Günther Spahn

Effects of Mind-Body Therapy on Quality of Life and Neuroendocrine and Cellular Immune Functions in Patients with Ulcerative Colitis

Background: The aim of this study was to investigate the effects of mind-body therapy on neuroendocrine and cellular immune measures, health-related quality of life and disease activity in patients with ulcerative colitis (UC) in remission. Methods: Thirty UC patients in remission or with low disease activity were randomly assigned to an intervention group (n = 15) or a usual-care waiting control group (n = 15). Intervention consisted of a structured 60-hour training program over 10 weeks which included stress management training, moderate exercise, Mediterranean diet, behavioral techniques and self-care strategies. Quality of life, perceived stress and disease activity were assessed with standardized questionnaires (IBDQ, SF-36, PSS, CAI). In addition, the distribution of circulating lymphocytes and lymphocyte subsets as well as the β-adrenergic modulation of TNF-α production in vitro were analyzed. Urine catecholamines and plasma cortisol, prolactin and growth hormone were measured pre- and postinterventionally, and were compared with a healthy control group (n = 10). Results: In response to therapy, patients in the intervention group showed significantly greater improvement in the SF-36 scale Mental Health and the Psychological Health Sum score compared with changes observed in the usual-care waiting control group. Patients in the intervention group showed significantly greater improvement on the IBDQ scale Bowel Symptoms compared with the control group. However, no significant group differences in circulating lymphocyte subsets or endocrine parameters were observed in response to therapy. In addition, no significant effects of intervention on either the basal levels of TNF-α or the suppressive action of the β-adrenergic agonist isoproterenol on TNF-α production were observed. Conclusion: Mind-body therapy may improve quality of life in patients with UC in remission, while no effects of therapy on clinical or physiological parameters were found, which may at least in part be related to selective patient recruitment.

Thermal hydrotherapy improves quality of life and hemodynamic function in patients with chronic heart failure.

BACKGROUND Chronic heart failure is characterized by increased peripheral vascular resistance and reduced peripheral perfusion due to adrenergic and renin angiotensin activation and impaired endothelial function. Recent studies have shown that nonpharmacological peripheral vasodilation with thermal therapy by means of warm-water baths and sauna has beneficial effects in chronic heart failure. European hydrotherapy (according to Kneipp) additionally uses short cold water stimuli, which lead to prolonged vasodilation and adaptive responses. Studies on the efficacy of hydrotherapy in chronic heart failure are lacking. METHODS We studied 15 patients (5 men, 10 women, mean (+/- SD) age 64.3 +/- 1.8 years) with mild chronic heart failure (NYHA functional class II to III, ejection fraction 30%-40%). Patients were randomly assigned to 6 weeks of intensive home-based hydrotherapy or 6 weeks restriction in a crossover intervention trial. Quality of life and heart-failure--related symptoms were assessed by means of a validated questionnaire (PLC). Graded bicycle exercise test with incremental workloads (0, 50, 75, 100 watts) was performed at the end of each treatment period. The hydrotherapeutic program consisted of a structured combination of daily home-based external warm- and cold-water applications. RESULTS Baseline characteristics were balanced between the groups. With hydrotherapy, a significant (P < or =.05) improvement in 3 of 6 dimensions of quality of life (mood, physical capacity, enjoyment) and a significant reduction in heart-failure-related symptoms was found. Heart rates at rest and at 50-Watt workload were significantly reduced by hydrotherapy; blood pressure decreased nonsignificantly at rest and during exercise. The hydrotherapeutic treatment was well accepted and no relevant adverse effects were observed. CONCLUSIONS A home-based hydrotherapeutic thermal treatment program improves quality of life, heart-failure-related symptoms and heart rate response to exercise in patients with mild chronic heart failure. The results of this investigation suggest a beneficial adaptive response to repeated brief cold stimuli in addition to enhanced peripheral perfusion due to thermal hydrotherapy in patients with chronic heart failure.

