Factors Influencing the Compliance of Pregnant Women with Iron and Folic Acid Supplementation in the Philippines: 2017 Philippine Demographic and Health Survey Analysis.

Anemia in pregnancy, which is a public health concern for most developing countries, is predominantly caused by iron deficiency. At least, 180 days of iron and folic acid (IFA) supplementation is recommended for pregnant women to mitigate anemia and its adverse effects. This study aimed to examine compliance with the recommendation of IFA supplementation and its underlying factors using the 2017 Philippine National Demographic and Health Survey data. The variables assessed included age, highest level of education, occupation, wealth index, ethnicity, religion, residence, number of pregnancies, time of first antenatal care (ANC) visit and number of ANC visits. Compliance with the recommendation of at least 180 days of IFA supplementation was the outcome variable. The study assessed 7983 women aged 15-49 years with a history of pregnancy. Of these participants, 25.8% complied with the IFA supplementation recommendation. Multiple logistic regression analysis showed that pregnant women of Islamic faith and non-Indigenous Muslim ethnicity were less likely to comply with the IFA supplementation recommendation. Being aged between 25 and 34 years, having better education and higher wealth status, rural residency, initiating ANC visits during the first trimester of pregnancy and having at least four ANC visits positively influenced compliance with IFA supplementation. The effect of residence on IFA adherence differed across the wealth classes. Strategies targeted at specific groups, such as religious minorities, poor urban residents, the less educated and young women, should be strengthened to encourage early and regular antenatal care visits for improving compliance.

Women empowerment and skilled birth attendance in sub-Saharan Africa: A multi-country analysis.

INTRODUCTION: In 2017, the highest global maternal deaths occurred in sub-Saharan Africa (SSA). The WHO advocates that maternal deaths can be mitigated with the assistance of skilled birth attendants (SBAs) at childbirth. Women empowerment is also acknowledged as an enabling factor to women's functionality and healthcare utilisation including use of SBAs' services. Consequently, this study investigated the association between women empowerment and skilled birth attendance in SSA. MATERIALS AND METHODS: This study involved the analysis of secondary data from the Demographic and Health Surveys of 29 countries conducted between January 1, 2010, and December 3, 2018. For this study, only women who had given birth in the five years prior to the surveys were included, which is 166,022. At 95% confidence interval, Binary Logistic Regression analyses were conducted and findings were presented as adjusted odds ratios (aORs). RESULTS: The overall prevalence of skilled birth attendance was 63.0%, with the lowest prevalence in Tanzania (13.8%) and highest in Rwanda (91.2%). Women who were empowered with high level of knowledge (aOR = 1.60, 95% CI = 1.51, 1.71), high decision-making power (aOR = 1.19, 95% CI = 1.15, 1.23), and low acceptance of wife beating had higher likelihood of skill birth attendance after adjusting for socio-demographic characteristics. Women from rural areas had lesser likelihood (OR = 0.53, 95% CI = 0.51-0.55) of skilled birth attendance compared to women from urban areas. Working women had a lesser likelihood of skilled birth attendance (OR = 0.91, 95% CI = 0.88-0.94) as compared to those not working. Women with secondary (OR = 2.13, 95% CI = 2.03-2.22), or higher education (OR = 4.40, 95% CI = 3.81-5.07), and women in the richest wealth status (OR = 3.50, 95% CI = 3.29-3.73) had higher likelihood of skilled birth attendance. CONCLUSION: These findings accentuate that going forward, successful skilled birth attendant interventions are the ones that can prioritise the empowerment of women.

Women Empowerment and Skilled Birth Attendants among Women in Rural Ghana.

