Riscos à saúde dos trabalhadores em unidade de alimentação e nutrição de um Hospital Universitário

The Food and Nutrition Units (FNU) are designed to produce food for healthy and/or sick communities and need to be done in a way to ensure the quality of foodstuffs that were produced. In these units, in the working environment, in general, there is excessive noise, heat and physical condition with many adaptations, presence of obstacles, inadequate flows, as well as the ways of the working organization may represent risks for workers health and lead to errors during production and/or distribution of food. The main goal of this study was to analyse the working processes in the Food Production Unit of the university’s hospital and identify the workers' health risk factors, using for this the knowledge of ergonomics, specifically the method of Ergonomic Work Analysis (EWA). After this analysis it was possible to develop proposals that will bring improvements to the working conditions, minimizing health risk factors during the process of meals production. It’s crucial to reassert this method considers the work activity performed in real time and highlights the importance of listening and the engagement of the workers in the changing process. It is a descriptive research with a qualitative approach. In the field research were collected demographics data, employment characteristics of the individuals (age, education, stocking sector, the total length of service and length of service in the industry) and data related to their usual work (task analysis, activity analysis and Analysis of the working environment) in the FNU. The instruments that were used in this study were document analysis, global and systematic observations and semi structured interviews in order to identify the main complaints related to those activities developed by them. The study was based on data for the analysis of Bardin, 2011, so the documents have been selected and including those that treat issues related to risks to workers' health were selected. The result of semi-structured interviews, global and systematic observations took place a confrontation of this material to the theoretical framework, held the inference and the interpretation of results the light of the knowledge of ergonomics and legislation. Issues related to the risks and the perception of workers has crafted a table showing the frequency of responses to the physical, chemical and biological and even the risk of accidents and was made a descriptive analysis. The results of this analysis indicated that the unit in question presents several problems ambience of jobs, both in terms of physical structure, but also in the organization of work. Non-conformities that leads to a favourable environment to the development of disease and injury hazards and compromising the quality of food produced. It is necessary to comply with legislation and that short, medium and long-term measures are taken to ensure the physical integrity of workers and improve the working environment.

Avaliação da efetividade do Programa de Alimentação do Trabalhador

This study analyzed the Worker’s Healthy Eating Program in Rio Grande do Norte state (RN) to assess its possible impact on the nutritional status of the workers benefitted. To that end, we conducted a cross-sectional observational prospective study based on a multistage stratified random sample comparing 26 small and medium-sized companies from the Manufacturing Sector (textiles, food and beverages, and nonmetallic minerals) of RN, divided into two equal groups (WFP and Non WFP). Interviews were conducted at each company by trained interviewers from Tuesday to Saturday between September and December 2014. Data were collected on the company (characterization and information regarding the program’s desired results) and workers (personal and professional information, anthropometrics, health, lifestyle and food consumed the previous day). Population estimates were calculated for RN on the characteristics of workers and the study variables. The main variable was BMI. The secondary variables were waist circumference (WC), nutritional diagnosis, calorie intake, blood pressure, metabolic variables and lifestyle indicators. The statistical method used was hierarchical mixed effects linear regression for interval variables and hierarchical mixed effects logistic regression for binary variables. The variables measured in ordinal scales were analyzed by ordinal logistic regression adjusted for correlated variables, adopting robust standard errors. The results for interval variables are presented as point estimates and their 95% confidence intervals; and as odds-ratios and their 95% confidence intervals for binary variables. The Fisher’s exact and Student’s t-tests were used for simple comparisons between proportions and means, respectively. Differences were considered statistically significant at p<0.05. A total of 1069 workers were interviewed, of which 541 were from the WFP group and 528 from the Non WFP group. Subjects were predominantly males and average age was 34.5 years. Significant intergroup differences were observed for schooling level, income above 1 MW (minimum wage) and specific training for their position at the company. The results indicated a significant difference between the BMI of workers benefitted, which was on average 0.989 kg/m2 higher than the BMI of workers from the Non WFP group (p=0.002); and between the WC, with the waist circumference of WFP group workers an average of 1.528 cm larger (p<0.05). Higher prevalence of overweight and obesity (p<0.001) and cardiovascular risk (p=0.038) were recorded in the WFP group. Tests on the possible effect of the WFP on health (blood pressure and metabolic indicators) and lifestyle indicators (smoking, alcohol consumption and exercise) were not significant. With respect to worker’s diets, differences were significant for consumption of saturated fat (lunch and daily intake), salt (lunch, other meals and daily intake) and proteins (other meals and daily intake), with higher consumption of these nutrients in the WFP group. The study showed a possible positive impact of the WFP on nutritional status (BMI and WC) among the workers benefitted. No possible effects of the program were observed for the lifestyle indicators studied. Workers benefitted consumed less salt, saturated fat and protein. The relevance of the WFP is recognized for this portion of society and it is understood that, if the program can reach and impact those involved, the development of educational initiatives aimed at nutritional and food safety may also exert a positive influence.

