Efficacy of albendazole against the whipworm Trichuris trichiura - a randomised, controlled trial

Objectives and design. To test the efficacy of albendazole against the whipworm Trichuris trichiura for  school-based deworming in the south-western Cape, South Africa. Children infected with Trichuris were  randomised to 3 doses of albendazole (400; 800 or 1 200 mg), each repeated 4 times. The boy I girl ratio was 1. A group not infected With worms was treated with placebo, creating a negative control. Subjects and setting. Pupils at a primary school serving a wineproducing area approximately 90 km east of Cape Town.Outcome measures. Trichuris cure rates and reduction in the number of eggs/gin faeces, as well as the  infection dynamics of Trichuris and Ascaris during treatment with placebo.Results. Albendazole treatment was associated with Trichuris cure rates of 23% (400 mg), 56% (800  mg) and 67% (1 200 mg) after the final treatment. The corresponding reductions in the number of eggs/g of faeces were 96.8%, 99.3% and 99.7%. Environmental pollution by human faeces was confirmed because worm egg-negative children in the placebo group became egg-positive while the study was in progress.Conclusion. The 400 mg stat dose had a low Trichuris cure rate. To repeat the dose on 2 or 3 days would  increase cost, reduce compliance and complicate management. Albendazole cannot be used in deworming programmes in South Africa because it is a Schedule 4 prescription medicine. De-scheduling is needed urgently, particularly because of high efficacy against hookworm in KwaZulu-Natal and  neighbouring countries

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

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

Use of complementary medicine products: a nationally representative cross-sectional survey of 2019 Australian adults

© Author(s) (or their employer(s)) 2019. Objectives To provide a contemporary description of complementary medicine (CM) product use in Australia. Design Cross-sectional survey. Setting Online. Participants A nationally representative sample (n=2019) of the Australian adult population. Primary and secondary outcome measures Primary outcomes measures included the use and type of CM products used, and source of recommendation. Secondary measures included disclosure of CM product use to health practitioners, concomitant use of pharmaceuticals and predictors of use. Results Prevalence of CM product use was 50.3%, with the most frequently used being vitamin and mineral supplements (VMSs; 47.8%) and homoeopathic medicines the least used (6.8%). A majority of respondents using CM products were also using pharmaceutical products, and small but significant associations were found between the use of CM products and pharmaceuticals (p<0.05). Small statistically significant associations were found between use of vitamin products and disclosure of use to general practitioners (GPs; Cramer's V=0.13, p=0.004) and hospital doctors (Cramer's V=0.11, p=0.04), and between use of herbal medicines and disclosure to both GPs (Cramer's V=0.11, p=0.02) and hospital doctors (Cramer's V=0.12, p=0.03). Women, those with higher education and those with no private health insurance were more likely to use CM products (p<0.05), while those without chronic conditions were less likely to use CM products (p<0.05) (χ 2 (29)=174.70, p<0.001). Conclusions The number of Australians using CM products has remained relatively stable and substantial for nearly two decades. The majority of CM use relates to VMSs. Given the number of Australians using both CM products and pharmaceutical medicines, it is important to evaluate the potential clinical implications of such practices to ensure safe, effective and coordinated health policy and patient care

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

Using Super-Imposition by Translation And Rotation (SITAR) to relate pubertal growth to bone health in later life: the Medical Research Council (MRC) National Survey of Health and Development.

BACKGROUND: To explore associations between pubertal growth and later bone health in a cohort with infrequent measurements, using another cohort with more frequent measurements to support the modelling, data from the Medical Research Council (MRC) National Survey of Health and Development (2-26 years, 4901/30 004 subjects/measurements) and the Avon Longitudinal Study of Parents And Children (ALSPAC) (5-20 years) (10 896/74 120) were related to National Survey of Health and Development (NSHD) bone health outcomes at 60-64 years. METHODS: NSHD data were analysed using Super-Imposition by Translation And Rotation (SITAR) growth curve analysis, either alone or jointly with ALSPAC data. Improved estimation of pubertal growth parameters of size, tempo and velocity was assessed by changes in model fit and correlations with contemporary measures of pubertal timing. Bone outcomes of radius [trabecular volumetric bone mineral density (vBMD) and diaphysis cross-sectional area (CSA)] were regressed on the SITAR parameters, adjusted for current body size. RESULTS: The NSHD SITAR parameters were better estimated in conjunction with ALSPAC, i.e. more strongly correlated with pubertal timing. Trabecular vBMD was associated with early height tempo, whereas diaphysis CSA was related to weight size, early tempo and slow velocity, the bone outcomes being around 15% higher for the better vs worse growth pattern. CONCLUSIONS: By pooling NSHD and ALSPAC data, SITAR more accurately summarized pubertal growth and weight gain in NSHD, and in turn demonstrated notable associations between pubertal timing and later bone outcomes. These associations give insight into the importance of the pubertal period for future skeletal health and osteoporosis risk.NSHD: The authors are grateful to NSHD study members who took part in the clinic data collection for their continuing support. We thank members of the NSHD scientific and data collection teams at the following centres: MRC Unit for Lifelong Health and Ageing; Wellcome Trust (WT) Clinical Research Facility (CRF) Manchester; WTCRF and Medical Physics at the Western General Hospital in Edinburgh; WTCRF and Department of Nuclear Medicine at University Hospital Birmingham; WTCRF and the Department of Nuclear Medicine at University College London Hospital; CRF and the Department of Medical Physics at the University Hospital of Wales; CRF and Twin Research Unit at St Thomas’ Hospital London. ALSPAC: We are extremely grateful to all the families who took part in this study, the midwives for their help in recruiting them, and the whole ALSPAC team, which includes interviewers, computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, receptionists and nurses. The research was supported by the National Institute for Health Research Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London.This is the author accepted manuscript. It is currently under an indefinite embargo pending publication by Oxford Univeristy Press

