Use of complementary and alternative medicine treatments by mothers of children with developmental disabilities: a cross sectional study.

This study aims to determine the rates of complementary and alternative medicine methods used by mothers of children with developmental disabilities, reasons for using methods, and comparison of methods according to diagnosis groups. The cohort in this cross-sectional and correlational study consisted of the mothers of 390 students with developmental disabilities; 77.2% of the mothers reported using at least one complementary and alternative medicine treatment. The highest level of use was found in the groups of mothers of children with cerebral palsy (100%) and autism spectrum disorder (88.5%). The most commonly used treatments were biological therapies consisting of special diets and multivitamins, manipulative and body-based methods including massage and exercise, and mind-body interventions such as prayer, wearing amulets, and seeking help from a Muslim preacher (hodja). However, mothers never used alternative medicine treatments such as homeopathy, acupuncture, or Ayurveda, nor did they use energy-based healing techniques such as reiki, tai chi, yoga, kinesiology, or neurofeedback exercises. Health care professionals, especially nurses as health care team members, should be knowledgeable and careful about the benefits, side effects, administration methods, and contraindications of complementary and alternative medicine treatments.

Use of complementary and alternative medicine in children with recurrent acute otitis media in Italy.

Controlling environmental factors, chemoprophylaxis, immunoprophylaxis and surgery are considered possible means of preventing recurrent acute otitis media (RAOM), but there are no available data concerning the paediatric use of complementary and alternative medicine (CAM). We evaluated the uses of CAM (homeopathy and/or herbal medicine) as means of preventing AOM in children with a history of RAOM. Eight hundred and forty Italian children with RAOM (≥3 episodes in six months) aged 1-7 years were surveyed in 2009 using a face-to-face questionnaire, filled by parents or caregivers, that explored the prevalence, determinants, reasons, cost, and perceived safety and efficacy of CAM. About one-half (46%) of the children used CAM, significantly more than the number who used immunoprophylaxis (influenza vaccine 15%; p<0.05), PCV-7 34%; p<0.05) or chemoprophylaxis (2%; p<0.001). Use of CAM in the family was the only important factor positively associated with the use of CAM in children (adjusted OR 7.94; 95% CI: 5.26-11.99). The main reasons for using CAM were a fear of the adverse effects of conventional medicine (40%) and to increase host defences (20%). CAM was widely seen as safe (95%) and highly effective (68%). CAM prescribers were paediatricians in 50.7% of cases; self-initiation was reported by 23% of respondents. CAM expenditure was between Euro 25 and Euro 50/month in 27.6% of cases and ≥ Euro 50/month in 16%. Children with RAOM should be considered among the categories of subjects likely to be using CAM. Together with the fact that paediatricians are the main prescribers, this is worrying because of the current lack of evidence regarding the efficacy, safety and cost-effectiveness of CAM in the prevention of RAOM.

Integration of informal medical practitioners in DOTS implementation to improve case detection rate.

OBJECTIVE: To integrate informal registered medical practitioners (IRMP) in Directly Observed Therapy Short Course (DOTS) implementation to improve case detection rate. METHODS: This interventional study was conducted in the settlement area of Malir district whereas New Karachi was taken as control, between February to November 2005. All registered healthcare providers within 5 kilometer around Tuberculosis (TB) DOTS center Malir were included. New sputum positive and sputum direct smear negative cases of pulmonary Tuberculosis above 15 years residing in the catchments area were included as target population. Informal registered medical practitioners were trained for the referral of suspected cases to the TB DOTs center where three sputum samples were taken, and X-ray chest was done to confirm if sputum direct smear (D/S) was negative. Demographic data regarding age, gender, address, case number, onset of symptoms, treatment given, response, compliance to treatment was all collected. RESULTS: Out of 64 health care providers there were a drop out of 6 leaving 58 informal registered medical practitioners (36 homeopathic/22 Hakims) who referred 54 cases, of these 16 cases were actual suspects. Two out of these 16 (12.5%) were Tuberculosis positive. One was Sputum D/S positive and the other sputum direct smear negative with X-ray chest positive. Comparison of data (Malir and New Karachi diagnostic center) showed that by incorporating homeopathic and Hakims an increase in the proportion of case identification (0.477) was significantly higher in Malir (intervention area) vs New Karachi (non-intervention area) (0.316). CONCLUSION: Integration of informal registered medical practitioners was found to be effective in DOTS implementation hence they can be incorporated in other national programmes to improve public health.

