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Foley H, Steel A, Cramer H, Wardle J, Adams J. Disclosure of complementary medicine use to medical providers: a systematic review and meta-analysis. Sci Rep 2019; 9:1573. [PMID: 30733573 PMCID: PMC6367405 DOI: 10.1038/s41598-018-38279-8] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 12/20/2018] [Indexed: 12/03/2022] Open
Abstract
Concomitant complementary medicine (CM) and conventional medicine use is frequent and carries potential risks. Yet, CM users frequently neglect to disclose CM use to medical providers. Our systematic review examines rates of and reasons for CM use disclosure to medical providers. Observational studies published 2003-2016 were searched (AMED, CINAHL, MEDLINE, PsycINFO). Eighty-six papers reporting disclosure rates and/or reasons for disclosure/non-disclosure of CM use to medical providers were reviewed. Fourteen were selected for meta-analysis of disclosure rates of biologically-based CM. Overall disclosure rates varied (7-80%). Meta-analysis revealed a 33% disclosure rate (95%CI: 24% to 43%) for biologically-based CM. Reasons for non-disclosure included lack of inquiry from medical providers, fear of provider disapproval, perception of disclosure as unimportant, belief providers lacked CM knowledge, lacking time, and belief CM was safe. Reasons for disclosure included inquiry from medical providers, belief providers would support CM use, belief disclosure was important for safety, and belief providers would give advice about CM. Disclosure appears to be influenced by the nature of patient-provider communication. However, inconsistent definitions of CM and lack of a standard measure for disclosure created substantial heterogeneity between studies. Disclosure of CM use to medical providers must be encouraged for safe, effective patient care.
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Affiliation(s)
- H Foley
- Faculty of Health, University of Technology Sydney, Ultimo, Australia.
| | - A Steel
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - H Cramer
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - J Wardle
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - J Adams
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
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Upchurch DM, Gill M, Jiang L, Prelip M, Slusser W. Use of Mind-Body Therapies Among Young Adults Aged 18-24 Years: Findings From the 2012 National Health Interview Survey. J Adolesc Health 2018; 63:227-232. [PMID: 29970333 PMCID: PMC6113068 DOI: 10.1016/j.jadohealth.2018.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/03/2018] [Accepted: 03/05/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the prevalence, patterns, and satisfaction of use of mind-body therapies (MBTs) in a nationally representative sample of young adults (ages 18-24 years). METHODS Young adults interviewed in the 2012 National Health Interview Survey were analyzed (n = 3,286). Individual types (e.g., mindfulness) and a combined measure of use of any MBT were assessed. Reasons for and satisfaction with use was also investigated. Design-based F tests and logistic regression were used; all analyses were weighted and stratified by gender. RESULTS Overall, 14.6% of young adults used MBT in the past year (9.6% of men and 19.1% of women, p < .001). Among men, higher levels of education, greater numbers of health conditions, and healthy behaviors were associated with greater odds of MBT use. Among women, Latina and black women had lower odds of use (vs. white). Higher education, greater mental distress, and greater numbers of health conditions and healthy behaviors were associated with greater odds of use. While both men and women reported stress reduction and general wellness as top reasons for use, men also reported the use to improve athletic performance. CONCLUSIONS Young adulthood is a critical period in the life course when individuals are establishing lifestyle and health behaviors that can be enduring. Because stress is a persistent problem, and many MBTs can be helpful with management of stress and anxiety, young adult may be underutilizing these modalities. Public health and educational strategies for greater engagement in MBT among young adults are warranted.
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Affiliation(s)
- Dawn M Upchurch
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California.
| | - Monique Gill
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California.
| | - Linghui Jiang
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California.
| | - Michael Prelip
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California.
| | - Wendelin Slusser
- UCLA Chancellor's Office - Healthy Campus Initiative, Los Angeles, California.
