Encuesta a profesionales sobre la nueva base de datos de composición de alimentos de Uruguay / Survey of professionals on the new database of food composition in Uruguay

Introducción. El Capítulo Nacional URUGUAYFOODS, perteneciente a la Red Latinoamericana de Composición de Alimentos (LATINFOODS, INFOODS, FAO), realizó recientemente una investigación para identificar cuáles tablas/bases de datos de composición de alimentos (TCA/ BDCA) utilizan los profesionales nacionales, así como la percepción de sus limitaciones, con el fin de ser tenidos en cuenta en la creación de la nueva BDCA nacional. Objetivo. Caracterizar el uso de las TCA/BDCA de composición de alimentos y describir las características y limitaciones de las mismas, mediante el análisis de la encuesta realizada a profesionales del área de salud, nutrición y alimentos de Uruguay en el año 2022. Materiales y métodos. Se trató de un estudio cuantitativo, descriptivo y transversal. La información fue obtenida a través de una encuesta de participación voluntaria. La muestra estuvo conformada por 94 profesionales nacionales. Se analizó la variable uso y frecuencia de uso de dichas herramientas respecto a la edad y población específica con la que trabaja el profesional encuestado. Resultados. La preferencia de uso fue la base de datos USDA y CENEXA, antes que la TCAU, resultando en una debilidad importante en todas las áreas en donde se utilicen estos datos, pues no refleja los hábitos ni costumbres de la población. Conclusiones. Los potenciales usuarios de la nueva BDCA nacional pretenden que sea de acceso fácil y gratuito, en idioma español, en formato digital, con información actualizada y con posibilidad de elección de datos en porción o cada 100 gramos(AU)

Introduction. The URUGUAYFOODS National Chapter, belonging to the Latin American Food Composition Network (LATINFOODS, INFOODS, FAO), recently carried out an investigation to identify which food composition tables and databases (TCA and BDCA) are used by national professionals, as well as the perception of their limitations, in order to be taken into account in the creation of the new national BDCA. Objective. Characterize the use of TCAs and BDCAs for food composition and describe their characteristics and limitations through the analysis of the survey carried out among professionals in the area of health, nutrition, and food in Uruguay in 2022. Materials and methods. It was a quantitative, descriptive, and cross-sectional study. The information was obtained through a voluntary participation survey. The sample consisted of 94 national professionals. The variable use and frequency of these tools were analyzed with respect to the age and specific populations with which the surveyed professional works. Results. The preference for use was the USDA and CENEXA databases rather than the TCAU, resulting in a significant weakness in all areas where these data are used since they do not reflect the habits and customs of the population. Conclusions. Potential users of the new national BDCA want it to be easily and freely accessible, in Spanish, in digital format, with up-to-date information, and with the possibility of choosing data in portions or every 100 grams(AU)

Broadening risk factor or disease definition as a driver for overdiagnosis: A narrative review.

Medical overuse-defined as the provision of health services for which potential harms exceed potential benefits-constitutes a paradigm of low-value care and is seen as a threat to the quality of care. Value in healthcare implies a precise definition of disease. However, defining a disease may not be straightforward since clinical data do not show discrete boundaries, calling for some clinical judgment. And, if in time a redefinition of disease is needed, it is important to recognize that it can induce overdiagnosis, the identification of medical conditions that would, otherwise, never cause any significant symptoms or lead to clinical harm. A classic example is the impact of recommendations from professional societies in the late 1990s, lowering the threshold for abnormal total cholesterol from 240 mg/dl to 200 mg/dl. Due to these changes in risk factor definition, literally overnight there were 42 million new cases eligible for treatment in the United States. The same happened with hypertension-using either the 2019 NICE guidelines or the 2018 ESC/ECC guidelines criteria for arterial hypertension, the proportion of people overdiagnosed with hypertension was calculated to be between 14% and 33%. In this review, we will start by discussing resource overuse. We then present the basis for disease definition and its conceptual problems. Finally, we will discuss the impact of changing risk factor/disease definitions in the prevalence of disease and its consequences in overdiagnosis and overtreatment (a problem particularly relevant when definitions are widened to include earlier or milder disease).

The Uncanny of the Illness Experience: Can Phenomenology Help?

