Dietary improvement was assessed using 24-hour food recall in a sample of 180 homemakers who had completed six to 18 months of instruction in the Virginia Expanded Food and Nutrition Education Program (EFNEP) to determine whether they retained dietary improvement six to 36 months after leaving the program. These homemakers provided additional information on Perceived Educational Gains and Program Benefits received from participating in EFNEP. Family factors were explored which were believed to be related to dietary change - Family Composition, Family Resource Assistance, Household Roles and Responsibilities, Family Support, and Family Diet Control. Diet Scores increased significantly (p<.01) from program Entry to Exit; greatest increases were in average daily servings from milk and fruit-vegetable groups. Slight but significant (p<.01) regression occurred in average Diet Score and servings of milk from Exit to Follow-up. Homemakers with higher Diet Scores at program Entry had higher scores at program Exit and Follow-up, and higher Program Benefit Scores. Length of time in program was not significantly associated with Dietary Improvement or Retention. High average Educational Gain and Program Benefit Scores at Follow-up were evidence that EFNEP was successful from the perspective of homemakers served. Family Composition was not associated with Dietary Improvement. Family Support emerged as the only family measure related to diet; higher Family Support Scores were associated not only with greater Perceived Educational Gains and Program Benefits, but also with higher Diet Scores at program completion and follow-up. Results of the study confirmed the Virginia EFNEP to be effective in improving diets of homemakers and sustaining these changes, and suggested a key role for family support in influencing dietary outcome and program success from the view of participants. / Ph. D.

In 1981, President Ronald Reagan issued Executive Order 12291 which requires Federal agencies to perform benefits assessments of proposed major regulations and prohibits them from taking regulatory action unless potential benefits exceed potential costs to society. A review of welfare economics literature and applications of the CBA model to health, education, and nutrition is presented. CBA for use in the Cooperative Extension Service Expanded Food and Nutrition Education Program (EFNEP) is then systematically examined using the following criteria: 1) theoretical considerations - can the economic criterion appropriately be applied to EFNEP?; and 2) application of the CBA model - can it be made operational? Following the critique of application of CBA to EFNEP, conclusions are drawn as to the appropriate use of CBA or alternative techniques in evaluating EFNEP and similar programs. / Doctor of Philosophy

The Expanded Food and Nutrition Education Program (EFNEP) is a federal program designed to improve the nutritional status of the population and provide employment for paraprofessional aides from the indigenous target population and an example of a change agency. Diffusion and change literature offer many models and possible personality characteristics that may be associated with effective change agents. The purpose of the study was to examine characteristics of paraprofessionals employed in the Adult phase of Virginia EFNEP and their relationship to paraprofessional effectiveness and how well they fit the diffusion model. Effectiveness for the paraprofessional was measured as homemaker success (change in nutrient intake and food behavior) and as paraprofessional performance (workload and home visit evaluation). Personality, training, and demographic characteristics of the 40 paraprofessionals were obtained through a mailed Paraprofessional Questionnaire and the Sixteen Personality Factor (16PF) Test. Demographics, food behavior and knowledge, and nutrient intake for a sample of three homemakers per paraprofessional (N=116) were obtained from EFNEP Family Records. Homophily, the measure of correspondence, was calculated by comparing each paraprofessional with their sample of three homemakers. Three personality factors (concrete thinking, impulsivity, and self-discipline) along with homophily were correlated with change in food behavior, none with change in nutrient intake, and two (concrete thinking and low tension) along with perfect match homophily were correlated with workload. There were no apparent difference in training. When all factors were analyzed by stepwise multiple regression, homophily along with three of the second-order personality factors were related to change in food behavior. One second order factor, low anxiety along with perfect match, was related to workload. Implications for practice include: (a) EFNEP paraprofessionals, in part, appear to be fitting the model of change agent effectiveness, in that homophily is influencing the homemakers and (b) low anxiety and low tension appear to be related to effectiveness and could be used in employee selection and future training. Recommendations for future study include: (a) further study into quantification of homophily and (b) investigation of relationship of characteristics to supervisor view of effectiveness. / Ph. D.

