Determinants of patients preferring Complementary and Alternative medicine attending public hospitals in Lahore, Pakistan.

OBJECTIVE: To find the frequency and determinants of patients preferring complementary and alternative medicine over registered medical doctors.. METHODS: This cross-sectional study was conducted at Services Hospital, Mayo Hospital and Jinnah Hospital in Lahore, Pakistan, from June 8 to August 20, 2017.A pre-tested self-administered questionnaire was used to collect data. SPSS 20 was used for data analysis. . RESULTS: Of the 385 subjects, 200(51.9%) had visited at least one complementary and alternative medicine healer in their life. Besides, 166(83%) subjects confirmed positive outcome of such therapies. When asked about reasons behind their choice,227(59%)subjects mentioned cost effectiveness, 99(25.7%) better understanding, 131(34%) guidance about disease by such healers, 198(51.4%) harmless therapies, 198(51.4%) natural ingredients of medicines, 154(40%) accessibility, 161(41.8%) psychological satisfaction, 221(57.4%) said fewer appointments, 222(57.7%) said diagnosis without laboratory tests, 131(34%)family influence, 52(13.5%) had surgical fears, 101(26.2%) said faith in spiritual exercises, 63(16.4%) were addicted to complementary and alternative medicine products, 122(31.7%) said better communication) while183(47.5%) said sparing more time for consultation. CONCLUSIONS: There were a variety of beliefs and reasons behind patients preferring complementary and alternative medicine providers over medical doctors.

The homeopathic choice for children: a qualitative research on the decision making process of the families.

AIM: To explore the experiences of parents who chose homeopathic treatment for their children, with particular regard to the decision-making process within the family and the availability of conventional and homeopathic healthcare services. METHODS: Semi-structured interview with parents immediately after or before the homeopathic visit at the Homeopathic Clinic of Campo di Marte Hospital of Lucca (Italy) from1st March, 2012 to 18 July 2012. Answers were analyzed by frequency of response and grouped into main areas: 1. Choice of homeopathy. 2. Intra-family dynamics. 3. Behaviour in emergency situations. 4. The relationship with the homeopathic doctor. 5. The role of friends and acquaintances. 6. The 'cut off' of use of homeopathy. RESULTS: Parents who choose homeopathic treatments for their children are strongly influenced by context. The choice of homeopathy is usually made by mothers and is rarely hindered by fathers, grandparents or friends, whose approval is important and encourages parents to use homeopathy for their children, both for prevention and treatment. Easy access to the homeopathic doctor was frequently requested, especially for acute situations. CONCLUSION: This research confirms the importance of context in decision making processes. Other characteristics of families which use homeopathy, such as level of education, personal coping strategies and family context should be investigated.

Doctors of Plural Medicine, Knowledge Transmission, and Family Space in India.

The transmission of traditional medical knowledge - either institutionally or through established lineages - is assumed to involve one single tradition or another. In India however, families of doctors often engage with multiple traditions, including Ayurveda, Unani, homeopathy, yoga, and biomedicine. Parents, children, siblings and spouses trained in different medical systems occasionally share knowledge and clinical space, producing versatile therapies. By exploring such cases, I challenge studies focused on single traditions and propose to examine "family space" as the physical and relational proximity that enables kin doctors to experiment with plural therapies while negotiating legitimacy and authority within the changing institution of the Indian family.

Preparo dos pais para a desospitalização de crianças em uso de traqueostomia e gastrostomia / Preparación de los padres para la deshospitalización de niños en uso de traqueostomía y gastrostomía / Parents' preparation for the dehospitalization of children using tracheostomy and gastrostomy

