Práticas integrativas e complementares na atenção primária à saúde / Prácticas integradoras y complementarias en la atención primaria de salud / Integrative and complementary practices in primary health care

RESUMO Objetivo: identificar as práticas integrativas e complementares realizadas pelos profissionais da saúde nas Unidades Básicas de Saúde. Método: trata-se de um estudo realizado a partir de uma pesquisa qualitativa em cinco Unidades Básicas de Saúde de Pelotas, município do Rio Grande do Sul, Brasil, entre janeiro e março de 2020. A produção de informações ocorreu a partir de entrevistas com roteiro semiestruturado. A análise foi realizada por meio da proposta de maneira operativa, em três etapas: pré-análise; classificação dos dados; reflexão em busca da interpretação e compreensão de tudo o que foi exposto. Resultados: as 16 participantes eram todas mulheres, com idade entre 33 e 59 anos, sendo nove enfermeiras. As práticas aplicadas pelas profissionais para o cuidado aos usuários eram: Auriculoterapia, Arteterapia, Reiki e Plantas Medicinais. O registro é realizado conforme a organização de cada Unidade Básica de Saúde, podendo ocorrer no Prontuário Eletrônico do Cidadão, no prontuário físico, em um caderno utilizado para o registro e/ou em ficha específica. Considerações finais: ressalta-se a importância das práticas integrativas e complementares na atenção primária, devido ao vínculo entre profissionais e usuários, ampliando o cuidado integral.

RESUMEN Objetivo: identificar las prácticas integradoras y complementarias realizadas por los profesionales de la salud en las Unidades Básicas de Salud. Método: se trata de un estudio realizado a partir de una investigación cualitativa en cinco Unidades Básicas de Salud de Pelotas, municipio de Rio Grande do Sul, Brasil, entre enero y marzo de 2020. La producción de informaciones se produjo a partir de entrevistas con guion semiestructurado. El análisis fue realizado por medio de la propuesta de manera operativa, en tres etapas: preanálisis; clasificación de los datos; reflexión en busca de la interpretación y comprensión de todo lo que fue expuesto. Resultados: las 16 participantes eran todas mujeres, con edad entre 33 y 59 años, siendo nueve enfermeras. Las prácticas aplicadas por las profesionales para el cuidado a los usuarios eran: Auriculoterapia, Arteterapia, Reiki y Plantas Medicinales. El registro es realizado conforme la organización de cada Unidad Básica de Salud, pudiendo ocurrir en el Registro Médico Electrónico del Ciudadano, en el Registro Médico físico, en un cuaderno utilizado para el registro y/o en ficha específica. Consideraciones finales: se resalta la importancia de las prácticas integradoras y complementarias en la atención primaria, debido al vínculo entre profesionales y usuarios, ampliando el cuidado integral.

ABSTRACT Objective: to identify the integrative and complementary practices held by health professionals in Primary Health Care Units. Method: this is a study conducted from qualitative research in five Primary Health Care Units of Pelotas, municipality of Rio Grande do Sul, Brazil, between January and March 2020. The production of information occurred from interviews with a semi-structured script. The analysis was performed by means of the proposal in an operative way, in three stages: pre-analysis; data classification; reflection in search of interpretation and understanding of everything that was exposed. Results: the 16 participants were all women, aged between 33 and 59 years, nine of whom were nurses. The practices applied by professionals for the care of users were: Auriculotherapy, Art Therapy, Reiki and Medicinal Plants. The record is performed according to the organization of each Primary Health Care Units, and may occur in the Citizen's Electronic Medical Record, in the physical record, in a notebook used for registration and/or in a specific form. Final considerations: it is underlined the importance of integrative and complementary practices in primary care, due to the bond between professionals and users, expanding comprehensive care.

A survey on Koreans' preferred type of collaboration between conventional medical and traditional Korean medicine doctors.

