The double task of preventing malnutrition and overweight: a quasi-experimental community-based trial

Background: The Maternal-Child Pastoral is a volunteer-based community organization of the Dominican Republic that works with families to improve child survival and development. A program that promotes key practices of maternal and child care through meetings with pregnant women and home visits to promote child growth and development was designed and implemented. This study aims to evaluate the impact of the program on nutritional status indicators of children in the first two years of age. Methods: A quasi-experimental design was used, with groups paired according to a socioeconomic index, comparing eight geographical areas of intervention with eight control areas. The intervention was carried out by lay health volunteers. Mothers in the intervention areas received home visits each month and participated in a group activity held biweekly during pregnancy and monthly after birth. The primary outcomes were length and body mass index for age. Statistical analyses were based on linear and logistic regression models. Results: 196 children in the intervention group and 263 in the control group were evaluated. The intervention did not show statistically significant effects on length, but point estimates found were in the desired direction: mean difference 0.21 (95%CI −0.02; 0.44) for length-for-age Z-score and OR 0.50 (95%CI 0.22; 1.10) for stunting. Significant reductions of BMI-for-age Z-score (−0.31, 95%CI −0.49; -0.12) and of BMI-for-age > 85th percentile (0.43, 95%CI 0.23; 0.77) were observed. The intervention showed positive effects in some indicators of intermediary factors such as growth monitoring, health promotion activities, micronutrient supplementation, exclusive breastfeeding and complementary feeding. Conclusions: Despite finding effect measures pointing to effects in the desired direction related to malnutrition, we could only detect a reduction in the risk of overweight attributable to the intervention. The findings related to obesity prevention may be of interest in the context of the nutritional transition. Given the size of this study, the results are encouraging and we believe a larger study is warranted.

The State as Part of the Republic

The State as Part of the Republic The main objective of this article is to analyze an ideal of civic life, the Republic, based on the form of the sovereign state. Historically, the convergence between Republic and sovereign state has been truncated by the former's commitment to the thesis of royal absolutism. However, as the democratic issue (translated in the values of equality and pluralism) was absorbed by sovereignism, such convergence became more plausible. As viewed in this article, the theoretical bridge of that passage is the concept of political representation. The issue is thus to show in what way a certain vision of the political form (that of the state) can fit into a theory of political representation that contemplates the above-mentioned values.

TITANS OF CAPITALISM IN THE MODERNIZATION OF BRAZILIAN TERRITORY: URBAN AND AWARDS PUBLIC ASSISTANCE DURING THE FIRST REPUBLIC (1889-1930)

In Brazil, the newly created Republic expressed interests of the elite increasingly committed to foreign capital. The Rio de Janeiro saw accumulate vast resources in trade and finance, deriving for industrial applications. The city appears as articulator of Brazilian territory and mediation between it and the international market. In the capital of the Republic, the conservative plan would sweep the old city and inaugurate images copied from Europe and installed in the tropics with civilizing purpose. This materialized with infrastructure financing and loans to entrepreneurs in Europe and North America, awarded public service concessions. The project relied on strong support of mayors (members or representatives of the companies involved in the reforms). This work aims to address the relationship between the mayors of Rio de Janeiro during the First Republic and international capital, focusing on strategies for the production of new spaces in motion the modernization of Brazil and its international image.