Ziel des Forschungsvorhabens war es, die Wirksamkeit des homöopathischen Behandlungsverfahrens in Anwendung der klassischen Homöopathie im Vergleich zum chemotherapeutischen Behandlungsverfahren und zu einem Placebo bei der Behandlung akuter katarrhalischer Eutererkrankungen zu prüfen. Der Fokus wurde auf Mastitiden gelegt, die entweder unspezifisch waren oder durch umweltassoziierte Erreger hervorgerufen wurden. Es sollten die Möglichkeiten, aber auch die Grenzen des homöopathischen und des chemotherapeutischen Behandlungsverfahrens aufgezeigt und Schlussfolgerungen im Hinblick auf die homöopathische Behandlung von Eutererkrankungen abgeleitet werden.

People have always been fascinated by the extent to which belief or will may influence<p>behavior. Proverbs, like “we tend to get what we expect,” and concepts, such as optimistic<p>thinking or self-fulfilling prophecy, reflect this intuition of an important link between one’s<p>dispositions and subsequent behavior. In other words, one’s predictions directly or<p>indirectly cause them to become true. In a similar manner, every culture, country or<p>religion has their own words for ‘expectation,’ ‘belief,’ ‘disappointment,’ ‘surprise,’ and<p>generally all have the same meaning: under uncertainty, what one expects or believes is the<p>most likely to happen. This relation between what caused a reaction in the past will<p>probably cause it again in the future might not be realistic. If the expected outcome is not<p>confirmed, it may result in a personal ‘disappointment’, and if the outcome fits no<p>expectations, it will be a ‘surprise’. Our brain is hardwired with this heuristic capacity of<p>learning the cause-effect relationship and to project its probability as the basis for much of<p>our behavior, as well as cognitions. This experience-based expectation is a form of<p>learning that helps the brain to bypass an exhaustive search in finding a satisfactory<p>solution. Expectations may thus be considered an innate theory of causality; that is, a set of<p>factors (causes) generating a given phenomenon (effects) influence the way we treat<p>incoming information but also the way we retrieve the stored information. These<p>expectancy templates may well represent one of the basic rules of how the brain processes<p>information, affecting the way we perceive the world, direct our attention and deal with<p>conflicting information. In fact, expectations have been shown to influence our judgments<p>and social interactions, along with our volition to individually decide and commit to a<p>particular course of action. However, people’s expectations may elicit the anticipation of<p>their own automatic reactions to various situations and behaviors cues, and can explain that<p>expecting to feel an increase in alertness after coffee consumption leads to experiencing<p>the consequent physiologic and behavioral states. We call this behavior-response<p>expectancy. This non-volitional form of expectation has been shown to influence<p>cognitions such as memory, pain, visual awareness, implicit learning and attention, through<p>the mediation of phenomena like placebo effects and hypnotic behaviors. Importantly,when talking about expectations, placebo and hypnosis, it is important to note that we are<p>also talking about suggestion and its modulating capability. In other words, suggestion has<p>the power to create response expectancies that activate automatic responses, which will, in<p>turn, influence cognition and behavior so as to shape them congruently with the expected<p>outcome. Accordingly, hypnotic inductions are a systematic manipulation of expectancy,<p>similar to placebo, and therefore they both work in a similar way. Considering such<p>assumptions, the major question we address in this PhD thesis is to know if these<p>expectancy-based mechanisms are capable of modulating more high-level information<p>processing such as cognitive conflict resolution, as is present in the well-known Stroop<p>task. In fact, in a recent series of studies, reduction or elimination of Stroop congruency<p>effects was obtained through suggestion and hypnotic induction. In this PhD thesis, it is<p>asked whether a suggestion reinforced by placebos, operating through response-expectancy<p>mechanisms, is able to induce a top-down cognitive modulation to overcome cognitive<p>conflict in the Stroop task, similar to those results found using suggestion and hypnosis<p>manipulation. / Doctorat en Sciences Psychologiques et de l'éducation / info:eu-repo/semantics/nonPublished

