RESUMO
It is important for the practicing primary care provider to become familiar with the unique health care needs for people who identify as transgender men, transgender women, and non-binary people, who are all within the scope of practice of a general obstetrician-gynecologist and other primary care providers. A review of the unique health needs and essential terminology is presented. This knowledge is a basic foundation to develop a welcoming and inclusive practice for people who are gender nonconforming. This fund of knowledge is essential the practicing primary care providers and support staff.
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Ginecologia , Atenção Primária à Saúde , Pessoas Transgênero , Androgênios/uso terapêutico , Neoplasias do Ânus/diagnóstico , Atrofia , Neoplasias da Mama/diagnóstico , Anticoncepção , Detecção Precoce de Câncer , Feminino , Exame Ginecológico , Hospitalização , Humanos , Dispositivos Intrauterinos , Masculino , Mamografia , Teste de Papanicolaou , Infecções por Papillomavirus/diagnóstico , Quartos de Pacientes , Procedimentos de Readequação Sexual , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/tratamento farmacológico , Infecções Sexualmente Transmissíveis/prevenção & controle , Testosterona/uso terapêutico , Neoplasias do Colo do Útero/diagnóstico , Vagina/patologiaRESUMO
People who identify as lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) are underserved and face barriers to knowledgeable health care. Most health systems are ill prepared to provide care that addresses the needs of the LGBTQ community. Basic steps to developing an LGBTQ welcoming health care program are presented. It can be adapted to diverse health care models, from obstetrics and gynecology and other primary care services whether public or private and to hospitals and specialty clinics. This LGBTQ inclusive health care model was developed in collaboration with the LGBTQ community, a multidisciplinary team of health care providers, and professionals of Law and Information Technology.
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Assistência Ambulatorial/métodos , Atitude do Pessoal de Saúde , Atenção à Saúde , Pessoal de Saúde/educação , Acessibilidade aos Serviços de Saúde , Atenção Primária à Saúde , Desenvolvimento de Programas , Minorias Sexuais e de Gênero , Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial , Ginecologia , Disparidades em Assistência à Saúde , Humanos , Obstetrícia , Participação dos Interessados , Populações VulneráveisRESUMO
BACKGROUND: Gender-affirming hormone therapy with either estradiol or testosterone is commonly prescribed for transgender individuals. Masculinizing or feminizing hormone therapy may impact clinical chemistry analytes, but there is currently a lack of published reference intervals for the transgender population. METHODS: Healthy transgender and nonbinary individuals who had been prescribed either estradiol (n = 93) or testosterone (n = 82) for at least 12 months were recruited from primary care and internal medicine clinics specializing in transgender medical care. Electrolytes, creatinine, urea nitrogen, enzymes (alkaline phosphatase, ALK; alanine aminotransferase, ALT; aspartate aminotransferase, AST; gamma-glutamyltransferase, GGT), hemoglobin A1c, lipids [total cholesterol, high-density lipoprotein (HDL), triglycerides], and high-sensitivity C-reactive protein (hsCRP) were measured on 2 clinical chemistry platforms. Reference intervals (central 95%) were calculated according to Clinical Laboratory Standards Institute guidelines. RESULTS: There was minimal impact of gender-affirming hormone therapy on electrolytes, urea nitrogen, hemoglobin A1c, and hsCRP. In general, the enzymes studied shifted toward affirmed gender. Creatinine values for both transgender cohorts overlaid the reference interval for cisgender men, with no shift toward affirmed gender for the estradiol cohort. The effects on lipids were complex, but with a clear shift to lower HDL values in the testosterone cohort relative to cisgender women. CONCLUSIONS: Transgender individuals receiving either masculinizing or feminizing hormone therapy showed significant changes in some analytes that have sex-specific variation in the cisgender population. The clearest shifts toward affirmed gender were seen with enzymes for the estradiol and testosterone cohorts and with creatinine and HDL in the testosterone cohort.
