P-539 Background: During 2001, persons who attributed their health problems to environmental exposures, e.g. electromagnetic fields (EMF), were counselled in an interdisciplinary environmental medicine pilot project in the Basel area. Methods: All participants had a medical and a psychological-psychiatric examination and were visited at home by an environmental hygienist. High and low frequency EMF measurements were conducted at the homes of those participants who attributed health complaints to EMF. EMF were always measured on the bed and additionally in other rooms depending on duration of stay in the respective rooms and the concerns of the participants. The plausibility of a context of the health complaints and the EMF were discussed in joint project team case conferences. Plausibility was judged on the basis of the following criteria: EMF had to exceed a tenth of the Swiss threshold values to be considered in the case conference (low frequency: 10 V/m, 0.1μT, high frequency: 0.6 V/m). The exposure had to occur in an area where the participant spent at least several hours or more every day. Prerequisite was that the exposure occurred before the onset of symptoms. Results: 25 of 63 (40%) of participants suspected EMF as cause of their health complaints. All EMF measurements yielded fields below the Swiss threshold values. It is not possible to prove a causal relation of health complaints due to environmental exposures based on single case evaluations and currently, there is uncertainty about whether EMF can cause any health symptoms or not. In the present project, according to the thorough examinations and case discussions, in 8 of the 25 (32%) participants, at least one of the reported symptoms was regarded to be possibly connected to the EMF exposure. All symptoms concerned a reduction in well-being. In addition, psychiatric diagnoses did not exclude environmentally caused symptoms. 45% of the participants reported half a year after counselling that they had benefited from the project and their health problems had improved. Conclusions: Experience of this pilot project was that participants had highly complex problems. Thus, only an interdisciplinary team is likely to be able to adequately diagnose environmental related health problems and provide suitable advice to concerned persons. The evaluation interview showed that a large proportion of the participants benefited of the project. Although time-intensive, such an approach might be an effective way to counsel individuals with symptoms attributed to EMF.

In dermatopharmacotherapy the choice of the appropriate vehicle is essential. Acuity of the efflorescence, localization, and extent of the affection, skin type, cosmetic preferences of the patient as well as removability with water, cooling and occlusive effects of the vehicle are important criteria for the choice of the appropriate vehicle. Adapted therapeutic and utilization modalities support a successful dermatopharmacotherapy and compliance.

P-715 Background: During 2001, persons who attributed their health problems to environmental exposures were counselled in an interdisciplinary environmental medicine pilot project in the Basel area. For this counselling, congruence of patients’ and experts’ health-belief models is an important factor. Method: We assessed the medical, psychiatric and environmental background in every participant in an environmental medicine project and discussed the explanatory value of our findings for each reported symptom. High and low psychological stress was extracted from questionnaires (self assessment of psychological stress) and the experts’ joint case conference (expert assessment of psychological stress). Results: Overall, 46% of reported symptoms could be explained by psychiatric factors alone. However, every second participant had at least one symptom that could be plausibly explained by simultaneously occurring medical, psychological or environmental findings. Psychiatric disorders were frequent, but did not exclude environmentally caused symptoms. Evaluation of self and expert judgement of psychological stress yielded four subgroups: two concordant and two discordant assessments of high or low stress load. Differentiation of these subgroups yielded characteristic differences with respect to the number of psychiatric diagnoses, psychological conflicts, environmental exposures and burden of chronic (somatic) illness. Conclusion: Experience of this pilot project was that participants had highly complex problems. Evaluation of experts’ and self rated psychological stress yielded information with respect to factors that contribute to a characterisation of this patient group. Only an interdisciplinary structure including medical, psychiatric and environmental expertise is likely to adequately diagnose and advise persons with environmentally related symptoms. Importance of interdisciplinary assessments have been recognised internationally, e.g. by WHO's recommendation of counselling persons with symptoms attributed to electromagnetic fields (“electromagnetic hypersensitive persons”/ fact sheet no. 296 from December 2005). However, although the results of the pilot study raised great interest, the establishment of a permanent interdisciplinary counselling structure was not yet successful.

