Efficacy of acupuncture on cardiovascular complications in patients with diabetes mellitus in Korea: A nationwide retrospective cohort.

OBJECTIVE: The main aim of this study is to investigate whether acupuncture could be an effective complementary treatment for reducing the risk of macrovascular complications in diabetic patients currently taking antidiabetic medications using a nationwide population-based database. METHODS: We conducted a retrospective cohort study to assess the efficacy of acupuncture on cardiovascular complications in diabetic patients using data from patients between 40 and 79 years of age, newly diagnosed with diabetes between 2003 and 2006, found in the National Health Insurance Service-National Sample Cohort (NHIS-NSC) in Korea. From the data, we identified 21,232 diabetic patients who were taking antidiabetic medication between 2003 and 2006. The selected patients were divided into two groups-those who received acupuncture at least three times and those who received no acupuncture (non-acupuncture) in the year following their diagnosis of diabetes. After 1:1 propensity score matching (PSM), each group had 3350 patients, and the observation ceased at the occurrence of a major adverse cardiovascular event (MACE), which was defined as either myocardial infarction, stroke, or death due to cardiovascular cause. RESULTS: After PSM, the acupuncture group had a lower incidence of MACE (hazard ratio [HR]: 0.87; 95% confidence interval [CI]: 0.81-0.94; P = 0.0003) and all-cause mortality (HR: 0.77; 95% CI: 0.70-0.84; P < 0.0001) than the non-acupuncture group; the HRs for stroke-related mortality (HR: 0.75; 95% CI: 0.56-1.00; P = 0.0485), ischemic heart disease mortality (HR: 0.53; 95% CI: 0.34-0.84; P = 0.006) and circulatory system disease mortality (HR: 0.67; 95% CI: 0.55-0.82; P < 0.0001) were lower in the acupuncture group than in the non-acupuncture group in the secondary analysis. CONCLUSION: Our results indicate that diabetic patients receiving acupuncture treatment might have a lower risk of MACE, all-cause mortality and cardiovascular mortality. This population-based retrospective study suggests beneficial effects of acupuncture in preventing macrovascular complications associated with diabetes. These findings call for further prospective cohort or experimental studies on acupuncture treatment for cardiovascular complications of diabetes. Please cite this article as: Jung H, Won T, Kim GY, Jang J, Yeo S, Lim S. Efficacy of acupuncture on cardiovascular complications in patients with diabetes mellitus in Korea: A nationwide retrospective cohort. J Integr Med. 2023; 21(2): 176-183.

Acupuncture for cancer patients with nausea and vomiting: A protocol for systematic review and meta-analysis.

BACKGROUND: Nausea and vomiting are among the most common adverse effects experienced by cancer patients undergoing treatment worldwide. Their treatment with pharmacologic therapy can often be complicated by medication interactions and other unwanted side effects. The aim of this systematic review and meta-analysis protocol is to assess the effectiveness and safety of acupuncture therapy for treating nausea and vomiting in patients with cancer. METHODS: Three electronic databases and 2 clinical registry platforms will be searched from inception to May 2022: the MEDLINE via PubMed, Embase via Ovid, the Cochrane Central Register of Controlled Trials via the Cochrane Library, the World Health Organisation International Clinical Trials Registry Platform, and National Institutes of Health Clinical trials.gov. Search terms will include nausea, vomiting, cancer, and acupuncture. Two researchers will independently select studies, extract data and assess the risk of bias. The primary outcome will be the incidence of nausea and/or vomiting or other validated outcome measures. Meta-analysis will be carried out using RevMan V.5.4. The quality of evidence from randomized clinical trials will be evaluated with the Grading of Recommendations Assessment, Development and Evaluation System tool. RESULTS: The results will provide a high-quality synthesis of evidence for clinicians in the field of oncology. CONCLUSION: The conclusion is expected to provide evidence to determine whether acupuncture is an effective and safe treatment for cancer patients with nausea and vomiting.

Efficacy of Acupuncture for Insomnia: A Systematic Review and Meta-Analysis.

