Use of integrative and complementary health practices by Brazilian population: results from the 2019 National Health Survey.

BACKGROUND: In 2006, Brazil implemented the National Policy on Integrative and Complementary Practices of the SUS. and in 2015, the Brazilian Ministry of Health issued a reinforcement to this policy to increase access to integrative and complementary health practices (ICHP). In this study, we described the prevalence of ICHP in Brazilian adults according to their sociodemographic characteristics, self-perceived health, and chronic diseases. METHODS: This is a nationally representative cross-sectional survey including 64,194 participants from the 2019 Brazilian National Health Survey. Types of ICHP were categorized according to their purposes: health promotion (Tai chi/Lian gong/Qi gong, yoga, meditation, and integrative community therapy) or therapeutic practices (acupuncture, auricular acupressure, herbal treatment and phytotherapy, and homeopathy). Participants were classified as non-practitioners and practitioners, who in turn were grouped according to use of ICHP in the last 12 months: only used health promotion practices (HPP); only used therapeutic practices (TP); used both (HPTP). Multinomial logistic regressions were performed to estimate the associations of ICHP with sociodemographic characteristics, self-perceived health status, and chronic diseases. RESULTS: Brazilian adults showed an ICHP use prevalence of 6.13% [95%CI = 5.75-6.54]. Compared to non-practitioners, women and middle-aged adults were more likely to use any ICHP. Afro-Brazilians were less likely to use both HPP and HPTP, whereas Indigenous people were more likely to use both HPP and TP. We found a positive gradient of association among participants with higher income and educational attainment and access to any ICHP. People from rural areas and those with negative self-perceived health were more likely to use TP. Participants with arthritis/rheumatism, chronic back problems, and depression were more likely to use any ICHP. CONCLUSIONS: We found that 6% of Brazilian adults reported using ICHP in the previous 12 months. Women, middle-aged individuals, chronic patients, people with depression, and wealthier Brazilians are more likely to use any type of ICHP. Of note, rather than suggesting to expand the offer of these practices in the Brazilian public health system, this study diagnosed Brazilians' behavior of seeking for complementary healthcare.

Protocol for a Nested Randomized Controlled Trial to Evaluate the Feasibility and Preliminary Efficacy of the Mindfulness Based Health Promotion Program on the Quality of Life of Older Adults Assisted in Primary Care-"The MBHP-Elderly Study".

Introduction: Population aging is a global phenomenon that has grown rapidly and progressively all over the world. Interventions that promote health must be studied and implemented to make the aging process be with quality of life. Depression and anxiety are the most common mental health conditions that compromise the quality of life on the elderly and it can cause damage to the autonomy and activities of daily life. Mindfulness training has been shown to improve psychological health and quality of life on adults. Studies involving Mindfulness-Based Interventions (MBIs) with older people are scarce in the literature, but they have been increasing in recent years showing promising results for healthy aging. This trial will investigate the feasibility and preliminary efficacy of an MBI on the quality of life of elderly assisted in the Primary Care. Materials and Methods: A cohort-nested randomized controlled trial with 3 assessment points (baseline, post-intervention and 1-year follow up) will be conducted to compare a MBI program (Mindfulness-Based Health Promotion) to a cognitive stimulation control-group in a Primary Care facility. One-hundred and two older adults will be recruited from a cohort of this facility and they will be randomized and allocated into an intervention group (N = 76) and the control group (N = 76). The primary outcome evaluated will be the improvement of quality of life assessed by the WHOQOL-BREF and WHOQOL-OLD. The secondary outcomes will be cognitive function, psychological health, sleep quality, self-compassion, and religiosity. Qualitative data will be assessed by focus group and the word free evocation technique. The feasibility of the program will also be evaluated by adherence and unwanted effects questionnaires. Discussion: This cohort-nested clinical trial will be the first mixed-methods study with 3 assessment points which will study the feasibility and preliminary efficacy of a mindfulness-based program for older people in Latin America population. If the findings of this study confirm the effectiveness of this program in this population it will be possible to consider it as intervention that might be implemented as public policy addressed to older people in healthcare systems. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03048708. Registered retrospectively on October 11th 2018.

Mindfulness, perceived stress, and subjective well-being: a correlational study in primary care health professionals.

BACKGROUND: Primary health care professionals (PHPs) usually report high levels of distress and burnout symptoms related to job strain. Mindfulness, defined as non-judgmental-present-moment awareness, seems to be a moderator in the causal association between life stressors and well-being. This study aimed to verify correlations among self-reported mindfulness, perceived stress (PS), and subjective well-being (SW) in Brazilian PHPs. METHODS: We performed a correlational cross-sectional study in a purposive sample of Brazilian PHPs (physicians, nurses, nursing assistants, and community health workers), working in community-oriented primary care programs (known locally as "Family Health Programs"). We used validated self-reporting instruments: the Mindful Attention Awareness Scale (MAAS), the Perceived Stress Scale (PSS), and the Subjective Well-being Scale (SWS). We performed a multivariate analysis of variance (MANOVA), through regression coefficients (beta) in relation to the professional category (nursing assistant), in addition to the length of time in the same job (under than 6 months) that had indicated the lowest level of PS. RESULTS: Participants (n=450) comprised community health workers (65.8%), nursing assistants (18%), registered nurses (10.0%), and doctors (family physicians) (6.0%); 94% were female and 83.1% had worked in the same position for more than one year. MANOVA regression analysis showed differences across professional categories and length of time in the same job position in relation to mindfulness, PS, and SW. Nurses demonstrated lower levels of mindfulness, higher PS, and SW negative affect, as well as lower SW positive affect. Being at work for 1 year or longer showed a clear association with higher PS and lower SW positive affect, and no significance with mindfulness levels. Pearson's coefficient values indicated strong negative correlations between mindfulness and PS, and medium correlations between mindfulness and SW. CONCLUSION: In this study, there were clear correlations between mindfulness, PS, and SW across different primary care professional categories and time in the same job position, suggesting specific vulnerabilities that should be addressed through the development of staff awareness, stress prevention, and well-being interventions.

