Some Selected Abstract::

1.  

Jorm AF, Christensen H, Griffiths KM, Parslow RA, Rodgers B, Blewitt KA. Effectiveness of complementary and self-help treatments for anxiety disorders. Med J Aust. 2004 Oct 4;181(7 Suppl):S29-46.

Centre for Mental Health Research, Australian National University, Building 63, Eggleston Road, Acton, ACT 0200, Australia. anthony.jorm@anu.edu.au.

OBJECTIVES: To review the evidence for the effectiveness of complementary and self-help treatments for anxiety disorders. DATA SOURCES: Systematic literature search using PubMed, PsycLit, and the Cochrane Library. DATA SYNTHESIS: 108 treatments were identified and grouped under the categories of medicines and homoeopathic remedies, physical treatments, lifestyle, and dietary changes. We give a description of the 34 treatments (for which evidence was found in the literature searched), the rationale behind the treatments, a review of studies on effectiveness, and the level of evidence for the effectiveness studies. CONCLUSIONS: The treatments with the best evidence of effectiveness are kava (for generalised anxiety), exercise (for generalised anxiety), relaxation training (for generalised anxiety, panic disorder, dental phobia and test anxiety) and bibliotherapy (for specific phobias). There is more limited evidence to support the effectiveness of acupuncture, music, autogenic training and meditation for generalised anxiety; for inositol in the treatment of panic disorder and obsessive-compulsive disorder; and for alcohol avoidance by people with alcohol-use disorders to reduce a range of anxiety disorders.

2.  

Moseley GL, Nicholas MK, Hodges PW. Does anticipation of back pain predispose to back trouble?  Brain. 2004 Oct;127(Pt 10):2339-47.

Prince of Wales Medical Research Institute, Randwick, Sydney, Austalia. l.moseley@fhs.usyd.edu.au
Limb movement imparts a perturbation to the body. The impact of that perturbation is limited via anticipatory postural adjustments. The strategy by which the CNS controls anticipatory postural adjustments of the trunk muscles during limb movement is altered during acute back pain and in people with recurrent back pain, even when they are pain free. The altered postural strategy probably serves to protect the spine in the short term, but it is associated with a cost and is thought to predispose spinal structures to injury in the long term. It is not known why this protective strategy might occur even when people are pain free, but one possibility is that it is caused by the anticipation of back pain. In eight healthy subjects, recordings of intramuscular EMG were made from the trunk muscles during single and repetitive arm movements. Anticipation of experimental back pain and anticipation of experimental elbow pain were elicited by the threat of painful cutaneous stimulation. There was no effect of anticipated experimental elbow pain on postural adjustments. During anticipated experimental back pain, for single arm movements there was delayed activation of the deep trunk muscles and augmentation of at least one superficial trunk muscle. For repetitive arm movements, there was decreased activity and a shift from biphasic to monophasic activation of the deep trunk muscles and increased activity of superficial trunk muscles during anticipation of back pain. In both instances, the changes were consistent with adoption of an altered strategy for postural control and were similar to those observed in patients with recurrent back pain. We conclude that anticipation of experimental back pain evokes a protective postural strategy that stiffens the spine. This protective strategy is associated with compressive cost and is thought to predispose to spinal injury if maintained long term.

3.  

Nayak NN, Shankar K. Yoga: a therapeutic approach. Phys Med Rehabil Clin N Am. 2004 Nov;15(4):783-98, vi. Review.

Department of Physical Medicine and Rehabilitation (117), Veterans Affairs Northern California Health Care System, 150 Muir Road, Martinez, CA 94553, USA. Niminayak@yahoo.com

Yoga, practiced widely in the East, is now popular in the West as part of a healthy lifestyle. This article brings a medical perspective to the practice of yoga. Selected yoga postures that are believed to benefit certain medical conditions are highlighted. In addition, the philosophy, general guidelines, and medical benefits of yoga practice are described.

4.  

Ottawa Panel. Ottawa Panel evidence-based clinical practice guidelines for therapeutic exercises in the management of rheumatoid arthritis in adults.
Phys Ther. 2004 Oct;84(10):934-72. Review.

Ottawa Panel.

BACKGROUND AND PURPOSE: The purpose of this project was to create guidelines for the use of therapeutic exercises and manual therapy in the management of adult patients (>18 years of age) with a diagnosis of rheumatoid arthritis according to the 1987 American Rheumatism Association criteria. METHODS: Evidence from comparative controlled trials was identified and synthesized using The Cochrane Collaboration methods. An expert panel was formed by inviting professional stakeholder organizations to each nominate a representative. This panel developed a set of criteria for grading the strength of both the evidence and the recommendation. RESULTS: Six positive recommendations of clinical benefit were developed on therapeutic exercises. The efficacy of manual therapy interventions could not be determined for lack of evidence. DISCUSSION AND CONCLUSION: The panel recommends the use of therapeutic exercises for rheumatoid arthritis. Further research is needed to determine the efficacy of manual therapy in the management of this disease.

5.  

Schmid W, Aldridge D. Active music therapy in the treatment of multiple sclerosis patients: a matched control study. J Music Ther. 2004 Fall;41(3):225-40.

Twenty multiple sclerosis patients (14 female, 6 male) were involved in the study, their ages ranging rom 29 to 47 years. Ten participants formed the therapy group, and 10 the control group. The groups were comparable on the standard neurological classification scheme Expanded Disability Status Scale (EDSS). Exclusion criteria were pregnancy and mental disorders requiring medication. Measurements were taken before therapy began (T1), and subsequently every 3 months (T2-T4). This battery included indicators of clinical depression and anxiety (Beck Depression Inventory and Hospital Anxiety and Depression Scale), a self-acceptance scale (SESA) and a life quality assessment (Hamburg Quality of Life Questionnaire in Multiple Sclerosis). In addition, data were collected on cognitive (MSFC) and functional (EDSS) parameters. Patients in the therapy group received 3 blocks of music therapy in single sessions over the course of the one year project (8 to 10 sessions respectively). The music therapy approach used for this study is based on the Nordoff Robbins approach (Nordoff & Robbins, 1977). There was no significant difference between the music therapy treatment group and the control group. However, the effect size statistics comparing both groups show a medium effect size on the scales measuring self esteem (d = 0.5423, r =.026), depression HAD-D (d = 0.63, r = 0.310) and anxiety HAD-A (d = 0.63, r = 0.310). Significant improvements were found for the therapy group over time (T1-T4) in the scale values of self esteem, depression, and anxiety. Given the stigmatizing effect of a chronic degenerative disease, the positive benefits of music therapy point to a realm of aesthetic considerations in assessing clinical improvement.

