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ZUSAMMENFASSUNG Hintergrund Verschiedene Studien berichten über das Stresserleben von Krankenhausmitarbeitern während der COVID-19-Pandemie, aber auch vor der Pandemie fühlten sich viele ärztliche Klinikmitarbeiter durch ein hohes Arbeitspensum oder unklare Vorgaben emotional erschöpft. Methoden Kognitive Bewertungen und das Stresserleben von ärztlichem Krankenhauspersonal aus 6 Kliniken im zeitlichen Verlauf der COVID-19-Pandemie wurden ausgewertet. Neben der deutschsprachigen Version des „Stress Appraisal Measure“ (SAM) wurden die COVID-19-Patientenbelegungen und die relative Bettenbelegung erfragt; Korrelationen im Quer- und Längsschnitt wurden berechnet. Ergebnisse Teilnehmer t1: 170, t2: 55, t3: 47 Ärzte. Obwohl keine Erfahrung mit einer solchen Pandemie vorhanden war, waren die SAM-Mittelwerte nicht auffallend unterschiedlich im Zeitverlauf. Höhere lokale Neuinfektionen gingen nicht einher mit einer erhöhten Bewertung, die Situation als bedrohlich oder stressend zu erleben. Hohe positive Korrelationen der gleichen SAM-Unterskalen im Längsschnitt könnten ein Hinweis sein für ein zeitstabiles Persönlichkeitsmerkmal, welches die kognitiven Bewertungen beeinflusst. Schlussfolgerung Die Ergebnisse geben erste Hinweise, dass das ärztliche Personal eine gute Strategie zur Bewältigung des pandemiebedingten Stresserlebens hatte. Eine differenziertere Analyse des Stresserlebens von medizinischem Personal im Allgemeinen, und nicht nur zu besonderen Zeiten der Pandemie, könnte zukünftig vorgenommen werden.

Background: An effective and well-tolerated topical treatment of Raynaud’s phenomenon is needed. The aim of this pilot study was to determine change in skin temperature and self-reported warmth perception from topical rosemary essential oil in patients with systemic sclerosis and secondary Raynaud’s phenomenon. Patients and Methods: Twelve patients with progressive systemic sclerosis and Raynaud’s phenomenon were consecutively enrolled in an open-label pilot study at a university outpatient rheumatology clinic. Each patient received an application of olive oil to both hands as a control and 3 h later an application of a 10% essential oil of Rosmarinus officinalis L. Clinical severity and subjective warmth perception were assessed; skin temperature was measured by infrared thermography. Results: Skin temperature increased significantly after both olive oil and rosemary oil but differences between oils did not reach significance. Self-reported warmth perception increased after rosemary oil but not after olive oil. No adverse effects were observed. Conclusion: Topical rosemary essential oil increased warmth perception in patients with systemic sclerosis-related Raynaud’s phenomenon but did not increase finger skin temperature more than the olive oil control.

Objective: Warm footbaths infused with Sinapis nigra (mustard, or MU) or Zingiber officinale (ginger, or GI) are used for various thermoregulatory conditions, but little is known about how they are perceived by individuals, both short- and long-term. We analyzed the immediate and long-term effects of MU and GI on warmth and stimulus perception in healthy adults. Methods: Seventeen individuals (mean age 22.1±2.4 years; 11 female) received three footbaths (mean temperature was 40 ± 0.2°C, administered between 1:30 and 6:30 p.m.) in a randomized order with a crossover design: 1. with warm water only (WA), 2. with warm water and MU, and 3. with warm water and GI. Warmth and stimulus perception at the feet were assessed at the 1st, 5th, 10th, 15th, and 20th minute of the footbaths, in the late evening (EVE), and the following morning (MG). We further assessed well-being (at EVE and MG) and sleep quality (at MG). The primary outcome measure was the warmth perception at the feet at the 10th minute of the footbath. Results: At the 10th minute of the footbath, warmth perception at the feet was significantly higher with MU and GI compared to WA. The immediate thermogenic effects pointed to a quick increase in warmth and stimulus perception with MU, a slower increase with GI, and a gradual decrease with WA. Regarding the long-term effects, warmth and stimulus perception were still higher after GI compared to WA at EVE and MG. No differences were seen for general well-being and sleep quality. Conclusion: Thermogenic substances can significantly alter the dynamics of warmth and stimulus perception when added to footbaths. The different profiles in the application of GI and MU could be relevant for a more differentiated and specific use of both substances in different therapeutic indications.

Human agents immersed in metaverse technologies such as virtual reality (VR) are routinely disconnected from their actual physical appearance and embodied in another virtual body, referred to as self-avatar. Such body transformations can have implications for patients with eating disorders, or persons with extreme body dissatisfaction (BD). Changes in BD, weight anxiety, or body image are theoretically linked to visual selective attention, which can be measured with eye-tracking. In the present study, 43 women with high or low BD were immersed in animated body-weight manipulated self-avatars in VR. Prior to a brief mirror exposure with their self-avatars, they experienced synchronous visuo-motor and visuo-tactile contingencies in VR to increase embodiment, delivered through small movement exercises with real-time animation from first-person-perspective and passive haptics. In a cross-over study design, self-avatar weight was manipulated (normal weight vs. overweight) in both groups (low BD vs. high BD) and subjective experience was assessed before and after exposure. In contrast to our hypotheses, BD was not affected by the self-avatar condition. Embodiment decreased during mirror exposure. Interestingly, disembodiment was stronger in women with low BD. Further, eye-tracking showed that participants with high BD looked longer at weight-related body-parts when immersed in the overweight self-avatar, whereas participants with low BD looked longer at weight-related body-parts when immersed in the normal-weight self-avatar. Overall, results support body-specific visual attention and suggest a paradoxical disembodiment rejection of self-avatars during mirror exposure supported by selective gaze patterns, possibly alleviating momentary body experience.

