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Researchers find flaws in CAM-use studies

The methodologies of studies that find positive results from treating older, nondemented adults with complementary and alternative medicine (CAM) may deserve a second look, say researchers in the October 2007 issue of the Journal of Clinical Psychiatry. The researchers reviewed 33 studies and found the ones that had positive results often had substantial methodological limitations.

The researchers searched PubMed studies from 1966-September 1996 and PsycINFO studies from 1984-September 2006 using the combinations of terms including "depression," "anxiety," and "sleep; older adult/elderly," "randomized controlled trial," and a list of 56 terms related to CAM. They found 29 studies that met the inclusion criteria of sample size of 30 of more, treatment duration of two weeks or longer, and publication in English. Four more studies were added to the mix from manual bibliography searches.

The researchers reviewed the 33 articles for methodological quality using a modified Scale for Assessing Scientific Quality of Investigations (SASQI). A study was said to be positive if the CAM therapy proved significantly more effective than an inactive control (or as effective as active control) on at least one primary psychological outcome, the researchers say. They compared positive and negative studies on these characteristics: CAM treatment category, symptom(s) assessed, country where the study was conducted, sample size, treatment duration, and mean sample age.

Of the 33 articles reviewed, 67% were considered positive. These studies were found to have lower SASQI methodology scores than the negative studies. Mind-body and body-based therapies had somewhat higher rates of positive results than energy- or biologically-based therapies, the researchers say.

Overall, they conclude a few well-conducted studies suggested therapeutic potential for certain CAM interventions in older adults (such as mind-body interventions for sleep disturbances and acupressure for sleep and anxiety).

CAM use common in older adults

A recent study found that use of complementary and alternative medicine (CAM) in older adults is common, especially when they have health problems.

The researchers had three objectives in this study. They wanted to assess the prevalence and patterns of CAM use in a probability-based sample of older adults, describe the characteristics of older CAM users, and identify factors associated with complementary and alternative medicine use or nonuse. The researchers took a random sample of community-dwelling adults aged 65 or older from the Minnesota Driver's License/Identification Tape, using names from the Twin Cities seven-county metropolitan area. The adults in the survey received a questionnaire in the mail that included items on demographics, health status, health care utilization, CAM modality use, reasons for use, costs, and complementary and alternative therapy use satisfaction. The researchers then performed descriptive statistics, chi-square tests, and regression analysis on the data.

Overall, 62.9%, or 445, respondents reported use of one or more CAM modalities, with an average of three modalities. The top five CAM modalities used were nutritional supplements (44.3%), spiritual healing/prayer (29.7%), megavitamins (28.3%), herbal supplements (20.7%), and chiropractors (17.8%). The respondents noted that maintaining health and treating a health condition were the primary reasons for CAM use, with many using CAM to treat arthritis (44.4%) and chronic pain (23.5%).

Demographic variables were not significantly different between CAM users and nonusers, the researchers say. CAM users reported more unhealthy days than nonusers did, and overall satisfaction with CAM use was high (80%). The users say they were motivated to use CAM by symptoms of a health problem and desire for personal control over health. The main barriers to CAM use were lack of reason to use and knowledge of CAM. Only 53% of users disclosed CAM use to their primary care providers, a finding that concerned the researchers.

For more information about the survey, see the November 2007 issue of the Journal of Alternative and Complementary Medicine.

University of South Carolina establishes center to study CAM

The University of South Carolina in Columbia has received a $6 million grant from the National Institutes of Health to create a Center of Excellence for Complementary and Alternative Medicine Research on Autoimmune and Inflammatory Disease, one of 11 such centers in the nation.

Several research projects for the center are planned. Prakash Nagarkatti, PhD, Associate Dean for Basic Science at the School of Medicine, is the principal investigator for the grant and will lead the study on the mechanism by which resveratrol, a compound in the skin of red grapes, may help treat multiple sclerosis. Mitzi Nagarkatti, PhD, Chair of the Department of Pathology and Microbiology, will study how a compound in hemp may be useful in treating autoimmune hepatitis, and Lorne Hofseth, PhD, Assistant Professor in the SC College of Pharmacy, will study the anti-inflammatory properties of American ginseng in treating colitis.