ABSTRACT: Although collaborative treatment by traditional Korean medicine doctors (KMDs) and medical doctors occurs, it is mainly done by referral. As no survey of the general public's preference for the type of collaboration has ever been conducted, we aimed to investigate Koreans' preferences for a collaborative treatment type.The responders were extracted by random digit dialing and then reextracted using the proportional quota sampling method by sex and age. From July to October 2017, telephone interviews were conducted and the participant responses regarding treatment history for spinal or joint diseases, experiences with collaborative treatment, and preferred type of collaborative treatment were recorded.Of the 1008 respondents, 44.64% reported a history of treatment for spinal or joint diseases at a medical institution. The concurrent collaborative treatment system, in which both KMDs and medical doctors are present in one location participating in the treatment concurrently, was the most preferred system among the respondents. Respondents who reported experience with traditional Korean medicine hospitals were more likely to prefer a one-stop treatment approach than those who did not have experience with traditional Korean medicine hospitals (adjusted odds ratio: 1.73; 95% confidence interval: 1.12-2.68). Respondents who were familiar with collaborative treatment but did not report any personal experience with it were more likely to prefer a one-stop treatment approach than those who were not familiar with collaborative treatment (adjusted odds ratio: 1.82; 95% confidence interval: 1.37-2.44).Koreans prefer a concurrent type of collaborative treatment system by KMDs and medical doctors. Therefore, efforts and support are needed to increase the application of the concurrent type of collaborative system.

[Holistic approach of the care of the infant with hypoxic-ischaemic encephalopathy in Spain]. / Atención integral del neonato con encefalopatía hipóxico-isquémica en España.

INTRODUCTION: There is not much information about the care of infants with hypoxic-ischaemic encephalopathy (HIE) treated with therapeutic hypothermia (TH) in Spain. This includes whether protocols are routinely used, the type of neuro-monitoring performed, and how information on the neurological prognosis is presented to families. The answers to these would allow to detect and implement areas of improvement. METHOD: A cross-sectional analysis was performed on the responses to structured questionnaires sent to all the Spanish neonatal units that were performing TH in June 2015. Questions were divided into 5sections: 1) the availability of protocols and technological resources, 2) the use of neuro-monitoring tools, 3) the knowledge and training of the professionals; 4) the prognostic information given to the parents; and 5) the discharge report and the follow-up plan. RESULTS: Most centres (95%) use servo controlled whole-body cooling methods and have specific management protocols. Sedation is used in 70% of centres, and in 68% of them the onset of enteral feeding is delayed until the end of the cooling period. Amplitude-integrated electroencephalography monitoring is used in more than 80% of the centres, although only in 50% are nurses able to interpret it. Cerebral oxygen saturation is not often monitored (16%). As regards diagnostic-prognostic studies, neuroimaging is universal, but brain damage biomarkers are hardly used (29%). Prognostic information is offered within the first 72 posnatal hours in 21% of the centres, and is given without the presence of the nurse in 70% of the centres. Follow-up is performed by a neuro-paediatrician (84%), with an uneven duration between centres. CONCLUSIONS: The care of infants with HIE treated with TH in Spain is generally adequate, although there are areas for improvement in neuromonitoring, sedation, prognostic information, teamwork, and duration of follow-up.

Holistic support coupled with prospective tracking reduces abandonment in childhood cancers: A report from India.

BACKGROUND: High cure rates of over 80% in childhood cancers reported from high-income countries (HICs) are not replicated in low- and middle-income countries (LMICs). Treatment abandonment (TxA) is an important reason for this poorer outcome. We assessed the effect of a holistic support group approach coupled with prospective tracking on TxA in children with cancer in a limited-resources environment. METHODS: In 2010, all existing nongovernmental organizations (NGOs) working with childhood cancer at our hospital were brought together to form a pediatric cancer foundation with the aim of providing holistic support to the patient and family, including financial, psychosocial, lodging, educational, and bereavement support. Simultaneously, prospective tracking of all children with a Time-Responsive Electronic Abandonment Tracking (TREAT) system was also established. The impact of these measures on TxA over the 2009-2016 period was compared using the log-rank test. RESULTS: The annual rate of abandonment reduced from 20% in 2009 to 10.4% in 2010 and 5.2% in 2011. It has been consistently between 3% and 6% from 2012 to 2016 (P -0.04). TxA after the initiation of treatment dropped from 9% in 2009 to 1% in 2016 (P -0.02), while refusal to initiate treatment dropped from 11% to 2.7% (P -0.23) over the same period. CONCLUSIONS: A holistic support group consisting of the hospital team, as well as existing NGOs and governmental organizations, along with a systematic and prospective tracking system significantly reduced abandonment in a resource-constrained setting. This cost-effective holistic support group may be applicable in other LMICs with similar healthcare systems.

