BACKGROUND:Integrative medicine (IM) is a patient-centered, healing-oriented clinical paradigm that explicitly includes all appropriate therapeutic approaches whether they originate in conventional or complementary medicine (CM). While there is some evidence for the clinical and cost-effectiveness of IM practice models, the existing evidence base for IM depends largely on studies of individual CM therapies. This may in part be due to the methodological challenges inherent in evaluating a complex intervention (i.e., many interacting components applied flexibly and with tailoring) such as IM.METHODS/DESIGN:This study will use a combination of observational quantitative and qualitative methods to rigorously measure the health and healthcare utilization outcomes of the University of Arizona Integrative Health Center (UAIHC), an IM adult primary care clinic in Phoenix, Arizona. There are four groups of study participants. The primary group consists of clinic patients for whom clinical and cost outcomes will be tracked indicating the impact of the UAIHC clinic (n=500). In addition to comparing outcomes pre/post clinic enrollment, where possible, these outcomes will be compared to those of two matched control groups, and for some self-report measures, to regional and national data. The second and third study groups consist of clinic patients (n=180) and clinic personnel (n=15-20) from whom fidelity data (i.e., data indicating the extent to which the IM practice model was implemented as planned) will be collected. These data will be analyzed to determine the exact nature of the intervention as implemented and to provide covariates to the outcomes analyses as the clinic evolves. The fourth group is made up of patients (n=8) whose path through the clinic will be studied in detail using qualitative (periodic semi-structured interviews) methods. These data will be used to develop hypotheses regarding how the clinic works.DISCUSSION:The US health care system needs new models of care that are more patient-centered and empower patients to make positive lifestyle changes. These models have the potential to reduce the burden of chronic disease, lower the cost of healthcare, and offer a sustainable financial paradigm for our nation. This protocol has been designed to test whether the UAIHC can achieve this potential.TRIAL REGISTRATION:Clinical Trials.gov NCT01785485.

Integrative Medicine (IM) is a care approach that focuses on the overall well-being and healing process of patients rather than solely on their disease. IM educates and empowers people to be active players in their own care, emphasizes the therapeutic relationship, and makes use of all appropriate evidence-based approaches. The health-oriented foundations of IM are in line with the recently posed concept that describes health as ”the ability to adapt and to self-manage”. Due to the shared underpinnings of both IM and the new concept of health, incorporation of this new concept of health may serve as a facilitator for the development and implementation of IM. From a practical viewpoint, working from an integrative care approach requires specific competences from healthcare providers, such as socio-communicative and self-reflective skills, and reflexivity towards a holistic perspective on health. Previous studies have shown that a Mind-Body Medicine (MBM) course can potentially foster these competences among future healthcare providers. This thesis intended to gain increased insight into the prerequisites and tools for implementation of IM. Therefore, in the first part it aimed to explore the attitudes and practice of IM among Dutch nurses and the support for the new dynamic concept of health as ”the ability to adapt and to self-manage” among main stakeholders within the Dutch healthcare community. Furthermore, in the second part it aimed to evaluate the possibilities of an MBM course among medical and nursing students as a tool to foster an integrative care approach. Methods Both quantitative and qualitative research designs were used. Attitudes and practice of IM were assessed in a semi-structured survey study among 355 Dutch nurses (study I). Support for the new concept of health was explored in a mixed method study, where in the first step data from interviews and focus-groups among 140 stakeholders were investigated by use of manifest content analysis, and in the second step a cross-sectional survey was performed among 1938 stakeholders to verify the findings of the first step (study II). The MBM course was evaluated by a controlled, quasi-experimental intervention study (74 participants / 61 controls among medical students and 47 participants / 64 controls among nursing students) in which validated questionnaires were used (study III). Furthermore, in-depth interviews with 11 medical and 15 nursing students were employed and analysed by a Phenomenological Hermeneutical method to obtain an in-depth understanding of the meaning of the MBM course for the participants (study IV). Findings Study I showed an overall positive attitude towards IM among nurses. Patient-centeredness and a focus on individuals’ own resources and responsibility to promote health met the most support among both nurses and other stakeholders. These elements were considered to be the main positive aspects of the new dynamic concept of health among stakeholders as well (study II). Use of evidence-based and safe complementary therapies and a healing environment received some support from the nurses, but lack of knowledge and lack of evidence seems to hinder further incorporation in the current healthcare practice (study I). Additionally, study II revealed that health was perceived to