Drug use during early pregnancy: cross-sectional analysis from the Childbirth and Health Study in Primary Care in Iceland.

OBJECTIVE: To analyse drug use in early pregnancy with special focus on socio-demographic factors associated with psychotropic and analgesic drug use. DESIGN: Cross-sectional study. SETTING AND SUBJECTS: A total of 1765 women were invited via their local health care centres, and 1111 participated at 11-16 weeks of pregnancy by filling out a postal questionnaire concerning socio-demographic and obstetric background, stressful life events, and drug use. MAIN OUTCOME MEASURES: Drug use prior to and early on in pregnancy, socio-demographic factors, smoking, and adverse life events were investigated. Drug categories screened for were psychotropics (collective term for antidepressants, relaxants, and sleep medication), analgesics, hormones, nicotine, vitamins/minerals, and homeopathic medicine. RESULTS: Drug use from the aforementioned drug categories, excluding vitamins/minerals and homeopathic medicine, was reduced by 18% during early pregnancy, compared with six months prior to conception (49% vs. 60%). Psychotropic drug use during early pregnancy was associated with elementary maternal education (p < 0.5), being unemployed (p < 0.001), being single/divorced/separated (p < 0.01), smoking prior to or during pregnancy (p < 0.01), forced to change job/move house (p < 0.001), and psychotropic drug use six months prior to pregnancy (p < 0.001). No items on the stressful life events scale were associated with increased analgesic use, which increased only with multiparity. CONCLUSIONS: Use of analgesics and psychotropic drugs seems common in pregnancy. Our results indicate that lack of a support network, stressful life events, and lower status in society may predispose women to more drug use. GPs and midwives responsible for maternity care could take this into account when evaluating risk and gain for women and foetuses in the primary care setting.

Drug utilization patterns in Rawalpindi and Islamabad, Pakistan.

OBJECTIVES: To assess the prevalence of self medication among Pakistanis in rural and urban settings. METHODS: A door-to-door survey was carried out during June and July 2008 and 2009 after due verbal consent taken from the residents. The houses were randomly selected from ultra posh area, quarters of government employees, residents of Barani Training Institute, low socio-economic population in the surrounding of Adiallah road near Rawalpindi, and a remote village Raye Chak, (population 5000) some 50 kilometers away from the city. RESULTS: There were 2042 dosage forms of drugs from 430 houses; allopathic medicine 89.3%; traditional medicines 6.7%; and homeopathic drugs 4% representation. The top 10 companies had more than 57% market share among 147 firms whose products were reported. The availability of paediatric drugs mixtures/syrups was 24%, and injectiables, 5.5%. Nonsteroidal anti-inflammatory drugs (NSAID) had 38% representation; antimicrobials 25%, multivitamins and haematinics were 1.6% that was contrary to the general perception of the irrational use of this group of medicines. CONCLUSION: Alternative medicine is gaining ground. Overuse of anti-inflammatory drugs suggest higher prevalence of pain, inflammation and infections than systemic disorders in society.

Community attitudes towards bears, bear bile use, and bear conservation in Luang Prabang, Lao PDR.

BACKGROUND: Bear bile is widely believed across much of Asia to have medicinal properties. As a result, great numbers of bears have been poached from the wild and numerous bear farms have been set up to drain the animals' bile on a regular basis. Although most such farms are now illegal, they continue to exist in countries such as Lao PDR. A new bear sanctuary is under construction in Luang Prabang in the northern part of the country with the aim of providing shelter to bears rescued from these farms. Understanding the level and nature of local communities' support for this sanctuary is vital for the long-term success of conservation efforts in the area, including outreach. METHODS: This research, drawing from both ethnozoological and conservation frameworks, comprises a household survey (n = 263) administered in five villages surrounding the sanctuary and in-depth interviews conducted with key community leaders and institutional representatives. The questionnaire assessed local socio-economic status and attitudes towards bears, bear bile use, and bear conservation in general. RESULTS: Respondents have generally positive attitudes towards bears and bear conservation. Age, gender, ethnicity, village, and household size have significant influence on attitudes towards bear bile use, which may also be determined by the expansion of sources for the supply of the traditional medicine market in neighboring China. However, many locals lack knowledge about the current status of wild and captive bears. This may be due to inadequate outreach involving community incentives for positively influencing attitudes. We argue that local communities will need to be integrated into conservation efforts while enhancing knowledge of conservation issues through improved outreach and communication. CONCLUSION: Positive attitudes towards bears appear prevalent in the communities surrounding the new sanctuary. Villagers are familiar with laws regarding wildlife conservation but lack a deeper understanding of the status and plight of wild bears in the country, particularly how bear farming is a threat to the species. Conservation efforts must entail culturally relevant co-educational initiatives to garner further support from local communities.

