Percepção de médicos e enfermeiros da Estratégia de Saúde da Família sobre terapias complementares

OBJECTIVE: To analyze Estratégia de Saúde da Família (Family Health Strategy) professionals' perception of complementary and integrative therapies. METHODS: A study with 177 doctors and nurses was conducted in 2008, based on a self-administered questionnaire. The outcome variables were "interest in complementary and integrative therapies" and "agreement with the National Policy on Complementary and Integrative Therapies. Sex, age, graduate level of education, postgraduate level of education, length of time since graduation, length of time of work, having children, providing complementary and integrative therapies in the workplace, and using homeopathy or acupuncture comprised the independent variables. Data were analyzed using Chi-square test and Fisher's exact test. RESULTS: A total of 17 health centers provided complementary and integrative therapies; 12.4% of professionals had a specialization in homeopathy or acupuncture; 43.5% of doctors were specialists in family and community medicine/family health. Of all participants, 88.7% did not know the national directives for this area, although 81.4% agreed with their inclusion in the Sistema Único de Saúde (Unified Health System). The majority (59.9%) showed an interest in qualifications and all agreed that these therapies should be approached during the graduate course. Agreement with the inclusion of such therapies was significantly associated with the fact of being a nurse (p = 0.027) and using homeopathy for oneself (p = 0.019). Interest in complementary therapies was associated with the use of homeopathy for oneself (p = 0.02) and acupuncture by family members (p = 0.013). CONCLUSIONS: Complementary and integrative therapies are accepted by the professionals studied. This acceptance is associated with previous contact with such therapies and, probably, with residency/specialization in family and community medicine/family health.OBJETIVO: Analisar a percepção de profissionais da Estratégia de Saúde da Família sobre práticas integrativas e complementares. MÉTODOS: Estudo com 177 médicos e enfermeiros a partir de um questionário auto-aplicado em 2008. As variáveis desfecho foram "interesse pelas práticas integrativas e complementares" e "concordância com a Política Nacional de Práticas Integrativas e Complementares". Sexo, idade, graduação, pós-graduação, tempo de formado e de trabalho, possuir filhos, oferta de práticas integrativas e complementares no local de trabalho e uso de homeopatia ou acupuntura compuseram as variáveis independentes. Os dados foram analisados pelo teste do qui-quadrado e teste exato de Fisher. RESULTADOS: Dezessete centros de saúde ofereciam práticas integrativas e complementares; 12,4% dos profissionais possuíam especialização em homeopatia ou acupuntura; 43,5% dos médicos eram especialistas em medicina de família e comunidade/saúde da família. Dos participantes, 88,7% desconheciam as diretrizes nacionais para a área, embora 81,4% concordassem com sua inclusão no Sistema Único de Saúde. A maioria (59,9%) mostrou interesse em capacitações e todos concordaram que essas práticas deveriam ser abordadas na graduação. A concordância com a inclusão dessas práticas mostrou-se associada significativamente com o fato de ser enfermeiro (p = 0,027) e com o uso de homeopatia para si (p = 0,019). Interesse pelas práticas complementares esteve associado a usar homeopatia para si (p = 0,02) e acupuntura para familiares (p = 0,013). CONCLUSÕES: Existe aceitação das práticas integrativas e complementares pelos profissionais estudados, associada ao contato prévio com elas e possivelmente relacionada à residência/especialização em medicina de família e comunidade/saúde da família.OBJETIVO: Analizar la percepción de profesionales de la Estrategia Salud de la Familia sobre prácticas integrales y complementarias. MÉTODOS: Se realizó estudio con 177 médicos y enfermeros a partir de un cuestionario auto-aplicado en 2008. Las variables consideradas fueron "interés por las prácticas integrales y complementarias" y "concordancia con la Política Nacional de prácticas integrales y complementarias". Sexo, edad, estudio universitario, postgrado, tiempo de formación y de trabajo, poseer hijos, oferta de prácticas integrales y complementarias en el lugar de trabajo y uso de homeopatía o acupuntura conformaron las variables independientes. Los datos fueron analizados por la prueba de chi-cuadrado y la prueba exacta de Fisher. RESULTADOS: Diecisiete centros de salud ofrecían prácticas integrales y complementarias; 12,4% de los profesionales poseían especialización en homeopatía o acupuntura; 43,5% de los médicos eran especialistas en medicina de familia y comunidad/salud de la familia. De los participantes, 88,7% desconocían las directrices nacionales para el área, a pesar de que el 81,4% concordasen con su inclusión en el Sistema Único de Salud. La mayoría (59,9%) mostró interés en capacitaciones y todos concordaran que esas prácticas deberían ser abordadas en el estudio universitario. La concordancia con la inclusión de tales prácticas se mostró asociada significativamente con el hecho de ser enfermero (p=0,027) y con el uso de homeopatía para sí mismo (p=0,019). Interés por las prácticas complementarias estuvo asociado con el uso de homeopatía para sí mismo (p=0,02) y acupuntura para familiares (p=0,013). CONCLUSIONES: Existe aceptación de las prácticas integrales y complementarias por los profesionales estudiados, asociada al contacto previo con las mismas y posiblemente relacionada a la residencia/especialización en medicina de familia y comunidad/salud de la familia

