Progress on Prevention and Treatment of Cerebral Small Vascular Disease Using Integrative Medicine / 中国结合医学杂志

Cerebral small vessel disease (CSVD) is a senile brain lesion caused by the abnormal structure and function of arterioles, venules and capillaries in the aging brain. The etiology of CSVD is complex, and disease is often asymptomatic in its early stages. However, as CSVD develops, brain disorders may occur, such as stroke, cognitive dysfunction, dyskinesia and mood disorders, and heart, kidney, eye and systemic disorders. As the population continues to age, the burden of CSVD is increasing. Moreover, there is an urgent need for better screening methods and diagnostic markers for CSVD, in addition to preventive and asymptomatic- and mild-stage treatments. Integrative medicine (IM), which combines the holistic concepts and syndrome differentiations of Chinese medicine with modern medical perspectives, has unique advantages for the prevention and treatment of CSVD. In this review, we summarize the biological markers, ultrasound and imaging features, disease-related genes and risk factors relevant to CSVD diagnosis and screening. Furthermore, we discuss IM-based CSVD prevention and treatment strategies to stimulate further research in this field.

Cultural stress: The undiagnosed epidemic of our time / 中西医结合学报

Global technologies that have made the world more interconnected have also, inadvertently, amplified the forces of stress that are now with us 24 hours a day, 7 days a week. The accumulated impact of this stress I call cultural stress anxiety syndrome and call on integrative medicine practitioners to recognize that it is exacerbating whatever acute stressors are also present in our patients' lives. In this Commentary, I outline seven major components of cultural stress (time pressure, digital intrusion, digital dependency, isolation, sedentary lifestyle, poor sleep and uncertainty), describe their health consequences, and finally, offer cultural stress-specific remedies I have utilized in my own practice, along with studies that affirm their efficacy. My hope is that we, as integrative medicine practitioners who are cognizant of the role that stress plays in disease development, will more fully appreciate the added impact of cultural stress, and advise our patients on the importance of proactive stress management. Please cite this article as: Murad H. Cultural stress: the undiagnosed epidemic of our time. J Integr Med. 2023; 21(3): 221-225.

Intelligent Chinese Medicine: A New Direction Approach for Integrative Medicine in Diagnosis and Treatment of Cardiovascular Diseases / 中国结合医学杂志

High mortality rates from cardiovascular diseases (CVDs) persist worldwide. Older people are at a higher risk of developing these diseases. Given the current high treatment cost for CVDs, there is a need to prevent CVDs and or develop treatment alternatives. Western and Chinese medicines have been used to treat CVDs. However, several factors, such as inaccurate diagnoses, non-standard prescriptions, and poor adherence behavior, lower the benefits of the treatments by Chinese medicine (CM). Artificial intelligence (AI) is increasingly used in clinical diagnosis and treatment, especially in assessing efficacy of CM in clinical decision support systems, health management, new drug research and development, and drug efficacy evaluation. In this study, we explored the role of AI in CM in the diagnosis and treatment of CVDs, and discussed application of AI in assessing the effect of CM on CVDs.

Ioga e suas práticas meditativas em dores crônicas / Yoga and its meditative practices in chronic pain / El yoga y sus prácticas meditativas en el dolor crónico

Objetivo: Analisar os efeitos das práticas meditativas que envolvem posturas físicas, respiração, uso de som, visualização, e práticas de relaxamento como parte da terapêutica para controle e melhora das dores crônicas . Método: Trata-se de uma revisão da literatura nas bases de dados Medline, Science Direct, Pubmed e Scielo, tendo como período de referência os últimos 15 anos. As palavraschave utilizadas foram "ioga" e "dores crônicas" e suas correspondentes em inglês, "Yoga" e "chronic pain", isolados ou de forma combinada, sem delimitar um intervalo temporal. Resultados: Um número crescente de estudos científicos tem demonstrado a melhora de questões físicas, mentais, emocionais, espirituais e relacionais da prática de ioga e suas técnicas isoladas RM indivíduos com diferentes condições de saúde. Houve redução de ansiedade e de estresse, bem como melhora da atenção plena, da função executiva, humor, estado emocional, autocompaixão e saúde mental geral. Considerações Finais: As evidências em literatura vêm demonstrando que a dor crônica não é unifatorial, mas associada a comorbidades que acabam levando a inúmeras patologias e interferência na qualidade de vida. A ioga oferece vários benefícios para controle da dor, remodelação e fortalecimento do corpo e da psique. Portanto, a ioga pode ser uma terapia complementar benéfica para o manejo de dores crônicas, embora sejam necessários mais estudos e mais evidências na prática clínica

Objective: To analyze the effects of meditative practices involving physical postures, breathing, sound use, visualization, and relaxation practices as part of therapy for the control and improvement of chronic pain. Method: This is a review of the literature in medline, science direct, pubmed and scielo databases, having as reference period the last 15 years. The keywords used were "yoga" and "chronic pain" and their corresponding ones in English, "Yoga" and "chronic pain", isolated or in combination, without delimiting a time interval. Results: An increasing number of scientific studies have demonstrated the improvement of physical, mental, emotional, spiritual and relational issues of yoga practice and its techniques isolated RM individuals with different health conditions. There was a reduction in anxiety and stress, as well as improvement in mindfulness, executive function, mood, emotional state, self-compassion and general mental health. Final Considerations: The evidence in the literature has shown that chronic pain is not unifactorial, but associated with comorbidities that end up leading to numerous pathologies and interference in quality of life. Yoga offers several benefits for pain control, remodeling and strengthening of the body and psyche. Therefore, yoga can be a beneficial complementary therapy for the management of chronic pain, although more studies and more evidence are needed in clinical practice.

