Direito humano à alimentação adequada: percepções de participantes do Programa Bolsa Família / Human Right to Adequate Food: perceptions from Bolsa Família Program participants

Introdução: A Política Nacional de Segurança Alimentar e Nutricional teve no Programa Bolsa Família (PBF) uma de suas principais expressões para combater a miséria e a fome. Objetivo: Identificar percepções e conhecimentos de titulares do PBF acerca das dimensões de Direito Humano à Alimentação Adequada (DHAA) e de alimentação saudável. Métodos: Estudo qualitativo com amostra representativa de mulheres titulares do PBF da região dos Morros de Santos-SP (n=190). Entrevistas semiestruturadas foram registradas em áudio e transcritas literalmente, para análise temática de conteúdo. Núcleos temáticos e categorias foram produzidos em cada uma das dimensões de interesse. Resultados: As participantes, com média de idade de 33 anos e consideradas de baixa renda, demonstraram desconhecimento sobre DHAA. Poucos discursos destacaram o combate à fome e a busca por cidadania, mas desvelaram ceticismo em relação às garantias consolidadas. A rotina nos serviços de saúde para o acompanhamento das condicionalidades do PBF emergiu na dimensão de direitos. A definição de alimentação saudável pelas participantes enfatizou a importância dos alimentos in natura e minimamente processados, mas revelou os produtos ultraprocessados como alternativa diante das dificuldades financeiras para acessar alimentos saudáveis. Conclusões: Os achados explicitam a necessidade de viabilizar políticas públicas e ações para emancipação e fortalecimento das famílias titulares do PBF, na perspectiva cidadã de defesa da exigibilidade do DHAA.

Introduction: The National Policy for Food and Nutrition Security instituted the BolsaFamília Program (BFP) as one of its main measures to combat extreme poverty and hunger. Objective: To identify the perceptions and knowledge of BFPparticipantsregarding the dimensions of the Human Right to Adequate Food (HRAF) and healthy eating. Methods: This was a qualitative study with a representative sample of women who participate in the BFP in the Morros de Santos region-SP (n=190). Semistructured interviews were audio recorded and transcribed for thematic content analysis. Thematic centres and categories were produced for each dimension of interest. Results: The participants, with a mean age of 33 years and considered low income, showed a lack of knowledge about HRAF. Few interviews highlighted the fight against hunger and the search for citizenship, but they revealed scepticism regarding the consolidated guarantees. The routine in the health services for monitoring the conditionalities of the BFP emerged in the rights dimension. The definition of healthy eating by the participants emphasized the importance of fresh and minimally processed foods but revealed the use of ultra-processed foods asalternatives given the financial difficulties in accessing healthy foods. Conclusions: The findings reveal the need to develop public policies and actions for the emancipation and strengthening of families entitled to the BFP from the citizen perspective of defending the enforceability of the HRAF.

Health services, intersectoriality and social control: a comparative study on a conditional income transfer program.

The Bolsa Família Program (BFP) is one of the largest conditional cash transfer programs in the world, providing cash transfers and intersectoral actions. The aim of this study was to compare whether there is a difference in access to health services, intersectoral actions and social control, between families entitled or not, to the BFP. A cross-sectional study was carried out. A representative sample of a peripheral, socioeconomically vulnerable population from a large urban center in southeastern Brazil was calculated, totaling 380 families. Chi-square or Fisher's exact tests and multiple correspondence analysis were used to compare groups. Families entitled to the BFP had worse living conditions in general and greater access to health services, such as: medical care (p-value 0.009), community healthcare agent (p-value 0.001) and home visits (p-value 0.041). Being entitled or not affected the variability in the pattern of access to services by 31%; low access to intersectoral actions was identified in both groups; social control was incipient. There was an adequate focus on the program; greater access to health services was related to compliance with conditionalities; low access to intersectoral actions can restrict the interruption of the cycle of intergenerational transmission of poverty.

Food insecurity and financial aid among university students: pre-Covid-19 scenario of a public university in southeastern Brazil / Insegurança alimentar de estudantes universitários e permanência estudantil: cenário pré-Covid-19 em uma universidade pública no sudeste do Brasil

ABSTRACT: Objective: To estimate the prevalence of food insecurity among beneficiary and non-beneficiary university students of financial aid and associated factors. Methods: A cross-sectional study, with a probabilistic sample of 100 university students, was conducted at a federal university located on the coastal city of São Paulo in southeastern Brazil. The data made it possible to address sociodemographic aspects, food security and food quality markers. Data analysis involved descriptive statistics, Fisher's exact association test and Mann-Whitney comparisons of means were used to investigate the prevalence of food insecurity between groups and associations with covariables at 5%. Results: The results revealed significant differences between groups. Receiving financial aid was associated with more vulnerability to facing food insecurity: 94% have some level of food insecurity (p=0.001); non-white skin color (p=0.019); overseeing one's own income (p=0.001); the amount of money available to stay at the university (p=0.030). According to food quality markers, both groups often consumed ultra-processed foods (unhealthy quality marker). In contrast, most (92.3%) were concerned with consuming healthy foods. Conclusion: The pre-Covid-19 scenario reveals that despite receiving financial aid, a large part of students faced food insecurity in the three months prior to the study. Therefore, food insecurity should be recognized as a public health concern among university students, and adequate resources should be made available to avoid the occurrence of dropouts and assist in breaking the intergenerational cycle of social exclusion and the human right to food.

