Elke Stedefeldt

Knowledge, attitudes and practices of food handlers in food safety: An integrative review

This study presents an overview of the relationship between knowledge, attitudes and practices (KAP) of food handlers with training in food safety, in addition to proposing reflections on the training of food handlers, considering its responsibility for food safety and health of consumers. The review was based on the integrative method. The descriptors used were: (food handler), (knowledge, attitudes and practice) and (training). Six databases were searched, 253 articles were consulted and 36 original articles were included. Fifty per cent of the articles pointed that there was no proper translation of knowledge into attitudes/practices or attitudes into practices after training. Knowledge, attitudes and practices of food handlers are important for identifying how efficient training in food safety is allowing prioritize actions in planning training. The evaluation of KAP is the first step to understand the food handlers point of view. After this evaluation other diagnostic strategies become necessary to enhance this understanding.

Instrumento de avaliação das Boas Práticas em Unidades de Alimentação e Nutrição Escolar: da concepção à validação

The scope of this study was to elaborate and validate an assessment tool for Best Practices in School Food and Nutrition Units. For this purpose a survey was conducted in the city of Santos (Sao Paulo - Brazil), in two stages: 1) Preparation of a Checklist for Best Practices in School Food and Nutrition Units (BPAE checklist). 2) Validation of the BPAE checklist. This checklist was applied in 76 public schools along with two other reference checklists. Sensitivity and specificity were estimated using the Receiver Operating Characteristics (ROC) Curve and the checklist was evaluated by application of the Likert scale. The thematic groups received weights to calculate the percentage of adequacy. After the application of the checklists in schools, the area under the curve value of 0.79 was found for the SS-196 checklist and 0.85 for the 542/2006 administrative checklist. These values indicate good suitability of the BPAE checklist to identify inadequacies, and it also received a positive assessment from the school food nutritionists. It proved that the checklist will assist in decision-making to ensure quality control. Once the BPAE checklist has been fully tested and validated it should prove an important tool for quality control in school nutrition.

Inspection Score and Grading System for Food Services in Brazil: The Results of a Food Safety Strategy to Reduce the Risk of Foodborne Diseases during the 2014 FIFA World Cup

In 2014, Brazil hosted one of the most popular sport competitions in the world, the FIFA World Cup. Concerned about the intense migration of tourists, the Brazilian government decided to deploy a food safety strategy based on inspection scores and a grading system applied to food services. The present study aimed to evaluate the results of the food safety strategy deployed during the 2014 FIFA World Cup in Brazil. To assess food safety, an evaluation instrument was applied twice in 1927 food service establishments from 26 cities before the start of the competition. This instrument generated a food safety score for each establishment that ranged from 0.0 (no flaws observed) to 2565.95, with four possible grades: A (0.0–13.2); B (13.3–502.6); C (502.7–1152.2); and pending (more than 1152.3). Each food service received a stamp with the grade of the second evaluation. After the end of the World Cup, a study was conducted with different groups of the public to evaluate the acceptance of the strategy. To this end, 221 consumers, 998 food service owners or managers, 150 health surveillance auditors, and 27 health surveillance coordinators were enrolled. These participants completed a survey with positive and negative responses about the inspection score system through a 5-point Likert scale. A reduction in violation scores from 393.1 to 224.4 (p < 0.001) was observed between the first and second evaluation cycles. Of the food services evaluated, 38.7% received the A stamp, 41.4% the B stamp, and 13.9% the C stamp. All positive responses on “system reliability” presented a mean of 4.0 or more, indicating that the public believed this strategy is reliable for communicating risks and promoting food safety. The strategy showed positive results regarding food safety and public acceptance. The deployed strategy promoted improvements in the food safety of food services. The implementation of a permanent policy may be well accepted by the public and may greatly contribute to a reduction in foodborne diseases (FBDs).