Understanding quality of life within occupational therapy intervention research: A scoping review.

INTRODUCTION: There is little consensus regarding the meaning of quality of life (QOL) within occupational therapy literature. Measurement of QOL has varied in both research and practice. This scoping review explored the definitions and measures used within occupational therapy quantitative intervention research to evaluate QOL as an outcome. METHODS: The review was completed by searching six databases using occupational therapy-related and QOL-related terms. Data were extracted from each article and authors performed descriptive statistics to establish trends for both definitions and measures. RESULTS: Eighteen publications met the inclusion criteria. Seven articles included a definition of QOL. Most authors defined QOL as a multidimensional construct, comprised of varying domains. Fourteen different standardised measures and two non-standardised measures were utilised. CONCLUSIONS: A clear conceptualisation of QOL that incorporates occupational therapy values such as client-centredness and holism is needed to advocate for the profession's role in health care and to encourage the development of suitable outcome measures.

Establishment of Normative Self-Rated Health Status Data and Association between Ideal Life Expectancy and Social Wellness of General Population in Korea.

PURPOSE: The purpose of this study was to establish normative data for holistic health parameters in the general Korean population and to investigate the factor associated with ideal life expectancy (ILE) among these holistic health parameters and sociodemographic variables. METHODS: This study used a questionnaire to obtain self-reported physical, mental, social, spiritual, and general health status and then evaluated their association with ILE. A total of 1,241 individuals responded to the questionnaire, from which we established a multidimensional health status reference data set representing the Korean population. To explain factors associated with ILE, we stratified results by age and gender and performed multiple logistic regression of sociodemographic variables and multidimensional health status. RESULTS: Women reported poor health status more frequently for all five health categories. The average ILE was 87.46 years versus 84.42 years of life expectancy in the general Korean population. Single marital status, higher income, and better social health were significantly associated with higher ILE. CONCLUSION: ILE could be a good indicator reflecting social wellness in a certain society. Comprehensive social health promotion programs can improve individuals' attitudes toward life expectancy, especially for vulnerable groups.

Integrative medicine primary care: assessing the practice model through patients' experiences.

BACKGROUND: The University of Arizona Integrative Health Center (UAIHC) was an innovative integrative medicine (IM) adult primary care clinic in Phoenix, Arizona. UAIHC used a hybrid payment model to deliver comprehensive healthcare that includes conventional and complementary medical treatments. METHODS: Fidelity measures were collected to evaluate how well the IM care delivery process matched ideals for IM. Patient experiences are presented here. Patients visiting UAIHC on 1 of 10 randomly selected days between September 2013 and February 2015 were surveyed. Patients were asked about their experience with: holistic care; promotion of health, self-care, and well-being; relationship and communication with practitioners; and overall satisfaction. RESULTS: Eighty-three patients completed surveys. Based on patient-reported experiences, UAIHC delivered IM care as defined by the practice model. CONCLUSIONS: Patients received holistic care, established positive caring relationships with providers who promoted their self-care and well-being, and reported high overall satisfaction with UAIHC.

Value orientations and social attitudes in the holistic milieu.

Based on a representative population survey for Germany this article investigates whether engagement in holistic activities is associated with privatized lifestyles and lack of social responsibility or with countercultural orientations and base-democratic political commitment. To analyse this question, respondents who are engaged in holistic activities are divided into three groups that are compared with each other as well as with Christians and non-religious people. The findings show that the three holistic groups are characterized by clearly different attitudinal patterns: Respondents engaged in body-mind-spirit activities have an affinity to self-directed ways of life, post-materialism and environmentalism. Holistic Christians try to combine the Christian ideal of altruism and post-materialist orientations. Those who are attracted only to magical-occult practices are primarily concerned with individualistic self-improvement and correspond more to the image of the hedonist consumer at the esoteric marketplace.

