Evaluating the Risks and Benefits of Routine Iron Supplementation … · 2019-11-26 · iron supplementation, considering outcomes for iron-sufficient and iron-deficient infants as

2016 MUIH Research Symposium

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Evaluating the Risks and Benefits of Routine Iron Supplementation in US Infants Burkholder AJ BACKGROUND: Iron is essential for healthy growth and development in early life - physical, cognitive, and psychosocial. It is also a pro-oxidant and a leading cause of pediatric poisoning in the US. Iron supplementation for US infants is broadly recommended, with scant data on prevalence of deficiency, and little research to assess risks of supplementation for iron-sufficient infants. RESEARCH OBJECTIVE(S): The objective of this review was to evaluate the risks and benefits of routine iron supplementation, considering outcomes for iron-sufficient and iron-deficient infants as distinct subgroups of this population. METHODS: PubMed was searched with key terms: iron deficiency OR iron deficiency anemia AND infants (randomized controlled trials only). For inclusion, studies had to include full-term infants (≤12 months), and must have ascertained baseline iron status. Outcomes of interest included hematology, anthropometry, psychomotor development, and morbidity. RESULTS: 22 randomized controlled trials studying the effects of iron supplementation in infancy were found (date range: 1996-2013), measuring at least one of the outcomes. Of these, 11 studies met the inclusion criteria. Two were excluded due to poor quality. This review found no harms for iron-deficient infants and some benefits (hematological, anthropometric). For iron-sufficient infants, there were some positive hematological effects, as well as consistent negative effects on growth outcomes, and some evidence of lower developmental test scores long term. CONCLUSION: Given that the majority of infants in the US are likely iron-sufficient, based on data presented from similar countries, and that iron may not be a benign therapeutic intervention for this subgroup, current recommendations for routine iron supplementation should be revised. Emphasis should be placed on other preventive strategies for infant iron deficiency, including delayed cord clamping and improved guidelines for complimentary feeding.


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US Western Herbal Medicine Providers and Their Attitudes, Skills and Use of Evidence-Based Practice Clare B, Snow J, Leach MJ. BACKGROUND: Evidence-based practice (EBP) has been the focus of expanding attention in the teaching and delivery of both complementary and conventional healthcare. However, its impact on Western herbal medicine (WHM) - a system of healthcare grounded in tradition but increasingly influenced by biomedicine - has not been well explored to date. RESEARCH OBJECTIVE(S): To investigate US WHM providers’ attitude toward EBP; level of EBP-related skill; degree of EBP uptake; level of training in EBP; and perceived barriers and facilitators to EBP uptake. METHODS: A convenience sample of US clinical herbalists was invited to complete a modified online version of the previously validated Evidence-Based practice Attitude and utilization Survey (EBASE) in February/March 2015. RESULTS: Two hundred and eleven herbal practitioners were contacted and seventy-four (35%) completed the survey. Respondents demonstrated a generally positive attitude toward EBP (median attitude subscore 31 [possible range = 8-40]) and a moderate to high level of self-assessed skill in EBP (median skill subscore 46 [13-65]). Participants reported a moderate level of EBP uptake (median use subscore 12 [0-24]) and identified a lack of clinical evidence in herbal medicine as the primary barrier to use. Access to evidence via the Internet, online databases and full-text journal articles were the most commonly reported facilitators of EBP uptake in WHM practice. CONCLUSION: The attitudes, skill level, and uptake of EBP amongst US WHM practitioners were similar to that of other complementary and alternative medicine providers. Access to relevant evidence, along with educational initiatives emphasizing the appraisal and application of evidence, may help to improve EBP uptake by US WHM providers.


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Student Transformation in the Yoga Therapy Program at MUIH: Proposed Design for a Pilot Longitudinal Study Freeman C, Valdes L. BACKGROUND: Educational programs at MUIH are promoted as transformational for students as they develop into practitioners and future leaders in the healthcare field. Many students informally report undergoing meaningful and substantial shifts in personal outlook and behavior, although these changes have never been measured explicitly at the University. This study will measure outcomes relevant to two of the University’s foundational principles - transformation and resilience – in our yoga therapy students. RESEARCH OBJECTIVE(S): This research will help determine if and to what degree health-related behaviors and/or health and well-being change in students enrolled in our MS of yoga therapy program. The pilot study will also help determine effect size for a larger-scale study in the future. METHODS: This longitudinal study will use validated questionnaires to measure health behaviors and health- and well-being-related outcomes relevant to the mission, vision and foundational principles of MUIH. Measures will include the International Physical Activity Questionnaire; the Meaning and Purpose Survey and the General Life Satisfaction Survey from the NIH Toolbox; as well as the Global Health and Satisfaction with Social Roles and Activities Surveys from the Patient Reported Outcomes Measurement Information System (PROMIS) toolbox. Surveys will be administered online to students in the yoga therapy program at four time points: upon admission, midway through the program, upon graduation, and one year post-graduation. Data will be analyzed using a general linear mixed model. DISCUSSION: This pilot study is novel in that we propose to assess how one of our programs – driven by the Institutional principles – is changing students’ health behaviors as well as related health and well-being outcomes. While the specific data gathered may not interest those outside of MUIH, the research design itself may be applicable to other institutions who wish to perform similar assessments.


