Side-effects of complementary and alternative medicine

Association between belief and attitude toward preference of complementary alternative medicine use

BACKGROUND

There is a steep increase in the consumer use of complementary alternative medicine (CAM), with many users unaware of the need to inform their health care providers. Various predictors including psychosocial factors such as beliefs and behavior have been accounted for preference toward CAM use, with varying results.

METHODS

This study investigates the belief and attitude regarding preference toward CAM use among the Malaysian population by using a questionnaire-based, cross-sectional study.

RESULTS

A large majority of the 1,009 respondents admitted to taking at least one type of CAM (n=730, 72.3%). Only 20 (1.9%) respondents were found to have negative beliefs (total score <35), 4 (0.4%) respondents had neutral beliefs (total score =35), and 985 (97.6%) respondents had positive belief toward CAM (total score >36). A total of 507 (50.2%) respondents were categorized as having a negative CAM attitude, while 502 (49.8%) respondents were categorized as having a positive CAM attitude. It was demonstrated that there was a positive correlation between belief and attitude score (ρ=0.409, P<0.001). Therefore, the higher the belief in CAM, the more positive the attitude was toward CAM. Those who were using CAM showed a stronger belief (P=0.002), with a more positive attitude (P<0.001) toward it, than those who were not using CAM.

CONCLUSION

Identifying belief regarding preference toward CAM use among the public could potentially reveal those with a higher tendency to use CAM. This is important as not everyone feels the need to reveal the use of CAM to their health care providers, which could lead to serious repercussions such as interactions and adverse effects.

Recent Advances in Anticancer Activities and Drug Delivery Systems of Tannins

Tannins, polyphenols in medicinal plants, have been divided into two groups of hydrolysable and condensed tannins, including gallotannins, ellagitannins, and (-)-epigallocatechin-3-gallate (EGCG). Potent anticancer activities have been observed in tannins (especially EGCG) with multiple mechanisms, such as apoptosis, cell cycle arrest, and inhibition of invasion and metastases. Furthermore, the combinational effects of tannins and anticancer drugs have been demonstrated in this review, including chemoprotective, chemosensitive, and antagonizing effects accompanying with anticancer effect. However, the applications of tannins have been hindered due to their poor liposolubility, low bioavailability, off-taste, and shorter half-life time in human body, such as EGCG, gallic acid, and ellagic acid. To tackle these obstacles, novel drug delivery systems have been employed to deliver tannins with the aim of improving their applications, such as gelatin nanoparticles, micelles, nanogold, liposomes, and so on. In this review, the chemical characteristics, anticancer properties, and drug delivery systems of tannins were discussed with an attempt to provide a systemic reference to promote the development of tannins as anticancer agents.

Complementary and alternative medicine use amongst patients with cardiovascular disease in Singapore

BACKGROUND

Data on complementary and alternative medicine (CAM) use in patients with cardiovascular disease (CVD) are lacking. We aim to investigate the prevalence of CAM use among patients with CVD attending a tertiary centre for cardiovascular care, their attitudes and beliefs towards CAM, and factors associated with CAM usage.

METHODS

A cross-sectional, self-administered written survey was conducted on consecutive patients attending outpatient cardiovascular clinics at our tertiary institution over 2 months from June to July 2014. Information gathered included demographic data and various aspects of CAM use.

RESULTS

A total of 768 responses (562 males, mean age 57 ± 13 years, 74 % Chinese, 6 % Malay, 14 % Indian) were included. The prevalence of CAM use in the cohort was 43.4 % (333/768). Biologically-based systems (29.4 %) was the most common type of CAM used. Some patients (19.0 %) used multiple types of CAM simultaneously. External influences (78.1 %) were cited more than internal influences (47.8 %) to affect CAM use. Malay ethnicity (compared to Chinese) was the only significant negative multivariate predictor of CAM use (OR = 0.531 (95 % CI 0.147 to 0.838), p = 0.018). A significantly higher proportion of CAM users compared to non-CAM users were non-compliant to medications (35.6 %, n = 114 vs. 20.5 %, n = 84, p < 0.001) and consults (41.4 %, n = 130 vs. 28.1 %, n = 112, p < 0.001) respectively.

CONCLUSION

The usage of CAM is prevalent amongst our patients with CVD. CAM use was associated with poorer reported compliance to medications and consults. Understanding the factors influencing CAM use amongst CVD patients provides medical professionals with an opportunity to better discuss CAM use and potentially enhance the patient-physician interaction.

PHARMACEUTICAL EVALUATION AND TOXICOLOGICAL QUANTIFICATION OF HEAVY METALS AND ADULTERATED ALLOPATHIC CONTENTS IN RAW AND FINISHED DOSAGE FORM OF ANTIHYPERTENSIVE HERBAL PRODUCTS

BACKGROUND

Herbal products of questionable quality create major concern for human population since their production is often not controlled and regulated.

MATERIAL AND METHODS

Antihypertensive herbal products were subjected to pharmaceutical quality control parameters specified in Pharmacopoeias, toxic quantification of heavy metals by flame atomic absorption spectrophotometer and adulterated allopathic contents were quantified using advanced HPLC techniques.

RESULTS

A lot of variations in pharmaceutical parameters like moisture contents and LOD% values were observed. Also deviations to a greater extent in weight variation, (P1, P2, P6, P12, P16, P17, P19, and P20), and hardness of the tablets of products (P1, P3, P8 and P11) were found. Friability of tablets of the Products (P3, P9 and P11) was found failed. Heavy metals i-e Fe (1597.20ppm, 1648ppm) in P5, P9, Pb (61.32ppm, 16.59 ppm) in P5, Cr (96.91ppm,108.48 ppm) in P4, P14, Cd (39.53ppm, 32.31 ppm) in P11, P12, Cu (28.22ppm, 21.04 ppm) in P15, P17, Zn (80.31ppm,76.27 ppm) in P15, P16, Ni (45.46ppm,22.18ppm) in P9, P13 in toxic concentrations were detected. Adulterated allopathic contents of Amlpdopine in higher quantities, administered according to manufacturer dose were found in P12 (20.30 mg/day), Verapamil in P2 (93.50 mg/day), Nifedipine (38.65 mg/day) in P6. Products P4, P5 and P7 were found to have a combination of Amlodipine and Hydrochlorothiazide and higher concentrations were found in P5 (10.72 mg/day, 24.75 mg/day).

