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Biomedical subjects

A Michalsen

Publications and source records attributed to A Michalsen.

At least 19 recordsLinked to original sources
PubMed2006

[Stress management in the treatment of essential arterial hypertension].

Between 60 and 90% of patients consult their family doctor for stress-associated complaints. Not infrequently, a considerable number of these patients already have elevated blood pressure. The positive effect on high blood pressure of relaxation techniques has been confirmed in various studies. Accordingly, stress management should now have a permanent place in effective antihypertensive treatment. Appropriate relaxation techniques include, for example, autogenic training, progressive muscle relaxation, visualization and breathing exercises, chi gong and yoga. These practices are incorporated in various lifestyle programs. They act in different ways, and can be offered to the patient in accordance with his/her individual wishes.

Autogenic Training↗
PubMed2006

[Mind-body medicine as a part of German integrative medicine].

Mind-body medicine (MBM) as a holistic approach to health and healing has been shaped by research into stress physiology and stress psychology, by psychoneuro(endocrino)immunology and by Antonovsky's salutogenetic paradigm. MBM seeks to acknowledge physical, psychological as well as social and spiritual aspects of human beings. MBM constitutes one of the traditions, which the emerging field of integrative medicine in Germany draws upon, others being mainstream medicine, traditional European naturopathy and non-European methods like traditional Chinese medicine. The article outlines historical aspects of MBM, gives a brief review of research evidence, and introduces clinical MBM institutes in Germany. Especially the Clinic and Chair of Complementary and Integrative Medicine, Alfried Krupp von Bohlen und Halbach Foundation at the University Duisburg-Essen has been integrating MBM into the concept of integrative medicine. Considering that a growing number of health issues arises due to maladaptive lifestyles, MBM is being identified as a development that supports a shift from increasingly expensive treatments to more cost-effective preventive approaches.

Delivery of Health Care, Integrated↗
PubMed2006

[Glycotoxins and cellular dysfunction. A new mechanism for understanding the preventive effects of lifestyle modifications].

Recently the AGE-RAGE interaction was identified as a potential mechanism underlying chronic and inflammatory diseases like atherosclerosis, diabetes mellitus and kidney disease. Advanced glycation end products (AGEs) are the derivatives of glucose-protein or glucose-lipid reactions and are mainly generated from the diet (depending on intensity of heating, cooking time and oxygenation). Binding of AGEs or other ligands to the AGE receptor (RAGE) results in cellular activation, i.e. increased expression of inflammatory mediators and oxidative stress. Diet-derived AGEs thus induce deleterious effects on tissues and the cardiovascular system. Recent research also found that other lifestyle factors are associated with pronounced inflammatory activation, e.g. psychosocial stress and smoking. In addition, each intake of meals is associated with proinflammatory cellular changes. The AGE-RAGE model and investigations of the underlying cellular mechanisms thus may lead to a better understanding of the health benefits of diets (Mediterranean diet, uncooked vegetarian diets), caloric restriction and intermittent fasting. The clinical impact of low-AGE diets and fasting and the interaction between stress and food intake should be further investigated in controlled trials.

Cell Physiological Phenomena↗
PubMed2006

Mediterranean diet has no effect on markers of inflammation and metabolic risk factors in patients with coronary artery disease.

OBJECTIVE: Mediterranean diet is associated with decreased levels of inflammatory markers and metabolic risk factors in epidemiologic studies and recent trials on patients with metabolic syndrome. Given the recent improvements in medical treatments, it is unclear if such beneficial effects are also present in patients with coronary artery disease (CAD). We therefore investigated the effect of Mediterranean diet on markers of inflammation and metabolic risk factors in patients with treated CAD. DESIGN: Randomized, controlled trial. SUBJECTS: A total of 101 patients (59.4+/-8.6 years, 23% female) with established and treated CAD (80% statins). INTERVENTIONS: Participants were assigned to a Mediterranean diet group (MG; n=48) with a 1-year program of 100 h of education, or to a written advice-only group (AG; n=53). Before and after intervention, we measured serum high-sensitivity C-reactive protein (hs-CRP), fibrinogen, fasting insulin, homocysteine, serum lipids and plasma fatty acids. RESULTS: The Mediterranean diet program increased the intakes of fish, fruits/vegetables and moderately of canola/olive oil and increased plasma concentrations of long-chain n-3 polyunsaturated fatty acids in the MG. Median hs-CRP and mean fibrinogen, homocysteine, fasting insulin, triglycerides and serum cholesterols remained unchanged in both groups. CONCLUSIONS: Adoption of a Mediterranean diet by patients with medically treated CAD has no effect on markers of inflammation and metabolic risk factors. SPONSORSHIP: Alfried Krupp Foundation, Essen, Germany.

