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Stuck for something to do this weekend? Trying to keep the costs down during the holidays?
You're in luck!
Discover all the free days out across the UK right here.
Whether you're planning a staycation in the UK, or just want to fill a free Saturday, there's a free day out for the whole family. From parks and castles to museums and galleries, enjoy everything the UK has to offer, for free.
Scroll down to see all the free days out in the UK.
Want the best without having to search? Check out our handy guide with our top picks across England, Scotland, Wales and Northern Ireland.
162+ free days out across the UK (for July 2019)
31 free days out for couples (perfect for Valentine's Day)
Have we missed off your favourite free day out in the UK? Let us know!
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Concessions: Free entry
Dad's Army Museum | Thetford, Norfolk
Calling all Dad's Army fans - have YOU heard of the Dad's Army Museum in Thetford, Norfolk? If not, you simply have to check it out! This fabulous museum is…
Maidstone Museum | Kent
Whether you're a Maidstone local or you're planning a trip to visit this part of Kent, you'll definitely want to check out the Maidstone Museum. This museum…
Eynsford Castle | Kent
If you're a fan of castles, then you will definitely want to plan a trip to visit Eynsford Castle in Kent! This fascinating ruin is free to enter, and it's…
Viking Ship 'Hugin' | Kent
Wowee, this would make a great day out with all the family, and the best part is that it's 100% FREE! This ship can be found permanently on display on the…
Geocaching | Llanerchaeron, Wales
Calling all geocaching fans, or those who are curious about this activity! It's the largest treasure hunt, stretching right across the UK! Here's all you need…
The Helix | Falkirk, Scotland
Scotland is best known for its sweeping natural landscapes and thriving cultural hubs in the cities. The Helix is a wonderful mixture of both! The Kelpies are…
Lee Valley Sculpture Trail | Waltham Cross, Hertfordshire
This free activity is definitely better in warmer weather, but when the time is right it looks like so much fun! Lee Valley is a 10,000 acre and 26 miles long…
Natural History Museum | Tring, Hertfordshire
It's FREE entry to the Natural History Museum in Tring, Hertfordshire. Not only can you explore a plethora of intriguing and highly educational exhibits, but…
St Albans Museum & Gallery | Hertfordshire
If you're ever passing through St Albans in Hertfordshire, then make sure you stop by the St Albans Museum & Gallery. This museum only opened on Friday 8th…
Geocaching | Clumber Park, Nottinghamshire
Have you ever had a go at geocaching? It's the biggest treasure hunt that stretches across the UK! All you need is your smartphone or a GPS to track the…
St Lawrence Church | Ipswich
If you're planning a trip to Ipswich, you must stop by the stunning medieval St Lawerence Church! This church is the proud owner of the older original set of…
Ipswich Museum | Ipswich
This wonderful museum first opened in 1847. Museum lectures were then inaugurated in 1848 by Professor Henslow who was none other than Charles Darwin's mentor!…
Wardown House Museum & Art Gallery | Luton
If you're thinking of booking a trip to the town of Luton, you should definitely pay a visit to Wardown House Museum & Art Gallery. This venue is free to enter…
Stockwood Discovery Centre | Luton
Have YOU paid a visit to the fabulous Stockwood Discovery Centre in Luton? Not only is it free entry to get in, but this wonderful place offers beautiful…
The Bunyan Museum | Bedford
Whether you're a local to Bedford or you're enjoying a weekend away to this pretty town, it's definitely worth checking out The John Bunyan Museum! Author of…
Natural History Museum | Colchester, Essex
If you're ever visiting Colchester in Essex, or perhaps you're a resident looking to be a tourist in your home town - be sure to visit the Natural History…
Geocaching | Clent Hills, Birmingham
Have YOU heard of geocaching? It's the biggest treasure hunt across the UK! All you need is your smartphone or a GPS to track co-ordinates and find the hidden…
Southend Central Museum | Southend, Essex
If you're ever exploring Southend-on-Sea or the surrounding areas of this part of Essex, then you have to stop by the Central Museum to see all it has to…
Sky Garden | London
Did you know that entry to the Sky Garden on Fenchurch Street is actually open to the public for free entry?! All you need to do is book your slot ahead of…
Leicester Cathedral | Leicester
Did you know that Leicester Cathedral is now the final resting place for King Richard III? Why not stop by to take a look at his tomb and find out more about…
New Walk Museum & Art Gallery | Leicester
Whether you're a Leicester local or just a visitor passing through, you'll definitely want to stop off and take a look around the New Walk Museum and Art…
Victoria Park | Portsmouth
If you're looking to plan a trip to Portsmouth or you're looking to be a tourist in your home. This glorious park covers 15 acres of luscious grassed areas,…
Royal Armouries | Leeds
The Royal Armouries are a well-visited and loved sight to see in Leeds! You can spend a whole day perusing the armours and weaponry from across the world from…
Botanic Gardens | Inverness, Scotland
Enjoy free entry to these stunning botanical gardens in Inverness! These gardens have been around since 1993, and they are simply an oasis of calm, situated…
Doncaster Museum & Art Gallery | Doncaster
Explore wonderfully curated pieces from history - all the way from the Ice Age up to the 21st Century in Doncaster museum! Regular events relating to the local…
Virginia Water Lake | Runnymede, Surrey
The stunning Virginia Water Lake can be found at Windsor Great Park, located in the borough of Runnymede. If you ever find yourself on the Surrey and Berkshire…
Dartington Crystal Factory Tour | Torrington, Devon
Discover just how Dartington Crystal is made, from start to finish, in a guided tour of their very own factory in Torrington, North Devon. Best of all,…
Gorgie City Farm | Edinburgh, Scotland
Looking for a day out with a difference in Edinburgh? Head down to Gorgie City Farm, a real working farm based right in the city. There are lots of different…
Stonebridge City Farm | Nottingham
Who'd have thought it, a real working farm right in the heart of Nottingham! Pop along to the Stonebridge City Farm to check it out for yourself. Stonebridge…
Surrey Docks Farm | London
If you're in the capital and fancy a bit of rural life, why not head down to Surrey Docks Farm for a fun (and free!) day out? It's definitely a great way to…
Bath City Farm | Bath
Love animals? Have a spare few hours in Bath? Head down to Bath City Farm for a fun, free day out you won't forget. Situated on a 37-acre plot in Bath is the…
The Lightbox Gallery | Woking, Surrey
The Lightbox Gallery in Woking is a wonderful place to spend a few hours. It's a fun interactive gallery with lots of changing exhibitions, and general…
Alice Holt Forest | Farnham, Surrey
Explore the outdoors at Alice Holt Forest in Farnham, Surrey. This is a great place to while a few free hours and best of all, entrance to the forest is…
Saltaire Victorian Village | Bradford
Pay a visit to Saltaire, the Victorian model village located in Shipley, West Yorkshire. Given status as a UNESCO World Heritage site in 2001, Saltaire is a…
Bradford Industrial Museum | Yorkshire
Planning a staycation in Yorkshire? Make sure you pay a visit to the Bradford Industrial Museum, which provides a brilliant insight into this Yorkshire town's…
Queen Elizabeth Olympic Park | London
Open 24/7, every day of the week, Queen Elizabeth Olympic Park in London is a must visit for sports lovers and a great free day out for the whole family. Home…
Roskilly's Farm | Cornwall
Pay a visit to a real, working Cornish farm! Roskilly's Farm in Cornwall is a fun day out for the whole family and best of all, it won't cost you a penny.…
City of London Police Museum | London
Interested in police and crime? Planning a visit to London? Then make sure you stop by the City of London Police Museum - it's right up your street! The City…
Shipley Art Gallery | Gateshead, Newcastle
If you're in the Gateshead area with time to spare, make sure you check out the Shipley Art Gallery. The Shipley Art Gallery always has lots of great…
The Pineapple | Stirlingshire, Scotland
Next time you're planning a visit to Scotland, make sure you include a trip to The Pineapple, near Airth in Stirlingshire. This bizarre fruit-inspired building…
Stafford Castle & Visitor Centre | Stafford
Make sure you pay a visit to Stafford Castle and Visitor Centre the next time that you're in the area. Admission to this historic building is completely free,…
Big Pit National Coal Museum | Pontypool, Wales
One of the greatest museums in Wales, Big Pit National Coal Museum, is completely free to enter and is a great day out for the whole family. Big Pit is a real…
Parliament Buildings | Belfast, Northern Ireland
If you're paying a visit to Belfast and want to immerse yourself in the city's rich history and culture, then look no further than the Parliament Buildings.…
The Potter Trail | Edinburgh, Scotland
Potterheads, you'll love this free activity in Edinburgh. Enjoy a guided tour of all the Harry Potter hotspots in Edinburgh, for zero cost. Magical! Discover…
Reelig Glen | Inverness, Scotland
Get back to nature with a woodland walk at Reelig Glen, Inverness. Explore the woodland and marvel at the huge trees that tower above you. This makes a great…
Cumberland House Natural History Museum | Portsmouth
Cumberland House Natural History Museum is a must-visit destination for history and nature buffs alike. There's so much to see and do, but best of all entrance…
