Comunicación en el consultorio de medicina familiar: trabajo multicéntrico, cualitativo cuantitativo, en los meses de abril a julio de 2014, en Buenos Aires, Rosario y Tucumán / Communication in Family Medicine practice: multicenter research trial, qualitative and quantitative, from April to June 2014. in the City of Buenos Aires, Rosario and Tucumán

Introducción: la comunicación es trascendental para la vida en sociedad. El éxito de cualquier entrevista clínica depende de la calidad de la comunicación entre el médico y el paciente. Distintos factores pueden interferir en esta, como el ambiente, el tiempo y las interrupciones. Objetivo: Evaluar el grado de comprensión del mensaje transmitido por el médico hacia el paciente. Material y método: Trabajo multicéntrico, cualitativo cuantitativo. Componente cuantitativo: descriptivo de corte transversal de abril a julio de 2014. Se incluyeron 1200 adultos de ambos sexos, que asistieron a los Ce.M.A.P y 40 médicos de familia. Componente cualitativo: Muestreo no probabilístico, intencional, hasta saturación de datos. Triangulación y convergencia de datos. Resultados y discusión: Respecto al componente cuantitativo, se encontró que nuestras hipótesis acerca de la falta de comprensión del mensaje (indicaciones y problema de salud) no pudieron comprobarse. Ya que las indicaciones realizadas por el médico tuvieron una adecuación total del 60% y comprendieron el problema de salud un 77% de los pacientes entrevistados. Para el componente cualitativo luego del análisis temático se obtuvieron barreras (tiempo, paciente polidemandante, ideas previas, omisión de indicaciones no farmacológicas) y facilitadores (conocimiento previo del problema de salud, longitudinalidad, paciente acompañado) para la comprensión del mensaje. Conclusiones: Los pacientes entienden el mensaje de sus médicos de familia, ya que contamos con herramientas concretas como la escucha empática, el proceso clínico centrado en la persona y la longitudinalidad en la atención (AU)

Introduction: communication is important for life in a society. Success in any clinical interview depends on the quality of patient-doctor communication. Different factors may interfere, like the environment, time and interruptions. Objective: Asses the level of understanding of the message given to the patient by the doctor. Material and method: Multicenter research trial, qualitative and quantitative. Quantitative component: cross sectional descriptive from April to June 2014. 1200 adults of both sexes who assisted to the primary health care center: "Ce.M.A.P." in the City of Buenos Aires, Rosario and Tucumán and 40 family practitioners. Qualitative component: nonprobability, intentional sampling upon data saturation. Data triangulation and convergence. Results and discussion: as regards the quantitative component, we found out that our hypothesis in relation to the lack of understanding in the message (indications and health problem) could not be proven. Since 60% of the practitioner's indications were followed and 77% of the interviewed patients understood the health problem. Considering the qualitative component after the thematic analysis, barriers (time, highly demanding patient, previous knowledge, omission of non-pharmacological indications) and facilitators were obtained (previous knowledge of health problem, longitudinality, accompanied patient) to understand the message. Conclusion: patients understand their family practitioner's message since we have specific tools like empathic listening, patient centered healthcare and longitudinality in attention (AU)

Preferencias alimentarias durante el recreo escolar: Niños de primaria de 9 a 10 años / Food preferences during lunch break: Elementary school children from 9 to 10 years

Resumen La alimentación de los niños durante el horario escolar es fundamental, por lo que a fin de adecuar la oferta alimentaria, es indispensable conocer cuáles son las preferencias alimentarias del alumnado. Así, el propósito de este estudio fue identificar los motivos de las preferencias y el consumo de alimentos durante el recreo escolar. Participaron 38 niños de 9-10 años de edad (55% niñas y 45% niños), alumnos de una escuela primaria pública de tiempo completo. Este estudio etnográfico comprendió el registro de alimentos consumidos y preferidos habitualmente, así como las narrativas de los niños, a través de observación dirigida, entrevistas no estructuradas y elaboración de dibujos. Se encontró que las preferencias alimentarias de los niños están estrechamente vinculadas al contexto familiar y los sentimientos ligados a éste. No obstante, en dichas preferencias influyen también la educación alimentaria recibida (escolar y extra-escolar), así como la disponibilidad-restricción de alimentos dentro de la escuela. En conclusión, aunque las y los niños podían no consumir en el recreo escolar su alimento favorito, adaptaban sus preferencias en función de los alimentos disponibles en la escuela, de modo que la selección variaba en función de la percepción y ponderación de las propiedades organolépticas del alimento (e.g., sabor, consistencia, temperatura).

