RESUMEN

INTRODUCTION: Micronutrient deficiencies are common in low-income and middle-income countries and are usually related to inadequate food intake, poor diet quality and low bioavailability. Copper, selenium and zinc are essential minerals in several enzymatic reactions and their deficiencies are associated with worse prognosis in pregnancy, compromising maternal health as well as her offspring. Thus, the objective of the present systematic review will be to describe the prevalence of copper, selenium and zinc deficiencies in women of childbearing age. METHODS AND ANALYSIS: The search will be performed by independent reviewers. The bases used will be PubMed/MEDLINE, Science direct, Lilacs, Adolec, Scopus, EMBASE, CINAHL, Web of Science, CENTRAL, IMSEAR, PAHOS, WPRIM, IMEMR, AIM for grey literature OpenGrey and OVID. National data will be searched in BDTD. A first search will be performed and a second search will be performed just before submission. Risk of bias assessment will be performed using the Joanna Briggs group prevalence study checklist. Combinable studies will be performed meta-analysis. Heterogeneity will be tested using Cochran's Q test and quantified by the inconsistency test (I²). In the presence of high heterogeneity, meta-analysis will be performed using the random effects model with Stata metaprop. Summary prevalence will be generated for each outcome, presented in Forest plot figures. ETHICS AND DISSEMINATION: This systematic review will be solely based on published and retrievable literature, no ethics approval will be obtained. Our dissemination strategy will involve the presentation in scientific meetings, as well as the publication of article(s), posters and presentations in congresses. PROSPERO REGISTRATION NUMBER: CRD42020165352.

Asunto(s)

Asunto(s)

RESUMEN

OBJECTIVE: To test the hypothesis that a continuing educational strategy (ie, "the manual") in primary health-care improves infant feeding practices among infants under 1 year of age. METHODS: A before and after study was conducted at primary health-care units in Embu das Artes, Brazil. The intervention was the use of a manual created to support continuing educational activities on breastfeeding and complementary feeding to be performed by tutors of Estratégia Amamenta e Alimenta Brasil with health-care teams, in a period of 8 months. Five hundred sixty-one mothers before and 598 mothers after intervention were interviewed about breastfeeding and complementary feeding practices. Multivariate analysis was performed using Poisson multilevel regression to test the hypothesis. RESULTS: Lack of minimum food diversity (before 62.9%; after 50.3%) and lack of food adequacy (before 77.5%; after 63.3%) decreased significantly. Regression analysis confirmed that infants after the intervention had lower prevalence of inadequacy of complementary feeding. While the intervention did not show significant association with exclusive breastfeeding, it showed association with the improvement of complementary feeding practices. CONCLUSIONS: The manual is a continuing educational strategy that improved complementary feeding practices in primary health care.

Asunto(s)

RESUMEN

The present study aims to describe the evolution of an intervention, using a methodology that adopts the critical event as the unit of analysis, and to identify strategic factors that facilitate the continuation of the interventions. Six critical events were identified: dispute care models for health; area of advice: dispute field; change policy; break of interorganizational relations; lack of physical structure and turnover of staff; difficulty in organizing practices in the work process. these are developed into strategic factors: enabling network of allies; meetings and educational activities/building capacity; benefits perceived by community members; mobilization of key actors; intervention's compatibility with the government's vision; restoration of interrelationship; and stability of the workforce. These strategic factors form a group of interrelated conditions that provide the strengthened linkages between elements in the intervention, supporting the hypothesis that they collaborate for the sustainability of the interventions in health. Tracking down the transformations of an intervention set by the critical events, it was verified that these factors performed a protective role at times of changes in the intervention process.

Asunto(s)

RESUMEN

OBJECTIVES: Public health interventions are increasingly represented as complex systems. Research tools for capturing the dynamic of interventions processes, however, are practically non-existent. This paper describes the development and proof of concept process of an analytical tool, the critical event card (CEC), which supports the representation and analysis of complex interventions' evolution, based on critical events. METHODS: Drawing on the actor-network theory (ANT), we developed and field-tested the tool using three innovative health interventions in northeastern Brazil. Interventions were aimed to promote health equity through intersectoral approaches; were engaged in participatory evaluation and linked to professional training programs. The CEC developing involve practitioners and researchers from projects. Proof of concept was based on document analysis, face-to-face interviews and focus groups. RESULTS: Analytical categories from CEC allow identifying and describing critical events as milestones in the evolution of complex interventions. Categories are (1) event description; (2) actants (human and non-human) involved; (3) interactions between actants; (4) mediations performed; (5) actions performed; (6) inscriptions produced; and (7) consequences for interventions. CONCLUSIONS: The CEC provides a tool to analyze and represent intersectoral internvetions' complex and dynamic evolution.

Asunto(s)

RESUMEN

Abstract: The present study aims to describe the evolution of an intervention, using a methodology that adopts the critical event as the unit of analysis, and to identify strategic factors that facilitate the continuation of the interventions. Six critical events were identified: dispute care models for health; area of advice: dispute field; change policy; break of interorganizational relations; lack of physical structure and turnover of staff; difficulty in organizing practices in the work process. these are developed into strategic factors: enabling network of allies; meetings and educational activities/building capacity; benefits perceived by community members; mobilization of key actors; intervention's compatibility with the government's vision; restoration of interrelationship; and stability of the workforce. These strategic factors form a group of interrelated conditions that provide the strengthened linkages between elements in the intervention, supporting the hypothesis that they collaborate for the sustainability of the interventions in health. Tracking down the transformations of an intervention set by the critical events, it was verified that these factors performed a protective role at times of changes in the intervention process.