Swansea Museum | Swansea, Wales
Paying a visit to Swansea anytime soon? Make sure you take a trip to the Swansea Museum to explore the city's vibrant culture and history. An exploration of…
Gnoll Country Park | Neath, Wales
Explore the beautiful grounds of Gnoll Estate for absolutely free. Pack a picnic, grab the kids and enjoy getting back to nature! Situated in the Vale of Neath…
Laing Art Gallery | Newcastle
Art lovers, make sure you check out the Laing Art Gallery next time you're in Newcastle. Home to an impressive collection of both historic and contemporary…
The Donkey Sanctuary | Sidmouth, Devon
Looking for a fun, free day out that's a bit different to the typical museum outing? Pay a visit to The Donkey Sanctuary in Sidmouth, Devon for a day out the…
Clifton Suspension Bridge | Bristol
Pay a visit to one of Bristol's most iconic spots, the Clifton Suspension Bridge during your next visit to the city. Beautiful all throughout the year, it's a…
Bristol Cathedral | Bristol
Dating back over 1,000 years, Bristol Cathedral is one of the most beautiful and historic buildings in the country and is well worth a visit the next time…
M Shed | Bristol
If you're planning a trip to Bristol and want to find out more about the city and its people, a trip to the M Shed museum is a must. Filled with artefacts and…
Blaise Castle House Museum | Bristol
Take a visit to the Blaise Castle House Museum in Bristol the next time you're in the area, for a free day out that's different from the rest! Explore how life…
Banksy Walking Tour | Bristol
Now a world-famous artist, the infamous pieces of Banksy's art are a must-see for those visiting Bristol. Although Banksy's identity remains a mystery, it is…
Bristol Museum & Art Gallery | Bristol
No trip to Bristol is complete without a trip to the Bristol Museum & Art Gallery. Comprised of nineteen galleries over three floors, this museum truly has…
Haldon Forest Park | Exeter
Just 15 minutes from Exeter lies Haldon Forest Park, consisting of 3,500 acres of luscious woodland. It's the perfect place to enjoy a stroll, dog walk or even…
Royal Albert Memorial Museum & Art Gallery | Exeter
Pay a visit to the Royal Albert Memorial Museum & Art Gallery the next time you're in Exeter. It's a great day out for families, plus is totally free! This…
Modern Art Oxford | Oxford
Modern Art Oxford is a contemporary art gallery in Oxford, and is a must visit for art lovers the next time you're visiting the area. The gallery is filled…
Pitt Rivers Museum | Oxford
Pitt Rivers Museum, Oxford is a must for history and culture buffs all across the world. Founded in 1884, Pitt Rivers Museum has established itself as one of…
City of Oxford Walking Tour | Oxford
What better way to explore a city than by walking its streets, guided by a fully trained local tour guide? Discover all the hot spots and local tours of Oxford…
Ashmolean Museum | Oxford
Paying a visit to the historic city of Oxford? Make sure you add a trip to the Ashmolean Museum to the top of your to-do list. Widely recognised as being the…
Jesmond Dene Park | Newcastle
Jesmond Dene Park is a great place to visit the next time you're in Newcastle. Located in the East End of the city, the woodland park is a perfect free day out…
Ouseburn Farm | Newcastle
Based right in the centre of Newcastle upon Tyne, Ouseburn Farm is a hidden gem and well worth a visit next time you're in the area. Ouseburn Farm is a working…
York City Walls | York
A visit to York City Walls is a must for anyone planning a trip to this historic city. Dating all the way back to the Middles Ages, the York City Walls really…
York Museum Gardens | York
Unwind during your next trip to York in the York Museum Gardens, the perfect place to spend a sunny afternoon. Plus, entrance is free all year round! Located…
City of York Walking Tours | York
There's no better way to explore a city than by walking its streets guided by a local. The Association of Voluntary Guide to the City of York (AVG) knows this,…
People's Palace | Glasgow, Scotland
Glasgow's People's Palace and Winter Gardens are the perfect place to find out all about Glasgow, it's history and it's people. Don't miss this one out on your…
Botanical Gardens | Glasgow, Scotland
Glasgow Botanical Gardens, located in the West End of the city, should be top of the to-do list for any nature lovers visiting Glasgow. Explore the beautiful…
Gallery of Modern Art | Glasgow, Scotland
Gallery of Modern Art is located in the heart of Glasgow and is a must for anyone visiting the city. Comprised of world-class art spread over four galleries,…
Pulteney Bridge | Bath
A must for architecture lovers and film buffs alike, Pulteney Bridge is a great free tip you should take the next time you visit Bath. Pulteney Bridge is one…
Victoria Art Gallery | Bath
Art lovers, make sure you include a visit to the Victoria Art Gallery next time you're in Bath. Filled with both permanent and temporary exhibitions, there's…
Bath Abbey | Bath
No visit to Bath is complete without a trip to the historic Bath Abbey. Make a trip to this Grade I listed building top of your to-do list! Steeped in a rich…
Royal Victoria Park | Bath
Royal Victoria Park, Bath is a great place to spend a few spare hours the next time you're in the city. Perfect all year round, the 57-acre parkland is filled…
Cardiff Story Museum | Cardiff, Wales
No visit to Cardiff is complete without a visit to the Cardiff Story Museum. Find out all about Cardiff, its history and its people in this fun, educational,…
Glamorgan Canal Nature Reserve | Cardiff, Wales
Nature lovers, make sure you pay a visit to Glamorgan Canal Nature Reserve the next time you're in Cardiff. Take a step outside of the busy city centre with a…
Llandaff Cathedral | Cardiff, Wales
Pay a visit to Llandaff Cathedral, one of the oldest Christian sites in Britain. Llandaff Cathedral dates all the way back to 1107, and much of the present day…
Bute Park | Cardiff, Wales
Time to spare in Cardiff? Weather looking good? Make sure you head to Bute Park - the perfect place to spend a lazy afternoon. There is so much to do, both for…
Biddenden Vineyard | Kent
No trip to Kent is complete without paying a visit to the Biddenden Vineyards. Take a wander through Kent's first commercial vineyard, which is still run by…
Turner Contemporary | Kent
Pay a visit to Margate's internationally renowned art gallery, located in the picturesque setting of the harbour looking out to the North Sea. Filled with…
Rochester Cathedral | Kent
Pay a visit to Rochester Cathedral, a place of Christian worship since 604 AD. Located in the heart of Rochester's busy high street and just a five-minute walk…
Kent Firefighting Museum | Kent
Pay a visit to the Kent Firefighting Museum and discover loads of fun and interesting facts about the history of the fire engine, firefighting and more. This…
Spitfire and Hurricane Memorial Museum | Kent
Home to iconic fighter planes of the Second World War, the Spitfire and Hurricane Memorial Museum in Manston, Kent is a must-visit museum the next time you're…
Tia Rescue Centre | Doncaster
If you love animals and live in the Doncaster area, pay a visit to the Tia Centre, the greyhound and Shire horse rescue centre. Set across 70 acres of…
Half Price Entry at Chessington World of Adventures & More
Struggling for things to do whilst Schools out? Pick up an 'Attack A Snak' in store today and you will be able to get half price entry at Chessington World of…
National Football Museum | Manchester
Manchester residents only
Are you or your kids footie mad? Then I've got the perfect day out for you. The National Football Museum in Manchester offers free admission to Manchester…
Museum of London Docklands | London
The Museum of London Docklands is a fab, free way to spend an afternoon in London. Perfect for the whole family, it's not to be missed! This 200-year-old…
Sherling High-Level Walkway | London
The Sherling High-Level Walkway and Viewing Gallery offers free daily access to exciting theatre production workshop views. It's a must-visit for theatre…
Gods Own Junkyard | London
Enjoy a different day out in London by taking a trip the Gods Own Junkyard in south London. It's filled to the brim with brightly coloured lights and signs and…
Mudchute Park & Farm | London
Set in 32 acres of countryside in the heart of East London, the Mudchute is a community charity, complete with stables, a working farm and a wide range of free…
Bushy Park | London
If you enjoy fresh air and wildlife, Bushy Park is for you. With an area of 445 hectares (1,099 acres), it is the second largest Royal Park and home to around…
Horniman Museum & Gardens | London
If you find yourself in South East London, make sure you pay a visit to the Horniman Museum & Gardens. It's the perfect place to enjoy some rare greenery in…
Bank of England Museum | London
Next time you're in London, don't forget to pay a visit to the Bank of England Museum. Discover the important role that the Bank of England continues to play…
The Tall Ship | Glasgow, Scotland
The Tall Ship is one of the best free trips in Glasgow for the whole family. Explore one of Scotland's most famous ships and enjoy some good old fashioned sea…
Riverside Museum | Glasgow, Scotland
The Riverside Museum in Glasgow is an award-winning transport museum and should be top of your to-do list next time you're in Glasgow. With over 3,000 objects…
Lichfield Cathedral | Birmingham
Lichfield Cathedral is a hidden gem in the heart of the country. On arrival, you will receive a warm welcome and a free Pilgrim Guide to guide you round the…
City of Bath Walking Tours | Bath
Literary fans can follow in Jane Austen's footsteps and join this free tour of her favourite city. You'll discover the main points of historical and…
Maiden Castle | Weymouth
