National Patterns Of Use Research Articles

Use of Relaxation Techniques and Complementary and Alternative Medicine by American Adults with Insomnia Symptoms: Results from a National Survey

Though relaxation training is recommended for insomnia, national patterns of use remain unknown. Similarly, rates of complementary and alternative medicine (CAM) use by adults with insomnia are not well established. We sought to elucidate the patterns and reasons for use of relaxation techniques and CAM use by adults with insomnia symptoms. We used the 2007 National Health Interview Survey (n = 23,358) to estimate prevalence of use among adults by self-reported insomnia symptom status. Among adults reporting insomnia symptoms (n = 4,415), we examined reasons for use and disclosure to medical professionals. We employed logistic regression to determine the adjusted associations between relaxation techniques use, CAM use, and insomnia symptoms. Among adults with insomnia symptoms, 23% used relaxation techniques and 45% used CAM annually. After adjustment, adults with insomnia symptoms had higher likelihood of using relaxation techniques (aOR 1.48, 95% CI 1.32, 1.66) and CAM (aOR 1.29, 95% CI 1.15, 1.44) compared with adults without insomnia. Deep breathing exercise was the most commonly used relaxation technique. Fewer than 2% of adults with insomnia used CAM specifically for insomnia. Only 26% of adults with insomnia symptoms disclosed their relaxation techniques use to medical professionals. Being male, lower educational and physical activity levels, income < $20,000, living in South, and hypertension were associated with lower likelihood of relaxation techniques use among adults with insomnia symptoms. While adults with insomnia symptoms commonly use relaxation techniques and CAM, few are using for their insomnia. Facilitating discussions about relaxation techniques may foster targeted use for insomnia.

Psychopharmacology: concepts and opinions about the use of stimulant medications

Psychopharmacology: concepts and opinions about the use of stimulant medications

Letter Regarding Article by Masoudi et al, “National Patterns of Use and Effectiveness of Angiotensin-Converting Enzyme Inhibitors in Older Patients With Heart Failure and Left Ventricular Systolic Dysfunction”

To the Editor: We read with great interest the article by Masoudi et al,1 in which “a stubborn, persistent gap between ideal practice and actual use of ACE inhibitors for heart failure” was shown. The editorial by Mark Hlatky2 also stimulated our reflections. The gap between ideal and practical use in the cardiovascular field and other fields of medicine may have various explanations. Data have shown that the “real patient” is different from the “trial patient”; in fact the latter, even if old, is usually in good general condition, without comorbidities and cognitive and physical impairments. This patient may be considered a “robust” or an “intermediate” subject.3 In the real world, however, many patients are frail, with severe comorbidities, polypharmacy, cognitive or physical disabilities, and …

