Factors associated with herb and dietary supplement use by young adults in the United States

Effects of Oral Multi-Vitamin Multi-Mineral Supplement Formulations on Laboratory Outcomes and Quality of Life: A Quasi-Experimental Study

Background

Multi-vitamin multi-mineral (MVMM) products often come in several single-substance capsules from different manufacturers. However, attempts to mix several vitamins and minerals into one MVMM product have been complicated and often involve legal concerns. This study aimed to comparatively investigate the changes in laboratory parameters and the quality of life (QOL) among individuals who received different MVMM formulations.

Methods

This three-arm non-randomized controlled trial was conducted at VitalLife Scientific Wellness Center (VSWC), Bangkok, Thailand. A total of 72 healthy adult individuals with total serum 25-(OH)D level of 20–29 ng/ml were invited to choose from the three available options, namely, (1) Hydro-Cell-Key (HCK®, Hepart AG, Switzerland) contains vitamin D3 2,000 IU, vitamin C 1,000 mg, vitamin E 166 mg, vitamin A 1 mg, coenzyme Q10 30 mg, natural carotenoids 8 mg, and citrus flavonoids 200 mg in granule formulation; (2) VTL-7 (VWSC) contains similar vitamins and minerals but in capsule formulation; and (3) placebo capsule (no supplement). The 36-Item Short-Form Health Survey (SF-36) was used to measure QOL at baseline, month 3 and 6. A generalized estimating equation (GEE) was used to compare the repeated-measure outcomes across the three groups. This study was registered at the Thai Clinical Trial Registration (TCTR20190205002) and approved by the Bumrungrad International Institutional Review Board (BI-IRB No.258-10-18PhFub).

Results

Both VTL-7 and HCK saw a significantly higher increase in vitamin D than placebo at months 3 and 6, i.e., VTL-7 from 25.15 ± 2.13 to 35.53 ± 6.11 (p < 0.001) and 33.38 ± 6.89 (p < 0.001); HCK from 24.25 ± 3.08 to 28.43 ± 5.93 (p = 0.005) and 27.40 ± 5.24 (p = 0.012); and placebo from 24.00 ± 2.73 to 23.05 ± 4.39 (p = 0.273) and 22.30 ± 6.23 (p = 0.200), respectively. Similarly, β-carotenoids of VTL-7 vs. HCK groups significantly increased from 0.88 ± 0.68 vs. 0.94 ± 0.55 at baseline to 3.03 ± 1.79 (p < 0.001) vs. 1.09 ± 0.61 (p = 0.125) and 3.26 ± 1.74 (p < 0.001) vs. 1.15 ± 0.66 (p = 0.064), respectively. These findings were corroborated through the GEE analysis. Other micronutrients at months 3 and 6 did not increase significantly from baseline in any group. The overall QOL among the three groups in terms of physical (p = 0.560) and mental (p = 0.750) health increased but was not statistically significant.

Conclusion

The supplements of MVMM in capsule formulation increased the serum levels of some micronutrients to a higher extent than that of granule formulation. Participant adherence remains a potential confounder and should be further explored.

Clinical Trial Registration

identifier: TCTR20190205002.

Magnitude and Determinant Factors of Herbal Medicine Utilization Among Mothers Attending Their Antenatal Care at Public Health Institutions in Debre Berhan Town, Ethiopia

Background

World health organization defined herbal medicines as the practice of herbs, herbal materials, herbal preparations, and finished herbal products. Globally women are the primary utilizer of herbal medicine and even they consume it during their pregnancy period. The World health organization reported that the majority of the global population used traditional medicine. This study aimed to assess the magnitude and determinant factors of herbal medicine utilization among pregnant mothers attending their antenatal care at public health institutions in Debre Berhan town, Ethiopia.

Methodology

Institution-based cross-sectional study was conducted among pregnant mothers who attended their antenatal care at public health institutions in Debre Berhan town, Ethiopia from 12 February 2021 to 12 April 2021. A systematic random sampling method was used to get selected pregnant mothers. Epi data version 3.1 and SPSS version 25 were used for data entry and analysis, respectively. P-value ≤0.05 was used as a cut point of statistical significance in multivariable binary logistic regression.

Results

A total of 422 pregnant mothers were included with a 100% response rate and 277 (65.6%) of them used an herbal medicine during their current pregnancy. Educational level up to primary school [AOR 2.21, 95% CI: 1.17 – 4.18], monthly family income of <2,800 ETB [AOR 1.72, 95% CI: 1.01–2.92], and lack of awareness of the complication of herbal medicine utilization [AOR 10.3, 95% CI: 6.27–16.92] were determinant factors of herbal medicine utilization.

Conclusion

The utilization of herbal medicine among pregnant mothers in this study is high and almost all of them did not disclose their utilization of herbal medicine to their healthcare providers. The ministry of health should integrate traditional medicine with conventional medicines. Midwives and obstetricians should openly discuss regarding benefits and complications of herbal medicine utilization for those pregnant mothers during their antenatal care counseling sessions as routine care.

