Category Archives: Alternative Medicine

Introduction

Diabetic kidney disease (DKD) is one of the most frequent and serious complications in diabetic patients and is the leading cause of chronic kidney disease (CKD) worldwide.1 It is usually accompanied by hypertension, albuminuria, and progressive decline in renal function, with excess morbidity and mortality due to macro- and microvascular complications. Effective management of DKD thus entails a comprehensive approach not only to slow kidney disease progression but also to minimize the risk of atherosclerosis and cardiovascular events including dietary control, lifestyle modification, and a wide array of medications for metabolic and hypertensive control.2

Based on the chronic and complex nature of the disease, patients with DKD are at risk to develop medication non-adherence and self-usage of complementary or alternative medicines (CAM).3 The World Health Organization defines medication adherence as the degree to which a persons behavior, including taking medications, corresponds with the agreed recommendations from a health-care provider. It has been shown that low adherence to prescribed anti-diabetes medicines is more common in developing countries and responsible for 30% to 50% of treatment failure to achieve adequate glycemic control.4 In addition, many studies have reported that usage of CAM is common in these patients, while its efficacy and safety data remain in question.5 Medication adherence is similarly important in CKD patients, given its potential impact on disease progression, its complications and quality of life.6,7

The number of patients with diabetes in Thailand was reported as 4.4 million in 2018, with the estimated prevalence of CKD of around 30%.8 Similar to other countries worldwide, DKD is currently the most common cause of advanced CKD requiring renal replacement therapy (RRT) and its economic burden is a significant contributor to overall healthcare spending in Thailand.9 Currently, the cost of treatment (including RRT) is covered by three national health-care schemes, which are the Civil Servant/State Enterprise Medical Benefit Scheme (CSMBS) for civil officers and dependents, the Social Security Scheme (SSS) for private employees, and the Universal Health Coverage Scheme (UCS) for the remaining citizens, respectively. Quantification of the problem with medication-taking behavior in the patients, and also identification of those who are at risk should be concerned as one important factor that may improve therapeutic effectiveness. We hypothesized that low medication adherence and CAM usage would also be common in Thai patients, and this might be associated with worse clinical outcome. To address this issue, we conducted a self-reported survey to identify the prevalence of medication non-adherence and self-usage of herbal or complementary medicines in Thais with pre-dialysis diabetic CKD, predictive factors, and their effects on the kidney disease progression.

This cross-sectional questionnaire-based study was conducted at the outpatient clinics of Siriraj Hospital, the largest university-based tertiary care center in Thailand, from May 2018 to April 2021. The study was carried out in accordance with the guidelines of the Declaration of Helsinki, and approved by the Siriraj Institutional Review Board, Faculty of Medicine Siriraj Hospital, Mahidol University prior to the study (Si349/2018).

Patients were individually invited to participate in the study if they were more than 18 years old, had been diagnosed at our hospital with DM type 2 and CKD for more than one year without dialysis treatment. Patients will be excluded if they had any other significantly debilitating diseases, apparent cognitive or psychiatric problems, or were unable to communicate in Thai. A written informed consent was obtained from all participants who agreed to complete the study questionnaire and permitted for review of their electronic medical records. Relevant clinical data including the blood pressure, prescribed medicines and important laboratory results documented on the study date and the latest visit date in the period of approximately one year earlier were abstracted and recorded for further analysis.

The questionnaire used in the study consisted of three parts mainly to evaluate the prescribed medication adherence and the practice of self-medication. The first part obtained the demographic data of the participants, including age, gender, education level, monthly income, health-care scheme, disease duration, and home medicine management. The second was the Medication Taking Behavior in Thai (MTB-Thai) questionnaire of which has been developed and validated to use in Thai patients since 2016, with permission obtained from the original researcher.10 The MTB-Thai questionnaire consists of 6 items relevant to medication adherence in the past 2 weeks with the response choices in a 4-point Likert scale. The total score for the MTB-Thai ranges from 0 to 24, and medication adherence is graded as high (24 score), medium (2223 score) and low (<22 score) based on its original validation. The third part evaluated self-usage of herbal or complementary medicines using questions modified from a part of the international complementary and alternative medicine questionnaire (ICAM-Q).11 In brief, the participants will be asked to list the non-prescribed products including the over-the-counter analgesics, herbs/herbal medicine, vitamins/minerals or other supplements that were taken in the past 12 months; the source of product information, and the reasons for self-administration.

The sample size was calculated using an estimating proportion of one group based on the report prevalence of 45.8% for medication misbehavior in Thai diabetic patients.12 This would require the sample size to be around 200 to achieve the margin of error of 15% and a 95% confidence interval (CI).

Descriptive data for continuous variables were presented as median with interquartile range (IQR) or mean with standard deviation (SD) based on ShapiroWilk test for normality, and frequency distribution with percentage for categorical variables. Comparing the parameters from two-time points and difference between groups of defined medication adherence status was determined using chi-square test of categorical data, and t-test or non-parametric equivalent for continuous data with non-normal distribution, and a P value of less than 0.05 was considered statistically significant. To investigate determinants for medication adherence, we used a multivariate linear regression analysis as independent variables of aforementioned socio-demographic data (age, gender, education level, monthly income level, medical welfare scheme), vision problems, type of home medicine management, number of prescribed medicine, history of CAM usage, the level of glycemic or hypertensive control, and CKD staging were stratified. In addition, multinomial logistic regression was used to identify medication adherence and patient factors (age, sex, health-care scheme, the level of glycemic and hypertensive control, CAM usage) with the risk of being rapid CKD progressor (annual rate of eGFR decline greater than 5 mL/min/1.73 m2) as previously defined by the KIDGO consensus conference.13

Table 1 details the demographic and baseline characteristics of survey participants. The final sample with adequate questionnaire responses for purpose of analysis comprised 220 pre-dialysis diabetic CKD participants, out of which 54.1% were male with the mean age of 71.3 years (older than 65 in 72.3%). In terms of educational background, 2.7% had received no formal education and nearly half of participants educated at the primary level or lower (47.4%). A substantial proportion were classified as having a low to middle income of less than 10,000 to 10,00030,000 Thai baht per month (30.6% and 46.6% respectively). The medical service/drug expense was covered by the CSMBS in approximately half of the participants (54.5%), followed by the UCS (20.9%).

Table 1 Socio-Demographic and Baseline Characteristics of Survey Participants

The median duration of known diabetes and CKD were 14 and 4.5 years with the mean number of 7.6 different prescribed medicines. Most patients received co-medication of both oral anti-diabetics and anti-hypertensive (95.4%) while lipid lowering medicines were prescribed in 84.8%. Sulfonylurea and metformin were two most commonly used anti-diabetic medicines (58.8% and 48.9%), while 57.2% received combination of medications including insulin. As for the anti-hypertensive agents, renin-angiotensin-aldosterone system inhibitors with angiotensin-converting enzyme inhibitors or angiotensin receptor blocker were most frequently prescribed (55.7%). The majority of patients reported self-administration of the prescribed medicine at home (80.3%).

Table 2 shows comparison of clinical and laboratory results between the study visit and those in the previous visit of around one year earlier (10.2 2.9 months). Overall, most patients were classified in CKD stage III (eGFR 3059 mL/min/1.73 m2, 71.9% vs 73.1%) followed by stage IV (eGFR 1529 mL/min/1.73 m2, 18.6% vs 15.0%) and stage II (eGFR 6089 mL/min/1.73 m2, 4.5% vs 8.2%). There were no significant differences in the systolic blood pressure and the biochemical-metabolic parameters including blood sugar, HbA1C and cholesterol levels. However, compared to the previous year, the serum creatinine was significantly higher 1.5 (1.3, 2.0) vs 1.4 (1.2, 1.9) mg/dL and eGFR was lower 40.2 14.4 vs 42.4 14.2 mL/min/1.73 m2 (p<0.0001). The median average eGFR decline of patients in this study was 1.9 mL/min/1.73 m2 per year.

Table 2 Comparison of the Clinical and Laboratory Results at the Study Visit and Earlier Period of Approximately One Year (Median, IQR)

Medication adherence level as measured by the sum score from MTB-Thai questionnaire and classified as having high, medium and low adherence was observed in 50.9%, 24.1% and 25.0% of survey participants, respectively. Considering the frequency of responses to the MTB-Thai-6 items, not taking medicines as times prescribed, forget to take mediciness and adjust dosage regimens were three most commonly reported non-adherence practices (Table 3).

