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2.  Impact of Colored Light on Cardiorespiratory Coordination 
Background. Light exposure to the eye can influence different physiological functions, for example, the suprachiasmatic nucleus (SCN). By affecting the autonomic nervous system, the SCN may influence the heart rate variability (HRV). Standardized colored light exposure alters HRV but the results are inconsistent. In this study we investigated the effects of nonstandardized red light (approx. 640 nm) and blue (approx. 480 nm) light (approx. 50 lx) on cardiorespiratory coordination and HRV. Methods. 17 healthy subjects (7 males, age: 26.5 ± 6.2 years) were exposed to the following sequence (10 minutes each): daylight-red light-daylight-blue light-daylight. Red and blue lights were created by daylight passing through colored glass panes. Spectral measures of HRV (LF: low frequency, HF: high frequency oscillations, and sympathovagal balance LF/HF) and measures of cardiorespiratory coordination (HRR: heart respiration ratio, PCR: phase coordination ratio) were analyzed. Results. The LF component increased and the HF component decreased after red light. Consequently, LF/HF increased after red light. Furthermore, during red light HRR and PCR confined to 4 : 1, that is, 4 heartbeats during one respiratory cycle. Conclusion. Nonstandardized red and blue lights are able to alter the autonomic control reflected by HRV as well as cardiorespiratory coordination.
PMCID: PMC3893775  PMID: 24489590
3.  Linguistic Processing and Classification of Semi Structured Bibliographic Data on Complementary Medicine 
Cancer Informatics  2009;7:159-169.
Complementary and alternative therapies and medicines (CAM) such as acupuncture or mistletoe treatment are much asked for by cancer patients. With a growing interest in such therapies, physicians need a simple tool with which to get an overview of the scientific publications on CAM, particularly those that are not listed in common bibliographic databases like MEDLINE. CAMbase is an XML-based bibliographical database on CAM which serves to address this need. A custom front end search engine performs semantic analysis of textual input enabling users to quickly find information relevant to the search queries. This article describes the technical background and the architecture behind CAMbase, a free online database on CAM ( We give examples on its use, describe the underlying algorithms and present recent statistics for search terms related to complementary therapies in oncology.
PMCID: PMC2730176  PMID: 19718447
cancer; complementary medicine; database; semantic web; literature
4.  The oil-dispersion bath in anthroposophic medicine – an integrative review 
Anthroposophic medicine offers a variety of treatments, among others the oil-dispersion bath, developed in the 1930s by Werner Junge. Based on the phenomenon that oil and water do not mix and on recommendations of Rudolf Steiner, Junge developed a vortex mechanism which churns water and essential oils into a fine mist. The oil-covered droplets empty into a tub, where the patient immerses for 15–30 minutes. We review the current literature on oil-dispersion baths.
The following databases were searched: Medline, Pubmed, Embase, AMED and CAMbase. The search terms were 'oil-dispersion bath' and 'oil bath', and their translations in German and French. An Internet search was also performed using Google Scholar, adding the search terms 'study' and 'case report' to the search terms above. Finally, we asked several experts for gray literature not listed in the above-mentioned databases. We included only articles which met the criterion of a clinical study or case report, and excluded theoretical contributions.
Among several articles found in books, journals and other publications, we identified 1 prospective clinical study, 3 experimental studies (enrolling healthy individuals), 5 case reports, and 3 field-reports. In almost all cases, the studies described beneficial effects – although the methodological quality of most studies was weak. Main indications were internal/metabolic diseases and psychiatric/neurological disorders.
Beyond the obvious beneficial effects of warm bathes on the subjective well-being, it remains to be clarified what the unique contribution of the distinct essential oils dispersed in the water can be. There is a lack of clinical studies exploring the efficacy of oil-dispersion baths. Such studies are recommended for the future.
PMCID: PMC2612644  PMID: 19055811
5.  Eurythmy Therapy in clinical studies: a systematic literature review 
We aimed to overview the current literature on eurythmy therapy (EYT) which is an integral part of Anthroposophic Medicine. EYT can be described as a movement therapy in which speech movements are transposed into exercises which address the patient's capability to soul expression and strengthen his salutogenetic resources.
We searched several databases such as Cochrane, EMBASE, NCCAM, NLM, DIMDI, CAMbase, and Medline for case-control studies, cohort studies and randomised controlled trials on the treatment effects of EYT in a clinical setting. In a second search we included journal databases from Karger, Kluwer, Springer, Thieme, and Merkurstab archive.
