Volume 22, Issue 3

Fisetin, a flavonol belonging to the flavonoid subclass, is a ubiquitous dietary flavonoid present in fruits and vegetables, including fruit peels, and has proven potential for anticancer activity, especially for lung cancer – a leading cause of cancer-related deaths globally. The current paper provides the most detailed and elaborate list of the various roles of fisetin in experimentally induced lung cancer cells, and these roles include the promotion of apoptosis, inhibition of cell proliferation, migration, and invasion, as well as the regulation of autophagy. Among the molecular targets, some identified pathways, such as PI3K/Akt, MAPK, and NF-κB, that fisetin affects are crucial for tumor formation, so it can be considered a potential chemopreventive agent. Moreover, fisetin improves the effectiveness of conventional treatments as a chemo- and radiosensitizer and minimizes side effects. However, the overall utility of fisetin for clinical use is now somewhat restricted by its poor solubility and short half-life. It is predicted that the future development of nanotechnologies for drug delivery, such as nanoparticle encapsulation, might help solve these difficulties. Further Preclinical and clinical investigations are required to uniformly determine the safety, efficacy, and standard dosage of fisetin for consumption in lung cancer therapy.

Vitiligo, also known as baras in Unani medicine, causes patches of depigmented skin due to the loss of melanocytes. According to ancient Unani scholars, factors like excessive phlegm in the blood and weakened color-controlling power were believed to be the cause. This study dives into the historical insights of luminaries like Majūsī and Hakim Akbar Arzānī, alongside modern medical understanding. It explores the pathophysiology, epidemiology, and clinical features of vitiligo, while also addressing confusing definitions, dietary influences, and demographic patterns. We take a close look at the classification, prognosis, and investigative methods. The aim of this research is to bring together traditional and modern perspectives to fully understand vitiligo, covering its cultural, historical, and scientific aspects. By incorporating epidemiological data, dietary considerations, and insights into the underlying mechanisms, we enhance diagnostic and treatment approaches. In conclusion, this study establishes a cohesive connection between the historical wisdom of Unani medicine and the current scientific discourse on vitiligo. By merging these perspectives, we gain a comprehensive understanding of the condition, enabling a more holistic approach to diagnosis and management. As dermatological research continues to evolve, the integration of traditional and modern insights becomes crucial in effectively addressing complex skin disorders like vitiligo.

Anorexia nervosa (AN) can be a severe psychiatric disorder associated with one of the highest mortality rates among mental health conditions. AN treatment demands a comprehensive, multidisciplinary approach. However, conventional therapies often fall short in addressing the full biopsychosocial complexity of the illness. This narrative review explores the emerging role of complementary medicine (CM) in the management of AN, emphasizing its scientific rationale, clinical applications, and relevance within integrative care models. By synthesizing findings from current literature, the review examines a range of CM interventions, such as functional nutrition, dietary supplementation, phytotherapy, aromatherapy, acupuncture, reflexology, massage therapy, mindfulness meditation, yoga, Qigong, Tai Chi, homeopathy, and Bach Flower Remedies. These modalities aim to restore nutritional equilibrium, improve psychological well-being, enhance body image, reduce stress and anxiety, foster self-regulation, and strengthen the mind-body connection. When used alongside standard treatments, CM may offer a more holistic and individualized approach to care, supporting sustained recovery and reducing relapse risk. Nevertheless, while preliminary evidence is encouraging, further high-quality research is needed to validate the efficacy of these therapies and inform the development of evidence-based integrative treatment protocols for AN.

Breast cancer remains the leading cause of cancer-related death worldwide, underscoring the urgent need for novel therapeutic strategies. Icariin, a prenylated flavonol glycoside derived from Epimedium species, has emerged as a promising multi-targeted agent with potent anticancer activity. Preclinical studies demonstrate that icariin modulates key oncogenic pathways, including PI3K/Akt, MAPK, NF-κB/SIRT6, and AMPK/mTOR to inhibit tumor cell proliferation, induce apoptosis, and regulate autophagy. Moreover, icariin exhibits anti-metastatic effects by suppressing epithelial-to-mesenchymal transition, matrix metalloproteinase activity, and immunomodulatory actions that may enhance antitumor immunity. Despite these encouraging findings, a comprehensive understanding of its molecular mechanisms and translational potential remains limited. Here, we systematically review the latest in vitro and in vivo evidence on icariin’s pharmacological effects in breast cancer models. We highlight advances in nanoformulation approaches to improve their bioavailability and identify critical knowledge gaps. This review aims to guide future research toward optimized delivery systems and well-designed clinical trials by integrating mechanistic insights with formulation science. Ultimately, elucidating the full therapeutic profile of icariin will inform its incorporation into complementary and integrative oncology regimens, potentially improving outcomes for patients with diverse breast cancer subtypes.