The purpose of this study was to explore the incentives and barriers perceived by low-income women of child-bearing age related to their participation in nutrition education programs. The specific programs of concern in this study are the Expanded Food and Nutrition Education Program (EFNEP) and the Food Stamp Nutrition Education (FSNE) program. This qualitative study sought to hear the voices of the women so that nutrition programs can be made more successful in reaching this population. Personal interviews were conducted with 23 women in their homes or appropriate local sites, and transcripts were analyzed to identify categories and themes. People of low socioeconomic status and those with the least education have higher rates of obesity and overweight and suffer disproportionately from poor health. Women receiving Temporary Assistance to Needy Families (TANF) also receive Medicaid. Medicaid costs have escalated due to the obesity rate, which is currently estimated at 64% of the adult population. In addition, 30% of American children are experiencing obesity or are overweight. It is important for parents to understand the causes of obesity and the effects of the chronic diseases related to obesity. Prevention programs are more cost effective than medical treatment of the diseases associated with obesity, and proper nutrition can reduce the incidence of chronic diseases. Findings of this study suggest that isolation is the main impediment to participating in nutrition education programs. Missing from the interviewed women's circumstances are social capital, human capital, and economic capital. Social capital relates to the connections and relationships that are important in life. Human capital involves the knowledge and skills acquired through life experiences. Economic capital refers to individual wealth or economic resources available to an individual or community. Nutrition education programs should be refined to incorporate opportunities for socialization that will develop trust and reciprocity, as well as nutrition knowledge. Based on the results of this study, Virginia Cooperative Extension programs will be adapted to incorporate weight control and cooking classes with nutritious recipes. The learning environment will be safe, learner-centered, and fun. New marketing tools that are more appealing to the prospective clients will be developed. / Ed. D.

O controle da hiperfosfatemia é a peça chave do tratamento do distúrbio mineral e ósseo em pacientes com doença renal crônica. O seu manejo é multifatorial e inclui a restrição dietética de fósforo (P), o uso apropriado de quelantes de P e a dose correta de terapia renal substitutiva. O objetivo deste estudo foi avaliar o efeito da aplicação de uma tabela de contagem de fósforo com cloridrato de sevelamer nos níveis séricos de fósforo de pacientes em hemodiálise. Foram recrutados 56 pacientes, os quais foram divididos em grupo intervenção A (n=18) e B (n=19) e grupo controle C (n=19). O grupo controle (GC) teve seus dados dietéticos, estado nutricional, carga de comprimidos e percentual de adesão ao cloridrato de sevelamer, além de parâmetros laboratoriais, como o P, o cálcio (Ca), o produto cálcio-fósforo (CaxP) e o hormônio da paratireoide (PTH), observados por 4 meses (T0, T1, T2, T3 e T4). Os grupos A (GA) e B (GB) tiveram os mesmos parâmetros investigados pelo GC, entretanto os 2 primeiros meses foram apenas de observação. Após essa fase, esses dois grupos foram orientados a controlar sua alimentação por meio da tabela de contagem de fósforo que consiste em uma ferramenta que auxilia no controle da ingestão alimentar de P por meio de lista de alimentos divididos em grupos alimentares com pontuações delimitadas e proporcionais aos teores de P, pelo período de 2 meses. Nesse período, o GA foi orientado a utilizar o cloridrato de sevelamer com dose fixa de 2 comprimidos (800mg) ao dia. Já o GB, utilizou o cloridrato de sevelamer por meio do autoajuste da sua dose com o auxílio de uma tabela que determina sua dose conforme o número de porções alimentares consumidas. Ao final do estudo, observou-se níveis de P de 4,92±1,42mg/dL; 5,44±1,21mg/dL e 5,07±1,24mg/dL, para os grupos A, B e C, respectivamente, não sendo encontrada diferenças estatísticas ao longo do trabalho. O CaxP manteve-se entre o início e final do estudo em ambos os grupos, apresentando-se <55mg2/dL2. No GA, os níveis de Ca reduziram de 9,52±1,01mg/dL para 9,17±0,77mg/dL entre T0 e T4; já no GB, esse parâmetro reduziu de 9,46±1,07mg/dL em T1 para 9,04±0,86mg/dL em T4; no GC, T4 (8,6±0,58mg/dL) apresentou-se com níveis menores de Ca ao ser comparado com T1, T2 e T3. O PTH manteve-se ao longo do estudo em ambos os grupos com níveis >300pg/mL. Em relação ao consumo do quelante, houve redução significativa da carga de comprimidos ao comparar, nos grupos A e B, os tempos T1 (GA: 122,22±90,1 e GB: 170,58±109,12) e T2 (GA: 103,67±63,53 e GB: 162±71,47) com T3 (GA: 49,89±15,23 e GB: 127,11±66,65) e T4 (GA: 45,94±14,96 e GB: 109,89±58,42). Apenas