6.  

UK BEAM Trial Team. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care.
BMJ. 2004 Dec 11;329(7479):1381.

OBJECTIVE: To assess the cost effectiveness of adding spinal manipulation, exercise classes, or manipulation followed by exercise ("combined treatment") to "best care" in general practice for patients consulting with low back pain. DESIGN: Stochastic cost utility analysis alongside pragmatic randomised trial with factorial design. SETTING: 181 general practices and 63 community settings for physical treatments around 14 centres across the United Kingdom. PARTICIPANTS: 1287 (96%) of 1334 trial participants. MAIN OUTCOME MEASURES: Healthcare costs, quality adjusted life years (QALYs), and cost per QALY over 12 months. RESULTS: Over one year, mean treatment costs relative to "best care" were 195 pounds sterling (360 dollars; 279 euros; 95% credibility interval 85 pounds sterling to 308 pounds sterling) for manipulation, 140 pounds sterling (3 pounds sterling to 278 pounds sterling) for exercise, and 125 pounds sterling (21 pounds sterling to 228 pounds sterling) for combined treatment. All three active treatments increased participants' average QALYs compared with best care alone. Each extra QALY that combined treatment yielded relative to best care cost 3800 pounds sterling; in economic terms it had an "incremental cost effectiveness ratio" of 3800 pounds sterling. Manipulation alone had a ratio of 8700 pounds sterling relative to combined treatment. If the NHS was prepared to pay at least 10,000 pounds sterling for each extra QALY (lower than previous recommendations in the United Kingdom), manipulation alone would probably be the best strategy. If manipulation was not available, exercise would have an incremental cost effectiveness ratio of 8300 pounds sterling relative to best care. CONCLUSIONS: Spinal manipulation is a cost effective addition to "best care" for back pain in general practice. Manipulation alone probably gives better value for money than manipulation followed by exercise.

7.  

West J, Otte C, Geher K, Johnson J, Mohr DC. Effects of Hatha yoga and African dance on perceived stress, affect, and salivary cortisol. Ann Behav Med. 2004 Oct;28(2):114-8.

Reed College, USA. jeremy.west@stanford.edu

BACKGROUND: Dance and yoga have been shown to produce improvements in psychological well-being. PURPOSE: The aim of this study was to examine some of the psychological and neuroendocrine response to these activities. METHODS: Sixty-nine healthy college students participated in one of three 90-min classes: African dance (n = 21), Hatha yoga (n= 18), or a biology lecture as a control session (n = 30). Before and after each condition participants completed the Perceived Stress Scale (PSS), completed the Positive Affect and Negative Affect Schedule, and provided a saliva sample for cortisol. RESULTS: There were significant reductions in PSS and negative affect (ps < .0001) and Time x Treatment interactions (ps < .0001) such that African dance and Hatha yoga showed significant declines, whereas there was no significant change in biology lecture. There was no significant main effect for positive affect (p = .53), however there was a significant interaction effect (p < .001) such that positive affect increased in African dance, decreased in biology lecture, and did not change significantly in Hatha yoga. There was a significant main effect for salivary cortisol (p < .05) and a significant interaction effect (p < .0001) such that cortisol increased in African dance, decreased in Hatha yoga, and did not change in biology. Changes in cortisol were not significantly related to changes in psychological variables across treatments. There was 1 significant interaction effect (p = .04) such that change in positive affect and change in cortisol were negatively correlated in Hatha yoga but positively correlated in Africa dance and biology. CONCLUSIONS: Both African dance and Hatha yoga reduced perceived stress and negative affect. Cortisol increased in African dance and decreased in Hatha yoga. Therefore, even when these interventions produce similar positive psychological effects, the effects may be very different on physiological stress processes. One factor that may have particular salience is that amount of physiological arousal produced by the intervention.

Some Selected Abstract::

1.  

Adams M, Pacher T, Greger H, Bauer R. Inhibition of leukotriene biosynthesis by stilbenoids from Stemona species. J Nat Prod. 2005 Jan;68(1):83-5.

Institute of Pharmaceutical Sciences, Department of Pharmacognosy, University of Graz, A-8010 Graz, Austria.

Fifteen stilbenoids and two alkaloids from Stemona collinsae, S. tuberosa, and S. peirrei were tested alongside the commercially available stilbenoids resveratrol and pinosylvin for inhibition of leukotriene formation in an ex vivo test system based on activated human neutrophilic granulocytes. The stilbenoids resveratrol (1), pinosylvin (2), dihydropinosylvin (3), stilbostemin A (4), stilbostemin B (5), stilbostemin D (6), stilbostemin F (7), stilbostemin G (8), stemofuran B (9), stemofuran C (10), stemofuran D (11), stemofuran G (12), stemofuran J (13), stemanthrene A (14), stemanthrene B (15), stemanthrene C (16), and stemanthrene D (17) showed structure-dependent activities with IC(50) values ranging from 3.7 to >50 microM. The alkaloids tuberostemonine (18) and neotuberostemonine (19) were inactive at a concentration of 50 microM.

2.  

Bloomberg GR, Chen E. The relationship of psychologic stress with childhood asthma. Immunol Allergy Clin North Am. 2005 Feb;25(1):83-105.

Division of Allergy and Pulmonary Medicine, Washington University Medical School, St. Louis Children's Hospital, One Children's Place, St. Louis, MO 63110, USA. bloomberg@kids.wustl.edu

The psychologic influence on childhood asthma has long been a subject of investigation and controversy. This article illustrates the evidence that psychologic stress is related to children with asthma. Individual experience, the impact of family and neighborhood, the effect of caregiver mental status, and the presence of negative psychologic events affect symptoms and management. The pathways through which these factors influence asthma are mediated through cognitive and biologic mechanisms, with evidence indicating changes in behavior and alteration in immune response as underlying mechanisms. Psychologic issues are important in the patient with severe asthma. The mind-body paradigm that links psychologic stress to disease is necessary when considering the global evaluation of childhood asthma.