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Axelsson E, Määttä S. Taktil massage som behandling för ungdomar med anorexia nervosa. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/010740830702700308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Italia S, Wolfenstetter SB, Teuner CM. Patterns of complementary and alternative medicine (CAM) use in children: a systematic review. Eur J Pediatr 2014; 173:1413-28. [PMID: 24782030 DOI: 10.1007/s00431-014-2300-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/15/2014] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Utilization of complementary and alternative medicine (CAM) among children/adolescents is popular. This review summarizes the international findings for prevalence and predictors of CAM use among children/adolescents. We therefore systematically searched four electronic databases (PubMed, Embase, PsycINFO, AMED; last update in 07/2013) and reference lists of existing reviews and all included studies. Publications without language restriction reporting patterns of CAM utilization among children/adolescents without chronic conditions were selected for inclusion. The prevalence rates for overall CAM use, homeopathy, and herbal drug use were extracted with a focus on country and recall period (lifetime, 1 year, current use). As predictors, we extracted socioeconomic factors, child's age, and gender. The database search and citation tracking yielded 58 eligible studies from 19 countries. There was strong variation regarding study quality. Prevalence rates for overall CAM use ranged from 10.9-87.6 % for lifetime use and from 8-48.5 % for current use. The respective percentages for homeopathy (highest in Germany, United Kingdom, and Canada) ranged from 0.8-39 % (lifetime) and from 1-14.3 % (current). Herbal drug use (highest in Germany, Turkey, and Brazil) was reported for 0.8-85.5 % (lifetime) and 2.2-8.9 % (current) of the children/adolescents. Studies provided a relatively uniform picture of the predictors of overall CAM use (higher parental income and education, older children), but only a few studies analyzed predictors for single CAM modalities. CONCLUSION CAM use is widespread among children/adolescents. Prevalence rates vary widely regarding CAM modality, country, and reported recall period.
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Affiliation(s)
- Salvatore Italia
- Department of International Health, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands,
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Patterns of utilization of complementary and alternative medicine in 2 pediatric gastroenterology clinics. J Pediatr Gastroenterol Nutr 2014; 59:334-9. [PMID: 24854897 DOI: 10.1097/mpg.0000000000000439] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The aim of the present study was to assess the prevalence and patterns of complementary and alternative medicine (CAM) use among pediatric patients with gastrointestinal (GI) disorders at academic clinics in Canada. METHODS The survey was carried out at 2 hospital-based gastroenterology clinics: the Stollery Children's Hospital in Edmonton and the Children's Hospital of Eastern Ontario (CHEO) in Ottawa. RESULTS CAM use at the Stollery was 83% compared with 36% at CHEO (P < 0.001). The most common reason for not using CAM was lack of knowledge about it. Most respondents felt comfortable discussing CAM in their clinic and wanted more information on CAM. The most common CAM products being taken were multivitamins (91%), calcium (35%), vitamin C (32%), probiotics (14%), and fish oil/omega-3 fatty acids (13%). The most common CAM practices being used were massage (43%), chiropractic (27%), faith healing (25%), and relaxation (18%). Most respondents believed that CAM was helpful, and most of the 23 reported adverse effects were minor. Seven were reported as moderate, and 3 were reported as severe. Many (42%) patients used CAM at the same time as prescription medicines, and of these patients, concurrent use was discussed with their physician (76%) or pharmacist (52%). CONCLUSIONS CAM use is high among pediatric patients with GI disorders and is much greater among those in Edmonton than in Ottawa. Most respondents reported their CAM use as helpful, with little or no associated harm. Many patients fail to disclose their concurrent use of CAM and conventional medicines to their doctors, increasing the likelihood of interactions.
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Dwyer J, Nahin RL, Rogers GT, Barnes PM, Jacques PM, Sempos CT, Bailey R. Prevalence and predictors of children's dietary supplement use: the 2007 National Health Interview Survey. Am J Clin Nutr 2013; 97:1331-7. [PMID: 23576049 PMCID: PMC3652925 DOI: 10.3945/ajcn.112.052373] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Little is known about the characteristics of US children who are dietary supplement users. OBJECTIVE We described the prevalence and predictors of and reasons for giving children dietary supplements. DESIGN The study included children <18 y of age who participated in the Complementary and Alternative Medicine supplement of the National Health Interview Survey of 2007 whose proxies provided complete information on child dietary supplement use. RESULTS A total of 37% of subjects used dietary supplements, 31% of subjects used multivitamin mineral (MVM) products exclusively, 4% of subjects used single vitamins or minerals solely or in combination with MVMs, and 2% of subjects used nonvitamin, nonmineral products either solely or in combination with other supplements. Users were more likely than nonusers to be Asian, white, or non-Hispanic; belong to families with higher parental education and income levels; reside in areas other than the South; be in good, very good, or excellent health; have private health insurance; and have a usual place at which they received conventional medical care. Children (3%) with the most disease burden and health care were more likely to use supplements than were healthier children. Supplements were given for the prevention or treatment of many illnesses and conditions. Neither the caregiver's reasons nor specific supplements used were consistently associated with particular conditions. CONCLUSIONS The 37% of US children who used any type of dietary supplements differed from nonusers in family socioeconomic status and many other health-related characteristics. Users were given supplements to prevent or treat many illnesses and conditions for which there is only limited evidence of their efficacy.