Objectives. To examine the effects of warm footbaths with thermogenic medicinal powders on vitality and heart rate variability in healthy adults. Intervention and Outcome. Seventeen healthy young adults (22.1 ± 2.4 years, 11 females) received three footbaths (WA: warm water only; GI: warm water and ginger; MU: warm water and mustard) in randomized order with a crossover design. We assessed vitality with the Basler Befindlichkeit questionnaire (BBS) and heart rate variability (HRV) before (t0), immediately after (t1), and 10 minutes following footbaths (t2). The primary outcome measure was self-reported vitality, measured via the BBS, at t1. Results. The primary outcome measure, self-reported vitality, was higher after GI and tended to be higher after MU compared to WA with medium effect sizes (GI vs. WA, mean difference −2.47 (95% CI −5.28 to 0.34),padj=0.048, dadj = 0.74), MU vs. WA, −2.35 (−5.32 to 0.61),padj=0.30, dadj = 0.50). At t2, the standard deviation of beat-to-beat intervals (SDNN) of HRV increased, and the stress index tended to decrease after all three footbath conditions with small to medium effect sizes (0.42–0.66). Conclusion. There is preliminary evidence that footbaths with thermogenic agents GI and MU may increase self-reported vitality during a short-time period with a more pronounced effect with GI. After a short follow-up, all three conditions tended to shift the autonomic balance towards relaxation. Future research should investigate these effects in clinical samples with a larger, more diverse sample size.

Background: COVID-19-related lockdowns and homeschooling have imposed a substantial burden on school-aged children and parents. Waldorf education is a reform-educational concept. Little is known about the situation of German Waldorf families under pandemic conditions. Methods: A cross-sectional, online, parent-proxy survey was conducted regarding the third pandemic wave. The primary outcome was parents’ support needs, assessed with questions from the German COPSY (COVID-19 and PSYchological Health) study; the secondary outcome was children’s HRQoL (KIDSCREEN-10, proxy version). Results: We analyzed questionnaires from 431 parents of 511 Waldorf students aged 7 to 17 years. While 70.8% of Waldorf parents (WPs) reported a general need for support in dealing with their children, 59.9% of COPSY parents (CPs) indicated this need. WPs’ support needs in dealing with their children’s academic demands were similar to CPs’ needs but relatively higher in terms of dealing with emotions and moods, behavior, and relationships within the family. WPs sought support mainly from school and teachers (65.6%). Support needs were high, although WPs rated their children’s HRQoL higher than CPs. Conclusions: Our results underline the substantial pandemic-related burden on families across school types. WPs participating in this survey gave evidence that supports should focus on academic demands as well as psychosocial issues.

Sense of coherence (SOC) is a personal resource that allows people to stay healthy in spite of stressful situations. SOC is known to be low in eating disorders. We explored whether SOC correlated with anorexia nervosa (AN) symptoms several years after initial hospitalization for AN, to inform us whether AN treatment concepts could more specifically focus on increasing SOC.Former patients were contacted 5-11 years after hospitalization for AN in a German integrative medicine hospital. Participants completed the Eating Disorder Inventory (EDI-2) and the SOC Questionnaire (SOC-13). Hospital records were reviewed. Correlations between EDI-2 subscales and SOC-13 were tested. A t-test was conducted to assess the difference between the SOC-13 and the norm. A median split was performed, dividing SOC scores into two groups and comparing these with EDI-2 subscales.Of 149 previously hospitalized female patients, 83 could be contacted and 68 agreed to participate (46%). 17.6% self-reported that they currently suffered from an eating disorder. The mean follow-up time was 7.2 years. All EDI-2 subscales correlated negatively with the SOC-13 score (Amongst previously hospitalized AN patients, the SOC was lower than a normative sample and correlated with on-going eating disorder symptoms in long-term follow-up. Strengthening SOC as a personal resource should be incorporated as a specific goal in AN treatment and its impact on long-term outcomes evaluated.

Psychophysiological disorders due to work-related stress continue to be highly costly for health systems and approaches for cost-effective and easily accessible interventions are much needed. Both heart rate variability-biofeedback (HRV-Bfb) and mindfulness-based interventions (MBI) have been empirically shown to reduce stress. This study compares these two interventions in the work context to a wait-list-control-group (WLC). In this three-armed randomized controlled trial (RCT), 69 healthy adults employed in the same organization were randomized to participate in HRV-Bfb, MBI or the WLC. Participants were assessed for psychophysiological parameters of stress (stress perception, coping, HRV parameters and cortisol) and stress related symptoms (depressive symptoms, psychological wellbeing, mindfulness and self-compassion). Participants trained using either HRV-Bfb or MBI for 6 weeks on a daily basis. Outcomes were assessed at baseline, after the intervention and at follow-up 12 weeks later. Results did not show any statistically significant differences between HRV-Bfb and MBI groups, and neither of the intervention groups (IGs) differed from the WLC. Findings suggest an overall reduction in stress for all groups, including the WLC, with mostly small to medium effect sizes. However, it is important to note that participants with higher baseline stress levels might benefit more from mindfulness and biofeedback-based stress reduction interventions. The results have to be interpreted with caution due to the relatively small sample size. MBI might have a slightly stronger effect on stress reduction in comparison to HRV-Bfb, as suggested by the effect sizes. This study highlights issues and challenges of the implementation of such interventions in corporate health management.

