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.
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.
O artigo traz reflexões sobre a alimentação, enquanto prática social, no período demarcado pelo primeiro centenário do Colégio Pedro II (1837-1937), importante instituição de ensino do Brasil. ...Compreender a alimentação em sua complexidade demanda um exercício exploratório de aproximações dos diferentes núcleos de saberes história, antropologia, sociologia, comunicação, nutrição, psicologia- que estruturam o pensamento sobre esse fenômeno. Considerando essa interdisciplinaridade é que traçamos como o objetivo desta pesquisa, compreender como a escola, enquanto espaço de socialização, medeia as práticas alimentares de jovens estudantes. Para tal, utilizamos de fontes primárias da instituição, tais como regulamentos e regimentos internos, além do documento Memória Histórica do Colégio de Pedro Segundo, de Escragnolle Doria (1997). Recorremos às noções de representações para estudar os textos entendendo-os como discursos e práticas do mundo social que os tornam inteligíveis e possíveis. Identificamos que as relações sociais estabelecidas em torno da alimentação podem ter contribuído para a manutenção da ordem, disciplina, organização, estruturação do poder e fortalecimento da hierarquia social interna no Colégio Pedro II ao longo dos anos, ao mesmo tempo que também favoreceu a diferenciação dos estudantes dessa escola em relação a outros.
Scenario of research on Food Service in Brazil CAMPOS, Flávia Milagres; PRADO, Shirley Donizete; KRAEMER, Fabiana Bom ...
Revista de Nutrição,
02/2017, Letnik:
30, Številka:
1
Journal Article
Recenzirano
Odprti dostop
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.
Comer, alimentar ou nutrir circulam na nossa cultura, aproximadamente, como sinônimos e desse modo não dão conta das transformações que vêm ocorrendo na alimentação, que desejadas ou indesejadas ...contam com um hibridismo de padrões que representa uma mudança tanto de regras como de preferências alimentares. O objetivo do artigo é tornar essas concepções de senso comum categorias de análise e interpretação para pesquisas das Ciências Humanas e da Saúde, numa perspectiva teórica, através da conceituação. Neste espaço interdisciplinar da Nutrição e das Ciências Sociais, o alimento aparece associado a uma função natural (biológica), numa concepção em que natureza se contrapõe à cultura, e a comida assume sentidos e significados culturais (simbólicos). A alimentação expressa divisão do trabalho, da riqueza, é criação histórico-cultural através da qual se pode estudar uma sociedade. Atribui-se à Nutrição um sentido de ação racional, oriundo da constituição dessa ciência na modernidade, inserida num processo histórico de racionalização científica do comer e do alimentar-se. Consideramos que através da conceituação na prática interdisciplinar de pesquisa, que envolve um espaço compartilhado de saberes, podemos ser menos limitados por um modelo teórico uniformizado de saber e mais livres para pensar questões sobre a vida.
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.
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