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Use of complementary and alternative medicine by parents of children with HIV infection and asthma and well children.



Objective: Although the use of complementary and alternative medicine The term complementary and alternative medicine (CAM) is an umbrella term for alternative medicine and complementary medicine.

Alternative medicine describes practices used in place of conventional medical treatments.
 (CAM) in children is increasing, little is known about its use in children with human immunodeficiency virus human immunodeficiency virus
n.
HIV.


Human immunodeficiency virus (HIV)
A transmissible retrovirus that causes AIDS in humans.
 (HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States. ) infection. This study investigated the use of CAM by parents of children with HIV infection (H), children with asthma (A), and well children (W). Our hypothesis was that parents of the H group are more likely to use CAM than parents of the W or A group because of the nature and severity of the illness.

Materials and Methods: Parents of 152 subjects [H (n = 46). A (n = 53), and W (n = 53)] were interviewed on the use of CAM for their children, types of CAM, reasons for use/nonuse, methods of payment, and perceived benefits for their children.

Results: Compared with parents of the W and A groups, parents of the H group were less likely to be employed, were less likely to have private insurance, were less likely to have a high school or college education, and were more likely to be black. Interestingly, 38% of the W parents used CAM in their children compared with 22% in the H group and 25% in the A group. More than 80% of all three groups paid out of pocket for their use of CAM in their children. Within these groups, H parents were more likely to want CAM as part of their child's medical care (H = 91% vs W = 75% and A = 67%, P = 0.02) and were more likely to believe that CAM was expensive (H = 78% vs W = 57% and A = 60%, P < 0.01).

Conclusions: Our study revealed a relatively high rate of CAM usage by parents of all three study groups. Although parents of children with HIV infection were more likely to want CAM as part of their children's medical care, their rate of CAM usage was not higher than that in well children. This may be related to their socioeconomic factors. A larger and more diverse study population may provide more information on factors contributing to CAM usage in chronically ill and well children.

Key Words: asthma, complementary and alternative medicine, well children, human immunodeficiency virus infection, prevalence

**********

There has been an increasing interest in complementary and alternative medicine (CAM), both among health care professionals and the general public. (1) A national survey in 1997 by Eisenberg et al (2) indicated that 42% of adults in the general population in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area.  used CAM, an increase of 8% from a previous 1990 survey conducted by the same authors. (3) In a more recent survey published in 2004 and conducted by the National Center for Health Statistics National Center for Health Statistics (NCHS) is part of the Centers for Disease Control and Prevention (CDC), which is part of the United States Department of Health and Human Services.

NCHS is the United States' principal health statistics agency.
, the Centers for Diseases Control and Prevention revealed that 62% of US adults used some form of CAM therapy during 2002. (4) In particular, patients with chronic conditions such as cancer, asthma, chronic pain, and other recurring illnesses for which conventional medical therapy has been inadequate or not helpful have often turned to CAM. (5-12)

Infection caused by human immunodeficiency virus (HIV) at present is incurable incurable /in·cur·a·ble/ (in-kur´ah-b'l)
1. not susceptible of being cured.

2. a person with a disease which cannot be cured.


in·cur·a·ble
adj.
. Despite advances in the treatment of HIV infection, morbidity remains high. (13) In light of the limitations of conventional medical therapy for HIV infection, CAM utilization would be expected to be high. Indeed, several studies have demonstrated a high rate of CAM utilization in adult patients with HIV infection. In these studies, the incidence of CAM usage ranged from 15 to 100%, depending on the patient population studied and the definition of CAM used by the investigators. (14-18)

In contrast to the volume of data concerning CAM usage in adults, the data in children are more limited. In particular, there have been no published studies of CAM usage in the pediatric pediatric /pe·di·at·ric/ (pe?de-at´rik) pertaining to the health of children.

pe·di·at·ric
adj.
Of or relating to pediatrics.
 HIV-infected population. Surveys of CAM usage have shown that the incidence of CAM use in the general pediatric population is between 9 and 70%. (19-24) There was a higher rate of CAM usage in children with chronic conditions such as cystic fibrosis cystic fibrosis (sĭs`tĭk fībrō`sĭs), inherited disorder of the exocrine glands (see gland), affecting children and young people; median survival is 25 years in females and 30 years in males. , asthma, and cancer. (5-7,11,21-23)

Given the increasing interest in CAM and the serious nature of HIV infection, we hypothesized that parents of children with HIV infection would be more likely to use CAM therapies for their children than children with a less severe chronic condition such as asthma or parents of well children. To test this hypothesis, we conducted a survey of CAM usage in families with HIV-infected children, children with asthma, and well children.

Materials and Methods

All the study subjects were recruited from the patient population seen at the primary care and subspecialty subspecialty,
n a limited portion of a narrowly defined professional discipline. E.g., surgery is a specialty of medicine and pediatric vascular surgery is a subspecialty.
 care clinics at the State University of New York (body) State University of New York - (SUNY) The public university system of New York State, USA, with campuses throughout the state.  at Stony Brook, New York
''For other uses of Stony Brook, see Stony Brook.


Stony Brook is a hamlet (unincorporated community) (and census-designated place) located in the Town of Brookhaven in Suffolk County, New York. The population was 13,727 at the 2000 census.
. The institutional review board approved the protocol, and written informed consent was obtained from all parents guardians of study patients. Care was undertaken to ensure that one questionnaire per child per family was used.

