Prácticas de alimentación complementaria, características sociodemográficas y su asociación con anemia en niños peruanos de 6-12 meses / Complementary feeding practices, sociodemographic characteristics and their association with anemia in Peruvian children aged 6-12 months

RESUMEN Introducción: Existen escasos estudios que asocien la anemia con las prácticas de alimentación complementaria en ciudades de provincias de Perú. Objetivo: Determinar las prácticas de alimentación complementaria, las características sociodemográficas y su asociación con la anemia en niños entre 6 a 12 meses de edad de Cusco-Perú entre agosto y diciembre del 2017. Material y Métodos: Es un estudio transversal y analítico con datos de 360 madres y niños. Se evaluaron las prácticas de alimentación complementaria mediante un cuestionario semi-estructurado y se calculó su asociación con la variable de interés "anemia". Se estimaron las razones de prevalencias crudas y ajustadas mediante modelos lineales generalizados con familia Poisson y función de enlace log, con intervalos de confianza a 95%, y se consideraron significativos los valores p<0,05. Resultados: La prevalencia de anemia fue 68,3%. Los factores asociados fueron: vivir en condición de pobreza (RPa 1,27; p=0,002), recibir una inadecuada diversidad diaria de alimentos (RPa 1,13; p=0,038); recibir una inadecuada cantidad diaria de alimentos (RPa 1,15; p=0,036) y la suplementación con papilla (RPa 1,51; p=0,002). La suplementación con hierro (RPa 0,37; p<0,001) fue factor protector. Conclusiones: Vivir en pobreza se asoció con padecer anemia; así como algunas prácticas de alimentación complementaria. Estas últimas pueden ser modificables mediante un correcto seguimiento en las visitas domiciliarias y la adecuada asignación de personal para esta actividad.

ABSTRACT Introduction: There are few studies that associate anemia with complementary feeding practices in cities of the provinces of Peru. Objective: To determine the characteristics of complementary feeding practices, sociodemographic characteristics and their association with anemia in children between 6 and 12 months of age from Cusco-Peru between August - December, 2017. Material and Methods: A cross-sectional and analytical study based on the data from 360 mothers and children was carried out. The complementary feeding practices were evaluated through a semi-structured questionnaire, and their association with the variable of interest "anemia" was calculated. The crude (cPR) and adjusted (aPR) prevalence ratios were estimated using linear and generalized Poisson regression models and log link function, with their respective 95 % confidence intervals (95 % CI). P-values <0.05 were considered significant. Results: The prevalence of anemia was 68,3 %. Associated factors were: living in poverty (aPR 1.27, p= 0.002), receiving an inadequate daily diversity of foods (aPR 1.13, p= 0.038); receiving an inadequate daily amount of food (aPR 1.15, p= 0.036) and supplementation with porridge (aPR 1.51, p= 0.002). Iron supplementation (aPR 0.33, p <0.001) was a protective factor. Conclusions: Living in poverty has been associated with anemia as well as some complementary feeding practices. These findings could be modified through proper follow-up in home visits and appropriate assignment of personnel for this activity.

The Effect of Social Media Health Education on Physical Activity among Saudi Adult Females Attending Ministry of Health Primary Health Care Centers of Jeddah Kingdom of Saudi Arabia, 2018. (Interventional Study)

Background: The relationship between physical activity andbetter quality of life, and association between inactivity andvarious non-communicable diseases are well documented.The objective of present study was to describe pattern ofphysical activity in women attending primary health carecenters in Jeddah, and to evaluate the impact of utilizing socialmedia to encourage Physical Education in inactive women.Materials and Methods: Through a cross section studydesign, 310 attendants of the primary health care centers inJeddah were selected randomly to assess the pattern ofPhysical Education by using Global Physical ActivityQuestionnaire (GPAQ) version 2.0. Out of the detected inactivewomen, 35 were subjected to an intervention using socialmedia to encourage physical activity; the impact of interventionwas done using pre-post analysis.Results: Only 13(10.3%) of the respondents reported that theyexert vigorous activity at work, and a greater percentage167(55.5%) exerting moderate activity. Only one quarter of therespondents 73(24.3%) pointed 8 that they perform vigorousactivity in recreation and leisure time with average METs of(median, IQR: 1440: 960-2640). The overall energyexpenditure of active respondents accounted for and averageMETs of (median, IQR: 2640: 1440-5760). The number ofrespondents who had been categorized as being inactivewas 90 corresponding to 29.9% of the respondents. Afterintervention, 17(48.6%) of the originally inactive womenbecame active with a statistically significant increase inaverage METs which reached up to (median, IQR: 3100: 1380-5300) p< 0.05.Conclusion: The prevalence of inactivity of women isconsiderably high and accord similar studies in other settings,our trial in its current form using social media is effective inencouraging physical activity in physically inactive women.