RESUMO Objetivo: relatar a experiência de uma ação educativa para o preparo dos pais para a desospitalização de crianças em uso de traqueostomia e gastrostomia. Método: relato de experiência sobre uma ação educativa, que é parte de um Programa de Treinamento de um hospital público de alta complexidade referência em pediatria, no período de dezembro de 2017 a dezembro de 2018. Resultados: o preparo dos responsáveis para a desospitalização de crianças em uso de traqueostomia e gastrostomia foi feito a partir de 5 etapas: 1) Instruções aos pais; 2) Treinamento dos pais para manuseio do dispositivo utilizado pela criança; 3) Manipulação dos dispositivos pelos pais sob supervisão do enfermeiro; 4) Feedback oferecido pela Enfermagem; e 5) Avaliação da ação educativa. Considerações finais: Acredita-se que a educação terapêutica fornecida aos envolvidos contribuiu na qualificação do cuidado à criança em uso de traqueostomia e gastrostomia, favorecendo sua qualidade de vida e reduzindo as intercorrências domiciliares relacionadas ao manuseio inadequado dos dispositivos em questão.

resumen Objetivo: relatar la experiencia de una acción educativa para la preparación de los padres para la deshospitalización de niños en uso de traqueostomía y gastrostomía. Método: relato de experiencia sobre una acción educativa, que hace parte de un Programa de Entrenamiento de un hospital público de alta complejidad referencia en pediatría, en el período de diciembre de 2017 a diciembre de 2018. Resultados: la preparación de los responsables para la deshospitalización de niños en uso de traqueostomía y gastrostomía se hizo a partir de 5 etapas: 1) Instrucciones a los padres; 2) Entrenamiento de los padres para manejo del dispositivo utilizado por el niño; 3) Manipulación de los dispositivos por los padres bajo supervisión del enfermero; 4) Feedback ofrecido por la Enfermería; y 5) Evaluación de la acción educativa. Consideraciones finales: Se cree que la educación terapéutica proporcionada a los involucrados contribuyó en la calificación del cuidado del niño en uso de traqueostomía y gastrostomía, favoreciendo su calidad de vida y reduciendo las complicaciones domiciliarias relacionadas con el manejo inadecuado de los dispositivos en cuestión.

ABSTRACT Objective: to report the experience of an educational action for the preparation of parents for the dehospitalization of children using tracheostomy and gastrostomy. Method: experience report on an educational action, which is part of a Training Program of a public hospital of high complexity reference in pediatrics, from December 2017 to December 2018. Results: the preparation of those responsible for the dehospitalization of children using tracheostomy and gastrostomy was made from 5 stages: 1) Instructions to parents; 2) Training of parents to handle the device used by the child; 3) Manipulation of the devices by parents under the supervision of the nurse; 4) Feedback offered by Nursing; and 5) Evaluation of educational action. Final considerations: It is believed that the therapeutic education provided to those involved contributed to the qualification of care for children using tracheostomy and gastrostomy, favoring their quality of life and reducing home complications related to inadequate handling of the devices in question.

A relação com o saber nas atividades lúdicas escolares / The relationship with knowledge in school recreational activities / La relación con el saber en las actividades lúdicas escolares

O brincar é uma atividade importante para o desenvolvimento infantil, porque melhora aspectos cognitivos, emocionais e físicos. Além disso, jogos e brincadeiras podem ser explorados como recurso educacional. Partindo do entendimento da ludicidade enquanto um processo subjetivo, este trabalho investigou a relação com o saber estabelecida durante as brincadeiras, buscando compreendê-las em suas dimensões epistêmica, social e identitária. Dezesseis estudantes do 5º ano do ensino fundamental foram entrevistados a partir de um roteiro baseado no instrumento "balanço do saber", proposto por Bernard Charlot. As questões foram adaptadas para possibilitar apreender o que as crianças dizem aprender durante as brincadeiras em que participam, com ênfase naquelas realizadas em sala de aula. Os resultados da análise de conteúdo realizada mostraram que, apesar de existirem conflitos sobre como se estabelecem as funções lúdica e educativa, quando a brincadeira infantil é utilizada como recurso pedagógico, os sujeitos podem identificar benefícios no processo de aprendizagem por meio dela. Aponta-se, também, a necessidade de considerar a condição social da criança no ambiente escolar para o sucesso ao utilizar essas atividades como práticas pedagógicas.(AU)

