Roberto Teixeira de Lima

Pré-natal na atenção primária do município de João Pessoa-PB: caracterização de serviços e usuárias

OBJETIVOS: caracterizar a assistencia pre-natal em Unidades basicas de Saude envolvendo profissionais e usuarias do municipio de Joao Pessoa-PB. METODOS: estudo do tipo transversal e analitico-descritivo. A fim de caracterizar o pre-natal, um instrumento especifico foi elaborado com base nas diretrizes do Programa de Humanizacao do Pre-natal e Nascimento reunindo questoes distribuidas e analisadas segundo a triade avaliativa: estrutura, processo e resultados. RESULTADOS: observou-se boa infra-estrutura em maior parte dos servicos; quanto ao processo, identificou-se baixa adesao aos requisitos minimos do Programa de Humanizacao do Pre-natal e Nascimento (39,9%), alem de baixo percentual de servicos com atividades de educacao em saude (45,5%) e avaliacao interna (47,7%). Para os resultados da assistencia, altos percentuais de gestantes com intercorrencias clinicas (60,9%), inadequada situacao nutricional (56,3% sobrepeso e obesidade) e baixa prevalencia de aleitamento materno exclusivo (58,05 ± 34,19 dias) foram observados. CONCLUSOES: aspectos de processo referentes a adesao ao pre-natal, presenca de servicos com atividades de educacao em saude e indicadores de avaliacao interna alem de questoes de resultados envolvendo intercorrencias clinicas, inadequada situacao nutricional na gestacao e baixa prevalencia de aleitamento materno exclusivo sao barreiras a qualidade das acoes de pre-natal no âmbito da atencao primaria a saude.

Prevalência de fatores de risco para doenças crônicas não-transmissíveis: impacto de 16 semanas de treinamento futebolístico em índices do estado nutricional e da aptidão física de praticantes de futebol society

The study objective is to identify the prevalence of risk factors (RF) to non-transmissible chronic diseases (NTCD) in society soccer practitioners and the impact of 16 weeks of soccer training in the nutritional status (NS) and the physical ability index. Methods: Sample: 45 individuals (38.6 ± 7.4 years), divided in two groups: experimental (G1 = 22) and control (G2 = 23). The G1 was submitted to a training program of three sessions by week in alternated days with 90 minutes (min) duration. The G2 participated once a week, in soccer game, with 90 min duration. The research variables contemplated RF for NTCD, anthropometric indicators, biochemical analysis and physical ability index. Data analysis counted on descriptive and inferential statistics by SPSS 13.0. Results: The major risk factors prevalence’s pointed to: the overweight (65.0%), cancer family history (57.5%) and cardiac disease (55.0%) and hypertriglyceridemia (32.5%). The G1 presented body mass (p = 0.007), waist circumference (p = 0.010), body mass index (p = 0.007) and fat percentage (p = 0.004), reduction, fact no observed in G2. In both of the groups, total cholesterol analysis, triglycerides and fasting glucose, didn’t demonstrative significant reduction during the observation period (p > 0.05). G1 got better indexes of maximum oxygen consumption (p = 0.011), muscular resistance (p = 0.000) and flexibility (p = 0.000), what did not happen in G2. Conclusion: The soccer players presented high prevalence of RF to NTCD. In general terms, G1 got satisfactory changes in NS and physical ability index during 16 weeks period, conditions that weren’t identified in G2.O objetivo do estudo foi identificar a prevalencia de fatores de risco (FR) para doencas cronicas nao-transmissiveis (DCNT) em praticantes de futebol society e o impacto de 16 semanas de treinamento futebolistico em indices do estado nutricional e da aptidao fisica. METODOS: Amostra: 45 individuos (38,6 ± 7,4 anos), divididos em dois grupos: Experimental (G1 = 22) e Controle (G2 = 23). O G1 submeteu-se a um programa de treinamento de tres sessoes semanais em dias alternados com duracao de 90 minutos (min). O G2 participou, uma vez por semana, de jogo de futebol, com duracao de 90 min. As variaveis de investigacao contemplaram FR para DCNT, indicadores antropometricos, analises bioquimicas e da aptidao fisica. A analise dos dados contou com estatistica descritiva e inferencial mediante o SPSS 13.0. RESULTADOS: As maiores prevalencias de FR apontaram para o sobrepeso (65,0%), historia familiar de câncer (57,5%) e cardiopatias (55,0%) e hipertrigliceridemia (32,5%). O G1 apresentou diminuicao na massa corporal (p = 0,007), circunferencia abdominal (p = 0,010), indice de massa corporea (p = 0,007) e percentual de gordura (p = 0,004), fato nao observado no G2. Em ambos os grupos, as analises do colesterol total, triglicerideos e glicose em jejum, nao mostraram diminuicao significativa durante o periodo investigado (p > 0,05). O G1 obteve melhores indices de consumo maximo de oxigenio (p = 0,011), resistencia muscular (p = 0,000) e flexibilidade (p = 0,000), o que nao ocorreu no G2. CONCLUSAO: Os futebolistas apresentaram alta prevalencia de FR para DCNT. Em termos gerais, o G1 obteve mudancas satisfatorias no estado nutricional e na aptidao fisica durante o periodo de 16 semanas, condicao nao identificada no G2.

