Population-level trends in self-reported healthcare utilization among older adults in Mexico with and without cognitive impairment.

BACKGROUND: Older adults with cognitive impairment exhibit different patterns of healthcare utilization compared to their cognitively healthy counterparts. Despite extensive research in high-income countries, similar studies in low- and middle-income countries are lacking. This study aims to investigate the population-level patterns in healthcare utilization among older adults with and without cognitive impairment in Mexico. METHODS: Data came from five waves (2001-2018) of the Mexican Health and Aging Study. We used self-reported measures for one or more over-night hospital stays, doctor visits, visits to homeopathic doctors, and dental visits in the past year; seeing a pharmacist in the past year; and being screened for cholesterol, diabetes, and hypertension in the past two years. Cognitive impairment was defined using a modified version of the Cross Cultural Cognitive Examination that assessed verbal memory, visuospatial and visual scanning. Total sample included 5,673 participants with cognitive impairment and 34,497 without cognitive impairment interviewed between 2001 and 2018. Generalized Estimating Equation models that adjusted for time-varying demographic and health characteristics and included an interaction term between time and cognitive status were used. RESULTS: For all participants, the risk for one or more overnight hospital stays, doctor visits, and dental visits in the past year, and being screened for diabetes, hypertension, and high cholesterol increased from 2001 to 2012 and leveled off or decreased in 2015 and 2018. Conversely, seeing a homeopathic doctor decreased. Cognitive impairment was associated with higher risk of hospitalization (RR = 1.13, 1.03-1.23) but lower risk of outpatient services (RR = 0.95, 0.93-0.97), cholesterol screening (RR = 0.93, 0.91-0.96), and diabetes screening (RR = 0.95, 0.92-0.97). No significant difference was observed in the use of pharmacists, homeopathic doctors, or folk healers based on cognitive status. Interaction effects indicated participants with cognitive impairment had lower risk for dental visits and hypertension screening but that these trajectories differed over time compared to participants without cognitive impairment. CONCLUSIONS: We identified distinct population-level trends in self-reported healthcare utilization and differences according to cognitive status, particularly for elective and screening services. These findings highlight the necessity for policy interventions to ensure older adults with cognitive impairment have their healthcare needs met.

Illness perception and health care use in individuals with irritable bowel syndrome: results from an online survey.

BACKGROUND: Individual illness perception is known to influence a range of outcome variables. However, little is known regarding illness perception in irritable bowel syndrome (IBS) and its relation to the use of the health care system. This study hypothesised a relationship between illness perception and inappropriate health care use (under-, over- and misuse). METHODS: An internet-based, cross-sectional study in participants affected by IBS symptoms was carried out (April - October 2019) using open questions as well as validated standardized instruments, e.g. the illness perception questionnaire revised (IPQ-R) and its subscales. Sub-group comparisons were done non-parametrically and effect sizes were reported. Potential predictors of (1) conventional health care utilisation and (2) utilisation of treatment approaches with lacking or weak evidence regarding effectiveness in IBS were examined with logistic regression analyses and reported as odds ratio (OR) and 95% confidence interval. RESULTS: Data from 513 individuals were available. More than one-third (35.7%) of participants were classified as high utilisers (> 5 doctor visits during the last year). Several indicators of inappropriate health care use were detected, such as a low proportion of state-of-the-art gynaecological evaluation of symptoms (35.0% of women) and a high proportion of individuals taking ineffective and not recommended non-steroidal antirheumatic drugs for IBS (29.4%). A majority (57.7%) used treatment approaches with lacking or weak evidence regarding the effectiveness in IBS (e.g. homeopathy). Being a high utiliser as defined above was predicted by the perceived daily life consequences of IBS (IPQ-R subscale "consequences", OR = 1.189 [1.100-1.284], p ≤ 0.001) and age (OR = 0.980 [0.962-0.998], p = 0.027). The use of treatment approaches with lacking or weak evidence was forecasted by the perceived daily life consequences (OR = 1.155 [1.091-1.223], p ≤ 0.001) and gender (reference category male: OR = 0.537 [0.327-0.881], p = 0.014), however effect sizes were small. CONCLUSIONS: Daily life consequences, perceived cure and personal control as aspects of individual disease perception seem to be related to individuals' health care use. These aspects should be a standard part of the medical interview and actively explored. To face inappropriate health care use patients and professionals need to be trained. Interdisciplinary collaborative care may contribute to enhanced quality of medical supply in IBS.

