Lumbar spine bone mineral density in women breastfeeding for a period of 4 to 6 months: systematic review and meta-analysis.

BACKGROUND: During the breastfeeding period, important transient changes in calcium homeostasis are verified in the maternal skeleton, to meet the demand for calcium for breastmilk production. The literature is inconclusive regarding the causes and percentages of involvement of bone densitometry resulting from exclusive breastfeeding (4 to 6 months). METHODS: This article aims to systematically review the literature, to determine the occurrence, intensity, and factors involved in alterations in maternal bone mineral density (BMD), during a period of 4 to 6 months of exclusive breastfeeding. The search descriptors "woman", "breastfeeding", "human milk", and "bone mineral density" were used in the electronic databases of the Virtual Health Library, Scielo (Scientific Electronic Library Online), CAPES Periodicals Portal, LILACS, Embase, PubMed/Medline, Cochrane, Scopus, and Web of Science in June 2023. Inclusion criteria for breastfeedingmothers were; aged to 40 years, primigravida, exclusively breastfeeding, with BMD assessments using dual-energy X-ray absorptiometry (DXA), with values expressed at baseline and from 4 to 6 months postpartum. The Jadad scale, Newcastle-Ottawa Scale, and Oxford Centre for Evidence-based Medicine - levels of evidence were adopted to assess the quality of the studies. For the meta-analytical study, statistical calculations were performed. RESULTS: Initially, 381 articles were found using the search strategy and 26 were read in full. After risk of bias analysis, 16 articles remained in the systematic review and four were included in the meta-analysis. The studies showed a reduction in bone mass in the lumbar spine in the first months postpartum (4 - 6 months), when compared with a longer period of breastfeeding (12-18 months). The breastfeeding group presented a greater impact in the meta-analysis than the control group (non-breastfeeding, pregnant, or immediate postpartum), with a reduction in BMD in the lumbar spine of -0.18 g/cm2 (-0.36, -0.01 g/cm2); 95% Confidence Interval, on a scale from 0 to 10. CONCLUSIONS: Our results demonstrated a transitory reduction in bone densitometry of the lumbar spine during exclusive breastfeeding for 4 to 6 months, which was gradually restored later in the postpartum period. More prospective studies are needed to better understand the topic. TRIAL REGISTRATION: PROSPERO platform (nº CRD42021279199), November 12th, 2021.

Adesão ao tratamento de hipertensão arterial / Adherence to arterial hypertension treatment

Objetivo ­ Verificar se o número de medicamentos usados pelo paciente é fator de risco associado à baixa adesão ao tratamento de Hipertensão Arterial. A não adesão ao tratamento da Hipertensão Arterial Sistêmica é um complexo problema de saúde pública que permanece como um desafio às equipes de saúde. No Brasil, a Hipertensão Arterial atinge 32,5% (36 milhões) de indivíduos adultos e mais de 60% dos idosos, contribuindo direta ou indiretamente para 50% das mortes por doenças cardiovasculares2 . Considera-se adesão ao tratamento o grau de coincidência entre a orientação médica e o comportamento do paciente. Tendo em mente que vários são os fatores de risco associados à baixa adesão ao tratamento, este estudo busca analisar a adesão ao tratamento medicamentoso em pacientes portadores de Hipertensão Arterial atendidos por uma equipe de Estratégia Saúde da Família (ESF) na cidade de Auriflama ­ SP. Métodos ­ Trata-se de uma pesquisa de natureza quantitativa, exploratória, descritiva com delineamento transversal. Para verificar a adesão ao tratamento, utilizou-se o questionário ARMS 12 adaptado. Resultados ­ Participaram do estudo 126 Hipertensos. Os fatores relacionados com a baixa adesão foram: idade (indivíduos mais jovens, 100%), sexo (homens, 75,9%), estado civil (viúvos, 92,9%), coabitação (pessoas que residem sozinhas, 84,6%), renda (população com baixa renda, 70,3%), escolaridade (menos que oito anos de estudos, 71,4%), tempo de tratamento medicamentoso (menos de seis meses de tratamento, 100%) e níveis pressóricos (limítrofe e hipertensão, 72,4%). Os Hipertensos apresentaram baixa adesão ao tratamento. Conclusão ­ Conclui-se que o número de medicamentos não interfere na adesão ao tratamento

Objective ­ To verify whether the number of medications used by the patient is a risk factor associated with poor adherence to arterial hypertension treatment. Non-adherence to the treatment of systemic hypertension is a complex public health problem that remains a challenge to health teams. In Brazil, Hypertension affects 32.5% (36 million) of adult individuals and more than 60% of the elderly, contributing directly or indirectly to 50% of deaths from cardiovascular disease 2. Consider treatment adherence or degree of coincidence between medical advice and patient behavior. Bearing in mind that several risk factors associated with treatment adherence, this study seeks to analyze adherence to drug treatment in patients with hypertension treated by a Family Health Strategy (FHS) team in the city of Auriflama - SP. Methods ­ This is a quantitative, descriptive and cross-sectional research. To check treatment adherence, use the adapted ARMS 12 questionnaire. Results ­ 126 Hypertensive patients participated in the study. Factors related to poor adherence were: age (younger, 100%), gender (men, 75,9%), marital status (widowed, 92,9%), cohabitation (single-dwelling, 84,6%), income (low income population, 70,3%), education (less than eight years of schooling, 71,4%), duration of drug treatment (less than six months of treatment, 100%) and blood pressure levels (borderline and hypertension, 72,4%). Hypertensive patients reported poor adherence to treatment. Conclusion ­ It was concluded that number of medications does not interfere with treatment adherence.

