The shortage of general practitioners (GPs) and the aging workforce of established GPs in Switzerland are persistent. Furthermore, data on GPs with additional training in complementary medicine (CM) are lacking. This study aimed to obtain information on GPs with training in CM. A nationwide cross-sectional study was conducted using an anonymous online survey to assess the demographics, practice structures, workloads, and future perspectives. The participants were members of four CM societies representing doctors with CM certificates (n = 1,067) in traditional Chinese medicine/acupuncture (TCM/A), homeopathy (HOM), anthroposophical medicine, and phytotherapy. Overall, 206 GPs were included and divided into three groups: TCM/A (n = 73), HOM (n = 76), and others (n = 57). Most participants were male, and approximately half worked in double or group practices. They worked an average of 36 h per week, which had decreased by 13 h over the past 5 years, with plans for further reduction in the future. Approximately 18% planned to continue working beyond the retirement age, and 4% wanted to retire before that age. The majority expressed optimism about the future of CM in Swiss healthcare but less for individual CM disciplines. Compared to the 2015 Swiss Workforce Study, more CM GPs were female, worked less often in group practices, made fewer house calls, and were more optimistic about the future. CM-GPs in Switzerland face the same challenges as conventional GPs. National action and collaboration are needed to improve working conditions and to address the trend towards part-time work and an ageing workforce to safeguard healthcare for the population.

Palliative care focuses on the quality of life of people with life-limiting illnesses through bio-psycho-social-spiritual support and multiprofessional collaboration, as early as possible in the disease course and continuing until the end of life. In this context, many patients also seek integrative medical approaches which, with their salutogenetic and multidimensional orientation, align well with the core principles of palliative care. Using anthroposophic medicine and phytotherapy as examples, a spectrum of remedies, external applications, and artistic therapies is presented that can relieve symptoms and strengthen inner resources. A competent indication with careful consideration of benefits and burdens is essential. When applied appropriately, integrative interventions can contribute to providing individualized and comprehensive support for people at the end of life and effectively reinforce the principles of palliative care.

In Switzerland, a wide range of integrative oncology (IO) treatments is offered by various medical disciplines. A certificate of competence (SIWF: Swiss Institute for Medical Education, allows to bill from basic incurance) can be obtained for five disciplines: anthroposophic medicine (VAOAS), classical homeopathy (SVHA), phytotherapy (SMGP), TCM/acupuncture (ASA), and clinical hypnosis (SMSH). For Mind Body Medicine a CAS can be obtained (SFMBM). Integrative Nursing is an important therapeutic partner in many medical disciplines, with own established education programmes. These seven core disciplines of IO are based on different concepts and traditions, but they also have, at least in part, commonalities such as a multidimensional view of humanity, a focus on salutogenesis, the strengthening of self-efficacy, and the importance of lifestyle factors and individualised therapy. These core disciplines are offered with varying availability at the centres of the Swiss Network for Integrative Oncology (SNIO: www.integrative-oncology.ch), generally accompanying conventional oncological therapies and close, transparent communication with oncology specialists. The SNIO aims to develop quality criteria, coordinating treatment offers, promote network research, and encourage further training in order to enable coordinated and quality-assured care.

