Cost analysis in a Traditional, Complementary and Integrative Medicine unit in Brazil.

OBJECTIVE: To analyze the costs of a specialized service in Traditional Complementary and Integrative Medicines (TCIM) in Northeast Brazil to provide data on the cost linked to the implementation and maintenance of services of this nature and to identify the average cost per user for the Unified Health System. METHODS: This is a partial, descriptive, quantitative economic assessment, which used secondary data, later grouped in Microsoft Excel spreadsheets. The method used to analyze such costs was absorption costing, from which the service was divided into three costing centers: productive, administrative and auxiliary. RESULTS: After analyzing the data, the total cost of the service in 2014 was estimated at R$ 1,270,015.70, with a proportion of 79.69% of direct costs. The average cost per user in this period was R$ 36.79, considering the total of 34,521 users in individual and collective practices. CONCLUSIONS: The service has a cost per user compatible with a specialized service; however, TCIM offers a comprehensive and holistic approach, which can have a positive impact on quality of life.

Marcgrave and Piso's plants for sale: The presence of plant species and names from the Historia Naturalis Brasiliae (1648) in contemporary Brazilian markets.

ETHNOPHARMACOLOGICAL RELEVANCE: Parallelisms between current and historical medicinal practices as described in the seventeenth century treatise Historia Naturalis Brasiliae (HNB) provide us with an overview of traditional plant knowledge transformations. Local markets reflect the actual plant use in urban and rural surroundings, allowing us to trace cross-century similarities of ethnobotanical knowledge. AIMS OF THE STUDY: We aim to verify in how far the HNB, created in seventeenth-century northeastern Brazil, correlates with contemporary plant use in the country by comparing the plant knowledge therein with recent plant market surveys at national level. MATERIALS AND METHODS: We conducted a literature review on ethnobotanical market surveys in Brazil. We used the retrieved data on plant composition and vernacular names, together with our own fieldwork from the Ver-o-Peso market in Belém, to compare each market repertoire with the useful species in the HNB. We analyzed similarities among markets and the HNB with a Detrended Correspondence Analysis and by creating Venn diagrams. We analyzed the methods of the different markets to check whether they influenced our results. RESULTS: Out of the 24 markets reviewed, the greatest similarities with the HNB are seen in northern Brazilian markets, both in plant composition and vernacular names, followed by the northeast. The least overlap is found with markets in the central west and Rio de Janeiro. Most of the shared vernacular names with the HNB belonged to languages of the Tupi linguistic family. CONCLUSION: The similarity patterns in floristic composition among Brazilian markets and the HNB indicate the current wider distribution and trade of the species that Marcgrave and Piso described in 1648 in the northeast. Migration of indigenous groups, environmental changes, globalized and homogenous plant trade, and different market survey methods played a role in these results. The HNB is a reference point in time that captures a moment of colonial cultural transformations.

Cost analysis in a traditional, complementary and integrative medicine unit in Brazil / Análise de custos em unidade de medicina tradicional, complementar e integrativa no Brasil

ABSTRACT OBJECTIVE To analyze the costs of a specialized service in Traditional Complementary and Integrative Medicines (TCIM) in Northeast Brazil to provide data on the cost linked to the implementation and maintenance of services of this nature and to identify the average cost per user for the Unified Health System. METHODS This is a partial, descriptive, quantitative economic assessment, which used secondary data, later grouped in Microsoft Excel spreadsheets. The method used to analyze such costs was absorption costing, from which the service was divided into three costing centers: productive, administrative and auxiliary. RESULTS After analyzing the data, the total cost of the service in 2014 was estimated at R$ 1,270,015.70, with a proportion of 79.69% of direct costs. The average cost per user in this period was R$ 36.79, considering the total of 34,521 users in individual and collective practices. CONCLUSIONS The service has a cost per user compatible with a specialized service; however, TCIM offers a comprehensive and holistic approach, which can have a positive impact on quality of life.

RESUMO OBJETIVO Analisar os custos de um serviço especializado em Medicinas Tradicionais Complementares e Integrativas (MTCI) no Nordeste brasileiro, com o intuito de fornecer dados sobre o custo atrelado à implantação e manutenção de serviços dessa natureza e identificar o custo médio por usuário para o Sistema Único de Saúde. MÉTODOS Trata-se de uma avaliação econômica do tipo parcial, com caráter descritivo, de natureza quantitativa, que utilizou dados secundários, posteriormente agrupados em planilhas do Microsoft Excel. O método utilizado para analisar tais custos foi o de custeio por absorção, a partir do qual o serviço foi dividido em três centros de custeio: produtivo, administrativo e auxiliar. RESULTADOS Após a análise dos dados, o custo total do serviço em 2014 foi estimado em R$ 1.270.015,70, com proporção de 79,69% de custos diretos. O custo médio por usuário neste período foi R$ 36,79, considerando o total de 34.521 usuários em práticas individuais e coletivas. CONCLUSÕES O serviço apresenta um custo por usuário compatível com um serviço especializado, contudo, as MTCI oferecem abordagem compreensiva e holística, as quais podem impactar de forma positiva a qualidade de vida.

