Complementary and alternative medicine during COVID-19 pandemic: What we have done

Bridging the knowledge-practice gap: A cross-sectional survey assessing physician knowledge, attitude and practice toward complementary and alternative medicine

Complementary and alternative medicine (CAM) is widely used in multiple countries, including Saudi Arabia, yet its integration into mainstream healthcare requires evidence-based guidance. However, little is known about the current level of awareness attitudes and practice of physicians regarding CAM in Jazan region, which is a predominantly rural region in the southwestern part of Saudi Arabia. This region is known for its diverse residents with unique cultural and healing practices. The study aimed to assess physicians' awareness, attitudes, and practices regarding CAM in the Jazan region. We conducted a cross-sectional survey among physicians in five governorates of Jazan using convenience sampling. The structured questionnaire explored CAM-related awareness, attitudes, and practices. Data were analyzed using descriptive and inferential statistics to identify associated factors. Of 159 responding physicians (58.5% male and 41.5% females), 81.1% were aware of CAM, but only 7.5% had received formal pre-service training. Attitudes towards CAM were generally positive, with a median attitude score of 23 (out of a total of 30), particularly towards the need for more research and education on CAM. However, despite the generally positive attitudes toward CAM, only 25.8% of physicians reported plans to integrate CAM into their practice, and 37.7% had previously recommended CAM therapies to their patients. Factors significantly associated with awareness and practice included age, gender, work experience, and healthcare setting. In conclusion, despite high awareness and positive attitudes towards CAM among Jazan physicians, there is a significant gap in formal training and limited integration into practice, a matter which underscores the need for further exploration of the factors influencing this discrepancy.

Efficacy of traditional Chinese medicine on shortening the negative conversion time of SARS-CoV-2 ribonucleic acid in patients with mild COVID-19: a retrospective cohort study

Background

The holistic view of the 'The unity of man and nature' promotes the development and application of traditional Chinese medicine (TCM). Despite the absence of modern pharmacological therapies with robust efficacy against coronavirus disease 2019 (COVID-19), TCM has exhibited potential utility for treating the disease in clinical practice.

Methods

A retrospective cohort study was conducted to investigate the therapeutic effect of TCM treatment intensity (TCMTI) in patients with mild COVID-19. A total of 6120 laboratory-confirmed patients with mild COVID-19 were recruited from temporary isolation facilities. The primary outcome measure was severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ribonucleic acid conversion time. In addition, restricted cubic spline models were employed to elucidate nonlinear relationships.

Results

The median age (range) of the study participants was 43.0 (2.0-75.0) years, with a median hospitalization duration of 9.7 (4.1-22.5) days. The median time for achieving SARS-CoV-2 ribonucleic acid negativity was 6.67 days. The restricted cubic spline models revealed a remarkable nonlinear association between TCMTI and the time-to-ribonucleic acid negativity. After adjusting for potential confounders, the high TCMTI group exhibited a markedly shorter median time to SARS-CoV-2 ribonucleic acid negativity and reduced hospitalization duration (P < 0.001) than the low TCMTI group. Moreover, the mean time to achieve SARS-CoV-2 ribonucleic acid negativity was shortened by 1.909 days (P < 0.001) in the high-TCMTI group compared to the low-TCMTI group.

Conclusion

This study suggests that early initiation and intensified use of TCM may accelerate the time required to achieve SARS-CoV-2 ribonucleic acid negativity in patients with COVID-19, bearing considerable implications for public health.

Media impact research: a discrete SIR epidemic model with threshold switching and nonlinear infection forces

The media's coverage has the potential to impact human behavior and aid in the control of emergent infectious diseases. We aim to quantify and evaluate the extent to which media coverage can influence infectious disease control through a mathematical model, thus proposing a switching epidemic model that considers the effect of media coverage. The threshold strategy incorporates media influence only when the number of infected cases surpasses a specific threshold; otherwise, it is disregarded. When conducting qualitative analysis of two subsystems, focusing on the existence and stability of equilibria. Using numerical methods, the codimension-2 bifurcation analysis is adopted here to investigate the various types of equilibria within the switching system that play a vital role in pest control. On the other hand, codimension-1 bifurcation analysis reveals the existence of periodic, chaotic solutions, period-doubling bifurcations, multiple attractors and other complexities within the proposed model, which could pose challenges in disease control. Additionally, the impact of key parameters on epidemic outbreaks is analyzed, such as the initial values of susceptible and infective individuals, and discuss the potential benefits of mass media coverage in preventing emerging infectious diseases. The modeling and analytical techniques developed for threshold control strategies can be applied to other disease control efforts.

