Nelson Filice de Barros

Uso de medicinas alternativas e complementares por pacientes com câncer: revisão sistemática

Interest in complementary and alternative medicine has increased, especially among oncology patients. A systematic literature review of the profile of patients who choose to use this type of medicine, as well as their motivations, was carried out on the PubMed database. For this search, the key words used were ?cancer and complementary alternative medicine? and ?oncology and complementary alternative medicine?, covering the period between 1995 and 2005. The selection criteria were the following: key words were present in the article title; article was written in either English, Portuguese, or Spanish; and study was performed with an adult population. From the 43 articles analyzed, it could be concluded that the use of complementary and alternative medicine is part of these patients? social scope. Moreover, its use plays an important role in the identity construction of cancer patients, helping them to make decisions related to conventional treatment.

Medicinas Alternativas e Complementares: uma metassíntese

The growing use of Complementary and Alternative Medicines (CAM) has led to an increase in the number of qualitative studies on the subject, thus justifying a meta-synthesis of the resulting material. The current article presents a systematic review of qualitative studies on CAM published in international journals. The review was conducted according to the meta-synthesis methodology. A search was performed in journals through the Periodicals Periodical of CAPES, the National Agency for the Evaluation of Graduate Studies, and 32 articles were selected for analysis. The reviewed studies raise questions focusing on: patients, their therapeutic experiences, and their social and cultural contexts; professionals, professional relations, and the process of professionalization of CAM; and CAM and their relationship to biomedicine. The article concludes that qualitative studies on CAM call for an exploratory view of the theme, seeking to identify the experiences of patients and professionals with these therapies and discussing the impact of their use on conventional medicine or biomedicine.

Stop saying ''epileptic''

The purpose of this study was to evaluate the impact upon attitude and perceived stigma of using different terms for referring to persons with epilepsy among teenagers. High school students received one of two versions of a brief questionnaire and of the Stigma Scale of Epilepsy (SSE). The versions differed only in the term used: “people with epilepsy” (PWE) in the group‐1 (N = 109) and “epileptics” in group‐2 (N = 105). Group‐1 responded that 62% of PWE and group‐2, that 93% of epileptics have more difficulty finding employment. Group‐1 responded that 37% of PWE and group‐2, that 70% of epileptics have more difficulties at school. Group‐1 responded that 41% of PWE and group‐2, that 87% of epileptics are rejected by the society. None of individuals in group‐1 indicated that they were prejudiced toward PWE, whereas 3% of group‐2 indicated that they were prejudiced toward epileptics. The SSE score (range from 0 to 100, higher the score, higher the degree of perceived stigma) was 49 [confidence interval (CI) = 46.9–52.0] for group‐2 and 45 (CI = 42.4–48.2) for group‐1 (p = 0.03). In conclusion, the words we use can influence our perceptions and have consequences in terms of social stigma associated with epilepsy. We should refrain from using the term “epileptic” to refer to a person with epilepsy, and consider the importance of our choice of words as part of the effort to bring epilepsy out of the shadows.

A pós-graduação em Saúde Coletiva no Brasil: trajetória

In this paper we review the issue of post-graduate in Public Health in Brazil. The review aims to situate the main specific aspects of building the field of postgraduate studies and its institutionalization, preceded by a study of the main features of post-graduate courses. The main sources are documents setting out the legislation on the graduate and data on their development in the country. All studies reviewed show an increase in the number of programs and courses that began in the 1970s, diversification of the names and areas of concentration and continuity of regional imbalance, since 66% of the programs are in the Southeast region.

A Medicina Integrativa e a construção de um novo modelo na saúde

Medicina Integrativa (MI) e o conceito mais recente no debate das Medicinas Alternativas e Complementares (MAC), em busca do modelo que viabilize introducao e gerenciamento de novas praticas nos sistemas nacionais de saude. Este artigo analisou diferentes definicoes de MI e sua relacao com as MAC, por meio de revisao sistematica da literatura no Medline, no periodo de 1996 a 2005. Foram utilizadas as palavras Integrative Medicine e selecionados 36 trabalhos que apresentaram definicao de MI. Identificou-se que as MAC sao parte da MI, e as definicoes abrangem: integracao da medicina convencional com as MAC; utilizacao de evidencias; combinacao de antigos sistemas de cura com a biomedicina; valorizacao do relacionamento medico-paciente e da comunicacao; consideracao da pessoa por inteiro; e enfoque na saude, na cura e na prevencao de doencas. Conclui-se que o crescente interesse de usuarios, profissionais e gestores aponta a necessidade do desenvolvimento do modelo de MI, dando suporte a implementacao e ao gerenciamento de novas praticas de cuidado e cura.

