Effects of In-Kind transfers on female labor supply: evidence from the food supply program comedores comunitarios

En la literatura se argumenta que las transferencias en especie podrían tener efectos positivos sobre la oferta laboral. En este trabajo utilizamos el programa de nutrición de la ciudad de Bogotá, Comedores Comunitarios, para esclarecer dicho punto. El programa otorga un almuerzo diario a las personas pobres que son vecinas de los comedores. Utilizando la técnica de emparejamiento con la Encuesta de Calidad de Vida 2007, una encuesta de corte transversal, se encuentra tanto efectos significativos positivos como negativos en la oferta laboral femenina para diferentes grupos de mujeres (con diferencias en edad, composición del hogar y acceso a redes sociales). Estos resultados son relevantes para entender los incentivos al trabajo heterogéneos generados cuando se aplica esta clase de programas.

Infant feeding choices: experience, self-identity and lifestyle

In England 78% of mothers initiate breastfeeding and in the UK less than 1% exclusively breastfeed until 6 months, despite WHO recommendations to do so. This study investigated women’s infant feeding choices using in-depth interviews with 12 mothers of infants aged 7-18 weeks. Using content analysis, four themes emerged: (1) Information, Knowledge and Decision Making, (2) Physical Capability, (3) Family and Social Influences, (4) Lifestyle, Independence and Self-Identity. Whilst women were aware of the ‘Breast is Best’ message, some expressed distrust in this information if they had not been breastfed themselves. Women felt their own infant feeding choice was influenced by the perceived norm amongst family and friends. Women described how breastfeeding hindered their ability to retain their self-identities beyond motherhood as it limited their independence. Several second-time mothers felt they lacked support from health professionals when breastfeeding their second baby, even if they had previously encountered breastfeeding difficulties. The study indicates that experience of breastfeeding, and belief in the health benefits associated with it are important factors for initiation of breastfeeding, whilst decreased independence and self-identity may influence duration of breastfeeding. Intervention and support schemes should tackle all mothers, not just first-time mothers.

A multilevel model for the study of breastfeeding determinants in Brazil

The benefits of breastfeeding for the children`s health have been highlighted in many studies. The innovative aspect of the present study lies in its use of a multilevel model, a technique that has rarely been applied to studies on breastfeeding. The data reported were collected from a larger study, the Family Budget Survey-Pesquisa de Orcamentos Familiares, carried out between 2002 and 2003 in Brazil that involved a sample of 48 470 households. A representative national sample of 1477 infants aged 0-6 months was used. The statistical analysis was performed using a multilevel model, with two levels grouped by region. In Brazil, breastfeeding prevalence was 58%. The factors that bore a negative influence on breastfeeding were over four residents living in the same household [odds ratio (OR) = 0.68, 90% confidence interval (CI) = 0.51-0.89] and mothers aged 30 years or more (OR = 0.68, 90% CI = 0.53-0.89). The factors that positively influenced breastfeeding were the following: higher socio-economic levels (OR = 1.37, 90% CI = 1.01-1.88), families with over two infants under 5 years (OR = 1.25, 90% CI = 1.00-1.58) and being a resident in rural areas (OR = 1.25, 90% CI = 1.00-1.58). Although majority of the mothers was aware of the value of maternal milk and breastfed their babies, the prevalence of breastfeeding remains lower than the rate advised by the World Health Organization, and the number of residents living in the same household along with mothers aged 30 years or older were both factors associated with early cessation of infant breastfeeding before 6 months.

