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PubMed2005

The Herdecke Questionnaire on Quality of Life (HLQ): validation of factorial structure and development of a short form within a naturopathy treated in-patient collective.

BACKGROUND: Quality of life (QoL) of patients has become a central evaluation parameter that also acts as an aid for decisions related to treatment strategies particularly for patients with chronic illnesses. In Germany, one of the newer instruments attempting to measure distinct QoL aspects is the "Herdecke Questionnaire for Quality of Life" (HLQ). In this study, we aimed to validate the HLQ with respect to its factorial structure, and to develop a short form. The validation has been carried out in relation to other questionnaires including the SF-36 Health Survey, the Mood-Scale Bf-S, the Giessen Physical Complaints Questionnaire GBB-24 and McGill's Pain Perception Scale SES. METHODS: Data for this study derived from a model project on the treatment of patients using naturopathy methods in Blankenstein Hospital, Hattingen. In total, 2,461 patients between the ages of 16 and 92 years (mean age: 58.0 +/- 13.4 years) were included in this study. Most of the patients (62%) suffered from rheumatic diseases. Factorial validation of the HLQ, it's reliability and external consistency analysis and the development of a short form were carried out using the SPSS software. RESULTS: Structural analysis of the HLQ-items pointed to a 6-factor model. The internal consistency of both the long and the short version is excellent (Cronbach's alpha is 0.935 for the HLQ-L and 0.862 for the HLQ-S). The highest reliability in the HLQ-L was obtained for the "Initiative Power and Interest" scale, the lowest for the 2-item scales "Digestive Well-Being" and the "Physical Complaints". However, the scales found by factor analysis herein were only in part congruent with the original 5-scale model which was approved a multitrait analysis approach. The new instrument shows good correlations with several scales of other relevant QoL instruments. The scales "Initiative Power and Interest", "Social Interaction", "Mental Balance", "Motility", "Physical Complaints", "Digestive Well-Being" sufficiently differentiate the diagnostic groups, particularly between the patients suffering on connective tissue and soft tissue disorders from those with metabolic and nutritional disorders or hypersensitivity reactions. CONCLUSION: Both the factorial validation and the development of a consistent short-form of the HLQ are important steps forward for researchers in the field of QoL who wish to use the HLQ as a reliable and valid instrument. The results indicate that the HLQ is a unique QoL-instrument that can be used for both in-patient and out-patient-treatment. However, to improve to profile of the HLQ, there is still the need for strengthening the Questionnaire in the dimensions of physical well-being. This is the subject of a separate ongoing study.

Adolescent↗
PubMed2001

The sociopolitical status of U.S. naturopathy at the dawn of the 21st century.

Naturopathic medicine in the United States had its inception around the turn of the 20th century. Subsequently, it underwent a process of relatively rapid growth until around the 1930s, followed by a period of gradual decline almost to the point of extinction due to biomedical opposition and the advent of "miracle drugs." Because its therapeutic eclecticism had preadapted it to fit into the holistic health movement that emerged in the 1970s, it was able to undergo a process of organizational rejuvenation during the last two decades of the century. Nevertheless, U.S. naturopathy as a professionalized heterodox medical system faces several dilemmas as it enters the new millennium. These include (1) the fact that it has succeeded in obtaining licensure in only two sections of the country, namely, the Far West and New England; (2) increasing competition from partially professionalized and lay naturopaths, many of whom are graduates of correspondence schools; and (3) the danger of cooptation as many biomedical practitioners adopt natural therapies.

Culture↗
PubMed2000

Homeopathy and naturopathy: practice characteristics and pediatric care.

