Even worse for Black girls: the longitudinal association of racial bullying with the initiation of alcohol and tobacco use.

We used Poisson's linear regression to examine the association between racial bullying (RB) and the initiation of alcohol and tobacco uses after nine months. Two cluster randomized controlled trials were conducted in 2019 with fifth (girls: 50.0%; 10 years old: 82.0%; White: 36.8%; Black: 58.7%; Others: 4.5%) and seventh graders (girls: 49.5%; 12 years old: 78.1%; White: 33.2%; Black: 60.4%; Others: 6.4%) from 30 public schools in the municipality of São Paulo, Brazil. We restricted our analyzes on two subsets of students in each grade: those who reported no lifetime alcohol use at baseline and those who reported no lifetime baseline tobacco use. At baseline, 16.2% of fifth and 10.7% of seventh graders reported suffering from RB in the 30 days before data collection. After nine months, 14.9% of fifth graders started using alcohol and 2.5%, tobacco. Among seventh graders, the figures were 31.2% and 7.7%, respectively. RB predicted the initiation of use of alcohol (risk ratio - RR=1.36, 95%CI=1.07-1.70) and tobacco (RR=1.81, 95%CI=1.14-2.76) among seventh graders, with race-gender differences, particularly in Black girls (alcohol: RR=1.45, 95%CI=1.07-1.93; tobacco: RR=2.34, 95%CI=1.31-3.99). School-based programs and policies must explicitly address issues related to racism and gender in alcohol and tobacco prevention strategies.

Mindfulness para dor em mulheres com câncer de mama: protocolo de revisão de escopo / Mindfulness for pain in women with breast cancer: a scope review protocol

OBJETIVO: Protocolo de revisão de escopo que será conduzida de acordo com a metodologia do Joanna Briggs Institute (JBI) para mapear e caracterizar evidências disponíveis sobre o uso de intervenções baseadas em mindfulness para manejo da dor em pessoas com diagnóstico de câncer de mama, nas diferentes etapas de tratamento. MÉTODO: Serão incluídos estudos realizados em mulheres adultas com 18 anos ou acima, que tenham recebido diagnóstico de câncer de mama e que passaram por intervenções baseadas em atenção plena direcionadas para manejo da dor. Será considerado o contexto clínico das participantes. Incluiremos artigos de estudos quantitativos e qualitativos, além da chamada literatura cinzenta, sem limites de idioma e tempo. Será utilizada uma estratégia de pesquisa em 3 etapas. As bases de dados utilizadas serão PubMed, CINAHL, Web of Science, BVS, PsycInfo e Google Scholar. Os resultados serão apresentados de forma gráfica e resumo narrativo, redigidos de acordo com o PRISMA-ScR.

OBJECTIVE: A scope review protocol that will be conducted according to the Joanna Briggs Institute (JBI) methodology to map and characterize available evidence on the use of mindfulness-based interventions for pain management in people diagnosed with breast cancer throughout different stages of treatment. METHOD: Studies conducted in adult women aged 18 years or older, who have received a diagnosis of breast cancer and who have undergone mindfulness-based interventions aimed at pain management will be included. The clinical context of the participants will be considered. We will include articles from quantitative and qualitative studies, in addition to the so-called grey literature, with no limits on language and time. A 3-step research strategy will be used. The following databases will be used: PubMed, CINAHL, Web of Science, VHL, PsycInfo, and Google Scholar. The results will be presented in a graphic and narrative summary, written in accordance with PRISMA-ScR.

Reduced circulating folate among older adults caused by continuous work: nested cross-sectional study conducted in a country with folic acid fortification program.

Population aging is 1 of the biggest challenges facing public health today, and cognitive dysfunction is an important concern. Cognitive impairment may be associated with high folate concentrations and low vitamin B12 concentrations; the latter is a common problem among elderly people. Therefore, we hypothesized there was a high circulating folate concentration among older people living in a country with a mandatory folic acid fortification program. We conducted a cross-sectional study to investigate nutritional status of folate and vitamin B12 among aged people. Three dietary recalls, serum folate (sfolate), erythrocyte (red blood cell) folate (RBC folate), and serum vitamin B12 and homocysteine were collected. Linear regression models were used to investigate factors associated with circulating vitamins. We interviewed 169 participants. Half reported inadequate consumption of folate. However, RBC folate deficiency was observed in 27%, 13% in the serum, and a 10% excess of sfolate. One-quarter reported inadequate consumption of B12, but only 5% had deficiency. Factors negatively associated with circulating folate were continuous work and smoking, and positively associated with polyunsaturated fatty acid. Factor negatively associated with the circulating B12 were use of a dental prosthesis and intake of saturated fatty acid. Permanent investigation of excess of sfolate and B12 deficiency, especially among older adults living in countries exposed to a mandatory folic acid fortification program, is important because of the possible relation to the cognitive function.

Fostering emotional self-regulation in female teachers at the public teaching network: A mindfulness-based intervention improving psychological measures and inflammatory biomarkers.

