Publications by authors named "Gustav Dobos"

218 Publications

Integrative pediatrics survey: Parents report high demand and willingness to self-pay for complementary and integrative medicine in German hospitals.

Complement Ther Med 2021 Jul 8;60:102757. Epub 2021 Jul 8.

Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany; National Centre for Naturopathic Medicine, Southern Cross University, Lismore Campus, Australia.

Background: In Germany, there is hardly any institutionalization of pediatric complementary and integrative medicine (CIM) present, which is one reason why the statutory health insurance companies usually do not cover the costs. Which in turn serves as an obstacle for integrating CIM into routine pediatric care. Within the present study, we assessed existing demand for CIM methods in parents of children in clinical primary care and whether the parents would be willing to cover the costs privately.

Methods: Parents who visited the Pediatric Department of the Elisabeth Hospital, Essen, Germany and the Children's Hospital St. Marien, Landshut, Germany with their children in 2015 and 2016 were asked to take part in a paper-pencil survey. Both outpatients and inpatients were interviewed.

Results: 1323 parents took part in the survey. 40 % of them stated that they already use CIM for their children. Homeopathy was the most frequently mentioned with almost 60 %, followed by osteopathy and phytotherapy. More than 80 % of the participants endorsed the expansion of the CIM offers in respective hospitals. Homeopathy was the method most desired by the parents, followed by osteopathy, phytotherapy and massage therapies. The majority (88 %) of the parents stated that they would like to take advantage of an extended range of services, including extra services that they would have to pay privately for.

Conclusion: Many parents are already using CIM for their children and are looking forward to CIM being incorporated in clinical primary care. They would also be willing to bear the costs themselves if the therapy in question is not covered by their insurance. pay for the costs themselves if the therapy is not covered by their insurance.
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http://dx.doi.org/10.1016/j.ctim.2021.102757DOI Listing
July 2021

The INTREST registry: protocol of a multicenter prospective cohort study of predictors of women's response to integrative breast cancer treatment.

BMC Cancer 2021 Jun 23;21(1):724. Epub 2021 Jun 23.

Department of Psychology, Chair of Research Methodology and Statistics in Psychology, Witten / Herdecke University, Witten, Germany.

Background: Cancer registries usually assess data of conventional treatments and/or patient survival. Beyond that, little is known about the influence of other predictors of treatment response related to the use of complementary therapies (CM) and lifestyle factors affecting patients' quality and quantity of life.

Methods: INTREST is a prospective cohort study collecting register data at multiple German certified cancer centers, which provide individualized, integrative, in- and outpatient breast cancer care. Patient-reported outcomes and clinical cancer data of anticipated N = 715 women with pTNM stage I-III breast cancer are collected using standardized case report forms at the time of diagnosis, after completing neo-/adjuvant chemotherapy, after completing adjuvant therapy (with the exception of endocrine therapy) as well as 1, 2, 5, and 10 years after baseline. Endpoints for multivariable prediction models are quality of life, fatigue, treatment adherence, and progression-based outcomes/survival. Predictors include the study center, sociodemographic characteristics, histologic cancer and comorbidity data, performance status, stress perception, depression, anxiety, sleep quality, spirituality, social support, physical activity, diet behavior, type of conventional treatments, use of and belief in CM treatments, and participation in a clinical trial. Safety is recorded following the Common Terminology Criteria for Adverse Events.

Discussion: This trial is currently recruiting participants. Future analyses will allow to identify predictors of short- and long-term response to integrative breast cancer treatment in women, which, in turn, may improve cancer care as well as quality and quantity of life with cancer.

Trial Registration: German Clinical Trial Register DRKS00014852 . Retrospectively registered at July 4th, 2018.
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http://dx.doi.org/10.1186/s12885-021-08468-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8220783PMC
June 2021

Yoga in women with abdominal obesity - Do lifestyle factors mediate the effect? Secondary analysis of a RCT.

Complement Ther Med 2021 Jun 16;60:102741. Epub 2021 Jun 16.

Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany; National Centre for Naturopathic Medicine, Southern Cross University, Lismore, Australia; Australian Research Center in Complementary and Integrative Medicine, Faculty of Health, University of Technology-Sydney, Sydney, Australia.

Introduction: The reduction of obesity is an important challenge for health policy. Although dietary interventions are widely available, patient adherence is usually low. A promising alternative is yoga. We hypothesized that weight reduction through yoga is mediated by aspects related to eating habits as well as physical aspects.

Methods: This is an exploratory secondary analysis of a randomized controlled trial comparing the effects of yoga to waiting list in women with abdominal obesity. Body mass index (BMI) and waist circumference were assessed as outcomes; physical exercise habits, physical activity habits at leisure time, physical activity habits at work time, daily fruit and vegetable intake, nutrition self-efficacy, and physical self-efficacy were captured as mediators. Measures were assessed at weeks 0 and 12. The original trial was conducted between April and August 2015. The secondary analysis was performed December 2019.

Results: Forty patients were randomized to the 12 weekly yoga sessions (48.5 ± 7.9 years) and 20 patients to the waitlist group (46.4 ± 8.9 years). Physical exercise habits fully mediated the effect of yoga on BMI (B=-0.26;CI[-.56;-.07]). Daily fruit and vegetable intake partially mediated the effect of yoga on BMI (B=-0.13;CI[-.38;-.01]). No further mediation effects were found.

Conclusions: Yoga supports people with overweight in eating healthier and increasing their physical activity which in turn leads to a reduced BMI. Yoga's effects on waist circumference seem to be due to other mechanisms.
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http://dx.doi.org/10.1016/j.ctim.2021.102741DOI Listing
June 2021

Fasting alters the gut microbiome reducing blood pressure and body weight in metabolic syndrome patients.

Nat Commun 2021 03 30;12(1):1970. Epub 2021 Mar 30.

Experimental and Clinical Research Center, a joint cooperation of Max Delbruck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany.

