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Bauer N, Löffler C, Öznur Ö, Uecker C, Keil T, Langhorst J. Mind-body-medicine and comprehensive lifestyle-modification in patients with Crohn's disease—Feasibility of a randomized controlled trial under pandemic circumstances. Front Integr Neurosci 2022; 16:960301. [PMID: 36081609 PMCID: PMC9447476 DOI: 10.3389/fnint.2022.960301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/08/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Mind-body medicine (MBM) focuses on stress reduction and lifestyle changes. The primary objective of this pilot trial was to test study feasibility of a complex integrative MBM program for patients with Crohn's disease (CD), especially in rural regions, and under pandemic conditions. Methods Patients were stratified and randomized to the intervention group (IG) or the control group (CG). The intervention included a weekly 6-h session for 10 weeks. The CG (waiting list) received an initial 90-min workshop and started the intervention 9 months later. The primary outcome for study feasibility was recruitment and retention rates, as well as reasons for drop-out. The trial took place in Bamberg, Germany (September 2020 to December 2021). Results Totally 700 members of the German Crohn's and Colitis Organization—DCCV—were contacted. A total of 15% (102/700; 95% CI 12–17%) expressed interest to participate. Following screening, 41% (95% CI 32–50) were randomized to IG (n = 22) and CG (n = 20). The patients were on average (±standard deviation) 48 ± 13 years old, 67% were female, and have been suffering from CD for 20 ± 12 years. Patients traveled 71.5 ± 48.7 km (range: 9–227 km) to the intervention with no differences between IG and CG. At the 6-month follow-up, 36/42 (86%, 95% CI 74–95%) participants completed final assessment and 19/22 (86%, 95% CI 70–100%) the intervention. The most important reasons for non-responding were work-related (12/60; 20%) and for or drop-out pandemic-related anxiety (3/6). No patient and staff member became infected with SARS-CoV-2 during the study. Conclusion The feasibility of the MBM study was confirmed in terms of predefined recruitment and retention criteria, both despite difficult conditions (including the rural setting) and patients' fears associated with the pandemic. It was crucial to develop appropriate hygiene and safety concepts that enable chronically ill patients to participate in helpful group-based interventions even under pandemic conditions. Clinical trial registration ClinicalTrials.gov, identifier: NCT05182645.
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Affiliation(s)
- Nina Bauer
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, Bamberg, Germany
- Department of Integrative Medicine, Medical Faculty, University of Duisburg-Essen, Bamberg, Germany
| | - Claudia Löffler
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Özlem Öznur
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, Bamberg, Germany
- Department of Integrative Medicine, Medical Faculty, University of Duisburg-Essen, Bamberg, Germany
| | - Christine Uecker
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, Bamberg, Germany
- Department of Integrative Medicine, Medical Faculty, University of Duisburg-Essen, Bamberg, Germany
| | - Thomas Keil
- Institute of Clinical Epidemiology and Biometry, Julius Maximilians University of Würzburg, Würzburg, Germany
- State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jost Langhorst
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, Bamberg, Germany
- Department of Integrative Medicine, Medical Faculty, University of Duisburg-Essen, Bamberg, Germany
- *Correspondence: Jost Langhorst
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Teich N, Ludewig C, Schmelz R, Bästlein EC, Geißler S, Nagl S, Walldorf J, Krause T, Maaser C, Mohl W, Wedemeyer HH, Bauer T, Büning C, Grunert P, Hasselblatt P, Hänschen M, Kahl M, Engelke O, Schubert S, Holler B, Streetz K, Arnim UV, Schmidt K, Stallmach A. [Effects of SARS-CoV-2 Infection on Symptoms and Therapy of Inflammatory Bowel Disease]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 59:1189-1196. [PMID: 34748206 DOI: 10.1055/a-1508-6734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The influence of a SARS-CoV-2 infection on inflammatory bowel disease (IBD) has not yet been well characterized and it is unclear whether this requires an adaptation of the immunosuppressive therapy. METHODS A national register was established for the retrospective documentation of clinical parameters and changes in immunosuppressive therapy in SARS-CoV-2 infected IBD patients. RESULTS In total, only 3 of 185 IBD patients (1.6 %) were tested for SARS-CoV-2 infection because of abdominal symptoms. In the course of COVID-19 disease, 43.5 % developed diarrhea, abdominal pain or hematochezia (risk of hospitalization with vs. without abdominal symptoms: 20.0 % vs. 10.6 %, p < 0.01). With active IBD at the time of SARS-CoV-2 detection, there was an increased risk of hospitalization (remission 11.2 %, active IBD 23.3 % p < 0.05). IBD-specific therapy remained unchanged in 115 patients (71.4 %); the most common change was an interruption of systemic therapy (16.2 %). DISCUSSION New abdominal symptoms often appeared in SARS-CoV-2 infected IBD patients. However, these only rarely led to SARS-CoV-2 testing. A high IBD activity at the time of SARS-CoV-2 detection was associated with an increased risk of hospitalization.
