A formação do nutricionista para atuação no SUS: um olhar sobre a produção científica obrigatória dos cursos do Rio Grande do Norte

The National Curricular Guidelines for nutrition course predict training directed to the work in the Unified Health System (SUS) and the mandatory completion of course work. The aim of this study was to analyze the formation of dieticians in Rio Grande do Norte state/Brazil to work in the SUS, from the compulsory scientific production provided for training. This is a bibliometric study, quantitative approach, performed with completion of course works of five nutrition undergraduate courses in Rio Grande do Norte state in the years 2013/2013. From the reading of the works, the following variables were collected: nature of the institution, institution administrative category, location, work title, number of authors, work format, titration of the teacher advisor, study type, area of interest, scenery of accomplishment, submission to the ethics committee, suitability of descriptors and, as pertaining to the field of public health, the subfield of public health and the theme. The pedagogical projects of the courses were read and were identified opportunities to develop research in the graduation. For detection of significant categories we applied the Pearson chisquare test. We analyzed 195 works, coming mostly belonging to universities courses (79.0%) and private institutions (56.4%). A higher frequency of articles (68.2%), developed by one student (65.6%), guided by master teachers (57.9%), with cross-sectional study design (49.2%), conducted in laboratory (25%) and without submission to the ethics committee in research (49.2%) was find. The median adequacy of descriptors was 50%. As for the interest of the study, there was a higher frequency of work in the field of public health (p <0.001), within this subfield highlighting the nutritional epidemiology (63.0%) (p <0.001) and the subject nutrition assessment (57, 4%) (p <0.001). In cut on three major areas of dietician performance, was significant performing work in the field of public health in public institutions (p <0.05). The presence of complementary activities was unanimous in the pedagogical projects of the courses. The results of the study showed some methodological weaknesses in the research approaches, as well as a hegemonic positivist training. Despite the emphasis on public health, it was noticed little approximation of policies and nutrition programs in the context of the mandatory recearch of Rio Grande do Norte state nutrition courses.

Aspectos ambientais e sociais envolvidos na transmissão da L. chagasi no município de Parnamirim/RN

Visceral leishmaniasis hás adapted in the past 20 years to periurban and urban areas, and in Natal, Rio Grande do Norte, it became endemic. Thid study aimed to evaluate the environmental and social aspectsof Leishmania chagasi infection and its epidemiologic transmission chain in an urban, periurban and rural area of Parnamirim-RN. A study with three sections was conducted: Section 1: Sectional study of the human and canine infection by L. chagasi and its environmental and social determinants. Section 2: Observational longitudinal cohort to evaluate the dynamics of the canine infection. Section 3: Longitudinal study to evaluate the behavior of Lu. Longipalpis vector and the seasonal factors related to its dynamics. To include in the study the hauses were randomly selected and georreferenciated. Montenegro skin test was done in the human population and blood samples were collected for anti-Leishmania antibody detection. The canine population was examinated for L. chagasi infection by RIFI, ELISA and ELISA for rK39. An entomologic surveillance was monthly done with CDC light trapsin 10 houses of each locality. Quantitative and qualitative analyses was done using STATISC 6.0. Probality and prediction maps were done using ArcGis 9.0 model. In the human population L. chagasi infection was associated with the area of the hause, age, sex, population densyti, vegetation, kind of the floor of thr hause, water and resides destiny. In the canine population L. chagasi infection was associated with the breed, size, time of living in the hause, presence of dogs in the neighborhood, presence of horses and donkeys in the neighborhood, vegetation, kind of the floor and walls of the hause. The human infection was associated with canine infction only when analyzed taking into account the locality. In the prospective study, serum conversion and antibody lost observed in 30,8% and 22% of the animals examined, respectively. The human infection rate by L. chagasi was 24,6%, by the presence of anti-Leishmania antibody and 38,6% by the Montenegro skin test. The canine infection rate 32,5% by the presence of anti-Leishmania antibody. The vector Lu longipalpis showed an atypical behavior. These results indicate that environmental and social factors are important variables associated with L. chagasi infection in humans and canines, with punctual association of thr last two. Control measures of the infection on the studied points are necessary, in the aim to reduce the endemic focus of the disease in the study area. This research was carried out in a multidisciplinary involving the categories of: doctor, biologist, veterinarian, statistical, pharmaceutical and biochemical

Ensaio clínico randomizado sobre a prática da atenção farmacêutica nas farmácias comunitárias

