Update from the Clificol Project: Omicron in Hong-Kongand worldwide overview of the pandemic

The Clificol® COVID-19 Support Project is an innovative international data collection project aimed at documenting the presenting symptoms, use of homeopathy through the pandemic and tackling some of the core questions in homeopathy. The Covid-19 pandemic raised many questions and mobilised many resources. In order to make good use of resources, sound knowledge of the presenting complaints and demographics are required. In particular, we aimed to characterise the recent Omicron wave in Hong-Kong and to get an overall picture of the global pandemic as experienced by the homeopathic community. This online multi-national data-collection project is supported by the ECH, ECCH, ICH, HRI, LMHI, and other professional associations. The collected data includes demographic information, severity, conventional diagnosis and treatment, presenting symptoms as well as the remedies prescribed. The outcome of treatment was tracked using the ORIDL scale. More recently a 23-items prospective questionnaire was added to the input in order to gather targeted data about the presenting complaints. The recent wave of the Omicron variant in Hong-Kong, was analysed (N=372 cases) in terms of the symptomatology of this variant. The data from the 23-items questionnaire is compared to the longer questionnaire (150 items) used by the Hong-Kong team (21 practitioners). The most frequently reported common Clinical symptoms were extreme tiredness (60%), sore throat (46%), headache during fever (45%), dryness of mouth (37%), poor appetite (37%), runny nose (34%) and unusual muscle pains (31%).Also, the cases collected from around the world over the course of the pandemic (N=1300) were analysed, providing an overall picture of the pandemic and its specificities per country and over time. Clificol has shown and continues to show the value of data collection for the homeopathy community, providing important information for the management of future pandemics and opening new avenues for research in homeopathy.

An evidence mapping of systematic reviews and meta-analysis on traditional Chinese medicine for ulcerative colitis.

BACKGROUND: Traditional Chinese Medicine (TCM) has been a proposed treatment option for ulcerative colitis (UC), however it has been difficult to understand the breadth and depth of evidence as various Chinese medicine therapies may produce effects differently. The aim of this evidence mapping is to visually understand the available evidence in the use of TCM in the treatment of UC, and to identify gaps in evidence to inform priorities of future research. METHODS: A systematic electronic literature search of six databases were performed to identify systematic reviews (SRs) on different Chinese medicine therapies in the treatment in UC. Methodological quality of the included SRs was assessed using AMSTAR 2. RESULTS: The mapping was based on 73 SRs, which included nine interventions that met eligibility criteria. The quality of the included SRs was very low. The diseases stages of patients with UC varied greatly, from active to remission, to non-acute outbreak, to not reported. The results mostly favored the method of intervention. Oral administration combined with enema was the most widely used route of administration in secondary research. CONCLUSION: Based on the current evidence, the treatment of UC with TCM can only be recommended cautiously. A majority of included SRs did not report the location of the disease, the disease classification, and the route of administration of the intervention. Further research is needed on the effectiveness of Chinese medicine alone in the treatment of UC. The effectiveness of combined Chinese and conventional medicine combined with different routes of administration cannot be confirmed. Attention should be paid to the methodological quality of the systematic review. Unifies the outcome indicators used in the evaluation of effectiveness.

Dropout and transfer paths: What are the risky profiles when analyzing university persistence with machine learning techniques?

University dropout is a growing problem with considerable academic, social and economic consequences. Conclusions and limitations of previous studies highlight the difficulty of analyzing the phenomenon from a broad perspective and with bigger data sets. This paper proposes a new, machine-learning based method, able to examine the problem using a holistic approach. Advantages of this method include the lack of strong distribution hypothesis, the capacity for handling bigger data sets and the interpretability of the results. Results are consistent with previous research, showing the influence of personal and contextual variables and the importance of academic performance in the first year, but other factors are also highlighted with this model, such as the importance of dedication (part or full time), and the vulnerability of the students with respect to their age. Additionally, a comprehensive graphic output is included to make it easier to interpret the discovered rules.

A text-mining approach to obtain detailed treatment information from free-text fields in population-based cancer registries: A study of non-small cell lung cancer in California.

