Maria Angélica Tavares de Medeiros

Education of dietitian's in Brazil: Minimum clock hours of instruction for a bachelor's degree in nutrition

This essay aims to debate the minimum clock hours of instruction necessary for obtaining a bachelors degree in nutrition considering the challenges to educate health professionals. Official documents on the minimum clock hours of instruction required by undergraduate nutrition programs were analyzed to investigate compliance with the curriculum guidelines for the area, the law that regulates the profession of dietitian, and the necessary education for the Sistema Unico de Saude (Unified Health Care System). Compared with other health programs, nutrition presented the smallest increase in the minimum clock hours of instruction required for the degree. The changes that occurred in the epidemiological, demographic, and nutritional profile of the population and scientific advances require specific nutrition actions. Since Sistema Unico de Saude focuses on comprehensiveness in the three levels of care, on humanization, and on health care, the theoretical and methodological concepts given in undergraduate programs need to be improved for the dietitians education to meet the Sistema Unico de Saude needs. Incorporation of the knowledge needed for working with food and nutritional phenomena, including its social and cultural dimensions, management of public policies, quantity cooking, and food and nutritional surveillance requires a higher minimum clock hours of instruction. In conclusion, dietitians need a minimum clock hours of instruction of 4,000 to acquire a proper education, integrate into the university life, and coordinate interdisciplinary experiences of the triad teaching/research/extension.

A dinâmica do aleitamento materno entre famílias em vulnerabilidade social: o que revela o sistema de busca ativa

OBJECTIVE: This study describes the breastfeeding practices of vulnerable groups living in an area covered by the Northwest Health District of Campinas (SP), Brazil. METHODS: A cross-sectional study was done by visiting all families in the studied area and performing a census-like survey called active search. An exploratory study was done of the breastfeeding practices of a socially vulnerable population living in the outskirts of Campinas. This area has approximately 165,000 inhabitants and three primary healthcare facilities. RESULTS: The survey found 1,139 children under six years of age and 72.6% of the families were below the poverty line; 93.3% of the children were breastfeed for a median of 8 months (CI 95% 7.0 - 8.9 months); exclusive breastfeeding lasts a median of 4 months (CI 95% 3.9 - 4.1 months), and more than 20% of the children were given other foods during their first month of life. Most of the families reported that the primary healthcare facilities gave them no information on breastfeeding. CONCLUSION: Breastfeeding and exclusive breastfeeding in the studied area found by active search lasted longer than the national average and longer than those of families with similar socioeconomic characteristics. This reinforces the importance of primary healthcare incorporating this strategy in actions that promote breastfeeding.

Atenção nutricional no pré-natal e no puerpério: percepção dos gestores da Atenção Básica à Saúde

Objective: To evaluate the perception of managers regarding the nutritional care to prenatal and postpartum in Primary Health Units in Southern,Sao Paulo, Brazil. Methods: It was conducted a census of 28 Primary Health Units from the insular area, using interviews with managers. The nutritional care was assessed according to infrastructure, work process and food and nutrition surveillance. Results: The insertion of dietitians was the main insufficient component of dimension structure, interfering negatively on nutritional care for 60% of managers. It was founded low compliance for the following variables of the process dimension: calculate the body mass index (35%), monitoring of nutritional status in body mass index/gestational week curve (46%) and conducting individualized nutritional counseling in antenatal (14%). Conclusion: Prenatal and postpartum nutritional care is unsatisfactory to achieve comprehensive care. It is necessary to sensitize local managers awareness and qualify the health teams to ensure the effectiveness of such actions in Santos.

A integralidade como eixo da formação em proposta interdisciplinar: estágios de Nutrição e Psicologia no campo da Saúde Coletiva

This paper aimed to analyze the experience in interdisciplinary training for Nutrition and Psychology undergraduate courses at the Baixada Santista campus of Universidade Federal de Sao Paulo, focusing on comprehensive care. It took place between 2010 e 2012, in the Primary Care Health of Unified Health System of Santos municipality, Sao Paulo, Brazil, in the the territory of Monte Serrat Hill. We used field records from memories of supervisions and meetings between teachers and health team, according to qualitative research. Narratives have been constructed and Singular Therapeutic Projects. In joint-supervision by professors of Nutrition and Psychology courses, we debated situations highlighted by students and constructed work plans for each training cycle. Through interdisciplinary practices reflections and actions to SUS consonants were realized. Our results corroborate the importance of interdisciplinar work towards comprehensive care, promoting ways of listenning which leads to special health care in close relation to the services.

