Expert consensus-based clinical recommendation for an integrative anthroposophic treatment approach to acute tonsillitis in childhood.

BACKGROUND: Medical guidelines are an important basis for qualitative and cost-effective patient care. However, there is a lack of clinical recommendations in anthroposophic medicine (AM), an integrative medicine approach frequently practised in Europe. Acute tonsillitis, which includes tonsillopharyngitis, is a common childhood disease. that is mostly caused by a viral infection. Symptomatic treatment is therefore of high importance, and AM can offer several therapy options. METHODS: 53 physicians from Germany, Spain, Netherlands, Switzerland, Austria, and Hungary with at least one year of experience in anthroposophic paediatric medicine were invited to participate in an online Delphi process. The process comprises five survey rounds starting with open-ended questions and ending with final statements, which need 75% agreement of experts to reach consensus. Expert answers were evaluated by two independent reviewers using MAXQDA and Excel. RESULTS: Response rate was between 28% and 45%. The developed recommendation included 15 subtopics. These covered clinical, diagnostic, therapeutic and psychosocial aspects of acute tonsillitis. Six subtopics achieved a high consensus (>90%) and nine subtopics achieved consensus (75-90%). CONCLUSION: The clinical recommendation for acute tonsillitis in children aims to simplify everyday patient care and provide decision-making support when considering and prescribing anthroposophic therapies. Moreover, the recommendation makes AM more transparent for physicians, parents, and maybe political stakeholders as well.

An expert consensus-based guideline for the integrative anthroposophic treatment of acute gastroenteritis in children.

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

Treatment of hyperemesis gravidarum with anthroposophic complex therapy in 3 case reports.

BACKGROUND: Hyperemesis gravidarum (HG) is generally characterized by intractable nausea and vomiting which interferes with daily life. As the cause of HG has not yet been clearly identified, conventional medicine therapies address only the symptoms. Conventional treatment is also effective for a comparatively short time and may have unfavorable side effects. Given that the condition affects more than 1% of pregnant women, there is a significant need for effective long-lasting treatments with limited side effects. CASE REPORTS: This paper is based on three case reports of pregnant women suffering from HG. They received inpatient treatment based exclusively on anthroposophic medical approaches at the Paracelsus Hospital Richterswil, Switzerland. Treatments were selected individually based on the specific patient profiles and included infusion therapy with Nux vomica, Solum uliginosum compositum and Bryophyllum pinnatum as well as art therapy (wet-on-wet painting), eurythmy therapy and rhythmical massage therapy. Anthroposophic complex therapies induced an improvement in symptoms of nausea and vomiting within one week in all three cases. CONCLUSION: Anthroposophic complex therapy is a valuable option in the treatment of HG. Well-tolerated and long-lasting, it represents a holistic and causal approach that does not only address symptoms.

The Contribution of Anthroposophic Medicine to Self-Management: An Exploration of Concepts, Evidence, and Patient Perspectives.

BACKGROUND: In Western healthcare policies, promotion of self-management of patients is an important topic. Currently, there is also a worldwide interest in the integration of complementary and alternative medicine (CAM) and conventional medicine into integrative medicine. This article explores the contribution of anthroposophic medicine (AM) to the promotion of self-management of patients. MATERIAL AND METHODS: The scientific literature on concepts of, evidence on and experiences of patients with AM was explored. RESULTS: The AM approach contributes to: (1) a patient-centered, collaborative promotion of patient self-management by means of application of basic values (equivalence, servitude, and presence of mind) and specific methods; (2) a better coping with health-related issues by providing a spiritual worldview that serves as a coping strategy; by treating patients in such a way that they (further) develop self-regulating functioning, both on the physiological and the psychosocial level, thus enabling the self-management of disease-related symptoms; and by treating with (non-verbal) therapies that improve emotion-focused coping skills; and (3) a better self-monitoring of: one's own activity during treatment and in dealing with treatment- and health-related issues, and the physiological and/or psychological responses to these (self-reflection) activities. CONCLUSION: AM provides specific contributions to promoting self-management of patients.