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Rationale and Design for a Study Characterizing Adult Five Element Acupuncture Patients in the United States Gigliotti T, Most H, Hockmeyer T, York A, Snow J. BACKGROUND: Acupuncture in the United States is practiced in a diversity of styles, each with its own distinct diagnostic and treatment approach. Previous studies characterizing patients undergoing acupuncture treatment have focused on Traditional Chinese Medicine acupuncture or non-specified styles. Patients receiving Five Element acupuncture treatment in the United States have not been surveyed and described. A better understanding of the patient population would help guide Five Element-based education, clinical, and research initiatives. RESEARCH OBJECTIVE(S): The study aims to describe the adult patient population receiving care from Five Element-based U.S. acupuncturists. METHODS: The study uses a cross-sectional, descriptive survey design. Patients of alumni and students from the three primary Five Element acupuncture schools in the U.S. will be used as a convenience sample. Participants will be recruited through their acupuncturist and provided with a link to an anonymous online survey. The survey will be open for 30 days and there will be no maximum enrollment. Characteristics to be described include: a) motivations for seeking care; b) global physical and mental health; c) health-related behaviors; and d) demographics. The bulk of the questionnaire is extracted from the Adult Alternative Medicine supplement to the 2012 National Health Interview Survey. The Global Short Form v1.1, developed by Patient Reported Outcomes Measurement Information System (PROMIS), is included to measure self-assessed physical and mental health. Descriptive statistics will be employed to summarize and describe the data. DISCUSSION: This poster describes the rationale and design for a study investigating the motivations, health status, behaviors, and demographics of patients receiving Five Element acupuncture. The authors are unaware of any previous research characterizing this patient population. The multi-dimensional questionnaire will elicit a range of data needed to guide education, clinical, and research initiatives.


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Examination of the Effects of Acupuncture Treatment on Sleep in a Clinical Setting: A Hypothetical Study Hockmeyer TR BACKGROUND: Approximately 35% of the U.S. adult population report “mild” insomnia, 10 – 15% “severe” disturbance, and 6% - 10% prescription sleep medication use. Acupuncture may be an effective treatment for insomnia though no large-scale study has examined its efficacy in a clinical setting. We propose the following study design to investigate the effectiveness of acupuncture for improving sleep in a clinical setting. RESEARCH AIMS: To evaluate nighttime sleep and reported sleepiness across 6 weeks in MUIH Student Clinic patients undergoing acupuncture treatment. The study hypothesis is that patients undergoing acupuncture treatment for sleep complaints will demonstrate improved sleep. METHODS: Sleep quality, quantity and daytime sleepiness in patients undergoing acupuncture treatment for sleep complaints (N = 100) would be compared to control groups of patients receiving acupuncture not specifically for sleep complaints (N = 100) or nutritional counseling (N = 100). Weekly acupuncture treatments would be administered for 6 weeks. Wrist actigraphs would be worn continuously to approximate sleep/wake; and questionnaire of perceived sleepiness (Stanford Sleepiness Scale; SSS) completed weekly. Statistical analyses would be performed using analysis of variance (ANOVA); within-subject factors Treatment Number (1-4), and Group (acupuncture for primary sleep complaints; acupuncture not for primary sleep complaints; or nutritional counseling) with covariates age and secondary complaints. Dependent measures would include actigraph total sleep time, sleep efficiency, and # awakenings and SSS subjective sleepiness. DISCUSSION: With this design, I would expect to find acupuncture to be an efficacious treatment for improving sleep in a clinical setting. Study limitations might include control of factors contributing to sleep disruption (e.g., caffeine or medications), variability of results based on practitioner and treatment design, and response bias. Future directions might include retrospective examination of patient records to correlate points used and degree of sleep improvement. The MUIH student clinic is a potential resource of patients and data for sizeable clinical research studies with minimal intrusion on patient and practitioner time and treatment.


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Acupuncture as an Alternative Treatment for Cystic Acne: a Case Study Homan C BACKGROUND: Severe acne presents as pustules or pus-filled lesions and nodules or cysts. The side effects of commonly prescribed medications suggest the need for alternative therapies. This case demonstrates that acupuncture channel physiology may provide an explanatory model and therapeutic approach. CASE PRESENTATION: A 37-year old male professional presented to his physician with cystic acne of sudden onset one month after receiving dental work. He had a history of cysts in his sinuses and gallbladder, but no prior history of acne. Lesions were distributed over 60% of his back and on the soft skin of the anterior surface of his elbows, axilla, and inguinal areas. He received antibiotic and nutrition therapies for two years with no improvement. He received several months of acupuncture treatment, also with no improvement. He did not want to take isotretinoin due to common severe side effects, which include eye irritation, joint pain, nosebleed, rash, skin infection and bone tenderness and was referred by his physician for a different acupuncture approach. The sudden onset of symptoms on the surface of the body after receiving dental work indicated the release of a pathogen from the deepest to the most superficial anatomical layer of the body, a physiological process that can be explained by the divergent channel mechanism. After three months of divergent channel treatment, which directed the body’s resources to safely eliminate the pathogenic factor, the lesions were significantly reduced in number and were no longer raised. Subsequent treatment of the primary channels to address ongoing weaknesses of the organs and substances resolved lingering discoloration. CONCLUSION: This case suggests that acupuncture channel physiology may help to explain otherwise confusing presentations and to direct treatment strategies.