comprise six dimensions: bodily functions, mental functions &amp; perception, spiritual / existential dimension, quality of life, social and societal participation and daily functioning. In line with patients, nurses had a more broad conception of health in comparison to other healthcare professionals. Study III showed long-term beneficial effects of the MBM course on two dimensions of empathy (personal distress and empathic concern) among medical students, and on perceived stress and empathy (personal distress) among nursing students. Study IV brought forth that the MBM course can be understood as a pathway to inner awareness and a support to connecting with others as well as the outside world. The following themes were identified: “ability to be more present”, “an increased perception and awareness of self”, and “connecting on a deeper level with others”. Conclusion It can be concluded from the results in the first explorative part of this thesis that the observed positive attitudes and perceptions among healthcare professionals toward IM and the newly proposed health concept can serve as important facilitators for further implementation of IM within the Dutch healthcare system. Furthermore, the increased ability to deal with stress, improved empathic abilities and more openness toward different perspectives on health and new treatment options among medical and nursing students following a MBM course, as reported in the second part of this thesis, suggest that this course might be a suitable tool to foster an integrative care approach among future healthcare professionals. / IM (Integrativ Vård mer adekvat term på svenska) är ett vårdkoncept/vårdansats som mer fokuserar på patienters välmående och läkeprocesser än enbart deras sjukdom. IM överlämnar makten och utbildar individen till att själv bli aktiva i sin vård, den framhäver vikten av en god vårdande relation och använder alla tillämpliga evidensbaserade metoder. Den hälsofrämjande grunden i IM är i linje med ett nyligen utvecklat hälsobegrepp, som beskriver hälsa som ”en persons förmåga till att anpassa sig och hantera utmaningar”. Utifrån den liknande grunden och förutsättningarna hos IM och det nya hälsobegreppet så kan en integration av dem vara en understödjande faktor för utveckling och implementering av IM. Utifrån en praktisk synvinkel så innebär en integrativ vårdansats att den som vårdar måste inneha specifika kompetenser och förmågor relaterade till bland annat socio-kommunikativ och självreflektiv förmåga, såväl som en reflektiv öppenhet till ett holistiskt perspektiv på hälsa. Tidigare forskning har visat att en Mind-Body Medicine (MBM) kurs potentiellt kan understödja utveckling av dessa kompetenser bland framtida vårdare. Denna avhandling avsåg i första hand att uppnå ökad insikt i förutsättningar och verktyg för implementering av Integrativ Vård. Mer specifikt syftade den till att beskriva attityder till, och utövande av IM bland Nederländska sjuksköterskor, samt undersöka stödet för det nya dynamiska hälsobegreppet (”en persons förmåga till att anpassa sig och hantera utmaningar”) bland intressenter inom Nederländsk Hälso- och Sjukvård. Vidare i andra hand, avsåg avhandlingen också att utvärdera förutsättningarna för att använda en MBM kurs som ett verktyg till att understödja och fostra ett mer integrativt förhållningssätt bland läkar- och sjuksköterskestudenter. Metod Både kvantitativ såväl som kvalitativ forskningsdesign tillämpades. Attityder till, och utövande av IM undersöktes i en semistrukturerad enkätstudie bland 355 Nederländska sjuksköterskor (studie I). Stödet för det nya hälsobegreppet undersöktes i en studie som genomfördes med mixad design, där i det första steget data från individuella- och fokusgruppintervjuer bland 140 intressenter genomgick en manifest innehållsanalys, och i det andra steget genomfördes en tvärsnittsstudie bland 1938 intressenter för att validera fynden från det första steget (Studie II). MBM kursen utvärderades i en kontrollerad, kvasi-experimentell interventionsstudie (71 deltagare/61 kontroller bland läkarstudenter, och 47 deltagare/64 kontroller bland sjuksköterskestudenter) med validerade frågeformulär (Studie III). Vidare även i en Fenomenologisk-Hermeneutisk ansats via individuella intervjuer med 11 läkar- och 15 sjuksköterskestudenter för att uppnå en djupare förståelse över MBM kursens betydelse för deltagarna (Studie IV). Fynd I studie I framkom att sjuksköterskorna övergripande hade en positiv attityd till IM. Patientcentrering och fokus på individens resurser, samt deras egna ansvar för att arbeta hälsofrämjande var områden som hade mest stöd bland både sjuksköterskor och andra intressenter. Dessa element ansågs också av intressenterna vara den mest positiva aspekten av det nya dynamiska hälsobegreppet (Studie II). Användandet av evidensbaserade komplementärmedicinska metoder och hälsofrämjande miljöer stöddes till viss del av sjuksköterskorna men brist på kunskap och brist på evidens förefaller vara hinder för integration i nuvarande vårdpraxis (Study I). I studie II framkom att begreppet hälsa uppfattades som att bestå i sex olika dimensioner; ”kroppslig funktion”, ”mental funktion och perception”, ”spirituell/existentiell dimension”, ”livskvalitet”, ”social-samhällelig inklusion” samt ”daglig funktion”. I samklang med patienter, så hade sjuksköterskor en bredare syn på hälsa än andra hälsoprofessioner. I studie III framkom långsiktiga positiva effekter av att delta i MBM kursen avseende i två dimensioner av empatisk förmåga (Personal distress och Empatic concern) bland läkarstudenterna, samt avseende upplevd stressnivå (perceived stress) och empati (personal distress) bland