Connectedness to nature and its association with food choice motives among primary health care professionals. / Conexão com a natureza e associação com motivos de escolhas alimentares entre profissionais da atenção primária à saúde.

Connectedness to nature can boost well-being and lead to healthier and more sustainable food choices. Health professionals have the potential to be key agents in promoting environmental health. A cross-sectional study was conducted with 146 primary healthcare professionals to determine the association betweennature connectedness and food choicemotives considered important for human and environmental health. We used the 14-item Connectedness to Nature Scale (CNS) and the Food Choice Questionnaire (FCQ), consisting of 36 items distributed between nine factors, including "health", "natural content", and "ethical concern". The average CNS score was 53.8 (± 9). The highest scoring factors of the FCQ were sensory appeal and price.Ethical concern was ranked last. There was a significant positive association between degree of nature connectedness and scoring for the factors health (p = 0.031), natural content (p = 0.001), and ethical concern (p <0.001). The results of this unprecedented studyshow that increased connectedness to nature may lead to healthier and more sustainable food choices.

A conexão com a natureza pode favorecer o bem-estar e a adoção de práticas alimentares sustentáveis. Profissionais de saúde seriam agentes fundamentais nesta interface, promovendo a saúde ambiental. Estudo transversal com 146 profissionais da atenção primária avaliou a associação entre conexão com a natureza e os motivos para escolhas alimentares consideradas importantes à saúde humana e ambiental. Aplicou-se Escala de Conexão com a Natureza (ECN), contendo 14 itens que medem o quanto a pessoa se sente integrada ao meio ambiente, variando de 14 a 70 pontos; e o Questionário sobre Motivos para as Escolhas Alimentares (FCQ), com 36 itens distribuídos em nove fatores, dentre os quais elegeu-se para este estudo: "Saúde", "Conteúdo Natural" e "Preocupação Ética". A pontuação média na ECN foi de 53,8, (± 9). "Apelo Sensorial" e "Preço" foram os fatores mais pontuados; "Preocupação Ética" ocupou a última posição. Houve associação positiva significativa da ECN com a pontuação nos fatores "Saúde" (p = 0,031), "Conteúdo Natural" (p = 0,001) e "Preocupação Ética" (p < 0,001). Os resultados desta pesquisa inédita permitiram concluir que aumentar conexão com a natureza pode favorecer escolhas alimentares mais saudáveis e sustentáveis.

Conexão com a natureza e associação com motivos de escolhas alimentares entre profissionais da atenção primária à saúde / Connectedness to nature and its association with food choice motives among primary health care professionals

Resumo A conexão com a natureza pode favorecer o bem-estar e a adoção de práticas alimentares sustentáveis. Profissionais de saúde seriam agentes fundamentais nesta interface, promovendo a saúde ambiental. Estudo transversal com 146 profissionais da atenção primária avaliou a associação entre conexão com a natureza e os motivos para escolhas alimentares consideradas importantes à saúde humana e ambiental. Aplicou-se Escala de Conexão com a Natureza (ECN), contendo 14 itens que medem o quanto a pessoa se sente integrada ao meio ambiente, variando de 14 a 70 pontos; e o Questionário sobre Motivos para as Escolhas Alimentares (FCQ), com 36 itens distribuídos em nove fatores, dentre os quais elegeu-se para este estudo: "Saúde", "Conteúdo Natural" e "Preocupação Ética". A pontuação média na ECN foi de 53,8, (± 9). "Apelo Sensorial" e "Preço" foram os fatores mais pontuados; "Preocupação Ética" ocupou a última posição. Houve associação positiva significativa da ECN com a pontuação nos fatores "Saúde" (p = 0,031), "Conteúdo Natural" (p = 0,001) e "Preocupação Ética" (p < 0,001). Os resultados desta pesquisa inédita permitiram concluir que aumentar conexão com a natureza pode favorecer escolhas alimentares mais saudáveis e sustentáveis.