Objectives Neurodegeneration continues to drive conditions of progressive cognitive decline from amnesia to severe dementia in different age groups. Despite, the availability of standard drugs, the need for multi-targeted interventions with no side-effects remains to be explored. Hence, this study evaluates the neuroprotective effects of Aframomum melegueta and Aframomum danielli seeds dietary inclusion on neurocognitive decline in scopolamine-administered male rats. Methods Seven groups of experimental rats were studied for 14 days: normal rats (group 1), untreated scopolamine-administered rats (group 2), scopolamine-administered rats treated with donepezil (group 3), scopolamine-administered rats treated with dietary inclusions of 4 and 8 % A. melegueta (groups 4 and 5 respectively), and 4 and 8 % A. danielli (groups 6 and 7 respectively). Rats were trained with Morris water maze, pre-treated with the diets, and administered (I. P) scopolamine (3 mg/kg body weight from days 12–14). Memory functionality was evaluated using the maze test and hippocampal and cortical brain regions were analyzed biochemically. Results Scopolamine administration impaired working memory, evidenced by increased escape latency and activities of neurodegenerative biomarkers in untreated rats. A. melegueta and A. danielli dietary inclusions significantly reduced escape latency, improved working memory, and restored key biomarkers, including acetylcholinesterase, butyrylcholinesterase, monoamine oxidase, and reactive oxygen species. Treated rats also exhibited elevated total thiol levels, and improved anti-inflammatory markers (IL-10). Conclusions Both A. melegueta and A. danielli seeds showed improved neuroprotective effect in the brain of scopolamine-induced amnesia rats highlighting significant intervention against cognition. However, A. melegueta showed greater neuroprotective efficacy.

Objectives Ulcerative colitis, with a complex and poorly understood aetiology, is a chronic inflammatory disease of the colon. Current therapies present many side effects and lack efficiency. This study aimed to assess the healing properties of aqueous and ethanolic extracts from the roots of Dracaena arborea on ulcerative colitis induced in rats. Methods Acetic acid (4 %) was injected (intrarectal) to induce colitis. Prednisolone (20 mg/kg), aqueous (500 mg/kg) and ethanolic (100 mg/kg) extracts were administered orally. Clinical parameters were measured through stool consistency, relative body mass, mass-to-length ratio, macroscopic alterations of the colon, and serum and haematological parameters. Oxidative stress markers (in both serum and tissue) and anti-inflammatory parameters were evaluated. Results The results showed that both extracts significantly reduced diarrhea severity, ulcer scores, and prevented the reduction in the colon mass/length ratio. The aqueous and ethanolic extracts significantly increased red blood cell count and haematocrit percentage, as well significantly reducing white blood cell, lymphocyte, monocyte, and granulocyte counts. Regarding oxidative stress markers, in both serum and tissue, the extracts significantly reduced MDA concentrations while increasing GSH concentrations, SOD and catalase activities. The aqueous and ethanolic extracts also significantly reduced NO concentrations and MPO activity. Only the ethanolic extract significantly inhibited TNF-α, IL-6 and IL-1β production. Additionally, both extracts exhibited reparative effects on intestinal epithelium by activating tissue regeneration mechanisms. Conclusions These findings suggest that D. arborea possessed anti-colitis effects in acetic acid-induced ulcerative colitis in rats.