The microbiota and microbiome and disruption of the gut-brain axis were linked to various metabolic, immunological, physiological, neurodevelopmental, and neuropsychiatric diseases. After a brief review of the relevant literature, we present our hypothesis that intestinal serotonin, produced by intestinal enterochromaffin cells, picked up and stored by circulating platelets, participates and has an important role in the regulation of membrane permeability in the intestine, brain, and other organs. In addition, intestinal serotonin may act as a hormone-like continuous regulatory signal for the whole body, including the brain. This regulatory signal function is mediated by platelets and is primarily dependent on and reflects the intestine’s actual health condition. This hypothesis may partially explain why gut dysbiosis could be linked to various human pathological conditions as well as neurodevelopmental and neuropsychiatric disorders.

Objective. To analyze the thermogenic effects of footbaths with medicinal powders in adolescents with anorexia nervosa (AN) in comparison to healthy controls (HCs). Intervention and Outcomes. Forty-one female participants (21 AN, 20 HCs; 14.22 ± 1.54 years) received three footbaths—warm water and mustard (MU, Sinapis nigra), warm water and ginger (GI, Zingiber officinale), or warm water only (WA), in random order within a crossover design. Data were collected before (t1), immediately after foot immersion (maximum 20 minutes) (t2), and after 10 minutes subsequently (t3). Actual skin temperature (high resolution thermography) and perceived warmth (HeWEF questionnaire) were assessed at each time point for various body parts. The primary outcome measure was self-perceived warmth at the feet at t3. Secondary outcome measures were objective skin temperature and subjective warmth at the face, hands, and feet. Results. Perceived warmth at the feet at t3 was significantly higher after GI compared to WA (mean difference −1.02) and MU (−1.07), with no differences between those with AN and HC (−0.29). For the secondary outcome measures, a craniocaudal temperature gradient for the skin temperature (thermography) was noted at t1 for patients with AN and HC (AN with colder feet). The craniocaudal gradient for subjective warmth was only seen for patients with AN. Conclusion. Footbaths with ginger increased warmth perception at the feet longer than with mustard or warm water only for adolescents with AN as well as for HC. The impact of ginger footbaths on recovery of thermoregulatory disturbances in patients with AN repeated over extended periods merits further investigation.

BackgroundIntegrative medicine (IM) is a patient-centered, evidence-based, therapeutic paradigm which combines conventional and complementary approaches. The use of IM in pediatrics has increased in the past two decades and parents’ demand for it is growing. An IM whole systems approach is anthroposophic medicine. Considering the growing demand for integrative approaches in children, it is relevant from a public health perspective to find out which kind of children use IM in Germany and whether they differ from the entirety of pediatric inpatients in Germany. Moreover, it would be interesting to known, whether these patients are willing to travel a longer distance to gain integrative treatment.MethodsThe present study investigates the standard ward documentation datasets of 29,956 patients of all German integrative anthroposophic pediatric inpatient wards from 2005 to 2016 and compares them systematically to collect data of the entirety of all pediatric inpatient wards in Germany. Apart from patients’ age and gender, and the ICD-10 admission diagnoses, the geographical catchment area of the hospitals were analyzed.ResultsSociodemographic characteristics of pediatric inpatients in the integrative anthroposophic departments (IAH) did not differ from the entirety of all pediatric inpatients. Regarding clinical characteristics, higher frequencies were found for endocrine, nutritional and metabolic diseases (IAH: 7.24% vs. 2.98%); mental, behavioral, and neurodevelopmental disorders (IAH: 9.83% vs. 3.78%) and nervous diseases (IAH: 8.82% vs. 5.16%) and lower frequencies for general pediatric diseases such as respiratory diseases (IAH: 17.06% vs. 19.83%), digestive diseases (IAH: 3.90% vs. 6.25%), and infectious and parasitic diseases (IAH: 12.88% vs. 14.82%) in comparison to the entirety of all pediatric inpatients in Germany. The IAH showed a broad catchment area, with most patients being from former, Western federal republic of Germany. Large catchment areas (> 100 km) for the IAH are merely covered by severe and chronic diseases.ConclusionPediatric inpatients of IAH do not differ from the entirety of pediatric inpatients in Germany regarding sociodemographic characteristics but show differences regarding clinical characteristics. Parents are willing to travel further distance to get specialized integrative anthroposophic medical care for children with severe and chronic diseases.

