Influence of acupuncture needle physical-chemical properties on needling quality.

OBJECTIVES: This study analyzed the physical-chemical properties of three different brands of acupuncture needle, classified by acupuncturists as high (A), medium (B) and low (C) quality. METHODS: Experienced acupuncturists, rated, in terms of perceived needling quality, three acupuncture needle brands as high (A), medium (B) and low (C) quality. Next, scanning electron microscopy (SEM) images of the tip and surface finish of the needles of each brand were analyzed. A mechanical test was developed and performed to evaluate the compressive force required to insert the needles through a smooth surface (silicon). In addition, X-ray fluorescence spectroscopy (XRF) and dispersive energy spectroscopy (DES) were conducted to analyze the material composition of the needles and presence of oxidation. RESULTS: SEM images revealed that needle brands A and B presented a sharper tip and a more regular surface finish in comparison to brand C. In the insertion test, needle brands A and B had similar performance characteristics, with A requiring less force to penetrate the silicon device when compared to B, while C failed to penetrate the silicon and complete the test. The XRF analysis did not reveal any differences in material composition between the three brands. However, brand C exhibited particles embedded on the needle surface and DES confirmed oxidation. CONCLUSION: This study demonstrates that perceived needling quality by acupuncturists can be correlated with physical-chemical properties of the needles, especially those related to finishing quality of the tip and the surface of the needles.

The role of the vagus nerve in fibromyalgia syndrome.

Fibromyalgia (FM) syndrome is a common illness characterized by chronic widespread pain, sleep problems, fatigue, and cognitive difficulties. Dysfunctional neurotransmitter systems that influence the body's endogenous stress response systems are thought to underlie many of the major FM-related symptoms. A model of FM pathogenesis suggests biological and psychosocial variables interact to influence the genetic predisposition, but the precise mechanisms remain unclear. The Polyvagal Theory provides a theoretical framework from which to investigate potential biological mechanisms. The vagus nerve (VN) has anti-inflammatory properties via its afferent and efferent fibers. A low vagal tone (as assessed by low heart rate variability), has been observed in painful and inflammatory diseases, including FM, while the ventral branch of the VN is linked to emotional expression and social engagement. These anti-inflammatory and psychological (limbic system) properties of the VN may possess therapeutic potential in treating FM. This review paper summarizes the scientific literature regarding the potential role of the VN in transducing and/or therapeutically managing FM signs and symptoms.

Peripheral receptors and neuromediators involved in the antihyperalgesic effects of acupuncture: a state-of-the-art review.

The present study aims to describe state-of-the-art of preclinical studies that have investigated peripheral receptors and neuromediators involved in the antihyperalgesic effects of acupuncture. The PubMed, Scopus, and Web of Science databases were searched using the integrative review method. Preclinical articles that involved the study of peripheral receptors and neuromediators on the pain control effects of acupuncture in rats or mice were selected using a predefined search strategy. From this search, 456 articles were found, and 29 of them met the inclusion criteria of the study. The selected articles addressed the following peripheral receptors: opioid (n = 9), adenosine (n = 5), cannabinoid (n = 5), transient receptor potential vanilloid (TRPV) (n = 3), histamine (n = 2), adrenergic (n = 1), muscarinic (n = 1), corticotrophin-releasing factor (CRF) (n = 2), IL-1 (n = 1), and endothelin (n = 1) receptors. The peripheral neuromediators correlated with the peripheral pain control effect were as follows: opioid peptides (n = 4), adenosine (n = 3), histamine (n = 1), substance P (n = 1) calcitonin gene-related peptide (CGRP) (n = 1), anandamide (n = 1), nitric oxide (n = 1), and norepinephrine (n = 1). This review summarizes the methods used to investigate the peripheral effects of acupuncture and discusses the main findings on each family of receptors and neuromediators. Ten families of peripheral receptors and 8 types of neuromediators were correlated with the antihyperalgesic effects of acupuncture in preclinical studies. Considering the benefits of a better understanding of the role of peripheral receptors and neuromediators in the context pain management, the findings of the present study highlight the importance of deepening the exploration of the peripheral mechanisms of acupuncture.

