Community awareness and use of anti-Müllerian hormone testing in Australia: a population survey of women.

STUDY QUESTION: What is the anti-Mullerian hormone (AMH) test usage, awareness, and perceived reasons for testing in a representative community sample of women in Australia? SUMMARY ANSWER: : Among women aged 18-55 years, 13% had heard about AMH testing and 7% had had an AMH test, with the top three reasons for testing including due to infertility investigations (51%), considering pregnancy and wanting to understand their chances (19%) or to find out if a medical condition had affected fertility (11%). WHAT IS KNOWN ALREADY: The growing availability of direct-to-consumer AMH testing has raised concerns about overuse, however as most AMH tests are paid for privately by consumers, data on test usage is not publicly available. STUDY DESIGN, SIZE, DURATION: National cross-sectional survey of 1773 women, conducted in January 2022. PARTICIPANTS/MATERIALS, SETTING, METHODS: Females aged 18-55 years were recruited from the representative 'Life in Australia' probability-based population panel and completed the survey online or by telephone. Main outcome measures included if and how participants had heard about AMH testing, whether they had ever had an AMH test, main reason for testing and test access. MAIN RESULTS AND THE ROLE OF CHANCE: Of the 2423 women who were invited 1773 responded (73% response rate). Of these, 229 (13%) had heard about AMH testing and 124 (7%) had had an AMH test. Testing rates were highest among those currently aged 35-39 years (14%) and associated with educational attainment. Almost all accessed the test through their general practitioner or fertility specialist. Reasons for testing were: part of an infertility investigation (51%), considering pregnancy and wanting to understand chances of conceiving (19%), finding out if a medical condition had affected fertility (11%), curiosity (9%), considering egg freezing (5%), and considering delaying pregnancy (2%). LIMITATIONS, REASONS FOR CAUTION: Although the sample was large and mostly representative, it was over-represented by people holding a university degree and under-represented by people aged 18-24, however, we used weighted data where possible to account for this. All data were self-reported so there is a risk of recall bias. The number of survey items was also restricted, so the type of counselling women received prior to testing, reasons for declining an AMH test or test timing were not measured. WIDER IMPLICATIONS OF THE FINDINGS: Whilst most women reported having an AMH test for appropriate reasons, about one third had it for reasons not supported by evidence. Public and clinician education about the lack of utility of AMH testing for women not undergoing infertility treatment is needed. STUDY FUNDING/COMPETING INTEREST(S): This project was supported by a National Health and Medical Research Council (NHMRC) Centre for Research Excellence grant (1104136) and Program grant (1113532). T.C. is supported by an NHMRC Emerging Leader Research Fellowship (2009419). B.W.M. reports research funding, consultancy and travel support from Merck. D.L. is the Medical Director of City Fertility NSW and reports consultancy for Organon, Ferring, Besins and Merck. The authors have no other competing interests. TRIAL REGISTRATION NUMBER: N/A.

Creating falseness-How to establish statistical evidence of the untrue.

Null hypothesis significance testing is the typical statistical approach in search of the truthfulness of hypotheses. This method does not formally consider the prior credence in the hypothesis, which affects the chances of reaching correct conclusions. When scientifically implausible or empirically weakly supported hypotheses are tested, there is an increased risk that a positive finding in a test in fact is false positive. This article argues that when scientifically weakly supported hypotheses are tested repeatedly-such as when studying the clinical effects of homeopathy-the accumulation of false positive study findings will risk providing false evidence also in systematic reviews and meta-analyses. False positive findings are detrimental to science and society, as once published, they accumulate persistent untrue evidence, which risks giving rise to nonpurposive research programmes, policy changes, and promotion of ineffective treatments. The problems with false positive findings are discussed, and advice is given on how to minimize the problem. The standard of evidence of a hypothesis should depend not only on the results of statistical analyses but also on its a priori support. Positive findings from studies investigating hypotheses with poor theoretical and empirical foundations should be viewed as tentative until the results are replicated and/or the hypothesis gains more empirical evidence supporting it as likely to be true.

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.

Predictors of transitions in vitality: the italian longitudinal study on aging.