Objetivo: Analizar los efectos de las prácticas meditativas que involucran posturas físicas, respiración, uso del sonido, visualización y prácticas de relajación como parte de la terapia para el control y la mejora del dolor crónico. Método: Se trata de una revisión de la literatura en las bases de datos medline, science direct, pubmed y scielo, teniendo como período de referencia los últimos 15 años. Las palabras clave utilizadas fueron "yoga" y "chronic pain" y sus correspondientes en inglés, "Yoga" y "chronic pain", aisladas o en combinación, sin delimitar un intervalo de tiempo. Resultados: Un número creciente de estudios científicos han demostrado la mejora de los problemas físicos, mentales, emocionales, espirituales y relacionales de la práctica del yoga y sus técnicas aisladas RM individuos con diferentes condiciones de salud. Hubo una reducción en la ansiedad y el estrés, así como una mejora en la atención plena, la función ejecutiva, el estado de ánimo, el estado emocional, la autocompasión y la salud mental general. Consideraciones Finales: La evidencia en la literatura ha demostrado que el dolor crónico no es unifactorial, sino que se asocia con comorbilidades que terminan dando lugar a numerosas patologías e interferencias en la calidad de vida. El yoga ofrece varios beneficios para el control del dolor, la remodelación y el fortalecimiento del cuerpo y la psique. Por lo tanto, el yoga puede ser una terapia complementaria beneficiosa para el tratamiento del dolor crónico, aunque se necesitan más estudios y más evidencia en la práctica clínica.

Cuidado transpersonal mediado por Reiki: vivencias de familiares de niños con enfermedad falciforme / Cuidado transpessoal mediado por Reiki: vivências de familiares de crianças com doença falciforme / Transpersonal care through Reiki: Experiences of family members of children with sickle cell disease

Objetivo: To understand the experiences of family members of children with sickle cell disease during transpersonal nursing care meetings mediated by Reiki. Materials and methods: Convergent care research, underpinned by Watson's Theory on Human Care, developed in a health facility for people with sickle cell disease in the state of Bahia, Brazil. The study was carried out from August to October 2016. Interviews with participants took place before and after six sessions of transpersonal care mediated by Reiki with seven family members. Thematic content analysis was applied to the data collected. Results: Participants realized the importance of cultivating self-recognition, identifying their fears and feelings, valuing self-care, reflecting on their health priorities and needs, and recognizing their potential for transforming their practices. After the meetings, feelings emerged towards valuing the self as a person to be cared for, reducing anxiety and stress, reconnecting with beliefs and deities, acceptance of the disease, the role of caregiver and the future, as well as better interaction with family members in order to manage conflicts harmonically. Conclusions: Transpersonal care favors nursing professionals' autonomy to create their own way of thinking and practicing longitudinal care, which can be applied throughout the process of prevention, diagnosis tion of the disease to achieve healing. It is up to these professionals to deepen theoretically on this approach and use the Clinical Caritas Process in the systematization of nursing care.

Objetivo: comprender las vivencias de los familiares de niños con enfermedad falciforme durante encuentros de cuidado transpersonal de enfermería mediados por Reiki. Materiais e métodos: estudio convergente asistencial con base en la Teoría del Cuidado Humano de Watson, desarrollado en un centro de atención en salud para personas con enfermedad falciforme en el estado de Bahía, Brasil, entre agosto y octubre de 2016. Se llevaron a cabo una serie de entrevistas antes y después de seis encuentros de cuidado mediado por Reiki con siete familiares de niños con enfermedad falciforme. La información recopilada fue sometida a análisis de contenido temático. Resultados: los participantes dieron cuenta de la importancia de cultivar el autorreconocimiento, identificar sus miedos y sentimientos, valorar el autocuidado, reflexionar sobre sus prioridades y necesidades de salud y reconocer el potencial de cada uno para transformar sus prácticas de vida. Tras las reuniones surgieron sentimientos de valoración del yo como persona a cuidar, reducción de la ansiedad y el estrés, reconexión con creencias y deidades, aceptación de la enfermedad, reflexión en torno al rol de cuidador y el futuro, así como deseos de una mejor interacción con sus familiares para gestionar eventuales conflictos de forma armónica. Conclusiones: el cuidado transpersonal favorece la autonomía de los profesionales en enfermería para crear su propia forma de concebir y practicar el cuidado longitudinal, el cual puede ser aplicado en todo el proceso de prevención, diagnóstico y rehabilitación del estado patológico a fin de alcanzar la sanación. Así, corresponde a la enfermería profundizar teóricamente en este enfoque y hacer uso del Proceso Clínico Caritas para la sistematización de la atención de enfermería.

