Prescription pattern of traditional Chinese medicine for climacteric women in Taiwan.

BACKGROUND: Traditional Chinese medicine (TCM) has become more popular as a therapy for symptom relief among menopause-aged women. The aim of this study was to analyze the utilization of TCM for climacteric women in Taiwan. METHODS: The study analyzed frequency distributions among 19 379 women aged 45-55 years, recruited from a random-sampled cohort of 200 000 people from the National Health Insurance database. Data mining was conducted to explore the co-prescription patterns for finished herbal products (FHP). RESULT: There were 19 379 women aged 45-55 years in the sample; of these, 12 572 (64.9%) utilized TCM services at least once. A total of 4078 (21.0%) of the 19 379 climacteric women utilized 145 200 (79.2%) TCM visits. Of these, 39 802 (21.7%) visits were because of diseases of the musculoskeletal system and connective tissue, of which more than half were treated with acupuncture and traumatology manipulative therapies. There were 28 154 visits with FHP prescriptions because of non-specific symptoms and ill-defined conditions, and Jia-wei-xiao-yao-san was the most frequent formula. Nearly two-thirds of FHP contained more than two herbal formulae. CONCLUSIONS: Women of climacteric age in Taiwan utilized TCM more often than other age groups. To deal with multiple symptoms and/or diseases among climacteric women, new prescription patterns of combining two or more herbal formulae have evolved. Studies on safety issues and drug-herb interactions are warranted for future research.

Redox potential of tea infusion as an index for the degree of fermentation.

Redox potential of tea infusion is suggested as an index for the extent of tea fermentation. The potential was measured between platinum and Ag/AgCl electrode pair with a voltmeter with high input impedance (>1000 Gohms). Phosphate buffer (10 mM, pH 7.0) was used to extract the infusion and served as the supporting electrolytes for the electrochemical measurement. The reliability (the Nernst's behavior) for redox potential measurement was verified with a standard redox couple, ferricyanide/ferrocyanide. Tentative interferences from dissolved oxygen and the major coexisting reducing chemical, ascorbate, were discussed. Redox potential showed strong correlation with the fermentation process during indoor withering process. Eleven kinds of tea with different fermentation extents including Sencha, Pilochun, Pouchong, Formosa oolong tea, Lipton green tea, Lipton black tea, and Taiwanese black tea were tested.

Hypotriglyceridemic effect of Anka (a fermented rice product of monascus sp.) in rats.

Experimental rats with hypertriglyceridemia were prepared by feeding a high-fructose diet. Dried Anka powder (2%), a rice product fermented with Monascus sp., was mixed with basic high-fructose (30%) or basal-diet feed. Serum and liver lipids were measured after 6 months. The concentrations of serum triglycerides, total cholesterol, VLDL-C, and LDL-C had significantly decreased, whereas that of HDL-C had slightly increased in 30% fructose-Anka-fed rats as compared with the 30% fructose-fed rats, but hepatic lipase activity had increased in the Anka-fed groups. The ratio of lipoprotein lipase/hepatic lipase was not significantly different between 30% fructose-Anka-fed rats and 30% fructose-fed rats. The dietary intake and weight of these two groups were approximately the same. Similar results were obtained in noninduced hypertriglyceridemic rats. The concentrations of triglycerides and cholesterol did not significantly differ in the liver. Interestingly, Anka can suppress serum triglycerides in rats with induced hypertriglyceridemia. The antioxidant enzyme SOD activity was also measured in serum, and no significant change was observed. On the basis of these findings, we suggest that Anka may be used to suppress hypertriglyceridemia and hyperlipidemia in rats and possibly in man.

Inhibition of xanthine oxidase and suppression of intracellular reactive oxygen species in HL-60 cells by theaflavin-3,3'-digallate, (-)-epigallocatechin-3-gallate, and propyl gallate.