The effect of homeopathically prepared thyroxine on highland frogs: influence of electromagnetic fields.

BACKGROUND: Previous experiments show that amphibian larvae are responsive to homeopathically prepared thyroxine. METHODS: We studied the effect of a highly diluted and agitated thyroxine solution exposed to various electromagnetic fields on metamorphosis in highland Rana temporaria. The devices tested were: microwave oven, mobile phone, airport X-ray, and a red light barcode scanner. Animals were treated either with homeopathically prepared thyroxine (10(-30) parts by weight, 10(-35) in the water in which the animals were kept), or analogously prepared blank solution, or analogously prepared thyroxine exposed to the electromagnetic field of one of the devices tested. Solutions were administered at 48h intervals according to a standardized protocol. RESULTS: Animals treated with the standard test solution thyroxine 10(-30) metamorphosed more slowly than the control animals, ie the effect of the homeopathically prepared thyroxine was opposed to the usual physiological effect of molecular thyroxine. The cumulative number of test animals that had reached the four-legged stage at defined points in time was smaller in the group treated with homeopathically prepared thyroxine at most of the points in time. This was found independently by all three research teams involved. In contrast, this effect did not occur when the thyroxine solution had been exposed to the field of the early model microwave oven, or mobile phone. There was no difference between aqueous or alcoholic solutions were used, and there was, if any, only a small protective effect from aluminum foil. Airport X-ray and red light barcode scanning did not diminish the effect of the homeopathic solution.

Integrative and complementary practices: use by community health agents in self-care.

OBJECTIVE: To verify the use of integrative and complementary practices (ICPs) by community health agents working in family health teams. METHODS: Cross-sectional, quantitative research, conducted in the city of Montes Claros, Minas Gerais. An structured form was used for the characterization of participants and use of ICPs. Descriptive and bivariate analyses were conducted. RESULTS: Use of ICPs was referenced by 94 (40.7%) agents. The use of medicinal plants was predominant (32.5%). There were associations between: ICPs in general and negative self-perception of health (p=0.032), homeopathy and higher education (p=0.015), massage and living with partner(p=0.024), chiropractic care and income equal to or greater than four minimum wages (p=0.031), relaxation/meditation and religion (p=0.028). CONCLUSION: The use of ICPs was verified in the healthcare of community agents. It is necessary to strengthen these practices for the promotion of health and prevention of diseases.

Who uses complementary and alternative medicine in Israel?

OBJECTIVE: To describe the Israeli complementary and alternative medicine users and examine whether they are the same or different from non-users. DESIGN: This analysis was conducted on data collected from the use of health services module (n=2,365) of the Israeli National Health Interview Survey conducted 2003-2004. The questionnaire was based on the European Health Interview Survey and was administered over the telephone by trained interviewers. SUBJECTS: This survey was conducted on a random sample of the Israel general population age 21 years or more. OUTCOME MEASURES: Chi-square tests and logistic regression analyses were conducted. Complementary and alternative medicine was defined as self-reported use of homeopath, acupuncturist, chiropractor/osteopath, naturopath, or other complementary and alternative provider services for the subjects' own health needs in the last 12 months. RESULTS: Almost 6 percent of Israelis reported using complementary and alternative medicine. Use increased with income. Users were more likely to visit any doctor or a specialist in the prior 4 weeks to the survey compared to nonusers. Users self-reported similar use of pain medications compared to nonusers. CONCLUSIONS: These findings inform the international debate regarding if and how complementary and alternative medicine services should be covered by national health insurance.

Evaluation of mammographic density and (99m)Tc-sestamibi scintimammographic uptake in postmenopausal women on hormone replacement therapy.