La stimulation magnétique répétitive transcrânienne (rTMS) du cortex moteur à visée antalgique réunit deux conditions extrêmement intéressantes: un accès non invasif à une cible corticale éloquente et, par la modulation de son activité, la possibilité d'influencer le transfert et l'intégration du message nociceptif. L'objectif de cette thèse est d'évaluer comment une approche de recherche clinique permet à la fois de progresser dans la compréhension des mécanismes qui sous-tendent l'effet antalgique de la rTMS et d'optimiser cet effet chez le patient. Une première étude paramétrique, concernant la technique de stimulation, a montré que l'orientation du courant était cruciale pour le développement d'un effet antalgique, l'orientation la plus favorable étant celle activant des interneurones corticaux. Nous n'avons toutefois pas objectivé de modification spécifique d'une composante sensorielle de la douleur en rapport avec cet effet local, ni une influence liée au caractère somatotopique de la stimulation. Ainsi, l'efficacité de la stimulation ne semble pas tributaire de sa localisation en regard de la représentation corticale du territoire douloureux. L'action sur la composante sensorielle de la douleur n'expliquant pas à elle seule l'effet antalgique de la rTMS, nous avons analysé les interactions entre effet antalgique et effet placebo : la rTMS a une efficacité propre, indépendante de l'effet placebo et lorsqu'elle est efficace, elle majore l'effet d'une séance placebo réalisée par la suite, par un phénomène de conditionnement. La rTMS active facilite les mécanismes de contrôle central de la douleur grâce à ses connexions à distance et à son action sur les systèmes endorphiniques, également impliqués dans l'effet antalgique du placebo. A la lumière de ces résultats, nous avons analysé les critères cliniques sur lesquels reposent l'efficacité à long terme des procédures de stimulation épidurale antalgique du cortex moteur et la valeur prédictive de la rTMS: l'efficacité de la rTMS apparaît comme un marqueur utile pour prédire l'efficacité au long cours de la stimulation corticale épidurale, lorsque la douleur est évaluée non seulement dans sa dimension sensorielle pure mais également à travers son retentissement psychologique global. L'ensemble de ces travaux suggère une action multiple de la rTMS s'exerçant probablement dans les 3 sphères (sensori-discriminative, affective et cognitive) qui sous- tendent la perception et le vécu de la douleur chronique / Repetitive transcranial magnetic stimulation (rTMS) of the motor cortex allows a non- invasive access to an eloquent cortical area and, by the modulation of its activity, the possible interference with central integration of pain. ln this thesis we have applied clinical research methods to enhance the understanding of the mechanisms of pain relief by rTMS and to optimize its clinical effect in chronic pain patients. A first parametrical study, concerning technical aspects of the stimulation, showed the crucial role of current orientation to increase the magnitude of analgesic effects, a postero-anterior orientation promoting interneuronal activation being superior to a latero-medial direction. We found neither a selective modification of sensorial component of pain nor a somatotopic effect of the stimulation: indeed, rTMS analgesic efficacy was not dependent upon stimulation being applied to the cortical representation of the painful territory. The impossibility to explain the whole analgesic effect of rTMS by an isolated modulation of sensory components of pain prompted us to study the interactions between real and placebo rTMS analgesic effects. Active rTMS has a specific analgesic effect, and, when efficacious, it was able to enhance the placebo effect of subsequent sham stimulation. The value of rTMS to adequately predict the long-term efficacy of invasive motor cortex epidural stimulation (surgically implanted MCS) was assessed in a further study. The analgesic efficacy of single-point rTMS proved to be useful to predict the long-term outcome of surgically implanted MCS, provided that such outcome assessment was not exclusively founded on pain intensity but also on the psychological consequences of chronic pain. These results suggest that rTMS exerts its analgesic effects at multiple levels, and probably modifies the 3 different spheres (sensori-discriminative, affective and cognitive) at the origin of perception and consequences of chronic pain in daily life