Periods of fasting and refeeding may reduce cardiometabolic risk elevated by Western diet. Here we show in the substudy of NCT02099968, investigating the clinical parameters, the immunome and gut microbiome exploratory endpoints, that in hypertensive metabolic syndrome patients, a 5-day fast followed by a modified Dietary Approach to Stop Hypertension diet reduces systolic blood pressure, need for antihypertensive medications, body-mass index at three months post intervention compared to a modified Dietary Approach to Stop Hypertension diet alone. Fasting alters the gut microbiome, impacting bacterial taxa and gene modules associated with short-chain fatty acid production. Cross-system analyses reveal a positive correlation of circulating mucosa-associated invariant T cells, non-classical monocytes and CD4 effector T cells with systolic blood pressure. Furthermore, regulatory T cells positively correlate with body-mass index and weight. Machine learning analysis of baseline immunome or microbiome data predicts sustained systolic blood pressure response within the fasting group, identifying CD8 effector T cells, Th17 cells and regulatory T cells or Desulfovibrionaceae, Hydrogenoanaerobacterium, Akkermansia, and Ruminococcaceae as important contributors to the model. Here we report that the high-resolution multi-omics data highlight fasting as a promising non-pharmacological intervention for the treatment of high blood pressure in metabolic syndrome patients.
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http://dx.doi.org/10.1038/s41467-021-22097-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010079PMC
March 2021

The use and benefits of Craniosacral Therapy in primary health care: A prospective cohort study.

Complement Ther Med 2021 May 26;58:102702. Epub 2021 Feb 26.

Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.

Background: Patients frequently use treatments complementary to standard primary care. This prospective cohort-study examined the use, benefits, and safety of Craniosacral Therapy (CST).

Methods: Consecutive out-patients utilizing CST from 2015 to 2019 were asked to provide anonymized data on symptom intensity, functional disability, and quality of life before and after treatment using an adapted 11-point numerical rating scale (NRS) version of the Measure Yourself Medical Outcome Profile (MYMOP). Treatment expectations were assessed as were concurrent therapies/medication and safety. Mean differences were analyzed using paired sample t-tests with 95 % confidence intervals (CI), predictors of treatment response using linear regression modelling.

Results: CST therapists submitted 220 patient records (71.4 % female) including 15.5 % infants and toddlers, 7.7 % children, and 76.8 % adolescents and adults. Patients received on average 7.0 ± 7.3 CST sessions to treat 114 different, acute and chronic conditions. Symptom intensity significantly decreased by -4.38 NRS (95 %CI=-4.69/-4.07), disability by -4.41 NRS (95 %CI=-4.78/-4.05), and quality of life improved by 2.94 NRS (95 %CI = 2.62/3.27). Furthermore, CST enhanced personal resources by 3.10 NRS (95 %CI = 1.99/4.21). Independent positive predictors of change in the adapted total MYMOP score included patients' expectations (p = .001) and therapists' CST experience (p = .013), negative predictors were symptom duration (p < .002) and patient age (p = .021); a final categorical predictor was CST type (p = .023). Minor but no serious adverse events occurred.

Conclusions: In primary care, patients and parents of underage children use CST for preventive and therapeutic purposes. Considering the design limitations, CST appears to be overall effective and safe in infants, children, and adults.
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http://dx.doi.org/10.1016/j.ctim.2021.102702DOI Listing
May 2021

Effects of an Integrative Mind-Body-Medicine Group Program on Breast Cancer Patients During Chemotherapy: An Observational Study.

Curr Pharm Des 2021 ;27(8):1112-1120

Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.

Background: Breast cancer is one of the leading cancers in women in the Western world. Cancer treatment, especially chemotherapy, is often associated with physical and psychosocial side effects.

Objective: To improve the quality of life and manage side effects, a new integrative mind-body-medicine group concept for breast cancer patients receiving chemotherapy was developed and pilot tested.

Methods: Breast cancer patients participated in a 66 hours mind-body-medicine group program tailored to the needs of cancer patients during chemotherapy. The program was integrated into standard care encompassing mindfulness training, yoga, moderate exercise, nutrition, complementary self-help strategies, cognitive restructuring, and acupuncture. Quality of life (EORTC QLQ-C30), depression and anxiety (HADS), stress (PSS-10), and fatigue (BFI) were assessed before and after the program, as well as satisfaction and safety. Analyses were carried out on exploratory basis with paired samples t-tests.

Results: Fifty-seven female patients, aged 51.3±10.5 years, with breast cancer diagnoses were enrolled. After completing the program, global EORTC quality of life was improved (D=9.5; 95%-CI=[2.9|16.1]; p=.005), although the EORTC-symptom scales assessing fatigue (D=9.9; 95%-CI=[1|18.8]; p=.030), nausea (D=7.1; 95%- CI=[0.6|13.6]; p=.031), and dyspnea (D=12.5; 95%-CI=[2.9|22.1]; p=.011) were found to be increased. Stress (D=-3.5; 95%-CI=[-5|-2.1]; p=.000), anxiety (D=-3.8; 95%-CI=[-4.9|-2.7]; p=.000) and depression (D=-3.9; 95%-CI=[-4.9|-2.8]; p=.000) were also found to be significantly reduced. Regarding the severity of (D=0.2; 95%- CI=[-0.8|0.5]; p=.644) and the impairment due to fatigue (D=0.1; 95%-CI=[-0.8|0.6]; p=.696), no significant worsening was observed. Patients were satisfied with the program. No serious adverse events were reported.

Conclusion: Breast cancer patients benefit from an integrative mind-body-medicine group program during chemotherapy regarding the quality of life and psychological symptoms. Randomized controlled trials are warranted.
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http://dx.doi.org/10.2174/1381612826666201211111122DOI Listing
May 2021

Comprehensive Lifestyle-Modification in Patients with Ulcerative Colitis-A Randomized Controlled Trial.

J Clin Med 2020 Sep 24;9(10). Epub 2020 Sep 24.

Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34 a, 45276 Essen, Germany.

Patients with ulcerative colitis suffer from impaired health-related quality of life (HrQoL). Comprehensive lifestyle-modification might increase HrQoL and decrease disease activity. Ninety-seven patients in clinical remission with impaired HrQoL were randomly assigned to a 10 week comprehensive lifestyle-modification program (LSM; = 47; 50.28 ± 11.90 years) or control ( = 50; 45.54 ± 12.49 years) that received a single workshop of intense training in naturopathic self-help strategies. Primary outcome was HrQoL (Inflammatory Bowel Disease Questionnaire; IBDQ) at week 12. Secondary outcomes included IBDQ subscales; generic HrQoL; disease activity and microbiome. Both groups showed improvement in HrQoL from baseline to post-treatment at week 12. The IBDQ sum score showed no significant group difference ( = 0.251). If patients attended more than 50% of the training sessions, a significant group effect ( = 0.034) was evident in favor of LSM. In addition, the SF-36 mental component summary ( = 0.002) was significantly different between the groups in favor of LSM. Disease activity microbiome and adverse events did not differ. Both a single workshop and a 10-week comprehensive lifestyle-modification program can improve HrQoL in patients with ulcerative colitis in remission with no apparent effects on clinical disease activity. A treatment difference was observed when examining a subsample of patients who attended ≥ 50% of sessions.
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http://dx.doi.org/10.3390/jcm9103087DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7599849PMC
September 2020

Comparative efficacy of different exercise interventions in chronic non-specific low back pain: protocol of a systematic review and network meta-analysis.