Child's play is an important activity for child development since it improves cognition, emotional, and physical aspects. Games can also be explored as an educational resource. Starting from the understanding that playfulness is a subjective process, this work has investigated the relationship to the knowledge stablished during games, aiming to understand it in its epistemic, social, and identitary dimensions. A group of 16 5th grade students were interviewed from a script based on the instrument "balance of knowledge," as proposed by Bernard Charlot. The questions were adapted to enable the apprehension of what children say they learn on the games they play, emphasizing those which are played in classrooms. The results of the content analysis performed have showed that, despite the conflicts on how both playful and educative functions are stablished when child's play is used as a pedagogic resource, the subjects can identify benefits on the process of learning with it. The need to consider the child's social condition in the school environment to reach success when using these activities as pedagogical practices is also pointed out.(AU)

Jugar es una actividad importante para el desarrollo de los niños, porque mejora aspectos cognitivos, emocionales y físicos. Por tanto, los juegos son explorados como recurso educativo. Partiendo de la comprensión de que lo lúdico es un proceso subjetivo, este trabajo analizó la relación con el saber que se establece durante el juego, con el objetivo de comprenderlo en sus dimensiones epistémica, social e identitaria. Se entrevistó a dieciséis estudiantes de quinto grado a partir de un guion basado en el instrumento "balance del saber" propuesto por Bernard Charlot. Las preguntas fueron adaptadas para permitir la aprehensión de lo que los niños dicen que aprenden en sus juegos, enfatizando los que se juegan en las aulas. Los resultados del análisis de contenido realizado mostraron que, a pesar de que existen conflictos sobre cómo se establecen ambas funciones lúdica y educativa cuando se utiliza el juego infantil como recurso pedagógico, los niños pueden identificar beneficios en el proceso de aprendizaje a través del juego. Se señala la necesidad de considerar la condición social del niño en el entorno escolar para alcanzar el éxito al utilizar estas actividades como prácticas pedagógicas.(AU)

O inventário de envolvimento paterno revisado: inclusão de pais com filhos pré-escolares / The inventory of father involvement revised: inclusion of fathers with preschool children / El inventario de envolvimiento paterno revisado: inclusión de padres de preescolares

Apesar da importância do envolvimento paterno, sua avaliação persiste desafiadora. No Brasil, o Inventário de Envolvimento Paterno (IFI-BR) vem se mostrando adequado para uso com pais de crianças de 5 a 10 anos. Entretanto, do ponto de vista do desenvolvimento infantil e de intervenções preventivas, seria importante avaliar o envolvimento paterno quando as crianças são mais novas. Assim, este trabalho teve como objetivos: identificar limitações do IFI-BR, quando usado com pais de crianças entre 2 e 10 anos, e avaliar itens para o IFI-BR-revisado. No Estudo 1, 434 pais com filhos no Ensino Infantil ou Fundamental 1 responderam a um questionário sociodemográfico e ao IFI-BR. Com base em análises de dados omissos, estrutura interna e precisão, modificações foram sugeridas, visando à manutenção da estrutura interna original do instrumento. No Estudo 2, 572 pais com filhos na mesma faixa etária responderam a um questionário sociodemográfico e à versão modificada do IFI-BR. Foram comparadas as frequências de dados omissos e estimativas de precisão para os itens originais e modificados, selecionando aqueles que melhor representavam essa amostra de pais para compor a versão revisada do IFI-BR. Esses resultados indicaram evidências adequadas de validade, com base no conteúdo da versão revisada do IFI-BR, quando utilizada para avaliar a qualidade do envolvimento paterno de pais brasileiros com filhos do Ensino Infantil ao Fundamental 1. Após verificadas evidências de validade adicionais, essa versão revisada do IFI-BR poderá ser utilizada, por exemplo, em estudos longitudinais e na avaliação de intervenções precoces com pais.(AU)

Despite the importance assigned to father involvement, evaluating this construct remains a challenge. In Brazil, the Inventário de Envolvimento Paterno (IFI-BR) has showed satisfactory evidence of validity for fathers of children between 5 and 10 years old. From the perspective of child development and preventive interventions, however, evaluating father involvement with younger children is essential. Hence, this study sought to: identify limitations of the IFI-BR for fathers of children between 2 and 10 years old, and evaluate items for a revised IFI-BR. In Study 1, 434 fathers of children in early childhood and primary school settings answered a sociodemographic questionnaire and the IFI-BR. Based on analyses of missing data, internal structure, and reliability, modifications were suggested to maintain the original internal structure. In Study 2, 572 fathers of children in the same age range answered a sociodemographic questionnaire and the modified IFI-BR. After comparison between values for missing data and reliability of the original and modified items, the items that best represented the broader sample of fathers were selected to compose the revised IFI-BR. Results indicated adequate evidence of content validity for the revised IFI-BR when used to assess the involvement of Brazilian fathers with children in early childhood education and primary school settings. After additional evidence has been verified, this revised IFI-BR can be used, for example, in longitudinal studies and to evaluate early interventions with fathers.(AU)

