ISSN: 2278-4500

Research Updates-Homeopathy
A monthly research e-Journal by IPRH
Please quote this article as Res. Up. Hom. 2012; 1(10):48-58, ISSN 2278-4500 Dr. Rupali Dixit Bhalerao
M.D, Senior Research Fellow, Central council for Research in Homoeopathy, 61-65, Institutional area, Janakpuri, Opp D Block, New Delhi. 110058. Contact: 09871106514, Email: dr_rupalibhalerao@yahoo.co.in

Introduction
It is a necessity of profession and scientific society in any systems of medicine to have research data in a particular disease condition to establish its efficacy. Moreover, it is an ever increasing demand by policy makers for evidence based data to have a better decision making in favor of a particular system of treatment. Homoeopathic research is need of the hour to prove its effectiveness to its critics. Children are frequent visitors at homoeopathic consultation chambers. As physicians we must be updated with current research literature for self-satisfaction and educating parents. This article is a small effort to provide research update in last 10 years related to pediatric disorders and role of homoeopathy in them. In the recent past, some studies suggested that parents use Homeopathy more frequently than conventional treatment for their children1. An ethnographic study of committed adult users in South London found that they consulted their General Practitioners for diagnosis but took Homeopathy for treatment because antibiotics and other drugs were seen as weakening the immune system and counteracting the remedy.1 Many of these participants were mothers who made health decisions for their children using this same set of beliefs. A recent qualitative study in Norway also found the same2.

Homoeopathy for children A Global view

Homeopathy is a form of complementary/alternative medicines which is considered as a safe and effective form of treatment for children and adults. Within UK Homeopathy use is estimated at 1.9% of the adult population and around 11% for children less than 16 years. The numbers of patients using complementary medicines, including Homoeopathy are growing worldwide. The use of complementary medicine, however, is not limited to adults but is also common in children (1118%) with Homoeopathy being one of the most popular systems. This wide and growing use of complementary medicines implies a perceived deficiency in conventional medical treatment, paralleled by increasing patient dissatisfaction with conventional medicine (drug side-effects, perceived lack of holistic care), and the attraction of longer appointment times with complementary therapists.

Homoeopathy for pediatrics population in general

Title of study Thompson EA, Bishop JL, Northstone K. The use of homeopathic products in childhood: data generated over 8.5 years from the Avon Longitudinal Study of Parents and Children (ALSPAC)3. Spence DS, Thompson EA, Barron SJ. Homeopathic Treatment for Chronic Type of study Population based Longitudinal Study of Parents and Children (ALSPAC). Questionnaire provided to mothers. Outcomes were based on scores on a 7-point Likert-type scale at the Results Eleven and eight-tenths percent (11.8%) of this cohort used a HP at least once up to 8.5 years of age. Chamomilla for teething and Arnica for soft-tissue bruising were the most commonly used products. In an observational study of 6544 consecutive patients during a 6year period, and over 23,000 Conclusion Research could focus on greater information delivery to the community and monitoring of potential health and cost benefits, or side-effects of the use of HP for acute and chronic conditions in children. Homeopathic intervention offered positive health changes to a substantial proportion of a

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Research Updates-Homeopathy
A monthly research e-Journal by IPRH
Disease: A 6-Year, UniversityHospital Outpatient Observational Study4. end of the consultation and were assessed as overall outcomes compared to the initial baseline assessments. consultations, results showed that 70.7 % reported positive health changes, with 50.7 % recording their improvement as better (+2) or much better (+3). Of the 1270 children that were treated 80.5 % had some improvement, and 65.8 % were better (+2) or much better (+3). In a prospective, multi-centre cohort study with 103 primary care practices treating 3981 patients, disease severity decreased significantly (p<0.001) over a 2 year period. Major improvements were observed for quality of life for adults and young children. 28 % (1130) of the patients were children and 97 % of all diagnoses where chronic with an average duration of 8.8 years. The most frequent diagnoses were allergic rhinitis in men, headache in women, and atopic dermatitis in children. A survey of more than 900 patients treated homeopathically showed substantial improvement in Quality of life over the first 6 months after treatment and this effect remained more or less stable over the following years. Nine hundred and fifty-one homoeopathic preparations were used by 718 Children (weighted prevalence 4.6%). large Cohort of patients with a wide range of chronic diseases.