BACKGROUND: A critical public health issue is maternal mortality. Around 810 women die per day from pregnancy and childbirth, with approximately 99 percent of these deaths recorded in low-and middle-income countries (LMICs). In sub-Saharan Africa (SSA), more than half of these mortalities are registered. The situation is remarkably similar in Ghana, with maternal mortality standing at 319 deaths per 100,000 live births in 2015. METHODS: Using data from 2014 Demographic and Health Surveys, the study examined the association between women empowerment and skilled birth attendance among women in rural Ghana. RESULTS: Women with medium decision-making (OR = 0.75, CI = 0.61, 0.93), low knowledge level (OR = 0.55, CI = 0.40, 0.76), high acceptance of wife beating (OR = 0.68, CI = 0.51, 0.90), with less than 4 ANC visits (OR = 0.25, CI = 0.19, 0.32), whose partner had higher education (OR = 1.96, CI = 1.05, 3.64), and who had a big problem with the distance getting to the health facility (OR = 0.63, CI = 0.50, 0.78) had a significant association with skilled birth attendants. Decision-making power, women's knowledge level, acceptance of wife beating, antenatal care visit, partner's education, getting medical help for self, and distance to health facility were seen to have a significant association with skilled birth attendants among women in Ghana. CONCLUSION: Efforts to increase the current SBA should concentrate on the empowerment of women, male involvement in maternal health problems, women's education, and participation in the ANC. There is a need to review current policies, strategies, and services to improve maternal health conditions.

Dimensions of women's empowerment on access to skilled delivery services in Nepal.

BACKGROUND: Each day, approximately 810 women die during pregnancy and childbirth and 94% of the deaths take place in low and middle income countries. Only 45% of the births in South Asia are attended by skilled professionals, which is lower than that in other Asian regions. Antenatal and postnatal care received from skilled providers can help prevent maternal and neonatal mortality by identifying pregnancy-related complications. Women's empowerment is considered to be a significant determinant of maternal health care outcomes; however, studies on the contextual influences of different dimensions of empowerment in Nepal are relatively limited. Therefore, this study analyzed nationwide survey data to examine the influence of women's economic empowerment, sociocultural empowerment, familial/interpersonal empowerment and media and information technology empowerment on accessing skilled delivery services among the married women in Nepal. METHODS: This study examined the influence of women's empowerment on skilled delivery services among married women (n = 4400) aged 15-49 years using data from the 2016 Nepal Demographic and Health Survey. Descriptive analysis and binary logistic regression analysis were employed to analyze the data. RESULTS: Significant associations were found between women's media and information technology empowerment, economic empowerment and sociocultural empowerment and access to skilled birth attendants. Specifically, the education of women, their occupation, owning a bank account, media exposure, and internet use were significantly associated with the use of skilled birth attendants. CONCLUSION: Focusing on women's access to media and information technology, economic enhancement and education may increase the use of skilled birth attendants in Nepal.

Association between selenium intake and breast cancer risk: results from the Women's Health Initiative.

PURPOSE: It has been hypothesized that selenium (Se) can prevent cancer, and that Se deficiency may be associated with an increased risk of breast cancer. However, findings from epidemiological studies have been inconsistent. The objective of this study was to assess the association between Se intake and risk of breast cancer in the Women's Health Initiative (WHI). METHODS: This study included 145,033 postmenopausal women 50-79 years who completed baseline questionnaires between October 1993 and December 1998, which addressed dietary and supplemental Se intake and breast cancer risk factors. The association between baseline Se intake and incident breast cancer was examined in Cox proportional hazards analysis. RESULTS: During a mean follow-up of 15.5 years, 9487 cases of invasive breast cancer were identified. Total Se (highest versus lowest quartile: HR 1.00, 95% CI 0.92-1.09, Ptrend = 0.66), dietary Se (highest versus lowest quartile: HR 0.99, 95% CI 0.89-1.08, Ptrend = 0.61), and supplemental Se (yes versus no: HR 0.99, 95% CI 0.95-1.03) were not associated with breast cancer incidence. CONCLUSIONS: This study indicates that Se intake is not associated with incident breast cancer among postmenopausal women in the United States. Further studies are needed to confirm our findings by using biomarkers such as toenail Se to reduce the potential for misclassification of Se status.

Electroacupuncture for postoperative pain after nasal endoscopic surgery: study protocol for a pilot randomized controlled trial.

