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1.
Arch. pediatr. Urug ; 92(2): e211, dic. 2021. tab
Artigo em Espanhol | LILACS, BNUY, UY-BNMED | ID: biblio-1278304

RESUMO

Introducción: las cardiopatías congénitas (CC) son patologías frecuentes en pediatría. Son causa de importante morbimortalidad en la infancia. Son pacientes complejos, que requieren abordaje integral, en equipo interdisciplinario. Objetivos: describir las características epidemiológicas, clínicas y evolutivas de niños portadores de CC asistidos en la Unidad de Cardiología del HP-CHPR durante el año 2015, así como su estado nutricional y los factores que pudieran influir en este. Material y método: estudio descriptivo, retrospectivo, a través de la revisión de historias clínicas de pacientes portadores de CC, hospitalizados en la Unidad de Cardiología del HP-CHPR en 2015. Se describieron características epidemiológicas y clínicas de los pacientes. Resultados: en el período evaluado egresaron 63 pacientes, que representaron una tasa de 6,58/1.000 egresos hospitalarios. Tenían un promedio de edad de 23,8 meses. Un total de 8 pacientes fueron diagnosticados en el período prenatal, 54 presentaban CC no cianóticas. Habían sido sometidos a tratamiento quirúrgico 24 niños, 13 con cirugía correctiva. Se diagnosticó desnutrición en 43%. Esta fue más prevalente en portadores de CC cianótica, de defectos complejos, y de cromosomopatías u otras malformaciones. Conclusión: los niños con CC representaron un pequeño porcentaje de quienes requirieron hospitalización en el HP-CHPR. El porcentaje de desnutrición fue elevado. Este estudio confirma la importante morbimortalidad de los niños pequeños portadores de CC. Es importante reconocer el mayor riesgo de estos pacientes y actuar en forma individualizada y oportuna.


Introduction: congenital heart disease (CHD) is a frequent pathology among children. It may cause significant morbidity and mortality during childhood. These are complex patients, who require a comprehensive approach and an interdisciplinary team. Objective: to describe the epidemiological, clinical and evolutionary characteristics of children with CHD assisted in the Cardiology Department of the Children Hospital-CHPR in 2015. Material and Methods: descriptive, retrospective study, review of clinical records of patients with CHD, hospitalized in the Cardiology Department of the Children's Hospital PRHC in 2015. Epidemiological and clinical characteristics of patients were described. Results: 63 patients were hospitalized during the evaluated period, a total rate of 6.58/1.000 discharges. They had an average age of 23.8 months. Eight patients were diagnosed in the prenatal period, 54 presented non-cyanotic CHD. Twenty-four children had undergone surgical treatment, 13 had had corrective surgery. Malnutrition was diagnosed in 43% and it was more prevalent in cyanotic CHD carriers, complex defects, and chromosomopathies or other malformations. Conclusion: CHD represented a small percentage of the children who required hospitalization at the PH-PRHC. The percentage of malnutrition was high. The study confirmed the significant morbidity and mortality of these patients. It is important to recognize the highest risk of these patients and act in a customized and timely fashion.


Introdução: as cardiopatias congênitas (CC) são patologias comuns em pediatria. Elas são uma causa significativa de morbidade e mortalidade na infância. Os pacientes são complexos e requerem uma abordagem integral e uma equipe interdisciplinar. Objetivos: descrever as características epidemiológicas, clínicas e evolutivas de crianças com CC atendidas na Unidade de Cardiologia do Hospital Pediátrico PHPR durante o ano de 2015, descrever seu estado nutricional e os fatores que poderiam influenciá-lo. Material e métodos: estudo descritivo, retrospectivo, feito por meio da revisão de prontuários de pacientes com CC, internados na Unidade de Cardiologia do HP-CHPR em 2015. Foram descritas as características epidemiológicas e clínicas dos pacientes. Resultados: no período avaliado, 63 pacientes receberam alta hospitalar, representando uma taxa de 6,5/1.000 altas hospitalares. Eles tinham uma idade média de 23,8 meses. Oito pacientes foram diagnosticados no período pré-natal, 54 apresentavam CC não cianótica. 24 crianças tinham sido submetidas a tratamento cirúrgico, 13 tinham recebido cirurgia corretiva. 43% foram diagnosticadas com desnutrição, a qual foi mais prevalente em portadores de CC cianótica, defeitos complexos e malformações cromossômicas ou outras. Conclusão: os CCs representaram um pequeno percentual de crianças que necessitaram de internação no HP-CHPR. O percentual de desnutrição foi alto. Este estudo confirma a morbidade e mortalidade significativas de crianças pequenas com CC. É importante reconhecer o risco aumentado desses pacientes e agir de forma individualizada e oportuna.