It is widely acknowledged that there is a strong need to identify which modifiable risk factors predict healthy aging to use this information as the scientific basis for systematic interventions. Data from a 4-year longitudinal study on aging among 5632 older Italians were used. The definition of vitality was based on both cognitive and physical status, and the envisaged transitions were: positive or nonpositive stable, positive or negative transition, lost, and deceased. Predictors associated with different vitality trajectories were investigated by multinomial logistic analysis with a six-level outcome. Age and educational level were predictors of being "positive stable," whereas the other factors behaved differently according to comparison group. For example, being overweight is a common predictor except when compared to the deceased group, as is depressive symptomatology except when compared to the "positive transition" group. Interventions are warranted to reduce social inequalities, promote adequate body weight, and prevent and treat depressive symptoms.

Homeopathy for childhood diarrhea: combined results and metaanalysis from three randomized, controlled clinical trials.

BACKGROUND: Previous studies have shown a positive treatment effect of individualized homeopathic treatment for acute childhood diarrhea, but sample sizes were small and results were just at or near the level of statistical significance. Because all three studies followed the same basic study design, the combined data from these three studies were analyzed to obtain greater statistical power. METHODS: Three double blind clinical trials of diarrhea in 242 children ages 6 months to 5 years were analyzed as 1 group. Children were randomized to receive either an individualized homeopathic medicine or placebo to be taken as a single dose after each unformed stool for 5 days. Parents recorded daily stools on diary cards, and health workers made home visits daily to monitor children. The duration of diarrhea was defined as the time until there were less than 3 unformed stools per day for 2 consecutive days. A metaanalysis of the effect-size difference of the three studies was also conducted. RESULTS: Combined analysis shows a duration of diarrhea of 3.3 days in the homeopathy group compared with 4.1 in the placebo group (P = 0.008). The metaanalysis shows a consistent effect-size difference of approximately 0.66 day (P = 0.008). CONCLUSIONS: The results from these studies confirm that individualized homeopathic treatment decreases the duration of acute childhood diarrhea and suggest that larger sample sizes be used in future homeopathic research to ensure adequate statistical power. Homeopathy should be considered for use as an adjunct to oral rehydration for this illness.

Use of alternative therapies for menopause symptoms: results of a population-based survey.

OBJECTIVE: To describe self-reported prevalence of the use of alternative therapies for menopause symptoms and subject characteristics associated with their use. METHODS: A telephone survey of 886 women aged 45-65 years (87.2% response rate) was conducted at Group Health Cooperative in Washington state. Women were asked about eight alternative therapies and their use for menopause symptoms. RESULTS: The proportion of women who used each therapy was 76.1% for any therapy, 43.1% for stress management, 37.0% for over-the-counter alternative remedies, 31.6% for chiropractic, 29.5% for massage therapy, 22.9% for dietary soy, 10.4% for acupuncture, 9.4% for naturopath or homeopath, and 4.6% for herbalists. The proportion of women who used it to manage menopause symptoms was 22.1% for any therapy, 9.1% for stress management, 13.1% for over-the-counter alternative remedies, 0.9% for chiropractic, 2.6% for massage therapy, 7.4% for dietary soy, 0.6% for acupuncture, 2.0% for naturopath or homeopath, and 1.2% for herbalists. Among women who used these therapies, 89-100% found them to be somewhat or very helpful. A history of breast cancer was associated with a six-fold increase in use of dietary soy for menopause symptoms (odds ratio 6.23, 95% confidence limits 2.54, 15.28). Current users of hormone replacement therapy were half as likely to use alternative remedies or providers (odds ratio 0.48, 95% confidence limits 0.29, 0.77) as were never users. Sleep disturbances were associated with a four-fold increase in the use of body work, a three-fold increase in the use of stress management, and more than doubled the use of dietary soy products to manage menopause symptoms. CONCLUSION: The use of alternative therapies for menopause symptoms is common, and women who use them generally find them to be beneficial. Physicians should routinely ascertain perimenopausal women's use of alternative therapies.

Popularity of complementary and alternative medicine in Japan: a telephone survey.

