Elsa Regina Justo Giugliani

Evaluation of the Impact of the Baby-Friendly Hospital Initiative on Rates of Breastfeeding

The Baby-Friendly Hospital Initiative (BFHI) is based on the Ten Steps to Successful Breast-Feeding, a program which summarize the practices that maternity wards need to adopt to support breastfeeding.1 There are more than 16 000 Baby-Friendly Hospitals throughout the world, and of these, more than 200 are located in Brazil. Despite the abundance of studies evaluating each of the 10 steps or a combination of them, information on the impact of BFHI on the duration of breastfeeding is limited. Recently, a large randomized controlled trial including 31 hospitals in Belarus showed that an intervention based on BFHI principles increased breastfeeding rates, especially exclusive breastfeeding.2 The present study reproduced these results using a less complex study design.

Uso de chupeta e sua relação com o desmame precoce em população de crianças nascidas em Hospital Amigo da Criança

Objective: to assess the use of pacifiers and its relationship with early weaning among children born at a Child-Friendly Hospital. Method: a cohort study was carried out with 250 healthy singleton babies, with birthweight > 2,500 g, and with ongoing breastfeeding, born at Hospital de Clinicas de Porto Alegre. All mothers lived in Porto Alegre. Data were collected through interviews with the mothers, both at the maternity ward and at their homes, at the end of the first and sixth month of life; and over the phone, in the second and fourth months. Survival curves were built to compare the prevalence of breastfeeding and exclusive breastfeeding during the first six months of life among pacifier and non-pacifier users.

Obesidade, práticas alimentares e conhecimentos de nutrição em escolares

OBJETIVO: Avaliar a associacao da obesidade com as praticas alimentares e conhecimentos de nutricao em escolares. METODOS: Peso e estatura foram medidos em 573 criancas de todas as escolas municipais de Dois Irmaos e Morro Reuter, RS. Obesidade foi definida como indice de massa corporal acima do percentil 95, tendo como referencia os dados do National Center for Health Statistics. Praticas alimentares e conhecimentos em nutricao foram avaliados por questionario auto-aplicado aos escolares. Foi realizada analise de regressao logistica simples e ajustada para verificar associacoes. RESULTADOS: A obesidade mostrou-se associada com menos conhecimento de nutricao e praticas alimentares menos saudaveis. Criancas com essas caracteristicas apresentaram cinco vezes mais chances de serem obesas (OR=5,3;1,1-24,9). CONCLUSOES: O nivel de conhecimento modifica a relacao entre obesidade e praticas alimentares, levantando a suspeita de que as criancas que sabem mais sobre nutricao relatam praticas sabidamente mais saudaveis e nao necessariamente as praticadas. As praticas alimentares menos saudaveis, quando considerado o nivel de conhecimento em nutricao dos escolares, foram fortemente associadas a obesidade.

Recent Trends in Maternal, Newborn, and Child Health in Brazil: Progress Toward Millennium Development Goals 4 and 5

We analyzed Brazils efforts in reducing child mortality, improving maternal and child health, and reducing socioeconomic and regional inequalities from 1990 through 2007. We compiled and reanalyzed data from several sources, including vital statistics and population-based surveys. We also explored the roles of broad socioeconomic and demographic changes and the introduction of health sector and other reform measures in explaining the improvements observed. Our findings provide compelling evidence that proactive measures to reduce health disparities accompanied by socioeconomic progress can result in measurable improvements in the health of children and mothers in a relatively short interval. Our analysis of Brazils successes and remaining challenges to reach and surpass Millennium Development Goals 4 and 5 can provide important lessons for other low- and middle-income countries.

A prática do aleitamento materno nas capitais brasileiras e Distrito Federal: situação atual e avanços

OBJETIVOS: Apresentar os indicadores de aleitamento materno (AM), obtidos na II Pesquisa de Prevalencia de Aleitamento Materno nas Capitais Brasileiras e Distrito Federal, bem como analisar sua evolucao no periodo de 1999 a 2008. METODOS: Pesquisa de corte transversal, envolvendo criancas menores de 1 ano de idade que participaram da segunda fase da campanha de multivacinacao de 2008. Foram utilizadas amostras por conglomerados, com sorteio em dois estagios. O questionario era composto por questoes fechadas, incluindo o consumo de leite materno, outros tipos de leite e outros alimentos no dia anterior a pesquisa. Foram analisadas as prevalencias de AM na primeira hora de vida; aleitamento materno exclusivo (AME) em menores de 6 meses; AM em criancas de 9 a 12 meses; e medianas do AME e AM. A variacao temporal do AM foi estabelecida por meio da comparacao das medianas do AME e AM em 1999 e 2008. RESULTADOS: Obtiveram-se dados de 34.366 criancas. Verificou-se que 67,7% (IC95% 66,7-68,8) mamaram na primeira hora de vida; a prevalencia do AME em criancas de 0 a 6 meses foi de 41% (IC95% 39,7-42,4), e do AM em criancas de 9 a 12 meses foi de 58,7% (IC95% 56,8-60,7). Houve aumento de 30,7 dias na duracao mediana do AME e de 45,7 dias na mediana do AM. CONCLUSAO: Houve melhora significativa da situacao do AM na ultima decada. Porem, ainda sao necessarios esforcos para que o Brasil atinja indices de AM compativeis com as recomendacoes da Organizacao Mundial da Saude.