Table 3 Medication Adherence Analysis from the 6-Item MTB-Thai Questionnaire as Reported by Survey Participants

Self-medication with over-the-counter analgesics including non-steroidal anti-inflammatory drugs was reported in 4.8% (Table 4). However, usage of herb/herbal or complementary medicines in the past 12 months was more frequent in the participants (24.1%), mostly aimed to promote general health or to treat symptomatic conditions (Table 4). Commonly used products included unidentified Thai herbal mixture (11), Cordyceps (6), Cod liver oil (6), Nan Fui Chao leaf (6), Turmeric (6), Ginkgo (4), Ginseng (4), Ling Zhi mushroom (4), Bitter gourd extract (3), non-specified Chinese herb (3), Red seaweed (2), and River spiderwort leaf (2). Responses from the participant revealed that information about possible product benefit was primarily derived from personal source including friends or other patients (19) and relatives (17); media source including television (11), radio (4) and social networks (2); self-perception (8); and providers in the drug store (2). No signs of toxicity or adverse events were observed at the visit.

Table 4 Self-Medication in the Past 3 Months as Reported by Survey Participants

In order to identify factors determining medication adherence, analysis of its association with the socio-demographic and selected clinical variables was conducted and shown in Table 5. As compared to the high- and medium-adherence group, individuals with low adherence were significantly more likely to be younger (<65), with lower educational status, vision problems, poorly controlled hypertension and lower eGFR value at the study visit by univariate analysis (Chi-square test, p < 0.05). Lower adherence was more frequently observed in diabetic CKD patients stage IVV (51.9%) compared to stage III (17.3%) and stage II (none reported). On cross-sectional multivariate linear regression analysis, only CKD stage IVV was found to be associated with low medication adherence (adjusted odds ratio 5.54, 95% CI 2.82 to 10.88, p < 0.001).

Table 5 Association of Medication Adherence Level with Socio-Demographic and Relevant Clinical Parameters

Considering the effect of medication adherence level on the clinical outcomes in particular of metabolic control and kidney function, we observed no differences in the FBS, HbA1C and cholesterol levels among group. However, patients with low medication adherence had higher systolic blood pressure (147 (134164) vs 133 (122143) and 137 (130147) mmHg; p = 0.0004) and lower eGFR (29.9 (23.6, 39.6) vs 43.9 (32.2, 51.2) and 43.4 (35.5, 50.8) mL/min/1.73 m2; p = 0.00001) at the study visit. Figure 1 shows that calculated annual eGFR change was significantly higher in the low medication adherence group (6.48 vs 2.27 and 0.5 mL/min/1.73 m2; p = 0.00001). In addition, the multinomial logistic regression analysis revealed that the only variable that represented a risk of being rapid CKD progressor was medication adherence, but not the age, gender, the level of glycemic or hypertensive control, or usage of herb/herbal or complementary medicines (p = 0.0002). Calculation for the risk of rapid CKD progressor over 12 months by dividing the number of rapid CKD progressor by the total number of patients stratified by the medication adherence level showed a statistically significant odds ratio of 1.15 (95% CI 1.06 to 1.25) in patients with low medication adherence.

Figure 1 Box plot (median, lower and upper quartiles, and range) showing changes in estimated glomerular filtration rate (eGFR) from the study visit and prior visit of around one-year in participants with low-, medium- and high-medication adherence (A) and calculated difference (median + SEM) in annual eGFR decline rate among these patient group (B).

The behavior of patients for not adhering to medication and self-using of complementary or alternative medicines is a growing concern in many countries around the world. While the problem has been investigated in several chronic non-communicable diseases, not much is known about the prevalence of low medication adherence and its impact on the outcome specifically in diabetic patients with CKD. In this study, data obtained from self-reported survey revealed that 24.1% and 25.0% of Thai patients with diabetic CKD were medium- and low-adherent to prescribed medicine, and 24.1% used herb/herbal or complementary medicines. Our findings are in the same range as those of previous reports and reviews in diabetic patients from low to middle income and Middle East countries.1417 Moreover, our data showed that the adherence level was lowest in diabetic patients with stage IVV of CKD with a significant odds ratio of 5.54, and low adherence was associated with an increased risk of being rapid CKD progressor. The study confirms that medication adherence is common and may result in poorer outcome in diabetic patients with CKD.

It is generally accepted that medication adherence in patients with chronic disease may be affected by various factors.4 Recent systematic review and meta-analysis studies revealed that 67.4% of pre-dialysis CKD patients had the problems of medication adherence, and a total of 19 factors have been identified including socio-demographic, patient-related, therapy related, disease related and health care service related components.18,19 Insights into the factors that may influence medication adherence are important for identification of patients at risk and also the adherence barriers that should be overcome. We found in this study that the factors of age, educational status, vision problems, poorly controlled hypertension and late CKD stage were statistically correlated by univariate analysis. The effect of age on medication adherence was similarly observed in another study in Thai CKD patients, but not other factors.17 It is not surprising to us that medication adherence is higher in the elderly 65 years. The reason for this tendency has been explained by the health belief model in that older patients generally perceive greater severity of the illness and increase awareness in self-care.20,21 Additionally, the patients who participated in this study do not have significant cognitive or functional impairment, including anxiety or depression problems, that may limit their understanding, implementation and adherence to therapy.19,21 Low educational status is most likely related to insufficient health literacy (for example, specific purpose of each medicine, disease knowledge and management plan) which is known to be positively correlated with medication adherence.15,18

We found in this study that severity of CKD stage in the diabetic patient was the significant predictor for low adherence by multivariate analysis, the data which is similar to that published in a recent systematic review in pre-dialysis CKD patients.19 Earlier studies have reported 1253% of patients with CKD stage IIIIV and 2174% with advanced kidney disease to be non-adherent.18,21 A similar proportion was observed in our study when comparing among CKD stages. The low adherent percentage increased from null in stage 2 to 17.3% and 51.9% in CKD stage III and IVV respectively. Another study also revealed that adherence to antihypertensive agents worsens with declining renal function, and poor adherence is associated with a greater risk of uncontrolled hypertension.22 The major factors contributing to non-adherence in later CKD stage might include higher pill burden (and also costs), personal concern for drug interaction, and suspected efficacy of some prescribed medicines.23,24 It is likely that these problems will be more apparent as the illness becomes longer and more severe. Further studies are needed to clarify to what extent these components influence medication taking behavior in diabetic CKD patients.

There remains a limited and inconclusive data concerning the effect of medication adherence on the clinical outcomes in DKD. Prior studies from United States and our country showed that stage IIIIV CKD patients with poor adherence were associated with increased risk of CKD progression,5,17 while result from the African American Study of Kidney Disease and Hypertension did not verify this correlation.25 It is interesting to note that the causes of CKD in these studies were diverse and not detailed. Our results indeed support the findings of an increased risk for diabetic patients with low medication adherence to have rapid CKD progression. The subtle but statistically significant risk should be primarily explained by uncontrolled hypertension since the parameters other than the systolic blood pressure (including the level of glycemic and lipid controls) were not different among group. Noteworthy, the concept of healthy adherer effect should also be considered since medication adherence may be just a surrogate marker for the personality or behavior relevant to motivation for healthy lifestyle and overall well-being.5

Finally, regarding self-usage of herbal or complementary products in nearly one-fourth of the patients, we observe no association with socio-demographic or clinical variables and no significant effects on the measured clinical outcomes. Slightly lower prevalence in our study compared to finding from previous Thai reports may be explained by the characteristics of our patients who mostly lived in the urban area.17,26 Interestingly, our participants gained knowledge of potential product benefit from various sources, and it is likely that they will not disclose if the issue was not raised at the visit. It is known that such products may be harmful if its toxicity has not been properly investigated (particularly in CKD patients) or preparations may be contaminated with other toxic non-herbal compounds.27 Moreover, interaction between a concurrently used medicine and these products may occur and result in adverse events or negative clinical outcomes.28 It is thus important that health-care providers should recognize self-usage of herb, complementary or alternative medicine in their patients, so as to avoid any potential adverse effects or toxicity that may occur.

