Can supervise: YES
Caut, C, Leach, M & Steel, A 2020, 'Dietary guideline adherence during preconception and pregnancy: A systematic review.', Maternal and Child Nutrition, pp. e12916-e12916.View/Download from: Publisher's site
The aim of this study is to determine the level of adherence to dietary guidelines among men and women during preconception, and pregnant women, and factors associated with adherence. Searches were conducted in CINAHL, AMED, EMBASE, and Maternity and Infant Care from inception to March 2018. Observational studies assessing the primary outcome (adherence to dietary guidelines and/or nutritional recommendations) and/or secondary outcome (factors associated with adherence) were eligible. Study quality was assessed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional studies. Men or women (aged ≥18 years) who identified as trying/intending to conceive or were pregnant. Eighteen studies were included. The quality of studies was fair (44%) to good (56%). Most studies indicated preconceptual and pregnant women do not meet recommendations for vegetable, cereal grain, or folate intake. Pregnant women did not meet iron or calcium intake requirements in 91% and 55% of included studies, respectively, and also exceeded fat intake recommendations in 55% of included studies. Higher level education was associated with improved guideline adherence in pregnant women, whereas older age and non-smoking status were associated with greater guideline adherence in preconceptual and pregnant women. The findings of this review suggest that preconceptual and pregnant women may not be meeting the minimum requirements stipulated in dietary guidelines and/or nutritional recommendations. This could have potential adverse consequences for pregnancy and birth outcomes and the health of the offspring. Major knowledge gaps identified in this review, which warrant further investigation, are the dietary intakes of men during preconception, and the predictors of guideline adherence.
Filbet, M, Schloss, J, Maret, JB, Diezel, H, Palmgren, PJ & Steel, A 2020, 'The use of complementary medicine in palliative care in France: an observational cross-sectional study', Supportive Care in Cancer.View/Download from: Publisher's site
© 2020, Springer-Verlag GmbH Germany, part of Springer Nature. Purpose: Palliative care for cancer deals with physical, psychosocial, and spiritual issues faced by cancer patients, their families, communities, and healthcare providers. Research on complementary medicine (CM) use in France is limited despite high rates of reported CM use in other countries including by palliative patients. This study describes the use of CM by individuals receiving palliative care in Lyon, France. Design: This study employed an observational cross-sectional survey design. Setting/participants: The study was conducted in three palliative care centers in Lyon, France; two tertiary hospitals and one palliative care unit (3 sites). Inpatients and outpatients visiting the palliative care clinic with a primary diagnosis of cancer at each study site were invited to participate. Results: Of 138 eligible patients, 100 completed the survey (RR 72.4%). The majority (90.7%) reported using CM in the previous 6 months or since their primary cancer diagnosis. Participant CM use was either the same (20.7%) or increased since their primary cancer diagnosis (33.7%). Average out-of-pocket expenses associated with CM use in the previous 6 months or since diagnosis were €157.40 (SD €330.15). The most common CM health professional visited was an aromatherapist (72.7%), a Coupeurs de feu (38.6%), osteopath (28.6%) and naturopath (15.3%). The most common CM used were aromatherapy oils (33.7%), homeopathy (30.0%), and vitamins (29.4%). Conclusion: This second survey on CM use in France; is the first conducted in palliative care centers. Results show people with cancer in Lyon, France, have a very high prevalence of CM utilization.
Harvie, A, Steel, A & Wardle, J 2020, 'A qualitative study of classical Chinese medicine in community health focusing on self-care: practitioner and staff perspectives', INTEGRATIVE MEDICINE RESEARCH, vol. 9, no. 1, pp. 42-47.View/Download from: Publisher's site
Harvie, A, Steel, A & Wardle, J 2020, 'Classical Chinese medicine self-care: participant’s perspectives on a pilot program for community health', European Journal of Integrative Medicine, pp. 101158-101158.View/Download from: Publisher's site
Malhotra, V, Harnett, J, McIntyre, E, Steel, A, Wong, K & Saini, B 2020, 'The prevalence and characteristics of complementary medicine use by Australians living with sleep disorders – Results of a cross-sectional study', Advances in Integrative Medicine, vol. 7, no. 1, pp. 14-22.View/Download from: Publisher's site
© 2019 Elsevier Ltd Objectives: To report the prevalence and characteristics of complementary medicine use and product utilization by Australians living with sleep disorders. Design: A cross-sectional study. Methods: 2025 adults representative of the Australian population by age, gender and state/territory of residence completed a survey consisting of 50 items including demographic, health services and complementary product/service utilization and health status items. The sociodemographic characteristics, prevalence and frequency of complementary medicine (CM) use, and out of pocket CM expenses were compared between those reporting a sleep disorder to those without a sleep disorder. Results: Of the 2019 respondents completing the online survey, 265 (13%) reported sleep disorders. Of these 265 respondents, the median age bracket was 40–50 years; 54.7% were females. The mean health-related quality of life score in this group was 44.8 ± 23.3; the group had a higher level of comorbid conditions compared to those without sleep disorders (p < 0.001). Two thirds (63.8%) of participants with a sleep disorder used complementary medicine compared to 52% of those without a sleep disorder (p < 0.001). Massage therapists and chiropractors were the main complementary medicine practitioners consulted by the group with sleep disorders; the average annual amount spent on visits to complementary medicine practitioners was significantly higher in this group (Australian dollars, AUD 160.0 ± 545.0) than in participants without sleep disorders (AUD 62.8 ± 251.0), p < 0.001. There were no significant differences in spending on complementary medicine products annually - those with a sleep disorder spent on average AUD 59.73 ± 266.38 annually, whilst those without spent AUD 62.8 ± 251.0 (p = 0.42). Of those with a sleep disorder, 97% reported consulting a general practitioner compared with 89.3% in the non-sleep disorders group (p < 0.001). Conclusion: Both complementary medicine and con...
© 2020 Problem: Limited literature is available about women who wish to breastfeed but experience unexpected feelings of aversion in reaction to their infant suckling at the breast while breastfeeding. Background: Breastfeeding benefits mothers, infants and society yet breastfeeding rates continue to fall below recommendations in part due to inadequate tailored support after hospital discharge. Influences on breastfeeding are complex and include many physiological, psychosocial and cultural factors. Aim: To better understand the experience of women who have feelings of aversion during breastfeeding by synthesising the existing literature. Methods: MEDLINE, CINAHL, PsycINFO, Maternity and Infant Care databases were searched for relevant literature published between 2000 to 2019. Using Covidence software, five qualitative research studies were identified. Studies were then analysed using meta-ethnographic qualitative synthesis. Findings: Feelings of aversion during breastfeeding were described as visceral and overwhelming; leading to feelings of shame and inadequacy. This synthesis identified five findings; a central conceptual category of “it's such a strong feeling of get away from me” with four key metaphors translated from this central conceptual category: “I do it because I feel it is best for my baby”, “I can't control those feelings”, “I should be able to breastfeed my son and enjoy it”, and “I'm glad I did it”. This phenomenon may negatively affect a women's sense of self and impact on the mother-infant relationship. Conclusion: Some women who want to breastfeed can experience feelings of aversion while breastfeeding. The feelings of ‘aversion’ while breastfeeding can inhibit women from achieving their personal breastfeeding goals.
Steel, A, Breakspear, I, Carter, J, Pinder, TA & Smith, C 2020, 'Formation of the Australian Naturopathic Council (ANC): Formalising a new era of unity for Australian naturopathy', Australian Journal of Herbal and Naturopathic Medicine, vol. 31, no. 4, pp. 142-144.View/Download from: Publisher's site
© NHAA 2019. Naturopathy has been practised in Australia since the early 1900s and since this time the profession has matured and evolved. Contemporary naturopaths face new challenges that require a strong and unified voice that represents all sectors of the profession – education, regulation and professional associations. In response, the Australian members of the World Naturopathic Federation (WNF) have formed the Australian Naturopathic Council (ANC). The organisational members of the ANC are committed to a common purpose to improve communication and understanding as well as to share resources and efforts to the benefit of the Australian naturopathic profession. The formation of the ANC is a milestone in the continued maturation and professionalisation of naturopathy in Australia.
Steel, A, Foley, H, Bradley, R, Van De Venter, C, Lloyd, I, Schloss, J, Wardle, J & Reid, R 2020, 'Overview of international naturopathic practice and patient characteristics: results from a cross-sectional study in 14 countries.', BMC complementary medicine and therapies, vol. 20, no. 1, p. 59.View/Download from: Publisher's site
BACKGROUND:Naturopathy is a distinct system of traditional and complementary medicine recognized by the World Health Organization and defined by its philosophic approach to patient care, rather than the treatments used by practitioners. Worldwide, over 98 countries have practicing naturopaths, representing 36% of all countries and every world region. The contributions of naturopaths to healthcare delivery services internationally has not been previously examined. Thus, the primary intention of this research was to conduct an international survey of naturopathic practice and patient characteristics in order to gain insight to the breadth of their practices and the type of clinical conditions routinely encountered. METHODS:The cross-sectional study was conducted in naturopathic clinics in 14 countries within 4 world regions including the European (Portugal, United Kingdom, Switzerland, Spain), Americas (Canada, United States, Chile, Brazil), Western Pacific (Hong Kong, Australia, New Zealand) and African (South Africa). Naturopathic practitioners in each country were invited to prospectively complete an online survey for 20 consecutive cases. The survey was administered in four languages. RESULTS:A total of 56 naturopaths from 14 countries participated in the study, providing a mean of 15.1 cases each (SD 7.6) and 851 cases in total. Most patients were female (72.6%) and all age categories were represented with a similar proportion for 36-45 years (20.2%), 46-55 years (19.5%), and 56-65 years (19.3%). A substantial majority (75%) of patients were considered by the participant to be presenting with chronic health conditions. The most prevalent category of health conditions were musculoskeletal (18.5%), gastrointestinal (12.2%), and mental illness (11.0%). The most common treatment categories prescribed or recommended to patients by the participants were dietary changes (60.5%), lifestyle and behaviour changes (56.9%), herbal medicines (54.2%) and nutritional supplem...
Steel, A, Goldenberg, JZ, Hawrelak, JA, Foley, H, Gerontakos, S, Harnett, JE, Schloss, J & Reid, R 2020, 'Integrative physiology and traditional naturopathic practice: results of an international observational study', Integrative Medicine Research, pp. 100424-100424.View/Download from: Publisher's site
Foley, H, Steel, A & Adams, J 2020, 'Consultation with complementary medicine practitioners by individuals with chronic conditions: Characteristics and reasons for consultation in Australian clinical settings', HEALTH & SOCIAL CARE IN THE COMMUNITY.View/Download from: Publisher's site
James, PB, Wardle, J, Steel, A & Adams, J 2020, 'An assessment of Ebola-related stigma and its association with informal healthcare utilisation among Ebola survivors in Sierra Leone: a cross-sectional study', BMC PUBLIC HEALTH, vol. 20, no. 1.View/Download from: Publisher's site
James, PB, Wardle, J, Steel, A, Adams, J, Bah, AJ & Sevalie, S 2020, 'Providing healthcare to Ebola survivors: A qualitative exploratory investigation of healthcare providers' views and experiences in Sierra Leone', GLOBAL PUBLIC HEALTH.View/Download from: Publisher's site
McIntyre, E, Foley, H, Diezel, H, Harnett, J, Adams, J, Sibritt, D & Steel, A 2020, 'Development and preliminarily validation of the Complementary Medicine Disclosure Index', Patient Education and Counseling, vol. 103, no. 6, pp. 1237-1244.View/Download from: Publisher's site
© 2020 Elsevier B.V. Objective: Non-disclosure of complementary medicine (CM) use to doctors is associated with health risks. No standardised, validated instrument exists to measure reasons for CM use disclosure behaviour to doctors in clinical research or practice. This study aims to develop and validate an index that measures the relative importance of reasons for CM disclosure and non-disclosure. Methods: Using data from the Complementary Alternative Medicine Use Health Literacy Disclosure Study (N = 2019), we developed a CM Disclosure Index (CMDI) using a formative measurement approach. The adequacy of the measurement models was assessed by conducting variance-based structural equation modelling using partial least squares to analyse multicollinearity, significance and relevance of the formative indicators to their relative primary constructs. Results: The CMDI consists of two second-order measurement models, each with three sub-domains, and demonstrated acceptable construct validity indicating the index is a useful measure to identify the reasons for CM use disclosure behaviour. Conclusion: The CMDI provides a preliminary tool to measure the relative importance of the reasons for CM use disclosure and non-disclosure to doctors. Practice implications: Understanding patients' reasons for disclosure and non-disclosure can assist in developing targeted interventions to both patients and practitioners to facilitate effective patient-practitioner communication and improve patient safety.
Steel, A, Diezel, H, Wardle, J & Adams, J 2020, 'Working with women: Semi-structured interviews with Australian complementary medicine maternity care practitioners.', Women and Birth.View/Download from: Publisher's site
PROBLEM:Despite the known prevalence of complementary medicine use by women during pregnancy and childbirth and the evolution of preferred models of maternity care, very little is known about the nature and characteristics of the care provided to women by complementary medicine practitioners during this important life stage. BACKGROUND:Woman-centred care is a speciation of person-centred care which has achieved prominence in maternity care policy in recent years. There is also evidence that the core principles of some complementary medicine systems of medicine emphasise patient-centredness and that these principles are core drivers toward complementary medicine use in multiple populations. AIM:This study aims to explore the approach to care delivered by complementary medicine practitioners to women during pregnancy and birth. METHODS:Semi-structured individual interviews were conducted with 23 complementary medicine practitioners who identified as specialising in maternity care. Data from the interviews were analysed using a framework approach. FINDINGS:The analysis of the perspective of complementary medicine practitioner's experiences providing care to pregnant and birthing women identified three main themes: Responding to women's expectations of care; providing woman-centred care; and the therapeutic relationship at the heart of woman-centred care. DISCUSSION:The approach to maternity care reported by complementary medicine practitioners aligns with the principles of woman-centred care, possibly due to the similarities between woman-centred care and the core features of many systems of medicine within complementary medicine. CONCLUSION:Complementary medicine practitioners may contribute to an overall experience of woman-centred maternity care for pregnant and birthing women.
Adams, J, Steel, A, Frawley, J, Leach, M, McIntyre, E, Broom, A & Sibbritt, D 2020, 'The health care utilization and out-of-pocket expenditure associated with asthma amongst a sample of Australian women aged over 45 years: analysis from the '45 and up' study', JOURNAL OF ASTHMA.View/Download from: Publisher's site
Steel, A, Peng, W, Sibbritt, D & Adams, J 2020, 'Introducing national osteopathy practice-based research networks in Australia and New Zealand: an overview to inform future osteopathic research', SCIENTIFIC REPORTS, vol. 10, no. 1.View/Download from: Publisher's site
Carter, T, Goldenberg, JZ & Steel, A 2019, 'An examination of naturopathic treatment of non-specific gastrointestinal complaints: comparative analysis of two cases.', Integrative medicine research, vol. 8, no. 3, pp. 209-215.View/Download from: Publisher's site
Background:Functional gastrointestinal disorders (FGID) affect more than one-third of the general population and contribute a considerable burden on the health and wellbeing of the community and the economy. This study aims to examine the treatment approaches and outcomes of naturopathic management of individuals presenting with a non-specific FGID. Methods:We report a comparison of two clinical case studies of patients being treated by a naturopath for a functional gastrointestinal disorder. The care was provided by two different student practitioners under the supervision of an industry qualified mentor within a multidisciplinary academic clinic at the Endeavour College of Natural Health. A student practitioner and student observer conduct consultations under the supervision of an industry qualified mentor. The outcomes of care were measured by the Gastrointestinal Symptom Rating Scale. Results:Clinical notations partially correlate to Jane's outcomes measured by gastrointestinal rating scale scores, which remain stable. Significant changes in Rona's gastrointestinal rating scale scores equate to only generalizable minimal clinical notations. Conclusions:The holistic and individualised approach core to naturopathic medicine practice is also informed by traditional methods, research evidence and the pragmatic needs of the patient. The emphasis within naturopathic treatment approaches on dietary changes and lifestyle prescription alongside other ingestive therapies such as herbal and nutritional medicine underscores the need for clinical research designs which support evaluation of complex interventions in real-world settings.
Casteleijn, D, Steel, A, Bowman, D, Lauche, R & Wardle, J 2019, 'A naturalistic study of herbal medicine for self-reported depression and/or anxiety a protocol.', Integrative medicine research, vol. 8, no. 2, pp. 123-128.View/Download from: Publisher's site
Background:Mental health conditions including anxiety and depression account for around 8% of the global disease burden. Anxiety and depression often coexist and impose a high individual and social burden. Patients with mental and behavioural conditions may be at increased risk of co-morbidities and are often high health-care utilisers. Herbal medicine is estimated to be used by up to 80% of the worlds population, and by 22% of Australian women seeking care for depression. The holistic and tailored treatment approach offered by practitioners of herbal medicine is difficult to capture in randomised controlled trials and as such there is a paucity of research demonstrating the outcomes of real-life practice. This project aims to address this gap with a whole practice, observational model. Methods/Design:The study will employ a naturalistic observational design. Two-hundred patient participants will be recruited to be treated by 15 clinician participants from different naturopathic clinics. The observed changes in anxiety and depression symptoms of patients will be documented across three consultations using validated patient-reported outcome measures (SF-36, DASS-21, GHQ-28 and POMS-2). Conclusion:Clinical studies investigating the efficacy of individualised herbal medicine treatment as prescribed by a naturopath are rare. Our study attempts to fill this gap with a longitudinal observation of individualised care as practiced by naturopaths in Australia; to offer valuable insights into the effectiveness of individualised herbal medicine practice and provide contextualisation of data currently focused on individual herbal medicines in specific conditions.Trial Registration: Australian and New Zealand Clinical Trials Registry: ACTRN12616000010493.
Foley, HM & Steel, AE 2019, 'Adverse events associated with oral administration of melatonin: A critical systematic review of clinical evidence.', Complementary therapies in medicine, vol. 42, pp. 65-81.View/Download from: Publisher's site
While melatonin was once thought of simply as a sleep-inducing hormone, recent research has resulted in development of a deeper understanding of the complex physiological activity of melatonin in the human body. Along with this understanding has come widespread, increasing use of melatonin supplementation, extending beyond its traditional use as a sleep aid into novel fields of application. This increased use often involves off-label and self-prescription, escalating the importance of safety data. In order to examine the current knowledge relating to safety of the exogenous neurohormone, we conducted a comprehensive, critical systematic review of clinical evidence. We examined controlled studies of oral melatonin supplementation in humans when they presented any statistical analysis of adverse events. Of the fifty articles identified, twenty-six found no statistically significant adverse events, while twenty-four articles reported on at least one statistically significant adverse event. Adverse events were generally minor, short-lived and easily managed, with the most commonly reported adverse events relating to fatigue, mood, or psychomotor and neurocognitive performance. A few studies noted adverse events relating to endocrine (e.g. reproductive parameters, glucose metabolism) and cardiovascular (e.g. blood pressure, heart rate) function, which appear to be influenced by dosage, dose timing and potential interactions with antihypertensive drugs. Oral melatonin supplementation in humans has a generally favourable safety profile with some exceptions. Most adverse effects can likely be easily avoided or managed by dosing in accordance with natural circadian rhythms. Further research is required to explore the potential for melatonin to interact with endogenous hormones and pharmaceuticals.
Gray, AC, Diezel, H & Steel, A 2019, 'The use of learning technologies in complementary medicine education: Results of a student technology survey', Advances in Integrative Medicine, vol. 6, no. 4, pp. 174-180.View/Download from: Publisher's site
© 2019 Background: Learning technologies are becoming universal in health professional education. Despite the potential philosophical and ideological dissonance between CM and technology, the actual use of learning technologies by CM students is currently unknown. As such, there is a need to explore the prevalence and nature of use of educational technologies by CM students. Methods: A cross-sectional survey examining students’ behaviours and attitudes to learning technologies at the Endeavour College of Natural Health. Survey items focused on student demographic and educational background, and their use of technology. Chi-square tests were used to examine bivariate relationships and the characteristics of technology use based on respondents’ age were determined using a backward stepwise logistic regression. Results: There were 576 responses to the survey. The majority of respondents reported having a mobile phone (96.2%) or a laptop (85.9%), rather than a desktop computer (24.7%). Of those with phones, 92% had a smart phone. Almost all students access their emails every day (84%). Older students (>35 years old) were found to be more likely to have a desktop computer (OR 1.9) and access LinkedIn (OR 2.95), but were less likely to use an eBook reader (OR 2.63) or Facebook (OR 0.21). Discussion: CM educational institutions need to adapt in relation to teaching and learning due to the changing use of and impact of technologies by more non- traditional students. This study points to the need for further research to explore the values, attitudes and use of technology by faculty in complementary medicine institutions.
Harvie, A, Steel, A & Wardle, J 2019, 'Traditional Chinese Medicine Self-Care and Lifestyle Medicine Outside of Asia: A Systematic Literature Review.', Journal of alternative and complementary medicine (New York, N.Y.), vol. 25, no. 8, pp. 789-808.View/Download from: Publisher's site
Background: Chinese medicine, when applied as a whole system of care, traditionally incorporates self-care techniques and patient understanding as key aspects of patient recovery and health maintenance. Objectives: This review aims to explore the literature to date on Traditional Chinese Medicine (TCM) self-care in settings outside of Asia, beyond the sole application of t'ai chi or qigong, to consider simple self-care techniques as health care interventions that may be generalized to a wider population. Design: AMED, CINAHL, EMBASE, PubMed, and MEDLINE databases were searched for articles from inception to July 2018. Studies were included, which were undertaken in settings outside of Asia and/or Asian communities, and were excluded if they solely examined t'ai chi or qigong. Results: Findings of the included studies (n = 37) were categorized into four key areas in relation to the TCM self-care component evaluated: self-acupressure, self-acupuncture, self-moxibustion, and the adoption of prescribed lifestyle, diet, and exercise advice based on a TCM diagnosis. The studies included randomized clinical trials, case studies, hospital audits, and qualitative evaluations. The studies assessed TCM self-care in relation to a wide range of health conditions, with the majority of studies concluding positive findings. Conclusion: This review draws attention to the potential role of TCM self-care techniques, in settings outside of Asia, beyond the sole practices of t'ai chi and qigong, as an adjunct to health maintenance and recovery. Only tentative conclusions can be drawn from the existing research, however, due to variability across studies in reporting transparency and the overall low number of studies retrieved. Further research is warranted.