OBJECTIVE: To examine the effect of a mindfulness-based program specifically designed for teachers in reducing perceived stress and improving the quality of experienced emotion in female active working teachers. A second outcome evaluated is the associated change in cellular inflammatory activity, measured by peripheral blood levels of cytokines. METHOD: Eighty-eight female active teachers from public schools from São Paulo Municipality were recruited, and randomly allocated to an eight-week Mindfulness-Based Health Program for Educators (MBHP-Educa) or to Neuroscience for Education Program (Neuro-Educa: active control group). The venue of both programs were several public school facilities, where many of the teachers actually worked. Both groups received activities during eight weeks in a 2 â€‹h/week regimen, totalizing 16 â€‹h. Sixty-five participants completed the program and pre- and post-interventions measures were taken from the following scales: Interpersonal Multidimensional Reactivity Scale (IRI), Positive-and-Negative Affects Scale (PANAS), Perceived Stress Scale (PSS), Connor-Davidson Resilience Scale (CD-RISC), and a primary outcome in Ryff's Psychological Well-Being Scale (PBWS). At pre-and post-intervention, blood samples were collected for the measurement of several important inflammatory biomarkers, Tumor Necrosis Factor - α (TNF-α), Interleukin 1ß (IL-1ß), Interleukin 6 (IL-6), Interleukin 8 (IL-8), Interleukin 10 (IL-10) and Interleukin 12p70 (IL-12P70) through flow cytometry assay. Intervention effects were analyzed via Generalized mixed models (GLMM). RESULTS: According to the GLMM, MBHP-Educa significantly reduced the scores of perceived stress (p â€‹< â€‹0.0001), and negative affect (p â€‹< â€‹0.0001) compared to active control group (Neuro-Educa). Conversely, an increase was observed on Psychological Well Being Scale in dimensions of Self-acceptance (p â€‹< â€‹0.0001), and Autonomy (p â€‹= â€‹0.001), as well as improvements in Resilience (p â€‹< â€‹0.0001), and Positive Affect (p â€‹< â€‹0.0001). MBHP-Educa also promoted a reduction in the levels of IL-6 (p â€‹= â€‹0.003), IL-8 (p â€‹= â€‹0.036), and increase in the levels of IL-10 (p â€‹< â€‹0.0001) and IL-12p70 (p â€‹< â€‹0.044). TNF-α, IL-1ß, and IL-10p70 showed results below theoretical limit of detection accepted for CBA kit. CONCLUSIONS: Our data suggest that mindfulness-based interventions introduced as a strategy for reducing stress, promoting well-being and improve immune function can be a useful asset in promoting psychological health among teachers in Basic Education.

Mindfulness meditation training effects on quality of life, immune function and glutathione metabolism in service healthy female teachers: A randomized pilot clinical trial.

BACKGROUND: Despite the crucial role of educators in encourage students' academic learning, addressing educator stress inside the classroom remains a significant challenge in the educational context. Mindfulness Meditation training (MM) has been recommended as an environmental enrichment strategy in schools to help teachers cope with stress and cultivating a state of awareness in daily life. Although studies have shown that MM can improve immune system dynamics the biological mechanism underlying glutathione metabolism in a healthy human is unclear. OBJECTIVE: The purpose of this study was to determine whether MM training benefits psychological and behavioral response, immunological functions and glutathione metabolism in service healthy female teachers from public schools. METHODS: We randomly assigned 76 teachers to an 8-week Mindfulness-Based Health Program for Educators (MBHPEduca) or Neuroscience for Education program (Neuro-Educa; active control group). Using the quality of life as our primary outcome, perceived stress, negative affectivity, and resilience as our secondary outcome, and pro-inflammatory cytokines and glutathione levels as our third outcome at baseline and post-intervention that occurred in public schools. Blood samples were collected for the measurement of three proinflammatory markers, including interleukin-1ß (IL-1ß), interleukin-6 (IL-6), and interleukin-8 (IL-8) and three GSH metabolism, including Cysteine (Cys), Homocysteine (HCys) and GSH were conducted at pre-and post-intervention, with selfreported assessments over time. Treatment effects were analyzed using generalized estimating equations (GEE) with to intention to treat. RESULTS: We observed statistically significant improvements to the MBHP-Educa group compared to active control in perceived stress, resilience, positive and negative affect, and quality of life after 8-weeks MM (p â€‹< â€‹0.0001). Further, the MBHP-Educa group exhibited lower circulating IL-6 production accompanied by high circulating GSH, and Cys (p â€‹< â€‹0.0001). Additional analyses indicated that enhancing quality of life through mindfulness meditation training was mediated by reducing perceived stress and serum levels of IL- 6 and increasing resilience and teachers 'plasma GSH levels. CONCLUSIONS: The present study is a pilot trial with low-power and provides preliminary evidence that mindfulness meditation training help teachers to cope with stress in the school environment with an impact on the quality of life, immune function, and glutathione metabolism.

Mindfulness, promoção da saúde e semiótica: bases para modelos comunicacionais em saúde online / Mindfulness, health promotion, and semiotics: Bases for communication models in online health / Mindfulness, promoción de la salud e semiótica: bases para modelos de comunicación en salud em línea

OBJETIVO: identificar como o texto verbo-visual do curso produz sentidos e como isso pode auxiliar na construção do design de outros cursos. MÉTODO: foi feita a análise semiótica de duas práticas e de um print de tela do curso denominado Programa de Autocuidado Baseado em Mindfulness, na modalidade Educação à Distância, desenvolvido pelo Centro Brasileiro de Mindfulness e Promoção da Saúde ("Mente Aberta"), do Departamento de Medicina Preventiva da Universidade Federal de São Paulo. Foram avaliados os elementos estéticos que contribuiriam para a construção de um ambiente de prática eufórico (ligado à saúde) e estabelecidas relações entre o plano de conteúdo e o plano de expressão das práticas, responsáveis pela construção de um sistema semissimbólico. RESULTADOS: confirmou-se a valorização de uma estética da simplicidade de cores e formas que converge para uma afirmação dos valores calma e bem-estar compatíveis com as práticas de mindfulness. CONCLUSÃO: a partir dessa análise, busca-se refletir sobre as bases para o desenvolvimento de modelos comunicacionais relacionados à promoção da saúde em ambiente digital.

