Use of Topical Complementary and Alternative Medicines (CAM) in Diabetic Septic Foot Disease in Makkah Region, Western of Saudi Arabia, an Exploratory Study

Diabetes is a chronic condition that is significantly impacted daily by environment. At least one in five Saudis, suffer from diabetes. “Diabetes is a pandemic of unprecedented magnitude spiraling out of control” (Boulton). Saudi Arabia ranks the second highest in the Middle East, and is the seventh in the world for the prevalence of diabetes (WHO). Diabetes mellitus (DM) has been found to be related to high mortality, morbidity accompanied by poor general health and lower quality of life. Current Saudi diabetes patients’ behaviors, practices, and beliefs regarding foot health problems such as ulcers, are not well investigated. Diabetic patients frequently utilize natural remedies and Herbs for self-medication as a part of complementary and alternative Medicine. Aim of study: To explore the widespread use of the alternative remedies in the local communities of the Western Saudi Arabia, the drives behind using and to focus on the potential adverse effects following their usage. Method: A descriptive, cross-sectional study of 386 diabetic patients with feet problems in Makkah Region, West of Saudi Arabia during the period April - June 2023. Results: Out of the 531 participants, only 386 participants reported diabetic foot disorder (DFD). Most of the participant were above 65 years of age group (24.61 %). Male (52.08%) more than female (47.92%) in the research group. All of the participants had diabetic foot disorders at least once. The prevalence of complementary and alternative medicines (CAM) use among them was 67.88%, as solitary or in combination with hospital medicines. Honey headed the list followed by myrrh and black seeds. Acquaintances advice (59.54%) was the most reason for using the alternative medicine. 60.30% of Diabetic foot patient complained of adverse effects during CAM remedies use. Conclusion: Consumption of CAM remedies among diabetic patients for Diabetic Foot Disorder (DFD) is common. Honey headed the list followed by myrrh and black seeds. Additional wide-scale research is required to establish their actual efficacy, safety and potential adverse out-comes and to generalize the outcomes.

Attitudes and understanding of complementary and alternative medicine in cancer care:An exploratory study of patients’perspectives in Karachi,Pakistan

Objective:To evaluate the prevalence and types of complementary and alternative medicine(CAM)modalities among patients with cancer in Karachi,Pakistan.Methods:This descriptive cross-sectional study was conducted from March 2021 to December 2021.Five hundred patients with cancer were invited to participate in the study.Electronic databases,namely,Google scholar,Publons,EMBASE,PubMed,Chinese National Knowledge Infrastructure Database,and ResearchGate was used for questionnaire designed.The self-administered survey included questions on demographic characteristics,education level,socio-economic conditions and information about CAM therapies,prevalence,effectiveness,and common CAM modalities.Statistical analysis was conducted using SPSS software version 22.Results:Out of the 500 invited patients,433(86.6%)successfully completed and returned the questionnaires.In contrast to patients who were with younger,highly educated,professionally active,higher income,and had advanced cancer,time since diagnosis,type of treatment,cancer types and family history are significantly associated with CAM use.The results showed that 59.8%of the participants were acquainted with complementary and/or alternative medicine and considered safe owing to its natural ingredients.The prevalence of CAM usage among cancer patients was 40.9%and the most widely used CAM modality was herbal medicine(27.7%)and dietary supplements(28.8%).Patients used CAM as a complementary therapy to improve the morphological parameter(28.2%),strengthen the immune system(6.8%),and to decrease the side effects of conventional treatment(18.1%).Most of the respondents get the information regarding CAM therapy from the electronic media(43.2%)and the family members(48%)rather than healthcare personnel.Conclusions:Participants used CAM modalities along with the conventional health care practices.Further multicentre studies should be conducted to provide information regarding the usage of CAM therapies and their eventual benefits in patients with cancer.

A review of complementary and alternative medicine used in cancer care:challenges and prospects

Cancer is a leading cause of death globally,and most patients with cancers frequently seek for complementary and alternative medicine(CAM)to ameliorate their condition.Some of the available CAM care include:acupuncture,aromatherapy,Ayurvedic medicinal drug,cannabis,chelation remedy,homeopathy,hypnotherapy,massage therapy,naturopathic medication,and conventional Chinese remedy amongst others.Despite the growing use of CAM,the evidence-base for its efficacy and safety is limited.Major challenges confronting the efficient deployment of CAM is lack of standardization and regulation;as well as the demand for more extensive studies to validate their safety and efficacy.Integrative oncology which is the combination of CAM and conventional cancer care is likewise complicated through the potential adverse interactions between CAM options and most cancers drugs.The article serves as a guide for healthcare providers and patients to determine how CAM can be safely integrated into the cancer care paradigm.Taking into account safety concerns,however,more studies need to be conducted to properly evaluate its efficacy.Ultimately,CAM can help cancer patients in achieving greater health and well-being.