James, PB, Kaikai, AI, Bah, AJ, Steel, A & Wardle, J 2019, 'Herbal medicine use during breastfeeding: a cross-sectional study among mothers visiting public health facilities in the Western area of Sierra Leone.', BMC complementary and alternative medicine, vol. 19, no. 1.View/Download from: Publisher's site
BACKGROUND:The use of medications, including herbal medicines during breastfeeding is always a concern among women. Currently, there is no published evidence on whether Sierra Leonean women use herbal medicine during breastfeeding. This study investigates the prevalence, correlates and pattern of herbal medicine use during breastfeeding. METHODOLOGY:We conducted a cross-sectional study among 378 current breastfeeding mothers visiting public healthcare facilities within the Western area of Sierra Leone. Descriptive statistics and logistic regression analysis were used for data analysis. RESULTS:Over a third of mothers (n = 140, 37.0%) used herbal medicine during breastfeeding. However, very few herbal medicine users (2.1%, n = 3) used herbal medicine to augment breastfeeding. Dietary changes were the most common method used to increase breast milk supply (93.9%, n = 355) with cassava leaves sauce and tubers being the most common dietary addition. Mothers with children more than six months old were more likely to use herbal medicine than mothers with younger children (OR:1.8; CI:1.13-2.85,p = 0.013). Among herbal medicine users, only 11.4% (n = 16) disclosed their herbal medicine use to their conventional healthcare providers. CONCLUSION:The use of herbal medicine among breastfeeding mothers attending public health facilities in the Western area of Sierra Leone is common. Whilst this use is not usually specific to increasing breast milk supply, our study indicates that herbal medicines may be used to 'cleanse' initial breast milk.
Leech, B, Schloss, J & Steel, A 2019, 'Association between increased intestinal permeability and disease: A systematic review', Advances in Integrative Medicine, vol. 6, no. 1, pp. 23-34.View/Download from: Publisher's site
© 2018 Elsevier Ltd Objective: Increased intestinal permeability (IP) may play an important role in health and disease. The purpose of this review is to explore the association between IP and diseases frequently found within clinical practice. Design and methods: A systematic literature search was conducted up until July 2018 in MEDLINE, PubMed, EMBASE and AMED. A total of 48 articles met the inclusion/exclusion criteria. Results: IP is strongly associated with autoimmune disease and liver conditions, with the estimated prevalence of 25–87.5% and 17–65% respectively. IP also correlates with diabetes (30–65%), food allergies/hypersensitivity, irritable bowel syndrome (35.6%), polycystic ovary syndrome and autism (36.7%). Disease severity in addition to clinical symptoms of menstrual disorders, food allergy or hypersensitivity directly correlates with IP. Finally, the severity of IP appears to be exacerbated by the presence of dysbiosis, inflammation and glucose metabolism disorders. Conclusions: IP is a potentially influential factor that coincides with a variety of health conditions and diseases. IP should be considered as a factor in the pathophysiology and differential diagnosis for patient's presenting with autoimmune diseases, non-alcoholic fatty liver disease, liver cirrhosis, polycystic ovary syndrome, irritable bowel syndrome, diabetes, autism, food allergies and food hypersensitivity. Further research is required to determine if IP plays a pathogenic role in the progression and development of disease or whether the disease causes IP. While the clinical significance between IP and these diseases is unclear, the findings of the review suggest the treatment of IP in patients presenting with these conditions may warrant the consideration of clinicians.
Leech, B, Schloss, J & Steel, A 2019, 'Treatment Interventions for the Management of Intestinal Permeability: A Cross-Sectional Survey of Complementary and Integrative Medicine Practitioners.', Journal of alternative and complementary medicine (New York, N.Y.), vol. 25, no. 6, pp. 623-636.View/Download from: Publisher's site
Objectives: This study aims to explore the treatment interventions complementary and integrative medicine (CIM) practitioners use in the management of an emerging health condition, increased intestinal permeability (IP), and the association these methods have on the observed time to resolve this condition. Design and setting: A cross-sectional survey of Australian naturopaths, nutritionists, and Western herbal medicine practitioners was undertaken (n = 227) through the Practitioner Research and Collaboration Initiative (PRACI) network. Outcome measures: Frequencies and percentages of the treatment methods, including chi-square analysis to examine the associations between treatment methods and observed time to resolve IP. Results: Thirty-six CIM practitioners responded to the survey (response rate 15.9%). CIM practitioners were found to use a multimodal approach in the management of IP with 92.6% of respondents using three or more categories of treatment interventions (nutritional, herbal, dietary, and lifestyle) with a mean total of 43.0 ± 24.89 single treatment interventions frequently prescribed. The main treatments prescribed in the management of IP were zinc (85.2%), probiotics: multistrain (77.8%), vitamin D (75.0%), glutamine (73.1%), Curcuma longa (73.1%), and Saccharomyces boulardii (70.4%). CIM practitioners also advocate patients with IP to reduce alcohol (96.3%), gluten (85.2%), and dairy (75.0%) consumption. Evaluation of antibiotics (75.0%) and nonsteroidal anti-inflammatory drugs (73.1%) prescriptions were frequently advised by CIM practitioners. A longer observed time to resolve IP was seen in CIM practitioners who did not reduce intense exercise in the management of IP (p = 0.02). Conclusions: This study represents the first survey of the treatments prescribed by CIM practitioners for IP and suggests that CIM practitioners use numerous integrative treatment methods for the management of IP. The treatment interventions frequently prescribed by CIM ...
Morns, M, Bowman, D & Steel, A 2019, 'Breastfeeding difficulties: The role of integrative medicine (IM) in breastfeeding support', Advances in Integrative Medicine, vol. 6, no. 1, pp. 3-4.View/Download from: Publisher's site
The benefits of breastfeeding for mother and child have been well documented, yet only a small percentage of mothers reach their own breastfeeding goals. In part, this disconnect is due to women’s need for ongoing clinical breastfeeding support, however there is a marked difference between the type of care required by mothers and the lactation support provided in primary care settings. If appropriately trained, integrative medicine (IM) practitioners are uniquely positioned to fill this gap and provide the care nursing mothers need to meet World Health Organisation (WHO) recommendations for breastfeeding.
Many women access IM for preconception and pregnancy care [1,2]. This role in women’s maternity care offers IM practitioners an opportunity to broaden their clinical focus during this period to address the modifiable risk factors which may influence breastfeeding success in the postnatal period. With a patient-centred approach, long-standing therapeutic relationships and longer consult duration, IM lends itself to uncovering deeper issues relating to breastfeeding that may not be identified during routine antenatal check-ups or postnatal visits with a doctor. For these reasons, IM practitioners are well-positioned to holistically address breastfeeding issues, avert many common breastfeeding difficulties before they arise and provide the level of woman-centred support needed to assist women towards breastfeeding success.
Breastfeeding complications are often complex with varied and individual underlying causes which can be physical, social and/or emotional in nature. Many women experience a lack of confidence as a result of a perceived difference between their actual and expected milk supply while breastfeeding . They often do not receive adequate ongoing clinical support to increase milk supply in a way that facilitates natural, physiological mechanisms and emphasises the health of the mother and baby. Research examining infant feeding practices has found t...
Schloss, J, Ryan, K, Reid, R & Steel, A 2019, 'A randomised, double-blind, placebo-controlled clinical trial assessing the efficacy of bedtime buddy® for the treatment of nocturnal enuresis in children.', BMC pediatrics, vol. 19, no. 1, pp. 421-421.View/Download from: Publisher's site
BACKGROUND:Nocturnal enuresis (NE), or 'bedwetting', is a form of night-time urinary incontinence occurring in younger children. A diagnosis of NE can be socially disruptive and psychologically stressful for a child. The most common strategies used by parents to manage NE are waking the child during the night to use the bathroom and limiting the child's water intake before going to bed. Behavioural or educational therapies for NE such as urotherapy or bladder retraining are widely accepted and considered as a mainstream treatment option for non-neurogenic lower urinary tract dysfunction in children. Pharmacotherapy also plays an ancillary role. However, there is no gold standard therapy or intervention to effectively manage NE. METHODS:This study aims to determine the efficacy of a herbal combination in the treatment of NE in children. The target population for this study is 80 children aged between 6 and 14 years old (males and females) who have primary nocturnal enuresis ≥3 per week (wet nights). The active group will receive one or two capsules per day containing 420 mg of a proprietary blend of Urox® (Seipel Group, Brisbane, Australia) containing Cratevox™ (Crataeva nurvala L; Capparidaceae; Varuna) stem bark extract standardised for 1.5% lupeol: non-standardised Equisetum arvense L. (Equisetaceae; Horsetail) stem extract; and, non-standardised Lindera aggregata Sims. The primary outcome for this study is the frequency of nocturia. Secondary outcomes include safety, quality of life, and daytime incontinence. Each participation will be involved in the trial for 32 weeks including contact with the research team every 2 weeks for the first 8 weeks and then every 8 weeks until trial completion. DISCUSSION:This study examines a novel treatment for an under-researched health condition affecting many children. Despite the availability of several therapies for NE, there is insufficient evidence to support the use of any one intervention and as such this randomised pl...
Steel, A, Rainforest, J & Schloss, J 2019, 'Verifying the validity of urinary kryptopyrrole (UKP) testing in an adult population: Protocol for a multi-stage research project', Advances in Integrative Medicine, vol. 6, no. 3, pp. 120-125.View/Download from: Publisher's site
© 2019 Elsevier Ltd Introduction: Urinary kryptopyrroles (UKP) are described as pyrrole compounds excreted in urine and have been associated with a broad range of signs and symptoms. However, causality between elevated UKP and the described symptoms of pyrrole disorder have not been established. A four stage project has been developed to verify the validity of a urinary kryptopyrroles test and attempt to establish a reference range for a healthy population. Methods: Stage one will consist of a survey to clinicians who are currently using UKP testing in their practice to understand their perceptions of the clinical value and applicability of the test in addition to identifying the condition for stage three. Stage two consists of a clinical trial to establish a normal reference range for UKP in a healthy population. Stage three is a clinical trial exploring the correlation, if any, between UKP in a diagnosed health condition to the healthy population group. Stage four is a pragmatic trial assessing UKP levels in patients as used by clinicians as part of routine clinical practice. Recruitment: Recruitment for stage one will be via email invitation to SAFE Analytical laboratories Pty Ltd customer database. Stage two and three will be targeting the wider community in the greater Brisbane area in Queensland and aims to recruit 120 participants per stage. Recruitment for stage four will be conducted through community based clinical practices. Conclusion: At the conclusion of all stage, the validation of the UKP test from SAFE Analytical laboratories will be analysed. Formulation of a reference range for a healthy population range will be explored and compared to a diagnosed condition and other conditions as tested by clinicians in practice.
Wardle, J, Steel, A, Casteleijn, D & Bowman, D 2019, 'An evidence-based overview of naturopathic practice in Australia', Australian Journal of Herbal and Naturopathic Medicine, vol. 31, no. 1, pp. 9-14.View/Download from: Publisher's site
© NHAA 2019. Naturopaths are consulted by 6.2% of the Australian adult population, which is comparable to the rates of consultations with acupuncturists (7.9%) and osteopaths (5.4%)1. The Review of the Australian Government Rebate on Natural Therapies for Private Health Insurance2 (‘the Natural Therapies Review’) found there is evidence to suggest whole-system naturopathic practice is effective in improving patient health for a range of chronic health conditions. However, the Natural Therapies Review noted the unregulated nature of the workforce made it difficult to apply in the Australian context, particularly as most of the identified research was conducted in North America. Yet, Australian naturopathic education is comparable in both length and breadth to North American courses. The Australian naturopathic profession has been calling for registration for many years3 and every government report in the last 20 years examining the need for registration of naturopathy has recommended this should occur4. Despite the continued exclusion of naturopaths from the prevailing Australian regulatory mode, the profession has grown in size, strength and professional status at a national and international level. For example, the regulatory model developed by the naturopathic profession in lieu of government registration5 is held up as a best-practice model for self-regulation that could be adopted by other unregistered health professions. Alongside this, Australian naturopathic education is recognised by the international peak body — the World Naturopathic Federation (WNF) — as aligning with the highest tier of professional qualification internationally6 and Australian naturopathic researchers attract more government research funding than other registered complementary medicine professions. Even so, since the Natural Therapies Review in 2013 the evidence for whole-system naturopathic practice has continued to increase: Whereas the Natural Therapies Review found only one syste...
Steel, A, Bradley, R & Wardle, J 2019, 'Naturopathic Research: Prevalent, Relevant, But Largely Hidden in Plain Sight.', Journal of alternative and complementary medicine (New York, N.Y.), vol. 25, no. 2, pp. 123-124.View/Download from: Publisher's site
Adams, J & Steel, A 2019, 'Future-Proofing the Field of Naturopathy Research: Nurturing International Research Leadership in an Evolving Profession.', Journal of Alternative and Complementary Medicine.View/Download from: Publisher's site
Agu, JC, Hee-Jeon, Y, Steel, A & Adams, J 2019, 'A Systematic Review of Traditional, Complementary and Alternative Medicine Use Amongst Ethnic Minority Populations: A Focus Upon Prevalence, Drivers, Integrative Use, Health Outcomes, Referrals and Use of Information Sources.', Journal of Immigrant and Minority Health, vol. 21, pp. 1137-1156.View/Download from: Publisher's site
Ethnic minority populations have been identified as high users of traditional, complementary and alternative medicine (TCAM). This paper reports the systematic review of TCAM use amongst ethnic minorities. A comprehensive literature search was conducted in Ovid, PubMed and CINAHL. Included studies were original, peer-reviewed, English language articles with the primary focus on TCAM use amongst ethnic minority populations. A total of 17 articles met the inclusion criteria and were included in the systematic review. A considerable level of TCAM use was observed amongst ethnic minority populations usually attributed to its perceived safe and natural properties. Ethnic minority populations predominantly used TCAM concurrently with conventional medicine and primary TCAM referral sources were family and friends. A substantial level of TCAM integration with conventional medicine is common practice amongst these populations and the lack of disclosure about TCAM use raises an important area for further research inquiry.
Foley, H, Steel, A, Cramer, H, Wardle, J & Adams, J 2019, 'Disclosure of complementary medicine use to medical providers: a systematic review and meta-analysis.', Scientific reports, vol. 9, no. 1.View/Download from: Publisher's site
Concomitant complementary medicine (CM) and conventional medicine use is frequent and carries potential risks. Yet, CM users frequently neglect to disclose CM use to medical providers. Our systematic review examines rates of and reasons for CM use disclosure to medical providers. Observational studies published 2003-2016 were searched (AMED, CINAHL, MEDLINE, PsycINFO). Eighty-six papers reporting disclosure rates and/or reasons for disclosure/non-disclosure of CM use to medical providers were reviewed. Fourteen were selected for meta-analysis of disclosure rates of biologically-based CM. Overall disclosure rates varied (7-80%). Meta-analysis revealed a 33% disclosure rate (95%CI: 24% to 43%) for biologically-based CM. Reasons for non-disclosure included lack of inquiry from medical providers, fear of provider disapproval, perception of disclosure as unimportant, belief providers lacked CM knowledge, lacking time, and belief CM was safe. Reasons for disclosure included inquiry from medical providers, belief providers would support CM use, belief disclosure was important for safety, and belief providers would give advice about CM. Disclosure appears to be influenced by the nature of patient-provider communication. However, inconsistent definitions of CM and lack of a standard measure for disclosure created substantial heterogeneity between studies. Disclosure of CM use to medical providers must be encouraged for safe, effective patient care.
Gray, AC, Steel, A & Adams, J 2019, 'A critical integrative review of complementary medicine education research: key issues and empirical gaps.', BMC complementary and alternative medicine, vol. 19, no. 1.View/Download from: Publisher's site
BACKGROUND:Complementary Medicine (CM) continues to thrive across many countries. Closely related to the continuing popularity of CM has been an increased number of enrolments at CM education institutions across the public and private tertiary sectors. Despite the popularity of CM across the globe and growth in CM education/education providers, to date, there has been no critical review of peer-reviewed research examining CM education undertaken. In direct response to this important gap, this paper reports the first critical review of contemporary literature examining CM education research. METHODS:A review was undertaken of research to identify empirical research papers reporting on CM education published between 2005 and 17. The search was conducted in May 2017 and included the search of PubMed and EBSCO (CINAHL, MEDLINE, AMED) for search terms embracing CM and education. Identified studies were evaluated using the STROBE, SRQP and MMAT appraisal tools. RESULTS:From 9496 identified papers, 18 met the review inclusion criteria (English language, original empirical research data, reporting on the prevalence or nature of the education of CM practitioners), and highlighted four broad issues: CM education provision; the development of educational competencies to develop clinical skills and standards; the application of new educational theory, methods and technology in CM; and future challenges facing CM education. This critical integrative review highlights two key issues of interest and significance for CM educational institutions, CM regulators and researchers, and points to number of significant gaps in this area of research. There is very sporadic coverage of research in CM education. The clear absence of the robust and mature research regarding educational technology and e-learning taking place in medical and or allied health education research is notably absent within CM educational research. CONCLUSION:Despite the high levels of CM use in the community, and t...
James, PB, Wardle, J, Steel, A & Adams, J 2019, 'Pattern of health care utilization and traditional and complementary medicine use among Ebola survivors in Sierra Leone.', PloS one, vol. 14, no. 9.View/Download from: Publisher's site
BACKGROUND:It is well established that Ebola Survivors experience a myriad of physical and psychological sequelae. However, little is known about how they seek care to address their health needs. Our study determines the current healthcare seeking behaviour among Ebola survivors and determines the prevalence, pattern of use and correlates of traditional and complementary medicine (T&CM) use among Ebola survivors in Sierra Leone. METHODS:We conducted a nationwide questionnaire survey among a cross-sectional sample of Ebola Survivors in Sierra Leone between January and August 2018. We employed descriptive statistics, chi-square test, Fisher exact two-tailed test and backward stepwise binary regression analysis for data analysis. A p-value less than 0.05 was considered statistically significant. RESULTS:Ebola Survivors who participated in our study (n = 358), visited a healthcare provider (n = 308, 86.0%), self-medicated with conventional medicines (n = 255, 71.2%) and visited a private pharmacy outlet (n = 141, 39.4%). Survivors also self-medicated with T&CM products (n = 107, 29.9%), concurrently self-medicated with conventional and T&CM products (n = 62, 17.3%), and visited a T&CM practitioner (n = 41, 11.5%). Almost half of (n = 163, 45.5%) Ebola survivors reported using T&CM treatments for post ebola related symptoms and non-Ebola related symptoms since their discharge from an Ebola treatment centre. Ebola survivors who considered their health to be fair or poor (AOR = 4.08; 95%CI: 2.22-7.50; p<0.01), presented with arthralgia (AOR = 2.52; 95%CI: 1.11-5.69, p = 0.026) and were discharged three years or less (AOR = 3.14; 95%CI: 1.13-8.73, p = 0.028) were more likely to use T&CM. Family (n = 101,62.0%) and friends (n = 38,23.3%) were the common sources of T&CM information. Abdominal pain (n = 49, 30.1%) followed by joint pain (n = 46, 28.2%) and back pain (n = 43, 26.4%) were the most cited post-Ebola indications for T&CM use. More than three-quarters of T&CM use...
James, PB, Wardle, J, Steel, A & Adams, J 2019, 'Post-Ebola psychosocial experiences and coping mechanisms among Ebola survivors: a systematic review.', Tropical medicine & international health : TM & IH, vol. 24, no. 6, pp. 671-691.View/Download from: Publisher's site
OBJECTIVE:A myriad of physical and psychosocial sequelae have been reported among Ebola survivors from previous Ebola virus disease (EVD) outbreaks, including the most recent in West Africa. This review examines the various forms of psychological distress experienced by EVD survivors, family and community reactions to EVD survivors and EVD survivors' coping mechanisms. METHODS:We conducted a literature search of original articles employing Medline (Ovid), PubMed, Web of Science, Scopus, CINAHL, EBSCO host academic search complete, PsycINFO (EBSCO) and Embase databases. RESULTS:Our search identified 1890 articles of which 24 met our inclusion criteria. Various forms of psychological distress were prevalent among EVD survivors including depression, anxiety, anger, grief, guilt, flashbacks, sadness, worthlessness, substance addiction, suicidal tendencies and self-stigmatisation. Family and community responses to EVD survivors ranged from acceptance to rejection, isolation, stigmatisation and discrimination. EVD survivors' coping strategies included engagement with religious faith, EVD survivors associations and involvement in EVD prevention and control interventions. CONCLUSION:Psychological distress, including that resulting from family and community stigma and discrimination, appears common among EVD survivors. Community-based mental health and psychosocial interventions integrated within a broader package of care for EVD survivors that also recognises the physical health challenges are required. Well-designed longitudinal studies can provide clear insights on the nature and trajectory of the psychosocial issues currently experienced by EVD survivors.
James, PB, Wardle, J, Steel, A & Adams, J 2019, 'Utilisation of and Attitude towards Traditional and Complementary Medicine among Ebola Survivors in Sierra Leone.', Medicina (Kaunas, Lithuania), vol. 55, no. 7.View/Download from: Publisher's site
Background and objectives: In addition to conventional healthcare, Ebola survivors are known to seek traditional and complementary healthcare (T&CM) options to meet their healthcare needs. However, little is known about the general beliefs of Ebola survivors regarding T&CM and the impact of these beliefs in influencing their decisions around T&CM use. This study examines Ebola survivors' attitudes towards T&CM use in Sierra Leone. Materials and Methods: We conducted a nationwide quantitative cross-sectional study of 358 Ebola survivors in Sierra Leone between January and August 2018. We used descriptive analysis, chi-square tests and backward stepwise binary logistic regression for data analysis. Results: Close to half of the survivors (n = 163, 45.5%) had used T&CM since their discharge from an Ebola treatment centre. Survivors who viewed T&CM as boosting their immune system/resistance were 3.89 times (95%CI: 1.57-9.63, p = 0.003) more likely to use T&CM than those who did not view T&CM as boosting their immune system/resistance. Additionally, survivors who viewed T&CM as having fewer side effects than conventional medicine were more likely to use T&CM [OR = 5.03 (95%CI: 1.92-13.19, p = 0.001)]. Ebola survivors were more influenced to use T&CM based on their personal experience of the effectiveness of T&CM than by clinical evidence [OR = 13.72 (95%CI: 6.10-30.84, P < 0.001)]. Ebola survivors who perceived T&CM as providing them with more control than conventional medicine over their health/body were more likely to use T&CM [OR = 4.15 (95%CI: 1.74-9.89, p = 0.001)] as opposed to those who did not perceive T&CM in this way. Conclusions: Considering the widespread use of T&CM, an understanding of Ebola survivors' attitudes/beliefs towards T&CM is useful to healthcare providers and policymakers with regard to public education and practitioner-survivors communication, T&CM regulation and research in Sierra Leone. Ebola survivors appear to turn to T&CM not only for tr...