CONCLUSION

The antihypertensive herbal products contained different kind of adulterants. Our findings suggest that effective regulatory measures should be put in place to address this problem. This will help to decrease the toxic effects of these remedies and increase the commercialization, internationalization and harmonization of antihypertensive herbal products.

Saw Palmetto for Symptom Management During Radiation Therapy for Prostate Cancer

CONTEXT

Lower urinary tract symptoms (LUTSs) affect 75%-80% of men undergoing radiation therapy (RT) for prostate cancer.

OBJECTIVES

To determine the safety, maximum tolerated dose (MTD), and preliminary efficacy of Serenoa repens commonly known as saw palmetto (SP) for management of LUTS during RT for prostate cancer.

METHODS

The dose finding phase used the time-to-event continual reassessment method to evaluate safety of three doses (320, 640, and 960 mg) of SP. Dose-limiting toxicities were assessed for 22 weeks using the Common Terminology Criteria for Adverse Events for nausea, gastritis, and anorexia. The exploratory randomized controlled trial phase assessed preliminary efficacy of the MTD against placebo. The primary outcome of LUTS was measured over 22 weeks using the International Prostate Symptom Score. Additional longitudinal assessments included quality of life measured with the Functional Assessment of Cancer Therapy-Prostate.

RESULTS

The dose finding phase was completed by 27 men who reported no dose-limiting toxicities and with 20 participants at the MTD of 960 mg daily. The exploratory randomized controlled trial phase included 21 men, and no statistically significant differences in the International Prostate Symptom Score were observed. The prostate-specific concerns score of the Functional Assessment of Cancer Therapy-Prostate improved in the SP group (P = 0.03). Of 11 men in the placebo group, two received physician-prescribed medications to manage LUTS compared with none of the 10 men in the SP group.

CONCLUSION

SP at 960 mg may be a safe herbal supplement, but its efficacy in managing LUTS during RT needs further investigation.

Complementary and Integrative Health Practices Among Hispanics Diagnosed with Colorectal Cancer: Utilization and Communication with Physicians

OBJECTIVE

Complementary and integrative health (CIH) use among Hispanic adults with colorectal cancer (CRC) diagnosis is not well documented. Understanding the prevalence and patterns of CIH use among Hispanics offers insights to uncover potential needs for clinical services.

DESIGN

Participants were age 21 years or older with a first-time diagnosis of CRC from population-based cancer registries in California. In-person and/or telephone-based interviews were administered to collect data on CIH use. Demographic and clinical diagnosis data were abstracted from medical records. Descriptive statistical and logistic regression was used to analyze the frequencies and associations between selected patient characteristics and CIH use.

RESULTS

Among 631 Hispanic patients, 40.1% reported ever using CIH. Herbal products/dietary supplements were used most often (35.3%), followed by bodywork (16.5%), mind-body practices (7.8%), and homeopathy (6.7%). About 60% of participants reported CIH use to address specific health conditions; however, most patients did not discuss CIH use with their physicians (76.3%). Women reported higher CIH use than did men (45.1% versus 35.9%; odds ratio, 1.49 [95% confidence interval, 1.07-2.08]; p = 0.02). CIH use did not differ by clinical stage, time since diagnosis, or preferred language.

CONCLUSIONS

CIH use is prevalent among Hispanic patients with CRC, especially women. Little communication about CIH use occurs between participants and their healthcare providers. Efforts aimed at improving integrative oncology services provide an opportunity to address such gaps in healthcare service.

Level of use and safety of botanical products for itching vulvar dermatoses. Are patch tests useful?

BACKGROUND

Topical remedies based on botanical ingredients are popular.

OBJECTIVES

To assess: (i) the usage of botanical substances in subjects affected with itching and chronic vulvar complaints; (ii) the incidence of side-effects associated with their use and the frequency of contact allergy; (iii) the diagnostic usefulness of patch testing.

METHODS

Sixty-six patients were provided with a questionnaire to assess the prevalence and type of topical botanical preparations used and the occurrence of adverse reactions. Patients were patch tested with (i) the Italian baseline series, (ii) a topical medicament series, and (iii) a botanical series.

RESULTS

Forty-two patients (63.6%) reported the use of natural topical products on the vulva. Seven (16.7%) noted adverse reactions; 27 showed positive reactions with the baseline series; 14 (21.2%) had at least one relevant reaction, mainly to allergens in topical products and cosmetics; and 2 (3%) showed positive reactions to the botanical series. Of the 7 patients complaining of adverse effects of botanical products, 3 (42.8%) showed relevant sensitization.

CONCLUSIONS

The use of natural topical products is widespread among women affected with itching vulvar diseases. Contact dermatitis is a possible adverse effect. Botanical series are of questionable usefulness, owing to the wide variety of botanical ingredients.

Herbal Supplements and Hepatotoxicity: A Short Review

Herbal products have gained popularity over the past few decades. The reasons attributed to the rise in popularity are cheaper costs, easy availability, patient compliance and fewer side effects. However, liver toxicity following consumption of herbal remedies is on the increase. Thus, there is an urgent need to understand the mechanism of action of the herbal supplements on the liver. Occasionally, herbal supplements may also interact with conventional drugs. The present review focusses on a few herbs such as Aloe barbadensis, Atractylis gummifera, Centella asiatica, Mitragyna speciosa, Morinda citrifolia, Larea tridentata, Symphytum officinale, Teucrium chamaedrys and Xanthium strumarium, which are reported to cause hepatotoxicity in humans and animals. Prior knowledge on hepatotoxicity caused by herbs may be beneficial for clinicians and medical practitioners.

Practices and attitudes toward complementary and alternative medicine in inflammatory bowel disease: a survey of gastroenterologists

BACKGROUND

Use of complementary and alternative medicine (CAM) is increasingly prevalent among patients with inflammatory bowel disease (IBD). We sought to characterize the practices and attitudes of IBD physician providers toward CAM.