La participación paterna es importante, pero su evaluación sigue siendo desafiadora. En Brasil, el Inventário de Envolvimento Paterno (IFI-BR) demuestra ser adecuado para aplicar a padres de niños de 5 a 10 años de edad. No obstante, desde la perspectiva del desarrollo infantil y de las intervenciones preventivas, sería importante evaluar la participación de los padres de niños más jóvenes. Este estudio tuvo como objetivos: identificar limitaciones del IFI-BR cuando se aplica a padres de niños entre los 2 y 10 años y evaluar ítems para el IFI-BR-revisado. En Estudio 1, 434 padres con hijos en el jardín de infantes o escuela primaria respondieron un cuestionario sociodemográfico y el IFI-BR. Con base en el análisis de datos faltantes, estructura interna y exactitud, se sugirieron modificaciones para mantener la estructura interna original del instrumento. En Estudio 2, 572 padres respondieron un cuestionario sociodemográfico y la versión modificada del IFI-BR. Se compararon las frecuencias de datos faltantes y estimaciones de exactitud para los ítems originales y modificados, seleccionando aquellos que representaban mejor a esta muestra de padres para la versión revisada del IFI-BR. Estos resultados indicaron evidencia adecuada de validez, basada en el contenido de la versión revisada del IFI-BR, cuando se utilizó para evaluar la calidad de la participación de padres brasileños con niños en el jardín de infantes y en la escuela primaria. Después de verificada la evidencia adicional de validez, la versión revisada del IFI-BR se puede utilizar, por ejemplo, en estudios longitudinales y en la evaluación de intervenciones precoz con los padres.(AU)

Considerações éticas relacionadas às condutas terapêuticas de pacientes terminais / Ethical considerations related to the therapeutic management of terminally ill patients / Consideraciones éticas relacionadas con la conducta terapéutica de los pacientes terminales

Objetivo: Conhecer as considerações éticas relacionadas às condutas terapêuticas das equipes de saúde frente aos pacientes terminais. Metodologia: Trata-se de um estudo exploratório de natureza qualitativa. Realizado no período de dezembro de 2020, através do acesso ao Banco de Teses e Dissertações da CAPES, considerando que este, coordena o Sistema de Pós-graduação brasileiro. Resultados: Foram identificadas seis classes semânticas, de modo que a mesma formulou a seguinte distribuição de contextos temáticos: Classe 1 Paciente terminal; Classe 2 Condutas médicas; Classe 3 Manejo terapêutico; Classe 4 Protocolos clínicos e aspectos metodológicos dos estudos; Classe 5 Dependências metodológicas e Classe 6 Suporte clínico na terminalidade Dependências metodológicas. Discussão: A morte e a vida tornam-se um impasse enfrentado pelos profissionais de saúde, pois existem fatores decisivos na vida de cada paciente em situação terminal com nenhuma esperança de cura, envolvendo assim questões éticas. Conclusão: Portanto, torna-se necessário que as instâncias de saúde assegurem protocolos, treinamentos e aporte psicológicos para esses profissionais que atuam diretamente com pacientes em situações terminais de vida, para que possa haver uma ressignificação do processo de cuidado com pacientes e segurança na tomada de decisões por parte dos profissionais de saúde, e assim possa preservar a ética.