3.  

Bodin P, Fagevik Olsen M, Bake B, Kreuter M. Effects of abdominal binding on breathing patterns during breathing exercises in persons with tetraplegia. Spinal Cord. 2005 Feb;43(2):117-22.

Department of Physiotherapy, Sahlgrenska University Hospital, Goteborg, Sweden.

STUDY DESIGN: Cross-sectional, experimental. OBJECTIVES: To investigate and compare static lung volumes and breathing patterns in persons with a cervical spinal cord lesion during breathing at rest, ordinary deep breathing, positive expiratory pressure (PEP) and inspiratory resistance-positive expiratory pressure (IR-PEP) with and without an abdominal binder (AB). SETTING: The outpatient clinic at the Spinal Unit at Sahlgrenska University Hospital, Goteborg, Sweden. METHOD: The study group consisted of 20 persons with complete cervical cord lesion at C5-C8 level. Breathing patterns and static lung volumes with and without an AB were measured using a body plethysmograph. RESULTS:: With an AB, static lung volumes decreased, vital capacity increased, breathing patterns changed only marginally and functional residual capacity remained unchanged during PEP and IR-PEP. CONCLUSION: Evidence supporting the general use of an AB to prevent respiratory complications by means of respiratory training is questionable. However, the interindividual variation in our results indicates that we cannot rule out that some patients may benefit from the treatment.

4.  

Bugbee ME, Wellisch DK, Arnott IM, Maxwell JR, Kirsch DL, Sayre JW, Bassett LW. Breast core-needle biopsy: clinical trial of relaxation technique versus medication versus no intervention for anxiety reduction. Radiology. 2005 Jan;234(1):73-8.

Iris Cantor Center for Breast Imaging, Department of Radiology, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Room 165-47, Box 956952, Los Angeles, CA 90095-6952, USA.

PURPOSE: To evaluate effectiveness of oral anxiolytic medication versus relaxation technique for anxiety reduction in women undergoing breast core-needle biopsy (CNB). MATERIALS AND METHODS: The institutional review board reviewed and approved the study. Informed consent was obtained from 143 consecutive women scheduled for breast CNB. Women were randomized as follows: no anxiety intervention (usual care group), relaxation therapy with an audiotape of classical music and ocean sounds during CNB (relaxation group), and 0.5-mg of alprazolam administered orally 15 minutes before CNB (medication group). Anxiety before, during, and 24 hours after the procedure was assessed with State-Trait Anxiety Inventory and self-reported visual analog scale from 0 (no anxiety) to 10 (worst anxiety). Data analysis was performed with statistical software. Descriptive statistics were computed for all variables. Group differences were determined with analysis of variance. Differences in mean values were assessed with Bonferroni multiple comparison procedure. Categorical demographic differences were assessed with chi(2) statistic. RESULTS: Preprocedural State-Trait Anxiety Inventory scores indicated that women were not inherently anxious: usual care group, score of 44.63; relaxation group, 45.74; and medication group, 49.1. Scores represented significantly elevated anxiety for women in all three groups when compared with the normative value of 35.12 (P < .0001), with no statistically significant differences between the scores of the three groups. Women in medication group reported significant reductions in anxiety (-44%) from levels determined before the procedure to levels determined during the procedure (P = .02) and significant reduction during the procedure when compared with changes in usual care (+15%) and relaxation (-8%) groups (P = .02). Women in all three groups reported significant reduction in anxiety from levels determined before the procedure to levels determined at 24 hours after it (P < .0001). There was no significant difference (P = .95) in 24-hour postprocedural anxiety levels among the three groups. CONCLUSION: Use of oral anxiolytic medication before breast CNB can significantly reduce anxiety women experience during the procedure. (c) RSNA, 2004.

5.  

Cohen MH, Sandler L, Hrbek A, Davis RB, Eisenberg DM.
Policies pertaining to complementary and alternative medical therapies in a random sample of 39 academic health centers. Altern Ther Health Med. 2005 Jan-Feb;11(1):36-40.

Harvard Medical School Osher Institute, Boston, Mass, USA.

This research documents policies in 39 randomly selected academic medical centers integrating complementary and alternative medical (CAM) services into conventional care. Twenty-three offered CAM services-most commonly, acupuncture, massage, dietary supplements, mind-body therapies, and music therapy. None had written policies concerning credentialing practices or malpractice liability. Only 10 reported a written policy governing use of dietary supplements, although three sold supplements in inpatient formularies, one in the psychiatry department, and five in outpatient pharmacies. Thus, few academic medical centers have sufficiently integrated CAM services into conventional care by developing consensus-written policies governing credentialing, malpractice liability, and dietary supplement use.

6.  

Cohen-Katz J, Wiley SD, Capuano T, Baker DM, Kimmel S, Shapiro S.The effects of mindfulness-based stress reduction on nurse stress and burnout, Part II: A quantitative and qualitative study. Holist Nurs Pract. 2005 Jan-Feb;19(1):26-35.

Lehigh Valley Hospital, Department of Family Medicine, 17th & Chew Sts, Allentown, PA 18105, USA. Joanne.Cohen-Katz@lvh.com

This article is the second in a series reporting on research exploring the effects of Mindfulness-based Stress Reduction on nurses and describes the quantitative data. The third article describes qualitative data. Treatment group participants reduced scores on 2 of 3 subscales of the Maslach Burnout Inventory significantly more than wait-list controls; within-group comparisons for both groups pretreatment and posttreatment revealed similar findings. Changes were maintained as long as 3-month posttreatment. Implications of these findings are discussed.

7.  

Grabois M. Management of chronic low back pain. Am J Phys Med Rehabil. 2005 Mar;84(3 Suppl):S29-41.

Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA.

