This study aims to assess the acceptability, adherence, and retention of a feasibility trial on milk fortification with calcium and vitamin D (Ca+VitD) and periodontal therapy (PT) among low income ...Brazilian pregnant women with periodontitis (IMPROVE trial). This 2 × 2 factorial feasibility trial used a mixed-methods evaluation. In total, 69 pregnant women were randomly allocated to four groups: 1. fortified sachet with Ca+VitD and milk plus early PT (throughout gestation); 2. placebo and milk plus early PT; 3. fortified sachet with Ca+VitD and milk plus late PT after childbirth; 4. placebo and milk plus late PT. Data were collected via questionnaires, field notes, participant flow logs, treatment diary, and focal group discussions. Quantitative and qualitative data were analysed using appropriate descriptive statistics and content analysis, respectively. Eligibility rate (12%) was below the target of 15%, but participation (76.1%) and recruitment rate (2 women/week) exceeded the targets. Retention rate (78.6%) was slightly below the target (80%). Adherence to the PT was significantly higher in the early treatment groups (98.8%) compared to the late treatment groups (29%). All women accepted the random allocation, and baseline groups were balanced. There was no report of adverse events. This multi-component intervention is acceptable, well-tolerated, and feasible among low-risk pregnant women in Brazil.
There are difficulties in carrying out research in low-income urban communities, but the methodological challenges and suggestions on how to deal with them are often undocumented. The aims of this ...study are to describe the challenges of recruiting and enrolling low-income pregnant women with periodontitis to a clinical trial on vitamin D/calcium milk fortification and periodontal therapy and also to describe the patient-, study protocol- and setting-related factors related to women's ineligibility and refusal to participate in the study.
A mixed-method sequential exploratory design was applied. Qualitative and quantitative data on recruitment to a 2 × 2 factorial feasibility clinical trial were used. Eighteen women attending the health centre in a low-income area in Duque de Caxias (Rio de Janeiro, Brazil) took part in focus group discussions, and the data were thematically analysed. Quantitative data were analysed using appropriate descriptive statistics, including absolute and relative frequencies.
Of all referrals (767), 548 (78.5%) did not meet the initial eligibility criteria. The main reason for exclusion (58%) was advanced gestational age (> 20 weeks) at first prenatal appointment. In the periodontal examination (dental screen), the main reason for exclusion was the presence of extensive caries (64 out of 127 exclusions). Non-participation of those eligible after the periodontal examination was approximately 24% (22 out 92 eligible women) and predominantly associated with patient-related barriers (e.g. transportation barriers, family obligations, patients being unresponsive to phone calls and disconnected telephones). The study recruited 70 women with periodontitis in 53 weeks and did not reach the benchmark of 120 women in 36 weeks (58.3% of the original target). Recruitment was severely hindered by health centre closures due to general strikes. The recruitment yields were 9.1% (70/767) of all women contacted at first prenatal visit and 76.1% (70/92) of those screened eligible and enrolled in the trial. Women did not report concerns regarding random allocation and considered fortified milk as a healthful and safe food for pregnant women. Some women reported that financial constraints (e.g. transportation costs) could hinder participation in the study.
Engagement between the research team and health centre staff (e.g. nurses) facilitated referral and recruitment, yet some pregnant women failed to participate in the study largely due to significant patient-related sociodemographic barriers and setting-related factors. Our data illustrate the complexity of overcoming recruitment and enrolment challenges for clinical trials in resource-limited settings.
ClinicalTrials.gov, NCT03148483. Registered on 11 May 2017.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Periodontitis is a common oral inflammation, which is a risk factor for adverse pregnancy outcomes. Intakes of vitamin D and calcium are inversely associated with occurrence and progression of ...periodontitis. This study aims to assess the feasibility of a multi-component intervention, including provision of milk powder supplemented with calcium and vitamin D and periodontal therapy (PT), for improving maternal periodontal health and metabolic and inflammatory profiles of low-income Brazilian pregnant women with periodontitis.
The IMPROVE trial is a feasibility randomised controlled trial (RCT) with a 2 × 2 factorial design with a parallel process evaluation. Pregnant women with periodontitis, aged 18-40 years and with < 20 gestational weeks (
= 120) were recruited and randomly allocated into four groups: (1) fortified sachet (vitamin D and calcium) and powdered milk plus PT during pregnancy, (2) placebo sachet and powdered milk plus PT during pregnancy, (3) fortified sachet (vitamin D and calcium) and powdered milk plus PT after delivery and (4) placebo sachet and powdered milk plus PT after delivery. Dentists and participants are blinded to fortification. Acceptability of study design, recruitment strategy, random allocation, data collection procedures, recruitment rate, adherence and attrition rate will be evaluated. Data on serum levels of vitamin D, calcium and inflammatory biomarkers; clinical periodontal measurements; anthropometric measurements; and socio-demographic questionnaires are collected at baseline, third trimester and 6-8 weeks postpartum. Qualitative data are collected using focus group, for analysis of favourable factors and barriers related to study adherence.