Reduced SARS-CoV-2 infection risk is associated with the use of Seven-Flavor Herb Tea: A multi-center observational study in Shanghai, China

OBJECTIVE

Omicron, a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant, is responsible for numerous infections in China. This study investigates the association between the use of Seven-Flavor Herb Tea (SFHT) and the risk of SARS-CoV-2 infection to develop precise and differentiated strategies for control of the coronavirus disease 2019 (COVID-19).

METHODS

This case-control study was conducted at shelter hospitals and quarantine hotels in China. A total of 5348 laboratory-confirmed COVID-19 patients were enrolled between April 1 and May 31, 2022, while 2190 uninfected individuals served as healthy controls. Structured questionnaires were used to collect data on demographics, underlying diseases, vaccination status, and use of SFHT. Patients were propensity-score-matched using 1:1 nearest-neighbor matching of the logit of the propensity score. Subsequently, a conditional logistic regression model was used for data analysis.

RESULTS

Overall, 7538 eligible subjects were recruited, with an average age of [45.54 ± 16.94] years. The age of COVID-19 patients was significantly higher than that of uninfected individuals ([48.25 ± 17.48] years vs [38.92 ± 13.41] years; t = 22.437, P < 0.001). A total of 2190 COVID-19 cases were matched with uninfected individuals at a 1:1 ratio. The use of SFHT (odds ratio = 0.753, 95% confidence interval: 0.692, 0.820) was associated with a lower risk of SARS-CoV-2 infection compared to untreated individuals.

CONCLUSION

Our findings suggest that taking SFHT reduces the risk of SARS-CoV-2 infection. This is a useful study in the larger picture of COVID-19 management, but data from large-sample multi-center, randomized clinical trial are warranted to confirm the finding. Please cite this article as: Zhang SX, Chen XX, Zheng Y, Cai BH, Shi W, Ru M, Li H, Zhang DD, Tian Y, Chen YL. Reduced SARS-CoV-2 infection risk is associated with the use of Seven-Flavor Herb Tea: a multi-center observational study in Shanghai, China. J Integr Med. 2023; Epub ahead of print.

How fast and how well the Omicron epidemic was curtailed. A Guangzhou experience to share

Introduction

SARS-CoV-2 has ravaged the world and undergone multiple mutations during the course of the COVID-19 pandemic. On 7 April 2022, an epidemic caused by SARS-CoV-2 Omicron (BA.2) variant broke out in Guangzhou, China, one of the largest transportation and logistical hubs of the country.

Methods

To fast curtained the Omicron epidemic, based on the routine surveillance on the risk population of SARS-CoV-2 infection, we identify key places of the epidemic and implement enhanced control measures against Omicron.

Results

Transmission characteristics of the Omicron variant were analyzed for 273 confirmed cases, and key places involved in this epidemic were fully presented. The median incubation time and the generation time were 3 days, and the reproduction number Rt was sharply increased with a peak of 4.20 within 2 days. We tried an all-out effort to tackle the epidemic in key places, and the proportion of confirmed cases increased from 61.17% at Stage 2 to 88.89% at Stage 4. Through delimited risk area management, 99 cases were found, and the cases were isolated in advance for 2.61 ± 2.76 days in a lockdown zone, 0.44 ± 1.08 days in a controlled zone, and 0.27 ± 0.62 days in a precautionary zone. People assigned with yellow code accounted for 30.32% (84/277) of confirmed COVID-19 cases, and 83.33% of them were detected positive over 3 days since code assignment. For the districts outside the epicenter, the implementation duration of NPIs was much shorter compared with the Delta epidemic last year.

Conclusion

By blocking out transmission risks and adjusting measures to local epidemic conditions through the all-out effort to tackle the epidemic in key places, by delimiting risk area management, and by conducting health code management of the at-risk population, the Omicron epidemic could be contained quickly.