METHODS

A web-based survey was sent to non-trainee physician members of the American Gastroenterological Association with an interest in IBD. The survey included multiple-choice and Likert scale questions which queried physician perceptions of CAM and their willingness to discuss CAM with patients.

RESULTS

The vast majority of respondents (80%) considered themselves IBD subspecialists with 75% holding academic appointments. Nearly a third reported initiating conversations on CAM in the majority of their patient interactions, while 90% perceived that a majority of their patients were reluctant to bring up the topic of CAM. Nearly three quarters (72%) of respondents felt comfortable discussing CAM, while those that did not most frequently cited lack of knowledge as the reason. More than half (55%) stated they had no systematic approach to discussing CAM. Most gastroenterologists (65%) reported no formal training in CAM. Most gastroenterologists had recommended use of probiotics, and nearly half had recommended acupuncture. A vast majority believed that there was adjunctive role for CAM in treatment of IBD.

CONCLUSIONS

Academic IBD specialists were receptive to the use of CAM, and most felt that it had a role in the treatment of IBD, without necessarily compromising conventional therapy. Formal educational initiatives and societal recommendations on the use of CAM may facilitate a more systematic approach to its use in daily practice.

In vitro antimicrobial activity of Luffa operculata

Introduction

Luffa operculata is probably one of the most popular herbal medicines used in the treatment of rhinitis and rhinosinusitis. However, its specific mechanism of action is still unknown.

Objective

To evaluate in vitro antibacterial activity of L. operculata against three ordinary agents of upper respiratory tract infection: Staphylococcus aureus, Streptococcus pneumoniae and Streptococcus pyogenes.

Methods

Different concentrations of L. operculata alcoholic extract were applied to bacterial broth containing reference and community strains of the three described agents. After a 24-h incubation period, the bacterial culture turbidity was measured. The samples were then inoculated onto Mueller-Hinton and human blood agar plates. Bacterial growth was analyzed after 24- and 48-h incubation period. The test was considered negative when there was no environmental turbidity, confirmed by the absence of bacterial growth into the inoculated plates. Tests were considered positive when either turbidity changes were observed on the bacterial broth or when bacterial growth was detected on inoculated plates. Appropriate statistical analysis of the data was performed.

Results

L. operculata extracts showed antibacterial activity mainly to S. pyogenes followed by S. pneumoniae and S. aureus.

Conclusions

L. operculata extract showed promising antibacterial activity in vitro against the studied agents.

Cervical necrotizing fasciitis resulting in acupuncture and herbal injection for submental lipoplasty

Acupuncture is used for some conditions as an alternative to medication or surgical intervention. Several complications had been reported, and they are generally due to physical injury by the needle or transmission of diseases. Necrotizing fasciitis is an uncommon infection, but potentially lethal, especially when associated with systemic disorders such as diabetes. The authors report a case of serious cervical necrotizing fasciitis that developed after acupuncture and herbal injection treatment of fat accumulation of the submental area in a 32-year-old healthy woman. She presented with discharging wound over the submental area. The initial diagnosis was based on clinical information, in which localized necrosis areas in the cervical and chin regions were observed. Wide antibiotic therapy was applied, followed by surgical drainage, debridement, and negative pressure wound therapy. Culture was positive for Serratia liquefaciens and Staphylococcus intermedius. She made a good recovery.

Exploring the role of multiple chronic conditions in traditional Chinese medicine use and three types of traditional Chinese medicine therapy among adults in Taiwan

INTRODUCTION

Numerous people with chronic conditions like to use traditional Chinese medicine (TCM) treatment, or integrated treatment of TCM and Western medicine (WM). Our study explored the associations between multiple chronic conditions (MCC) and TCM use and the use of specific types of TCM therapy among adults in Taiwan. In addition, we explored the TCM use of adults with seven common types of chronic conditions.

METHODS

In our study, a national representative sample in 2005 was used. The Chronic Condition Indicator and the Clinical Classifications System created by the U.S. Agency for Healthcare Research and Quality were used to define the number of chronic conditions of adults. Logistic regressions adjusted for demographic characteristics were used to analyze the associations. The frequency of TCM use among adults with different numbers of chronic conditions was quantified.

RESULTS

TCM use for adults with ≥5 chronic conditions (odds ratio [OR] 1.86) was higher than TCM use for adults with 2-4 chronic conditions (OR 1.51) and TCM use for adults with one chronic condition (OR 1.48). The increase in the OR of the use of Chinese herbs and traumatology manipulative therapy according to the number of chronic conditions was not as substantial as that of acupuncture-moxibustion. The frequency of TCM use exhibited an increasing trend with the increase in the number of chronic conditions (p<.001). Among the seven common types of chronic conditions for adults, TCM use for adults with arthropathy (OR 2.01) was the highest.

CONCLUSION

The probability and frequency of TCM use increased as the number of chronic conditions increased. The probability of Chinese herbs use, traumatology manipulative therapy use, and, particularly, acupuncture-moxibustion use increased as the number of chronic conditions increased. We suggest that government policy makers emphasize administering integrated TCM and WM care to people with chronic conditions or MCC.

Relation of Complementary-Alternative Medicine use with glomerular filtration rate and depression in patients with chronic kidney disease at predialysis stage

AIM

Complementary and alternative medicine is a broad field of health including all health care practices and methods, and their accompanying theories and beliefs. In the present study, we aimed to examine the frequency of complementary-alternative medicine use, and its relation with glomerular filtration rate and depression in patients with chronic kidney disease at predialysis stage.

METHODS

A total of 1053 predialysis patients; 518 female and 535 male, that were followed up with chronic kidney disease for at least 3 months were enrolled into the study. Demographic features, biochemical parameters and findings of physical examination were recorded. Their compliance to diet, and knowledge about disease were questioned. Beck depression inventory and questionnaire regarding complementary-alternative medicine use were performed.

RESULTS

The overall frequency of complementary-alternative medicine use was 40.3% . Total ratio of herbal products was 46%. Complementary-alternative medicine use was significantly more frequent in female or single patients, and patients that informed about chronic kidney disease or under strict diet (P = 0.007, P = 0.016, P = 0.02, P = 0.016, respectively). When glomerular filtration rate of participants were considered, complementary-alternative medicine use was similar in different stages of kidney disease. Depression was observed in 41.9% of patients and significantly frequent in patients with alternative method use (P = 0.002). Depression score was higher as creatinine increases and glomerular filtration rate decreases (P = 0.002; r = 0.093).

