Formação do nutricionista para atuação na Atenção Primária à Saúde: perspectiva de docentes / Nutritionist training in order to work in Primary Health Care: lecturers' perspective

Objetivo: Analisar a formação do nutricionista para a atuação na Atenção Primária à Saúde (APS), na perspectiva docente. Método: Estudo de abordagem qualitativa junto a docentes de Cursos de Nutrição de Universidades Públicas da região sudeste do país, identificadas pelo sistema de dados oficial do Ministério da Educação (site e-MEC). Coleta de dados por meio de questionário autoaplicado, com questões norteadoras cujas respostas foram processadas por meio de Análise de Conteúdo. Resultados: As informações foram obtidas junto a 21 docentes de 13 Instituições de Ensino Superior e organizadas nas categorias temáticas: Referencial teórico na formação do nutricionista para atuar na AB, classificados como setoriais com foco na alimentação e nutrição, intersetoriais com destaque para a alimentação e nutrição em Saúde Coletiva e educacionais relacionados à educação e formação dos profissionais; Formação do nutricionista na AB: dos temas abordados à prática em campo, vinculados às áreas de conhecimento Ciências Sociais, Humanas e Econômicas, Ciências das Alimentação e Nutrição e Ciência dos Alimentos; e A formação nas perspectivas teórica e prática, que indicam estratégias convencionais e também de metodologias ativas. Conclusão: As políticas públicas do Sistema Único de Saúde (SUS) favorecem a formação do nutricionista para atuação na APS, sendo necessária maior articulação ensino-serviço para formação de nutricionistas identificados com demandas sociais.

Objective: To analyze the training of nutritionists to work in Primary Health Care (PHC), from the teaching perspective. Method: Qualitative study with professors of Nutrition Courses at Public Universities in the southeastern region of the country, identified by the official data system of the Ministry of Education, the e-MEC website. Data collection through a questionnaire with guiding questions and with results evaluated by Content Analysis. Results: Data was obtained from 21 professors from 13 Higher Education Institutions and organized into thematic categories: Theoretical framework in training nutritionists to work in PHC, classified as sectorial with a focus on food and nutrition, intersectoral with emphasis on food and nutrition in Collective Health and education related to the education and training of professionals; Nutritionist training in PHC: from the topics addressed to field practice, linked to the fields of Social and Economic Sciences, Feeding and Nutrition Sciences and Food Science; and Training in theoretical and practical perspectives, which indicates conventional strategies and also active methodologies. Conclusion: The public policies of the Unified Health System (SUS) favors the training of nutritionists to work in PHC, requiring greater teaching-service articulation to train nutritionists identified with social demands.

Perceptions of patients in the waiting line for bariatric surgery: contributions from the experience of an educational process / Percepções de pacientes na fila de espera para cirurgia bariátrica: contribuições a partir da experiência de um processo educativo / Percepciones de pacientes en la fila de espera para cirugía bariátrica: contribuciones a partir de la experiencia de un proceso educativo

The present study is a qualitative research with the objective of analyzing the perceptions of patients in the face of the challenges in the bariatric surgery line through focal groups. All patients were treated with an outpatient protocol, however, they were divided into two groups, one participated in the educational process and the other did not. Four categories of analysis were drawn up and discussed in the light of the current literature. Patients from the educational process were able to express themselves with greater positivity in view of the challenges and they showed better resources for going through the emotional suffering, the worsening of comorbidities and the risk of death. The results show the potential of education in health and of group work in the promotion of self-care and well-being.(AU)

O presente estudo trata-se de uma pesquisa qualitativa com o objetivo de analisar as percepções dos pacientes diante dos desafios na fila da cirurgia bariátrica por meio de grupos focais. Todos os pacientes foram atendidos com protocolo ambulatorial, porém, foram divididos em dois grupos, um participou do processo educativo e o outro não. Quatro categorias de análise foram elaboradas e discutidas à luz da literatura atual. Os pacientes do processo educativo conseguiram se expressar com maior positividade diante dos desafios e apresentaram melhores recursos para atravessar o sofrimento emocional, o agravamento das comorbidades e o risco de morte. Os resultados mostram o potencial da educação em saúde e do trabalho em grupo na promoção do autocuidado e do bem-estar.(AU)