Assuntos
Humanos , Masculino , Feminino , Gravidez , Lactente , Pré-Escolar , Criança , Adolescente , Desnutrição/complicações , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/epidemiologia , Hospitalização , Diagnóstico Pré-Natal , Epidemiologia Descritiva , Estudos Retrospectivos , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Cardiopatias Congênitas/cirurgia , Cardiopatias Congênitas/classificação
2.
Infectio ; 25(4): 207-211, oct.-dic. 2021. tab, graf
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1286715

RESUMO

Resumen Objetivo: Describir la proporción, características clínicas, demográficas y programáticas de casos fatales de coinfección TB/VIH de Cali-Colombia, en 2017. Material y Método: Estudio de corte transversal, con información de las bases de datos del programa de tuberculosis, las historias clínicas y unidades de análisis de mortalidad disponibles. Resultados: Se depuraron 257 casos fatales por TB, el 24,5% (63/257) falleció con coinfección TB/VIH. La mediana de edad fue 43 años (Rango Intercuartílico: 30-52), 73% (46/63) eran hombres, 76,2% (48/63) no pertenecían al régimen contributivo, 28,6% eran habitantes de calle. 81,2% (39/48) eran casos nuevos de TB, 76,6% (37/47), inició tratamiento; al 74,6% (47/63) se les realizó unidad de análisis de mortalidad. La presentación pulmonar fue frecuente (75,9%-44/58), en 60% de los registros se observó desnutrición (Índice de Masa Corporal <20), en 39,7% (25/63) dependencia al alcohol, tabaco o farmacodependencia. Conclusiones: La mortalidad asociada a TB/VIH es prevenible, pero en 2017 representó la cuarta parte de la mortalidad por TB en Cali. Hombres adultos con condiciones de vulnerabilidad social, diagnosticados en estados avanzados de enfermedad, fueron blanco de fatalidad. Mejorar los sistemas de información e integrar los programas de TB/VIH, deben ser estrategias prioritarias para la salud pública en Colombia.


Abstract Objective: To describe the proportion, clinical, demographic and programmatic characteristics of fatal cases of TB/HIV coinfection from Cali-Colombia, in 2017. Material and Method: Cross-sectional study, with information from the TB program databases, clinical records and mortality analysis units available. Results: 257 TB fatal cases were cleared in Cali in 2017, 24.5% (63/257) of these died with TB/HIV coinfection. The median age was 43 years (Interquartile Range: 30-52), 73% (46/63) were men, 76.2% (48/63) did not belong to the contributory health regimen, 28.6% were homeless. 81.2% (39/48) were new TB cases, 76.6% (37/47) started treatment; 74.6% (47/63) had mortality analysis register. Pulmonary presentation was frequent (75.9% -44 / 58), in 60% of the registries malnutrition was observed (Body Mass Index <20), in 39.7% (25/63), dependence on alcohol, tobacco or drug dependence was registered. Conclusions: Mortality associated with TB/HIV is preventable, but in 2017 it represented a quarter of the TB mortality in Cali. Adult men with conditions of social vulnerability, diagnosed in advanced stages of disease, were fatally targeted. Improving information systems and integrating TB/HIV programs should be priority strategies for public health in Colombia.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Tuberculose , HIV , Índice de Massa Corporal , Infecções por HIV , Saúde Pública , Estudos Transversais , Mortalidade , Estratégias de Saúde , Colômbia , Vulnerabilidade Social , Desnutrição
3.
Multimedia | Recursos Multimídia | ID: multimedia-9473

RESUMO

Nos dias 29 e 30 de setembro de 2021, foi realizado o seminário virtual “Guias Alimentares baseados no nível de processamento dos alimentos: evidências científicas e implementação”, uma iniciativa da Coordenação Geral de Alimentação e Nutrição (CGAN) do Ministério da Saúde em parceria com a Organização Pan-Americana da Saúde/ Organização Mundial da Saúde (OPAS/OMS). O objetivo do seminário virtual foi disseminar evidências científicas recentes sobre o impacto do nível de processamento dos alimentos na saúde, na obesidade e outras doenças crônicas, bem como discutir estratégias de implementação e disseminação de Guias Alimentares baseados no nível de processamento dos alimentos nas Américas. O seminário faz parte das atividades da Rede de Ação sobre Guias Alimentares baseados no nível de processamento dos alimentos nas Américas, liderada pelo Ministério da Saúde do Brasil, desde 2018, com o apoio da OPAS/OMS e da Organização das Nações Unidas para Agricultura e Alimentação (FAO). Em 2017, o Brasil foi o primeiro país a assumir compromissos para enfrentar todas as formas de desnutrição, considerando o papel dos sistemas alimentares, no âmbito da Década de Ação pela Nutrição das Nações Unidas (2016-2015).