Background: Interest in alternatives to hormone therapy (HT) for menopausal symptoms increased following its association with serious health risks. In terms of phytotherapeutic interventions, while traditional use supports a range of herbs for treating menopausal symptoms, evidence from rigorous scientific trials is limited, and has largely focused on the phytoestrogenic plants. Because of some safety concerns over long-term use of isoflavones, the present study focused on two non-estrogenic herbs, Hypericum perforatum and Vitex agnus-castus, also employed in this context in the Anglo-American and European traditions. Both herbs have shown effectiveness for the alleviation of symptoms of premenstrual syndrome (PMS), which is reported to be more severe during the perimenopause, and may account for many of the so-called 'menopausal symptoms' at this time. Research on menopausal vasomotor symptoms is prone to substantial placebo responses. There has been much interest in increasing our understanding of the placebo response with a view to controlling it in clinical research and harnessing it in clinical practice. Methods & Results: A double-blind, randomised controlled trial (RCT), with a 16-week treatment phase, was conducted on 100 late-perimenopause and early postmenopause women. The herbal combination (Hypericum and Vitex) was not found to be superior to placebo for any of the endpoints - daily weighted flushing scores, overall menopausal symptoms (on the Greene Climacteric Scale) and depression (on the Hamilton Depression Inventory). However, significant improvements across the treatment phase were observed in both arms for all of these outcome measures. No significant change was found for either group on the Utian quality of life scale. The effects of the herbal combination were also examined on PMS-like symptoms in the small sub-population of late-perimenopausal women, and found to be superior to placebo for total PMS-like symptoms and the sub-clusters, PMS-D (depression) and PMS-C (cravings). The active treatment group also showed significant improvements on PMS-A (anxiety) and PMS-H (hydration), although these effects were not superior to placebo. Predictors of the placebo response were investigated and found to include study-entry anxiety for the outcome measures of flushing, depression and overall menopausal symptoms, and improvement during non-treatment run-in for depression and overall symptoms. Because no difference had been found between 'active' and placebo groups in the menopause RCT, it was hypothesised that the same predictors would predict the response to the study treatment. However, low anxiety was significantly associated with improvement in this group. None of the other variables that predicted the placebo response was relevant to the study treatment response. This finding is discussed with reference to the possibility that 'drug' effects and placebo effects are not necessarily additive, and that the same magnitude of effect in both arms might not necessarily imply activity via the same pathways. Conclusions: This research contributes to the growing body of scientific knowledge about evidence-based complementary therapies that informs the community, health-care providers and regulatory authorities. The findings may facilitate identification of potential placebo responders in future research. The need for more research in the area of mechanisms of placebo versus active responses is supported.

It is known that some psychiatric disorders may deteriorate in relation to the menstrual cycle. However, in some conditions, such as premenstrual dysphoric disorder (PMDD), symptomatology is triggered mainly by the variations in ovarian steroid hormones. Although symptoms induced by fluctuations in ovarian steroids often are affective, little is known about how emotion processing in women is influenced by variations, or actual levels, of ovarian steroid hormones. The general aim of this thesis was to evaluate menstrual cycle effects on reactivity in emotion generating and controlling areas in the corticolimbic system to emotional stimulation and anticipation, in healthy controls and women with PMDD. A second aim was to evaluate corticolimbic reactivity during long-term administration of exogenous ovarian steroids. In study I, III and IV effects of the menstrual cycle on emotional reactivity in women with PMDD was studied. In study I, women with PMDD in displayed higher amygdala reactivity than healthy controls to emotional faces, not in the luteal phase as was hypothesised, but in the follicular phase. No difference between menstrual cycle phases was obtained in women with PMDD, while healthy controls had an increased reactivity in the luteal phase. The results of study I was further elaborated in study III, where women with PMDD were observed to have an increased anticipatory reactivity to negative emotional stimuli. However, no differences in amygdala reactivity to emotional stimuli were obtained across the menstrual cycle. Finally, in study IV the hypothesis that amygdala reactivity increase in the luteal phase in women with PMDD is linked to social stimuli rather than generally arousing stimuli was suggested, tested and supported. In study II, re-exposure to COC induced mood symptoms de novo in women with a previous history of COC-induced adverse mood. Women treated with COC reported increased levels of mood symptoms both as compared to before treatment, and as compared to the placebo group. There was a relatively strong correlation between depressive scores before and during treatment. The effects of repeated COC administration on subjective measures and brain function were however dissociated with increased aversive experiences accompanied by reduced reactivity in the insular cortex.

No description available.