Abstract Feeding children during school hours is essential, so to adapt the food supply, it is necessary to know what students' food preferences are. Thus, the purpose of this study was to identify the reasons for preferences and food consumption during school breaks. Thirty-eight children with an age range of 9 to 10 years (55% girls and 45% boys), from a full-time public primary school participated. This ethnographic study comprised the recording of commonly consumed and preferred foods, as well as children's narratives, through directed observation, unstructured interviews and drawings. It was found that children's food preferences are closely linked to the family context and the feelings linked to them. However, these preferences also influence the food education received (school and extra-school), as well as the availability-restriction of food within the school. In conclusion, although children could not consume their favorite food at school, they adapted their preferences according to the foods available at school, so the selection varied based on the perception and weighting of the organoleptic properties of the food (e.g., taste, consistency, temperature).

Avaliação nutricional dos profissionais do serviço de nutrição e dietética de um hospital terciário de Porto Alegre / Nutritional evaluation of employees on a nutritional and dietary service of a tertiary hospital in Porto Alegre

Este estudo objetivou identificar o perfil antropométrico e bioquímico e analisar a evolução do ganho de peso dos profissionais do Serviço de Nutrição e Dietética (SND) do Hospital de Clínicas de Porto Alegre (HCPA). Estudo de caráter longitudinal retrospectivo, com 190 funcionários. Aplicou-se questionário estruturado e foram realizadas análises bioquímicas e avaliação antropométrica. Observou-se excesso de peso em 60,8% dos funcionários. O ganho de peso encontrou-se associado ao tempo de serviço, turno de trabalho e prática de atividade física. O estudo demonstrou que 1 ano a mais de trabalho esteve associado ao ganho de peso médio de 500 g, o turno de trabalho com ganho de peso médio de 4 kg e a prática de atividade física com perda de peso médio de 3,3 kg. A associação entre ganho de peso, tempo e turno de trabalho em colaboradores de serviços de nutrição remete à necessidade de criação de programas de educação nutricional que promovam hábitos alimentares saudáveis.

This study aimed to identify anthropometric and biochemical status and to analyze the weight gain of collaborators of nutrition and dietetics services of Hospital de Clínicas de Porto Alegre (HCPA). This was a retrospective longitudinal study enrolled 190 employees. Nutritional assessment and clinical analysis was measurement. A structured questionnaire was applied all employees. The prevalence of excess weight was 60.8%. Weight gain was significantly associated to length of service, working shift and physical activity. The study showed that an additional year of work was associated with weight gain around 500 g, the shift in average gain of 4 kg and physical activity with average weight loss of 3.3 kg. The association between weight gain, working time and working shift in employees refers to the need to create nutrition intervention program aiming to promote healthy eating habits.

Comportamento alimentar e imagem corporal entre estudantes de nutrição de uma universidade pública de Porto Alegre - RS / Eating behavior and body image among nutrition students from a public university of Porto Alegre, RS, Brazil

