The Efficacy of a Persian Medicine-Based Dietary Protocol on Hospitalized COVID-19 Patients: A Randomized Controlled Trial

This study aimed to evaluate the effectiveness of a Persian Medicine-based dietary protocol (PM diet) in patients infected with COVID-19. A randomized clinical trial was performed from July 2020 to January 2021 in Tehran, Iran. Eighty patients admitted due to pulmonary dysfunction caused by COVID-19 were randomly allocated into two groups: the PM diet or the common hospital (CH) diet. Eight beds in 2 rooms were considered for each group. Patients were randomly hospitalized in these rooms and received these diets up to discharge or death. Oxygen saturation level and duration of hospitalization, the rate of mortality, duration of fever, and duration of cough were considered as the primary and secondary outcomes, respectively. Oxygen saturation and fever duration were not different between groups (P value= 0.08, 0.312, respectively). But the duration of hospitalization and the duration of cough in the PM diet group were significantly shorter than in the CH diet (P value= 0.002, 0.009, and HR=2.02, 1.86 respectively). The mortality rate was significantly lower in the PM diet group than in the CH diet group (Odds ratio: 0.12, P value=0.026). PM diet caused a lower mortality rate, shorter hospital stay, and better improvement in cough, but did not have a significant effect on O2 saturation and fever. Copyright © 2023 Tehran University of Medical Sciences.

Barriers to the Engagement of Complementary and Integrative Health Providers in Public Health Responses to COVID-19: Recommendations From a Multidisciplinary Expert Panel.

OBJECTIVE: The purpose of this project was to explore barriers to the involvement of complementary and integrative health (CIH) providers in the public health response to COVID-19 and potential solutions for future involvement in public health crises. METHODS: An expert panel of 10 people, which included doctors of chiropractic, naturopathic doctors, public health practitioners, and researchers from the United States, was convened for a day-long online panel discussion. Facilitators asked panelists how CIH practitioners could contribute and be mobilized. We summarized themes and recommendations from the discussion. RESULTS: Despite their skills and resources, few CIH providers participated in public health efforts like testing and contact tracing during the COVID-19 pandemic. Panelists described that CIH professionals may not have participated in those efforts due to the CIH providers possibly not having sufficient public health training and limited contact with public health professionals, as well as policy and financial challenges during the pandemic. Panelists proposed solutions to these barriers, including more public health training, stronger formal relationships between CIH and public health organizations, and improved financial support for both CIH care and public health efforts. CONCLUSION: Through an expert panel discussion, we identified barriers that hindered the involvement of CIH providers in the public health response to the COVID-19 pandemic. During future pandemics in the United States, public health planners should recognize CIH providers as part of the existing labor resource, with clinical expertise and community-level connections that can be called upon in a crisis. During future events, CIH professional leaders should be more proactive in seeking out a supportive role and sharing their knowledge, skills, and expertise.

Performance of Early Warning Scoring Systems Regarding Adverse Events of Unanticipated Clinical Deterioration in Complementary and Alternative Medicine Hospitals.

PURPOSE: This study aims to examine the performance of early warning scoring systems regarding adverse events of unanticipated clinical deterioration in complementary and alternative medicine hospitals. METHODS: A medical record review of 500 patients from 5-year patient data in two traditional Korean medicine hospitals was conducted. Unanticipated clinical deterioration events included unexpected in-hospital mortality, cardiac arrest, and unplanned transfers to acute-care conventional medicine hospitals. Scores of the Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), and National Early Warning Score 2 (NEWS2) were calculated. Their performance was evaluated by calculating areas under the receiver-operating characteristic curve for the event occurrence. Multiple logistic regression analyses were performed to determine the factors associated with event occurrence. RESULTS: The incidence of unanticipated clinical deterioration events was 1.1% (225/21101). The area under the curve of MEWS, NEWS, and NEWS2 was .68, .72, and .72 at 24 hours before the events, respectively. NEWS and NEWS2, with almost the same performance, were superior to MEWS (p = .009). After adjusting for other variables, patients at low-medium risk (OR = 3.28; 95% CI = 1.02-10.55) and those at medium and high risk (OR = 25.03; 95% CI = 2.78-225.46) on NEWS2 scores were more likely to experience unanticipated clinical deterioration than those at low risk. Other factors associated with the event occurrence included frailty risk scores, clinical worry scores, primary medical diagnosis, prescribed medicine administration, acupuncture treatment, and clinical department. CONCLUSIONS: The three early warning scores demonstrated moderate-to-fair performance for clinical deterioration events. NEWS2 can be used for early identification of patients at high risk of deterioration in complementary and alternative medicine hospitals. Additionally, patient, care, and system factors need to be considered to improve patient safety.