Objectives The incidence of cancer, a second leading cause of death globally, continues to rise steadily, and could reach 28.4 million cases by 2040, if no action is taken. Prostate cancer, the second most common cancer in men globally following lung cancer, accounted for 1,414,259 new cases and led to 375,304 deaths in 2022. Chemotherapy and surgery remain the major treatments however, they are associated with side effects. In this study, the anticancer potentials of ten (10) isoflavonoids from Millettia griffoniana Bail was explored. Methods Anti-cell growth (MTT), proliferative (CCK-8) and clonogenic effects of these isoflavonoids were investigated. Furthermore, the most potent compound (isojamaicin) was investigated for its potential to induce apoptosis, inhibit cell migration/invasion and cell adhesion. Results Out of the 10 isoflavonoids isolated from M. griffoniana , isojamaicin significantly inhibited PC3 and LNCaP cell growth and proliferation in a concentration dependent manner. It also significantly (p<0.001) inhibited PC3 cell clone formation. It induced a potent (near 40 %) increment of apoptotic cell population in PC3 cells at both 30 and 60 μg/mL; which was followed by a notable increase in caspase-3 activity. Isojamaicin induced potent inhibition of PC3 cell invasion/migration and increased adhesion of PC3 cells to the extracellular matrix (collagen). Conclusions This study provides an unprecedented report of the anti-prostate cancer potential of isojamaicin and its possible underlying mechanisms. It merits further in vivo research to support the in vitro findings.

Objectives Mosquitoes are the most common vector for transmitting causative agents from an infectious source to a susceptible host. The key tool for preventing the spread of infection is vector control. Mosquito control is achieved by a variety of means, including personal protection, the use of synthetic insecticides, and so on. Mosquito resistance to chemical insecticides has resulted in mosquito control failure all over the world. This study was done to evaluate the mosquito larvicide effect of Dawa-e-Hilteet to develop an effective herbal alternative for mosquito control. Methods Five different concentrations of Dawa-e-Hilteet in the range of 25–125 ppm were taken and subjected to bioassay against late third instar larvae of Anopheles stephensi . After 24 h, mortality response was observed and compared with Neem seeds extract. Log probit regression analysis was applied to the mortality data to calculate the median lethal concentrations LC50 and LC90 for the larvae subjected to the treatment. Results 91 % mortality in larvae of Female A. stephensi was recorded at 125 ppm of Dawa-e-Hilteet . The mortality percentage increased with the increase in concentration. Hydro alcoholic extract of Dawa-e-Hilteet revealed LC50 value at 66.799 ppm and LC90 value at 119.709 ppm. Conclusions Dawa-e-Hilteet extract exhibited larvicidal activity against late third instar larvae of Female A. stephensi and was found to be more potent than Neem extract.

Objectives Natural compounds that can induce the opening of the mitochondrial membrane permeability transition (MMPT) pore may be useful therapeutic agents in treating diseases associated with mitochondrial dysfunction e.g. cancer, diabetes, and neurodegenerative diseases. This pore represents a promising target for therapeutic intervention. Therefore, this study investigated the potential of the methanol extract of Funtumia elastica stem bark on the MMPT pore, mitochondrial ATPase (mATPase), cytochrome c release (cyt c), and mitochondrial lipid peroxidation (mLPO) in rat liver. Methods Male Wistar rats (100–120 g) were used in this study. Differential centrifugation was used to isolate mitochondria from rat liver. MMPT pore opening, mATPase activity, cyt c, and mLPO were assayed. Results The results indicate that the methanol extract of F. elastica induced MMPT pore opening in the absence of calcium ions. Also, in the presence of calcium ions, the extract significantly (p<0.05) reversed the opening of the MMPT pore by 21.0, 30.0, 34.0, and 38.0 % at 12, 36, 60, and 84 μg/mL, respectively. The extract activated mitochondrial ATPase activity significantly (p<0.05) compared to the control. The extract elevated cytochrome c release with increasing extract concentration relative to the control. The extract also inhibited iron-induced mitochondrial lipid peroxidation by 29.0, 38.7, 59.9, 83.0, and 87.0 % at 150, 300, 600, 1,200, and 2,400 μg/mL, respectively. Conclusions Our results showed that the methanol extract of F. elastica contains potent phytochemicals that can trigger MMPT pore opening, activate mATPase, cyt c, and inhibit mLPO. This extract may find use in diseases associated with apoptosis dysfunction.