We found 8 citations which met the inclusion criterion: 4 publications referring to a prospective cohort study without control group (the AMOS study), and 4 articles referring to 2 explorative pre-post studies without control group, 1 prospective, non-randomized comparative study, and 1 descriptive study with a control group. The methodological quality of studies ranged in from poor to good, and in sample size from 5 to 898 patients. In most studies, EYT was used as an add-on, not as a mono-therapy. The studies described positive treatment effects with clinically relevant effect sizes in most cases.
Indications, study designs and the usage of additional treatments within the identified studies were quite heterogeneous. Despite of this, EYT can be regarded as a potentially relevant add-on in a therapeutic concept, although its specific relevance remains to be clarified. Well performed controlled studies on this unique treatment are highly recommended.
PMCID: PMC2322948  PMID: 18377647
6.  Emotional and rational disease acceptance in patients with depression and alcohol addiction 
The concept of a rational respectively emotional acceptance of disease is highly valued in the treatment of patients with depression or addiction. Due to the importance of this concept for the long-term course of disease, there is a strong interest to develop a tool to identify the levels and factors of acceptance. We thus intended to test an instrument designed to assess the level of positive psychological wellbeing and coping, particularly emotional disease acceptance and life satisfaction
In an anonymous cross-sectional survey enrolling 115 patients (51% female, 49% male; mean age 47.6 ± 10.0 years) with depression and/or alcohol addiction, the ERDA questionnaire was tested.
Factor analysis of the 29-item construct (Cronbach's alpha = 0.933) revealed a 4-factor solution, which explained 59.4% of variance: (1) Positive Life Construction, Contentedness and Well-Being; (2) Conscious Dealing with Illness; (3) Rejection of an Irrational Dealing with Disease; (4) Disease Acceptance. Two factors could be ascribed to a rational, and two to an emotional acceptance. All factors correlated negatively with Depression and Escape, while several aspects of Life Satisfaction" (i.e. myself, overall life, where I live, and future prospects) correlated positively. The highest factor scores were found for the rational acceptance styles (i.e. Conscious Dealing with Illness; Disease Acceptance). Emotional acceptance styles were not valued in a state of depression. Escape from illness was the strongest predictor for several acceptance aspects, while life satisfaction was the most relevant predictor for "Positive Life Construction, Contentedness and Well-Being".
The ERDA questionnaire was found to be a reliable and valid assessment of disease acceptance strategies in patients with depressive disorders and drug abuses. The results indicate the preferential use of rational acceptance styles even in depression. Disease acceptance should not be regarded as a coping style with an attitude of fatalistic resignation, but as a complex and active process of dealing with a chronic disease. One may assume that an emotional acceptance of disease will result in a therapeutic coping process associated with higher level of life satisfaction and overall quality of life.
PMCID: PMC2262062  PMID: 18208595
7.  CAMbase – A XML-based bibliographical database on Complementary and Alternative Medicine (CAM) 
The term "Complementary and Alternative Medicine (CAM)" covers a variety of approaches to medical theory and practice, which are not commonly accepted by representatives of conventional medicine. In the past two decades, these approaches have been studied in various areas of medicine. Although there appears to be a growing number of scientific publications on CAM, the complete spectrum of complementary therapies still requires more information about published evidence. A majority of these research publications are still not listed in electronic bibliographical databases such as MEDLINE. However, with a growing demand by patients for such therapies, physicians increasingly need an overview of scientific publications on CAM. Bearing this in mind, CAMbase, a bibliographical database on CAM was launched in order to close this gap. It can be accessed online free of charge or additional costs.
The user can peruse more than 80,000 records from over 30 journals and periodicals on CAM, which are stored in CAMbase. A special search engine performing syntactical and semantical analysis of textual phrases allows the user quickly to find relevant bibliographical information on CAM. Between August 2003 and July 2006, 43,299 search queries, an average of 38 search queries per day, were registered focussing on CAM topics such as acupuncture, cancer or general safety aspects. Analysis of the requests led to the conclusion that CAMbase is not only used by scientists and researchers but also by physicians and patients who want to find out more about CAM.
Closely related to this effort is our aim to establish a modern library center on Complementary Medicine which offers the complete spectrum of a modern digital library including a document delivery-service for physicians, therapists, scientists and researchers.
PMCID: PMC1853104  PMID: 17407592
8.  Checklist for the qualitative evaluation of clinical studies with particular focus on external validity and model validity 
It is often stated that external validity is not sufficiently considered in the assessment of clinical studies. Although tools for its evaluation have been established, there is a lack of awareness of their significance and application. In this article, a comprehensive checklist is presented addressing these relevant criteria.