The current study aims to determine whether hypofractionated radiotherapy (HF) leads to lower rates of acute radiodermatitis compared to conventional normofractionated radiotherapy (CF). A total of 166 patients with invasive breast cancer or DCIS were included in a prospective cohort study. Evaluation of acute radiodermatitis was obtained before radiotherapy, at the end of the treatment (T1), and 6 weeks after the treatment (T2) using CTCAE (v5.0) scores, the Skindex-16 questionnaire, and ultrasound measurement of the skin. CTCAE and Skindex-16 scores in the CF-group were significantly higher compared to the HF group indicating more pronounced side effects at the end of the treatment (CTCAE: CF-RT 1.0 (IQR: 0.0) vs. HF-RT 0.0 (0.25), p = 0.03, Skindex-16: CF: 20.8 (IQR: 25.8), HF: 8.3 (27.1), p = 0.04). At 6 weeks after the treatment, no significant differences between the two fractionation schemes were observed. Ultrasound based assessment showed that the skin thickness in the treated breast was higher compared to the healthy breast at all time-points. However, no significant difference between HF and CF was seen either at T1 or T2. The current study complements and confirms pre-existing evidence that HF leads to a lower degree of acute radiodermatitis and better patient reported outcome compared to CF at the end of treatment. This should be considered whenever fractionation of adjuvant breast cancer treatment is being discussed.

To compare the effects between warm water (WW) and ginger footbaths (WW+ginger) on sleep quality and warmth regulation in adults with self-reported insomnia symptoms.A prospective randomized-controlled study in which 28 participants (mean age 50.9 years, 64.3% women, insomnia symptom duration 11.4 years) were randomized to receive WW (n = 13) or WW+ginger (n = 15) daily for 2 weeks. Treatment involved nightly footbaths (12 liters of 38-42 °C warm tap water, maximum duration 20 min) with and without topical ginger (80 g of powdered ginger rhizomes).The primary outcome measure was self-reported sleep quality (global score from Pittsburgh Sleep Quality Index, PSQI) at 2 weeks. Secondary outcomes included measures of insomnia severity (Insomnia Severity Index, ISI) and warmth regulation (Herdecke Warmth Perception Questionnaire, HWPQ and 24-hour distal-proximal skin temperature gradient, DPG).WW+ginger had no greater effect on PSQI (mean between-difference 0.0 [95% CI -3.0 to 2.9], Cohen's d=0.0) or ISI (-0.2 [-3.9 to 3.4], 0.0) than WW. Nor were there any significant differences in HWPQ perceived warmth (0.1 ≥d≥0.5) or DPG (0.1 ≥d≥0.4) between WW and WW+ginger. Both groups improved over time in PSQI (WW+ginger: d=0.7, WW: d=1.3) and ISI (WW+ginger: d=0.8, WW: d=1.0). Perceived warmth of the feet increased only in WW+ginger over time (d=0.6, WW: d=0.0).This dose of ginger (6.67 g/liter) did not have greater effects on sleep quality, insomnia severity or warmth regulation than WW. Considering effect sizes, costs and risks, the use of WW would be recommended over WW+ginger in this patient population.

Objectives There is limited research addressing physical and emotional exhaustion among healthcare providers (HCPs) in COVID-19 departments. We examined the impact of an integrative medicine (IM) intervention for HCPs working in isolated COVID-19 in-patient departments, addressing concerns and wellbeing. Methods HCPs working in 3 isolated COVID-19 in-patient departments underwent 40-minute IM treatment sessions (including acupuncture, manual-movement and/or mind-body modalities) provided by integrative oncology practitioners. The MYCAW (Measure Yourself Concerns and Well-being) questionnaire was used to address the two leading concerns and post-treatment reflections and narrative. Data were qualitatively analyzed using ATLAS.Ti software for systematic coding. Results A total of 181 HCPs underwent 305 IM treatments. Narrative themes focused on physical symptoms (primarily pain and fatigue) and emotional concerns, including perceived communication barriers with patients; and reflections on wellbeing and insights following IM treatments. HCPs reported feeling a sense of "relief" which was likely related to the 3 main effects of the IM intervention: a sense of "being cared for" and treated; experiencing emotional, sometimes spiritual effects of the treatment; and the feeling of relaxation, combined with the relief of pain. Qualitative analysis identified clusters of emotional and spiritual-related keywords such as "calming", "release", "relaxation” and “disengagement” following the first IM session (119 of 181 narratives, 65.7%). Conclusions HCPs working in isolated COVID-19 departments reported improved wellbeing and the addressing of their concerns following IM treatment sessions provided during their work shift. Further research is needed to explore the impact of IM on HCPs burnout and resilience in palliative care settings.

AIM Oximetry values are influenced by the averaging time (AT) used. We aimed to evaluate the effect of different ATs on number, duration, mean single event and total integral of desaturations in preterm infants and children to convert between parameters obtained with different ATs. METHODS In a prospective observational study, 49 children underwent sleep laboratory-based polysomnography and 15 preterm infants were studied in the intensive care unit. Their raw red-to-infrared-saturation-data were reprocessed using seven different ATs (3-16 seconds). Desaturation thresholds were

Objectives Acute gastroenteritis is one of the major causes of hospital admission in childhood. The primary objective of the treatment is rehydration, but conventional drug therapies are limited. Therefore, several pediatricians supplement conventional treatment with complementary and alternative therapies. In the two German departments for pediatric integrative medicine, children suffering from an acute gastroenteritis are treated with supportive therapy based on anthroposophic medicine. However, up to now scientifically validated guidelines for these therapies are lacking. Design We consulted an expert pool of 50 physicians with expertise in anthroposophic medicine as well as pediatrics and invited them to participate in an online-based Delphi process. Results were analyzed by means of qualitative content analysis with two independent raters using MAXQDA. Using four rounds of questioning, a consensus-based guideline was developed. Results A strong consensus (>90%) or consensus (>75-90%) was achieved for 14 of 16 subsections. The guideline describes disease characteristics, the most useful diagnostics, drug as well as non-drug treatment recommendations and advises for a good physician-patient interaction. Conclusion The guideline will help clinicians, as well as family doctors, in their daily routine and make anthroposophic medicine more tangible for parents and health insurance companies.

