Use Of Natural Health Products Research Articles

Factors influencing the use of natural health products, in particular for concentration and cognition in Germany

BackgroundNatural health products (NHP) are an important part of the healthcare system. They are mainly non-prescription and sold over the counter, which requires active decision making by the consumer. Within the framework of the Complementary and Alternative Healthcare Model, this study aims to identify factors that influence NHP usage, in particular related to concentration and cognition (CC), a topic that concerns all ages and social classes within the population.MethodsData were collected by means of a representative online survey (n = 1,707) in Germany in April 2022. Three user groups were defined: NHPCC users, who used NHP for CC (12 month prevalence); nCC-NHP users, who used NHP but not for CC indications (12 month prevalence); and past NHP users, who have used NHP but not within the previous 12 months. Independent influencing variables were categorized into predisposing, enabling, need, and health service use factors. Data were analyzed with descriptive statistics, inferential statistics, and binary logistic regression models to compare NHPCC users to nCC-NHP users (model 1) and to past NHP users (model 2).ResultsA higher share of NHPCC and nCC-NHP users compared to past NHP users were women, self-medicated with NHP, and used information about NHP provided by health professionals or on product. Their openness-to-change value orientation was more pronounced than of past users. Compared to nCC-NHP and past NHP users, the probability of being an NHPCC user increased if an individual had more difficulties in daily attention and memory performance, made use of health professionals and literature to seek information about NHP, and used NHP for health support and illness prevention. Additionally, a female gender, NHP self-medication, and having higher values of self-transcendence were significant indicators for NHPCC usage compared to past NHP usage.ConclusionNHP manufacturers, health professionals, and policymakers should be aware of the factors that lead to NHP consumption decisions and consider them in the development and optimization of healthcare strategies as well as in the marketing and communication strategies of companies producing NHP, in particular for CC. The current study can contribute to characterizing the target groups and to defining the aims and communication channels of such campaigns.

Knowledge, attitudes, and practice of university's employees about complementary and alternative medicine (CAM)

BackgroundThe use of natural health products has increased globally. It is important to properly regulate these products to guarantee good quality control, ensure consumers' safety, and integrate them into modern medicine. This study was conducted to identify the prevalence of NHP use among university employees in Nineveh Province, Iraq, along with the employees’ awareness, usage patterns, attitudes, and information needs. MethodA cross-sectional study was conducted between 2 October and 6 December 2022 in four main universities (Mosul, Nineveh, Al- Hamdaniya, and Tal-Afar) in Nineveh Province, Iraq. Data were collected face-to-face through an interviewer-administrated structured questionnaire from a multi-stage sampling of employees. Information was gathered using a data collection form and sent to a Microsoft Office Excel® (2010) spreadsheet. Statistical significance was determined using a chi-squared test, with a p-value of less than 0.01 representing a significant finding. ResultsOur results showed that (42.2% of the sample used herbal medications. However, we identified a statistically significant correlation between the female gender and herbal medicine use (p = 0.001). More than half of those surveyed (56%) felt that herbal medicines might be used to prevent and treat sickness, and 49% felt that they were safe to use. A total of 153 people (37.4%) said they felt comfortable combining herbal remedies with conventional treatments. Females were shown to have more knowledge regarding the origin of herbal medicines than males, and this difference was statistically significant (p = 0.05). Further, there was a statistically significant difference between the percentage of those with no medical problems and those with chronic diseases who used herbal medicines (p = 0.001). Intriguingly, over half of all respondents (n = 204; 49.9%) initially relied on herbal remedies whenever they fell ill, and nearly as many (n = 172; 42.1%) did not even check with their doctors before using herbal remedies. ConclusionWhen writing prescriptions and delivering medications to patients, doctors, nurses, and pharmacists should take care to inform patients about the effectiveness and adverse effects of herbal medicine (HMs) using evidence-based information. To increase patients’ awareness of pharmaceutical use, patient counselling and education are necessary.

Current Advancements and Novel Strategies in the Treatment of Metastatic Melanoma.