The inhibitory effects of five tea polyphenols, namely theaflavin (TF1), theaflavin-3-gallate (TF2), theaflavin-3,3'-digallate (TF3), (-)-epigallocatechin-3-gallate (EGCG), and gallic acid, and propyl gallate (PG) on xanthine oxidase (XO) were investigated. These six antioxidant compounds reduce oxidative stress. Theaflavins and EGCG inhibit XO to produce uric acid and also act as scanvengers of superoxide. TF3 acts as a competitive inhibitor and is the most potent inhibitor of XO among these compounds. Tea polyphenols and PG all have potent inhibitory effects (>50%) on PMA-stimulated superoxide production at 20 approximately 50 microM in HL-60 cells. Gallic acid (GA) showed no inhibition under the same conditions. At 10 microM, only EGCG, TF3, and PG showed significant inhibition with potency of PG > EGCG > TF3. The superoxide scavenging abilities of these six compunds are as follows: EGCG > TF2 > TF1 > GA > TF3 > PG. PG was the most potent inhibitor of PMA-stimulated H(2)O(2) production in HL-60 cells. The order of H(2)O(2) scavenging ability was TF2 > TF3 > TF1 > EGCG > PG > GA. Therefore, the antioxidative activity of tea polyphenols and PG is due not only to their ability to scavenge superoxides but also to their ability to block XO and related oxidative signal transducers.

Respiratory symptoms of primary school children living in a petrochemical polluted area in Taiwan.

In 1994-1995 a cross-sectional epidemiological study investigating the respiratory health of school children in two Taiwan areas was conducted; one area was located in a region with petrochemical manufacturing complexes (Linyuan), and the other was situated in a reference area with no local industrial emissions (Taihsi). All primary school children residing in the two areas were involved in the study. Four hundred seventy children were studied in the area with high exposure to industrial emissions, and 611 children lived in the reference area. Respiratory health was assessed by evaluation of the children's respiratory symptoms and illnesses, using a parent-completed questionnaire. Particulates, sulfur dioxide (SO2), nitrogen dioxide (NO2), and acid aerosols levels were significantly higher in the exposed area than in the reference area. The school children in the petrochemical area had significantly more upper respiratory symptoms and asthma compared with the children living in the control area. Although the association with known petrochemical air pollution is suggestive, this cross-sectional study cannot confirm a causal relation and further studies are needed.

Prospective, randomized trial of hypertonic glucose water and sodium tetradecyl sulfate for gastric variceal bleeding in patients with advanced liver cirrhosis.

BACKGROUND AND STUDY AIMS: Information about the appropriate endoscopic treatment of gastric variceal bleeding is sparse. We therefore designed a prospective and randomized study to evaluate and compare efficacy and complication rates of two agents, hypertonic glucose water (50% GW) and sodium tetradecyl sulfate (STS), in treating acute gastric variceal bleeding after esophageal varix eradication. PATIENTS AND METHODS: Of 51 patients with advanced cirrhosis of the liver (Child's C), with acute gastric variceal bleeding initially evaluated, 25 patients were randomized to receive 1.5% STS and 26 to receive 50% glucose water. Treatment was aimed at achieving initial and permanent hemostasis by variceal eradication. RESULTS: Control of acute gastric variceal bleeding was achieved in 80% of the STS group and 92% of the GW group. The rebleeding rate in the STS group was 70%, while in the GW group it was 30% (P < 0.05). Overall, obliteration was achieved in only 32% of the STS group and 81% of the GW group during admission (P < 0.05). There was a trend toward a higher gastric ulcer rate in the STS group compared with the GW group (92% vs. 30%; P < 0.05). The rebleeding control rate and permanent hemostasis rate in the GW group (70%, 54%) were also significantly higher than in the STS group (21%, 12%; P < 0.05; P < 0.05). The hospital mortality for the STS group was 50%, and for the GW group 30%. CONCLUSION: Treatment with hypertonic glucose water in gastric vericeal bleeding was superior to treatment with STS in controlling bleeding and in achieving vericeal obliteration, less rebleeding, and a lower complication rate. The results of this study suggest that hypertonic glucose water is a clinically effective, easily available, and safe sclerosing agent.

The role of colonoscopy in screening persons with family history of colorectal cancer.