Witt CM, Luedtke R, Baur R, Willich SN. Homeopathic Medical Practice: Long-term results of a Cohort Study with 3981 Patients5

The main outcome measures were: Patient and physician assessments (numeric rating scales from 0 to 10) and quality of life at baseline, and after 3, 12, and 24 months.

Disease severity and quality of life demonstrated marked and sustained improvements following homeopathic treatment period.

Gthlin C, Lange O and Walach H. Measuring the effects of acupuncture and homoeopathy in general practice: An uncontrolled prospective documentation approach6. Du Y, Knopf H. Paediatric homoeopathy in Germany: results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)7.

Last-week homoeopathy use was recorded among 17,450 children aged 0-17 years who participated in the 2003-2006 German Health Interview and Examination Survey for Children and Adolescents (KiGGS)

Paediatric homoeopathy is quite popular in Germany, particularly among children from families with a higher socioeconomic status. The high level of paediatric homoeopathy use in Germany warrants a critical review to determine whether it is evidence based and costeffective.

Respiratory Disorders In Children

It is commonly seen that most of children are coming for respiratory allergies or infections. Our medication has definite role in treatment of these respiratory disorders like Asthma, Rhinitis, Bronchitis, Allergies and Pharyngitis. Following are positive as well as negative studies on this particular aspect for clinicians.

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Research Updates-Homeopathy
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Cost effectiveness in respiratory illness as compare to conventional medicine
Title of study Rossi E, Crudeli L, Endrizzi C, Garibaldi D. Cost-benefit evaluation of homeopathic versus conventional therapy in respiratory diseases8. Type of study A retrospective observational study was conducted on 105 out of 233 patients suffering from chronic respiratory disease. Results Homeopathic treatment for respiratory diseases (asthma, allergic complaints, Acute Recurrent Respiratory Infections) was associated with a Significant reduction in the use and costs of conventional drugs. The 'homeopathic strategy' yielded significantly better results than the 'antibiotic strategy' in terms of medical effectiveness Conclusion Costs for homeopathic therapy are significantly lower than those for conventional Pharmacological therapy. Homeopathy may be a cost-effective alternative to antibiotics in the treatment of recurrent infantile rhinopharyngitis.

Trichard M et al. studied the economic effect of Homoeopathy and antibiotic strategies in treatment of rhinopharingitis in 9 children

David Riley. Homeopathy and Conventional Medicine: An Outcomes Study Comparing Effectiveness in a Primary Care Setting10

Prospective, pragmatic study. Medical effectiveness was assessed in terms of (i) episodes of acute rhinopharyngitis, (ii) complications, (iii) adverse effects. Quality of life was assessed using the Par-Ent-Qol scale. Direct medical costs (medical consultations, drug prescriptions, prescriptions for further tests) and indirect medical costs (sick-leave) were evaluated from three viewpoints (society, patient, Social Security) using public prices and French Social Security tariffs. An international multicenter, prospective, observational study in a real world medical setting comparing the effectiveness of homeopathy with conventional medicine.

The adverse events for those treated with conventional medicine was 22.3% versus 7.8% for those treated with homeopathy. Seventynine percent (79.0%) of patients treated with homeopathy were very satisfied and 65.1% of patients treated with conventional medicine were very satisfied.

Homeopathy appeared to be at least as effective as conventional medical care in the treatment of patients with the three conditions studied.

Studies with positive outcome in Upper Respiratory illnesses

Title of study Max Haidvogl et al. Homeopathic and conventional treatment for acute respiratory and ear complaints: A comparative study on outcome in the primary care setting11 Type of study International, multi-centre, comparative cohort study of nonrandomised design. The majority of patients in both groups reported their outcome after 14 days of treatment as complete recovery or major improvement. Results However, onset of improvement within the first 7 days after treatment was significantly faster upon homeopathic treatment both in children (p = 0.0488) and adults (p = 0.0001). Conclusion In primary care, homeopathic treatment for acute respiratory and ear complaints was not inferior to conventional treatment.

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Research Updates-Homeopathy
A monthly research e-Journal by IPRH
Nita M. Ramchandani. Homoeopathic treatment of upper respiratory tract infections in children: Evaluation of thirty case series12 The number of attacks of the URTIs during the 6 months period preceding the date of commencement of the homoeopathic treatment (Control value) and 6 months period following the date of commencement of treatment (Treatment value) were compared. The results of the study indicated statistically significant differences (p < 0.001%, t-test and Wilcoxon non-parametric test) in the two data sets in favour of homoeopathic treated cases. The results of the study indicate the utility of the homoeopathic remedies prescribed based on the concept of individualization in the treatment of URTIs in children vis--vis improving the prescribing skills particularly with respect to the process of selection and types of medicines. In this study, there was a clinically relevant effect of individualized homeopathic care in the prevention of URTI in children.

