Complementary and alternative medicine (CAM) use among Jordanian patients with chronic diseases

Safety classification of herbal medicine use among hypertensive patients: a systematic review and meta-analysis

Background

The use of herbal medicines (HMs) for the treatment of hypertension (HTN) is increasing globally, but research on the potential adverse effects and safety of HMs in HTN patients is limited. Therefore, this systematic review and meta-analysis aim to determine the global prevalence of HM usage among HTN patients and assess the safety of identified herbs based on current scientific evidence.

Methods

The PubMed/MEDLINE, EMBASE (Ovid), and Cumulated Index to Nursing and Allied Health Literature (CINAHL) databases were searched for cross-sectional studies on the use of HM among HTN patients. Our review includes studies published in English up to the year 2023. After extracting and appraising the data from the studies, a meta-analysis was conducted using the Stata version 16.0 to estimate the pooled prevalence of HM use in patients with HTN (PROSPERO: CRD42023405537). The safety classification of the identified HM was done based on the existing scientific literature.

Results

This study analyzed 37 cross-sectional studies from 21 countries and found that 37.8% of HTN patients used HM to manage their health. The prevalence of HM use varied significantly based on publication year and geographical region. Among the 71 identified herbs, Allium sativum L., Hibiscus sabdariffa L., and Olea europaea L. were the most commonly used. However, four herbs were identified as contraindicated, 50 herbs required caution, and only 11 herbs were considered safe for use.

Conclusion

The study highlights the potential risks of toxicities and adverse effects associated with HM use in the treatment of HTN. Ensuring patient safety involves using safe HMs in appropriate doses and avoiding contraindicated HMs. Future research should focus on identifying commonly used herbs, especially in resource-limited countries with poor HTN management, and additional clinical research is required to assess the toxicity and safety of commonly used HMs.

Beliefs, awareness, use, and factors associated with herbal supplements usage among patients with chronic diseases-A cross-sectional insight from Alkharj, Saudi Arabia

BACKGROUND

Herbal supplements (HSs) are used to treat a variety of diseases and ailments. Individuals with chronic diseases are at a higher risk of having adverse events and drug interactions from the use of HSs.

AIM

This study determined the beliefs, awareness, use, and factors associated with HSs usage among patients with chronic diseases in Alkharj, Saudi Arabia.

METHOD

A cross-sectional study was conducted among patients with chronic diseases between February and June 2019. Face-to-face interviews were conducted at various out-patient clinics in different hospitals. Patients diagnosed with chronic diseases were included in the study. Data were analyzed by descriptive, comparative, and inferential statistics using SAS ver. 9.4.

RESULTS

The study participants were consisted of 533 patients, with mean age 53.6 ±12.9 years. The most prevalent chronic diseases were diabetes mellitus (67.7%), followed by hypertension (54.8%), and hyperlipidemia (53.8%). Among the studied participants, 336 (63%) had used at least one HS, whereby the most commonly used HSs were ginger (74.7%), mint (72%), and cumin (66.7%). Almost 78% of HSs users did not consult any healthcare provider about their use. HSs use varied significantly between female and male participants (p<0.05), whereby 61.5% of female participants used HSs in comparison to the male participants (38.5%). Gender (AOR 0.328; 95% CI 0.139-0.772; p = 0.0107), number of chronic diseases (AOR 1.585; 95% CI 1.084-2.318; p = 0.0312), and hyperlipidemia (AOR 2.818; 95% CI 1.507-5.269; p = 0.0.0012) were the pure factors of HSs use among the studied patients.

CONCLUSION

The results of this study showed that HSs usage was high among patients with chronic diseases in Saudi Arabia. Concurrent usage of HSs with drugs should be well-discussed with healthcare providers to avoid potential adverse events or drug interactions especially among patients with chronic diseases.

Rates, patterns, and predictors of complementary medicine use among patients with musculoskeletal diseases

AIM

To investigate the extent of complementary medicine (CM) use and the most common therapies utilized by Jordanian patients with musculoskeletal (MSK) diseases.

METHODS

A semi-structured questionnaire was used to conduct a cross-sectional survey of outpatient orthopedic and rheumatology patients at an academic medical center in Amman, Jordan between January and September 2020.

RESULTS

A convenience sample of 1001 patients was interviewed (82% females). Pearson's chi-square comparisons showed that nutritional CM was used by 43.4% of patients, while 29.8% used physical CM, and 16% used both. Almost all used the nutritional or physical CM in addition to their prescribed treatment. Nutritional form use was significantly higher among females, older age groups, married people, and those who worked (p < .05). Physical form use was statistically more prevalent in older age groups and those with a higher level of education (p < .05). Family income and urban residence were not significantly associated with the use of either form of CM therapy. Olive oil was the most frequently reported nutritional type (22.9%), and cupping was the most reported physical type (41.6%). Recommendations to use CM came primarily from family members or friends (64% of nutritional CM users and 59% of physical CM users). A physician or pharmacist was cited more frequently with physical CM (24% versus 8% for the nutritional form). In contrast, media sources were cited more for nutritional than physical form (28% versus 7%). Over half of the patients believed they received the desired effect from CM. Surprisingly, only 9.5% of the patients admitted to discussing their CM use with their physician.

CONCLUSION

CM use is prevalent among Jordanian patients with MSK disorders. Most patients rely on family and friends for recommendations, and they rarely inform their physician of the CM use. Physicians should routinely inquire about CM to provide patients with information regarding their benefits and risks.