CONCLUSION

We determined that complementary-alternative medicine use gradually increases at predialysis stage as glomerular filtration rate decreases and there is a strict relation between complementary-alternative medicine use and depression or female gender. Disorder related stressors may lead to seeking of alternative methods.

High prevalence of complementary and alternative medicine use in patients with genetically proven mitochondrial disorders

Despite major advances in understanding the pathophysiology of mitochondrial diseases, clinical management of these conditions remains largely supportive, and no effective treatment is available. We therefore assumed that the burden of disease combined with the lack of adequate treatment leaves open a big market for complementary and alternative medicine use. The objective of this study was to evaluate the use and perceived effectiveness of complementary and alternative medicine in children and adults with genetically proven mitochondrial disease. The reported use was surprisingly high, with 88% of children and 91% of adults having used some kind of complementary and alternative medicine in the last 2 years. Also, the mean cost of these treatments was impressive, being <euro>489/year for children and <euro>359/year for adult patients. Over-the-counter remedies (e.g., food supplements, homeopathy) and self-help techniques (e.g., Reiki, yoga) were the most frequently used complementary and alternative therapies in our cohort: 54% of children and 60% of adults reported the various complementary and alternative medicine therapies to be effective. Given the fact that currently no effective treatment exists, further research toward the different therapies is needed, as our study clearly demonstrates that such therapies are highly sought after by affected patients.

Perceptions of complementary and alternative medicine among cardiac patients in South Trinidad: a qualitative study

BACKGROUND

Complementary and alternative medicine (CAM) has been practiced for centuries owing to the absence or limited availability of conventional medicine. CAM has persisted globally with over USD34 billion spent annually, despite modernization, globalization, technological advancement, and limited supportive evidence. The present qualitative study explores the perception of CAM among cardiac patients with respect to rationale, perceived outcomes, influences, and public health concerns.

METHODS

This study used a qualitative, interpretative approach. Twelve cardiac disease patients were recruited from private clinics in South Trinidad and interviewed. The study obtained ethical approval, and all participants provided written consent. The semi-structured interviews were digitally recorded, transcribed, and thematically analyzed. Participants with poor cognitive function, difficulty speaking, and those not understandable owing to language barriers were excluded.

RESULTS

CAM use was based largely on patient perception regardless of the clinical reality. The perceived mode of action and its natural character was responsible for the therapeutic outcomes and uses. Participants reported that CAM provided holistic care, improved the quality of life, overcame the limitations of conventional medicine, satisfied their increased expectation for comprehensive care, and prevented or counteracted adverse effects caused by conventional medicine. Participants reported a lack of scientific information on CAM and stated that policy makers should assist patients through increased research, public health education, and improved integration of CAM and conventional medicine.

CONCLUSIONS

The participants' use of CAM was largely based on perception. CAM was thought to improve therapeutic outcomes, provide holistic care, decrease or prevent complications from conventional medicine, and improve quality of life. Participants acknowledged that they may be ill-informed about the basic concepts or actions of CAM. They urged policymakers to create an environment that assists the public and health care providers in promoting safe and effective CAM practice.

Effect of ethanolic extract of Ecballium elaterium against Staphylococcus aureus and Candida albicans

OBJECTIVE

To evaluate the antimicrobial activity of ethanolic extract of Ecballium elaterium (E. elaterium) fruits alone against Staphylococcus aureus (S. aureus) strains and Candida albicans (C. albicans) strains, or in combination with penicillin against Staphylococcus areus strains.

METHODS

Evaluation of the antimicrobial activity or synergy interaction was carried out using microdilution method.

RESULTS

The results showed that ethanolic extract of E. elaterium fruits has antimicrobial activity against methicillin resistant S. aureus (MRSA), methicillin sensitive S. aureus (MSSA) and C. albicans. This extract showed a significant decrease in minimum inhibitory concentrations (MIC) of penicillin against both MRSA and MSSA strains. Fractional inhibitory concentration index (FIC) between penicillin and ethanolic extract of E. elaterium fruits against these test strains was less than 0.5.

CONCLUSIONS

This study suggests that ethanolic extract of E. elaterium fruits has antimicrobial activity against S. aureus and C. albicans and there is a possibility of concurrent use of penicillin and E. elaterium extract in combination in the treatment of infections caused by MRSA and MSSA strains. A wider study is needed to identify the effective components, the mode of action and the possible toxic effect in vivo of these ingredients.

CAM utilization among OEF/OIF veterans: findings from the National Health Study for a New Generation of US Veterans

BACKGROUND

Complementary and alternative medicine (CAM) is increasingly seen as an adjunct to traditional plans of care. This study utilized a representative sample of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans and OEF/OIF-era veterans to explore the prevalence and characteristics of CAM users.

RESEARCH DESIGN

The National Health Study for a New Generation of US Veterans (NewGen) is a longitudinal health study of a population-based cohort of OEF/OIF (deployed) and OEF/OIF-era (nondeployed) veterans. Data from the 2009-2011 NewGen survey (n=20,563) were analyzed to determine prevalence of CAM use by demographic and military characteristics, the types of CAM modalities used, and where the modalities were sought. Results were weighted to the entire population of OEF/OIF and OEF/OIF-era veterans.

RESULTS

There was no statistically significant association between CAM use and deployment. Those who used Department of Veterans Affairs (VA) health care after separation were more likely to be CAM users compared with those who did not use VA care; however, the majority of veterans using CAM are using it outside the VA health care system. Massage was the most prevalent CAM modality followed by chiropractic treatment; males were less likely to use CAM than women.

CONCLUSIONS

CAM modalities are being utilized by OEF/OIF veterans for health problems mainly outside the VA. Policymakers should determine appropriate use of these modalities.

Use of mental health services by women in low and middle income countries

Purpose

– The purpose of this paper is to examine sex differences in mental health service usage among upper-middle, lower-middle, and low-income countries (LICs).