Thematic Trends in Complementary and Alternative Medicine Applied in Cancer-Related Symptoms

Purpose： The main goal of this study is to discover the scientific evolution of Cancer-Related Symptoms in Complementary and Alternative Medicine research area, analyzing the articles indexed in the Web of Science database from 1980 to 2013.Design/Methodology/Approach： A co-word science mapping analysis is performed under a longitudinal framework（1980 to 2013）. The documental corpus is divided into two subperiods,1980–2008 and 2009–2013. Thus, the performance and impact rates, and conceptual evolution of the research field are shown.Findings： According to the results, the co-word analysis allows us to identify 12 main thematic areas in this emerging research field： anxiety, survivors and palliative care,meditation, treatment, symptoms and cancer types, postmenopause, cancer pain, low back pain, herbal medicine, children, depression and insomnia, inflammation mediators, and lymphedema. The different research lines are identified according to the main thematic areas,centered fundamentally on anxiety and suffering prevention. The scientific community can use this information to identify where the interest is focused and make decisions in different ways.Research limitation： Several limitations can be addressed： 1） some of the Complementary and Alternative Medicine therapies may not have been included; 2） only the documents indexed in Web of Science are analyzed; and 3） the thematic areas detected could change if another dataset was considered.Practical implications： The results obtained in the present study could be considered as an evidence-based framework in which future studies could be built.Originality/value： Currently, there are no studies that show the thematic evolution of this research area.

Complementary and alternative medicine applications in cancer medicine

Besides conventional medicine,many patients with cancer seek complementary and alternative medicine(CAM)as an additional treatment option.Since the early 1970s,the use of CAM in cancer treatment has expanded worldwide.CAM,as a tempting option,was used by patients with cancer mainly due to easy accessibility.Patients with cancer used CAM to achieve better quality of life or to find a cure.As physicians are mainly unaware of CAM use by patients,doctor-patient communication about CAM use should be brought to a higher level.To identify circumstances in which CAM are preferred,further investigations are needed especially in biologically based therapies.Clinical-based evidence for mind-body therapies have been established,so this type of CAM can be recommended for patients with cancer during chemotherapy.Future studies are necessary to fill the gaps so that CAM users,as well as medical experts,are in position to clearly determine all the benefits and disadvantages of the mentioned therapy.

Usage of complementary and alternative medicine in older adults: prevalence, subtypes and associated factors;a cross-sectional observation

Background:The usage of complementary and alternative medicine(CAM)is common in many healthcare settings worldwide.However,the factors associated with CAM usage in older adults and its relation with mood and cognitive function is under-studied.We used a cross-sectional study to explore the 12-month prevalence of usage of CAM among older adults in Singapore and its associated factors including mental health status.Methods:Using a door-to-door census and questionnaire survey,community dwellers aged 60 or above were voluntarily recruited in the Singapore Longitudinal Aging Study.Demographic information,usage of CAM in past 12 months,life-style,cognitive and depressive status using Mini-Mental Status Examination and Geriatric Depression Scale were collated from each participant.Results:Out of 4985 participants,2692(54%)used some types of CAM.The most common type of CAM was herbal medicine,followed by Qigong and Acupuncture.The usage of CAM was higher in Chinese females and those with higher educational levels.Having a history of chronic diseases was associated with higher prevalence of CAM use.Usage of CAM was also correlated with higher physical and social activities.No correlation was observed between cognitive or depressive status and the use of CAM.Conclusion:These results show a high prevalence of CAM usage among older adults in Singapore,which should be considered by medical practitioners treating this age group.Additionally,despite higher prevalence of suffering from multiple chronic diseases,the lack of association of CAM usage with poorer performance in mood and cognitive assessments suggests a protective role against depression and cognitive decline for CAM practices.