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Rationale and Methodology for a Pilot Study Comparing Five Element Acupuncture Alone to Acupuncture with Crystals for Treatment of Chronic Pain Johanison D, Kilgallen L BACKGROUND: There is extensive research regarding the benefits of acupuncture treatments with patients suffering from chronic pain. There is anecdotal information suggesting that the addition of crystals during the course of acupuncture treatments reduces pain intensity, positively modifying pain interference and behavior. There is however, no known research that has been completed using acupuncture with crystals in adults suffering from chronic pain. RESEARCH OBJECTIVE(S): This poster describes the rationale and methodology of a pragmatic-oriented pilot study designed to compare the effectiveness of Five Element Acupuncture alone to Five Element Acupuncture with crystals for treatment of all types of chronic pain in adults. METHODS: New as well as continuing adult patients with chronic pain of any location or etiology will be eligible to participate. Participants will be randomized to receive ten acupuncture treatments alone or acupuncture plus treatment with crystals. Crystals and Acupuncture will be selected based on diagnosis of Constitutional Factor as used in the Five Element acupuncture theory. Crystals will be placed in the vicinity of the pain, with a Master crystal placed between the patient’s feet. The primary outcome will be a comparison of Pain Intensity with secondary comparisons of Pain Interference, and Pain Behavior. Comparisons will be measured by the validated PROMIS Pain Management Tool, using the short forms to measure outcomes. DISCUSSION: Reducing chronic pain with an efficient holistic approach can offer physical and economic benefits for both patient and society.


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Are Soy Supplements or Soy Foods Effective for Hot Flashes in Menopausal Women? Keating A, Muller-Flynn E, Gudelsky D, McKee C, Peterson A. BACKGROUND: Hot flashes, a vasomotor symptom associated with menopausal estrogen deficiency, are experienced by approximately 75% of North American Women, and are a primary reason women seek treatment. There is increased interest in safe and effective alternatives to Hormone Replacement Therapy (HRT) as recent studies indicate that HRT increases the risk of breast cancer and stroke. RESEARCH OBJECTIVE(S): The objective is to determine if research supports the use of soy foods or supplements to decrease the frequency or severity of hot flashes in menopausal women. METHODS: The PubMed database was searched using combinations of the following terms: menopause, hot flashes, and soy foods. Search results were filtered by randomized controlled trial (RCT) and English language. Abstracts were screened for inclusion. The methodological quality of selected studies was reviewed using the SIGN checklist for controlled trials (version 2.0) and study interventions and outcomes were summarized. RESULTS: Thirteen studies were retrieved and four were discarded; one was in Spanish, one reviewed another study, and two were not randomized controlled trials. All studies reviewed (n=9) were double-blind RCTs, with the exception of one randomized cross-over study; five met the criteria of high quality, and four were of moderate quality. Six of the nine studies demonstrated a reduction of frequency of hot flashes, with one showing a reduction in severity. Two studies showed no effect, and one study which combined soy with black cohosh showed increased symptoms. The dosage and form of soy used varied across the studies. All of the studies demonstrating a beneficial effect of soy utilized a food or supplement providing a minimum of 60 mg. of soy isoflavones. CONCLUSION: This review of the literature supports the effectiveness of soy supplements and soy foods in the reduction of frequency and severity of hot flashes in menopausal women. Future research should focus on further clarifying effective dose and relevance to diet.


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Integrating Electrodermal Scan with Chinese, Functional, Homeopathic, Sufi, and Nanotechnology Medicine in Treatment of Chronic Lyme Disease Lee G BACKGROUND: Lyme disease patients often have multiple infections, most commonly Bartonella, Babesia, Mycoplasma, Rocky Mountain Spotted Fever (RMSF), Ehrlichia, or Brucellosis. Blood tests detect 40-65% of Lyme disease cases, while co-infection tests have a lower rate of detection. Electrodermal scans may help detect the frequencies of hundreds of infections including Lyme disease. They may also aid in identify optimal treatments for resolving persistent tick-borne infection symptoms. CASE DESCRIPTION: A 48-year-old Caucasian woman diagnosed with Lyme disease, Bartonella, and Babesia presented with comorbid symptoms of brain fog, sleep disturbance, anxiety, hopelessness, irritability, fatigue, vision problems, confusion, dizziness, and loss of identity. She reported pain in her foot, face, jaw, hip, knee, and calves. Despite three years of antibiotic treatment, the patient experienced debilitating symptoms and sought alternative treatment. Zyto electrodermal scans were used to detect frequencies of multiple infections: Herpes, Staphylococcus, Babesia, Bartonella, fungal, and cestodes. These scans reported elevated inflammatory cytokines, histamine levels, mercury, lymphatic congestion, mid-brain inflammation, encephalitis, and kidney-adrenal-thyroid depletion. These scans also identified leaky gut and methylation issues. Treatment started with detoxification of her organs, methylation pathways, lymphatic and nervous system. Next, mitochondrial, thyroid, and hypothalamus-pituitary-adrenal energy levels were supplemented. She received many treatments for her infections, including microcurrent, acupuncture, cupping and bloodletting, cold laser, moxabustion, emotional healing, and liver-gall bladder flushes. She received supplements for: hypothalamus-pituitary-adrenal and mitochondrial replenishment, healing leaky gut, detoxification, sleep, liver support, and increasing dopamine and probiotics. She received antimicrobial remedies: liposomal herbs, essential oils, ionic silver, and homeopathics for Bartonella and RMSF. Over 18 months, she reported 50% improvement of symptoms in the first two months. At four months, she reported feeling 90% better. Symptoms improved unless she ate sugar, wheat, alcohol, or dairy. CONCLUSION: Based on these promising results, chronic Lyme patients may recover faster through targeted treatments and remedies guided by electrodermal scans.


