Publications by authors named "Holger Cramer"

204 Publications

Yoga for treating low back pain: a systematic review and meta-analysis.

Pain 2021 Jul 28. Epub 2021 Jul 28.

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

Abstract: Yoga is frequently used for back pain relief. However, evidence was judged to be of only low- or moderate. To assess the efficacy and safety of yoga in patients with low back pain a meta-analysis was performed. Therefore Medline/PubMed, Scopus, and the Cochrane Library was searched to May 26 2020. Only randomized controlled trials (RCTs) comparing Yoga with passive control (usual care or waitlist), or an active comparator, for patients with low back pain, that assessed pain intensity or pain-related disability as a primary outcome were considered to be eligible. Two reviewers independently extracted data on study characteristics, outcome measures, and results at short-term and long-term follow-up. Risk of bias was assessed using the Cochrane Risk of Bias Tool. 30 articles on 27 individual studies (2702 participants in total) proved eligible for review. Compared to passive control, yoga was associated with short-term improvements in pain intensity (15 RCTs; Mean Difference (MD)=-0.74 points on a numeric rating scale; 95%CI=-1.04,-0.44; Standardized Mean Difference (SMD)=-0.37 95%CI=-0.52,-0.22), pain-related disability (15 RCTs; MD=-2.28; 95%CI=-3.30,-1.26; SMD=-0.38 95%CI=-0.55,-0.21), mental health (7 RCTs; MD=1.70; 95%CI=0.20,3.20; SMD=0.17 95%CI=0.02,0.32) and physical functioning (9 RCTs; MD=2.80; 95%CI=1.00,4.70; SMD=0.28 95%CI=0.10,0.47). Except for mental health all effects sustained long-term. Compared to an active comparator, yoga was not associated with any significant differences in short- or long-term outcomes.In conclusion, yoga revealed robust short- and long-term effects for pain, disability, physical function and mental health, when compared to non-exercise controls. However these effects were mainly not clinically significant.
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http://dx.doi.org/10.1097/j.pain.0000000000002416DOI Listing
July 2021

Learning to Fly: Conceptions and Misconceptions, Uses and Misuses of Pilot Studies in Clinical Research.

Authors:
Holger Cramer

J Altern Complement Med 2021 Jul;27(7):531-534

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

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http://dx.doi.org/10.1089/acm.2021.0197DOI Listing
July 2021

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

Complement Ther Med 2021 Aug 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
August 2021

Translation, Cross-Cultural Adaptation, and Psychometric Validation of the English Version of the Postural Awareness Scale.

Pain Med 2021 Jul 7. Epub 2021 Jul 7.

Pacific University, School of Graduate Psychology, Forest Grove, OR.

Purpose: The Postural Awareness Scale (PAS) was developed among a sample of German speakers to measure self-reported awareness of body posture. The first aim of this study was to conduct an English translation and cross-cultural adaptation of the PAS. The second aim was to assess psychometric properties of the English version of the PAS.

Methods: Forward and backward translations were conducted. The translated scale was then pretested in a small sample of English-speaking adults (n = 30), followed by cognitive interviews. Finally, consensus of the translated scale was achieved among an expert committee (n = 5), resulting in the Postural Awareness Scale-English Version (PAS-E). Psychometric properties of the PAS-E were investigated among a sample of individuals with chronic pain (n = 301) by evaluating factor structure, reliability, and construct validity. Analyses of variance were conducted to calculate differences in PAS-E scores between specific subgroups (pain conditions, sex, and history of mindfulness practice). Linear regression analyses investigated whether the scores on the PAS-E predicted levels of pain, stress, and mood.

Results: The results obtained from an exploratory factor analysis showed a two-factor solution and were supported by a confirmatory factor analysis. The scale demonstrated good internal consistency and satisfactory construct validity. No significant differences related to sex at birth or pain duration were found.

Conclusion: PAS-E demonstrated good psychometric properties, and therefore, can and should be used both for research and clinical practice.
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http://dx.doi.org/10.1093/pm/pnab200DOI 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

It Takes a Village: JACM Establishes a New Group of Executive Editors.

