A alimentação saudável na ótica dos adolescentes: percepções e barreiras à sua implementação e características esperadas em materiais educativos

Este estudo visou avaliar percepções, barreiras e características de materiais educativos de promoção de alimentação saudável descritas por adolescentes. Realizaram-se quatro grupos focais com 25 adolescentes com perguntas sobre: percepção e motivação para modificar a dieta; conceito de alimentação saudável e barreiras para sua adoção; e características de impressos para a promoção de práticas alimentares saudáveis. Observou-se uma freqüente indecisão quanto a classificar a dieta como saudável. Os adolescentes referiram não se sentir confiantes para modificar a dieta, mas relataram conceitos adequados sobre alimentação saudável. As principais barreiras citadas foram focadas em aspectos pessoais e sociais, como: a tentação, o sabor dos alimentos, a influência dos pais e a falta de tempo e de opções de lanches saudáveis na escola. Para os jovens, materiais educativos de promoção de alimentação saudável devem reforçar seus benefícios imediatos e destacar mensagens alarmantes sobre os riscos à saúde advindos de uma alimentação inadequada.

A perceção dos chefs sobre o conceito de alimentação saudável e sua influência no bem-estar das pessoas : um estudo exploratório

As artes culinárias, os seus intervenientes e a envolvente associada às mesmas, assumem hoje um interesse crescente por parte dos consumidores, podendo funcionar como uma ferramenta de educação, tornando os consumidores mais recetivos à influência da alimentação na saúde. Por outro lado, o entretenimento direcionado para alimentação poderá conduzir o consumidor a um desvio das suas práticas alimentares saudáveis, envolvendo os espetadores numa fantasia e glamour, de cenários encenados que parecem reais em particular para pessoas sem qualificações em artes culinárias. Esta investigação pretende aferir a perceção dos Chefs sobre o conceito de alimentação saudável e a sua influência no bem-estar das pessoas na região da grande Lisboa. Metodologicamente, realizaram-se entrevistas a Chefs, privilegiando o método qualitativo. A informação recolhida foi tratada recorrendo-se à análise de conteúdo, utilizando-se o software QSR Nvivo 10®. As entrevistas seguiram um guião pré-estabelecido, incidindo sobre os seguintes temas: i) hábitos alimentares dos Chefs em casa; ii) perceção sobre alimentação saudável; iii) práticas em contexto de trabalho. Os Chefs percecionaram corretamente o conceito de alimentação saudável e associaram o bem-estar como o principal benefício associado à sua prática. Porém, nos seus locais de trabalho, os Chefs referem que se sentem pressionados pelas questões economicistas aquando da elaboração das suas receitas. Importa pois promover uma oferta alimentar atrativa e simultaneamente saudável, contribuindo para o bem-estar das pessoas.

Plano de comunicação: hábitos alimentares dos jovens portugueses

O intuito deste projecto de investigação é o de fazer um plano de comunicação para alterar o comportamento dos jovens face aos hábitos alimentares. O público-alvo desta comunicação são jovens entre os 16 e 21 anos. O problema em estudo neste trabalho são os hábitos alimentares dos jovens portugueses, tendo como objetivo a melhoria por parte dos jovens dos hábitos alimentares. Uma vez que estamos a alterar comportamentos e atitudes, este plano de comunicação insere-se no âmbito do marketing social. O presente projecto foi desenvolvido em três fases: primeiro foi feita uma revisão da literatura para perceber quais os hábitos alimentares dos jovens e o que já foi feito de comunicação para esta causa. Em seguida foi efectuado um questionário aos jovens para que fosse possível perceber o que consomem, as noções que têm de alimentação saudável e como se deve comunicar sobre hábitos alimentares com o target definido. Por fim, realizou-se uma estratégia de comunicação com base nas respostas dos inquiridos. A estratégia de comunicação é o mais adequada possível para os jovens, a fim de se conseguir passar a mensagem. De acordo com os resultados obtidos podemos perceber que muitos dos inquiridos não têm a melhor alimentação, contudo a maioria tem noção do que são bons hábitos alimentares. Relativamente aos meios para passar a mensagem, os inquiridos elegeram aqueles mais direcionados aos jovens. O resultado deste projecto foi um plano de comunicação com o objetivo dos jovens alterarem os seus hábitos alimentares. Este plano teve grande enfoque na publicidade, nas relações públicas e nos social media.