Abstract Connectedness to nature can boost well-being and lead to healthier and more sustainable food choices. Health professionals have the potential to be key agents in promoting environmental health. A cross-sectional study was conducted with 146 primary healthcare professionals to determine the association betweennature connectedness and food choicemotives considered important for human and environmental health. We used the 14-item Connectedness to Nature Scale (CNS) and the Food Choice Questionnaire (FCQ), consisting of 36 items distributed between nine factors, including "health", "natural content", and "ethical concern". The average CNS score was 53.8 (± 9). The highest scoring factors of the FCQ were sensory appeal and price.Ethical concern was ranked last. There was a significant positive association between degree of nature connectedness and scoring for the factors health (p = 0.031), natural content (p = 0.001), and ethical concern (p <0.001). The results of this unprecedented studyshow that increased connectedness to nature may lead to healthier and more sustainable food choices.

Fatores associados ao bem-estar em profissionais da atenção primária / Factors associated with well-being in primary care professionals / Factores asociados con el bienestar de profesionales de la atención primaria

Objetivo: Investigar fatores associados ao bem-estar subjetivo (BES) em profissionais da Atenção Primária a Saúde (APS). Métodos: Estudo transversal realizado em 2017 com 142 profissionais da APS de um município paulista que responderam aos instrumentos: Escala de BES (EBES), Escala de Conexão com a Natureza (ECN); Maslach Burnout Inventory (MBI); Estado de Saúde Autorreferido (ESA); Questionário sociodemográfico. Aplicou-se análise estatística, ajustados modelos de regressão linear múltipla, com resposta normal para explicar pontuações dos 3 domínios da escala EBES, em função das variáveis independentes estatisticamente mais fortes (p<0,20), em análise prévia bivariada. Considerou-se estatisticamente significativo se p<0,05. Resultados: Amostra com predomínio de pessoas do sexo feminino (n=116; 81,7%), cor da pele autoatribuída branca (n=123;86,6%), idade até 35 anos (n=77; 54,2%), casadas ou em união estável (n= 91; 64,1%), com graduação ou pós (n=83; 58,5%) e trabalhadoras da saúde há mais de 5 anos (n= 102; 71,8). Maiores níveis de BES associados à escolaridade (ter graduação ou pós, p=0,039) e menores à idade (acima de 35 anos, p=0,025), ESA ruim ou muito ruim (p=0,005 para satisfação com a vida e p=0,028 para afetos positivos), hospitalização no último ano (p=0,017), morar sozinho (p=0,007) e burnout (p=0,004 na pontuação geral e p=0,030 na dimensão despersonalização" do MBI). Conclusão: Aspectos sociodemográficos (idade acima de 35 anos e residir sozinho) impactam negativamente o bem-estar dos profissionais investigados, assim como condição ruim de saúde e grau de estresse relacionado ao trabalho. Ter graduação ou pós pode favorecer a satisfação com a vida.

Objective: To investigate factors associated with subjective well-being (SWB) in Primary Health Care (PHC) professionals. Methods: Cross-sectional study conducted in 2017 with 142 PHC professionals from a city in São Paulo State who answered the instruments: SWB Scale (SWBS), Connectedness to Nature Scale (CNS); Maslach Burnout Inventory (MBI); Self-Reported Health Status (SRHS); sociodemographic questionnaire. Statistical analysis was applied and adjusted for multiple linear regression models, with normal responses to explain scores of the three domains of the SWBS scale as a function of the statistically stronger independent variables (p<0.20) in former bivariate analysis. It was considered statistically significant if p<0.05. Results: Sample with a predominance of females (n=116; 81.7%), white self-assigned skin colour (n=123; 86.6%), aged up to 35 years (n=77; 54.2%), married or in a stable relationship (n=91; 64.1%), graduated or postgraduate (n=83; 58.5%) and health workers for more than 5 years (n= 102; 71.8). Higher levels of SWB associated with schooling (being undergraduate or graduate, p=0.039) and underage (over 35 years, p=0.025), bad or very bad SRHS (p=0.005 for life satisfaction and p=0.028 for positive affects), hospitalization in the last year (p=0.017), living alone (p=0.007) and Burnout (p=0.004 in the overall score and p=0.030 in the depersonalization dimension of the MBI). Conclusion: Sociodemographic aspects (over 35 years old and living alone) negatively impact the well being of the professionals investigated as poor health status and work-related stress level. Having an undergraduate or graduate degree can promote life satisfaction.