Social media, vaccine hesitancy and trust deficit in immunization programs: a qualitative enquiry in Malappuram District of Kerala, India.

BACKGROUND: With increased penetration of the internet and social media, there are concerns regarding its negative role in influencing parents' decisions regarding vaccination for their children. It is perceived that a mix of religious reasons and propaganda by anti-vaccination groups on social media are lowering the vaccination coverage in Malappuram district of Kerala. We undertook a qualitative study to understand the factors responsible for generating and perpetuating vaccine hesitancy, the pathways of trust deficit in immunization programs and the interaction between various social media actors. METHODS: In-depth interviews and focus group discussions were conducted among parents/caregivers, physicians, public sector health staff, alternative system medical practitioners, field healthcare workers and teachers in areas with highest and lowest vaccination coverage in the district, as well as with communication experts. RESULTS: The trust deficit between parents/caregivers and healthcare providers is created by multiple factors, such as providers' lack of technical knowledge, existing patriarchal societal norms and critical views of vaccine by naturopaths and homeopaths. Anti-vaccine groups use social media to influence caregivers' perceptions and beliefs. Religion does not appear to play a major role in creating vaccine resistance in this setting. CONCLUSIONS: A long-term, multipronged strategy should be adopted to address the trust deficit. In the short to medium term, the health sector can focus on appropriate and targeted vaccine-related communication strategies, including the use of infographics, soft skills training for healthcare workers, technical competency improvement through a mobile application-based repository of information and creation of a media cell to monitor vaccine-related conversations in social media and to intervene if needed.

Use of Complementary and Alternative Medicines among Cancer Patients: A Single-Center Study.

PURPOSE: It is usual for cancer patients to use complementary and alternative medicines (CAMs) and yet the literature evaluating their efficacy in cancer patients is very limited. The objective of the present study was to report on the nature, frequency of use, and patient-reported outcome of CAMs in a single-center study. METHODS: All the consecutive patients treated between November 2017 and June 2018 at the Lucien Neuwirth Cancer Institute (France) were screened. Their reasons for using CAMs and their usage habits were collected. Patients evaluated their benefit. RESULTS: Of the 209 patients screened, 200 patients were included. CAMs ranged from osteopathy, homeopathy, acupuncture, healing touch, magnetism, naturopathy, suction cups, Chinese medicine, reflexology, to hypnosis. CAMs were widely used (n = 166, 83%), the first being osteopathy (n = 99, 49.5%), the second homeopathy (n = 78, 39.0%), and finally acupuncture (n = 76, 38.0%). Whatever the CAM, high satisfaction rates were reported (median satisfaction: 61-81%). CAMs were mainly used to prevent/treat side effects of anticancer treatments (81.2% for healing touch), increase well-being (55.4% for naturopathy), improve the immune system (16.9% for homeopathy), and treat cancer (n = 3, 5.1% for homeopathy). Patients could easily consider using CAMs, as up to 50.8% would have accepted a consultation. CONCLUSIONS: The reasons for using CAMs differed among patients. They praised CAMs and kept asking for more information although there is limited evidence about their efficacy in the literature. Thus, prospective randomized controlled trials exploring the safety and efficacy of CAMs in cancer patients are needed.

Do sociodemographic characteristics associated with the use of CAM differ by chronic disease?

