Depression, pregnancy-related anxiety and parental-antenatal attachment in couples using preimplantation genetic diagnosis.

STUDY QUESTION: Do preimplantation genetic diagnosis (PGD) couples experience higher levels of stress during pregnancy and the perinatal period compared with couples who conceive spontaneously (SC) or with ICSI? SUMMARY ANSWER: PGD couples did not experience more psychological stress during pregnancy and beyond than ICSI or SC couples. WHAT IS ALREADY KNOWN: Previous studies have shown that assisted reproduction technology (ART) couples are more prone to pregnancy-related anxieties than SC couples, but display depressed feelings to an equal or lesser extent. However, only one study has focused on a female PGD sample, which may be a more vulnerable group than other ART groups, due to the potentially complex hereditary background, adverse childhood experiences and losses. In that study, PGD women experienced a reduction in state anxiety, and maternal-antenatal attachment did not differ from normative data. Unfortunately, no data exist on pregnancy-related anxiety, depression and parental-antenatal attachment. Valuable information from both parents (e.g.: couples) is also lacking. STUDY DESIGN, SIZE, DURATION: For this longitudinal prospective study questionnaire, data from 185 women and 157 men (157 couples) were collected between February 2012 until April 2014. Data were analysed using multilevel analysis. The couples conceiving after PGD, ICSI or SC were followed from the first trimester of the pregnancy until the third month post-partum. PARTICIPANTS/MATERIALS, SETTING, METHODS: A total of 60 PGD, 58 ICSI and 69 SC couples were initially recruited by various departments of Universitair Ziekenhuis Brussel (UZ Brussel). At each trimester (T1: 12-14 weeks, T2: 20-22 weeks, T3: 30-32 weeks) of pregnancy, depression (EPDS), pregnancy-related anxieties (PRAQ) and parental-antenatal attachment (M/PAAS) were recorded. At T4 (3 months post-partum), depression (EPDS) was assessed again. In the first trimester (T1) broad socio-demographic data and at T4 perinatal health data of both mother and child were recorded. Differences between conception groups over time were analysed using multilevel analyses, taking into account covariation between measurements and within couples. Several perinatal covariates as well as social desirability, coping and adult attachment style were controlled for. MAIN RESULTS AND THE ROLE OF CHANCE: All three conception groups had similar scores for depression during pregnancy and beyond. Also, pregnancy-related anxiety scales did not differ among the three groups. All groups also followed a similar trajectory in time regarding their scores for anxiety, depression and parental-antenatal attachment. ART groups did not give more socially desirable answers than SC controls. The subsequent moderators: coping and adult attachment style did not add any relevant information. No interaction effects occurred between gender and conception groups. LIMITATIONS, REASONS FOR CAUTION: The participants were Caucasian, Dutch-speaking couples, with medium to high socio-economic status, from a single centre. Our data should be replicated by multicultural and multicentre studies. Furthermore, the inclusion of an additional control group of couples who did not opt for PGD but for prenatal diagnosis may point to the most beneficial strategy for the couple. WIDER IMPLICATIONS OF THE FINDINGS: PGD parents invest a similar amount of time and emotion in their future children compared with controls. This implies that successful PGD treatment makes an important psychological contribution towards the well-being of couples given their complex hereditary and family backgrounds. STUDY FUNDING/COMPETING INTERESTS: This research project was funded by grants from the internal research council of the Vrije Universiteit Brussel (OZR), the Flemish Fonds Wetenschappelijk Onderzoek (FWO) and the Wetenschappelijk Fonds Willy Gepts (WGFG). UZ Brussel and the Centre for Medical Genetics have received several educational grants for organizing the data collection, from IBSA, Ferring, Organon, Shering-Plough, Merck and Merck Belgium. M.B. has received consultancy and speaker's fees from Organon, Serono Symposia and Merck.

Medical pluralism among indigenous peoples in northeast India - implications for health policy.