Clinical effectiveness of medical ozone therapy in COVID-19: the evidence and gaps map.

Ozone therapy (OT), a medical procedure, has been showing good results during the coronavirus disease (COVID-19). We aimed to build an evidence and gaps map (EGM) of OT in the COVID-19 ranking the articles found according to levels of evidence and outcomes. The EGM brings bubbles of different sizes and different colors according to the articles. The OT intervention used was major or minor autohemotherapy, rectal insufflation and ozonized saline solution. EGM was based on 13 clinical studies using OT for COVID-19 involving a total of 271 patients. We found 30 outcomes related to OT in COVID-19. Our EGM divided the outcomes into six groups: 1-clinical improvement; 2-hospitalization; 3-inflammatory, thromboembolic, infectious, or metabolic markers; 4-radiological aspects, 5-viral infection and 6-adverse events. Major autohemotherapy was present in 19 outcomes, followed by rectal insufflation. Improvement in clinical symptoms of COVID-19, improvement of respiratory function, improvement of oxygen saturation, reduction in hospital internment, decrease in C-reactive protein, decrease in ferritin, decrease in lactate dehydrogenase, decrease in interleukin 6, decrease in D-dimer, radiological improvement of lung lesions and absence of reported adverse events were related in the papers. The most commonly used concentrations of OT in major autohemotherapy and in rectal insufflation were 40 µg/mL and 35 µg/mL, respectively. Here, we bring the first EGM showing the efficacy and safety of OT in the treatment of COVID-19. OT can be used as integrative medical therapy in COVID-19 at a low cost and improve the health conditions of the patients.

Unravelling the truth: Examining the evidence for health-related claims made by naturopathic influencers on social media - a retrospective analysis.

Background: Social media platforms are frequently used by the general public to access health information, including information relating to complementary and alternative medicine (CAM). The aim of this study was to measure how often naturopathic influencers make evidence-informed recommendations on Instagram, and to examine associations between the level of evidence available or presented, and user engagement. Methods: A retrospective observational study using quantitative content analysis on health-related claims made by naturopathic influencers with 30000 or more followers on Instagram was conducted. Linear regression was used to measure the association between health-related posts and the number of Likes, and Comments. Results: A total of 494 health claims were extracted from eight Instagram accounts, of which 242 (49.0%) were supported by evidence and 34 (6.9%) included a link to evidence supporting the claim. Three naturopathic influencers did not provide any evidence to support the health claims they made on Instagram. Posts with links to evidence had fewer Likes (B=-1343.9, 95% CI=-2424.4 to -263.4, X=-0.1, P=0.02) and fewer Comments (B=-82.0, 95% CI=-145.9 to -18.2, X=-0.2, P=0.01), compared to posts without links to evidence. The most common areas of health were claims relating to 'women's health' (n=94; 19.0%), and 'hair, nail and skin' (n=74; 15.0%). Conclusion: This study is one of the first to look at the evidence available to support health-related claims by naturopathic influencers on Instagram. Our findings indicate that around half of Instagram posts from popular naturopathic influencers with health claims are supported by high-quality evidence.

The use of complementary and traditional medicine for the treatment of patients with COVID-19: A systematic review.