Melanoma is the deadliest form of skin cancer in the world with a growing incidence in North America. Contemporary treatments for melanoma include surgical resection, chemotherapy, and radiotherapy. However, apart from resection in early melanoma, the prognosis of patients using these treatments is typically poor. In the past decade, there have been significant advancements in melanoma therapies. Immunotherapies such as ipilimumab and targeted therapies such as vemurafenib have emerged as a promising option for patients as seen in both scientific and clinical research. Furthermore, combination therapies are starting to be administered in the form of polychemotherapy, polyimmunotherapy, and biochemotherapy, of which some have shown promising outcomes in relative efficacy and safety due to their multiple targets. Alongside these treatments, new research has been conducted into the evidence-based use of natural health products (NHPs) and natural compounds (NCs) on melanoma which may provide a long-term and non-toxic form of complementary therapy. Nevertheless, there is a limited consolidation of the research conducted in emerging melanoma treatments which may be useful for researchers and clinicians. Thus, this review attempts to evaluate the therapeutic efficacy of current advancements in metastatic melanoma treatment by surveying new research into the molecular and cellular basis of treatments along with their clinical efficacy. In addition, this review aims to elucidate novel strategies that are currently being used and have the potential to be used in the future.

The effects of Guarana (Paullinia cupana) supplementation on the cognitive performance of young healthy adults – a Systematic Review

Objectives Guarana (Paullinia cupana) from the Sapindaceae family, native to the Amazon basin, is a natural stimulant herb that can be found in popular energy drinks, pharmaceutical shops or local herb shops. With the use of natural health products increasing, guarana has gained a fair amount of popularity in the past years. In this systematic review, we examined the effects of guarana supplementation on cognitive performance. A secondary objective was to compare guarana with caffeine on cognitive performance. Methods Searches were made in PubMed using the terms ‘Guarana’ or ‘Paullinia cupana’. Filters focused on Controlled Clinical trials. Inclusion criteria were met by studies using interventions with guarana, while focusing on guarana’s effects on cognition. Participants needed to be young, healthy adults. Studies not published in English or Greek were excluded. The last date of our search was March 7, 2019. Results A total of 29 studies were identified and screened. After screening, 17 studies were excluded. The remaining 12 studies were found eligible for data extraction. After reading the full text of the 12 studies, 3 studies were excluded. In the end, 9 studies were found eligible for our systematic review (n = 369 participants). In these studies, guarana showed to improve reaction time and accuracy of performance at cognitive tasks. No significant differences were found when comparing guarana with caffeine. Conclusion Guarana seems to improve reaction time and accuracy of performance at tasks, but no significant effects were found when compared with caffeine. High quality randomized controlled clinical trials with a low risk of bias are needed to further study the herb.

No improvement in disclosure of natural health product use to primary care medical doctors in the last 15 years: A survey of naturopathic patients

BackgroundThe use of natural health products (NHPs) is common in North America. In 2003, we found that 42% of NHP users had not disclosed this information to their primary care medical doctors (MDs). We repeated our survey in 2018/2019 to explore if the rate of NHP use disclosure had improved. MethodsFrom November 2018–February 2019, a 21-item survey about NHP use and disclosure was administered to adult patients who visited the Robert Schad Naturopathic Clinic in Toronto, Canada. ResultsAlmost all patients surveyed were using NHPs (99%), and 46% were using NHPs and prescription medication concurrently. Consistent with our 2003 findings, 42% of respondents who used NHPs did not disclose this information to their MD. ConclusionDisclosure of NHP use to MDs by naturopathic patients is limited and remained unchanged over the past 15 years. Future research should explore primary care MDs’ hesitancy to inquire about patient NHP use.

Hand It to Dr Google: The Quality of Online Information on Ganglion Cysts.

Background: The internet is becoming a common source of health information for hand surgery patients. This study evaluates the quality of web-based resources on ganglion cysts of the hand. Methods: We completed a search for "ganglion cyst" on 3 search engines (Google, Dogpile, and Yippy). The quality of the top-100 patient education websites was assessed using a validated internet rating tool. Websites were evaluated based on affiliation, accountability, currency, interactivity, website organization, readability, coverage, and accuracy. Results: Of the 100 websites, the majority (74%) had commercial affiliations. Only 34% of websites identified an author, and even fewer identified the authors' credentials (27%) or affiliations (26%). A third of the websites cited references, and less than half provided an update date. The average readability based on Flesch-Kincaid grade level was 9.2, and only 3% could be read at or below 6th grade reading level. Prevention was the most poorly covered topic at 13% due to omission. In all, 66% of the websites were completely accurate in terms of global accuracy. Websites were most likely to present inaccurate information on treatment, often failing to mention conservative treatment (watch-and-wait approach) or promoting the use of natural health products. We also found 5% of websites presented closed rupture of the ganglion cyst as a legitimate home remedy. Conclusions: The overall quality of online information on ganglion cysts is highly variable and may occasionally be harmful for patients. It is increasingly important for physicians to prompt patients about their internet use.