Ética da alimentação: porque devemos, segundo Kant, escolher uma alimentação adequada e saudável

This thesis proposes the adoption of a practical and philosophic approach to the discussion about what should be a healthy food, in view of the actual problems concerning this subject (from famine to obesity), which affect food and nutritional security and constitute target of many official policies. In order to handle this task, this work resorts to ethic, pedagogical and anthropological concepts inherent to Immanuel Kant’s philosophy, as valuable contributions to the practice of the professional nutritionist committed to the support and accomplishment of the human right to adequate nutrition (DHAA). Under this assumption, it intends to surpass the prevailing idea inside the social programs and policies favoring the utilitarian argument. It considers rather that a healthy food is also a duty of virtue, according to the Kantian duties to one-self. The liberation of transgenic seeds in Brazil comes up as an example of the violation of the right to food security and affects it negatively, resulting from the conflict between politics and moral faced by the Brazilian government. This paper concludes that DHAA realization requires not only a committed state, but also committed citizens and suggests that Kant’s philosophy should offer important contributions to supporting the practice of the professional nutritionist, awarding him the necessary information about this matter.

Ética da alimentação: porque devemos, segundo Kant, escolher uma alimentação adequada e saudável

This thesis proposes the adoption of a practical and philosophic approach to the discussion about what should be a healthy food, in view of the actual problems concerning this subject (from famine to obesity), which affect food and nutritional security and constitute target of many official policies. In order to handle this task, this work resorts to ethic, pedagogical and anthropological concepts inherent to Immanuel Kant’s philosophy, as valuable contributions to the practice of the professional nutritionist committed to the support and accomplishment of the human right to adequate nutrition (DHAA). Under this assumption, it intends to surpass the prevailing idea inside the social programs and policies favoring the utilitarian argument. It considers rather that a healthy food is also a duty of virtue, according to the Kantian duties to one-self. The liberation of transgenic seeds in Brazil comes up as an example of the violation of the right to food security and affects it negatively, resulting from the conflict between politics and moral faced by the Brazilian government. This paper concludes that DHAA realization requires not only a committed state, but also committed citizens and suggests that Kant’s philosophy should offer important contributions to supporting the practice of the professional nutritionist, awarding him the necessary information about this matter.

Escola de verão: Exercício/Alimentação e Saúde para crianças dos 6 aos 12 anos de idade.

Introdução: A obesidade infantil é, atualmente, a doença nutricional pediátrica mais prevalente a nível mundial. Vários factores podem contribuir para o aparecimento desta patologia, contudo, são os de natureza ambiental, nomeadamente, o comportamento alimentar e o exercício físico, os que exercem maior influência na magnitude da expressão clínica da doença. Neste quadro, teve lugar em Coimbra, durante a última quinzena de Junho de 2014 a "Escola de Verão: Exercício, Alimentação e Saúde", a qual envolveu uma equipa multidisciplinar constituída por nutricionistas, enfermeiros, médicos e profissionais de educação física. Este campo de férias teve como objetivos: incutir estilos de vida saudáveis, baseados numa alimentação equilibrada e na prática regular de exercício físico, por forma a prevenir e/ou tratar a obesidade infantil; diminuir o sedentarismo inerente à época de férias; e, envolver os pais/familiares por forma a conseguir mudar comportamentos de forma efetiva. Metodologia: Participaram na Escola de Verão 36 crianças, as quais foram envolvidas em diversas atividades focadas na promoção de um estilo de vida saudável (alimentação equilibrada, exercício físico e promoção da saúde). Foram realizadas avaliações antropométricas (peso e estatura) e da composição corporal, usando um estadiómetro e uma balança de bioimpedância. Determinou-se o índice de Massa Corporal (IMC), utilizando as curvas de crescimento da OMS para classificar o estado nutricional. A pressão arterial foi avaliada segundo as recomendações da Sociedade Europeia de Hipertensão (ESH) de 2009. Resultados: As 36 crianças tinham uma média de idade de 8 anos (Desvio-Padrão (DP) =1 ano), 52,8% eram do sexo feminino e 47,2% do sexo masculino. No início do campo de férias, 45,7% (n=16) tinham excesso de peso, sendo que destas 34,3% (n=12) eram obesas. No que se refere ao IMC no final houve uma diminuição com significado estatístico (p<0,041) relativamente ao IMC Inicial. Não se verificaram alterações com significado estatístico no que se refere à massa gorda. Conclusões: Ao longo desta quinzena educativa, as crianças, no quadro das respetivas famílias, melhoraram os seus hábitos alimentares e tomaram consciência da relevância da atividade física na prevenção da obesidade e promoção da saúde. Programas deste tipo podem resultar numa abordagem eficaz na prevenção e tratamento da obesidade infantil.

