Representaciones sociales sobre el Programa Mais Médicos entre consejeros municipales de salud de Brasil / Social representations on Mais Médicos Program among municipal health councelors of Brazil

Introducción: La atención primaria de salud en Brasil se considera una prioridad. En el año 2013 se creó el Programa Mais Médicos, de formación en servicio y de ampliación de la cantidad de médicos en el país. La cooperación cubana, gestionada por la Organización Panamericana de la Salud fue quien envió la mayor cantidad de profesionales. Objetivo: Analizar las representaciones sociales de los consejeros de salud sobre el Programa Mais Médicos, en municipios en los que prestaron atención a su población médicos provenientes de Cuba. Métodos: Estudio de caso descriptivo de corte transversal abordado con metodología cualitativa. La muestra fue intencional. Se trabajó con 58 entrevistas semiestructuradas y el análisis fue realizado mediante el software gratuito Iramuteq con la técnica de análisis lexical. Resultados: Se pudo distinguir cuatro grupos de representaciones, sobre el funcionamiento de los consejos municipales de salud, sobre las representaciones del Programa Mais Médicos, sobre las redes de atención y sobre los médicos brasileños y cubanos. El estudio aporta evidencias de la aplicación de un nuevo modelo de atención para los consejeros que objetivaron y anclaron en el concepto de nacionalidad. El modelo cubano incorpora características de humanismo, atributos que no estaban contenidos en las representaciones sobre los médicos locales. Conclusiones: Las representaciones sociales sobre el Programa Mais Médicos aluden a una acción que mejora la calidad de los servicios, no obstante, la literatura sobre atención básica aún deja ver algunos problemas de acceso y tránsito por la red del sistema único de salud(AU)

Introduction: Primary health care in Brazil is considered a priority. In 2013, Mais Médicos Program was created, providing in-service training and expanding the number of doctors in the country. Cuban cooperation, managed by the Pan American Health Organization, sent the largest number of professionals. Objective: Analyze the social representations of health counselors on Mais Médicos Program, in municipalities in which doctors from Cuba cared to their population. Methods: Descriptive cross-sectional case study approached with qualitative methodology. The sample was intentional. It was conducted a work with 58 semi-structured interviews and the analysis was carried out using the free software Iramuteq with the lexical analysis technique. Results: Four groups of representations could be distinguished: on the functioning of the municipal health councils, on the representations of Mais Médicos Program, on the care networks and on Brazilian and Cuban doctors. The study brings evidence of the application of a new model of care for counselors who objectified and anchored in the concept of nationality. The Cuban model incorporates characteristics of humanism, attributes that were not contained in the representations about local doctors. Conclusions: The social representations on Mais Médicos Program allude to an action that improves the quality of services, however, the literature on basic care still shows some problems of access and transit through the network of the health system(AU)

[Food and nutrition in primary care in Brazil]. / Alimentación y nutrición en atención primaria en Brasil.

OBJECTIVE: To describe food and nutrition actions in primary health care in Brazil. METHODS: Exploratory review of articles published between 2007 and 2016. Lilacs, PubMed, Scopus and Web of Science databases were consulted. RESULTS: 103 articles were included, mostly published between 2012 and 2016 and developed mainly in the Southeast region of Brazil. The most prevalent research topics were food behaviour or consumption, nutritional status and non-communicable diseases. Most research was led by universities and was focused on diagnosis. Few actions on health promotion, healthy eating, assistance, treatment, integral health care and prevention of diseases related to food and nutrition were found in the review. CONCLUSION: National interest in food and nutrition has increased, however academic production is still far from the actual needs for providing evidence that impacts health status. More research is needed to describe, propose and evaluate programmes and actions. Therefore, it is essential for closer relationships to be forged between universities, managers and health services in order to identify common interests and to develop research that meets the needs of the area and contribute to planning and improving programmes and actions.

[Humanism in the practice of Cuban cooperating physicians in Brazil: narratives of basic health care teamsHumanismo na prática dos médicos colaboradores cubanos no Brasil: narrativas das equipes de atenção básica]. / Humanismo en la práctica de médicos cooperantes cubanos en Brasil: narrativas de equipos de atención básica.