Objetivo: compreender as vivências de familiares de crianças com doença falciforme durante os encontros de cuidado transpessoal de Enfermagem mediado pelo Reiki. Materiales y métodos: estudo convergente assistencial, fundamentado na Teoria do Cuidado Humano de Watson desenvolvido em um centro de referência a pessoas com doença falciforme no estado da Bahia, Brasil, entre agosto e outubro de 2016. As entrevistas ocorreram antes e após seis encontros de cuidado mediado pelo Reiki com sete familiares. Os relatos foram submetidos à análise de conteúdo temática. Resultados: os participantes perceberam a importância de cultivar o autorreconhecimento, identificar seus temores e sentimentos, valorizar o autocuidado, refletir sobre suas prioridades e necessidades de saúde e reconhecer suas potencialidades para a transformação das suas práticas. Após os encontros, emergiram sensações de valorização do eu enquanto pessoa a ser cuidada, diminuição da ansiedade e do estresse, reconexão com as crenças e as divindades, aceitação da doença, do papel de cuidador e do futuro, bem como melhor interação com familiares de modo a gerir conflitos harmonicamente. Conclusões: o cuidado transpessoal favorece a autonomia das enfermeiras para criar um modo de fazer próprio, permite a prática de um cuidado longitudinal, que pode ser aplicado durante todo o processo de prevenção, diagnóstico e reabilitação do estado de adoecimento, a fim de alcançar o healing. Cabe à enfermagem o aprofundamento teórico e o uso do Clinical Caritas Process na sistematização da assistência de enfermagem.

A Breakthrough Point in Integrative Medical Research: Challenge of Treating Overlapping Symptoms in Functional Gastrointestinal Disorders / 中国结合医学杂志

Functional gastrointestinal disorders (FGIDs) are common disorders that are characterized by persistent and recurring gastrointestinal symptoms. Many patients with FGIDs have overlapping symptoms, which impaired the quality of life and ability to work of patients, and left a considerable impact on health-care systems and society. Chinese medicines (CMs) are commonly utilized by many patients with FGIDs. This article discusses the current status of diagnosis and treatment of FGIDs, the advantages and characteristics of CM treatment, and how integrated medicine can make a breakthrough in FGIDs diagnosis and treatment.

¿Qué es la Medicina del Estilo de Vida y por qué la necesitamos? / What is Lifestyle Medicine and why do we need it?

Medicina del Estilo de Vida (MEV), se define como la práctica basada en la evidencia, de asistir a individuos y familias en la adopción y mantención de conductas que mejoran la salud y calidad de vida, tales como alimentación saludable, realización de actividad física periódica, sueño reparador, manejo del estrés, cese del uso de sustancias tóxicas y una sólida red de apoyo social. Esta disciplina de la medicina, ha demostrado ser efectiva en la prevención, manejo y a veces reversión de las patologías que conllevan la mayor morbimortalidad global, tales como hipertensión arterial, diabetes mellitus tipo 2, enfermedad coronaria y obesidad. Es más, se estima que el 80% de las enfermedades crónicas no transmisibles podrían prevenirse llevando un estilo de vida más saludable. Ciertas barreras estructurales han hecho que la incorporación de la MEV en las mallas curriculares universitarias y establecimientos de salud sea más lenta de lo esperado, sin embargo, cada vez son más las instituciones académicas y prestadoras de salud que adoptan los principios de la MEV, y la aparición de sociedades médicas relacionadas a esta disciplina en casi todos los continentes, están acelerando el paso hacia una medicina más focalizada en tratar las causas de la enfermedad, en lugar de centrarse en lo sintomático

Lifestyle Medicine (LM) is the evidence based practice of assisting individuals and families to adopt and sustain behaviors that can improve health and quality of life. These include healthy diet, participating in regular physical activity, having good quality sleep, managing stress, avoiding risky substance abuse and building strong social connections. LM has demonstrated its effectiveness at preventing, managing and sometimes reversing the diseases that globally carry the biggest morbidity and mortality burden, such as hypertension, type 2 diabetes mellitus, coronary artery disease and obesity. More so, it is estimated that 80% of non-communicable chronic diseases could be avoided by living a healthier lifestyle. Certain structural barriers have made LM's incorporation into the medical curriculum and clinical practice slower than expected, however, more and more academic institutions and healthcare providers are adopting LM's principles. The appearance of medical associations related to this discipline in almost every continent is accelerating the pace towards a medicine that is more centered on the root-causes of disease, rather than focusing on symptoms

Traditional, complementary, and integrative medicine evidence map: a methodology to an overflowing field of data and noise / Mapas de la evidencia de las medicinas tradicionales, complementarias e integrativas: metodología para un campo desbordado de datos e interferencias / Mapa de evidências das medicinas tradicionais, complementares e integrativas: uma metodologia para um campo repleto de dados e ruído

ABSTRACT Every day there is criticism about lack of evidence on traditional, complementary, and integrative medicine (TCIM). But is this narrative evidence-based? Are we really missing research about TCIM? Or are we just not looking correctly at the evidence? Evidence maps are a useful method with the dual function of synthesizing available evidence on a specific topic and identifying knowledge gaps. This article presents a six-step evidence map methodology along with recently published TCIM evidence maps, including one related to COVID-19. TCIM evidence maps are useful instruments to inform decision-making for policymakers, health practitioners, and patients.

