Carlos Alberto Feldens

Impacts of the 10 Steps to Healthy Feeding in Infants: a randomized field trial

This study assesses the impact of an intervention known as the Ten Steps to Healthy Feeding: A Nutritional Guide for Children under Two on nutritional conditions and infant health in low-income families. Two hundred newborns were randomized to the intervention group and three hundred to the control group. Parents of the intervention group received nutritional orientation during the childs first year of life. Both groups received visits at 6 and 12 months and routine follow-up by their pediatricians. The results (n = 397) showed that the intervention was associated with a higher proportion of exclusive breastfeeding at 4 months (RR = 1.58; 95%CI: 1.21-2.06) and 6 months (RR = 2.34; 95%CI: 1.37-3.99) and breastfeeding at 12 months (RR = 1.26; 95%CI: 1.02-1.55) and a lower proportion of children with diarrhea (RR = 0.68; 95%CI: 0.51-0.90), respiratory problems (RR = 0.63; 95%CI: 0.46-0.85), use of medication (RR = 0.56; 95%CI: 0.34-0.91), and dental caries (RR = 0.56; 95%CI: 0.32-0.96) in the 12-16 month bracket. The intervention had no effect on the occurrence of anemia, hospitalization, or nutritional status. The results suggest that the nutritional orientation program led to positive changes in infant feeding practices and health conditions, but that it was insufficient to prevent iron deficiency anemia.

Early Feeding Practices and Severe Early Childhood Caries in Four-Year-Old Children from Southern Brazil: A Birth Cohort Study

The aim of this study was to investigate the relationship between feeding practices in the first year of life and the occurrence of severe early childhood caries (S-ECC) at 4 years of age. A birth cohort study (n = 500) was conducted in children who were born within the public health system in São Leopoldo, Brazil. Feeding practices were assessed using standardized methods at 6 and 12 months of age. A total of 340 children were examined at 4 years of age. S-ECC was defined as recommended by an expert panel for research purposes: ≧1 cavitated, missing or filled smooth surfaces in primary maxillary anterior teeth or d1+ mfs ≧5. Poisson regression with robust variance was used in order to determine the early feeding practices which represent risk factors for the occurrence of S-ECC at 4 years of age. The multivariable model showed a higher adjusted risk of S-ECC for the following dietary practices at 12 months: breastfeeding ≧7 times daily (RR = 1.97; 95% CI = 1.45–2.68), high density of sugar (RR = 1.43; 95% CI = 1.08–1.89), bottle use for liquids other than milk (RR = 1.41; 95% CI = 1.08–1.86), as well as number of meals and snacks >8 (RR = 1.42; 95% CI = 1.02–1.97). Mother’s education ≤8 years was also associated with the outcome. The present study identified early feeding practices which represent risk factors for caries severity in subsequent years. These findings may contribute to developing general and oral health interventions, with special attention to families with low maternal education.

Utilização de serviços odontológicos por crianças de 0 a 5 anos de idade no Município de Canela, Rio Grande do Sul, Brasil

The aim of this study was to assess the use of dental services and age at first dental visit in preschool children in Canela, Rio Grande do Sul State, Brazil. A representative sample of under-five children was surveyed on National Childrens Vaccination Day. Childrens parents completed questionnaires containing socio-demographic data and age at first dental visit. Data were analyzed using multiple logistic regression. 192 children were examined. 13.3% of the sample had already visited the dentist at least once, but only 4.3% had their first dental visit by one year of age. The number of children who had already visited a dentist increased with age. Girls showed higher odds of having visited a dentist (OR = 1.46; 95%CI: 1.01-2.1). Public health strategies are needed to determine the effectiveness of health promotion and improve the use of dental services by preschool children.

Maternal Dietary Counseling in the First Year of Life Is Associated with a Higher Healthy Eating Index in Childhood

Food preferences are established in early childhood and track later in life. Therefore, it is important to promote healthy feeding practices as early as possible. A randomized field trial was conducted with 500 mother-child pairs from a low-income area of São Leopoldo, State of Rio Grande do Sul, Brazil, to evaluate the impact of a nutritional intervention in the first year of life on the dietary quality of 3- to 4-y-old children. Mother-child pairs were randomized either to intervention and control groups and dietary counseling was provided for mothers in the intervention group during 10 home visits in the course of the first year of life. These visits were carried out by fieldworkers who counseled the mothers about the Ten Steps for Healthy Feeding from Birth to Two Years of Age, based on the WHO guidelines. Dietary intake was assessed at 3-4 y of age for 345 children using two 24-h food recalls. Overall diet quality was determined by the Healthy Eating Index. The prevalence of poor diet in the intervention group was lower compared with the control group [relative risk (RR) = 0.30; 95% CI = 0.13-0.71). The number of children who achieved the 75th percentile for the vegetable and fruit component score was higher in the intervention than in control group (RR = 1.95; 95% CI = 1.31-2.89 and RR = 1.49; 95% CI = 1.07-2.07, respectively). Such data provide evidence that dietary counseling for mothers during the first year of life improves the overall dietary quality of children in a low-income population.

