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Use and Safety of Anthroposophic Medications for Acute Respiratory and Ear Infections: A Prospective Cohort Study
Harald J. Hamre, Anja Glockmann, Michael Fischer, David S. Riley, Erik Baars and Helmut Kiene
Drug Target Insights , 2012,
Abstract: Objective: Anthroposophic medications (AMED) are widely used, but safety data on AMED from large prospective studies are sparse. The objective of this analysis was to determine the frequency of adverse drug reactions (ADR) to AMED in outpatients using AMED for acute respiratory and ear infections. Methods: A prospective four-week observational cohort study was conducted in 21 primary care practices in Europe and the U.S.A. The cohort comprised 715 consecutive outpatients aged 1 month, treated by anthroposophic physicians for acute otitis and respiratory infections. Physicians’ prescription data and patient reports of adverse events were analyzed. Main outcome measures were use of AMED and ADR to AMED. Results: Two patients had confirmed ADR to AMED: 1) swelling and redness at the injection site after subcutaneous injections of Prunus spinosa 5%, 2) sleeplessness after intake of Pneumodoron 2 liquid. These ADR lasted one and two days respectively; both subsided after dose reduction; none were unexpected; none were serious. The frequency of confirmed ADR to AMED was 0.61% (2/327) of all different AMED used, 0.28% (2/715) of patients, and 0.004% (3/73,443) of applications. Conclusion: In this prospective study, anthroposophic medications used by primary care patients with acute respiratory or ear infections were well tolerated. Abbreviations: A-: anthroposophy; ADR: adverse drug reactions; AE: adverse events; AM: anthroposophic medicine; AMED: AM medication; C-: conventional; ENE-patients: eligible, not enrolled patients; IIPCOS: International Primary Care Outcomes Study
Use and Safety of Anthroposophic Medications for Acute Respiratory and Ear Infections: A Prospective Cohort Study
Harald J. Hamre,Anja Glockmann,Michael Fischer,David S. Riley
Drug Target Insights , 2007,
Abstract: Objective: Anthroposophic medications (AMED) are widely used, but safety data on AMED from large prospective studies are sparse. The objective of this analysis was to determine the frequency of adverse drug reactions (ADR) to AMED in outpatients using AMED for acute respiratory and ear infections.Methods: A prospective four-week observational cohort study was conducted in 21 primary care practices in Europe and the U.S.A. The cohort comprised 715 consecutive outpatients aged 1 month, treated by anthroposophic physicians for acute otitis and respiratory infections. Physicians’ prescription data and patient reports of adverse events were analyzed. Main outcome measures were use of AMED and ADR to AMED.Results: Two patients had confirmed ADR to AMED: 1) swelling and redness at the injection site after subcutaneous injections of Prunus spinosa 5%, 2) sleeplessness after intake of Pneumodoron 2 liquid. These ADR lasted one and two days respectively; both subsided after dose reduction; none were unexpected; none were serious. The frequency of confirmed ADR to AMED was 0.61% (2/327) of all different AMED used, 0.28% (2/715) of patients, and 0.004% (3/73,443) of applications.Conclusion: In this prospective study, anthroposophic medications used by primary care patients with acute respiratory or ear infections were well tolerated.Abbreviations: A-: anthroposophy; ADR: adverse drug reactions; AE: adverse events; AM: anthroposophic medicine; AMED: AM medication; C-: conventional; ENE-patients: eligible, not enrolled patients; IIPCOS: International Primary Care Outcomes Study
Anthroposophic Therapy for Anxiety Disorders: A Two-year Prospective Cohort Study in Routine Outpatient Settings
Harald J. Hamre, Claudia M. Witt, Gunver S. Kienle, Anja Glockmann, Renatus Ziegler, Stefan N. Willich and Helmut Kiene
Clinical Medicine Insights: Psychiatry , 2012,
Abstract: Background and Methods: Anthroposophic treatment for anxiety disorders includes special artistic and physical therapies and special medications. We conducted a prospective cohort study of 64 consecutive adult outpatients starting anthroposophic treatment for anxiety disorders under routine conditions. Main outcomes were Anxiety Severity (physician and patient ratings 0–10), Self-rating Anxiety Scale (0–100), Center for Epidemiological Studies Depression Scale, German version (CES-D, 0–60), and SF-36 Mental Component Summary. Results: Mean age was 42.3 years. Most frequent diagnoses were generalized anxiety disorder (44% of patients, n = 28/64) and panic disorder (39%). Median disease duration was 4.5 years. The anthroposophic treatment modalities used were medications (56% of patients), eurythmy therapy (41%), art therapy (30%), and rhythmical massage therapy (3%). Median number of eurythmy/art/massage sessions was 12, median therapy duration was 120 days. From baseline to six-month follow-up, all outcomes improved significantly; average improvements were: Physician-rated Anxiety Severity 3.60 points (95% confidence interval 2.97–4.22, p < 0.001), patient-rated Anxiety Severity 3.50 (2.88–4.12, p < 0.001), Self-rating Anxiety Scale 11.88 (7.70–16.05, p < 0.001), CES-D 8.79 (5.61–11.98, p < 0.001), and SF-36 Mental Component 9.53 (5.98–13.08, p < 0.001). All improvements were maintained until last follow-up after 24 months. Conclusions: Patients with anxiety disorders under anthroposophic treatment had long-term improvements of symptoms and quality of life.