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Affiliation(s)
- Niels Teich
- Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten, Leipzig, Germany
| | - Clara Ludewig
- Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten, Leipzig, Germany
| | - Renate Schmelz
- Medizinische Klinik und Poliklinik 1, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Germany
| | | | - Sven Geißler
- Praxisgemeinschaft für Rheumatologie und Gastroenterologie, Cottbus, Germany
| | - Sandra Nagl
- III. Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Jens Walldorf
- Universitätsklinik für Innere Medizin I, Martin-Luther-Universität Halle-Wittenberg Medizinische Fakultät, Halle, Germany
| | | | - Christian Maaser
- Ambulanzzentrum Gastroenterologie am Klinikum Lüneburg, Lüneburg, Germany
| | - Wolfgang Mohl
- Zentrum für Gastroenterologie Saar MVZ GmbH Saarbrücken, Saarbrücken, Germany
| | - Heiner H Wedemeyer
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Tilman Bauer
- Gemeinschaftspraxis für Gastroenterologie und Kindergastroenterologie, Freinurg, Germany
| | | | - Philip Grunert
- Klinik für Innere Medizin IV (Gastroenterologie, Hepatologie und Infektiologie), Universitatsklinikum Jena, Jena, Germany
| | - Peter Hasselblatt
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany
| | | | - Matthias Kahl
- Fachinternistische Schwerpunktpraxis, Hamburg, Germany
| | - Olaf Engelke
- Internistische Gemeinschaftspraxis Wanne-Eickel, Herne, Germany
| | - Stefan Schubert
- MVZ für Gastroenterologie am Bayerischen Platz, Berlin, Germany
| | - Babett Holler
- Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie und Infektiologie, Universitätsklinikum Leipzig, Germany
| | | | - Ulrike von Arnim
- Department of Gastroenterology, Hepatology and Infectious diseases, Universitätsklinikum Magdeburg AöR, Magdeburg, Germany
| | | | - Andreas Stallmach
- Klinik für Innere Medizin IV (Gastroenterologie, Hepatologie und Infektiologie), Universitatsklinikum Jena, Jena, Germany
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Radon K, Bakuli A, Pütz P, Le Gleut R, Guggenbuehl Noller JM, Olbrich L, Saathoff E, Garí M, Schälte Y, Frahnow T, Wölfel R, Pritsch M, Rothe C, Pletschette M, Rubio-Acero R, Beyerl J, Metaxa D, Forster F, Thiel V, Castelletti N, Rieß F, Diefenbach MN, Fröschl G, Bruger J, Winter S, Frese J, Puchinger K, Brand I, Kroidl I, Wieser A, Hoelscher M, Hasenauer J, Fuchs C. From first to second wave: follow-up of the prospective COVID-19 cohort (KoCo19) in Munich (Germany). BMC Infect Dis 2021; 21:925. [PMID: 34493217 PMCID: PMC8423599 DOI: 10.1186/s12879-021-06589-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the 2nd year of the COVID-19 pandemic, knowledge about the dynamics of the infection in the general population is still limited. Such information is essential for health planners, as many of those infected show no or only mild symptoms and thus, escape the surveillance system. We therefore aimed to describe the course of the pandemic in the Munich general population living in private households from April 2020 to January 2021. METHODS The KoCo19 baseline study took place from April to June 2020 including 5313 participants (age 14 years and above). From November 2020 to January 2021, we could again measure SARS-CoV-2 antibody status in 4433 of the baseline participants (response 83%). Participants were offered a self-sampling kit to take a capillary blood sample (dry blood spot; DBS). Blood was analysed using the Elecsys® Anti-SARS-CoV-2 assay (Roche). Questionnaire information on socio-demographics and potential risk factors assessed at baseline was available for all participants. In addition, follow-up information on health-risk taking behaviour and number of personal contacts outside the household (N = 2768) as well as leisure time activities (N = 1263) were collected in summer 2020. RESULTS Weighted and adjusted (for specificity and sensitivity) SARS-CoV-2 sero-prevalence at follow-up was 3.6% (95% CI 2.9-4.3%) as compared to 1.8% (95% CI 1.3-3.4%) at baseline. 91% of those tested positive at baseline were also antibody-positive at follow-up. While sero-prevalence increased from early November 2020 to January 2021, no indication of geospatial clustering across the city of Munich was found, although cases clustered within households. Taking baseline result and time to follow-up into account, men and participants in the age group 20-34 years were at the highest risk of sero-positivity. In the sensitivity analyses, differences in health-risk taking behaviour, number of personal contacts and leisure time activities partly explained these differences. CONCLUSION The number of citizens in Munich with SARS-CoV-2 antibodies was still below 5% during the 2nd wave of the pandemic. Antibodies remained present in the majority of SARS-CoV-2 sero-positive baseline participants. Besides age and sex, potentially confounded by differences in behaviour, no major risk factors could be identified. Non-pharmaceutical public health measures are thus still important.
