Sandra Maria Chaves dos Santos

O Programa Saúde da Família: contribuições para uma reflexão sobre a inserção do nutricionista na equipe multidisciplinar

Brazil is presently experiencing the implementation of a differentiated model to provide health basic care, conduced by a multidisciplinary action directed towards an intervention aiming at then population health promotion, consolidated on the Brazilian Family Health Program. The objective of promotion, consolidated on the specially in Brazil, will not be achieved unless effective action in the area of food health monitoring system. Thus, this paper reflects on the epidemiologic transition being experienced in Brazil and discusses the food and nutritional problems in this process. Some basic proposals of Family Health Program and Food and Nutrition National Policy area also emphasized. This article still argues that the nutritionist can contribute yo the necessary transformation, acting on the practices and results of this new model of intervention. Finally, the authors focus on the impossibility of effective transformation of health basic care without the support of professionals who have been studding and practicing the food and nutrition surveillance and the dietary assistance to the populations.

Avaliação de políticas públicas de segurança alimentar e combate à fome no período 1995-2002: 4 - Programa Nacional de Alimentação Escolar

This study evaluated the Brazilian National School Nutrition Program from a structure-process-results perspective. The methodology involved document research and a case study in 45 counties and 73 schools in the State of Bahia, including program manager interviews and household questionnaires involving 3,367 children (7-14 years of age). Relating to program structure, the study analyzed the evolution of normative instruments and some infrastructure aspects. Managers reported problems with the installations for preparing and distributing meals in 28% of the counties. Decentralization to the county (municipal) level was present in 93% of cases and to the school level in about 20%; however, nearly 70% of the schools received the food supplies directly. Although Social Control Councils were created, members were not always chosen democratically. Acceptability of the meals was good, as expected considering the widespread poverty in the target population. Overall program coverage was high (95%), but 77% of schoolchildren in the interior and 39% in the capital city did not receive meals every day. So far, irregular school meal distribution has frustrated the programs aspirations to become a universal social policy and ensure a basic right for children.

Desigualdade, pobreza e condições de saúde e nutrição na infância no Nordeste brasileiro

Estudo transversal, envolvendo 2.001 criancas das areas rural e urbana de dez municipios da Bahia, Brasil. Avalia-se a relacao entre os gradientes da desigualdade e os fatores do ambiente familiar, de saude e nutricao, utilizando-se a regressao logistica multinomial multivariada. As criancas do tercil intermediario das condicoes de vida e aquelas do tercil mais pobre tem chances significantes e crescentes de viverem na area rural, em domicilio chefiado pela mulher, ter o pai desempregado, mae com baixa escolaridade, de dormir com mais de uma pessoa na mesma cama, deficit linear grave e consumir retinol abaixo da mediana. A existencia de mais de uma crianca no domicilio, ser portadora de deficit ponderal e ter o consumo de lipideo abaixo da mediana foram eventos tambem significantes para as criancas mais pobres. A anemia foi identificada entre as criancas do tercil intermediario. A desigualdade expoe as criancas a chances crescentes de inadequado estado de saude e nutricao. Politicas de saude podem implementar medidas emergenciais no sentido de minimizar os males impostos pela desigualdade a saude e nutricao na infância.

Comida de rua e intervenção: estratégias e propostas para o mundo em desenvolvimento

The objective of this study is to analyze the intervention strategies presented for the street food segment, based on national and international studies and reports. According to the literature, it is observed a broad character of these intervention strategies, including actions directed to sellers, consumers, public human resources and to the development of appropriate technologies. In relation to the vendors, the strategies highlight the necessity of the activity regulation, the establishment of sanitary regulations, guidelines or codes to the activity as well as training of food handlers and vendors. To consumers, the actions comprise mainly the implementation of educational programs. At public administration sphere the strategies turn to human resources capacitating. Considering the appropriate technologies two possibilities are identified: the construction of specialized street food centers and the improvement of existing stalls. One can conclude that given the increase in sales of street food and the potential sanitary risks inherent to this sector, studies point to strategies to organize this segment, which can subsidize the development of social policies for this area in Brazil.

