The development status and analysis of Traditional Chinese Medicine in Brazil / 国际中医中药杂志

The medical insurance is provided by the Unified Health System (SUS) covering most of Brazilians and alsocombined with private insurance, and every Brazilan could get access to basic health services. The major diseaseas leading to death in Brazil are ischemic heart disease, stroke and lower respiratory infection. The incidence of AD, chronic kidney disease and diabetes are increasing in recent years. Traditional Chinese Medicine (TCM), which was represented by acupuncture, was introduced to Brazil in the early 19th. At present, acupuncture has been widely accepted and used, which was included in SUS. A number of universities have acupuncture courses. However, the specialities and advantages of TCM needs to be strengthened, the local practioners lack the understanding of TCM theory, the appropriate use of herbal medicine, and there lacks TCM education standards, all these limit the development of TCM. Thus, in order to promote the development and dissemination of TCM in Brazil, it is suggested to give full play of the characteristics of TCM in preventing disease, increase the research and development input of herbal medicine, standardize the education stystem of TCM, etc.

Auriculotherapy in primary health care: A large-scale educational experience in Brazil.

Auriculotherapy consists of physical stimuli applied to the outer ear and is commonly associated with traditional Chinese medicine (TCM). The authors present and discuss the development of a course that offers a semi-on-site auriculotherapy course for Brazilian primary health care (PHC) professionals. The course was funded by the Brazilian Ministry of Health and developed at the Federal University of Santa Catarina in 2015 by a team of experts in auriculotherapy. It consisted of 75 h of distance learning (five sequential modules) and 5 h of on-site learning. The modules included the following items: (1) introduction to integrative practices; (2) ear reflexology; (3) introduction to TCM; (4) biomedical view of auriculotherapy; and (5) auriculotherapy in PHC. The teaching material included a workbook for each module, 14 video lectures and an interactive ear (online resource) to study location and application to the main auricular points. The on-site lectures follow a structured script of ear palpation techniques, auricular seed insertion practice and clinical case discussions, under the supervision of trained instructors. The course was offered in 2016 and 2017 and on-site lectures took place in 25 cities, covering all Brazilian regions, in coordination with municipal or state boards of health. A total of 4273 health professionals concluded the training and their evaluation of the course was highly positive. The Brazilian experience of large-scale training shows the potential to disseminate auriculotherapy in the context of PHC, given that its practice is fast, easy to learn, safe, effective for different health problems and well accepted by the patients.

Evaluation of the effectiveness of a care program for elderly patients with hip fractures: a network strategy / Avaliação da efetividade de um programa de atenção ao idoso com fratura de quadril: uma estratégia de rede

Abstract Objective: Evaluate the effectiveness of a care program for elderly persons with hip fractures due to a fall, based on a public network in Canoas, Rio Grande do Sul, Brazil. Methods: a prospective cohort study of quantitative character was carried out. A total of 182 elderly person above 60 years diagnosed with hip fractures were included. The sample was divided into two groups, one who underwent their usual treatment (n=91) and another who were included in a care program for elderly persons with hip fractures (n=91). The program had as its main axis a clinical Protocol and an Access Protocol. The treatment of choice was surgical in all cases. In statistical analysis, categorical variables were described by absolute and relative frequencies. The Mann-Whitney test was used to compare numeric variables. In the comparison of proportions, the Pearson's Chi-squared test or Fisher's exact test were applied. The significance level adopted was 5%. Results: The average age was 79.4 years, with a prevalence of the female gender. The most frequent morbidity was hypertension. After the implementation of the program there was a reduction in the average time between the fracture and the beginning of surgery, the average length of hospitalization, the urinary tract infection rate, the death rate and care costs. Conclusion: The care program of elderly persons with hip fractures modified the expected results as it reduced mortality, average hospital stay, postoperative complications and the costs of treatment during the hospitalization. AU

Resumo Objetivo: Avaliar a efetividade de um programa de atenção ao idoso com fratura de quadril decorrente de queda, aplicado a uma rede pública de assistência, no município de Canoas, no Rio Grande do Sul, Brasil. Métodos: Estudo de coorte, prospectivo de caráter quantitativo. Foram incluídos no estudo 182 idosos acima de 60 anos com diagnóstico de fratura de quadril. A amostra foi dividida em dois grupos, um grupo submetido a tratamento usual (n=91) e outro grupo de pacientes incluído em um programa para atenção ao idoso com fratura de quadril (n=91). O programa teve como eixo principal um protocolo clínico e um protocolo de acesso. O tratamento de escolha foi cirúrgico em todos os casos. Na análise estatística, as variáveis categóricas foram descritas por frequências absolutas e relativas. Para comparar variáveis numéricas o teste de Mann-Whitney foi utilizado. Na comparação de proporções, os testes qui-quadrado de Pearson ou exato de Fisher foram aplicados. O nível de significância adotado foi de 5%. Resultados: A média de idade foi de 79,4 anos, com prevalência do sexo feminino. A morbidade mais frequente foi a hipertensão. Após a implementação do programa houve redução do tempo médio decorrido entre a fratura e o início da cirurgia, da média de permanência, da taxa de infecção do trato urinário, da taxa de óbito e dos custos assistenciais. Conclusão: O programa de atenção ao idoso com fratura de quadril modificou os resultados esperados porque reduziu a mortalidade, a média de permanência hospitalar, as complicações pós-operatórias e os custos dos tratamentos durante a internação. AU

