Introduction: The use of traditional, complementary, and integrative medicine (TCIM) has grown rapidly worldwide. The aim of this umbrella review is to provide a comprehensive synthesis of the available evidence on factors associated with TCIM use to identify the most influential factor driving the use of TCIM. This review was guided by the following research question: What is the most influential factor driving TCIM use? Methods: This review was conducted in accordance with PRISMA guidelines. International literature was systematically searched using PubMed, Embase, and manual searching of reference lists. The search was limited to peer-reviewed systematic literature reviews published between January 2005 to March 2024, in Arabic and English languages, and reported empirical research findings on factors associated with TCIM use. Results: A total of 62 review articles were included. The following five prominent factors were identified and critically analyzed: Socioeconomic status; dissatisfaction with conventional medicine; internal locus of control; being holistic, natural, and safe; and perceived usefulness. Of these, perceived usefulness, defined as the perceived benefits of a TCIM modality in meeting specific health needs or goals, was the most influential factor driving TCIM use. Discussion: The findings of this umbrella review revealed that individuals would not use a specific type of TCIM unless they perceived some benefit from its use, even if the benefit lacked supporting scientific evidence. This insight provides a foundation for researchers, health practitioners, and policymakers to advance TCIM research, clinical practice, and policy by targeting its perceived benefits. Focusing on perceived benefits can help researchers prioritize areas that are most valued by patients, leading to more impactful studies and evidence-based recommendations for practice. Understanding perceived benefits can also lead to more informed discussions between patients and health practitioners, creating a more collaborative and culturally sensitive health care environment. Furthermore, addressing perceived benefits can guide regulations to ensure the safe, effective, and ethical use of TCIM practices, leading to more effective integration of TCIM into conventional medicine as the evidence of its usefulness accumulates.

Complementary, alternative, and integrative medicine (CAIM) has been increasing in popularity among patients with cardiovascular illnesses. However, little is known about perceptions of CAIM among cardiology researchers and clinicians. In response, this study aimed to assess the practices, perceptions, and attitudes towards CAIM among cardiology researchers and clinicians.

An anonymous, digital cross-sectional survey was administered to researchers and clinicians who have published articles in cardiology journals indexed in OVID MEDLINE. The survey was sent to 37,915 researchers and clinicians and included 5-point Likert scales, multiple-choice questions, and open-ended questions. Basic descriptive statistics were drawn from quantitative data, and a thematic content analysis was conducted to analyze open-ended responses.

Among the 309 respondents, the majority (n = 173, 55.99%) identified themselves as both researchers and clinicians in the field of cardiology. While 45.78% (n = 114) of participants expressed agreement regarding the safety of CAIM therapies, 44.40% (n = 111) disagreed on their efficacy. Most respondents believed in the value of conducting research on CAIM therapies (79.2%, n = 198). Respondents perceived mind-body therapies (57.61%, n = 159) and biologically based practices (47.46%, n = 131) as the most promising interventions for the prevention and treatment of cardiovascular conditions. Biofield therapies were the least favoured for integration into mainstream medical practices (11.93%, n = 29).

While cardiology researchers and clinicians perceive CAIM therapies to have potential, many are hesitant about integrating such interventions into the current medical system due to a perceived lack of scientific evidence and standardized products. Insights from this study may help establish educational resources for healthcare practitioners.

To explore factors influencing diabetes medication-taking among adults of Vietnamese heritage with type 2 diabetes mellitus (T2DM) residing in Australia. Barriers to and enablers of optimal medication use, as perceived by those with diabetes and health professionals working with this community, were explored via the Theoretical Domains Framework (TDF).

This qualitative study was conducted between November 2021 - March 2023 with input from an advisory group consisting of 4 individuals of Vietnamese heritage (a person living with T2DM, a credentialed diabetes care and education specialist, a General Practitioner, and Nephrologist). Data were collected using semistructured interviews with people with T2DM (adults, living in Australia, Vietnamese country of birth and/or language spoken at home) and focus group discussions with health professionals involved in the care of people with T2DM from Vietnamese background. Recruitment of participants was from a national diabetes registry and/or a tertiary hospital. The 14 domains of the TDF informed the development of the study aim, guided data collection, and thematic analysis. The TDF is a comprehensive framework that can be used to identify barriers and facilitators that influence health behaviors.

Twenty-three interviews were conducted with adults with T2DM (n = 14 women; median [IQR] age = 60 [16] years; n = 15 insulin-treated; all Vietnamese born, with n = 15 reporting Vietnamese as primary language). One focus group was undertaken with each group of health professionals (n = 7 doctors - 5 endocrinologists and 2 advanced endocrinology physician trainees, n = 6 credentialed diabetes care and education specialists, and n=3 pharmacists). A wide range of themes about the barriers and enablers [determinants] of medication taking were generated and mapped on 13 of 14 Theoretical Domains Framework domains, only excluding the domain of ``goals.'' The most important (determined through frequency and richness) domains that influenced medication-taking were: Environmental Context and Resources-access to subsidized medications is facilitated via the Australian Pharmaceutical Benefits Scheme, but high costs remained a significant barrier for many. Emotion-participants reported anxiety about diabetes complications as a motivator for medication-taking, while fears about long-term side effects created barriers. Social Influences-family support was an enabler of medication-taking. However, lack of support and pressure to use alternative treatments posed barriers for some participants. Beliefs About Consequences- belief in the negative outcomes of missed doses motivated medication-taking, while a lack of immediate side effects from missed doses reinforced perceptions that skipping medication was harmless. Memory, attention, and decision making-participants prioritized certain medications, sometimes neglecting others they viewed as less important.

Medication-taking among adult Australian Vietnamese individuals with T2DM is influenced by a complex interplay of environmental, social, and individual factors. This study identified potentially relevant domains that can guide future interventions to enhance medication-taking in this population.

Complementary health approaches (CHAs) encompass a diverse range of practices used both independently and alongside conventional medical treatments. Understanding how graduate students across disciplines perceive CHAs is important because these trainees will occupy roles as clinical practitioners, medical researchers, healthcare policy makers, and consumers. The purpose of this research was to (a) explore differences in perceptions of CHAs across disciplines, (b) examine differences between medical versus mental health trainees' willingness to recommend CHAs, and (c) determine whether an association exists between descriptive terminology and willingness to recommend CHAs.

Ratings of familiarity, perceptions of legitimacy, and willingness to recommend CHAs were examined among graduate trainees (N = 416). Responses from (a) clinical practice versus (b) research only trainees; and, within clinical fields, (c) medical versus (d) mental health trainees were compared via sequential rank agreement.

Clinical practice trainees were more familiar with CHAs than research only trainees. Mental health trainees were most familiar with CHAs and perceived them as more legitimate than medical trainees. Perceptions of CHA legitimacy positively correlated with willingness to recommend across disciplines. Medical trainees associated CHAs with the term "alternative; " mental health trainees characterized them as "complementary." Association with "complementary" correlated with increased willingness to recommend.

Mental health trainees characterize CHAs as "complementary; " they are also most likely to perceive CHAs as legitimate and to recommend them in practice. Clinical trainees and providers might be more likely to integrate CHAs into practice if characterized as "legitimate" and "complementary."

There has been growing interest in the role of complementary and alternative medicine (CAM) as part of end-of-life care.

This study prospectively examined the prevalence, predictors and outcomes of ingestible CAM use among cancer patients in their last year of life in Singapore.

This study (N = 427) utilized data across 12 months (four time points) prior to patient death. Utilizing mixed effects logistic regressions, we examined sociodemographic, clinical (symptom burden) and treatment-related factors associated with CAM use. Subsequently, the association between patient quality of life (i.e., physical, social, emotional, functional well-being) and CAM use were examined.

