Use of complementary and alternative medicine in Norway: a cross-sectional survey with a modified Norwegian version of the international questionnaire to measure use of complementary and alternative medicine (I-CAM-QN)

Background - In recent decades complementary and alternative medicine (CAM) has been widely used worldwide as well as in Norway, where CAM is offered mainly outside the national health care service, mostly complementary to conventional treatment and fully paid for by the patients. With few exceptions, previous research has reported on frequency and associations of total CAM use in Norway rather than on single therapies and products. Therefore, in this present study we will map the use of CAM more precisely, including types of services, products, and self-help practices and further include reasons for use and helpfulness of the specific therapies used based on a modified Norwegian version of the I-CAM-Q (I-CAM-QN). Method - Computer assisted telephone interviews using I-CAM-QN were conducted with 2001 randomly selected Norwegians aged 16 and above using multistage sampling in January 2019 with age and sex quotas for each area. Weights based on sex, age, education, and region corrected for selection biases, so that results are broadly representative of the Norwegian population. Descriptive statistics were carried out using Pearson’s Chi-square tests and t-tests to identify group differences. Result - CAM use was reported by 62.2% of the participants during the prior12 months. Most participants had used natural remedies (47.4%), followed by self-help practices (29.1%) and therapies received from CAM providers (14.7%). Few of the participants had received CAM therapies from physicians (1.2%). Women were generally more likely to use CAM than men, younger people more likely than older, and participants with lower university education and income more likely than participants without university education, with higher university education and higher income. Mean number of visits per year to the different CAM providers ranged from 3.57 times to herbalists to 6.77 times to healers. Most of the participants found their use of CAM helpful. Conclusion - This study confirms that CAM is used by a considerable segment of the Norwegian population. We suspect that the number of participants reporting CAM use is greater when specific therapies are listed in the questionnaire as a reminder (as in the I-CAM-QN) compared to more general questions about CAM use. The CAM modalities used are mainly received from CAM providers operating outside public health care or administered by the participants themselves

Communication and information needs about complementary and alternative medicine: a qualitative study of parents of children with cancer

Background: Many parents choose support such as Complementary and Alternative Medicine (CAM) for themselves and their children who have cancer. The aim of this paper is to describe, how parents who have children with cancer communicated with conventional health care providers about CAM, and what types and sources of information they would like to receive about CAM when the child was ill. Method: This focused ethnography draws from in-depth, semi-structured interviews conducted with 22 families in Norway with 24 adult participants (two couples), including two individuals who had had cancer themselves. Four domains were explored in the data analysis: the use of CAM, advice from laypeople about CAM, communication with conventional health care providers about CAM, and parents’ information needs about CAM. Results: Many of the participants had personal experiences with CAM before the child received the cancer diagnosis. The health care providers did not raise the question about CAM in the consultations. However, when the parents raised the question, they were mostly met in a positive way. The participants did not receive any information about CAM at the hospital, which they would have appreciated. Instead, they received recommendations about CAM from laypersons, which were mostly rejected, as the advice was not in line with their health values/philosophy. Conclusion: The reason participants did not disclose CAM use is that physicians did not ask them about it. However, positive communication about conventional treatment facilitated fruitful conversations about CAM. The participants wanted information about CAM from authoritative sources, primary from health care providers at the hospital and the Children’s Cancer Society. They demand information about risks and benefits when using CAM as well as whether CAM can improve the immune system, fight the cancer, and improve the quality of life of the family. An evidence-based decision aid is warranted to enable health care providers and parents of children with cancer to make well-informed decisions about CAM

Health and Occupational Injury Experienced by Latinx Child Farmworkers in North Carolina, USA

Children as young as 10 years old are hired to work on farms in the United States (U.S.). These children are largely Latinx. Using interview data collected from 202 North Carolina Latinx child farmworkers in 2017, this analysis documents the heath characteristics and occupational injuries of Latinx child farmworkers and delineates characteristics associated with their health and occupational injuries. Latinx child farmworkers include girls (37.6%) and boys (62.4%), aged 10 to 17 years, with 17.8% being migrant farmworkers. Three-quarters reported receiving medical and dental care in the past year. Respiratory (15.8%) and vision (20.3%) problems were prevalent. Girls more than boys, and younger more than older children had greater health service utilization. Occupational injuries were common, with 26.2% reporting a traumatic injury, 44.1% a dermatological injury, 42.6% a musculoskeletal injury, and 45.5% heat-related illness in the past year. Age increased the odds of reporting work injuries and heat-related illness, and being a non-migrant reduced the odds of reporting work injuries. These results emphasize the need for greater documentation of child farmworker occupational health and safety. They underscore the need to change occupational safety policy to ensure that children working in agriculture have the same protections as those working in all other U.S. industries

