Exploring perceptions about Mindfulness and Mindful Eating Programs for low-income women with overweight in primary health care.

Background: Obesity and overweight are public health problems of multifactorial etiology, aggravated by the challenge that is maintaining weight loss. Used in the context of general health, mindfulness-based interventions (MBIs) have also showed positive effects when targeting changes to overweight-related eating behaviors. Methods: This study consists of a pragmatic randomized controlled trial conducted with 284 women from primary health care units. Data were collected from the last session with 16 focus groups, considering each intervention group (mindfulness or mindful eating) Aim: This article aims to present the perceptions of low-income overweight women who participated in Mindfulness and Mindful Eating intervention groups in primary health care according to each type of intervention. Results: Seven themes were identified: course challenges; valorization of the teacher's attitudes; mindfulness understanding; self-awareness development; change of expectations; development of a different food-weight relationship; and discover of a wide range of benefits. Conclusion: Mindfulness and Mindful eating interventions affect not only an individual's relationship with body and food, but also life and human relations. The results indicate the feasibility of the intervention, which addresses a large number of patients who lack treatment options for overweight or emotional and psychological issues associated with this condition. MBIs such as mindful eating are applicable in primary health care facilities, targeting overweight women and supporting treatment by addressing a repressed demand in the system. Similar to mind-body therapies, these interventions allow for comprehensive care.ClinicalTrials.gov, (NCT02893150) on 30 March 2017.

Comparative effectiveness of mindfulness and mindful eating programmes among low-income overweight women in primary health care: A randomised controlled pragmatic study with psychological, biochemical, and anthropometric outcomes.

Obesity is a chronic and multifactorial disease, with growing rates in the last 50 years worldwide, reaching pandemic levels. It is a major public health problem and is difficult to treat. Different approaches have been used to improve this scenario, including mindfulness-based interventions to enhance dietary behaviour and nutritional status. We compared the effectiveness of a 10-week mindful eating programme with that of a 10-week mindfulness programme and of a no-treatment control group. The sample was composed of adult, low-income women with a body mass index (BMI) ≥ 25 to < 40 receiving primary health care in São Paulo, Brazil. The participants (n = 284) were randomised into 3 groups: the control, mindfulness, and mindful eating. We took anthropometric and body composition measurements, applied psychometric measures, and performed biochemical tests at pre-intervention, post-intervention, and after 3 months. We estimated the regression coefficients among the analysis of adherent participants (per protocol: PP) and among those of all participants randomised to treatment (intention-to-treat: ITT) in addition to multiple imputation (MI). Both groups showed improvement in eating behaviour and reduction of binge eating both in the post-intervention and follow-up periods, but without significant changes in weight or most of the biological tests. Those in the mindful eating programme performed slightly better than those in the mindfulness and control groups in terms of improving eating behaviour and reducing binge eating among low-income overweight women.

Mindful eating for overweight and obese women in Brazil: An exploratory mixed-methods pilot study.

Background: Worldwide, approximately 95% of obese people who follow diets for weight loss fail to maintain their weight loss in the long term. To fill this gap, mindfulness-based interventions, with a focus on mindful eating, are promising therapies to address this challenging public health issue. Aim: To verify the effects of the Mindfulness-Based Eating Awareness Training (MB-EAT) protocol by exploring quantitative and qualitative data collected from Brazilian women. Methods: A single-group, mixed-methods trial was conducted at a public university with adult women (n = 34). Four MB-EAT groups were offered weekly for 2.5-h sessions over 12 weeks. Pre- and post-intervention assessments included body mass index (BMI) and self-report measures of anxiety, depression, mindfulness, self-compassion, and eating behaviour. Qualitative information was collected using focus groups in the last session of each group, including both participants and MB-EAT instructors. The qualitative data were examined using thematic analyses and empirical categories. Results: Twenty participants (58.8%) completed both pre- and post-intervention assessments, with adequate attendance (≥4 sessions). There was a significant average decrease in weight of 1.9 ± 0.6 kg from pre- to post-intervention. All participants who had scored at the risk level for eating disorders on the EAT-26 decreased their score below this risk level. Qualitative analysis identified that participants were able to engage a more compassionate perspective on themselves, as well as greater self-awareness and self-acceptance. Conclusion: The MB-EAT showed preliminary efficacy in promoting weight loss and improvements in mindfulness and eating behaviour. This intervention promoted effects beyond those expected, extending to other life contexts.