Síndrome dispéptica: relato de caso, conceitos básicos e visão antroposófica / Dyspeptic syndrome: case report, basic concepts and anthroposophic approach

A autora relata o caso de um paciente de 69 anos que apresentava quadro crônico de dispepsia por aproximadamente 40 anos. Foram realizados exames laboratoriais e de imagem ao longo desse período. Tratado com medicina convencional alopática sem adesão adequada, com sintomas relacionados ao estresse e ansiedade associados à doença. A visão ampliada pela medicina antroposófica e seus tratamentos, juntamente com práticas meditativas, levaram o paciente à melhora significativa tanto de seus sintomas clínicos quanto emocionais.(AU)

The author reports the case of a 69 year-old patient who had chronic dyspepsia for about 40 years. Laboratory and imaging tests were performed during this period. In the same period the patient was treated with allopathic conventional medicine without proper result, with symptoms related to the stress and anxiety associated with the disease. The change of approach by starting to use anthroposophic medicine and its treatments, along with meditative practices, led the patient to a significant improvement of his clinical and psychological symptoms.(AU)

A gestante na visão da antroposofia: contribuições para um acompanhamento psicológico integral / The pregnant woman in the perspective of anthroposophy: contributions to a comprehensive counseling

A partir do conhecimento das alterações fisiológicas e psíquicas, do momento de crise biográfica e das consequências da saúde mental da gestante no desenvolvimento fetal, percebe-se a importância do acompanhamento psicológico neste período da vida da mulher. Este estudo aborda os conceitos sobre a gestação e o que ocorre com a mulher grávida na perspectiva da antroposofia, visando fornecer elementos complementares para a reflexão de uma prática psicológica mais integral no acompanhamento às gestantes. A metodologia utilizada foi o levantamento de bibliografia disponível sobre gestação sob o ponto de vista da antroposofia e das abordagens tradicionais da psicologia, em português e inglês. A bibliografia sobre o processo emocional da gestante durante a gravidez é mais focada em intercorrências do que no processo natural que ocorre neste período. As publicações referentes à gestação fisiológica são raras, em sua maioria encontradas em livros. A bibliografia relacionada à antroposofia é bastante escassa. Não foi encontrado nenhum artigo sobre o tema, em inglês ou português. No entanto, tem-se indicações deste processo por meio de publicações em livros. A antroposofia visa ampliar o conhecimento obtido pelo método científico convencional, buscando o entendimento dos sintomas a partir da observação fenomenológica. A literatura tradicional mostra-se bastante rica no que diz respeito à observação fenomenológica do que ocorre à gestante, quando se exclui a parte interpretativa das modificações. É de suma importância que mais psicólogos se interessem e se envolvam com esta temática, para podermos criar equipes interdisciplinares mais completas e oferecermos um acompanhamento mais integral às gestantes.(AU)

From the knowledge of the physiological and psychological changes, the time of biographical crisis and the consequences that pregnant woman's mental health have in fetal development, we can realize the importance of counseling in this period of woman's life. This study addresses the concepts of pregnancy and what happens to pregnant women from the perspective of anthroposophy, in order to provide additional information for the reflection of a more comprehensive psychological practice in monitoring pregnant women. The methodology used was the bibliography available survey about pregnancy from the point of view of anthroposophy and traditional approaches of psychology, in Portuguese and English. The literature on the emotional process of the mother during pregnancy is more focused on complications than in the natural process that occurs during this period. Publications related to physiological pregnancy are rare, mostly found in books. The literature related to anthroposophy is rather scarce. We found no article on the subject in English or Portuguese. However, it has been given indications in this subject in books. Anthroposophy aims to extend the knowledge obtained by the conventional scientific method, seeking the understanding of the symptoms from the phenomenological observation. The traditional literature is quite rich in phenomenological observation of what happens to pregnant, if we exclude the interpretation of the changes. It is very important that more psychologists get interested and involved with this issue, in order to create more complete interdisciplinary teams and offer a more comprehensive care to pregnant women.(AU)

The subjectively perceived quality of postgraduate medical training in integrative medicine within the public healthcare systems of Germany and Switzerland: the example of anthroposophic hospitals.