Objective: To know the ethical considerations related to the therapeutic behavior of health teams towards terminal patients. Methodology: This is an exploratory study of a qualitative nature. Carried out in January 2020, through access to the CAPES Theses and Dissertations Bank, considering that it coordinates the Brazilian Postgraduate System. Results: Six semantic classes were identified, so that it formulated the following distribution of thematic contexts: Class 1 Terminal patient; Class 2 Medical conducts; Class 3 Therapeutic management; Class 4 Clinical protocols and methodological aspects of the studies; Class 5 Methodological dependencies and Class 6 Clinical support in terminality Methodological dependencies. Discusson: Death and life become an impasse faced by health professionals, as decisive there are factors in the life of each patient in a terminal situation with no hope of cure, thus involving ethical issues. Conclusion: Therefore, it is necessary that health institutions ensure protocols, training and psychological support for these professionals who work directly with patients in terminal situations, so that there can be a new meaning for the process of patient care and safety in decision-making by health professionals, and thus can preserve ethics.

Objetivo: Conocer las consideraciones éticas relacionadas con las conductas terapéuticas de los equipos de salud frente a los pacientes terminales. Metodología: Se trata de un estudio exploratorio de carácter cualitativo. Realizado en el período de diciembre de 2020, a través del acceso al Banco de Tesis y Disertaciones de la CAPES, considerando que este, coordina el Sistema de Pós-graduación brasileño. Resultados: Se identificaron seis clases semánticas, por lo que se formuló la siguiente distribución de contextos temáticos: Clase 1 Paciente terminal; Clase 2 Conductas médicas; Clase 3 Manejo terapéutico; Clase 4 Protocolos clínicos y aspectos metodológicos de los estudios; Clase 5 Dependencias metodológicas y Clase 6 Apoyo clínico en la terminalidad Dependencias metodológicas. Discusión: La muerte y la vida se convierten en un impasse al que se enfrentan los profesionales de la salud, porque hay factores decisivos en la vida de cada paciente en situación terminal sin esperanza de curación, lo que implica cuestiones éticas. Conclusión: Por lo tanto, se hace necesario que las instancias de salud garanticen protocolos, capacitación y apoyo psicológico para estos profesionales que trabajan directamente con los pacientes en situaciones de vida terminal, para que pueda haber una resignificación del proceso de atención al paciente y seguridad en la toma de decisiones por parte de los profesionales de la salud, y así poder preservar la ética.

Complementary and alternative medicine use in lung cancer patients in eight European countries.

This paper presents findings from a cross-sectional survey about the use of complementary and alternative medicine (CAM) in patients with lung cancer, forming part of a larger study. Data from 111 lung cancer patients in 8 countries in Europe were collected through a descriptive 27-item questionnaire. The data suggest that 23.6% of the lung cancer patients used CAM after the diagnosis with cancer. The most popular CAM modalities were herbal medicine (48.1%), medicinal teas (11.5%), homeopathy (11.5%), use of animal extracts (11.5%) and spiritual therapies (11.5%). Herbal use increased by three times after the diagnosis of cancer. Patients seemed quite satisfied with the CAM used. They were also spending on average about 142 Euros monthly on CAM therapies or remedies. The most common motivation to use CAM was to increase the body's ability to fight the cancer. Main sources of information about CAM were friends and family. As CAM is increasingly used by patients with lung cancer, it is important to be able to assist patients make an appropriate decision by discussing the issue of CAM openly, providing reassurance and communicating safe and appropriate information to patients.

A qualitative study of patient's views on the consultation at the Glasgow Homoeopathic Hospital, an NHS integrative complementary and orthodox medical care unit.

We investigated consultations at the Glasgow Homoeopathic Hospital (GHH), by the use of in-depth, semi-structured interviews with a purposive sample of 14 patients. Interviews (lasting 1-2 h) were taped and transcribed verbatim. Analysis was based on a grounded theory approach. Two main categories of themes emerged: (1) those "outside" the consultation, related to expectations, initially formed from experiences of family and friends, but then strengthened by ongoing attendance at GHH; and (2) themes "inside" the consultation including length of consultations, the whole-person approach, being treated as an individual, and telling and having their "story" listened to in depth. Equality of relationship, mutual respect, and sharing decisions were also prominent themes. In conclusion, patients attending the GHH highly value the holistic approach, and view time, empathy, and the therapeutic relationship as being of key importance.

Suicide of the elderly in Singapore.

