The effect of birth timing manipulation around carnival on birth indicators in Brazil.

This paper studies the patterns and consequences of birth timing manipulation around the carnival holiday in Brazil. We document how births are displaced around carnival and estimate the effect of displacement on birth indicators. We show that there is extensive birth timing manipulation in the form of both anticipation and postponement that results in a net increase in gestational length and reductions in neonatal and early neonatal mortality, driven by postponed births that would otherwise happen through scheduled c-sections. We also find a reduction in birthweight for high-risk births at the bottom of the weight distribution, driven by anticipation. Therefore, restrictions on usual delivery procedures due to the carnival holiday can be both beneficial and detrimental, raising a double-sided issue to be addressed by policymakers.

The effects of a national policy to reduce c-sections in Brazil.

In this paper, we assess the effects of a national policy implemented in Brazil to avoid unnecessary cesareans. The policy has a supply-side component that prohibits elective c-sections before the 39th gestational week and a demand-side awareness component. Since the policy is not binding for cases with a strong medical c-section indication, we use births of breech- and transverse-positioned babies as a counterfactual for births of cephalic-positioned babies in a difference-in-differences framework. Our results reveal that the policy decreases the rate of c-sections by 1.6 percentage point, and slightly increases gestational time, birthweight, and first-minute APGAR scores. There is evidence that policy effectiveness is driven by its demand-side component.

The Role of Preschool Dosage and Quality in Children's Self-Regulation Development.

The present study examined how the dosage and quality of the federal preschool program "Head Start" (HS) in the US related to children's self-regulation skills in kindergarten. Using Propensity Score Matching and multiple regression (OLS), this study explored how the number of years and hours a week of HS were related to self-regulation among 2,383 children, who entered the program either at 3 or 4 years old. An additional year in HS was significantly positively associated with self-regulation in kindergarten, while the number of hours a week in HS was not. However, the quality of teacher-child interactions moderated the relation between hours a week in HS and self-regulation. Findings contribute to the growing body of evidence about how dosage and quality of early childhood education experiences relate to children's development.

Enriching cross-sectoral collaboration to foster inclusive cultures in schools: a Model to address the needs of diverse Chilean Students.

Inclusive education involves the interaction of diverse actors from different societal sectors, such as education, health, and policy. Inclusion laws and regulations in Chile are relatively new and have been taken as a regional model. However, the efforts to implement them have revealed some structural difficulties that must be discussed. This conceptual analysis article aims to provide insights to enrich cross-sectoral collaboration to foster inclusive cultures in Chilean schools. Considering the OECD Analytical Framework, which describes a systemic approach, we provide definitions for the critical components of the model and discuss the advances and challenges of current Chilean public policies in this field -including the Chile Crece Contigo and the School Integration Programs (SIP)-, the Chilean education system functioning, the social contexts, and students' needs and supports based on the available evidence. Building from inclusive education literature and previous experiences, we delve into the model to address the needs of students with disabilities, social and cultural disadvantages, students belonging to the indigenous population, and students with a low socioeconomic level to propose action guidelines with a particular focus on integrating inclusive practices at the school level.

Pulmonary and Gastrointestinal Parasitic Infections in Small Ruminant Autochthonous Breeds from Centre Region of Portugal-A Cross Sectional Study.

The production of small ruminant autochthonous breeds in the Centre region of Portugal is practiced in a semi-extensive husbandry system, exposing animals to parasitic infections. The main objective of this study was to estimate the prevalence of lungworm infection and identify risk factors. Fecal samples of 203 goats and 208 sheep from 30 herds were collected per rectum and subjected to the modified Baermann test. The overall prevalence of infection was 57.7%, significantly higher in goats (95.6%) than in sheep (20.7%) (p < 0.001). According to the binary logistic regression model, sheep dewormed with albendazole, mebendazole plus closantel, or ivermectin plus clorsulon presented a risk of Protostrongylidae infection 29.702, 7.426, or 8.720 times higher, respectively, than those dewormed with eprinomectin. Additionally, the presence of gastrointestinal parasites was investigated in 307 fecal samples using Mini-FLOTAC®. The overall prevalence of infection was 86.3%, also significantly higher in goats (93.2%) than in sheep (79.9%) (p < 0.001). Strongyle-type eggs were the most frequently identified, both in sheep (69.8%) and goats (87.8%), followed by Eimeria oocysts (40.3% in sheep and 68.9% in goats). Considering the high prevalence and the burden of lungworm parasitic infection, it is urgent to determine its economic impact and the repercussions in animal health in the Centre region of Portugal to establish appropriate therapeutic guidelines.

