Bioethics in Unani medicine: Relevant quotes from Kamilussanah, a 10th century manuscript

The World Health Organization (WHO) in its Alma Ata Declaration, 1978, focuses on the development, promotion and recognition of the traditional medical systems. India has taken steps in this direction by recognising Unani medicine with other traditional medical systems practised in India. Presently, Government is promoting integration of the recognised traditional medical systems with conventional medicine at the national level, as an interdisciplinary approach to providing better patient-centred care. Bioethics is a field of enquiry that examines ethical issues and dilemmas emerging from medical care and research involving humans. Although the term ‘bioethics’ was first mentioned in 1927 and later established as a distinct discipline in 1970s, the ethical principles in various contexts had been described centuries ago in the classical texts pertaining to traditional medical systems. Since ethics as a code of conduct was followed by ancient Unani physicians to safeguard the interests of humanity when providing healthcare, it was felt that a review of classical Unani manuscripts should be attempted to give an insight into codes of conduct described by various Unani physicians. In this paper, a 10th century book, “Kamilussanah” authored by Ali ibn Abbas al-Majoosi, also known as Majoosi (930-994 CE), is reviewed through the prism of ethics.

Da contracultura à somaterapia: a criação e o desenvolvimento inicial de uma terapia anarquista / From counterculture to somatherapy: the creation and early development of an anarchist therapy

Resumo Este trabalho faz parte de uma pesquisa maior, na qual se procura compreender como a somaterapia de Roberto Freire surgiu e se desenvolveu a partir da contracultura dos anos 1970. Abordam-se a criação e o desenvolvimento inicial da somaterapia, partindo do que se compreende ser um "mito de criação": uma narrativa ordenada e coerente que explica o surgimento da terapia e que aparece, de forma recorrente, com poucas alterações. Analisam-se, ainda, narrativas posteriores a esse período que remetem ao processo de nomeação da somaterapia. Nesta análise, são encontrados conflitos de dados e incongruências que indicam a complexidade desses processos e o esforço dos autores no sentido de ordenação e legitimação da técnica terapêutica.

Abstract This work is part of a larger survey on how Roberto Freire's somatherapy emerged and developed from the counterculture of the 1970s, addressing the creation and initial development of somatherapy, starting from what is understood to be a "creation myth," an orderly and coherent narrative explaining the emergence of this therapy that is frequently repeated with few changes. Later narratives referring to the process of naming somatherapy are also examined, revealing inconsistencies and conflicts in the data that indicate the complexity of these processes and the authors' efforts to add order and legitimacy to this therapeutic technique.

Anti-Ehrlichia properties of the dichloromethane fraction of Ageratum conyzoides associated with doxycycline: In vitro study / Propriedades anti-Ehrlichia da fração diclorometânica de Ageratum conyzoides associada com doxiciclina: estudo in vitro

ABSTRACT: The increasing number of cases of canine ehrlichiosis caused by Ehrlichia canis in hospitals and veterinary clinics has demonstrated the need for a new drug protocol for this disease. Doxycycline is used to treat ehrlichiosis, but the resistance of the microorganism to this treatment protocol, as well as the various side effects to the animals, has become a concern. Several studies have shown a positive interaction with extracts of plants and drugs, which allow for the reduction of the concentration necessary to produce the desired effect, minimizing adverse effects. This study determined the efficiency of the combination of the dichloromethane (DCM) fraction of Ageratum conyzoides L. with anti-Ehrlichia activity and doxycycline by using the checkerboard assay. Plant material was collected in São Luís, northeastern Brazil, followed by extraction in MeOH: H2O (8:2) and partitioning of the DCM fraction. After determining the Minimum Inhibitory Concentration (MIC) of the fraction under study against DH82 cells infected with Ehrlichia canis, it was combined with doxycycline to derive the Fractional Inhibitory Concentration Index (CIF Index). A reduction of 5.83 times the doxycycline minimum inhibitory concentration was observed, showing that this fraction of A. conyzoides composed predominantly by the class of lignans, identified by mass spectrometry notably intensified the activity of doxycycline against E. canis, resulting in a synergistic effect.

RESUMO: O crescente número de casos de erliquiose canina por Ehrlichia canis em hospitais e clínicas veterinárias tem demonstrado a necessidade de um novo protocolo de medicamentos para essa doença. A doxiciclina é usada para tratar a erliquiose, mas a resistência do microrganismo a esse protocolo de tratamento, bem como os diversos efeitos colaterais para os animais, tornou-se uma preocupação. Vários estudos têm demonstrado interação positiva com extratos de plantas e fármacos, que permitem a redução da concentração necessária para produzir o efeito desejado, minimizando os efeitos adversos. Este estudo determinou a eficiência da combinação da fração diclorometânica (DCM) de Ageratum conyzoides L. com atividade anti-Ehrlichia canis associada com doxiciclina por meio do ensaio de Checkerboard. O material vegetal foi coletado em São Luís, Maranhão, nordeste do Brasil, seguido pela extração em MeOH:H2O (8:2) e partição da fração diclorometânica. Após a determinação da Concentração Inibitória Mínima (CIM) da fração em estudo frente às células DH82 infectadas com Ehrlichia canis, a mesma foi combinada com a doxiciclina para derivação do Índice de Concentração Inibitória da Fração (Índice CIF). Observou-se uma redução de 5,83 vezes a concentração inibitória mínima da doxiciclina mostrando que esta fração de A. conyzoides, composta predominantemente por lignanas identificadas por espectrometria de massas, notavelmente intensificou a atividade desse fármaco contra E. canis, resultando em um efeito sinérgico.