Knowledge, Attitudes, and Use of Protein Supplements among Saudi Adults: Gender Differences

Saudi Arabia has witnessed recent reforms and positive socio-political changes that have led to increased opportunities for women to participate in fitness centers. This study investigated protein supplement consumption among Saudi females compared with that among males and examined the knowledge and attitudes of the participants toward protein supplement use. A cross-sectional study was conducted in Riyadh using a previously validated, self-administered online survey. The questionnaire included items related to the prevalence, knowledge, attitudes, and practice of protein supplementation. The participants were 354 adults (58.2% were females). The results showed that over 47% of the participants attended fitness centers with more male (80.3%) than female (41%) attendees. Nearly 50% of the participants consumed protein supplements, with males (68.7%) using significantly (p < 0.001) more protein supplements than females (35.6%). The powdered form was most commonly consumed. The percentage of gym attendees (67.8%) who used protein supplements was higher than that among non-gym attendees (32.2%). Gaining muscles (56.1%) followed by compensating for protein deficiency (28.6%) were the reasons for taking protein supplements, with a significant gender difference (p < 0.001). Coaches provided the most information on protein supplements. The participants appeared to be knowledgeable about protein supplements. Although over 68% of protein supplement users suffered from various symptoms, only 20% of the participants thought that there was no risk in taking protein supplements, with significant gender differences. It was concluded that Saudi male participants are twice more likely to attend the gym and consume protein supplements compared with females. Of both genders, those attending the gym consumed more protein supplements than non-gym attendees.

Adherence to the Mediterranean Diet and Its Association with the Level of Physical Activity in Fitness Center Users: Croatian-Based Study

The Mediterranean diet (MD) is based on the traditional cuisine of south European countries, and it is considered one of the healthiest dietary patterns worldwide. The promotion of combined MD and physical activity has shown major benefits. However, the association between physical activity and the MD in regular fitness center users is still insufficiently investigated. This cross-sectional survey-based study was conducted on 1220 fitness center users in Croatia. The survey consisted of three parts: general information, the Mediterranean Diet Serving Score (MDSS) and the International Physical Activity Questionnaire Short Form (IPAQ-SF). The results showed that 18.6% of fitness center users were adherent to the MD, and there was a significant positive correlation between the level of physical activity and the MDSS score (r = 0.302, p < 0.001). Moreover, after dividing the sample into tertiles based on the IPAQ-SF score, the third tertile (MET > 3150 min/wk) had the most fitness center users (34.4%) adherent to the MD, while the first tertile (MET < 1750 min/wk) had the least (6.1%). These outcomes emphasize the importance of physical activity as they imply that, with higher levels of physical activity, people are also possibly more aware of the importance that a healthy and balanced diet has on their well-being.

Herbalism for Modern Obstetrics

More pregnant and nursing mothers are using herbal remedies than health care providers realize. Lack of familiarity with herbalism in addition to the sparsity of high-quality research for many complementary and alternative medicines are barriers for the western practitioner to engage a patient about herbal therapies. This review provides historical information and available evidence for Traditional Chinese and Western herbal medicines commonly sought by pregnant and nursing mothers. We will review herbs commonly used for: nausea and vomiting, constipation, gestational diabetes, threatened miscarriage, immune system support, parturition preparation, postpartum depression, postpartum bleeding and pain, wound healing, and lactation support.

Neuroenhancement: State of the Art and Future Perspectives

Pharmacological neuroenhancement refers to the non-medical use of prescription drugs, alcohol, illegal drugs, or the so-called soft enhancers for the purpose of improving cognition, mood, pro-social behavior, or work and academic performance. This phenomenon is undoubtedly more frequent than previously supposed especially amongst university students. The aim of the present paper was to carefully review and comment on the available literature on neuroenhancement, according to Prisma guidelines. The results showed a great use of all prescribed drugs (benzodiazepines, antidepressants, antipsychotics, nootropic compounds, and especially stimulants) as neuroenhancers amongst healthy subjects, although probably the real prevalence is underestimated. The use of illicit drugs and soft enhancers is similarly quite common. Data on the improvement of cognition by other compounds, such as oxytocin and pheromones, or non-pharmacological techniques, specifically deep brain stimulation and transcranial magnetic stimulation, are still limited. In any case, if it is true that human beings are embedded by the desire to overcome the limits of their intrinsic nature, neuroenhancement practices put into question the concept of authenticity. Therefore, the problem appears quite complex and requires to be deepened and analyzed with no prejudice, although within an ethical conceptual frame.

The use of herbal and dietary supplement among community-dwelling elderly in a suburban town of Malaysia

BACKGROUND

The use of herbal and dietary supplement (HDS) in health and disease management has gained global attention. HDS are generally accepted by the public and are associated with positive health behaviours. However, several reports have been documented with regards to their potential adverse effects and interaction with conventional medicines. Limited data is currently available on the use of HDS among elderly population in Malaysia. This present study aims to investigate the prevalence of and pattern of HDS use among a sample of community-dwelling elderly in a suburban town in Malaysia.

METHODS

A cross-sectional survey was conducted between March and May 2019 among the elderly aged ≥60 years old. The participants with the following criteria were included in the study: aged ≥60 years, residing in Puncak Alam and able to understand Malay or English language. Data were collected using a pre-validated questionnaire. All statistical analysis was conducted using IBM SPSS ver. 23.

RESULTS

Overall, 336 out of 400 elderly responded to the survey, achieving a response rate of 84%. This study observed that almost 50% of the respondents were using at least one type of HDS in the past one month of the survey. Among HDS non-users, most of them preferred to use modern medicines (62.6%, 114/182). Among the HDS users, 75.3% (116/154) were using at least one type of modern medicine (prescription or over-the-counter medicine). Multivariate analysis showed that having good to excellent perceived health (adjusted OR = 2.666, 95% CI = 1.592-4.464), having felt sick at least once in the past one month (adjusted OR = 2.500, 95% CI = 1.426-4.383), and lower body mass index (adjusted OR = 0.937, 95% CI = 0.887-0.990) were associated with HDS use. It was noted that only a small percentage of HDS users (16.2%, 25/154) had informed healthcare providers on their HDS use.