Assuntos
Dieta Saudável , Guias Alimentares , Desnutrição/prevenção & controle , Segurança Alimentar , Vulnerabilidade Social , Comportamento Alimentar , Advocacia em Saúde
4.
Multimedia | Recursos Multimídia | ID: multimedia-9476

RESUMO

Nos dias 29 e 30 de setembro de 2021, foi realizado o seminário virtual “Guias Alimentares baseados no nível de processamento dos alimentos: evidências científicas e implementação”, uma iniciativa da Coordenação Geral de Alimentação e Nutrição (CGAN) do Ministério da Saúde em parceria com a Organização Pan-Americana da Saúde/ Organização Mundial da Saúde (OPAS/OMS). O objetivo do seminário virtual foi disseminar evidências científicas recentes sobre o impacto do nível de processamento dos alimentos na saúde, na obesidade e outras doenças crônicas, bem como discutir estratégias de implementação e disseminação de Guias Alimentares baseados no nível de processamento dos alimentos nas Américas. O seminário faz parte das atividades da Rede de Ação sobre Guias Alimentares baseados no nível de processamento dos alimentos nas Américas, liderada pelo Ministério da Saúde do Brasil, desde 2018, com o apoio da OPAS/OMS e da Organização das Nações Unidas para Agricultura e Alimentação (FAO). Em 2017, o Brasil foi o primeiro país a assumir compromissos para enfrentar todas as formas de desnutrição, considerando o papel dos sistemas alimentares, no âmbito da Década de Ação pela Nutrição das Nações Unidas (2016-2015).


Assuntos
Dieta Saudável , Guias Alimentares , Segurança Alimentar , Obesidade/prevenção & controle , Comportamento Alimentar , América Latina , Alimentos Industrializados , Vulnerabilidade Social , Nutrição da Criança , Desnutrição/prevenção & controle , Bebidas Adoçadas com Açúcar
5.
Multimedia | Recursos Multimídia | ID: multimedia-9478

RESUMO

Nos dias 29 e 30 de setembro de 2021, foi realizado o seminário virtual “Guias Alimentares baseados no nível de processamento dos alimentos: evidências científicas e implementação”, uma iniciativa da Coordenação Geral de Alimentação e Nutrição (CGAN) do Ministério da Saúde em parceria com a Organização Pan-Americana da Saúde/ Organização Mundial da Saúde (OPAS/OMS). O objetivo do seminário virtual foi disseminar evidências científicas recentes sobre o impacto do nível de processamento dos alimentos na saúde, na obesidade e outras doenças crônicas, bem como discutir estratégias de implementação e disseminação de Guias Alimentares baseados no nível de processamento dos alimentos nas Américas. O seminário faz parte das atividades da Rede de Ação sobre Guias Alimentares baseados no nível de processamento dos alimentos nas Américas, liderada pelo Ministério da Saúde do Brasil, desde 2018, com o apoio da OPAS/OMS e da Organização das Nações Unidas para Agricultura e Alimentação (FAO). Em 2017, o Brasil foi o primeiro país a assumir compromissos para enfrentar todas as formas de desnutrição, considerando o papel dos sistemas alimentares, no âmbito da Década de Ação pela Nutrição das Nações Unidas (2016-2015).


Assuntos
Dieta Saudável , Guias Alimentares , Comportamento Alimentar , Alimentos Industrializados , Segurança Alimentar , Promoção da Saúde , Desenvolvimento Sustentável , Desnutrição/prevenção & controle , Vulnerabilidade Social
7.
BMC Geriatr ; 21(1): 619, 2021 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-34724908