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Affiliation(s)
- Johanna Dwyer
- Office of Dietary Supplements, NIH, Bethesda, MD 20008, USA.
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Italia S, Batscheider A, Heinrich J, Wenig C, Bauer CP, Koletzko S, Lehmann I, Herbarth O, von Berg A, Berdel D, Hoffmann B, Schaaf B, Wolfenstetter SB. Utilization and costs of conventional and alternative pharmaceuticals in children: results from the German GINIplus and LISAplus birth cohort studies. Pharmacoepidemiol Drug Saf 2012; 21:1102-11. [PMID: 22855275 DOI: 10.1002/pds.3323] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 06/22/2012] [Accepted: 06/26/2012] [Indexed: 11/09/2022]
Abstract
PURPOSE The socioeconomic determinants for drug utilization, especially in children, have not been investigated sufficiently so far. The study's aim was the estimation of prevalences and determinants of conventional, homeopathic and phytotherapeutic drugs and expenditures. METHODS Population-based data on drug utilization of 3,642 children in two German birth cohorts (GINIplus and LISAplus, 10-year follow-up) were collected using a self-administered questionnaire. For analysis, the reported drugs (use within the last four weeks) were classified into the therapeutic categories of 'conventional medicine', 'homeopathy', 'phytotherapy' and 'others'. Drug costs were estimated using pharmaceutical identification numbers. RESULTS In all, 42.3% of the children reported drug use; 24.1% of the drugs were homeopathic and 11.5% were phytotherapeutic. The proportion of children who took at least one homeopathic remedy was 14.3%. Drugs prescribed by physicians were dominated by conventional medicine (76.5%), whereas in non-prescribed drugs, both homeopathy and conventional medicine accounted for 37% each. Boys (OR = 0.78) used less homeopathy than girls. Income showed only a weak influence. Education had a strong effect on the use of phytotherapy such that children of mothers with higher school education (>10 years vs. <10 years) used more phytotherapy (OR = 2.01). If out-of-pocket payments arose (n = 613), the mean was €20. On average, total drug expenditures summed up to €39 in 4 weeks for drug users if only clearly identifiable prices for drugs were considered (58% of all data). CONCLUSIONS Utilization of homeopathy is common in children from the analyzed cohort. User profiles of homeopathy and phytotherapy differ from each other and should be analyzed separately.
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Affiliation(s)
- Salvatore Italia
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany
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Toupin April K, Moher D, Stinson J, Byrne A, White M, Boon H, Duffy CM, Rader T, Vohra S, Tugwell P. Measurement properties of questionnaires assessing complementary and alternative medicine use in pediatrics: a systematic review. PLoS One 2012; 7:e39611. [PMID: 22768098 PMCID: PMC3387262 DOI: 10.1371/journal.pone.0039611] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Accepted: 05/23/2012] [Indexed: 11/19/2022] Open
Abstract
Objective Complementary and alternative medicine (CAM) is commonly used by children, but estimates of that use vary widely partly due to the range of questionnaires used to assess CAM use. However, no studies have attempted to appraise measurement properties of these questionnaires. The aim of this systematic review was to critically appraise and summarize measurement properties of questionnaires of CAM use in pediatrics. Study design A search strategy was implemented in major electronic databases in March 2011 and conference websites, scientific journals and experts were consulted. Studies were included if they mentioned a questionnaire assessing the prevalence of CAM use in pediatrics. Members of the team independently rated the methodological quality of the studies (using the COSMIN checklist) and measurement properties of the questionnaires (using the Terwee and Cohen criteria). Results A total of 96 CAM questionnaires were found in 104 publications. The COSMIN checklist showed that no studies reported adequate methodological quality. The Terwee criteria showed that all included CAM questionnaires had indeterminate measurement properties. According to the Cohen score, none were considered to be a well-established assessment, two approached the level of a well-established assessment, seven were promising assessments and the remainder (n = 87) did not reach the score’s minimum standards. Conclusion None of the identified CAM questionnaires have been thoroughly validated. This systematic review highlights the need for proper validation of CAM questionnaires in pediatrics, which may in turn lead to improved research and knowledge translation about CAM in clinical practice.
