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Bortolini GA, Pereira TN, Carmo ASD, Martins AMTM, Silva JPD, Silva SAD, Marinho PAS, Lima AMCD, Spaniol AM, Claumann GS, Silveira JACD, Silva JRMD. Analysis of the elaboration and proposal of a Brazilian intersectoral strategy for the prevention and care of childhood obesity. CAD SAUDE PUBLICA 2023; 39:e00117722. [PMID: 37851726 PMCID: PMC10581684 DOI: 10.1590/0102-311xen117722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 05/05/2023] [Accepted: 07/20/2023] [Indexed: 10/20/2023] Open
Abstract
The Brazilian Strategy for the Prevention and Care of Childhood Obesity (PROTEJA) aims to implement a set of actions to prevent obesity in Brazil. As such, this qualitative and descriptive documentary study presents the Strategy's stages of the operational design, general proposal, evaluation and monitoring conducted by the Brazilian Ministry of Health's technical coordination. After analyzing the epidemiological data on children and the existing policies aimed at obesity prevention, and reviewing the scientific literature and recommendations, PROTEJA was formulated and approved by the Brazilian Ministry of Health, and 1,320 municipalities committed to implementing 20 essential and 5 complementary actions, from 41, including some structural to improve environments. Coordinated by the Brazilian Ministry of Health in partnership with subnational governments and universities, the Strategy also relies on a local team for implementation support, as well as implementation and impact evaluations. Actions will be monitored annually, and the indicators will impact financial incentives. As a strong, evidence-based and innovative strategy aiming to promote healthy environments in cities, PROTEJA has the potential to open a path to childhood obesity reversal, as well as add to the implementation science and contribute to the development and improvement of public policies for obesity prevention; however, its implementation remains a challenge.
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Affiliation(s)
- Gisele Ane Bortolini
- Ministério do Desenvolvimento e Assistência Social, Família e Combate à Fome, Brasília, Brasil
- Ministério da Saúde, Brasília, Brasil
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Pedraza DF. Childcare appointment at the Family Health Strategy in municipalities in the inland region of the State of Paraíba, Brazil. CIENCIA & SAUDE COLETIVA 2023; 28:2291-2302. [PMID: 37531537 DOI: 10.1590/1413-81232023288.06022023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 04/17/2023] [Indexed: 08/04/2023] Open
Abstract
This article aims to evaluate the childcare appointments by health professionals working at the Family Health Strategy in municipalities in the State of Paraíba, compare the performance by health team type (The Mais Médicos Program or conventional), and analyze the association of client satisfaction with the developed actions. This cross-sectional study evaluated the structural conditions of health units, the work process of health professionals, and client satisfaction, observing childcare appointments in 22 health teams. Poor employment relationships and professionals' knowledge about child growth curves were highlighted in the structure. In the 175 appointments observed, we detected neglect in completing the Child Health Booklet (CHB), obtaining data on food consumption, and guidance practices. Only 36% of the appointments were classified with adequate duration. There was greater satisfaction for appointments developed in health teams of the Mais Médicos Program, with longer duration and better performance in guidance practices. The implementation of childcare appointments reveals significant gaps that can influence maternal satisfaction.
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Affiliation(s)
- Dixis Figueroa Pedraza
- Programa de Pós-Graduação em Saúde da Família, Rede Nordeste de Formação em Saúde da Família (RENASF), Universidade Estadual da Paraíba (UEPB). R. das Baraúnas 351, Campus Universitário, Bodocongó. 58109-753 Campina Grande PB Brasil.