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Using Healing Narratives in Online Health Coaching Education: Teaching Core Competencies Marra R, Kreisberg J. BACKGROUND: Given a healthcare industry that favors measured outcomes, health coaching programs rely heavily on evidence-based approaches and assessment. The International Coaching Federation, however, equally emphasizes core competencies that are difficult to quantify such as establishing trust and intimacy, active listening, powerful questioning and creating awareness. In attending to the whole person, these competencies are key for the teacher/student and the coach/client relationships. RESEARCH OBJECTIVE(S): The authors propose that a structured, online discussion facilitates four ICF competencies - creating awareness, active listening, asking powerful questions and establishing trust and intimacy - by offering opportunities to experience differing perspectives. The online classroom’s written, audio and video components allow students to listen to and inquire of each other, deepen awareness, and establish trust. METHODS: Twenty-two adults, age 23-54, participated in online discussions as part of MUIH’s Health and Wellness Coaching Program. Through two assignments, five weeks apart, participants explored their healing narratives with each other. An initial heuristic approach left narratives and dialogues uninterpreted, offering empirical evidence of personal experiences. Subsequent analysis explored examples of the four ICF competencies. RESULTS: Interpersonal and intrapersonal awareness emerged through dialogue. Active listening emerged as foundational to other competencies. Trust and intimacy were prerequisites for and consequences of the dialogues. Powerful questioning was least witnessed. Often, two or three competencies were noted in a single sentence. We observed no hard boundaries between expressions that create awareness, demonstrate active listening, establish trust and intimacy, and ask powerful questions. We noted that competencies are intimately connected and that participants expressed deepening self-acceptance and strengthening of interpersonal connections. CONCLUSION: Four ICF core competencies – creating awareness, active listening, asking powerful questions and establishing trust and intimacy can be taught and developed through semi-synchronous online health coaching education. Students who shared personal healing narratives deepened their embodiment of competencies and were aware of this deepening.


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Nutrition and Herbal Interventions to Improve Menopausal Symptoms: A Case Study Mirkin LI BACKGROUND: Many menopausal women do not find adequate symptom relief through conventional medicine. Excessive alcohol intake and high-glycemic-index (GI) diets can exacerbate symptoms such as hot flashes, fatigue and mood changes. An integrative approach using nutritional, lifestyle and herbal interventions can expand treatment options. CASE DESCRIPTION: A 54-year-old African American woman sought help for menopause-related symptoms including low energy, lack of drive, mood swings, impaired memory, and joint and muscular discomfort. Client was already taking aspirin (81 mg. daily), rosuvastatin (5mg.), and olmesartan (20 mg.), prescribed by an internist. A simplified version of the validated Menopause Rating Scale (MRS) was used to track the client’s main symptoms. She was also asked to keep a log noting the number of alcoholic drinks consumed per week, and the types of carbohydrates consumed, which would later be rated as high, medium or low GI in educational sessions with the practitioner. Motivational interviewing was used to elicit the client’s reasons for wanting to reduce alcohol intake and improve food choices. Over 12 sessions, four nutritional and herbal products were introduced: Pycnogenol to reduce joint and muscle pain; Remifemin (standardized black cohosh) to address hot flashes; rhodiola to improve drive, mood, verbal acuity and energy; and an evidence-based low-GI meal-replacement medical food to improve nutrient intake and reduce glycemic load. Neurotransmitter testing was used to help guide product selection. Through these interventions, the client was able to reduce her scores on the MRS from the 3–4 range (severe to very severe) to the 0–1 range (none to mild). Alcohol consumption was reduced from 7 glasses 4–5 days week, to 1–2 glasses 2 days per week. These positive changes were sustained at least 2 years. CONCLUSION: An integrative approach using nutritional, lifestyle and herbal interventions may be a treatment option for menopausal women seeking long-term symptom relief. Further research is warranted.