OBJECTIVE: The aim of this study was to evaluate the use and effectiveness of non-pharmacological therapies as part of the treatment of COVID-19 and its complications, either combined or not with the usual treatment. METHODS: A systematic review was conducted between August and October 2021 using PubMed, Scopus, CINAHL and Web of Science databases. From a total of 204 articles identified, 33 were included in the final sample (15 clinical trials and 18 quasi-experimental studies). The methodological evaluation was carried out using STROBE and CONSORT guidelines. RESULTS: There is a growing literature on the use of CAM for COVID-19. Most studies have shown positive findings, particularly for the use of TCM, other herbal therapies and acupuncture. Nevertheless, most studies were carried out in Asia and relied on quasi-experimental designs. The current evidence is available for physical outcomes (mortality rate, pneumonia resolution and other symptoms, negative PCR test, and hospitalization and ICU admissions) and for mental health outcomes. CONCLUSION: Despite a positive role of CAM on COVID-19 outcomes, the evidence is still mostly based on quasi-experimental studies. More robust clinical trials are needed in order to generate better evidence in this area.

AYUSH (Indian System of Medicines) Therapeutics for COVID-19: A Living Systematic Review and Meta-Analysis (First Update).

Background: In India, alternative and complementary therapies (Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy [AYUSH] medicines) are extensively utilized in COVID-19 management, and some were investigated clinically. This study assessed the effectiveness of AYUSH therapeutic on COVID-19 through a living systematic review and meta-analysis approach. Methods: Databases like PubMed; the Cochrane central register of controlled trials; WHO COVID-19 database; the central trial registry-India; Digital Helpline for Ayurveda Research Articles and AYUSH research portal, and preprint repositories were searched till August 1, 2021. Randomized controlled trials or analytical observational studies were included only. Primary outcomes selected were clinical improvement, WHO ordinal scale, viral clearance, and mortality, whereas secondary outcomes were the use of O2 therapy or mechanical ventilator, admission to high dependency unit or emergency unit, duration of hospitalization, the time to symptom resolution, and adverse events. The risk of bias was evaluated by Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB-2) and Risk of Bias in Nonrandomized Studies-of Interventions (ROBINS-I) tools; data were synthesized through RevMan 5.4 tool, and the certainty of the evidence was ranked through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: Of 3609 studies retrieved, 17 were included in the systematic review, and 3 AYUSH therapeutics were meta-analyzed. Meta-analysis suggested that add-on AYUSH-64 likely provides therapeutic benefits by reducing time to symptom resolution (mean difference [MD] 2.35 days lower [95% confidence interval, CI; 4.05 lower to 0.65 lower]) and hastening clinical improvement (365 more per 1000 [95% CI; 4 more to 1000 more]) in mild-to-moderate COVID-19 patients. Kabasura Kudineer adjuvant to standard care is likely to reduce symptom resolution (MD; 1.93 days lower [95% CI; 2.28 lower to 1.58 lower]) and hospital stay (MD; 4.2 days lower [95% CI; 4.97 lower to 3.43 lower]) in mild-to-moderate COVID-19 patients. Co-administration of Guduchi (Tinospora cordifolia [Willd.] Miers.) to standard care may reduce the duration of hospitalization (MD; 3.93 days, lower [95% CI; 8.83 lower to 0.97 higher]) in mild-to-moderate COVID-19 patients. Furthermore, all three agents seemed safe in adjunct usage to standard care. The certainty of evidence for most outcomes was moderate to low, primarily due to the high risk of bias or imprecision owing to the small sample size. Conclusion: Rational use of integrated or standalone AYUSH interventions in mild-to-moderate COVID-19 patients is safe and may provide therapeutic benefits. The effect estimates may be changed with additional evidence in upcoming updates.

Nurses' Use of Holistic, Complementary and Alternative Medicine Methods Against COVID-19 Anxiety

