What is happening with the clinical nutritionist? Realities and challenges.

BACKGROUND: At hospital level, clinical nutritionists play a fundamental role in health recovery, contributing to shorter hospital stays and addressing hospital malnutrition. However, in Latin America no studies have been conducted on the activities of the nutritionist and the factors influencing their performance. AIMS: to describe the activities of the clinical nutritionist in public and private hospital settings in Latin America and to determine the factors associated with disciplinary practice. METHODS: A cross-sectional analytical, quantitative study was conducted. Participants consisted of hospital nutritionists from 13 Latin American countries who had participated in a previously validated online survey on the activities performed during their daily work, obtaining a Professional Activities Score (PAS). RESULTS: 1222 nutritionists participated. Of the activities associated with the professional role, the only ones who reached over 75 % of execution were: performing nutritional intervention; performing nutritional assessment and diagnosis; providing counseling and dietary prescription; developing nutritional care plans for patients with nutritional problems; and performing the monitoring and evaluation of results of priority patients. The least frequent activities were: university teaching and collaborating in research. Regarding the reasons for not performing activities: 34.0 % reported not being included in the activities, 24.5 % mentioned lack of time, and 13.6 % indicated that the activities were conducted by another professional. Variables positively associated with an increase in the PAS were: having spent more years exercising the profession (Beta: 0.028, 95 % CI: 0.004; 0.051), and having a greater number of specialties (4 or more, Beta: 2.294, 95 % CI: 1.031; 3.557). Working in lower-complexity facilities (Low: Beta: -1.037, 95 % CI: -1.443; -0.630), and having more reasons for not performing the activities (3 or more: Beta: -3.105, 95 % CI: -4.111; -2.099) were inversely associated. From the sample, 1.8 % held a doctorate in clinical nutrition, 43.9 % had a specialty, and 64.4 % had a diploma or postgraduate degree in clinical nutrition. CONCLUSION: None of the activities related to the nutritionist work was performed on a 100 % basis. In Latin America, Ministries of Health should standardize and regulate the functions of the clinical nutritionist, as well as quantifying understaffing and proposing solutions to alleviate the shortage of these professionals, acknowledging the positive impact that they have on the recovery of hospital patients.

Barriers and Opportunities for Clinical Nutritionists in 13 Latin American Countries: A Qualitative Study.

A clinical nutritionist (CN) is a university-educated professional trained to perform preventive and recovery functions in the health of patients. The actions of these professionals, both worldwide and in Latin America, may face barriers and opportunities that require careful identification and examination. The main objective of this study is to identify the most important barriers and opportunities for the clinical nutritionist in 13 Latin American countries. A qualitative study was carried out; the initial phase involved conducting in-depth individual interviews with 89 informants, experienced CNs from 13 Latin American countries. After calculating the mean and standard deviation, we ranked the top 10 most frequently reported barriers by assigning a score ranging from 1 to 10. Additionally, 3 opportunities were identified with a lower score from 1 to 3. Means and standard deviation were calculated to sort the responses. Results: the most important barrier was the absence of public policies that regulate and/or monitor compliance with the staffing of CNs according to the number of hospital beds, while the most important opportunity was the advances in technology such as software, body analysis equipment and other tools used in Nutritional Care. The identified barriers can interfere with the professional performance of CNs and, moreover, make it difficult to monitor the good nutritional status of patients. It is recommended to consider the barriers identified in this study, as well as the opportunities, with a view to improving the quality of hospital services with an adequate supply of nutritionists.

Can Integrated Care Help in Meeting the Challenges Posed on Our Health Care Systems by COVID-19? Some Preliminary Lessons Learned from the European VIGOUR Project.

The COVID-19 pandemic puts health and care systems under pressure globally. This current paper highlights challenges arising in the care for older and vulnerable populations in this context and reflects upon possible perspectives for different systems making use of nested integrated care approaches adapted during the work of the EU-funded project VIGOUR ("Evidence based Guidance to Scale-up Integrated Care in Europe", funded by the European Union's Health Programme 2014-2020 under Grant Agreement Number 826640).

Mutaciones de/ en lo corporal / Pedagogy of the Corporeidad and Human Potential

La autora de este articulo, desde su análisis teórico, desvela como Gabriela L. al sentir en la explanada resultante, movimiento y no la ausencia de feminidad, de sensualidad, sustituye la mutilación. Gabriela L. trascendiendo, con la auto-grafía de su cuerpo, entrega una experiencia donde lo personal, lo público y lo social se entrecruzan. Su cuerpo vive una mutación a partir de una mutilación que ella "extraña" a través del texto escrito y fotográfico. Esta experiencia estética moviliza, con otras mujeres, una acción desmitificadora de lo corporal dado como normal. Esta elección muestra la instalación posible en lo dable, en lo posible a construir. De la mutilación dada se puede llegar a la construcción de la propia mutación del pensamiento. Con la muerte de Gabriela L. no llega al fin su pensamiento, éste es memoria presente en nuestras reflexiones. Quiere decir que nuestro propio cuerpo toma su cuerpo, su experiencia, su extrañamiento, su reflexión. Se trata según ella de ver, en la trascendencia de Gabriela L. lo colectivo en lo individual.

The author of this article, from her theoretical analysis, shows how Gabriela L. by feeling movement and not lack of femininity, replaces sensuality for mutilation. Going beyond the autography of her body, Gabriela L. Lives an experience where the personal, the public and the social interrelates. Her body lives a mutation from a mutilation that is "odd" to her through the written and photographic text. This aesthetic experience mobilizes, with other women, a demystifying action of the corporal expressed as the normal. This election shows the possible installation in what is possible, as far as possible to construct. From the given mutilation one can arrive at the construction of the own mutation of thought. With the death of Gabriela L. her thoughts do not come to an end, they are present in our reflections, which means that our own body takes her body, her experience, her oddness, her reflection. According to Maria del Carmen, it's important to see in Gabriela L.'s significance, the collective withing the individual.