A comparative analysis of recommendations provided by clinical practice guideline for use of natural health products in the treatment of menopause-related vasomotor symptoms

ObjectivesTo systematically review Clinical Practice Guidelines (CPGs) for the management of menopause-related vasomotor symptoms (VMS) to 1) identify those that include Natural Health Products (NHPs); 2) identify which NHPs were included and the evidence supporting the recommendation for the place in therapy; and 3) compare methodological quality of the CPGs. MethodsPubMed, EMBASE, Web of Science, BMJ Best Practice, DynaMed Plus and websites of gynecological and menopausal societies were searched (Jan 2000–Nov 2018). Records were screened to identify CPGs that were published in English, since 2000 and were for use in North America. CPGs were reviewed for inclusion of NHPs. Data regarding NHPs (evidence, recommendation) were extracted and analyzed. CPGs were critically appraised using the AGREE II tool. ResultsFive of six CPGs that met general inclusion criteria included NHPs. Black cohosh, isoflavones, soy food/extracts and phytoestrogens were included in all five CPGs. Comparative analysis of recommendations and level of supporting evidence revealed differences. All CPGs included recommendations regarding the use of NHPs in general, although recommendations differed. Four of five CPGs made recommendations for unique NHPs, however, recommendations differed. Using the AGREE II tool, CPGs scored well on domains for purpose and clarity. Lack of detailed description of methodology and author expertise affected scores in other domains. ConclusionFive CPGs included general recommendations for the role of NHPs in treating VMS, with recommendations ranging from use with caution to not recommended. There were inconsistencies among CPGs regarding NHPs included and what evidence was used in making recommendations.

The effects of Guarana (Paullinia cupana) supplementation on the cognitive performance of young healthy adults – a Systematic Review

Abstract Objectives Guarana (Paullinia cupana) from the Sapindaceae family, native to the Amazon basin, is a natural stimulant herb that can be found in popular energy drinks, pharmaceutical shops or local herb shops. With the use of natural health products increasing, guarana has gained a fair amount of popularity in the past years. In this systematic review, we examined the effects of guarana supplementation on cognitive performance. A secondary objective was to compare guarana with caffeine on cognitive performance. Methods Searches were made in PubMed using the terms ‘Guarana’ or ‘Paullinia cupana’. Filters focused on Controlled Clinical trials. Inclusion criteria were met by studies using interventions with guarana, while focusing on guarana’s effects on cognition. Participants needed to be young, healthy adults. Studies not published in English or Greek were excluded. The last date of our search was March 7, 2019. Results A total of 29 studies were identified and screened. After screening, 17 studies were excluded. The remaining 12 studies were found eligible for data extraction. After reading the full text of the 12 studies, 3 studies were excluded. In the end, 9 studies were found eligible for our systematic review (n = 369 participants). In these studies, guarana showed to improve reaction time and accuracy of performance at cognitive tasks. No significant differences were found when comparing guarana with caffeine. Conclusion Guarana seems to improve reaction time and accuracy of performance at tasks, but no significant effects were found when compared with caffeine. High quality randomized controlled clinical trials with a low risk of bias are needed to further study the herb.

Integrative Approaches to Stress Management.

This narrative review provides an overview of the scope of psychosocial distress and stress in cancer patients and survivors and the potential negative consequences of untreated symptoms. Evidence-based interventions to treat these symptoms are reviewed, beginning with a summary of published clinical practice guidelines, followed by more detailed reviews of the specific integrative interventions with the largest empirical support: cognitive-behavioral stress management, yoga, mindfulness-based interventions, and massage. We also comment on use of natural health products because of their popularity. Finally, we conclude with recommendations to improve the quality of research in integrative interventions for stress management.

