BACKGROUND: The use of complementary and alternative medicine (CAM) is common among individuals with underlying chronic illnesses. OBJECTIVE: This systematic review and meta-analysis investigated the global prevalence and patterns of CAM use among individuals with chronic kidney disease (CKD). SEARCH STRATEGY: PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature Plus were searched from inception until 26th February 2024. INCLUSION CRITERIA: Original articles reporting the use of at least one type of CAM among individuals aged above 18 years old and at all stages of CKD or undergoing any form of kidney replacement therapy. DATA EXTRACTION AND ANALYSIS: Two independent reviewers performed the literature screening. The data were extracted from the included studies by one reviewer and cross-checked by another. Discrepancies were resolved by discussion and consensus among two reviewers. Primary information included prevalence of CAM use, types of CAM used, reasons for CAM use, factors associated with CAM use, and disclosure to healthcare providers. Meta-analyses were performed to determine the pooled prevalence of CAM use and non-disclosure of CAM using a random effect model. RESULTS: Forty-one studies were included in this systematic review and meta-analysis. The pooled prevalence of CAM use was 43% (95% confidence interval: 34%, 51%), I² = 99.46%. The reasons for CAM use included treatment of underlying comorbidities, complications or symptoms, maintenance of general health, and treatment of CKD. Nutritional approaches were the most common CAM modality, with 412 different herbal and dietary supplements reported; psychological and physical approaches included massage therapy, relaxation techniques, and mind-body practices; and other complementary health approaches such as homeopathy, traditional Chinese medicine, and Ayurvedic medicine were also frequently reported. Factors associated with CAM use included sociodemographic characteristics such as older age, female gender, or higher income; disease or therapy factors such as not having diabetes, relying on hemodialysis, or poor adherence to medication; and patient or internal factors such as positive attitude towards CAM and perceived safety of CAM. About 66% (61%, 72%) of CAM users did not disclose the use of CAM to their healthcare providers. CONCLUSION CAM use is prevalent among individuals with CKD, and healthcare providers should communicate openly and effectively to emphasize the rational use of CAM to avoid potential harm. Please cite this article as: Chin JW, Abdullah R, Tan BWW, Wong KW, Khor BH. Prevalence and patterns of complementary and alternative medicine usage among adults with chronic kidney disease: A systematic review and meta-analysis. J Integr Med. 2025; 23(4): 370-381.
Adult ; Humans ; Complementary Therapies/statistics & numerical data* ; Prevalence ; Renal Insufficiency, Chronic/therapy*

INTRODUCTION: Identifying peripheral arterial disease (PAD) during diabetic foot screening (DFS) is crucial in reducing the risk of diabetic foot ulcerations and lower limb amputations. Screening assessments commonly used include absolute systolic toe pressure (ASTP) and toe-brachial index (TBI). There is a lack of research defining the threshold values of both assessment methods. We aimed to compare the accuracy of ASTP and TBI and establish optimal threshold values of ASTP and TBI with reference to the internationally accepted ankle-brachial pressure index (ABPI) screening test, for a multiethnic diabetic population in Singapore. METHODS: A retrospective, observational study of DFS results from January 2017 to December 2017 was conducted. Receiver operating characteristic analysis was conducted for ASTP and TBI using the internationally accepted ABPI cut-off value of ≤0.9 to indicate PAD. RESULTS: A total of 1,454 patients with mean (standard deviation) age of 63.1 (12.4) years old were included. There were 50.8% men and 49.2% women, comprising 69.7% Chinese, 13.5% Indian, 10.1% Malay and 6.7% other ethnicities. Areas under the curve for ASTP and TBI were 0.89 (95% confidence interval [Cl] 0.85-0.94) and 0.94 (95% Cl 0.90-0.98), respectively, and the difference was statistically significant (P<0.001). Derived optimal threshold values to indicate ABPI≤0.9 for ASTP and TBI were <95.5mmHg (specificity 0.86, sensitivity 0.84) and <0.7 (specificity 0.89, sensitivity 0.95), respectively. CONCLUSION ASTP or TBI may be used to detect ABPI-determined PAD in DFS. The optimal threshold values derived from a multiethnic Asian diabetic population were <95.5mmHg for ASTP and <0.7 for TBI.
Ankle Brachial Index/methods* ; Diabetes Mellitus/epidemiology* ; Diabetic Foot/diagnosis* ; Female ; Humans ; Male ; Middle Aged ; Peripheral Arterial Disease/diagnosis* ; Retrospective Studies ; Toes