Pregnant women autonomy when choosing their method of childbirth: Scoping review.

This paper has as its theme the autonomy of pregnant women in relation to choosing the method of birth for their child. The objective was to carry out a scoping review to study the literature and evidence of how autonomy is being offered to parturient women. Study design and location: In October 2023, a search was carried out using the terms "pregnant women" AND "delivery" AND "autonomy" in the following databases: PubMed, Web of Science, Scopus, Scielo and LILACS. The search included articles from 2016 to 2023. Of the 179 articles found, 15 met the criteria and were selected for this review. Results: the pregnant woman's autonomy in choosing the method of childbirth is influenced by several factors, such as the obstetrician's recommendation, the medical team, and negative and positive experiences. Thus, when this autonomy is shared with the obstetrician, the obstetrician recommends cesarean section as the safest route, but does not explain the benefits and harms of both routes (vaginal and cesarean section), causing the woman to accept the cesarean section. Midwives recommend vaginal birth because they believe it to be natural and safe and explain the benefits and harms of both methods, respecting the pregnant woman's choice of the method she prefers. Conclusion: women have the fundamental right to choose their method of birth and must be properly guided throughout prenatal care, whether by an obstetrician or a midwife, about the options, risks and benefits of each method of childbirth, respecting the ethical principle of beneficence.

Perinatal complications of the maternal-Fetal dyad in primiparous women subjected to vaginal delivery versus elective cesarean section: A retrospective study of clinical results associated with bioethical precepts.

The obstetrics field is undergoing transformation and committing to ensuring the autonomy of pregnant women in decisions related to birth based on scientific information. The physiological process of birth typically results in vaginal delivery, but medicine has evolved to include obstetric surgeries that are safe and result in few perioperative complications, especially when cesarean section is performed from 39 weeks of gestational age. Thus, the question is whether clinicians should interfere with pregnant women's freedom to choose their mode of delivery by trying to persuade them to choose vaginal delivery. The objective was to analyze the perinatal complications of the maternal-fetal dyad in primiparous women subjected to vaginal delivery versus elective cesarean section with respect to the bioethical precepts of autonomy, beneficence and nonmaleficence. In total, 2,507 women, including 1,807 (72.1%) with vaginal deliveries and 700 (27.9%) with cesarean deliveries, were analyzed between 2017 and 2020. There was no difference between the types of delivery in maternal readmission, death, admission to the intensive care unit, an Apgar score <7 in the 5th minute of life, maternal blood transfusion or comorbidities of the mothers or newborns. The elective cesarean section group showed less need for therapeutic uterotonics. In primigravidae, it was observed that elective cesarean section did not present a higher risk of complications than vaginal delivery. Therefore, this guarantees the autonomy and right of the individual to choose the mode of delivery.

Glutathione levels are associated with methotrexate resistance in acute lymphoblastic leukemia cell lines.