OBJECTIVES: The government of India is promoting and increasing investment in the traditional medicine systems of Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH) in the northeast region of India. But there are few empirical data that support this policy decision. This study estimates the awareness and use of the different medical systems in rural Meghalaya, a state in north-east India with a predominantly ethnic tribal population. METHOD: We conducted a cross-sectional multistage random sample household survey across all districts of Meghalaya. To enable appropriate estimates for the whole of rural Meghalaya, the data were weighted to allow for the probability of selection of households at each stage of the sampling process. RESULTS: Both local tribal medicine and biomedicine were widely accepted and used, but the majority (68.7%, 95% CI: 51.9-81.7) had not heard of AYUSH and even fewer had used it. Tribal medicine was used (79.1%, 95% CI 66.3-88.0), thought to be effective (87.5%, 95% CI: 74.2-94.1) and given in a variety of disorders, including both minor and major diseases. In the 3 months prior to the survey, 46.2% (95% CI: 30.5-62.8) had used tribal medicine. Only 10.5% (95% CI: 6.1-17.6) reported ever using any of the AYUSH systems. CONCLUSION: Our comparative estimates of the awareness and use of tribal medicine, different systems of AYUSH and of biomedicine among indigenous populations of India question the basis on which AYUSH is promoted in the northeast region of India and in the state of Meghalaya in particular.

What is the out-of-pocket expenditure on medicines in India? An empirical assessment using a novel methodology.

The share of expenditure on medicines as part of the total out-of-pocket (OOP) expenditure on healthcare services has been reported to be much higher in India than in other countries. This study was conducted to ascertain the extent of this share of medicine expenditure using a novel methodology. OOP expenditure data were collected through exit interviews with 5252 out-patient department patients in three states of India. Follow-up interviews were conducted after Days 1 and 15 of the baseline to identify any additional expenditure incurred. In addition, medicine prescription data were collected from the patients through prescription audits. Self-reported expenditure on medicines was compared with the amount imputed using local market prices based on prescription data. The results were also compared with the mean expenditure on medicines per spell of ailment among non-hospitalized cases from the National Sample Survey (NSS) 75th round for the corresponding states and districts, which is based on household survey methodology. The share of medicines in OOP expenditure did not change significantly for organized private hospitals using the patient-reported vs imputation-based methods (30.74-29.61%). Large reductions were observed for single-doctor clinics, especially in the case of 'Ayurvedic' (64.51-36.51%) and homeopathic (57.53-42.74%) practitioners. After adjustment for socio-demographic factors and types of ailments, we found that household data collection as per NSS methodology leads to an increase of 25% and 26% in the reported share of medicines for public- and private-sector out-patient consultations respectively, as compared with facility-based exit interviews with the imputation of expenditure for medicines as per actual quantity and price data. The nature of healthcare transactions at single-doctor clinics in rural India leads to an over-reporting of expenditure on medicines by patients. While household surveys are valid to provide total expenditure, these are less likely to correctly estimate the share of medicine expenditure.

Families' visits to practitioners of complementary and alternative medicine in a total population (the HUNT studies).

AIMS: To investigate characteristics of families with adolescent children who have visited practitioners of complementary and alternative medicine (CAM). METHODS: The Nord-Trøndelag Health Studies (HUNT) invited all inhabitants aged 13 years and older to a population-based study. The data of parents and adolescents were merged through the Norwegian family register. A family CAM visitor was a family where either the adolescent or the mother or father had visited a CAM practitioner in the previous year. The data were analyzed using multivariable logistic regression. RESULTS: A total of 7,888 adolescents with mother and/or fathers were included. The prevalence of families visiting CAM practitioners was 19.8%. The odds of a family visiting a CAM practitioner was significantly associated (p < 0.01) with a father with poor self-reported global health (adjusted odds ratio (adjOR) 3.0, 95% confidence interval (95% CI) 1.7-5.3), who exercised (adjOR 1.3, 1.1-1.5) or smoked daily (adjOR 0.7, 0.6-0.8). Family CAM visits were also associated with the mother having a recent health complaint (adjOR 1.4, 1.1-1.7) or having fair global health (adjOR 1.6, 1.2-2.0), or with the adolescent, mother or father having visited a general practitioner during the past year (adolescent adjOR 1.3, 1.2-1.5; mother 1.7, 1.5-2.0; father 1.4, 1.2-1.6). For family visits to a homeopath, the strongest association was the mother having visited a general practitioner (adjOR 1.9, 1.4-2.5). For visits to chiropractors the strongest association was whether the father was currently working (adjOR 2.1, 1.2-3.8). CONCLUSIONS: The factor most strongly associated with families' visits to CAM practitioners was a father who had poor self-reported health.