Chronic low back pain is common. It presents a clinical challenge with widespread implications for resource utilization on a national scale. The causes of chronic low back pain may be mechanical or nonmechanical, nociceptive or neuropathic. Diagnosis is problematic because available tools lack both specificity and sensitivity. In rare instances, the cause of chronic low back pain can be attributed to an identified cause. Comprehensive pain management relies on the use of pharmacotherapy, physical therapy, and a multidisciplinary approach to treatment. Recent studies have shown a benefit for traditional adjunctive therapies and interdisciplinary treatment. Antidepressants and opioids have been and remain key elements for medical management, and some recently developed therapies have shown promising results in clinical trials. The following article presents an overview of evidence-based management for chronic low back pain, with an emphasis on pharmaceutical therapies.

8.

Honda K, Jacobson JS. Use of complementary and alternative medicine among United States adults: the influences of personality, coping strategies, and social support. Prev Med. 2005 Jan;40(1):46-53.

Department of Epidemiology, Columbia University, New York, NY 10032, USA. kh2086@columbia.edu

BACKGROUND: Although patterns of utilization of complementary and alternative medicine (CAM) in the community have begun to be described, few studies have addressed the relationships between dispositional psychological factors and the use of CAM. The aim of this study was to examine the associations between CAM use and personality, coping strategies, and perceived social support in a representative sample of adults in the United States. METHODS: Data were drawn from the Midlife Development in the United States Survey (MIDUS), a representative sample of 3,032 adults aged 25-74 in the US population. We analyzed use of acupuncture, biofeedback, chiropractic, energy healing, exercise/movement therapy, herbal medicine, high-dose megavitamins, homeopathy, hypnosis, imagery techniques, massage, prayer/spiritual practice, relaxation/mediation, and special diet within the last year. Multiple logistic regression analyses were used to evaluate the association of personality, dispositional coping strategies (primary and secondary control), and perceived social support and strain with CAM use, controlling for sociodemographic factors, medical care access, and physical and mental disorders. RESULTS: Openness was positively associated with the use of all types of CAM except manipulative body-based methods. Extroversion was inversely correlated with the use of mind-body therapies. Primary control was inversely and secondary control directly correlated with the use of CAM. Perceived friend support was positively associated with the use of mind-body therapies, manipulative body-based methods, and alternative medical systems. Perceived partner strain was positively associated with the use of biologically based therapies, and family strain increased the odds of manipulative body-based methods. CONCLUSIONS: This study is the first to document a significant association between specific domains of personality, coping strategies, and social support, and the use of CAM among adults in the general population. Understanding the relationships between psychological factors and CAM use may help researchers and health care providers to address patients' needs more effectively and to achieve better adherence to treatment recommendations.

9.

Olincy A, Martin L. Diminished suppression of the P50 auditory evoked potential in bipolar disorder subjects with a history of psychosis. Am J Psychiatry. 2005 Jan;162(1):43-9.

Department of Veterans Affairs and University of Colorado Health Sciences Center, Denver 80262, USA.

OBJECTIVE: People with schizophrenia, schizoaffective disorder, and bipolar illness share clinical symptoms, biological findings, and genetic susceptibility. Diminished suppression of the P50 auditory evoked potential is a phenotype used in studies of genetic susceptibility in schizophrenia. In patients with acute mania, this inhibitory deficit has been correlated with severity of clinical symptoms. This study addresses whether diminished P50 auditory evoked potential suppression represents a phenotype associated with psychosis in bipolar illness. METHOD: The P50 auditory evoked potential response to paired stimuli was measured in 64 subjects with bipolar illness. The Structured Clinical Interview for DSM-IV and a life chart determined diagnosis. The Beck Depression Inventory, Young Mania Rating Scale, and the Positive and Negative Syndrome Scale measured severity of current illness. Groups were compared with previously collected data from 36 schizophrenia patients and 42 healthy subjects. RESULTS: P50 suppression significantly differed between bipolar disorder patients with a lifetime history of psychosis and healthy subjects. P50 suppression in bipolar disorder patients without a history of psychosis did not differ from that of the healthy subjects. Severity of current symptoms did not correlate with P50 suppression. CONCLUSIONS: A longitudinal history of psychosis in subjects with bipolar illness was associated with diminished suppression of the P50 auditory evoked potential. This deficit may represent a common physiological mechanism associated with the vulnerability to psychosis in people with bipolar illness as well as in people with schizophrenia.

10.

Takahashi T, Murata T, Hamada T, Omori M, Kosaka H, Kikuchi M, Yoshida H, Wada Y. Changes in EEG and autonomic nervous activity during meditation and their association with personality traits. Int J Psychophysiol. 2005 Feb;55(2):199-207.

Department of Neuropsychiatry, Faculty of Medical Sciences, University of Fukui, Matsuoka-cho, Fukui 910-1193, Japan.

Meditation is the attainment of a restful yet fully alert physical and mental state practiced by many as a self-regulatory approach to emotion management, but the psychophysiological properties and personality traits that characterize this meditative state have not been adequately studied. We quantitatively analyzed changes in psychophysiological parameters during Zen meditation in 20 normal adults, and evaluated the results in association with personality traits assessed by Cloninger's Temperament and Character Inventory (TCI). During meditation, increases were observed in fast theta power and slow alpha power on EEG predominantly in the frontal area, whereas an increase in the normalized unit of high-frequency (nuHF) power (as a parasympathetic index) and decreases in the normalized unit of low-frequency (nuLF) power and LF/HF (as sympathetic indices) were observed through analyses of heart rate variability. We analyzed the possible correlations among these changes in terms of the percent change during meditation using the control condition as the baseline. The percent change in slow alpha EEG power in the frontal area, reflecting enhanced internalized attention, was negatively correlated with that in nuLF as well as in LF/HF and was positively correlated with the novelty seeking score (which has been suggested to be associated with dopaminergic activity). The percent change in fast theta power in the frontal area, reflecting enhanced mindfulness, was positively correlated with that in nuHF and also with the harm avoidance score (which has been suggested to be associated with serotonergic activity). These results suggest that internalized attention and mindfulness as two major core factors of behaviors of mind during meditation are characterized by different combinations of psychophysiological properties and personality traits.