RESUMO

BACKGROUND: Frailty is a kind of geriatric syndrome, which is very common in the elderly. Patients with malnutrition are at higher risk of frailty. This study explored the correlation between nutrition and frailty and compared the receiver operating characteristic curve of different nutritional indexes for frailty. METHODS: This cross-sectional study included 179 inpatients aged ≥65 years old. Frailty was measured using Fried Frailty Phenotype, handgrip strength was measured using JAMAR@Plus and the 4.57 m usual gait speed was measured using a stopwatch. Comprehensive nutritional assessment refers to the application of Mini Nutritional Assessment (MNA) to assess the nutritional status of patients. RESULTS: Compared with the non-frailty group, the upper arm circumference, calf circumference, hemoglobin, albumin, prealbumin, cholesterol and low density lipoprotein in the frailty group were lower (P < 0.05). Comprehensive nutritional assessment, whether as a categorical variable or a continuous variable, was significantly correlated with frailty (P < 0.05). Model1 showed that the risk of frailty in malnourished patients was 3.381 times higher than that in well nourished patients (P = 0.036). Model2 showed that the risk of frailty decreased by 13.8% for every 1 point increase in MNA score (P = 0.009). The area under the curves of albumin, prealbumin and hemoglobin was larger (AUC > 0.65), AUC was 0.718, 0.693 and 0.743, respectively. CONCLUSIONS: Our results suggest that malnutrition is closely related to frailty. As for single nutritional indexes, albumin, prealbumin and hemoglobin were found to be associated with frailty. Further cohort studies are needed to verify their ability to screen for frailty.


Assuntos
Fragilidade , Desnutrição , Idoso , Estudos Transversais , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Avaliação Geriátrica , Força da Mão , Humanos , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Avaliação Nutricional , Estado Nutricional , Curva ROC
8.
BMC Geriatr ; 21(1): 628, 2021 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-34736396

RESUMO

BACKGROUND: Malnutrition is a common and significant problem in older adults. Insight into factors underlying malnutrition is needed to develop strategies that can improve the nutritional status. Compromised intestinal integrity caused by gut wall hypoperfusion due to atherosclerosis of the mesenteric arteries in the aging gastrointestinal tract may adversely affect nutrient uptake. The presence of compromised intestinal integrity in older adults is not known. The aim of this study is to provide a proof-of-concept that intestinal integrity is compromised in older adults during daily activities. METHODS: Adults aged ≥75 years living independently without previous gastrointestinal disease or abdominal surgery were asked to complete a standardized walking test and to consume a standardized meal directly afterwards to challenge the mesenteric blood flow. Intestinal fatty acid-binding protein (I-FABP) was measured as a plasma marker of intestinal integrity, in blood samples collected before (baseline) and after the walking test, directly after the meal, and every 15 min thereafter to 75 min postprandially. RESULTS: Thirty-four participants (median age 81 years; 56% female) were included. Of the participants, 18% were malnourished (PG-SGA score ≥ 4), and 32% were at risk of malnutrition (PG-SGA score, 2 or 3). An I-FABP increase of ≥50% from baseline was considered a meaningful loss of intestinal integrity and was observed in 12 participants (35%; 8 females; median age 80 years). No significant differences were observed in either baseline characteristics, walking test scores, or calorie/macronutrient intake between the groups with and without a ≥ 50% I-FABP peak. CONCLUSION: This study is first to indicate that intestinal integrity is compromised during daily activities in a considerable part of older adults living independently.


Assuntos
Desnutrição , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Ingestão de Energia , Feminino , Humanos , Masculino , Estado Nutricional , Projetos Piloto
9.
BMC Geriatr ; 21(1): 631, 2021 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-34736423

RESUMO

BACKGROUND: In the mid-seventies, biliopancreatic diversion became popular as weight-loss surgery procedure. This bariatric procedure combines distal gastric resection and intestinal malabsorption, leading to greater weight loss and improvement of co-morbidities than other bariatric procedures. Nowadays, biliopancreatic diversion has become obsolete due to the high risk of nutritional complications. However, current patients with biliopancreatic diversions are aging. Consequently, geriatricians and general practitioners will encounter them more often and will be faced with the consequences of late complications. CASE PRESENTATION: A 74-year old female presented with weakness, recurrent falls, confusion, episodes of irresponsiveness, anorexia and weight loss. Her medical history included osteoporosis, herpes encephalitis 8 years prior and a biliopancreatic diversion (Scopinaro surgery) at age 52. Cerebral imaging showed herpes sequelae without major atrophy. Delirium was diagnosed with underlying nutritional deficiencies. Biochemical screening indicated vitamin A deficiency, vitamin E deficiency, zinc deficiency and severe hypoalbuminemia. While thiamin level and fasting blood glucose were normal. However, postprandial hyperinsulinemic hypoglycemia was observed with concomitant signs of confusion and blurred consciousness. After initiating parenteral nutrition with additional micronutrient supplementation, a marked improvement was observed in cognitive and physical functioning. CONCLUSIONS: Long-term effects of biliopancreatic diversion remain relatively underreported in older patients. However, the anatomical and physiological changes of the gastrointestinal tract can contribute to the development of metabolic and nutritional complications that may culminate in cognitive impairment, functional decline and delirium. Therefore, it is warranted to evaluate the presence of metabolic disturbances and nutritional complications in older patients after biliopancreatic diversion.