El presente estudio se trata de una investigación cualitativa con el objetivo de analizar las percepciones de los pacientes ante los desafíos en la fila de la cirugía bariátrica por medio de grupos focales. Todos los pacientes fueron atendidos con protocolo ambulatorio, pero se dividieron en dos grupos, uno participó en el proceso educativo y el otro no. Se elaboraron y discutieron cuatro categorías de análisis a la luz de la literatura actual. Los pacientes del proceso educativo consiguieron expresarse con mayor positividad antes los desafíos y presentaron mejores recursos para pasar por el sufrimiento emocional, el agravamiento de las comorbilidades y el riesgo de muerte. Los resultados muestran el potencial de la educación en salud y del trabajo en grupo de la promoción del autocuidado y del bienestar.(AU)

A nutritionist approach to psychiatric treatment: Notes from a brief experience

ABSTRACT Objective: This study aims to describe the work of the nutritionist in a psychiatric outpatient clinic of a university hospital, with patients with excess weight due to the use of certain psychiatric medications. Method: Content analysis of the clinical history and brief field notes, as complementary material. The clinical-qualitative method was applied in data collection and analysis. Results: Conversations with patients focused on their relationship with food were more effective in managing excessive weight gain than insistence on individualized and restrictive diets. The role of the family was important to strengthen the bond and favor dietary changes. Efforts to identify the emotions involved in eating, including the pleasures given by emotional, cultural, and social factors were also important. Conclusions: Nutritional care in the psychiatric field should emphasize dialogue related to the eating practices of patients. Strict dietary prescriptions can have the same unproductive effect as traditional biomedical practices if they do not consider subjective aspects of patients.

RESUMEN Objetivo: El objetivo de este estudio fue describir el trabajo del nutricionista en una clínica ambulatoria de psiquiatría de un hospital universitario, en pacientes con exceso de peso debido al uso de ciertos medicamentos psiquiátricos. Método: Análisis del contenido de la historia clínica y de breves notas de campo, como material complementario. Se aplicó el método clínico-cualitativo en la recolección y análisis de los datos. Resultados: El autor principal de este artículo, una nutricionista, indica que las conversaciones con pacientes centradas en su relación con la comida fueron más efectivas para manejar el aumento de peso excesivo do que la insistencia en las dietas individualizadas y restrictivas. El rol de la familia fue importante para fortalecer el vínculo e favorecer los cambios alimentarios. También fueran importantes los esfuerzos para identificar las emociones involucradas en la alimentación, incluidas los placeres dados por factores emocionales, culturales y sociales. Conclusiones: La atención nutricional en el campo psiquiátrico debe enfatizar el diálogo relacionado con las prácticas alimentarias de los pacientes. Las prescripciones estrictamente dietéticas pueden tener el mismo efecto improductivo que las prácticas biomédicas tradicionales si tampoco toman en cuenta los aspectos subjetivos de los pacientes.

Fases psicológicas de gestantes com HIV: estudo qualitativo em hospital / Psychological phases of pregnant women with HIV: a qualitative study in a hospital / Fases psicológicas de embarazadas con VIH: estudio cualitativo en un hospital

Resumo Houve mudança de paradigma quanto ao prognóstico da infecção pelo vírus da imunodeficiência humana, passando da morte para problema crônico, mas ainda hoje a infecção implica revisão de vida da mulher que convive com a doença. O objetivo deste artigo foi apresentar as fases psicológicas pelas quais passam as gestantes após descobrirem a contaminação. Foi realizado estudo clínico-qualitativo a partir de entrevistas individuais, e a amostra foi intencional e fechada pelo critério de saturação teórica. Após análise qualitativa de conteúdo, foram estabelecidas três fases psicológicas evolutivas: confusão emocional, dúvida existencial e ambiguidade funcional. A notícia do teste positivo desencadeia emoções intensas e mecanismos de defesa, sobretudo devido ao medo de transmissão vertical. Dessa forma, é fundamental que equipes de saúde ampliem a compreensão sobre esta vivência tão significativa para gestantes e seus familiares.

Abstract There has been a paradigm shift regarding the prognosis of Human Immunodeficiency Virus infection, changing it from death to a chronic condition, but the infection still implies a review of the life of women who are living with this virus. The objective of this article is to present the psychological phases which pregnant women go through after knowing about their infection. A clinical-qualitative study was carried out, applying individual interviews, with an intentional sample, using the theoretical saturation criterion. Three evolutionary psychological phases emerged from the analysis: emotional confusion; existential doubt; functional ambiguity. The news of the presence of the virus brings intense emotions triggering defense mechanisms, especially, against the strong fear of vertical transmission. It is, thus, fundamental for health teams to broaden the understanding of this experience so significant for pregnant women and their families.

