Religious and secular spirituality: Methodological implications of definitions for health research.

The importance of spirituality as a research topic has been increasingly recognized, which has led to several studies on the topic. Areas including psychology, medicine, and nursing have produced studies on spirituality under a plurality of definitions and methods, which reveals the complexity of the theme. However, this has resulted in a range of potential problems, including: (1) the use of overlapping and contradictory terms between studies, or even within the same study, (2) research methodologies that do not fit the definitions (sometimes unreflectively) assumed by the authors, (3) difficulties, or even the impossibility, of comparing the results of studies, (4) controversies in respect of the inclusion/exclusion of secular groups in research on spirituality, and (5) ambiguous measurements, often being exclusively dependent on each participant's individual interpretation of what spirituality means. This article discusses these problems, recommends theoretical and methodological alternatives and presents taxonomy of definitions of spirituality.

Double-blind evaluation of homeopathy on cocaine craving: a randomized controlled pilot study.

BACKGROUND: Brazil is among the nations with the greatest rates of annual cocaine usage. Pharmacological treatment of cocaine addiction is still limited, opening space for nonconventional interventions. Homeopathic Q-potencies of opium and Erythroxylum coca have been tested in the integrative treatment of cocaine craving among homeless addicts, but this setting had not proven feasible, due to insufficient recruitment. OBJECTIVE: This study investigates the effectiveness and tolerability of homeopathic Q-potencies of opium and E. coca in the integrative treatment of cocaine craving in a community-based psychosocial rehabilitation setting. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS: A randomized, double-blind, placebo-controlled, parallel-group, eight-week pilot trial was performed at the Psychosocial Attention Center for Alcohol and Other Drugs (CAPS-AD), Sao Carlos/SP, Brazil. Eligible subjects included CAPS-AD patients between 18 and 65 years of age, with an International Classification of Diseases-10 diagnosis of cocaine dependence (F14.2). The patients were randomly assigned to two treatment groups: psychosocial rehabilitation plus homeopathic Q-potencies of opium and E. coca (homeopathy group), and psychosocial rehabilitation plus indistinguishable placebo (placebo group). MAIN OUTCOME MEASURES: The main outcome measure was the percentage of cocaine-using days. Secondary measures were the Minnesota Cocaine Craving Scale and 12-Item Short-Form Health Survey scores. Adverse events were reported in both groups. RESULTS: The study population comprised 54 patients who attended at least one post-baseline assessment, out of the 104 subjects initially enrolled. The mean percentage of cocaine-using days in the homeopathy group was 18.1% (standard deviation (SD): 22.3%), compared to 29.8% (SD: 30.6%) in the placebo group (P < 0.01). Analysis of the Minnesota Cocaine Craving Scale scores showed no between-group differences in the intensity of cravings, but results significantly favored homeopathy over placebo in the proportion of weeks without craving episodes and the patients' appraisal of treatment efficacy for reduction of cravings. Analysis of 12-Item Short-Form Health Survey scores found no significant differences. Few adverse events were reported: 0.57 adverse events/patient in the homeopathy group compared to 0.69 adverse events/patient in the placebo group (P = 0.41). CONCLUSIONS: A psychosocial rehabilitation setting improved recruitment but was not sufficient to decrease dropout frequency among Brazilian cocaine treatment seekers. Psychosocial rehabilitation plus homeopathic Q-potencies of opium and E. coca were more effective than psychosocial rehabilitation alone in reducing cocaine cravings. Due to high dropout rate and risk of bias, further research is required to confirm our findings, with specific focus on strategies to increase patient retention. TRIAL REGISTRATION: RBR-2xzcwz (http://www.ensaiosclinicos.gov.br).

Respiratory training as strategy to prevent cognitive decline in aging: a randomized controlled trial.