Patients’ perceptions and use of natural health products

Despite a lack of good scientific evidence for their benefit, Canadians take a lot of natural health products (NHPs). The objectives of this study were to determine patients' perception of the efficacy, safety and quality of NHPs and to characterize NHP use. A standardized, 18-question survey was distributed to the general public through a variety of methods. A total of 326 individuals completed the survey. Eighty-five percent of respondents take 1 or more NHPs. Forty-seven percent agreed/strongly agreed that NHPs are safer than prescription medications and 24% disagreed/strongly disagreed that prescription medications are more effective than NHPs. Three-quarters of respondents agreed/strongly agreed that health care providers should recommend NHPs more often, as most stated they preferred to take an NHP for both a minor ailment (82%) and chronic medical condition (60%). Respondents used 124 different NHPs, most commonly vitamin D, vitamin B and magnesium. Respondents purchased NHPs primarily from health/vitamin stores (66%) and accessed the Internet for information about them (64%). Younger, female respondents were more likely to take NHPs. Patients appear to be comfortable foregoing education from health care professionals about the benefits and risks of NHPs. Patients' comfort with self-prescribing NHPs seems to stem from a perception of general efficacy and quality with little to no concern about harm and appears to be strongly influenced by lay sources of information. Most respondents take 1 or more NHPs, preferring to use NHPs over prescription medications for minor and chronic health concerns seemingly based on a perception of safety and quality.

Creation of a Natural Health Products Database for Assessing Safety for Patients with Chronic Kidney Disease or Renal Transplant

There is a lack of published safety information on the use of natural health products (NHPs) for patients with chronic kidney disease (CKD) or renal transplant. To create an online database to provide evidence-based safety recommendations for commonly used NHPs, specific to patients with CKD or renal transplant. NHPs used by CKD and transplant patients in British Columbia were identified from the records of the BC Provincial Renal Agency. For each NHP, several databases (MEDLINE, Embase, Lexi-Natural Products, PubMed Dietary Supplement Subset, and Natural Medicines) were searched for any information pertaining to dosage, adverse drug reactions, drug interactions, immunomodulatory effects, and pharmacokinetics in patients with renal disease. Each NHP was given 1 of 4 safety ratings: likely safe, possibly safe, possibly unsafe, and likely unsafe. An NHP was classified as "possibly unsafe" for patients with renal transplant if it had demonstrated in vitro immunomodulatory effects and/or significant interactions with transplant medications due to effects on the cytochrome P450 3A4 isozyme. Of the 19 627 BC-registered patients with renal disease (as of August 2014), 4122 (21%) were using one or more NHPs. The Herbal-CKD website (www.herbalckd.com) was created in 2015 to provide information about 47 commonly used NHPs and 2 known nephrotoxins (aristolochic acid and silver). This website provides a systematic evaluation of safety information for selected NHPs for patients with CKD (both nondialysis and dialysis-dependent) and kidney transplant. The most common NHP safety classification was "possibly safe", reflecting the paucity of studies in renal populations and the availability of safety data for the general population. Limitations of the website include difficulty in interpreting and generalizing the safety literature because most NHP formulations are not standardized, and others are combination products. The website www.herbalckd.com provides an easy-to-use, evidence-based tool for health care professionals to assess the safety of NHPs for CKD and transplant patients.

Self-reported use of natural health products among rheumatology patients: A cross-sectional survey.

To describe the self-reported use of natural health products (NHPs) and identify characteristics that predict selected NHP use in rheumatology patients. We conducted a cross-sectional survey of consecutive rheumatology patients in two major clinics in Edmonton, Alberta. Survey items included demographic data, rheumatologic diagnoses, prescribed medications, NHPs, and information regarding patients' use of NHPs. Selected NHPs of interest - defined to include joint-specific products, oils with putative joint benefits, and other non-vitamin, non-mineral products - were classified by 2 reviewers. The characteristics of selected NHP users and non-users were compared using chi-squared and ANOVA tests, followed by multivariable-adjusted logistic regression. 1063 patients completed the survey (response rate = 36%, mean age 53 [sd 15], 70% female). 36% of respondents reported using one or more of a wide range of selected NHPs (mean 1.8, range 1-9). The most common source of NHP recommendations for selected NHP users were physicians (42%). Significant predictors of selected NHP use were: being female (aOR 1.41, 95%CI [1.05-1.90], p = 0.02), having a post-secondary degree (aOR 1.60 [1.15-2.22], p = 0.005), and the number of non-rheumatic medications (aOR 1.08 [ 1.00-1.15], p = 0.03) and NSAIDs (aOR 1.32 [1.06, 1.63], p = 0.01). Similar findings were observed among only inflammatory arthritis patients. Our study confirms the frequent use of selected NHPs, possibly to mitigate persistent symptoms of rheumatologic illness. Rheumatologists appear to be trusted sources of advice and recommendations on NHP use and should provide balanced counselling for their patients.