Resumen Hubo un cambio de paradigma con respecto al pronóstico de la infección por Virus de la Inmunodeficiencia Humana, pasando de la muerte a un problema crónico, pero aún hoy la infección implica la revisión de la vida de la mujer que convive con la enfermedad. El objetivo de este artículo fue presentar las fases psicológicas por las que pasan las embarazadas luego de descubrir la contaminación. Se realizó un estudio clínico-cualitativo, a partir de entrevistas individuales y la muestra fue intencional y cerrada por el criterio de saturación teórica. Luego del análisis cualitativo de contenido, se establecieron tres fases psicológicas evolutivas: confusión emocional, duda existencial y ambigüedad funcional. La noticia del test positivo desencadena emociones intensas y mecanismos de defensa, sobre todo debido al temor a la transmisión vertical. De esta forma, es fundamental que los equipos de salud amplíen la comprensión sobre esta vivencia tan significativa para las embarazadas y sus familiares.

Randomized controlled trial protocol: A quanti-quali approach for analyzing the results of an intervention on the waiting list for bariatric surgery / Protocolo de estudo controlado randomizado: abordagem quanti-quali para análise de resultados de uma intervenção em fila de espera para cirurgia bariátrica

ABSTRACT Objective This article aims to describe the protocol of a randomized clinical trial and the baseline results of the study of a one-year interdisciplinary intervention in users of the public health system in the bariatric surgery waiting list. Methods A randomized, single-blind clinical trial will be conducted including 88 participants recruited on an outpatient clinic of the public health system. Participants were randomized into the control group (n=44), receiving the usual treatment; and into the intervention group (n=44), participating in the educational intervention. Participants had their food intake, negative affectivity and physical inactivity/sedentary behavior assessed, as well as anthropometric and body composition measurements; their blood samples were collected; and also had different physical capacity tests. Results Of the 157 participants invited, 27 had severe functional limitations, one was under-age, and four declined the study due to associated diseases. Eighty-eight participants were randomized: 44 for the Control Group and 44 for the Intervention Group. When comparing the demographic and biochemical characteristics, there were no differences between groups except for serum glucose (GC=110.4±46.8mg/dL and GI93.1±16.9mg/dL, p=0.039). Conclusion This study protocol describes the methodology used in the study of educational intervention for the promotion of health care of patients on the waiting list for bariatric surgery. It shows that there is similarity between the baseline comparison groups. Registro Brasileiro de Ensaios Clínicos (Brazilian Clinical Trials Registry), RBR-775y3d.

RESUMO Objetivo Descrever protocolo de ensaio clínico randomizado e resultados de linha de base dos efeitos de intervenção interdisciplinar de um ano, com usuários do sistema público de saúde na fila de espera para cirurgia bariátrica. Métodos Será conduzido um ensaio clínico randomizado, uni-cego, com 88 participantes recrutados em ambulatório do sistema público de saúde e randomizados entre o grupo controle (n=44) que recebe o tratamento habitual e entre o grupo de intervenção (n=44) que participa da intervenção educativa. Os participantes tiveram o consumo alimentar, afetividade negativa e inatividade física/comportamento sedentário avaliados, bem como medidas antropométricas e de composição corporal, amostras de sangue e testes de capacidade física. Resultados Dos 157 participantes convidados, 27 apresentaram limitações funcionais graves, 1 era menor de 18 anos e 4 declinaram devido a doenças associadas. Oitenta e oito participantes foram randomizados: 44 para o Grupo Controle e 44 para o Grupo Intervenção. Quando comparados quanto as características demográficas e bioquímicas, não houve diferença entre os grupos, exceto para glicose sérica (GC=110,4±46,8mg/dL e GI93,1±16,9mg/dL; p=0,039). Conclusão Este protocolo de estudo descreve a metodologia utilizada no estudo de intervenção educativa para a promoção do cuidado integral com pacientes em espera para cirurgia bariátrica. Mostra que há semelhança entre os grupos de comparação na linha de base. Registro Brasileiro de Ensaios Clínicos RBR- 775y3d.

