Veronica Tuffrey

Yoga for anxiety: a systematic review of the research evidence

Between March and June 2004, a systematic review was carried out of the research evidence on the effectiveness of yoga for the treatment of anxiety and anxiety disorders. Eight studies were reviewed. They reported positive results, although there were many methodological inadequacies. Owing to the diversity of conditions treated and poor quality of most of the studies, it is not possible to say that yoga is effective in treating anxiety or anxiety disorders in general. However, there are encouraging results, particularly with obsessive compulsive disorder. Further well conducted research is necessary which may be most productive if focused on specific anxiety disorders.

A review and meta-analysis of the impact of intestinal worms on child growth and nutrition

More than a half of the worlds population are infected with one or more species of intestinal worms of which the nematodes Ascaris lumbricoides, Trichuris trichiura and the hookworms are the most common and important in terms of child health. This paper: (1) introduces the main species of intestinal worms with particular attention to intestinal nematodes; (2) examines how such worms may affect child growth and nutrition; (3) reviews the biological and epidemiological factors that influence the effects that worms can have on the growth and nutrition of children; (4) considers the many factors that can affect the impact of treatment with anthelmintic drugs; (5) presents the results of a meta-analysis of studies of the effect of treating worm infections on child growth and nutrition; (6) discusses the results in terms of what is reasonable to expect that deworming alone can achieve; (7) describes some important characteristics of an ideal study of the effects of deworming; and (8) comments on the implications for programmes of recommendations concerning mass deworming.

Women's mid-life health experiences in urban UK: an international comparison

Objectives First, to investigate cross-cultural variations in symptom prevalence for mid-life women using data from studies undertaken in the UK, Japan, China, Canada and the USA, and, second, to examine the relationship between symptoms, ethnicity, age and menopausal status for Londons multi-ethnic urban women aged 45–55 years. Methods Cross-sectional, self-administered, postal questionnaire of women aged 45–55 years in London, UK (n = 1115), recruited from general practitioner lists. Participants recalled 15 general symptoms and the prevalence rates were compared with those of cohorts from methodologically similar studies. Results London women experienced high levels of general symptom reporting. Tiredness was the most prevalent symptom (65%) followed by aches or stiffness in the joints (54%). The prevalence of seven symptoms varied by menopausal group. Only the symptom of hot flushes varied by age. Tiredness, insomnia and irritability varied by ethnic group. The pattern of symptom reporting for the London cohort was more similar to the pattern of women in Beijing than to the pattern of cohorts in Manitoba, Massachusetts and Japan. Conclusions Our data do not support the existence of a single menopausal syndrome. There appears to be dialectic between culture and biology. It can be argued that symptoms experienced during the menopausal transition arise through a complexity of factors, not simply declining levels of estrogen or ethnicity; geographic location, local culture and temporality are factors that also need to be taken into account.

Chinese medicine treatment for menopausal symptoms in the UK health service: is a clinical trial warranted?

OBJECTIVES The aims of this pilot study were to evaluate treatment effects, ascertain safety and formulate best practice Chinese medicine protocols relevant for London women suffering from menopausal symptoms. STUDY DESIGN This clinical pilot study employed a case series design within a wider action-based research project. 117 perimenopausal women between 45 and 55 years of age recruited from the general population were treated for menopausal symptoms by six experienced practitioners of Chinese medicine at the Polyclinic of the University of Westminster. Practitioners were instructed to treat as near to their usual practice style as possible. This involved using Chinese herbal medicine and/or acupuncture along with dietary and lifestyle advice. A maximum of 12 treatments over 6 months was allowed per patient. OUTCOME MEASURES The menopause specific quality of life questionnaire (MenQoL), the Greene climacteric scale, and flushing diaries were used to evaluate treatment outcomes. Liver and kidney function tests were carried out at intake and after 1, 6 and 12 treatments to evaluate the safety particularly in relation to the use of herbal medicines. RESULTS Patients showed significant improvement across all domains measured by the MenQoL and Greene climacteric scales. Reduction on the MenQoL scale between first and last visit was from 4.31 to 3.27 (p<0.001) and on the Green climacteric scale from 21.01 to 13.00 (p<0.001). Study participants did not reliably complete their flushing diaries. No adverse events or abnormal liver or kidney function values were observed during the course of the study. CONCLUSIONS Further research that seeks to investigate the effects observed in more detail and to evaluate them against other forms of treatment and/or no-treatment controls is warranted. This could be achieved by way of a pragmatic randomized controlled trial that evaluated Chinese medicine against orthodox medical care.