Authors:
Holger Cramer

J Altern Complement Med 2021 Jun;27(6):465-466

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

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http://dx.doi.org/10.1089/acm.2021.29093.hcrDOI Listing
June 2021

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

Complement Ther Med 2021 Aug 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
August 2021

Complementary Medicine Use in Patients with Low Back or Neck Pain: Results of the 2017 National Health Interview Survey.

Pain Med 2021 Jun 9. Epub 2021 Jun 9.

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

Objective: Complementary and integrative medicine (CIM) including mind-body medicine (MBM) is a treatment option that has been proven to alleviate symptoms in patients with low back and neck pain.

Methods: Prevalence and predictors of MBM use and consultation of CIM practitioners in patients with low back and neck pain in the American adult population are examined using data from the National Center for Health Statisticś National Health Interview Survey, 2017.

Results: A weighted total of 81,671,436 (33.1%) participants reported low back and neck pain. Of those, more participants used mantra meditation, mindfulness meditation, spiritual meditation, guided imagery, and progressive relaxation compared to participants without low back and neck pain (all p <0.001). Spiritual meditation was the most popular (12.6%) followed by mindfulness meditation (6.9%) and progressive relaxation (5.4%). Participants with low back and neck pain consulted practitioners for CIM more often than those without (p < 0.001). MBM use was predicted by being female, having a higher educational level, being employed, and living in the Western United States. Consultation of practitioners for CIM was predicted by younger age, being female, not being married or living with a partner, having a higher educational level, being employed, living in the Western United States, and being uninsured.

Conclusions: MBM is a popular treatment option for people with low back and neck pain. Practitioners for CIM are also being sought out by people with such complaints. Further research in this direction is relevant.
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http://dx.doi.org/10.1093/pm/pnab169DOI Listing
June 2021

Increasing Trend of Yoga Practice Among U.S. Adults from 2002 to 2017.

J Altern Complement Med 2021 Jun 1. Epub 2021 Jun 1.

Department of Public Health, Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center, Lubbock, TX, USA.

Benefits, risks, and the increasing popularity of yoga use warrant assessing yoga practice prevalence and users' profiles. This study describes trends in yoga practice exclusively among American adults from 2002 to 2017, compares the profile of yoga users, and identifies factors related to yoga use over time. This study is a secondary analysis done in 2019 and 2020 using the National Health Interview Survey (NHIS) 2002, 2007, 2012, and 2017 data. Population weights were used to obtain statistically accurate estimates of yoga use prevalence for the U.S. population. Descriptive statistics were used to profile the sociodemographic and health-related characteristics of yoga users. Multivariable logistic regression was used to identify factors associated with yoga use in each cohort defined by the NHIS year. Yoga practice prevalence nearly tripled from 5.1% in 2002 to 13.7% in 2017 (weighted estimate 10,386,456 and 32,761,194 American adults, respectively). Typical yoga users were young non-Hispanic single white female adults with bachelor or higher education and health insurance, and resided in the west region of the United States. Yoga use pattern change over time was significantly related to only younger age ( < 0.001) but not to other sociodemographic or health-related factors. Yoga has gained increasing popularity in the past two decades among American adults, with younger adults being the driving force. Yoga appears to be adopted for general well-being or prevention more than for specific disease treatment. Future research should evaluate how yoga can be effectively and safely integrated into preventive medicine strategies.
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http://dx.doi.org/10.1089/acm.2020.0506DOI Listing
June 2021

Taking a Closer Look at Methodological Quality: JACM Partners with Cochrane Complementary Medicine.

J Altern Complement Med 2021 Apr;27(4):285-286

Cochrane Complementary Medicine, Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.

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http://dx.doi.org/10.1089/acm.2021.29092.hcrDOI Listing
April 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

Effect of Honey-Lemon Spray Versus Benzydamine Hydrochloride Spray on Radiation-Induced Acute Oral Mucositis in Head and Neck Cancer Patients: A Pilot, Randomized, Double-Blind, Active-Controlled Clinical Trial.

J Altern Complement Med 2021 Mar 28;27(3):255-262. Epub 2021 Jan 28.

Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Oral mucositis (OM) is the most prevalent side effect in patients with head and neck cancer (HNC). It causes an obvious decrease in quality of life (QoL) in these patients, so different medications have been recommended for OM, however, without optimal response. This randomized trial aimed to assess the effects of a honey-lemon spray compared with benzydamine hydrochloride in prevention of radiation-induced OM in patients with HNC. Forty-six patients with HNC received external beam radiotherapy for 5 days per week. Patients were randomized to treatment with either benzydamine hydrochloride spray or honey-lemon spray for 5 weeks and continued for 1 week after the end of treatment. The oral cavity was examined weekly, with a score given to each site based on the degree of mucositis using a 4-point scale, and a mean mucositis score was calculated as the primary outcome. Occurrence of OM, pain, QoL, and adverse effects were defined as secondary outcomes. Patients, therapists, and outcome assessors were blinded to group allocation. No significant group differences occurred in the mucositis score, pain, or QoL. Mucositis occurrence rates were higher in the benzydamine hydrochloride group compared with the honey-lemon group (hazard ratio = 2.1, 95% confidence interval: 1.1 to 4.2). Two patients in the honey-lemon group had mild nausea and burning throat; no adverse effects occurred in the benzydamine hydrochloride group. There were no significant group differences in mucositis severity between patients treated with honey-lemon spray and benzydamine hydrochloride. The potential preventive effects of honey-lemon spray need to be confirmed in further trials. The trial registration number is IRCT20161024030467N1.
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http://dx.doi.org/10.1089/acm.2020.0468DOI Listing
March 2021

The More Things Change….

Authors:
Holger Cramer

J Altern Complement Med 2021 Jan;27(1):1-2

Editor-in-Chief, JACM.

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http://dx.doi.org/10.1089/acm.2020.29088.hcrDOI Listing
January 2021

Nursing Procedures for the Prevention and Treatment of Mucositis Induced by Cancer Therapies: Clinical Practice Guideline Based on an Interdisciplinary Consensus Process and a Systematic Literature Search.

Integr Cancer Ther 2021 Jan-Dec;20:1534735420940412

Evang. Kliniken Essen-Mitte, University of Duisburg-Essen, Essen, Germany.

Background: Patients with cancer receiving tumor therapy often suffer from oral mucositis.

Objectives: The aim of this project was to summarize experiences with nursing procedures by experts in integrative oncology and to establish recommendations for nursing interventions that can prevent or cure mucositis.

Methods: The study design was an interdisciplinary consensus process based on a systematic literature search.

Results: The panel discussed and agreed on 19 nursing procedures, which included mouthwashes, such as teas, supplements, oil applications, and different kinds of ice cubes to suck, as well as flaxseed solution, propolis, and mare milk. Twelve interventions were classified as effective, with effectiveness for OraLife, propolis, sea buckthorn pulp oil, marshmallow root tea also for xerostomia, Helago chamomile oil, mare milk, and Saliva Natura rated as highly effective in clinical experience. In the systematic literature search, a total of 12 out of 329 randomized controlled trials and meta-analyses on chamomile (n = 3), (n = 1) and sage (n = 1), propolis (n = 2), and sucking ice cubes (cryotherapy; n = 5) met all inclusion criteria. Trial evidence for effectiveness in oral mucositis was revealed for propolis and cryotherapy.

Conclusions: The current evidence supports the use of some nursing procedures (f.e. propolis for 2 and 3 grade mucositis) for improving oral mucositis during cancer therapies. There is still a need to define general clinical practice guidelines for the supportive treatment of mucositis, as well as for more interdisciplinary research in this area.
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http://dx.doi.org/10.1177/1534735420940412DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7960907PMC
January 2021

Mental health outcomes in patients with cancer diagnosis: Data showing the influence of resilience and coping strategies on post-traumatic growth and post-traumatic symptoms.

Data Brief 2021 Feb 24;34:106667. Epub 2020 Dec 24.