Introduction: Methotrexate (MTX), a folic acid antagonist and nucleotide synthesis inhibitor, is a cornerstone drug used against acute lymphoblastic leukemia (ALL), but its mechanism of action and resistance continues to be unraveled even after decades of clinical use. Methods: To better understand the mechanisms of this drug, we accessed the intracellular metabolic content of 13 ALL cell lines treated with MTX by 1H-NMR, and correlated metabolome data with cell proliferation and gene expression. Further, we validated these findings by inhibiting the cellular antioxidant system of the cells in vitro and in vivo in the presence of MTX. Results: MTX altered the concentration of 31 out of 70 metabolites analyzed, suggesting inhibition of the glycine cleavage system, the pentose phosphate pathway, purine and pyrimidine synthesis, phospholipid metabolism, and bile acid uptake. We found that glutathione (GSH) levels were associated with MTX resistance in both treated and untreated cells, suggesting a new constitutive metabolic-based mechanism of resistance to the drug. Gene expression analyses showed that eight genes involved in GSH metabolism were correlated to GSH concentrations, 2 of which (gamma-glutamyltransferase 1 [GGT1] and thioredoxin reductase 3 [TXNRD3]) were also correlated to MTX resistance. Gene set enrichment analysis (GSEA) confirmed the association between GSH metabolism and MTX resistance. Pharmacological inhibition or stimulation of the main antioxidant systems of the cell, GSH and thioredoxin, confirmed their importance in MTX resistance. Arsenic trioxide (ATO), a thioredoxin inhibitor used against acute promyelocytic leukemia, potentiated MTX cytotoxicity in vitro in some of the ALL cell lines tested. Likewise, the ATO+MTX combination decreased tumor burden and extended the survival of NOD scid gamma (NSG) mice transplanted with patient-derived ALL xenograft, but only in one of four ALLs tested. Conclusion: Altogether, our results show that the cellular antioxidant defense systems contribute to leukemia resistance to MTX, and targeting these pathways, especially the thioredoxin antioxidant system, may be a promising strategy for resensitizing ALL to MTX.

Different forms of administration of biotherapy 7dH in mice experimentally infected by Trypanosoma cruzi produce different effects.

OBJECTIVE: To evaluate the effects of different forms of administration of the blood trypomastigotes biotherapy 7dH in mice experimentally infected with Trypanosoma cruzi. MATERIAL AND METHODS: Male swiss mice were inoculated with 1400 blood trypomastigotes of the Y strain of T. cruzi and allocated into 5 treatment groups: IC (distilled water); TCBZ (benznidazole); TBA(7dH) (biotherapy 7dH 20 days after infection); TBB(7dH)7 (biotherapy 7dH seven days before infection); TBB(7dH)30 (biotherapy 7dH 30 days before infection). Parasitological parameters assessed included pre-patent and patent periods, parasitemia peak, total parasitemia, mortality and survival rates. Cure index was obtained by fresh blood examination, hemoculture and polymerase chain reaction (PCR). RESULTS: The TBB(7dH)7 group showed a reduction in parasitemia peak, parasitemia area under the curve and total parasitemia. TBB(7dH)30 showed a tendency to increased pre-patent and survival periods, peak parasitemia was increased without increased total parasitemia. TBA(7dH) did not present significant alterations in the parasitological parameters analyzed. CONCLUSIONS: Biotherapy 7dH given before infection (7 or 30 days) produces different effects suggesting modulation of the host's immune system. The effects range from reduced parasitemia to its effective increase. The use of biotherapy to treat T. cruzi infection including dose, potency and schedule deserves further investigation.

Corrigendum to "Assesment of SARS-CoV-2 infection-in dentists and supporting staff at a university dental hospital in Argentina". Journal of Oral Biology and Craniofacial Research Volume 11, Issue 2 (2021) Pages 169-173.

[This corrects the article DOI: 10.1016/j.jobcr.2021.01.006.].

Data on statistical experimental design to formulate amphotericin B-loaded Eudragit RL100 nanoparticles coated with hyaluronic acid for the treatment of vulvovaginal candidiasis.

Data described in this article are related to the research article entitled "Amphotericin B-loaded Eudragit RL100 nanoparticles coated with hyaluronic acid (AMP EUD nanoparticles/HA) for the treatment of vulvovaginal candidiasis" [1]. In this work, we report original data on the statistical experimental design to formulate uncoated AMP EUD nanoparticles, data on the validation of spectrophotometric method to quantify the AMP released from uncoated EUD nanoparticles and coated with HA to obtain the in vitro drug release profiles as well as the drug encapsulation efficiency. In addition, we describe original data on characterization, including diameter size, polydispersity index, zeta potential, FTIR, DSC/TG, and XRD; data on diameter of in vitro inhibition halos of Candida albicans; and on the vaginal burden of infected animals treated with uncoated AMP EUD nanoparticles and AMP EUD nanoparticles/HA. Finally, different histological sections of endocervix collected from treated and untreated animals were inserted into this manuscript.

Amphotericin B-loaded Eudragit RL100 nanoparticles coated with hyaluronic acid for the treatment of vulvovaginal candidiasis.

