Health policy versus kava (Piper methysticum): Anxiolytic efficacy may be instrumental in restoring the reputation of a major South Pacific crop.

ETHNOPHARMACOLOGICAL RELEVANCE: Kava (Piper methysticum G. Forst. f.) is by far the most important plant used in the islands of Melanesia, Polynesia and Micronesia for its relaxing effects. Kava drinking is a pillar of South Pacific societies and is also the foundation of their economies. Preparations of kava extract as herbal medicinal drugs were banned in Germany in 2002 and again in 2019, with dramatic consequences for the South Pacific economies. In 2002, the major regulatory argument for the ban of kava was safety issues. In 2019, the assessment report of the European Medicines Agency's Herbal Medicinal Product Committee (HMPC) justified a negative benefit-to-risk ratio by a supposed lack of efficacy of ethanolic extracts for an indication of which kava extract preparations never had an approval. In this HMPC report the efficacy in the approved indications 'nervous anxiety, tension and restlessness' was attributed to the extract branded as 'WS 1490', which was assumed to have been prepared with acetone as an extraction solvent. In addition to this change of indication and the attribution of efficacy to acetone kava extract alone, the German health authorities and the HMPC still refuse to discuss quality issues as a likely factor impacting drug safety. The first case reports of liver toxicity were observed with an acetone extract in a timely relationship with the introduction of 'two-day kava' instead of 'noble kava' as used in ethanolic kava extracts. AIM OF THE STUDY: The correlation between clinical benefits and the type of extract preparation was examined. METHODS: In order to identify the types of kava material and extracts used in clinical trials, the respective publications were compared with regulatory databases and protocols of a German regulatory advisory board. RESULTS AND CONCLUSIONS: The comparison reveals inconsistencies in the regulatory decisions. In all studies with WS 1490, the evidence points to the use of an ethanolic extract. The efficacy of kava extract for the approved indication was clearly demonstrated. The HMPC report and the recent renewed German regulatory ban of kava therefore require major revision, which should include the impact of the use of "two-day kava" on drug safety. Such a revision could contribute to restoring the reputation of "noble kava" on the international markets.

A matched-pair analysis on survival and response rates between German and non-German cancer patients treated at a Comprehensive Cancer Center.

BACKGROUND: Research shows disparities in cancer outcomes by ethnicity or socio-economic status. Therefore, it is the aim of our study to perform a matched-pair analysis which compares the outcome of German and non-German (in the following described as 'foreign') cancer patients being treated at the Center for Integrated Oncology (CIO) Köln Bonn at the University Hospital of Bonn between January 2010 and June 2016. METHODS: During this time, 6314 well-documented patients received a diagnosis of cancer. Out of these patients, 219 patients with foreign nationality could be matched to German patients based on diagnostic and demographic criteria and were included in the study. All of these 438 patients were well characterized concerning survival data (Overall survival, Progression-free survival and Time to progression) and response to treatment. RESULTS: No significant differences regarding the patients' survival and response rates were seen when all German and foreign patients were compared. A subgroup analysis of German and foreign patients with head and neck cancer revealed a significantly longer progression-free survival for the German patients. Differences in response to treatment could not be found in this subgroup analysis. CONCLUSIONS: In summary, no major differences in survival and response rates of German and foreign cancer patients were revealed in this study. Nevertheless, the differences in progression-free survival, which could be found in the subgroup analysis of patients with head and neck cancer, should lead to further research, especially evaluating the role of infectious diseases like human papillomavirus (HPV) and Epstein-Barr virus (EBV) on carcinogenesis and disease progression.

Vitamin D status and its determinants in healthy pregnant women living in Switzerland in the first trimester of pregnancy.

OBJECTIVES: Our study aimed at assessing the prevalence and determinants of vitamin D deficiency (25-hydroxy-vitamin D [25(OH)D] < 20 ng/mL) in pregnant women in the first trimester living in Switzerland. METHODS: From September 2014 through December 2015, 204 pregnant women were conveniently recruited during their first clinical appointment at the Clinic of Obstetrics of the University Hospital Zurich (between week 6 and 12 of pregnancy). Blood samples were collected and a questionnaire focusing on lifestyle and skin colour was completed face-to-face with the responsible physician. Logistic regression analyses were performed with vitamin D status as dependent variable. RESULTS: 63.2% of the participating women were vitamin D deficient, and the median vitamin D concentration in the overall sample was 17.1 ng/mL [Q1, Q3: 9.78, 22.3]. The highest proportions of vitamin D deficiency were detected in women originating from Africa and Middle East (91.4% deficient, median vitamin D concentration of 10.7 ng/mL [Q1, Q3: 6.55, 14.45]) and from South-East Asia/Pacific (88.5% deficient, median vitamin D concentration of 8.4 ng/mL [Q1, Q3: 6.10, 14.88]). Multivariable logistic regression showed that significant risk factors of vitamin D deficiency were country of origin (women born in Switzerland and Germany had a lower risk than women born in other countries), smoking status (lower risk for former smokers) and intake of vitamin D supplements. CONCLUSIONS: Our results confirm a high prevalence of vitamin D deficiency in this Swiss cohort, in particular in women coming from Asian and African countries, and underline the importance of appropriate counseling and vitamin D supplementation in early pregnancy.