High levels of risk factors and poor secondary prevention for coronary heart disease patients in public hospitals: A descriptive repeated measures study

BACKGROUND

Secondary prevention is a priority after coronary revascularization for effective long-term cardiovascular care. Coronary Heart Disease is a major health problem in Jordan, but little is known about the current provision of secondary prevention.

AIM

The aim of this study was to evaluate risk factors and explore the current provision of secondary Coronary Heart Disease prevention among patients presenting with first-time Coronary Heart Disease at two time points: during hospitalization (Time 1) and 6 months later (Time 2), in multicentre settings in Jordan.

METHODS

A descriptive, repeated measures research study design was applied to a consecutive sample of 180 patients with first-time Coronary Heart Disease. Demographic and clinical details were recorded from medical files. Self-administered questionnaires developed by the researchers were used to measure secondary prevention information related to Coronary Heart Disease, including secondary prevention services, lifestyle advice received and medical advice topics. A short form of the International Physical Activity Questionnaire was used to measure physical activity. Participants were assessed at Times 1 and 2.

RESULTS

Unstructured lifestyle advice given to the patients at Times 1 and 2 most frequently related to medications, smoking, diet and blood lipids control advice topics, with no statistically significant improvement in cardiovascular risk factors among patients between Times 1 and 2.

CONCLUSION

Despite an extremely high prevalence of risk factors in this population, the provision of secondary prevention is poor in Jordan, which requires urgent improvement, and the contribution of nurses' to secondary prevention should be enhanced.

A Cross-Sectional Assessment of Complementary and Alternative Medicine (CAM) Use among Patients with Chronic Diseases (CDs) in Qassim, Saudi Arabia

This study aims to investigate CAM use among CD patients from Qassim, Saudi Arabia and to compare CAM practice with different demographic and disease characteristics of the participants. A cross-sectional study was conducted among CD patients. During the three-months of data collection period, a total of 377 patients were approached and 208 patients participated in the study, giving a response rate of 55.17%. A p value of <0.05 was considered as significant. Among the study population, 94 (45.2%) patients were CAM users. Diabetes mellitus patients were the majority (48 (51.06%)) followed by hypertensive patients (34 (36.17%)). Spiritual therapies were the most common CAM followed by herbal products. Among CAM users, 41 (19.7%) patients reported disclosing CAM use to their health care providers. Among all the sociodemographic variables, gender (p = 0.029), marital status (p = 0.034) and education level (p = 0.047) were significantly associated with CAM use. In conclusion, the use of CAM among CD patients was relatively high in Qassim. Patients reported using CAM without disclosing to their health care providers which is a major health risk. It is critical to counsel CD patients regarding rational and informed CAM use in order to prevent harmful and unwanted effects.

Herbal supplements in Jordan: a cross-sectional survey of pharmacists' perspectives and knowledge

OBJECTIVES

Pharmacists are ideal partners for engaging with the needs and expectations of patients. They can play a vital role by providing information and supplying herbal medicines. In some community settings, pharmacists are also the main first point of care. This study explored Jordanian community pharmacists' perspectives and knowledge of herbal medicines available in pharmacies.

DESIGN

A cross-sectional study using an online survey was developed, and it was distributed via social media platforms. The one-way analysis of variance (ANOVA) test was used to compare the mean knowledge scores between different demographic groups. Multiple linear regression analysis was used to identify predictors of herbal medicines knowledge.

SETTING

Jordanian community pharmacies.

PARTICIPANTS

401 Jordanian community pharmacists.

RESULTS

Herbal supplements are sold in practically all pharmacies (98.5%). Slimming aids (14.7%), followed by sexual and sports enhancements (14%) and maintaining general health (12.1%) were most requested by Jordanian customers. While supplements for maintaining general health (12%), followed by slimming aids (11.4%) and skin conditions (9.3%) were most recommended by Jordanian pharmacists. 63.1% were not aware of potential herb-drug interactions, 95.6% did not receive complaints from customers about herbal medicines and 41.2% would not report adverse reactions to the national pharmacovigilance services. The mean knowledge score for knowledge of use, regulation, adverse reactions, and drug interactions was 3.7 (SD: 0.7), 3.5 (SD: 0.8), 3.6 (SD: 0.8), and 3.6 (SD: 0.8) (out of 5), respectively. ANOVA test showed that total pharmacists' knowledge scores significantly differed based on the length of time practising pharmacy (p<0.05).

CONCLUSION

This study highlights some key concerns relating to recommendations, awareness and reporting of herbal medicines among Jordanian community pharmacists. Pharmacists need enhanced education to provide objective and evidence-based information on the benefits-risks of herbal medicines. Future studies need to be carried out to confirm whether our findings are transferable to other Middle Eastern countries.

Attitude and practice toward traditional medicine among hypertensive patients on follow-up at Mizan–Tepi University Teaching Hospital, Southwest Ethiopia

Introduction:

Traditional medicine has been used for the management of common mild conditions such as headache, diarrhea, and common cold as well as in the treatment of chronic diseases including hypertension. The usage of this medicine is regarded as acceptably safe with most Ethiopian people. Attitude and practices toward traditional medicine are crucial elements of hypertension control and its favorable outcome expectation. This study aimed at assessing the attitude and practice toward traditional medicine among hypertensive patients on follow-up at Mizan–Tepi University Teaching Hospital, Southwest Ethiopia.

Method:

Facility-based cross-sectional study was conducted from 1^st December 2020 to 30^th December 2020 among 173 hypertensive patients. A consecutive sampling technique was used to select study participants. Data were collected through interviewer-administered structured questionnaire and analyzed using Statistical Package for the Social Sciences software version 23. Multivariable logistic regression analysis was done to identify the independent predictors of patients’ attitude toward traditional medicine and their traditional medicine use at a p value ⩽0.05.

