Integrative Care Model of Complementary Therapies and Humanizing Practices in Primary Health Care: Qualitative Meta-synthesis.

Context: The World Health Organization (WHO) seeks to support member states in providing Traditional, Complementary, and Integrative Medicine (TCIM) services within Primary Health Care (PHC). Health professionals' offer of and referral to complementary therapies and humanizing practices can encounter some difficulties due to both conventional medical knowledge and institutional organizations. An integrative care model of complementary therapies and humanizing practices may be a strategy to overcome such difficulties. Objective: The study aimed to identify an integrative care model of complementary therapies and humanizing practices and to determine their influence on PHC. Design: The research team performed: (1) a qualitative meta-synthesis based on data from two systematic reviews that included more than 15000 professionals from 18 countries, and (2) qualitative research conducted with 24 participants, professionals from the South and Southeast regions of São Paulo, SP, Brazil. Setting: The study occurred at the Paulista School of Medicine at the Federal University of Sao Paulo (UNIFESP) in Sao Paulo, Brazil. Results: The analysis of the integrative care model resulted in two syntheses: (1) that PHC is offering complementary therapies and humanizing practices that have had a positive and subjective influence on PHC and (2) complementary therapies and humanizing practices improve PHC's service quality and resolvability and reduce medicalization. Conclusions: The work process in PHC may pose difficulties for the provision of integrative and holistic care yet promoting a model to integrate complementary therapies and humanizing practices with conventional medicine in health services may improve PHC and the perceptions of health professionals, managers, and patients about the positive and subjective effects of these practices.

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.

Traditional, complementary, and integrative medicine evidence map: a methodology to an overflowing field of data and noise.

Every day there is criticism about lack of evidence on traditional, complementary, and integrative medicine (TCIM). But is this narrative evidence-based? Are we really missing research about TCIM? Or are we just not looking correctly at the evidence? Evidence maps are a useful method with the dual function of synthesizing available evidence on a specific topic and identifying knowledge gaps. This article presents a six-step evidence map methodology along with recently published TCIM evidence maps, including one related to COVID-19. TCIM evidence maps are useful instruments to inform decision-making for policymakers, health practitioners, and patients.

Es habitual que se critique la falta de evidencia con respecto a las medicinas tradicionales, complementarias e integrativas. Sin embargo, ¿se basa en la evidencia este discurso? ¿Falta realmente investigación sobre las medicinas tradicionales, complementarias e integrativas o es que simplemente no estamos analizando la evidencia de forma adecuada? Los mapas de evidencia son un método útil que tiene una función doble: sintetizar la evidencia disponible por temas específicos y determinar si hay alguna laguna en el conocimiento. En este artículo se presenta una metodología de elaboración de mapas de la evidencia en seis pasos, junto con los mapas de la evidencia de las medicinas tradicionales, complementarias e integrativas publicados recientemente, incluido un mapa sobre la COVID-19. Los mapas de la evidencia de las medicinas tradicionales, complementarias e integrativas son instrumentos útiles para fundamentar la toma de decisiones por parte de los encargados de las políticas, el personal de salud y los pacientes.

A crítica é diária de que faltam evidências em medicinas tradicionais, complementares e integrativas (MTCI). Mas será que esta narrativa se baseia em evidências? Realmente faltam pesquisas em MTCI? Ou será que simplesmente não estamos atentando corretamente às evidências? Os mapas de evidências consistem em uma metodologia útil de dupla função: sintetizar as evidências existentes em um determinado tópico e identificar as lacunas de conhecimento. Neste artigo é apresentada uma metodologia de mapa de evidências de seis passos junto com mapas de evidências de MTCI recém-publicados, incluindo um relacionado à COVID-19. Os mapas de evidências de MTCI são instrumentos úteis para subsidiar a tomada de decisão dos responsáveis por políticas, profissionais da saúde e pacientes.

Double nursing degree: potentialities and challenges of an international student academic experience. / Dupla titulação em enfermagem: potencialidades e desafios de uma experiência de internacionalização acadêmica discente.