Prevalence of health promotion programs in primary health care units in Brazil

OBJECTIVE Assessment of prevalence of health promotion programs in primary health care units within Brazil’s health system. METHODS We conducted a cross-sectional descriptive study based on telephone interviews with managers of primary care units. Of a total 42,486 primary health care units listed in the Brazilian Unified Health System directory, 1,600 were randomly selected. Care units from all five Brazilian macroregions were selected proportionally to the number of units in each region. We examined whether any of the following five different types of health promotion programs was available: physical activity; smoking cessation; cessation of alcohol and illicit drug use; healthy eating; and healthy environment. Information was collected on the kinds of activities offered and the status of implementation of the Family Health Strategy at the units. RESULTS Most units (62.0%) reported having in place three health promotion programs or more and only 3.0% reported having none. Healthy environment (77.0%) and healthy eating (72.0%) programs were the most widely available; smoking and alcohol use cessation were reported in 54.0% and 42.0% of the units. Physical activity programs were offered in less than 40.0% of the units and their availability varied greatly nationwide, from 51.0% in the Southeast to as low as 21.0% in the North. The Family Health Strategy was implemented in most units (61.0%); however, they did not offer more health promotion programs than others did. CONCLUSIONS Our study showed that most primary care units have in place health promotion programs. Public policies are needed to strengthen primary care services and improve training of health providers to meet the goals of the agenda for health promotion in Brazil.

Entre o fazer e o dever

A compreensão da ocorrência das doenças em termos de risco e o estabelecimento de relações com os chamados estilos de vida, colocam na experiência de doença um acréscimo de conotações morais, um dever de autodisciplina e responsabilidade. Estes princípios têm sido inúmeras vezes sublinhados nos discursos e políticas da Saúde Pública, nomeadamente no que concerne às doenças cardiovasculares pela importância epidemiológica, económica e social de que se revestem e consequente necessidade de redução da sua grande incidência na população, como é o caso de Portugal. A hipertensão, como doença crónica e fator de risco cardiovascular sujeita os doentes a controlo médico periódico, terapêutica farmacológica e impele a um comprometimento com comportamentos alimentares e exercício físico adequado. Através das entrevistas realizadas a doentes hipertensos utentes da consulta específica em Cuidados de Saúde Primários, verifica-se a presença de modos diversos de agir perante a circunstância de se ter hipertensão arterial, mostrando a presença de várias racionalidades, apreciações e valorações práticas dos comportamentos de saúde e doença e do próprio corpo. Para os doentes hipertensos entrevistados, a hipertensão arterial não é encarada como uma “verdadeira doença”, sendo vista sobretudo como resultado do envelhecimento e dos excessos que se acumularam no corpo, consequentes da própria vida. Nas narrativas de experiência de doença, os conceitos de moderação e equilíbrio, “ter cuidado”, parecem servir de mecanismo de operacionalização entre aquilo que são as recomendações médicas e as práticas individuais. Constatam-se as capacidades dos doentes hipertensos construírem para si formas de gestão da doença e do medo, sendo que os seus comportamentos podem passar por assumir o controlo dos fatores de risco ou ignorá-los. Em qualquer dos casos, as representações e ações relativas à hipertensão e às recomendações médicas a ela associadas integram-se nas práticas quotidianas dos doentes, ajustando-se a hábitos e representações instaladas, constituindo-se em modos distintos de agir dos doentes hipertensos.