no GA foi observado melhora do percentual de adesão ao quelante quando comparado T1 com 66,21% de adesão com T3 que obteve 88,96% (p=0,014), e T2 que apresentou 64,92% de adesão contra 88,96% em T3 (p=0,009). Os dados dietéticos apontaram redução do consumo de P, após intervenção, apenas no GB ao comparar T0 (1039,43±66,78mg) com T4 (857,83±65,6mg). Não foram identificados prejuízos no estado nutricional após o término do trabalho. O estudo demonstrou que a aplicação da tabela de contagem de fósforo com cloridrato de sevelamer auxilia no controle dos níveis séricos de P tanto por meio da dose mínima do quelante como pelo autoajuste da sua dose. / Control of hyperphosphatemia is the key factor of treatment of mineral and bone disorders in patients with chronic kidney disease. Its management is multifactorial and includes dietary restriction of phosphorus (P), appropriate use of phosphate binders and the correct dose of renal replacement therapy. This study aimed to evaluate an intervention with a phosphorus counting table with sevelamer hydrochloride on serum phosphorus in patients on hemodialysis. Fifty-six patients were recruited and divided into intervention group A (n = 18) and B (n = 19) and control group C (n=19). Control group (CG) had dietary data, nutritional status, dose and percentage of adherence to sevelamer hydrochloride and laboratory parameters, such as P, calcium (Ca), calcium-phosphorus product (CaxP) and parathyroid hormone (PTH), observed for four months (T0, T1, T2, T3 e T4). Groups A (AG) and B (BG) had the same parameters evaluated for CG. However, the first two months were only observation. After this period, the two groups were conducted to control their diet with a phosphorus counting table help, which it\'s a tool that assists the control of dietary P intake through a food list divided into food groups with defined and proportional scores in relation to P content, for 2 months. In this period, AG was instructed to use sevelamer hydrochloride with a fixed dose of two tablets (800mg) daily. BG used the sevelamer hydrochloride through self-adjustment of its dose with a chart helps that establish its dose according to the number of consumed servings. At the end of the study, serum levels of P were 4.92±1.42mg/dL; 5.44±1.21mg/dL and 5.07±1.24mg/dL, for groups A, B, and C, respectively, with no statistical differences throughout the study. CaxP remained stable before and after intervention in both groups, showing <55mg2/dL2. In AG, serum Ca reduced from 9.52±1.01mg/dL to 9.17±0.77mg/dL between T0 and T4; Already BG, this parameter reduced from 9.46±1.07mg/dL at T1 to 9.04±0.86mg/dL at T4; in CG, T4 (8.6±0.58mg/dL) showed reduced levels of Ca when compared to T1, T2, and T3. PTH maintained throughout the study in both groups with levels >300pg/mL. About phosphate binder, there was a significant reduction in its dose when comparing, in AG and BG, at T1 (AG: 122.22±90.1 and BG: 170.58±109.12) and T2 (AG: 103.67±63.53 and BG: 162±71.47) with T3 (AG: 49.89±15.23 and BG: 127.11±66.65) and T4 (AG: 45.94±14.96 and BG: 109.89±58.42). Only in the AG, the percentage of adherence to treatment with phosphate binder was improved when compared T1 with 66.21% of adhesion with T3 that obtained 88.96% (p = 0.014), and T2 that presented 64.92% of adhesion against 88.96% in T3 (p = 0.009). Dietary data indicated a reduction of P consumption after an intervention, only in BG when compared T0 (1039.43±66.78mg) with T4 (857.83±65.6mg). No damage to nutritional status was observed at the end of the study. Intervention with a phosphorus counting table with sevelamer hydrochloride assists in the control of serum P levels both through the minimum dose of the phosphate binder and self-adjustment of its dose.

Imagens associadas a informações escritas ou verbais podem aumentar a atenção, compreensão, lembrança e favorecer a adesão às informações. Diante do consumo elevado de alimentos ultraprocessados ricos em gordura e açúcar que contribuem para a obesidade são necessários instrumentos de educação alimentar e nutricional que favoreçam o aprendizado sobre o conteúdo energético e nutricional dos alimentos, de modo que o comensal possa fazer melhores escolhas alimentares. O objetivo do estudo foi compreender como as imagens influenciam no aprendizado de orientações nutricionais e nas práticas alimentares. Trata-se de um estudo experimental, de natureza quantitativa e qualitativa, realizado com 64 mulheres, 33 participaram de oficinas de educação alimentar e nutricional com imagens (grupo imagem: Gi), e 31 mulheres participantes de oficinas de educação alimentar e nutricional sem imagens (grupo sem imagem: Gsi), subdivididas em dois subgrupos, de mulheres eutróficas e obesas. As oficinas consistiram de encontros em grupo onde foram passadas verbalmente informações alimentares e nutricionais, com ou sem o apoio da visualização de fotos sobre quatro temas que compõe um instrumento imagético para orientação alimentar e nutricional, que são: Vida doce, cuidando