A randomized, controlled, crossover study in patients with mild and moderate asthma undergoing treatment with traditional Chinese acupuncture

OBJECTIVES:This study sought to verify the effects of acupuncture as an adjuvant treatment for the control of asthma.METHODS:This was a randomized, controlled, crossover trial conducted at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. A total of 74 patients with mild/moderate, persistent asthma were randomized into two therapeutic groups: Group A - 31 patients underwent 10 real weekly acupuncture sessions, followed by a 3-week washout period and 10 sham weekly acupuncture sessions; and Group B - 43 patients underwent 10 sham weekly acupuncture sessions, followed by a 3-week washout period and 10 real weekly acupuncture sessions. Patients used short- and long-acting β-2 agonists and inhaled corticosteroids when necessary. Prior to treatment and after each period of 10 treatment sessions, the patients were evaluated for spirometry, induced sputum cell count, exhaled nitric oxide (NO) and with the Short Form 36 (SF-36) and Questionnaire on Quality of Life-Asthma (QQLA) questionnaires. Daily peak flow and symptom diaries were registered. The level of significance adopted was 5% (α=0.05).RESULTS:In Group B, after real acupuncture, there was a decrease in eosinophils (p=0.035) and neutrophils (p=0.047), an increase in macrophages (p=0.001) and an improvement in peak flow (p=0.01). After sham acupuncture treatment, patients experienced less coughing (p=0.037), wheezing (p=0.013) and dyspnea (p=0.014); similarly, after real acupuncture, patients reported less coughing (p=0.040), wheezing (p=0.012), dyspnea (p<0.001) and nocturnal awakening episodes (p=0.009). In Group A, there was less use of rescue medication (p=0.043). After the sham procedure, patients in Group A experienced less coughing (p=0.007), wheezing (p=0.037), dyspnea (p<0.001) and use of rescue medication (p<0.001) and after real acupuncture, these patients showed improvements in functional capacity (p=0.004), physical aspects (p=0.002), general health status (p<0.001) and vitality (p=0.019). Sham acupuncture also led to significant differences in symptoms, but these were not different from those seen with real acupuncture. Spirometry and exhaled NO levels did not show a difference between sham and real acupuncture treatment. In addition, no significant difference was demonstrated between treatments regarding the quality of life evaluation.CONCLUSION:Real and sham acupuncture have different effects and outcomes on asthma control. The crossover approach was not effective in this study because both interventions led to improvement of asthma symptoms, quality of life and inflammatory cell counts. Thus, sham acupuncture cannot serve as a placebo in trials with acupuncture as the main intervention for asthma.

Educação médica em terapêuticas não convencionais / Medical education in non-conventional therapies

A demanda da população pela medicina alternativa e complementar (CAM) vem aumentando substancialmente nas últimas décadas, exigindo dos médicos noções básicas dessas diversas terapias, a fim de que possam orientar os pacientes em tratamentos diferentes dos que estão habituados a prescrever. Assim sendo, compete às escolas de medicina propiciar aos estudantes o conhecimento das evidências científicas, dos pressupostos teóricos e das abordagens práticas empregadas por estas distintas formas de tratamento. A presente revisão tem o propósito de fomentar a discussão sobre o ensino de terapêuticas não convencionais nas escolas de medicina, enfocando o interesse da população e da classe médica, a importância das iniciativas na graduação e na pós-graduação (residência), e as perspectivas da educação médica em terapêuticas não convencionais.

The demand of the population by complementary and alternative medicine (CAM) has been substantially increasing in the last decades, requiring that doctors have basic notions of these various therapies, in order to guide patients in different treatments of those who are accustomed to prescribe. In this way, the medical schools have the responsibility to provide to students the knowledge of scientific evidences, theoretical assumptions and practical approaches used in these different forms of treatment. The present review has the purpose of fomenting the discussion regarding the teaching of non-conventional therapeutics in medical schools. It is focused on the interest of the population and the medical class, the importance of the initiatives in undergraduate and graduate (residency), and the perspectives of medical education in non-conventional therapeutics.

Da Medicina tradicional chinesa à prática de acupuntura médica baseada em evidência / From traditional chinese medicine to the practice of acupunture based in evidence

Acupuntura é uma prática milenar que faz parte da chamada medicina tradicional chinesa. Tem sido praticada por milhares de anos na China e alguns países do continente asiático. Como tem sido descrita como efetiva no tratamento de diversas doenças e condições, a acupuntura tem sido considerada um instrumento útil na prática da saúde. Da prática primitiva até os dias de hoje, a acupuntura tem ganhado novos adeptos, atraindo assim a atenção da comunidade científica, a fim de entender melhor o seu mecanismo de ação e sua efetividade. Vários estudos têm sido feitos e publicado envolvendo acupuntura, mas há ainda controvérsia acerca de sua eficácia e efetividade. Novos estudos devem ser feitos para estabelecer o real papel da acupuntura no tratamento de diversas doenças e condições.

Acupuncture is a healing technique practiced for thousand years in China and some Asian countries, and was considered as part of Traditional Chinese medicine. As it claimed to be effective in treatment of several diseases and conditions, it has been described as useful instrument in ancient practice. From primitive to nowadays practice, acupuncture is gaining more adepts, thus attracting attention of scientific community in order to better understand its mechanism and its effectiveness. Several studies have been published concerning to acupuncture, but there is still controversy about its efficacy and effectiveness. Further studies should continue to be performed in order to establish the real role of acupuncture in treatment of several diseases and conditions.