Half of the patients (50%) reported using CAM at least once in the last year of life while 36% of patients reported using CAM in the last 3 months of life. Among CAM users, 67% reported using western herbal supplements while 56% reported using traditional Chinese medicine. Further, 27-28% of patients used CAM consistently (i.e., for six months or more). Most patients (73%) reported using CAM as a complementary treatment. Patients who were ethnically Chinese (OR: 5.59, 95% CI: 2.29-13.69), reported less financial difficulties (OR: 0.82, 95% CI: 0.69-0.98), and believed in other curative treatments for cancer (OR: 2.39, 95% CI: 1.00-5.70) were more likely to use CAM. Controlling for time, CAM use (β: 0.60, CI: 0.01-1.19) was associated with higher social well-being.

A significant proportion of terminal cancer patients reported using CAM as a complementary treatment in the last year of life.

Research on the benefits of medical cannabis (MC) is emerging and supports its use as a treatment for post-traumatic stress disorder (PTSD). This study aimed to evaluate the cost effectiveness of MC as an adjunctive therapy for moderate PTSD under varying reimbursement scenarios.

A cost-utility analysis was conducted from the US payor perspective, using pricing data from the largest multi-state MC producer and established literature on standard PTSD treatments. We analyzed eight MC product types: dried flower, oral solutions, tablets, and edibles, each available in low/moderate (LM) and high-cost formulations. Incremental cost-utility ratios (ICURs) were calculated for these products across reimbursement levels of 100%, 75%, 50%, and 25%. Probabilistic sensitivity analyses with 10,000 Monte Carlo simulations were conducted to assess cost-effectiveness acceptability across willingness-to-pay (WTP) thresholds of $0-$100,000 per quality-adjusted life year (QALY) gained.

Non-flower MC products (edibles, oral solutions, and tablets) consistently demonstrated cost-effectiveness under a WTP threshold of $50,000, even at 100% reimbursement. Dried flower products, while less cost effective due to higher costs, achieved cost effectiveness under 75% or lower reimbursement levels for LM cost formulations. Sensitivity analyses confirmed robust ICURs for non-flower products, with narrower variability compared to dried flower products.

Medical cannabis products, particularly non-flower formulations, represent a cost-effective adjunctive therapy for moderate PTSD under various reimbursement scenarios. This analysis underscores the importance of evidence-based reimbursement policies to improve patient access to cost-effective treatments while ensuring financial sustainability for payors.

Complementary and Alternative Medicine (CAM) refers to a diverse array of healthcare practices that lie outside conventional Western medicine, including herbal remedies, spiritual healing, and traditional therapies. CAM use has become increasingly prevalent worldwide, driven by cultural, religious, and socioeconomic factors, including in Saudi Arabia. This systematic review and meta-analysis aimed to estimate the prevalence of CAM use in Saudi Arabia and examine the patterns of its utilization across various populations.

A systematic literature review was conducted using the PRISMA framework to identify studies investigating the prevalence and patterns of CAM use among diverse populations in Saudi Arabia. Databases searched included Cochrane, Clinicaltrials.gov, CINAHL, Web of Science, and PubMed.

Seven cross-sectional studies, with a total of 4112 participants were included. The studies encompassed a wide range of populations, from adolescents to adults with chronic illnesses. The pooled prevalence of CAM use was calculated to be 0.515 (95% CI [0.373-0.657]) using a random-effects model, showing that 51.5% of the Saudi population engages in CAM practices. Significant heterogeneity was observed across the included studies, likely due to differences in population demographics, CAM definitions, and study methodologies.

The findings emphasize the cultural and religious impact on CAM use and its significance in healthcare delivery. Future research should focus on standardizing CAM definitions, exploring the efficacy of popular therapies, and integrating CAM into conventional healthcare to provide holistic and culturally sensitive care.

PROSPERO CRD42024608257.

Ayurveda, a traditional system of medicine, has gained recognition in the Organisation for Economic Cooperation and Development (OECD) countries as a complementary and alternative medicine for managing noncommunicable diseases (NCDs). Qualitative studies have been conducted in various OECD countries regarding the use of Ayurveda for NCD management. However, no qualitative systematic review has been conducted on this topic.

This review aimed to synthesize the experiences, perceptions, and perspectives of patients with NCDs and Ayurvedic practitioners on the use of Ayurveda for NCD management in OECD countries.

The JBI qualitative systematic review guidelines were followed. Several databases were searched to identify published and unpublished qualitative studies.

Of the 18,541 records identified, 9 studies met the eligibility criteria and were included in the review. Using the JBI checklist for qualitative research (10 criteria), the critical appraisal scores of the studies ranged from moderate to high quality. Patients turned to Ayurveda because of concerns about side effects and dissatisfaction with conventional Western treatments and were driven by the perceived gentleness and holistic qualities of Ayurveda. Complementing these patient insights, Ayurvedic practitioners emphasized that Ayurveda identifies and addresses the root causes of diseases rather than treating symptoms alone. Integration challenges, limited medication access, and regulatory constraints were identified as factors affecting Ayurveda's service delivery.

Patients preferred Ayurveda because of its natural approach and fewer side effects, whereas Ayurvedic practitioners valued its holistic approach. However, its wider acceptance has been hampered by hurdles such as regulatory barriers and limited access to medicines. Strategies to overcome some of the barriers identified in this review as well as to promote the strengths discussed in this review may facilitate the effective use of Ayurveda to manage NCDs in OECD countries. Trial Registration: PROSPERO, Registration No. CRD42023397952.

Understanding the characteristics and expectations of people with multiple sclerosis (pwMS) who utilize complementary therapies can help integrate these therapies into conventional care.

To describe the characteristics of pwMS who use complementary therapies, their general reasons and targeted symptoms, and their expectations regarding the effects of these therapies.

A cross-sectional survey of pwMS from the Swiss Multiple Sclerosis Registry was conducted from October 2022 to August 2023.

888 pwMS participated (39.3 % participation rate). 48.2 % had used complementary therapies in the last six months. The most typical reasons were to improve quality of life (43.9 %) and alleviate MS symptoms (37.8 %). Participants expected manual therapies and natural substances to be most effective for physiological complaints, with median effectiveness scores of 7 (interquartile range [IQR]: 5-9 and 5-8). Mind-body therapies and natural substances were also expected to be the most effective for psychological complaints (median of 7 and 6, IQR: 3.5-8 and 3-8). Complementary therapies were considered safe (median safety scores ranging from 7 to 9).

PwMS frequently use complementary therapies, and their reasons and expectations can differ. Understanding the characteristics of pwMS who use complementary therapies, their reasons for use, and their expectations can support tailoring MS treatment.

This study aimed to evaluate the utilization of complementary and alternative medicine (CAM) among Chinese patients with inflammatory arthritis (IA), the types of CAM used, and the factors associated with its use. This cross-sectional study was conducted at the Department of Rheumatology and Immunology at the First Affiliated Hospital of Anhui Medical University. Data were collected from 503 IA patients using self-administered questionnaires and electronic medical records. Demographic, clinical, and disease activity data and pain, fatigue, emotion, and sleep quality assessments were analyzed. The study found that 50.3% of patients with IA used CAM, with herbal medicines and products being the most common therapies utilized by 74.3% of CAM users. CAM users reported significantly higher levels of fatigue, negative emotion states, and poorer sleep quality compared to non-users. Multivariate logistic regression analysis identified age, employment status, disease duration, IA family history, and disease activity as significant predictors of CAM use. This study revealed a high prevalence of CAM use among patients with IA in China. Healthcare professionals should enhance their understanding of CAM to inform and guide patients better and ensure the safe and effective integration of CAM therapies with conventional treatments.

The growing popularity of herbal medicine (HM) underscores the need for high quality clinical trials to support its evidence-based integration. Pilot trials are essential for addressing methodological challenges in this field. This study evaluates the design quality, feasibility, and reporting of HM pilot trials, with a focus on their capacity to inform future full-scale studies.