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Alves RL, Toral N, Gonçalves VSS. Individual and Socioeconomic Contextual Factors Associated with Obesity in Brazilian Adolescents: VigiNUTRI Brasil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:430. [PMID: 36612753 PMCID: PMC9819061 DOI: 10.3390/ijerph20010430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
This study investigated the association of socioeconomic contextual factors of the municipality of residence of adolescents, their eating behavior and food consumption with the prevalence of obesity. This was a cross-sectional study, based on individual data regarding anthropometry, eating behavior (eating in front of screens and having at least three main meals a day), and markers of healthy and unhealthy eating of 23,509 adolescents aged 10 to 19 years, participating in the Food and Nutrition Surveillance of the Brazilian Population monitored in Primary Health Care (VigiNUTRI Brasil) assessment in 2018. Based on multilevel Poisson regression, a higher prevalence of obesity was observed among adolescents living in municipalities with per capita income above USD209.68 (PR = 1.22; 95% CI 1.05;1.42) and among those who consumed hamburgers and/or processed meats the previous day (PR = 1.09; 95% CI 1.01;1.17). Adolescents who had the habit of having three main meals a day (PR = 0.81; 95% CI 0.73;0.89 p < 0.05) and who consumed fresh fruit the previous day (PR = 0.91; 95% CI 0.84;0.98 p < 0.001) had lower prevalence of obesity. The results reinforce the influence of the social context and food consumption on obesity rates. The persistence of this situation implies a worsening in the current and future health of adolescents.
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Affiliation(s)
- Rafaella Lemos Alves
- Graduate Program in Human Nutrition, University of Brasília, Brasília 70910-900, DF, Brazil
| | - Natacha Toral
- Graduate Program in Human Nutrition, University of Brasília, Brasília 70910-900, DF, Brazil
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Kunihiro S, da Silva Vernasque JR, da Silva C, dos Santos MF, Cremasco CP, Gabriel Filho LRA. Intersectoral Actions for the Promotion and Prevention of Obesity, Diabetes and Hypertension in Brazilian Cities: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13059. [PMID: 36293640 PMCID: PMC9602621 DOI: 10.3390/ijerph192013059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/19/2022] [Accepted: 09/24/2022] [Indexed: 06/16/2023]
Abstract
This study showed the effectiveness of biomedical interventions in obesity, diabetes and hypertension (NCDs), but innovative and intersectoral elements in the fight against obesity, type 2 diabetes and hypertension were rare. BACKGROUND Is it possible to find effective and innovative actions to promote health and prevent NCDs in Brazilian municipalities? Can they be replicated? OBJECTIVE Our objectives were to identify innovative and effective intersectoral actions for promoting and preventing NCDs in Brazilian municipalities. METHODS This is a systematic review in an exploratory theoretical essay with a qualitative and quantitative approach. It is descriptive and analytical in terms of reporting findings and results. Inclusion and exclusion criteria favored health promotion work. Bias risk assessments was performed using the Cochrane GRADE and bias risk, with meta-analyses using RevMan and Iramuteq. RESULTS Meta-analysis of biometric markers resulted in -4.46 [95% IC; -5.42, -3.49], p = 0.00001, indicating a reduction in NCD risk rates. The textual meta-analysis revealed P(r) ≈ 83% (Reinert), meaning low connectivity between the 'halos'. CONCLUSIONS There is evidence of the effectiveness in interventions, but innovative and intersectoral elements to combat and prevent NCDs were barely seen. While evidence of intervention effectiveness was observed, innovative and intersectoral elements to combat and prevent NCDs were barely noticed.