Objective To share the experience of a Double Nursing degree promoted between the Nursing School of the Universidade de São Paulo and the Health Sciences Institute of the Universidade Católica Portuguesa, reflecting on the potentialities and challenges of this opportunity for graduate students. Method This is an experience report presented in chronological order and of a descriptive nature. The double degree in Nursing was accomplished over a period of 6 months in a different institution from the institution of origin. Results Among the activities developed during the Double Degree are: participating in examining boards, congresses, seminars, courses, meetings, lectures, colloquium, classes, research groups and technical visits to health services. A table presents and describes the main benefits of the experience experienced by the authors. Conclusion When well-planned and well-developed, a double degree can promote personal, cultural and professional development of the students, favoring internationalization and contributing to the qualification of graduate programs.

Role of complementary therapies in the understanding of primary healthcare professionals: a systematic review.

Objective To identify the understanding of the healthcare professionals in relation to the role of complementary therapies in primary health care. Method Systematic review by way of the following information sources: PubMed, CINAHL, PeriEnf, AMED, EMBASE, Web of Science, Psicoinfo and Psicodoc, using the keyword Primary Health Care alone, and associated with the following keywords: Medicinal Plants, Herbal Medicine, Homeopathy, Traditional Chinese Medicine, Acupuncture, Anthroposophical Medicine. Results Twenty-two studies from 1986 to 2011 were included. We identified three styles of practice: conventional medicine, complementary therapies and integrative medicine. Positioning professional practices within these three styles may facilitate discussion of concepts of health care, enhancing the health care provided as a result. Conclusion The work process in primary care presents difficulties for conducting integrative and holistic health care, but this practice has been introduced over time by professionals who integrate conventional medicine and complementary therapies, concerned with the care and well-being of patients.

Offer of integrative and complementary health practices for the elderly in health services: A protocol for systematic review and meta analysis.

INTRODUCTION: Integrative and complementary health practices (ICHP) question the hegemony of the biomedical, technical and hospital paradigm, as they are an important axis in the process of redefining the health care model. Understanding how ICHP are offered to the elderly population can help to improve the production of changes in care and in the daily life of health services. OBJECTIVE: To identify and summarize the scientific evidence on the provision of ICHP for the elderly in health services. METHODS: This is a research protocol for a scoping review following the recommendations of the Extension for Scoping Reviews method proposed by the Joanna Briggs Institute. Studies will be collected in the following databases, Latin American and Caribbean Health Sciences Literature, Web of Science, Scopus, Scielo, Online System for Searching and Analyzing Medical Literature (MEDLINE), Embase, Virtual Library in Health and gray literature. Two independent reviewers will perform screening, data extraction, and risk of bias assessment using the Joanna Briggs Institute Critical Assessment Checklist. For the quality of evidence, the Grading of Recommendations, Assessment, Development and Evaluation analysis will be used. RESULTS: This review will provide information on the provision of ICHP for the elderly population in health services. CONCLUSIONS: This scoping review will provide evidence to help health professionals, managers and users to recognize more effective therapeutic inventions for promoting, preventing and protecting comprehensive health at different levels of care.

Efficacy and Safety of Auricular Acupuncture for Depression: A Randomized Clinical Trial.