The checklist was developed by listing the most commonly used assessment criteria for clinical studies. Additionally, specific lists for individual applications were included. The categories of biases of internal validity (selection, performance, attrition and detection bias) correspond to structural, treatment-related and observational differences between the test and control groups. Analogously, we have extended these categories to address external validity and model validity, regarding similarity between the study population/conditions and the general population/conditions related to structure, treatment and observation.
A checklist is presented, in which the evaluation criteria concerning external validity and model validity are systemised and transformed into a questionnaire format.
The checklist presented in this article can be applied to both planning and evaluating of clinical studies. We encourage the prospective user to modify the checklists according to the respective application and research question. The higher expenditure needed for the evaluation of clinical studies in systematic reviews is justified, particularly in the light of the influential nature of their conclusions on therapeutic decisions and the creation of clinical guidelines.
PMCID: PMC1764896  PMID: 17156475
9.  Engagement of patients in religious and spiritual practices: Confirmatory results with the SpREUK-P 1.1 questionnaire as a tool of quality of life research 
Quality of life is a multidimensional construct composed of functional, physical, emotional, social and spiritual well-being. In order to examine how patients with severe diseases view the impact of spirituality and religiosity on their health and how they cope with illness, we have developed the SpREUK questionnaire. We deliberately avoided the intermingling of attitudes, convictions and practices, and thus addressed the distinct forms and frequencies of spiritual/religious practices in an additional manual, the SpREUK-P questionnaire.
The SpREUK-P was designed to differentiate spiritual, religious, existentialistic and philosophical practices. It was tested in a sample of 354 German subjects (71% women; 49.0 ± 12.5 years). Half of them were healthy controls, while among the patients cancer was diagnosed in 54%, multiple sclerosis in 22%, and other chronic diseases in 23%. Reliability and factor analysis of the inventory were performed according to the standard procedures.
We confirmed the structure and consistency of the previously described 18-item SpREUK-P manual and improved the quality of the current construct by adding several new items. The new 25-item SpREUK-P 1.1 (Cronbach's alpha = 0.8517) has the following scales: (1) conventional religious practice (CRP), (2) existentialistic practice (ExP), (3) unconventional spiritual practice (USP), (4) nature/environment-oriented practice (NoP), and (5) humanistic practice (HuP). Among the tested individuals, the highest engagement scores were found for HuP and NoP, while the lowest were found for the USP. Women had significantly higher scores for ExP than male patients. With respect to age, the engagement in CRP increases with increasing age, while the engagement in a HuP decreased. Individuals with a Christian orientation and with a religious and spiritual attitude had the highest engagement scores for CRP, while the engagement in an USP was high with respect to a spiritual attitude. Variance analyses confirmed that the SpR attitude and religious affiliation are the main relevant covariates for CRP and ExP, while for the USP the SpR attitude and the educational level are of significance, but not religious affiliation. Patients with multiple sclerosis overall had the lowest engagement scores for all five forms of SpR practice, while it is remarkable that cancer patients had lower scores for HuP and USP than healthy subjects.
The current re-evaluation of the SpREUK-P questionnaire (Version 1.1) indicates that it is a reliable, valid measure of five distinct forms of spiritual, religious and philosophical practice that may be especially useful for assessing the role of spirituality and religiosity in health related research. An advantage of our instruments is the clear-cut differentiation between convictions and attitudes on the one hand, and the expression of these attitudes in a concrete engagement on the other hand.
PMCID: PMC1253527  PMID: 16144546
Questionnaires; Religion and Medicine; Spirituality and Religion; religious practices; coping; chronic disease, cancer; multiple sclerosis
10.  The Herdecke questionnaire on quality of life (HLQ): Validation of factorial structure and development of a short form within a naturopathy treated in-patient collective 
Quality of life (QoL) of patients has become a central evaluation parameter that also acts as an aid for decisions related to treatment strategies particularly for patients with chronic illnesses. In Germany, one of the newer instruments attempting to measure distinct QoL aspects is the "Herdecke Questionnaire for Quality of Life" (HLQ). In this study, we aimed to validate the HLQ with respect to its factorial structure, and to develop a short form. The validation has been carried out in relation to other questionnaires including the SF-36 Health Survey, the Mood-Scale Bf-S, the Giessen Physical Complaints Questionnaire GBB-24 and McGill's Pain Perception Scale SES.