Assuntos
Desvio Biliopancreático , Desnutrição , Obesidade Mórbida , Idoso , Desvio Biliopancreático/efeitos adversos , Feminino , Humanos , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/etiologia , Perda de Peso
10.
Ann Palliat Med ; 10(10): 11191-11202, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34763477

RESUMO

OBJECTIVE: We aimed to summarize the enteral nutrition (EN) management of stroke patients according to recent evidence. BACKGROUND: Stroke patients have a high incidence of dysphagia, which is the main cause of malnutrition, and stroke with malnutrition leads to high recurrence and mortality. Insufficient food intake caused by dysphagia is the main cause of malnutrition in stroke patients, which is associated with poor prognosis, increased mortality, and deteriorated outcomes in patients with stroke. Dehydration is also worthy of attention. METHODS: Non-systematic searches of the PubMed database were conducted to retrieve relevant English-language articles, and the CNKI and Wanfang database were searched for relevant Chinese-language articles. Fifteen recent guidelines or expert consensuses on the clinical nutritional management of stroke patients were published between 2013 and 2021, of which eight are from China. CONCLUSIONS: Before providing nutritional support, swallowing, hydration, and risk of malnutrition need to be screened by a dietitian or professional. Although the initiation time of nutritional support is different in each guideline, tube feeding is preferable for patients with dysphagia. The appropriate dosage, formula, and treatment of complications need to be further studied. Also, nutritional support for stroke patients at different stages needs to be further improved. The continuous improvement and details of stroke nutrition guidelines contribute to standardized clinical nutrition practices and benefit patients.


Assuntos
Transtornos de Deglutição , Desnutrição , Acidente Vascular Cerebral , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia , Nutrição Enteral , Humanos , Apoio Nutricional , Acidente Vascular Cerebral/complicações
11.
Ann Palliat Med ; 10(10): 10600-10606, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34763507

RESUMO

BACKGROUND: Malnutrition is common and detrimental in cancer patients undergoing chemotherapy. There are close associations between olfactory dysfunction, depression, and malnutrition, but how they correlate in cancer patients undergoing chemotherapy remains unclear. METHODS: Two hundred and one cancer patients undergoing chemotherapy were recruited to this study. Their risk of malnutrition was assessed using the Simplified Nutritional Appetite Questionnaire (SNAQ); odor identification was assessed by Sniffin' Sticks test; self-measurement of olfaction was assessed by Self-reported Mini Olfactory Questionnaire (Self-MOQ); and depressive symptoms were assessed using the Beck Depression Inventory (BDI). Correlation analyses and mediation analyses were used to explore the relationships between olfaction, depression, and risk of malnutrition. RESULTS: The SNAQ score was negatively correlated with the Self-MOQ score and BDI score, and positively correlated with body mass index (BMI) scores and odor identification. The Self-MOQ score was negatively correlated with odor identification and positively correlated with BDI scores, and the duration of chemotherapy was negatively correlated with odor identification. Mediation analyses suggested that BDI scores exhibited a partial mediation effect on the relationship between Self-MOQ score and SNAQ scores. CONCLUSIONS: The influence of olfactory dysfunction on risk of malnutrition is mediated by depressive symptoms in cancer patients undergoing chemotherapy. Early intervention of olfactory dysfunction and depressive symptoms may be helpful in reducing the risk malnutrition in cancer patients undergoing chemotherapy.