The androgen receptor (AR) is a nuclear receptor involved in regulating gene expression, maintaining the sexual phenotype, and contributing to the development of prostate cancer (PCa). The binding of agonists, such as dihydrotestosterone (DHT), triggers conformational changes in the AR, affecting coactivator interactions, and regulates downstream signaling pathways. Although AR activation depends on interactions between its ligand-binding domain (LBD) and coactivators, the precise impact of ligand binding on these interactions remains unclear. Antagonists such as apalutamide, bicalutamide, and enzalutamide inhibit AR activation and are used to treat PCa. However, their long-term effectiveness is often reduced due to mutations in AR-LBD, which can shift the AR from an antagonistic to an agonistic state, diminishing treatment efficacy. The mechanisms driving this conversion have not been fully elucidated. This study employed atomic-level investigations through molecular dynamics simulation with multiple replicas covering a total time frame of 10.5 μs, to investigate ligand induced perturbations in mutants AR_LBD, particularly focusing on conformational changes and the effect on AR-coactivator interaction. The results demonstrated that DHT, an agonist, stabilizes the activation function-2 region (AF-2), thereby promoting AR-coactivator interactions, while antagonists induce distinct changes in helix 12 that disrupt these interactions. In addition, F876L and T877A mutations in AR-LBD alter the ligand-to-coactivator allosteric pathway involving the coactivator, helix 3 (H3), helix 4 (H4), the loop between H3-H4, and helix 12 (H12), potentially converting the AR-apalutamide complex from an antagonistic to an agonistic state. The free energy decomposition calculations exhibited that AR mutant systems possess higher binding affinities than antagonistic ARs, with electrostatic interactions and conformational entropies associated with the determination of the binding free energies. The study suggests that point mutations in AR-LBD induce a shift from an antagonistic to an agonistic state by altering the AR and AF-2 structure, resulting in continuous coactivator recruitment and sustained AR activity. Through the application of a dynamic cross-correlation matrix, principal component analysis, free energy landscape computation, and structural community analysis, this research offers valuable insights into AR-coactivator interactions, paving the way for more effective treatments against castration-resistant prostate cancer.

Efficacy and safety of phytotherapy and anthroposophic medicine in bronchial asthma: A systematic review.

BackroundFeline oral squamous cell carcinoma (FOSCC) is the most common malignant oral tumor in cats, characterized by invasive and aggressive behavior regardless of its location. Conventional treatments, including surgery, radiation therapy, and chemotherapy, often yield unsatisfactory outcomes, with tumor progression and tissue destruction frequently leading to euthanasia. In anthroposophical medicine, extracts of Viscum album have been developed as complementary cancer treatments, with Iscador, the oldest and most widely used oncological drug, showing promising anticancer potential. This study investigated, for the first time, the cytotoxic and apoptotic effects of IscM and IscQu, two Viscum album extracts, on FOSCC cells.MethodsUsing primary cultures of three FOSCC cell lines, cell viability assays were performed to assess cytotoxicity, and the effects on apoptotic cell death, cell cycle arrest, and cellular and nuclear morphology were evaluated. Additionally, mRNA expression levels of Cyclin D, Cdk4, Bcl-2, Bax, and p53 were analyzed.ResultsThe results revealed that both IscM and IscQu induced apoptotic cell death and promoted cell cycle arrest in all three FOSCC cell lines tested. IscQu exhibited relatively stronger pro-apoptotic effects compared to IscM, although no significant differences were observed among the cell lines.ConclusionThese findings suggest that Viscum album extracts, particularly IscQu, may exert anti-tumor effects on feline oral squamous cell carcinoma cells in vitro.

Peroxisome proliferator-activated receptor gamma (PPARγ) is a key target for metabolic disorders that contribute to obesity and type 2 diabetes mellitus (T2DM). However, full agonists such as thiazolidinediones (TZDs) have limitations in terms of side effects. Selective PPARγ modulators (SPPARγMs) that target alternative binding pockets offer the potential for safer partial agonists. Here, we employed six computational algorithms (Fpocket, DeepSite, CavityPlus, DoGSiteScorer, CASTpFold, POCASA) to identify a novel allosteric pocket (pocket 6-5) in the PPARγ ligand-binding domain (LBD), localized at the helix 3 (H3), helix 2 (H2), helix 2'(H2'), and β-sheet interface. A virtual screening of 4,097 natural compounds from traditional Chinese medicine (TCM) libraries was conducted, which led to the identification of ginsenoside Rg5 (TWSZ-5) as a top hit. Molecular docking and molecular dynamics (MD) dynamics revealed TWSZ-5 stabilizes pocket 6-5 through hydrogen bonds with Ser342, Gln345, Lys261, and Lys263. TWSZ-5 promoted beige adipocyte differentiation in adipose-derived stem cells (ADSCs) in vitro, upregulating Ucp1, Prdm16, Cpt1α, and Pgc1α. The present study identifies TWSZ-5 as a novel SPPARγM that utilizes an allosteric binding pocket to enhance thermogenesis while mitigating adverse effects. These findings emphasize the potential of TCM derivatives and structure-based screening strategies to develop safer antidiabetic therapies with precision pharmacology.