Anthroposophic therapy for children with chronic disease: a two-year prospective cohort study in routine outpatient settings
Harald J Hamre, Claudia M Witt, Gunver S Kienle, Christoph Meinecke, Anja Glockmann, Stefan N Willich, Helmut Kiene
BMC Pediatrics , 2009, DOI: 10.1186/1471-2431-9-39
Abstract: In conjunction with a health benefit program, consecutive outpatients starting anthroposophic treatment for any chronic disease participated in a prospective cohort study. Main outcome was disease severity (Disease and Symptom Scores, physicians' and caregivers' assessment on numerical rating scales 0–10). Disease Score was documented after 0, 6, and 12 months, Symptom Score after 0, 3, 6, 12, 18, and 24 months.A total of 435 patients were included. Mean age was 8.2 years (standard deviation 3.3, range 1.0–16.9 years). Most common indications were mental disorders (46.2% of patients; primarily hyperkinetic, emotional, and developmental disorders), respiratory disorders (14.0%), and neurological disorders (5.7%). Median disease duration at baseline was 3.0 years (interquartile range 1.0–5.0 years). The anthroposophic treatment modalities used were medications (69.2% of patients), eurythmy therapy (54.7%), art therapy (11.3%), and rhythmical massage therapy (6.7%). Median number of eurythmy/art/massage therapy sessions was 12 (interquartile range 10–20), median therapy duration was 118 days (interquartile range 78–189 days).From baseline to six-month follow-up, Disease Score improved by average 3.00 points (95% confidence interval 2.76–3.24 points, p < 0.001) and Symptom Score improved by 2.41 points (95% confidence interval 2.16–2.66 points, p < 0.001). These improvements were maintained until the last follow-up. Symptom Score improved similarly in patients not using adjunctive non-anthroposophic therapies within the first six study months.Children under anthroposophic treatment had long-term improvement of chronic disease symptoms. Although the pre-post design of the present study does not allow for conclusions about comparative effectiveness, study findings suggest that anthroposophic therapies may play a beneficial role in the long-term care of children with chronic illness.Chronic illness affects 15%–18% of children [1] and can lead to functional limitation, depe
Anthroposophic therapy for chronic depression: a four-year prospective cohort study
Harald J Hamre, Claudia M Witt, Anja Glockmann, Renatus Ziegler, Stefan N Willich, Helmut Kiene
BMC Psychiatry , 2006, DOI: 10.1186/1471-244x-6-57
Abstract: 97 outpatients from 42 medical practices in Germany participated in a prospective cohort study. Patients were aged 20–69 years and were referred to anthroposophic therapies (art, eurythmy movement exercises, or rhythmical massage) or started physician-provided anthroposophic therapy (counselling, medication) for depression: depressed mood, at least two of six further depressive symptoms, minimum duration six months, Center for Epidemiological Studies Depression Scale, German version (CES-D, range 0–60 points) of at least 24 points. Outcomes were CES-D (primary outcome) and SF-36 after 3, 6, 12, 18, 24, and 48 months. Data were collected from July 1998 to March 2005.Median number of art/eurythmy/massage sessions was 14 (interquartile range 12–22), median therapy duration was 137 (91–212) days. All outcomes improved significantly between baseline and all subsequent follow-ups. Improvements from baseline to 12 months were: CES-D from mean (standard deviation) 34.77 (8.21) to 19.55 (13.12) (p < 0.001), SF-36 Mental Component Summary from 26.11 (7.98) to 39.15 (12.08) (p < 0.001), and SF-36 Physical Component Summary from 43.78 (9.46) to 48.79 (9.00) (p < 0.001). All these improvements were maintained until last follow-up. At 12-month follow-up and later, 52%–56% of evaluable patients (35%–42% of all patients) were improved by at least 50% of baseline CES-D scores. CES-D improved