BACKGROUND: Population-based cancer registries have treatment information for all patients making them an excellent resource for population-level monitoring. However, specific treatment details, such as drug names, are contained in a free-text format that is difficult to process and summarize. We assessed the accuracy and efficiency of a text-mining algorithm to identify systemic treatments for lung cancer from free-text fields in the California Cancer Registry. METHODS: The algorithm used Perl regular expressions in SAS 9.4 to search for treatments in 24,845 free-text records associated with 17,310 patients in California diagnosed with stage IV non-small cell lung cancer between 2012 and 2014. Our algorithm categorized treatments into six groups that align with National Comprehensive Cancer Network guidelines. We compared results to a manual review (gold standard) of the same records. RESULTS: Percent agreement ranged from 91.1% to 99.4%. Ranges for other measures were 0.71-0.92 (Kappa), 74.3%-97.3% (sensitivity), 92.4%-99.8% (specificity), 60.4%-96.4% (positive predictive value), and 92.9%-99.9% (negative predictive value). The text-mining algorithm used one-sixth of the time required for manual review. CONCLUSION: SAS-based text mining of free-text data can accurately detect systemic treatments administered to patients and save considerable time compared to manual review, maximizing the utility of the extant information in population-based cancer registries for comparative effectiveness research.

A Pilot Study of Prospective Data Collection by Italian Homeopathic Doctors.

OBJECTIVE: The main purpose of this article is to report the systematic data collection pertaining to the consultations of a group of qualified homeopathic physicians. Studies have been performed concerning: (1) the most frequently treated pathologies; (2) the symptoms reported by patients, with a particular focus on "fear" symptoms; and (3) the evaluation of the outcomes of the treatment, including likelihood ratio (LR) for fear symptoms of mostly prescribed remedies. DESIGN: Prospective observational study. SETTING: Individualized homeopathic treatment at private homeopathic surgeries in Italy. PARTICIPANTS: Adult patients asking for homeopathic therapy for a series of common ailments. OUTCOME MEASURES: Types of diseases and remedies used and clinical parameters (frequency of acute attacks, and their intensity and duration); the overall outcome of the cure was registered using the Outcome Related to Impact on Daily Living (ORIDL) scale. RESULTS: Only 94 patients could be enrolled by eight homeopathic doctors in a 2-year period between 2015 and 2017. Ninety (72 females, 18 males) patients completed the observation period. The most represented pathologies belonged to the group "Anxiety and anxiety disorders" followed by gastrointestinal ailments. The most prescribed remedy was Phosphorus (9 cases), followed by Natrum muriaticum (4 cases) and Ignatia (4 cases). The intensity of the symptoms and the frequency of the attacks decreased during the course of the study. Most patients reported a positive outcome (ORIDL scale). In the "Phosphorus" group, LR values were calculated for fear symptoms: LR+ for fear of dark = 2.25 (95% confidence interval [CI] = 0.56 to 9.02), LR- for fear of crowds = 1.27 (95% CI = 1.13 to 1.42), and LR- for fear of ghosts = 1.12 (95% CI = 1.04 to 1.22). CONCLUSION: The recruited group was smaller than expected, but data from most participants could be collected. Positive clinical outcomes were recorded and LR of a few specific fears contributed to distinguish Phosphorus patients from the remaining population.

La partería tradicional / Traditional midwifery

RESUMEN Introducción: Las parteras tradicionales apoyan en la atención del parto humanizado, lo cual les permite a las mujeres en trabajo de parto controlar la situación y tomar sus propias decisiones. Objetivo: Describir las prácticas de la partería tradicional en tres regiones del Departamento del Magdalena, Colombia. Métodos: Estudio descriptivo transversal, enfoque cuantitativo, desarrollado con 15 parteras de los municipios de Santa Marta, Ariguaní y Fundación, departamento del Magdalena, los datos fueron recolectados utilizando un cuestionario estructurado y validado, aplicado en el primer semestre de 2016. La muestra fue tomada a conveniencia, dado al nivel de accesibilidad de las investigadoras con las parteras se pudo obtener 5 parteras de cada población, para un total de 15. Los datos cuantitativos fueron analizados utilizando estadística descriptiva (distribución porcentual y media). Resultados: El 54 por ciento se encontraba entre los 50 y 80 años de edad, vivían en zona rural 80 por ciento, tenían entre 30 y 60 años de experiencia como parteras 53 por ciento, todas son mujeres (100 por ciento) y sabían leer y escribir, 93 por ciento hablaba español, solo el 7 por ciento hablaba la lengua nativa, 47 por ciento aprendió a atender partos por tradición familiar, el 25 por ciento aprendió sola, el 20 por ciento aprendió a atender partos por medio de otra persona y el 8 por ciento aprendió por medio de un curso de capacitación. Conclusión: La partería en esta región continúa transfiriéndose de generación en generación, teniendo prácticas tradicionales como el uso de tomas después de la atención del parto(AU)

