Background: The use of complementary alternative medicine (CAM) is potentially prevalent among paediatric patients with chronic diseases but with variable rates among different age groups, diseases and countries. There are no recent reports on CAM use among paediatric patients with inflammatory bowel disease (IBD) and juvenile idiopathic arthritis (JIA) in Europe. We hypothesized that CAM use associates with a more severe disease in paediatric IBD and JIA.
Methods: A cross-sectional questionnaire study among adolescent
outpatients with IBD and JIA addressing the frequency and type of CAM use
during the past year. The patients were recruited at the Children's Hospital,
University of Helsinki, Finland.
Results: Of the 147 respondents, 97 had IBD (Crohn's disease: n
= 46; median age 15.5, disease duration 3.4 years) and 50 had JIA (median age
13.8, disease duration 6.9 years). During the past 12 months, 48% regularly
used CAM while 81% reported occasional CAM use. Compared to patients with JIA,
the use of CAM in IBD patients tended to be more frequent. The most commonly
used CAM included probiotics, multivitamins, and mineral and trace element
supplements. Self-imposed dietary restrictions were common, involving 27.6% of
the non-CAM users but 64.8% of all CAM users. Disease activity was associated
with CAM use in JIA but not in IBD.
Conclusions: CAM use is frequent among
adolescents with IBD and JIA and associates with self-imposed dietary
restrictions. Reassuringly, adherence to disease modifying drugs is good in
young CAM users. In JIA, patients with active disease used more frequently CAM
than patients with inactive disease. As CAM use is frequent, physicians should
familiarise themselves with the basic concepts of CAM. The potential
pharmacological interaction or the toxicity of certain CAM products warrants
awareness and hence physicians should actively ask their patients about CAM
use.
Muller A. Teaching lesbian, gay, bisexual and transgender health in a
South African health sciences faculty: addressing the gap. BMC Med Educ 2013, 13:174
doi:10.1186/1472-6920-13-174
ABSTRACT
Background: People who identity as lesbian, gay, bisexual and
transgender (LGBT) have specific health needs. Sexual orientation and gender
identity are social determinants of health, as homophobia and heteronormativity
persist as prejudices in society. LGBT patients often experience discrimination
and prejudice in health care settings. While recent South African policies
recognise the need for providing LGBT specific health care, no curricula for
teaching about LGBT health related issues exist in South African health sciences
faculties. This study aimed to determine the extent to which LGBT health
related content is taught in the University of Cape Town’s medical curriculum.
Methods: A curriculum mapping exercise was conducted through an
online survey of all academic staff at the UCT health sciences faculty,
determining LGBT health related content, pedagogical methodology and
assessment. Results: 127 academics, across 31 divisions and research units in the Faculty of Health Sciences, responded to the survey, of which 93 completed the questionnaire. Ten taught some content related to LGBT health in the MBChB curriculum. No LGBT health related content was taught in the allied health sciences curricula. The MBChB curriculum provided no opportunity for students to challenge their own attitudes towards LGBT patients, and key LGBT health topics such as safer sex, mental health, substance abuse and adolescent health were not addressed.
Conclusion: At present, UCTs health sciences curricula do not
adequately address LGBT specific health issues. Where LGBT health related
content is taught in the MBChB curriculum, it is largely discretionary,
unsystematic and not incorporated into the overarching structure. Coordinated
initiatives to integrate LGBT health related content into all health sciences
curricula should be supported, and follow an approach that challenges students
to develop professional attitudes and behaviour concerning care for patients
from LGBT backgrounds, as well as providing them with specific LGBT health
knowledge. Educating health professions students on the health needs of LGBT
people is essential to improving this population’s health by providing
competent and non-judgmental care.
Clar C, Tsertsvadze A, Coiurt R, Lewando
Hundt G, Clarke A, Sutcliffe P. Clinical effectiveness of manual therapy for
the management of musculoskeletal and non-musculoskeletal conditions:
systematic review and update of UK evidence report. Chiropractic
& Manual Therapies 2014, 22:12 doi:10.1186/2045-709X-22-12
ABSTRACT
Background: This systematic review updated and extended the
"UK evidence report" by Bronfort et al. (Chiropr Osteopath 18:3,
2010) with respect to conditions/interventions that received an 'inconclusive?
or 'negative? evidence rating or were not covered in the report.
Methods: A literature search of more than 10 general medical
and specialised databases was conducted in August 2011 and updated in March
2013. Systematic reviews, primary comparative studies and qualitative studies
of patients with musculoskeletal or non-musculoskeletal conditions treated with
manual therapy and reporting clinical outcomes were included. Study quality was
assessed using standardised instruments, studies were summarised, and the
results were compared against the evidence ratings of Bronfort. These were
either confirmed, updated, or new categories not assessed by Bronfort were
added.
Results: 25,539 records were found; 178 new and additional
studies were identified, of which 72 were systematic reviews, 96 were
randomised controlled trials, and 10 were non-randomised primary studies. Most
'inconclusive? or 'moderate? evidence ratings of the UK evidence report were
confirmed. Evidence ratings changed in a positive direction from inconclusive
to moderate evidence ratings in only three cases (manipulation/mobilisation
[with exercise] for rotator cuff disorder; spinal mobilisation for cervicogenic
headache; and mobilisation for miscellaneous headache). In addition, evidence
was identified on a large number of non-musculoskeletal conditions not previously
considered; most of this evidence was rated as inconclusive.
Conclusions: Overall, there was limited high
quality evidence for the effectiveness of manual therapy. Most reviewed
evidence was of low to moderate quality and inconsistent due to substantial methodological
and clinical diversity. Areas requiring further research are highlighted.
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