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Environment International Dec 2022The World Health Organization (WHO) and the International Labour Organization (ILO) are the producers of the WHO/ILO Joint Estimates of the Work-related Burden of... (Meta-Analysis)
Meta-Analysis
The effect of occupational exposure to welding fumes on trachea, bronchus and lung cancer: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury.
BACKGROUND
The World Health Organization (WHO) and the International Labour Organization (ILO) are the producers of the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury (WHO/ILO Joint Estimates). Welding fumes have been classified as carcinogenic to humans (Group 1) by the WHO International Agency for Research on Cancer (IARC) in IARC Monograph 118; this assessment found sufficient evidence from studies in humans that welding fumes are a cause of lung cancer. In this article, we present a systematic review and meta-analysis of parameters for estimating the number of deaths and disability-adjusted life years from trachea, bronchus, and lung cancer attributable to occupational exposure to welding fumes, to inform the development of WHO/ILO Joint Estimates on this burden of disease (if considered feasible).
OBJECTIVES
We aimed to systematically review and meta-analyse estimates of the effect of any (or high) occupational exposure to welding fumes, compared with no (or low) occupational exposure to welding fumes, on trachea, bronchus, and lung cancer (three outcomes: prevalence, incidence, and mortality).
DATA SOURCES
We developed and published a protocol, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic databases for potentially relevant records from published and unpublished studies, including Medline, EMBASE, Web of Science, CENTRAL and CISDOC. We also searched grey literature databases, Internet search engines, and organizational websites; hand-searched reference lists of previous systematic reviews; and consulted additional experts.
STUDY ELIGIBILITY AND CRITERIA
We included working-age (≥15 years) workers in the formal and informal economy in any Member State of WHO and/or ILO but excluded children (<15 years) and unpaid domestic workers. We included randomized controlled trials, cohort studies, case-control studies, and other non-randomized intervention studies with an estimate of the effect of any (or high) occupational exposure to welding fumes, compared with occupational exposure to no (or low) welding fumes, on trachea, bronchus, and lung cancer (prevalence, incidence, and mortality).
STUDY APPRAISAL AND SYNTHESIS METHODS
At least two review authors independently screened titles and abstracts against the eligibility criteria at a first review stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. If studies reported odds ratios, these were converted to risk ratios (RRs). We combined all RRs using random-effects meta-analysis. Two or more review authors assessed the risk of bias, quality of evidence, and strength of evidence, using the Navigation Guide tools and approaches adapted to this project. Subgroup (e.g., by WHO region and sex) and sensitivity analyses (e.g., studies judged to be of "high"/"probably high" risk of bias compared with "low"/"probably low" risk of bias) were conducted.
RESULTS
Forty-one records from 40 studies (29 case control studies and 11 cohort studies) met the inclusion criteria, comprising over 1,265,512 participants (≥22,761 females) in 21 countries in three WHO regions (Region of the Americas, European Region, and Western Pacific Region). The exposure and outcome were generally assessed by job title or self-report, and medical or administrative records, respectively. Across included studies, risk of bias was overall generally probably low/low, with risk judged high or probably high for several studies in the domains for misclassification bias and confounding. Our search identified no evidence on the outcome of having trachea, bronchus, and lung cancer (prevalence). Compared with no (or low) occupational exposure to welding fumes, any (or high) occupational exposure to welding fumes increased the risk of acquiring trachea, bronchus, and lung cancer (incidence) by an estimated 48 % (RR 1.48, 95 % confidence interval [CI] 1.29-1.70, 23 studies, 57,931 participants, I 24 %; moderate quality of evidence). Compared with no (or low) occupational exposure to welding fumes, any (or high) occupational exposure to welding fumes increased the risk dying from trachea, bronchus, and lung cancer (mortality) by an estimated 27 % (RR 1.27, 95 % CI 1.04-1.56, 3 studies, 8,686 participants, I 0 %; low quality of evidence). Our subgroup analyses found no evidence for difference by WHO region and sex. Sensitivity analyses supported the main analyses.
CONCLUSIONS
Overall, for incidence and mortality of trachea, bronchus, and lung cancer, we judged the existing body of evidence for human data as "sufficient evidence of harmfulness" and "limited evidence of harmfulness", respectively. Occupational exposure to welding fumes increased the risk of acquiring and dying from trachea, bronchus, and lung cancer. Producing estimates for the burden of trachea, bronchus, and lung cancer attributable to any (or high) occupational exposure to welding fumes appears evidence-based, and the pooled effect estimates presented in this systematic review could be used as input data for the WHO/ILO Joint Estimates. PROTOCOL IDENTIFIER: https://doi.org/10.1016/j.envint.2020.106089.