Assuntos
Desnutrição , Neoplasias , Transtornos do Olfato , Depressão , Humanos , Desnutrição/etiologia , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Transtornos do Olfato/induzido quimicamente , Olfato
12.
Artigo em Inglês | MEDLINE | ID: mdl-34770239

RESUMO

This study aimed to evaluate the role of the general condition and oral health status in determining the primary nutritional route and suitable food form for oral ingestion among malnourished inpatients. This cross-sectional study included 255 inpatients referred to a nutrition support team (NST), which included dental professionals, at an acute care hospital. We assessed the participants' basic information, and Dysphagia Severity Scale (DSS) and Oral Health Assessment Tool (OHAT) scores. The nutritional intake mode was evaluated based on the Functional Oral Intake Scale scores at the initial NST consultation (FOIS-I), and then revised by the NST based on the participants' general condition and oral health (FOIS-R). There was a divergence between FOIS-I and FOIS-R, with FOIS-R being significantly higher than FOIS-I (p < 0.001). Logistic regression analysis of FOIS-R identified that consciousness level (odds ratio (OR): 0.448; 95% confidence interval (CI): 0.214-0.935) and DSS (OR: 3.521; 95% CI: 2.574-4.815) significantly affected the oral nutrition intake. Among participants who could ingest orally (FOIS-R ≥ 3; n = 126), FOIS score had significant negative and positive associations with the OHAT and DSS scores, respectively. These findings suggest that appropriate assessment of oral health status, including swallowing function, might contribute to high-quality nutrition management.


Assuntos
Transtornos de Deglutição , Desnutrição , Estudos Transversais , Deglutição , Transtornos de Deglutição/epidemiologia , Ingestão de Alimentos , Humanos , Desnutrição/epidemiologia
13.
Front Public Health ; 9: 722290, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34722437

RESUMO

Both malnutrition and poor mental health are leading sources of global mortality, disease, and disability. The fields of global food security and nutrition (FSN) and mental health have historically been seen as separate fields of research. Each have undergone substantial transformation, especially from clinical, primary care orientations to wider, sociopolitical approaches to achieve Sustainable Development Goals. In recent years, the trajectories of research on mental health and FSN are further evolving into an intersection of evidence. FSN impacts mental health through various pathways such as food insecurity and nutrients important for neurotransmission. Mental health drives FSN outcomes, for example through loss of motivation and caregiving capacities. They are also linked through a complex and interrelated set of determinants. However, the heterogeneity of the evidence base limits inferences about these important dynamics. Furthermore, interdisciplinary projects and programmes are gaining ground in methodology and impact, but further guidance in integration is much needed. An evidence-driven conceptual framework should inform hypothesis testing and programme implementation. The intersection of mental health and FSN can be an opportunity to invest holistically in advancing thinking in both fields.


Assuntos
Desnutrição , Saúde Mental , Saúde Global , Humanos , Estado Nutricional , Desenvolvimento Sustentável
14.
Health Policy Plan ; 36(10): 1574-1592, 2021 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-34788442

RESUMO

There is consensus that policy coherence is necessary for implementing effective and sustainable approaches to tackle malnutrition. We look at whether policies and programmes provide a coherent pathway to address nutrition priorities and if programmes are designed to deliver interventions aligned to the nutrition policy agenda in Nigeria and Burkina Faso. A systematic desk review was performed on nutrition-relevant policy and programme documents, obtained through grey literature searches and expert recommendations. We developed a framework with an impact pathway structure that includes five process steps, which was used to guide coding, data reduction and synthesis and structure the analysis. We assessed internal coherence along process steps within a given document and external coherence across process steps for explicitly linked policy/programme pairs. The majority of policies and programmes had partial internal coherence for both countries. The identification of relevant nutrition interventions to address challenges and reach objectives was the strongest connection within policies (16 out of 45 had complete coherence), while among programmes, the strongest connection was coverage indicators that measure interventions (9 out of 21 had complete coherence). Eight programmes explicitly referenced at least one nutrition-relevant policy, with a total of 16 linked policy/programme pairs (13 pairs for Burkina Faso and 3 for Nigeria) across health, nutrition, agriculture and social focus areas. However, none of the linked pairs were assessed to have complete external coherence, suggesting that priorities at the policy level are not fully realized nor translated at the programme level. This study offers a new approach for the assessment of policy and programme coherence and specifically examines policy and programme linkages. We conclude that improved leadership on country priority setting and better alignment for nutrition within and across sectors is needed to enhance the effectiveness of nutrition investments.