RESUMO: Objetivo : Estimar a prevalência de Insegurança Alimentar entre estudantes universitários que recebem ou não Auxílio Permanência Estudantil e fatores associados. Métodos: Estudo transversal exploratório, conduzido com amostra probabilística de 100 estudantes de uma universidade federal brasileira, situada no litoral paulista, na região sudeste do Brasil. Os dados coletados permitiram abordar aspectos sociodemográficos, de segurança alimentar e marcadores de qualidade alimentar. Conduziu-se análises descritivas, teste de associação Exato de Fisher e comparação de médias Mann-Whitney, para descrever a prevalência de insegurança alimentar entre bolsistas e não bolsistas e fatores associados a 5%. Resultados: Os resultados mostram que o grupo de estudantes bolsistas é mais vulnerável e significativamente associado ao enfrentamento da insegurança alimentar - 94% dos bolsistas em algum nível de insegurança alimentar (p=0.001), à não ser branco (p=0.019), ao grau de escolaridade dos pais (p=0.001), a ser o principal responsável pela própria renda (p=0.001) e ao valor disponível para se manter na universidade (p=0.030). Ambos os grupos consomem alimentos ultraprocessados com frequência, por outro lado, a maioria deles (92,3%) se preocupa em consumir alimentos saudáveis. Conclusão: O cenário pré Covid-19, revela que mesmo recebendo o auxílio, a maioria dos universitários enfrentou insegurança alimentar nos 3 meses anteriores à pesquisa. Portanto, a insegurança alimentar deve ser reconhecida como um problema de saúde pública entre universitários, ganhar espaço na agenda pública brasileira e recursos suficientes para evitar a ocorrência da evasão escolar, promovendo a quebra do ciclo intergeracional de exclusão social e o direito humano à alimentação.

Consumption of ultra-processed foods and associated factors in adults: evidence from the 2008-2009 Campinas Health Survey. / Consumo de alimentos ultraprocessados e fatores associados em adultos: evidências do Inquérito ISACamp 2008-2009.

The aim of the present study was to evaluate the consumption of ultra-processed (UP) foods and associated factors among adults. We used cross-sectional data on 947 adults from the 2008-2009 Campinas Health Survey. Food consumption data were collected using the 24-h dietary recall method and food items were classified according to NOVA classification based on the nature, extent and purpose of industrial processing. Linear regression models were run to evaluate the association between the consumption UP foods and predictor variables with a 5% significance level. The average daily energy intake per capita was 2000.6 kcal and UP foods represented 24.1% of this intake. UP food consumption was higher among women and increased with the increase in schooling. Consumption was also higher among young adults between 20 and 29 years old as well as ex-smokers and individuals who were physically active at leisure. The results show that there is still time to intervene in favor of the health of the adult population. Thus, studies dedicated to the investigation of food intake from the perspective of the NOVA classification, the possible repercussions for health and the evaluation of food and nutrition actions and policies should be prioritized in the current context of Brazil.

O objetivo do estudo foi avaliar o consumo de alimentos ultraprocessados (UP) e fatores associados em adultos. Trata-se de um estudo transversal de base populacional, com dados do Inquérito de Saúde de Campinas (ISACamp) 2008-2009. Analisou-se dados de 947 adultos, avaliou-se o consumo alimentar por recordatório de 24h e classificou-se os alimentos utilizando a NOVA classificação baseada na natureza, extensão e propósito do processamento industrial de alimentos. O teste de associação entre o consumo de UP e as variáveis preditoras utilizou modelo de regressão linear múltiplo com significância à 5%. O consumo energético médio foi 2.002,6 kcal per capita/dia, das quais 24,1% atribui-se aos UP. O consumo de UP foi maior em mulheres e aumentou conforme o grau de escolaridade, também foi maior entre os adultos jovens, entre 20 e 29 anos, assim como entre os ex-fumantes e os fisicamente ativos no lazer. Os resultados revelam que ainda há tempo de intervir em favor da saúde da população adulta. Nesse sentido, pesquisas que se dediquem a estudar o consumo alimentar na perspectiva da NOVA classificação de alimentos, as possíveis repercussões para saúde e a avaliação das ações e políticas de alimentação e nutrição devem ser prioritárias no contexto atual do país.

Prenatal and puerperium nutritional care from an integrality perspective in a city of Baixada Santista, São Paulo, Brazil / Atenção nutricional ao pré-natal e puerpério, na perspectiva da integralidade, em um município da Baixada Santista, São Paulo, Brasil

Abstract Objectives: to perform a comparative assessment of the nutritional care process in the prenatal and puerperium periods at a primary care unit in the city of Santos, SP, Brazil before and after the implantation of the Prenatal and Puerperium Nutritional Care Strategy. Methods: a cross-sectional study was composed of 58 pairs of women and their children, of whom, 30 underwent prenatal care before and 28 of them after the implantation by collecting data from perinatal registrations and children's charts. The care was evaluated by the official National guidelines. The chi-square test was used to compare variables between the pre and post intervention groups. Results: there was a significant improvement after the nutritional intervention, regarding to height (p=0.001), registration on pre-pregnancy weight (p=0.032), follow up on Body Mass Index/gestational week (p=0.001), registration on newborn's weight at discharge (p=0.011) and daily weight gain at the first pediatric consultation (p=0.019). Conclusions: the Prenatal and Puerperal Nutritional Care Strategy contributed to improve maternal-child nutritional care and the data registration on patients' charts, demonstrating the necessity to establish processes/flows and an integral care for this population.

