RESUMEN
Introducción: La consulta nutricional es la primera línea de atención en niñas y niños en salud pública que presentan condiciones de malnutrición por déficit o exceso. Sin embargo, la atención a estos niños y niñas fue afectada por las movilizaciones sociales y la pandemia por COVID-19. Objetivo: Evaluar la tendencia de las consultas realizadas a menores de 9 años por profesional nutricionista en la región del Maule, Chile, desde el año 2017 a 2021. Métodos: Estudio descriptivo de corte longitudinal histórico basado en los datos de los Registros Estadísticos Mensuales (REM) del Servicio de Salud del Maule, las tendencias fueron analizadas con coeficiente de determinación (R2) mediante la regresión de Prais-Winsten. Resultados: Se analizaron 274.377 consultas nutricionales de niños/as menores de 9 años. 53,8% en clasificación de malnutrición por exceso y 12,1% en déficit. Se registró una disminución de 56,8% en las consultas nutricionales durante las movilizaciones sociales y un 92% al inicio de pandemia. Se observó una tendencia al aumento de las consultas por déficit nutricional, especialmente en menores de 12 meses (R2 0,633, β=4,45, p<0,001). Conclusión: La situación social y epidemiológica afectaron significativamente las atenciones nutricionales en salud pública. Es necesario dar una mayor visibilidad de los profesionales nutricionistas y promover el desarrollo de estrategias innovadoras para afrontar este escenario epidemiológico.
Background: The nutritional appointments is the first line of care for children with malnutrition or overweight in public primary health, but its normal functioning was affected by social mobilizations and the COVID-19 pandemic. Objective: To evaluate trends in consultations among children under 9 years of age in the Maule region, Chile, between 2017 and 2021. Methods: Descriptive longitudinal study based on data from the Monthly Statistical Records (REM) of the Maule Health Service, the trends were analyzed with coefficient of determination (R2) using Prais-Winsten regression. Results: 274,377 nutritional consultations were analyzed, of which 53.8% were overweight and 12.1% with malnutrition. A 56.8% decrease in nutritional consultations was recorded during social mobilizations and 92% at the beginning of the pandemic. A tendency to increase consultations due to malnutrition was observed, especially in children under 12 months of age (R2 0.633, β=4.45, p<0.001). Conclusion: The social and epidemiological situations significantly affected nutritional care in public health. It is necessary to give nutrition professionals greater visibility and promote the development of innovative strategies to deal with this epidemiological scenario.
RESUMEN
RESUMEN La migración internacional ha aumentado exponencialmente en Chile, lo que ha representado un desafío para el sistema de salud. El presente estudio transversal exploratorio, de metodología cualitativa y abordaje multidisciplinario, busca describir barreras y dificultades en la consulta nutricional a personas migradas, desde la perspectiva de profesionales nutricionistas de los centros de salud familiar de una comuna de la Región Metropolitana; dada la relevancia de la Atención Primaria en el sistema de salud nacional, y la particularidad de la alimentación, que conjuga valores nutricionales relacionadas con la salud, así como aspectos simbólicos significativos para las personas, posicionando a las nutricionistas en un escenario donde buscan mantener un estado nutricional óptimo en una población culturalmente diferente. Se realizaron once entrevistas a nutricionistas, las cuales fueron codificadas y analizadas temáticamente, identificando cuatro ejes narrativos de barreras y dificultades: escasez de recursos en la atención de una demanda poblacional creciente, problemas lingüísticos de comunicación (idiomáticos y dialectales), desconocimiento del funcionamiento del sistema sanitario chileno por parte de los/las usuarios/as migrados/as, y divergencia de prácticas y concepciones sanitarias entre migrados/as y nutricionistas. Del estudio se concluye que la atención nutricional con el usuario/a migrante internacional es compleja y se debe considerar abordar los temas antes mencionados al momento de generar respuestas institucionales de atención, programas y políticas enfocadas en la atención al usuario/a migrante internacional, de manera de lograr una promoción auténtica y pertinente de hábitos alimentarios saludables y el mantenimiento del Efecto Migrante Sano.