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Affiliation(s)
- Stephen Kunihiro
- School of Sciences and Engineering, São Paulo State University (UNESP), Tupã 17602-673, Brazil
| | - Juliana Ribeiro da Silva Vernasque
- Faculty of Medical and Biological Sciences, São Paulo State University (Unesp), Botucatu 18618-687, Brazil
- Marília Medical School, FAMEMA, Marília 17519-030, Brazil
| | - Celso da Silva
- School of Sciences and Engineering, São Paulo State University (UNESP), Tupã 17602-673, Brazil
- Maurício de Nassau College—Dean’s Office, Maurício de Nassau University Center (UNINASSAU), Recife 52011-220, Brazil
- The Regional Council of Administration—CRA/SP, São Paulo 01427-001, Brazil
| | | | - Camila Pires Cremasco
- School of Sciences and Engineering, São Paulo State University (UNESP), Tupã 17602-673, Brazil
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Brandão AL, Casemiro JP, dos Reis EC, Vitorino SAS, de Oliveira ADSB, Bortolini GA. Recomendações para o fortalecimento da atenção nutricional na atenção primária à saúde brasileira. Rev Panam Salud Publica 2022; 46:e119. [PMID: 36245900 PMCID: PMC9553020 DOI: 10.26633/rpsp.2022.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/18/2022] [Indexed: 12/04/2022] Open
Abstract
Objetivo. Elaborar recomendações para o fortalecimento da alimentação e nutrição (A&N) na atenção primária à saúde (APS) brasileira a partir de um consenso de especialistas. Métodos. Realizou-se estudo descritivo e exploratório utilizando a técnica Delphi. De 172 especialistas em A&N na APS convidados a participar, 116 aceitaram o convite e 72 participaram da primeira rodada. A segunda rodada teve 56 participantes das cinco macrorregiões brasileiras, entre gestores, profissionais de saúde, representantes da sociedade civil e pesquisadores. As recomendações foram construídas por análise temática das respostas a perguntas abertas sobre obstáculos, estratégias, ações e iniciativas de cinco componentes técnicos da Política Nacional de Alimentação e Nutrição (vigilância alimentar e nutricional, atenção e coordenação do cuidado nutricional, promoção da saúde, intersetorialidade e gestão das ações de A&N). Na segunda rodada, os especialistas classificaram cada item proposto quanto à sua pertinência e relevância para fins de recomendação. Resultados. Os especialistas elaboraram 35 recomendações, organizadas em seis categorias: estrutura; agenda de A&N na APS; organização em rede e organização da APS; processos de trabalho de A&N na APS; planejamento, monitoramento e avaliação das ações de A&N na APS; e sistema de informação. As categorias foram organizadas em dois blocos: “ações estruturantes da APS para o fortalecimento da A&N” e “ações estruturantes da A&N para o fortalecimento da APS”. Conclusões. As recomendações foram produzidas por pessoas experientes que acompanham a trajetória da A&N e da APS por diferentes pontos de vista, sendo úteis para a gestão e proposição de políticas públicas rumo ao fortalecimento da A&N nas APS brasileira.
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Affiliation(s)
- Ana Laura Brandão
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro (RJ), Brasil
| | - Juliana Pereira Casemiro
- Departamento de Nutrição Social, Instituto de Nutrição, Universidade do Estado do Rio de Janeiro, Rio de Janeiro (RJ), Brasil
| | - Erika Cardoso dos Reis
- Departamento de Nutrição Clínica e Social, Escola de Nutrição, Universidade Federal de Ouro Preto, Ouro Preto (MG), Brasil
| | | | - Amanda da Silva Bastos de Oliveira
- Superintendência de Segurança Alimentar e Nutricional, Secretaria de Desenvolvimento Social e Direitos Humanos do Estado do Rio de Janeiro, Rio de Janeiro (RJ), Brasil
| | - Gisele Ane Bortolini
- Coordenação-Geral de Alimentação e Nutrição, Ministério da Saúde, Brasília (DF), Brasil
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Melo D, Venancio S, Buccini G. Brazilian Strategy for Breastfeeding and Complementary Feeding Promotion: A Program Impact Pathway Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9839. [PMID: 36011476 PMCID: PMC9408563 DOI: 10.3390/ijerph19169839] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The Brazilian Breastfeeding and Complementary Feeding Strategy (Estratégia Amamenta e Alimenta Brasil-EAAB) aims to improve Primary Health Care (PHC) workers' counseling skills to promote and support infant and young children feeding (IYCF). However, the maintenance and scaling up of the EAAB has been challenging. The theory-driven Program Impact Pathway (PIP) is recommended to assess and enhance the large-scale implementation of IYCF programs. The purpose of this study was to document barriers and facilitators to scale up the EAAB using a PIP analysis. METHODS First, we reviewed EAAB documents to develop an initial PIP diagram. Then, we interviewed EAAB key informants to identify Critical Quality Control Points (CCP) in the PIP. We revised and analyzed the PIP to inform the EAAB core functions and pathways. RESULTS Six CCPs for EAAB maintenance were identified: CCP1-Definition and strengthening of the coordination in states and municipalities; CCP2-Maintenance of tutors' work; CCP3-Feasibility of the certification process; CCP 4-Quality improvement of IYCF activities in PHC units; CCP 5-Adequate use of monitoring systems; and CCP 6-Consistent implementation monitoring. Four implementation pathways and seven core functions identified may assist with scaling up the EAAB in Brazil. CONCLUSION The PIP analysis proved to be useful for documenting the factors that influence the maintenance and scaling up of the EAAB.