Environmental illnesses raise diagnostic and therapeutic conflicts in scientific discussions and clinical practice. When a patient's health-belief model, based on environmental origins, does not match that of the expert, the therapeutic relationship can be endangered. Our study investigates this discrepancy, which has not been empirically evaluated so far. Patient (n=61) and expert disease concepts were systematically investigated. Our results indicate that in cases in which both concepts are favourable, the patient suffered minor psychiatric disorders with stable psychic structures and the symptoms were associated with medical or environmental causes. If both concepts were unfavourable, a higher proportion of psychiatric disorders with unstable psychic structures were present. In the case of incongruent concepts, the expert evaluations allow a more accurate assessment of the psychiatric diagnoses, psychic states and the psychic attribution of somatic and psychic burden.

Environmental illnesses raise diagnostic and therapeutic conflicts in scientific discussions and clinical practice. When a patient's health-belief model, based on environmental origins, does not match that of the expert, the therapeutic relationship can be endangered. Our study investigates this discrepancy, which has not been empirically evaluated so far. Patient (n=61) and expert disease concepts were systematically investigated. Our results indicate that in cases in which both concepts are favourable, the patient suffered minor psychiatric disorders with stable psychic structures and the symptoms were associated with medical or environmental causes. If both concepts were unfavourable, a higher proportion of psychiatric disorders with unstable psychic structures were present. In the case of incongruent concepts, the expert evaluations allow a more accurate assessment of the psychiatric diagnoses, psychic states and the psychic attribution of somatic and psychic burden.

BACKGROUND AND AIM In Switzerland, the prevalence of health problems attributed to environmental exposures is unknown, and views differ regarding its magnitude. In the present study we investigated the frequency of environmentally related health problems amongst the patients of Swiss sentinel physicians and assessed symptoms and suspected environmental exposures. METHODS During 2002, nearly 250 "Swiss Sentinel Surveillance Network" physicians were asked to record the number of patients presenting with environmental health problems and to complete a questionnaire inquiring about suspected environmental exposures and health problems. Physicians offering "alternative" medical therapies also participated in the study. The results were compared with the experience of a Basel University pilot project which evaluated patients with environment-related health problems simultaneously from the medical, psychiatric and environmental viewpoint. RESULTS 354 environment-related consultations were reported by 72 physicians, corresponding to 0.03% of all sentinel-physician consultations. There were considerable differences both within the group of Sentinella physicians, and between physicians offering "alternative" medical therapies and the Sentinella physicians, in the frequency of environmentally-related consultations, the character of the reported symptoms and the suspected environmental exposures. CONCLUSION Overall, environmental medicine consultations in general practice were rare. However, experience of the environmental medicine pilot project showed that concerned persons seek help from various health care providers and from environmental agencies. Effective treatment should include counselling by medical, psychiatric and environmental professionals.