Resumo Objetivos: avaliar comparativamente o processo da atenção nutricional ao pré-natal e ao puerpério em Unidade Básica de Saúde do município de Santos, SP, Brasil antes e após intervenção para implantar uma Estratégia de Atenção Nutricional ao Pré-natal e Puerpério-EANPP. Métodos: estudo transversal cujo universo foi composto por 58 pares de mulheres e seus filhos, das quais 30 realizaram o pré-natal antes e 28 após a implantação, utilizando registros das fichas perinatais e dos prontuários das crianças. Avaliou-se a atenção segundo diretrizes oficiais nacionais. Para comparar as variáveis entre os Grupos PRÉ e PÓS-intervenção utilizou-se o teste qui-quadrado. Resultados: houve melhora significante na atenção nutricional após a intervenção, destacando-se: aferição da estatura (p=0,001), registro de peso pré-gestacional (p=0,032), acompanhamento do Índice de Massa Corporal/semana gestacional (p=0,001), registro de peso do recém-nascido na alta (p=0,011) e ganho ponderal diário na primeira consulta pediátrica (p=0,019). Conclusão: a EANPP contribuiu para aprimorar os registros em prontuários e a atenção nutricional materno infantil, demonstrando a necessidade de estabelecer fluxos/processos e fomentando o cuidado integral a essa população.

Validação de conteúdo de instrumento de avaliação da atenção nutricional na atenção primária à saúde / Content validation of the nutritional attention assessment instrument in primary health care

RESUMO Objetivo Construir e validar o conteúdo de um instrumento para avaliar a organização da atenção nutricional na Atenção Primária à Saúde no Brasil. Métodos Trata-se de um estudo transversal e de validação. A construção do Instrumento de Avaliação da Atenção Nutricional foi baseada em revisão de literatura e em consulta a documentos oficiais. O instrumento foi submetido à validação de conteúdo utilizando técnica Delphi em duas rodadas. Resultados O painel para validação foi formado por 29 especialistas das cinco Macrorregiões Brasileiras: 13 docentes/pesquisadores do ensino superior, sete gestores de alimentação e de nutrição, quatro profissionais da Atenção Primária à Saúde e cinco alinhados ao tema, a maioria (89,7%) atuante em serviços públicos, com experiência acima de seis anos. O instrumento validado contém 68 questões e 10 indicadores: (1) Atuação do nutricionista; (2) Apoio às ações de Atenção Nutricional: infraestrutura e educação permanente; (3) Intersetorialidade; (4) Controle Social; (5) Vigilância Alimentar e Nutricional; (6) Atenção Nutricional Individual; (7) Atenção Nutricional para grupos; (8) Atenção Nutricional voltada ao pré-natal; (9) Atenção Nutricional voltada ao puerpério/aleitamento e (10) Atenção Nutricional à saúde da criança. Conclusão O instrumento proposto avança ao viabilizar o estabelecimento de processos avaliativos da Atenção Nutricional. Espera-se que ele seja amplamente utilizado para avaliar a atenção nutricional ofertada em municípios, em estados e na esfera federal. Os resultados obtidos com futuras aplicações poderão contribuir para respaldar a qualificação da gestão das políticas de alimentação e de nutrição.

ABSTRACT Objective Construct and validate the content of an instrument to evaluate the organization of nutritional care in Primary Health Care in Brazil. Methods This is a cross-sectional and validation study. The construction of the Nutritional Attention Assessment Instrument was based on literature review and review of official documents. The instrument was submitted to content validation using the Delphi technique in two rounds. Results The validation panel consisted of 29 specialists from the five Brazilian Macroregions: 13 higher education teachers/investigators, seven food and nutrition managers, four Primary Health Care professionals and five professionals knowledgeable of the subject, most of them (89.7%) working in the public service with experience of over six years. The validated instrument contains 68 questions and 10 indicators: (1) Nutritionist performance; (2) Support to the Nutritional Attention actions: infrastructure and permanent education; (3) Intersectoriality; (4) Social Control; (5) Food and Nutrition Surveillance; (6) Individual Nutritional Attention; (7) Nutritional Attention for Groups; (8) Nutritional Attention focused on prenatal care; (9) Nutritional Attention focused on postpartum/breastfeeding and (10) Nutritional Attention focused on child health. Conclusion The proposed instrument is an advance which enables the establishment of evaluation processes for Nutritional Attention. It is expected that this instrument be widely used to evaluate the Nutritional Attention given in the municipalities, states and at the federal level. The results obtained with future applications may contribute to support management qualification of food and nutrition policies.