Assuntos
Desnutrição , Estado Nutricional , Burkina Faso , Humanos , Desnutrição/prevenção & controle , Nigéria , Política Nutricional
15.
Int J Public Health ; 66: 609179, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34744575

RESUMO

Objective: To describe the inequalities in the double burden of malnutrition (DBM) in the adult population. Methods: Study carried out with data from the VIGITEL study, conducted in 2019 in all Brazilian capitals. Underweight and excess weight were evaluated on the basis of years of schooling and age. Multi-level analysis was performed including Human Development Index of each capital and individual-level variables. The inequality slope index was used to assess the magnitude of the inequalities found. All analyses considered the svy command owing to the complexity of the sampling process. Results: 47.119 individuals were studied. Men with no education had 6 percentage points more underweight compared to those with higher education. Higher prevalence of excess weight was found among men with higher education and women with no education. In women, the difference was 18 percentage points between extreme categories. Elderly people with no education had 10 percentage points more excess weight than those with higher education. Conclusions: The findings suggest the need for intersectoral actions that can cope with the social inequalities and help confronting with the DBM in Brazil.


Assuntos
Disparidades nos Níveis de Saúde , Desnutrição , Adulto , Brasil/epidemiologia , Feminino , Humanos , Masculino , Desnutrição/epidemiologia , Fatores Socioeconômicos
16.
Pan Afr Med J ; 39: 277, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34754354

RESUMO

Introduction: malnutrition due to inadequate food supply is a major challenge in low- and middle-income countries. The purpose of this study is to identify the sociocultural drivers of malnutrition. Methods: we conducted a qualitative study in the Amoron´I Mania region, Madagascar. The study involved pregnant women, mothers and fathers, grandmothers and health actors such as "matrones", community workers and health workers. A total of 24 semi-structured individual interviews and 6 focus groups were used to collect data. Thematic analysis was used. Results: malnutrition refers to a lack of food and undernourishment. It revolves around the amount of rice consumption, socio-cultural factors and insufficient financial resources. Vulnerable groups were mainly composed of children and pregnant women. Severe malnutrition including signs was reported, but there was evidence for local adaptation. Thus, families were trying by different means to fight against malnutrition. Conclusion: the socio-cultural context modulates knowledge and perception of the causes, the manifestations and the vulnerability or non-vulnerability of an individual as well as the severity of malnutrition.


Assuntos
Abastecimento de Alimentos , Conhecimentos, Atitudes e Prática em Saúde , Desnutrição/epidemiologia , População Rural/estatística & dados numéricos , Adolescente , Adulto , Idoso , Feminino , Grupos Focais , Pessoal de Saúde/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Madagáscar/epidemiologia , Masculino , Desnutrição/fisiopatologia , Pessoa de Meia-Idade , Percepção , Gravidez , Pesquisa Qualitativa , Índice de Gravidade de Doença , Populações Vulneráveis/estatística & dados numéricos , Adulto Jovem
17.
Cien Saude Colet ; 26(suppl 3): 4859-4870, 2021.
Artigo em Português | MEDLINE | ID: mdl-34787181

RESUMO

The scope of this article is to evaluate the potentialities of indicators of the nutritional status of iodine in individuals or populations. The review was based on PRISMA. The search for articles occurred in January 2019, in the Pubmed, Scopus and LILACS databases, using the key words: indicators AND nutritional status AND iodine. The selection followed the stages of excluding the duplicates, reading the titles, abstracts and analyses in full. The methodological quality of the studies was evaluated by the Downs and Black instrument. A total of 178 studies were identified and 20 were included. Urinary Iodine Concentration (UIC) was analyzed in 65% of the studies and was considered the best indicator to evaluate the nutritional status of iodine in the population. Thyroglobulin was determined in 20% of the studies and reflected the pre-existing state of iodine. Thyroid stimulating hormone was verified in 45% of the articles and was important for the surveillance of iodine deficiency among newborns. Only one study evaluated capillary iodine, useful for analyzing long-term dietary intake. In the evaluation of methodological quality, the lowest score was 12 and the highest 16, in 17 possible points. The use of UIC is recommended for the diagnosis of deficiency and excess of iodine in the population.


Assuntos
Iodo , Desnutrição , Ingestão de Alimentos , Humanos , Recém-Nascido , Estado Nutricional , Tireoglobulina
18.
J Glob Health ; 11: 04060, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34737860