to identify nurses' perceptions of the characteristics of anthroposophic nursing care. qualitative study carried out in Tortosa, Spain. Semi-structured online and face-to-face interviews with 23 international nurses with experience in anthroposophic nursing, about the characteristics of anthroposophic nursing. Data was transcribed between 2023-2024 and subjected to a reflective thematic analysis using ATLAS-ti®. four characteristic areas are described: anthroposophic anthropology as a salutogenic basis that values the relationship between care, nature, and human suffering; external applications as complementary therapeutic techniques; sincere nursing involvement with the patient, family and community based on therapeutic links; path of self-knowledge as a support tool in patient care. anthroposophic nurses combine nursing science and anthroposophic medicine to achieve coherence and inner strength. There is a demand for research and continuing education in anthroposophic nursing and homogeneity in the theoretical and practical foundations provided by anthroposophic nursing and existing training courses.

Bufadienolides from Helleborus foetidus and their cytotoxic properties on MCF-7 breast cancer cells

Bryophyllum spp. preparations are widely used in Anthroposophic Medicine, most often for mental and behavioral disorders, including anxiety. Studies in animals revealed various anxiolytic and neurosedative effects for Bryophyllum pinnatum. We set out to investigate the effectiveness of Bryophyllum 50% chewable tablets, a product registered without indication by means of notification in Switzerland, in the treatment of anxiety symptoms in psychiatric and psychosomatic patients. A total of 99 patients with anxiety symptoms were recruited from the waiting list for an inpatient stay at the hospital "Klinik Arlesheim", Department of Psychiatry and Psychosomatics; of these, 54 completed the study and returned fully completed questionnaires. Patients were treated with Bryophyllum 50% chewable tablets (350 mg tablets, made from leaf press juice, 3 × 2 per day; Weleda AG Arlesheim, Switzerland) and filled out questionnaires at baseline and after two and three weeks of tablet intake. The primary endpoint of the study was the change in anxiety symptoms measured with the Beck Anxiety Inventory (BAI). A clinically relevant decrease in BAI score from baseline (27.4 ± 12.0) to after two (22.4 ± 12.1; p < 0.001) and three (20.6 ± 12.9; p < 0.001) weeks of treatment was observed. Additional improvements were observed in the secondary endpoints (including in depression, sleep quality, and stress); tolerability and compliance were very good. The results suggest that Bryophyllum 50% chewable tablets have beneficial effects on anxiety-related symptoms. Since the study design does not allow us to conclude causality between treatment and observed improvements, a randomized clinical trial is urgently needed.