Some Selected Abstract::

1.  

Abraham S, Kumar MS, Sehgal PK, Nitish S, Jayakumar ND. Evaluation of the inhibitory effect of triphala on PMN-type matrix metalloproteinase (MMP-9).  J Periodontol. 2005 Apr;76(4):497-502.

Department of Periodontia, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India.

BACKGROUND: This study evaluated the inhibitory activity of triphala on PMN-type matrix metalloproteinase (MMP-9) expressed in adult periodontitis patients and compared its activity with another ayurvedic drug, kamillosan, and doxycycline, which has known inhibitory activity. METHODS: Matrix metalloproteinases (MMPs) were extracted from gingival tissue samples from 10 patients (six males, four females) with chronic periodontitis. Tissue extracts were treated with the drug solutions, the inhibition was analyzed by gelatin zymography, and the percentage of inhibition was determined by a gel documentation system. RESULTS: The activity of MMPs was significantly decreased with the use of the drugs. Triphala showed a 76.6% reduction of MMP-9 activity, whereas kamillosan showed a 46.36% reduction at a concentration of 1,500 microg/ml (crude extract) and doxycycline showed a 58.7% reduction at a concentration of 300 microg/ml (pure drug). CONCLUSION: The present study showed the strong inhibitory activity of triphala on PMN-type MMPs involved in the extracellular matrix (ECM) degradation during periodontitis.

2.  

Arold G, Donath F, Maurer A, Diefenbach K, Bauer S, Henneicke-von Zepelin HH, Friede M, Roots I. No relevant interaction with alprazolam, caffeine, tolbutamide, and digoxin by treatment with a low-hyperforin St John's wort extract. Planta Med. 2005 Apr;71(4):331-7.

Institute of Clinical Pharmacology, University Medical Center Charite, Humboldt University, Berlin, Germany.

We evaluated the pharmacokinetic interaction between a low-hyperforin St John's wort (SJW) extract and alprazolam, caffeine, tolbutamide, and digoxin. Previous reports on other SJW products had shown remarkably decreased plasma concentrations of certain co-medicated drugs, which was attributed to an inducing effect of SJW on cytochrome P-450 (CYP) and p-glycoprotein (p-gp) activity. Two randomised, placebo-controlled studies were performed with 28 healthy volunteers (age 18 - 55 years) in each study. In study A, single doses of alprazolam (1 mg; substrate of CYP3A4) and caffeine (100 mg; CYP1A2) were given on days 1 and 11. In study B, single doses of tolbutamide (500 mg, days 1 and 11; CYP2C9) and multiple doses of digoxin (0.75 mg on days -2 and -1, 0.25 mg/die on days 1 to 11; p-gp) were given. The participants received SJW (Esbericum capsules; 240 mg/die of extract, 3.5 mg hyperforin) or placebo on days 2 to 11. Blood for pharmacokinetic analysis was drawn on days 1 and 11. No statistically significant differences were found in the primary kinetic parameter, AUC0 - 24, of alprazolam, caffeine (AUC0 - 12), paraxanthine, tolbutamide, 4-hydroxytolbutamide, and digoxin between the placebo group and the SJW group at the end of the study. The SJW-induced change in AUCs was less than 12 % of the initial median AUC of the participants in studies A and B, thus clinically irrelevant. On day 11, trough concentrations were 2.0 (range 0.6 - 4.1) microg/L and 1.0 (0.2 - 3.9) microg/L for hypericin and pseudohypericin, respectively, whereas hyperforin concentrations were below the quantification limit (< 1 microg/L). Kinetics of investigated probe drugs were only marginally influenced by concomitant treatment with Esbericum capsules. This may be due in particular to the low hyperforin plasma concentration as this SJW component has been shown to activate the PXR receptor which regulates expression of CYP3A4 and p-gp. Our findings corroborate the view that reports about interactions of other SJW extracts seem not to be predictive for the product we studied.

3.  

Barnes S, Prasain J. Current progress in the use of traditional medicines and nutraceuticals. Curr Opin Plant Biol. 2005 Jun;8(3):324-8.

Department of Pharmacology and Toxicology, McCallum Research Building, University of Alabama at Birmingham, 1918 University Boulevard, Birmingham, Alabama 35294, USA. sbarnes@uab.edu

Traditional medicines in the form of botanical dietary supplements and nutraceuticals have found a place in 21st century healthcare. They nonetheless all contain compounds that are foreign to humans (i.e. xenobiotics) and that are subject to the same pharmacological issues encountered by synthetic therapeutic agents. It is crucial therefore for all parties, the medical profession, investigative scientists, the regulatory agencies and the public, to understand the particular characteristics of botanicals and nutraceuticals and their potential for success and failure in preventing and confronting disease.

4.  

Bhimani S.  Clinical study of efficacy of glycoban cap in patients of non- insulin dependent diabetes (NIDDM) mellitus. Antiseptic. 2005 Feb; 102(2): 71-75.

Mangalam Hospital, 25, New Jagnath, Behind Astron Cinema, Rajkot

Latest WHO estimate: By 2025 the number of diabetes will rise to 228 million (1985-84 million). Diabetes (Madhumeha) mean honey urine is a complex metabolic disorder. The early model of the diseases as dysfunction of metabolism and transport of glucose is no longer adequate. We now know that lipids, proteins, aminoacids, ketones and hormones are involved. Now the liver muscles, adipose tissue and the brain are the ports of the total picture. Allopathic treatments are done mainly by Oral Hypoglycaemic Agents (OHA). No attempt is made to restore the pancreases, so by paying the needed emphasis on this newly developing insight a group effort was put forward for the patients of latent and prediabetics by launching a well designed "Clinical evaluation study on GLUCOBAN cap. " at our hospital. Here it has to be noted that the each of the following ingredients being used in the formation of Glycoban cap. is nature based and has been found with having specific mode of action in restoring the process according to the classical text book of Ayurveda.

5.  

Browall M, Magri M, Selvekerova S, Madsen E, Milovics L, Bruyns I, Gudmundsdottir G, Hummerston S, Ahmad AM, Platin N, Kearney N, Patiraki E. Use of complementary and alternative medicine in cancer patients: a European survey. Ann Oncol. 2005 Apr;16(4):655-63.