Design/methodology/approach

– Data from 62 low- and middle-income countries (LAMICs) were collected with the World Health Organization – Assessment Instrument for Mental Health Systems (WHO-AIMS). Sex differences in mental health service utilization were assessed by comparing the proportion female in the general population with the proportion female treated for mental illness in five different types of mental health facility.

Findings

– Two-sided t-tests for significance (a=0.05) revealed a significant difference between the proportion female in the population and the proportion treated in inpatient facilities (community-based and mental hospitals) in LICs. There was also a trend toward decreased use of outpatient facilities by women in LICs (p=0.08). Lower-middle and upper-middle income countries showed no differences. In day treatment facilities for the entire sample, there was a significant difference between the proportion female in the population and the proportion treated female (weighted mean difference overall=0.10, p=0.035).

Research limitations/implications

– The authors found significantly reduced utilization of mental health services by women in LICs in community-based inpatient facilities and mental hospitals and a trend toward decreased use in outpatient facilities. Future studies investigating the factors contributing to the lower utilization of services by women in LICs are essential.

Originality/value

– This study presents the first comprehensive study of mental health service usage by sex in 62 LAMICs.

Efficacy and safety of herbal medicines in treating gastric ulcer: A review

Gastric ulcer is a common disorder of the digestive system. Current therapeutic regimens largely rely on Western medicine. However, numerous studies have demonstrated that herbal medicines can effectively treat gastric ulcer in humans and various animal models via divergent mechanisms. This review updates the efficacy and safety of herbal medicines in treating gastric ulcer, and the mechanisms of their action in humans and animal models. Studies have demonstrated that the efficacy of herbal medicines is comparable or superior to that of drugs such as omeprazole or cimetidine in humans and animal models, and herbal medicines display fewer adverse effects. The mechanisms by which herbal medicines benefit gastric ulcer include stimulation of mucous cell proliferation, anti-oxidation, and inhibition of gastric acid secretion and H(+)/K(+)-ATPase activity. Some herbal medicines also exhibit antimicrobial properties. Utilization of herbal medicines could be a valuable alternative to treat gastric ulcer in humans effectively, with few adverse effects.

Use of Complementary and Alternative Medical Therapies in a Pediatric Neurology Clinic

Background:

Complementary and alternative medicine (CAM) is increasingly used in adults and children. Studies on CAM in neurological disorders have focused on the adult population and its use among pediatric neurology patients has not been well characterized.

Objectives:

The purpose of this study was: 1) To characterize the prevalence of CAM in pediatric neurology patients; 2) To determine the perceived effectiveness of CAM in these children; 3) To compare the cost of CAM with conventional therapies; and 4) To describe caregiver or patient-related variables associated with the use of CAM.

Methods:

This was a cross-sectional survey of patients and families attending the Alberta Children's Hospital neurology clinic between February and May 2004. Patients were considered eligible if they were between two and 18 years of age and had a known history of neurological disorders. Caregivers completed several self-administered questionnaires regarding their socio-demographic profile, their child's neurological illness, and their experience with CAM. Caregivers also rated their child's quality of life using the Pediatric Quality of Life Inventory.

Results:

One hundred and five of 228 (46%) families completed the survey. The mean age of the neurology patients was 9.8 ± 4.5 years. Forty-six (44%) out of 105 patients received one or more types of CAM, with the most common types being chiropractic manipulations (15%), dietary therapy (12%), herbal remedies (8%), homeopathy (8%), and prayer/faith healing (8%). Caregivers' sociodemographic variables or pediatric health-related quality of life were not significantly associated with the use of CAM. Fifty-nine percent of CAM users reported benefits, and only one patient experienced side effects. There was no significant difference in the total median cost of CAM compared to conventional therapies ($31.70 vs. $50.00 per month). Caregivers' personal experience or success stories from friends and media were common reasons for trying CAM.

Conclusions:

The use of CAM was common among pediatric neurology patients. Over half of the families reported benefits with CAM, and side effects were perceived to be few. Physicians should initiate discussion on CAM during clinic visits so that the families and patients can make informed decisions about using CAM. Further studies should address the specific role of CAM in children with neurological disorders, and to determine the potential interactions between CAM and conventional therapies in these patients.

Attitudes and practices of complementary and alternative medicine among adolescents in Saudi Arabia

The aim of this study was to investigate the attitudes and use of complementary and alternative medicine (CAM) among Saudi Arabian adolescents. A multistage stratified sampling method was used to select 736 adolescents (358 males, 378 females) aged 15–19 years from secondary schools. The study was carried out in Al-Khobar city, Eastern region of Saudi Arabia. The findings revealed that the use of CAM by adolescents in their lifetime ranged from 1.6% for acupuncture to 58.6% for honey treatment, with significant differences between genders, except in the use of dietary supplements, black cumin, and acupuncture therapies. Females were more likely to use CAM for treating abdominal pains, cold and flu, and cough than males (P < 0.000). Family members and friends (67.7%) were the main source of CAM usage, followed by television (10%), and Internet (8%). Religious and medicinal herb healers were the CAM healers most commonly visited by adolescents. Nearly 21–43% of adolescents had positive attitudes toward CAM, with some significant differences between males and females. It can be concluded that CAM is widely used by Saudi adolescents, but caution should be exercised for the safe usage of some CAM treatments. CAM should not be ignored; however there is an urgent need to establish regulations for CAM usage.

Dietary supplements use and related factors of preschoolers in 3 korean cities

PURPOSE

To estimate the prevalence of dietary supplement (DS) use, investigate the related factors associated with DS use among preschoolers and support the adequate nutrition.

METHODS

We conducted a questionnaire survey of mothers of children aged between 1 and 6 years who visited pediatric clinics in 3 Korean cities (Jeonju, Suncheon, Jeongeup) between October and November 2012 at Presbyterian Medical Center. The responses from 929 questionnaires were analyzed.

