Suchergebnisse

Apresentação do Dossiê organizado por Jonatan Sacramento e Julian Simões

Health politics defend that people with mental diseases should be kept within the community. The family is asked to look after these people, without being prepared for that. The family doesn't understand their ill relatives neither the revelation of the illness, dealing as well with guilt, physical and emotional overload, social isolation and frequently economical difficulties. This study allows us to identify the health needs in the families with relatives suffering from mental illness, and develop healthy strategies to overcome the difficulties caused by the illness. Our aim is to promote health in these families. For this investigation we conducted semi-structured interviews within a sample composed by relatives of mental patients. The families feel insecure and don't know what to do, saying it would be important to know how to deal with the ill person and where to turn to in case of family instability. The information allows us to help the family to readjust their new life ...

Editorial

RESUMO Emergências em Saúde Pública e desastres são eventos que causam impactos sobre a sociedade, afetando a vida e o cotidiano das pessoas, suas condições de saúde e segurança. As ciências sociais têm um papel fundamental na análise de tais eventos ao fornecerem uma perspectiva crítica acerca da dimensão das estruturas sociais, culturais, políticas e econômicas envolvidas. Neste artigo, buscou-se abordar os conceitos intercambiáveis de emergências em saúde pública e desastres, e suas inter-relações com os aspectos sociais, ao analisar como os teóricos sociais consideram o tema sob o enfoque do risco, a fim de melhor compreender os processos de vulnerabilização. Para tanto, foi realizado estudo exploratório que se concentrou nas abordagens sociológicas, conceituais e epistemológicas, buscando fornecer elementos para a construção de ideações, tecnologias e práticas que possam ser agregadas às ações de gestão do risco. Os resultados destacam a necessidade de (re)análises desses fenômenos a partir da ampliação da discussão em busca de uma maior aproximação entre as ciências sociais e as bases interdisciplinares, na direção da estruturação de arcabouço teórico mais consensual e plausível sobre as questões complexas observadas nas situações de emergências e desastres e seus impactos na sociedade contemporânea.

As mudanças curriculares, a inserção das novas tecnologias, o contexto social e as condições econômicas e políticas da sociedade moderna afetam o processo de formação de professores. Partindo deste entendimento, este trabalho apresenta análises, discussão e significação da Educação em Saúde (ES), na formação inicial e continuada de professores, com uso do filme comercial "Uma Prova de Amor (EUA, 2009)". A questão orientadora foi: que aprendizagens em educação em saúde são produzidas na discussão de filmes comerciais, em aulas da educação básica ou superior? Vinte e seis professores de Ciências Biológicas, em formação inicial e continuada, com reuniões formativas sistemáticas, participaram de sete sessões fílmicas. Em cada uma delas, o grupo assistia a um filme e discutia as compreensões de saúde e educação em saúde. As sessões foram audiogravadas, transcritas, lidas e identificados os excertos significativos. A Análise Microgenética das transcrições das discussões produzidas mostrou que o debate e as interações no grupo possibilitaram ampliar e ressignificar o entendimento de saúde numa articulação de aspectos anatômicos, fisiológicos e bioquímicos, sociais, emocionais e ambientais. Além disso, questões como finitude da vida, eutanásia, direito a morte digna e envelhecimento foram contempladas na discussão, ampliando a compreensão da promoção da saúde.

Ready-to-eat cereals (RTECs) have become a popular breakfast option claiming to provide important nutrients to children's diets, despite being a source of excess sugar and, therefore, a health concern. Thus, food reformulation constitutes an important public health strategy that could benefit from inputs provided by nutrient profiling. This study aimed to assess the adequacy of the RTECs for children available in Portuguese supermarkets, applying three nutrient profile models (NPMs)-the nutrient profile model of the World Health Organization's Regional Office for Europe (WHO-EURO), the profile of the private-sector EU Pledge (EU-Pledge), and the national model developed by the Directorate-General of Health (NPM-PT)-in order to explore the potential for reformulation of the RTECs identified as not adequate and evaluate the impact of RTECs' reformulation on the nutritional quality of Portuguese children's diets. In total, 78 RTECs intended for children were assessed and two scenarios-current (not considering reformulation) and alternative (considering reformulation to accomplish the nutrient profile requirements)-were considered to assess the impact of reformulation on nutritional quality. Across all RTECs, only 5.1% could be promoted to children according to the considered NPMs. The most common nutrients requiring reformulation were sugar, saturated fatty acids (SFA), salt, and dietary fiber. The scenarios of reformulation considered could reduce the RTECs average content of total sugars, SFA, and salt by 43%, 8.7%, and 1.1%, respectively, and dietary fiber intake could be increased by 34%. Thus, these results support policies to implement reformulation strategies for developing healthier food products to be promoted to children.