A comprehensive collection of HM pilot trials was conducted using PubMed, Web of Science, and Embase, based on predefined inclusion criteria. Data were extracted on trial characteristics, reporting quality, and progression to full-scale studies. To gather additional information on follow-up studies, authors of selected trials were contacted directly by email. Adherence to Consolidated Standards of Reporting Trials (CONSORT) guidelines for pilot trials was evaluated, and Poisson regression was applied to identify factors influencing reporting completeness.

A total of 123 HM pilot trials were reviewed, predominantly from Asia (78.1%). Trials most commonly addressed respiratory (14.6%), nervous (14.6%), and reproductive systems (13.0%). Key gaps in reporting included feasibility assessments (13.1%), sample size rationale (47.2%), and randomization methods (35.8%). HM-specific details, including ingredient processing, quality control, and safety assessments, were inconsistently reported. Among the trials, 4 (3.3%) progressed to full-scale studies. Factors such as trial registration (incidence rate ratio (IRR) = 1.20, 95% CI: 1.11-1.30) and protocol publication (IRR = 1.16, 95% CI: 1.08-1.24) were positively associated with reporting completeness. Moreover, an analysis of the origin of HMs revealed that modern HM trials were 4.7 times more likely to progress to full-scale studies compared to traditional HM trials (odds ratio = 4.70, 95% CI: 0.37-252.91), although the result did not reach statistical significance (P = .300).

HM pilot trials, as they stand, are not yet equipped to reliably guide full-scale studies. Core issues in methodological rigor, particularly in feasibility assessment, sample size justification, and randomization processes, limit their effectiveness and integration into evidence-based practice. A dedicated checklist that merges pilot study standards with the unique needs of HM trials is essential.

HM is increasingly used worldwide, but there are challenges in ensuring its effectiveness through clinical trials. This study aimed to evaluate the quality and reporting of pilot trials involving HM, which are smaller studies conducted before larger trials. Pilot trials are essential to identify potential issues in study design and ensure the reliability of future full-scale trials. We reviewed 123 trials from 21 countries and found that many lacked clear details on key aspects, such as sample sizes, randomization, and feasibility. These gaps make it difficult for pilot trials to reliably inform full-scale studies. Apart from this, the pilot trials reporting checklist did not include important details specific to herbal treatments, such as ingredient processing and quality control. In addition, only a few trials progressed to larger studies, often due to funding problems or other practical issues. Our study highlights the need for better reporting standards tailored to HM trials, with clear guidelines to address the unique aspects of herbal treatments. By improving the methodological rigor of pilot trials, we can ensure that HM becomes a more reliable and integral part of evidence-based health care.

Complementary and alternative medicine (CAM) encompasses a wide variety of health practices and products that are generally not included in conventional medicine. This study evaluates knowledge, attitude, and practice (KAP) among medical students toward CAM in Iran.

In this cross-sectional study, we developed and used a questionnaire to evaluate the KAP of medical students regarding CAM. The sampling method was convenience sampling. Two hundred and twenty medical students who were in their first to three (junior) and the last 2 years of education (senior) participated in this study. The data was collected from January to May 2017. Data analysis employed descriptive statistics, chi-square test, and independent t-test. Statistical significance was set at p-values less than 0.05.

Of 220 medical students, 125 respondents were CAM users (56.81%). The score of attitude about CAM was 60.13 ± 10.48 in junior students and 60.81 ± 7.32 among senior students. The score of knowledge about CAM was significantly (p = 0.02) higher in senior students (9.05 ± 4.12) than in juniors (7.74 ± 5.23). Traditional Persian medicine (TPM) was found to be the most commonly practiced CAM by both groups of students and their families. Leeching in students and chiropractic in their families had the lowest CAM use rates.

Although CAM knowledge was relatively low in medical students, they have a positive attitude toward it. TPM was the most common practice among CAM approaches. It is necessary to incorporate CAM modalities especially TPM education into the curriculum of medical students and other healthcare disciplines to enhance students' knowledge and attitude toward CAM and its role in healthcare.

Background: Complementary and integrative medicine (CIM) encompasses over 400 modalities, according to the World Health Organization (WHO). In 2011, 70% of the European Union's population reported having used CIM at least once, with 25% using it annually. This study examines the engagement, motivations, and satisfaction of users in the French health care system through data from Medoucine, France's largest online platform for complementary therapies. Methods: A cross-sectional descriptive analysis was conducted using Medoucine's database from 2017 to 2023, adhering to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Data were sourced from practitioner profiles, appointment logs, and patient comments collected at baseline (day 0, J0) and follow-up (day 30, J30). Survey questions, including "What type of complementary therapy are you seeking?" provided clarity on how CIM therapies were introduced. The study included a "recommendation question" at baseline to evaluate satisfaction: "Would you recommend this practitioner to your friends and family?". Response rates varied between 10% and 67%, depending on the question. Categorical variables were analyzed as percentages. Results: Among 225,251 platform users, 67.7% (152,464) responded to the recommendation question at J0, 15% (33,823) reported health improvements at J30, and 10% (22,596) discovered sustainable health strategies. Most users were women (68.6%). Key motivations included well-being and personal development (17.4%), stress, anxiety, and phobias (17.1%), and sleep disorders (7%). Hypnosis (15%), traditional Chinese medicine (8.4%), and reflexology (6.7%) were the most commonly selected modalities. At J30, 74.8% reported health improvements, with notable benefits for well-being (80.7%) and stress (76.3%). Conclusion: This study underscores the growing demand for CIM therapies in France, driven by a need for stress relief, personal development, and physical and psychological health management. High satisfaction rates and perceived health benefits highlight the potential of CIM to complement conventional care. Integrating evidence-based CIM into mainstream health care systems, as recommended by the WHO, offers an opportunity to address patient needs and enhance health care delivery.

The utilization of complementary medicine (CM) in patients with cancer brings substantial challenges to optimal cancer care by posing a risk of side effects and drug interaction, and might delay cancer care delivery. We aimed to characterize the patterns and predictors of CM utilization in patients with breast cancer (BC) and patients with colorectal cancer (CRC), and the impact on presentation and diagnosis interval.

We interviewed patients with BC and patients with CRC using a semistructured questionnaire to gather sociodemographic, clinical, presentation and diagnosis interval, and CM utilization data. The domains of CM used were categorized according to the classification of the National Institutes of Health/National Center for Complementary and Integrative Health.

One hundred forty-two patients with BC and 227 patients with CRC (N = 369) were included. The prevalence of CM utilization was 69.9%, with biologically based therapies being the most commonly used type. Younger age, higher educational attainment, and a greater number of health facility visits before diagnosis were significantly associated with higher odds of CM utilization (odds ratio [OR], 2.05 [95% CI, 1.19 to 3.54]; P = .010; OR, 1.07 [95% CI, 1.02 to 1.11]; P = .007, respectively). The diagnosis interval was significantly longer in patients who used CM compared to nonusers (incidence rate ratio [IRR], 2.74 [95% CI, 1.77 to 4.26]; P < .001). A greater number of CM modalities used were significantly associated with longer presentation and diagnosis intervals (IRR, 1.68 [95% CI, 1.06 to 2.66]; P = .027; IRR, 1.62 [95% CI, 1.04 to 2.52]; P = .033, respectively).

A significant portion of the local patients with BC and patients with CRC used CM. CM utilization was associated with age, education, number of health facility visits, and prolonged diagnosis interval. These findings underscore the need for CM disclosure among patients for better patient education and monitoring.

The utilization of Complementary and Alternative Medicine (CAM) has been on the rise, despite the expansion of conventional medicine across populations. The choice and utilization of CAM are informed by individuals' health-care-seeking behavior and the derived benefits. This study examined the factors responsible for the choice and utilization of CAM in the management of common childhood diseases among residents of Makun community, Sagamu, Ogun state Nigeria.