Context • Health professionals have been experiencing physical and mental fatigue, affective disorders, and sleep problems due to the stress experienced during the COVID-19 pandemic. As in most outbreaks and pandemics, nurses are at the forefront of the fight against the coronavirus and have experienced high anxiety levels. People can resort to many methods of coping with stressful situations, including complementary and alternative medicine (CAM). Objective • The study intended to assess nurses' anxiety levels about COVID-19 during the peak period of its second wave in Turkey and to examine the methods that they used to cope with that anxiety as well as their attitudes toward CAM. Design • The research team designed a descriptive and cross-sectional study Setting • The study was conducted in a training and research hospital in the Aegean region of Turkey between February 2021 and May 2021, during the second wave of the COVID-19 pandemic. Participants • Participants were 168 nurses working in the hospital. Outcome Measures • Data were collected with the Sociodemographic Information Form, Coronavirus Anxiety Scale (CAS), and Holistic Complementary and Alternative Health Questionnaire (HCAMQ), which has two subdimensions, CAM and Holistic Health (HH). Results • A significant relationship was found between the unit where the nurses worked and their scores on the CAM subdimension (P < .037). A significant relationship was also found between the nurses' anxiety about the COVID-19 epidemic and the scores on the holistic health (HH) subdimension (P < .001) and the HCAMQ (P < .016). To cope with anxiety, the nurses who experienced anxiety used the following complementary methods: (1) saying prayers and worshipping (56.6%), (2) taking hot and cold showers (54.6%), and (3) drinking herbal teas and infusions (49.3%). A weak correlation was found between the CAS, CAM, and HCAMQ scores (P < .05). Conclusions • The current study found that it could be beneficial for nurses to apply complementary methods to reduce their anxiety, because it's not known how long the COVID-19 pandemic will continue. In line with these results, it's extremely important to determine the psychological symptoms and to determine the priorities for solving these problems in nurses. Therefore, it's recommended that nurses should identify their anxieties about COVID-19 and that they should use complementary methods to manage their anxieties. © 2023, InnoVision Communications. All rights reserved.

Exploring Young Adults' Perspectives of Participation in a Mindfulness-Based Music Therapy Intervention Before and During the COVID-19 Pandemic.

Purpose: To explore adolescent and young adults' (AYAs) experiences with participation in a mindfulness-based music therapy intervention during cancer treatment before and during the COVID-19 pandemic. Methods: Sixteen young adults (20-39 years old) who received cancer treatment and participated in a mindfulness-based music therapy intervention for anxiety and stress were interviewed using a semistructured interview guide. Interviews were audio recorded and transcribed verbatim. The interview guide contained prompts about reasons for joining the study, usual coping strategies, experience with the in-person and virtual delivery formats of the intervention, and suggestions for improvement. Themes were derived from the data using inductive content analysis methods. Results: Findings from the interviews included the following: (1) virtual group participants reported difficulty finding a private place to attend the intervention sessions, (2) participants experienced a sense of relaxation in response to intervention participation, (3) in-person group participants felt a sense of connection to the music and their family members who were present during the intervention, while virtual group participants felt a sense of connection to mindfulness, (4) virtual group participants reported that practicing music and mindfulness together was synergistic, and (5) in-person intervention delivery was preferred to virtual intervention delivery. Conclusion: This study provides insight into the contextual factors that impact satisfaction with the intervention and the effect of the intervention on anxiety and stress. Overall, while virtual mindfulness-based music therapy delivery may be more feasible, there are still important advantages to in-person delivery that should be considered in the design of future mindfulness-based music therapy interventions. ClinicalTrials.gov Identifier: NCT03709225.

Repercussions experienced by health professionals working with Integrative and Complementary Practices during the pandemic / Repercussões vivenciadas por profissionais de saúde atendidos com Práticas Integrativas e Complementares durante a pandemia

RESUMO Objetivo analisar as repercussões vivenciadas por profissionais de saúde que foram atendidos com a utilização de práticas integrativas e complementares durante a pandemia da COVID-19. Métodos estudo qualitativo cujos dados foram coletados por meio de entrevistas, as quais foram transcritas e submetidas a análise de conteúdo temática. Resultados participaram 12 profissionais de saúde do sexo feminino que apontaram a importância da inclusão das práticas integrativas e complementares no fortalecimento do bem-estar dos profissionais de saúde no Sistema Único de Saúde e a relevância da oferta destes atendimentos no cenário pandêmico, pois as ajudou no enfrentamento do estresse, insônia, cansaço mental e ansiedade. Emergiram duas categorias: Sensação de valorização, acolhimento, reconhecimento e cuidado e Repercussões na saúde emocional e física das trabalhadoras. Conclusão os dados demonstraram as repercussões positivas das Práticas Integrativas e Complementares desenvolvidas pelos profissionais de saúde, demonstrando a potencialidade dessas práticas na promoção da saúde mental. Contribuições para a prática a implementação de ações com o uso das Práticas Integrativas e Complementares pelos gestores se constitui em forma de cuidado pelo profissional de saúde no Sistema Único de Saúde, pois estas resultam em qualidade de vida, promoção e restabelecimento da saúde física e mental dos indivíduos atendidos.