BACKGROUND: Integrative medicine (IM) integrates evidence-based Complementary and Alternative Medicine (CAM) with conventional medicine (CON). Medical schools offer basic CAM electives but in postgraduate medical training (PGMT) little has been done for the integration of CAM. An exception to this is anthroposophic medicine (AM), a western form of CAM based on CON, offering an individualized holistic IM approach. AM hospitals are part of the public healthcare systems in Germany and Switzerland and train AM in PGMT. We performed the first quality evaluation of the subjectively perceived quality of this PGMT. METHODS: An anonymous full survey of all 214 trainers (TR) and 240 trainees (TE) in all 15 AM hospitals in Germany and Switzerland, using the ETHZ questionnaire for annual national PGMT assessments in Switzerland (CH) and Germany (D), complemented by a module for AM. Data analysis included Cronbach's alpha to assess internal consistency questionnaire scales, 2-tailed Pearson correlation of specific quality dimensions of PGMT and department size, 2-tailed Wilcoxon Matched-Pair test for dependent variables and 2-tailed Mann-Whitney U-test for independent variables to calculate group differences. The level of significance was set at p < 0.05. RESULTS: Return rates were: D: TE 89/215 (41.39%), TR 78/184 (42.39%); CH: TE 19/25 (76%), TR 22/30 (73.33%). Cronbach's alpha values for TE scales were >0.8 or >0.9, and >0.7 to >0.5 for TR scales. Swiss hospitals surpassed German ones significantly in Global Satisfaction with AM (TR and TE); Clinical Competency training in CON (TE) and AM (TE, TR), Error Management, Culture of Decision Making, Evidence-based Medicine, and Clinical Competency in internal medicine CON and AM (TE). When the comparison was restricted to departments of comparable size, differences remained significant for Clinical Competencies in AM (TE, TR), and Culture of Decision Making (TE). CON received better grades than AM in Global Satisfaction and Clinical Competency. Quality of PGMT depended on department size, working conditions and structural training features. CONCLUSION: The lower quality of PGMT in German hospitals can be attributed to larger departments, more difficult working conditions, and less favorable structural features for PGMT in AM, possibly also in relation to increased financial pressure.

Opposite drug prescription and cost trajectories following integrative and conventional care for pain--a case-control study.

OBJECTIVES: Pharmacotherapy may have a limited role in long-term pain management. Comparative trajectories of drug prescriptions and costs, two quality-of-care indicators for pain conditions, are largely unknown subsequent to conventional or integrative care (IC) management. The objectives of this study were to compare prescribed defined daily doses (DDD) and cost of first line drugs for pain patients referred to conventional or anthroposophic IC in Stockholm County, Sweden. METHODS: In this retrospective high quality registry case-control study, IC and conventional care patients were identified through inpatient care registries and matched on pain diagnosis (ICD-10: M79), age, gender and socio-demographics. National drug registry data was used to investigate changes in DDD and costs from 90/180 days before, to 90/180 days after, index visits to IC and conventional care. The primary selected drug category was analgesics, complemented by musculo-skeletal system drugs (e.g. anti-inflammatories, muscle relaxants) and psycholeptics (e.g. hypnotics, sedatives). RESULTS: After index care visits, conventional care pain patients (n = 1050) compared to IC patients (n = 213), were prescribed significantly more analgesics. The average (95% CI) group difference was 15.2 (6.0 to 24.3), p = 0.001, DDD/patient after 90 days; and 21.5 (7.4 to 35.6), p = 0.003, DDD/patient after 180 days. The cost of the prescribed and sold analgesics was significantly higher for conventional care after 90 days: euro/patient 10.7 (1.3 to 20.0), p = 0.025. Changes in drug prescription and costs for the other drug categories were not significantly different between groups. CONCLUSIONS: Drug prescriptions and costs of analgesics increased following conventional care and decreased following IC, indicating potentially fewer adverse drug events and beneficial societal cost savings with IC.