Desenvolvimento e aplicação de um novo índice para avaliação do pré-natal

OBJECTIVE To develop and apply a new instrument to evaluate prenatal care based on the guidelines of the Brazilian Humanization Program for Prenatal Care and Birth, including quantitative and qualitative elements distributed according to the evaluation triad of structure, process, and outcomes. METHODS An analytic, descriptive, quantitative cross-sectional study was carried out with 238 women receiving care in 44 primary care services in the city of João Pessoa, Northeast Brazil, between November 2010 and December 2011. Physicians and nurses involved in prenatal care were also interviewed. The instrument developed by the investigators contains 23 questions relating to structure, process and outcomes of pre-natal care. Based on the information collected, pre-natal care was classified according to an IPR/Pre-Natal index (Índice IPR/Pré-Natal, where I stands for infrastructure, P for work process and R for results). A value of 1 is attributed to each question if it complies with the criteria established for quality, or 2 if it does not comply. The percent of adequate answers in relation to the 23 total questions is used to classify prenatal care as: upper adequate (100% adequate answers); adequate (>75%); intermediate (51 to 74%); and inadequate (<50%). The classification categories for the Pre-Natal/IPR index were compared to those of the Kessner and Adequacy of Prenatal Care Utilization (APNCU) indices. RESULTS Questions relating to the work process contributed significantly to the classification of prenatal care as intermediate according to the IPR/Pre-Natal. IPR/Pre-Natal classification categories were consistent to detect prematurity, insufficient weight at birth and absence of exclusive breastfeeding. CONCLUSIONS The IPR/Pre-Natal index effectively incorporated quantitative and qualitative elements for the assessment of pre-natal care.

Perfil dietético, estado nutricional e prevalência de obesidade centralizada em praticantes de futebol recreativo

