Práticas integrativas e complementares em saúde entre estudantes universitários: motivos de uso e de não uso / Integrative and complementary health practices among university students: reasons for use or non-use

Resumo O objetivo deste estudo é compreender os motivos de uso e não uso das práticas integrativas e complementares entres estudantes universitários da área da saúde. Trata-se de uma pesquisa quanti-qualitativa, com dados coletados por meio de questionários (667) e entrevistas (34) e submetidos à análise de conteúdo. Os efeitos terapêuticos, a influência familiar e a oferta de alternativa à biomedicina foram as principais razões elencadas para o uso das práticas integrativas e complementares, ao tempo que a ausência de demanda, o desinteresse e a falta de oportunidade foram as motivações mais frequentes para o não uso. Nesse sentido, as motivações de uso enfatizam as vantagens obtidas através da interlocução com essas práticas e alguns contextos que determinam sua adoção. Em relação às motivações de não uso, destaca-se um cenário de baixa oferta e dominância da biomedicina na cultura ocidental contemporânea. Portanto, esses resultados corroboram a demanda de enfrentamento da monocultura da biomedicina, bem como a abordagem das práticas integrativas na educação superior. Desse modo, a universidade pode se construir a partir da tessitura entre diferentes culturas em saúde, com a facilitação do emprego das práticas não hegemônicas e a ampliação das bases epistêmicas de cuidado na formação e vida da comunidade acadêmica.

Abstract The objective of this study is to understand the reasons for use or non-use of the integrative and complementary practices among university health students. It is a quantitative and qualitative research, with data collected with questionnaires (667) and interviews (34), and investigated by content analysis. Therapeutic effects, family influence, and offer of alternatives to biomedicine were the main reasons for use of integrative and complementary practices, while the absence of demand, disinterest, and lack of opportunity were the most frequent barriers for use. Therefore, the motivations for use emphasize advantages obtained with these practices and some contexts that determine their adoption. Regarding the barriers for use, a scenario of low availability and dominance of biomedicine in contemporary western culture stands out. Therefore, these results corroborate the demand to confront the monoculture of biomedicine, as well as the inclusion of integrative practices in higher health education. Thus, university can be built on dialogues between different cultures in health, facilitating the use of non-hegemonic practices and expanding the epistemic bases of care in the formation and the life of the academic community.

The contribution and perspectives of proteomics to uncover ovarian cancer tumor markers.

Despite all the advances in understanding the mechanisms involved in ovarian cancer (OC) development, many aspects still need to be unraveled and understood. Tumor markers (TMs) are of special interest in this disease. Some aspects of clinical management of OC might be improved by the use of validated TMs, such as differentiating subtypes, defining the most appropriate treatment, monitoring the course of the disease, or predicting clinical outcome. The Food and Drug Administration (FDA) has approved a few TMs for OC: CA125 (cancer antigen 125; monitoring), HE4 (Human epididymis protein; monitoring), ROMA (Risk Of Malignancy Algorithm; HE4+CA125; prediction of malignancy) and OVA1 (Vermillion's first-generation Multivariate Index Assay [MIA]; prediction of malignancy). Proteomics can help advance the research in the field of TMs for OC. A variety of biological materials are being used in proteomic analysis, among them tumor tissues, interstitial fluids, tumor fluids, ascites, plasma, and ovarian cancer cell lines. However, the discovery and validation of new TMs for OC is still very challenging. The enormous heterogeneity of histological types of samples and the individual variability of patients (lifestyle, comorbidities, drug use, and family history) are difficult to overcome in research protocols. In this work, we sought to gather relevant information regarding TMs, OC, biological samples for proteomic analysis, as well as markers and algorithms approved by the FDA for use in clinical routine.

A proteomic signature of ovarian cancer tumor fluid identified by highthroughput and verified by targeted proteomics.