OBJECTIVE: To evaluate changes in mammographic density and (99m)Tc-sestamibi scintimammographic uptake in postmenopausal women on hormone replacement therapy (HRT). METHODS: Seventy-five postmenopausal women were prospectively studied and allocated into three groups: 50 women were randomized to either Group 1 (G1, n=25), which received 2mg of 17beta-oestradiol continuously combined with 1mg of norethisterone acetate (E2/NETA, Kliogest, Medley) or Group 2 (G2), which received 2.5mg/day of tibolone (Livial, Organon). The remaining 25 women, who were asymptomatic and had no desire to undergo HRT, constituted the control group (G3). Each patient was submitted to both mammography and scintimammography at baseline and after six months. Mammographic density was evaluated by using the BI-RADS classification system. The classification system of Barros et al. was used in the interpretation of scintimammography. For statistical analysis, the Chi-square test, ANOVA and Pearson's correlation were used. RESULTS: At six months, increased mammographic density was observed in 48% of G1, 12% of G2 and 16% of G3 patients (p<0.001). The increase in sestamibi uptake was 56% in G1, 28% in G2 and 24% in G3 (p<0.001). Increases in both density and uptake were significantly higher in the group on E2/NETA than among tibolone users and the controls. CONCLUSION: In postmenopausal women, HRT with E2/NETA was associated with increased mammographic density and increased (99m)Tc-sestamibi scintimammographic uptakes, suggesting greater mithochondrial activity in the cells of the mammary duct. This was not observed in users of 2.5 mg of tibolone, demonstrating that the effects on the breast were reduced. The same was observed in the control group.

CAM use among older adults age 65 or older with hypertension in the United States: general use and disease treatment.

OBJECTIVES: Hypertension (HT) is a common condition among older adults that greatly increases morbidity and mortality risk. Although a number of antihypertensive therapies are currently available, adherence and control are low. The purpose of this study was to assess the use of complementary and alternative medicine (CAM) among older adults with HT. DESIGN: Using a nationally representative cross-sectional survey, the authors examined the prevalence of CAM use among older adults with and without diagnosed HT and the degree to which CAM is used specifically for HT treatment. SUBJECTS: Subjects were 5821 adults age > or = 65 who participated in the 2002 National Health Interview Survey (NHIS), including the Alternative Health supplement. OUTCOME MEASURES: HT status was assessed by self-report. CAM use was classified as any CAM use, use of four CAM modalities, and specific CAM therapies. RESULTS: Any CAM use was higher for persons with HT compared to those without diagnosed HT (69.5% versus 65.6%). Only 7.8% of CAM users reported using CAM to treat HT. Homeopathic treatment (16.7%), healing ritual (14.5%), and diet-based therapies (13.0%) were the most common HT therapies. Frequency of use of specific types of CAM therapies did not differ by HT status other than for biologically based therapies, which were used less often by those with HT. CONCLUSIONS: CAM use is high among older adults with HT, but the vast majority of CAM is used for treating or preventing other conditions. Healthcare providers treating patients with HT should be aware of CAM among their patients.

National patterns and correlates of complementary and alternative medicine use in adults with diabetes.

OBJECTIVE: The aim of this study was to determine national patterns and correlates of complementary and alternative medicine (CAM) use among adults with diabetes. METHODS: The authors compared CAM use in 2474 adults with and 28,625 adults without diabetes who participated in the most comprehensive national survey on CAM use (2002 National Health Interview Survey). Eight CAM use categories were created, including dietary, herbal, chiropractic, yoga, relaxation, vitamin, prayer, and other (acupuncture, Ayurveda, biofeedback, chelation, energy healing or Reiki therapy, hypnosis, massage, naturopathy, and homeopathy). An overall CAM use category also was created that excluded vitamins and prayer. Patterns of use were compared with chi-square and independent correlates of CAM use with multiple logistic regression controlling for relevant covariates. STATA was used for analysis to account for the complex survey design. RESULTS: Prevalence of overall use of CAM did not differ significantly by diabetes status (47.6 versus 47.9%, p = 0.81). Diabetes was not an independent predictor of overall use of CAM (OR 0.93, 95% confidence interval [CI] 0.83, 1.05). However, persons with diabetes were more likely to use prayer (OR 1.19, 95% CI 1.05, 1.36), but less likely to use herbs (OR 0.86, 95% CI 0.75, 0.99), yoga (OR 0.56, 95% CI 0.43, 0.72), or vitamins (OR 0.82, 95% CI 0.72, 0.93) than people without diabetes after controlling for relevant covariates. Independent correlates of overall use of CAM differed by age, income, employment, comorbidity, and health status between people with and without diabetes. CONCLUSIONS: This study found that there has been a dramatic increase in overall use of CAM in adults with diabetes; diabetes was not an independent predictor of overall use of CAM; and people with diabetes were more likely to use prayer, but less likely to use herbs, yoga, or vitamins compared to persons without diabetes.