Issue Highlights

HomeCirculationVol. 111, No. 17Issue Highlights Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBIssue Highlights Originally published3 May 2005https://doi.org/10.1161/circ.111.17.2151Circulation. 2005;111:2151PERCUTANEOUS MITRAL VALVE REPAIR FOR CHRONIC ISCHEMIC MITRAL REGURGITATION: A REAL-TIME THREE-DIMENSIONAL ECHOCARDIOGRAPHIC STUDY IN AN OVINE MODEL, by Daimon et al.Ischemic mitral regurgitation is associated with adverse prognosis in patients with chronic heart failure as well as after myocardial infarction and coronary revascularization. There is great interest in surgical remodeling procedures and mitral valve reconstruction to correct the mitral regurgitation and potentially improve prognosis. One of the limitations to this approach has been the relatively high operative morbidity and even mortality associated with such surgical procedures. In this issue of Circulation, Daimon et al demonstrate the utility of percutaneous placement of an annuloplasty device in a sheep model of chronic ischemic mitral regurgitation. They demonstrate the benefit of this approach in reducing mitral regurgitation as well as beneficially improving mitral annular dimension and functional closure of the valve. This study supports the clinical potential of percutaneous nonsurgical approaches to treating patients with ischemic mitral regurgitation. See p 2183.INFLAMMATION AND CAROTID ARTERY—RISK FOR ATHEROSCLEROSIS STUDY (ICARAS), by Schillinger et al.Prior studies have demonstrated that inflammatory markers such as C-reactive protein (CRP) are related to prevalent and incident cardiovascular events. However, the temporality of the relations between inflammation and atherosclerosis has been less clear. Inflammation may predispose to atherosclerosis, but it is equally plausible that atherosclerosis predisposes to inflammation. In a prospective study of almost 1300 patients, Schillinger and colleagues examined the relation between CRP and serum amyloid A and ultrasound progression of carotid atherosclerosis. In adjusted analyses compared with the bottom quartile, individuals in the top quartiles of CRP and serum amyloid A, respectively, were about 4 and 2 times more likely to develop progression of carotid atherosclerosis. This study documents that inflammatory markers predict atherosclerosis progression. Although the authors cannot prove a causal relation, their study is consistent with the hypothesis that inflammation may contribute to atherosclerosis progression. See p 2203.DUAL ANTIPLATELET THERAPY WITH CLOPIDOGREL AND ASPIRIN IN SYMPTOMATIC CAROTID STENOSIS EVALUATED USING DOPPLER EMBOLIC SIGNAL DETECTION: THE CLOPIDOGREL AND ASPIRIN FOR REDUCTION OF EMBOLI IN SYMPTOMATIC CAROTID STENOSIS (CARESS) TRIAL, by Markus et al.Patients with symptomatic carotid stenosis are at high risk for stroke. Unlike coronary occlusion, cerebrovascular ischemia in such patients is rarely caused by carotid occlusion at the plaque but rather is due to platelet emboli arising from its ruptured surface. Indeed, asymptomatic microembolic signals can be detected by transcranial Doppler ultrasound in up to half of patients with symptomatic carotid stenosis. The role of platelets was for the first time convincingly clarified in the CARESS study, which randomized such patients to aspirin or aspirin and clopidogrel. Not only were microemboli more frequent in patients with events than in those without, dual platelet inhibition also was more effective in inhibiting platelet activity ex vivo and in reducing microemboli as detected by transcranial Doppler ultrasound. Thus, CARESS adds to the plausibility of dual antiplatelet therapy to prevent embolic stroke. See p 2233.Visit http://www.circ.ahajournals.org:Clinician UpdateControversies in Antiplatelet Therapy for Patients With Cardiovascular Disease. See p e267.Images in Cardiovascular MedicineTraumatic Coronary Artery Fistula in a Child. See p e272. Download figureDownload PowerPointCorrespondenceLetter Regarding Article by Rosenhek et al, “Statins but Not Angiotensin-Converting Enzyme Inhibitors Delay Progression of Aortic Stenosis.” See p e274.Letter Regarding Article by Masoudi et al, “National Patterns of Use and Effectiveness of Angiotensin-Converting Enzyme Inhibitors in Older Patients With Heart Failure and Left Ventricular Systolic Dysfunction.” See p e276.Letter Regarding Article by Kaufmann et al, “Systemic Inhibition of Nitric Oxide Synthase Unmasks Neural Constraint of Maximal Myocardial Blood Flow in Humans.” See p e278. Previous Back to top Next FiguresReferencesRelatedDetails May 3, 2005Vol 111, Issue 17 Advertisement Article InformationMetrics https://doi.org/10.1161/circ.111.17.2151 Originally publishedMay 3, 2005 PDF download Advertisement

Patterns of use of hormone replacement therapy in one million women in Britain, 1996–2000

To describe national patterns of use of hormone replacement therapy (HRT) in 1996-2000. Population-based study of women aged 50-64. England and Scotland. A total of 1,091,250 women were recruited between May 1996 and December 2000. Women invited for screening at 66 NHS breast screening units were sent a questionnaire to complete before they were screened; 71% of women screened participated. Prevalence of use of HRT. Overall, 33% of women reported that they were currently using HRT, the average duration of use being 5.8 years; 50% were ever-users. Current use of HRT was about twice as common at age 50-54 than 60-64, but varied little by time or region, the prevalences being 33%-34% in each year from 1996 to 2000; 30% in Scotland and 35% in southeast England. The prevalence of current use of HRT varied substantially depending on the woman's history of gynaecological surgery and past health, and was as follows in women with a history of: bilateral oophorectomy (66%); hysterectomy without bilateral oophorectomy (48%); neither hysterectomy nor bilateral oophorectomy (27%); breast cancer (6%); other cancer (25%); stroke (24%); venous thromboembolism (24%); diabetes (25%); heart disease (31%); or hypertension (31%). There was considerably less variation in the prevalence of use of HRT according to deprivation index, education, parity, body mass index, exercise, smoking or alcohol consumption. HRT is currently used by around one-third of women aged 50-64 in Britain and appears to be influenced considerably more strongly by a woman's medical and surgical history than by socio-economic or lifestyle factors.