Política de práticas integrativas em Recife: análise da participação dos atores

OBJECTIVE To examine the involvement of stakeholders in the implementation of a local policy of integrative practices. METHODOLOGICAL PROCEDURES Qualitative study conducted in the city of Recife, Northeastern Brazil. Data was collected from local health board records between 2004 and 2009, interviews with managers and key informants and focus groups with providers and users. The analysis was performed using the condensation of meaning model. The results were grouped into four categories of stakeholders according to their influence and interest, namely: subjects; population; leaders; and players. ANALYSIS OF RESULTS Five years after the policy was implemented in Recife, only a single service offered integrative practices. The population, or users, did not have any effective involvement and did not make any contributions to the policy, and health providers, despite their willingness to participate in the process, were not involved. The leaders included the local health board, managers and medical organizations; the latter two were also players as they were effectively involved in the formulation of the policy. CONCLUSIONS The involvement of few stakeholders in the formulation of an integrative practice policy makes it difficult its implementation and widens the gap between formulation and implementation, hindering the achievement of expected results.OBJETIVO: Analisar a participacao dos atores envolvidos na evolucao de politica municipal de praticas integrativas. PROCEDIMENTOS METODOLOGICOS: Estudo com abordagem qualitativa em Recife, PE. A coleta dos dados foi realizada por meio de consultas as atas do conselho municipal de saude, entre 2004 e 2009, entrevistas com informantes-chave e gestores, e grupos focais com profissionais e usuarios. Os dados foram analisados segundo o modelo de condensacao de significados. Para apresentacao dos resultados, quatro categorias de atores foram formadas, segundo seu poder e interesse, a saber: sujeitos, populacao, lideres e jogadores. RESULTADOS: Apos cinco anos da implantacao da politica em Recife, so um servico oferecia praticas integrativas. A populacao ou os usuarios nao tiveram participacao efetiva e nao contribuiram com a politica; os profissionais de saude, apesar do interesse em participar do processo, nao foram incluidos. Os lideres encontrados foram o Conselho Municipal de Saude, os gestores e as entidades medicas, sendo os dois ultimos tambem considerados jogadores, pois participaram efetivamente da elaboracao da politica. CONCLUSOES: A participacao de poucos atores na construcao de uma politica de praticas integrativas dificulta sua consolidacao e amplia a distância entre formulacao e implementacao, prejudicando o alcance dos resultados esperados.

Medicinas alternativas e complementares no ensino médico: revisão sistemática

The continuous increase in the use of complementary and alternative medicines (CAM) requires health professionals to be prepared to inform and treat their patients, recognize side effects and drug interactions, and safely practice complementary medicines, whether singly or in combination with conventional medicine. The current study includes a systematic literature review on the teaching of CAM in medical schools, with the aim of reflecting on the published evidence. A total of 33 articles were analyzed, indexed in the Pubmed database, identified by the descriptors “complementary and alternative medicine teaching” in English and Portuguese. The articles discussed different ways of including complementary and alternative medicines in teaching, positive attitudes towards them by medical students, and the desire to learn them in order to treat and orient future patients. In conclusion, the rationale for teaching CAM in medical schools is to add diagnostic and therapeutic tools to medical practice for patient care, disease prevention, and health promotion at various levels of complexity in the health system.

O ensino das ciências sociais nas escolas médicas: revisão de experiências

O presente artigo descreve e analisa a literatura sobre o ensino das ciencias sociais nas escolas medicas em diferentes paises, durante o periodo de 1960 a 2000. A metodologia baseia-se na analise documental/bibliografica de estudos ja sistematizados sobre o tema e de levantamento realizado nos bancos de dados Lilacs, Medline e Sociological Abstracts. Com referencia as experiencias de 1980 a 2000, os dados levantados de 21 artigos assinalam: objetivos - acompanhar e atender as mudancas sociais, as ocorridas na prestacao de servicos de saude, as necessidades da populacao; tecnicas de ensino - enfase no processo de ensino-aprendizagem ativo, atividades em pequenos grupos, problemas como ponto de partida, trabalhos de campo, pesquisas, uso de material audiovisual, dramatizacao e outros; conteudos - grande diversidade tematica comprovando os resultados das decadas anteriores e variando de acordo com as diferentes escolas medicas: comportamento pessoal, interpessoal, medico, comunidade e ambiente, organizacao do cuidado a saude; relacoes saude-sociedade; relacao medico-paciente; aspectos historico-sociais da pratica medica; variaveis sociais no diagnostico, prognostico e tratamento; relacoes doenca-familia. As conclusoes apresentam alguns aspectos gerais e os principais resultados encontrados na pesquisa.

O campo da Saúde Coletiva na perspectiva das disciplinas

This article discusses the field of Collective Health from the disciplines that structure the curriculum of the Collective Health area postgraduate courses in 2006. From the database of programs, including masters, doctoral and professional masters were classified 1,171 subjects, in what we call disciplinary fields, linking this to the P. Bourdieus notion of champ (field). Twenty-eight disciplinary fields were described, in three large groups. It was concluded that the field of collective health has a wide range of disciplinary fields, especially the frequency: Epidemiology (16%), Humanities and Social Sciences in Health (7.9%); Curriculum (7.9%); Systems and Health Services (7.4%), Environment and Health (7.2%) Health Policies (6.3%).

Evidências qualitativas sobre o acompanhamento por doulas no trabalho de parto e no parto

The objective of this study was to conduct a metasynthesis of evidence of the work of doulas assisting women in labor and during childbirth. Articles between 2000 and 2009 were located in the Medline, PubMed, SciELO, and Lilacs databases using the key search words: doulas, gestation, labor, and alternative therapy. Seven articles were selected for the study and four categories were created: the support provided by doulas; the birth mothers experiences; professional relationship: and opinions and experiences of professionals. The doulas offered physical, emotional, spiritual and social support. Experiments showed that the professionals stimulated the mother/child relationship, oriented towards successful breastfeeding, and contributed to the prevention of post-partum depression. Controversy was observed among professionals regarding acceptance of the role of the doula as a member of the obstetrics team. The doulas care was considered innovative, calming, encouraging, and attended all the needs of the pregnant woman. The conclusion is that qualitative studies on the work of doulas are recent, incipient, but revealing as to the important possibility of humanizing labor and childbirth.