Aslak Steinbeck et al. Homeopathic care for the prevention of upper respiratory tract infections in children: A pragmatic, randomised, controlled trial comparing individualized homeopathic care and waiting-list controls13 A.K.Vichitra et al. Bronchial Asthma14

Open, pragmatic, randomised parallel-group trial with waiting-list group as control.

There was a significant difference in median total symptom score in favour of homeopathic care (24 points) compared to the control group (44 points) (p = 0.026).

It was a multi-centric, observational, prospective study (Open clinical trial) carried out during the period 1978 2003.

Chaturbhuja Nayak et al. A multi-centric open clinical trial to evaluate the usefulness of 13 predefined homeopathic medicines in the management of acute rhinitis in children15

In this multi-centric open clinical trial, a total of 784 children (408 males; 384 females) aged 6 months to 15 years; presenting symptoms of acute rhinitis were enrolled. Symptoms were assessed using an acute rhinitis symptom score (ARSS).

Out of 2107 patients followed up, 52 patients were cured and 1822 patients improved in varying degrees: marked improvement in 856 patients, moderate improvement in 444 patients and mild improvement in 522 patients. Out of 784 children enrolled, 638 children were followed up and analyzed. A significant change in the score from the baseline (p<0.05) was observed.

The outcome of the study shows that homoeopathic medicines have a role in managing acute attacks of bronchial asthma as well as in controlling recurrent attacks. This study indicates the usefulness of homeopathic medicines in the management of acute rhinitis of children; controlled studies are needed to investigate their efficacy and effectiveness.

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Research Updates-Homeopathy
A monthly research e-Journal by IPRH
Negative studies in Respiratory illnesses
Some of the studies do not show significant improvement after homoeopathic medication. One of the studies described below shows failure due to flaws in its methodology.
Title of study E S M de Lange de Klerk. Effect of homoeopathic medicines on daily burden of symptoms in children with recurrent upper respiratory tract infections16 Type of study Randomised double blind placebo controlled Study. Mean score for daily symptoms, number of antibiotic courses, and number of adenoidectomies and tonsillectomies over one year of follow up. Results In both groups the use of antibiotics was greatly reduced compared with that in the year before entering the trial. Conclusion Individually prescribed homoeopathic medicines seem to add little to careful counseling of children with recurrent upper respiratory tract infection in reducing the daily burden of symptoms, use of antibiotics, and need for adenoidectomy and tonsillectomy. A future study using this design is not feasible, further investigation of a potential role for homeopathy in asthma management might be better conducted in primary care with children with less severe asthma.

E.A. Thompson. The feasibility of a pragmatic randomised controlled trial to compare usual care with usual care plus individualized homeopathy, in children requiring secondary care for asthma17

In a pragmatic parallel group randomised controlled trial (RCT) design. Outcome measures included the Juniper Asthma Control Questionnaire, Quality of Life Questionnaire and a resource use questionnaire.

Evidence in favour of adjunctive homeopathic treatment was lacking.

Diarrhoea In Children
Diarrhoea is one of the most frequently encountered problems in paediatric age group. The severity of diarrhoea infection varies from patient to patient and from few loose stools with discomfort to severe dehydration. Meta analysis by Jennifer Jacob et al on Diarrhoea RCTs reflects efficacy of homoeopathic medicines in decreasing duration of diarrhoea. Following studies show the utility of homoeopathic medicine in diarrhoea.
Title of study C.Nayak et al. A Prospective Multicentre Observational Study to Determine the Usefulness of Predefined Homoeopathic Medicines in the Management of Acute Diarrheal Disease in Children. HOMOEOPATHIC LINKS18 Type of study A prospective, multi-centre observational study. A total of three hundred twenty seven children in the age-group 6 months to 12 years were included. Diarrhea index score was assessed before and after treatment. Results The difference in the mean number of stools and diarrhea index score was found to be statistically significant (p=0.000, <0.05) after the prescription of trial homoeopathic medicines in 321 children. Conclusion This was an observational study with positive results leads to further validation by suitable Randomized Control Trial(s).

