Miek C. Jong

Attitudes toward integrative paediatrics: a national survey among youth health are physicians in the Netherlands

BackgroundIntegrative Medicine (IM) is an emerging field in paediatrics, especially in the USA. The purpose of the present study was to assess the attitudes and beliefs of Youth Health Care (YHC) physicians in the Netherlands toward IM in paediatrics.MethodsIn October 2010, a link to an anonymous, self-reporting, 30-item web-based questionnaire was mailed to all members of the Dutch Organisation of YHC physicians. The questionnaire included questions on familiarity with IM, attitudes towards Integrative Paediatrics (IP), use and knowledge of Complementary and Alternative Medicine (CAM), demographic and practice characteristics.ResultsA total of 276 YHC physicians (response rate of 27%) responded to the survey. Of the respondents, 52% was familiar with IM and 56% had used some kind of CAM therapy during the past 2 years, of which self-medicated herbal and/or homeopathic remedies (61%) and supplements (50%) were most frequently mentioned. Most of the YHC physicians (62%) seldom asked parents of clients about CAM use. One third of the YHC physicians recommended CAM to their clients. In general, about 50% or more of the respondents had little knowledge of CAM therapies. Predictors for a positive attitude towards IP were familiarity with IM, own CAM use, asking their clients about CAM use and practising one or more forms of CAM therapy. Logistic regression analysis showed that the following factors were associated with a higher recommendation to CAM therapies: own CAM use (odds ratio (OR) = 3.8; 95% confidence interval (CI) = 2.1-6.9, p = 0.001) and practising CAM (OR 4.4; 95% CI = 1.6-11.7, p = 0.003).ConclusionsIn general Dutch YHC physicians have a relative positive attitude towards IP; more than half of the respondents used one or more forms of CAM and one third recommended CAM therapies. However, the majority of YHC physicians did not ask their clients about CAM use and seemed to have a lack of knowledge regarding CAM.

Effectiveness of motivational interviewing and physical activity on prescription on leisure exercise time in subjects suffering from mild to moderate hypertension

BackgroundPhysical inactivity is considered to be the strongest individual risk factor for poor health in Sweden. It has been shown that increased physical activity can reduce hypertension and the risk of developing cardiovascular diseases. The objective of the present pilot study was to investigate whether a combination of Motivational Interviewing (MI) and Physical Activity on Prescription (PAP) would increase leisure exercise time and subsequently improve health-related variables.MethodsThis pilot study was of a repeated measures design, with a 15 months intervention in 31 patients with mild to moderate hypertension. Primary outcome parameter was leisure exercise time and secondary outcome parameters were changes in blood pressure, Body Mass Index (BMI), waist circumference, lipid status, glycosylated haemoglobin (HbA1c) and maximal oxygen uptake (VO2 max). Assessments of the outcome parameters were made at baseline and after 3, 9 and 15 months.ResultsLeisure exercise time improved significantly from < 60 min/week at baseline to a mean activity level of 300 (± 165) minutes/week at 15 months follow up. Furthermore, statistically significant improvements (p < 0.05) were observed in systolic (-14,5 ± 8.3 mmHg) and diastolic blood pressure (-5,1 ± 5.8 mmHg), heart rate (-4.9 ± 8.7 beats/min, weight (-1.2 ± 3.4 kg) BMI -0.6 ± 1.2 kg/m2), waist circumference (-3.5 ± 4.1 cm) as well as in VO2 max (2.94 ± 3.8 ml/kg and 0.23, ± 0.34 lit/min) upon intervention as compared to baseline.ConclusionsA 15 month intervention period with MI, in combination with PAP, significantly increased leisure exercise time and improved health-related variables in hypertensive patients. This outcome warrants further research to investigate the efficacy of MI and PAP in the treatment of mild to moderate hypertension.

Adverse drug reactions to anthroposophic and homeopathic solutions for injection: a systematic evaluation of German pharmacovigilance databases

Medicinal solutions for injection are frequently applied in anthroposophic medicine and homeopathy. Despite their extensive use, there is little data published on the safety of these products. Therefore, we investigated the safety of anthroposophic and homeopathic solutions for injection through a systematic evaluation of adverse drug reactions (ADRs).

Citrus/Cydonia Compositum Subcutaneous Injections versus Nasal Spray for Seasonal Allergic Rhinitis: A Randomized Controlled Trial on Efficacy and Safety

Background. Clinical experiences in vitro and clinical studies have demonstrated the curative potency and safety of Citrus/Cydonia compositum in seasonal allergic rhinitis treatment. Objectives. To compare the efficacy and safety of two routes of administration (nasal spray versus subcutaneous injections). Methodology: Design. a national, randomised, comparative clinical trial with two parallel groups. Participants. 23 patients fulfilled the study requirements. Intervention. after a one- or two-week wash-out period, 23 patients were randomized, to a 6-week treatment period. Outcomes. immunological and symptom severity changes and safety. Immunologic outcome assessments were blinded to group assignment. 23 patients were randomized and from 22/23 patients (11 in each group) blood samples were analyzed before and after treatment. Conclusion. Both routes of administration demonstrate immunological and clinical effects, with larger inflammatory and innate immunological effects of the nasal spray route and larger allergen-specific clinical effects of the subcutaneous route, and are safe.

