Objective To analyze public policies on food and nutrition in Brazil, with emphasis on the last fifteen years (2003-2018). Methods Historical-documentary analysis based on a bibliographical survey on indexed bases and exploratory visits to websites of government agencies. Results The scientific and governmental findings were organized according to the Lula, Dilma and Temer governments. They explore the development of several public policies and welfare programs in food and nutrition, focusing mainly on Brazilian Hunger Eradication Program, Assistance for Needy Families Program, National Policy on Food and Nutrition Security, Food Acquisition Program, National School Nutrition Program, National Food and Nutrition Security Policy, National Food and Nutrition Surveillance System and Brazilian Misery Eradication Program. The centrality of the idea of the fight against hunger and misery in public policies during Lula’s first and second terms and Dilma’s first term stand out. Dilma’s second term is marked by the focus on healthy eating, as well as presenting the first signs of fragilization of public policies on food and nutrition. Currently, the Temer government is characterized by processes of institutional and programmatic rupture, budget cuts and setbacks in acquired rights. There is evidence of the need to activate national and international instruments to enforce the human right to adequate food and consequent strengthening of public policies on food and nutrition. Conclusion This period presents an expansion and qualification of public policies on food and nutrition, mainly in the Lula and Dilma administration, with setbacks in the Temer administration, in which continuous budget cuts weaken social, hunger reduction, poverty reduction and food and nutrition security policies.
RESUMO Objetivo: Avaliar a percepção dos gestores quanto à atenção nutricional ao pré-natal e ao puerpério na rede básica de município da Baixada Santista, São Paulo, segundo estrutura e processo. Métodos: Realizou-se censo das 28 unidades básicas da área insular por meio de entrevistas com gestores. Avaliou-se a atenção nutricional segundo infraestrutura, processo de trabalho e vigilância alimentar e nutricional. Resultados: A inserção do nutricionista foi o principal componente insuficiente da dimensão estrutura, interferindo negativamente na atenção nutricional para 60% dos gestores. Encontrou-se baixa conformidade para as seguintes variáveis da dimensão processo: cálculo do índice de massa corporal (35%), acompanhamento do estado nutricional na curva índice de massa corporal/semana gestacional (46%) e realização de aconselhamento nutricional individualizado no pré-natal (14%). Conclusão: A atenção nutricional pré-natal e puerperal é insatisfatória para alcançar a integralidade do cuidado. Faz-se necessário sensibilizar gestores locais e capacitar equipes de saúde para assegurar a efetividade de tais ações em Santos.
The authors report on the development of a work accident monitoring system in Piracicaba, São Paulo State, Brazil, with the following characteristics: information feeding the system is obtained in real time directly from accident treatment centers; the system has universal monitoring, covering all work-related accidents in Piracicaba, regardless of the nature of the worker's employment conditions, place of work, or place of residence; health surveillance and promotion of health initiatives are triggered by identification of sentinel events; spatial distribution analysis of work-related accidents is a basic tool in designing accident awareness strategies and accident prevention policies. The system was implemented in November 2003 and by October 2004 had identified 5,320 work-related accidents, or a 3.8% annual proportional incidence of work-related accidents in the municipal area. We illustrate spatial analysis of registered work-related accidents and present a detailed investigation of one example of a serious accident.
This essay aims to debate the minimum clock hours of instruction necessary for obtaining a bachelor's degree in nutrition considering the challenges to educate health professionals. Official documents on the minimum clock hours of instruction required by undergraduate nutrition programs were analyzed to investigate compliance with the curriculum guidelines for the area, the law that regulates the profession of dietitian, and the necessary education for the Sistema Único de Saúde (Unified Health Care System). Compared with other health programs, nutrition presented the smallest increase in the minimum clock hours of instruction required for the degree. The changes that occurred in the epidemiological, demographic, and nutritional profile of the population and scientific advances require specific nutrition actions. Since Sistema Único de Saúde focuses on comprehensiveness in the three levels of care, on humanization, and on health care, the theoretical and methodological concepts given in undergraduate programs need to be improved for the dietitians education to meet the Sistema Único de Saúde needs. Incorporation of the knowledge needed for working with food and nutritional phenomena, including its social and cultural dimensions, management of public policies, quantity cooking, and food and nutritional surveillance requires a higher minimum clock hours of instruction. In conclusion, dietitians need a minimum clock hours of instruction of 4,000 to acquire a proper education, integrate into the university life, and coordinate interdisciplinary experiences of the triad teaching/research/extension.