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

The presented data provide a panoramic concerning the influence of different coping strategies in the relationship between resilience and post traumatic growth or post-traumatic symptoms in patients with a cancer diagnosis. These expand the results presented in the related research article of Gori et al. [1], entitled "Pathways to post-traumatic growth in cancer patients: moderated mediation and single mediation analyses with resilience, personality, and coping strategies". A sample of 154 patients completed a survey, where the Post-Traumatic Growth Inventory, Impact of Event Scale-Revised, Connor-Davidson Resilience Scale, and Coping Orientation to Problems Experienced were included. All the measures for the data collection were in their Italian versions. Data were elaborated by performing single mediation analyses, considering each time the different coping strategies as mediators. The dataset (.xlsx) includes the survey scores, while the tables and figures provide the analysed data, where the mediation models are shown. These data may provide useful bases for future research concerning mental health outcomes in patients with cancer and for tailored programs in preventive or intervention perspectives.
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http://dx.doi.org/10.1016/j.dib.2020.106667DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773862PMC
February 2021

Eine Frage der Kontrolle: Zunehmende Abgabe der Eigenverantwortung für die Gesundheit und was das mit uns zu tun hat.

Authors:
Holger Cramer

Complement Med Res 2021;28(1):5-8. Epub 2020 Dec 29.

Klinik für Naturheilkunde und Integrative Medizin, Evang. Kliniken Essen-Mitte, Medizinische Fakultät, Universität Duisburg-Essen, Essen, Deutschland,

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http://dx.doi.org/10.1159/000513876DOI Listing
December 2020

The Relevance of Complementary and Integrative Medicine in the COVID-19 Pandemic: A Qualitative Review of the Literature.

Front Med (Lausanne) 2020 11;7:587749. Epub 2020 Dec 11.

Department of Internal and Integrative Medicine, Immanuel Krankenhaus Berlin, Berlin, Germany.

During the COVID-19 pandemic people are facing risks of adverse health effects due to the restrictions implemented such as quarantine measures, reduced social contact, and self-isolation. In this qualitative review, we collected data on potential preventive and therapeutic health benefits of Complementary and Integrative Medicine (CIM) that might be useful during the COVID-19 pandemic. We have reviewed the scientific literature to summarize CIM practices that could be beneficial for improving physical and mental health and well-being of the population under the current pandemic circumstances. It must be noted that this review is not SARS-CoV-2 specific and we explicitly do not intend to make any SARS-CoV-2 specific health claims in this article. A qualitative, non-systematic literature review was conducted in Medline to identify literature describing preventive and therapeutic CIM approaches for strengthening mental and physical health. For a variety of CIM approaches clinical evidence was identified, indicating beneficial effects. CIM approaches include specific dietary measures and selected micronutrients, physical activity, techniques from Mind-Body Medicine, single botanicals or botanical compounds, and spending time in nature among others. The effects of CIM measures on conditions like obesity and hypertension are of special relevance here, as these conditions are considered as risk factors for a severe course of COVID-19. Moreover, a possibly direct effect of CIM approaches on immune functions and clinical parameters in respiratory tract infections, such as influenza, were identified. The findings of this review could be helpful for clinicians, patients, and the general population during the current pandemic when discussing and/or considering CIM options. CIM offers a variety of preventive and therapeutic options for strengthening physical and mental resilience, which could also be useful in the current COVID-19 pandemic. The evidence of CIM approaches with a potential benefit in the COVID-19 pandemic in different areas is worth to be analyzed. While this qualitative review has several obvious limitations, it might serve as useful starting point for further research on this topic.
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http://dx.doi.org/10.3389/fmed.2020.587749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761649PMC
December 2020

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

Do women who consult with naturopaths or herbalists have a healthy lifestyle?: a secondary analysis of the Australian longitudinal study on women's health.

BMC Complement Med Ther 2020 Nov 18;20(1):349. Epub 2020 Nov 18.

Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Level 8, Bldg 10, 235-253 Jones St, Ultimo, NSW, Sydney, Australia.

Background: Australians report consulting with a naturopaths or herbalists to improve their wellbeing, yet little is known about the associations between these consultations and the patients' health behaviours. This cross-sectional study aimed to examine the relationship between health behaviour and consultations with naturopaths or herbalists in three age cohorts of Australian women.

Methods: Women aged 19-25 years, 31-36 years, and 62-67 years from the Australian Longitudinal Study on Women's Health (ALSWH) were surveyed regarding smoking, alcohol or drug use, physical activity and dietary behaviour; and whether they consulted with naturopath/herbalists in the last 12 months. Associations were analysed using multivariable logistic regression.

