Entre Silêncios e Formas: Censura e Pós-Censura na Arte Brasileira Contemporânea / Between Silences and Forms: Censorship and Post-Censorship in Contemporary Brazilian Art / Entre los Silencios y Las Formas: Censura y Poscensura en el Arte Brasileño Contemporáneo

O artigo trata da censura na arte brasileira contemporânea que, desde 2016, com o encerramento da exposição Queermuseu, marcou o retorno de um tipo de ato censório (pós-censura) que difere da censura praticada desde a redemocratização. Para tal, apresentamos um retorno até as formas da censura institucionalizada na Ditadura Militar (censura clássica) e sua dissolução na cultura. Com apoio em trechos de algumas entrevistas que realizamos em nosso campo empírico, a articulação teórica é feita entre os campos da estética, da política e da psicanálise, com apoio principal nas teorias de Michel Foucault, Jacques Rancière e Sigmund Freud. Argumentamos que a censura expõe de forma inequívoca o fato de que a criação responde às transformações no campo político que, por sua vez, geram novas formas artísticas. Conclui-se que a prinicipal marca da pós-censura é a imprecisão da figura do censor e que, tanto num como noutro contexto, a censura impede o exercício da função social da arte, questão que deve ser observada na psicanálise para além da subjetividade individual do artista.

The article deals with censorship in contemporary Brazilian art which, since 2016, with the closing of the Queermuseu exhibition, marked the return of a type of censorship act (post-censorship) that differs from the censorship practiced since redemocratization. To this end, we present a return to the forms of institutionalized censorship in the Military Dictatorship (classical censorship) and its dissolution in culture. Supported by excerpts from some interviews that we carried out in our empirical field, the theoretical articulation is made between the fields of aesthetics, politics and psychoanalysis, with main support in the theories of Michel Foucault, Jacques Rancière and Sigmund Freud. We argue that censorship unequivocally exposes the fact that creation responds to transformations in the political field which, in turn, generate new artistic forms. It is concluded that the main mark of post-censorship is the imprecision of the figure of the censor and that, both in one context and in another, censorship prevents the exercise of the social function of art, an issue that must be observed in psychoanalysis beyond individual subjectivity of the artist.

El artículo trata de la censura en el arte brasileño contemporáneo que, desde 2016, con la clausura de la exposición Queermuseu, marcó el retorno de un tipo de acto de censura (poscensura) que difiere de la censura practicada desde la redemocratización. Para ello, presentamos un retorno a las formas de censura institucionalizadas en la Dictadura Militar (censura clásica) y su disolución en la cultura. Apoyada en extractos de algunas entrevistas que realizamos en nuestro campo empírico, se realiza la articulación teórica entre los campos de la estética, la política y el psicoanálisis, con apoyo principal en Michel Foucault, Jacques Rancière y Sigmund Freud. Argumentamos que la censura expone de manera inequívoca que la creación responde a transformaciones en el campo político que, a su vez, generan nuevas formas artísticas. Se concluye que la principal marca de la poscensura es la imprecisión de la figura del censor y que, tanto en un contexto como en otro, la censura impide el ejercicio de la función social del arte, cuestión que debe observarse en el psicoanálisis más allá de la subjetividad individual del artista.

Relação entre iniquidade racial e violência obstétrica no parto / Relation between racial inequality and obstetric violence in childbirth

A iniquidade racial é a desigualdade em oportunidades e condições de vida que acontece em decorrência da etnia de uma pessoa. Indivíduos pretos, pardos e indígenas são modelos de povos que resistem aos desafios subsequentes dos processos históricos de segregação. Objetivo: Verificar a influência dos aspectos raciais na prática de violência obstétrica na atenção ao parto e nascimento. Métodos: Trata-se de um estudo com abordagem quantitativa, de corte transversal, com coleta de dados prospectiva, realizado em uma maternidade pública na cidade de Goiânia, Goiás. Resultados: Pode-se determinar um cuidado menos satisfatórios para as mulheres negras quando comparado com as brancas para a maioria dos indicadores avaliados neste estudo. Mulheres pretas e pardas têm maior chance de sofrerem manobra de Kristeller, amniotomia precoce, privação alimentar no trabalho de parto, clampeamento imediato do cordão umbilical e menor chance de contato pele a pele e de ser ofertado métodos não farmacológicos para o alívio da dor. Conclusão: O fator raça/cor influencia no tratamento em que as mulheres recebem dentro do estabelecimento de saúde.

Racial inequity is inequality in opportunities and living conditions that occurs as a result of a person's ethnicity. Black, brown and indigenous individuals are models of peoples who resist the subsequent challenges of historical processes of segregation. Objective: To verify the influence of racial aspects in the practice of obstetric violence in labor and birth care. Methods: This is a cross-sectional study with a quantitative approach, with prospective data collection, carried out in a public maternity hospital in the city of Goiânia, Goiás. Results: Less satisfactory care can be determined for black women when compared to white women for most of the indicators evaluated in this study. Black and brown women are more likely to undergo the Kristeller maneuver, early amniotomy, food deprivation during labor, immediate clamping of the umbilical cord and less chance of skin-to-skin contact and being offered non-pharmacological methods for pain relief. Conclusion: The race/color factor alone influences the treatment that women receive within the health establishment.

Solid-state properties of pink clay from Jequitinhonha Valley in Brazil for pre-formulation study

Abstract Clay minerals are still widely used in pharmaceutical products for human health and cosmetic purposes. Pre-formulation studies were conducted to identify solid-state properties of pink clay, a sample from Diamantina, Brazil. Among the solid properties to be analyzed, we have selected type identification, iron phases, crystallinity, powder flow characteristics, thermal behavior, and non-isothermal phase transition kinetics. The pink clay is composed of (1:1) clay type and kaolinite as the main component. The Mössbauer spectrum of pink clay shows Fe3+(α-Fe2O3) Clay minerals are still widely used in pharmaceutical products for human health and cosmetic purposes. Pre-formulation studies were conducted to identify solid-state properties of pink clay, a sample from Diamantina, Brazil. Among the solid properties to be analyzed, we have selected type identification, iron phases, crystallinity, powder flow characteristics, thermal behavior, and non-isothermal phase transition kinetics. The pink clay is composed of (1:1) clay type and kaolinite as the main component. The Mössbauer spectrum of pink clay shows Fe3+(α-Fe2O3) hematite, Fe2+, and Fe3+ with large Δ/2ξq of about 2.80 and 2.69 mm.s-1 respectively, related to iron silicates, most likely pyroxene, and a superparamagnetic Fe3+. Pink clay exhibits poor flow properties. The thermal behavior indicates a phase-transition between 400 - 600 ºC associated with the dehydroxylation of the pink clay system requiring ~300 kJ mol-1, being constant until the process reaches a conversion of ~50% when the energy is enhanced to ~530 kJ mol-1, concluding the whole dehydroxylation process (α=80%). Solid-state properties and characteristics found for the pink clay must be considered for the proper design of formulations. This type of clay shows unique pharmaceutical properties that can be favorably exploited by the cosmetic industry