Self-reported hypertension in adults residing in Campinas, Brazil: prevalence, associated factors and control practices in a population-based study. / Hipertensão arterial autorreferida em adultos residentes em Campinas, São Paulo, Brasil: prevalência, fatores associados e práticas de controle em estudo de base populacional.

OBJECTIVES: Evaluate the prevalence of self-reported hypertension in adults aged 20 to 59 years as well as identify associated factors, the use of health services and disease control practices according to the possession or not of a private healthcare plan. METHODS: A population-based, cross-sectional study was conducted in the city of Campinas, Brazil, involving 957 adults. RESULTS: The prevalence of self-reported hypertension was 14.1%, with greater frequencies found among women, individuals aged ≥ 40 years, those who declared their skin color to be black, those with less schooling, those who did not practice active leisure activities, ex-smokers, overweight or obese individuals and those who rated their own health as not being excellent/very good. No inequalities were detected between individuals with hypertension covered by a private healthcare plan or the Brazilian public healthcare system with regard to access to services, the use of disease-controlling medications and having received counseling on how to manage the disease. However, differences were found regarding the practice of physical activity and diet. CONCLUSION: Despite the equity disclosed in access to health care, the present findings demonstrate that an insufficient proportion of adults adopt changes in lifestyle to control hypertension, underscoring the central role of public health administrators.

Hipertensão arterial autorreferida em adultos residentes em Campinas, São Paulo, Brasil: prevalência, fatores associados e práticas de controle em estudo de base populacional / Self-reported hypertension in adults residing in Campinas, Brazil: prevalence, associated factors and control practices in a population-based study

Resumo O objetivo deste artigo é avaliar a prevalência de hipertensão arterial autorreferida em adultos de 20-59 anos, identificar os fatores associados, o uso dos serviços de saúde e as práticas de controle da doença segundo posse ou não de plano de saúde. Estudo transversal de base populacional realizado em Campinas-SP, em que foram analisados 957 adultos. A prevalência de hipertensão arterial autorreferida foi de 14,1%, revelando-se mais elevada em mulheres, em indivíduos com ≥ 40 anos, nos que se declararam de cor preta, com menor escolaridade, nos inativos no lazer, ex-fumantes, naqueles com sobrepeso ou obesidade, nos que relataram duas ou mais doenças e que autoavaliaram a saúde como não sendo excelente/muito boa. Não foram detectadas desigualdades entre hipertensos cobertos por planos de saúde e os SUS dependentes quanto ao acesso ao serviço, uso de medicamentos para controle da doença e ser orientado sobre os cuidados com a doença, mas houve diferenças quanto a prática de atividade física e o uso de dieta. Apesar da equidade revelada quanto ao acesso à atenção à saúde, é incipiente a proporção de adultos que adota mudanças no estilo de vida para o controle da doença, reafirmando o papel central da gestão das políticas de saúde, que precisam trabalhar intersetorialmente

Abstract Objectives: Evaluate the prevalence of self-reported hypertension in adults aged 20 to 59 years as well as identify associated factors, the use of health services and disease control practices according to the possession or not of a private healthcare plan. Methods: A population-based, cross-sectional study was conducted in the city of Campinas, Brazil, involving 957 adults. Results: The prevalence of self-reported hypertension was 14.1%, with greater frequencies found among women, individuals aged ≥ 40 years, those who declared their skin color to be black, those with less schooling, those who did not practice active leisure activities, ex-smokers, overweight or obese individuals and those who rated their own health as not being excellent/very good. No inequalities were detected between individuals with hypertension covered by a private healthcare plan or the Brazilian public healthcare system with regard to access to services, the use of disease-controlling medications and having received counseling on how to manage the disease. However, differences were found regarding the practice of physical activity and diet. Conclusion: Despite the equity disclosed in access to health care, the present findings demonstrate that an insufficient proportion of adults adopt changes in lifestyle to control hypertension, underscoring the central role of public health administrators.

Evaluation of nutritional care of overweight adults from the perspective of comprehensive health care / Avaliação da atenção nutricional ao excesso de peso sob a ótica da integralidade em saúde

ABSTRACT Objective: Describe and evaluate the nutritional care provided for overweight adults by the Primary and Secondary Health Care services of Santos, São Paulo, Brazil. Methods: This study was carried out between 2013 and 2015 integrating quantitative and qualitative approaches; it was divided into two phases: (1) characterization and (2) evaluation. In phase 1, a census of Primary Health Care Units (n=28) and Secondary Health Care Units (n=4) was conducted using interviews with health service managers and/or health professionals. Data were analyzed using exploratory data analysis. In phase 2, in-depth interviews were conducted with health service managers and/or health professionals investigating a sample of the Primary Health Care services and the totality of Secondary Health Care services provided. Thematic analysis was carried out using the theoretical framework for comprehensive health care proposed by Pinheiro & Mattos. Results: A total of 40 professionals were interviewed: 36 in the primary health care services and 4 in the secondary health care services. Nutritional care in the Primary Care services is focused on individual care and referrals to other services; nutrition diagnosis and health promotion occur only when overweight is associated with another disease. It was observed that the referral and counter-referral system and intersectorial collaborations were ineffective. In Secondary Care services, nutritional care is focused on clinical care using traditional approaches to nutrition education. Limiting factors for promoting comprehensive care were identified at the two levels of care: unproductive actions, lack of actions for health promotion and protection, and little dialogue between the Primary and Secondary care services. Conclusion: Overweight is not an outcome based on Primary and Secondary Care, but rather on prescriptive practices, which are not very effective in promoting users' autonomy. It is necessary to guide the actions taken in these two levels of care to ensure the promotion of effective nutritional care.