ABSTRACT Introduction: Traditional midwives support humanized delivery, which allows women in labor to control the situation and make their own decisions. Objective: To describe the practices of traditional midwifery in three regions of Magdalena Department, Colombia. Methods: Cross-sectional descriptive study, with a quantitative approach, developed with 15 midwives from the municipalities of Santa Marta, Ariguaní, and Fundación, Magdalena Department. The data were collected using a structured and validated questionnaire, applied in the first semester of 2016. The sample was taken at convenience, given the researchers' level of accessibility with the midwives. Five midwives from each population could be obtained, for a total of 15. The quantitative data were analyzed using descriptive statistics (percentage and average distribution). Results: 54 percent were at age 50-80 years, 80 percent lived in rural areas, 53 percent had 30-60 years of experience as midwives, all are women (100 percent) and knew how to read and write, 93 percent spoke Spanish, only 7 percent spoke the native language, 47 percent learned how to assist births by family tradition, 25 percent learned by themselves, 20 percent learned how to assist births through another person, and 8 percent learned by means of a training course. Conclusion: Midwifery in this region continues to be transferred from generation to generation, having traditional practices, such as the use of intakes after delivery care(AU)

Maternal health care initiatives: Causes of morbidities and mortalities in two rural districts of Upper West Region, Ghana.

BACKGROUND: Maternal and neonatal morbidities and mortalities have received much attention over the years in sub-Saharan Africa; yet addressing them remains a profound challenge, no more so than in the nation of Ghana. This study focuses on finding explanations to the conditions which lead to maternal and neonatal morbidities and mortalities in rural Ghana, particularly the Upper West Region. METHOD: Mixed methods approach was adopted to investigate the medical and non-medical causes of maternal and neonatal morbidities and mortalities in two rural districts of the Upper West Region of Ghana. Survey questionnaires, in-depth interviews and focus group discussions were employed to collect data from: a) 80 expectant mothers (who were in their second and third trimesters, excluding those in their ninth month), b) 240 community residents and c) 13 healthcare providers (2 district directors of health services, 8 heads of health facilities and 3 nurses). RESULT: Morbidity and mortality during pregnancy is attributed to direct causes such urinary tract infection (48%), hypertensive disorders (4%), mental health conditions (7%), nausea (4%) and indirect related sicknesses such as anaemia (11%), malaria, HIV/AIDS, oedema and hepatitis B (26%). Socioeconomic and cultural factors are identified as significant underlying causes of these complications and to morbidity and mortality during labour and the postnatal period. Birth asphyxia and traditional beliefs and practices were major causes of neonatal deaths. CONCLUSION: These findings provide focused targets and open a window of opportunity for the community-based health services run by Ghana Health Service to intensify health education and promotion programmes directed at reducing risky economic activities and other cultural beliefs and practices affecting maternal and neonatal morbidity and mortality.

Representações sociais de profissionais da saúde acerca das plantas medicinais / Representaciones sociales de profesionales de la salud acerca de las plantas medicinales / The social representations of health professionals about medicinal plants

Introdução: as plantas medicinais fazem parte da cultura popular e atualmente tem-se observado um progressivo interesse e sensibilização dos profissionais de saúde, em especial os que atuam na Estratégia de Saúde da Família. Objetivo: conhecer as representações sociais de profissionais da Estratégia Saúde da Família sobre as plantas medicinais. Métodos: estudo com abordagem qualitativa fundamentado na Teoria das Representações Sociais, realizado com 30 profissionais em seis Unidades Estratégias Saúde da Família do município do Rio Grande/RS/Brasil. Os dados foram colhidos por meio de entrevista semiestruturada, entre os meses de junho a dezembro de 2014, e analisados à luz da análise temática. Resultados: três categorias revelam as representações sociais dos profissionais: Dimensão imagética das plantas medicinais; O saber sustentado no conhecimento híbrido; A indicação de plantas medicinais. As imagens traduzem a realidade externa, sendo que o conhecimento sobre as plantas se fundamenta tanto no saber popular quanto no reificado, demonstrando o entrelaçamento dos aspectos subjetivos e objetivos na representação. A prescrição das plantas medicinais já vem sendo adotada nas unidades estudadas. Conclusões: a utilização das plantas está incorporada no cotidiano dos usuários das unidades, sendo adotada como um recurso terapêutico complementar ao tratamento das morbidades. Embora os profissionais desconhecem as legislações que regulamentam essa prática, há um engajamento em adotarem o uso dessas plantas na prática do serviço de saúde, principalmente diante da parceria com a universidade do município(AU)