The use of complementary alternative medicine (CAM) in 1 001 German adults: results of a population-based telephone survey.

AIM OF THE STUDY: The objective of this study was to evaluate the patterns of use of complementary alternative medicine (CAM) in a representative adult population in Germany. METHODS: A population-based telephone survey was conducted in Lübeck, Germany. We performed computer-assisted telephone interviews (CATI) in order to obtain information on demographics, health status, prevalence of CAM usage, motivation for using CAM, type of CAM and health problems for which CAM were used. RESULTS: 1,001 adults (median age 48 years) participated in the study (response 46.8%). 79.6% of the interviewed subjects reported health problems. The most frequently named problems were chronic pain (45.3%), circulation problems (32.9%) and colds with fever (27.8%). Non-users of CAM had a lower incidence (76.6%) of overall illness than users (83.5%) (OR 0.65, 0.47-0.89). 42.3% of the participants had used CAM. The CAM user group consisted of significantly more females (72.8 vs. 55.5%) (OR 2.32, 1.74-3.08) and involved better educated subjects (school education >12 years, 36.6 vs. 27.9%, OR 3.25, 1.35-7.81) than the non-user group. The main health problems for which CAM was used were chronic pain (36.3%), some cases of uncomplicated colds (16.9%) and for improving general health (14.7%). Three procedures accounted for the majority of usage: Acupuncture (34.5%), homeopathy (27.3%) and herbal medicine (9.7%). A large number of participants reported as the main reason for using CAM the wish to avoid drugs as much as possible (31.7%). 26.7% reported opting for CAM due to the recommendation of their physician. 23.9% gave unsatisfactory results of conventional medicine as reason for CAM usage. CONCLUSIONS: CAM is used widely for different complaints by the general population. This frequent use of CAM has implications for the health-care system and health policy.

O cuidado em saúde promovido pelas religiões afro-brasileiras / Health care promoted by afro-brazilian religions / El cuidado en salud promovido por las religiones afrobrasileñas

No decorrer da história, sempre foram infindáveis os casos em que os sujeitos recorriam a centros espíritas ou terreiros de religiões de matrizes africanas em decorrência de problemas como doenças, desempregos ou amores mal resolvidos, com o objetivo de saná-los. Por conta disso, este artigo visa apresentar os resultados da pesquisa relacionados ao objetivo de mapear os processos de cuidado em saúde ofertados em três terreiros de umbanda de uma cidade do litoral piauiense. Para isso, utilizamos o referencial da Análise Institucional "no papel". Os participantes foram três líderes de terreiros e os respectivos praticantes/consulentes dos seus estabelecimentos religiosos. Identificamos perspectivas de cuidado que se contrapunham às racionalidades biomédicas, positivistas e cartesianas, e faziam referência ao uso de plantas medicinais, ao recebimento de rezas e passes e à consulta oracular. A partir desses resultados, podemos perceber ser cada vez mais necessário, portanto, que os povos de terreiros protagonizem a construção, implementação e avaliação das políticas públicas que lhe sejam específicas.(AU)

In history, there have always been endless cases of people turning to spiritual centers or terreiros of religions of African matrices due to problems such as illnesses, unemployment, or unresolved love affairs. Therefore, this article aims to present the research results related to the objective of mapping the health care processes offered in three Umbanda terreiros of a city on the Piauí Coast. For this, we use the Institutional Analysis reference "on Paper." The participants were three leaders of terreiros and the respective practitioners/consultants of their religious establishments. We identified perspectives of care that contrasted with biomedical, positivist, and Cartesian rationalities and referred to the use of medicinal plants, the prescript of prayers and passes, and oracular consultation. From these results, we can see that it is increasingly necessary, therefore, that the peoples of the terreiros lead the construction, implementation, and evaluation of public policies that are specific to them.(AU)