Aged ; Feasibility Studies ; Health Status ; Humans ; Mobile Applications ; Treatment Outcome

Asian People ; Humans ; Prevalence ; Stereotyping

Introduction: This study aimed to determine the prevalence and factors associated with female sexual dysfunction in an outpatient clinic in Malaysia. Methods: The study was conducted among female patients aged 50 years and older who attended the outpatient clinic of a public hospital in Malaysia. A self-administered questionnaire was used that was based on the Malay version of the Female Sexual Function Index questionnaire. The predictors of female sexual dysfunction were identified using multivariate logistic regression analysis. Results: A total of 263 females were recruited in this study, with a mean age of 60.6 ± 6.7 years. The distribution of the respondents’ ethnicities was mostly Malay (42.2%), followed by Chinese (41.8%) and Indian (16.0%). The prevalence of female sexual dysfunction among participants was 68.8%. The prevalence of the subscales of female sexual dysfunction was as follows: desire (85.2%), satisfaction (74.9%), arousal (71.1%), lubrication (66.9%), pain (61.2%), and orgasm (60.8%). According to multivariate logistic regression, patients of Indian ethnicity had an increased risk of female sexual dysfunction (OR=16.60, 95% CI=2.54–108.63), and a higher frequency of sexual intercourse was correlated with a lower risk of female sexual dysfunction (OR=0.13, 95% CI=0.08–0.24). Conclusion Seven-tenths of the middle-aged female patients attending the outpatient clinic suffered from female sexual dysfunction. Indian ethnicity and having a lower frequency of sexual intercourse were predictors of female sexual dysfunction. Future intervention studies are needed to address this problem.
Prevalence ; Sexual Dysfunction, Physiological ; Women ; Ambulatory Care Facilities ; Middle Aged

The Singapore Health Services cluster (SingHealth) radiology film archives are a valuable repository of local radiological cases dating back to the 1950s. Some of the cases in the archives are of historical medical interest, i.e. cerebral angiography in the workup of patients with hemiplegia. Other cases are of historical social interest, being conditions seen during earlier stages of Singapore's development, i.e. bound feet. The archives form a unique portal into the development of local radiology as well as the national development of Singapore. A selection from the archives is published in commemoration of the International Day of Radiology in 2020, as well as the 200th anniversary of the Singapore General Hospital in 2021. This pictorial essay comprises gastroenterology, musculoskeletal and obstetrics and gynaecology cases from the archives.

INTRODUCTION: Prehabilitation may benefit older patients undergoing major surgeries. Currently, its efficacy has not been conclusively proven. This is a retrospective review of a multimodal prehabilitation programme. METHODS: Patients aged 65 years and above undergoing major abdominal surgery between May 2015 and December 2019 in the National University Hospital were included in our institutional programme that incorporated aspects of multimodal prehabilitation and Enhanced Recovery After Surgery concepts as 1 holistic perioperative pathway to deal with issues specific to older patients. Physical therapy, nutritional advice and psychosocial support were provided as part of prehabilitation. RESULTS: There were 335 patients in the prehabilitation cohort and 256 patients whose records were reviewed as control. No difference in postoperative length of stay ( CONCLUSION The current study found no differences in traditional surgical outcome measures with and without prehabilitation. An increase in patient mobility in the immediate postoperative period was noted with prehabilitation, as well as an association between prehabilitation and increased adherence to postoperative adjuvant therapy. Larger prospective studies will be needed to validate the findings of this retrospective review.
Humans ; Postoperative Complications/prevention & control* ; Preoperative Care ; Preoperative Exercise ; Prospective Studies ; Retrospective Studies