Oral health and mineral/vitamin supplementation are much overlooked in the public prenatal assistance in Brazil and of scarcity of clinical trials addressing these issues in low and middle-income countries,. To fill this gap the present study was designed to assess the feasibility of a RCT on acceptability of a multi-component intervention combining conventional periodontal treatment and consumption of milk fortified with calcium-vitamin D for improving periodontal conditions and maternal metabolic and inflammation status, among Brazilian low-income pregnant women with periodontitis. Thus, we hope that this relatively low-cost and safe multicomponent intervention can help reduce inflammation, improve maternal periodontal health and metabolic profile and consequently prevent negative gestational outcomes.
NCT, NCT03148483. Registered on May 11, 2017.
A conceptual discussion on the discourses of the social actors in the field of Food and Nutrition is proposed, presenting the existing conflicts, discursive strategies and struggles for academic ...legitimacy. The line of argumentation follows the biopower concept developed by Michel Foucault, who presents medicine as a knowledge-power focused at the same time on the body and the population, the human body and the biological processes, producing disciplinary results and widespread regulatory effects on society. Based on this concept it is argued that the discourses produced in the field put hegemonic and counter-hegemonic interests in confrontation, political disputes disguised by "abstract" epistemological discussions, strategies to lure consumers, life standardization and medicalization. Such discourses translate instances of power in dispute, economic interests, structural conflicts, political impasses. New elements are presented for the production of knowledge for professionals of Nutrition and for the perception of the feeding act beyond the nutritional, biological, biomedical and epistemological parameters, which in essence are clearly political once they convey tensions between the conceptual structures that also operate in the interior of the field. It is assumed that there is no such health or nutrition as abstract, neutral fields, detached from reality; such dimensions are part of the material, concrete life and carry symbolic, cultural and subjective values. Considering only the nutritional aspects of nutrition is to impoverish and weaken it, and the discussion that seems to be "merely conceptual" brings to light important issues that the professionals in the field of Food and Nutrition should address.
Propõe-se uma discussão conceitual acerca dos discursos dos atores sociais do campo da Alimentação e Nutrição ao apresentar conflitos existentes, estratégias discursivas em jogo e lutas por legitimidade no espaço acadêmico. O eixo principal da argumentação se dá a partir do conceito de biopoder, de Michel Foucault, que apresenta a medicina como um saber-poder que incide, ao mesmo tempo, sobre o corpo e a população, sobre o organismo e os processos biológicos, produzindo resultados disciplinares e efeitos regulamentadores disseminados por toda a sociedade. A partir desse conceito, argumenta-se que os discursos produzidos no campo colocam, frente a frente, interesses hegemônicos e contra-hegemônicos, disputas políticas travestidas de discussões epistemológicas "abstratas", estratégias de sedução, normatização e medicalização da vida. Tais discursos traduzem instâncias de poder em confronto, interesses econômicos, conflitos estruturais, embates políticos. São apresentados novos elementos para pensar a produção de conhecimento para profissionais da Nutrição e da percepção do ato alimentar para além de parâmetros nutricionais, biológicos, biomédicos e epistemológicos que, na sua essência, são nitidamente políticos, pois traduzem tensões entre estruturas conceituais que também operam no interior do campo. Postula-se que não há saúde ou nutrição em abstrato, como campos neutros, desconectados da realidade; essas dimensões fazem parte da vida material, concreta e estão carregadas de valores simbólicos, culturais e subjetivos. Pensar a Nutrição apenas em seus aspectos nutricionais é empobrecê-la e enfraquecê-la, e essa discussão, que parece ser "meramente conceitual", traz à tona questões importantes que precisam ser discutidas pelos profissionais do campo da Alimentação e Nutrição.
Scenario of research on Food Service in Brazil CAMPOS, Flávia Milagres; PRADO, Shirley Donizete; KRAEMER, Fabiana Bom ...
Revista de Nutrição,
02/2017, Volume:
30, Issue:
1
Journal Article
Peer reviewed
Open access
ABSTRACT Objective: The present study aims to investigate the scenario of research on Food Service in Brazil based on the Stricto Sensu Graduate Programs in Nutrition, research groups, and scientific ...production. Methods: A search of the research lines including studies related to this topic and the researchers engaged in those studies was conducted. The research groups were identified on the Directory of Research Groups in Brazil website and the profile of the scientific production was based on articles included in the Scientific Electronic Library Online database. Articles published in international journals that were related to research lines focused on food production were also searched and analyzed. Results: The search identified only two graduate programs with research lines that describe the food production as the object of study although 13 graduate programs carry out research related to Food Service, especially focused on nutritional and sanitary aspects of food. The same trend was observed in the national articles. The internationalization of these two research line results from the academic publication in 22 different journals over the past 5 years. Thirty five professors were identified and most of them hold a PhD in Food Science and Technology. The number of research groups increased from two in 2000 to twenty nine in 2010. Conclusion: The inclusion of Food Service in graduate programs is still limited. The main trend observed is towards a closer relationship with Food Science and Technology in terms of the lines of research, professional qualification, and published studies.