Abordagem e tratamento do tabagismo / Approach and treatment of smoking

O Sistema Único de Saúde (SUS) tem papel fundamental no auxílio às pessoas que desejam parar de fumar. Para tanto, é muito importante que os profissionais atuantes na atenção básica e assistência à saúde estejam preparados para oferecer esse auxílio. Considerando esse contexto, a Diretoria de Vigilância Epidemiológica da Secretaria de Estado da Saúde de Santa Catarina (DIVE/SES/SC), por meio de sua Gerência de Análises Epidemiológicas e Doenças e Agravos Não Transmissíveis (GADNT) e a Escola de Saúde Pública de Santa Catarina (ESPSC) disponibilizam o curso "Abordagem e Tratamento do Tabagismo".

Profile of acupuncture use among primary care physicians working in the Brazilian public healthcare system.

BACKGROUND: An introductory acupuncture course has been offered to primary health care physicians and family medicine residents in southern Brazil since 2011. OBJECTIVE: To analyze the profile of acupuncture utilization of primary care physicians who completed an introductory course of acupuncture between 2011 and 2018. METHOD: A survey using an electronic questionnaire was sent to all 119 physicians who completed the course. RESULTS: Fifty-five physicians answered the questionnaire. The majority of them reported continuation of the practice of acupuncture in scheduled appointments and on spontaneous demand. The most commonly used principles of point selection were traditional acupuncture point function, myofascial trigger point needling and point protocols. As barriers to the practice of acupuncture, time limitation and inadequate physical space were predominant. The participants described the problem-solving potential of the procedure and good patient acceptance as facilitators. The most common problems treated with acupuncture were musculoskeletal pain, and mood and anxiety disorders. A reduction in referrals to specialists and reduced prescription of pain medications were also reported. Most physicians answered that they often combined acupuncture with other medications or associated acupuncture with other complementary practices. The main adverse events reported by the participants were vascular trauma and fainting. CONCLUSION: Most primary care physicians who completed the introductory course and answered the survey still used acupuncture in their routine, primarily for the management of musculoskeletal conditions and mental health conditions. These physicians reported reductions in specialist referrals and prescription of pain medication after integrating basic acupuncture skills into primary care practice.

International ResearchKit App for Women with Menstrual Pain: Development, Access, and Engagement.

BACKGROUND: Primary dysmenorrhea is a common condition in women of reproductive age. A previous app-based study undertaken by our group demonstrated that a smartphone app supporting self-acupressure introduced by a health care professional can reduce menstrual pain. OBJECTIVE: This study aims to evaluate whether a specific smartphone app is effective in reducing menstrual pain in 18- to 34-year-old women with primary dysmenorrhea in a self-care setting. One group of women has access to the full-featured study app and will be compared with 2 control groups who have access to fewer app features. Here, we report the trial design, app development, user access, and engagement. METHODS: On the basis of the practical implications of the previous app-based study, we revised and reengineered the study app and included the ResearchKit (Apple Inc) framework. Behavior change techniques (BCTs) were implemented in the app and validated by expert ratings. User access was estimated by assessing recruitment progress over time. User evolution and baseline survey respondent rate were assessed to evaluate user engagement. RESULTS: The development of the study app for a 3-armed randomized controlled trial required a multidisciplinary team. The app is accessible for the target population free of charge via the Apple App Store. In Germany, within 9 months, the app was downloaded 1458 times and 328 study participants were recruited using it without external advertising. A total of 98.27% (5157/5248) of the app-based baseline questions were answered. The correct classification of BCTs used in the app required psychological expertise. CONCLUSIONS: Conducting an innovative app study requires multidisciplinary effort. Easy access and engagement with such an app can be achieved by recruitment via the App Store. Future research is needed to investigate the determinants of user engagement, optimal BCT application, and potential clinical and self-care scenarios for app use. TRIAL REGISTRATION: ClinicalTrials.gov NCT03432611; https://clinicaltrials.gov/ct2/show/NCT03432611 (Archived by WebCite at http://www.webcitation.org/75LLAcnCQ).

Auriculotherapy in primary health care: A large-scale educational experience in Brazil.