RESUMO Objetivo: Descrever e avaliar a atenção nutricional aos adultos com excesso de peso, na Atenção Primária e Secundária à Saúde, em Santos, São Paulo. Métodos: Estudo de caráter quanti e qualitativo, realizado entre 2013 e 2015, em duas etapas: diagnóstico (1) e avaliação (2). Na etapa 1, fez-se um censo dos serviços de Atenção Primária e Secundária (n=28) e Atenção Secundária a Saúde (n=4), entrevistando gestores e/ou profissionais; realizou-se análise exploratória dos dados. Na etapa 2, entrevistaram-se, em profundidade, gestores e/ou profissionais com uma amostra dos serviços da Atenção Primária a Saúde e a totalidade dos de Atenção Secundária a Saúde; realizou-se análise temática, utilizando o referencial teórico de integralidade segundo Pinheiro & Mattos. Resultados: Entrevistaram-se 40 profissionais: 36 na Atenção Primária a Saúde e quatro na Atenção Secundária a Saúde. A atenção nutricional na Atenção Primária a Saúde, restringe-se ao atendimento individual, com encaminhamento a outro ponto; diagnóstico nutricional e ações de promoção da saúde só ocorrem quando o excesso de peso se associa a outra doença; verificaram-se fragilidades na referência e contrarreferência e na efetivação da intersetorialidade. Na Atenção Secundária a Saúde, a atenção nutricional direciona-se ao atendimento clínico, utilizando abordagens tradicionais de educação alimentar. Nos dois pontos de atenção identificaram-se fatores limitantes da integralidade: ações fragmentadas; ausência de ações de promoção e proteção da saúde e pouco diálogo entre a Atenção Primária a Saúde e Atenção Secundária a Saúde. Conclusão: O excesso de peso não é um desfecho pautado na Atenção Primária a Saúde e, na Atenção Secundária a Saúde, pauta-se por práticas prescritivas, pouco potentes para promover a autonomia dos sujeitos. Faz-se necessário reorientar as ações nesses dois pontos de atenção, para qualificar a atenção nutricional.

Atenção nutricional no pré-natal e no puerpério: percepção dos gestores da Atenção Básica à Saúde / The nutritional care during the prenatal and postpartum: Perceptions of managers of Primary Health Care

RESUMO Objetivo: Avaliar a percepção dos gestores quanto à atenção nutricional ao pré-natal e ao puerpério na rede básica de município da Baixada Santista, São Paulo, segundo estrutura e processo. Métodos: Realizou-se censo das 28 unidades básicas da área insular por meio de entrevistas com gestores. Avaliou-se a atenção nutricional segundo infraestrutura, processo de trabalho e vigilância alimentar e nutricional. Resultados: A inserção do nutricionista foi o principal componente insuficiente da dimensão estrutura, interferindo negativamente na atenção nutricional para 60% dos gestores. Encontrou-se baixa conformidade para as seguintes variáveis da dimensão processo: cálculo do índice de massa corporal (35%), acompanhamento do estado nutricional na curva índice de massa corporal/semana gestacional (46%) e realização de aconselhamento nutricional individualizado no pré-natal (14%). Conclusão: A atenção nutricional pré-natal e puerperal é insatisfatória para alcançar a integralidade do cuidado. Faz-se necessário sensibilizar gestores locais e capacitar equipes de saúde para assegurar a efetividade de tais ações em Santos.

ABSTRACT Objective: To evaluate the perception of managers regarding the nutritional care to prenatal and postpartum in Primary Health Units in Southern,São Paulo, Brazil. Methods: It was conducted a census of 28 Primary Health Units from the insular area, using interviews with managers. The nutritional care was assessed according to infrastructure, work process and food and nutrition surveillance. Results: The insertion of dietitians was the main insufficient component of dimension structure, interfering negatively on nutritional care for 60% of managers. It was founded low compliance for the following variables of the process dimension: calculate the body mass index (35%), monitoring of nutritional status in body mass index/gestational week curve (46%) and conducting individualized nutritional counseling in antenatal (14%). Conclusion: Prenatal and postpartum nutritional care is unsatisfactory to achieve comprehensive care. It is necessary to sensitize local manager's awareness and qualify the health teams to ensure the effectiveness of such actions in Santos.

