Objective: As insomnia is highly prevalent, and side effects of medication are well-known, mind-body interventions are increasingly being sought. The objective of this study is to present a narrative review regarding the effects of mind-body interventions for the treatment of insomnia. Method: A PubMed search was conducted including only randomized, controlled trials in which the main objective was to treat insomnia. Discussion: Twelve studies were selected. In three of the studies, objective parameters (polysomnography) were analyzed. Mind-body interventions were able to improve sleep efficiency and total sleep time. Most can ameliorate sleep quality; some can reduce the use of hypnotic drugs in those who are dependent on these drugs. Conclusion: According to the studies we selected, self-reported sleep was improved by all mind-body treatments, among them yoga, relaxation, Tai Chi Chih and music. Cognitive behavioral therapy seems to be the most effective mind-body intervention. Cognitive behavioral therapy was the only intervention that showed better results than medication. However, considering that only five of the twelve studies chosen reached a score of 3 in the Jadad scale, new studies with a higher methodological quality have to be conducted especially in mind-body interventions that belong to the complementary or alternative medicine field.

Meditation is the third most commonly requested complementary and alternative medicine (CAM) therapy reported in a US survey. Those who suffer from chronic pain are those who most frequently use CAM therapies. This review aims to evaluate whether meditation-based interventions can help the treatment of fibromyalgia. A PubMed search was conducted using the terms "fibromyalgia" and "meditation", or "mindfulness", or "mantra" or "relaxation response". We selected articles which clearly described a meditation intervention being used in the treatment of fibromyalgia. Only four articles were classified with score 3 in the Jadad scale. Another seven articles were included in this review. Most of the results indicate improvement in fibromyalgia-related symptoms in patients who participated in a meditation-based intervention. Considering only 4 of the 13 studies achieved a score of 3 on the Jadad scale, researchers of meditation interventions should discuss the best methodologic control for these studies.

Menopause is an important episode in the life of women and, for the great majority of women, occurs in their fifties. The climacteric period, which is often associated with insomnia, represents one of the most important changes in the female reproductive cycle because it marks the end of reproductive capacity. Hormonal therapy has been considered the most useful and standardized method for treating menopause and climacteric-associated symptoms despite its side-effects. The present study is a review of the scientific literature about the efficacy, toxicity and safety of complementary and alternative therapies used as alternatives to hormone therapy to treat insomnia in menopausal women. Mind-body therapies and the use of isoflavonoids have exhibited promise as interventions for treating insomnia in the climacteric at our Walk-In Clinic of Sleep Disturbance at the Universidade Federal de São Paulo. This review will describe the use of complementary and alternative therapies and their effectiveness in treating insomnia in this period of a woman's life.

Background Despite the recent advances in the treatment of rheumatic diseases, especially if early diagnosed, it is already known that they are poorly recognized and managed by physicians in general, especially in primary care setting. Continuing medical education has been an alternative used in the rheumatology training for doctors. Regarding the specificities of rheumatology physical examination, real patients seemed to be the best option to facilitate the teaching-learning process in this area. Objectives To assess the confidence of physicians to recognize the rheumatic diseases, after participation in a workshop using active teaching methodology with real patients. Methods A practical workshop was conducted after a one-day scientific meeting in Natal-Brazil, focused in update general practitioners on more prevalent rheumatic diseases in primary care level. Forty five participants had an intensive practical training in osteoarthritis (OA), rheumatoid arthritis (RA), ankylosing spondylitis (AS) and back pain. The workshop was divided into three modules: 1-discussion of clinical cases, 2-training in physical examination with real patients, 3-radiological interpretation. Each module had a duration of 45 minutes and was led by 2-3 Rheumatology professors. Three groups of 15 participants were rotated among them. For the training of physical examination, there were selected 09 patients with OA, RA and AS at different stages of disease. Patients were informed about participation in the activity and signed the consent form. At the end, a questionnaire with a 5-point Likert scale was used to assess participants’ confidence and satisfaction with the teaching method employed. Results Twenty-two doctors and 11 medical students who completed the questionnaire, assessed the workshop as excellent (94%) or good (6%). Compared with the traditional method of lecture, respondents rated the method as “much more efficient” (76%) or “more efficient” (24%) for their learning process. They stated that the use of real patients to give them more intimacy with the symptoms and signs of the diseases studied had a very positive impact. For all participants, the confidence in the diagnosis of diseases covered by workshop has increased from one to three levels in the Likert scale used. Conclusions The use of active teaching methods with real patients proved to be a valid strategy in Rheumatology training for primary care physicians, enabling them to improved diagnosis and patient care. We expect that, in the future and after others effective interventions like this one, our patients would be refered to rheumatologists, if necessary, as early as possible. References Anne, B.; Debbie, M.; Sylvia, V.; Friedo, D.; Liesbeth, B.; Zuzana, Jong. Real patient learning integrated in a preclinical block musculoskeletal disorders. Does it make a difference? Clin Rheumatol. 2011 August; 30(8): 1029–1037. Bezerra, E.L.M.; Vilar, M.J.P.; Azevedo, G.D. Elective Rheumatology Program With A Primary Health Care Focus. Arthritis & Rheumatism. October 200...