Trata-se de relato de experiência de estágio interdisciplinar em Nutrição Social e em Psicologia da Universidade Federal de São Paulo campusBaixada Santista, com foco na integralidade da atenção. O trabalho ocorreu entre 2010 e 2012, na Atenção Básica de Saúde do Sistema Único de Saúde no território Centro/Morro do município de Santos, São Paulo. Utilizaram-se registros de campo contendo memórias de supervisões e de reuniões entre professores e equipe de saúde. Construíram-se narrativas e projetos terapêuticos singulares. Em supervisão conjunta de professores de Nutrição e Psicologia, debateram-se situações destacadas pelos estudantes e planos de trabalho construídos para cada ciclo de formação. Isto fundamentou práticas interdisciplinares, reflexões e ações consoantes ao Sistema Único de Saúde, realizadas pelos estagiários. Os resultados corroboram a importância do trabalho interdisciplinar para a promoção da integralidade, constituindo formas de escuta e atenção diferenciadas aos usuários, em estreita relação com os serviços.
This scientific note presents preliminary developments of the Covid-19 pandemic on unemployment, poverty, and hunger in Brazil. The data on unemployment rate, un employment insurance claims, contingent of families in extreme poverty, and food insecurity was collected in government information systems, research published by public agencies, scientific articles, and in news portals. In an upward trajectory since 2015, the increase in unemployment and the number of families in extreme poverty was exacerbated after the pandemic began, drastically reducing the purchase power and access to healthy and adequate food, affecting mainly women and the populations of the Northern and Northeastern regions. Between January and September 2020, there was a 3% increase in unemployment in Brazil and, in October 2020, there were almost 485 thousand more families in extreme poverty compared to January of the same year. There are inadequate and insufficient responses from the Brazilian government to the articulated set of problems. The Covid-19 pandemic is a new element that potentiates the recent increase in hunger in Brazil, which occurs in parallel with the dismantling of the Food and Nutrition Security programs and the expansion of fiscal austerity measures, started with the political-economic crisis in 2015. There is an urgent need to recover the centrality of the agenda to fight hunger in Brazil, associated with the development of more robust contributions on the impact of the pandemic on the phenomena of poverty and hunger.
Objective: Describe and evaluate the nutritional care provided for overweight adults by the Primary and Secondary Health Care services of Santos, São Paulo, Brazil. Methods: This study was carried out between 2013 and 2015 integrating quantitative and qualitative approaches; it was divided into two phases: (1) characterization and (2) evaluation. In phase 1, a census of Primary Health Care Units (n=28) and Secondary Health Care Units (n=4) was conducted using interviews with health service managers and/or health professionals. Data were analyzed using exploratory data analysis. In phase 2, in-depth interviews were conducted with health service managers and/or health professionals investigating a sample of the Primary Health Care services and the totality of Secondary Health Care services provided. Thematic analysis was carried out using the theoretical framework for comprehensive health care proposed by Pinheiro & Mattos. Results: A total of 40 professionals were interviewed: 36 in the primary health care services and 4 in the secondary health care services. Nutritional care in the Primary Care services is focused on individual care and referrals to other services; nutrition diagnosis and health promotion occur only when overweight is associated with another disease. It was observed that the referral and counter-referral system and intersectorial collaborations were ineffective. In Secondary Care services, nutritional care is focused on clinical care using traditional approaches to nutrition education. Limiting factors for promoting comprehensive care were identified at the two levels of care: unproductive actions, lack of actions for health promotion and protection, and little dialogue between the Primary and Secondary care services. Conclusion: Overweight is not an outcome based on Primary and Secondary Care, but rather on prescriptive practices, which are not very effective in promoting users’ autonomy. It is necessary to guide the actions taken in these two levels of care to ensure the promotion of effective nutritional care.
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