Validade e confiabilidade da "Escala de Atencão Plena e Consciência" (MAAS) e "Questionário das Cinco Facetas de Mindfulness" (FFMQ) entre profissionais da Atenção Primária à Saúde / Validity and reliability of the "Mindfulness and Consciousness Scale" (MAAS) and "Five Facet Mindfulness Questionnaire" (FFMQ) among Attention Professionals Primary Health

Introdução: Há crescente interesse em correlacionar níveis de consciência e bem estar através de programas que unam práticas contemplativas, e vem sido evidenciado redução de afeto negativo e aumento da habilidade autoregulativa, por meio do acréscimo de capacidade metacognitiva (mindfulness). Objetivo: O objetivo deste estudo é avaliar a validade e confiabilidade de duas escalas que mensuram mindfulness e as suas inter-relações com variáveis sócio demográficas e de bem estar subjetivo junto a profissionais da atenção primária à saúde (APS). Método: Para a validade de constructo utilizar-se-á uma validade convergente (escala de bem-estar subjetivo - EBES), e para a consistência interna será utilizado cálculo alfa de Cronbach. Correlacionaremos os resultados de duas partes da MAAS na fidedignidade split-half, com índice Kappa. Também com o intuito de reforçar o poder de confiabilidade do estudo, será utilizado o sistema de "teste ­ reteste" aplicando-se novamente tanto os instrumentos que medem Mindfulness (FMMQ e MAAS) como a EBES. Será adotado como nível de significância de 5% em todos os testes estatísticos (?=0,05). Resultados parciais: Incluímos até o momento 449 sujeitos de equipes mínimas de APS (médicos, enfermeiras, auxiliares, agentes comunitários de saúde) das unidades do território Aricanduva/Sapobemba/São Mateus, do Programa de Atenção Básica e Saúde da Família. Resultados esperados e conclusões: Estima-se avaliar as propriedades psicrométricas das escalas originais quando utilizadas em profissionais de APS e contribuir para a maior compreensão sobre o nível de mindfulness destes profissionais, bem como suas implicações para a redução de casos de esgotamento profissional.

Efeitos da meditação em profissionais da Atenção Primária à Saúde: uma revisão da literatura / Effects of Meditation on Primary Health Care Professionals: A Review of the literature

Introdução: O Ministério da Saúde entende a Estratégia Saúde da Família (ESF) como principal reorganizadora da Atenção Primária à Saúde (APS) no Sistema Único de Saúde (SUS). A ESF está entre as maiores coberturas de APS no mundo. Na medida em que delega múltiplas e complexas atribuições às suas equipes, com elevado grau de responsabilidade sanitária nos territórios atendidos, é esperado um risco psicossocial e de estresse ocupacional aumentado entre os profissionais da ESF. Objetivos: Avaliar os efeitos da meditação em profissionais da APS, mediante revisão da literatura sobre o tema. Método: Revisão narrativa da literatura, nas bases de dados Bireme, Scielo e Medline, com utilização dos seguintes descritores em português e inglês: meditação; profissionais; saúde; atenção primária. Resultados: Foram encontrados 54 artigos, dos quais foram selecionados 18, sendo excluídos os artigos cuja temática não atendia ao objetivo desse estudo. A maioria dos estudos constatou efeitos significativos da meditação em profissionais da APS, relativos à redução do estresse, ansiedade, depressão, entre outras, até vários meses após a aplicação da mesma, com melhora na qualidade de vida e dos serviços prestados à população usuária, que a meditação pode ser um expediente tanto terapêutico como preventivo para estes profissionais (FRANCO, 2010); com destaque para a diminuição de sentimentos negativos e ruminação mental ou intelectual (MARTIN-ASUERO;GARCIA-BANDA, 2010); melhora significativa no bem estar, atenção, empatia e maior de qualidade no atendimento prestado por estes profissionais (KRASNER ET AL, 2009); nesta mesma direção também concordam Irving, Dobkin, Park (2009); Oman et al (2008) e Praisman (2008), em seus respectivos estudos. Conclusão: Frente à literatura revisada, pode-se concluir que os efeitos da meditação são significativos, com número cada vez maior de publicações no mundo, mas não foram encontradas pesquisas desta natureza em profissionais da APS no Brasil, indica-se a necessidade de estudos sobre a aplicação desta promissora prática, com o propósito de avaliar seus efeitos na saúde, qualidade de vida no trabalho prestado por estes profissionais, em âmbito da produção científica nacional.