RESUMO

Background: Home visits by community health workers are promoted to improve the coverage and uptake of evidence-based newborn services and behaviours. However, evidence on the effectiveness of these home visits delivered through government systems at scale is limited, as is evidence from the post-neonatal period. From 2013 to 2017, the Government of India piloted an intervention called Home Based Newborn Care Plus with the goal of reducing pneumonia- and diarrhoea-related morbidity and malnutrition. Village-based Accredited Social Health Activists were incentivised to make quarterly home visits to infants between three and 12 months of age. After the pilot, the intervention was adapted and scaled up nationally (with an additional visit at 15 months of age) as a new programme called Home Based Care for Young Child. Methods: The study used a quasi-experimental, difference-in-differences method to assess the quantitative impact on key outcome indicators by comparing changes over time in treatment districts with matched control districts. This was supplemented by a quantitative health worker survey and qualitative data collected at worker and community level. Results: The intervention led to a significant increase in the number of home visits, and their content became more aligned with Home Based Newborn Care Plus protocols. However, absolute levels of coverage remained low. The intervention had no detectable effect on the key outcomes of feeding practices, handwashing, iron and folic acid and oral rehydration solution supplementation, growth monitoring, and immunisation. Conclusions: Given the scale up of Home-Based Care for Young Child, there is a need to identify appropriate and comprehensive support for Accredited Social Health Activists to attain high coverage and quality and deliver impact. This will require reconsidering current design elements (such as incentives) and solving the underlying demand side and system level challenges (such as workload and supply chains) constraining Accredited Social Health Activists.


Assuntos
Agentes Comunitários de Saúde , Desnutrição , Criança , Visita Domiciliar , Humanos , Índia , Lactente , Saúde do Lactente , Recém-Nascido
19.
Cien Saude Colet ; 26(10): 4511-4518, 2021 Oct.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34730639

RESUMO

The undernutrition and obesity pandemics associated with climate change are a global syndemic. They have a point of convergence, which is the unsustainable current food systems. This paper aims to discuss the role of public health policies, particularly the Brazilian Unified Health System (SUS) in the context of Primary Health Care, in combating the global syndemic and in the development of sustainable food systems. In this scenario, the National Food and Nutrition Policy is a leading intersectoral tool for an adequate and healthy diet and food and nutrition security. Also, the Dietary Guidelines for the Brazilian population is a strategic tool to support food and nutrition education. We highlight the need to articulate health, agriculture, and environmental policies to achieve sustainable development. Thus, SUS can be the arena to promote the main discussions on this topic, potentiating individual, group, and institutional actions to provide a fairer, healthy, and sustainable food system.


Assuntos
Abastecimento de Alimentos , Desnutrição , Saúde Global , Humanos , Política Nutricional , Estado Nutricional , Sindemia
20.
Trials ; 22(1): 767, 2021 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-34732233

RESUMO

BACKGROUND: While it is well established that perioperative use of oral nutrition supplement (ONS) improves nutrition status among severely malnourished surgical cancer patients, the evidence requires further substantiation for non-severely malnourished patients with cancer. This protocol paper presents the rationale and design of a randomised controlled trial to evaluate the effectiveness of preoperative as well as an extended 90-day postoperative use of ONS on nutritional and clinical outcomes among patients undergoing elective surgery for breast and colorectal cancer. METHODS: Patients with primary breast and colorectal cancer undergoing elective surgery are recruited from two tertiary hospitals. Eligible patients are assigned into one of the three intervention arms: (i) Group SS will receive ONS in addition to their normal diet up to 14 days preoperatively and postoperatively up to discharge; (ii) Group SS-E will receive ONS in addition to their normal diet up to 14 days preoperatively, postoperatively up to discharge and for an extended 90 days after discharge; and (iii) Group DS will receive ONS in addition to their normal diet postoperatively up to discharge from the hospital. The ONS is a standard formula fortified with lactium to aid in sleep for recovery. The primary endpoints include changes in weight, body mass index (BMI), serum albumin and prealbumin levels, while secondary endpoints are body composition (muscle and fat mass), muscle strength (handgrip strength), energy and protein intake, sleep quality, haemoglobin, inflammatory markers (transferrin, high sensitivity C-reactive protein, interleukin-6), stress marker (saliva cortisol), length of hospital stay and postoperative complication rate. DISCUSSION: This trial is expected to provide evidence on whether perioperative supplementation in breast and colorectal cancer patients presenting with high BMI and not severely malnourished but undergoing the stress of surgery would be beneficial in terms of nutritional and clinical outcomes. TRIAL REGISTRATION: ClinicalTrial.gov NCT04400552. Registered on 22 May 2020, retrospectively registered.


Assuntos
Neoplasias Colorretais , Desnutrição , Neoplasias Colorretais/cirurgia , Suplementos Nutricionais , Força da Mão , Humanos , Desnutrição/diagnóstico , Desnutrição/etiologia , Desnutrição/prevenção & controle , Estado Nutricional , Alta do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto
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