The treatment of vulvovaginal candidiasis (VVC) is based on oral and vaginal formulations which show limited effectiveness. In this study, amphotericin B-loaded Eudragit RL100 nanoparticles coated with hyaluronic acid (AMP EUD nanoparticles/HA) were developed to overcome the drawbacks of the conventional formulations. AMP EUD nanoparticles/HA were synthesized by nanoprecipitation, formulated by statistical experimental design, and characterized. AMP release from EUD nanoparticles/HA and its antifungal activity in a murine model of VVC were evaluated. Nanoparticles showed 147.6 ±â€¯16.7 nm of diameter, 0.301 ±â€¯0.09 of polydispersity index, - 29.9 ±â€¯3.76 mV of zeta potential, and 87.27 % of encapsulation efficiency. They released about 81 % of AMP in 96 h; and provided the elimination of 100 % of the vaginal fungal burden in 24 h. It was suggested that the AMP EUD nanoparticles/HA penetrated into the vaginal epithelium via CD44 receptors. These AMP EUD nanoparticles/HA represent a non-conventional vaginal formulation to improve the treatment of VVC.

Changes of RAPD profile of Trypanosoma cruzi II with Canova and Benznidazole.

Chagas disease, caused by the protozoan Trypanosoma cruzi, involves immunomediated processes. Canova (CA) is a homeopathic treatment indicated in the diseases in which the immune system is depressed. This study evaluated the Random Amplification of Polymorphic DNA (RAPD) profile of T. cruzi under the influence of CA and Benznidazole (BZ). Mice infected with the genetic lineage of T. cruzi II (Y strain) were divided into 4 groups: Infected animals treated with saline solution (control group); treated with CA; treated with BZ; treated with CA and BZ combined. Treatment was given at the 5th-25th days of infection (D5-25). The parasites were isolated by haemoculture in Liver Infusion Tryptose (LIT) medium: at D5 (before treatment), D13, 15 and 25 (during treatment) and D55 and 295 (after treatment). DNA was extracted from the mass of parasites. RAPD was done with the primers lambdagt11-F, M13F-40 and L15996, the amplified products were eletrophoresed through a 4% polyacrylamide gel. Data were analyzed by the coefficient of similarity using the DNA-POP program. 163 markers were identified, 5 of them monomorphic. CA did not act against the parasites when used alone. The RAPD profiles of parasites treated with BZ and CA+BZ were different from those in the control group and in the group treated with CA. The actions of the CA and BZ were different and the action of BZ was different from the action of CA+BZ. These data suggest that CA may interact with BZ. The differences in the RAPD profile of the Y strain of T. cruzi produced by BZ, CA+BZ and the natural course of the infection suggest selection/suppression of populations.

Yeasts from Canastra cheese production process: Isolation and evaluation of their potential for cheese whey fermentation.

Canastra cheese is a cheese with geographical indication recognized by the Brazilian National Institute of Industrial Protection under number IG201002. It is produced in seven municipalities in the state of Minas Gerais in a region called Serra da Canastra. In this work, samples of milk, "pingo" (natural starter), whey and Canastra cheese were collected on a farm in Medeiros-MG/Brazil to evaluate the yeast microbiota and select yeasts for whey fermentation to produce ethanol and volatile aromatic compounds of relevance in the production of cheese. Thirty-nine isolates capable of fermenting lactose in a synthetic medium were identified by MALDI-TOF as Kluyveromyces lactis (29), Torulaspora delbrueckii (7) and Candida intermedia (3). Eleven isolates of K. lactis and three of T. delbrueckii efficiently fermented lactose until 4th day, and due to this reason were selected for cheese whey fermentation with Brix 12, 14 and 18. Generally, the isolates T. delbrueckii B14, B35, and B20 and K. lactis B10 were the most effective regardless of the initial Brix value. The identification of these four isolates by MALDI TOF was confirmed by sequencing of the ITS region. In the fermentation of cheese whey 14 Brix, T. delbrueckii B14 and B35, respectively yielded 24.06g/L and 16.45g/L of ethanol, while K. lactis B10 was more efficient in the consumption of lactose. In sequential culture with K. lactis B10 inoculated 48h after T. delbrueckii B14, 97.82% of the total sugars were consumed resulting in the production of 19.81g/L ethanol and 39 aromatic volatile compounds. The most abundant compounds were 3-methyl-1-butanol, octanoic acid and ethyl decanoate, which are reported as important for the aroma and flavor of cheeses. Based in our results, B10 isolate inoculated 48h after B14 isolate is a promising yeast inoculum to be used for fermentation of dairy substrates.

