Age, race, and ethnicity in the use of complementary and alternative medicine for health self-management: evidence from the 2002 National Health Interview Survey

OBJECTIVES: Determine if complementary and alternative medicine (CAM) use for treating existing conditions and for health maintenance differs by age and ethnicity. METHODS: Data from the 2002 National Health Interview Survey were used to operationalize distinct types of CAM in terms of (a) no use, (b) use for treatment only, (c) use for prevention only, and (d) use for both treatment and prevention. Differences in CAM use by age and ethnicity were examined using SUDAAN to adjust for design effects. RESULTS: Associations of age with CAM use are curvilinear but differed by ethnicity. Some types of CAM are used primarily for treatment; others are used for health maintenance. DISCUSSION: CAM use is one component of adults' overall approach to health self-management. Patterns of CAM use by age and ethnicity likely reflect differences in CAM availability and prevailing public health policies when adults began making their own health-related decisions.     

Why patients with inflammatory bowel disease use or do not use complementary and alternative medicine: a Canadian national survey.

BACKGROUND: The use of complementary and alternative medicine (CAM) is common in patients with inflammatory bowel disease (IBD). OBJECTIVES: To determine the factors associated with use of CAM, the reasons commonly cited for use or nonuse of CAM, and the correlations between the factors associated with use of CAM and reasons for CAM use. SUBJECTS: The study included 2828 members of the Crohn's and Colitis Foundation of Canada. METHODS: Subjects were mailed a questionnaire that included items on demographic characteristics, disease and treatment history, health attitudes and behaviours, and reasons for use or nonuse of CAM. Logistical regression was used to determine significant associations with current CAM use. RESULTS: In patients with Crohn's disease and ulcerative colitis, CAM use was associated with more severe disease activity, use of CAM for other purposes, use of exercise and prayer for IBD, and a desire for an active role in treatment decisions. CAM use was also associated with younger age in those with Crohn's disease, and less confidence in their IBD physician in those with ulcerative colitis. The most common reasons for CAM use were a desire for greater control, having heard or read that CAM might help, and the emphasis CAM places on treating the whole person. The most common reasons for not using CAM were that conventional treatments were successful, that not enough was known about CAM and a belief that CAM would not help. CONCLUSION: Disease activity and health attitudes and behaviours, but not demographic characteristics, are associated with CAM use by those with IBD.     

A survey of perceptions and practices of complementary alternative medicine among Canadian gastroenterologists

BACKGROUND:

Despite a high prevalence of complementary alternative medicine (CAM) use among inflammatory bowel disease (IBD) patients, there is a dearth of information about the attitudes and perceptions of CAM among the gastroenterologists who treat these patients.

OBJECTIVE:

To characterize the beliefs, perceptions and practices of gastroenterologists toward CAM use in patients with IBD.

METHODS:

A web-based survey was sent to member gastroenterologists of the Canadian Association of Gastroenterology. The survey included multiple-choice and Likert scale questions that queried physician knowledge and perceptions of CAM and their willingness to discuss CAM with patients.

RESULTS:

Fifty-three per cent of respondents considered themselves to be IBD subspecialists. The majority (86%) of gastroenterologists reported that less than one-half of their patient population had mentioned the use of CAM. Only 8% of physicians reported initiating a conversation about CAM in the majority of their patient encounters. Approximately one-half (51%) of respondents were comfortable with discussing CAM with their patients, with lack of knowledge being cited as the most common reason for discomfort with the topic. Most gastroenterologists (79%) reported no formal education in CAM. While there was uncertainty as to whether CAM interfered with conventional medications, most gastroenterologists believed it could be effective as an adjunct treatment.

CONCLUSION:

Our findings demonstrate that gastroenterologists were hesitant to initiate discussions about CAM with patients. Nearly one-half were uncomfortable or only somewhat comfortable with the topic, and most may benefit from CAM educational programs. Interestingly, most respondents appeared to be receptive to CAM as adjunct therapy alongside conventional IBD treatment.     