CONCLUSION

The use of HDS is common among the elderly sampled. Hence, healthcare providers should be more vigilant in seeking information of HDS use for disease management in their elderly patients. Campaigns that provide accurate information regarding the appropriate use of HDS among the elderly are pertinent to prevent misinformation of the products.

Sport Dietary Supplements and Physical Activity in Biomedical Students

Biomedical students should have suitable knowledge about sport dietary supplements (SDS) usage as they are future medical professionals who will have SDS users in their care. The aim of this study was to assess the habits, opinions, and knowledge about SDS usage, along with the level of physical activity, in 386 biomedical students at the University of Split School of Medicine. A specialized questionnaire was developed by a group of experts for the assessment of habits, opinions, and knowledge about SDS and the International Physical Activity Questionnaire—Short Form (IPAQ-SF) was used to evaluate the level of physical activity. The results showed that 49.2% of students used SDS and there was a significant positive correlation between the knowledge questionnaire score and the level of physical activity (r = 0.744, p < 0.001). Moreover, SDS users had a higher knowledge questionnaire score (p < 0.001) and a higher level of physical activity (p < 0.001) compared to non-users. These results suggest that more physically active students are better informed about SDS, but these results also imply that SDS should be implemented in the study program of future medical professionals to ensure that they are informed for their own personal consumption and will be confident in giving advice about SDS usage to their future patients.

Distinct kratom user populations across the United States: A regional analysis based on an online survey

OBJECTIVE

Kratom preparations have raised concerns of public health and safety in the United States. This paper analyzed the patterns and predictors of kratom use by four U.S. regions according to the U.S. Census.

METHOD

An anonymous cross-sectional online survey yielded 8,049 valid responses. The data were categorised by regions (Northeast, South, Midwest, and West) and analyzed for the following predictors: age, gender, marital status, ethnicity, employment status, insurance coverage, education, and household income.

RESULTS

After adjusting for state population, the survey response rates were highest from Oregon, Idaho, and Florida. Kratom use was significantly lower for both prescription drug dependency and acute or chronic pain in the Northeast region than the rest of the country. Multiple logistic regression models found that gender, employment, and education were significant on the regional level. Higher education was associated with lower kratom use for an illicit drug dependency (p = .002) independent of region whereas men were less likely to use kratom for acute or chronic pain in the Northeast (p < .001) but more likely in the Midwest (p = .041).

CONCLUSIONS

The regional pattern of kratom use differed from opioid use data in both demographics and trend direction warranting further investigation.

The Use of Complementary and Alternative Medicine among Korean Young Adult Members of Fitness Centers

In general, the pattern and perception of complementary and alternative medicine (CAM) use in young people are little known. Particularly, given South Korea's dual health care system that includes both Korean traditional medicine and Western medicine, young adults in South Korea may be unique for the study of CAM use. Accordingly, this study investigated the modality, purpose, and perceptions of CAM use among young adults in South Korea and determined the predictors of CAM use. In addition, reasons for CAM use were compared to those for exercise. A survey was conducted among 649 young members of fitness centers (aged 20-39 years). The structured written questionnaire included the questions related to use of 30 CAM modalities, satisfaction with CAM use, factors associated with CAM use, reasons for exercise and CAM use, and perceptions of CAM. The most common therapies used in lifetime were acupuncture, massage, moxibustion/cupping, yoga, and diet-based therapies. The most satisfied therapy was massage followed by aroma therapy. The main reasons for using CAM were to relieve musculoskeletal pains while those for doing exercise were to lose weight, to promote health, and to have a positive body image. Multiple logistic regression analysis revealed that higher education level, having a religion, and having a health problem were significant independent predictors of CAM use after controlling for other factors. The majority of respondents reported "relief of pain and symptoms" as the perceived effect of CAM and "lack of advertising" as the weakness of CAM. The majority of respondents got CAM information from mass media and Internet. In conclusion, CAM use is significantly associated with education level, religious status, and health status in Korean young adult members of fitness centers. The main purposes of utilizing CAM and performing exercise are different.

Factors affecting consumers' decisions on the use of nutraceuticals: a systematic review

There is a high and increasing global prevalence of nutraceuticals use. This study aims to systematically review and critically appraise all available evidence to identify the factors affecting consumers' decisions in taking nutraceuticals. Questionnaire, interview or focus group studies which directly reported factors affecting consumers' decisions in using nutraceuticals were included. A thematic synthesis method was employed to synthesis the findings from the included studies. Out of the 76 studies included, the key factors identified as the most important factors motivating consumers to take nutraceuticals were the perceived health benefits and safety of nutraceuticals, as well as the advice from healthcare professionals, friends and family. The identified barriers to take nutraceuticals were a lack of belief in the health benefit of nutraceuticals, the high cost of nutraceuticals and consumers' lack of knowledge about nutraceuticals. As a chief course of recommendation for the use of nutraceuticals, healthcare professionals should strive to utilise reliable information from clinical evidence to help consumers in making an informed decision in using nutraceuticals. Future studies should explore the possible ways to improve channelling clinical evidence information of nutraceuticals to the public.

The relationship between women's characteristics and herbal medicines use during pregnancy

The use of herbal medicines (HM) has been increasing worldwide. This cross-sectional study investigated the prevalence of and characteristics related to use of HM among 320 pregnant women. Participants were admitted to Mazandaran-based hospitals' postnatal wards from March to June 2015. Data were collected via a self-report questionnaire, including herbs used during pregnancy and demographic, socioeconomic, and pregnancy-related factors. Nearly half (48.4%) of the women reported taking one or more HM during pregnancy. The most frequently used herbs were sour orange (30.97%), peppermint (19.81%), and Borage (19.46%). Most women (29.20%) were advised by their relatives to take these and did not disclose this use to their health care providers (50%) because they perceived their use as safe (39.7%). The use of herbs was greater among pregnant women with upper secondary level education, living in their own house and from higher socioeconomic classes. Most of the information sources for women were informal, indicating they were not knowledgeable about the herbs' safety and efficacy during pregnancy. Health care providers should be informed about HM and question pregnant women about their use of HM during pregnancy so that they can advise them about potential side effects and drug interactions.