The aim of the study was to evaluate the diet profile, nutritional status and centralized obesity (CO) prevalence in recreative soccer practitioners. Methods: Sample: 40 male individuals (38.6 ± 7.4 years). To evaluate the habitual consumption (HC) it was used a quantitative of meal frequency. The nutritional status was evaluated by the Body Mass Index (BMI). The CO was defined as waist circumference (WCIRC) above 102 cm. Results: There was a predominance of “B” social class individuals (80.0%), white ones (67.5%), married (62.5%) and public workers (52.5%). The average showed: body mass of 77.2 ± 11.8 kg, as high as 1.71 ± 0.1 m, BMI 26.4 ± 3.1 kg/m2 and WCIRC 92.3 ± 8.8 cm, HC 2623.2 ± 438.5 kcal and the nutrients proportions was 48.2 ± 5.7% carbohydrates, 17.6 ± 2.4% proteins, 34.9 ± 4.2% total fat, 568.2 ± 112.7 mg cholesterol and 20.2 ± 6.1 g diet fibers. In relation to nutritional status, 35.0% are eutrophic, 52.5% present overweight and 12.5% present obesity. In relation to the obesity pattern, 12.5% present centralized fat. Among the correlations it was observed a strong association between WCIRC x IMC (r = 0.91) and WCIRC x body mass (r = 0,88). Conclusion: The soccer practitioners must be orientated over the nutritional adequation importance to life quality and sports practice, fact that is related to nutrients proportions that showed carbohydrates uptake reduction and high cholesterol and proteins uptake. The nutritional status showed values prevalence of overweight and obesity. The OC showed evident, that is dangerous because of the association of this obesity pattern with various chronic diseases that aren’t transmissible.

Insegurança alimentar relacionada à área de residência em município do Semiárido brasileiro

O objetivo desta pesquisa foi investigar a situacao de inseguranca alimentar (IA) em relacao a area de residencia de criancas menores de cinco anos de idade em municipio do Semiarido brasileiro. O delineamento foi transversal de base populacional. Foram analisados dados demograficos e situacao de IA a partir da Escala Brasileira de Inseguranca Alimentar (EBIA), envolvendo sorteio aleatorio de criancas que compareceram a Campanha Nacional de Vacinacao, realizada em 2010. Foi realizada associacao entre a area de residencia e a situacao de IA da crianca por meio de teste do χ2, calculo da odds ratio (OR) e respectivo intervalo de confianca de 95% (IC95%), fixando como valor de significância estatistica p<0,05. O estudo envolveu uma casuistica de 370 criancas. Foi verificado que residir na area rural aumentava duas vezes a chance de IA (OR=2,2; IC95% 1,32-3,65). Contudo, quando investigados os casos de maior gravidade de IA, as familias da area rural apresentaram os menores percentuais de IA grave (4,3%) em comparacao a urbana (7,9%), com p=0,002. Assim, supoe-se que as familias da area rural encontram formas de apoio social para as consequencias mais graves de IA, recorrendo a recursos que sao improvaveis no meio urbano, como a agricultura de subsistencia e o auxilio solidario.

Prevalence of risk factors of non-transmissible chronic diseases: the impact of 16 weeks of soccer training at nutritional status and physical aptitude indexes in society soccer practitioners