Overweight in Sateré-Mawé indigenous residents of an urban area in Parintins, Amazonas / Sobrepeso em indígenas Sateré-Mawé residentes em área urbana de Parintins, Amazonas

ABSTRACT Objective To verify overweight prevalence in the Sateré-Mawé indigenous population over 18 years of age, residing in the city of Parintins (AM), Brazil, and to assess its associated variables. Methods Household survey performed in the urban area of Parintins in 2017, visiting new households in each interview, completing the census universe. Self-declared Sateré-Mawé, over 18 years of age, residing in the city for a period longer than one year were considered eligible. Overweight was considered for body mass index values ≥ 25 kg/m2 or ≥ 27 kg/m2, for those over 60 years of age. Household information on social assistance, as well as individual information such as speaking the indigenous language, years living in the city and also in the indigenous territory, income, work, schooling, marital status, leisure and transport physical activity level, and time watching television per week were retrieved. The hierarchical logistic model analysis was carried out, calculating the odds ratio and confidence interval (95%). Results A total of 174 subjects participated in the survey, 42% being overweight. Those who spoke the Sateré-Mawé language, number of years living in the city, working outside home and being married had a positive effect on the outcome, but lost significance in the final model. Only transport insufficient physical activity (OR=2.24, 95% CI=1.01-4.98) and being in the age group from 30 to 59 years (OR=8.79, 95% CI=3.41-22.64) maintained statistical significance. Conclusion Efforts to provide visibility to the health situation of urban indigenous populations in Brazil are necessary. Poor transport infrastructure in the city seems to favor transport physical activity levels as a necessity, in addition to age, which is commonly associated with overweight.

RESUMO Objetivo Verificar a prevalência de sobrepeso em indígenas Sateré-Mawé maiores de 18 anos de idade, residentes na cidade de Parintins (AM), Brasil, identificando as variáveis associadas. Métodos Um inquérito domiciliar foi realizado em 2017 na cidade de Parintins e identificou novos domicílios em cada entrevista, alcançando o universo censitário. Foram elegíveis os autodeclarados Sateré-Mawé maiores de 18 anos e residentes há mais de um ano na cidade. O sobrepeso foi considerado para valores de índice de massa corporal ≥25 kg/m2 ou ≥27 kg/m2 para os maiores de 60 anos de idade. Coletou-se informações domiciliares sobre bolsa família, bem como individuais como falar a língua indígena, anos morando na cidade e na terra indígena, renda, trabalho, escolaridade, estado civil, nível de atividade física no lazer e no deslocamento e tempo assistindo televisão na semana. Foi utilizado o modelo logístico hierarquizado, calculando a razão de chances e intervalo de confiança (95%). Resultados Participaram do estudo 174 pessoas no total, sendo que 42% deles estavam com sobrepeso. Falar a língua Sateré-Mawé, a quantidade de anos residindo na cidade, trabalhar fora de casa e ser casado tiveram efeito positivo no desfecho, porém perderam significância no modelo final. Somente atividade física insuficiente no deslocamento (OR=2,24 IC 95%=1,01-4,98) e a faixa etária dos 30 a 59 anos (OR=8,79 IC 95%=3,41-22,64) mantiveram-se significativas. Conclusão Esforços para dar visibilidade à situação de saúde das populações indígenas urbanas no Brasil são necessários. A fraca infraestrutura de transporte na cidade parece favorecer a atividade física no deslocamento como necessidade, além da idade, já comumente associada ao sobrepeso.

Avaliação da presença de ácidos graxos trans e ácidos graxos saturados em bolachas recheadas e bolachas wafers produzidas no Brasil / Evaluation of the presence of trans fatty acids and saturated fatty acids in stuffed cookies and wafers cookies produced in Brazil

Diversas evidências científicas demonstram que o consumo de ácidos graxos trans está associado com mortes por doenças cardiovasculares. A OMS, em 2018, considerando a presença de ácidos graxos trans nos alimentos recomendou a sua total eliminação até o ano de 2023. Sendo assim, no Brasil, em 2019, a RDC 332 aborda que a partir de 01 de janeiro de 2023 estarão proibidas a produção e a importação de ácidos graxos trans em alimentos destinados ao consumo humano. Atualmente, a legislação que está em vigor sobre ácidos graxos trans é a RDC 54, da ANVISA, que estabelece que, somente os alimentos que apresentarem teores de ácidos graxos trans ≤ 0,1 g por porção e somatória de ácidos graxos saturados e ácidos graxos trans até 1,5 g por porção podem alegar zero trans na rotulagem nutricional. As bolachas recheadas e bolachas wafers são importantes representantes de alimentos ultraprocessados, sendo muito consumidas por adultos e principalmente por crianças pelo seu baixo custo e acessibilidade. A partir destas considerações, o objetivo desse estudo foi o de avaliar os teores de ácidos graxos trans e ácidos graxos saturados por cromatografia gasosa em bolachas recheadas e bolachas wafers, comercializadas no Estado de São Paulo, analisando os teores dos ácidos graxos e comparando com a RDC 54. Em 2018 e 2019, foram analisadas 65 bolachas recheadas, e 40 bolachas wafers, as bolachas foram divididas entre as que possuíam ácidos graxos trans nos rótulos, e as que possuíam a ausência dessa gordura. Os teores de ácidos graxos trans encontrados nas bolachas com a presença de ácidos graxos trans na rotulagem, variaram de 0,34 a 5,21 g por 100 g e 0,19 e 8,54 g por 100 g nas bolachas recheadas e nas bolachas wafers, respectivamente. Diante disso, constatou-se que algumas marcas de bolachas recheadas e bolachas wafers apresentaram grandes quantidades de gordura trans em sua composição. Em relação às bolachas recheadas e wafers com a ausência de gordura trans nos rótulos, todas as bolachas estavam em acordo com a legislação vigente em relação aos valores menores ou iguais a 0,1 g de gordura trans por porção, porém, em relação à somatória de ácidos graxos trans e ácidos graxos saturados de até 1,5 g por porção, todas estavam com valores superiores, dessa maneira, os fabricantes dessas bolachas não poderiam alegar zero trans na rotulagem nutricional, e por isto, estavam em desacordo com a legislação vigente. Em 2022, foram reanalisadas seis amostras de bolachas recheadas e quatro amostras de bolachas wafers, que em 2018 apresentaram altos teores de ácidos graxos trans. Também foram analisadas três bolachas wafers que em 2022 ainda apresentavam altos teores de gorduras trans nos rótulos. Os resultados dessas amostras demonstraram que em 2022 ainda há em supermercados brasileiros, bolachas com altos teores de ácidos graxos trans e ácidos graxos saturados em sua composição. Diante disso, ratifica-se a necessidade do cumprimento da legislação vigente e da RDC 332 em 2023 e de fiscalizações mais frequentes pelos órgãos competentes, devido aos malefícios do consumo dos ácidos graxos trans para a saúde da população