Objectives To investigate the effect of orally administered cytidine-5′-diphosphocholine (citicholine) (50,100,200 mg/kg), α-tocopherol (Vit E; 25 mg/kg), caffeine (10 mg/kg), L-dopa (25 mg/kg) or the combination of Vit E, caffeine with citicholine (100 mg/kg) on nigrostriatal neuronal damage induced in the mice brain by subcutaneous (s.c.) rotenone. Methods Swiss male mice received rotenone (1.5 mg/kg, s.c, three times per week) alone or with other drugs for 2 weeks. Mice were evaluated for brain malondialdehyde (MDA), reduced glutathione (GSH), and nitric oxide (NO), paraoxonase-1 (PON-1), acetylcholinesterase (ACHE), interlukin-1beta (IL-1β), nuclear factor kappa B (NF-κB) and monocyte chemoattractant protein (MCP-1). Histopathologic examination was also done. Results Cticholine co-treatment at 50, 100 or 200 mg/kg significantly decreased brain MDA and increased PON-1 activity in a dose-dependent manner. When given at 200 mg/kg, it also significantly decreased NO production, while at 100 and 200 mg/kg significantly increased GSH brain. MCP-1 significantly decreased upon treatment with 100 or 200 mg/kg of citicholine. IL-1 β and NF-κB significantly decreased and AChE significantly increased by 200 mg/kg citicholine. Oxidative stress and inflammatory biomarkers also showed favorable changes after Vit E, caffeine or L-dopa. However, the combination of Vit E and/or caffeine with 100 mg/kg citicholine was not superior to that of only citicholine at 100 or 200 mg/kg. Conclusions Citicholine is neuroprotective in acute rotenone nigrostriatal degeneration via antioxidant and anti-inflammatory properties. It is suggested that citicholine may have a role in treatment of Parkinson’s disease by decreasing neuro-inflammation and oxidative stress, preventing the development of neuronal damage.

Objectives Quercetin is a naturally occurring plant flavonoid commonly used as a nutritional supplement due to its antioxidant and anti-inflammatory properties. Its well-known low bioavailability has led to the design of different quercetin formulations by various commercial entities seeking to market a highly bioavailable quercetin product. This study investigates four different commercially available quercetin formulations (LMQ, QUX, QUO, and QUV) for their physicochemical properties that influence bioavailability. LMQ and QUX are liquid-based formulations while QUO and QUV are solid powder-based formulations. Methods Studies were conducted on particle size using a particle size analyzer; solubility (in water, simulated gastric and intestinal fluid) using Ultra High Performance Liquid Chromatography (UHPLC) to quantify the quercetin content; intestinal permeability and toxicity using Caco-2 cells and HepG2 liver cells. Results LMQ and QUX had the narrowest particle size distribution as well as the highest solubility while QUO and QUV had the widest particle size distribution but the poorest solubility. One formulation (QUO) exhibited a significant reduction in cell viability with HepG2 and Caco-2 cells including a significant decrease in TEER value change (−39.0 %; p<0.01); its higher Caco-2 cell permeability (P app 2.85 × 10 −4  ± 4.22 × 10 −5 ; p<0.05) likely resulted from reduced membrane integrity. The other formulations significantly increased the TEER value within the first 4 h ( ≥ 22.7 %; p<0.05). Conclusions The particle size distribution of each of the individual formulations reflected their solubilities in water and gastrointestinal fluids. Despite QUO having the highest permeability, its negative change in TEER value over time revealed its evident cytotoxic effects. QUV performed poorly in terms of solubility, and permeability. LMQ and QUX were the most consistent across each study with LMQ performing better than QUX overall. Findings of this study present one formulation (LMQ) with superior intestinal absorption while maintaining high cell viability, thus making it one of the safer and more effective quercetin formulations.

Objectives To describe the prevalence and profile of NZ osteopaths treating people experiencing headaches and migraines. This study is the first to describe this practice. Background Manual and manipulative therapy interventions are commonly sought by individuals experiencing headaches or migraines. Evidence supports the use of manual therapy as part of the management of headache and migraine disorders. Osteopaths are health professionals who provide care for individuals experiencing headaches and migraines. However, there is a lack of data concerning the profile of osteopaths treating these conditions, in addition to their diagnostic and management strategies. Methods The Osteopathy Research Connect-New Zealand (ORC-NZ), a practice-based research network for the New Zealand osteopathy profession, was established, and recruitment occurred between August to December 2018. Results Two hundred and seventy-seven respondents provided responses to the headache and migraine items on the ORC-NZ practice questionnaire. Of these respondents, 235 (84.8 %) indicated treating headaches often, and 107 (38.6 %) indicated treating migraines often. Osteopaths who reported often treating patients with migraines and headaches were more likely to report clinically supervising associates and be co-located with a general practitioner. In terms of management, they tend to use HVLA, are likely to treat TMJ in the case of migraines, and the thoracic spine for patients with headaches. Further, NZ osteopaths frequently refer patients with migraines and/or headaches to other practitioners. Conclusions NZ osteopaths treat patients with migraines and/or headaches and frequently refer them to other practitioners. NZ osteopaths are aware of the inter-professional approach required for this patient population.