Nutritional information of meals supplied by companies, participating in the workers` meal program in Sao Paulo, Brazil

Objective. To compare the nutritional value of meals provided by companies participating in the Workers` Meal Program in the city of Sao Paulo, Brazil, to the nutritional recommendations and guidelines established by the Ministry of Health for the Brazilian population. Methods. The 72 companies studied were grouped according to economic sector (industrial, services, or commerce), size (micro, small, medium, or large), meal preparation modality (prepared on-site by the company itself, on-site by a hired caterer, or off-site by a hired caterer), and supervision by a dietitian (yes or no). The per capita amount of food was determined based on the lunch, dinner, and supper menus for three days. The nutritional value of the meals was defined by the amount of calories, carbohydrates, protein, total fat, polyunsaturated fat, saturated fat, trans fat, sugars, cholesterol, and fruits and vegetables. Results. Most of the menus were deficient in the number of fruits and vegetables (63.9%) and amount of polyunsaturated fat (83.3%), but high in total fat (47.2%) and cholesterol (62.5%). Group 2, composed of mostly medium and large companies, supervised by a dietician, belonging to the industrial and/or service sectors, and using a hired caterer, on averaged served meals with higher calorie content (P < 0.001), higher percentage of polyunsaturated fat (P < 0.001), more cholesterol (P = 0.015), and more fruits and vegetables (P < 0.001) than Group 1, which was composed of micro and small companies from the commercial sector, that prepare the meals themselves on-site, and are not supervised by a dietitian. Regarding the nutrition guidelines set for the Brazilian population, Group 2 meals were better in terms of fruit and vegetable servings (P < 0.001). Group I meals were better in terms of cholesterol content (P = 0.05). Conclusions. More specific action is required targeting company officers and managers in charge of food and nutrition services, especially in companies without dietitian supervision.

Trends and patterns of exclusive breastfeeding for under-6-month-old children

Objective: To study the trends and patterns of exclusive breastfeeding (EBF) for under-6-month-old infants in the city of Bauru, southeastern Brazil.Methods: We compared data from three cross-sectional surveys, using similar methodologies, which were part of a project for monitoring breastfeeding indicators in the state of São Paulo, Brazil. The sample included infants aged 0 to 6 months who attended one of the two rounds of the nationwide infant vaccination campaign in 1999, 2003 and 2006 (respectively: 496, 674 and 509 infants). Descriptive statistics were used to compare the prevalence of EBF according to age (in months) and group of children under 6 months of age. Differences in prevalence were expressed as percentage-points and submitted to statistical analysis (Pearson's chi-square and tendency), and the level of significance was set at p < 0.05. Factors associated with EBF interruption in 2006 were evaluated by univariate and multivariate analyses.Results: An increase in the prevalence of EBF was observed in under-6-month-old infants: 1999-2003, increase of 9.1 percentage-points; 2003-2006, increase of 6.6 percentage-points, resulting in an annual increase rate of 2.3 percentage-points for the first period and 2.2 percentage-points for the second period. Significant inverse association was observed between EBF and the use of pacifiers (prevalence ratio = 2.03; 95% confidence interval 1.44-2.84).Conclusion: EBF prevalence in under-6-month-old infants in the city of Bauru, southeastern Brazil, increased almost threefold over the period studied, from 8.5% in 1999 to 24.2% in 2006, a total increase of 184.7%. The use of pacifiers was the only factor strongly associated with the interruption of EBF.

Perfil dos beneficiários do Programa de Suplementação Alimentar de uma unidade básica de saúde de Botucatu, São Paulo

OBJETIVO: Este estudo objetivou apreender algumas características sócio-sanitárias do grupo de beneficiários do Programa de Suplementação Alimentar de unidade básica de saúde de um município de médio porte do interior paulista. Especificamente, buscou-se delinear o perfil deste grupo quanto aos fatores de risco para a desnutrição infantil a que estava exposto e dimensionar a utilização dos critérios de inclusão neste programa. MÉTODOS: A pesquisa é de cunho descritivo e se baseou em documentos oficiais vigentes para a definição dos fatores de risco a serem analisados. Foram avaliadas 290 crianças cujas mães ou responsáveis foram entrevistados, segundo um protocolo previamente estabelecido. RESULTADOS: O grupo de beneficiários caracterizou-se por ser heterogêneo quanto à freqüência e ao grau da exposição a fatores de risco para a desnutrição, denotando que há diferenças nos problemas socioeconômicos e sanitários apresentados, como também na combinação entre eles, em cada família. CONCLUSÃO: Para a otimização do programa, ainda vigente no município, sugere-se a padronização loco-regional de critérios de inclusão, conforme a proposta oficial central, com o registro claro dos mesmos e, também, a aplicação de métodos avaliativos periódicos, adequada capacitação da equipe de saúde e maior envolvimento da população usuária.

