“Políticas de enxotamento” de moradores de rua: uma análise do ponto de vista da criminologia crítica

O presente trabalho tem como objetivo analisar as “políticas de enxotamento” de moradores de rua sob o ponto de vista da Criminologia Crítica. Para tanto, aborda-se, dentre outros aspectos, o sentimento de insegurança da sociedade que fomenta a elaboração de políticas cada vez mais repressivas tendentes a segregar os indivíduos mais pobres. Na sequência, investiga-se a proposta da teoria das janelas quebradas e do modelo tolerância zero de segurança como forma de atender ao clamor social, buscando reduzir as possibilidades de incidência do delito e amenizar o sentimento de insegurança da sociedade. Além disso, analisam-se as semelhanças dessas propostas com a prevenção situacional. Esta, da mesma forma que aquelas, volta-se para o espaço urbano, vislumbrando na preservação do meio uma possibilidade de prevenir a sociedade contra a criminalidade. Ao pressupor a classificação dos atributos do ambiente das cidades em positivos e negativos, a prevenção situacional sujeita-se a identificar como negativos elementos que dizem respeito não apenas ao aspecto físico do meio, mas também ao social. É o que ocorre com os moradores de rua que, em razão de já serem previamente rotulados pela sociedade como perigosos e sujos, são enxotados das cidades a pretexto de garantir a segurança da população. Tais práticas, que recebem o nome de “políticas de enxotamento”, mostram-se extremamente repressivas, punindo o indivíduo em razão de sua condição pessoal, não por suas ações, mas por sua maneira de ser. Dessa forma, nota-se que as “políticas de enxotamento”, independentemente do viés em que se pretenda inseri-la (preventivo ou repressivo), utilizam-se de uma noção limitada de segurança segundo a qual a segurança dos incluídos não engloba a garantia de direitos aos excluídos. Assim, diante da impossibilidade de se garantir segurança a alguns sem garanti-la a todos, verifica-se a necessidade de ampliação desse conceito

Depression among women of reproductive age in rural Bangladesh is linked to food security, diets and nutrition

Objective: To quantify the relationship between screening positive for depression and several indicators of the food and nutrition environment in Bangladesh. Design: We used cross-sectional data from the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) trial in Bangladesh to examine the association of depression in non-peripartum (NPW) and peripartum women (PW) with food and nutrition security using multivariable logistic regression and dominance analysis. Setting: Rural north-eastern Bangladesh. Participants: Women of reproductive age. Results: Of 2599 women, 40 % were pregnant or up to 1 year postpartum, while 60 % were not peripartum. Overall, 20 % of women screened positive for major depression. In the dominance analysis, indicators of food and nutrition security were among the strongest explanatory factors of depression. Food insecurity (HFIAS) and poor household food consumption (FCS) were associated with more than double the odds of depression (HFIAS: NPW OR = 2·74 and PW OR = 3·22; FCS: NPW OR = 2·38 and PW OR = 2·44). Low dietary diversity (<5 food groups) was associated with approximately double the odds of depression in NPW (OR = 1·80) and PW (OR = 1·99). Consumption of dairy, eggs, fish, vitamin A-rich and vitamin C-rich foods was associated with reduced odds of depression. Anaemia was not associated with depression. Low BMI (<18·5 kg/m2) was also associated with depression (NPW: OR = 1·40). Conclusions: Depression among women in Bangladesh was associated with many aspects of food and nutrition security, also after controlling for socio-economic factors. Further investigation into the direction of causality and interventions to improve diets and reduce depression among women in low- and middle-income countries are urgently needed

Depression among women of reproductive age in rural Bangladesh is linked to food security, diets and nutrition