sjuksköterskestudenterna. I studie IV framkom att MBM kursen kan ses som ”en väg till inre medvetenhet och stöd till att knyta an till andra och den omgivande världen” vidare identifierades temana: ”en förmåga till en mer medveten närvaro”, ”en ökad uppfattningsförmåga och inre medvetenhet” samt ”att knyta an till andra människor på en djupare nivå”. Slutsats Utifrån resultaten i avhandlingens explorativa (I, II) del är slutsatsen att de observerade positiva attityderna, och uppfattningarna bland vårdgivare avseende IM och det nyutvecklade hälsobegreppet kan ses som viktiga facilitatorer för ytterligare implementering av IM i det Nederländska hälso- och sjukvårdssystemet. Vidare, den ökade förmågan att hantera stress, utveckla empatisk förmåga och mer öppenhet för nya perspektiv på hälsa och behandlingsalternativ hos läkar- och sjuksköterskestudenter efter deltagande i en MBM kurs (implementeringsdelen i denna avhandling, III, IV), stöttar antagandet att kursen kan ses som ett användbart verktyg för att understödja en mer integrativ vårdansats bland framtida vårdpersonal. / <p>Vid tidpunkten för disputationen var följande delarbeten opublicerade: delarbete 3 i tryck, delarbete 4 inskickat.</p><p>At the time of the doctoral defence the following papers were unpublished: paper 3 in press, paper 4 submitted.</p>

Introduktion: WHO betonar vikten av att integrera traditionell- och komplementärmedicin i nationella hälsovårdssystem. I Sverige förekommer integrativ medicin med antroposofisk inriktning på Vidarkliniken i Järna. Syfte: Att studera förändringar av självskattat hälsotillstånd hos patienter som erhållit antroposofisk vård på Vidarklinikens öppenvårdsmottagning i Norrköping. Metod: En kvantitativ metod med enkäter till 26 patienter på Vidarklinikens öppenvårdsmottagning i Norrköping, konsekutiv datainsamling. Hälsorelaterad livskvalitet skattades med hjälp av EQ-5D (rörlighet, hygien, aktivitet, smärta och oro) och EQ-VAS (totalt hälsotillstånd) samt två enkäter, konstruerade för denna studie, med VAS-skalor för sömnkvalitet, fysiskt tillstånd, psykiskt tillstånd och förutsättningar att hantera sin livssituation, samt patienternas beskrivning av måluppfyllelse. Därutöver undersöktes patienternas sjukskrivningsgrad och läkemedelsförbrukning. Resultat: Patienterna hade mycket varierande diagnoser och ofta sammansatt problematik. Vanligast var utmattning, fibromyalgi och smärta. Resultaten varierade mellan diagnosgrupperna. Huvuddelen av patienterna rapporterade stor tillfredsställelse med vård, behandling och bemötandet från personal, till hög grad uppnådda förväntningar och mål, samt att överlag ha fått bättre förutsättningar att hantera sin livssituation. Det fanns ingen signifikant skillnad i medelvärdet för EQ-5D index eller EQ-VAS, men trend till signifikant förbättring vad gäller sömnkvalitet och psykiskt tillstånd, samt signifikant förbättring av självskattat fysiskt tillstånd (p=0.021). Vid delanalys av de enskilda dimensionerna (EQ-5D) fann man förbättrat tillstånd i någon/några av dimensionerna hos 36 % av patienterna, oftast vad gäller rörlighet och minst vanligt vad gäller smärta. Slutsats: I denna grupp med omfattande och varierande och ofta mycket långvarig problematik påvisades stor uppskattning av vården, trender till förbättrade resultat vid sömnkvalitet och psykiskt tillstånd, samt signifikant förbättrade resultat vid självskattat fysiskt tillstånd. / Introduction: WHO stresses the importance of integrating traditional and complementary medicine into national health systems. In Sweden, integrative medicine with an anthroposophical focus is practised at Vidar Clinic in Järna. Purpose: To study changes in the self-rated health status of patients receiving anthroposophic care at Vidar Clinic outpatient facility in Norrköping. Method: A quantitative method using questionnaires to 26 patients at the Vidar Clinic outpatient facility in Norrköping, [using] consecutive data collection. Health-related quality of life was estimated using EQ-5D (mobility, hygiene, activity, pain and anxiety) and EQ-VAS (overall health status) along with two questionnaires specially designed for this study, with VAS scales for sleep quality, physical condition, mental condition and the ability to manage their lives, as well as the patients’ description of whether or not they felt fulfilled in their lives. In addition, the patients’ sickness absence rates and drug consumption were analysed. Results: The patients had extremely varying diagnoses and often complex problems. The most common were fatigue, fibromyalgia and pain. The results varied between the diagnostic groups. The majority of the patients reported great satisfaction with their care and treatment and how they were being cared for by the staff; to a large extent they felt that their expectations and goals had been achieved, and that in general they had been given better capabilities to manage their lives. There was no significant difference in the mean value for the EQ-5D index or EQ-VAS, but a tendency to significant improvement in sleep quality and mental condition, and a significant improvement in self-estimated physical condition (p=0.021). When a partial analysis was conducted of the individual dimensions (EQ-5D), improved conditions were found in one/some of the dimensions in 36 per cent of the patients, usually in terms of mobility and least common with regard to pain. Conclusion: In this group, with extensive and varied and often very long-term problems, great appreciation of the care was shown, there were tendencies to improved results in sleep quality and mental condition, and significantly improved results in self-estimated physical condition.

