Infant feeding practices, childhood growth and obesity in adult life

A saúde infantil é amplamente afetada pelo estado nutricional. Há um interesse crescente acerca da possibilidade do estado nutricional apresentado pela criança e das práticas alimentares na primeira infância estarem relacionados à obesidade em indivíduos adultos, aumentando os riscos para complicações metabólicas. Sabe-se que estudos prospectivos possibilitam a investigação e a avaliação apropriadas de determinantes do desenvolvimento infantil. Consequentemente, o presente artigo objetivou revisar as principais evidências disponíveis a partir de estudos longitudinais sobre associações entre práticas alimentares na primeira infância, padrões de crescimento infantil e estado nutricional verificados durante a vida adulta

Fidedignidade de rótulos de alimentos comercializados no município de São Paulo, SP

OBJETIVO: Avaliar a fidedignidade das informações sobre dados nutricionais declarados em rótulos de alimentos comercializados. MÉTODOS: Foram avaliados 153 alimentos industrializados habitualmente consumidos por crianças e adolescentes, comercializados no município de São Paulo (SP) entre os anos de 2001 e 2005. Os teores de nutrientes informados pelos rótulos foram confrontados com os resultados obtidos por métodos analíticos (físico-químicos) oficiais, considerando a variabilidade de 20% tolerada pela legislação vigente, para aprovar ou condenar as amostras. Foram calculadas médias, desvios-padrão e intervalos com 95% de confiança para os nutrientes analisados, assim como a distribuição da freqüência percentual de amostras condenadas. RESULTADOS: Todos os produtos salgados analisados apresentaram inconformidades relativamente ao conteúdo de fibra alimentar, sódio ou de gorduras saturadas. Os produtos doces apresentaram variação de zero a 36% de condenação relativamente ao teor de fibra alimentar. Mais da metade (52%) dos biscoitos recheados foram condenados quanto à quantidade de gorduras saturadas. Os nutrientes implicados com a obesidade e suas complicações para a saúde foram aqueles que apresentaram maiores proporções de inconformidade. A falta de fidedignidade das informações de rótulos nas amostras analisadas viola as disposições da Resolução da Diretoria Colegiada 360/03 da ANVISA e os direitos garantidos pela lei de Segurança Alimentar e Nutricional e pelo Código de Defesa do Consumidor. CONCLUSÕES: Foram encontrados altos índices de não conformidade dos dados nutricionais nos rótulos de alimentos destinados ao público adolescente e infantil, indicando a urgência de ações de fiscalização e de outras medidas de rotulagem nutricional

Comércio varejista de alimentos no município de São Paulo: a evolução da legislação sanitária

O código Sanitário Municipal de Alimentos, Decreto Municipal nº 25.544, de 14 de março de 1988, regulamentou a fiscalização sanitária de g~eneros alimentícios no varejo até 26 de novembro de 2002, data em que entrou em vigor a Lei Estadual nC 10.083, de 23 de setembro de 1998, Código Sanitário do estado de São Paulo, utilizado pelos serviços municipais de vigilância, em caráter temporário, até a promulgação do atual Código Sanitário do Município de São Paulo nº 13.735, em 9 de janeiro de 2004. Este código regulamenta todos os serviços e produtos de interesse da saúde, inclusive a produção e distribuição de alimentos e água para consumo humano. Por meio do estudo dos diferentes códigos vigentes no município e de legislações esparsas, foi possível identificar as nmudanças ocorridas na legislação e nos procedimentos administrativos da vigilância sanitária do varejo de alimentos no Município de São Paulo. Concluiu-se que o Código Sanitário do Município de São Paulo é uma legislação completa e atualizada, com previsão legal de utilização de regulamentos técnicos modernos de forma combinada, especialmente os que tratam da produção e distribuição de alimentos, com ênfase nas Boas Práticas de Fabricação (BPFs)

Inspeção sanitária em creches: uma proposta de roteiro de inspeção

O trabalho apresenta um projeto de intervenção na realidade concreta das ações de Vigilância Sanitária, através da proposição de um roteiro para inspeção destinado a creches. Os objetivos específicos foram identificar os fundamentos jurídicos, técnico-científicos e sanitários que possam nortear a prática de inspeções sanitárias em creches; elaborar uma proposta de roteiro que permita um processo de análise mais explícito, objetivo e homogêneo e discutir a contribuição do instrumento proposto para a atividade de Vigilância Sanitária, com base na literatura científica pesquisada. Para a realização do trabalho foi feita uma revisão fundamentada em textos didáticos e normativos das áreas de educação e saúde, legislação sobre Vigilância Sanitária e Educação Infantil, outros roteiros já existentes e artigos da literatura científica sobre agravos à saúde em crianças que frequentam creches. O trabalho focaliza o conteúdo da legislação específica vigente e sua aplicabilidade na prática da inspeção sanitária em creches e baseia-se na Portaria - MS n. 321 de 26.05.1988. Este estudo apresenta um instrumento para avaliar a qualidade do atendimento nas creches sob o aspecto da promoção da saúde e sugere estudos posteriores de validação para o contexto, com a possível inclusão de um sistema de classificação para os padrões de conformidade, por meio de uma metodologia estatística