OBJECTIVE: To describe the practice characteristics and pediatric care of homeopathic practitioners (HPs) and naturopathic doctors (NDs). DESIGN: Cross-sectional, descriptive survey. SETTING: Homeopathic and naturopathic practices in Massachusetts. PARTICIPANTS: Homeopathic practitioners (N = 42) and NDs (N = 23) identified from the yellow pages, regional and national society membership lists, schools, magazine advertisements, and by word-of-mouth. The response rate was 55% (23/42) for HPs and 65% (15/23) for NDs. MAIN OUTCOME MEASURES: Demographics, practice characteristics, fee structure, and amount of pediatric care. Practitioners were asked for their approach to childhood immunizations and to treating a febrile neonate. Data were analyzed using simple descriptive statistics. RESULTS: Almost all respondents were white. Among the HPs, 13 (57%) were licensed medical doctors. Naturopathic doctors and HPs reported having an average of only 25 to 40 patient visits per week, but children and adolescents accounted for up to one third of these visits. Nearly all reported treating children, but fewer than half of the practitioners reported any formal pediatric training. Initial patient visits typically lasted more than 1 hour and cost $140 to $150. Follow-up visits were scheduled every 4 to 6 weeks and lasted more than 30 minutes on average. Insurance covered less than one third of the patient visits, and sliding scale payments were offered by less than half of the respondents. Most practitioners reported that they did not actively recommend immunizations and fewer than half of the nonphysician practitioners reported that they would refer a 2-week-old neonate with a fever to a medical doctor or emergency medical facility. CONCLUSIONS: Many patients using homeopathy and naturopathy are children. Visits to these providers are frequent and fees are primarily paid out-of-pocket. Failure on the part of these providers to recommend immunizations or recognize potentially serious illnesses is cause for concern.

Adult↗
PubMed1992

[Naturopathy as a contribution to cost control. Attempt at a cost analysis].

OBJECTIVE: A data analysis has been performed to investigate to what extent naturopathy may contribute to reducing costs of medical care. METHODS: The study included anonymous data from the second quarter of 1988 obtained from the North-Württemberg Kassenärztlichen Vereinigung (insurance company). Physicians practicing in this area at that time were compared to a similarly large collective of those designated additionally as naturopaths and/or homeopaths. RESULTS: Differences between the two groups were significant with respect to drug costs and disability certificates however not with respect to physician fees.

Cost Control↗
PubMed1991

[Naturopathy and alternative medicine--definition of the concept and delineation].

Naturopathic and biological systems of medicine are defined as disciplines that are not directed straight-away against pathological processes as such; their effect is based on stimulating the body's own resources of healing and regulating the dysfunctions that become manifest as disease, using natural active principles as levers to fight disease. Genuine naturopathic systems have mostly been able to prove their science-based efficacy and can be employed successfully especially in chronic diseases and in the after-treatment of severe disease patterns i.e. within the framework of post-disease treatment or rehabilitation. This is contrasted by methods that have not been scientifically proven or acknowledged, i.e. "fringe" systems based on speculative models of thinking, that could not be proven as being clinically effective. These methods cannot be equated with those of naturopathy. German private sickness insurance companies exclude from payment all methods of examination and treatment that are not scientifically recognised, but the German state-managed sickness insurance system provides for paying a subsidy unless the method in question has been specifically excluded. Attention is drawn to the problems that arise if persons who are entitled to receiving a subsidy take out an additional private insurance to supplement the same.

Complementary Therapies↗
PubMed1991

[Naturopathy--definition, importance in the education of physicians and pharmacists].

Recent legislation on licenses for physicians and pharmacists prescribes the teaching of naturopathic methods. This requires a clear definition of the subject, which is given in different ways, all definitions leading to the same result. The essential effect of naturopathic methods is to activate sick persons, i.e. it is--in the strict sense of these words--rehabilitating and preventive. Patients who were instructed by their physician and other therapists can subsequently apply these methods autonomously. To teach naturopathy and its methods is likely to be a good means to help students to develop a better understanding of causality in medicine which, as a result of recent physical knowledge and theses, has become very complex and difficult to comprehend.

Curriculum↗
PubMed1994

[Expert assessment of naturopathy, alternative treatment methods and homeopathic practitioners].

An expert opinion on genuine naturopathy cures which have widely been integrated into so-called "medical-school" treatment usually presents no problem. Difficulties may arise, however, when evaluating so-called alternative or unconventional methods, as it is typical for these to be based on hypothetical thinking patterns, and more so, as there is no proof of action in the postulated fields of indication that would meet current standards. Here, it is the task of the expert to determine whether the assertions of the appliers of these methods are comprehensible and substantiated and whether the methods may be considered medically indicated for the individual case. The claim of those practicing these methods that they are the only ones capable of judging them must be denied in principle. To determine if there is a medical indication for treatment by a non-medical practitioner in any individual case, the criteria applied should be basically the same as for medical treatment by a physician. Also, according to a judgment by the German Federal Court, a non-medical practitioner using invasive methods must meet the same standards of knowledge and advanced training as any general practitioner working in this field.

Complementary Therapies↗