BACKGROUND: Postoperative pain is common after nasal endoscopic surgery. It interferes with the quality of sleep and delays postoperative recovery. Acupuncture is an effective tool for pain management. However, electroacupuncture specifically for the relief of postoperative pain after nasal endoscopic surgery has not yet been studied in a randomized controlled trial. METHODS/DESIGN: This randomized sham-controlled patient- and assessor-blind pilot trial has been designed to evaluate the efficacy and safety of electroacupuncture in managing postoperative pain following nasal endoscopic surgery to treat sinusitis due to nasal polyps. Altogether, 30 participants will be randomly allocated to an electroacupuncture or non-invasive sham control in a 1:1 ratio. Treatment will occur within 2 h before the operation, immediately after the operation upon arrival in the recovery ward, and once daily for 3 days. The primary outcome is the pain numerical rating scale, which will be analyzed using the area under the curve. The secondary outcome measures include heart rate and blood pressure after the operation, sleep quality during the hospital stay (actigraph), quality of recovery, and the 36-item short form health survey. This trial will use an intention-to-treat analysis. DISCUSSION: This pilot randomized controlled trial will explore the feasibility of the further clinical application of electroacupuncture for the management of postoperative pain. It will inform the design of a further full-scale trial. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1900024183. Registered on 29 June 2019.

Disparities in complementary alternative medicine use and asthma exacerbation in the United States.

Background: Complementary and alternative medicines (CAM) are associated with poor asthma medication adherence, a major risk factor for asthma exacerbation. However, previous studies showed inconsistent relationships between CAM use and asthma control due to small sample sizes, demographic differences across populations studied, and poor differentiation of CAM types.Methods: We examined associations between CAM use and asthma exacerbation using a cross-sectional analysis of the 2012 National Health Interview Survey. We included adults ≥18 years with current asthma (n = 2,736) to analyze racial/ethnic differences in CAM use as well as the association between CAM use and both asthma exacerbation and emergency department (ED) visit for asthma exacerbation across racial/ethnic groups. We ran descriptive statistics and multivariable logistic regressions.Result: Blacks (OR = 0.63 [0.49-0.81]) and Hispanics (OR = 0.66 [0.48-0.92]) had decreased odds of using CAM compared to Whites. Overall, there was no association between CAM use and asthma exacerbation (OR = 0.99 [0.79-1.25]) but the subgroup of 'other complementary approaches' was associated with increased odds of asthma exacerbation among all survey respondents (1.90 [1.21-2.97]), Whites (OR = 1.90 [1.21-2.97]), and Hispanics (OR = 1.43 [0.98-2.09). CAM use was associated with decreased odds of an ED visit for asthma exacerbation (OR = 0.65 [0.45-0.93]). These associations were different among racial/ethnic groups with decreased odds of ED visit among Whites (OR = 0.50 [0.32-0.78]) but no association among Blacks and Hispanics.Conclusion: We found that both CAM use and the association between CAM use and asthma exacerbation varied by racial/ethnic group. The different relationship may arise from how CAM is used to complement or to substitute for conventional asthma management.

Erythrocyte membrane n-3 polyunsaturated fatty acids are inversely associated with the presence and progression of nonalcoholic fatty liver disease in Chinese adults: a prospective study.

PURPOSE: Previous studies have shown that high-dose supplementation with n-3 polyunsaturated fatty acids (PUFAs) may benefit patients with nonalcoholic fatty liver disease (NAFLD), but the association of n-3 PUFAs with NAFLD among individuals with normal diets is only speculative. We investigated the cross-sectional and prospective associations between n-3 PUFAs and NAFLD in Chinese adults. METHODS: This community-based prospective study included 3049 men and women (40-75 years) in Guangzhou, China, whose participants completed an NAFLD ultrasound evaluation and erythrocyte PUFA tests. A total of 2660 participants underwent the second NAFLD evaluation approximately 3 years later. α-Linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in erythrocytes were measured by gas chromatography. RESULTS: After adjusting for potential confounders, we observed inverse associations between DHA, DHA + EPA, total n-3 PUFAs and the presence of NAFLD in the cross-sectional analysis. The adjusted odds ratios (95% confidence interval) of NAFLD for the highest (vs. lowest) tertile were 0.74 (0.61, 0.90) for DHA, 0.82 (0.67, 1.00) for EPA, 0.73 (0.60, 0.88) for DHA + EPA and 0.74 (0.61, 0.91) for total n-3 PUFAs  (all P values≤0.05). Over the average 3.12 years of follow-up, higher levels of DHA was associated with an improvement of NAFLD. The hazard ratio of improved NAFLD for the highest tertile was 1.18 (95% CI 1.09, 1.33) for DHA. Pathway analyses showed that favorable associations may be mediated by improvements in inflammatory markers (e.g., interleukin 1 beta and tumor necrosis factor alpha-like). CONCLUSIONS: Erythrocyte membrane n-3 PUFAs are inversely associated with the presence and progression of NAFLD in Chinese adults. TRIAL REGISTRATIONS: ClinicalTrials.gov NCT03179657.