Importance: Depression is a leading cause of disability worldwide, and there is increasing interest in nonpharmacological treatments. Auricular acupuncture (AA) is a simple, low-cost, and well-tolerated option, but further studies are needed to establish its efficacy and safety. Objective: To estimate the efficacy and safety of auricular acupuncture as a treatment for depression. Design, Setting, and Participants: This randomized clinical trial was conducted at 4 university research centers in Brazil, from March to July 2023. Eligible patients were adults aged 18 to 50 years whose score on the Patient Health Questionnaire-9 (PHQ-9) indicated moderate depression (score 10-14) or moderately severe depression (score 15-19). Exclusion criteria included previous application of AA, risk of suicidal ideation, or severe depression (PHQ-9 score >20). An intent-to-treat analysis and modified intent-to-treat analysis were conducted. Intervention: Participants were randomized into 2 treatment groups, which included specific AA (SA) and nonspecific AA (NSA). Both groups received 12 sessions of AA with semipermanent needles with daily stimulation twice a week over 6 weeks and were followed-up for 3 months. All participants continued with their usual care for ethical reasons. The SA group's treatment protocol consisted of 6 acupuncture points on the auricular pavilion chosen according to the diagnosis of depression by traditional Chinese medicine (Shenmen, subcortex, heart, lung, liver, and kidney). The NSA group's acupuncture points were the external ear, the cheek and face area, and 4 nonspecific points in the helix region unassociated with mental health symptoms. A locator device was used to confirm which areas had neuroreactive points. Main Outcomes and Measures: The primary outcome was a reduction of at least 50% in the PHQ-9 score (ie, depression recovery) at 3 months. Secondary outcomes included depression recovery at 4 and 6 weeks; depression remission (PHQ-9 score < 5) at 4 weeks, 6 weeks, and 3 months); and adverse events. Results: A total of 304 participants were screened, and 74 participants (62 women [84%]; median [IQR] age, 29 [23-27] years) were included in the intention-to-treat analysis, with 37 participants randomized to each group (SA and NSA). A total of 47 participants (64%) were followed-up through 3 months. The results showed no statistically significant difference in depressive recovery between the groups at 3 months (14 of 24 participants in the SA group [58%] vs 10 of 23 participants in the NSA group [43%]; risk ratio [RR], 1.34; 95% CI, 0.76-2.45; P = .38). The proportions of depression recovery and remission at 4 and 6 weeks based on the PHQ-9 were higher in the SA group (except for depression recovery at 6 weeks) with no statistically significant differences. However, a statistically significant difference was observed in symptom remission at 3 months (11 of 24 participants in the SA group [46%] vs 3 of 23 participants in the NSA group [13%]; RR, 1.99; 95% CI, 1.16-3.34; P = .02) in favor of SA. There were no significant differences in adverse event rates between the groups, evidencing the intervention's safety. Most participants reported mild pain at the needle application site (33 patients [94%] in the SA group vs 32 patients [91%] in the NSA group). Five participants dropped out of the study due to adverse events. Conclusions and Relevance: The results of this randomized clinical trial suggest that SA over 6 weeks is safe. Although there was no statistically significant difference between groups for the primary efficacy outcome, patients receiving SA did experience greater symptom remission at 3 months. A larger sample size and longer intervention are needed to further evaluate the efficacy of SA for depression. Trial Registration: ClinicalTrials.gov Identifier: NCT05855421.

Occupational health, integrative and complementary practices in primary care, and the Covid-19 pandemic.

OBJECTIVE: To identify the possible repercussions of the COVID-19 pandemic on the workers' health, the care strategies used, and the provision of Integrative and Complementary Practices in health services in the context of COVID-19. METHOD: Descriptive study, with a qualitative approach, which used a focus group for data collection and content analysis according to Bardin. RESULTS: Eleven health professionals from the city of Registro (SP) participated and, based on the information analysis, four categories emerged: (1) Changes in work routine caused by the pandemic and the feelings they generate in health professionals; (2) Integrative and Complementary Practices as a self-care strategy in the pandemic; (3) Provision of Integrative and Complementary Practices during the pandemic; and (4) Occupational health as the focus and strategy motivator to resume the provision of Integrative and Complementary Practices in the municipality. CONCLUSION: This study allowed the identification of the impact of the pandemic, especially on workers' mental health, which influenced the search for care strategies that included the Integrative and Complementary Practices. Professionals with this training began to offer the Integrative and Complementary Practices in the service to other workers, given the interruption of their provision to the population due to the COVID-19 pandemic.

Primary health care performance according to clusters of convergent municipalities in the state of São Paulo.

OBJECTIVE: To describe the performance of Primary Health Care, according to conglomerates of São Paulo cities that present homogeneous indicators. METHODS: This is a descriptive study, based on secondary data extracted from official sources of the Unified Health System, for the year 2018. An analysis matrix was created, with the proposition of performance (access, effectiveness and adequacy) and context indicators (population, health determinants and financing) selected and organized in dimensions and sub-dimensions. Cluster Analysis was used to identify the groups of homogeneous municipalities. RESULTS: 645 municipalities were divided in 6 conglomerates. Clusters 2 and 3 were formed predominantly by small municipalities with greater access to health; cluster 3 has less social vulnerability and greater investment in health. Clusters 1, 4 and 5 were formed by the largest municipalities with less access to health; cluster 4 presents greater social vulnerability, less coverage of private health plans and a greater percentage of health resources; cluster 5 was characterized by greater Gross Domestic Product per capita and greater coverage of private health plans. Cluster 6, formed by the city of São Paulo, was a particular case. Cluster 2 drew attention, as it was shown to have increased coverage, but signaled lower efficacy and adequacy levels. Cluster 3 had the best performance among all clusters. CONCLUSION: These findings can support regional and municipal management, given the complexity of the territory of São Paulo, pointing to scenarios that demand broader public management initiatives.