There are some limitations in our study. First, we used self-report questionnaire as a tool for measuring medication adherence which is known to be associated with over-estimation of adherence. Further study using a mixed-method approach that combines feasible subjective questionnaires and objective measurement of adherence will be valuable. Second, in our study, we selected patient-related and disease-related factors previously described to be associated with medication adherence by gathering data from the questionnaire and the electronic health record. Other predictors, such as psychological factors, factors of intention (motivation), medication knowledge, health care provider related factors, and other non-therapeutic factors were not accounted for. However, it is likely that these factors would not have had a major influence in this particular patient group and might not be much varied among our participants who were all treated in a single center. Third, we cannot clearly establish the temporal sequence of the estimated associations between low adherence and CKD outcome as these were measured at the same time. However, the clinical baseline of approximately one-year earlier was similar among group and adherence level was associated with a significant change in the last eGFR measurement at the study visit. It is thus suggested that diabetic CKD patients with low medication adherence are at risk for worse kidney outcome. Finally, similar to other observational studies, the possibility of residual confounding and bias cannot be ruled out.29

To our knowledge, this study is the first to identify medication adherence and its association with clinical outcome, specifically in patients with pre-dialysis diabetic CKD. We show that a significant proportion of patients self-reported suboptimal adherence to their medications, and usage of herbal and/or complementary medicines. Late CKD stage is the factor significantly associated with low adherence and it further heightened the risk for disease progression. Though we need more information to contextualize the adherence issue in diabetic CKD patients, our study underscores the urgent need for effective interventions to improve adherence and thus to improve clinical outcome in these high-risk group patients.

The raw data of our study are in Thai and can only be made available upon request with modifications that will provide data security to the participants of our study.

We are grateful to Ms. Naparat Kaewkaukul (Renal Division, Siriraj Hospital) for her invaluable assistance in data collection and preparation.

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

The authors report no conflicts of interest for this work and declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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2. Persson F, Rossing P. Diagnosis of diabetic kidney disease: state of the art and future perspective. Kidney Int Suppl. 2018;8(1):27. doi:10.1016/j.kisu.2017.10.003

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4. Sabat E. Adherence to Long-Term Therapies: Evidence for Action. Geneva, Switzerland: World Health Organization; 2003.

5. Kifle ZD. Prevalence and correlates of complementary and alternative medicine use among diabetic patients in a resource-limited setting. Metabol Open. 2021;13(10):100095. doi:10.1016/j.metop.2021.100095

6. Wee HL, Seng BJ, Lee JJ, et al. Association of anemia and mineral and bone disorder with health-related quality of life in Asian pre-dialysis patients. Health Qual Life Outcomes. 2016;14:94. doi:10.1186/s12955-016-0477-8

7. Cedillo-Couvert EA, Ricardo AC, Chen J, et al. Self-reported medication adherence and CKD progression. Kidney Int Rep. 2018;3(3):645651. doi:10.1016/j.ekir.2018.01.007

8. United States Renal Data System. 2018 USRDS annual data report: epidemiology of kidney disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2018.

9. Kanjanabuch T, Takkavatakarn K. Global dialysis perspective: Thailand. Kidney360. 2020;1(7):671675. doi:10.34067/KID.0000762020

10. Sakthong P, Sonsa-Ardjit N, Sukarnjanaset P, Munpan W, Suksanga P. Development and psychometric testing of the medication taking behavior in Thai patients (MTB-Thai). Int J Clin Pharm. 2016;38(2):438445. doi:10.1007/s11096-016-0275-8

11. Quandt SA, Verhoef MJ, Arcury TA, et al. Development of an international questionnaire to measure use of complementary and alternative medicine. J Altern Complement Med. 2009;15(4):331339. doi:10.1089/acm.2008.0521

12. Sakthong P, Chabunthom R, Charoenvisuthiwongs R. Psychometric properties of the Thai version of the 8-item Morisky Medication Adherence Scale in patients with type 2 diabetes. Ann Pharmacother. 2009;43(5):950957. doi:10.1345/aph.1L453

13. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3(1):1150.

14. Azharuddin M, Adil M, Sharma M, Gyawali B. A systematic review and meta-analysis of non-adherence to anti-diabetic medication: evidence from low- and middle-income countries. Int J Clin Pract. 2021;75(11):e14717. doi:10.1111/ijcp.14717

15. Alalami U, Saeed KA, Khan MA. Prevalence and pattern of traditional and complementary alternative medicine use in diabetic patients in Dubai, UAE. Arab J Nutr Exerc. 2017;2017:10.

16. Alsanad S, Aboushanab T, Khalil M, Alkhamees OA. A descriptive review of the prevalence and usage of traditional and complementary medicine among Saudi diabetic patients. Scientifica. 2018;2018:6303190. doi:10.1155/2018/6303190

17. Tangkiatkumjai M, Walker DM, Praditpornsilpa K, Boardman H. Association between medication adherence and clinical outcomes in patients with chronic kidney disease: a prospective cohort study. Clin Exp Nephrol. 2017;21:504512. doi:10.1007/s10157-016-1312-6

18. Mechta Nielsen T, Frjk Juhl M, Feldt-Rasmussen B, Thomsen T. Adherence to medication in patients with chronic kidney disease: a systematic review of qualitative research. Clin Kidney J. 2018;11(4):513527. doi:10.1093/ckj/sfx140

19. Seng JJB, Tan JY, Yeam CT, et al. Factors affecting medication adherence among pre-dialysis chronic kidney disease patients: a systematic review and meta-analysis of literature. Int Urol Nephrol. 2020;52:903916. doi:10.1007/s11255-020-02452-8

20. Huang CW, Wee PH, Low LL, et al. Prevalence and risk factors for elevated anxiety symptoms and anxiety disorders in chronic kidney disease: a systematic review and meta-analysis. Gen Hosp Psychiatry. 2021;69:2740. doi:10.1016/j.genhosppsych.2020.12.003

21. Karamanidou C, Clatworthy J, Weinman J, Horne R. A systematic review of the prevalence and determinants of nonadherence to phosphate binding medication in patients with end-stage renal disease. BMC Nephrol. 2008;9:2. doi:10.1186/1471-2369-9-2

22. Schmitt KE, Edie CF, Laflam P, Simbartl LA, Thakar CV. Adherence to antihypertensive agents and blood pressure control in chronic kidney disease. Am J Nephrol. 2010;32(6):541548. doi:10.1159/000321688

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Medical Adherence and Progression of Diabetic Chronic Kidney | PPA - Dove Medical Press

The Complementary and Alternative Medicine Market report includes in-depth competitive analysis with the aim of estimating financial growth and maximizing profit potential of the business.In the Complementary and Alternative Medicine market research report, industry trends are plotted at macro level which helps clients and businesses to understand the market and possible future issues.The comprehensive data and brilliant forecasting techniques used in this report coincide with precision and accuracy.Complementary and Alternative Medicine Market can be obtained through market details such as growth drivers, latest developments, market business strategies, regional study and future status of the market.The report also covers insights, including the latest opportunities and challenges in the complementary and alternative medicine industry, as well as historical and future market trends.The geographic scope of products is also methodically taken into account for major global areas such as Asia, North America, South America and Africa.An international complementary and alternative medicine report offers appropriate solutions to complex business challenges and works towards an effortless decision-making process.

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Major players dominating the market across the globe are:

Nordic Naturals, Natures Bounty, Unity Woods Yoga Center, Columbia Nutritional, First Natural Brands Ltd., Ayush Ayurveda, Sheng Chang Pharmaceutical Company, Pure Encapsulations, LLC.Quantum-Touch et Herb Pharm, LLC

Complementary and Alternative Medicine Market Segmentation:

By Type (Alternative Medical Systems, Mind-Body Interventions, Biology-Based Therapies, Manipulative and Body-Based Methods, Energy Therapies, Others)

By end users (hospitals, specialized clinics, therapy centers, others)

By distribution channel (hospital, specialized clinics/centres, direct contact, online training, others)

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Answers to key questions in the report:

Country Level Analysis of Complementary and Alternative Medicine Market:

Asia-Pacific: China, Japan, India and Rest of Asia-Pacific

Europe: Germany, UK, France and Rest of Europe

North America: United States, Mexico and Canada

Latin America: Brazil and Rest of Latin America

Middle East and Africa: GCC countries and rest of Middle East and Africa

Study objectives

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Complementary and Alternative Medicine Market Covid-19 Impact | Analysis by Current Industry Status & Growth Opportunities and Top Key Players...