[Palliative care for patients with Turkish or Arabic migration background in Lower Saxony : A survey from palliative care professionals' perspective]. / Palliative Versorgung von Menschen mit türkischem oder arabischem Migrationshintergrund in Niedersachsen : Eine Befragung spezialisierter Palliativversorger.

BACKGROUND AND OBJECTIVES: People with a migration background (MB) are an important part of German society. If and how they use specialised palliative care (SPC) has not been studied. We aimed to assess the current SPC for patients with Turkish or Arabic MB (the largest group of immigrants in Germany with a shared ascribed culture) from the point of view of healthcare professionals (HCP) in Lower Saxony. METHOD: All HCPs in institutions providing SPC (n = 90) were invited to participate in an anonymous online survey which contained closed and open questions about care for this patient group, characteristics of the last patient with Turkish or Arabic MB they cared for, and resources and strategies to care for these patients. The survey was analysed using descriptive statistics and qualitative content analysis. RESULTS: Fifty-five HCPs in SPC participated, mostly nurses aged between 40 and 60 years. One fifth had not cared for a patient with Turkish or Arabic MB during the last 12 months. Given their local population, 84.6% estimated that they cared for a lower number of patients than would be representative. In care, problems with communication as well as difficulties to interact with and manage families, and in organising and planning care were most prevalent. Only 21% of participants had access to interpreters. DISCUSSION: Patients with Turkish or Arabic MB seem to be underrepresented in SPC. The high rate of communication problems highlights the necessity of reliable and accessible interpreter services. Most difficulties were of psychosocial nature, showing how important the holistic approach of SPC is in caring for terminally ill patients with Turkish or Arabic MB.

Motives and decisions for and against having children among nonheterosexuals and the impact of experiences of discrimination, internalized stigma, and social acceptance.

Same-sex parents are increasingly a topic of public discourse. A growing number of homosexuals openly speak about their desire to have children or are already living together in different family constellations. The current study examined the decisions for or against having children and the motivations behind those decisions among nonheterosexuals living in Germany. A sample of 1,283 nonheterosexuals participated by means of an online survey. As some nonheterosexual individuals do not identify themselves with a male or female gender identity, a third category, "gender different," was generated. Motives for (not) having children, perceptions of social acceptance, experiences of discrimination in relation to one's sexual orientation, and levels of internalized stigma were taken into account regarding their influence on the decision about parenthood. Most respondents (80%) reported that they did not have children. However, among this group, 43% stated that they had decided to have children later in their lives, 24% were undecided, and 11% had already decided against having children. The most important influences on the decision of whether to have children were respondents' age and their desire for emotional stabilization. Negative experiences as a result of sexual orientation and internalized stigma had no impact on the decisions regarding parenthood.

Use of the palm Euterpe edulis martius in landscape units managed by migrants of German origin in Southern Brazil.

BACKGROUND: People influence their environments through the manipulation of landscapes and species. Human influence on the landscape may lead to the development of differentiated landscape units that originate from past use and may be related to the presence of certain species. This study investigated the presence of the palm Euterpe edulis and its current and past importance in landscape units established by a community of German descendants located in southern Brazil. The objectives of this study were to characterize the use of the species, to identify the importance of E.edulis for the German immigrant community, to identify past and current uses of E.edulis, to describe the historical use of the landscape, and lastly, to identify landscape units in which E.edulis is found. METHODS: The researched community is composed of people of German descent residing in southern Brazil. A variety of research tools were used to achieve the objectives of the research. Semi-structured interviews and free-listings were conducted in all family units. The interviews focused on groups of people in the community who had current or historical connection with the species. Group workshops and guided tours were conducted to identify different landscape units. The data were analyzed using descriptive statistics, use-value index, citation frequency, salience index, and informant perception analysis. RESULTS: Over the historical period studied, the community demonstrated changes with respect to economic activities. These changes are reflected in the transformation of the landscape. The species E.edulis was and still is very important for people in the community; its importance is reflected in its high use value, citation frequency and salience. The species is found within various landscape units in the community as well as in homegardens and in secondary forests. CONCLUSIONS: The landscape heterogeneity of this community is influenced by changes in economic activities and by the relationship with the conservation unit. Landscape units resulting from this relationship may be identified. The species E.edulis is found within these landscape units and is integrated into the livelihood of the community.