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Affiliation(s)
- Daiane Melo
- Department of Nutrition, School of Public Health, University of São Paulo, Professor Mello de Moraes Avenue, 1235, São Paulo 05508-030, SP, Brazil
| | - Sonia Venancio
- Health Institute of São Paulo, State Health Secretariat, R. Santo Antônio, 590, Bela Vista, São Paulo 01314-000, SP, Brazil
| | - Gabriela Buccini
- Department of Social and Behavioral Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV 89119, USA
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Borges LKS, Nascimento FFD, Mascarenhas MDM, Rodrigues MTP. Coverage of food consumption assessment in children participating in the Healthy Growth Program - Brazil, 2015-2018. CIENCIA & SAUDE COLETIVA 2022; 27:2317-2324. [PMID: 35649019 DOI: 10.1590/1413-81232022276.13822021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 09/08/2021] [Indexed: 11/22/2022] Open
Abstract
This study aimed to compare the prevalence of food consumption assessment coverage in children under 10 years old before and after the implementation of the Healthy Growth Program (HGP). In this sense, a cross-sectional study was conducted using data from 548 municipalities registered in the HGP and available in the Food and Nutritional Surveillance System of the Brazilian Ministry of Health. The food consumption assessment coverage indicator was analyzed per geographic regions, a Chi-square test was performed and the Prevalence Ratios (PR) and their respective 95% confidence intervals (95% CI) were estimated. Food consumption assessment coverage increased from 0.25% in 2015 to 1.78% in 2018 (PR=7.09; 95%CI 7.00;7.18). The Southern region showed the highest and the Midwestern region the lowest increase in food consumption coverage. Although food consumption assessment coverage has increased less than the five-percent target set by the HGP, there has been an improvement in monitoring the nutritional status of children, which requires developing actions that support mapping the food and nutritional scenario of children in Brazil.
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Affiliation(s)
- Luana Kelly Silva Borges
- Programa de Pós-Graduação em Saúde e Comunidade, Universidade Federal do Piauí (UFPI). Av. Frei Serafim 2280, Centro (Sul). 64001-450 Teresina PI Brasil.
| | - Fernando Ferraz do Nascimento
- Programa de Pós-Graduação em Saúde e Comunidade, Universidade Federal do Piauí (UFPI). Av. Frei Serafim 2280, Centro (Sul). 64001-450 Teresina PI Brasil.
| | - Márcio Dênis Medeiros Mascarenhas
- Centro de Inteligência em Agravos Tropicais, Emergentes e Negligenciados, Programa de Pós-Graduação em Saúde e Comunidade, UFPI. Teresina PI Brasil
| | - Malvina Thaís Pacheco Rodrigues
- Centro de Inteligência em Agravos Tropicais, Emergentes e Negligenciados, Programa de Pós-Graduação em Saúde e Comunidade, UFPI. Teresina PI Brasil
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SATO Y, MATA MMD, MEDEIROS MATD. Food and nutrition actions for the maternal and child population in primary healthcare: comparative analysis of municipalities in the Metropolitan Region of Baixada Santista, São Paulo, Brazil. REV NUTR 2022. [DOI: 10.1590/1678-9865202235e210230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Objective Characterize and comparatively analyse the organization of nutritional attention to prenatal care, the puerperium period and breastfeeding, in primary health care, in two municipalities of Baixada Santista, São Paulo, Brazil. Methods This was an exploratory-analytical study of family health units and the mixed basic care units of Cubatão (n=17) and Guarujá (n=14). For this purpose, seven domains of the Nutritional Attention Assessment Instrument in Primary Health Care were used. Descriptive analysis and the Mann-Whitney and Pearson’s chi-square tests were performed. Results In the comparison between the municipalities, the best scores were obtained in Guarujá. Statistically significant differences were found for the following indicators: support for nutritional attention actions: infrastructure and permanent education (<0.001); food and nutritional surveillance (<0.001); nutritional attention focused on prenatal care (<0.001); and nutritional attention focused on postpartum care and breastfeeding (0.012). Nutritional attention actions for mother-infant groups were more frequent in the city of Guarujá, which compared with Cubatão, achieved better scores for the nutritional attention evaluation indicators. Conclusion The municipality of Guarujá had better indicators of infrastructure and permanent education, food and nutrition surveillance, and puerperal and breastfeeding nutritional care. However, weaknesses persist in the organization of nutritional care in the two cities studied, especially regarding the work process.