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Affiliation(s)
- Karine Toupin April
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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Ndetan H, Evans MW, Hawk C, Walker C. Chiropractic or osteopathic manipulation for children in the United States: an analysis of data from the 2007 National Health Interview Survey. J Altern Complement Med 2012; 18:347-53. [PMID: 22384933 DOI: 10.1089/acm.2011.0268] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES The aim of this study was to describe use of chiropractic and/or osteopathic manipulation by children in the United States along with the specific health conditions for which they sought care. METHODS The study was a secondary data analysis of the National Health Interview Survey 2007, Child Alternative Medicine file as well as the Child Core Sample. National population estimates were generated for reported use of chiropractic or osteopathic manipulation (C/OM) by children for specific health conditions. Odds ratios (OR) and 95% confidence intervals (CI) were generated from binary logistic regression models that assessed the likelihood that children of specific characteristics would use this therapy. RESULTS National estimates indicated that 2.3 million children (2.3%) in the United States had used C/OM in 2007. C/OM was the most common complementary and alternative medicine procedure. Children aged 12-18 years were more likely to have seen these providers than were younger age groups (OR=3.4 [95% CI, 2.1-5.5]). Homeopathy (1.2%), massage (1.0), and naturopathy (0.3%) were the next most common procedures. The most common complaints were back and neck pain. Other conditions for which children were seen included other musculoskeletal conditions, sinusitis, allergies, and nonmigraine headaches. Racial categories did not differ significantly regarding use of manipulation, but those children with both mother and father in the household were more likely to have used this form of care (OR=1.7 [95% CI, 1.1-2.6]). CONCLUSIONS C/OM is primarily used for back and neck pain, which is increasing in prevalence in children. Teens are more likely to use it than are younger children.
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Huillet A, Erdie-Lalena C, Norvell D, Davis BE. Complementary and alternative medicine used by children in military pediatric clinics. J Altern Complement Med 2011; 17:531-7. [PMID: 21649519 DOI: 10.1089/acm.2010.0339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES The objective of this study was to evaluate the prevalence, types, perceived effects, and factors that influence the use of complementary and alternative medicine (CAM) by military children. DESIGN A parent survey was administered in two military general pediatric clinics from June to September 2009. Parents completed surveys about their children including the following items: demographic information, a list of specific CAM therapies, family CAM use, and child health status. RESULTS Caregivers completed 278 surveys. The overall use of CAM was 23%. The most common type of CAM used was herbal therapy (34%). The CAM therapies most commonly reported to be very helpful were special diets (67%), melatonin (57%), vitamins and minerals used at doses higher than the recommended daily allowance (50%), and massage therapy (50%). The majority of users reported no side-effects (96%). Among CAM users, 53% had discussed their CAM use with a physician and 47% had seen a CAM practitioner. Factors associated with CAM use in multiple regression analysis included chronic conditions (p = 0.001), parent/sibling use of CAM (p < 0.001), and parent age over 30 years (p = 0.02). Primary sources of CAM information were friends and family (68%) and doctors (44%). Common reasons for using CAM were to promote general health (70%), to relieve symptoms (56%), and to improve quality of life (48%). Eighty percent (80%) of all respondents indicated they would use CAM if recommended by a physician. CONCLUSIONS In this military population with access to universal health care, CAM use is higher than the U.S. national average and nearly double that of the 2007 National Health Interview Survey study. Patients with chronic conditions, family members using CAM, and parental age over 30 years are more likely to use CAM. CAM is perceived as helpful with minimal to no side-effects. Pediatricians should inquire about CAM use and be prepared to provide guidance on this topic.
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Affiliation(s)
- Adam Huillet
- Developmental and Behavioral Pediatrics, Madigan Army Medical Center, Fort Lewis, WA, USA.