Parkinson is a neurodegenerative disease where dopaminergic neurons progressively die in the brainstem. Tremor and difficulties to walk are recognizable movement symptoms for many people suffering from Parkinson. Over time, nearly a quarter of patients will have so much trouble walking that they often end up freezing on the spot and falling, and many become housebound.

People are primarily treated with medicine, but in some cases doctors use Deep Brain Stimulation (DBS). In DBS, the surgeon places a thin metal wire in the brain, which can be used to send electrical pulses. DBS is effective in treating tremor, but alleviating difficulties in walking and freezing remains a challenge.

Now, a study from the University of Copenhagen conducted in mice demonstrate that DBS treatment of walking problems in Parkinson could be optimised by targeting specific eurons in the brainstem possibly benefitting some of the more than 7 to 10 million people suffering from the disease worldwide.

Based on previous animal studies of motor circuits, which are responsible for the planning, control, and execution of voluntary movements, scientists has hypothesized that freezing of walking in Parkinson could be alleviated. That would require DBS to stimulate neurons in the pedunculopontine nucleus (PPN), which is located in the brainstem. The PPN was thought to send signals from the brain to the spinal cord leading to body movements.

However, initial results from clinical trials with DBS of the PPN had very variable effect on movement recovery, particularly in patients who experience freezing of walking. It has therefore been debated where within the brainstem an optimal stimulation should be. Our study brings new knowledge to the table regarding the best area for DBS in order to alleviate this particular symptom, says corresponding author Professor Ole Kiehn at the Department of Neuroscience.

Previous results from the group showed that stimulation of so-called excitatory neurons in the PPN could initiate locomotion in normal mice. It raised the possibility that these nerve cells could indeed be used to treat movement symptoms in mice with features of Parkinsons Disease.

We use a technology to target specific group of cells in the PPN in order to close in on what areas are the best to stimulate, if we want to alleviate these particular symptoms. The result shows that the motor improvement is optimal, if we stimulate what we call excitatory neurons in the caudal area of the PPN, explains Ole Kiehn.

We believe that clinical trials with brainstem DBS are the right strategy to facilitate patients to walk properly again. But the variable clinical results occur, because DBS would require higher precision to target the particular group of neurons in the caudal PPN. It is a very delicate area, because if we were to stimulate excitatory neurons in other areas than the caudal PPN, it would cause complete immobilization instead.

In Parkinsons Disease, nerve cells that produce dopamine progressively die. Since the 1960s, doctors have relied on medication to replace the missing dopamine, but it is notoriously difficult to fully control symptoms as the disease progresses.

In many people the movement symptoms do not respond well to medical treatment in the later stages of this disease, so there has been done a lot of research into alternative treatments, including a search for optimal targets for deep brain stimulation, explains Postdoc Debora Masini, first author of the new study, which included several different strategies to substantiate their findings.

When we stimulated these specific neurons in the caudal area of the PPN, the animals were able to walk normally, across longer distances and with normal walking speed, as opposed to before the stimulation, where they would display symptoms of Parkinsons Disease, says Debora Masini.

We systematically compared stimulation of different locations and cell types in a series of complementary experiments. And they allpointed towards the same conclusion.It strongly indicates these excitatory neurons in the caudal PPN are an ideal target for recovery of movement loss, she says.

The researchers hope that the new study could aid clinicians when they pick the exact location for DBS in the brainstem.

The mice in our study only partially represents the complexity of this disease, but the results have been very telling. Nearly everything we have learned in the beginning on how to treat Parkinsons Disease comes from animal models, including the medication we use nowadays for patients. In this sense, it is a valid approach, and we hope our study can help provide better treatment for human patients, says Debora Masini.

Reference:Masini D, Kiehn O. Targeted activation of midbrain neurons restores locomotor function in mouse models of parkinsonism. Nat Commun. 2022;13(1):504. doi:10.1038/s41467-022-28075-4

This article has been republished from the following materials. Note: material may have been edited for length and content. For further information, please contact the cited source.

Originally posted here:

New Brain Target Could Improve Treatment for Parkinson's - Technology Networks

Objective

In the era of evidence-based medicine, research in the area of herbal psychopharmacology has increased dramatically in recent decades. To date, however, there is no comprehensive review of safflower as an herbal antidepressant and anxiolytic with details on its psychopharmacology and applications in depression and anxiety.

This research is a review and qualitative research through an electronic survey among the Saudi population, thus assessing their knowledge about using safflower in treating depression and anxiety. The survey was distributed in Saudi Arabia in December 2021 and the results were finalized in January 2022.

A total of 1074 Saudi participants were included in the study; 1002 (93.3%) participants reported knowing safflower very well while 72 (6.7%) had never heard of it. Some participants had used safflower infusions to treat anxiety and depression; 446 (44.4%)participants had never used it, but the remaining 558 (55.6%) had used it to varying degrees to treat anxiety and depression. Among the 752participants who previously tried safflower, 279 (37.1%) reported that safflower was very effective, 389 (51.73%) reported some improvement, and 93 (12.36%) reported no improvement.

Emerging medical evidence is guiding herbal treatments. This research illustrates that more than 75% of the Saudi population are using Safflower to treat psychological stress. It elaborates that more than half of the population are already using safflower off the label to treat depression and anxiety and that they find it useful. A well-constructed clinical trial is thus critical to prove the evidence-based benefits of safflower in treating depression and anxiety. More studies on possible side effects are required to guarantee its safety. Nature has previously provided remarkable remedies, and more work will illustrate the value of safflower.

An herb is a friend of the physicians and a praise of the cooks. - Charlemagne

Natural products can boost health in humans and animals, and they have a significant role in the prevention of diseases. These natural products have various biological properties such as antioxidant, anti-inflammatory, and anti-apoptotic activities. In vitro and in vivo studies have further established the usefulness of natural products in various pre-clinical models of neurodegenerative disorders [1].

In Arabic countries, funerals involve prayers at the mosque and tradition suggests that a safflower drink be included to soothe the mourners. Similarly, safflower is given in the puerperium period after delivery or even a miscarriage. Women are encouraged to add safflower to their drinks to help them cope with postpartum symptoms.

One Saudi study evaluated the prevalence, knowledge, and attitudes toward herbal medications used by Saudi women in the central region during pregnancy, labor, and after delivery. Of the 612 participants, 25.3%, 33.7%, and 48.9% used herbs during pregnancy, during labor, and after delivery, respectively. The primary motives for using herbal medicine during pregnancy, during labor, and after delivery were to boost general health, ease and accelerate labor, and clean the womb, respectively [2].

The safflower drink consists of safflower petals soaked in water until the water becomes yellow and the safflower aroma can be smelled and tasted.Although this traditional herbal recipe is easy, it is not broadly studied beyond local tradition. This review is targeted at physicians and pharmacists and the value it has for their patients, specifically psychiatric patients with depression and anxiety.

Safflower (Usferin Arabic and Kafesheh in Persian, anciently named bastard saffron) is a highly branched, herbaceous, thistle-like annual plant with many long sharp spines on the leaves. The plants are 30 to 150 cm tall with globular flower heads (capitula) and brilliant yellow, orange, or red flowers in July. Each branch will usually have from one to five flower heads containing 15 to 20 seeds per head [3].

Traditionally, the crop was grown for its flowers, used as a food additive, for making dyes, and in medicines. In the last 50 years, it has been cultivated mainly for the vegetable oil extracted from its seeds. Safflower oil is flavorless and colorless, and nutritionally similar to sunflower oil. It is used mainly as cooking oil, in salad dressing, and in the production of margarine. It may also be taken as a nutritional supplement. The International Nomenclature of Cosmetic Ingredients (INCI) identifier ofsafflower is Carthamus tinctorius [3].

A search of MEDLINE (PubMed), PsycINFO, Google Scholar, and Cochrane Library databases was conducted (up to September 19, 2021) on the use of safflower as herbal medicine. Several in vitro and in vivo clinical trials provide preliminary positive evidence for its antidepressant effects and anxiolytic activity. To date, however, there is no comprehensive review of safflower as an herbal antidepressant and anxiolytic with details on its psychopharmacology and applications in depression and anxiety in humans.