Assuntos
Pessoas Transgênero , Proteína C-Reativa , Química Clínica , Creatinina , Estradiol , Feminino , Hemoglobinas Glicadas , Humanos , Lipídeos , Masculino , Nitrogênio , Testosterona/uso terapêutico , UreiaRESUMO
BACKGROUND: Transgender women and nonbinary people seeking feminizing therapy are often prescribed estrogen as a gender-affirming hormone, which will alter their reproductive hormone axis. Testosterone, estradiol, and other reproductive hormones are commonly evaluated to assess therapy, but reference intervals specific to transgender women have not been established. The objective of this study was to derive reference intervals for commonly measured analytes related to reproductive endocrinology in a cohort of healthy gender nonconforming individuals on stable feminizing hormone therapy. METHODS: Healthy transgender individuals who had been prescribed estrogen (n = 93) for at least a year were recruited from internal medicine and primary care clinics that specialize in transgender medical care. Total testosterone and estradiol were measured using immunoassay and mass spectrometry; LH, FSH, sex hormone binding globulin, prolactin, progesterone, anti-mullerian hormone (AMH), and dehydroepiandrosterone sulfate (DHEAS) were measured using immunoassay; free testosterone was calculated. Reference intervals (central 95%) were calculated according to Clinical Laboratory Standards Institute guidelines. RESULTS: The distribution of results for transgender women was different than what would be expected from cisgender men or women across all measurements. Use of spironolactone was associated with changes in the result distribution of AMH, FSH, LH, and progesterone. Compared to liquid chromatography coupled to tandem mass spectrometry (LC/MS/MS), immunoassay was sufficient for the majority of estradiol and total testosterone measurements; free testosterone added little clinical value beyond total testosterone. CONCLUSION: Reference intervals specific to transgender women should be applied when evaluating reproductive endocrine analytes. Spironolactone is a significant variable for result interpretation of some tests.
Assuntos
Pessoas Transgênero , Feminino , Humanos , Masculino , Valores de Referência , Espectrometria de Massas em Tandem , TestosteronaRESUMO
BACKGROUND: Gender-affirming therapy with testosterone is commonly prescribed to aid in the masculinization of transgender men. Sex-hormone concentrations are routinely measured, but interpretation of results can be difficult due to the lack of published reference intervals. METHODS: Healthy transgender individuals who had been prescribed testosterone (n = 82) for at least a year were recruited from internal medicine and primary care clinics that specialize in transgender medical care. Total testosterone and estradiol were measured using immunoassay and mass spectrometry; LH, FSH, SHBG, prolactin, progesterone, anti-Müllerian hormone (AMH), and dehydroepiandrosterone sulfate (DHEAS) were measured using immunoassay; free testosterone was calculated. Reference intervals (central 95%) were calculated according to Clinical Laboratory Standards Institute guidelines. RESULTS: When evaluating general endocrine laboratory tests in people using masculinizing hormones, reference intervals for cisgender men can be applied for total and free testosterone and SHBG and reference intervals for cisgender women can be applied for prolactin. Reference intervals for estradiol, LH, FSH, AMH, and DHEAS differ from those used for cisgender men and cisgender women, and therefore should be interpreted using intervals specific to the transmasculine population. For testosterone and estradiol, results from immunoassays were clinically equivalent to mass spectrometry. CONCLUSION: Masculinizing hormones will alter the concentrations of commonly evaluated endocrine hormones. Providers and laboratories should use appropriate reference intervals to interpret the results of these tests.
