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Secondary analysis of a national survey.The aim of this study was to investigate the prevalence, patterns, and predictors of chiropractic utilization in the US general population.Chiropractic is one of the largest manual therapy professions in the United States and internationally. Very few details have been reported about the use of chiropractic care in the United States in recent years.Cross-sectional data from the 2012 National Health Interview Survey (n = 34,525) were analyzed to examine the lifetime and 12-month prevalence and utilization patterns of chiropractic use, profile of chiropractic users, and health-related predictors of chiropractic consultations.Lifetime and 12-month prevalence of chiropractic use were 24.0% and 8.4%, respectively. There is a growing trend of chiropractic use among US adults from 2002 to 2012. Back pain (63.0%) and neck pain (30.2%) were the most prevalent health problems for chiropractic consultations and the majority of users reported chiropractic helping a great deal with their health problem and improving overall health or well-being. A substantial number of chiropractic users had received prescription (23.0%) and/or over-the-counter medications (35.0%) for the same health problem for which chiropractic was sought and 63.8% reported chiropractic care combined with medical treatment as helpful. Both adults older than 30 years (compared to younger adults), and those diagnosed with spinal pain (compared to those without spinal pain) were more likely to have consulted a chiropractor in the past 12 months.A substantial proportion of US adults utilized chiropractic services during the past 12 months and reported associated positive outcomes for overall well-being and/or specific health problems for which concurrent conventional care was common. Studies on the current patient integration of chiropractic and conventional health services are warranted.3.

Background: Special diets are frequently used by the public but reasons for use and characteristics of users remain unclear.AIM: To determine prevalence of the use of special diets, the individual characteristics associated with their use and reasons for use. Methods: The secondary analysis used data from the 2012 National Health Interview Survey (NHIS), a cross-sectional household interview survey of a nationally representative sample of non-hospitalized US adult populations ( n = 34,525). The dependent variables in this secondary analysis were the use of a special diet (vegetarian, macrobiotic, Atkins, Pritikin, and Ornish) ever and during the past 12 months. Independent variables included sociodemographic, clinical and behavioral variables. Prevalence of special diet use and reasons for use were analyzed descriptively. Associations between independent and dependent variables were analyzed using Chi-square tests and logistic regression. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Results: Lifetime and 12-month prevalence of using special diets were 7.5% (weighted n = 17.7 million) and 2.9% (weighted n = 6.9 million), respectively. Individuals using special diets in the past 12 months were more likely female (OR = 1.45; 95% CI = 1.21-1.74), not married (OR = 0.76; 95% CI = 0.63-0.91), college-educated (OR = 1.98; 95% CI = 1.25-3.11) and depressed (OR = 1.50; 95% CI = 1.14-1.98). They more likely also used herbal products (OR = 2.35; 95%CI = 1.84-2.99), non-vitamin (OR = 1.82; 95% CI = 1.45-2.27) and vitamin supplements (OR = 1.57; 95% CI = 1.24-1.99). Diets were mainly used to improve overall health (76.7%) or for general wellness/prevention (70.4%). Conclusions: Special diets are mainly used for unspecific health reasons by those who are females, have a college degree or with depression, and commonly used in conjunction with herbs and dietary supplements. Refereed/Peer-reviewed

Die Mind-Body-Medizin (MBM) nutzt gezielt die Interaktion zwischen Psyche, Korper und Verhalten, um somatische Erkrankungen und deren psychische Begleitsymptomatik supportiv zu behandeln. In der Onkologie fokussiert die MBM auf die Reduktion von Begleitsymptomen und Nebenwirkungen der kurativen oder adjuvanten Therapie. Zahlreiche Verfahren der MBM sind mittlerweile in wissenschaftlichen Studien evaluiert worden. So zeigten Metaanalysen, dass „mindfulness-based stress reduction“, ein achtsamkeitsbasiertes Gruppenprogramm, eine signifikante positive Wirkung auf Lebensqualitat, Fatigue, Schlafstorungen, Stress, Angst und Depressivitat bei Frauen mit Mammakarzinom ausubt. Ahnliches gilt fur Yoga: Ein aktueller Cochrane-Review fand positive Wirkungen auf Lebensqualitat und korperliche wie psychische Symptomatik bei Frauen mit Mammakarzinom. Die Wirkungen beider Methoden bei anderen Tumorentitaten sind jedoch unklar. Hypnotherapie reduzierte in randomisierten Studien Schmerz und Stress im Zusammenhang mit Brustbiopsien oder Lumpektomien sowie padiatrischen Lumbalpunktionen. Daneben finden sich positive Wirkungen auf mit Radiotherapie assoziierter Fatigue sowie menopausale Symptome bei Frauen unter antihormoneller Therapie. Die MBM kann insbesondere als multimodales Programm in die supportive Onkologie integriert werden. Im Rahmen klinischer Studien zeigten solche Programme positive Wirkungen auf korperliche und psychische Symptomatik bei gemischten onkologischen Patientengruppen. Da alle Einzelinterventionen sowie multimodale Programme effektiv und auch sicher zu sein scheinen, kann die MBM als sinnvolle supportive Erganzung in der Onkologie berucksichtigt werden.

© 2017 Wolters Kluwer Health, Inc. All rights reserved. Study Design. Secondary analysis of a randomized controlled trial. Objective. This secondary analysis aims to examine associations of improvement of chronic neck pain with patients' and intervention-related characteristics. Summary of Background Data. Previous research has found that Tai Chi and neck exercises significantly improved chronic nonspecific neck pain; however, the factors for treatment success remain unclear. Methods. Subjects with chronic nonspecific neck pain were randomly assigned to 12 weeks of group Tai Chi or conventional neck exercises, and they attended 12 weekly sessions of 60 to 90 minutes. The interventions included exercises to improve body awareness, that is, interoceptive and postural awareness. A linear forward stepwise regression analysis was conducted to examine associations with improvements in neck pain intensity. Potential predictor variables included baseline pain, age, sex, the type of intervention, attendance rate and home practice duration, and changes in psychological well-being, perceived stress, and postural and interoceptive awareness during the study. Results. Overall 75 patients were randomized into Tai Chi or conventional exercises, with the majority being women (78.7%). Participants reported an average pain intensity of 50.7±20.4 mm visual analog scale at baseline, and the average reduction of pain intensity in both groups was 21.4±21.3 mm visual analog scale. Regression analysis revealed that reductions in pain intensity from baseline to 12 weeks were predicted by higher pain intensity at baseline (r 2 =0.226, P