Alterações e problemas relacionados com a alimentação e estratégias adaptativas utilizadas em crianças e adolescentes com doença oncológica nos primeiros seis meses de quimioterapia

Enquadramento: A investigação em enfermagem é escassa no que se refere a alterações relacionadas com a alimentação em doentes oncológicos pediátricos, durante os tratamentos, e às estratégias adaptativas utilizadas, sendo pertinente a realização de estudos nesta área. Objetivos: Com a presente investigação pretendeu-se identificar as alterações sentidas e problemas alimentares mais frequentes em crianças e adolescentes a realizarem quimioterapia; identificar as estratégias adaptativas utilizadas, assim como, identificar relações entre estas variáveis e as características sociodemográficas e clínicas. Metodologia: Realizou-se uma investigação quantitativa, descritivo-analítica, com uma amostra de 30 crianças/adolescentes, nos primeiros seis meses de tratamento de quimioterapia. Os dados foram colhidos através de entrevista coletiva e autorrelato respondendo a um questionário de variáveis sociodemográficas e clínicas; a um Inventário de alterações e problemas relacionados com a alimentação e a um Inventário de estratégias de adaptação relacionadas com a alimentação (adaptado de Rehwaldt et al., 2009). Os dados foram processados e analisados informaticamente com recurso ao Statistical Package for the Social Science (SPSS), na versão 22.0 para Windows. Resultados: Apesar de a maioria dos entrevistados manter o seu padrão alimentar, registou-se em várias crianças/adolescentes alterações no que se refere a alimentos (carne, alimentos fritos, lacticínios e peixe) e a bebidas (bebidas com gás). Tal poderá dever-se às alterações alimentares mais sentidas (perda significativa de paladar ou olfato mais apurado), ou aos problemas alimentares referidos mais frequentemente (náuseas, vómitos ou dificuldade em engolir). As estratégias consideradas mais eficazes pelas crianças/adolescentes foram: comer alimentos mais proteicos, beber mais água às refeições para ajudar a diminuir o mau sabor, escovar os dentes antes e/ou depois de comer. As estratégias referidas como menos eficazes foram: usar menos sal e diminuir a quantidade de temperos e especiarias. Foram encontradas diversas relações estatisticamente significativas entre as variáveis estudadas. Conclusão: É fundamental que o enfermeiro, como elemento da equipa multidisciplinar, centre os seus esforços na identificação de possíveis alterações e problemas alimentares nas crianças e adolescentes sujeitos a quimioterapia, de modo a personalizar os ensinos acerca da alimentação e a propor estratégias que se adequem a cada situação.

Impact of parenteral nutrition standardization on costs and quality in adult patients