Hypoacousis prevalence in Kaiowá and Guarani indigenous children

OBJETIVOS: identificar a prevalência de hipoacusia em crianças indígenas Kaiowá e Guarani. MÉTODOS: estudo transversal, com uma amostra de 126 crianças indígenas de zero a 59 meses da Terra Indígena de Caarapó, em Mato Grosso do Sul, Brasil. As crianças foram submetidas ao exame das emissões otoacústicas evocadas transitórias, que serviu como triagem auditiva. O reteste foi realizado nas crianças que apresentaram resultado alterado na triagem auditiva. Os casos que, no reteste, permaneceram alterados foram encaminhados para o exame da imitanciometria. RESULTADOS: na triagem auditiva, foram identificadas 25 (23,6%) crianças com resultado alterado; dessas, 17 apresentaram resultado normal no reteste e 6 permaneceram com resultado alterado, sendo encaminhadas para imitanciometria. A prevalência de hipoacusia identificada ao final do estudo foi de 5,6%, sendo 3 (2,8%) do tipo condutiva e 3 (2,8%) do tipo neurossensorial. Estas últimas foram encaminhadas à avaliação otorrinolaringológica complementar para confirmação diagnóstica. As alterações auditivas identificadas neste estudo não apresentaram diferenças significantes quanto ao sexo e grupo etário. CONCLUSÕES: a prevalência de alteração auditiva encontrada nesta população alerta para a necessidade de implantação de programas de saúde auditiva e sua articulação com outras ações desenvolvidas na atenção à saúde infantil dos Kaiowá e Guarani.

Perfil de usuários e percepção sobre a qualidade do atendimento nutricional em um programa de saúde para a terceira idade

Objetivou-se analisar o perfil dos usuários de um serviço de nutrição e a percepção dos mesmos sobre a qualidade do atendimento, em uma pesquisa quali-quantitativa, utilizando entrevistas semiestruturadas, conduzidas logo após o atendimento nutricional a 32 idosos de um programa para a terceira idade no município de Viçosa - MG. Predominou o sexo feminino, com idades entre 60 e 78 anos; a hipertensão arterial foi a doença de maior ocorrência; a maioria está satisfeita com o atendimento; 44,8% têm dificuldades para mudar a alimentação e 100% foram otimistas quanto ao resultado do acompanhamento nutricional; a maioria é portadora de doenças crônicas não-transmissíveis, possui autonomia, compreende o serviço como instrumento de auxílio na qualidade de vida e associa a satisfação com o atendimento a aspectos de cuidado e atenção. Estimular pesquisas com programas de nutrição na terceira idade se torna cada vez mais necessário, para que se busque qualidade nutricional e melhores estratégias de atendimento aos idosos.

Malnutrition in the second year of life and psychosocial care: a case-control study in an urban area of Southeast Brazil

O objetivo do estudo foi identificar e medir a presença de associação entre cuidado psicossocial e desnutrição. Realizou-se estudo caso-controle incluindo 101 crianças desnutridas (peso/idade < percentil 5 do padrão NCHS/OMS), com idades entre 12 e 23 meses, que foram comparadas a 200 controles eutróficos (peso/ idade > percentil 25) em termos de sua exposição a uma série de comportamentos maternos indicadores da qualidade de seu cuidado psicossocial. Criou-se um escore de cuidado psicossocial, variando de 0 a 14, de acordo com o número de comportamentos maternos desejáveis não observados: quanto maior o escore, pior a qualidade do cuidado psicossocial. Mediante análise de regressão logística verificou-se maior risco de desnutrição para as crianças no 2º e 3º tercis do escore de cuidado psicossocial. Esta associação foi modificada pela renda per capita. Após ajustes para possíveis confundidores, nas crianças dos estratos superiores de renda não houve associação entre cuidado psicossocial e desnutrição. Para as crianças com nível mais baixo de renda, pior cuidado psicossocial dobrou o risco de desnutrição (OR = 7,26; IC95%: 2,42-21,82) em relação àquele associado apenas à baixa renda (OR = 3,08; IC95%: 1,28-7,42).