Results:

Eighty-seven (50.29%) of the total 173 approached patients were found to have good attitude toward traditional medicine. Ninety-seven (56.07%) participants had used traditional medicine at least once in their lifetime and 45 (46.39%) patients used traditional medicine and modern medicine concomitantly. Participants’ residence (adjusted odds ratio = 2.79, confidence interval = 1.01–7.74, p-value = 0.049) and educational status (adjusted odds ratio = 1.76, confidence interval = 1.61–5.09, p-value = 0.032) had significant association with attitude toward traditional medicine, while patients’ age (adjusted odds ratio = 1.43, confidence interval = 1.32–4.96, p-value = 0.039), residence (adjusted odds ratio = 2.18, confidence interval = 1.10–4.32, p-value = 0.025), and occupation (adjusted odds ratio = 3.38, confidence interval = 1.55–7.38, p-value = 0.002) had significant association with their traditional medicine use.

Conclusion:

Half of the study participants had good attitude toward traditional medicine, and nearly, one-fourth of the participants had practiced traditional medicine along with modern medicine. Health service providers should be aware of traditional medicine use and advise patients on the dosing of traditional medicine.

Self-management using crude herbs and the health-related quality of life among adult patients with hypertension living in a suburban setting of Malaysia

PURPOSE

To determine the prevalence of crude herbs' use in the self-management of hypertension and the health-related quality of life (HRQOL) in patients with hypertension.

METHODS

This cross-sectional study was performed among patients with hypertension attending a government health clinic. Socio-demographic characteristics, lifestyle modifications, medical history and predictors of crude herbs users were obtained. The diversity of crude herbs used was assessed using a modified international complementary and alternative medicine questionnaire (I-CAM-Q) and the HRQOL was assessed using the SF36 instrument.

RESULTS

Out of the 294 patients recruited, 52.4% were female, 41.5% were Malay and 38.8% were within the 60 to69 age category. The prevalence of crude herbs users was 30.6% and the most common herbs used were pegaga (Centella asiatica), peria (Momordica charantia) and betik (Carica papaya). Using the regression analysis, significantly higher odds of using crude herbs are noted among Malay or Indian patients who have these characteristics: attained secondary education, experienced falls or muscle pain, and had systolic blood pressure of more than 140 mmHg. There was no significant difference in HRQOL domains between the crude herb users and non-users (p>0.05).

CONCLUSION

Besides taking allopathic medications, certain patients with hypertension use crude herbs as a form of self-management. Although patients are adamant about integrating crude herbs as a form of self-management, the effects of doing so have not been properly investigated. This implies that the healthcare staff members need to communicate with the patients regarding the use of crude herbs together with conventional drugs.

Beliefs About Illness and Treatment Decision Modelling During Ill-Health in Arabic Families

Background

The use of self-prescribed antibiotics and other unproven herbal remedies is common in the Arab world. Understanding how family members decide to manage illness is an important priority for health care providers.

Purpose

This paper presents a new model that can be viewed as an extension to the Health Belief Model and help clarifies the cognitive processes families use to manage illness in an Arab family in Jordan. It aims to generate an understanding of family beliefs about the causes of illness and appraisal of how best to manage illness in an Arab family.

Methods

A qualitative approach using a family interview method was used to collect data. Twenty-five families participated in semi-structured interviews designed to elicit representational models of illness and treatment-decisions.

Results

Thematic analysis revealed two forms of intertwined beliefs: core beliefs (fatalistic) and secondary beliefs (biomedical, supernatural and situational beliefs). Four key elements were identified as underpinning the involvement of family in treatment decision: perceived threat of illness, efficacy of treatment option, cost or availability and family prior experience.

Conclusion

An understanding of the health belief model and related cognitive appraisal processes used by families may assist health care providers to engage with and overcome some of the social, cultural, and structural variables that could influence how family members decide to manage illness in Jordan.

The potential of drug-herbal interaction among patients with chronic diseases in Saudi Arabia

AIMS

This study aimed to estimate the prevalence of the potential drug-herbal interaction among patients with chronic diseases in Al-Kharj, Saudi Arabia and to explore factors associated with the potential of drug-herbal interaction.

METHOD

A cross-sectional study was conducted through interview-based questionnaire at outpatient clinics in Al-Kharj. The study included patients with chronic diseases who used herbal products.

RESULTS

This study included 336 patients in total. The mean age of participants was 52.4 ± 12.0 years, and their most-used medications were metformin, atorvastatin, and aspirin, while their most-used herbs were ginger (74.7%), mint (72%), and cumin (66.7%). In 310 out of 336 (92.26%) cases, at least one potential drug-herbal interaction was found, and most of these interactions (84%) were moderate.

CONCLUSION

A substantial percentage of potential drug-herbal interactions were found among patients with chronic diseases. Healthcare providers are encouraged to discuss the safety and efficacy of herbal products with their patients.

Knowledge level and attitude towards complementary and alternative treatment methods among medical students: a cross-sectional survey study in Turkey

OBJECTIVE

People often use complementary and alternative medicine (CAM) methods in Turkey, but reliability of the application of these methods is controversial. Considering the role of medical students (i.e. physician candidates) in sustainable health, their perspectives on CAM methods are important. This report explores the level of knowledge, experience, and preferences for the use of CAM methods among medical school students.

MATERIAL AND METHODS

A survey about the use of CAM and interest in CAM methods was applied to 101 first-year and 87 fifth-year medical school students. The binary and multinomial logistic regression models were used for statistical analysis.

