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

Adaptive coping strategies in patients with chronic pain conditions and their interpretation of disease

<p>Abstract</p> <p>Background</p> <p>We examined which adaptive coping strategies, referring to the concept of 'locus of disease control', were of relevance for patients with chronic pain conditions, and how they were interconnected with patients' life satisfaction and interpretation of disease.</p> <p>Methods</p> <p>In a multicenter cross-sectional anonymous survey with the AKU questionnaire, we enrolled 579 patients (mean age 54 ± 14 years) with various chronic pain conditions.</p> <p>Results</p> <p>Disease as an adverse interruption of life was the prevalent interpretation of chronic pain conditions. As a consequence, patients relied on external powerful sources to control their disease (i.e., <it>Trust in Medical Help</it>; <it>Search for Information and Alternative Help</it>), but also on internal powers and virtues (i.e., <it>Conscious Way of Living</it>; <it>Positive Attitudes</it>). In contrast, <it>Trust in Divine Help </it>as an external transcendent source and <it>Reappraisal: Illness as Chance </it>as an internal (cognitive) strategy were valued moderately. Regression analyses indicated that <it>Positive Attitudes </it>and higher age were significant predictors of patients' life satisfaction, but none of the other adaptive coping strategies. While the adaptive coping strategies were not associated with negative interpretations of disease, the cognitive reappraisal attitude was of significant relevance for positive interpretations such as value and challenge.</p> <p>Conclusions</p> <p>The experience of illness may enhance intensity and depth of life, and thus one may explain the association between internal adaptive coping strategies (particularly <it>Reappraisal</it>) and positive interpretations of disease. To restore a sense of self-control over pain (and thus congruence with the situation), and the conviction that one is not necessarily disabled by disease, is a major task in patient care. In the context of health services research, apart from effective pain management, a comprehensive approach is needed which enhances the psycho-spiritual well-being of patients.</p

Homeopathic Preparations of Quartz, Sulfur and Copper Sulfate Assessed by UV-Spectroscopy

Homeopathic preparations are used in homeopathy and anthroposophic medicine. Although there is evidence of effectiveness in several clinical studies, including double-blinded randomized controlled trials, their nature and mode of action could not be explained with current scientific approaches yet. Several physical methods have already been applied to investigate homeopathic preparations but it is yet unclear which methods are best suited to identify characteristic physicochemical properties of homeopathic preparations. The aim of this study was to investigate homeopathic preparations with UV-spectroscopy. In a blinded, randomized, controlled experiment homeopathic preparations of copper sulfate (CuSO(4); 11c-30c), quartz (SiO(2); 10c-30c, i.e., centesimal dilution steps) and sulfur (S; 11×-30×, i.e., decimal dilution steps) and controls (one-time succussed diluent) were investigated using UV-spectroscopy and tested for contamination by inductively coupled plasma mass spectrometry (ICP-MS). The UV transmission for homeopathic preparations of CuSO(4) preparations was significantly lower than in controls. The transmission seemed to be also lower for both SiO(2) and S, but not significant. The mean effect size (95% confidence interval) was similar for the homeopathic preparations: CuSO(4) (pooled data) 0.0544% (0.0260-0.0827%), SiO(2) 0.0323% (-0.0064% to 0.0710%) and S 0.0281% (-0.0520% to 0.1082%). UV transmission values of homeopathic preparations had a significantly higher variability compared to controls. In none of the samples the concentration of any element analyzed by ICP-MS exceeded 100 ppb. Lower transmission of UV light may indicate that homeopathic preparations are less structured or more dynamic than their succussed pure solvent

High-field 1H T1 and T2 NMR relaxation time measurements of H2O in homeopathic preparations of quartz, sulfur, and copper sulfate

Quantitative meta-analyses of randomized clinical trials investigating the specific therapeutic efficacy of homeopathic remedies yielded statistically significant differences compared to placebo. Since the remedies used contained mostly only very low concentrations of pharmacologically active compounds, these effects cannot be accounted for within the framework of current pharmacology. Theories to explain clinical effects of homeopathic remedies are partially based upon changes in diluent structure. To investigate the latter, we measured for the first time high-field (600/500MHz) 1H T1 and T2 nuclear magnetic resonance relaxation times of H2O in homeopathic preparations with concurrent contamination control by inductively coupled plasma mass spectrometry (ICP-MS). Homeopathic preparations of quartz (10c-30c, n = 21, corresponding to iterative dilutions of 100−10-100−30), sulfur (13x-30x, n = 18, 10−13-10−30), and copper sulfate (11c-30c, n = 20, 100−11-100−30) were compared to n = 10 independent controls each (analogously agitated dilution medium) in randomized and blinded experiments. In none of the samples, the concentration of any element analyzed by ICP-MS exceeded 10ppb. In the first measurement series (600MHz), there was a significant increase in T1 for all samples as a function of time, and there were no significant differences between homeopathic potencies and controls. In the second measurement series (500MHz) 1year after preparation, we observed statistically significant increased T1 relaxation times for homeopathic sulfur preparations compared to controls. Fifteen out of 18 correlations between sample triplicates were higher for controls than for homeopathic preparations. No conclusive explanation for these phenomena can be given at present. Possible hypotheses involve differential leaching from the measurement vessel walls or a change in water molecule dynamics, i.e., in rotational correlation time and/or diffusion. Homeopathic preparations thus may exhibit specific physicochemical properties that need to be determined in detail in future investigation

Development of Specific Aspects of Spirituality during a 6-Month Intensive Yoga Practice