OBJECTIVE: To obtain information on the use of complementary and alternative medicine (CAM) in Japan. DESIGN: Nationwide, random-sampled and population-weighted telephone survey. METHODS: The survey was conducted by a telephone survey company in April 2001. The sample size of respondents was 1000. Using a region-, gender- and age-weighted sampling table, professional operators called respondents with random-digit dialling. Respondents were asked questions about their use of CAM in the past 12 months, out-of-pocket expenditures on CAM and orthodox Western medicine, reasons for the use of CAM and so on, as well as general socio-demographics. RESULTS: The percentage of respondents who had used at least one CAM therapy in the past 12 months was greater than those who had used orthodox Western medicine (76.0% (95% CI: 73.4-78.6) vs 65.6% (95% CI: 62.7-68.5). The percentage of use for each CAM therapy was as follows: nutritional and tonic drinks (43.1%), dietary supplements (43.1%), health-related appliances (21.5%), herbs or over-the-counter Kampo (17.2%), massage or acupressure (14.8%), ethical Kampo (Kampo prescribed by medical doctors) (10.0%), aromatherapy (9.3%), chiropractic or osteopathy (7.1%), acupuncture and moxibustion (6.7%), homeopathy (0.3%), and other therapies (6.5%). Regarding the reasons for the use of CAM, 60.4% responded that 'the condition was not serious enough to warrant orthodox Western medicine', and 49.3% were 'expecting health promotion or disease prevention'. Average annual out-of-pocket expenditures of all the 1000 respondents for CAM were half as much as those for orthodox Western medicine (19,080 yen (95% CI: 15,824-22,336) vs 38,360 yen (95% CI: 30,439-46,280)). CONCLUSIONS: CAM is very popular in Japan and the expenditures for them are not negligible, although there is still an overwhelming dominance of orthodox Western medicine with regard to cost, variety of indications, and severity of conditions.

Economic considerations in the use of neuromuscular blocking drugs.

The acceptance of new and increasingly expensive technologies is a major component of the rising costs of health care. While the practice of anesthesia has been relatively immune from the effects of cost containment, it is inevitable that practitioners will have to justify costly practices. Available pharmacoeconomic methods can be applied to the use of all anesthetic drugs, particularly neuromuscular blocking drugs. Cost-effectiveness analysis allows the practicing anesthesiologist to prioritize the use of neuromuscular blocking drugs to maximize their benefit while reducing unnecessary costs.

Complementary therapies and the general practitioner. A survey of Perth GPs.

OBJECTIVE: The purpose of this study was to identify the knowledge, attitudes and referral patterns of general practitioners (GPs) toward 10 specific complementary therapies. METHOD: The study was a descriptive cross-sectional postal survey, conducted between July 1998 and August 1998 inclusive. A random selection of 200 male and 200 female Western Australian GPs residing in Perth and listed in the Australian Medical Association database file of registered GPs. RESULTS: The response rate was 74.8% (n = 282). Over 90% of these GPs reported having been approached by more than 30 patients seeking their advice about complementary therapies in the past nine months. The majority of these patients were women, over the age of 35 years. Ten complementary therapies were listed in the questionnaire: acupuncture, hypnosis, meditation, spinal manipulation, yoga, homeopathy, herbal medicine, naturopathy, massage and aromatherapy. Just under half (132) of the respondents had undertaken studies in at least one of the listed complementary therapies, with over 60% reporting a wish for further training. Overall, 67.8% (191) of all respondents reported they were in favour of GP referrals to complementary therapists. However, 56.1% (158) were against complementary therapies being included in rebates for private health insurance. Overall, 75.0% (211) of GPs surveyed had already formally referred a patient to one or more of the listed therapies, the most frequent of these being acupuncture, massage, meditation, hypnosis and spinal manipulation as a part of their overall medical treatment. CONCLUSION: Perth GPs have a high level of interest in complementary therapies. Government regulation and registration of complementary therapies is seen by GPs as important in order to ensure professional standards of practice. Given the high level of interest, provision of undergraduate and postgraduate education in complementary therapies could be considered. In addition, the development of clinical guidelines would be of benefit.

Clastogenic potential of Ruta graveolens extract and a homeopathic preparation in mouse bone marrow cells.

Ruta graveolens belonging to family Rutaceae has long been traditionally used as a medicinal plant as well as a flavoring agent in food. However, very little data are available on the toxicity of the plant. This report presents evidence on the genotoxic and clastogenic potential of an extract of Ruta graveolens and Ruta 200C, a homeopathic preparation. Various types of chromosomal aberrations were noted in bone marrow cells after treatment. The percentage of aberrated cells in the 400mg/kgb.wt extract administered group was found to be 21% and with 1,000 mg/kg.b.wt it was 31%. The value for the Ruta 200C treated group was also elevated to 23% as compared to the 3%for untreated animals. In addition, bone marrow cells had higher incidence of micronuclei induction when treated with the extract (400 mg and 1,000 mg/kg body weight) and Ruta 200C for 30 days. Administration of the extract (1,000 mg/kg.b.wt) over a period of 30 days also resulted in damage to cellular DNA as evidenced by comet formation where the comet parameters such as percentage DNA in tail, tail length, tail moment of the bone marrow cells were increased several fold over control values. The comet tail moment of the bone marrow cells increased from 4.5 to 50.2 after the extract treatment. Administration of Ruta 200C for 5 consecutive days increased the tail moment to 11.7. These results indicate that Ruta graveolens and Ruta 200C may induce genotoxicity in animals.