This huge Iron Age hillfort covers an area the size of 50 football pitches. Discover its 4000 year history by reading the information panels that guide…
The Winter Garden | Sheffield
Visit one of the world's biggest greenhouses, where you'll find 2,500 different plants. It's a stunning world of greenery in the heart of the city. It…
Borough Market | London
Give your taste buds a treat with a visit to London's most renowned food market. It's a hub of traders selling exceptional British and international…
Lewis Carroll Centre | Liverpool
This new centre in the charming village of Daresbury is dedicated to the writer of Alice in Wonderland. Take a trip through the looking-glass, learn about his…
Healey's Cornish Cyder Farm | Newquay
Healey's Cornish Cyder Farm shop offers free tastings of all our products and you can 'watch them work'. They are the largest Cornish Cyder maker in…
Newlyn Art Gallery & The Exchange | Penzance
Admission is completely free for under 18s, Art Pass holders and supporters, otherwise is just £2.20 including gift donation for a 7-day pass. The Newlyn Art…
Antrim Round Tower | Belfast, Northern Ireland
Are you heading to Belfast? The Antrim Round Tower is open all year round and it's completely free to look at. The tower was built around the 10th century as a…
Malone House | Belfast
Malone House gives spectacular views over the beautiful Lagan Valley Regional Park. It is an elegant late Georgian mansion set amongst rolling meadows and…
Lagan Valley Regional Park | Belfast
The Lagan Valley Regional Park is just a short, 16-minute drive from Belfast city centre. It's a great place to visit, especially if you love nature. With 13…
Strickland's Glen | Bangor
Heading to Bangor soon? If you're looking for a free day out, Strickland Glen could be just the thing. The wooded glen, which follows the Bryans Burn, a stream…
Belfast Castle | Belfast
If you're visiting Belfast, a trip to Belfast castle is a must to soak up the history of the place. The site was first occupied by a castle built by the…
Mountsandel Fort | Coleraine, Northern Ireland
Just a short, 50-minute drive from Derry, Mountsandel Fort is based in the picturesque town of Coleraine. The surrounding Mountsandel Forest is extremely…
Dundrum Castle | Dundrum
It's hard to contemplate how something built in 1177 could still be standing, but that is the case for Dundrum Castle. The car park down below provides a…
Dunluce Castle | Bushmills, Northern Ireland
Dunluce castle sits along the dramatic Northern coasts, boasting breathtaking views across both land and sea. The castle has a rich and varied history, of…
Armagh County Museum | Armagh, Northern Ireland
Armagh County Museum should be right at the top of any culture-buffs list of places to visit. Not only is it the oldest county museum in Ireland, but its…
Ulster Museum | Belfast, Northern Ireland
After a 3 year £17million redevelopment project the Ulster Museum has reopened. The Museum has collections devoted to a number of subjects, from Archaeology…
Abergavenny Museum | Abergavenny
Abergavenny was once a bustling market town. The history of which, can be found in the Abergavenny Museum. The museum itself resides inside an old hunting…
Pontypool Museum | Pontypool
Pontypool Museum is situated in a rather modest stable block, accessed from a charming, cobbled courtyard. It's contents, however, and far from modest.…
South Wales Miners' Museum | Port Talbot, Wales
Just a short, six mile drive away from picturesque Port Talbot sits South Wales Miner Museum. It sits in the stunning Afan Valley, surrounded by Afan Forest…
Newport Museum & Art Gallery | Newport
Newport Museum and Art Gallery has been standing since 1988, hosting a wide collection of Newport's history, culture and environment. There are four…
Museum of Modern Art | Machynlleth
The Museum of Modern Art (MOMA) in Powys is a must-see for art and culture lovers alike. The MOMA sits beside The Tabernacle - a centre for the Performing…
Margam Country Park | Port Talbot
Margam Country Park is a truly magnificent day to spend a day. The scenery alone is simply stunning, but that's just the beginning. There are lots of other…
National Waterfront Museum | Swansea, Wales
Head to the National Waterfont Museum and learn about the history of innovation and industry in Wales. Particular emphasis is placed on The Industrial…
Afan Forest Park | Port Talbot
For fans of cycling and walking, cheap days out don't come much better than Afan Forest Park. Afan Forest Park is stretched over 64 square kilometres, with…
Dylan Thomas Centre | Swansea, Wales
If you're in or around Swansea, head to The Dylan Thomas Centre for a fun and cheap day out. It's situated in a beautiful building in the Maritime Quarter -…
National Roman Legion Museum | Caerleon
Have you visited the National Roman Legion Museum yet? If not, what are you waiting for? It's the perfect place to go to discover more about the Romans.…
St Fagans Museum of History | Cardiff, Wales
Cardiff is home to one of Europe's leading open-air museums, St Fagans National Museum of History. It's a beautiful site, surrounded by the stunning St Fagans…
National Slate Museum | Gwynedd
Planning a trip to Wales soon? Make sure you've got the National Slate Museum high up on your list - it's a great cheap day out for all the family to enjoy!…
National Wool Museum | Carmarthenshire
The National Wool Museum showcases the Welsh woollen industry in all its glory. Wales once relied heavily on its wool industry, as it was the most widespread…
National Museum Cardiff | Cardiff, Wales
What other museum would you go to when visiting Wales than The National Museum in Cardiff? It hosts a selection of World class art and natural history - a…
The National Gallery Complex | Edinburgh, Scotland
The National Gallery Complex is composed of three different Galleries, all situated in Edinburgh. The Scottish National Gallery has one of the best collections…
The Aberdeen Maritime Museum | Aberdeen
Aberdeen has had a long and fruitful relationship with the sea. Head to The Aberdeen Maritime Museum to learn all about it. Located on the historic Shiprow in…
The People's Story | Edinburgh, Scotland
There's nothing that helps you learn about the past more than discovering the stories of people that lived through it. At The People's Story in Edinburgh,…
Queensferry Museum | Edinburgh, Scotland
Queensferry sits to the West of Edinburgh and boasts fantastic sea views. If that wasn't reason enough to pay a visit, the Queensferry Museum certainly is.…
National Museum of Scotland | Edinburgh, Scotland
What better place to learn about Scottish history than at the National Museum of Scotland? There are many different collections, each enthralling visitors…
Kelvingrove Art Gallery & Museum | Glasgow, Scotland
If you're looking for cheap but amazing family days out in Glasgow, you've come to the right place. Kelvingrove Art Gallery houses one of Europe's great art…
Museum of Childhood | Edinburgh, Scotland
After a major refurbishment, Edinburgh's Museum of Childhood has now been reopened to the public. Discover how growing up has changed (and stayed the same!)…
The Writer's Museum | Edinburgh, Scotland
Whether you're an avid writer, reader, or just want to find more about those who are, The Writer's Museum in Edinburgh is the place for you. The museum offers…
St Giles' Cathedral | Edinburgh, Scotland
St Giles' Cathedral is a truly beautiful place. The stunning architecture is enough to astonish people of all ages - it's a great cheap day out for the whole…
Royal Botanic Garden | Edinburgh, Scotland
Founded in 1670, The Royal Botanic Garden (RBGE) was founded in 1670. Originally purposed as a physic garden, it's evolved over time to become a world-renowned…
Poole Museum | Poole
Poole Museum offers a wonderfully interesting, free day out for the whole family. The architecture of the Museum is just as interesting as its contents -…
Falmouth Art Gallery | Falmouth
Visiting Falmouth soon? A trip wouldn't be complete without a visit to Falmouth Art Gallery. Situated on The Moor and offering free entry for all, it's an…
Watchet Market House Museum | Somerset
Step back into the history of Watchet, an ancient sea port in Somerset, inside this small but substantial museum. The house itself is extremely charming, and…
The Shoe Museum | Somerset
Heading to Street in Somerset? The make sure you take a trip to The Shoe Museum - it's a truly fantastic day out for one and all. The shoe museum has four…
The Blake Museum | Bridgwater, Somerset
If you're passing through Bridgwater, make sure you visit the Blake Museum. Admission is free for everyone and it's open from 10am - 4pm Tuesday to Saturday.…
Bath Assembly Rooms | Bath
Step back into the heart of fashionable 18th Century life in the Bath Assembly Rooms situated in the centre of Bath. They are also home to the Fashion Museum.…
Bournemouth Aviation Museum | Bournemouth
Do you love planes and all things aviation? You're in for a treat! Bournemouth Aviation Museum Museum has so many exciting exhibitions for children of all ages…
Perry's Cider Mill | Somerset
Head to the picturesque Somerset village of Dowlish Wake where the cider mills and visitor centre still occupies the original family farm. You can sample the…
Decoy Country Park | Newton Abbot, Devon
Decoy Country Park is the perfect free day out for the whole family. Next time you're in the area make sure you check it out! Once a clay quarry, Decoy Country…
St Agnes Museum | Cornwall
We've found a lovely free day out for the whole family! St Agnes Museum, Cornwall is full of fascinating artefacts and information about the rich mining and…
Willows & Wetlands | Taunton
Looking for a free day out during your next visit to Taunton, Somerset? We've found an amazing one for you! Visit the Willows and Wetlands Visitor Centre and…