Gravidez ectópica em cicatriz de cesárea: série de casos com três possibilidades terapêuticas diferentes / Cesarean scar pregnancy: case series with three different types of management

A gestação ectópica em cicatriz de cesariana prévia é um evento iatrogênico raro, que vem crescendo junto com o aumento das taxas de cesariana. Ela não exi- be manifestação clínica específica, o que dificulta o diagnóstico e não apresenta tratamento preconizado, embora esteja associada a grandes complicações obsté- tricas como hemorragia incoercível, acretismo placentário e rotura uterina. Dessa forma, o presente artigo relata três casos clínicos em que diferentes tratamentos foram propostos, objetivando discutir algumas possibilidades terapêuticas como a aspiração manual intrauterina (AMIU) associada com o uso de metotrexato, lapa- roscopia e laparotomia, comparando os resultados encontrados.(AU)

Ectopic cesarean scar pregnancy is a rare iatrogenic event, which has been increase with growing in the percentage of cesarean delivery. It does not exhibit specific cli- nical manifestation, making diagnosis difficult and does not have yet recommended treatment, although is associated with major obstetrics complication such incoer- cible hemorrhage, abnormally invasive placenta and uterine rupture. Therefore, the present article reports three clinical cases witch different types of management, ai- ming discuss some possibilities such intrauterine manual aspiration after systemic methotrexate, laparoscopy or laparotomy surgical, comparing results.(AU)

Protocolo Calma nessa hora: acolhimento interdisciplinar em saúde mental para situações de crise e emergências / Keep Calm protocol: interdisciplinary support in mental health for crisis and emergencies situations / Protocolo Calma en esta hora: acogimiento interdisciplinario en salud mental para situaciones de crisis y emergencias

O estudo apresenta o protocolo de acolhimento do Calma Nessa Hora, um serviço de e-health via chat, de apoio a pessoas em sofrimento psicológico diante da COVID-19. Foi elaborado um diagrama de fluxo de atendimento com previsão de início e fim em uma sessão, contendo três etapas: avaliação, acolhimento e finalização. Cada etapa possuía marcos de tomada de decisão sobre o fluxo diante do conteúdo e do grau de risco da demanda. Na etapa de acolhimento foram priorizadas demandas de baixo e médio risco associadas à COVID-19, como questões sociais e de saúde; ansiedade, depressão ou luto; conflitos familiares e de trabalho. Situações de elevado risco, como intenção suicida e violência, seguiram fluxo específico de encaminhamento para a rede de saúde. O artigo descreve cada etapa e os diferentes fluxos a partir de casos-exemplo. O protocolo é interdisciplinar, com potencial aplicação em serviços de atenção à saúde e serviços-escola nas universidades

This paper presents the protocol of support from Keep Calm, an e-health service via chat for people suffering from psychological distress related to COVID-19. A flowchart diagram of one-session chats was developed. Each session consisted of three steps: evaluation, support and conclusion. For each stage, decision-making milestones on what to do next were taken according to content and risk degree of the demand. At the support step, demands related toCOVID-19 that did not involve high-risk situations were prioritized, that is, social and health issues, anxiety, depression symptoms or grief, and family or work conflicts. High-risk situations such as suicidal intention and violence, followed a specific referral flow to healthcare services. The article describes each step in detail and exemplifies the different flows according to case examples. The protocol is interdisciplinary and has the potential to be applied in health care services and school care services in universities