Influence of pharmacological education on perceptions, attitudes and use of dietary supplements by medical students

BACKGROUND

The ready availability and use of dietary supplements (DS) by the public means that healthcare professionals require education in this area. In the Republic of Serbia, education related to use of DS is included in undergraduate medical training and it is therefore important to assess the effectiveness of this education. The aim of our survey was to investigate the influence of pharmacological education on the use, attitudes and perceptions of risks associated with DS among medical students.

METHODS

Medical students at the University of Kosovska Mitrovica participated in the survey. Three hundred eighty questionnaires were distributed, yielding a response rate of 89% (n = 334). Data were categorized by year of study, completion of a one-year course in pharmacology and having passed the final exam. The results were compared between 192 (58%) medical students educated in pharmacology (MSEP) and 142 (42%) medical students not educated in pharmacology (MSNEP). The questionnaire was divided into 4 parts: socio-demographic and lifestyle/behavioral characteristics, use of DS, attitudes about efficacy, safety and perception of risk due to DS use. Chi-square test, Student's t-test, and Mann-Whitney U test were used for statistical analysis.

RESULTS

About 53% of respondents used some form of DS. Attitudes regarding the safety of DS consumption showed a difference between the groups. MSEP were more likely to agree that DS have the potential to cause adverse reactions (Likert scale mean 4.1 vs. 3.5, p < 0.001) as well as interactions with conventional drugs (Likert scale mean 4.2 vs. 3.2, p < 0.001) than MSNEP. Finally, MSEP ranked St. John's wort and ginkgo as the most dangerous DS, but creatine and vitamin C were both ranked as relatively safe. Conversely, MSNEP considered ginkgo and vitamin C the most harmful DS, claiming that omega-3 fatty acids and vitamin D had the least hazardous side effects.

CONCLUSION

Our results showed that pharmacological education gives young medical students a better understanding of the risks of DS-drug interactions and potential adverse effects. However, their overall attitudes and perception of risk indicate the need for further education.

Prevalence of dietary supplement use and associated factors among female college students in Saudi Arabia

Background

The economic boom in Saudi Arabia indirectly prompted the use of dietary supplements in the last two decades. Our aim is to investigate the prevalence of dietary supplement use and its association with sociodemographic/lifestyle characteristics among Saudi female students.

Methods

In this cross-sectional study, 534 female participants (≥19 years of age) completed a self-administered questionnaire that include sociodemographic and lifestyle characteristics, perceived health status, dietary supplement use, general awareness, attitudes and behavior.

Results

In all participants, the prevalence of dietary supplement use was 76.6% (n = 409). High level of education (p = 0.002) and more physical activity (p = 0.008) exhibited a significant positive association with users than to non-users. The frequency showed that beta-carotene (54.2%), chamomile (54.2%), and glucosamine (53.8%) were the most preferred diet supplements under the category “when needed”. Cod liver oil (71.3%), omega 3 (68.3%), multi-vitamins (61.5%), ginseng (60%), and vitamin A (60%), were mostly used “from time to time”. Multi-minerals (34.4%) were the preferred choice when it comes to daily use. The main reasons for supplement use were to “maintain healthy hair” and “injury and illness” (both 26.2%). About 38.4% were not aware and 30.3% disagree on differences taking supplements with or without consulting a medical professional. About 36.7% lack information about side effects while, 35.0% were unaware about any health effect of dietary supplements.

Conclusion

The prevalence of dietary supplement use was high in Saudi female students and was significantly associated with sociodemographic and lifestyle factors.

Cytochrome P450 inhibition by three licorice species and fourteen licorice constituents

The potential of licorice dietary supplements to interact with drug metabolism was evaluated by testing extracts of three botanically identified licorice species (Glycyrrhiza glabra L., Glycyrrhiza uralensis Fish. ex DC. and Glycyrrhiza inflata Batalin) and 14 isolated licorice compounds for inhibition of 9 cytochrome P450 enzymes using a UHPLC-MS/MS cocktail assay. G. glabra showed moderate inhibitory effects against CYP2B6, CYP2C8, CYP2C9, and CYP2C19, and weak inhibition against CYP3A4 (testosterone). In contrast, G. uralensis strongly inhibited CYP2B6 and moderately inhibited CYP2C8, CYP2C9 and CYP2C19, and G. inflata strongly inhibited CYP2C enzymes and moderately inhibited CYP1A2, CYP2B6, CYP2D6, and CYP3A4 (midazolam). The licorice compounds isoliquiritigenin, licoricidin, licochalcone A, 18β-glycyrrhetinic acid, and glycycoumarin inhibited one or more members of the CYP2C family of enzymes. Glycycoumarin and licochalcone A inhibited CYP1A2, but only glycycoumarin inhibited CYP2B6. Isoliquiritigenin, glabridin and licoricidin competitively inhibited CYP3A4, while licochalcone A (specific to G. inflata roots) was a mechanism-based inhibitor. The three licorice species commonly used in botanical dietary supplements have varying potential for drug-botanical interactions as inhibitors of cytochrome P450 isoforms. Each species of licorice displays a unique profile of constituents with potential for drug interactions.