First-degree relatives of colorectal cancer patients are at increased risk for developing colorectal neoplasms. In order to assess the potentiality of colonoscopy screening in this high-risk population, 213 asymptomatic family members (age range 30-69 years, mean 42.8 years) of those patients with colorectal cancer received colonoscopic examination at Chang-Gung Memorial Hospital from April 1992 to May 1994. Twenty-eight persons with 42 lesions (polyps or cancer) were identified, including 28 adenomas, nine hyperplastic polyps and five adenocarcinomas. The positive detection rate was 9.9% for adenoma and 2.3% for cancer. Colorectal neoplasms afflicted males more frequently than females (16.7 vs 5.7%, P < 0.05) and occurred less frequently in those < 40 years of age (5.5 vs 17.2%, P < 0.05). Forty-two per cent of the detected neoplastic lesions were beyond the reach of 60 cm flexible sigmoidoscopy and 36% of adenomas were < 0.5 cm in size and would be missed if patients were screened by air contrast barium enema. Cost analysis revealed that the charges of both screening colonoscopy and screening flexible sigmoidoscopy/air contrast barium enema were approximate. Colonoscopy also has a high acceptability and safety. It appears appropriate to use colonoscopy, rather than flexible sigmoidoscopy or air contrast barium enema, as an initial screening procedure for persons with a family history of colorectal cancer, especially those > 40 years of age.

Mercaptoethanol protects glutathione depleted cells.

Buthionine sulfoximine depleted the glutathione (GSH) level of mouse lymphoma L1210A cells in culture to 6% of control and killed the cells within 48 hours in medium supplemented with fetal calf serum or bovine serum albumin. Mercaptoethanol or alpha-thioglycerol but not GSH or cysteine added to the medium protected the cells from the effect of GSH depletion. Horse serum was also protective, and this effect was removed by dialysis over 65 hours and could not be restored by adding GSH. Mercaptoethanol alone had a protective action in the dialyzed sera. The results suggest that mercaptoethanol may act independently and perform the functions of GSH.

A primary health care project in Sarawak.

PIP: A joint pilot project between the Ministry of Health and the Dept. of Social and Preventive Medicine, University of Malaya, to test the value of village aides in extending the health care system into isolated Iban communities was begun in May 1979 in the Entabai District of Sarawak. A group of 15 village aides consisting of 11 traditional Iban manangs (medicine men) and 4 youths were trained to provide primary health care including simple curative care, preventive care, and to assist in the detection of malaria. Evaluation carreid out 2 years later showed the following. With regard to curative care, the village aides were each, on the average, treating 70.6 patients/month, the most common complaint being headache (30.4%), which along with abdominal pain, constipation, bodyache, diarrhea, vomiting, fever, worm infections, cough, and sore throat, accounted for 89% of all illnesses seen by them. Subsequent to the introduction of village aides in the project area, the number of seriously ill patients requiring admission to the rest beds of the klinik desa dropped by 43.8% and the number of emergency referrals to the backup divisional hospitals fell by 46.1% showing that patients were coming to the klink desa for treatment at an earlier stage. The 11 traditional Iban manangs, who had recently received training had, on their own accord, drastically reduced the use of traditional Iban modes of therapy in preference for modern medicine. During the 24 months immediately after the introduction of village aides into Entabai, 9 gravity feed water supply systems together with related health packages advocating general cleanliness, the use of latrines, and fences were affected, whereas only 6 such systems were installed in the previous 24 months, indicating that it is likely that the village aides were of some assistance in mobilizing the community with respect to self-help efforts. During the same period, the majority of longhouses in the area successfully established a number of vegetable gardens growing foods for home consumption, and continue to vigorously advocate breastfeeding of infants in opposition to bottlefeeding. During the 23 months after village aides were introduced, a total of 1093 blood films were collected by the 15 village aides, the average number of blood films/village aide being 3.2 blood slides/month. Village aides are socially accepted by the Iban community who utilize their curative skills when mild illness disturb them, but who proceed directly to the klinik desa when more serious illness such as fever strike. The project has established clear lines of communication between the health team and the community, and has stimulated the community to organize itself to achieve an increasingly high level of health through community participation and self-reliance. Plans have been approved in principle to train a further 2000 village aides in primary health care for the state of Sarawak.^ieng

Birth planning propaganda, incentives and peer pressure.

PIP: Family planning policies are promoted at every level of Chinese society through the 3 concepts: lateness in marriage and childbirth, spacing of children, and reduction in family size (late, long, and few). The minimum legal age for girls to marry is 18, for boys, 20, but marriage is discouraged until ages 23 and 25. The Chinese put free family planning services within the reach of every eligible couple. An equally great effort is put into the acceptance and use of the services. Propaganda is pervasive, and peer pressure at the community level is intense. Individual and group sessions effect sanctions against noncompliance. Generous paid leaves are the incentives for sterilization and abortion. Community involvement in birth control has evolved to the point where annual birth quotas are established and allotted among couples. To some visitors these methods are highly coercive, a serious invasion of privacy. The 1-child family is being publicized and promoted with a generous incentive program which pays 5 yuan a month as child-care subsidy until the child is 14 years old. Living space will be given the 1-child family on a preferential basis. When 1-child couples retire they will be entitled to a monthly pension for as long as they live. The pension amounts to 80% or higher of their monthly wage at the time of retirement. Childless couples will receive 100% of their wages.^ieng

Population's political clout.