© 2017 John Wiley & Sons Ltd Background: Perceived stress seems to be a risk factor for exacerbation of ulcerative colitis. Yoga has been shown to reduce perceived stress. Aims: To assess the efficacy and safety of yoga for improving quality of life in patients with ulcerative colitis. Methods: A total of 77 patients (75% women; 45.5 ± 11.9 years) with ulcerative colitis in clinical remission but impaired quality of life were randomly assigned to yoga (12 supervised weekly sessions of 90 min; n = 39) or written self-care advice (n = 38). Primary outcome was disease-specific quality of life (Inflammatory Bowel Disease Questionnaire). Secondary outcomes included disease activity (Rachmilewitz clinical activity index) and safety. Outcomes were assessed at weeks 12 and 24 by blinded outcome assessors. Results: The yoga group had significantly higher disease-specific quality of life compared to the self-care group after 12 weeks (Δ = 14.6; 95% confidence interval=2.6–26.7; P = 0.018) and after 24 weeks (Δ = 16.4; 95% confidence interval=2.5–30.3; P = 0.022). Twenty-one and 12 patients in the yoga group and in the self-care group, respectively, reached a clinical relevant increase in quality of life at week 12 (P = 0.048); and 27 and 17 patients at week 24 (P = 0.030). Disease activity was lower in the yoga group compared to the self-care group after 24 weeks (Δ = −1.2; 95% confidence interval=−0.1−[−2.3]; P = 0.029). Three and one patient in the yoga group and in the self-care group, respectively, experienced serious adverse events (P = 0.317); and seven and eight patients experienced nonserious adverse events (P = 0.731). Conclusions: Yoga can be considered as a safe and effective ancillary intervention for patients with ulcerative colitis and impaired quality of life. Trial registration: ClinicalTrials.gov identifier: NCT02043600.

Objective The purpose of this review is to identify evidence in herbal therapy in the treatment of ADHD concerning effectiveness and drug tolerability. Method For this Medline/PubMed, Scopus and the Cochrane Central Register of Controlled Trials (Central) were searched from their inception to 15 July 2016. Only randomized controlled trails (RCT) with children (0–18years) suffering from ADHD were included in this review. Results Nine RCTs with 464 patients comparing herbal pharmaceuticals to placebo or active control were included. Seven different herbs were tested in the treatment of ADHD symptoms. Low evidence could be found for Melissa officinalis , Valeriana officinalis and Passiflora incarnata . Limited evidence could be found for pine bark extract and Gingko biloba. The other herbal preparations showed no efficacy in the treatment of ADHD symptoms. Conclusion While there is still a lack of sufficient numbers of RCTs no concrete recommendations for use can be made so far.

Hintergrund: Der Einsatz komplementarer Therapien in der Padiatrie stellt im Rahmen integrativer Programme eine sinnvolle Erganzung zur konventionellen Medizin dar. Aufgrund der hohen Nutzung pflanzlicher Praparate unter Kindern und Jugendlichen ist das Ziel dieser Ubersicht die systematische Aufarbeitung der Evidenzlage phytotherapeutischer Mittel im Bereich der Kinder- und Jugendmedizin. Methodik: Medline/PubMed, Scopus und die Cochrane Library wurden bis zum 15. Juli 2016 durchsucht. Nur randomisierte und kontrollierte Studien (RCTs) bei Kindern und Jugendlichen (0–18 Jahre) wurden eingeschlossen. Ergebnisse: Es konnten 86 randomisierte kontrollierte Studien mit insgesamt 8516 Teilnehmern in den Uberblick eingeschlossen werden, wobei die Spannweite der Probandenzahlen in den einzelnen Studien von 5 bis 647 reichte. Die am haufigsten untersuchten Indikationen waren hierbei gastroenterologische Erkrankungen, dermatolo­gische Erkrankungen sowie Infektionen der oberen und unteren Atemwege. Schlussfolgerung: Insgesamt ist festzustellen, dass trotz der starken Nutzung pflanzlicher Mittel in der padiatrischen Praxis und in der Selbstmedikation nur wenige randomisierte Studien mit einer nur geringen Stichprobengrose verfugbar sind. Diese Ubersicht zeigt auf, in welchen Bereichen der groste Forschungsbedarf besteht.

Background: In order to present recent findings on the effectiveness and safety of phytotherapy for treatment of osteoarthritis (OA) we summarized the two latest Cochrane reviews (Cameron & Chrubasik, 2013; Cameron & Chrubasik, 2014). One of them included oral and the other topical herbal treatment options as a treatment for OA. Methods: We conducted a thorough evaluation of the Cochrane reviews. We assessed methodological quality of the reviews and extracted evidence. Results: Meta-analyses found evidence for effects of the oral herbal products Boswellia serrata and only partially for avocado-soybean unsaponifiable (ASU). However, they included only a small number of primary studies. The systematic review on topical herbal treatments included fewer trials and did not include a meta-analysis. Discussion: Based on the qualitative syn­thesis Boswellia serrata can be applied in the treatment of OA. It is not clear if ASU can be recommended. No valid recommendation can be given for or against other herbal therapies due to a lack of randomized ­clinical trials in the field.

An estimated 15.7 million Germans are currently practicing yoga or are at least interested in starting to practice, and they often perceive yoga as a therapeutic approach. From a healthcare system perspective, the situation is less clear. Here, yoga is only recognized as a recreational or preventive activity. When yoga teachers fulfill specific qualifications, their preventive yoga classes are covered by the statutory health insurances. Only those with additional qualifications in medicine or psychotherapy, however, can independently use and promote “yoga therapy.” The general perception of yoga in Germany as a preventive practice is reflected in the professional organization of yoga providers. Most providers are considered to be yoga teachers rather than yoga therapists and are organized mainly in yoga teacher associations. Despite the uncertain legal framework, yoga is now considered in a number of medical guidelines; in a number of hospitals, yoga is part of multimodal inpatient treatment programs and is delivered by physical therapists or members of other health professions. An increasing number of yoga therapy clinical trials are conducted in Germany, and efforts are underway to establish yoga therapy as an accepted adjunct treatment approach for selected medical conditions within the German healthcare system.

Objectives To systematically assess the evidence of Craniosacral Therapy (CST) for the treatment of chronic pain. Methods PubMed, Central, Scopus, PsycInfo and Cinahl were searched up to August 2018. Randomized controlled trials (RCTs) assessing the effects of CST in chronic pain patients were eligible. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for pain intensity and functional disability (primary outcomes) using Hedges’ correction for small samples. Secondary outcomes included physical/mental quality of life, global improvement, and safety. Risk of bias was assessed using the Cochrane tool. Results Ten RCTs of 681 patients with neck and back pain, migraine, headache, fibromyalgia, epicondylitis, and pelvic girdle pain were included. CST showed greater post intervention effects on: pain intensity (SMD = -0.32, 95%CI = [− 0.61,-0.02]) and disability (SMD = -0.58, 95%CI = [− 0.92,-0.24]) compared to treatment as usual; on pain intensity (SMD = -0.63, 95%CI = [− 0.90,-0.37]) and disability (SMD = -0.54, 95%CI = [− 0.81,-0.28]) compared to manual/non-manual sham; and on pain intensity (SMD = -0.53, 95%CI = [− 0.89,-0.16]) and disability (SMD = -0.58, 95%CI = [− 0.95,-0.21]) compared to active manual treatments. At six months, CST showed greater effects on pain intensity (SMD = -0.59, 95%CI = [− 0.99,-0.19]) and disability (SMD = -0.53, 95%CI = [− 0.87,-0.19]) versus sham. Secondary outcomes were all significantly more improved in CST patients than in other groups, except for six-month mental quality of life versus sham. Sensitivity analyses revealed robust effects of CST against most risk of bias domains. Five of the 10 RCTs reported safety data. No serious adverse events occurred. Minor adverse events were equally distributed between the groups. Discussion In patients with chronic pain, this meta-analysis suggests significant and robust effects of CST on pain and function lasting up to six months. More RCTs strictly following CONSORT are needed to further corroborate the effects and safety of CST on chronic pain. Protocol registration at Prospero CRD42018111975.