Background 20–90% of all women suffer from dysmenorrhea. Standard therapy of primary dysmenorrhea (PD) are NSAIDs and oral contraceptives, effective but not without possible side effects. Objective To examine the efficacy of rhythmical massage (Anthroposophic Medicine) and heart rate variability biofeedback compared to usual care (control group) on pain intensity in women with primary dysmenorrhea. Methods This was a three-arm randomized controlled study. Both interventions (rhythmical massage once a week or HRV biofeedback 15 min daily) were carried out over a period of three months. The third group (control) applied usual care. The primary outcome were between-group differences in mean pain intensity (detected by a Numeric Rating Scale, NRS) during menstruation after three months (post-assessment, t2). Secondary outcomes were the use of analgesics, quality of life (SF-12) and heart rate variability. Results The study involved 60 women, mean age 29.7 years, SD 8.0 (n = 23 rhythmical massage, n = 20 biofeedback, n = 17 control). For the primary outcome there was a significant difference between the groups after three months (p = .005). Bonferroni adjusted post-hoc tests revealed a significant difference between rhythmical massage and control group (mean difference: -1.61; 95 CI: -2.77/-0.44; p = .004; ES: -0.80). No significant differences were found between rhythmical massage and biofeedback (mean difference: -0.71; 95 CI: -1.82/ 0.40; p = .361; ES: -0.34) and between biofeedback and control group (mean difference: -0.90; 95 CI: -2.10/-0.30; p = .211; ES: -0.51). For the secondary outcomes no significant differences were found between the groups at t2. The drop-out rate was higher in the biofeedback group (n = 6) than in the massage (n = 2) or the control group (n = 4). Conclusion Preliminary evidence suggests that rhythmical massage might improve pain intensity after 12 weeks compared to usual care.

When a couple cannot conceive, it is commonly assumed that an underlying medical problem can be identified. However, emotional and psychological issues may play an important role in the development of infertility. In addition, assisted reproductive techniques (ARTs) themselves may add to this stress in susceptible individuals. Infertile couples may have an increased susceptibility to these adverse effects. This in turn may result in increased risks for long-term psychological and medical problems in both the parents and the newborn. Among mechanisms mediating these effects altered DNA methylation affecting epigenetic regulation, preterm delivery, vanishing twin syndrome and the persistence of cell-free fetal DNA might be particularly important. Since emotional and psychological problems are highly prevalent in this population and ARTs can adversely influence these, we suggest that a thorough psychological evaluation should be an integral part of both the evaluation process for infertility and the follow-up after assisted reproduction. Furthermore, regarding the mentioned studies here, we propose that ARTs may induce stress-related epigenetic and neurodevelopmental risk.

An effective and well-tolerated topical treatment of Raynaud's phenomenon is needed. The aim of this pilot study was to determine change in skin temperature and self-reported warmth perception from topical rosemary essential oil in patients with systemic sclerosis and secondary Raynaud's phenomenon.Twelve patients with progressive systemic sclerosis and Raynaud's phenomenon were consecutively enrolled in an open-label pilot study at a university outpatient rheumatology clinic. Each patient received an application of olive oil to both hands as a control and 3 h later an application of a 10% essential oil of Rosmarinus officinalis L. Clinical severity and subjective warmth perception were assessed; skin temperature was measured by infrared thermography.Skin temperature increased significantly after both olive oil and rosemary oil but differences between oils did not reach significance. Self-reported warmth perception increased after rosemary oil but not after olive oil. No adverse effects were observed.Topical rosemary essential oil increased warmth perception in patients with systemic sclerosis-related Raynaud's phenomenon but did not increase finger skin temperature more than the olive oil control.Hintergrund: Wirksame und gut verträgliche topische Behandlungen des Raynaud-Phänomens werden ge­braucht. Ziel dieser Pilotstudie war es, bei Patienten mit systemischer Sklerose und sekundärem Raynaud-Phänomen die Veränderung der Hauttemperatur und die selbstberichtete Wärmeempfindung nach topischer Anwendung von Rosmarinöl zu erfassen. Patienten und Methoden: In einer rheumatologischen Universitätsklinik wurden nacheinander zwölf Patienten mit progressiver systemischer Sklerose und Raynaud-Phänomen in eine offene Pilotstudie aufgenommen. Jeder Patient erhielt an beiden Händen eine Einreibung mit Olivenöl als Kontrolle und drei Stunden später eine Einreibung mit 10%igem Rosmarinöl (Rosmarinus officinalis L.). Der klinische Schweregrad und die subjektive Wärmeempfindung wurden bestimmt; die Hauttemperatur wurde mittels Infra­rot-Thermografie gemessen. Ergebnisse: Die Hauttemperatur stieg sowohl nach Olivenöl als auch nach Rosmarinöl signifikant an, aber die Unterschiede zwischen den Ölen erreichten keine Signifikanz. Die selbstberichtete Wärmeempfindung stieg nach der Anwendung von Rosmarinöl, nicht aber nach der Anwendung von Olivenöl. Es wurden keine unerwünschten Wirkungen beobachtet. Schlussfolgerung: Ätherisches Rosmarinöl zur äußerlichen Anwendung steigerte die Wärmeempfindung bei Patienten mit systemischer Sklerose und Raynaud-Phänomen, erhöhte aber die Hauttemperatur an den Fingern nicht stärker als die Olivenöl-Kontrolle.