This is a study based on data from all Coroners' case-files (Years 1969-1976) and a 'psychological post-mortem' study of all suicides for the year 1974--57 cases comprising of 39 males and 18 females. The trend of aged suicide in Singapore, the demographic data of the aged suicide population, the methods used by the aged suicide and the causative factors associated with suicide in aged are recorded, analysed and discussed. Reactions of the surviving relatives are also described. The unique features particular to the aged suicide in Singapore are noted and explained. Suicide of the aged in Singapore is mainly a study of the aged Chinese suicide.

Rewriting the history of Chinese families in nineteenth-century Australia.

The nineteenth-century Chinese population in Australia was made up mostly of men, drawing many commentators to the conclusion these men faced an absence of family life, resulting in prostitution, gambling, opium use and other so-called vices. Recent research has, however, expanded and complicated our knowledge of Chinese families in New South Wales and Victoria, particularly concerning the extent to which Chinese men and white Australian women formed intimate relationships. This article traces the origins of the misconceptions about Chinese families in nineteenth-century Australia, and considers how new directions in scholarship over the past decade are providing methods for enlarging our knowledge. It argues that instead of being oddities or exceptions, Chinese-European families were integral to the story of Australia's early Chinese communities.

Reflexões acerca do papel do fonoaudiólogo junto à família de uma criança com Transtorno Global do Desenvolvimento: estudo de caso / Considerations about the role of a speech-language pathologist with the family of a child with Pervasive Development Disorder: case report

O objetivo deste artigo foi refletir e discutir o papel do fonoaudiólogo na condução das estratégias terapêuticas junto à família de uma criança com Transtorno Global do Desenvolvimento. Esta pesquisa foi desenvolvida por meio de estudo de caso de uma criança com Transtorno Global do Desenvolvimento atendida de julho/2002 a novembro/2004. Os recortes do material clínico retratam o percurso seguido ao longo do eixo da história do paciente enfatizando os momentos significativos que geraram desenvolvimento do processo terapêutico fonoaudiológico no que se refere à comunicação oral e integração social no ambiente familiar. O enfoque das estratégias clínicas foi direcionado para propiciar um ambiente físico e emocional capaz de promover experiências constitutivas que respeitem a singularidade de cada paciente levando em conta a realidade da família e da comunidade onde se encontra inserido aquele núcleo social. Portanto, em nosso entender, a atuação fonoaudiológica pode ser direcionada para a criação de situações que favoreçam o processo [de cada paciente] de inclusão na vida cotidiana, com o respeito que todas as pessoas merecem.

The aim of this study was to reflect about and discuss the role of a speech-language pathologist with the family of a child with Pervasive Development Disorder. This case study reported the case of a child with Pervasive Development Disorder that attended speech-language therapy from July/2002 to November/2004. The excerpts of clinical material depict the course of the patient's history, emphasizing the significant moments that generated development of the therapeutical process related to oral communication and social interaction within his familiar setting. Clinical strategies focused a favorable physical and emotional environment, promoting constitutive experiences that respect the singularity of each patient, considering the realities of the family and the community it is part of. Therefore, in our understanding, speech-language therapy can be directed towards the creation of situations that promote the process [of each patient] of daily life inclusion, with the respect that all people deserve.

Condutas terapêuticas de atenção às famílias da população infantojuvenil atendida nos centros de atenção psicossocial infantojuvenis (CAPSI) do estado de São Paulo / Therapeutic interventions for children's and adolescents's families assisted in psychosocial care centres from São Paulo state