ABSTRACT International migration has increased exponentially in Chile, which has represented a challenge for the health system. Using qualitative methods and a multidisciplinary approach, this cross-sectional exploratory study seeks to describe barriers and difficulties for nutritional care for migrants from the perspective of nutritionists who work in health centers in a neighborhood of the Metropolitan Region of Chile. Given the relevance of primary care in the national health system and the particularity of food, which combines nutritional values related to health, as well as significant symbolic aspects for people, nutritionists are positioned to encourage optimal nutritional status in a culturally different population. Eleven interviews were conducted with nutritionists. The transcribed interviews were coded and analyzed thematically, identifying four narrative axes of barriers and difficulties: lack of resources for a growing population demand, linguistic communication problems (idiomatic and dialect), lack of knowledge about the functioning of the Chilean health system by migrants, and divergence of health practices and conceptions between migrants and nutritionists. The study concludes that nutritional care with international migrants is complex. The concerns mentioned above should be addressed when generating institutional responses of care, or creating programs and policies focused on the care of international migrants to achieve an authentic and pertinent promotion of healthy eating habits and the maintenance of the Healthy Migrant Effect.
RESUMEN
OBJETIVO: A desnutrição pode afetar adversamente a evolução clínica de pacientes hospitalizados e aumentar o tempo de permanência hospitalar. O objetivo deste estudo foi certificar critérios para avaliação e acompanhamento do estado nutricional de pacientes hospitalizados aceitos pela comunidade de pesquisadores, docentes e profissionais da área de nutrição clínica. MÉTODOS: Com este propósito aplicou-se um questionário via Internet, à comunidade científica, cadastrada na Plataforma Lattes - sistema nacional de cadastro curricular unificado on-line -, para apoiar atividades de fomento de agencias federais e estaduais. O questionário é composto de recomendações acompanhadas por uma escala Likert e espaços para justificativas dos participantes em relação à opção de aceitação parcial ou discordância do procedimento proposto. Foi considerado aprovado o procedimento que teve concordância total ou parcial maior ou igual a 70,0 por cento. RESULTADOS: Responderam ao questionário 35,2 por cento dos profissionais contatados. A maioria (84,0 por cento) era professor universitário, sendo 62,0 por cento de universidade pública; 67,0 por cento eram doutores; 63,0 por cento tinha mais de 20 anos de formado; 74,0 por cento eram nutricionistas e 25,0 por cento médicos. Os procedimentos propostos versam sobre as seguintes necessidades: triagem para definição de complexidade da atenção nutricional, indicadores de avaliação e monitoramento nutricional durante a internação e equipamentos e protocolos para o atendimento nutricional. Todos os procedimentos foram aceitos pelos entrevistados. Foi proposto pelos autores um modelo de triagem para definição da complexidade do atendimento nutricional, considerando os procedimentos aceitos. CONCLUSÃO: A aceitação dos procedimentos propostos fortalece o reconhecimento da necessidade de implantação de padrões para a avaliação e monitoramento nutricional nas instituições hospitalares.
OBJECTIVE: Malnutrition can adversely affect the clinical course of hospitalized patients and increase the length of hospital stay. The objective of this study was to certify procedures for assessing and following the nutritional status of hospitalized patients accepted by the clinical nutrition research community, professors and professionals. METHODS: For this purpose, a questionnaire was administered via the Internet to the scientific community registered in the Lattes Platform - national system of online, unified curriculum database to support the activities of the state and federal research funding agencies. The questionnaire consists of recommendations together with a Likert scale and space for the participants to justify their reasons for partial acceptance or rejection of the procedure proposed. The procedure that obtained total agreement or partial agreement >70.0 percent was approved. RESULTS: Roughly one-third (35.2 percent) of the professionals who received the questionnaire answered it. Most of them (84.0 percent) were university professors; 62.0 percent were of public universities; 67.0 percent had a PhD; 63.0 percent had twenty years or more of professional experience; 74.0 percent were dietitians and 25.0 percent were physicians. The proposed procedures cover the following needs: screening for defining the complexity of nutritional care, indicators of nutritional assessment and monitoring during hospital stay and equipment and protocols for nutritional care. All the procedures were accepted by the interviewees. A screening model to define the complexity of nutritional care was proposed based on the accepted procedures. CONCLUSION: Acceptance of the proposed procedures strengthens the acknowledgement of the need to implement standards for nutritional assessment and monitoring in hospitals.