Introdução: Transtornos alimentares (TAs) são mais prevalentes em grupos específicos da população. Nutricionistas vem sendo identificados como grupo vulnerável a esses distúrbios. Objetivo: Avaliar prevalências de comportamentos alimentares inadequados (CAI) e níveis de insatisfação com imagem corporal (IIC) entre alunos de Nutrição da Universidade Federal do Rio Grande do Sul. Métodos: Foram convidados todos os alunos matriculados no curso. Utilizaram-se questionários auto-aplicáveis validados para avaliação de CAI (EAT-26) e IIC Body Shape Questionnaire (BSQ). O índice de massa corporal foi calculado a partir das medidas de peso e estatura. Calculadas médias, desvios-padrão e freqüências absolutas e relativas. Associações analisadas pelo teste do qui-quadrado, ao nível de P<0,05, utilizando-se do programa SPSS 13.0. Resultados: Foram estudados 104 alunos, com média etária de 22±4,5 anos e 96,2% do sexo feminino. As prevalências de CAI e de IIC foram de, respectivamente, 11,8% e 13,5%. Observada associação entre CAI e ICC nesta população (X2=22,85; P=0,000). Discussão: As prevalências de CAI e de IIC encontraram-se abaixo do esperado, sugerindo menor prevalência de comportamento característico de TA, comparadas a estudantes de Nutrição de outras Universidades. Entretanto, 92,8% das estudantes com IIC eram eutróficas, corroborando com a literatura: a insatisfação surge com a crença de “estar obeso”, apesar da eutrofia. Conclusão: Na população estudada há preocupação com o corpo, demonstrando a influência da pressão sociocultural nesse grupo, o que é preocupante, pois são futuros nutricionistas que influenciarão na construção de um ideal de corpo de seus pacientes reforçando ou não padrões de beleza impostos pela nossa sociedade.

Introduction: Eating disorders (EDs) are more prevalent in specific population groups. Nutritionists have been identified as a group vulnerable to these disorders. Aim: To assess the prevalence of inadequate eating behaviors (IEBs) and the levels of dissatisfaction with body image (DBI) among students of Nutrition from the Universidade Federal do Rio Grande do Sul. Methods: All students enrolled in the Nutrition major were invited to participate. Validated self-administered questionnaires were used to assess IEBs (Eating Attitude Test - EAT-26) and DBI (Body Shape Questionnaire - BSQ). Body mass index was calculated using height and weight data. We calculated means, standard deviations, and absolute and relative frequencies. The associations were analyzed by means of the chi-square test at a significance level of P<0.05 using the software SPSS 13.0. Results: One hundred and four students were investigated. Their mean age was 22±4.5 years and 96.2% of them were female. Prevalence rates of IEBs and DBI were, respectively, 11.8% and 13.5%. We found an association between IEBs and DBI in this population (X2=22.85; P=0.000). Discussion: The prevalence rates of IEBs and DBI were found to be lower than expected, suggesting a lower prevalence of the typical behavior of EDs compared with students of Nutrition from other universities. However, we found that 92.8% of the students showing DBI had normal weight, what corroborates with the literature: dissatisfaction is associated with the belief that “one is fat”, although their weight is normal. Conclusion: Our population sample is concerned with body shape, evidencing that there social and cultural influence on this group. This finding is a reason for concern because this is a group of future nutrition professionals who might influence their patients with regard to their perceptions of the ideal body, reinforcing or not the beauty standards imposed by our society.

Revisión de la efectividad de los ingredientes de productos alternativos para la pérdida de peso / A systematic review of the effectiveness of alternative weight-loss products' ingredients

Objetivo La alta demanda para el tratamiento de la obesidad y la poca efectividad de las terapias convencionales favorecen el consumo de productos alternativos. Evaluar ensayos clínicos aleatorios sobre la pérdida de peso con los ingredientes de los productos alternativos de mayor consumo en México. Metodología Se realizó una encuesta para valorar la prevalencia de consumo de productos alternativos para la pérdida de peso en Ensenada, Baja California. Se investigaron los productos más vendidos y se obtuvieron los componentes activos. Se revisaron ensayos clínicos aleatorios registrados en Pubmed para los componentes activos mas utilizados. Se incluyeron y analizaron aquéllos que evaluaran cambios en el peso. Resultados Treinta y seis porciento de los encuestados han utilizado algún método alternativo para la pérdida de peso (83 por ciento mujeres). Los productos más referidos fueron licuados, tés, pastillas y linaza. Se encontraron 16 ensayos clínicos aleatorios de cuatro ingredientes: Garcinia Cambodia, té verde, L-carnitina y linaza. Solamente dos estudios demostraron una pérdida de peso significativa (2 5 por ciento) entre el grupo control y el experimental. En los estudios de L-Carnitina y linaza no se encontró una diferencia significativa. Conclusión Se concluye que no hay evidencias suficientes y de calidad que justifiquen la utilización de los productos alternativos para la pérdida de peso.