There is a lot of scientific evidence showing that consumption of trans fatty acids is associated with deaths from cardiovascular diseases. The WHO in 2018, considering the presence of trans fatty acids in foods, recommended their total elimination by the year 2023. Therefore, in Brazil in 2019, RDC 332 addresses that from January 1, 2023, the production and the importation of trans fatty acids in foods intended for human consumption are prohibited. Currently, the legislation in force on trans fatty acids is ANVISA's RDC 54, this RDC establishes that only foods that have trans fatty acids contents ≤ 0.1 g per serving and the sum of saturated fatty acids and trans fatty acids up to 1.5 g per serving can claim zero trans on nutrition labels. Stuffed cookies and wafer cookies are important representatives of ultra-processed foods, being widely consumed by adults and especially children due to their low cost and accessibility. Based on these considerations, the objective of this study was to evaluate the contents of trans fatty acids and saturated fatty acids by gas chromatography (AOAC method 996.06) in stuffed cookies and wafers cookies, commercialized in the State of São Paulo, analyzing the contents of the fatty acids and comparing with RDC 54. In 2018 and 2019, 65 stuffed cookies and 40 wafers cookies were analyzed, the cookies were divided between those that had trans fatty acids on the labels, and those that had the absence of this fat. The levels of trans fatty acids found in the cookies with the presence of trans fatty acids on the label ranged from 0.34 to 5.21 g per 100 g and 0.19 and 8.54 g per 100 g in the stuffed cookies and wafers cookies, respectively. Therefore, it was found that some brands of stuffed cookies and wafers cookies had large amounts of trans fat in their composition. Regarding the stuffed cookies and wafers cookies with the absence of trans fat on the labels, all cookies were in accordance with current legislation in relation to values less than or equal to 0.1 g of trans fat per serving, but in relation to the sum of acids trans fatty acids and saturated fatty acids up to 1.5 g per serving, all had higher values, thus, the manufacturers of these cookies could not claim zero trans on the nutrition label, and therefore, they were in disagreement with the current legislation. In 2022, six samples of stuffed cookies and four samples of wafers were reanalyzed, which in 2018 had high levels of trans fatty acids. Three wafers were also analyzed, which in 2022 still had high levels of trans fats on the labels. The results of these samples showed that in 2022 there are still cookies in brazilian supermarkets with high levels of trans fatty acids and saturated fatty acids in their composition. In view of this, the need to comply with current legislation and RDC 332 in 2023 and more frequent inspections by competent institutions are ratified, due to the harmful effects of the consumption of trans fatty acids on the health of the population

Challenges for building healthy food environment in an agricultural municipality in southern Brazil / Os desafios para a construção de ambientes alimentares saudáveis em um município agrícola no Sul do Brasil

ABSTRACT Objective The aim of this paper is to review the challenges for the development of healthier food environments in Palmeira da Missões, in Rio Grande do Sul, Brazil. Methods A qualitative approach was carried out with 29 participants. Data were produced through semi-structured interviews and the content was assessed by thematic categories. Results Three main difficulties were identified for the fostering of healthier food environments in the municipality: the disconnection between consumption and food production; the fragility in the food safety regulations and finally, the disconnection between public policies and local actions for food production. Conclusion The results allow to conclude that there are weaknesses concerning the food environments in Palmeira das Missões, which imply challenges for the fostering of healthy eating and, at the same time, a need for more effective articulation and local action.

RESUMO Objetivo Este trabalho analisou os desafios para a construção de ambientes alimentares mais saudáveis em Palmeira da Missões, no Rio Grande do Sul. Métodos Foi realizada uma pesquisa de abordagem qualitativa, que contou com a participação de 29 interlocutores. Os dados foram produzidos por meio de entrevistas semiestruturadas as quais foram analisadas através da avaliação análise de conteúdo por categorias temáticas. Resultados Foram identificadas três principais dificuldades para a promoção de ambientes alimentares mais saudáveis no município: a desconexão entre consumo e produção de alimentos; a fragilidade na legislação higiênico-sanitária dos alimentos; e por último, a desarticulação entre políticas públicas e ações locais para a produção de alimentos. Conclusão Os resultados permitem concluir que há fragilidades em relação aos ambientes alimentares em Palmeira das Missões, os quais implicam desafios para a promoção da alimentação saudável e, ao mesmo tempo, necessidade de articulação e atuação local mais efetiva.

Ischemic Heart Disease in German Immigrants and Their Descendants in a Region of Southern Brazil: A Comparison of Initial Symptoms Reported between two Generations

Abstract Background Nothing is known about ischemic heart disease (IHD) in the Germans who emigrated to Brazil during the last century. Objective We sought to compare age at diagnosis and IHD manifestations between German immigrants and their first-generation descendants in the region of Blumenau, Brazil. Methods We reviewed medical records of hospitals in Blumenau. Comparison of the groups in the evaluation times was made by analysis of variance (ANOVA) with repeated measures, and comparison of two factors was made by two-way ANOVA. The level of significance was set at p <0.05. Results Study population comprised 68 patients who were born in Germany (group G) and 99 descendants (group D). Twenty-nine patients of group D had two German parents and 70 had one. Mean age at diagnosis was 66.8 ± 10.6 years, with a significant difference between the groups, four years higher in Group G than group D (69.0 ± 8.8 vs 65.4 ± 11.5 years old) (p = 0.025). There was no significant difference in risk factors or coronary angiography data between the groups. HDL cholesterol levels were significantly higher in group G than in group D (48.4 ± 11.1 mg/dL vs 43.3 ± 11.2 mg/dL, p = 0.005). Conclusion At the time of first IHD diagnosis, mean age of the group G was significantly higher than group D, with no differences between groups in sex, risk factors, LDL levels, or clinical and angiographic manifestations. An earlier manifestation of the disease could be part of lifestyle changes in descendants, in this population that mantained eating habits characterized by high saturated fat consumption.