Impact of the Training of Professionals from São Paulo Public Health System in Phytotherapy Practice / Impacto da Capacitação de Profissionais da Rede Pública de Saúde de São Paulo na Prática da Fitoterapia

Abstract: Introduction: Following the introduction in 2006 of the National Policy on Integrative and Complementary Practices, and The National Policy on Medicinal Plants and Herbal Medicines, the Municipal Secretariat for the Environment of the City Hall of Sao Paulo initiated the Medicinal Plants Course, later expanded to The Medicinal Plants and Herbal Medicines Course for the training of health professionals. This study aimed to evaluate the impact of the 2014 and 2015 edition of the course "Medicinal Plants and Herbal Medicines" on health professional practices. Methods: An exploratory and descriptive study was conducted with a qualitative-quantitative approach. The quantitative process (Phase I) consisted of a questionnaire being emailed to health professionals who were involved in the course, divided into seven categories: biomedical professional, dental surgeon, nurse, pharmacist, physiotherapist, physician and nutritionist; and, out of 165 questionnaires, 114 responses were received (69.1%). The Qualitative and Quantitative process (Phase II), comprised semi-structured, in-person individual interviews to obtain detailed information on Phytotherapy practices, with 73 health professionals being interviewed, before and after the training, comparing their practices afterwards. Results: The course had a positive impact on the acceptance and application of Phytotherapy by health professionals with a significant increase (p<0.001) in the expansion of activities related to Phytotherapy (herbal tea "meetings", medicinal herb gardens and capacity training), regarding the use of herbal products, such as Matricaria chamomilla (chamomile), Maytenus ilicifolia (espinheira-santa), Valeriana officinalis (valeriana). An increase in the knowledge of Phytotherapy risks was also observed, although there was no increase in the reporting of adverse reactions. The study confirmed the importance of the inclusion of Medicinal Plants and Herbal Medicines Courses as part of undergraduate and postgraduate school, as well as the technical training and continuing education for SUS health professionals. Conclusion: The positive impact found out in almost all evaluated aspects, such as the increase in the knowledge and in the prescription of herbal medicines, confirms the importance of such courses. The results suggest the training promoted a positive impact on the Phytotherapy practice of the Public Health System professionals in São Paulo.

Resumo: Introdução: Após a aprovação da Política Nacional de Práticas Integrativas e Complementares e da Política Nacional de Plantas Medicinais e Fitoterápicos em 2006, a Secretaria Municipal do Verde e do Meio Ambiente de São Paulo iniciou o curso "Plantas Medicinais" que posteriormente foi ampliado para curso "Plantas Medicinais e Fitoterapia", com o propósito de capacitar profissionais de saúde. Este estudo teve como objetivo avaliar o impacto das edições de 2014 e 2015 do curso "Plantas Medicinais e Fitoterapia" nas práticas profissionais. Métodos: Realizou-se estudo exploratório, descritivo, com abordagem quali-quantitativa. No processo quantitativo (fase I), enviou-se um questionário via e-mail para profissionais de saúde egressos do curso, divididos em sete categorias: biomédico, cirurgião-dentista, enfermeiro, farmacêutico, fisioterapeuta, médico e nutricionista. Do total de 165 questionários, 114 foram respondidos (69,1%). No processo qualitativo e quantitativo (fase II), realizaram-se entrevistas semiestruturadas, presenciais e individuais visando obter informações detalhadas da prática fitoterápica. Entrevistaram-se 73 profissionais de saúde a fim de comparar as práticas deles antes e depois da capacitação. Resultados: O curso impactou positivamente a aceitação e a aplicação da fitoterapia pelos profissionais de saúde, com um aumento significativo (p < 0,001) na ampliação de atividades relacionadas à fitoterapia (rodas de "chás", "hortas medicinais" e capacitação). Houve ainda impacto na aplicação de produtos à base de plantas como Matricaria chamomilla (camomila), Maytenus ilicifolia (espinheira-santa) e Valeriana officinalis (valeriana). Verificou-se também aumento no conhecimento dos riscos da fitoterapia, embora sem o respectivo aumento na notificação de reações adversas. O estudo confirmou a importância da inclusão dos cursos em "Plantas Medicinais e Fitoterapia" na graduação e na pós-graduação, bem como da capacitação técnica e educação permanente para profissionais de saúde do SUS. Conclusão: O impacto positivo na quase totalidade dos aspectos avaliados, como o aumento do conhecimento e a prescrição de fitoterápicos, confirma a importância de tais cursos. Os resultados sugerem que a capacitação promoveu impacto positivo na prática fitoterápica dos profissionais da rede pública de saúde de São Paulo.