ABSTRACT Objective to analyze the repercussions experienced by health professionals who were assisted with the use of integrative and complementary practices during the pandemic of COVID-19. Methods qualitative study whose data were collected through interviews, which were transcribed and submitted to thematic content analysis. Results 12 female health professionals participated and pointed out the importance of the inclusion of integrative and complementary practices in strengthening the well-being of health professionals in the Unified Health System and the relevance of offering these services in the pandemic scenario, as it helped them face stress, insomnia, mental fatigue, and anxiety. Two categories emerged: Sensation of valorization, welcoming, recognition and care, and Repercussions on the emotional and physical health of the workers. Conclusion the data showed the positive repercussions of Integrative and Complementary Practices developed by health professionals, demonstrating the potentiality of these practices in promoting mental health. Contributions to practice the implementation of actions with the use of Integrative and Complementary Practices by managers constitutes a form of care by health professionals in the Unified Health System, as these result in quality of life, promotion, and restoration of physical and mental health of the individuals assisted.

Complementary Medicine Claims And COVID-19: A Narrative Review

Background: Coronavirus 2019 (COVID-19) has been at the center of researchers' attention from the beginning of the pandemic due to its global prevalence, and researchers have been conducting many studies and tried a variety of medicinal approaches to combat this pandemic. They aim to find a way to prevent or treat the condition. Every day brings fresh debates and developments, and social media abound with discussions and remarks associated with this global health challenge. Profiteers, on the other hand, promote false information among the public about the treatment of COVID-19 disease despite their limited scientific information and expertise. Several pharmaceutical companies commercialized their herbal-based products during the COVID-19 pandemic. Traditional medicine is mainly rooted in Iranian, Chinese, and Indian traditional medicine, acupuncture, and aromatherapy. A vast amount of information and treatment tactics has been spreading based on the theories in this field. However, in some cases, not only do these have no effect on disease treatment, but they can also have additional negative effects on the person's health and spread viruses even further. Therefore, more scientific studies are needed on the effects of traditional and alternative medicine on the prevention and treatment of COVID-19. Studies performed in this regard have drawbacks, such as a lack of a control group, quality evidence, randomization, and blinding methods, as well as imprecise assessment indicators, and long-term follow-up period. A few of these claims and treatment approaches are discussed in the present study.

Safety and use of complementary and alternative medicine in Norway during the first wave of the COVID-19 pandemic using an adapted version of the I-CAM-Q; a cross-sectional survey.

BACKGROUND: The COVID-19 pandemic lockdown has had a profound impact on physical and mental well-being throughout the world. Previous studies have revealed that complementary and alternative medicine (CAM) is frequently used for, and can be potential beneficial for strengthening physical mental resilience. The aims of this study were therefore to determine the prevalence and reasons for use of CAM during the first wave of the COVID-19 pandemic among a representative sample of the Norwegian population, and further determine self-reported effects and adverse effects of the CAM modalities used. METHODS: Computer assisted telephone interviews using a COVID-adapted I-CAM-Q questionnaire were conducted with 1008 randomly selected Norwegians aged 16 and above using multistage sampling during April and May 2020 applying age and sex quotas for each area. Frequencies, Pearson's chi-square tests, Fisher exact tests, and independent sample t-test were used to identify the users of CAM, what they used, why they used it and whether they experienced effect and/or adverse effects of the modalities used, and further to describe differences in sociodemographic factors associated with CAM use. Cronbach's alpha tests were used to test for internal consistency in the different groups of CAM. Significance level was set to p < 0.05. RESULTS: The study revealed that two thirds of the respondents (67%) had used CAM within the first 3 months of the COVID-19 pandemic, in particular CAM modalities that did not involve a provider. Most used were natural remedies and dietary supplement (57%, mainly vitamins and minerals), but self-help practices like yoga and meditation were also widely used (24%). Women used CAM modalities significantly more than men (77% vs. 58%). Most of the respondents found the modalities they used beneficial, and few reported adverse effects of the treatments. CONCLUSIONS: A large proportion of the Norwegian population used CAM during the first wave of the COVID-19 pandemic with high satisfaction and few reported adverse effects. CAM was rarely used to prevent or treat COVID-19, but rather to treat a long-term health condition, and to improve well-being.