Evaluation of biologic occupational risk control practices: Quality indicators development and validation

Background: There is growing demand for the adoption of qualification systems for health care practices. This study is aimed at describing the development and validation of indicators for evaluation of biologic occupational risk control programs. Methods: The study involved 3 stages: (1) setting up a research team, (2) development of indicators, and (3) validation of the indicators by a team of specialists recruited to validate each attribute of the developed indicators. The content validation method was used for the validation, and a psychometric scale was developed for the specialists` assessment. A consensus technique was used, and every attribute that obtained a Content Validity Index of at least 0.75 was approved. Results: Eight indicators were developed for the evaluation of the biologic occupational risk prevention program, with emphasis on accidents caused by sharp instruments and occupational tuberculosis prevention. The indicators included evaluation of the structure, process, and results at the prevention and biologic risk control levels. The majority of indicators achieved a favorable consensus regarding all validated attributes. Conclusion: The developed indicators were considered validated, and the method used for construction and validation proved to be effective.

The effect of Sao Paulo`s smoke-free legislation on carbon monoxide concentration in hospitality venues and their workers

Background Studies have shown that there is no safe level of secondhand smoke (SHS) exposure and there is a close link between SHS and the risk of coronary heart disease and stroke. Carbon monoxide (CO) is one of the most important components present in SHS. Objective To evaluate the impact of the smoking ban law in the city of Sao Paulo, Brazil, on the CO concentration in restaurants, bars, night clubs and similar venues and in their workers. Methods In the present study we measured CO concentration in 585 hospitality venues. CO concentration was measured in different environments (indoor, semi-open and open areas) from visited venues, as well as, in the exhaled air from approximately 627 workers of such venues. Measurements were performed twice, before and 12 weeks after the law implementation. In addition, the quality of the air in the city during the same period of our study was verified. Results The CO concentration pre-ban and pot-ban in hospitality venues was indoor area 4.57 (3.70) ppm vs 1.35 (1.66) ppm (p<0.0001); semi-open 3.79 (2.49) ppm vs 1.16 (1.14) ppm (p<0.0001); open area 3.31 (2.2) ppm vs 1.31 (1.39) ppm (p<0.0001); smoking employees 15.78 (9.76) ppm vs 11.50 (7.53) ppm (p<0.0001) and non-smoking employees 6.88 (5.32) ppm vs 3.50 (2.21) ppm (p<0.0001). The average CO concentration measured in the city was lower than 1 ppm during both pre-ban and post-ban periods. Conclusion Sao Paulos smoking-free legislation reduced significantly the CO concentration in hospitality venues and in their workers, whether they smoke or not.

Environmental management system and human resource practices: is there a link between them in four Brazilian companies?

The aim of this article is to analyze the theoretical model proposed by [Jabbour CJC, Santos FCA. Relationships between human resource dimensions and environmental management in companies: proposal of a model. Journal of Cleaner Production 2008;16(1):5 1-8.] based on the data collected in four Brazilian companies. This model investigates how the phases of the environmental management system can be linked to human resource practices in order to attain continuous improvement of a company`s environmental performance. Our aim is to contribute to a field, which has little empirical evidence. Although the interaction between the phases of the environmental management system and human resource practices is recommended by the specialized literature [Daily BE Huang S. Achieving sustainability through attention to human resource factors in environmental management. International Journal of Operations and Production Management 2001:21(12):1539-52.], the results indicate that most of the theoretical assumptions could not be confirmed in these Brazilian companies. (C) 2008 Elsevier Ltd. All rights reserved.