OBJECTIVE: To present the narratives of Brazilian members of family health teams with regard to the humanism perceived in the practice of Cuban physician cooperating in the Mais Médicos program. METHODS: Cross-sectional descriptive case study. A semi-structured interview was applied to Brazilian members of family health teams who had worked from the beginning of the program with Cuban physicians in selected municipalities included in the Mais Médicos program (20% or more of the population in extreme poverty and less than five physicians or a rate of 0.5 physicians per 1, 000 population prior to the program). The data were processed using the content analysis technique. RESULTS: Interviews were held with 30 senior nurses, 28 nursing assistants, one administrative technician, and 19 health agents. The interviewees offered a positive assessment of the work of the Cuban cooperating physicians, emphasizing their responsibility, ethics, and humanism, as well as the high quality of their medical -consultations and their good relations with their peers in basic health care teams. CONCLUSIONS: There were confirmed differences between the patterns of care of the Cuban cooperating physicians in the Mais Médicos program and the physicians who were working before in the studied communities prior to implementation of that program. The differential features of the Cuban physicians most frequently mentioned include their commitment to the population (both in medical consultations and in solving people's problems), their empathy, their respect, and in general, the human values with which they treat patients.

OBJETIVO: Apresentar as narrativas dos integrantes brasileiros das equipes de saúde da família sobre o humanismo percebido na prática dos colaboradores cubanos do Programa Mais Médicos. MÉTODOS: Trata-se de um estudo de caso descritivo transversal. Foi realizada uma entrevista semiestruturada com os integrantes brasileiros das equipes de saúde da família que trabalhavam desde o início do programa com médicos cubanos em municípios selecionados cadastrados no Programa Mais Médicos. Estas localidades têm 20% ou mais da população vivendo em situação de extrema pobreza, contando com menos de cinco médicos (taxa de 0,5 médico por 1.000 habitantes) antes do programa. Os dados foram analisados com o uso da técnica de análise de conteúdo. RESULTADOS: Foram entrevistados 30 enfermeiros diplomados, 28 técnicos em enfermagem, 1 técnico administrativo e 19 agentes comunitários de saúde. Os participantes avaliaram de forma positiva o trabalho dos médicos colaboradores cubanos destacando características como responsabilidade, postura ética e humanismo bem como a alta qualidade das consultas médicas e o bom relacionamento com os pares da atenção básica. CONCLUSÕES: Foram constatadas diferenças no padrão de atenção dos médicos colaboradores cubanos do Programa Mais Médicos em relação aos médicos brasileiros que atuavam nas comunidades estudadas antes da implantação do programa. Entre as características distintivas dos médicos cubanos destacadas estão o compromisso com os pacientes, tanto na consulta médica quanto na solução de problemas, a empatia, o respeito e o humanismo em geral com que eles tratam os pacientes.

Folic acid intake by pregnant women from Vale do Jequitinhonha, Brazil, and the contribution of fortified foods / Consumo de ácido fólico por gestantes do Vale do Jequitinhonha, Brasil, e a contribuição dos alimentos fortificados

The folate deficiency can result in irreversible health damage, such as the neural tube defects. The aim of this article is to determine the folate intake of pregnant women in Vale do Jequitinhonha, Minas Gerais state, Brazil, one of the poorest regions in the world. A descriptive, cross-sectional study was done in 2013 with 492 pregnant women attending the basic health units run by the public health service (Sistema Único de Saúde, SUS) in 15 municipalities. A standard questionnaire was used to gather the data, which included socioeconomic indicators and a food frequency questionnaire. The data were analyzed and compared statistically based on prevalence ratios and 95% confidence intervals. The prevalence of inadequate folate intake was associated with some socioeconomic factors: it was higher amongst the low income and less educated women, in younger women and those who had fewer meals per day. The prevalence of inadequate folate intake in the diet was 94.7% when the contribution of food fortification was not considered, 49.2% taking into account fortified foods, and 17.1% considering food folate, fortified foods, and supplementation with folic acid. We conclude that fortifying foods with folic acid at the current levels reduces the inadequacy of folate intake in the diet, but not enough to assure safe levels and to meet the nutritional requirements of pregnant women in Brazil.

A deficiência de folato pode acarretar prejuízos irreversíveis como os defeitos do tubo neural. O objetivo deste artigo é determinar o padrão de consumo de folato por gestantes no Vale do Jequitinhonha, Minas Gerais, Brasil, uma das regiões mais pobres do mundo. A pesquisa descritiva do tipo transversal foi realizada com 492 gestantes atendidas em Unidades Básicas de Saúde do SUS em 15 municípios do Vale do Jequitinhonha no ano de 2013. Para a coleta de dados foi utilizado um questionário padronizado, que inclui um questionário socioeconômico e inquérito de frequência alimentar. Os dados foram analisados e comparados estatisticamente através de razão de prevalências e intervalo de confiança de 95%. A prevalência de consumo insuficiente de folato mostrou-se associada com alguns fatores socioeconômicos: foi maior em gestantes com baixa renda, de baixa escolaridade e em gestantes mais jovens e que realizavam menos refeições por dia. Observou-se que a prevalência de consumo insuficiente de folato na dieta foi de 94,7% desconsiderando a inclusão de alimentos fortificados, 49,2% considerando a dieta com alimentos fortificados e 17,1% considerando a dieta, a fortificação e a suplementação medicamentosa com ácido fólico. Conclui-se que a fortificação de alimentos com ácido fólico nos níveis atuais reduz a inadequação do consumo na dieta, mas não é suficiente para suprir as necessidade e garantir os níveis seguros da oferta deste nutriente entre gestantes brasileiras.