Panorama atual dos programas de pós-graduação em Nutrição no Brasil

The aim of the present study is to describe the current profile of Brazilian graduate study programs in nutrition, based on selected indicators produced by annual reports of the Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior. Some descriptive data are presented for 11 programs allocated in the Medicine II committee for 2002-2004, referring to the total number of published papers, proportions of papers according to the Qualis system, and average number of international papers per permanent faculty member in nine programs. Six of 11 programs were from the Northeast and Central West regions, 4 from the Southeast, and 1 from the South. The overall evaluation for 2001-2003 showed that 2 programs received grade 5.3 and grade 4, and the other 6 grade 3. Universidade Federal de Pernambuco granted degrees to most Masters students (n= 51), while 5 programs granted degrees to 28 or more students. Only the Universidade Federal de Sao Paulo and Universidade Federal do Rio Grande do Norte Programs averaged more than 1 international paper per permanent faculty member for the period as a whole (2002-2004). In conclusion, there are still few graduate studies programs in the field of nutrition in Brazil, the existing programs are recent, and the trend towards higher standards necessarily involves a substantial increase in academic output. A significant improvement in the evaluation process is antecipated in the near future.

Avaliação de políticas públicas de segurança alimentar e combate à fome no período 1995-2002. 3 - o Programa Nacional de Controle da Deficiência de Vitamina A

Vitamin A supplements have been distributed during National Immunization Days since 1983, and Brazil has been a pioneer in this kind of strategy. The current study evaluated the National Program from 1995 to 2002, from a structure-process-results perspective. The methodology involved document research, interviews with health services managers, and a case study in 44 municipalities in Bahia State, resulting in 1,344 household interviews. In relation to structure, from 1998 on the program operated without a normative instrument due to the extinction of the National Institute of Nutrition. Improvements in the processes of vitamin supply procurement and distribution had a positive impact on coverage, reaching 3.5 million capsules in 2002 (72% coverage). For the 2,546 children studied in Bahia, vitamin A distribution was irregular, with annual coverage varying from 8% to 26%. Program managers reported time constraints and insufficient human resources, consistent with the hypothesis that this type of strategy does not help inform the population about the importance of vitamin A. These findings point to the need for systematic linkage between different levels of government in order to fully implement and monitor the program.

Feeding practice among children under 24 months in the semi-arid area of Paraíba, Brazil

OBJECTIVE: Examine the feeding practices among children under 24 months in the State of Paraiba, Brazil. METHODS: A cross-sectional study conducted in 14 municipalities identified as the poorest of the state; 539 households composed of at least one child between the ages of 0 and 23.9 months were investigated. A 24-hour recall was conducted with the mothers regarding food consumed by their children. The analytic model took into account established recommendations for appropriate child feeding practices for three age groups: 0-5.9 months; 6-12 months; 12-24 months. RESULTS: Children between 0-5.9 months: there is a high percentage of weaning (20.7%) and low prevalence of exclusive breastfeeding (30.5 %); children from 6-11.9 months: 45.2% of children were still breastfeeding, but only 21.7% of children between 6 and 9.9 months showed a timely complementary feeding; children between 12-23.9 months: the prevalence of weaning was 64.2%. Feeding practices were characterized by high consumption of milk-based food and low consumption of food sources of iron. CONCLUSION: Child feeding practices in the population studied were far from the recommendations for each stratum, indicating a risk for the food and nutritional security of this population.

Reflexões do I fórum de coordenadores de programas de pós-graduação em nutrição no Brasil

The need to share experiences coupled with an interest in constructing a network for communication among graduate programs in nutrition led to the first national conference of coordinators of graduate programs in nutrition held at Salvador in June, 2006. This report presents a summary of the major issues debated at the conference that were formulated towards strengthening these programs and the area of nutrition in general both technically and politically. The participants agree on the need for improvement in the process of recruiting students, avoiding inbreeding but giving special attention to those already engaged in undergraduate research projects. A consensus was that the programs should choose potential thesis advisors carefully, with emphasis on the quality and regularity of the intellectual production. It was considered important to structure the programs so as to allow students to work fulltime on the masters/PhD program. An analysis of factors that lead to successful publication of research results highlighted the importance of a creative approach to relevant topics using valid methodology. It was proposed that the programs should define an agenda of relevant research issues for the nutrition area. A successful graduate program in nutrition was defined as one that integrates project funding, recruitment of students with a vocation for research, and selection of professors with the ability to teach, develop relevant research projects and publish in refereed journals. In the political arena, the participants agreed to create a formal organization capable of representing and strengthening collective interests in the area of nutrition.