© 2019 Jacobs Institute of Women's Health Objective: Depression is a common comorbidity in patients with cardiovascular conditions. This study aims to assess the association between comorbid depression and health-promoting behavior in middle-aged and older Australian women with hypertension or heart disease. Methods: Data are from a subset of 45 and Up Study participants with diagnosed chronic illness (n = 1,925). Health behaviors including smoking status, alcohol consumption, and physical activity were assessed. Associations of depression with health behaviors in women with hypertension or heart disease were analyzed using unadjusted and adjusted (for chronic conditions and demographic measures) logistic regression models. Results: A total of 666 women with hypertension and 220 women with heart disease were included in the analysis. In adjusted analyses, women with hypertension and comorbid depression were 2.36 (95% confidence interval, 1.02–5.46) times more likely to be risky or high-risk drinkers and 55% (adjusted odds ratio, 0.45; 95% confidence interval, 0.27–0.73) less likely to be highly physically active, compared with women without depression. Women with heart disease and comorbid depression were 65% (adjusted odds ratio, 0.35; 95% confidence interval, 0.12–0.95) less likely to be highly physically active, compared with women without depression. Conclusions: This study provides the first data indicating that depression may be a barrier to health-promoting behavior in middle-aged and older women with hypertension or heart disease. Given that physical inactivity and risky alcohol consumption are important risk factors for aggravation of cardiologic conditions, health-promoting behaviors should be specifically targeted in the treatment of women with comorbid depression.

Background and objectives: Complementary and alternative medicine (CAM) use has been associated with preventive health behaviors. However, the role of CAM use in patients&rsquo, health behaviors remains unclear. This study aimed to determine the extent to which patients report that CAM use motivates them to make changes to their health behaviors. Materials and Methods: This secondary analysis of 2012 National Health Interview Survey data involved 10,201 CAM users living in the United States who identified up to three CAM therapies most important to their health. Analyses assessed the extent to which participants reported that their CAM use motivated positive health behavior changes, specifically: eating healthier, eating more organic foods, cutting back/stopping drinking alcohol, cutting back/quitting smoking cigarettes, and/or exercising more regularly. Results: Overall, 45.4% of CAM users reported being motivated by CAM to make positive health behavior changes, including exercising more regularly (34.9%), eating healthier (31.4%), eating more organic foods (17.2%), reducing/stopping smoking (16.6% of smokers), or reducing/stopping drinking alcohol (8.7% of drinkers). Individual CAM therapies motivated positive health behavior changes in 22% (massage) to 81% (special diets) of users. People were more likely to report being motivated to change health behaviors if they were: aged 18&ndash, 64 compared to those aged over 65 years, of female gender, not in a relationship, of Hispanic or Black ethnicity, compared to White, reporting at least college education, compared to people with less than high school education, without health insurance. Conclusions: A sizeable proportion of respondents were motivated by their CAM use to undertake health behavior changes. CAM practices and practitioners could help improve patients&rsquo, health behavior and have potentially significant implications for public health and preventive medicine initiatives, this warrants further research attention.

Background/research question: Yoga positively affects health-related quality of life and disease activity in ulcerative colitis. The underlying modes of action remain unclear. Within the present study we hypothesized that patients´ perceived stress mediates the effects of yoga on health-related[for full text, please go to the a.m. URL], Nützliche patientenrelevante Forschung; 21. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin

Objectives: To determine the effectiveness and safety of yoga interventions on disease symptoms, quality of life and function in patients diagnosed with chronic obstructive pulmonary disease (COPD). Data sources: Medline/PubMed, Scopus, and CENTRAL (Cochrane Central Register of Controlled Trials) were searched through 6 June 2019. Review methods: Randomized controlled trials assessing the effects of yoga on quality of life, dyspnea, exercise capacity, and pulmonary function (FEV1) in patients with COPD were included. Safety was defined as secondary outcome. Mean differences (MD) and standardized mean differences (SMD) with 95% confidence intervals (CIs) were computed. Risk of bias was assessed using the Cochrane tool. Results: Eleven randomized controlled trials with a total of 586 patients were included. Meta-analysis revealed evidence for effects of yoga compared to no treatment on quality of life on the COPD Assessment Test (MD = 3.81; 95% CI = 0.97 to 6.65; P = 0.009, I2 = 70%), exercise capacity assessed by the 6-minute walk test (MD = 25.53 m; 95% CI = 12.16 m to 38.90 m; P = 0.001, I2 = 0%), and pulmonary function assessed by FEV1 predicted (MD = 3.95%; 95% CI = 2.74% to 5.17%; P 2 = 0%). Only the effects on exercise capacity and pulmonary function were robust against methodological bias. Effects were only present in breathing-focused yoga interventions but not in interventions including yoga postures. Adverse events were reported infrequently. Conclusion: This meta-analysis found robust effects of yoga on exercise capacity and pulmonary function in patients with COPD. Yoga, specifically yoga breathing techniques, can be an effective adjunct intervention for patients with COPD. Yoga’s safety needs to be assessed in more depth in future studies.

BACKGROUND: Headache disorders are currently the sixth leading cause of disability across the globe and therefore carry a significant disease burden. This systematic review and meta-analysis aims to investigate the effects of yoga on headache disorders. METHODS: MEDLINE/PubMed, Scopus, the Cochrane Library, and PsycINFO were screened through May 2019. Randomized controlled trials (RCTs) were included when they assessed the effects of yoga in patients with a diagnosis of chronic or episodic headache (tension-type headache and/or migraine). Usual care (no specific treatment) or any active treatments were acceptable as control interventions. Primary outcome measures were headache frequency, headache duration, and pain intensity. For each outcome, standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated. RESULTS: Meta-analysis revealed a statistically significant overall effect in favor of yoga for headache frequency (5 RCTs; standardized mean difference (SMD) = − 1.97; 95% confidence interval (CI) − 2.75 to − 1.20; I(2) = 63.0%, τ(2) = 0.25, P = 0.03), headache duration (4 RCTs; SMD = − 1.45; 95% CI − 2.54 to − 0.37; I(2) = 69.0%, τ(2) = 0.33, P = 0.02), and pain intensity (5 RCTs; SMD = − 3.43; 95% CI − 6.08 to − 0.70, I(2) = 95.0%, τ(2) = 4.25, P < 0.01). The significant overall effect was mainly due to patients with tension-type headaches. For patients with migraine, no statistically significant effect was observed. DISCUSSION: Despite discussed limitations, this review found preliminary evidence of short-term efficacy of yoga in improving headache frequency, headache duration, and pain intensity in patients suffering from tension-type headaches. Further studies are urgently needed to draw deeper conclusions from the available results.