RESULTS

Sixteen percent of the first-year and 9% of the fifth-year students were familiar with "The Regulation on Traditional and Complementary Medical Practices" published by the Ministry of Health of Turkey in 2014. While participants reported the most familiarity with acupuncture treatment, they were the most unfamiliar with prolotherapy among all CAM methods. Seeking advice from a licensed physician before applying CAM methods was the general agreement among the participants. Interest in learning and practicing hypnosis was the highest-rated CAM method among the participants.

CONCLUSIONS

Increasing knowledge and awareness of CAM methods by including them into the medical curriculum would be essential for the correct use of CAM methods.

Role of Pharmacists in COVID-19 Disease: A Jordanian Perspective

OBJECTIVES

The novel 2019 coronavirus outbreak that first appeared in Wuhan has quickly gained global attention, due to its high transmissibility and devastating clinical and economic outcomes. The aim of this study was to assess the possible roles of Jordanian pharmacists in minimizing the stage of community transmission.

METHODS

A cross-sectional survey using Google forms targeting Jordanian pharmacists was conducted during March 2020 and distributed electronically by means of social media. Using the survey tool, we measured the pharmacists' knowledge, the educative activities they perform, and their perceptions regarding undertaking traditional and untraditional roles during the COVID-19 outbreak, as specified by the International Pharmaceutical Federation (FIP). Collected data were analyzed using SPSS version-19.

RESULTS

Jordanian pharmacists (n = 449) reported performing various educative activities, and in general, they were knowledgeable about various aspects of the COVID-19 disease (median knowledge score: 20 [range, 13-25]), but certain gaps in knowledge were detected that must be addressed. Pharmacists had positive perceptions about both their traditional and untraditional roles specified by the FIP, the median perceptions score was 4 (range, 1-5).

CONCLUSIONS

Jordanian pharmacists can be used to reduce community transmission of the outbreak. However, more actions are required to keep pharmacists knowledgeable with recent disease updates to enable them to perform their tasks effectively during times of crisis.

Effect of Rooibos (Aspalathus linearis) extract on atorvastatin-induced toxicity in C3A liver cells

Rooibos (Aspalathus linearis) has various health benefits. Two case studies have associated chronic Rooibos consumption with conventional prescription medications, including atorvastatin (ATV), with hepatotoxicity. Statins act by inhibiting hydroxymethylglutaryl‐coenzyme A reductase, a rate‐limiting enzyme in cholesterol synthesis. Although rare, statins are potentially hepatotoxic. The aim was to investigate interactions between aspalathin‐rich Rooibos extract GRT™ and ATV‐induced hepatotoxicity in C3A liver cells cultured with and without palmitate. Effects of co‐treatment of GRT + ATV on cell viability, oxidative stress, apoptosis, mitochondrial integrity, and cellular reactive oxygen species (ROS) production were assessed. Significantly increased ROS production was observed in cells exposed to ATV and palmitate. Combination therapy of GRT + ATV also showed significant increases in ROS production. Under palmitate‐treated conditions, ATV‐induced significant apoptosis which was not ameliorated by GRT + ATV co‐treatment. Despite studies purporting hepatoprotection from Rooibos, our study showed that GRT was unable to modulate ATV‐induced hepatotoxic effects in this model.

Herbal medicines: a cross-sectional study to evaluate the prevalence and predictors of use among Jordanian adults

Introduction

Understanding why adults resort to herbal medicine can help in planning interventions aimed at increasing awareness regarding herbal use. This study sought to investigate the prevalence and to determine factors for predicting the use of herbal medicine among Jordanian adults.

Methods

A cross-sectional study was conducted involving 378 older adults who were randomly selected from two different areas of Jordan. A questionnaire was used to gather data and validation criteria for validity and reliability of the content were tested by content and face validity in a panel of experts.

Results

From a total of 500 invited participants, 378 completed the questionnaire. The prevalence of the use of of herbal products in this study was high at 80.2%. Herbal medicines use was not associated with any demographic factors other than age (p < 0.05). Moreover, the only associated health-related characteristic was the patient’s disease state including, notably, hypertension (p < 0.05). Reasons for not using herbal medicines as reported by nonusers included mainly a lack of belief in their efficacy (52.2%). Another two important reasons were that the individuals believed themselves to healthy and have no need for their use (31.3%) and the unavailability of enough information about the herbal medicines (29.7%). Finally, the most common side effects as reported by patients in this study were nausea and vomiting (9.3%), and, to a lesser extent, skin rash (2.1%).

Conclusion

There is a high rate of use of herbal medicines in Jordan, especially among hypertensive patients. Therefore, there is a need to establish effective herbal medicine policies and health education programs to discuss the benefits and risks of herbal medicine use, with the aim of maximizing patient-desired therapeutic outcomes.

A cross-sectional analysis of patient characteristics, health conditions and patient experience at a Portuguese medical acupuncture teaching appointment

BACKGROUND

Acupuncture is one of the most popular and most frequently used complementary medicines worldwide, with benefits for several health conditions when integrated into Western medical practice.

OBJECTIVE

To perform a retrospective analysis of patient characteristics, health conditions and patient experience in a teaching medical acupuncture appointment at the Faculty of Medicine, University of Coimbra/Coimbra Hospital and University Centre.

METHODS

500 medical records between January 2010 and December 2015 were accessed and 324 were included. The characteristics examined include gender, age, health conditions treated, number of acupuncture needles used in each treatment, professional who referred the patient, type of stimulation, number of treatment sessions and patient experience regarding the degree of improvement at the end of treatment.