Food practices and their meanings in the daily routine of a university / Práticas alimentares e seus significados no cotidiano de uma universidade

ABSTRACT Objective This study aimed at knowing and analyzing sociocultural meanings of the daily dietary practices revealed by a university community, in the context of a wellness program to their community and its surroundings. Methods The research team ran 28 workshops with the participation of 34 university units and 558 subjects in total. All workshops were recorded and transcribed verbatim. Content analysis was performed with the identification of emerging themes and categories. Results From the analysis of this material four categories emerged. There is the desire caused by the pleasure of having meals in a group of people and consuming foods rich in fat and sugar, but with its consumption shrouded by guilt. Healthy foods were considered important but related to obligation and displeasure. The community also wants to consume healthy foods daily in the academic environment, however, pointed out barriers such as an increasing pace of work and lack of time. Conclusion It was possible to identify barriers and desires related to food practices in the daily life of the university. This study demonstrated that changing the eating behavior of an academic community is a major challenge for wellness programs, even for an institution that produces and disseminates scientific knowledge.

RESUMO Objetivo Este trabalho teve como objetivo conhecer e analisar os significados socioculturais das práticas alimentares cotidianas revelados pela comunidade de uma universidade brasileira no contexto de um programa de bem estar para sua comunidade e entornos. Métodos Foram realizadas 28 oficinas com a participação de 34 unidades universitárias e 558 pessoas. Todas as oficinas tiveram seu áudio gravado e transcrito. Foi realizada análise de conteúdo com a identificação de temas e categorias emergentes. Resultados A partir da análise do material transcrito, emergiram os significados em quatro categorias. Há o desejo pelo prazer de realizar as refeições em grupo e consumir alimentos ricos em gordura e açúcar, mas envolto por culpa. Alimentos saudáveis foram considerados importantes, mas seu consumo foi relacionado à obrigação e desprazer. Contudo, a comunidade deseja consumi-los diariamente no ambiente acadêmico, mas aponta barreiras como o aumento do ritmo de trabalho e falta de tempo. Conclusão Foi possível identificar barreiras e desejos relacionados às práticas alimentares no cotidiano da universidade. Este estudo mostrou que transformar o comportamento alimentar de uma comunidade acadêmica é um grande desafio para os programas de bem-estar, mesmo para instituições que produzem e disseminam conhecimentos científicos.

Psychological issues facing obese pregnant women: a systematic review.

OBJECTIVE: To identify, by qualitative and quantitative studies, the psychological aspects considered and/or evaluated during the prenatal care of obese pregnant women, as well as the psychological interventions adopted by health services. METHODS: Systematic review of literature using a mixed method approach, integrating both quantitative and qualitative studies. We used databases (Medline/PubMed, Web of Science, Embase, and SciELO) and publications from January 2003 to June 2013 using "Obesity," "Pregnancy," "Psy,*" or "Psychology" as Medical Subject Headings (MeSH terms). Prospective cohort, cross-sectional, case-control, clinical trial, and qualitative research studies were included. Eight articles are included in this review, three with qualitative and five with quantitative methodology. RESULTS: The majority of the studies demonstrate that emotional problems such as depression, anxiety, and stress are associated with the raising of Body Mass Index (BMI) during pregnancy. The results of the qualitative studies show psychological distress related to humiliation and exposure to stigmas surrounding obesity and its connection with gestation. CONCLUSION: There is an emotional demand related to obesity during pregnancy, which should be considered by prenatal multidisciplinary care team. There is a need to increasing attention and support provided for obese pregnant women.

Adolescents growing with HIV/AIDS: experiences of the transition from pediatrics to adult care

Abstract The main objective of this work is to describe the formation of the Transition Adolescent Clinic (TAC) and understand the process of transitioning adolescents with HIV/AIDS from pediatric to adult care, from the vantage point of individuals subjected to this process. A qualitative method and an intentional sample selected by criteria were adopted for this investigation, which was conducted in São Paulo, Brazil. An in-depth semi-structured interview was conducted with sixteen HIV-infected adolescents who had been part of a transitioning protocol. Adolescents expressed the need for more time to become adapted in the transition process. Having grown up under the care of a team of health care providers made many participants have reluctance toward transitioning. Concerns in moving away from their pediatricians and feelings of disruption, abandonment, or rejection were mentioned. Participants also expressed confidence in the pediatric team. At the same time they showed interest in the new team and expected to have close relationships with them. They also ask to have previous contacts with the adult health care team before the transition. Their talks suggest that they require slightly more time, not the time measured in days or months, but the time measured by constitutive experiences capable of building an expectation of future. This study examines the way in which the adolescents feel, and help to transform the health care transition model used at a public university. Listening to the adolescents’ voices is crucial to a better understanding of their needs. They are those who can help the professionals reaching alternatives for a smooth and successful health care transition.