This research is a review and qualitative research. An electronic survey was done on Google Forms and distributed among the Saudi population through social media, thus assessing their knowledge about using safflower in treating depression and anxiety. The survey was distributed in Saudi Arabia in December 2021 and the results were finalized in January 2022.

Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 23 (IBM Corp., Armonk, NY). The frequency and percentages were used to display categorical variables. A chi-squaretest was used to testthe association between categorical variables. The level of significance was set to 0.05.

This research has been ethically approved by the Central Research Ethics Committee at Prince Sultan Military Medical City in Riyadh on December 22, 2021, as project number 2021-51.

A total of 1074 participants were included in the study. Table 1 shows the sociodemographic and academic profiles of the participants. As for the age, 15 (1.4%) participants were less than 18 years old, 44 (4.1%) were between 18 and 25 years, 176 (16.4%) were between 26 and 35 years, 340 (31.7%) were between 36 and 45 years, 297 (27.7%) were between 46 and 55 years, 168 (15.6%) were between 56 and 65 years, and 34 (3.2%) were older than 65 years. Of the participants,100 (9.3%) were malesand 974 (90.7%) were females. As for the education level, 61 (5.7%) participants had an education of less than a high school degree, 168 (15.6%) had a high school degree or equivalent, 102 (9.5%) had a college education but not a degree, 104 (9.7%) had an associate degree, 555 (51.7%) had a bachelors degree, 64 (6%) had a graduate degree, and 20 (1.9%) did not specify their education.

Figure 1 displays the participants' previous knowledge of safflower. A total of 1002 (93.3%) participants reported they know safflower very well, while 72 (6.7%) reported they have never heard of it.

Figure 2 present the participants' source of information regarding safflower in participants who reported previously knowing safflower. A total of 775 (77.2%) participants reported they learned about safflower from family, 297 (29.6%) from social media, 214 (21.3%) from friends, 116 (11.6%) from books/publications, and 30 (3%) from other sources.

Table 2 demonstrates the participants' thoughts regarding the therapeutic benefits of safflower and their previous experience with it. As for the participants' awareness of the therapeutic benefits of safflower, 178 (17.7%) participants reported that the safflower has some general medical uses, while 826 (82.3%) reported that they are aware that it is used in treating psychological stress. As for participants' useof safflower infusion for medical purposes in general, 282 (28.1%) participants reported they never used it, while the remaining 722 (71.9%) had a varying degree of using it for general medical purposes. As for participants' useof safflower infusion to treat psychological stress, 245 (24.4%) reported they never used it, while the remaining 759 (75.6%) had a varying degree of using it to treat psychological stress. As for participants' useof safflower infusion to treat anxiety and depression symptoms, 446 (44.4%) reported they never used it, while the remaining 558 (55.6%) had a varying degree to treat anxiety and symptoms of depression.

Figure 3 illustrates the participants' reports on the improvement they experienced after using safflower. Among the 752 who previously tried safflower, 279 (37.1%) reported safflower was very effective, 389 (51.73%) reported they experienced some improvement, and 93 (12.36%) reported they experienced no improvement.

Figure 4 shows the participants' responses toward "Do you think safflower can be an effective medical treatment for symptoms of depression and anxiety?. Of the participants,834 (83.1%) reported that they think safflower can be effective in treating symptoms of depression and anxiety, while 170 (16.9%) did not think so.

Table 3 displays the factors associated with previous knowledge of safflower. Age was significantly associated with previously knowing about safflower (p < 0.001). The highest rate of knowing about safflower was seen in those between 46 and 55 years (97.3%) and those between 36 and 45 (94.7), while the lowest rate was found in those younger than 18 years (73.3%), and those older than 65 years (85.3). Gender was also significantly associated with previously knowing about safflower (p < 0.001). Females had a notably higher rate of knowing about safflower compared to males (95.8% vs. 69%). Education level was also significantly associated with previously knowing about safflower (p < 0.001). The lowest rate of previously knowing about safflower was found in those with education less than high school (69.7%), while the highest rate of previously knowing about safflower was found in those with bachelors degrees (95.9%).

Safflower has been used for its therapeutic value for centuries. Ancient writings like Historia Plantarum,abotanybook byJohn Raypublished in 1686, mentioned the use of safflower in treating respiratory and gastrointestinal diseases.

The modern literature has numerous studies proving that safflower has therapeutic advances in multiple medical conditions [4]. On top of the list of the medicinal uses of safflower is its miraculous healing properties [5]. It can help the body heal via its anti-inflammatory mechanisms [6]. Safflower also has value in cardiovascular diseases [7], specifically ischemic conditions [8].It can reverse cell death and regenerate adequate revascularization by angiogenesis [9].

Safflower can also overcome motor deficiencies in the central nervous system [10,11].The natural compound hydroxysafflor yellow A (HSYA) isolated from the flower of the Carthamus tinctorius (safflower plant) can reduce apoptosis, partially pointing to the fact that HSYA protects against cerebral ischemia/reperfusion injury [12]. Hydroxysafflor yellow B (HSYB) has shown neuroprotective actions by recuperating the energy metabolism, scavenging free radicals, and decreasing lipid peroxides in the brain tissue [13]. Both compounds offer protection in response to cerebral ischemic reperfusion injury [14].

The flavonoid extract of safflower appears to have neuroprotective effects against neurotoxin-induced cellular and animal models of Parkinsons disease [15]. Safflower has been included in the synthesis of NeuroAiD, a treatment used to support functional recovery after stroke [16].It is also a complementary treatment for other brain injuries andAlzheimer's disease [17]. HSYA has been used to treat cardiovascular and cerebrovascular diseases clinically in China, but the drug target is still not clear [4].

Safflower (Carthamus tinctorius) has been used in food and traditional medicine due to its active compounds such as flavonoids,phenylethanoidglycosides,coumarins,fatty acids, and steroids to treat conditions such as dysmenorrhea, amenorrhea, and other diseases [18].

Lack of Research

The evidence for the efficacy of many complementary and alternative interventions used to treat anxiety and depression remains poor. Recent systematic reviews point to a significant lack of methodologically rigorous studies within the field. However, this lack of evidence does not diminish the popularity of such interventions within the general Western population [19].

Bipolar patients experience residual anxiety and insomnia between mood episodes and increasingly self-prescribe alternative medicines. Prior work concluded that adjunctive herbal medicines may alleviate these symptoms and improve outcomes in standard treatment despite limited evidence. Physicians need to have a more in-depth understanding of the evidence-based benefits, risks, and drug interactions of alternative treatments [20]. Even for alcoholism, the historical use of plant extracts to create herbal preparations for alcohol use treatment has been recorded, but their efficacy remains debatable, as further research is necessary[21].

A 2017 study showed that components (especially N-hexadecanoicacid)ofCarthamus tinctorius extract induce antidepressant-like effects by interaction withdopaminergic(D1andD2)and serotonergic (5HT1A and 5-HT2A receptors) systems. These findings validate the folk use of Carthamus tinctorius extract for the management of depression [22].

The most recent publication on safflower in treating mental illness was from Saudi Arabia earlier this year and it investigated Saudis' attitudes toward mental distress and psychotropic medications, attribution of causes, and expected side effects. This work analyzed participants' expectations toward alternative or complementary medicines using aromatic and medicinal plants via a survey. Here, 39 plants and herbs were reported by the participants and were a good start for creating a local library of medicinal plants traditionally used for treating mental distress. Mint (Mentha sp.) was the most commonly cited plant; it was mentioned 32 times. This was followed by chamomile (Chamaemelum nobile), suggested 22 times, anise (Pimpinella anisum), suggested 16 times, and lavender (Lavandula sp.)and safflower (Carthamus tinctorius),suggested 11 times each. Most of the reported plants and herbs have been documented for their psychological properties such as neuroprotective, anxiolytic, antidepressant, and anti-stress features via the inherent phytochemicals and secondary metabolites [23]. Surprisingly, only 18.8% of the participants agreed that medicinal and aromatic plants could treat psychological disorders. Participants (82%) reported that physicians are the most trustful and preferred source of information about alternative and complementary medicine [23].