RESULTS

Patients range from 13 to 92 years old, with most between 40 and 59 yo (40.7%). In total, 71.3% were female and 28.7% male. The most commonly treated health conditions were musculoskeletal symptoms (60.4%), nervous and headaches (18.2%) and orofacial (11.3%). The median number of appointments was 6 and the median needles used per treatment was 12. In 52.2% of consultations, electrostimulation was performed. The majority of patients were referred by physical and rehabilitative medicine and dentists. 85.3% of patients reported improvement at the end of the treatment, with those who performed more sessions presenting a higher improvement.

CONCLUSIONS

This pioneering study in Portugal presents similar results to other countries regarding patient characterization. The high success rate (85.3%) regarding patient improvement recommends the use of acupuncture as an effective complementary therapy.

Medicinal plants’ use among patients with dyslipidemia: an Iranian cross-sectional survey

Background

Despite growing demand for medicinal plants, there is little data about their use by patients with dyslipidemia. We aimed to determine the prevalence, pattern, and associated factors for the use of medicinal plants among patients with dyslipidemia.

Methods

A 17-item semi-structured questionnaire was filled out by 195 patients with dyslipidemia in a cross-sectional study carried out in two academic endocrinology clinics in Shiraz, Iran. The questionnaire comprised of three main domains of demographic data (6 questions), clinical data (2 of them), and data related to the use of medicinal plants (totally 9 questions).

Results

A total of 77.4% of patients took medicinal plants. The most common medicinal herbs used by dyslipidemic patients were Zataria multiflora, Cinnamomum zeylanicum, and Zingiber officinale. Duration of dyslipidemia was significantly longer in herbal users than non-herbal users (p=0.04). Patients believing that concomitant use of conventional drugs and herbal preparations had synergic positive effects in addition to those persuaded that herbal preparations possessed less side effects, were significantly more likely to use medicinal plants (p=0.008 and 0.005, respectively). Additionally, most of the medicinal herb users (87.4%) changed neither the pattern nor the dosage of their medications all during herbal preparations use.

Conclusions

This study demonstrated a high prevalence of medicinal plants’ use among patients with dyslipidemia, which was associated with the duration of dyslipidemia, patients’ viewpoints about herbal preparations’ synergic positive effects, and their fewer side effects.

Use of complementary medicine among people with diabetes in eastern Turkey: A descriptive study

PURPOSE

To measure the frequency, type, purpose of complementary medicine (CM) use among people with diabetes mellitus.

MATERIALS AND METHODS

The population of this descriptive study consisted of the patients hospitalized in the endocrine clinic of a university hospital in Eastern Turkey who were diagnosed with diabetes. Data were collected from 316 patients.

RESULTS

43.0% of the patients were using CM, and 97.0% of those using CM tried herbal methods. The patients who had variable glycated haemoglobin values (60.3%) and those who had DM-related complications (60.3%) used CM more.

CONCLUSION

It was determined that CM usage was prevalent among the patients. The most frequently used CM method was herbal therapy. We found that the use of CM was more common in patients with poor metabolic control. Therefore, healthcare professionals must be assess use of CM and provide suitable counseling.

Prevalence of herbal medicine use among patients with kidney disease: A cross-sectional study from Morocco

INTRODUCTION

The objectives of this study were to determine the prevalence of herbal medicine use by patients hospitalized or consultant in the nephrology department of University Hospital center Hassan II Fez, the reasons of this use, to identify socio-demographic characteristics, and the etiology of kidney disease related to herbal medicine use, also the most used plants.

METHOD

Cross-sectional study on the use of herbal medicine conducted at the nephrology department of University Hospital Center Hassan II Fez, Morocco. During 6 months between August 2015 and February 2016. Patients older than 15 years (n=471) with varying degrees of kidney disease were included. The questionnaire contained questions related to socio-demographic data, the use of plants, knowledge about herbal medicine toxicity, and etiology of KD. Descriptive statistics were used to analyze socio-demographic characteristics related to herbal medicine use.

RESULTS

A total of 471 patients responded; the prevalence of herbal medicine use was 50.7%. Herbal medicine users were more likely to be males (OR 0.43; 95%CI 0.25-0.74); unemployed (OR 0.51; 95%CI 0.29-0.89), with unknown etiology (OR 0.43; 95%CI 0.22-0.84). Reasons of use were: belief in its efficacy (74%), easy access to medicinal herbal medicine (70%), and lower cost (48%). The most commonly used herbal medicine were Rosmarinus officinalis L.; Origanum compactum Benth; Artemisia herba-alba Asso and Mentha pulegium L. Potentially harmful herbal medicine included Aristolochia longa.

CONCLUSIONS

The prevalence of herbal medicine use is high among patients with kidney disease in nephrology department.

The use of herbal medicines among chronic disease patients in Thailand: a cross-sectional survey

Background

The study aimed to assess the prevalence and correlates of herbal medicine use among chronic disease patients in health care settings in Thailand.

Methods

In a cross-sectional study, 1374 adult chronic disease patients (median age 60 years) were consecutively sampled from health care facilities in Thailand. Logistic regression was used to estimate the independent predictors of herbal medicine use in the past 12 months.