Salutogênese e caminhos iniciáticos: a espiritualidade como item de saúde / Salutogenesis and initiatory paths: spirituality as a health item

O autor faz considerações referentes à questão da espiritualidade como cultivo interno, qualidade de vida e sanidade. Faz uma aproximação entre salutogênese de Antonovsky e o processo de maturação espiritual do indivíduo relatado em grande obras literárias budistas e nos grandes teóricos da psicologia correlacionando este processo com as questões relativas à sanidade anímica e espiritual e à resiliência do indivíduo diante dos desafios.(AU)

The author makes statements relating to the issue of spirituality as internal cultivation, the quality of life and sanity. Makes a connection between salutogenesis and the process of individual spiritual maturation and correlates with the issues concerning the soul and spiritual health, and resilience of the individual in the face of challenges.(AU)

Aspectos do sofrimento humano e do senso de coerência presentes no drama final de Jesus Cristo / Aspects of the human suffering and the sense of coherence in Jesus Christ's final drama

O autor revisa três momentos do drama sagrado de Jesus Cristo nos seus momentos finais e caracteriza três fases do sofrimento humano: o pedido "Pai, [...] afasta de mim este cálice", a necessidade de ajuda ao carregar a cruz, e as palavras na cruz "Deus meu, por que me abandonaste?" Dado o caráter não só humano (explicitado pelo sofrimento), mas também divino de Jesus Cristo, os Evangelhos apontam para as respectivas superações internas a esses aspectos do sofrimento: o medo e a entrega confiante, a necessidade de ajuda e a sua aceitação humilde, o abandono e a contemplação (ou a entrega) amorosa. Dessa forma, os três componentes do senso de coerência, como definidos pela salutogênese, estão presentes nesses três momentos do drama sagrado, a saber, a manuseabilidade, a significabilidade e a compreensibilidade.(AU)

The author reviews three moments of the Jesus Christ's sacred drama in his final moments and features three stages of human suffering: the request "Father, […] take this cup from me", the need for help to carry the cross, and the words on the cross "My God, why hast thou forsaken me?" As Jesus Christ had not only the human character (demonstrated by suffering), but also a divine one, the Gospels indicate the respective internal overruns to these aspects of suffering: fear and entrustment, the need for help and his humble acceptance, abandonment and loving contemplation (or giving of self). Thus, the three components of the sense of coherence, as defined by salutogenesis, are present in these three moments of the sacred drama, namely, manageability, meaningfulness and comprehensibility.(AU)

Aprendizado e percepções humanas segundo a antroposofia e as neurociências / Learning and human perceptions according to anthroposophy and neuroscience

A biografia humana se constrói com a ajuda das percepções humanas. As neurociências descrevem o fenômeno perceptivo, mapeando seus processos no corpo humano em relação aos marcos neurológicos evolutivos, ao aprendizado e à memória. A antroposofia mostra como o desenvolvimento perceptivo contribui com o amadurecimento do indivíduo a cada setênio. Ainda pelo conhecimento médico-escolar antroposófico, temos indicações para a educação, oferecendo estímulos adequados para a evolução do ser que, ao longo da vida, colaboram com melhores respostas imunológicas e menor manifestação de doenças crônicas.(AU)

Human biography is demonstrated with the help of human perceptions. The neurosciences describe the perceptive phenomenon, mapping its processes in the human body in relation to evolutionary neurological milestones, learning and memory. Anthroposophy reveals how perceptive development contributes to the maturing of the individual in every seven-year period. Additionally, through medical-educational anthroposophic knowledge, there are indications to education, providing suitable stimuli to the evolution of the being, collaborating with better immunological responses and reduced manifestations of chronic diseases in the years of life.(AU)