Patients with insomnia frequently use acupuncture as an alternative treatment to pharmacotherapy globally. The aim of this paper is to assess the effect of acupuncture on insomnia. Seven medical databases, including MEDLINE, EMBASE, CENTRAL, CNKI, RISS, NDSL, and OASIS, were used to identify studies published through July 09, 2020. Twenty-four randomized controlled trials (RCTs) were included in this qualitative review comparing acupuncture to either pharmacotherapy or sham-acupuncture therapy. Methodological quality was assessed, using the Cochrane risk of bias (ROB). In the subsequent quantitative meta-analysis of studies comparing acupuncture versus pharmacotherapy, fifteen RCTs demonstrated that acupuncture had a significant effect on patients with insomnia as assessed by the Pittsburgh sleep quality index (PSQI) (RR: -0.74; 95% CI: -1.07 to -0.40; [Formula: see text] ¡0.0001; [Formula: see text] = 89%; [Formula: see text] = 1475). A subgroup analysis showed that there was no significant effect after weeks 1 and 2, but six studies found that acupuncture had a significant effect insomnia at week 3 (RR: -0.97; 95% CI: -1.65 to -0.28; [Formula: see text] = 0.006; [Formula: see text] = 91%; [Formula: see text] = 463) and nine studies demonstrated a significant effect at week 4 (RR: -0.70; 95% CI: -1.15 to -0.25; [Formula: see text] = 0.002; [Formula: see text] = 85%; [Formula: see text] = 594). These results suggest that insomnia patients may experience significant improvement in symptoms after more than three weeks of acupuncture treatment compared to pharmacological treatments.

Paid protection? Ethics of incentivised long-acting reversible contraception in adolescents with alcohol and other drug use.

Pregnant adolescents have a higher risk of poor maternal and fetal outcomes, particularly in the setting of concomitant maternal alcohol and other drug (AOD) use. Despite numerous programmes aimed at reducing overall teen pregnancy rates and the recognition of AOD use as a risk factor for unintended pregnancy in adolescents, interventions targeting this specific group have been sparse. In adult drug-using women, financial incentives for contraception have been provided but are ethically controversial. This article explores whether a trial could ethically employ monetary incentives in adolescents with AOD use to promote the use of long-acting reversible contraception (LARC), with special attention to the relevant distinctions between adults and adolescents. We conclude that a trial of incentives to promote LARC in this patient population is ethically permissible if the incentives are small, are tied to completion of an educational activity to minimise the quick fix temptation and potential for non-attendance to the risks and benefits of LARC and are provided only to the adolescent after an assessment of her reasoning to rule out coercion (eg, by guardians) as motivation. Information about treatment for AOD use and follow-up care in case of problems with the contraceptive or desire for removal should also be provided. Before implementing such a trial, qualitative research with input from providers, potential patients and their parents should be conducted to inform the programme's specific structure.

HPV vaccine uptake in a school-located vaccination program.

Previous research has implied that while parents may be willing to have their adolescents receive some recommended vaccines via school-located vaccination program (SLVP), they were less likely to agree to the HPV vaccine being administered via SLVP. During an SLVP in a large urban area, 86% of those participating in the program received an HPV vaccine.

Trust and a school-located immunization program.

PURPOSE: To determine variables associated with parental trust in a school-located immunization program (SLIP) and the effect of trust-building interventions on trust and participation in SLIPs. METHODS: Parents among eight schools randomized to a trust-building intervention or a control condition (four schools each) completed a five-item trust survey before SLIP implementation both in year 1 (fall 2012) and in year 2 (fall 2013). Mean trust scores were calculated. Associations between baseline demographic and experiential variables and mean trust scores were analyzed. Mean trust scores in intervention and control schools were compared before SLIP in years 1 and 2, and SLIP participation rates were noted. RESULTS: From year 1, 1,608 parent surveys were analyzed. Baseline mean trust score across schools was 3.59 of 5 (5 = highest trust). In a multiple linear regression model, annual household income, survey language version, participation in a previous SLIP, child's health insurance status, and perceived vaccine importance were significantly associated with parental trust in SLIPs (R(2)= .06, p < .001). There was no difference in mean trust scores between intervention and control schools (p = .8). In year 2, 844 surveys were analyzed, and a modest difference was observed between intervention and control schools (mean trust score = 3.66 and 3.57, respectively, p = .07). SLIP participation rates appeared higher in intervention (7.7%) versus control schools (4.3%) in year 1. CONCLUSIONS: Baseline trust in SLIPs among a low-income, largely Hispanic group of parents in Texas was moderately high. Factors associated with trust included demographic and experiential variables, and interventions aimed at increasing parents' perception of vaccine importance and participation in SLIPs may be effective in increasing parental trust in SLIPs.