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.

Speech-Language and Nutritional Sciences in hospital environment: analysis of terminology of food consistencies classification.

PURPOSE: To verify if there is an agreement between speech-language pathologists and nutritionists about the classification of food textures used in hospitals and their opinions about the possible consequences of differences in this classification. METHODS: This is a descriptive, cross-sectional study with 30 speech-language pathologists and 30 nutritionists who worked in 14 hospitals of public and/or private network in Belo Horizonte, Brazil. The professionals answered a questionnaire, prepared by the researchers, and classified five different foods, with and without theoretical direction. The data were analyzed using Fisher's exact and Z -tests to compare ratios with a 5% significance level. RESULTS: Both speech-language therapists (100%) and nutritionists (90%) perceive divergence in the classification and, 86.2% and 100% of them, respectively, believe that this difference may affect the patients' recovery. Aspiration risk was the most mentioned problem. For the general classification of food textures, most of the professionals (88.5%) suggested four to six terms. As to the terminology used in the classification of food presented without theoretical direction, the professionals cited 49 terms and agreed only in the solid and liquid classifications. With theoretical direction, the professionals also agreed in the classification of thick and thin paste. CONCLUSION: Both the professionals recognized divergences in the classification of food textures and the consequent risk of damage to patient's recovery. The use of theoretical direction increased the agreement between these professionals.

Fonoaudiologia e nutrição em ambiente hospitalar: análise de terminologia de classificação das consistências alimentares / Speech-Language and Nutritional Sciences in hospital environment: analysis of terminology of food consistencies classification

RESUMO Objetivos: Verificar se há concordância entre fonoaudiólogos e nutricionistas na classificação de consistências alimentares utilizadas em hospitais e as opiniões sobre as possíveis consequências das divergências nessa classificação. Métodos: Estudo descritivo transversal com 30 fonoaudiólogos e 30 nutricionistas que trabalhavam em 14 hospitais da rede pública e/ou privada de Belo Horizonte. Os profissionais responderam um questionário elaborado pelas pesquisadoras e classificaram cinco alimentos, com e sem direcionamento teórico. Empregaram-se os testes estatísticos Exato de Fisher e Z para comparação de proporções, com nível de significância de 5%. Resultados: Tanto fonoaudiólogos (100%) quanto nutricionistas (90%) percebem divergência nas classificações, sendo que, respectivamente, 86,2% e 100% acreditam que essa divergência pode prejudicar a recuperação dos pacientes. O risco de aspiração de alimento foi o prejuízo mais citado. Para a classificação geral das consistências alimentares, a maior parte dos profissionais (88,5%) sugeriu de quatro a seis termos. Quanto à terminologia utilizada na classificação dos alimentos apresentados sem direcionamento teórico, os profissionais citaram 49 termos e concordaram apenas na classificação do sólido e do líquido. Com o direcionamento teórico, os profissionais concordaram também na classificação do pastoso grosso e do pastoso fino. Conclusão: Tanto fonoaudiólogos quanto nutricionistas reconhecem divergências na classificação das consistências alimentares e o consequente risco de prejuízos à recuperação do paciente. A utilização do direcionamento teórico aumentou a concordância entre os profissionais.

ABSTRACT Purpose To verify if there is an agreement between speech-language pathologists and nutritionists about the classification of food textures used in hospitals and their opinions about the possible consequences of differences in this classification. Methods This is a descriptive, cross-sectional study with 30 speech-language pathologists and 30 nutritionists who worked in 14 hospitals of public and/or private network in Belo Horizonte, Brazil. The professionals answered a questionnaire, prepared by the researchers, and classified five different foods, with and without theoretical direction. The data were analyzed using Fisher's exact and Z -tests to compare ratios with a 5% significance level. Results Both speech-language therapists (100%) and nutritionists (90%) perceive divergence in the classification and, 86.2% and 100% of them, respectively, believe that this difference may affect the patients' recovery. Aspiration risk was the most mentioned problem. For the general classification of food textures, most of the professionals (88.5%) suggested four to six terms. As to the terminology used in the classification of food presented without theoretical direction, the professionals cited 49 terms and agreed only in the solid and liquid classifications. With theoretical direction, the professionals also agreed in the classification of thick and thin paste. Conclusion Both the professionals recognized divergences in the classification of food textures and the consequent risk of damage to patient's recovery. The use of theoretical direction increased the agreement between these professionals.