OBJECTIVE: to analyze an online course on health promotion based on mindfulness (mindfulness) through the theory of discursive semiotics in one of its most recent developments, the visual or plastic aspect. The objective is to identify how the verbal-visual text of the course produces meanings and how it can help in the design of other courses. METHOD: a semiotic analysis of two practices and a screen print of the course called Mindfulness-Based Self-Care Program, in distance learning, developed by the Brazilian Center for Mindfulness and Health Promotion ("Open Mind"), of the Department of Preventive Medicine at the Federal University of São Paulo. RESULTS: the aesthetic elements that contributed to the construction of an euphoric practice environment (linked to health) were evaluated and relationships were established between the content plan and the practice expression plan, responsible for the construction of a semi-symbolic system. CONCLUSION: it was confirmed the appreciation of an aesthetics of simplicity of colors and shapes that was converged to an affirmation of the values ​​of calm and well-being compatible with the practices of mindfulness. From this analysis, we seek to reflect on the bases for the development of communicational models related to health promotion in a digital environment.

OBJETIVO: analizar un curso en línea sobre promoción de la salud basado en la atención plena (mindfulness) a través de la teoría de la semiótica discursiva en uno de sus desarrollos más recientes, el aspecto visual o plástico. El objetivo es identificar cómo el texto verbal-visual del curso produce significados y cómo puede ayudar en el diseño de otros cursos. MÉTODO: se llevó a cabo un análisis semiótico de dos prácticas y una impresión de pantalla del curso llamado Programa de autocuidado basado en la atención plena, en educación a distancia, desarrollado por el Centro Brasileño de Mindfulness y Promoción de la Salud ("Mente Abierta"), del Departamento de Medicina Preventivade de la Universidad Federal de São Paulo. RESULTADOS: se evaluaron los elementos estéticos que contribuyeron a la construcción de un entorno de práctica eufórica (vinculado a la salud) y se establecieron relaciones entre el plan de contenido y el plan de expresión de práctica, responsables de la construcción de relaciones semi-simbólicas. CONCLUSIÓN: se confirmó la valoración de una estética de simplicidad de colores y formas, que convergió en una afirmación de los valores de calma y bienestar compatibles con las prácticas de mindfulness. A partir de este análisis, buscamos reflexionar sobre las bases para el desarrollo de modelos comunicacionales relacionados con la promoción de la salud en un entorno digital.

Terapia cognitiva baseada em mindfulness no atendimento clínico individual de depressão / Mindfulness-Based Cognitive Therapy in individual clinical care for depression / Terapia cognitiva basada en la atención plena en la atención clínica individual para la depresión

OBJETIVO: estudo de casos múltiplos teve objetivo de avaliar a aplicabilidade do protocolo de grupo de um programa de 8 semanas de Terapia Cognitiva Baseada em Mindfulness adaptado para o atendimento clínico individual de pacientes com sintomas de depressão. MÉTODO: para o estudo de casos múltiplos, no qual 11 casos de pacientes com diagnóstico de depressão leve à moderada submetidos à intervenção adaptada desse protocolo foram avaliados nos resultados de medidas de depressão, ansiedade, estresse e mindfulness. RESULTADOS: indicaram redução significativa destes sintomas, bem como aumento de mindfulness na vida cotidiana. CONCLUSÃO: os benefícios da intervenção de Terapia Cognitiva Baseada em Mindfulness podem se apresentar tanto no contexto de atendimento clínico grupal, bem como no individual. Neste estudo, Todos os participantes do estudo tiveram melhora significativa dos sintomas de depressão, bem como dos níveis de ansiedade e estresse, condizente com a os dados apresentados na literatura. É premente a necessidade de maior número de estudos desta natureza. Pesquisas futuras, especialmente as de natureza empírica, controlados e randomizados, consolidarão a validade externa dos resultados encontrados por estudos com a natureza como o deste.

OBJECTIVE: the aim of this multiple case study was to to evaluate the applicability of the group protocol of an 8-week Mindfulness-Based Cognitive Therapy program adapted for the individual clinical care of patients with symptoms of depression. METHOD: the method used was to study multiple cases, in which 11 cases of patients with a diagnosis of mild to moderate depression who underwent intervention adapted from this protocol were evaluated in the results of measures of depression, anxiety, stress and mindfulness. RESULTS: the results indicated a significant reduction in these symptoms, as well as an increase in mindfulness in everyday life. CONCLUSION: the benefits of the Mindfulness-Based Cognitive Therapy intervention can be presented both in the context of group clinical care, as well as in the individual. In this study, all study participants had significant improvement in the symptoms of depression, as well as in the levels of anxiety and stress, consistent with the data presented in the literature. There is an urgent need for a greater number of studies of this nature. Future research, especially those of an empirical nature, controlled and randomized, will consolidate the external validity of the results found by studies with nature such as this one.