BACKGROUND: Complementary and alternative medicine (CAM) is oftenused to alleviate the discomfort, disability and pain involved in many chronic diseases. Besides this, females, middle-aged and higher educated people are also known to use CAM the most. This study explores whether the sociodemographic characteristics associated with CAM use differ by type of disease. METHODS: The following data were taken from the Belgian Health Interview Survey 2013 for the individuals aged 15+ years (n = 8942): sociodemographic characteristics, past 12-month diseases (using a list) and contact with a homeopath, chiropractor, acupuncturist and/or osteopath (CAM-therapists) in the past year. The association between CAM use and disease, controlled for gender, age, education and conventional medicine use, was assessed through logistic regressions. When interactions with the sociodemographic characteristics were found, stratified regressions were conducted. RESULTS: People with musculoskeletal diseases [odds ratio (OR) = 2.6], allergy (OR = 1.4) and severe headache (OR = 1.5) had higher odds of using CAM in the past year with statistical significance. For musculoskeletal diseases, the odds of using CAM was higher, with statistical significance, for every sociodemographic subclass. For allergy, CAM use was higher among men, people aged 45+ years and lower educated people, while for severe headache CAM use was higher among women, people aged 45+ years and higher educated people, all with statistical significance. CONCLUSIONS: Sociodemographic characteristics associated with CAM use differ by diseases. The role of CAM in disease management cannot be ignored. Making physicians aware for which disease CAM is used and by whom, may facilitate disease management.

Homeopathy in Public Health in India.

BACKGROUND: Based on a pluralistic approach to health care, India offers a range of medical treatment modalities to its population. In that context, the government of India aims at providing its people with wider access to homeopathy. This article provides insight into the infrastructural support put in place by the government to meet that aim. DATA AND METHODS: A literature review was carried out of recent surveys and articles to assess the morbidity trends in India and the treatment modalities being sought by patients. Extensive attempts were made to identify and access all data sources that could contribute to understanding the situation of homeopathy in public health in India. These efforts included analysis of secondary data about government wellness centres, as also a case study of one such centre. RESULTS: In India, homeopathy is well represented in public health, being a close second among the AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy) services. Homeopathy wellness centres comprise 31% of the total for AYUSH. Seven out of 10 diseases recognised as a national health burden are in the category of most commonly reported diseases at the homeopathy wellness centres. Academic homeopathy institutes comprise 35.8% of AYUSH colleges, the total student intakes of which are 13,658 and 32,256 respectively. Homeopathy practitioners are 37% of the AYUSH total. Homeopathy units comprise 1/19th of the number of allopathy units, yet the annual patient footfall in the former is 1/5th of the latter. CONCLUSION: Homeopathy services, wherever available, are being used fully and thus sharing the patient load in the government-run wellness centres. There is the potential for more homeopathic practitioners to contribute importantly to health care delivery in India.

[Sociodemographic profile of the homeopathy user in Spain]. / Perfil sociodemográfico del usuario de la homeopatía en España.

OBJECTIVE: To identify the sociodemographic profile of the homeopathy user in Spain. DESIGN: Quantitative study. LOCATION: Spain. CORPUS: The Centre for Sociological Research database (Study 3205, February 2018), with a total of 2,486 interviews, and the sub-sample that includes all patients who have claimed to use homeopathy in Spain in the last 12 months (n=124). MAIN MEASUREMENTS: The percentages, means and/or standard deviation of the factors were calculated, as well as the significance of the changes in the different variables analysed in the general population, and the specific users of homeopathy in Spain. This was determined by the variance analysis or Pearson's χ2 test, depending on the nature of the variable in the study. RESULTS: The homeopathy user-type profile in Spain is a woman, of middle/high social status, with higher university studies, and with a progressive political ideology. CONCLUSIONS: The Spanish profile is similar to that in other international studies.

Complementary and alternative medicine in radiation oncology : Survey of patients' attitudes.