Self- Reported Personal and Family History of Cancers in Brunei Darussalam: Result of an Integrated Health Survey.

INTRODUCTION: Cancers remain an important cause of mortality and morbidity, and overall incidence of cancers continues to increase worldwide with some cancers increasing while others decreasing. Understanding the epidemiology of cancer burden is important for health care planning. Most studies to date have reported incidence based on cancer registry. This aim of this study is to report the incidence of self-reported personal and family history of cancers. MATERIALS AND METHODS: Data on cancers were extracted from an anonymized database of a survey (Integrated Health Screening Survey) for civil servants conducted between 2008 and 2013 (N=21,437, mean age 40.61 ± 9.46 years old, men 45.1%). RESULTS: The overall incidence of self-reported cancers was 11.2%; personal and family histories were 0.6% and 9.4% respectively (1.2% did not state if cancers were either personal or family history). Commonly self-reported personal history of cancers were cancer of the breast, cervix and colorectal and for self-reported family history were cancers of the gastrointestinal tract, pulmonary, breast, head/neck and gynecological system. Common associations were with first degree relatives (single parent affected 50.8%, both parents affected 1.8%, siblings affected 21.9% and parents and siblings affected 3.1%). Involvement of grandparents accounted for 13.4%. The numbers affected ranged from one to three family members. For self-reported personal history of cancers, older age and gender were significant on univariate analysis and remained on multivariate analyses (p<0.05). For self-reported family history of cancers, older age, gender, professionals employment and smoking status were significant on univariate analysis but only older age, gender, race and professional employments remained significant factors on multivariate analyses (p<0.05). CONCLUSIONS: Our study showed that more than one in nine of participants reported personal or family histories of cancers, and certain characteristics were predictive of self-reporting history of cancers. Associations of cancers were mainly with first degree relatives.

Help-seeking from indigenous healers among persons of African ancestry in the United States: Ethnic and racial disparities in mental and physical health.

OBJECTIVE: Racial disparities in mental and physical health status are a persistent problem for people of African ancestry in the United States (U.S.). The current study seeks to determine whether indigenous help-seeking is related to ethnic and racial differences in health problems in persons of African ancestry. METHODS/DESIGN: Complex sampling produced a nationally representative sample of 3570 African Americans, 1623 Caribbean Blacks, and 1006 non-Hispanic Whites. All 3750 African Americans, 1438 (88.6%) African Caribbeans, and 891(88.6%) European Americans had relevant data for the current study. Respondents to the National Survey of American Life (NSAL) were studied with structural equation modeling (SEM) to evaluate a model of help seeking from "faith healers," "herbalists or rootworkers," or "astrologists or psychics." Mental and physical health were predicted by this indigenous help-seeking. RESULTS: Consistent with the hypothesis, SEM analyses indicated better model fit for African Americans with greater similarly to African Caribbean respondents (r = .901, p =  .001) than European Americans counterparts (r = -.332, p =  .382) in measurement models. These analyses also showed African Americans' indigenous help-seeking was negatively correlated with lifetime diagnoses of any DSM psychiatric disorders but positively correlated with burden of chronic diseases. The association between indigenous help-seeking and professional diagnoses of chronic diseases was negative for Caribbean Blacks. CONCLUSION: Culturally competent psychological or medical services by Western practitioners to people in the U.S Black population require attention to indigenous healing systems.

Assessing associational strength of 23 correlates of child anthropometric failure: An econometric analysis of the 2015-2016 National Family Health Survey, India.