Validade e confiabilidade da Escala de Solidão da UCLA versão 3 entre idosos brasileiros / Validez y confiabilidad de la Escala de Soledad de UCLA versión 3 entre adultos mayores brasileños / Validity and reliability of the UCLA Loneliness Scale version 3 among aged Brazilians

RESUMO Objetivo avaliar a validade e a confiabilidade da Escala de Solidão da UCLA versão 3 numa amostra de idosos brasileiros. Métodos estudo metodológico, realizado com 136 idosos cadastrados em unidades de saúde da família. A validade de construto foi verificada pela análise fatorial exploratória e correlação com medidas de depressão e apoio social. A confiabilidade foi avaliada pelo alfa de Cronbach. Resultados na análise fatorial exploratória foi extraído um componente cuja variância explicou 43,6% da composição do instrumento. Todos os itens apresentaram cargas fatoriais satisfatórias (≥0,30) distribuídas entre 0,43 e 0,76. A validade de construto também foi apoiada pela correlação positiva entre solidão e depressão (r= 0,665; p≤ 0,001) e correlação negativa entre solidão e apoio social (r= -0,576; p≤0,001). O alfa de Cronbach para a amostra foi de 0,88. Conclusão e implicações para a prática a Escala de Solidão da UCLA versão 3 apresenta evidências de validade e confiabilidade satisfatórias, podendo ser utilizada para avaliação da solidão entre idosos brasileiros.

RESUMEN Objetivo evaluar la validez y confiabilidad de la Escala de Soledad UCLA Versión 3 en una muestra de adultos mayores brasileños. Métodos estudio metodológico, realizado con 136 adultos mayores inscriptos en unidades de salud familiar. La validez de constructo se verificó mediante análisis factorial exploratorio y correlación con medidas de depresión y apoyo social. La fiabilidad se evaluó mediante el alfa de Cronbach. Resultados en el análisis factorial exploratorio se extrajo un componente, cuya varianza explicó el 43,6% de la composición del instrumento. Todos los ítems tuvieron una carga factorial satisfactoria (≥ 0,30) distribuida entre 0,43 y 0,76. La validez de constructo también se verificó por la correlación positiva entre soledad y depresión (r = 0,665; p≤ 0,001) y correlación negativa entre soledad y apoyo social (r = -0,576; p≤0,001). El alfa de Cronbach para la muestra fue de 0,88. Conclusión e implicaciones para la práctica la Escala de Soledad de UCLA Versión 3 presenta evidencias de validez y confiabilidad satisfactorias, y puede utilizarse para evaluar la soledad entre adultos mayores brasileños.

ABSTRACT Objective to assess the validity and reliability of the UCLA Loneliness Scale, version 3, in a sample of aged Brazilians. Methods a methodological study carried out with 136 older adults registered in family health units. Construct validity was verified by exploratory factor analysis and correlation with depression and social support measures. Reliability was assessed by means of Cronbach's alpha. Results in the exploratory factor analysis, a component was extracted, whose variance explained 43.6% of the instrument's composition. All items had a satisfactory factor load (≥ 0.30) distributed between 0.43 and 0.76. Construct validity was also supported by the positive correlation between loneliness and depression (r = 0.665; p≤0.001) and a negative correlation between loneliness and social support (r = -0.576; p≤0.001). It was also supported by the positive correlation between loneliness and depression (r = 0.665; p≤0.001) and a negative correlation between loneliness and social support (r = -0.576; p≤0.001). Cronbach's alpha for the sample was 0.88. Conclusion and implications for the practice the UCLA Loneliness Scale version 3, presents evidence of satisfactory validity and reliability, and can be used to assess loneliness among aged Brazilians.

Gestão e liderança na percepção de enfermeiros: um caminhar à luz da burocracia profissional / Gestión y liderazgo en la percepción de los enfermeros: un paseo a la luz de la burocracia profesional / Management and leadership in the nurses' perception: A walk in the light of professional burocracy

Resumo Objetivo analisar os estilos e fatores intervenientes na gestão e liderança de enfermeiros em três países, Brasil, Portugal e Espanha, à luz da Burocracia Profissional. Método estudo exploratório e descritivo de abordagem qualitativa realizado em três hospitais universitários localizados em diferentes países: Brasil, Espanha e Portugal. Participaram da pesquisa 30 enfermeiros. Os dados foram coletados por meio de um roteiro de coleta de dados com questões sociodemográficas e entrevistas analisadas com auxílio do software WebQda. Resultados diferentes percepções sobre os elementos integradores da participação foram reveladas nos três países, destacando-se a comunicação em diversas óticas. Verificou-se algumas convergências em relação ao trabalho em equipe, sendo a confiança o elemento que impulsiona e motiva a equipe. Sinaliza-se para uma relação participativa no desenvolvimento do trabalho. Conclusão e implicações para a prática foi possível identificar, nos três países, a importância da comunicação no processo de gestão, bem como dos estilos de gestão e de liderança, como elementos que oportunizam a atuação da equipe. Também foi evidenciada a presença de fatores intervenientes de relevância, tais como escuta, clima organizacional, relação interpessoal, transparência no trabalho e delegação de funções, os quais envolvem a burocracia profissional em que o conhecimento do enfermeiro possibilita o exercício de suas habilidades de forma horizontalizada e participativa.

Resumen Objetivo analizar los estilos y factores implicados en la gestión y el liderazgo de enfermeros en tres países, Brasil, Portugal y España, a la luz de la Burocracia Profesional. Método estudio descriptivo exploratorio con abordaje cualitativo realizado en tres hospitales universitarios ubicados en diferentes países: Brasil, España y Portugal. Treinta enfermeros participaron en la investigación. Los datos fueron recolectados a través de un script de recopilación de datos con preguntas sociodemográficas y entrevistas analizadas con la utilización del software WebQda. Resultados se revelaron diferentes percepciones sobre los elementos integradores de la participación en los tres países, destacando la comunicación desde diferentes perspectivas. Se constataron algunas convergencias en relación al trabajo en equipo, siendo la confianza el elemento que impulsa y motiva al equipo. Se advierte una relación participativa en el desarrollo del trabajo. Conclusión e implicaciones para la práctica se pudo advertir, en los tres países, la importancia de la comunicación en el proceso de gestión, así como los estilos de gestión y liderazgo, como elementos que permiten mejorar el desempeño del equipo. También se evidenciaron factores intervinientes relevantes, como la escucha, el clima organizacional, la relación interpersonal, la transparencia en el trabajo y la delegación de funciones, que conforman la burocracia profesional en la cual el conocimiento de los enfermos les permite el despliegue de sus competencias de manera horizontal y participativa.

