Resumo em Inglês:

ABSTRACT OBJECTIVE To document the evidence about marketing of ultra-processed foods and “non-alcoholic” beverages in Latin America. METHODS We performed a structured search of quantitative and qualitative studies in PubMed, SciELO and LILACS, published between January 2000 and May 2017 and conducted in Latin America. We conducted a quality assessment following a standardized tool and a thematic analysis to identify key typologies of marketing across studies RESULTS Out of 521 studies screened by title and abstract, we included 36 in this review; 27 of them analyzed television advertisement. Other marketing channels studied were food packaging, point of sale and outdoor advertisement. Studies found television advertises foods and beverages that are mostly ultraprocessed foods and have low nutritional value, particularly those promoted during children’s programming. We also observed children have a literal interpretation of images printed on food packaging, so this can be deceiving. Several studies also found proximity to unhealthy foods may increase their consumption. Finally, the thematic analysis identified the following typologies of food marketing: a) television advertisement, b) food packaging marketing, c) marketing strategies at points of sale and d) other marketing strategies. We found almost no advertisements for unprocessed or minimally processed foods such as fruits and vegetables. We did not find any studies on digital marketing conducted in the region. CONCLUSIONS This review found that the main channel of food marketing was television advertising. This synthesis provides insights to the challenges unhealthy eating represents to the public health of Latin America and identifies knowledge gaps to guide future research.

Resumo em Espanhol:

RESUMEN OBJETIVO Evaluar la efectividad de las intervenciones para la prevención de factores de riesgo e incidencia de diabetes tipo 2 en población empleada. MÉTODOS Revisión sistemática sobre intervenciones dirigidas a población empleada adulta en riesgo de diabetes tipo 2 publicadas en Medline, Embase, Web of Science, Registro Central Cochrane de Ensayos Controlados y Lilacs. Se seleccionaron ensayos aleatorizados, estudios cuasi-experimentales y de cohortes; en idioma inglés, español y portugués; publicados entre los años 2000 al 2017. La efectividad de la intervención fue evaluada en términos de incidencia de diabetes tipo 2 y de reducción significativa del peso corporal u otro parámetro antropométrico o metabólico. RESULTADOS Se generaron 3.024 artículos, de los cuales fueron eliminados 2.825 que no respondieron la pregunta de investigación, 130 que no evaluaron intervenciones originales, 57 fuera del ámbito laboral y dos revisiones; quedando 10 artículos seleccionados. Las intervenciones basadas en programas estructurados previamente evaluados e integrados al ámbito laboral tuvieron impacto favorable en la reducción del peso corporal y otros factores de riesgo. CONCLUSIONES La efectividad de las intervenciones en estilo de vida para la prevención de diabetes tipo 2 debe estar basada en programas estructurados con efectividad probada y adaptados al ámbito laboral, con participación del empleador en la disposición de horarios y ambientes en el trabajo.

Resumo em Inglês:

ABSTRACT OBJECTIVE To evaluate the effectiveness of interventions aimed at the prevention of risk factors and incidence of type 2 diabetes in the workers population. METHODS Systematic review of interventions aimed at adult workers at risk of type 2 diabetes published in Medline, Embase, Web of Science, Central Cochrane Registry of Controlled Trials, and Lilacs. Randomized trials, quasi-experimental research and cohort studies were selected; in English, Spanish and Portuguese; published from 2000 to 2017. Intervention effectiveness was evaluated concerning the incidence of type 2 diabetes and a significant reduction in body weight, or another anthropometric or metabolic parameter. RESULTS 3,024 articles were generated, of which 2,825 that did not answer the research question were eliminated, as well as 130 that did not evaluate original interventions, 57 carried out outside the workplace and two reviews; so that 10 selected items remained. Interventions based on structured programs previously evaluated and integrated into the workplace had a favorable impact on the reduction of body weight and other risk factors. CONCLUSIONS The effectiveness of lifestyle interventions for the prevention of type 2 diabetes should be based on structured programs with proven effectiveness and adapted to the workplace, with employer participation in the provision of schedules and work environments.

Resumo em Português:

RESUMO A filosofia da alocação de órgãos é resultado de duas vertentes aparentemente inconciliáveis: utilitarismo e justiça distributiva. O processo de doação e transplante de órgãos no Brasil revela grandes desigualdades entre regiões e unidades da federação, desde a captação de órgãos até o implante dos órgãos. Nesse contexto, o transplante de pulmão é realizado em poucos centros no país e ainda é um tratamento, cujos resultados de longo prazo são limitados. A alocação dos poucos órgãos captados para os poucos procedimentos realizados é definida principalmente por meio da cronologia, um critério que nem é vinculado à necessidade, critério da justiça distributiva, e nem à utilidade, critério do utilitarismo. O presente artigo revisa a filosofia da alocação de órgãos com enfoque no caso dos transplantes de pulmão no Brasil.