The brief psychotherapeutic intervention relaxation, mental images and spirituality: a systematic review

ABSTRACT BACKGROUND: The brief psychotherapeutic intervention "relaxation, mental images and spirituality" (relaxamento, imagens mentais e espiritualidade, RIME) is a form of complementary and alternative health-related therapy. It is a pioneer in the matter of relating the elements of spirituality to relaxation and to visualization of mental images. OBJECTIVE: To ascertain the history, use and benefits of RIME that have been reported in the scientific literature, within different health/disease contexts. The questions that guided this study were: In what contexts has the brief RIME psychotherapeutic intervention been used? What were its benefits? DESIGN AND SETTING: Systematic review, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, in a public university. METHODS: The BVSPsi, CINAHL, MEDLINE, SciELO, SCOPUS and Web of Science databases were searched in September and October 2018. RESULTS: The findings showed that RIME promoted resignification of the symbolic pain of the death of patients without the possibility of cure; improved quality of life within the process of dying; contributed to the quality of life of breast cancer patients with cure possibilities; contributed to the emotional wellbeing of ostomized patients; brought quality-of-life benefits for patients with head-and-neck cancer; promoted empowerment for women with breast cancer and strengthened their libido; and promoted resignification of the spiritual pain of bereaved youths, offering a satisfactory return from mourning preparation. CONCLUSIONS: It was found that RIME has a construct history based on rigorous scientific methodology, covering quality of life and spiritual, emotional and subjective wellbeing. RIME has not been used internationally and new studies within this field, with different cases, should be encouraged. SYSTEMATIC REVIEW REGISTRATION: PROSPERO ID 164211.

Intergenerational Differences in using Complementary and Alternative Medicine Practices

Objective: This study aims to discover the reasons for using CAM practices among individuals in different age groups, to examine the differences between generations in terms of CAM use, and to explore the attitudes and behaviors of different generations regarding CAM use. Methods: This study was conducted between November 2016 and April 2017 with 320 people who agreed to participate in the study. Questionnaires were used to determine their sociodemographic characteristics as well as attitudes and behaviors towards the use of CAM practices. Results: Of the participants, 67.2% were female; 14.4%, 10.9%, 20.6%, and 54.1% were in the experienced-silent, baby boomer, X, and Y generations, respectively; and 65% experienced at least one CAM practice. The study determined that 50% of the participants in the experienced-silent generation, 65.7% of the participants in the baby boomer generation, 59.1% of the participants in the X generation, and 71.1% of the participants in the Y generation had used CAM practices. A statistically significant difference was found between these generations in terms of CAM use (p<0.05). Conclusions: The present study determined that the number of CAM users has been increasing, and found that the majority of participants had knowledge about CAM practices, but did not consider CAM as a better treatment option. They did not agree that alternative therapies were as effective as conventional therapies, so they were hesitant to use CAM practices.

Estrategias no farmacológicas para el manejo de los síntomas vasomotores en la menopausia

Los síntomas vasomotores afectan a gran número de mujeres en la peri y posmenopausia, impactando notablemente en la calidad de vida; por otro lado, su duración en el tiempo es incierta y muchas veces prolongada. Si bien la terapia hormonal de la menopausia (THM) constituye el tratamiento más efectivo para los síntomas climatéricos en su conjunto, en algunos casos existen contraindicaciones para su uso. Por lo tanto, ofrecer estrategias de tratamiento en las mujeres con contraindicación al tratamiento hormonal resulta mandatorio. Contamos con una amplia gama de opciones no hormonales, tanto farmacológicas como no farmacológicas. Dentro de estas últimas se incluyen las terapias alternativas o naturales (isoflavonas y cimicifuga racemosa), las modificaciones sobre el estilo de vida y las terapias complementarias. Las terapias alternativas presentaron resultados controvertidos en cuanto a la efectividad sobre los síntomas climatéricos y, por otro lado, debido a que su mecanismo de acción involucra a los receptores estrogénicos, están contraindicadas en las pacientes con antecedentes personales de cánceres hormonodependientes. Las modificaciones del estilo de vida impactan positivamente la salud general de la mujer, más allá de los síntomas climatéricos. En cuanto a las terapias complementarias, las únicas recomendadas son la terapia cognitiva conductual y la hipnosis. Se debe individualizar en cada caso la mejor opción terapéutica, teniendo en cuenta los antecedentes, interacciones medicamentosas, estado cognitivo, entre otros, ya que el objetivo final es mejorar la calidad de vida de nuestras pacientes.

Vasomotor symptoms affect a large number of women in the peri and post menopause with significant impact on quality of life; the duration of these symptoms is uncertain and often prolonged. Although menopausal hormone therapy is the most effective treatment for climacteric symptoms, there are some contraindications for its use. Therefore, it is mandatory to offer other treatment strategies for women with contraindication to hormonal treatment. We have a wide range of non-hormonal options available, both pharmacological and non-pharmacological. Among the latter, we include alternative or natural therapies (isoflavones and cimicifuga racemosa), lifestyle changes, and complementary therapies. Alternative therapies show controversial results regarding effectiveness on climacteric symptoms, and their mechanism of action involves estrogen receptors; they are contraindicated in patients with a personal history of hormone-dependent cancers. Lifestyle modifications have a positive impact on women's general health, beyond the climacteric symptoms. The only complementary therapies recommended are cognitive behavioral therapy and hypnosis. In each case, the best therapeutic option should be individualized, taking into account the patient's clinical history, drug interactions and cognitive status, since the ultimate goal is to improve quality of life.