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Fouladbakhsh JM, Vallerand AH, Jenuwine ES. Self-treatment of pain among adolescents in an urban community. Pain Manag Nurs 2011; 13:80-93. [PMID: 22652281 DOI: 10.1016/j.pmn.2011.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Revised: 08/14/2011] [Accepted: 08/16/2011] [Indexed: 11/24/2022]
Abstract
Pain occurrence among adolescents, whether acute or chronic, persistent or intermittent, remains high, with potentially serious effects on quality of life, physical and emotional functioning, and psychosocial adjustment. The prevalence of pain in adolescents varies widely, and although discussed in the literature for more than two decades, data on adolescent knowledge and pain self-treatment is scarce. This descriptive-correlational study identified pain prevalence and intensity and pain self-treatment choices among adolescents in a diverse urban community. Almost 90% (n = 253) of high school students reported pain in the preceding 2 weeks and completed a series of study questionnaires (demographic data form, Brief Pain Inventory-Short Form, Adolescent Self-Treatment Survey). Respondents ranged in age from 14 to 19 years (mean 16) and were predominantly female (70%) and caucasian (75%). The sample was representative of all high school grades, and the majority (86%) reported participation in sports, dance, and physical activities. Mean pain scores ranged from 3.0 (current pain) to 6.5 (worst pain), with significantly higher scores among girls. A gender-related effect was also noted for pain interference in activities, mood, and sleep among the adolescent girls compared with the boys. Gender also predicted use of self-treatment methods, with girls more likely to use over-the-counter medications and nonpharmacologic therapies. Number of pain sites was also a strong predictor of use of self-treatment methods among adolescents. Knowledge of the pain experience during adolescence will help guide community-based nursing initiatives aimed at increasing awareness, promoting knowledge about pain and its treatment, and ensuring safety and positive outcomes related to self-treatment.
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Goldman RD, Vohra S, Rogovik AL. Vitamin use among children attending a Canadian pediatric emergency department. Fundam Clin Pharmacol 2011; 25:131-7. [PMID: 20199586 DOI: 10.1111/j.1472-8206.2010.00816.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Increasing use of vitamins has been documented worldwide in children and adolescents, and potential for vitamin-drug interactions exists. The aim of this study was to identify vitamin use by children visiting a pediatric emergency department (ED). A survey of parents and/or patients 0-18 years was conducted at a large pediatric ED in Canada. A total of 1804 families were interviewed. The main outcome measure was prevalence of vitamin use by children in the preceding 3 months. A third (32.3%) of the patients in our cohort had used vitamins in the preceding 3 months, and 48% of them were taking vitamins daily. Over 8% of all children used vitamins within the last 24 h. The use of vitamins was higher with older patient and parental age (P<0.001), chronic patient illness (P<0.001), completed immunization (P<0.001), concurrent patient use of prescribed medications (P=0.02), higher parental education (P<0.01), and English as a primary language spoken at home (P=0.002). Prevalence of vitamin use among children in the ED is 32% in the preceding 3 months and 8% within the last 24 h. In light of these findings, pediatricians should ask about vitamin use and discuss with parents potential interactions and possible adverse effects.
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Affiliation(s)
- Ran D Goldman
- Division of Pediatric Emergency Medicine, BC Children's Hospital, Department of Pediatrics, University of British Columbia, Child & Family Research Institute, Vancouver, BC, Canada.
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Affiliation(s)
- Cora Collette Breuner
- Department of Pediatrics, Division of Adolescent Medicine, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
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Rogovik AL, Vohra S, Goldman RD. Safety considerations and potential interactions of vitamins: should vitamins be considered drugs? Ann Pharmacother 2009; 44:311-24. [PMID: 20040703 DOI: 10.1345/aph.1m238] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To examine adverse effects, adverse events, and potential interactions of vitamins in light of their current prevalence of use, and to discuss whether vitamins should be considered over-the-counter drugs or natural health products/dietary supplements. DATA SOURCES We performed a MEDLINE/PubMed search, explored 4 online databases (Medline Plus, Drug Digest, Natural Medicine Comprehensive Database, and the database of the University of Maryland), and examined reference lists of included studies published from 1966 through October 2009. STUDY SELECTION AND DATA EXTRACTION The studies were reviewed, with an emphasis on randomized controlled clinical trials. We included articles with the most clinically important information with regard to adverse events and interactions. DATA SYNTHESIS Vitamins are used by over one third of the North American population. Vitamins have documented adverse effects and toxicities, and most have documented interactions with drugs. While some vitamins (biotin, pantothenic acid, riboflavin, thiamine, vitamin B(12), vitamin K) have minor and reversible adverse effects, others, such as fat-soluble vitamins (A, E, D), can cause serious adverse events. Two water-soluble vitamins, folic acid and niacin, can also have significant toxicities and adverse events. CONCLUSIONS Our recommendation is that vitamins A, E, D, folic acid, and niacin should be categorized as over-the-counter medications. Labeling of vitamins, especially those intended for children and other vulnerable groups, should include information on possible toxicities, dosing, recommended upper intake limits, and concurrent use with other products. Vitamin A should be excluded from multivitamin supplements and food fortificants.
