Carla Maria Vieira

Análise institucional e educação: reforma curricular nas universidades pública e privada

This text discusses some professional practices carried out in the field of higher education in a context of curriculum changes in the medical and nursing courses of a public university (Universidade Federal Fluminense - UFF - in Niteroi, RJ, Brazil) and in the nutrition course of a private university (Universidade Metodista - UNIMEP - in Piracicaba, sp, Brazil). Based on concepts from institutional analysis, we investigate similarities and differences between the public and private processes of curriculum reform, as well as aspects of our own professional histories. This paper was produced in the context of disciplines and seminars in institutional analysis for the Graduate Program in Collective Health at the Department of Preventive and Social Medicine of the School of Medical Sciences at UNICAMP, conducted between 2002 and 2004 under the responsibility of the last-mentioned co-author of this article.

Significados da dieta e mudanças de hábitos para portadores de doenças metabólicas crônicas: uma revisão

Eating behavior and the psycho-cultural significance of food for patients with chronic metabolic disorders have been a focus of interest due to the difficulty in ensuring the compliance of these patients in terms of changing their habits and in fostering self-care. A review of the literature was condusted using the LILACS and MEDLINE databases and the PUBMED search engine to identify qualitative studies in which the opinion of patients with respect to diet and lifestyle was analyzed. Key words used were: metabolic syndrome; eating behavior; diet; obesity; psychological factors; qualitative study; and dietary habits. Inclusion criteria consisted of: articles in English, Spanish or Portuguese, published between 2000 and 2008; studies carried out in adult populations; containing one or more of the key words in the title. Based on the 15 papers analyzed, it was concluded that compliance with a change of habit is a dynamic process that depends on various individual factors and requires greater interaction between professionals and patients in clinical practice. Promoting self-care depends on respecting the decisions and feelings resulting from personal experience.

The pain and pleasure of being what one is: Viewpoints of health professionals and patients about being overweight/obese

The objective of this article is to discuss the meanings that health professionals and patients in treatment attribute to obesity. The research consisted of a qualitative survey in health, based on in-depth interviews with patients and professionals at an out-patient clinic at the University Hospital in Barcelona, Spain. Here, we discuss the concept of obesity, the meanings of diagnoses, the singularities involved in managing treatment, and the process of becoming ill, all in the light of the anthropology of health that has a sociocultural orientation. Obesity is usually seen by the professionals as a risk-factor disease. For patients, the incorporation of this rationality is procedural and is mixed in with other meanings attributed to being overweight/obese that have been gradually developed throughout life. A patient’s autonomy in choosing to be fat, or obese, and to adhere to treatment, is defined as a process that requires support in order to come to joint proposals in caring for these problems.

Nutrition and self-care practices of patients with chronic Metabolic Syndrome: a qualitative study

OBJETIVO: Analisar aspectos subjetivos das praticas alimentares e autocuidado de pacientes na convivencia com os sintomas cronicos vinculados a Sindrome Metabolica. METODOS: Estudo clinico-qualitativo (exploratorio, nao-experimental), realizado com amostra propositalmente pequena de nove pacientes em tratamento ambulatorial de endocrinologia em hospital universitario do Estado de Sao Paulo, Brasil. O grupo foi fechado por saturacao de dados. As entrevistas foram realizadas em profundidade, com orientacao psicodinâmica na conducao dos dialogos. A categorizacao do discurso foi desenvolvida por meio da analise de conteudo. A abordagem psicodinâmica foi a referencial teorico complementada pela antropologia social. RESULTADOS: Praticas alimentares revelaram-se como mediadoras de autonomia e como fonte de vulnerabilidade na convivencia com o processo de adoecimento cronico. Acolhimento e compreensao dos aspectos psicologicos e culturais da alimentacao sao necessarios no tratamento diante das dificuldades para estabelecer mudancas no comportamento alimentar. CONCLUSAO: Trata-se de uma contribuicao de abordagem interdisciplinar, que valoriza a escuta de subjetividades no tratamento.