Workplace, Household, and Personal Predictors of Pesticide Exposure for Farmworkers

In this article we identify factors potentially associated with pesticide exposure among farmworkers, grade the evidence in the peer-reviewed literature for such associations, and propose a minimum set of measures necessary to understand farmworker risk for pesticide exposure. Data sources we reviewed included Medline, Science Citation Index, Social Science Citation Index, PsycINFO, and AGRI-COLA databases. Data extraction was restricted to those articles that reported primary data collection and analysis published in 1990 or later. We read and summarized evidence for pesticide exposure associations. For data synthesis, articles were graded by type of evidence for association of risk factor with pesticide exposure as follows: 1 = association demonstrated in farmworkers; 2 = association demonstrated in nonfarmworker sample; 3 = plausible association proposed for farmworkers; or 4 = association plausible but not published for farmworkers. Of more than 80 studies we identified, only a third used environmental or biomarker evidence to document farmworker exposure to pesticides. Summaries of articles were compiled by level of evidence and presented in tabular form. A minimum list of data to be collected in farmworker pesticide studies was derived from these evidence tables. Despite ongoing concern about pesticide exposure of farmworkers and their families, relatively few studies have tried to test directly the association of behavioral and environmental factors with pesticide exposure in this population. Future studies should attempt to use similar behavioral, environmental, and psychosocial measures to build a body of evidence with which to better understand the risk factors for pesticide exposure among farmworkers

Farmworker Exposure to Pesticides: Methodologic Issues for the Collection of Comparable Data

The exposure of migrant and seasonal farmworkers and their families to agricultural and residential pesticides is a continuing public health concern. Pesticide exposure research has been spurred on by the development of sensitive and reliable laboratory techniques that allow the detection of minute amounts of pesticides or pesticide metabolites. The power of research on farmworker pesticide exposure has been limited because of variability in the collection of exposure data, the predictors of exposure considered, the laboratory procedures used in analyzing the exposure, and the measurement of exposure. The Farmworker Pesticide Exposure Comparable Data Conference assembled 25 scientists from diverse disciplinary and organizational backgrounds to develop methodologic consensus in four areas of farmworker pesticide exposure research: environmental exposure assessment, biomarkers, personal and occupational predictors of exposure, and health outcomes of exposure. In this introduction to this mini-monograph, first, we present the rationale for the conference and its organization. Second, we discuss some of the important challenges in conducting farmworker pesticide research, including the definition and size of the farmworker population, problems in communication and access, and the organization of agricultural work. Third, we summarize major findings from each of the conference’s four foci—environmental exposure assessment, biomonitoring, predictors of exposure, and health outcomes of exposure—as well as important laboratory and statistical analysis issues that cross-cut the four foci

Rural-Urban Differences in Dental Service Utilization and Dental Service Procedures Received Among US Adults: Results from the 2016 Medical Expenditure Panel Survey

PURPOSE: To assess rural-urban differences in dental service use and procedures and to explore the interaction effects of individual and county-level factors on having dental service use and procedures. METHODS: Data were from the 2016 Medical Expenditure Panel Survey (MEPS). We assessed rural-urban differences in three outcome variables: number of dental visits (1, 2, or 3+ visits), preventive care procedures (Yes/No), treatment procedures (Yes/No). The study sample included 8,334 adults ≥ 18 years of age who reported at least one dental visit in the past year. Sampling weights embedded in MEPS were incorporated into all the analyses. FINDINGS: A significant interaction between residential location and race/ethnicity (p=0.030) suggested limited access to dental visits for minority groups especially for blacks in the more rural areas. Adults from a more rural area were less likely to have received a preventive procedure (AOR=0.55, 95% CI: 0.35-0.87) than those from an urban area. Adults of racial/ethnic minority groups, with lower SES, and without dental insurance were less likely to have received a preventive procedure (all p<0.01), but were more likely to have received a treatment procedure (all p<0.05). CONCLUSIONS: The study showed rural adults were less likely to have received preventive dental procedures than their urban counterparts. Racial/ethnic minority groups living in a more rural area had even more limited access to dental services. Innovative service delivery models that integrate tele-health and community-based case management may contribute to addressing these gaps in rural communities