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This chapter describes pseudoscience and questionable ideas related to substance use disorders and addiction. The chapter opens by discussing diagnostic controversies and myths that influence treatments. Dubious treatments include naturopathy, homeopathy, orthomolecular medicine, acupuncture, energy medicine, hypnosis, chiropractic care, and animal-assisted therapy. The fuzzy boundary between science-based and pseudoscientific approaches is also considered. The chapter closes by reviewing research-supported approaches.
It is important to avoid injuries at all stages of life. Older people are at a relatively higher risk of developing injuries as well as dying from injuries, compared to younger people. Falling is an important cause of death amongst older persons. The risk of hip fracture increases exponentially with age in both men and women. It is reported that 30% of people with a hip fracture will die in the following year. Physical exercise can help by building stronger bones and muscles. Although driving is important for functional independence and development and maintenance of social relationships, older people may develop impaired driving performance and a formal driving evaluation may be advisable. Also, the danger of cumulative and repetitive trauma to the brain has been known for many years and head injuries double the risk of Alzheimer’s. The human brain is not well protected from damages inflicted by physical forces. All injuries to the head are bad, including big ones and repetitive small ones. All forms of head injuries must be avoided throughout life.
The emergency department (ED) is a unique potential location for recruitment into studies of complementary and alternative medicine (CAM) therapies. We sought to determine the stated willingness of ED patients with musculoskeletal complaints to participate in CAM research for their presenting problem, and to determine the characteristics of this population.
Methods:
The study was carried out in the ED of Vancouver General Hospital weekdays between 10 am and 6 pm from Oct. 16, 2000, to Nov. 21, 2000. All adults who presented with musculoskeletal complaints involving the spine, upper extremity or lower extremity, unless they had pain severe enough to impair their ability to answer questions or unless there was a language or other communication barrier, were approached by a research nurse. If it was learned that they had already been assessed by an emergency physician, they were eliminated as potential study participants. After being presented background information by the research nurse, consenting patients were asked a series of standardized questions during a 15-minute private interview prior to their assessment by an emergency physician.
Results:
Of 107 eligible patients, 93 participated (87%). Most symptoms began on the day of presentation (44%) or in the previous week (41%). The mean age of those studied was 38 years, and 56% were male. Most presenting problems involved the ankle/foot (29%), multiple sites (19%), the lumbosacral region (14%) or the wrist/hand (14%). Seventy-six percent of patients had utilized CAM previously during their lives, and 13% were currently using CAM for their presenting problem. The majority of patients stated an informed hypothetical willingness to enroll in a CAM study of the following therapies: traditional Chinese medicine 74% (69/93: 95% confidence interval [CI] 64.1%–82.7%); chiropractic 70% (65/93: 95%CI 59.5%–79.0%); and other CAM therapies 92% (86/93: 95%CI 85.1%–96.9%). Of patients asked, 99% stated they would comply with 4 to 6 weeks of outpatient follow-up, and 70% stated they would participate in a placebo-controlled study. Logistic regression modeling, performed for secondary purposes, indicated that willingness to participate in traditional Chinese medicine or chiropractic research was independent of age, sex, educational status, pain severity or prior exposure to the modality of interest.
Conclusions:
ED patients with musculoskeletal complaints have a high stated willingness to participate in CAM research, even if this involves outpatient follow-up or a placebo-controlled design. ED-based CAM research appears feasible and should be pursued.
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