Medicina antroposófica: um novo paradigma para as questões da medicina moderna / Anthroposophic medicine: a new paradigm for the questions of modern medicine

Nesse artigo é feita uma introdução sobre o sistema de tratamento da Medicina Antroposófica (MA), introduzidas suas bases cognitivas e científicas, os seus métodos de diagnóstico e tratamento, assim como os resultados em relação à sua situação atual, eficácia, efetividade e segurança. A MA é um sistema complementar e integrativo de tratamento que reconhece no ser humano dimensões espirituais e existenciais que interagem com os níveis somáticos e psicológicos na saúde e na doença. A MA se propõe não como uma medicina alternativa, mas como uma ampliação da prática médica pois, ao mesmo tempo que o médico antroposófico obrigatoriamente tem uma formação convencional e também lança mão dos seus recursos diagnósticos e terapêuticos, ele trabalha com os recursos trazidos por uma visão do ser humano que é provida pela Antroposofia. A MA trabalha de modo multidisciplinar, compreendendo um sistema de tratamentos que inclui medicamentos e outras modalidades de terapia. Como a MA se define como um sistema de tratamento complementar ou integrativo, são também comentados o contexto atual, as demandas e necessidades que não estão sendo adereçadas pelo modelo convencional de atendimento médico e como as práticas integrativas e complementares surgiram com uma opção para um entendimento mais amplo do processo de saúde e doença e o seu tratamento. Como um sistema de medicina integrativa, A MA se coloca como um novo paradigma para a resolução das questões que estão sendo enfrentadas atualmente, seja no âmbito existencial do indivíduo seja nas questões sociais e ecológicas da saúde. A MA tem uma proposta que pode contribuir para a ampliação do escopo de atendimento médico convencional pois tem uma base epistemológica clara, recursos próprios baseados na autonomia do paciente e mostrado bons resultados em termos de segurança, eficácia e efetividade.

This is a brief introduction to the system of Anthroposophic Medicine (AM), its cognitive and scientific foundation, its diagnostic and therapeutic approaches and information on research, safety and effectiveness. Anthroposophic Medicine is a complementary therapy system that acknowledges a spiritual and existential dimension in man, which is assumed to interact with psychological and somatic levels in health and disease. AM it is not an alternative medicine; it aims to integrate the methods, diagnosis and treatment of conventional medicine with an holistic approach to promote health and preventing and treating disease provided by Anthroposophy. AM has a multidisciplinary approach provided by physicians, and therapists and includes anthroposophic therapies (counseling, special medications, artistic and physical therapies). The treatment is individualized according to the needs of the patient. Complementary and alternative medicine has been adopted in the last decades because it appears as an answer to the needs and demands that have not been addressed by the conventional model of health care. In this scenario, AM has a new paradigm to offer in order to help address the questions faced by modern society, be it at existential level, be it the social and ecological questions. AM can contribute to the extension of conventional medical care because has an clear and well established epistemological basis that can help support the conceptual integration of complementary and conventional medicine, an approach to promote health , prevent and treat illness, and is safe, effective and can add value to the health system.

Parental Sense of Coherence in the first 2 years of life is not related to parental and child diurnal cortisol rhythm or proxies of anthroposophic lifestyle.

AIM: Sense of Coherence (SOC) is hypothesized to have direct physiological consequences on endocrine and immunological processes. In this study, we compare parental SOC scores from pregnancy in groups of infants and parents representing different lifestyles (anthroposophic, partly anthroposophic and nonanthroposophic). We also analyse whether these could predict cortisol levels of the parents and their infants at 6-24 months postpartum. METHODS: Parental SOC-13 was collected during the third trimester of pregnancy from a birth cohort of families with different lifestyles. Salivary samples were collected from the whole family when the child was 6 months (n = 210), 12 (n = 178) and 24 months of age (n = 149), and cortisol levels were analysed with radioimmunoassay technique. RESULTS: Sense of Coherence scores did not differ between the three lifestyle groups, and there were no correlations between SOC scores and salivary cortisol concentrations in separate analyses of mothers, fathers and children at any sampling age or at any sampling time during the day (morning, afternoon, bedtime). CONCLUSION: Sense of Coherence scores did not vary in parents with different lifestyles and were not associated with salivary cortisol levels in parents or in children.