BMJ Open 2020 08 5;10(8):e036050. Epub 2020 Aug 5.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, University of Duisburg-Essen, Faculty of Medicine, Essen, Germany.

Introduction: Chronic non-specific low back pain is a major public health problem. Evidence supports the effectiveness of exercise as an intervention. Due to a paucity of direct comparisons of different exercise categories, medical guidelines were unable to make specific recommendations regarding the type of exercise working best in improving chronic low back pain. This network meta-analysis (NMA) of randomised controlled trials aims to investigate the comparative efficacy of different exercise interventions in patients with chronic non-specific low back pain.

Methods And Analysis: MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, SPORTDiscus, Clinicaltrials.gov and the WHO International Clinical Trials Registry Platform search portal were searched on November 2019 and without language restrictions. The search will be updated after data analysis. Studies on adults with non-specific low back pain of at least 12 weeks duration comparing exercise to either no specific intervention (ie, no treatment, wait-list or usual care at the treating physician's discretion) and/or functionally inert interventions (ie, sham or attention control interventions) will be eligible. Pain intensity and back-specific disability are defined as primary outcomes. Secondary outcomes will include health-related physical and mental quality of life, work disability, frequency of analgesic use and adverse events. All outcomes will be analysed short-term, intermediate-term and long-term. Data will be extracted independently by two review authors. Risk of bias will be assessed using the recommendations by the Cochrane Back and Neck Group and be based on an adaptation of the Cochrane Risk of Bias tool.

Ethics And Dissemination: This NMA will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses_NMA checklist. The results will be presented in peer-reviewed journals, implemented in existing national and international guidelines and will be presented to health care providers and decision makers. The planned completion date of the study is 1 July 2021.

Prospero Registration Number: CRD42020151472.
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http://dx.doi.org/10.1136/bmjopen-2019-036050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7409959PMC
August 2020

Diagnostic Performance of Simultaneous [F]-FDG PET/MR for Assessing Endoscopically Active Inflammation in Patients with Ulcerative Colitis: A Prospective Study.

J Clin Med 2020 Aug 1;9(8). Epub 2020 Aug 1.

Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany.

To investigate the diagnostic performance of simultaneous F-fluoro-deoxyglucose ([F]-FDG) PET/MR enterography in assessing and grading endoscopically active inflammation in patients with ulcerative colitis. 50 patients underwent PET/MR 24 h before ileocolonoscopy. Inflammatory activities of bowel segments were evaluated with both Mayo endoscopic subscore and Nancy histologic index. MR, DWI (Diffusion-weighted imaging) and PET were utilized as qualitative parameters for detecting endoscopically active inflammation. SUVmaxQuot in each segment (maximum of standard uptake value relative to liver) was calculated to quantify inflammation. In the study arm without bowel purgation, combined reading of PET and MR resulted in significantly increased specificity against each submodality alone (0.944 vs. 0.82 for MR and 0.843 for PET, < 0.05) and highest overall accuracy. In the study arm with bowel purgation, the significantly lower specificity of PET (0.595) could be markedly improved by a combined reading of PET and MR. Metabolic conditions in bowel segments with both endoscopic and histological remission were significantly lower than in segments with endoscopic remission but persistent microscopic inflammation (SUVmaxQuot 0.719 vs. 0.947, < 0.001). SUVmaxQuot correlated highly with Mayo endoscopic subscore (ρ = 0.718 and 0.606) and enabled grading of inflammatory activity. Simultaneous [F]-FDG PET/MR may be considered as an alternative to endoscopy in clinical trials.
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http://dx.doi.org/10.3390/jcm9082474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7465255PMC
August 2020

Complementary Medicine Use and Uptake of Cancer Screening Among US Adults: A Nationally Representative Cross-Sectional Survey.

Integr Cancer Ther 2020 Jan-Dec;19:1534735420943286

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.

Cancer screenings can considerably reduce cancer mortality. There is limited information on the association between complementary medicine use and adherence to recommended cancer screenings. In this study, the potential associations between uptake of cancer screening and consultations with complementary medicine practitioners or mind-body medicine use are examined. This is a cross-sectional analysis of the 2017 National Health Interview Survey of a population-based sample (n = 26 742; response rate = 80.7%). Age- and sex-related risk groups for breast cancer (women 45 years and older), cervical cancer (women 21 years and older), and colorectal cancer (45 to 85 years) were analyzed in 2018. Prevalence of complementary medicine use in the past 12 months as well as prevalence of cancer screening uptake in the past 12 months were calculated. At least one complementary medicine approach was used by 32.4% of participants. Controlling for sociodemographic and clinical variables, individuals who consulted a chiropractor or naturopath or who used mind-body medicine approaches were more likely to take up Pap smear test (odds ratio = 1.20-1.35), mammography (odds ratio = 1.22-1.38), and/or colorectal cancer screening (odds ratio = 1.18-1.37). Those consulting a homeopath were more likely to take up Pap smear test (odds ratio = 1.33). No association was found between consultations of practitioners of chelation therapy or traditional medicine and cancer screening uptake. Complementary medicine use seems to be associated with a better adherence to cancer screening. Individuals who consulted a chiropractor or naturopath or who used mind-body medicine approaches were more likely to take up the recommended screening.
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http://dx.doi.org/10.1177/1534735420943286DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7376296PMC
July 2020

Conventional and Complementary Healthcare Utilization Among US Adults With Cardiovascular Disease or Cardiovascular Risk Factors: A Nationally Representative Survey.

J Am Heart Assoc 2020 05 29;9(9):e014759. Epub 2020 Apr 29.

Department of Internal and Integrative Medicine Evangelische Kliniken Essen-Mitte Faculty of Medicine University of Duisburg-Essen Essen Germany.