Introducción: las plantas medicinales son parte de la cultura popular y ahora se ha visto un progresivo interés y el conocimiento de los profesionales de la salud, especialmente los que trabajan en la estrategia de salud de la familia. Objetivo: conocer las representaciones sociales de los miembros del equipo de la Estrategia de Salud de la Familia acerca de las plantas medicinales. Métodos: estudio con enfoque cualitativo basado en la Teoría de las Representaciones Sociales, realizado con 30 profesionales en las seis familiares del condado Unidades Estrategias de Salud de Río Grande / RS / Brasil. Los datos fueron recolectados a través de entrevista semiestructurada, entre los meses de junio a diciembre de 2014 y analizados a la luz de la análisis temático. Resultados: tres categorías revelan las representaciones sociales de los profesionales: las imágenes de la dimensión de las plantas medicinales; El saber sustentado en el conocimiento híbrido; La indicación de las plantas medicinales. Las imágenes reflejan la realidad externa, y el conocimiento de las plantas se basa tanto en el conocimiento popular como el cosificado, que muestra la interrelación de los aspectos subjetivos y objetivos de la representación. La prescripción de las plantas medicinales se ha adoptado en las unidades estudiadas. Conclusiones: el uso de plantas está integrado en el diario de los usuarios de las unidades, siendo adoptado como un enfoque terapéutico complementario al tratamiento de morbilidades. Aunque los profesionales son conscientes de las leyes que regulan esta práctica, existe el compromiso de adoptar el uso de estas plantas en la práctica de la atención de la salud, especialmente en la colaboración con la universidad de la ciudad(AU)

Introduction: Medicinal plants are part of popular culture and now there has been an increasing interest and knowledge by health professionals, especially those working on family health strategy. Objective: To know the Family Health Strategy team members' social representations about medicinal plants. Methods: A qualitative study based on the social representations theory was carried out with 30 professionals in the six familial Health Strategies Units of the county of Rio Grande, RS, Brazil. Data were collected through a semi-structured interview between June and December 2014 and analyzed under thematic analysis. Results: Three categories reveal the social representations of professionals: the images on the dimension of medicinal plants; the knowledge supported by hybrid knowledge; the indication of medicinal plants. The images reflect the external reality and the knowledge about the plants is based on both popular and reified knowledge, which shows the interrelation of the subjective and objective aspects of representation. Prescription of medicinal plants has been adopted in the units studied. Conclusions: The use of plants is integrated in the daily users of the units, being adopted as a therapeutic approach complementary to the treatment of morbidities. Although professionals are aware of the laws that regulate this practice, there is a commitment to adopt the use of these plants in the practice of health care, especially in collaboration with the city university(AU)

Efectividad de la suplementación de calcio en el índice de masa corporal en personas obesas. Un overview de revisiones sistemáticas / Effectiveness of calcium supplementation on body mass index in obese people. An overview of systematic reviews

Introducción: según la Organización Mundial de la Salud, la obesidad se puede definir como una acumulación anormal o excesiva de grasa que puede ser yatrogénica para la salud. Objetivo: resumir las revisiones sistemáticas Cochrane y no Cochrane que evalúen el efecto de la suplementación de calcio para la disminución del índice de masa corporal en personas obesas. Materiales y métodos: se realizó una búsqueda en la base de datos Medline (1980-septiembre de 2015), metabuscador TripDatabase y Epistemonikos (hasta septiembre de 2015), Cochrane BVS (hasta septiembre de 2015); se buscó de forma manual en revistas relacionadas con el tema de interés; se buscaron actas de congresos, se realizaron seguimientos de referencias relevantes y se contactó con expertos en el área. Resultados: la búsqueda preliminar arrojó un total de 7.163 artículos potencialmente elegibles. Según los criterios de elegibilidad incluimos dos revisiones sistemáticas de estudios clínicos aleatorizados. Conclusión: el suplemento de calcio, al parecer, no incidiría en la disminución del índice de masa corporal, DM 0,12 (-0,62, 0,86); p = 0,75, presentando ‘muy baja evidencia’ según GRADE, esto quiere decir que ‘presenta una gran incertidumbre sobre la estimación del efecto’ (AU)