The study objective is to identify the prevalence of risk factors (RF) to non-transmissible chronic diseases (NTCD) in society soccer practitioners and the impact of 16 weeks of soccer training in the nutritional status (NS) and the physical ability index. Methods: Sample: 45 individuals (38.6 ± 7.4 years), divided in two groups: experimental (G1 = 22) and control (G2 = 23). The G1 was submitted to a training program of three sessions by week in alternated days with 90 minutes (min) duration. The G2 participated once a week, in soccer game, with 90 min duration. The research variables contemplated RF for NTCD, anthropometric indicators, biochemical analysis and physical ability index. Data analysis counted on descriptive and inferential statistics by SPSS 13.0. Results: The major risk factors prevalence’s pointed to: the overweight (65.0%), cancer family history (57.5%) and cardiac disease (55.0%) and hypertriglyceridemia (32.5%). The G1 presented body mass (p = 0.007), waist circumference (p = 0.010), body mass index (p = 0.007) and fat percentage (p = 0.004), reduction, fact no observed in G2. In both of the groups, total cholesterol analysis, triglycerides and fasting glucose, didn’t demonstrative significant reduction during the observation period (p > 0.05). G1 got better indexes of maximum oxygen consumption (p = 0.011), muscular resistance (p = 0.000) and flexibility (p = 0.000), what did not happen in G2. Conclusion: The soccer players presented high prevalence of RF to NTCD. In general terms, G1 got satisfactory changes in NS and physical ability index during 16 weeks period, conditions that weren’t identified in G2.O objetivo do estudo foi identificar a prevalencia de fatores de risco (FR) para doencas cronicas nao-transmissiveis (DCNT) em praticantes de futebol society e o impacto de 16 semanas de treinamento futebolistico em indices do estado nutricional e da aptidao fisica. METODOS: Amostra: 45 individuos (38,6 ± 7,4 anos), divididos em dois grupos: Experimental (G1 = 22) e Controle (G2 = 23). O G1 submeteu-se a um programa de treinamento de tres sessoes semanais em dias alternados com duracao de 90 minutos (min). O G2 participou, uma vez por semana, de jogo de futebol, com duracao de 90 min. As variaveis de investigacao contemplaram FR para DCNT, indicadores antropometricos, analises bioquimicas e da aptidao fisica. A analise dos dados contou com estatistica descritiva e inferencial mediante o SPSS 13.0. RESULTADOS: As maiores prevalencias de FR apontaram para o sobrepeso (65,0%), historia familiar de câncer (57,5%) e cardiopatias (55,0%) e hipertrigliceridemia (32,5%). O G1 apresentou diminuicao na massa corporal (p = 0,007), circunferencia abdominal (p = 0,010), indice de massa corporea (p = 0,007) e percentual de gordura (p = 0,004), fato nao observado no G2. Em ambos os grupos, as analises do colesterol total, triglicerideos e glicose em jejum, nao mostraram diminuicao significativa durante o periodo investigado (p > 0,05). O G1 obteve melhores indices de consumo maximo de oxigenio (p = 0,011), resistencia muscular (p = 0,000) e flexibilidade (p = 0,000), o que nao ocorreu no G2. CONCLUSAO: Os futebolistas apresentaram alta prevalencia de FR para DCNT. Em termos gerais, o G1 obteve mudancas satisfatorias no estado nutricional e na aptidao fisica durante o periodo de 16 semanas, condicao nao identificada no G2.

Influence of the C677T Polymorphism of the MTHFR Gene on Oxidative Stress in Women With Overweight or Obesity: Response to a Dietary Folate Intervention

ABSTRACT The C677T polymorphism of the methylenetetrahydrofolate reductase gene (MTHFR) is related to folate metabolism and can alter the levels of biochemical markers. Objective: Investigate the influence of the MTHFR C677T polymorphism on the effects of a dietary folate intervention on oxidative stress in women with overweight or obesity. Methods: Forty-eight adult women with overweight or obesity were subjected to a 24-hour dietary recall, anthropometric measurements, biochemical analysis, and genotyping of the MTHFR C677T polymorphism. They were allocated by convenience sampling to 2 groups, which received 300 g of folate-rich vegetables containing 191 µg/d (Group 1) (n = 24) or 95 µg/d (Group 2) (n = 24) of folate for 8 weeks. Results: The dietary intervention increased the serum folic acid levels in the 2 analyzed groups. The intervention with 191 µg/d of folate led to relevant results in terms of homocysteine levels (p = 0.0005) and total antioxidant capacity (p = 0.0261); the effect was larger among carriers of the TT genotype. Conclusions: The study demonstrated the beneficial effect of folate intake in terms of a TAC elevation for the CC and TT genotypes of the MTHFR C677T polymorphism, an increase in folic acid levels for all genotypes, and a reduction in the Hcy levels for the TT genotype in response to an intervention consisting of an intake of 191 µg/d of folate supplied by vegetables.