Mindfulness as a complementary intervention in the treatment of overweight and obesity in primary health care: study protocol for a randomised controlled trial.

BACKGROUND: Mindfulness has been applied in the United States and Europe to improve physical and psychological health; however, little is known about its feasibility and efficacy in a Brazilian population. Mindfulness may also be relevant in tackling obesity and eating disorders by decreasing binge eating episodes-partly responsible for weight regain for a large number of people-and increasing awareness of emotional and other triggers for overeating. The aim of the present study protocol is to evaluate and compare the feasibility and efficacy of two mindfulness-based interventions (MBIs) addressing overweight and obesity in primary care patients: a general programme called Mindfulness-Based Health Promotion and a targeted mindful eating protocol called Mindfulness-Based Eating Awareness Training. METHODS/DESIGN: A randomised controlled trial will be conducted to compare treatment as usual separately in primary care with both programmes (health promotion and mindful eating) added to treatment as usual. Two hundred forty adult women with overweight and obesity will be enrolled. The primary outcome will be an assessment of improvement in eating behaviour. Secondary outcomes will be (1) biochemical control; (2) anthropometric parameters, body composition, dietary intake and basal metabolism; and (3) levels of mindfulness, stress, depression, self-compassion and anxiety. At the end of each intervention, a focus group will be held to assess the programme's impact on the participants' lives, diet and health. A feasibility study on access to benefits from and importance of MBIs at primary care facilities will be conducted among primary care health care professionals and participants. Monthly maintenance sessions lasting at least 1 hour will be offered, according to each protocol, during the 3-month follow-up periods. DISCUSSION: This clinical trial will result in more effective mindfulness-based interventions as a complementary treatment in primary care for people with overweight and obesity. If the findings of this study confirm the effectiveness of mindfulness programmes in this population, it will be possible to improve quality of life and health while optimising public resources and reaching a greater number of people. In addition, on the basis of the evaluation of the feasibility of implementing this intervention in primary care facilities, we expect to be able to suggest the intervention for incorporation into public policy. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02893150 . Registered retrospectively on 30 March 2017.

LED versus daylight phototherapy at low irradiance in newborns ≥35 weeks of gestation: randomized controlled trial.

OBJECTIVE: To compare the decline in TSB after 24 h of LED or fluorescent phototherapy from below in breastfed neonates ≥35 weeks of gestation. METHODS: Seventy-four neonates treated with a 17-bulb blue LED were compared with 76 neonates treated with a 7-bulb daylight device in a rooming-in unit. Spectral irradiance was measured at 5 points on a 30 × 60 cm rectangle on the gel transparent mattress. RESULTS: TSB of 14.0 ± 1.2 mg/dL at 64 ± 15 h after birth when starting phototherapy were similar in both groups. TSB declined by 0.16 ± 0.09 in the LED versus 0.16 ± 0.08 mg/dL/hour in the daylight group after 24 h of therapy (p = 0.87). Mean irradiance (µW/cm(2)/nm) was 10.5 ± 0.9 (32.5 at the central, 5.9 at the superior and 3.9 for the inferior points) in the LED versus 8.7 ± 0.6 (range, 8.3 to 9.8) in the daylight group (p < 0.001). Hypothermia (<36.0 °C) was more frequent in LED than in fluorescent (23% versus 9%; p = 0.02) group. CONCLUSION: LED with heterogeneous irradiance was as effective as daylight phototherapy with homogeneous irradiance; however there is a greater need for rigorous control of the room temperature (NCT01340339).

Transcutaneous bilirubin in exclusively breastfed healthy term newborns up to 12 days of life.