Background Cardiovascular diseases (CVDs) and their risk factors need guideline-oriented treatment to provide the best benefit for patients. These guidelines include recommendations for regular checkups, realized by general medical practitioners. In addition, individuals with CVD or CVD risk factors tend to use complementary methods for their condition. There is limited information on the association between complementary healthcare utilization and the adherence to recommended conventional health care. Methods and Results In this cross-sectional analysis of the nationally representative 2017 National Health Interview Survey (n=26 742; response rate 80.7%) we examined the prevalence of conventional and complementary healthcare utilization within the past 12 months in individuals with CVD and/or CVD risk factors and the interactions between the two categories of health care. Of all participants, 38.1% reported risk factors for CVD and 11.4% a CVD diagnosis (groups show an overlap). Overall prevalence of visits to conventional and complementary medicine providers and the use of mind-body medicine was high within the population analyzed. Individuals with CVD and/or CVD risk factors using complementary health care were as likely or more likely to consult general practitioners (CVD: adjusted odds ratio [aOR], 1.17; 95% CI, 0.93-1.47; CVD risk: aOR, 1.21; 95% CI, 1.05-1.39) and medical specialists (CVD: aOR, 1.38; 95% CI, 1.17-1.64; CVD risk: aOR, 1.42; 95% CI, 1.28-1.58) than those not using complementary health care. Those using complementary health care were as likely to adhere to medical checkup as those not using complementary health care. Conclusions Complementary healthcare utilization use was not associated with a reduced adherence to conventional health care and recommended checkups. The potential positive association of complementary and conventional healthcare utilization needs to be confirmed in further studies.
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http://dx.doi.org/10.1161/JAHA.119.014759DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428557PMC
May 2020

Perceived stress mediates the effect of yoga on quality of life and disease activity in ulcerative colitis. Secondary analysis of a randomized controlled trial.

J Psychosom Res 2020 03 31;130:109917. Epub 2019 Dec 31.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany. Electronic address:

Objective: Yoga positively affects health-related quality of life and disease activity in ulcerative colitis. The underlying modes of action remain unclear. Within the present study we hypothesized that patients´ perceived stress mediates the effects of yoga on health-related quality of life and disease activity.

Methods: This is a secondary analysis of a randomized controlled trial comparing the effects of yoga to written self-care advice in patients with inactive ulcerative colitis and impaired quality of life. Perceived stress was assessed using the Perceived Stress Questionnaire, health-related quality of life using the Inflammatory Bowel Disease Questionnaire and disease activity using the Clinical Activity Index. Outcomes were assessed at weeks 0, 12 and 24.

Results: Seventy-seven patients participated. Thirty-nine patients attended the 12 supervised weekly yoga sessions (71.8% women; 45.0 ± 13.3 years) and 38 patients written self-care advice (78.9% women; 46.1 ± 10.4 years). Perceived stress correlated significantly with health-related quality of life and disease activity at week 24. Perceived stress at week 12 fully mediated the effects of yoga on health-related quality of life (B = 16.23; 95% Confidence interval [6.73; 28.40]) and disease activity (B = -0.28; 95% Confidence interval [-0.56; -0.06]) at week 24.

Conclusion: Our findings confirm the importance of perceived stress in reducing disease activity and increasing health-related quality of life in patients with ulcerative colitis and impaired quality of life. Practitioners should keep psychosocial risk in mind as a risk factor for disease exacerbation, and consider yoga as an adjunct intervention for highly stressed patients with ulcerative colitis. CLINICALTRIALS.

Gov Registration Number: The trial was registered at clinicaltrials.gov prior to patient recruitment (registration number NCT02043600).
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http://dx.doi.org/10.1016/j.jpsychores.2019.109917DOI Listing
March 2020

Craniosacral therapy for chronic pain: a systematic review and meta-analysis of randomized controlled trials.

BMC Musculoskelet Disord 2019 Dec 31;21(1). Epub 2019 Dec 31.

Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.

Objectives: To systematically assess the evidence of Craniosacral Therapy (CST) for the treatment of chronic pain.

Methods: PubMed, Central, Scopus, PsycInfo and Cinahl were searched up to August 2018. Randomized controlled trials (RCTs) assessing the effects of CST in chronic pain patients were eligible. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for pain intensity and functional disability (primary outcomes) using Hedges' correction for small samples. Secondary outcomes included physical/mental quality of life, global improvement, and safety. Risk of bias was assessed using the Cochrane tool.

Results: Ten RCTs of 681 patients with neck and back pain, migraine, headache, fibromyalgia, epicondylitis, and pelvic girdle pain were included. CST showed greater post intervention effects on: pain intensity (SMD = -0.32, 95%CI = [- 0.61,-0.02]) and disability (SMD = -0.58, 95%CI = [- 0.92,-0.24]) compared to treatment as usual; on pain intensity (SMD = -0.63, 95%CI = [- 0.90,-0.37]) and disability (SMD = -0.54, 95%CI = [- 0.81,-0.28]) compared to manual/non-manual sham; and on pain intensity (SMD = -0.53, 95%CI = [- 0.89,-0.16]) and disability (SMD = -0.58, 95%CI = [- 0.95,-0.21]) compared to active manual treatments. At six months, CST showed greater effects on pain intensity (SMD = -0.59, 95%CI = [- 0.99,-0.19]) and disability (SMD = -0.53, 95%CI = [- 0.87,-0.19]) versus sham. Secondary outcomes were all significantly more improved in CST patients than in other groups, except for six-month mental quality of life versus sham. Sensitivity analyses revealed robust effects of CST against most risk of bias domains. Five of the 10 RCTs reported safety data. No serious adverse events occurred. Minor adverse events were equally distributed between the groups.

Discussion: In patients with chronic pain, this meta-analysis suggests significant and robust effects of CST on pain and function lasting up to six months. More RCTs strictly following CONSORT are needed to further corroborate the effects and safety of CST on chronic pain.

Protocol Registration At Prospero: CRD42018111975.
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http://dx.doi.org/10.1186/s12891-019-3017-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937867PMC
December 2019

Treatment of signs and symptoms of the common cold using EPs 7630 - results of a meta-analysis.

Heliyon 2019 Nov 26;5(11):e02904. Epub 2019 Nov 26.

Emeritus, University of Cologne, Institute of Medical Statistics, Informatics and Epidemiology, Kerpener Straβe 62, 50931 Cologne, Germany.