A Fitter Future for All - Framework launched

Obesity is a modern lifestyle epidemic that is threatening our health and well-being.This was the key message delivered by Health Minister Edwin Poots at the launch of The Framework for Preventing and Addressing Overweight and Obesity in Northern Ireland 2012-2022: 'A Fitter Future for All'.This ten year strategy will seek to improve the health and wellbeing of people throughout their entire life, from newborns to seniors.Minister Poots said: "We need to face the issue of obesity head on. It's an issue that will require commitment and action from across all sectors, including other government departments and agencies. It is therefore my intention to invest more than £7 million towards tackling the problem of obesity over the next three years."The negative impact on health caused by obesity cannot be over stated. Being obese increases the risk of developing serious illnesses such as heart disease, stroke, some cancers and type 2 diabetes."It is a significant challenge facing modern society and if we don't tackle it now we are storing up a multitude of problems for ourselves in the future."The Minister continued: "More and more of our children and young people are becoming overweight or obese and are putting themselves at risk of developing a range of health problems in their later years."Evidence shows that it is more likely that an obese child will become an obese adult. This in turn will lead to a greater strain on our health and social care services, with more people requiring treatment for obesity related illnesses and specialist care."The proposed framework looks to address a number of key issues, including:-increasing levels of breastfeeding;increasing knowledge and skills about food and its preparationencouraging participation in physical activity;promoting walking and cycling; making sure how we live and where we live encourages and supports healthy eating and physical activity;encouraging and supporting more community involvement with these issues; and;continuation of reformulation of processed foods.The Minister added: "In Northern Ireland 59% of adults are either overweight (36%) or obese (23%). Another worrying statistic is that 8% of children aged 2-15 years were assessed as being obese. These figures demonstrate the scale of the problem and the enormous challenge we are facing."The new framework sets challenging targets. To date we have focussed on simply trying to stop the rise in the levels of obesity, however under A Fitter Future For All we are seeking to actually reduce the level of obesity by 4% and overweight and obesity by 3% among adults. In addition, we are seeking a 3% reduction of obesity and 2% reduction of overweight and obesity among our children and young people." "Meeting these targets will require changes in our lifestyles and behaviours. Most importantly, individuals need to be given the opportunity to make decisions that will benefit their own health and wellbeing".Referring to the 'Give It A Go!' initiative, to increase awareness of the range of nutritional and physical activity initiatives in the southern area, the Minister said: "The Give It A Go! Initiative is a great example of how collaborative work can make such a positive contribution to peoples' lives by providing opportunities for learning, participation in physical activity and for social interaction."Tackling obesity and seeing positive results throughout the life course of the entire population will take time but I strongly believe that the actions set out in this framework will inspire and enable people to improve their diets and be more active."Encouraging people to consider the framework and adopt a healthier lifestyle, the Minister concluded: "Government cannot tackle obesity on its own. We can encourage and promote healthy eating and physical activity but as a society, we must take more individual responsibility for our own health outcomes."Dr Tracy Owen, Consultant in Public Health Medicine with the PHA, said: "The PHA is already working with partner organisations across many of the areas included in the framework 'A Fitter Future for All' and is addressing issues such as developing people's skills and knowledge about healthier eating along with encouraging participation in physical activity. The framework gives us the opportunity to raise awareness of this important area and strengthen action."As the Minister has mentioned, a good example of this coordinated action is the PHA supported initiative Give it a Go! which is providing people in the Southern area with the opportunity to learn about food through supermarket tours and Cook it! classes and to get active through walks, spinning classes and many other activities, all of which are free. These taster sessions are aimed at raising awareness of healthier lifestyles which will ultimately make changes in behaviour more likely."These changes, no matter how small, can help people to lose weight, maintain a healthy weight and bring big benefits to their general health. Importantly, we have developed this joint programme by working closely with our partners, particularly local councils."

Public Health England Briefing Papers

-Social and economic inequalities in diet and physical activity - Obesity and disability - adults - Obesity and alcohol - an overview - A simple guide to classifying body mass index in children - Knowledge and attitudes towards healthy eating and physical activity - Brief intervetions for weight management - Data sources:environmental influences on physical activity and diet - Measuring diet and physical activity in weight management interventions - Obesity and Mental Health - Obesity and ethnicity - Variation in Childrens BMI by month of measurement - The economic burden of obesity - Bariatric surgery for obesity - Review of dietary assessment methods in public health - Obesity and life expectancy -

ProHealthClinical Primary Care Weight Management in Hertfordshire

The aim of this intervention is to: i) help primary care patients with a BMI of 30 or above or 28 with co-morbidities achieve a weight loss of 5 per cent or more using a computerised lifestyle protocol within a 12 week period ii) establish primary care weight management services in the county and train primary care workforce in weight management intervention iii)help patients make sustainable lifestyle changes in terms of healthy eating and physical activity

Obesity prevention opinions of school stakeholders: a qualitative study.

BACKGROUND: In general, schools are an important setting to implement current recommendations for obesity prevention in children because the vast majority of children attend school. This study investigated the opinions of different school stakeholders on the feasibility and acceptability of current obesity prevention strategies that could be implemented in Swiss schools. METHODS: Research methods were comprised of a qualitative study which included school directors, physical education teachers, catering staff, school nurses and health educators, parents of young adolescents, and young adolescents interviewed (N = 40) categorized into 6 focus groups. Open-ended questions were used to determine the participants' opinion regarding current obesity prevention recommendations, and healthy eating and physical activity promotion strategies. RESULTS: All participants approved the implementation of nutritional standards for food and drinks sold in schools, but thought that increasing the attractiveness of healthy options was the best strategy to improve eating habits. Enjoying participation in physical activity classes or after-school activities was stressed. Participants suggested offering classes for all students with poor physical condition, independent of weight status. Stakeholders called for governmental support and global coordination of interventions balanced with providing schools with enough autonomy to adapt programs relevant to their individual circumstances. They recommended integrating all school stakeholders in obesity prevention initiatives, with special attention to students and local authorities. CONCLUSIONS: Participants agreed that schools are a crucial setting to implement childhood obesity prevention strategies. They called on school stakeholders to join efforts aiming to encourage healthy behaviors and to support and reinforce parents' efforts by spreading consistent and coherent health messages.