Despite the broad consensus that investments in nutrition-sensitive programmes are required to reduce child undernutrition, in practice empirical studies and interventions tend to focus on few nutrition-specific risk factors in isolation. The 2015-16 National Family Health Survey provides the first opportunity in more than a decade to conduct an up-to-date comprehensive evaluation of the relative importance of various maternal and child health and nutrition (MCHN) factors in respect to child anthropometric failures in India. The primary analysis included 140,444 children aged 6-59 months with complete data on 20 MCHN factors, and the secondary analysis included a subset of 25,603 children with additional paternal data. Outcome variables were stunting, underweight and wasting. We conducted logistic regression models to first evaluate each correlate separately in age- and sex-adjusted models, and then jointly in a mutually adjusted model. For all anthropometric failures, indicators of past and present socioeconomic conditions showed the most robust associations. The strongest correlates for stunting were short maternal stature (OR: 4.39; 95%CI: 4.00, 4.81), lack of maternal education (OR: 1.74; 95%CI: 1.60, 1.89), low maternal BMI (OR: 1.64; 95%CI: 1.54, 1.75), poor household wealth (OR: 1.25; 95%CI: 1.15, 1.35) and poor household air quality (OR: 1.22; 95%CI: 1.16, 1.29). Weaker associations were found for other correlates, including dietary diversity, vitamin A supplementation and breastfeeding initiation. Paternal factors were also important predictors of anthropometric failures, but to a lesser degree than maternal factors. The results remained consistent when stratified by children's age (6-23 vs 24-59 months) and sex (girls vs boys), and when low birth weight was additionally considered. Our findings indicate the limitation of nutrition-specific interventions. Breaking multi-generational poverty and improving environmental factors are promising investments to prevent anthropometric failures in early childhood.

Coffee consumption and risk of hypertension in the SUN Project.

BACKGROUND & AIMS: Evidence on coffee consumption and its association with the incidence of hypertension is still inconsistent. The aim of this study was to examine the association of regular or decaffeinated coffee consumption with the risk of developing hypertension in a middle-aged Mediterranean cohort. METHODS: The SUN Project is a prospective open cohort with more than 22,500 Spanish university graduates. For the present study, we analyzed data from 13,374 participants initially free of hypertension (mean follow-up 9.1 years). The consumption of regular and decaffeinated coffee was obtained at baseline using a previously validated semi-quantitative food frequency questionnaire. Validated, self-reported medical diagnoses of hypertension were collected biennially. We used Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for incident hypertension according to baseline coffee consumption. We assessed the interaction with sex and baseline adherence to the Mediterranean diet. RESULTS: Among 121,397 person-years of follow-up, a total of 1757 participants developed hypertension. Overall, coffee consumption -either caffeinated or decaffeinated- was not significantly associated with the risk of hypertension. Only among women, higher consumption of regular coffee was associated with a 26% lower risk of hypertension (>=2 cups/d vs. never/seldom, 95% CI 9%-39%; p for interaction: 0.0236). Women with a low baseline adherence to the Mediterranean diet showed the strongest risk reduction (HR ≥ 2 cups/d vs. never/seldom 0.58, 95% CI (0.41-0.82) p for interaction = 0.0452). CONCLUSION: In the SUN project we found an inverse association between regular coffee consumption and the risk of hypertension in women, which was strongest among women with a suboptimal food pattern (low adherence to the Mediterranean diet).

[Use of medicinal plants in patients with symptoms of generalized anxiety]. / Uso de plantas medicinales en pacientes con síntomas de ansiedad generalizada.

BACKGROUND: Anxiety is one of the most common mental disorders. It has an impact on the decrease of productivity, the affectation of quality of life, and the increase in health care costs. The study of plant species with medicinal properties to treat anxiety has made significant progress, since they have been evaluated through in vitro, in vivo and clinical studies. OBJECTIVE: To identify the use of medicinal plants among patients with symptoms of generalized anxiety disorder (GAD). MATERIAL AND METHODS: A diagnostic questionnaire, including the Hamilton Anxiety Rating Scale, and another related with the use of medicinal plants, was applied. It was designed specifically for this study, and it was used in subjects and/or their companions, who visited an Instituto Mexicano del Seguro Social hospital. RESULTS: The study had 985 subjects, 802 women, with a median age of 37.1 ± 15.17; anxiety symptoms were identified in 95.9% (940); according to the number of signs and symptoms, 53.1% (523) of subjects may have suffered a moderate or severe degree of anxiety. 23.09% (187) used medicinal plants to treat their symptoms. 39 plant species were identified as used by patients with GAD symptoms. Of these, 76.3% (29) had a history of ethnomedical use on mental disorders. CONCLUSIONS: A high percentage of the population in Mexico presents symptoms of GAD. A significant number of patients use medicinal plants to treat the symptoms of anxiety, even when they do not know that their symptomatology is part of a mental disorder.