Results

The prevalence of herbal medicine use in the past 12 months was 35.9%. Of participants who were using herbal medicine in the past 12 month, 53.7% used it for treating a long-term health condition, 40.0% used herbal medicine in order to improve well-being and 6.3% for treating an acute illness. More than half of the herbal medicine users (57.2%) rated their herbal medicine use as very helpful, 33.3% as somewhat helpful and 6.5% not at all helpful or do not know. In adjusted logistic regression analysis, having Grade 6 to 12 education (Odds Ratio-OR: 1.71, Confidence Interval-CI: 1.04, 2.82), rural residence (OR: 0.76, CI: 0.60, 0.97), other religion (OR: 0.57, CI: 0.35, 0.97), anxiety (OR: 1.64, CI: 1.25, 2.16), low quality of life (OR: 0.42, CI: 0.31, 0.56) and having multiple chronic conditions (OR: 1.82, CI: 1.30, 2.56) were associated with past 12-month herbal medicine use. Further, in adjusted logistic regression analysis, having arthritis, asthma, cancer, cardiovascular disease, dyslipidaemia, gastrointestinal disease, dyslipidaemia were positively and hypertension negatively associated with past 12-month herbal medicine use.

Conclusions

The study found a high prevalence of herbal medicine use among chronic disease patients in Thailand. Several factors (education, rural residence, anxiety, low quality of life and multiple chronic conditions) associated with herbal medicine use were identified. This knowledge will support health care providers and policy makers in decision making on the use of herbal medicine.

Barriers to good glycemic control levels and adherence to diabetes management plan in adults with Type-2 diabetes in Jordan: a literature review

Poorly controlled Type-2 diabetes is considered a significant public health problem and associated with adverse outcomes in Jordan. This review focuses on barriers to good glycemic control levels and adherence to diabetes management plan in adults with Type-2 diabetes in Jordan. The aim was to identify the extent of Type-2 diabetes and the influence of knowledge, perceptions and sociocultural factors on adherence to the diabetes management plan. Thirty-two studies were included in the literature review. The high prevalence rate of poorly controlled Type-2 diabetes is associated with many negative consequences among patients in Jordan. Despite the publication of research findings that have shown the importance of adherence to diet, physical activity, medications, monitoring blood glucose and foot care, the level of adherence is still unsatisfactory among patients in Jordan. This review also identified that social, cultural and religious factors influence diabetes management. These factors highlighted the overwhelming influence of socio-cultural factors and lifestyles as determinants of patients' health and health behaviors. For example, the influence of family, friends and culture on herbal use and food preferences that patients make on a daily basis and during social gatherings. A holistic approach incorporating patient-centered care could usefully be incorporated into educational programs to improve the understanding of patients' health and information needs. The importance of factors beyond the individual level in terms of social, cultural, organizational and policy influences such as food habits, religious beliefs and lack of continuity of care were identified as key factors which influence adherence to the diabetes management plan. Recognition of multiple determinants of patients' health among health care professionals may expand the scope of interventions to seek to modify social norms and values and improve patient outcomes.

Traditional methods for managing illness in newborns and infants in an Arab society

AIM

This study explored self-management practices in relation to traditional methods for managing illness in newborns and infants and the implications of these practices on infant health.

BACKGROUND

Self-medication with folk remedies is believed to have short- and long-term impacts on well-being. Little is known about how mothers in Arab societies used their traditional beliefs and practices in self-managing their newborns' and infants' health.

METHODS

Data were collected from five focus groups using open-ended questions with 37 mothers. Participants were selected using snowball sampling and were recruited from four different cities in Jordan between June 2016 and August 2016.

ETHICAL APPROVAL

All identifying information regarding the study participants has been omitted, and this study was approved by the Academic Research Committee at the University of Jordan.

FINDINGS

Mothers were more willing to try herbal remedies, traditional massage and certain foods to self-manage their infants' health. Folk remedies were not restricted to traditions handed down through generations, but included a representation of newly emerged trends towards 'safety' or 'nature'.

CONCLUSIONS

While the use of folk remedies have been handed down generations as customs, today, virtual support groups and social media provide modern resources for folk remedies' promotion in care and self-management.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Nursing and health policymakers can use our findings for planning and developing strategies and health policies that increase public awareness about adverse health effects associated with herbal remedies. Such strategies are likely to be facilitated through partnerships between nursing and midwifery education institutions, antenatal clinics and social media in the region.

Self-medication among people living with hypertension: a review

BACKGROUND

Self-medication is commonly practised by patients, underpinned by health beliefs that affect their adherence to medication regimens, and impacting on treatment outcomes.

OBJECTIVES

This review explores the scope of self-medication practices among people with hypertension, in terms of the scale of use, types of medication and influencing factors.

METHOD

A comprehensive search of English language, peer-reviewed literature published between 2000 and 2014 was performed. Twenty-seven studies met the inclusion criteria; 22 of these focused on complementary and alternative medicines (CAMs).

RESULTS

Anti-hypertensive medications are listed among the 11% of products that patients reportedly obtain over-the-counter (OTC) for self-medication. On average, 25% of patients use CAMs, mostly herbs, to lower blood pressure. Recommendations by family, friends and neighbours are the most influential factors for self-medication with CAMs. Faith in treatment with CAMs, dissatisfaction with conventional medicine and the desire to reduce medication costs are also cited. Most (70%) patients with hypertension take OTC medicines to treat minor illnesses. The concurrent use of anti-hypertensive medications with analgesics and herbal medicines is commonly practised. The sociodemographic profile of patients engaging in self-medication differs markedly in the articles reviewed; self-medication practices cannot be attributed to a particular profile. Low disclosure of self-medication is consistently reported.

CONCLUSION

This review highlights a high proportion of people with hypertension practise self-medication. Further studies are needed to assess the impact of self-medication with OTC and anti-hypertensive medications on hypertension treatment. Health professionals involved in hypertension management should be mindful of any types of self-medication practices.