Abstract Objective to analyze the styles and factors involved in nurses' management and leadership in three countries, Brazil, Portugal and Spain, in the light of Professional Bureaucracy. Method a descriptive and exploratory study with a qualitative approach carried out in three university hospitals located in different countries, namely: Brazil, Spain and Portugal. Thirty nurses participated in the research. Data was collected through a collection script with sociodemographic questions and interviews analyzed using the WebQda software. Results different perceptions about the integrating elements of participation in the three countries were revealed, highlighting communication from different perspectives. Some convergences in relation to teamwork were verified, where trust was the element that drives and motivates the team. It is a participatory relationship in the development of work. Conclusion and implications for the practice in the three countries, it was possible to identify the importance of communication in the management process, as well as the management and leadership styles, as elements that favor performance of the team. Presence of relevant intervening factors was also evidenced, such as choice, organizational climate, interpersonal relationships, transparency in work and delegation of functions, which involves professional bureaucracy in which the nurses' knowledge allows them to exercise their skills in a horizontal and participatory manner.

Dissolution profile of different brands of low solubility drugs available in the Nigerian and Brazilian pharmaceutical markets / Dissolution profile of different brands of low solubility drugs available in the Nigerian and Brazilian pharmaceutical markets

The purpose of this work was to elaborate a diagnosis of the dissolution test in Africa in comparison with Brazil, evaluating the dissolution profile of low solubility drugs such as albendazole, ibuprofen, furosemide, glibenclamide, hydrochlorothiazide and carvedilol to ascertain their quality. The dissolution profiles were evaluated by utilizing the United States Pharmacopeia (USP). The glibenclamide medicine was evaluated according to the Food and Drug Administration (FDA), while a dissolution method was developed for the carvedilol medicine. A filter selection test for all the drugs showed that cannula is suitable for all, except for carvedilol, which is centrifuged. The various brands of Nigerian and Brazilian medicines tested showed some statistical differences. The suitable conditions that allowed the dissolution of carvedilol to be determined were the USP type II apparatus at 75 rpm containing 900 mL of acetate buffer, pH 4.5. The results of the dissolution test showed that out of the 17 different brands of Brazilian medicines and 17 different products from Nigeria, 94.12% and 58.82% passed respectively

O objetivo deste trabalho foi elaborar um diagnóstico do teste de dissolução na África em comparação ao Brasil, avaliando o perfil de dissolução de medicamentos de baixa solubilidade como albendazol, ibuprofeno, furosemida, glibenclamida, hidroclorotiazida e carvedilol para verificar sua qualidade.Os perfis de dissolução foram avaliados utilizando a Farmacopeia dos Estados Unidos (USP). O medicamento glibenclamida foi avaliado de acordo com a Food and Drug Administration (FDA), enquanto um método de dissolução foi desenvolvido para o medicamento carvedilol.Um teste de seleção de filtro para todos os medicamentos mostrou que a cânula é adequada para todos, exceto para o carvedilol, que é centrifugado. As diversas marcas de medicamentos Nigerianos e Brasileiros testadas apresentaram algumas diferenças estatísticas. As condições adequadas que permitiram a determinação da dissolução do carvedilol foram o aparelho USP tipo II a 75 rpm contendo 900 mL de tampão acetato, pH 4,5. Os resultados do teste de dissolução mostraram que das 17 diferentes marcas de medicamentos brasileiros e 17 diferentes produtos da Nigéria, 94,12% e 58,82% foram aprovados, respectivamente

Glycemic control and associated factors in patients with type 1 diabetes mellitus in primary care in Southeastern Brazil

Abstract Diabetes is a self-managed condition with knowledge, attitudes and practices that can influence the overall treatment and outcomes delay the complications of diabetes. However, the few reported studies published point out that: low education level, poor adherence to pharmacotherapy and diet recommendations, infrequent monitoring of blood glucose, and insulin dosage regimen are associated with higher hemoglobin levels. This study aimed to assess the knowledge, adherence medication, and complexity of pharmacotherapy in T1DM patients in Brazil. A cross-sectional study was conducted involving 156 T1DM patients who were attending in primary care. Logistic regression analyses were conducted to assess the variables associated with glycemic control. The overall assessments of T1DM patients for the glycemic control were bad (121, 77.6%). However, T1DM patients with high MedTake Test (OR=2.4, CI=1.1-5.7) and Morisky-Green Test (OR= 2.5, CI=1.1-6.1), and in the use of dosage insulin (>40 units, OR=0.3, CI=0.1-0.7) and postprandial glucose (100-125mg/dl, OR=3.8, CI=1.1-14.6) had better glycemic control compared to uncontrolled patients. Glycemic control in Brazilians adults with T1DM is low. We suggested the screening patients with low MedTake and Morisky-Green Tests, increasing patient knowledge as part of a complex intervention that may lead to substantially improved treatment outcomes in primary care

Overweight and associated factors in Basic Education teachers during the Covid-19 pandemic: gender differentials / Excesso de peso e fatores associados entre professores da Educação Básica durante a pandemia de Covid-19: diferenciais de sexo

ABSTRACT Objective To estimate the prevalence of overweight among teachers in Minas Gerais during the Covid-19 pandemic and to review relevant gender associated factors. Methods Cross-sectional and analytical study, websurvey type, carried out with 15,641 teachers of public Basic Education in Minas Gerais, Brazil. Data collection took place from August to September 2020 with the use of a digital form. The dependent variable was overweight, calculated by the body mass index using the teachers' self-reported weight and height. Poisson regression was used, with robust variance. Results Among the participating teachers, 52.4% were overweight. When stratified by gender, 51.1% women and 58.2% men were considered overweight, with a significant difference between them (p<0.001). There was a higher prevalence of overweight among women in the age group of 30 to 59 years (PR=1.39) and in women 60 years or older (PR=1.45) living in the metropolitan region of the state (PR=1.06) who had children (PR=1.19), who were not exercising (PR=1.09) and with a worse dietary pattern during the pandemic (PR=1.12), much afraid of Covid-19 (PR=1.04) and with anxiety and/or depression during the pandemic (PR=1.14). Among men, there was a higher prevalence of overweight among those individuals aged 30 to 59 years (PR=1.19), who lived with a spouse (PR=1.15) working more than 40 hours per week (PR=1.12) and those with the worst dietary pattern during the pandemic (PR=1.10). Conclusion The results showed a 52.4% prevalence of overweight teachers and different associated factors between the genders.