The illness experience encompasses not only several changes in bodily processes but also the very feeling of becoming ill. This seemingly non-scientific aspect of being sick is characterized by forms of uncanny body experiences and an unhomelike being-in-the-world. Both include disconcerting phenomena, feelings of fear, restlessness, and inexplicability. In this paper we discuss some contributions aiming to understand the illness experience, focusing on the concept of the uncanny. This life event brings changes in the familiarity of our world, revelation of what previously was and should have remained hidden, loss of control, and the certainty of mortality. The experience of uncanniness is here conceptualized as a psychopathological phenomenon that should be regarded as a general symptom of diseases and should be identified and approached. We discuss the impact of these considerations on medical practice, focusing on the role of physicians and ultimately on the purpose of medicine.

Spatial analysis on tuberculosis and the network of primary health care / Análisis espacial en tuberculosis y la red de atención primaria en salud / Análise espacial em tuberculose e a rede de atenção primária em saúde

ABSTRACT Objective: to analyze the spatial distribution of new cases of tuberculosis compared to the location of the Primary Healthcare Units that performed the compulsory notification. Method: ecological study conducted in Belém, Pará, with 5,294 new cases of tuberculosis notified to Sistema de Informação de Agravos de Notificação for the period from 2010 to 2014. The cases were georeferenced using the software applications ArcGis 10.2 and TerraView 4.2.2. The techniques of Kernel density and global Moran geostatistics were used. Results: the incidence of tuberculosis cases did not vary significantly between the years studied, however there was a variation in incidence between neighborhoods. Health units that exhibited higher number of notifications can suffer great influence of migration from nearby neighborhoods. Conclusion: the spatial dynamics of tuberculosis associated with health services allows to know the areas with increased risk of tuberculosis and the density of notifications of health units.

RESUMEN Objetivo: analizar la distribución espacial de los nuevos casos de tuberculosis, relacionándolos con la ubicación de las Unidades de Atención Primaria en Salud que realizaron la notificación obligatoria. Método: estudio ecológico realizado en Belém (Pará, Brasil) con 5.294 nuevos casos de tuberculosis notificados al Sistema de Información de Agravios de Notificación (Sinan) en el período del 2010 al 2014. Los casos fueron georreferenciados por medio de los programas informáticos ArcGis 10.2 y TerraView 4.2.2. Se emplearon la técnica de densidad Kernel y la técnica geoestadística Moran global. Resultados: la incidencia de casos de tuberculosis no presentó variación significativa entre los años estudiados, sin embargo hubo una variación de la incidencia entre los barrios. Las unidades de salud que presentaron un mayor número de notificaciones pueden sufrir gran influencia de la migración de los barrios vecinos. Conclusión: la dinámica espacial de la tuberculosis asociada a los servicios de salud permite conocer las áreas con mayor riesgo de tuberculosis y la densidad de notificaciones de las unidades de salud.

RESUMO Objetivo: analisar a distribuição espacial dos casos novos de tuberculose relacionando-os com a localização das Unidades de Atenção Primária em Saúde que realizaram a notificação compulsória. Método: estudo ecológico realizado em Belém, Pará, com 5.294 casos novos de tuberculose notificados ao Sistema de Informação de Agravos de Notificação no período de 2010 a 2014. Os casos foram georreferenciados por meio dos softwares ArcGis 10.2 e TerraView 4.2.2. Foram usadas a técnica de densidade Kernel e a técnica geoestatística Moran global. Resultados: a incidência de casos de tuberculose não variou de forma significativa entre os anos estudados, porém houve uma variação da incidência entre os bairros. As unidades de saúde que exibiram maior número de notificações podem sofrer grande influência da migração dos bairros vizinhos. Conclusão: a dinâmica espacial da tuberculose associada aos serviços de saúde permite conhecer as áreas com maior risco de tuberculose e a densidade de notificações das unidades de saúde.

Spatial analysis on tuberculosis and the network of primary health care.

OBJECTIVE: to analyze the spatial distribution of new cases of tuberculosis compared to the location of the Primary Healthcare Units that performed the compulsory notification. METHOD: ecological study conducted in Belém, Pará, with 5,294 new cases of tuberculosis notified to Sistema de Informação de Agravos de Notificação for the period from 2010 to 2014. The cases were georeferenced using the software applications ArcGis 10.2 and TerraView 4.2.2. The techniques of Kernel density and global Moran geostatistics were used. RESULTS: the incidence of tuberculosis cases did not vary significantly between the years studied, however there was a variation in incidence between neighborhoods. Health units that exhibited higher number of notifications can suffer great influence of migration from nearby neighborhoods. CONCLUSION: the spatial dynamics of tuberculosis associated with health services allows to know the areas with increased risk of tuberculosis and the density of notifications of health units.