A descriptive cross-sectional design was adapted for this study, using an interview-administered questionnaire to elicit data on respondents' socio-demographic characteristics, knowledge, utilization, and factors influencing the utilization of CAM and perceived effects and satisfaction. Multi-stage sampling technique was used to select a total of 332 respondents comprising 129 males and 203 females. Data were analyzed with the Statistical Package for Social Sciences and presented using tables, percentages, and frequencies.

The findings revealed the following as the most influencing factors for the choice and utilization of CAM: Effectiveness (75.9 %), affordability (82.9 %), accessibility (81.7 %), and tolerance for children (44.6 %). CAM therapies that are always utilized in the management of common childhood diseases include herbal medicine (36.7 %), natural supplements (21.4 %), dietary therapy (13.3 %), and chiropractic (10.2 %). Perceived benefits include satisfaction (71.1 %), effectiveness (45.8 %), safety (37.3 %), and minimal side effects (46.7 %).

The study concludes that despite the popularity of conventional or orthodox medicine in Nigeria, there is still a significant percentage of the population who actively utilize complementary and alternative medicine therapies in the management of common childhood diseases. CAM therapies are mostly used in communities as either primary or adjunct therapy, due to high perceived safety and effectiveness.

It is pertinent for Nurses to be aware of the knowledge of CAM and It is pertinent for Nurses to be aware of the growing popularity and utilization of Complementary and Alternative Medicine in managing common childhood diseases. Nurses need to develop solid strategies to ensure there is an open conversation regarding CAM use by clients towards improving the care of communities and mitigating the uncontrolled utilization of complementary and alternative medicine in the care of children.

Complementary and alternative medicine (CAM) is used by some farmers to support herd health management practices. There is concern by a large majority of the veterinary community, who consider CAM to be counter to evidence-based practice. Little is known about what and how CAM is used on farms, and it is not clear which products or practices are encompassed by what farmers consider to be CAM. This paper reports on a study exploring the use of CAM on dairy farms in the UK.

Twenty farms with a range of management systems and herd sizes were recruited. Interviews were conducted with 24 farmers via face-to-face, telephone or videoconferencing modalities necessitated by the Covid-19 movement restrictions. 16 farms were visited to collect observational data using ethnographic fieldnotes and photographs. Interviews were conducted using topic guides and explored participants' experience of CAM and potential influence on antibiotic use. Interviews were audio recorded, transcribed, and thematically analysed using NViVo software.

A range of views and conceptualisation of CAM was identified among the participating dairy farmers. CAM was not usually seen as one particular product or health management tool but encompassed a range of health management strategies and philosophies. Results indicated that some farmers explore and engage with a range of complementary and alternative medicines and approaches to animal health on dairy farms. Some farmers considered food products, shop bought products, environmental enrichment, in-depth animal observations and technology to form part of their CAM approach. Farmers associated CAM with holistic health management and animal welfare. CAM formed part of a wider ethos regarding holistic farming and land use and was sometimes used to support them in avoiding overuse of antibiotics.

Farmers use CAM, and their conceptualisation of it is complex. Several resources and stakeholders were consulted by farmers to understand CAM and conventional medicine. Farmers interest in CAM warrants further consideration. This may support dairy farmers to reduce antimicrobial use responsibly, with veterinary support.

Auriculotherapy has become a promising complementary therapy and is widely used to manage various symptoms and diseases. However, little is known about patients' knowledge and attitudes. This study aimed to identify and synthesize the factors that influence acceptance and adherence related to auriculotherapy from patients' perspectives.

The thematic synthesis developed by Thomas and Harden was applied to guide this review. Six common English databases (PubMed, Web of Science, Embase, Cochrane Library, CINAHL, and PsycINFO) and four common Chinese databases (CNKI, VIP, WangFang, and Sinomed) were searched in December 2023. The quality of the included studies was assessed using the Critical Appraisal Skills Programme. Data synthesis was conducted using the theoretical domains framework.

Ten studies with eleven publications were included. Twenty-four barriers and fourteen facilitators on patients' acceptance and adherence to auriculotherapy were identified under nine of the theoretical domains framework domains. Among these domains, "knowledge (n = 2)", "memory, attention and decision processes (n = 2)", and "environmental context and resources (n = 5)" reported only barriers. Besides, the most frequently mentioned domains in the included studies were "beliefs about consequences (n = 10)" and "emotions (n = 6)".

Our findings provide a comprehensive overview of the factors affecting the patients' behavior in receiving and complying with auriculotherapy, which may help healthcare professionals deeply understand the factors that influence patients' intentions to use auriculotherapy and better interact with them. Further research that addresses these modifiable factors and develops relevant interventions may aid in meeting the growing use of auriculotherapy by patients.

This study was registered with PROSPERO in Dec 2023 (Registration number: CRD42023488856).

Sjögren's is a chronic autoimmune disease with diverse symptomatology, and varying patient satisfaction with management. Patients with chronic conditions are known to be higher users of complementary and alternative (CAM) practices, yet little information regarding extent of such use exists. This paper describes usage of CAM practices among people living with Sjögren's, encompassing visits to healthcare providers, CAM practitioners, self-administered CAM and self-help practices. We explored both purposes and perceived helpfulness of the various modalities utilised. 296 respondents completed an online survey administered through Sjögren's Research Ireland in 2023. An adapted form of the International Complementary and Alternative Medicine Questionnaire (I-CAM-Q) was utilised as the survey instrument. 88.5% of respondents had a formal diagnosis of Sjögren's. The majority (93.6%) were female, across all age groups. Over half (52%) of non-retired respondents were at least partially unable to work due to their diagnosis. Over half of all respondents (58.8%) listed at least one concomitant health problem. Most respondents (248, 83.8%) had used some form of CAM within the preceding 12 months. One-in-four had attended a CAM practitioner, most commonly chiropractors (8.4%) or acupuncturists (7.8%). Conventional healthcare and CAM providers were both consulted more commonly for management of chronic conditions or for well-being than for acute symptom management, although this was particularly stark for CAM consultations. 196 respondents (66.2%) reported use of self-administered CAM, predominantly vitamins/minerals or dietary supplements. 69.9% used various self-care practices, with the most reported being meditation, relaxation techniques and prayer. People living with Sjögren's attend both conventional healthcare providers and CAM practitioners to a high degree and use a diverse range of complementary therapies and practices. Health care professionals need to consider and discuss potential CAM use by this patient cohort and offer evidence-based patient education about therapies and practices encountered.

Large language models (LLMs) have the potential to enhance evidence synthesis efficiency and accuracy. This study assessed LLM-only and LLM-assisted methods in data extraction and risk of bias assessment for 107 trials on complementary medicine. Moonshot-v1-128k and Claude-3.5-sonnet achieved high accuracy (≥95%), with LLM-assisted methods performing better (≥97%). LLM-assisted methods significantly reduced processing time (14.7 and 5.9 min vs. 86.9 and 10.4 min for conventional methods). These findings highlight LLMs' potential when integrated with human expertise.

Breast cancer survivors undergoing long-term endocrine therapy often experience multiple symptoms, including pain, fatigue, sleep disturbance, hot flashes, anxiety, and depression. This study explored the feasibility and acceptability of integrating acupuncture for symptom management in medically underserved breast cancer survivors.

This randomized controlled trial was conducted at two clinics serving medically underserved populations. Breast cancer survivors (N = 62) were randomized to receive acupuncture (n = 31) or usual care (n = 31). The acupuncture group underwent 10 sessions over 5 weeks. Symptoms were assessed at baseline and Weeks 6 and 12.