BACKGROUND: Inadequate oxygenation may cause lesions and brain atrophy during aging. Studies show a positive association between pulmonary function and the cognitive performance of individuals from middle age on. OBJECTIVE: To investigate the effect of aerobic physical exercises and respiratory training on the blood oxygenation, pulmonary functions, and cognition of the elderly. DESIGN: This was a randomized and controlled trial with three parallel groups. A total of 195 community-dwelling elderly were assessed for eligibility; only n=102 were included and allocated into the three groups, but after 6 months, n=68 were analyzed in the final sample. Participants were randomized into a social interaction group (the control group), an aerobic exercise group (the "walking" group), or a respiratory training group (the "breathing" group). The main outcome measures were the Wechsler Adult Intelligence Scale, Wechsler Memory Scale, Wisconsin Card Sorting Test, respiratory muscular strength, cirtometry (thoracic-abdominal circumference); oxygen saturation in arterial blood (SpO2), and hemogram. RESULTS: No differences were observed for any of the blood parameters. Aerobic exercise and respiratory training were effective in improving the pulmonary parameters. Better cognitive performance was observed for the breathing group as regards abstraction and mental flexibility. The walking group remained stable in the cognitive performance of most of the tests, except attention. The control group presented worst performance in mental manipulation of information, abstraction, mental flexibility, and attention. CONCLUSION: Our results showed that both the walking and breathing groups presented improvement of pulmonary function. However, only the breathing group showed improved cognitive function (abstraction, mental flexibility). The improvement in cognitive functions cannot be explained by blood parameters, such as SpO2, erythrocytes, hemoglobin, and hematocrit.

Influence of microelement concentration on the intensity of alcohol withdrawal syndrome.

AIMS: To establish a nutritional and constitutional profile concerning the micronutrient plasma concentration of patients who suffer from AWS. METHOD: Observational case control study to determine whether patients who exhibited symptoms of AWS (N = 60) had micronutrient plasmatic concentration deficiencies when compared with healthy controls (N = 34). RESULTS: There were statistically significant differences between the concentrations of nutrients that are correlated with glutamate hyperactivity (zinc, magnesium and folate/vitamin B12/homocysteine). CONCLUSION: Evidence from literature and our experiment suggests that brain activity, especially the glutamatergic system, might be directly involved in micronutrient concentrations. Therefore, their supplementation to the AWS patient might improve symptom evolution.

Effects of low doses of polyunsaturated Fatty acids on the attention deficit/hyperactivity disorder of children: a systematic review.

UNLABELLED: Since attention deficit/hyperactivity disorder (ADHD) presents high prevalence among children, science has been researching alternative forms of treatment that do not involve medication. OBJECTIVE: To evaluate the effects of polyunsaturated fatty acids (PUFAs) on attention deficit/hyperactivity disorder. METHODS: We reviewed the articles published between 1980 and 2012 indexed in the databases PubMed, APA psychNET, Scopus and Web of Knowledge. RESULTS: Initially 231 articles were selected, out of which 12 met the inclusion criteria. The articles selected reported a modest cognitive and behavioral improvement of the patients after treatment with low doses of PUFAs. Those results might be associated with the evaluation methodology, the doses of PUFAs administered or the duration of treatment.

The influence of the polyunsaturated fatty acids on body weight and anxiolytic-like behavior in female rats.

Some studies have showed the benefits of polyunsaturated fatty acids (PUFAs) as a complement in weight loss diets, even though the results are hardly conclusive. Additionally, anxiety is another relevant factor that influences not only the appetite but the locomotion of the animals as well. This study evaluated the effect of a diet enriched with PUFAs in relation to body weight in an animal model of anxiety (the elevated plus maze). Female Wistar rats were allocated to one of four groups and were fed different diets for 30 days: control diet (commercial chow (Nuvilab(®)); diet enriched with fish oil; diet enriched with linseed oil, and diet enriched with soybean oil. The body weight was not influenced by the kind of diet. The group that received food enriched with linseed oil remained in the open arms for longer periods when compared with the control group. This result suggests an anxiolytic-like effect in that group.