Impacto da dor miofascial no hábito alimentar

Pós-graduação em Alimentos e Nutrição - FCFAR

Prevalence of health promotion programs in primary health care units in Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Orthorexia nervosa behavior in a sample of Brazilian dietitians assessed by the Portuguese version of ORTO-15

BACKGROUND: Orthorexia nervosa (ON) is described as an obsessive pathological behavior characterized by a strong preoccupation with healthy eating and the avoidance of foods or ingredients considered unhealthy by the subject. Although it is still not officially recognized as an eating disorder, previous studies have discussed its frequency in some groups and a fifteen-question test (ORTO-15) was developed elsewhere to assess ON behavior. OBJECTIVE: The present study aimed to evaluate ON behavior in a sample of Brazilian dietitians after testing the psychometric properties of the Portuguese version of ORTO-15. METHODS: A total of 392 dietitians answered an online version of the test. The answers were analyzed regarding ON tendency, according with the scoring grid proposed by its authors. Exploratory factor analysis was performed and internal consistency was assessed. RESULTS: It was found that three questions of the test presented loadings lower than 0.5. The 12 remaining question formed 3 factors with internal consistency of -0.51, 0.63 and 0.47. The answers of the participants to these questions revealed a tendency to orthorexic behavior, mainly regarding aspects such as: making food choices conditioned by worry about health status, evaluating food rather from nutritional quality than from its taste, believing that consuming healthy food may improve appearance, discrediting the influence of mood on eating behavior and banning food choices considered by them as eating transgressions. CONCLUSION: There is no evidence of the validity and reliability of the ORTO-15 with the initial psychometric evaluation performed. Further analyses are needed. Nevertheless, it was possible to observe a high frequency of orthorexic behavior among the studied Brazilian dietitians. However, additional studies are needed to completely understand dietitians behavior toward ON. (Eat. Weight Disord. 17: e29-c35, 2012). (C) 2012, Editrice Kurtis

Análisis de la cadena de valor, canales cortos de comercialización y horticultura multifuncional como opciones de puesta en valor: Caso de la Huerta de Aranjuez