Introduction The environmental medicine project Basel, Switzerland, counselled persons who related their health problems to environmental exposures. Complainants reported of symptom duration of several years (med. 3 yrs.) and having consulted physicians (69%) and/or alternative health care services (60%) beforehand. Participants in the project presented complex problems, investigations were very time consuming. To evaluate the benefit of the study, participants' individual project perception was assessed about half a year later. Methods All participants took part in medical and psychological-psychiatric examinations and were visited at home by the corresponding environmental agency. Results were discussed in a case conference and subsequently, counselling was offered. Finally, the project was evaluated, using telephone interviews. Participants were asked about changes in their health status, fulfilment of expectations in the project, whether they would recommend participation in such a study to others and about realisation of given advice and its effect. Each of these variables was tested with regard to age, sex, education and whether the team rated the suspected environmental exposure to be a plausible cause of the health complaints. SAMPLE: 63 persons completed the study, 54 (86%) could be interviewed for the evaluation. Mean age in the group was 54 years, 60% were female. In 40% of the cases the relationship between environmental exposure and at least one health problem was rated to be plausible by the project team. Results Descriptive results of variables of satisfaction and compliance are given in the table below. Improvement of health status was negatively correlated to age and positively to environmental aetiology of health problems (LRT, both p = 0.01) as was the case with fulfilled expectations in the project (LRT, both p = 0.03). Successful implementation of given advice decreased with age (LRT p = 0.04) and was positively correlated with an environmental aetiology of the health problem (borderline, LRT p = 0.06). Recommendation of the project to others was correlated to none of the factors.Conclusions Environmental aetiology of health problem rated ‘plausible’ and age were predictors that determined satisfaction of the participants of our environmental medicine project. Other reasons to approve or disapprove of the project are more likely to be found on an individual level. Worsening of the health status might be an effect of older age. Approximately one third of the participants were able to benefit of the interdisciplinary project approach to improve long lasting health problems where support had been seeked in various health care settings beforehand.

AnlaÈsslich des Symposiums zum 60. Geburtstag von Prof. Malte BuÈ hring in Berlin am 16. 01. 1999 gab Dr. Dr. B. Uehleke einen Ûberblick uÈ ber die Situation der Lehre und stellte eine Idealvorstellung vor. Unter der neuen Regierung wird es einen gaÈnzlich anderen Ansatz zu einer Approbationsnovelle geben; solange gilt die alte Approbationsordnung, in der das Gebiet «Grundlagen und MoÈ glichkeiten der Naturheilkunde und HomoÈ opathie» enthalten ist und mit 10 PruÈ fungsfragen in der 2. Ørztlichen PruÈ fung gepruÈ ft wird. BezuÈ glich Umfang und Inhalt der Lehrangebote an den einzelnen FakultaÈ ten ist nach wie vor eine grosse Streubreite festzustellen. FuÈ r die Zukunft wird ein zweiteiliges Lehrkonzept vorgeschlagen, welches im September in Ûberlingen innerhalb der AG diskutiert worden war: Ein Teil I der Naturheilkunde koÈ nnte bereits in den ersten Semestern angeboten werden, z. B. Hausmittel bei banalen Erkrankungen, da hierzu keine klinischen Vorkenntnisse erforderlich sind. Teil II waÈre eine Vertiefung und Ausweitung, die auf entsprechende Voraussetzungen bei den StudentInnen hinsichtlich Klinik, Pharmakologie, Biometrie aufbauen wuÈ rde. Uehleke stellte in Berlin dar, dass die Naturheilkunde eine ideale BruÈ cke zwischen naturwissenschaftlichen, vorklinischen FaÈchern und der Klinik bilden koÈ nnte, und leitete daraus die Forderung an die Politik ab, einen zukuÈ nftigen themenvernetzten Unterricht (z. B. Anatomie des Bewegungsapparates gleichzeitig mit Kurs uÈ ber Massage) durch zu institutionalisierende Vertreter der Naturheilkunde zu organisieren. Bericht aus der Arbeitsgemeinschaft «FED» (Fasten, ErnaÈhrung, DiaÈ tetik)

The goal of the present study was to investigate whether suggestions for cold or warmth during hypnosis affect fingertip skin temperature. Hypnosis without specific suggestions for cold or warmth (`neutral hypnosis') caused a drop in respiration frequency, however, pulse rate, fingertip skin temperature, and electrodermal activity were not affected. The cold and warmth suggestions decreased and increased fingertip skin temperature, respectively. Compared with the neutral trance phase, the other three autonomic variables measured were also affected by suggestions for cold. However, there was no association between the changes in autonomic variables induced by suggestions and hypnotizability scores measured by the `Stanford Hypnotic Clinical Scale for Adults'. Fingertip skin temperature was mostly affected when the images used for the cold and warmth suggestions during hypnosis included experiences of physical temperature and psychological stress or relaxation, indicating that the psychological content of the imagery amplified the autonomic response.