Objectives Despite the strong impetus for complementary and integrative medicine (CIM) clinicians to engage with research evidence, the enablers and barriers to evidence implementation for most CIM disciplines remain poorly understood. Identifying these determinants represents a critical first step to facilitating the uptake of research evidence in CIM practice, which this study aimed to examine. Methods This cross-sectional study set-out to examine the enablers and barriers to evidence implementation across nine Australian CIM disciplines. Participants were invited to complete the 84-item online Evidence-Based practice Attitude and utilization Survey (EBASE). Results Two-hundred-and-three CIM practitioners completed the survey (78 % female; 65 % aged 40–59 years). CIM practitioner engagement in evidence implementation was at a low-moderate level. Attitude did not pose as a barrier, with most practitioners reporting a predominantly positive attitude toward evidence implementation. Similarly, education was not a major barrier, with most practitioners self-reporting a moderately-high skill level across 13 evidence implementation-related activities. The only factors largely reported as moderate or major barriers to evidence implementation were lack of clinical evidence in CIM, and lack of time. Conclusions This study offers important insights into the barriers and enablers of evidence implementation within CIM disciplines. While practitioners generally held positive attitudes toward EI, utilisation of evidence-based practices remained low, with structural challenges (i.e. evidence and time) the prevailing issue of concern. Potential solutions, such as decision-support systems and targeted education initiatives, warrant further investigation to ensure their feasibility and effectiveness in enhancing evidence-based practice, improving healthcare efficiency, and optimising patient outcomes in CIM.

Introduction The incidence of post-surgery outcomes, such as pain and constipation, in patients undergoing coronary artery bypass surgery can impact the healing process and the quality of life of patients. This study aimed to investigate the effect of olive oil consumption on pain and constipation in adult coronary bypass surgery patients. Methods A randomized controlled trial in Qazvin, Iran (2022–2023) assigned 110 patients scheduled for coronary artery bypass surgery to two groups using four-block randomization. In the intervention group, patients received 30 cc of extra virgin olive oil daily with food from the day before the operation to 30 days after. The control group received usual care. Pain and constipation levels were measured before and after surgery and up to 30 days post-surgery using the visual pain scale (VAS) and Bristol stool form scale (BSFS). Results With similar background variables between the two groups, the results indicated that the average pain and constipation scores in the intervention group decreased more than in the control group (p-value < 0.05). Conclusions Based on the study’s findings and the positive impact of olive oil consumption on reducing pain and constipation, incorporating olive oil into the diet of heart surgery patients is recommended.

Objectives Periodontitis is an inflammatory disease affecting tooth-supporting structures due to dysbiosis in plaque bio-film. While NSPT remains the gold standard treatment, it limits in its capacity to fully eradicate pathogens, necessitating adjunct antimicrobial therapy. Local drug delivery(LDD) offers targeted treatment with fewer side effects compared to systemic antimicrobial therapy. Recent studies highlight herbal extracts, such as licorice ( Glycyrrhiza glabra ), which exhibit antimicrobial and anti-inflammatory properties, making them promising candidates for LDD. Therefore, the goal was to evaluate the effectiveness of licorice gel and tetracycline gel as a non-surgical treatment auxiliary for individuals with stage II periodontitis and grade B type-2 diabetes. Methods In this randomized, double-blind clinical trial, 20 patients with Type-II diabetes were included. Following NSPT, licorice and tetracycline gel were applied locally as adjuncts to both the test and control groups. Clinical parameters such as Probing pocket depth (PPD), Clinical attachment level (CAL), Bleeding on probing (BOP) were evaluated at base line and 1 month and Landry’s healing index at 7th day. Results In intergroup analysis, licorice gel has shown statistically significant reduction in PPD and CAL with better healing when compared to tetracycline gel.However, there was no statistically significant difference between the groups in terms of bleeding on probing. Conclusions Both licorice and tetracycline gel are equally effective in treating pockets but licorice gel as an LDD agent has shown better and encouragingoutcomes in terms of healing, PPD and CAL.