El estudio presenta el protocolo del apoyo del Calma En Esta Hora, un servicio de e-health via chat de apoyo para personas con problemas psicológicos como consecuencia de COVID-19. Se preparó un flujograma con inicio y fin en una sesión, en tres etapas: evaluación, acogimiento y finalización. Para cada etapa se definieron hitos de decisión sobre el flujo en función del contenido y el grado de riesgo de la demanda. En la etapa de acogida, se priorizaron las demandas de bajo y medio riesgo asociadas a Covid-19, como problemas sociales y de salud; ansiedad, depresión o duelo; conflictos familiares y laborales. Las situaciones de alto riesgo, como intención de suicídio y violencia, siguieron un flujo específico a la red sanitaria. El artículo describe cada paso y los flujos basándose en casos de ejemplo. El protocolo es interdisciplinario con potencial aplicación en los servicios de salud y en las universidades

Pandemics and communication: an experimental assessment / Pandemias y comunicación: una evaluación experimental / Pandemias e comunicação: uma avaliação experimental

Abstract Communication is a key factor in containing a pandemic. Fragmented information may affect people's perceptions and behaviors, especially in times of governmental miscommunication, potentially jeopardizing efforts aimed at containing the spread of the disease. To test whether and how people have been sensitive to broken information during the COVID-19 pandemic in Brazil, we performed a randomized survey experiment on a sample of 571 respondents. We found that more pessimistic or more optimistic fragmented messages about the pandemic have no overall significant average effect on perceptions and planned behavior of the respondents. The exploratory analyses showed that particular sociodemographic groups are more sensitive to these fragmented messages. While less educated people react to more pessimistic messages with an increased likelihood to intensify prevention measures, people aged 60 or older - the high-risk group for COVID-19 complications - react to more optimistic messages with a reduced probability to intensify prevention measures. Besides providing insights to the public administration literature on disaster management, the results reinforce the need for governments to consistently centralize communication efforts to guarantee that people are equipped with complete and accurate information to form their perceptions and adequate their behaviors towards a health crisis.

Resumen En un intento por contener una pandemia, la comunicación puede ser la clave del éxito o el fracaso. La información fragmentada puede afectar las percepciones y los comportamientos de las personas, especialmente en tiempos de mala comunicación del gobierno, lo que puede socavar sus esfuerzos de colaboración para prevenir la propagación de la enfermedad. Para testar si las personas son sensibles a la información fragmentada durante la pandemia de COVID-19 en Brasil, utilizamos un experimento aleatorio con 571 encuestados. Nuestros resultados indican que los mensajes rotos, más pesimistas o más optimistas, con respecto a la pandemia no tienen un efecto medio significativo en las percepciones y los comportamientos planificados de los encuestados. Sin embargo, en un análisis más exploratorio, nuestros resultados muestran que ciertos grupos sociodemográficos son más sensibles a dicha información fragmentada. Mientras que las personas con un bajo nivel de educación reaccionan a mensajes más pesimistas con una mayor probabilidad de intensificar las medidas preventivas, las personas mayores (de 60 años o más), que conforman el grupo riesgo de complicaciones resultantes del nuevo coronavirus, reaccionan a mensajes más optimistas con una gran reducción en la posibilidad de que intensifiquen las medidas preventivas. Además de contribuir a la literatura sobre gestión de desastres, nuestro trabajo refuerza la necesidad de que los gobiernos centralicen los esfuerzos de comunicación para garantizar que las personas reciban información completa y precisa para formar sus percepciones y adaptar sus comportamientos a una crisis de salud pública.

Resumo Na tentativa de conter uma pandemia, comunicação pode ser a chave para o sucesso ou para o fracasso. Informações fragmentadas podem afetar as percepções e comportamentos das pessoas, especialmente em tempos de má comunicação governamental, potencialmente minando os seus esforços colaborativos para impedir a disseminação da doença. Para testar se e como as pessoas se apresentam sensíveis a informações quebradas durante a pandemia da COVID-19 no Brasil, usamos um experimento aleatório junto a 571 respondentes. Nossos resultados apontam que mensagens quebradas, mais pessimistas ou mais otimistas, com relação à pandemia não têm um efeito médio significante nas percepções e comportamentos planejados dos respondentes. Numa análise mais exploratória, no entanto, nossos resultados mostram que certos grupos sociodemográficos são mais sensíveis a tais informações quebradas. Enquanto pessoas com baixo nível de escolaridade reagem a mensagens mais pessimistas com um aumento na chance de elas intensificarem medidas de prevenção, pessoas mais velhas (com 60 anos ou mais) - que compõem o grupo de risco para complicações decorrentes do novo coronavírus - reagem a mensagens mais otimistas com uma grande redução na chance de elas intensificarem medidas de prevenção. Além de contribuir com a literatura de gestão de desastres, nosso trabalho reforça a necessidade de governos centralizarem esforços de comunicação, de forma a garantir que as pessoas estejam munidas com informações completas e precisas para formarem suas percepções e adequarem seus comportamentos a uma crise de saúde pública.