The majority of participants (55%) were Black, mean age was 55.2 ± 9.3 years, and 62.9% had a household income below $55,000. Retention (90.3%), engagement (93.1%), and acceptability (92.8%) rates were high, demonstrating that integrating acupuncture into care for medically underserved breast cancer survivors is both feasible and acceptable. At Week 6, the acupuncture group showed significant reduction compared to the usual care group in pain, fatigue, sleep disturbance, depression, anxiety, and the symptom cluster score. All improvements persisted to Week 12 except for those in anxiety.

Integrating acupuncture for symptom management in medically underserved breast cancer survivors is both feasible and acceptable. This approach offers potential benefits for reducing multiple symptoms and addressing health disparities.

Low- and middle-income countries (LMICs) bear a disproportionate burden of mental illness, with limited access to biomedical care. This study examined pathways to care for psychosis in rural Uganda, exploring factors influencing treatment choices.

We conducted a mixed-methods study in Buyende District, Uganda, involving 67 in-depth interviews and 4 focus group discussions (data collection continued until thematic saturation was reached) with individuals with psychotic disorders, family members, and local leaders. Structured questionnaires were administered to 41 individuals with psychotic disorders.

Three main themes emerged: (1) Positive attitudes towards biomedical providers, (2) Barriers to accessing biomedical care (3) Perceived etiologies of mental illness that influenced care-seeking behaviors. While 81% of participants eventually accessed biomedical care, the median time to first biomedical contact was 52 days, compared to 7 days for any care modality.

Despite a preference for biomedical care, structural barriers and diverse illness perceptions led many to seek pluralistic care pathways. Enhancing access to biomedical services and integrating traditional and faith healers could improve mental health outcomes in rural Uganda.

We aimed to investigate the subject matters and the quality of publications detailing the findings of cohort studies within the realm of complementary and alternative medicine (CAM).

A scoping review was conducted on cohort studies in the CAM field up to the conclusion of 2023. The evaluation of their quality was carried out utilizing the 'Strengthening the Reporting of Observational Studies in Epidemiology' (STROBE) checklist. Moreover, an analysis of their research settings and associated variables, including publication year, type of disease, intervention method, and study field, was conducted.

Overall, 215 articles were identified. The majority of these cohorts, approximately 42.3%, originated from Taiwan, with stroke and cardiovascular diseases emerging as the most prevalent outcomes of interest. The mean STROBE score was 1.38 (SD=0.57) out of 2. The lowest scores were associated with the methods and funding sections. Methodologically, the principal weaknesses were linked to sample size, loss to follow-up, and bias control.

The frequency of cohort studies in CAM was limited, predominantly concentrated in a few countries. Chinese medicine and acupuncture were the main intervention methods, while other CAM interventions received less focus. Furthermore, the quality of these studies was deemed unsatisfactory in most cases.

Objective: Owing to perceived additional costs, patients may avoid integrative health and medicine (IHM) treatments, while insurers may not cover IHM. We hypothesized that adult beneficiaries of a health system's employee insurance plan with musculoskeletal (MSK) conditions receiving covered outpatient IHM would have reduced total allowed costs over the 1-year follow-up compared with matched controls, secondarily exploring medical and pharmaceutical cost subsets. Methods: We queried medical records and claims spanning 2018-2023 for beneficiaries aged 18-89 years with a new MSK episode. Patients were divided into cohorts: (1) IHM within 3 months after MSK diagnosis and (2) no IHM after initial primary care. After inflation adjustment and trimming, propensity score matching was used to balance cohorts on demographics, comorbidity, health care utilization, and prior 12-month spend. Least-squares mean total, medical, and pharmaceutical allowed costs (United States Dollar) over the 1-year follow-up were analyzed using a linear mixed model. Findings were compared with a generalized linear model without trimming. Results: There were 251 patients per matched cohort, with adequate covariate balance. There was no meaningful between-cohort difference (IHM minus No IHM) in least-squares mean total cost (+703 [95% CI: -314, 1720]). Secondary outcomes included medical cost (+878 [95% CI: 61, 1695]) and pharmaceutical cost (+6 [95% CI: -71, 83]). A generalized linear model revealed no meaningful difference in estimated mean total medical costs (-2561 [95% CI: -7346, +2224]). Conclusions: IHM use among adult health system beneficiaries with MSK conditions was not associated with meaningful differences in 1-year follow-up total health care costs compared with matched controls. Our study was underpowered for secondary outcomes, which should be interpreted with caution. Future research should include a larger sample of patients and examine longitudinal changes in patient-reported outcomes.

Traditional/alternative and complementary medicine (TCM) encompasses products, practices and practitioners that do not form part of conventional treatment and are not an integral part of the main health care systems. They are very common in the management of epilepsy and mental health conditions, particularly in low- and middle-income countries (LMIC). For instance, in a population-based survey in Africa, over 70% of people with epilepsy had visited a traditional health practitioner before the survey, with similarly high estimates reported in Asia and South America. Accessibility, cultural appropriateness/alignment, non-response to conventional (biomedical) medicine, and exercise of control over one's treatment were some of the reasons TCM was preferred over conventional medicine. There is also emerging evidence that TCM products administered alone or together with anti-seizure medications result in improvement in seizure control, psychiatric comorbidities, and quality of life. Most of the convincing evidence is from biological-based therapies for example, multivitamin supplementation, ketogenic diet and cannabidiol extracts. Mind-based therapies e.g. Yoga and whole-body systems therapies e.g. Ayurdelic and Traditional Chinese Medicine have also generated interest in epilepsy care. There is a paucity of effectiveness studies of these therapies in LMIC such as Africa, where capacity to take these products through clinical trials is limited. There are however serious concerns on reliability of reported findings because of inadequate randomization, and small sample sizes, and concerns on quality and safety owing to lack of standardization of bioactive compounds, accidental or intention botanical substitution of products and unhygienic handling. There is growing interest in TCM worldwide because of its economic potential, concerns on safety and quality and potential for integration into the health care systems. There is urgent need to develop and implement national TCM regulatory policies and programmes aimed at expanding the knowledge base and providing guidance on quality assurance standards. However, LMIC continue to lag in implementation of these policies and guidelines, especially in the areas of research and development and regulation of TCM practice. Working with stakeholders, countries are advised to assess their own national situations in relation to TCM, and then develop practical solutions to accommodate these approaches. For instance, conduct surveys on benefits and risks of TCM in the management of epilepsy in the local context and use this information to promote appreciation of a role for TCM, which will ease integration into the main health systems.

Hypertension is recognized as a modifiable risk factor for cardiovascular diseases, alongside dyslipidemia. Studies have revealed that between 15 and 31% of individuals have both hypertension and dyslipidemia. However, emerging evidence suggests that natural therapies and yoga can help manage mild increases in blood pressure. This study aimed to evaluate the impact of yogic and naturopathy treatments on lipid profiles in hypertensive patients, thereby contributing to the existing literature.

A randomized controlled experiment was conducted, involving 262 hypertensive patients randomly assigned to either the study group (SG) or control group (CG). The SG, consisting of 131 individuals, received yoga and naturopathic treatments for 10 days, while the CG (n = 131) did not. The lipid profile was measured at the beginning and end of the 10 days, and they were followed up and reassessed after 9 months.

The study involved a total of 262 individuals, with 111 in the SG and 125 in the CG. After the 10-day intervention period, the SG showed significant reductions in total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, very low-density lipoprotein, apolipoprotein-A (Apo-A), apolipoprotein-B (Apo-B), and lipoprotein-A (Lp-A) (p < 0.001) compared to the CG. Also, the change was observed after 9 months in Apo-A, Apo-B, and Lp-A significantly (p < 0.001).