Oncologia integrativa: das práticas complementares aos seus resultados / Integrative oncology: from complementary practices to its results

Introdução: A Medicina Integrativa é um campo de estudo relativamente novo, muito procurado por pacientes oncológicos, que busca trazer abordagens alternativas, de maneira segura e baseada em evidências, aos tratamentos oncológicos convencionais. Desta forma, objetivamos com este estudo construir um panorama do que se sabe de mais recente sobre práticas complementares e seus resultados no manejo dos pacientes em tratamento de câncer. Métodos: Através da plataforma Omnis, selecionamos nove artigos de acordo com os critérios: abordagem ao assunto proposto, disponibilidade online do artigo e não especificidade quanto ao tipo de câncer, excluindo um total de 42 artigos. Para a descrição dos resultados, separamos as terapias complementares abordadas nos estudos e analisamos os desfechos encontrados. Resultados: Entre as terapias de mind-body, ressaltamos uma melhora significativa do estresse, depressão e ansiedade, fadiga e qualidade de vida. A massagem oncológica, individualizada para cada paciente, mostrou melhora principalmente para dor e fadiga, e bem-estar geral. Sobre os fitoterápicos e suplementos, existem poucos estudos com boas evidências; porém, há relato de diminuição da dor, náusea e vômitos, principalmente após uso de cannabidiol. Podemos ressaltar também a importância da dieta e exercício físico na melhora da microbiota intestinal, intimamente relacionada ao sistema imune, e alívio de fadiga, problemas no sono, ansiedade e bem-estar geral. Por último, citamos a prática integrativa mais estudada, a acupuntura, e a melhora da dor relatada por 74% dos pacientes de um estudo após apenas uma sessão. Conclusão: Apesar dos resultados positivos encontrados, muitas são as limitações citadas nos estudos, como a falta de padronização e amostras pequenas. Isso reflete na prática médica como a comunicação ineficaz entre médicos e pacientes ou orientações defasadas. Por fim, são necessários novos estudos controlados randomizados para estabelecer resultados mais consistentes.

Introduction: Integrative medicine is a relatively new field of study trying to bring alternative, safe and evidence-based approaches to conventional oncology treatments. Thus, we aim with this study to build a panorama of what is known of the most recent on complementary practices and their results in the management of patients in cancer treatment. Methods: Through the Omnis platform, we selected nine articles according to the criteria of approach to the proposed subject, online availability of the article and inespecificity regarding the type of cancer, excluding a total of 42 articles. For the description of the results, we separated all complementary therapies included in the studies and analyzed the outcomes. Results: Among the mind-body therapies, we emphasize a significant improvement of stress, emotional disturbances (depression and anxiety), fatigue and quality of life. Oncological massage, individualized for each patient, showed improvement mainly for pain and fatigue, as well as improvement of general well-being. On herbs and supplements, there are few studies with good evidence; however, there is a decrease in pain, nausea and vomiting, especially after the use of cannabidiol. We also emphasized the importance of diet and physical exercise in improving the intestinal microbiota, closely related to the immune system, and to relieving fatigue, sleep problems, anxiety and general well-being. Finally, we cited the most studied integrative medicine practice, acupuncture, and the improvement of pain reported by 74% of the patients, in a trial, after only one session. Conclusion: Despite the positive results found, there are many limitations cited in each study, such as lack of standardization and small samples. This reflects in medical practice as an ineffective communication between doctors and patients or outdated guidance. Finally, further randomized controlled trials are needed to establish results that are more consistent.

A "miracle" cancer drug in the era of social media: A survey of Brazilian oncologists' opinions and experience with phosphoethanolamine / Uma "milagrosa" droga contra o câncer na era da mídia social: uma pesquisa sobre a opinião e a experiência dos oncologistas brasileiros com a fosfoetanolamina

Summary Introduction: Patients who are treating cancer have often used alternative therapies. In the internet era, information can be broadcasted widely, and this happened with phosphoethanolamine in Brazil, where this substance was claimed by the population to be the "cure for cancer." Method: This is a cross-sectional study developed by the Brazilian Society of Clinical Oncology (SBOC). An objectively structured questionnaire was sent by e-mail and SMS to active MDs members of the SBOC. Descriptive statistics was used to evaluate the data. Statistical significance between the variables was tested by Pearson's Chi-squared test (p<0.05 was considered significance). Results: The survey was sent to 1,072 oncologists, and 398 (37.1%) answered at least part of it. One hundred and fifteen (28.9%) had followed patients who had used phosphoethanolamine. Among these, 14 (12.2%) observed adverse events and four (3.5%) attributed clinical benefit to the substance. Most of the oncologists (n=331; 83.2%) believe that it should only be used as part of a clinical trial protocol. Most physicians did not recommend this drug to their patients (n=311; 78.1%). Oncologists in Southeast, South and Midwest Brazil were more likely to have patients taking the drug compared to the Northern and Northeastern regions. Conclusion: This is the first survey to assess the opinion and experience of oncologists about this alternative therapy. Most oncologists in Brazil do not believe that synthetic phosphoethanolamine is active in cancer treatment, do not recommend its use without proper evaluation, and state that it should only be available to patients in the context of clinical trials.

Resumo Introdução: Alguns pacientes com diagnóstico de câncer utilizam terapias alternativas. Na era da internet, as informações podem se dissipar de forma rápida e abrangente, como foi o caso da fosfoetanolamina no Brasil, onde foi aclamada pela população como sendo a "cura para o câncer". Método: Trata-se de um estudo transversal desenvolvido pela Sociedade Brasileira de Oncologia Clínica (SBOC). Através de e-mail e SMS, enviou-se um questionário com perguntas objetivas para oncologistas membros ativos da SBOC. Os dados foram avaliados por meio de estatística descritiva. A significância estatística entre as variáveis ​​foi testada pelo teste Qui-quadrado de Pearson (p<0,05 foi considerado significativo). Resultados: O questionário foi enviado para 1.072 oncologistas, tendo 398 (37,1%) respondido pelo menos parte dele. Cento e quinze (28,9%) tinham pacientes que fizeram uso da fosfoetanolamina. Desses, 14 (12,2%) observaram eventos adversos e quatro (3,5%) atribuíram benefício clínico para a substância. A maioria (n=331; 83,2%) acreditava que ela só deveria ser utilizada dentro de um ensaio clínico. A principal recomendação dada aos pacientes foi contra o seu uso (n=311; 78,1%). Oncologistas das regiões Sudeste, Sul e Centro-Oeste tiveram mais pacientes que tomaram a substância quando comparados com as regiões Norte e Nordeste. Conclusão: Este é o primeiro estudo que avalia a opinião dos oncologistas sobre essa terapia alternativa e sua experiência. A maioria dos oncologistas brasileiros não acredita que a fosfoetanolamina sintética seja ativa no tratamento do câncer, não recomendando seu uso sem avaliação adequada, e afirmam que a substância só deve estar disponível no contexto de ensaios clínicos.