Adolescents growing with HIV/AIDS: experiences of the transition from pediatrics to adult care.

The main objective of this work is to describe the formation of the Transition Adolescent Clinic (TAC) and understand the process of transitioning adolescents with HIV/AIDS from pediatric to adult care, from the vantage point of individuals subjected to this process. A qualitative method and an intentional sample selected by criteria were adopted for this investigation, which was conducted in São Paulo, Brazil. An in-depth semi-structured interview was conducted with sixteen HIV-infected adolescents who had been part of a transitioning protocol. Adolescents expressed the need for more time to become adapted in the transition process. Having grown up under the care of a team of health care providers made many participants have reluctance toward transitioning. Concerns in moving away from their pediatricians and feelings of disruption, abandonment, or rejection were mentioned. Participants also expressed confidence in the pediatric team. At the same time they showed interest in the new team and expected to have close relationships with them. They also ask to have previous contacts with the adult health care team before the transition. Their talks suggest that they require slightly more time, not the time measured in days or months, but the time measured by constitutive experiences capable of building an expectation of future. This study examines the way in which the adolescents feel, and help to transform the health care transition model used at a public university. Listening to the adolescents' voices is crucial to a better understanding of their needs. They are those who can help the professionals reaching alternatives for a smooth and successful health care transition.

Emotional Experiences of Obese Women with Adequate Gestational Weight Variation: A Qualitative Study.

BACKGROUND: As a result of the growth of the obese population, the number of obese women of fertile age has increased in the last few years. Obesity in pregnancy is related to greater levels of anxiety, depression and physical harm. However, pregnancy is an opportune moment for the intervention of health care professionals to address obesity. The objective of this study was to describe how obese pregnant women emotionally experience success in adequate weight control. METHODS AND FINDINGS: Using a qualitative design that seeks to understand content in the field of health, the sample of subjects was deliberated, with thirteen obese pregnant women selected to participate in an individual interview. Data was analysed by inductive content analysis and includes complete transcription of the interviews, re-readings using suspended attention, categorization in discussion topics and the qualitative and inductive analysis of the content. The analysis revealed four categories, three of which show the trajectory of body care that obese women experience during pregnancy: 1) The obese pregnant woman starts to think about her body;2) The challenge of the diet for the obese pregnant woman; 3) The relation of the obese pregnant woman with the team of antenatal professionals. The fourth category reveals the origin of the motivation for the change: 4) The potentializing factors for change: the motivation of the obese woman while pregnant. CONCLUSIONS: During pregnancy, obese women are more in touch with themselves and with their emotional conflicts. Through the transformations of their bodies, women can start a more refined self-care process and experience of the body-mind unit. The fear for their own and their baby's life, due to the risks posed by obesity, appears to be a great potentializing factor for change. The relationship with the professionals of the health care team plays an important role in the motivational support of the obese pregnant woman.

The pain and pleasure of being what one is: viewpoints of health professionals and patients about being overweight/obese.

The objective of this article is to discuss the meanings that health professionals and patients in treatment attribute to obesity. The research consisted of a qualitative survey in health, based on in-depth interviews with patients and professionals at an out-patient clinic at the University Hospital in Barcelona, Spain. Here, we discuss the concept of obesity, the meanings of diagnoses, the singularities involved in managing treatment, and the process of becoming ill, all in the light of the anthropology of health that has a sociocultural orientation. Obesity is usually seen by the professionals as a risk-factor disease. For patients, the incorporation of this rationality is procedural and is mixed in with other meanings attributed to being overweight/obese that have been gradually developed throughout life. A patient's autonomy in choosing to be fat, or obese, and to adhere to treatment, is defined as a process that requires support in order to come to joint proposals in caring for these problems.

[Health education in Brazil: from Paulo Freire to today]. / Education populaire et education pour la santé au Brésil, sur les traces de Paulo Freire....

This paper examines the experience of Brazil in the area of health education integrated in popular education movements. More specifically, the paper discusses the link between health education and popular education, focusing in particular on the work of Paulo Freire. Anti-slavery movements, protest movements against social inequalities and the reconstruction of democracy after the end of the military dictatorship (1965-1984) provided fertile ground for a dynamic process of change--a process illustrated by the creation of the Unified Health System. These developments occurred in a context of social change and unrest. Since then, other actors and other forms of action have emerged, though creativity and popular empowerment remain central to the process of change. However, in popular education, nothing is set in stone and new issues have emerged, as Paulo Freire had predicted. The point is to recognize that popular education applied to health, or rather integrating health, is constantly changing and developing.