Background: Parenteral nutrition (PN) is a costly therapy that can also be associated with serious complications. Therefore, efforts are focusing on reducing rate of complications, and costs related to PN. Objective: The aim was to analyze the effect of the implementation of PN standardization on costs and quality criteria. Secondary aim was to assess the use of individualized PN based on patient's clinical condition. Methods: We compare the use of PN before and after the implementation of PN standardization. Demographic, clinical and PN characteristics were collected. Costs analysis was performed to study the costs associated to the two different periods. Quality criteria included were: 1) PN administration; 2) nutrition assessment (energy intake between 20-35 kcal/kg/day; protein contribution according to nitrogen balance); 3) safety and complications (hyperglycemia, hypertriglyceridemia, hepatic complications, catheter-related infection); 4) global efficacy (as serum albumin increase). Chi-square test was used to compare percentages; logistic regression analysis was performed to evaluate the use of customized PN. Results: 296 patients were included with a total of 3,167 PN compounded. During the first period standardized PN use was 47.5% vs 85.7% within the second period (p < 0.05). No differences were found in the quality criteria tested. Use of individualized PN was related to critical care patients, hypertriglyceridemia, renal damage, and long-term PN. Mean costs of the PN decreased a 19.5%. Annual costs savings would be € 86,700. Conclusions: The use of customized or standard PN has shown to be efficient and flexible to specific demands; however customized PN was significantly more expensive.

Outcomes of a general hospital-based Home Parenteral Nutrition (HPN) program: report of our experience from a 26-year period

Background: Home parenteral nutrition (HPN) was introduced in Spain in the late 1980s. Our hospital was a pioneering medical centre in this field. Aim: Analyze outcomes of our HPN program. Methods: Retrospective study of patients receiving HPN between 1986-2012. Study variables are expressed as frequency, mean ± SD (range), median [interquartile range]. Parametrics, non-parametrics test and survival analysis (p < 0.05) were applied. Results: 91 patients (55 females and 36 males, mean age: 50.6 ± 5 yrs.) who received HPN for an accrual period of 55,470 days (median: 211 days [range: 63-573]) were included. The most prevalent underlying condition was cancer (49.5%), with the commonest HPN indication being short bowel syndrome (41.1%). The most frequently used catheter type was the tunneled catheter (70.7%). The complication rate was 3.58/1,000 HPN days (2.68, infection; 0.07, occlusion; 0.07 thrombosis; and 0.59, metabolic complications). Complications were consistently associated with both the underlying condition and HPN length. Infections were most frequent within the first 1,000 days of HPN. Liver disease incidence was related to HPN duration. HPN could be discontinued in 42.3% of patients. Ten-year survival rate was 42%, and varied across the underlying conditions. Conclusions: In the present series, the commonest reason for HPN was cancer. Our complication rate is in keeping with that reported in the literature. The overall survival rate was 42%, and varied across the underlying conditions.

Controle social e políticas públicas: contribuições para aprimorar o controle social do programa nacional de alimentação escolar

The National School Feeding Programme (PNAE) is a public policy in Brazil for over 60 years and represents one of the most important programs of feeding and nutrition in the world. The role of family farming as a source of employment in rural areas, food provider and for ensuring much of the Brazil’s food security is constantly present at the government's and social movement’s agendas. Law 11.947 of 2009 marked its integration in the food supply for the National School Feeding Programme. Article 14 of aforementioned law highlights that a minimum of 30% (thirty percent) of the funds transferred by the National Development Fund Education (FNDE) to the Programme must be used for the purchase of food directly from family farmers or their organizations. The national school feeding policy under the responsibility of the FNDE and is subjected to agencies of internal control, such as the General Controllership of the Union (CGU), of external control, such as the Audit Courts of the Union and the of the states, and to the social control of the school feeding councils. Those funds are transferred to the implementing agencies, which are the education offices of the states, municipalities and of the Federal District. These entities must annually present their accountings to the School Feeding Councils, which analyze them and then issue a conclusive report to the FNDE, approving with or without reservations, or rejecting them. In this sense, this research aims to propose parameters that should contribute to the improvement of the social control over purchases from family farming for the National School Feeding Programme. The study was conducted by non parametric sampling alongside the managers of the implementing entities, school feeding councils and Family Farming Organizations all across Brazil, from the databases provided by FNDE and by the National Union of Cooperatives of Family Agriculture and Solidarity Economy (Unicafes). The study points out that the legal framework of PNAE seeks to ensure the participation of family farming in the food supply for the Programme, despite allowing the executing agencies to justify the non-compliance of the minimum required in a number of ways. The survey also signalizes that the school feeding councils follow the implementation of the Programme very shyly, and points out that there is room to expand and enhance the participation of these councils and organizations of family farming in the execution of PNAE. Its effectiveness requires a constant and effective process of training of the agents involved in the Programme.