Objetivo: Investigar los factores asociados con el bienestar subjetivo (BES) de profesionales de la Atención Primaria de Salud (APS). Métodos: Estudio transversal realizado en 2017 con 142 profesionales de la APS de un municipio de São Paulo que contestaron a los siguientes instrumentos: la Escala de BES (EBES), la Escala de Conexión con la Naturaleza (ECN); el Maslach Burnout Inventory (MBI); el Estado de Salud Auto referido (ESA); el Cuestionario sociodemográfico. Se aplicó el análisis estadístico, ajustados modelos de regresión linear múltiple con respuesta normal para explicar las puntuaciones de los 3 dominios de la escala EBES, según las variables independientes estadísticamente más fuertes (p<0,20), en análisis previo bivariado. Se há considerado estadísticamente significativo si p<0,05. Resultados: Hubo el predominio de personas del sexo femenino (n=116; 81,7%), del color de piel blanco auto atribuido (n=123; 86,6%), edad hasta los 35 años (n=77; 54,2%), casadas o en unión estable (n= 91; 64,1%), con graduación o post grado (n=83; 58,5%) y trabajadoras del área de la salud desde hace más de 5 años (n= 102; 71,8). Mayores niveles de BES asociados con la escolaridad (tener graduación o post grado p=0,039) y los menores de edad (por encima de los 35 años, p=0,025), malo o muy malo ESA (p=0,005 para la satisfacción con la vida y la p=0,028 para los afectos positivos), la hospitalización del último año (p=0,017), vivir solo (p=0,007) y burnout (p=0,004 para la puntuación general y p=0,030 para la dimensión "despersonalización" del MBI). Conclusión: Los aspectos socio demográficos (por encima de los 35 años y vivir solo) impactan negativamente en el bienestar de los profesionales investigados, así como la mala condición de salud y el grado de estrés relacionado con el trabajo. Tener graduación o post grado puede favorecer la satisfacción con la vida.

Implementation of Brazil's National Policy on Complementary and Integrative Practices: strengths and weaknesses. / Potencialidades e fragilidades de implantação da Política Nacional de Práticas Integrativas e Complementares.

This narrative review examines the literature on complementary and integrative practices (CIPs) and their incorporation into Brazil's national health system (Sistema Único de Saúde - SUS) in an attempt to understand the strengths and weaknesses of the implementation of the National Policy on Complementary and Integrative Practices in the SUS (PNPIC, acronym in Portuguese). A search was conducted of the MEDLINE, LILACS, and SciELO databases, resulting in final sample of 25 articles. Our analysis identified five key themes in the literature related to the strengths and weaknesses of policy implementation: 1) Professional training in CIPs in the SUS; 2) structuring the provision of CIPs, access, and health promotion; 3) knowledge, access, and acceptance of service users in relation to CIPs; 4) knowledge of SUS professional staff and managers in relation to the PNPIC; and 5) scope and monitoring and evaluation of the PNPIC. In consonance with the conclusions of the PNPIC management reports, the findings provide a deeper insight into policy implementation problems and reinforce the need to empower the actors involved in this process to tackle these challenges.

Esta revisão narrativa tem por objetivo analisar a produção científica sobre as Práticas Integrativas e Complementares (PIC) no Sistema Único de Saúde (SUS) visando compreender as potencialidades e fragilidades do processo de implantação da Política Nacional de Práticas Integrativas e Complementares (PNPIC). Após busca nas bases de dados, 25 artigos foram selecionados e os seus resultados analisados criticamente. Da análise do material emergiram cinco temas principais que explicitaram potencialidades e fragilidades de implantação da política: 1) Formação profissional em PIC para o SUS; 2) Estruturação da oferta em PIC, acesso e promoção da saúde; 3) Conhecimento, acesso e aceitação de usuários em relação às PIC; 4) Conhecimento de profissionais e gestores em relação à PNPIC; e 5) Escopo, monitoramento e avaliação da PNPIC. Os resultados se alinham aos relatórios de gestão da PNPIC aprofundando o conhecimento acerca da implantação da política e reforçando a necessidade de empoderamento dos atores do SUS para o enfrentamento de seus desafios.