Introduction: According to the World Health Organization, obesity can be defined as abnormal or excessive fat accumulation that may be iatrogenic health. Objective: To summarize systematic reviews Cochrane and non Cochrane that evaluate the effect of calcium supplementation for reducing body mass index in obese people. Methods: A search was performed in the Medline database (1980-September 2015), metabuscador Tripdatabase and Epistemonikos (until September 2015), Cochrane BVS (to September 2015), was hand searched journal issue interest searched conference proceedings, monitoring was conducted relevant references and contacted experts in the field. Results: The preliminary search yielded a total of 7,163 articles potentially eligible, according to the eligibility criteria include two systematic reviews of randomized trials. Conclusion: Calcium supplementation appears not impact in reducing BMI, DM 0.12 (-0.62, 0.86); p = 0.75. presenting ‘evidence very low’ according GRADE, this means that ‘presents a great uncertainty about the estimate of effect’ (AU)

Maternal, newborn and child health needs, opportunities and preferred futures in Arusha and Ngorongoro: hearing women's voices.

BACKGROUND: With the approaching sunset on the Millennium Development Goals (MDGs), Tanzania continues with its final national push towards achievement of MDG #4 and MDG #5. The Mama Kwanza Socio-economic Health Initiative (MKSHI) was introduced in the hope of contributing to improving maternal, newborn, and child health in Arusha and Ngorongoro. The MKSHI project is a holistic, inter-sectoral approach to maternal, newborn, and child health which aligns with the Government of Tanzania's Vision 2025. At the project onset, a baseline assessment was conducted to launch ongoing benchmarking, monitoring, and evaluation of the project's impacts and implications. The aim of this baseline assessment was twofold. First it was to determine the state of maternal, newborn, and child health in the two project sites. Second it was to ensure that a baseline of key indicators was established as well as identification of unique indicators relevant to the populations of interest. RESULTS: The baseline study was a mixed methods approach to identify maternal, newborn, and child risk factors and indicators in the two target sites. This paper focuses on the qualitative methods and findings. The qualitative component included a series of five community dialogue meetings and thirty-seven individual/dyad interviews with women, providers, and stakeholders. Initially, community meetings were held as open dialogues on maternal, newborn, and child health issues, opportunities, and preferred futures. Individual/dyad interviews were held with women, providers, and stakeholders who held unique information or experiences. Both community dialogue and interview data was analysed for themes and guiding or critical comments. Three over-arching findings emerged: What took you so long to come? How do we know what you know? and How will it change for our daughters? CONCLUSIONS: Participant voices are vital in ensuring the achievement of local and global efforts and preferred futures for maternal, newborn, and child health services. This study contributes to the inclusion of women in all aspects of the planning, implementation, and delivery of maternal, newborn, and child health services in the target areas and beyond.

A multiregional registry experience using an electronic medical record to optimize data capture for longitudinal outcomes in endovascular abdominal aortic aneurysm repair.

OBJECTIVE: Registries have been proven useful to assess clinical outcomes, but data entry and personnel expenses are challenging. We developed a registry to track patients undergoing endovascular aortic aneurysm repair (EVAR) in an integrated health care system, leveraging an electronic medical record (EMR) to evaluate clinical practices, device performance, surgical complications, and medium-term outcomes. This study describes the registry design, data collection, outcomes validation, and ongoing surveillance, highlighting the unique integration with the EMR. METHODS: EVARs in six geographic regions of Kaiser Permanente were entered in the registry. Cases were imported using a screening algorithm of inpatient codes applied to the EMR. Standard note templates containing data fields were used for surgeons to enter preoperative, postoperative, and operative data as part of normal workflows in the operating room and clinics. Clinical content experts reviewed cases and entered any missing data of operative details. Patient comorbidities, aneurysm characteristics, implant details, and surgical outcomes were captured. Patients entered in the registry are followed up for life, and all relevant events are captured. RESULTS: Between January 2010 and June 2013, 2112 procedures were entered in the registry. Surgeon compliance with data entry ranges from 60% to 90% by region but has steadily increased over time. Mean aneurysm size was 5.9 cm (standard deviation, 1.3). Most patients were male (84%), were hypertensive (69%), or had a smoking history (79%). The overall reintervention rate was 10.8%: conversion to open repair (0.9%), EVAR revision (2.6%), other surgical intervention (7.3%). Of the reinterventions, 27% were for endoleaks (I, 34.3%; II, 56.9%; III, 8.8%; IV and V, 0.0%), 10.5% were due to graft malfunction, 3.4% were due to infection, and 2.3% were due to rupture. CONCLUSIONS: Leveraging an EMR provides a robust platform for monitoring short-term and midterm outcomes after abdominal aortic aneurysm repair. Use of standardized templates in the EMR allows data entry as part of normal workflow, improving compliance, accuracy, and data capture using limited but expert personnel. Assessment of patient demographics, device performance, practice variation, and postoperative outcomes benefits clinical decision-making by providing complete and adjudicated event reporting. The findings from this large, community-based EVAR registry augment other studies limited to perioperative and short-term outcomes or small patient cohorts.

