the Diabetes Prevention Program. Participants in EDU only group received a weekly standardized curriculum matched in attention and time to the yoga with EDU arm. The primary outcome was to assess the feasibility of conducting a randomized trial by assessing recruitment rate and adherence to the protocol. Secondly, we aimed to collect preliminary data on changes in cardiometabolic factors including insulin resistance (IR) as measured by Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), blood pressure, fasting lipids, body weight and composition, habitual physical activity, and dietary intake from baseline to 12-week intervention. Results: We identified 238 adults at high risk for metabolic syndrome medical records review utilizing an electronic recruitment tool. Among eligible individuals, 67 (28%) were enrolled and 56 (84%) completed the 12-week assessment. The median attendance was 8 of 12 sessions for the yoga with EDU and 9 of 12 sessions for the EDU arm. Self-reported median frequency of home practice was 2.8 (IQR 1.4) times per week among the yoga with EDU group and 3.3 (IQR 1.1) times per week among the EDU group. Participants in the yoga with EDU arm versus EDU alone demonstrated a non-significant decrease in HOMA-IR (-0.21 (S.D. 0.99) versus 0.02 (S.D. 0.74), p=0.29). Both groups had similar changes in blood pressure, lipids, weight, body composition, energy intake, and physical activity from baseline to 12 weeks. Conclusions: It is feasible to implement yoga combined with EDU and conduct a prospective trial to assess effectiveness on cardiometabolic risk reduction in adults with metabolic syndrome.