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Silva RPC, Vergara CMAC, Sampaio HADC, Vasconcelos Filho JE, Strozberg F, Ferreira Neto JFR, Mafra MLP, Garcia Filho C, Carioca Filho AAF. Sistema de Vigilância Alimentar e Nutricional: tendência temporal da cobertura e estado nutricional de adultos registrados, 2008-2019. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2022; 31:e2021605. [DOI: 10.1590/s1679-49742022000100019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 01/10/2022] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Analisar a tendência temporal da cobertura do Sistema de Vigilância Alimentar e Nutricional (Sisvan) e do estado nutricional, entre adultos acompanhados na Atenção Primária à Saúde do Brasil, 2008-2019. Métodos Estudo ecológico de séries temporais, sobre dados das macrorregiões brasileiras. A variação percentual anual da classificação do estado nutricional e da cobertura total foi estimada pela regressão de Prais-Winsten. Resultados Foram identificados 115.034.534 registros no período. A cobertura passou de 5,0% em 2008 para 10,6% em 2019, com variação anual de 8,4%, intervalo de confiança de 95% (IC95% 6,7;10,0) A obesidade apresentou tendência crescente entre 2008 e 2019, com variação anual de 6,4% (IC95% 5,3;7,3), assim como o sobrepeso (1,8%; IC95% 1,2;2,5). Já o baixo peso (-7,0%; IC95% -8,0;-6,1) e a eutrofia (-3,8%; IC95% -4,1;-3,4) decresceram no período. Conclusão Identificou-se melhora na cobertura do Sisvan, tendo-se observado aumento de excesso de peso e obesidade na população estudada.
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Machado AD, Bertolini AM, Brito LDS, Amorim MDS, Gonçalves MR, Santiago RDAC, Marchioni DM, Carvalho AMD. The role of the Brazilian Unified Health System in combating the global syndemic and in the development sustainable food systems. CIENCIA & SAUDE COLETIVA 2021; 26:4511-4518. [PMID: 34730639 DOI: 10.1590/1413-812320212610.11702021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/28/2021] [Indexed: 11/21/2022] Open
Abstract
The undernutrition and obesity pandemics associated with climate change are a global syndemic. They have a point of convergence, which is the unsustainable current food systems. This paper aims to discuss the role of public health policies, particularly the Brazilian Unified Health System (SUS) in the context of Primary Health Care, in combating the global syndemic and in the development of sustainable food systems. In this scenario, the National Food and Nutrition Policy is a leading intersectoral tool for an adequate and healthy diet and food and nutrition security. Also, the Dietary Guidelines for the Brazilian population is a strategic tool to support food and nutrition education. We highlight the need to articulate health, agriculture, and environmental policies to achieve sustainable development. Thus, SUS can be the arena to promote the main discussions on this topic, potentiating individual, group, and institutional actions to provide a fairer, healthy, and sustainable food system.