Evoluçäo do padräo de aleitamento materno

OBJETIVO: Acompanhar a evolucao da pratica do aleitamento materno na clientela de maternidade e avaliar as acoes para sua promocao. METODOS: Foram comparadas duas coortes de criancas nascidas em epocas diferentes em hospital de Porto Alegre, RS, quanto as prevalencias do aleitamento materno nos primeiros seis meses de vida das criancas bem como as taxas de interrupcao precoce da amamentacao. Os dois estudos foram prospectivos, envolvendo 202 criancas na coorte de 1987 e 187 na de 1994, todas saudaveis, com peso de nascimento igual ou superior a 2.500 g, tendo iniciado o aleitamento materno e cujos pais morassem juntos. O acompanhamento foi realizado atraves de correspondencia, no estudo de 1987, e de visitas domiciliares, no estudo de 1994. RESULTADOS: As curvas de sobrevida do aleitamento materno revelaram que o percentual de criancas amamentadas ao longo dos primeiros seis meses foi semelhante nas duas coortes. A prevalencia do aleitamento materno exclusivo, apesar de baixa nos dois grupos, foi superior na populacao de 1994, especialmente entre as criancas cujas maes tinham maior escolaridade. Nao houve diferenca no indice de interrupcao precoce entre as duas coortes (36% na coorte de 1987 e 39% na de 1994). CONCLUSOES: Os resultados apontam para uma apatia do servico com relacao a promocao do aleitamento materno no periodo estudado, justificando plenamente o investimento na promocao da amamentacao, especialmente nas familias menos privilegiadas.

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.

Influência das avós na prática do aleitamento materno

OBJETIVO: Verificar a influencia das avos na pratica do aleitamento materno. METODOS: Estudo prospectivo com 601 maes de recem-nascidos normais nascidos em hospital universitario na cidade de Porto Alegre, no Estado do Rio Grande do Sul. Os dados foram coletados na maternidade e nos domicilios, com um, dois, quatro e seis meses pos-parto, mediante entrevista com as maes. As informacoes sobre as avos foram obtidas na primeira visita ao domicilio. Regressao logistica multipla foi utilizada para testar associacoes entre variaveis relacionadas as avos e prevalencias de amamentacao. RESULTADOS: As seguintes variaveis mostraram associacao significativa com interrupcao do aleitamento materno exclusivo no primeiro mes: avos maternas e paternas que aconselhavam o uso de agua ou cha (RC=2,2 e 1,8, respectivamente) e de outro leite (RC=4,5 e 1,9, respectivamente). Interrupcao do aleitamento materno nos primeiros seis meses esteve associada com avos maternas e paternas que aconselhavam o uso de outro leite (RC=2,4 e 2,1, respectivamente). Contato nao diario com a avo materna foi fator de protecao para a manutencao da amamentacao aos seis meses. CONCLUSOES: As avos podem influenciar negativamente na amamentacao, tanto na sua duracao quanto na sua exclusividade. Essa informacao pode ser util no planejamento de estrategias de promocao do aleitamento materno.

Insatisfação corporal em escolares de dois municípios da região Sul do Brasil

OBJECTIVE: The objective of this study is to assess the prevalence of body dissatisfaction among students and identify the associated factors in two small cities in the south of Brazil. METHODS: A cross-sectional study with 573 students aging from 8 to 10 years old from the cities of Dois Irmaos and Morro Reuter, Rio Grande do Sul, Brazil. Data were collected on the childrens body dissatisfaction and weight through a corporal image scale (Childrens figure rating scale) and anthropometry. The mothers answered a questionnaire on preoccupations and perceptions regarding the childs weight. The body mass index was utilized for nutritional status classification. A logistic regression analysis was done to determine associations between the studied variables and body dissatisfaction. RESULTS: The prevalence of body dissatisfaction was about 63.9% and 16.9% were overweight. The variables associated with body dissatisfaction were: risk for obesity (Odds ratio=2.91; IC95% 1.26-6.74); obesity (Odds ratio=4.47; IC95% 1.12-17.9); living in urban area (Odds ratio=1.75; IC95% 1.03-2.97); mothers with less than eight years of formal education (Odds ratio=1.57; IC95% 1.03-2.40); evaluation, according to mother, that the childs weight was below or above the adequate weight (Odds ratio=1.65; IC95% 1.05-2.59) and child worried with their own weight (Odds ratio=1.53; IC95% 1.05-2.23). CONCLUSION: A high prevalence of body dissatisfaction is also observed in preadolescents of small cities. The data generated by this study are enough to alert parents, educators and health professionals for the necessity to develop strategies that aim to improve the childs satisfaction with their own body.

The relationship between family violence and teenage aggressiveness

The following is an exploratory study on family violence in two different schools, public and the other private, Porto Alegre, Rio Grande do Sul. Seventy-six families were interviewed, 36 with adolescents classified as aggressive by teachers and 40 with non-aggressive adolescents. Total number of subjects was 213. Physical and severe violence, frequent or occasional, was present in more than half of the sample: 41 reports - 53.9%. A third of the cases occurred in the private school (37%), with twice as many in the public school (63%). However, rates of severe or frequent episodes were similar in both schools. The relationship between violent behavior by teenagers and physical punishment by parents was significant. That is, aggressive adolescents were punished more than non-aggressive ones (odds ratio = 4.3). Prevalence of physical abuse was higher in the older, male teenager group, in the presence of sibling aggression, and in low-income and dysfunctional families. The study shows that physical abuse is more present in society than we would like to imagine.