This thesis explores the ontological content of the integration of complementary and alternative medicine (CAM) in biomedical education, through a critical exploration of “CAM" policy related documents from the World Bank, the World Health Organization and Health Canada, as a means of contextualizing "CAM" in biomedical education. It also interrogates curriculum documents from a project that seeks to standardize “CAM” in biomedical education. This thesis suggests that there are ontological parallels to the colonial era conversion of indigenous medicine evoked in the contemporary 'integration' of CAM in biomedical education.

Made available in DSpace on 2016-06-02T20:45:41Z (GMT). No. of bitstreams: 1 5341.pdf: 545106 bytes, checksum: e05e8119c32326b9e9c3e4558289ed42 (MD5) Previous issue date: 2013-04-05 / Introduction: Based in proposed changes in the health care model, aiming at complying the principles of Unified Health System, and enhanced by international bodies such as World Health Organization, the use of integrative practices have increased in the services of health care in Brazil. In the case of traditional medicine or complementary and alternative system, the primary health care has become the main focus of action globally, with several benefits brought across studies. With the large number of information related to the issue, aimed to review the literature indexed in databases the search for scientific evidence concerning in the period between 2006 and 2012. Methods: The integrative literature review enables the synthesis of the state of knowledge of a subject, occurring in six stages: identifying the topic, literature search, categorization of studies, evaluation studies, interpretation of results and presentation of the synthesis. Results: Selected 42 studies for analysis, present a strong presence of traditional practices in the field of primary care globally, and experiences the use of alternative and complementary medicine, outside Brazil, in tertiary care setting. It is observed lack of knowledge of professionals and shortages public policies for real theme development, as well as further evidence about the costs of this change in the way health care. Conclusion: Based on the benefits already identified and discussed, the comprehensive improvement in the quality of life in communities, points to the need for greater investment in research, dissemination and training in the area, in order to supply an increasing demand, as well as studies that brings evidence to safety use and public investments. / Introdução: com base nas propostas de mudança no modelo de cuidado à saúde, com vistas a atender os princípios do Sistema Único de Saúde, e incentivado por órgãos internacionais, como a Organização Mundial da Saúde, tem-se fortalecido o uso de práticas integrativas nos Serviços de Cuidado à Saúde do Brasil. Tratando-se de medicina tradicional ou de sistemas alternativos e complementares, a atenção primária à saúde tem-se tornado principal foco das ações de forma global, com inúmeros benefícios trazidos ao longo dos estudos. Frente ao grande número de informações relacionadas ao tema, objetivou-se revisar a literatura indexada em bases de dados, para a busca de evidências científicas relacionadas, no período compreendido entre 2006 e 2012. Metodologia: a revisão integrativa de literatura possibilita a síntese do estado de conhecimento de um tema, ocorrendo, assim, em seis fases: identificação do tema, busca na literatura, categorização dos estudos, avaliação dos estudos, interpretação dos resultados e apresentação da síntese. Resultados e discussão: selecionados 42 estudos para análise, que trazem uma forte presença de práticas tradicionais no campo da atenção primária globalmente, e algumas experiências de uso de medicina alternativa e complementar, fora do Brasil, em ambiente de cuidados terciários. Observa-se desconhecimento por parte de profissionais e escassez de políticas públicas para real desenvolvimento do tema, assim como de maiores evidências a cerca dos custos dessa mudança na forma de cuidado à saúde. Conclusão: Considerando-se os benefícios identificados e discutidos de melhoria global na qualidade de vida das comunidades, aponta-se para a necessidade de maiores investimentos em pesquisas, divulgação e formação profissional na área, a fim de suprir uma demanda crescente, assim como estudos que tragam evidências para segurança de uso e para os investimentos públicos.