Caracterización del sistema de salud de Honduras / Characterization of the Health System of Honduras

Este artículo describe el actual Sistema de Salud de Honduras, en los primeros párrafos trata sobre la demografía de la población del país, y se mencionan algunos indicadores básicos de salud, en la segunda parte se describe la estructura del sistema como es la conformación de las instituciones que la integran, la cobertura, sus recursos y el inanciamiento y por último se presentan las conclusiones de algunos retos que enfrenta el Sistema de Salud hondureño. Objetivo: caracterizar el sistema de salud de Honduras. Metodología: descriptivo retrospectivo y cualitativo, técnica: revisión documental. Este trabajo se realizó en la ciudad de Tegucigalpa, M.D.C., desde el mes de abril del 2016 a marzo del 2017, se hizo una búsqueda de la información actualizada en los portales de cada institución, como en algunas revistas médicas relacionadas al tema...(AU)

Bioactive Compounds from Plants Used in Peruvian Traditional Medicine.

It is estimated that there are as many as 1400 plant species currently used in traditional Peruvian medicine; however, only a few have undergone scientific investigation. In this paper, we make a review of the botanical, chemical, pharmacological and clinical propierties of the most investigated Peruvian medicinal plants. The plant species selected for this review are: Smallanthus sonchifolius (yacon), Croton lechleri (sangre de grado), Uncaria tomentosa/U. guianensis (uña de gato), Lepidium meyenii (maca), Physalis peruviana (aguaymanto), Minthostachys mollis (muña), Notholaena nivea (cuti-cuti), Maytenus macrocarpa (chuchuhuasi), Dracontium loretense (jergon sacha), Gentianella nitida (hercampuri), Plukenetia volubilis (sacha inchi) and Zea mays (maiz morado). For each of these plants, information about their traditional uses and current commercialization is also included.

Salud pública, medicina natural y tradicional y la economía de los recursos / Public health, natural and traditional medicine and economy of resources

El 20 de mayo de 2015, en la Gaceta Oficial No. 17, extraordinaria, el Ministerio de Salud Pública de Cuba presentó la Resolución No. 38 que tiene en su primer resuelvo y transcribo: Reconocer a la Medicina Natural y Tradicional (MNT) como especialidad médica, integradora y holística de los problemas de salud, emplea métodos para la promoción de salud, prevención de enfermedades, su diagnóstico, tratamiento y rehabilitación a partir de los sistemas médicos tradicionales y otras modalidades terapéuticas que se integran entre sí y con los tratamientos convencionales de la Medicina Occidental Moderna. Esta resolución, que viene a sustituir una anterior de similar contenido, la 261 del 24 de agosto de 2009,2 ha revitalizado el debate académico sobre este particular en el contexto cubano. De todo lo escrito y con vehemencia discutido por los que se oponen y los que defiende las citadas resoluciones y sus implicaciones para el sistema de salud cubano (disponibles en el sitio de la Revista Cubana de Salud Pública* parece estar claro que el desarrollo de la medicina natural y tradicional es política del gobierno cubano. El Lineamiento 158 de la política del Estado, emitido en abril de 2011 como resultado del VI Congreso del Partido Comunista de Cuba,3 refiere: Prestar la máxima atención al desarrollo de la medicina natural y tradicional. El Ministerio de Salud Pública, por su parte, ha incluido el tema en sus objetivos de trabajo priorizados en función de la optimización del marco regulador para la medicina natural y tradicional en el Sistema Nacional de Salud (SNS). No obstante a ello, hay una consistente oposición en el ámbito académico a consagrar, en resoluciones oficiales, el uso de técnicas de diagnóstico y tratamiento fuertemente cuestionables por su no probada eficacia bajo la lupa de ensayos clínicos controlados. Todo cuesta, el sostenimiento humano y logístico de la medicina natural y tradicional implica, para cada técnica aprobada, una erogación de recursos que deben planificarse cuidadosamente. Tenemos un sistema de salud integrado y los esfuerzos por desarrollar la medicina natural y tradicional dentro del arsenal de herramientas para la promoción de salud, la prevención de enfermedades o complicaciones, el diagnóstico y el tratamiento oportunos son bienvenidos. El desafío es, garantizar la seguridad del paciente en cada acto médico y que los recursos, siempre limitados e insuficientes, se utilicen de la manera más racional posible a la luz de la mejor evidencia científica disponible(AU)

The use of an integrated molecular-, chemical- and biological-based approach for promoting the better use and conservation of medicinal species: a case study of Brazilian quinas.