Assuntos
Pessoas Transgênero , Estrogênios , Feminino , Humanos , Imunoensaio , Masculino , Valores de Referência , TestosteronaRESUMO
Excessive and inappropriate use of medications, or 'polypharmacy', has been recognized as a public health problem. In addition, there is growing use of dietary supplements in the United States; however, little is known about the patterns of supplement use. Recent reports in the literature of cases of excessive or inappropriate use of herbal dietary supplements leading to the term 'polyherbacy'. The clinical vignettes described in this article highlight the need for further research on the nature and extent of multiple and inappropriate dietary supplement use or 'dietary supplement polypharmacy'. Clinical interviewing and population surveys both address this issue in complementary ways, and provide a further understanding of dietary supplement use patterns.
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BACKGROUND: Many laboratory tests are reported and interpreted with sex-specific reference intervals. However, transgender individuals receiving masculinizing or feminizing hormone therapy experience physiological changes predisposing some laboratory tests to shift outside of existing reference intervals. In this study, we review laboratory testing of a large cohort of transgender individuals who were prescribed hormone therapy for at least 6 months at an academic medical center. METHODS: Transgender patients were identified using a search function within the electronic health record with gender identity status verified by chart review. Patients were grouped based on type of hormone therapy administered. All laboratory studies were ordered for medical purposes as part of clinical care; as a result, the exact laboratory tests differed among the patients. Some of the patients had sufficient data for both 6- and 12-month comparisons with baseline laboratory values. RESULTS: Statistically significant changes were observed at 6- and 12-month comparisons in basic chemistry, endocrine, and hematologic parameters for transgender individuals receiving masculinizing or feminizing hormones. Chart review demonstrated variation in route of administration of hormone therapy and frequency of gender-affirming surgery within the study population. CONCLUSIONS: Transgender individuals receiving hormone therapy experienced significant changes in components of basic chemistry, endocrine, and hematologic parameters following administration of hormone therapy. Variability in hormone dosing and route of administration for gender-affirming treatment warrants further investigation.
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Serviços de Laboratório Clínico/normas , Atenção à Saúde/normas , Hematologia/normas , Terapia de Reposição Hormonal/métodos , Pessoas Transgênero/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Referência , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: The complete blood count (CBC) is a cornerstone of patient care. Several of the normal values for the components of the CBC differ by sex and, therefore, male-specific and female-specific reference intervals are required to interpret these laboratory results. Transgender individuals are often prescribed hormone therapy to affirm their gender, with resulting serum hormone concentrations similar to those of cisgender individuals. Gender-specific reference intervals for transgender men and women have not been established for any laboratory measurements, including hematology. We established clinically relevant hematological reference intervals for transgender individuals receiving stable hormone therapy. METHODS: Healthy transgender individuals prescribed testosterone (nâ¯=â¯79) or estrogen (nâ¯=â¯93) for ≥12â¯months were recruited from internal medicine and primary care clinics that specialize in transgender medical care. Concentrations for hemoglobin, hematocrit, MCV, MCHC, and RDWCV, as well as counts for red cells, white cells, and platelets, were evaluated. Results were interpreted in reference to the overall distribution of values and relative to serum estradiol and total testosterone concentrations. Calculated reference intervals were compared to established cisgender reference intervals. RESULTS: Regardless of serum hormone concentration, individuals prescribed testosterone or estrogen had hematology parameters that were not clinically different from cisgender males and females, respectively. CONCLUSION: The hematology parameters for transgender men and women receiving stable hormone therapy should be evaluated against the cisgender male and cisgender female reference ranges, respectively and does not require concurrent sex hormone analysis. Care providers can utilize this observation to aid in interpretation of hematology laboratory values for transgender people.