Safflower (Carthamustinctorius)petal extract exerts neuroprotective and antioxidant activities [24], which helps with its antidepressant and antianxiety properties [25]. A recent study was performed to evaluate the antianxiety and antidepressant effect of Carthamus tinctorius petal extract. The results show that Carthamus tinctorius produced very significant anxiolytic and antidepressant effects compared to control, similar to the standard anxiolytic and antidepressant drugs diazepam and nortriptyline. Hence, they concluded that safflower may be an alternative therapeutic while treating patients with anxiety and depressive disorders [25].

Lack of Human Studies

Safflower has been used in several cultures as a medicine for multiple conditions, especially mental illnesses, but such use is rarely recorded. No official clinical trial has yet measured its efficacy in treating mental illness in humans. This lack of human studies underscores the need to explore new treatments. Such a study is more feasible in some countries than others due to cultural beliefs and rituals.

Herbal teas with numerous ingredients, especially flowers, are common in traditional medicines and pharmacopeias of Greece and the Eastern Mediterranean. A study of traditional herbal mixtures with flowers shows their botanical ingredients and records the local medicinal uses of these mixtures in Greece, Lebanon, Syria, Iran, and Turkey. These mixtures are not consumed as a treatment when one is sick but rather to avoid getting sick as a preventive measure. The formulations can reach 40 ingredients (Zhourat in Arabic). The ingredients are usually whole or coarsely chopped in more traditional formulations, thus leading to the extreme variability of individual doses [26].

Emerging medical evidence is guiding herbal treatments. This research illustrates that more than 75% of the Saudi population are using Safflower to treat psychological stress. It elaborates that more than half of the population are already using safflower off the label to treat depression and anxiety and that they find it useful. A well-constructed clinical trial is thus critical to prove the evidence-based benefits of safflower in treating depression and anxiety. More studies on possible side effects are required to guarantee its safety. Nature has previously provided remarkable remedies, and more work will illustrate the value of safflower.

Read this article:

The Use of Safflower (Carthamus tinctorius) in Treating Depression and Anxiety - Cureus

Newswise Olivia Gatlin usually knows when a seizure is coming: She starts to get anxious. The feeling starts in her feet and moves to her neck. Sometimes shes not sure if shes experiencing an aura, or anxiety. In either case, the 42-year-old uses self-taught breathing exercises to calm herself.

But until recently, Gatlin had never discussed anxiety with her neurologist.

I took it for granted that the anxiety was coming along with my seizures, and I was just going to have to deal with it, she said.

The impact of anxiety

Studies estimate that some form of anxiety disorder affectsat least 25% of people with epilepsy, yet anxiety is underdiagnosed and undertreated. More attention often is paid to depression, possibly because of the risk for suicide. However, anxiety disordersalso can increase risk for suicide, said Coraline Hingray, Ple Universitaire du Grand Nancy and Centre Psychothrapique deNancy, France, during a session at the American Epilepsy Society (AES) Annual Meeting in 2021. Also, said Hingray, anxiety in people with epilepsy is astronger influence on quality of lifethan either depression or seizure frequency. And it is associated with poorer epilepsy outcomes.

A recent studyfound that among people with newly diagnosed epilepsy, those screening positive for both anxiety and depression had 7 times the risk of recurrent seizures, despite treatment with anti-seizure medications (ASMs), compared with those who screened negative for both conditions.

A2021 survey by the ILAE Psychology Task Forcefound that only 41% of epilepsy care providers screened patients for anxiety at every visit. Another 1% never screened for anxiety, and 31% screened only if the patient or a family member spontaneously mentioned anxiety during a visit.

Bidirectional relationship

There is a bidirectional relationship between anxiety and epilepsy, said Heidi Munger Clary, Wake Forest University School of Medicine, USA, and co-chair of ILAEs Integrated Mental Health Care Pathways Task Force. People with anxiety are at greater risk for epilepsy, and people with epilepsy are more likely to develop anxiety. That is likely related to the same structures being involved in both conditions.

Addressing anxiety in people with epilepsy can make a major difference, said Munger Clary. Its critical that we do what we can to address anxiety and depression. We talk about anxiety less, and the amount of expertise and comfort with managing it is lower, she said. But there is a big opportunity for us to impact care and improve lives.

Screening for anxiety: A first step and a conversation starter

Many neurologists cite time constraints as a barrier to screening. The GAD-7 screening tool takes only a few minutes and can be completed in the waiting room. Its used in the general population to screen for anxiety and has been validated in people with epilepsy.

GAD-7 is available onlinein more than 50 languages.

Printable versions of GAD-7 in English are availablehereandhere.

This pageprovides a printable GAD-7 in French (Canada).

This pageprovides printable GAD-7 versions in Arabic, Traditional Chinese, Simplified Chinese, Hindi, Korean, Russian, Spanish, and Thai.

And an online, automatically scored, English versionis available here(no log-in is required and no identifying information is collected)

GAD-2, a short version of GAD-7, appears just as effective in identifying anxiety in people with epilepsy. A score of 3 or more on the GAD-2 identifies generalized anxiety disorder at least 86% of the time.

The Epilepsy Anxiety Survey Instrument (EASI-18) and its briefer counterpart, brEASI, are also anxiety screeners designed and validated in people with epilepsy. They arefreely available in Englishand currently being translated and validated in other languages.

Offering a screening tool before an office visit is an excellent way to start a conversation about anxiety, said Munger Clary. If time or resource constraints prevent using a screener, she recommends asking a single question during the visit. I might ask, Are you having any challenges with mood? or Are you having challenges with depression or anxiety?, she said. Patients seem to respond well.

Barriers to anxiety management

More than 93% of respondents to the ILAE Psychology Task Force survey agreed that the management of depression and anxiety is integral to the care of people with epilepsy, but only 40% agreed that they had adequate resources.

Guidelines, or the lack thereof, are another concern. I think everyone recognizes that anxiety is common and problematic, but there arent integrated protocols on what to do, said Milena Gandy, School of Psychological Sciences, Macquarie University, Australia. These barriers should not deter epilepsy care providers, said Gandy. The psychosocial factors are potentially modifiable, whereas many of the medical factors arent. You cant change the type of epilepsy people have, but you can help people modify the way they think, what they do, and how they understand their epilepsy.

Types of anxiety

A 2011 consensus statement from the ILAE states that its essential to establish the relationship, if any, between the anxiety and the epilepsy. Anxiety can be any of several types, and many people experience more than one type:

Anxiety also can be associated with fear of seizure recurrence (seizure phobia), or a reaction to the diagnosis of epilepsy and the limitations associated with it.

Medication and counseling

Gatlin, who lives in North Carolina, started medication after she began to have panic attacks in late 2021. The attacks started days after her first generalized tonic-clonic seizure. They come out of nowhere.

I get pressure on my chest and my hands go numb, she said. You feel like youre having a heart attack, like youre going to die, she said. The first time I really discussed anxiety with my doctor was when I started having these attacks.

Panic disorder may respond to any of several medications. Interictal anxiety often responds to medication or psychotherapy.

If the anxiety is pervasive and not seizure related, Munger Clary usually offers patients a selective serotonin reuptake inhibitor (SSRI) or selective norepinephrine uptake inhibitor (SNRI), if they arent already taking one. I can do that on my own, and its pretty effective, she said.

A 2016 review article inEpileptic Disordersdiscusses clinical, neurobiological, and pharmacological aspects of treating anxiety in people with epilepsy. The article includes recommendations for treatment of several anxiety disorders, including panic attacks, social anxiety, post-traumatic stress disorder, generalized anxiety disorder and obsessive-compulsive disorder.

When it comes to psychotherapy, finding counselors who specialize in people with epilepsy, or in people with chronic conditions, would be ideal but isnt necessary, said Munger Clary. I think most people with epilepsy could benefit from a counselor with just general expertise, she said.

Gandy agreed. Seeing a psychologist and getting care is more important than finding someone who specializes in epilepsy, though in an ideal world you would want someone who has a bit of understanding of epilepsy and can tailor treatment to some of the unique challenges of seizures, as well as the stigma people face and what they can and cant do.

For more about cognitive behavioral therapy (CBT), a recommended treatment for some types of anxiety, see the callout box below.