RESUMO Objetivo Estimar a prevalência de excesso de peso entre professores de Minas Gerais durante a pandemia de Covid-19 e analisar os fatores associados segundo o sexo. Métodos Estudo transversal e analítico, do tipo websurvey, realizado com 15.641 professores da educação básica pública de Minas Gerais, Brasil. A coleta de dados ocorreu de agosto a setembro de 2020, via formulário digital. A variável dependente foi o excesso de peso, calculado pelo índice de massa corporal através do peso e altura autorreferidos pelos professores. Utilizou-se a Regressão de Poisson, com variância robusta. Resultados Entre os professores participantes, 52,4% estavam com excesso de peso. Quando estratificado por sexo, 51,1% das mulheres e 58,2% dos homens estavam com excesso de peso, apresentando diferença significativa entre eles (p<0,001). Houve maior prevalência de excesso de peso entre as mulheres de 30 a 59 anos (RP=1,39) e 60 anos ou mais (RP=1,45), da região metropolitana do Estado (RP=1,06), com filhos (RP=1,19), que não estavam praticando exercício físico durante a pandemia (RP=1,09), com pior padrão alimentar durante a pandemia (RP=1,12), com muito medo da Covid-19 (RP=1,04) e com ansiedade e/ou depressão durante a pandemia (RP=1,14). Entre os homens, houve maior prevalência de excesso de peso entre aqueles de 30 a 59 anos (RP=1,19), que viviam com cônjuge (RP=1,15), que trabalhavam mais de 40 horas semanais (RP=1,12) e aqueles com pior padrão alimentar durante a pandemia (RP=1,10). Conclusão Os resultados evidenciaram que 52,4% dos professores respondentes estavam com excesso de peso, tendo sido encontrados diferentes fatores associados entre os sexos.

Dietary patterns and cardiometabolic risk factors of a federal public institution staff in the northern region of Brazil / Padrões alimentares e fatores de risco cardiometabólicos em funcionários de uma instituição pública federal na região norte do Brasil

ABSTRACT Objective To identify dietary patterns in an adult population and assess those patterns association with cardiometabolic risk factors. Methods Cross-sectional study conducted with 130 workers of a university in Tocantins, Brazil, aged 20-59 years. Dietary patterns were identified by principal component analysis based on a food frequency questionnaire. Body mass index, waist circumference, blood pressure, fasting glycemia, triacylglycerols, low-density lipoprotein and high-density lipoprotein cholesterol were measured. Multinomial logistic regression was used to assess the association between dietary patterns and cardiometabolic risk factors. Results Three dietary patterns were identified that together explained 78.74% of total variance: healthy, western and fit dietary patterns. In the adjusted model, greater adherence to the healthy pattern was associated with lower fasting glucose values (OR: 0.89; 95%IC: 0.82-0.97; p=0.009) and with higher concentrations of low-density lipoprotein cholesterol (OR: 1.02; 95%IC: 1.00-1.04; p=0.024); the western dietary pattern was associated with higher fasting glucose values (OR: 1.06; 95%IC: 1.00-1.13; p=0.05) and the fit pattern was associated with lower concentrations of low-density lipoprotein cholesterol (OR: 0.98; 95%IC: 0.97-0.99; p=0.048). Conclusion Food was an important risk and protective factor for cardiometabolic changes.

RESUMO Objetivo Identificar padrões alimentares em uma população adulta e avaliar a associação com fatores de risco cardiometabólico. Métodos Estudo transversal realizado com 130 funcionários entre 20 e 59 anos de uma universidade do Tocantins, Brasil. Os padrões alimentares foram identificados por análise de componentes principais com base em um questionário de frequência alimentar. Foram mensurados índice de massa corporal, perímetro da cintura, pressão arterial, glicemia de jejum, triglicerídeos, lipoproteínas de baixa densidade e lipoproteínas de alta densidade. As associações dos padrões com os fatores de risco cardiometabólico foram determinadas por regressão logística multinomial. Resultados Três padrões foram identificados que explicaram 78.74% da variância total: saudável, ocidental e fit. No modelo ajustado, a maior adesão ao padrão saudável foi associada com menores valores de glicemia de jejum (OR: 0.89; 95% IC: 0.82-0.97; p=0.009) e com maiores concentrações de lipoproteína de baixa densidade colesterol (OR: 1.02; 95% IC: 1.00-1.04; p=0.024); o padrão ocidental foi associado com maiores valores de glicemia de jejum (OR: 1.06; 95% IC: 1.00-1.13; p=0.05) e o padrão fit foi associado com menores concentrações de lipoproteína de baixa densidade colesterol (OR: 0.98; 95% IC: 0.97-0.99; p=0.048). Conclusão A alimentação constituiu um importante fator de risco e de proteção para alterações cardiometabólicas.

Off-label drug use in an adult intensive care unit of a Brazilian hospital

Abstract The objective of this study was to determine the prevalence and describe the factors associated with off-label drug use in an adult intensive care unit (ICU) of a Brazilian hospital. An analytical, cross-sectional, prospective study was conducted in the adult ICU population from March 2018 to May 2018. Off-label use of medication was classified by indication, dosage, route of administration, type and volume of diluent, and duration of administration. Most patients were female (57.89%), non-elderly (56.14%), and had a mean age of 54.44 ± 17.15 years. The prevalence of off-label drug use was 70.31%, but was not associated with the clinical severity of the patients. A statistically significant association was observed between label use of drugs and prescribing potentially inappropriate medicines (PIM). The most common reasons for off-label drug use were therapeutic indication (19.58%) and volume of diluent (23.30%). Drug administration by enteral tubes accounted for the largest number of off-label uses due to route of administration (90.85%). There was a higher prevalence of off-label use of systemic antimicrobials (14.44%) and norepinephrine (9.28%). Our study provided a broad characterization of off-label drug use in an adult ICU and showed why it is important for health professionals to evaluate the specific risks and benefits of this practice