Prevalence and associated factors of herbal medicine use among pregnant women on antenatal care follow-up at University of Gondar referral and teaching hospital, Ethiopia: a cross-sectional study

BACKGROUND

Improving maternal and child health is one of the public health priorities in several African countries including Ethiopia. However, research on herbal medicine use during pregnancy is scarce in Ethiopia. The present study aimed at assessing the prevalence and correlates of herbal medicine use among pregnant women on antenatal care (ANC) follow-up at Gondar university referral hospital, Ethiopia METHODS: An institutional-based cross sectional study was conducted on 364 pregnant women attending ANC clinic from March to May 2016 at University of Gondar referral and teaching hospital, northwest Ethiopia. Data on socio-demography, pregnancy related information as well as herbal medicine use was collected through an interviewer-administered questionnaire. Descriptive statistics, univariate and multivariate logistic regression analysis were performed to determine prevalence and associated factors of herbal medicine use.

RESULTS

From 364 respondents, 48.6% used herbal medicine during current pregnancy. ginger (40.7%) and garlic (19%) were the two most commonly used herbs in pregnancy. Common cold (66%) and inflammation (31.6%) were the most common reasons for herbal use. Majority of herbal medicine users (89.8%) had not consulted their doctors about their herbal medicine use. Rural residency (Adjusted odds ratio (AOR): 3.15, Confidence interval (CI): 1.17-6.14), illiteracy (AOR: 4.05, CI: 2.47-6.62) and average monthly income less than 100 USD (AOR: 3.08CI: 1.221-7.77) were found to be strong predictors of herbal medicine use.

CONCLUSIONS

The use of herbal medicine during pregnancy is a common practice and associated with residency, level of education and average monthly income. From the stand point of high prevalence and low disclosure rate, the health care providers should often consult pregnant women regarding herbal medicine use.

Branched-Chain Amino Acid Supplementation in Combination with Voluntary Running Improves Body Composition in Female C57BL/6 Mice

Exercise is an inexpensive intervention that may be used to reduce obesity and its consequences. In addition, many individuals who regularly exercise utilize dietary supplements to enhance their exercise routine and to accelerate fat loss or increase lean mass. Branched-chain amino acids (BCAAs) are a popular supplement and have been shown to produce a number of beneficial effects in rodent models and humans. Therefore, we hypothesized that BCAA supplementation would protect against high fat diet (HFD)-induced glucose intolerance and obesity in mice with and without access to exercise. We subjected 80 female C57BL/6 mice to a paradigm of HFD feeding, exercise in the form of voluntary wheel running, and BCAA supplementation in the drinking water for 16 weeks (n = 10 per group). Body weight was monitored weekly, while food and water consumption were recorded twice weekly. During the 5th, 10th, and 15th weeks of treatment, glucose tolerance and body composition were analyzed. Exercise significantly improved glucose tolerance in both control-fed and HFD-fed mice. BCAA supplementation, however, did not significantly alter glucose tolerance in any treatment group. While BCAA supplements did not improve lean to fat mass ratio in sedentary mice, it significantly augmented the effects of exercise on this parameter.

Self-medication among medical and pharmacy students in Bangladesh

Background

This cross-sectional survey examined the pattern of self-medication and factors associated with this practice among medical and pharmacy students in context to Bangladesh.

Methods

The study used a self-administered questionnaire. A total of 500; 250 medical and 250 pharmacy, students participated in the study. As it is a comparative analysis between the medical and pharmacy students, we used independent t test and Chi square test.

Results

The findings indicated that the impact of self-medication is almost similar in medical and pharmacy students. It was found that medical students were more careful about getting advice from a physician or seeking professional help from some healthcare personnel. About the safety of self-medication pharmacy students were more aware than medical students were. The study also showed that female and younger medical or pharmacy students were more aware about self-medication.

Conclusions

The current study presents a comprehensive picture of self-medication in medical and pharmacy students in Bangladesh. It is clear from the findings that practice of self-medication is highly prevalent in medical and pharmacy students in the country. This may potentially increase misuse or irrational use of medicines.

Emergency Department Visits for Adverse Events Related to Dietary Supplements

BACKGROUND

Dietary supplements, such as herbal or complementary nutritional products and micronutrients (vitamins and minerals), are commonly used in the United States, yet national data on adverse effects are limited.

METHODS

We used nationally representative surveillance data from 63 emergency departments obtained from 2004 through 2013 to describe visits to U.S. emergency departments because of adverse events related to dietary supplements.

RESULTS

On the basis of 3667 cases, we estimated that 23,005 (95% confidence interval [CI], 18,611 to 27,398) emergency department visits per year were attributed to adverse events related to dietary supplements. These visits resulted in an estimated 2154 hospitalizations (95% CI, 1342 to 2967) annually. Such visits frequently involved young adults between the ages of 20 and 34 years (28.0% of visits; 95% CI, 25.1 to 30.8) and unsupervised children (21.2% of visits; 95% CI, 18.4 to 24.0). After the exclusion of unsupervised ingestion of dietary supplements by children, 65.9% (95% CI, 63.2 to 68.5) of emergency department visits for single-supplement-related adverse events involved herbal or complementary nutritional products; 31.8% (95% CI, 29.2 to 34.3) involved micronutrients. Herbal or complementary nutritional products for weight loss (25.5%; 95% CI, 23.1 to 27.9) and increased energy (10.0%; 95% CI, 8.0 to 11.9) were commonly implicated. Weight-loss or energy products caused 71.8% (95% CI, 67.6 to 76.1) of supplement-related adverse events involving palpitations, chest pain, or tachycardia, and 58.0% (95% CI, 52.2 to 63.7) involved persons 20 to 34 years of age. Among adults 65 years of age or older, choking or pill-induced dysphagia or globus caused 37.6% (95% CI, 29.1 to 46.2) of all emergency department visits for supplement-related adverse events; micronutrients were implicated in 83.1% (95% CI, 73.3 to 92.9) of these visits.