Chlorpromazine for schizophrenia: a Cochrane systematic review of 50 years of randomised controlled trials

BACKGROUND: Chlorpromazine (CPZ) remains one of the most common drugs used for people with schizophrenia worldwide, and a benchmark against which other treatments can be evaluated. Quantitative reviews are rare; this one evaluates the effects of chlorpromazine in the treatment of schizophrenia in comparison with placebo. METHODS: We sought all relevant randomised controlled trials (RCT) comparing chlorpromazine to placebo by electronic and reference searching, and by contacting trial authors and the pharmaceutical industry. Data were extracted from selected trials and, where possible, synthesised and random effects relative risk (RR), the number needed to treat (NNT) and their 95% confidence intervals (CI) calculated. RESULTS: Fifty RCTs from 1955–2000 were included with 5276 people randomised to CPZ or placebo. They constitute 2008 person-years spent in trials. Meta-analysis of these trials showed that chlorpromazine promotes a global improvement (n = 1121, 13 RCTs, RR 0.76 CI 0.7 to 0.9, NNT 7 CI 5 to 10), although a considerable placebo response is also seen. People allocated to chlorpromazine tended not to leave trials early in both the short (n = 945, 16 RCTs, RR 0.74 CI 0.5 to 1.1) and medium term (n = 1861, 25 RCTs, RR 0.79 CI 0.6 to 1.1). There were, however, many adverse effects. Chlorpromazine is sedating (n = 1242, 18 RCTs, RR 2.3 CI 1.7 to 3.1, NNH 6 CI 5 to 8), increases a person's chances of experiencing acute movement disorders, Parkinsonism and causes low blood pressure with dizziness and dry mouth. CONCLUSION: It is understandable why the World Health Organization (WHO) have endorsed and included chlorpromazine in their list of essential drugs for use in schizophrenia. Low- and middle-income countries may have more complete evidence upon which to base their practice compared with richer nations using recent innovations

(Wild)fire is not an ecosystem service

In their paper entitled “Wildfires as an ecosystem service”, Pausas and Keeley (2019) summarize the benefits generated by – as well as the evolutionary and socioecological importance of – wildfires for humankind. Although we recognize the importance of wildfires in such a context, we argue that presenting wildfire per se as an ecosystem service is conceptually incorrect and can be misleading for policy makers and resource managers. Throughout their paper, the authors repeatedly refer to (wild)fire as a potential provider of multiple ecosystem services (and not as an ecosystem service itself, as indicated in their article’s title). We believe that this is more than a dispute over semantics, for such a contradiction could lead to misperceptions about the definition of the term “ ecosystem services”, which is especially concerning in light of its real-world applications to fire management.ÂS received support from the Portuguese Foundation for Science and Technology (FCT) through PhD grant SFRH/BD/ 132838/2017, funded by the Ministry of Science, Technology and Higher Education, and by the European Social Fund–Operational Program Human Capital within the 2014–2020 EU Strategic Framework. AR is funded by Xunta de Galicia (post-doctoral fellowship ED481B2016/084-0). This research was developed as part of the project FirESmart (PCIF/MOG/0083/2017), which received funding from the FCT. The authors declare that they have no conflicts of interest.info:eu-repo/semantics/publishedVersio

'Skeletal muscle function deficit' in a nationally representative British birth cohort in early old age

BACKGROUND: Recommendations for identifying age-related muscle dysfunction have recently been published. We aimed to compare definitions for clinically relevant weakness and low lean mass proposed by the Foundation for the National Institutes of Health (FNIH) Sarcopenia project with the definition of sarcopenia proposed by the European Working Group on Sarcopenia in Older People (EWGSOP). METHODS: 1566 men and women from a British birth cohort had measures of appendicular lean mass, grip strength and timed up and go speed at ages 60–64. Prevalence of low lean mass, weakness and slowness, identified using the FNIH and EWGSOP recommendations were estimated and compared: using kappa statistics and; by testing cross-sectional associations of both definitions of low lean mass and weakness with slowness and self-reported difficulties walking. RESULTS: The combined prevalence of low lean mass and weakness ranged from 1.1% in men using FNIH criteria to 6.4% in women using EWGSOP criteria. There was limited overlap between the groups identified using the different criteria, driven by limited agreement between the two definitions of low lean mass. Using FNIH criteria, both low lean mass and weakness were associated with higher odds of slowness and difficulties walking whereas low lean mass classified using EWGSOP criteria was not associated with these markers of mobility impairment. CONCLUSIONS: At relatively young ages, signs of skeletal muscle function deficit with potential clinical relevance are already identifiable in the general population. This suggests that implementation of strategies to prevent mobility limitations, related to age-related muscle dysfunction, may need to start at least as early as midlife