RESUMEN Es habitual que se critique la falta de evidencia con respecto a las medicinas tradicionales, complementarias e integrativas. Sin embargo, ¿se basa en la evidencia este discurso? ¿Falta realmente investigación sobre las medicinas tradicionales, complementarias e integrativas o es que simplemente no estamos analizando la evidencia de forma adecuada? Los mapas de evidencia son un método útil que tiene una función doble: sintetizar la evidencia disponible por temas específicos y determinar si hay alguna laguna en el conocimiento. En este artículo se presenta una metodología de elaboración de mapas de la evidencia en seis pasos, junto con los mapas de la evidencia de las medicinas tradicionales, complementarias e integrativas publicados recientemente, incluido un mapa sobre la COVID-19. Los mapas de la evidencia de las medicinas tradicionales, complementarias e integrativas son instrumentos útiles para fundamentar la toma de decisiones por parte de los encargados de las políticas, el personal de salud y los pacientes.

RESUMO A crítica é diária de que faltam evidências em medicinas tradicionais, complementares e integrativas (MTCI). Mas será que esta narrativa se baseia em evidências? Realmente faltam pesquisas em MTCI? Ou será que simplesmente não estamos atentando corretamente às evidências? Os mapas de evidências consistem em uma metodologia útil de dupla função: sintetizar as evidências existentes em um determinado tópico e identificar as lacunas de conhecimento. Neste artigo é apresentada uma metodologia de mapa de evidências de seis passos junto com mapas de evidências de MTCI recém-publicados, incluindo um relacionado à COVID-19. Os mapas de evidências de MTCI são instrumentos úteis para subsidiar a tomada de decisão dos responsáveis por políticas, profissionais da saúde e pacientes.

Integrative medicine in the era of cancer immunotherapy: Challenges and opportunities / 中西医结合学报

Cancer immunotherapy has led to a new era of cancer treatment strategies, and transforming healthcare for cancer patients. Meanwhile, reports of immune-related adverse events have been increasing, greatly hindering the use of cancer immunotherapy. Traditional Chinese medicine (TCM), which has been widely used in Asian countries for thousands of years, is known to play a complementary role in the treatment of cancer. Taken in combined with conventional modern therapies, such as resection, ablation and radiotherapy, TCM exerts its main anti-cancer effects in two ways: health-strengthening (Fu-Zheng) and pathogen-eliminating (Qu-Xie). Theoretically, pathogen-eliminating TCM can promote the release of tumor-related antigens and should be able to increase the effect of immunotherapy, while health-strengthening TCM may have immune-enhancing mechanisms that overlap with immunotherapy. In the era of cancer immunotherapy, it is important to balance the use of TCM and immunotherapy, with the goal of enhancing immune efficacy and antagonizing immune toxicity. In this article, we discuss this issue by considering the mechanism of tumor immunotherapy, alongside the theoretical basis of TCM treatment of tumors, with the aim of bringing new insights to future research in this field.

Reframing Palliative Care: An East-West Integrative Palliative Care Model / 中国结合医学杂志

Convergence of principles of palliative care and integrative medicine has led to the introduction of the new practice of integrative palliative care in which integrative therapies (including mind-body modalities, traditional Chinese medicine, Ayurveda, and dietary supplements) are used to provide symptom management for patients who are dying or experiencing the sequelae of serious illness and its treatment. We propose an East-West Integrative palliative care model using non-drug therapies, such as acupuncture, diet, exercise, and stress management that shift the paradigm from suppressing the symptoms of illness to addressing both the root cause of the symptoms and the imbalance and declining homeostatic reserve that perpetuate these symptoms. This whole-person model expands the reach of palliative care, prolonging a better quality of life and allowing the patient to maintain as many activities as possible by preventing symptoms and improving function. Through this approach we reframe the dialogue such that patients are "living better" rather than "dying better" when faced with serious illness or death. In this article, we provide an overview of the principles of palliative care, integrative medicine, and the novel area of integrative palliative care, and propose an East-West integrative palliative care model that incorporates and broadens the scope of these existing approaches.