BACKGROUND: Complementary and alternative medicine (CAM) are gaining in importance, but objective data are mostly missing. However, in previous trials, methods such as acupuncture showed significant advantages compared to standard therapies. Thus, the aim was to evaluate most frequently used methods, their significance and the general acceptance amongst cancer patients undergoing radiotherapy (RT). METHODS: A questionnaire of 18 questions based on the categorical classification released by the National Centre for Complementary and Integrative Health was developed. From April to September 2015, all patients undergoing RT at the Department of Radiation Oncology, Technical University of Munich, completed the survey. Changes in attitude towards CAM were evaluated using the questionnaire after RT during the first follow-up visit (n = 31). RESULTS: Of 634 patients, 333 answered the questionnaire (52.5%). Of all participants, 26.4% used CAM parallel to RT. Before RT, a total of 39.3% had already used complementary medicine. The most frequently applied methods during therapy were vitamins/minerals, food supplements, physiotherapy/manual medicine, and homeopathy. The majority (71.5%) did not use any complementary treatment, mostly stating that CAM was not offered to them (73.5%). The most common reasons for use were to improve the immune system (48%), to reduce side effects (43.8%), and to not miss an opportunity (37.8%). Treatment integrated into the individual therapy concept, e.g. regular acupuncture, would be used by 63.7% of RT patients. CONCLUSION: In comparison to other studies, usage of CAM parallel to RT in our department is considered to be low. Acceptance amongst patients is present, as treatment integrated into the individual oncology therapy would be used by about two-third of patients.

Prevalence of homeopathy use by the general population worldwide: a systematic review.

AIM: To systematically review surveys of 12-month prevalence of homeopathy use by the general population worldwide. METHODS: Studies were identified via database searches to October 2015. Study quality was assessed using a six-item tool. All estimates were in the context of a survey which also reported prevalence of any complementary and alternative medicine use. RESULTS: A total of 36 surveys were included. Of these, 67% met four of six quality criteria. Twelve-month prevalence of treatment by a homeopath was reported in 24 surveys of adults (median 1.5%, range 0.2-8.2%). Estimates for children were similar to those for adults. Rates in the USA, UK, Australia and Canada all ranged from 0.2% to 2.9% and remained stable over the years surveyed (1986-2012). Twelve-month prevalence of all use of homeopathy (purchase of over-the-counter homeopathic medicines and treatment by a homeopath) was reported in 10 surveys of adults (median 3.9%, range 0.7-9.8%) while a further 11 surveys which did not define the type of homeopathy use reported similar data. Rates in the USA and Australia ranged from 1.7% to 4.4% and remained stable over the years surveyed. The highest use was reported by a survey in Switzerland where homeopathy is covered by mandatory health insurance. CONCLUSIONS: This review summarises 12-month prevalence of homeopathy use from surveys conducted in eleven countries (USA, UK, Australia, Israel, Canada, Switzerland, Norway, Germany, South Korea, Japan and Singapore). Each year a small but significant percentage of these general populations use homeopathy. This includes visits to homeopaths as well as purchase of over-the-counter homeopathic medicines.

Spatial distribution of health consultations in the past two weeks by provider type and district: Pakistan Social and Living Standards Measurement Survey 2014-15.

Place is a nexus between epidemiology and Geographic Information System. In this study, the Pakistan Social and Living Standards Measurement survey 2014-15 data on percent distribution of health consultations, in the past 2-weeks by type of healthcare provider were mapped cumulatively, as well as disaggregated by urban and rural areas, using a GIS programme to visualize spatial distribution in the country by district. Private sector is the main and preferred provider for healthcare services when Pakistanis get sick or injured. Differences between and within provinces - at the district level - exist, but in spite of significant investment by the government in public sector health and nutrition services; most people prefer going to private dispensaries and hospitals. Harnessing the visualization power of GIS for better decision making in health sector is contingent upon easy availability of up-to-date GIS shapefiles to analyze and depict health data on maps.

[Complementary and alternative medicine use in surgical patients]. / Nem konvencionális gyógymódok használata sebészeti betegek között.

