Validação de conteúdo de instrumento de avaliação da atenção nutricional na atenção primária à saúde / Content validation of the nutritional attention assessment instrument in primary health care

RESUMO Objetivo Construir e validar o conteúdo de um instrumento para avaliar a organização da atenção nutricional na Atenção Primária à Saúde no Brasil. Métodos Trata-se de um estudo transversal e de validação. A construção do Instrumento de Avaliação da Atenção Nutricional foi baseada em revisão de literatura e em consulta a documentos oficiais. O instrumento foi submetido à validação de conteúdo utilizando técnica Delphi em duas rodadas. Resultados O painel para validação foi formado por 29 especialistas das cinco Macrorregiões Brasileiras: 13 docentes/pesquisadores do ensino superior, sete gestores de alimentação e de nutrição, quatro profissionais da Atenção Primária à Saúde e cinco alinhados ao tema, a maioria (89,7%) atuante em serviços públicos, com experiência acima de seis anos. O instrumento validado contém 68 questões e 10 indicadores: (1) Atuação do nutricionista; (2) Apoio às ações de Atenção Nutricional: infraestrutura e educação permanente; (3) Intersetorialidade; (4) Controle Social; (5) Vigilância Alimentar e Nutricional; (6) Atenção Nutricional Individual; (7) Atenção Nutricional para grupos; (8) Atenção Nutricional voltada ao pré-natal; (9) Atenção Nutricional voltada ao puerpério/aleitamento e (10) Atenção Nutricional à saúde da criança. Conclusão O instrumento proposto avança ao viabilizar o estabelecimento de processos avaliativos da Atenção Nutricional. Espera-se que ele seja amplamente utilizado para avaliar a atenção nutricional ofertada em municípios, em estados e na esfera federal. Os resultados obtidos com futuras aplicações poderão contribuir para respaldar a qualificação da gestão das políticas de alimentação e de nutrição.

ABSTRACT Objective Construct and validate the content of an instrument to evaluate the organization of nutritional care in Primary Health Care in Brazil. Methods This is a cross-sectional and validation study. The construction of the Nutritional Attention Assessment Instrument was based on literature review and review of official documents. The instrument was submitted to content validation using the Delphi technique in two rounds. Results The validation panel consisted of 29 specialists from the five Brazilian Macroregions: 13 higher education teachers/investigators, seven food and nutrition managers, four Primary Health Care professionals and five professionals knowledgeable of the subject, most of them (89.7%) working in the public service with experience of over six years. The validated instrument contains 68 questions and 10 indicators: (1) Nutritionist performance; (2) Support to the Nutritional Attention actions: infrastructure and permanent education; (3) Intersectoriality; (4) Social Control; (5) Food and Nutrition Surveillance; (6) Individual Nutritional Attention; (7) Nutritional Attention for Groups; (8) Nutritional Attention focused on prenatal care; (9) Nutritional Attention focused on postpartum/breastfeeding and (10) Nutritional Attention focused on child health. Conclusion The proposed instrument is an advance which enables the establishment of evaluation processes for Nutritional Attention. It is expected that this instrument be widely used to evaluate the Nutritional Attention given in the municipalities, states and at the federal level. The results obtained with future applications may contribute to support management qualification of food and nutrition policies.

Desigualdades socioeconômicas na percepção do ambiente de mobilidade ativa / Socioeconomic inequalities in perception of active mobility environment

O objetivo do estudo foi descrever a percepção do ambiente relacionado à mobilidade ativa pela população de Santos (São Paulo, Brasil), comparando distintas regiões do município caracterizadas por diferentes níveis socioeconômicos. Foram escolhidos de forma proporcional e aleatória 10 setores censitários da cidade de Santos. Em cada setor foi realizado a aplicação do questionário Neighborhood Environment Walkability Scale (NEWS - Brasil). Para coletada de dados foram abordados 30 indivíduos de cada setor avaliado, sendo estas pessoas que circulavam na rua e se identificavam como moradoras do setor, assim, a amostra foi composta por 300 indivíduos. Na análise dos dados foi utilizada análise fatorial exploratória a fim de reduzir os parâmetros avaliados em fatores compostos. Foi verificada a diferença dos fatores observados em cada região do município por meio do teste de Kruskal-Wallis. Houve diferenças significativas entre os setores de maior e menor nível socioeconômico. O setor de maior nível socioeconômico apresenta a percepção positiva sobre a proximidade dos estabelecimentos, a existência de facilitadores para a prática de atividades físicas e a segurança relacionada ao tráfego e à criminalidade quando comparado com o de menor nível socioeconômico que teve percepção positiva em relação a proximidade de locais de lazer e segurança com a vizinhança. Deste modo, observa-se que a houve desigualdade socioeconômica na percepção do ambiente construído podendo esta influenciar o nível de atividade física da população, havendo assim, necessidade de mais estudos e revisão no planejamento de políticas públicas relacionadas à construção e manutenção de facilitadores da prática de atividade física no ambiente urbano.