Results: A total of 9151 (19-25 years), 8200 (31-36 years) and 11,344 (62-67 years) women were included in the analysis. Between 7.3 and 11.9% of women reported to have consulted with naturopaths/herbalists in the last 12 months. Women of all cohorts consulting with naturopath/herbalist were less likely to smoke (19-25 yrs.: Odds Ratio [OR] 0.61; 31-36 years: OR 0.58; 62-67 years: OR 0.29), more likely to report at least moderate levels of physical activity (19-25 yrs.: OR 1.41; 31-36 years: OR 1.34; 62-67 years: OR 1.34), and the use of vegetarian diets(19-25 yrs.: OR 1.40; 31-36 years: OR 1.77; 62-67 years: OR 2.28), compared to women not consulting with naturopaths/herbalists. Women consulting with naturopaths/herbalists however were also more likely to have used marijuana (19-25 yrs.: OR 1.18; 31-36 years: OR 1.42), or illicit drugs in the last 12 months (19-25 yrs.: OR 1.24; 31-36 years: OR 1.40).

Conclusions: Consultations with a naturopath or herbalist are associated with positive health behaviours that are protective of internationally important non-communicable diseases. Psychoactive drug use is also reported among women visiting a naturopath or herbalist. Further research is needed to understand the role naturopaths play in advising patients with regards to health and non-healthy behaviours.
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http://dx.doi.org/10.1186/s12906-020-03153-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7673082PMC
November 2020

Gynecologists' attitudes toward and use of complementary and integrative medicine approaches: results of a national survey in Germany.

Arch Gynecol Obstet 2021 04 17;303(4):967-980. Epub 2020 Nov 17.

Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitätsstrasse 21-23, 91054, Erlangen, Germany.

Purpose: Despite patients' widespread use and acceptance of complementary and integrative medicine (IM), few data are available regarding health-care professionals' current implementation of it in clinical routine. A national survey was conducted to assess gynecologists' attitudes to and implementation of complementary and integrative treatment approaches.

Methods: The Working Group on Integrative Medicine of the German Society of Gynecological Oncology conducted an online survey in collaboration with the German Society of Gynecology and Obstetrics (DGGG) in July 2019. A 29-item survey was sent to all DGGG members by email.

Results: Questionnaires from 180 gynecologists were analyzed, of whom 61 were working office-based in private practice and 95 were employed in hospitals. Seventy percent stated that IM concepts are implemented in their routine clinical work. Most physicians reported using IM methods in gynecological oncology. The main indications for IM therapies were fatigue (n = 98), nausea and vomiting (n = 89), climacteric symptoms (n = 87), and sleep disturbances (n = 86). The most commonly recommended methods were exercise therapy (n = 86), mistletoe therapy (n = 78), and phytotherapy (n = 74). Gynecologists offering IM were more often female (P = 0.001), more often had qualifications in anthroposophic medicine (P = 0.005) or naturopathy (P = 0.019), and were more often based in large cities (P = 0.016).

Conclusions: There is strong interest in IM among gynecologists. The availability of evidence-based training in IM is increasing. Integrative therapy approaches are being implemented in clinical routine more and more, and integrative counseling services are present all over Germany. Efforts should focus on extending evidence-based knowledge of IM in both gynecology and gynecological oncology.
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http://dx.doi.org/10.1007/s00404-020-05869-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7985114PMC
April 2021

Prevalence and predictors of yogic breathing and meditation use - A nationally representative survey of US adult yoga practitioners.

Complement Ther Med 2021 Jan 12;56:102617. Epub 2020 Nov 12.

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

Introduction: Yoga practice in common usage is often confined to the physical aspects of the comprehensive practice. The purpose of this study was to examine the use of two additional aspects of yoga as part of yoga practice, i.e. yogic breathing and meditation (YoBaM). Prevalence and predictors of YoBaM use among yoga practitioners in the US general population were analyzed.

Method: Cross-sectional data from the 2012 and 2017 National Health Interview Survey (NHIS) (N = 61,267) was used. 12-month prevalence of yoga use and YoBaM use among yoga practitioners were analyzed descriptively for the two cohorts respectively. Logistic regression analyses were used to analyze sociodemographic and health-related predictors of YoBaM use among yoga practitioners.