Depression is common in haemodialysis (HD) patients and is often unrecognised and undertreated, though associated with excess morbidity and mortality. Diagnosis is challenging due to symptom overlap with kidney failure, with fatigue being the most common overlapping symptom. Research on the effectiveness of antidepressant medication in this setting is sparse. A recent systematic review advocated well-designed Randomised Controlled Trials (RCTs) in this setting. The studies reported in this thesis had a number of aims. The main aim was to undertake a multicentre feasibility randomised, double blind, placebo-controlled trial of sertraline in patients on HD with Major Depressive Disorder (MDD). To identify suitable patients for this, a screening phase was required, which also allowed determination of the prevalence of depression in this setting and of the relative effectiveness of screening tools Patient Health Questionnaire-2 (PHQ-2), Patient Health Questionnaire-9 (PHQ-9), and Beck Depression Inventory-II (BDI-II). It also allowed examination of the relationships of fatigue in this setting (assessed mainly by the Multidimensional Fatigue Inventory (MFI), including those with a diagnosis, and management of depression. The finding, during screening, that a large proportion of the HD cohort was already on antidepressant treatment, presented the opportunity to study 'real-life' practice patterns in the management of antidepressant treatment in this setting. Recruitment into the RCT was difficult. 1,355 patients in five HD centres were considered for screening, but 243 of these were excluded, mainly because of their inability to read and understand English. Of the remaining 1,110 patients, 709 consented to screening. 231 of these screened positive for high depression symptoms but 130 were not considered for the trial phase, mainly because of concurrent treatment for depression (68 patients), and other contraindicated conditions and medication. In addition, 38 patients declined to take part in the psychiatric interview necessary for diagnosis of MDD. Of the 63 who underwent the diagnostic interview, 37 (58.7%) were diagnosed with MDD and 30 consented to enter the RCT and were randomised into sertraline or placebo groups. This was half of the anticipated recruitment into the RCT. Twenty-one patients (70%) completed the six-month study, eight of 15 in the sertraline group and 13 of 15 in the placebo group (p < 0.05). Drop out was mainly due to adverse or serious adverse events. Depression scores (BDI-II and Montgomery-Åsberg Depression Rating Scale (MADRS)) improved significantly in both the sertraline and placebo groups over six months but there were no significant differences between the treatment groups. There was a slight suggestion of more rapid improvement over the first two months on sertraline, but this was not significant. Fatigue scores were high in all sub-domains - with only a weak relationship with age and comorbidity. Mental fatigue was the strongest independent predictor of high depressive symptoms (BDI-II ≥16, PHQ-9 ≥8), while physical fatigue had the strongest relationship with dialysis recovery time, and survival. Distinguishing between these components of fatigue may have a role in refining the diagnosis and management of MDD. Forty-one of the 76 patients on antidepressant medication at screening were followed up for a mean of 14±5 months. Ten different antidepressant agents were being taken - the most common being Citalopram (39%). Most had been prescribed by GPs. Two-thirds of patients either deteriorated or failed to improve in terms of BDI-II scores during follow-up, many of whom had had no adjustment of medication during this time. Diagnostic evaluation at follow-up showed 37% to be suffering from current or recurrent major depressive episodes (MDE), 48% to have evidence of past MDE, and 15% to have no evidence of ever having been depressed. These empirical studies confirm that depression is very common in HD patients. Its diagnosis is complicated due to symptom overlap with the uraemic syndrome. Fatigue seems to be a key area of overlap with symptoms of depression with a complex relationship. There was no obvious benefit from antidepressants in this feasibility RCT and there was a high drop-out rate due to adverse events, particularly in the sertraline group. These findings raise concerns about the benefits and risks of antidepressants in patients on HD. Current practice patterns may be subjecting patients to substantial risk for little or no benefit. Identifying whether antidepressant medication is effective in this context is a major clinical need, hence the requirement for a definitive study. There is no doubt that to undertake a definitive study would pose considerable recruitment challenges. The findings presented here emphasise the importance of finding ways to overcome these challenges that might include efforts to incorporate patients already taking antidepressants.

: This thesis focuses on monitoring attitudes of general practitioners in Southern Bohemia toward non-conventional medicine. In its theoretical part, the thesis deals with clarifying the concepts of non-conventional medicine, alternative medicine, and scientific medicine. Furthermore, the thesis describes various approaches to non-conventional medicine. In its practical part I examined the level of knowledge about non-conventional medicine among doctors. The research was conducted through anonymous questionnaires filled in by general practitioners. The questionnaires were then used for creating the charts. These charts indicate how doctors view various approaches to non-conventional medicine, to what extent they support using these methods among their patience, and how they view the quality of medical education in this area in the Czech Republic.

No description available.