A lo largo de la historia, siempre hubo casos en los cuales las personas buscan en los centros espíritas o terreros de religiones africanas la cura para sus problemas, como enfermedades, desempleo o amoríos mal resueltos. Por este motivo, este artículo pretende presentar los resultados de la investigación con el objetivo de mapear los procesos de cuidado en salud ofrecidos en tres terreros de umbanda de una ciudad del litoral de Piauí (Brasil). Para ello, se utiliza el referencial del Análisis Institucional "en el Papel". Los participantes fueron tres líderes de terreros y los respectivos practicantes / consultivos de los establecimientos religiosos que los mismos conducían. Se identificaron perspectivas de cuidado que se contraponían a las racionalidades biomédicas, positivistas y cartesianas, y hacían referencia al uso de plantas medicinales, al recibimiento de rezos y pases y a la consulta oracular. Los resultados permiten concluir que es cada vez más necesario que los pueblos de terreros sean agentes protagónicos de la construcción, implementación y evaluación de las políticas públicas destinadas específicamente para ellos.(AU)

HIV risk behavior among injection drug users in Tehran, Iran.

AIMS: Iran faces parallel human immunodeficiency virus (HIV) and injection drug use epidemics; more than 62% of known HIV cases occur among injection drug users (IDU). We conducted a formative study of IDU in Tehran to explore risk behavior in the wake of the recent harm reduction efforts. PARTICIPANTS AND DESIGN: Key informant interviews (n = 40), focus group discussions (nine groups of IDU, n = 66) and a review of existing published and unpublished literature were conducted. Participants included IDU, physicians, policy makers, police, IDU advocates and their families. IDU were diverse in gender, education, income and neighborhood of residence. Interviews were transcribed and analyzed using grounded theory. A typology of IDUs in Tehran, categorized according to self-defined networks as well as HIV risks, is presented. This categorization is based on the groups identified by IDUs, compared to those identified by other key informants, and on a secondary data review. FINDINGS: Homeless, female, young IDU and users of a more potent form of heroin were identified as having increased risks for HIV. Participants described shortening transitions from smoked opium to injected opiates. Whereas a majority of participants considered needle sharing less common than previously, sharing continues in locations of group injection, and in states of withdrawal or severe addiction. System-wise barriers to harm reduction were discussed, and include the cost or stigma of purchasing needles from pharmacies, over-burdened clinics, irregular enforcement of laws protecting IDU and lack of efforts to address the sexual risks of IDU. CONCLUSIONS: This research is one of the first to describe a diversity of IDU, including women and higher socio-economic class individuals, in Tehran. While efforts in harm reduction in Iran to date have been notable, ongoing risks point to an urgent need for targeted, culturally acceptable interventions.

Utilization of alternative systems of medicine as health care services in India: Evidence on AYUSH care from NSS 2014.

AYUSH, an acronym for Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-Rigpa and Homeopathy represents the alternative systems of medicine recognized by the Government of India. Understanding the patterns of utilization of AYUSH care has been important for various reasons including an increased focus on its mainstreaming and integration with biomedicine-based health care system. Based on a nationally representative health survey 2014, we present an analysis to understand utilization of AYUSH care across socioeconomic and demographic groups in India. Overall, 6.9% of all patients seeking outpatient care in the reference period of last two weeks have used AYUSH services without any significant differentials across rural and urban India. Importantly, public health facilities play a key role in provisioning of AYUSH care in rural areas with higher utilization in Chhattisgarh, Kerala and West Bengal. Use of AYUSH among middle-income households is lower when compared with poorer and richer households. We also find that low-income households display a greater tendency for AYUSH self-medication. AYUSH care utilization is higher among patients with chronic diseases and also for treating skin-related and musculo-skeletal ailments. Although the overall share of AYUSH prescription drugs in total medical expenditure is only about 6% but the average expenditure for drugs on AYUSH and allopathy did not differ hugely. The discussion compares our estimates and findings with other studies and also highlights major policy issues around mainstreaming of AYUSH care.

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.

Chasing the dragon: the cultural metamorphosis of opium in the United States, 1825-1935.

Many things to many people, opium has played a role in the emergence of several power bases in the United States. In turn, these bases of power have shaped what opium is for the rest of us. Allopathic medicine brought opium and its derivatives under its control around the turn of the century, promulgating "addiction theory" and addiction clinics as part of its rise to preeminence among rival forms of medicine. Opium also played a role in the U.S.'s international economic and imperialistic ascendance. When politicians began to deploy a new discourse on opium early in this century, they were able to appropriate medical rhetoric. As the politics of opium heated up, some doctors were able to exploit the emerging politically inspired discourse to generate a subtly different medical knowledge of opiates and addiction while establishing a new subdiscipline with the political support of lawmakers and state institutions.

