Estratégia de saúde da família e adesão ao tratamento do diabetes: fatores facilitadores / Family health strategy and diabetes treatment adherence: facilitating factors / Estrategia de salud familiar y adherencia al tratamiento de diabetes: factores facilitadores

O diabetes mellitus é um importante e crescente problema de saúde, estando entre as doenças crônicas não transmissíveis mais prevalentes no mundo. Este estudo teve como objetivo abordar a percepção dos profissionais de saúde em relação aos aspectos facilitadores da adesão ao tratamento do diabetes mellitus. Realizou-se um estudo clínico-qualitativo em formato de grupo focal, que teve como público-alvo os profissionais da Estratégia Saúde da Família (ESF) de um município de pequeno porte do Centro-Oeste de Minas Gerais. Os profissionais apontaram as seguintes práticas como favorecedoras da adesão: construção de vínculo, participação da família, utilização de linguagem acessível, estímulo à participação ativa do paciente no tratamento, realização de acolhimento, práticas que incluem a intersetorialidade, a multidisciplinaridade e a interdisciplinaridade, ações de apoio matricial, interconsultas, atendimentos compartilhados e trabalhos com grupos. Percebe-se que a adesão depende de uma série de fatores interligados, que incluem a proposta de política pública, participação da gestão municipal, organização dos serviços, formação dos profissionais e suas concepções a respeito do processo saúde-doença, concepção de clínica, dinâmica de trabalho das equipes e capacidade dos profissionais de interagirem com a população. A experiência descrita neste artigo pode servir de inspiração para melhorias nas intervenções dos profissionais de saúde na Atenção Primária à Saúde (APS).

Diabetes Mellitus is a major health issue, consisting of one the most prevalent chronic noncommunicable diseases worldwide. This study addresses the perception of health personnel regarding the facilitating aspects of diabetes mellitus treatment adherence. A clinical-qualitative study based on a focus group was carried out with professionals from the Family Health Strategy (FHS) of a small city in Minas Gerais, Brazil. Respondents pointed to the following practices as favoring adherence: bonding, family participation, use of accessible language, stimulus to the patient's active participation in the treatment, user embracement, intersectoral, multidisciplinary and interdisciplinary practices, matrix support actions, inter-consultations, shared care, and group work. Results show that adherence depends on a series of interconnected factors, which include public policy proposals, participation of municipal management, organization of services, training of professionals and their conceptions about the health-disease process, clinical concept, team dynamics, and the professionals' ability to interact with patients. The experience described here can help improve the interventions of Primary Health Care (PHC) professionals.

La diabetes mellitus es un problema de salud importante y creciente, y se encuentra entre las enfermedades crónicas no transmisibles más prevalentes en el mundo. Este estudio tuvo como objetivo abordar la percepción de los profesionales de la salud en relación a los aspectos que facilitan la adherencia al tratamiento de la diabetes mellitus. Se realizó un estudio clínico-cualitativo en formato de grupo focal, con un público objetivo de profesionales de la Estrategia de Salud Familiar (ESF) de una pequeña ciudad del centro-oeste de Minas Gerais (Brasil). Los profesionales señalaron las siguientes prácticas como favorecedoras de la adherencia: construcción del vínculo, participación familiar, uso de lenguaje accesible, fomento de la participación activa del paciente en el tratamiento, acogida, prácticas que incluyen la intersectorialidad, multidisciplinariedad e interdisciplinariedad, matriz de acciones de apoyo, interconsulta, servicios compartidos y trabajo con grupos. Se observó que la adherencia depende de una serie de factores interconectados que incluyen la propuesta de política pública, la participación de la gestión municipal, la organización de los servicios, la formación de los profesionales y sus concepciones sobre el proceso salud-enfermedad, concepción de la clínica, dinámica de trabajo de equipos y la capacidad de los profesionales para interactuar con la población. La experiencia descrita en este artículo puede servir de inspiración para mejorar las intervenciones de los profesionales sanitarios en Atención Primaria.