La Vega de Aranjuez ha sido desde hace siglos conocida por la notoriedad de sus jardines y huertas históricas y también, en épocas más recientes, por ser la despensa de Madrid. A mediados del siglo XX, sin embargo, con las transformaciones que el sector agrario ha experimentado no sólo a nivel local, sino a escala global, empezó un proceso de declive que se ha acentuado en los últimos años. Paralelamente, en el año 2001, la Unesco declara el Paisaje Cultural de Aranjuez, como Patrimonio de la Humanidad con un valor universal excepcional. Parte de lo que sustenta este reconocimiento a nivel internacional radica en las peculiaridades del paisaje que conforma la actividad agraria. El cambio de orientación, eminentemente hortofrutícola hacia cultivos extensivos y superficies en barbecho, y la pérdida de importancia del sector, no han pasado desapercibidos para la administración local y han sido varios los intentos de recuperación y dinamización del sector en los últimos años. La investigación de la que es objeto esta Tesis Doctoral surgió por iniciativa del Ayuntamiento de Aranjuez, que en al año 2010 deseó conocer la situación del sector hortícola en el municipio, para lo cual, encargó un estudio a la UPM-ETSIA. Para conocer la realidad desde una perspectiva integral, se planteó abordar el análisis desde la perspectiva de Cadena de Valor. Las implicaciones de este concepto, su evolución y su papel como instrumento de análisis de la cadena alimentaria, han sido revisadas y presentadas en el epígrafe del Marco Conceptual. Por cadena de valor se entiende el conjunto de procesos desde el consumidor, a través de los proveedores que proporcionan productos, servicios e información que añaden valor hacia los clientes (Lambert & Cooper, 2000; Chen, 2004). Para el análisis de la situación del sector hortícola en Aranjuez, se procedió en varios pasos, los cuales constituyeron la primera fase de la investigación y contemplaron lo siguiente: 1. La identificación de los problemas y de las demandas de los actores de la cadena, realizando cortes transversales en el mercado a distintos niveles para conocer los puntos de vista de los operadores de la cadena (Gunasekaran & Patel ,2004; Rojas, 2009; Schiefer, 2007). Para ello se diseñaron cuestionarios y se dirigieron a representantes de cinco eslabones de la cadena presentes en el caso de estudio: Agricultores (15), Mayoristas (11), Detallistas (55), Consumidores (85) y Restaurantes (36), tanto en Aranjuez como en Madrid (un total de 202). 2. Análisis D.A.F.O de cada uno de los eslabones y de la cadena completa, como herramienta para identificar y sintetizar la problemática y las potencialidades del sector. 3. Análisis global de la Cadena de Valor mediante el Método de Organización Sectorial, según Briz, de Felipe y Briz (2010), el cual permite estudiar aspectos de la estructura, la conducta y el funcionamiento de la cadena. 4. Jornada de análisis por parte de un Panel de Expertos en la sede de la Fundación Foro Agrario, en la cual se presentaron las conclusiones del análisis de la cadena de valor y se plantearon estrategias para la dinamización del sector. Con los resultados del análisis en esta primera fase de la investigación, se obtuvo una panorámica de la cadena de valor. Algunos de los aspectos más destacados son los siguientes: • El eslabón productivo en Aranjuez está muy atomizado y trabaja por lo general de forma independiente. Cultiva hasta veinte productos hortícolas diferentes, entre los cuales los frutales están casi en desaparición y hay poca presencia de producto ecológico. Le preocupan los precios poco estables y bajos y por lo general no trabaja con contratos. •El eslabón mayorista prácticamente carece de presencia en Aranjuez y está representado en su mayoría por operadores de Mercamadrid, los cuales demandan mayores volúmenes y mejor normalización de los productos hortícolas procedentes de Aranjuez. • El eslabón detallista consultado es diverso (con representación de comercios minoristas, supermercados e hipermercados) y también demanda mayores volúmenes de producción y mejoras en la normalización. Un 80% conoce los productos de Aranjuez, especialmente el espárrago y la fresa-fresón citados en un 74% y 63% de los casos respectivamente. • En el eslabón de consumidores, el 79% de los encuestados da importancia a la procedencia de los productos hortícolas y un 82% conoce los productos de la Huerta de Aranjuez, siendo los más consumidos el espárrago y el fresón. Un 42% de los encuestados compra producto ecológico por razones de salud, sabor y buscando la ausencia de químicos. • El eslabón de restaurantes es un gran consumidor de hortalizas, la gran mayoría de los productos incluidos en el análisis se oferta en más del 75% de los casos. Las más presentes son tomate y espárrago. La fresa y el fresón (en un 83% de los casos), y el espárrago (72%) seguido de la alcachofa (44%) son los productos de Aranjuez que más se conocen en el conjunto de los restaurantes entrevistados. El 75% de los restaurantes prefiere el producto fresco frente al procesado o congelado. La mayoría de los restaurantes locales (92%) estaría dispuesto a incluir en su carta una diferenciación para los productos de Aranjuez. Sin embargo, en el resto de restaurantes el porcentaje es mucho menor (21%). Entre las conclusiones del análisis se evidenció que un 52% de las ventas de los agricultores se realizaba sin intermediarios y un 69% de los consumidores se manifestaba interesado en adquirir productos de Aranjuez directamente del campo a su casa. Se identificó de esta manera que el acortamiento de la cadena se está utilizando como una forma de crear valor. Para profundizar en este aspecto, se planteó una segunda fase en la investigación. Además de estudiar diversos aspectos de los canales cortos de comercialización, se planteó estudiar el enfoque multifuncional de la horticultura, como estrategia para poner en valor la Huerta ribereña. Para dar una coherencia con la fase anterior, el planteamiento se realizó también desde la perspectiva de la cadena de valor, orientando la consulta hacia el eslabón consumidor. De esta manera, se realizó una consulta mediante cuestionario a 221 consumidores sobre diferentes aspectos relativos a los Canales Cortos de Comercialización (CCC) y la Horticultura Multifuncional (HM)1, lo cual permitió realizar un análisis cuantitativo de diferentes variables. Para completar la visión integral de la cadena corta, se seleccionaron 6 proyectos significativos que son ejemplos de diversas tipologías de canales cortos de comercialización en Aranjuez y Madrid, como representantes del denominado eslabón de “Promotores de CCC” y se consultó también a la Asociación de Productores de la Huerta de Aranjuez, constituida formalmente en el año 2014, como representante del eslabón Productor. Para la obtención de información, la cual tiene un carácter cualitativo en el caso de estos dos eslabones de la cadena, se realizaron cuestionarios y Estudios de Caso de cada proyecto. Los cuestionarios de esta segunda fase de consulta a los eslabones de la cadena corta contuvieron cuestiones relativas a los canales cortos de comercialización, tanto a nivel general (concepto de canal corto, puntos fuertes y ventajas que aportan, dificultades para su desarrollo, factores clave para su éxito) como para el caso concreto de la Huerta de Aranjuez (perfil del consumidor, factores implicados en la compra de verduras, utilización de diversas modalidades de canal corto, relación con las tecnologías de la