Mindfulness has emerged as key construct in mental health over past decades. While current mindfulness-based interventions (MBIs) are usually rooted in Asian contemplative traditions, mindfulness practices can equally be found in other knowledge systems, including integrative medicine systems such as anthroposophic medicine (AM). The Activity-Based Stress Release (ABSR) program incorporates the latter as part of an 8-week-long online intervention combining mindfulness exercises, behavioral self-observation, and mindful movement practices derived from this integrative medicine frame. The program could offer additional means for cultivating mindfulness, thereby addressing the necessity for diverse approaches in conjunction with individual differences, diverse clinical demands, or restricted capacities to perform certain mindfulness practices. Using an observational repeated-measures design, the current study aimed to assess a large-scale online implementation of this program in terms of its feasibility, assessing perceived stress and mindfulness. Individuals who enrolled in any of the 37 ABSR program iterations carried out during 2023 and agreed to participate in the study completed online surveys including validated stress and mindfulness scales at the beginning, middle, end, and follow up of the intervention. Linear-mixed models were used for data analysis. A total of 830 individuals took part in the study, of which 53.5% filled in at least 2 surveys. In line with our expectation, mindfulness scores increased significantly over the course of the intervention, while stress scores decreased significantly in this timeframe. We further found differential effects of self-practice frequency and duration on the outcomes. This study provides a first indication of stress reduction in conjunction with the online implementation of this novel MBI. The work further suggests that this AM-based intervention indeed targets mindfulness, as do other MBIs, and that it is adaptable to an online format. However, given the observational single-arm design, controlled studies will be necessary to confirm these results. Nonetheless, the study adds a novel contribution to existent MBIs, which is significant in view of the need for diverse approaches to meet the heterogeneity of individual predispositions and clinical requirements. It remains to established by forthcoming research for which groups of individuals or clinical features this approach could be especially beneficial or less suitable.

IntroductionCancer is a debilitating disease with an often chronic course. One of the most taxing and prevalent sequelae in this context is cancer-related fatigue (CRF) resulting from the disease and/or associated treatments. Over the last years mindfulness-based interventions such as eurythmy therapy (ERYT), a mindful-movement therapy from anthroposophic medicine, have emerged as promising adjunct therapies in oncology. This prospective study investigated an online implementation of ERYT for CRF using a single arm repeated-measures design based on two consecutive studies.MethodStudy 1 consisted of an initial assessment before, during, after, and at follow up of a 6-week online ERYT-based program in a mixed sample of N = 165 adults with or without cancer diagnosis. Study 2 involved a similar design with an adapted 8-week online ERYT-based program in a sample of N = 125 adults who had been diagnosed with cancer. Outcomes were assessed using the Functional Assessment of Chronic Illness Therapy–Fatigue, Perceived Stress Scale, Mindful Attention Awareness Scale, and Insomnia Severity Index (for Study 1 all, for Study 2 only the former three). We additionally performed an exploratory analysis regarding practice frequency and duration. Data were analyzed using Linear Mixed-Effect Models per outcome; ANOVA was used for practice times.ResultsFor Study 1, mixed-effects model estimates showed no significant effect on fatigue, but pointed to significantly improved emotional and physical well-being, reduced stress, as well as increased mindfulness (mixed subjects). Functional and social well-being or sleep quality did not change significantly. Study 2 model estimates on the other hand showed significantly improved CRF in conjunction with the ERYT-based online intervention, as well as improved stress and mindfulness scores (cancer-diagnosed subjects).ConclusionTaken together, while our results should be interpreted with caution given the single-arm design and relatively high dropout, they suggest online ERYT may be associated with a reduction in fatigue for individuals diagnosed with cancer, an increase in mindfulness, and benefits for stress and certain well-being indicators. The online group format is advantageous in view of affordability and accessibility, the latter being particularly relevant for individuals who due to high symptom severity cannot leave their homes. Randomized-controlled studies will be needed to confirm these findings.

The skyrmion crystal (SkX) and helix (HL) phases, present in typical chiral magnets, can each be considered as forms of density waves but with distinct topologies. The SkX exhibits gyrodynamics analogous to electrons under a magnetic field, while the HL state resembles topological trivial spin density waves. However, unlike the charge density waves, the theoretical analysis of the sliding motion of SkX and HL remains unclear, especially regarding the similarities and differences in sliding dynamics between these two spin density waves. In this Letter, we systematically explore the sliding dynamics of SkX and HL in chiral magnets in the limit of large current density. We demonstrate that the sliding dynamics of both SkX and HL can be unified within the same theoretical framework as density waves, despite their distinct microscopic orders. Furthermore, we highlight the significant role of gyrotropic sliding induced by impurity effects in the SkX state, underscoring the impact of nontrivial topology on the sliding motion of density waves. Our theoretical analysis shows that the effect of impurity pinning is much stronger in HL compared with SkX, i.e., χ^{SkX}/χ^{HL}∼α^{2} (χ^{SkX}, χ^{HL}: susceptibility to the impurity potential, α (≪1) is the Gilbert damping). Moreover, the velocity correction is mostly in the transverse direction to the current in SkX. These results are further substantiated by realistic Landau-Lifshitz-Gilbert simulations.