Fulfillment of the brazilian agenda of priorities in health research.

This commentary describes how the Brazilian Ministry of Health's (MoH) research support policy fulfilled the National Agenda of Priorities in Health Research (NAPHR). In 2003, the MoH started a democratic process in order to establish a priority agenda in health research involving investigators, health managers and community leaders. The Agenda was launched in 2004 and is guiding budget allocations in an attempt to reduce the gap between scientific knowledge and health practice and activities, aiming to contribute to improving Brazilian quality of life. Many strategies were developed, for instance: Cooperation Agreements between the Ministry of Health and the Ministry of Science and Technology; the decentralization of research support at state levels with the participation of local Health Secretariats and Science and Technology Institutions; Health Technology Assessment; innovation in neglected diseases; research networks and multicenter studies in adult, women's and children's health; cardiovascular risk in adolescents; clinical research and stem cell therapy. The budget allocated by the Ministry of Health and partners was expressive: US$419 million to support almost 3,600 projects. The three sub-agenda with the higher proportion of resources were "industrial health complex", "clinical research" and "communicable diseases", which are considered strategic for innovation and national development. The Southeast region conducted 40.5% of all projects and detained 59.7% of the resources, attributable to the concentration of the most traditional health research institutes and universities in the states of São Paulo and Rio de Janeiro. The second most granted region was the Northeast, which reflects the result of a governmental policy to integrate and modernize this densely populated area and the poorest region in the country. Although Brazil began the design and implementation of the NAPHR in 2003, it has done so in accordance with the 'good practice principles' recently published: inclusive process, information gathering, careful planning and funding policy, transparency and internal evaluation (an external independent evaluation is underway). The effort in guiding the health research policy has achieved and legitimated an unprecedented developmental spurt to support strategic health research. We believe this experience is valuable and applicable to other countries, but different settings and local political circumstances will determine the best course of action to follow.

Determinants of mild-to-moderate malnutrition in preschoolers in an urban area of Northeastern Brazil: a hierarchical approach.

OBJECTIVE: To investigate the determinants of mild-to-moderate malnutrition in preschoolers. DESIGN: Cross-sectional study conducted in October and November 1996, with a representative sample of 1740 children less than 5 years old from the city of Salvador, situated in the Brazilian Northeastern region. Socio-economic and dietary data were collected through a structured questionnaire. Anthropometric measures were performed in duplicate and data analysis was based upon the hierarchical model approach. Logistic regression analysis was used to estimate the prevalence ratio and to identify the determinants of mild-to-moderate deficits in weight-for-age and height-for-age Z-scores. RESULTS: Family monthly income under US$67.00 per capita and family headed by a woman were the main basic determinants of mild-to-moderate weight-for-age and height-for-age deficits in the studied children. Household agglomeration, an underlying determinant, was associated with weight-for-age and height-for-age deficits. Among the immediate determinants, age above 6 months and dietary caloric availability in the lowest tertile (<930 kcal day-1) were also associated with weight-for-age deficits. In addition to these, hospitalisation in the 12 months preceding the interview was shown to be a predictor of mild-to-moderate weight-for-age and height-for-age deficits. CONCLUSION: Adverse social and economic factors interact with family environmental factors to define food consumption and morbidity patterns that culminate in a high prevalence of mild-to-moderate malnutrition. The strengthening and restructuring of nutrition and healthcare actions, the definition of public policies that improve family income, and the adequate insertion of women in the labour market are possible strategies to reduce mild-to-moderate malnutrition and to sustain the decline already observed in severe malnutrition.

[Evaluation of Brazilian public policies to promote food security and fight hunger, 1995-2002. 2 - the Workers' Nutrition Program]. / Avaliação de políticas públicas de segurança alimentar e combate à fome no período 1995-2002: 2 - Programa de Alimentação do Trabalhador.