OBJETIVO: el objetivo de este estudio de caso múltiple fue evaluar la aplicabilidad del protocolo grupal de un programa de terapia cognitiva basada en la atención plena de 8 semanas adaptado para la atención clínica individual de pacientes con síntomas de depresión. MÉTODO: el método utilizado fue estudiar múltiples casos, en el que 11 casos de pacientes con un diagnóstico de depresión leve a moderada que se sometieron a una intervención adaptada de este protocolo fueron evaluados en los resultados de las medidas de depresión, ansiedad, estrés y atención plena. RESULTADOS: los beneficios de la intervención de Terapia Cognitiva Basada en Mindfulness se pueden presentar tanto en el contexto de la atención clínica grupal, como en el individual. En este estudio, todos los participantes del estudio tuvieron una mejoría significativa en los síntomas de la depresión, así como en los niveles de ansiedad y estrés, consistente con los datos presentados en la literatura. Existe una necesidad urgente de un mayor número de estudios de esta naturaleza. Las investigaciones futuras, especialmente las de carácter empírico, controladas y aleatorizadas, consolidarán la validez externa de los resultados encontrados por estudios de naturaleza como este.

Validity evidence of an Instrument for Mindfulness Assessment (MA) based on its internal structure and external criterion / Evidências de validade de uma Medida de Atenção Plena (MAP) / Evidencias de validez de la Medida de Atención Plena (MAP)

Operationalizing the concept of mindfulness has been a challenge for researches. In this article, we present and discuss the procedures for the assessment of the internal structure and validity of the criteria for Mindfulness Assessment (MAP), as well as the results obtained. The collection of factors was done by exploratory factor analysis (EFA), and item- selection by item response theory (IRT). This study counted with 788 Brazilians, with ages ranging from 17 to 65 years (M = 26.11; SD = 9.59); 79% of which were women. Four factors were extracted: Mindfulness (α = 0.88), Attention (α = 0.84), Acceptance (α = 0.74) and Novelty seeking (α = 0.62). 47 items were retained in the MAP. We also compared the scores between non-meditator (n = 653) and meditator (n = 112) respondents. Analyses by IRT showed the items to be adequately adjusted. Significant differences between scores of meditators and non-meditator respondents were revealed. These findings suggest that the MAP is a valid and reliable instrument, regarding its internal structure and criterion-related evidence, which suggests its appropriateness in the study of adults...(AU)

A operacionalização da atenção plena (Mindfulness) tem sido um desafio para os pesquisadores. Neste artigo, serão apresentados e discutidos os procedimentos e resultados para verificação da estrutura interna e validade de critério da medida de atenção plena (MAP). Participaram desse estudo 788 brasileiros, com idades entre 17 e 65 anos (M = 26,11; DP = 9,59), sendo que 79% eram mulheres. A extração dos fatores se deu pela análise fatorial exploratória e a seleção dos itens incluiu métodos da teoria de resposta ao item (TRI). Foram extraídos quatro fatores: mindfulness (α = 0,88), atenção (α = 0,84), aceitação (α = 0,74) e produção de novidades (α = 0,62), tendo sido mantidos 47 itens. As análises pela TRI indicaram bons índices de ajuste dos itens. Ademais, foram encontradas diferenças nos escores de respondentes meditadores e não meditadores. Conclui-se que a MAP possui evidências de validade baseada em sua estrutura interna e de critério, o que sugere a sua adequação para a mensuração do construto em adultos...(AU)

La operacionalización del concepto de la atención plena (Mindfulness) ha sido un desafío para los investigadores. En este artículo, serán presentados y discutidos los procedimientos para verificar la estructura interna y la validez de criterio de una medida de la atención plena (MAP). Participaron 788 brasileños, de entre 17 y 65 años (M = 26,11, SD = 9,59); siendo la mayoría mujeres (79%). La extracción de los factores fue hecha a través de un análisis factorial exploratorio, y la selección de los ítems incluye métodos de la teoría de respuesta al ítem (IRT). Se extrajeron cuatro factores: atención plena (α = 0,88), atención (α = 0,84), aceptación (α = 0,74) y producción de lo nuevo (α = 0,62) y se mantuvieron 47 ítems. Los análisis realizados por el TRI indican buenos índices de ajuste de los elementos. Por otra parte, no se encontraron diferencias en las puntuaciones de los respondientes meditadores y no meditadores. Se concluye que la MAP tiene evidencia de validez en función de su estructura interna, lo que sugiere su validez para la medición de la atención plena en adultos...(AU)

Effects of Mindfulness-Based Interventions on Biomarkers and Low-Grade Inflammation in Patients with Psychiatric Disorders: A Meta-Analytic Review.

Mindfulness-Based Interventions (MBIs) present positive effects on mental health in diverse populations. However, the detailed associations between MBIs and biomarkers in patients with psychiatric disorders remain poorly understood. The aim of this study was to examine the effects of MBIs on biomarkers in psychiatric illness used to summarise the effects of low-grade inflammation. A systematic review of PubMed, EMBASE, PsycINFO, and the Cochrane Library was conducted. Effect sizes (ESs) were determined by Hedges' g and the number needed to treat (NNT). Heterogeneity was evaluated. A total of 10 trials with 998 participants were included. MBIs showed significant improvements in the event-related potential amplitudes in attention-deficit hyperactivity disorder, the methylation of serotonin transporter genes in post-traumatic stress disorder, the salivary levels of interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF-α) in depression, and the blood levels of adrenocorticotropic hormone (ACTH), IL-6, and TNF-α in generalised anxiety disorder. MBIs showed low but significant effects on health status related to biomarkers of low-grade inflammation (g = -0.21; 95% confidence interval (CI) -0.41 to -0.01; NNT = 8.47), with no heterogeneity (I2 = 0; 95% CI 0 to 79). More trials are needed to establish the impact of MBIs on biomarkers in psychiatric illness.

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

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.

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.

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.