Quantification of DeQi Sensation by Visual Analog Scales in Healthy Humans after Immunostimulating Acupuncture Treatment

Acupuncture is the most popular component of traditional Chinese medicine in Western countries. However, the mechanisms of its effects remain unclear. The therapeutic effect of acupuncture appears when a sensation of DeQi is achieved. We previously reported that repeated, but not single acupuncture treatment affected leukocyte circulation and blood pressure in healthy young humans. The objective of this study was to quantify DeQi sensation by using visual analog scales (VASs) and, to test whether DeQi induction is an important factor for the therapeutic effects of acupuncture in the same cohort. After either acupuncture or sham-acupuncture (placebo) treatment, a questionnaire containing five individual VASs was given to subjects to evaluate their DeQi sensation, including numbness, pressure, heaviness, warmth, and radiating paraesthesia, respectively. A separate VAS to measure their levels of anxiety during the treatment was also included. Our results showed that acupuncture significantly induced higher VAS values for numbness, pressure, warmth, and radiating paraesthesia, but not for heaviness than the placebo across three treatment sessions. Additionally, acupuncture did not induce higher anxiety levels than the placebo. These data confirm that VAS is an objective and reliable way to quantify DeQi sensation and, indicate that DeQi is unique to verum acupuncture treatment. Furthermore, either acupuncture-induced therapeutic effects or DeQi sensation should not be attributed to the stress-mediated effects. In summary, the induction of DeQi in each treatment session is an important factor for the physiological outcomes of repeated acupuncture treatment, and VASs offer objective, an easy and reliable way to assess it.

Repeated acupuncture treatment affects leukocyte circulation in healthy young male subjects : A randomized single-blind two-period crossover study

Acupuncture is the most popular component of traditional Chinese medicine in western countries, which has been widely used in the treatment of numerous medical conditions, e.g., pain, emesis or asthma. However, the effects of acupuncture on neuroendocrine and immune functions in humans remain unclear. Therefore, the present study was performed to analyse whether acupuncture treatment affects leukocyte circulation as well as plasma levels of cortisol and norepinephrine in humans. Ten healthy young male subjects were enrolled in a randomized single-blind two-period crossover study. Each period contained three sessions of either acupuncture or sham acupuncture (placebo) treatment. After randomisation, the group 1 (n=5) received acupuncture treatment at acu-points ST36, LI11, SP10, and GV14, while sham acupuncture was performed for group 2 (n=5). Two weeks later, each group received the alternative treatment. Blood samples were taken before needling, 10 min after, and 30 min after removing the needles in the first and the third session. In addition, blood pressure and heart rate were determined simultaneously. Although acupuncture treatment did not affect leukocyte circulation in peripheral blood after the first session, we observed a significant decrease in leukocyte and lymphocyte values after the third session. In contrast, cortisol and norepinephrine plasma levels remained unchanged by acupuncture. These data indicate that repeated acupuncture treatment can affect leukocyte circulation in healthy humans by still unknown mechanisms.

Can a Multimodal Mind-Body Program Enhance the Treatment Effects of Physical Activity in Breast Cancer Survivors With Chronic Tumor-Associated Fatigue? A Randomized Controlled Trial

Background. Chronic fatigue is one of the most restricting symptoms following primary breast cancer treatment, but clinical studies on symptom management are rare. The objective was to evaluate the impact of a multimodal mind–body program (MMMT), including moderate physical activity as compared with a walking intervention alone, on chronic fatigue symptoms of women with stage I to IIIA breast cancer. Patients and Methods. Sixty-four women (mean age = 56.7 years) suffering from chronic fatigue after active tumor treatment were randomly assigned to either an experimental or a control (n = 32 each) intervention (10 weeks). Fatigue, quality of life (QoL), functional well-being, anxiety, and depression were measured with standard questionnaires at baseline, after 10 weeks, and after 3 months. Results. Compared with baseline, both groups had reduced fatigue scores after treatment without any significant difference between groups (posttreatment, Δ = −0.3, confidence interval = −1.6 to 1.0, P = .678; follow-up, Δ = −0.4, confidence interval = −1.8 to 0.9, P = .510). All patients also improved regarding QoL and general functional well-being. Conclusion. Since both interventions reduced fatigue symptoms and enhanced QoL to a similar extent, we observed no verifiable add-on effect of the MMMT regarding fatigue symptoms. Considering the higher costs with additional expenditure related to MMMT, home-based walking intervention is recommended.