O perfil socioeconômico e clínico de pacientes matriculados no programa hiperdia em Belém (PA) / Social, economic and clinical profile of patients enrolled in the hiperdia program in Belém, Brazil

Analisar o perfil socioeconômico e clínico de pacientes hipertensos matriculados na Estratégia Saúde da Família, do bairro do Parque Verde, no programa HiperDia, em Belém, Pará, Brasil. Estudo transversal, descritivo, observacional, de natureza quantitativa. A amostra do estudo foi selecionada por amostragem não probabilística por conveniência constituída por 75 pacientes cadastrados no programa; foi aplicado um questioná­rio, no período de outubro e novembro/2015, que constou de variáveis de caráter socioeconômico e dados clínicos. Dos 75 hipertensos, 65% são do sexo feminino, 58% se encontram na faixa etária de 60 anos ou mais e 42% na faixa etária de 30 a 59 anos, 45% são casados, 61% recebem até um salário mínimo, 68% com ensino fundamental incompleto. O perfil dos hipertensos da pesquisa não difere de estudos nacionais e locais. Dessa forma, é possível observar a necessidade de implementar ações de promoção à saúde, visando direcionar práticas para melhorar a qualidade de vida da população.

The socio-economic and clinical profile of patients suffering from hypertension enrolled for the Family Health Strategy in the district Parque Verde, in the HiperDia program in Belém PA Brazil, is analyzed. The transversal, descriptive, observational and quantitative study comprised 75 patients enrolled in the program. Sample was selected by non-probabilistic, convenience sampling. A questionnaire, featuring socio-economic variables and clinical data, was applied in October and November 2015. 65% of the 75 hypertensive patients were female; 58% were within the 60-year-old bracket; 42% were within the 30-59-year-old bracket; 45% were married; 61% received minimum wage; 68% had incomplete basic education. The profile of these hypertension patients did not differ from those studied in nation and local research. Implementing activities for health promotion were required to direct practices for the improvement of the population´s life quality.

Incontinência urinária feminina e fatores de risco / Female urinary incontinence and risk factors

Este estudo teve como objetivo realizar uma revisão literária acerca dos fatores de risco associados à incontinência urinária (IU). A revisão de literatura estendeu-se de fevereiro a novembro de 2005, mediante o levantamento bibliográfico em livros de acervos particulares e nas bases de dados Lilacs, Scielo, Pub Med, Cochrane, Medline utilizando-se as seguintes palavras-chave: incontinência urinária feminina, fatores de risco, epidemiologia e prevalência. A IU é definida como qualquer perda involuntária de urina e tem como etiologia alterações vesicais ou uretrais. O assoalho pélvico é responsável pela ação esfincteriana uretral, vaginal e retal e permite a passagem do feto durante o parto. Já a bexiga é responsável pelo armazenamento e eliminação da urina. Para que a micção ocorra de maneira adequada é necessário que haja uma interação sincrônica entre a bexiga, o assoalho pélvico, o sistema nervoso central (SNC) e sistema nervoso periférico (SNP), durante as fases de enchimento e esvaziamento. Qualquer alteração em uma dessas fases ou estruturas resulta em disfunções miccionais. Sendo assim, os fatores de risco que interferem nessas estruturas podem estar associados ao aparecimento ou agravamento da IU.

The aim of this literature review was the risk factors of female urinary incontinence (UI) risk factors. This review was carried out from February to November 2005 and the scientific search was done in Lilacs, Scielo, Pub Med, Cochrane and Medline using the key words: risk factors and female urinary incontinence, epidemiology, prevalence. The UI is the complain of any involuntary leakage of urine and its etiology is related to vesical and urethral problems. The pelvic floor has the function of tighten and close vagina, urethra and anal sphincter. The bladder is responsible for storage and emptying of urine. For a normal micturion we have a perfect neurologic system integrated with bladder and pelvic floor. Any problem of one of that parts can produce an UI and the risk factors that interfere on these structures can produce or aggravate the UI.