João Aprígio Guerra de Almeida

Breastfeeding: a nature-culture hybrid

Objective: To contribute to the creation of a new theoretical synthesis about the relationship between the biological and social dimensions of breastfeeding, categorizing it as a nature-nurture hybrid. Sources of data: The methodological approach of the present article was based on the qualitative health research frame, and data were analyzed on the basis of dialectic-hermeneutic principles. Primary sources, comprising historical documents, books, scientific articles and medical theses written in the 19th and 20th centuries were analyzed. Summary of the findings: Depending on the moment in history and on the expectations that surround the act of breastfeeding, the aspects related to nature and nurture, i.e., to biology and society, sometimes separate out and sometimes intermingle. A comprehensive approach to breastfeeding makes possible to see that it had to be considered instinctive, natural and biological in order to be assimilated as a cultural habit, and thus, it is not open to any kind of questioning. On other occasions, particularly in the course of the past decade, there has been a steady tendency to supplant traditional biological reductionism, which yielded cultural interpretations that do not reduce the human being to the status of a mammal like any other. Under this point of view, breastfeeding, in addition to being biologically determined, is socially conditioned, and thus constitutes an act embedded in ideologies and determinants resulting from the concrete conditions of life. In real life, however, a process apparently so natural, so loaded with affection and emotion is, in fact, affected by the most aggressive market interests, very often presented as scientific knowledge and decked out as health provisions. Conclusion: Breastfeeding focused as a nature-culture hybrid symbolizes the theoretical and methodological changes in the field, especially in the late 1990s. These changes reflect a renewed appreciation of biology and a more in-depth approach to interdisciplinary processes.

Alegações maternas para o desmame: estudo qualitativo

OBJECTIVE: To study the reasons for weaning given by women receiving care at a Baby-Friendly Maternity in Teresina, state of Piaui, Brazil. METHODS: The methodological principles of qualitative research were applied, supported by the social representation theory. Data were collected from 24 women who were in the process of weaning their babies before the 4th month of life. RESULTS: The decision-making process that leads women to wean their babies is complex and guilt-ridden. The following reasons for weaning were mentioned: having weak or little milk; puerperal problems affecting the breasts; lack of experience; disparity between the needs of the mother and the needs of the baby; external factors; work; ambiguity between wish/capacity to breastfeed and between burden/desire. CONCLUSIONS: A sense of solitude/isolation on the part of the mother and the need for support, not only from health services, but also from other segments of society, were conveyed in all interviews. The model of health care providing should be amended so as to treat breastfeeding as an act to be learned by women and protected by society.

Hábitos alimentares de crianças menores de 1 ano amamentadas e não-amamentadas

OBJETIVOS: Descrever os habitos alimentares de criancas amamentadas e nao-amamentadas atraves da analise dos alimentos consumidos pelas criancas menores de 1 ano de idade na cidade de Feira de Santana, BA, no ano de 2001. METODOS: Foi realizado um estudo transversal, no qual foram aplicados questionarios as maes das criancas menores de 1 ano no dia nacional de vacinacao, presentes nas 44 (71%) unidades de vacinacao, selecionadas por estratificacao simples. Foram avaliadas 2.319 criancas, representando 24,3% da populacao estimada. As medidas de associacao calculadas foram: razao de prevalencia, com intervalo de confianca a 95%, e de significância estatistica, atraves do teste do qui-quadrado com respectivo valor p. RESULTADOS: Nas criancas com idade igual ou inferior a 4 meses e nao-amamentadas, foi observada uma chance 8,2 e 6,7 vezes maior de a crianca ser alimentada, respectivamente, com a refeicao da familia (IC 95% 3,23-20,66) e com papas de legumes (IC 95% 3,84-11,78). Na mesma faixa etaria, as prevalencias de criancas nao-amamentadas que receberam agua, chas, sucos e papa de frutas foram significativamente maiores (70,7% versus 19,7%, 63,3% versus 26,7%, 33,3% versus 4,9% e 14,4% versus 1,4%, respectivamente). CONCLUSOES: As criancas amamentadas, quando comparadas com as nao-amamentadas, apresentaram melhores habitos no que se refere a epoca de introducao dos alimentos complementares.