Aplicação da técnica de grupo focal em pesquisa da Rede-SANS sobre as ações de alimentação e nutrição na atenção básica em saúde / Application of the focus group technique in research with the SANS network on procedures in food and nutrition in basic health care

Grupo focal como recurso da pesquisa qualitativa é importante ferramenta na avaliação propositiva de projetos de articulação de redes e movimentos sociais. Seis grupos focais foram aplicados como uma das etapas de pesquisa do Projeto Rede de Segurança Alimentar e Nutricional Sustentável (Rede-SANS), rede social de articulação da academia com os movimentos populares e poder público, em defesa do Direito Humano à Alimentação Adequada. Este relato teve como objetivo discutir a experiência da aplicação da referida técnica para investigar as percepções de profissionais de saúde sobre as ações de alimentação e nutrição na Atenção Básica. Os grupos focais permitiram aproximação e troca de experiências de 52 profissionais de 13 municípios de diferentes regiões do Estado de São Paulo para debater questões de segurança alimentar no contexto da área da saúde e promoveu reflexões sobre a alimentação, vigilância nutricional e intersetorialidade, como temas emergentes nos grupos. A técnica aplicada se demonstrou adequada para investigar o tema em profundidade, em pouco tempo, com um número grande de profissionais de distintos contextos para além dos objetivos da pesquisa. A realização dos grupos focais possibilitou o fortalecimento do processo de articulação de rede para a promoção de ações locais de segurança alimentar e nutricional sustentável.

Focus groups are seen as important tools in qualitative research for evaluating projects aimed at articulating social networks and movements. Six focus groups were held as one of the stages in research as part of the Food Safety and Sustainable Nutrition Project (SANS). This social network articulates the academic world with social movements and government in defense of the human right to suitable nutrition. This report is aimed at discussing the experience of applying focus groups to the investigation of perceptions by health professionals of activities related to food and nutrition in basic health care. These groups made it possible to bring together 52 professionals from 13 municipalities in the State of São Paulo, Brazil, and they exchanged experiences and debated issues related to food safety in the area of health care. The group discussions identified eating, nutrition vigilance and intersectoriality as emerging topics. The focus group technique proved to be a suitable tool for investigating the topic quickly and in depth, with a large number of professionals working in different contexts. In fact, the discussions went beyond the objectives of the research, since the group work made it possible to strengthen the process of articulation carried out by a network that promoting local measures in food safety and sustainable nutrition.

Nutrition and self-care practices of patients with chronic Metabolic Syndrome: a qualitative study

OBJECTIVE: To analyze subjective aspects of eating habits and self-care of patients living with chronic symptoms linked to metabolic syndrome. METHODS: A clinical and qualitative (exploratory, non-experimental) study, conducted with an intentionally small sample of nine patients in treatment at an outpatient endocrinology clinic of a university hospital in São Paulo, Brazil. The sample was closed when data saturation occurred. The in-depth interviews were conducted with a psychodynamic orientation toward the conduct of dialogues. The categorization of the discourse was developed through content analysis. The psychodynamic approach provided a theoretical reference complemented by social anthropology. RESULTS: Eating habits have been revealed as mediators of autonomy and as a source of vulnerability in the process of coping with chronic illness. Reception and understanding of the psychological and cultural aspects of food are needed in treatment faced with the difficulty of establishing changes in eating behavior. CONCLUSION: This is a contribution of an interdisciplinary approach that values listening subjectivity during treatment.

OBJETIVO: Analisar aspectos subjetivos das práticas alimentares e autocuidado de pacientes na convivência com os sintomas crônicos vinculados à Síndrome Metabólica. MÉTODOS: Estudo clínico-qualitativo (exploratório, não-experimental), realizado com amostra propositalmente pequena de nove pacientes em tratamento ambulatorial de endocrinologia em hospital universitário do Estado de São Paulo, Brasil. O grupo foi fechado por saturação de dados. As entrevistas foram realizadas em profundidade, com orientação psicodinâmica na condução dos diálogos. A categorização do discurso foi desenvolvida por meio da análise de conteúdo. A abordagem psicodinâmica foi a referencial teórico complementada pela antropologia social. RESULTADOS: Práticas alimentares revelaram-se como mediadoras de autonomia e como fonte de vulnerabilidade na convivência com o processo de adoecimento crônico. Acolhimento e compreensão dos aspectos psicológicos e culturais da alimentação são necessários no tratamento diante das dificuldades para estabelecer mudanças no comportamento alimentar. CONCLUSÃO: Trata-se de uma contribuição de abordagem interdisciplinar, que valoriza a escuta de subjetividades no tratamento.