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Demographics and Perspectives of Graduate Students in Yoga Therapy: Study Design and Rationale Moonaz S, Sullivan M. BACKGROUND: The only accredited Master of Science in Yoga Therapy (MSYT) in the U.S. graduated its first cohort of students in 2015. This program is the first of its kind and information is lacking about characteristics, motivations, perceptions, expectations and career aspirations for students choosing yoga therapy training in the context of higher education. RESEARCH OBJECTIVE(S): This poster describes methodology and rationale for a mixed methods study to analyze the characteristics and experience of students in the first cohort of the MSYT at Maryland University of Integrative Health. METHODS: Survey participants were recruited among the students of the first cohort of the MSYT (n=23), prior to graduation. Data collection was divided into two sections: in-depth interview and written survey. Information gathered included motivations for joining the program, experience in the program, past training, career goals and demographics such as age, marital status, residence, income and education status. Training was held for all interviewers and data coders to ensure consistency. In-depth interviews were conducted by university personnel outside of the yoga therapy program. Thematic coding is currently underway following the creation of an initial codebook based on consensus after the first two interviews. Each subsequent interview will be coded by two trained personnel and codes will be finalized through consensus. Major themes will be reported with examples from interview text. Demographic data will be analyzed and reported quantitatively as percentages or proportions. DISCUSSION: The development and implementation of this study may be useful to yoga therapy organizations, the healthcare field and institutions of higher education. Understanding student demographics, experience, perceptions and motivations in choosing the context of higher education for yoga therapy training could help to clarify the needs and expectations of students as well as to inform the role of higher education in the training of yoga therapists.


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A Narrative Review of Acupuncture’s Effect on Neuro-Endocrine-Immune Pathways Most H, Zhu H. BACKGROUND: Western medicine recognizes the importance of the mind-body connection (how the brain/mind/thoughts affect the body and vice versa) in maintaining health, and is uncovering its biological mechanisms. These mechanisms include changes in hormonal levels, immune function and nervous system activity. Demonstrating acupuncture’s effects on these neuro-endocrine-immune pathways may be the first step in understanding the biological underpinnings of acupuncture as a valuable mind-body therapy. RESEARCH OBJECTIVE(S): To describe acupuncture’s effect on the endocrine, immune and nervous systems that forms the connection between mind and body. METHODS: Separate searches were run in PubMed, filtered for English and last 5 years, using the following terms: Acupuncture AND adrenergic response, cholinergic response, endorphins, cortisol, immune system, fMRI, cerebro-spinal fluid, immune function. When run together, the string yielded 339 articles. Specific papers for inclusion were screened by abstract for relevance. RESULTS: In all, 45 papers were identified as sufficiently relevant in describing acupuncture’s effect on specific biological systems. Papers focused on basic science research, including the specific mechanisms of action of acupuncture through measurement of serum, urine and cerebro-spinal fluid markers and fMRI imaging. Acupuncture engages the relaxation response through the parasympathetic nervous system and endocrine system, through increasing acetylcholine, endogenous opioids, cannabinoids, anandamides, and the GABAergic system. Acupuncture has been shown to reduce pain through increased opioid peptides, serotonin and norepinephrine response, increase immune function through NK cell and cytokine activity and directly affect specific brain regions, particularly the limbic lobe. CONCLUSION: This review shows that there is strong biological evidence for acupuncture’s effect on the endocrine, immune and nervous system pathways that underlie mind-body connections. This suggests that acupuncture may be a valuable mind-body therapy that should be further explored in research and clinical settings.


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Yoga Therapy for Chronic Pain & Stress Paul T BACKGROUND: Neck and upper back pain are frequent results of common everyday stressors. Current chronic pain therapies have many challenges and there is a need for cost-effective and preventive self-care options. CASE DESCRIPTION: A 44 year old female balancing a busy work/school/family life presented at a yoga therapy practice with neck/back pain, joint tension, stiffness, poor quality sleep and anxiety. The client was observed to have high energy, poor flexibility and low breath flow throughout the body. Structural evaluation demonstrated weak lower/middle trapezius muscles, tight pectorals and tight hamstrings. The daily stress of balancing a busy life was assessed as contributing to the pain and muscular tension. Treatment included restorative and strengthening yoga postures with focus on breath and meditation. The client reported feeling at ease, relaxed and pain-free after each of the four therapeutic sessions. Specific postures and breathing exercises for home practice included: side body stretch, spinal twist on a bolster, forearm plank, cobra, legs up the wall and three-part breath. At the conclusion of treatment, the client reported decreased pain and tension and had incorporated more self-care routines in her daily life. CONCLUSION: This case report aligns with a growing body of evidence supporting yoga therapy for stress and pain management. The patient’s presentation is typical in the modern workforce and associated with common everyday stress patterns. Pain is a major expense in the workplace and causes burdens at the personal, social and institutional level. Yoga may be a cost-effective form of self-care for chronic pain/stress and could be a valuable addition to workplace wellness programs.


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Assessing the Relationship between Psychological Empowerment and Health Literacy Competencies in Young Adults Pille RO BACKGROUND: In the evolving health literacy field, little attention has been paid to young adults, health promotion-related health literacy competencies, and psychological empowerment as a factor that can predict those competencies. RESEARCH OBJECTIVE(S): Determine to what extent empowerment predicts the four health literacy (HL) competencies of accessing, understanding, appraising, and applying health information in the understudied health promotion domain for the understudied young adult population. METHODS: An online survey was distributed to 400 young adults, ages 18-24, to assess health promotion-related health literacy competencies and psychological empowerment. Invitations to participate in the survey were sent to a random sample of young adults at a federal agency. This quantitative, non-experimental study used multiple linear regression analysis for data collected through an online survey using the Health Literacy Survey Questionnaire (HLSQ) to measure competencies (4-point scale with 1 = very difficult, 4 = very easy) and the Orientation to Life Questionnaire (OLQ) to measure empowerment (7-point scale with 1 = low, 7 = high). RESULTS: Self-report data was provided by 109 participants. After eliminating records with missing information, data was analyzed on 82 participants. Results from the HLSQ showed that regarding health information, young adults perceived accessing as fairly easy (M = 2.9, SD = .20), understanding as fairly easy (M = 3.0, SD = .28), appraising as fairly easy (M = 3.1, SD = .31), and applying as fairly easy (M = 3.2, SD = .19). Regression analysis showed that empowerment significantly predicted three of the four HL competencies—accessing, ß =.30, t(76) = 2.62, p = 0.01, understanding, ß =.41, t(76) = 3.77, p = <0.01, and appraising, ß =.40, t(76) = 3.63, p = <.01. Empowerment did not significantly predict applying, ß =.20, t(76) = 1.66, p = 0.10. CONCLUSION: Study findings provided novel insights about young adults as they perceived a facility with health promotion-related HL competencies and demonstrated that empowerment predicted three of four competencies.