RESULTS

Approximately 45.1% of the preschoolers used DS in the past month. The following factors were associated with greater use of DS: older age (p<0.001), whether or not the preschoolers attended kindergarten (p<0.001), higher mother's concern about the nutritional facts (p<0.001), whether or not the mother use DS (p<0.001), whether or not the mother counsel with a doctor or pharmacist about DS use (p<0.001). Vitamin·mineral supplements (77.5%) were the most commonly used DS among the preschoolers, followed by ginseng (49.3%) and probiotics (25.6%). Additionally, of the DS users, 95.9% gave DS to their healthy children. Of the users and non-users, 97.6% and 62.2%, respectively, indicated that they would like to have their children take DS. The information on DS was obtained from family or friends in 48.2% of the DS users and from doctors in only 6.1%.

CONCLUSION

Approximately half of the preschoolers in our study used DS, which might not have been medically indicated for most of them. Therefore, the role of professionals in counseling on desirable diet behaviors and DS use for preschoolers is warranted.

Use and predictors of oral complementary and alternative medicine by patients with inflammatory bowel disease: a population-based, case-control study

BACKGROUND

The use of complementary and alternative medicine (CAM) in the general population and in patients with chronic diseases has increased markedly in recent decades. We aimed to determine the prevalence, type, and predictors of oral CAM use among patients with inflammatory bowel disease (IBD) compared with the general population in a large, population-based, case-control study.

METHODS

Overall, 1370 patients with IBD and 598 control subjects in Canterbury, New Zealand, were recruited. Environmental and phenotypic data were obtained through a questionnaire and case note review. Predictors of oral CAM use were identified using binary logistic regression.

RESULTS

In the previous year, 44.1% of patients with IBD and 42.3% of control subjects used oral CAM (odds ratio [OR], 1.078; 95% confidence interval [CI], 0.885-1.312). The types of oral CAM used most frequently were vitamins (Crohn's disease [CD], 25.2%; ulcerative colitis, 23.7%; control subjects, 24.9%), followed by herbs (CD 15.1%, ulcerative colitis 15.2%, control subjects 12.8%), and dietary supplements (CD, 8.5%; ulcerative colitis 12.6%, control subjects 12.1%). Female gender (OR, 1.61; 95% CI, 1.25-2.08), younger age (P = 0.005), higher education (P = 0.002), higher income (P = 0.04), being a vegetarian (OR, 3.58; 95% CI, 1.97-6.48) and a middle social class at birth (P = 0.024) were independent predictors of oral CAM use in patients with IBD. Disease phenotype was not associated with oral CAM use. In control subjects, female gender (OR, 2.67; 95% CI, 1.85-3.86), higher education (P = 0.003) and a diagnosis of asthma (P = 0.017) predicted oral CAM use.

CONCLUSIONS

Oral CAM use is common in, and does not differ between, patients with IBD and the general population in Canterbury, New Zealand. Socio-demographic factors, and not disease phenotype, predict oral CAM use in patients with IBD.

Two cases of food additive-induced severe liver damage associated with positive results on lymphocyte stimulation test and for antinuclear antibodies

Two cases of severe liver injury and positive result for antinuclear antibodies induced by food additives are reported. The first patient reported long-term intake of Mabo Ramen(®) noodle soup, nutritional supplements, and over-the-counter drugs. Total bilirubin, aspartate aminotransferase, and alanine aminotransferase were 9.6 mg/dL, 1,048, and 1,574 IU/L, respectively. Antinuclear antibody was 80×. The drug-induced lymphocyte stimulation test (DLST) was positive for Mabo Ramen(®) and its additives such as Xanthan gum, guar gum, and Doubanjiang. Histologic examination of a liver biopsy specimen showed lymphocyte infiltration and necrosis. The autoimmune hepatitis score was 3. The second patient reported intake of dietary supplements, including Bimore C(®) and Chokora BB(®). Laboratory tests revealed that total bilirubin was 9.8 mg/dL, aspartate aminotransferase was 1,130 IU/L, and alanine aminotransferase was 1,094 IU/L. Antinuclear antibody was 320×. Co-existing pancreatic damage was confirmed by the findings on abdominal CT and elevation of serum lipase, span-1, and DUPAN-2. DLSTs were positive for both supplements. These two supplements contained additives such as titanium oxide, magnesium stearate, and hydroxypropylcellulose. DLSTs for all three additives were positive. Histologic examination revealed periportal necrosis and lymphocyte infiltration of lobular and portal areas. These two cases demonstrate that repeating DLSTs is useful for identifying causative constituents in foods and supplements.

The use of complementary and alternative medicine by pediatric food-allergic patients in Japan

BACKGROUND

In developed countries, increasing food allergy prevalence and concern regarding food allergies have been reported. Although the use of complementary and alternative medicine (CAM) for the treatment of allergic diseases has increased in some Western countries, the actual proportion and patterns of CAM use for pediatric food allergies in Japan are still unknown.

METHODS

Fourteen allergy centers in Japan participated in the study using a questionnaire survey regarding the use of CAM by pediatric patients. A diagnosis of food allergy was made at each hospital by pediatric allergists.

RESULTS

Surveys were completed by parents/guardians, and data were collected for a total of 962 pediatric food-allergic patients. Overall, 8.4% of the participants used CAM to treat a food allergy. The major CAM therapies used were herbal teas (22.2%), including several Japanese herbal teas, Chinese herbal medicine (18.5%) and lactic acid bacteria (16%). Among the participants using CAM to treat food allergy, 13.6% thought that the CAM being used was very effective, while 11.1% of participants thought that CAM caused some type of side effect.

CONCLUSIONS

Our study is the first large-scale national survey regarding the use of CAM in pediatric patients with food allergies in Japan. Unlike in the USA, which has a higher rate of CAM use (17%), approximately 8.4% of food-allergic patients used CAM in Japan. Interestingly, the major types of CAM used in Japan differed from those used in the USA. Cultural differences and food customs may affect the use of CAM.

Herbal medicine, Chaplin, and "The Kid"

At variance with other largely safe complementary alternative medicines like homeopathy and acupuncture, which only carry the risk of inducing patients to shun effective treatment, herbal remedies are real, albeit impure, drugs and therefore fully capable of producing undesirable consequences if misused. The advantages they offer are uncertain since genuine evidence of efficacy and effectiveness is present in only a few cases. A result of this imbalance is that studies in this field are considerably more meaningful when they deal with untoward effects than with therapeutic uses. This disproportion has suggested to us the curious similarity with the situation portrayed in the film "The Kid" where the essential task of the protagonist (Chaplin) is to repair the windows his stone-throwing child has just broken.