Objective: To quantify the relationship between screening positive for depression and several indicators of the food and nutrition environment in Bangladesh.Design: We used cross-sectional data from the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) trial in Bangladesh to examine the association of depression in non-peripartum (NPW) and peripartum women (PW) with food and nutrition security using multivariable logistic regression and dominance analysis.Setting: Rural north-eastern Bangladesh.Participants: Women of reproductive age.Results: Of 2599 women, 40 % were pregnant or up to 1 year postpartum, while 60 % were not peripartum. Overall, 20 % of women screened positive for major depression. In the dominance analysis, indicators of food and nutrition security were among the strongest explanatory factors of depression. Food insecurity (HFIAS) and poor household food consumption (FCS) were associated with more than double the odds of depression (HFIAS: NPW OR = 2·74 and PW OR = 3·22; FCS: NPW OR = 2·38 and PW OR = 2·44). Low dietary diversity (<5 food groups) was associated with approximately double the odds of depression in NPW (OR = 1·80) and PW (OR = 1·99). Consumption of dairy, eggs, fish, vitamin A-rich and vitamin C-rich foods was associated with reduced odds of depression. Anaemia was not associated with depression. Low BMI (<18·5 kg/m2) was also associated with depression (NPW: OR = 1·40).Conclusions: Depression among women in Bangladesh was associated with many aspects of food and nutrition security, also after controlling for socio-economic factors. Further investigation into the direction of causality and interventions to improve diets and reduce depression among women in low-and middle-income countries are urgently needed. © © The Authors 2020

Food and Agricultural Approaches to Reducing Malnutrition (FAARM): protocol for a cluster-randomised controlled trial to evaluate the impact of a Homestead Food Production programme on undernutrition in rural Bangladesh

IntroductionChronic undernutrition affects over 150 million children worldwide and has serious consequences. The causes are complex and include insufficient dietary diversity and poor hygiene practices. Systematic reviews of nutrition-sensitive agricultural interventions concluded that while these hold promise, there is insufficient evidence for their impact on child growth. The Food and Agricultural Approaches to Reducing Malnutrition (FAARM) project is a 1:1 cluster-randomised trial aiming to evaluate the impact of a Homestead Food Production (HFP) programme implemented by Helen Keller International on women’s and children’s undernutrition.Methods and analysisThe HFP intervention comprises training of women’s groups and asset distribution to support year-round home gardening, poultry rearing and improved nutrition and hygiene practices. Formal trainings are supplemented by behaviour change communication during household visits, and facilitated links between producer groups and market actors. The FAARM trial will examine if and how this complex intervention reduces undernutrition. In 2015, FAARM enrolled married women and their children (0–3 years) in 96 rural settlements of Habiganj district in Sylhet division, Bangladesh. Covariate-constrained randomisation was used to assign 48 settlements to receive a 3-year HFP intervention, with the other 48 acting as controls, targeting over 2700 women. To study impact pathways, a surveillance system collects data on all participants every 2 months. In late 2019, children 0–3 years of age (born during the intervention period) will be surveyed, thus capturing impact during the critical first 1000 days of life. Children’s length/height-for-age z-scores will be compared between intervention and control arms using mixed-effects linear regression. Secondary outcomes include women’s and children’s micronutrient status, dietary intake, dietary diversity and other indicators of child growth, development and morbidity.Ethics and disseminationEthical approval was received in Bangladesh and Germany. Results will be disseminated through peer-reviewed publications and presentations in Bangladesh and internationally.Trial registration numberNCT02505711; Pre-results.</jats:sec

Food and agricultural approaches to reducing malnutrition (FAARM): Protocol for a cluster-randomised controlled trial to evaluate the impact of a Homestead Food Production programme on undernutrition in rural Bangladesh