Biomarkers↗
PubMed2005

[Effects of nutritional factors on haemostasis].

Among all exogenic factors nutrition has a most relevant impact on the haemostatic system and related cardiovascular and thrombotic disease. Whereas obesity and high-caloric diet are associated with negative changes of mostly all parameters of haemostasis, fibrinolysis and platelet reactivity, weight reduction and lifestyle modification induce respective beneficial effects. Recent studies demonstrate large evidence for the beneficial effects of a mediterranean diet in thrombotic diseases not mediated by cholesterol or weight reduction. The principal sources of fat within this diet, olive oil and omega-3 polyunsaturated fatty acids from fatty fish, nuts, seeds, and vegetables show a variety of beneficial effects on the haemostatic system in experimental and observational studies. Furthermore, for an increasing number of substances such as plant-based polyphenols and for moderate alcohol consumption attenuation of coagulation and platelet reactivity have been demonstrated. In the clinical context, mediterranean diet may exert its beneficial effects through synergistic action on haemostasis, endothelial function and vascular inflammation.

Cardiovascular Diseases↗
PubMed2004

[Health-related control belief and quality of life in chronically ill patients after a behavioral intervention in an integrative medicine clinic--an observational study].

BACKGROUND: In 1999 the Clinic for Internal Medicine and Integrative Medicine was founded in Essen as a regular part of the German inpatient health care system. Integrative medicine (standard internal medicine, evidence-based complementary and alternative medicine combined with intensified lifestyle modification) aims to help patients with chronic illness to cope with their condition more effectively and to achieve a health-promoting lifestyle. Techniques include cognitive restructuring, the elicitation of the relaxation response, and lifestyle education. The goal is to increase health-related quality of life (QoL) as well as control beliefs and to reduce morbidity in later life. AIM: To demonstrate changes in quality of life, lifestyle, and control beliefs after a two-week hospital stay. METHODS: Uncontrolled prospective observational study with 557 consecutive hospital patients. Outcome parameters were quality of life (SF36), control beliefs (GKU), and daily health-related behavior (nutrition, physical activity, relaxation) on admission, at discharge, as well as 3 and 6 months after discharge. RESULTS: Weekly physical activity increases by 29%, consumption of not recommendable foods decreases by 18%. The majority of patients (57%) engage in relaxation exercises 6 months after discharge (on admission 23%). The physical sum scale (SF36) increases from 33.9 (95% KI 32.5-35.3) on admission to 37.3 (35.8-38.9) 6 months after discharge, the mental sum scale from 41.2 (39.5-42.9) to 45.1 (43.5-46.7). The ratio internal/external control belief rises from 1.17 (95% KI 1.11-1.24) to 1.32 (1.24-1.40). Pretherapeutic ratio internal/external control belief and its increase are associated with rises in QoL. CONCLUSIONS: After integrative medicine treatment a lasting increase in QoL and lifestyle changes can be achieved. Reinforcement of internal control beliefs and own competence is possible and enhances outcomes in chronically ill patients.

Behavior Therapy↗
PubMed2004

[Acupuncture in the treatment of pain--hypothesis to adaptive effects].

A basic principle in conventional pain therapy is that the treatment should be tailored to the pathological mechanism of the disease. This is based on the knowledge of the effector mechanisms of the applied treatment modalities. Although for acupuncture the mode of action still remains elusive in many parts, evidence about its mechanisms in pain treatment is growing. A better understanding of the hypalgesic effects of acupuncture might lead to a more differentiated and mechanism guided application. The aim of this article is to evaluate the scientific data about the neurobiological mechanisms of acupuncture in the treatment of pain. Data are critically evaluated regarding their relevance for clinical practice. Possible mechanisms are differentiated in local and systemic effects and the question of point specificity is discussed. Additionally a comprehensive hypothesis is set up for the long-term effects of acupuncture in the treatment of chronic pain. In this context acupuncture is considered as a mode of repetitive, nociceptive stimulation, which induces adaptive processes on different physiological levels leading to an improved ability of the nociceptive system to cope with painful stimuli.

Acupuncture Analgesia↗
PubMed2003

The short-term effects of fasting on the neuroendocrine system in patients with chronic pain syndromes.