The efficacy of preparation EPs 7630 in the common cold (CC) was assessed by performing meta-analyses of randomized, double-blind, placebo-controlled trials. Mean differences (MD) and risk ratios (RR) with their 95% confidence intervals (CI) were computed. Five trials with a total of 833 patients were included. All trials had a treatment period of ten days with visits at days 3, 5, and 10 after baseline and used a ten-symptom Cold Intensity Score (CIS) as the primary outcome. Significant differences favoring EPs 7630 were observed for total CIS reduction (day 5: MD = -2·30; 95%CI = -4·12,-0·49; day 10: MD = -1·16; 95%CI = -2·22,-0·10), proportion of patients with substantial improvement (day 5: RR = 1·73; day 10: RR = 1·06) and complete remission (day 5: RR = 2·52; day 10: RR = 2·13). Subjects treated with EPs 7630 missed fewer days at work, used less paracetamol and had an improved sleep quality. No serious adverse reactions to EPs 7630 were reported. The results support the efficacy of EPs 7630 in adults with CC.
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http://dx.doi.org/10.1016/j.heliyon.2019.e02904DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6888731PMC
November 2019

Distinct patterns of short-chain fatty acids during flare in patients with ulcerative colitis under treatment with mesalamine or a herbal combination of myrrh, chamomile flowers, and coffee charcoal: secondary analysis of a randomized controlled trial.

Eur J Gastroenterol Hepatol 2020 02;32(2):175-180

Labor LS SE & Co. KG/Enterosan, Bad Bocklet-Großenbrach, Germany.

Objectives: Short-chain fatty acids are involved in the regulation of the gut immune system. In ulcerative colitis, short-chain fatty acids are often reduced, especially during flare. This study evaluated exploratively the pattern of butyrate and total short-chain fatty acids in patients with ulcerative colitis during flare treated either with mesalamine or a herbal preparation consisting of myrrh, chamomile flowers, and coffee charcoal which showed promising results in maintaining remission in a randomized double-blind, double-dummy, controlled clinical trial (EudraCT-Number 2007-007928-18).

Methods: Patients were treated with the herbal preparation or mesalamine. Clinical activity was monitored by Clinical Colitis Activity Index. Using gas chromatography, we analyzed fecal samples of 38 patients who experienced a flare during treatment.

Results: Paired t-test showed a significant decline of total short-chain fatty acids [M before = 66.12, SD = 39.59; M after = 29.83, SD = 15.05; 95% bootstrap confidence interval (20.53-55.30); P = 0.01) and of butyrate [M before 11.35, SD = 7.56; M after = 6.50, SD = 3.55; 95% bootstrap confidence interval (2.06-8.11); P = 0.02] in the event of a flare for patients treated with mesalamine but not for patients treated with the herbal preparation.

Conclusion: Patients who received the herbal preparation did not show a significant decline of total short-chain fatty acids in the event of a flare. Since a decline of short-chain fatty acids might lead to unfavorable health impairments, a combination of the two treatments should be further investigated.
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http://dx.doi.org/10.1097/MEG.0000000000001582DOI Listing
February 2020

Cancer, sleep problems, and mind-body medicine use: Results of the 2017 National Health Interview Survey.

Cancer 2019 Dec 16;125(24):4490-4497. Epub 2019 Sep 16.

Department of Internal and Integrative Medicine, Essen-Mitte Clinic, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.

Background: Sleep problems affect physical and emotional well-being as well as immune system function. Evidence has demonstrated an improvement in sleep problems in patients with cancer through the use of mind-body medicine (MBM). In the current study, the authors sought to elucidate the prevalence of sleep problems and the use of MBM in adult cancer survivors.

Methods: The authors analyzed data from the 2017 US National Health Interview Survey (NHIS) to estimate the prevalence of sleep problems and use of MBM in adult cancer survivors using means, standard deviations, weighted frequencies, and distributions. Backward stepwise multiple logistic regression analyses were used to identify independent predictors of MBM use within the past 12 months: age, sex, ethnicity, region, educational level, employment, and time since cancer diagnosis.

Results: A weighted total of 13,750,028 cancer survivors (59.2%) reported sleep problems. For the most part, survivors with sleep problems were aged ≥40 years, female, and non-Hispanic white. More survivors with (weighted N = 3,794,493; 27.6%) compared with without (weighted N = 1,695,435; 17.9%) sleep problems used MBM. Among cancer survivors with sleep problems, the most commonly used mind-body practice was spiritual meditation (weighted N = 1,972,578; 14.3%), followed by yoga (weighted N = 1,695,553; 17.9%). The use of MBM was independently predicted by being female, living in the western United States, having a higher educational level, and being employed.

Conclusions: The high prevalence of sleep problems in cancer survivors is a major health issue that needs to be addressed. A considerable number of cancer survivors with sleep problems use MBM. This finding warrants the investigation of MBM concepts as treatment options for cancer survivors experiencing sleep problems.
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http://dx.doi.org/10.1002/cncr.32469DOI Listing
December 2019

Motivations for Adopting and Maintaining a Yoga Practice: A National Cross-Sectional Survey.

J Altern Complement Med 2019 Oct 28;25(10):1009-1014. Epub 2019 Aug 28.

Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.

Yoga practice is becoming increasingly popular around the world, yet little is known regarding people adopt the practice of yoga or how their reasons for practice change with continued practice. Furthermore, whether those who practice different types of yoga have different motives remains unknown. To address these issues, the authors conducted a national cross-sectional online survey of 1,702 yoga practitioners in Germany, asking about demographic information and motives for initiating and continuing yoga practice. The most common primary reasons for starting yoga were relaxation (26.6%) and prevention (25.5%), which were also the most common secondary reasons. Nine hundred and forty-one (55.3%) reported a different primary reason for maintaining than for adopting yoga practice. Prevention (38.4%) and spirituality (26.4%) were the most commonly reported primary reasons for maintaining yoga practice. More highly educated participants and those practicing longer than 5 years at the time of the survey were more likely to have reported a different current primary reason for yoga practice than that for which they started practicing. These results shed light on yoga's appeal to novices and regular practitioners, with important implications for making yoga appealing to beginners as well as promoting the practice as a long-term lifestyle behavior.
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http://dx.doi.org/10.1089/acm.2019.0232DOI Listing
October 2019

Effects of occlusal splint therapy in patients with migraine or tension-type headache and comorbid temporomandibular disorder: A randomized controlled trial.

Medicine (Baltimore) 2019 Aug;98(33):e16805

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen.

Background: Migraine and tension-type headache often occur comorbid with temporomandibular disorder; occlusal splint therapy is the most common treatment for temporomandibular disorder. The aim of this study was to assess the effects of occlusal splint therapy on headache symptoms in patients with migraine and/or tension-type headache comorbid with temporomandibular disorder.