Health Status and the Use of Complementary and Alternative Therapies in the Community Dwelling Pre-elderly and Elderly / 재활간호학회지

PURPOSE: The purpose of this study was to identify health status and the use of complementary and alternative therapies in the community dwelling pre-elderly and elderly. METHODS: A total of 193 subjects participated in this study. They were recruited from one senior welfare center, four senior citizen centers and subjects' home in two cities. Data were collected with self-reported questionnaires to measure health status and the use of complementary and alternative therapies. Data were analyzed by t-test, ANOVA using SPSS/WIN 22.0. RESULTS: Health status in this subjects was different depending on their age, sex, education, religion, type of family, and average monthly living expenses. Most used items as complementary and alternative medicine are diet therapy, herbal medicine such as health supplement food therapy, vitamin therapy, and Korean folk remedies. There were statistically significant differences in using complementary and alternative therapies according to one's current health status (F=7.09, p<.001), comparing health status to peers (F=3.67, p=.013), and chronic disease having more than three months (t=-2.50, p=.013). CONCLUSION: This study suggest that individualized health care should be continued for the pre-elderly and elderly. Moreover, we need to prepare long term care plans such as educations for applying complementary and alternative therapies.

Use of Complementary and Alternative Medicine and Assessment of Dermatology Quality of Life Index among Dermatology Outpatients: A Cross-sectional Comparative Study.

Aims: The aims of this study were to examine the frequency of complementary and alternative medicine (CAM) use among dermatology outpatients, and compare the socio demographic factors and dermatology life quality index (DLQI) values between CAM users and non-users. The CAM approaches and knowledge of the patients were also evaluated. Study Design: A descriptive cross-sectional study design was used. Place and Duration of Study: This study was conducted at the Sisli Etfal Training and Research Hospital Dermatology outpatient clinic, between January of 2011 and May of 2011. Method: A total of 522 consecutive patients were included in this study. The patients were older than 18 years old, and answered an interviewer-administered questionnaire about CAM use. The demographics, dermatological condition, CAM treatment, time of usage, benefits and side effects, and the patients’ answers from the questions about CAM were recorded. The quality of life was evaluated using the Turkish version of the DLQI questionnaire. Results: The prevalence of CAM use was 16.8%, and the mean age of CAM users (28.2±14.3) was statistically lower than that of non-CAM users (36.0±16.9): 50% of the CAM users did not know the definition of CAM; 56.8% learned the CAM treatment model from a friend, neighbour or relative; 61.3% used CAM because of dissatisfaction with conventional medicine; 10% of the CAM users explained that they had benefits; and 18.2% claimed that they had side effects. There was a statistically significant difference between the mean DLQI scores of the CAM users (13.2±5.2) and non-users (11.5±4.2) (p=.05). Conclusion: This study determined that the usage of CAM was common; however, the knowledge of CAM was poor in our patients. The most commonly used CAM treatment was herbal therapy, and the major factors for choosing CAM were the disease duration and dissatisfaction with western conventional medicine. The measurement of the DLQI of the patients showed that CAM users were the patients most greatly affected by their skin conditions.

Prevalence and Characteristics of Nonmotor Symptoms in Korean Parkinson's Disease Patients and Its Relationship With Experience of Alternative Therapies

BACKGROUND: The aim of this study was to determine the prevalence and characteristics of nonmotor symptoms (NMS)and alternative therapies (ATs) in Korean PD and to elucidate its association. METHODS: Demographic, social, and motor (Hoehn and Yahr stage; HY stage, motor section of Unified Parkinson Disease Rating Scale; mUPDRS) and NMS questionnaire were recorded in all PD patients (N=50) without significant cognitive impairment. RESULTS: Mean age and HY stage were 70.1 years and 2.3. Mean total numbers of positive NMS (tNMS) per patient was 12.9 and all patients had at least five NMS (range, 5-25). The most common items were nocturia (82%), constipation (70%) and memory disturbance (66%). Urinary (68%) domain was the most frequently involved. The tNMS was higher in female and in the group with higher mUPDRS score. Sleep and depression/anxiety domains were more involved in women. 63% of patients had experienced ATs and among them 29% of patients used ATs simultaneously. Health related food (32%), herbal medicine (32%), ginseng (32%) and acupuncture (23%) were the most commonly used. There was no association between ATs usage and demographic, social, motor and nonmotor characteristics. Among the ATs users, 20% of patients reported the effectiveness of ATs but the mean ATs costs was 12.4 fold higher than the medical costs. CONCLUSIONS: We suggest that mean tNMS is higher in Korean PD patients comparing with other previous studies. Women might be more vulnerable to NMS than men expecially in sleep and depression/anxiety. We couldn't found the associated between usage of ATs and clinical variables including NMS.

Salud mental y nuevas complementariedades terapéuticas. La experiencia en dos hospitales públicos de Buenos Aires, Argentina / Saúde mental e novas complementaridades terapêuticas. Experiência em dois hospitais públicos de Buenos Aires, Argentina / Mental health and new therapeutic complementarities. The experience in two public hospitals in Buenos Aires, Argentina

En las últimas décadas las terapias alternativas se han convertido en una opción cada vez más frecuente entre la población general de las ciudades industrializadas, aunque su aceptación como opciones válidas en el sistema de salud aún se encuentra en discusión. A pesar de ello, en la Ciudad de Buenos Aires (Argentina) han surgido talleres dentro de los hospitales generales que ofertan terapias alternativas/complementarias, asociadas a servicios o profesionales de la salud mental. A partir de un estudio cualitativo en dos hospitales públicos de la Ciudad Autónoma de Buenos Aires, indagaremos los motivos que dan origen a dicho fenómeno, destacando las formas de expresión que adquiere y la complejidad de un campo en construcción.