The study was conducted during the period of June 1998 through March 2000. Parents/guardians of perinatally acquired HIV-infected children with no other chronic illness and parents of the asthmatic and well children were interviewed on the use of CAM for their children. The first author conducted all of the interviews in a private room during a routine clinic visit.

Using a questionnaire, data also were collected regarding patient demographics and type of medical insurance, as well as education level, marital status marital status,
n the legal standing of a person in regard to his or her marriage state.
, and employment status of the parent(s)/guardian(s). The HIV-infected patients were classified on the basis of standard pediatric HIV clinical and immune categories. (25) Parents/guardians were specifically questioned on their use of different CAM therapies. CAM modalities Modalities
The factors and circumstances that cause a patient's symptoms to improve or worsen, including weather, time of day, effects of food, and similar factors.
 were reviewed and discussed with each parent/guardian. Examples of each CAM modality modality /mo·dal·i·ty/ (mo-dal´i-te)
1. a method of application of, or the employment of, any therapeutic agent, especially a physical agent.

2.
 in the questionnaire were provided during the interview process. Questions raised by parents/guardians were discussed, and clarifications were made as needed as needed prn. See prn order. . Complementary and alternative medicine as defined by the National Center for Complementary and Alternative Medicine National Center for Complementary and Alternative Medicine,
n.pr established in 1998 as a Center of the National Institutes of Health. Supports and conducts research on complementary and alternative med-icine and informs healthcare pro-fessionals about
 (NCCAM NCCAM National Center for Complementary and Alternative Medicine (NIH)
NCCAM National Colorectal Cancer Awareness Month (March) 
) is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. (26) The different CAM modalities included in the questionnaire were selected to represent the five main categories of CAM, based on the NCCAM: alternative medical systems (homeopathy homeopathy (hōmēŏp`əthē), system of medicine whose fundamental principle is the law of similars—that like is cured by like. ); mind-body interventions (hypnosis hypnosis

State that resembles sleep but is induced by a person (the hypnotist) whose suggestions are readily accepted by the subject. The hypnotized individual seems to respond in an uncritical, automatic fashion, ignoring aspects of the environment (e.g.
, prayer, healing ritual, meditation, and yoga); biologically based therapies (aromatherapy aromatherapy

Therapy using essential oils and water-based colloids extracted from plant materials to promote physical, emotional, and spiritual health and balance. Single or combined extracts may be diffused into inhaled air, used in massage oil, or added to bathwater.
, home remedies, herbal remedies, and vitamins including minerals and antioxidants Antioxidants
Substances that reduce the damage of the highly reactive free radicals that are the byproducts of the cells.

Mentioned in: Aging, Nutritional Supplements

antioxidants,
n.
; manipulative and body-based methods (chiropractic chiropractic (kīrəprăk`tĭk) [Gr.,=doing by hand], medical practice based on the theory that all disease results from a disruption of the functions of the nerves.  care, massage therapy Massage Therapy Definition

Massage therapy is the scientific manipulation of the soft tissues of the body for the purpose of normalizing those tissues and consists of manual techniques that include applying fixed or movable pressure, holding, and/or
) as well as energy therapies (acupuncture acupuncture (ăk`ypŭng'chər), technique of traditional Chinese medicine, in which a number of very fine metal needles are inserted into the skin at specially designated points. , therapeutic touch, and qi gong qi gong (che´ kung´) [Chinese] qi cultivation, a broad range of practices, incorporating meditation, movement exercises, and breath control, whose purpose is to manipulate and develop qi, and ranging in application from the meditative ). For each specific treatment, parents/guardians were asked about the specific CAM modality used, cost, mode of payment, and effects of the remedy. Parents/guardians were also asked if they thought CAM was expensive, whether they would like to see CAM included in their child's medical care, and whether they have disclosed CAM usage to their primary physician.

Data from the questionnaire were entered into a Filemaker database (Filemaker Inc, Santa Clara Santa Clara, city, Cuba
Santa Clara (sän`tä klä`rä), city (1994 est. pop. 217,000), capital of Villa Clara prov., central Cuba.
, CA). Demographics, use of CAM therapies, reasons for use, and costs of use were compared across the three groups by means of the Student t test and [chi square chi square (kī),
n a nonparametric statistic used with discrete data in the form of frequency count (nominal data) or percentages or proportions that can be reduced to frequencies.
] analysis. Analysis of variance was used to compare means across the three groups. The effects of individual demographic characteristics on the likelihood of CAM usage in each study group were analyzed by using the [chi square] test or Fisher exact test. The statistical analysis was performed using Statistical Analysis Software (SAS (1) (SAS Institute Inc., Cary, NC, www.sas.com) A software company that specializes in data warehousing and decision support software based on the SAS System. Founded in 1976, SAS is one of the world's largest privately held software companies. See SAS System.  Version 7, Cary, NC). Statistical significance was designated at a level of P < 0.05.