Os Centros de Atenção Psicossociais Infantojuvenis (CAPSi) são elementos estratégicos da atenção pública em saúde mental ofertado para população infantojuvenil com sofrimento psíquico intenso e persistente. São articulados numa rede de atenção que extrapola o campo da saúde e interage com os recursos do território de determinada comunidade para promover inclusão social de crianças e adolescentes e conta para tanto também com a co-responsabilização das famílias, escolas e outros setores sociais. No rol de suas condutas terapêuticas há espaço reservado para o atendimento de familiares quando essa medida for necessária para aquela dirigida à clientela em foco. OBJETIVO: identificar condutas terapêuticas oferecidas às famílias de crianças e adolescentes atendidos nos CAPSi. MÉTODO: estudo transversal em crianças e adolescentes provenientes dos prontuários ativos, selecionados aleatoriamente, de 19 CAPSi do Estado de São Paulo no período de setembro de 2008 a fevereiro de 2009. A análise descritiva foi apresentada por meio de tabelas de número e porcentagem. RESULTADOS: a mãe se revelou a principal cuidadora dessa população fora dos serviços. Contudo, há de se destacar a importante ausência de registros de atendimento ou propostas realizadas às famílias. CONSIDERAÇÕES FINAIS: a principal conduta indicada para as famílias são os atendimentos grupais, as famílias têm sido pouco privilegiadas nas condutas terapêuticas dentro dos projetos terapêuticos da população atendida. As falhas de registro nos prontuários pesquisados podem ser uma limitação do estudo. As ações são preponderantemente institucionais e as ofertas extramuros são raríssimas.

A relação de ajuda não-diretiva junto ao cuidador de um idoso incapacitado / Non-directive support to caregivers of incapacitated elderly / La relación de ayuda no-directiva junto al cuidador de un anciano incapacitado

O Brasil está na posição de um país estruturalmente envelhecido frente ao aumento da expectativa de vida de sua população. No ano de 2007, mais de 7% da população tinha idade de 60 anos ou mais, devido à melhoria na qualidade de vida e a diminuição da taxa de natalidade. O objetivo desse estudo foi analisar a interação de um profissional com um cuidador de uma pessoa idosa, com base na teoria da relação de ajuda não-diretiva. Para isso, foi gravado o processo interativo entre o profissional e o participante, posteriormente transcrito na íntegra, literalmente, e analisado conforme as teorias da relação de ajuda não-diretiva e da relação interpessoal em enfermagem. Os resultados mostraram que o processo interativo estabelecido proporcionou, ao participante, um momento de reflexão sobre a sua vivência na função que assumiu de cuidador, e, mostrou também, os benefícios trazidos pela relação de ajuda não-diretiva na medida em que possibilitou, ao participante, uma maior compreensão e consciência do momento em que vive, trazendo a ampliação da congruência entre seus sentimentos e pensamentos. Mostrou, finalmente, a contribuição que a relação de ajuda não-diretiva pode ter nas propostas de acolhimento das novas diretrizes do Sistema Único de Saúde.

The increase in life expectancy in Brazil sets it as a structurally old country. In the year 2007, more than 7% of the population was aged 60 years or more, due to an improve in quality of life and decrease in the birth rate. The study aimed to analyze the interaction of a professional with a caregiver of an elderly, based on the non-directive support relationship theory. The interactive process between professional and participant was recorded, subsequently fully transcribed, literally, and analyzed according to the theories of non-directive support relationship and interpersonal relationship in nursing. Results showed that the interactive process established afforded the participant a moment of thought about the experiences this person had in the role of caregiver, and also showed the benefits brought by the non-directive support relationship. The relationship enabled, for the participant, a better understanding and conscience of the moment they live, increasing the congruence between feelings and thoughts. Finally, it showed the contribution the non-directive support relationship can have on the proposals of welcoming, of the Single Health System new guidelines.

El Brasil está en la posición de un país estructuralmente envejecido, debido al aumento de la expectativa de vida de su población. En el año de 2007, más de 7% de la población tenía 60 años de edad o más, debido a la mejoría en la calidad de vida y disminución de la tasa de natalidad. El objetivo del estudio fue analizar la interacción de un profesional con un cuidador de un anciano, con base en la teoría de la relación de ayuda no-directiva. Para esto, fue grabado el proceso interactivo entre profesional y participante, posteriormente transcripto en su totalidad, literalmente, y analizado conforme las teorías de relación de ayuda no-directiva y de relación interpersonal en enfermería. Los resultados mostraron que el proceso interactivo establecido proporcionó al participante un momento de reflexión acerca de su vivencia en la función de cuidador. Mostró también los beneficios traídos por la relación de ayuda no-directiva, ya que posibilitó al participante una mayor comprensión y consciencia del momento que vive, ampliando la congruencia entre sus sentimientos y pensamientos. Finalmente demostró la contribución que la relación de ayuda no-directiva puede tener en las propuestas de acogimiento de las nuevas directrices del Sistema Único de Salud.

