Atualização dos parâmetros de aquisição do Programa Nacional de Alimentação Escolar com base no Guia Alimentar para a População Brasileira / Actualización de los parámetros de adquisición del Programa Nacional de Alimentación Escolar en base a la Guía Alimentaria para la Población Brasileña / Update of the acquisition parameters of the Brazilian National School Feeding Program based on the Dietary Guidelines for the Brazilian Population

O Guia Alimentar para a População Brasileira é reconhecido como um potente indutor de políticas públicas de alimentação e nutrição. Nessa perspectiva, este artigo apresenta o percurso metodológico e as evidências que subsidiaram a elaboração dos novos parâmetros de aquisição de alimentos do Programa Nacional de Alimentação Escolar (PNAE). Tal elaboração envolveu as análises de: (1) participação dos recursos federais utilizados para compra de alimentos, agrupados segundo a classificação NOVA, empregada no Guia Alimentar para a População Brasileira, pelo conjunto de municípios brasileiros e segundo classificação da execução (positiva ou negativa); (2) cardápios mensais de referência que foram elaborados seguindo recomendações do Guia Alimentar para a População Brasileira; (3) aquisição de alimentos por amostra de 525 municípios, envolvendo a participação relativa dos grupos de alimentos (segundo a NOVA) no total de gastos e de energia e a qualidade nutricional dos alimentos adquiridos; e (4) alimentos ultraprocessados que não devem ser ofertados no ambiente escolar. Foi proposta a adoção dos seguintes parâmetros para participação dos grupos de alimentos em relação ao total de recursos federais empregados na compra de alimentos: ≥ 75% de recursos para alimentos in natura ou minimamente processados; < 20% para alimentos processados ou ultraprocessados e < 5% para ingredientes culinários processados e a ampliação da lista de alimentos cuja aquisição com recursos federais do PNAE é proibida. Esse processo subsidiou a elaboração da Resolução CD/FNDE nº 6, de 8 de maio de 2020, que dispõe sobre o atendimento da alimentação escolar aos alunos da educação básica no âmbito do PNAE.

La Guía Alimentaria para la Población Brasileña está reconocida como un potente inductor de políticas públicas de alimentación y nutrición. Desde esta perspectiva, este artículo presenta la trayectoria metodológica y evidencias que apoyaron la elaboración de los nuevos parámetros de adquisición de alimentos del Programa Nacional de Alimentación Escolar (PNAE). Tal elaboración implicó los análisis de: (1) participación de los recursos federales utilizados para la compra de alimentos, agrupados según la clasificación NOVA, empleada en el Guía Alimentaria para la Población Brasileña, por el conjunto de municipios brasileños, y según la clasificación de la ejecución (positiva o negativa); (2) menús mensuales de referencia que fueron elaborados siguiendo recomendaciones del Guía Alimentaria para la Población Brasileña; (3) adquisición de alimentos mediante una muestra de 525 municipios, implicando la participación relativa de los grupos de alimentos (según NOVA) en el total de gastos y de energía, así como la calidad nutricional de los alimentos adquiridos; y (4) alimentos ultraprocesados que no deben ser ofrecidos en el entorno escolar. Se propuso la adopción de los siguientes parámetros para la participación de los grupos de alimentos, en relación con el total de recursos federales empleados en la compra de alimentos: ≥ 75% de recursos para alimentos in natura o mínimamente procesados; < 20% para alimentos procesados o ultraprocesados, y < 5% para ingredientes culinarios procesados, así como la ampliación de la lista de alimentos, cuya adquisición con recursos federales del PNAE está prohibida. Este proceso apoyó la elaboración de la Resolución CD/FNDE nº 6, del 8 de mayo de 2020, que organiza la atención de la alimentación escolar a alumnos de educación básica en el ámbito del PNAE.

The Dietary Guidelines for the Brazilian Population is acknowledged as a powerful inducer of public food and nutrition policies. In this perspective, this article presents the methodological path and evidence that supported the elaboration of the new parameters of food acquisition of the Brazilian National School Feeding Program (PNAE). This elaboration involved the analyses of: (1) participation of federal resources used to purchase food, grouped according to the NOVA classification, used in Dietary Guidelines for the Brazilian Population, by the set of Brazilian municipalities and according to the classification of the execution (positive or negative); (2) monthly reference menus that were prepared following Dietary Guidelines for the Brazilian Population recommendations; (3) analysis of food acquisition by the sampling of 525 municipalities, involving the relative participation of food groups (according to NOVA) in total expenditures and energy and nutritional quality of purchased foods; and (4) analysis of ultra-processed foods that should not be offered in the school environment. We proposed the adoption of the following parameters for the participation of food groups in relation to the total federal resources used in the purchase of food: ≥ 75% of resources for fresh or minimally processed foods; < 20% for processed or ultra-processed foods and < 5% for processed culinary ingredients, as well as the expansion of the list of foods whose acquisition with federal resources from PNAE is prohibited. This process supported the elaboration of Resolution CD/FNDE n. 6 of May 8, 2020, which provides for the attendance of school feeding to primary education students within the PNAE.