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Examination of the Effects of Acupuncture Treatment on Sleep in a Clinical Setting: A Hypothetical Study Rupp T BACKGROUND: Approximately 35% of the U.S. adult population report “mild” insomnia, 10 – 15% “severe” disturbance, and 6% - 10% prescription sleep medication use. Acupuncture may be an effective treatment for insomnia though no large-scale study has examined its efficacy in a clinical setting. We propose the following study design to investigate the effectiveness of acupuncture for improving sleep in a clinical setting. RESEARCH AIMS: To evaluate nighttime sleep and reported sleepiness across 6 weeks in MUIH Student Clinic patients undergoing acupuncture treatment. The study hypothesis is that patients undergoing acupuncture treatment for sleep complaints will demonstrate improved sleep. METHODS: Sleep quality, quantity and daytime sleepiness in patients undergoing acupuncture treatment for sleep complaints (N = 100) would be compared to control groups of patients receiving acupuncture not specifically for sleep complaints (N = 100) or nutritional counseling (N = 100). Weekly acupuncture treatments would be administered for 6 weeks. Wrist actigraphs would be worn continuously to approximate sleep/wake; and questionnaire of perceived sleepiness (Stanford Sleepiness Scale; SSS) completed weekly. Statistical analyses would be performed using analysis of variance (ANOVA); within-subject factors Treatment Number (1-4), and Group (acupuncture for primary sleep complaints; acupuncture not for primary sleep complaints; or nutritional counseling) with covariates age and secondary complaints. Dependent measures would include actigraph total sleep time, sleep efficiency, and # awakenings and SSS subjective sleepiness. DISCUSSION: With this design, I would expect to find acupuncture to be an efficacious treatment for improving sleep in a clinical setting. Study limitations might include control of factors contributing to sleep disruption (e.g., caffeine or medications), variability of results based on practitioner and treatment design, and response bias. Future directions might include retrospective examination of patient records to correlate points used and degree of sleep improvement. The MUIH student clinic is a potential resource of patients and data for sizeable clinical research studies with minimal intrusion on patient and practitioner time and treatment.


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Effect of Dairy Consumption on Fat Loss in Overweight Adults: A Review of the Literature Sarry L, Bowden B, Costello K, Cribbs L, Minichino-Sikora B. BACKGROUND: Opinions regarding the health effects of dairy products have become both polarizing and nuanced in recent years, particularly with respect to their influence on chronic health conditions seen in the West. Previous summary work on the impact of dairy products on body composition has been somewhat equivocal, likely resulting from overly broad inclusion criteria. RESEARCH OBJECTIVE(S): We sought an updated answer to the specific question of what effect inclusion of dairy products within a weight-reduction protocol would have on fat loss during the short- to medium-term. METHODS: To this end, we conducted a review of randomized controlled trials by searching PubMed. Altogether, forty studies were extracted after search parameters were carefully optimized and exhausted. Thirteen studies were deemed to be wholly relevant following filtering. RESULTS: The overall quality of studies was low and several studies were subject to sources of bias. Nevertheless, consolidation of data strongly supports the notion that dairy products do not hinder weight loss in diverse adult populations. The data trend towards a near-significant augmentation of fat loss, with a weighted effect size of 0.31 ± 0.50 additional pounds of fat lost per serving of dairy, per eight weeks of protocol. Moderately calorie-restricted diets primarily investigating body composition had the largest effects. CONCLUSION: Possible mechanisms behind the observed results are discussed. Future research should aim to include more traditional sources of dairy, employ larger subject pools, and ensure more commensurate conditions within and between trial arms.