Loranthus europaeus as an Alternative Medicine in Treatment of Acute Cutaneous Lesihmaniasis: Review Article

Loranthus europaeus (LE) is a well-known medical plant that has been used as a folk medicine for long time ago. Recently many different researches have shown that it contains many bioactive compounds like: flavonoids, alkaloids, terpenoides, phenolic acids and others. Cutaneous Leishmaniasisis (CL) is an endemic disease in Iraq since ancient time and now it is running major outbreaks. There are many modalities of treatments but researchers are always seeking for new treatments. Most recently Loranthus europaeus has been tried in treatment of CL in a form of 40% ointment and gives a very encouraging result when compared with other standard treatments.

Effects of COVID-19 fear and anxiety on attitudes towards complementary and alternative medicine use in women with gynecological cancer during the COVID-19 pandemic

Objective:Patients with gynecological cancer commonly use complementary and alternative medicine(CAM)methods to cope with the disease.However,despite the existence of treatment strategies,the effect of fear and anxiety caused by coronavirus disease 2019(COVID-19)pandemic on attitudes about CAM use is unclear.This study was carried out to investigate the effect of fear and anxiety experienced by patients with gynecological cancer during the COVID-19 pandemic on their attitudes towards the use of CAM.Methods:This is a cross-sectional and descriptive study that included 177 women with gynecological cancer;participants were recruited from a social networking site for cancer patients in Turkey between June and December 2021.Data were collected using an online survey that included the Personal Information Form,the Fear of COVID-19 Scale,the Coronavirus Anxiety Scale,and the Attitude Towards Holistic Complementary and Alternative Medicine Scale.Descriptive statistics,t-test,Pearson’s correlation test,and simple linear and multiple regression analyses were performed to analyze the data.Results:During the pandemic,55.4%of the participants reported using CAM methods,but only 22.6%were using CAM before the pandemic.The participants who used CAM during the pandemic also scored higher on the fear of COVID-19 and coronavirus anxiety scales(20.69±5.37 and 13.09±6.29,respectively)compared to the participants who did not use CAM(9.29±2.72 and 6.35±2.06,respectively).Fear of COVID-19 accounted for 52%of the CAM attitude score,while coronavirus anxiety accounted for 15%of the CAM attitude score.Fear of COVID-19 and coronavirus anxiety together accounted for 53%of CAM attitude.Conclusion:Gynecological cancer patients with high levels of COVID-19-related anxiety and fear during the pandemic used CAM more.Given that the psychological effects of the pandemic will continue in the coming years,CAM use should be evaluated as a coping strategy,especially due to the COVID-19-related anxiety and fear experienced by patients with gynecological cancer.While the rational and effective CAM methods should be supported,strategies should be developed to prevent misuse of CAM and its interference in prescribed medical treatments.

Cross-Sectional Survey on Complementary and Alternative Medicine Awareness among Health Care Professionals and Students Using CHBQ Questionnaire in a Balkan Country

Objective： To conduct a study on attitudes, knowledge, and use of complementary and altemative medicine （CAM） therapies in Serbia. Available data about CAM therapies in the region are scarce, opinions lacking from health sector. Balkan region countries had a delay in issuing national policies on CAM therapies. Methods： The questionnaire used was based on previously validated CAM Health Belief Questionnaire （CHBQ）, formulated as 5-item Likert type scale, adjusted for local environment. Health care students and professionals were evaluated. The questionnaire comprehended 10 closed questions on attitudes, knowledge and use of CAM therapies. This survey was conducted in eight cities of Serbia, January 2010-July 2011. A total of 797 participants was included. The second group of participants was 145 healthcare professionals （50 academic staff, 64 clinical staff, 19 pharmacists, 6 other clinical branch specialists and 6 nurses）. Data were collected by an interview. Examinees could acquire maximum of 70 points, 35 representing neutral attitude. Restdts： Students of dentistry （54.65 ± 6.07） were better informed on CAM therapies than medicine students （50.26 ± 7.92）. Pharmacy students （51.16 ± 7.10） accepted low-scientific CAM. Pharmacists scored better than university professors （55.12±6.55 vs. 50.29± 9.50）. Primary health care professionals had better awareness than pharmacists in dispensing pharmacies. Both groups of participants preferred use of vitamins over any other CAM therapy. Conclusion： These pioneering efforts in the region exposed weaknesses in CAM attitudes of current and future health care professionals. Nevertheless, awareness on alternative medicine treatment choices is growing among Balkan prescribers. Supportive legal framework would facilitate dissemination of CAM medical practices.