[INR telemonitoring: efficacy and safety of a telemonitoring program in 453 patients]. / telemonitorização de INR: eficácia e segurança de um sistema de avaliação em 453 doentes.

INTRODUCTION: The INR analyses of patients taking oral anticoagulants brings great burden to healthcare professionals, overspending founds from the National Health Service (NHS) and loss of quality of life of patients who are forced to frequent hospital visits. It should not be surprising that the technology is at the forefront of health care nowadays and some projects have been developed in the area of anticoagulation for INR self-monitoring by telephone, mobile phone or internet. The aim of this study was to assess the efficacy and safety of an INR telemonitoring system that was implemented in our hospital in 2006. METHODS: A prospective, observational study of 453 patients who were included in this telemonitoring system from 2006 until late November 2010. The communication between patients and health professionals was done via mobile phone messages in a standardized and codified system that included information about maintenance or modification of therapy and the date of the next evaluation. When necessary the patient could send a request for help through a code for that purpose. In the studied population the following parameters were evaluated: withdrawal of the telemonitoring project, need for change of anticoagulant dose, requests for clarification by the patient, hospitalization for bleeding complications and INR > 10. RESULTS: In our study population 53% were female, mean age = 57 +/- 16 years. The percentage of INR values within the therapeutic range was 83%. There were no dropouts of the telemonitoring project. The percentage of patients with major and minor bleeding complications during follow-up was 0.4% and 0.2% respectively. CONCLUSIONS: The telemonitoring system proves safe and effective remote monitoring of INR analysis, allowing efficient monitoring of INR with low prevalence of major or minor bleeding.

Educação em saúde: co-participação das educadoras infantis no processo desaúde das crianças

Partindo de minha experiência na área de educação em saúde e visto que esta é um elemento-chave para a formação de consciência, para a participação e a co-responsabilidade no exercício da cidadania, desenvolvi este estudo na área da Educação para Saúde no Centro de Desenvolvimento Infantil Mocotó (CDI), pertencente à Sociedade Alfa Gente (SAG). Este estudo tem como objeto a prática educativa na assistência de enfermagem, com a implementação da metodologia problematizadora à luz do referencial teórico da Educação Libertadora de Paulo Freire, para construir com as educadoras infantis do CDI Mocotó a co-responsabilidade no atendimento integral às crianças. Tem como objetivo instrumentalizar as educadoras infantis para o atendimento dos problemas básicos de saúde das crianças que freqüentam o CDI, apoiadas na metodologia problematizadora. É um estudo reflexivo de abordagem qualitativa desenvolvido na modalidade convergente assistencial, do qual participaram 16 educadoras infantis e seis trabalhadoras da creche. Foram realizados seis encontros, denominados: primeiro: Pensando a saúde das crianças; segundo: A criança está muito quente...; terceiro: Que agressividade é essa?; quarto: a criança precisa comer; quinto: Higiene? É necessário. E sexto: Caiu? o que eu faço agora. Uma etapa desenvolveu-se na promoção do diálogo e no resgate da auto-estima das participantes e outra etapa se constituiu no desenvolvimento da prática educativa sobre a saúde das crianças. O processo educativo como exercício de uma pedagogia libertadora e problematizadora constituiu-se em base importante para as mudanças na articulação das ações para resolução, não só de problemas pelas educadoras, mas de um contexto vivenciado por elas. ...

Educaçäo em saúde: co-participaçäo das educadoras Infantis no processo saúde doença no Centro de Desenvolvimento Infantil / Health education: co-participation of child educators at the health-disease process at the Child Development Center

Apresentamos neste relato o trabalho desenvolvido com as Educadoras Infantis do Centro Desenvolvimento Infantil (CDI) - Mocotó no período da Prática Assistencial do Curso de Pós Graduaçäo em Enfermagem em 1999. A partir de uma necessidade considerada em relaçäo à atençäo integral das crianças atendidas pelo CDI com a utilizaçäo de uma prática educativa que proporcionasse mudanças na dinâmica do dia a dia do CDI em relaçäo à saúde: um assumir com responsabilidade a saúde das crianças. Num leque täo amplo de necessidades, a busca conjunta na superaçäo da realidade.