Insurance coverage, medical conditions, and visits to alternative medicine providers: results of a national survey

BACKGROUND: In 1997, patients made an estimated 629 million visits to complementary and alternative medicine (CAM) providers; however, little is known about factors associated with visits to CAM providers. OBJECTIVE: To examine the effect of insurance coverage on frequency of use of CAM providers. METHODS: We conducted a nationally representative, random household telephone survey of 2055 adults. MAIN OUTCOME MEASURE: The number of visits made to CAM providers. RESULTS: An estimated 44% of the US population used at least 1 CAM therapy in 1997. Of those using CAM, 52% had seen at least 1 CAM provider in the last year. Among those who used a CAM therapy, factors independently associated with seeing a provider were having been in the upper quartile of visits to conventional providers in the last year (adjusted odds ratio [AOR], 2.00; 95% confidence interval [CI], 1.33-3.01), female sex (AOR, 1.67; 95% CI, 1.17-2.38), and having used the therapy to treat diabetes (AOR, 5.20; 95% CI, 1.40-19.40), cancer (AOR, 2.99; 95% CI, 1.04-8.62), or back or neck problems (AOR, 1.51; 95% CI, 1.02-2.23). Factors independently associated with frequent use (. or = 8 visits per year) of a CAM provider were full insurance coverage of the CAM provider (AOR, 5.06; 95% CI, 2.45-10.47), partial insurance coverage (AOR, 3.26; 95% CI, 1.72-6.19), having used the therapy for wellness (AOR, 2.85; 95% CI, 1.63-4.98), and having seen the provider for back or neck problems (AOR, 2.26; 95% CI, 1.29-3.94). Conservative extrapolation to national estimates suggests that 8.9% of the population (17.5 million adults) accounted for more than 75% of the 629 million visits made to CAM providers in 1997. CONCLUSIONS: A small minority of persons accounted for more than 75% of visits to CAM providers. Extent of insurance coverage for CAM providers and use for wellness are strong correlates of frequent use of CAM providers.     

Trends in hearing impairment in United States adults: the national health interview survey, 1986-1995

BACKGROUND: United States trends in the prevalence of hearing impairment have not been reported. These trends could be rising due to changes in environmental noise exposure; alternatively, rates could be declining via a compression of morbidity hypothesis that has been postulated to be occurring in older adults residing in developed nations. METHODS: The National Health Interview Survey is a continuous multistage area probability survey of the U.S. civilian noninstitutionalized population living at addressed dwellings. Adults within randomly selected households were administered a chronic conditions list that included questions about hearing impairment. Complete data were available on 107,100 white and 17,904 African-American adults aged 18 years and older in survey years 1986-1995. Race-specific rates of hearing impairment were adjusted for age and sample survey design. RESULTS: Annual age-adjusted rates of some hearing impairment ranged from 11.0% to 12.7% in whites and 5.9% to 8.5% in African Americans. Rates of severe bilateral hearing impairment in these race groups were 0.7% to 1.1% and 0.1% to 0.5%, respectively. There was no evidence of change in rates of hearing impairment among participants stratified by race and 10-year age groups. CONCLUSIONS: Reported rates of hearing impairment remained relatively stable in the U.S. noninstitutionalized population from 1986 to 1995. There was no evidence of change in rates in adults grouped into 10-year age groups. Population-based studies designed to include clinical and self-reported measures of hearing impairment are needed to further examine trends in hearing impairment.     

The cardiovascular patient's perceptions of complementary and alternative medicine

BACKGROUND: Complementary and alternative medicine (CAM) use is common among patients with cardiovascular disorders and is generally underrecognized by physicians. The attitudes of these patients regarding these therapies and their perceptions of safety and efficacy have not been well defined. METHODS: A written survey was received from a cohort of outpatients seen at a large outpatient cardiovascular clinic in Texas. Over 75% of patients responded, with more than 90% of returned surveys adequate for analysis. RESULTS: Of the 210 respondents 113 admitted to CAM use, with Vitamins E and C being the most frequently utilized agents. Women were significantly more likely to take CAM than men (69 vs. 46%, p = 0.002), particularly those taking hormone replacement therapy. Over half of patients surveyed stated their cardiologist was unaware of their use of CAM. Only 15% of patients felt that CAM was more efficacious than their traditional medications, but almost half felt it was significantly safer. A similar number were unaware of any interactions between CAM and their other medications. CONCLUSIONS: Use of CAM is common in cardiology outpatients, and many patients remain unaware of potential health risks. Physicians should routinely question patients about use of CAM and attempt to educate users regarding potential health risks.     