Complementary and Alternative Medicine:Is It Possible to Be Mainstream?

Complementary and alternative medicine （CAM）, also known as non-conventional medicine, is used to refer to a broad set of health care practices （such as herbal medicine, acupuncture, yoga, Taichi, Qigong, meditation, manual therapies, homeopathic medicine, etc.） that are not part of a country＇s own tradition, or not integrated into its dominant health care system.（1） In fact, CAM is generally used in most developed countries, especially in North America, Europe and Australia, while ＂traditional medicine （TM）＂ is more common instead when referring to Africa, Latin America, South-East Asia, and/or the Western Pacific region.

The knowledge, attitude, practice and predictors of complementary and alternative medicine use among type 2 diabetes mellitus patients in Indonesia

Objective: The prevalence of complementary and alternative medicine(CAM) usage among patients with type 2 diabetes mellitus(T2DM) in Indonesia is high. However, to date, little is known about why Indonesian T2DM patients choose CAM therapies, how their knowledge, attitude and practice(KAP) of CAM affects their choices, or how demographics correlate with patient choices. Therefore, this study aimed to investigate the KAP and predictors of CAM usage in T2DM patients in Indonesia.Methods: This was an observational, cross-sectional study. Patients were interviewed using a questionnaire. Chi-square tests or Fisher’s exact tests were used to compare demographic and clinical data, as well as KAP assessments, between T2DM patients who use and do not use CAM. Multivariate logistic regression analyses were used to investigate predictors of CAM usage.Results: A total of 628 T2DM patients were enrolled in the study. CAM therapies were used by 341 patients(54.3%). The most common therapies were herbs and spiritual healing, used by 100.0% and 68.3% of CAM-using patients, respectively. CAM therapies were frequently recommended by family members(91.5%), and CAM users had significantly more knowledge and more positive attitudes toward CAM therapies than nonusers. Among users, 66% said they would not follow their healthcare providers’ instructions to not use CAM therapies, and 69.5% said they would not disclose their plan to use CAM therapies with their healthcare provider. Neither demographic nor clinical characteristics were associated with CAM use. The factors that best predicted the use of CAM therapies were their availability and low cost(odds ratio [OR] = 4.59;95% confidence interval [CI]: 3.01–7.01), the belief that CAM therapies were safe(OR = 2.04;95% CI: 1.40–2.95), the belief that CAM therapies could help with diabetes control(OR = 1.75;95% CI: 1.15–2.66), and the belief that CAM therapies could help maintain physical health(OR = 1.68;95% CI: 1.13–2.49).Conclusion: CAM therapy users were more knowledgeable and had more positive attitudes toward CAM,but most of them chose not to disclose their CAM use to their healthcare providers. CAM use in Indonesia was associated with its accessibility, affordability, safety and effectivity, but not with any demographic or clinical characteristics. This study provided new evidence and insights for nurses and physicians in Indonesia that will help to design educational programs about the safety and efficacy of CAM therapies.

A Survey of Complementary and Alternative Medicine in Iran

Objective： To survey the use, capability and satisfaction of complementary and alternative medicine （CAM） in comparison with conventional medicine in Iran. Methods： In this national survey, a cross-sectional study was designed, 5,000 people were surveyed to identify predictors of Iranian traditional medicine （ITM） use compared with conventional medicine. Data were collected through a questionnaire that covered three different predictor categories： demographic information, patient＇s viewpoint, and patients＇ experiences. Results： Most of the participants preferred government owned hospitals rather than other places. Praying for one＇s own health was the most frequent and favorable ITM domain （P=0.017） based on patients＇ interests, both in low- （P=0.08） and high- level （P=0.011） educated subjects. Among the participants, 97.8% had previous conventional medicine history due to their chronic diseases Conclusions： Iranianpatients resort to ITM as a choice at the late stage of the disease. Current deficiency in integration of CAM and conventional medicine is in contrast to the increasing demand on patients＇ side. Health care organizers should be facilitating the CAM services by tuition of CAM practitioners and supporting eligible CAM centers for diagnosis and treatment of patients.