Background: Obesity and its associated diseases in the 21st century has led to new public policies with international commitments. Objective: The objective of this review was to examine public initiatives and policies to tackle obesity in Brazil and Portugal over the past two decades, identifying frameworks, guidelines and strategic actions. Methods: Official documents Brazilian and Portuguese public health policies were analyzed for international guidelines from 1999 to 2019. The documents were organized and analyzed by date. Additionally, they were evaluated for frameworks and actions proposed for individuals, communities, and the population across all levels of healthcare. Conclusion: This study shows that Portugal and Brazil have taken different paths when it comes to the creation and implementation of their strategies to manage obesity. In Brazil, actions aimed at promoting healthy eating have been introduced to children and are implemented by many government agencies. Portugal, on the other hand, has provided greater access to individualized healthcare services and has involved different sectors in addressing these issues. (c) 2021 da Graça da Costa et al.

Background Excessive consumption of sugar has a well-established link with obesity. Preliminary results show that a tax levied on sugar-sweetened beverages (SSBs) by the Portuguese government in 2017 led to a drop in sales and reformulation of these products. This study models the impact the market changes triggered by the tax levied on SSBs had on obesity incidence across various age groups in Portugal. Methods and findings We performed a national market analysis and population-wide modelling study using market data for the years 2014-2018 from the Portuguese Association of Non-Alcoholic Drinks (GlobalData and Nielsen Consumer Panel), dietary data from a national survey (IAN-AF 2015-2016), and obesity incidence data from several cohort studies. Dietary energy density from SSBs was calculated by dividing the energy content (kcal/gram) of all SSBs by the total food consumption (in grams). We used the potential impact fraction (PIF) equation to model the projected impact of the tax-triggered change in sugar consumption on obesity incidence, through both volume reduction and reformulation. Results showed a reduction of 6.6 million litres of SSBs sold per year. Product reformulation led to a decrease in the average energy density of SSBs by 3.1 kcal/100 ml. This is estimated to have prevented around 40-78 cases of obesity per year between 2016 and 2018, with the biggest projected impact observed in adolescents 10 to <18 years old. The model shows that the implementation of this tax allowed for a 4 to 8 times larger projected impact against obesity than would be achieved though reformulation alone. The main limitation of this study is that the model we used includes data from various sources, which can result in biases-despite our efforts to mitigate them-related to the methodological differences between these sources. Conclusions The tax triggered both a reduction in demand and product reformulation. These, together, can reduce obesity levels among frequent consumers of SSBs. Such taxation is an effective population-wide intervention. Reformulation alone, without the decrease in sales, would have had a far smaller effect on obesity incidence in the Portuguese population.

For the first time, in 2012, the Portuguese Government, through the National Program for the Promotion of Healthy Eating of the Directorate-General for Health, implemented a set of concerted measures for improving the dietary habits, nutritional status and health of the population. Prior to, and since 2007, several epidemiological, social and political circumstances converged, for later enabling the development of a national strategy throughout the decade 2010-2020. This was also supported by specific international guidelines, namely from the World Health Organization and the European Commission. The national strategy objectives have been: (a) To increase the knowledge about the population's food consumption, its determinants and consequences; (b) to modify the access to certain food items specially in schools, workplaces and public spaces; (c) To inform and empower individuals regarding shopping, preparation and storage of healthy foods, especially amongst those most vulnerable or with a lower income; (d) to identify and promote actions capable of encouraging a healthier diet through the integration of other societal sectors, namely agriculture, sports, environment, education, social security and local authorities; and (e) to better capacitate different professionals who, owing to their roles, may influence nutritional knowledge, attitudes and behaviors. Several actions are described, including the creation of legislation to address these objectives. It is worth noting that one of the biggest challenges to this public policy has been the interventions within the environments where people live. By knowingly being central to food choice determinants, these environmental modifications were also where the stakeholders felt the greatest tensions and difficulties, but also where there are the greatest gains to be made. Solutions to overcome these problems and other perceived difficulties have been proposed here and are considered to be some of the main lessons and achievements throughout this process. (c) 2020 The Author(s). Published by S. Karger AG, Basel on behalf of NOVA National School of Public Health.