Introduction Chronic undernutrition affects over 150 million children worldwide and has serious consequences. The causes are complex and include insufficient dietary diversity and poor hygiene practices. Systematic reviews of nutrition-sensitive agricultural interventions concluded that while these hold promise, there is insufficient evidence for their impact on child growth. The Food and Agricultural Approaches to Reducing Malnutrition (FAARM) project is a 1:1 cluster-randomised trial aiming to evaluate the impact of a Homestead Food Production (HFP) programme implemented by Helen Keller International on women's and children's undernutrition. Methods and analysis The HFP intervention comprises training of women's groups and asset distribution to support year-round home gardening, poultry rearing and improved nutrition and hygiene practices. Formal trainings are supplemented by behaviour change communication during household visits, and facilitated links between producer groups and market actors. The FAARM trial will examine if and how this complex intervention reduces undernutrition. In 2015, FAARM enrolled married women and their children (0-3 years) in 96 rural settlements of Habiganj district in Sylhet division, Bangladesh. Covariate-constrained randomisation was used to assign 48 settlements to receive a 3-year HFP intervention, with the other 48 acting as controls, targeting over 2700 women. To study impact pathways, a surveillance system collects data on all participants every 2 months. In late 2019, children 0-3 years of age (born during the intervention period) will be surveyed, thus capturing impact during the critical first 1000 days of life. Children's length/height-for-age z-scores will be compared between intervention and control arms using mixed-effects linear regression. Secondary outcomes include women's and children's micronutrient status, dietary intake, dietary diversity and other indicators of child growth, development and morbidity. Ethics and dissemination Ethical approval was received in Bangladesh and Germany. Results will be disseminated through peer-reviewed publications and presentations in Bangladesh and internationally. Trial registration number NCT02505711; Pre-results. © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ

Maternal hemoglobin concentrations across pregnancy and maternal and child health: a systematic review and meta‐analysis

Maternal anemia is a well‐recognized global health problem; however, there remain questions on specific hemoglobin (Hb) thresholds that predict health risk or protection for mother and child. We conducted a systematic review and meta‐analysis to examine the associations of maternal Hb concentrations with a range of maternal and infant health outcomes, accounting for the timing of measurement (preconception, and first, second, and third trimesters), etiology of anemia, and cutoff category. The systematic review included 272 studies and the meta‐analysis included 95 studies. Low maternal Hb (\u3c110 g/L) was associated with poor birth outcomes (low birth weight, preterm birth, small‐for‐gestational‐age (SGA), stillbirth, and perinatal and neonatal mortality) and adverse maternal outcomes (postpartum hemorrhage, preeclampsia, and blood transfusion). High maternal Hb (\u3e130 g/L) was associated with increased odds of SGA, stillbirth, preeclampsia, and gestational diabetes. Relationships varied by the timing of measurement and cutoff category (stronger associations with lower cutoffs); limited data were available on anemia etiology. There were insufficient data for other maternal outcomes and long‐term child health outcomes. Current data are insufficient for determining if revisions to current Hb cutoffs are required. Pooled high‐quality individual‐level data analyses, as well as prospective cohort studies, would be valuable to inform the reevaluation of Hb cutoffs

Impact of unseasonable flooding on women's food security and mental health in rural Sylhet, Bangladesh: a longitudinal observational study

Background Climate change will lead to more frequent and intensive flooding. In April, 2017, unseasonably early flooding led to the inundation of low-lying cropland before the rice harvest in northeastern Bangladesh. We describe coping strategies and quantify short-term and medium-term effects of flooding events on food security and depressive symptoms of women. Methods This observational study is part of the cluster-randomised Food and Agricultural Approaches to Reducing Malnutrition trial (FAARM; NCT02505711). Women self-reported flooding exposure on behalf of their households when surveyed (approximately 6 months after the event). Remote sensing analysis was used to detect the extent of the flooding. We collected data on household food security at baseline, depressive symptoms 4–5 months before the flooding, and coping strategies immediately after the event. We followed up on these outcome measurements for depressive symptoms and food security for up to 2·5 years after the flooding event. We used multilevel regression adjusting for intervention allocation and pre-flooding measures to quantify the flood's effect on household food security and women's mental health. Findings The FAARM trial included 2700 young women in 96 settlements in rural Sylhet, Bangladesh. 1335 (56%) of 2405 women reported that their household being greatly affected, with many losing a large part of their rice harvest. Borrowing money with interest was the most common coping strategy, with households paying back on average 1·5 times the borrowed amount. Greatly affected households had higher odds of food insecurity, with a decreasing effect with increasing time after the flood (odds ratio: 2·4 [p<0·0001] 0·5 years after; 1·6 [p<0·0001] 2·0 years after]; and 1·3 [p=0·012] 2·5 years after). Women in such households also had 1·45 times higher odds of depression (p=0·0001) 2·5 years after the flooding event. Interpretation The 2017 flooding event negatively affected food security and the mental health of women in rural Sylhet, Bangladesh, and few affected women received formal government support. To reduce the impact of future floods, livelihood adaptations and expansion of financial protection programmes are essential measures to pursue. Funding German Federal Ministry for Education and Research (Berlin, Germany) and UK Department for International Development (London, UK)