Use of alternative-complementary-medicine (CAM) in Calabrian children.

OBJECTIVE: The use of complementary and alternative medicine (CAM) has not been widely studied among children in Italy. ISTAT-2005 survey showed a prevalence of 10% concerning children treated with CAM. The lack of data about the use of CAM in pediatrics in the South of Italy aimed us to conduct an epidemiological inquiry in Calabria. METHODS: The study has been conducted from 2009 and 2011 at the Pediatric Units of: University "Magna Graecia"-Catanzaro (CZ), Pugliese-Ciaccio Hospital-Catanzaro (CZ), Annunziata Hospital-Cosenza (CS), Jazzolino Hospital- ViboValentia (VV), Riuniti Hospitals-Reggio Calabria (RC) and San Giovanni di Dio Hospital-Crotone (KR). All information was collected through a questionnaire proposed to children's parents admitted to these hospitals as out-patients or in-patients. RESULTS: 1387 parents were approached to complete the questionnaire. 21(1,5%) refused to answer. A total of 1366 questionnaire was analyzed: 378 at CZ , 450 at CS, 131 at KR, 201 at VV and 206 at RC, with a response rate of 98,5%. In total, the percentage of children using CAM varied from 18% in Crotone to 38% in Cosenza. The parents who used CAM for their children were older and with a higher education. Phytotherapy was preferred to homeopathy. The gastrointestinal pathologies and upper respiratory tract are those ones for which frequently parents recur to CAM. Of note we have not to disregard their use " to strengthen" the immune system. In most of cases CAM have been prescribed by pediatrician. CONCLUSIONS: Our study remarks that the use of CAM is increased dramatically among the calabrian children in the last years as well as in other countries. Pediatricians need to improve their knowledge about CAM in order to better manage the parental attitude.

Complementary and alternative medicines in ankylosing spondylitis: a cross-sectional study.

Prevalence of dietary complementary and alternative medicine (CAM) and consultation with a CAM practitioner was examined in a cross-sectional study of 75 AS patients. Seventy one of 75 (94.7%) study participants reported previous or current CAM use. Among these AS patients, 44 (72.1%) reported dietary CAM use and 27 (36.0%) were seeing a CAM practitioner at the time of study. Of 89 dietary CAM, 50 (56.4%) were perceived to be of slight or no benefit, and only 10 (11.2%) were initiated by a CAM practitioner. Compared with non-users, current dietary CAM users were more likely to be female (OR 6.5; 95% CI, 1.8-23.9). Patients attending a CAM practitioner were more likely to have university education (OR 5.7; 95% CI, 1.5-21.9) and higher BASDAI (OR 1.3; 95%CI, 1.0-1.7). Despite low rates of perceived benefit, dietary CAM use and CAM practitioner attendance is common among AS patients.

Determinants of perceived morbidity and use of health services by children less than 15 years old in rural Bangladesh.

This study examined the association of a number of social and economic and other factors with perceived morbidity and use of health services by children in rural Bangladesh, using the data of a health and socioeconomic survey conducted in Matlab, Bangladesh in 1996. One of the factors of interest was women's social position measured with indicators such as their education, domestic autonomy, social networks and social prestige. Other factors of interest were economic in nature and included the availability of high-quality primary health care (PHC) facilities in one part of the study area. A total of 52% of the 3,793 children below 15 had an episode of an acute illness in the month preceding the interview. The medical care sought for acute illnesses was grouped into four categories: medical doctors, paramedics, traditional and untrained village doctors (including drug sellers) and homeopaths. A total of 55% of the children who were sick in the past month consulted any type of health provider. Logistic regression was used to estimate the effects of the various independent variables on the two dependent variables: perceived morbidity of under-15 children and health service use for under-15 sick children. The results revealed that age of the child was the most important factor influencing perceived morbidity while social and economic variables were in general not related to perceived morbidity. Prolonged and severe illnesses and illnesses of young and male children were more likely to be treated by health providers, particularly by physicians. While women's education and social network influenced visits to any health providers socioeconomic indicators influenced visits to physicians. Availability of PHC facilities in one part of the study area also led to more use of modern medical care. The findings highlight that improvement of women's education and of social and economic status in general, in combination with more availability of high-quality PHC will in Bangladesh lead to better health care of children.

One woman's crusade. An interview with Dr. Mawaheb T. El Mouelhy.