The role of complementary and alternative medicine in diabetes

Complementary and alternative medicine (CAM) describes a diverse group of medical and health care systems, practices, and products not currently considered to be part of conventional medicine. Inadequacies in current treatments for diabetes have led 2 to 3.6 million Americans to use CAM for diabetes treatment, despite limited studies of safety and efficacy of CAM methods. CAM is used mostly by West Indians, Africans, Indians, Latin Americans, or Asians. Prayer, acupuncture, massage, hot tub therapy, biofeedback, and yoga have been used as well as various plant remedies for treating diabetes. Several CAM practices and herbal remedies are promising for diabetes treatment, but further rigorous study is needed in order to establish safety, efficacy, and mechanism of action. In the meantime, it is important to be aware that many patients with diabetes may be using CAM and to consider potential interactions with conventional medicines being used.     

全国多中心老年晚期癌症患者失眠情况调查

目的 调查老年晚期癌症患者失眠的发生率,探索失眠人群在症状、情绪和生活质量方面与非失眠人群的差异及失眠的风险因素。方法 2019年7月至2020年12月,使用MD安德森症状问卷(MDASI)、医院焦虑抑郁量表(HADS)、患者健康问卷-9(PHQ-9)、失眠严重指数量表(ISI)及欧洲生活质量五维度五水平问卷(EQ-5D-5L)对全国10个中心的晚期恶性肿瘤患者(≥65岁)进行调查,共计696例患者符合标准而纳入研究。采用SAS 9.4统计软件进行数据分析。根据数据类型,分别采用t检验或χ²检验进行组间比较。使用多元logistic回归分析失眠的风险因素。结果 老年晚期恶性肿瘤患者轻度及以上失眠发生率为31.9%(222/696)。失眠组症状负担、心理痛苦发生率显著高于无失眠组,生活质量显著低于无失眠组,差异均有统计学意义(P<0.001)。抑郁、焦虑是失眠的风险因素(OR=0.254, 95%CI 0.105～0.119,P=0.002;OR=0.286, 95%CI 0.615～0.687,P=0.005)。结论 老年晚期恶性肿瘤患者的失眠值得重视,即便...     

Relation of inflammation to peripheral arterial disease in the national health and nutrition examination survey, 1999-2002

The relation between inflammation and peripheral arterial disease (PAD) is not well characterized. This study examined this relation and its consistency across important subgroups in a cross-sectional, nationally representative sample of the adult United States population. C-reactive protein (CRP), fibrinogen, leukocyte count, and PAD were assessed in a sample of 4,787 participants aged>or=40 years in the National Health and Nutrition Examination Survey 1999-2002. PAD was defined as an ankle-brachial blood pressure index <0.9. Graded relations were present between inflammatory markers and PAD. The multivariate adjusted odds ratios of PAD associated with the highest versus the lowest quartile of CRP, fibrinogen, and leukocyte count were 2.14 (95% confidence interval [CI] 1.41 to 3.25), 2.49 (95% CI 1.27 to 4.85), and 1.67 (95% CI 0.84 to 3.31), respectively (each p trend<0.05 across quartiles). Associations between inflammation and PAD were similar across gender, obesity, and diabetic subgroups. However, the odds ratios of PAD for the highest CRP quartile versus the 3 lowest quartiles were 3.10 (95% CI 1.76 to 5.45) for non-Hispanic blacks versus 1.50 (95% CI 0.98 to 2.28) for non-Hispanic whites and 1.11 (95% CI 0.57 to 2.17) for Mexican Americans (p interaction=0.049) and 5.59 (95% CI 1.82 to 17.17) for patients aged 40 to 54 years versus 2.01 (95% CI 1.13 to 3.58) for patients aged 55 to 69 years and 0.98 (95% CI 0.65 to 1.48) for patients aged>or=70 years (p interaction=0.018). Odds ratios of PAD for the highest fibrinogen quartile versus the lowest 3 quartiles were 3.26 (95% CI 1.69 to 6.28) for current smokers versus 0.83 (95% CI 0.51 to 1.35) for never smokers (p interaction=0.006). In conclusion, in the general United States adult population, inflammation is independently associated with PAD.     