INTRODUCTION: Due to the rise in use of non-conventional therapies, we may consider the application of those in perioperative setting. AIM: The aims of the authors were to measure the attitude of patients waiting for elective surgery towards naturopathic methods, to determine their use and factors influencing their usage. METHOD: A questionnaire was applied that patients filled in individually and anonymously at the First Department of Surgery of Semmelweis University, between July 1, 2014 and April 30, 2016. RESULTS: 63.6% of the 519 participants (response rate = 21%) were interested in non-conventional therapies, and 26.8% of them applied naturopathy. In this group there were significantly more females (p = 0.022; OR: 1.066-2.3635), patients with university degree (p = 0.000315; OR: 1.3915-3.1132), aged 40-49 (p = 0.012419; OR: 1.1451-3.2405), and patients with hormonal disease (p = 0.039482; OR: 1.0186-5.7242). In terms of lifetime prevalence the most popular methods were traditional Chinese medicine (8.9%), alternative movement and massage therapy (7.5%) and homeopathy (7.3%). Only 12.9% of the patients reported the application of these methods to the physician. CONCLUSION: Surgical patients are interested in naturopathic methods, and one-fourth of them actually use them even in the perioperative period. Orv. Hetil., 2016, 157(37), 1483-1488.

Why parents refuse immunization?

Rates of child immunization are falling in many countries, leading to the increase of morbidity and mortality from diseases controlled by vaccinations. The simplified model of the natural history of immunization follows a sequence of fear of the disease before vaccination, followed by acceptance of the vaccination until plateau, where the population forgets the morbidity and mortality of pre-immunization. Historical factors including withdrawals of vaccines, and publications regarding the true or falsified dangers of vaccines still resonate with parents. Building on these historical factors, unscientific sources such as naturopaths, homeopaths, chiropractors, celebrities and lay-people with anecdotal evidence and even scientific sources such as some universities and some medical doctors push their views on anti-vaccination, which proves to make the decision to vaccinate more difficult on parents. The main reason that parents refuse vaccination is a desire to protect their children. These parents believe that vaccination is harmful, or that not vaccinated children are healthier than vaccinated children. Scientific data often will lose with pseudoscientific, false or anecdotal data that have higher sensational and emotional impact on parents. With so many sources giving so many factors which sometimes contradict themselves, it is indeed difficult for a parent to make a clear decision for their child.

Doctors and Their Patients in the Seventeenth to Nineteenth Centuries.

How can these finings be interpreted in conclusion? Analysis has revealed firstly that, depending on the chosen period, the socio-geographical situation and the profile of the individual doctor's practice, the clientele varied widely in terms of gender, age and social rank. The consultation behaviour of men and women changed noticeably. Findings overall suggest that up until t8o the gender distribution varied in the individual practices. There was a trend for women to be overrepresented in urban practices during the earlier period. But in general, from the mid-nineteenth century they predominated - in towns as well as in the country in allopathic as well as homeopathic practices. The absence of children, which was bemoaned by many physicians, did not apply to the practices under investigation. On the contrary: the percentage is consistently high while older patients remained underrepresented right up until the end of the period under investigation, even though their proportion increased in the individual practices during the course of the nineteenth century In each of the nineteenth century practices investigated - and increasingly among the lower and middle classes - the physicians' services were used by several members of the same family. We have found no evidence to support the thesis that up until the nineteenth century academic physicians were mainly consulted by aristocratic or wealthy bourgeois patients. The theory probably applies only to early modern urban doctors. In the practices examined here, from the middle of the eighteenth century, patients from all social strata went to consult physicians. The participation of members of the lower classes or from an artisanal, (proto) industrial or agricultural background clearly increased over time 'despite ubiquitous economic and cultural barriers. That the annual numbers of consultations per physician increased - despite the growing number of physicians available - suggests that for economically disadvantaged social groups also, the consultation of learned physicians became more common: in towns from the first half of the nineteenth century and in the country from the middle of the century. In addition, the individual findings reveal that, prior to the introduction of statutory health insurance for salaried persons, patients of more secure social standing consulted a physician considerably more frequently in the course of the year than lower class patients. While the patient structure clearly changed around 1800, the relationship between physician and patient continued without major changes from the seventeenth to the nineteenth century. The therapeutic encounter up until the end of the investigated period can be summarized as a negotiation process. Patients were discerning in their choice of healer and did not refrain from using rival services. They sought help for unpleasant symptoms such as indigestion, pain or fever, and only rarely in cases of emergency Therapy was decided on after an exchange between a critical and autonomous client and the medical specialist who was generally willing to compromise. While the patient structure clearly changed around 1800, the relationship between physician and patient continued without major changes from the seventeenth to the nineteenth century. The therapeutic encounter up until the end of the investigated period can be summarized as a negotiation process. Patients were discerning in their choice of healer and did not refrain from using rival services. they sought help for unpleasant symptoms such as indigestion, pain or fever, and only rarely in cases of emergency. Therapy was decided on after an exchange between critical and autonomous client and the medical specialist who was generally willing to compromise.

