Juliana Stefanello

Significados atribuídos por puérperas adolescentes à maternidade: autocuidado e cuidado com o bebê

The objectives of this study were to identify the meanings attributed by adolescent mothers towards care for their babies and self-care, and to identify what they recognize as difficulties during their postpartum period and concerning caring for their respective babies. This study used a qualitative approach that took place in a maternity hospital that attends women through the Brazilian National Health Care System (Sistema Unico de Saude) from January to March of 2005. The subjects were 22 adolescent first time pregnant women. The data was collected via semi-structured interviews, recorded, and submitted to posterior thematic content analysis. Maternity is understood as a psychological, social, and physical change with maternal care as a duty to be exercised, taking priority when compared with self-care. The lack of experience, information, and their financial situations were pointed out as the main difficulties to care, with family listed as support. Society underestimates the adolescents capacity to care for the child, needing to create strategies for developing the adolescents autonomy in order that she actively assume her maternal responsibilities. DESCRIPTORS: Womens health. Adolescent health. Postpartum period. Self care.

Influence of iron on vitamin A nutritional status.

Iron deficiency seems to deteriorate vitamin A metabolism leading to a reduction in serum retinol and an increase in hepatic retinol and retinyl ester. These alterations probably result from an increase in retinol sequestration to the liver and/or impairment in the activity of hepatic retinyl ester hydrolases decreasing vitamin A mobilization.

The Influence of Vitamin A Supplementation on Iron Status

Vitamin A (VA) and iron deficiencies are important nutritional problems, affecting particularly preschool children, as well as pregnant and lactating women. A PubMed (National Library of Medicine, National Institutes of Health, Bethesda, MD, USA) literature review was carried out to search for clinical trials published from 1992 to 2013 that assessed the influence of vitamin A supplementation on iron status. Simultaneous use of iron and vitamin A supplements seemed to be more effective to prevent iron deficiency anemia than the use of these micronutrients alone. Some studies did not include a placebo group and only a few of them assessed vitamin A status of the individuals at baseline. Moreover, the studies did not consider any inflammatory marker and a reasonable number of iron parameters. Another important limitation was the lack of assessment of hemoglobin variants, especially in regions with a high prevalence of anemia. Assessment of hemoglobin variants, inflammatory markers and anemia of chronic inflammation would be important to the studies investigated. Studies involving different populations are necessary to elucidate the interaction between the two micronutrients, especially regarding iron absorption and modulation of erythropoiesis.

Crenças e tabus relacionados ao cuidado no pós-parto: o significado para um grupo de mulheres

Objective: To identify the meaning of care in the puerperal phase, within the family context. Methods: It is a qualitative research, developed with 12 puerperal women and their relatives, who helped them with care after delivery. Data collection was performed by means of semi-structured interviews. The data were analyzed based on the technique of thematic content analysis. Results: In the postnatal period, care needs to be doubled, as it affects mother and child, besides the body vulnerability, which is open to diseases. In articulation with these ideas, the recommendations and restrictions as components of postpartum care are justified. Conclusion: Care in the puerperal phase is a feminine practice filled with beliefs and taboos that grants women with power of agents in this process, since she bears the knowledge of many generations at the same time that they act as subjects and reinvent the previously established systems, constructing themselves as mothers.

Beliefs and taboos related to the care after delivery: their meaning for a women group

Objective: To identify the meaning of care in the puerperal phase, within the family context. Methods: It is a qualitative research, developed with 12 puerperal women and their relatives, who helped them with care after delivery. Data collection was performed by means of semi-structured interviews. The data were analyzed based on the technique of thematic content analysis. Results: In the postnatal period, care needs to be doubled, as it affects mother and child, besides the body vulnerability, which is open to diseases. In articulation with these ideas, the recommendations and restrictions as components of postpartum care are justified. Conclusion: Care in the puerperal phase is a feminine practice filled with beliefs and taboos that grants women with power of agents in this process, since she bears the knowledge of many generations at the same time that they act as subjects and reinvent the previously established systems, constructing themselves as mothers.

Breast feeding among Brazilian adolescents: practice and needs.

OBJECTIVES to characterise breast feeding practices among Brazilian adolescents and identify their breast feeding needs. METHODS the study was undertaken in Ribeirão Preto, Brazil in two stages. The first stage analysed data from the Second National Survey of Breast-feeding Prevalence, held in August 2008, which included 229 adolescent mothers. The second stage was a qualitative approach, and involved interviews with 10 adolescent mothers in a primary care unit. The data from the first stage were analysed in June 2010 based on descriptive statistics. The data obtained from the interviews were transcribed and organised using thematic content analysis. FINDINGS breast feeding was reported by 75% of the adolescent mothers. Of the 144 mothers with infants aged <180 days, 84% reported that they were breast feeding: 19% were breast feeding exclusively, 17% were breast feeding predominantly, 49% were providing complementary feeding, and 16% had weaned their infants. Analysis of the interviews led to the identification of three thematic units: concern for the childs health; breast feeding difficulties; and health team and family support. CONCLUSIONS the majority of the adolescent mothers presented conditions that were favourable to breast feeding (e.g. did not work outside the home, only had one child, breast fed in the first hour post partum). However, the practice of breast feeding still failed to meet the recommendations of the World Health Organization. The interviews led to identification of the breast feeding needs and demands of adolescent mothers, many of which were related to the needs of their infants. It is important to know what adolescent mothers think about breast feeding, in order to encourage the establishment of practices to keep breastfeeding as longer as possible in a satisfactory way for both mothers and infants.