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Research Updates-Homeopathy
A monthly research e-Journal by IPRH
Manoj Patel et al. An approach to acute diarrhea disorders through sector and Constitutional homoeopathic treatment in adivasi children attending Balwadis in palghar & vikramgarh taluka, thane district, Maharashtra19 Jacobs J et al. Homeopathic treatment of acute childhood diarrhea: results from a clinical trial in Nepal20 Randomised case control single blind trial. Three group Acute medicine Group, Acute followed by constitutional group & placebo group. 3 years of follow up study. Acute medicine has definite role in altering course of diarrhoea and in group which followed by constitutional medicine shown significant impact in bringing down the frequency, duration & intensity of diarrhoea. Definite management strategy in acute diarrhoea.

Randomized, double-blind, placebo-controlled trial. Children received either an individualized homeopathic medicine or placebo, to be taken one dose after each unformed stool for 5 days.

Of the 126 children initially enrolled, 116 completed treatment. The mean number of stools per day over the entire 5day treatment period was 3.2 for the treatment group and 4.5 for the placebo group (P = 0.023).

Jacobs J et al. Treatment of acute childhood diarrhea with homeopathic medicine: a randomized clinical trial in Nicaragua21

A randomized double-blind clinical trial comparing homeopathic Medicine with placebo.

J. Jacobs et al. Homeopathy for Childhood Diarrhea: Combined Results and Meta-analysis from Three Randomized, Controlled Clinical Trials22

Three double blind clinical trials of diarrhea in 242 children ages 6 months to 5 years were analyzed as 1 group. Children were randomized to receive either an individualized homeopathic medicine or placebo to be taken as a single dose after each unformed stool for 5 days

The treatment group had a statistically significant (P < .05) decrease in duration of diarrhea, defined as the number of days until there were less than three unformed stools daily for 2 consecutive days. There was also a significant difference (P < .05) in the number of stools per day between the two groups after 72 hours of treatment. Combined analysis shows a duration of diarrhea of 3.3 days in the homeopathy group compared with 4.1 in the placebo group (P = 0.008).

These results are consistent with the finding from the previous study that individualized homeopathic treatment decreases the duration of diarrhea and number of stools in children with acute childhood diarrhea. The statistically significant decrease in the duration of diarrhea in the treatment group suggests that homeopathic treatment might be useful in acute childhood diarrhea.

The results from these studies confirm that individualized homeopathic treatment decreases the duration of acute childhood diarrhea and suggest that larger sample sizes be used in future homeopathic research to ensure adequate statistical power.

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Research Updates-Homeopathy
A monthly research e-Journal by IPRH
Trial with Homoeopathic Combination medicine & Non significant results
Title of study Type of study Results There was no significant difference in the likelihood of resolution of diarrheal symptoms between the treatment and placebo groups. Children in the treatment group had an average of 2.6 unformed stools per day compared to 2.8 among those in the placebo group; this difference was not significant (p = 0.43). Conclusion The homeopathic combination therapy tested in this study did not significantly reduce the duration or severity of acute diarrhea in Honduran Children. Jacobs J et al. A double-blind randomized Homeopathic combination controlled trial. remedy in the treatment of A total of 292 children with acute acute childhood diarrhea in diarrhea was recruited; 145 were Honduras23 randomized to the experimental group and 147 to the placebo group.

Skin Disorders In Children

Recently there has been a constant increase in the number of cases of allergy, particularly in developed countries, to such an extent that expressions like disease of the third millennium and allergic epidemic have been used to describe the phenomenon. There has been an increase in the use of complementary or alternative medicine in patients affected by skin disease, in particular those with chronic or inflammatory dermatosis. The prevalent use of complementary and alternative medicine (CAM) in children has been estimated to be higher than 40% in the USA and it has been reported recently that in the Tuscany Region of Italy more than 25% of children use CAM, and 23.4% of these consume homeopathic products. following data suggest the utility of homoeopathy in skin diseases for children.
Title of study Elio Rossi et al. Homeopathy in paediatric atopic diseases: long-term results in children with atopic dermatitis24 Type of study Data derive from an observational longitudinal study carried out on 213 children (38.6%) with atopic diseases out of 551 children consecutively examined from September 1998 to December 2008. We used the Glasgow Homeopathic Hospital Outcome Score to evaluate the results that were classified on the basis of a Likert scale. Results The parents of paediatric patients suffering from AD, who had started homeopathic treatment at <4.9 years of age were invited to follow-up assessment 8 years later and 40 children (mean age 12.9) were examined; 28/40 (70%) had a complete disappearance of AD, 12/40 children (30.0%) were still affected by AD; 8/40 (20%) had asthma and 8/40 patients had, or developed, allergic rhinitis. Conclusion These preliminary results seem to confirm a positive therapeutic effect of homeopathy in atopic children. Furthermore, according to the data from the literature paediatric patients treated with homeopathy seem to show a reduced tendency to maintain AD and develop asthma (and allergic rhinitis) in adult age.