© 2019 The Author(s). Background: Distortion of taste sensations is a common chemotherapy-induced side effect; however, treatment evidence is limited. Pilot data indicated that acupuncture might be able to improve symptoms of dysgeusia. Thus, the aim of this study is to investigate the effects and side effects of hypoglossal acupuncture in the treatment of dysgeusia in patients with breast cancer undergoing chemotherapy. Methods/design: The study is a randomized controlled trial comparing a single verum acupuncture treatment with two active comparators: sham acupuncture and dietary recommendations. Sample size calculation revealed a total of 75 patients pending an alpha of 0.05, a power of 0.8, and an estimated effect size of 0.80. Patients with breast cancer undergoing platinum- or taxane-based chemotherapy will be included if they present with phantogeusia (abnormal taste sensations without an external oral stimulus) with an intensity of 4 points or above on an 11-point numeric rating scale (NRS). The primary outcome is phantogeusia; secondary outcomes include parageusia (abnormal taste of food), hypogeusia (reduced taste sensations), hypergeusia (increased taste sensations), xerostomia (dry mouth), stomatitis, appetite, and functional impairment. All outcomes will be assessed at baseline and prior to the next chemotherapy administration using an 11-point NRS for each. All adverse events will be recorded. Discussion: The results of this study will demonstrate the extent to which hypoglossal acupuncture may influence the intensity of and functional impairment due to chemotherapy-induced dysgeusia. Trial registration: Clinical Trials.gov, NCT02304913. Registered on 19 November 2014.

Objectives To assess the prevalence of Christmas-related injuries for Santa Claus, Santa’s helpers, Santa impersonators and Christmas revellers. Methods Data were obtained from the US using National Electronic Injury Surveillance System (NEISS), a national probability sample of U.S. hospitals with 24-hour accident and emergency services. Data from 2007 to 2016 were analysed regarding emergency visits involving injuries related to Christmas products, and weighted prevalence and patterns of Christmas-related injuries were reported. Results No injuries directly affecting Santa Claus, Santa Claus’ helpers, or Santa impersonators were identified. U.S.-wide, 277 children were injured by Santa impersonators. Further injuries were reported in association with artificial Christmas trees (17,928 injuries), real Christmas trees (2216 injuries), Christmas tree stands/supports (2839 Injuries), tree lights (31,855 injuries), electrical decorations (36,054 injuries), non-electrical decorations (80,208 injuries), and Christmas presents (2305 injuries). Almost all injuries occurred in Caucasians and injuries were most common in children, adults aged 30–60, and in those aged 70 or older. Injuries related to electrical Christmas decorations were more common in males; those related to non-electrical Christmas decorations were more common in females. Conclusions Despite inherent dangers associated with his work, Santa Claus appears to be safe and is not responsible for Christmas-related injuries. In contrast, the considerable safety hazards of Santa impersonation practices and Christmas products require further investigation.

Background Being a major health risk and very prevalent in the population, sleep problems are an important health care issue. Methods We used the 2017 National Health Interview Survey (NHIS) to study the prevalence of sleep problems and the use of mind body medicine (MBM) among individuals with sleep problems in a representative sample of the US population (N = 26,742). Using chi-squared tests and backward stepwise multiple logistic regression analyses, predictors of sleep problems and of MBM use in the past 12 months were identified. Results The prevalence of sleep problems was 49.3%, with higher prevalence being associated with higher age, being female, being non-Hispanic White, and higher education. Among individuals with sleep problems, 29.8% used MBM vs. only 17.5% without. Being less than 30 years of age, female, non-Hispanic White, living in the Western US, having a higher education, and being diagnosed with heart disease predicted MBM use among individual's with sleep problems. Yoga (16.3%), spiritual meditation (13.6%), and mindfulness meditation (7.5%) were the most used MBM approaches. Conclusion The characteristics of individuals with sleep problems were largely in line with the literature, while notably Whites were more prone to sleep problems than other ethnicities. MBM treatments commonly used were yoga, spiritual meditation and mindfulness meditation; although evidence supports its use for sleep problems, tai chi was used rarely by the wider population. Further studies should explore reasons for ethnical differences in MBM use and why some effective MBM approaches are not commonly used.

© 2019, Springer Science+Business Media, LLC, part of Springer Nature. Purpose of Review: This study aims to systematically review and summarise the efficacy and safety of yoga for osteoarthritis. Medline (through PubMed), Scopus, and the Cochrane Library were searched through April 2018 for randomised controlled trials of yoga for osteoarthritis. Primary outcomes were pain intensity, function, and quality of life; secondary outcomes were mental health and safety. Risk of bias was assessed using the Cochrane tool and quality of evidence through GRADE. Recent Findings: Nine trials including 640 individuals with mainly lower extremity osteoarthritis aged 50–80 years were identified, with 80.3% female participants (median). Meta-analyses revealed very low–quality evidence for the effects of yoga on pain (vs. exercise: standardised mean difference (SMD) = − 1.07; 95%CI − 1.92, − 0.21; p = 0.01; vs. non-exercise: SMD = − 0.75; 95%CI − 1.18, − 0.31; p < 0.001), physical function (vs. exercise: SMD = 0.80; 95%CI 0.36; 1.24; p < 0.001; vs. non-exercise: SMD = 0.60; 95%CI 0.30, 0.98; p < 0.001), and stiffness (vs. exercise: SMD = − 0.92; 95%CI − 1.69, − 0.14; p = 0.008; vs. non-exercise: SMD = − 0.76; 95%CI − 1.26, − 0.26; p = 0.003) in individuals with knee osteoarthritis. Effects were not robust against potential methodological bias. No effects were found for quality of life, and depression, or for hand osteoarthritis. Safety was rarely reported. Summary: The findings of this meta-analysis indicate that yoga may be effective for improving pain, function, and stiffness in individuals with osteoarthritis of the knee, compared to exercise and non-exercise control groups. Due to the low methodological quality and potential risk of bias, only a weak recommendation can be made at this time for the use of yoga in adults with osteoarthritis of the knee.

The efficacy of Pelargonium sidoides preparation EPs 7630 in the common cold (CC) was assessed by performing meta-analyses of randomized, double-blind, placebo-controlled trials. Mean differences (MD) and risk ratios (RR) with their 95% confidence intervals (CI) were computed. Five trials with a total of 833 patients were included. All trials had a treatment period of ten days with visits at days 3, 5, and 10 after baseline and used a ten-symptom Cold Intensity Score (CIS) as the primary outcome. Significant differences favoring EPs 7630 were observed for total CIS reduction (day 5: MD = -2·30; 95%CI = -4·12,-0·49; day 10: MD = -1·16; 95%CI = -2·22,-0·10), proportion of patients with substantial improvement (day 5: RR = 1·73; day 10: RR = 1·06) and complete remission (day 5: RR = 2·52; day 10: RR = 2·13). Subjects treated with EPs 7630 missed fewer days at work, used less paracetamol and had an improved sleep quality. No serious adverse reactions to EPs 7630 were reported. The results support the efficacy of EPs 7630 in adults with CC., Respiratory system; Infectious disease; Pharmacology; Evidence-based medicine; Clinical research; Common cold, Efficacy, EPs 7630, Meta-analysis, Pelargonium sidoides, Safety

© 2019 Background and purpose: This prospective observational study aimed to investigate the effects of an interdisciplinary multimodal integrated care program in patients with chronic migraine and/or tension-type headache. Materials and methods: Patients (n = 158) underwent inpatient, outpatient and/or semi-stationary treatment including conventional as well as complementary headache treatment. Headache frequency was defined as the primary outcome; secondary outcomes included pain (VAS, PPS), medication use, quality of life (SF-36), function (HDI, PSFS), depression and anxiety (HADS), and pain self-efficacy (PSEQ). Results: Headache frequency decreased from 17.0 ± 8.8 days/month at treatment start to 11.4 ± 9.2 at treatment end and to 10.6 ± 9.3 at 6-month follow-up (p < 0.001). All other outcome measures also improved across the course of the study (all p < 0.001). Conclusions: An integrated care approach based on integrative medicine improved headache symptoms and functioning in patients with chronic migraine and/or tension-type headache. Interdisciplinary multimodal treatment approaches seem to adequately address the specific treatment needs of headache patients.