Community Pharmacists' Views and Practices Regarding Natural Health Products Sold in Community Pharmacies.

BackgroundReports of regulatory and evidentiary gaps have raised concerns about the marketing and use of natural health products (NHPs). The majority of NHPs offered for sale are purchased at a community pharmacy and pharmacists are “front-line” health professionals involved in the marketing and provision of NHPs. To date, the involvement of pharmacists in pharmacy care involving NHPs and the degree to which concerns over the safety, efficacy, marketing and regulation of NHPs are addressed in pharmacy care in Canada have not been studied.MethodsUsing Qualtrics, a web-based data collection and analysis software, and a study instrument made up of fifteen (15) open-ended, closed and rating scale questions, we surveyed the attitudes and practices of 403 community pharmacists in the Canadian province of Alberta regarding NHPs offered for sale in community pharmacies.ResultsThe majority of pharmacists surveyed (276; 68%) recommend NHPs to clients sometimes to very often. Vitamin D, calcium, multivitamins, prenatal vitamins, probiotics and fish oil and omega-3 fatty acids were the most frequently recommended NHPs. The most common indications for which NHPs are recommended include bone and musculoskeletal disorders, maintenance of general health, gastrointestinal disorders and pregnancy. Review articles published in the Pharmacist’s Letter and Canadian Pharmacists Journal were the primary basis for recommending NHPs. The majority of pharmacists surveyed (339; 84%) recommend the use of NHPs concurrently with conventional drugs, while a significant number and proportion (125; 31%) recommend alternative use. Pharmacists in the study overwhelmingly reported providing counselling on NHPs to clients based on information obtained mainly from the Natural Medicines Comprehensive Database.ConclusionsThe study findings indicate a high prevalence of pharmacy care relating to NHPs among study participants. Although pharmacists’ practices around NHPs are consistent with the existing licensing framework, we found some involvement in problematic practices that necessitate further research and potential policy scrutiny. The study also uncovered patterns of recommendations, including sources relied on in recommending NHPs and in providing counselling to patients, that raise concerns about the quality and credibility of NHP-related care provided to pharmacy patrons.

Fish-Derived Omega-3 Fatty Acids and Prostate Cancer: A Systematic Review.

Background. The use of natural health products in prostate cancer (PrCa) is high despite a lack of evidence with respect to safety and efficacy. Fish-derived omega-3 fatty acids possess anti-inflammatory effects and preclinical data suggest a protective effect on PrCa incidence and progression; however, human studies have yielded conflicting results. Methods. A search of OVID MEDLINE, Pre-MEDLINE, Embase, and the Allied and Complementary Medicine Database (AMED) was completed for human interventional or observational data assessing the safety and efficacy of fish-derived omega-3 fatty acids in the incidence and progression of PrCa. Results. Of 1776 citations screened, 54 publications reporting on 44 studies were included for review and analysis: 4 reports of 3 randomized controlled trials, 1 nonrandomized clinical trial, 20 reports of 14 cohort studies, 26 reports of 23 case-control studies, and 3 case-cohort studies. The interventional studies using fish oil supplements in patients with PrCa showed no impact on prostate-specific antigen levels; however, 2 studies showed a decrease in inflammatory or other cancer markers. A small number of mild adverse events were reported and interactions with other interventions were not assessed. Cohort and case-control studies assessing the relationship between dietary fish intake and the risk of PrCa were equivocal. Cohort studies assessing the risk of PrCa mortality suggested an association between higher intake of fish and decreased risk of prostate cancer–related death. Conclusions. Current evidence is insufficient to suggest a relationship between fish-derived omega-3 fatty acid and risk of PrCa. An association between higher omega-3 intake and decreased PrCa mortality may be present but more research is needed. More intervention trials or observational studies with precisely measured exposure are needed to assess the impact of fish oil supplements and dietary fish-derived omega-3 fatty acid intake on safety, PrCa incidence, treatment, and progression.