Objective To model the reduction in premature deaths attributed to noncommunicable diseases if targets for reformulation of processed food agreed between the Portuguese health ministry and the food industry were met. Methods The 2015 co-regulation agreement sets voluntary targets for reducing sugar, salt and trans-fatty acids in a range of products by 2021. We obtained government data on dietary intake in 2015-2016 and on population structure and deaths from four major noncommunicable diseases over 1990-2016. We used the Preventable Risk Integrated ModEl tool to estimate the deaths averted if reformulation targets were met in full. We projected future trends in noncommunicable disease deaths using regression modelling and assessed whether Portugal was on track to reduce baseline premature deaths from noncommunicable diseases in the year 2010 by 25% by 2025, and by 30% before 2030. Findings If reformulation targets were met, we projected reductions in intake in 2015-2016 for salt from 7.6 g/day to 7.1 g/day; in total energy from 1911 kcal/day to 1897 kcal/day due to reduced sugar intake; and in total fat (% total energy) from 30.4% to 30.3% due to reduced trans-fat intake. This consumption profile would result in 248 fewer premature noncommunicable disease deaths (95% CI: 178 to 318) in 2016. We projected that full implementation of the industry agreement would reduce the risk of premature death from 11.0% in 2016 to 10.7% by 2021. Conclusion The co-regulation agreement could save lives and reduce the risk of premature death in Portugal. Nevertheless, the projected impact on mortality was insufficient to meet international targets.

The National School Feeding Program - NSFP is the public health policy that guarantees the minimum supply of healthy food and offers space for the construction of healthy eating habits in Brazilian schools. The objective of the present study was to evaluate the presence of Food and Nutrition Education (FNE) actions within the framework of the NSFP to verify its adequacy toward the program's legislation and to investigate which parameters are predictors of running school gardens. This was a cross-sectional observational study using secondary data obtained from the database of the Efficient School Lunch Management Award for the year 2010, with a sample of 749 municipalities in Brazil. A binary logistic regression was performed, considering the running of school gardens as a dependent variable, and the FNE indicators and the demographic variables as independent. The model containing the presence of FNE in the school curriculum was significant (p<0.001). The presence of FNE in school curricula OR=2.406;95%CI=[1.725, 3.357] was the most significant predictor of running school gardens, followed by the use of food from family farms OR=2.049;95%CI=[1.477, 2.842] and the carrying out of culinary workshops OR=2.032;95%CI=[1.442; 2.863], considering p<0.05. The presence of FNE in the school curriculum was positively associated with growing vegetable gardens, showing that complex actions that require more resources can be stimulated from simpler measures, and the NSFP as a public health policy is an important tool to promote actions throughout the national territory.

ObjectiveTo describe the implementation, main intervention areas and initial results of the Integrated Strategy for the Promotion of Healthy Eating (EIPAS) in Portugal.MethodsEIPAS was published as a Law, in December of 2017, as a result of a collaboration between several ministries, including the Finance, Internal Affairs, Education, Health, Economy, Agriculture, and Sea Ministries, aiming at improving the dietary habits of the Portuguese population. The working group, led by the Ministry of Health, developed this strategy for over a year. The framework produced was based on WHO and European Commission recommendations as well as on relevant data from the last Portuguese dietary intake survey (2015/2016). EIPAS also reflects the results of a public hearing, including the food industry, among others, and the experience gathered, since 2012, through the National Programme for the Promotion of Healthy Eating. It considers the health in all policies' challenge set by WHO and has four different strategic areas, namely (1) creation of healthier food environments, (2) improvement of the quality and accessibility of healthy food choices for consumers, (3) promotion and development of literacy, in order to encourage healthy food choices, and (4) promotion of innovation and entrepreneurship. In order to achieve these goals, a set of 51 actions was established and assigned to the seven ministries involved.ResultsUnder the scope of this strategy, Portugal has already implemented several actions, including (1) definition of standards for food availability at all public healthcare institutions; (2) implementation of a sugar tax on sweetened beverages; (3) implementation of a voluntary agreement with the food industry sector for food reformulation (work in progress); (4) design of a proposal for an interpretative model of front-of-pack food labelling; (5) improvement of the nutritional quality of food aid programmes for low-income groups; and (6) regulation of marketing of unhealthy foods to children.ConclusionsFor the first time, Portugal has a nutrition policy based on the WHO concept of health in all policies' and on the national data on food intake. The implementing process of all 51 actions and the inherent complexities and difficulties found so far have made this process be an authentic political and social laboratory that deserves to be followed.