Potencialidades e fragilidades de implantação da Política Nacional de Práticas Integrativas e Complementares / Implementation of Brazil's National Policy on Complementary and Integrative Practices: strengths and weaknesses

Resumo Esta revisão narrativa tem por objetivo analisar a produção científica sobre as Práticas Integrativas e Complementares (PIC) no Sistema Único de Saúde (SUS) visando compreender as potencialidades e fragilidades do processo de implantação da Política Nacional de Práticas Integrativas e Complementares (PNPIC). Após busca nas bases de dados, 25 artigos foram selecionados e os seus resultados analisados criticamente. Da análise do material emergiram cinco temas principais que explicitaram potencialidades e fragilidades de implantação da política: 1) Formação profissional em PIC para o SUS; 2) Estruturação da oferta em PIC, acesso e promoção da saúde; 3) Conhecimento, acesso e aceitação de usuários em relação às PIC; 4) Conhecimento de profissionais e gestores em relação à PNPIC; e 5) Escopo, monitoramento e avaliação da PNPIC. Os resultados se alinham aos relatórios de gestão da PNPIC aprofundando o conhecimento acerca da implantação da política e reforçando a necessidade de empoderamento dos atores do SUS para o enfrentamento de seus desafios.

Abstract This narrative review examines the literature on complementary and integrative practices (CIPs) and their incorporation into Brazil's national health system (Sistema Único de Saúde - SUS) in an attempt to understand the strengths and weaknesses of the implementation of the National Policy on Complementary and Integrative Practices in the SUS (PNPIC, acronym in Portuguese). A search was conducted of the MEDLINE, LILACS, and SciELO databases, resulting in final sample of 25 articles. Our analysis identified five key themes in the literature related to the strengths and weaknesses of policy implementation: 1) Professional training in CIPs in the SUS; 2) structuring the provision of CIPs, access, and health promotion; 3) knowledge, access, and acceptance of service users in relation to CIPs; 4) knowledge of SUS professional staff and managers in relation to the PNPIC; and 5) scope and monitoring and evaluation of the PNPIC. In consonance with the conclusions of the PNPIC management reports, the findings provide a deeper insight into policy implementation problems and reinforce the need to empower the actors involved in this process to tackle these challenges.

Uma Estratégia de Redução do Estresse entre Estudantes Médicos / A Strategy for Stress Reduction among Medical Students

Resumo: Introdução: O curso de graduação em Medicina expõe os alunos a uma quantidade significativa de estresse, o que pode gerar consequências negativas para o aprendizado, a motivação e o contato com os pacientes. Algumas técnicas e práticas têm sido indicadas para auxiliar no manejo e na redução do estresse, como é o caso da meditação que já é utilizada em escolas médicas. Este estudo avaliou os efeitos de um programa de redução do estresse e desenvolvimento da empatia em medicina (Redemed©) sobre a percepção de estresse de seus participantes e possíveis grupos de acolhimento. Método: Este é um ensaio quase experimental cuja amostra foi composta por 40 estudantes que compuseram o grupo controle e 47 alunos de um grupo de intervenção que participaram de oito encontros semanais de duas horas divididas em: 30 minutos de teoria sobre como o estresse influencia o estado de saúde, 60 minutos de vivências interpessoais e 30 minutos de ioga e meditação. Ambos os grupos, antes e depois do curso, responderam ao questionário sobre estresse percebido (PSS - Escala de Cohen). Resultados: Após os oito encontros semanais, o grupo intervenção apresentou melhora significativa (p = 0,030), demonstrando que a participação no curso Redemed© mostrou-se eficaz no controle do estresse entre os estudantes do presente estudo. Os alunos também foram questionados quanto à autopercepção sobre se sentirem ou não apoiados por outros grupos. Os três grupos de acolhimentos mais citados entre os alunos, tanto do grupo ativo como do controle, foram: amigos/família, centro acadêmico e a equipe do esporte que praticavam. Após as oito semanas, enquanto o grupo controle permaneceu com as mesmas indicações, no grupo intervenção foram citados: amigos/família, Redemed© e centro acadêmico. Conclusão: Este estudo mostrou que o programa Redemed©, com encontros durante oito semanas utilizando a meditação como sua técnica central, foi eficaz na redução do estresse percebido pelos estudantes de Medicina que participaram dessa intervenção quando comparado ao grupo controle (p = 0,000). As práticas integrativas e complementares podem ser uma ferramenta importante dentro das escolas médicas, de modo a levar os estudantes a lidar melhor com o estresse a que estão expostos ao longo do curso.

