Women's use of complementary and alternative medicine products and services during pregnancy : insights for safe, informed maternity care

University of Technology Sydney. Faculty of Health.Aim: The aim of this project is to explore the use of complementary and alternative medicine (CAM) products and services by women during pregnancy, with a focus upon: determining the current prevalence of CAM use and examining the determinants, characteristics and attitudes of women who use CAM; investigating the utilisation of various information sources used by pregnant women to make decisions about the use of CAM; and examining the extent to which pregnant women choose to self-prescribe certain CAM products. Method: The study sample was obtained via the Australian Longitudinal Study on Women’s Health (ALSWH). The ALSWH is a longitudinal study of women in three age groups (“young” 18-23, “mid age” 45-50 and “older” 70-75 years), who were randomly selected from the Australian national Medicare database to investigate multiple factors affecting health and wellbeing of women over a 20-year period. This research project analyses data from a sub-study survey administered in 2010. Participants in the sub-study were identified based upon their reporting of being pregnant or as having recently given birth in the 2009 ALSWH Survey 5 (n=2,316) of the young cohort. A total of 1,835 women responded to the sub-study survey and were included in the analysis (79.2% response rate). Results: CAM use during pregnancy is high with 91.7% (n=1,485) of women using a CAM product (52.0% excluding vitamins and minerals) and 48.1% (n=623) of women consulting a CAM practitioner. CAM practitioner visits were more likely for selected pregnancy-related health concerns, namely back pain or backache, and neck pain. Employment was also found to be predictive of pregnant women’s visits to a CAM practitioner. Significant health history and demographic predictors of CAM product use were tiredness and fatigue, embarking on preparation for labour and having a university education. Further analysis found that of the 447 women who did consult a CAM practitioner prior to pregnancy 62.4% (n=279) continued to utilise a CAM practitioner during pregnancy. Certain attitudes were found to be associated with women who use CAM products during pregnancy and women were more likely to use herbal medicine if they suffered from anxiety, sleeping problems and/or fatigue. The self-prescription of herbal medicine was also found to be widespread. Of the women deciding whether or not to visit a CAM practitioner, nearly half (48%, n=493) were influenced by their own personal experience of CAM and 43% (n=423) by family and friends. Conclusion: CAM use by women during pregnancy is high. Maternity health care professionals need to inquire about CAM use during routine antenatal visits in order to ensure safe maternal outcomes

The Association between women’s choice of birth setting and their use of CAM during labor and birth.

Purpose: Contemporary maternity care often means women are able to choose a number of settings for their birth including hospitals, birth centers, and community settings. There is also evidence that many women utilised complementary and alternative medicine (CAM) during pregnancy and birth. The purpose of this study is to examine the association between women’s choice of birth setting and their use of CAM during labor and birth. Methods: Longitudinal data from a sub-study of women (n = 2445) from the nationally-representative Australian Longitudinal Study of Women’s Health (ALSWH) was analyzed for relationships between women’s birth setting (hospital, birth center, or community) and their demographics, attitudes towards maternity care (including CAM), and use of CAM during pregnancy and birth. Results: The characteristics associated with women’s choice of birth setting include some demographic features such as employment status, health care subsidy, and level of education. Women’s birth setting choice was also linked to a preference for CAM practitioner by women birthing in birth centers and community settings. In contrast, women birthing in hospitals held more positive views towards obstetric care. There was a higher use of CAM during pregnancy by women birthing in birth centers and community but this was not consistent across all CAMs investigated. Naturopaths, herbal medicines, homeopathy and flower essences were more commonly used by women birthing in community compared with those in a birth center. There was also a higher rate of CAM use for intrapartum pain management for women birthing outside of a hospital setting, although women attending a birth center were more likely than those birthing in community to use pharmacological pain management techniques. Conclusion: There are characteristic differences between women birthing in different birth settings which seems to be influenced as much by preference for maternity care and interest in CAM use as it is by demographics

The associations between medical, allied and complementary medicine practitioner visits and childhood vaccine uptake