Topics: Humans; Adolescent; Lung Neoplasms; World Health Organization; Cost of Illness
PubMed: 36402034
DOI: 10.1016/j.envint.2022.107565 -
NTP Monograph Dec 2019Traffic-related air pollution (TRAP) contributes significantly to ambient air pollution, especially in urban settings. Air pollution has been established as a risk... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Traffic-related air pollution (TRAP) contributes significantly to ambient air pollution, especially in urban settings. Air pollution has been established as a risk factor for hypertension and cardiovascular disease in adults, but this effect is less studied in other susceptible populations. There is increasing evidence that air pollution may adversely affect hypertensive disorders of pregnancy (e.g., gestational hypertension, preeclampsia, eclampsia).
OBJECTIVE
Because reports indicate that air pollution may be linked to hypertensive disorders, the National Toxicology Program (NTP) conducted a systematic review to evaluate whether exposure to TRAP during pregnancy is associated with hypertensive disorders of pregnancy.
METHODS
A systematic review protocol was developed and utilized for this evaluation that followed the Office of Health Assessment and Translation approach for conducting literature-based health assessments. This evaluation considered a range of traffic-related air pollutant measurements (e.g., fine particulate matter [PM2.5]) and traffic measures (e.g., proximity to major roads) in the literature search. Confidence ratings and level-of-evidence conclusions were developed for bodies of evidence for a given exposure measure when there was sufficient evidence (i.e., more than three studies). Changes in blood pressure during pregnancy, gestational hypertension, preeclampsia, eclampsia, or hemolysis, elevated liver enzyme levels, and low platelet count (HELLP) syndrome were considered as measures of hypertension. Hazard conclusions were developed using a two-step process. First, confidence ratings were developed for individual air pollutants (e.g., PM2.5, nitrogen oxides [NOx]) and traffic measures (traffic density and proximity to major roads). Overall hazard conclusions were then developed for TRAP, considering the combined bodies of evidence across different individual measures of traffic-related pollutants.
RESULTS AND EVIDENCE SYNTHESIS
The literature search and screening process identified 18 relevant epidemiological studies and one relevant animal study (from 344 potentially relevant references) that met the objective and the inclusion criteria. The human bodies of evidence for traffic-related PM2.5 and NO2 present a consistent pattern of findings that exposure to these pollutants is associated with the development of hypertensive disorders of pregnancy. There is a similar pattern of findings, but a smaller effect size, for bodies of evidence that residing in high-traffic density regions or in close proximity to major roads are associated with developing hypertensive disorders during pregnancy. There is a moderate level of evidence in the combined human body of evidence based primarily on the TRAP air pollutant studies with support from the traffic measures studies. There is an inadequate level of evidence in the animal body of evidence due to the lack of experimental animal studies identified for these measures. Evidence for other traffic-related pollutants that were identified (i.e., carbon monoxide [CO], black carbon [BC], and elemental carbon [EC]), including one animal study for CO, were few in number or provided inconsistent results across studies, and level-of-evidence conclusions were not reached.
DISCUSSION AND CONCLUSION
NTP concludes that exposure to TRAP is presumed to be a hazard to pregnant women for developing hypertensive disorders of pregnancy. This conclusion was based on moderate confidence and moderate level of evidence in the combined body of evidence from human studies reporting on multiple measures of TRAP exposure (traffic-related PM2.5 and NO2) with support from studies on traffic measures (residing in high-traffic density regions or in close proximity to major roads during pregnancy). (This section of the abstract has been abridged.).