do açúcar - aborda o conteúdo de açúcar em doces e bebidas; Comida gostosa e com pouca gordura - trata sobre o teor de gordura em alimentos; Comer bem fazendo as melhores escolhas - sobre substituições alimentares; e Cuido de mim com comida saudável - para estimular o consumo de frutas, verduras e legumes. Cada grupo participou de dois dias de oficinas sendo abordados dois temas do instrumento imagético por oficina. A avaliação das mensagens aprendidas nas oficinas foi feita individualmente por meio de questionário semiestruturado, aplicado logo após as oficinas (T0) e depois de 30 (T30) e 60 dias (T60) da 2a oficina. No T60 também foi aplicado individualmente às participantes um questionário de avaliação das práticas alimentares e realizados grupos focais. Foram realizadas 24 oficinas, com a participação de 4 a 8 pessoas por oficina, e 5 grupos focais. O Gi apresentou memorização 21% maior que o Gsi (IC 95%: 0,93 a 2,4; p<0,01) no tempo T0, não havendo diferença entre os grupos nos demais tempos. O intervalo de 30 dias (T0-T30) determinou diminuição do percentual de lembrança das mensagens tanto no Gi (1,97; IC: 1,44 - 2,49; p<0,01) quanto no Gsi (0,86; IC 95%: 0,32 - 1,40; p<0,01). A avaliação qualitativa empregada apontou que ambos os grupos aprenderam as mensagens, entretanto as imagens permitiram uma lembrança mais apurada das mensagens, atribuído ao impacto e à concretização das orientações por meio das imagens e recursos semióticos, e despertaram sentidos e sensações associadas ao gosto dos alimentos retratados nas fotos. As fotos exploraram representações e metáforas que causaram impacto e remeteram a sensações no indivíduo, relacionadas ao gosto dos alimentos, as quais podem implicar desafios ao comensal diante de suas escolhas alimentares. As oficinas contribuíram para o aprendizado e isso se traduziu, em ambos os grupos, na conscientização e por vezes na aplicação dos conhecimentos nas práticas alimentares. / Images closely linked to written or spoken text can markedly increase attention, comprehension, recall and favors adherence to information. Faced with the high consumption of ultra-processed foods rich in fat and sugar that contribute for obesity, food and nutritional education tools are necessary to promote learning about the energy and nutritional content of food, so that people could make better food choices. The aim of the study was to understand how images influence the learning of nutritional education and food practices. It´s an experimental study, quantitative and qualitative nature, carried out with 64 women, 33 participated of food and nutrition education workshops with images (group image: Gi), and 31 attending food and nutritional education workshops without images (Group without image: Gsi), subdivided into two subgroups, of normal weight and obese women. The workshops consisted of group meetings where food and nutrition information was verbally accessed, with or without the support of photo visualization about four themes that composes the pictorial instrument of food and nutrition education, which are: \"Sweet life, being aware of sugar\" - about sugar content in sweets and beverages; \"Tasty food with little fat\" - about fat content in food; \"Eating well by making the best choices\" - about food replacements; and \"I take care of myself by eating healthy food\" - to stimulate consumption of fruits and vegetables. Each group participated in two days of workshops and two themes of the pictorial instrument were addressed in each workshop. The evaluation of the messages learned in the workshops was individually done with a semi-structured questionnaire, that have been applied immediately after the workshops (T0) and after 30 (T30) and 60 days (T60) of the 2nd workshop. In T60, it was also individually applied to the participants one questionnaire to evaluate feeding practices and focus groups were done. Twenty-four workshops, with participation of 4 to 8 women in each, and 5 focus groups have been done. The Gi had 21% greater memory than Gsi (95% CI: 0.93 to 2.4, p <0.01) at T0, with no difference between groups in the other times. The 30-day interval (T0-T30) resulted in a decrease in recall percentage of the messages in both Gi (1, 97: CI: 1.44-2.49, p <0.01) and Gsi (0.86, 95% CI: 0.32-1.40, p <0.01). The qualitative evaluation has shown that both groups learned the messages, however the images allowed for a better recall of the messages, attributed to the impact and the application of the orientations through semiotic images and resources, and awoke senses and sensations associated with the taste of food portrayed in the photos. The photos explored representations and metaphors that caused impact and referred to sensations in the individual, related to the taste of food, which can imply challenges to the person in front of their food choices. The workshops contributed to the learning and this translated, in both groups, in the awareness and sometimes in the application of the knowledge in the alimentary practices.