These findings underscore the potential of naturopathic and yogic interventions in improving lipid profiles in hypertensive patients, thereby contributing to the current literature. In conjunction with conventional management, these specific interventions could be considered as a safer form of complementary therapy in the treatment of dyslipidemia among hypertensive patients. Thus, these findings hold promise for the integration of naturopathic and yogic therapies in the standard care of hypertensive patients.

Traditional Chinese non-pharmacological therapy has gained popularity in the management of overweight and obesity. This study aims to reveal trends and hotspots of global research on traditional Chinese non-pharmacological therapies for overweight and obesity.

Publications on traditional Chinese non-pharmacological therapies for overweight and obesity between 2004 and 2023 were searched from the Web of Science Core Collection. Bibliometric analyses and visualization were performed using VOSviewer, CiteSpace, and R software.

A total of 566 publications from 246 journals were included in this study. Annual number of publications and cited times in the field were generally increasing. China contributed the most publications, followed by the United States and Republic of Korea, and Chengdu University of Traditional Chinese Medicine from China had the highest number of publications among institutions. Stener-Victorin E was not only the most productive author but also, along with Cabioglu MT, the most cited authors. Evidence-Based Complementary and Alternative Medicine was both the largest source journal and the most cited journal. The highly cited references mainly consists of clinical trials, narrative reviews and systematic reviews focusing on acupuncture therapy. Keywords analysis indicated that acupuncture therapy and traditional Chinese exercise constituted the main components of traditional Chinese non-pharmacological therapy in weight management.

This study revealed a growing interest in traditional Chinese non-pharmacological therapies for managing overweight and obesity, with acupuncture therapies and traditional Chinese exercises as the main research focuses. This study offers insights into traditional Chinese non-pharmacological therapies in weight management, and may benefit further research.

The use of complementary and alternative medicine (CAM) has increased. Phytotherapy, also known as herbal medicine, is one of the CAM therapies that involves using medicinal plants and plant-derived substances. This study aims to evaluate the use of phytopharmaceuticals and the factors associated with their use in patients with Systemic sclerosis (SSc). Our study is designed as a survey and consists of two parts with 32 questions. The first part gathers demographic data with 14 questions, and the second part assesses participants' knowledge about phytotherapy with 18 questions. The questionnaire was administered face-to-face to patients with SSc who consented to participate. One hundred participants completed the survey. Fifty-two (52%) participants had diffuse sclerosis. Raynaud's phenomenon affected 97 (97%) participants; 53 (53%) participants suffered from lung involvement, and 64 (64%) had musculoskeletal system involvement. A total of 55 (55%) participants had used phytopharmaceuticals after SSc diagnosis. Phytotherapy users and non-users had similar demographic and clinical characteristics in terms of age, gender, disease duration, type of SSc, organ involvement, and education level. Participants mostly used the following phytopharmaceuticals: 23 participants used Camellia sinensis (green tea), 16 used Hypericum perforatum, and 12 used Curcuma longa (curcumin). The most improved symptoms with phytopharmaceuticals were musculoskeletal system findings and skin thickness, as stated by participants. A significant portion of SSc patients used phytopharmaceuticals in their disease duration. Although patients stated that they benefited from phytopharmaceuticals, studies on the effectiveness of these treatments are insufficient.

Zhumeria majdae, a unique native plant of southern Iran, has been traditionally used to treat various health issues. Preclinical studies suggest its therapeutic potential for immunological and inflammatory disorders. This study investigates the effect of Z. majdae essential oil (ZMEO) on TNBS-induced colitis in rats, focusing on the NF-κB/p38 MAPK/Nrf-2 pathway.

Forty-eight male Wistar rats were used, with all groups except the sham group receiving a single intra-rectal dose of TNBS. Three different doses of ZMEO and also 1 mg/kg dexamethasone were administered orally for 2 weeks. Colon tissue was analyzed for ulcer index, histological changes, inflammatory cytokines, apoptotic factors, and levels of NF-κB, p38 MAPK, and Nrf-2.

GC-mass analysis identified 25 compounds with linalool (52.01%) and camphor (31.01%) as the major compounds in ZMEO. ZMEO ameliorated colon injuries, reduced ulcer index, and prevented the elevation of pro-inflammatory cytokines and pro-apoptotic proteins. It also increased the levels of IL-10 and Bcl-2 proteins. Furthermore, ZMEO decreased the expression of p-NF-κB and p38 MAPK while increasing the expression of pNrf-2.

ZMEO mitigates colon damage associated with IBD by suppressing inflammatory cytokines and pro-apoptotic proteins possibly through modulating the NF-κB/p38 MAPK/Nrf-2 signaling pathway.

The role of animal-assisted therapy (AAT) in complementary and alternative medicine is well acknowledged. AAT is widely patronized, in developed countries such as USA, Canada, and many European countries, but less so in developing countries in Africa including Ghana. For persons in developing African countries and elsewhere to benefit from AAT, healthcare professionals must be acquainted with it recommend it to their patients when necessary. This study therefore assessed the perspectives of clinical-level medical students on AAT.

A semi-structured questionnaire was used to collect data in a cross-sectional study from 206 randomly selected clinical-level medical students of the University for Development Studies, Tamale, Ghana. The data was analyzed using Microsoft Excel and SPSS (Version 26) and the results were presented in Tables and charts. The association between demographic variables and the knowledge and attitude of the students were determined using ANOVA, while bivariate Pearson's correlation was used to measure the relationships between continuous variables. Associations were considered significant when p-value < 0.05.

The knowledge about AAT among the medical students was very poor (0.971 ± 2.407 over 10; 9.7%); almost all of them (≈ 99.0%) had very little or no exposure to AAT in school or at home. The attitude of the students was however averagely positive (3.845 ± 0.748 over 7; 54.9%), with a perceived health benefit of ATT score of 4.768 ± 1.002 (68.1%). The motivation of the students to acquire more knowledge and skills about AAT mostly through lectures and practical sessions (70.9%) was good (4.809 ± 1.221; 68.7%). Female students were significantly more knowledgeable about AAT than their male counterparts (1.5 versus 0.6; p-value = 0.006). No other sociodemographic characteristics had any significant association with knowledge, attitude, and perception of benefit variables. However, a significant positive relationship was found to exist between the students' knowledge, attitude and perception of animal-assisted therapy (r ≥ 0.236; p-value ≤ 0.001).

We conclude that the knowledge about AAT among medical students is inadequate and this is worrying given the beneficial complementary role of AAT in achieving SDG 3. Medical schools and their regulators in Ghana should incorporate complementary and alternative medicine (CAM) lessons in their training curricula. For practising medical doctors, topics on CAM should be discussed during their Continuous Professional Development sessions. With better knowledge, physicians would possibly be more willing and confident in recommending this useful complementary and alternative medicine to patients who may seek other forms of therapy besides conventional medicine or which will augment the orthodox medication the patients may have been using to treat their conditions.