Activity of neurons in the preoptic area and their participation in reproductive senescence: Preliminary findings.

Alterations in the hypothalamic-pituitary-gonadal axis in females determine the transition from regular to irregular reproductive cycles, with loss of fertility. Stimulation of noradrenergic neurons of the anteroventral periventricular neurons (AVPV) is essential for regular reproductive cycles. Therefore, we examined the activity of neurons of the AVPV and measure the noradrenaline (NE) of acyclic rats, in constant estrus, and compared it with that of cyclic rats in estrus. Female cyclic (4-5 months) and acyclic (17-18 months) rats were euthanized at 10, 14, and 18 h in estrus. Brains were processed for immunoreactivity to antigens related to Fos (FRA) in AVPV, and the NE was determined by HPLC-ED. Plasma concentrations of LH, FSH, E2 and P4 were determined. In the acyclic animals, plasma LH was higher but the FSH was lower. There was decreasing P4 at different times, while the E2 was constant and lower in acyclic rats. FRA-ir expression in AVPV neurons of acyclic rats as well as turnover of NE was higher when compared with cyclic group. The preliminary findings showed increased activity in AVPV neurons in aging contribute to changes in the temporal pattern of neuroendocrine signaling, compromising the accuracy of inhibitory and stimulatory effects, causing irregularity in the estrous cycle and determining reproductive senescence.

Atividade dos neurônios do núcleo anterovental periventricular e sua participação no envelhecimento reprodutivo de ratas / Activity of anteroventral periventricular nucleus neurons in reproductive aging of female rats

Alterações do eixo hipotálamo-hipófise-gônadas em fêmeas determinam a transição de ciclos reprodutivos regulares para irregulares, com perda da fertilidade. Interação dos neurônios GnRH e esteróides gonadais está interligado pelas alças de retroalimentação e alterações nesse mecanismo estão relacionados com a senescência reprodutiva. Estímulos da noradrenalina (NA) e neurônios da área pré-óptica (APO) são essenciais para liberação das gonadotrofinas, pois neurônios GnRH expressam receptores para estrógeno β e progesterona. O objetivo deste estudo foi avaliar a atividade das células neuronais da APO no período de transição para a estropausa em ratas Wistar. Ratas Wistar cíclicas (4-5 meses) no dia do estro e acíclicas (17-18 meses) em constante estro (CE) foram perfundidas ou decapitadas às 10, 14 e 18 horas. Encéfalos perfundidos foram processados por imunohistoquímica para avaliação da imunorreatividade para antígenos relacionados ao Fos da APO. Após a decapitação, o encéfalo foi retirado e realizado microdissecção da APO e determinação do conteúdo de NA e seu metabolito; o plasma foi utilizado para dosagens de LH, FSH, E2 e P4. Os resultados obtidos evidenciaram secreção plasmática maior de LH e menor de FSH e E2 no grupo de ratas acíclicas. O número de neurônios FRA-IR foi maior em ratas acíclicas, nos horários das 10 (p<0,001) e das 18 (p<0,05) em relação ao grupo de animais com ciclo regular. Nas ratas acíclicas, o conteúdo armazenado de NA foi menor às 14h e 18h (p<0,001) e o metabólito foi constante e maior às 18h, comparada com o mesmo horário das ratas do grupo cíclica (p<0,05). Conclui-se que alterações neurais e ovarianas que ocorrem no CE determinam o declínio para a ocorrência da ciclicidade dos ciclos e caracterizam o período de periestropausa.

Changes of the hypothalamic-pituitary-gonadal axis in females determine the transition from regular to irregular reproductive cycles, with a loss of fertility. Interaction of GnRH neurons and gonadal steroid is connected by feedback and changes in this mechanism are related to reproductive senescence. Noradrenaline (NE) stimulation and preoptic area (POA) neurons are essential for release of gonadotropins, as GnRH neurons express receptors for estrogen β and progesterone. The objective of this study was to evaluate the activity of neurons in POA nuclei, in transition period for estropause in Wistar rats. Cyclic Wistar rats (4-5 months) on the day of estrus and acyclic (17-18 months) in estrus constant (CE) were decapitated or perfused at 10, 14 and 18 hours. Perfused brains were processed for immunohistochemistry to evaluate the immunoreactivity to antigens related to the Fos in POA. After decapitation, the brain was removed and carried microdissection of POA and determining the content of NE and its metabolite; Plasma was used for measurements of LH, FSH, E2 and P4. The results showed higher plasma secretion of LH, FSH and E2 lower in the group of acyclic rats. The number of FRA-IR neurons was higher in acyclic rats in the 10 hours (p <0.001) and 18 (p <0.05) compared to the group of animals with regular cycle. In rats acyclic, the stored contents of NE was lower at 14h and 18h (p <0.001), and the metabolite was constant and greater at 18h compared to the same time of the rats of the cyclic group (p <0.05). It follows that neural and ovarian changes that occur in the CE decline to determine the occurrence of cyclicity of cycles and featuring periestropausa period.