Auriculotherapy consists of physical stimuli applied to the outer ear and is commonly associated with traditional Chinese medicine (TCM). The authors present and discuss the development of a course that offers a semi-on-site auriculotherapy course for Brazilian primary health care (PHC) professionals. The course was funded by the Brazilian Ministry of Health and developed at the Federal University of Santa Catarina in 2015 by a team of experts in auriculotherapy. It consisted of 75 h of distance learning (five sequential modules) and 5 h of on-site learning. The modules included the following items: (1) introduction to integrative practices; (2) ear reflexology; (3) introduction to TCM; (4) biomedical view of auriculotherapy; and (5) auriculotherapy in PHC. The teaching material included a workbook for each module, 14 video lectures and an interactive ear (online resource) to study location and application to the main auricular points. The on-site lectures follow a structured script of ear palpation techniques, auricular seed insertion practice and clinical case discussions, under the supervision of trained instructors. The course was offered in 2016 and 2017 and on-site lectures took place in 25 cities, covering all Brazilian regions, in coordination with municipal or state boards of health. A total of 4273 health professionals concluded the training and their evaluation of the course was highly positive. The Brazilian experience of large-scale training shows the potential to disseminate auriculotherapy in the context of PHC, given that its practice is fast, easy to learn, safe, effective for different health problems and well accepted by the patients.

Correction to: Electroacupuncture induces antihyperalgesic effect through endothelin-B receptor in the chronic phase of a mouse model of complex regional pain syndrome type I.

The original version of this article contains an error. The Author Francisco José Cidral-Filho incorrectly listed as Francisco José Cidra-Filho. The correct spelling is presented above. The original article has been corrected.

Electroacupuncture induces antihyperalgesic effect through endothelin-B receptor in the chronic phase of a mouse model of complex regional pain syndrome type I.

Complex regional pain syndrome (CRPS) is a disorder that involves abnormal inflammation and nerve dysfunction frequently resistant to a broad range of treatments. Peripheral nerve stimulation with electroacupuncture (EA) has been widely used in different clinical conditions to control pain and inflammation; however, the use of EA in the treatment of CRPS is under investigation. In this study, we explore the effects of EA on hyperalgesia and edema induced in an animal model of chronic post-ischemia pain (CPIP model) and the possible involvement of endothelin receptor type B (ETB) in this effect. Female Swiss mice were subjected to 3 h hind paw ischemia/reperfusion CPIP model. EA treatment produced time-dependent inhibition of mechanical and cold hyperalgesia, as well as edema in CPIP mice. Peripheral administration (i.pl.) of BQ-788 (10 nmol), an ETB antagonist, prevented EA-induced antihyperalgesia while intrathecal administration prolonged EA's effect. Additionally, peripheral pre-treatment with sarafotoxin (SRTX S6c, 30 pmol, ETB agonist) increased EA anti-hyperalgesic effect. Furthermore, the expression of peripheral ETB receptors was increased after EA treatments, as measured by western blot. These results may suggest that EA's analgesic effect is synergic with ETB receptor activation in the periphery, as well as central (spinal cord) ETB receptor blockade. These data support the use of EA as a nonpharmacological approach for the management of CRPS-I, in an adjuvant manner to ETB receptor targeting drugs.

Integrating acupuncture into primary health care: the experience of an educational model implemented within the Brazilian Unified Health System in Florianópolis.

OBJECTIVE: Primary health care (PHC) is the main entry point and the first level of contact for individuals, families and communities within the Brazilian public health system. Considering that few studies have investigated the use of acupuncture in PHC, this article presents our experience in the city of Florianópolis when integrating acupuncture into PHC using an educational programme developed to teach acupuncture to primary care physicians (PCPs). METHODS: The course programme was designed using the WHO standards for acupuncture training and discussed at three consensus meetings. Between 2011 and 2014 three iterations of an introductory acupuncture course for PCPs were offered. During this period 53 physicians finished the programme. RESULTS: The number of acupuncture sessions in PHC rose from 1349 in 2011 to 6488 in 2015. It was observed in 2015 that 81% of the course participants working in PHC were regularly using acupuncture in their daily practice, with a mean number of sessions of 11.35 sessions per month. Moreover, collaborative work, which started during the course between the PCPs and the acupuncture specialists in secondary and tertiary public health care, helped to increase the quality of acupuncture referrals and facilitate clinical case discussions. CONCLUSIONS: Our experience in the city of Florianópolis shows that teaching acupuncture to PCPs is a sustainable model that can help introduce acupuncture into PHC. Furthermore it can expand access to acupuncture treatment for the population and increase the communication between PCPs and acupuncture specialists.