Results

Parents/guardians of 152 study subjects were interviewed. This included parents/guardians of 46 perinatally acquired HIV-infected children with no other chronic illness, parents/guardians of 53 children with moderate to severe asthma and with no other chronic illness, and parents/guardians of 53 well children. When the three study groups were compared (Table 1), parents/guardians of the HIV group were less likely to be employed (P < 0.01), less likely to have private insurance (P < 0.01), more likely to have no high school or college education (P = 0.01), and more likely to be black (P < 0.01). There was no significant difference among the three groups in terms of marital status (P = 0.32). Among the three groups, the vast majority of the parents/guardians interviewed were female. The patients' mean age for the three groups was 7.3 [+ or -] 4.2 years and was comparable among the three study groups. Ninety-six percent of the HIV-infected patients were receiving highly active antiretroviral antiretroviral /an·ti·ret·ro·vi·ral/ (-ret´ro-vi?ral) effective against retroviruses, or an agent with this quality.

an·ti·ret·ro·vi·ral
adj.
 treatment: 56% were receiving a protease inhibitor protease inhibitor (prō`tē-ās'), any of a class of drugs that interfere with replication of the AIDS virus (HIV), by blocking an enzyme (protease) necessary in the late stages of its reproduction.  therapy and 40% were receiving a protease protease /pro·te·ase/ (pro´te-as) endopeptidase.

pro·te·ase
n.
Any of various enzymes, including the proteinases and peptidases, that catalyze the hydrolytic breakdown of proteins.
 inhibitor-sparing regimen. Four percent of these patients were not receiving any antiretroviral medications. Thirty-four percent were in the pediatric HIV clinical categories A (mildly symptomatic disease); 32% in the clinical category B (moderately symptomatic disease); and 34% in the clinical category C (severely symptomatic disease). At the time of the study, 72% were classified into the immune category 1 (no immune suppression). Twenty-two percent of patients were in the immune category 2 (moderate immune suppression) and 6% were in the immune category 3 (severe immune suppression).

The effects of individual demographic characteristics on the likelihood of using CAM therapies were evaluated in each study group. Within the HIV group, CAM usage by parents/guardians was reported in 40% (10 of 25) of those who had a high school education compared with none (0 of 21) of those with less than a high school education (P < 0.01). In the same group, CAM usage was reported in 40% (8 of 20) of nonblacks versus 9% (2 of 26) of blacks (P = 0.04). For this analysis, blacks included blacks and interracial in·ter·ra·cial  
adj.
Relating to, involving, or representing different races: interracial fellowship; an interracial neighborhood.
 persons with one black parent. Employment status, insurance status, and marital status were not statistically different between CAM users and CAM nonusers in the HIV group.

In the asthma group, CAM usage was reported in 31.7% (13 of 41) of those who had a high school education compared with none (0 of 12) of those with less than a high school education (P = 0.02). In addition, CAM usage was reported in 33.3% (13 of 39) of those who were employed and in none (0 of 14) of those who were unemployed (P = 0.01). Ethnicity, insurance status, and marital status were not statistically different between CAM users and CAM nonusers in the asthma group.

Within the healthy child group, there was no difference in educational status, ethnicity, insurance status, employment status, and marital status between CAM users and CAM nonusers.

The overall prevalence of CAM usage in the three study groups is shown in Table 2. The rates of CAM usage in the healthy child group (38%), the asthma group (25%), and the HIV group (22%) were not significantly different (P = 0.16). The different CAM modalities used also are shown in Table 2. The most frequent CAM modalities used were multivitamins (117 of 152, 77%), prayer (109 of 152, 72%), and home remedies (36 of 152, 24%), followed by aromatherapy 33/152 (21%) and herbal remedies 29/152 (19%). The parents/guardians of well children were more likely to use herbal therapies than the parents of either the HIV or the asthma group (32% vs 11% and 13%, P = 0.01); the majority of these patients absorbed the cost of such therapies themselves (88%). All three groups used home remedies (20 to 28%) for wound healing wound healing Physiology The repair of a wound Steps Inflammation, repair and closure, remodeling, final healing; repair of incisions may be either simple–'clean' wounds with little loss of tissue heal by 'primary intention', or 'dirty' wounds heal by , cold symptoms, or relief of upset stomach, and they were equally likely to use aromatherapy (17 to 24%) and chiropractic care (4 to 7%). Parents/guardians of HIV-infected children were more likely to pray (83%), compared with those of asthmatic (62%) and well children (72%) (P = 0.03). All three groups used meditation (4 to 11%). Massage was used by all three groups (4 to 13%) for stress reduction, emotional relief, and aid in coping with illnesses. There was a very low usage of acupuncture, homeopathy, healing rituals, and therapeutic touch that precluded detailed statistical analysis of the use of these modalities. None used hypnosis, qi gong, or yoga.

The attitude of parents/guardians toward CAM usage is shown in Table 3. Parents/guardians of the HIV-infected patients were more likely to want CAM modalities (mostly acupuncture and massage) to be part of their children's regular medical care (P = 0.02). They were also more likely to believe that CAM was expensive (P < 0.01). Compared with the families of well children and HIV-infected patients, parents/guardians of the asthma group were more likely to fear the side effects Side effects

Effects of a proposed project on other parts of the firm.
 of CAM (P = 0.03) and were less likely to believe that CAM would improve the quality of life of their children (P = 0.01). The majority of parents/guardians in all three groups thought CAM was cost-effective (economical in terms of the health benefits received for the money spent). Fifty percent of parents/guardians in the healthy child and HIV-infected groups and 75% in the asthma group informed providers about their use of CAM.