© 2019 Elsevier Ltd Background: The question of whether yoga practice ameliorates or even aggravates eating disorders is currently under debate. The aim of this review was to systematically assess and the effectiveness and safety of yoga in patients with eating disorders. Methods: Medline/PubMed, PsycINFO, and the Psychological and Behavioral Science Collection were screened through July 2018 for randomized controlled trials, non-randomized controlled trials and longitudinal observational studies on yoga for patients with eating disorders and other individuals with disordered eating and/or body dissatisfaction. Risk of bias was assessed using the Cochrane risk of bias tool and the Newcastle-Ottawa Quality Assessment Scale. Results: Eight randomized trials and four uncontrolled trials involving a total of 495 participants were included. Risk of bias was mixed. Comparing yoga to untreated control groups, effect sizes ranged from negligible effects of d = 0.02 to very large effects of d = 2.15. However, most effects were small to moderately sized and in most cases not significant. No safety-related data were reported. Conclusions: There is limited evidence on the effectiveness and safety of yoga in patients with eating disorders. Yoga can be preliminarily considered as an additional treatment option in multimodal psychiatric treatment programs.

ObjectivesAs clinical practice guidelines vary widely in their search strategies and recommendations of complementary and alternative medicine (CAM) for depression, this overview aimed at systematically summarising the level 1 evidence on CAM for patients with a clinical diagnosis of depression.MethodsPubMed, PsycInfo and Central were searched for meta-analyses of randomised controlled clinical trials (RCTs) until 30 June 2018. Outcomes included depression severity, response, remission, relapse and adverse events. The quality of evidence was assessed according to Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) considering the methodological quality of the RCTs and meta-analyses, inconsistency, indirectness, imprecision of the evidence and the potential risk of publication bias.ResultsThe literature search revealed 26 meta-analyses conducted between 2002 and 2018 on 1–49 RCTs in major, minor and seasonal depression. In patients with mild to moderate major depression, moderate quality evidence suggested the efficacy of St. John’s wort towards placebo and its comparative effectiveness towards standard antidepressants for the treatment for depression severity and response rates, while St. John’s wort caused significant less adverse events. In patients with recurrent major depression, moderate quality evidence showed that mindfulness-based cognitive therapy was superior to standard antidepressant drug treatment for the prevention of depression relapse. Other CAM evidence was considered as having low or very low quality.ConclusionsThe effects of all but two CAM treatments found in studies on clinical depressed patients based on low to very low quality of evidence. The evidence has to be downgraded mostly due to avoidable methodological flaws of both the original RCTs and meta-analyses not following the Consolidated Standards of Reporting Trials and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Further research is needed.

© 2019 American Academy of Physical Medicine and Rehabilitation Background: The use of complementary and alternative medicine (CAM) therapies have been reported for the management of arthritis. However, little is known about CAM use among adults with self-reported doctor-diagnosed arthritis. Objectives: To determine (1) the prevalence and type of CAM use, (2) the difference in characteristics between CAM users and non-CAM users, and (3) the factors related to CAM use, among U.S. adults with self-reported doctor-diagnosed arthritis. Design: Secondary analysis of the 2012 National Health Interview Survey (NHIS) data. Setting: The NHIS is a cross-sectional survey that gathers health-related data on the civilian, noninstitutionalized U.S. population. Participants: The NHIS 2012 uses a complex, multistage sampling design and oversamples minorities to achieve population representation; it included 34 525 adults, with 7179 adults having arthritis. Methods: Data were analyzed using Stata 15.1 survey syntax. The potential factors related to CAM use included sociodemographics and health-related characteristics. Main Outcome Measurements: CAM modalities were categorized into six groups: natural products, manipulative therapies, mind-body therapies, special diets, movement therapies, and other practitioner-based CAM modalities. Results: Of the adults with arthritis, 2428 (weighted estimate of 36.2% of U.S. adult population) had used CAM within the last year. Adults with arthritis reported greater use of CAM than those without, particularly the use of natural products, manipulative therapies and other practitioner-based CAM modalities. Factors associated with higher CAM use included being female, residing in regions other than the U.S. South, having a college degree or higher, reporting very good/excellent self-rated health status, and having current symptoms of joint stiffness/pain. Conclusion: As more than one-third of U.S. adults with arthritis seek CAM therapies, open and nonjudgmental conversations between conventional medicine providers, CAM providers, and patients should be encouraged to ensure patient health care needs are being met. Level of Evidence: III.

Background - While yoga can improve health-related variables and health behavior, different yoga styles and practice components appear to be associated with specific health outcomes. The aim of this study was to explore the connection between yoga use, health, and health behaviors across different yoga styles.Methods - A cross-sectional anonymous online survey (n = 1,702; 88.9% female; 93.3% German nationality; mean age 47.2 ± 10.8 years; 58.2% yoga teachers) assessed yoga practice characteristics, health-related variables and health behavior. The survey was distributed in Germany only but not limited to German participants.Results - Ashtanga yoga (15.7%), Hatha yoga (14.2%), and Sivananda yoga (22.4%) were the most commonly practiced yoga styles; participants practiced for a mean of 12.7 ± 10.0 years. Most participants had good to excellent (96.1%) overall health; 87.7% reported improved health since starting yoga. Controlling for sociodemographic and clinical factors, health-related variables were mainly associated with frequency of yoga postures practice (p Conclusion - Yoga practitioners generally have a good overall health and a healthy lifestyle. While health variables are mainly associated with practice of yoga postures, health behaviors are also associated with the study of yoga philosophy. Yoga interventions targeting prevention or health promotion should include yoga philosophy to modify health behaviors. The specific yoga style employed may also influence health outcomes.

In evidence-based medicine, meta-analyses are often considered to provide an exceptionally high level of evidence. Beyond other systematic review formats, meta-analyses allow for statistically pooling results of original research. This approach allows us to increase statistical power, improve precision, investigate heterogeneity, and settle controversies across different clinical trials. However, meta-analysis requires rigour in methodology, in order to avoid "mixing apples and oranges". Study design, participants, interventions, comparators, and outcomes need to be clearly defined, and statistical methods need to be applied precisely. For researchers in specialized fields such as integrative medicine, additional considerations on the unique features of therapies need to be applied. This article describes practical and academic insights into preparing a meta-analysis for publication.