It is commonly reported that short term fasting leads to mood enhancement and emotional harmonisation. We investigated psychosocial well-being and the neuroendocrine response, assessed by nightly urinary excretion of cortisol and catecholamines, in 28 inpatients with chronic pain syndromes during and after a one-week modified fast. Twenty-two of the patients (51.4 +/- 2.7 years, BMI 26.8 +/- 1.0 kg/m2) participated in a 7-day fast with daily intake of 300 kcal/day, six control patients (47.5 +/- 4.0 years; BMI 22.9 +/- 1.1 kg/m2) received a vegetarian-based diet. With fasting significant increases of the urinary concentration of noradrenaline (17.8 +/- 3.0-27.8 +/- 3.8 microg/ml), adrenaline (1.5 +/- 0.2-3.4 +/- 0.7 microg/ml) and cortisol (26.1 +/- 3.7-40.7 +/- 6.1 microg/ml) were observed, whereas controls showed no significant endocrine changes. The neuroendocrine response to fasting was pronounced in younger subjects (age <50 years) and in the presence of a BMI >25 kg/m2, moreover the increase in cortisol excretion was significantly higher in subjects with lower baseline cortisol levels. Mood and well-being increased non-significantly in both groups. Fasting was well tolerated, and regarded as beneficial by most fasting patients. Our results show that short-term fasting leads to neuroendocrine activation and may suggest that the extent of this response is dependent on the individual metabolic and endocrine state at baseline.

Affect↗
PubMed2003

Effects of short-term modified fasting on sleep patterns and daytime vigilance in non-obese subjects: results of a pilot study.

BACKGROUND: Periodically repeated short-term fasting is a frequently practised tradition worldwide. Empirical reports suggest that during fasting periods the quality of sleep and daytime performance are improved. The effects of a home-based 1-week modified fasting on sleep patterns and daytime vigilance and performance were analysed in 15 healthy non-obese volunteers. METHODS: Sleep was measured by polysomnography before and after a 7-day fasting period; sleep inventories with assessment of daytime performance were collected throughout the observation period. Blood samples and urine were drawn at the beginning and at the end of fasting. RESULTS: 13 subjects (12 females, 1 male; age 41.2 +/- 13.4 years; BMI 23.9 +/- 4.2 kg/m(2)) completed the fasting period; weight decreased from 66.5 +/- 11.7 kg to 63 +/- 11.9 kg. Compared to baseline, a significant decrease in arousals, a decrease in periodic leg movements (PLM) and a non-significant increase in REM sleep were observed at the end of fasting. Subjective sleep ratings showed a fasting-induced increase in global quality of sleep, daytime concentration, vigour and emotional balance. Clinical laboratory tests showed a decrease in serum magnesium; urinary melatonin excretion decreased moderately. CONCLUSION: This open pilot study demonstrates that along with a decrease in sleep arousals a 1-week fasting period promotes the quality of sleep and daytime performance in non-obese subjects. The observed decrease in PLM might point to a nutritional modification of brain dopaminergic functions. In terms of evolutionary development, an improved daytime performance during periods of food deprivation could have been beneficial for the success in search for food.

Adult↗
PubMed2002

[Smoking cessation for hospital staff. A controlled intervention study].

BACKGROUND AND OBJECTIVE: Smoking prevalence in Germany remains high instead of public information and education. Smoke free hospitals are propagated, but frequently the smoking prevalence in hospital staff is even higher than in the general population. The objectives of the study were to determine the prevalence of smoking amongst hospital employees in a German teaching hospital and subsequently to promote and optimise smoking cessation within controlled trial with additional evaluation of mindfulness based stress reduction, supported by a common workplace action. PATIENTS AND METHODS: A hospital survey was carried out by anonymous questionnaires. Participation in a physician-supervised smoking cessation program with nicotine replacement, brief intervention and, additionally, in a 20-hour stress reduction program over 8 weeks (group B) was offered to all smokers. Primary outcomes were abstinence rates at 3 months, secondary endpoints included abstinence rates at 6 months, cigarette consumption in smokers and expiratory CO-concentration. RESULTS: Out of 345 employees 296 (86 %) revealed their smoking status, 140 were smokers (47,3 %). 116 of 140 smokers agreed with participation in a smoking cessation program. 53 subjects participated additionally in the stress reduction groups (Group B), 63 subjects wished no additional stress reduction (Group A). Abstinence rates at 3 and 6 months were 38,2 % and 29,7 % for all subjects. Participants with stress reduction showed non-significant higher abstinence rates (3 months: A: 35 % vs. B: 42 % and 6 months: A: 20 % vs. B: 41,2 %), a significant lower CO-concentration and a lower smoking intensity in recurrent smokers. CONCLUSION: With a common work place action a substantial part of employees quits smoking. Thus, the study provides support for the active promotion of physician-supervised smoking cessation programs among hospital employees. Supportive mindfulness-based stress reduction may enhance smoking cessation, yet has to be further tested in larger randomised controlled trials.