Burnout and Well-Being Levels of Medical Students: a Cross-Sectional Study / Níveis de Burnout e Bem-Estar de Estudantes de Medicina: um Estudo Transversal

Abstract: Introduction: The presence of chronic stress, caused by the activities and demands of the medical course, can lead to what is called 'burnout', a syndrome characterized by three dimensions: emotional exhaustion, dehumanization (or depersonalization) and reduced professional achievement. Considering the increased incidence of burnout syndrome, anxiety and depression symptoms, suicide attempts and suicide rates among medical students, as a consequence of increasing demands for professional and financial success at the expense of physical and mental health, one understands the importance of studying the subject and proposing measures of prevention and control. The aim of this study was to evaluate and describe the levels of burnout and well-being of medical students at a Brazilian public university. Method: The stress and well-being levels of students from the first to the sixth year for the Medical Course at Universidade Federal de São Paulo were evaluated using MBI-SS and WHOQOL-BREF questionnaires, applied online on the REDCAP platform. Results: A total of 302 students completed the questionnaires. Regarding the MBI-SS, students showed a low value in the emotional exhaustion factor and high levels of professional disbelief and effectiveness, indicating a burnout that ranged from low to moderate. It was also observed that female students showed a greater tendency toward emotional exhaustion when compared to male ones, as well as the fact that students from the 1st and 2nd years showed higher values of professional effectiveness when compared with 3rd and 4th years, with no difference between genders. Based on the answers from WHOQUOL-BREF questionnaire, the students thought they had a good quality of life. Discussion: These results reinforce possible factors that might interfere with the students' quality of life: excessive workload, teaching model based on extensive lectures, lack of stimulation, recognition for their efforts. Conclusion: The medical students evaluated in this study have a good quality of life and show low or moderate burnout levels.

Resumo: Introdução: A presença de estresse crônico, causado pelas atividades e exigências do curso de Medicina, pode levar ao que se chama de burnout, uma síndrome caracterizada por três dimensões: exaustão emocional, desumanização (ou despersonalização) e reduzida realização profissional. Diante do aumento da incidência de síndrome de burnout, sintomas de ansiedade e depressão, tentativas de suicídio e suicídio entre estudantes de Medicina, encarado como consequência de exigências cada vez maiores de alcance de sucesso profissional e financeiro em detrimento da saúde física e mental, entende-se a importância de estudar o assunto e propor medidas de prevenção e controle. Este estudo teve como objetivos avaliar e descrever os níveis de burnout e qualidade de vida dos estudantes de Medicina da Universidade Federal de São Paulo. Método: Foram avaliados os níveis de burnout e qualidade de vida dos alunos do primeiro ao sexto ano do curso de Medicina da Unifesp, a partir dos questionários MBI-SS e Whoqol-Bref, on-line, em plataforma REDCap. Resultados: Um total de 302 estudantes responderam aos questionários completos. Em relação ao MBI-SS, os estudantes apresentaram baixo valor no fator exaustão emocional e altos valores na descrença e eficácia profissional, indicando um burnout entre baixo e moderado. Observou-se também que estudantes do gênero feminino apresentaram maior tendência à exaustão emocional em comparação ao gênero masculino, bem como estudantes do primeiro e segundo anos apresentaram maiores valores de eficácia profissional quando comparados com os do terceiro e quarto anos, sem diferença entre os gêneros. A partir das respostas do Whoqol-Bref, os estudantes consideraram ter boa qualidade de vida. Esses resultados indicam possíveis fatores que podem interferir na qualidade de vida dos estudantes: a carga horária excessiva de atividades, modelo de ensino baseado em aulas expositivas extensas, ausência de estímulo e reconhecimento pelos seus esforços. Conclusão: Os estudantes de Medicina avaliados neste estudo têm boa qualidade de vida e níveis baixos ou moderados de burnout, atentando-se para as diferenças entre anos de curso e características sociodemográficas.

Mindfulness in Education and Paulo Freire: a reflective approach / Mindfulness en la Educación y Paulo Freire: un abordaje reflexivo / Mindfulness na Educação e Paulo Freire: uma abordagem reflexiva

This essay makes a theoretical reflection upon possible conceptual proximities between the contemporary application of Mindfulness in education and the educational proposals of Paulo Freire. The study manages to approximate Freire to Mindfulness through a few concepts such as "openness to the new" and 'critical curiosity', which are related to a certain kind of development of awareness. We conclude that the contributions of mindfulness to the educational process as understood by Paulo Freire are related to the ability to develop a state of presence that brings more awareness to mental and emotional states, as much as it leads to conscious actions opposed to actions in the autopilot. Awareness (which is close to the concept of action-reflection in Freire) becomes, thus, a keyword for transformation towards lesser mental, emotional, physical and social/interpersonal suffering, both in Freire and in Mindfulness.(AU)

Este ensayo proporciona una reflexión teórica sobre la posible proximidad conceptual entre la aplicación contemporánea de Mindfulness (atención plena) en la educación y las propuestas educativas de Paulo Freire. El estudio consigue aproximar los conceptos de Freire del cuadro de referencia de la Atención Plena, por medio de conceptos tales como "apertura a lo nuevo" y "curiosidad crítica", relacionados con cierto tipo de desarrollo de la conciencia (awareness). Se concluye que las contribuciones de la atención plena para el proceso educativo, conforme entendido por Paulo Freire, se relacionan con la capacidad de desarrollar un estado de presencia que brinde más conciencia de los estados mentales y emocionales, además de llevar las acciones conscientes en oposición a las inconscientes. La conciencia, concepto próximo al de reflexión-acción en Freire, se convierte, por lo tanto, en una palabra clave para la transformación hacia la disminución del sufrimiento mental, emocional, físico y social/interpersonal, tanto en Freire como en Mindfulness.(AU)