Evaluation of holistic sexuality education: A European expert group consensus agreement.

OBJECTIVES: Holistic sexuality education (HSE) is a new concept in sexuality education (SE). Since it differs from other types of SE in a number of important respects, strategies developed for the evaluation of the latter are not necessarily applicable to HSE. In this paper the authors provide a basis for discussion on how to evaluate HSE. METHODS: First, the international literature on evaluation of SE in general was reviewed in terms of its applicability to HSE. Second, the European Expert Group on Sexuality Education extensively discussed the requirements of its evaluation and suggested appropriate indicators and methods for evaluating HSE. RESULTS: The European experience in SE is scarcely represented in the general evaluation literature. The majority of the literature focuses on impact and neglects programme and implementation evaluations. Furthermore, the current literature demonstrates that evaluation criteria predominantly focus on the public health impact, while there is not yet a consensus on sexual well-being criteria and aspects of positive sexuality, which are crucial parts of HSE. Finally, experimental designs are still considered the gold standard, yet several of the conditions for their use are not fulfilled in HSE. Realising that a new evaluation framework for HSE is needed, the European expert group initiated its development and agreed upon a number of indicators that provide a starting point for further discussion. CONCLUSIONS: Aside from the health impact, the quality of SE programmes and their implementation also deserve attention and should be evaluated. To be applicable to HSE, the evaluation criteria need to cover more than the typical public health aspects. Since they do not register long-term and multi-component characteristics, evaluation methods such as randomised controlled trials are not sufficiently suitable for HSE. The evaluation design should rely on a number of different information sources from mixed methods that are complemented and triangulated to build a plausible case for the effectiveness of SE in general and HSE in particular.

Modelo Holístico de Evaluación de la Prueba Testifical (HELPT) / A holistic model for the evalutation of the testimony (Helpt)

En este trabajo se presenta una propuesta de protocolo de evaluación de las declaraciones e identificaciones realizadas por posibles víctimas de delitos. El protocolo, denominado HELPT, se enmarca en un enfoque holístico de evaluación de la prueba testifical que considera todos los posibles factores de influencia: de codificación, de retención y de recuperación. Entre estos factores resultarán relevantes a) la capacidad para testificar de las víctimas, donde se tienen en cuenta los procesos cognitivos de atención, percepción, memoria y lenguaje; b) las características específicas del delito; c) los antecedentes del hecho evaluado y sus consecuencias; d) otros factores que pudieran afectar a la calidad y exactitud de las declaraciones e identificaciones, como el número de veces que la víctima tuvo que contar lo ocurrido, los métodos empleados para obtener el relato y posibilidades de sugestión. El método contempla procedimientos específicos de análisis exhaustivo de los expedientes y de formulación y contrastación de hipótesis (Scott y Manzanero, 2015), de evaluación de la competencia para testificar (Contreras, Silva y Manzanero, 2015) y de obtención de las declaraciones (González, Muñoz, Sotoca y Manzanero, 2013)

A proposed protocol for evaluating the statements and identifications made by the potential victims of crimes is presented in this paper. The protocol, called HELPT, is part of a holistic approach to evaluating the testimony that takes into account all possible factors of influence: encoding, retention and recovery. Among these factors, the following will be relevant: a) the ability of victims to testify, as well as cognitive processes of attention, perception, memory and language; b) the specific characteristics of the offence; c) the history of the event and its consequences; d) other factors that might affect the quality and accuracy of the statements and identifications, such as the number of times the victim had to tell what happened, the methods used to obtain the story and possibilities of suggestion. The method includes specific procedures for exhaustive analysis of the testimonies and for the formulation and testing of hypotheses (Scott & Manzanero, 2015), the evaluation of the competence to testify (Contreras, Silva, & Manzanero, 2015) and the obtaining of statements (González, Muñoz, Sotoca, & Manzanero, 2013)

The work left undone. Understanding the challenge of providing holistic lung cancer nursing care in the UK.