Complementary and alternative medicine use among cancer patients in Palestine with special reference to safety-related concerns

ETHNOPHARMACOLOGICAL RELEVANCE

The use of CAM including herbal medicine as the most preferred CAM modality, among cancer patients who are taking prescription medications has shown to be highly prevalent worldwide as well as in several Middle Eastern countries, with a high percentage of the patients do not disclose their CAM use to treating physician.

AIM OF THE STUDY

The current study aimed to evaluate the patterns of CAM use among two cohorts of cancer patients in Palestine over a three-year period, and to identify socio-demographic factors that are associated with CAM use.

MATERIALS AND METHODS

Across-sectional survey of patients attending outpatient cancer clinics. The method was based on a semi-structured questionnaire. In order to identify safety-related concerns associated with the products listed, a literature search was conducted using different databases (PubMed, Micromedex, AltMedDex, and the Natural Medicine Comprehensive Database).

RESULTS

In 472 cancer patients including 372 of the 2011 cohort; and 100 of the 2014 cohort, the overall prevalence of CAM use was 69.5%. CAM users were more likely to be ≤65 years old, village resident, being in the midst of chemotherapy, to have high interest spiritual quest, and to have no other chronic diseases. A significant number of CAM users reported using herbal preparations (98.3%, and 89.6% in the two study cohorts, respectively). In the current study, a total of 40 plant taxa belonging to 23 botanical families were reported by ≥3 cancer patients in the two cohort groups. The top most commonly used plant in the 2011 cohort group was Arum palaestinum (43.5%), while Ephedra foeminea emerged as the top most commonly utilized plant (from 0.0% in 2011 to 55.2% in the 2014 cohort), mainly due to a recent publicizing and portraying of the plant in the local media as an effective cancer herbal remedy. Safety-related concerns were associated with 33 (82.5%) herbs, including herb-drug interactions with altered pharmacokinetics (8, 20% herbs), direct toxic effects (16, 40% herbs), and increased in vitro response of cancer cells to chemotherapy (30, 75% herbs).

CONCLUSIONS

CAM use, especially herbal medicine in cancer is highly prevalent in Palestine. This study has demonstrated the role of the media on the emergence of new CAM herbal therapies among cancer patients in Palestine, and discussed its potential implications on patients and for oncologists who are treating them. Some of the most widely used herbal medicines by cancer patients in the present work are known to interact with conventional anticancer drugs. Hence, the disclosure of the use of herbal remedies by patients to health professionals with sufficient training in CAM use is important for the later in order to assess whether there are any possible herbal drug interactions and/or harmful drug reactions.

Ethnopharmacological survey about medicinal plants utilized by herbalists and traditional practitioner healers for treatments of diarrhea in the West Bank/Palestine

ETHNOPHARMACOLOGICAL RELEVANCE

Folk herbal medicine knowledge and its utilization by aboriginal cultures are not only useful for conservation of cultural traditions and biodiversity, but also useful for community healthcare and drug discovery in the present and in the future.

AIM OF THE STUDY

Using a semi-structured questionnaire, an ethnopharmacological survey of medicinal plants used for treatment of diarrhea in the West Bank/Palestine was investigated.

RESULTS

Information about fifty medicinal plants used for treatment of diarrhea, including the names of plants, parts used, mode and methods of preparation was obtained from 100 traditional healers and herbalists. This research is the first scientific work in the Middle East to collect data about plants used by traditional healers for treatments of diarrhea and their evidence based effects against this disease. The fidelity levels were 97% for Salvia fruticosa, Teucrium polium and Musa paradisiaca, 95% for Camellia sinensis and Aegle marmelos, 79% for Oryza sativa and Solanum tuberosum, 77% for Quercus boissieri, 66% for Psidium guajava, 56% for Anthemis palestina, 54% for Solanum nigrum and 52% for Juglans regia while the highest use and choice values were for S. fruticosa, T. polium and M. paradisiaca as well as the factor of informant's consensus for medicinal plants used for treatment of diarrhea was 0.505.The leaves were the most commonly used parts, followed by fruits, roots and rhizomes, while decoctions and infusions are the preferred methods of preparation.

CONCLUSIONS

The Palestinian traditional medicine is rich with herbal remedies for treatment of diarrhea in comparison with other countries, but most of these herbal remedies lack standard in-vitro and in-vivo evaluations to establish their antidiarrheal effects. Therefore, the information obtained can serve as a basis for further phytochemical and pharmacological studies to determine their efficacy and safety which might contribute to a better integration of Palestinian traditional medicine into the national health system in the future.

The utilization of traditional, complementary and alternative medicine for non-communicable diseases and mental disorders in health care patients in Cambodia, Thailand and Vietnam

BACKGROUND

The purpose of our study was to determine the prevalence of traditional, complementary and alternative medicine (TCAM) use in patients with chronic diseases in lower Mekong countries.

METHODS

A cross-sectional study was conducted in a health care setting using a random sample of 4799 adult patients (Mean age: 52.3 years, SD = 22.7) with chronic diseases in Cambodia, Vietnam and Thailand. The measure included the International Questionnaire to measure usage of complementary and alternative medicine (I-CAM).