Food and nutrition insecurity: a marker of vulnerability to asthma symptoms.

OBJECTIVE To evaluate the association between food and nutrition insecurity and asthma in children from Latin America. DESIGN Cross-sectional study. SETTING São Francisco do Conde, Bahia, north-eastern Brazil. SUBJECTS The study included 1307 children aged 6-12 years from public elementary schools. Asthma symptoms were collected using a questionnaire that was translated and adapted from the International Study of Asthma and Allergies in Childhood, phase III. The diagnosis of asthma was determined based on reports of wheezing in the previous 12 months. The Brazilian Food Insecurity Scale was used to identify food insecurity. We also obtained demographic, socio-economic and anthropometric information for each participant. We used multivariate logistic regression analyses to assess the associations of interest. RESULTS Of the children surveyed, 10·4% had a history of wheezing and 64·5% had some degree of food and nutrition insecurity. We found a positive dose-response relationship and statistically significant associations of asthma with moderate (OR = 1·71, 95% CI 1·01, 2·89) and severe (OR = 2·51, 95% CI 1·28, 4·93) food and nutrition insecurity. CONCLUSIONS The results show that moderate and severe food and nutrition insecurity are markers of vulnerability to wheezing. It is important to note that the results of studies in this field have potential implications for social policies that promote food security. Further studies to identify the mechanisms involved in the relationship between food and nutrition insecurity and asthma are needed.

Proposta metodológica para avaliação de formação em alimentação saudável

OBJETIVO: Considerando a prioridade da promocao da alimentacao saudavel na escola e tendo a educacao alimentar e nutricional como estrategia, este artigo descreve a construcao e verifica a aplicabilidade de um metodo para avaliacao de processos de formacao nesta area. METODOS: O desenvolvimento contemplou: definicao do objeto e objetivos da avaliacao; modelo da avaliacao; definicao das dimensoes a serem avaliadas; selecao e construcao de indicadores e do plano de analise. O metodo foi aplicado em programa de formacao em Salvador (BA), para professores, gestores e merendeiras. RESULTADOS: Foi elaborado um protocolo com doze indicadores distribuidos em cinco dimensoes e foram definidos parâmetros para avaliacao de resultados. Na aplicacao-piloto verificou-se que o curso alcancou desempenho global muito bom de acordo com o plano de analise. Os participantes se mostraram interessados e sem dificuldades para responder as questoes, indicando adequacao das variaveis em observacao. De forma geral, os resultados alcancados com o uso do metodo se mostram compativeis com o que encontra na literatura sobre o tema. Na medida em que a observacao mostrou a existencia de alguns problemas no desenvolvimento do programa, admite-se que reajustes precisam ser feitos nos indicadores e particularmente no plano de analise para que o resultado final seja capaz de discriminar problemas especificos. CONCLUSAO: O metodo se mostrou sensivel as varias dimensoes da formacao. Sugerem-se, entretanto, novos testes com o protocolo por ser um tema de grande amplitude e dinamismoOBJECTIVE: Considering that promoting healthy eating in school is a priority and having food and nutrition education as strategy, this article describes the construction and investigates the applicability of a method to assess the training processes in this area. METHODS: The development of this method included: object definition and assessment objectives; assessment model; definition of the dimensions to be assessed; and selection and construction of indicators and plan of analysis. The method was administered in a training program in Salvador (BA) to professors, managers and cook assistants. RESULTS: A protocol with twelve indicators distributed into five dimensions was developed, defining parameters to assess results. In the pilot-administration, the method revealed that the course reached a very good global performance according to the analysis plan. The participants demonstrated interest and no difficulties to answer the questions, indicating the appropriateness of the investigated variables. Generally, the results obtained with the method are compatible with the literature on the theme. As observation revealed the existence of some problems in the development of the program, readjustments of the indicators, and especially of the analysis plan, were admittedly needed for the final result to be able to discriminate specific problems. CONCLUSION: The method was sensitive to multiple training dimensions. However, new tests with the protocol are suggested since this is a theme of great breadth and dynamism.