PIP: China's birth planning program has its own separate administrative hierarchy. The political commitment to population planning which originates with the top leadership extends to peer pressure exerted on couples at the brigade and neighborhood level. While family planning services are primarily delivered in health structures, responsibility for the population program falls to the Leading Group on Birth Planning. Not only health officials but also officials responsible for economic planning, political propaganda, scientific research, trade unions, women's affairs, and all those whose participation is considered necessary to the program's success attend meeting. The Leading Group on Birth Planning is chaired by a Vice-Premier. At each administrative level, provincial to work brigade, the same pattern is repeated: centralized responsibility combined with broad representation and high-level potitical leadership. With a tight, working structure, China has been able to enact its birth control program with remarkable speed and effectiveness. Each production brigade has its own planned birth leading group headed by the captain of the brigade or the captain of the women's team. The leading group supervises the barefoot doctors, midwives, and team level health aides who deliver contraceptives to households or accompany people to the community health center to obtain surgical services.^ieng

Health services and the family planning component.

PIP: This is a composite article made up of statements from journals and reports of Americans who have visited China in the 1977-79 period. Observers comment on the health delivery system in China. It is remarkable that, without expensive technology, complex health facilities, and highly trained personnel, China has been able to reduce its death rate substantially in recent years. Reduction of the infant and child mortality rates has encouraged people to practice family planning with assurance that their children will survive to adulthood. The following 2 factors have been responsible for the improvements in the Chinese health delivery system: 1) use of barefoot doctors and other health outreach personnel working at the community level; and 2) use of a combination of traditional Chinese medicine, e.g., acupuncture and herbal medicines, with techniques imported from the West, e.g., X-ray and modern drugs. Often Western methods are used for diagnosis and traditional medicines for treatment. Research into the method of action of traditional medicines is ongoing. Family planning is seen at every level of health service provision. Barefoot doctors actually bring contraceptives to the people at their homes or work places. Family planning services and supplies are free. Provision of supplies is accomplished by minimally trained personnel with referral to more trained people available when necessary.^ieng

Main puteri: an indigenous Kelantanese form of psychotherapy.

The permainan puteri (usually abbreviated to main puteri) is an indigenous Kelantanese healing ceremony in which the bomoh (traditional medicine-man), the sick individual and other participants become spirit-medium through whom puteri (spirits) are able to enact a permainan ('play'). It has been successfully used as a psychotherapy for depression. The bomoh assisted by his minduk (master of spirits) and a troupe of musicians, is able to provide a conceptual framework around which the sick individual can organize his vague, mysterious and chaotic symptoms so that they become comprehensible and orderly. At the same time the bomoh is able to draw the sick individual out of his state of morbid self-absorption and heighten his feelings of self-worth. The involvement of his family, relatives and friends tends to enhance group solidarity and reintegrate the sick individual into his immediate social group.

Traditional and modern medicine in Malaysia.

Malaysia has a large variety of traditional medical systems that are a direct reflection of the wide ethnic diversity of its population. These can be grouped into four basic varieties, namely, traditional "native," traditional Chinese, traditional Indian and modern medicine, examples of which are described. In spite of the great inroads made by modern medicine, the traditional systems are firmly established. Patients move from one system to another or use several systems simultaneously. The integration of the traditional Malay birth attendant into the health team is described. The forces influencing the development, acceptance and integration of the medical systems is discussed.

Incorporating the traditional birth attendant into the health team: the Malaysian example.

Domiciliary deliveries have always been the responsibility of traditional birth attendants. Since Independence, acquired in 1957, educated young women have been trained as auxiliary midwives and sent to serve in rural communities where they usually are met with resistance by the established traditional birth attendants. To counter this and to incorporate the traditional birth attendants into the health team, new roles were developed for each so that the two would be able to cooperate and support each other rather than rival and antagonise each other. A specific experience in one area of Malaysia is examined as an example.