O discurso sobre os riscos relacionados às plantas medicinais na medicina popular / The discourse on the risks related to medicinal plants in folk medicine

Introdução: Na medicina popular as plantas medicinais são utilizadas dentro de um contexto cultural e histórico, portanto, possuem suas representações simbólicas e um sistema teórico de explicação do processo de saúde/doença e na caracterização das enfermidades e dos doentes (araujo, 2002). Objetivos:Investigar o relato de queixas (reações adversas) ou satisfação no consumo de plantas medicinais (PMs), relatadas por consumidores em um ponto de comércio de PMs no município de diadema, sp. método: por meio de métodos e técnicas da etnografia (observação participante e entrevistas semi-estruturadas), aplicou-se uma ficha de dados para o registro das queixas ou satisfação no consumo de PMs em um tradicional ponto de comércio popular "casa de ervas" de diadema (Soares Neto, 2009). Os consumidores foram abordados aleatoriamente durante a compra das PMs. Resultados: Foram realizadas 100 entrevistas, das quais apenas cinco relataram queixas relacionadas ao consumo de PMs. A grande maioria dos relatos foi de satisfação com o uso de "plantas medicinais". Alguns dos entrevistados diziam que tinham feito pouco uso das PM, mas com as informações dos benefícios vistos na televisão ou indicação de amigos e familiares sentiram-se motivados em consumi-las. Algumas das justificativas favoráveis mais marcantes foram: i) "sempre usei plantas medicinais, e tem que acostumar as crianças desde pequenas. sempre tive resultados satisfatórios, e só vou ao médico quando não tem outro jeito. o remédio de farmácia ajuda por um lado, mas faz mal pelo outro". ii) "faço pouco uso de plantas medicinais, e sempre fez o efeito esperado; os médicos mandam usar". iii) "sempre uso plantas medicinais e também medicamentos, mas acho melhor usar planta medicinal; a gente confia que faz o efeito esperado".iv) "um amigo indicou. nunca faz mal; meu avô fazia".Conclusão: mesmo sendo uma área urbana, os resultados mostram a importância terapêutica e cultural das PMs e da medicina popular. Nesse contexto, podemos utilizar o conceito de risco das ciências sociais: "o risco não como um 'fato' a ser compreendido, quantificado e gerenciado, mas como uma coisa construída socialmente" (de seta et al., 2006), portanto um campo para ações educacionais. Desta forma, é preciso desenvolver programas diferenciados junto à população e profissionais da saúde na construção de um diálogo entre os saberes sobre saúde, doença,PMs, medicamentos e da importância de comunicar casos de suspeitas de reações adversas por PMs.

(N-3) Fatty acids: molecular role and clinical uses in psychiatric disorders.

New discoveries in the field of neurophysiology and neuropharmacology have revealed the role of (n-3) fatty acids in controlling inflammation and protecting neuron cells from oxidative damage, preserving their function. It has also been thought that their psychoactive properties could be beneficial in certain psychiatric illnesses. This article discusses the newest discoveries of the affected activities by these fats in the cerebral cortex and the efforts that have been made to put them in practice in clinical trials in humans. In general, we were able to detect certain discord in the scientific community when designing placebo-based studies (mainly in establishing the appropriate therapeutic dose of (n-3) fatty acids, varying from the recommended dietary dose to an amount that may be 3 or 4 times higher), and in interpreting results. Although many studies have had the validity of their results questioned because of their small sample size, several studies seem to indicate that the (n-3) fatty acids are useful therapeutic tools in treating psychiatric conditions such as major depression, bipolar disorder, and several other disorders. Larger sample size studies are still required to better analyze the treatment potential of these agents.

Effects of polyunsaturated fatty acids on cocaine-conditioned place preference in mice.