Abstract: Introduction: Undergraduate medical students experience a considerable amount of stress, which can negatively affect their learning, motivation and contact with patients. Some techniques and practices for stress management and reduction, such as meditation, have been recommended and used in medical schools. This study evaluated the effects of a Stress Reduction and Empathy Development Program in Medicine (REDEMED©) on participants' perception of stress and possible support groups. Method: This is a quasi-experimental trial whose sample comprised 40 students in a control group and 47 students in an intervention group. The students in the intervention group participated in eight weekly sessions lasting two hours each. The course hours were divided into: 30 minutes of theoretical content on how stress influences one's health, 60 minutes of interpersonal practices and 30 minutes of yoga and meditation practices. Both groups, before and after the program, answered the questionnaire on perceived stress (PSS - Cohen's scale). Results: After the eight weekly meetings, the intervention group showed significant improvement (p = 0.030), showing that participation in the REDEMED© course proved to be effective in stress control among the students in the study. The students were also questioned about their self-perception of whether or not they felt they were supported by any other groups. The three support groups most often referred to by the students, in both the intervention and the control group, were: friends/family, the Students' Union and their sports team. After eight weeks, while the control group still referred to the same groups, the intervention group mentioned friends/family, REDEMED© and the Students' Union. Conclusion: This study showed that the REDEMED© program, meeting for eight weeks using meditation as its central technique, was effective in reducing the stress perceived by medical students who participated in this intervention when compared to the control group (p = 0,000). Integrative and complementary practices can be an important tool within medical schools, empowering students to better cope with the stress they are exposed to throughout the course.

Existe Alteração em Marcadores Inflamatórios em Estudantes de Medicina após Participação em Programa Mente-Corpo? / Is There Any Change in Inflammatory Markers in Medical Students after Participating in a Mind-Body Program?

RESUMO Introdução Estudantes do curso de Medicina estão expostos a carga elevada de estresse, desencadeada por terem que lidar com adoecimento e morte dos pacientes, extensa carga horária, privação de sono, competitividade, cobrança, responsabilidade e medo de errar, entre outros fatores. Algumas técnicas e práticas como a meditação têm sido utilizadas para auxiliar no manejo e redução de estresse, já sendo utilizadas em escolas médicas. O estresse pode ativar componentes do sistema inflamatório, desencadeando uma série de doenças. As desordens causadas pelo estresse podem ser mensuradas por meio de marcadores sorológicos, sendo que os biológicos são os principais utilizados. Objetivo Avaliar os efeitos de um programa de práticas mente-corpo, Redução de Estresse e Desenvolvimento da Empatia na Medicina (Redemed©), nos níveis dos marcadores pró- e anti-inflamatórios de estudantes de medicina. Metodologia Trata-se de um estudo quase-experimental, composto por 86 estudantes, sendo 44 do grupo intervenção, que participaram do programa Redemed© com oito encontros semanais, englobando técnicas de meditação e exercícios de vivências interpessoais, e 42 estudantes do grupo controle. Ambos os grupos, antes e após o curso, coletaram sangue para análise dos marcadores: proteína C reativa (PCR), fator de necrose tumoral-alfa (TNF-alfa), interleucina 06 (IL06) e interleucina 10 (IL10). Resultados Neste estudo, não foi observada alteração estatisticamente significativa nas citocinas pró-inflamatórias: PCR, TNF-α e IL06. No entanto, a IL-10, que é uma citocina anti-inflamatória, apresentou uma variação positiva e estatisticamente significativa (p: 0,009). Ela tem sido utilizada em estudos com práticas integrativas e complementares a fim de demonstrar seus benefícios. Conclusão O programa Redemed© parece beneficiar os estudantes de Medicina por meio da modulação inflamatória e como grupo de acolhimento no qual eles puderam compartilhar seu estresse e treinar estratégias de enfrentamento. Este estudo, mesmo não tendo encontrado diferença estatística significativa nos marcadores pesquisados, com exceção da IL10, traz à tona este tema importante do grande estresse vivenciado por estudantes de Medicina e a necessidade de as escolas médicas terem maior cuidado com seus alunos, acolhendo e trabalhando o estresse desses estudantes de forma a reduzir e gerenciar melhor este fator de adoecimento em suas vidas.