Este ensaio traz uma reflexão teórica sobre a possível proximidade conceitual entre a aplicação contemporânea de Mindfulness (Atenção Plena) na Educação e as propostas educacionais de Paulo Freire. O estudo consegue aproximar os conceitos de Freire do quadro referencial da Atenção Plena, por meio de conceitos como "abertura ao novo" e "curiosidade crítica", relacionados a certo tipo de desenvolvimento da consciência (awareness). Conclui-se que as contribuições da Atenção Plena para o processo educacional, conforme entendido por Paulo Freire, relacionam-se à capacidade de desenvolver um estado de presença que traga mais consciência aos estados mentais e emocionais, além de levar a ações conscientes em oposição a ações inconscientes. Consciência, conceito próximo ao de reflexão-ação em Freire, torna-se, portanto, uma palavra-chave para a transformação em direção à diminuição do sofrimento mental, emocional, físico e social/interpessoal, tanto em Freire quanto no Mindfulness.(AU)

Evaluation of the quality of Primary Health Care services for children: reflections on the feasibility of using the Brazilian version of the Primary Care Assessment Tool as a routine assessment tool / Avaliação da qualidade dos serviços de Atenção Primária à Saúde para crianças: reflexões sobre a viabilidade do uso rotineiro do Primary Care Assessment Tool-Brazil

ABSTRACT Objective To assess the quality of the Primary Health Care services provided to children and the feasibility of using the Brazilian version of Primary Care Assessment Tool (PCAT-Brazil) as a routine quality assessment tool. Methods A cross-sectional study was carried out in Joanópolis, a small rural town in the State of São Paulo (SP), Brazil. Seven health professionals and 502 caretakers of children using the public health center were interviewed using the PCAT-Brazil, collecting data on the core and related attributes of Primary Health Care provided to children. The score of each attribute was calculated. Results Caretakers rated as good the following attributes; "degree of affiliation", "first contact care − use of services", "coordinated care", and "comprehensive care − available services". The attributes of "first contact accessibility", "long term person care", "comprehensive care − offered services" and "family- and community-oriented care" were scored as poor. The health professionals only rated the attribute of "first contact accessibility" as satisfactory, and considered that all other Primary Health Care attributes needed improvement. To conduct this study, at least 1,241 working hours were invested, and the estimated budget was R$12.900,00 (or U$3,953.00). Conclusion The use of the PCAT-Brazil as a routine assessment and planning tool seemed to be not feasible in the given setting due to high costs, lack of trained personnel and the huge workload. To overcome the encountered obstacles, advices are given based on field experience.

RESUMO Objetivo Avaliar a qualidade dos serviços de Atenção Primária à Saúde prestados às crianças e a viabilidade de usar a versão brasileira da Primary Care Assessment Tool (PCAT-Brazil) como ferramenta rotineira de avaliação da qualidade. Métodos Estudo transversal, realizado em Joanópolis, um pequeno município rural no Estado de São Paulo. Sete profissionais de saúde e 502 responsáveis legais de crianças que usaram o centro de saúde foram entrevistados usando a PCAT-Brazil, para coleta de dados sobre os atributos essenciais e derivados dos serviços de Atenção Primária à Saúde oferecidos às crianças. Foi calculado o escore para cada atributo. Resultados Os responsáveis classificaram como satisfatórios os atributos como "grau de afiliação", "acesso de primeiro contato − utilização", "coordenação" e "integralidade − serviços disponíveis". Os atributos "acesso de primeiro contato − acessibilidade", "longitudinalidade", "integralidade − serviços prestados" e "orientação familiar e comunitária" foram classificados como insatisfatórios. Por outro lado, os profissionais de saúde apenas classificaram o atributo "acessibilidade do primeiro contato" como satisfatório e consideraram todos os outros atributos de Atenção Primária à Saúde como necessidade de melhoria. Para realizar este estudo, foram investidas pelo menos 1.241 horas de trabalho e o orçamento estimado foi de R$12.900,00 (ou U$3,953.00). Conclusão Usar a PCAT-Brazil como ferramenta de avaliação e planejamento de rotina pareceu não ser viável neste estudo, pelos altos custos, pela falta de pessoal treinado e pelo grande número de horas de trabalho exigido. Para superar os obstáculos encontrados, conselhos foram formulados com base na experiência de campo.

Evidência de validade da medida de atenção plena pela relação com outras variáveis / Validity evidence of a measurement of mindfulness, based on its relations to other variables / Evidencia de validez de la medida de atención plena por la relación con otras variables

Atenção plena é uma qualidade da consciência que surge ao prestar atenção às experiências percebidas no momento presente. Este artigo objetiva buscar evidências de validade da Medida de Atenção Plena (MAP) pela sua relação com outros construtos. Participaram 553 brasileiros adultos, a maioria universitários e com média de idades de 23,15 anos (DP = 7,34), os quais responderam às MAP, Bateria Fatorial de Personalidade, Escala de Afetos Positivos e Afetos Negativos, Escala de Satisfação de Vida, Bateria Psicológica da Atenção e à Medida de Inteligência Emocional. Foram efetuadas correlações entre os escores da MAP e os demais instrumentos. Encontraram-se correlações significativas entre mindfulness e os traços abertura e realização, afeto negativo e satisfação de vida. Atenção alternada, concentrada e geral e inteligência emocional mostraram-se associadas ao fator mindfulness. Conclui-se que a MAP possui evidências favoráveis de validade pela relação com outras variáveis, entretanto, novos estudos são demandados com o instrumento. (AU)