Collaborative attitudes between pharmacists and physicians in Brazil

Abstract Pharmacist-physician collaboration is a strategy for optimizing patient care and improving health outcomes. Nevertheless, there is a lack of information in Brazil about collaborative practices among these professionals. The aim of this study was to measure collaborative attitude of pharmacists and physicians who were working together in a teaching hospital. A cross-sectional study was conducted from June 2018 to January 2019 with pharmacists and physicians working in a teaching hospital in Northeastern Brazil. These professionals were invited to provide responses to the Brazilian version of the "Scale of Attitudes Towards Pharmacist-Physician Collaboration" (SATP2C); their scores ranged between 16 and 64 points. The software Epi Info TM (version 3.5.4) was used for data analysis, and data were expressed in means. Forty-four professionals participated in this study. The mean age was 33.5 (DP = 7.1) years. More than half of participants were male (n = 25, 56.8%). The means from the SATP2C for pharmacists and physicians were 54.20 and 50.91, respectively, indicating good collaborative attitudes. There was no statistical difference between the mean scores of pharmacists and physicians. Participants showed a predisposition for collaborative teamwork. Future studies should focus on understanding the process by which collaboration translates into clinical practice

The clinical pharmacist's role in a high-cost medicine pharmacy: Patient-centered care

Abstract In Brazil, medicine dispensing is a pharmacy service provided within the national health system that allows the pharmacist to interact directly with the patient in order to prevent, detect and solve problems related to pharmacotherapy and health needs. However, it is known that most dispensing services provided in the country are still limited to supplying medications and, at their finest, offering advice on medication utilization. Attempts to change this scenario present new challenges the area of pharmacy, which involve the need for a patient-centered pharmaceutical service model. This paper describes the patient-centered pharmaceutical service of high-cost medicine dispensing performed at a pharmacy linked to the Brazilian Unified Health System. In the model described here, the medicine-dispensing activity is the pharmacist's main field of practice, which consists of identifying patient needs related to health care itself and medication utilization. It also aims to introduce the instrument developed (a Pharmaceutical Care Protocol) that contributed to implementing this clinical service provided by the pharmacist. The protocols guide and qualify the service by providing information that helps in evaluating the effectiveness and safety of treatments and in the preparation of the care plan and can be used as a basis for other services that intend to adopt clinical pharmacy practices.

Bleeding associated with self-medication in warfarin users: A prospective observational study in Ijuí (Brazil)

Abstract Warfarin has been associated with bleeding and venous thromboembolism. Objective: This study aimed to estimate the association between bleeding and concomitant self-medication, and the incidence of adverse drug reactions in patients using warfarin. Setting: the public health network of Ijuí, a municipality in southern Brazil. This was an open prospective cohort, conducted for a period of 18 months with users of warfarin, treated at the public health service. The association between bleeding and self-medication was evaluated by means of the Cox Model with left truncation, using the time variable. Main outcome measurement: bleeding reported in the follow-up. Cases of thromboembolism and death were also registered. All patients treated with warfarin in the public health system of the municipality (98) were identified. Sixty-eight were interviewed and followed up, of whom 63 completed follow-up and five died during the study. Bleeding rates of 37.7 /100 patients/year, thromboembolism of 4.8/100 patients / year and deaths of 4.8 /100 patients / year were observed. The results showed that patients, who take warfarin and self-medicated present a two-fold increased bleeding, compared with those who do not self-medicate. The bleeding risk associated with self-medication ranged from 2.001 to 2.685; those values maintained their significance even when adjusted for number of interactions, CYP polymorphism, TTR and age in COX analysis. These results greatly suggest the need for providing greater assistance to patients who take anticoagulant medications with the purpose of reducing self-medication and consequently, adverse reactions.

Nutritional status of children under five years of age in Rondônia, Brazil Northern region and in Brazil: 2008 to 2019 / Estado nutricional das crianças menores de cinco anos em Rondônia, região Norte e Brasil: 2008 a 2019

ABSTRACT Objective To describe the nutritional profiles of children under five years of age in the state of Rondônia, comparing them with those from the Northern Region of Brazil and from Brazil. Methods This was a time series ecological study. Data were collected from the Food and Nutrition Surveillance System. The information concerned Body Mass Index by age, gender and place of residence. A time-trend analysis was performed using linear regression applying the Prais-Winsten technique and serial autocorrelation verification using the Durbin and Watson test in Stata®16.0. Results There was an annual increasing trend for the thinness, risk of overweight, overweight and obesity regardless of gender, age and location and for extreme thinness, with the exception of girls and for the age of 2 to 5 years, which revealed a stationary trend. Among boys and children of both genders under two years of age, annual growth trends were higher for non-eutrophic nutritional status when compared to the other groups. The growth rates of nutritional disorders found in the Northern region were higher than in the state of Rondônia and in Brazil. Conclusion It is necessary to review health policies aiming at the promotion and prevention of nutritional problems considering the current situation where extreme conditions such as thinness and obesity coexist, with special attention to male children under 2 years of age.

RESUMO Objetivo Descrever o perfil nutricional de crianças menores de cinco anos no estado de Rondônia comparando com dados da Região Norte e do Brasil. Métodos Estudo ecológico do tipo série temporal. Os dados foram coletados do Sistema de Vigilância Alimentar e Nutricional e utilizou-se o Índice de Massa Corporal por idade, sexo e local de moradia. Foi realizada análise de tendência temporal por meio de regressão linear aplicando a técnica de Prais-Winsten e verificação de autocorrelação serial por meio do teste de Durbin e Watson no Stata®16.0. Resultados Houve tendência anual crescente para a magreza, risco de sobrepeso, sobrepeso e obesidade independente do sexo, idade e local, e para a magreza extrema com exceção das meninas e para a idade de dois a cinco anos, que tiveram tendência estacionária. Entre os meninos e crianças menores de dois anos, as tendências de crescimento foram mais elevadas para o estado nutricional não eutrófico quando comparado aos outros grupos. As taxas de crescimento de agravos nutricionais encontradas na região Norte foram superiores ao estado de Rondônia e ao Brasil. Conclusão É necessário rever as políticas de saúde visando a promoção e prevenção de agravos nutricionais considerando a atualidade e onde coabitam extremos como a magreza e obesidade, com atenção especial às crianças com menos de dois anos e do sexo masculino.