Idiopathic clubfoot treated with the Ponseti method: factors associated with patient follow-up.

BACKGROUND: Follow-up after treatment with the Ponseti method is important because of the known association be- tween lack of brace wear and recurrence. This study was designed to ascertain factors associated with patients who did not return for the recommended follow-up versus those who did. METHODS: Between January 1, 2000, and December 31, 2009, 222 patients were treated for idiopathic clubfoot at the New York Ponseti Clubfoot Center at NYU Hospital for Joint Diseases, of which 93 patients (143 feet) were potentially available for follow-up (i.e., ≤ 7 years of age, had not moved, or transferred care to another institution). Attempts were made to contact all patients' parents or guardians by telephone to respond to a survey, which included questions from the Disease Specific Instrument and the Oxford Ankle Foot Questionnaire. Forty-two of the 93 patients (45%) responded. The responder group, those who answered the survey, was compared to the group of non-responders. The responder group was further divided into a returning group (35 out of 42, 83%) and a lost to follow-up group (17%, not followed-up in over a year). A chart review was performed for demographics, Dimeglio/Bensahel and Catterall/Pirani scores, and treatment. RESULTS: When comparing the responder and non- responder groups, the responder group had significantly lower (p < 0.05) Catterall/Pirani scores at initial visit than the non-responder group (5.0 versus 5.5), but otherwise these two groups were similar. Among the responders, 91% or more were very satisfied/satisfied with status and appearance of foot in both lost to follow-up and returning groups. The lost to follow-up group was significantly (p < 0.05) older at the time of the survey (5 years versus 3.7 years), required significantly fewer casts (4.4 versus 5.5), had significantly lower Dimeglio/Bensahel scores at time of the start of foot adbuction orthoses (FAO) (0.0 versus 2.0), and trended toward greater footwear limitations (p = 0.051) compared with the returning group. CONCLUSIONS: Number of casts, severity scores at the start of FAO, and footwear limitations are possible factors to differentiate between lost to follow-up and returning patients. This information may help other clubfoot centers provide vigilant outreach and therefore decrease recurrence rate.

Completeness and usability of ethnicity data in UK-based primary care and hospital databases.

BACKGROUND: Ethnicity recording across the National Health Service (NHS) has improved dramatically over the past decade. This study profiles the completeness, consistency and representativeness of routinely collected ethnicity data in both primary care and hospital settings. METHODS: Completeness and consistency of ethnicity recording was examined in the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES), and the ethnic breakdown of the CPRD was compared with that of the 2011 UK censuses. RESULTS: 27.1% of all patients in the CPRD (1990-2012) have ethnicity recorded. This proportion rises to 78.3% for patients registered since April 2006. The ethnic breakdown of the CPRD is comparable to the UK censuses. 79.4% of HES inpatients, 46.8% of outpatients and 26.8% of A&E patients had their ethnicity recorded. Amongst those with ethnicity recorded on >1 occasion, consistency was over 90% in all data sets except for HES inpatients. Combining CPRD and HES increased completeness to 97%, with 85% of patients having the same ethnicity recorded in both databases. CONCLUSIONS: Using CPRD ethnicity from 2006 onwards maximizes completeness and comparability with the UK population. High concordance within and across NHS sources suggests these data are of high value when examining the continuum of care. Poor completeness and consistency of A&E and outpatient data render these sources unreliable.

