Global strategy for asthma management and prevention

The use of and search for drugs and dietary supplements derived from plants have accelerated in recent years. Ethnopharmacologists, botanists, microbiologists, and natural-products chemists are combing the Earth for phytochemicals and “leads” which could be developed for treatment of infectious diseases. While 25 to 50% of current pharmaceuticals are derived from plants, none are used as antimicrobials. Traditional healers have long used plants to prevent or cure infectious conditions; Western medicine is trying to duplicate their successes. Plants are rich in a wide variety of secondary metabolites, such as tannins, terpenoids, alkaloids, and flavonoids, which have been found in vitro to have antimicrobial properties. This review attempts to summarize the current status of botanical screening efforts, as well as in vivo studies of their effectiveness and toxicity. The structure and antimicrobial properties of phytochemicals are also addressed. Since many of these compounds are currently available as unregulated botanical preparations and their use by the public is increasing rapidly, clinicians need to consider the consequences of patients self-medicating with these preparations.

Plant Products as Antimicrobial Agents

Context.—A prior national survey documented the high prevalence and costs of
alternative medicine use in the United States in 1990.Objective.—To document trends in alternative medicine use in the United States
between 1990 and 1997.Design.—Nationally representative random household telephone surveys using comparable
key questions were conducted in 1991 and 1997 measuring utilization in 1990
and 1997, respectively.Participants.—A total of 1539 adults in 1991 and 2055 in 1997.Main Outcomes Measures.—Prevalence, estimated costs, and disclosure of alternative therapies
to physicians.Results.—Use of at least 1 of 16 alternative therapies during the previous year
increased from 33.8% in 1990 to 42.1% in 1997 (P≤.001).
The therapies increasing the most included herbal medicine, massage, megavitamins,
self-help groups, folk remedies, energy healing, and homeopathy. The probability
of users visiting an alternative medicine practitioner increased from 36.3%
to 46.3% (P=.002). In both surveys alternative therapies
were used most frequently for chronic conditions, including back problems,
anxiety, depression, and headaches. There was no significant change in disclosure
rates between the 2 survey years; 39.8% of alternative therapies were disclosed
to physicians in 1990 vs 38.5% in 1997. The percentage of users paying entirely
out-of-pocket for services provided by alternative medicine practitioners
did not change significantly between 1990 (64.0%) and 1997 (58.3%) (P=.36). Extrapolations to the US population suggest a 47.3%
increase in total visits to alternative medicine practitioners, from 427 million
in 1990 to 629 million in 1997, thereby exceeding total visits to all US primary
care physicians. An estimated 15 million adults in 1997 took prescription
medications concurrently with herbal remedies and/or high-dose vitamins (18.4%
of all prescription users). Estimated expenditures for alternative medicine
professional services increased 45.2% between 1990 and 1997 and were conservatively
estimated at $21.2 billion in 1997, with at least $12.2 billion paid out-of-pocket.
This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations.
Total 1997 out-of-pocket expenditures relating to alternative therapies were
conservatively estimated at $27.0 billion, which is comparable with the projected
1997 out-of-pocket expenditures for all US physician services.Conclusions.—Alternative medicine use and expenditures increased substantially between
1990 and 1997, attributable primarily to an increase in the proportion of
the population seeking alternative therapies, rather than increased visits
per patient.

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Trends in Alternative Medicine Use in the United States, 1990-1997 Results of a Follow-up National Survey

Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma

The present report meta-analyzes more than 300 empirical articles describing a relationship between psychological stress and parameters of the immune system in human participants. Acute stressors (lasting minutes) were associated with potentially adaptive upregulation of some parameters of natural immunity and downregulation of some functions of specific immunity. Brief naturalistic stressors (such as exams) tended to suppress cellular immunity while preserving humoral immunity. Chronic stressors were associated with suppression of both cellular and humoral measures. Effects of event sequences varied according to the kind of event (trauma vs. loss). Subjective reports of stress generally did not associate with immune change. In some cases, physical vulnerability as a function of age or disease also increased vulnerability to immune change during stressors.

/pdf/psychological-stress-and-the-human-immune-system-a-meta-3lp53rp4yz.pdf

Psychological Stress and the Human Immune System: A Meta-Analytic Study of 30 Years of Inquiry

Background Many people use unconventional therapies for health problems, but the extent of this use and the costs are not known. We conducted a national survey to determine the prevalence, costs, and patterns of use of unconventional therapies, such as acupuncture and chiropractic. Methods We limited the therapies studied to 16 commonly used interventions neither taught widely in U.S. medical schools nor generally available in U.S. hospitals. We completed telephone interviews with 1539 adults (response rate, 67 percent) in a national sample of adults 18 years of age or older in 1990. We asked respondents to report any serious or bothersome medical conditions and details of their use of conventional medical services; we then inquired about their use of unconventional therapy. Results One in three respondents (34 percent) reported using at least one unconventional therapy in the past year, and a third of these saw providers for unconventional therapy. The latter group had made an average of 19 visits to suc...

