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      Traditional, complementary and integrative healthcare: global stakeholder perspective on WHO’s current and future strategy

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          Abstract

          As the ‘WHO Traditional Medicine Strategy: 2014–2023’ is entering its final phase, reflection is warranted on progress and the focus for a new strategy. We used WHO documentation to analyse progress across the objectives of the current strategy, adding the role of traditional, complementary and integrative healthcare (TCIH) to address specific diseases as a dimension absent in the current strategy. Our analysis concludes on five areas. First, TCIH research is increasing but is not commensurate with TCIH use. TCIH research needs prioritisation and increased funding in national research policies and programmes. Second, WHO guidance for training and practice provides useful minimum standards but regulation of TCIH practitioners also need to reflect the different nature of formal and informal practices. Third, there has been progress in the regulation of herbal medicines but TCIH products of other origin still need addressing. A risk-based regulatory approach for the full-range of TCIH products seems appropriate and WHO should provide guidance in this regard. Fourth, the potential of TCIH to help address specific diseases is often overlooked. The development of disease strategies would benefit from considering the evidence and inclusion of TCIH practices, as appropriate. Fifth, inclusion of TCIH in national health policies differs between countries, with some integrating TCIH practices and others seeking to restrict them. We encourage a positive framework in all countries that enshrines the role of TCIH in the achievement of universal health coverage. Finally, we encourage seeking the input of stakeholders in the development of the new WHO Traditional Medicine Strategy.

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          Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment.

          Answer questions and earn CME/CNE Patients with breast cancer commonly use complementary and integrative therapies as supportive care during cancer treatment and to manage treatment-related side effects. However, evidence supporting the use of such therapies in the oncology setting is limited. This report provides updated clinical practice guidelines from the Society for Integrative Oncology on the use of integrative therapies for specific clinical indications during and after breast cancer treatment, including anxiety/stress, depression/mood disorders, fatigue, quality of life/physical functioning, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance. Clinical practice guidelines are based on a systematic literature review from 1990 through 2015. Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy-induced nausea and vomiting. Acetyl-L-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy due to a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related side effects. In summary, there is a growing body of evidence supporting the use of integrative therapies, especially mind-body therapies, as effective supportive care strategies during breast cancer treatment. Many integrative practices, however, remain understudied, with insufficient evidence to be definitively recommended or avoided. CA Cancer J Clin 2017;67:194-232. © 2017 American Cancer Society.
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            Traditional, complementary and alternative medicine use in Sub-Saharan Africa: a systematic review

            Background The WHO estimates that a considerable number of people in Sub-Saharan Africa (SSA) rely on traditional, complementary and alternative medicine (TCAM) to meet their primary healthcare needs, yet there remains a dearth of research evidence on the overall picture of TCAM utilisation in the region. Methods We conducted a literature search of original articles examining TCAM use in SSA between 1 January 2006 and 28 February 2017, employing Medline, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Scopus, ProQuest, PubMed, Embase and African Journals Online databases. A critical appraisal of relevant articles reporting a quantitative or mixed-method design was undertaken. Results Despite the heterogeneity and general low quality of the identified literature, the review highlights a relatively high use of TCAM alone or in combination with orthodox medicine, in both general population and in specific health conditions in SSA. TCAM users compared with non-TCAM users are more likely to be of low socioeconomic and educational status, while there were inconsistencies in age, sex, spatial location and religious affiliation between TCAM users and non-TCAM users. Most TCAM users (55.8%–100%) in SSA fail to disclose TCAM use to their healthcare providers, with the main reasons for non-disclosure being fear of receiving improper care, healthcare providers’ negative attitude and a lack of enquiry about TCAM use from healthcare providers. Conclusion TCAM use in SSA is significant, although most studies emerge from a few countries. Factors associated with TCAM use in SSA are similar to those observed in other regions, but further research may be required to further elucidate challenges and opportunities related to TCAM use specific to SSA.
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              Who Uses CAM? A Narrative Review of Demographic Characteristics and Health Factors Associated with CAM Use

              Complementary and Alternative Medicines (CAM) are used by an extensive number of patients in the UK and elsewhere. In order to understand this pattern of behavior, it is helpful to examine the characteristics of people who use CAM. This narrative review collates and evaluates the evidence concerning the demographic characteristics and health status factors associated with CAM use in community-based non-clinical populations. A systematic literature search of computerized databases was conducted, and published research papers which present evidence concerning associations between CAM use and demographic and health characteristics are discussed and evaluated. The evidence suggests that people who use CAM tend to be female, of middle age and have more education. In terms of their health, CAM users tend to have more than one medical condition, but might not be more likely than non-users to have specific conditions such as cancer or to rate their own general health as poor. The multivariate studies that have been conducted suggest that both demographic and health characteristics contribute independently to CAM use. In conclusion, demographic characteristics and factors related to an individual's health status are associated with CAM use. Future research is needed to address methodological limitations in existing studies.
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                Author and article information

                Journal
                BMJ Glob Health
                BMJ Glob Health
                bmjgh
                bmjgh
                BMJ Global Health
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2059-7908
                2023
                2 December 2023
                : 8
                : 12
                : e013150
                Affiliations
                [1 ]International Federation of Anthroposophic Medical Associations , Brussels, Belgium
                [2 ]departmentDivision of General Pediatrics , Ringgold_27230Geneva University Hospitals , Geneve, Switzerland
                [3 ]departmentHealth and Family Welfare Department, Government of Delhi , Directorate of Ayush , Delhi, India
                [4 ]World Naturopathic Federation , Toronto, Ontario, Canada
                [5 ]departmentNational Centre for Naturopathic Medicine , Ringgold_4571Southern Cross University , Lismore, New South Wales, Australia
                [6 ]RedePICS Brasil, Brazilian Network of Integrative and Complementary Practices in Healthcare , Belo Horizonte, Brazil
                [7 ]Traditional Complementary and Integrative Medicine Network for the Americas , Bogotá, Colombia
                [8 ]Keny Medical Research Institute , Nairobi, Kenya
                [9 ]EUROCAM , Brussels, Belgium
                [10 ]European Federation of Homeopathic Patients’ Associations , Amsterdam, The Netherlands
                [11 ]Academy of Integrated Health and Medicine , La Jolla, California, USA
                [12 ]Indonesian Public Health Association , Jakarta, Indonesia
                [13 ]departmentDepartment of Public Health , University of Muhammadiyah Surakarta , Jakarta, Indonesia
                [14 ]World Integrated Medicine Forum , London, UK
                [15 ]departmentCenter for Evidence-Based Chinese Medicine , Ringgold_47839Beijing University of Chinese Medicine , Beijing, China
                Author notes
                [Correspondence to ] Dr Tido von Schoen-Angerer; tido.von.schoenangerer@ 123456gmail.com
                Author information
                http://orcid.org/0000-0003-3601-7480
                Article
                bmjgh-2023-013150
                10.1136/bmjgh-2023-013150
                10693890
                38050407
                1aed272a-8fa2-4d14-a421-a61bebc0a980
                © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 15 June 2023
                : 12 November 2023
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                health policy,public health,health systems
                health policy, public health, health systems

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