Complementary and Alternative Medicine Therapies for Chronic Pain

ABSTRACT Pain afflicts over 50 million people in the US, with 30.7% US adults suffering with chronic pain. Despite advances in therapies, many patients will continue to deal with ongoing symptoms that are not fully addressed by the best conventional medicine has to offer them. The patients frequently turn to therapies outside the usual purview of conventional medicine （herbs, acupuncture, meditation, etc.） called complementary and alternative medicine （CAM）. Academic and governmental groups are also starting to incorporate CAM recommendations into chronic pain management strategies. Thus, for any physician who care for patients with chronic pain, having some familiarity with these therapies--including risks and benefits--will be key to helping guide patients in making evidence-based, well informed decisions about whether or not to use such therapies. On the other hand, if a CAM therapy has evidence of both safety and efficacy then not making it available to a patient who is suffering does not meet the need of the patient. We summarize the current evidence of a wide variety of CAM modalities that have potential for helping patients with chronic pain in this article. The triad of chronic pain symptoms, ready access to information on the internet, and growing patient empowerment suggest that CAM therapies will remain a consistent part of the healthcare of patients dealing with chronic pain.

A Survey of Application of Complementary and Alternative Medicine in Chinese Patients with Parkinson’s Disease: A Pilot Study

Objective:To investigate the prevale nee and spectrum of complementary and alternative medicine(CAM)application and its related-factors in Parkinson's disease(PD)patients in China.Methods:A structured questionnaire regarding the use of CAMs was administered to PD patients by face-to-face interview.Demographic and social variables,clinical characteristics and treatments,and the related factors of PD were also surveyed.Results:Ninety out of 113 patients(79.6%)reported that they had received CAMs treatment,of which 48.6%(55/113)patients had received CAMs treatment for PD.The top 3 kinds of CAMs for PD were Chinese materia medica,rehabilitation exercise,and acupuncture ordinally.The source of information regarding CAMs treatment mainly came from relatives and friends(51.8%,73 cases),followed by physicians(31.9%,45 cases),and medias such as television,newspapers or the internet(16.3%,28 cases).Fifty percent of CAM users reported a good therapeutic efficacy,whereas 39% patients reported that they felt neither better nor worse after the treatment,while 11% patients claimed worsening of symptoms.Multiple correspondence analyses survey found the main factors affecting the selectivity of CAMs ranked in the following order:in come,education,occupati on,habitati on,age at on set,Hoeh n and Yahr staging,PD durati on,and gen der.Conclusion:CAMs,especially Chin ese materia medica,rehabilitation exercise,and acupuncture,are widely used for PD patients in China.

Action Mechanisms of Complementary and Alternative Medicine Therapies for Rheumatoid Arthritis

Rheumatoid arthritis （RA） is characterized as a chronic inflammatory disease in joints and concomitant destruction of cartilage and bone. Cartilage extracellular matrix components, such as type Ⅱ collagen and aggrecan are enzymatically degraded by matrix metalloproteinases （MMPs） and aggrecanases in RA. Currently, treatments targeting cytokines, including anti-tumor necrosis factor （TNF） α antibodies, soluble TNF receptor, anti-interleukin （IL）-6 receptor antibody, and IL-1 receptor antagonist, are widely used for treating RA in addition to anti- inflammatory agents and disease-modifying antirheumatic drugs （DMARDs）, such as methotrexate, but these treatments have some problems, especially in terms of cost and the increased susceptibility of patients to infection in addition to the existence of Iow-responders to these treatments. Therefore, therapeutics that can be safely used for an extended period of time would be preferable. Complementary and alternativemedicines including traditional Chinese medicines （TCM） have been used for the arthritic diseases through the ages. Recently, there are many reports concerning the anti-arthritic action mechanisms of TCM-based herbal formulas and crude herbal extracts or isolated ingredients. These natural herbal medicines are thought to moderately improve RA, but they exert various actions for the treatment of RA. In this review, the current status of the mechanism exploration of natural compounds and TCM-based herbal formulas are summarized, focusing on the protection of cartilage destruction in arthritic diseases including RA and osteoarthritis.