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Research Updates-Homeopathy
A monthly research e-Journal by IPRH
Comparative trials (Homoeopathy vs Conventional)on atopic dermatitis
Title of study Witt CM. Homoeopathic versus conventional therapy for atopic eczema in children: medical and economic results25 Type of study In a prospective multicentre comparative observational nonrandomised study, 135 children (homoeopathy n = 48 vs. conventional n = 87) with mild to moderate atopic eczema were included. The primary outcome was the SCORAD (Scoring Atopic Dermatitis) at 6 months. Prospective multi-centre cohort study. Patients (or parents) assessed eczema symptoms by numerical rating scales as well as diseasespecific Atopic LebensqualitaetsFragebogen (ALF) and general quality of life (KINDL, KITA) at 0, 6 and 12 months. Results The adjusted SCORAD showed no significant differences between the groups at both 6 months & 12 months. Adjusted costs were higher in the homoeopathic than in the conventional group. Quality of life was not Significantly different between both groups. Eczema symptoms (assessed by patients or their parents) improved from 0 to 12 months for both treatment options, Disease-related quality of life improved in both groups similarly. Conclusion Homoeopathy & conventional treatment are equally effective.

Keil T.Homoeopathic versus conventional treatment of children with eczema: a comparative Cohort study26

Over a period of 12 months, both therapy groups improved similarly regarding perception of eczema symptoms (assessed by patients or parents) and Disease-related quality of life. This study shows the importance of constitutional treatment in cure and control of scabies & its utility in communicable diseases.

Scabies
Chandrasekhar Goda et al. Role of homoeopathic constitutional treatment in scabies infection in adivasi children attending ashram shalas (resident school) in palghar & vikramgarh taluka, thane district, Maharashtra27 Prospective randomised controlled trial. Three groups were made; Constitutional, Acute totality & Placebo, followed for three years. Results analyzed at end of each year. At end of First Year= Constitutional G= 90% improvement, Acute G=27%, Placebo G= 4% Second year: Constitutional G= 98% improvement, Acute G=48%, Placebo G= 12%. Improvement in constitutional group was significant & prevalence of scabies in school dropped from 52% to 17% when prevalence in other schools is not changed.

Psychiatric Disorders
ADHD, Autism, Mental retardation are common causes of consultation for homoeopaths as our system deals with mind along with physical symptoms of children. Webster Universal Dictionary defines temperament as characteristic
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Research Updates-Homeopathy
A monthly research e-Journal by IPRH
combination of bodily, mental, and moral qualities, which together constitute the character and disposition of an individual and predispose him to act and behave in a particular manner. Every child though not diseased has certain traits / temperament in them, which may not be suited to their growth. Each child develops certain behavior or habits, which are quite often out of proportion. Like some of the children want to cling to the mother strongly while sleeping, without mother they can't sleep. Some children in anger break things and hit others while some are so shy that they hide or run away the moment they see any stranger or guest. These do not show any obvious signs of illness but these are indications, which point to their inner disturbances. Every Homoeopath tries to understand these inner disturbances, through various pointers such as fears, dreams, fantasies, movies, cartoons which they like, their reaction to illness. By understanding all this and subsequently treating this, it not only frees the child of his disease and enhances his immunity but it improves the attitude of child towards life, it channelizes energy of child in a proper direction where he can explore his potential and creativity to a maximum. Much work has not been done in this particular field, but some studies are available to find utility of homoeopathy in this field of psychiatric illness in children.
Title of study Frei H et al. Homeopathic treatment of children with attention deficit hyperactivity disorder: a randomised, double blind, placebo controlled crossover trial28 Type of study The aim of this study was to obtain scientific evidence of the effectiveness of homeopathy in ADHD. Results During the crossover trial, CGI parent-ratings were significantly lower under verum (average 1.67 points) than under placebo (P =0.0479). Long-term CGI improvement reached 12 points (63%, P<0.0001). Twenty-five eligible studies were identified from an initial pool of 1,431. Study quality according to SIGN 50 criteria varied, with 6 assessed as good, 9 as fair, and 10 as poor. Outcome was unrelated to SIGN quality. Conclusion The trial suggests scientific evidence of the effectiveness of homeopathy in the treatment of attention deficit hyperactivity disorder, particularly in the areas of behavioral and cognitive functions. The database on studies of homeopathy and placebo in psychiatry is very limited, but results do not preclude the possibility of some benefit. Meaningful safety data were lacking in the reports, but the superficial findings suggested good tolerability of homeopathy. Most useful medicine were Belladonna, Baryta carb, Baryta mur etc.