Selecting treatment

Neurologists dont necessarily need a definitive answer for how to manage someones anxiety, said Munger Clary. Often, the choice of treatment depends on what the person with epilepsy prefers. Having a conversation about wellnesshealthy eating, good sleep patterns, physical activitycan help people begin to address anxiety before (or instead of) medication or counseling. Munger Clarypublished a study in 2021in which 89% of participants were willing to try wellness options for their anxiety.

Connecting patients with an epilepsy support group or asking if they have one or two supportive family member or friends also can make a big difference, said Munger Clary. And for people with epilepsy-related anxiety, an epilepsy action plan can ease fears and establish a protocol.

Other options include educational handouts about relaxation techniques, suggestions for apps or online materials, a referral to a psychologist or psychiatrist, and epilepsy support groups. And then there are alternative medicine types of opportunities--relaxation training, yoga, said Munger Clary. You can think through a lot of options and hopefully theres something that can be done, if the person is looking for help.

Who is responsible?

In the ILAE survey, 64% of epilepsy care providers said they werent responsible for managing anxiety in their epilepsy patients. This needs to change, said Adriana Bermeo Ovalle, Rush Medical Center, Chicago, USA. Epilepsy providers should screen, diagnose, and pursue treatment of the psychiatric conditions that epilepsy patients face on a daily basis, she said in a 2021 AES Annual Meeting session on patient care. We dont have the luxury of not making the diagnosis, she said.

Bermeo Ovalle recommends that neurologists become familiar with SSRIs and SNRIs for anxiety.

There are some intriguing data showing an improvement in seizure frequency when people with epilepsy are treated with SSRIs, said Munger Clary. There needs to be more research, of course, but it does raise the questionif the same brain structures are involved in both conditions, will we one day discover a drug that can treat both?

Cognitive behavioral therapy (CBT): What is it?

CBT aims to change unhelpful patterns of thinking and behavior. It is based on the principle that learning coping skills can help not only with mental health, but also day-to-day functioning, including medication adherence and lifestyle modifications.

CBTs impact can be broad. It is hard to manage a health condition and it requires skills how do I problem-solve this, where do I ask for help with that, what can I do, said Gandy. Some people might have those skills naturally, but others might need a bit of help. Thats where CBT can come in.

One 2019 studyrandomized 200 people with epilepsy and depression to either an online CBT intervention or to usual care, with anxiety as a secondary outcome.

People receiving CBT had significantly greater improvements in anxiety (as well as in depression, stress, social-occupational impairment, and epilepsy-related quality of life). At 3months, they reported fewer illness-related days off work and fewer days hospitalized, compared with people in the control group.

Online help for anxiety

Online, interactive courses are becoming more common for managing anxiety. Gandy runs a 10-week course that provides online psychoeducation similar to what would be given through in-person cognitive behavioral therapy, but with several advantages.

The typical counseling session is 50 minutes; thats a long time to pay attention, Gandy said. And often, people with epilepsy have additional attention challenges, as well as practical difficulties that make it difficult for them to keep in-person appointments. Online interventions can get around these barriers.

Delivered over 10 weeks, the course offers 6 online lessons, worksheets, other resources and case studies, as well as brief weekly contact with a clinician through email and telephone.

Actionable advice on anxiety and epilepsy

Gatlin urged neurologists to be upfront with their patients about anxiety and epilepsy. Doctors need to cover any and every side effect or other experience we could have, she said. People need to know that anxiety and panic could come along with the seizures, so they are prepared for it.

Her advice to people with epilepsy: Pay attention to yourself. Epilepsy has made me much better at listening to my body and evaluating myself, said Gatlin. There are ways to deal with anxiety, but first you have to be conscious of whats happening to you.

The benefits of targeting mental health in people with epilepsy are wide reaching, said Gandy. You can help peoples quality of life as well as epilepsy outcomes. She said ILAEs Integrated Mental Health Care Pathways Task Force is studying what can be learned from other disciplinessuch as oncology and cardiologyabout integrating mental health care into epilepsy care.

One in three patients that walks through your door are going to be anxious at some stage, she said. We know that depression and anxiety predict poorer outcomes. Its not an easy thing to fix, but theres no reason not to focus on it.

ILAE hasmore informationabout screening tools for anxiety and depression in people with epilepsy.

***

Founded in 1909, the International League Against Epilepsy (ILAE) is a global organization with more than 125 national chapters.

Through promoting research, education and training to improve the diagnosis, treatment and prevention of the disease, ILAE is working toward a world where no persons life is limited by epilepsy.

Website|Facebook|Instagram|YouTube

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The rest is here:

Anxiety in people with epilepsy affects seizure control and quality of life. Too often, it is overlooked. - Newswise

Rule change won't affect critical cases

Public Health Minister Anutin Charnvirakul insists the Universal Coverage for Emergency Patients (UCEP) scheme for treating Covid-19 sufferers is not being scrapped following his signing off on changes to the programme.

Mr Anutin said he formally approved the changes on Feb 18, which will go into effect on March 1.

He also sought to ease people's fears the scheme would be abolished, saying people infected with the virus can still obtain treatment under the programme.

Under the UCEP scheme, patients can seek treatment at any medical facility for three days, after which they will be transferred to a hospital where their state welfare and/or health insurance scheme is registered.

However, the government recently removed Covid-19 from the list of conditions covered by UCEP, which means that from March 1, those who test positive for Covid-19 but do not require critical care will have to pay their own medical bills if they choose to seek treatment at private hospitals.

Yesterday, Mr Anutin said a new scheme called Universal Coverage for Emergency Patients (UCEP) Plus is being launched, which will handle Covid-19 sufferers who require emergency treatment for moderate to severe symptoms.

The Public Health Minister added that in practice, there should be no glitches in providing treatment under the UCEP after March 1.

He said the changes were intended to streamline the scheme and bring about improved budget management while keeping up Covid-19 treatment standards.

"We have to make necessary adjustments [to the UCEP scheme] for the sake of giving fair and effective treatment while also considering budgetary factors," he said.

Also yesterday, the National Health Security Office (NHSO), which runs the gold card universal health care programme, said most Covid-19 sufferers in the latest outbreak did not exhibit severe symptoms, despite rapidly rising caseloads.

The situation was generally less critical than in previous outbreaks, according to NHSO deputy secretary-general Yupadee Sirisinsuk.

Those with mild conditions receive home isolation care and the NHSO has a network of medical facilities to adequately provide medical services to sufferers in home quarantine.

"The idea of home isolation is not to leave sufferers to fend for themselves. We've got teams of medical and care workers to regularly follow up on their conditions," she said.

Symptoms permitting, sufferers should avoid going to hospitals that are reserved for those who require more intensive treatment, according to Dr Yupadee.

The majority of sufferers with no or mild symptoms are young people who tend to develop a fever. Close monitoring is necessary for sufferers who are elderly or those with underlying illnesses.

Meanwhile, Mr Anutin said the Department of Thai Traditional and Alternative Medicine has asked the Public Health Ministry to approve the use of green chiretta (fah talai jone) for treatment of asymptomatic sufferers.

Green chiretta would provide a safer option than favipiravir, a medicine which may be too strong for sufferers with no symptoms, the Public Health Minister said.

Originally posted here:

Anutin insists govt will cover Covid treatment cost despite review - Bangkok Post

Rule change won't affect critical cases

Public Health Minister Anutin Charnvirakul insists the Universal Coverage for Emergency Patients (UCEP) scheme for treating Covid-19 sufferers is not being scrapped following his signing off on changes to the programme.

Mr Anutin said he formally approved the changes on Feb 18, which will go into effect on March 1.

He also sought to ease people's fears the scheme would be abolished, saying people infected with the virus can still obtain treatment under the programme.

Under the UCEP scheme, patients can seek treatment at any medical facility for three days, after which they will be transferred to a hospital where their state welfare and/or health insurance scheme is registered.

However, the government recently removed Covid-19 from the list of conditions covered by UCEP, which means that from March 1, those who test positive for Covid-19 but do not require critical care will have to pay their own medical bills if they choose to seek treatment at private hospitals.

Yesterday, Mr Anutin said a new scheme called Universal Coverage for Emergency Patients (UCEP) Plus is being launched, which will handle Covid-19 sufferers who require emergency treatment for moderate to severe symptoms.