Identifying bottlenecks in the iron and folic acid supply chain in Bihar, India: a mixed-methods study

Background: Maternal anaemia prevalence in Bihar, India remains high despite government mandated iron supplementation targeting pregnant women. Inadequate supply has been identified as a potential barrier to iron and folic acid (IFA) receipt. Our study objective was to examine the government health system’s IFA supply and distribution system and identify bottlenecks contributing to insufficient IFA supply. Methods: Primary data collection was conducted in November 2011 and July 2012 across 8 districts in Bihar, India. A cross-sectional, observational, mixed methods approach was utilized. Auxiliary Nurse Midwives were surveyed on current IFA supply and practices. In-depth interviews (n = 59) were conducted with health workers at state, district, block, health sub-centre, and village levels. Results: Overall, 44% of Auxiliary Nurse Midwives were out of IFA stock. Stock levels and supply chain practices varied greatly across districts. Qualitative data revealed specific bottlenecks impacting IFA forecasting, procurement, storage, disposal, lack of personnel, and few training opportunities for key players in the supply chain. Conclusions: Inadequate IFA supply is a major constraint to the IFA supplementation program, the extent of which varies widely across districts. Improvements at all levels of infrastructure, practices, and effective monitoring will be critical to strengthen the IFA supply chain in Bihar

Key Food Hygiene Behaviors to Reduce Microbial Contamination of Complementary Foods in Rural Bangladesh

Microbial contamination of complementary foods puts young children at risk of developing intestinal infections and could be reduced by improved handwashing and food hygiene practices. We aimed to identify which promoted food hygiene practices are associated with reduced complementary food contamination in a rural population in Bangladesh. We collected cross-sectional data on reported and observed maternal food hygiene behaviors and measured Escherichia coli counts as an indicator of microbial contamination in complementary food samples from 342 children of women enrolled in the Food and Agricultural Approaches to Reducing Malnutrition trial in Sylhet, Bangladesh. We used multivariable logistic regression to examine associations of food hygiene behaviors with food contamination. Approximately 46%of complementary food samples had detectable levels of Escherichia coli. Handwashing with soap at critical times and fresh preparation of food before feeding were strongly associated with reduced odds of food sample contamination (odds ratio [OR]: 0.8, 95% confidence interval [CI]: 0.6-0.9 and OR: 0.3, 95% CI: 0.1-0.7, respectively); in contrast, there was no or only weak evidence that reheating of stored food, safe food storage, and cleanliness of feeding utensils reduced contamination. Reduction in food contamination could be more than halved only when several food hygiene behaviors were practiced in combination. In conclusion, single food hygiene practices showed limited potential and a combined practice of multiple food hygiene behaviors may be needed to achieve a substantial reduction of complementary food contamination