OBJETIVO: Analizar aspectos subjetivos de las prácticas alimenticias y el autocuidado de pacientes en la convivencia con los síntomas crónicos vinculados al Síndrome Metabólico. MÉTODOS: Estudio clínico-cualitativo (exploratorio, no-experimental), realizado con una muestra propositalmente pequeña de nueve pacientes en tratamiento ambulatorio de endocrinología en un hospital universitario del Estado de Sao Paulo, Brasil. El grupo fue determinado por saturación de datos. Las entrevistas fueron realizadas a profundidad, con orientación psicodinámica en la conducción de los diálogos. La categorización del discurso fue desarrollado por medio del análisis de contenido. El abordaje psicodinámico fue el referencial teórico complementado por la antropología social. RESULTADOS: Las prácticas alimenticias se revelaron como mediadoras de la autonomía y como fuente de vulnerabilidad en la convivencia con el proceso de sufrimiento crónico. La acogida y comprensión de los aspectos psicológicos y culturales de la alimentación son necesarios en el tratamiento frente a las dificultades para establecer cambios en el comportamiento alimenticio. CONCLUSIÓN: Se trata de una contribución de abordaje interdisciplinario, que valoriza la escucha de subjetividades en el tratamiento.

[The significance of dietary and behavioral changes in patients with chronic metabolic disorders: a review]. / Significados da dieta e mudanças de hábitos para portadores de doenças metabólicas crônicas: uma revisão.

Eating behavior and the psycho-cultural significance of food for patients with chronic metabolic disorders have been a focus of interest due to the difficulty in ensuring the compliance of these patients in terms of changing their habits and in fostering self-care. A review of the literature was condusted using the LILACS and MEDLINE databases and the PUBMED search engine to identify qualitative studies in which the opinion of patients with respect to diet and lifestyle was analyzed. Key words used were: metabolic syndrome; eating behavior; diet; obesity; psychological factors; qualitative study; and dietary habits. Inclusion criteria consisted of: articles in English, Spanish or Portuguese, published between 2000 and 2008; studies carried out in adult populations; containing one or more of the key words in the title. Based on the 15 papers analyzed, it was concluded that compliance with a change of habit is a dynamic process that depends on various individual factors and requires greater interaction between professionals and patients in clinical practice. Promoting self-care depends on respecting the decisions and feelings resulting from personal experience.

Significados da dieta e mudanças de hábitos para portadores de doenças metabólicas crônicas: uma revisão / The significance of dietary and behavioral changes in patients with chronic metabolic disorders: a review

Eating behavior and the psycho-cultural significance of food for patients with chronic metabolic disorders have been a focus of interest due to the difficulty in ensuring the compliance of these patients in terms of changing their habits and in fostering self-care. A review of the literature was condusted using the LILACS and MEDLINE databases and the PUBMED search engine to identify qualitative studies in which the opinion of patients with respect to diet and lifestyle was analyzed. Key words used were: metabolic syndrome; eating behavior; diet; obesity; psychological factors; qualitative study; and dietary habits. Inclusion criteria consisted of: articles in English, Spanish or Portuguese, published between 2000 and 2008; studies carried out in adult populations; containing one or more of the key words in the title. Based on the 15 papers analyzed, it was concluded that compliance with a change of habit is a dynamic process that depends on various individual factors and requires greater interaction between professionals and patients in clinical practice. Promoting self-care depends on respecting the decisions and feelings resulting from personal experience.

Comportamento alimentar e significados psicoculturais da alimentação para portadores de distúrbios metabólicos crônicos têm sido foco de interesse em virtude da dificuldade de adesão às mudanças de hábitos e à promoção do autocuidado. Revisão bibliográfica foi realizada a partir das bases de dados Lilacs e Medline® e no sistema de busca Pubmed, visando estudos qualitativos que analisam a visão dos pacientes sobre dieta e estilo de vida. Palavras chaves: metabolic syndrome, eating behavior, diet, obesity, psychological factors, qualitative study e dietary habits. Critérios de inclusão: idioma inglês, espanhol ou português; período 2000 a 2008; população adulta; contendo um ou mais descritores no título. A partir de 15 artigos analisados foi concluído que a adesão às mudanças de hábitos é um processo dinâmico, dependente de vários fatores individuais para seu estabelecimento e requer maior interação entre profissionais e pacientes na prática clínica. A promoção do autocuidado depende do respeito às decisões e aos sentimentos decorrentes da vivência pessoal.