Potencialidades e fragilidades de implantação da Política Nacional de Práticas Integrativas e Complementares / Implementation of Brazil's National Policy on Complementary and Integrative Practices: strengths and weaknesses

Resumo Esta revisão narrativa tem por objetivo analisar a produção científica sobre as Práticas Integrativas e Complementares (PIC) no Sistema Único de Saúde (SUS) visando compreender as potencialidades e fragilidades do processo de implantação da Política Nacional de Práticas Integrativas e Complementares (PNPIC). Após busca nas bases de dados, 25 artigos foram selecionados e os seus resultados analisados criticamente. Da análise do material emergiram cinco temas principais que explicitaram potencialidades e fragilidades de implantação da política: 1) Formação profissional em PIC para o SUS; 2) Estruturação da oferta em PIC, acesso e promoção da saúde; 3) Conhecimento, acesso e aceitação de usuários em relação às PIC; 4) Conhecimento de profissionais e gestores em relação à PNPIC; e 5) Escopo, monitoramento e avaliação da PNPIC. Os resultados se alinham aos relatórios de gestão da PNPIC aprofundando o conhecimento acerca da implantação da política e reforçando a necessidade de empoderamento dos atores do SUS para o enfrentamento de seus desafios.

Abstract This narrative review examines the literature on complementary and integrative practices (CIPs) and their incorporation into Brazil's national health system (Sistema Único de Saúde - SUS) in an attempt to understand the strengths and weaknesses of the implementation of the National Policy on Complementary and Integrative Practices in the SUS (PNPIC, acronym in Portuguese). A search was conducted of the MEDLINE, LILACS, and SciELO databases, resulting in final sample of 25 articles. Our analysis identified five key themes in the literature related to the strengths and weaknesses of policy implementation: 1) Professional training in CIPs in the SUS; 2) structuring the provision of CIPs, access, and health promotion; 3) knowledge, access, and acceptance of service users in relation to CIPs; 4) knowledge of SUS professional staff and managers in relation to the PNPIC; and 5) scope and monitoring and evaluation of the PNPIC. In consonance with the conclusions of the PNPIC management reports, the findings provide a deeper insight into policy implementation problems and reinforce the need to empower the actors involved in this process to tackle these challenges.

Curando dentro, cuidando fuera: mujeres latinoamericanas y prácticas terapéuticas en el contexto migratorio transnacional / Healing inside, caring outside: Latin American women and therapeutic practices in the transnational migration context / Curando dentro, cuidando fora: mulheres latino-americanas e práticas terapêuticas no contexto migratório transnacional

Resumen El siguiente artículo intenta reflexionar acerca de la relación que se construye entre las mujeres latinas migrantes y las prácticas terapéuticas, atendiendo a los roles designados o asumidos por ellas en los procesos de salud/enfermedad/atención. Se realizó una investigación etnográfica con mujeres caribeñas establecidas en España, con el fin de indagar acerca de determinadas actividades curativas y de cuidado ejercidas por ellas, tanto al interior del hogar como hacia afuera. Además del componente descriptivo, se trabajó con las narrativas y significados específicos elaborados en torno a dichas ocupaciones. Su análisis permitió identificar facetas contradictorias y conflictivas en el desarrollo de la identidad y la experiencia migratoria femenina. Por un lado, las actividades de cuidado como principal alternativa laboral evidencian la desigualdad de oportunidades y ámbitos de incidencia social accesibles a las latinoamericanas. Al mismo tiempo reflejan mecanismos de reproducción de esquemas esencialistas, que naturalizan la división del trabajo en función de "cualidades" étnicas y de género. Por otro lado, el manejo de conocimientos específicos sobre curación, tratamiento y asistencia supone para las mujeres la posesión de un papel distintivo y potencialmente empoderador al interior de la comunidad como continuadoras de determinados saberes tradicionales.

Abstract The article attempts to reflect on the relationship between Latin American immigrant women and therapeutic practices, according to the roles designated or assumed by them in healthcare processes. An ethnographic research was carried out with Caribbean women settled in Spain, in order to inquire about certain curative and care activities exercised by them, both inside and outside their homes. In addition to the descriptive component, we worked specifically with the narratives and meanings elaborated around these occupations. Their analysis allowed us to identify conflicting facets in the development of female identity and migratory experience. Being a caregiver as their main job alternative evidence the inequality of opportunities and social impact areas accessible to Latin women; at the same time, they reproduce essentialist schemes, which naturalize the division of labour according to ethnic and gender "qualities". On the other hand, the management of specific knowledge about healing, treatment and assistance allow women to possess a distinctive and potentially empowering role within the community as continuators of certain traditional knowledge.

Resumo O presente trabalho procura refletir sobre a relação que se constrói entre as mulheres latinas migrantes e as práticas terapêuticas, de acordo com os papéis designados ou assumidos por elas nos processos de saúde/doença/cuidado. Uma pesquisa etnográfica foi realizada com mulheres caribenhas instaladas na Espanha, a fim de indagar sobre certas atividades curativas e cuidados exercidos por elas, tanto dentro como fora de casa. Além do componente descritivo, trabalhamos com narrativas e significados específicos elaborados em torno dessas ocupações. Sua análise permitiu identificar facetas conflitantes no desenvolvimento da identidade feminina e da experiência de migração. As atividades de cuidado como principal alternativa de trabalho evidenciam a desigualdade de oportunidades e áreas de impacto social acessíveis aos latino-americanos; ao mesmo tempo, refletem mecanismos de reprodução de esquemas essencialistas, que naturalizam a divisão do trabalho de acordo com "qualidades" étnicas e de gênero. Por outro lado, a gestão de conhecimentos específicos sobre cura, tratamento e assistência supõe para as mulheres a posse de um papel distintivo e potencialmente empoderador dentro da comunidade como continuadores de certos conhecimentos tradicionais.