This study evaluated the Workers' Nutrition Program in Brazil from 1995 to 2002, from a structure-process-results perspective. The methodology involved documental research and a case study in 45 municipalities in the State of Bahia, resulting in 2,389 household interviews. In relation to structure, we analyzed the program's normative evolution until 2002. As for nutritional recommendations, the program shifted from insufficient calorie supply in the 1980s to a positive association between overweight and employment in companies adopting the Workers' Nutrition Program. In Bahia, overall program coverage was insufficient among the 5,120 adults 20 years or older who were interviewed. A significant difference was observed in access to food benefits among workers in the interior of the State (6.1%) as compared to the State capital, Salvador (26.1%). However, targeting was adequate: all workers benefiting from the program in the interior and 92.4% of those in Salvador earned less than five times the minimum wage (approximately US dollars 950/month). It is necessary to improve the program's coverage in the target population in order to raise workers' awareness about their rights and the actions developed by the program.

Epidemiologia da carencia de vitamina A no Nordeste do Brasil / Epidemiology of vitamin A deficiency in Brazil Northeast

A deficiencia de vitamin A e responsavel por alteracoes em tecidos epiteliais especializados podendo levar a xeroftalmia e cegueira nutricional. Alemdisto, em anos recentes foi demonstrado que ofrecer suplementacao com vitamina A a criancas pre-escolares, em areas onde a deficiencia e endemica, pode reduzir a mortalidade de 23 per cento a 30 percento em media. Os primeiros relatos de carencia de vitamina A e xeroftalmia no Brasil ocorreram em 1864 e 1883, em escravos mal alimentados. Neste seculo, durante as secas periodicas na regiao Nordeste, houve relatos de cegueira noturna e de outras lesoes oculares. Nas ultimas decadas, diversos estudos determinaram niveis de retinol serico ou hepatico (este ultimo em amostras de necropsias) demonstrando que a hipovitaminose A e um problema de saude publica no Nordeste. No inicio da decada de 1980 encontraram-se lesoes oculares por deficiencia de vitamina A tanto em estudos epidemiologicos em campo, nos estados da Paraiba e Rio Grande do Norte, como tambem atraves do acompanhamento dos casos atendidos na enfermaria do Hospital Universitario de Joao Pessoa, Paraiba. Dentre os fatores de risco para a xeroftalmia corneal destacaram-se o desmame precoce, a idade abaixo de 12 meses e as infeccoes. Recentemente a deficiencia de vitamina A tem sido descrita na regiao Nordeste tambem em epocas de safras regulares, embora a maioria dos casos de xeroftalmia e cegueira nutricional tenham sido registrados durante periodos agudos de seca. Nesta regiao a carencia nutricional e permanente e qualquer fator precipitante pode romper o fragil equilibrio resultante das adaptacoes fisiopatologicas a desnutricao

Epidemiologia da carencia de vitamina A no Nordeste do Brasil / Epidemiology of vitamin A deficiency in Brazil Northeast

A deficiencia de vitamin A e responsavel por alteracoes em tecidos epiteliais especializados podendo levar a xeroftalmia e cegueira nutricional. Alemdisto, em anos recentes foi demonstrado que ofrecer suplementacao com vitamina A a criancas pre-escolares, em areas onde a deficiencia e endemica, pode reduzir a mortalidade de 23 per cento a 30 percento em media. Os primeiros relatos de carencia de vitamina A e xeroftalmia no Brasil ocorreram em 1864 e 1883, em escravos mal alimentados. Neste seculo, durante as secas periodicas na regiao Nordeste, houve relatos de cegueira noturna e de outras lesoes oculares. Nas ultimas decadas, diversos estudos determinaram niveis de retinol serico ou hepatico (este ultimo em amostras de necropsias) demonstrando que a hipovitaminose A e um problema de saude publica no Nordeste. No inicio da decada de 1980 encontraram-se lesoes oculares por deficiencia de vitamina A tanto em estudos epidemiologicos em campo, nos estados da Paraiba e Rio Grande do Norte, como tambem atraves do acompanhamento dos casos atendidos na enfermaria do Hospital Universitario de Joao Pessoa, Paraiba. Dentre os fatores de risco para a xeroftalmia corneal destacaram-se o desmame precoce, a idade abaixo de 12 meses e as infeccoes. Recentemente a deficiencia de vitamina A tem sido descrita na regiao Nordeste tambem em epocas de safras regulares, embora a maioria dos casos de xeroftalmia e cegueira nutricional tenham sido registrados durante periodos agudos de seca. Nesta regiao a carencia nutricional e permanente e qualquer fator precipitante pode romper o fragil equilibrio resultante das adaptacoes fisiopatologicas a desnutricao