[Scientific research in nursing education: Rio de Janeiro and Minas Gerais research groups]. / Produção científica em educação em enfermagem: grupos de pesquisa Rio de Janeiro e Minas Gerais.

This study aims to characterize the scientific production of the Research Groups in Nursing Education (RGNE) of the states of Rio de Janeiro and Minas Gerais, in Brazil. This is a documentary quantitative descriptive retrospective research, conducted by searching the CVs of all researchers who are part of the RGNEs in the Lattes database, followed by the search, organization, and evaluation of their scientific production according to Qualis/CAPES. The period studied was from 1995 to 2009 (the last five CAPES triennia) and included articles, books, book chapters, and full papers in conference proceedings. Results show that Rio de Janeiro has the higher number of articles in Nursing Education, highlighting the qualification of researchers at doctorate level. Both states present historic and socio-economic factors that favor scientific development.

Meditation: Evidence Map of Systematic Reviews.

Study Basis: This evidence map presents a summary of studies that addressed the effects of meditation on various clinical and health conditions. Meditation is a contemplative practice that has been used for the promotion of health, and the treatment of different conditions. Method: The study is based on the search of four electronic databases for the period 1994-November 2019 and includes systematic reviews, meta-analyses, meta-syntheses, and integrative reviews. 3iE evidence gap map was the methodology of choice, and AMSTAR 2 was used for the analyses. Tableau was used to graphically display the confidence level, number of reviews, health outcomes, and intervention effects. Results: This map encompasses 191 studies, with Mindfulness being the key word that retrieved the highest number of results. Several meditation techniques were evaluated in different contexts, and the confidence levels of 22 studies were high, 84 were moderate, and 82 were low. Two 2 meta-syntheses and 1 integrative review were also included. Most of the studies reported positive effects and a beneficial potential of the practice of meditation. Health outcomes were divided into five groups out of which mental health and vitality, and well-being and quality of life stood out with the largest number of studies. Conclusions: Meditation has been applied in different areas. This Evidence Map intends to be an easy visual tool to access valuable evidence-based information on this complementary therapy for patients, health professionals, and managers.

Pediatrics massage evidence map.

BACKGROUND: This evidence map describes Pediatrics Massage intervention research reporting health outcomes. Massage is a complementary therapy and can be defined as any form of systematic tactile stimulation by human hands, the type of massage typically used in pediatrics care is a gentle, slow stroking of each part of the body in turn. METHODS: The evidence map is based on the 3iE evidence gap map methodology. We searched four electronic databases from inception to November 2019 and included systematic reviews and non-systematic reviews. Systematic reviews were analyzed based on AMSTAR 2. We used tableau to graphically display confidence level, number of reviews, outcomes and a broad estimate of effectiveness. RESULTS: The map is based on 38 reviews. Most of the reviews were published in the last ten years. The Pediatrics Massage was the most researched intervention. Massage was evaluated as an intervention in several health outcomes, resulting in the following confidence levels: 11 high, 13 moderate and 14 low. Every outcome effect was classified: 6 as no effect; 1 mixed and 28 as positive. The outcomes were divided into four major groups: physical and metabolic effects; vitality, well-being and quality of life, mental health; and management. High quality studies presented no effect and positive effects, highlighting outcomes related to neuro-motor development (Badr et al., 2015; Bennett et al., 2013; Vickers et al., 2015), growth (Badr et al., 2015; Bennett et al., 2013; Vickers et al., 2015) and stress disorders (Bennett et al., 2013; Vickers et al., 2015). CONCLUSIONS: Pediatrics massage has been applied in different areas and these Evidence Gap Map provides an easy visualization of valuable information for patients, health practitioners and managers, in order to promote evidence-based complementary therapies.

Mind-Body Therapies From Traditional Chinese Medicine: Evidence Map.