EPA-1131 – Do we neglect the addictive dimension of eating disorders? clinical qualitative study of subjects that dropped out from outpatient treatment

Introduction According to literature dropout predicts insufficient results for inpatient treatment for anorexia and poor prognosis for adolescents or adults, with proven increased tendency to subsequent admissions. There are few qualitative studies on dropout, and its high rates for EDs remain a concern for clinicians and researchers alike. Objective To analyze in greater depth the ’addictive’ dimension of EDs – a category of analysis found by the clinical qualitative study, which has been little explored by literature. Method Clinical qualitative method and semi-structured in-depth interviews recorded and fully transcribed. Sample composed according to data saturation, consisting of 8 ≥18 y.o. dropout patients diagnosed with EDs at a specialized outpatient unit in a public university hospital. Theoretical basis relies on scientific literature review on EDs and addiction, and on the psychodynamic description of EDs as ’addictions’. Results The in depth analysis of the categories ’enslavement to addiction (compulsively)’ - addictive dimension of anorexia and bulimia, ’I don’t like if things get out of my control’ – dropout as relief, and ’Anorexia and Bulimia is for life’ – attachment to the symptom signals elements for treatment based on the ’addictive/compulsive’ lived experience. Conclusion The findings support refinement of treatment approach while understanding EDs in their addictive dimension, with possible impact on compliance. This often neglected facet is revealed by research subjects, adding symbolic elements considered with the discussion of neurobiology and psychoanalytic theory, demonstrating significant association between EDs and addiction and pointing out to new paths for treatment innovation.

Aplicação da técnica de grupo focal em pesquisa da Rede-SANS sobre as ações de alimentação e nutrição na atenção básica em saúde

Focus groups are seen as important tools in qualitative research for evaluating projects aimed at articulating social networks and movements. Six focus groups were held as one of the stages in research as part of the Food Safety and Sustainable Nutrition Project (SANS). This social network articulates the academic world with social movements and government in defense of the human right to suitable nutrition. This report is aimed at discussing the experience of applying focus groups to the investigation of perceptions by health professionals of activities related to food and nutrition in basic health care. These groups made it possible to bring together 52 professionals from 13 municipalities in the State of Sao Paulo, Brazil, and they exchanged experiences and debated issues related to food safety in the area of health care. The group discussions identified Aplicacao da tecnica de Grupo Focal em pesquisa da Rede-SANS sobre as acoes de alimentacao e nutricao na atencao basica em saude Application of the focus group technique in research with the SANS network on procedures in food and nutrition in basic health care Carla Maria Vieira1, Lais Sartori Santiago2, Patricia Cristina Wesolowski Tavares2, Adriana Brandt3, Flavia Negri4, Maria Rita Marques de Oliveira5 Trabalho realizado na Universidade Estadual Paulista “Julio de Mesquita Filho” (UNESP) – Botucatu (SP), Brasil. 1Nutricionista, Doutora em Ciencias Medicas/Saude Mental pela Faculdade de Ciencias Medicas da Universidade Estadual de Campinas (UNICAMP) – Campinas (SP), Brasil; Pesquisadora Colaboradora no Departamento de Psicologia Medica e Psiquiatria na UNICAMP – Campinas (SP), Brasil; Docente do Curso de Nutricao da Universidade Metodista de Piracicaba (UNIMEP) – Piracicaba (SP), Brasil. 2Nutricionista pelo Curso de Nutricao da UNIMEP – Piracicaba (SP), Brasil; Bolsista do Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq) no Instituto de Biociencias da UNESP – Botucatu (SP), Brasil. 3Graduada em Direito pela Universidade Federal de Mato Grosso – Cuiaba (MT), Brasil; Membro do Instituto Harpia Harpyia; Bolsista do CNPq no Instituto de Biociencias pela UNESP – Botucatu (SP), Brasil. 4Mestranda na Faculdade de Saude Publica da Universidade de Sao Paulo (USP) – Sao Paulo (SP), Brasil; Bolsista do CNPq no Instituto de Biociencias pela UNESP – Botucatu (SP), Brasil. 5Doutora em Ciencias dos Alimentos pela Faculdade de Farmacia da USP – Sao Paulo (SP), Brasil; Docente no Curso de Nutricao da UNESP – Botucatu (SP), Brasil. Endereco para correspondencia: Carla Maria Vieira – Rua Petropolis, 219/315 – CEP:13104-150 – Campinas (SP), Brasil – E-mail: cmvieira@unimep.com.br Fonte de financiamento: FINEP Convenio: 01.10.0466.00. Conflito de interesses: nada a declarar.Focus groups are seen as important tools in qualitative research for evaluating projects aimed at articulating social networks and movements. Six focus groups were held as one of the stages in research as part of the Food Safety and Sustainable Nutrition Project (SANS). This social network articulates the academic world with social movements and government in defense of the human right to suitable nutrition. This report is aimed at discussing the experience of applying focus groups to the investigation of perceptions by health professionals of activities related to food and nutrition in basic health care. These groups made it possible to bring together 52 professionals from 13 municipalities in the State of Sao Paulo, Brazil, and they exchanged experiences and debated issues related to food safety in the area of health care. The group discussions identified eating, nutrition vigilance and intersectoriality as emerging topics. The focus group technique proved to be a suitable tool for investigating the topic quickly and in depth, with a large number of professionals working in different contexts. In fact, the discussions went beyond the objectives of the research, since the group work made it possible to strengthen the process of articulation carried out by a network that promoting local measures in food safety and sustainable nutrition.