Introdução: A criação de programas de equipe multiprofissional de saúde desponta como uma alternativa eficiente para controlar a evolução dos pacientes portadores de diabetes, e a inserção do farmacêutico em tais programas tem contribuído para melhorar o acompanhamento desses pacientes. Objetivo: Avaliar o impacto da intervenção do farmacêutico no acompanhamento dos pacientes diabéticos tipo 2, em farmácias comunitárias. Métodos: Ensaio clínico randomizado, uni-cego envolvendo 100 pacientes diabéticos tipo 2 de ambos os gêneros, usuários de farmácia comunitária, com idade igual ou superior a 30 anos, em uso de hipoglicemiantes orais com adição ou não de insulina e foram acompanhados por 6 meses. Os pacientes do grupo controle receberam o tratamento habitual existente em qualquer farmácia, e os de intervenção receberam o acompanhamento do farmacêutico incluindo intervenções aos problemas relacionados aos medicamentos. Os desfechos primários avaliados foram os valores da hemoglobina glicada (HbA1c), glicose basal e um questionário de qualidade de vida validado denominado de Diabetes Quality of Life Measure (DQOL) - Brasil; e como desfechos secundários as dosagens dos triglicérides, colesterol total, (HDL) colesterol, (LDL) colesterol, tensão arterial e a satisfação do usuário com o serviço prestado. Essa pesquisa contou com a colaboração de vários profissionais das diferentes áreas do conhecimento a seguir nominados: médico, farmacêutico bioquímico, enfermeiro, nutricionista e estatístico. Resultados: Finalizaram o estudo 89 pacientes. Durante o acompanhamento 95,7% (45/47) dos pacientes no grupo intervenção apresentaram problemas relacionados aos medicamentos (PRM), perfazendo um total de 141, com uma média de 3 eventos por paciente, ocorrendo uma resolutividade de 61,7% (87/141). A categoria que mais apresentou PRM foi a de efetividade com 34,1% (48/141) e a classe farmacológica mais utilizada foi a dos hipoglicemiantes orais com 35% (49/141). As variáveis de desfechos primários como hemoglobina glicada (HbA1c) e a glicose basal não apresentaram valores estatisticamente significantes quando comparadas o final com o inicial do acompanhamento nos grupos intervenção e controle considerando um p<0,05, mas o questionário de qualidade de vida DQOL Brasil apresentou resultados estatisticamente significante com um p=0,000. Os desfechos secundários, com exceção da satisfação do usuário, não apresentaram valores xi estatisticamente significantes quando comparados o final com o início do acompanhamento nos grupos de intervenção e controle. Conclusão: Os resultados indicam que as modificações das variáveis clínicas não apresentaram valores significativos no controle da enfermidade e comorbidades, enquanto que na avaliação da qualidade de vida os pacientes afirmaram que melhoraram; portanto, pode-se postular que a intervenção farmacêutica é uma atividade necessária, mas que a prática do Pharmaceutical Care trará benefícios com sustentabilidade para os pacientes se houver uma efetiva integração do farmacêutico numa equipe multiprofissional de saúde, o que está indisponível nas Farmácias Comunitárias

Nutrição social no Brasil: [mais] uma estratégia biopolítica?

Inspirés par la « méthode » artisanat intellectuel propose par le sociologue Wright Mills, notre étude porte sur la formation du champ de pratiques discursives et non discursives (Michel Foucault) de la nutrition sociale dans le contexte de la société brésilienne dans lequel s insère le champ de la santé. Le travail empirique s épuise sur une source de documents normatifs de ce champ et s oriente à vérifier et à comprendre comment le praticien de la nutrition émerge dans le scènario des pratiques de la santé au Brésil à partir du milieux du 20ème siècle, tout en construisant son « regime de vérité » fondé dans des processus biopolitiques du champ de la médecine sociale. Nous avons relié deux phénomènes: a) l émergeance du champ biomédical de la nutrition comme une instance biopolitique, en approchant cette formation à l'histoire de la médecine sociale, depuis ses débuts européens jusqu'au contexte brésilien ; b) les pratiques discursives et non discursives du champ de la nutrition lequel est compris dans le Sistema Único de Saúde (SUS - Système Unique de Santé) brésilien. La démarche de recherche comprend l'élaboration et analyse d'une archive composée de publications qui contiennent l'Histoire du praticien de la nutrition au Brésil et des publications officielles disponibles dans le site web « Política Nacional de Alimentação e Nutrição » (Politique Nationale d'Alimentation et de Nutrition) lesquelles sont considérées comme des guides d actions des praticiens de la nutrition sociale dans le Sistema Único de Saúde (SUS). Le concept de biopouvoir, décrit par Michel Foucault entre 1974 et 1979, et la notion de biopolitique, dans son sens réinterprété et mis à jour par Giorgio Agamben, Antônio Negri et Michael Hardt, ont fourni le support théorique de cette recherche