PROMOTORES E DETRATORES DE EMPATIA DOS ESTUDANTES DE MEDICINA BRASILEIROS NO PERÍODO ENTRE 2010-2021

Introduction: empathy is an essential skill for establishing a quality doctor-patient relationship, especially when promoting the effectiveness of diagnostic and therapeutic processes. In view of recent curricular reforms aimed at a humanistic and renovating teaching, it is necessary to study which factors influence the levels of empathy among medical students in Brazil. Objective: to identify common characteristics and determinants of empathy levels among medical students in Brazil. Methods: integrative literature review, searching for articles indexed on the PubMed and Scholar Google platforms, using the terms "medical students" AND "empathy", and their equivalents in Portuguese. Inclusion criteria were: publications in the last ten years (2011-2021), in Portuguese or English, that dealt with undergraduate medical education in Brazil. Theses, experience reports, opinion articles, texts not available in full, or whose content did not match the research object were excluded. Results: 0f 4,175 articles found, twelve met the inclusion criteria. The studies showed differences in the levels of empathy according to gender, with females having the highest scores; family and cultural aspects; and choice of medical specialty. Most articles found alterations in the levels of empathy among medical students at different stages of the course – the initial semesters had higher levels than the final semesters –, with a significant decline throughout the course, although there is still some controversy on the subject, since that some studies obtained stable scores. In addition, the incidence of depression, anxiety, and social stress were found to negatively affect empathy, with stress being indicated as the main cause of this decline. Professors were pointed out as examples of promoters or detractors of an empathetic doctor-patient relationship. All the studies analyzed called attention to the indispensable insertion of empathy-promoting guidelines in the mandatory curriculum, since medical graduation was indicated as the main moment of decline in empathic levels. Conclusion: there is an urgent need for project initiatives that aim to develop empathy levels in students, as well as to promote their mental health during the course, revisiting the parameters used as the basis for medical education. Opening this space for discussion, dialogue and development will bring psycho-emotional benefits not only for students, but also for professors, future professionals, and patients.Introdução: a empatia é uma habilidade essencial para o estabelecimento de uma relação médico-paciente de qualidade, principalmente ao promover a efetividade dos processos diagnósticos e terapêuticos. Tendo em vista as reformas curriculares recentes que visam a um ensino humanístico e renovador, há de se estudar quais fatores influenciam os níveis de empatia dos estudantes de medicina no Brasil. Objetivo: identificar características e determinantes dos níveis de empatia comuns entre os estudantes de medicina no Brasil. Métodos: revisão integrativa de literatura, com busca de artigos indexados nas plataformas PubMed e Scholar Google, usando os termos “medical students” AND “empathy”, e seus equivalentes em português. Os critérios de inclusão foram: publicações nos últimos dez anos (2011-2021), em português ou inglês, que tratavam da graduação em medicina no Brasil. Foram excluídas teses, relatos de experiência, artigos de opinião, textos não disponibilizados na íntegra, ou cujo conteúdo não condizia com o objeto de pesquisa. Resultados: de 4.175 artigos encontrados, doze atenderam aos critérios de inclusão. Os trabalhos demonstraram diferenças nos níveis de empatia de acordo com o gênero, sendo o feminino com maiores escores; aspectos familiares e culturais; e escolha da especialidade médica. A maioria dos trabalhos encontrou alterações nos níveis de empatia entre estudantes de medicina em estágios diferentes do curso – os semestres iniciais tinham maiores níveis que os semestres finais –, com significativo declínio ao longo do curso, embora ainda haja certa controvérsia sobre o tema, já que alguns estudos obtiveram escores estáveis. Além disso, foi apontado que a incidência de depressão, ansiedade e estresse social afetava negativamente a empatia, sendo o estresse indicado como a principal causa deste declínio. Os professores foram apontados como exemplos de promotores ou detratores de uma relação médico-paciente empática. Todos os estudos analisados chamaram a atenção para a imprescindível inserção de pautas promotoras de empatia no currículo obrigatório, uma vez que a graduação em medicina foi apontada como o principal momento de declínio dos níveis empáticos. Conclusão: urge a necessidade de iniciativas de projetos que visem ao desenvolvimento dos níveis de empatia dos estudantes, bem como promovam sua saúde mental frente ao curso, revisitando os parâmetros utilizados como base para o ensino médico. A abertura deste espaço de discussão, diálogo e desenvolvimento trará benefícios psicoemocionais não somente para os estudantes, como também para professores, futuros profissionais e pacientes.