© 2018 The Authors Background: Vaccination rates have remained steady for a number of years in Australia, however geographical areas of lower vaccine coverage remains a day-to-day challenge. The study explores parental attitudes, beliefs and intentions in relation to vaccination and examines the early effects of recent No Jab No Pay legislation. Methods: A national survey of was conducted, using an online questionnaire. Parents from all states in Australia with at least one child aged <6 years were invited to participate. Results: A total of 429 parents participated in the study. The substantial majority of participants reported having their youngest child's vaccination status up to date (n = 401, 93.5%). A child's vaccinations were more likely to be up to date if they had consulted a paediatrician in the previous 12-months (OR 5.01; 95%CI 1.05, 23.92; p =.043). Conversely they were less likely to be vaccinated if they were influenced by information from a complementary medicine (CM) practitioner (OR 0.03; 95%CI 0.01, 0.15; p <.001) or had visited a CM-practitioner (OR 0.09; 95%CI 0.02, 0.33; p <.001) in the previous 12-months. A total of 2.6% of parents had immunised their child as a result of the No Jab No Pay legislation, while 3.9% stated the legislation had no effect, and 1.2% said it had made them less likely to vaccinate. A further 1.2% of parents stated they are considering vaccination as a result of the legislative changes. Conclusion: Parents who have not vaccinated their children appear to trust non-mainstream sources of information such as CM-practitioners. Further research is required to determine how to manage the challenges and opportunities of CM-practitioners as a source of vaccine information

Is there an association between the use of complementary medicine and vaccine uptake: Results of a pilot study

© 2018 The Author(s). Objective: Despite the incredible success of paediatric immunisation, support is not universal. It has been suggested that complementary medicine practitioners enable vaccine rejection and his study aims to explore the relationship between complementary medicine use and paediatric vaccination. A total of 149 Australian parents were recruited via a parenting website and Facebook groups to complete an online questionnaire. Results: The majority of parents (66.4%) stated that their children's vaccination status was up-to-date. Vaccination status was associated with parental education, area of residence, income, private health insurance, and having a Health Care Card (p < 0.05). Children's vaccinations were more likely to be up-to-date if they had consulted a general practitioner in the previous 12 months (OR 21.75; p < 0.001), and less likely to be up-to-date if they had consulted a complementary medicine practitioner (OR 0.10; p < 0.001) in the same period. Concerns about vaccine safety and efficacy were the most common reasons for a child's immunisation status not being up-to-date. These findings highlight an interface between lower vaccine uptake and visits to complementary medicine practitioners. These results emphasise the need to examine the routine paediatric care practices of complementary medicine practitioners as a crucial piece of the puzzle in understanding vaccine rejection

Is there a role for Western herbal medicine in treating cyclic perimenstrual pain and discomfort?

© 2018 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Conventional treatments for cyclic perimenstrual pain and discomfort, while numerous and diverse, have drawbacks including side effects, interference with women's reproductive function and, importantly, failure to address symptoms. Many women turn to herbal medicine to treat a myriad of menstrual symptoms. Clinical evidence supports the efficacy of Vitex agnus-castus but other medicinal herbs typically used by Western herbalists for treating menstrual symptoms are unsupported by clinical trials. This raises concerns around the efficacy and safety of these herbs. Women's treatment options need to be extended and individualised, where current conventional strategies fail, requiring appropriate clinical trials of potentially useful herbal medicines

Production of π0 and η mesons in Cu+Au collisions at sNN =200 GeV

Production of π0 and η mesons has been measured at midrapidity in Cu+Au collisions at sNN=200GeV. Measurements were performed in π0(η)→γγ decay channel in the 1(2)-20GeV/c transverse momentum range. A strong suppression is observed for π0 and η meson production at high transverse momentum in central Cu+Au collisions relative to the p+p results scaled by the number of nucleon-nucleon collisions. In central collisions the suppression is similar to Au+Au with comparable nuclear overlap. The η/π0 ratio measured as a function of transverse momentum is consistent with mT-scaling parametrization down to pT=2GeV/c, its asymptotic value is constant and consistent with Au+Au and p+p and does not show any significant dependence on collision centrality. Similar results were obtained in hadron-hadron, hadron-nucleus, and nucleus-nucleus collisions as well as in e+e- collisions in a range of collision energies sNN=3-1800 GeV. This suggests that the quark-gluon-plasma medium produced in Cu+Cu collisions either does not affect the jet fragmentation into light mesons or it affects the π0 and η the same way