Complementary and Alternative Medicine use in Pediatric Attention-Deficit Hyperactivity Disorder (ADHD): Reviewing the Safety and Efficacy of Herbal Medicines

Natural health products (NHPs), including herbal medicines, are a modality of complementary and alternative medicine (CAM) commonly used by pediatric patients with attention-deficit hyperactivity disorder (ADHD). Most families of pediatric patients find NHP treatment to be beneficial; however, clinical evidence of efficacy remains weak or lacking. Evidence of herbal medicine safety is similarly scarce, particularly with respect to herb-drug interactions and adverse events (AEs) associated with concurrent use of NHPs and ADHD prescription drugs. To support both families and physicians managing ADHD care, this review focuses on integrating available data on the safety and efficacy of herbal medicines commonly used by pediatric ADHD patients. In addition to reviewing results from clinical trials, patient surveys, and experimental studies relating to commonly used herbal medicines, the paper discusses adverse event reports involving concurrent use of herbs and ADHD drugs, identified through the FDAble database. While NHP and other CAM offer patients alternative treatment options with potential benefits as well as risks, additional research is needed to support open discussion and evidence-based decision making by families and physicians.

The African Pitocin - a midwife’s dilemma: the perception of women on the use of herbs in pregnancy and labour in Zimbabwe, Gweru

IntroductionThe use of natural health products is gradually increasing all over the world with up to 50% of the general population having tried at least one herbal product. This becomes a dilemma to the midwife who has limited or no knowledge on their effects in pregnancy, hence the need to explore the perceptions of women on the use herbs in pregnancy and labour.MethodsThe research, which was a case study of a Claybank Private Hospital in Gweru, Zimbabwe, adopted a qualitative approach with a triangulation of data from interviews, observations and analysis of maternal records. A sample of 20 women, admitted to using herbs, was purposively selected from the labour and post natal wards.ResultsA variety of substances, but mainly the elephant's dung, was used. The family, (mother) prescribed the herbs. The women did not have knowledge on how the substances work but believed in them, as they have stood the test of time.ConclusionThe African women in Zimbabwe cannot be stopped from taking herbs as it is engraved in their culture and have absolute faith in them. Whilst the herbs are assumed by the women to be effective, their safety is questionable, especially in women with underlying obstetric complications. It is therefore recommended to scientifically explore the safety and effectiveness of the most commonly used herbs if pregnancy is to be safe. Whilst the women can not be stopped from taking these herbs, it is important to build a trusting relationship between the midwife and the mother so that communication about the use of herbs can be done freely without fear or judgement.

Yellow Card reports associated with use of natural health products in children – An exploratory analysis

Abstract of a presentation given at the Research council for complementary medicine 2015 conference (RCCM): demonstrating the value of integrative medicine, 10 September, London, UK.

Native/Aboriginal Students use Natural Health Products for Health Maintenance More so than Other University Students

Background and aim: University student use of Natural Health Products (NHP) for health maintenance (HealthM) is assessed in Canada. We hypothesize greater use of NHP by Native/Aboriginal and female students. Demographic predictor variables and the top ten NHP used are determined. Methods: A cross-sectional survey of 963 students (n=212 Native/Aboriginal; n=751 non-Native/Aboriginal) was conducted. Fisher's exact and χ² tests analyzed group differences. Multiple logistic regressions determined predictor variables of NHP use. Results: Of 963 surveyed students, 268 (27.8%) used NHP for HealthM, while 695 students (72.2%) did not. More Native/Aboriginal students used commercial tobacco (47% vs. 13%, P<0.001) and NHP (67% vs. 45%, P<0.001) than non- Native/Aboriginal students. Gender was not associated with NHP use (P=0.527). Canadians used echinacea more than non-Canadians (Odds Ratio (OR)=4.96; 95% Confidence Interval (CI): 1.2-21.0). Ginger (OR=0.39; 95% CI: 0.2-0.78) and garlic (OR=0.28; 95% CI: 0.13-0.6) were popular amongst non-Canadians. Native/Aboriginal students used homeopathics (OR=39.9; 95% CI: 8.6-185.4) and rat root (OR=56.73; 95% CI: 6.91-465.8). Chamomile was less used by males (OR=0.33; 95% CI: 0.13-0.83) and used more by upperclassmen (OR=2.6 95% CI: 1.3-5.3). Conclusion: Homeopathics and rat root are popular amongst Native/Aboriginal students. Garlic and ginger are more popular amongst non-Canadians than Canadian students; however, more Canadians used echinacea for HealthM than non-Canadians. Chamomile is less popular amongst males. Commercial tobacco is used more by Native/Aboriginal students. Predictors of NHP use are: Native/ Aboriginal and upperclassman.