Exploring factors associated with traumatic dental injuries in preschool children: a Poisson regression analysis.

OBJECTIVE This cross-sectional study aimed to investigate the factors associated with dental trauma in preschool children using Poisson regression analysis with robust variance. SUBJECTS AND METHODS The study population comprised 888 children aged 3- to 5-year-old attending public nurseries in Canoas, southern Brazil. Questionnaires assessing information related to the independent variables (age, gender, race, mothers educational level and family income) were completed by the parents. Clinical examinations were carried out by five trained examiners in order to assess traumatic dental injuries (TDI) according to Andreasens classification. One of the five examiners was calibrated to assess orthodontic characteristics (open bite and overjet). Multivariable Poisson regression analysis with robust variance was used to determine the factors associated with dental trauma as well as the strengths of association. Traditional logistic regression was also performed in order to compare the estimates obtained by both methods of statistical analysis. RESULTS 36.4% (323/888) of the children suffered dental trauma and there was no difference in prevalence rates from 3 to 5 years of age. Poisson regression analysis showed that the probability of the outcome was almost 30% higher for children whose mothers had more than 8 years of education (Prevalence Ratio = 1.28; 95% CI = 1.03-1.60) and 63% higher for children with an overjet greater than 2 mm (Prevalence Ratio = 1.63; 95% CI = 1.31-2.03). Odds ratios clearly overestimated the size of the effect when compared with prevalence ratios. CONCLUSIONS These findings indicate the need for preventive orientation regarding TDI, in order to educate parents and caregivers about supervising infants, particularly those with increased overjet and whose mothers have a higher level of education. Poisson regression with robust variance represents a better alternative than logistic regression to estimate the risk of dental trauma in preschool children.

Dental anomalies and associated factors in 2- to 5-year-old Brazilian children

BACKGROUND Dental anomalies in primary teeth may lead to functional and aesthetic disorders, and their recognition contributes to early diagnosis and long-term treatment planning. OBJECTIVE This study investigated the prevalence of dental anomalies in primary dentition and associated factors in Brazilian preschoolers. METHODS The study population of this cross-sectional study comprised 1260 2- to 5-year-old children from public nurseries in Canoas, southern Brazil. Dental anomalies were recorded by five trained examiners according to Kreiborg criteria; classification included double teeth, hypodontia, supernumerary, and microdontia. RESULTS Dental anomalies as a group were found in 2.5% of children, although no significant difference occurred between genders and races. All the anomalies were observed in the anterior region, with no significant differences between the arches. However, supernumerary teeth were significantly more frequent among the non-white racial group (Fisher; P = 0.025) and double teeth on the lower arch (McNemar; P = 0.020). Individual anomaly frequencies were: double teeth, 1.3%; hypodontia, 0.6%; supernumerary, 0.3%; and microdontia, 0.3%. CONCLUSIONS The frequency of primary dentition anomalies as a group was greater than that reported in other populations; the findings of this study provide a clear vision of the distribution of this oral condition and may well contribute to early detection and treatment planning.

Effectiveness of a nutrition program in reducing symptoms of respiratory morbidity in children : A randomized field trial

OBJECTIVES To assess the effectiveness of home visits advising mothers about breast feeding and weaning in reducing symptoms of respiratory morbidity at the age of 12 months. METHODS A randomized field trial was conducted with mothers who gave birth within the public health system in the Brazilian city of Sao Leopoldo (2001/2002). The intervention group received dietary advice during the first year based on a Brazilian national health policy for primary care, which is based on WHO guidelines. Morbidity data was assessed in 397 children at 12 months. RESULTS A total of 23.3% of the children in the intervention group and 39.7% of the controls had one or more of the following symptoms during the month preceding assessment: cough, stuffy nose, runny nose, or breathlessness. The risk of respiratory morbidity symptoms was 41% lower for the intervention group (RR: 0.59; 95% CI: 0.43-0.81). The number of families needed to be visited to avoid one children presenting symptoms of respiratory morbidity (Number Needed to Treat) was 6.1. The intervention-group status was also associated with a longer duration of exclusive (RR:1.59; 95% CI: 1.21-2.07; p=0.001) and total breastfeeding (RR: 1.25; 95% CI:1.02-1.55; p=0.032) later introduction of solid foods (RR:1.11; 95% CI: 1.02-1.21; p=0.023), and a lower proportion of current medication use (RR:0.56; 95% CI:0.34-0.91;p=0.016). CONCLUSION A nutrition education program during the first year of life has a positive impact on reducing respiratory symptoms in infants.