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Hematologia/normas , Hormônios/uso terapêutico , Pessoas Transgênero , Adulto , Estrogênios/sangue , Feminino , Hormônios Esteroides Gonadais/sangue , Hemoglobinas/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Concerns have been raised about the sufficiency of dietary botanical supplement (DBS) surveillance in the US. The Food and Drug Administration's Center for Food Safety and Applied Nutrition's Adverse Event Reporting System (CAERS) represents one of the few existing surveillance mechanisms, but it has not been well characterized with respect to DBS adverse effects. OBJECTIVE: To characterize data on DBSs associated with adverse event reports submitted to CAERS. METHODS: We requested and obtained CAERS data from 1999 to 2003 involving adverse effects associated with the 6 most frequently used DBSs: Echinacea, ginseng, garlic, Ginkgo biloba, St. John's wort, and peppermint. We summarized and characterized the adverse event reports received, focusing on the composition of the DBSs and the nature of associated adverse events. We also cross-referenced reported single-ingredient DBSs with corresponding available product information. A sample of CAERS cases associated with signal DBSs was also characterized in detail. RESULTS: CAERS reports involving ginseng DBSs were most frequently reported during the study period, whereas reports involving St. John's wort were the least frequently reported. Most CAERS reports involved multiple-ingredient DBSs, and 3-13% of reports involved multiple DBSs. Gastrointestinal and neurologic problems were the most common clinical outcomes among single-ingredient DBS-associated adverse events. CONCLUSIONS: CAERS surveillance of DBS adverse effects is potentially as effective as other passive surveillance methods, but the number of reports is relatively small, validation is incomplete, and some inconsistencies within reports were found. Reports in CAERS may underrepresent DBS adverse events associated with DBS consumption.
Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/normas , Suplementos Nutricionais/efeitos adversos , Suplementos Nutricionais/normas , Vigilância de Produtos Comercializados/normas , United States Food and Drug Administration/normas , Sistemas de Notificação de Reações Adversas a Medicamentos/tendências , Echinacea/efeitos adversos , Alho/efeitos adversos , Ginkgo biloba/efeitos adversos , Hypericum/efeitos adversos , Mentha piperita/efeitos adversos , Panax/efeitos adversos , Vigilância de Produtos Comercializados/tendências , Estados Unidos , United States Food and Drug Administration/tendênciasRESUMO
OBJECTIVE: To examine the extent to which US adults use herbs (herbal supplements) in accordance with evidence-based indications. PATIENTS AND METHODS: The Alternative Health supplement of the 2002 National Health Interview Survey (NHIS) is part of an annual, nationally representative survey of US adults. It contains data on adults' use of the 10 herbs most commonly taken to treat a specific health condition in the past year (January 1 to December 31, 2002). The Natural Standard database was used to formulate evidence-based standards for herb use. These standards were applied to the NHIS data to identify groups of people who used herbs appropriately and inappropriately, using a multivariable logistic regression model. RESULTS: Of the 30,617 adults surveyed, 5787 (18.9%) consumed herbs in the past 12 months; of those, 3315 (57.3%) used herbs to treat a specific health condition. Among people who used only 1 herb (except echinacea and ginseng), approximately one third used it consonant with evidence-based indications. Women and people with a college education were more likely to use herbs (with the exception of echinacea) concordant with scientific evidence. Adults younger than 60 years and black adults were significantly less likely to use herbs (with the exception of echinacea) based on evidentiary referents than their counterparts. However, for echinacea users, no significant differences were detected. CONCLUSION: Roughly two thirds of adults using commonly consumed herbs (except echinacea) did not do so in accordance with evidence-based indications. Health care professionals should take a proactive role, and public health policies should disseminate evidence-based information regarding consumption of herbal products.