Cost analysis in a traditional, complementary and integrative medicine unit in Brazil / Análise de custos em unidade de medicina tradicional, complementar e integrativa no Brasil

ABSTRACT OBJECTIVE To analyze the costs of a specialized service in Traditional Complementary and Integrative Medicines (TCIM) in Northeast Brazil to provide data on the cost linked to the implementation and maintenance of services of this nature and to identify the average cost per user for the Unified Health System. METHODS This is a partial, descriptive, quantitative economic assessment, which used secondary data, later grouped in Microsoft Excel spreadsheets. The method used to analyze such costs was absorption costing, from which the service was divided into three costing centers: productive, administrative and auxiliary. RESULTS After analyzing the data, the total cost of the service in 2014 was estimated at R$ 1,270,015.70, with a proportion of 79.69% of direct costs. The average cost per user in this period was R$ 36.79, considering the total of 34,521 users in individual and collective practices. CONCLUSIONS The service has a cost per user compatible with a specialized service; however, TCIM offers a comprehensive and holistic approach, which can have a positive impact on quality of life.

RESUMO OBJETIVO Analisar os custos de um serviço especializado em Medicinas Tradicionais Complementares e Integrativas (MTCI) no Nordeste brasileiro, com o intuito de fornecer dados sobre o custo atrelado à implantação e manutenção de serviços dessa natureza e identificar o custo médio por usuário para o Sistema Único de Saúde. MÉTODOS Trata-se de uma avaliação econômica do tipo parcial, com caráter descritivo, de natureza quantitativa, que utilizou dados secundários, posteriormente agrupados em planilhas do Microsoft Excel. O método utilizado para analisar tais custos foi o de custeio por absorção, a partir do qual o serviço foi dividido em três centros de custeio: produtivo, administrativo e auxiliar. RESULTADOS Após a análise dos dados, o custo total do serviço em 2014 foi estimado em R$ 1.270.015,70, com proporção de 79,69% de custos diretos. O custo médio por usuário neste período foi R$ 36,79, considerando o total de 34.521 usuários em práticas individuais e coletivas. CONCLUSÕES O serviço apresenta um custo por usuário compatível com um serviço especializado, contudo, as MTCI oferecem abordagem compreensiva e holística, as quais podem impactar de forma positiva a qualidade de vida.

Exploring an Integrative Therapy for Treating COVID-19: A Randomized Controlled Trial / 中国结合医学杂志

OBJECTIVES@#To develop a new Chinese medicine (CM)-based drug and to evaluate its safety and effect for suppressing acute respiratory distress syndrome (ARDS) in COVID-19 patients.@*METHODS@#A putative ARDS-suppressing drug Keguan-1 was first developed and then evaluated by a randomized, controlled two-arm trial. The two arms of the trial consist of a control therapy (alpha interferon inhalation, 50 µg twice daily; and lopinavir/ritonavir, 400 and 100 mg twice daily, respectively) and a testing therapy (control therapy plus Keguan-1 19.4 g twice daily) by random number table at 1:1 ratio with 24 cases each group. After 2-week treatment, adverse events, time to fever resolution, ARDS development, and lung injury on newly diagnosed COVID-19 patients were assessed.@*RESULTS@#An analysis of the data from the first 30 participants showed that the control arm and the testing arm did not exhibit any significant differences in terms of adverse events. Based on this result, the study was expanded to include a total of 48 participants (24 cases each arm). The results show that compared with the control arm, the testing arm exhibited a significant improvement in time to fever resolution (P=0.035), and a significant reduction in the development of ARDS (P=0.048).@*CONCLUSIONS@#Keguan-1-based integrative therapy was safe and superior to the standard therapy in suppressing the development of ARDS in COVID-19 patients. (Trial registration No. NCT04251871 at www.clinicaltrials.gov ).