In England best practice guidance in cancer recommends that all patients have access to a specialist nurse such as the tumour specific clinical nurse specialist. The role has become pivotal providing aspects of care e.g. meeting information needs, holistic nurse led follow up including symptom control, managing care and providing psychological and social interventions including referral to others in the role of keyworker. There are approximately 295 lung cancer nurse specialists in England and recent study to model optimum caseload used an on line survey to look at workload of lung cancer specialist nurses. A survey of 100 lung cancer nurses from across the UK (RR78%) examined the perception of the work left undone against best practice guidance, caseload size, workload and other factors. 67 of 78 respondents perceived they left work such as proactive management (52) undertaking holistic needs assessments (46) providing appropriate psychological care (26) and meeting information needs (16). The majority (70) worked unpaid overtime (mean 3.8 h range 1-10 h) per week. Although proactive management is thought to result in better outcomes for lung cancer patients in terms of survival, quality of life and decisions of end of life a substantial number of the specialist nurses felt that factors such as caseload and organisational factors inhibited this.

La verdadera eficiencia de las Unidades de Memoria. ¿Qué falla? / Alzheimer disease and the delay of its diagnosis

Introducción: El deterioro cognitivo es un problema de salud pública extraordinariamente prevalente en la población general. Las Unidades de Memoria son necesarias dada la necesidad de llevar a cabo una aproximación holística tanto a pacientes como a cuidadores. Sin embargo, los datos disponibles son controvertidos tanto respecto a la demora en el diagnóstico como al tratamiento de nuestros pacientes. Pacientes y métodos: Llevamos a cabo un estudio epidemiológico retrospectivo en la Unidad de Estudio de la Cognición y la Conducta, en el Servicio de Neurología del Hospital Clínico San Carlos de Madrid. Se revisaron 620 historias clínicas y se seleccionaron aquellos pacientes con enfermedad de Alzheimer (EA) según criterios NINCSADRDA, desde 2008 a 2011. Se analizaron variables como la edad, el sexo, la dominancia manual, el nivel educativo, la presencia de un cuidador, GDS (Global Deterioration Scale) y meses transcurridos desde los primeros síntomas hasta el diagnóstico. El análisis estadístico se llevó a cabo mediante SPSS versión 19. Describimos la correlación entre variables como la edad, el sexo, el nivel educativo y la presencia de un cuidador con el GDS y los meses de demora diagnóstica. Resultados: Evaluamos 229 personas con EA (67,7 % mujeres, 32,3 % hombres). La distribución de GDS fue: GDS 4: 45,4 %; GDS 5: 28,4 %; GDS 6: 21,0 %; GDS 7: 5,2 %. La mediana de edad fue de 81 años (hombres, 80; mujeres, 81). La mediana de nivel educativo fue de 5 años (hombres, 7; mujeres, 5).El 87,8 % tenían un cuidador (GDS 4: 35,7 %, GDS 5: 67,9 %, GDS 6: 96,4 %, GDS7: 100 %). La mediana de meses de demora diagnóstica fue de 36 en hombres y de 30 en mujeres (GDS 4: 24, GDS 5: 36, GDS 6: 48 y GDS 7: 51 meses). Teniendo en cuenta la situación social, la mediana de meses de demora diagnóstica fue de 24 en aquellos pacientes que vivían solos y de 36 en pacientes con cuidador. No hubo diferencias entre personas con más de 6 años de nivel educativo o con menos de 6 (mediana de meses: 36, en ambos casos). Con clu - siones: Las Unidades de Memoria son necesarias para la realización de un diagnóstico precoz y el inicio de un tratamiento óptimo. Sin embargo, hoy en día existe un gran retraso en el área a la hora de poder llevar a cabo estos objetivos. El diagnóstico de EA se realiza tarde en los hombres y en pacientes con mejor soporte social en nuestro medio(AU)