Variability on red blood cell transfusion practices among Brazilian neonatal intensive care units

BACKGROUND: Guidelines for red blood cell (RBC) transfusions exist; however, transfusion practices vary among centers. This study aimed to analyze transfusion practices and the impact of patients and institutional characteristics on the indications of RBC transfusions in preterm infants. STUDY DESIGN AND METHODS: RBC transfusion practices were investigated in a multicenter prospective cohort of preterm infants with a birth weight of less than 1500 g born at eight public university neonatal intensive care units of the Brazilian Network on Neonatal Research. Variables associated with any RBC transfusions were analyzed by logistic regression analysis. RESULTS: Of 952 very-low-birth-weight infants, 532 (55.9%) received at least one RBC transfusion. The percentages of transfused neonates were 48.9, 54.5, 56.0, 61.2, 56.3, 47.8, 75.4, and 44.7%, respectively, for Centers 1 through 8. The number of transfusions during the first 28 days of life was higher in Center 4 and 7 than in other centers. After 28 days, the number of transfusions decreased, except for Center 7. Multivariate logistic regression analysis showed higher likelihood of transfusion in infants with late onset sepsis (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.8-4.4), intraventricular hemorrhage (OR, 9.4; 95% CI, 3.3-26.8), intubation at birth (OR, 1.7; 95% CI, 1.0-2.8), need for umbilical catheter (OR, 2.4; 95% CI, 1.3-4.4), days on mechanical ventilation (OR, 1.1; 95% CI, 1.0-1.2), oxygen therapy (OR, 1.1; 95% CI, 1.0-1.1), parenteral nutrition (OR, 1.1; 95% CI, 1.0-1.1), and birth center (p < 0.001). CONCLUSIONS: The need of RBC transfusions in very-low-birth-weight preterm infants was associated with clinical conditions and birth center. The distribution of the number of transfusions during hospital stay may be used as a measure of neonatal care quality.

What loggers leave behind: Impacts on big-leaf mahogany (Swietenia macrophylla) commercial populations and potential for post-logging recovery in the Brazilian Amazon

The sustainability of current harvest practices for high-value Meliaceae can be assessed by quantifying logging intensity and projecting growth and survival by post-logging populations over anticipated intervals between harvests. From 100%-area inventories of big-leaf mahogany (Swietenia macrophylla) covering 204 ha or more at eight logged and unlogged forest sites across southern Brazilian Amazonia, we report generally higher landscape-scale densities and smaller population-level mean diameters in eastern forests compared to western forests, where most commercial stocks survive. Density of trees >= 20 cm diameter varied by two orders of magnitude and peaked at 1.17 ha(-1). Size class frequency distributions appeared unimodal at two high-density sites, but were essentially arnodal or flat elsewhere; diameter increment patterns indicate that populations were multi- or all-aged. At two high-density sites, conventional logging removed 93-95% of commercial trees (>= 45 cm diameter at the time of logging), illegally eliminated 31-47% of sub-merchantable trees, and targeted trees as small as 20 cm diameter. Projected recovery by commercial stems during 30 years after conventional logging represented 9.9-37.5% of initial densities and was highly dependent on initial logging intensity and size class frequency distributions of commercial trees. We simulated post-logging recovery over the same period at all sites according to the 2003 regulatory framework for mahogany in Brazil, which raised the minimum diameter cutting limit to 60 cm and requires retention during the first harvest of 20% of commercial-sized trees. Recovery during 30 years ranged from approximately 0 to 31% over 20% retention densities at seven of eight sites. At only one site where sub-merchantable trees dominated the population did the simulated density of harvestable stems after 30 years exceed initial commercial densities. These results indicate that 80% harvest intensity will not be sustainable over multiple cutting cycles for most populations without silvicultural interventions ensuring establishment and long-term growth of artificial regeneration to augment depleted natural stocks, including repeated tending of outplanted seedlings. Without improved harvest protocols for mahogany in Brazil as explored in this paper, future commercial supplies of this species as well as other high-value tropical timbers are endangered. Rapid changes in the timber industry and land-use in the Amazon are also significant challenges to sustainable management of mahogany. (C) 2007 Elsevier B.V. All rights reserved.

Brazilian Agriculture and Environmental Legislation: Status and Future Challenges

Brazilian agriculture covers about one-third of the land area and is expected to expand further We assessed the compliance of present Brazilian agriculture with environmental legislation and identified challenges for agricultural development connected to this legislation We found (i) minor illegal land use in protected areas under public administration, (ii) a large deficit in legal reserves and protected riparian zones on private farmland, and large areas of unprotected natural vegetation in regions experiencing agriculture expansion Achieving full compliance with the environmental laws as they presently stand would require drastic changes in agricultural land use, where large agricultural areas are taken out of production and converted back to natural vegetation The outcome of a full compliance with environmental legislation might not be satisfactory due to leakage, where pristine unprotected areas become converted to compensate for lost production as current agricultural areas are reconverted to protected natural vegetation. Realizing the desired protection of biodiversity and natural vegetation, while expanding agriculture to meet food and biofuel demand, may require a new approach to environmental protection New legal and regulatory instruments and the establishment of alternative development models should be considered