Case–control analysis of the health and nutrition of orphan schoolchildren in Ethiopia

Objectives  To undertake a case–control analysis of the health, nutrition and caring practices of orphans enrolled in primary schools in Ethiopia.

Methods of nutrition surveillance in low-income countries.

BackgroundIn 1974 a joint FAO/UNICEF/WHO Expert Committee met to develop methods for nutrition surveillance. There has been much interest and activity in this topic since then, however there is a lack of guidance for practitioners and confusion exists around the terminology of nutrition surveillance. In this paper we propose a classification of data collection activities, consider the technical issues for each category, and examine the potential applications and challenges related to information and communication technology.AnalysisThere are three major approaches used to collect primary data for nutrition surveillance: repeated cross-sectional surveys; community-based sentinel monitoring; and the collection of data in schools. There are three major sources of secondary data for surveillance: from feeding centres, health facilities, and community-based data collection, including mass screening for malnutrition in children. Surveillance systems involving repeated surveys are suitable for monitoring and comparing national trends and for planning and policy development. To plan at a local level, surveys at district level or in programme implementation areas are ideal, but given the usually high cost of primary data collection, data obtained from health systems are more appropriate provided they are interpreted with caution and with contextual information. For early warning, data from health systems and sentinel site assessments may be valuable, if consistent in their methods of collection and any systematic bias is deemed to be steady. For evaluation purposes, surveillance systems can only give plausible evidence of whether a programme is effective. However the implementation of programmes can be monitored as long as data are collected on process indicators such as access to, and use of, services. Surveillance systems also have an important role to provide information that can be used for advocacy and for promoting accountability for actions or lack of actions, including service delivery.ConclusionThis paper identifies issues that affect the collection of nutrition surveillance data, and proposes definitions of terms to differentiate between diverse sources of data of variable accuracy and validity. Increased interest in nutrition globally has resulted in high level commitments to reduce and prevent undernutrition. This review helps to address the need for accurate and regular data to convert these commitments into practice.

Chinese herbal medicine for treating menopausal symptoms in London women: developing a good practice protocol via the factor analysis of prescribing patterns in a clinical study

The objective of the study described in this paper was to define Chinese medicine formula patterns for the treatment of menopausal women in London. These formula patterns are intended to inform the development of best practice guidelines for a future pragmatic randomised controlled trial, with the ultimate goal of evaluating the possibility of integrating Chinese medicine treatment strategies for menopausal symptoms into the UK National Health Service. Data from a clinical study that had demonstrated the effectiveness and safety of Chinese medicine in treating 117 perimenopausal women at the Westminster University Polyclinic in London were analysed for symptom occurrence and herb use. The frequency of occurrence of different presenting symptoms and the frequency of use of individual herbs is described, the patterns of combined herb use were analysed by means of factor analysis, and the correlations between these patterns and the presenting symptoms were analysed using the chi square test. Treating the emergent use patterns as Chinese herbal medicine formulas, five distinctive formula patterns emerged in the course of this study. While there is some overlap between these formulas and their associated symptom patterns and those described in Chinese medicine textbooks and guidelines, some formula patterns appear to be unique to London women. This indicates that best practice guidelines for the Chinese medicine treatment of menopausal symptoms, which have been shown to vary cross-culturally, need to be derived from local clinical practice.