OBJECTIVE: To determine the curve of transcutaneous bilirubin in breastfed term neonates up to 12 days of life. METHODS: In a prospective cohort study, we performed a 12-day evaluation of 223 healthy, exclusively breastfed, appropriate-for-gestational-age neonates who roomed-in for at least 48 hours. Each newborn had forehead transcutaneous bilirubin and body weight measured at the end of 1, 2, 3, 4, 5, 6, 8, 10, and 12 days. Regression analysis was used with bilirubin as a third-degree polynomial function of time. The 25th, 50th, 75th, 90th, and 95th percentile curves were constructed by using the residual mean square for each day. RESULTS: Patients were 46% white, 34% mixed race, and 20% black, the mean birth weight was 3260 g (range: 2560-4090 g), the mean gestational age was 39.4 weeks (range: 37.0-41.9 weeks), 51% were male, 74% were born by vaginal delivery, and 66% had been breastfed since delivery. The mean highest weight loss was 4.7% (range: 1%-12%) at the second or third day, and in most infants the weight returned to the birth weight at the fifth day. With 2007 total bilirubin measurements, bilirubin concentrations reached the 50th percentile level (5.6 mg/dL) at the third and fourth days and returned to the 24-hour level (4.8 mg/dL) at the sixth day. The 95th percentile bilirubin level was 8.2 mg/dL at 24 hours of life, reached 12.2 mg/dL on the fourth day, and declined to 8.5 mg/dL on the 12th day. CONCLUSIONS: The transcutaneous bilirubin curve represents the natural history of bilirubinemia in exclusively breastfed healthy term newborns in the first 12 days of life.

Effects of curcumin in an orthotopic murine bladder tumor model.

Cigarette smoking (CS) is the main risk factor for bladder cancer development. There are more than 100 carcinogens present in cigarette smoke. Among the potential mediators of CS-induced alterations is nuclear factor-kappa (NF-kappaB), which is responsible for the transcription of genes related to cell transformation, tumor promotion, angiogenesis, invasion and metastasis. Curcumin is a polyphenol compound derived from Curcuma longa that suppress cellular transformation, proliferation, invasion, angiogenesis, and metastasis by down regulating NF-kappaB and its regulated genes. The aim of our study was to assess the effects of curcumin in bladder urothelial carcinoma. We studied the effects of curcumin in vitro and in vivo using the orthotropic syngeneic bladder tumor animal model MB49. Curcumin promotes apoptosis of bladder tumor cells in vitro. In vivo tumors of animals treated with curcumin were significantly smaller as compared to controls. Using immunohistochemistry, we demonstrated a decrease in the expression of Cox-2 by 8% and Cyclin D1 by 13% in the animals treated with curcumin; both genes regulated by NF-kappaB and related to cell proliferation. In this study, we showed that curcumin acts in bladder urothelial cancer, possibly dowregulating NF-kappaB-related genes, and could be an option in the treatment of urothelial neoplasms. The results of our study suggest that further research is warranted to confirm our findings.

Effects of curcumin in an orthotopic murine bladder tumor model

Cigarette smoking (CS) is the main risk factor for bladder cancer development. There are more than 100 carcinogens present in cigarette smoke. Among the potential mediators of CS-induced alterations is nuclear factor-kappa (NF-êB), which is responsible for the transcription of genes related to cell transformation, tumor promotion, angiogenesis, invasion and metastasis. Curcumin is a polyphenol compound derived from Curcuma longa that suppress cellular transformation, proliferation, invasion, angiogenesis, and metastasis by down regulating NF-êB and its regulated genes. The aim of our study was to assess the effects of curcumin in bladder urothelial carcinoma. We studied the effects of curcumin in vitro and in vivo using the orthotropic syngeneic bladder tumor animal model MB49. Curcumin promotes apoptosis of bladder tumor cells in vitro. In vivo tumors of animals treated with curcumin were significantly smaller as compared to controls. Using immunohistochemistry, we demonstrated a decrease in the expression of Cox-2 by 8 percent and Cyclin D1 by 13 percent in the animals treated with curcumin; both genes regulated by NF-êB and related to cell proliferation. In this study, we showed that curcumin acts in bladder urothelial cancer, possibly dowregulating NF-êB-related genes, and could be an option in the treatment of urothelial neoplasms. The results of our study suggest that further research is warranted to confirm our findings.