ABSTRACT Introduction Medical students are exposed to high stress levels, triggered by having to deal with their illness and death of their patients, extensive workloads, sleep deprivation, competition, having to fulfil demanding duties, responsibility, and fear of making mistakes, among other factors. Some techniques and practices, such as meditation, are used in medical schools to help manage and reduce stress. Stress can activate components of the inflammatory system, triggering a series of pathologies. The disorders caused by stress can be measured by means of serological markers, with biological markers being the main ones used. Objective. To evaluate the effects of a program of mind-body practices, Reduction of Stress and Development of Empathy in Medicine (REDEMED ©), on pro- and anti-inflammatory markers of medical students. Methodology This is a quasi-experimental study, composed of 86 students: 44 in the intervention group, who participated in the REDMED© program with eight-weekly meetings that included meditation techniques and exercises of interpersonal experiences, and 42 students in the control group. Before and after the course, blood was collected from both groups for analysis of the markers: C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL06) and interleukin-10 (IL10). Results No statistically significant changes were observed in the proinflammatory cytokines CRP, TNF-α and IL06. However, IL-10, an anti-inflammatory cytokine, showed a positive and statistically significant variation (p: 0.009). It has been used in studies with integrative and complementary practices to demonstrate its benefits. Conclusion The REDEMED© program seems to benefit medical students through inflammatory modulation and as a group that provides a forum to share their stress and receive coaching in coping strategies. This study, even though it did not find a statistically significant difference in the markers studied, with the exception of IL10, raises the important theme of the high levels of stress that medical students experience, and the need for medical schools to take greater care of their students, addressing stress in order better manage it in their own lives.

Guidance on Healthy Eating Habits from the Medical Student's Perspective / Orientação de Hábitos Alimentares Saudáveis sob o Olhar do Estudante de Medicina

ABSTRACT Although nutrition is one of the most significant aspects of good health and well-being, preventing many diseases and reducing premature death and disability, most medical curricula still do not cover this topic in depth, devoting only a few hours to it. This leaves an important gap in the training of medical professionals, in a context of an increase in chronic diseases, where healthy eating is essential, not only for prevention but also to guarantee treatment success. The present study interviewed medical students from the first to the sixth years of graduation, in order to understand what they consider to be a healthy diet and whether they consider themselves capable of guiding their future patients in the adoption and practice healthy eating habits. This is a qualitative study in which semi-structured interviews were conducted with 28 undergraduate medical students of a public university in the state of São Paulo. The data were analyzed using the technique of Content Analysis, with a thematic representational approach. Two major themes emerged, showing possible gaps in the students' knowledge about nutrition and the difficulty they have in helping their patients switch to healthier eating habits, given that they themselves have difficulty doing the same. There is a need for medical schools to promote students' health, both physical and mental, in response to the high demands of the courses. This may include health promotion activities aimed at the students themselves, encouraging them to adopt healthier lifestyles, especially healthier eating habits, so that they can share their own experiences with future patients. This may benefit their professional practice, giving them greater confidence when giving nutrition guidance to their patients, as they will have already experienced and applied the principles in their own lives. Patient-centered care can be a way to address this system and help patients effectively switch to healthier habits, thereby reducing suffering and improving quality of life. Empowerment through activities that receive and support the student and the patient is an essential tool for behavioral change.

RESUMO The rising number of students leagues in the Escola Paulista de Medicina of the Universidade Federal de São Paulo (EPM-Unifesp) leads to questions about their meaning to students and their role in medical training, as well as concerns about learning distortions, early specialization, social relevance, and insertion in the Brazilian national health system, called the Sistema Único de Saúde (SUS). In order to try and clarify these questions, this qualitative study analyzes the statues of the leagues, and the statements of tutors and students, gathered by means of four focal groups with students and two interviews with the tutors. We found 45 leagues currently running at the EPM-Unifesp, most of them associated with a medical specialty. The main motivators for joining in a league were: the search for practical activities, the desire to gain more experience of a particular specialty, the desire for more knowledge, and the need to be recognized as a responsible adult. Of the leagues studied, few conducted research or university extension activities, focusing on treatment and theoretical classes, supervised by professors, non-teacher physicians, resident doctors, or more senior students. The tutors are in charge of the organizational aspects. The leagues can reproduce graduation models, such as an overburdoning with activities and poor expository classes. Concerning insertion in the SUS, the leagues could be a means of training future SUS professionals. Although students claim that they intend to specialize in the league's field, the tutors disagree that they lead to early specialization. We consider that while leagues fill gaps in the learning and expectations of the course, they are limited in regards to the impact of their activities on medical training and their social relevance. They can subvert the curricular structure and favor early specialization. We recommend that universities pay closer attention to students leagues, observing their number, selection process, activities, tutors involved and explicit objectives, with the purpose of evaluating their roles in the curriculum and medical training.