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Affiliation(s)
- Katja Radon
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336, Munich, Germany.
- Center for International Health (CIH), University Hospital, LMU Munich, 80336, Munich, Germany.
- Comprehensive Pneumology Center (CPC) Munich, German Center for Lung Research (DZL), 89337, Munich, Germany.
| | - Abhishek Bakuli
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Peter Pütz
- Institute of Computational Biology, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Faculty of Business Administration and Economics, Bielefeld University, 33615, Bielefeld, Germany
| | - Ronan Le Gleut
- Institute of Computational Biology, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Core Facility Statistical Consulting, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764, Neuherberg, Germany
| | | | - Laura Olbrich
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
- German Center for Infection Research (DZIF), partner site, Munich, Germany
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
- German Center for Infection Research (DZIF), partner site, Munich, Germany
| | - Mercè Garí
- Institute of Computational Biology, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764, Neuherberg, Germany
| | - Yannik Schälte
- Institute of Computational Biology, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Center for Mathematics, Technische Universität München, 85748, Garching, Germany
| | - Turid Frahnow
- Institute of Computational Biology, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Faculty of Business Administration and Economics, Bielefeld University, 33615, Bielefeld, Germany
| | - Roman Wölfel
- German Center for Infection Research (DZIF), partner site, Munich, Germany
- Bundeswehr Institute of Microbiology, 80937, Munich, Germany
| | - Michael Pritsch
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
- German Center for Infection Research (DZIF), partner site, Munich, Germany
| | - Camilla Rothe
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Michel Pletschette
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Raquel Rubio-Acero
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Jessica Beyerl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Dafni Metaxa
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Felix Forster
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336, Munich, Germany
- Comprehensive Pneumology Center (CPC) Munich, German Center for Lung Research (DZL), 89337, Munich, Germany
| | - Verena Thiel
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Noemi Castelletti
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Friedrich Rieß
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
- German Center for Infection Research (DZIF), partner site, Munich, Germany
| | - Maximilian N Diefenbach
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Günter Fröschl
- Center for International Health (CIH), University Hospital, LMU Munich, 80336, Munich, Germany
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Jan Bruger
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Simon Winter
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Jonathan Frese
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Kerstin Puchinger
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Isabel Brand
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
- German Center for Infection Research (DZIF), partner site, Munich, Germany
| | - Andreas Wieser
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
- German Center for Infection Research (DZIF), partner site, Munich, Germany
| | - Michael Hoelscher
- Center for International Health (CIH), University Hospital, LMU Munich, 80336, Munich, Germany
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
- German Center for Infection Research (DZIF), partner site, Munich, Germany
| | - Jan Hasenauer
- Institute of Computational Biology, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Center for Mathematics, Technische Universität München, 85748, Garching, Germany
- Interdisciplinary Research Unit Mathematics and Life Sciences, University of Bonn, 53113, Bonn, Germany
| | - Christiane Fuchs
- Institute of Computational Biology, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Faculty of Business Administration and Economics, Bielefeld University, 33615, Bielefeld, Germany
- Core Facility Statistical Consulting, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Center for Mathematics, Technische Universität München, 85748, Garching, Germany
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