Educação permanente em acupuntura: análise de um processo educativo e suas repercussões na prática de médicos da atenção primária à saúde / Permanent education in acupuncture: analysis of an educational process and its repercussions on the practice of physicians in the primary health care

Atenção primária à saúde (APS) é a principal porta de entrada e o primeiro nível de contato para indivíduos, famílias e comunidades no Sistema Único de Saúde (SUS). Neste contexto, a Política Nacional de Prática Integrativas de Complementares recomenda que a acupuntura seja integrada aos cuidados da APS. Considerando que poucos estudos investigaram experiências de integração da acupuntura na APS, a presente tese tem o objetivo de analisar as repercussões de um processo de educação permanente em acupuntura na prática de médicos que atuam na atenção primária à saúde do município de Florianópolis. Trata-se de um estudo exploratório e descritivo norteado pela abordagem qualitativa. O trabalho envolveu a construção de uma atividade de ensino debatida por 13 especialistas em ensino de acupuntura durante três oficinas de consenso. Adicionalmente, buscando captar diferentes fases do processo de ensino-aprendizagem, dez médicos da APS de Florianópolis participaram de três grupos focais realizados antes do início, no final e oito meses após o término de um curso de introdução à acupuntura. Além disso, foi realizado um grupo focal com seis residentes de medicina de família e comunidade, participantes do mesmo curso, um ano após término do mesmo. Complementaram a coleta de dados o diário de campo do pesquisador e o registro de sessões de acupuntura em base de dados secundários. Utilizando o referencial da Grounded Theory, a análise dos dados (gravados e transcritos) envolveu a codificação aberta, axial e seletiva e, com auxílio do software Atlas.ti 5.0, os dados foram organizados em dois quadros de categorias. No período entre 2011 e 2014 foram realizadas três edições do curso e durante este período 53 médicos concluíram a atividade. O número de sessões de acupuntura na APS aumentou de 1.349 em 2011 para 6.488 em 2015. Neste último ano, dos 37 participantes do curso que continuavam trabalhando na APS, 30 utilizavam regularmente acupuntura em sua prática diária. A análise dos dados dos grupos focais demonstrou as motivações dos médicos para obtenção de uma nova ferramenta terapêutica, as diferentes formas de aplicação dos conhecimentos adquiridos, as interfaces entre acupuntura e APS e a integração de diferentes racionalidades médicas (Biomedicina e a Medicina Tradicional Chinesa) nos cuidados à saúde. O estudo mostra que a repercussão do ensino da acupuntura na prática de médicos da APS reflete-se na ampliação do olhar sobre processo saúde-doença, no aumento dos recursos terapêuticos e na criação de uma postura reflexiva sobre o uso de saberes médicos tradicionais e biomédicos nos cuidados à saúde.(AU)

Primary health care (PHC) is the main entry point and the first level of contact for individuals, families and communities within the Brazilian public health system. In this context, the National Policy on Complementary Integrative Practice recommends that acupuncture should be integrated into PHC. Considering that few studies have investigated experiences of acupuncture integration in PHC, this thesis aims to analyze the impact of an education process in acupuncture on the clinical practice of primary care doctors in the city of Florianópolis. This is an exploratory and descriptive study using a qualitative approach. The study involved the development of an educational activity discussed by 13 experts in acupuncture education during three consensus meetings. Seeking to capture different phases of the educational process, ten primary care doctors participated in three focus groups conducted before the start, at the end and eight months after an introductory acupuncture course. In addition, we conducted a focus group with six family medicine residents, which enrolled the same educational activity, one year after the end of course. The research methods were complemented with field notes and records from acupuncture sessions in a secondary database. Using the Grounded Theory approach, the data analysis (recorded and transcribed) involved the open, axial and selective coding and, using the Atlas.ti 5.0 software; data were organized in two tables of categories. Between 2011 and 2014 there were three editions of the course and during this period 53 doctors completed the activity. The number of acupuncture sessions in PHC increased from 1,349 in 2011 to 6,488 in 2015, and during this last year 30 out of 37 course participants, who were still working in PHC, were regularly using acupuncture in their daily practice. The focus groups analysis showed the motivations of doctors to obtain a new therapeutic tool, the different ways to use the acquired knowledge, the interfaces between acupuncture and PHC and the integration of different medical rationalities (Biomedicine and Traditional Chinese Medicine) in clinical practice. The study shows that the impact of acupuncture education in the practice of PHC doctors is reflected in an expanded vision towards the health-disease process, in the increase of therapeutic resources and in the creation of a reflective stance on the use of traditional and biomedical medical knowledge in health care.(AU)