Gesundheitsbezogene Kontrollüberzeugung und Lebensqualität bei chronisch Kranken nach stationärer Behandlung mit Integrativer Medizin – eine Beobachtungsstudie

Health-Related Control Belief and Quality of Life in Chronically Ill Patients after a Behavioral Intervention in an Integrative Medicine Clinic – an Observational Study Background: In 1999 the Clinic for Internal Medicine and Integrative Medicine was founded in Essen as a regular part of the German inpatient health care system. Integrative medicine (standard internal medicine, evidence-based complementary and alternative medicine combined with intensified lifestyle modification) aims to help patients with chronic illness to cope with their condition more effectively and to achieve a health-promoting lifestyle. Techniques include cognitive restructuring, the elicitation of the relaxation response, and lifestyle education. The goal is to increase health-related quality of life (QoL) as well as control beliefs and to reduce morbidity in later life. Aim: To demonstrate changes in quality of life, lifestyle, and control beliefs after a two-week hospital stay. Methods: Uncontrolled prospective observational study with 557 consecutive hospital patients. Outcome parameters were quality of life (SF36), control beliefs (GKÜ), and daily health-related behavior (nutrition, physical activity, relaxation) on admission, at discharge, as well as 3 and 6 months after discharge. Results: Weekly physical activity increases by 29%, consumption of not recommendable foods decreases by 18%. The majority of patients (57%) engage in relaxation exercises 6 months after discharge (on admission 23%). The physical sum scale (SF36) increases from 33.9 (95% KI 32.5–35.3) on admission to 37.3 (35.8–38.9) 6 months after discharge, the mental sum scale from 41.2 (39.5–42.9) to 45.1 (43.5–46.7). The ratio internal/external control belief rises from 1.17 (95% KI 1.11–1.24) to 1.32 (1.24–1.40). Pretherapeutic ratio internal/external control belief and its increase are associated with rises in QoL. Conclusions: After integrative medicine treatment a lasting increase in QoL and lifestyle changes can be achieved. Reinforcement of internal control beliefs and own competence is possible and enhances outcomes in chronically ill patients.

Neue Trends bei alten Themen - alte Themen in neuen Trends

Background: Acupuncture is frequently used to treat seasonal allergic rhinitis (SAR) despite limited scientific evidence. Objective: To evaluate the effects of acupuncture in patients with SAR. Design: Randomized, controlled multicenter trial. (ClinicalTrials.gov: NCT00610584) Setting: 46 specialized physicians in 6 hospital clinics and 32 private outpatient clinics. Patients: 422 persons with SAR and IgE sensitization to birch and grass pollen. Intervention: Acupuncture plus rescue medication (RM) (cetirizine) (n = 212), sham acupuncture plus RM (n = 102), or RM alone (n = 108). Twelve treatments were provided over 8 weeks in the first year. Measurements: Changes in the Rhinitis Quality of Life Questionnaire (RQLQ) overall score and the RM score (RMS) from baseline to weeks 7 and 8 and week 16 in the first year and week 8 in the second year after randomization, with predefined noninferiority margins of –0.5 point (RQLQ) and –1.5 points (RMS). Results: Compared with sham acupuncture and with RM, acupuncture was associated with improvement in RQLQ score (sham vs. acupuncture mean difference, 0.5 point (97.5% CI, 0.2 to 0.8 point; P<0.001); RM vs. acupuncture mean difference, 0.7 point (97.5% CI, 0.4 to 1.0 point; P<0.001)) and RMS (sham vs. acupuncture mean difference, 1.1 points (97.5% CI, 0.4 to 1.9 points; P<0.001); RM vs. acupuncture mean difference, 1.5 points (97.5% CI, 0.8 to 2.2 points; P<0.001)). There were no differences after 16 weeks in the first year. After the 8-week follow-up phase in the second year, small improvements favoring real acupuncture over the sham procedure were noted (RQLQ mean difference, 0.3 point (95% CI, 0.03 to 0.6 point; P = 0.032); RMS mean difference, 1.0 point (95% CI, 0.2 to 1.9 points; P = 0.018)). Limitation: The study was not powered to detect rare adverse events, and the RQLQ and RMS values were low at baseline. Conclusion: Acupuncture led to statistically significant improvements in disease-specific quality of life and antihistamine use measures after 8 weeks of treatment compared with sham acupuncture and with RM alone, but the improvements may not be clinically significant.