similarly in patients not using antidepressants or psychotherapy during the first six study months (55% of patients).In outpatients with chronic depression, anthroposophic therapies were followed by long-term clinical improvement. Although the pre-post design of the present study does not allow for conclusions about comparative effectiveness, study findings suggest that the anthroposophic approach, with its recourse to non-verbal and artistic exercising therapies can be useful for patients motivated for such therapies.Depressive disorders are a major health problem, affecting one-fourth to one-t
Anthroposophic medical therapy in chronic disease: a four-year prospective cohort study
Harald J Hamre, Claudia M Witt, Anja Glockmann, Renatus Ziegler, Stefan N Willich, Helmut Kiene
BMC Complementary and Alternative Medicine , 2007, DOI: 10.1186/1472-6882-7-10
Abstract: In conjunction with a health benefit program in Germany, 233 outpatients aged 1–74 years, treated by 72 anthroposophic physicians after a consultation of at least 30 min participated in a prospective cohort study. Main outcomes were disease severity (Disease and Symptom Scores, physicians' and patients' assessment on numerical rating scales 0–10) and quality of life (adults: SF-36, children aged 8–16: KINDL, children 1–7: KITA). Disease Score was documented after 0, 6 and 12 months, other outcomes after 0, 3, 6, 12, 18, 24, and (Symptom Score and SF-36) 48 months.Most common indications were mental disorders (17.6% of patients; primarily depression and fatigue), respiratory diseases (15.5%), and musculoskeletal diseases (11.6%). Median disease duration at baseline was 3.0 years (interquartile range 0.5–9.8 years). The consultation leading to study enrolment lasted 30–60 min in 51.5% (120/233) of patients and > 60 min in 48.5%. During the following year, patients had a median of 3.0 (interquartile range 1.0–7.0) prolonged consultations with their anthroposophic physicians, 86.1% (167/194) of patients used anthroposophic medication.All outcomes except KITA Daily Life subscale and KINDL showed significant improvement between baseline and all subsequent follow-ups. Improvements from baseline to 12 months were: Disease Score from mean (standard deviation) 5.95 (1.74) to 2.31 (2.29) (p < 0.001), Symptom Score from 5.74 (1.81) to 3.04 (2.16) (p < 0.001), SF-36 Physical Component Summary from 44.01 (10.92) to 47.99 (10.43) (p < 0.001), SF-36 Mental Component Summary from 42.34 (11.98) to 46.84 (10.47) (p < 0.001), and KITA Psychosoma subscale from 62.23 (19.76) to 76.44 (13.62) (p = 0.001). All these improvements were maintained until the last follow-up. Improvements were similar in patients not using diagnosis-related adjunctive therapies within the first six study months.Patients treated by anthroposophic physicians after an initial prolonged consultation had long-term re
Anthroposophic therapy for asthma: A two-year prospective cohort study in routine outpatient settings
Harald J Hamre, Claudia M Witt, Gunver S Kienle, et al
Journal of Asthma and Allergy , 2009, DOI: http://dx.doi.org/10.2147/JAA.S7184
Abstract: nthroposophic therapy for asthma: A two-year prospective cohort study in routine outpatient settings Original Research (5763) Total Article Views Authors: Harald J Hamre, Claudia M Witt, Gunver S Kienle, et al Published Date November 2009 Volume 2009:2 Pages 111 - 128 DOI: http://dx.doi.org/10.2147/JAA.S7184 Harald J Hamre1, Claudia M Witt2, Gunver S Kienle1, Christof Schnürer3, Anja Glockmann1, Renatus Ziegler4, Stefan N Willich2, Helmut Kiene1 1Institute for Applied Epistemology and Medical Methodology, Freiburg, Germany; 2Institute of Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin, Germany; 3Internal Medicine Practice, A Fraenkel Centrum, Badenweiler, Germany; 4Society for Cancer Research, Arlesheim, Switzerland Background: Anthroposophic treatment for asthma includes special artistic and