Methods: Sixty adult patients with migraine and/or tension-type headache and comorbid temporomandibular disorder were randomly assigned to individualized occlusal splint therapy applied during day- and nighttime plus usual care (n = 30) or usual care alone (n = 30). Primary outcome was the change in current pain intensity on a 100 mm visual analogue scale from week 1 to week 12. Secondary outcomes included changes in headache days and headache hours assessed by headache diaries over a 2-week period, health-related quality of life (SF-36), and adverse events from week 1 to week 12 and (in the occlusal splint plus usual care group only) to week 24.

Results: No group differences in changes in pain intensity from week 1 to week 12 were found. The number needed to treat was 3.8. Physical quality of life reduced stronger in the usual care group than in the occlusal splint plus usual care group. In the occlusal splint plus usual care group, headache intensity significantly decreased and physical quality of life significantly increased from week 1 to week 12 and to week 24 (all P < .001). No adverse events were reported.

Conclusions: A day- and night-time occlusal splint therapy in addition to usual care was not superior to usual care alone in patients with chronic headache and comorbid TMD. Four patients need to be treated to induce a minimal clinically relevant improvement in one patient. The small sample size and lack of power limit these findings.
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http://dx.doi.org/10.1097/MD.0000000000016805DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6831110PMC
August 2019

Complementary therapies for clinical depression: an overview of systematic reviews.

BMJ Open 2019 08 5;9(8):e028527. Epub 2019 Aug 5.

Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, Universitat Duisburg-Essen, Essen, Germany.

Objectives: As clinical practice guidelines vary widely in their search strategies and recommendations of complementary and alternative medicine (CAM) for depression, this overview aimed at systematically summarising the level 1 evidence on CAM for patients with a clinical diagnosis of depression.

Methods: PubMed, PsycInfo and Central were searched for meta-analyses of randomised controlled clinical trials (RCTs) until 30 June 2018. Outcomes included depression severity, response, remission, relapse and adverse events. The quality of evidence was assessed according to Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) considering the methodological quality of the RCTs and meta-analyses, inconsistency, indirectness, imprecision of the evidence and the potential risk of publication bias.

Results: The literature search revealed 26 meta-analyses conducted between 2002 and 2018 on 1-49 RCTs in major, minor and seasonal depression. In patients with mild to moderate major depression, moderate quality evidence suggested the efficacy of St. John's wort towards placebo and its comparative effectiveness towards standard antidepressants for the treatment for depression severity and response rates, while St. John's wort caused significant less adverse events. In patients with recurrent major depression, moderate quality evidence showed that mindfulness-based cognitive therapy was superior to standard antidepressant drug treatment for the prevention of depression relapse. Other CAM evidence was considered as having low or very low quality.

Conclusions: The effects of all but two CAM treatments found in studies on clinical depressed patients based on low to very low quality of evidence. The evidence has to be downgraded mostly due to avoidable methodological flaws of both the original RCTs and meta-analyses not following the Consolidated Standards of Reporting Trials and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Further research is needed.
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http://dx.doi.org/10.1136/bmjopen-2018-028527DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6686993PMC
August 2019

Integrated care for migraine and chronic tension-type headaches: A prospective observational study.

Complement Ther Clin Pract 2019 Aug 16;36:1-6. Epub 2019 Apr 16.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.

Background And Purpose: This prospective observational study aimed to investigate the effects of an interdisciplinary multimodal integrated care program in patients with chronic migraine and/or tension-type headache.

Materials And Methods: Patients (n = 158) underwent inpatient, outpatient and/or semi-stationary treatment including conventional as well as complementary headache treatment. Headache frequency was defined as the primary outcome; secondary outcomes included pain (VAS, PPS), medication use, quality of life (SF-36), function (HDI, PSFS), depression and anxiety (HADS), and pain self-efficacy (PSEQ).

Results: Headache frequency decreased from 17.0 ± 8.8 days/month at treatment start to 11.4 ± 9.2 at treatment end and to 10.6 ± 9.3 at 6-month follow-up (p < 0.001). All other outcome measures also improved across the course of the study (all p < 0.001).

Conclusions: An integrated care approach based on integrative medicine improved headache symptoms and functioning in patients with chronic migraine and/or tension-type headache. Interdisciplinary multimodal treatment approaches seem to adequately address the specific treatment needs of headache patients.
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http://dx.doi.org/10.1016/j.ctcp.2019.04.001DOI Listing
August 2019

Adverse effects of yoga: a national cross-sectional survey.

BMC Complement Altern Med 2019 Jul 29;19(1):190. Epub 2019 Jul 29.

Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Sydney, Australia.

Background: While yoga is increasingly used for health purposes, its safety has been questioned. The aim of this cross-sectional survey was to analyze yoga-associated adverse effects and their correlates.

Methods: A cross-sectional anonymous national online survey among German yoga practitioners (n = 1702; 88.9% female; 47.2 ± 10.8 years) was conducted from January to June 2016. Participants were queried regarding their yoga practice, i.e. yoga styles used, length and intensity of yoga practice, practice patterns, and whether they had experienced acute or chronic adverse effects of their yoga practice. Independent predictors of acute or chronic adverse effects were identified using multiple logistic regression analyses.

Results: Ashtanga yoga (15.7%), traditional Hatha yoga (14.2%), and Sivananda yoga (22.4%) were the most commonly used yoga styles. 364 (21.4%) yoga users reported 702 acute adverse effects, occurring after a mean of 7.6 ± 8.0 years of yoga practice. The most commonly reported yoga practices that were associated with acute adverse effects were hand-, shoulder- and head stands (29.4%). Using Viniyoga was associated with a decreased risk of acute adverse effects; practicing only by self-study without supervision was associated with higher risk. One hundred seventy-three participants (10.2%) reported 239 chronic adverse effects. The risk of chronic adverse effects was higher in participants with chronic illnesses and those practicing only by self-study without supervision. Most reported adverse effects concerned the musculoskeletal system. 76.9% of acute cases, and 51.6% of chronic cases reached full recovery. On average 0.60 injuries (95% confidence interval = 0.51-0.71) per 1000 h of practice were reported, with Power yoga users reporting the highest rate (1.50 injuries per 1000 h; 95% confidence interval = 0.98-3.15).