Homeopathic treatments in psychiatry: a systematic review of randomized placebo-controlled studies28

To systematically review placebocontrolled randomized trials of homeopathy for psychiatric conditions.

B Indira et al.Behavioural Problems of Mentally Challenged Children. Clinical Research Studies29

Study were to identify a group of most useful homoeopathic medicines in the treatment of behavioral problems found in mentally challenged children and to identify their reliable indications, most useful potencies, frequency

Eight hundred and thirty five (835) children were followed up, out of which 531 children showed improvement in common behavioral problems of mentally challenged children like aggressiveness,

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Research Updates-Homeopathy
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of administration and relationship with other medicines. Dolce Filho R. Homeopathic approach in the treatment of patients with mental disability30 The author describes his experience assisting mentally disabled patients with homeopathy. In these patients' anamneses, common traits shared by some syndromes, pathologies and behavior, were taken into consideration, mainly to choose the most characteristic symptoms in each case. destructiveness, disruptiveness etc., whereas 304 children did not improve. The study includes 58 cases of Patients suffering from this pathology: 28 females and 30 males, ages ranging from 1 to 49 years (mean 20). Forty-seven had some improvement.

Homeopathy is a Useful alternative to relieve pathologies associated with mental disability.

Conclusion
As apparent from the presented research literature on pediatric, there is genuine need of more research in pediatric disorders for progress of our profession. In clinics we are showing results but they are not getting documented because of lack of orientation in research publication or documentation. This article is an effort to create awareness amongst the professionals about studies in pediatrics and to make our science more of use for society.

