Physician and patient attitudes towards complementary and alternative medicine in obstetrics and gynecology

<p>Abstract</p> <p>Background</p> <p>In the U.S., complementary and alternative medicine (CAM) use is most prevalent among reproductive age, educated women. We sought to determine general attitudes and approaches to CAM among obstetric and gynecology patients and physicians.</p> <p>Methods</p> <p>Obstetrician-gynecologist members of the American Medical Association in the state of Michigan and obstetric-gynecology patients at the University of Michigan were surveyed. Physician and patient attitudes and practices regarding CAM were characterized.</p> <p>Results</p> <p>Surveys were obtained from 401 physicians and 483 patients. Physicians appeared to have a more positive attitude towards CAM as compared to patients, and most reported routinely endorsing, providing or referring patients for at least one CAM modality. The most commonly used CAM interventions by patients were divergent from those rated highest among physicians, and most patients did not consult with a health care provider prior to starting CAM.</p> <p>Conclusion</p> <p>Although obstetrics/gynecology physicians and patients have a positive attitude towards CAM, physician and patients' view of the most effective CAM therapies were incongruent. Obstetrician/gynecologists should routinely ask their patients about their use of CAM with the goal of providing responsible, evidence-based advice to optimize patient care.</p

Estudo da mastigação e da deglutição em crianças e adolescentes com Sequência de Möbius Study of chewing and swallowing in children and teenagers with Möbius syndrome

OBJETIVOS: Descrever as alterações morfofuncionais nas funções de mastigação e deglutição, reconhecer as consistências alimentares mais bem aceitas e avaliar a presença de manobras compensatórias durante a deglutição em crianças com Sequência de Möbius. MÉTODOS: A casuística consistiu de oito crianças, sendo três do sexo feminino e cinco do sexo masculino, na faixa etária de cinco a 15 anos, diagnosticadas com Sequência de Möbius. As crianças foram avaliadas em situação de alimentação, nas quais foram oferecidos alimentos de consistência líquida, pastosa e sólida. Os dados coletados foram registrados em protocolo de avaliação adaptado por Guedes, Shintani e Cabello (2003). RESULTADOS: Os resultados obtidos demonstraram significância entre a condição de mobilidade de língua e o tipo de mastigação. As variáveis velocidade de mastigação e contração do masseter, também se mostraram dependentes (p=0,018), uma vez que não houve alteração da velocidade da mastigação quando a contração do masseter estava presente. O pão de queijo mostrou-se como a melhor consistência sólida, pois produziu um bolo mais coeso e menos espalhado na cavidade oral. CONCLUSÕES: As alterações morfofuncionais presentes nos pacientes com Sequência de Möbius contribuíram para a alteração da dinâmica da mastigação e deglutição. Toda a amostra fez uso de manobras compensatórias e, mesmo com a ausência dos sinais clínicos sugestivos de penetração/aspiração, estes pacientes devem ser submetidos à terapia fonoaudiológica, a fim de adequar os órgãos fonoarticulatórios na tentativa de proporcionar uma refeição mais prazerosa.<br>PURPOSE: To describe morphofunctional alterations in the functions of chewing and deglutition, to recognize the most accepted food consistency, and to evaluate the presence of compensatory maneuvers during deglutition, in children and adolescents with Möbius syndrome. METHODS: The subjects were eight children (three female and five male), with ages ranging from five to 15 years, diagnosed with Möbius syndrome. The children were evaluated during a feeding situation, where they were offered food with different consistencies: liquid, pasty and solid. Data were registered in an evaluation protocol adapted by Guedes, Shintani and Cabello (2003). RESULTS: Results showed a significant relation between tongue mobility condition and type of mastication. The variables speed of mastication and contraction of the masseter muscle were also dependents (p=0018), since there was no change in the speed of mastication when the contraction of the masseter was present. The cheese bread was the best solid consistency food for evaluation, because it produced a more cohesive and less widespread mass in the oral cavity. CONCLUSIONS: The morphofunctional alterations found in patients with Möbius syndrome contributed to change the dynamics of chewing and swallowing. All subjects in the sample used compensatory maneuvers. Therefore, even in the absence of clinical signs that suggest penetration/aspiration, patients with such diagnosis should be referred to speech therapy, in order to provide adequate conditions for a more pleasant meal