Submitted by Bárbara Maria Dultra (dultra.dultra@gmail.com) on 2018-01-26T13:58:00Z No. of bitstreams: 1 Tese - MÃOS QUE SE ABRAÇAM - AFETIVIDADE, CUIDADO E AS PRÁTICAS INTEGRATIVAS COMPLEMENTARES NO COMPLEXO HOSPITALAR PROFESSOR EDGAR SANTOS DA UFBA.pdf: 2952557 bytes, checksum: c0fa63e4886ec7f1cdd7e54f2e83bd8c (MD5) / Approved for entry into archive by Maria Auxiliadora da Silva Lopes (silopes@ufba.br) on 2018-01-30T12:52:02Z (GMT) No. of bitstreams: 1 Tese - MÃOS QUE SE ABRAÇAM - AFETIVIDADE, CUIDADO E AS PRÁTICAS INTEGRATIVAS COMPLEMENTARES NO COMPLEXO HOSPITALAR PROFESSOR EDGAR SANTOS DA UFBA.pdf: 2952557 bytes, checksum: c0fa63e4886ec7f1cdd7e54f2e83bd8c (MD5) / Made available in DSpace on 2018-01-30T12:52:02Z (GMT). No. of bitstreams: 1 Tese - MÃOS QUE SE ABRAÇAM - AFETIVIDADE, CUIDADO E AS PRÁTICAS INTEGRATIVAS COMPLEMENTARES NO COMPLEXO HOSPITALAR PROFESSOR EDGAR SANTOS DA UFBA.pdf: 2952557 bytes, checksum: c0fa63e4886ec7f1cdd7e54f2e83bd8c (MD5) / Esta pesquisa tem como objetivo principal: identificar e analisar as situações em que o Terapeuta e o Assistido do Ambulatório de Práticas Integrativas Complementares do Complexo Hospitalar Professor Edgar Santos, conhecido como Hospital das Clínicas, reconhecem a presença da Afetividade e do Cuidado como formas de acolhimento, suas contribuições para estreitar o vínculo entre ambos e visibilizar as Práticas Integrativas Complementares. Este objetivo foi traçado com o intuito de encontrar resposta para o problema: Como a afetividade e o Cuidado contribuem para estreitar a relação Terapeuta-Assistido e visibilizar as Práticas Integrativas Complementares? Para dar conta de alcançar este intento e analisar as informações colhidas no campo empírico, foram escolhidos como trilha metodológica a perspectiva multirreferencial, como método de investigação, o Estudo de Caso, através da abordagem de pesquisa qualitativa, exploratória, e como técnicas análise documental, análise bibliográfica, investigação participante e entrevista semi-estruturada. Dois métodos foram empregados para trabalhar com as informações: Análise de Conteúdo e Análise Contrastiva. Além disso, os diálogos teóricos se basearam nos referenciais: Bioenergético-Vitalista; Cartesiano- Newtoniano e Complexo/Multirreferencial, que ajudaram a compreender a complexidade do ser humano como ente bio-psico-social-espiritual. Estes aportes foram fundamentais, embora insuficientes para dar conta do objeto em estudo, então, outros autores, a exemplo de: Maturana, Morin, Ardoino, Toralba Reselló, foram “convidados” à interlocução com a pesquisadora e com os atores sociais (gestores, terapeutas e assistidos), que atuam no referido ambulatório. Isto contribuiu para expandir o saber sobre o “cuidar demonstrando afeto e respeito à idiossincrasia humana”. Os resultados alcançados indicaram que foram identificados no Ambulatório de Práticas Integrativas Complementares, pilares que estreitam o vínculo entre terapeutas e assistidos, advindos da afetividade e do cuidado como: sentimentos e emoções emanados entre estes; acolhimento amoroso dos terapeutas, desde a anamnese, baseado em princípios/valores humanizados e respeito à idiossincrasia dos assistidos; gentileza, dedicação e preocupação com questões de ordem pessoal; política humanizada implantada no ambulatório, creditando valor a pequenos gestos como: o sorriso, o toque, o abraço, o olhar nos olhos, o passar óleo nos pés, a escuta sensível, a confiança, a esperança, a sensibilidade. Estes pilares foram valorizados tanto quanto os aspectos técnicos. Isto demonstrou que “sutilezas”, na interação terapeuta-assistido, têm relevância e se constituem em elementos imprescindíveis que vinculam afetivamente estes intérpretes sociais. / ABSTRACT This research has as main objective: To identify and analyze the situations in which the Therapist and the Assistant of the Complementary Integrative Practices Clinic from Edgar Santos Hospital Complex, known as Hospital das Clínicas, recognize the presence of Affectivity and Care as a host, their contributions to strengthen the bond between them and to make visible the Complementary Integrative Practices. This objective was designed to find an answer to the problem: How does affection and care contribute for strengthening the Therapistassisted relationship and to making the Complementary Integrative Practices more visible? In order to achieve this aim and to analyze the collected informations in the empirical field, the multireferential perspective was chosen as a methodological track, which made it possible to use the Case Study, through a qualitative and exploratory research approach, instruments / techniques (documentary analysis, bibliographic analysis, participant