A narrative review on yoga: a potential intervention for augmenting immunomodulation and mental health in COVID-19.

BACKGROUND: The ongoing novel coronavirus disease 2019 (COVID-19) pandemic has a significant mortality rate of 3-5%. The principal causes of multiorgan failure and death are cytokine release syndrome and immune dysfunction. Stress, anxiety, and depression has been aggravated by the pandemic and its resultant restrictions in day-to-day life which may contribute to immune dysregulation. Thus, immunity strengthening and the prevention of cytokine release syndrome are important for preventing and minimizing mortality in COVID-19 patients. However, despite a few specific remedies that now exist for the SARS-CoV-2virus, the principal modes of prevention include vaccination, masking, and holistic healing methods, such as yoga. Currently, extensive research is being conducted to better understand the neuroendocrinoimmunological mechanisms by which yoga alleviates stress and inflammation. This review article explores the anti-inflammatory and immune-modulating potentials of yoga, along with its role in reducing risk for immune dysfunction and impaired mental health. METHODS: We conducted this narrative review from published literature in MEDLINE, EMBASE, COCHRANE databases. Screening was performed for titles and abstracts by two independent review authors; potentially eligible citations were retrieved for full-text review. References of included articles and articles of major non-indexed peer reviewed journals were searched for relevance by two independent review authors. A third review author checked the excluded records. All disagreements were resolved through discussion amongst review authors or through adjudication by a fourth review author. Abstracts, editorials, conference proceedings and clinical trial registrations were excluded. OBSERVATIONS: Yoga is a nonpharmacological, cost-effective, and safe intervention associated with several health benefits. Originating in ancient India, this vast discipline consists of postures (asanas), breathing techniques (pranayama), meditation (dhyana/dharana), and relaxation. Studies have demonstrated yoga's ability to bolster innate immunity and to inhibit cytokine release syndrome. As an intervention, yoga has been shown to improve mental health, as it alleviates anxiety, depression, and stress and enhances mindfulness, self-control, and self-regulation. Yoga has been correlated with numerous cardioprotective effects, which also may play a role in COVID-19 by preventing lung and cardiac injury. CONCLUSION AND RELEVANCE: This review paves the path for further research on yoga as a potential intervention for enhancing innate immunity and mental health and thus its role in prevention and adjunctive treatment in COVID-19.

Remote Delivery of Yoga Interventions Through Technology: Scoping Review.

BACKGROUND: The popularity of yoga and the understanding of its potential health benefits have recently increased. Unfortunately, not everyone can easily engage in in-person yoga classes. Over the past decade, the use of remotely delivered yoga has increased in real-world applications. However, the state of the related scientific literature is unclear. OBJECTIVE: This scoping review aimed to identify gaps in the literature related to the remote delivery of yoga interventions, including gaps related to the populations studied, the yoga intervention characteristics (delivery methods and intervention components implemented), the safety and feasibility of the interventions, and the preliminary efficacy of the interventions. METHODS: This scoping review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Item for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Scientific databases were searched throughout April 2021 for experimental studies involving yoga delivered through technology. Eligibility was assessed through abstract and title screening and a subsequent full-article review. The included articles were appraised for quality, and data were extracted from each article. RESULTS: A total of 12 studies of weak to moderate quality were included. Populations varied in physical and mental health status. Of the 12 studies, 10 (83%) implemented asynchronous delivery methods (via prerecorded material), 1 (8%) implemented synchronous delivery methods (through videoconferencing), and 1 (8%) did not clearly describe the delivery method. Yoga interventions were heterogeneous in style and prescribed dose but primarily included yoga intervention components of postures, breathing, and relaxation and meditation. Owing to the heterogeneous nature of the included studies, conclusive findings regarding the preliminary efficacy of the interventions could not be ascertained. CONCLUSIONS: Several gaps in the literature were identified. Overall, this review showed that more attention needs to be paid to yoga intervention delivery methods while designing studies and developing interventions. Decisions regarding delivery methods should be justified and not made arbitrarily. Studies of high methodological rigor and robust reporting are needed.