Conclusions: One in five adult yoga users reported at least one acute adverse effect in their yoga practice, and one in ten reported at least one chronic adverse effect, mainly musculoskeletal effects. Adverse effects were associated with hand-, shoulder- and head stands; and with yoga self-study without supervision. More than three quarters of of cases reached full recovery. Based on the overall injury rate per 1000 practice hours, yoga appears to be as safe or safer when compared to other exercise types.
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http://dx.doi.org/10.1186/s12906-019-2612-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6664709PMC
July 2019

Hypoglossal acupuncture for acute chemotherapy-induced dysgeusia in patients with breast cancer: study protocol of a randomized, sham-controlled trial.

Trials 2019 Jul 4;20(1):398. Epub 2019 Jul 4.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276, Essen, Germany.

Background: Distortion of taste sensations is a common chemotherapy-induced side effect; however, treatment evidence is limited. Pilot data indicated that acupuncture might be able to improve symptoms of dysgeusia. Thus, the aim of this study is to investigate the effects and side effects of hypoglossal acupuncture in the treatment of dysgeusia in patients with breast cancer undergoing chemotherapy.

Methods/design: The study is a randomized controlled trial comparing a single verum acupuncture treatment with two active comparators: sham acupuncture and dietary recommendations. Sample size calculation revealed a total of 75 patients pending an alpha of 0.05, a power of 0.8, and an estimated effect size of 0.80. Patients with breast cancer undergoing platinum- or taxane-based chemotherapy will be included if they present with phantogeusia (abnormal taste sensations without an external oral stimulus) with an intensity of 4 points or above on an 11-point numeric rating scale (NRS). The primary outcome is phantogeusia; secondary outcomes include parageusia (abnormal taste of food), hypogeusia (reduced taste sensations), hypergeusia (increased taste sensations), xerostomia (dry mouth), stomatitis, appetite, and functional impairment. All outcomes will be assessed at baseline and prior to the next chemotherapy administration using an 11-point NRS for each. All adverse events will be recorded.

Discussion: The results of this study will demonstrate the extent to which hypoglossal acupuncture may influence the intensity of and functional impairment due to chemotherapy-induced dysgeusia.

Trial Registration: Clinical Trials.gov, NCT02304913 . Registered on 19 November 2014.
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http://dx.doi.org/10.1186/s13063-019-3525-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610893PMC
July 2019

Mind-body medicine use by women diagnosed with breast cancer: results of a nationally representative survey.

Support Care Cancer 2020 Mar 11;28(3):1077-1082. Epub 2019 Jun 11.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276, Essen, Germany.

Purpose: Worldwide breast cancer is the most commonly diagnosed cancer in women and often associated with a profound physiological stress reaction. Mind-body medicine modalities have been proven effective in reducing stress symptoms. This article will cover the prevalence of MBM use in women with and without breast cancer in the US population and detect predictors of MBM use in women diagnosed with breast cancer.

Methods: The 2017 National Health Interview Survey (NHIS) was used to study the prevalence of breast cancer and the use of mind-body medicine (MBM) among individuals with breast cancer in the US population. Using chi-squared tests and backward stepwise multiple logistic regression analyses, predictors of MBM use in women with breast cancer in the past 12 months were identified.

Results: The prevalence of breast cancer in women was 3.1%. Among women diagnosed with breast cancer, 25.2% had used MBM in the past 12 months. Spiritual meditation (14.3%), followed by yoga (9.6%), and mindfulness meditation (4.3%) were the most commonly used MBM approaches for women with breast cancer diagnosis. Only higher education independently predicted the use of MBM among them.

Conclusions: In this nationally representative sample of the USA, the most common used MBM approach was spiritual meditation, while this approach is much less researched than the evidence based approaches of yoga and mindfulness meditation. Especially stressed individuals worldwide could benefit from MBM the literature suggests. Particularly in the acute survivorship stage, influencing the initial stress reaction could be beneficial.
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http://dx.doi.org/10.1007/s00520-019-04914-xDOI Listing
March 2020

The Crisis of Medicine and the Benefits of Complex Pain Therapy Procedures Such As Cupping: More Research Needed.

Complement Med Res 2019 27;26(3):145-147. Epub 2019 May 27.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.

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http://dx.doi.org/10.1159/000500466DOI Listing
October 2019

The use of mind-body medicine among US individuals with sleep problems: analysis of the 2017 National Health Interview Survey data.

Sleep Med 2019 04 18;56:151-156. Epub 2019 Jan 18.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany; Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, Australia.

Background: Being a major health risk and very prevalent in the population, sleep problems are an important health care issue.

Methods: We used the 2017 National Health Interview Survey (NHIS) to study the prevalence of sleep problems and the use of mind body medicine (MBM) among individuals with sleep problems in a representative sample of the US population (N = 26,742). Using chi-squared tests and backward stepwise multiple logistic regression analyses, predictors of sleep problems and of MBM use in the past 12 months were identified.

Results: The prevalence of sleep problems was 49.3%, with higher prevalence being associated with higher age, being female, being non-Hispanic White, and higher education. Among individuals with sleep problems, 29.8% used MBM vs. only 17.5% without. Being less than 30 years of age, female, non-Hispanic White, living in the Western US, having a higher education, and being diagnosed with heart disease predicted MBM use among individual's with sleep problems. Yoga (16.3%), spiritual meditation (13.6%), and mindfulness meditation (7.5%) were the most used MBM approaches.

Conclusion: The characteristics of individuals with sleep problems were largely in line with the literature, while notably Whites were more prone to sleep problems than other ethnicities. MBM treatments commonly used were yoga, spiritual meditation and mindfulness meditation; although evidence supports its use for sleep problems, tai chi was used rarely by the wider population. Further studies should explore reasons for ethnical differences in MBM use and why some effective MBM approaches are not commonly used.
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http://dx.doi.org/10.1016/j.sleep.2019.01.008DOI Listing
April 2019

Yoga in Arterial Hypertension.

Dtsch Arztebl Int 2018 12;115(50):833-839

Department of Naturopathy and Integrative Medicine, Essen Central Hospitals, Faculty of Medicine,Duisburg-Essen University.

Background: Yoga seems to exert its effect against arterial hypertension mainly through the associated breathing and meditation techniques, and less so through yoga postures. The goal of this trial was to compare the blood pressure-lowering effect of yoga interventions with and without yoga postures in patients with arterial hypertension.