physical therapies and special medications. Methods: We studied consecutive outpatients starting anthroposophic treatment for asthma under routine conditions in Germany. Main outcomes were average asthma severity (0–10, primary outcome); symptoms (1–4); and asthma-related quality of life at 12-month follow-up (Asthma Quality of Life Questionnaire [AQLQ] overall score, 1–7, for adults; KINDL Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents, asthma module, 0–100, for children) at 12-month follow-up. Results: Ninety patients (54 adults, 36 children) were included. Anthroposophic treatment modalities used were medications (88% of patients, n = 79/90); eurythmy therapy (22%); art therapy (10%); and rhythmical massage therapy (1%). Median number of eurythmy/art/massage sessions was 12 (interquartile range 10–20), median therapy duration was 120 days (84–184). From baseline to 12-month follow-up, all outcomes improved significantly (P < 0.001 for all comparisons). Average improvements were: average asthma severity 2.61 points (95% confidence interval CI: 1.90–3.32); cough 0.93 (95% CI: 0.60–1.25); dyspnea 0.92 (95% CI: 0.56–1.28); exertion-induced symptoms 0.95 (95% CI: 0.64–1.25); frequency of asthma attacks 0.78 (95% CI:0.41–1.14); awakening from asthma 0.90 (95% CI: 0.58–1.21); AQLQ overall score 1.44 (95% CI:0.97–1.92); and KINDL asthma module 14.74 (95% CI: 9.70–19.78). All improvements were maintained until last follow-up after 24 months. Conclusions: Patients with asthma under anthroposophic treatment had long-term improvements of symptoms and quality of life.
Outcome of anthroposophic medication therapy in chronic disease: A 12-month prospective cohort study
Harald J Hamre, Claudia M Witt, Anja Glockmann, Renatus Ziegler, Gunver S Kienle et al
Drug Design, Development and Therapy , 2008, DOI: http://dx.doi.org/10.2147/DDDT.S
Abstract: tcome of anthroposophic medication therapy in chronic disease: A 12-month prospective cohort study (3530) Total Article Views Authors: Harald J Hamre, Claudia M Witt, Anja Glockmann, Renatus Ziegler, Gunver S Kienle et al Published Date January 2008 Volume 2008:2 Pages 25 - 37 DOI: http://dx.doi.org/10.2147/DDDT.S Harald J Hamre1, Claudia M Witt2, Anja Glockmann1, Renatus Ziegler3, Gunver S Kienle1, Stefan N Willich2, Helmut Kiene1 1Institute for Applied Epistemology and Medical Methodology, Freiburg, Germany; 2Institute of Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin, Germany; 3Society for Cancer Research, Arlesheim, Switzerland Background: Anthroposophic medications (AMED) are prescribed in 56 countries. Objective: To study clinical outcomes in patients prescribed AMED for chronic disease. Design: Prospective cohort study. Setting: 110 medical practices in Germany. Participants: 665 consecutive outpatients aged 1–71 years, prescribed AMED for mental, respiratory, musculoskeletal, neurological, genitourinary, and other chronic diseases. Main outcomes: Disease and Symptom Scores (physicians’ and patients’ assessment, 0–10) and SF-36. Results: During the first six months, an average of 1.5 AMED per patient was used, in total 652 different AMED. Origin of AMED was mineral (8.0% of 652 AMED), botanical (39.0%), zoological (7.2%), chemically defined (13.0%), and mixed (33.0%). From baseline to six-month follow-up, all outcomes improved significantly: Disease Score improved by mean 3.15 points (95% confidence interval 2.97–3.34, p 0.001), Symptom Score by 2.43 points (2.23–2.63, p 0.001), SF-36 Physical Component Summary by 3.04 points (2.16–3.91, p 0.001), and SF-36 Mental Component Summary by 5.75 points (4.59–6.92, p 0.001). All improvements were maintained at 12-month follow-up. Improvements were similar in adult men and women, in children, and in patients not using adjunctive therapies. Conclusion: Outpatients using AMED for chronic disease had long-term reduction of disease severity and improvement of quality of life.