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Affiliation(s)
- Alexander L Rogovik
- Pediatric Research in Emergency Therapeutics (PRETx) Program, St. Michael's Hospital, Toronto, ON, Canada
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Practice parameter for the psychiatric assessment and management of physically ill children and adolescents. J Am Acad Child Adolesc Psychiatry 2009; 48:213-33. [PMID: 20040826 DOI: 10.1097/chi.0b013e3181908bf4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This practice parameter describes the psychiatric assessment and management of physically ill children and adolescents. It reviews the epidemiology, clinical presentation, assessment, and treatment of psychiatric symptoms in children and adolescents with physical illnesses and the environmental and social influences that can affect patient outcome.
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Kemper KJ, Vohra S, Walls R. American Academy of Pediatrics. The use of complementary and alternative medicine in pediatrics. Pediatrics 2008; 122:1374-86. [PMID: 19047261 DOI: 10.1542/peds.2008-2173] [Citation(s) in RCA: 191] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The American Academy of Pediatrics is dedicated to optimizing the well-being of children and advancing family-centered health care. Related to these goals, the American Academy of Pediatrics recognizes the increasing use of complementary and alternative medicine in children and, as a result, the need to provide information and support for pediatricians. From 2000 to 2002, the American Academy of Pediatrics convened and charged the Task Force on Complementary and Alternative Medicine to address issues related to the use of complementary and alternative medicine in children and to develop resources to educate physicians, patients, and families. One of these resources is this report describing complementary and alternative medicine services, current levels of utilization and financial expenditures, and associated legal and ethical considerations. The subject of complementary and alternative medicine is large and diverse, and consequently, an in-depth discussion of each method of complementary and alternative medicine is beyond the scope of this report. Instead, this report will define terms; describe epidemiology; outline common types of complementary and alternative medicine therapies; review medicolegal, ethical, and research implications; review education and training for complementary and alternative medicine providers; provide resources for learning more about complementary and alternative medicine; and suggest communication strategies to use when discussing complementary and alternative medicine with patients and families.
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Feldmann JM, Wiemann CM, Sever L, Hergenroeder AC. Folk and traditional medicine use by a subset of Hispanic adolescents. Int J Adolesc Med Health 2008; 20:41-51. [PMID: 18540283 DOI: 10.1515/ijamh.2008.20.1.41] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED Rates of Folk and Traditional Medicine (FTM) use are high among Hispanic adults. No data have been published on FTM use among the rapidly growing Hispanic adolescent population. OBJECTIVES To determine the prevalence of and personal factors associated with FTM use among Mexican-American adolescents. STUDY GROUP 182 Mexican-American adolescents (14-19 years) from community-based organizations. METHODS We conducted a cross-sectional survey using a self-report instrument available in English and Spanish. RESULTS In the past year, 49 (26.9%) subjects reported FTM use, all prompted by illness: 43 (23.6%) used herbal remedies, and 8 (4.4%) used traditional healers. Five subjects reported using dangerous herbs. Among herbal users, 56.3% did not disclose FTM use to medical providers, largely due to the providers' lack of inquiry. Logistic regression comparing herbal users with non-FTM users found subjects dissatisfied with their most recent medical visit (AOR = 10.6; 95% CI = 2.8-40.7) and subjects endorsing family FTM use (AOR = 8.4; 95% CI = 4.0-30.2) were more likely to use herbal remedies. Acculturation, insurance status, socioeconomic status, and having a personal healthcare provider were not related to herbal use. CONCLUSIONS The use of practitioner-based FTM modalities was rare among this convenience sample of Mexican-American adolescents. Self-treatment with herbal use was common; harmful herbs were used infrequently. Access to care does not appear to motivate herb use. The high rates of herb use by dissatisfied patients, paired with high rates of non-disclosure and lack of provider inquiry, suggests that efforts to provide more culturally sensitive care, including routine inquiry about FTM use in Mexican-American adolescents, are needed. Patterns of complimentary and alternative medicine (CAM)/FTM use vary between age and ethnic cohorts.