Wollaton Hall, Gardens & Deer Park | Nottingham
If you're ever in Nottingham, Wollaton Hall is a must visit free activity for you and your family. Enjoy wandering around a spectacular Elizabethan mansion in…
Fry Art Gallery | Saffron Walden, Essex
Make sure you add The Fry Art Gallery to your 'to see' list on your next visit to Saffron Walden. Situated in this lovely market town, This Public Art Gallery…
Harborough Museum | Harborough
Based in the lovely, history market town of Market Harborough, Harborough Museum is a must-see for anyone visiting the area. The museum will transport you back…
Charnwood Museum | Loughborough
Check out a wide range of exhibits reflecting the history, geology, archaeology and industries of Charnwood and the surrounding area. What a lovely free day…
The Higgins Art Gallery & Museum | Bedford
The Higgins Art Gallery & Bedford Museum is the perfect free day out if you're visiting Bedford. It is bursting with history and culture and has something the…
Thetford Priory | Thetford, Norfolk
Visit the extensive remains of one of the most important East Anglian monasteries, the Cluniac Priory of Our Lady of Thetford. This free day out features lots…
Firehouse Museum | Stalham
Stalham Firehouse Museum is an excellent free day out for everyone to enjoy! Visit the Firehouse museum and see old fire fighting equipment, a wartime pump and…
Norwich Cathedral | Norwich, Norfolk
Become one of the thousands of people that visit Norwich Cathedral from all over the world! It's a fascinating free day out where you'll get to explore the…
John Jarrold Printing Museum | Norwich, Norfolk
If you're looking for a free day out and you are a fan of the traditional printed press, John Jarrold Printing Museum is definitely the free day trip for you!…
Ferry Meadows Country Park | Peterborough
Take a trip to Peterborough and enjoy 500 acres of meadows, lakes and woods that run alongside the River Nene. You can go cycling, walking, pony riding, nature…
Kettle's Yard | Cambridge
Next time you're in Cambridge, make sure you visit Kettle's Yard! Kettle's Yard Gallery is a major centre for 20th century and contemporary art. Designed by…
The Fitzwilliam Museum | Cambridge
Visit the Fitzwilliam Museum in Cambridge and soak up all the arts and culture on this fantastic free day out! There's something for the whole family at this…
Lapworth Museum of Geology | Birmingham
The Lapworth Museum of Geology has the finest and most extensive collections of fossily, minerals and rocks in the Midlands. Dating back to 1880, the Museum is…
Herbert Art Gallery & Museum | Coventry
Looking for things to do in Coventry? Why not pay a visit to the Herbert Art Gallery & Museum! Managed as part of Culture Coventry, in partnership with three…
Worcester City Art Gallery & Museum | Worcester
Worcester City Art Gallery and Museum is the perfect free and fun day out for the whole family. There are so many amazing things to see and do, so make sure…
Birmingham Museum & Art Gallery | Birmingham
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text:
Prevalence and determinants of complementary and alternative medicine use among infertile patients in Lebanon: a cross sectional study
Ghina S Ghazeeri1,
Johnny T Awwad1,
Mohamad Alameddine2,
Zeina MH Younes3 &
Farah Naja3,4
Complementary and alternative medicine (CAM) is widely used for the treatment of infertility. While the Middle East and North Africa region has been shown to house one of the fastest growing markets of CAM products in the world, research describing the use of CAM therapies among Middle-Eastern infertile patients is minimal. The aim of this study is to examine the prevalence, characteristics and determinants of CAM use among infertile patients in Lebanon.
A cross sectional survey design was used to carry out face-to-face interviews with 213 consecutive patients attending the Assisted Reproductive Unit at a major academic medical center in Beirut. The questionnaire comprised three sections: socio-demographic and lifestyle characteristics, infertility-related aspects and information on CAM use. The main outcome measure was the use of CAM modalities for infertility treatment. Determinants of CAM use were assessed through the logistic regression method.
Overall, 41% of interviewed patients reported using a CAM modality at least once for their infertility. There was a differential by gender in the most commonly used CAM therapies; where males mostly used functional foods (e.g. honey & nuts) (82.9%) while females mostly relied on spiritual healing/prayer (56.5%). Factors associated with CAM use were higher household income (OR: 0.305, 95% CI: 0.132–0.703) and sex, with females using less CAM than males (OR: 0.12, 95% CI: 0.051–0.278). The older patients were diagnosed with infertility, the lower the odds of CAM use (p for trend <0.05). Almost half of the participants (48%) were advised on CAM use by their friends, and only 13% reported CAM use to their physician.
The considerably high use of CAM modalities among Lebanese infertile patients, added to a poor CAM use disclosure to physicians, underscore the need to integrate CAM into the education and training of health professionals, as well as enhance infertile patients' awareness on safe use of CAM products.
Complementary and Alternative Medicine (CAM) refer to a heterogeneous group of practices that are defined by The National Center for Complementary and Alternative Medicines as "a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine" [1]. According to the World Health Organization (WHO), more than three-quarters of the world's population use complementary and alternative medicine (CAM) for health care. Up to date, there is still inadequate data concerning the potential benefits or risks attributed to the use of CAM [2]. Moreover, exchange of information on CAM use between the patient and physician has also been shown to be scarce [1]. The most reported reasons for the increase in the use of CAM include the absence of perceived efficacy and experience of adverse effects with conventional medicine, a perceived harmlessness of CAM treatments as well as the belief that use of CAM therapies allows users more active involvement in treatment and in healthcare decisions [3–5].
Infertility has been identified by the WHO as an international public health concern, affecting an estimated 72.4 million women in year 2007 [6, 7].
While assisted reproductive technologies (ART) serve as promising treatment options for these patients to achieve parenthood, they do not always prove to be successful, and the expense associated with their utilization has proven to be a burden, leaving couples feeling "desperate" to try anything to conceive [4, 5, 8]. Previous studies about prevalence of CAM use among infertility patients reported estimates between 30 and 60% [1, 9–11].
While the Middle East and North Africa region has been shown to house one of the fastest growing markets of CAM products in the world [12], research describing the use of CAM therapies among Middle-Eastern infertile patients is minimal. A recent study on the use of complementary and alternative medicines by a sample of Turkish women for fertility enhancement found that 82% of study participants have used CAM at least once for their infertility problem [4]. In Lebanon, no data exists on the prevalence, types, characteristics, and reasons for using CAM among infertile couples. With Lebanon showing the lowest fertility rate among the Arab countries [total fertility rate dropping from 3.2 in the year 2004 to 1.8 in the year 2009 [13–15], it may be hypothesized that couples are increasingly seeking alternative and complementary treatment modalities.
The lack of systematic information on the prevalence, types and mode of CAM use for the treatment of infertility in the Arab world in general, and Lebanon in particular, has hindered public efforts to enhance the safety of public consumption and slowed down the integration of CAM treatments into mainstream medicine.
The purpose of this study is to examine the frequency, types, modes and determinants of CAM use among couples seeking infertility treatment in Lebanon.
A cross sectional survey was undertaken at the Assisted Reproductive Technology (ART) Unit at a major tertiary hospital in Beirut, American University of Beirut Medical Center, Lebanon. Ethical approval was obtained from the Institutional Review Board (IRB) at the American University of Beirut (AUB). "During the interview, a semi structured questionnaire was completed (Additional file 1)". The ART unit, initiated in 1993, is the largest in the country, accepting patients rom fall of the Lebanese governorates and performing between 80 and 120 cycles per month, including intra-uterine insemination (IUI), in-vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI). The ART unit team consists of four specialized physicians, three embryologists and four nurses. Between January 2011 and August 2011, all patients (males and females) attending a routine visit at the ART unit were approached to complete an anonymous questionnaire about their use of CAM. When couples presented to the unit, the partner receiving treatment was invited to participate in the study. To be included in the study, patients had to be over 18 years of age, diagnosed with infertility for a minimum of one year and be conversant in either the English or Arabic language. All eligible patients were approached by a trained female nurse. Interviews took place in the visit room individually and lasted approximately 15 minutes. Subject's written consent was obtained.
A face-to-face interview was undertaken with consecutive infertile patients attending the ART unit at AUB-MC. During the interview, a semi structured questionnaire was completed.