Reid, R, Steel, A, Wardle, J & Adams, J 2019, 'Naturopathic Medicine for the Management of Endometriosis, Dysmenorrhea, and Menorrhagia: A Content Analysis.', Journal of Alternative and Complementary Medicine, vol. 25, no. 2, pp. 202-226.View/Download from: Publisher's site
OBJECTIVES:To explore the recommendations of naturopathic medicine for the management of endometriosis, dysmenorrhea, and menorrhagia, drawing on traditional and contemporary sources. DESIGN:Content analysis. SETTING:Australia, Canada, and the United States of America (USA). SUBJECTS:Contemporary sources were identified from reviewing naturopathic higher education institutions' recommended texts, while traditional sources were identified from libraries which hold collections of naturopathic sources. Sources were included if they were published from 1800 to 2016, were in English, published in Australia, Canada, or the USA, and reported on the topic. Included sources were as follows: 37 traditional texts; 47 contemporary texts; and 83 articles from naturopathic periodicals. RESULTS:Across included sources, the most reported disciplines were herbal medicine, clinical nutrition, mineral medicines, homeopathy, hydrotherapy, and chemical-based medicines. Herbal medicines were extensively reported from all sources for the management of endometriosis, dysmenorrhea, and menorrhagia. Clinical nutrition was only recommended from contemporary sources for all three conditions. Mineral medicines were mentioned in both traditional and contemporary sources, but were only recommended for dysmenorrhea and menorrhagia. There were limited recommendations for homeopathy and hydrotherapy treatments in all conditions across all sources. Chemical-based medicines were only mentioned for dysmenorrhea and menorrhagia, and recommendations ceased after 1922. Recommendations for endometriosis were not present in any of the traditional sources, across all reported disciplines. CONCLUSIONS:The findings of this article provide insights into the documented historical and contemporary treatments within naturopathic medicine for endometriosis, dysmenorrhea, and menorrhagia. While philosophical principles remain the core of naturopathic practice, the therapeutic armamentarium appears to have changed...
Steel, A, Peng, W, Gray, A & Adams, J 2019, 'The Role and Influence of Traditional and Scientific Knowledge in Naturopathic Education: A Qualitative Study.', Journal of Alternative and Complementary Medicine, vol. 25, no. 2, pp. 196-201.View/Download from: Publisher's site
OBJECTIVES:To explore the perceptions, experiences, and attitudes toward scientific and traditional knowledge within contemporary naturopathic education. DESIGN:A qualitative focus group and semistructured individual interview study. SETTINGS/LOCATION:Naturopathic educational organizations and institutions in North America (United States/Canada) and Australia. SUBJECTS:Seven focus groups (three in Australia and four in the United States/Canada) involving a total of 29 students, and one-on-one interviews with 28 faculty and professional leaders of the naturopathic profession from Australia, Canada, and the United States. RESULTS:Four themes have been identified in this study, including finding the balance between traditional and scientific knowledge; supporting the balance through critical appraisal in the curriculum; the exception of traditional knowledge in the critical gaze; and focusing on critical thinking in the naturopathic curriculum. Both naturopathic students and leaders highlight the significance of balancing tradition and science in the naturopathic educational context, although they hold diverse differing viewpoints. The importance of critical appraisal skills as well as the differentiation between critical thinking and critical appraisal have also been emphasized by participants with regard to the future development of naturopathic curriculum. CONCLUSIONS:This is the first study focusing on the interface between traditional and scientific knowledge within the naturopathic education setting. The development of a framework for the critical appraisal of traditional naturopathic knowledge is required to help navigate the variety of knowledge sources available to naturopathic students and to help deliver the best outcomes for their future clinical practice.
Bishop, FL, Lauche, R, Cramer, H, Pinto, JW, Leung, B, Hall, H, Leach, M, Chung, VC, Sundberg, T, Zhang, Y, Steel, A, Ward, L, Sibbritt, D & Adams, J 2019, 'Health Behavior Change and Complementary Medicine Use: National Health Interview Survey 2012.', Medicina (Kaunas, Lithuania), vol. 55, no. 10.View/Download from: Publisher's site
Background and objectives: Complementary and alternative medicine (CAM) use has been associated with preventive health behaviors. However, the role of CAM use in patients' health behaviors remains unclear. This study aimed to determine the extent to which patients report that CAM use motivates them to make changes to their health behaviors. Materials and Methods: This secondary analysis of 2012 National Health Interview Survey data involved 10,201 CAM users living in the United States who identified up to three CAM therapies most important to their health. Analyses assessed the extent to which participants reported that their CAM use motivated positive health behavior changes, specifically: eating healthier, eating more organic foods, cutting back/stopping drinking alcohol, cutting back/quitting smoking cigarettes, and/or exercising more regularly. Results: Overall, 45.4% of CAM users reported being motivated by CAM to make positive health behavior changes, including exercising more regularly (34.9%), eating healthier (31.4%), eating more organic foods (17.2%), reducing/stopping smoking (16.6% of smokers), or reducing/stopping drinking alcohol (8.7% of drinkers). Individual CAM therapies motivated positive health behavior changes in 22% (massage) to 81% (special diets) of users. People were more likely to report being motivated to change health behaviors if they were: aged 18-64 compared to those aged over 65 years; of female gender; not in a relationship; of Hispanic or Black ethnicity, compared to White; reporting at least college education, compared to people with less than high school education; without health insurance. Conclusions: A sizeable proportion of respondents were motivated by their CAM use to undertake health behavior changes. CAM practices and practitioners could help improve patients' health behavior and have potentially significant implications for public health and preventive medicine initiatives; this warrants further research attention.
Harnett, JE, McIntyre, E, Steel, A, Foley, H, Sibbritt, D & Adams, J 2019, 'Use of complementary medicine products: a nationally representative cross-sectional survey of 2019 Australian adults.', BMJ open, vol. 9, no. 7.View/Download from: Publisher's site
OBJECTIVES:To provide a contemporary description of complementary medicine (CM) product use in Australia. DESIGN:Cross-sectional survey. SETTING:Online. PARTICIPANTS:A nationally representative sample (n=2019) of the Australian adult population. PRIMARY AND SECONDARY OUTCOME MEASURES:Primary outcomes measures included the use and type of CM products used, and source of recommendation. Secondary measures included disclosure of CM product use to health practitioners, concomitant use of pharmaceuticals and predictors of use. RESULTS:Prevalence of CM product use was 50.3%, with the most frequently used being vitamin and mineral supplements (VMSs; 47.8%) and homoeopathic medicines the least used (6.8%). A majority of respondents using CM products were also using pharmaceutical products, and small but significant associations were found between the use of CM products and pharmaceuticals (p<0.05). Small statistically significant associations were found between use of vitamin products and disclosure of use to general practitioners (GPs; Cramer's V=0.13, p=0.004) and hospital doctors (Cramer's V=0.11, p=0.04), and between use of herbal medicines and disclosure to both GPs (Cramer's V=0.11, p=0.02) and hospital doctors (Cramer's V=0.12, p=0.03). Women, those with higher education and those with no private health insurance were more likely to use CM products (p<0.05), while those without chronic conditions were less likely to use CM products (p<0.05) (χ2(29)=174.70, p<0.001). CONCLUSIONS:The number of Australians using CM products has remained relatively stable and substantial for nearly two decades. The majority of CM use relates to VMSs. Given the number of Australians using both CM products and pharmaceutical medicines, it is important to evaluate the potential clinical implications of such practices to ensure safe, effective and coordinated health policy and patient care.
Lee, H, Peng, W, Steel, A, Reid, R, Sibbritt, D & Adams, J 2019, 'Complementary and alternative medicine research in practice-based research networks: A critical review.', Complementary therapies in medicine, vol. 43, pp. 7-19.View/Download from: Publisher's site
AIMS:To provide a critical analysis of peer-reviewed literature reporting research from practice-based research networks (PBRNs) relating to complementary and alternative medicine (CAM). METHODS:A comprehensive literature search of peer-reviewed literature reporting PBRN research focusing upon CAM was conducted in PubMed, Ovid Medline, EMBASE, and CINAHL from their inceptions to June 2017. PBRN registry and websites of relevant PBRNs were also searched for further information. With regards to the nested PBRN studies included in our review, no study design restrictions were imposed and both empirical research and relevant methodologically-focused manuscripts were included. Methodological quality was evaluated via a number of established tools. RESULTS:A total of 51 articles reporting upon CAM research in PBRNs including six articles outlining CAM-focused PBRN establishment were included in the review. The findings of the literature were categorised as either: health services research (including work examining characteristics of patients and practices, doctor-patient communication, and CAM prevalence); effectiveness/safety research; or feasibility research. While 19 studies from non-CAM focused PBRNs tended to report on CAM prevalence and doctor-patient communication about CAM use, 26 articles from CAM-focused PBRNs reported on the characteristics of CAM users, practice patterns, and effectiveness/safety of CAM practice. DISCUSSION AND CONCLUSION:PBRNs - both CAM-focused and non-CAM focused - have provided a useful platform for research investigations around a number of core CAM-related issues. Given the increasing popularity of CAM use in healthcare and the identified benefits of practice-relevant research, further in-depth CAM research nested within PBRN designs is warranted.
Leech, B, McIntyre, E, Steel, A & Sibbritt, D 2019, 'Risk factors associated with intestinal permeability in an adult population: A systematic review.', International Journal of Clinical Practice, vol. 73, no. 10, pp. e13385-e13385.View/Download from: Publisher's site
BACKGROUND:Increased intestinal permeability (IP) involves the loss of integrity between the cells of the small intestine. IP has been suggested to contribute to the pathogenesis and exacerbation of many chronic diseases. Many potential risk factors for IP are proposed in contemporary literature. The purpose of this review is to identify the most significant risk factors for IP. METHODS:A systematic search of literature published up until September 2018 in the PubMed, EMBASE, CINAHL, and Scopus databases was conducted. RESULTS:A total of 47 articles met the inclusion criteria. Elevated levels of proinflammatory markers, dyslipidaemia, hyperglycaemia, insulin resistance, anthropometric measurements resembling obesity, advanced disease severity, comorbidity and the consumption of a Western-style diet were identified as the strongest risk factors for altered intestinal integrity. The risk of IP increases when coupled with a multiple disease state or combined with other environmental risk factors. Furthermore, many of the identified risk factors such as anthropometric measurements and biomarkers were external from intestinal health and rather resembled a metabolic-like condition. CONCLUSIONS:This review identified a number of potential risk factors for IP, ranging from biomarkers to anthropometric measurements, demographics, dietary intake and chronic diseases. These risk factors warrant the attention of clinicians and other healthcare providers to aid the identification of potential patients at risk of altered IP. Further research needs to examine whether the identified risk factors are homogeneous with the diagnosis of IP or whether the disease state influences the association.
Steel, A, Munk, N, Wardle, J, Adams, J, Sibbritt, D & Lauche, R 2019, 'Generational differences in complementary medicine use in young Australian women: Repeated cross-sectional dataset analysis from the Australian longitudinal study on women's health.', Complementary therapies in medicine, vol. 43, pp. 66-72.View/Download from: Publisher's site
OBJECTIVE:Examine the generational differences in complementary medicine (CM) utilisation between young women from the X and Millennial generations. DESIGN:Secondary analysis of two cross-sectional surveys from the Australian Longitudinal Study on Women's Health (ALSWH). SETTING:Australia. MAIN OUTCOME MEASURES:Differences between young Generation X women (surveyed 1996; aged 18-23 years), and Millennial women (surveyed 2014; aged 19-24 years) regarding consultations with CM practitioners, sociodemographic characteristics, and health. Predictors for CM consultations were analysed via logistic regression analyses. RESULTS:Of the 14,247 Generation X women, 19.4% reported consulting CM, compared to 26.8% of the 11,344 Millennial women. CM consultations was predicted in both cohorts by higher age, education beyond primary school, non-urban (vs. urban) residence, and frequent back pain or headaches. Obesity and regular smoking predicted non-use in both. Significant cohort differences were found in physical activity levels (moderate/high levels associated with increased CM consultations in Millennial, but not Generation X women), and health status (Generation X women reporting fair-poor health were more likely to consult CM practitioners, while Millennial women reporting good health were less likely to do so, compared to women with very good/excellent health). CONCLUSIONS:The increase in CM utilization among young Australian women from Generation X compared to the Millennial generation could indicate different health consumer patterns for future middle-aged and older adult Australian women. Further increases in CM usage may be observed as current young women age into characteristics traditionally linked with higher CM use such as worsening health status and increased disposable income.
Steel, A, Vaughan, B, Orrock, P, Peng, W, Fleischmann, M, Grace, S, Engel, RM, Sibbritt, D & Adams, J 2019, 'Prevalence and profile of Australian osteopaths treating older people.', Complementary therapies in medicine, vol. 43, pp. 125-130.View/Download from: Publisher's site
OBJECTIVES:To explore the characteristics of the Australian osteopathy workforce who participate in the management of older patients with musculoskeletal complaints. DESIGN:Secondary analysis of a cross-sectional survey of osteopaths. SETTING:The Osteopathy Research and Innovation Network (ORION), an Australian practice-based research network. MAIN OUTCOME MEASURES:The demographic, practice and treatment characteristics of osteopaths who identify as 'always'or 'often' treating patients aged 65 years or over. RESULTS:Over half (58%) of total participants (n = 992) indicated often treating older people and this was associated with referral patterns with other health professionals and a non-urban practice location. Osteopaths providing care to older people were more likely to discuss diet/nutrition and medications, and provide pain counselling. Osteopaths who treated older adults were more likely to treat shoulder musculoskeletal disorders, degenerative spine disorders, chronic or persistent pain, and tendinopathies. CONCLUSIONS:A substantial proportion of Australian osteopaths treat older adults frequently. The potential value and impact of osteopathy in managing the health needs of an ageing population warrants close examination from both researchers and policy makers.
Steel, A, Hall, H, Diezel, H, Wardle, J & Adams, J 2019, 'Filling the gaps in contemporary maternity care: The perceptions of complementary medicine practitioners providing care to women during pregnancy.', Complementary therapies in clinical practice, vol. 34, pp. 174-178.View/Download from: Publisher's site
BACKGROUND AND PURPOSE:As many as one in two women consult with a complementary medicine (CM) practitioner for pregnancy-related health care, yet little is known about the reason for such a high rate of use. This paper presents the perceptions of CM practitioners regarding the role they play within the existing maternity care system. MATERIALS AND METHODS:Semi-structured interviews with 23 CM practitioners were conducted and the transcripts analysed, using a Framework approach. RESULTS:Key themes pertaining to the perceived role of CM practitioners in maternity care emerged. (1) Becoming a maternity care provider: responding to a need and filling gaps in the system; (2) Characterising CM maternity care: Holistic, nurturing and addressing unmet health concerns and; (3) Treating health complaints neglected by conventional maternity care. CONCLUSION:CM practitioners often acknowledge their specialist roles as part of a multidisciplinary team of practitioners rather than attempting to offer comprehensive pregnancy care.
Gan, WC, Smith, L, McIntyre, E, Steel, A & Harnett, JE 2019, 'The prevalence, characteristics, expenditure and predictors of complementary medicine use in Australians living with gastrointestinal disorders: A cross-sectional study.', Complementary therapies in clinical practice, vol. 35, pp. 158-169.View/Download from: Publisher's site
AIMS:To determine the prevalence, characteristics, expenditure and predictors of complementary medicine (CM) use in Australian adults living with gastrointestinal disorders (GID). METHODS:A cross-sectional study involving 2,025 Australian adults was conducted. Participants were recruited through purposive convenience sampling. Descriptive statistics were conducted to report the prevalence of people living with GIDs and their CM use, including CM products, mind-body practices and CM practitioner services. Chi-square test and independent-samples t-test were used to determine the associations between sociodemographic or health-related variables with CM use. Binary logistic regression was conducted to determine the significant predictors of CM use in GID participants. Economic data was calculated based on the mean out-of-pocket expenditure on CM. RESULTS:Of the 293 participants reporting a GID, 186 (63.5%) used CM products, 55 (18.8%) used a mind-body practice and 141 (48.1%) visited at least one CM practitioner in the last 12 months. Collectively, the majority of GID participants using any type of CM were female, aged 40-49 years, married and employed. The mean score for health-related quality of life was 49.6 out of 100 in GID participants and 68.2 in participants without a GID (p < 0.001). Average annual out-of-pocket expenditure on CM products was AUD127.29 by CM products users with a GID. The predictors of CM products, mind-body practices and CM practitioner services use differed. Of the 111 CM product users with a GID, 103 (92.8%) disclosed all or some of their CM use to general practitioner, 89 (80.2%) to specialist doctor, 79 (71.2%) to pharmacist and 69 (62.1%) to hospital doctor. CONCLUSIONS:A substantial proportion of Australian adults living with GID use CM products, mind-body practices and CM practitioner services. This study provides important insights to inform and guide the development of a more coordinated health care services for individuals living ...
McIntyre, E, Adams, J, Foley, H, Harnett, J, Leach, MJ, Reid, R, Schloss, J & Steel, A 2019, 'Consultations with Naturopaths and Western Herbalists: Prevalence of Use and Characteristics of Users in Australia.', Journal of Alternative and Complementary Medicine, vol. 25, no. 2, pp. 181-188.View/Download from: Publisher's site
OBJECTIVES:To report the prevalence of naturopathic and Western herbal medicine service utilization in Australia, and describe the characteristics of individuals who use these services. DESIGN:This is a national cross-sectional study. SETTINGS:Online survey platform. SUBJECTS:Purposive convenience sampling was used to recruit 2025 adults who were matched to Australian population demographics by gender, age, and state of residence. INTERVENTIONS:A survey instrument consisting of 50 items covering demographics, health service utilization, health status, health literacy, and medicine disclosure to complementary healthcare providers. OUTCOME MEASURES:The prevalence, frequency, and cost of naturopathy and Western herbal medicine consultations and sociodemographic characteristics of users of naturopathic and Western herbalist services and associations between these factors. RESULTS:The final data set included 2019 participants: 6.2% (n = 126) consulted a naturopath and 3.8% (n = 76) a Western herbalist. These health services were most commonly used to improve well-being. An average of AUD$102.67 and AUD$49.64 was spent per user on consultations with naturopaths and Western herbalists, respectively, in the previous year. The most prevalent users were those between 18 and 29 years of age (39.3%), in a relationship (51%), employed (70%), and held a bachelor degree or higher (40.5%). Some degree of financial difficulty was reported by 65.4% of users. Having a chronic illness (p < 0.01) and using both conventional and complementary medicines (p = 0.05) were both associated with using naturopathic or Western herbal medicine services. Less than 40% of participants disclosed their use of conventional medicines to Western herbalists. CONCLUSIONS:Naturopathy and Western herbal medicine services are used by a substantial number of Australian adults who also use conventional health services. Accordingly, research is needed to determine how these health professions can be better in...
Reid, R, Steel, A, Wardle, J, McIntyre, E, Harnett, J, Foley, H & Adams, J 2019, 'The prevalence of self-reported diagnosed endometriosis in the Australian population: results from a nationally-representative survey.', BMC research notes, vol. 12, no. 1.View/Download from: Publisher's site
OBJECTIVE:Currently, it is estimated that one in 10 women of reproductive age are affected by the reproductive condition known as endometriosis. However, there has been limited research and policy attention on the prevalence of endometriosis in Australia. Utilising a nationally-representative Australian sample (N = 2025), this study aimed to report on the prevalence of endometriosis in the general population and to examine the sociodemographic factors associated with the condition. RESULTS:The results identified a prevalence rate for endometriosis of 3.4%, which aligns with previous Australian research on this topic. However, the prevalence rate from this data set is lower than the estimate prevalence from the Global Burden of Disease Study. In addition, this study reported that women self-reporting diagnosis of endometriosis, were between 40-49 years of age, with a higher proportion living in South Australia (18.2%) compared to women within the general population (8.4%). The findings highlight endometriosis as a significant health care issue warranting further research and policy attention. While acknowledging some limitations, the study provides an important foundation for further large-scale research to be conducted on this important women's health topic.
Schloss, J, McIntyre, E, Steel, A, Bradley, R, Harnett, J, Reid, R, Hawrelak, J, Goldenberg, J, Van De Venter, C & Cooley, K 2019, 'Lessons from outside and within: Exploring advancements in methodology for naturopathic medicine clinical research', Journal of Alternative and Complementary Medicine, vol. 25, no. 2, pp. 135-140.View/Download from: Publisher's site
James, PB, Bah, AJ, Tommy, MS, Wardle, J & Steel, A 2018, 'Herbal medicines use during pregnancy in Sierra Leone: An exploratory cross-sectional study', Women and Birth.View/Download from: Publisher's site
© 2017 Australian College of Midwives. Background: The influence of complementary therapies on maternal health has attracted the attention of policy makers, health professionals and researchers globally especially in developing countries. However, there is lack of evidence on whether Sierra Leonean women use herbal medicine during pregnancy which limit the chance of providing better maternity care. Aim: This study was conducted to determine the prevalence and pattern of herbal medicines use among pregnant women attending an antenatal clinic at a tertiary maternal hospital in Sierra Leone. Methods: A cross-sectional study was conducted among pregnant women (n = 134) who were at least 18 years of age and who have had at least one previous pregnancy, using face to face interview. Descriptive statistics, univariate and multivariate logistic regression analysis were used for data analysis. Results: The response rate was 82.7%. Nearly two-thirds of pregnant women reported using herbal medicine (62.7%). Herbal medicine users were more likely to be Muslim than Christian. Luffa acutangula (L.) Roxb was the most cited herbal medicine used and was mostly indicated for urinary tract infection and pedal oedema. Perceived effectiveness and safety over conventional medicine (70.2%) was key driver for use, and majority did not disclose their use of herbs to their maternal health professional (95.2%). Conclusion: Herbal medicine use among pregnant women in this study was widespread. Maternal health providers should be aware of this relatively common practice and routinely discuss and educate pregnant women on the potential risks and benefits associated with the use of herbs.
James, PB, Kamara, H, Bah, AJ, Steel, A & Wardle, J 2018, 'Herbal medicine use among hypertensive patients attending public and private health facilities in Freetown Sierra Leone.', Complementary therapies in clinical practice, vol. 31, pp. 7-15.View/Download from: Publisher's site
This study aimed to determine the prevalence, determinants and pattern of herbal medicine use among hypertensive patients in Freetown.We conducted a cross-sectional study among hypertensive patients attending public and private health facilities in Freetown, Sierra Leone between August and October 2016. We analyzed the data using SPSS version 24. We used Chi-square, Fisher exact two-tailed test and regression analysis for data analysis. A p-value less than 0.05 was considered statistically significant.Out of 260 study participants, over half (n = 148, 56.9%) reported using herbal medicine for the treatment of hypertension alone or together with comorbid condition(s). The most commonly used herbal medicine among users were honey (n = 89, 33.3%), moringa (n = 80, 30.0%) and garlic (n = 73, 27.3%). No significant difference existed between users and non-users of herbal medicine with regards to socio-demographic and health-related factors. The majority (n = 241, 92.7%) of respondents considered herbal medicine beneficial if it was recommended by a healthcare provider yet 85.1% (n = 126) did not disclose their herbal medicine use to their health care provider.There is a high use of herbal medicines among hypertensive patients in Freetown, Sierra Leone. It is essential for healthcare providers to take heed of the findings of this study and routinely ask their patients about their herbal medicine use status. Such practice will provide the opportunity to discuss the benefits and risks of herbal medicine use with the aim of maximizing patient desired therapeutic outcomes.