Nutritional care during prenatal and postpartum periods: A report of experiences in a city on São Paulo's coast

The purpose of this study is to present a report of the experiences of the adoption of the Approach to Nutritional Care during Prenatal and Postpartum Periods, resulting from a partnership between the university and the municipal primary health care system of Santos, SP, Brazil. This approach was developed through joint work plans based on the need to incorporate nutritional care into the prenatal and postpartum care. All stages of design and implementation and the results of this strategy were documented in a field diary. This approach was adopted in two basic health units between 2010 and 2014. The stages of this process were planned in conjunction with health care teams and consisted of putting together interdisciplinary groups for nutrition education during the prenatal period. Interdisciplinary educational group meetings were held focusing on listening to the needs of pregnant women, the provision of prenatal nutritional care, and on the project to monitor the nutritional status of newborns through home visits up to the 15 days of postpartum. The interdisciplinary activities strengthened the bond between the users and the health care team members, contributing to the provision of effective care and promoting integrality. Home visiting contributed to encourage exclusive breastfeeding.

A system for occupational injury surveillance in Piracicaba, southeastern Brazil.

This article describes the experience of developing the Occupational Injury Surveillance System in the city of Piracicaba, in upstate São Paulo, Brazil. The system has the following characteristics: the information entered into the system is obtained directly, in real time, where the injured individuals receive medical treatment; the system has universal coverage, including all accidents occurring on the job in Piracicaba regardless of the workers employment status, workplace, and place of residence; the health monitoring and promotion actions are activated in response to the identification of sentinel events; and the analysis of spatial distribution of occupational injuries is a basic tool for elaborating strategies for treating the injured as well as policies for accident prevention. The system began operating on November 1, 2003. 10,777 occupational injuries had been identified by October 31, 2005, corresponding to an annual incidence proportion of 3.8% in the city. We present a brief description of a detailed investigation of one of the injuries.

Educational training of nutritionists in Public Health Nutrition: A systematic review

The present systematic review aimed to synthesize the findings of studies in the literature on the educational training of nutritionists in Public Health. The study was conducted by searching international databases (PubMed, Science Direct, Lilacs, PsycINFO, Scopus, and Web of Science), as well as in the gray literature. The steps of systematic search followed the recommendations of the Preferred Reporing Itens for Systematic Reviews and Meta-Analysis. Eligibility criteria included studies on the Public Health training in Nutrition Undergraduate courses, whose subjects were students, educators, and professionals who practice in the field of Nutrition. A total of 633 articles were identified, of which, 66 were eligible for reading and analysis of the full text and 12 were included in the systematic review. Of these, five of these 12 articles used quantitative methods, 3 used mixed methods, and 4 used exclusively qualitative methods. There was high heterogeneity among the

Hipertensão arterial autorreferida em adultos residentes em Campinas, São Paulo, Brasil: prevalência, fatores associados e práticas de controle em estudo de base populacional

OBJECTIVES Evaluate the prevalence of self-reported hypertension in adults aged 20 to 59 years as well as identify associated factors, the use of health services and disease control practices according to the possession or not of a private healthcare plan. METHODS A population-based, cross-sectional study was conducted in the city of Campinas, Brazil, involving 957 adults. RESULTS The prevalence of self-reported hypertension was 14.1%, with greater frequencies found among women, individuals aged ≥ 40 years, those who declared their skin color to be black, those with less schooling, those who did not practice active leisure activities, ex-smokers, overweight or obese individuals and those who rated their own health as not being excellent/very good. No inequalities were detected between individuals with hypertension covered by a private healthcare plan or the Brazilian public healthcare system with regard to access to services, the use of disease-controlling medications and having received counseling on how to manage the disease. However, differences were found regarding the practice of physical activity and diet. CONCLUSION Despite the equity disclosed in access to health care, the present findings demonstrate that an insufficient proportion of adults adopt changes in lifestyle to control hypertension, underscoring the central role of public health administrators.Resumo O objetivo deste artigo e avaliar a prevalencia de hipertensao arterial autorreferida em adultos de 20-59 anos, identificar os fatores associados, o uso dos servicos de saude e as praticas de controle da doenca segundo posse ou nao de plano de saude. Estudo transversal de base populacional realizado em Campinas-SP, em que foram analisados 957 adultos. A prevalencia de hipertensao arterial autorreferida foi de 14,1%, revelando-se mais elevada em mulheres, em individuos com ≥ 40 anos, nos que se declararam de cor preta, com menor escolaridade, nos inativos no lazer, ex-fumantes, naqueles com sobrepeso ou obesidade, nos que relataram duas ou mais doencas e que autoavaliaram a saude como nao sendo excelente/muito boa. Nao foram detectadas desigualdades entre hipertensos cobertos por planos de saude e os SUS dependentes quanto ao acesso ao servico, uso de medicamentos para controle da doenca e ser orientado sobre os cuidados com a doenca, mas houve diferencas quanto a pratica de atividade fisica e o uso de dieta. Apesar da equidade revelada quanto ao acesso a atencao a saude, e incipiente a proporcao de adultos que adota mudancas no estilo de vida para o controle da doenca, reafirmando o papel central da gestao das politicas de saude, que precisam trabalhar intersetorialmente