Percepções de pacientes sobre alimentação no seu processo de adoecimento crônico por síndrome metabólica: um estudo qualitativo / Perceptions of patients with metabolic syndrome regarding their diet during onset of the disease: a qualitative study

OBJETIVO: Investigar aspectos psicoculturais que envolvem as práticas alimentares e a imagem corporal no processo de adoecimento crônico por síndrome metabólica. MÉTODOS: Estudo clínico-qualitativo realizado por meio de entrevistas semidirigidas de questões abertas, submetidas à técnica de análise de conteúdo e interpretação dos dados com base no referencial teórico psicodinâmico. Foram entrevistados nove indivíduos em tratamento ambulatorial para síndrome metabólica em hospital universitário em Campinas (SP). RESULTADOS: Os resultados foram organizados empiricamente em três categorias: "Quem é gordo é horrível"; "O peso é muito e a gordura estorva demais"; "Como muito pouco. Ninguém acredita". Os sujeitos do estudo revelaram rejeição à obesidade, reforçada pela cultura de enaltecimento da magreza. A insatisfação com a imagem corporal leva os pacientes a um desvio de foco do problema, o que interfere no desenvolvimento do autocuidado e no manejo do tratamento dos distúrbios que caracterizam a síndrome metabólica. Tanto a dissociação entre as práticas alimentares e o excesso de peso quanto a utilização dos alimentos para preencher lacunas de ordem emocional expressam dificuldades de enfrentamento dos conflitos, o que colabora com o desvio de foco acima referido. CONCLUSÃO: O cuidado nutricional e as propostas dietéticas para portadores de síndrome metabólica devem estabelecer escuta acurada das demandas emocionais, que se manifestam por meio da insatisfação com a imagem corporal, das dificuldades para estabelecer mudanças nas práticas alimentares e/ou dos episódios de compulsão alimentar.

OBJECTIVE: This study aimed to investigate the psychological and cultural issues regarding dietary habits and body image during the onset of metabolic syndrome. METHODS: A clinical, qualitative study was conducted with a sample of nine outpatients being treated for metabolic syndrome at a university teaching hospital in Campinas, São Paulo, Brazil. Data were collected using semistructured interviews with open questions and then submitted to content analysis. Interpretation of data was based on a psychodynamic theoretical framework. RESULTS: The results were organized empirically into three categories: "Fat people look terrible"; "I am too heavy and my weight bothers me"; and "I eat so little; nobody believes it". The participants in this study revealed their rejection of obesity, reinforced by a culture that exalts thinness. Dissatisfaction with their body image resulted in the patients deflecting the focus of the problem, thereby affecting the development of self-care and management of the treatment for the metabolic disorders that characterize metabolic syndrome. Dissociation between dietary habits and excess weight, as well as the use of food to fill emotional gaps, reflect difficulties in facing conflicts and contribute towards deflecting the focus of the problem. CONCLUSION: Nutritional care and diets proposed for patients with metabolic syndrome should take into consideration emotional demands resulting from dissatisfaction with body image, difficulties in implementing changes in dietary habits and episodes of compulsive overeating.

Utilização de vídeo como estratégia de educação nutricional para adolescentes: comer... o fruto ou o produto? / Using video as a nutrition education strategy for adolescents: eating... the fruit or the product?

Este artigo consiste na avaliação do vídeo "Comer... o fruto ou o produto?", concebido como estratégia de educação nutricional para trabalhar com adolescentes. Os objetivos da pesquisa foram identificar elementos do vídeo que despertaram reflexão dos participantes sobre os tópicos da argumentação e identificar elementos do roteiro facilitadores e dificultadores da aproximação ao tema. O método caracterizou-se pelo emprego de análises qualitativas e quantitativas. Os sujeitos foram 14 mensageiros de instituição pública. Os dados foram levantados em dois momentos: o primeiro, coletivamente, em oficina, e o segundo, individualmente, através de entrevista, três meses após assistirem ao vídeo. Os elementos que despertaram reflexão nos adolescentes foram os personagens simbolizando a influência das marcas e o poder da publicidade, e uma cena de um homem comendo no lixo. Os fatores dificultadores foram as cenas mudas, as muito abstratas e as baseadas em valores de classe social diferente daquela a qual pertenciam os mensageiros.