Registro de la Enfermedad Renal Diabética en la Atención Primaria de Salud. Cuba, 2015 / Registry of Diabetic Kidney Disease in Primary Health Care Centers in Cuba, 2015

Introducción: La base del Sistema Nacional de Salud en Cuba radica en los médicos de la familia que registran, evalúan los riesgos, tratan y dan seguimiento a los pacientes con enfermedades crónicas. La Diabetes Mellitus (DM) es la causa principal de enfermedad renal crónica avanzada (ERC) y estos pacientes también son dispensarizados en el país. Objetivos: Caracterizar a la ERC y la ERC-DM, según su registro en la Atención Primaria de Salud. Material y Métodos: Pacientes registrados con ERC (tasa de filtración glomerular <60 mL/min/1,73 m2) en total y de causa diabética en Cuba en 2015, la prevalencia x 1 000 habitantes, según sexo, edad, provincia y nación. Los datos primarios se obtuvieron de los registros de la Dirección Nacional de Estadísticas. Resultados: La prevalencia nacional con ERC fue 2.16 x 1 000 habitantes (incremento de 17,7 vs 2014) y la prevalencia de ERC-DM fue de 0,48 x 1 000 habitantes (incremento de 25,9 vs 2014). Existió un aumento a mayor edad y alcanzó su valor máximo en el grupo de edades de 60-64 años tanto para la ERC (11,4 x 1 000) y en la ERC-DM (2,92 x 1 000). Del total de pacientes con ERC, los diabéticos representaron en 2014, 12,7 por ciento y en 2015, 13,6 por ciento, con mayor frecuencia en el sexo femenino en ambos años 2014=12,7 por ciento y 2015=14,4 por ciento. La prevalencia de pacientes con ERC y la proporción de pacientes con ERC-DM fue menor que lo reportado por la III Encuesta Nacional de Factores de Riesgo. Conclusiones: La ERCestá sub diagnosticada en el país y la ERC-DM lo es aún en mayor grado. Se requiere la implementación de intervenciones efectivas para el diagnóstico temprano de los pacientes en la Atención Primaria de Salud(AU)

Introduction: The basis of Cuban National Health System lies in the Family Doctors who register, evaluate the risks, treat, and follow-up patients with chronic diseases. Diabetes Mellitus(DM) is the main cause of advanced chronic kidney disease (CKD), and these patients are also identified and treated all over the country. Objectives: To characterize the CKD and the CKD + DM according to their registries in the Primary Health Care Centers. Material and methods: Patients with CKD caused by diabetes (glomerular filtration rate <60 mL/min/1,73 m2) who were registered in Cuba in the year 2015; with reported prevalence per 1 000 inhabitants; and also characterized according to sex, age, province, and nation. The primary data were taken from the Registries of the National Direction of Statistics. Results: The national prevalence of CKD was 2,16 per 1 000 inhabitants (increase of 17,7 vs 2014), and the prevalence of CKD + DM was 0,48 per 1 000 inhabitants (increase of 25,9 vs 2014). There was an increase at older age, and reached a maximum value in the group of ages from 60-64 years, both for the CKD (11,4 x 1 000) and the CKD + DM (2,92 x 1 000). Out of the total of patients with CKD, the diabetic ones represented the 12,7 percent in 2014, and the 13,6% in 2015, with a higher frequency in the female sex in both years (2014=12,7%, and 2015=14,4%). The prevalence in patients with CKD, and the proportion of patients with CKD + DM was lower than the one reported by the Third National Survey on Risk Factors. Conclusions: CKD is underdiagnosed in the country, and the same thing happens with CKD + DM, but even in a higher degree. The implementation of effective actions is required for the early diagnosis of the patients in the Primary Health Care(AU)

Scientific evidence on therapeutic marihuana use in individuals treated in Health Care Services / Evidências científicas sobre o uso terapêutico da maconha para as pessoas que frequentam os serviços de saúde / Evidencias científicas sobre el uso terapéutico de marihuana a personas atendidas en Servicios de Salud