Background: The mind-body therapies of traditional Chinese medicine include several intervention types and combine physical poses with conscious relaxation and breathing techniques. The purpose of this Evidence Map is to describe these different interventions and report related health outcomes. Methods: This evidence map is based on the 3iE Evidence Gap Map methodology. We searched seven electronic databases (BVS, PUBMED, EMBASE, PEDro, ScienceDirect, Web of Sciences, and PschyInfo) from inception to November 2019 and included systematic reviews only. Systematic reviews were analyzed based on AMSTAR 2. We used Tableau to graphically display quality assessment, the number of reviews, outcomes, and effects. Results: The map is based on 116 systematic reviews and 44 meta-analyses. Most of the reviews were published in the last 5 years. The most researched interventions were Tai Chi and Qi Gong. The reviews presented the following quality assessment: 80 high, 43 moderate, 23 low, and 14 critically low. Every 680 distinct outcome effect was classified: 421 as potential positive; 237 as positive; 21 as inconclusive/mixed; one potential negative and none no effect. Positive effects were related to chronic diseases; mental indicators and disorders; vitality, well-being, and quality of life. Potential positive effects were related to balance, mobility, Parkinson's disease, hypertension, joint pain, cognitive performance, and sleep quality. Inconclusive/mixed-effects justify further research, especially in the following areas: Acupressure as Shiatsu and Tuiná for nausea and vomiting; Tai Chi and Qi Gong for acute diseases, prevention of stroke, stroke risk factors, and schizophrenia. Conclusions: The mind-body therapies from traditional Chinese medicine have been applied in different areas and this Evidence Map provides a visualization of valuable information for patients, professionals, and policymakers, to promote evidence-based complementary therapies.

MUSIC INTERVENTIONS IN PEDIATRIC ONCOLOGY: Systematic review and meta-analysis.

BACKGROUND: Pain is a disagreeable and distressing feeling that affects human beings in multi-dimensional ways. A number of non-pharmacological interventions have had varying degrees of success in treating cancer-related pain, such as breathing and relaxation techniques, and music therapy, which have been identified as beneficial therapies for alleviating pain and anxiety. OBJECTIVE: Identify the therapeutic effects of music interventions in psychological and physiological terms and on the quality of life of children undergoing cancer treatment. METHOD: Systematic review of effectiveness based on the methodology of the Joanna Briggs Institute. RESULTS: Eleven articles were included with a total of 429 children, whose ages ranged from 0 to 18 years. The mean duration of the music intervention was 30.6 (±SD 9.8) min. In a combined estimate of five studies for pain and anxiety outcomes, there were benefits to using music when compared with the control group (SMD -1.05; CI 95 % -1.70 - 0.40 N = 453 I2 = 90 %). A combined analysis of five studies to assess quality of life showed that the use of music was favorable when compared with the control (SMD -0.80; CI 95 % -1.17-0.43 N = 457= I2 = 71 %). CONCLUSION: After completing this review, it was determined that there is evidence to support the use of music to reduce pain and anxiety and improve the quality of life of children undergoing cancer treatment.

[Parallel between permanent education and health administration complex]. / Paralelo entre educação permanente em saúde e administração complexa.

Education is a political process, in which the society operates consistently on the development of the individual, aiming to integrate it into the way of living being. The present work represents a theoretical refection, from a parallel between the guidelines of the National Politics in Continuing Education in Health and the principles of the Complex Administration. From a brief review of the literature, it is attempted to contextualize the policy and this new form of administration based on freedom, cooperation, aggregation and self-organization. Results of the study suggest that the relation between continuing education and complex administration could facilitate the implementation of nursing care and health, as well as management's activities by promoting autonomy, as well as personal, professional and organizational growth.

Evidence map on the contributions of traditional, complementary and integrative medicines for health care in times of COVID-19.

BACKGROUND: Due to the pandemic, there is a significant interest in the therapeutic resources linked to TCIM to support potentially therapeutic research and intervention in the management of Coronavirus - 19 (COVID-19). At the date of this evidence map´s publication, there is no evidence of specific treatments for COVID-19. This map organizes information about symptoms management (especially on dimensions related to mental health and mild viral respiratory infections, as well as immune system strengthening and antiviral activity). METHOD: This evidence map applies methodology developed by Latin American and Caribbean Center on Health Sciences Information based on the 3iE evidence gap map. A search was performed in the Traditional, Complementary and Integrative Medicine Virtual Health Library and PubMed, using the MeSH and DeCS terms for respiratory viral diseases associated with epidemics, COVID-19 symptoms, relevant mental health topics, pharmacological and non-pharmacological interventions related to TCIM. RESULTS: For the map, 126 systematic reviews and controlled clinical studies were characterized, distributed in a matrix with 62 interventions (18 phytotherapy, 9 mind-body therapies, 11 traditional Chinese medicine, 7 homeopathic and anthroposophic dynamized medicines and 17 supplements), and 67 outcomes (14 immunological response, 23 mental health, 25 complementary clinical management of the infection and 5 other). CONCLUSION: The map presents an overview of possible TCIM contributions to various dimensions of the COVID-19 pandemic, especially in the field of mental health, and it is directed to researchers and health professionals specialized in TCIM. Most of the antiviral activity outcomes described in this map refers to respiratory viruses in general, and not specifically to SARS-CoV-2 (Severe Acute Respiratory Syndrome CoronaVirus 2). This information may be useful to guide new research, but not necessarily to support a therapeutic recommendation. Finally, any suspicion of COVID-19 infection should follow the protocols recommended by the health authorities of each country/region.