research and semistructured interviews), using two methods: Content Analysis and Contrastive Analysis. In addition, the theoretical dialogues permeated thoughts such as the Bioenergetic-Vitalist; the Cartesian-Newtonian and Complex / Multireferential, which helped to assimilate the complexity of the human being as a bio-psycho-social-spiritual pearson. These contributions were fundamental, although insufficient to account for the object under study, so other authors, such as: Maturana, Morin, Ardoino, Toralba Reselló, were invited to interact with the researcher and social actors (managers, therapists and assisted), who work in said outpatient clinic. This contributed to expand the knowledge about "caring showing affection and respect to human idiosyncrasy". The results indicated that complementary pillars were identified in the outpatient clinic of complementary integrative practices, which strengthen the bond between therapists and caregivers, resulting from affection and care as: valuation of feelings and emotions emanating between these actors; loving reception of therapists since the anamnesis, based on the humanized principles / values and respect to the idiosyncrasy of the assisted ones; aspects such as kindness, dedication and concern with personal questions; the humanized policy implanted in the clinic, crediting value to small gestures such as: smile, touch, hug, eye contact, oil on feet, sensitive listening, confidence, hope, sensitivity. These pillars were valued as much as the technical aspects. This has demonstrated that "subtleties" in the therapist-assisted interaction are relevant and constitute essential elements that affectively bind these social interpreters. Keywords: Therapist-patient. Affectivity. Caution. Holistic Health. Humanization of health services. Integrative medicine. / SOMMAIRE Cette recherche a pour objet principal : Identifier et analyser les situations dans lesquelles le Therapeute et le Patient de l´Ambulatoire de Pratiques Intégratives Complémentaires du Complexe Hospitalier Professor Edgar Santos, connu comme Hospital das Clínicas, reconnaisse la présence de l´Affectivité et des Soins comme formes d´accueil, leurs contributions pour renforcer le lien entre les deux et rendre visibles les Pratiques Intégratives Complémentaires. Cet objet a été conçu pour trouver une réponse à la question : Comment l´Affectivité et les Soins contribuent-ils au renforcement des relations Thérapeute-Patient et rendre visibles les Pratiques Intégratives Complémentaires ? Afin d´atteindre cet objectif et d´analyser les informations recueillies dans le champ empirique, a été choisie la méthodologie de la perspective multiréférentielle, ce qui a permis d´utiliser l´Étude de Cas, moyennant l´approche de recherche qualitative, exploratoire, des instruments/techniques (analyse documentaire, analyse bibliographique, recherche participative et entretien semi-structurée), en utilisant deux méthodes : l´Analyse de Contenu et l´Analyse Comparative. De plus, les dialogues théoriques ont imprégné des pensées, comme le Bioénergétique-Vitaliste, Cartésienne-Nestonienne et le Complexe/Multiréférentielle, qui ont contribué dans l´assimilation de la complexité de l´être humain comme un être bio-psyco-social-spirituel. Ces contributions ont étées fondamentales, mais, néanmoins, insuffisantes pour l´accomplissement de l´objet de l´étude. Ainsi, d´autres auteurs, comme par exemple, Maturana, Morrin, Ardoino, Toralba Reselló ont été « invités » à interagir avec la chercheuse et avec les acteurs sociaux (gestionnaires, thérapeutes et patients), qui font partie de l´ambulatoire. Cela a contribué à augmenter le connaissance sur les « les soins qui montrent l´affection et le respect à l´idiosyncrasie humaine ». Les résultats obtenus ont indiqué que ont été identifiés dans l´ambulatoires de pratiques intégratives complémentaires des piliers qui renforcent le lien entre thérapeutes et patients, résultant de l´affectivité et des soins comme, par exemple, la valorisation des sentiments et des émotions émanant de ces acteurs ; l´accueil adorable des thérapeutes dès l´anamnèse, basé sur des principes / valeurs humanisés et le respect à l´idiosyncrasie des patients ; des aspects comme “politesse”; “dédication”; “préoccupation avec des questions personnelles”; la politique humanisée implantée dans l´ambulatoire, valorisant de petits gestes comme : sourire; toucher; regarder dans les yeux; passer l´ huile sur les pieds; l´écoute sensible; la confiance; l´espoir, la sensibilité, ce qui démontre que “subtilités” dans l´interaction thérapeute-patient sont importantes et constituent des éléments essentiels qui lient affectivement ces acteurs sociaux.

