The Journal of the Royal Society for the Promotion of Health最新文献

Although practitioner-prescribed 'western' herbal medicine (phytotherapy) is a popular complementary therapy in the UK, no clinical studies have been reported on patient-orientated outcomes. The objective of this pilot study was to investigate the effects of phytotherapy on symptoms of osteoarthritis of the knee. A previous study of Chinese herbal medicine for the treatment of irritable bowel syndrome, published in the Journal of the American Medical Association, acted as a model in the development of the protocol of this investigation. Twenty adults, previously diagnosed with osteoarthritis of the knee, were recruited from two Inner London GP practices into this randomized, double-blind, placebo-controlled, pilot study carried out in a primary-care setting. All subjects were seen in consultation three times by a herbal practitioner who was blinded to the randomization coding. Each subject was prescribed treatment and given lifestyle advice according to usual practice: continuation of conventional medication where applicable, healthy-eating advice and nutrient supplementation. Individualized herbal medicine was prescribed for each patient, but only dispensed for those randomized to active treatment-- the remainder were supplied with a placebo. At baseline and outcome (after ten weeks of treatment), subjects completed a food frequency questionnaire and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee health and Measure Yourself Outcome Profile (MYMOP) wellbeing questionnaires. Subjects completing the study per protocol (n = 14) reported an increased intake of wholegrain foods (p = 0.045) and oily fish (p = 0.039) compared to baseline, but no increase in fruit and vegetables and dairy products intakes. There was no difference in the primary outcome measure of knee health assessed as the difference in the mean response (baseline-week 10) in WOMAC score between the two treatment groups. However, there was, compared with baseline, improvement in the active group (n = 9) for the mean WOMAC stiffness sub-score at week 5 (p = 0.035) and week 10 (p = 0.060) but not in the placebo group (n = 5). Furthermore, for the active, but not the placebo group, the mean WOMAC total and sub-scores all showed clinically significant improvement (> or = 20%) in knee symptoms at weeks 5 and 10 compared with baseline. Moreover, the mean MYMOP symptom 2 sub-score, mostly relating to osteoarthritis (OA), showed significant improvement at week 5 (p = 0.02) and week 10 (p = 0.008) compared with baseline for the active, but not for the placebo group. This pilot study showed that herbal medicine prescribed for the individual by a herbal practitioner resulted in improvement of symptoms of OA of the knee.

Aims: The rapid economic transition in the Gulf Arab countries has resulted in marked changes in fertility and marriage patterns and a decrease in the number of children per family. Yet little is known about the determinants of family size in urban and less urban areas.

Methods: A cross-sectional study was carried out on 450 Kuwaiti women aged 20-60 years who attended health care centres in Al Asima and Al Jahra governorates. A semi-structured questionnaire was administered through face-to-face interview which included variables on socio-demographic characteristics, family size, actual and ideal spacing, marriage related variables, health conditions and utilization of health services. Both univariate and multivariate analyses were performed to identify the factors that affect family size.

Results: The socio-economic indicators were significantly better in Al Asima, the capital, than in Al Jahra, a less urbanized area. On average, family size for the total sample was 5.97 +/- 0.114 with a larger size (6.27 +/- 0.242) in Al Jahra than in Al Asima (5.80 +/- 0.118) but without a significant difference. Al Jahra women reported a larger number of deliveries and past pregnancies but a lower usage of contraceptive measures. The total fertility rate was 3.65 in Al Asima, 3.84 in Al Jahra and 3.71 births per woman in the total population. Family size was inversely related to the educational level of women and their husbands. Currently employed women had a smaller family size (5.22 +/- 0.119) than the unemployed (6.81 +/- 0.187); p < 0.0005. Health problems in the interviewee or her husband played a minor role in the decision to have more children. Families where the husband was the decision-maker on the number of children had a significantly larger family size (6.91 +/- 0.451) than families where the couple both participated in the decision (5.83 +/- 0.129; p = 0.032). The duration of marriage, ideal number of children, age of women at last delivery, number of rooms and the crowding index had significant positive effects on family size, whereas age at first delivery, duration between two consecutive pregnancies and history of past abortions were inversely related to family size in the stepwise multiple regression analysis.

Conclusions: Although women in the less urbanized areas in the Gulf Arab populations are more disadvantaged with respect to socio-economic characteristics than women in the more urbanized areas, there were no significant differences in family size in these contrasting communities. The impact of socio-demographic characteristics on family size was minor compared to factors related to fertility and the husband's desire to have more children. Fertility and family planning policies should consider these issues in order to promote more effective programmes.