Complementary and alternative medicine (CAM) use among children with current asthma.

OBJECTIVE: To estimate the prevalence of complementary and alternative medicine (CAM) use among children with current asthma. DESIGN: We analyzed data from the Asthma Call Back Survey (ACBS) 2006-2008. ACBS is a follow-up to the state-based Behavioral Risk Factor Surveillance System (BRFSS) survey that collects information on asthma and related factors including CAM use for asthma. The survey is administered to the parents who report in a subset of BRFSS states that their children have asthma. 5435 children had current asthma and were included in this analysis. RESULTS: Overall, 26.7% (95% confidence interval [CI]=24.5-29.0) of children with current asthma reported CAM use in the previous 12 months. Among them, the three most commonly used therapies were breathing techniques (58.5%; 95% CI=53.6-63.5), vitamins (27.3%; 95% CI=23.0-31.5), and herbal products (12.8%; 95% CI=9.2-16.4). Multivariate analysis of CAM use revealed higher adjusted odds ratios (aOR) among children who experienced cost barriers to conventional health care compared with children with no cost barrier (aOR=1.8; 95% CI=1.2-2.8). Children with poorly controlled asthma were most likely to use all types of CAM when compared to their counterpart with well-controlled asthma: aOR=2.3 (95% CI=1.6-3.3) for any CAM; aOR=1.7 (95% CI=1.2-2.6) for self-care based CAM; and aOR=4.4 (95% CI=1.6-9.3) for practitioner-based CAM. CONCLUSIONS: Children with poorly controlled asthma are more likely to use CAM; this likelihood persists after controlling for other factors (including parent's education, barriers to conventional health care, and controller medication use). CAM is also more commonly used by children who experienced cost barriers to conventional asthma care. CAM use could be a marker to identify patients who need patient/family education and support thus facilitate improved asthma control.

Asthma outcome measures.

Asthma is a common chronic disease with underlying inflammation of the airway. Advances in science have led to increased understanding of the heterogeneous nature of asthma and its complex mechanisms. Traditionally, asthma-practice guidelines have focused on optimizing lung function and the US FDA has required increases in lung function and reduction of exacerbation as primary outcomes in clinical trials of new asthma therapeutics. Improved lung function is a critical indicator of bronchodilator therapy, but the importance of long-term asthma control while maintained on controller medication is increasingly emphasized. The NIH asthma guidelines suggest the use of patient-reported outcomes, including health-related quality-of-life measures, to assess asthma control. Clinical practices and research studies concerning asthma can benefit from harmonizing the major outcome measures so that comparisons across studies can be made. In this article, we review common asthma outcome measures with a focus on recent efforts to harmonize outcomes for therapeutic clinical trials in asthma.

Characteristics of complementary and alternative medicine use among adults with current asthma, 2006.

BACKGROUND: Prevalence estimates of complementary and alternative medicine (CAM) use among persons with asthma vary widely; prior studies reported that patients do not discuss CAM use with their physicians. The authors examined the prevalence and characteristics of CAM use among adults with asthma to prepare physicians to discuss CAM use with their patients. METHODS: CAM use among adults with current asthma was analyzed using the 2006 Behavioral Risk Factor Surveillance System (BRFSS) data from a subset of 25 states that completed the follow-up Asthma Callback Survey. CAM use was defined as a "Yes" response to the use of one or more CAM therapies to control asthma during the previous 12 months. Statistics were calculated using SAS v9.2 Proc Surveyfreq to provide weighted estimates and account for complex sample design. RESULTS: The prevalence of CAM use among adults with asthma was 39.6% (95% confidence interval [CI] = 36.9-42.3). There was no significant association with CAM use by sex, race/ethnicity, age, education, or geographic region. After adjusting for demographics and region, CAM use was significantly higher among persons with (1) financial barriers to asthma care (odds ratio [OR] = 2.8, 95% CI = 1.9-4.1); (2) an emergency room (ER) visit due to asthma (OR = 1.7 95% CI = 1.1-2.6); and (3) > or =14 asthma-associated disability days during the previous year (OR = 2.1, 95% CI = 1.4-3.1). CONCLUSIONS: CAM use is common among adults with asthma. It is associated with financial barriers to asthma care and poor asthma control. Physicians should discuss CAM use with their asthma patients.

Acupuncture-point stimulation for chemotherapy-induced nausea and vomiting.