A review of low-level air pollution and adverse effects on human health: implications for epidemiological studies and public policy

The aim of this study was to review original scientific articles describing the relationship between atmospheric pollution and damage to human health. We also aimed to determine which of these studies mentioned public policy issues. Original articles relating to atmospheric pollution and human health published between 1995 and 2009 were retrieved from the PubMed database and analyzed. This study included only articles dealing with atmospheric pollutants resulting primarily from vehicle emissions. Three researchers were involved in the final selection of the studies, and the chosen articles were approved by at least two of the three researchers. Of the 84 non-Brazilian studies analyzed, 80 showed an association between atmospheric pollution and adverse effects on human health. Moreover, 66 showed evidence of adverse effects on human health, even at levels below the permitted emission standards. Three studies mentioned public policies aimed at changing emission standards. Similarly, the 29 selected Brazilian studies reported adverse associations with human health, and 27 showed evidence of adverse effects even at levels below the legally permitted emission standards. Of these studies, 16 mentioned public policies aimed at changing emission standards. Based on the Brazilian and non-Brazilian scientific studies that have been conducted, it can be concluded that, even under conditions that are compliant with Brazilian air quality standards, the concentration of atmospheric pollutants in Brazil can negatively affect human health. However, as little discussion of this topic has been generated, this finding demonstrates the need to incorporate epidemiological evidence into decisions regarding legal regulations and to discuss the public policy implications in epidemiological studies.

The teaching of acupuncture in the University of São Paulo School of Medicine, Brazil / O ensino da acupuntura na Faculdade de Medicina da Universidade de São Paulo, Brasil

OBJECTIVE: Since being introduced as an elective discipline (non-obligatory) in the second semester of 2002, acupuncture has been taught in the University of São Paulo School of Medicine. We conducted this study to verify interest and acceptance among under graduate medical students and to discern a positive influence contributing to improveing their skills. METHODS: The study was conducted from 2002 to 2007 using descriptive statistical methods. RESULTS: The average number of students who concluded the discipline is 24.9 students per semester with an average number of medical students per semester of 87.5 (28 percent of all medical students in the 7th and 8th semesters). After a semester of basic training in acupuncture, only eight students per group are promoted (after selection) to the Medical Academic League of Acupuncture which lasts for two years. Every semester, all eight vacancies are filled. Among the students who concluded the course, 98 percent described course quality as good or very good, 85 percent considered themselves at least partially able to use acupuncture and 79 percent stated that the course influenced them in their medical education. CONCLUSION: There is a genuine interest to learn acupuncture, almost 30 percent of all students volunteer for a brief training in acupuncture while some of them choose additional training of two years indue to the importance of acupuncture as part of professional skills. Results indicate that acupuncture should be included as an elective discipline for medical students.

OBJETIVO: Após ter sido introduzida como disciplina eletiva (não obrigatória) no segundo semestre de 2002, a acupuntura tem sido ensinada na Faculdade de Medicina da Universidade de São Paulo (FMUSP) desde então. Esse estudo foi realizado com o intuito de verificar o interesse e a aceitação da acupuntura entre os estudantes de medicina da FMUSP e se, de alguma forma, ela poderia influenciá-los positivamente, contribuindo para melhorar as suas competências. MÉTODOS: O estudo foi conduzido durante o período de 2002 a 2007, utilizando-se métodos de estatística descritiva. RESULTADOS: A média de todos os estudantes que concluíram a disciplina foi de 24,9 alunos por semestre, sendo que a média de estudantes de medicina por semestre é de 87,5 (28 por cento de todos os estudantes de medicina nos 7º e 8º semestres). Após o primeiro semestre de formação básica em acupuntura, apenas oito alunos por grupo são promovidos (após seleção) para a Liga Médica Acadêmica de Acupuntura, que tem a duração de dois anos. Em todos os semestres, as oito vagas são preenchidas. Entre os estudantes que concluíram o curso, 98 por cento consideraram-no de boa ou muito boa qualidade, 85 por cento consideravam-se parcialmente capazes para empregar a acupuntura e 79 por cento consideraram que o curso contribuiu para a sua educação médica. CONCLUSÃO: Existe um real interesse para a aprendizagem da acupuntura, pois em torno de 30 por cento de todos os alunos quiseram passar por um breve treinamento em acupuntura, alguns deles optando por uma formação de dois anos em reconhecimento à importância da acupuntura como parte da capacitação profissional. Os resultados sugerem que a acupuntura deve ser incluída como uma disciplina eletiva para alunos de medicina.

O ensino de práticas não-convencionais em Saúde nas Faculdades de Medicina: panorama mundial e perpspectivas brasileiras / The teaching of non-conventional practices regarding health care in Medical Education Schools: world scenario and brazilian perspectives

Na última década, a demanda da população mundial por práticas não-convencionais em saúde aumentou em saúde aumentou substancialmente, exigindo cada vez mais do médico noções básicas das diversas terapêuticas vigentes, a fim de que possa orientar os pacientes que, sob seus cuidados, desejem utilizar tratamentos distintos dos que está habituado a empregar. Desta forma, compete às escolas de medicina propiciarem aos graduandos e pós-graduandos o conhecimento das evidências científicas, dos pressupostos teóricos e das abordagens clínicas e terapêuticas empregadas por estas distintas formas de tratamento. Com o intuito de fomentar a discussão sobre o ensino de práticas médicas não-convencionais assunto, enfoncando o interesse da população e da classe médica (estudantes, residentes e especialistas) nestas terapêuticas, a importância e as iniciativas brasileiras e de outros países no ensino na graduação, na pós-graduação e na residência, e as perspectivas para o futuro da educação médica em práticas não-convencionais em saúde.