Mindfulness is a quality of consciousness, which may occur when one is intentionally aware of inner experiences. In this study, we have gathered validity evidence for a Measurement of Mindfulness (MAP), based on its relation to other variables (N=553). Participants included 553 Brazilian adults, mostly undergraduate students, with a mean age of 23.15 years (SD 7.34). We correlated the z-scores of MAP with the scores of the Factorial Battery of Personality, Positive affect and Negative Affect Scales, Satisfaction with Life Scale, Psychological Battery of Attention, and Measurement of Emotional Intelligence. Correlations were made between the MAP and other instruments. Significant correlations were found between mindfulness and the traits Openness and Satisfaction, negative affect and life satisfaction. Focused, alternating and general attention showed significant associations with mindfulness. Furthermore, we observed significant associations of emotional intelligence with mindfulness and novelty seeking. We conclude that the MAP is a valid instrument based on its relations to other variables; however, further studies with this instrument are necessary. (AU)

Atención Plena es una cualidad de la conciencia que surge al prestar atención a las experiencias internas percibidas en el presente momento. Este artículo tiene por objetivo buscar evidencias de validez de la Medida de Atención Plena en su relación con otros constructos. Participaron 553 brasileños adultos, mayoría universitarios y con edad media de 23,75 años; DP=7,34), los cuales respondieron Medida de Atención Plena (MAP), Batería Factorial de Personalidad, Escala de Afectos Positivos y Afectos Negativos, Escala de Satisfacción de vida, Batería Psicológica de Atención, y Medida de Inteligencia Emocional. Fueron efectuadas correlaciones entre los resultados de MAP y los demás instrumentos. Se encontraron correlaciones significativas entre Atención Plena y los trazos de Apertura y Realización, afecto negativo y satisfacción de vida. Atención alternada, concentrada y general, e inteligencia emocional se mostraron asociadas al factor Atención Plena. El estudio permite concluir que MAP posee evidencias favorables de validez por su relación con otras variables, mientras tanto, nuevos estudios son necesarios con el instrumento. (AU)

Estresse percebido em profissionais da Estratégia Saúde da Família / Perceived stress among Primary Health Care Professionals in Brazil

RESUMO: Objetivo: Avaliar o estresse percebido (EP) de profissionais da Estratégia de Saúde da Família (ESF) e a associação com características das equipes. Também foi investigada a ocorrência de associação entre EP e morbidade autorreferida. Métodos: Trata-se de estudo transversal com 450 trabalhadores de 60 equipes em 12 Unidades Básicas de Saúde (UBS), em uma região de São Paulo. As diferenças entre o escore total da Escala de Estresse Percebido e suas associações com as características individuais e das equipes foram avaliadas por meio de modelos múltiplos de regressão linear. Resultados: Observaram-se níveis mais elevados de EP naqueles com tempo de trabalho igual ou superior a um ano na mesma equipe, nas categorias de médicos, enfermeiros e agentes comunitários de saúde, gênero feminino, em não praticantes de credos religiosos, e em profissionais de UBS com equipes incompletas (ausência do médico). Menor estresse percebido foi encontrado em viúvos. Observou-se que indivíduos com níveis mais elevados de EP têm mais chance de relatar problemas crônicos de saúde. Conclusão: Conclui-se que a percepção de estresse na população estudada está associada a fatores individuais, profissionais, e à composição das equipes nas unidades básicas de saúde.

ABSTRACT: Objective: To evaluate the perceived stress (PS) of professionals in Primary Health Care and its association with the characteristics of the teams in the Family Health Program (FHP). The association between PS and self-referred morbidity was also investigated. Methods: This is a cross-sectional study conducted with 450 employees from 60 teams in 12 Basic Health Units (BHUs) in a region of São Paulo. The differences in the total score in the Perceived Stress Scale were evaluated through multiple linear regression models. Results: Higher levels of PS were observed in those who had been working for one year or more in the same team, in the categories of doctors, nurses and community health workers, females, non-religious, and in BHU professionals in incomplete teams (absence of a physician). Lower perceived stress was found in widowers. It was observed that individuals with higher levels of PS have higher chances of reporting chronic health problems. Conclusion: It can be concluded that the perception of stress in this population is associated with individual, professional factors, and the composition of teams in healthcare units.

Uma agenda de pesquisa para a Atenção Primária à Saúde no estado de São Paulo, Brasil: o estudo ELECT / A research agenda for Primary Health Care in the state of Sao Paulo, Brazil: the ELECT study / Una agenda de investigación para la Atención Primaria de Salud en el estado de Sao Paulo, Brasil: el estudio ELECT

A consolidação da Atenção Primária à Saúde (APS) requer políticas públicas embasadas por evidências científicas. Este artigo apresenta o estudo ELECT, cujo objetivo foi identificar temas prioritários de pesquisa para a fortalecimento da APS no estado de São Paulo, Brasil. Com a participação de especialistas e de um grupo focal com usuários, foi obtida uma lista com os vinte principais obstáculos, bem como dez temas de pesquisa prioritários, na APS. Os resultados apontam para problemas e temas de pesquisas relacionados à: organização da gestão, capacitação de profissionais e gestores, valorização profissional, criação de mecanismos de colaboração entre equipes de saúde e informatização dos recursos. Espera-se, assim, estimular o debate no contexto da APS sobre o papel da priorização de pesquisas, seus obstáculos e proposições de pesquisa. Almeja-se, também, estimular a adoção de modelos mais participativos de seleção de temas de pesquisa.(AU)