Consumo alimentar e condições de trabalho no corte manual de cana de açúcar no estado de São Paulo1 / Food consumption and working conditions in manual sugarcane harvesting in Sao Paulo state

Objetivo Descrever as condições de trabalho e aspectos relacionados à alimentação do trabalhador no corte manual de cana para contribuir para desenvolver políticas públicas de vigilância e atenção integral em Saúde do Trabalhador. Métodos Foram utilizados a observação direta do trabalho no campo em colheita no estado de São Paulo e aplicado questionário semi-estruturado a um grupo de 40 cortadores manuais de cana migrantes procedentes do estado do Ceará, durante 15 dias da safra 2007/2008. Aspectos sócio-demográficos, consumo de água, reposição eletrolítica, alimentação e aspectos culturais, pausas, dores e a jornada de trabalho foram registrados. Resultados Os trabalhadores ingerem de 5 a 10 litros de água/dia e a diluição dos repositores eletrolíticos foi inferior à adequada. A alimentação durante a safra não garantia a segurança alimentar e nutricional. A alimentação foi monótona, conservada e consumida em temperatura inadequada, e incompatível com os hábitos culturais, gerando desperdício e redução do consumo alimentar. Os trabalhadores relataram dores e câimbras no decorrer da jornada. As pausas para descanso foram insuficientes. O pagamento pela quantidade de produção, o processo de trabalho e as práticas de pagamento foram considerados determinantes da situação de precariedade ampla a que estes trabalhadores estavam submetidos. O trabalho no corte manual de cana é extenuante e o pagamento por produção pode ser um agravante para a saúde, pois implica na redução das pausas para descanso. A alimentação e hidratação corretas poderiam minimizar o desgaste e as dores durante o trabalho...

Objective To describe the working conditions and aspects related with food consumption amongst manual workers in sugar-cane crops intending to contribute to developing public policies towards workers’ health surveillance and delivering comprehensive services. Methods Direct observation at the work field in upstate São Paulo and a semi-structured questionnaire were conducted with a group of forty sugar-cane migrant workers who came from Ceará state to work as hand harvesters in São Paulo state, over 15 days during the 2007/2008 crop season. Socio-demographic data, water consumption, food consumption and cultural habits, hydro-electrolyte reposition, work pauses, body pains and duration of working days were registered. Results Workers ingested 5 to 10 liters of water/day and the dilution of electrolytes replacement was below the adequate recommendations. Food consumptions during the crop season did not ensure food and nutritional security. Food consumption was monotonous, conserved and consumed at inadequate temperature, and incompatible with cultural habits, implying reduction and wastage of food. Workers reported pains and cramps during the work day. Pauses for resting were insufficient. Payment by results, the working process and payment practices were taken as determinants of a wide range of precarious conditions to which these workers were subjected. The hand harvesting of sugar-cane is extenuating and the payment by results may be a grievance for health as it implies reducing the work resting pauses. Food consumption and adequate hydration could minimize the working wear and pains during the job...

Nutritional variables and work-related accidents: a case-control study.

BACKGROUND: Nutritional aspects are important for the prevention of diseases and disorders, and few studies have focused on the relationship between risk of work injury and nutritional variables. OBJECTIVE: This study aimed to verify whether nutritional variables constitute risk factors for work-related accidents. PARTICIPANTS: 1,422 industrial workers (600 cases plus 822 controls). METHODS: A case-control study was carried out in an industrial city in south-east Brazil. A multiple logistic regression model was adjusted using work-related accidents as the response variable and nutritional variables as predictors. The associations were assessed by Odds Ratio (OR), with a p-value < 0.05. RESULTS: 47.29% of the workers were overweight or obese. Protective factors for work-related accidents were (a) attending formal education for an above average number of years (OR=0.91, p< 0.0001) and (b) eating a traditional dinner (OR=0.67, p=0.0087). Risks factors were (a) hard physical effort in the workplace (OR=1.37, p< 0.0001), (b) having lunch in the workplace (OR=1.57, p<0.0001) and (c) receiving government benefits in the form of food stamps (OR=1.39, p=0.0350) or food baskets (OR=1.30, p=0.0414). CONCLUSION: Our findings suggest an association between nutritional variables and work-related accidents. This indicates the need, during the formulation of policies for these kinds of government benefits, to include nutrition aspects in order to minimize work-related accidents risks.

Migrant labor and wear-out in manual sugarcane harvesting in São Paulo, Brazil.

The scope of this paper is to describe the work of manual sugarcane harvesters, assessing the nutritional behavior and body composition between the beginning and the end of the harvest. A descriptive longitudinal study was made of harvesters in Piracicaba, São Paulo, Brazil, who answered a socio-demographic questionnaire and authorized measurement of Body Mass Index, Body Fat Percentage and Arm Muscle Circumference at three stages. Creatine kinase on the skeletal isoform, C-reactive protein and plasma urea were measured at the end of the harvest. Thirty male migrant harvesters with ages ranging from 18 to 44 from the Northeast (Ceará) were assessed over a nine-month period. The workers suffered significant body fat and weight loss in the first half of the harvest. Eighteen workers had abnormal levels of creatine kinase and four - out of 24 who had donated blood - had altered urea levels. Sugarcane harvesting work causes weight and body fat loss and gains in the lean body mass index, which suffers wear-out when working on consecutive harvests. It can also cause changes in biochemical markers of chronic systemic inflammation. Further studies will make it possible to comprehend the relationships between stress, wear-out, labor longevity and health in sugarcane harvesting.