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Objectives: Osteoarthritis (OA) of the knee is one of the most common chronic diseases among older adults. This study aimed to test the effects of cabbage leaf wraps (CLWs) in the treatment of symptomatic OA. Methods: Patients with OA of the knee at stages II to III (Kellgren-Lawrence) were randomly assigned to 4 weeks of treatment with CLWs (daily for at least 2h), topical pain gel (TPG) (10mg diclofenac/g, at least once daily), or usual care (UC). The primary outcome measure was pain intensity (VAS) after 4 weeks. Secondary outcomes included functional disability Western Ontario and McMaster Universities Arthritis Index (WOMAC), quality of life (SF-36), self-efficacy (Arthritis Self-Efficacy Scale-D), physical function (30 s Chair Stand Test), pressure pain sensitivity (PPT), satisfaction, and safety after 4 and 12 weeks. Results: In total, 81 patients were included in this study (42 women, 65.9±10.3 y). After 4 weeks patients in the CLW group reported significantly less pain compared with those in the UC group (difference, -12.1; 95% [confidence interval] CI, -23.1, -1.0; P=0.033) but not when compared with the TPG group (difference, -8.6; 95% CI, -21.5, 4.4; P=0.190). Significant effects were also found in WOMAC, SF-36, 30-second Chair Stand Test, and PPT scores in the CLW group compared with the UC group. Compared with TPG, effects from CLW were found for WOMAC after 4 weeks and for quality of life after 12 weeks. Patients were satisfied with both active interventions, and except for 2 adverse events in both groups the applications were well tolerated. Conclusions: CLWs are more effective for knee OA than UC, but not compared with diclofenac gel. Therefore, they might be recommended for patients with OA of the knee. Further research is warranted.

© 2016 Elsevier Ltd. Objective: To determine whether the odds of positive conclusions in randomized controlled trials (RCTs) of yoga, differ between yoga styles. Design: Systematic review of yoga RCTs. Medline/PubMed, Scopus, the Cochrane Library, IndMED and the tables of content of specialist yoga journals, not listed in medical databases, were screened up to 12 February, 2014 for RCTs comparing yoga interventions to non-yoga interventions. The RCTs' conclusions were classified as positive (yoga is helpful for a respective condition) or not positive; and these were compared between different yoga styles using the Chi squared test and multiple logistic regression analysis. Results: A total of 306 RCTs were included. These applied 52 different yoga styles, the most commonly used of which were: hatha yoga (36 RCTs), Iyengar yoga (31 RCTs), pranayama (26 RCTs), and the integrated approach to yoga therapy (15 RCTs). Positive conclusions were reached in 277 RCTs (91%); the proportion of positive conclusions did not differ between yoga styles (p = 0.191). Conclusion: RCTs with different yoga styles do not differ in their odds of reaching positive conclusions. Given that most RCTs were positive, the choice of an individual yoga style can be based on personal preferences and availability.

Herbal medicine is a promising alternative in the treatment of acute rhinosinusitis (ARS). We performed a systematic review for phytopharmaceutical treatments of ARS. A computerized search of databases (Cochrane Library, PubMed, and Scopus) up to 16 September 2015 was performed. Randomized controlled trials (RCTs) and controlled trials (CTs) were included and assessed using the Cochrane risk of bias tool. Seven trials on Pelargonium sidoides (EPs 7630, Umckaloabo®), Myrtol (GeloMyrtol® forte), BNO 1016 (Sinupret® extract), BNO 101 (Sinupret®), Cyclamen europaeum (Nasodren®), and Esberitox® were included. Risk of bias was heterogeneous. EPs 7630 appeared to be useful in the treatment of ARS. Myrtol showed benefits against a placebo compound, and BNO 1016 and BNO 101 might be helpful; however, there was little evidence for the effectiveness of Cyclamen europaeum and Esberitox®. Herbal medicine might be effective for the treatment of ARS, but given the low number of clinical trials and the heterogeneous methodological quality, further research is necessary.

Mindfulness- and acceptance-based interventions are increasingly studied as a potential treatment for a variety of mental conditions.To assess the effects of mindfulness- and acceptance-based interventions on psychotic symptoms and hospitalization in patients with psychosis.MEDLINE/PubMed, Embase, the Cochrane Library, and PsycINFO were screened from inception through April 2015. Randomized controlled trials (RCTs) were analyzed when they assessed psychotic symptoms or hospitalization in patients with psychosis; affect, acceptance, mindfulness, and safety were defined as secondary outcomes.Eight RCTs with a total of 434 patients comparing mindfulness-based (4 RCTs) or acceptance-based interventions (4 RCTs) to treatment as usual or attention control were included. Six RCTs had low risk of bias. Moderate evidence was found for short-term effects on total psychotic symptoms, positive symptoms, hospitalization rates, duration of hospitalization, and mindfulness and for long-term effects on total psychotic symptoms and duration of hospitalization. No evidence was found for effects on negative symptoms, affect, or acceptance. No serious adverse events were reported.Mindfulness- and acceptance-based interventions can be recommended as an additional treatment for patients with psychosis.背景：作为各种精神疾病的潜在治疗，基于正念和无怨接受的干预正得到越来越多的研究。目的：评估基于正念和无怨接受的干预对精神病患者的精神病症状和住院治疗的影响方法：从开始到 2015 年 4 月筛选了MEDLINE/PubMed、Embase, Cochrane Library 和 PsycINFO。评估精神病患者的精神病症状或住院治疗时，分析了随机对照试验 (Randomized Controlled Trial, RCT)；情绪反应、无怨接受、正念以及安全被定义为次要结果。结果：包括 8 项 RCT，共计 434名患者，对基于正念（4 项 RCT）或基于无怨接受（4 项 RCT）的干预与常规治疗或注意力控制进行了比较。6 项 RCT 具有低偏倚风险。发现了对总体精神病症状、阳性症状、住院率、住院持续时间和正念具有短期影响，对总体精神病症状和住院持续时间具有长期影响的适度证据。未发现对阴性症状、情绪反应或无怨接受有影响的证据。未曾报告严重不良事件。结论：基于正念和无怨接受的干预可推荐为精神病患者的附加治疗。.Las intervenciones basadas en la conciencia plena y la aceptación se estudian cada vez más como posible tratamiento para varios trastornos mentales.Evaluar los efectos de las intervenciones basadas en la conciencia plena y la aceptación en los síntomas psicóticos y en la hospitalización de los pacientes con psicosis.Se examinaron MEDLINE/PubMed, Embase, la bibliografía de Cochrane y PsycINFO desde su creación hasta abril de 2015. Se analizaron los ensayos aleatorizados comparativos (EAC) que evaluaban los síntomas psicóticos o la hospitalización de los pacientes con psicosis; como resultados secundarios se definieron el afecto, la aceptación, la conciencia plena y la seguridad.Se incluyeron ocho EAC con un total de 434 pacientes que comparaban las intervenciones basadas en la conciencia plena (4 EAC) o las intervenciones basadas en la aceptación (4 EAC) con el tratamiento normal o con el control de atención. Seis EAC tuvieron un bajo riesgo de sesgos. Se observaron evidencias moderadas para los efectos a corto plazo de los síntomas psicóticos totales, los síntomas positivos, los índices de hospitalización, la duración de la hospitalización y la conciencia plena y para los efectos a largo plazo de los síntomas psicóticos totales y la duración de la hospitalización. No se observaron evidencias en los efectos sobre los síntomas negativos, el afecto o la aceptación. No se comunicaron acontecimiento adversos graves.Las intervenciones basadas en la conciencia plena y la aceptación pueden recomendarse como tratamiento adicional para los pacientes con psicosis.