The aim of this study in hypnosis was the exemplary verification of a regulatory intervention in patients with pollinosis. Hypnosis and self-hypnosis are established methods in medicine. 52 patients with pollinosis participated in this clinical study. It lasted over two pollen seasons. Self-hypnosis was learned quite easily. It resulted in a clear yet statistically weak beneficial effect on the subjective assessment of the pollinosis symptoms, on the consumption of drugs and on other objective findings. From a methodological point of view this study might suggest that the classical comparison of experimental groups in clinical research could hide some larger therapeutic effects in individual patients. Therefore, it would be desirable to consider also individual data analysis in all future studies dealing with psychological or psychosomatic mechanisms and in all studies which capture parameters interactive at different levels. The beneficial effect of hypnosis on the swelling of the nasal mucous membrane in a provocation test initiated a subsequent small project on the possible mode of action of hypnosis in this pollinosis study. However, the results were inconclusive.

Wie bereits angekuÈ ndigt, wird seit Mitte des Jahres 1998 auch die stiftungseigene Buchreihe «edition forschung» von der Stiftung selbst, im KVC Verlag, Essen, herausgegeben. Der erste im neuen Verlag erschienene Titel ist die Doktorarbeit von Nicola Clausius. Diese Doktorarbeit hat insofern einen besonderen Stellenwert, als die hier vorgestellten Daten die Grundlage fuÈ r die im «Lancet» (1997;350:834±843) veroÈ ffentlichte Arbeit von Klaus Linde et al.: «Are the clinical effects of homoeopathy placebo effects? A meta-analysis of placebo-controlled trials» sind. Damit das wissenschaftliche Arbeiten mit dem umfangreichen Datenmaterial moÈ glich wird, liegt der tabellarische Anhang der VeroÈ ffentlichung auf Diskette bei.

Although fulminating non-cardiogenic pulmonary edema following cardiopulmonary bypass is not a new phenomenon, the exact cause and pathogenesis are still unknown. The causative agent of this potentially lethal syndrome was hypothesized to be either protamine or blood products. There was no evidence that an antibody-mediated reaction plays a role and patients were reported to have negative skin tests. We report, for the first time, a patient who presented with fulminating non-cardiogenic pulmonary edema after repeated protamine administration with a subsequent positive skin test to protamine. Specific IgG antibodies to protamine were also found; however, the level was in the range of that of exposed non-reacting controls. IgE antibodies could not be detected.

A cooperative photopatch test study was conducted by 45 dermatologic centers in Austria, Germany, and Switzerland. Results obtained from 1985 to 1990 are presented. A standard photopatch test tray of 32 substances was applied to the back of patients with suspected photosensitivity. After applications for 24 hours, test sites were irradiated with 10 joules/cm2 UVA. Unirradiated controls were included. Readings were performed immediately and 24, 48, and 72 hours after irradiation; responses were qualitatively graded on a 4-point scale. All data were stored and processed by a computer. With computer-assisted analysis of reaction patterns photoallergic reactions were identified and distinguished from phototoxic reactions. Data of 1129 patients were evaluated. Among a total of 2859 positive test reactions in 870 patients, 2041 in 778 patients were found to be photoinduced and 818 in 413 patients were contact reactions; 108 reactions in 83 patients were classified as photoallergic. Nonsteroidal anti-inflammatory drugs, disinfectants, sunscreens, phenothiazines, and fragrances caused most often photoallergic reactions. Many unspecific phototoxic reactions were induced by tiaprofenic acid, promethazine, carprofen, chlorpromazine, fenticlor, wood tar, balsam of Peru, and perfumes. Despite the distinction between photoallergic and phototoxic responses, many test reactions lacked relevance for the patients' dermatoses.