As coisas estão no (meu) mundo, só que eu preciso aprender. Autobiografia, reflexividade e formação em Educação Nutricional

This paper gives clues for the educative action in nutrition subjects. It deals about the professors experiences deployments lived in 2003 e 2004, both in Nutrition undergraduate course of the Federal University of the Rio Grande do Norte (UFRN), in Nutrition Education and Supervised Internship in Social Nutrition academic disciplines, as well as in the II Update Course in Nutrition Practices for Health Basic Care , offered to the supervisors nutritionists of internship, in this same department, being able to be characterized as an action-research, with interventionism purpose. The study stands out the importance of a new point of view about the nutritionist formation to overcome the limits imposed by the scientism, and the adoption of a complex and reflexive reference about the educational practice in this area. The corpus is made up by 81 undergraduate students alimentary autobiography (source of generating subjects for interventions with the nutritionists), 17 questionnaires and 05 interviews, being 03 of them biography (the start up for an initial dialogue with the nutritionists). The data found and the professors experiences allied to a theoretic reference, by the light of the education proposals for the XXI century were used as establishment elements for the proposition of five guidance axles used to build a complex and reflexive nutrition education, which are: 1) Take the cookery and the culture of eating together as significant elements for the human being integral formation; 2) Conceive the religion manifestations associated to feeding process as relevant elements of the human food culture; 3) Discuss the rupture nature/culture aiming the preservation of live in earth; 4) Search for the overcoming of the identity conflicts by a higher inclosing conscience degrees of being part of this process. 5) Face the limits of fragmented formation. The presented thesis stands that the autobiography method, allied to the freirean pedagogy and to a complex reference, could be taken as an important tool to the health educative subjects, contributing to the formation of reflective individuals able to transform themselves and the world.

Ética da alimentação: porque devemos, segundo Kant, escolher uma alimentação adequada e saudável

This thesis proposes the adoption of a practical and philosophic approach to the discussion about what should be a healthy food, in view of the actual problems concerning this subject (from famine to obesity), which affect food and nutritional security and constitute target of many official policies. In order to handle this task, this work resorts to ethic, pedagogical and anthropological concepts inherent to Immanuel Kant’s philosophy, as valuable contributions to the practice of the professional nutritionist committed to the support and accomplishment of the human right to adequate nutrition (DHAA). Under this assumption, it intends to surpass the prevailing idea inside the social programs and policies favoring the utilitarian argument. It considers rather that a healthy food is also a duty of virtue, according to the Kantian duties to one-self. The liberation of transgenic seeds in Brazil comes up as an example of the violation of the right to food security and affects it negatively, resulting from the conflict between politics and moral faced by the Brazilian government. This paper concludes that DHAA realization requires not only a committed state, but also committed citizens and suggests that Kant’s philosophy should offer important contributions to supporting the practice of the professional nutritionist, awarding him the necessary information about this matter.

Ética da alimentação: porque devemos, segundo Kant, escolher uma alimentação adequada e saudável

This thesis proposes the adoption of a practical and philosophic approach to the discussion about what should be a healthy food, in view of the actual problems concerning this subject (from famine to obesity), which affect food and nutritional security and constitute target of many official policies. In order to handle this task, this work resorts to ethic, pedagogical and anthropological concepts inherent to Immanuel Kant’s philosophy, as valuable contributions to the practice of the professional nutritionist committed to the support and accomplishment of the human right to adequate nutrition (DHAA). Under this assumption, it intends to surpass the prevailing idea inside the social programs and policies favoring the utilitarian argument. It considers rather that a healthy food is also a duty of virtue, according to the Kantian duties to one-self. The liberation of transgenic seeds in Brazil comes up as an example of the violation of the right to food security and affects it negatively, resulting from the conflict between politics and moral faced by the Brazilian government. This paper concludes that DHAA realization requires not only a committed state, but also committed citizens and suggests that Kant’s philosophy should offer important contributions to supporting the practice of the professional nutritionist, awarding him the necessary information about this matter.