En el Sistema Único de Salud (SUS) brasileiro, la atención primaria de la salud (APS) es la principal puerta de entrada y el primero nivel de contacto para individuos, familias y comunidades. En ese contexto la Política Nacional de Prácticas Integrativas y Complementarias recomienda que la acupuntura sea integrada a los cuidados de la APS. Teniendo en cuenta que pocos estudios investigaran experiencias de integración de la Acupuntura en la APS, la presente tesis tiene como objetivo el de analizar las repercusiones de un proceso de educación permanente en acupuntura en la práctica de médicos que actúan en la Atención Primaria de la Salud, en el municipio de Florianópolis. Tratase de un estudio exploratorio y descriptivo, que tuvo como norte el abordaje cualitativo. El trabajo implicó en la construcción de una actividad de enseñanza debatida junto a 13 especialistas en enseñanza en acupuntura durante tres talleres de consenso. Buscando captar las diferentes fases del proceso de enseñanza-aprendizaje, diez médicos de la APS de Florianópolis participaron de tres grupos focales realizados en el inicio, en el final y ocho meses después del término de un curso de introducción a la acupuntura. También fue realizado un grupo focal con seis residentes de la residencia en medicina y comunidad, participantes del mismo curso, un año después de terminado el mismo. Además, complementaron la colección de datos, el diario de campo del investigador y el registro de las sesiones de acupuntura en base de datos secundaria. Utilizando el marco de la teoría fundamentada, el análisis de los datos implicó la codificación abierta, axial y selectiva y, con la ayuda de un software Atlas.ti 5.0 se organizaron los datos en dos tablas de categorías. Entre 2011 y 2014 hubo tres ediciones del curso y durante este período de 53 médicos completaron la actividad. El número de sesiones de acupuntura en la APS aumentó de 1.349 en 2011 a 6.488 en 2015, y en este último año de los 37 participantes en el curso que todavía estaban trabajando en la APS, 30 utilizaban regularmente la acupuntura en su práctica diaria. El análisis de los datos de los grupos focales mostró las motivaciones de los médicos para obtener una nueva herramienta terapéutica, las diferentes formas de aplicación de los conocimientos adquiridos, las interfaces entre la acupuntura y la APS y la integración de las diferentes racionalidades médicas (Biomedicina y Medicina Tradicional China) en el cuidado de la salud. El estudio muestra que el impacto de la educación de la acupuntura en la práctica de los médicos de la atención primaria se refleja en la expansión de su mirada sobre el proceso de salud-enfermedad, el aumento de los recursos terapéuticos y la creación de una postura reflexiva sobre el uso de los conocimientos médicos tradicionales y biomédicos en el cuidado de la salud.(AU)

Teaching acupuncture: the Brazilian Medical Residency Programme.

Acupuncture has had a successful story in Brazil. With its use in the public health system supported by legislation since 1988, its recognition as a medical specialty in 1995 enabled the introduction of an annual board examination and the creation of an official Medical Residency Programme. Since then, medical acupuncture has developed considerably, mostly through its massive spread into the Brazilian public health system. Brazil is the only country outside China that has created a Medical Residency Programme on Acupuncture. The 2-year programme consists of 5760 training hours, beginning with major clinical areas (internal medicine, neurology, orthopaedics and gynaecology) during 24 weeks in the first year. The residents study and practice acupuncture using the traditional Chinese Medicine approach and also the biomedical model. Specialists educated by this programme are therefore expected to have an optimum knowledge of both Western and Eastern medicine. Since it was first created, nine public health institutions have adopted the residency programme on acupuncture so, rather than being an alternative therapy, acupuncture has become an easily accessible and well-accepted conventional medical resource in Brazil.