Resumo em Inglês:

ABSTRACT The philosophy of organ allocation is the result of two seemingly irreconcilable principles: utilitarianism and distributive justice. The process of organ donation and transplantation in Brazil reveals large inequalities between regions and units of the Federation, from the harvesting of organs to their implantation. In this context, lung transplantation is performed in only a few centers in the country and is still a treatment with limited long-term results. The allocation of the few organs harvested for the few procedures performed is defined mainly by chronology, a criterion that is not linked to necessity, which is a criterion of distributive justice, and neither to utility, a criterion of utilitarianism. This article reviews the organ allocation philosophy focusing on the case of lung transplantations in Brazil.

Resumo em Português:

RESUMO OBJETIVO: Identificar e avaliar criticamente revisões sistemáticas sobre a efetividade de intervenções para reduzir a prescrição de medicamentos potencialmente inapropriados para pacientes idosos. MÉTODOS: Overview de revisões sistemáticas. A busca e a seleção dos estudos foram feitas nas bases de dados Medline, Biblioteca Cochrane, Embase, CINAHL, Biblioteca Virtual em Saúde e Web of Science, combinando os termos aged, prescriptions, inappropriate prescribing e potentially inappropriate medication list com seus sinônimos remissivos e outros descritores associados até junho de 2017. Foram incluídas revisões sistemáticas com ou sem metanálise, que tenham abordado a efetividade de qualquer intervenção ou a combinação de intervenções para reduzir a prescrição de medicamentos potencialmente inapropriados para pacientes idosos, sem restrição quanto ao desenho dos estudos primários, idioma ou data de publicação. Para avaliação da qualidade metodológica das revisões sistemáticas selecionadas, foi utilizado o instrumento A MeaSurement Tool to Assess systematic Reviews. A seleção e a avaliação da qualidade metodológica foram realizadas por dois avaliadores independentes. As divergências foram superadas por consenso. Os principais achados foram agrupados em categorias temáticas, definidas com base em análise de conteúdo e discutidas qualitativamente na forma de síntese narrativa. RESULTADOS: Vinte e quatro revisões sistemáticas foram incluídas no estudo. Quanto ao desenho do estudo e à avaliação da qualidade metodológica, prevaleceram revisões sistemáticas de ensaios clínicos controlados randomizados e estudos de qualidade moderada, respectivamente. As intervenções foram analisadas em cinco categorias temáticas: serviços de revisão de medicamentos, intervenções farmacêuticas, sistemas informatizados, intervenções educacionais e outras. As intervenções estudadas apresentaram bons resultados e a maioria contribuiu para reduzir a prescrição de medicamentos inapropriados para pacientes idosos. CONCLUSÕES: As revisões sistemáticas incluídas nesse overview apontaram benefícios potenciais de diferentes intervenções. No entanto, não foi possível determinar qual a mais efetiva. É provável que intervenções multifacetadas alcancem resultados melhores do que intervenções isoladas.

Resumo em Inglês:

ABSTRACT OBJECTIVE: Identify and critically evaluate systematic reviews addressing the effectiveness of interventions to reduce the number of prescriptions of potentially inappropriate medication to older patients. METHODS: This is an overview of systematic reviews. The studies were searched and selected from Medline, Cochrane Library, Embase, CINAHL, Virtual Health Library, and Web of Science databases, combining the terms aged, prescriptions, inappropriate prescribing and potentially inappropriate medication list with their entry terms and other related descriptors, published by June 2017. This study included systematic reviews with or without meta-analysis that addressed the effectiveness of any intervention or combined interventions to reduce the number of prescriptions of potentially inappropriate medications to older patients, without restriction in terms of design, language or date of publication of primary studies. AMSTAR – A MeaSurement Tool to Assess systematic Reviews – was used to evaluate the methodological quality of selected systematic reviews. Study selection and the methodological quality evaluation were performed by two independent evaluators, who resolved any divergence by consensus. The main findings were grouped into thematic categories, defined after a content analysis and discussed qualitatively as narrative synthesis. RESULTS: This study analyzed 24 systematic reviews. In terms of study design and methodological quality evaluation, most were systematic reviews of randomized controlled clinical trials and studies of moderate quality, respectively. The interventions were analyzed in five thematic categories: medication review services, pharmaceutical interventions, computerized systems, educational interventions, and others. The interventions analyzed showed good results and most of them helped reduce the number of prescriptions of potentially inappropriate medication to older patients. CONCLUSIONS: The systematic reviews included in this overview showed potential benefits of different interventions. However, it was not possible to determine the most effective intervention. Combined interventions are likely to provide better results than isolated interventions.