Inhibitory effect of 4-O-methylhonokiol on lipopolysaccharide-induced neuroinflammation, amyloidogenesis and memory impairment via inhibition of nuclear factor-kappaB in vitro and in vivo models

<p>Abstract</p> <p>Background</p> <p>Neuroinflammation is important in the pathogenesis and progression of Alzheimer disease (AD). Previously, we demonstrated that lipopolysaccharide (LPS)-induced neuroinflammation caused memory impairments. In the present study, we investigated the possible preventive effects of 4-<it>O</it>-methylhonokiol, a constituent of <it>Magnolia officinalis</it>, on memory deficiency caused by LPS, along with the underlying mechanisms.</p> <p>Methods</p> <p>We investigated whether 4-<it>O</it>-methylhonokiol (0.5 and 1 mg/kg in 0.05% ethanol) prevents memory dysfunction and amyloidogenesis on AD model mice by intraperitoneal LPS (250 μg/kg daily 7 times) injection. In addition, LPS-treated cultured astrocytes and microglial BV-2 cells were investigated for anti-neuroinflammatory and anti-amyloidogenic effect of 4-<it>O</it>-methylhonkiol (0.5, 1 and 2 μM).</p> <p>Results</p> <p>Oral administration of 4-<it>O</it>-methylhonokiol ameliorated LPS-induced memory impairment in a dose-dependent manner. In addition, 4-<it>O</it>-methylhonokiol prevented the LPS-induced expression of inflammatory proteins; inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) as well as activation of astrocytes (expression of glial fibrillary acidic protein; GFAP) in the brain. In <it>in vitro </it>study, we also found that 4-<it>O</it>-methylhonokiol suppressed the expression of iNOS and COX-2 as well as the production of reactive oxygen species, nitric oxide, prostaglandin E₂, tumor necrosis factor-α, and interleukin-1β in the LPS-stimulated cultured astrocytes. 4-<it>O</it>-methylhonokiol also inhibited transcriptional and DNA binding activity of NF-κB via inhibition of IκB degradation as well as p50 and p65 translocation into nucleus of the brain and cultured astrocytes. Consistent with the inhibitory effect on neuroinflammation, 4-<it>O</it>-methylhonokiol inhibited LPS-induced Aβ_1-42generation, β- and γ-secretase activities, and expression of amyloid precursor protein (APP), BACE1 and C99 as well as activation of astrocytes and neuronal cell death in the brain, in cultured astrocytes and in microglial BV-2 cells.</p> <p>Conclusion</p> <p>These results suggest that 4-<it>O</it>-methylhonokiol inhibits LPS-induced amyloidogenesis via anti-inflammatory mechanisms. Thus, 4-<it>O</it>-methylhonokiol can be a useful agent against neuroinflammation-associated development or the progression of AD.</p

Prevalence of herbal and dietary supplement usage in Thai outpatients with chronic kidney disease: a cross-sectional survey

Background: There are few studies of the prevalence and patterns of herbal and dietary supplement (HDS) use in patients with chronic kidney disease (CKD), although many researchers and health professionals worldwide have raised concern about the potential effects of HDS on patients with renal insufficiency. A survey was conducted to determine: the prevalence and patterns of HDS use in Thai patients with CKD; the demographic factors related to HDS use; the reasons why Thai patients with CKD use HDS; respondent experiences of benefits and adverse effects from HDS; and the association between conventional medication adherence and HDS use. Methods: This cross-sectional survey recruited patients with CKD attending two teaching hospitals in Thailand. Data were collected via an interview using a semi-structured interview schedule regarding demographics, HDS usage, reasons for HDS use, and respondent experiences of effects from HDS. Conventional medication adherence was measured using the Thai version of 8-Item Morisky Medication Adherence Scale. Descriptive statistics were used to analyse the prevalence and the patterns of HDS use. Chi-square tests and multiple logistic regression were used to determine any associations between HDS use, demographics and conventional medication adherence. Results: Four hundred and twenty-one eligible patients were recruited. The prevalence of HDS use in the previous 12 months was 45%. There were no demographic differences between HDS users and non-users, except former drinkers were less likely to use HDS, compared with non-drinkers (OR 0.43, 95% CI 0.25-0.75). Those with a medium level of adherence to conventional medication were less likely to use HDS compared with those with a low level of adherence (OR 0.53, 95% CI 0.32-0.87). Maintaining well-being was most common purpose for using HDS (36%). Nearly 18% used HDS, such as holy mushroom, river spiderwort and boesenbergia, to treat kidney disease. The top three most often reported reasons why respondents used HDS were family and friend’s recommendation, followed by expecting to gain benefit from HDS and wanting to try them. Perceived beneficial effects on renal function from HDS were reported by around 10% of HDS users. Among HDS users, seven patients perceived worsening CKD from HDS, such as river spiderwort, kariyat and wheatgrass. Additionally, 72% of respondents did not inform their doctor about their HDS use mainly because their doctor did not ask (46%) or would disapprove of their HDS use (15%). Conclusions: Around half of the Thai patients with CKD used HDS. Health professionals should be aware of HDS use amongst such patients and enquire about HDS use as a part of standard practice in order to prevent any detrimental effects on kidney function