[Hahnemann's youngest patients - an analytic study of the first homeopathic treatments for children]. / Die jungsten Patienten Hahnemanns - eine analytische Studie zur Kinderpraxis in den Anfangen der Homoopathie.

This article develops a fragmentary history of early homeopathic treatment of children. It begins with an outline of Samuel Hahnemann's perception and treatment of children during the "Medical Enlightenment". This is followed by an investigation of attitudes towards children in early homeopathic literature, in comparison to those of mainstream medicine of the period. The central part of the article is the ensuing analysis of letters sent to Hahnemann by parents seeking advice on how to treat their children's illness; this correspondence includes detailed descriptions of diseases and therapies, and also sheds light on parental feelings about children and family life. The correspondence leads us to conclude that there was no proper model of healing children at the beginning of homeopathic medicine. During the 19th century and perhaps later, homeopathy was based on medical theories prevalent in 18th century medicine. The adults writing these letters came from the upper classes and were always convinced adherents of homeopathy. In response to Hahnemann's queries, many letters contain exact description of somatic and psychic symptoms. Unlike Hahnemann's brief style, many of the parents delve into each detail of the child's condition, and also express themselves emotionally on subjects such as their children, fears of sickness and death. It is also apparent that women, who bore the main responsibility for family life, had a good deal of authority over the course of treatment, as well as the choice of physician.

Treatment for hyperactive children: homeopathy and methylphenidate compared in a family setting.

The sharp increase of the prescription of methylphenidate (MPD) in hyperactive children in recent years is a matter of increasing uneasiness among professionals, parents and politicians. There is little awareness of treatment alternatives. The purpose of this prospective trial was to assess the efficacy of homeopathy in hyperactive patients and to compare it MPD. The study was performed in a paediatric practice with conventional and homeopathic backgrounds. Children aged 3-17 y, conforming to the DSM-IV criteria for attention deficit hyperactivity disorder (ADHD) with a Conners Global Index (CGI) of 14 or higher were eligible for the study. All of them received an individual homeopathic treatment. When clinical improvement reached 50%, the parents were asked to reevaluate the symptoms. Those who did not improve sufficiently on homeopathy were changed to MPD, and again evaluated after 3 months. One hundred and fifteen children (92 boys, 23 girls) with a mean age of 8.3 y at diagnosis were included in the study. Prior to treatment the mean CGI was 20.63 (14-30), the mean index of the homeopathy group 20.52 and of the MPD-group 20.94. After an average treatment time of 3.5 months 86 children (75%) had responded to homeopathy, reaching a clinical improvement rating of 73% and an amelioration of the CGI of 55%. Twenty-five children (22%) needed MPD; the average duration of homeopathic (pre-) treatment in this group was 22 months. Clinical improvement under MPD reached 65%, the lowering of the CGI 48%. Three children did not respond to homeopathy nor to MPD, and one left the study. In cases where treatment of a hyperactive child is not urgent, homeopathy is a valuable alternative to MPD. The reported results of homeopathic treatment appear to be similar to the effects of MPD. Only children who did not reach the high level of sensory integration for school had to be changed to MPD. In preschoolers, homeopathy appears a particularly useful treatment for ADHD.

Alternative medicine in allergies - prevalence, patterns of use, and costs.

BACKGROUND: There is evidence that the use of alternative medicine (AM) for allergies has increased. However, little is known from population-based studies about what determines its use. The objective of this study was to evaluate the patterns of use of AM for allergies. METHODS: A population-based nested case-control study was conducted in 2000-01 using computer-assisted telephone interviews. Three hundred and fifty-one adults participated (median age 46 years) with allergies including hay fever, asthma, atopic eczema, and food hypersensitivity. Information was obtained on demographics, prevalence, motivation, information, type of AM, provider, costs, willingness to pay, and subjective assessment of AM. RESULTS: 26.5% of participants used AM because of their allergies. Compared to nonusers, this group of users was significantly younger (median age 43 vs 47; p=0.004) and better educated (school education > 8 year vs