The majority of research on yoga focuses on its psychophysiological and therapeutic benefits, while the spiritual aspects are rarely addressed. Changes of specific aspects of spirituality were thus investigated among 160 individuals (91% women, mean age 40.9 ± 8.3 years; 57% Christians) starting a 2-year yoga teacher training. We used standardized questionnaires to measure aspects of spirituality (ASP), mindfulness (FMI—Freiburg Mindfulness Inventory), life satisfaction (BMLSS—Brief Multidimensional Life Satisfaction Scale), and positive mood (lightheartedness/relief). At the start of the course, scores of the respective ASP subscales for search for insight/wisdom, transcendence conviction, and conscious interactions/compassion were high, while those for religious orientation were low. Within the 6 month observation period, both conscious interactions/compassion (effect size, Cohen's d = .33), Religious orientation (d = .21), Lightheartedness/Relief (d = .75) and mindfulness (d = .53) increased significantly. Particularly non-religious/non-spiritual individuals showed moderate effects for an increase of conscious interactions/compassion. The results from this study suggest that an intensive yoga practice (1) may significantly increase specific aspects of practitioners' spirituality, mindfulness, and mood, (2) that these changes are dependent in part on their original spiritual/religious self-perception, and (3) that there are strong correlations amongst these constructs (i.e., conscious interactions/compassion, and mindfulness)

Wave reflection, assessed by use of the ARCSolver Algorithm for pulse wave separation, is reduced under acute µg conditions in parabolic flight

Weightlessness during long-term space flight over 6-12 months leads to complex individual cardiovascular adaptation. The initial central blood volume expansion followed by a loss of plasma volume is accompanied by changes in vascular mechanoreceptor loads and responsive-ness, altered autonomic reflex control of heart rate and blood pressure, and hormonal changes in the long run. Hence, function and structure of the heart and blood vessels may change. Hemodynamic data obtained during short- and long-term space flight may indicate that the adaptation process resembles ageing of the cardiovascular system characterized by decreased diastolic blood pressure, increased central sympathetic nerve traffic and increased arterial pulse wave velocity. Experiments during parabolic flights in supine position suggest, that stroke volume does not change during transitions between µ-g and 1-g. We tested a novel method of pulse wave separation based on simple oscillometric brachial cuff waveform reading to investigate pulse wave reflection during acute weightlessness in healthy subjects. We hypothesized that the wave reflection magnitude (RM) remains unaltered during parabolic flights in supine position

¿Egocentrismo o altruismo en la adolescencia? Un estudio empírico sobre los estudiantes de colegios Waldorf, cristianos y públicos

Este artículo presenta una síntesis de un estudio sobre los posicionamientos egocéntricos en la adolescencia realizado en tres contextos escolares diferentes. El análisis permitió determinar que el posicionamiento egocéntrico puede ser mejor determinado a través de dos predictores: el sentido del propio bienestar (eudemonismo) y la convicción de que “la lástima ajena previene tomar iniciativas propias”. Estos dos factores fueron correlacionados con la satisfacción del contexto escolar específico, la orientación espiritual y la idea de ayudar a otros. Los posicionamientos y los ideales éticos difieren entre los estudiantes de los tres contextos escolares: colegios Waldorf, colegios cristianos y colegios estatales. Los resultados confirman que la tendencia egocéntrica fue significativamente inferior en el grupo femenino de adolescentes. Este artículo invita a reflexionar sobre el papel que juega el contexto escolar en el proceso de desarrollo de la etapa adolescente a la adulta de los estudiantes. Palabras clave: egocentrismo; adolescencia; altruismo; Rudolf Steiner

Operation of a high purity germanium crystal in liquid argon as a Compton suppressed radiation spectrometer

A high purity germanium crystal was operated in liquid argon as a Compton suppressed radiation spectrometer. Spectroscopic quality resolution of less than 1% of the full-width half maximum of full energy deposition peaks was demonstrated. The construction of the small apparatus used to obtain these results is reported. The design concept is to use the liquid argon bath to both cool the germanium crystal to operating temperatures and act as a scintillating veto. The scintillation light from the liquid argon can veto cosmic-rays, external primordial radiation, and gamma radiation that does not fully deposit within the germanium crystal. This technique was investigated for its potential impact on ultra-low background gamma-ray spectroscopy. This work is based on a concept initially developed for future germanium-based neutrinoless double-beta decay experiments.Comment: Paper presented at the SORMA XI Conference, Ann Arbor, MI, May 200

Slow breathing reduces sympathoexcitation in COPD

Neurohumoral activation has been shown to be present in hypoxic patients with chronic obstructive pulmonary disease (COPD). The aims of the present study were to investigate whether there is sympathetic activation in COPD patients in the absence of hypoxia and whether slow breathing has an impact on sympathoexcitation and baroreflex sensitivity. Efferent muscle sympathetic nerve activity, blood pressure, cardiac frequency and respiratory movements were continuously measured in 15 COPD patients and 15 healthy control subjects. Baroreflex sensitivity was analysed by autoregressive spectral analysis and the alpha-angle method. At baseline, sympathetic nerve activity was significantly elevated in COPD patients and baroreflex sensitivity was decreased (5.0+/-0.6 versus 8.9+/-0.8 ms.mmHg(-1)). Breathing at a rate of 6 breaths.min(-1) caused sympathetic activity to drop significantly in COPD patients (from 61.3+/-4.6 to 53.0+/-4.3 bursts per 100 heartbeats) but not in control subjects (39.2+/-3.2 versus 37.5+/-3.3 bursts per 100 heartbeats). In both groups, slow breathing significantly enhanced baroreflex sensitivity. In conclusion, sympathovagal imbalance is present in normoxic chronic obstructive pulmonary disease patients. The possibility of modifying these changes by slow breathing may help to better understand and influence this systemic disease