Discussion

This study revealed a relatively high rate of CAM usage by parents/guardians of our pediatric outpatient population. It is difficult to compare the prevalence of CAM usage in our study population with that reported in the literature because of the lack of uniform definitions of CAM. (19,20,24) Spigelblatt et al (20) conducted the largest survey of CAM usage in well children. These investigators found an 11% prevalence of CAM usage. This study was performed in Canada and covered different modalities such as osteopathy osteopathy (ŏstēŏp`əthē), practice of therapy based on manipulation of bones and muscles. This school of medicine, founded by A. T. , oligopathy, and homeopathy and may not reflect the same CAM usage in the United States. Our survey used a broader definition of CAM and included practices such as prayer, herbal remedies, meditation, and home remedies. These remedies may be easier to access than those used by Spigelblatt et al, and that might explain the higher rate of CAM usage in our study.

In our present study we found a comparable rate of CAM usage in children with HIV infection, children with asthma, and well children that is different from our prestudy hypothesis that parents of HIV-infected children would be more likely to use CAM therapies than parents of children with a less severe chronic condition such as asthma or parents of well children. It is possible that because our study population of HIV-infected patients was relatively healthy, their parents/guardians were therefore less likely to seek alternative therapies. The sample size in each of the clinical and immunologic categories was not large enough to assess CAM usage on the basis of HIV clinical and immunologic status, which would have been helpful in assessing the validity of this speculation. Also, some parents/guardians may have been aware of the potential drug-drug interactions and thus were reluctant to use any biologically based CAM therapies.

Although we speculate that mild immunologic impairment may have been the factor that resulted in a lower rate of CAM usage in the HIV-infected group than we had hypothesized, our data suggest that the most likely reason was lack of access. In our survey, the parents/guardians of the HIV-infected patients had the highest interest in CAM therapy. However, they also had the highest rate of unemployment, the lowest rate of high school or college education, and the highest rate of being on Medicaid. It may be that the HIV-infected families are interested in CAM but have limited access to such treatment modalities treatment modality Medtalk The method used to treat a Pt for a particular condition  as the result of socioeconomic barriers. This could also explain the difference between the rate of CAM usage in our pediatric HIV-infected group as compared with that reported in HIV-infected adults (15 to 68%). (8,16-18) Most adults with HIV infection who use CAM are well educated and have full-time employment (8,17,27) and therefore may have more resources to access CAM. Acupuncture, massage therapy, and homeopathy are the most common CAM therapies used by HIV-infected adults. These therapies are not usually covered by the majority of medical insurance and are relatively expensive. (16,28-31)

The relatively lower rate of CAM usage in our asthmatic children may reflect the specific treatment preference of our study population. The vast majority of our asthmatic patients have been compliant with their scheduled outpatient appointments and had well-controlled asthma (data not shown). Indeed, the fact that asthmatic patients came regularly to the clinic may indicate their preference for conventional medicine over CAM. Supporting this speculation is our finding that the parents/guardians of asthmatic children were more likely to fear the potential side effects of CAM and were less likely to believe that CAM would improve the quality of life of their children.

Surprisingly, more than one third of our healthy child population used CAM. This high CAM usage rate in the well children group may be because parents/guardians of this group are more health-minded. Since these children have no underlying illness, their parents/guardians may possibly be more willing to try CAM with prevention of illness and general wellness in mind.

Potential limitations to our study include small sample size for each group; therefore, our results may not be representative of the true prevalence of CAM use in the pediatric population. We also used only a single institution for our survey, which would fail to account for any regional or geographic differences in CAM usage among the pediatric population. Additional studies using larger and more diverse populations may provide further information regarding CAM usage in pediatrics and in those children with chronic illnesses such as HIV infection and asthma.

Although we found a high incidence of CAM usage in our patient population, 25 to 50% of parents/guardians reported that they did not inform their health care provider that they were using CAM. Some CAM treatments may be associated with adverse side effects or interactions with conventional therapies. (32-34) Given the increasing use of CAM and the significant degree of underreporting demonstrated in our study as well as in others, it is important for health care providers to actively question parents/guardians and patients on possible CAM use. Subsequently, comprehensive programs can be developed to address both holistic and specific needs of the patients through collaboration between traditional and alternative medicine practitioners.

In summary, our survey of CAM usage by families of HIV-infected children, well children, and asthmatic children demonstrated a relatively high rate of CAM usage among all three groups. There was a lower rate of CAM usage in the HIV group than we originally had anticipated, which may have been the result of socioeconomic barriers. Future work should be directed to assessing the importance of socioeconomic barriers as an impediment to CAM usage as well as to determine the importance of CAM to the medical care of the HIV-infected pediatric patients pediatric patient Child, see there . In addition, parents/guardians need to be encouraged to inform their clinicians of any CAM usage to receive more comprehensive health care for their children. Clinicians should actively inquire about CAM usage to fully understand their patients' needs and to be able to provide a complete comprehensive care for children.

Appendix of Terminology

Complementary and alternative medicine is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Complementary medicine is used together with conventional medicine. Alternative medicine is used in place of conventional medicine.