Fatores associados ao aleitamento materno e desmame em Feira de Santana, Bahia

OBJETIVOS: conhecer a prevalencia do aleitamento materno e os fatores associados ao desmame das criancas menores de um ano, em Feira de Santana, no ano 2001. METODOS: estudo transversal com aplicacao de questionarios as 2319 maes presentes nas 44 (71,1%) unidades de vacinacao selecionadas, por estratificacao simples. Foi calculada a razao de prevalencia e considerado como significante p < 0,05 e intervalo de 95% de confianca. RESULTADOS: a prevalencia do aleitamento foi 69,2% nos menores de um ano. A ocorrencia da amamentacao exclusiva foi maior nas criancas que nao usavam chupeta (49,4%) e que mamaram no primeiro dia de vida (40,4%). As variaveis estatisticamente significantes relacionadas com as maiores chances de amamentar foram: amamentacao no primeiro dia (p <0,001), maes que nao trabalhavam fora do lar (p <0,001), menor renda familiar (p <0,001), multiparidade (p = 0,03) e a nao utilizacao de chupetas (p <0,001). CONCLUSOES: as atividades assistenciais quanto a prevencao do desmame devem estar voltadas sobretudo para as maes que trabalham fora do lar, aquelas de maior renda familiar e primiparas. Quanto as criancas, para as que nao foram aleitadas no peito no primeiro dia de vida e que usam chupetas.

Aleitamento materno: o desafio de compreender a vivência

This work aims to contribute to a reflection on the role of health professionals regarding women who breastfeed. Publications from scientific journals, theses, dissertations, textbooks and papers from national and international organizations were consulted. This reflection originates from the scientific evidences on the requirements of breastfeeding assistance regarding what the woman experiences during this process. The limitations of health professionals, including nutritionists, are pointed out, in respect to the requirements of providing breastfeeding assistance. This study evidenced the need to train health professionals to provide breastfeeding assistance that goes beyond the biological aspect, encompassing all facets of womanhood. In the same manner, we urge that the debate on the nutritionist’s role in breastfeeding assistance be expanded as it is still scarce.

Aleitamento materno: como é vivenciado por mulheres assistidas em uma unidade de saúde de referência na atenção materno-infantil em Teresina, Piauí

OBJETIVOS: ampliar a compreensao acerca de como as mulheres que desmamaram os seus filhos antes do quarto mes de vida percebem a amamentacao e a assistencia recebida no curso do ciclo gravidico-puerperal. METODOS: adotou-se a Teoria das Representacoes Sociais como referencial teorico-metodologico. Ao todo foram entrevistadas 24 mulheres com base num questionario semi-estruturado. A analise dos dados se deu a partir do metodo de analise de conteudo. RESULTADOS: a analise do discurso das entrevistadas permitiu evidenciar um verdadeiro descompasso entre o discurso proferido pela instituicao, em favor da amamentacao exclusiva ate o sexto mes de vida, e a vivencia das mulheres com relacao a este ato, que se traduziu na impossibilidade de cumprir tal orientacao frente as suas condicoes concretas de vida. CONCLUSOES: os resultados revelaram a necessidade de uma urgente reformulacao nos referenciais que embasam as acoes de saude voltadas para essa area, com vistas a contemplar, alem dos determinantes biologicos, os condicionantes socioculturais que permeiam a amamentacao.

Adequacy of human milk viscosity to respond to infants with dysphagia: experimental study