The first draft of the questionnaire was drafted by an expert panel including two physicians, a health management professor and an epidemiologist and was based on a synthesis of tools used in similar studies [4, 10]. To enhance the content validity of this questionnaire and ensure its appropriateness to the local cultural context, a pilot study involving a sample of 15 subjects was carried out. Certain culturally sensitive items were identified and in turn were excluded, such as the number of sexual partners in the past and the age at which sexual activity was commenced. The final version of the questionnaire consisted of three sections. The first section included questions about the socio-demographic and lifestyle characteristics, such as age, sex, religion, number of years being married, education, income, living with parents-in-law, health insurance, smoking status (and number of years smoked) and self-perceived level of stress. Subjects were considered "insured" if they were found to have private and/or public insurance. Self-perceived stress was recorded as a number from 0 to 10, with a value of 0 being the lowest, indicating "no stress", and a value of 10 being the highest, indicating "extreme stress" [16]. The second section of the questionnaire addressed aspects of the subject's infertility, such as the age at diagnosis, kinship to spouse, presence of fertility problems in the family, duration of infertility, barriers to adherence to treatment, and conventional treatment modalities that have been utilized. In the last section of the questionnaire, participants were asked about the types of CAM treatments used since diagnosis with infertility for the purpose of improving their condition, frequency of use, the provider of CAM modalities, disclosure of CAM use to the physician, usefulness of CAM, side effects and purpose of use. For the purpose of this study, side effects referred to any unpleasant event that could be experienced by the patient as a result of his/her use of a specific CAM modality. This unpleasant event could range from psychological distress to serious medical condition. Use of CAM was defined as the use of any one or more CAM type for the purpose of infertility treatment since diagnosis.
The data was described by frequencies and percentages and by means and standard deviations for categorical and continuous variables respectively. The relationship between the various demographic and infertility-related characteristics and use of CAM was assessed by estimating odds ratios (OR) and 95% confidence intervals (CI) using logistic regression with "use of CAM" as the outcome variable. Multivariate logistic regression modeling was used to assess the predictors of CAM use. Variables were put in the model in order of strength of their association with CAM use as per the univariate analysis. The effect of each variable on the model was assessed and this variable was kept in if it significantly contributed to a better fit of the model. Statistical significance was set at p <0.05, with all tests being two-sided. SPSS 18.0 software was utilized to analyze the obtained data.
Descriptive analyses
Out of the 262 patients approached, 213 agreed to participate in the study (response rate: 81.3%). Lack of sufficient time to spend on the interview and fear of name disclosure were the main reasons that were reported for the refusal to participate. Analysis of findings showed that 41% of patients have used a form of CAM at least once as a treatment for their infertility. When "prayer" was excluded from the definition of CAM, prevalence of CAM use in the study population became 23%.
Demographic, lifestyle, reproductive and infertility related characteristics of the study population are presented in Table 1. Study participants' mean age was 34.7 ± 6.4 years, with no significant difference between users and non users of CAM. Among the socio-demographic factors considered in this study, sex, years of marriage, income, education and religion were found to be significantly associated with the use of CAM. The odds of using CAM were significantly lower among females (OR: 0.24, CI: 0.13–0.44). Being married from more than 7 years was associated with a significantly higher odd of using CAM (OR: 2.35, CI: 1.21–4.56). Patients with monthly income ranging between $1000 and $2000 and greater than $2000 were less likely to use CAM as compared to patients with income less than $1000. Higher education (university and college levels) was associated with lower prevalence of CAM use (OR: 0.35, CI: 0.20–0.62). Use of CAM was significantly lower among Christian participants as compared to Muslim patients (OR: 0.44, CI: 0.21–0.92). As for infertility related characteristics, prevalence of CAM use decreased with increasing age at diagnosis with infertility and increased with longer duration of infertility (OR: 1.11, CI: 1.04–1.18).
Table 1 Demographic, lifestyle, reproductive and infertility-related characteristics of users and non-users of CAM treatments*
The types and modes of CAM used by study participants are presented in Table 2. Types of CAM were divided into dietary supplements and spiritual/prayer therapy. Dietary supplements included vitamins and minerals, over the counter supplements, herbal therapies and functional foods. Included among the over the counter supplements are fish oils such as salmon and cod liver oils, omega-3 supplements, and products from general nutrition centers. Herbal therapies include plants that are consumed for their claimed health benefits, and encompass remedies such as feverfew, garlic, black seed, ginger, ginkgo, and Asian ginseng.[17] "Functional foods" included any foods that were perceived as having a fertility-enhancing property beyond their basic function; such as honey, and foods containing essential fats (e.g. fish, nuts and seeds). For the purpose of this study, spiritual/prayer therapy referred to any religion-related activity practiced to improve fertility. The most commonly used CAM treatment among males was found to be functional foods (82.9%), whereas spiritual therapy or "prayers" and herbal therapies, were the most commonly used CAM treatments among females (56.5% and 43.5% for spiritual and herbal therapies, respectively).
Among the CAM users, 90.2% of the males reported using CAM in order to improve their sperm characteristics (sperm motility, production and/or quality) and 87% of female participants reported using CAM in order to enhance their chances of achieving a pregnancy. Other reasons for CAM use reported by patients included relaxation, enhancing psychological well-being or strengthening energy.
When asked about how they chose the CAM modality used, almost half of the participants indicated referral by friends (48.3%) and influence by media (33.3%). Only 6.9% (n = 6) of patients used CAM because of a referral by a health care practitioner. The use of CAM among study participants was regular for the majority of patients (two or more times per week for a minimum of one month) (70.1%). Factors that drove patients to utilize CAM were "belief in its advantages" (56.3%), followed by "trying CAM because of a suggestion" (51.7%), with a few reporting their uptake of CAM to be due to "dissatisfaction with conventional medicine" (9.2%) and feeling that they "had no other alternative" (11.5%). Out of the 87 users of CAM, only 11 patients (12.6%) reported their use of CAM to their physician. Reported reasons for not using CAM were that the physician had not prescribed them (53.2%), followed by the lack of belief in the benefits of CAM as enhancers of fertility (48.4%) (Table 2).
Table 2 Types and modes of CAM use among couples seeking infertility treatment (n = 87)
Results of the multivariate logistic regression analysis examining the association of the various demographic and infertility-related characteristics and CAM use are presented in Table 3. Sex, age at diagnosis with infertility, household income, and type of infertility treatment were independent predictors of CAM use. Prevalence of CAM use was lower among females (OR: 0.12, CI: 0.051–0.278). In addition, the older the patients were diagnosed with infertility the less likely they were to use a CAM modality (p for trend < 0.001). Subjects belonging to the highest income bracket (>2000$/month) used less CAM therapies as compared to those in the lowest income bracket (<1000$/month) (OR: 0.305, CI: 0.132–0.703). Subjects undergoing IUI or IVF procedures were more likely to be CAM users (OR: 20.918; CI: 1.1–7.75). Age, barriers to medical treatment adherence, years of marriage, and religion were not found to reach statistical significance after multivariate adjustment.
Table 3 Multivariate Logistic Regression Model with OR estimates and 95% CI for the association between demographic and fertility-related factors and the use of CAM among study participants (n = 213)
This study investigated the prevalence and determinants of CAM use among infertile patients attending the Assisted Reproductive Technology (ART) Unit at the American University of Beirut Medical Center, a major tertiary hospital in Beirut, Lebanon. We found that 41% of infertile patients used a form of CAM at least once as a treatment for their infertility. Studies on prevalence of CAM use among infertile patients reported a wide range of estimates. Similar to our findings, a study from the United Kingdom assessing CAM use among 400 infertile women found 40% of participants to have used CAM as a therapy for their failure to conceive [11]. Furthermore, in Denmark, a prospective observational cohort study reported a 31% prevalence of CAM use among infertile women [1]. However, in the United States, a lower prevalence was found in a cohort study of 428 couples seeking infertility treatment (29%) [10], while a relatively high prevalence (82%) of CAM use among Turkish infertile patients was recently reported [4]. Possible reasons for the discrepancy in prevalence estimates reported in the literature could be the heterogeneity of CAM practices, where there may be differences in what is defined as a CAM treatment and what types of CAM modalities are included in the studies. Other reasons may be differences in study design as well as in cultural backgrounds which could lead to differential patterns of use.
Our findings showed that among women, "spiritual healing", specifically "prayer" and "religious vows", were the most commonly practiced CAM therapies. Religious vows involve making a promise to perform a specific deed once the prayer has been answered. Lebanon seems to be a country whereby religion is highly influential on people's daily practices, with prayer being an integral part of the culture. Spiritual healing has been suggested to have potentially beneficial effects through its provision of hope and in turn, a positive attitude towards patients' conventional infertility treatment, as was suggested in the Turkish study assessing CAM use for infertility enhancement [4].