Nas últimas décadas, terapias alternativas têm se tornado cada vez mais comuns entre a população geral em cidades industrializadas, embora sua aceitação como opções válidas no sistema de saúde ainda esteja em discussão. No entanto, na Cidade de Buenos Aires (Argentina), oficinas emergiram dentro de hospitais gerais que oferecem terapias alternativas / complementares, serviços associados e profissionais de saúde mental. A partir de um estudo qualitativo em dois hospitais públicos da Cidade Autônoma de Buenos Aires, vamos investigar as razões que dão origem a este fenômeno, destacando as formas de expressão que adquirem e a complexidade de um campo em construção.

In recent decades, alternative therapies have become an increasingly common option among the general population in industrialized cities, although their acceptance as valid options in the health system is still under discussion. Nevertheless, in the City of Buenos Aires (Argentina) workshops have emerged within general hospitals that offer alternative / complementary therapies, associated to mental health professionals and departments. From a qualitative study in two public hospitals in the Autonomous City of Buenos Aires, we will investigate the reasons that lead to this phenomenon, emphasizing the forms of expression they acquire and complexity of a field under construction.

Práticas integrativas e o empoderamento da enfermagem / Integrative practices and nursing empowerment / Practicas integrativasy empoderamiento de enfermeria

Estudo teórico-reflexivo, construído com base na leitura crítica da Política Nacional de Práticas Integrativas e Complementares (PNPIC), no Sistema Único de Saúde (SUS), e na necessidade de discutir a formação do enfermeiro nessa perspectiva. O objetivo foi analisar a possibilidade do empoderamento da enfermagem à proposta de inserção das práticas integralizantes no ato de cuidar em enfermagem. Realizou-se uma pesquisa exploratória e sistemática em livros e documentos em formato eletrônico, com a utilização dos descritores em ciências da saúde, da Biblioteca Virtual em Saúde (BVS). Foram utilizados 28 trabalhos relevantes, disponibilizados na íntegra e publicados nos últimos dez anos. As pesquisas demonstraram que o desconhecimento dos enfermeiros em relação à legislação e a falta de capacitação específica são limitações para a atuação profissional nessa área. Dessa forma, será preciso, ainda, incluir na graduação disciplinas teórico-práticas de terapias alternativas, e, quando egressos, os enfermeiros devem procurar pós-graduações na área.

Theoretical and reflective study based on a critical reading of the National Policy on Integrative and Complementary Practices (in Portuguese, PNPIC) in the Brazilian Unified Health System (in Portuguese, SUS) and on the need for discussing nursing education in this perspective. The objective was to analyze the possibility of nursing empowerment and the proposal of inserting integrative practices in nursing care. An exploratory and systematic research in books and documents in electronic format was carried out, using descriptors in health sciences, at the Virtual Health Library (BVS). Twenty-eight relevant and unabridged studies published in the last ten years were used. The studies demonstrated nurses were unfamiliar with the legislation and lacked specific training and that such limitations hinder professional performance in the area. The inclusion in undergraduate courses of theoretical and practical courses on alternative therapies is necessary. Graduate nurses should seek postgraduate training in the area.

Investigación teórico reflexiva construida en base a una lectura crítica de la Política Nacional de Prácticas Integrativas y Complementarias (PNPIC) en el Sistema Único de Salud (SUS) y de la necesidad de discutir la formación del enfermero desde esta perspectiva. Su objetivo fue analizar la posibilidad de empoderamiento de enfermería a la propuesta de inserción de prácticas integrativas en el cuidado de los enfermeros. Se realizó una investigación sistemática exploratoria en libros y documentos en formato electrónico con palabras clave en ciencias de la salud de la Biblioteca Virtual en Salud (BVS). Se consideraron 28 trabajos relevantes, disponibles en su integridad y publicados en los últimos diez años. La investigación demuestra que la falta de conocimiento de la legislación y de formación específica de los enfermeros son limitaciones para la práctica profesional en esta área. Por lo tanto, en los cursos de grado deberían incluirse asignaturas teórico - prácticas de terapias alternativas y, al egresar, los enfermeros deberían cursar un postgrado.

Efecto de la oración de intercesión sobre la evolución de pacientes críticamente enfermos / The effect of intercessory prayer on critically-ill patient outcome

Objetivo. Evaluar el efecto de la oración intercesora remota sobre la evolución clínica y la mortalidad de los pacientes críticamente enfermos. Materiales y métodos. Se condujo un experimento controlado de asignación aleatoria, doblemente enmascarado. Un grupo de pacientes admitidos a la unidad de cuidados intensivos de la Clínica de los Andes de Tunja (n=100), fue asignado aleatoriamente y pareado por gravedad a uno de dos grupos. El primer grupo (n=50) recibió intervención con oración intercesora remota adicional al manejo convencional según las guías de la unidad de cuidados intensivos. El segundo grupo no recibió la intervención de la oración. Se analizaron las variables basales demográficas y de creencia en la oración, y las de resultado clínico como índice de disfunción orgánica múltiple, días de estancia y mortalidad. Resultados. No hubo diferencias estadísticamente significativas en las variables basales entre los dos grupos. En el grupo de oración, en comparación con el de control, la estancia fue significativamente mayor (p<0,02), el número de muertes fue menor (9 Vs. 15, p<0,05), y la mortalidad estandarizada fue menor (0,67 % Vs. 0,89 %, p<0,05). Por último, el índice de disfunción orgánica múltiple fue significativamente menor en el grupo de oración (3,24 Vs. 5,6, p=0,1). Conclusiones. La oración intercesora remota demostró capacidad para disminuir la mortalidad y los índices de disfunción orgánica múltiple, a expensas de un aumento de los días de estancia.