The NCCAM classifies CAM therapies into five categories, or domains, described below. (26)

Alternative medical systems

Alternative medical systems are built on complete systems of theory and practice. Often, these systems have evolved apart from and earlier than the conventional medical approach used in the United States. Examples of alternative medical systems that have developed in Western cultures include homeopathic medicine Homeopathic Medicine Definition

Homeopathy, or homeopathic medicine, is a holistic system of treatment that originated in the late eighteenth century. The name homeopathy is derived from two Greek words that mean "like disease.
 and naturopathic medicine Naturopathic Medicine Definition

Naturopathic medicine is a branch of medicine in which a variety of natural medicines and treatments are used to heal illness.
.

Mind-body interventions

Mind-body medicine uses a variety of techniques designed to enhance the mind's capacity to affect bodily function Noun 1. bodily function - an organic process that takes place in the body; "respiratory activity"
bodily process, body process, activity

control - (physiology) regulation or maintenance of a function or action or reflex etc; "the timing and control of his
 and symptoms. Some techniques that were considered to be CAM in the past have become mainstream (for example, patient support groups and cognitive-behavioral therapy Cognitive-Behavioral Therapy Definition

Cognitive-behavioral therapy is an action-oriented form of psychosocial therapy that assumes that maladaptive, or faulty, thinking patterns cause maladaptive behavior and "negative" emotions.
). Other mind-body techniques are still considered CAM, including meditation, prayer, mental healing, and therapies that use creative outlets such as art, music, or dance.

Biologically based therapies

Biologically based therapies in CAM use substances found in nature, such as herbs, foods, and vitamins. Some examples include dietary supplements, herbal products, and the use of other so-called natural but as yet scientifically unproven therapies (for example, using shark cartilage shark cartilage,
n cartilage obtained from the hammerhead and dogfish sharks, used as an anticancer, antiinflammatory, and antiangiogenic treatment. Precautions for those with liver disease.
 to treat cancer).

Manipulative and body-based methods

Manipulative and body-based methods in CAM are based on manipulation and/or movement of one or more parts of the body. Some examples include chiropractic or osteopathic os·te·op·a·thy  
n.
A system of medicine based on the theory that disturbances in the musculoskeletal system affect other bodily parts, causing many disorders that can be corrected by various manipulative techniques in conjunction with conventional
 manipulation and massage.

Energy therapies

Energy therapies involve the use of energy fields. They are of two types, described below.

Biofield therapies are intended to affect energy fields that purportedly surround and penetrate the human body. The existence of such fields has not yet been scientifically proven. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in, or through, these fields. Examples include qi gong, Reiki Reiki Definition

Reiki is a form of therapy that uses simple hands-on, no-touch, and visualization techniques, with the goal of improving the flow of life energy in a person.
, and therapeutic touch.

Bioelectromagnetically based therapies involve the unconventional use of electromagnetic fields electromagnetic field

Property of space caused by the motion of an electric charge. A stationary charge produces an electric field in the surrounding space. If the charge is moving, a magnetic field is also produced. A changing magnetic field also produces an electric field.
, such as pulsed fields, magnetic fields magnetic fields,
n.pl the spaces in which magnetic forces are detectable; created by magnetostrictive ultrasonic scalers to cause the tips of instruments such as ultrasonic scalers to vibrate.
, or alternating-current or direct-current fields.

Definitions

Acupuncture describes a family of procedures involving stimulation of anatomic points on the body by a variety of techniques. American practices of acupuncture incorporate medical traditions from China, Japan, Korea, and other countries. The acupuncture technique that has been most studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation.

Aromatherapy involves the use of essential oils (extracts or essences) from flowers, herbs, and trees to promote health and well-being.

Chiropractic is a CAM alternative medical system. It focuses on the relation between bodily structure Noun 1. bodily structure - a particular complex anatomical part of a living thing; "he has good bone structure"
anatomical structure, body structure, complex body part, structure

layer - thin structure composed of a single thickness of cells
 (primarily that of the spine) and function and how that relation affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool.

Dietary supplements are products (other than tobacco) taken by mouth that contain a "dietary ingredient" intended to supplement the diet. Dietary ingredients may include vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, and metabolites Metabolites
Substances produced by metabolism or by a metabolic process.

Mentioned in: Interactions
. Dietary supplements come in many forms, including extracts, concentrates, tablets, capsules, gel caps, liquids, and powders.

Healing rituals involve a type of folk medicine folk medicine, methods of curing by means of healing objects, herbs, or animal parts; ceremony; conjuring, magic, or witchcraft; and other means apart from the formalized practice of medical science.  that have persisted since the beginning of culture and have flourished long before the development of conventional medicine. Folk healers usually participate in a training regimen of observation and imitation, with healing often considered a gift passed down through several generations. Folk healers may use a range of remedies including prayer, healing touch or lying on of hands, charms, herbal teas or tinctures, magic rituals, and others. They are found in all cultures and operate under a variety of names and labels.

Homeopathic medicine is a CAM alternative medical system. In homeopathic medicine, there is a belief that "like cures like," meaning that small, highly diluted quantities of medicinal substances are given to cure symptoms, when the same substances given at higher or more concentrated doses would actually cause those symptoms.

Home remedies are nonvitamin, nonmineral natural products prepared at home, taken by mouth, and contain a dietary ingredient intended to supplement the diet or cure a certain ailment ail·ment
n.
A physical or mental disorder, especially a mild illness.
 other than vitamins and minerals. Garlic, for example has been used to treat fevers, sore throat Sore Throat Definition

Sore throat, also called pharyngitis, is a painful inflammation of the mucous membranes lining the pharynx. It is a symptom of many conditions, but most often is associated with colds or influenza.
, digestive ailments, and so forth.

