[Use and acceptance of classical natural and alternative medicine in Germany--findings of a representative population-based survey]. / Inanspruchnahme und Akzeptanz klassischer Naturheilverfahren und alternativer Heilmethoden in Deutschland -- Ergebnisse einer reprasentativen Bevolkerungsstudie.

BACKGROUND: The use of classical natural therapies and alternative medicine is becoming increasingly popular in Germany and other European countries. Only few population-based studies in Germany have investigated the use and acceptance of a variety of classical and alternative methods, including their possible determinants. METHODS: Cross-sectional survey of a nationally representative sample of men and women aged 18 to 69 years, applying a standardized self-administered questionnaire, that included questions on 21 different healing methods, on personal reasons for use, on individual attitudes to natural therapies, and on the socioeconomic background. RESULTS: Overall, 70% of women and 54% of men had used at least one classical natural or alternative healing method (including homeopathic and anthroposophic medicine) during the 12 months preceding the study. The most frequently used methods were classical therapies such as exercise therapy (32% of women, 26% of men), herbal medicine (33% of women, 20% of men), hydrotherapy (24% of women, 17% of men), and medical massage (22% of women, 15% of men). About 20% of women and 10% of men had applied homeopathic therapies, and about 9% (11% women, 6% men) had used acupuncture. In multivariate logistic regression analyses gender and education were the best predictors of classical and alternative medicine use. Women and persons with at least high-school education used these methods significantly more often than men and persons with lower education. Age-stratified analyses revealed that the age-group of the 40-49-year-old people used classical and alternative methods significantly more often than younger or older age-groups. The most frequently reported health problems for which natural therapies had been applied were back pain (57%), cold (29%), headaches (19%), strain (15%) and gastrointestinal ailments (12%). Overall, the efficacy and usefulness of natural healing methods was evaluated positive by the majority of the study population. 58% would appreciate it if physicians would more often prescribe such therapies, and 48% would like to have more information about the benefit of natural healing methods. CONCLUSIONS: The prevalence of use of natural medicine varies substantially across different types of healing methods. The observed overall acceptance together with the marked need for more information should be used more intensively for the development of health promotion strategies and underpins the necessity of reinforced research activities in this field.

[Effects of Kneippism, a standardized complex therapy, on pain, quality of life and use of medicines: cohort study with a one-year follow-up]. / Auswirkungen der Kneipp-Kur, einer standardisierten Komplextherapie, auf schmerz, Lebensqualität und medikamentenverbrauch: kohortenstudie mit 1-jahres-follow-up.

BACKGROUND: Inpatient as well as outpatient cure in a spa environment with commonly 3- to 4-week duration features a combination of different treatments customized according to the needs of the individual patient. The physiological rationale and the mode of action are widely accepted. However, firm quantitative evidence of the clinical effectiveness is incomplete. OBJECTIVE: To document the effects of a well standardized complex therapeutic regimen (Kneippism) on pain, quality of life, and drug consumption during therapy and with 1-year follow up. STUDY DESIGN: Prospective cohort study with assessments at the beginning, during, and at the end of treatment and with follow-up investigations 3, 6, and 12 months thereafter. SETTING: Four spa clinics in Bad Wörishofen, Southern Bavaria. PATIENTS: 363 patients (248 outpatients, mean duration of therapy 23.3 days, and 115 inpatients, mean duration of therapy 27.4 days), one half between 40 and 60 years old above 60 years of age, predominantly suffering from musculoskeletal and/or cardiovascular diseases. INTERVENTION: Custom-tailored combination of therapies comprising of hydro-, kinesi-, and phytotherapy, dietetics, 'ordnungstherapie', and continued disease-specific standard treatment, if necessary. MAIN OUTCOME MEASURE: Pain, patients' self-rating, (IRES questionnaire), medication. RESULTS: The monitored dimensions of pain improved significantly during treatment and remained at that level essentially for the complete follow up interval. The same was true for various dimensions of reported subjective complaints as well as for drug consumption. CONCLUSION: When estimating the clinical relevance of a complex therapeutic regimen such as a cure of 3- to 4-week duration, the question of the impact of the specific effect of single components is secondary to the question of the overall relevance of that therapeutic concept. The findings of this study point at potential long-term effects of at least 1-year duration.

[Hemorheologic findings in diabetes and their clinical relevance]. / Hämorheologische Befunde beim Diabetes und ihre klinische Relevanz.

Diabetics mostly display a deterioration of blood flow properties. Studies of various hemorheological factors in 163 diabetics (96 females, 67 males; 52 subjects with uncomplicated and 49 with proliferative retinopathy) disclosed in comparison to 79 matched controls: Concentrations of macromolecular proteins, especially of fibrinogen, were raised independently of actual diabetic metabolic situation; this was linked with an increase in plasma viscosity and in erythrocyte aggregation, specially pronounced in patients with renal affection. Erythrocyte flexibility assessed by filtration testing was deteriorated in dependence of metabolic control, impairment increasing in patients with progressing diabetic proliferative retinopathy. Duration of diabetes, type of diabetes and of treatment exert only indirect influence on blood rheology. Risk factors such as hypertension, arteriosclerosis and smoking have an aggravating effect. The complex disturbances of blood fluidity can contribute to the development of microcirculatory blood flow disorders, whereby, of course platelet hyperreactivity and hypercoagulation come into play, too. Especially a good diabetes control is a premise for an efficient blood flow promoting rheologic therapy.

Effect of metabolic control and concomitant diseases upon the rheology of blood in different states of diabetic retinopathy.