Objectives Preterm infants often face multiple challenges due to immature organ systems. Given the clinical status of infants, massage can serve as a non-pharmaceutical intervention. This study evaluates the effects of I LOVE U and field massages on weight and gastrointestinal function in NICU-admitted preterm infants. Methods A controlled trial was conducted with 84 preterm infants. The infants were randomized into two intervention groups (I LOVE U and field massages) and a control group. The control group received routine care, while the intervention groups received routine care plus either I LOVE U or field massages. Massages were administered for 15 min twice daily before feeding for 5 days. Gastrointestinal variables were measured, including residual gastric volume, abdominal circumference, defecation frequency, and weight before and after the intervention. Data were analyzed with SPSS version 22. Results The study findings revealed no significant differences in weight or gastrointestinal function indices among the groups over the study period. Conclusions The findings demonstrated that infants in the massage intervention group exhibited better weight status and lost less weight than the controls post-intervention. Moreover, the I LOVE U massage technique enhanced defecation in infants, suggesting better impacts on gastrointestinal factors. Further interventional studies, however, are recommended to explore the effects of this specific massage technique. Trial registration This trial was registered with the Iranian Registry of Clinical Trials under Reg. NO. IRCT20221220056884N1.

Objectives Diabetic neuropathy results in chronic pain. Traditional treatments often offer limited relief, prompting the exploration of alternative therapies like Evening Primrose Oil (EPO). This study aimed to assess the efficacy of EPO in the treatment of painful diabetic neuropathy. Methods In this interventional clinical trial, Patients were randomly assigned to three groups. Group A, consisted of 24 patients, received 1,000 mg of EPO soft gel capsules every 12 h. Group B, consisted of 21 patients, received 1,000 mg of EPO soft gel capsules daily. Group C, also with 21 patients, was divided so that half of the patients received placebo capsules daily and the other half every 12 h. After 4 weeks, patients returned, and questionnaires were completed. Statistical analysis of the data was conducted using SPSS version 25. Results Groups A and B showed significant reductions in visual analog scale (VAS) pain scores, with Group A achieving the most improvement (mean pre-test: 5.96; post-test: 4.63). Analysis of covariance (ANCOVA) revealed significant differences in post-intervention scores (p<0.001) for VAS and Neuropathy total symptom score-6 (NTSS-6), indicating effective interventions. Treatment A was more effective than Treatment B for reducing pain (VAS mean difference= −0.52; p=0.044) and McGill Pain Questionnaire (MPQ) scores (mean difference= −9.56; p<0.001). Conclusions EPO could serve as a valuable alternative therapy for managing painful diabetic neuropathy with fewer side effects than traditional treatments. Further research is warranted to validate these results and explore EPO treatment long-term efficacy and safety.

Objectives The use of complementary and alternative medications (CAM) and natural health products (NHPs) to enhance mood and reduce cognitive decline is well known yet research guiding Older Adult patients and their health care teams on such usage is limited. The purpose of this study was to understand CAM and NHP usage patterns for cognitive health among healthy Older Adults to enable the construct of better guidelines for health care practitioners regarding such usage. Methods A qualitative study was designed to determine usage patterns of CAM and NHPs among Older Adults. Participants were recruited from the Center for Elder Research at Sheridan College and open-ended questions were utilized during one-on-one interviews with interested participants to determine usage patterns in relation to cognitive health. Results A total of 10 participants completed the interviews with an age range of 63–86 years. Results were analyzed using the triangulation method based on a Grounded Theory approach to identify 6 main emerging themes: fear of cognitive health decline, strategies to mitigate perceived/self-diagnosed cognitive health decline, dietary influences on cognitive health, healthcare ownership and self-care, CAM and NHPs loyalty, and supporting Older Adult CAM and NHPs use. Percentages of each response within each main theme was also determined. Conclusions Older Adults appeared to be cognizant of their cognitive health and tended to rely on CAM and NHPs to improve self-perceived decline in cognitive health. Older Adults expressed a desire for their health care practitioners to become more accommodating of such usage and for the government to support them financially for expenditures on CAM and NHPs. Older Adults indicated a preference of visiting health care practitioners who supported the use of these products.