INTRODUCCIÓN: la ansiedad es uno de los trastornos mentales más comunes. Incide en la pérdida de productividad, la afectación de la calidad de vida y el aumento en el gasto de la atención médica. El estudio de especies vegetales con propiedades medicinales para tratar la ansiedad ha progresado, al evaluarse con estudios in vitro, in vivo y clínicos. OBJETIVO: identificar el uso de plantas medicinales en pacientes con síntomas de trastorno de ansiedad generalizada (TAG). MATERIAL Y MÉTODOS: se aplicó un cuestionario diagnóstico que incluía la Escala para ansiedad generalizada de Hamilton y otro relacionado con el uso de plantas medicinales. Se diseñó ex profeso para personas que acuden a consulta a un hospital del IMSS o sus acompañantes (si eran derechohabientes). RESULTADOS: participaron 985 personas, 802 mujeres, con una mediana de edad de 37.1 ± 15.17; en 95.9% (940) se identificaron síntomas de ansiedad; el 53.1% (523) de los encuestados pudo haber estado padeciendo un grado de ansiedad moderada o severa. Del total, 23.09% (187) usaban plantas medicinales para tratar sus síntomas. Se identificaron 39 especies vegetales que empleaban los pacientes con síntomas de TAG. De ellas, 76.3% (29) tenía antecedentes de uso etnomédico en trastornos mentales. CONCLUSIONES: un alto porcentaje de la población en México presenta síntomas de TAG. Un número importante de los pacientes usa plantas medicinales para tratar los síntomas de ansiedad, aun cuando no saben que su sintomatología es parte de un desorden mental.

Bangladesh Chars Tobacco Assessment Project (CTAP) 2018: a data note.

OBJECTIVES: The Chars Tobacco Assessment Project 2018 is a holistic survey conducted in the chars (riverine islands) of Gaibandha in Northern Bangladesh, covering 985 households over 24 clusters. The survey was conducted with two objectives: (1) to assess levels of tobacco consumption and evaluate prevailing socio-economic, behavioral and health status of the chars population, and (2) to look at the effectiveness of advocacy campaigns to reduce tobacco consumption through behavioral nudges via randomized controlled trials (RCTs) in rural Bangladesh. The study site was purposively chosen due to its high tobacco consumption rate, and the geographical segregation of the chars aided in reducing spillovers for RCT design. DATA DESCRIPTION: In addition to detailed information on tobacco (smoking and smokeless) consumption and perception, data was collected on: household composition, housing and plot ownership, consumption, risks and shocks coping, dowry, farm production, loans, savings and lending, labor income, asset holdings, migration and remittance, anthropometry, respiratory diseases, co-morbidities, reproductive history, risk and time preference. Unique to the dataset are carbon monoxide readings for accurate short term smoking measurement and FEV1 and PEF values for identification of long term lung damage. The data is representative only for the chars of Gaibandha.

Mindfulness and emotion regulation: promoting well-being during the transition to college.

BACKGROUND AND OBJECTIVES: Managing stress is very important for first-year college students adjusting to undergraduate life. Aspects of emotion regulation, including mindfulness and the ability to regulate distressing emotion adaptively, often correlate positively with well-being. However, little research has examined overlapping and/or distinct effects of these constructs in predicting changes in adjustment over a stressful transition. Thus, the present study examined the contributions of mindfulness and adaptive emotion regulation abilities in maintaining well-being during the transition to college. We further examined experience with mind-body practices, which may promote mindfulness and positive adjustment. DESIGN: Online surveys were administered to 158 undergraduates near the beginning and end of their first semester. METHODS: Near semester start and end, students reported levels of mindfulness, adaptive emotion regulation abilities, emotional and spiritual well-being, and experience with mind-body practices. RESULTS: Compared to mindfulness, adaptive emotion regulation abilities largely demonstrated stronger cross-sectional and longitudinal associations with well-being. However, mindfulness uniquely protected against changes in depression for students with greater emotion regulation difficulties. Over half of participants reported having tried mind-body practices, but just 1% reported current use. CONCLUSIONS: Promoting mindfulness practices and adaptive emotion regulation abilities at the start of college may build resilience in undergraduate students.