Drug utilization pattern during pregnancy in North India.

BACKGROUND: Pregnancy is a special physiological condition, where drug treatment presents a special concern. AIMS: To evaluate the drug utilization pattern during pregnancy and to evaluate the effect of the educational and economic status on it.. DESIGN: The retrospective cross-sectional study. SETTING: The postgraduate Department of Pharmacology and Therapeutics of a medical college. and the antenatal clinic of the institution. MATERIALS AND METHODS: Medical students filled 405 questionnaires after interviewing pregnant women (243 primigravida and 152 multigravida). All the collected questionnaires were analysed for various study parameters. STATISTICAL ANALYSIS USED: Inter-group comparison was done using chi-square test. P value < 0.05 was considered statistically significant. RESULTS: A total of 700, 1086 and 686 drugs, with an average of 1.73, 2.89 and 2.49 drugs per pregnant women, were used during first, second and third trimester of pregnancy, respectively. A majority of the drugs used, were from category-A, followed by category-B and category-D. However, category C and X drugs constituted 2.90 (20) and 5.71% (40) of drugs used during the third trimester and first trimester, respectively. Herbal/homeopathic drugs constituted 6.42 (45), 3.68 (40) and 1.46% (10) of the drugs used in the first, second and third trimester of pregnancy, respectively (P=649). 33.33% (135) women believed that drug use during pregnancy is dangerous to both mother and child and 37.03% (150) believed that drugs are dangerous throughout pregnancy. 55.55% (225) females advocated the use of iron/folic acid during pregnancy. 24.69% (100) of women had knowledge about barrier contraceptives. Self-medication and homeopathic/ herbal drugs use was found more in graduates than in undergraduates; as well as, it was more in the higher socioeconomic group than the lower socioeconomic group. CONCLUSION: There is a need to educate and counsel women of child-bearing age, regarding the advantages and disadvantages of drug use during pregnancies, with special reference to alternative therapies and self-medication.

Consumer preferences in social health insurance.

Allowing consumers greater choice of health plans is believed to be the key to high quality and low costs in social health insurance. This study investigates consumer preferences (361 persons, response rate 43%) for hypothetical health plans which differed in 12 characteristics (premium, deductibles, no-claim discount, extension of insurance and financial services, red tape involved, medical help-desk, choice of family physicians and hospitals, dental benefits, physical therapy benefits, benefits for prescription drugs and homeopathy). In 90% the health plan with the most attractive characteristics was preferred, indicating a predominantly rational kind of choice. The most decisive characteristics for preference were: complete dental benefits, followed by zero deductibles, and free choice of hospitals.

Prevalencia del Molar en C: estudio Transversal / Prevalence of C-Shaped Molar: cross-sectional Study

El objetivo fue evaluar mediante tomografía computarizada de haz cónico (CBCT), la prevalencia y tipología de conductos en C en molares inferiores. Se analizaron 422 CBCT y 1105 molares inferiores de pacientes de ambos géneros, mayores de 10 años, obtenidas en 2018. Variables registradas: género, número de pieza, y tipología, según clasificación anatómica de Fan, en los tres tercios. Se observaron cortes coronario, medio y apical. Se compararon frecuencias observadas con frecuencias esperadas bajo suposición de independencia, se utilizó prueba de bondad de ajuste de Chi-cuadrado. La comparación de pares de porcentajes se realizó con prueba de diferencia de proporciones de Pearson Chi-cuadrado con p-valores simulados por prueba de Monte Carlo. Según los resultados, el molar en C no se distribuyó homogéneamente en las tomografías analizadas. Chi-cuadrado (X2=264.13 p-valor <2,2) (p-valor dos colas <0.001), tampoco se distribuyó homogéneamente en el total de piezas dentarias Chi-cuadrado (X2=1011,1, p-valor <2.2e-16) (p-valor dos colas <0.001). Las variables género y presencia de molar en C no se distribuyeron independientemente, Chi-cuadrado (X2=4.7367, p-valor =0,042) (p-valor<0,05). Las variables tipología y piezas dentarias no se distribuyeron independientemente, Pearson Chi-cuadrado (p-valor<0.001), al igual que las variables tipología y tercios, Pearson Chi-cuadrado (p-valor<0.001). En conclusión, la CBCT es valiosa para identificar estas anatomías. Haber encontrado mayor prevalencia de tipología I confirma lo establecido en la literatura. Tienen alta prevalencia en las poblaciones asiáticas pero en caucásica son poco frecuentes (3%) (AU)

The methodological quality of randomized controlled trials of homeopathy, herbal medicines and acupuncture.