Acupuncture for anxiety in lactating mothers with preterm infants: a randomized controlled trial.

The purpose of this study was to evaluate the effect of acupuncture versus placebo acupuncture on anxiety in lactating mothers with preterm infants. A parallel, randomized, patient-assessor blind, placebo-controlled trial was conducted in a tertiary school hospital in Londrina, Brazil, between 2011 and 2012. Mothers (n = 29) with very low birth weight infants born at this institution were randomly assigned to two treatment groups: acupuncture, AG (n = 14), or placebo acupuncture, PG (n = 15). Treatment sessions occurred once a week, using 5 Chinese auricular points unilaterally. The primary outcome measure was STAI-State scores, and secondary outcome measure was salivary cortisol levels. Both measures were collected before and after treatment and submitted to a blind assessor. Before-after treatment mean difference in STAI-State scores was observed in both groups (AG = 8.71 and PG = 8.20), not statistically significant (P = 0.888), although within group analysis was significant for both groups (P < 0.005). Salivary cortisol levels did not change after treatment in both groups (P = 0.480). There was no correlation between STAI and salivary cortisol results. At infants hospital discharge, 76% subjects were breastfeeding exclusively. There was no difference between real and placebo acupuncture for anxiety in mothers with preterm infants.

Leite produzido e saciedade da criança na percepção da nutriz durante o aleitamento materno exclusivo

The aims of this study were to analyze maternal perceptions about the milk they produced and its relationship with the duration and experience of exclusive breastfeeding. The participants of this cross-sectional, descriptive-analytic study were 231 breastfeeding mothers who accompanied their less-than-4-month-old children in a Brazilian Public Health Care Clinic in Ribeirao Preto, Brazil. Data were analyzed using comparison among averages, Fishers exact test, and logistic regression, demonstrating that 71% of the participants claimed to produce good milk, perceiving the childs satisfaction after breastfeeding. Perception of milk was statistically significant when associated with child satisfaction. Breastfeeding mothers who perceive an unsatisfied child are 32 times more likely to have a bad perception of their milk. There was a significant difference between lactation intervals carried out by women who had and who did not have good perceptions of the breast milk. Child satisfaction was the indicator most used to evaluate milk. This study evidences the need to encourage womens capacity towards good milk production.The aims of this study were to analyze maternal perceptions about the milk they produced and its relationship with the duration and experience of exclusive breastfeeding. The participants of this cross-sectional, descriptive-analytic study were 231 breastfeeding mothers who accompanied their less-than-4-month-old children in a Brazilian Public Health Care Clinic in Ribeirao Preto, Brazil. Data were analyzed using comparison among averages, Fishers exact test, and logistic regression, demonstrating that 71% of the participants claimed to produce good milk, perceiving the childs satisfaction after breastfeeding. Perception of milk was statistically significant when associated with child satisfaction. Breastfeeding mothers who perceive an unsatisfied child are 32 times more likely to have a bad perception of their milk. There was a significant difference between lactation intervals carried out by women who had and who did not have good perceptions of the breast milk. Child satisfaction was the indicator most used to evaluate milk. This study evidences the need to encourage womens capacity towards good milk production. DESCRIPTORS: Breast feeding. Human milk. Maternal and child health.Los objetivos fueron analizar la percepcion materna sobre la leche producida y su relacion con la duracion y conduccion de la lactancia exclusiva. Estudio transversal, descriptivo analitico, com 231 nodrizas acompanando sus hijos menores de 4 meses en una Unidad de Salud en Ribeirao Preto, Brazil. Los datos fueron analizados mediante comparacion entre medias, test exacto de Fisher y regresion logistica. 71% de las participantes reportaron producir buena leche, percibiendo el nino satisfecho despues de mamar. La percepcion de la leche fue estadisticamente significativa cuando asociada a saciedad del nino. Las nodrizas que perciben el nino insatisfecho tienen 32 veces chance de mala percepcion sobre su leche. Hubo diferencia significativa entre intervalos de mamadas para mujeres que tenian o no buena percepcion sobre la leche. La satisfaccion del nino fue el indicador mas utilizado para evaluar la leche. Hay que estimular la capacidad de las mujeres para buena produccion de leche.