Health-seeking behaviour and community perceptions of childhood undernutrition and a community management of acute malnutrition (CMAM) programme in rural Bihar, India: a qualitative study.

OBJECTIVE: Since 2009, Médecins Sans Frontières has implemented a community management of acute malnutrition (CMAM) programme in rural Biraul block, Bihar State, India that has admitted over 10 000 severely malnourished children but has struggled with poor coverage and default rates. With the aim of improving programme outcomes we undertook a qualitative study to understand community perceptions of childhood undernutrition, the CMAM programme and how these affected health-seeking behaviour. DESIGN: Semi-structured and narrative interviews were undertaken with families of severely malnourished children, non-undernourished children and traditional and allopathic health-care workers. Analysis of transcripts was by qualitative content analysis. SETTING: Biraul, Bihar State, India, 2010. SUBJECTS: One hundred and fifty people were interviewed in individual or group discussions during fifty-eight interviews. RESULTS: Undernutrition was not viewed as a disease; instead, local disease concepts were identified that described the clinical spectrum of undernutrition. These concepts informed perception, so caregivers were unlikely to consult health workers if children were 'only skinny'. Hindu and Muslim priests and other traditional health practitioners were more regularly consulted and perceived as easier to access than allopathic health facilities. Senior family members and village elders had significant influence on the health-seeking behaviour of parents of severely malnourished children. CONCLUSIONS: The results reaffirm how health education and CMAM programmes should encompass local disease concepts, beliefs and motivations to improve awareness that undernutrition is a disease and one that can be treated. CMAM is well accepted by the community; however, programmes must do better to engage communities, including traditional healers, to enable development of a holistic approach within existing social structures.

Utilization of complementary and alternative medicine (CAM) among children from a German birth cohort (GINIplus): patterns, costs, and trends of use.

BACKGROUND: The use of complementary and alternative medicine (CAM) is widespread among children in Germany and other European countries. Only a few studies are available on trends in pediatric CAM use over time. The study's objective was to present updated results for prevalence, predictors, and costs of CAM use among German children and a comparison with findings from a previous follow-up of the same birth cohort. METHODS: Data were collected for 3013 children on their utilization of medicinal products (during the last 4 weeks) and consultation with CAM providers (in the preceding year) from a German birth cohort study (GINIplus, 15-year follow-up) using a self-administered questionnaire. The reported medicinal CAMs were classified into six categories (homeopathy, herbal drugs, nutritionals, minerals and trace elements, microorganisms, further CAM). Drug prices were traced using pharmaceutical identification numbers (PZNs), or otherwise conservatively estimated. Finally, the results were compared with data obtained from the 10-year follow-up of the same birth cohort study by adopting the identical methodology. RESULTS: In all, 26% of the reported 2489 drugs were medicinal CAM. The 4-week prevalence for homeopathy and herbal drug use was 7.5% and 5.6%, respectively. Some 13.9% of the children used at least one type of medicinal CAM in the preceding 4 weeks. The 1-year prevalence for consultation with CAM providers was 10.8%. From the drugs identified as CAM, 53.7% were homeopathic remedies, and 30.8% were herbal drugs. Factors associated with higher medicinal CAM use were female gender, residing in Munich, and higher maternal education. A homeopathy user utilized on average homeopathic remedies worth EUR 15.28. The corresponding figure for herbal drug users was EUR 16.02, and EUR 18.72 for overall medicinal CAM users. Compared with the 10-year follow-up, the prevalence of homeopathy use was more than halved (-52%) and dropped substantially for herbal drug use (-36%) and overall CAM use (-38%) as well. CONCLUSION: CAM use among 15-year-old children in the GINIplus cohort is popular, but decreased noticeably compared with children from the same cohort at the age of 10 years. This is possibly mainly because German health legislation normally covers CAM for children younger than 12 years only.