Generic drugs in Brazil: historical overview and legislation

The Brazilian generic drugs policy was implemented in 1999 with the aim of stimulating competition in the market, improve the quality of drugs and improve the access of the population to drug treatment. The process of implementing this policy allowed the introduction and discussion of concepts that had never before been used in the context of drug registration in Brazil: bioavailability, bioequivalence, pharmaceutical equivalence, generic drugs, biopharmaceutical classification system, biowaiver. The present article provides definitions for these concepts in the context of Brazilian legislation as well as a historical and chronological description of the implementation of the generic drugs policy in Brazil, including a list of current generic drug legislation. This article contributes to the understanding of the Brazilian generic drugs policy and facilitates the search for information concerning the legal requirements for registration of drugs in Brazil.

A survey on the sanitary condition of commercial foods of plant origin sold in Brazil

The objective of the study was to evaluate the hygienic conditions and practices of commercial foods of plant origin in establishments and street marketed by street vendors in cities in the State of Rio de Janeiro, Brazil. Forty different sales points were evaluated (establishments that prepared and sold fruit juices and street vendors that commercialized fresh coconut water, sugarcane juice and orange juice) using a questionnaire with 12 items, divided into three blocks (salesmen/handlers, operations, installations). The results indicated that the activities related to the commerce of fruit beverages in the cities of Sao Goncalo and Rio de Janeiro required the elaboration of a set of actions by the Sanitary Vigilance Agency in order to improve the hygienic and sanitary level and minimize health risk to consumers. Important requirements in the legislation relevant to this type of food are still not followed; adequate packaging and storage of the raw material, obtaining the raw material from registered suppliers, hygiene of the handlers and adequate management of wastes produced during the activities in question are amongst the main items deserving attention. (C) 2009 Elsevier Ltd. All rights reserved.

Knowledges and practices of successful literacy teachers (Brazil, 1950-1980)

Significant changes have marked Brazilian education in the period focused on by this research. Aiming to understand the configurations of the teaching profession in that period, this work focuses on the issue of the school success in the area of literacy by means of an analysis of the practices of literacy teachers who were at work between the 1950s and 1980s. The research is based on life-history accounts. The study aimed at describing the various experiences of these teachers identifying the knowledges and practices that sustained their successful literacy work as well as the various factors of a social, religious, political, familiar or other nature that, in the history of each of these teachers, favoured the development of a pedagogical style of literacy particular to each one of them. Despite the peculiarities and originality of each history, the success in the literacy process, as the defining feature of the profile of the four teachers, results from two main aspects: first, the autonomy that each one managed to keep in the development of his/her teaching work, particularly in the organisation of the teaching practices that indicated greater chances of a pupil`s learning to read and write; second, their trust in the capacity of every child for learning, independently of his/her social, economic and cultural conditions. Based on this evidence it is argued that the success of the pedagogical work, particularly during the early years of schooling, lies in an ethics of the teaching work with a double implication: first, it requires the teachers` dedication to their pupils, and second, it requires respect for the work of the teacher, so that she/he can maintain her/his autonomy and inventiveness. These aspects indicate the need for reflection on teaching work and a review of current teacher education policies, particularly the policies targeted at teachers working with literacy practices.

Exposure to contaminated water: perceptions and practices in a neighborhood in the city of Manaus, Brazil

Objective. To investigate the modes of water supply and the perception concerning the problems caused by this water among residents of a neighborhood without public supply of water, settled in an area previously used as a garbage dump in the city of Manaus, Brazil. Methods. One hundred and sixty-two semi-structured household interviews were conducted. In addition, a focal group with teachers from a local public school and a meeting with residents were held. The instruments employed focused on the perception and modes of water use and on the process of exposure to chemical contaminants through water. Results. Untreated well water was used by most families. This water was considered to be ""good"" by 64.8% of the individuals interviewed. Most residents (88.3%) declared knowledge about the garbage dump. Of these, 77.6% stated that the garbage dump caused health and environmental problems. However, qualitative analysis of the responses revealed that the residents were not aware of contamination by chemical elements or of the consequences of such contamination. The activities carried out with teachers revealed that they were partially aware of the problem, but did not design interventions to address the issue. In a meeting with neighborhood residents, the presence of social activism concerning the problem was identified, but it did not extend beyond the neighborhood or reach governmental spheres. Conclusions. The study identified a situation of critical exposure that tends to be maintained as a result of misperceptions and lack of social mobilization. The dissemination of research results to teachers and residents was useful to empower subjects.