PIP: The views and background of the 1992 recipient of the Organon Family Planning Scholarship, the Egyptian El Mouelhy, were summarized; a report was also provided on the population views of Egyptian Dr. Maher Mahran, a professor of gynecology and obstetrics at Ain Shams University and director of the Egyptian National Population Council (NPC). El Mouelhy stated that the population problem in Egypt is a reflection of 98% of the population being settled on only 4% of the land area. The average number of children per family is 4, and the growth rate is 2.4%. Population growth is expected to reach 93 million, a doubling by 2025. Illiterates have the highest fertility; illiteracy in rural areas can be as high as 6.4%. Her solution is to rely on the cooperative efforts of government and nongovernmental groups to improve the status of women. Dr. Mahran reports that one goal of the NPC is to encourage redistribution of the population along the northern coast and Red Sea areas and to develop satellite communities outside Cairo. There are currently 14,000 societies in Egypt devoted to the goals of family planning and better health care for women and children. Local health motivators have also been successful at outreach. The location of the Third UN World Population Conference in Cairo this year is a positive impetus to the family planning effort. Egypt is the first Muslim country to reach 50% contraceptive use. NPC will be directing efforts to underserved rural areas. El Mouelhy on her return will be preparing a national population plan of action.^ieng

Medication use during pregnancy: data from the Avon Longitudinal Study of Parents and Children.

OBJECTIVE: To present data on the self-reported use of all types of medicinal products collected during pregnancy in a large cohort in southwest England. METHODS: Pregnant women with a delivery date during 1991-1992 and forming part of the prospective, population-based Avon Longitudinal Study of Parents and Children (ALSPAC) were sent up to four self-completion postal questionnaires during pregnancy. Text data collected from the questions on drug usage were coded using an ALSPAC drug dictionary based on the World Health Organization Drug Dictionary. RESULTS: At least one antenatal self-completion questionnaire was completed for 14,119 pregnancies, and 11,545 women completed all four. The data included prescription, over-the-counter, herbal and homeopathic products as well as iron, vitamins and other supplements. Only 7.6% did not report use of any medicinal product throughout their entire pregnancy. The remaining 92.4% used at least one product at some stage. After exclusion of iron, folate, vitamins, supplements, herbal and homeopathic products and skin emollients, 83% of those completing all questionnaires had used conventional therapeutic drugs. Analgesics were reported by approximately one-third of women at each stage during pregnancy, and paracetamol was the most frequently reported substance. Iron preparations were reported by 33% of the full cohort, at some stage, and folate by 21.9%. Use of anti-anaemic products increased during pregnancy with the greatest incidence at 32 weeks. Other vitamins and supplements were taken by 17.4% at some stage. Use of vitamins decreased throughout pregnancy from 9.6% in early pregnancy to 5% at 32 weeks. Antacids were reported by 23% at 32 weeks. The reported incidence of antibiotic use decreased slightly during pregnancy from 8% early on to 5.8% at 32 weeks; amoxicillin was the most frequently reported antibacterial. CONCLUSION: Use of medicinal products was high during pregnancy in the ALSPAC cohort. This finding is consistent with data from recent publications.

Achieving self-sufficiency. The Turkey Contraceptive Social Marketing project sold 2.1 million cycles of low-dose pills in 1992.

PIP: To encourage women in lower socioeconomic groups to realize the benefits of low-dose oral contraceptive (OC) use, the Turkey Contraceptive Social Marketing (CSM) project was initiated in December 1991. Until this time, most Turkish women who used OCs could only obtain high-dose preparations. Many discontinued use because of health concerns, causing the OC market to decline. Working with 3 OC manufacturers, Wyeth, Schering, and Organon CSM is promoting 5 different low-dose OCs with a method-specific educational campaign. Packaging of the OCs contains use instructions written for low-literacy women. Survey results show an increase in OC use in Metropolitan areas from 8 to 12% during 1990-92, with low-dose OCs capturing 61% of the market in 1992 vs. 50% in 1991. With sales at 128% of the first year's objective, the total OC market showed its first increase in years (to 18%). The low-dose OCs have an approval rating of 84%, and 61% of current acceptors are from lower socioeconomic groups. The success of the program was assured by the marketing efforts of the manufacturers, who tripled CSM's efforts. This result has led to plans to include injectables and implants in CSM's marketing efforts, with commercial distribution to being in 1994.^ieng