In this study, the most commonly utilized CAM therapy by men was "functional foods", specifically fish, nuts, and seeds, honey and royal honey. Seeds and nuts have been reported by complementary medicine practitioners to be beneficial for treating infertility due to their polyunsaturated fatty acid content [18]. Honey has been traditionally used among the Lebanese and other Arab populations for treatment of many diseases, such as the common cold and cough, in addition to infertility. Royal honey, also called "food for queens", is a honey bee secreted from the glands in the hypopharynx of worker bees that is believed to give the queen bees their longevity and fertility. Furthermore, honey is mentioned in both the Quran (the Muslim Holy Book) and the Holy Bible as having the feature of healing mankind [19, 20].
In addition to prayers and functional foods, our results showed that herbal therapies were used by men and women for infertility treatment, including blackseed, ginseng, maca, and marjoram. Blackseed, the common name for Nigella sativa L. seeds, is traditionally used as a spice and food preservative. Although hexane extracts of this seed have been shown to have significant antifertility activity in rats [21], it is a common belief among muslims and Christians in Lebanon and other countries of the Middle East that this seed possesses curative abilities for a wide range of diseases, including fertility [22]. Ginseng, maca and marjoram are herbal plants that have been suggested in the literature to confer beneficial effects on male fertility [23–25].
Although minimal or no risk has been associated with prayer and the use of functional foods for infertility treatment, herbal therapies have been reported to adversely affect chances of pregnancy and health. Phytoestrogens present in herbal supplements have been suggested to have negative estrogenic effects on implantation [1]. Furthermore, the side effects associated with a number of herbs is still unknown [2].
It is disconcerting that only 7% of the CAM users in our sample reported being advised on CAM modalities by their "health practitioner", and the disclosure rate of CAM use to the physician was found to be low (13%). These findings are consistent with previous research, where in a review of qualitative and quantitative studies evaluating the disclosure of patients' CAM use to medical practitioners, Robinson & McGrail [26] reported disclosure rate to be as low as 23% in some of their included studies. Possible reasons for why patients seem to find it difficult to report their CAM use to their physician include the fear of receiving a negative reaction and disapproval from their physician, believing that their physician did not need to know about their CAM use, and/or because their physician had not inquired about their CAM use [26, 27]. This low disclosure rate of CAM use is alarming and may warrant the need to train physicians on probing their patients on CAM use [22]. Health care practitioners need to become more aware of the increasing prevalence of their patients' CAM use in order to be able to improve the provision of evidence-based knowledge to their patients concerning the use of these therapies [28].
Our results indicated that sex, age at infertility diagnosis, household income and the type of infertility treatment were independent correlates of CAM use. Males were found to be at higher odds of using CAM. This is in contrast to other studies that found women to be at higher odds of using CAM compared to men [11, 27, 29]. A possible explanation of our finding could be the fact that in the Arab culture, including Lebanon, fertility is linked to manhood, leading male infertility to be an issue for masculinity, marriage and family life [30]. As such, males in this culture may be placing more attention on treatments to enhance their fertility as a mean to restore their "manhood" [30]; such assumption would need to be substantiated in future sociological/ anthropological research.
Our results showed that higher income was associated with lower use of CAM therapies. In previous studies of determinants of CAM use, household income was consistently positively correlated with CAM use [10, 11, 31]. This relationship between CAM use and a high income status in other studies could be attributed to the fact that couples of high income would be more likely to afford the cost of CAM, in addition to their infertility treatments [11]. In those studies, the most widely used CAM were costly modalities, such as acupuncture and massage therapy. In our study population on the other hand, the most widely used CAM modalities were functional foods and prayers among male and female patients, respectively; both of which are therapies that are considered of lower cost, and thus may be less likely to pose as a financial burden to patients of lower income.
Several limitations are to be considered in this study. First, the fact that recruitment of participants took place in an Assisted Reproductive Technologies Unit might have led to an underestimation of the prevalence of CAM use since surveyed subjects have a potential bias toward conventional treatment. Second, given that participants in this study were recruited from one clinical setting raises questions concerning the generalizability of our findings; however, the ART unit at the American University of Beirut Medical Center is considered the largest unit for infertility treatment in Lebanon (as reflected by the high number of cycles it performs per month) and is a major referral center for the treatment of infertility from all other governorates. Third, the cross sectional nature of the study does not allow establishing causality between the various correlates and the CAM use. Finally, the possibility of a recall bias cannot be ruled out in self reports concerning CAM use.
Our results showed that a considerable proportion of patients used CAM therapies for infertility treatment. "Functional foods" and "spiritual healing" were the most commonly used CAM modalities by our sample of male and female patients, respectively. CAM use is associated with lower household income, male gender, younger age at infertility diagnosis, and undergoing ART procedures for infertility treatment. The considerably high use of CAM modalities among Lebanese infertile patients, added to a poor CAM use disclosure to physicians suggests the need for physicians to initiate discussions with their patients regarding CAM use. In addition future research is needed in areas such as CAM education of healthcare workers and patients' awareness on the proper use of the CAM modalities.
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Bishop FL, Yardley L, Lewith GT: Why consumers maintain complementary and alternative medicine use: A qualitative study. J Altern Complement Med. 2010, 16 (Suppl 2): 175-182.
Edirne T, Arica SG, Gucuk S, Yildizhan R, Kolusari A, Adali E, Can M: Use of complementary and alternative medicines by a sample of Turkish women for infertility enhancement: A descriptive study. BMC Complement Altern Med. 2010, 10: 11-10.1186/1472-6882-10-11.
Rayner JA, McLachlan HL, Forster DA, Cramer R: Australian women's use of complementary and alternative medicines to enhance fertility: Exploring the experiences of women and practitioners. BMC Complement Altern Med. 2009, 9: 52-10.1186/1472-6882-9-52.
Boivin J, Bunting L, Collins JA, Nygren KG: International estimates of infertility prevalence and treatment-seeking: Potential need and demand for infertility medical care. Hum Reprod. 2007, 22 (Suppl 6): 1506-1512.
Cousineau TM, Domar AD: Psychological impact of infertility. Best Pract Res Clin Obstet Gynaecol. 2007, 21 (Suppl 2): 293-308.
Current practices and controversies in assisted reproduction. Report of a WHO meeting. Edited by: Vayena E, Rowe P, Griffin P. 2002, Geneva: World Health Organization
Vincent C, Furnham A: Why do patients turn to complementary medicine? An empirical study. Br J Clin Psychol. 1996, 35 (Pt 1): 37-48.
Smith JF, Eisenberg ML, Millstein SG, Nachtigall RD, Shindel AW, Wing H, Cedars M, Pasch L, Katz PP, Infertility Outcomes Program Project Group: The use of complementary and alternative fertility treatment in couples seeking fertility care: Data from a prospective cohort in the United States. Fertil Steril. 2010, 93 (Suppl 7): 2169-2174.
Coulson C, Jenkins J: Complementary and alternative medicine utilisation in NHS and private clinic settings: A United Kingdom survey of 400 infertility patients. J Exp Clin Assist Reprod. 2005, 2 (Suppl 1): 5-
Gruenwald J, Herzberg F: The Global Nutraceuticals Market. Business Briefing – Innovative Food Ingredients. 28-31. [http://www.bbriefings.com/pdf/foodingredients_2002/]
Khlat M, Deeb M, Courbage Y: Fertility levels and differentials in Beirut during wartime: An indirect estimation based on maternity registers. Popul Stud (Camb). 1997, 51 (Suppl 1): 85-92.
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Hughes C, Davoodi-Semiromi Y, Colee JC, Culpepper T, Dahl WJ, Mai V, Christman MC, Langkamp-Henken B: Galactooligosaccharide supplementation reduces stress-induced gastrointestinal dysfunction and days of cold or flu: a randomized, double-blind, controlled trial in healthy university students. Am J Clin Nutr. 2011, 93 (Suppl 6): 1305-1311.
Pribitkin ED, Boger G: Herbal therapy: What every facial plastic surgeon must know. Arch Facial Plast Surg. 2001, 3 (Suppl 2): 127-132.
Veal L: Complementary therapy and infertility: an Icelandic perspective. Complement Ther Nurs Midwifery. 1998, 4 (Suppl 1): 3-6.
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Bible Verses about Honey Isaiah 7:15. [http://www.openbible.info/topics/honey
Keshri G, Singh MM, Lakshmi V, Kamboj VP: Post-coital contraceptive efficacy of seeds of Nigella sativa in rats. Indian J Physiol Pharmacol. 39 (Suppl 1): 59-62.
Naja F, Alameddine M, Abboud M, Bustami D: Al Halaby R: Complementary and Alternative Medicine use among pediatric patients with leukemia: the case of Lebanon. Integr Cancer Ther. 2011, 10 (Suppl 1): 38-46.
El-Ashmawy IM, Saleh A, Salama OM: Effects of marjoram volatile oil and grape seed extract on ethanol toxicity in male rats. Basic Clin Pharmacol Toxicol. 2007, 101 (Suppl 5): 320-327.