Topics: Air Pollutants; Animals; Humans; Hypertension, Pregnancy-Induced; Traffic-Related Pollution; Vehicle Emissions
PubMed: 33560269
DOI: 10.22427/NTP-MGRAPH-7 -
Mutation Research. Reviews in Mutation... 2016Accumulating evidence suggests that epigenetic alterations play an important role in chemically-induced carcinogenesis. Although the epigenome and genome may be equally... (Review)
Review
Accumulating evidence suggests that epigenetic alterations play an important role in chemically-induced carcinogenesis. Although the epigenome and genome may be equally important in carcinogenicity, the genotoxicity of chemical agents and exposure-related transcriptomic responses have been more thoroughly studied and characterized. To better understand the evidence for epigenetic alterations of human carcinogens, and the potential association with genotoxic endpoints, we conducted a systematic review of published studies of genotoxic carcinogens that reported epigenetic endpoints. Specifically, we searched for publications reporting epigenetic effects for the 28 agents and occupations included in Monograph Volume 100F of the International Agency for the Research on Cancer (IARC) that were classified as "carcinogenic to humans" (Group 1) with strong evidence of genotoxic mechanisms of carcinogenesis. We identified a total of 158 studies that evaluated epigenetic alterations for 12 of these 28 carcinogenic agents and occupations (1,3-butadiene, 4-aminobiphenyl, aflatoxins, benzene, benzidine, benzo[a]pyrene, coke production, formaldehyde, occupational exposure as a painter, sulfur mustard, and vinyl chloride). Aberrant DNA methylation was most commonly studied, followed by altered expression of non-coding RNAs and histone changes (totaling 85, 59 and 25 studies, respectively). For 3 carcinogens (aflatoxins, benzene and benzo[a]pyrene), 10 or more studies reported epigenetic effects. However, epigenetic studies were sparse for the remaining 9 carcinogens; for 4 agents, only 1 or 2 published reports were identified. While further research is needed to better identify carcinogenesis-associated epigenetic perturbations for many potential carcinogens, published reports on specific epigenetic endpoints can be systematically identified and increasingly incorporated in cancer hazard assessments.
Topics: Animals; Carcinogenicity Tests; Carcinogens; Environmental Exposure; Epigenesis, Genetic; Gene Expression Regulation; Genetic Association Studies; Genetic Predisposition to Disease; Genetic Variation; Humans; Mutagenicity Tests; Mutagens; Occupational Exposure
PubMed: 27234561
DOI: 10.1016/j.mrrev.2016.03.004 -
Acta Medica (Hradec Kralove) 2017CVD is an important global healthcare issue; it is the leading cause of global mortality, with an increasing incidence identified in both developed and developing... (Review)
Review
BACKGROUND AND OBJECTIVES
CVD is an important global healthcare issue; it is the leading cause of global mortality, with an increasing incidence identified in both developed and developing countries. It is also an extremely costly disease for healthcare systems unless managed effectively. In this review we aimed to: - Assess the effect of computer-assisted versus oral-and-written history taking on the quality of collected information for the prevention and management of CVD. - Assess the effect of computer-assisted versus oral-and-written history taking on the prevention and management of CVD.
METHODS
A systematic review of randomised controlled trials that included participants of 16 years or older at the beginning of the study, who were at risk of CVD (prevention) or were either previously diagnosed with CVD (management). We searched all major databases. We assessed risk of bias using the Cochrane Collaboration tool.
RESULTS
Two studies met the inclusion criteria. One comparing the two methods of history-taking for the prevention of cardiovascular disease n = 75. The study shows that generally the patients in the experimental group underwent more laboratory procedures, had more biomarker readings recorded and/or were given (or had reviewed), more dietary changes than the control group. The other study compares the two methods of history-taking for the management of cardiovascular disease (n = 479). The study showed that the computerized decision aid appears to increase the proportion of patients who responded to invitations to discuss CVD prevention with their doctor. The Computer- Assisted History Taking Systems (CAHTS) increased the proportion of patients who discussed CHD risk reduction with their doctor from 24% to 40% and increased the proportion who had a specific plan to reduce their risk from 24% to 37%.
DISCUSSION
With only one study meeting the inclusion criteria, for prevention of CVD and one study for management of CVD we did not gather sufficient evidence to address all of the objectives of the review. We were unable to report on most of the secondary patient outcomes in our protocol.
CONCLUSIONS
We tentatively conclude that CAHTS can provide individually-tailored information about CVD prevention. However, further primary studies are needed to confirm these findings. We cannot draw any conclusions in relation to any other clinical outcomes at this stage. There is a need to develop an evidence base to support the effective development and use of CAHTS in this area of practice. In the absence of evidence on effectiveness, the implementation of computer-assisted history taking may only rely on the clinicians' tacit knowledge, published monographs and viewpoint articles.