BACKGROUND: To investigate the methodological quality of randomized controlled trials in three areas of complementary medicine. METHODS: The methodological quality of 207 randomized trials collected for five previously published systematic reviews on homeopathy, herbal medicine (Hypericum for depression, Echinacea for common cold), and acupuncture (for asthma and chronic headache) was assessed using a validated scale (the Jadad scale) and single quality items. RESULTS: While the methodological quality of the trials was highly variable, the majority had important shortcomings in reporting and/or methodology. Major problems in most trials were the description of allocation concealment and the reporting of drop-outs and withdrawals. There were relevant differences in single quality components between the different complementary therapies: For example, acupuncture trials reported adequate allocation concealment less often (6% versus 32% of homeopathy and 26% of herb trials), and trials on herbal extracts had better summary scores (mean score 3.12 versus 2.33 for homeopathy and 2.19 for acupuncture trials). Larger trials published more recently in journals listed in Medline and in English language scored significantly higher than trials not meeting these criteria. CONCLUSION: Trials of complementary therapies often have relevant methodological weaknesses. The type of weaknesses varies considerably across interventions.

Evaluation of the automated Bact-Alert system for pediatric blood culturing.

The Organon Teknika BacT/Alert (Organon Teknika, Durham, NC), using the Pedi-BacT 20 mL aerobic bottle (BPBCS) was compared to the Wampole Isolator (WI) 1.5 Microbial tube (Wampole Laboratories, Cranbury, NJ), for detection and recovery of pediatric pathogens. The BPBCS continuously monitors culture bottles for changes in CO2 concentrations, while WI cultures are examined twice daily for appearance of colonial growth on agar media. Of 5,175 paired blood cultures, 383 pathogens were recovered from 606 positive cultures. There were 272 pathogens recovered by both systems, 64 from BPBCS only, and 47 from WI only. Overall recovery rates were 88% for BPBCS and 83% for WI. There was no significant difference between the two systems in detection or times to positivity of staphylococci, Enterobacteriaceae, or pseudomonads. Trends toward better recovery of streptococci (20 vs. 10) and fastidious microaerophiles (3 vs. 0) were found with BPBCS, whereas more slowly growing pathogens (Rochalimaea henselae [1], Mycobacterium avium-intracellulare [1]) were recovered by WI only, but because of their lower frequency did not achieve statistical significance. Detection of Haemophilus influenzae (14.9 hours in WI vs. 45.4 hours in BPBCS) was faster with WI. False positive plus contaminant cultures were detected in 5.9% BPBCS versus 1.5% WI. BPBCS offers detection of bacteremia at a rate comparable to WI with advantages of automation.

A controlled trial of buprenorphine treatment for opium dependence: the first experience from Iran.

AIMS: To evaluate the effect of a 4 mg/day sublingual dose of buprenorphine in the maintenance treatment of opium dependence in comparison with a 1 mg/day dose over an 18-week treatment period. As a secondary objective, the results were determined concurrently for subjects treated with a 2 mg/day dose. DESIGN: Subjects were assigned randomly to three dosage groups. PARTICIPANTS: 330 consecutive (320 men and 10 women) opium addicts who met the DSM-IV criteria for opioid dependence and were seeking treatment. INTERVENTION: Subjects received a 1, 2 or 4 mg/day dose of buprenorphine and were treated in an outpatient clinic where they also received a weekly 1-hour clinical counseling session. MEASUREMENTS: Addiction Severity Index, retention in treatment, and illegal opioid use as determined by random urine testing. FINDINGS: The mean age was 37.5 years (SD=11.4, range 19-72). Overall, 194 (58.8%) of the patients completed the 18 week study. Completion rates by dosage groups were 47.3% for the 1 mg group, 58.2% for the 2 mg group and 70.9% for the 4 mg group (chi(2)=12.7, df=2, P=0.0017). CONCLUSIONS: The results support the efficacy and safety of buprenorphine for opium addiction and suggest that an adequate dose of buprenorphine would help to increase the success rate.