The use of natural health products by paediatric patients in respite care.

To determine the use and potential interactions of natural health products (NHPs) with conventional medications in children with life-limiting illnesses. The present study was a retrospective medical record review of palliative care patients <18 years of age who were admitted for respite care to a Canadian paediatric hospice between January 1, 2008 and December 31, 2013. The NHPs were identified according to Health Canada's inclusion criteria. A total of 106 children were included in the present study. Eighty-two (77.4%) had used one or more NHPs: 60 (56%) used vitamins and minerals; 45 (42.5%) used other products including probiotics, omega-3, organic acids and essential fatty acids; 34 (32.1%) used everyday consumer products; 12 (11.3%) used herb or plant-based remedies; and one (0.9%) used homeopathic remedies. Thirty-nine potential NHP-medication and 10 potential NHP-NHP interactions were identified. A considerable number of patients (n=54) used at least one medication and NHP, or two NHPs with potential interactions. The most common type of interaction was pharmacokinetic: decreasing blood concentrations of the medication, NHP or both (43.9% of NHP users); and enhancing the blood concentration of an NHP for NHP-NHP interactions (22% of NHP users). A high proportion of patients in respite care use NHPs. Most used NHPs and medications that have potential interactions, although there were no adverse clinical manifestations in the present study. It is important to educate health care professionals about NHPs, the evidence available and lack thereof. This could reduce the most serious interactions and improve the alliance between parents and health care providers to balance the potential risks and benefits of NHPs.

Natural health product use in children: Common and important.

Division of Clinical Pharmacology, Departments of Paediatrics, Physiology & Pharmacology, and Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario Correspondence: Dr Michael Rieder, e-mail mrieder@uwo.ca Accepted for publication January 7, 2015 In the current issue of Paediatrics & Child Health, Beringer et al (pages 23-29) report the results of a review of medical records investigating the use of natural health products (NHPs) by children in a hospice in Ontario between 2008 and 2013. The authors have demonstrated a very high rate of use of NHPs, with three-quarters of the children receiving at least one NHP in addition to conventional therapy. This finding is higher than in previous studies investigating NHP use in Canadian children; for example, the work of Adams et al (1) which demonstrated a rate of 37% among children with chronic health problems attending specialty clinics in Ontario and Alberta. The reasons for this may lie in the nature of the patients; as the authors note, the children in this study have complex disease with limited life expectancy. These figures are also closer to those observed among adult patients with cancer, in whom up to 60% use some type of NHP (2). An additional important finding in this study is that there were a number of potential drug-NHP or NHP-NHP interactions, which were present among 66% of all patients. Of interest, there were no clinically relevant drug-NHP interactions reported during the study period. This observation should be interpreted with some caution because under-reporting of adverse events is common in records reviews, and adverse events may not have been as well appreciated in the setting of hospice care. What is the take-home message of this article for the clinician? First, that use of NHPs is likely to be common among children, especially among children with complex and serious disease. Second, that some of this NHP use may have the potential for producing interactions not only with concurrent drug therapy but also with other NHPs. This highlights the importance of a careful history, with clinicians being nonjudgemental with regard to NHP use to encourage candor on the part of children and their parents. In this respect, pharmacy team members can be a vital resource, particularly with respect to medication history at the time of hospital admission or clinic visit. In addition, clinicians need to take advantage of drug information resources to ensure that they have timely and accurate information with regard to potential drug-NHP and NHP-NHP interactions. editorial