Prevalência e fatores associados a comportamentos sugestivos de transtornos alimentares entre estudantes de medicina, enfermagem e nutrição

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Aplicação da técnica de grupo focal em pesquisa da Rede-SANS sobre as ações de alimentação e nutrição na atenção básica em saúde

Focus groups are seen as important tools in qualitative research for evaluating projects aimed at articulating social networks and movements. Six focus groups were held as one of the stages in research as part of the Food Safety and Sustainable Nutrition Project (SANS). This social network articulates the academic world with social movements and government in defense of the human right to suitable nutrition. This report is aimed at discussing the experience of applying focus groups to the investigation of perceptions by health professionals of activities related to food and nutrition in basic health care. These groups made it possible to bring together 52 professionals from 13 municipalities in the State of São Paulo, Brazil, and they exchanged experiences and debated issues related to food safety in the area of health care. The group discussions identified eating, nutrition vigilance and intersectoriality as emerging topics. The focus group technique proved to be a suitable tool for investigating the topic quickly and in depth, with a large number of professionals working in different contexts. In fact, the discussions went beyond the objectives of the research, since the group work made it possible to strengthen the process of articulation carried out by a network that promoting local measures in food safety and sustainable nutrition.

Medicinal plants in pregnancy and lactation: perception of the health risk and practical educational group in Araraquara, São Paulo State, Brazil

The use of medicinal plants among pregnant women and lactating is a common practice in diverse countries. However, many medicinal plants are contraindicated during pregnancy and lactating, due to various adverse effects, such as teratogenic, embryotoxic and abortive effects, exposing these women, their fetus and babies to health unknown risks. Thus, the purpose of this commentary, was to analyze the perception about the use of medicinal plants by pregnant women and lactating registered in the "baby on board" NGO, Araraquara, São Paulo state, Brazil, between 2010 at 2013. The group was constituted by 48 women, between the first and last trimester of pregnancy or whilst breastfeeding. Information was collected during group meetings by oral interview, using a questionnaire, as script. The nature of the study was a qualitative analysis. The results were based on reports about the use of medicinal plants by pregnant women during group meetings: use, indication of use, knowledge about risks. All participants received written and oral information about the study and they gave a written informed consent. The use of medicinal plants is a reality among pregnant and lactating women of the "baby on board" NGO. They reported that they feel that "natural" products are not harmful for their health. The primary information sources for the majority of women about medicinal plants during pregnancy are family, neighbors and herbalists. The plants most cited (in popular name in Brazil) were: senna, chamomile, boldo, lemon balm, lemon grass. They were used mainly for: nausea, heartburn, indigestion, flatulence, intestinal and abdominal pain, anxiety, intestinal constipation and low milk production. The pregnant and lactating women lacked knowledge about the health risks of the use of medicinal plants and herbal medicines in pregnancy and lactation. They also reported difficulties in clarifying some questions about the use of medicinal plants with their doctors. The results of the present study showed that educative actions about the rational use of medicinal plants in pregnancy and breastfeeding could be part of the operating protocols to promote the maternal and child health programs in Araraquara. Thus, our results also suggest the importance of creating institutionalized places, to the implementation of continued education programs about rational use of medicinal plants in pregnancy and lactation. These targeted programs are not only for health professionals, but also for community members, pregnant women and breastfeeding. Our results pointed out the importance of guidance of doctors and healthcare professionals on the scientific studies about medicinal plants and herbal medicines and the risk/benefit of using herbs during pregnancy. Finally, it is noted the importance of the health professionals to inform women of childbearing on risks to their health, as well as on possibilities of utilization of herbs during fertile period, giving special attention to the potential risk of self-medication.