Hypnosis is an altered state of consciousness An altered state of consciousness is any condition which is significantly different from a normative waking beta wave state. The expression was coined by Charles Tart and describes induced changes in one's mental state, almost always temporary.  characterized by increased responsiveness to suggestion. This state is attained by first relaxing the body, then shifting the client's attention toward a narrow range of objects or ideas as suggested by the therapist. The procedure is used to access various levels of the mind to effect positive changes in a person's behavior and to treat numerous health conditions.

Massage therapy involves pressing, rubbing, and otherwise manipulating muscle and connective connective - An operator used in logic to combine two logical formulas. See first order logic.  tissue to enhance the function of those tissues and promote relaxation and well-being.

Meditation involves mental calmness and physical relaxation achieved by suspending the stream of thoughts that normally occupy the mind. Generally performed once or twice a day for approximately 20 minutes at a time, meditation is used to reduce stress, alter hormone levels, and elevate one's mood.

Osteopathic medicine osteopathic medicine
n.
See osteopathy.
 is a form of conventional medicine that in part emphasizes diseases arising in the musculoskeletal system Noun 1. musculoskeletal system - the system of muscles and tendons and ligaments and bones and joints and associated tissues that move the body and maintain its form . There is an underlying belief that all of the body's systems work together, and disturbances in one system may affect function elsewhere in the body. Some osteopathic physicians practice osteopathic manipulation, a full-body system of hands-on techniques to alleviate pain, restore function, and promote health and well-being.

Qi gong is a component of traditional Chinese medicine Traditional Chinese Medicine Definition

Traditional Chinese medicine (TCM) is an ancient and still very vital holistic system of health and healing, based on the notion of harmony and balance, and employing the ideas of moderation and prevention.
 that combines movement, meditation, and regulation of breathing to enhance the flow of qi (an ancient term given to what is believed to be vital energy) in the body, improve blood circulation, and enhance immune function Immune function
The state in which the body recognizes foreign materials and is able to neutralize them before they can do any harm.

Mentioned in: Herbalism, Traditional Chinese, Stress Reduction
.

Therapeutic touch is derived from an ancient technique called laying-on of hands. It is based on the premise that it is the healing force of the therapist that affects the patient's recovery; healing is promoted when the body's energies are in balance; and, by passing their hands over the patient, healers can identify energy imbalances.

Yoga is a combination of breathing exercises, physical postures, and meditation. Yoga calms the nervous system and balances the body, mind, and spirit. Yoga has been used to lower blood pressure, reduce stress, and improve coordination, flexibility, concentration, sleep, and digestion.

References

1. Astin J. Why patients use alternative medicine, results of a national study. JAMA JAMA
abbr.
Journal of the American Medical Association
 1998;279:1548-1553.

2. Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990-1997. JAMA 1998;280:1569-1575.

3. Eisenberg DM, Kessler RC, Foster C, et al. Unconventional medicine in the United States, prevalence, costs, and patterns of use. N Engl J Med 1993;328:246-252.

4. Barnes PM, Powell-Griner E, McFann K, et al. CDC See Control Data, century date change and Back Orifice.

CDC - Control Data Corporation
: Complementary and Alternative Medicine Use Among Adults: United States, 2002. Advance Data from Vital and Health Statistics, May 27, 2004. Number 343.

5. Krauss HH, Godfrey C, Kirk J, et al. Alternative healthcare: its use by individuals with physical disabilities. Arch Phys Med Rehabil 1998;79:1440-1447.

6. Grootenhuis MA, Last BF, de Graff-Nijkerk JH, et al. Use of alternative treatment in pediatric oncology. Cancer Nursing 1998;21:282-288.

7. Stern RC, Canda ER, Doershuk CF. Use of nonmedicinal treatment by cystic fibrosis patients. J Adolesc Health 1992;13:612-615.

8. London AS, Foote-Ardah CE, Fleishman JA, et al. Use of alternative therapists among people in care for HIV in the United States. Am J Public Health 2003;93:980-987.

9. Ernst J. Alternative treatment modalities in human immunodeficiency immunodeficiency

Defect in immunity that impairs the body's ability to resist infection. The immune system may fail to function for many reasons. Immune disorders caused by a genetic defect are usually evident early in life.
 virus/acquired immune deficiency immune deficiency
n.
See immunodeficiency.
 syndrome. Clin Infect Dis 2003;37(Suppl 2):S150-S153.

10. Shenfield G, Lim E, Allen H. Survey of the use of complementary medicines and therapies in children with asthma. J Paediatr Child Health 2002;38:252-257.

11. Sanders H, Davis MF, Duncan B, et al. Use of complementary and alternative medical therapies among children with special health care needs in southern Arizona Southern Arizona is a region of the United States. It is the southernmost portion of the 48th state, Arizona. Southern Arizona's boundaries are not well defined, but certainly include all of present-day Cochise County, Pima County, Graham County, and Santa Cruz County. . Pediatrics 2003;111:584-587.

12. Shen Shen, in the Bible, place, perhaps close to Bethel, near which Samuel set up the stone Ebenezer.  J, Andersen R, Albert PS, et al. Use of complementary/alternative therapies by women with advanced-stage breast cancer. BMC (BMC Software, Inc., Houston, TX, www.bmc.com) A leading supplier of software that supports and improves the availability, performance, and recovery of applications in complex computing environments.  Complementary Altern Med 2002;2:8.