Orientador: Nelson Filice de Barros / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T16:48:28Z (GMT). No. of bitstreams: 1 Bonon_MicheleMazzocato_M.pdf: 2404891 bytes, checksum: 88f399a1a097e77f8de59a1bf1ae4f7d (MD5) Previous issue date: 2013 / Resumo: O presente estudo apresenta os resultados de uma revisão sistemática da literatura sobre as relações entre a Saúde Mental e as Racionalidades Médicas (RM) /Práticas Integrativas e Complementares (PIC). O levantamento foi realizado em cinco bases de dados eletrônicas, sem restrição da data de publicação dos artigos e considerando combinações de palavras chave. Inicialmente foram analisadas 168 referências (90; 54% de acupuntura; 40; 24% de fitoterapia; 33; 20% de homeopatia; 05; 0% de medicina antroposófica e 0; 0% de termalismo). A predominância das referências de acupuntura motivou o aprofundamento da análise das interações da Medicina Tradicional Chinesa/Acupuntura com a Saúde Mental. Constatou-se que as aplicações da Medicina Tradicional Chinesa na Saúde Mental caracterizam-se pelo uso complementar de diferentes modalidades de acupuntura, em vários contextos, e da sua combinação com outras intervenções de Medicina Alternativa e Complementar. Conclui-se que embora haja constatações positivas provenientes do uso das RM-PIC na Saúde Mental, foi observado que a maior parte dos artigos desconsidera os elementos intrínsecos da RM"MTC" em que a PIC"acupuntura" se origina, assim como a amplitude e complexidade do campo da saúde mental. Tendo em vista que o Brasil engloba a tríade SM-RM-PIC em seu sistema público de saúde e neste contexto a literatura disponível sobre as possibilidades do uso das RM-PIC em Saúde Mental é praticamente inexistente, sugere-se a realização de pesquisas que abordem esse tema, sobretudo no contexto nacional / Abstract: This study presents the results of a systematic review of the literature on the relationship between mental health and Medical Rationalities/ Complementary and Alternative Medicine. The survey was conducted in five electronic databases without restricting the publication of articles and considering combinations of keywords. Were initially analyzed 168 references (90, 54% acupuncture, 40, 24% of phytotherapy, 33, 20% of homeopathy, 05, 0% of anthroposophic and 0, 0% of termal water). The predominance of acupuncture references motivated further analysis of the interactions of Traditional Chinese Medicine/Acupuncture and Mental Health. It was found that applications of Traditional Chinese Medicine in Mental Health are characterized by complementary use of different modes of acupuncture in various contexts, and their combination with other interventions for Complementary and Alternative Medicine. It was concluded that although there positive findings from the use of the RMPIC in Mental Health, it was observed that most of the articles disregards the intrinsic elements of the MR"TCM" that CAM "acupuncture" originates as well as the amplitude and complexity of the field of mental health. Considering that Brazil encompasses the triad MH-MR-CAM in its public health system and in this context the available literature on the possibilities of using the MR-CAM in Mental Health is virtually non-existent, it is suggested to conduct research that address this issue, especially in the national context / Mestrado / Ciências Sociais em Saúde / Mestra em Saúde Coletiva

This mixed methods study examined the association between the frequency of five lifestyle-related complementary and alternative medicine (CAM) practices and perceived quality of life (QOL) and stress among patients in Japan diagnosed with chronic disease, and also examined why patients decided to receive Okada purifying therapy [(OPT) biofield therapy]. Data from 1,190 patients were analyzed using bivariate and multiple regression analysis, followed by analysis of one-on-one in-depth interviews conducted among 25 patients on reasons why patients decided to practice OPT. Grounded theory methodology was used to analyze transcribed interview data. Results of multiple regression analysis indicated that engaging in arts and cultural activities and exercise was associated with a decrease in perceived stress, while arts and cultural activities, exercise, consumption of organic (additive-free) food, and practice of OPT were associated with increased QOL. Gender weakly moderated the effects of arts and cultural activities on stress but not on QOL, and gender did not have any moderating effects on the association of OPT with either stress or QOL. One theme, five clusters, and 13 categories emerged from the qualitative analysis. Feelings of desperation due to unrelieved symptoms of disease seemed to be the principal reason for most patients’ practice of OPT. Other reasons were perception of the limits of conventional medicine in being able to treat patients’ disease, dissatisfaction with conventional medicine, positive relationship with staff and doctors of the integrative medicine clinic providing OPT, and benefits of OPT, among others. Although many patients expressed feeling doubts towards the practice of OPT at first, many seemed satisfied with the results of the practice, mainly because they were able to manage their symptoms and gain a sense of control. This may have led to an increase in QOL. The mixed methods design was able to inform the interpretation of the association of OPT with reported increase in QOL in the quantitative phase of the research.