CONCLUSIONS

An estimated 23,000 emergency department visits in the United States every year are attributed to adverse events related to dietary supplements. Such visits commonly involve cardiovascular manifestations from weight-loss or energy products among young adults and swallowing problems, often associated with micronutrients, among older adults. (Funded by the Department of Health and Human Services.).

Self-medication practices and risk factors for self-medication among medical students in Belgrade, Serbia

Introduction

Self-medication among future health care professionals can represent a serious threat to professionalism in medicine and it has potential to put at risk public trust into this profession. The aim of this research was to investigate prevalence and risk factors for self-medication among population of medical students, because it was previously shown that their attitudes towards pharmacotherapy could affect the way they could prescribe medication in the future.

Material and Methods

Research was performed as a cross-sectional study and it included 1296 (84.1%) 1st, 3rd and 6th year students of School of Medicine, University of Belgrade. Students filled out a demographic and self-medication questionnaire created for the purpose of this research and the Physical Health Questionnaire – 9 (PHQ-9). Questions about self-medication were related to the period of the previous year.

Results

Self-medication was reported by 79.9% students. The most frequently self-prescribed medications were analgesics (55.4%). Independent risk factors for self-medication were possession of home-pharmacies (OR = 5.3, CI 95% 3.89–7.23), lower level of father's education (OR = 1.6, CI 95% 1.18–2.25), consumption of alcoholic beverages (OR = 1.5, CI 95% 1.13–2.08), less than 1 hour spent in physical activity per week (OR = 1.4, CI 95% 1.00–2.02), female gender (OR = 1.4, CI 95% 1.02–1.89), older age (OR = 1.1, CI 95% 1.07–1.21) and higher PHQ-9 score (OR = 1.09, CI 95% 1.05–1.12).

Conclusions

Self-medication is an important issue among population of medical students. Prevalence of self-medication could be controlled through regulatory authorities and further education.

Knowledge and use of dietary supplements by students of College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria

RATIONALE

Nutritional supplements are preparations intended to supplement the diet and provide nutrients. They include vitamins, minerals, fiber, fatty acids, or amino acids, that may be missing or may not be consumed in sufficient quantities in a person's diet. Many health professionals including dietitians, physicians and pharmacists are supplement users.

OBJECTIVES

The objectives of the present study were to determine knowledge and use of dietary supplements among students of College of Medicine, University of Lagos who are potential health professionals.

METHODOLOGY

A self-administered questionnaire with a mix of open and close ended questions was employed to collect data in this study. It was distributed to 300 students that were in their final year in various departments of the college.

FINDINGS

Response rate was 89%. About 86% of the students have used dietary supplement before while half of them (50%) have used it in the past 12 months. The common types of dietary supplements used in the past 12 months are the vitamins. The reasons for use by the students were good health, poor diet, to boost immunity, weight gain and doctor's prescription. Most of the students were occasional and once in a while users.

CONCLUSIONS

Majority of the students were aware of dietary supplement use and most of them were occasional users.

Complementary and conventional medicine use among youth with recurrent headaches

OBJECTIVE

To identify prevalence and patterns of complementary and alternative medicine (CAM) use among youth with recurrent headaches (HA) and evaluate associations with co-occurring health problems and limitations as well as with the use and expenditures for conventional medical care.

METHODS

Variables were constructed for youth aged 10 to 17 by using linked data from the 2007 National Health Interview Survey and the 2008 Medical Expenditures Panel Survey. Bivariate, logistic, and 2-part regression analyses were used.

RESULTS

Of the 10.6% of youth experiencing HA, 29.6% used CAM, rising to 41% for the many HA sufferers who also experienced difficulties with emotions, concentration, behavior, school attendance, or daily activities. Biologically based products (16.2%) and mind-body therapies (13.3%) were most commonly used, especially by the 86.4% of youth with HA experiencing at least 1 other chronic condition. Compared with non-CAM users, youth with HA who used CAM also had higher expenditures for and use of most types of conventional care.

CONCLUSIONS

CAM use is most common among youth with HA experiencing multiple chronic conditions and difficulties in daily functioning. Associations among CAM use, multiple chronic conditions, and higher use of conventional care highlight the need for medical providers to routinely ask about CAM use to meet the complex health needs of their patients and facilitate the optimal integration of care. Research is needed to identify models for coordinating complementary and conventional care within a medical home and to understand the health benefits or risks associated with CAM use in conjunction with conventional treatments for patients with HA.

Prevalence of herbal and dietary supplement usage in Thai outpatients with chronic kidney disease: a cross-sectional survey

BACKGROUND

There are few studies of the prevalence and patterns of herbal and dietary supplement (HDS) use in patients with chronic kidney disease (CKD), although many researchers and health professionals worldwide have raised concern about the potential effects of HDS on patients with renal insufficiency. A survey was conducted to determine: the prevalence and patterns of HDS use in Thai patients with CKD; the demographic factors related to HDS use; the reasons why Thai patients with CKD use HDS; respondent experiences of benefits and adverse effects from HDS; and the association between conventional medication adherence and HDS use.

METHODS

This cross-sectional survey recruited patients with CKD attending two teaching hospitals in Thailand. Data were collected via an interview using a semi-structured interview schedule regarding demographics, HDS usage, reasons for HDS use, and respondent experiences of effects from HDS. Conventional medication adherence was measured using the Thai version of 8-Item Morisky Medication Adherence Scale. Descriptive statistics were used to analyse the prevalence and the patterns of HDS use. Chi-square tests and multiple logistic regression were used to determine any associations between HDS use, demographics and conventional medication adherence.