Leach, MJ & Steel, A 2018, 'The potential downstream effects of proposed changes in Australian private health insurance policy: The case for naturopathy', Advances in Integrative Medicine, vol. 5, no. 2, pp. 48-51.View/Download from: Publisher's site
© 2018 Elsevier Ltd The Australian government has recently announced major reforms to the private health insurance (PHI) system. Amongst the changes are the removal of government-subsidised PHI rebates for consultations with most unregistered complementary medicine practitioners, including naturopathy. However, there are several doubts about these reforms, as this commentary explains, which primarily relate to (1) the basis of the decision, and (2) the consequences of the proposed changes. In terms of the former, an insufficient clinical evidence base was claimed to be the main driver of this decision. However, the evidence informing this decision had several limitations, and in the case of naturopathy, was somewhat contradictory. The absence of enforceable standards (from statutory registration) was another factor contributing to the decision; yet, for naturopathy, this has largely been the product of government inaction, rather than a lack of action from the profession. In terms of the downstream effects of these reforms, these could be considerable, including mass membership withdrawal from ancillary (extras) cover and cost-shifting to the public health sector; potentially leading to a rise in PHI premiums, increased demand for general practice services, and a rise in the number of avoidable hospitalisations. The proposed changes also deviate from international standards and declarations, and contravene key performance indicators of a quality health care system. In light of these concerns, the commentary calls for an immediate rethink of the intended PHI reforms, at least for naturopathy.
Leech, B, Schloss, J & Steel, A 2018, 'Health services research as a framework for expanding a whole systems research agenda in complementary and integrative medicine: The example of intestinal permeability', European Journal of Integrative Medicine, vol. 17, pp. 22-25.View/Download from: Publisher's site
© 2017 Elsevier GmbH Introduction Two of the three pillars of evidence-based practice emphasise the importance of using the best available academic research and experience from clinical practice to inform patient care. This paper aims to outline the potential value of exploring and describing insights from clinical practice through health services research to inform whole system research. Methods Concepts and ideas were developed from non-systematic review of published literature and extensive academic and clinical experience within the disciplines of health services research and clinical trials. Results Through deductive reasoning, complementary and integrative medicine (CIM) practitioners may have identified new understanding of the management of disease not yet seen in published literature. The area where investigating CIM practitioners in clinical practice may advance the clinical understanding of particular conditions is extensive. For instance, increased intestinal permeability (IP) is speculated to be involved in diseases frequently seen within clinical practice. IP is considered multifactorial with involvement from genetic and environmental factors. Conclusions CIM practitioners report clinical experience in the management of digestive disorders; their practice wisdom may add new knowledge to the significance of IP within clinical practice and outline testing parameters. Furthermore, the whole system treatment approach used by CIM practitioners may provide insight into new options for the management of IP not known or shared in published literature. Investigating the approaches CIM practitioners use within clinical practice may provide advancements in the clinical understanding of IP and other conditions. Exploring clinical practice may identify new knowledge that may translate to improvement in patient care.
Leech, B, Schloss, J & Steel, A 2018, 'Investigation into complementary and integrative medicine practitioners' clinical experience of intestinal permeability: A cross-sectional survey.', Complementary therapies in clinical practice, vol. 31, pp. 200-209.View/Download from: Publisher's site
This study aims to explore the conditions complementary and integrative medicine (CIM) practitioners associate with increased intestinal permeability (IP) and the methods they employ to assess IP.A cross-sectional survey of naturopaths, nutritionists and Western herbal medicine practitioners was undertaken (n = 227) through the Practitioner Research and Collaboration Initiative (PRACI) network.CIM practitioners (n = 36, response rate 15.9%) associate IP with gastrointestinal (100.0%), autoimmune (91.7%), skin (91.7%), neurological (80.6%), respiratory (55.6%) and liver-related conditions (44.4%). CIM practitioners frequently treat IP (72.7%); observing a minimum 3 months of treatment is required to resolve IP. Patient's signs and symptoms were the main reasons CIM practitioners suspected IP (94.1%).CIM practitioners observe a clinical link between IP and a wide range of conditions, including those not yet recognised within the literature. The clinical experience of CIM practitioners holds substantial value to the advancement of research and the clinical management of IP.
Morns, M & Steel, A 2018, 'Naturopathic support for nursing aversion associated with tandem breastfeeding', Australian Journal of Herbal and Naturopathic Medicine, vol. 30, no. 2, pp. 74-76.
Steel, A, Jackson, N, Blaich, R, Kirk, M & Wardle, J 2018, 'Impact of the workforce distribution on the viability of the osteopathic profession in Australia: results from a national survey of registered osteopaths.', Chiropractic & Manual Therapies, vol. 26, pp. 34-34.View/Download from: Publisher's site
Workforce distribution has an important influence on the quality of healthcare delivered in a region, primarily because it impacts access to health services in the community and overall health equity in the population. Distribution of osteopaths in Australia does not appear to follow the Australian population with the majority of osteopaths located in Victoria. The implications of this imbalance on the osteopathic workforce have not yet been explored.A secondary analysis of data from a survey of 1531 members of Osteopathy Australia in 2013. The analysis focused on the practice and occupational characteristics associated with practice locality.The survey was completed by a representative sample of 432 osteopaths. Respondents practicing outside Victoria were more likely to report higher income across all income brackets, and were less likely to report a preference for more patients.The Australian osteopathic profession should examine the issue of imbalanced workforce distribution as a priority. The results of this study are worth considering for all stakeholders as part of a coordinated approach to ensure the ongoing health of the Australian osteopathic workforce.
Steel, A, Tricou, C, Monsarrat, T, Ruer, M, Deslandes, C, Sisoix, C & Filbet, M 2018, 'The perceptions and experiences of osteopathic treatment among cancer patients in palliative care: a qualitative study.', Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, vol. 26, no. 10, pp. 3627-3633.View/Download from: Publisher's site
PURPOSE:This research aimed to explore the perceptions and experiences of cancer patients receiving osteopathic treatment as a complementary therapy when it is used in addition to conventional treatment for cancer pain. METHODS:This qualitative study employed semi structured interviews of cancer patients in a palliative care unit in Lyon, France, who received treatment from an osteopath alongside their conventional cancer treatment. We analysed data using grounded theory and qualitative methods. RESULTS:We interviewed 16 patients. The themes identified through the analysis included a low awareness of osteopathy among the population and an accompanying high level of misconceptions. The benefits of osteopathy were described as more than just the manual treatments with participants valuing osteopathy as a holistic, meditative, and non-pharmaceutical approach. Participants also described the osteopathic treatments as assisting with a range of cancer-related health complaints such as pain, fatigue, and sleep problems. Offering osteopathic treatment at an accessible location at low or no cost were identified by participants as enablers to the continued use of osteopathy. CONCLUSIONS:The findings of this study provides preliminary data which suggests, when delivered alongside existing medical care, osteopathy may have health benefits for patients with complex conditions such as cancer.
Goldenberg, JZ, Steel, A, Day, A, Yap, C, Bradley, R & Cooley, K 2018, 'Naturopathic approaches to irritable bowel syndrome: protocol for a prospective observational study in academic teaching clinics', Integrative Medicine Research, vol. 7, no. 3, pp. 279-286.View/Download from: Publisher's site
Blaich, R, Steel, A, Clark, D & Adams, J 2018, 'Challenges and opportunities for Australian osteopathy: A qualitative study of the perceptions of registered osteopaths', International Journal of Osteopathic Medicine, vol. 30, pp. 18-24.View/Download from: Publisher's site
© 2018 Elsevier Ltd Background: The professional landscape of osteopathy in Australia has evolved substantially over recent years including changes in research, education and integration within the wider healthcare system. The challenges and opportunities experienced by members of the Australian osteopathic profession warrant closer examination. Objective: Explore the perceptions of registered practising osteopaths in Australia regarding challenges and opportunities for the profession. Design and setting: The study employed a qualitative inductive design and approach through which three focus groups of registered practicing osteopaths were convened across three Australian locations. Methods: The data were collected through semi-structured thematic guides. Data were analysed from transcripts using framework analysis. Participants: Registered osteopaths (n = 17) participated in the focus group representing a range of gender, age, education, and years of practice amongst participants. Results: Thematic descriptive analysis of the osteopaths' accounts identified different perspectives about whether the osteopathic profession was moving in the optimal direction. These included a question about whether osteopaths were best placed as generalists or specialists; the importance of quality education and relevant, rigorous research as pillars for the sustainability of osteopathy; a need for clarity about the place of osteopathy in the healthcare system; and the need to increase public awareness about osteopathy. Conclusion: This study highlights a number of these challenges and in doing so, provides an opportunity for stakeholders to find appropriate solutions to support the advancement of the profession. To this end there needs to be more effective communication/liaison between the osteopathic profession and education providers, regulators, Government departments, and other healthcare professionals.
James, PB, Wardle, J, Steel, A & Adams, J 2018, 'Traditional, complementary and alternative medicine use in Sub-Saharan Africa: a systematic review.', BMJ global health, vol. 3, no. 5, pp. e000895-e000895.View/Download from: Publisher's site
Background:The WHO estimates that a considerable number of people in Sub-Saharan Africa (SSA) rely on traditional, complementary and alternative medicine (TCAM) to meet their primary healthcare needs, yet there remains a dearth of research evidence on the overall picture of TCAM utilisation in the region. Methods:We conducted a literature search of original articles examining TCAM use in SSA between 1 January 2006 and 28 February 2017, employing Medline, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Scopus, ProQuest, PubMed, Embase and African Journals Online databases. A critical appraisal of relevant articles reporting a quantitative or mixed-method design was undertaken. Results:Despite the heterogeneity and general low quality of the identified literature, the review highlights a relatively high use of TCAM alone or in combination with orthodox medicine, in both general population and in specific health conditions in SSA. TCAM users compared with non-TCAM users are more likely to be of low socioeconomic and educational status, while there were inconsistencies in age, sex, spatial location and religious affiliation between TCAM users and non-TCAM users. Most TCAM users (55.8%-100%) in SSA fail to disclose TCAM use to their healthcare providers, with the main reasons for non-disclosure being fear of receiving improper care, healthcare providers' negative attitude and a lack of enquiry about TCAM use from healthcare providers. Conclusion:TCAM use in SSA is significant, although most studies emerge from a few countries. Factors associated with TCAM use in SSA are similar to those observed in other regions, but further research may be required to further elucidate challenges and opportunities related to TCAM use specific to SSA.
Steel, A, Rapport, F & Adams, J 2018, 'Towards an implementation science of complementary health care: Some initial considerations for guiding safe, effective clinical decision-making', Advances in Integrative Medicine, vol. 5, no. 1, pp. 5-8.View/Download from: Publisher's site
© 2018 Elsevier Ltd Background: The effective translation of research findings into clinical practice is a significant challenge to the evidence-based practice movement. In response, implementation science (IS) – the study and application of methods to facilitate the integration of research findings and evidence into healthcare policy and practice – has emerged over recent years. Discussion: While IS has been developed for a wide range of health care settings and disciplines, there has been a paucity of critical discourse on the role of IS in complementary medicine (CM) practice – an area of health care that has gained increasing popularity across many countries and in addition, introduces a number of unique and significant challenges with regards to IS and research translation. In addressing this significant knowledge gap, this paper identifies a number of core features and considerations instrumental in progressing the examination and application of IS to CM-related practice and clinical decision-making. IS (and its scientific study/practice) is a contemporary scholarly field that cannot be dismissed by those invested in ensuring that CM research is, and remains, practice-, practitioner- and patient-relevant.
Adams, J, Sibbritt, D, Steel, A & Peng, W 2018, 'A workforce survey of Australian osteopathy: analysis of a nationally-representative sample of osteopaths from the Osteopathy Research and Innovation Network (ORION) project.', BMC health services research, vol. 18, no. 1, pp. 352-352.View/Download from: Publisher's site
BACKGROUND:Limited information is available regarding the profile and clinical practice characteristics of the osteopathy workforce in Australia. This paper reports such information by analysing data from a nationally-representative sample of Australian osteopaths. METHODS:Data was obtained from a workforce survey of Australian osteopathy, investigating the characteristics of the practitioner, their practice, clinical management features and perceptions regarding research. The survey questionnaire was distributed to all registered osteopaths across Australia in 2016 as part of the Osteopathy Research and Innovation Network (ORION) project. RESULTS:A total of 992 Australian osteopaths participated in this study representing a response rate of 49.1%. The average age of the participants was 38.0 years with 58.1% being female and the majority holding a Bachelor or higher degree qualification related to the osteopathy professional. Approximately 80.0% of the osteopaths were practicing in an urban area, with most osteopaths working in multi-practitioner locations, having referral relationships with a range of health care practitioners, managing patients a number of musculoskeletal disorders, and providing multi-model treatment options. CONCLUSIONS:A total of 3.9 million patients were estimated to consult with osteopaths every year and an average of approximate 3.0 million hours were spent delivering osteopathy services per year. Further research is required to provide rich, in-depth examination regarding a range of osteopathy workforce issues which will help ensure safe, effective patient care to all receiving and providing treatments as part of the broader Australian health system.
Steel, A, Leach, M, Wardle, J, Sibbritt, D, Schloss, J, Diezel, H & Adams, J 2018, 'The Australian Complementary Medicine Workforce: A Profile of 1,306 Practitioners from the PRACI Study.', Journal of alternative and complementary medicine (New York, N.Y.), vol. 24, no. 4, pp. 385-394.View/Download from: Publisher's site
This study aims to describe the Australian complementary medicine (CM) workforce, including practice and professional characteristics.National cross-sectional survey.Australia.Any individual who self-identified as a practitioner qualified in any one of 14 CM professions and working in any state or territory of Australia was eligible to participate in the survey.A 19-item online survey was developed following a review of existing CM workforce data and in alignment with other CM workforce survey projects in progress at the time. The survey items were presented under three main constructs: demographic characteristics, professional characteristics, and practice characteristics.Descriptive statistical analysis, including frequencies and percentages, of multiple choice survey items was used. Open response items were analyzed to determine the mean, standard deviation (SD), minimum, and maximum. The demographic data were evaluated for representativeness based on previously reported CM workforce figures.The survey was completed by 1306 CM practitioners and was found to be nationally representative compared with the most recent registrant data from the Chinese Medicine Board of Australia. Participants primarily practiced in the most populous Australian states and worked in at least one urban clinical location. Most participants held an Advanced Diploma qualification or lower, obtained their qualification ten more years ago, and practiced in a clinical environment alongside at least one other practitioner from another health profession. Participants reported diverse clinical practice specialties and occupational roles. Per week, participants worked an average of 3.7 days and treated 23.6 clients.The results from this survey of practitioners from most complementary professions in Australia provide new insights into the national complementary medicine workforce. Further exploration of the CM workforce is warranted to inform all who provide patient care and develop health poli...
Steel, A, McIntyre, E, Harnett, J, Foley, H, Adams, J, Sibbritt, D, Wardle, J & Frawley, J 2018, 'Complementary medicine use in the Australian population: Results of a nationally-representative cross-sectional survey', Scientific Reports, vol. 8, no. 1, pp. 1-7.View/Download from: Publisher's site
In order to describe the prevalence and characteristics of complementary medicine (CM) practice and product use by Australians, we conducted a cross-sectional online survey with Australian adults aged 18 and over. Rates of consultation with CM practitioners, and use of CM products and practices were assessed. The sample (n = 2,019) was broadly representative of the Australian population. Prevalence of any CM use was 63.1%, with 36% consulting a CM practitioner and 52.8% using any CM product or practice. Bodywork therapists were the most commonly consulted CM practitioners (massage therapists 20.7%, chiropractors 12.6%, yoga teachers 8.9%) and homeopaths were the least commonly consulted (3.4%). Almost half of respondents (47.8%) used vitamin/mineral supplements, while relaxation techniques/meditation were the most common practice (15.8%). CM users were more likely to be female, have a chronic disease diagnosis, no private health insurance, a higher education level, and not be looking for work. Prevalence of CM use in Australia has remained consistently high, demonstrating that CM is an established part of contemporary health management practices within the general population. It is critical that health policy makers and health care providers acknowledge CM in their attempts to ensure optimal public health and patient outcomes.
Steel, A, Wardle, J, Frawley, J, Adams, J, Sibbritt, D & Lauche, R 2018, 'Associations between complementary medicine utilisation and the use of contraceptive methods: Results of a national cross-sectional survey', Complementary Therapies in Clinical Practice, vol. 33, pp. 100-106.View/Download from: Publisher's site
Background and purpose
This study examines the relationship between the use of complementary medicine (CM) interventions or consultations with CM practitioners and women's choice of contraceptive method.
Materials and methods
A secondary analysis of a cross-sectional survey of Australian Women aged 34–39 years from the Australian Longitudinal Study on Women's Health (ALSWH) was conducted. Associations between use of CM and contraception were analysed using Chi-squared tests and multivariate logistic regression.
Based on the responses from the included women (n = 7299), women who consulted a naturopath/herbalist were less likely to use implant contraceptives (OR 0.56; 95% confidence interval (CI) 0.33; 0.95). Those consulting a chiropractor (OR 1.54; 95%CI 1.05; 2.25) or an osteopath (OR 2.16; 95% CI 1.32; 3.54) were more likely to use natural contraception.
There may be a link between women's choice of contraceptive method and their use of CM, in particular, with CM practitioner consultations.
Brinkhaus, B, Haramati, A, Falkenberg, T, Willich, SN, Weeks, J, Al-Bedah, AMN, Boon, H, Caceres Guido, PA, Khalil, M, Lee, MS, Lin, CA, Liu, J, Schiff, E, Steel, A, Street, R & Watanabe, K 2017, 'The Berlin Agreement: Self-Responsibility and Social Action in Practicing and Fostering Integrative Medicine and Health Globally', JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE, vol. 23, no. 5, pp. 320-321.View/Download from: Publisher's site
Cramer, H, Park, CL, Steel, A, Gangadhar, BN & Pilkington, K 2017, 'Yoga in Prevention and Therapy', Evidence-Based Complementary and Alternative Medicine, vol. 2017.View/Download from: Publisher's site
Foley, H & Steel, A 2017, 'Patient perceptions of clinical care in complementary medicine: A systematic review of the consultation experience', PATIENT EDUCATION AND COUNSELING, vol. 100, no. 2, pp. 212-223.View/Download from: Publisher's site
Foley, H & Steel, A 2017, 'Patient perceptions of patient-centred care, empathy and empowerment in complementary medicine clinical practice: A cross-sectional study', Advances in Integrative Medicine, vol. 4, no. 1, pp. 22-30.View/Download from: Publisher's site
© 2017 Elsevier Ltd Objective Patient-centred care (PCC) is increasingly recognised as a valuable paradigm of clinical care, particularly in the field of chronic disease. As the use of complementary medicine (CM) grows, so does the need to explore the clinical experience of CM patients. This study aims to provide an examination of patient perceptions of the degree to which CM practitioners employ a patient-centred approach during consultation. Design Cross-sectional survey preliminary study. Methods A patient-reported survey was administered to assess perceptions of practitioner empathy and support, patient empowerment, and PCC in a multi-profession CM student clinic offering acupuncture, homeopathy, naturopathy, nutrition and myotherapy. The survey was comprised of four existing measures: the Consultation and Relational Empathy (CARE) measure, Patient-Centred Care scale, Perceived Provider Support scale and Empowerment scale. Results Amongst 252 respondents, positive perceptions towards all five professions were consistently reported by participants for all four measures. A higher proportion of positive experiences of practitioner empathy and PCC were reported by participants consulting with a naturopath, nutritionist or homeopath compared to those consulting with a myotherapist or acupuncturist. Participants who visited the clinic for assistance with a chronic health condition reported more positive perceptions for items regarding communication from the Patient-Centred Care scale (p = 0.02) and self-efficacy from the CARE measure (p = 0.04). Conclusion CM clinical care appears to be characterised by a patient-centred, empathic and empowering approach. CM may present a valuable resource of PCC, particularly within the field of chronic disease management. Further research is required in order to explore this approach in the wider CM community.
Foley, H & Steel, A 2017, 'The Nexus Between Patient-Centered Care and Complementary Medicine: Allies in the Era of Chronic Disease?', Journal of Alternative and Complementary Medicine, vol. 23, no. 3, pp. 158-163.View/Download from: Publisher's site
Complementary medicine (CM) holds an established place of value for health care consumers around the world. Consumers seek CM specifically for the type of clinical care provided by CM practitioners, which is perceived as holistic and individualized. The holistic approach of CM has been described as patient-centered and there are indeed many parallels between the philosophy of holism and the paradigm of patient-centered care (PCC). In light of the contemporary movement toward PCC as a means of improving health care delivery, it is worth exploring CM as a potential existing resource of PCC. This is of particular interest with consideration to the growing burden of chronic disease, the emphasis of PCC in chronic disease management, and the high representation of chronic disease sufferers among CM users. However, there has been minimal investigation into the question of whether the holistic philosophies of CM are translated by CM practitioners into practical, clinical application. The changing landscape of CM practice necessitates a deeper understanding of the nature of CM clinical care to assess the role of CM in the contemporary health care environment.