Unconventional medicine in the United States. Prevalence, costs, and patterns of use.

Objective This is the first in a series of investigations of the social consequences of psychiatric disorders based on the National Comorbidity Survey. Data on the relationship between preexisting psychiatric disorders and subsequent educational attainment are presented. Method The National Comorbidity Survey is a nationally representative survey of 8,098 respondents in the age range 15-54 years. A subsample of 5,877 respondents completed a structured psychiatric interview and a detailed risk factor battery. Diagnoses of DSM-III-R anxiety disorders, mood disorders, substance use disorders, and conduct disorder were generated, and survival analyses were used to project data on school terminations to the total U.S. population. Results Early-onset psychiatric disorders are present in more than 3.5 million people in the age range of the National Comorbidity Survey who did not complete high school and close to 4.3 million who did not complete college. The most important disorders are conduct disorder among men and anxiety disorders among women. The proportion of school dropouts with psychiatric disorders has increased dramatically in recent cohorts, and persons with psychiatric disorders currently account for 14.2% of high school dropouts and 4.7% of college dropouts. Conclusions Early-onset psychiatric disorders probably have a variety of adverse consequences. The results presented here show that truncated educational attainment is one of them. Debate concerning whether society can afford universal insurance coverage for the treatment of mental disorders needs to take these consequences into consideration.

Social consequences of psychiatric disorders, I: Educational attainment.

Data from the US National Comorbidity Survey on 5877 respondents 15-54 years of age were used to assess the relationship between retrospectively identified early-onset psychiatric disorders and subsequent adolescent parenthood Between 21-24% of the samples male and female age cohorts reported having their first child at ages 15-19 years The cumulative and conditional probability curves for adolescent parenthood were consistently higher among men and women with prior psychiatric diagnoses of anxiety affective addictive and conduct disorders than among those without psychiatric diagnoses The diagnosis most predictive of adolescent parenthood was addictive disorders The population attributable risk proportions of births of first children to teenagers associated with the psychiatric disorders were 111% in the teenage female subsample with premarital childbearing 62% in the teenage female subsample with marital childbearing and 337% in the teenage male subsample with premarital parenthood Physicians and mental health professionals who work with adolescents with psychiatric conditions should be aware of the increased risk of adolescent pregnancy and a mental health component should be added to adolescent pregnancy prevention programs

https://ajp.psychiatryonline.org/doi/pdfplus/10.1176/ajp.154.10.1405

Social Consequences of Psychiatric Disorders, II: Teenage Parenthood

There is inconsistency in the literature on the relationship between age and depressive symptoms Although a careful review shows that some of this inconsistency can be reconciled by recognizing the nonlinear relationship (Newmann, 1989), 2 additional issues remain unclear One is that most previous studies used depression screening scales that contain somatic items that could introduce an age bias The other is that most previous studies combined samples of men and women even though there is evidence that the sex difference in depressive symptoms varies with age These 2 issues are addressed in this article, using analyzed data from 2 large national surveys There is a consistent, but quite modest, nonlinear association between age, somatic, and nonsomatic depressive symptoms in both surveys There is no significant sex difference in the age curves

The relationship between age and depressive symptoms in two national surveys.

OBJECTIVE The authors' goal is to provide basic epidemiologic data on the issue of reactivity to stress and HIV symptom onset by studying the relationship between a broad set of naturally occurring stressor events and HIV natural history in a large longitudinal community sample of HIV-seropositive homosexual men. METHOD Subjects were recruited from a cohort of 1,011 homosexual men enrolled in the Chicago site of the Multicenter AIDS Cohort Study who also participated in the Coping and Change Study. The men were given self-administered questionnaires assessing behavioral, psychological, and psychosocial variables. Relationships between reports of stressful life events and longitudinal biomedical data measuring illness progression were examined. Life events were assessed by reports on the numbers of lovers, friends, and acquaintances who were diagnosed with AIDS or had died of AIDS and by scores on a checklist of 24 more general serious stressor events. The variables indicating progression of illness among initially asymptomatic men were a drop in T-helper lymphocyte percent (CD4%) between pairs of examinations of at least 25% and onset between examinations of thrush and/or fever lasting a minimum of 2 weeks. RESULTS The authors found no evidence that serious stressor events have any meaningful effect on symptom onset indicated by either a drop in CD4% or onset of fever or thrush. CONCLUSIONS There is no need for asymptomatic people with HIV infection to restrict their lives in order to avoid exposure to stressful life experiences or to develop special skills for coping with stress to forestall the progression of HIV illness.

Cindy Foster

Papers

Unconventional medicine in the United States. Prevalence, costs, and patterns of use.

Social consequences of psychiatric disorders, I: Educational attainment.

Social Consequences of Psychiatric Disorders, II: Teenage Parenthood

The relationship between age and depressive symptoms in two national surveys.

Stressful life events and symptom onset in HIV infection.