Dental anxiety and phobia not rarely cause the patient to delay seeking oral health care if he ever seeks it at all. The present research aimed at providing a literature overview concerning to the applicability of Behavioral Medicine resources in management of dental anxiety and phobia, considering patients who have restrictions on use of drugs. Several risks factors are involved in the rise of such behaviors. These include educational, psychosocial, and economic factors. Comorbidity presentation can also occur, and the level of triggering elements can vary. Although the number of individuals affected by the psychological disorders is significant, the applicability and effectiveness of Behavioral Medicine resources as a means of their management are mostly reported in anecdotal studies. Due to the significant percentage of the society that is affected by dental anxiety and phobia, it produces a negative impact on both individual health and public health system, as shown in our findings. It becomes clear the need for developing new methodological approaches to the training of a more adequate number of professional able to deliver safe and effective Behavioral Medicine resources in medical care to patients with of dental anxiety and phobia, and thus lead to the better outcomes than has been observed.

Introdução: Desde os primeiros relatos da sífilis na história da humanidade, tem-se verificado que é uma doença com alta frequência global, inclusive entre os brasileiros, apesar da adoção de iniciativas de prevenção das infecções sexualmente transmissíveis difundidas pelo governo. O recrudescimento da prevalência e incidência e a sua mortalidade em todo o mundo justificam o estudo em tela. Objetivo: Demonstrar, por meio de relato de caso clínico, que as manifestações não usuais da sífilis secundária podem ocorrer com frequência muito elavada. Métodos: Análise descritiva de um caso clínico respaldado pela produção científica em fluxo com o propósito de demonstrar os resultados observados. Paciente feminino, 15 anos, procura a Unidade Básica de Saúde para reavaliação do quadro clínico de hipótese conflitante após diagnóstico e tratamento proposto pela Unidade de Pronto Atendimento previamente, evoluindo com refrataridade e repercussão estética desfavorável. Afirma que há um mês evoluiu com lesões disseminadas em tronco, membros e face de aspecto maculopapular, bem delimitadas, homogêneas e pruriginosas. Ausência de exsudação. Nega febre. Nega ulcerações genitais prévias. Vida sexual ativa sem uso de preservativos. Solicitado teste rápido de doença sexualmente transmissível, com positividade para sífilis. Iniciada a administração da penicilina benzatina e realizada a notificação. Solicitado Estudo Laboratorial de Doenças Venéreas, o qual evidenciou 1/64. No momento, paciente encontra-se em acompanhamento clínico; portanto, de prognóstico indefinido. Resultados: Este caso clínico ilustra o polimorfismo da sífilis secundária, sendo mandatório ao médico ter um amplo conhecimento dessa entidade mórbida, com o estabelecimento de um diagnóstico precoce, instaurar um tratamento efetivo, eficiente e seguro, capaz de promover uma convalescença satisfatória e reduzir os índices estatísticos tão elevados. Conclusão: O potencial de apresentação dermatológico variado da sífilis aponta a necessidade de, sempre que possível, ela seja cogitada como hipótese diagnóstica plausível no que tange às demais doenças dermatológicas, bem como a relevância da realização de screnning investigativo adequado em casos suspeitos.