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Affiliation(s)
- Jennifer M Feldmann
- Section of Adolescent Medicine, University of Texas Health Science Center, Houston, Texas 77030, United States of America.
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Patterson C, Arthur H, Noesgaard C, Caldwell P, Vohra J, Francoeur C, Swinton M. Exploring adolescent complementary/alternative medicine (CAM) use in Canada. J Interprof Care 2008; 22:45-55. [PMID: 18202985 DOI: 10.1080/13561820701795374] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A qualitative study using a grounded theory approach investigated adolescents' perceptions about complementary/alternative medicine (CAM) use. Adolescents, attending a clinic at the Canadian College of Naturopathic Medicine, were interviewed after receiving ethics approval. Data were collected using semi-structured interviews. The decision of adolescents to use CAM was based within the context of their world and how it shaped influencing factors. Factors that influenced adolescents' decision to use CAM were identified as certain personality traits, culture, media, social contacts and the ability of CAM providers to develop therapeutic relationships. The barriers and benefits of CAM use influenced evaluation of choices. The importance of barriers in limiting freedom of choice in health care decisions should be investigated by practitioners as they provide care to adolescents. Health care planning for integrative models of care requires determining the "right" blend of expertise by knowing interprofessional boundaries, determining mixed skill sets to provide the essential services and ensuring appropriate regulation that allows practitioners to use their full scope of practice.
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Abstract
Complementary and alternative medicine (CAM) has enjoyed tremendous public interest in North America in recent years. CAM is used most often by those who have serious, chronic, or recurrent illness, sometimes for symptom control and sometimes to combat the primary disease. Others use CAM to promote wellness or as a prophylaxis. CAM therapies are increasingly being offered in conventional medical settings and at various other centers and institutes. The relevant ethical commitments or values that must be considered are social commitment to public welfare, nonmaleficence, respect for patient autonomy/consumer choice, recognition of medical pluralism, and public accountability. This article explores the major ethical principles involved in pediatric CAM use and how they affect clinical care and research.
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Affiliation(s)
- Sunita Vohra
- Complementary and Alternative Research and Education (CARE) Program, Stollery Children's Hospital, Edmonton, AB, Canada.
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Abstract
The use of complementary and alternative medical (CAM) therapies is increasing among well children and adolescents and in those children who have special health care needs. Integrative pediatrics, a holistic practice that includes an examined integration of CAM and conventional therapies, is ideally suited for primary care. This article describes how to integrate evidence-based CAM therapies for colic, atopy, ADHD, eating disorders, and other conditions commonly seen in primary care practice.
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Affiliation(s)
- Lawrence D Rosen
- Department of Pediatrics, Division of Pediatric Integrative Medicine, Hackensack University Medical Center, Hackensack, NJ 07601, USA.
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Fitzgerald M, Culbert T, Finkelstein M, Green M, Johnson A, Chen S. The Effect of Gender and Ethnicity on Children’s Attitudes and Preferences for Essential Oils: A Pilot Study. Explore (NY) 2007; 3:378-85. [PMID: 17681258 DOI: 10.1016/j.explore.2007.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Indexed: 11/17/2022]
Abstract
CONTEXT Aromatherapy is frequently recommended for children but children's preferences for specific essential oils are not well documented. OBJECTIVE To measure preferences of school aged children for essential oils based on gender and ethnicity. DESIGN Descriptive study measuring children's responses to and preferences for selected essential oils. SETTING Pediatric integrative medicine clinic in a Midwestern children's hospital. PARTICIPANTS Healthy school-age children of Latino (N = 39) and non-Latino Caucasian (NLC) (N = 48) ethnicity, 41.7% of the NLC group and 59.0% of the Latino Group were males. INTERVENTION Participants smelled single essential oils, answered three forced choice questions and one open ended question, order of exposure was varied. OUTCOME MEASURES Participants evaluated each scent's effect on mood and energy, stated their preferences, indicated if scents evoked particular thoughts and selected a favorite essential oil. RESULTS Females were more likely to feel happy when smelling sweet orange (p = .043). Female Latinos were more likely than NLC females to find sweet orange calming (56.2% vs. 18.5%). Male Latinos were more likely (65.2%) to describe peppermint as "energetic" than male NLC (30%). Children chose an essential oil that they rated as "making them feel happy" (72.6%) and/or as "liking the most" (64.3%). Other results that approached statistical significance were: females felt more energetic with spearmint (p = .055). Latinos preferred spearmint over NLC (p = .075), and all males felt more energetic when smelling ginger (p = .091). Ginger and lavender were the least preferred. Results indicate that children have specific essential oil scent preferences. There is trend toward differences based on gender and ethnicity.