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Medicina Baseada em Evidências/estatística & dados numéricos , Pesquisas sobre Atenção à Saúde , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fitoterapia/estatística & dados numéricos , Automedicação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Echinacea , Feminino , Ginkgo biloba , Humanos , Masculino , Pessoa de Meia-Idade , Panax , Fitoterapia/normas , Automedicação/normas , Estados UnidosRESUMO
BACKGROUND: Electronic medical records (EMRs) and laboratory information systems (LISs) commonly utilize patient identifiers such as legal name, sex, medical record number, and date of birth. There have been recommendations from some EMR working groups (e.g., the World Professional Association for Transgender Health) to include preferred name, pronoun preference, assigned sex at birth, and gender identity in the EMR. These practices are currently uncommon in the United States. There has been little published on the potential impact of these changes on pathology and LISs. METHODS: We review the available literature and guidelines on the use of preferred name and gender identity on pathology, including data on changes in laboratory testing following gender transition treatments. We also describe pathology and clinical laboratory challenges in the implementation of preferred name at our institution. RESULTS: Preferred name, pronoun preference, and gender identity have the most immediate impact on the areas of pathology with direct patient contact such as phlebotomy and transfusion medicine, both in terms of interaction with patients and policies for patient identification. Gender identity affects the regulation and policies within transfusion medicine including blood donor risk assessment and eligibility. There are limited studies on the impact of gender transition treatments on laboratory tests, but multiple studies have demonstrated complex changes in chemistry and hematology tests. A broader challenge is that, even as EMRs add functionality, pathology computer systems (e.g., LIS, middleware, reference laboratory, and outreach interfaces) may not have functionality to store or display preferred name and gender identity. CONCLUSIONS: Implementation of preferred name, pronoun preference, and gender identity presents multiple challenges and opportunities for pathology.
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PURPOSE: The correlates of complementary and alternative medicine (CAM) utilization among elders have not been fully investigated. This study was designed to identify such correlates in a large sample of older adults, thus generating new data relevant to consumer education, medical training, and health practice and policy. DESIGN AND METHODS: A subsample from the 2000 Wave of the Health and Retirement Study (n = 1,099) aged 52 or older were surveyed regarding use of CAM (chiropractic, alternative practitioners, dietary and herbal supplements, and personal practices). RESULTS: Of respondents over 65 years of age, 88% used CAM, with dietary supplements and chiropractic most commonly reported (65% and 46%, respectively). Users of alternate practitioners and dietary supplements reported having more out-of-pocket expenses on health than nonusers of these modalities. Age correlated positively with use of dietary supplements and personal practices and inversely with alternative practitioner use. Men reported less CAM use than women, except for chiropractic and personal practices. Blacks and Hispanics used fewer dietary supplements and less chiropractic, but they reported more personal practices than Whites. Advanced education correlated with fewer chiropractic visits and more dietary and herbal supplement and personal practices use. Higher income, functional impairment, alcohol use, and frequent physician visits correlated with more alternative practitioner use. There was no association between CAM and number of chronic diseases. IMPLICATIONS: The magnitude and patterns of CAM use among elders lend considerable importance to this field in public health policy making and suggest a need for further epidemiological research and ongoing awareness efforts for both patients and providers.
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Terapias Complementares/estatística & dados numéricos , Atividades Cotidianas , Idoso , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Inquéritos e Questionários , Estados UnidosRESUMO
OBJECTIVES: Complementary and alternative medicine (CAM) is a diverse collection of approaches used to prevent or treat diseases. The goal of this study was to examine relationships between dental patient characteristics and current usage of CAM therapies. METHODS: The CAM definition encompassed 24 therapies excluding prayer. Associations and trends in usage were assessed for gender, income, education, and age. Multivariable logistic and negative binomial models were used to identify factors impacting the use and number of CAM therapies used. RESULTS: In dental patients (n = 402), nearly 67 percent of subjects reported at least one CAM treatment. Gender was significantly associated with recent utilization of CAM, biological, manipulative (all P < 0.01), and mind-body (P = 0.04) therapies, as well as the number (P < 0.01) of therapies used. Higher education levels were significant in usage of any CAM, biological, and mind-body therapies (P < 0.01). CONCLUSION: A large proportion of dental patients reported use of CAM therapies. While CAM therapies and those who use them are diverse, given their widespread use, they clearly have potential impacts on the oral health of the public. Knowledge of the characteristics of dental patients who use CAM therapies is a first step in developing a broader understanding how CAM therapies and associated beliefs may affect oral health and public health programs.