Methods: 75 patients taking medications for arterial hypertension (72% women, mean age 58.7 ± 9.5 years) were randomized into three groups: a yoga intervention group with yoga postures (25 patients, of whom 5 dropped out of the trial before its end), a yoga intervention group without yoga postures (25 patients, 3 dropouts), and a wait list control group (25 patients, one dropout). The interventions consisted of 90 minutes of yoga practice per week for twelve weeks. The data collectors, who were blinded to the intervention received, assessed the primary outcome measures "systolic 24-hour blood pressure" and "diastolic 24-hour blood pressure" before and after the intervention. In this report, we also present the findings on secondary outcome measures, including follow-up data.

Results: After the intervention, the systolic 24-hour blood pressure in the yoga intervention group without yoga postures was significantly lower than in the control group (group difference [Δ]= -3.8 mmHg; [95% confidence interval (CI): (-0.3; -7.4) p = 0.035]); it was also significantly lower than in the yoga intervention group with yoga postures (Δ = -3.2 mmHg; 95% CI: [-6.3; -0.8]; p = 0.045). Diastolic blood pressures did not differ significantly across groups. No serious adverse events were encountered in the course of the trial.

Conclusion: In accordance with the findings of earlier studies, we found that only yoga without yoga postures induced a short-term lowering of ambulatory systolic blood pressure. Yoga is safe and effective in patients taking medications for arterial hypertension and thus can be recommended as an additional treatment option for persons in this category.
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http://dx.doi.org/10.3238/arztebl.2018.0833DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375068PMC
December 2018

Richtig vorbeugen — Symptome lindern.

Authors:
Gustav Dobos

MMW Fortschr Med 2019 Feb;161(2):18-19

Klinik für Naturheilkunde und Integrative Medizin, Essen, Deutschland.

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http://dx.doi.org/10.1007/s15006-019-0102-yDOI Listing
February 2019

Gua Sha therapy for chronic low back pain: A randomized controlled trial.

Complement Ther Clin Pract 2019 Feb 10;34:64-69. Epub 2018 Nov 10.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany; Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, Australia.

Objective: To test the efficacy of Gua Sha therapy in patients with chronic low back pain.

Methods: 50 patients with chronic low back pain (78% female, 49.7 ± 10.0 years) were randomized to two Gua Sha treatments (n = 25) or waitlist control (n = 25). Primary outcome was current pain intensity (100-mm visual analog scale); secondary outcome measures included function (Oswestry Disability Index), pain on movement (Pain on Movement Questionnaire), perceived change in health status, pressure pain threshold, mechanical detection threshold, and vibration detection threshold.

Results: After treatment, patients in the Gua Sha group reported lower pain intensity (p < 0.001) and better overall health status (p = 0.002) compared to the waitlist group. No further group differences were found. No serious adverse events occurred.

Conclusions: Gua Sha appears to be an acceptable, safe, and effective treatment for patients with chronic low back pain. Further rigorous studies are needed to confirm and extend these results.
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http://dx.doi.org/10.1016/j.ctcp.2018.11.002DOI Listing
February 2019

Associations of yoga practice, health status, and health behavior among yoga practitioners in Germany-Results of a national cross-sectional survey.

Complement Ther Med 2019 Feb 31;42:19-26. Epub 2018 Oct 31.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.

Background: While yoga can improve health-related variables and health behavior, different yoga styles and practice components appear to be associated with specific health outcomes. The aim of this study was to explore the connection between yoga use, health, and health behaviors across different yoga styles.

Methods: A cross-sectional anonymous online survey (n = 1,702; 88.9% female; 93.3% German nationality; mean age 47.2 ± 10.8 years; 58.2% yoga teachers) assessed yoga practice characteristics, health-related variables and health behavior. The survey was distributed in Germany only but not limited to German participants.

Results: Ashtanga yoga (15.7%), Hatha yoga (14.2%), and Sivananda yoga (22.4%) were the most commonly practiced yoga styles; participants practiced for a mean of 12.7 ± 10.0 years. Most participants had good to excellent (96.1%) overall health; 87.7% reported improved health since starting yoga. Controlling for sociodemographic and clinical factors, health-related variables were mainly associated with frequency of yoga postures practice (p < 0.05), health behaviors also with yoga philosophy study (p < 0.05). The various yoga styles were associated with specific health-related variables (p < 0.05).

Conclusion: Yoga practitioners generally have a good overall health and a healthy lifestyle. While health variables are mainly associated with practice of yoga postures, health behaviors are also associated with the study of yoga philosophy. Yoga interventions targeting prevention or health promotion should include yoga philosophy to modify health behaviors. The specific yoga style employed may also influence health outcomes.
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http://dx.doi.org/10.1016/j.ctim.2018.10.026DOI Listing
February 2019

Emotional release and physical symptom improvement: a qualitative analysis of self-reported outcomes and mechanisms in patients treated with neural therapy.

BMC Complement Altern Med 2018 Nov 27;18(1):311. Epub 2018 Nov 27.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.

Background: Neural Therapy (NT) is a common complementary treatment approach using injections with short-acting local anesthetics to treat pain and chronic diseases. However, little is known about the underlying mechanisms and the domains of treatment response. This study therefore analyzed patient experiences following NT injections with procaine.

Methods: Maximum variation sampling was used to collect data from semi-structured interviews conducted with 22 hospital inpatients aged 59.6 ± 14.9 years (81.8% female). Each had multiple (9.4 ± 6.9) diagnoses. They were undergoing two weeks of integrative treatment, which included individualized NT. The interview data were analyzed in MAXQDA using qualitative content analysis.

Results: With injection, patients first described local anesthetic effects including temporary blocking of pain and increased local warmth. Second, patients reported on vegetative reactions frequently leading to turmoil within the body like initial aggravation of existing symptoms or the appearance of new, concealed or phantom symptoms. This often required the need for rest to deal with the treatment stimulus. As a third step, many patients could gain physical and emotional release and relief in symptoms, mood and functioning. Emotional release was often accompanied by weeping and initially overwhelmed affected patients with dissociated memories. However, in cases where patients were able to experience those memories with a new distance, a fourth step of integration was achievable. It included reframing processes as well as a gain in pain perception and body-awareness. As a possible fifth step, patients experienced improved mood, increased pain acceptance and empowerment. Adverse events of NT included pain from the injections, vegetative complaints and emotional turmoil that lasted for minutes or hours, with a maximum of two days.

Conclusions: Patients treated with procaine injections reported different psychophysiological outcomes contributing to the understanding of the mechanisms underlying NT. Further efficacy studies should separate specific NT from non-specific/placebo effects.

Trial Registration: DRKS00004567 .
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http://dx.doi.org/10.1186/s12906-018-2369-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6258402PMC
November 2018
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