Ortiz, M, Schnabel, K, Teut, M, Rotter, G, Binting, S, Cree, M, Lotz, F, Suhr, R, Brinkhaus, B, Parvizi, MM, Handjani, F, Zarshenas, MM, Moein, MR, Nimrouzi, M, Hatam, G, Hasanzadeh, J, Hamidizadeh, N, Parvizi, MM, Heydari, M, Namazi, MR, Parvizi, Z, Pasalar, M, Mosaffa-Jahromi, M, Bagheri-Lankarani, K, Afsharypuor, S, Tamaddon, AM, Ostovar, M, Peloni, G, Bolliger, I, Faria, RMDC, Quadri, P, Sanzeni, W, Zemp, D, Risvoll, H, Giverhaug, T, Halvorsen, KH, Waaseth, M, Musial, F, Rossi, E, Baccetti, S, Picchi, M, Conti, T, Firenzuoli, F, Guido, C, Bosco, F, Guido, C, Rossi, E, Panozzo, M, Picchi, M, Cervino, C, Nurra, L, Rossi, E, Picchi, M, Firenzuoli, F, Traversi, A, Vuono, K, Sabatini, F, Bellandi, T, Rutert, B, Eggert, A, Seifert, G, Stritter, W, Holmberg, C, Längler, A, Salamonsen, A, Wiesener, S, Schad, F, Steele, M, Kröz, M, Matthes, H, Herbstreit, C, Thronicke, A, Schlingensiepen, I, von Schoen-Angerer, T, Schneider, R, Waeber, L, Vagedes, J, Kaczala, G, Pharisa, C, Wildhaber, J, Huber, B, Sidorov, P, Sovershaeva, E, Simões-Wüst, AP, Nietlispach, A, Mennet, M, Schnelle, M, von Mandach, U, Wang, X, Woo, HL, Lee, JM, Wu, Y, Cho, Y, Yun, Y, Kim, H, Jung, W, Jang, B-H, Ziea, E, Hui, H, Li, M, Tsui, D, Lam, C, Hsieh, J, Chan, E, Balneaves, L, Burnside, S, Doyle, E, Dorazio, S, Chan, PK, Bhagra, A, Chen, P-H, Chung, VCH, Wu, JCY, Lin, ZX, Wong, W, Wu, XY, Ho, RST, Wong, CHL, Chan, L, Ziea, ETC, Elder, W, Cardarelli, R, Kaspar, C, Kempenich, R, Kopferschmitt, J, Marinko, Z, Damir, S, Vcev, A, Monezi, R, Ruggerini, EM, Fuchigami, IM, Mazini, ACM, Monezi, R, Oliveira, MW, Papuga, P, Schloss, J, Steel, A, Jacobsen, MDS, Monezi, R, Jacobsen, MR, Mangini, MT, Trapani, G, Di Giampietro, T, Zanino, L, Ciullo, L, Lanaro, D, Cerritelli, F, Macrì, F, Tsai, A, Lin, C, Wu, T-H, D’Alessandro, E, Watts, S, Zhang, Y, Wu, X, Li, X, Fei, Y, Liu, J, Zhao, N, Jia, L, Yan, X, Zhen, F, Liu, Z, Liu, J, Ahn, J, Yun, Y, AlEidi, S, Mohamed, AG, Al-Beda, AM, Abutalib, RA, Khalil, MKM, Amri, H, Badekila, S, Behmanesh, E, Mozaffarpour, S, Behmanesh, E, Mozaffarpour, S, Behmanesh, E, Shirooye, P, Meybodi, RN, Mokaberinejad, R, Tansaz, M, Mozaffarpour, S, Chung, VCH, Wu, XY, Wu, JCY, Daneshfard, B, Hosseinkhani, A, Tafazoli, V, Jaladat, AM, Jaladat, AM, Sadeghi, H, Jia, L, Zhao, N, Yan, X, Zhou, L, Zhao, M, Li, W, Liu, J, Liu, Z, Jia, L, Zhao, N, Yan, X, Zhou, L, Zhao, M, Li, W, Liu, J & et al. 2017, 'World Congress Integrative Medicine & Health 2017: part three', BMC Complementary and Alternative Medicine, vol. 17, no. S1.View/Download from: Publisher's site
Schloss, J & Steel, A 2017, 'Quince fruit compared to Vitamin B6 for treatment of nausea and vomiting in Pregnancy', Advances in Integrative Medicine, vol. 4, no. 2, pp. 80-81.View/Download from: Publisher's site
The synopsis is based on the following article: Jafari-Dehkordi,
E, Hashem-Dabaghian F, Aliasl F, Aliasl J, Taghavi-Shirazi M,
Sadeghpour O, Sohrabvand F, Minaei B, Ghods R. Comparison of
quince with vitamin B6 for treatment of nausea and vomiting in
pregnancy: a randomised clinical trial.
Steel, A & Reid, R 2017, 'A need for a better understanding of the role, value and effectiveness of complementary and integrative medicine for women with endometriosis', Advances in Integrative Medicine, vol. 4, no. 1, pp. 3-4.View/Download from: Publisher's site
Steel, A, Goldenberg, J & Cooley, K 2017, 'Establishing an international research collaborative for naturopathy: The International Research Consortium of Naturopathic Academic Clinics (IRCNAC)', Advances in Integrative Medicine, vol. 4, no. 3, pp. 93-97.View/Download from: Publisher's site
© 2017 Elsevier Ltd Naturopathy is a system of healthcare through which practitioners apply core philosophies, theories and principles to integrate medical knowledge with natural treatment options. In recent years the naturopathic community has developed a stronger international coherence. Alongside this growing connectivity in the global naturopathic profession, there have been a number of calls for more systematic research attention to be devoted to naturopathy as a substantive research topic, as well as a need for the naturopathic profession to hone a culture of research and evidence-based practices and skillsets. Progress in this area has been made through the development of more pragmatic and whole systems naturopathic research. One aspect which is currently missing in the global naturopathic research landscape despite this growing pattern of practice-based, whole systems research is the application of international multicentre research projects. In response, we have established a research consortium for naturopathic academic clinics in four countries and across multiple world regions. This paper serves to overview the mission, scope and membership of the research consortium and explore some of the research designs and questions which it may support.
Steel, A, Sundberg, T, Reid, R, Ward, L, Bishop, F, Leach, M, Cramer, H, Wardle, J & Adams, J 2017, 'Osteopathic manipulative treatment: A systematic review and critical appraisal of comparative effectiveness and health economics research (vol 27, pg 165, 2017)', MUSCULOSKELETAL SCIENCE AND PRACTICE, vol. 30, pp. 86-86.View/Download from: Publisher's site
Wardle, J, Steel, A, Lauche, R & Adams, J 2017, 'Collaborating with medicine? Perceptions of Australian naturopaths on integrating within the conventional medical system', Journal of Interprofessional Care, vol. 31, no. 6, pp. 734-743.View/Download from: Publisher's site
Complementary and alternative medicine (CAM) is an increasingly prevalent part of contemporary health care. Whilst there have been some attempts to understand the dynamics of CAM integration in the health care system from the perspective of conventional care providers and patients, little research has examined the view of CAM practitioners. This study aims to identify the experiences of integration within a conventional healthcare system as perceived by naturopaths. Qualitative semi-structured interviews were conducted using a purposeful sample of 20 practising naturopaths in South East Queensland, Australia to discuss their experiences and perceptions of integrating with conventional medical providers. Analysis of the interviews revealed five broad challenges for the integration of CAM according to naturopaths: competing paradigms between CAM and conventional medicine; co-option of CAM by conventional medical practitioners; the preservation of separate CAM and conventional medical worlds by patients and providers due to lack of formalised relations; negative feedback and biases created through selective or limited experience or information with CAM; and indifferent, reactive and one-sided interaction between CAM and conventional medical providers. Naturopaths support the integration of health services and attempt to provide safe and appropriate care to their patients through collaborative approaches to practice. The challenges identified by naturopaths associated with integration of CAM with conventional providers may impact the quality of care of patients who choose to integrate CAM and conventional approaches to health. Given the significant role of naturopaths in contemporary health-care systems, these challenges require further research and policy attention.
Adams, J, Lauche, R, Peng, W, Steel, A, Moore, C, Amorin-Woods, LG & Sibbritt, D 2017, 'A workforce survey of Australian chiropractic: the profile and practice features of a nationally representative sample of 2,005 chiropractors.', BMC Complementary and Alternative Medicine, vol. 17, no. 1, pp. 1-8.View/Download from: Publisher's site
BACKGROUND: This paper reports the profile of the Australian chiropractic workforce and characteristics of chiropractic care from a large nationally-representative sample of practitioners. METHODS: A 21-item questionnaire examining practitioner, practice and clinical management characteristics was distributed to all registered chiropractors (n = 4,684) in Australia in 2015 via both online and hard copy mail out. RESULTS: The survey attracted a response rate of 43% (n = 2,005), and the sample is largely representative of the national chiropractic workforce on a number of key indicators. The average age of the chiropractors was 42.1 years, nearly two-thirds are male, and the vast majority hold a bachelor degree or higher qualification. Australian chiropractors are focused upon treating people across a wide age range who mainly present with musculoskeletal conditions. Australian chiropractors have referral relationships with a range of conventional, allied health and complementary medicine (CAM) providers. CONCLUSION: The chiropractic profession represents a substantial component of the contemporary Australian health care system with chiropractors managing an estimated 21.3 million patient visits per year. While the Australian chiropractic workforce is well educated, research engagement and research capacity remains sub-optimal and there is much room for further capacity building to help chiropractic reach full potential as a key integrated profession within an evidence-based health care system. Further rich, in-depth research is warranted to improve our understanding of the role of chiropractic within the Australian health care system.
Adams, J, Peng, W, Steel, A, Lauche, R, Moore, C, Amorin-Woods, L & Sibbritt, D 2017, 'A cross-sectional examination of the profile of chiropractors recruited to the Australian Chiropractic Research Network (ACORN): a sustainable resource for future chiropractic research', BMJ Open, vol. 2017, no. 7.View/Download from: Publisher's site
The Australian Chiropractic Research Network (ACORN) practice-based research network (PBRN) cohort was established to provide sustainable infrastructure necessary to address lack of rigorous investigation and to bridge the research–practice gap focused on chiropractic care for future years. This paper presents the profile of chiropractors recruited to the ACORN PBRN, a nationally representative sample of chiropractors working in Australia.
Cross-sectional analysis of baseline data from a cohort study of chiropractors in Australia.
All registered chiropractors in Australia were invited to participate in the ACORN study and those who completed a practitioner questionnaire and consent form were included in the PBRN cohort.
A total of 1680 chiropractors (36%) were recruited to the cohort database. The average age of the PBRN participants is 41.9 years and 63% are male. The vast majority of the PBRN participants hold a university degree.
General practitioners were identified as the most popular referral source for chiropractic care and low back pain and neck pain were the most common conditions 'often' treated by the PBRN chiropractors. The chiropractors in this PBRN cohort rated high velocity, low amplitude adjustment/manipulation/mobilisation as the most commonly used technique/method and soft tissue therapy as the most frequently employed musculoskeletal intervention in their patient management.
The ACORN PBRN cohort constitutes the largest coverage of any single healthcare profession via a national voluntary PBRN providing a sustainable resource for future follow-up. The ACORN cohort provides opportunities for further nested substudies related to chiropractic care, chiropractors, their patients and a vast range of broader healthcare issues with a view to helping build a diverse but coordinated research programme and further research capacity building around Australian chiropractic.
Adams, J, Steel, A, Frawley, J, Broom, A & Sibbritt, D 2017, 'Substantial out-of-pocket expenditure on maternity care practitioner consultations and treatments during pregnancy: estimates from a nationally-representative sample of pregnant women in Australia.', BMC Pregnancy and Childbirth, vol. 17, no. 114, pp. 1-8.View/Download from: Publisher's site
BACKGROUND: A wide range of health care options are utilised by pregnant women in Australia. The out-of-pocket costs of maternity care in Australia vary depending on many factors including model of care utilised, health insurance coverage, and women's decision to access health services outside of conventional maternity care provision. METHODS: Women from the 1973-78 cohort of the Australian Longitudinal Study on Women's Health (ALSWH) who identified as pregnant or as recently having given birth in 2009 were invited to complete a sub-study questionnaire investigating health service utilisation during their most recent pregnancy. RESULTS: A total of 1,835 women agreed to participate in the sub-study. The majority of women (99.8%) consulted with a conventional health care practitioner during pregnancy, 49.4% consulted with a complementary and alternative medicine practitioner at least once during pregnancy and 89.6% of the women used a complementary and alternative medicine product. Women reported an average of AUD$781.10 in out-of-pocket expenses for consultations with conventional health care practitioners, AUD$185.40 in out-of-pocket expenses for consultations with complementary and alternative medicine practitioners and AUD$179.60 in out-of-pocket expenses for complementary and alternative medicine products. From the study data we estimate Australian pregnant women spend over AUD$337 M on out-of-pocket health services. CONCLUSION: While the majority of pregnant women in Australia may obtain health services via the publically-funded health care system and/or private health insurance coverage, our analysis identifies substantial out-of-pocket expenditure for health care by pregnant women - a trend in public spending for maternity care of importance to policy makers, health administrators, and health professionals.
Frawley, J, Sibbritt, D, Steel, A, Chang, S & Adams, J 2017, 'Complementary and Conventional Health-care Utilization Among Young Australian Women With Urinary Incontinence.', Urology, vol. 99, pp. 92-99.View/Download from: Publisher's site
OBJECTIVE: To examine the relationship between health status and health service utilization (including conventional and complementary and alternative medicine [CAM]) accessed by women experiencing urinary incontinence (UI). Although a high number of younger women report symptoms of UI, such as leaking urine, only a small proportion seek help for these symptoms. MATERIALS AND METHODS: The Australian Longitudinal Study on Women's Health is a large nationally representative study that investigates the health and well-being of women. The 2 most recent surveys (2006 and 2009) of the young cohort (women aged 28-33 and 31-36 respectively) were analyzed. RESULTS: The presence of UI was 8.5% in 2006 (n = 859) and 23.3% in 2009 (n = 1878), whereas the percentage of women who sought help for their UI was 18.6% (n = 160) and 2.2% (n = 182) respectively. Women with UI had poorer health compared with women without UI (P < .005), and women who sought help for their symptoms had poorer physical functioning than women who did not (P < .005). Women who sought help were greater users of conventional and CAM health services (P < .005), including a general practitioner, specialist, hospital doctor, physiotherapist, and naturopath. CONCLUSION: UI is relatively common in younger women. However, many do not seek help. Of the women who do seek care, a large number visit CAM professionals as well as conventional medical professionals, despite a lack of research evaluating the efficacy of CAM treatment. Research is needed to explore CAM practitioner approaches to the treatment of UI and to evaluate the efficacy of these treatments.
Steel, A, Adams, J & Sibbritt, D 2017, 'The Characteristics of Women Who Use Complementary Medicine While Attempting to Conceive: Results from a Nationally Representative Sample of 13,224 Australian Women.', Womens Health Issues, vol. 27, no. 1, pp. 67-74.View/Download from: Publisher's site
BACKGROUND: Preconception is acknowledged globally as an important part of ensuring health for the next generation and is underpinned by principles of health promotion and preventive medicine. There is a demand for more holistic, preventive health care within preconception health services. Many women are also using complementary medicine during their reproductive years. MATERIALS AND METHODS: This paper presents a longitudinal analysis of women's consultations with a complementary medicine practitioner while attempting to become pregnant, and the characteristics of women who choose to consult a complementary medicine practitioner during the preconception period. The cross-sectional and longitudinal analyses conducted in this study utilise data from the 1973 through 1978 cohort of the Australian Longitudinal Study on Women's Health (n = 13,224). Multivariate logistic regression models and generalized estimating equation models, with and without time lag, were used. RESULTS: Women who identified as attempting to conceive were more likely to consult with an acupuncturist (adjusted odds ratio, 1.46) or a naturopath/herbalist (adjusted odds ratio, 1.30). Women who consulted with an acupuncturist were likely to be consulting with a specialist doctor (odds ratio, 3.73) and/or have previous fertility issues (odds ratio, 2.30). Women who consulted with a naturopath were more likely to report experiencing premenstrual tension (odds ratio, 2.30) but less likely to have had a previous miscarriage (odds ratio, 0.18). CONCLUSIONS: Policymakers and other health professionals need to be aware that health professionals who are largely unregulated and structurally isolated from conventional health care may be actively contributing to women's reproductive and physical health during the preconception period.
Steel, A, Sibbritt, D, Schloss, J, Wardle, J, Leach, M, Diezel, H & Adams, J 2017, 'An Overview of the Practitioner Research and Collaboration Initiative (PRACI): a practice-based research network for complementary medicine.', BMC Complementary and Alternative Medicine, vol. 17, no. 1, pp. 87-87.View/Download from: Publisher's site
BACKGROUND: The Practitioner Research and Collaboration Initiative (PRACI) is an innovative, multi-modality practice-based research network (PBRN) that represents fourteen complementary medicine (CM) professions across Australia. It is the largest known PBRN for complementary healthcare in the world and was launched in 2015. The purpose of this paper is to provide an update on the progress of the PRACI project, including a description of the characteristics of PRACI members in order to facilitate further sub-studies through the PRACI PBRN. METHODS: A CM workforce survey was distributed electronically to CM practitioners across fourteen disciplines, throughout Australia. Practitioners electing to become a member of PRACI were registered on the PBRN database. The database was interrogated and the data analysed to described sociodemographic characteristics, practice characteristics, professional qualification and practice interest of PRACI members. RESULTS: Foundational members of PRACI were found to be predominately female (76.2%) and middle-aged (82.5%). Members were primarily located in urban settings (82.5%) across the Eastern seaboard of Australia (82.5%), with few working remotely. The main modalities represented include massage therapists (58.5%), naturopaths (26.4%) and nutritionists (14.4%). The primary area of clinical interest for PRACI members were general health and well-being (75.4%), musculoskeletal complaints (72%) and pain management (62.6%). CONCLUSIONS: PRACI provides an important infrastructure for complementary healthcare research in Australia and its success relies on CM practitioners being involved in the research being conducted through the PBRN. The aim of this database is to ensure that the research conducted through PRACI is rigorous, robust, clinically relevant and reflects the diversity of clinical practice amongst CM practitioners in Australia.
Wardle, J, Frawley, J, Adams, J, Sibbritt, D, Steel, A & Lauche, R 2017, 'Associations between complementary medicine utilization and influenza/pneumococcal vaccination: Results of a national cross-sectional survey of 9151 Australian women', Preventive Medicine, vol. 105, pp. 184-189.View/Download from: Publisher's site
Influenza and pneumococcal vaccination is recommended for all adults, with older adults considered a high-risk group for targeted intervention. As such it is important for factors affecting vaccine uptake in this group to be examined. Complementary medicine (CM) use has been suggested as a possible factor associated with lower vaccination uptake. To determine if associations exist between influenza and pneumococcal vaccine uptake in older Australian women and the use of CM, data from women aged 62–67 years surveyed as part of the Australian Longitudinal Study on Women's Health (ALSWH) were analyzed in 2013 regarding their health and health care utilization. Associations between the uptake of influenza and pneumococcal vaccinations and the use of CM were analyzed in 2016 using chi-squared tests and multiple logistic regression modelling. Of the 9151 women, 65.6% and 17.7% reported that they had influenza and pneumococcal vaccination within the past 3 years respectively. Regression analyses show that women who consulted naturopaths/herbalists (OR = 0.64) and other CM practitioners (OR = 0.64) were less likely to have vaccination (influenza only), as were women who used yoga (OR = 0.77–0.80) and herbal medicines (OR = 0.78–0.83) (influenza and pneumococcal). Conversely, women using vitamin supplements were more likely to receive either vaccination (OR = 1.17–1.24) than those not using vitamin supplements. The interface between CM use and influenza and pneumococcal vaccination uptake in older women appears complex, multi-factorial and often highly individualized and there is a need for further research to provide a rich examination of the decision-making and motivations of stakeholders around this important public health topic.
Steel, A, Sundberg, T, Reid, R, Ward, L, Bishop, FL, Leach, M, Cramer, H, Wardle, J & Adams, J 2017, 'Osteopathic manipulative treatment: A systematic review and critical appraisal of comparative effectiveness and health economics research.', Musculoskeletal Science and Practice, vol. 27, pp. 165-175.View/Download from: Publisher's site
In recent years, evidence has emerged regarding the effectiveness of osteopathic manipulative treatments (OMT). Despite growing evidence in this field, there is need for appropriate research designs that effectively reflect the person-centred system of care promoted in osteopathy and provide data which can inform policy decisions within the healthcare system. The purpose of this systematic review is to identify, appraise and synthesise the evidence from comparative effectiveness and economic evaluation research involving OMT. A database search was conducted using CINAHL, PubMed, PEDro, AMED, SCOPUS and OSTMED.DR, from their inception to May 2015. Two separate searches were undertaken to identify original research articles encompassing the economic evaluation and comparative effectiveness of OMT. Identified comparative effectives studies were evaluated using the Cochrane risk of bias tool and appraised using the Good Reporting of Comparative Effectiveness (GRACE) principles. Identified economic studies were assessed with the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines. Sixteen studies reporting the findings of comparative effectiveness (n = 9) and economic evaluation (n = 7) research were included. The comparative effectiveness studies reported outcomes for varied health conditions and the majority (n = 6) demonstrated a high risk of bias. The economic evaluations included a range of analyses and considerable differences in the quality of reporting were evident. Despite some positive findings, published comparative effectiveness and health economic studies in OMT are of insufficient quality and quantity to inform policy and practice. High quality, well-designed, research that aligns with international best practice is greatly needed to build a pragmatic evidence base for OMT.
Steel, A, Sundberg, T, Reid, R, Ward, L, Bishop, FL, Leach, M, Cramer, H, Wardle, J & Adams, J 2017, 'Reply to the letter to the editor: 'Systematic review of comparative effectiveness and health economics research relating to osteopathic manipulative treatment'.', Musculoskeletal Science and Practice, vol. 29, pp. e18-e18.View/Download from: Publisher's site
Steel, A, Blaich, R, Sundberg, T & Adams, J 2017, 'The role of osteopathy in clinical care: Broadening the evidence-base', International Journal of Osteopathic Medicine, vol. 24, pp. 32-36.View/Download from: Publisher's site
© 2017 Elsevier Ltd.Osteopathy is a system of health care practiced in various countries throughout the world that focuses on osteopathic manual techniques as a cornerstone of patient care. However, we still know little about the practice, role and use of osteopathy within the broader health system in most countries. With this in mind, this paper proposes a possible framework for advancing further research on this topic. The framework is divided into issues associated with core stakeholders including health consumers, osteopaths, other health professionals, and policymakers and funding bodies. The development of a rigorous health services research agenda around this topic has much to offer and the framework outlined here is offered with the hope of inspiring a broader field of inquiry into osteopathy in the clinical care setting.
Schloss, J & Steel, A 2016, 'Medical synopsis: Nightly fasting may assist breast cancer patients and other people with cancer', Advances in Integrative Medicine, vol. 3, no. 2, pp. 66-67.View/Download from: Publisher's site
© 2016 Elsevier Ltd Design A multi-site randomised clinical trial. Participants The Women's Healthy Eating and Living (WHEL) study of patients with breast cancer. Data was collected from 2413 women with breast cancer but without diabetes mellitus, aged 27–70 years at diagnosis. A total of 2064 participants (85.5%) were Caucasian with 1335 (55.3%) college educated. Intervention Dietary analysis including timing of consumption at baseline, year 1 and year 4. A 24-h dietary recall collected by telephone on random days during a 3-week period, stratified for weekends vs weekdays. Nightly fasting duration was estimated by calculating the elapsed hours between the first and last eating episode for each day and subtracting that time from 24 h. Potential confounders were identified including daily intake (kilocalories), eating episodes per day and eating after 8 pm. Comparator No comparator was used in this study. Major outcomes Participants reported a mean (SD) nightly fasting duration of 12.5 h and 4.4 eating episodes per day. One-third of the sample consumed 25 kcal or more after 8 pm. A short nightly fasting duration (<13 h per night) was significantly associated with college education, a lower BMI, shorter sleep duration, higher self-reported kilocalorie intake, more eating episodes, and eating after 8 pm. A short nightly fast (<13 h) was significantly associated with an increased risk for breast cancer recurrence (36% higher risk). Each 2-h increase in nightly fasting duration was statistically significant for lower HbA1c level (0.37 mmol/mol lower) and more hours of sleep per night. Nightly fasting was not associated with BMI or CRP concentrations. Eating after 8 pm was significantly associated with increased higher CRP and BMI. Settings The United States of America: Clinical sites included University of California, San Diego; University of California, Davis; Stanford University; Kaiser Permanente, Northern California; M.D. Anderson Cancer Centre; Arizona Cancer Ce...