información y comunicación (TICs) y la producción ecológica o la importancia del factor confianza). También aspectos relacionados con la Horticultura Multifuncional, como son, la valoración de diferentes actividades o proyectos de carácter agro-turístico, educativo, social o terapéutico, o la percepción del consumidor de las actividades de huerta como fuente de bienestar y como agente satisfactor de diversas necesidades humanas. Para completar la visión sobre estos dos temas, CCC y HM, se realizó una consulta mediante cuestionario a Expertos en el campo de los canales cortos de comercialización, procedentes del ámbito académico, y a Profesionales en activo trabajando en proyectos de horticultura social y terapéutica. La información aportada, aunque tiene carácter cualitativo, complementa el estudio ofreciendo la perspectiva académica en el caso de los canales cortos y amplía la información sobre la horticultura multifuncional, tratando cuestiones relativas al desempeño profesional o a la formación existente en España en el campo de la horticultura social y terapéutica. Los resultados de esta segunda fase de la investigación, entre otras cuestiones, evidenciaron que: • Los canales cortos de comercialización implican mucho más que la simple reducción de intermediarios y comprenden una gran diversidad de tipologías. • Los casos estudiados, están enfocados en su mayoría al producto ecológico y su funcionamiento está muy fundamentado en el uso de TICs y en el factor confianza. • En relación a la compra de verduras en el ámbito de los canales cortos, son aspectos muy valorados por el consumidor la calidad del producto, la rapidez y frescura con la que llega del campo a la mesa y que el Producto sea recogido en su punto óptimo de maduración. • Las actividades en el ámbito de la horticultura multifuncional son valoradas positivamente por los consumidores, siendo las más puntuadas las de huerto educativo, huerto terapéutico, seguidas de visitas guiadas y degustaciones de productos de huerta en restaurantes. • Por lo general existe una valoración muy alta de la huerta como fuente de bienestar y de satisfacción de necesidades humanas básicas, especialmente las de una alimentación saludable y de conexión con la naturaleza. Para terminar esta síntesis de la investigación realizada, se presentan las principales conclusiones a nivel global de la Tesis, que son las siguientes: 1. La metodología de cadena de valor ha resultado adecuada para conocer la complejidad y el funcionamiento del sector hortícola arancetano desde una perspectiva integral. 2. La Huerta de Aranjuez cuenta con importantes fortalezas, sustentadas en la calidad de sus suelos y en la fama que mantienen sus productos, pero también debilidades. Esto supone poco volumen de producción, que dificulta la relación con mayoristas y grandes detallistas. 3. El acortamiento de la cadena, mediante canales cortos de comercialización se ha identificado como una forma de creación de valor en la cadena. Existen oportunidades de abastecimiento a consumidores de Madrid mediante canales cortos, sin embargo, las modalidades que requieren mayor organización o requisitos de producción ecológica todavía no están desarrolladas. 4. La producción ecológica podría ser una estrategia para crear valor pero todavía es un método de cultivo muy minoritario en la cadena productiva arancetana. 5. Las peculiaridades de la Huerta de Aranjuez propician la puesta en práctica del enfoque multifuncional de la horticultura como vía de desarrollo económico. Los resultados apuntan a una posible demanda de servicios que contemplen actividades de horticultura de carácter educativo, terapéutico y agro-turístico, conducidas por profesionales. Existe una percepción positiva sobre el potencial de la huerta como fuente de bienestar y de satisfacción de necesidades humanas básicas. 6. La puesta en marcha de proyectos empresariales en el ámbito de la horticultura social es una apuesta interesante para crear valor en la huerta que ha sido valorada positivamente por los eslabones de la cadena corta consultados. 7. El campo de la Horticultura Multifuncional que contempla aspectos educativos, sociales y terapéuticos conforma una disciplina con posibilidades de desarrollo que en la investigación se perciben como limitadas por la falta de profesionales y su acceso a una formación adecuada en España. El estudio de los Canales Cortos de Comercialización y de la Horticultura Multifuncional como vías de puesta en valor en el caso de la Huerta de Aranjuez ha tenido un carácter exploratorio y en gran parte cualitativo en esta Tesis Doctoral. Ambos conceptos han desvelado cierta complejidad y requieren de un mayor conocimiento en diversos aspectos para su puesta en práctica con éxito. Se abre, por tanto, un campo para futuras investigaciones que profundicen en estos ámbitos. ABSTRACT La Vega de Aranjuez has been known for centuries for the reputation of its orchards and historic gardens and, more recently, as the pantry of Madrid. However, in the mid-twentieth century, with the transformations in agriculture, not only locally, but globally, began a process of decline that has been accentuated in recent years. Meanwhile, in 2001, Unesco declared Aranjuez Cultural Landscape, as a World Heritage Site with outstanding universal value. Part of what underpins this international recognition lies in the peculiarities of the landscape created by farming. The shift, from an eminently horticultural vocation to extensive field crops and fallow surfaces, and the loss of importance of the sector, have not gone unnoticed for local authorities and have been several attempts at recovery and revitalization of the sector in recent years. The beginning of this research came at the initiative of the municipality of Aranjuez, which in 2010 wanted to know the situation of the horticultural sector, for which he commissioned a study by the UPM-ETSIA. To know reality from an integral perspective, it was proposed to approach the analysis from the perspective of value chain. The implications of this concept, its evolution and its role as an instrument of analysis of the food chain, have been reviewed and presented in Chapter 3.2. The value chain concept refers to all the processes from the consumer, through suppliers who provide products, services and information that add value to customers (Lambert & Cooper, 2000; Chen, 2004). For the analysis of the situation of the horticultural sector in Aranjuez, which constituted the first phase of research, it proceeded in several steps: 1. Identifying the problems and demands of the actors in the chain, making transverse cuts in the market at different levels to meet the views of the chain operators (Gunasekaran & Patel , 2004; Rojas, 2009; Schiefer, 2007). Questionnaires were designed for it and went to representatives of the five links in the chain: Farmers (15), Wholesalers (11), Retailers (55), Consumers (85) and Restaurants (36), both in Aranjuez and Madrid (a total of 202). 2. SWOT analysis of each chain actor and of the whole supply chain, as a tool to identify and synthesize the problems and potential of the sector. 3. Analysis of the whole supply chain by Industrial Organization Method according to Briz et al. (2010), which allows to study aspects of the structure, conduct and performance of the chain. 