The Effect of Health Promotion Program in Vulnerable Women with Osteoarthritis

PURPOSE: This study was to develop and evaluate a health promotion program for women with osteoarthritis. METHODS: The research adopted the nonequivalent control group pretest-posttest design. The subjects were 34 in the experimental group and 34 in the control group sampled among vulnerable women aged over 40. The independent variable was the health promotion program, and the dependent variables were perceived health status, balance, K-WOMAC, depression, life satisfaction and health promoting behavior. The health promotion program was performed for 50minutes each session, twice a week and for 8 weeks. Data were collected from July 1 to September 11, 2010. RESULTS: The experimental group showed significant differences in perceived health status, balance, WOMAC pain, WOMAC difficulty of performing activity, depression, and health promoting behavior compared to the control group. There was no significant difference in WOMAC stiffness, waist, weight, and life-satisfaction. CONCLUSION: The results of this study suggest that the health promotion program can be applied in degenerative arthritis education to improve self-care.

Acceso al programa de hipertensión en el Sistema General de Seguridad Social en Salud, 2008 / Acesso ao programa de hipertensão no sistema geral de seguridade social em saúde, 2008 / Access to the hypertension program in the general social welfare health system, 2008

Con esta investigación se evaluó el acceso de los usuarios con hipertensión arterial a las actividades de promoción y prevención del programa, para lo cual se realizó un estudio evaluativo, con una entrevista aplicada a una muestra de 403 hipertensos seleccionados aleatoriamente de las bases de datos de tres Empresas Promotoras de Salud (EPS), cuatro Empresas Promotoras de Salud del Régimen Subsidiado (EPSS) y la Secretaría de Salud, y a responsables de programas y profesionales de estas instituciones. Se realizó análisis univariado y multivariado que permitió la conformación de tres tipologías de pacientes. Se encontró que en Manizales los hipertensos se caracterizan por tener una edad promedio de 69,7 años, y ser el 55,6% del sexo masculino. El acceso al programa de hipertensión se caracteriza porque se tiene implementado el programa acorde con la guía con algunas diferencias entre instituciones, como existencia de clubes y estrategias de educación. Los hipertensos tienen garantizado el acceso potencial, evidenciándose una falencia en el suministro de medicamentos y en la oportunidad de la cita con el especialista, los pacientes asisten de manera oportuna a los controles, sin embargo la integralidad del programa se ve afectada por la inasistencia de la mayoría de éstos a las actividades grupales justificadas en razones como la oferta del programa, falta de tiempo y recursos económicos. La mayoría de los usuarios se encuentran satisfechos con la atención que reciben en los controles.

This paper presents the results of a research to evaluate the access of hypertensive users to the activities of the Promotion and Prevention Programs. This evaluative study was carried out through interviews applied to a population of 403 hypertensive patients selected at random out of three Health Promotion Entities (EPS by its initials in Spanish), four Institutions of Social Protection Health Promotion Centers (EPSS), the Health Secretary, and the people responsible for the programs and professionals from these institutions. Univariated and multivariate analyses were carried out, in order to construct three sets of patients. In Manizales, hypertensive patients have an average age of 69.7 years and 55.6% are male. Access to the hypertension program was characterized by the fact that the program is based on the norm, with some differences among institutions, such as the existence of clubs and educational strategies. Potential access to hypertensive patients is guaranteed, but the provision of medications and the opportunity to have appointments with specialists were found to be deficient. Hypertensive patients attend their individual check-ups, but their absence in group activities affects the integrality of the program. They justify their absence with lack of offers of the program, lack of time, and economic problems. Most users find the control session attention satisfactory.

Com esta pesquisa se avaliou o acesso dos usuários com hipertensão arterial às atividades de promoção e prevenção do programa, para o qual se realizou uma pesquisa evaluativo, com uma entrevista aplicada a uma amostra de 403 hipertensos selecionados aleatoriamente das bases de dados de três Empresas Promotoras de Saúde (EPS), quatro Empresas Promotoras de Saúde do Regime Subsidiado (EPSS) e a Secretaria de Saúde, e responsáveis de programas e profissionais destas instituições. Realizou-se análise uni-variado e multivariado que permitiu a conformação de três tipologias de pacientes. Encontrou-se que em Manizales os hipertensos se caracterizam por ter uma idade média de 69,7 anos, e ser o 55,6% do sexo masculino. O acesso ao programa de hipertensão se caracteriza por que se tem implementado o programa acorde com a guia com algumas diferenças entre instituições, como existência de clubes e estratégias de educação. Os hipertensos têm garantido o acesso potencial, evidenciando se uma falência no subministro de medicamentos e na oportunidade do encontro com o especialista, os pacientes assistem de maneira oportuna aos controles, sem embargo a integralidade do programa se vê afetado por a não assistência da maioria destes às atividades grupais justificadas em razões como a oferta do programa, falta de tempo e recursos econômicos. As maiorias dos usuários se encontram satisfeitos com a atenção que recebem nos controles.