Schloss, J & Steel, A 2016, 'Medical synopsis: Yoga may assist females with multiple sclerosis by influencing cortisol and adrenocorticotropic hormone (ACTH) levels', Advances in Integrative Medicine, vol. 3, no. 3, pp. 112-113.View/Download from: Publisher's site
Steel, A 2016, 'Guest editorial: Consultations with complementary and alternative medicine (CAM) practitioners in pregnancy influenced by women’s life circumstances', Australian Journal of Herbal Medicine, vol. 28, no. 1, p. 1.
Steel, AE 2016, 'Important considerations of the use of complementary and alternative medicine through pregnancy, labour and birth: an update based on recent Australian research', Australian Journal of Herbal Medicine, vol. 28, no. 2, pp. 36-40.
Wardle, J, Cook, N, Steel, AE & Barker, C 2016, 'The World Naturopathic Federation: global opportunities for the Australian profession', Australian Journal of Herbal Medicine, vol. 28, no. 1, pp. 3-3.
Reid, R, Steel, A, Wardle, J, Trubody, A & Adams, J 2016, 'Complementary medicine use by the Australian population: a critical mixed studies systematic review of utilisation, perceptions and factors associated with use.', BMC Complementary and Alternative Medicine, vol. 16, pp. 1-23.View/Download from: Publisher's site
BACKGROUND: There is increasing evidence that complementary medicine (CM) services are being used by a substantial proportion of the Australian population and this topic has attracted keen interest from primary health care providers and policy makers. This article outlines the first summative critical review of the predictors of CM use in Australia as well as the characteristics and perceptions of Australian CM users over the last 14 years. METHODS: A literature search was conducted to ascertain original research from 2000 to 2014 in the AMED; CINAHL; and PubMed databases. Selected articles were subject to a critical appraisal analysis to identify the quality of the article. The search was confined to peer reviewed original articles published in English which identified the nature of CM services use in Australia. RESULTS: The findings indicate a correlation between CM users and gender, with reports of a higher rate of use from females compared to males. Female CM users are more likely to be middle-aged with a higher education and higher annual income in comparison to female non-CM users. An association between resident location and use of CM disciplines was also identified with reports of rural residents utilising manual therapies more frequently compared to urban residents. CM users are more likely to seek CM services for a range of chronic conditions including diseases identified as National Health Priority Areas by the Australian Government. CONCLUSIONS: This article provides the first comprehensive review examining the nature of CM use in Australia. The review findings offer important insights into the characteristics and features of CM use in Australia and provide insights for national and regional primary health care initiatives and of interest to medical doctors, allied health professionals, CM practitioners, researchers and policy makers.
Steel, A, Lucke, J, Reid, R & Adams, J 2016, 'A systematic review of women's and health professional's attitudes and experience of preconception care service delivery.', Family practice, vol. 33, no. 6, pp. 588-595.View/Download from: Publisher's site
The value and importance of preconception care (PCC) have been acknowledged by leading health organizations as a vital element within preventive medicine and health promotion for the wider population. The translation of PCC from position statement to relevant service and programme delivery is essential for the benefits of PCC to be realized and relies on insights from health services research. This article aims to review contemporary health services research literature examining women's and health professionals' perceptions and experiences of PCC services.A systematic review of original research published between 2003 and 2015 was conducted in November 2015. Multiple databases (PubMed, CINAHL, AMED and Maternity and Infant Care) were searched through two distinct searches to capture research literature reporting the perspective of health professionals and women towards PCC service delivery.The search identified 13 papers (4 reported the perceptions of women, 11 described the views of health professionals [2 papers reported findings from both groups]). The analyses of the contemporary literature revealed five broad areas of focus: women's service needs regarding PCC, PCC training and education requirements, role delineation around PCC, priority and value of PCC and barriers and obstacles to PCC.Despite the mounting evidence supporting the value and importance of PCC, there is insufficient research attention given to the clinical reality of PCC service and programme delivery. The transfer of PCC guidelines from broad policy to grass roots practice requires a more detailed consideration of the practicalities of implementing PCC within contemporary women's health care.
Adams, J, Steel, A, Moore, C, Amorin-Woods, L & Sibbritt, D 2016, 'Establishing the ACORN National Practitioner Database: Strategies to Recruit Practitioners to a National Practice-Based Research Network', JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS, vol. 39, no. 8, pp. 594-602.View/Download from: Publisher's site
Frawley, J, Sibbritt, D, Broom, A, Gallois, C, Steel, A & Adams, J 2016, 'Complementary and alternative medicine practitioner use prior to pregnancy predicts use during pregnancy.', Women and Health, vol. 56, no. 8, pp. 926-939.View/Download from: Publisher's site
The objective of this study was to determine if prior visits to a complementary and alternative medicine (CAM) practitioner were associated with CAM use during pregnancy. The study sample comprised the Australian Longitudinal Study on Women's Health. Women were surveyed prior to pregnancy in 2006, and then again in 2010 if they were pregnant or had recently given birth, and asked a range of questions relating to demographic variables, health status and use of CAM. A multivariable analysis identified significant covariates associated with visits to specific CAM practitioner modalities during pregnancy. Of the 447 women who consulted a CAM practitioner prior to pregnancy, 62.4% (n = 279) continued this use during pregnancy. Prior use of massage therapy, acupuncture, herbalist/naturopath or chiropractor was related to use of the same service during pregnancy. Higher income and working full-time were associated with the continued use of massage, while continued visits to a chiropractor were associated with having depressive symptoms, a urinary tract infection and living in a rural community. Prior use of CAM was highly related to continuing use during pregnancy. Further research is required to elucidate the benefits women attain from a CAM-model of care that they do not get from their conventional maternity care providers alone.
Frawley, J, Sibbritt, D, Broom, A, Gallois, C, Steel, A & Adams, J 2016, 'Women's attitudes towards the use of complementary and alternative medicine products during pregnancy.', Journal of Obstetrics and Gynaecology, vol. 36, no. 4, pp. 462-467.View/Download from: Publisher's site
The aim of this study was to analyse women's attitudes towards the use of complementary and alternative medicine (CAM) products during pregnancy. The study sample was obtained via the Australian Longitudinal Study on Women's Health or ALSWH. A response rate of 79.2% (n = 1,835) was attained. Women who use herbal medicines (34.5%, n = 588) view CAM as a preventative measure, are looking for something holistic and are concerned about evidence of clinical efficacy when considering the use of these products during pregnancy. Women who use aromatherapy (17.4%, n = 319) and homoeopathy (13.3%, n = 244) want more personal control over their body and are concerned more about their own personal experience of the efficacy of CAM than clinical evidence of efficacy. As CAM use in pregnancy appears to be increasingly commonplace, insights into women's attitudes towards CAM are valuable for maternity healthcare providers.
Frawley, J, Sundberg, T, Steel, A, Sibbritt, D, Broom, A & Adams, J 2016, 'Prevalence and characteristics of women who consult with osteopathic practitioners during pregnancy; a report from the Australian Longitudinal Study on Women's Health (ALSWH).', Journal of Bodywork and Movement Therapies, vol. 20, no. 1, pp. 168-172.View/Download from: Publisher's site
The use of complementary medicine (CM) is common during pregnancy with visits to osteopathic practitioners growing in recent years. This study was conducted to investigate the prevalence and characteristics of women who consult osteopathic practitioners during pregnancy.The study sample was obtained via the Australian Longitudinal Study on Women's Health (ALSWH). The women answered questions about consultations with osteopathic practitioners, pregnancy-related health concerns and attitudes to CM use.A total response rate of 79.2% (1835) was obtained. Of these, 104 women (6.1%) consulted with an osteopath during pregnancy for a pregnancy-related health condition. Women were more likely to consult an osteopath if they suffered from back pain, sadness, weight management issues, or had a history of retained placenta.Women are visiting osteopaths for help with common pregnancy health complaints, highlighting the need for research to evaluate the safety, clinical and cost effectiveness of osteopathy in pregnancy.
Hall, H, Lauche, R, Adams, J, Steel, A, Broom, A & Sibbritt, D 2016, 'Healthcare utilisation of pregnant women who experience sciatica, leg cramps and/or varicose veins: A cross-sectional survey of 1835 pregnant women', Women and Birth, vol. 29, no. 1, pp. 35-40.View/Download from: Publisher's site
Lauche, R, Hall, H, Adams, J, Steel, A, Broom, A & Sibbritt, D 2016, 'Health-care utilisation amongst pregnant women who experience sleeping problems and/or tiredness or fatigue: secondary analysis of a cross-sectional survey of 1835 pregnant women.', Sleep and Breathing, vol. 20, no. 1, pp. 355-362.View/Download from: Publisher's site
Sleeping problems and fatigue in pregnancy are often accepted as a normal part of pregnancy; however, these conditions can be linked to serious consequences for both the mother and child. Despite established links between sleeping disturbance and a wide range of pregnancy complications, little is known about the health-care utilisation of women experiencing sleeping problems and fatigue. This study addresses the existing gap in the literature by examining cross-sectional data to identify health service utilisation patterns of pregnant women experiencing sleeping problems and/or tiredness or fatigue.In 2010, a sub-study of the Australian Longitudinal Study on Women's Health was conducted as a cross-sectional survey of 2445 women who had recently given birth. Associations between reported symptoms of sleeplessness and/or tiredness or fatigue and health service utilisation were determined using logistic regression analysis.During their pregnancy, 15.2 % of women experienced sleeping problems while 35.4 % experienced tiredness or fatigue. Women most commonly consulted with an obstetrician (n = 96) or a general practitioner (GP) (n = 74) for their tiredness or fatigue rather than a midwife (n = 56). A substantial number of women sought help from a complementary and alternative medicine (CAM) practitioner for sleeping problems (33 %) or tiredness/fatigue (28 %).Sleeping problems and/or tiredness or fatigue is reported by a reasonable percentage of pregnant women, and women obtain assistance from conventional and CAM practitioners for their symptoms, but not all seek help. Given the serious implications of untreated sleep- and fatigue-related symptoms for mother and baby, this area of research deserves and requires more attention.
Steel, A, Adams, J, Frawley, J, Wardle, J, Broom, A, Sidebotham, M & Sibbritt, D 2016, 'Does Australia's Health Policy Environment Create Unintended Outcomes for Birthing Women?', BIRTH-ISSUES IN PERINATAL CARE, vol. 43, no. 4, pp. 273-276.View/Download from: Publisher's site
Steel, A, Frawley, J, Sibbritt, D, Broom, A & Adams, J 2016, 'The characteristics of women who use hypnotherapy for intrapartum pain management: Preliminary insights from a nationally-representative sample of Australian women', Complementary Therapies in Medicine, vol. 25, pp. 67-70.View/Download from: Publisher's site
Wardle, JL, Sibbritt, D, Broom, A, Steel, A & Adams, J 2016, 'Is Health Practitioner Regulation Keeping Pace with the Changing Practitioner and Health-Care Landscape? An Australian Perspective', FRONTIERS IN PUBLIC HEALTH, vol. 4.View/Download from: Publisher's site
Wardle, J, Frawley, J, Steel, A & Sullivan, E 2016, 'Complementary medicine and childhood immunisation: A critical review.', Vaccine, vol. 34, no. 38, pp. 4484-4500.View/Download from: Publisher's site
Vaccination is one of the most significant and successful public health measures of recent times. Whilst the use of complementary medicine (CM) continues to grow, it has been suggested that CM practitioners hold anti-vaccination views. The objective of this critical review is to examine the evidence base in relation to CM practitioner attitudes to childhood vaccination alongside attitudes to vaccination among parents who visit CM practitioners and/or use CM products.A database search was conducted in MEDLINE, PubMed, CINAHL, EMBASE and AMED for research articles published between January 2000 and September 2015 that evaluated either CM practitioner or CM user attitudes and intention towards childhood vaccination.A total of 23 articles were found that detailed the attitudes of CM practitioners to vaccination. A further 16 papers examined the association between the use of CM products and visits to CM practitioners, and immunisation. The interface between CM and vaccination is complex, multi-factorial and often highly individualised. The articles suggest that there is no default position on immunisation by CM practitioners or parents who use CM themselves, or for their children. Although CM use does seem positively associated with lower vaccination uptake, this may be confounded by other factors associated with CM use (such as higher income, higher education or distrust of the medical system), and may not necessarily indicate independent or predictive relationships.Although anti-vaccination sentiment is significant amongst some CM practitioners, this review uncovers a more nuanced picture, and one that may be more agreeable to public health values than formerly assumed.
Steel, A, Cramer, H, Leung, B, Lauche, R, Adams, J, Langhorst, J & Dobos, G 2016, 'Characteristics of Homeopathy Users among Internal Medicine Patients in Germany', Forschende Komplementaermedizin: Wissenschaft Praxis Perspektiven, vol. 23, no. 5, pp. 284-289.View/Download from: Publisher's site
Homeopathy use continues to grow in many European countries, and some studies have examined the characteristics of patients using homeopathy within the general population. The aim of this study was to identify predictors for homeopathy use among internal medicine patients.
Patients and Methods
A cross-sectional analysis was conducted among all patients being referred to the Department of Internal and Integrative Medicine at Essen, Germany, over a 3-year period. The analysis examined whether patients had used homeopathy for their primary medical complaint before, the perceived benefit, and the perceived harm of homeopathy use. Odds ratios with 95% confidence intervals were calculated using multiple logistic regression analysis.
Of 2,045 respondents, 715 (35.0%) reported having used homeopathy for their primary medical complaint (diagnosis according to the International Statistical Classification of Diseases and Related Health Problems), with 359 (50.2%) reporting perceived benefits and 15 (2.1%) reporting harm. Homeopathy use was positively associated with female gender, high school level education, suffering from fibromyalgia or subthreshold depression, and being fast food abstinent, while patients with osteoarthritis, spinal or other pain, smokers, and patients with a high externalsocial health locus of control were less likely to use homeopathy.
Personal characteristics and health status may impact on the use and the perceived helpfulness of homeopathy.
Cramer, H, Ward, L, Steel, A, Lauche, R, Dobos, G & Zhang, Y 2016, 'Prevalence, Patterns, and Predictors of Yoga Use Results of a US Nationally Representative Survey', AMERICAN JOURNAL OF PREVENTIVE MEDICINE, vol. 50, no. 2, pp. 230-235.View/Download from: Publisher's site
Reid, RJ & Steel, AE 2015, 'The importance of the PRACI project for grass roots complementary medicine practice: A call for practitioner involvement', Australian Journal of Herbal Medicine, vol. 27, no. 3.
Schloss, J & Steel, A 2015, 'Thriving after cancer: The role of integrative medicine (IM) in cancer survivorship and wellbeing programs', Advances in Integrative Medicine, vol. 2, no. 3, pp. 123-124.View/Download from: Publisher's site
Wardle, J & Steel, A 2015, 'Systematic reviews in integrative medicine: A clinician's guide to publication', Advances in Integrative Medicine, vol. 2, no. 2, pp. 103-109.View/Download from: Publisher's site
© 2015. The role of evidence-based medicine in integrative medicine is becoming increasingly important, and with this increasing comes a need for succinct summaries of research evidence. Systematic reviews are essential to summarise evidence relating to efficacy and safety of healthcare and to summarise health care trends and phenomena accurately and reliably. However, reviews can bring with them numerous biases and methodological issues, particularly related to the sourcing of information used, and therefore need to be conducted in a systematic and methodical process. Specialised fields such as integrative medicine bring with them their own unique challenges in conducting an accurate and reliable review. This article describes practical and academic insights into writing a systematic review for publication.
Steel, A, Lucke, J & Adams, J 2015, 'The prevalence and nature of the use of preconception services by women with chronic health conditions: an integrative review.', BMC Women's Health, vol. 15, pp. 1-12.View/Download from: Publisher's site
BACKGROUND: There is growing evidence that preconception care may have an important role in preventing short and long term adverse health consequences for women and their offspring. This is particularly the case for women with chronic health conditions due to the rising prevalence of chronic disease in global populations. With this in mind, this paper presents an integrative systematic review of contemporary research outlining the use of preconception services and practices by women with chronic health conditions. METHODS: A search was conducted through PubMed, CINAHL, AMED, and Maternity and Infant Care databases which identified 672 papers examining preconception care and preconception services for women with chronic health conditions. Fourteen papers which were written in English, presented original research, and reported on the prevalence or nature of use of preconception care by women with chronic health conditions were included in the review. Critical appraisal of study quality and thematic categorical grouping of identified papers was undertaken. RESULTS: Current research evidence, as identified through this review, examines three major topic areas: the prevalence of preconception care practices, use of services and characteristics of users; knowledge of the value and impact of preconception care and availability of preconception services for women with chronic health conditions; and women's attitudes, approaches and experiences of preconception care and preconception services. Prevalence estimates of engagement with preconception care range between 18.1% and 45%, with most studies focusing on women with type 1 or 2 diabetes. Significant gaps in women's knowledge of preconception care for women with chronic health conditions were also identified. Women with chronic health conditions reported experiencing emotional distress as a result of their engagement with preconception care services. They also commonly described feeling a need to employ discipline to c...
Adams, J, Frawley, J, Steel, A, Broom, A & Sibbritt, D 2015, 'Use of pharmacological and non-pharmacological labour pain management techniques and their relationship to maternal and infant birth outcomes: Examination of a nationally representative sample of 1835 pregnant women', Midwifery, vol. 31, no. 4, pp. 458-463.View/Download from: Publisher's site
© 2015 Elsevier Ltd. Women use various labour pain management techniques during birth. The objective of this study is to investigate women's use of pharmacological and non-pharmacological labour pain management techniques in relation to birth outcomes. Methods: a sub-survey of a nationally representative sample of pregnant women (. n=1835) from the Australian Longitudinal Study on Women's Health. Results: our analysis identified women's use of water for labour pain management as decreasing the likelihood of their baby being admitted to special care nursery (OR=0.42, p<0.004) whereas the use of epidural increased this likelihood (OR=3.38, p<0.001) as well as for instrumental childbirth (OR=7.27, p<0.001). Epidural and pethidine use decreased women's likelihood of continuing breast-feeding (ORs=0.68 and 0.59, respectively, both p<0.01) whereas the use of breathing techniques and massage for pain control increased the likelihood of women continuing breast-feeding (ORs=1.72 and 1.62, respectively, both p<0.01). Conclusions: our study illustrates associations between the use of both pharmacological and non-pharmacological labour pain management techniques and selected birth outcomes while controlling for confounding variables. There remain significant gaps in the evidence base for the use of non-pharmacological labour pain control methods and our findings provide a platform with which to develop a broad clinical research programme around this topic.
Adams, J, Steel, A, Chang, S & Sibbritt, D 2015, 'Helping address the national research and research capacity needs of Australian chiropractic: introducing the Australian Chiropractic Research Network (ACORN) project.', Chiropractic and Manual Therapies, vol. 23, no. 12.View/Download from: Publisher's site
Chiropractic is a popular health care choice in Australia and yet major gaps in our empirical understanding of this area of practice remain. Furthermore, while some research excellence exists, a largely uncoordinated approach to research activity and development has in effect led to silos of interest and a lack of strategic 'big-picture' planning essential to producing a sustainable research culture and capacity for the profession. This commentary identifies the significance of a number of key features - including a national, coordinated focus, and a rich engagement with the practitioner and patient base amongst others - arguably important to the future development of research and research capacity within Australian chiropractic. The design features and phases of the Australian Chiropractic Research Network (ACORN) project are also outlined. ACORN is one contemporary initiative specifically developed to address chiropractic's research and research capacity building needs and help grow a broad evidence-base to inform safe, effective patient care.
Cramer, H, Frawley, J, Steel, A, Hall, H, Adams, J, Broom, A & Sibbritt, D 2015, 'Characteristics of women who practice yoga in different locations during pregnancy', BMJ Open, vol. 5, no. 8, pp. e008641-e008641.View/Download from: Publisher's site
Frawley, J, Adams, J, Steel, A, Broom, A, Gallois, C & Sibbritt, D 2015, 'Women's Use and Self-Prescription of Herbal Medicine during Pregnancy: An Examination of 1,835 Pregnant Women', Women's Health Issues, vol. 25, no. 4, pp. 396-402.View/Download from: Publisher's site
Steel, A, Adams, J, Frawley, J, Broom, A & Sibbritt, D 2015, 'The characteristics of women who birth at home, in a birth centre or in a hospital labour ward: A study of a nationally-representative sample of 1835 pregnant women', Sexual & Reproductive Healthcare, vol. 6, no. 3, pp. 132-137.View/Download from: Publisher's site
Steel, A, Adams, J, Sibbritt, D & Broom, A 2015, 'The outcomes of complementary and alternative medicine use among pregnant and birthing women: current trends and future directions.', Women's Health, vol. 11, no. 3, pp. 309-323.View/Download from: Publisher's site
Complementary and alternative medicine is used by a substantial number of pregnant women and maternity care providers are often faced with the task of ensuring women are using safe and effective treatments while respecting a woman's right to autonomous decision-making. In the era of evidence-based medicine maternity health professionals are expected to draw upon the best available evidence when making clinical decisions and providing health advice. This review will outline the current trends in research evidence associated with the outcomes of complementary and alternative medicine use amongst pregnant and birthing women as well as highlight some potential directions for future development in this important yet largely unknown topic in contemporary maternity care.
Steel, A, Hemmings, B, Sibbritt, D & Adams, J 2015, 'Research challenges for a complementary medicine higher education institution: Results from an organisational climate survey', EUROPEAN JOURNAL OF INTEGRATIVE MEDICINE, vol. 7, no. 5, pp. 442-449.View/Download from: Publisher's site
Steel, AE, Adams, J, Sibbritt, D, Broom, A, Gallois, C & Frawley, JE 2015, 'Managing the pain of labour: factors associated with the use of labour pain management for pregnant Australian women.', Health Expectations, vol. 18, no. 5, pp. 1633-1644.View/Download from: Publisher's site
Despite high rates of women's use of intrapartum pain management techniques, little is known about the factors that influence such use. ... Examine the determinants associated with women's use of labour pain management. ... Cross-sectional survey of a substudy of women from the 'young' cohort of the Australian Longitudinal Study of Women's Health (ALSWH). ... Women aged 3135 years who identified as being pregnant or recently given birth in the 2009 ALSWH survey (n = 2445) were recruited for the substudy. The substudy survey was completed by 1835 women (RR = 79.2%).
