Alexandre dos Santos Brito

Mild but Not Light or Severe Food Insecurity Is Associated with Obesity among Brazilian Women

Our aim was to determine whether food insecurity was associated with a higher prevalence of obesity in a large random sample of Brazilian women of reproductive age. The data were derived from the 3rd edition of the Childrens and Womens National Demographic and Health Survey conducted in 2006-07. This was a nationally representative cross-sectional study. Obesity (BMI ≥ 30 kg/m(2)) was the outcome variable. Associations were measured using crude and adjusted prevalence ratios (PR) with 95% CI through Poisson regression models taking into account the complex sampling design. The sample included 10,226 women from 18 to 45 y of age. The prevalence of any level of food insecurity measured by the Brazilian Food Insecurity Scale was 40.9%, with 25.5% light, 10.1% mild, and 5.3% severe food insecurities. The prevalence of obesity was 17.4%. We found a borderline effect of light food insecurity and increased prevalence of obesity in Brazil (PR = 1.16; 95% CI = 0.98-1.38; P = 0.08). Women with mild food insecurity had a higher risk of being obese than their food-secure counterparts (PR = 1.49; 95% CI = 1.17-1.90; P = 0.010) after adjustment for skin color/ethnicity, years of schooling, geographical region, income, age, and marital status. In conclusion, this study suggests that mild but not light or severe food insecurity was associated with obesity as assessed by BMI, even after adjusting for various confounding factors in this large cross-sectional survey performed in a middle-income country undergoing the nutrition transition.

Incidência e mortalidade por câncer de tireóide no Brasil

In this study we evaluated the incidence and mortality due to thyroid cancer (TC) in Brazil using incidence data provided by seven Brazilian cancer registries and mortality data from the Brazilian Mortality Information System. Five-year age-adjusted mortality rates were calculated over a 20-year period (1980-1999) for the country as a whole. We have calculated a 3-year age-adjusted incidence rate using data available since 1993. Age-adjusted mortality rates decreased from 0.22/100,000 to 0.28/100,000 (-21%) among males, and from 0.42/100,000 to 0.51/100,000 (-17%) among females. Among males, age-adjusted incidence rates varied from 0.7/100,000 in Belém to 3.0/100,000 in São Paulo. These cities also presented the lowest (0.8/100,000) and the highest (10.9/100,000) age-adjusted incidence rates among females. The downward tendency of mortality is probably explained by an improvement in diagnosis and treatment of TC over the study period, whereas geographical variations in incidence are probably related to availability of medical care resources in the different regions and the quality of cancer registers data.

Fatores associados ao aleitamento materno exclusivo: o papel do cuidado na atenção básica

The aim of this study was to assess the association between promotion, protection, and support for breastfeeding in primary health care services and prevalence of exclusive breastfeeding in the first six months of life. A cross-sectional study was conducted in a representative sample of 1,029 mothers of infants younger than six months treated at primary health care facilities in the city of Rio de Janeiro, in southeastern Brazil. Prevalence ratios (PR) were estimated by Poisson regression. Prevalence of exclusive breastfeeding was 58.1%. Factors associated with increased prevalence of exclusive breastfeeding were: white skin color (PR = 1.20; 95%CI: 1.05-1.36); schooling (PR = 1.19; 95%CI: 1.05-1.35); marital status (married or in common-law marriage) (PR = 1.72; 95%IC:1.02-2.90); previous breastfeeding (PR = 1.27; 95%CI: 1.08-1,49); exclusive breastfeeding at the time of hospital discharge (PR = 2.01; 95%CI: 1.20-3.36); group support for the mother (PR = 1.14; 95%CI: 1.01-1.28); and orientation on breastfeeding (PR = 1.20; 95%CI: 1.08-1.33). Prevalence of exclusive breastfeeding decreased 17% per month in the infants life. Support groups and orientation by primary health care for breastfeeding were associated with increased exclusive breastfeeding prevalence.

Estimativas de parâmetros no linkage entre os bancos de mortalidade e de hospitalização, segundo a qualidade do registro da causa básica do óbito

The purpose of the study was to compare the linkage parameter estimates between hospitalization and mortality databases, calculated separately for the subsets of deaths from ill-defined causes and deaths from known causes. The databases for deaths from known causes and ill-defined causes were linked to a hospital admissions database. Parameters were estimated using two strategies: (1) first name, last name, and day, month, and year of birth, (2) full name and date of birth. In the first strategy, the estimates for the first and last name were at least 97% in both sets. However, the items day, month, and year of birth produced low values in both sets. In the second strategy there was an important difference between the two groups, with much lower values for full name and especially for date of birth in the group of deaths from ill-defined causes. Our results emphasize the need for pilot studies to evaluate possible internal heterogeneity of databases during the planning stage of linkage projects.

Degree of compliance with the ten steps of the Breastfeeding- Friendly Primary Care Initiative and its association with the prevalence of exclusive breastfeeding ☆

OBJECTIVE To analyze the association between the degree of compliance with the ten steps of the Breastfeeding-Friendly Primary Care Initiative (BFPCI) and the prevalence of exclusive breastfeeding (EBF) in infants younger than six months in the city of Rio de Janeiro. METHODS This was a cross-sectional study conducted in a representative sample of 56 primary health care units of this municipality. The assessment of compliance with the ten steps of the BFPCI was carried out by interviewing health care professionals, pregnant women, and mothers; the generated performance scores were classified into tertiles. To obtain the outcome, i.e., the EBF, a data collection questionnaire was applied to mothers of children younger than six months who were followed up at these units in November of 2007. Prevalence ratios were obtained for the EBF using Poisson regression with robust variance. RESULTS The prevalence of EBF was 47.6%. In the multivariate analysis, the upper tertile of performance showed a 34% higher prevalence of EBF (PR=1.34, 95% CI: 1.24 to 1.44) and the second tertile was 17% higher (PR=1.17, 95% CI: 1.08 to 1.27) than the first tertile. Mothers who did not work outside home had a 75% higher prevalence of EBF (PR=1.75, 95% CI: 1.53 to 2.01); assistance in a basic health unit, as opposed to a family health unit, implied a 10% higher prevalence (PR=1.10, 95% CI: 1.03 to 1.19). The prevalence of EBF decreased 1% for each day of the infants life (PR=0.993, 95% CI: 0.992 to 0.993). CONCLUSION Given the contribution of BFPCI to the practice of EBF, a greater investment in the expansion and sustainability of this initiative is recommended, as well as its association with other strategies to promote, protect, and support breastfeeding.

VI Latin American Workshop on Leadership in Nutrition, Cuba 2012: the first harvest.

To the Editor: In the mid-1990s, led by Professors Ricardo Uauy and Juan Rivera, a group of Latin-American public health nutrition leaders envisioned that leadership development focused on young investigators was essential for combating the major nutrition challenges in Latin America. In 1997, the first Taller Latinoamericano de Liderazgo en Nutrici on (Latin American Workshop on Leadership in Nutrition) was held. Since then, these workshops have occurred every 3 y, preceding the Latin American Nutrition Society (SLAN) Conference. Here are the main discussions and concerns from the participants selected for the VI Latin American Nutrition Leadership Workshop held in Cuba in 2012.