Adults at high-risk of severe coronavirus disease-2019 (Covid-19) in Brazil.

OBJECTIVE To estimate the proportion and total number of the general adult population who may be at higher risk of severe Covid-19 in Brazil. METHODS We included 51,770 participants from a nationally representative, household-based health survey (PNS) conducted in Brazil. We estimated the proportion and number of adults (≥ 18 years) at risk of severe Covid-19 by sex, educational level, race/ethnicity, and state based on the presence of one or more of the following risk factors: age ≥ 65 years or medical diagnosis of cardiovascular disease, diabetes, hypertension, chronic respiratory disease, cancer, stroke, chronic kidney disease and moderate to severe asthma, smoking status, and obesity. RESULTS Adults at risk of severe Covid-19 in Brazil varied from 34.0% (53 million) to 54.5% (86 million) nationwide. Less-educated adults present a 2-fold higher prevalence of risk factors compared to university graduated. We found no differences by sex and race/ethnicity. São Paulo, Rio de Janeiro, Minas Gerais, and Rio Grande do Sul were the most vulnerable states in absolute and relative terms of adults at risk. CONCLUSIONS Proportion and total number of adults at risk of severe Covid-19 are high in Brazil, with wide variation across states and adult subgroups. These findings should be considered while designing and implementing prevention measures in Brazil. We argue that these results support broad social isolation measures, particularly when testing capacity for SARS-CoV-2 is limited.

Nurses in the Kanban: are there news meanings of professional practice in innovative tools for hospital care management? / Enfermeiros na operacionalização do Kanban: novos sentidos para a prática profissional em contexto hospitalar?

Kanban is a care management tool that values multi-professional work and intensive use of data and has been growingly used in Brazil to address overcrowding in hospital emergency services (HES). The researchers monitored the Kanban for ten months in multiple wards of a municipal HES, and their observations were recorded in field diaries and discussed in biweekly research team meetings. The empirical material was organized from two questions: Are there changes in "traditional attributions" of Kanban-operating nursing? Are Medicine-Nursing interprofessional relationships transformed? A strong nurse adherence to this tool was observed, coupled with greater specialization and fragmentation of their work: nurses working as diarists assume more traditional administrative functions, while those on-call develop more direct assistance to patients. Nurses consider that clinical decisions are still in the doctors' hands, although Kanban provides them with a stronger influence on such decisions. Nurses' role in the management of significant mass of clinical and operational data, central to Kanban's operationalization, strengthens their professional authority.

O Kanban, uma tecnologia de gestão do cuidado caracterizada pela valorização do trabalho multiprofissional e o uso intensivo da informação, tem sido crescentemente utilizado para enfrentar a superlotação dos serviços de emergência hospitalar (SEH). Pesquisadores acompanharam durante dez meses o Kanban em vários setores de um SEH municipal. Suas observações, registradas em diários de campo, foram discutidos em reuniões quinzenais por um coletivo de pesquisadores. O material empírico foi organizado a partir de duas questões: Há mudanças nas "atribuições tradicionais" da enfermagem atuando no Kanban? Há transformações nas relações interprofissionais entre Medicina e Enfermagem na operacionalização do Kanban? Observou-se forte adesão dos enfermeiros ao arranjo, pari passu com uma maior especialização e fragmentação do seu trabalho. Os diaristas assumem funções administrativas tradicionais da enfermagem, enquanto os plantonistas desenvolvem assistência direta aos pacientes. Os enfermeiros consideram que a decisão clínica ainda é do médico, embora o Kanban propicie sua maior influência na decisão. A gestão de grande massa de dados clínico-operacionais pelos enfermeiros, central na operacionalização do Kanban, reforça sua autoridade profissional.