A Pilot Feasibility Study of a Questionnaire to Determine European Union-Wide CAM Use

Background: No questionnaire specifically measuring the core components of complementary and alternative medicine (CAM) use has been validated for use across European Union (EU) countries. We aimed to determine the face validity, acceptability and the participants’ comprehension of a pre-existing questionnaire designed to measure ‘CAM use’, to provide a comparative, standardised questionnaire for use by health care providers, policy makers and purchasers throughout Europe. Methods: Established procedures were employed to translate the questionnaire into 4 EU languages. The translated questionnaires were piloted on 50 healthy adults from each country who may never have used CAM. 10 participants per country also took part in audio-recorded think aloud interviews about the questionnaire. The interviews were transcribed and analysed in the language in which they were conducted; findings were summarised in English. Questionnaire data were pooled across countries, and patterns of completion and missing data were analysed. Results: The questionnaire was translated into Italian, Spanish, Dutch and Romanian. The mean age of the participants was 43.6 years. 34% were male, 87.4% were either light or heavy CAM users, and 12.6% were non-users. Qualitative analysis identified common problems across countries including a ‘hard-to-read’ layout, misunderstood terminology and uncertainty in choosing response options. Quantitative analysis confirmed that a substantial minority of respondents failed to follow questionnaire instructions and that some questions had substantial rates of missing data. Conclusions: The I-CAM-Q has low face validity and low acceptability, and is likely to produce biased estimates of CAM use if applied in England, Romania, Italy, The Netherlands or Spain. Further work is required to develop the layout, terms, some response options and instructions for completion before it can be used across the EU.

Attitudes, Beliefs, and Practices of Integrative Medicine Among Nurses in the Netherlands

Purpose: This study assessed the attitude, beliefs, and practices of integrative medicine (IM) among nurses in the Netherlands. Design: Subscribers of a Dutch nursing journal were asked to fill in an anonymous, structured, online survey related to the topic under study. Results: A total of 355 people responded, of which 37% were familiar with the concept of IM in advance. On completion of the survey, the majority (83%) considered IM as a (very) important innovation in health care. Familiarity (odds ratio = 3.20; 95% confidence interval [1.48, 6.94]) and organization (nursing home compared to hospital (odds ratio = 5.98; 95% confidence interval [1.36, 26.23]) were characteristics associated with a positive attitude toward IM. Between 23% and 46% of respondents encountered obstacles regarding implementation of IM. The main obstacles were lack of support (69% to 78%), means (57% to 85%), and time (63% to 70%). Conclusions: Dutch nurses seem to have relatively positive attitudes and beliefs regarding IM. The outcome of this survey may contribute an increased awareness of the key role that nurses can play in the development and implementation of IM.

Resistance to Antibiotics and Antifungal Medicinal Products: Can Complementary and Alternative Medicine Help Solve the Problem in Common Infection Diseases? The Introduction of a Dutch Research Consortium

The increase of antibiotic resistance worldwide, rising numbers of deaths and costs associated with this, and the fact that hardly any new antimicrobial drugs have been developed during the last decade have increased the interest in Complementary and Alternative Medicine (CAM) therapeutic interventions, if proven safe and effective. Observational studies on clinical CAM practices demonstrate positive effects of treatment of infections with CAM therapies (clinical effects, patient satisfaction) in combination with small percentages of antibiotics prescription. However, Cochrane reviews and other studies demonstrate that in most instances the quality of clinical trials on CAM treatment of infections is currently too low to provide sufficient evidence. Therefore a Dutch consortium on (in vitro and clinical) scientific research on CAM and antibiotic resistance has been formed. The aim and objective of the consortium is to establish an enduring partnership and to develop expertise to further develop and investigate safe and effective CAM treatments for infectious diseases of humans (and animals). A first ongoing project on the development of safe and effective biobased CAM antimycotics in women with (recurrent) vaginal candidiasis infection is introduced.

A comparative in vitro study of the effects of separate and combined products of Citrus e fructibus and Cydonia e fructibus on immunological parameters of seasonal allergic rhinitis.