RESULTS

Four hundred and twenty-one eligible patients were recruited. The prevalence of HDS use in the previous 12 months was 45%. There were no demographic differences between HDS users and non-users, except former drinkers were less likely to use HDS, compared with non-drinkers (OR 0.43, 95% CI 0.25-0.75). Those with a medium level of adherence to conventional medication were less likely to use HDS compared with those with a low level of adherence (OR 0.53, 95% CI 0.32-0.87). Maintaining well-being was most common purpose for using HDS (36%). Nearly 18% used HDS, such as holy mushroom, river spiderwort and boesenbergia, to treat kidney disease. The top three most often reported reasons why respondents used HDS were family and friend's recommendation, followed by expecting to gain benefit from HDS and wanting to try them. Perceived beneficial effects on renal function from HDS were reported by around 10% of HDS users. Among HDS users, seven patients perceived worsening CKD from HDS, such as river spiderwort, kariyat and wheatgrass. Additionally, 72% of respondents did not inform their doctor about their HDS use mainly because their doctor did not ask (46%) or would disapprove of their HDS use (15%).

CONCLUSIONS

Around half of the Thai patients with CKD used HDS. Health professionals should be aware of HDS use amongst such patients and enquire about HDS use as a part of standard practice in order to prevent any detrimental effects on kidney function.

The prevalence of herb and dietary supplement use among children and adolescents in the United States: Results from the 2007 National Health Interview Survey

OBJECTIVE

The purpose of this study is to examine the national prevalence of herb and dietary supplement usage among children and adolescents age 4-17 in the United States, and to identify population factors associated with usage.

METHODS

Weighted population estimates are derived from the 2007 National Health Interview Child Complementary and Alternative Medicine Supplement (sample n=9417). Wald chi-square tests are used to compare factors associated with herb and dietary supplement use.

RESULTS

An estimated 2.9 million children and adolescents used herbs or dietary supplements in 2007. Pediatric herb and supplement use was more common among adolescents and non-Hispanic whites, and positively associated with parental education and household income. Children with activity limitations due to chronic health conditions, long-term prescription use, or relatively heavy use of physician services were also more likely to use herbal supplements. Echinacea and fish oil were most commonly used herbs and supplements.

CONCLUSIONS

Children in the US appear to use herbs or dietary supplements at a much lower rate than adults. This analysis shows a pattern of moderate and appropriate herb and supplement use in the pediatric population.

Ischemic colitis induced by the newly reformulated multicomponent weight-loss supplement Hydroxycut®

Ischemic colitis accounts for 6%-18% of causes of acute lower gastrointestinal bleeding. It is more often multifactorial and more common in elderly. Drugs are considered important causative agents of this disease with different mechanisms. In this paper, we describe a 37-year-old otherwise healthy female presented with sudden onset diffuse abdominal pain and bloody stool. Radiologic, colonoscopic and histopathologic findings were all consistent with ischemic colitis. Her only suspected factor was hydroxycut which she had been taking for a period of 1 mo prior to her presentation. Her condition improved uneventfully after cessation of hydroxycut, bowel rest, intravenous hydration, and antibiotics. This is a first case of ischemic colitis with clear relationship with hydroxycut use (Naranjo score of 7). Our case demonstrates the importance of questioning patients regarding the usage of dietary supplements; especially since many patients consider them safe and do not disclose their use voluntarily to their physicians. Hydroxycut has to be considered as a potential trigger for otherwise unexplained ischemic colitis.

Sociodemographic, lifestyle and dietary correlates of dietary supplement use in a large sample of French adults: results from the NutriNet-Santé cohort study

Information on the determinants of dietary supplement (DS) use in France is largely lacking, especially in population subgroups such as smokers. Also, little is known about the role of health professionals in DS purchases. The aim of the present study was to describe DS use along with its sociodemographic, lifestyle and dietary correlates in a large sample of French adults (age 18+years) participating in the NutriNet-Santé cohort study. Data were collected by self-administered Internet questionnaires. Food intakes were assessed by 24 h dietary records. Data on DS use were available for 79 786 participants. Supplement users were compared with non-users by logistic regression. Current DS use at least three times/week was reported by 14·6 % of men and 28·1 % of women. Mg, and vitamins B6 and C were the most frequently consumed nutrients. DS were prescribed or recommended by a physician in 54·9 % of the cases. DS use was positively associated with knowledge of nutritional recommendations and organic product consumption, following a healthier diet and lifestyle (non-smoker, moderate leisure-time physical activity). Current smokers used less DS than did non-smokers, but their DS consumption was substantial (19·0 %) and they were more likely to self-medicate. The present study provides updated and detailed information on DS use determinants in a large French cohort, including a focus on smokers, for whom the long-term effects of DS use are poorly documented and could represent a risk. These findings pave the way for future aetiological studies.

Use of complementary and alternative medical therapies among youth with mental health concerns

BACKGROUND

Use of complementary and alternative medical (CAM) therapies is common among adults with mental health concerns, but little is known about CAM use among adolescents with mental health concerns.

METHODS

Data from the 2007 National Health Interview Survey were analyzed for youth from 7 to 17 years old. The study focused on 3 common mental health conditions: attention-deficit/hyperactivity disorder (ADHD), anxiety, and depression. CAM therapy use was identified by criteria from the National Institutes of Health National Center for Complementary and Alternative Medicine.