The flow properties of blood are abnormal in diabetes. The red cell deformability (RCD) is reduced and depends on the metabolic state; the red cell aggregation (RCA) and plasma viscosity are increased independent of the metabolism. According to the following nosological factors 157 diabetics were studied: duration of diabetes, type of therapy, ophthalmoscopic status, metabolic state and general health status. Although a deterioration of the flow properties of blood can be observed in long-term diabetics, in patients receiving antidiabetic drugs or insulin and in cases of pronounced retinopathy, these changes can all be attributed to a higher incidence of insufficiently controlled metabolism and to the presence of subsequent diseases. There is some evidence that the rheological changes cannot be neglected considering the development and progression of diabetic microangiopathy.

[Coagulation studies and rheological measurements during streptokinase therapy of myocardial infarction (author's transl)]. / Gerinnungsbefunde und rheologische Messungen bei Streptokinasebehandlung des akuten Myokardinfarktes.

In a multicenter, randomized trial of streptokinase in acute myocardial infarction one group of patients was given streptokinase for 24 h; the remainder served as controls and received a placebo infusion instead. Coagulation assays and rheological measurements were serially performed on patients entered into the trial at one of the participating centers. Streptokinase was found to improve considerably the flow properties of blood for a period of time exceeding the duration of its administration. These results may well explain the positive clinical effect of streptokinase therapy observed in this trial.

[Treatment of decompensated valvular disease with nitroglycerin (author's transl)]. / Therapie dekompensierter Herzklappenvitien mit Nitroglycerin.

The effects of parenteral nitroglycerin after acute and continuous infusion were investigated in 12 patients with mitral and (or) aortic valvular disease (stage IV of the New York Heart Association) and severe therapy-resistant pulmonary congestion. Intravenous injection of 1 mg led to immediate and marked decrease of right atrial mean pressure, and pulmonary artery and pulmonary capillary mean pressures, whereas mean arterial blood pressure, stroke volume index, cardiac frequency, and cardiac index remained unchanged. With a dosage of 3-10 mg/h the pressure lowering of the right circulation could be sustained. Pressure lowering of the right circulation abolished pulmonary congestion and led to marked reduction of shortness of breath. The principle of venous pooling can thus not only be used successfully in cases of increased pulmonary capillary pressure due to primary myocardial insufficiency, but also in cases with pulmonary congestion due to decompensated valvular disease.

Hemorrheological abnormalities in different states of diabetic retinopathy. Effect of metabolic control and subsequent diseases.

The flow properties of blood are abnormal in diabetes. The red cell deformability (RCD) is reduced and depends on the metabolic state, the red cell aggregation (RCA) and plasma viscosity are increased independent of the metabolism. 157 diabetics were studied according the following nosological factors: duration of diabetes, type of therapy, ophthalmoscopic status, metabolic state and general health status. Although a deterioration of the flow properties of blood can be observed in long-term diabetics, in patients receiving antidiabetic drugs or insulin and in cases of pronounced retinopathy, these changes can all be attributed to a higher incidence of insufficiently controlled metabolism and the presence of subsequent diseases. There is some evidence that the rheological changes cannot be neglected considering the development and progression of diabetic microangiopathy.

[Dopamine and dobutamine in the treatment of severe cardiac failure (author's transl)]. / Dopamin und Dobutamin in der Behandlung der schweren Herzinsuffizienz.

Ten patients in severe cardiac failure were treated with dopamine (4 microgram/kg . min) and dobutamine (7.5 microgram/kg.min). Both drugs brought about a similar increase in stroke volume and cardiac output of about 50% and 60%, respectively, accompanied by a fall in peripheral vascular resistance of about 33%. On dopamine the heart rate increased by 12%, but remained unaltered on dobutamine. There was a significant fall in the preload of both ventricles with dobutamine, while ventricular filling pressure during dopamine infusion was only slightly decreased, unchanged or even increased. The pulmonary (wedge) pressure during dopamine infusion averaged 9 mm Hg higher than during dobutamine (P less than 0.001). There is thus the potential danger with dopamine of aggravating pulmonary congestion. Furthermore, the improvement in cardiac function due to dopamine is at the expense of a higher oxygen demand than with dobutamine. Dobutamine is, therfore, preferable to dopamine in the treatment of advanced myocardial failure.

[Treatment of bradycardiac arrhythmias with depot-orciprenaline (author's transl)]. / Behandlung bradykarder Rhythmusstörungen mit Depot-orciprenalin

24 patients with bradycardiac arrhythmias of various origin were treated with a new depot preparation of orciprenaline. The special galenical preparation guarantees effectiveness ofr 8-10 hours. In 21 patients (87%), therefore, one dragee morning and evening was sufficient to obtain a mean rise in frequency of 57%. The preparation had to be discontinued in 3 cases because of side effects such as increase in ventricular extrasystoles, anginal complaints and critical rise of blood pressure in hypertension. Because of its trouble-free administration in a depot form the preparation not only offers a practical advantage over the short-acting commercial preparations, but also shows a reliable efficacy. It can therefore be given under regular supervision in all forms of bradycardiac arrhythmias with stable ventricular frequency and satisfactory cardiac output.

Red cell aggregation in blood flow. I. New methods of quantification.

The rheological behavior of normal and pathological red cell aggregates in viscometric flow (artificial flow in cone plate chamber) is studied by direct microscopy, (rheoscopy) viscometry and photometry. Marked differences between normal and pathological blood are measured in the microrheological properties of red cell aggregates; only discreet differences are measured by blood viscometry (macrorheology). Both in normal and abnormal blood, red cell aggregation is a reversible process in the presence of adequate shear forces; their respective influences on apparent blood viscosity at low rates of shear are complex functions of shear rate, shear time, hematocrit and plasma viscosities. Pathological red cell aggregation (RCA) forms more rapidly and extensively than normal RCA. The pathological aggregates frequently have a tendency to grow at low rates of shear and they are highly shear resistant.