Women's use of herbal and alternative medicines for preconception care.

BACKGROUND: Use of complementary and alternative medicine (CAM), particularly herbal and alternative medicine supplements, for preconception care and fertility management is becoming increasingly common. AIMS: To determine the factors associated with the use of CAMs by women for preconception care. MATERIALS AND METHODS: 412 women who had visited an antenatal 'first visit' clinic situated at a Brisbane obstetric hospital or had visited a private ultrasound clinic in the same city for the purposes of a routinely indicated ultrasound scan in the first trimester were recruited into the study. Data were collected via a cross-sectional questionnaire. RESULTS: Complementary and alternative medicines (not including multivitamins) were used during preconception by 8.3% of women attending for obstetric care. Approximately half (55.8%) of women taking herbal and alternative medicines ceased these medications on discovery of their pregnancy, though fewer (17.4%) ceased taking multivitamin supplements. Baseline characteristics (age, education and income) are not significantly different between CAM users and those who did not take CAMs preconception. The results of statistical analyses showed that only visiting a practitioner to check for health (OR = 2.00; 95% CI: 1.33, 3.00) and trying to lose weight prior to pregnancy (OR = 1.53; 95% CI: 1.00, 2.36) were the key predictors for women using CAM during preconception. CONCLUSIONS: Women do consume CAMs to enhance preconception care to a certain extent, though CAM users remain in the minority. CAM users also tend to cease use once pregnant.

Whom to Ask for Professional Help in Case of Major Depression? Help-Seeking Recommendations of the Sardinian Public.

Purpose of the study is to investigate help-seeking preferences of the Sardinian public in case of depression. A telephone survey was conducted among the adult population, using quota sampling (N = 1,200). Respondents were presented with a vignette depicting a person with symptoms of major depressive disorder, followed by a fully structured interview. Psychologists were most frequently selected as source of professional help, followed by psychiatrists and G.P.s. Residents of small towns more frequently recommended mental health professionals than city residents. Public help-seeking preferences reflect the availability of services, beliefs about the appropriate treatment of depression and attitudes towards those providing it.

Determinants and pattern of care seeking for preterm newborns in a rural Bangladeshi cohort.

BACKGROUND: Despite the increased burden of preterm birth and its complications, the dearth of care seeking data for preterm newborns remains a significant knowledge gap. Among preterm babies in rural Bangladesh, we examined: 1) determinants and patterns of care seeking, and 2) risk analysis for care-seeking from qualified and unqualified providers. METHOD: Trained community health workers collected data prospectively from 27,460 mother-liveborn baby pairs, including 6,090 preterm babies, between June 2007 and September 2009. Statistical analyses included binomial and multinomial logistic regressions. RESULTS: Only one-fifth (19.7%) of preterm newborns were taken to seek either preventive or curative health care. Among care-seeker preterm newborns, preferred providers included homeopathic practitioners (50.0%), and less than a third (30.9%) sought care from qualified providers. Care-seeking from either unqualified or qualified providers was significantly lower for female preterm babies, compared to male babies [Relative Risk Ratio (RRR) for unqualified care: 0.68; 95% Confidence Interval (CI): 0.58, 0.80; RRR for qualified care: 0.52; 95% CI: 0.41, 0.66]. Among preterm babies, care-seeking was significantly higher among caregivers who recognized symptoms of illness [RR: 2.14; 95% CI: 1.93, 2.38] or signs of local infection (RR: 2.53; 95% CI: 2.23, 2.87), had a history of child death [RR: 1.21; 95% CI: 1.07, 1.37], any antenatal care (ANC) visit [RR: 1.41; 95% CI: 1.25, 1.59]. Birth preparedness (RRR: 1.24; 95% CI: 1.09, 1.68) and any ANC visit (RRR: 1.73; 95% CI: 1.50, 2.49) were also associated with increased likelihood of care seeking for preterm babies from qualified providers. CONCLUSION: To improve care seeking practices for preterm babies and referral of sick newborns to qualified providers/facilities, we recommend: 1) involving community-preferred health care providers in community-based health education and awareness raising programs; 2) integrating postnatal care seeking messages into antenatal counselling; and 3) further research on care seeking practices for preterm babies.