Introdução: A prática de grupos é um tipo de assistência em saúde que vem sendo realizada na Atenção Básica. A alimentação é um dos assuntos que são abordados nessa prática, uma vez que esta é um fator de risco modificável para o desenvolvimento das doenças crônicas não transmissíveis. Diante desse quadro, os profissionais de saúde contam com a Educação Alimentar e Nutricional que visa promover a prática de hábitos alimentares saudáveis. Para a avaliação de grupos, eles fazem uso, principalmente, de dados objetivos. No entanto, a realização de uma avaliação a partir de uma perspectiva de dados qualitativos tem sido cada vez mais utilizada pela importância de se estabelecer uma relação direta com os sujeitos, conhecendo as suas vivências. Objetivo: Analisar a vivência de participantes submetidos em dois modelos de grupos educativos de alimentação e nutrição realizados no âmbito da Atenção Básica no município de São Paulo. Métodos: Pesquisa avaliativa com abordagem qualitativa, realizada no Centro de Saúde Escola Geraldo de Paula Souza com os usuários que estiveram presentes, pelo menos, em metade dos encontros dos grupos de alimentação e nutrição tradicionalmente realizados pelo local no ano de 2015 (Modelo A) e de um outro grupo, implantado por meio de pesquisa, no ano de 2016 (Modelo B). Grupos do Modelo A possuíam como objetivo incentivar e apoiar as mudanças alimentares enquanto que grupos do Modelo B tinham como intenção o fortalecimento da autonomia nas escolhas alimentares. Ambos os Modelos possuíram enquadres semelhantes, sendo o A formado por sete encontros e o B por seis com duração de 1h30min cada. A condução de grupos do Modelo A foi realizada pela equipe responsável pela assistência nutricional do local e, do Modelo B, por uma nutricionista doutoranda, idealizadora do modelo de intervenção, juntamente com o apoio de uma observadora e também da equipe. A produção dos dados foi realizada por meio de entrevistas semiestruturadas com 7 participantes do Modelo A e 8 do B. Essas entrevistas foram transcritas e submetidas à Análise de Conteúdo Temática com o auxílio do software NVivo11. Para esta pesquisa, utilizou-se um recorte dos resultados dessa análise que se referia a avaliação da vivência. Resultados: Emergiram quatro categorias e 12 unidades temáticas. Todas as categorias estiveram presentes em ambos os Modelos, sendo elas: Modelo Educativo, Comparecimento, Potencialidades e Fragilidades do grupo educativo de alimentação e nutrição. Oito unidades temáticas emergiram no Modelo A e essas também estavam presentes no Modelo B. Além dessas oito, o Modelo B apresentou mais quatro unidades temáticas. Verificou-se que, em ambos os Modelos, a vivência em grupo propiciou o reconhecimento de estratégias didáticas utilizadas, incentivo ao cuidado, ganhos a partir da convivência com o outro, como ampliação de conhecimento e reconhecimento de benefícios provocados na saúde, e demanda por atendimento individualizado. No Modelo A, enfatizou-se a relação unidirecional entre participante e profissional, aproximando-o mais do conceito de agrupamento. No Modelo B, destacou-se a interação social e a existência do vínculo entre os participantes, Conclusão: Em ambos os Modelos a prática de grupo oferece estratégias que incentivam o cuidado com a saúde, possibilita aprendizados provenientes da socialização e oportuniza o conhecimento de demandas pela atenção individualizada. Grupos que são desenhados a partir de uma abordagem de educação tradicional possuem ações voltadas a prevenção enquanto que grupos que usam a educação dialógica se aproximam das ações de promoção da saúde. / Introduction: The practice of groups is a type of health care that is being carried out in Primary Care. The food is one of the subjects that are dealt in these groups, since this is a modifiable risk factor for the development of chronic non-communicable diseases. Faced with this situation, health professionals rely on Food and Nutrition Education to promote the practice of healthy eating habits. For the evaluation of groups, professionals make use, mainly, of objective data. However, the performance of an evaluation from a qualitative data perspective has been increasingly used for the importance of establishing a direct relationship with the subjects, knowing their experiences. Objective: To analyze the experience of participants submitted to two models of educational groups of food and nutrition carried out in the scope of Primary Care in the city of São Paulo. Methods: Evaluative research with qualitative approach carried out at the Geraldo de Paula Souza School Health Center with the users who were present at least half of the meetings of the educational groups of food and nutrition traditionally carried out by the local in the year 2015 (Model A) and of another group, implemented through research, in the year 2016 (Model B). Model A groups aimed to encourage and support food changes while Model B groups were intended to strengthen autonomy in food choices. Both models had similar frames, being A formed by seven meetings and B by six with duration of 1h30min each. The model A group was conducted by the team responsible for the nutritional assistance of the local and, of the Model B, by a PhD nutritionist, idealizing the intervention model, along with the support of an observer and also of the team. The data production was carried out through semi-structured interviews guided by a script with 7 participants of Model A and 8 of B. These interviews were transcribed and submitted to Thematic Content Analysis with the aid of NVivo11 software. For this research, was used a cut-off of the results of this analysis that referred to the evaluation of the living. Results: Four categories and 12 thematic units emerged. All categories were present in both Models, being: Educational Model, Attendance, Potentialities and Fragilities of the educational group of food and nutrition. Eight thematic units emerged in Model A and these were also present in Model B. In addition to these eight, Model B presented four more thematic units. It was verified that in both Models, the experience in a group allowed the recognition of used didactic strategies, incentive to care, gains from living with the other, such as expansion of knowledge and recognition of health benefits, and demand for individualized service. In Model A, the unidirectional relationship between participant and professional was emphasized, bringing it closer to the concept of grouping. In Model B, it was highlighted the social interaction and the existence of the bond between the participants. Conclusion: In both Models, group practice offers strategies that encourage health care, enable learning from socialization, and facilitate the knowledge of demands for individualized attention. Groups that are drawn from a traditional education approach have actions aimed at prevention while groups that use dialogic education approach health promotion actions.