Este trabalho se propõe a discutir comparativamente as ações de alimentação e nutrição que remetem ao tema da Segurança Alimentar e Nutricional (SAN) no Brasil e em Portugal, tendo em vista que diversos países têm estabelecido diretrizes para a garantia da alimentação adequada. Ambas as nações vivenciam situações de reduzida taxa de fecundidade, aumento da expectativa de vida e prevalências elevadas de doenças e agravos não transmissíveis. No Brasil, 30,2% das famílias vivem em insegurança alimentar; em Portugal, mesmo sem contabilizar a insegurança, 18,0% de seus habitantes encontram-se em risco de pobreza. A Política Nacional de Alimentação e Nutrição (PNAN) é o atual documento brasileiro que visa assegurar o acesso universal ao alimento. Portugal, devido à sua inserção na União Europeia, norteia-se pelo Segundo Plano de Ação Europeu para Política de Alimentação e Nutrição, da WHO, mas também pelo Plano Nacional de Saúde, atualizado periodicamente. Pautados pela intersetorialidade, os países apresentam ações relativas à SAN comuns, como aquelas relacionadas ao combate à obesidade, ao incentivo ao aleitamento materno, à prevenção de deficiências nutricionais e promoção de ações de educação alimentar em meio escolar, enquanto que, especificamente no Brasil, encontram-se estratégias relativas ao combate à desnutrição e, em Portugal, aquelas ligadas à indústria e à produção de alimentos seguros. Com relação à abordagem acerca da SAN, são verificadas distinções: a SAN é mais amplamente discutida pela política brasileira, enquanto que, em Portugal, o tema encontra-se implícito nas diversas ações de alimentação e nutrição.Palavras-chave: Política Pública de Saúde; Segurança Alimentar e Nutricional; Programas de Nutrição; Brasil; Portugal. ; This paper aims to compare food and nutrition actions related to foodsecurity (FS) in Brazil and Portugal, keeping in mind that several countries have established guidelines to guarantee adequate food. Both nations are experiencing a reduction in fertility rates, increased life expectancy, and a high prevalence of non-communicable diseases. In Brazil, 30.2% of households live in food insecurity; in Portugal, even without estimating food insecurity, 18.0% of its inhabitants are at risk for poverty. The National Food and Nutrition Policy is the current Brazilian document which seeks to ensure universal access to food. Portugal, due to its inclusion in the European Union, is guided by the Second WHO European Action Plan for Food and Nutrition Policy as well as by the Portuguese National Health Plan, which has been updated periodically. Guided by the intersectoral approach, these countries share actions related to FS, such as combating obesity, preventing nutritional deficiences and promoting nutrition education in schools, whereas, specifically in Brazil, some strategies also combat malnutrition and, in Portugal, are linked to industry and the production of safe food. With relation to FS, some distinctions were seen: FS is more widely discussed by Brazilian policies, while this subject is implied in several food and nutrition actions in Portugal.Keywords: Health Public Policy; Food Security; Nutrition Programs; Brazil; Portugal.

O cinema, como recurso didático, apresenta inúmeras possibilidades, aliando o aspecto cultural a conceitos escolares, tornando-se uma poderosa ferramenta de reflexão, contextualização e aprendizado. Nesse contexto, relata-se uma atividade realizada em uma turma do Ensino Fundamental, possuindo como foco a recorrência dos conteúdos relacionados ao corpo humano, saúde e higiene pessoal a partir da exibição do filme "Osmose Jones - Uma Aventura Radical pelo Corpo Humano", conjuntamente a resolução de questões e discussão de pontos relevantes no filme, enfatizando-se a retificação de erros conceituais. Ainda, os alunos responderam a um questionário acerca da utilização de filmes em sua realidade escolar e das suas concepções sobre o assunto: esta metodologia é escassamente aproveitada como recurso didático, apesar dos alunos considerarem o uso do cinema em aulas importantes e apontarem que auxilia no processo de aprendizagem. Além disso, foi perceptível a facilidade em associar os conteúdos às analogias presentes no filme e a compreensão dos conceitos apresentados. Portanto, essa metodologia auxiliou na constituição da capacidade imaginativa e de associação da linguagem fílmíca cotidiana com os conhecimentos provenientes do ensino de Ciências e promoveu a conscientização acerca da problemática saúde, levando a constituição de um cidadão crítico e pensante.