Use of traditional and complementary medicine for COVID 19 prophylaxis among healthcare professionals and students in Jordan: A cross-sectional study

INTRODUCTION

There is inadequate evidence to recommend the use of any traditional and complementary medicine (T&CM) methods such as vitamin, mineral, herbal or other dietary supplements to prevent or treat COVID 19. Members of the medical team are particularly at risk of exposure to high viral load of coronavirus. They have also the best access to professional information regarding disease treatment and prophylaxis and disseminate such knowledge. The aim of the study was to assess the prevalence of use of T&CM for the prophylaxis of COVID 19 among the healthcare professionals and students in Jordan, along with the most common types and the factors associated with T&CM use.

METHODOLOGY

A cross-sectional study of T&CM use was conducted in Jordan using a snowball sampling method to distribute Google Forms and to enrol participants during coronavirus outbreak between June 10, 2021, and August 28, 2021. The study included healthcare professionals or students who consented to participate in the survey. The survey excluded those participants who had filled the questionnaire at least once or were pregnant/breast-feeding at the time of the study. The questionnaire consisted of 29 items, including screening, checkbox, dichotomous, matrix and open-ended questions.

RESULTS

The response rate was 97.1%. Out of 560 study respondents, 359 (64.1%) reported using T&CM for COVID 19 prevention. Vitamins and nutrients were consumed by almost half (48.4%) of study participants, while nonpharmacological methods and herbal remedies were consumed by 35.2% and 25.2%, respectively. The most common source of information regarding T&CM use for COVID 19 prophylaxis included scientific publications (59.5%), followed by disease treatment guidelines (38.0%) and social media (32.3%). Adverse effects were reported by 8.5% and possible adverse effects were reported by another 8.5% of participants. The T&CM use was associated with working in contact with COVID 19 patients (OR: 1.625 (95% CI 1.047-2.523) (P = 0.03) and having a colleague as a source of information (OR: 1.720 (95% CI 1.026-2.883) (P = 0.04).

CONCLUSIONS

The prevalence of T&CM use for COVID 19 prevention among healthcare professionals and students in Jordan is high, with a significant proportion of participants reporting adverse effects. There is an urgent need for further research toward efficacy and safety of T&CM in COVID 19 prophylaxis as well as development of appropriate public health policy on this issue specific to each country.

Cost-Effectiveness Analysis of the TCM "Yupingfeng Granules" in the Treatment of Acute Exacerbations of COPD Based on a Randomized Clinical Trial

Introduction

Traditional Chinese medicine (TCM) is becoming increasingly important as it provides further options for treating many diseases worldwide. The TCM "Yupingfeng" has been used in China for over 800 years, and its clinical efficacy and safety for COPD treatment have been proven in previous studies. The objective of this study was to compare the long-term cost-effectiveness of Yupingfeng granules and the current conventional treatment for COPD patients in China.

Methods

A Markov model was constructed from the perspective of the Chinese healthcare system using TreeAge Pro 2011. The model cycle length was 12 months, and the cycle time was set to 10 years. Data from a randomized controlled trial were used to generate the number of acute exacerbations, COPD assessment test (CAT) score and actual medication used. The state transition probabilities, costs and quality-adjusted life years (QALYs) were derived from available sources. A threshold of 72,447 yuan per QALY gained was used as a cost-effectiveness criterion. One-way and probabilistic sensitivity analyses were conducted to verify the model. In addition, the cost-effectiveness of a 35-year cycle was evaluated as a scenario analysis.

Results

In the basic-case analysis, the ICER of adding Yupingfeng granules to the current conventional treatment drugs was ¥2123.04 per QALY, which was less than the threshold (one-time per capita GDP).Sensitivity analyses showed the results to be robust. Probabilistic sensitivity analysis showed that the probability of the ICER being less than the one-time per capita GDP threshold was 100%. In the scenario analysis, the incremental cost-effectiveness was ¥12,051.27 per QALY which was also under the one-time per capita GDP.

Conclusion

By reducing the number of acute exacerbations of COPD, thereby correspondingly reducing the follow-up treatment cost, Yupingfeng granules combined with conventional treatment were found to provide a cost-effective therapeutic strategy for COPD.