Pak SC, Lim SC, Nah SY, Lee J, Hill JA, Bae CS: Role of Korean red ginseng total saponins in rat infertility induced by polycystic ovaries. Fertil Steril. 2005, 84 (Suppl 2): 1139-1143.
Clément C, Kneubühler J, Urwyler A, Witschi U, Kreuzer M: Effect of macca supplementation on bovine sperm quantity and quality followed over two spermatogenic cycles. Theriogenology. 2010, 74 (Suppl 2): 173-183.
Robinson A, McGrail MR: Disclosure of CAM use to medical practitioners: a review of qualitative and quantitative studies. Complement Ther Med. 2004, 12 (Suppl 2–3): 90-98.
Hori S, Mihaylov I, Vasconcelos JC, McCoubrie M: Patterns of complementary and alternative medicine use amongst outpatients in Tokyo. Japan. BMC Complement Altern Med. 2008, 8: 14-10.1186/1472-6882-8-14.
Tan M, Uzun O, Akçay F: Trends in complementary and alternative medicine in Eastern Turkey. J Altern Complement Med. 2004, 10 (Suppl 5): 861-865.
Al-Windi A: Determinants of complementary alternative medicine (CAM) use. Complement Ther Med. 2004, 12 (Suppl 2–3): 99-111.
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Department of Obstetrics and Gynecology, American University of Beirut Medical Center Beirut, Beirut, Lebanon
Ghina S Ghazeeri & Johnny T Awwad
Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
Mohamad Alameddine
Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
Zeina MH Younes & Farah Naja
Department of Nutrition and Food Sciences Faculty of Agricultural and Food Sciences (FAFS), American University of Beirut, P.O.Box 11–0236, Riad El Solh, 11072020, Beirut, Lebanon
Farah Naja
Ghina S Ghazeeri
Johnny T Awwad
Zeina MH Younes
Correspondence to Farah Naja.
GG assisted in the design of the study and acquisition of data, in addition to writing the first draft of the manuscript. FN conceived of the study, participated in the design of the study, evaluated the results and corrected the manuscript for publication. JA helped in drafting the manuscript and discussion of results. MA conducted the statistical analysis. ZY contributed in obtaining the completed questionnaire and assisted to analyzing the data. All authors read and approved the final manuscript.
12906_2012_1137_MOESM1_ESM.docx
Additional file 1: Questionnaire used to assess the prevalence and determinants of the use of complementary and alternative medicine (CAM) among Lebanese infertile patients.(DOCX 42 KB)
Ghazeeri, G.S., Awwad, J.T., Alameddine, M. et al. Prevalence and determinants of complementary and alternative medicine use among infertile patients in Lebanon: a cross sectional study. BMC Complement Altern Med 12, 129 (2012). https://doi.org/10.1186/1472-6882-12-129

redpajama_set_name: RedPajamaCommonCrawl


text:
Using number in everyday life
Jill Porter
The Routledge Companion to Severe, Profound and Multiple Learning Difficulties
London, U. K.
Porter, J. (2015). Using number in everyday life. In The Routledge Companion to Severe, Profound and Multiple Learning Difficulties (pp. 316-323). London, U. K.: Taylor and Francis.
Using number in everyday life. / Porter, Jill.
The Routledge Companion to Severe, Profound and Multiple Learning Difficulties. London, U. K. : Taylor and Francis, 2015. p. 316-323.
Porter, J 2015, Using number in everyday life. in The Routledge Companion to Severe, Profound and Multiple Learning Difficulties. Taylor and Francis, London, U. K., pp. 316-323.
Porter J. Using number in everyday life. In The Routledge Companion to Severe, Profound and Multiple Learning Difficulties. London, U. K.: Taylor and Francis. 2015. p. 316-323
Porter, Jill. / Using number in everyday life. The Routledge Companion to Severe, Profound and Multiple Learning Difficulties. London, U. K. : Taylor and Francis, 2015. pp. 316-323
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Many people look forward to vacations. Perhaps you head to the Gulf coast with your family or go to a forest to camp. There are so many outdoor activities you can be involved in wherever you are. Whether you go camping outdoors, swim at the beach, or fish on your favorite lake, you will likely enjoy your time.
Outdoor activities are often the reasons for planning for vacations all year long. Your kids might drag out the water toys, and you might get out your favorite novel. Many families plan vacations during the summer, but if you chose the right location, outdoor activities can be enjoyed all year round.
Camping is a great family activity. It is truly a bonding experience living off the land, whether you go camping for a long weekend, or decide to participate in a longer camping trip. If you have a favorite campground, or are looking to start a new tradition, camping and hiking are great family activities.
If you love to just enjoy the sun and to feel of sand against your skin then the Gulf of Mexico might be a great option for you. Just do not forget to bring your sunscreen! If you go to a smaller lake, you might enjoy wake boarding, tubing, or water skiing. If you choose to go to a beach, you could enjoy the sun, soft sand, and the various beach attractions.
If you love fishing, then you might want to head to the shore. You can spend your days with family and get up early to get the best of the fishing. Make sure to come up with a few fish stories just in case the catch is not as good as you thought it would be.
Whatever you choose for outdoor activities or even indoor fun , hopefully you will make the best of your vacation and family time.


From the forests side, waddling from side to side, hurried a funny and unusual assistant towards the shooters - a brown bear. Faithful friend and comrade - so have soldiers called a smart bear - he put a box of ammunition on the ground and stood on all fours.
— Commander! - a soldier ran to the tired man - they are retreating!
The steel traps, someone put traps and they worked! The man nodded, letting the courier go. Yes, the idea of traps has been extremely successful - caught in the teeth of steel, an ordered formation of the opponent simply fell apart.
The most distant place from the checkpoint - is a goal number one for any intruders. Yes, the enemy gave up and was scared, but everyone knew for sure - maybe in an hour or two - and the enemy will attack again. This short pause should be used wisely. Someone asleep, leaned against a tree, someone is bandaging his wounds. Technicians inspect weapons and combat systems. And for the commander this lull in fighting is a good opportunity to assess the changed balance of power and raise the morale of the soldiers.
Enemy sniper managed to hide himself well and waited for exactly the moment when the shot will accurately hit the target.
Shouting, noise, and volleys of weapons, suddenly pierced the ringing silence and came to S.Putnik from afar.
Gently overturned on his back, he felt only the heat radiating from the heart throughout the body, and saw how there a few leaves falling from a birch tree.
"Autumn will come soon ... That's it - he thought - just like in his dreams - he died defending his country ..."
Roar of a soldier, who rushed into attack, raised the other soldiers. Following the bear, as an indomitable avalanche they swooped down on the enemy.
Just in a few minutes, the enemy was completely destroyed. The enemies thought, that having lost the commander, the soldiers will lose their morale, wasn't justified. And certainly it was more difficult to assume that bear on the battlefield could do such deeds! Already three bullets entered his head, all sides were covered with bright red blood from the deep sword and ax, but he threw himself upon towards the enemy.
Put enemy to a flight, the bear and the soldiers returned to their commander. Bear Comrade layed down next to his friend. Everyone understood, that all that remains is to give the last honors to the defenders of homeland.
A few leaves quietly planned down from the birch… As soon as they have touched the wounded bodies, a turquoise glow started to break out of the earth. For a few minutes it completely enveloped the hill, soldiers and their weapons.
The soldiers were unable see such a bright light, they turned away, covering their eyes. But a silhouette of a girl in the glow.
Only the wind carried her words: "How do you like your home land, so it loves you ..."
Radiance extinguished almost immediately. Missed and getting rid of the circles under their eyes, the soldiers saw that on the ground there were left only a rifle and the reward of valour stained in blood.
That, what happened just on the eyes of the soldiers, prompted them to think that their commander was reborn as a mighty hero. Picking up his reward and rifle, they hurried to the nearest castle trying to revive the man in the Prime inductor.
Once the clean prime has touched the reward, the room flooded with radiance.
The next morning, S.Putnik and Bear Comrade were standing at the castles walls. Homeland will never stay without defenders!
Class talents mark enemy heroes for 4 sec, allowing the hero to attack them and use Aimed Shot regardless of range. Marked enemies cannot hide outside the visibility zone.
After S.Putnik had applied one of his skills against his enemy, he marks him with an aim that allows him to attack the enemy hero from each range during 4 seconds.
The hero is accompanied by a bear whose attacks deal 18-114 physical damage. The bear has 520-3844 Health (based on the highest of its Strength and Intellect) and respawns next to the hero 30 sec after its death.
Using a talent defines the bear's behavior depending on the target: attack the indicated enemy, move to and defend a given point or follow the hero.
A faithful front line comrade follows S.Putnik in every fight, the bear with a nickname - Bear Comrade. Although the bear belongs to the class of beings that are summoned by the heroes, he has a significant difference to those - Bear Comrade is not tied to the hero and thanks to this he can move around the whole map.
On the order of his master, Bear Comrade can attack the specified target, keep an area secured (if an enemy comes along, he will attack him) or together with S.Putnik be like a normal summoned nursling.