The aim of this integrative review was to "identify, synthesize and evaluate the scientific evidence available on therapeutic marihuana use in those treated in health care services". The articles analyzed were selected from the following databases LILACS, CINAHL and MEDLINE and using tools such as WOS (Web of Science) and SCOPUS. After a broad search in Spanish, Portuguese and English, a total of ninety article were identified. The final selection consisted of six articles, four of which were primary articles and the other two were case studies. The analysis found that there are gaps in the evidence on the therapeutic effects of cannabis. Some positive effects are suggested, potentially useful in some cases, but probable adverse effects were also reported, it being therefore recommended that use of marihuana and marihuana-based products be weighed up depending on the pathologies present in the individual.

Esta revisão integrativa tem como objetivo "identificar, sintetizar e avaliar a evidência científica disponível sobre o uso terapêutico da maconha em pessoas tratadas em diferentes serviços de saúde". Para a seleção dos artigos trabalhou no LILACS, CINAHL, MEDLINE, e outros como WOS (Web of Science) e de dados Scopus; após uma busca em idiomas, espanhol, português e inglês, foram identificadas noventa artigos. A seleção final seis artigos considerados; a análise mostra que existem lacunas na evidência sobre o efeito terapêutico da cannabis. Eles sugerem alguns efeitos positivos; uso dose recomendada de acordo com patologias presentes em pessoas.

La presente revisión integrativa tiene como objetivos "identificar, sintetizar y evaluar las evidencias científicas disponibles sobre el uso terapéutico de marihuana en personas atendidas en diferentes servicios de salud". Para la selección de artículos a analizar se trabajó en las bases de datos LILACS, CINAHL, MEDLINE, y otras herramientas como WOS (Web of Science) y SCOPUS; posterior a una amplia búsqueda en idiomas, español, portugués e inglés, se logró identificar un total de noventa artículos. La selección final consideró seis artículos, cuatro de ellos, artículos primarios y dos estudios de casos; del análisis se observa que hay lagunas de evidencias sobre el efecto terapéutico de la cannabis. Se sugieren algunos efectos positivos, potencialmente útiles en algunos casos, pero también se refieren a los probables efectos adversos, por lo cual recomiendan medir el uso de la marihuana o productos derivados de ella, según patologías presentes en las personas.

Evaluación de calidad de atención en centro de atención primara de salud / Evaluation of care quality in primary health care centers

INTRODUCCIÓN: la calidad de la atención como política sanitaria es considerada una estrategia para el logro de la equidad en salud. OBJETIVOS: Evaluar las características y la calidad de atención de los centros de atención primaria de la salud (CAPS). MÉTODOS: Se realizó un estudio transversal evaluativo, que involucró a 89 CAPS de las provincias de Buenos Aires y Entre Ríos, que se autoevaluaron bajo la supervisión de un equipo docente de la Facultad de Ciencias Médicas de la Universidad Nacional de La Plata. Se evaluaron 200 estándares,agrupados en las siguientes dimensiones: Conducción y gestión (CG), Recursos humanos (RH), Registros e información (RI), Actividades de organización (AO), Normas de atención (N), Actividades del equipo de salud sobre la comunidad (AC), Participación social (PS), ReferenciaContrarreferencia (RF), Planta física (PF), Recursos materiales (RM) e Insumos (I). RESULTADOS: Sólo el 18% de los CAPS cuentan con unequipo de salud básico. El nivel de calidad global fue de 58±14%. Encuanto a las dimensiones, el ranking fue: I 87%, RM 70%, AO 66%, AC63%, PF 61%, CG 55%, RF 55%, N 47%, RH 43%, RI 41%, PS 32%.CONCLUSIONES: Estos resultados permiten establecer un diagnósticode situación en cada CAPS para sustentar planes de mejora específicosy un diagnóstico integral para respaldar la definición de ejes estratégicosen las políticas sanitarias.