Adult↗
PubMed2002

[Short-term therapeutic fasting in the treatment of chronic pain and fatigue syndromes--well-being and side effects with and without mineral supplements].

BACKGROUND: Fasting followed by vegetarian diet has shown to be an effective treatment for rheumatoid arthritis, moreover fasting is frequently used as an adjunctive treatment in chronic pain and stress/exhaustion syndromes. Data on well-being and the frequency of side effects during fasting are mostly retrospective. Mineral supplements are frequently used in order to compensate for fasting-induced tissue acidosis and to reduce side effects. There are only limited data that support this practice. OBJECTIVE: To study the effects of oral mineral supplements on common side effects and well-being during short-term fasting. PATIENTS AND METHODS: 209 consecutive inpatients with chronic pain/exhaustion syndromes were recruited. In a controlled non-randomised study design all patients underwent fasting (250 kcal; 3 l fluid intake/day) over 7 days, in study phase 1 without (n = 103) and in study phase 2 with (n = 106) concomitant prescription of standardised oral mineral supplements (3 x 2 to 3 x 3 Bullrich's Vital). Weight, blood pressure and urinary pH were recorded daily. Well-being and mood as well as common side effects (i.e. fatigue, hunger, heart burn, headache) were assessed with standardised self-reports. RESULTS: Baseline characteristics of the 209 patients (mean age 54.7 +/- 10.5 years; 83.3% female) were balanced. Both groups showed a fasting-induced decrease of blood pressure, a slight decrease in mood and well-being on days 3 and 4 with consecutive increase and moderate hunger, i.e. in the evening. Side effects and general tolerability of fasting as well as well-being and mood were not different between the groups. There were no serious side effects in both groups. CONCLUSIONS: Short-term fasting in inpatients with pain and stress syndromes is safe and well tolerated, concomitant mineral supplements have no additive benefit.

Chronic Disease↗
PubMed2001

[Quality of life and psychosocial factors during treatment with antihypertensive drugs. A comparison of captopril and quinapril in geriatric patients].

BACKGROUND: There is an increasing prevalence of older adults (> 65 years) with hypertension and the need for antihypertensive medication. It is well established that elderly hypertensive patients benefit from drug treatment with regards to cardiovascular morbidity and mortality. Due to the comorbidity and reduced quality of life (QOL) in the elderly, drug-induced changes of well-being and QOL are especially important to maintain compliance and social abilities. Whereas in most studies different antihypertensive agents exerted similar influences on QOL, Captopril was found to be superior to other antihypertensives in some trials. PATIENTS AND METHOD: In this controlled non-randomized study 100 elderly hypertensive patients (mean age 75.4 +/- 7.2 years; 56% female) were treated with Captopril (25-50 mg twice daily) or the newer ACE-inhibitor Quinapril (5-20 mg per day). Blood pressure and QOL were recorded initially and after 6 months, assessment of QOL was based on a validated questionnaire (PLC). RESULTS: Blood pressure fell from 153/82 mm Hg to 142/80 mm Hg with Captopril and 154/82 to 142/80 mm Hg [corrected] with Quinapril. An improvement of QOL was only seen with Quinapril, mainly due to better mood and lower depression scores. Analysis of underlying psychosocial factors on QOL found lack of social support, female sex and a current life event as additional significant negative influences on QOL. CONCLUSION: A favorable antidepressive effect of Quinapril in elderly hypertensive patients is concluded and should be studied in further investigations.

Adaptation, Psychological↗
PubMed2001

[Anesthesia in ambulatory general practice].

Over the last years, ambulatory anaesthesia has gained more significance within the realm of anaesthesiology in Germany. The German health care system aspires to improve the link between ambulatory and clinical health care. Also, the increasing percentage of older people has changed the demographics of society considerably. As potential patients, older people tend to suffer from more pre-existing diseases than younger people, without necessarily being willing to forego ambulatory treatments. According to the guidelines of the "Bundesärztekammer", procedures in an ambulatory setting--and thus ambulatory anaesthesia--may not pose greater risks to patients than the same procedures performed in a clinical setting. The guidelines specifically include the pre-, intra- and post-operative care. This article reviews the guidelines of the "German Society of Anaesthesiology and Intensive Care Medicine" (DGAI) and other professional organizations with respect to ambulatory anaesthesia. It also reviews important structural and procedural requirements and recommendations for the implementation of ambulatory anaesthesia. Topics included are technical requirements, equipment, selection of patients, informed consent, fasting regulations, choice of anaesthetics and postoperative care. In order to accomplish a favourable outcome quality in ambulatory anaesthesia, professional judgement and implementation of the respective guidelines appear to be important rules of conduct.