Introdução: A prática de grupos é um tipo de assistência em saúde que vem sendo realizada na Atenção Básica. A alimentação é um dos assuntos que são abordados nessa prática, uma vez que esta é um fator de risco modificável para o desenvolvimento das doenças crônicas não transmissíveis. Diante desse quadro, os profissionais de saúde contam com a Educação Alimentar e Nutricional que visa promover a prática de hábitos alimentares saudáveis. Para a avaliação de grupos, eles fazem uso, principalmente, de dados objetivos. No entanto, a realização de uma avaliação a partir de uma perspectiva de dados qualitativos tem sido cada vez mais utilizada pela importância de se estabelecer uma relação direta com os sujeitos, conhecendo as suas vivências. Objetivo: Analisar a vivência de participantes submetidos em dois modelos de grupos educativos de alimentação e nutrição realizados no âmbito da Atenção Básica no município de São Paulo. Métodos: Pesquisa avaliativa com abordagem qualitativa, realizada no Centro de Saúde Escola Geraldo de Paula Souza com os usuários que estiveram presentes, pelo menos, em metade dos encontros dos grupos de alimentação e nutrição tradicionalmente realizados pelo local no ano de 2015 (Modelo A) e de um outro grupo, implantado por meio de pesquisa, no ano de 2016 (Modelo B). Grupos do Modelo A possuíam como objetivo incentivar e apoiar as mudanças alimentares enquanto que grupos do Modelo B tinham como intenção o fortalecimento da autonomia nas escolhas alimentares. Ambos os Modelos possuíram enquadres semelhantes, sendo o A formado por sete encontros e o B por seis com duração de 1h30min cada. A condução de grupos do Modelo A foi realizada pela equipe responsável pela assistência nutricional do local e, do Modelo B, por uma nutricionista doutoranda, idealizadora do modelo de intervenção, juntamente com o apoio de uma observadora e também da equipe. A produção dos dados foi realizada por meio de entrevistas semiestruturadas com 7 participantes do Modelo A e 8 do B. Essas entrevistas foram transcritas e submetidas à Análise de Conteúdo Temática com o auxílio do software NVivo11. Para esta pesquisa, utilizou-se um recorte dos resultados dessa análise que se referia a avaliação da vivência. Resultados: Emergiram quatro categorias e 12 unidades temáticas. Todas as categorias estiveram presentes em ambos os Modelos, sendo elas: Modelo Educativo, Comparecimento, Potencialidades e Fragilidades do grupo educativo de alimentação e nutrição. Oito unidades temáticas emergiram no Modelo A e essas também estavam presentes no Modelo B. Além dessas oito, o Modelo B apresentou mais quatro unidades temáticas. Verificou-se que, em ambos os Modelos, a vivência em grupo propiciou o reconhecimento de estratégias didáticas utilizadas, incentivo ao cuidado, ganhos a partir da convivência com o outro, como ampliação de conhecimento e reconhecimento de benefícios provocados na saúde, e demanda por atendimento individualizado. No Modelo A, enfatizou-se a relação unidirecional entre participante e profissional, aproximando-o mais do conceito de agrupamento. No Modelo B, destacou-se a interação social e a existência do vínculo entre os participantes, Conclusão: Em ambos os Modelos a prática de grupo oferece estratégias que incentivam o cuidado com a saúde, possibilita aprendizados provenientes da socialização e oportuniza o conhecimento de demandas pela atenção individualizada. Grupos que são desenhados a partir de uma abordagem de educação tradicional possuem ações voltadas a prevenção enquanto que grupos que usam a educação dialógica se aproximam das ações de promoção da saúde. / Introduction: The practice of groups is a type of health care that is being carried out in Primary Care. The food is one of the subjects that are dealt in these groups, since this is a modifiable risk factor for the development of chronic non-communicable diseases. Faced with this situation, health professionals rely on Food and Nutrition Education to promote the practice of healthy eating habits. For the evaluation of groups, professionals make use, mainly, of objective data. However, the performance of an evaluation from a qualitative data perspective has been increasingly used for the importance of establishing a direct relationship with the subjects, knowing their experiences. Objective: To analyze the experience of participants submitted to two models of educational groups of food and nutrition carried out in the scope of Primary Care in the city of São Paulo. Methods: Evaluative research with qualitative approach carried out at the Geraldo de Paula Souza School Health Center with the users who were present at least half of the meetings of the educational groups of food and nutrition traditionally carried out by the local in the year 2015 (Model A) and of another group, implemented through research, in the year 2016 (Model B). Model A groups aimed to encourage and support food changes while Model B groups were intended to strengthen autonomy in food choices. Both models had similar frames, being A formed by seven meetings and B by six with duration of 1h30min each. The model A group was conducted by the team responsible for the nutritional assistance of the local and, of the Model B, by a PhD nutritionist, idealizing the intervention model, along with the support of an observer and also of the team. The data production was carried out through semi-structured interviews guided by a script with 7 participants of Model A and 8 of B. These interviews were transcribed and submitted to Thematic Content