Steel, A, Frawley, J, Adams, J & Diezel, H 2015, 'Trained or professional doulas in the support and care of pregnant and birthing women: A critical integrative review', Health and Social Care in the Community, vol. 23, no. 3, pp. 225-241.View/Download from: Publisher's site
© 2014 John Wiley & Sons Ltd. The professionalisation of doula care and research interest in this area of maternity care/support have both grown internationally in recent years highlighting important broader issues around the access, continuity and delivery of maternity care services. However, no work to date has provided a critical appraisal of the international literature on this topic. In response, this paper presents the first critical review of international empirical literature examining professional doula care for pregnant and birthing women. A database search of AMED, CINAHL, Maternity and Infant Care, and MEDLINE using the search term, "doula" was undertaken. A total of 48 papers published between 1980 and March 2013 involving trained or professional doulas were extracted. Four descriptive categories were identified from the review: 'workforce and professional issues in doula care'; 'trained or professional doula's role and skill'; 'physical outcomes of trained or professional doula care'; and 'social outcomes of trained or professional doula care'. Of the studies evaluating outcomes of doula care, there were a number with design and methodology weaknesses. The review highlights a number of gaps in the research literature including a lack of research examining doula workforce issues; focus upon the experience and perspective of significant stakeholders such as expectant fathers with regard to trained or professional doula care; clinical trials measuring both subjective experiences and physical outcomes of trained or professional doula support; synergy between the design of clinical trials research examining trained or professional doula care and the clinical reality of professional doula practice. It is imperative that key aspects of trained doula care be subject to further rigorous, empirical investigation to help establish an evidence base to guide policy and practice relating to this area of support and care for pregnant and birthing women.
Diezel, H, Adams, J, Wardle, J & Steel, A 2014, 'Does Complementary and Alternative Medicine Exist in Australian Nursing and Midwifery Courses?', The Journal of Alternative and Complementary Medicine, vol. 20, no. 5, pp. A100-A100.View/Download from: Publisher's site
Steel, AE & McEwen, B 2014, 'The need for higher degrees by research for complementary medicine practitioners', Australian Journal of Herbal Medicine, vol. 26, no. 4, pp. 136-140.
The need for research in complementary medicine (CM), which is meaningful and relevant within a real world setting, has been
growing since the advent of the evidence-based practice movement. This need has not, however, been successfully addressed
due to both insufficient interest amongst the research population and issues with the usefulness of much of the completed research
to inform the practical needs of clinicians and policy makers. These issues may be attenuated by seeing an increased number of
CM practitioners involved in future research projects. However, the absence of appropriate and focused research training for CM
practitioners may hinder the number of practitioners pursuing research careers. With this in mind, there is a real need to see an
increase in both the availability of higher degrees by research at both undergraduate and postgraduate level for CM practitioners as
well as the institutions offering these degrees. In particular, ensuring that CM practitioners are able to receive primary supervision of
a research project by researchers with a detailed understanding of CM is vital if effective and meaningful CM research, which is wellsupported
within higher education institutions, is to occur.
Steel, AE, Wardle, J, Diezel, HM, Johnstone, K & Adams, J 2014, 'Educating for collaboration: The outcomes of an interprofessional education workshop for complementary and alternative maternity care providers', Advances in Integrative Medicine, vol. 1, no. 1, pp. 17-24.View/Download from: Publisher's site
Objectives: Despite high community use of complementary and alternative medicine (CAM) poor collaboration between conventional and CAM practitioners have been identified in many health sectors including maternity care. This is in part associated with a deficit in the formal training of CAM practitioners which overlooks collaborative practice skills and guidelines. This study evaluates the outcomes of an interprofessional education workshop which endeavours to improve the collaborative practice of CAM practitioners providing care to pregnant women. Methods: A pre-workshop and post-workshop questionnaire which evaluated the participants' perception of self-proficiency and their interprofessional practice behaviours when providing maternity care. Descriptive and inferential statistical analysis of the data was undertaken. Results: CAM practitioners (n = 30) providing care to pregnant women participated in the project. Prior to taking part in the workshop a low level of confidence in pregnancy-specific physiology and psychology knowledge more broadly but also poor confidence in engaging with conventional maternity care providers and understanding conventional models of maternity care was identified amongst participants. Participants who felt more positive about their knowledge of pregnancy and birth physiology were more likely to enquire about women's conventional care and discuss safety issues with women in their care. Following workshop involvement the participant's awareness of the models of maternity care available to Australian women improved alongside participants' knowledge of the scope and role of obstetricians and midwives. There was a reduced need by participants to have their role acknowledged by conventional care providers as important to enable effective collaboration after workshop completion. Conclusions: Interprofessional education is argued to be a valuable tool to promote interprofessional collaboration and communication. It may be employed as a use...
Bowman, D, Steel, A, Adams, J, Sibbritt, D & Broom, A 2014, 'The characteristics of women using different forms of botanical medicines to manage pregnancy-related health conditions: A preliminary cross-sectional analysis', Advances in Integrative Medicine, vol. 1, no. 3, pp. 138-143.View/Download from: Publisher's site
Objective: To ascertain the attitudes, perceptions and characteristics of women who used varying forms of botanical medicine (herbal extracts and tinctures, herbal teas, aromatherapy oils) during pregnancy, birth and lactation. Methods: Longitudinal data from a sub-study of women (n = 2445) from the Australian Longitudinal Study of Women's Health (ALSWH) was analysed for the characteristics of women who used only one form of botanical medicine (herbal extracts and tinctures, herbal teas or aromatherapy oils), Fisher's exact tests were used to compare categorical variables due to the small cell numbers of the individual categories. A modified Bonferroni correction was used to compensate for multiple testing. All analyses were performed using Stata 11.1 and statistical significance was set at p = 0.05. Results: Women who held private health insurance were more likely to consult with an acupuncturist or naturopath for pregnancy-related health conditions and use herbal extracts and tinctures rather than herbal teas or aromatherapy oils. Women who used herbal extracts and tinctures also reported higher rates of epidural use and were more likely to initiate breastfeeding than those using aromatherapy oils. Women who used herbal teas were more likely to discuss their expectations of their birth with a general practitioner than a midwife and use birthing pools, baths or showers as intrapartum pain management. Women who used herbal teas were also more likely to initiate breastfeeding than those choosing aromatherapy, and moreover, continue breastfeeding for more than 6 months. Women who showed a preference for breathing techniques as intrapartum pain management were more likely to use aromatherapy rather than herbal extracts, tinctures or teas during pregnancy. Conclusions: Our analysis is a preliminary insight into an as yet unassessed aspect of maternity care. More in-depth investigation of the characteristics of women who choose to use herbal medicines, teas and aromat...
Frawley, J, Adams, J, Broom, A, Steel, A, Gallois, C & Sibbritt, D 2014, 'Majority of Women Are Influenced by Nonprofessional Information Sources When Deciding to Consult a Complementary and Alternative Medicine Practitioner During Pregnancy', Journal of Alternative and Complementary Medicine, vol. 20, no. 7, pp. 571-577.View/Download from: Publisher's site
Frawley, JE, Steel, A, Adams, J, sibbritt, D, Broom, A & Gallois, C 2014, 'The Association between women's choice of birth setting and their use of CAM during labor and birth.', Journal of Alternative and Complementary Medicine, vol. 20, no. 5, pp. 1-1.View/Download from: Publisher's site
Purpose: Contemporary maternity care often means women are
able to choose a number of settings for their birth including
hospitals, birth centers, and community settings. There is also
evidence that many women utilised complementary and alternative
medicine (CAM) during pregnancy and birth. The purpose
of this study is to examine the association between
women's choice of birth setting and their use of CAM during
labor and birth.
Methods: Longitudinal data from a sub-study of women
(n = 2445) from the nationally-representative Australian Longitudinal
Study of Women's Health (ALSWH) was analyzed for
relationships between women's birth setting (hospital, birth
center, or community) and their demographics, attitudes towards
maternity care (including CAM), and use of CAM during
pregnancy and birth.
Results: The characteristics associated with women's choice of
birth setting include some demographic features such as employment
status, health care subsidy, and level of education.
Women's birth setting choice was also linked to a preference for
CAM practitioner by women birthing in birth centers and
community settings. In contrast, women birthing in hospitals
held more positive views towards obstetric care. There was a
higher use of CAM during pregnancy by women birthing in birth
centers and community but this was not consistent across all
CAMs investigated. Naturopaths, herbal medicines, homeopathy
and flower essences were more commonly used by women
birthing in community compared with those in a birth center.
There was also a higher rate of CAM use for intrapartum pain
management for women birthing outside of a hospital setting,
although women attending a birth center were more likely than
those birthing in community to use pharmacological pain management
Conclusion: There are characteristic differences between women
birthing in different birth settings which seems to be
influenced as much by preference for maternity care and interest
in CAM use as it is by...
Steel, A, Adams, J & Sibbritt, D 2014, 'Developing a multi-modality complementary medicine practice-based research network: The PRACI project', Advances in Integrative Medicine, vol. 1, no. 3, pp. 113-118.View/Download from: Publisher's site
© 2014 Elsevier Ltd Objectives Outline the protocol to be used in the establishment of the Practitioner and Researcher Collaboration Initiative (PRACI) – an innovative national practice-based research network (PBRN) for complementary medicine (CM) professions in Australia. Design and methods A multiphase research design will be employed. Phase 1 will involve geographical mapping of CM practitioner workforce population and location across Australia. Phase 2 involves initial practitioner member recruitment encompassing a preliminary workforce survey to allow population of key information for the PRACI database. Phase 3 will employ a comprehensive practitioner member survey which examines the nature and characteristics of contemporary CM practice. Results PRACI will be a multi-modality PBRN which encompasses 14 CM professions: acupuncturists, aromatherapists, Ayurveda practitioners, Bowen therapists, Chinese herbalists, homoeopaths, kinesiologists, massage therapists, musculoskeletal therapists, myotherapists, naturopaths, nutritionists (non-dietetic), reflexologists, Western herbalists, and yoga teachers. Once established, researchers will be able to utilise the PRACI network and infrastructure to undertake CM research which is embedded in, responsive to, and informed by clinical practice. An Expression of Interest (EOI) process by which potential new research through PRACI is vetted based upon feedback by researchers, community representatives and practitioner members. The PRACI network will enable a broad range of research designs including experimental, observational and qualitative research. As such, research conducted through PRACI will be able to examine important research questions and advance new knowledge about contemporary CM practice. Conclusions PRACI is a practice-based research network which has the potential to offer the CM professions a legacy of clinically relevant research which is embedded in the realities of practice and which can provide a plat...
Steel, A, Adams, J, Sibbritt, D, Broom, A, Frawley, J & Gallois, C 2014, 'Relationship between complementary and alternative medicine use and incidence of adverse birth outcomes: An examination of a nationally representative sample of 1835 Australian women', Midwifery, vol. 30, no. 12, pp. 1157-1165.View/Download from: Publisher's site
Objective: there is evidence of high use of complementary and alternative medicine (CAM) by pregnant women. Despite debate and controversy regarding CAM use in pregnancy there has been little research focus upon the impacts of CAM use on birth outcomes. This paper reports findings outlining the incidence of adverse birth outcomes among women accessing CAM during pregnancy.
Design: a survey based cohort sub study from the nationally representative Australian Longitudinal Study on Women's Health (ALSWH) was undertaken in 2010.
Participants.: women (aged 31-36 years) who identified in 2009 as pregnant or recently given birth (n=2445) from the younger cohort (n=8012) of ALSWH were recruited for the study.
Measurements and findings: participants' responses were analysed to examine the relationship between use of CAM and adverse birth outcomes from their most recent pregnancy. Of the respondents (n=1835; 79.2%), there were variations in birth outcomes for the women who used different CAM. Notably, the outcome which was most commonly associated with CAM use was emotional distress. This was found to occur more commonly in women who practised meditation/yoga at home, used flower essences, or consulted with a chiropractor. In contrast, women who consulted with a chiropractor or consumed herbal teas were less likely to report a premature birth, whilst participation in yoga classes was associated with an increased incidence of post parturn/intrapartum haemorrhage.
Key conclusions: the results emphasise the necessity for further research evaluating the safety and effectiveness of CAM for pregnant women, with a particular focus on birth outcomes. Implications for practice: health professionals providing care need to be aware of the potential birth outcomes associated with CAM use during pregnancy to enable the provision of accurate information to women in their care, and to assist in safely supporting women accessing CAM to assist with pregnancy, labour and birth.
Steel, A, Adams, J, Sibbritt, D, Broom, A, Frawley, J & Gallois, C 2014, 'The Influence of Complementary and Alternative Medicine Use in Pregnancy on Labor Pain Management Choices: Results from a Nationally Representative Sample of 1,835 Women', JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE, vol. 20, no. 2, pp. 87-97.View/Download from: Publisher's site
Steel, A, Adams, J, Sibbritt, D, Broom, A, Gallois, C & Frawley, J 2014, 'Determinants of Women Consulting with a Complementary and Alternative Medicine Practitioner for Pregnancy-Related Health Conditions', Women and Health, vol. 54, no. 2, pp. 127-144.View/Download from: Publisher's site
Steel, A, Adams, J, Broom, A, Sibbritt, D, Frawley, J & Gallois, C 2014, 'Marginalization and Companionable Silence: CAM Practitioners' Perspectives of Their Interprofessional Relationships with Maternity Care Providers', The Journal of Alternative and Complementary Medicine, vol. 20, no. 5, pp. A111-A111.View/Download from: Publisher's site
Diezel, HM, Steel, AE, Wardle, J & Johnstone, K 2013, 'Patterns and influences of interprofessional communication between midwives and CAM practitioners: A preliminary examination of the perceptions of midwives', Australian Journal of Medical Herbalism, vol. 25, no. 1, pp. 4-10.
Women are increasingly using complementary and alternative medicine (CAM) such as naturopathy and Western herbal medicine during their pregnancy and midwives have described an affinity for CAM. However, the reality of the midwife-CAM practitioner interfa
Pierantozzi, AM, Steel, A & Seleem, M 2013, 'Integrating complementary and alternative medicine into medical intern teaching: Preliminary findings from an Australian Hospital', COMPLEMENTARY THERAPIES IN CLINICAL PRACTICE, vol. 19, no. 4, pp. 237-242.View/Download from: Publisher's site
Steel, A, Diezel, H, Wardle, J & Johnstone, K 2013, 'Patterns of inter-professional communication between complementary and conventional practitioners providing maternity care services: A preliminary examination of the perceptions of CAM practitioner', Australian Journal of Herbal Medicine, vol. 25, no. 2, pp. 57-61.
© National Herbalists Association of Australia 2013. Inter-professional communication is well acknowledged as a vital piece in the practice of multi-disciplinary health care.Yet, even in health sectors such as maternity care where high rates of complementary and alternative medicine (CAM) use are well documented, there is little examination of the inter-professional communication patterns between CAM and conventional care providers. This study reports preliminary findings from a survey of CAM practitioners (n=31) which examines their perceived interprofessional communication patterns with conventional maternity care providers. The results indicate CAM practitioners may provide care to women from preconception care through to the postnatal period. The practitioners were most likely to receive referrals from other women or previous clients (sometimes: 41%; often 27%), rather than from health professionals. Formal communication was most likely to be directed to other CAM practitioners (sometimes: 18%; often: 4%) and least likely to be directed to obstetricians (sometimes: 0%; often: 4%). No participants reported receiving formal communications from obstetricians but a small number indicated receiving formal communication from midwives (sometimes: 7%; often: 4%) and other CAM practitioners (sometimes: 17%; often: 4%). These low rates of communication may be impacting on patient safety through overtreatment or therapeutic interactions. There are concerns that policy and legislative barriers may be limiting the inter-professional communication practices of conventional care providers. Similarly, educational and regulatory weaknesses in CAM may be contributing to poor inter-professional communication practices for CAM practitioners. Further substantive research is needed to contextualise and verify these findings.
Wardle, J, Steel, A & McIntyre, E 2013, 'Independent registration for naturopaths and herbalists in Australia: The coming of age of an ancient profession in contemporary healthcare', Australian Journal of Herbal Medicine, vol. 25, no. 3.
Recent changes in the healthcare landscape in Australia have prompted renewed debate regarding the most appropriate regulatory model for naturopaths and herbalists. Numerous government reports have recommended independent statutory regulation yet naturopaths and Western herbalists are yet to be included in the National Registration and Accreditation Scheme. This has left professional associations to carry the administrative burden and manage the conflicting interests of practitioner regulation and professional advocacy. The outcome of this self-regulatory model has damaged advancement of these professions through limiting the scope of professional associations to promote the value of practitioners within contemporary healthcare. It has also left naturopaths and Western herbalists vulnerable to health policy reform which impact on unregistered practitioners. In response, an independent registration body, the Australian Register of Naturopaths and Herbalists (ARONAH) has been established which mirrors the NRAS process and offers legitimacy to the professions whilst also safeguarding the public. This paper outlines: the history of the registration debate in Australia; the scope and role of ARONAH; the relationship between ARONAH and the existing professional associations and the rationale underpinning important standards and guidelines developed by ARONAH for its members. © National Herbalists Association of Australia 2013.
Wardle, J, Adams, J, Lui, C & Steel, AE 2013, 'Current challenges and future directions for naturopathic medicine in Australia: a qualitative examination of perceptions and experiences from grassroots practice', BMC Pregnancy Childbirth, vol. 13, no. 15, pp. 1-10.View/Download from: Publisher's site
Naturopaths are an increasingly significant part of the healthcare sector in Australia, yet despite their significant role there has been little research on this practitioner group. Currently the naturopathic profession in Australia is undergoing a period of rapid professional growth and change. However, to date most research exploring the perceptions of naturopaths has been descriptive in nature and has focused on those in leadership positions rather than grassroots practitioners. This article explores the perceptions and experiences of practising naturopaths on the challenges and future directions of their profession.
Wardle, JL, Steel, AE & Adams, J 2013, 'Tensions in Naturopathic Education Response', JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE, vol. 19, no. 12, pp. 979-980.View/Download from: Publisher's site
Frawley, JE, Adams, J, Sibbritt, D, Steel, AE, Broom, A & Gallois, C 2013, 'Prevalence and determinants of complementary and alternative medicine use during pregnancy: Results from a nationally representative sample of Australian pregnant women', Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 53, no. 4, pp. 347-352.View/Download from: Publisher's site
Background: Pregnant women have been identi?ed as high users of complementary and alternative medicine (CAM). However, no research to date has provided a detailed analysis of the prevalence and determinants of CAM consumption amongst pregnant women. Aim: To examine the prevalence and determinants of CAM use by pregnant women, utilising a national representative sample. Methods: The study sample was obtained via the Australian Longitudinal Study on Womens Health. This paper is based on a sub-study of 1,835 pregnant women, administered in 2010. The women answered questions about CAM use, demographics, pregnancy-related health concerns and health service utilisation. Results: Complementary and alternative medicine use was found to be high with 48.1% (n = 623) of pregnant women consulting a CAM practitioner and 52.0% (n = 842) of women using CAM products (excluding vitamins and minerals) during pregnancy. CAM practitioner visits were more likely for selected pregnancy-related health concerns, namely back pain or back ache, neck pain and labour preparation. Women were less likely to consult a CAM practitioner if they suffered with headaches/migraines. Employment was also found to be predictive of pregnant womens visits to a CAM practitioner. Signi?cant health history and demographic predictors of CAM product use were tiredness and fatigue, embarking on preparation for labour and having a university education. Conclusion: Most pregnant women are utilising CAM products and/or services as part of their maternity care and obstetricians, general practitioners and midwives need to enquire with women in their care about possible CAM use to help promote safe, effective coordinated maternity care.
Steel, AE, Diezel, HM, Johnstone, K, Sibbritt, D, Adams, J & Adair, R 2013, 'The Value of Care Provided by Student Doulas: An Examination of the Perceptions of Women in Their Care', Journal of Perinatal Education, vol. 22, no. 1, pp. 39-48.View/Download from: Publisher's site
This study provides an examination of women's perceptions of care provided by student doulas undertaking a formal qualification in doula support services. Feedback forms completed by women attended by student doulas undertaking a formal qualification in doula support services were analyzed. The women (N = 160) consistently rated the student doulas' contribution to their experience of birth favorably. Qualitative analysis revealed that women value the presence of their student doulas highly with reference to the student doulas' demeanor, support provided to family, interface with other health professionals, and learned skills. Within the Australian context, this study suggests that the support provided by student doulas that have completed a formal training course is held in positive regard by the women receiving their care.
Steel, AE, Frawley, JE, Sibbritt, D & Adams, J 2013, 'A preliminary profile of Australian women accessing doula care: Findings from the Australian Longitudinal Study on Women's Health', Australian and New Zealand Journal of Obstetrics & Gynaecology, vol. 53, no. 6, pp. 589-592.View/Download from: Publisher's site
Despite growing interest and controversy regarding the value of doulas in contemporary maternity care, little is known about the profile of women who choose to involve a doula in their care team. This preliminary analysis indicates that women's attitudes towards maternity care may influence their use of a doula more so than demographic factors. Further research examining these
Frawley, J, Sibbritt, D, Adams, J, Steel, A, Wardle, J, Broom, A, Lui, C & Murthy, V 2012, 'OA16.04. Women’s sources of information for CAM use during pregnancy.', BMC complementary and alternative medicine, vol. 12, no. Suppl 1, pp. O65-O65.View/Download from: Publisher's site
Steel, A, Diezel, H, Sibbritt, D & Adams, J 2012, 'OA13.03. Promoting safe and integrated maternity care through interprofessional education.', BMC complementary and alternative medicine, vol. 12, no. Suppl 1, pp. O51-O51.View/Download from: Publisher's site
Steel, A, Sibbritt, D, Adams, J & Daley, J 2012, 'P04.80. Navigating the divide: women's engagement with conventional and complementary medicine in pregnancy.', BMC complementary and alternative medicine, vol. 12, no. Suppl 1, pp. P350-P350.View/Download from: Publisher's site
Adams, J & Steel, A 2012, 'Investigating complementary and alternative medicine in maternity care: The need for further public health/health services research', Complementary Therapies in Clinical Practice, vol. 18, no. 2, pp. 73-74.View/Download from: Publisher's site
Adams, J & Steel, AE 2012, 'Editorial: Investigating complementary and alternative medicine in maternity care: The need for further public health/health services research', Complementary Therapies in Clinical Practice, vol. 18, pp. 73-74.
The relationship between complementary and alternative medicine (CAM) and maternity care has attracted much attention over recent years and there has been a movement towards developing and promoting an evidence-base to help understand the interface between CAM, midwifery and wider mainstream maternity care.