Attitudes towards vaccination: users of complementary and alternative medicine versus non-users.

PRINCIPLES: Children whose parents use complementary and alternative medicine (CAM) often show a lower rate of vaccination than those of parents favouring conventional medicine. We have investigated whether this applies to the paediatric patients presenting to an emergency department in German-speaking Switzerland, where popularity of CAM is rather high. METHODS: A cross-sectional survey was performed of paediatric patients presenting to an urban, tertiary paediatric emergency department. 1,007 (63%) of the distributed 1,600 questionnaires were available for analysis. RESULTS: 12.7% of all respondents reported refusing some basic vaccination: 3.9% because of recommendation of the physician, 8.7% despite their physician's recommendation. Socio-demographic characterisation of the group of patients refusing vaccination showed older age of children, higher proportion of girls, more single-mothers families and decreased household income. Refusal of basic vaccination was significantly more frequent among CAM-users than among non-users (18.2% versus 3.5%, p <0.001). The highest frequencies of refusal were reported by patients who consulted physicians practicing herbal medicine, anthroposophical medicine or homeopathy. Users and non-users of CAM however, showed comparable rates of immunisation in the case of the vaccinations against invasive meningococcal, pneumococcal disease and flu. Surprisingly, the rate for vaccination against tick-borne encephalitis was higher in the CAM-users group than among the non-users (21.2% versus 15.4%, p <0.05). CONCLUSIONS: A considerable proportion of the study population did not fully accept basic vaccinations. Refusal to follow the basic vaccination schemata was more frequent among CAM-users than non-users and reflected in most cases parental wishes rather than physicians' recommendations.

Spread of Traditional Medicines in India: Results of National Sample Survey Organization's Perception Survey on Use of AYUSH.

For the first time, we have a comprehensive database on usage of AYUSH (acronym for Ayurveda, naturopathy and Yoga, Unani, Siddha, and Homeopathy) in India at the household level. This article aims at exploring the spread of the traditional medical systems in India and the perceptions of people on the access and effectiveness of these medical systems using this database. The article uses the unit level data purchased from the National Sample Survey Organization, New Delhi. Household is the basic unit of survey and the data are the collective opinion of the household. This survey shows that less than 30% of Indian households use the traditional medical systems. There is also a regional pattern in the usage of particular type of traditional medicine, reflecting the regional aspects of the development of such medical systems. The strong faith in AYUSH is the main reason for its usage; lack of need for AYUSH and lack of awareness about AYUSH are the main reasons for not using it. With regard to source of medicines in the traditional medical systems, home is the main source in the Indian medical system and private sector is the main source in Homeopathy. This shows that there is need for creating awareness and improving access to traditional medical systems in India. By and large, the users of AYUSH are also convinced about the effectiveness of these traditional medicines.

Health seeking behavior of couples with secondary infertility.