A latent class analysis of friendship network types and their predictors in the second half of life.

OBJECTIVES: Friendships contribute uniquely to well-being in (late) adulthood. However, studies on friendship often ignore interindividual differences in friendship patterns. The aim of this study was to investigate such differences including their predictors. METHOD: The study builds on Matthews's qualitative model of friendship styles. Matthews distinguished 3 approaches to friendship differing by number of friends, duration of friendships, and emotional closeness. We used latent class analysis to identify friendship network types in a sample of middle-aged and older adults aged 40-85 years (N = 1,876). Data came from the German Aging Survey (DEAS). RESULTS: Our analysis revealed 4 distinct friendship network types that were in high congruence with Matthews's typology. We identified these as a discerning style, which focuses on few close relationships, an independent style, which refrains from close engagements, and 2 acquisitive styles that both acquire new friends across their whole life course but differ regarding the emotional closeness of their friendships. Socioeconomic status, gender, health, and network-disturbing and network-sustaining variables predicted affiliations with network types. DISCUSSION: We argue that future studies should consider a holistic view of friendships in order to better understand the association between friendships and well-being in the second half of life.

The family as the foundation of political rule in western philosophy: a comparative analysis of Aristotle's politics and Hegel's philosophy of right.

For both Aristotle and Hegel, the family is the foundation in which the universalized rule of law is validated according to the political structure of the 'Polis' or 'State' itself. This composite whole or structure of society (Ancient Polis/Modern State) is the political end of humanity for both philosophers, which in turn finds its primordial beginning in the family. For Aristotle, it is in the kingly rule of the household that the property-based distinction of citizenship is set for the rule of his ideal Polis. For Hegel, it is in the love affirmed through caring affection within the nuclear family that the dialectical framework for the freedom of civil society, and the rational unity of a congregational 'spirit' in the State, finds its foundation. For both thinkers, the family sets the base for a political theory that defines citizenship in a manner that transcends the particularities of kin bonds.

Seeing your way to health: the visual pedagogy of Bess Mensendieck's physical culture system.

This essay examines the images and looking practices central to Bess M. Mensendieck's (c.1866-1959) 'functional exercise' system, as documented in physical culture treatises published in Germany and the United States between 1906 and 1937. Believing that muscular realignment could not occur without seeing how the body worked, Mensendieck taught adult non-athletes to see skeletal alignment and muscular movement in their own and others' bodies. Three levels of looking practices are examined: didactic sequences; penetrating inspection and appreciation of physiological structures; and ideokinetic visual metaphors for guiding movement. With these techniques, Mensendieck's work bridged the body cultures of German Nacktkultur (nudism), American labour efficiency and the emerging physical education profession. This case study demonstrates how sport historians could expand their analyses to include practices of looking as well as questions of visual representation.

Integration versus apartheid in post-Roman Britain: a response to Thomas et Al. (2008).

The genetic surveys of the population of Britain conducted by Weale et al. and Capelli et al. produced estimates of the Germani immigration into Britain during the early Anglo-Saxon period, c.430-c.730. These estimates are considerably higher than the estimates of archaeologists. A possible explanation suggests that an apartheid-like social system existed in the early Anglo-Saxon kingdoms resulting in the Germani breeding more quickly than the Britons. Thomas et al. attempted to model this suggestion and showed that it was a possible explanation if all Anglo-Saxon kingdoms had such a system for up to 400 years. I noted that their explanation ignored the probability that Germani have been arriving in Britain for at least the past three millennia, including Belgae and Roman soldiers, and not only during the early Anglo-Saxon period. I produced a population model for Britain taking into account this long term, low level migration that showed that the estimates could be reconciled without the need for introducing an apartheid-like system. In turn, Thomas et al. responded, criticizing my model and arguments, which they considered persuasively written but wanting in terms of methodology, data sources, underlying assumptions, and application. Here, I respond in detail to those criticisms and argue that it is still unnecessary to introduce an apartheid-like system in order to reconcile the different estimates of Germani arrivals. A point of confusion is that geneticists are interested in ancestry, while archaeologists are interested in ethnicity: it is the bones, not the burial rites, which are important in the present context.

Albertus, "Magnus" or Magus? Magic, natural philosophy, and religious reform in the late middle ages.

This article analyzes the fifteenth-century attempt by the Dominican order, especially in Cologne, to win canonization for the thirteenth-century natural philosopher Albert the Great. It shows how Albert's thought on natural philosophy and magic was understood and variously applied, how the Dominicans at Cologne composed his vitae, and how the order's Observant movement participated in these developments. It situates the canonization attempt at the intersection of two significant trends in which the order was a leading participant: first, the late medieval efforts to reform Christian society beginning with the religious life of monks and mendicants; second, the increasing concerns about the practice of learned and demonic mafic that laid groundwork for the witch-hunting of the early modern period. This article aims to shed light on intersections of science and religion -- their apprehension and negotiation -- at a decisive moment in European history for both fields of human endeavor.