The Rema-Kalenga Wildlife Sanctuary (RKWS) is a protected forest in Bangladesh that houses a variety of rare flora and fauna and supports the sustenance of 13 ethnic communities. This forest's indigenous and other inhabitants traditionally have a strong cultural connection to the plants, particularly medicinal plants. Due to modern allopathic medicine's rapid growth and commercial tree species prioritization, many medicinal plants are now on the verge of endangerment. Under such circumstances, it is crucial to explore how the local community perceives the importance of herbal treatments in contrast to allopathy, the underlying reasons for their perceptions, and the specific ailments for which they use the plants. The main objectives are: 1) to evaluate the perceptions of the local community towards allopathy and herbal medicine using Nussbaum's central capabilities approach, 2) to identify medicinal plant diversity, therapeutic usages, and quantitative indices, 3) to determine the factors that influence the use of medicinal plants. Repeated interviews and field surveys were conducted at the RKWS, interviewing 145 people, including the indigenous community (72.42 %) and traditional healers (8.27 %) from the surrounding seven villages. The study identified 51 medicinal plant species belonging to 39 families for their potent medicinal properties in treating various ailments. The predominant parts of the plants used in the treatments were leaves and roots. The uses were classified into 12 categories according to Nussbaum's central capabilities. The findings identified Aloe vera, Phyllanthus emblica, and Azadirachta indica as highly culturally important species. In contrast, Terminalia arjuna, Swertia chirata, and Azadirachta indica were found to have the highest relative importance. The underlying determinants influencing the preferences of individual users towards herbal medicine were income from agroforestry, beliefs, knowledge, and ethnicity, as revealed by the analysis of the ordinal logit model. The respondents viewed their strong inclination toward herbal medicine with many positive attitudes. Herbal medicine users held a negative perception of allopathy except for affiliation and practical reasons being viewed as the positive outcomes. Conversely, allopathic medicine users expressed mixed perceptions towards the treatment, with both positive and negative aspects being identified. Promoting the sustainable use of medicinal plants and their conservation efforts is imperative for the benefit of present and future generations in this region.

Complementary and integrative medicine (CIM) is increasingly being integrated into preoperative, intraoperative, and postoperative phases to enhance patient outcomes, manage symptoms, and improve overall well-being. CIM encompasses a broad range of therapies and practices that are not typically part of conventional medical care, such as herbal and non-herbal medicine, yoga, acupuncture, meditation, chiropractic care, and dietary supplements. This review explores the existing evidence on the application, benefits, and challenges of CIM therapies and practices in surgical settings, highlighting the importance of integrating these therapies and approaches with conventional medical practices to enhance patient outcomes.

While traditional medicine (TM) is employed by a significant portion of the global population for managing health issues, clinical guidelines and state recommendations often overlook this practice. The aim of this study was to describe the frequency of use of TM to control 3 metabolic risk factors (MRF): hypertension, hypercholesterolemia, and hyperglycaemia; and the sociodemographic, economic, and clinical characteristics associated with the use of TM.

Cross-sectional descriptive study that analyses data obtained from a representative population survey in 2 health districts, one urban in the south of Quito and another in a forested rural area with diverse ethnic groups in Esmeraldas, Ecuador. We include 602 individuals with at least one MRF. We calculated the proportion of people reporting the regular use of TM (herbal or traditional remedy) to control their MRF and we assessed potential associations with sociodemographic, economic, and clinical characteristics with a multivariable logistic regression model.

In two very different sociocultural contexts in Ecuador we found that use of TM to control MRF was frequent (39.4% in Esmeraldas, 31.1% in Quito), frequently in combination with CM. There is a notable percentage of people, 33.9% in Esmeraldas and 39.0% in Quito, who did not take any treatment for their MRF, and the remainder used CM alone. In both settings, an individual's education lever was significantly associated with TM use. Whereas in Quito individuals with higher education more frequently treated their MRF with TM (aOR 2.04, 95% CI 1.03-3.90), in the rural, hard-to-reach context of Esmeraldas, it was more frequent among people with no formal schooling (aOR: 3.76; 95%CI 1.59-8.88), as well as those of younger age (aOR by year: 0.97; 95% CI 0.95-0.99) and afro ethnicity (aOR: 2.13; 95%CI 1.02-4.45).

Traditional medicine is used by a significant proportion of the population in Ecuador, highlighting the need for a more accessible and intercultural healthcare approach. The health system should ensure access to the necessary information and resources for the management of their metabolic risk factors.

Integrative nursing interventions (INI) play a significant role in healthcare, particularly in the prevention and treatment of chronic diseases. Integrating evidence-based INI into healthcare aligns with global initiatives such as the WHO's Decade of Healthy Aging 2020-2030. Many INI are low-threshold practices, empowering patients to independently manage health. However, the extent to which INI are used by home-care nursing-services (HNS) remains largely unknown. This study aims to explore the field of INI in German HNS regarding nurses' use of INI as well as attitudes, subjective knowledge, and information needs on the subject.

A cross-sectional anonymous online survey with 29 Likert scale items and two open-ended questions was conducted between April 2023 and July 2023. The survey targeted nurse managers of HNS in Baden-Württemberg, Germany. Descriptive analysis was performed for quantitative data, while content analysis according to Kuckartz was applied to analyze open-ended text responses.

In total, n = 68 out of n = 1,331 HNS took part in the survey yielding a response rate of 5.1%. Their overall attitude toward INI was clearly positive (10-point Likert scale M ± SD: 8.37 ± 2.22). The average self-assessed knowledge level about INI was moderate (M ± SD: 5.39 ± 2.76). Almost half of the participants (45.6%) declared to incorporate INI in patient care. Most participants (84.2%) lacked employees with additional qualifications in INI. The INI used most were medicinal herbal teas (61%), compresses (57%), and aromatherapy (48%). Acupressure showed the greatest disparity between actual use in participating HNS (4.3%) and interest in further education (61%). The most common symptoms for which INI are used are pain, respiratory problems, anxiety, and palliative care. The main challenges reported for the use of INI in HNS are financial aspects, qualification and limited resources (staff and time).

This exploratory study provides the first insights into nurses' attitudes, self-assessed knowledge, and utilization of INI in German HNS. Overall response rate was low (5.1%), therefore, the results should be interpreted with caution. Urgent action is needed to address financial aspects and further education on INI, to promote integration of INI in HNS to the best possible extent.

In health care, two in three users of complementary therapies (CT) stay silent about their CT use. Disclosure of CT use to physicians is important for patient safety, participation, and shared decision-making. Common reasons for CT nondisclosure include patients´ expectations of physicians' unaccepting response to disclosure, physicians not asking, and patients believing it is unnecessary. This study aimed to increase understanding of patient silence. We investigated how the reasons for nondisclosure of CT use reported by CT users were associated with the frequency of CT disclosure and how these associations and reported justifications to keep silent reflect patient silence among the study participants.

This mixed-methods study used existing data from the non-probability-based online survey (n = 6802) targeted to CT users among the general population in Finland. A qualitative structured tabular thematic analysis was conducted for the selected 342 brief texts describing the reasons and justification for not telling physicians about CT use. The associations between the frequency of CT disclosure and the reasons for CT nondisclosure were analysed by crosstabulations and binary logistic regression analysis with SPSS (v28).

Three types of patient silence were revealed. Avoidant silence illustrates the respondents coping with the fear of unwanted response from a physician and avoiding the expected negative consequences of CT disclosure. Precautionary silence exemplifies respondents striving to prevent the reoccurrence of previously experienced frustration of wishes to be seen and heard as CT users. Conditional silence portrays the self-confidence of respondents who assessed their need to disclose CT use to physicians on a case-by-case basis.

Silence, for some patients, may serve as a way of warding off past and possible future fears and frustrations related to CT disclosure. It is important to recognise different types of patient silence related to CT disclosure to enhance patient participation and shared decision-making in health care. Efforts are needed to provide health policy decision-makers with information about CT users' lived experiences with CT communication in health care.

This study aimed to explore women with breast cancer (WBC) lived experiences on the use of Complementary and Alternative Medicine (CAM) for breast cancer management. van Manen's phenomenology of practice was used as the methodology and method in this study. In-depth interviews guided by semi-structured questions were conducted with 21 WBC recruited using convenience sampling. The thematic analysis generated four main themes: Access, affordability and support for medical treatment, beliefs in CAM treatment, feeling the potential benefits of CAM, and Acknowledging the negative aspects of CAM. The outcomes from using CAM based on the lived experiences of WBC indicated that some CAM treatments could improve quality of life. However, some fraudulent CAM obtained from unprofessional CAM providers could cause harmful effects, delay medical cancer treatment, and increase breast cancer treatment costs. Therefore, there is an urgent need to enhance the awareness of appropriate treatment, including evidence-based CAM, for WBC. Improved understanding in the use of CAM as a part of quality breast cancer care services could contribute to increasing the quality of life and survival rates of women with breast cancer.