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Terapias Complementares , Serviços de Saúde Bucal , Feminino , Humanos , MasculinoRESUMO
BACKGROUND: Previous research has indicated that older adults with severe life stress show attenuated immune responses to influenza vaccination. Associations among mood, optimism, stress, and the in vitro cytokine response to influenza virus and vaccine were evaluated in 18 healthy older adults with low to moderate life stress. METHODS: Peripheral blood mononuclear cells were stimulated in cultures with 1999-2000 influenza vaccine viruses (A/Beijing/262/95, A/Sydney/5/97, and B/Yamanashi/166/98) and the 2000-2001 trivalent vaccine (containing A/New Caledonia/20/99, A/Panama/2007/99, and B/Yamanashi/166/98). The levels of T-helper type 1 (interleukin-2 and interferon-gamma) and type 2 (interleukin-10) cytokines were measured in culture supernatants. RESULTS: Stress, age, and current health practices were unrelated to cytokine production. Older adults reporting greater anger, fatigue, confusion, and total mood disturbance had poorer cytokine responses to live virus and vaccine stimulation. In contrast, older adults who reported greater vigor and those who were more optimistic had greater cytokine responses to both live virus and vaccine. These relationships were largely unaffected by medications or health conditions. CONCLUSIONS: These findings suggest that among older adults, even mild to moderate mood disturbance is associated with an attenuated cellular immune response to live influenza virus and vaccine.
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Citocinas/biossíntese , Transtornos do Humor/imunologia , Orthomyxoviridae/imunologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Vacinas contra Influenza/imunologia , Interferon gama/biossíntese , Interleucina-10/biossíntese , Interleucina-2/biossíntese , Masculino , Células Th1/imunologia , Células Th2/imunologiaRESUMO
In order to assess attitudes, awareness, and behavior related to complementary and alternative medicine (CAM) among academic physicians, a questionnaire study was conducted with faculty in one of the largest teaching hospitals in the United States. The survey assessed attitudes toward and awareness of 11 CAM therapies in regard to patient usage and usefulness. The majority of respondents believed that only 20% or less of their patients used CAM. Respondents varied widely on level of knowledge/awareness of specific CAM therapies. Those who were more knowledgeable were more likely to perceive CAM as useful and to have recommended more therapies. The modalities respondents noted as knowing the least about were deemed the least useful. Limited knowledge of most CAM therapies and limited awareness of patient CAM use points to the need for continuing education efforts for physicians, focusing on CAM.
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Atitude do Pessoal de Saúde , Terapias Complementares , Docentes de Medicina/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Hospitais de Ensino , Corpo Clínico Hospitalar/psicologia , Adulto , Competência Clínica , Currículo , Educação Médica/organização & administração , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Iowa , Masculino , Corpo Clínico Hospitalar/estatística & dados numéricos , Pessoa de Meia-Idade , Encaminhamento e Consulta , Autocuidado , Inquéritos e Questionários , Recursos HumanosRESUMO
This pilot study investigated the prevalence and specific reasons for usage of complementary and alternative medicine (CAM) among patients of a dental school clinic. Four hundred and two patients completed a 30-page survey on CAM usage. A higher rate of CAM usage was found in this dental school clinic population than rates previously reported in a general population. More than three-quarters (76.1%) of the respondents reported using at least one CAM treatment in the past 12 months; 93.3% reported using at least one CAM treatment at some time in their lives. High rates of chiropractic use were found in this population. Tooth pain was the most frequently reported dental condition motivating CAM use. About 10% of dental school clinic patients use topical oral herbal and/or natural products to treat dental conditions, most frequently for preventive/oral health reasons or for tooth pain.