RESULTS

In a sample of 5651 individuals, representing 7 million youth, with 1 or more mental health concerns in the past 12 months, 28.9% used 1 or more types of CAM therapy, excluding vitamins/minerals. In contrast, only 11.6% of those without mental health concerns reported CAM therapy use (P < .05). Among youth with 1 or more mental health conditions, the most commonly used CAM therapies were mind-body therapies (16.3%) and biologically based therapies (11%); use was higher for therapies that could be directly accessed (18.6%) than for therapies delivered in groups (11.8%) or through a health professional (10.2%). In the multivariable regression model, demographic factors significantly associated with CAM therapy use were higher household income, higher parental education, having other chronic health conditions, use of prescription medications, and difficulty affording mental health counseling.

CONCLUSIONS

Readily accessible CAM therapies are commonly used by youth with ADHD, depression, and anxiety, particularly those who have comorbid chronic health conditions, receive prescription medications, and have difficulty affording counseling. Clinicians can use these data to guide inquiries and counseling. Researchers should explore the longitudinal relationship between access to coordinated care within a medical home and use of CAM therapies among youth with mental health concerns.

Naturopathic physicians: holistic primary care and integrative medicine specialists

The use of Complimentary and Alternative Medicine (CAM) is increasing in the United States; there is a need for physician level practitioners who possess extensive training in both CAM and conventional medicine. Naturopathic physicians possess training that allows integration of modern scientific knowledge and the age-old wisdom of natural healing techniques. Naturopathic philosophy provides a framework to implement CAM in concert with conventional therapies. The naturopathic physician's expertise in both conventional medicine and CAM allows a practice style that provides excellent care through employing conventional and CAM modalities while utilizing modern research and evidence-based medicine.

Use of multivitamins, folic acid and herbal supplements among breast cancer survivors: the black women's health study

BACKGROUND

Complementary and alternative medicine (CAM) use, including herbals and multivitamin supplements, is quite common in the U.S., and has been shown to be highest in breast cancer survivors. However, limited data are currently available for CAM usage among African Americans. Thus, we sought to determine the prevalence of multivitamins, folic acid and herbal supplement usage in African American breast cancer survivors, and to compare the characteristics of users and nonusers.

METHODS

A cohort study of breast cancer survivors, who completed the 1999 Black Women's Health Study questionnaire and self-reported having been diagnosed with breast cancer between 1995 and 1999, comprised the study population. In this study, the intake of natural herbs, multivitamins and folic acid at least three days per week within the past two years was used as a proxy for typical usage of this complimentary alternative medicine (CAM) modality.

RESULTS

A total of 998 breast cancer survivors were identified. Overall, 68.2% had used either herbals or multivitamin supplements or both. The three most frequently used herbals were garlic (21.2%), gingko (12.0%), and echinacea (9.4%). The multivariate analysis determined that single marital status (OR=1.58; 95%CI: 1.04-2.41), and alcohol consumption of 1-3 drinks per week (OR=1.86, 95%CI: 1.28-2.68) were significantly associated with increased herbal use. Multivitamin use was significantly lower among obese women (OR=0.66, 95%CI: 0.46-0.94) and current smokers (OR=0.53, 95%CI: 0.34-0.82).

CONCLUSIONS

A significant number of African American breast cancer survivors are using herbals and multivitamins as CAM modality. Additional research is needed to understand the impact of herbals and multivitamins in African American breast cancer survivors.

Complementary and alternative medicine use among cancer survivors: a population-based study

INTRODUCTION

The use of complementary and alternative medicine (CAM) among cancer survivors is high, yet less is known about reasons behind such use or the communication of CAM with conventional medical providers.

METHODS

Cross-sectional, multivariate logistic regression models were developed to evaluate the similarities and differences between cancer survivors and non-cancer controls in the 2007 National Health Interview Survey with 23,393 participants, including 1,471 cancer survivors.

RESULTS

Among cancer survivors, 66.5% reported ever using CAM and 43.3% having used CAM in the past year. When compared with the general population, cancer survivors used CAM more often for general disease prevention, immune enhancement, and for pain (Adjusted Odds Ratio [AOR] 1.27, 95% Confidence Interval [CI] 1.10-1.48; AOR 1.32, 95% CI 1.05-1.62; AOR 1.42, 95% CI 1.05-1.92, respectively). Cancer survivors were more likely to use CAM because of recommendations from their provider (AOR 1.54, 95% CI 1.26-1.88) and were more likely to disclose their CAM use to their provider (AOR 1.45, 95% CI 1.22-1.72).

DISCUSSIONS/CONCLUSIONS

When compared to the general population, cancer survivors were more likely to use CAM and communicate this use with providers, indicating a growing integration of CAM in conventional medical care.

IMPLICATIONS FOR CANCER SURVIVORS

Cancer survivors are more likely than the general population to communicate CAM use with providers, suggesting greater integration of CAM use in conventional care. However, the majority of CAM use is still not being communicated to providers, indicating an important area for improvement in patient-centered care.

Herbal use before and during pregnancy

OBJECTIVE

We estimated the prevalence and patterns of herbal use among US women before and during pregnancy.

STUDY DESIGN

The National Birth Defects Prevention Study is an ongoing, population-based, case-control study. This analysis included 4239 women from 10 centers in the United States who delivered infants without major birth defects from 1998-2004.

RESULTS

The prevalence of reported herbal use 3 months before or during pregnancy was 10.9%. During pregnancy, prevalence was 9.4% and was highest in the first trimester. Higher prevalence was associated with age greater than 30 years and education greater than 12 years. Use varied considerably by state (5-17%). Ginger and ephedra were the most commonly reported products early in pregnancy; teas and chamomile were most commonly reported throughout pregnancy.

CONCLUSION

Potentially 395,000 US births annually involve antenatal exposure to herbal products. Health care providers should inquire routinely about herbal use and educate patients about what little is known regarding risks of these products.