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Affiliation(s)
- Alisson Diego Machado
- Departamento de Clínica Médica, Disciplina de Nefrologia, Faculdade de Medicina, Universidade de São Paulo. Av. Dr. Enéas de Carvalho Aguiar 255 sala 7115, Cerqueira César. 05403-000 São Paulo SP Brasil.
| | - Ana Maria Bertolini
- Departamento de Saúde Ambiental, Faculdade de Saúde Pública, Universidade de São Paulo. São Paulo SP Brasil
| | | | | | - Mônica Rocha Gonçalves
- Núcleo de Apoio às Atividades de Cultura e Extensão Sustentarea, Faculdade de Saúde Pública, Universidade de São Paulo. São Paulo SP Brasil
| | | | - Dirce Maria Marchioni
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo. São Paulo SP Brasil
| | - Aline Martins de Carvalho
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo. São Paulo SP Brasil
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Santos SMCD, Ramos FP, Medeiros MATD, Mata MMD, Vasconcelos FDAGD. Advances and setbacks in the 20 years of the Brazilian National Food and Nutrition Policy. CAD SAUDE PUBLICA 2021; 37Suppl 1:e00150220. [PMID: 34730732 DOI: 10.1590/0102-311x00150220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 01/18/2021] [Indexed: 11/21/2022] Open
Abstract
We sought to analyze the processes of formulation, updating and implementation of the Brazilian National Food and Nutrition Policy (PNAN), from 1999 to April 2020. This is a discussion paper, using institutional documentary sources, bibliographic search in national and international databases, as well as theses and dissertations. The theory of the cycle of public policies was adopted to systematize and present the set of information. PNAN was established in 1999 and updated ten years later, in a participatory process, based on an innovative approach centered on the paradigms of healthy food practices, the human right to food and nutritional security, aligned with the Brazilian Unified National. Regarding implementation, there are advances related to the publication of Food Guides with national guidelines; to the promotion of research in food and nutrition; to collective action to build the regulatory agenda, even if with disputes, and to the decentralization of financial resources for the execution of PNAN actions. The monitoring and evaluation focused on the food and nutritional situation; we found that there were insufficient mechanisms to feed back the policy. After 20 years, PNAN maintains the challenge of effectively fulfilling its historic commitment: the universal guarantee of the human right to adequate and healthy food.
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Pedraza DF. Nutritional deviations in children: comparative analysis of data from the food and nutrition surveillance system and those obtained by anthropometrists. REVISTA PAULISTA DE PEDIATRIA 2021; 40:e2020439. [PMID: 34614140 PMCID: PMC8543823 DOI: 10.1590/1984-0462/2022/40/2020439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 03/21/2021] [Indexed: 11/22/2022]
Abstract
Objective: To compare the prevalence rates of nutritional deviations in children under five years of age according to data from the Food and Nutrition Surveillance System (Sistema de Vigilância Alimentar e Nutricional — SISVAN) and those obtained by trained anthropometrists. Methods: This is a descriptive cross-sectional study based on data from 10 municipalities and 2 sources: i) SISVAN Web (secondary database) and ii) an investigation that evaluated the implementation of food and nutrition actions in the Family Health Strategy in the state of Paraíba (primary database), with 24,137 and 897 individuals, respectively. Proportions of overweight — according to weight/age (W/A), weight/height (W/H), and body mass index/age (BMI/A) — and stunting — according to the height/age (H/A) index — based on classifications of SISVAN Web and those obtained by trained anthropometrists were compared using the two-proportion Z-test. Results: Frequencies of overweight, according to W/A (10.0 vs. 7.8%), W/H (17.2 vs. 14.3%), and BMI/A (18.1 vs. 14.4%), as well as stunting (12.3 vs. 8.6%), were higher on data from SISVAN Web than on those obtained by trained anthropometrists, and the differences were significant. Conclusions: The findings point to distortions in the nutritional classification of children under five years of age monitored by SISVAN Web.