Objective: To evaluate the effect of remote intercessory prayer on clinical outcomes and mortality in critically-ill patients. Materials and methods: A randomized controlled double-blind trial was conducted. One hundred patients admitted to the intensive care unit (ICU) of Clínica de los Andes de Tunja was randomly allocated and pair-matched by severity of the illness. All patients received conventional ICU treatment according to clinical guidelines. The treatment group had intercessory prayers whereas control group did not. Baseline demographic and belief-related variables were analyzed as well as clinical outcome variables such as multiple organ dysfunction, length of stay and mortality. Results: No differences were found between groups regarding baseline variables. Length of stay was significantly increased in the treatment group (p<0.02), mortality rate was lower in prayer group (9 versus 15, p<0.05) as well as standardized mortality rate (0.67 versus 0.89, p<0.05). Finally, the multiple organ dysfunction score was significantly lower in the treatment group (3.24 versus 5.6, p=0.1). Conclusions: Remote intercessory prayer was shown to decrease mortality and multiple organ dysfunction scores, at the expense of the length of stay.

Tratamiento eficaz con tintura de añil 5 por ciento de una paciente infestada por Pediculus capitis / Effective treatment of a patient infested with pediculus capitis by using 5 percent Indigofera suffruticosa Mill tincture

Introducción: en Cuba se reportaron altas frecuencias de pediculosis capitis desde finales de los años noventa, particularmente en algunos grupos de escolares y sus convivientes. Estos últimos se involucran en la cadena de transmisión de esos insectos y pueden desempeñar, en la actualidad, una función importante como reservorios del parásito. Objetivo: reportar la eficacia del tratamiento con añil cimarrón en una paciente infestada de Pediculus capitis. Métodos: se describe un caso de infestación persistente con pediculosis capitis en una paciente de 55 años de edad, tratada con solución de permetrina 1 por ciento y posteriormente con tintura de añil cimarrón 5 por ciento. Resultados: la identificación microscópica de adultos y estadios pre-adultos del parásito confirmaron la presencia de Pediculus capitis. El tratamiento del cabello con permetrina 1 por ciento no fue eficaz en 2 aplicaciones realizadas. Como alternativa de tratamiento, se aplicó tintura de añil 5 por ciento, lo que permitió disminuir la población de ectoparásitos adultos y logró eliminar la infestación después de una segunda aplicación, con la constante extracción de las liendres realizada por el personal paramédico encargado del caso. Conclusión: la aplicación de este procedimiento inocuo podría servir como alternativa terapéutica para esta afección.

Introduction: pediculosis capitis was very frequently reported in Cuba since the end of the 90's, particularly in some groups of school children and their relatives. The latter are involved in a chain of transmission of these insects and may play an important role at present as parasite reservoirs. Objective: to report on the efficacy of the treatment of one female patient suffering from Pediculus capitis by using 5 percent Indigofera suffruticosa Mill (añil cimarrón) tincture. Methods: a case of persistent infestation with pediculosis capitis was described in which a 55 years-old patient was firstly treated with 1 percent permethrin solution and later with 5 percent Indigofera suffruticosa Mill tincture. Results: the microscopic identification of adult parasites and pre-adult stages of the parasite confirmed the presence of pediculus capitis. The hair treatment with 1 percent permethrin was not effective after two applications. As an alternative, 5 percent Indigofera suffruticosa Mill tincture was used and then the population of adult ectoparasites was reduced and the infestation was eliminated after the second application, with the paramedical staff continuously taking the nits out from the patient's hair. Conclusion: the use of this innocuous method may become a therapeutic alternative to treat this illness.

Musicoterapia aplicada a niños con síndrome de Down / Musicotherapy applied to children with Down's syndrome

INTRODUCCIÓN. El síndrome de Down continúa siendo la enfermedad genética por aberración cromosómica más frecuente. La música se ha utilizado con fines terapéuticos en estos pacientes y se han obtenido buenos resultados, por lo que se decidió aplicarla a un grupo de niños con esta condición genética e investigar la percepción que de ella tienen padres y profesores. MÉTODOS. Se realizó un estudio descriptivo sobre el conocimiento de padres y profesores acerca de la musicoterapia y de los resultados de su aplicación en 18 niños con síndrome de Down matriculados en el Circulo Infantil Especial Zunzún, en La Habana. Después de 9 meses de aplicación de la terapia se realizó una encuesta a las 12 profesoras y a 18 padres y madres de estos niños. RESULTADOS. Cinco (41,6 por ciento) profesoras conocían de la musicoterapia antes de su aplicación, mientras que en los padres el conocimiento fue proporcionalmente menor. Todas las profesoras reconocieron nuevas habilidades en el 100 por ciento de los niños y los avances más importantes fueron el lenguaje, la socialización y el aprendizaje. El 77,7 por ciento de los padres señalaron avances en la socialización, el lenguaje y las habilidades motoras. El 100 por ciento de las educadoras y el 88,8 por ciento de los padres se mostraron satisfechos y desean que se mantenga en la institución. CONCLUSIONES. Existía desconocimiento de esta terapia por parte de profesoras y padres. Se reconocieron avances en diferentes áreas del lenguaje, aprendizaje y la socialización, por lo que se recomienda como método terapéutico desde edades tempranas, para mejorar la calidad de vida del niño y de la familia