Migrant labor and wear-out in manual sugarcane harvesting in São Paulo, Brazil / Trabalho e desgaste de migrantes no corte manual de cana de açúcar no Estado de São Paulo, Brasil

The scope of this paper is to describe the work of manual sugarcane harvesters, assessing the nutritional behavior and body composition between the beginning and the end of the harvest. A descriptive longitudinal study was made of harvesters in Piracicaba, São Paulo, Brazil, who answered a socio-demographic questionnaire and authorized measurement of Body Mass Index, Body Fat Percentage and Arm Muscle Circumference at three stages. Creatine kinase on the skeletal isoform, C-reactive protein and plasma urea were measured at the end of the harvest. Thirty male migrant harvesters with ages ranging from 18 to 44 from the Northeast (Ceará) were assessed over a nine-month period. The workers suffered significant body fat and weight loss in the first half of the harvest. Eighteen workers had abnormal levels of creatine kinase and four - out of 24 who had donated blood - had altered urea levels. Sugarcane harvesting work causes weight and body fat loss and gains in the lean body mass index, which suffers wear-out when working on consecutive harvests. It can also cause changes in biochemical markers of chronic systemic inflammation. Further studies will make it possible to comprehend the relationships between stress, wear-out, labor longevity and health in sugarcane harvesting.

Descrever o trabalho de cortadores manuais de cana de açúcar avaliando o comportamento nutricional e a composição corporal do início ao final da safra. Estudo descritivo longitudinal de cortadores na região de Piracicaba, São Paulo, Brasil, por meio de um questionário sociodemográfico e antropométrico que permitiu medir Índice de Massa Corporal, Percentual de Gordura Corporal e Circunferência Muscular do Braço em três momentos. Ao final da safra foi dosada a Creatina Quinase na isoforma esquelética, proteína C reativa e ureia plasmática. Durante nove meses, 30 homens safristas migrantes nordestinos (Ceará), com idade de 18 a 44 anos foram estudados. Os trabalhadores tiveram perda significativa de gordura corporal e peso na primeira metade da safra. A maioria ganhou massa magra e os mais velhos na atividade ganharam menos. Dezoito trabalhadores apresentaram valores alterados de Creatina Quinase e quatro tiveram uréia alterada dentre os 24 que cederam sangue. O trabalho no corte de cana gera perda de peso e gordura corporal e aumento de massa magra que se desgasta com a história de trabalho em safras sucessivas. Pode ainda causar alteração de marcadores bioquímicos de inflamação crônica sistêmica. Novos estudos permitirão entender a relação esforço, desgaste, longevidade laboral e saúde no corte de cana.

[Spatial distribution of risks for work-related injuries in a city of Southeastern Brazil]. / Topologia do risco de acidentes do trabalho em Piracicaba, SP.

OBJECTIVE: To assess spatial distribution of risks for work-related injuries controlled for nutritional variables and other covariables. METHODS: Hospital-based spatial case-control study with work-related injuries spatial distribution as the main variable of interest. A total of 794 workers were selected between May and October 2004. Inclusion criteria for cases (N=263) were: worker with work-related injury; living in Piracicaba (Southeastern Brazil); age between 15 and 60 years old; and cared at an orthopedics and trauma center. Controls (N=531) met the same criteria for age and residence, but had non-work-related injuries and workers accompanying cases were included as well. Spatial distribution was estimated by adjusting a generalized additive model with geographical coordinates of cases and controls as spatial non-linear component and the remaining covariables as linear components. RESULTS: The variation of estimated spatial risks for work-related injuries controlled for gender (OR=1.87, p<0.001), schooling (OR=0.85, p<0.0001), self-employed (OR=0.36, p<0.01), and waist circumference (OR=0.98, p=0.05) showed that the mideastern area and north-to-south "strip" have higher risk for injuries. CONCLUSIONS: The use of geoprocessing tools and nutritional variables can provide input for understanding the universe of risks for work-related injuries. Further investigation exploring these factors is needed.

Topologia do risco de acidentes do trabalho em Piracicaba, SP / Spatial distribution of risks for work-related injuries in a city of Southeastern e Brazil

OBJETIVO: Analisar a distribuição espacial do risco de acidente do trabalho controlado por variáveis nutricionais e outras co-variáveis. MÉTODOS: Estudo caso-controle espacial de base hospitalar, tendo como variável de interesse a localização espacial dos acidentes do trabalho. Foram amostrados 794 trabalhadores, no período de maio a outubro de 2004. Os critérios de inclusão para casos (N=263) foram: ser trabalhador acidentado do trabalho, morador de Piracicaba, com idade entre 15 e 60 anos, e atendido em centro de ortopedia e traumatologia. Os controles (N=531) tiveram o mesmo critério de idade e residência na cidade, exceto que o acidente não era do trabalho, tendo sido considerandos também trabalhadores acompanhantes dos casos. A distribuição espacial da estimativa baseou-se no ajuste do modelo aditivo generalizado, tendo as coordenadas geográficas dos casos e controles como componente espacial não linear e as demais co-variáveis como componente linear. RESULTADOS: A variação da estimativa do risco espacial de acidentes do trabalho, controlada por sexo (OR=1,87; p<0,001), escolaridade (OR=0,85; p<0,0001), ser autônomo (OR=0,36; p<0,01) e circunferência de cintura (OR=0,98; p=0,05), mostra que as regiões de maior risco foram a centro-leste e a área que forma um "corredor" entre as regiões sul-norte. CONCLUSÕES: O uso de ferramentas de geoprocessamento e a consideração de variáveis nutricionais fornecem elementos para a compreensão das relações que compõem o risco de acidentes do trabalho, sendo oportuna a continuidade de investigações que contemplem esses fatores.