Necrotizing fasciitis after acupuncture in a patient with aplastic anemia

OBJECTIVES

The objective of this study was to describe a serious complication of acupuncture treatment in a high-risk patient with aplastic anemia.

DESIGN

A 44-year-old woman with aplastic anemia experienced right calf pain after running. After poor results with physical therapy, she received needle acupuncture for pain relief. However, aggravated pain with swelling of the right calf developed 2 days later.

RESULTS

On admission, she had a temperature of 38.8°C, a white blood cell count of 500/μL, and hemoglobin of 5.7 g/dL. Ultrasound and computed tomography scans showed swelling of the right calf muscle fascia, and aspiration drew out Staphylococcus infection. The symptoms improved after treatment with parenteral antibiotics.

CONCLUSIONS

This case illustrates that necrotizing fasciitis must be considered as a possible complication of acupuncture in high-risk patients, and that early recognition and treatment of this life-threatening soft-tissue infection must be emphasized. Extreme caution should be employed when using acupuncture for high-risk patients, such as those with aplastic anemia.

Alternative and complementary treatment for food allergy

Despite increased consumer interest in complementary and alternative medicine (CAM) for the treatment of food allergy, there remains a relative paucity of knowledge regarding the clinical efficacy, mechanisms of action, and safety of most CAM treatments available to consumers. This article focuses on recent advances in CAM for food allergy, including acupuncture, herbal medicine, probiotics, and alternative approaches to allergen immunotherapy. The mechanism of action of several novel approaches to treatment of food allergy is reviewed, but FAHF-2 is the only investigational herbal formulation currently validated for use in human clinical trials.

Attitudes towards complementary and alternative medicine in chronic pain syndromes: a questionnaire-based comparison between primary headache and low back pain

Background

Complementary and Alternative Medicine (CAM) is widely used and popular among patients with primary headache or low back pain (LBP). Aim of the study was to analyze attitudes of headache and LBP patients towards the use of CAM.

Methods

Two questionnaire-based surveys were applied comparing 432 primary headache and 194 LBP patients.

Results

In total, 84.75% of all patients reported use of CAM; with significantly more LBP patients. The most frequently-used CAM therapies in headache were acupuncture (71.4%), massages (56.4%), and thermotherapy (29.2%), in LBP thermotherapy (77.4%), massages (62.7%), and acupuncture (51.4%). The most frequent attitudes towards CAM use in headache vs. LBP: "leave nothing undone" (62.5% vs. 52.1%; p = 0.006), "take action against the disease" (56.8% vs. 43.2%; p = 0.006). Nearly all patients with previous experience with CAM currently use CAM in both conditions (93.6% in headache; 100% in LBP). However, the majority of the patients had no previous experience.

Conclusion

Understanding motivations for CAM treatment is important, because attitudes derive from wishes for non-pharmacological treatment, to be more involved in treatment and avoid side effects. Despite higher age and more permanent pain in LBP, both groups show high use of CAM with only little specific difference in preferred methods and attitudes towards CAM use. This may reflect deficits and unfulfilled goals in conventional treatment. Maybe CAM can decrease the gap between patients' expectations about pain therapy and treatment reality, considering that both conditions are often chronic diseases, causing high burdens for daily life.

Toxicity of Salvia officinalis in a newborn and a child: an alarming report

Although it is widely believed that herbal products are beneficial to the health, some herbal products can result in serious adverse effects, such as epileptic seizures, especially in children who are particularly susceptible. Sage oil contains well-known convulsant substances such as thujone, camphor, and cineole in different proportions. We report 2 cases, those of a newborn and a toddler, who experienced generalized tonic-clonic seizures after accidental exposure to sage oil. No other causes of seizure were detected by our clinical inquiries in either of the patients. The seizures occurred as an isolated event in the toddler, but in a repeated manner in the newborn; both patients experienced good outcomes. In any case of a first seizure of unexplained origin, the possibility of exposure to a herbal product should be kept in mind. Parents should be informed about the pros and cons of these untested remedies, which are presented as an alternative to conventional medicine.

Responding to GPs' information resource needs: implementation and evaluation of a complementary medicines information resource in Queensland general practice

BACKGROUND

Australian General Practitioners (GPs) are in the forefront of primary health care and in an excellent position to communicate with their patients and educate them about Complementary Medicines (CMs) use. However previous studies have demonstrated that GPs lack the knowledge required about CMs to effectively communicate with patients about their CMs use and they perceive a need for information resources on CMs to use in their clinical practice. This study aimed to develop, implement, and evaluate a CMs information resource in Queensland (Qld) general practice.

METHODS

The results of the needs assessment survey of Qld general practitioners (GPs) informed the development of a CMs information resource which was then put through an implementation and evaluation cycle in Qld general practice. The CMs information resource was a set of evidence-based herbal medicine fact sheets. This resource was utilised by 100 Qld GPs in their clinical practice for four weeks and was then evaluated. The evaluation assessed GPs' (1) utilisation of the resource (2) perceived quality, usefulness and satisfaction with the resource and (3) perceived impact of the resource on their knowledge, attitudes, and practice of CMs.

RESULTS

Ninety two out of the 100 GPs completed the four week evaluation of the fact sheets and returned the post-intervention survey. The herbal medicine fact sheets produced by this study were well accepted and utilised by Qld GPs. The majority of GPs perceived that the fact sheets were a useful resource for their clinical practice. The fact sheets improved GPs' attitudes towards CMs, increased their knowledge of those herbal medicines and improved their communication with their patients about those specific herbs. Eighty-six percent of GPs agreed that if they had adequate resources on CMs, like the herbal medicine fact sheets, then they would communicate more to their patients about their use of CMs.

CONCLUSION

Further educational interventions on CMs need to be provided to GPs to increase their knowledge of CMs and to improve their communication with patients about their CMs use.