ETHNOPHARMACOLOGICAL RELEVANCE: Quina is a popular name originally attributed to Cinchona pubescens Vahl (=Cinchona succirubra) and Cinchona. calisaya Wedd., species native from Peru that have the antimalarial alkaloid quinine. In Brazil, bitter barks substitutes for the Peruvian species began to be used centuries ago, and they still are sold in popular markets. To assess the authenticity and the conditions on which samples of quinas have been commercialized, using the DNA barcode, chemical and biological assays. MATERIALS AND METHODS: Starting with 28 samples of barks acquired on a popular market, 23 had their DNA extracted successfully. The regions matK and rbcL were amplified and sequenced for 15 and 23 samples, respectively. Phytochemical analyses were performed by chromatographic methods, and biological essays were done by antimalarial tests in vitro. RESULTS: The identified species belonged to six different families, many of them endangered or with no correlation with use in traditional medicine as a Brazilian quina. The absence of typical bitter chemical substances indicated that barks have been collected from other species or from very young trees. The results of biological essays confirm the lack of standardization of the sold materials. CONCLUSION: The integrated approaches proved to be efficient to evaluate medicinal plants sold in popular markets and can be useful for promoting their better use and conservation.

Changes in the trade in native medicinal plants in Brazilian public markets.

Plants continue to be an important source of new bioactive substances. Brazil is one of the world's mega-diverse countries, with 20 % of the world's flora. However, the accelerated destruction of botanically rich ecosystems has contributed to a gradual loss of native medicinal species. In previous study, we have observed a fast and intensive change in trade of medicinal plants in an area of Amazon, where human occupation took place. In this study, we surveyed 15 public markets in different parts of Brazil in search of samples of 40 plants used in traditional medicine and present in first edition of Brazilian Official Pharmacopoeia (FBRAS), published in 1926. Samples of plants commercialized as the same vernacular name as in Pharmacopoeia were acquired and submitted to analysis for authentication. A total of 252 plant samples were purchased, but the laboratory analyses showed that only one-half of the samples (126, 50.2 %) were confirmed as the same plant species so named in FBRAS. The high number of unauthenticated samples demonstrates a loss of knowledge of the original native species. The proximity of the market from areas in which the plant occurs does not guarantee that trade of false samples occurs. The impact of the commerce of the substitute species on their conservation and in public health is worrying. Strategies are necessary to promote the better use and conservation of this rich heritage offered by Brazilian biodiversity.

Haitian picuristes/injectionists as alternatives to conventional health care providers in South Florida.

Barriers in seeking access to conventional health care services continue to be a problem in the United States, especially among recent racial and ethnic immigrants who tend to be least able to afford adequate health insurance coverage. Ethnic immigrants sometimes seek out traditional healers as unconventional providers of health care services to overcome barriers in accessing the conventional health care delivery system. The purpose of this work is to provide insight into the practices of Picuristes or Haitian "lay injectionists" in their role as alternative, unconventional providers of health care services among Haitian immigrants in South Florida. Based on in-depth interviews with 10 picuristes who were identified through venue and snowball sampling and who volunteered to participate in a larger exploratory study that examined various aspects of picuriste practices, findings revealed benefits and risks of seeking health care services from these traditional practitioners. Among the benefits reported to their services were greater accessibility, affordability, convenience, and cultural compatibility. Risks observed from analysis of picuriste interviews included the lack of formal medical training for picuristes, their nonadherence to established standards for safe injections and their potential to expose clients and the community to contaminated needles, syringes, and other biohazardous waste materials. Insight was also gained into how picuristes learned to practice their trade and to incorporate Haitian cultural beliefs regarding the relationship between clients and healers. Given the continuation of barriers to health care among ethnic immigrants, implications for conventional heath care practice and social policy are also discussed.

Dynamics of medicinal plants knowledge and commerce in an urban ecosystem (Pernambuco, Northeast Brazil).

Given the importance of markets and fairs for the commerce of medicinal plants, an ethnobotanical study was undertaken at the Caruaru Fair (Pernambuco, northeastern Brazil) to compare the richness of species sold and their values of relative importance (RI) using two datasets collected with a 4-year interval. The seasonality of these plants' supplies was also analyzed. The Caruaru Fair is located in the 18 de Maio Park. It covers an area 40,000 m(2) and is used by merchants who sell several types of products, such as supplies, handicrafts, clay and aluminum utensils, shoes, clothes and medicinal plants. Semistructured interviews were carried out with the vendors who agreed to take part in the study in order to record which plants were sold and their respective indications. The plants were collected, and the species were determined. The information was analyzed with quantitative tools. A total of 169 plants were identified from both surveys, which were significantly different with regard to species richness (p < 0.05) but did not vary in relation to species' Relative Importance (p > 0.05). In relation to the seasonality of the plant supply, habit may explain the lack of some species during certain periods of the year, as most of the absent plants are herbaceous. In terms of the species most sold locally, it was found that spontaneous tree species are well known and extensively commercialized.

Centroamérica: la producción de medicamentos fitoterapéuticos y de materias primas agrícolas para la industria farmacéutica / Central America: the production of phytotherapeutic drugs and agricultural raw materials for the pharmaceutical industry

En Centroamérica se ha hecho esfuerzos en los últimos años para promover la investigación y ampliar la producción y el uso de plantas medicinales. Se ha procurado comprobar sus efectos farmacológicos, estudiar los mejores métodos de extracción e identificar la característica de sus principios activos. Se realizan también esfuerzos para un mayor conocimiento de la flora nacional con objeto de descubrir nuevas sustancias que puedan utilizarse para curar distintas enfermedades, sobre todo aquellas que aparecen con mayor frecuencia entre la población.