Anthroposophic therapy for asthma: A two-year prospective cohort study in routine outpatient settings  [cached]
Harald J Hamre,Claudia M Witt,Gunver S Kienle,et al
Journal of Asthma and Allergy , 2009,
Abstract: Harald J Hamre1, Claudia M Witt2, Gunver S Kienle1, Christof Schnürer3, Anja Glockmann1, Renatus Ziegler4, Stefan N Willich2, Helmut Kiene11Institute for Applied Epistemology and Medical Methodology, Freiburg, Germany; 2Institute of Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin, Germany; 3Internal Medicine Practice, A Fraenkel Centrum, Badenweiler, Germany; 4Society for Cancer Research, Arlesheim, SwitzerlandBackground: Anthroposophic treatment for asthma includes special artistic and physical therapies and special medications.Methods: We studied consecutive outpatients starting anthroposophic treatment for asthma under routine conditions in Germany. Main outcomes were average asthma severity (0–10, primary outcome); symptoms (1–4); and asthma-related quality of life at 12-month follow-up (Asthma Quality of Life Questionnaire [AQLQ] overall score, 1–7, for adults; KINDL Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents, asthma module, 0–100, for children) at 12-month follow-up.Results: Ninety patients (54 adults, 36 children) were included. Anthroposophic treatment modalities used were medications (88% of patients, n = 79/90); eurythmy therapy (22%); art therapy (10%); and rhythmical massage therapy (1%). Median number of eurythmy/art/massage sessions was 12 (interquartile range 10–20), median therapy duration was 120 days (84–184). From baseline to 12-month follow-up, all outcomes improved significantly (P < 0.001 for all comparisons). Average improvements were: average asthma severity 2.61 points (95% confidence interval CI: 1.90–3.32); cough 0.93 (95% CI: 0.60–1.25); dyspnea 0.92 (95% CI: 0.56–1.28); exertion-induced symptoms 0.95 (95% CI: 0.64–1.25); frequency of asthma attacks 0.78 (95% CI:0.41–1.14); awakening from asthma 0.90 (95% CI: 0.58–1.21); AQLQ overall score 1.44 (95% CI:0.97–1.92); and KINDL asthma module 14.74 (95% CI: 9.70–19.78). All improvements were maintained until last follow-up after 24 months.Conclusions: Patients with asthma under anthroposophic treatment had long-term improvements of symptoms and quality of life.Keywords: anthroposophy, art therapy, asthma, combined modality therapy, drug therapy, eurythmy therapy, prospective studies, quality of life
Costs of shoulder pain in primary care consulters: a prospective cohort study in The Netherlands
Ton Kuijpers, Maurits W van Tulder, Geert JMG van der Heijden, Lex M Bouter, Dani?lle AWM van der Windt
BMC Musculoskeletal Disorders , 2006, DOI: 10.1186/1471-2474-7-83
Abstract: A prospective cohort study consisting of 587 patients with a new episode of shoulder pain was conducted with a follow-up period of 6 months. Data on costs were collected by means of a cost diary during 6 months.84% of the patients completed all cost diaries. The mean consumption of direct health care and non-health related care was low. During 6 months after first consultation for shoulder pain, the mean total costs a patient generated were €689. Almost 50% of this total concerned indirect costs, caused by sick leave from paid work. A small proportion (12%) of the population generated 74% of the total costs.The total costs in the 6 months after first consultation for shoulder pain in primary care, mostly generated by a small part of the population, are not alarmingly high.Shoulder pain is common with a one-year prevalence ranging between 5% and 47%[1-6]. The prevalence in the general population in The Netherlands has recently been estimated at 17% [7]. The annual incidence of shoulder pain in Dutch general practice ranges between 12 and 25/1000/year [7-9]. Shoulder pain has an unfavourable outcome in many patients. About 40 to 50% of all patients who present with a new episode of shoulder pain in primary care report persistent symptoms after 6 to 12 months [10-12].Musculoskeletal disorders are the second most expensive disease group for health care costs in the Netherlands, and represent 6% of the total healthcare costs [13]. Information on the costs associated with health care use and loss of productivity in patients with shoulder pain is very scarce, especially for the large majority of patients who are treated in primary health care.We performed a cohort study among patients who presented shoulder pain to their general practitioner, and followed them for 6 months. Our objective was to determine the shoulder pain related costs during the 6 months following first consultation for their complaints in general practice.Between January 2001 and June 2003, 103 general p
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