Integrative and Complementary Practices (ICPs) are therapeutic approaches that integrate traditional and complementary methods with conventional ones, promoting comprehensive and humanized care, recognized and regulated by the Unified Health System (UHS) in Brazil. This study aimed to conduct a literature review on ICPs, reporting the services offered by the municipality of Juiz de Fora, MG, Brazil. Sources included clinical trials, cohort studies, systematic reviews, full articles, official documents, legislation, theses, dissertations, and others. It was observed that ICPs provide benefits in health promotion and disease prevention through less invasive and more natural methods, reducing costs and contributing to overall well-being, as they consider the human being holistically, addressing physical, emotional, and spiritual needs. In this context, the Ministry of Health has already formalized 30 practices, highlighting phytotherapy, acupuncture, homeopathy, anthroposophic medicine, chiropractic, osteopathy, and massage therapy, among others, which allow the participation of various professionals as these are non-exclusive activities. ICPs encompass different knowledge and therapeutic care approaches, involving beliefs about health, disease, and healing, and various ways of coping with illnesses. In Juiz de Fora, MG, the municipality offers services in addition to phytotherapy, including acupuncture, anthroposophy, meditation, Reiki, and homeopathy. Therefore, ICPs represent an important strategy for promoting health and well-being, offering effective and humanized therapeutic alternatives, valuing prevention and treatment of diseases holistically, promoting comprehensive care, and improving the population's quality of life.

In this narrative, a general practitioner and psychotherapist trained in anthroposophic medicine presents the narrative and treatment of a 60-year-old woman who experienced the horrors of the "Dark Sabbath" attack in southern Israel on October 7, 2023. The patient's story is narrated by the physician, who shares his multi-disciplinary and multi-modal anthroposophic medicine approach to address the patient's acute stress disorder-related symptoms and concerns.

Expert consensus-based clinical recommendation for an integrative anthroposophic treatment approach to acute tonsillitis in childhood

Glutamate 139 of tropomyosin is critical for cardiac thin filament blocked-state stabilization

Background: Bryophyllum preparations are widely used in anthroposophic medicine, most often for mental and behavioural disorders. Three prospective studies have revealed positive effects of Bryophyllum pinnatum on sleep quality, and various trials have shown very good tolerability. Results from animal models have indicated CNS depressant and anxiolytic effects. This survey was conducted at the hospital “Klinik Arlesheim” in Switzerland to find out how the physicians and the nursing staff perceive the effectiveness and the tolerability of the Bryophyllum preparations they most frequently use. Design: Internal, anonymous online survey of healthcare professionals (April 8–May 31, 2022). The questionnaire comprised 105 multiple-choice questions. Answering the questions was taken as consent to participate in the survey. Participants and Methods: All physicians and nursing staff with a valid email address at the hospital “Klinik Arlesheim AG” were invited via email to participate in this REDCap survey. The data were analysed descriptively. Results: Out of 266 invited participants, 48 answered some and 36 answered all questions (response rate between 18.0% and 13.5%). The participants had long experience with Bryophyllum preparations and were comprised approximately equal numbers of physicians and nursing staff. Various Bryophyllum preparations from the hospital’s own production and Wala Heilmittel GmbH (in both cases produced from the species B. daigremontianum) and from Weleda AG (species B. pinnatum) were used. The indications for which most participants had prescribed or administered Bryophyllum preparations “very frequently” were anxiety, sleep disorders, crisis situations in oncology, posttraumatic stress disorder, benzodiazepine dependence/withdrawal, and depression. Improvements such as relief from restlessness, decreased anxiety, balance, easier falling asleep, better sleeping through, increased resilience, mood elevation, and less urge to move one’s legs were reported “frequently” or “very frequently.” Almost all participants agreed that Bryophyllum can be used to reduce the intake of synthetic sedatives or psychotropic drugs, but only approximately half believed that it could replace them. The majority of participants mentioned good tolerability of the various products, but a few reported occasional stomach or intestinal irritation, daytime fatigue, drowsiness, diarrhoea, and nausea. Conclusion: Bryophyllum preparations are perceived as helpful in the treatment of various mental disorders, particularly anxiety, and are generally well tolerated. Most of these preparations are used for indications that have not yet been clinically investigated.