Results: 12-month prevalence of yoga use and YoBaM use were 8.9 % and 4.8 % respectively in 2012. In 2017, 13.3 % had practiced yoga in the past 12 months and 7.0 % had used YoBaM. Yoga practitioners aged between 50 and 64 compared to being 29 or younger, females, Hispanics and those experiencing mild to severe forms of psychological distress were more likely to use YoBaM as part of their yoga practice. Yoga practitioners living in the Midwest or in a relationship were less likely to use YoBaM.

Conclusion: In recent years, the number of yoga practitioners in the US general population has considerably increased and YoBaM use is common among yoga practitioners. YoBaM use seems to be associated with age, gender, ethnicity, region, marital status and psychological distress dimensions.
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http://dx.doi.org/10.1016/j.ctim.2020.102617DOI Listing
January 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

Topical sp. Preparation as Palliative Care for Chemotherapy-Induced Peripheral Neuropathy of Patients: A Randomized Placebo-Controlled Pilot Trial.

J Altern Complement Med 2020 Sep;26(9):807-812

Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect of various anticancer regimens with different sensory-motor abnormalities in patients. The aim of this study was to examine the feasibility of using sp. oil as a palliative treatment in such patients. This was a pilot randomized placebo-controlled double-blind clinical study. Imam Hossein Hospital, Tehran, Iran. Patients 18-80 years of age undergoing chemotherapy treatment recently or during the last 6 months were enrolled after meeting the inclusion criteria. The intervention group used sp. as a topical ointment and the placebo group used topical paraffin for 4 weeks. Feasibility of recruitment, including treatment acceptability (evaluated as number of patients leaving the study early), and compliance (defined as consumption of a minimum 80% of the ointment) with the intervention were assessed. Neuropathic pain change was defined as the secondary outcome, too. Totally, 50 out of 73 participants were identified eligible and were randomly divided into intervention or placebo groups. There was no significant difference between groups in terms of sociodemographic data. At the end of the study, 24% (confidence interval [95% CI]: 9-45) (intervention group) and 12% (95% CI: 2-31) (placebo group) of patients revealed treatment unacceptability. Meanwhile, 12% (95% CI: 2-31) in the intervention group and 28% (95% CI: 12-49) in the placebo group did not show the compliance. Moreover, according to patients' records, pain reduction was higher in the intervention group compared to the placebo group ( = 0.001). This preliminary study showed that topical use of sp. was feasible and acceptable in patients suffering from CIPN.
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http://dx.doi.org/10.1089/acm.2020.0012DOI Listing
September 2020

The effects of berry on acute respiratory viral infections: A rapid review of clinical studies.

Adv Integr Med 2020 Dec 22;7(4):240-246. Epub 2020 Aug 22.

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

Brief Overview: Collectively the evidence obtained from across five clinical studies involving 936 adults indicate that mono-herbal preparations of L. berry (), when taken within 48 hours of the onset of acute respiratory viral infection, may reduce the duration and severity of common cold and influenza symptoms in adults. There is currently no evidence to support the use of berry for the treatment or prevention of COVID-19. Given the body of evidence from preclinical studies demonstrating the antiviral effects of berry, alongside the results from clinical studies involving influenza viral infections included in this review, pre-clinical research exploring the potential effects of berry on COVID-19 are encouraged.

Verdict: The evidence included in this review is mostly derived from clinical studies involving adult participants and examining short-term use of commercial formulations of berry for up to 16 days. Findings from included studies suggest that mono-herbal preparations of berry (in extract or lozenge formulation) may reduce influenza-type symptoms, including fever, headache, nasal congestion and nasal mucous discharge in adults, when taken within the first 48 hours of symptom onset. Within 2-4 days of treatment, most adult participants experienced significant symptom reduction, by an average of 50%. Evidence regarding the effectiveness of berry on the symptom of cough, and need for/use of medicines (including antibiotics) to treat acute respiratory infections, is currently unclear and inconsistent. Adverse events were rare with no serious events reported. Adverse events, reported in two studies, were more common in comparators than in treatments. There is currently no reliable or sufficient scientific evidence to support the use of in pregnant or lactating women.
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http://dx.doi.org/10.1016/j.aimed.2020.08.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7443157PMC
December 2020

Multivitamins for acute respiratory tract infections: a rapid review.