Adolescent↗
PubMed1999

[Hyperthermia-induced priming effect in neutrophil granulocytes].

BACKGROUND AND OBJECTIVE: Whole-body infrared-A irradiation (WBIAI) according to Ardenne is a newly developed version of hyperthermia. In clinical use benefits for patients with chronic infections have been reported. In order to find out more about the immunological background of the method we studied the question whether hyperthermia leads to priming effects in human polymorphonuclear leukocytes (PMN). MATERIAL AND METHODS: We therefore investigated the production of reactive oxygen radical species (ROS) measured by lucigenin-dependent chemiluminescence after stimulation with N-formylpeptide (FMLP, 10(-6) and 10(-7) M), C5a complement (10(-7) and 10(-8) M) or phorbolester (PMA, 10(-7) and 10(-8) M) in isolated PMN of 8 volunteers undergoding a 60-min hyperthermia treatment with the WBIAI. Blood was drawn 0/60/240/510 min after the start of hyperthermia treatment. In addition, we measured blood pressure, pulse, and temperature. RESULTS: In 5 cases a significant increase in ROS (p < 0.05) could be measured beginning 240 min after start of hyperthermia and further increasing until the 510-min time point. These results suggest a priming effect in PMN lasting far beyond the actual treatment period. The increase of ROS production following stimulation with FMLP, C5a or PMA was 60.4 +/- 21.6, 86.0 +/- 23.3, and 63.3 +/- 15.9% (SEM), respectively. Moreover, in all probands the maximal ROS production in PMN was observed 510 min after the beginning of WBIAI treatment. In 3 cases no difference in ROS could be observed. There was no difference in temperature, blood pressure, and pulse between responders and nonresponders. CONCLUSIONS: Our results show a hyperthermia-dependent priming effect of ROS production in PMN, suggesting an increase in immune reaction within the observation period of 510 min. Further investigations are necessary in order to specify responders and nonresponders and to characterize the results in specific diseases and the constitutions of the patients.

Complement C5a↗
PubMed1999

[Changes of short-time heart rate variability during hyperthermia treatment with infrared A whole body irradiation].

BACKGROUND: Measures of heart rate variability (HRV) are widely recognized as being an important indicator method for autonomical function and cardiovascular neural regulation. The low-frequency component in spectral analysis is increased during conditions of raised sympathetic activation, the high-frequency component is closely correlated with vagal activity. Whole-body infrared-A irradiation (WBIAI) according to von Ardenne is a newly developed version of hyperthermia. In clinical use peripheral vasodilatation with significant increases in heart rate and hypotension were noted as acute effects of WBIAI. In order to evaluate the effect of WBIAI on autonomic function, we measured HRV during serial hyperthermias. PATIENTS AND METHODS: Power spectral density analysis of HRV during the first and the last of 4 serial WBIAI treatments with 30-60 min endurance was performed in 10 patients with chronic pain disorders. Tympanal body temperature was recorded continuously and was supposed to increase by 1 degrees C during treatment. Electrocardiographic monitoring was performed using a Marquette HoIter ECG. RR data were manually edited and standard frequency domain measures of the first and the last 5 min of treatment computed. The subjective efficacy of the treatment was rated by prestandardized interviews. RESULTS: Body temperature increased by 0.9 degrees C during the first treatment and 1.2 degrees C during the last treatment. In all patients the rise in body temperature due to treatment was accompanied by a significant increase in heart rate and a decrease of arterial blood pressure. During hyperthermia a slight decrease of absolute low-frequency and total power as well as a sharp decrease of high-frequency power and a significant increase of the low/high-frequency ratio could be noted. The rise in low/high-frequency ratio during WBIAI was less distinct at the last treatment compared to the initial treatment. Hyperthermia was regarded as a safe, well-tolerable and effective treatment. CONCLUSION: The results suggest that the cardiovascular response during WBIAI is accompanied by significant changes in autonomic cardiac regulation: A significant decrease of low-frequency power corresponding to depressed vagal activity results in an increase of Iow/high-frequency ratio. During serial hyperthermias the acute response is diminished suggesting an adaption of the autonomic response to hyperthermia. Further studies are necessary to investigate the long-standing autonomic effects of the treatment and include analysis of influencing factors such as the level of physical activity and constitutional individual conditions.

Body Temperature↗