Topics: Cardiovascular Diseases; Decision Support Systems, Clinical; Humans; Medical History Taking
PubMed: 29439755
DOI: 10.14712/18059694.2018.1 -
Evidence-based Complementary and... 2019Available data indicate that diabetes mellitus leads to elevated cost of healthcare. This imposes a huge economic burden on households, societies, and nations. As a... (Review)
Review
BACKGROUND
Available data indicate that diabetes mellitus leads to elevated cost of healthcare. This imposes a huge economic burden on households, societies, and nations. As a result many Ghanaians, especially rural folks, resort to the use of phytomedicine, which is relatively less expensive. This paper aims at obtaining information on plants used in Ghana to treat diabetes mellitus, gather and present evidence-based data available to support their uses and their mechanisms of action, and identify areas for future research.
METHOD
A catalogue of published textbooks, monographs, theses, and peer-reviewed articles of plants used in Ghanaian traditional medicine between 1987 and July 2018 for managing diabetes mellitus was obtained and used.
RESULTS
The review identified 76 plant species belonging to 45 families that are used to manage diabetes mellitus. Leaves were the part of the plants frequently used for most preparation (63.8%) and were mostly used as decoctions. Majority of the plants belonged to the Euphorbiaceae, Lamiaceae, Asteraceae, and Apocynaceae families. Pharmacological data were available on 23 species that have undergone studies. Forty species have been studied using animal models. Only twelve plants and their bioactive compounds were found with data on both preclinical and clinical studies. The records further indicate that medicinal plants showing antidiabetic effects did so via biochemical mechanisms such as restitution of pancreatic -cell function, improvement in insulin sensitivity by receptors, stimulating rate of insulin secretion, inhibition of liver gluconeogenesis, enhanced glucose absorption, and inhibition of G-6-Pase, -amylase, and -glucosidase activities.
CONCLUSION
This review contains information on medicinal plants used to manage diabetes mellitus, including their pharmacological properties and mechanisms of action as well as models used to investigate them. It also provides gaps that can form the basis for further investigations and development into useful medications for effective treatment of diabetes mellitus.
PubMed: 31118963
DOI: 10.1155/2019/6021209 -
Journal of the National Cancer... Jul 2020Whether low-dose ionizing radiation can cause cancer is a critical and long-debated question in radiation protection. Since the Biological Effects of Ionizing Radiation...
Whether low-dose ionizing radiation can cause cancer is a critical and long-debated question in radiation protection. Since the Biological Effects of Ionizing Radiation report by the National Academies in 2006, new publications from large, well-powered epidemiological studies of low doses have reported positive dose-response relationships. It has been suggested, however, that biases could explain these findings. We conducted a systematic review of epidemiological studies with mean doses less than 100 mGy published 2006-2017. We required individualized doses and dose-response estimates with confidence intervals. We identified 26 eligible studies (eight environmental, four medical, and 14 occupational), including 91 000 solid cancers and 13 000 leukemias. Mean doses ranged from 0.1 to 82 mGy. The excess relative risk at 100 mGy was positive for 16 of 22 solid cancer studies and 17 of 20 leukemia studies. The aim of this monograph was to systematically review the potential biases in these studies (including dose uncertainty, confounding, and outcome misclassification) and to assess whether the subset of minimally biased studies provides evidence for cancer risks from low-dose radiation. Here, we describe the framework for the systematic bias review and provide an overview of the eligible studies.
Topics: Epidemiologic Studies; Humans; Neoplasms, Radiation-Induced; Radiation Protection; Radiation, Ionizing; Risk
PubMed: 32657348
DOI: 10.1093/jncimonographs/lgaa009 -
BMC Cancer Nov 2016Cancer survivors are at risk of developing second and subsequent primary cancers, referred to as multiple primary cancers (MPCs). It is not clear whether the risk of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cancer survivors are at risk of developing second and subsequent primary cancers, referred to as multiple primary cancers (MPCs). It is not clear whether the risk of MPCs has increased over recent decades, but increasing use of radiological imaging and potentially harmful effects of certain cancer treatments raise this possibility. A systematic review was undertaken to assess whether there has been a temporal change in the risk of developing MPCs.
METHODS
A systematic search to identify population-based studies of MPCs was performed in Medline/PubMed and Embase databases from inception to August 2016. Included studies were those reporting risk of MPCs for all sites combined following a first cancer at any site or a specific site, using standard incidence ratios (SIRs) or equivalent, and with analysis stratified by calendar years.