Health Behaviors and Health Perceptions among Medical and Law Students

BACKGROUND: Modern physicians' role as a model is very important in advocating health promoting behaviors for their patients. In this study, we compared health promoting behaviors and corresponding health perceptions between law students and medical students with evaluation of the association between health promoting behaviors and corresponding health perceptions. METHODS: The data of this survey, conducted among law students and medical students attending a university in a metropolitan city in June, 2004, were collected by self-administered questionnaire based on FANTASTIC lifestyle checklist adjusted to reflect Korean circumstances. RESULTS: Qestionnaires from 74 law students and 136 medical students were analysed. The medical students showed better health behaviors in terms of fastening seatbelt, leisure time, sleep, and salt intake reduction. The medical students showed better health perceptions in terms of exercise, activity, body weight, animal fat and salt intake reduction, smoking cessation. The law students showed better perceptions in being impatient. Significant association between health behavior and health perception was observed in relationship with family and friends, exercise, activity, breakfast, reduced intake animal fat, smoking cessation, reduced drug and drinking habits, sleep, fastening seatbelt, regular physical exam, positive thought, and school satisfaction in the law students. In the medical students, significant association was observed in relationship with family and friends, exercise, breakfast, reduced drinking, sleep, fastening seatbelt, coping skills for stress, regular physical exam, and positive thought. CONCLUSION: Even though the medical students were more concerned about and engaged in some health promoting behaviors, other factors affecting medical students' health promoting behaviors than health perception should be addressed further.

The Effect of Spa-aqua Therapy on Lifestyle-related Diseases in Collaboration with Public Spa Facility / 日本温泉気候物理医学会雑誌

<b>Aims</b><br>Yufuin is one of the most famous spa resorts in Japan. However, little attention has been paid to public spa facilities from the viewpoint of their roles in health promotions for the residents. The Yufuin Onsenkan (spa facility) is located in the central portion of the Yufuin spa and has a complete set of spa baths and pools. The aim of this study is to assess the effect of spa-aqua therapy on various lifestyle-related diseases in collaboration with this public spa facility.<br><b>Methods</b><br>We have introduced spa-aqua therapy to patients who had been diagnosed and treated as having certain lifestyle-related diseases (diabetes, hypertension, hyperlipidemia, etc) in our outpatient clinic. One hundred and twenty-four patients consented to participate in the program of aqua exercises (30 minute walk) at least three times a week for more than three months under the supervision of medical doctors, aqua therapists, and public health nurses. These patients were assessed for clinical symptoms and laboratory data at 12 months following the spa-aqua therapy. Subsequently, brachial-ankle pulse wave velocity (baPWV) was measured on 92 healthy volunteers, 21 diabetes patients, and 39 hypertension patients to evaluate the effect of aqua-therapy on arteriosclerosis caused by lifestyle-related diseases.<br><b>Results</b><br>Decreases in clinical symptoms, improvement of laboratory data, and decreases in frequency and dosage of medical prescription were observed in 89 of 124 patients. Specifically, lowered levels of fasting blood sugar and hemoglobin Alc were observed in 20 of 24 diabetic patients and remarkable effects such as lowered blood pressure and decreased dosage of medicine and frequency of medical prescription were observed in 16 out of 20 hypertensive patients. As an index of arteriosclerosis caused by some lifestyle-related diseases, we also measured baPWV on 92 healthy volunteers, 21 diabetes patients, and 39 hypertensive patients before and after introduction of aqua-exercise. From the viewpoint of health insurance, annual medical fees of 35 patients, who were randomly selected from among 124 patients, decreased significantly after receiving aqua therapy combined with medicines. The baPWV values of diabetic and hypertensive patients were significantly higher than those of healthy volunteers before commencing aqua-exercise, and the baPWV values of diabetic and hypertensive patients did not improve significantly after six months of aqua-exercise, suggesting that a longer period of exercise is required.<br><b>Conclusion & Discussion</b><br>In collaboration with a public spa facility used daily by many residents, we succeeded in naturally introducing aqua-spa exercise to the usual habitual behavior of patients with lifestyle-related diseases. This kind of preliminary trial may have future potential not only of promoting health care for local residents but also providing prospects for health care businesses in spa resort areas.