Cristiano Siqueira Boccolini

Fatores que interferem no tempo entre o nascimento e a primeira mamada

The current study investigated factors associated with time between birth and first breastfeeding. A representative sample of mothers (10% of deliveries in 47 maternity hospitals in Rio de Janeiro, Brazil) was interviewed (n = 10,077). A random effects proportional risks survival model (at the maternity ward level) was employed, in a three-tier hierarchical approach. Models were fitted separately for normal and cesarean delivery. Time to initiation of breastfeeding in the first 24 hours of life differed between mothers with vaginal delivery (median 4 hours) versus cesarean section (10 hours). Common risk and protective factors were identified: maternal age; neonatal complications; neonatal care considered sub-optimal by the mother; admission of the newborn to the nursery; parity; birth weight. The model predicted 33% of variance in first breastfeeding. In conclusion, time from delivery to first breastfeeding was increased by biological factors, high cesarean rates, and inadequate childbirth and neonatal care practices.

Breastfeeding during the first hour of life and neonatal mortality

OBJECTIVE To analyze the correlation between breastfeeding in the first hour of life with neonatal mortality rates. METHODS The present study used secondary data from 67 countries, obtained from the Demographic and Health Surveys. Initially, for data analysis, Spearman Correlation (95% CI) and Kernel graphical analysis were employed, followed by a Negative Binomial Pois- son regression model, adjusted for potential confounders. RESULTS Breastfeeding within the first hour of life was negatively correlated with neo- natal mortality (Spearmans Rho = -0.245, p = 0.046), and this correlation was stronger among countries with more than 29 neonatal deaths per 1000 newborns (Spearmans Rho = -0.327, p = 0.048). According to the statistical model, countries with the lowest breastfeeding tertiles had 24% higher neonatal mortality rates (Rate ratio = 1.24, 95% CI = 1.07-1.44, p < 0.05), even when adjusted for potential confounders. CONCLUSION The protective effect of breastfeeding during the first hour of life on neo- natal mortality in this ecological study is consistent with findings from previous observa- tional studies, indicating the importance of adopting breastfeeding within the first hour as a routine neonatal care practice.

Pesticide use and non-Hodgkin's lymphoma mortality in Brazil.

INTRODUCTION Brazil is one of the major pesticide consumers in the world. The continuous exposure to these substances may be etiologically associated with the development of Non-Hodgkins Lymphoma (NHL). OBJECTIVE Estimate the correlation between the per capita sales of pesticides in 1985 (exposure) and NHL mortality rates between 1996 and 2005 (outcome), by Brazilian micro-regions. METHOD In this ecological descriptive study, the per capita consumption of pesticides in 1985 was used as a proxy of the population exposure to these chemicals in Brazil. All deaths by NHL occurred in the 446 non-urban micro-regions, between 1996 and 2005, among individuals with ages between 20 and 69, of both sexes, were retrieved from the Brazilian Mortality Information System. Micro-regions were then categorized into low, medium, high and very high pesticide consumption, according to the quartiles of per capita consumption of pesticides. NHL mortality rates and rate ratios for each quartile were obtained using the lowest quartile as reference. In addition, the Spearmans correlation coefficient between pesticide consumption and NHL mortality rates was estimated. RESULTS A moderate correlation between per capita pesticides consumption and standardized mortality rate for NHL was observed (r=0.597). In addition, using the lowest quartile of pesticide consumption as a reference, the higher the quartile of pesticide consumption, the higher was NHL mortality risk: men - (second quartile - MRR=1.69, CI 95% 1.68-1.84; third quartile - MRR=2.41, CI 95% 2.27-2.57; fourth quartile - MRR=2.92, CI 95% 2.74-3.11) and females (second quartile - MRR=1.87, CI 95% 1.69-2.06; third quartile - MRR=2.28, IC 95% 2.10-2.47; fourth quartile - MRR=3.20; CI 95% 2.98-3.43). CONCLUSION Our results suggest that pesticide exposure may play a role in the etiology of NHL.

Peso ao nascer e fatores associados ao período pré-natal: um estudo transversal em hospital maternidade de referência

O presente estudo analisou fatores relacionados ao peso ao nascer em um hospital maternidade do municipio do Rio de Janeiro. Trata-se de estudo seccional, descritivo, conduzido no Hospital Maternidade Herculano Pinheiro (HMHP), Rio de Janeiro, entre dezembro de 2008 e fevereiro de 2009, com puerperas entre 20 e 34 anos. Foram aplicados os testes de Qui-quadrado, t de student e modelo de regressao logistica. Dos recem-nascidos, 14,6% tinham baixo peso ao nascer (inferior a 2500g). Encontrou-se correlacao negativa entre o peso ao nascer e o habito de fumar da mae. As variaveis peso pre-gestacional, indice de massa corporal pre-gestacional materno e numero de consultas no pre-natal apresentaram associacao positiva com o peso ao nascer. A analise multipla indicou a idade materna como fator de risco para o baixo peso ao nascer. Conclui-se que a situacao sobre o estado civil, onde este se apresentou como uma variavel importante, assim como o numero de consultas pre-natal que na analise do grupo nao apresentou significado estatistico, merece maior investigacao com outros estudos.

Inequities in Milk-Based Prelacteal Feedings in Latin America and the Caribbean The Role of Cesarean Section Delivery

Background: Prelacteal feeds (ie, foods other than breast milk offered before the milk comes in) have been identified as a risk factor for shorter breastfeeding duration and neonatal mortality. Objective: This study aimed to test for socioeconomic inequities on the risk of milk-based prelacteal feeding associated with cesarean section delivery. Methods: We conducted secondary cross-sectional data analyses of 7 Demographic and Health Surveys conducted in Latin American and Caribbean countries between 2005 and 2010 (N = 49 253 women with children younger than 3 years of age). Multivariate logistic regression was used to test the association between cesarean section delivery and the risk of milk-based prelacteal feeding in the total samples as well as within the lowest and highest wealth quintile subsamples by country and in the pooled sample. Results: Almost one-third of newborns received milk-based (22.9%) prelacteal feeds. Prelacteal feeding prevalence varied from 17.6% in Guiana to 55% in Dominican Republic. Cesarean section delivery was associated with significantly higher odds of introduction of milk-based prelacteals in all countries (adjusted odds ratio [AOR] range, 2.34 in Bolivia to 4.50 in Peru). The association between cesarean section delivery and risk of milk-based prelacteal feeds was stronger among the poorest than wealthiest women (AOR [95% confidence interval], 2.94 [2.58-3.67] vs 2.17 [1.85-2.54]). Conclusion: Women of lower socioeconomic status may need additional breastfeeding support after cesarean section delivery to prevent the introduction of milk-based prelacteals. Reducing the rates of cesarean section deliveries is likely to reduce the prevalence of prelacteal feeding.

Artigo OriginalBreastfeeding duration and associated factors between 1960 and 2000Duração do aleitamento materno e fatores associados entre 1960 e 2000

Objective To describe a historical series on the median duration of breastfeeding in a population of mothers whose children were born from the 1960s onwards, identifying factors associated with the interruption of breastfeeding in each decade.