After improving to "Weighty Argument" Bear Comrade can stun an opponent by few seconds and mark him with the "Exemplary Sniper" aim.
The Warm Welcome talent reduces Stamina (based on Strength) or Will (based on Intellect) of all enemies hit by 87-734 for 4 sec, depending on the hero's highest parameter.
The sniper rifle of S.Putnik can not only shoot with usual bullets. In a close range, he can shoot with an everything breaking load, which deals significant damage.
After improving to «Ground's Teeth», these ability not only deals damage, but also decreases the defense of the target.
Places an invisible mantrap on the selected point which lasts 120 sec and deals 96-845 damage to the first enemy hero that steps on it, reducing their Speed by 50% for 4 sec.
With this talent, S.Putnik can disperse a network of invisible steel traps which will damage enemies after triggering, slow them mark with the "Exemplary Sniper" aim.
Besides the obvious use of steel traps by the defense, they can also be used by attacking the enemies, while limiting their maneuvers and push them closer to their base.
Casts for 1.5 sec and deals 146-1284 damage to the selected enemy hero.
The ultimate of the Hero allows him after making a short pause to aim to deal an substantial damage to the enemy. The ultimate ability can be used on any distance, if the target was marked with the "Exemplary Sniper" aim before.
After the ability is improved to "Devastation", the ability won't have a cooldown, once you have killed an enemy.


text:
Home Top News Germany plot in Ice Hockey World Cup! Historic win against Canada
Germany plot in Ice Hockey World Cup! Historic win against Canada
They fought, did magic, and threw themselves into everything that flew towards the German goal – in the end, the German ice hockey cracks celebrated a historic victory that they deserved. (Everything you need to know about the 2021 World Cup)
All 64 games! The Ice Hockey World Championship will be live on SPORT1 from May 21 to June 6
After a perfect start to the tournament with two wins in 22 hours, national coach Tony Soderhome's team defeated 26-time world champions Canada 3: 1 (2: 1, 0: 0, 1: 0) to win their first World Cup in 25 years against Ice Hockey Homeland.
"It's unusual that we blocked shots, fought and won duels. I've never seen a game like this," cheered goalkeeper Matthias Niederberger, who played a key role in the victory with 39 (!) Marches. SPORT1: "It's very gratifying that we can win such a close game against Canada."
German World Cup plot: "Lion wants heart"
The German team had to work hard for this feeling, however, Niederberger admitted that it was "incredibly tired".
For example: "Thigh cramps started in the second period," the goalie said. "It's very hard work. But you try everything. We have the heart of a lion. You saw it today."
Compared to 9: 4 against Italy and 5: 1 against Norway, the DEB selection again increased significantly, especially in terms of usage, underlining their medal aspirations in Riga.
With another win on Wednesday against the newly promoted Kazakhstan, the Group B leaders could already make it right for the quarterfinals. (Ice Hockey World Cup: Germany – Kazakhstan, live on TV and stream from 3pm on Wednesday)
See also Mol is first and foremost from home, from the world, and from business
Mannheim's Stephen Loip (11th) and Matthias Placha (12th) and their future club teammate Corbynian Holzer (58th) scored for the third victory in the 39th World Cup qualifier against Germany, as did young star Lucas Rachel in the first two games.
Ice Hockey World Cup: Many favorites fail
Nick Paul (19th) scored for World No. 1, who had previously lost to Latvia (0: 2) and the United States (1: 5). In addition to Canadians, favorites Sweden, Finland and Russia have already slipped against the minors.
During the last German World Cup victory over Canada in Vienna in 1996, Lucas Rachel's father Martin, Leon Trozitlin's father Peter and goal scorer Dieter Hegen stood on the ice. Good omen: On the way to the exciting Olympic Friday in 2018, the DEB team defeated the Maple Leafs 4-3 in the semifinals.
"We want to win the game and there's no question about it," defender Moritz Cedar said confidently: "The Latvians have shown the way, and now it's our turn."
The last fight two years ago resulted in a 1: 8 bankruptcy. However, at the time, there were still many NHL top players, and this time Canada has the youngest World Cup squad.
The Canadians, who scored only their first goal in the 111th minute, started with anger in their stomachs and German goal pressure. However, Kniterberger acted as usual and ruined the chances.
Germany is fighting
However, the goals fell on the other side: Lloyd's leading goal was deflected by a 2-0 shot 38 seconds later after a strong prep by two – time Stanley Cup winner Tom Gonhawk.
See also Rainer Colmond unrecognizable in photo: "I cut in half"
Canada coach Gerard Calland has retired to appoint his team. Just before the first third siren, Paul ran to the ground.
The game was now tough, with the Germans surviving two minutes into the second period, more than 3: 5, with great fighting effort.
"It's incredible how everyone throws themselves into the scenes," Loeb said SPORT1. Nico Kromer also acknowledged: "We took an incredible amount of interest in it. I'm proud to be a part of this team. Everyone helps."
The Canadians' pressure increased again in the further course of the game, but Kniterberger was always the last stop. Holzer then pushed towards the empty Canadian goal – finally perfecting the historic German World Cup plot.
Everything about the Ice Hockey World Championship
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Robert Bly is 90 today.
Oscar Peterson died on this date in 2007.
Joseph Smith, Jr. was born on this date in 1805. Harriet Monroe, who founded Poetry magazine in 1912, was born on this date in 1860. Helmut Schmidt was born on this date in 1918. Chet Baker was born in 1929 on this date.
Emperor Akihito is 83. Paul Hornung is 81. Jorma Kaukonen is 76. Harry Shearer is 73 today. General Wesley Clark is 72 today. Susan Lucci is 70. Adrian Belew is 67 today. Dame Carol Ann Duffy is 61. Joan Severance is 58 today. Donna Tartt is 53. Eddie Vedder is 52 today.
O? Christmas Tree? O, Christmas Tree!
Some funny and lovely piano performances by Victor Borge from the super blog "The Gad About Town".
The Hungarian Rhapsody piece is wonderful! Thanks so much, Mark. I loved it.


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Hypothesis 1: The team condition of the construction teams is positively related to team performance.
Hypothesis 2: The team condition is positively related to the transformational leadership quality of the leader.
2013; Müller, Geraldi, & Turner, 2012).
sonal relationships (Toor & Ofori, 2007).
working together in the form of teams.
workplace (Yang, Huang, & Wu, 2011).
Murphy & Ledwith, 2007; Yang 2011).


Loyola University Maryland's Sellinger School of Business and Management will present Building a Better World Through Business, an annual series of events celebrating ways that businesses create sustainable economic and social development in their communities. The series will take place March 26–28, 2019, on Loyola's Evergreen campus.
The Building a Better World Through Business event series begins with a keynote address by Bill Strickland, executive chairman of the Manchester Bidwell Corporation—an extraordinary jobs training center and community arts program. He will present "The Art of Leadership, and the Business of Social Change," on Tuesday, March 26, at 7:30 p.m. in the McManus Theatre. A reception and book signing will follow the presentation.
Strickland leads his staff in working with corporations, community leaders, and schools to give disadvantaged children and adults the opportunities they need to build a better future. His centers are open in many cities across the country including Pittsburgh, Cincinnati, San Francisco, Grand Rapids, New Haven, Boston, and Buffalo; with many more in the planning stages, including international centers in Israel, London, and Japan.
Strickland is also the author of Make the Impossible Possible, a recipient of The White House's "Coming Up Taller" Award, and the founder of the Grammy-winning MCG Jazz, the most successful jazz subscription series in America. He was named one of the 25 members of the White House Council for Community Solutions by then-President Barack Obama and was honored by the United States Senate for his contribution to social innovation.
• On Wednesday, March 27, the "Build Your World Career Fair 2019," will be held at McGuire Hall East from 4–6 p.m. Students will have the opportunity to meet with primarily for-profit companies—many of whom hire all majors, offer full-time, part-time, and internship opportunities. For more information and to register for the event, students may sign up in Handshake.
• A breakfast and panel discussion, "Loyola, Business, and Community Partners: Coming Together to Build a Better Baltimore," will explore the relationship between business and community partners in driving Baltimore's growth and development. The panelists are Augie Chiasera, president of Greater Baltimore/Chesapeake Region at M&T Bank; Tyson Garith, director of partnerships and business services at Strong City Baltimore; Kelly Hodge-Williams, '89, former president and CEO of Business Volunteers Maryland; and Michael Walton, principal of Tower Hill Atlantic, LLC, founding principal of Atlantic Investment Associates, and member of the board of sponsors for the Sellinger School of Business and Management. John Brothers, president of the T. Rowe Price Foundation and Program for Charitable Giving, will moderate the panel discussion. The event will be held on Thursday, March 28, with breakfast at 8:30 a.m. and discussion from 9–11 a.m. in Loyola's 4th Floor Program Room located in the Andrew White Student Center.
Building a Better World Through Business events are free and open to the public. Registration is required. To learn more and register for events, visit www.loyola.edu/better-business.