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Presence in Conventional and Complementary Healthcare: A Narrative Review Snow J, Chittum H, Freeman C, Padgett J, Moonaz S. BACKGROUND: The effect of any treatment combines specific effects related to the treatment itself with “context effects” from the surrounding environment. “Presence” (including “healing presence” and “therapeutic presence”) has been promoted in nursing and psychotherapy as a key component of intra- and inter-personal healing environments. The concept has been promoted to a lesser degree in complementary and integrative healthcare (CIH). If presence does affect client outcomes, and if it can be cultivated by practitioners, enhanced presence may improve outcomes across a variety of healthcare disciplines. RESEARCH OBJECTIVE(S): 1) Summarize the qualitative and quantitative research on presence in nursing, psychotherapy, and CIH; 2) Propose a direction for future research in CIH disciplines. METHODS: Nine databases were searched; search terms included "therapeutic presence", "nursing presence", “healing presence”, and ("Professional-Patient Relations"[MeSH] AND “presence”[ti]). Additional papers were located through reference lists from previously identified articles. RESULTS: Qualitative research and conceptual analyses provide evidence-based constructs of presence in nursing and psychotherapy. While discipline-specific differences are evident, both disciplines describe presence as an intentional process of “being with and for” the patient. Specific measures of presence are few and vary by discipline (e.g., Presence of Nursing Scale (PONS) and Therapeutic Presence Inventory-therapist (TPI-T)). Preliminary studies suggest that health outcomes may be more closely associated with patient-reported measures of presence, rather than practitioner-reported measures. There is little research investigating presence in CIH. CONCLUSION: Research on presence is in its infancy, particularly in CIH. Preliminary research suggests that concepts of presence may be discipline specific. Given CIH’s overall emphasis on optimizing healing environments, the following research should be prioritized: CIH-specific conceptual analysis of presence, incorporating patient perspectives; development or adaptation of an instrument for measuring presence in CIH; development and assessment of training programs to cultivate presence in CIH practitioners; and assessment of associations between presence and health outcomes in CIH.


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A Survey of the Yoga Therapy Workforce in the US and Canada: Methodology and Rationale Sullivan M, Snow J, Leach M, Moonaz S. BACKGROUND: Yoga therapy is an emerging healthcare profession. Educational standards and programmatic accreditation are in place and practitioner certification is scheduled for 2016. Despite this, we still know very little about the current yoga therapy workforce. RESEARCH OBJECTIVE(S): This poster describes the methodology and rationale for the development and implementation of a survey to characterize the yoga therapy workforce in the US and Canada. METHODS: The cross-sectional survey was designed to capture key demographic data on the yoga therapy workforce. Information collected included: age, gender, education, training as a yoga teacher and yoga therapist, years of practice, styles of yoga that inform the practice, group versus individual practice, fees and income, client population, other modalities used by practitioners, and the settings in which yoga therapy is practiced. Survey participants were recruited through the International Association of Yoga Therapy, a worldwide organization dedicated to establishing yoga as a respected form of therapy. Email notifications were sent to 5137 members in the US and Canada, which included detailed information about the study along with a link to the online survey. The survey was administered using the SurveyMonkey™ web-based platform and all data were collected anonymously. Reminder emails were sent to members over a 4-week window, ending November 2015. DISCUSSION: The development and implementation of this online survey will help to characterize the current yoga therapy workforce in the US and Canada. This information will be valuable in informing the development and implementation of pertinent research and educational initiatives for yoga therapy, as well as educating the public, yoga associations, and healthcare professionals about this developing discipline.


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A Literature Review: Do Mindfulness Interventions Reduce Blood Pressure in Hypertensive Populations? Swartout J, Struthers C, Henderson N BACKGROUND: Hypertension is the main contributor to heart disease and stroke (CVD) affecting approximately 1 billion people worldwide. Hypertension medications can have undesirable side effects and researchers are exploring other treatment options such as mindfulness therapies to reduce blood pressure. RESEARCH OBJECTIVE(S): The objective of this review is to evaluate the validity, significance, and clinical relevance of existing clinical trials and pilot studies regarding the efficacy of meditation on reducing blood pressure in persons with hypertension or persons at risk for hypertension. METHODS: PubMed search terms were entered as the following search string: “Hypertension AND (Mindfulness OR Meditation) AND Blood Pressure.” The search was filtered by Randomized Control Trial. Of the 18 studies retrieved, 14 were relevant to the research question. Abstracts were screened for inclusion, and relevant studies were assessed for internal validity using the SIGN checklist for controlled trials (version 2.0). Data were extracted from all studies assessed as having acceptable or high quality methodology (i.e. minimized bias). RESULTS: 18 studies were retrieved and screened. 14 were directly relevant to the research question and were assessed, with eight having acceptable (n=7) or high methodology (n=1). In all 8 studies, mindfulness interventions resulted in significant decrease of blood pressure compared to the control groups. Sample size ranged from n=20 to n=207 and decreases in blood pressure ranged from .9mmHg to 21.9mmHg. CONCLUSION: This literature review supports the effectiveness of mindfulness practices to reduce systolic, diastolic, or overall blood pressure in pre-hypertensive and hypertensive individuals. Due to statistically significant reductions in blood pressure across the studies, negligible financial costs, and minimal potential harm, mindfulness techniques may be a clinically relevant therapy to reduce blood pressure. The relatively small sample size of each study (mean =93) presents some question as to the internal validity; incorporating further studies with larger sample sizes is warranted.