Bibliography

1. Barry C. The body, Health and Healing in Alternative and integrated Medicine: An Ethnography of Homoeopathy in South London. Brunel University; 2003. 2. Steinsbekk A, Brentzen N, Brien S: Why do parents take their children to a homeopath? Forchende Komplementarmedizin 2006, 13:88-93. 3. Thompson EA, Bishop JL, Northstone K. The use of homeopathic products in childhood: data generated over 8.5 years from the Avon Longitudinal Study of Parents and Children (ALSPAC).J Altern Complement Med. 2010 Jan; 16(1):69-79. 4. Spence DS, Thompson EA, Barron SJ. Homeopathic Treatment for Chronic Disease: A 6-Year, UniversityHospital Outpatient Observational Study. The Journal of Alternative and Complementary Medicine. Volume 11, Number 5, 2005, pp. 793-798. 5. Witt CM, Luedtke R, Baur R, Willich SN. Homeopathic Medical Practice: Long-term results of a Cohort Study with 3981 Patients. BMC Public Health 2005, 5:115. 6. Gthlin C, Lange O and Walach H. Measuring the effects of acupuncture and homoeopathy in general practice: An uncontrolled prospective documentation approach. . BMC Public Health 2004, 4:6. 7. Du Y, Knopf H. Paediatric homoeopathy in Germany: results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Pharmacoepidemiol Drug Saf. 2009 May; 18(5):370-9. 8. Rossi E, Crudeli L, Endrizzi C, Garibaldi D.Cost-benefit evaluation of homeopathic versus conventional therapy in respiratory diseases. Homeopathy. 2009 Jan; 98(1):2-10 9. Trichard M, Chaufferin G, Nicoloyannis N. Pharmacoeconomic comparison between homeopathic and antibiotic treatment strategies in recurrent acute rhinopharyngitis in children. Homeopathy 2005 Jan; 94(1):39. 10. David Riley. Homeopathy and Conventional Medicine: An Outcomes Study Comparing Effectiveness in a Primary Care Setting, The Journal Of Alternative And Complementary Medicine Volume 7, Number 2, 2001, pp. 149159.
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11. Max Haidvogl et al. Homeopathic and conventional treatment for acute respiratory and ear complaints: A comparative study on outcome in the primary care setting. BMC Complementary and Alternative Medicine 2007, 7:7doi:10.1186/1472-6882-7-7) 12. Nita M. Ramchandani. Homoeopathic treatment of upper respiratory tract infections in children: Evaluation of thirty case series, Complementary Therapies in Clinical Practice, Volume 16, Issue 2, May 2010, Pages 101-108. 13. Aslak Steinbeck et al.Homeopathic care for the prevention of upper respiratory tract infections in children: A pragmatic, randomised, controlled trial comparing individualized homeopathic care and waiting-list controls. Complementary Therapies in Medicine. Volume 13, Issue 4 , Pages 231-238, December 2005. 14. A.K.Vichitra et al. Bronchial Asthma. Clinical Research Studies | Series 1 | 2008 | Pg 27-40. 15. Chaturbhuja Nayak et al. A multi-centric open clinical trial to evaluate the usefulness of 13 predefined homeopathic medicines in the management of acute rhinitis in children. Int J High Dilution Res 2010; 9(30): 1527 16. 16. 16. E S M de Lange de Klerk. Effect of homoeopathic medicines on daily burden of symptoms in Children with recurrent upper respiratory tract infections. BMJ 1994;309:1329-32 17. E.A. Thompson. The feasibility of a pragmatic randomised controlled trial to compare usual care with usual care plus individualized homeopathy, in children requiring secondary care for asthma. Homeopathy, July 2011, Volume 100, Issue 3, 122130. 18. C.Nayak et al. A Prospective Multicentre Observational Study to Determine the Usefulness of Predefined Homoeopathic Medicines in the Management of Acute Diarrheal Disease in Children. Homoeopathic Links Spring 2010, Vol 23: pg. 60-63 19. Manoj Patel et al. An approach to acute diarrhea disorders through sector and Constitutional homoeopathic treatment in adivasi children attending Balwadis in palghar & vikramgarh taluka, thane district, Maharashtra. Indian Journal of Research in Homoeopathy, Vol. 4, No.4, October-December 2010. 20. Jacobs J et al. Homeopathic treatment of acute childhood diarrhea: results from a clinical trial in Nepal. Altern Complement Med. 2000 Apr;6(2):131-9. 21. Jacobs J et al.Homeopathic combination remedy in the treatment of acute childhood diarrhea in Honduras. J Altern Complement Med. 2006 Oct; 12(8):723-32. 22. Jacobs J et al. Homeopathy for Childhood Diarrhea: Combined Results and Meta-analysis from Three Randomized, Controlled Clinical Trials. Pediatrics. 2003 Mar; 22(3):229-34.22 23. Jacobs J et al.Homeopathic combination remedy in the treatment of acute childhood diarrhea in Honduras. J Altern Complement Med. 2006 Oct; 12(8):723-32. 24. Elio Rossi et al. Homeopathy in paediatric atopic diseases: long-term results in children with atopic dermatitis. Homeopathy, Vol. 101, No1, 2012. 25. Witt CM. Homoeopathic versus conventional therapy for atopic eczema in children: medical and economic results. Dermatology. 2009; 219(4):329-40. Epub 2009 Oct 13. 26. 26. Keil T.Homoeopathic versus conventional treatment of children with eczema: a comparative Cohort study. Complement Ther Med. 2008 Feb;16(1):15-21. Epub 2006 Dec 27. 27. Chandrasekhar Goda et al. Role of homoeopathic constitutional treatment in scabies infection in adivasi children attending ashram shalas (resident school) in palghar & vikramgarh taluka, thane district, Maharashtra. Indian Journal of Research in Homoeopathy, Vol 4, No. 2, April-June 2010. 28. Frei H et al. Homeopathic treatment of children with attention deficit hyperactivity disorder: a randomised, double blind, placebo controlled crossover trial. Eur J Pediatr. 2005 Dec; 164(12):758-67. Epub 2005 Jul 27. 29. Homeopathic treatments in psychiatry: a systematic review of randomized placebo-controlled studies. J Clin Psychiatry. 2011, Jun, 72 6 - 795-805. 30. B Indira et al.Behavioural Problems of Mentally Challenged Children. Clinical Research Studies, Series 1, 2008, Pg 15-26. 31. Dolce Filho R. Homeopathic approach in the treatment of patients with mental disability. Homeopathy. 2006 Jan; 95 (1):31-44.

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