Background: Cognitive impairment is a prevalent public health problem in general population. Memory Clinics are necessary in order to implement a holistic approach to patients and caregivers. However, data report many controversial aspects about the delay of diagnosis and treatment of our patients. Methods: retrospective epidemiological study was carried out. We reviewed 620 medical histories selecting those patients diagnosed of Alzheimer disease (AD) (NINCS-ADRDA criteria) in BCU-HCSC from 2008 to 2011. We analyzed age, sex, handness, educational level, caregiver, GDS and time (months) from first symptoms till diagnosis. We made a statistical analysis using SPSS 19 version. We describe the correlation between factors like age, sex, educational level and caregiver presence with GDS and months from first symptoms at the time of diagnosis. Results:We evaluated 229 AD (67.7% women, 32.3 % men). The distribution of GDS score was: GDS 4: 45.4 %, GDS 5: 28.4 %, GDS 6: 21.0 %, GDS 7: 5.2 %. The median age was 81(men 80, women 81) The median of educational level was 5 years (men 7, women 5). 87.8 % had a caregiver (GDS 4: 35.7 %, GDS 5: 67.9 %, GDS 6: 96.4%, GDS7: 100 %). The median of months from first symptoms to diagnosis was 36 in men and 30 in women (GDS4: 24, GDS 5: 36, GDS 6: 48 and GDS 7: 51 months). Regarding the social situation, the median of months from first symptoms till diagnosis was 24 for patients who live alone and 36 for patients with caregiver. There was no diference between people with more than 6 years of educational level and less of six years (median of 36 months in both cases). Conclusions: Memory clinics are necessary in order to make an early diagnosis and implement an optimal treatment for AD patients. However, nowadays there is a great delay in our area in order to make an optimal medical approach of these patients. Alzheimer diagnosis is made later in men and patients with better social support(AU)

Emotionless holism: factor and Rasch analysis of the Chinese Integrative Medicine Attitude Questionnaire.

OBJECTIVE: To examine the Eastern-Western difference in the interpretation of Integrative Medicine Attitude Questionnaire (IMAQ) by assessing the psychometric properties of a revised Chinese medicine (CM)-specific version of IMAQ (CM-IMAQ). METHODS: Factor and Rasch analysis were performed with data collected from a mail survey of 165 Hong Kong Western medical doctors (WMD) randomly sampled from the official registry. The structural validity, unidimensionality, item fit, and differential item functioning (DIF) of the Hong Kong CM-IMAQ were evaluated. RESULTS: Confirmatory factor analysis (CFA) demonstrated that the original IMAQ factor structure was not concordant with our data on Chinese WMD, and subsequent explanatory factor analysis (EFA) validated a new three-factor model for CM-IMAQ: (1) attitude towards "tonification", (2) attitude towards the effectiveness of CM, and (3) attitude towards CM knowledge. The original IMAQ factor on holism and doctor-patient relationship disappeared. Rasch analysis confirmed the unidimensionality of "tonification" and the effectiveness domains, but further refinement of the knowledge domain is needed. CONCLUSIONS: Cultural adaptation of the IMAQ has demonstrated differences between Eastern and Western doctors trained in allopathic medicine in their interpretations of holism in healthcare. For Chinese WMD, the emphasis of holistic care is placed on "tonifying" the body rather than on nurturing the mind and spirit. Confucian and Taoist conceptualizations of mental health as well as the persistent stigma towards mental illness within modern Chinese culture may explain why Chinese WMD do not regard mental health promotion as part of routine healthcare.

Participants' evaluation of the project P.A.T.H.S.: are findings based on different datasets consistent?

Subjective outcome evaluation findings based on the perspective of the participants of the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes) in nine datasets collected from 2005 to 2009 (n = 206, 313 program participants) were examined in this paper. Based on the consolidated data with schools as units, results showed that the participants generally had positive perceptions of the program, implementers, and benefits of the program. More than four-fifths of the participants regarded the program as beneficial to their holistic development. Multiple regression analysis revealed that the perceived qualities of the program and the program implementers predicted perceived effectiveness of the program. Based on the subjective outcome evaluation findings, the present study provides support for the effectiveness of the Tier 1 Program of the Project P.A.T.H.S. in Hong Kong.