The aim of the study was to describe the perception of the built environment related to active mobility by the population of Santos (São Paulo, Brazil), comparing areas of the city characterized by their different socioeconomic levels. Ten census tracts in the city of Santos were randomly selected and distributed proportionally to the population of each area. The questionnaire Neighborhood Environment Walkability Scale (NEWS - Brazil) was applied in 30 individuals walking in street and identified as residents of each sector, thus the sample consisted of 300 individuals. Factor analysis was used to reduce the parameters evaluated in composite factors. Difference in the factors between regions of the city were assessed with the Kruskal-Wallis test. There were significant differences between the sectors of high and low socioeconomic status. The high socioeconomic sector has a positive perception about the proximity of the premises, the existence of facilitators to physical activity and safety related to traffic and crime compared to lower socioeconomic sector that had a positive perception about the proximity of the places of entertainment and safety related to neighborhood. Thereby, was observed a socioeconomic inequality in the perception of the built environment that can influence the level physical activity of the population, thus requiring more researches and planning of public policies aiming to the increase physical activity practices and active mobility in the urban environment.

Dyslipidemia in racially admixtured children with cystic fibrosis.

OBJECTIVES: There are few studies reporting lipid profile in cystic fibrosis (CF) and most of them are in adult Caucasians. Therefore, the aim of this study was to evaluate the lipid profile of racially admixtured youths with CF. MATERIALS AND METHODS: A cross-sectional survey conducted between August and September 2009 at a reference service for CF, evaluating clinical and laboratory data. RESULTS: Forty-six patients aged from 6 years to 16 years and 2 months (median: 9 years and 10 months; 65.2% males) were evaluated. Of these, 26% were Whites, 54.4% Mulattoes and 19.6% Blacks. There were no diabetics, one patient had glucose intolerance and three had insulin resistance. Pancreatic sufficiency was present in 74% and malnutrition in 26% of the patients. The lipid profile revealed hypertriglyceridemia in 56%, hypercholesterolemia in 17.4% and hypocholesterolemia in 46.5%. In 30.4% of the patients, hypertriglyceridemia and hypocholesterolemia was observed. The serum levels of high density lipoprotein (HDL) were low in 56.5% and the low density lipoprotein (LDL) elevated in 15.2% of the patients. CONCLUSIONS: The lipid profile of this sample of Brazilian racially admixtured patients with CF showed a higher prevalence of hypertriglyceridemia and hypocholesterolemia. There was no association of dyslipidemia with the various racial groups, nutritional status, pancreatic sufficiency or glucose tolerance.

Low prevalence of glucose intolerance in racially mixed children with cystic fibrosis.

OBJECTIVE: To evaluate glucose tolerance in racially mixed Brazilian youth with cystic fibrosis (CF). METHODS: Cross-sectional study conducted between August and September 2007, at a reference service for CF, evaluating: glycated hemoglobin (HbA1c), blood glucose, and insulin levels, before and 2 h after a glucose overload. RESULTS: There were 46 patients aged between 6 yr and 16 yr and 2 months (median: 9 yr and 10 months) of whom 64% were boys. Of these, 26% were Whites; 54.4% Mulattoes; and 19.6% Blacks. HbA1c was normal in all patients. Only one participant (12-yr old) had glucose intolerance. Insulin levels ranged from 1 to 23 µIU/mL (median: 4.5 µIU/mL) at baseline and from 3.2 to 192.1 µIU/mL (median: 11 µIU/mL) after a glucose overload. Insulin resistance evaluated by the HOMA index, stratified by sex and age, was present in three patients. The ΔF508 mutation was present in only 4.3% of the sample, all of them being heterozygous. CONCLUSIONS: The low prevalence of carbohydrate intolerance in this population is probably a result of their young age. Another possibility is the low frequency of the ΔF508 mutation. Although not conclusive, these data suggest that in addition to age, the genotype:phenotype ratio may influence the development of glucose intolerance in patients with CF.