Regional food dishes in the Brazilian National School Food Program: Acceptability and nutritional composition

Objective: the objective of this study was to evaluate the nutritional composition and describe the acceptability of regional culinary dishes served to students from public schools of rural and urban areas. Methods: Ten Brazilian regional dishes were evaluated for acceptability and nutritional composition. the survey was conducted in schools located in rural and urban areas of two cities in the state of Sao Paulo. Dish acceptability was evaluated using leftover analysis and a 5-point facial hedonic scale. the adherence index was calculated and used as an indirect measure of acceptance, and the nutritional composition was calculated based on the technical files of each dish. Results: A total of 2,384 students from 20 schools participated in the study and 1,174 tasted and evaluated the dishes. the test using the 5-point facial hedonic scale demonstrated that five dishes (Caldo verde soup, persimmon jelly, chicken with okra, pureed cornmeal with spinach, and arugula pizza) had an acceptability rate above 85.0%. the mean adherence indices were 57.3% and 55.6% in urban and rural environments, respectively. Analysis of the nutritional composition of regional dishes indicates that these dishes can partially meet macronutrient recommendations. Conclusion: the tested dishes can become part of school menus as they were accepted or partly accepted by the students regardless of school location, whether rural or urban. the cultural heritage is an important resource for the food sovereignty of a country and should be constantly encouraged.

Uma experiência de integração ensino-serviço e a mudança de práticas profissionais: com a palavra, os profissionais de saúde

El objetivo fue analizar los cambios en las practicas de salud a partir de la insercion de las actividades de una universidad publica en la atencion basica en salud de Santos, estado de Sao Paulo, Brasil. Se trata de una encuesta cualitativa con profesionales de atencion basica en salud envueltos en acciones de ensenanza y extension de la universidad. Algunos entrevistados relatan que no participan en la planificacion conjunta de las actividades y reiteran la dicotomia entre teoria y practica. Los profesionales senalan potencialidades en la integracion ensenanza-servicio-comunidad en lo que se refiere a los cambios de las practicas, entendiendo que la universidad no sustituye el servicio pero propicia un momento de pausa y discusion que permite cambiar la forma de relacionarse y percibir los problemas de los usuarios, de repensar la concepcion de salud, el cuidado y el trabajo en equipo, ademas de favorecer el estudio y el contacto con nuevas herramientas/formas de trabajo.Objetivou-se analisar as mudancas nas praticas em saude a partir da insercao das atividades de uma universidade publica na atencao basica em saude de Santos, SP, Brasil. Trata-se de pesquisa qualitativa com profissionais da atencao basica em saude envolvidos em acoes de ensino e extensao da universidade. Alguns entrevistados relatam nao participar do planejamento conjunto das atividades e reiteram a dicotomia entre teoria e pratica. Os profissionais apontam potencialidades na integracao ensino-servico-comunidade no que diz respeito a mudancas das praticas, entendendo que a universidade nao substitui o servico, mas propicia um momento de pausa e discussao, que permite mudar a forma de se relacionar e perceber os problemas dos usuarios, de repensar a concepcao de saude, cuidado e trabalho em equipe, alem de favorecer o estudo e o contato com novas ferramentas/formas de trabalho.

Métodos para aplicar las pruebas de aceptación para la alimentación escolar: validación de la tarjeta lúdica

The objective of this study was to validate methods to assess the acceptability on scholar feeding. A total of 354 students took part in this survey, from second to fiyears of public education system in Santos city, Sao Paulo, Brazil. A comparison between three methods was used: mixed facial hedonic scale of fi points, playful cards and leftover analysis that was the reference method. Kappa statistics and quadratic kappa were used to verify the concordance between the methods. There was an estimated reasonable agreement between the leftover analysis and the affective methods: mixed facial hedonic scale (kappa = 0.2414) and playful cards (kappa=0.2758), all of them with p<0,001. When compared the mixed facial hedonic scale and the playful cards, it was observed a quadratic kappa of 0.3846. It is recommended that the application of the validated methods in the school context be studied in different spheres of government and in other countries as well.

