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PubMedDate not supplied

Clinical practice guidelines in complementary and alternative medicine. An analysis of opportunities and obstacles. Practice and Policy Guidelines Panel, National Institutes of Health Office of Alternative Medicine.

An estimated 1 of 3 Americans uses some form of complementary and alternative medicine (CAM), such as acupuncture, homeopathy, or herbal medicine. In 1995, the National Institutes of Health Office of Alternative Medicine convened an expert panel to examine the role of clinical practice guidelines in CAM. The panel concluded that CAM practices currently are unsuitable for the development of evidence-based practice guidelines, in part because of the lack of relevant outcomes data from well-designed clinical trials. Moreover, the notions of standardization and appropriateness, inherent in guideline development, face challenging methodologic problems when applied to CAM, which considers many different treatment practices appropriate and encourages highly individualized care. Due to different belief systems and divergent theories about the nature of health and illness, CAM disciplines have fundamental differences in how they define target conditions, causes of disease, interventions, and outcome measures of effectiveness. These differences are even more striking when compared with those used by Western medicine. The panel made a series of recommendations on strategies to strengthen the evidence base for future guideline development in CAM and to meet better the current information needs of clinicians, patients, and guideline developers who seek information about CAM treatments.

Complementary Therapies↗
PubMed1998

Improving safety for teens working in the retail trade sector: opportunities and obstacles.

BACKGROUND: Using both quantitative and qualitative data, this study examined teen workers' perceptions about their work environments and the ways in which teens believe workplaces can be made safer. METHODS: We conducted telephone interviews (n = 117) and six focus groups (n = 49) with two separate samples of North Carolina teens who worked in the retail trade sector. RESULTS: Survey findings indicate one-fifth of teens used equipment they thought dangerous; nearly 40% always or often felt rushed at work; and about half received training on how to avoid injury. Teens in the focus groups expressed concerns about workplace physical hazards, the threat of assault, being rushed, and having little power in the work environment. They also indicated that their workplace safety training was ineffective and that child labor laws were unnecessary. CONCLUSIONS: In order to be effective, interventions targeted at working teens need to address the organization of work and adolescent-manager interaction patterns.

Accidents, Occupational↗
PubMedDate not supplied

Preconception care of women with diabetes: the unrevealed obstacles.

In spite of the widely accepted knowledge that elevated blood glucose levels in early pregnancy are associated with a significantly increased risk of birth defects in infants of women with established diabetes, the majority of diabetic women do not plan their pregnancies and enter pregnancy with inadequate blood glucose control. This article reviews the current research on circumstances and factors associated with unplanned diabetic pregnancies and offers recommendations to encourage effective pregnancy planning and preconception care among women with diabetes.

Congenital Abnormalities↗