Evaluation of inflammatory markers in the practice of meditation in students of medicine: controlled clinical trial

INTRODUCTION Stress, depression and anxious symptoms are more pronounced in medical students than in students in other courses. Chronic psychological stressors are associated with inflammation. The markers considered most evident for low-grade chronic inflammation associated with diseases are pro inflammatory cytokines and C-reactive protein (CRP). OBJECTIVE To evaluate the effects of a course of stress reduction and empathy development in medical students (REDEMED) through inflammatory markers. METHODS Controlled clinical trial, whose sample consisted of 55 students of the active group, who performed eight weekly classes of two hours of meditation techniques and exercises to explore interpersonal experiences, and 54 students who composed the control group. Blood was taken from both groups before and after the eight-week course for analysis of inflammatory markers: C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α). RESULTS Due to loss of students to follow-up and problems with processing some blood samples, analysis included results from only 31 from the active group and 29 from the control group. There were no significant differences between the control and active groups in relation to the inflammatory markers PCR and TNF-α. DISCUSSION REDEMED did not present significant alterations of the inflammatory markers evaluated in this group of medical students in the evaluated period. Investigations of different biomarkers and other categories (genetic, neurobiological, etc.) could be carried out for the same purpose.(AU)

How does a meditation course impact on the empathy level of medical students?

Objective: To investigate the empathy levels throughout the years of graduation on medical students before and after a course of Stress Reduction and Empathy Development (REDEMED). METHODThe course was comprised of eight two hour meetings, where meditation practices and group activities focused on interpersonal skills were proposed. Thirty-one students who completed the course composed the active group, while 29 students were in the control group. RESULTSThe mean scores of the JSE-S for the active group before and after the course were, respectively: 1st year: 118.5 and 123; 2nd year: 120 and 124; 3rd year: 123 and 126; 4th year: 122.5 and 131; 5th and 6th years: 128 and 127. In the control group, the mean initial scores and the scores after 9 weeks were: 1st year: 120.5 and 115; 2nd year: 115 and 118; 3rd year: 114 and 116; 4th: 111.5 and 114.5; 5th and 6th years: 116 and 115. When analyzing by graduation year, the first year of medical school was the only group that presented a significant difference in change of JSE-S (p: 0.001) when compared to the control group of the same year. DISCUSSION Completing the REDEMED course proved to be effective in the development of empathy among students.(AU)

A stress reduction course impact on medical students of different graduation years

OBJECTIVE To investigate the impact of a stress reduction and empathy development course (REDEMED) on perceived stress levels of medical students in different undergraduate years. METHOD Medical students from the 1st to the 6th year were invited to an initial lecture in which the REDEMED course program was presented (8 weekly meetings of 2 hours duration about interpersonal experiences and meditation). Stakeholders comprised the active group (n = 31) and other volunteer students constituted the control group (n = 29). RESULTSThe mean scores in the PSS of the active group at week 0 and at week 9 were, respectively: 1st year (34.5 and 24); 2nd year (30 and 22); 3rd year (34 and 24) 4th (27.5 and 20); 5th and 6th year combined (27 and 25). In the control group, the initial and final mean scores were respectively: 1st year (27 and 29); 2nd year (28 and 25) 3rd year (26 and 24); 4th (30.5 and 27.5); 5th and 6th combined (30 and 25). The first year of medical school students was the only group that presented a significant stress variation (p: 0.000) when compared to the control group of the same year. DISCUSSIONThis strategy could be used in undergraduate medical coursesto help on stress symptoms reduction especially at the beginningof the course when it presented greater impact. (AU)