The Public Health Minister added that in practice, there should be no glitches in providing treatment under the UCEP after March 1.

He said the changes were intended to streamline the scheme and bring about improved budget management while keeping up Covid-19 treatment standards.

"We have to make necessary adjustments [to the UCEP scheme] for the sake of giving fair and effective treatment while also considering budgetary factors," he said.

Also yesterday, the National Health Security Office (NHSO), which runs the gold card universal health care programme, said most Covid-19 sufferers in the latest outbreak did not exhibit severe symptoms, despite rapidly rising caseloads.

The situation was generally less critical than in previous outbreaks, according to NHSO deputy secretary-general Yupadee Sirisinsuk.

Those with mild conditions receive home isolation care and the NHSO has a network of medical facilities to adequately provide medical services to sufferers in home quarantine.

"The idea of home isolation is not to leave sufferers to fend for themselves. We've got teams of medical and care workers to regularly follow up on their conditions," she said.

Symptoms permitting, sufferers should avoid going to hospitals that are reserved for those who require more intensive treatment, according to Dr Yupadee.

The majority of sufferers with no or mild symptoms are young people who tend to develop a fever. Close monitoring is necessary for sufferers who are elderly or those with underlying illnesses.

Meanwhile, Mr Anutin said the Department of Thai Traditional and Alternative Medicine has asked the Public Health Ministry to approve the use of green chiretta (fah talai jone) for treatment of asymptomatic sufferers.

Green chiretta would provide a safer option than favipiravir, a medicine which may be too strong for sufferers with no symptoms, the Public Health Minister said.

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Anutin insists govt will cover treatment cost despite review - Bangkok Post

How could elective medication and your eating regimen be advantageous? The significant truth that experts of the elective medication industry push is the way that what you put into your body intensely affects your wellbeing. A huge number will suggest spices, nutrients and different enhancements to help the normal individual with incidental objections, however for individuals with constant or difficult sicknesses a unique eating regimen is as a rule suggested.

There are various weight control plans that are ordinarily endorsed by elective medication professionals for those patients with customary protests. The individuals who gripe of weariness, weight gain, or simply broad chronic weakness can frequently profit from a detoxifying or purging eating routine. Patients with diabetes and indigestion are frequently put on explicit eating regimens to further develop their conditions. For more difficult ailments like disease, more severe weight control plans are authorized. Many individuals have had unbelievable karma beating disease by utilizing a macrobiotic eating regimen.

So we should check out the meaning of a macrobiotic eating routine and start with examining the word macrobiotic. Macrobiotics, from the Greek "full scale" (huge, long) + "profiles" (life), is a way of life that joins a dietary routine. The most punctual recorded utilization of the term macrobiotics is found in the composition of Hippocrates, the dad of Western Medicine. However, the advanced eating regimen and reasoning was created by a Japanese instructor named George Ohsawa, who accepted that effortlessness was the way to ideal wellbeing. A macrobiotic eating regimen comprises of low-fat, high-fiber diet of entire grains, vegetables, ocean green growth, and seeds and is rich in phytoestrogens from soy items. It is significantly more than an eating regimen however it is a lifestyle that targets accomplishing offset with nature which incorporates an offset with your own body.

Anyway an expression of caution, similarly as with any change to your dietary or exercise systems it is vital to follow a clinical experts guidance while attempting an eating regimen, so make certain to check with your specialist prior to beginning any prohibitive eating routine.

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Alternative Medicine and Your Diet

In the last 10 years I have seen several acupuncturists. They were all Chinese who studied their profession in China. All the doctors I have seen thought that conventional and alternative medicine should be combined together, and that eliminating one totally, would be harmful.

Some Alternative Medicine Works, Some Do Not.

many people wonder if it works. My answer is it depends what treatment you are receiving and how much do you believe in it. Let me ask you this: Does antibiotics works? Does all the pharmaceutical medicine you take works? The matter of fact is that all pharmaceutical medicine MAY fix one problem and MAY also cause another. So by taking it you expose your body to new diseases. Acupuncture, Tai Ci, yoga, meditation and many other alternative methods to heal the body including simply exercise, does work. They work on different parts of the body. One thing is for sure: None of these methods will MAYBE harm your body in any way. You not exposing your self to any diseases, and the only thing you do is helping the body to heal, NATURALLY.

I had to have an operation once and then I went to see my acupuncture doctor for maintenance of my body. After all, it was not a natural process but it had to be done. Because an operation involves opening the body up, thus exposing the insides to bacteria, a patient will be given a course of antibiotics. Antibiotics is a medicine that kills a large range of bacteria in the body. In our body we always have good bacteria that IS in charge oN proper function of our immune system but in some cases we have bad bacteria that causes infection. If not treated, that infection can be deadly. I started taking my antibiotics after that operation and when I came to see my acupuncturist Dr Henry Su I asked him if I should take the antibiotics since it causes damage as well as doing good. Can acupuncture alone treat the bad bacteria in my body and cleanse it in a natural way. His answer was: You should take your antibiotics until you finish its course but also take the herbs I am giving you. Acupuncture cannot deal with a possible internal infection, for this you need something stronger than acupuncture. There is no contradiction in this case, and we sometimes have to combine traditional and conventional medicine.

Alternative medicine is designed to work slowly on the root of a problem you may have. To properly fix a problem, heal a disease or make any good progress one has to be patient and work on it thoroughly. Thorough work takes time, thorough work also has a solid base to success. There is no quick fix, and there is no instant success. In closing, heal your body naturally over time and enjoy a good healthy life for ever.

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Alternative Medicine Vs Conventional Medicine Does ...

Looking for an answer to the question: What are the five major types of complementary and alternative medicine? On this page, we have gathered for you the most accurate and comprehensive information that will fully answer the question: What are the five major types of complementary and alternative medicine?

Types of Complementary and Alternative Medicine Mind-Body Therapies. These combine mental focus, breathing, and body movements to help relax the body and mind. ... Biologically Based Practices. This type of CAM uses things found in nature. ... Manipulative and Body-Based Practices. These are based on working with one or more parts of the body. ... Biofield Therapy. ... Whole Medical Systems. ...

Alternative medicine is used in place of standard medical care. An example is treating heart disease with chelation therapy (which seeks to remove excess metals from the blood) instead of using a standard approach. Examples of alternative practices include homeopathy, traditional medicine, chiropractic, and acupuncture.

Top 10 Types Of Alternative Medicine Acupuncture. Acupuncture it's at least a 2.500 years old technique that originated from China. ... Chiropractic Medicine. In 1895 Doctor D. ... Energy Therapy. It's another form of alternative medicine that uses human energy to release tension and everyday stress. Magnetic Field Therapy. ... Reiki. ... Herbal Medicine. ... Acupressure. ... Homeopathy. ... Yoga. ... Meditation. ...

The NCCAM divides CAM into four major domainsMind-Body Medicine, Manipulative and Body-Based Practices, Energy Medicine, and Biologically-Based Practices.

One of the most widely used classification structures, developed by NCCAM (2000), divides CAM modalities into five categories:Alternative medical systems,Mind-body interventions,Biologically based treatments,Manipulative and body-based methods, and.Energy therapies.

Types of complementary therapiesAcupuncture.Yoga.Tai chi and qigong.Meditation.Music and art therapy.Massage.Physical activity.Nutrition.

Naturopathy Methods of treatment center on modifying the diet, using nutritional supplements, herbal medicine, Chinese medicine, acupuncture, and hydrotherapy.

What are the different types of CAM?Acupuncture.Ayurveda.Homeopathy.Naturopathy.Chinese or Oriental medicine.

Complementary and alternative medicine includes practices such as massage, acupuncture, tai chi, and drinking green tea. Complementary and alternative medicine (CAM) is the term for medical products and practices that are not part of standard medical care.

Complementary medicine is used along with standard medical treatment but is not considered by itself to be standard treatment. One example is using acupuncture to help lessen some side effects of cancer treatment. Alternative medicine is used instead of standard medical treatment.

Complementary and alternative medicine (CAM) can include the following:acupuncture,Alexander technique,aromatherapy,Ayurveda (Ayurvedic medicine),biofeedback,chiropractic medicine,diet therapy,herbalism,

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What Are The Five Major Types Of Complementary And ...