Medical cannabis legalization and state-level prevalence of serious mental illness in the National Survey on Drug Use and Health (NSDUH) 2008-2015.

Although research has established a link between cannabis legalization and use, and cannabis use and mental health, the relationship between medical cannabis legalization and mental health remains uncharacterized. This analysis investigated the relationship between state medical cannabis laws (restrictive, i.e. covering a narrow set of medical conditions; or liberal, i.e. covering a broad range of medical conditions), whether the law permits patients to petition their physician to approve medical cannabis use for specific medical conditions, and state prevalence of serious mental illness (SMI) in the National Survey of Drug Use and Health 2008-2015. In a covariate-adjusted meta-regression, liberal laws were significantly associated with higher prevalence of SMI (Coeff = 0.003, SE = 0.001, p < .001). Restrictive laws (Coeff = 0.001, SE = 0.001, p = .285) and the ability to petition physician approval (Coeff = -0.001, SE = 0.001, p = .140) were non-significant. When added to the model, state past-year cannabis use was significantly associated with higher prevalence of SMI (Coeff = 0.037, SE = 0.015, p = .018), liberal laws remained significant (Coeff = 0.002, SE = 0.001, p = .015), and restrictive laws (Coeff = -0.0001, SE = 0.001, p = .945) and the ability to petition a physician (Coeff = 0.001, SE = 0.001, p = .290) remained non-significant. Medical cannabis laws are likely related to state mental health, and a higher prevalence of cannabis use partially explains this relationship.

Herbal medicine use among Type 2 diabetes mellitus patients in Nigeria: understanding the magnitude and predictors of use.

Background Patients with chronic diseases exploit complementary and alternative treatment options to manage their conditions better and improve well-being. Objective To determine the prevalence and predictors of herbal medicine use among Type 2 Diabetes patients in Lagos, Nigeria. Setting Secondary healthcare facilities in Lagos state, Nigeria. Method The study design was a cross sectional survey. A two-stage sampling approach was used to select the health facilities and patients were recruited consecutively to attain the sample size. Data was collected using a structured and standardized interviewer-administered questionnaire. Characteristics, prevalence and predictors of herbal medicine use were assessed using descriptive statistics and multivariate regression analyses. Main outcome measure Herbal medicine use among Type 2 diabetes mellitus patients. Results 453 patients were surveyed, 305 (67.3%) reported herbal medicine use, among whom 108 (35.4%) used herbal and conventional medicines concurrently; 206 (67.5%) did not disclose use to their physician. Herbal medicine use was significantly associated with age (p = 0.045), educational level (p = 0.044), occupation (p = 0.013), duration of diabetes disease (p = 0.007), mode of diabetes management (p = 0.02), a positive history of diabetes (p = 0.011) and presence of diabetes complication (p = 0.033). Formulations or whole herbs of Vernonia amygdalina, Moringa oleifera, Ocimum gratissimum, Picralima nitida, and herbal mixtures were the commonest herbal medicine. Beliefs and perceptions about herbal medicine varied between the users and non-users. Conclusion The use of herbal medicine among Type 2 diabetes mellitus patients in Lagos, Nigeria is high. There is dire need for health care practitioners to frequently probe patients for herbal medicine use and be aware of their health behaviour and choices, with a view to manage the disease better.

Medical Marijuana Users are More Likely to Use Prescription Drugs Medically and Nonmedically.