Treatment Behaviour of Leprosy Patients on Time Scale.

Leprosy is not a disease of modern civilization and industrialization, but its origin is as old as 4600 BC. Although the cure of leprosy is possible by MDT, there are certain misbelieves in the mind of leprosy patients leads to delay in disease reporting. Wandering of the patient from one healer to another healer also one of the cause that delays the start of MDT. It is known fact that the delayed response in getting medical treatment for leprosy causes permanent physical deformities in the patient. This study is aimed to identify the treatment behavior of leprosy patients on time scale. A total of 251 study subjects were selected randomly attending the Skin & VD OPD of S S Hospital of IMS, BHU, Varanasi. Questions related to treatment behavior on time scale were administered to leprosy patients aged 15 years or above by the interviewer himself. Time gap to start the initial treatment was significantly less in MB cases (5.3 months) as compared to PB cases (7.2 months). MB cases wasted significantly more time with allopathic treatment other than MDT. Urban patients (1.3 months) wasted more time with homeopathy than the rural patients (0.9 months). More than half the cases (51.4%) went for the treatment within three months of noticing symptoms of leprosy. There is a considerable delay in starting the MDT after noticing the first symptom of leprosy. As early as possible, measures to start the proper treatment i.e. MDT should be taken to avoid permanent disability due to leprosy.

Pattern and predictors of complementary and alternative medicine (CAM) use among pediatric patients with epilepsy.

Parents of pediatric patients with chronic conditions such as epilepsy increasingly opt for complementary and alternative medicine (CAM). However, data on the pattern and reasons of CAM use in childhood epilepsy are scarce. The objectives of this study were as follows: first, to characterize CAM use among pediatric patients with epilepsy by assessing its spectrum, prevalence, costs, and frequency of use; second, to evaluate the influence of CAM use on compliance and satisfaction with conventional care as well as to explore parent-child neurologist communication concerning CAM; and third, to investigate predictors of CAM use. A postal survey was administered to all parents of pediatric outpatients with epilepsy aged 6 to 12, who have received treatment at the neuropediatric outpatient clinic of the University Children's Hospital Heidelberg between 2007 and 2009. One hundred thirty-two of the 297 distributed questionnaires were suitable for inclusion in statistical analysis (44.7%). Forty-nine participants indicated that their children used CAM during the previous year (37.1%). Thirty different types of CAM were used, with homeopathy (55.1%), osteopathy (24.5%), and kinesiology (16.3%) being the most commonly named. A mean of 86€ (0€-500€) and 3h (1 h-30 h) per month was committed to CAM treatment. Only 53% of the users informed their child neurologist of the additional CAM treatment, while 85.6% of all parents wished to discuss CAM options with their child neurologist. Seventy-five percent of users considered the CAM treatment effective. Among the participants most likely to seek CAM treatment are parents whose children show a long duration of epileptic symptoms, parents who make use of CAM treatment themselves, and parents who value a holistic and natural treatment approach. A substantial portion of pediatric patients with epilepsy receive CAM treatment. The high prevalence of use and significant level of financial and time resources spent on CAM indicate the high importance of these treatment options for parents. On the other hand, communication concerning CAM with the child neurologist is largely insufficient despite the wish to speak about CAM. Complementary and alternative medicine users' high compliance with conventional treatment and high perceived effectiveness of CAM support an integrative approach to CAM for pediatric patients with epilepsy. Our study implies that in addition to open parent-child neurologist communication, active inquiry on CAM treatments is necessary to enable informed decision making by parents and to establish the suitability of CAM treatment for the patient. Reliable predictors for CAM use, which allow for improved identification of patients with a high likelihood to receive CAM treatment, are the duration of the illness, use of CAM by the parents themselves, and the desire of the parents to receive a holistic and natural treatment for their child.