Health status and health care utilisation of patients in complementary and conventional primary care in Switzerland--an observational study.

BACKGROUND: The study is part of a nationwide evaluation of complementary and alternative medicine (CAM) in primary care in Switzerland. OBJECTIVES: Patient health status with respect to demographic attributes such as gender, age, and health care utilisation pattern was studied and compared with conventional primary care. METHODS: The study was performed as a cross-sectional survey including 11932 adult patients seeking complementary or conventional primary care. Patients were asked to document their self-perceived health status by completing a questionnaire in the waiting room. Physicians were performing conventional medicine and/or various forms of complementary primary care such as homeopathy, anthroposophic medicine, neural therapy, herbal medicine, or traditional Chinese medicine. Additional information on patient demographics and yearly consultation rates for participating physicians was obtained from the data pool of all Swiss health insurers. These data were used to confirm the survey results. RESULTS: We observed considerable and significant differences in demographic attributes of patients seeking complementary and conventional care. Patients seeking complementary care documented longer lasting and more severe main health problems than patients in conventional care. The number of previous physician visits differed between patient groups, which indicates higher consumption of medical resources by CAM patients. CONCLUSIONS: The study supports the hypothesis of differences in socio-demographic and behavioural attributes of patients seeking conventional medicine or CAM in primary care. The study provides empirical evidence that CAM users are requiring more physician-based medical services in primary care than users of conventional medicine.

Volume of blood required to detect common neonatal pathogens.

OBJECTIVE: To determine the minimum volume of blood and the absolute number of organisms required for detection of bacteremia and fungemia by an automated colorimetric blood culture system (BacT/Alert, Organon Teknika). DESIGN: Common neonatal pathogens, Escherichia coli, Streptococcus agalactiae (group B streptococcus (GBS): one American Type Culture Collection (ATCC) strain and one clinical isolate), Staphylococcus epidermidis, and Candida albicans, were seeded into blood to produce bacteremia or fungemia with low colony counts (1 to 3 colony-forming units (CFU) per milliliter) and ultra-low colony counts (<1 CFU/ml). For each organism, 96 culture bottles were inoculated with either 0.25, 0.5, 1.0, or 4.0 ml of the two seeded blood concentrations. Blood culture bottles were incubated in the BacT/Alert device for 5 days, and time to positivity was noted when applicable. All bottles were subcultured on plated media. DATA ANALYSIS: The Poisson statistic was used to calculate the probability of finding at least one viable CFU per inoculated culture bottle. The fraction of culture bottles with positive findings per group was divided by the probability of one or more organisms present to give the positivity index. RESULTS: Plated subculture identified no growth of organisms not detected by the colorimetric detection system. The false-positive rate for the automated device was less than 1%. The positivity index for the GBS clinical isolate was 1.13, for the GBS ATCC isolate 0.96, for S. epidermidis 0.94, for C. albicans 0.97, and for E. coli 0.95. There was a statistically significant difference with time to positivity and inocula volume (p <0.01), but the difference was not clinically important. CONCLUSIONS: If one or two viable colony-forming units are in the blood inoculated into culture media, the BacT/Alert system will detect growth rapidly. Because there appears to be a sizable subset of neonates who are at risk of sepsis with a colony count less than 4 CFU/ml, then a 0.5 ml inoculum of blood into the culture media is inadequate for sensitive and timely detection of bacteremia. One to two milliliters of blood should increase microorganism recovery in the face of low-colony-count sepsis.

Improving homeopathic prescribing by applying epidemiological techniques: the role of likelihood ratio

A committee of the Dutch Association of Homeopathic Physicians is trying to validate materia medica by evaluating successful cases. These cases are presented and assessed by a group of experienced homeopathic... (AU)