Amount of systemic steroid medication is a strong predictor for the use of complementary and alternative medicine in patients with inflammatory bowel disease: results from a German national survey

OBJECTIVES: Previous studies have suggested that inflammatory bowel disease (IBD) patients rank high among users of complementary and alternative medicine (CAM). To further elucidate this phenomenon, we sent questionnaires to a large sample of IBD patients in Germany to determine the patterns and predictors of their CAM use. METHODS: Pretested 73-item questionnaires were mailed to a randomly selected representative sample of 1000 IBD patients from the approximately 16,000 members and associates of the German Crohn's and Colitis Association. Predictors of CAM use were evaluated by logistic regression models. RESULTS: Completed questionnaires were returned by 684 patients (female patients, 61.4%; Crohn's disease patients, 58.3%; ulcerative colitis patients, 38.2%). Of the 671 adult respondents, 344 (51.3%) had experience with CAM, and significantly more of the ulcerative colitis patients (59.8%) than the Crohn's disease patients (48.3%) had experience with CAM. There was no difference by gender. Homeopathy (52.9%) and herbal medicine (43.6%) were the most commonly used types of CAM. The most frequent personal reasons for CAM use were the search for an "optimum treatment" (78.9%) and the wish to stop taking steroids (63.8%). Using logistic regression, we found that total cortisone intake (P = 0.0077), but not duration of disease, was a strong predictor of CAM use. Other predictors were experience with psychosomatic and psychotherapeutic support (P = 0.0029), relaxation techniques (P = 0.0284), an academic education (P = 0.0173), a diet utilizing whole grains (P = 0.0123), and a normal body weight (P = 0.0215). Although 80% of patients indicated that they were interested in using CAM in the future, only 24.7% felt sufficiently informed about it. CONCLUSIONS: More than 50% of a large group of German IBD patients had used CAM. Prolonged or intensive steroid treatment, an academic education, active ways of coping, and a health-conscious life-style are associated with CAM use. Given the potential side effects and interactions, the treating physician should focus on thorough information about the benefits and limitations of conventional and complementary treatment options, especially for IBD patients who have received prolonged or intensive steroid treatment.     

Use of complementary and alternative medicine in children with asthma

BACKGROUND:

Because of the potential risk of interaction with, and underuse of, conventional medications, it is important to document the prevalence of the use of complementary and alternative medicines (CAMs) in asthmatic children.

OBJECTIVE:

To ascertain the prevalence and type of CAMs, and to identify factors associated with their use.

METHODS:

A cross-sectional survey of children who presented to the Asthma Centre of The Montreal Children’s Hospital (Montreal, Quebec) between 1999 and 2007 was conducted. At the initial consultation, parents completed a questionnaire inquiring, in part, about CAM use. Computerized health records provided information regarding patient characteristics and their condition.

RESULTS:

The median age of the 2027 children surveyed was 6.1 years (interquartile range 3.3 to 10.5 years); 58% were male and 59% of children had persistent asthma. The prevalence of CAM use was 13% (95% CI 12% to 15%). Supplemental vitamins (24%), homeopathy (18%) and acupuncture (11%) were the most commonly reported CAMs. Multivariable logistic regression analysis confirmed the association of CAM use with age younger than six years (OR 1.86; 95% CI 1.20 to 2.96), Asian ethnicity (OR 1.89; 95% CI 1.01 to 3.52), episodic asthma (OR 1.88; 95% CI 1.08 to 3.28) and poor asthma control (OR 1.98; 95% CI 1.80 to 3.31).

CONCLUSION:

The prevalence of reported CAM use among Quebec children with asthma remained modest (13%), with vitamins, homeopathy and acupuncture being the most popular modalities. CAM use was associated with preschool age, Asian ethnicity, episodic asthma and poor asthma control.