Wir suchen dringend für unsere anthroposophische Arztpraxis im Allgäu eine/n Weiterbildungsassistenten/in und/oder eine/n Facharzt/-ärztin für Allgemeinmedizin mit Interesse an der Anthroposophie Rudolf Steiners. Wir sind eine Allgemeinarztpraxis im Allgäu mit Stammsitz in Kempten und einer Filialpraxis im Nachbarort Wiggensbach. Unser Schwerpunkt ist die Anthroposophische Medizin. In der Stammpraxis arbeiten 3 Ärzte und ein Weiterbildungsassistent. Es besteht ein reger Kontakt zur Freien Schule Albris (Waldorfschule). Wir behandeln die ganze Familie, d. h. vom Säugling bis zum geriatrischen Patienten. Am Ort sind einige Heileurythmisten, Rhythmische Masseure und andere künstlerische Therapeuten vertreten. Wir haben die Berechtigung für die Weiterbildung in der Allgemeinmedizin und in der Anthroposophischen Medizin für jeweils 2 Jahre und dürfen in unseren Praxen 3 Assistenten gleichzeitig beschäftigen. Sie können gerne vorab auf unserer Webseite (www.praxis-dr-weichert.de) schauen, die zwar keinen umfänglichen Einblick gibt, aber einen ersten Eindruck vermittelt. Näheres gerne auch in einem Telefongespräch. Bei Interesse verabreden Sie gerne per E-Mail oder Telefon einen Gesprächstermin.

EmrE is a small multidrug resistance (SMR) pump of antiparallel topology that confers resistance to a broad range of polyaromatic cations in Escherichia coli. Atomic-level understanding of conformational changes for the selectivity of substrate and transport of a diverse array of drugs through the smallest known efflux pumps is crucial to multi-drug resistance. Therefore, the present study aims to provide insights into conformational changes during the transport through EmrE transporter at different pH. Molecular dynamics simulations have been carried out on the complete structure of EmrE in the absence of substrate. Computational analyses such as secondary structure, principal component, dynamic cross-correlation matrix, and hydrogen bond calculations have been performed. Analysis of MD trajectories in this study revealed pH-dependent interactions that influenced the structural dynamics of EmrE. Notably, at high pH, Glu14 and Tyr60 in both monomers formed electrostatic interactions, while these interactions decreased significantly at a low pH. Interestingly, a kink at helix 3 (H3) and dual open conformation of EmrE at low pH were also observed in contrast to a closed state discerned towards the periplasmic side at high pH. Significant interactions between C-terminal residues and residues at the edge of H1 & Loop1 and H3 & Loop3 were identified, suggesting their role in stabilizing the closed conformation of EmrE at the periplasmic end under high pH conditions. The present study enhances our understanding of EmrE’s conformational changes, shedding light on the pH-dependent mechanisms that are likely to impact its function in multi-drug resistance. Communicated by Ramaswamy H. Sarma