Use of traditional Chinese medicine among pregnant women in Taiwan

Objective

To investigate the patterns of traditional Chinese medicine (TCM) use among pregnant women in the National Health Insurance program in Taiwan.

Methods

Women who gave birth in Taiwan in 2006 were identified from the National Health Insurance Research Database. Claims for reimbursement following TCM ambulatory visits by these women were analyzed.

Results

In total, 20.9% of women in the study who gave birth in 2006 used TCM during pregnancy, with older women more likely to utilize this form of care (23.9% of women > 35 years of age vs 16.2% of women < 20 years of age). There was an increase in the use of TCM for pregnancy-related problems such as hypertension (194 women before pregnancy vs 2163 during) and nausea/vomiting (220 women before vs 1648 during). The predominant modality (88.4%) of TCM treatment during pregnancy was herbal preparation.

Conclusion

Traditional Chinese medicine, with the exception of acupuncture, is popular among pregnant women in Taiwan. In addition to its efficacy, the safety of TCM during pregnancy requires future investigation.     

Vascular assessment of the right internal jugular vein in low birth weight newborns

Abstract

Objective: To determine the dimensions and depth of the right internal jugular vein (RIJV) in low birth weight newborns by ultrasound and assess the differences in weight and determine the relationship of the vein with the carotid artery.

Method: We performed a vascular assessment of the RIJV in 100 low birth weight newborns. The subjects were divided into three groups, low birth weight (LBW) newborns, <2500?g; very low birth weight (VLBW) newborns, <1500?g; and extremely low birth weight (ELBW) newborns <1000?g.

Results: Of the newborns, 39% had LBW, 33% had VLBW, and 28% had ELBW. The medians were gestational age 31 weeks, weight 1300?g, anteroposterior diameter of the RIJV 2.2?mm, and the distance from the skin–RIJV 3.6?mm. In LBW newborns, the median anteroposterior diameter of RIJV was 2.7?mm; in LBW newborns 2.2; in ELBW newborns 1.9 (p?<?0.001); the median distance from skin to RIJV for LBW newborns was 4.1?mm; for VLBW newborns, 3.6 and for ELBW newborns 2.9 (p?<?0.01); differences that were statistically significant.

Conclusions: In low birth weight newborns, the diameter and depth of the RIJV is directly proportional to the weight of the subjects studied.     

妊娠合并内科疾病产后出血的预防及处理

目前妊娠合并内科疾病患者产后出血的发生率有升高趋势,其预防和处理亦越来越受到产科医生的关注。本文就妊娠合并血液系统疾病、妊娠合并肝病、妊娠合并呼吸系统及循环系统疾病、妊娠合并重症感染患者产后出血的预防及处理问题进行讨论,为产科医生处理此类复杂情况提供参考。     

Determinants of health-seeking behavior toward Chinese or Western medicine in Taiwan: An analysis of biobank research database

Background and purposeHealth-seeking behavior has a direct impact on individual's health. A proper understanding of patients' demographics and health factors is essential in constructing high-quality health care services toward Chinese or Western medicine. The objective of this study was to understand the tendency among Taiwanese to opt for either Chinese or Western medicine when both services are available.Materials and methodsThis study was based on the analysis of secondary data. A total of 13,151 individuals with an age of 30 years or more were selected from the Taiwan Biobank Research Database in Taiwan. Multiple logistic regression analysis was used to identify factors associated with health-seeking behaviors toward Chinese or Western medicine.ResultsAmong all the participants, 50.8% showed a greater tendency to seek Western medicine treatment, while 10.4% showed a preference for Chinese medicine treatment. Main drivers for a Chinese medicine health-seeking behavior were women, hypotension, low income, normal HbA1c, normal total cholesterol, and yang deficiency. The preference for Western medicine treatment was associated mainly with men, an older age, a married status, lower income, a lower education, an abnormal cholesterol level, and the absence of stasis.ConclusionHealthcare providers should understand the factors associated with health-seeking behavior and refer patients to their desired treatment.     