Women's perceptions on milk produced and child satisfaction during exclusive breast feeding

The aims of this study were to analyze maternal perceptions about the milk they produced and its relationship with the duration and experience of exclusive breastfeeding. The participants of this cross-sectional, descriptive-analytic study were 231 breastfeeding mothers who accompanied their less-than-4-month-old children in a Brazilian Public Health Care Clinic in Ribeirao Preto, Brazil. Data were analyzed using comparison among averages, Fishers exact test, and logistic regression, demonstrating that 71% of the participants claimed to produce good milk, perceiving the childs satisfaction after breastfeeding. Perception of milk was statistically significant when associated with child satisfaction. Breastfeeding mothers who perceive an unsatisfied child are 32 times more likely to have a bad perception of their milk. There was a significant difference between lactation intervals carried out by women who had and who did not have good perceptions of the breast milk. Child satisfaction was the indicator most used to evaluate milk. This study evidences the need to encourage womens capacity towards good milk production.The aims of this study were to analyze maternal perceptions about the milk they produced and its relationship with the duration and experience of exclusive breastfeeding. The participants of this cross-sectional, descriptive-analytic study were 231 breastfeeding mothers who accompanied their less-than-4-month-old children in a Brazilian Public Health Care Clinic in Ribeirao Preto, Brazil. Data were analyzed using comparison among averages, Fishers exact test, and logistic regression, demonstrating that 71% of the participants claimed to produce good milk, perceiving the childs satisfaction after breastfeeding. Perception of milk was statistically significant when associated with child satisfaction. Breastfeeding mothers who perceive an unsatisfied child are 32 times more likely to have a bad perception of their milk. There was a significant difference between lactation intervals carried out by women who had and who did not have good perceptions of the breast milk. Child satisfaction was the indicator most used to evaluate milk. This study evidences the need to encourage womens capacity towards good milk production. DESCRIPTORS: Breast feeding. Human milk. Maternal and child health.Los objetivos fueron analizar la percepcion materna sobre la leche producida y su relacion con la duracion y conduccion de la lactancia exclusiva. Estudio transversal, descriptivo analitico, com 231 nodrizas acompanando sus hijos menores de 4 meses en una Unidad de Salud en Ribeirao Preto, Brazil. Los datos fueron analizados mediante comparacion entre medias, test exacto de Fisher y regresion logistica. 71% de las participantes reportaron producir buena leche, percibiendo el nino satisfecho despues de mamar. La percepcion de la leche fue estadisticamente significativa cuando asociada a saciedad del nino. Las nodrizas que perciben el nino insatisfecho tienen 32 veces chance de mala percepcion sobre su leche. Hubo diferencia significativa entre intervalos de mamadas para mujeres que tenian o no buena percepcion sobre la leche. La satisfaccion del nino fue el indicador mas utilizado para evaluar la leche. Hay que estimular la capacidad de las mujeres para buena produccion de leche.

Association between the degree of implementation of the Brazilian Breastfeeding Network and breastfeeding indicators

O objetivo foi avaliar a implantacao da Rede Amamenta Brasil e seu impacto sobre indicadores de aleitamento materno (AM). Realizou-se analise de implantacao de segundo tipo, incluindo 56 unidades basicas de saude (UBS) de tres municipios brasileiros. Para a avaliacao do grau de implantacao, criou-se um escore para cada UBS baseado no cumprimento dos criterios de certificacao do Ministerio da Saude; para a analise dos efeitos da implantacao, foram pesquisadas as prevalencias de amamentacao exclusiva e de amamentacao. Verificou-se que 18 (32,1%) UBS cumpriam os quatro criterios preconizados para certificacao. Foram incluidas no estudo 1.052 criancas menores de um ano, sendo 563 menores de seis meses. Verificou-se que as UBS que cumpriam os quatro criterios de certificacao tiveram maior prevalencia de amamentacao exclusiva (44%), quando comparadas as demais UBS. Dificuldades para a implantacao da Rede Amamenta Brasil foram identificadas, e os indicadores de AM variaram de acordo com o numero de criterios de certificacao cumpridos pelas UBS.This study aimed to evaluate the implementation of the Brazilian Breastfeeding Network and its impact on breastfeeding indicators. Implementation was analyzed according to type, including 56 primary healthcare units from three Brazilian municipalities. For evaluation of the degree of implementation, a score was created for each unit based on compliance with Ministry of Health certification criteria. Effects of implementation were analyzed according to exclusive and overall breastfeeding rates. Eighteen (32.1%) of the units met the four criteria for certification. The study sample included 1,052 children less than one year of age, of whom 563 were less than six months old. Units that met the four criteria for certification showed higher rates of exclusive breastfeeding (44%) when compared to the other units. Difficulties in implementing the Brazilian Breastfeeding Network were identified, and breastfeeding indicators varied according to the number of certification criteria met by the primary healthcare unit.