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Terapias Complementares/estatística & dados numéricos , Assistência Odontológica/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Atitude Frente a Saúde , Dor nas Costas/prevenção & controle , Exercícios Respiratórios , Quiroprática/estatística & dados numéricos , Clínicas Odontológicas , Escolaridade , Feminino , Humanos , Renda/estatística & dados numéricos , Iowa , Masculino , Pessoa de Meia-Idade , Terapia Ortomolecular/estatística & dados numéricos , Fitoterapia/estatística & dados numéricos , Projetos Piloto , Religião , Faculdades de Odontologia , Óleo de Melaleuca/uso terapêutico , Odontalgia/prevenção & controle , População Branca/estatística & dados numéricos , Adulto JovemAssuntos
Idoso de 80 Anos ou mais , Plantas Medicinais/efeitos adversos , Polimedicação , Idoso , Feminino , HumanosRESUMO
OBJECTIVE: Previous studies have noted the role of race/ethnicity in use of complementary and alternative medicine (CAM). Asian and Pacific Islanders (APIs) in particular have been found to use herbs more frequently, although the patterns of use among this population have not been described. The goal of this study was to characterize the rates and patterns of herb use among the API population of the United States. DESIGN: Data from the 2002 US National Health Interview Survey, including the supplement on CAM, were analyzed using SAS. Cross-tabulation and logistical regression were used to determine the association between herb use and race/ethnicity, while adjusting for demographic factors. RESULTS: After adjusting for age, gender and educational attainment, we found that APIs were more likely to use herbs than non-Hispanic Whites (OR=1.3; 95% CI: 1.1, 1.5; p=0.013), with the difference being most prominent in those 60 years old or older (OR=2.9; 95% CI: 1.8, 4.5; p<0.0001). Herb use among APIs was more common among women, those with higher education and income, and those in older age groups. Patterns of use also varied among API subgroups, with Chinese Americans reporting the highest rates of herb use in their lifetimes (44%) and in the previous 12 months (33%). CONCLUSION: Considerable diversity exists within API subgroups with regard to the prevalence and demographic and health correlates of natural herb use. Herb use is more common among APIs than non-Hispanic Whites, particularly among the elderly. The disaggregation of APIs by racial/ethnic subgroups may be important for patient-health care professional interactions, and when designing studies of racial/ethnic minority populations.
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Asiático , Medicamentos de Ervas Chinesas/uso terapêutico , Comportamentos Relacionados com a Saúde/etnologia , Havaiano Nativo ou Outro Ilhéu do Pacífico , Fitoterapia/estatística & dados numéricos , Adulto , Fatores Etários , Estudos Transversais , Emigração e Imigração , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores Sexuais , Classe Social , Estados Unidos , População BrancaRESUMO
PURPOSE: The purpose of this report is to characterize reports to poison control centers (PCCs) involving two widely used herbal dietary supplements (HDSs), Echinacea, and St. John's wort (SJW). METHODS: We purchased data from the American Association of Poison Control Center's (AAPCC) toxic exposure surveillance system (TESS(R)) on reports made to PCCs in 2001 involving Echinacea or SJW. Analyses were limited to those cases in which Echinacea or SJW were the only associated products, and in which these HDSs were deemed primary to observed adverse effects. Descriptive statistics were generated for selected demographic and exposure-related variables. RESULTS: During 2001, PCCs were contacted regarding 406 exposures involving Echinacea and 356 exposures involving SJW. Most of the reported exposures for both HDSs occurred among children 5 years and younger, and the majority of exposures were coded as unintentional. For both HDSs, exposures among patients >/=20 years old were more likely to be associated with adverse effects. Intentional exposures accounted for 21% of SJW cases and 3% of Echinacea cases, with 13% of SJW exposures reported as 'suspected suicidal'. CONCLUSIONS: TESS represents a potentially important means of assessing and characterizing HDS-related adverse effects. Detailed studies validating the clinical events and outcomes of a sample of exposures reported to TESS(R) might offer substantial insights into adverse events (AEs) that could be systematically studied with other, established pharmacoepidemiological study designs.