The effect of laughter therapy on nursing students' anxiety, satisfaction with life, and psychological well-being during the COVID-19 pandemic: Randomized controlled study.

Background: Changes in routine due to the pandemic have increased nursing students' anxiety about clinical learning. The inadequacy experienced before graduation caused them to experience high levels of anxiety characterized by feelings of insecurity and unhappiness and negatively affected their life satisfaction. Methodological studies are needed to confirm the efficacy of laughter therapy, which is effective in reducing anxiety and stress, on the online platform. The current study protocol was designed to evaluate the effect of online laughter therapy on anxiety, life satisfaction, and psychological well-being. Methods: Forty students were selected for the intervention group and forty students for the control group by assigning 1:1 with a real random number selector among 140 senior nursing students who made up the universe. The intervention group received ten sessions of online laughter therapy two days a week for five weeks. Participants in the control group did not receive any intervention during the study. Data were obtained at the beginning of the study and after five weeks with the 'State-Trait Anxiety Inventory', 'Satisfaction with Life Scale' and 'Psychological Well-Being Scale'. Results: After laughter therapy, the intervention result showed a significant increase in life satisfaction and psychological well-being scores (p < 0.001) and a significant decrease in anxiety scores (p < 0.001) in the intervention group compared to the control group. Conclusion: The study reveals that online laughter therapy significantly positively affects nursing students' anxiety, life satisfaction, and psychological well-being.

Acupuncture in Multidisciplinary Treatment for Post-COVID-19 Syndrome.

Background: Post-COVID syndrome (PCS) is a complex, multisystem illness that may follow SARS-CoV-2/COVID-19 infection. As there is limited evidence for individual therapies and no singular treatment for PCS, guidelines endorse a multidisciplinary approach. This is a case report of a patient with PCS benefiting from a comprehensive approach including acupuncture with symptom-titrated physical activity (STPA). Case: A 50-year-old woman presented from a Long-COVID Clinic referral to an outpatient hospital-affiliated acupuncturist. She had 8 months of fatigue, anosmia, chest pressure, palpitations, and other symptoms following mild assay-confirmed COVID-19. Prior/concurrent medical testing revealed multisystem-inflammatory involvement (pericardial effusion, thyroid dysfunction, and elevated d-dimers). Cardiology/pulmonology cleared the patient for exercise to tolerance considering that serious pathology was absent. The acupuncturist's Traditional Chinese Medicine impression was of Qi Deficiency of the Heart, Lung, Spleen, and Kidney. This patient received 7 sessions of scalp, auricular, and body acupuncture. Physical-therapist (PT)-led STPA began 1-week post-acupuncture, involving 6 30-minute exercise sessions while monitoring her heart rate, with as-needed rest. Results: The patient's chest pressure and palpitations resolved after 1 acupuncture treatment. With 6 additional treatments, spanning 9 weeks, overlapping with PT-led SPTA, she recovered completely and resumed her normal exercise. Conclusions: Acupuncture appeared to facilitate PCS recovery. However, the independent effects of acupuncture are less clear, given the concurrent STPA/exercise therapy, and should be explored using large study designs. Acupuncture is an attractive potential PCS therapy, considering its holistic approach and that it may be added to a multidisciplinary, guideline-concordant regimen.

The Use of Complementary Alternative Medicine in HIV-infected Patients during COVID-19 Pandemic: Its Related Factors and Drug Interactions with Antiretroviral Therapy