Evaluation practices in the field of Food and Nutrition

The objective of this study was to characterize and analyze the different existing methods for the evaluation of food and nutrition programs and services in Brazil, through a systematic review of the literature focused on complete articles published in national indexed journals. We searched the PubMed, MedLine and LILACS databases using the following search terms and Boolean operators: “evaluation and program”; “project”; “intervention”; “servisse”; “actions and nutrition”; “nutritional”. The research was restricted to articles written in Portuguese, English and Spanish and published between 2001 and 2015. Twenty-two studies were selected and the analysis indicates; most were carried out through quantitative approaches and external evaluations based on epidemiological theory; participatory evaluation strategies are still uncommon; Impact assessments and implementation were predominant; there is little diversity in terms of references to the theoretical framework in the field of evaluation of health care programs in the planning and execution of the evaluation processes analyzed. The results of this study indicate the need for a more comprehensive evaluation considering the complexity of the interventions evaluated using the theoretical-methodological apparatus available in the literature to understand the importance of the different perspectives of the agents involved in the evaluation processes.

Evaluation of nutritional care of overweight adults from the perspective of comprehensive health care

Objetivo: Descrever e avaliar a atencao nutricional aos adultos com excesso de peso, na Atencao Primaria e Secundaria a Saude, em Santos, Sao Paulo. Metodos: Estudo de carater quanti e qualitativo, realizado entre 2013 e 2015, em duas etapas: diagnostico (1) e avaliacao (2). Na etapa 1, fez-se um censo dos servicos de Atencao Primaria e Secundaria (n=28) e Atencao Secundaria a Saude (n=4), entrevistando gestores e/ou profissionais; realizou-se analise exploratoria dos dados. Na etapa 2, entrevistaram-se, em profundidade, gestores e/ou profissionais com uma amostra dos servicos da Atencao Primaria a Saude e a totalidade dos de Atencao Secundaria a Saude; realizou-se analise tematica, utilizando o referencial teorico de integralidade segundo Pinheiro & Mattos. Resultados: Entrevistaram-se 40 profissionais: 36 na Atencao Primaria a Saude e quatro na Atencao Secundaria a Saude. A atencao nutricional na Atencao Primaria a Saude, restringe-se ao atendimento individual, com encaminhamento a outro ponto; diagnostico nutricional e acoes de promocao da saude so ocorrem quando o excesso de peso se associa a outra doenca; verificaram-se fragilidades na referencia e contrarreferencia e na efetivacao da intersetorialidade. Na Atencao Secundaria a Saude, a atencao nutricional direciona-se ao atendimento clinico, utilizando abordagens tradicionais de educacao alimentar. Nos dois pontos de atencao identificaram-se fatores limitantes da integralidade: acoes fragmentadas; ausencia de acoes de promocao e protecao da saude e pouco dialogo entre a Atencao Primaria a Saude e Atencao Secundaria a Saude. Conclusao: O excesso de peso nao e um desfecho pautado na Atencao Primaria a Saude e, na Atencao Secundaria a Saude, pauta-se por praticas prescritivas, pouco potentes para promover a autonomia dos sujeitos. Faz-se necessario reorientar as acoes nesses dois pontos de atencao, para qualificar a atencao nutricional.