Should Weights and Risk Categories Be Used for Inspection Scores To Evaluate Food Safety in Restaurants

The objective of this study was to verify the characteristics of food safety inspections, considering risk categories and binary scores. A cross-sectional study was performed with 439 restaurants in 43 Brazilian cities. A food safety checklist with 177 items was applied to the food service establishments. These items were classified into four groups (R1 to R4) according to the main factors that can cause outbreaks involving food: R1, time and temperature aspects; R2, direct contamination; R3, water conditions and raw material; and R4, indirect contamination (i.e., structures and buildings). A score adjusted for 100 was calculated for the overall violation score and the violation score for each risk category. The average violation score (standard deviation) was 18.9% (16.0), with an amplitude of 0.0 to 76.7%. Restaurants with a low overall violation score (approximately 20%) presented a high number of violations from the R1 and R2 groups, representing the most risky violations. Practical solutions to minimize this evaluation bias were discussed. Food safety evaluation should use weighted scores and be risk-based. However, some precautions must be taken by researchers, health inspectors, and health surveillance departments to develop an adequate and reliable instrument.

The use of health risk scores and classification in food service An experience in Baixada Santista's public schools - Brazil

Purpose – The aim of this study was to evaluate the good manufacturing practices in meal services in public schools and day care centres in Baixada Santista, Brazil using a health risk classification. Design/methodology/approach – A total of 59 public schools and day care centres in nine municipalities of Baixada Santista – Brazil were randomly selected. The sanitary conditions were evaluated by applying a validated checklist specific to school meal service. The questions were scored according to the health risks detected. A percentage of conformity to good manufacturing practices was calculated, than schools and day care centres were classified according to health risk in relation to the scores obtained for each thematic area addressed in the checklist and in relation to the overall score. Findings – It was observed that 62 per cent of the schools were classified as average health risk failing to comply with Brazilian legislation on food safety rules. The thematic areas that showed lower percentage of co...

Una experiencia de integración enseñanza-servicio y el cambio de prácticas profesionales: los profesionales de la salud tienen la palabra

El objetivo fue analizar los cambios en las practicas de salud a partir de la insercion de las actividades de una universidad publica en la atencion basica en salud de Santos, estado de Sao Paulo, Brasil. Se trata de una encuesta cualitativa con profesionales de atencion basica en salud envueltos en acciones de ensenanza y extension de la universidad. Algunos entrevistados relatan que no participan en la planificacion conjunta de las actividades y reiteran la dicotomia entre teoria y practica. Los profesionales senalan potencialidades en la integracion ensenanza-servicio-comunidad en lo que se refiere a los cambios de las practicas, entendiendo que la universidad no sustituye el servicio pero propicia un momento de pausa y discusion que permite cambiar la forma de relacionarse y percibir los problemas de los usuarios, de repensar la concepcion de salud, el cuidado y el trabajo en equipo, ademas de favorecer el estudio y el contacto con nuevas herramientas/formas de trabajo.Objetivou-se analisar as mudancas nas praticas em saude a partir da insercao das atividades de uma universidade publica na atencao basica em saude de Santos, SP, Brasil. Trata-se de pesquisa qualitativa com profissionais da atencao basica em saude envolvidos em acoes de ensino e extensao da universidade. Alguns entrevistados relatam nao participar do planejamento conjunto das atividades e reiteram a dicotomia entre teoria e pratica. Os profissionais apontam potencialidades na integracao ensino-servico-comunidade no que diz respeito a mudancas das praticas, entendendo que a universidade nao substitui o servico, mas propicia um momento de pausa e discussao, que permite mudar a forma de se relacionar e perceber os problemas dos usuarios, de repensar a concepcao de saude, cuidado e trabalho em equipe, alem de favorecer o estudo e o contato com novas ferramentas/formas de trabalho.

The Role of Training Strategies in Food Safety Performance: Knowledge, Behavior, and Management

Abstract It is well known that participation in training programs tends to improve food handlers knowledge. However, several factors can prevent the transformation of food safety knowledge into positive attitude and adequate practices. Among these factors we find the risk/benefit perceptions, perceived behavioral control and intention, motivation, leadership, and other psychological factors. Understanding the relationship of these factors can provide guidance to plan more effective food safety training. The food safety laws and standards in several countries, including Brazil, list the topics to be addressed in training of food handlers. However, the laws and standards do not establish clear guidelines. This chapter aspires to discuss different strategies to evaluate food handlers and practices to plan strategies applied to handlers in food chain production. Such discussion aims to present the weaknesses and strengths in food safety quality control, covering the role of trainers, stakeholders, the laws, and food safety standards.