UNLABELLED: Tumor fluid samples have emerged as a rich source for the identification of ovarian cancer in the context of proteomics studies. To uncover differences among benign and malignant ovarian samples, we performed a quantitative proteomic study consisting of albumin immunodepletion, isotope labeling with acrylamide and in-depth proteomic profiling by LC-MS/MS in a pool of 10 samples of each histological type. 1135 proteins were identified, corresponding to 505 gene products. 223 proteins presented associated quantification and the comparative analysis of histological types revealed 75 differentially abundant proteins. Based on this, we developed a panel for targeted proteomic analysis using the multiple reaction monitoring (MRM) method for validation of 51 proteins in individual samples of high-grade serous ovarian tumor fluids (malignant) and benign serous cystadenoma tumor fluids. This analysis showed concordant results in terms of average amounts of proteins, and APOE, SERPINF2, SERPING1, ADAM17, CD44 and OVGP1 were statistically significant between benign and malignant group. The results observed in the MRM for APOE were confirmed by western blotting, where APOE was more abundant in malignant samples. This molecular signature can contribute to improve tumor stratification and shall be investigated in combination with current biomarkers in larger cohorts to improve ovarian cancer diagnosis. BIOLOGICAL SIGNIFICANCE: Despite advances in cancer research, ovarian cancer has a high mortality and remains a major challenge due to a number of particularities of the disease, especially late diagnosis caused by vague clinical symptoms, the cellular and molecular heterogeneity of tumors, and the lack of effective treatment. Thus, efforts are directed to better understand this neoplasia, its origin, development and, particularly the identification and validation of biomarkers for early detection of the disease in asymptomatic stage. In the present work, we confirmed by MRM method in individual ovarian tumor fluid samples the regulation of 27 proteins out of 33 identified in a highthroughput study. We speculate that the presence and/or differential abundance observed in tumor fluid is a cooperation primarily of high rates of secretion of such tumor proteins to extra tumor environment that will at the end accumulate in plasma, and also the accumulation of acute-phase proteins throughout the entire body. On top of that, consideration of physiological influences in the interpretation of expression observed, including age, menopause status, route-of-elimination kinetics and metabolism of the tumor marker, coexisting disease, hormonal imbalances, life-style influences (smoking, alcoholism, obesity), among others, are mandatory to enable the selection of good protein tumor marker candidates for extensive validation.

Representações sociais de doença, usos e significados atribuídos às Práticas Integrativas e Complementares por universitários / Social representations of disease, uses and meanings attributed to Integrative and Complementary Practices by students

RESUMO O objetivo deste estudo foi apreender as representações sociais de estudantes universitários sobre a doença e analisar os usos e significados conferidos por eles às Práticas Integrativas e Complementares. Para isso, realizou-se uma pesquisa qualitativa apoiada na Teoria das Representações Sociais, utilizando um questionário semiestruturado para a coleta dos dados, que incluiu, em sua estrutura, o Teste de Associação Livre de Palavras. A maior parte dos estudantes declarou estar no primeiro semestre do curso, na faixa etária de 18 a 24 anos e possuir religião. Para eles, a doença esteve mais associada ao desequilíbrio, sendo a massagem a prática mais adotada. Esses estudantes relacionaram as práticas integrativas à produção de benefícios à vida, à saúde e à manutenção ou alcance da qualidade de vida individual. Nesse sentido, as respostas sugerem que os discentes acreditam na eficácia das práticas integrativas, considerando-as como ligadas à promoção, prevenção e recuperação da saúde. Eles mostram-se abertos a outras racionalidades médicas, ainda que também estejam ligados ao modelo biomédico. Compreender como estudantes pensam a doença e a utilização de práticas integrativas colabora para atribuir sentidos aos projetos terapêuticos organizados no sistema de saúde, dirigindo-se a atenção para a construção da integralidade do cuidado.

ABSTRACT The objective of this study was to apprehend the social representations of university students about disease and to analyze the uses and meanings conferred by them to Integrative and Complementary Practices. For this purpose, a qualitative research based on the Theory of Social Representations was carried out, using a semi-structured questionnaire to collect the data, which included, in its structure, the Free Word Association Test. The majority of students declared to be attending the first semester of the course, in the age group of 18 to 24 years old and has a religion. For them, disease was most associated with imbalance, with massage being the practice most adopted. These students have related integrative practices to production of benefits to life, health and maintenance or achievement of individual quality of life. In this sense, the answers suggest that students believe in the efficacy of integrative practices, considering them as linked to health's promotion, prevention and recovery. They are open to other medical rationalities, although they are also linked to the biomedical model. Understanding how students think about disease and use of integrative practices collaborate to assign meanings to therapeutic projects organized in health system, directing the health care to construction of comprehensive care.