RESULTS
We identified 28 articles eligible for inclusion, comprising 26 population-based studies and two monographs. MPC incidence was reported in nearly 6.5 million cancer survivors. For all first cancer sites combined, a higher rate of MPCs was reported in more recent than earlier calendar periods in four of the six relevant studies. The SIRs ranged from 1.14 for a first cancer diagnosis in the early 1980s to 1.21-1.46 in the late 1990s in the USA and Australia. Two studies from Italy and France showed no significant difference in SIRs across time periods 1978-2010 and 1989-2004. The remaining 22 studies reported various temporal trends in the risk of developing MPCs after a first cancer at a specific site, but most showed little change.
CONCLUSION
Overall, the risk of developing MPCs appears to have increased since the 1980s when considering studies of all primary cancer sites combined from the USA and Australia but not from Europe. With the introduction of more routine nuclear medical imaging over the last 15 years, more studies are needed to confirm recent trends of MPC risk in adult cancer survivors.
Topics: Female; Humans; Male; Neoplasms, Multiple Primary; Neoplasms, Second Primary; Population Surveillance; Risk; SEER Program; Spatio-Temporal Analysis; Survivors
PubMed: 27814758
DOI: 10.1186/s12885-016-2876-y -
Seizure Mar 2016Warnings of L-carnitine induced seizures are recorded on product monographs and pharmacy databases, without any referenced literature. This medication can potentially... (Review)
Review
OBJECTIVE
Warnings of L-carnitine induced seizures are recorded on product monographs and pharmacy databases, without any referenced literature. This medication can potentially improve the hospital course in those patients with valproic acid (VPA) induced hyperammonemic encephalopathy, but may be withheld because of this warning. The goal was to perform an extensive systematic review of the literature to document the incidence of levocarnitine (L-carnitine) induced seizures in those patients on VPA therapy.
METHODS
Articles from MEDLINE, BIOSIS, EMBASE, Global Health, Scopus, Cochrane Library, the International Clinical Trials Registry Platform, clinicaltrials.gov (inception to June 2015), and reference lists of relevant articles were searched. The strength of evidence was to be adjudicated using both the Oxford and GRADE methodology by two independent reviewers.
RESULTS
We failed to identify a single study implicating L-carnitine supplementation leading to seizures in any patient on VPA therapy. This contradicts all quoted, but unsubstantiated, concerns on product monographs and pharmacy databases related to seizure induction/propagation with L-carnitine supplementation.
CONCLUSION
There is no literature available to support claims of L-carnitine induced seizures during supplementation in patients on VPA therapy for seizures. This contradicts quoted, but not referenced, concerns on the product monograph. In patients suffering from hypocarnitinemia or hyperammonemic encephalopathy while on VPA, L-carnitine supplementation can be considered knowing there is no data to support seizure propagation or induction with administration of this supplement.
Topics: Anticonvulsants; Carnitine; Databases, Factual; Humans; Seizures; Valproic Acid
PubMed: 26889779
DOI: 10.1016/j.seizure.2016.01.020 -
NTP Monograph Mar 2019Many cancer chemotherapy agents are known carcinogens, genetic toxicants, and developmental toxicants. Secondary malignancies, such as therapy-related acute myeloid...
INTRODUCTION
Many cancer chemotherapy agents are known carcinogens, genetic toxicants, and developmental toxicants. Secondary malignancies, such as therapy-related acute myeloid leukemia, are caused by cancer chemotherapy agents administered to patients for the treatment of cancer. Occupational exposure to these agents was first documented in the 1970s and continues to occur, despite the issuance of safe handling guidelines in 1980s.
OBJECTIVES
Based on the evidence of carcinogenicity and genetic toxicity associated with direct administration of cancer chemotherapy agents and current evidence of occupational exposure, the National Toxicology Program (NTP) conducted a systematic review to: (1) evaluate whether occupational exposure (e.g., medical, manufacturing, research, and veterinary) is associated with any adverse health outcomes in humans, and (2) summarize the prevalence and levels of chemotherapy agents in the workplace as measured by environmental monitoring and biomonitoring for possible worker exposures.
METHODS
The evaluation was conducted following the Office of Health Assessment and Translation (OHAT) method. A literature search was performed up to February 23, 2017, using PubMed, Embase, Scopus, Toxline, and Web of Science. Relevant human studies were data extracted and assessed for risk of bias. Bodies of evidence were assessed to develop confidence ratings and level-of-evidence conclusions that reflect the certainty in the evidence that occupational exposure to cancer chemotherapy agents are associated with health effects on a per outcome basis.