Objective The high demand for obesity treatment and conventional therapies' lack of effectiveness increases the use of alternative products. This study was aimed at assessing evidence from randomised clinical trials regarding the effectiveness of alternative weight-loss products' ingredients. Methods A survey was conducted in Ensenada, Baja California, to assess the frequency of consuming alternative products used for weight reduction. The ingredients in the products most in demand were included in this review. The Pubmed database was searched for all randomised clinical trial papers including these ingredients and assessing weight loss. Results Thirty-six percent of the subjects questioned had used alternative methods for weight-loss, 83 percent of them being women. The most frequently used products were shakes, tea, pills and flaxseed/linseed. Sixteen randomised clinical trials using four ingredients were used: Garcinia cambogia, green tea, L-carnitina and flaxseed. Only two studies (green tea and Garcinia cambogia) showed significant weight-loss (25 percent) amongst control and experimental groups. There was no significant difference between the groups in the studies regarding L-carnitina and flaxseed. Conclusions There is a lack of evidence regarding quality studies justifying the use of alternative products for weight loss.

Diagnóstico de granulomatosis de Wegener en pacientes con enfermedades oculares inflamatorias / Diagnosis of Wegener's granulomatosis in patients with ocular inflamatory disease

Objetivo. Informar las manifestaciones oftalmológicas en pacientes con granulomatosis de Wegener (GW). Método. Se revisó la base de datos del Instituto de Oftalmología Conde de Valenciana. Se recolectó la exploración oftalmológica completa, los exámenes de laboratorio y de gabinete, el tratamiento y la evolución. Resultados. Se incluyeron 11 pacientes con GW (18 ojos). Siete pacientes masculinos y 4 femeninos con edad promedio de 43.7 años (28-55). Tres habían tenido diagnóstico previo de GW y los 8 restantes se diagnosticaron en nuestro departamento. Siete presentaron cuadros bilaterales y 4 unilaterales. Las formas de presentación clínica fueron escleritis necrosante con queratitis ulcerativa periférica (QUP) (7/18), escleritis difusa (3/18), escleritis nodular (1/18), uveítis anterior no granulomatosa (1/18), neuropatía óptica isquémica (1/18), neuropatía óptica retrobulbar (1/18), desprendimiento de retina seroso (2/18) y dacriocistitis (2/18). De los 18 ojos, la capacidad visual final fue mejor o igual a 20/40 en 13, 20/400 en 3, cuenta dedos a 30cm o no-percepción de luz en 1. Actualmente 7 pacientes se encuentran en fase inactiva. Conclusiones. Las manifestaciones oftalmológicas más frecuentes en pacientes con GW fueron: escleritis necrosante y QUP. En la mayoría, la GW se diagnosticó después de las manifestaciones oftalmológicas, sin embargo, todos presentaron síntomas sistémicos u oftalmológicos previos.

OBJECTIVE: Report the ophthalmologic manifestations among patients with Wegener 's Granulomatosis (WG). METHOD: We reviewed the database of the Instituto de Oftalmologia Fundación Conde de Valenciana in order to collect information regarding complete ophthalmic examination, laboratory and cabinet tests, treatment, and disease progression. RESULTS: We included 11 patients with WG (18 eyes). Seven men and four women, mean age 43.7 years (range = 28-55). Three patients had a prior diagnosis of WG and the remaining eight patients were diagnosed by our study team. Seven subjects developed a bilateral affection and four had unilateral involvement. The clinical presentation was necrotizing scleritis with peripheral ulcerative keratitis (PUK) (7/18), diffuse scleritis (3/18), nodular scleritis (1/18), non-granulomatous uveitis (1/18), optic ischemic neuropathy (1/18), retrobulbar neuritis (1/18), serous retinal detachment (2/18), and dacryocystitis (2/18). Final visual acuity was better or equal to 20/40 (13/18), 20/400 (3/18), finger-counting or no-perception of light in 1/18. Currently, seven patients are symptom free. CONCLUSIONS: The most frequent ophthalmic manifestations among our patients with WG were: necrotizing scleritis and PUK. In most cases, WG was diagnosed after ophthalmic manifestations; however, all patients displayed prior systemic or ocular symptoms.