Background and objectives: Based on our previous single-center study on optimization of treatment of chronic otitis media with effusion (COME) and adenoid hypertrophy (AH) in children using a noninvasive system approach to lower the necessity of antibiotics, analgesic use, and surgical interventions, we proceeded to perform a multicenter investigation in an outpatient setting. The purpose of the previous prospective study in 2013–2015 was to compare outcomes in the treatment of COME and AH using the noninvasive multimodal integrative method (IM) versus conventional treatment practice (COM). Materials and Methods: In this paper, we retrospectively analyze the data of patients treated with the integrative method between 2017 and 2020 in a multicenter setting and compared the outcomes with data from 2013–2015 in order to evaluate generalizability. In both periods, all eligible and willing participants were included and treated with the IM protocol under real-life conditions. The treatment involved pneumatization exercises, education, an antiallergic diet, nasal hygiene, useful constitutional therapy, and thermal interventions (P.E.A.N.U.T.). A total of 48 versus 28 patients, aged 1–8, were assessed, presenting with COME and AH, with moderate to severe hearing impairment at entry. Results: The significant improvement found in both audiometric measures (intact hearing) and tympanometric measures (normal A-type curve) was similar in both datasets with respect to conventional treatment. The new data confirms that the P.E.A.N.U.T. method results in a significant reduction of antibiotics, analgesic use, and surgical interventions. Conclusion: In this multicenter trial, we confirm the effectiveness of the noninvasive system approach for the treatment of COME in lowering the need for antibiotics and analgesic use and elective surgery. This could be especially important with respect to a generally observed increase in antibiotic resistance. The method is easy to perform in different clinical settings and is effective, safe, and well-tolerated.

We provide a brief review of the significance of platelets, mitochondria, vitamin D, serotonin, and the gut microbiome in COVID-19. We hypothesize that hyperactive platelets and mitochondrial dysfunction, as well as low vitamin D level, gut dysbiosis, and increased serum serotonin produced by enterochromaffin cells, may all represent important aspects in the pathophysiology of COVID-19.

ObjectiveTo assess the impact of a multidisciplinary complementary and integrative medicine (CIM) intervention on physical and emotional concerns among front-line COVID-19 healthcare providers (HCPs).MethodsA multimodality CIM treatment intervention was provided by integrative practitioners to HCPs in three isolated COVID-19 departments. HCPs’ two main concerns were scored (from 0 to 6) before and following the CIM intervention using the Measure Yourself Concerns and Wellbeing questionnaire. Postintervention narratives identified reflective narratives specifying emotional and/or spiritual keywords.ResultsOf 181 HCPs undergoing at least one CIM treatment, 119 (65.7%) completed post-treatment questionnaires. While HCPs listing baseline emotional-related concerns benefited from the CIM intervention, those who did not express emotional or spiritual concerns improved even more significantly following the first session, for both leading concerns (p=0.038) and emotional-related concerns (p=0.023). Nevertheless, it was shown that following subsequent treatments HCPs who expressed emotional and spiritual concerns improved more significantly than those who did not for emotional-related concerns (p=0.017).ConclusionsA CIM intervention for front-line HCPs working in isolated COVID-19 departments can significantly impact emotional-related concerns, more so after the first treatment and among HCPs not using emotional-spiritual keywords in post-treatment narratives. Referral of HCPs to CIM programmes for improved well-being should avoid referral bias to those not expressing emotional/spiritual concerns.