OBJECTIVE: To determine the factors affecting the health-seeking behavior of couples with secondary infertility in Karachi. DESIGN: A descriptive case series. PLACE AND DURATION OF STUDY: The data was collected from women attending infertility clinics in five tertiary care hospitals in Karachi from March to June 2003. PATIENTS AND METHODS: All currently married women, between the age of 15-35 years, with at least one previous conception, irrespective of outcome, attending an infertility clinic and consenting to participate in the study, were included. Women with corrective surgery on vagina and uterus, and cases of primary infertility, were excluded. Multiple logistic regression models were used to determine the association of various factors, affecting the health-seeking behavior, with statistical significance set at p < 0.05 for the covariates and the interaction terms between various factors. RESULTS: The women consulted multiple health care providers for treatment of secondary infertility. The main reasons for seeking treatment were couple s wish (54.2%), family pressure (22.6%) and want of a son by husbands or in-laws (20.4%). The most commonly sought providers were physicians (74.7%), Traditional Birth Attendants (TBA, 39.5%), Spiritual healers (26%), Hakeems (23%) and Homeopaths (17.2%). Most of the women who consulted non-physicians were illiterate (69.4%) as compared to those who consulted a physician (37.8%, p-value = 0.00). The non-physicians were more commonly consulted by women belonging to low socioeconomic group. The posttreatment complications were more common among women who consulted non-physicians. CONCLUSION: Pressure from husbands and in-laws compels women for consulting multiple providers. Health seeking behavior for infertility is affected by the literacy and socioeconomic status of the women.

Factors affecting decisions to seek treatment for sick children in Kerala, India.

The purpose of this study was to measure the effects of social and economic variables, disease-related variables, and child gender on the decisions of parents in Kerala, India, to seek care for their children and on their choice of providers in the allopathic vs. the alternative system. A case-control analysis was done using data from the Kerala section of the 1996 Indian National Family Health Survey, a cross-sectional survey of a probability sample of households conducted by trained interviewers with a close-ended questionnaire. Of the 469 children who were eligible for this study because they had at least one common symptom suggestive of acute respiratory illness or diarrhea during the 2 weeks before the interview, 78 (17%) did not receive medical care, while the remaining 391 (83%) received medical care. Of the 391 children who received medical care, 342 (88%) received allopathic medical care, and 48 (12%) received alternative medical care. In multivariable analyses, parents chose not to seek medical care for their children significantly more often when the illness was mild, the child had a specific diagnosis, the mother had previously made fewer antenatal visits, and the family had a higher economic status. When parents sought medical care for their children, care was sought significantly more often in the alternative provider system when the child was a boy, the family lived in a rural area, and the family had a lower social class. We conclude that, in Kerala, disease severity and economic status predict whether children with acute respiratory infection or diarrhea are taken to medical providers. In contrast, most studies of this issue carried out in other populations have identified economic status as the primary predictor of medical system utilization. Also in Kerala, the gender of the child did not influence whether or not the child was taken for treatment but did influence whether care was sought in the alternative or the allopathic system.

Drug consumption pattern in low socio-economic group in an urban community.

117 families, having a total population of 558 were studied regarding drug consumption pattern. It was found that the average no. of episodes per person was 0.99 of which drugs were consumed for 72% of episodes. Significant difference was observed in consumption of drugs between males and females. Allopathic medicines were consumed for 93.3% of the episodes and the major source (53.8%) of medical care was from private practitioners. It was seen that the number of drugs consumed per episode of sickness rose as the per capita income increased. Vitamins and Minerals (22.3%) were the main group of drugs consumed. Drugs acting on the alimentary system (17.5%), Respiratory System (14.7%), Antimicrobials (14.6%) and Analgesics (10.8%) contributed to 80% of drug intake.

Chiropractic or osteopathic manipulation for children in the United States: an analysis of data from the 2007 National Health Interview Survey.

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.

Time to talk.

PIP: In the US, a workshop has been developed to provide parents with accurate information about sexuality and contraception that they can convey to their children, to help parents bridge the communication gap, to deliver guidelines for fostering their children's self-esteem, and to provide a framework that parents can use to explain their own values about sexuality to their children. "Time to Talk" was launched in Houston, Texas, in 1992. The initial workshops were conducted at local hospitals and consisted of 150-minute sessions attended by parents and their children. Most of the parents had children between the ages of 11 and 14 and found the workshops to be valuable. The workshop was developed because, although teenagers consider their parents their most valuable source of sex information, only one-third of US children surveyed had discussed birth control with their parents. Without parental guidance, young teens become pregnant or acquire sexually transmitted diseases (STDs). Workshop parents are advised to begin their discussions before they are perfectly comfortable with their topic, that discomfort is perfectly acceptable. The interactive nature of the workshop is fostered by giving parents exercises designed to help them become better sex educators at home. Small group discussions followed by written assessments allow parents to share their anxieties as well as to articulate their need for information and their desire to learn techniques for conversations about sexuality. Parents are urged to give their children permission to talk and learn about sexuality at any time and any age; parents are also encouraged to take advantage of opportunities to initiate discussions. Workshop participants are told that talking about sex does not encourage early experimentation, in fact, it helps youngsters to postpone the initiation of intercourse and to show more responsibility in using contraceptives. A typical workshop includes the presentation of medical and biological information and role-playing. The parents take home comprehensive booklets and fact sheets with information on sexuality, contraception, and sexually transmitted diseases and answers to many of the questions adolescents ask. Workshop facilitators consider "Time to Talk" only the first step in a lifelong process of sex education. There is no doubt that teens will get information about sex, the only question is how and where they will get it.^ieng