PURPOSE: Assess the effectiveness of acupuncture-point stimulation on acute and delayed chemotherapy-induced nausea and vomiting in cancer patients. MATERIALS AND METHODS: Randomized trials of acupuncture-point stimulation by needles, electrical stimulation, magnets, or acupressure were retrieved. Data were provided by investigators of the original trials and pooled using a fixed-effects model. RESULTS: Eleven trials (N = 1,247) were pooled. Overall, acupuncture-point stimulation reduced the proportion of acute vomiting (relative risks [RR] = 0.82; 95% CI, 0.69 to 0.99; P = .04), but not the mean number of acute emetic episodes or acute or delayed nausea severity compared with controls. By modality, stimulation with needles reduced the proportion of acute vomiting (RR = 0.74; 95% CI, 0.58 to 0.94; P = .01), but not acute nausea severity. Electroacupuncture reduced the proportion of acute vomiting (RR = 0.76; 95% CI, 0.60 to 0.97; P = .02), but manual acupuncture did not; delayed symptoms were not reported. Acupressure reduced mean acute nausea severity (standardized mean difference = -0.19; 95% CI, -0.38 to -0.01; P = .03) and most severe acute nausea, but not acute vomiting or delayed symptoms. Noninvasive electrostimulation showed no benefit for any outcome. All trials used concomitant pharmacologic antiemetics, and all, except electroacupuncture trials, used state-of-the-art antiemetics. CONCLUSION: This review complements data on postoperative nausea and vomiting, suggesting a biologic effect of acupuncture-point stimulation. Electroacupuncture has demonstrated benefit for chemotherapy-induced acute vomiting, but studies with state-of-the-art antiemetics as well as studies for refractory symptoms are needed to determine clinical relevance. Acupressure seems to reduce chemotherapy-induced acute nausea severity, though studies did not involve a placebo control. Noninvasive electrostimulation seems unlikely to have a clinically relevant impact when patients are given state-of-the-art pharmacologic antiemetic therapy.

The effects of payment method on clinical decision-making: physician responses to clinical scenarios.

BACKGROUND: The influence of payment mechanisms on physician decisions is not well understood. OBJECTIVES: The objective of this study was to test 2 null hypotheses: 1) physicians' clinical decisions would not be influenced by payment incentives; and 2) physicians would have equal concern about medical decisions made under capitation or fee-for-service (FFS) arrangements. RESEARCH DESIGN: We conducted a physician survey in which patient insurance status (capitated or FFS) was randomly incorporated into 4 clinical scenarios using a Latin square design. SUBJECTS: We used a nationally representative random sample of family physicians in direct patient care. MEASURES: We used treatment decisions and physician "bother" scores (a measure of discomfort about decisions) in response to the clinical scenarios and adjusted for physician gender, age, board certification, income, practice location, practice mix, practice setting, geographic region, local area managed care penetration, and capitation or risk pool contracts in practice. RESULTS: Seventy-two percent of sampled physicians responded. Comparing decisions made under capitation to FFS, physicians were less likely to indicate they would perform discretionary care (relative risks [RR] range, .64-.82; P<0.001), but payment had no effect on selection of life-saving care (RR, 1.02, not significant). Physicians felt significantly more "bothered" when they made clinical decisions under capitated payment (P<0.001 in all scenarios), regardless of whether a treatment was discretionary or life-saving, and whether the decision was made for or against the treatment (P<0.001). CONCLUSIONS: Payment mechanism has significant effects on clinical decision-making. Reduction of resources spent for discretionary care might be achieved under capitated arrangements; however, physicians respond with greater levels of discomfort under capitation than FFS.

Convulsive syncope associated with acupuncture.

Syncope is a rare but known reaction to acupuncture; however, convulsive syncope has never been previously documented as a reaction to acupuncture. This case report describes an episode of convulsive syncope, characterized by irregular clonic-tonic movements while the patient was unconscious. The episode occurred immediately after the insertion of acupuncture needles into the bilateral ST-36 acupuncture point. Here we discuss the presentation, possible causes, and prevention of convulsive syncope.

Use of complementary/alternative therapies by women with advanced-stage breast cancer.

BACKGROUND: This study sought to describe the pattern of complementary/alternative medicine (CAM) use among a group of patients with advanced breast cancer, to examine the main reasons for their CAM use, to identify patient's information sources and their communication pattern with their physicians. METHODS: Face-to-face structured interviews of patients with advanced-stage breast cancer at a comprehensive oncology center. RESULTS: Seventy three percent of patients used CAM; relaxation/meditative techniques and herbal medicine were the most common. The most commonly cited primary reason for CAM use was to boost the immune system, the second, to treat cancer; however these reasons varied depending on specific CAM therapy. Friends or family members and mass media were common primary information source's about CAM. CONCLUSIONS: A high proportion of advanced-stage breast cancer patients used CAM. Discussion with doctors was high for ingested products. Mass media was a prominent source of patient information. Credible sources of CAM information for patients and physicians are needed.