Levantamento etnobotânico das plantas medicinais utilizadas pela comunidade de Inhamã, Pernambuco, Nordeste do Brasil / An ethnobotanical survey of medicinal plants used by the rural community of Inhamã, state of Pernambuco, Northeastern Brazil

Avaliou-se o conhecimento, uso, obtenção e indicação terapêutica de plantas utilizadas pela comunidade rural de Inhamã, situada no município de Abreu e Lima, PE, Brasil. Foram realizadas entrevistas semi-estruturadas com 75 moradores. Foram citadas 155 espécies, distribuídas em 112 gêneros e 59 famílias. Conforme a indicação terapêutica, as espécies foram agrupadas em sistemas corporais reconhecidos pela Organização Mundial de Saúde e o índice de importância relativa (IR) foi calculado para cada espécie. Destacaram-se pelo número de espécies, as famílias: Asteraceae, Fabaceae e Lamiaceae. As doenças mais citadas estiveram relacionadas aos sistemas respiratório e gastrointestinal. Ocimum gratissimum, alfavaca, apresentou o maior valor de IR (2,0), seguido por Lippia alba, erva cidreira (1,6), Mentha villosa, hortelã pequena (1,6) e Musa paradisiaca, banana (1,5), indicadas para tratamento de transtornos dos sistemas respiratório, digestório e nervoso. Apenas 11% das espécies citadas tiveram prescrições médicas. Inhamã diferencia-se de outras comunidades próximas a centros urbanos porque os moradores cultivam a maioria das espécies medicinais que consomem.

This study evaluated the extent of knowledge and use and the acquisition of medicinal plants in the rural community of Inhamã, located in the municipality of Abreu e Lima in the state of Pernambuco, Brazil. Medical indications for medicinal plants in this community were also characterized. We conducted semi-structured interviews with 75 community residents. A total of 155 plant species were reported, distributed among 112 genera and 59 families. Species were grouped by body system benefitted according to the code established by the World Health Organization, and relative importance (RI) was calculated for each species. The most represented families were Asteraceae, Fabaceae, and Lamiaceae. The majority of the disease symptoms reported was related to the respiratory and gastrointestinal systems. The Ocimum gratissimum, clove basil, presented the greatest RI value (2.0), followed by Lippia alba, bushy lippia (1.6), Mentha villosa, mint (1.6), and Musa paradisiaca, banana (1.5), all of which are used to treat ailments of the respiratory, gastrointestinal and nervous systems. Of the species reported, only 11% have medical indications. Inhamã differs from other communities located near urban centers, as the local residents cultivate the majority of the medicinal plants they use.

[GRADE guidelines: 12. Developing Summary of Findings tables - dichotomous outcomes]. / GRADE-Leitlinien: 12. Erstellen von "Summary-of-Findings"-Tabellen - Dichotome Endpunkte.

Summary of Findings (SoF) tables present, for each of the seven (or fewer) most important outcomes, the following: the number of studies and number of participants; the confidence in effect estimates (quality of evidence); and the best estimates of relative and absolute effects. Potentially challenging choices in preparing SoF tables include using direct evidence (which may have very few events) or indirect evidence (from a surrogate) as the best evidence for a treatment effect. If a surrogate is chosen, it must be labeled as substituting for the corresponding patient-important outcome. Another such choice is presenting evidence from low-quality randomised trials or high-quality observational studies. When in doubt, a reasonable approach is to present both sets of evidence; if the two bodies of evidence have similar quality but discrepant results, one would rate down further for inconsistency. For binary outcomes, relative risks (RRs) are the preferred measure of relative effect and, in most instances, are applied to the baseline or control group risks to generate absolute risks. Ideally, the baseline risks come from observational studies including representative patients and identifying easily measured prognostic factors that define groups at differing risk. In the absence of such studies, relevant randomised trials provide estimates of baseline risk. When confidence intervals (CIs) around the relative effect include no difference, one may simply state in the absolute risk column that results fail to show a difference, omit the point estimate and report only the CIs, or add a comment emphasizing the uncertainty associated with the point estimate. KEY STATEMENTS: Summary of Findings (SoF) tables provide succinct; easily digestible presentations of confidence in effect estimates (quality of evidence) and magnitude of effects. SoF tables should present the seven (or fewer) most important outcomes. These outcomes must always be patient-important outcomes and never be surrogates, although surrogates can be used to estimate effects on patient-important outcomes. SoF tables should present the highest quality evidence. When the quality of two bodies of evidence (e.g., randomised trials and observational studies) is similar, SoF tables may include summaries from both. SoF tables should include both relative and absolute effect measures, and separate estimates of absolute effect for identifiable patient groups with substantially different baseline or control group risks.

Survey of inspection and palpation rates among spine providers: evaluation of physician performance of the physical examination for patients with low back pain.