Opium administration to infants in Peshawar region of Pakistan.

Use of opium for sedating infants in the North-West Frontier Province of Pakistan causes a grave public health problem. Among the infants hospitalized for opium overdosage, 22 were studied in detail, and their major clinical picture is presented in this paper. The effect of opium use on the nutritional status of these infants, or the relation of infant opium use to addiction in adult life, have not been assessed. It is, however, pointed out that opium overdosage of infants contributed to infant mortality. Despite emergency treatment, the lethality rate of opium overdosed infants was 40 per cent. It is emphasized that a preventive programme should be undertaken to educate parents who are ignorant of the dangers of opium administration to infants.

Use of complementary or alternative medicine in a general population in Great Britain. Results from the National Omnibus survey.

BACKGROUND: A representative sample of the adults in England, Scotland and Wales was interviewed to estimate levels of use of complementary or alternative medicines (CAMs) and their socio-economic correlates. METHODS: The Omnibus survey is a multi-purpose survey carried out in the United Kingdom by the Office for National Statistics on behalf of non-profit making organizations. The survey is carried out in 2 out of 3 months each quarter using a stratified random, probability sample of households. An eight-question module was added to the interview schedule of the survey in March 2001. Topics included practitioner-based use of 23 named CAM therapies in the past 12 months. The resulting data were analysed in conjunction with socio-economic and demographic variables. RESULTS: A response rate of 65 per cent (1794/2761) was achieved. An estimated 10.0 per cent of the population [95 per cent confidence interval (CI) 8.7-11.5 per cent] had received any CAM therapy from a practitioner in the past year. No individual therapy was used by more than 2 per cent of the sample. An estimated 6.5 per cent (95 per cent CI 5.4-7.6) had used one of the five main therapies: acupuncture, homeopathy, chiropractic, osteopathy or herbal medicine. Estimates of CAM use were similar in England, Scotland and Wales. There was a significant positive association between CAM use and non-manual social class (p < 0.002), age left full-time education (p < 0.001), and gross income over pounds sterling 15,600 (p < 0.001). More than half (52 per cent) of the respondents that had used CAM in the past year had not told their general practitioner. CONCLUSIONS: Strong correlations between the use of CAM and gross socio-economic indicators are demonstrated in the survey. Repeated national surveys of this type could provide a useful vehicle for collecting information about changing patterns of CAM use on a routine basis.

Hill tribe opium addicts: a retrospective study of 1,382 patients.

This paper presents the results of a retrospective study of 1,382 patients admitted to the Narcotics Treatment Centre for Hill Tribes in Thailand, which was operated by the WHO/UN/Thai Programme for Drug Abuse Control. The study revealed widespread opium addiction among the hill tribes. Of these, the Karen were the largest group. Mean age on admission for treatment was 35 years. The male:female ratio was 7:1. Sixty-six per cent were heads of households. About one-third came from households with more than one addict. The mean duration of daily opium use before admission was 7.9 years. Over 90% of them were addicted to opium; there were eight heroin users. The mean amount of opium used daily was 3.9 g for males and 3.2 g for females. About three-quarters of them used salicylate analgesics with opium. Illness, in particular abdominal pain, was the most frequent cause of their addiction.