Campylobacter fetus in abomasal fluid from spontaneously aborted bovine and ovine fetuses

Pregnancy losses are a major concern in livestock industry due to their economic impact on producers. Campylobacter fetus subspecies fetus (Cff) and C. fetus subspecies venerealis (Cfv) are directly related to reproductive failures in ruminants. Cff colonizes the gastrointestinal tract of a wide range of hosts leading to abortion, while Cfv is restricted to genital tract being generally associated to infertility in bovine. Considering the great economic losses related to campylobacteriosis in cattle and ovine herds, this study aims to investigate the occurrence of C. fetus, considering Cff and Cfv subspecies, in bovine and ovine spontaneously aborted fetuses in state of Rio Grande do Sul, Brazil. In this study, samples of abomasal fluid collected from 30 spontaneously aborted bovine (n = 18) and ovine (n = 12) fetuses were investigated for the detection of Campylobacter fetus throughout conventional PCR. Positive fetuses for C. fetus presence were further analyzed by molecular assays for Cff and Cfv detection, in order to determine subspecies identification. When available, samples of the main organs of the thoracic and abdominal cavities, as well as the brain, skeletal muscle, eyelid, skin, and placenta were collected for further histopathological analyses and bacterial culture, aiming to assess the presence of infection lesions and pathogens in those sites, respectively. Additionally, RT-qPCR assays were also performed for the detection of ruminant pestivirus, in order to detect bovine viral diarrhea cases. Throughout the present methodology, C. fetus was detected in the abomasal fluid samples of 2 bovine fetuses, being both identified as Cfv subspecies by PCR. Histopathological analyses demonstrated that macroscopic and microscopic changes found in the Cfv-positive animals were not either specific or directly related to Campylobacter infections. Moreover, no significant bacterial growth was observed in microbiological culture from the collected tissues, and both fetuses were negative for ruminant pestivirus. Differently, there was no detection of C. fetus in any of the analyzed ovine fetuses. Considering that abortion diagnosis rates reported in cattle and sheep industry are highly variable among the published studies, and that abortion diagnoses are commonly inconclusive due to difficulties in sampling methodology and inadequate identification of the pathogen involved, it is important to investigate the etiological causes of abortion the herds for better understanding the causes of pregnancy issues and monitoring their occurrence. In addition, the absence of pathognomonic lesions in the tissues investigated in the histopathological analyses observed in this study strongly suggests that well-known etiological agents commonly associated to abortion, such as Leptospira spp., Toxoplasma spp., Chlamydia spp. and Neospora caninum, are unlikely to be the cause of infection of the analyzed fetuses. Taking this into account, the presence of C. fetus in the abomasal fluid samples from two bovine fetuses demonstrated in the present study suggests the possible association of Cfv not only with infertility, but also with cases of bovine abortion, highlighting the importance of investigating unusual causal agents of abortions in sheep and cattle. Overall, an adequate diagnosis is essential for establishing better prevention strategies to avoid the circulation of abortion-related infectious agents in the herds.(AU)

Quantificação de bactérias lácticas em produtos lácteos com potencial probiótico comercializados nos supermercados de Volta Redonda e Barra Mansa / Quantification of lactic bacteria with potential probiotic dairy products sold in supermarket of Volta Redonda and Barra Mansa

No setor lácteo, os alimentos funcionais que são benéficos à saúde atingiram um bom mercado consumidor. Um produto para ser considerado probiótico deve apresentar contagem de microrganismos maior ou igual a 1x107 células viáveis/g ou mL do produto. O objetivo do trabalho foi avaliar a contagem de bactérias lácticas viáveis em produtos comerciais que declaram a presença de microrganismos nos rótulos. Foram analisadas 24 amostras de 5 diferentes marcas de iogurtes e leites fermentados comercializadas em supermercados de Volta Redonda/RJ e de Barra Mansa/RJ. Foram realizadas a avaliação microbiológica de viabilidade das bactérias lácticas, a análise de pH e a acidez titulável. Todas as marcas avaliadas apresentaram contagens superiores a 107 UFC/mL de bactérias láticas. Os valores de pH e acidez titulável atendem os critérios legais.