What influences quality of life in older people living with HIV

BackgroundPeople with HIV with access to treatment are growing older and living healthier lives than in the past, and while health improvements and increased survival rates are welcome, the psychological and social consequences and quality of life of ageing are complex for this group. Understanding how ageing, HIV and quality of life intersect is key to developing effective interventions to improve QoL.MethodsOne hundred people with HIV over the age of 50 (range 50–87, mean 58), were recruited through HIV community organizations, and clinics, and included men who have sex with men (MSM), and Black African and White heterosexual men and women. The WHOQOL-HIV BREF was used, as well as the Every Day Memory Questionnaire, and additional questions on anxiety and depression to supplement the WHOQOL.ResultsWhile most rated their quality of life (QoL) positively, bivariate analysis showed that better QoL (total score and most domains) was strongly associated with being a man; in a relationship; in paid employment; having higher level of income; not on benefits, and to a lesser degree with being MSM, having higher level of education, and diagnosed after the age of 40. Multivariate analysis showed that not being on benefits was the variable most consistently associated with better quality of life, as was being partnered. Concerns about everyday memory difficulties, and anxiety and depression scores were strong predictors of poorer quality of life.ConclusionWhile the cross-sectional nature of the investigation could not establish that the associations were causal, the findings indicate that concerns about memory difficulties, anxiety and depression, as well as gender, ethnicity, financial factors, and relationship status, are important contributors to QoL in this group. These findings point towards the need for further research to clarify the mechanisms through which the factors identified here affect QoL, and to identify possible interventions to improve the QoL of older people living with HIV.

Ein Vergleich von Beschreibungen menopau-saler Beschwerden in TCM-Lehrbüchern mit den konkreten Erfahrungen von Londoner Frauen in den Wechseljahren und dessen Implikationen für die Chinesische-Medizin-Forschung