RESULTS AND EVIDENCE SYNTHESIS
The literature search and screening process identified 110 epidemiological studies relevant to assessing possible adverse health outcomes. Most studies addressing health outcomes evaluated potential DNA damage (n = 66; specifically, structural chromosomal aberrations (CA) and micronucleus (MN) induction and comet assay endpoints) and spontaneous abortion (n = 16). In addition to DNA damage, groups of studies were identified to evaluate the potential association between occupational exposure to cancer chemotherapy agents and adverse health outcomes, including cancer (three studies) and adverse effects on reproduction (30 studies). Additional health outcomes included acute effects, immune effects, and liver and kidney toxicity. One hundred seventy-one studies were identified to assess workplace exposure based on reporting of environmental contamination (107 studies) and urine and/or blood monitoring of these agents (82 studies).
DISCUSSION AND CONCLUSIONS
NTP concluded that there is a moderate level of evidence that occupational exposure to chemotherapy agents is associated with increased incidence of spontaneous abortion, particularly when evaluating studies of nursing and pharmacy personnel. NTP also concluded that there is a moderate level of evidence that exposure to chemotherapy agents in the workplace is associated with genetic toxicity in humans based on consistent reports significantly higher levels of structural CA (% of cells with CA and number of CA), MN induction (number of cells with MN and number of MN) and DNA damage measured by comet assay (% tail DNA, tail length, tail moment, and DNA damage index) in exposed personnel. There was inadequate evidence for NTP to reach level-of-evidence conclusions on the remaining health outcomes, including cancer, primarily due to few studies per outcome and heterogeneity in the data. Despite current safety guidelines, cancer chemotherapy agents were commonly detected in environmental samples of the workplace (e.g., surface wipes and air sampling) and biosamples (e.g., urine or blood) of workers handling these agents, including data collected as recently as 2014 to 2016. Considering the potential for occupational exposure to these agents and the association between exposure and DNA damage and spontaneous abortions, there is a continued need to reduce exposures through training in safe handling procedures and provision and use of personal protective equipment and associated safety containment equipment. Health surveillance of occupationally exposed personnel would also benefit from improved exposure characterization methods, such as use of daily diaries that are assessed and validated to estimate exposure levels and additional environmental monitoring and biomonitoring data that include analytical chemistry approaches to assess multiple agents. There is also a need to better understand the sources (i.e., activities or physical locations) of worker exposure, especially in settings that have not been adequately studied (e.g., home care, veterinary clinics).
PubMed: 33556047
DOI: 10.22427/NTP-MGRAPH-5 -
Health Expectations : An International... Oct 2014Health-care professionals worldwide have started to appreciate patients' perspectives on the use of complementary and alternative medicine (CAM) particularly given its... (Review)
Review
BACKGROUND
Health-care professionals worldwide have started to appreciate patients' perspectives on the use of complementary and alternative medicine (CAM) particularly given its popularity. However, cultural perspectives may vary and it may not be possible to apply research findings on the use of CAM from the west to the east.
OBJECTIVE
This systematic review aims to synthesize usage patterns of traditional Chinese medicine (TCM) amongst Chinese populations in different parts of the world and explore potential geographical variations.
SEARCH STRATEGY
Six international and four Chinese databases were searched, and manual searches of relevant monographs and government publications were carried out.
INCLUSION CRITERIA
Quantitative, qualitative or mixed-method research that aimed to investigate Chinese patients' perception of, and perspectives on, TCM was included.
DATA EXTRACTION AND SYNTHESIS
For each study included, texts under the headings of 'results' or 'findings' were extracted and subjected to analysis. A thematic synthesis approach was adopted for synthesizing qualitative and quantitative studies.
MAIN RESULTS
Amongst the 28 studies included, twenty were quantitative surveys, six were qualitative studies and two were mixed-method studies. The overall methodological quality was mediocre. Data synthesis suggested that patients from all regions share a common cultural affinity to TCM and consider it to be an effective complement to western medicine (WM) for treating chronic or serious diseases. However, heterogeneous views on (i) disclosing TCM use to WM doctors and (ii) the potential harm of herbs emerged across different study locations.
DISCUSSION AND CONCLUSIONS
Future research should explore how variation in health systems may influence patients' perception of CAM in different countries.
Topics: Attitude to Health; China; Humans; Medicine, Chinese Traditional; Qualitative Research
PubMed: 22647085
DOI: 10.1111/j.1369-7625.2012.00794.x