A review of the pharmacological effects of Arctium lappa (burdock)

Arctium lappa, commonly known as burdock, is being promoted/recommended as a healthy and nutritive food in Chinese societies. Burdock has been used therapeutically in Europe, North America and Asia for hundreds of years. The roots, seeds and leaves of burdock have been investigated in view of its popular uses in traditional Chinese medicine (TCM). In this review, the reported therapeutic effects of the active compounds present in the different botanical parts of burdock are summarized. In the root, the active ingredients have been found to "detoxify" blood in terms of TCM and promote blood circulation to the skin surface, improving the skin quality/texture and curing skin diseases like eczema. Antioxidants and antidiabetic compounds have also been found in the root. In the seeds, some active compounds possess anti-inflammatory effects and potent inhibitory effects on the growth of tumors such as pancreatic carcinoma. In the leaf extract, the active compounds isolated can inhibit the growth of micro-organisms in the oral cavity. The medicinal uses of burdock in treating chronic diseases such as cancers, diabetes and AIDS have been reported. However, it is also essential to be aware of the side effects of burdock including contact dermatitis and other allergic/inflammatory responses that might be evoked by burdock.

Thrombocytopenia as an adverse effect of complementary and alternative medicines, herbal remedies, nutritional supplements, foods, and beverages

BACKGROUND

Thrombocytopenia is a well-recognized adverse effect of many drugs. However, the association of thrombocytopenia with complementary/alternative medicines, herbal remedies, nutritional supplements, foods, and beverages has been rarely described, except for reports of thrombocytopenia caused by quinine-containing beverages.

OBJECTIVES

To systematically identify all published reports of thrombocytopenia associated with these substances and to assess the evidence supporting their causal association with thrombocytopenia.

METHODS

Eleven databases were searched to identify relevant published reports. A priori criteria were defined for article selection and assessment. Each selected article was independently assessed by the three authors to document the presence of the criteria and determine the level of evidence for a causal association of the reported substance with thrombocytopenia.

RESULTS

Twenty-seven articles were identified that reported the occurrence of thrombocytopenia with 25 substances (other than quinine). However, only six articles describing five substances (cow's milk, cranberry juice, Jui [Chinese herbal tea], Lupinus termis bean, and tahini [pulped sesame seeds]) reported clinical data supporting definite evidence of a causal association with thrombocytopenia. Four articles provided probable evidence for four additional substances, and five articles provided possible evidence for five additional substances. In the remaining articles, the association with thrombocytopenia was unlikely or the articles were excluded from review.

CONCLUSIONS

Reports of thrombocytopenia describing definite or probable evidence for an association of a complementary/alternative medicines, herbal remedies, nutritional supplements, foods, and beverages are rare. Whether the occurrence of thrombocytopenia with these substances is uncommon or unrecognized is unknown.

A rede de comércio popular de drogas psicoativas na cidade de Diadema e o seu interesse para a Saúde Pública

O comércio popular de drogas vegetais sem garantia de qualidade implica risco sanitário. O presente estudo faz uma análise da rede de comércio popular de drogas vegetais psicoativas (DVPs) na cidade de Diadema e os riscos associados ao seu consumo. São apresentados dados parciais de um projeto realizado em colaboração com outras áreas de investigação. Métodos da etnofarmacologia, tais como entrevistas informais, semiestruturadas e observação participante foram utilizados para a realização do trabalho de campo, durante o qual selecionaram-se quatro comerciantes, a fim de registrar a obtenção, manipulação, acondicionamento e uso das DVPs comercializadas (nomes populares, receitas, partes utilizadas, contraindicações e doses). Foram registradas 63 DVPs distintas, e posteriormente categorizadas de acordo com suas possíveis ações psicoativas, predominando as estimulantes (67%) e depressoras (27%). Observaram-se deficiências na manipulação e acondicionamento das drogas por parte dos comerciantes, expondo seus clientes a possíveis riscos à saúde. Os resultados obtidos nesse estudo possibilitaram observar prioridades de adequação na comercialização de drogas vegetais no comércio popular a fim de resguardar a saúde de seus usuários, bem como a necessidade de promover um diálogo entre este e o sistema formal de saúde.

Uso de terapias complementares por mães em seus filhos: estudo em um hospital universitário

O objetivo deste estudo é avaliar a utilização de terapias complementares (TC) por mães em seus filhos. Trata-se de um estudo transversal, descritivo. Foram entrevistadas 202 mães de crianças assistidas em um hospital universitário. As variáveis analisadas foram: uso de terapias complementares/motivos para tal, tipos de terapias utilizadas, sua finalidade, seus efeitos, revelação ao médico/motivos para tal e reação do médico. A prevalência de uso de terapias complementares foi 87,6%. De 177 mães que utilizavam TC, muitas mencionaram mais de um tipo, sendo: chás (72,8%), benzimento (41%), simpatias (12,9%), remédios/xaropes caseiros (8,4%), oração/promessa (7,4%), homeopatia (4,0%), tratamento espiritual/parapsicológico (4,0%), mistura de substâncias desconhecidas/garrafada (3%), massagem (2%) e reiki/florais (1,5%). As ervas mais utilizadas foram erva-doce (16,7%), camomila (14,8%) e hortelã (10,9%); 57,6% das mães não informaram o uso ao médico. Dos 499 tratamentos empregados, houve percepção de melhora em 429 (86%) e relato de dois casos de efeitos adversos. A prevalência do uso de terapias complementares foi alta, sendo os chás a terapia mais utilizada e erva-doce, camomila e hortelã as ervas mais usadas. Houve percepção de melhora na maioria das terapias usadas.

Complementary/alternative medicines in allergic disease

Complementary/alternative medicines is a generic term that encompasses a variety of approaches, including homeopathy, acupuncture, phytotherapy and numerous holistic or behavioral techniques. Complementary/alternative medicines are widely used in a number of conditions, including asthma and rhinitis. The medical literature on complementary/alternative medicines is impressive, but there are few clinical studies conducted with an appropriate methodology, and their results are negative or conflicting. In general, the results are insufficient to provide recommendations for the use of complementary/alternative medicines in clinical practice. Regarding diagnostic techniques, none have demonstrated the capability of distinguishing between healthy and allergic subjects and none are able to identify sensitizations.