Nutritional Care for older adults in Primary Health Care, from the perspective of health professionals / Atenção Nutricional à pessoa idosa na Atenção Primária à Saúde, sob a ótica de profissionais de saúde

Abstract Objective: to characterize and analyze Nutritional Care (NC) for older adults in Primary Health Care (PHC), identifying how food and nutrition actions (F&N) were performed and the conceptions that guided them. Methods: a cross-sectional, quantitative and qualitative study was performed in PHC in Santos, São Paulo, Brazil, in two phases: i) a census study was carried out of health units, N=28 (100%), with managers who answered a structured interview to assess NC; followed by descriptive analysis. ii) a deeper investigation of this diagnosis was performed, using semi-structured interviews with key informants (interviewees) of care for older adults; being a nutritionist was not a criteria, as there were only three such professionals throughout the entire PHC, and one of the health regions studied was not served by a nutrition professional. The concept of theoretical saturation was used for the sampling plan; content analysis was carried out and the inferences were supported by references of integrality and aging. Results: NC for older adults was highlighted by individual care, predominant in all the services studied (28) (100%); nutritionists participated in this activity in just nine units (32.1%). Theoretical saturation was achieved with nine interviews. According to the discourse analysis, F&N actions were generic, focused on the treatment of diseases, influenced by negative aspects attributed to aging, there was no planning based on the needs of the territory, and health professionals identified themselves as information transmitters, leaving the responsibility of acting on such information to the older adults themselves. Conclusion: F&N actions were guided by the biomedical paradigm, fragmented, restricted to disease management, imputing the responsibility for health to the individual themselves. Thus, NC distanced itself from the promotion of healthy aging, weakening its strategic role in the quest for integrated care.

Resumo Objetivo: caracterizar e analisar a Atenção Nutricional (AN) à pessoa idosa na Atenção Primária à Saúde (APS), identificando como se realiza e as concepções que permeiam as ações de alimentação e nutrição (A&N). Método: estudo transversal, quanti-qualitativo, realizado na APS de Santos SP, Brasil, em duas etapas. i) correspondeu a um estudo censitário das unidades de saúde, N=28 (100%), com participação de gestores de todos os serviços, mediante respostas a instrumento estruturado para diagnóstico da AN. Analisaram-se descritivamente os dados. ii) consistiu no aprofundamento desse diagnóstico, utilizando entrevista semiestruturada com informantes-chave (entrevistados) do cuidado às pessoas idosas; ser nutricionista não foi um critério, pois havia três para toda a APS e uma das regiões de saúde estudadas não contava com esse profissional. Utilizou-se o conceito de saturação teórica para o plano amostral; realizou-se análise de conteúdo e as inferências pautaram-se em referenciais teóricos de integralidade e envelhecimento. Resultados: A AN à pessoa idosa destacou-se pela predominância de atendimento individual nas 28 (100%) unidades estudadas; em apenas nove (32,1%) destas havia participação de nutricionista. Atingiu-se a saturação teórica temática com nove informantes-chave. As ações de AN revelaram-se genéricas, orientadas à assistência às doenças, inexistindo planejamento, segundo demandas dos territórios. Os entrevistados vincularam aspectos negativos ao envelhecimento e identificaram o seu papel como de transmissores de conhecimento, cabendo à pessoa idosa aplicá-lo. Conclusão: As ações de AN orientaram-se pelo paradigma biomédico, eram fragmentadas, restritas ao manejo de doenças, imputando exclusivamente ao indivíduo a responsabilidade pelo próprio cuidado. Assim, a AN afastou-se da promoção de envelhecimento saudável, enfraquecendo seu caráter estratégico para o alcance da integralidade.