Pakistani immigrants are the largest non-Western ethnic minority group in Norway. Traditional medicines (TM) are extensively used in Pakistan, and studies show that ethnic minorities also use them to recover from illness after migration to the Western world. This study aims to explore Pakistani immigrants' experiences and perceptions of risk regarding the use of TM to treat illnesses.

A qualitative study was conducted through in-depth interviews (n = 24) with Pakistani immigrants in Norway from February to March 2023. Participants were recruited through purposive and snowball sampling methods. The data was analyzed using Braun & Clarke's reflexive thematic analysis (RTA) using Nvivo.

RTA revealed three main themes and six sub-themes. The main themes were: (a) House of knowledge, (b) Choosing the best possible approach for health restoration, and (c) Adverse effects of TM used. A total of 96 different TM were identified, including herbs, food items, animal products, minerals, herbal products, and ritual remedies. All participants used TM to restore health in acute and chronic diseases, and many used TM along with conventional medicines. The participants' mothers were the primary source of knowledge about TM, and they passed it on to the next generation. They also frequently used religious knowledge to recover from illness. Although TM is considered safe because of its natural origin, some participants experienced adverse effects of TM, but none of them reported it to the health authorities.

The study helps to understand the experiences and perceptions of risk of Pakistani immigrants in Norway regarding traditional practices for treating health complaints. Public health policies to improve the health of these immigrants should consider the importance of TM in their lives. Further research is necessary to explore the safety and toxicity of those TM that are common in Pakistani households in Norway.

People with cancer experience heightened levels of stress and anxiety, including psychological or physical. In recent years, digitally delivered complimentary therapies, such as meditation, have gained attention in cancer research and advocacy communities for improving quality of life. However, most digital meditation resources are commercially available and are not tailored to the unique needs of cancer patients (addressing fears of recurrence). As such, this study lays the foundation to co-design a publicly available digital meditation program called iCANmeditate that contains cancer-specific meditation content.

To understand: (1) cancer patients' perceptions and practices of meditation, as well as their needs in addressing the stress that accompanies their cancer diagnosis and (2) current knowledge of meditation and prescribing trends amongst oncologists in Canada.

A mixed-methods design comprised of online patient and oncologist surveys and interviews with patients will be used. Survey data analysis will use multivariate logistic regressions to examine predictors of: (1) interest in using a meditation app among patients and (2) prescribing meditation among oncologists. Patient interviews will gather insights about the contexts of daily living where meditation would be most beneficial for people with cancer; this data will be analyzed thematically.

The results of this study will inform iterative co-design workshops with cancer patients to build the digital meditation program iCANmeditate; interview results will be used to develop vignettes or "personas" that will supply the initial stimulus material for the iterative co-design workshops. Once the program has been finalized in partnership with cancer patient participants, a usability and pilot study will follow to test the functionality and efficacy of the tool. Results from the oncologist survey will form the basis of knowledge mobilization efforts to facilitate clinical buy-in and awareness of the benefits of meditation to cancer patients.

Complementary and alternative medicine (CAM) is widely used by patients with cancer. Research indicates that the use of CAM is more prevalent in rural areas compared to urban areas. There is currently a lack of information regarding the scope and specifics of CAM use among patients in Sweden, particularly in rural areas. The aim of this study was to estimate the extent and characteristics of CAM use among cancer patients in the rural areas of Region Gävleborg.

A total of 631 questionnaires were sent out, and 376 of those were returned, corresponding to a response rate of 59.6%. Oncology patients received questionnaires at their initial appointment for curative care at Gävle Hospital's Department of Oncology. When enrolling in palliative outpatient care in their homes, palliative patients were sought out. Standard descriptive statistics were used to present the characteristics of the respondents. To determine odds ratios and potential factors (age, gender, diagnosis, and education) affecting CAM use after cancer diagnosis, a multivariable logistic model was constructed.

Based on clinical observations, the authors' hypothesis that CAM use is particularly common in small towns in the Hälsingland region was verified in this study. This was particularly pronounced among younger people and residents of small towns in the province of Halsingland. The higher level of CAM use appears to apply to both men and women.

CAM appears to be used more frequently by patients residing in rural areas. It is crucial that care providers enquire about all of the patient's health-seeking activities. Further research is needed on the usage of CAM in rural areas and the potential cultural influences contributing to CAM use. From a sociological standpoint, it is crucial to draw attention to the fact that CAM use may be more prevalent in certain rural areas, particularly in centralized societies where it is more difficult to access healthcare in remote regions.

Within the realms of human and artificial intelligence, the concepts of consciousness and comprehension are fundamental distinctions. In the clinical sphere, patient awareness regarding medication and its physiological processes plays a crucial role in determining drug efficacy and outcomes. This article introduces a novel perspective on prescription practices termed "Ultra-Overt Therapy" (UOT). A review of current supporting evidence was conducted through a non-systematic search in PubMed and Google Scholar, focusing on concepts such as the "mind-body relationship," "placebo response," "neuroscience," and "complementary medicine." Our findings, rooted in the mechanisms of the "placebo effect," the intricacies of "intersubjective therapy," the potency of "interoceptive awareness," and other domains of medical science, suggest that UOT holds theoretical promise. Future research endeavors focusing on these areas may elucidate the global impact of this method on medical treatment and patient care.

While research on complementary and alternative medicine (CAM) for the general population is expanding, there remains a scarcity of studies investigating the efficacy and utilisation of CAM practices, specifically in the paediatric population. In accordance with the World Health Organization (WHO), the prevalence of the parental utilisation of CAM in their dependents is estimated to reach up to 80%. This literature review identified broad, heterogeneous, and inconclusive evidence regarding CAM's applications and effectiveness, primarily attributed to variance in sociodemographic factors and differences in national healthcare systems. Additionally, the review identified a lack of consensus and polarised positions among mainstream professionals regarding the mechanisms of action, applications, and effectiveness of CAM. This narrative review presents varied results concerning the efficacy of most CAM therapies and their applications; however, some evidence suggests potential benefits for acupuncture, yoga, tai chi, and massage in improving physical and mental health. Moreover, the available evidence indicates that meditation may enhance mental health, while reiki may only influence patients' perceptions of comfort. In light of the intricate and multifaceted nature of herbal medicine, it is imperative to assess its efficacy on a case-by-case basis, taking into account the specific compounds and procedures involved. This comprehensive review serves as a valuable resource for health professionals, offering guidance for personalised healthcare approaches that consider the values and beliefs of patients, thereby facilitating integrated, evidence-based practices aimed at enhancing the quality of healthcare services and patient satisfaction.

Communicating effectively with patients having a traditional, alternative or complementary medicine-related health-belief model is challenging in today's cross-cultural society. This narrative review explores the integrative medicine setting of care, focusing on insights from the integrative oncology daily practice, while addressing the relevance to the mental health setting. The way in which healthcare providers can enhance cultural-sensitive communication with patients and informal caregivers; recognize and respect health-beliefs to bridge cultural gaps; and generate an open, non-judgmental and mindful dialogue are discussed.

Identifying cross-cultural barriers to healthcare provider-patient communication is important in order to address the potential for conflict between conventional and "alternative" health beliefs; difficulties in creating a shared-decision making process; disagreement on therapeutic goals and treatment plan; and finally, the potential for non-compliance or non-adherence to the conventional oncology treatment. Acquiring intercultural competencies is needed at all stages of medical education, and should be implemented in medical and nursing curricula, as well as during specialization and sub-specialization. As with patient-centered paradigms of care, integrative medicine entails a dual patient-centered and sensitive-cultural approach, based on a comprehensive bio-psycho-social-spiritual model of care.