Use of complementary and alternative medicine in pregnant women:A cross-sectional survey in the south of Iran

Objective: The use of traditional medicine and complementary alternative medicine(TM/CAM) derived from herbal remedies or natural supplements is increasing worldwide, but there are limited data on the use of TM/CAM during pregnancy. Iran has various ethnic populations, and the usage of TM/CAM by the different ethnic groups has not been researched. The aim of this study is to understand the use of TM/CAM modalities in pregnant women of different ethnic groups in southern Iran.Methods: This study was conducted in primary health care centers in Khuzestan Province, Iran, from May to August, 2016. A semi-structured valid questionnaire was used to gather information in pregnant women(n = 170).Results: About 46.5% of women in this study used TM/CAM during previous pregnancies. The majority(67%) of study participants were Arab. The Arab population showed increased use of TM/CAM during pregnancy(P = 0.014). Women with complications in former pregnancies had significantly higher incidence rate of TM/CAM use(65.8%) compared to the other group(39.6%)(P = 0.001).Conclusion: Understanding TM/CAM use and the associated factors in different ethnic groups of pregnant women will benefit the evaluation of the proper health policies and mother-infant health programs. This study contributes to the growing literature on TM/CAM, ethnic diversity and pregnant women.

Cancer Complementary and Alternative Medicine Research at the US National Cancer Institute

The United States National Cancer Institute （NCI） supports complementary and alternative medicine （CAM） research which includes different methods and practices （such as nutrition therapies） and other medical systems （such as Chinese medicine）. In recent years, NCI has spent around $120 million each year on various CAM-related research projects on cancer prevention, treatment, symptom/side effect management and epidemiology. The categories of CAM research involved include nutritional therapeutics, pharmacological and biological treatments, mind-body interventions, manipulative and body based methods, alternative medical systems, exercise therapies, spiritual therapies and energy therapies on a range of types of cancer. The NCI Office of Cancer Complementary and Alternative Medicine （OCCAM） supports various intramural and extramural cancer CAM research projects. Examples of these cancer CAM projects are presented and discussed. In addition, OCCAM also supports international research projects.

Research methods in complementary and alternative medicine： an integrative review

The scientific literature presents a modest amount ot evidence m the use or complementary ana al[erna- tire medicine （CAM）. On the other hand, in practice, relevant results are common. The debates among CAM practitioners about the quality and execution of scientific research are important, Therefore, the aim of this review is to gather, synthesize and describe the differentiated methodological models that encompass the complexity of therapeutic interventions. The process of bringing evidence-based medicine into clinical practice in CAM is essential for the growth and strengthening of complementary medicines worldwide.

Evidence-based Practice Method of Integrative Chinese and Western Medicine Based on Literature Retrieval through PICO Question and Complementary and Alternative Medicine Topics

An evidence-based practice method according to literature retrieval through PICO （Patients,Intervention,Comparison,Outcome） questions and complementary and alternative medicine （CAM） topics,which can obtain helpful evidence for guiding clinical practice,was introduced with a practical example in this paper.The knowledge of diseases and Western medicine treatment can be acquired by literature retrieval through PICO question,while searching by CAM topics may provide evidence for Chinese medicine （CM）.Thus the author held that literature retrieval through both PICO question and CAM topics was an ideal evidencebased practice method for integrative Chinese and Western medicine （ICWM）.However,since the standard in CM evidence hierarchy is still under study,the value of the CAM thematic retrieval method remains very limited.In the future,studies on the definition and hierarchy of CM evidences and the herb-drug interaction between Western and Chinese medicine during a combination therapy should be strengthened to improve the status of ICWM evidence-based practice.

Complementary and alternative medicine in pediatrics in Turkey

Background:Complementary and alternative medicine(CAM)is applied both to children and adults widely throughout the world.A previous pan-European survey showed a surprisingly high CAM-use in Turkish children.This review aimed to survey information on the use of CAM in pediatrics in Turkey.Data sources:A narrative,non-systematic review was conducted by melding expert opinions with a thorough and balanced review of available evidence.An unrestricted literature search using the key words,"alternative","complementary","integrative","prevalence"and"pediatric"or"children"and"Turkey"was performed by internet search in March,2012 using PubMed and Google Scholar.Results:CAM use was examined in general pediatrics,pediatric oncology,patients with asthma,and patients with diabetes.A frequency of CAM use was 87%in Turkish pediatric patients,with a mean of 60%.The primary sources of information about CAM are family and friends.Communication with patients/parents and health care professionals showed that most parents do not speak about CAM use with their physicians or nurses.Conclusions:CAM is extensively used in Turkish pediatric patients.This might be due to Turkey's status as a developing country in which a traditional medical system still dominates in comparison to developed countries.Thus,larger studies are required to prove an extensive use of CAM in Turkey,as this review article does not have the capacity for in-depth analysis.Knowledge about CAM and its related topics is essential for physicians and nurses in order to meet the patients'wish for a competent consultation concerning all aspects of a possible therapy.