School of Nursing, University of Manchester, Manchester, UK. alex.molassiotis@manchester.ac.uk

BACKGROUND: The aim of this study was to explore the use of complementary and alternative medicine (CAM) in cancer patients across a number of European countries. METHODS: A descriptive survey design was developed. Fourteen countries participated in the study and data was collected through a descriptive questionnaire from 956 patients. RESULTS: Data suggest that CAM is popular among cancer patients with 35.9% using some form of CAM (range among countries 14.8% to 73.1%). A heterogeneous group of 58 therapies were identified as being used. Herbal medicines and remedies were the most commonly used CAM therapies, together with homeopathy, vitamins/minerals, medicinal teas, spiritual therapies and relaxation techniques. Herbal medicine use tripled from use before diagnosis to use since diagnosis with cancer. Multivariate analysis suggested that the profile of the CAM user was that of younger people, female and with higher educational level. The source of information was mainly from friends/family and the media, while physicians and nurses played a small part in providing CAM-related information. The majority used CAM to increase the body's ability to fight cancer or improve physical and emotional well-being, and many seemed to have benefited from using CAM (even though the benefits were not necessarily related to the initial reason for using CAM). Some 4.4% of patients, however, reported side-effects, mostly transient. CONCLUSIONS: It is imperative that health professionals explore the use of CAM with their cancer patients, educate them about potentially beneficial therapies in light of the limited available evidence of effectiveness, and work towards an integrated model of health-care provision.

6.  

Debnath PK; Bhattacharya TK; Acharya SB. Effect of PGE, on blood 5-HT turnover in peripheral tissues in rats. Indian Journal of Physiology and Allied Sciences. 1994 Oct; 48(4): 174-8

Department of Internal Medicine, J.B. Roy State Ayurvedic Medical College, Calcutta.

5-Hydroxytryptamine (5-HT) is believed to be implicated in different physiological as well as diseased conditions of thyroid gland like other organs. An interrelationship between 5-HT and prostaglandins (PGs) seem to exist in different physiological functions both in central nervous system as well as in the periphery. PGE1 in varying doses (0.1, 0.4 and 0.8 mg/kg.) could not influence the 5-HT level in thyroid gland in our studies as also in stomach and intestine in rats. Whereas it increased in blood and brain tissues with a predetermined dose of 0.4 mg/kg. and in uterus, in doses of 0.1 and 0.4 mg/kg. (subcut.) irrespective of its oestrus cycle status.

7.  

Dunn JD, Cannon HE, Lewis T, Shane-McWhorter L. Development of a complementary and alternative medicine (CAM) pharmacy and therapeutics (P&T) subcommittee and CAM guide for providers.  J Manag Care Pharm. 2005 Apr;11(3):252-8.

Intermountain Health Care Health Plans, 4646 West Lake Park Blvd., Suite N3, Salt Lake City, UT 84120, USA. jeffrey.dunn@ihc.com

OBJECTIVE: The objective was 2-fold: (1) to evaluate the feasibility and value of developing a Pharmacy and Therapeutics (P&T) subcommittee aimed at scientifically evaluating complementary and alternative medicine (CAM) products for an integrated managed care organization (IMCO) and (2) to assess provider acceptance and usefulness of a CAM guide. METHODS: Three factors drove the decision to form a CAM P&T subcommittee to evaluate current commonly used CAM products: (1) physicians, pharmacists, and dieticians expressed a desire for an easy-to-use, scientifically based mechanism for evaluating the ever-increasing number of CAM products; (2) Intermountain Health Care Health Plans (Health Plans), the insurance division of this IMCO, offers access to certain CAM products to its members at a discounted price in an effort to remain competitive with other IMCOs; and (3) this IMCO owns and operates more than a dozen community pharmacies that sell CAM products. Some IMCO clinicians believed an efficacy and safety review of the products offered through the organization was warranted. Subcommittee members included clinical pharmacists (IMCO and university), pharmacy directors, a community pharmacist, practicing physicians (from the drug P&T committee), a medical director, dieticians and nutritionists, and a representative from the Health Plans sales department. The primary outcome was the development of a CAM guide listing recommendations for use of CAM products. Outcome measures included survey results (survey sent with guide to physicians and (pharmacists) regarding acceptance and usefulness of the guide. RESULTS: The CAM P&T subcommittee met monthly to evaluate current commonly used CAM products. A CAM guide was developed in paperback and electronic versions. The electronic version was downloadable to handheld devices. Thousands of CAM guides were disseminated to IMCO-employed physicians, network pharmacies, dieticians, and nutritionists affiliated with this managed care organization. A survey that accompanied distribution of the first CAM guide in 2003 showed that 89% of physicians and pharmacists felt that the guide would be somewhat or very helpful as a counseling aide; the remainder was unsure. A second CAM guide was disseminated one year later, in 2004. The accompanying survey showed that 78% of physicians and 97% of pharmacists felt that the guide would be somewhat or very helpful as a counseling aide; 7% of physicians and 3% of pharmacists felt the guide would be unhelpful. CONCLUSION: A CAM guide developed through the work of a subcommittee of the P&T committee of this IMCO appears to be widely accepted by pharmacists and physicians. A CAM guide should be easy to use and available online with the ability to download to a handheld device.

8.

Gabbard GO. Mind, brain, and personality disorders. Am J Psychiatry. 2005 Apr;162(4):648-55.