RESULTS

The 1 year prevalence of consulting TCAM providers was 26.0%; 27.0% in Cambodia, 26.3% in Thailand, 23.9% in Vietnam. The most commonly consulted TCAM providers were the herbalist (17.3%), massage therapist (6.0%), and acupuncturist (5.5%). For all different types of TCAM providers more than 80% of participants perceived the consultation as very or somewhat helpful. The own use of herbal medicine was 41.0%, own use of vitamins 26.5% and the own use of other supplements 9.7% in the past 12 months. The most common self-help practices in the past 12 months included praying for your own health (30.1%), meditation (13.9%) and relaxation techniques (9.9%). In multivariate logistic regression analyses, older age, rural residence and having two or more chronic conditions was associated with the use a TCAM provider; being female, urban residence, residing in Vietnam and having two or more chronic conditions was associated with the use of TCAM products; and being female, older age, rural residence, higher formal education, and residing in Cambodia was associated with the use of TCAM self-help practices.

CONCLUSIONS

TCAM use is common among chronic disease patients in lower Mekong countries and is associated with several sociodemographic and disease specific factors.

Role of biomarkers of nephrotoxic acute kidney injury in deliberate poisoning and envenomation in less developed countries

Acute kidney injury (AKI) has diverse causes and is associated with increased mortality and morbidity. In less developed countries (LDC), nephrotoxic AKI (ToxAKI) is common and mainly due to deliberate ingestion of nephrotoxic pesticides, toxic plants or to snake envenomation. ToxAKI shares some pathophysiological pathways with the much more intensively studied ischaemic AKI, but in contrast to ischaemic AKI, most victims are young, previously healthy adults. Diagnosis of AKI is currently based on a rise in serum creatinine. However this may delay diagnosis because of the kinetics of creatinine. Baseline creatinine values are also rarely available in LDC. Novel renal injury biomarkers offer a way forward because they usually increase more rapidly in AKI and are normally regarded as absent or very low in concentration, thereby reducing the need for a baseline estimate. This should increase sensitivity and speed of diagnosis. Specificity should also be increased for urine biomarkers since many originate from the renal tubular epithelium. Earlier diagnosis of ToxAKI should allow earlier initiation of appropriate therapy. However, translation of novel biomarkers of ToxAKI into clinical practice requires better understanding of non-renal factors in poisoning that alter biomarkers and the influence of dose of nephrotoxin on biomarker performance. Further issues are establishing LDC population-based normal ranges and assessing sampling and analytical parameters for low resource settings. The potential role of renal biomarkers in exploring ToxAKI aetiologies for chronic kidney disease of unknown origin (CKDu) is a high research priority in LDC. Therefore, developing more sensitive biomarkers for early diagnosis of nephrotoxicity is a critical step to making progress against AKI and CKDu in the developing world.

The Use of Complementary and Alternative Medicine among Lebanese Adults: Results from a National Survey

Objective. To examine the prevalence and correlates of Complementary and Alternative Medicine (CAM) use in Lebanon. Methods. A cross-sectional survey was conducted through face to face interviews on a nationally representative sample of 1,475 Lebanese adults. The survey questionnaire explored the sociodemographic and health related characteristics as well as the types and modes of CAM use. The main outcome in this study was the use of CAM during the last 12 months. Results. Prevalence of CAM use was 29.87% with "folk herbs" being the most commonly used (75%). Two out of five CAM users indicated using it as alternative to conventional therapies and only 28.4% of users disclosed the use of CAM to their physician. CAM use was significantly associated with higher income, presence of a chronic disease, and lack of access to needed health care. Lower odds of CAM use were observed among older adults and those with a higher education level. Conclusions. This study revealed a high prevalence of CAM use in Lebanon. Health policy and decision makers need to facilitate proper regulation and integration of CAM into mainstream medicine and educate health care providers and the public alike on the safe and effective use of CAM therapies.

Public awareness, patterns of use and attitudes toward natural health products in Kuwait: a cross-sectional survey

BACKGROUND

There has been a global rise in the use of natural health products (NHPs). Proper regulation of NHPs is pivotal to ensure good quality control standards, enhance consumers' safety and facilitate their integration into modern healthcare systems. There is scarcity of published data on the prevalence of NHPs usage among the general Kuwaiti population. Hence, this study was designed to determine awareness, patterns of use, general attitude and information requirements about NHPs among the public in Kuwait.

METHODS

A descriptive cross-sectional survey was performed using a pretested self-administered questionnaire on a sample of 1300 Kuwaiti individuals, selected from six governorates in Kuwait using a multistage stratified clustered sampling. Descriptive and multivariate logistic regression analysis were used in data analysis.

RESULTS

The response rate was 90.2%. NHPs were thought to be herbal remedies by most of participants (63.5%), followed by vitamins/minerals (40.5%), traditional medicines (21.1%), probiotics (14.9%), amino acids and essential fatty acids (7.2%), and homeopathic medicines (5.6%). NHPs usage was reported by 71.4% (95% CI: 68.8-74.0%) of respondents, and mostly associated with females (OR: 1.90; 95% CI: 1.44-2.51). Herbal remedies were the most commonly used (41.3%; 95% CI: 38.5-44.2%). The most common reasons for using NHPs were to promote and maintain health and to prevent illness and build immune system. Family members and/or friends and mass media were the main sources for providing information about NHPs. About 18% of consumers have experienced a side effect due to using a NHP. Attitudes toward NHPs were generally positive; with more than 75% of participants believing that the Ministry of Health in Kuwait should regulate the claims made by the manufacturers of NHPs and it is important to talk to a medical doctor or a pharmacist prior to using NHPs. Most of the respondents showed increased interest to acquire knowledge about different types of information related to NHPs.

CONCLUSIONS

The prevalence of use of NHPs among Kuwaiti population is high. The present findings have major public health policy implications for Kuwait. Therefore, there is an apparent need to establish effective health education programs and implement better and more regulated NHPs use policies in Kuwait.