Measurements of μμ pairs from open heavy flavor and Drell-Yan in p+p collisions at s =200 GeV

PHENIX reports differential cross sections of μμ pairs from semileptonic heavy-flavor decays and the Drell-Yan production mechanism measured in p+p collisions at s=200 GeV at forward and backward rapidity (1.2&lt;|η|&lt;2.2). The μμ pairs from cc, bb, and Drell-Yan are separated using a template fit to unlike- and like-sign muon pair spectra in mass and pT. The azimuthal opening angle correlation between the muons from cc and bb decays and the pair-pT distributions are compared to distributions generated using pythia and powheg models, which both include next-to-leading order processes. The measured distributions for pairs from cc are consistent with pythia calculations. The cc data present narrower azimuthal correlations and softer pT distributions compared to distributions generated from powheg. The bb data are well described by both models. The extrapolated total cross section for bottom production is 3.75±0.24(stat)±0.500.35(syst)±0.45(global) [μb], which is consistent with previous measurements at the Relativistic Heavy Ion Collider in the same system at the same collision energy and is approximately a factor of 2 higher than the central value calculated with theoretical models. The measured Drell-Yan cross section is in good agreement with next-to-leading-order quantum-chromodynamics calculations

Pseudorapidity Dependence of Particle Production and Elliptic Flow in Asymmetric Nuclear Collisions of p+Al, p+Au, d+Au, and ^{3}He+Au at sqrt[s_{NN}]=200 GeV.

Asymmetric nuclear collisions of p+Al, p+Au, d+Au, and ^{3}He+Au at sqrt[s_{NN}]=200  GeV provide an excellent laboratory for understanding particle production, as well as exploring interactions among these particles after their initial creation in the collision. We present measurements of charged hadron production dN_{ch}/dη in all such collision systems over a broad pseudorapidity range and as a function of collision multiplicity. A simple wounded quark model is remarkably successful at describing the full data set. We also measure the elliptic flow v_{2} over a similarly broad pseudorapidity range. These measurements provide key constraints on models of particle emission and their translation into flow

Associations Between Cancer Screening Behavior and Complementary Medicine Use: Results of a National Cross-Sectional Survey of 9151 Australian Women

© The Author(s) 2018. Introduction: Complementary medicine (CM) use has been found to influence the uptake of conventional cancer treatment. This study examines associations between CM use and cancer screening rates. Methods: Women aged 62 to 67 years from the Australian Longitudinal Study on Women’s Health were surveyed regarding their use of cancer screening initiatives. Associations between cancer screening behavior and visits to CM practitioners were analyzed. Results: Of the 9151 women, 9049 (98.9%) completed questions about cancer screening. A total of 65.1% of women had received a clinical skin examination, 54.3% colorectal cancer screening, 56.2% Pap test (within past 2 years), 83.3% mammogram (within past 2 years), 55.8% clinical breast examination, and 55.8% had conducted breast self-examination. Women who had consulted a massage therapist were more likely to undergo clinical skin examination (P =.002), clinical breast examination (P =.018), and mammogram (P =.001). Women who had consulted a chiropractor were more likely to undergo a clinical skin examination (P =.001), colorectal cancer screening (P =.020), and mammogram (P =.011). Women who had consulted an acupuncturist were more likely to undergo colorectal cancer screening (P =.019), and those who consulted with an osteopath were more liable to have a Pap test (P =.049). Conclusion: Women who visit CM practitioners are more likely to participate in cancer screening initiatives. Research is required to understand the current and potential role that CM practitioners (can) have as public health advocates, recommending preventative health measures such as cancer screening. Such an examination will help ensure optimal screening utilization and effective, timely care for all cancer patients