OBJECTIVE: The objective of the present study was to assess whether the administration of polyunsaturated fatty acids (PUFAs) would lead to alterations in cocaine-conditioned place preference by correlating behavioral data and plasma levels of PUFAs. METHODS: Five groups of C57Bl/6J mice received a linseed oil supplement or a control solution for 19 days and were conditioned to cocaine. RESULTS: PUFAs did not exert a protective effect against cocaine-conditioned place-preference behavior, although there were significant differences in the levels of eicosapentaenoic acid (EPA) and linoleic acid among the groups tested. Higher doses of PUFAs might be necessary to induce a change in the plasma level of EPA in cocaine-conditioned mice. DISCUSSION: PUFAs had no effect on cocaine-conditioned place preference.

Homeopathic potencies of Opium in alcohol dependence: exploratory open-label study / Potências homeopáticas de Opium na dependência do álcool:estudo exploratório e aberto / Potencias homeopáticas de Opium en alcoholismo:estudio exploratorio abierto

The conventional pharmacological options for the treatment of alcoholism are limited, which led to the search for solutions in alternative or complementary medicine (CAM). Homeopathy is a CAM modality recognized as medical specialty in Brazil. According to the clinical experience of the early homeopaths, Opium was used to treat patients with alcohol dependence. Aim: to perform a preliminary assessment of the effectiveness and tolerability of fifty-millesimal potencies of Opium in the treatment of alcohol-dependent patients. Methods: exploratory, prospective, open-label trial, with pre-treatment measures as control. Confidence intervals were used to estimate the magnitude of the clinical differences. Results: a total of 14 patients were included, from which 12 were evaluated (intention to treat analysis - ITT). There was a significant reduction in the average daily alcohol consumption (-29.37 units of alcohol/day; 95% CI=10.63; 48.11) and in the severity of alcohol dependence, measured by the mean score of the Short Alcohol Dependence Data questionnaire (-10.17; 95% CI= 4.12; 16.22). No serious adverse events were reported. Randomized controlled studies with larger samples are needed.(AU)

Contexto: as opções farmacológicas convencionais para o tratamento do alcoolismo ainda são limitadas, contribuindo para a busca de soluções na medicina alternativa ou complementar (CAM). A homeopatia é uma modalidade de CAM reconhecida como especialidade médica no Brasil. Na experiência clínica dos primeiros homeopatas, Opium era usado no tratamento de pacientes com dependência do álcool. Objetivo: avaliação preliminar da efetividade e da tolerabilidade de dinamizações homeopáticas de Opium no tratamento de pacientes dependentes do álcool. Métodos: estudo exploratório, prospectivo e aberto, com medidas pré-tratamento como controle. Intervalos de confiança foram utillizados para se estimar a magnitude das diferenças clínicas. Resultados: 14 pacientes foram incluídos e 12 avaliados (análise segundo a intenção de tratar- ITT). Houve uma redução clinicamente significativa no consumo médio diário de álcool (-29,37 unidades de álcool/dia, 95% CI=10,63; 48,11) e na severidade da dependência do álcool, medida pelo escore médio do questionário Short Alcohol Dependence Data (-10,17 pontos 95% CI= 4,12; 16,22). Não foram relatados ou observados eventos adversos graves. Os resultados justificam estudos maiores, randomizados e controlados.(AU)

Homeopathic potencies of Opium in alcohol dependence: exploratory open-label study / Potências homeopáticas de Opium na dependência do álcool: estudo exploratório e aberto / Potencias homeopáticas de Opium en alcoholismo: estudio exploratorio abierto

The conventional pharmacological options for the treatment of alcoholism are limited, which led to the search for solutions in alternative or complementary medicine (CAM). Homeopathy is a CAM modality recognized as medical specialty in Brazil. According to the clinical experience of the early homeopaths, Opium was used to treat patients with alcohol dependence. Aim: to perform a preliminary assessment of the effectiveness and tolerability of fifty-millesimal potencies of Opium in the treatment of alcohol-dependent patients. Methods: exploratory, prospective, open-label trial, with pre-treatment measures as control. Confidence intervals were used to estimate the magnitude of the clinical differences. Results: a total of 14 patients were included, from which 12 were evaluated (intention to treat analysis - ITT). There was a significant reduction in the average daily alcohol consumption (-29.37 units of alcohol/day; 95% CI=10.63; 48.11) and in the severity of alcohol dependence, measured by the mean score of the Short Alcohol Dependence Data questionnaire (-10.17; 95% CI= 4.12; 16.22). No serious adverse events were reported. Randomized controlled studies with larger samples are needed.