BACKGROUND: The use of complementary and alternative medicine (CAM) is widespread among patients with chronic disease despite lack of supporting evidence for most CAM types. Concerned regarding higher risk of COVID-19 for HIV-infected patients, probably increase the use of CAM during COVID-19 pandemic in this population. This study aimed to assess the prevalence and factors related to CAM use among HIV-infected patients during COVID-19 pandemic, then identify drug- to-drug interaction (DDI) of antiretroviral (ARV) drugs with CAM that they used. METHODS: The study was conducted in HIV Clinic Cipto Mangunkusumo Hospital in September-October 2021, specifically targeting adults HIV-infected patients routinely using ARV. Demographic and clinical data, including COVID-19 and vaccine history, were taken from clinic survey and hospital medical records data. RESULTS: 554 of 1275 patients (43.5%) reported using any type of ingested CAM during COVID-19 pandemic, mostly vitamins and/or minerals. Factors related to CAM use were history of COVID-19 infection (aOR 2.28;95% CI 1.65-3.14) and 2-5 years ARV duration compared to more than 10 years (aOR 1.4;95% CI 1.02-1.91). Five known potential interactions involving 20 patients and two potential weak interactions involving 8 patients were found, but many of other interactions categorized as unknown. Only limited number of patients (3.8%) were aware about the drug interaction between ARV and CAM that they used. CONCLUSION: CAM was commonly used by HIV-infected patients on ARV during the COVID-19 pandemics, but patient awareness related to CAM-ARV drug interactions was exteremely low.

Consultations with health care providers and use of self-management strategies for prevention and treatment of COVID-19 related symptoms. A population based cross-sectional study in Norway, Sweden and the Netherlands.

OBJECTIVES: The present study was initiated to determine consultations with health care providers and use of self-management strategies for prevention or treatment of COVID-19 related symptoms in countries with a full lockdown (Norway), a partial lockdown (the Netherlands) and no lockdown (Sweden) during the first three months of the COVID-19 pandemic, and if such use correlates with worries of being infected by COVID-19 disease. DESIGN: Data were collected in collaboration with Ipsos A/S in April-June 2020. An adapted version of the International Questionnaire to measure use of Complementary and Alternative Medicine (I-CAM-Q) was used with the categories "for prevention of COVID-19" and "to treat COVID-19-related symptoms" added. Data were collected among a representative sample in Norway, Sweden and the Netherlands using data assisted telephone interviews (Norway, n=990 and Sweden, n=500), and an online survey (the Netherlands, n=1004). Total response rate was 30%. RESULTS: Very few consulted a health care provider with the intention to treat or prevent COVID-19 (1.2% and 1.0% respectively) with medical doctors mostly visited (1.0% and 0.9% respectively). Similarly, the use of self-management strategies to prevent or treat COVID-19 was low (3.4% and 0.2% respectively); most commonly used for prevention of COVID-19 were vitamins and minerals (2.8%). Consultations with health care providers and use of self-management strategies for prevention of COVID-19 were positively associated with worries of being infected with COVID-19. CONCLUSIONS: The COVID-19 pandemic does not seem to have evoked a large-scale difference in behavior related to consultations with health care providers or the use of self-management strategies in any of the three countries.

A naturopathic treatment approach for mild and moderate COVID-19: A retrospective chart review.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has led to significant morbidity and mortality. Although COVID-19 vaccination is available, therapeutic options are still needed. The goal of the present manuscript is to report on a treatment strategy used in a naturopathic medical practice for mild and moderate COVID-19. DESIGN: A retrospective chart review was conducted of 30 consecutive patients diagnosed with mild and moderate COVID-19 who were provided multi-nutrient, herbal, and probiotic treatment in a rural, out-patient, naturopathic primary care setting. MAIN OUTCOMES MEASURES: The primary outcome was treatment safety; secondary outcomes included changes in symptoms, progression to severe COVID-19, incidence of long COVID, and recovery time. RESULTS: No side effects or adverse events were reported from treatment and all patients experienced resolution of symptoms presumed to be associated with COVID-19 infection. One patient who had been ill for 28 days prior to presentation was hospitalized. Five patients had an illness duration of more than one month. Time to treatment was correlated with duration of illness post-treatment (r = 0.63, p < 0.001) and more symptoms at presentation was correlated with a longer duration of illness (r = 0.52, p < 0.01). CONCLUSIONS: In this retrospective chart review, a multi-nutrient, herbal, and probiotic therapeutic approach for mild and moderate COVID-19 appeared to be well-tolerated. Delay in seeking treatment after symptom onset, as well as more symptoms at presentation, were correlated with a longer duration of illness. This treatment strategy may have clinical benefit, warranting prospective clinical trials with confirmed COVID-19 cases.