4. Analysis by a Panel of Experts at Foro Agrario Foundation headquarters, where the conclusions of the analysis were presented and strategies for the revitalization of the sector were raised. The results of the analysis in this first phase of the research, presented an overview of the value chain. Some of the highlights are: - The productive sector in Aranjuez is very fragmented and usually works independently. With a wide variety of horticultural products (up to 20), fruit crops almost disappearing and little presence of organic product. Is concerned about the unstable and low prices and usually does not work with contracts. - The wholesale sector with virtually no presence in Aranjuez is represented mostly by Mercamadrid operators, who demand higher volumes and better standardization of horticultural products from Aranjuez. - The retailer sector is diversified (with representation from retailers, supermarkets and hypermarkets) and also demand higher production volumes and improved standardization. 80% know the products of Aranjuez, especially asparagus and strawberry-strawberry cited by 74% and 63% of cases respectively. - Among the consumers, 79% give importance to the origin of horticultural products and 82% know the products from Aranjuez, the most consumed asparagus and strawberries. 42% buy organic products for health, taste and absence of chemicals. - Restaurants are big consumers of vegetables, most of the products included in the analysis is offered in over 75% of cases. The most: tomato and asparagus. Strawberry (83% of cases), and asparagus (72%) followed by the artichoke (44%) are the products of Aranjuez more known in all the surveyed restaurants. 75% of the restaurants prefer fresh product against processed or frozen. Most local restaurants (92%) would be willing to include in their menu a differentiation for products of Aranjuez. However, for those restaurants from Madrid the percentage is much lower (21%). Among the conclusions of the analysis it showed that 52% of sales were realized from farmers without intermediaries and 69% of consumers expressed interest in acquiring products directly from field to table. It has been identified that the shortening of the chain is being used as a way to create value. To deepen this aspect, a second phase investigation arose. Besides studying various aspects of the short supply chains, it was also proposed to study the functional approach of horticulture as a strategy to add value. To provide consistency with the previous phase, the focus was also conducted from the perspective of the value chain, directing the query to consumers. Thus, again it was used the questionnaire as a methodological tool, and 221 consumers were asked about different aspects of the Short Suppy Chains (SSC) and Multifunctional Horticulture (MH)2, which allowed a quantitative analysis of several variables. To complete the comprehensive view of the short chain, 6 significant projects were selected as examples of different types of short supply chains in Aranjuez and Madrid, representing "SSC Promoters" and also the “Asociación de Productores de la Huerta de Aranjuez”, formally constituted in 2014, was asked representing the productive sector. The Study Case and again the questionnaire were elected as methodological tools in a qualitative analysis. The questionnaires of this second phase of research contained short supply chain issues, as a general topic (short supply chain concept, strengths and advantages they bring difficulties for its development, key factors success) and also refered to the case of Aranjuez (consumer profile, factors involved in the purchase of vegetables, use of several types of short supply chains, relation with information and communication technologies (ICTs) and organic production or the importance of trust in short supply chains). It also contemplated aspects of multifunctional horticulture, such as the valuation of different activities (agro-tourism, educational, social or therapeutic horticulture) and consumer perception about horticultural activities as a source of welfare and satisfactor of human needs. To complete the vision of these two issues, SSC and MH, experts in the field of short supply chains and professionals working in the field of social and therapeutic horticulture were asked. The qualitative information provided, complements the study offering a new perspective in the value chain analysis, such as those relating to job performance, the difficulties encountered or training existing in our country in the field of social and therapeutic horticulture. The results of this second phase of research showed that: Short supply chains involve much more than simply reducing intermediaries and cover a wide range of types. The cases studied are mostly focused on ecological product and its operation is heavily based on the use of ICTs and the trust factor. In connection with the purchase of vegetables in the field of short supply chains, product quality, speed and freshness with which comes from the field to the table and products picked at its peak maturation, are aspects highly valued by the consumer. Activities in the field of multifunctional horticulture are positively valued by consumers, the most scored: the educational garden, therapeutic garden, followed by guided tours and tastings of vegetables from Aranjuez in restaurants. Horticultural activities were highly valuated as a source of welfare and satisfaction of human needs, especially those of healthy eating and connection with nature. To complete this summary, the main conclusions of the research are presented as follows: 1. The value chain approach has been adequate to meet the complexity and operation of the horticultural sector in Aranjuez from a holistic perspective. 2. La Huerta de Aranjuez has important strengths, underpinned by the quality of its soils and fame that keep their products, but also weaknesses. This implies low volume of production, which makes difficult the link with wholesalers and large retailers. 3. The shortening of the chain by short supply chains has been identified as a way of creating value in the chain. Opportunities exist to supply consumers from Madrid by short supply chains, however, methods that require greater organization or requirements of organic production are not yet developed. 4. Organic production could be a strategy to create value but is not generally being implemented in the production chain. 5. The peculiarity of the Huerta de Aranjuez favours the implementation of the multifunctional approach as a means of economic development. The results point to a possible demand for multifunctional horticulture that include educational, therapeutic and agro-tourism activities. There is a positive perception of the potential of horticultural activities as a source of welfare and satisfaction of basic human needs. 6. The implementation of business projects in the field of social horticulture are an interesting way to create value that has been highly valued in the short supply chain. 7. The field of Multifunctional Horticulture which includes educational, social and therapeutic aspects, forms a discipline with possibilities of development, which in research are seen as limited by the lack of professionals and access to adequate training in our country. The study of Short Supply Chains and Multifunctional Horticulture as strategies to create value in the case of the Huerta de Aranjuez has an exploratory character and largely qualitative in this research. Both concepts have revealed some complexity and require greater knowledge in various aspects for successful implementation. It opens therefore a field for future research to deepen in these areas.