Contexto: as opções farmacológicas convencionais para o tratamento do alcoolismo ainda são limitadas, contribuindo para a busca de soluções na medicina alternativa ou complementar (CAM). A homeopatia é uma modalidade de CAM reconhecida como especialidade médica no Brasil. Na experiência clínica dos primeiros homeopatas, Opium era usado no tratamento de pacientes com dependência do álcool. Objetivo: avaliação preliminar da efetividade e da tolerabilidade de dinamizações homeopáticas de Opium no tratamento de pacientes dependentes do álcool. Métodos: estudo exploratório, prospectivo e aberto, com medidas pré-tratamento como controle. Intervalos de confiança foram utillizados para se estimar a magnitude das diferenças clínicas. Resultados: 14 pacientes foram incluídos e 12 avaliados (análise segundo a intenção de tratar- ITT). Houve uma redução clinicamente significativa no consumo médio diário de álcool (-29,37 unidades de álcool/dia, 95% CI=10,63; 48,11) e na severidade da dependência do álcool, medida pelo escore médio do questionário Short Alcohol Dependence Data (-10,17 pontos 95% CI= 4,12; 16,22). Não foram relatados ou observados eventos adversos graves. Os resultados justificam estudos maiores, randomizados e controlados.

Psychoactive plants described in a Brazilian literary work and their chemical compounds.

Ethnopharmacological research investigates the plants and other medicinal and toxic substances utilized by different traditional populations. One approach in this field is a literature search of the available publications on medicinal plants. The purpose of the current study was to select plants with psychoactive effects described in a Brazilian literary work written by Pio Correa in 1926. Those mentioned plants were classified in accordance with their indications for use as stimulants and depressors of the central nervous system. For the phytochemical study herein, we researched these species via a database search, and all the obtained information was compiled into a new database to analyze possible correlations between the chemical compounds and the psychoactive categories. Of the 813 plants searched in the literary work, 104 presented chemical data in the scientific periodicals consulted. Seventy-five of them belong to the stimulant category, while 31 are depressors and two of them belong to both categories. Phenols and flavonoids were the main compounds observed in plants of both categories, though at different frequencies. Monoterpenes (29.9%) and sesquiterpenes (28.6%) were also observed in plants from the stimulant category, while 25.8% of plants from the depressor category were comprised of carotenoids and 22.6% of steroids. The main specific compounds were identified as ferulic acid, α-pinene, limonene, α-humulene and kaempferol among the stimulant plants. Otherwise, in depressor plants were characterized caffeic acid, kaempferol, quercetin, ß-carotene, physalins and withanolides as specific compounds. The association between ethnopharmacological and chemotaxonomic data, as presented in this study, could support plant selection in further investigations by research groups whose studies focus on psychoactive plants as potential therapeutics.

Acute efects of the Paulinia cupana, "guaraná" on the cognition of normal volunteers

A Paulinia Cupana (guaraná), é uma planta da flora brasileira que goza de grande prestígio na medicina popular. Dentre as características popularmente atribuidas a ela, citamos, a de ser potente estimulante das funçöes cerebrais. Os autores avaliaram os efeitos da administraçäo crônica da guraná sobre a cogniçäo de voluntários idosos normais. Foram estudados 45 voluntários, sendo distribuídos aleatoriamente para um dos três grupos experimentais: Placebo (n=15), Cafeina (N=15) e Guaraná (n=15), em estudo duplo-cego. Näo se obteve nenhuma mudança significativa na cogniçäo desses voluntários