Tachyphylaxis associated with continuous cisatracurium versus pancuronium therapy.

STUDY OBJECTIVES: To compare dosing requirements over time among patients receiving continuous cisatracurium versus pancuronium therapy, and to identify factors that may account for changes in pancuronium versus cisatracurium infusion requirements over time. DESIGN: Retrospective, comparative cohort analysis. SETTING: A tertiary level 1 trauma center. PATIENTS: Forty-five consecutive adult patients who were admitted to intensive care units at our institution from January 1998-August 2000 and received continuous cisatracurium or pancuronium therapy for at least 48 hours. MEASUREMENTS AND MAIN RESULTS: Dosing requirements of patients treated with pancuronium or cisatracurium were recorded over time throughout the treatment period. Factors that could affect dosing requirements of a neuromuscular blocking agent (NMBA) were stratified as time invariant (admitting service, acute physiology and chronic health evaluation II score, duration of mechanical ventilation, pressure control ventilation, baseline hepatic or renal insufficiency, thermal injury, train-of-four assessment, and concurrent drug administration or disorders affecting neuromuscular transmission) or time variant (concurrent sedation and narcotic analgesia therapy; serum magnesium, potassium, and creatinine concentrations; arterial pH level; temperature; peak airway pressure; and partial pressure of oxygen:fraction of inspired oxygen ratio). Hierarchical linear modeling was used to compare the dosing requirements and to identify confounders affecting the relationship. The infusion rate escalation for the cisatracurium group was greater (0.39 microg/kg/min; 95% confidence interval [CI] 0.22-0.56; 23 patients) than for the pancuronium group (-0.06 microg/kg/min; 95% CI -0.24-0.12; 22 patients; p<0.001) and was associated with an average daily cost/patient significantly higher (p<0.001) with cisatracurium ($258+/-$114) than pancuronium ($11+/-$5). Confounder analysis revealed that only the admitting service and the number of times the NMBA infusion was suspended because no twitch was detected differed between groups. Neither of these confounders significantly affected the temporal relationship between cisatracurium and pancuronium infusion rates. CONCLUSION: Dosing requirements increase over time at a significantly greater rate for cisatracurium than pancuronium infusions. Tachyphylaxis with cisatracurium is associated with substantial drug-related costs and is not accounted for by various disease-, patient-, and therapy-related factors. Further investigation is required to elucidate the mechanisms and risk factors underlying this phenomenon.

Psychosocial antecedents of injection risk reduction: a multivariate analysis.

The AIDS risk reduction model (ARRM) predicts decreased occurrence of AIDS risk behavior through a three-stage process: (a) perceiving one's behavior as risky and recognizing one's skills to reduce the behavior, (b) forming an intention to change behavior, and (c) acting on that intention. We used the ARRM to test a stage-based longitudinal structural equation model of the impact of intention to reduce injection risk behavior on subsequent behavior change in a sample of 294 HIV-negative opiate-addicted individuals in treatment. Intended risk reduction and continuous participation in treatment significantly predicted less injection risk behavior. Greater self-efficacy, less baseline risk behavior, less perceived susceptibility to AIDS, and greater fear of AIDS predicted intention to reduce risk. Leverage points for change are discussed.

Changes in public awareness of, attitudes to, and use of complementary therapy in North East Scotland: surveys in 1993 and 1999.