Warm footbaths infused with Sinapis nigra (mustard, or MU) or Zingiber officinale (ginger, or GI) are used for various thermoregulatory conditions, but little is known about how they are perceived by individuals, both short- and long-term. We analyzed the immediate and long-term effects of MU and GI on warmth and stimulus perception in healthy adults.Seventeen individuals (mean age 22.1±2.4 years; 11 female) received three footbaths (mean temperature was 40 ± 0.2°C, administered between 1:30 and 6:30 p.m.) in a randomized order with a crossover design: 1. with warm water only (WA), 2. with warm water and MU, and 3. with warm water and GI. Warmth and stimulus perception at the feet were assessed at the 1st, 5th, 10th, 15th, and 20th minute of the footbaths, in the late evening (EVE), and the following morning (MG). We further assessed well-being (at EVE and MG) and sleep quality (at MG). The primary outcome measure was the warmth perception at the feet at the 10th minute of the footbath.At the 10th minute of the footbath, warmth perception at the feet was significantly higher with MU and GI compared to WA. The immediate thermogenic effects pointed to a quick increase in warmth and stimulus perception with MU, a slower increase with GI, and a gradual decrease with WA. Regarding the long-term effects, warmth and stimulus perception were still higher after GI compared to WA at EVE and MG. No differences were seen for general well-being and sleep quality.Thermogenic substances can significantly alter the dynamics of warmth and stimulus perception when added to footbaths. The different profiles in the application of GI and MU could be relevant for a more differentiated and specific use of both substances in different therapeutic indications.Zielsetzung: Warme Fußbäder mit Sinapis nigra (Senf, abgekürzt MU für englisch mustard) oder Zingiber officinale (Ingwer, abgekürzt GI für englisch ginger) werden bei verschiedenen thermoregulatorischen Beschwerden eingesetzt, aber es ist wenig darüber bekannt, wie sie von den Menschen kurz- und langfristig empfunden werden. Wir analysierten die unmittelbaren und langfristigen Auswirkungen von MU und GI auf die Wärme- und Hautreizwahrnehmung bei gesunden Erwachsenen. Methoden: Siebzehn Personen (Durchschnittsalter 22,1 ± 2,4 Jahre; 11 weiblich) erhielten drei Fußbäder (mittlere Temperatur 40 ± 0,2°C, verabreicht zwischen 13:30 und 18:30 Uhr) in randomisierter Reihenfolge mit einem Cross-over-Design: 1. nur mit warmem Wasser (WA), 2. mit warmem Wasser und MU und 3. mit warmem Wasser und GI. Die Wärme- und Reizwahrnehmung an den Füßen wurde in der 1., 5., 10., 15. und 20. Minute der Fußbäder, am späten Abend (EVE) und am nächsten Morgen (MG) erhoben. Außerdem wurden das allgemeine Wohlbefinden (bei EVE und MG) und die Schlafqualität (bei MG) bewertet. Das primäre Ergebnis war die Wärmewahrnehmung an den Füßen in der 10. Minute des Fußbades. Ergebnisse: In der 10. Minute des Fußbades war die Wärmewahrnehmung an den Füßen bei MU und GI im Vergleich zu WA signifikant höher. Die unmittelbaren thermogenen Effekte wiesen auf einen schnellen Anstieg der Wärme- und Reizwahrnehmung mit MU, einen langsameren Anstieg mit GI und einen allmählichen Rückgang mit WA hin. Was die Langzeiteffekte betrifft, so waren Wärme- und Reizwahrnehmung nach GI im Vergleich zu WA bei EVE und MG immer noch höher. Für das allgemeine Wohlbefinden und die Schlafqualität wurden keine Unterschiede festgestellt. Schlussfolgerung: Thermogene Substanzen können die Dynamik der Wärme- und Reizwahrnehmung deutlich verändern, wenn sie Fußbädern zugesetzt werden. Die unterschiedlichen Profile bei der Anwendung von GI und MU könnten für einen differenzierteren und spezifischeren Einsatz beider Substanzen bei verschiedenen therapeutischen Indikationen von Bedeutung sein.

Background: Sense of coherence is a personal resource known to be low in eating disorders. We wanted to know if sense of coherence is still correlated to anorexia symptoms several years after initial hospitalisation for anorexia. Methods: 86 former female patients diagnosed with anorexia were contacted 5-11 years after hospitalisation in a German hospital; 68 of 149 women (46%) could be contacted and agreed to participate in a survey with the Eating Disorder Inventory (EDI-2) and the Sense of Coherence Questionnaire (SOC-13). Results: 17.6% of participants stated that they suffered from an eating disorder currently, with 7.4% having anorexia nervosa. Mean EDI-2 subscales (except for the bulimia sub-scale) were in the

István Molnár,1 Gabriella Hegyi,1,2 Lajos Zsom,3 Christine Saahs,4,5 Jan Vagedes,6,7 Gábor Kapócs,8 Zoltán Kovács,1 Martin-Günther Sterner,9 Henrik Szőke1,2 1Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary; 2Department of CAM, Faculty of Health Sciences, University of Pécs, Pécs, Hungary; 3Department of Nephrology, Fresenius Medical Care, Cegléd, Hungary; 4Department of Pediatrics, University of Vienna, Vienna, Austria; 5Pediatric Outpatient Department, Krems, Austria; 6University Children’s Hospital, University of Tuebingen, Tuebingen, Germany; 7Department of Complementary and Integrative Medicine, ARCIM Institute (Academic Research in Complementary and Integrative Medicine), Filderstadt, Germany; 8Department of Psychiatry and Psychiatric Rehabilitation, Saint John Hospital, Budapest, Hungary; 9Department of Medical Clinics I, Klinikum Niederlausitz, Lauchhammer, Germany Background: Pancreatic cancer is a malignant disease with a high mortality rate and severe pain that is challenging to manage. To reduce the excruciating abdominal pain, opioids and adjuvant agents are conventionally used.Objectives: PRNCPB is a treatment of neural therapy. The number of studies assessing the effect on patients’ QoL is limited and inconsistent. With this study, we intended to address this issue.Study design: A prospective nonrandomized study with a series of cases of unresectable pancreatic cancer was conducted.Setting: The study was performed at our pain clinic under real life conditions.Materials and methods: A total number of 16 patients with severe abdominal pain were enrolled in the study all of whom had responded to combined systemic analgesic therapy inadequately and had intolerable side effects contraindicating further increase in dose. The efficacy of this invasive, palliative analgesic procedure was evaluated 35 days after PRNCPB was performed. Primary outcomes were changed in pain intensity using the VAS questionnaire. Secondary outcomes were improved in QoL using the SF-36 questionnaire. Changes in pain medications and adverse reactions were monitored.Results: After PRNCPB patients experienced a significant decrease (P=0.002) in pain intensity as shown by the VAS score, and a decreased opiate demand. Their QoL scores considering effect sizes also improved (P