Menninger Department of Psychiatry, Baylor College of Medicine, One Baylor Plaza, MS HMC500, Houston, TX 77030, USA. ggabbard@bcm.tmc.edu

OBJECTIVE: The use of the terms "mind" and "brain" in psychiatry is often associated with a set of polarities. Concepts such as environment, psychosocial, and psychotherapy are linked with "mind," while genes, biology, and medication are often associated with "brain." The author examines these dichotomies as they apply to personality disorders. METHOD: Research on antisocial and borderline personality disorders that is relevant to these dichotomies is evaluated. The implications of the findings for the understanding of pathogenesis and treatment are reconsidered. RESULTS: In the clinical setting, it is problematic to lump together terms such as "genes," "brain," and "biological" as though they are separate and distinct from terms such as "environment," "mind," and "psychosocial." These dichotomies are problematic, because genes and environment are inextricably intertwined in the pathogenesis of personality disorders, psychosocial experiences may result in permanent changes in the brain, and psychotherapy may have its effect by altering brain structure and function. The "theory of mind" is a useful construct for bridging "mind" and "brain" in the treatment of personality disorders. CONCLUSIONS: Severe personality disorders are best understood and treated without "either-or" dichotomies of brain and mind. Each domain has a different language, however, and the language of the mind is necessary to help the patient develop a theory of mind.

9.

Graham RE, Ahn AC, Davis RB, O'Connor BB, Eisenberg DM, Phillips RS. Use of complementary and alternative medical therapies among racial and ethnic minority adults: results from the 2002 National Health Interview Survey. J Natl Med Assoc. 2005 Apr;97(4):535-45.

Division for Research and Education in Complementary and Integrative Medical Therapies, Osher Institute, Harvard Medical School, 401 Park Drive, Suite 22A-West, Boston, MA 02215, USA. robert_graham@hms.harvard.edu

PURPOSE: Complementary and alternative medicine (CAM) use among ethnic minority populations is poorly understood. We sought to examine CAM use in Hispanics, non-Hispanic blacks and non-Hispanic whites. METHODS: We analyzed data from the Alternative Health Supplement to the 2002 National Health Interview Survey (NHIS), including information on 19 different CAM therapies used in the past 12 months. RESULTS: An estimated 34% of Hispanic, non-Hispanic black and non-Hispanic white adults in the United States used at least one CAM therapy (excluding prayer) during the prior 12 months (2002). CAM use was highest for non-Hispanic whites (36%), followed by Hispanics (27%) and non-Hispanic blacks (26%). Non-Hispanic whites were more likely to use herbal medicine, relaxation techniques and chiropractic more frequently than Hispanics and non-Hispanic blacks. After controlling for other sociodemographic factors, Hispanic and non-Hispanic black races/ethnicities were associated with less CAM use, with adjusted odds ratios (95% confidence intervals) of 0.78 (0.70, 0.87) and 0.71 (0.65, 0.78), respectively. Hispanics cited using CAM because conventional medical treatments were too expensive more frequently than non-Hispanic blacks or whites. Hispanics had the highest provider nondisclosure rates (68.5%), followed by non-Hispanic blacks (65.1%) and non-Hispanic whites (58.1%). CONCLUSIONS: Excluding prayer, Hispanics and non-Hispanic blacks used CAM less frequently than non-Hispanic whites and were less likely to disclose their use to their healthcare provider. Further research is needed to improve our understanding of the disparities in CAM use.

10.

Hana G, Bar-Sela G, Zhana D, Mashiach T, Robinson E. The use of complementary and alternative therapies by cancer patients in northern Israel. Isr Med Assoc J. 2005 Apr;7(4):243-7.

Quality Improvement Unit, Rambam Medical Center, Haifa, Israel.

BACKGROUND: The use of complementary and alternative medicine has increased over the last decade in the western world. OBJECTIVES: To evaluate the extent and characteristics of CAM use among cancer patients in northern Israel. METHODS: Telephone interviews were conducted with 2,176 newly registered cancer patients or their family members, at least 1 year following referral. RESULTS: The rates of CAM use varied significantly according to demographic characteristics and chemotherapy treatment, from 3% in the basically educated elderly group up to 69% of educated Israeli-born Jews younger than 70 years receiving chemotherapy. The overall rate of CAM use was 17%. The most influential factors determining CAM use were academic or high school education, chemotherapy treatment, Israel as country of birth, and age 41-50 years. All patients used CAM in addition to conventional therapies. Less than half of them reported it to their physicians. The most frequently used treatments were various chemical, biological, botanic and homeopathy remedies. Friends and relatives were the main recommenders of CAM. Most CAM users reported that they used CAM because they believed it "strengthens the immune system," alleviates side effects of chemotherapy, improves quality of life, and helps to overcome pain and stress; 62% of them reported subjective beneficial effects. CONCLUSIONS: A predicting module of CAM user patients was built that may help physicians initiate conversations with their patients on CAM use. Expanding physicians' knowledge on CAM methods will encourage them to provide additional advice, promote the use of beneficial therapies, and inform patients about potentially harmful methods.

11.

Haraldsson K, Fridlund B, Baigi A, Marklund B. The self-reported health condition of women after their participation in a stress management programme: a pilot study. Health Soc Care Community. 2005 May;13(3):224-30.

Primary Health Care Research and Development Unit, Halland County Council, Falkenberg, Sweden. katarina.haraldsson@lthalland.se

From a public health perspective, it is important to develop effective measures to deal with stress which are based on the individual's participation, such as stress management provided in group sessions. Therefore, the aim of the present study was to compare and evaluate the self-reported health condition of women in terms of their general symptoms, stress and sense of coherence (SOC) after participation in a stress management programme. The intervention, which had a modified crossover design and involved 40 women divided into two groups (G1 and G2), comprised eight meetings, the content of which was both theoretical and practical, and included information about stress, stress management, massage and mental training. A questionnaire was filled in on three occasions: before and after the intervention (8 weeks later), and after another 8 weeks (16 weeks later). The questionnaire contained 60 items comprising background factors, general symptoms, stress and SOC. No significant differences existed between the groups at baseline. In favour of the intervention, significant differences were found between the groups with regard to fewer general symptoms (P = 0.035) as well as a tendency to stress reduction (P = 0.060). A comparison within groups showed that both groups had a significant reduction in symptoms after the intervention (G1, P = 0.002; and G2, P = 0.003) and in reduced stress (both P = 0.001). After a further 8 weeks, both groups still showed significantly fewer general symptoms and reduced stress, as well as significant improvements with regard to SOC (G1, P = 0.012; and G2, P = 0.026). These findings indicate that the combination of mental training and massage in this stress management programme had a positive influence on the women's health condition. The pilot study design could be used in a full-scale study with randomised groups.