Menopause in German and Chinese women--an analysis of symptoms, TCM-diagnosis and hormone status.

OBJECTIVE: To investigate menopause-related symptoms, traditional Chinese Medicine (TCM)-diagnosis and hormone status of two comparable urban samples of menopausal women, one in Essen (Germany) and the other in Shanghai (China). METHODS: Patients suffering from menopause-syndrome were recruited from the TCM-outpatient clinic of the University of Duisburg-Essen in Germany (35 subjects) and from the Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine in China (35 subjects). The Kupperman-Index for tracing menopausal symptoms was applied. The complete TCM-diagnosis was carried out by the same investigator in China as well as in Germany. Testosterone and estrogen blood samples were collected once from every woman. RESULTS: There were significant differences in specific symptoms of the Kupperman-Index, such as a higher prevalence of formication and depression in German menopausal women; whereas Chinese menopausal women suffered significantly more from vertigo, headache and paraesthesia symptoms. Concerning TCM-diagnosis, Shen ()-yang deficiency was diagnosed in 51.43% of the German women in contrast to 5.71% of the Chinese women; 17.14% of the German women were diagnosed as having Shen-yin deficiency compared to 74.29% of the Chinese women. The German women showed significantly lower mean hormone levels for testosterone compared to the Chinese women (P

Relevance of religion and spirituality in German patients with chronic diseases.

OBJECTIVE: Many American patients depend on religion to cope, but less is known about the spiritual/religious (SpR) characteristics of medical patients in Europe, a more secular environment. We examined self-categorizations of SpR (spiritual, religious, both, neither), patients' search for meaningful support, trust in higher source, positive interpretation of disease, and support in relations of life through SpR, as measured with the SpREUK questionnaire, in German medical patients. METHOD: We analyzed data on 710 West-German patients with a mean age of 54. Forty-two percent had chronic pain diseases, 25% cancer, 10% multiple sclerosis, 21% other chronic diseases, and 3% acute diseases. RESULTS: The general interest in search for meaningful support was moderate. Trust in a higher source and support in life through SpR were rated higher, while almost all patients had a positive interpretation of their diseases, i.e, hint to change life. The interest in SpR issues was highest in cancer patients and lowest in patients with multiple sclerosis. Univariate analyses confirmed that the SpR self-categorization was the strongest predictor of all four factors, while trust in a higher source was also affected by religious affiliation and age. Positive interpretations of disease correlated well with search for meaningful support. CONCLUSIONS: Patients with chronic diseases differ with respect to their SpR self-categorizations and may thus utilize different aspects of SpR. Cancer patients, in particular, often depend on their trust in a higher power and in conventional religious activities to help them to cope with their illness.

Measurements of daily urinary uranium excretion in German peacekeeping personnel and residents of the Kosovo region to assess potential intakes of depleted uranium (DU).

Following the end of the Kosovo conflict, in June 1999, a study was instigated to evaluate whether there was a cause for concern of health risk from depleted uranium (DU) to German peacekeeping personnel serving in the Balkans. In addition, the investigations were extended to residents of Kosovo and southern Serbia, who lived in areas where DU ammunitions were deployed. In order to assess a possible DU intake, both the urinary uranium excretion of volunteer residents and water samples were collected and analysed using inductively coupled plasma-mass spectrometry (ICP-MS). More than 1300 urine samples from peacekeeping personnel and unexposed controls of different genders and age were analysed to determine uranium excretion parameters. The urine measurements for 113 unexposed subjects revealed a daily uranium excretion rate with a geometric mean of 13.9 ng/d (geometric standard deviation (GSD)=2.17). The analysis of 1228 urine samples from the peacekeeping personnel resulted in a geometric mean of 12.8 ng/d (GSD=2.60). It follows that both unexposed controls and peacekeeping personnel excreted similar amounts of uranium. Inter-subject variation in uranium excretion was high and no significant age-specific differences were found. The second part of the study monitored 24 h urine samples provided by selected residents of Kosovo and adjacent regions of Serbia compared to controls from Munich, Germany. Total uranium and isotope ratios were measured in order to determine DU content. (235)U/(238)U ratios were within +/-0.3% of the natural value, and (236)U/(238)U was less than 2 x 10(-7), indicating no significant DU in any of the urine samples provided, despite total uranium excretion being relatively high in some cases. Measurements of ground and tap water samples from regions where DU munitions were deployed did not show any contamination with DU, except in one sample. It is concluded that both peacekeeping personnel and residents serving or living in the Balkans, respectively, were not exposed to significant amounts of DU.