Entspannungstechniken und die Schulung der Wahrnehmung sind die wichtigsten Elemente der Mind-Body-Medizin. Sie helfen Schmerzpatienten, Einfluss auf ihre Symptome zu nehmen.

12066 Background: Among females, breast cancer is the most commonly diagnosed cancer worldwide. Sleep problems impair 40 to 70 % of breast cancer survivors. The aim of this randomized controlled trial was to evaluate the effect of ear acupuncture on sleep quality in breast cancer survivors. Methods: Fifty-two female breast cancer survivors (mean age 55.73 ± 8.10) were randomized to either 10 treatments of ear acupuncture within five weeks (N = 26) or to a single session of psycho-education and given an advice booklet concerning insomnia (N = 26). Both interventions were delivered in a group setting. Primary outcome was sleep quality (measured by the Pittsburgh Sleep Quality Index) at week 5 corrected for treatment expectancies. Secondary outcomes were inflammation parameters (interleukin-6) at week 5, sleep quality at week 17, and stress, anxiety, depressive symptoms, quality of life and fatigue 5 weeks and 17 weeks after randomization. Results: Intention-to-treat analysis showed a significantly stronger increase of sleep quality in the ear acupuncture group compared to the psycho-education group ( p= .031; d = 0.64) at week 5. Furthermore, ear acupuncture improved stress ( p= .030; d = 0.64), anxiety ( p = .001; d = 0.97), and fatigue ( p = .012; d = 0.75) at week 5 compared to psycho-education. No significant group difference was found on any outcome at week 17. No serious adverse events occurred during the study period. Conclusions: Group ear acupuncture may be a helpful intervention in tackling sleep problems in breast cancer survivors in the short term and may reduce stress, anxiety and fatigue as well. Long-term effects remain questionable. Clinical trial information: NCT03874598 .

© 2019 American Cancer Society Background: Sleep problems affect physical and emotional well-being as well as immune system function. Evidence has demonstrated an improvement in sleep problems in patients with cancer through the use of mind-body medicine (MBM). In the current study, the authors sought to elucidate the prevalence of sleep problems and the use of MBM in adult cancer survivors. Methods: The authors analyzed data from the 2017 US National Health Interview Survey (NHIS) to estimate the prevalence of sleep problems and use of MBM in adult cancer survivors using means, standard deviations, weighted frequencies, and distributions. Backward stepwise multiple logistic regression analyses were used to identify independent predictors of MBM use within the past 12 months: age, sex, ethnicity, region, educational level, employment, and time since cancer diagnosis. Results: A weighted total of 13,750,028 cancer survivors (59.2%) reported sleep problems. For the most part, survivors with sleep problems were aged ≥40 years, female, and non-Hispanic white. More survivors with (weighted N = 3,794,493; 27.6%) compared with without (weighted N = 1,695,435; 17.9%) sleep problems used MBM. Among cancer survivors with sleep problems, the most commonly used mind-body practice was spiritual meditation (weighted N = 1,972,578; 14.3%), followed by yoga (weighted N = 1,695,553; 17.9%). The use of MBM was independently predicted by being female, living in the western United States, having a higher educational level, and being employed. Conclusions: The high prevalence of sleep problems in cancer survivors is a major health issue that needs to be addressed. A considerable number of cancer survivors with sleep problems use MBM. This finding warrants the investigation of MBM concepts as treatment options for cancer survivors experiencing sleep problems.

© 2018 Objective: To test the efficacy of Gua Sha therapy in patients with chronic low back pain. Methods: 50 patients with chronic low back pain (78% female, 49.7 ± 10.0 years) were randomized to two Gua Sha treatments (n = 25) or waitlist control (n = 25). Primary outcome was current pain intensity (100-mm visual analog scale); secondary outcome measures included function (Oswestry Disability Index), pain on movement (Pain on Movement Questionnaire), perceived change in health status, pressure pain threshold, mechanical detection threshold, and vibration detection threshold. Results: After treatment, patients in the Gua Sha group reported lower pain intensity (p < 0.001) and better overall health status (p = 0.002) compared to the waitlist group. No further group differences were found. No serious adverse events occurred. Conclusions: Gua Sha appears to be an acceptable, safe, and effective treatment for patients with chronic low back pain. Further rigorous studies are needed to confirm and extend these results.

Objective Chronic neck pain is a common problem that affects approximately half of the population. Conventional treatments such as medication and exercise have shown limited analgesic effects. This analysis is based on an original study that was conducted to investigate the physical and behavioral effects of a 9-week Iyengar yoga course on chronic non-specific neck pain. This secondary analysis uses linear mixed models to investigate the individual trajectories of pain intensity in participants before, during and after the Iyengar yoga course. Method Participants with chronic non-specific neck pain were selected for the study. The participants suffered from neck pain for at least 5 days per week for at least the preceding 3 months, with a mean neck pain intensity (NPI) of 40 mm or more on a Visual Analog Scale of 100 mm. The participants were randomized to either a yoga group (23) or to a self-directed exercise group (24). The mean age of the participants in the yoga group was 46, and ranged from 19 to 59. The participants in the yoga group participated in an Iyengar yoga program designed to treat chronic non-specific neck pain. Our current analysis only includes participants who were initially randomized into the yoga group. The average weekly neck pain intensity at baseline, during and post intervention, comprising 11 total time points, was used to construct the growth models. We performed a step-up linear mixed model analysis to investigate change in NPI during the yoga intervention. We fit nested models using restricted maximum-likelihood estimation (REML), tested fixed effects with Wald test p-values and random effects with the likelihood ratio test. We constructed 10 REML models. Results The model that fit the data best was an unconditional random quadratic growth model, with a first-order auto-regressive structure specified for the residual R matrix. Participants in the yoga group showed significant variation in NPI. They demonstrated variation in their intercepts, in their linear rates of change, and most tellingly, in their quadratic rates of change. Conclusions While all participants benefitted from the yoga intervention, the degree to which they benefitted varied. Additionally, they did not experience a consistent rate of reduction in NPI − their NPI fluctuated, either increasing and then decreasing, or vice-versa. We comment on the clinical and research implications of our findings.