Exploring an Integrative Therapy for Treating COVID-19: A Randomized Controlled Trial / 中国结合医学杂志

OBJECTIVES@#To develop a new Chinese medicine (CM)-based drug and to evaluate its safety and effect for suppressing acute respiratory distress syndrome (ARDS) in COVID-19 patients.@*METHODS@#A putative ARDS-suppressing drug Keguan-1 was first developed and then evaluated by a randomized, controlled two-arm trial. The two arms of the trial consist of a control therapy (alpha interferon inhalation, 50 µg twice daily; and lopinavir/ritonavir, 400 and 100 mg twice daily, respectively) and a testing therapy (control therapy plus Keguan-1 19.4 g twice daily) by random number table at 1:1 ratio with 24 cases each group. After 2-week treatment, adverse events, time to fever resolution, ARDS development, and lung injury on newly diagnosed COVID-19 patients were assessed.@*RESULTS@#An analysis of the data from the first 30 participants showed that the control arm and the testing arm did not exhibit any significant differences in terms of adverse events. Based on this result, the study was expanded to include a total of 48 participants (24 cases each arm). The results show that compared with the control arm, the testing arm exhibited a significant improvement in time to fever resolution (P=0.035), and a significant reduction in the development of ARDS (P=0.048).@*CONCLUSIONS@#Keguan-1-based integrative therapy was safe and superior to the standard therapy in suppressing the development of ARDS in COVID-19 patients. (Trial registration No. NCT04251871 at www.clinicaltrials.gov ).

Benefícios das práticas integrativas e complementares no cuidado de enfermagem / Benefits of integrative and complementary practices in nursing care / Beneficios de las prácticas integrativas y complementarias en el cuidado de enfermería

Objetivo: caracterizar os benefícios das práticas integrativas e complementares no cuidado de enfermagem. Método: revisão integrativa realizada nas bases de dados Scielo, Lilacs, PudMed e BVS. Os descritores de busca foram terapias complementares, cuidados em enfermagem, enfermagem holística, toque terapêutico, acupuntura, fitoterapia, aromaterapia, homeopatia. Encontrou-se 4421 artigos disponíveis nos idiomas Português, Espanhol e Inglês; publicados entre os anos 2006 e 2018. Destes foram selecionados 21 artigos. Resultados: entre os benefícios das práticas integrativas foi evidenciado o relaxamento e bem estar, alívio da dor e da ansiedade, diminuição de sinais e sintomas de doenças, estimula o contato profissional-paciente, redução do uso de medicamentos, fortalecimento do sistema imunológico, melhoria da qualidade de vida e diminuição de reações adversas. Considerações finais: É preciso protagonismo empoderamento e preparo da enfermagem para a implementação das PICs em sua prática diária qualificando as práticas assistenciais e reduzindo os custos hospitalares. (AU)

Objective: to characterize the benefits of integrative and complementary practices in nursing care. Method: integrative review in the SciELO, Lilacs, PudMed and Virtual Health Library databases. The search descriptors were Complementary Therapies, Nursing Care, Holistic Nursing, Therapeutic Touch, Acupuncture, Phytotherapy, Aromatherapy and Homeopathy. There were 4421 articles available in Portuguese, Spanish and English published between the years 2006 and 2018. Of these, 21 articles were selected. Results: the benefits of integrative practices showed relaxation and well-being, relief of pain and anxiety, reduction of signs and symptoms of diseases, stimulation of professional-patient contact, reduction of medication use, strengthening of the immune system, quality of life and reduction of adverse reactions. Final considerations: it is necessary to lead, empower and prepare nursing for the implementation of ICPs in their daily practice, qualifying care practices and reducing hospital costs.(AU)

Objetivo: caracterizar los beneficios de las prácticas integrativas y complementarias en el cuidado de enfermería. Método: revisão integrativa realizada nas bases de dados SciELO, Lilacs, PudMed y BVS. Los descriptores de búsqueda fueron Terapias Complementarias, Cuidados en Enfermería, Enfermería Holística, Toque Terapéutico, Acupuntura, Fitoterapia, Aromaterapia, Homeopatía. Se encontró 4421 artículos disponibles en portugués, español e Inglés; publicados entre los años 2006 y 2018. De ellos se seleccionaron 21 artículos. Resultados: los beneficios de las prácticas integrativas fueron evidenciados por la relajación y el bienestar, alivio del dolor y la ansiedad, disminución de signos y síntomas de enfermedades, estimula el contacto profesional-paciente, reducción del uso de medicamentos, fortalecimiento del sistema inmunológico, calidad de vida y disminución de las reacciones adversas. Consideraciones finales: Es necesario protagonismo, empoderamiento y preparación de la enfermería para la implementación de las PICs en su práctica diaria calificando las prácticas asistenciales y reduciendo los costos hospitalarios.(AU)

O que as revisões sistemáticas Cochrane dizem sobre o uso das 10 novas práticas de medicina integrativa incorporadas ao Sistema Único de Saúde / What systematic reviews allows the doctor to use the 10 new practices of integrated medicine to the Unified Health System