This paper examined the effects of the combined product, Citrus e fructibus/Cydonia e fructibus (Citrus/Cydonia; Citrus and Cydonia: each 0.01 g/mL), and separate products of Citrus (0.01 g/mL) and Cydonia (0.01 g/mL) on the immunological pathways involved in seasonal allergic rhinitis (SAR). Peripheral blood mononuclear cells (PBMCs) from five healthy and five grass pollen-allergic donors were isolated and analyzed in vitro after polyclonal and allergen-specific stimulation of T cells in the presence of the three extracts. The analyses demonstrated acceptable cell survival with no signs of toxicity. Citrus mainly had a selective effect on reducing allergen-specific chronic inflammatory (TNF-α; Citrus compared to Cydonia and Citrus/Cydonia: −87.4 (P < 0.001) and −68.0 (P < 0.05), resp.) and Th2 pathway activity (IL-5; Citrus compared to Cydonia: −217.8 (P < 0.01); while, both Cydonia and Citrus/Cydonia mainly affected the induction of the allergen-specific Th1 pathway (IFN-γ; Cydonia and Citrus/Cydonia compared to Citrus: 3.8 (P < 0.01) and 3.0 (P < 0.01), resp.). Citrus and Cydonia demonstrated different working mechanisms in the treatment of SAR and the combination product did not demonstrate larger effects than the separate preparations. Further effectiveness and efficacy studies comparing the effects of the products on SAR in vivo are indicated.

P02.128. The effects of guided imagery on preoperative anxiety and pain management in patients undergoing Laparoscopic Cholecystectomy in a multi-centre RCT study

PurposeLaparoscopic Cholecystectomy (LC) is common practicein treatment of symptomatic gall stones. LC is often associatedwith preoperative anxiety and stress which maynegatively impact postoperative pain perception andrecovery from surgery. The aim of the present study wasto investigate whether a “non-pharmacological” interventionwith guided imagery can reduce preoperative anxiety,postoperative pain perception and medication comparedto standard care in patients undergoing LC.MethodsIn a pragmatic multi-centre randomized controlled study140 patients were randomized to a Guided Imagery (GI)group or control group. The GI group was provided witha CD to practice guided imagery once a day, 7 days priorto surgery. Patients in the control group received standardcare instructions only. Primary outcome measurement wasthe use of postoperative analgesics. Secondary outcomeparameters were preoperative anxiety levels using theAmsterdam Preoperative Anxiety and Information Scale(APAIS), postoperative pain perception (VAS-scale), generalpatient satisfaction (PSQ) and safety (adverse events)with treatment.Results95 out of 140 randomized patients completed the study,43 in the GI and 52 in the control group. The major reasonsfor dropping out were acute LCs or cancellation ofLC. Both groups were highly comparable with respect todemographic data. The majority was female (GI: 77%,Control: 75%). Postoperative morphine use was not significantlydifferent between the GI (15.8±18.5 mg) andcontrol group (12.5±13.6 mg, p=0.34). No significant differenceswere observed in anxiety and postoperative VASscores. Twenty-three percent of patients did exercises1-3 times, 65% 4-7 times and 12% >7 times. Within GIgroup analysis showed significantly less postoperativemorphine use upon better compliance to GI exercises(p=0.02).ConclusionIt is not as simple as replacing a pill with a CD. GuidedImagery seems to reduce postoperative pain medicationonce compliance to imagery exercises is achieved.

Long-term benefits by a mind–body medicine skills course on perceived stress and empathy among medical and nursing students

Abstract Background: A significant number of medical students suffer from burnout symptoms and reduced empathy. This controlled, quasi-experimental study aimed to investigate whether a mind–body medicine (MBM) skills course could reduce perceived stress and increase empathy and self-reflection in medical and nursing students. Methods: The MBM course (consisting of experiential sessions of mind–body techniques and group reflections) was piloted among Dutch medical students and Swedish nursing students. Main outcome variables were perceived stress (PSS), empathy (IRI subscales perspective taking, fantasy, empathic concern, and personal distress), and self-reflection (GRAS). Participating and control students completed questionnaires at baseline, post-intervention, at 6 and 12 months follow-up. Results: Seventy-four medical and 47 nursing students participated in the course. Participating medical students showed significantly increased empathic concern [1.42 (95% CI 0.05, 2.78), p = 0.042], increased fantasy [3.24 (95% CI 1.58, 4.90), p < 0.001], and decreased personal distress [−1.73 (95% CI −3.04, −0.35), p = 0.010] compared to controls until 12 months follow-up. Participating nursing students showed significantly decreased levels of perceived stress [−5.09 (95% CI −8.37, −1.82), p = 0.002] and decreased personal distress [−5.01 (95% CI −6.97, −3.06), p < 0.001] compared to controls until 12 months follow-up. Conclusions: This study demonstrated long-term beneficial effects of the MBM course on perceived stress and empathy in medical and nursing students.