Previous Holocaust Experiences Continue to Affect Food Attitudes in Survivors

A qualitative study was conducted to determine if Holocaust survivors’ food attitudes are influenced by their earlier experiences. The 25 survivor interviewees (14 males, 11 females) ranged in age from 71 to 85 years and resided in Miami-Dade and Broward, Florida counties. Most (56%) were interned in concentration camps during the Holocaust. Interviews were tape-recorded and later transcribed. Results showed earlier experiences influenced food attitudes. The most common themes were: 1) Difficulty throwing food away - even when spoiled; 2) Storing excess food; 3) Craving a certain food; 4) Difficulty standing in line for food; and 5) Anxiety when food is not readily available. Sub-themes included healthy eating and empathy for those currently suffering from hunger. Fourteen (56%) fast for religious holidays, but 7 (28%) said they already had “fasted enough.” Dietitians and others are encouraged to evaluate food service programs to minimize uncomfortable food-related situations for Holocaust survivors.

Estratégias de promoção da saúde a partir da escola e da Unidade Básica de Saúde da Família, em Uberlândia (MG)

Health promotion is opposed directly to the biomedical model and established by intersectoral action, with collective and interdisciplinary approaches, considering the subject in their life contexts. Build healthy territories is to promote health, which necessarily includes intersectoral coordination and community mobilization. The health and education sectors can work together to promote health, developing so articulate actions and practices involving the subject in its territory of life and work. This study aimed to design and experience of health promotion strategies in school and Basic Health Units Family in Uberlândia - MG, from intersectoral relationship and community mobilization. The methodological research route was action research, or research intervention, because while researching already applied the ideas to solve problems through collective action. The research began in the Municipal School of Basic Education Prof. Eurico Silva, with the Health Centre's deployment to carry out surveillance and health promotion with active participation of students, involving all subjects of the school, students, teachers and other staff in the context of everyday life, which extrapolates the school walls, reaching the family and social groups in the community to which they belong. The health observatory has the objective existence with the establishment of the working groups, which at first were "healthy eating" and "drug-free world" and later, "dengue". The themes were chosen by the participants of the Health Centre, in which each is involved preferably. The second part of the research started with the approach between the Centre for Health and the health units (UBS and BFHU). The proposal was that the schools and the health nurse unit together should undertake prevention and health promotion, combating Aedes aegypti with intersectoral coordination and community mobilization. For it was crucial the involvement of ACS, ACE, ASE and the nurse coordinator of the Health Unit in creating community networks in the territory. home visits, community mobilization and intersectoral coordination: a training course in all BFHU and UBS teams with the following subjects was conducted. At this stage, were the Health Units that should approach the schools, in order to provide community networks to fight Aedes aegypti in each territory. The results and the scope of this experiment could only be brought to fruition because the Board of Health Surveillance and Care Coordination council of Basic embraced the proposal and helped in its implementation. It remains to continue consolidating this process of work in health units of primary care and the elementary schools, replicate the Health Centre's experience at school. The conclusion of this work is that schools and care facilities to health together with intersectoral coordination and community mobilization supported by community networks, can carry out prevention and health promotion, from a health model that considers the social determinants of health and overcoming hygienist model / sanitarian.