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Abstract
Resumo: A pandemia do COVID-19 tem alterado a rotina de vida das pessoas pela obrigatoriedade de permanência em casa, o que pode resultar em mudanças de comportamento.Objetivo: Identificar alterações nos hábitos de vida durante a pandemia da COVID-19, relacionando às alterações de peso corporal e aos níveis de ansiedade relatados.Método: Estudo transversal com adultos, de ambos os sexos, no qual os dados foram coletados por meio de questionário online, com auxílio da ferramenta Google Docs.Resultados: Participaram 258 pessoas, sendo 192 (74,4%) mulheres, eutróficos com idade entre 18 e 73 anos. Observou-se que 146 (56,6%) ganharam peso e, dentre estes, 105 (71,9%) utilizaram mais aplicativos para pedido de refeições, 104 (74,7%) relataram maior ingestão de doces e 105 (71,9%) de lanches calóricos, além de maior tempo de tela e ansiedade. Alterações negativas no estado emocional foram relatadas por 175 (67,8%) participantes, 150 (58,1%) afirmaram que a ansiedade aumenta seu apetite; 206 (79,8%) relataram aumento de ansiedade e dentre estes 133 (64,6%) utilizaram mais aplicativos de pedido de refeições e 65% relataram maior ingestão de doces e lanches.Conclusão: As alterações nos hábitos de vida ocorridas durante a pandemia relatada pela maioria dos entrevistados estavam associadas ao ganho de peso e aumento nos níveis de ansiedade, fatores que podem afetar a imunidade e elevar o risco a COVID-19.
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Machado PMDO, Lacerda JTD, Colussi CF, Calvo MCM. Structure and work process for food and nutrition actions in Primary Health Care in Brazil, 2014. ACTA ACUST UNITED AC 2021; 30:e2020635. [PMID: 33886807 DOI: 10.1590/s1679-49742021000200015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/04/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the conditions of structure and work process for food and nutrition actions in Primary Health Care in Brazil. METHODS This was a cross-sectional study with secondary data from the Program for Primary Health Care Access and Quality Improvement. The proportions of Primary Health Care Center (PHCC) and health team adequacy were described according to organizational variables, using prevalence ratios and Poisson regression. RESULTS 19,793 PHCCs and 24,549 teams were analyzed; 35.0% (n=6,928) of PHCCs were considered adequate in relation to structure and 7.9% (n=1,934) of the teams had adequate work process. Standing out in the analyses of association are PHCCs in the Southern region (44.7%) and teams in the Southeastern region (10.9%), in addition to municipalities with more than 300,000 inhabitants. CONCLUSION The PHCCs and teams analyzed presented a low proportion of adequacy for structure and work process for food and nutrition actions.
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Affiliation(s)
| | | | - Claudia Flemming Colussi
- Universidade Federal de Santa Catarina, Departamento de Saúde Pública, Florianópolis, SC, Brasil
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Bortolini GA, Pereira TN, Nilson EAF, Pires ACL, Moratori MF, Ramos MKP, Silva SAD, Carvalho MDFCCD, Bressan LÂ, Faller LDA. Evolução das ações de nutrição na atenção primária à saúde nos 20 anos da Política Nacional de Alimentação e Nutrição do Brasil. CAD SAUDE PUBLICA 2021; 37Suppl 1:e00152620. [DOI: 10.1590/0102-311x00152620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/01/2021] [Indexed: 11/21/2022] Open
Abstract
O objetivo do estudo é sistematizar as ações de alimentação e nutrição desenvolvidas na atenção primária à saúde (APS), de 1999 a 2019, identificando os avanços no período e perspectivas atuais. É uma pesquisa qualitativa realizada baseando-se na análise de documentos publicados entre 1999 e 2020, disponíveis em bases de dados científicos e na literatura cinza. Adicionalmente, realizou-se análise quantitativa valendo-se de sistemas de informação do Ministério da Saúde, como o Sistema de Vigilância Alimentar e Nutricional e o Sistema de Informação em Saúde para a Atenção Básica e dos microdados do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). As ações e marcos normativos identificados foram categorizados em gestão, vigilância alimentar e nutricional, promoção da alimentação adequada e saudável, atenção nutricional - múltipla carga de má nutrição e formação. Os resultados revelam que as ações de alimentação e nutrição acompanharam o cenário epidemiológico, considerando-se a múltipla carga da má nutrição, estando a primeira década mais direcionada ao enfrentamento da fome, da desnutrição e carências de micronutrientes e; a partir de 2006, passou a dar ênfase à prevenção e cuidado de pessoas com obesidade e outras doenças crônicas não transmissíveis, além da promoção da alimentação adequada e saudável, desenvolvendo, durante todo o período, ações com forte caráter intersetorial e compreendendo o lócus da APS como campo prioritário de atuação no Sistema Único de Saúde. A universalização das ações de alimentação e nutrição na APS, contudo, é ainda um desafio atual.