OBJECTIVE: To assess changes in awareness of, use of, attitudes to, and opinions about complementary and alternative medicine (CAM) amongst residents of North East Scotland and to obtain details about CAM use from respondents. STUDY DESIGN: Population survey carried out in 1999, 6 years after the initial study. Postal survey to 800 people to examine eight CAMs; acupuncture, aromatherapy, chiropractic, herbalism, homeopathy, hypnotherapy, osteopathy, and reflexology. RESULTS: A total of 432/800 (54%) responded, of whom 175 (41%) had used at least one type of CAM compared to 29% in 1993. Increases in use were statistically significant for aromatherapy (18% versus 9%), acupuncture (10% versus 6%) and reflexology (9% versus 3%). A greater proportion of 1999 respondents thought CAM should be available on the NHS but a smaller proportion of respondents had concerns about using CAM (25% in 1993 and 20% in 1999). Overall concerns about effectiveness of therapies had increased from 36 to 45%, but fewer individuals were concerned about the cost of therapy in the 1999 survey (52% in 1993 to 22% in 1999). A total of 175 individuals provided details about one CAM they had used. The self-reported primary reasons for using CAM were relief of pain due to headaches or musculoskeletal problems, and for relaxation and relief of stress. The majority of CAM was therapist administered (103/166) as opposed to a bought product. Effectiveness ratings were self-reported but overall 80/166 found CAM very effective and 62/166 partially effective. A total of 65% had consulted their GP about their health problem before using CAM, 59/157 indicated their GP knew they were using CAM and of these, 14 indicated their GP was administering the therapy. CONCLUSIONS: The study has provided further baseline data on which to assess trends in CAM use and highlighted issues for patients and the NHS about the use of CAM to relieve health problems. Results indicate a greater proportion of the population of North East Scotland are both aware of and using CAM to relieve health problems. More research into the implications for the NHS of concurrent use of CAM with conventional medicine is required.

Effects of homeopathic intervention on medication consumption in atopic and allergic disorders.

CONTEXT: Allergies are the most common immunologic diseases among the general population. Increasing evidence suggests that the incidence of allergic disorders is rising dramatically. Conventional medicine provides only limited relief and does not offer a complete cure to this health problem. Consequently, patients seek additional approaches and therapies to integrate into their healthcare. Homeopathy is one of the leading complementary modalities used to treat this health problem. OBJECTIVE: This preliminary study assessed the effect of integrating homeopathic treatment in allergic diseases on conventional medication consumption in a health maintenance organization. DESIGN: Retrospective outcome study designed as a before-after trial. SETTING: Patients were studied in a complementary medicine clinic affiliated with an Israeli health maintenance organization. PARTICIPANTS: Forty-eight patients were treated for allergic diseases with homeopathic remedies and conventional medications. MAIN OUTCOME MEASURES: A computerized medication chart for each patient was evaluated for conventional medication consumption 3 months before and 3 months after the homeopathic intervention. Each patient served as his or her own control. RESULTS: Fifty-six percent of patients in this study reduced their use of conventional medication following the homeopathic intervention. Patients who used conventional medications for their allergic disorders reduced their medication expense by an average of 60%, with an average savings of $24 per patient in the 3-month period following the homeopathic intervention. CONCLUSIONS: This retrospective outcome study demonstrates cost savings for an Israeli health maintenance organization. The homeopathic intervention led to a modest but significant reduction in the use of medications commonly used to treat allergic conditions and their complications. Larger controlled studies are needed to verify these findings.

Women's position during labour: influence on maternal and neonatal outcome.

AIM: To assess the maternal, perineal and neonatal outcomes of an upright position compared with a supine position during vaginal delivery, in terms of defined outcome variables. METHODS: This case-control study was carried out at the Department of Obstetrics and Gynaecology of the University Hospital Vienna between 1997 and 2002. A total of 307 women who delivered in an upright position were enrolled in the study. Upright position was defined as free squatting and was also described as an alternative birth position. 307 controls, delivering in a supine position, were selected from the delivery database as the next parity-matched normal spontaneous vaginal delivery. Our analysis was restricted to a sample of women with a gestational age > 37 weeks, a normal sized fetus and a pregnancy with cephalic presentation. Women with medical or obstetric risk factors were excluded. RESULTS: A statistically significant decrease for the use of medical analgesia (p = 0.0001) and oxytocin (p = 0.001) was observed in women using the upright birth position. The length of the first and second stages of labour did not significantly differ between the two groups (p > 0.05). A significantly lower rate of episiotomy was detected in women who delivered in an upright position compared with women delivering supine (p = 0.0001). The frequency of perineal tears, and vaginal and labial trauma did not differ between the two groups (p > 0.05). When analysing maternal blood loss, no significant differences between the two groups were found (p > 0.05). No differences in APGAR score < 7 at 1 and 5 minutes or cord pH < 7.1 were observed (p > 0.05). CONCLUSIONS: The data indicate that labouring and delivering in an upright position is associated with beneficial effects such as a lower rate of episiotomy, and a reduced use of medical analgesia and oxytocin. In our opinion, the best recommendation is to give low-risk maternity patients the option of bearing in the mode that is most comfortable for them.