Identification of educational objectives for obstetrics and gynecology residents in the ambulatory setting

OBJECTIVE: The primary objective of this study was to identify specific educational goals for obstetrics and gynecology residents in the ambulatory setting. STUDY DESIGN: A cross-sectional study of current practice patterns in primary care, benign gynecology, and office procedures was performed with mailings to local private practice obstetrician-gynecologists. Questions for the anonymous written survey were generated using the Council on Resident Education in Obstetrics and Gynecology educational objectives. Telephone interviews with staff from billing offices confirmed practitioner responses. RESULTS: Of 88 practitioners, 43 (49%) responded. Diagnoses made in the office correlated well with the topics considered important for resident knowledge. Most important primary care diagnoses were depression and abdominal pain; important gynecologic diagnoses were abnormal uterine bleeding, chronic pelvic pain, contraception, and vulvovaginal infection. CONCLUSION: This study offers a valid, practical foundation for developing a focused ambulatory resident education program based on current outpatient obstetrics-gynecology practice patterns.     

Complementary and alternative medicine (CAM) use among hypertensive patients in Palestine

PurposeTo explore the frequency of CAM use among hypertensive patients in Palestine, determine demographic characteristics that may increase the likelihood of CAM use and to find out how benefits were perceived by patients.MethodsAcross-sectional survey of patients attending outpatient hypertension clinics. The method was based on a semi-structured questionnaire.ResultsOf the 4575 hypertensive patients interviewed, 85.7% respondents used at least one type of CAM. Of the 3921 CAM users, 62.13% reported taking herbs. Most of these users were >50 years old, of low educational level, and had a family history of HTN, 62.9% claimed to have obtained the desired effect from taking these herbs; however, 68.1% did not disclose this fact to their health care providers, 83 plant taxa were reported by these patients, Allium sativum was the most commonly used herb.ConclusionsThe use of CAM, particularly herbal therapies for hypertension treatment, is highly prevalent in Palestine.     

Usage of complementary and alternative medicine: A survey among Indian dental professionals

ObjectiveCAM therapies are used along with standard medical care. Though there are various medical evidences to prove the effectiveness of CAM therapies in managing medical problems, the evidence for the dental application are still lacking in India. This could be attributed to the non-availability or the insufficient knowledge regarding the use of CAM in dentistry. Hence it is necessary to obtain the baseline knowledge regarding the use of CAM therapies among dentists.MethodCross sectional questionnaire based survey.ResultsThere were mixed attitudes towards CAM approaches in dental practices. Lack of clinical knowledge and exposure during their graduation and inadequate scientific evidence can be attributed to their hesitation in practicing the CAM.ConclusionThough interested, dental practitioners were still cautious in putting CAM into clinical practice. Only very few dentist used CAM therapies and they limited their use to topical application for oral problems.     

Use of complementary and alternative medicine among women with gynecologic cancers

OBJECTIVE: The aim of this study was to determine the prevalence and types of complementary and alternative medicine (CAM) usage by women with gynecologic cancer in an outpatient midwestern university practice. METHODS: Any patient with a gynecologic cancer seen in the outpatient clinic of the gynecologic oncology division at Washington University over a 3-month period was eligible, excluding those patients with a new cancer diagnosis. Subjects completed a questionnaire anonymously. Two by two comparisons were made using the Fisher exact test and P was considered significant at P < 0.05. RESULTS: Nearly half (49.6%) of 113 respondents had used CAM since being diagnosed with cancer. Characteristics significantly associated with CAM use include annual income greater than $30,000, cancer site of origin other than the cervix, and use of CAM prior to cancer diagnosis. Users with annual incomes greater than $30,000 were significantly more likely to use CAM in the "other" category that included acupuncture, reflexology, and electromagnetic therapy. Fewer than 25% of CAM users received information regarding CAM from a physician, nurse, or practitioner of CAM. Women used CAM in hopes of achieving a wide range of potential benefits including both improved well-being and anti-cancer effects. The most common actual benefit these women perceived was an improvement in psychosocial well-being, including increased hope or optimism. CONCLUSIONS: American patients with gynecologic cancer frequently use CAM in addition to standard medical therapy. Oncologists caring for women with gynecologic cancer should initiate a dialogue about usage of CAM, discussing the potential adverse effects of CAM and the patient's therapeutic goals.