Analysis with the aid of NVivo11 software. For this research, was used a cut-off of the results of this analysis that referred to the evaluation of the living. Results: Four categories and 12 thematic units emerged. All categories were present in both Models, being: Educational Model, Attendance, Potentialities and Fragilities of the educational group of food and nutrition. Eight thematic units emerged in Model A and these were also present in Model B. In addition to these eight, Model B presented four more thematic units. It was verified that in both Models, the experience in a group allowed the recognition of used didactic strategies, incentive to care, gains from living with the other, such as expansion of knowledge and recognition of health benefits, and demand for individualized service. In Model A, the unidirectional relationship between participant and professional was emphasized, bringing it closer to the concept of grouping. In Model B, it was highlighted the social interaction and the existence of the bond between the participants. Conclusion: In both Models, group practice offers strategies that encourage health care, enable learning from socialization, and facilitate the knowledge of demands for individualized attention. Groups that are drawn from a traditional education approach have actions aimed at prevention while groups that use dialogic education approach health promotion actions.

Made available in DSpace on 2014-06-11T19:23:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-04-16Bitstream added on 2014-06-13T20:30:23Z : No. of bitstreams: 1 criscuolo_c_me_arafcf.pdf: 883694 bytes, checksum: 04ef1e7b72e4501973161cb796a313c2 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Universidade Estadual Paulista (UNESP) / O envelhecimento populacional nas últimas décadas emerge a preocupação da criação de políticas públicas que favoreçam este envelhecimento com qualidade de vida. Visto que os principais problemas de saúde com os idosos estão relacionados com a sua alimentação e o estilo de vida, as atividades de educação nutricional tornam-se importantes para promoverem a saúde através de melhores práticas alimentares e do autocuidado dos indivíduos. O objetivo principal deste trabalho foi buscar evidências das contribuições da educação nutricional associada à educação problematizadora de Paulo Freire junto a um grupo de idosos. O trabalho foi pautado na metodologia do Estudo de Caso da pesquisa qualitativa em saúde com os seus principais instrumentos: entrevistas gravadas e encontros em grupo. Ocorreram nove encontros para discussão sobre alimentação e nutrição com um grupo de nove idosos, na Universidade Aberta à Terceira Idade, do Município de Araraquara/SP, no período de agosto a outubro de 2007. Após os encontros, foram realizadas entrevistas individuais nos domicílios dos participantes. Os resultados foram analisados através do método de análise de conteúdo. A investigação identificou que a maioria dos idosos buscava informações relevantes para a fase atual da vida e de socializálas. Eles possuíam diversas doenças crônicas relacionadas com a alimentação e desejavam aprofundar seus conhecimentos no assunto para melhor controlá-las. O principal tema que os indivíduos necessitavam e tinham interesse de conhecimento era sobre alimentação saudável e apenas dois indivíduos não apresentavam condições socioeconômicas para tê-la. Os resultados indicaram que todos os participantes tentaram se apropriar dos conhecimentos, bem como consolidar e aprofundar conhecimentos anteriores, que foram discutidos nos encontros em grupo, através... / The ageing population in recent decades emerge concerns of creation of public policies that promote this aging with quality of life. Since the main health problems in the elderly are related to their diet and way of life, nutrition education activities become important to promote health through better feeding practices and the individual self-care. The main aim of this work was to find evidences of nutrition education contributions related to the problematical education by Paulo Freire among an elderly group. The work was based on the Case Study methodology of qualitative research with its main instruments: recorded interviews and group meetings. Were executed nine meetings to discuss about food and nutrition, with a group of nine elderly, in the Open University for the Third Age, in Araraquara/ SP, from August to October 2007. After the meetings, individual interviews were conducted in the participant homes. The results were analyzed by the content analysis method. The research identified that all participants sought relevant information to their current life phase and socialize it. They had several chronic diseases related to the diet and wanted deeper their knowledge about it to better control them. The main theme individuals needed and had interest of knowledge was about healthy eating and just two individuals hadn’t socioeconomic conditions to have it. All the participants tried to attain the knowledge that was discussed in the group meetings, as well consolidate and deeper their previous knowledge, through the reflection and awareness process, bringing benefits on individual and collective ways. The nutrition education work associated with the problematical education showed contributions to the knowledge construction, to the behavior changes, as well the social coexistence, favoring the prevention and the health promotion and therefore an alternative to the public policies planning related to the elderly health.