Adv Integr Med 2020 Dec 30;7(4):227-231. Epub 2020 Jul 30.

Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, New South Wales, Australia.

Seven human clinical trials with some risk of bias suggest that multivitamins may be a safe and effective intervention to relieve some symptoms of respiratory tract infections, increase micronutrient status and immune function; however, further research is needed. There is currently insufficient evidence to recommend multivitamins as a therapy for the treatment or prevention of COVID-19. The overall quality of research examining the effect of prophylactic multivitamin supplementation on the effects of the acute respiratory tract infections (ARTI) is weak. Most of the available research included adults aged 50 years or over recruited through either the community or institutional settings (i.e. hospital facility, residential care facility). The multivitamin supplements used contained at least five vitamins and minerals and were administered between three months and two years (median: 15 months). Based on the available evidence, multivitamin supplementation does not appear to reduce the incidence of ARTI or mortality (both ARTI-related and all-cause). The effect of multivitamins taken before infection on the duration of ARTI is unclear due to conflicting results across studies. Multivitamins may, however, reduce the symptoms associated with ARTI such as headache, conjunctivitis, and activity restriction but not the overall symptom scores. No differences in health service visits, inclusive of primary and tertiary care, has been identified for individuals taking a multivitamin prior to an ARTI.
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http://dx.doi.org/10.1016/j.aimed.2020.07.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7392114PMC
December 2020

The effect of quercetin on the prevention or treatment of COVID-19 and other respiratory tract infections in humans: A rapid review.

Adv Integr Med 2020 Dec 30;7(4):247-251. Epub 2020 Jul 30.

School of Pharmacy and Pharmacology, Griffith University, Gold Coast, Queensland, Australia.

Brief Overview: There is currently insufficient evidence to recommend quercetin supplementation as a therapy for the treatment or prevention of COVID-19. Three human clinical trials with low risk of bias suggest that oral quercetin may have a beneficial effect on the incidence and duration of respiratory tract infections in certain populations; however, further research is needed.

Verdict: Current evidence on the efficacy of quercetin supplementation in the treatment and prevention of COVID-19 is insufficient for its clinical recommendation at this time. Quercetin exhibits both immunomodulatory and antimicrobial effects in preclinical studies; however, only three human clinical trials, each with a low risk of bias rating, were identified in this rapid review. One study reported a decrease in incidence of upper respiratory tract infections following a competitive athletic event. A larger community clinical trial reported a benefit in older, athletic adults only.
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http://dx.doi.org/10.1016/j.aimed.2020.07.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7392107PMC
December 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

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

Mind and Body: Italian Validation of the Postural Awareness Scale.

Front Psychol 2020 18;11:827. Epub 2020 May 18.

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

Postural awareness (PA) refers to a subjective conscious awareness of body posture and falls within the framework of mind-body integration. The aim of this research was to validate and evaluate psychometric properties of the Postural Awareness Scale (PAS) in an Italian population sample ( = 928; 45.04% men and 54.96% women; mean age = 29.96 years, standard deviation = 11.44). The results obtained with Velicer's Minimum Average Partial Test, Horn's Parallel Analysis, and exploratory factor analysis showed a two-factor solution, as supported by the confirmatory factor analysis: ease/familiarity with postural awareness and need for attention regulation with postural awareness. Furthermore, the findings highlighted both a good internal consistency (α = 0.76 for the total scale and α = 0.80, α = 0.79 for the two subscales) and a satisfactory construct validity. Furthermore, multivariate analysis of variance was carried out to assess differences in PA between specific subgroup. In particular, the positive effects of physical activity and healthy body weight were confirmed, whereas no significant differences related to gender or age were found. All these findings suggest that the Italian version of the PAS is a rapid instrument with good psychometric properties, which can be useful both for research and clinical practice.
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http://dx.doi.org/10.3389/fpsyg.2020.00827DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247442PMC
May 2020
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