ZusammenfassungBei der Evaluierung der Wirksamkeit der chinesischen Medizin stützt sich die klinische Forschung bei der Erstellung des Rahmens für ihre Hypothesen beinahe ausnahmslos auf Wissen aus TCM-Lehrbüchern, das entweder daraus oder anhand der klinischen Praxis ermittelt wird. Neueste historische Forschungsergebnisse zeigen, dass diese Lehrbücher, die Produkte eines politisch gesteuerten Modernisierungsprozesses sind, komplexe Mischformen aus westlichem und chinesischem Wissen darstellen, die darauf abzielen, die Eingliederung der chinesischen Medizin in biomedizinisch geprägte Praxiszusammenhänge zu erleichtern. Als solche beinhalten sie eine Reihe ungelöster und größtenteils nicht einmal zur Kenntnis genommener Widersprüche, wie etwa zwischen der in der chinesischen Medizintradition gängigen Betonung der je nach Region variierenden Sicht auf Krankheiten und der von der Biomedizin angestrebten Allgemeingültigkeit. Um die Auswirkungen dieser Widersprüche zu untersuchen, haben wir in einer Studie die auf eine bestimmte Region beschränkten Symptomkonfigurationen, wie sie von Londoner Frauen in den Wechseljahren erfahren wurden, mit den in TCM-Lehrbüchern beschriebenen Standardkonfigurationen verglichen. Die Ergebnisse dieser Studie bestätigen unsere These, dass die Krankheitsbeschreibungen in TCM-Lehr-büchern nicht immer auf klinischer Erfahrung fußen, auch wenn dies in diesen Lehrbüchern behauptet wird. Das wirft Fragen sowohl über das Verhältnis von Lehrbuchmeinung und klinischer Praxis auf als auch über die Validität von klinischen Forschungen, die auf Lehrbüchern und einer auf Lehrbücher gestützten normativen Praxis basieren. Wir sind der Ansicht, dass nur eine multidisziplinäre Herangehensweise, zu der auch eine Durchdringung des historischen Entstehens zeitgenössischen chinesischen Medizinwissens und seines Verhältnisses zur klinischen Praxis gehören, diese Probleme bewältigen und eine aussagekräftige Evaluation und sinnvolle Anwendung der chinesischen Medizin im Kontext des evidenzbasierten Gesundheitswesens des 21. Jahrhunderts gewährleisten kann.AbstractAlmost without exception clinical research seeking to evaluate the effectiveness of Chinese medicine relies on TCM textbook knowledge–accessed directly or via practitioners’ clinical usage–in order to frame its hypotheses. Recent historical research shows that these textbooks, products of a politically directed process of modernisation, constitute complex hybrids of western and Chinese knowledge that are designed to facilitate the integration of Chinese medicine into biomedically dominated contexts of practice. As such they produce a number of unresolved and generally unacknowledged tensions, such as between the emphasis on local illness experience in the Chinese medical tradition and the universality aspired to by biomedical knowledge. To examine the effect of these tensions we have carried out a study that compares local symptom patterns experienced by post-menopausal women in London with the universal patterns described in TCM textbooks. The results of this study confirm our proposition, namely that the TCM textbook descriptions of disease are not always grounded in clinical experience even if that is what textbooks claim. This raises questions about the relation of textbooks to clinical practice, and about the validity of clinical research based on textbooks and textbook derived normative practice. We argue that only a multidisciplinary approach that includes an understanding of the historical construction of contemporary Chinese medical knowledge and its relation to clinical practice can overcome these problems and enable a meaningful evaluation and utilisation of Chinese medicine in the context of 21st century evidence-based healthcare.Bei der Evaluierung der Wirksamkeit der chinesischen Medizin stützt sich die klinische Forschung bei der Erstellung des Rahmens für ihre Hypothesen beinahe ausnahmslos auf Wissen aus TCM-Lehrbüchern, das entweder daraus oder anhand der klinischen Praxis ermittelt wird. Neueste historische Forschungsergebnisse zeigen, dass diese Lehrbücher, die Produkte eines politisch gesteuerten Modernisierungsprozesses sind, komplexe Mischformen aus westlichem und chinesischem Wissen darstellen, die darauf abzielen, die Eingliederung der chinesischen Medizin in biomedizinisch geprägte Praxiszusammenhänge zu erleichtern. Als solche beinhalten sie eine Reihe ungelöster und größtenteils nicht einmal zur Kenntnis genommener Widersprüche, wie etwa zwischen der in der chinesischen Medizintradition gängigen Betonung der je nach Region variierenden Sicht auf Krankheiten und der von der Biomedizin angestrebten Allgemeingültigkeit. Um die Auswirkungen dieser Widersprüche zu untersuchen, haben wir in einer Studie die auf eine bestimmte Region beschränkten Symptomkonfigurationen, wie sie von Londoner Frauen in den Wechseljahren erfahren wurden, mit den in TCM-Lehrbüchern beschriebenen Standardkonfigurationen verglichen. Die Ergebnisse dieser Studie bestätigen unsere These, dass die Krankheitsbeschreibungen in TCM-Lehr-büchern nicht immer auf klinischer Erfahrung fußen, auch wenn dies in diesen Lehrbüchern behauptet wird. Das wirft Fragen sowohl über das Verhältnis von Lehrbuchmeinung und klinischer Praxis auf als auch über die Validität von klinischen Forschungen, die auf Lehrbüchern und einer auf Lehrbücher gestützten normativen Praxis basieren. Wir sind der Ansicht, dass nur eine multidisziplinäre Herangehensweise, zu der auch eine Durchdringung des historischen Entstehens zeitgenössischen chinesischen Medizinwissens und seines Verhältnisses zur klinischen Praxis gehören, diese Probleme bewältigen und eine aussagekräftige Evaluation und sinnvolle Anwendung der chinesischen Medizin im Kontext des evidenzbasierten Gesundheitswesens des 21. Jahrhunderts gewährleisten kann. Almost without exception clinical research seeking to evaluate the effectiveness of Chinese medicine relies on TCM textbook knowledge–accessed directly or via practitioners’ clinical usage–in order to frame its hypotheses. Recent historical research shows that these textbooks, products of a politically directed process of modernisation, constitute complex hybrids of western and Chinese knowledge that are designed to facilitate the integration of Chinese medicine into biomedically dominated contexts of practice. As such they produce a number of unresolved and generally unacknowledged tensions, such as between the emphasis on local illness experience in the Chinese medical tradition and the universality aspired to by biomedical knowledge. To examine the effect of these tensions we have carried out a study that compares local symptom patterns experienced by post-menopausal women in London with the universal patterns described in TCM textbooks. The results of this study confirm our proposition, namely that the TCM textbook descriptions of disease are not always grounded in clinical experience even if that is what textbooks claim. This raises questions about the relation of textbooks to clinical practice, and about the validity of clinical research based on textbooks and textbook derived normative practice. We argue that only a multidisciplinary approach that includes an understanding of the historical construction of contemporary Chinese medical knowledge and its relation to clinical practice can overcome these problems and enable a meaningful evaluation and utilisation of Chinese medicine in the context of 21st century evidence-based healthcare.