13. Lindegren ML, Byers RH, Thomas P, et al. Trends in perinatal perinatal /peri·na·tal/ (-na´t'l) relating to the period shortly before and after birth; from the twentieth to twenty-ninth week of gestation to one to four weeks after birth.

per·i·na·tal
adj.
 transmission of HIV/AIDS HIV/AIDS Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome  in the United States. JAMA 1999;282:531-538.

14. Anderson W, O'Connor BB, MacGregor RR, et al. Patient use and assessment of conventional and alternative therapies for HIV infection and AIDS. AIDS 1993;7:561-566.

15. Barton SE, Hawkins DA, Jadresic DM, et al. Alternative treatment for HIV infection. Br Med J 1989;298:1519-1520.

16. Fairfield KM, Eisenberg DM, Davis RB, et al. Patterns of use, expenditures and perceived efficacy of complementary and alternative therapies in HIV-infected patients. Arch Intern intern /in·tern/ (in´tern) a medical graduate serving in a hospital preparatory to being licensed to practice medicine.

in·tern or in·terne
n.
 Med 1998;158:2257-2264.

17. Greenblatt RM, Hollander H, McMaster JR, et al. Polypharmacy among patients attending an AIDS clinic; utilization of prescribed, unorthodox and investigational treatments. J Acquir Immune Defic Syndr 1991;4:136-143.

18. Hand R. Alternative therapies used by patients with AIDS. N Engl J Med 1989;320:629-630.

19. Ernst E. Prevalence of complementary and alternative medicine for children: a systematic review. Eur J Pediatr 1999;158:7-11.

20. Spigelblatt L. Laine-Ammara S, Pless B, et al. The use of alternative medicine by children. Pediatrics 1994;94:811-814.

21. Mottonen M, Uhari M. Use of micronutrients This is a list of micronutrients.

Vitamins
  • Vitamin A (retinol)
  • Vitamin B complex
  • Vitamin B1 (thiamin)
  • Vitamin B2 (riboflavin)
 and alternative drugs by children with acute lymphoblastic leukemia acute lymphoblastic leukemia
n. Abbr. ALL
Lymphoblastic leukemia occurring mainly in older adults, characterized by rapid onset and progression of symptoms. Also called acute lymphocytic leukemia.
. Med Pediatr Oncol 1997;28:205-208.

22. Fernandez C, Stutzer C, MacWilliam L, et al. Alternative and complementary therapy use in pediatric oncology patients in British Columbia British Columbia, province (2001 pop. 3,907,738), 366,255 sq mi (948,600 sq km), including 6,976 sq mi (18,068 sq km) of water surface, W Canada. Geography
: prevalence and reasons for use and non-use. J Clin Oncol 1998;16:1279-1286.

23. Southwood T, Malleson PN, Roberts-Thomson PJ, et al. Unconventional remedies used for patients with juvenile arthritis Juvenile Arthritis Definition

Juvenile arthritis (JA), also called juvenile rheumatoid arthritis (JRA), refers to a number of different conditions, all of which strike children, and all of which have immune-mediated joint inflammation as their major
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24. Loman DG. The use of complementary and alternative health care practices among children. J Pediatr Health Care 2003;17:58-63.

25. American Academy of Pediatrics The American Academy of Pediatrics ("AAP") is an organization of pediatricians, physicians trained to deal with the medical care of infants, children, and adolescents. Its motto is: "Dedicated to the Health of All Children. . Human Immunodeficiency Virus. In: Pickering LK, ed. Red Book: 2003 Report of the Committee on Infectious Diseases infectious diseases: see communicable diseases. , 26th ed. Elk Grove Village Elk Grove Village, village (1990 pop. 33,429), Cook and Du Page counties, NE Ill., a suburb of Chicago; inc. 1956. With a population of c.100 at the time of its establishment on open farmland, the village has grown dramatically and steadily, largely because of its , American Academy The American Academy in Berlin is a non-partisan academic institution in Berlin. It was founded in September 1994 by a group of prominent Americans and Germans, among them Richard Holbrooke, Henry Kissinger, Richard von Weizsäcker, Fritz Stern and Otto Graf Lambsdorff and opened in  of Pediatries, 2003, pp. 362-364.

26. National Center for Complementary and Alternative Medicine. Get the Facts. What Is Complementary and Alternative Medicine (CAM)? NCCAM Publication No. D156, May 2002.

27. Ostrow M, Cornelisse PGA (1) (Professional Graphics Adapter) An early IBM PC display standard for 3D processing with 640x480x256 resolution. It was not widely used.