Introduction : Afin de minimiser la morbidité postopératoire et les échecs du traitement dentaire, plusieurs schémas thérapeutiques antibiotiques ont été proposés. Cependant, l’utilisation intensive des antibiotiques dans les soins de santé a été débattue en raison des effets indésirables et la résistance bactérienne. De plus, l’impact des antibiotiques préopératoires sur le niveau osseux péri-implantaire n’est toujours pas clairement établi. Objectifs : L’objectif primaire de cette étude était d’évaluer si l’administration d’un antibiotique préopératoire (azithromycine 500 mg) avant la pose d’implant avait un impact sur les niveaux d’os crestal péri-implantaire après quatre mois chez les patients en bonne santé subissant une pose d’implant simple de type « platform-switching ». Les objectifs secondaires étaient d’évaluer la sévérité de la douleur postopératoire, la morbidité postopératoire associée à la chirurgie implantaire et le taux de survie des implants à quatre mois. Méthodes : Dix-neuf participants ont été recrutés dans un essai clinique randomisé à double insu en groupes parallèles. Les participants du groupe d’intervention ont reçu 500 mg d’azithromycine une heure avant la pose d’implant. Les participants du groupe contrôle ont reçu un placebo identique une heure avant la chirurgie implantaire. Les changements du niveau de l’os crestal péri-implantaire (résultat primaire) ont été mesurés quatre mois plus tard à l’aide de radiographies standardisées. La sévérité de la douleur et la morbidité postopératoire associées à la chirurgie (résultats secondaires) ont été évaluées par des examens cliniques et des questionnaires autoadministrés à une semaine et quatre mois postopératoires. Le taux de survie des implants et la santé péri-implantaire ont été évalués quatre mois après la pose d’implant, avant la mise en charge prothétique. Des analyses descriptives et bivariées ont été utilisées pour analyser les données. Une valeur de P ≤ 0,05 était considérée statistiquement significative. Résultats : Dix-huit participants ont complété l’étude (âge moyen : 52,8 ± 13,9ans). Les changements moyens du niveau osseux péri-implantaire pour le groupe intervention et le groupe contrôle étaient respectivement de -0,79 ± 0,57mm et de -0,35 ± 0,37mm. Il n’y avait pas de différences statistiquement significatives entre les deux groupes en ce qui concerne le remodelage osseux moyen péri-implantaire (-0,44mm (IC 95% : -0,94, +0,55)) et la sévérité de la douleur (P>0,05). Les interférences avec les activités quotidiennes, plus précisément, l’interférence de la chirurgie à ouvrir grand la bouche étaient significativement plus importante chez le groupe antibiotique comparativement au groupe intervention au cinquième jour postopératoire (P<0,05). Le taux de survie des implants était de 100% dans les deux groupes et la santé des tissus péri-implantaires était similaire entre les deux groupes quatre mois après la chirurgie. Conclusion : Les résultats préliminaires de cette étude clinique suggèrent qu’une dose préopératoire d’antibiotique chez les patients en bonne santé ayant une pose d’implant simple de type « platform-switching » n’apporte pas de bénéfice clinique. Des investigations additionnelles de plus grande envergure sont nécessaires afin de confirmer les résultats de cette étude. / Introduction: In order to minimise postoperative morbidity and failures of dental implant therapy, several antibiotic regimens have been proposed. However, the extensive use of antibiotics in health care has been debated due to the adverse effects and bacterial resistance. Furthermore, the impact of preoperative antibiotics on peri-implant bone level remains unclear. Objectives: The primary objective of this study was to assess whether giving a preoperative antibiotic (azithromycin 500mg) before implant placement would influence peri-implant crestal bone levels after four months in healthy patients undergoing straightforward platform-switched implant placement. The secondary objectives were to evaluate postoperative pain severity, surgery-associated morbidities, and four-month implant survival rate. Methods: Nineteen individuals were recruited in a double-masked two-arm randomised clinical trial. Participants in the intervention group received 500mg of azithromycin one hour before implant placement. Participants in the control group took one identical placebo one hour preoperatively. The changes in mesial and distal crestal bone level (primary outcome) were measured at baseline and four-month follow-up using standardised periapical radiographs. Pain severity and surgery-associated morbidities (secondary outcomes) were evaluated by clinical examinations and self-administered questionnaires at one-week and four-month follow-ups. Implant survival rate was assessed at the four-month follow-up. Descriptive and bivariate analyses were used to analyse the data. A P value ≤ 0.05 was considered statistically significant. Results: Eighteen participants completed the study (mean age: 52,8 ±13,9 years). The mean changes in peri-implant bone level for the intervention group and the control group were 0,79 ±0,57 mm and -0,35 ±0,37mm, respectively. There were no statistically significant differences between the two groups in mean change in peri-implant bone level (-0,44mm (95% CI: -0,94, +0,55)) and pain severity (P>0.05). Interferences with daily activities, more specifically the interference of surgery with opening the mouth larger was significantly higher in the antibiotic group compared to the control group (P<0.05) on the fifth postoperative day. The implant survival rate was 100% in both groups and peri-implant tissue health was similar between groups four months after surgery. Conclusion: The preliminary results of this clinical study demonstrates that giving one preoperative dose of antibiotic in healthy patients undergoing straightforward “platform-switching” implant placement does not provide any clinical benefit. Further larger controlled studies are needed to confirm the results of this study.