Study Background Establishing an evidence-informed expert consensus on the use of acupuncture for managing chronic musculoskeletal pain at the primary care level in Hong Kong, using the GRADE Evidence to Decision (EtD) framework. Two-rounds of Delphi study were conducted guided by the GRADE-ADOLOPMENT approach and informed by systematic review. Methods Sixteen local experts, including eight traditional Chinese medicine practitioners and eight biomedically trained doctors, were purposively sampled based on their clinical experience in pain management. A structured questionnaire was developed based on seven chronic musculoskeletal conditions and aligned with the six GRADE EtD criteria. Experts rated the appropriateness of acupuncture for each condition using a 4-point Likert scale. Consensus was defined as ≥75.0% agreement. Participants reviewed diagnostic criteria and selected core outcomes for evaluating treatment effectiveness. Results Positive consensus supported acupuncture for adhesive capsulitis, knee osteoarthritis, lumbar spinal stenosis with neurogenic claudication, and non-specific low back pain. Full agreement was reached on diagnostic criteria for all seven conditions. Pain relief, functional improvement, and health-related quality of life were identified as core outcomes. No consensus was reached for hip osteoarthritis, cervical radiculopathy, or lumbar radiculopathy. Experts highlighted the need for individualised treatment plans and further research on implementation and patient preferences. Conclusion This study presents the first expert-endorsed list of acupuncture recommendations for chronic musculoskeletal pain in Hong Kong. The findings support interprofessional collaboration and provide a foundation for developing referral pathways and clinical guidelines. However, the study is limited by reliance on expert opinion and indirect evidence, a potentially non-representative panel, and the absence of physiotherapist and patient perspectives. Future research should focus on implementation strategies and incorporate input from various stakeholder groups to strengthen the clinical integration of acupuncture.
Background Crocus sativus (Saffron) and its bioactive constituents, crocin and crocetin have gained attention for their neuroprotective and antioxidant properties in ocular health. This review synthesises clinical evidence from extracted studies evaluating their efficacy, safety and dosing across Age-related Macular Degeneration (AMD), Primary Open-Angle Glaucoma (POAG), Diabetic Macular Edema (DME), Central Serous Retinopathy (CSR), Stargardt Disease (STGD1) and Paediatric Myopia (PM). Methodology A systematic literature review was undertaken assessing randomized trials, observational or cohort studies, case studies or series written in English between January 2015 to January 2025. Studies were identified using PubMed, AMED, CINHAL, ScienceDirect and Scopus as well as the grey literature. Results Ten clinical trials were identified from 529 citations. Interventions involved oral supplementation of saffron (20-50mg/day), crocin (5-15mg/day) and crocetin (7.5mg/day) over durations ranging from 6 weeks to 12 months. Primary outcomes included visual acuity, retinal electrophysiology, intra-ocular pressure, macular thickness, and safety profiles. Conclusion Saffron, crocin and crocetin, demonstrate consistent efficacy and exceptional safety profiles across a range of ocular conditions. Saffron’s dose-dependent therapeutic effects are a promising adjunctive therapy in ophthalmology. Further large-scale trials are warranted to confirm these findings and refine condition specific dosing.
Metabolic and hormonal disturbances are common during the climacteric period and contribute to an increased risk of chronic diseases. Yoga has emerged as a promising complementary approach to promote women's health during midlife; however, long-term evidence remains limited. This longitudinal, community-based controlled study evaluated the effects of regular yoga practice over 24 months on anthropometric, metabolic, and hormonal parameters in climacteric women. A total of 182 Brazilian women aged 40-65 were followed; participants who chose to engage in yoga formed the intervention group, while sedentary women served as controls. Data were collected at baseline and after 6, 12, and 24 months. After 24 months, the yoga group showed significant reductions in BMI (-2.24 kg/m2; p = 0.008) and body fat percentage (-4.29%; p = 0.008), as well as decreases in systolic (-11.4 mm Hg; p = 0.012) and diastolic blood pressure (-5.5 mm Hg; p = 0.044). Improvements were also observed in fasting glucose (-9.1 mg/dL; p = 0.024), QUICKI (+0.03; p = 0.046), HDL-c (+9.6 mg/dL; p = 0.012), and non-HDL-c (-23.4 mg/dL; p = 0.018). Estradiol levels increased by 24.4 pg/mL in the yoga group and were significantly higher than in controls at 24 months (+40.9 pg/mL; p < 0.001), suggesting an endocrine-modulating effect. These findings support yoga as a promising nonpharmacological strategy to promote metabolic and hormonal health during the climacteric phase.
Background Crocus sativus L. is a culturally significant herbal remedy used by pregnant women in many regions, particularly in South Asia and the Middle East. Despite its widespread use, evidence regarding its clinical efficacy and safety profile remains limited and inconclusive. Objectives This integrative review aims to synthesize cultural beliefs, reported use, and clinical evidence on saffron use during pregnancy and childbirth, and to critically evaluate evidence regarding its maternal and fetal safety and therapeutic potential. Methods A systematic search of PubMed, Google Scholar, Scopus, and Web of Science was conducted to identify English-language articles from inception to June 2025. Included studies comprised clinical trials, observational studies, systematic reviews, and cultural accounts. Data were extracted on cultural beliefs, use patterns, clinical outcomes, and potential risks. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework guided study selection. Results Twelve studies were selected. Cultural practices strongly influence saffron use, with women consuming it to improve fetal complexion, maternal strength, and labor readiness. Clinical evidence indicates low-dose saffron (approximately 250 milligrams daily) may facilitate cervical ripening, reduce labor pain and anxiety, and shorten labor duration in term pregnancies. These effects are dose-dependent, with higher doses or occupational exposure linked to uterine stimulation and increased miscarriage risk. Conclusions Low-dose saffron shows promise for improving labor outcomes, though excessive consumption poses significant risks. Saffron use is deeply rooted in cultural beliefs, underscoring the need for respectful, dialogue-based approaches to guide patients safely. Standardized preparations and long-term safety data are needed before clinical recommendations can be made.
