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.
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.