STUDY DESIGN: Survey from July 2011 to April 2012 of adult patients with primary complaint of low back pain (LBP). OBJECTIVE: To determine the frequency of physical examination being performed by various providers, as measured by frequency of inspection and palpation, of patients with LBP and to describe patient ratings of these examinations. SUMMARY OF BACKGROUND DATA: The physical examination is a cornerstone of any evaluation of patients with LBP. With increasing reliance on diagnostic imaging, there is concern that patients are not being examined comprehensively, but to our knowledge, no studies have ever investigated how often the physical examination is performed in patients with LBP. METHODS: Survey participants were asked to list the types of physicians that they had seen for LBP within the past 1 year and for each physician encounter to answer 2 "yes/no" questions: (1) whether they had removed their clothes or put on a gown or shorts during the examination (our proxy for inspection) and (2) whether the provider had placed his or her hands on the patient (our proxy for palpation). Subjects also provided quality ratings for each provider's physical examination. Main outcome measures included frequency of inspection and palpation and subjects' ratings of each physical examination. RESULTS: A total of 295 surveys were collected reflecting 696 prior physician encounters. Inspection was done in 57% of physician encounters. Across specialties, orthopedic surgeons had the highest reported rate of inspection at 72%. The worst was among chiropractors at 40%. Palpation occurred in 80% of physician encounters. Chiropractors had the highest rate of palpation at 94%. The lowest rate was among neurosurgeons at 58%. CONCLUSION: Our data suggest that approximately 43% of patient visits for LBP involved no inspection and nearly 20% without palpation. These numbers reflect a need for improvement among providers who treat patients with LBP. LEVEL OF EVIDENCE: N/A.

Association rule mining and network analysis in oriental medicine.

Extracting useful and meaningful patterns from large volumes of text data is of growing importance. In the present study we analyze vast amounts of prescription data, generated from the book of oriental medicine to identify the relationships between the symptoms and the associated medicines used to treat these symptoms. The oriental medicine book used in this study (called Bangyakhappyeon) contains a large number of prescriptions to treat about 54 categorized symptoms and lists the corresponding herbal materials. We used an association rule algorithm combined with network analysis and found useful and informative relationships between the symptoms and medicines.

A holistic approach for assessing traffic safety in the United Arab Emirates.

Traffic accident and fatality rates can be utilized as indicators of traffic safety, but cannot reflect the overall status of traffic safety in a country. This paper uses a holistic perspective approach to investigate traffic safety in the United Arab Emirates (UAE). Initially, 12 potential items were selected to investigate the issue of traffic safety in the country. The investigation included data collection and analyses from official police reports, survey among road-users and interview of traffic safety experts. Based on data analysis and interpretation, the main factors affecting traffic safety in the UAE along with their level of deficiency were identified. The study revealed that the main factors contributing to traffic safety in the UAE are driving behaviour, awareness, education and training, infrastructure, vehicle, law enforcement, coordination and quality of resources. Among these factors, a major deficiency was found in the "driving behaviour", a minor deficiency in "vehicle safety", and a moderate deficiency in the others. Based on the deficiency level of the factors recommendations were proposed to improve the status of traffic safety in the country.

The chiropractic care of patients with cancer: a systematic review of the literature.

BACKGROUND AND SIGNIFICANCE: Cancer is the leading cause of death worldwide and accounted for 7.4 million deaths in 2004. By 2030, deaths from cancer have been estimated at 12 million with 30% being preventable. Complementary and alternative medicine remains popular among cancer patients; particularly with chiropractic services. However, the nature of the chiropractic clinical encounter and its reported benefits remains to be fully investigated. Towards these efforts, we begin with a systematic review of the literature on the chiropractic care of patients with cancer. METHODS: The following electronic databases were searched: MANTIS [1965-2010]; Index to Chiropractic Literature [1984-2010]; Pubmed [1966-2010]; Medline [1965-2010] EMBASE [1974-2010], AMED [1975-2010], CINAHL Plus [1965-2010], Alt-Health Watch [1965-2010] and PsychINFO [1965-2010]. Key words used were "cancer" and "neoplasm" in Boolean combination with "chiropractic." Primary investigation/reports in peer-reviewed English journals involving chiropractic care were reviewed. RESULTS: Our review revealed 60 case reports, 2 case series, 21 commentaries, 2 survey studies, and 2 literature reviews. The case reports were diagnostic with commentaries highlighting the importance of recognizing the patient presenting with NMS complaints due to an underlying neoplasm. The chiropractic clinical encounter prior to cancer diagnosis and subsequent medical referral is poorly characterized in the literature. CONCLUSION: Patients with cancer seek the care of chiropractors. The literature does not reflect or describe the totality of the chiropractic clinical encounter. We encourage further research in this field.