Resumo: O estudo busca descrever a evolução de uma intervenção, utilizando uma metodologia que adota o evento crítico como unidade de análise, além de identificar fatores estratégicos que facilitam a continuação das intervenções. Foram identificados seis eventos críticos: modelos em disputa na assistência à saúde; área de conselhos: campo de disputa; mudanças de políticas; quebra de relações entre organizações; falta de infraestrutura física e rotatividade de equipes e dificuldade na organização das práticas no processo de trabalho. Os eventos foram desdobrados em fatores estratégicos: potencialização de uma rede de aliados; reuniões e atividades educacionais ou de capacitação; benefícios percebidos pelos membros da comunidade; mobilização de atores-chave; compatibilidade da intervenção com a visão do governo; restauração do inter-relacionamento e estabilidade da força de trabalho. Esses fatores estratégicos formam um grupo de condições inter-relacionadas que fortalecem a articulação entre os elementos da intervenção, sustentando a hipótese de que colaboram com a sustentabilidade das intervenções na saúde. Ao identificar as transformações de uma intervenção relacionadas aos eventos críticos, verificou-se que esses fatores desempenharam papel protetor em momentos de mudanças no processo da intervenção.

Resumen: El estudio busca describir la evolución de una intervención, utilizando una metodología que adopta el evento crítico como unidad de análisis, además de identificar factores estratégicos que facilitan la continuación de las intervenciones. Se identificaron seis eventos críticos: modelos en disputa en la asistencia a la salud; área de consejos: campo de disputa; cambios de políticas; ruptura de relaciones entre organizaciones; falta de infraestructura física y rotatividad de equipos y dificultad en la organización de las prácticas en el proceso de trabajo. Los eventos fueron desdoblados en factores estratégicos: potencialización de una red de aliados; reuniones y actividades educacionales o de capacitación; beneficios percibidos por los miembros de la comunidad; movilización de actores-clave; compatibilidad de la intervención con la visión del gobierno; restauración de la interrelación y estabilidad de la fuerza de trabajo. Estos factores estratégicos forman un grupo de condiciones interrelacionadas que fortalecen la articulación entre los elementos de la intervención, manteniendo la hipótesis de que colaboran con la sostenibilidad de las intervenciones en la salud. Al identificar las transformaciones de una intervención relacionadas con los eventos críticos, se verificó que esos factores desempeñaron un papel protector en momentos de cambios en el proceso de la intervención.

Asunto(s)

RESUMEN

Foi realizada revisão da literatura com intuito de sistematizar o conhecimento produzido no campo da promoção da saúde em relação ao tema sustentabilidade. As bases de dados consultadas foram Lilacs, SciELO e Web of Science, no período entre 1989 e 2014. O corpus contou com 35 artigos, sendo analisados conceito de sustentabilidade, metodologia e resultados dos estudos. Verificou-se que os estudos têm se dedicado a encontrar fatores que influenciam a sustentabilidade de intervenções de saúde, no entanto, não há evidências sobre que fatores são suficientes para a sustentabilidade. Conclui-se que há pouca literatura sobre o tema em questão no âmbito nacional e se recomenda novas investigações.

Scientific review was performed aiming to systematize the knowledge produced in the field of health promotion, regarding sustainability. Databases consulted were Lilacs, SciELO and Web of Science, in the period between 1989 and 2014. The corpus included 35 papers being analyzed the concept of sustainability, methodology and studies results. It was found that the studies have been devoted to finding factors that influence the sustainability of health interventions, however, there is no scientific evidence about which factors are sufficient for the sustainability. It was concluded that there is little literature on the subject in question at the national level and further investigations are recommended.

RESUMEN

The author analizes the health promotion considering the use of evidence-based practice. Sometimes problems could arise from this approach. Indeed decisions concerning a specific case, are not only a technical issue, but involve normative judjements rarely well documented.

O autor discute a promoção da saúde considerando o uso da prática baseada em evidências. Algumas vezes podem surgir problemas com essa abordagem. De fato, decisões sobre casos específicos não se baseiam exclusivamente em aspectos técnicos, mas envolvem julgamentos normativos nem sempre adequadamene documentados.

Asunto(s)

RESUMEN

Partindo do pressuposto de que indicações metodológicas seguras com respeito à avaliação de programas de promoção da saúde devem se fundamentar numa reflexão crítica acerca da natureza dos referidos programas, o presente artigo faz uma revisão de duas perspectivas ontológicas tradicionais na base da maior parte da atividade científica. Enquanto para o realismo empírico os programas são objetos naturais, o idealismo e o relativismo os confinam rigorosamente ao domínio das representações e dos modelos. Ambas as perspectivas ontológicas, porém, deixam a desejar quanto aos programas de promoção da saúde. Sugere-se que o realismo crítico, o qual propõe uma ontologia em três camadas, oferece uma melhor estrutura para a compreensão dos programas de promoção da saúde. Nesta ontologia, a natureza dos programas reside em ações empreendidas para se criar as condições pelas quais engatilham-se.

Asunto(s)

Asunto(s)

Asunto(s)