Background and purpose Yoga and meditation are predominantly utilised by healthy well-educated young women, but little is known about utilisation by older chronically ill women. Therefore, the purpose of this study was to investigate the characteristics of yoga and meditation use among middle-to-higher aged Australian women with chronic conditions. Materials and methods This is a sub-study of the 45 and Up Study including 1925 Australian women aged 53–95 years diagnosed with chronic conditions (asthma, depression, diabetes, osteoarthritis, and osteoporosis). Information on yoga and meditation use frequencies (categories: ‘no yoga’, ‘at least once daily’, ‘at least once weekly’, and ‘at least once monthly’), self-perceived effectiveness and communication with health care providers were assessed via self-report. Logistic regression analyses were conducted to identify independent predictors of yoga and meditation use, using SPSS 24.0. Results Overall 6.8% and 10.7% of women reported the use of yoga and meditation respectively. Meditation was rarely practiced supervised (11.7%), compared to significant higher rates in yoga (53.2%). Predictors for yoga and meditation use were marital status (married/in relationship > not married/in relationship), higher health related hardiness, and higher education, whereas obesity, and diabetes decreased likelihood of use. While the majority found yoga and meditation helpful for their condition, the use was rarely monitored by or discussed with health care practitioners. Conclusion This study finds that yoga and meditation are used by middle-to-higher aged Australian women with chronic illnesses. The lack of communication with health care providers is concerning and might hinder coordinated and effective health care around chronic illness. Further research is necessary to help understand possible concurrent health care use and thereby help inform safe, effective and coordinate health seeking amongst those with chronic illness.

© 2018 Elsevier Ltd Stress demonstrably contributes to disease course in patients with inflammatory bowel diseases but the underlying mechanisms remain elusive. Here, we investigated if neuroendocrine regulation of pro- and anti-inflammatory cytokine production by peripheral blood immune cells is altered in patients with ulcerative colitis in remission (UCR). Using a whole blood stimulation assay, we measured the sensitivity of lipopolysaccharide (LPS)-induced TNF-α and IL-10 production to the glucocorticoid receptor agonist dexamethasone (DEX), the β 2 -adrenergic receptor agonist terbutaline (TERB), and the α7-nicotinic acetylcholine receptor agonist 3-[2,4-dimethoxy-benzylidene]-anabaseine (GTS-21) in UCR patients (N = 26) and in healthy controls (HC, N = 25). Additionally, we assessed anxiety and depression symptoms as well as chronic perceived stress and disease-specific quality of life. Results showed that UCR patients exhibited greater anxiety, depression and chronic stress levels than HC, and reduced disease-specific quality of life. Plasma concentrations of TNF-α IL-8, C-reactive protein (CRP) and lipopolysaccharide binding protein (LBP) were significantly higher, while LPS-induced IL-10 production was substantially lower in UCR compared to HC. Independent of group, DEX and GTS-21 dose-dependently inhibited TNF-α and IL-10 production, whereas TERB inhibited TNF-α and upregulated IL-10 production. However, at higher TERB doses (i.e., stress levels), upregulation of IL-10 production was significantly diminished in UCR compared to HC. Together, these findings demonstrate that downregulation of pro-inflammatory cytokine production in peripheral blood immune cells through glucocorticoid, adrenergic, and cholinergic mechanisms is essentially normal in UC in clinical remission and as efficient as in healthy individuals. However, UCR patients exhibited signs of systemic low-grade inflammation and dysregulation of anti-inflammatory IL-10 production. Impaired adrenergic upregulation of IL-10 production during remission could be one mechanism how stress facilitates relapse and conversion to symptomatic disease in these patients.

Complementary and Alternative Medicine (CAM) has not been systematically institutionalized in pediatric hospital care in Germany so far. For the responsible implementation and systematic evaluation of CAM in pediatric care, a model project was initialized in three different pediatric hospitals in Germany, one of them being the &ldquo, Kinderkrankenhaus St. Marien&rdquo, in Landshut, Germany. During this project, a concept of the implementation process was developed based on clinical care, teaching, and scientific evaluation. A project group was formed in St. Marien, which included leaders of the hospital, physicians, nurses, and physiotherapists. Over a period of three years, pediatric treatment modalities of the CAM-spectrum were systematically integrated into routine pediatric care and a new integrative medicine department was established. CAM is now being applied in an inpatient as well as outpatient setting, in addition to conventional medical treatments. The modalities now applied include Traditional Chinese Medicine (TCM), relaxation, hypnosis, reflexology, wraps and poultices, aromatherapy, homeopathy, yoga, and herbal medicine. Studies were initiated in some areas. The process and concept leading up to this successful implementation will be described in this article. We show that with motivated team players and structured proceedings, implementation of integrative medicine in a children&rsquo, s hospital can be successful.

BackgroundMindfulness-based stress reduction/cognitive therapy are frequently used for pain-related conditions, but their effects on headache remain uncertain. This review aimed to assess the efficacy and safety of mindfulness-based stress reduction/cognitive therapy in reducing the symptoms of chronic headache.Data sources and study selectionMEDLINE/PubMed, Scopus, CENTRAL, and PsychINFO were searched to 16 June 2017. Randomized controlled trials comparing mindfulness-based stress reduction/cognitive therapy with usual care or active comparators for migraine and/or tension-type headache, which assessed headache frequency, duration or intensity as a primary outcome, were eligible for inclusion. Risk of bias was assessed using the Cochrane Tool.ResultsFive randomized controlled trials (two on tension-type headache; one on migraine; two with mixed samples) with a total of 185 participants were included. Compared to usual care, mindfulness-based stress reduction/cognitive therapy did not improve headache frequency (three randomized controlled trials; standardized mean difference = 0.00; 95% confidence interval = −0.33,0.32) or headache duration (three randomized controlled trials; standardized mean difference = −0.08; 95% confidence interval = −1.03,0.87). Similarly, no significant difference between groups was found for pain intensity (five randomized controlled trials; standardized mean difference = −0.78; 95% confidence interval = −1.72,0.16).ConclusionsDue to the low number, small scale and often high or unclear risk of bias of included randomized controlled trials, the results are imprecise; this may be consistent with either an important or negligible effect. Therefore, more rigorous trials with larger sample sizes are needed.

© 2018 Wiley Periodicals, Inc. Yoga has become a popular approach to improve emotional health. The aim of this review was to systematically assess and meta-analyze the effectiveness and safety of yoga for anxiety. Medline/PubMed, Scopus, the Cochrane Library, PsycINFO, and IndMED were searched through October 2016 for randomized controlled trials (RCTs) of yoga for individuals with anxiety disorders or elevated levels of anxiety. The primary outcomes were anxiety and remission rates, and secondary outcomes were depression, quality of life, and safety. Risk of bias was assessed using the Cochrane tool. Eight RCTs with 319 participants (mean age: 30.0–38.5 years) were included. Risk of selection bias was unclear for most RCTs. Meta-analyses revealed evidence for small short-term effects of yoga on anxiety compared to no treatment (standardized mean difference [SMD] = −0.43; 95% confidence interval [CI] = −0.74, −0.11; P =.008), and large effects compared to active comparators (SMD = −0.86; 95% CI = −1.56, −0.15; P =.02). Small effects on depression were found compared to no treatment (SMD = −0.35; 95% CI = −0.66, −0.04; P =.03). Effects were robust against potential methodological bias. No effects were found for patients with anxiety disorders diagnosed by Diagnostic and Statistical Manual criteria, only for patients diagnosed by other methods, and for individuals with elevated levels of anxiety without a formal diagnosis. Only three RCTs reported safety-related data but these indicated that yoga was not associated with increased injuries. In conclusion, yoga might be an effective and safe intervention for individuals with elevated levels of anxiety. There was inconclusive evidence for effects of yoga in anxiety disorders. More high-quality studies are needed and are warranted given these preliminary findings and plausible mechanisms of action.