Marco legal do Programa Nacional de Alimentação Escolar: uma releitura para alinhar propósitos e práticas na aquisição de alimentos

This essay aims to discuss the acquisition of food by the National School Feeding Program in light of its current legal framework with a view to promote healthy and culturally sound eating habits that help to improve the health of Brazilian school children and promote local development. The study presents an analysis of the current legislation of the National School Feeding Program, evidencing its intention to influence the Brazilian feeding system and the food pattern of its population using school meals, highlighting the gaps that challenge the achievement of major changes in the execution of the program. From this analysis and based on the high and growing consumption of ultra-processed foods in Brazil, and considering the disadvantages of these foods when compared with minimally-processed or fresh foods, a proposal is developed to guide the construction of a list of foods that is consistent with the current legal framework of the Program and its objectives. It is argued that the prevalence of minimally-processed or fresh foods in school meals can be a strategy to rescue the healthy-food heritage and strengthen local development if promoting family farming.

Prevalence of overweight preschool children in public day care centers: a cross-sectional study

CONTEXT AND OBJECTIVE: Brazil is undergoing a period of epidemiological transition associated with demographic and nutritional changes. The prevalence of obesity is also increasing in children and is causing numerous health problems that are becoming public health issues. The aim here was to evaluate the prevalence of overweight among children of two and three years of age. DESIGN AND SETTING: Cross-sectional study in municipal day care centers in Taubate, state of Sao Paulo, Brazil. METHODS: Weight and height measurements were made on 447 preschool children forming a probabilistic randomized sample. Their body mass index (BMI) was calculated. Their nutritional status was classified using the World Health Organization reference cutoff points (2006). Their mean weight, height and BMI were compared according to their age and sex. RESULTS: The mean values for the final sample (n = 447) were as follows: mean age: 38.6 months (+/- 3.5) and Z scores for: weight/height (W/H): 0.50 (+/- 1.22); height/age: -0.03 (+/- 1.07); weight/age (W/A): 0.51 (+/- 1.23); and BMI: 0.51(+/- 1.23). The prevalence of overweight children (BMI > 1 z) was 28.86%, while the prevalence of underweight children (BMI < -2 z) was 0.89%. There were no differences in mean BMI among the two and three-year age groups (P = 0.66). CONCLUSION: A high prevalence of overweight was observed in the sample of two and three-year-old children, with practically no malnutrition, thus showing that a significant nutritional transition may already be occurring, even in medium-sized cities of developing countries.

Preditores da realização de consultas odontológicas de rotina e por problema em pré-escolares

OBJETIVO: Estimar a prevalência do uso de serviços odontológicos por pré- escolares e fatores associados. MÉTODOS: Estudo transversal com 1.129 crianças de cinco anos de idade da Coorte de Nascimentos de Pelotas 2004, RS, de setembro de 2009 a janeiro de 2010. Registrou-se o uso de serviço odontológico pelo menos uma vez na vida e o motivo para a primeira consulta odontológica da criança. As categorias do desfecho foram: ter feito a primeira consulta por rotina, para resolver um problema ou nunca ter ido ao dentista. Os exames bucais e as entrevistas foram realizados nos domicílios. Aspectos socioeconômicos e variáveis independentes ligadas à mãe e à criança foram analisados por meio de regressão logística multinomial. RESULTADOS: A prevalência de uso por qualquer motivo foi 37,0%. Os principais preditores para consulta de rotina foram nível econômico mais elevado, mãe com maior escolaridade e ter recebido orientação sobre prevenção. Principais preditores para consulta por problema foram ter sentido dor nos últimos seis meses, mãe com maior escolaridade e ter recebido orientação sobre prevenção. Cerca de 45,0% das mães receberam orientação de como prevenir cárie, principalmente fornecida por dentistas. Filhos de mães com história de maior aderência a programas de saúde tiveram maior probabilidade de ter feito uma consulta odontológica de rotina. CONCLUSÕES: A taxa de utilização dos serviços odontológicos por pré- escolares foi inferior às de consultas médicas (puericultura). Além da renda e da escolaridade, comportamentos maternos têm papel importante no uso por rotina. Relato de dor nos últimos seis meses e número elevado de dentes afetados por cárie, independentemente dos demais fatores, estiveram associados ao uso para resolver problema. É necessária a integração de ações de saúde bucal nos programas materno-infantis.