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STW-5 as a Treatment for Gastrointestinal Disorder in Children with Autism Spectrum Disorder: A Research Design Walker H BACKGROUND: Autism Spectrum Disorder (ASD) is a developmental disorder that impairs communication and daily functions. Many children affected by ASD experience concurrent Functional Gastrointestinal Disorders (FGID), which adversely affect quality of life. STW-5 is an herbal supplement that has been shown to alleviate FGID symptoms in adult populations. It has a strong safety profile; no serious side effects have been noted in previous trials. Its favorable tolerability suggests that this product may be a viable option for children with ASD and FGID. RESEARCH OBJECTIVE(S): This pilot study’s objective is to investigate the efficacy, tolerability, and safety of STW-5 as a treatment for FGID symptoms in children with ASD. METHODS: This randomized, double-blind, placebo-controlled 4-week pilot study will enroll approximately 40 participants age 6-12 with ASD and FGID. Eligibility will be determined using the DSM-IV for ASD and the Rome III Diagnostic Questionnaire for the Pediatric Functional GI Disorders for FGID. Participants will be randomly assigned to receive 15 drops of STW-5 three times a day or a matching placebo. The PedsQL Gastrointestinal Symptoms Module parent report will be administered at baseline, week 2, week 4, and at a 1-month follow up. The primary outcome is between-group differences in PedsQL scores for FGID symptoms at week 4. Secondary measurement will be within-group overall difference in scores. DISCUSSION: Studies have shown a higher prevalence of FGID symptoms in children with ASD. This suggests FGID may have an influence on quality of life and behavior in children with ASD. Previous treatment options, such as gluten-free and/or casein-free diets, have not provided clinically significant relief in FGID symptoms in for children with ASD. STW-5 has the potential to alleviate multiple symptoms of FGID without serious adverse side effects, leading to a higher quality of life.


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Exogenous Intestinal Alkaline Phosphatase as a Novel Therapeutic Intervention for Intestinal Permeability Walsh B, Sarry L. BACKGROUND: Intestinal microbes and their byproducts have predominantly local effects when confined to the digestive tract. Conversely, translocation of microbial elements and digesta across the intestinal wall causes marked systemic inflammation and immunologic responses. Increasing evidence suggests that abnormal intestinal permeability (IP) associates with an array of different conditions including neurodevelopmental disorders, autoimmunity, and metabolic derangements such as obesity, diabetes and atherosclerosis. To date, murine studies provisioning exogenous intestinal alkaline phosphatase (IAP), a multifunctional enzyme localized to the digestive mucosa, have demonstrated a decrease in IP. RESEARCH OBJECTIVE(S): The aim of our study is to determine whether supplemental IAP improves aberrant IP and its associated symptomology in humans. METHODS: Subjects will be generated by letter outreach via the assay vendor, practitioner organizations and patient advocacy groups. From the asserted correlation between functional bowel disorders and diminished barrier function, as well as standard attrition rate, we anticipate that screening 100 individuals will allow for retention of the 24 total individuals necessary to adequately power our study. Adults aged 18-55 with untreated functional gastrointestinal symptomology and experiencing protracted distress, T-score of 65 on the NIH PROMIS GI Symptom Scale (PGISS), and with serological evidence of elevated intestinal permeability will be included. Participants will be allotted to treatment arms using simple randomization and receive six weeks of twice-daily oral administration of either buffered saline carrier, or liquid-suspension calf IAP (activity 20,000 U) between meals, with maintenance of current self-care regimen (diet, exercise, supplementation, diary norms). The primary outcome is IP at Day 43 as measured by titer changes in serum antibodies indicative of reduced tight junction integrity as well as post-treatment PGISS T-score. Data will be analyzed using the Student’s T-test. DISCUSSION: This placebo-controlled pilot study is, to our knowledge, the first to test unadorned enzymatic therapy in the restoration of gastrointestinal permeability and amelioration of corresponding symptoms within humans. Given the prevalence of excessive IP in a growing list of systemic inflammatory conditions, this study may offer a novel therapeutic intervention for such IP.


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Integrative Treatments for Neurological Involuntary Movement Disorders: a Case Study Zhu H BACKGROUND AND AIM: Both Parkinson’s disease and dystonia may share some symptoms such as involuntary repetitive movement (tremor or shaking), rigidity and postural instability. There are few effective treatments in Western medicine, and most carry negative side-effects and risks. This case report examines the use of integrative approaches for these conditions. CASE PRESENTATION: The first patient is a 69-year-old male drummer who was diagnosed with Parkinson’s disease and had tried Amantadine. He was referred by his neurologist for a “turn-around treatment” after seeing no effect from the medication. Scalp acupuncture was provided to help control his tremors and rigidity. The tremors and rigidity were effectively controlled. To strengthen his muscles, Chinese herbal medicine was used. As a result, he is able to play his drum again. His neurologist suggested reconsideration of the diagnosis. The second patient, a 54-year-old male, had cervical dystonia and had used Levodopa. He stopped the medication due to side effects. In lieu of Western medication, he turned to acupuncture. Scalp acupuncture effectively reduced his shaking, spasms, stiffness and postural instability. A Chinese herbal formula was integrated into the treatment, leading to further improvement. He is able to live, work and travel internationally without being limited by his medical condition. CONCLUSION: Integrative healthcare, including acupuncture and Chinese herbs is very promising for treatment of Parkinson’s disease and dystonia. Scalp acupuncture, an integration of acupuncture and neuroscience, may effectively improve the symptoms of involuntary movement disorders. Chinese herbal medicine treats the patients based on the Disharmony Patterns of disease and body constitution so that the patients are treated as a whole person instead of focusing exclusively on the brain. These two cases provide encouraging findings that Parkinson’s Disease and dystonia may be treated with the same integrative modalities.

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