Lifestyle and salivary cortisol at the age of 12 and 24 months.

AIM: To analyse salivary cortisol levels in 12- and 24-month-olds from families with an anthroposophic lifestyle and comparisons ('partly anthroposophic' and 'non-anthroposophic'). METHODS: Salivary samples were collected at child ages of 12 (n = 178) and 24 (n = 149) months. Cortisol was analysed with radioimmunoassay technique. RESULTS: Evening cortisol levels in children from anthroposophic families were lower than in comparisons at 12 months of age (geometric means: anthroposophic 1.7, partly anthroposophic 1.9, non-anthroposophic 3.6 nmol/L; p = 0.024) and at 24 months of age (1.1, 1.8 and 2.9 nmol/L, respectively; p = 0.002). At 24 months of age, similar differences were noted also for the afternoon levels (2.3, 3.3 and 3.9 nmol/L, respectively; p = 0.043). At age 12 months, the differences in the evening cortisol were statistically explained by a meat-free diet and at age 24 months by the anthroposophic lifestyle as such. The circadian variations were parallel in the three groups at age 12 and 24 months. No cortisol differences were observed between parents representing different lifestyles. CONCLUSIONS: An anthroposophic lifestyle is associated with low cortisol levels in the evening at age 12 and 24 months, at age 24 months also in the afternoon.

Patient satisfaction with primary care: an observational study comparing anthroposophic and conventional care.

BACKGROUND: This study is part of a cross-sectional evaluation of complementary medicine providers in primary care in Switzerland. It compares patient satisfaction with anthroposophic medicine (AM) and conventional medicine (CON). METHODS: We collected baseline data on structural characteristics of the physicians and their practices and health status and demographics of the patients. Four weeks later patients assessed their satisfaction with the received treatment (five items, four point rating scale) and evaluated the praxis care (validated 23-item questionnaire, five point rating scale). 1946 adult patients of 71 CON and 32 AM primary care physicians participated. RESULTS: 1. Baseline characteristics: AM patients were more likely female (75.6% vs. 59.0%, p < 0.001) and had higher education (38.6% vs. 24.7%, p < 0.001). They suffered more often from chronic illnesses (52.8% vs. 46.2%, p = 0.015) and cancer (7.4% vs. 1.1%). AM consultations lasted on average 23,3 minutes (CON: 16,8 minutes, p < 0.001). 2. Satisfaction: More AM patients expressed a general treatment satisfaction (56.1% vs. 43.4%, p < 0.001) and saw their expectations completely fulfilled at follow-up (38.7% vs. 32.6%, p < 0.001). AM patients reported significantly fewer adverse side effects (9.3% vs. 15.4%, p = 0.003), and more other positive effects from treatment (31.7% vs. 17.1%, p < 0.001). Europep: AM patients appreciated that their physicians listened to them (80.0% vs. 67.1%, p < 0.001), spent more time (76.5% vs. 61.7%, p < 0.001), had more interest in their personal situation (74.6% vs. 60.3%, p < 0.001), involved them more in decisions about their medical care (67.8% vs. 58.4%, p = 0.022), and made it easy to tell the physician about their problems (71.6% vs. 62.9%, p = 0.023). AM patients gave significantly better rating as to information and support (in 3 of 4 items p [less than or equal to] 0.044) and for thoroughness (70.4% vs. 56.5%, p < 0.001). CONCLUSION: AM patients were significantly more satisfied and rated their physicians as valuable partners in the treatment. This suggests that subject to certain limitations, AM therapy may be beneficial in primary care. To confirm this, more detailed qualitative studies would be necessary.