Cognitive linguists posit that language as a system of meaning is closely related to cognition and to the associated perceptual and physiological structures of the body. From the cognitive semantic viewpoint, cognitive processes underpin and motivate linguistic phenomena such as categorisation, polysemy, metaphor, metonymy and image schemas. The pedagogical implication of the cognitive semantic perspective is that understanding these cognitive motivations facilitates language learning. This dissertation uses an applied cognitive semantic approach to `make sense' of a traditional knowledge system, Traditional Chinese Medicine (TCM). TCM views human physiology as a holistic and dynamic system that exemplifies the same principles as the cosmos-environment. TCM models result in a categorisation of physiological phenomena based on a complex system of experiential and cosmological correspondences. I suggest that the holistic epistemology of cognitive linguistics is well suited to an understanding of these holistic models. From a pedagogical viewpoint, I argue that an analysis of the cognitive motivations which underpin TCM categorisations and the polysemy of some key TCM terms can help the student make sense of TCM as a meaningful system of thought and practice. Both the theoretical and applied approaches explored in this dissertation should have relevance to other traditional knowledge systems, particularly traditional medical systems. / Linguistics / M.A. (Linguistics)

Depuis les recommandations de l'OMS de la fin des années 1970, de nombreux pays enAfrique ont mis en place des dynamiques de reconnaissance de la médecinetraditionnelle et de ses praticiens. Cette thèse s'intéresse au projet de développement dela « médecine intégrative » à Madagascar, consistant en son intégration au sein dusystème de soins officiel et conventionnel. Ce projet a pour objectif l'amélioration de lasanté des populations et passe par une double évaluation : au niveau social avecl'encadrement des activités des tradipraticiens et au niveau thérapeutique avec larecherche sur les plantes médicinales et le développement de remèdes traditionnelsaméliorés. Cette recherche est le fruit d'une démarche méthodologique qui s'appuie surdes enquêtes multi-situées, avec un terrain de recherche dans la capitale malgache et sesenvirons et avec l'ethnographie d'une localité rurale de la région Analanjirofo (côte estde Madagascar). Cette approche s'intéresse d'un côté aux tentatives d'applications desdécisions politiques en matière d'encadrement de la médecine traditionnelle et de l'autreà la pratique concrète des soins traditionnels ainsi qu'aux comportements individuels etcommunautaires face à la gestion des maux, des malheurs et de la maladie avec desétudes de cas approfondies. Cette thèse s'inscrit dans le champ de l'anthropologie de lasanté avec une orientation sur les dynamiques politiques et de développement. Unintérêt particulier est porté à la nature de la cohabitation entre praticiens (médecins,guérisseurs) se déclinant d'un simple référencement de patients à une plus rarecollaboration. Cette étude met en exergue le décalage pouvant exister entre desdécisions gouvernementales et leurs applications locales ainsi que les enjeux sociaux,politiques et économiques qui en résultent. / Following the WHO recommendations made in the late 1970s, many countries in Africahave implemented dynamics of recognition of traditional medicine and traditionalhealers. This dissertation focuses on the development of « integrative medicine » inMadagascar, consisting in its integration into the formal and conventional health caresystem. This development project, focusing on improving population's public health,requires a double evaluation: a social evaluation with the supervision of traditionalhealers' practices and a therapeutic evaluation with research on medicinal plants anddevelopment of improved traditional remedies. This research is the result of amethodological approach based on multi-located fieldworks conducted in the Malagasycapital and its surroundings and an ethnography of a rural town in the Analanjiroforegion (east coast of Madagascar). On one side, this approach focuses on the attempts ofapplication of political decisions regarding the supervision of traditional medicine andon the other side, on the real practice of traditional care as well as on individual andcommunal behaviours when facing disease, sickness, illness and misfortunes withextended case studies. This thesis contributes to the anthropology of health with a focuson political and developmental dynamics. A special emphasis is placed on the nature ofcohabitation existing between practitioners (doctors and traditional healers) going froma simple referencing of patients to a rare collaboration. This study tends to highlight thepossible gap between government decisions and local applications as well as theresulting social, political and economic issues.