INTRODUCTION. The Down's syndrome remains the more frequent genetic disease due to chromosomal aberration. The music has been used with therapeutic aims in these patients obtaining good results, thus we decide its implementation in a group of children presenting with this genetic condition and also to research its perception in parents and professors. METHODS. A descriptive study was conducted on the knowledge of parents and professors on Musicotherapy and of results of its implementation in 18 children with Down's syndrome from the Zunzún Special Nursery in La Habana. After 9 months of therapy12 professor and 18 parents were polled. RESULTS. Five professors (41,6 percent) known the Musicotherapy before its implementation, whereas in parents the knowledge of this type of therapy was poor. All professors recognized new abilities in the 100 percent of children and the more significant advances were in the language, the socialization and the learning. The 77,7 percent of parents indicated advances in socialization, language and motor abilities. The 100 percent of professors and the 88,8 percent of parents to be satisfied and they wish the continuation of this therapy in the institution. CONCLUSIONS. There was a lack of knowledge on this therapy in professors and parents. Advances were recognized in different areas of language, learning and socialization, thus it is recommendable its implementation from early ages to improve the quality of life of child and its family

Terapias alternativas para el tratamiento del lupus eritematoso sistémico. Revisión sistemática, Enero 2000 ­ Diciembre 2010 / Alternative therapies for the treatment of systemic lupus erythematosus. Systematic review, January 2000 - December 2010

Osler describió por primera vez las manifestaciones generales del Lupus Eritematoso Sistémico (LES) en 1895. Antes de este tiempo era considerada como una enfermedad cutánea desfigurante pero no mortal. En la actualidad se sabe que es una enfermedad inflamatoria crónica generalizada que sigue un curso de afectación a múltiples órganos, de causa aún desconocida. Existe dificultad para valorar la eficacia y efectividad de los medicamentos empleados en el tratamiento del LES, porque en la mayoría de los casos ocurre la remisión espontánea. Hay pocos estudios controlados aleatorizados debido a que es difícil suspender el tratamiento en un paciente con una enfermedad que pone en peligro su vida, y en este caso, puede traducirse en LES fulminante. Dependiendo de la gravedad de la enfermedad, el paciente puede necesitar un tratamiento mínimo o intenso y gran parte de la medicación convencional empleada puede traer efectos adversos que aumentan las complicaciones de la enfermedad. El interés del médico homeópata es buscar otras alternativas que le brinden una calidad de vida satisfactoria al paciente, evitando las complicaciones propias de la enfermedad y del tratamiento alópata. Para tal fin es necesario realizar la búsqueda de investigaciones científicas de tratamientos alternativos con validez científica que brinden satisfacción al paciente y que puedan ser reproducibles en nuestro medio. Entre las diversas terapias encontradas en los motores de base de datos, está la homeopatía, la acupuntura y suplementos vitamínicos que de acuerdo a los distintos estudios, benefician al paciente con LES disminuyendo la presencia de las distintas reacciones adversas del tratamiento normal.

Efetividade do Toque Terapêutico sobre a dor, depressão e sono em pacientes com dor crônica: ensaio clínico / The effectiveness of Therapeutic Touch on pain, depression and sleep in patients with chronic pain: clinical trial / Efectividad del Toque Terapéutico en dolor, depresión y sueño en pacientes con dolor crónica: ensayo clínico

Este estudo teve como objetivo verificar a efetividade do Toque Terapêutico na diminuição da intensidade da dor, escores de auto-avaliação de depressão e melhora da qualidade do sono. Consiste em um ensaio clínico do tipo antes e depois, realizado com 30 idosos com dor crônica não-oncológica que receberam 8 sessões de Toque Terapêutico Método Krieger-Kunz na Unidade Básica de Saúde de Fernandópolis (SP), Brasil. A Escala Analógica Visual para dor foi aplicada antes e após cada sessão, o Inventário de Depressão de Beck e o Índice de Qualidade do Sono de Pittsburgh, antes da primeira e após a última. A análise dos dados demonstrou diminuição significativa (p<0,05) na intensidade da dor, dos escores de auto-avaliação de depressão e do índice de qualidade do sono. Conclui-se que o Toque Terapêutico foi efetivo na diminuição da intensidade da dor, nas atitudes e nos sintomas depressivos e na melhora da qualidade do sono.

This research aimed to check the effectiveness of Therapeutic Touch on decreased pain intensity, depression self-assessment scores and improved sleep quality. A clinical before-after trial is presented. The study was carried out at a Basic Health Unit in Fernandópolis, SP-Brazil, involving 30 elderly patients with chronic non-oncologic pain who received 8 sessions of Therapeutic Touch in accordance with the Krieger-Kunz method. The Visual Analogue Scale for pain was applied before and after each session, and Beck Depression Inventory and the Pittsburgh Sleep Quality Index before the first and after the last session. Data analysis showed a significant decrease (p<0.05) in pain intensity, depression self-assessment scores and the sleep quality index. It is concluded that the Therapeutic Touch was effective to decrease pain intensity and depressive attitudes and symptoms, as well as to improve sleep quality.

Este estudio tuvo como objetivo verificar la efectividad del Tacto Terapéutico en la disminución de la intensidad del dolor, puntajes de autoevaluación de depresión y mejora de la calidad del sueño. Consistió en un ensayo clínico del tipo antes y después, realizado en una Unidad Básica de Salud de Fernandópolis - SP - Brasil, con 30 ancianos con dolor crónico no oncológico que recibieron 8 sesiones de Tacto Terapéutico Método Krieger-Kunz. La Escala Analógica Visual para dolor fue aplicada antes y después de cada sesión, el Inventario de Depresión de Beck y el Índice de Calidad del Sueño de Pittsburgh antes de la primera y luego de la última. El análisis de los datos demostró una disminución significativa (p< 0,005) en la intensidad del dolor, de los puntajes de autoevaluación de depresión y del índice de calidad del sueño. Se concluye en que el Tacto Terapéutico fue efectivo en la disminución de la intensidad del dolor, actitudes y síntomas depresivos y en la mejora de la calidad del sueño.