A prevalência da obesidade está aumentando em um ritmo alarmante, por isso estratégias de prevenção e controle da obesidade são importantes. Com isto em mente, foi realizada uma revisão sistemática com metanálise para avaliar o efeito dos programas de intervenções que incentivassem a prática de atividade física e a alimentação saudável, identificando os mais apropriados para a prevenção e controle da obesidade na população escolar. Foram incluídos estudos controlados randomizados disponíveis nas seguintes bases de dados eletrônicas: Pubmed, Lilacs, Embase, Scopus, Web of Science e Cochrane Library. A qualidade dos estudos foi avaliada levando em conta os critérios de sigilo de alocação propostos pela Colaboração Cochrane e da escala de Jadad. Com o auxílio do programa Review Manager versão 5.1 foram obtidas as seguintes estatísticas: medidas de sumário baseadas na diferença de medias padronizadas (DMP) e no odds ratio (OR). A obtenção dos respectivos intervalos de confiança (IC) seguiu um modelo de efeitos fixos ou randômicos, dependendo da heterogeneidade observada. Os resultados foram apresentados por meio de gráficos Forest Plot. Foram identificados 995 estudos, sendo que somente 26 foram incluídos na metanálise. Considerando as diferentes características das intervenções e dos desfechos dos estudos, foram obtidas 13 metanálises. Os resultados das metanálises das intervenções isoladas com atividade física apresentaram efeito estatisticamente significativo na redução da dobra cutânea tricipital DMP: -0,43 (IC95%: -0,51; -0,34), (P<0,01) e do percentual de gordura corporal com DMP: -0,13 (IC95%: -0,27; 0,00), (P=0,05). Também, houve efeito estatisticamente significativo das intervenções isoladas com educação nutricional na redução do sobrepeso com OR: -0,77 (IC95%: 0,66; 0,90), (P<0,01). Além disso, os escolares que receberam intervenções combinadas com atividade física e educação nutricional apresentaram redução significativa da obesidade com OR: 0,56 (IC95%: 0,43; 0,74), (P<0,01), do sobrepeso com OR: 0,75 (IC95%: 0,63; 0,89), (P<0,01) e do índice de massa corporal, com DMP: -0,37 (IC95%: -0,63; -0,12), (P<0,01). Não houve efeito significativo das intervenções na redução da circunferência da cintura e da dobra cutânea bicipital. Através desta metanálise concluiu-se que as intervenções combinadas com atividade física e educação nutricional tiveram os efeitos mais positivos como estratégia para a prevenção e controle da obesidade em escolares, do que quando aplicadas isoladamente. / The prevalence of obesity is increasing an alarming rate. Because of that strategies for the prevention and control of obesity are important. With that in mind, a systematic review with meta-analysis was conducted to evaluate the effects of intervention programs stimulating physical activity and healthy eating, and identifying those more suitable for the prevention and control of obesity among school-age students. We included randomized controlled trials available in the following electronic databases: Pubmed, Lilacs, Embase, Scopus, Web of Science and Cochrane Library. The quality of these studies was evaluated taking into account the criteria of allocation concealment proposed by the Cochrane Collaboration and the Jadad Scale. Summary statistics based on the standardized mean difference (SMD) and on the odds ratio (OR) were estimated using Review Manager version 5.1. Confidence intervals (CI) were obtained using fixed or randomized effects models, according to the heterogeneity observed in the data. Results were presented using Forest Plots. Among the 995 studies identified only, 26 were included in the meta-analysis. Considering the different characteristics of interventions and the study outcomes, 13 meta-analyses were obtained. The results of the meta-analyses focusing on isolated interventions based on physical activity showed a statistically significant effect on the reduction of triceps skinfold SMD: -0.43 (CI 95%: -0.51;-0.34), (P< 0.01) and body fat percentage with SMD: -0.13 (CI 95%: -0.27; 0.00), (P= 0.05). There was also a statistically significant effect of the isolated interventions isolated based on nutritional education on the reduction of overweight with OR: -0.77 (CI 95%: 0.66; 0.90), (P< 0.01). Besides that, students who received an intervention combining physical activities and nutritional education presented a significant reduction of obesity with OR: 0.56 (CI 95%: 0.43; 0.74), (P< 0.01), overweight with OR: 0.75 (CI 95%: 0.63; 0.89), (P< 0.01) and Body Mass Index with SMD: -0.37 (CI 95%: -0.63; -0.12), (P< 0.01). We did not find a significant effect of interventions on the reduction of waist circumference and biceps skinfold. In closing, these meta-analyses indicated that combined interventions based on physical activity and nutritional education had a more positive effect as a feasible strategy for the prevention and control of obesity in school-age students when compared to isolated.