A alimentação ao longo dos tempos

"Ciência e cultura mas que mistura” tem como principal objetivo dar a conhecer a TCA, promover a sua utilização como uma ferramenta acessível e desta forma contribuir para melhorar os hábitos alimentares dos cidadãos. A TCA é um documento de referência nacional para a composição dos alimentos consumidos em Portugal, que reúne informação sobre o teor de 42 componentes/nutrientes (Energia, Macroconstituintes, Ácidos Gordos, Colesterol, Vitaminas e Minerais). A versão atual da TCA inclui 1094 alimentos (crus, cozinhados e processados). É uma iniciativa do Instituto Ricardo Jorge, através do seu Departamento de Alimentação e Nutrição, em colaboração com a Associação dos Armadores de Pesca Local e Artesanal do Centro Sul e a Docapesca. Nesta primeira edição da iniciativa será apresentado o grupo do pescado, alimento-chave no padrão de alimentação mediterrânico.

Efeito da utilização do morango silvestre como aditivo aromático na alimentação de porcas em lactação e recria de leitões

O estudo foi conduzido em dois ensaios distintos, testando-se o efeito da utilização do morango silvestre, como aditivo aromático, no alimento composto comercial de porcas em lactação, e de leitões em recria. Utilizou-se um total de 47 porcas reprodutoras híbridas comerciais, de linha genética PIC© (Large White x Landrace) e 561 leitões, desmamados aos 28 dias de vida, seguindo-se uma recria de 14 dias. Utilizaram-se dois alimentos compostos comerciais distintos, a dieta controlo e a dieta experimental, preparada com base no alimento controlo, aditado com aroma de morango silvestre. Os leitões em recria receberam um alimento composto medicamentoso, com o mesmo aroma do alimento composto aromático experimental das porcas reprodutoras. Procedeu-se à pesagem dos leitões, por parque, ao desmame e no final da recria. Controlou-se o alimento distribuído e rejeitado, o que permitiu a determinação do alimento ingerido, por parque. Determinou-se o ganho médio diário e o índice de conversão alimentar, na fase de recria. Os resultados obtidos sugerem interesse na utilização deste aroma, permitindo melhores resultados no desempenho produtivo dos leitões, em aleitamento (+ 0,14 a 0,19 kg PV ao desmame) e em fase de recria (+ 17 a 32 g de GMD e - 0,09 a 0,04 de IC).

Laboratório Microbiologia do Departamento de Alimentação e Nutrição do Instituto Nacional de Saúde: funções essenciais

Actividades do Departamento de Alimentação e Nutrição no âmbito da vigilância e segurança alimentar. Acreditação de ensaios segundo a NP/EN ISO 17025. Requisitos da Norma ISO 7218, Amd 1:2013. Colheita de amostras de alimentos prontos a comer, para avaliação do nível de qualidade microbiológica. Colheita de amostras de superfícies higienizadas para avaliação do estado higiénico. Valores Guia, INSA. Actividades de controlo analítico no âmbito da investigação de surtos de toxinfecção alimentar.

Efeito da utilização do morango silvestre como aditivo aromático na alimentação de porcas em lactação e recria de leitões

O estudo foi conduzido em dois ensaios distintos, testando-se o efeito da utilização do morango silvestre, como aditivo aromático, no alimento composto comercial de porcas em lactação, e de leitões em recria. Utilizou-se um total de 47 porcas reprodutoras híbridas comerciais, de linha genética PIC© (Large White x Landrace) e 561 leitões, desmamados aos 28 dias de vida, seguindo-se uma recria de 14 dias. Utilizaram-se dois alimentos compostos comerciais distintos, a dieta controlo e a dieta experimental, preparada com base no alimento controlo, aditado com aroma de morango silvestre. Os leitões em recria receberam um alimento composto medicamentoso, com o mesmo aroma do alimento composto aromático experimental das porcas reprodutoras. Procedeu-se à pesagem dos leitões, por parque, ao desmame e no final da recria. Controlou-se o alimento distribuído e rejeitado, o que permitiu a determinação do alimento ingerido, por parque. Determinou-se o ganho médio diário e o índice de conversão alimentar, na fase de recria. Os resultados obtidos sugerem interesse na utilização deste aroma, permitindo melhores resultados no desempenho produtivo dos leitões, em aleitamento (+ 0,14 a 0,19 kg PV ao desmame) e em fase de recria (+ 17 a 32 g de GMD e - 0,09 a 0,04 de IC).