AVALIAÇÃO NA PRÁXIS DA SAÚDE: HISTÓRICO, ENFOQUES TEÓRICOS E FORTALECIMENTO DA INSTITUCIONALIZAÇÃO

Objectives: This paper aims to broaden the knowledge of managers, researchers, and health professionals about the topic: “Health Care Evaluation”, so as to institutionalize this evaluation, in order to strengthen its inclusion as a routine practice of health services, programs, and policies. Material and methods: This is a theoretical review of scientific papers, journals and books related to the topic, by means of a meta-analysis through a search on the Scielo and Bireme databases, from the sources Medline and Lilacs. Results and conclusion: The various authors specialized in the topic are unanimous in highlighting the importance of the Evaluation as an intrinsic activity of any health practices. Although in recent years there have been several government initiatives for the construction and strengthening of an evaluation policy — specifically in the primary care — it has not yet become part of the institutional culture, appearing in a poorly systematic and systematized manner and not always contributing to the decision making process, requiring, thus, technical and political investments by the sectoral public administration. Descriptors: Health Care Evaluation; Institutionalization; Health Services.

COMPARAÇÃO ENTRE O CONTEÚDO DE NUTRIENTES NOS RÓTULOS DE ALIMENTOS ENRIQUECIDOS COM ÁCIDO FÓLICO E FERRO COM O ENCONTRADO NA TACO E NO SOFTWARE DIETWIN

Objetivo: Comparar os valores de nutrientes encontrados nos rotulos de alimentos enriquecidos com acido folico e ferro comercializados em Joao Pessoa com os valores recomendados pela RDC n. 344 da ANVISA de 2002, e com os encontrados na Tabela Brasileira de Composicao de Alimentos e no software Dietwin. Material e Metodos: A amostra foi composta pelo levantamento de dados sobre a composicao de acido folico e ferro em 833 alimentos, contendo farinha de milho e farinha de trigo nos dois supermercados que comercializam produtos em nivel nacional, localizados no municipio de Joao Pessoa onde foram realizas 14 visitas. Todas as analises estatisticas foram realizadas com o auxilio do software Core R Development Team, para verificar as associacoes, utilizou-se o Teste Qui-quadrado com a concentracao dos nutrientes, originados das tres fontes de dados. Resultados: Dos 833 alimentos analisados, 111(13%) apresentavam valores nos rotulos, 535(64%) tinha a informacao de enriquecimento nos ingredientes e 187(23%) nao apresentavam informacao de enriquecimento nos ingredientes. Ao comparar-se os valores de acido folico e ferro, constatou-se que os valores descritos nos rotulos quanto ao acido folico eram semelhantes aos valores encontrados no software Dietwin, e com relacao ao ferro, os valores encontrados nos rotulos eram superiores aos encontrados no software Dietwin como tambem em relacao a Tabela Brasileira de Composicao dos Alimentos. Conclusao: No presente estudo observou-se que a fortificacao com acido folico foi ligeiramente superior ao recomendado com um aumento medio de 10,7%, ja a fortificacao com ferro supria uma quantidade duas vezes maior, em media, que a obrigatoria em 26% dos rotulos analisados, com base na legislacao vigente. DESCRITORES Seguranca Alimentar. Alimentos Enriquecidos. Acido Folico. Ferro.

Impacto de estratégias educacionais no pré-natal de baixo risco: revisão sistemática de ensaios clínicos randomizados

This study aimed to analyze the impact of educational strategies developed in low-risk prenatal care on obstetric outcomes from a systematic literature review. This review consulted databases PubMed, Medline, SciELO and Lilacs, analyzing randomized clinical trials with the following birth outcomes: birth weight, prematurity and breastfeeding, using the following combination of keywords: pre-natal, antenatal visits, education, health education, pregnancy outcomes, birth weight, prematurity, breastfeeding and randomized clinical trial. Nine studies were included following quality evaluation. Actions prove to be more effective when extended to the postpartum period. Most of them occurred during home visits and had a positive impact on breastfeeding and birth weight. The establishment of groups of pregnant women contributed to lower prevalence of prematurity. Breastfeeding was found to be the outcome most sensitive to educational strategies. Educational practices during the prenatal period contributed to favorable obstetric outcomes as they minimized pregnant women concerns and anxiety during the pregnancy process, preparing them for childbirth and postpartum, and should be incorporated into health services’ work process.