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Affiliation(s)
- Maura Fitzgerald
- Integrative Medicine Program, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN 55404, USA.
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Hughes SC, Wingard DL. Children's visits to providers of complementary and alternative medicine in San Diego. ACTA ACUST UNITED AC 2006; 6:293-6. [PMID: 17000420 DOI: 10.1016/j.ambp.2005.11.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2004] [Revised: 10/11/2005] [Accepted: 11/15/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Increased attention has been focused on the growing use of complementary and alternative medicine (CAM); however, few studies have included children in the general US population. The present study investigated children's visits to CAM providers and factors associated with these visits. METHODS Analysis of cross-sectional data from the 2001 United Way Outcomes and Community Impact Program telephone survey, a representative sample of households in San Diego County, California. We selected households with children younger than 19 years of age (N = 1104). Parents reported on children's CAM visits in the past year. RESULTS Approximately 23% of parents reported that their child saw a CAM provider in the past 12 months. CAM care was sought for sick and routine care. Children of white parents had greater odds of having a CAM visit in the past year compared with children whose parents were Hispanic (adjusted odds ratio 1.71, 95% confidence interval [95% CI] 1.11-2.63). Children whose parents were college graduates had a greater likelihood of seeing a CAM provider than children of parents with high school education (adjusted odds ratio = 1.82, 95% CI 1.19-2.79). Children who were insured were also more likely to have CAM visits than uninsured children (adjusted odds ratio = 2.32, 95% CI 1.04-5.21). CONCLUSIONS Visits to CAM providers were much more common among children in the general San Diego population compared with 1996 national estimates. Pediatric health care providers should remain aware that their patients may be using CAM so they can provide coordinated care.
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Affiliation(s)
- Suzanne C Hughes
- Department of Family and Preventive Medicine, University of California-San Diego, 9500 Gilman Drive 0607, La Jolla, CA 92093, USA
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Demattia A, Moskowitz H, Kemper KJ, Laraque D. Disparities in complementary and alternative medical therapy recommendations for children in two different socioeconomic communities. AMBULATORY PEDIATRICS : THE OFFICIAL JOURNAL OF THE AMBULATORY PEDIATRIC ASSOCIATION 2006; 6:312-7. [PMID: 17116603 DOI: 10.1016/j.ambp.2006.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Revised: 08/19/2006] [Accepted: 08/21/2006] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To compare the content, quality, and cost of recommendations for children made by complementary and alternative medicine (CAM) retailers within 2 New York City neighborhoods of divergent socioeconomic status (SES). METHODS Posing as consumers, researchers sought recommendations from CAM retailers for 2 clinical scenarios: 1) a febrile 6-week-old and 2) a 4-year-old with an upper respiratory infection (URI). All retailers selling CAM therapies outside the direction of a licensed provider within East Harlem (EH) and the Upper East Side (UES) were eligible and mapped. The febrile infant scenario was posed at sites in business in March (n = 23) and the URI scenario at sites that remained in business in April (n = 20) of 2004. RESULTS In response to the febrile infant scenario, 33% of UES retailers referred to a MD, 0% to the emergency department, and 47% made other recommendations-of which 43% were not indicated. In EH, 50% referred to a MD, 5% to the emergency department, and 37% made other recommendations. The mean price of UES recommendations was Dollars 9.66, whereas EH was Dollars 2.33 (P = .04). In response to the URI scenario, 93% of UES and 83% of EH retailers made recommendations. The mean price of UES recommendations was Dollars 10.55 while EH was Dollars 4.26 (P = .002). CONCLUSIONS Complementary and alternative medicine retailers made numerous recommendations for children, including some that were contraindicated for age. East Harlem retailers tended to refer an infant with a potentially serious condition to the emergency department or to an MD and made less expensive recommendations than their UES counterparts.
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Affiliation(s)
- Amy Demattia
- Division of General Pediatrics, Mount Sinai School of Medicine, New York, NY 10029, USA.
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