OBJECTIVES: Previous studies have found a negative population-level correlation between medical marijuana availability in US states, and trends in medical and nonmedical prescription drug use. These studies have been interpreted as evidence that use of medical marijuana reduces medical and nonmedical prescription drug use. This study evaluates whether medical marijuana use is a risk or protective factor for medical and nonmedical prescription drug use. METHODS: Simulations based upon logistic regression analyses of data from the 2015 National Survey on Drug Use and Health were used to compute associations between medical marijuana use, and medical and nonmedical prescription drug use. Adjusted risk ratios (RRs) were computed with controls added for age, sex, race, health status, family income, and living in a state with legalized medical marijuana. RESULTS: Medical marijuana users were significantly more likely (RR 1.62, 95% confidence interval [CI] 1.50-1.74) to report medical use of prescription drugs in the past 12 months. Individuals who used medical marijuana were also significantly more likely to report nonmedical use in the past 12 months of any prescription drug (RR 2.12, 95% CI 1.67-2.62), with elevated risks for pain relievers (RR 1.95, 95% CI 1.41-2.62), stimulants (RR 1.86, 95% CI 1.09-3.02), and tranquilizers (RR 2.18, 95% CI 1.45-3.16). CONCLUSIONS: Our findings disconfirm the hypothesis that a population-level negative correlation between medical marijuana use and prescription drug harms occurs because medical marijuana users are less likely to use prescription drugs, either medically or nonmedically. Medical marijuana users should be a target population in efforts to combat nonmedical prescription drug use.

Factors associated with alcohol consumption among medical cannabis patients with chronic pain.

INTRODUCTION: Chronic pain is the most common reason for medical cannabis certification. Data regarding alcohol use and risky drinking among medical cannabis patients with pain is largely unknown. Therefore, we examined the prevalence and correlates of alcohol use and risky drinking in this population. METHODS: Participants completed surveys regarding demographics, pain-related variables, anxiety, cannabis use, and past six-month alcohol consumption. Alcohol use groups were defined using the AUDIT-C [i.e., non-drinkers, low-risk drinkers, and high-risk drinkers (≥4 for men and ≥3 for women)] and compared on demographic characteristics, pain measures, anxiety, and cannabis use. RESULTS: Overall, 42% (n=330/780) were non-drinkers, 32% (n=251/780) were low-risk drinkers, and 26% (n=199/780) were high-risk drinkers. Compared to non-drinkers, low- and high-risk drinkers were significantly younger whereas a larger proportion of low-risk drinkers reported being African-American compared to non- or high-risk drinkers. High-risk drinkers reported significantly lower pain severity/interference compared to the other groups; high-risk drinkers were also less likely to be on disability compared to other groups. A multinomial logistic regression showed that patients reporting lower pain severity and less disability had greater odds of being classified a high-risk drinker. CONCLUSIONS: High-risk drinking appears common among medical cannabis patients. Future research should examine whether such use is concurrent or consecutive, and the relationship of such co-use patterns to consequences. Nevertheless, individuals treating patients reporting medical cannabis use for pain should consider alcohol consumption, with data needed regarding the efficacy of brief alcohol interventions among medical cannabis patients.

Epidemiological survey of patients with psoriasis in Matsumoto city, Nagano Prefecture, Japan.

A local epidemiological survey of psoriasis was conducted from 19 February to 30 June 2016 in Matsumoto city, Nagano Prefecture, Japan. Patients were predominantly male (268 cases, 71.5% males vs 107 cases, 28.5% females). We estimated that the prevalence of psoriasis was 0.097% in the Matsumoto area. The clinical types of psoriasis identified were psoriasis vulgaris (90.7%), psoriatic arthritis (5.9%), pustular psoriasis (2.1%), guttate psoriasis (1.0%) and psoriatic erythroderma (0.3%). The topical therapeutic agents included corticosteroids (84.0%), vitamin D3 analogs (61.5%), and a combination of calcipotriol and betamethasone dipropionate (31.0%). Current systemic treatments included cyclosporin (9.0%), etretinate (7.4%) and methotrexate (1.3%). Biologic treatments included adalimumab (4.0%), ustekinumab (2.7%), infliximab (1.3%) and secukinumab (0.8%). Ultraviolet B therapy (11.3%) was the predominant phototherapy in which narrow band ultraviolet B therapy accounted for the majority, followed by psoralen and ultraviolet A therapy (1.0%). According to the recent evolution of psoriasis treatment, the use of biologics has been increasing. This study demonstrates the changes of treatment trends of psoriasis in a non-metropolitan regional area.