Evaluation of the upper airway in children and adolescents with cystic fibrosis and obstructive sleep apnea syndrome.

OBJECTIVE: Obstructive sleep apnea syndrome (OSAS) in cystic fibrosis (CF) patients may be associated with the presence of upper airway obstruction caused by chronic infection and nasal polyposis that may also contribute to OSAS severity. Our objective was to identify the profile of findings in CF and OSAS patients by performing upper airway examinations. METHODOLOGY: Observational, cross-sectional study involving 63 children and adolescents between the ages of 2 and 14 with CF. All patients answered a questionnaire and underwent a standard otolaryngology examination, including an endoscopic nasal and nocturnal polysomnography. OSAS diagnosis was confirmed if the obstructive apnea index was >or=1. RESULTS: OSAS was identified in 35 (55.6%) patients. The upper airway findings were evaluated using multiple correspondence factorial analysis. The OSAS group presented with overjet >2mm, enlarged pharyngeal pillars, palatine tonsils and pharyngeal tonsils hypertrophy, ogival hard palates and characteristics of chronic rhinosinusitis. CONCLUSION: Bone and soft tissue structural alterations of the upper airway and chronic rhinosinusitis were associated with the OSAS group patients.

Brucella spp. lumazine synthase: a novel adjuvant and antigen delivery system to effectively induce oral immunity.

Brucella lumazine synthase (BLS) has been previously used with success as a delivery system for systemic immunization against murine cysticercosis. We herein determined the usefulness of BLS as a new antigen-delivery system and mucosal-adjuvant using KETc1, one of the peptides of the anti-cysticercosis vaccine. A protection of up to 98% was induced when KETc1 was used as a chimera fused to BLS. Used as adjuvant of KETc1, BLS also induced a high level of protection (79%), which did not significantly differ from that induced by the cholera toxin (74%). KETc1 and BLS administered separately also reduced the parasite load. KETc1 administered orally as a chimera, and to a lesser extent with BLS as adjuvant, elicited IgG and IgA specific antibodies, which were detectable both in fecal extracts and in sera, and increased B and CD4 activated cells. BLS-KETc1 also increased the levels of transcription of TNF-alpha, IL-2 and IFNgamma in Peyer's patches, and in spleen, only increased TNF-alpha was observed. Overall, these results showed that BLS can be used as both an antigen-carrier and as an adjuvant in the design of new oral subunit vaccines.

Determinaçäo radiográfica da maturidade esquelética e sua importância no diagnóstico e tratamento ortodôntico / Radiographic determination of skeletal maturity and the importance to diagnosis and orthodontic treatment

A compreensäo dos eventos relacionados ao crescimento é de suma importância na ortodôntia clínica. Os estágios de maturidade têm uma influência decisiva no diagnóstico, planejamento, prognóstico e resultado final do tratamento. A ordem e a interpretaçäo dos trabalhos, revisados na literatura, levaram a um esclarecimento de como o clínico pode utilizar-se da radiografia carpal para determinar a idade óssea do paciente. Alguns autores sugeriram um método mais simplificado para avaliar a maturaçäo esquelética, mediante o uso de películas radiográficas periapicais, para a verificaçäo da presença do osso sesamóide ulnar da articulaçäo metacarpofalangeana do dedo polegar. Os autores concluíram que a ossificaçäo do osso sesamóide pode ser utilizado como indicador do início do SPC Surto de Crescimento Puberal, sendo mais precoce nos indivíduos do sexo feminino. Da mesma forma, foram concordes em afirmar que a uniäo epifisária das falanges digitais indica o fim do SPC obedecendo a sequência: distal, proximal e média. A proposta deste trabalho é realizar uma pesquisa literária com a finalidade de determinar a época da maturaçäo esquelética, no paciente, através de radiografias carpais