The consolidation of Primary Health Care (PHC) requires public policies based on scientific evidence. This paper presents the ELECT study, aimed to identify priority research themes for strengthening PHC in the state of Sao Paulo, Brazil. A list of the twenty main obstacles and ten priority research themes in PHC were obtained with participation of specialists and a focus group with users. The results point to problems and research issues related to organizational management, training of professionals and managers, professional development, creation of cooperation mechanisms between health teams and computerization of resources. It is expected to stimulate debate in the context of the PHC on the role of research prioritization, its obstacles and research propositions. It also aims to encourage the adoption of more participatory models of selection of research topics.(AU)

La solidificación de la Atención Primaria de Salud (APS) requiere políticas públicas con base en evidencias científicas. Este artículo presenta el estudio ELECT, cuyo objetivo fue identificar temas prioritarios de investigación para el fortalecimiento de la APS en el estado de São Paulo. Con la participación de especialistas y de un grupo de opinión formado por usuarios, se obtuvo una lista con los veinte principales obstáculos, así como diez temas de investigación prioritarios en la APS. Los resultados señalan problemas y temas de investigación relacionados a la organización de la gestión, la capacitación de profesionales y gestores, la valorización profesional, la creación de mecanismos de colaboración entre equipos de salud e informatización de los recursos. Se espera por lo tanto incentivar el debate en el contexto de la APS sobre el papel de la priorización de investigaciones, sus obstáculos y propuestas de investigación. Se anhela también incentivar la adopción de modelos más participativos de selección de temas de investigación.(AU)

A systematic review of the process of regionalization of Brazil's Unified Health System, SUS. / O processo de regionalização do SUS: revisão sistemática.

This review focuses only on specific studies into the SUS regionalization process, which were based on empirical results and published since 2006, when the SUS was already under the aegis of the Pact for Health framework. It was found that the regionalization process is now underway in all spheres of government, subject to a set of challenges common to the different realities of the country. These include, primarily, that committee-structured entities are valued as spaces for innovation, yet also strive to overcome the bureaucratic and clientelist political culture. Regional governance is further hampered by the fragmentation of the system and, in particular, by the historical deficiency in planning, from the local level to the strategic policies for technology incorporation. The analyses enabled the identification of a culture of broad privilege for political negotiation, to the detriment of planning, as one of the main factors responsible for a vicious circle that sustains technical deficiency in management.

O processo de regionalização do SUS: revisão sistemática / A systematic review of the process of regionalization of Brazil's Unified Health System, SUS

Resumo Nesta revisão foram incluídos apenas estudos específicos sobre o processo de regionalização do SUS, baseados em resultados empíricos e publicados a partir de 2006, já sob o referencial do Pacto pela Saúde. Foi evidenciado que o processo de regionalização é hoje uma realidade em todas as esferas de governo, sujeito a um conjunto de desafios comuns às diversas realidades do país. Entre os principais, os colegiados são valorizados com espaços de inovação, mas ainda em busca da superação da cultura política burocrática e clientelista. A governança regional é ainda prejudicada pela fragmentação do sistema e, em particular, pela histórica deficiência com planejamento, desde o nível local às políticas estratégicas de incorporação tecnológica. As análises permitiram implicar a cultura de amplo privilégio para negociação política em detrimento do planejamento como uma das principais responsáveis por um ciclo vicioso que sustenta a deficiência técnica da gestão.

Abstract This review focuses only on specific studies into the SUS regionalization process, which were based on empirical results and published since 2006, when the SUS was already under the aegis of the Pact for Health framework. It was found that the regionalization process is now underway in all spheres of government, subject to a set of challenges common to the different realities of the country. These include, primarily, that committee-structured entities are valued as spaces for innovation, yet also strive to overcome the bureaucratic and clientelist political culture. Regional governance is further hampered by the fragmentation of the system and, in particular, by the historical deficiency in planning, from the local level to the strategic policies for technology incorporation. The analyses enabled the identification of a culture of broad privilege for political negotiation, to the detriment of planning, as one of the main factors responsible for a vicious circle that sustains technical deficiency in management.

Effects of mindfulness-based interventions on biomarkers in healthy and cancer populations: a systematic review.

BACKGROUND: Only a small number of articles have investigated the relationship between mindfulness-based interventions (MBIs) and biomarkers. The aim of this systematic review was to study the effect of MBIs on specific biomarkers (cytokines, neuropeptides and C-reactive protein (CRP)) in both healthy subjects and cancer patients. METHODS: A search was conducted using PubMed, EMBASE, PsycINFO and the Cochrane library between 1980 and September 2016. RESULTS: A total of 13 studies with 1110 participants were included. In the healthy population, MBIs had no effect on cytokines, but were found to increase the levels of the neuropeptide insulin-like growth factor 1 (IGF-1). With respect to neuropeptide Y, despite the absence of post-intervention differences, MBIs may enhance recovery from stress. With regard to CRP, MBIs could be effective in lower Body Mass Index (BMI) individuals. In cancer patients, MBIs seem to have some effect on cytokine levels, although it was not possible to determine which specific cytokines were affected. One possibility is that MBIs might aid recovery of the immune system, increasing the production of interleukin (IL)-4 and decreasing interferon gamma (IFN-γ). CONCLUSIONS: MBIs may be involved in changes from a depressive/carcinogenic profile to a more normalized one. However, given the complexity and different contexts of the immune system, and the fact that this investigation is still in its preliminary stage, additional randomized controlled trials are needed to further establish the impact of MBI programmes on biomarkers in both clinical and non-clinical populations.