Contribuições da fitoterapia para a qualidade de vida: percepções de seus usuários / Contributions of phytotherapy to quality of life: user perceptions / Contribuciones de la fitoterapia para la calidad de vida: percepciones de sus usuarios

Este estudo objetivou analisar as percepções de usuários de fitoterapia quanto às vantagens e desvantagens decorrentes da sua utilização e influência na qualidade de vida. Constitui-se em pesquisa qualitativa, desenvolvida entre maio e julho de 2006, junto a 22 usuários de um hospital especializado em terapias alternativas, localizado em Goiânia-GO, Brasil. Para análise dos dados, utilizou-se o referencial da análise de conteúdo. Os usuários referiram que, antes de iniciarem a terapêutica fitoterápica, buscaram tratamentos alopáticos, entretanto, não obtiveram sucesso. As vantagens decorrentes da utilização da fitoterapia apontadas pelos sujeitos relacionam-se à eficácia, ausência de efeitos colaterais, baixo custo e estímulo aos hábitos saudáveis de vida. Entre as contribuições para melhoria na qualidade de vida, destacou-se a harmonia familiar, maior capacidade para realizar atividades do cotidiano e o sentimento de bem-estar. A fitoterapia parece proporcionar mudanças significativas na vida de seus usuários e contribuir para melhorias na qualidade de vida.

The aim of this qualitative study was to examine user perceptions of the advantages and disadvantages of phytotherapy and its influence on quality of life. Twenty-two users at a hospital specializing in alternative therapies, in Goiânia, Goiás State, Brazil, were studied from May to July 2006. Data analysis was framed by content analysis. Users said that before starting phytotherapy they had sought allopathic treatment, which was unsuccessful. As benefits of phytotherapy, users mentioned its effectiveness, freedom from side-effects, low cost and encouragement of healthy living habits. Prominent among its contributions to improving quality of life were: harmony in the family, increased ability to perform everyday activities, and a sense of well-being. Phytotherapy appears to produce significant changes in users’ lives and to contribute to improving their quality of life.

Este estudio objetivó analizar las percepciones de usuarios de fitoterapia cuanto a las ventajas y desventajas de su uso y su influencia en la calidad de vida. Se constituye en pesquisa cualitativa, desarrollada entre mayo e julio de 2006 junto a 22 usuarios de un hospital especializado en terapias alternativas, situado en Goiânia-GO, Brasil. Para el análisis de los datos, se usó el referencial del análisis de contenido. Los usuarios refirieron que, antes de iniciar el tratamiento fitoterápico, han buscado tratamiento vinculado a la alopatía, sin embargo, no tuvieron éxito. Los beneficios de la utilización de la fitoterapia apuntados por los sujetos están relacionados con: la eficacia, la ausencia de efectos secundarios, el bajo costo y el fomento de hábitos saludables de vida. Entre las contribuciones para la mejora de la calidad de vida han destacado: la armonía familiar, una mayor capacidad para realizar actividades de la vida cotidiana y el sentido de bienestar. La fitoterapia parece proporcionar cambios significativos en la vida de sus usuarios, contribuyendo para mejoría de la calidad de vida.

Uso de terapias complementares por mães em seus filhos: estudo em um hospital universitário / Use of complementary therapies by mothers in their children: study at an university hospital

O objetivo deste estudo é avaliar a utilização de terapias complementares (TC) por mães em seus filhos. Trata-se de um estudo transversal, descritivo. Foram entrevistadas 202 mães de crianças assistidas em um hospital universitário. As variáveis analisadas foram: uso de terapias complementares/motivos para tal, tipos de terapias utilizadas, sua finalidade, seus efeitos, revelação ao médico/motivos para tal e reação do médico. A prevalência de uso de terapias complementares foi 87,6 por cento. De 177 mães que utilizavam TC, muitas mencionaram mais de um tipo, sendo: chás (72,8 por cento), benzimento (41 por cento), simpatias (12,9 por cento), remédios/xaropes caseiros (8,4 por cento), oração/promessa (7,4 por cento), homeopatia (4,0 por cento), tratamento espiritual/parapsicológico (4,0 por cento), mistura de substâncias desconhecidas/garrafada (3 por cento), massagem (2 por cento) e reiki/florais (1,5 por cento). As ervas mais utilizadas foram erva-doce (16,7 por cento), camomila (14,8 por cento) e hortelã (10,9 por cento); 57,6 por cento das mães não informaram o uso ao médico. Dos 499 tratamentos empregados, houve percepção de melhora em 429 (86 por cento) e relato de dois casos de efeitos adversos. A prevalência do uso de terapias complementares foi alta, sendo os chás a terapia mais utilizada e erva-doce, camomila e hortelã as ervas mais usadas. Houve percepção de melhora na maioria das terapias usadas.

The objective of this article is to evaluate the use of complementary therapies by mothers in their children. A cross-sectional and descriptive study with 202 mothers of children that attended an University Hospital were interviewed. The variables analyzed were: use of complementary therapies/reasons, therapies used its purpose, effects, doctor's revelation/reasons and doctor's reaction. The prevalence of complementary therapies use was of 87.6 percent. Among the 177 mothers that used complementary therapies, many mentioned more than one kind, as follow: teas (72.8 percent), blessings (41 percent), sympathies (12.9 percent), homemade remedies/syrups (8.4 percent), prayer/promises (7.4 percent), homeopathy (4.0 percent), spiritual/parapsychological treatment (4.0 percent), mixture of unknown substances/"garrafada" (bottled) (3 percent), massage (2 percent) and reiki/floral (1.5 percent). The most used herbs were anise (16.7 percent), chamomile (14.8 percent) and mint (10.9 percent); 57.6 percent of the mothers did not inform its use to the doctor. Out of 499 treatments employed, there was a perception of improvement in 429 (86 percent) and 2 reports of adverse effects. The prevalence of complementary therapies utilization was high, being teas the most utilized therapy and anise, chamomile and mint the most used herbs. There was perception of improvement in most of the used therapies.