Steel, AE & Adams, J 2012, 'Developing midwifery and complementary medicine collaboration: The potential of interprofessional education?', Complementary Therapies in Clinical Practice, vol. 18, no. 4, pp. 261-264.View/Download from: Publisher's site
A higher percentage of referrals to complementary and alternative medicine (CAM) by midwives can be linked to their af?nity with CAM. However, midwifery education does not commonly include CAM as part of the curriculum leaving potential for misinformation and unsafe practice. An approach to CAM education which encourages collaboration between all care providers is needed to ensure safe, womancentred maternity care. Whilst a number of models have been considered in health education they are not without their limitations when aiming to promote interprofessional collaboration.
Wardle, J, Steel, A & Adams, J 2012, 'A Review Of Tensions And Risks In Naturopathic Education And Training In Australia: A Need For Regulation', Journal Of Alternative And Complementary Medicine, vol. 18, no. 4, pp. 363-370.View/Download from: Publisher's site
In line with increasing complementary medicine (CAM) use, the Australian government has committed considerable resources to the training of CAM practitioners.
Steel, AE, Adams, J, Sibbritt, D, Broom, A, Gallois, C & Frawley, JE 2012, 'Utilisation of complementary and alternative medicine (CAM) practitioners within maternitycare provision: results from a nationally representative cohort study of 1,835 pregnant women', BMC Pregnancy and Childbirth, vol. 12, pp. 146-146.View/Download from: Publisher's site
Background: There is little known about women's concurrent use of conventional and complementary health care during pregnancy, particularly consultation patterns with complementary and alternative medicine (CAM). This study examines health service utilisation among pregnant women including consultations with obstetricians, midwives, general practitioners (GPs) and CAM practitioners.
Steel, A & Johnstone, K 2011, 'The impact of an inter-professional education workshop on the perceptions of practice behaviours of midwives in relation to complementary and alternative medicine', Women and Birth, vol. 24, pp. S44-S45.View/Download from: Publisher's site
Steel, A & Adams, J 2011, 'The Application And Value Of Information Sources In Clinical Practice: An Examination Of The Perspective Of Naturopaths', Health Information And Libraries Journal, vol. 28, no. 2, pp. 110-118.View/Download from: Publisher's site
Background: The approach of evidence-based medicine (EBM), providing a paradigm to validate information sources and a process for critiquing their value, is an important platform for guiding practice. Researchers have explored the application and value o
Steel, AE & Adams, J 2011, 'Approaches to clinical decision-making: A qualitative study of naturopaths', Complementary Therapies in Clinical Practice, vol. 17, pp. 81-84.View/Download from: Publisher's site
The type of information used and its application in clinical practice has generated interest due to its relationship to evidence-based medicine (EBM). However, it is also acknowledged that the principles of EBM place less value on practitioners' experience and intuitive insights when making clinical decisions.
Steel, AE & Adams, J 2011, 'The Interface Between Tradition and Science:Naturopaths' Perspectives of Modern Practice', Journal of Alternative and Complementary Medicine, vol. 17, no. 10, pp. 967-972.View/Download from: Publisher's site
Objectives: Although there has been much international commentary, little is known about the interface between traditional knowledge and scientific research in modern naturopathic practice. This study aimed to explore this interface from the perspective of naturopaths. Design: Semistructured interviews were conducted with naturopaths in current practice. The participants were selected using purposive sampling, and the data from the interviews were interpreted using thematic analysis. Settings/location: Interviews were conducted in a place suitable to each participant. Subjects: Twelve (12) naturopaths in current clinical practice were interviewed. The participants represented a diversity of characteristics including gender, time in practice, level of qualification, and clinical contact hours per week.
Steel, AE & Adams, J 2011, 'The role of naturopathy in pregnancy, labour and post-natal care: Broadening the evidence-base', Complementary Therapies in Clinical Practice, vol. 17, no. 4, pp. 189-192.View/Download from: Publisher's site
It is known that women are high users of complementary and alternative medicine (CAM) including naturopathy and that CAM is frequently used by pregnant women. However, we still know little about the consumption, practice and role of naturopathy in pregnancy, labour and post-natal care. With this in mind, this paper proposes a possible framework for advancing further research on this topic. The framework is divided into issues associated with three core stakeholder groups-pregnant women, naturopaths/herbalists and other maternity health professionals including obstetricians, midwives and general practitioners. The development of a rigorous health services research agenda around this topic has much to offer maternity-care users, practitioners and policy makers and the framework outlined here is offered with the hope of inspiring further inquiry into this significant issue in women's health.
Steel, AE, Adams, J & Sibbritt, D 2011, 'Complementary and Alternative Medicine in Pregnancy: a Systematic Review', Journal of the Australian Traditional-Medicine Society, vol. 17, no. 4, pp. 205-209.View/Download from: Publisher's site
A systematic review of recent peer-reviewed literature exploring womenâs use of complementary and alternative medicine (CAM) in pregnancy, birth and postnatal care.
Prior, J, Dunston, R, Kroll, T, Adams, J & Steel, A 2019, 'Traditional, complementary and integrative medicine and global health challenges' in Adams, J & et al (eds), Public Health and Health Services Research in Traditional, Complementary and Integrative Medicine: International Perspectives, Imperial College Press, London.
Schloss, J & Steel, A 2019, 'Traditional Medicine in Cancer Care' in Public Health And Health Services Research In Traditional, Complementary And Integrative Health Care: International Perspectives, World Scientific, USA, pp. 147-162.View/Download from: Publisher's site
In 2015, 8.8 million people worldwide died from cancer equating to 1 in 6 cancer-related deaths globally (World Health Organization, 2018). Cancer has created a significant burden on country and global economies and the lack of data has impacted the writing and development of cancer policies (World Health Organization, 2018). The economic burden of cancer is significant and continues to increase with current estimates suggesting a burden of approximately US$1.16 trillion (Stewart and Wild, 2014). A substantial proportion of health care services, funding and research addresses cancer prevention and treatment throughout the world, either directly or indirectly (Prager et al., 2018). Thirty to fifty percent of cancers are believed to be preventable by modifying lifestyle factors such as avoiding tobacco, reducing alcohol intake, maintaining a healthy body weight, exercising regularly and addressing infection-related risk factors (World Health Organization, 2018). However, once cancer develops more intensive interventions are needed and may encompass further surgery, chemotherapy, radiotherapy, immunotherapy, pharmacological treatment and other required treatments (Mihai et al., 2014; Inada et al., 2015).
Adams, J, James, PB, Wardle, J & Steel, A 2019, 'The Need for Research on the Use of Traditional, Complementary and Integrative Medicine in Emerging and Re-Emerging Infectious Disease Outbreaks: Ebola as a Case Study' in . Public Health and Health Services Research in Traditional, Complementary and Integrative Health Care: International Perspectives, World Scientific, USA, pp. 239-254.
Infectious diseases are considered a global health threat to human progress and survival especially those caused by emerging and re-emerging pathogens (Jones et al., 2008; Morens et al., 2004). Emerging infections are 'infections that have either not previously affected human or have already appeared in small human population and isolated regions but are rapidly increasing in incidence or geographic range (e.g. Ebola virus, Zika virus and Severe Acute Respiratory Synticial (SARS) virus)' whereas re-emerging infectious diseases are 'ones that were previously a significant local or global public health problem, and then declined dramatically, but are again becoming health problems for a significant proportion of the population (malaria and tuberculosis are examples)' (Heymann and Lee, 2009).
Over the past few decades, the world has witnessed an increased incidence in both emerging and re-emerging infectious diseases all due to biological, ecological, political and socioeconomic factors (Jones et al., 2008; Morse, 2004). Ease of international travel as well as global trade and commerce have amplified the global spread of emerging and re-emerging infectious diseases (Hsu and Shih, 2010; Scotto, 2011; Tatem et al., 2006). The World Health Organization (WHO) estimates that 52% of all deaths in low income countries are due to emerging and re-emerging infectious disease (WHO, 2017b). Women and children in low to middle income countries usually bear the greater burden of both morbidity and mortality for these diseases (Mathers, 2008) and higher incidence of these types of infectious diseases often occurred in places where health systems are under resourced or over-burdened and where therapeutic pluralism — the use of a range of (sometimes competing) modalities and knowledge systems to treat illness and maintain health — is common. Recent reports of antimicrobial resistance among emerging and re-emerging pathogens as well as concerns over the safety of antimicrobials (McCo...
Adams, J, Leach, M & Steel, A 2019, 'Models of care and women's health: Drawing upon aspects of complementary and integrative medicine' in Women's Health and Complementary and Integrative Medicine, Routledge, UK, pp. 152-166.
This chapter describes the disconnect between women's health care needs and the dominant model of health care, and explores that the role CIM can play in addressing women's unmet health care needs. It also explores the needs from a historical perspective describing the way women's health has been understood and managed in the past, and how this has been shaped by a woman's position in society at different times. The chapter examines the model of health the biomedical model currently dominating clinical decision making in most health systems across the globe. The provision of a health care system that focuses solely on patient experience, efficiency, safety and quality, population health outcomes and access, in a literal sense, is unlikely to be enough to serve the distinct needs of individuals in a given population.
Adams, J, Leech, B & Steel, A 2019, 'Traditional Medicine and Traditional Birth Attendant Use During Pregnancy and Birthing in Low to Middle-Income Countries' in Public Health and Health Services Research in Traditional, Complementary and Integrative Health Care: International Perspectives, World Scientific, UK, pp. 166-181.
Traditional medicine (TM) is increasingly being used among women during pregnancy and birthing throughout low to middle-income countries (LMICs). Rural and remote regions of LMICs have limited access to health services including skilled birth attendants (SBAs). Many of these rural and remote regions rely on traditional birth attendants (TBAs) to support expectant mothers through pregnancy and birthing. TBAs are trusted and valued members of the community who are frequently the source of information about TM use during pregnancy and childbirth. This chapter will provide an overview of pregnancy and childbirth in LMICs, illustrating many of the obstacles women encounter during pregnancy then it will describe the role TBAs play with a focus on TM use. Lastly a research agenda is discussed situating the current level of knowledge and illustrating gaps in the research.
Adams, J, Steel, A & Reid, R 2019, 'A Holistic Approach to Implementation Science (IS): Broadening the IS Gaze to Traditional, Complementary and Integrative Medicine' in Public Health and Health Services Research in Traditional, Complementary and Integrative Health Care: International Perspectives., World Scientific, USA, pp. 99-117.View/Download from: Publisher's site
This is an era where quality health care service delivery is expected to prioritise paradigms that may not always be in alignment with each other, such as evidence-based medicine (EBM) and patient-centred care. It is challenging for most health professionals to navigate these tensions, and traditional, complementary and integrative medicine (TCIM) clinicians are no different. This chapter will overview the recently established field of implementation science (IS) and the role it plays in the delivery of evidence-based medicine across all aspects of health care including TCIM. It will also identify aspects of TCIM which provide an opportunity for IS to expand and deepen its impact on evidence-based health service delivery.
Adams, J, Steel, A, Schloss, J & Peng, W 2019, 'Coordination, Collaboration and Capacity Building Through National Practice-Based Research Networks: A New Paradigm of Research in Traditional, Complementary and Integrative Medicine' in Public Health and Health Services Research in Traditional, Complementary and Integrative Health Care: International Perspectives, World Scientific, UK, pp. 79-97.
Health and medical research are often criticized as disconnected from the concerns, perspectives and behaviours of those under study (Rycroft-Malone et al., 2016). Indeed, researchers have themselves at times, wittingly or unwittingly, helped propagate this impression. The long-standing focus upon randomized controlled trials and other experimental designs (in public health and medicine more generally) as the gold standard has done little to promote a more inclusive flavour to the research process (Breckenridge et al., 2018). Similarly, the power dynamics encouraged in a traditional research model with the researcher hailed as 'expert' and the participant treated as nothing more than a 'subject' (non-expert) to be passively involved in fieldwork has also discouraged rich participant engagement often as to avoid what is seen as potential contamination of 'clean', rigorous scientific enquiry. These critiques are no less relevant for TCIM as they are for other health and health care research fields and there have been calls from within the TCIM research community to address these features (Paterson, 2007). Unfortunately, despite a diversity of approach and methodology, the TCIM research field continues to harbour a predominant focus and privileged standing for designs and models that are removed from the grass-roots reality of health care delivery and consumption (Adams, 2007).
Adams, J, Sibbritt, D, Prior, JH, Connon, I, McIntyre, E, Dunston, R, Lauche, R & Steel, A 2019, 'The role and influence of women in the workforce and practice of complementary and integrative medicine: Contemporary trends and future prospects' in Adams, J, Steel, A, Broom, A & Frawley, J (eds), Women's Health and Complementary and Integrative Medicine, Routledge, New York, pp. 142-151.View/Download from: Publisher's site
This chapter examines the role and significance of women across the Complementary and Integrative Medicine (CIM) workforce and practice. It explores the contemporary environment relating to CIM in high-income countries that may help facilitate or challenge what some scholars and commentators have interpreted as a 'feminist' CIM approach to health care. It has long been acknowledged that the biomedical model of health and conventional structures of health care delivery explicitly or implicitly help maintain paternalistic power dimensions. Research suggests the circumstances also apply to CIM use with women not only identified as predominant users of CIM but also as significant agents of influence upon the CIM use of others family members, friends and wider networks alike. Moving attention beyond informal care and carer roles, research has also suggested gender dimensions to CIM practice. As identified in the brief overview provided in the chapter, the influence and role of women with regards to CIM provision/workforce, practice and consumption are considerable
Adams, J, Steel, A, Peng, W, Sibbritt, D, Wardle, J & Fellows, P 2019, 'Capacity Building in TCIM: A Focus Upon Public Health and Health Services Research' in Public Health and Health Services Research in Traditional, Complementary and Integrative Health Care: International Perspectives, World Scientific, USA, pp. 119-128.View/Download from: Publisher's site
As the current book collection attests, the public health (PH) and health services research (HSR) of TCIM is gaining ground. However, it is imperative we not only facilitate interest but also ensure capacity and sustainability in this significant area of health and health care research (Adams et al., 2012). While a generation of public health and health services researchers have shown interest in this topic there remains only a small number of individuals (relatively insubstantial in number when compared to conventional medical research ranks) and even fewer teams dedicated to the PH and HSR of TCIM. It is well established that research disciplines and fields require strategic forward planning and capacity growth and development in order to attract and retain suitable academics and reach a critical mass where enquiry is sustainable and can serve the needs of practitioners, patients, communities, policymakers and other stakeholders (Cooke, 2005). Nevertheless, it still stands that analysis of the networks, mentoring, leadership and career development opportunities for budding researchers and scholars in the PH and HSR of TCIM does not instil optimism for the quality and future of the field.
This chapter outlines a number of challenges currently facing the PH/HSR of TCIM with regard to capacity building and growth and overviews a number of contemporary initiatives directly aimed at addressing these circumstances. The focus of this chapter is upon research and we highlight a number of recently established international research capacity building endeavours which aim to grow and deepen rigorous PH and HSR in TCIM.
Frawley, J, Steel, A, Leach, M, Aiyepola, A & Adams, J 2019, 'Complementary and integrative medicine use in pregnancy: Focus upon contemporary analysis of self-prescribed treatment among Australian women' in Women's Health and Complementary and Integrative Medicine, Routledge, UK, pp. 23-35.View/Download from: Publisher's site
Global interest in complementary and integrative medicine (CIM) has risen exponentially over recent decades, with recent research from a number of countries indicating that this interest in CIM may also extend to pregnancy (Frawley et al. 2013). Two recent literature reviews have highlighted the growing research interest and widespread use of CIM during pregnancy (Adams et al. 2009; Hall et al. 2011) and this chapter draws upon the findings of these two reviews and more recent literature as well as new analyses from contemporary fieldwork to examine the current opportunities and challenges of CIM use, specifically self-prescribed CIM, among pregnant women.
Peng, W, Sibbritt, D, Steel, A, Cramer, H & Adams, J 2019, 'Menopause and complementary and integrative medicine: A consideration of clinical evidence, grassroots use and contemporary clinical practice guidelines' in Women's Health and Complementary and Integrative Medicine, Routledge, UK, pp. 36-47.
Complementary and integrative medicine (CIM) use has been identified as prevalent among women for the management of menopausal symptoms, generating great interest and concern among conventional medical practitioners and health policy-makers. In this chapter, we draw upon recent quality reviews (e.g. systematic reviews with/without meta-analyses and Cochrane reviews) to investigate the empirical evidence for the efficacy of such CIM treatments as well as the prevalence, patterns, and menopausal women's decision-making of CIM use.
In addition to the clinical evidence of CIM treatments for the management of varied menopausal symptoms, this chapter also introduces contemporary guidelines on CIM use in the menopause to identify whether the 'lived' CIM use in menopause fits into the wider landscape of clinical practice guidelines for the menopause. The implications of a number of noteworthy clinical and practice-based issues are then addressed regarding CIM provision in the context of menopausal care.
Steel, A, Aiyepola, A, Frawley, J & Hall, H 2019, 'Maternity care providers and complementary and integrative medicine' in Women's Health and Complementary and Integrative Medicine, Routledge, UK, pp. 128-141.
These decisions may include the use of complementary and integrative medicine (CIM) for general health during pregnancy as well as pregnancy-related health complaints. While the Davis-Floyd model does not link specific paradigms to any one health profession, in this chapter explores the evidence underpinning any such relationships. The chapter focuses on obstetricians and midwives, and examining the potential role of these conventional health care providers in women's use of CIM during pregnancy, labour and birth. A study of a large, nationally representative sample of Australian women who had recently given birth was published in 2012 and provided the first examination of consultancy patterns across conventional maternity care providers and CIM practitioners during pregnancy. This finding supports previous research identifying midwives as a popular source of CIM information for pregnant women and often encouraging CIM use for women in their care. The study findings illustrate the inconsistent relationship between the available clinical evidence and the CIM practitioners used by pregnant women.
Adams, J, Hollenberg, D, Broom, A, Steel, AE, Sibbritt, D & Lui, C 2013, 'Integration in Primary Health Care: A focus upon practice and education and the importance of a critical social science perspective' in Adams, J, Magin, P & Broom, A (eds), Primary Health Care and Complementary and Integrative Medicine, Imperial College Press, London, pp. 203-227.View/Download from: Publisher's site
In this chapter we argue that the mainstream work and commentary around integrative health care and education has often lacked a critical social science perspective
Steel, AE, Frawley, JE, Adams, J, Sibbritt, D & Broom, A 2013, 'Primary Health Care, Complementary and Alternative Medicine and Women's Health: A Focus Upon Menopause' in Adams, J, Magin, P & Broom, A (eds), Primary Health Care and Complementary and Integrative Medicine, Imperial College Press, London, pp. 11-33.View/Download from: Publisher's site
Australian Women are integrating primary health care and complementary and alternative medicine to alleviate a range of symptoms and conditions. This chapter introduces the use of CAM for women's health in general and more particularly, explores the integration of CAM alongside mainstream primary health care
Adams, J, Lui, C, Sibbritt, D, Broom, A, Wardle, J, Homer, CS, Steel, AE & Beck, S 2012, 'Women's use of complementary and alternative medicine during pregnancy: A critical review of the literature' in Adams, J, Andrews, G, Barnes, J, Broom, A & Magin, P (eds), Traditional, Complementary and Integrative Medicine, Palgrave Macmillan, Basingstoke, pp. 35-43.
The use of complementary and alternative medicine has attracted much attention and debate in recent years. The objective of this critical review is to examine the evidence base on use of complementary products and therapies during pregnancy. It examines an important but neglected issue in maternity care. Methods: A database search was conducted in MEDLINE, CINAHL, AMED, and Maternity and Infant Care. A total of 24 papers published between 1999 and 2008 met the selection criteria and were included in the review. Results: Findings of these 24 papers were extracted and reported under four themes: "user prevalence and profile," "motivation and condition of use," "perception and self-reported evaluation," and "referral and information sources." Conclusions: This review highlights four research gaps in the literature, a lack of: large representative samples; in-depth understanding of user experiences and risk perceptions; research comparing consumption patterns across cultures and over time; and work exploring the nature of the therapeutic encounter with complementary practitioners in this area of women's health care.
Adams, J, Sibbritt, D, Broom, A, Wardle, J, Steel, AE, Murthy, V & Daley, J 2012, 'Research capacity building in traditional, complementary and integrative medicine: Grass-roots action towards a broader vision' in Adams, J, Andrews, G, Barnes, J, Broom, A & Magin, P (eds), Traditional, Complementary and Integrative Medicine, Palgrave Macmillan, London, pp. 275-281.
Developing capacity to undertake health research effectively is an integral component of national and global health research systems (Lansang and Dennis, 2004) and is essential to producing a sound evidence base for decision making in policy and practice (Cooke, 2005). Moreover, research capacity building (RCB) - nurturing and producing sustainable increased capacity for future research endeavours - is important fOr all health research fields and TCIM is no exception (Andrews, 2006; Adams, 2007). There is currently a great opportunity to embrace RCB in relation to TCIM in order to help develop an evidence base and a stronger and more robust research culture among scholars and practitioners alike.
Peng, W 2017, 'World Congress Integrative Medicine & Health 2017', Germany.
Steel, A, Frawley, J, Adams, J, Sibbritt, D & Broom, A 2015, 'The labour and birth outcomes associated with the use of herbal medicine in pregnancy.', NHAA International Conference on Herbal Medicine., Sydney,.
Steel, A, Adams, J, Broom, A, Sibbritt, D & Frawley, J 2014, ''Marginalization and Companionable Silence: CAM Practitioners' Perspectives of Their Interprofessional Relationships with Maternity Care Providers.'', 2014 International Research Congress on Integrative Medicine and Health, Miami, USA.
Steel, A, Sibbritt, D, Adams, J & Frawley, J 2014, 'The Association Between Women's Choice of Birth Setting and Their Use of CAM During Labor and Birth.', International Research Congress on Integrative Medicine and Health, Miami, Florida, USA.
Frawley, J & Steel, A 2014, 'Complementary and alternative medicine (CAM) use during pregnancy: Navigating safe maternity care', PHAA 43rd Annual Conference, The future of public health: big challenges, big opportunities, Public Health Association of Australia Annual Conference, Perth, Australia.
Steel, A, Adams, J, Sibbritt, D, Broom, A & Frawley, JE 2013, 'The influence of complementary and alternative medicine use in pregnancy on pain management in labour and birth outcomes', International Research Congress on Integrative Medicine and Health, London, UK.
Steel, A, Frawley, J & Frawley, JE 2013, Steel A, Frawley J, Dobson A, Jackson C, Lucke J, Tooth L, Brown W, Byles J, Mishra G. (2013). Women's health in NSW – a life course approach: an Evidence Check rapid review brokered by the Sax Institute. NSW Ministry of Health. https://www.saxinstitute.org.au/wp-content/uploads/Womens-health-in-NSW….