INTRODUCTION: the quality of care as health policy is considered a strategy to attain health equity. OBJECTIVES: Toevaluate the characteristics and care quality in primary health care centers (PHCC). METHODS: An evaluative cross-sectional study was conducted. It involved 89 PHCC from the provinces ofBuenos Aires and Entre Ríos. A self-assessment of care quality was performed under supervision of an advisory team from the Faculty of Medical Sciences of the National University of La Plata. Two hundred (200) standards were evaluated according to the following dimensions: Leadership and Management (LM), Human Resources (HR), Records and Information (RI), OrganizationActivities (OA), Norms and Guides (NG), Community Activities (CA), Social Participation (SP), Referral system (RS), Physical plant (PP), Material resources (MR) and Supplies (S). RESULTS: Only 18% of PHCC have a basic health team. The overall qualitylevel was 58±14%. In regard to the dimensions, the ranking was: S 87%, MR 70%, OA 66%, CA 63%, PP 61%, LM 55%, RS 55%, NG 47%, HR 43%, RI 41%, SP 32%. CONCLUSIONS: These results allow to perform a situational diagnosis of each PHCC to support specific improvement plans and a comprehensive diagnosis to define strategic priorities for health policies.

O fisioteraupeta no SUS: contribuição para as políticas públicas de saúde em Belém/PA / The physioterapist in SUS: contribution to public health policies in Belém / PA

INTRODUÇÃO: São abordados os históricos da Saúde Pública e da Fisioterapia, tanto no Brasil como em Belém, as representações sociais da Fisioterapia que lhe dão corpo e formatação e a realidade do fisioterapeuta municipal no SUS. O enfoque é dado ao processo de vivência dos fisioterapeutas no SUS, expondo a realidade da entrada da Fisioterapia nos serviços públicos, a partir da visão do fisioterapeuta municipal, participante do processo de municipalização preconizado pelo SUS. OBJETIVO: Esta dissertação analisa o processo de contribuição da Fisioterapia no SUS, a partir de ações mobilizadoras do fisioterapeuta municipal de Belém. MATERIAL E MÉTODO: O estudo foi realizado entrevistando dezoito fisioterapeutas atuantes no município e em posições legais de liderança, fazendo uso de entrevistas semiestruturadas, objetivando analisar suas opiniões acerca da atual conjuntura em que se encontra a Fisioterapia nas Políticas Públicas de Saúde da região. CONCLUSÃO: Conclui-se que o fisioterapeuta, sofre as mesmas dificuldades que muitos profissionais de saúde do município, devido a completa faltade vontade política dos atuais governantes, que só arrastam os problemas para o imediatismo e emergencialismo tardio. Aliado a este aspecto, sobressai a falta de coligação da classe de fisioterapeutas, que só tende a retardar e enfraquecer as possíveis lutas políticas em beneficio próprio, pois seus interesses ainda perpassam por questões individualizadas e desconectadas da necessidade do sistema de saúde vigente do país. Esses fatores se entrelaçam e dificultam a inserção mais contundente da Fisioterapia dentro das Políticas Públicas de Saúde de Belém.

INTRODUCTION: It presents historical issues of Public Health and Physical Therapy areas in Brazil in general and in the city of Belem; social representation issues of the Physical Therapy profession which characterizes its local cultural manifestation and the way physical therapy services are provided in Belem city, and the present conditions physical therapists who work for the Brazilian universal health care system in city health care centers deal with. Focus is given to experiences lived by physical therapists who work for the universal health care system, presenting the real conditions of the onset of physical therapy services in public centers from the perspective of physical therapists who work in city health care centers who participated in the process of municipalization of physical therapy services present in universal health care system.OBJECTIVE: This dissertation thesis analyzes the process of physical therapists ́ contribution to the Brazilian Universal Health Care system focused on advocacy professional actions performed by physical therapists who work at city health care centers. MATERIAL E MÉTODO: In this study, 18 physical therapists who work in city health care centers and who hold leadership positions at their workplaces were interviewed through semi-structured interviews whose goal was analyzing their opinions on the present conjuncture the physical therapy profession deals with concerning health public policies in the North region of Brazil. CONCLUSION: The study reaches the conclusion that the physical therapist faces the same difficulties many other health professionals who work in city health care centers do because of total lack of political will of present government rulers, and this situation just drags problems into immediacy and late emergency actions. Besides this situation, one may highlight lack of physical therapists professional coalition which retards advocacy for the physical therapy profession. The author states that physical therapists act based on individual interests which do not relate to Brazil ́s health care system needs. All these issues are interconnected and make it difficult for more appropriate implementation of physical therapists ́ intervention in public health policies in the city of Belém.