Alois Stacher - † 20. Juli 2013

Accessible online at: www.karger.com/fok Fax +49 761 4 52 07 14 Information@Karger.com www.karger.com Nachruf Alois Stacher Alois Stacher wurde am 16.02.1925 in Wien geboren. Dort besuchte er die Volksschule und das humanistische Gymnasium und legte im Jahr 1943 die Reifeprüfung ab. Anschließend wurde er zur Deutschen Wehrmacht eingezogen und am 27.04.1945 schwerst verwundet. Nach einem mehr als 2-jährigen Aufenthalt in einem amerikanischen Lazarett kam er im Jahre 1947 nach Wien zurück, wo er noch im selben Jahr mit dem Medizinstudium begann. Das Studium schloss er am 15.07.1952 mit der Promotion zum Doktor der Humanmedizin ab. Seine erste Tätigkeit als Arzt begann er im Wiener HanuschKrankenhaus, das sein gesamtes ärztliches Berufsleben bis zum Ende seiner aktiven Tätigkeit prägte. Im Jahre 1959 erhielt er die Facharztanerkennung für Innere Medizin. In der Folge widmete sich Stacher vor allem der Hämatologie. Seine erfolgreiche wissenschaftliche Tätigkeit auf diesem Gebiet war die Grundlage für die Habilitation im Fach Innere Medizin und die Ernennung zum Titularprofessor im Jahre 1973. Von 1975 bis 1990 leitete er das hämatologisch-onkologische Zentrum am Hanusch-Krankenhaus sowie das Ludwig Boltzmann-Institut für Leukämieforschung und Hämatologie, das dem Krankenhaus von 1968 bis 1993 angegliedert war. Schwerpunkt der wissenschaftlichen Tätigkeit von Stacher war in dieser Zeit die Leukämieund Lymphomforschung, mit der er sich auch international einen wissenschaftlichen Ruf erworben hat. In der Bevölkerung Wiens war Stacher vor allem durch seine gesundheitspolitische Tätigkeit bekannt. Im Jahr 1973 wurde er zum amtsführenden Stadtrat für Gesundheit und Soziales der Stadt Wien gewählt und übte das Amt bis zum Ende des Jahres 1989 aus. Dabei konzentrierte er sich auf den Ausbau des Sozialwesens und die Reorganisation der Wiener Spitäler. In diesem Rahmen initiierte er auch eine international anerkannte Psychiatriereform. Wie dem Verfasser des vorliegenden Nachrufs aus persönlichen Gesprächen bekannt ist, hat das Gelingen dieser Reform sowie die Errichtung eines modernen Spitals mit der Bezeichnung «Sozialmedizinisches Zentrum Ost» (Donauspital) im 22. Wiener Gemeindebezirk Stacher mit Stolz und Befriedigung erfüllt. Stacher hatte aber auch noch zahlreiche andere Funktionen inne, von denen nachfolgend nur die wichtigsten genannt werden sollen: – Präsident des Landesverbandes Wien des Österreichischen Roten Kreuzes 1973–1989 – Präsident des «Medizinisch-Wissenschaftlichen Fonds des Bürgermeisters der Bundeshauptstadt Wien» 1978–1989 – Präsident des Kuratoriums für psychosoziale Dienste in Wien 1979–1989 – Gründer und Präsident des Wiener Krankenanstaltenverbandes 1975–1989 – Vizepräsident der Krankenhausberatungsagentur des Gesundheitsministeriums 1988–1989 – stellvertretender Vorsitzender des «Fonds Gesundes Österreich» 1974–1989 – Mitglied des Kuratoriums des «Kardinal Innitzer-Studienfonds» 1974–1989 – Mitglied des «Kuratoriums der Hochschuljubiläumsstiftung» 1976–1989 – Mitglied des Vereinsausschusses des «Rudolfiner-Vereins», der die älteste Krankenpflegeschule Europas vor der Schließung bewahrte. Wer Stacher kannte weiß, dass er all diese Aufgaben nicht nur formal ausfüllte, sondern aktiv mitgestaltete und mit seiner Persönlichkeit prägte. Angesichts seiner vielfältigen Verantwortungen und seines medizinischen Hintergrunds als streng naturwissenschaftlich orientierter