Data for this study derived from a model project on the treatment of patients using naturopathy methods in Blankenstein Hospital, Hattingen. In total, 2,461 patients between the ages of 16 and 92 years (mean age: 58.0 ± 13.4 years) were included in this study. Most of the patients (62%) suffered from rheumatic diseases. Factorial validation of the HLQ, it's reliability and external consistency analysis and the development of a short form were carried out using the SPSS software.
Structural analysis of the HLQ-items pointed to a 6-factor model. The internal consistency of both the long and the short version is excellent (Cronbach's α is 0.935 for the HLQ-L and 0.862 for the HLQ-S). The highest reliability in the HLQ-L was obtained for the "Initiative Power and Interest" scale, the lowest for the 2-item scales "Digestive Well-Being" and the "Physical Complaints". However, the scales found by factor analysis herein were only in part congruent with the original 5-scale model which was approved a multitrait analysis approach. The new instrument shows good correlations with several scales of other relevant QoL instruments. The scales "Initiative Power and Interest", "Social Interaction", "Mental Balance", "Motility", "Physical Complaints", "Digestive Well-Being" sufficiently differentiate the diagnostic groups, particularly between the patients suffering on connective tissue and soft tissue disorders from those with metabolic and nutritional disorders or hypersensitivity reactions.
Both the factorial validation and the development of a consistent short-form of the HLQ are important steps forward for researchers in the field of QoL who wish to use the HLQ as a reliable and valid instrument. The results indicate that the HLQ is a unique QoL-instrument that can be used for both in-patient and out-patient-treatment. However, to improve to profile of the HLQ, there is still the need for strengthening the Questionnaire in the dimensions of physical well-being. This is the subject of a separate ongoing study.
PMCID: PMC1177980  PMID: 16004612
Questionnaires; Quality of life; short form; rheumatic diseases; naturopathy; Herdecke Questionnaire for Quality of Life;
11.  Role of religion and spirituality in medical patients: Confirmatory results with the SpREUK questionnaire 
Spirituality has become a subject of interest in health care as it is was recognized to have the potential to prevent, heal or cope with illness. There is less doubt that values and goals are important contributors to life satisfaction, physical and psychological health, and that goals are what gives meaning and purpose to people's lives. However, there is as yet but limited understanding of how patients themselves view the impact of spirituality on their health and well-being, and whether they are convinced that their illness may have "meaning" to them. To raise these questions and to more precisely survey the basic attitudes of patients with severe diseases towards spirituality/religiosity (SpR) and their adjustment to their illness, we developed the SpREUK questionnaire.
In order to re-validate our previously described SpREUK instrument, reliability and factor analysis of the new inventory (Version 1.1) were performed according to the standard procedures. The test sample contained 257 German subjects (53.3 ± 13.4 years) with cancer (51%), multiple sclerosis (24%), other chronic diseases (16%) and patients with acute diseases (7%).
As some items of the SpREUK construct require a positive attitude towards SpR, these items (item pool 2) were separated from the others (item pool 1). The reliability of the 15-item the construct derived from the item pool 1 respectively the 14-item construct which refers to the item pool 2 both had a good quality (Cronbach's alpha = 0.9065 resp. 0.9525). Factor analysis of item pool 1 resulted in a 3-factor solution (i.e. the 6-item sub-scale 1: "Search for meaningful support"; the 6-item sub-scale 2: "Positive interpretation of disease"; and the 3-item sub-scale 3: "Trust in external guidance") which explains 53.8% of variance. Factor analysis of item pool 2 pointed to a 2-factor solution (i.e. the 10-item sub-scale 4: "Support in relations with the External life through SpR" and the 4-item sub-scale 5: "Support of the Internality through SpR") which explains 58.8% of variance. Generally, women had significantly higher SpREUK scores than male patients. Univariate variance analyses revealed significant associations between the sub-scales and SpR attitude and the educational level.
The current re-evaluation of the SpREUK 1.1 questionnaire indicates that it is a reliable, valid measure of distinct topics of SpR that may be especially useful of assessing the role of SpR in health related research. The instrument appears to be a good choice for assessing a patients interest in spiritual concerns which is not biased for or against a particular religious commitment. Moreover it addresses the topic of "positive reinterpretation of disease" which seems to be of outstanding importance for patients with life-changing diseases.
PMCID: PMC550666  PMID: 15705195
Questionnaires; Religion and Medicine; Spirituality and Religion; coping; chronic disease, cancer

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