Influence of federal feeding programs on the anthropometric indicators of nutritional status of adolescents / Influência de programas federais de alimentação sobre os indicadores antropométricos do estado nutricional de adolescentes

ABSTRACT Objective To assess the influence of federal feeding programs on the anthropometric indicators of nutritional status of adolescents from Federal Institutes. Methods Temporal analysis of the anthropometric data of students from the capital of Rio Grande do Norte, Brazil (n=250), on admission in 2017 (baseline) and after one year, in 2018 (follow-up). Participation in student assistance programs, sociodemographic, anthropometric, dietary, and physical activity aspects were evaluated. The Split Plot ANOVA test was used to analyze height-for-age and body mass index-for-age as continuous variables (mean of z-score; variation in the mean of z-score between baseline and follow-up). Prevalence Ratio was used to analyze categorical variables: improvement in height-for-age (increase in z-score value between baseline and follow-up); improvement in body mass index-for-age (change in z-score towards zero between baseline and follow-up). Results There was a reduction in the height-for-age z-score (-0.173 to -0.350; p<0.001; eta=0.195), but this decline was smaller in the participants of both programs (from -0.249 to -0.357) compared to those not assisted by both simultaneously (from -0.149 to -0.345) (p=0.041). The improvement in height-for-age was positively associated with longer daily time spent at school and participation in the food program under the National Student Assistance Program. The improvement in body mass index-for-age was negatively associated with sex and positively with the number of people in the household. Conclusion The concomitant participation in the National School Feeding Program and in the National Student Assistance Program had a positive influence on the linear growth of students in situations of socioeconomic vulnerability.

RESUMO Objetivo Avaliar a influência de programas federais de alimentação sobre os índices antropométricos do estado nutricional de adolescentes matriculados em institutos federais. Métodos Análise temporal dos dados antropométricos de estudantes da capital do Rio Grande do Norte, Brasil (n=250) na admissão, em 2017 (baseline), e após um ano, em 2018 (follow-up). Foram avaliados a participação nos programas de assistência estudantil, aspectos sociodemográficos, antropométricos, práticas alimentares e de atividade física. O teste Split Plot ANOVA foi utilizado para analisar estatura-para-idade e índice de massa corporal-para-idade como variáveis contínuas (média de escore-z; variação da média de escore-z entre baseline e follow-up). A Razão de Prevalência foi utilizada para analisar as variáveis categóricas: melhora na estatura-para-idade (aumento no valor de escore-z entre baseline e follow-up) e melhora no índice de massa corporal-para-idade (mudança no escore-z em direção ao zero entre baseline e follow-up). Resultados Houve redução no escore-z de estatura-para-idade (de -0,173 para -0,350; p<0,001; eta=0,195), porém esse declínio foi menor nos participantes de ambos os programas (de -0,240 para -0,357) comparados àqueles que não foram assistidos simultaneamente por eles (de -0,149 para -0,345) (p=0,041). A melhora na estatura-para-idade associou-se positivamente a um maior tempo diário na escola e à participação no programa de alimentação do Programa Nacional de Assistência Estudantil. A melhora no índice de massa corporal-para-idade associou-se negativamente ao sexo e positivamente ao número de pessoas no domicílio. Conclusão A participação concomitante no Programa Nacional de Alimentação Escolar e no Programa Nacional de Assistência Estudantil teve uma influência positiva no crescimento linear dos escolares em situação de vulnerabilidade socioeconômica.

Food and nutrition actions for the maternal and child population in primary healthcare: comparative analysis of municipalities in the Metropolitan Region of Baixada Santista, São Paulo, Brazil / Ações de alimentação e nutrição à população materno infantil na Atenção Primária à Saúde: análise comparativa em municípios da Região Metropolitana da Baixada Santista, São Paulo, Brasil

ABSTRACT Objective Characterize and comparatively analyse the organization of nutritional attention to prenatal care, the puerperium period and breastfeeding, in primary health care, in two municipalities of Baixada Santista, São Paulo, Brazil. Methods This was an exploratory-analytical study of family health units and the mixed basic care units of Cubatão (n=17) and Guarujá (n=14). For this purpose, seven domains of the Nutritional Attention Assessment Instrument in Primary Health Care were used. Descriptive analysis and the Mann-Whitney and Pearson's chi-square tests were performed. Results In the comparison between the municipalities, the best scores were obtained in Guarujá. Statistically significant differences were found for the following indicators: support for nutritional attention actions: infrastructure and permanent education (<0.001); food and nutritional surveillance (<0.001); nutritional attention focused on prenatal care (<0.001); and nutritional attention focused on postpartum care and breastfeeding (0.012). Nutritional attention actions for mother-infant groups were more frequent in the city of Guarujá, which compared with Cubatão, achieved better scores for the nutritional attention evaluation indicators. Conclusion The municipality of Guarujá had better indicators of infrastructure and permanent education, food and nutrition surveillance, and puerperal and breastfeeding nutritional care. However, weaknesses persist in the organization of nutritional care in the two cities studied, especially regarding the work process.

RESUMO Objetivo Caracterizar e analisar comparativamente a organização da Atenção Nutricional ao pré-natal, ao puerpério e ao aleitamento, na Atenção Primária à Saúde, em dois municípios da Baixada Santista, São Paulo, Brasil. Métodos Realizou-se estudo exploratório-analítico das Unidades de Saúde da Família e Unidades Básicas de Saúde mistas de Cubatão (n=17) e Guarujá (n=14). Para tanto, foram utilizados sete domínios do Instrumento de Avaliação da Organização da Atenção Nutricional na Atenção Primária à Saúde, validado em seu conteúdo. Realizaram-se análise descritiva e os testes de Mann-Whitney e o Qui-quadrado de Pearson. Resultados Na comparação entre os municípios, as melhores pontuações foram obtidas em Guarujá. Encontraram-se diferenças estatisticamente significantes para os respectivos indicadores, Apoio às ações de Atenção Nutricional: Infraestrutura e Educação Permanente (<0,001); Vigilância Alimentar e Nutricional (<0,001); Atenção Nutricional ao Pré-Natal (<0,001); e a Atenção Nutricional ao Puerpério e ao Aleitamento (0,012). As ações de Atenção Nutricional ao grupo maternoinfantil foram mais frequentes no município de Guarujá, alcançando melhores pontuações dos indicadores de avaliação da Atenção Nutricional, comparativamente aos alcançados por Cubatão. Conclusão O município de Guarujá apresentou melhores indicadores de infraestrutura e educação permanente, vigilância alimentar e nutricional e atenção nutricional puerperal e ao aleitamento. Entretanto, persistem fragilidades na organização da Atenção Nutricional nos dois municípios estudados, principalmente quanto ao processo de trabalho.