Los hábitos de alimentación y el autocuidado de los pacientes con Síndrome Metabólico: un estudio cualitativo

OBJETIVO: Analisar aspectos subjetivos das praticas alimentares e autocuidado de pacientes na convivencia com os sintomas cronicos vinculados a Sindrome Metabolica. METODOS: Estudo clinico-qualitativo (exploratorio, nao-experimental), realizado com amostra propositalmente pequena de nove pacientes em tratamento ambulatorial de endocrinologia em hospital universitario do Estado de Sao Paulo, Brasil. O grupo foi fechado por saturacao de dados. As entrevistas foram realizadas em profundidade, com orientacao psicodinâmica na conducao dos dialogos. A categorizacao do discurso foi desenvolvida por meio da analise de conteudo. A abordagem psicodinâmica foi a referencial teorico complementada pela antropologia social. RESULTADOS: Praticas alimentares revelaram-se como mediadoras de autonomia e como fonte de vulnerabilidade na convivencia com o processo de adoecimento cronico. Acolhimento e compreensao dos aspectos psicologicos e culturais da alimentacao sao necessarios no tratamento diante das dificuldades para estabelecer mudancas no comportamento alimentar. CONCLUSAO: Trata-se de uma contribuicao de abordagem interdisciplinar, que valoriza a escuta de subjetividades no tratamento.

Práticas alimentares e autocuidado de pacientes com Síndrome Metabólica: um estudo qualitativo

OBJETIVO: Analisar aspectos subjetivos das praticas alimentares e autocuidado de pacientes na convivencia com os sintomas cronicos vinculados a Sindrome Metabolica. METODOS: Estudo clinico-qualitativo (exploratorio, nao-experimental), realizado com amostra propositalmente pequena de nove pacientes em tratamento ambulatorial de endocrinologia em hospital universitario do Estado de Sao Paulo, Brasil. O grupo foi fechado por saturacao de dados. As entrevistas foram realizadas em profundidade, com orientacao psicodinâmica na conducao dos dialogos. A categorizacao do discurso foi desenvolvida por meio da analise de conteudo. A abordagem psicodinâmica foi a referencial teorico complementada pela antropologia social. RESULTADOS: Praticas alimentares revelaram-se como mediadoras de autonomia e como fonte de vulnerabilidade na convivencia com o processo de adoecimento cronico. Acolhimento e compreensao dos aspectos psicologicos e culturais da alimentacao sao necessarios no tratamento diante das dificuldades para estabelecer mudancas no comportamento alimentar. CONCLUSAO: Trata-se de uma contribuicao de abordagem interdisciplinar, que valoriza a escuta de subjetividades no tratamento.

P02-141 - Psychological life experiences facing chronic diseases for patients with metabolic syndrome and impacts reported about health promotion in the Southeast Brazil: A clinical qualitative study

Introduction Receiving and understanding the psychological and sociocultural aspects associated to both health problems and difficulties to make the eating behaviour changes are relevant issues when treating individuals with Metabolic Syndrome. Objective and aims The reports given by chronic individuals in the present study allowed for analyzing the subjective expressions related to food, treatment management and patient adherence to self care propositions. Methods In-depth semi-directed interviews with open-ended questions, with psychodynamic orientation in the conducting dialogues were performed with nine patients from the endocrinology outpatient service of a public university hospital located in Southeast Brazil. From this broader objective, a selection was made of some experiences reported by the subjects, which were related to the process of managing treatment and eating behaviour, implied in chronic metabolic disorders. Results In this work, elements that mediate the process of developing autonomy in eating habits, living with the illnesses and vulnerability factors experiences by Metabolic Syndrome patients are identified in this study. Conclusion The interdisciplinary character of the present study promoted the valorisation of the practice of listening to the psychological and cultural meanings of eating behaviours, hence offering contributions regarding the nutritional care of individuals with Metabolic Syndrome.