Patterns of use of hormone replacement therapy in one million women in Britain, 1996–2000

Objective To describe national patterns of use of hormone replacement therapy (HRT) in 1996–2000.Design Population‐based study of women aged 50–64.Setting England and Scotland.Population A total of 1,091,250 women were recruited between May 1996 and December 2000.Methods Women invited for screening at 66 NHS breast screening units were sent a questionnaire to complete before they were screened; 71% of women screened participated.Main outcome measures Prevalence of use of HRT.Results Overall, 33% of women reported that they were currently using HRT, the average duration of use being 5.8 years; 50% were ever‐users. Current use of HRT was about twice as common at age 50–54 than 60–64, but varied little by time or region, the prevalences being 33%–34% in each year from 1996 to 2000; 30% in Scotland and 35% in southeast England. The prevalence of current use of HRT varied substantially depending on the woman's history of gynaecological surgery and past health, and was as follows in women with a history of: bilateral oophorectomy (66%); hysterectomy without bilateral oophorectomy (48%); neither hysterectomy nor bilateral oophorectomy (27%); breast cancer (6%); other cancer (25%); stroke (24%); venous thromboembolism (24%); diabetes (25%); heart disease (31%); or hypertension (31%). There was considerably less variation in the prevalence of use of HRT according to deprivation index, education, parity, body mass index, exercise, smoking or alcohol consumption.Conclusions HRT is currently used by around one‐third of women aged 50–64 in Britain and appears to be influenced considerably more strongly by a woman's medical and surgical history than by socio‐economic or lifestyle factors.

Factors influencing the use of breast reconstruction postmastectomy: a national cancer database study

Advances in surgical techniques and changes in our understanding of the biology of breast cancer have made immediate or early breast reconstruction a viable option for the majority of women with breast cancer. Little is known about national patterns of use of reconstruction. This study was undertaken to determine national patterns of care and factors that influence the use of breast reconstruction. A large convenience sample reported to the National Cancer Data Base was studied. Patients coded as undergoing mastectomy between 1985 and 1990 (n = 155,463) and between 1994 and 1995 (n = 68,348) were evaluated. The use of reconstruction in the two time periods was compared, and patient and tumor factors influencing the use of the procedure were compared. Between 1985 and 1990, 3.4% of mastectomy patients had early or immediate reconstruction, increasing to 8.3% in 1994-5. Patient age, income, geographic location, type of hospital where treatment occurred, and tumor stage all influenced the use of reconstruction in univariate analysis. In multivariate analysis, patients age 50 or under had a 4.3-fold greater likelihood of having reconstruction than their older counterparts. Patients with ductal carcinoma in situ were twice as likely as those with invasive cancer to have reconstruction. Family income of $40,000 or more (Odds Ratio 2.0), ethnicity other than African-American (Odds Ratio 1.6), surgery in a National Cancer Institute-designated cancer center (Odds Ratio 1.4), and surgery in a geographic region other than the Midwest or South (Odds Ratio 1.3) remained significant predictors of the use of reconstruction in multivariate analysis. Breast reconstruction is an underused option in breast cancer management. Predictors of the use of reconstruction do not reflect contraindications to the procedure, and indicate the need for both physician and patient education.

National Patterns of Psychotherapeutic Drug Use

Data on national patterns of use of psychotherapeutic drugs derive from a national sample of American adults. During the year preceding the interview, 13% of the men and 29% of the women had used such prescription drugs–in particular minor tranquilizers and daytime sedatives. Prevalence of prescription drug use varies greatly by sex, age, and region of the country.