(2) (Programmable Gate Array) See gate array and FPGA.
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Jocelyn Y. Ang, MD, Shibani Ray-Mazumder, SCD ScD [L.] Scien´tiae Doc´tor (Doctor of Science).
SCD 1 Sickle cell disease, see there 2 Subacute combined degeneration, see there 3 Sudden cardiac death, see there
, Sharon A. Nachman, MD, SCD, Chokechai Rongkavilit, MD, Basim I. Asmar, MD, and Clement L. Ren, MD

From the Division of Pediatric Infectious Diseases, Division of Pediatric Pulmonary, Allergy, and Immunology, Children's Medical Center, The State University of New York at Stony Brook Stony Brook may refer to:

Massachusetts:
  • Stony Brook, a tributary of the Charles River in Boston
  • Stony Brook (MBTA station) on the Orange Line in Jamaica Plain
  • Stony Brook (B&M station), a former Boston and Maine Railroad station in Weston
, Stony Brook, New York, and the Division of Infectious Diseases, Children's Hospital A children's hospital is a hospital which offers its services exclusively to children. The number of children's hospitals proliferated in the 20th century, as pediatric medical and surgical specialties separated from internal medicine and adult surgical specialties.  of Michigan, Wayne State University Wayne State University, at Detroit, Mich.; state supported; coeducational; established 1956 as a successor to Wayne Univ. (formed 1934 by a merger of five city colleges). , Detroit, Michigan “Detroit” redirects here. For other uses, see Detroit (disambiguation).
Detroit (IPA: [dɪˈtʰɹɔɪt]) (French: Détroit, meaning strait
.

Reprint requests to Basim I. Asmar, MD, Children's Hospital of Michigan, Division of Infectious Diseases, 3901 Beaubien Boulevard, Detroit, MI 48201. Email: basmar@wayne.edu

Accepted April 21, 2005.

RELATED ARTICLE: Key Points

* Complementary and alternative medicine (CAM) usage in children with human immunodeficiency virus (HIV) infection and asthma and well children was relatively high in our pediatric patient population.

* Parents/guardians of HIV-infected children demonstrated the highest interest in CAM therapy.

* CAM usage was not higher in HIV-infected children compared with well children and children with a less severe chronic condition such as asthma.

* Level of education, employment, and ethnicity appear to influence the use of CAM.
Table 1. Demographic characteristics of the three study groups

                                                   Healthy
                        HIV          Asthma        child
                        (n = 46)     (n = 53)      (n = 53)      P

Parents/guardian
  Male                   9%            0%            0%
  Female                91%          100%          100%
  Employment                                                     <0.01
    Working full-time   17%           43%           45%
    Working part-time    9%           25%           15%
    Unemployed          74%           32%           40%
  Race                                                           <0.01
    White               24%           66%           55%
    Hispanic             9%           13%            9%
    Black               44%            4%           21%
    Asian                0%            4%            6%
    Interracial         23%           13%            9%
  Education                                                       0.01
    College education   20%           43%           43%
    High school         36%           40%           36%
    No high school      44%           17%           21%
  Medical insurance                                              <0.01
    Private             15%           74%           62%
    Medicaid            84%           25%           37%
  Marital status                                                  0.32
    Married             61%           71%           55%
    Unmarried           39%           29%           45%
Patients
  Age (yr) [+ or -] SD   8 [+ or -]    7 [+ or -]    7 [+ or -]   0.75
                           4             4             4

Table 2. Overall prevalence of complementary and alternative medicine
modalities used in the three study groups (a)

                                                        Healthy
                                HIV         Asthma      child
                                (n = 46)    (n = 53)    (n = 53)

Overall Prevalence of CAM (b)   22%         25%         38%
Alternative medical systems
  Homeopathy                     1 (2.2%)    1 (1.9%)    0
Mind-body interventions
  Prayer                        38 (82.6%)  33 (62.3%)  38 (71.1%)
  Healing rituals                0           0           1 (1.9%)
  Meditation                     3 (6.5%)    2 (3.8%)    6 (11.3%)
Biologically-based therapies
  Aromatherapy                  11 (23.9%)   9 (17%)    12 (22.6%)
  Home remedies                 13 (28.3%)  11 (20.8%)  12 (22.6%)
  Herbal remedies                5 (10.9%)   7 (13.2%)  17 (32.1%)
  Vitamins (including           34 (73.9%)  40 (75.5%)  43 (81.1%)
    minerals and antioxidants)
Manipulative and body-based
  methods
  Massage therapy                2 (4.3%)    5 (9.4%)    7 (13.2%)
  Chiropractic care              2 (4.3%)    4 (7.5%)    2 (3.8%)
Energy therapies
  Therapeutic touch              0           1 (1.9%)    3 (5.7%)
  Acupuncture                    0           0           1 (1.9%)

(a) CAM, complementary and alternative medicine.
(b) P = 0.042; Healthy child group versus HIV and asthma groups
combined.

Table 3. Parents/guardians' attitudes toward complementary and
alternative medicine among the three study groups (a)

                                                Healthy
                             HIV       Asthma   child
                            (n = 46)  (n = 53)  (n = 53)  P

Want CAM for their child    91%       67%       75%        0.02
Believe CAM expensive
  Yes                       78%       60%       57%       <0.01
  No                         4%        9%       28%
  Don't know/not sure       17%       30%       16%
Fear of CAM side effects    11%       78%       11%        0.03
Believe CAM affect QOL                                     0.01
  Yes                       65%       40%       69%
  No                         2%       13%        4%
  Others                    33%       47%       27%
Believe CAM cost-effective                                <0.01
  Yes                       57%       68%       77%
  No                         9%       17%       18%
  Others                    35%       15%        6%
Told providers              50%       75%       50%       NS

(a) CAM, complementary and alternative medicine; QOL, quality of life;
NS, nonsignificant.
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Title Annotation:Original Article
Author:Ren, Clement L.
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Date:Sep 1, 2005
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