Nutrição funcional no pós-operatório de cirurgia plástica: enfoque na prevenção de seroma e fibrose / Functional nutrition in postoperative plastic surgery: focus on seroma and fibrosis prevention

INTRODUÇÃO: Com base na grande variedade de possíveis sequelas e intercorrências de cirurgias estéticas e no papel da nutrição no processo de recuperação dessas, percebe-se a necessidade de práticas terapêuticas que garantam eficácia do resultado estético final. MÉTODO: O presente estudo caracteriza-se como uma revisão não sistemática que associou possíveis nutrientes, compostos bioativos e fitoterápicos que previnam ou amenizem seroma e fibrose no pós operatório. Para tanto, foram utilizados artigos de revistas científicas do meio eletrônico, legislações nacionais e livros didáticos, publicados entre os anos de 2002 e 2012. RESULTADOS: Demonstrou-se que as principais causas de seroma e fibrose são cicatrização alterada, inflamação, estresse oxidativo e edema. Dessa forma, foi elaborado um guia prático com os nutrientes, compostos bioativos e fitoterápicos que podem ser utilizados a fim de prevenir, controlar ou amenizar as complicações no pós-cirúrgico de procedimentos estéticos. CONCLUSÃO: Salientou-se que para o tratamento das condições abordadas é fundamental que haja um trabalho multiprofissional, enfatizando um acompanhamento médico, nutricional e fisioterápico que abranja as alterações conhecidas na fisiopatologia de seroma e fibrose.

INTRODUCTION: Based on the wide range of possible consequences and complications of plastic surgery and the role of nutrition in the recovery process of these, we see the need for therapeutic practices to ensure effectiveness of the final aesthetic result. METHOD: This study is characterized as a non-systematic review of the possible associated nutrients, bioactive compounds and herbal medicines to prevent seroma and fibrosis. Thus, we used scientific journal articles from electronic media, national laws and textbooks published between 2002 and 2012. RESULTS: We demonstrated that the main causes of seroma and fibrosis are changed healing, inflammation, oxidative stress and edema. Thus, we designed a practical guide with nutrients, bioactive compounds and herbal medicines that can be used to prevent, control or mitigate the complications after plastic surgery. CONCLUSION: It was emphasized that for the treatment of covered conditions is essential that there is a multidisciplinary approach, emphasizing a medical, nutritional and therapeutic monitoring covering the known changes in the pathophysiology of seroma and fibrosis.

Food-based dietary guidelines and implementation: lessons from four countries--Chile, Germany, New Zealand and South Africa.

OBJECTIVE: Food-based dietary guidelines (FBDGs) are globally promoted as an important part of national food and nutrition policies. They are presented within policy as key features of the strategy to educate the public and guide policy-makers and other stakeholders about a healthy diet. This paper examines the implementation of FBDGs in four countries: Chile, Germany, New Zealand and South Africa - diverse countries chosen to explore the realities of the FBDG within policy on public health nutrition. DESIGN: A literature review was carried out, followed by interviews with representatives from the governmental, academic and private sector in all four countries. RESULTS: In all four countries the FBDG is mainly implemented via written/electronic information provided to the public through the health and/or education sector. Data about the impact of FBDGs on policy and consumers' food choice or dietary habits are incomplete; nutrition surveys do not enable assessment of how effective FBDGs are as a factor in dietary or behavioural change. Despite limitations, FBDGs are seen as being valuable by key stakeholders. CONCLUSION: FBDGs are being implemented and there is experience which should be built upon. The policy focus needs to move beyond merely disseminating FBDGs. They should be part of a wider public health nutrition strategy involving multiple sectors and policy levels. Improvements in the implementation of FBDGs are crucial given the present epidemic of chronic, non-communicable diseases.