Contexto: O Ministério da Saúde do Brasil anunciou, em março de 2018, uma expansão das políticas para práticas integrativas em saúde dentro do Sistema Único de Saúde (SUS), incorporando 10 novos tipos de práticas integrativas à lista de procedimentos disponíveis no sistema público de saúde brasileiro. Objetivo: Identificar, sintetizar e avaliar criticamente evidências de revisões sistemáticas Cochrane sobre as novas práticas de medicina integrativa inseridas no SUS. Métodos: Revisão de revisões sistemáticas conduzida pela Disciplina de Medicina Baseada em Evidências, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), sobre as seguintes intervenções: apiterapia, aromaterapia, bioenergética, constelação familiar, terapia de florais, cromoterapia, geoterapia, hipnoterapia, imposição de mãos e ozonioterapia. Resultados: Foram incluídas 16 revisões sistemáticas: 4 sobre apiterapia, 4 sobre aromaterapia, 6 sobre hipnoterapia e 2 sobre ozonioterapia. Não foram encontradas revisões sistemáticas Cochrane referentes aos temas bioenergética, constelação familiar, cromoterapia, geoterapia, terapia de florais ou imposição de mãos. A única evidência de alta qualidade encontrada nessas revisões foi sobre o potencial benefício da apiterapia, especificamente para o uso de curativos de mel para cura parcial de feridas por queimadura, para redução de tosse entre crianças com tosse aguda e para prevenção de reações alérgicas a picadas de insetos. Conclusão: Exceto por alguns usos específicos da apiterapia (mel para lesões por queimadura e para tosse aguda e do veneno de abelhas para reações alérgicas às picadas de insetos), o uso das 10 práticas integrativas recentemente incorporadas ao SUS não é embasado por evidências de revisões sistemáticas Cochrane.

Integrative Medicine on Optimizing Clopidogrel and Aspirin Therapy / 中国结合医学杂志

This article reviews the available published data on optimizing clopidogrel and aspirin therapy using translational and integrative medicine. Translational and evidence-based medical studies show that the CYP2C19 gene mutation (CYP2C19*2 and CYP2C19*3) could affect > 50% of the Chinese population, and that this mutation is closely associated with clopidogrel resistance and an increased risk of major adverse cardiovascular events, particularly stent thrombosis in patients following percutaneous coronary intervention (PCI). Adjusted-dose warfarin and aspirin reduce stroke in patients with atrial fibrillation (AF), and warfarin is substantially more efficacious than aspirin. However, a poor compliance is a big problem in warfarin use especially in China. The genetic variants of vitamin K expoxide reductase might account for the universally lower warfarin dosage used in Chinese population. The available evidence indicates that the integrating mainstream treatments (e.g., clopidogrel, CYP2C19 genotyping) and non-mainstream medicines [e.g., Chinese medicines, Naoxintong Capsule (, NXT)] to treat CYP2C19 gene mutation patients following PCI can be effective. Aspirin combined NXT and the adjusted-dose warfarin was equally effective in elderly patients with non-valvular AF in prevention of ischemic stroke.

Medicine in Future and Advantages of Integrated Chinese and Western Medicine / 中国结合医学杂志

The history of medical development shows that oriental medicine, or traditional medicine, was born through medical practice during the times when science and technology were immature and underdeveloped, whereas with the development of science and technology, Western medicine, or modern medicine, was born through experimental analysis and research. With the development of medicine, the pros and cons of both medical systems become increasingly evident. How to integrate them and learn from each other will be the direction of future development of medicine. The formation and development of integrated medicine will, inevitably, usher in a new era for medicine.

Effectiveness of Integrative Medicine Therapy on Coronary Artery Disease Prognosis: A Real-World Study / 中国结合医学杂志

OBJECTIVE@#To evaluate the effectiveness of integrative medicine (IM) on patients with coronary artery disease (CAD) and investigate the prognostic factors of CAD in a real-world setting.@*METHODS@#A total of 1,087 hospitalized patients with CAD from four hospitals in Beijing, China were consecutively selected between August 2011 and February 2012. The patients were assigned to two groups based on the treatment: Chinese medicine (CM) plus conventional treatment, i.e., IM therapy (IM group); or conventional treatment alone (CT group). The endpoint was major adverse cardiac events [MACE; including cardiac death, myocardial infarction (MI), and revascularization].@*RESULTS@#A total of 1,040 patients finished the 2-year follow-up. Of them, 49.4% (514/1,040) received IM therapy. During the 2-year follow-up, the total incidence of MACE was 11.3%. Most of the events involved revascularization (9.3%). Cardiac death/MI occurred in 3.0% of cases. For revascularization, logistic stepwise regression analysis revealed that age ⩾ 65 years [odds ratio (OR), 2.224], MI (OR, 2.561), diabetes mellitus (OR, 1.650), multi-vessel lesions (OR, 2.554), baseline high sensitivity C-reactive protein level ⩾ 3 mg/L (OR, 1.678), and moderate or severe anxiety/depression (OR, 1.849) were negative predictors (P<0.05); while anti-platelet agents (OR, 0.422), β-blockers (OR, 0.626), statins (OR, 0.318), and IM therapy (OR, 0.583) were protective predictors (P<0.05). For cardiac death/MI, age ⩾ 65 years (OR, 6.389) and heart failure (OR, 7.969) were negative predictors (P<0.05), while statin use (OR, 0.323) was a protective predictor (P<0.05) and IM therapy showed a beneficial tendency (OR, 0.587), although the difference was not statistically significant (P=0.218).@*CONCLUSION@#In a real-world setting, for patients with CAD, IM therapy was associated with a decreased incidence of revascularization and showed a potential benefit in reducing the incidence of cardiac death or MI.