OBJECTIVE: To assess spatial distribution of risks for work-related injuries controlled for nutritional variables and other covariables. METHODS: Hospital-based spatial case-control study with work-related injuries spatial distribution as the main variable of interest. A total of 794 workers were selected between May and October 2004. Inclusion criteria for cases (N=263) were: worker with work-related injury; living in Piracicaba (Southeastern Brazil); age between 15 and 60 years old; and cared at an orthopedics and trauma center. Controls (N=531) met the same criteria for age and residence, but had non-work-related injuries and workers accompanying cases were included as well. Spatial distribution was estimated by adjusting a generalized additive model with geographical coordinates of cases and controls as spatial non-linear component and the remaining covariables as linear components. RESULTS: The variation of estimated spatial risks for work-related injuries controlled for gender (OR=1.87, p<0.001), schooling (OR=0.85, p<0.0001), self-employed (OR=0.36, p<0.01), and waist circumference (OR=0.98, p=0.05) showed that the mideastern area and north-to-south "strip" have higher risk for injuries. CONCLUSIONS: The use of geoprocessing tools and nutritional variables can provide input for understanding the universe of risks for work-related injuries. Further investigation exploring these factors is needed.

Estado nutricional e práticas alimentares de trabalhadores acidentados / Nutritional status and dietary practices of injured workers

OBJETIVO: Identificar o estado nutricional e as práticas alimentares de trabalhadores acidentados de Piracicaba, SP. MÉTODOS: Estudo transversal com 600 trabalhadores acidentados, atendidos em um dos 8 serviços especializados do município, entre maio e outubro de 2004. Foram caracterizados a situação socioeconômica, ocupacional, as práticas alimentares e o estado nutricional (peso, altura e circunferência de cintura), verificando médias e desvio-padrão. RESULTADOS: Os acidentados eram, fundamentalmente, homens (87,33 por cento), operários (55,17 por cento), com idade média de 33 anos. A maioria se inseria no mercado formal (84,17 por cento), em turno diurno fixo (91,00 por cento), e 55,33 por cento possuía trabalho fixo. Aproximadamente a metade deles apresentou sobrepeso (28,26 por cento) ou obesidade (17,89 por cento), sendo maior nos que referiam pouco esforço físico no trabalho (54,90 por cento). Quase 1/3 dos trabalhadores tinha a circunferência da cintura aumentada, indicando risco cardiovascular. O benefício alimentação atendia a 85,33 por cento dos entrevistados. Predominou, na rotina alimentar, a realização de duas grandes refeições, almoço (95,67 por cento) e jantar (94,83 por cento); 24,16 por cento não ingeriam o desjejum diariamente, e 37,50 por cento consumiam alimentos entre as grandes refeições. O arroz e o feijão eram consumidos, diariamente, por 98,67 por cento, as carnes por 90,33 por cento e os farináceos por 81,50 por cento. Os laticínios compunham a alimentação diária de 63,33 por cento dos trabalhadores; 55,17 por cento consumiam verduras e/ou legumes diariamente e 32,67 por cento, frutas. Em contrapartida, 53,00 por cento mencionaram consumo diário de doces e refrigerantes e 38,67 por cento de frituras e salgadinhos. CONCLUSÃO: A alta prevalência de excesso de peso e os aspectos poucos saudáveis das práticas alimentares corroboram a tendência atual de aumento dessa doença, portanto, uma maior atenção a essas questões...

OBJECTIVE: To identify the nutritional status and dietary practices of injured workers of Piracicaba, São Paulo, Brazil. METHODS: Cross-sectional study with 600 injured workers seen at one of the 8 specialized centers of the city, between May and October 2004. The socioeconomic and occupational status, dietary practices and nutritional status (weight, height, waist circumference) were characterized, recording the means and standard deviation. RESULTS: The injured workers were mostly male (87.33 percent) factory workers (55.17 percent) with a mean age of 33 years. Most were formally employed (84.17 percent) in a fixed day shift (91.00 percent) and 55.33 percent had a fixed job. Nearly half of them were overweight (28.26 percent) or obese (17.89 percent) and excess weight was more common among those whose work required little physical activity (54.90 percent). Almost 1/3 of the workers had increased waist circumference, indicating cardiovascular risk. Most of the workers (85.33 percent) had access to the worker's food program. Most of them had two large meals daily, lunch (95.67 percent) and dinner (94.83 percent). Some (24.16 percent) did not have breakfast and some (37.50 percent) had snacks in between meals. Rice and beans were consumed daily by 98.67 percent of the workers, meats by 90.33 percent, starchy foods by 81.50 percent, dairy by 63.33 percent, vegetables by 55.17 percent and fruits by 32.67 percent. On the other hand, 53.00 percent reported consuming sweets and sodas daily and 38.67 percent reported eating fried and salty snacks daily. CONCLUSION: The high prevalence of excess weight and the not very healthy aspects of their dietary habits corroborate to the current trend of increasing obesity rates, therefore more attention needs to be given to issues regarding health surveillance of workers.