Maternal education is an independent determinant of cariogenic feeding practices in the first year of life

AIM: To identify risk factors for cariogenic feeding practices in the first year of life. STUDY DESIGN: Cohort study. METHODS: 500 children born within the public health care system in São Leopoldo, Brazil, were recruited in a follow-up program. Anthropometric and demographic data were collected soon after birth; data on feeding practices were assessed at 12 months of age using a standardised questionnaire; clinical examination at 4 years of age allowed identification of cariogenic feeding practices in the first year of life and to quantify their relative risks. In the present study, the attributable risks of each child were summed, and the outcome was assessed for the upper quartile of scores for cariogenic feeding practices. STATISTICS: Adjusted relative risks for the outcome were estimated using robust Poisson regression models. RESULTS: A total of 327 children comprised the final study sample, i.e. were followed from birth to 4 years of age. Multivariate analysis showed that the risk of cariogenic feeding practices doubled in children from mothers with less than 5 years of education (RR 2.19, 95%CI 1.26–3.82) and was 70% higher in children from mothers with 5–8 years of education when compared with maternal education >8 years. The other independent variables were not associated with the outcome. CONCLUSIONS: Low maternal education is a risk factor for cariogenic feeding practices, independently of other factors. Mothers with low educational levels should be the focus of child health promotion interventions, especially those aimed at controlling dental caries.

Cluster-randomized Trial of Infant Nutrition Training for Caries Prevention

The objective of this study was to estimate the caries impact of providing training in infant feeding guidelines to workers at Brazilian public primary care clinics. In a cluster-randomized controlled trial (n = 20 clinics), health care workers either were trained in guidelines for infant nutrition, stressing healthful complementary feeding, or were assigned to a ‘usual practices’ control, which allowed for maternal counseling at practitioner discretion. Training occurred once; the amount of counseling provided to mothers was not assessed. Eligible pregnant women were enrolled to follow health outcomes in their children. Early childhood caries (ECC) was measured at age three years (n = 458 children). The overall reductions in ECC (relative risk, 0.92; 95%CI, 0.75, 1.12) and severe ECC (RR, 0.87; 95%CI, 0.64, 1.19) were not statistically significant. There was a protective effect among mothers who remained exclusively at the same health center (S-ECC RR, 0.68; 95%CI, 0.47, 0.99) and among those naming the health center as their principal source of feeding advice (S-ECC RR, 0.53; 95%CI, 0.29, 0.97). Health care worker training did not yield a statistically significant reduction in caries overall, although caries was reduced among children of mothers more connected to their health centers (ClinicalTrials.gov NCT00635453).

Oral health–related quality of life and associated factors in Southern Brazilian elderly

OBJECTIVE The aim of the present study was to describe oral health-related quality of life (OHRQoL) and associated factors in elderly individuals treated at Family Health Units in urban areas of the city of Pelotas, Brazil. METHODS The sample was composed of 438 individuals aged 60 years old or older. Demographic, socio-economic, general health and behavioural variables were collected using standardised questionnaires. OHRQoL was measured with the oral health impact profile (OHIP-14). Poisson regression analysis was employed to identify factors associated with OHRQoL. RESULTS The mean total OHIP-14 score was 9.1 (standard deviation: 10.6), and major impacts were related to feeling conscious of psychological discomfort (28.1%) and difficulty eating (24.4%) due to teeth, mouth or dentures. The multivariate analysis revealed higher oral health impact scores among non-White individuals [Prevalence ratios (PR) = 1.33, 95% CI: 1.07-1.66; p = 0.011], those with depressive symptoms (PR = 1.61, 95% CI: 1.30-1.99; p < 0.001), tobacco users (PR = 1.46, 95% CI: 1.07-1.99; p = 0.016), non-denture users (PR = 1.42, 95% CI: 1.10-1.85, p = 0.008), those with a perceived need for dental treatment (PR = 1.99, 95% CI: 1.58-2.51; p < 0.001) and those with poor or very poor self-rated oral health (PR = 2.86, 95% CI: 1.93-4.24; p < 0.001). Lower scores were found among individuals aged 80 years or older (PR = 0.52, 95% CI: 0.33-0.82; p = 0.005) and those with household income of more than 1.5 times the minimum wage (PR = 0.65, 95% CI: 0.46-0.93; p = 0.018). CONCLUSIONS The findings of the present study underscore the need for public policies aimed at reducing social inequalities and providing adequate dental treatment to improve OHRQoL among elderly individuals.