Aim. The aim of this narrative review was to explore the potential contributions of CAM to reduce antibiotic use. Methods. We searched PubMed, Embase, and Cochrane Database of Systematic Reviews with a specific, limited set of search terms and collected input from a group of expert CAM researchers to answer the question: What is known about the contribution of CAM health and health promotion concepts, infection prevention, and infection treatment strategies to reduce antibiotic use? Results. The worldview-related CAM health concepts enable health promotion oriented infection prevention and treatment aimed at strengthening or supporting the self-regulating ability of the human organism to cope with diseases. There is some evidence that the CAM concepts of health (promotion) are in agreement with current conceptualization of health and that doctors who practice both CAM and conventional medicine prescribe less antibiotics, although selection bias of the presented studies cannot be ruled out. There is some evidence that prevention and some treatment strategies are effective and safe. Many CAM treatment strategies are promising but overall lack high quality evidence. Conclusions. CAM prevention and treatment strategies may contribute to reducing antibiotic use, but more rigorous research is necessary to provide high quality evidence of (cost-)effectiveness.

Objective Despite attempts to increase calmness in the Newborn Intensive Care Unit (NICU), preterm neonates still experience stress. The question arises how to further promote the infants’ wellbeing. Therefore, the immediate effects of pentatonic live music on preterm infants and their mothers were examined. Design and methods In a two-centre randomized controlled trial with crossover design preterm infants were exposed sequentially to two conditions: live pentatonic harp music (LPHM) used in Anthroposophic Medicine or standard care. The order of the conditions was randomized within each subject. The primary outcome was change of the number of oxygen desaturations Results 21 preterm infants were randomized (14 girls), mean gestational age at measurement 35 + 0 weeks (SD 1 week). The primary outcome parameter showed no significant changes. Regarding the secondary outcomes the comparison of the pre-post-differences between the conditions showed significant effects for the HRV parameters pNN50 (ΔpNN50 = 1.46%, z = −2.47, p = .001) and SDNN (ΔSDNN=−0.06 ms, z = −2.25, p = .002). The music intervention significantly increased the values of pNN50 (Mdn 1.2% vs. 2.6%, p = 0.04) and marginally those of SDNN (Mdn 31.7 ms vs. 36.4 ms, p = 0.05). No changes were found in the other parameters. Conclusions While the use of music in the NICU had no effect on the number of oxygen desaturations, it increased two HRV parameters indicative of infants’ parasympathetic tone.

The association between gastro-esophageal reflux disease (GERD) and asthma, although well established in adults, is less strong in the pediatric age group. Benefits of proton pump therapy are limited across age ranges. While there is a growing body of literature on the use of complementary treatments for both asthma and GERD, few studies have focused on treatment benefits for the GERD-asthma association. We present the case of a 2-year-old boy with asthma and GERD who was not responding to inhaled, low-dose corticosteroids, beta-mimetic therapy, and a 6-week course of proton pump inhibitor treatment. We noted a gradual disappearance of symptoms when he was given an oral preparation of Pulvis stomachicus cum Belladonna, an anthroposophic medication containing Matricaria recutita, Atropa belladonna, bismuth, and antimonite. Matricaria recutita and bismuth have known gastric protective properties, and Atropa belladonna contains anticholinergic agents that have a bronchodilatory effect. These complementary medications appear promising in terms of relieving the symptoms of GERD-associated asthma.

Introduction Reducing antibiotic use is a global priority, but the extent to which antibiotic prescriptions can be reduced in children hospitalized for community-acquired pneumonia is unknown. This study aimed to analyse the prescribing experience from a facility with a long-standing practice of restrictive antibiotic use. Methods We conducted a retrospective analysis of children from birth to 18 years, hospitalized for pneumonia at an integrative medicine hospital in Germany. Antibiotic prescription rate and clinical outcomes were analyzed. The Moreno Bacterial Pneumonia Score, a composite laboratory, clinical and radiologic score, was applied to estimate the proportion of viral and bacterial pneumonia. Results 252 pneumonia episodes were included, with 172 categorized as probably viral and 80 as bacterial pneumonia. Antibiotic prescription rate was 32 % overall, 26 % for presumed viral and 51 % for presumed bacterial pneumonia. Children with probable bacterial pneumonia who were managed with antibiotics had higher CRP values than those managed without antibiotics (p Conclusions The observed antibiotic prescription rate of 32 % was much lower than rates reported in the literature - 88–98 %. Children were safely managed with a restrictive antibiotic prescription strategy when physicians judged this to be appropriate. Our findings suggest that a delayed prescription strategy for childhood pneumonia deserves further study. Trial registration the study was registered at clinicaltrials.org, NCT03256474.