12.

Hernandez-Reif M, Field T, Ironson G, Beutler J, Vera Y, Hurley J, Fletcher MA, Schanberg S, Kuhn C, Fraser M. Natural killer cells and lymphocytes increase in women with breast cancer following massage therapy. Int J Neurosci. 2005 Apr;115(4):495-510.

Touch Research Institutes, University of Miami School of Medicine, Miami, FL 33101, USA. mhernan4@med.miami.edu

Women diagnosed with breast cancer received massage therapy or practiced progressive muscle relaxation (PMR) for 30-min sessions 3 times a week for 5 weeks or received standard treatment. The massage therapy and relaxation groups reported less depressed mood, anxiety, and pain immediately after their first and last sessions. By the end of the study, however, only the massage therapy group reported being less depressed and less angry and having more vigor. Dopamine levels, Natural Killer cells, and lymphocytes also increased from the first to the last day of the study for the massage therapy group. These findings highlight the benefit of these complementary therapies, most particularly massage therapy, for women with breast cancer.

13.

Kabat-Zinn J. Jon Kabat-Zinn, PhD. Bringing mindfulness to medicine. Interview by Karolyn A. Gazella. Altern Ther Health Med. 2005 May-Jun;11(3):56-64. No abstract available.

Losier A, Taylor B, Fernandez CV. Use of alternative therapies by patients presenting to a pediatric emergency department. J Emerg Med. 2005 Apr;28(3):267-71.

Department of Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.

Complementary and alternative medicine (CAM) is used by some patients to supplement their health care. Information on the use of CAM in children who are not chronically ill is sparse. We conducted a survey of caregivers presenting to a tertiary pediatric Emergency Department to determine CAM use in this population. Six hundred twenty questionnaires (77.6% of those distributed) were available for analysis. Approximately 13% of caregivers reported using CAM for their child. The most common CAM therapies used were homeopathy (20%), prayer/spiritual approaches (19.7%), and massage therapy (16.7%). Age of child greater than 1 year was associated with CAM use (p < 0.05), as was parental higher education (p < 0.0001). Income, ethnicity, parental age, and chronic illness were not correlated with CAM use. CAM therapies are infrequently used in pediatric patients presenting to the Emergency Department.

14.

Mechanick JI. The rational use of dietary supplements and nutraceuticals in clinical medicine. Mt Sinai J Med. 2005 May;72(3):161-5.

Division of Endocrinology, Diabetes and Bone Diseases, Mount Sinai School of Medicine, New York, NY 10029, USA.

The rational use of dietary supplements and nutraceuticals (DS/N) is based on objective evaluation of the clinical evidence as well as subjective evaluation of the risks, benefits, economic costs, and potential drug interactions. Since the use of DS/N has skyrocketed, physicians must learn about them in order to better communicate with and care for their patients. There are many evidence-based and rational uses for DS/N, but profiteering and quackery must be avoided at all costs.

15.

Molassiotis A, Fernadez-Ortega P, Pud D, Ozden G, Scott JA, Panteli V, Margulies A,

Reuter-Lorenz PA, Lustig C. Brain aging: reorganizing discoveries about the aging mind. Curr Opin Neurobiol. 2005 Apr;15(2):245-51.

Department of Psychology, University of Michigan, 525 East University, Ann Arbor, MI 48109-1109, USA. parl@umich.edu

New discoveries challenge the long-held view that aging is characterized by progressive loss and decline. Evidence for functional reorganization, compensation and effective interventions holds promise for a more optimistic view of neurocognitive status in later life. Complexities associated with assigning function to age-specific activation patterns must be considered relative to performance and in light of pathological aging. New biological and genetic markers, coupled with advances in imaging technologies, are enabling more precise characterization of healthy aging. This interdisciplinary, cognitive neuroscience approach reveals dynamic and optimizing processes in aging that might be harnessed to foster the successful aging of the mind.

16.

Sabina AB, Williams AL, Wall HK, Bansal S, Chupp G, Katz DL.Yoga intervention for adults with mild-to-moderate asthma: a pilot study. Ann Allergy Asthma Immunol. 2005 May;94(5):543-8.

Yale-Griffin Prevention Research Center, Derby, Connecticut 06418, USA.

BACKGROUND: Preliminary studies investigating yoga and breath work for treating asthma have been promising. Several randomized controlled trials have shown a benefit from yoga postures and breathing vs control, but the control in these cases involved no intervention other than usual care. This study advances the field by providing an active control. OBJECTIVE: To determine the effectiveness and feasibility of a yoga and breath work intervention for improving clinical indices and quality of life in adults with mild-to-moderate asthma. METHODS: A randomized, controlled, double-masked clinical trial was conducted between October 1, 2001, and March 31, 2003. Random assignment was made to either a 4-week yoga intervention that included postures and breath work or a stretching control condition. Outcome measures were evaluated at 4, 8, 12, and 16 weeks and included the Mini Asthma Quality of Life Questionnaire, rescue inhaler use, spirometry, symptom diaries, and health care utilization. RESULTS: Sixty-two participants were randomized to the intervention and control groups, and 45 completed the final follow-up measures. Intention-to-treat analysis was performed. Significant within-group differences in postbronchodilator forced expiratory volume in 1 second and morning symptom scores were apparent in both groups at 4 and 16 weeks; however, no significant differences between groups were observed on any outcome measures. CONCLUSIONS: Iyengar yoga conferred no appreciable benefit in mild-to-moderate asthma. Circumstances under which yoga is of benefit in asthma management, if any, remain to be determined.

17.

Vigne J. Meditation and mental health. Indian Journal of Clinical Psychology. 1997 Mar; 24(1): 46-51.

Sant Niwas Marg, Kankhal, 249408, Hardwar, UP.

Meditation has contributed to mental health in India since the beginning of its civilization. It is now used along with psychotherapy in many places in the West. It should be studied by clinical psychologists in India, both theoretically and practically the result of this work could be one of their important contributions to the emerging world psychology. The psychological mechanisms through which meditation heals the mind are studied in some detail. The indications of meditation for various psychopathological patients are suggested.