RESUMO Objetivo: Busca-se uma aproximação com o cenário da pesquisa em Alimentação Coletiva no Brasil a partir dos programas de pós-graduação Stricto Sensu pertencentes à área da Nutrição, dos grupos de pesquisa e da produção científica. Métodos: Foi realizado levantamento das linhas de pesquisa em que são desenvolvidos trabalhos de interesse, bem como de docentes vinculados a estas linhas. Para identificação dos grupos de pesquisa, empregou-se o site do Diretório de Grupos de Pesquisa no Brasil e o recorte da produção científica foi baseado nos artigos publicados no Scientific Eletronic Library Online. Também foi investigada a publicação internacional vinculada às linhas de pesquisa que se voltam à produção de refeições. Resultados: Apenas dois programas possuem linhas de pesquisa que descrevem a produção de refeições como objeto de estudo, embora 13 programas de pós-graduação desenvolvam estudos em interface com a Alimentação Coletiva voltados, principalmente, para aspectos nutricionais e sanitários dos alimentos. Essa tendência também foi observada nos artigos nacionais. A internacionalização nas duas linhas de pesquisa destacadas ocorreu por meio da publicação em 22 revistas diferentes nos últimos cinco anos. Entre os 35 docentes identificados, a maioria possui doutoramento na área de Ciência e Tecnologia de Alimentos. O número de grupos de pesquisa cresceu de dois, no ano 2000, para 29, em 2010. Conclusão: A inserção da Alimentação Coletiva na pós-graduação é limitada. A principal tendência é de aproximação com a Ciência e Tecnologia de Alimentos no que se refere às linhas de pesquisa, qualificação docente e trabalhos publicados.
Body changes are central to adolescence as a stage of life. To approach conflicts experienced by adolescents with body changes, this study aimed to identify social representations of the body among ...adolescents in the last year of primary school in private and municipal schools in Rio de Janeiro, Brazil. Participants were 13 to 18 years of age and studied in schools in neighborhoods with the highest and lowest scores on the Social Development Index. Focus groups were used to produce social representation of the body. Groups began by evoking five words that came to mind when hearing the word "body". The EVOC program was used to treat evoked words, complemented by thematic content analysis. Many teenagers spoke of "beauty" as synonymous with "beautiful body" and described a model of beauty: a muscular body for teenage boys and a slender and shapely body for teenage girls.
A profissão de nutricionista está inserida na lógica das políticas de Estado, que envolve um jogo de interesses econômicos, sociais e políticos. Uma grande expansão nos cursos de graduação tem sido ...observada no país, principalmente nas instituições de ensino privado. O sistema universitário foi incorporado pela economia de mercado capitalista global, e a Alimentação e Nutrição, como campo científico, vem se desenvolvendo nesse cenário. O presente ensaio tem por objetivo discutir a expansão dos cursos de graduação em Nutrição no momento atual das instituições de ensino superior e seus impactos sobre a formação do nutricionista. Uma pesquisa analítica e crítica foi desenvolvida a partir de análise documental, identificando elementos de um jogo simbólico que perpassa essa trajetória, orientando o processo de análise. Verificamos acelerada expansão das instituições de ensino superior com fins lucrativos no Brasil, que apresentou impactos no campo da Alimentação e Nutrição, tanto na expansão dos cursos de graduação em Nutrição quanto no modelo de ensino profissionalizante adotado voltado a atender aos interesses econômicos.DOI: 10.12957/demetra.2018.25310
Eating, nourishment or nutrition circulate in our culture as synonyms and thus do not account for the changes that occur in nourishment, which intended or unintended, have a hybridization pattern ...that represents a change of rules and food preferences. This paper aims to take these common sense conceptions as analytic categories for analyzing and interpreting research for the Humanities and Health Sciences in a theoretical perspective, through conceptualization. The food is associated with a natural function (biological), a concept in which nature is opposed to culture, and nourishment takes cultural meanings (symbolic), expressing the division of labor, wealth, and a historical and cultural creation through which one can study a society. One attributes to Nutrition a sense of rational action, derived from the constitution of this science in modernity, inserted in a historical process of scientific rationalization of eating and nourishing. We believe that through the practice of conceptualization in interdisciplinary research, which involves a shared space of knowledge, we can be less constrained by a unified theoretical model of learning and be freer to think about life issues.
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