Hämatoonkologe erscheint es besonders bemerkenswert, dass Stacher sich immer auch für die Belange einer ganzheitlichen Medizin interessiert und aktiv eingesetzt hat. Er betonte in persönlichen Gesprächen immer wieder, dass die Medizin während seines Studiums und zu Beginn seiner ärztlichen Tätigkeit zu einem erheblichen Anteil traditionelle Erfahrungsheilkunde war. Begriffe wie Komplementäroder Alternativmedizin existierten zu dieser Zeit noch nicht, sondern entwickelten sich aus einer Situation, in der erkannt wurde, dass die sogenannte Schulmedizin nicht in der Lage war, alle gesundheitlichen Probleme zu lösen. Stacher wies immer wieder auf die etwas paradoxe Situation hin, dass einerseits die naturwissenschaftlich orientierte Medizin beeindruckende Fortschritte zum Wohl der Patienten verzeichnete, andererseits aber die Zufriedenheit der Menschen mit dem GesundAlois Stacher – † 20. Juli 2013 heitsangebot nicht proportional dazu anstieg. Dies waren die wichtigsten Beweggründe dafür, dass Stacher sich schon seit Beginn seiner ärztlichen Tätigkeit auch für Denkweisen und Methoden interessiert hat, die nicht ausschließlich der Schulmedizin zugeordnet werden können. Der erste Kontakt Stachers mit komplementärmedizinischen Methoden war die Neuraltherapie, der bald darauf die Akupunktur und die Homöopathie folgten. Eine weitere Motivation für die Auseinandersetzung mit diesen Methoden war sein Interesse an der Regulationsmedizin und der Matrix. Eine Folge seines Interesses an diesen Themen war die Gründung des «Wiener Teams», das von Namen wie Otto Bergsmann, Johannes Bischko, Franz Hopfer, Gottfried Kellner, Rudolf Maresch, Felix Perger und Alfred Pischinger geprägt war und Forschungsaktivitäten auf den genannten Gebieten entfaltet hat. Den Anreiz zur Gründung der «Wiener Internationalen Akademie für Ganzheitsmedizin» (GAMED) im Jahre 1988 gab ein von Stacher organisierter internationaler Kongress in Wien über Ganzheitsmedizin. Damit verfolgte er das Ziel, eine vorurteilslose Diskussion und den Dialog verschiedener Denkrichtungen zu fördern. Das grundlegende Anliegen der GAMED ist eine Verbindung zwischen naturwissenschaftlich fundierter universitärer Medizin und der Erfahrungsheilkunde unter Berücksichtigung der psychischen und geistigen Aspekte sowie komplexer und regulativer Prozesse. Stacher hat immer auf die Wichtigkeit der postgradualen Ausbildung und der wissenschaftlichen Tätigkeit hingewiesen. Er war auch Mitbegründer der Zeitschrift Forschende Komplementärmedizin, wodurch die Möglichkeit zur Publikation von Arbeiten auf dem Gebiet der Komplementärmedizin geschaffen wurde. Die wissenschaftliche Tätigkeit Stachers manifestierte sich in der Herausgabe und Autorschaft von 26 wissenschaftlichen Pr oo f

Mind/Body-medizinische Interventionen für onkologische Patienten

Cancer changes the lives of the patients dramatically. Mind/Body interventions can, when applied in addition to conventional treatment, sustainably improve the resources for health and well-being. Lifestyle changes in regard to stress management, relaxation, exercise, social support and nutrition activate the potentials for self healing of the organism. Cognitive and mindfulness-based interventions improve the patientis coping skills and can contribute to finding meaning in the challenge that living with cancer implies. Integrative Medicine combines conventional treatments with evidence based naturopathy and Mind/Body interventions.