Neonatal nutrition is an important subject in health in the short, medium and long term. In preterm newborns, nutrition assumes a predominant role for the childs overall development. Babies with uncoordinated swallowing or respiration may not have the necessary oral abilities to suck the mothers breast and will need to implement different feeding practices; one of them is changing the consistency of the milk offered. Objectives Determine viscosity variations of untreated human and pasteurized milk without and with thickening to adapt the diet to the needs of dysphagic infants hospitalized in the Neonatal Intensive Cara Unit (NICU). Material and Methods The authors altered the viscosity of natural infant powdered milk and, after thickening, determined and adopted a thickening standard for human milk. Untreated human and pasteurized milk was thickened in concentrations of 2%, 3%, 5% and 7% and the viscosity were determined every 20 minutes for a period of 60 minutes at a temperature of 37ºC. Results The infant lactose formula thickened at concentrations of 2% and 3% produced viscosities of 8.97cP and 27.73 cP, respectively. The increases were significantly different after 1 hour. Inversely, untreated human milk at 2%, 3%, 5% and 7% produced diminished viscosity over time; the changes were more accentuated in the first 20 minutes. In pasteurized human milk, the 2% concentration had no variation in viscosity, but with the 3%, 5% and 7% concentrations, there was a significant decrease in the first 20 minutes with stability observed in the subsequent times. Conclusion In powdered milk, the viscosity increases over time; the viscosity in human milk diminishes. The results point out the importance not only of considering the concentration of the thickener but also the time being administered after its addition to effectively treat dysphagic infants.

Diagnóstico da situação do aleitamento materno no Estado do Piauí, Brasil

This study aims to evaluate the situation with breastfeeding in the State of Piauí, Brazil, at the time of the 2006 vaccination campaign. The sample consisted of 1,963 infants (< 1 year of age) from 45 municipalities. Medians and probabilities of breastfeeding categories were calculated by probit analysis. Multivariate logistic analysis was used to analyze the association between independent variables and partial and exclusive breastfeeding. The probabilities were: 16% for exclusive breastfeeding and 18% for predominant breastfeeding at 180 days of age and 58% for breastfeeding at 361 days. Median duration was 67 days for exclusive breastfeeding and 200 days for breastfeeding. The breastfeeding rate was higher for children whose mothers belonged to social classes C, D, and E (p = 0.024) and lived in the countryside (p = 0.009). Not nursing during the first 24 hours of life, using a pacifier, and bottle-feeding reduced the prevalence of breastfeeding (p < 0.001). The prevalence rates are below the recommended standards and reflect the need to prioritize actions to promote breastfeeding in the State.

Casca de banana: uma possível fonte de infecção no tratamento de fissuras mamilares

OBJECTIVE: the objective of the present investigation is to study the microbiology of banana peel being sold in the city of Rio de Janeiro, in an attempt to determine the possibility that the peel may represent a source of infection for women who use it to treat nipple fissures. METHODS: the following microorganisms were studied in 20 banana peel samples: mesophiles, total coliforms, fecal coliforms, Pseudomonas aeruginosa, lipolytic and proteolytic microorganisms, molds and yeasts, lactic bacteria, and coagulase-positive staphylococcus. RESULTS: the microbiological analyses revealed the occurrence of several typical groups of microorganisms, with the following distribution of positive results being detected in banana peel samples: mesophiles, 100%; total coliforms, 20%; coagulase-positive staphylococcus, 25%; molds and yeasts, 30%; proteolytic microorganisms, 70%; lipolytic microorganisms, 30%, and lactic bacteria, 95%. Fecal coliforms and Pseudomonas aeruginosa were not isolated. CONCLUSION: the results show the presence of potentially pathogenic microorganisms in levels which could compromise the microbiological quality of the banana peel. Its use for the treatment of nipple fissures can initiate an infectious process.

Methicillin-resistant Staphylococcus aureus in human milk

We collected and analyzed 500 samples of human milk, from five Brazilian cities (100 from each) to detect methicillin-resistant strains of Staphylococcus aureus (MRSA) producing enterotoxins. We found 57 strains of MRSA, and the mecA gene, responsible for resistance, was detected in all of them using a specific molecular probe. We examined 40 strains for the presence of four enterotoxins, after selecting a subset that included all strains from each region, except for the largest sample, from which 10 were randomly selected. Among these two presented enterotoxin B, and growth in human colostrum and trypicase soy broth. After 5 h of incubation at 37 degrees C, population sizes were already higher than 9.4 x 10(5) UFC/ml and enterotoxin was released into culture medium and colostrum. Our results stress the importance of hygiene, sanitary measures, and appropriate preservation conditions to avoid the proliferation of S. aureus in human milk.