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SILVA LESD, CALDEIRA TCM, CLARO RM. Food consumption, overweight, obesity, and sociodemographic profile in a Brazilian capital: a time trend analysis between 2006 and 2018. REV NUTR 2021. [DOI: 10.1590/1678-9865202134e200159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective To analyze the time trend of sociodemographic characteristics and the prevalence of food consumption, overweight, and obesity variables among adults in the city of Belo Horizonte, Brazil, between 2006 and 2018. Methods A time series study involving data from the Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel, Surveillance System of Risk and Protective Factors for Chronic Diseases by Telephone Survey), between 2006 and 2018 in Belo Horizonte (n=25,443). The annual prevalence of the population’s sociodemographic characteristics (sex, age groups, and years of schooling), and risk and protective factors for chronic diseases related to food consumption and nutritional status were estimated. Prais-Winsten regression models were used to investigate the temporal variation of each variable. Results From 2006 to 2018, there was a significant increase in the age and educational level of the adult population of Belo Horizonte. In the same period, the prevalence of recommended consumption of fruits and vegetables increased (from 23.0% to 29.2%), while that of consumption of fat-rich meat and regular consumption of soft drinks decreased (respectively, from 41.9% to 38.0%; from 35.3% to 15.2%). In parallel, the prevalence of overweight and obesity increased (respectively, from 38.5% to 53.3%; from 9.8% to 17.2%). Conclusions An important change in the population’s sociodemographic profile was noted. There are also favorable changes regarding the investigated aspects of food consumption, without these being sufficient to prevent the significant increase in the prevalence of overweight and obesity in the population.
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Lígia R, Patricia J. Measuring professional self and collective efficacy for dietary advice in Primary Health Care. Nutr Health 2020; 27:49-57. [PMID: 33172345 DOI: 10.1177/0260106020959595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is a lack of instruments to measure the ability of health professionals to promote dietary advice according to dietary guidelines. AIM To develop and validate a web-based and self-applied scale for measuring primary health care (PHC) professionals' self-efficacy and collective efficacy to apply the Brazilian Dietary Guidelines for dietary advice. METHODS Methodological procedures comprised six steps: development of the items; content validation with panel of experts; face validation through focus group conducted with PHC professionals; online reevaluation by the participants of content and face validation panels; online application with PHC professionals working all over Brazil's macro-regions; confirmatory factorial analysis to test construct validity. RESULTS The scale was initially developed with 22 items. After content and face validation panels, changes in content and semantics were performed. The second version consisted of 24 items equally divided into part A (self-efficacy) and B (collective efficacy). All items, when reevaluated, were considered clear and representative of the Brazilian Dietary Guidelines' chapters. The multidimensional model was shown to have excellent fit indices in the confirmatory factorial analysis. The scale's peak of information was centered around the mean, indicating that both domains are more precise for perception of self-efficacy and collective efficacy on average values. CONCLUSION The scale demonstrated validity for measuring PHC professionals' perceived self-efficacy and collective efficacy to apply the Brazilian Dietary Guidelines. To our knowledge, this is the first valid scale for measuring the capability of PHC professionals to apply national dietary guidelines for healthy diet promotion.
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Affiliation(s)
- Reis Lígia
- Postgraduate Program in Nutrition in Public Health, School of Public Health, University of São Paulo - Nutrition, São Paulo, Brazil
| | - Jaime Patricia
- Nucleus of Epidemiological Research on Nutrition and Health, 28133University of São Paulo (NUPENS/USP) - Nutrition, São Paulo, Brazil
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