Relationship between maternal biological features, environmental factors, and newborn neuromotor development associated with visual fixation abilities.

Newborn visual fixation abilities predict future cognitive, perceptive, and motor skills. However, little is known about the factors associated with the newborn visual fixation, which is an indicator of neurocognitive abilities. We analyzed maternal biological and environmental characteristics associated with fine motor skills (visual tracking) in 1 month old infants. Fifty-one infants were tested on visual tracking tasks (Infant Visuomotor Behavior Assessment Scale/ Guide for the Assessment of Visual Ability in Infants) and classified according to visual conducts scores. Differences between groups were compared considering motor development (Alberta Infant Motor Scale) maternal mental health (Edinburgh Postnatal Depression Scale and Hamilton Anxiety Scale); home environment (Affordances in the Home Environment for Development Scale); maternal care (Coding Interactive Behavior); breastmilk composition (total fatty acids, proteins, and cortisol); and maternal metabolic profile (serum hormones and interleukins). Mothers of infants with lower visual fixation scores had higher levels of protein in breastmilk at 3 months. Mothers of infants with better visual conduct scores had higher serum levels of T4 (at 1 month) and prolactin (at 3 months). There were no associations between visual ability and motor development, home environment, or maternal care. Early newborn neuromotor development, especially visual and fine motor skills, is associated with maternal biological characteristics (metabolic factors and breastmilk composition), highlighting the importance of early detection of maternal metabolic changes for the healthy neurodevelopment of newborns.

Organização, gestão e cuidado nutricional de pessoas com sobrepeso e obesidade na Atenção Primária à Saúde / Organization, management and nutritional care of overweight and obesity people in Primary Health Care

Objetivo: Avaliar a organização, gestão e o cuidado nutricional ofertado às pessoas com sobrepeso e obesidade na Atenção Primária à Saúde (APS). Métodos: Trata-se de um estudo transversal realizado com 54 profissionais da Atenção Primária à Saúde da cidade de Goiânia-GO. Os dados foram obtidos por meio do questionário eletrônico semiestruturado e autoaplicável. Resultados: Os profissionais participantes eram enfermeiros 88,9%, e com mais de cinco anos na função atual 79,6%. Ao analisar a infraestrutura e mobiliário, apenas 11,1% relataram cadeiras e bancos adequados, 33,3% acessibilidade física. O mapeamento do território foi referido por 51,8% dos profissionais. As principais estratégias para organização do cuidado e tratamento foram: central de regulação 79,6%, referência e contrarreferência 77,8%. Conclusão: Os resultados deste estudo refletem que a APS em Goiânia-GO, está em processo de implantação da gestão e cuidado nutricional que atendam às políticas públicas previstas para a prevenção e manejo do sobrepeso e obesidade.

Objective: To evaluate the organization, management, and nutritional care offered to overweight and obese individuals in primary healthcare (PHC) centers. Methods: A cross-sectional study was conducted with 54 professionals from PHC in the city of Goiânia-GO. Data were obtained using a semi-structured, self-administered electronic questionnaire. Results: The participating professionals were predominantly nurses (88.9%) with more than five years in their current position (79.6%). Regarding office infrastructure, including seating, only 11.1% reported adequate chairs and benches, while 33.3% reported adequate physical accessibility. Territory mapping was reported by 51.8% of professionals. The main strategies for organizing care and treatment were central regulation (79.6%), and referrals and counter-referrals (77.6%). Conclusion: The results of this study reflect that PHC in Goiânia-GO is in the process of implementing management services and nutritional care that meet the public policy standards envisaged for the prevention and management of overweight conditions and obesity.

Thrifty-Eating Behavior Phenotype at the Food Court - Programming Goes Beyond Food Preferences.

Introduction: Prenatal growth impairment leads to higher preference for palatable foods in comparison to normal prenatal growth subjects, which can contribute to increased body fat mass and a higher risk for developing chronic diseases in small-for-gestational-age (SGA) individuals throughout life. This study aimed to investigate the effect of SGA on feeding behavior in children and adolescents, as well as resting-state connectivity between areas related to reward, self-control, and value determination, such as orbitofrontal cortex (OFC), dorsolateral prefrontal cortex (DL-PFC), amygdala and dorsal striatum (DS). Methods: Caregivers and their offspring were recruited from two independent cohorts in Brazil (PROTAIA) and Canada (MAVAN). Both cohorts included anthropometric measurements, food choice tasks, and resting-state functional magnetic resonance imaging (fMRI) data. Results: In the Brazilian sample (17 ± 0.28 years, n=70), 21.4% of adolescents were classified as SGA. They exhibited lower monetary-related expenditure to buy a snack compared to controls in the food choice test. Decreased functional connectivity (n=40) between left OFC and left DL-PFC; and between right OFC and: left amygdala, right DS, and left DS were observed in the Brazilian SGA participants. Canadian SGA participants (14.9%) had non-significant differences in comparison with controls in a food choice task at 4 years old ( ± 0.01, n=315). At a follow-up brain scan visit (10.21 ± 0.140 years, n=49), SGA participants (28.6%) exhibited higher connectivity between the left OFC and left DL-PFC, also higher connectivity between the left OFC and right DL-PFC. We did not observe significant anthropometric neither nutrients' intake differences between groups in both samples. Conclusions: Resting-state fMRI results showed that SGA individuals had altered connectivity between areas involved in encoding the subjective value for available goods and decision-making in both samples, which can pose them in disadvantage when facing food options daily. Over the years, the cumulative exposure to particular food cues together with the altered behavior towards food, such as food purchasing, as seen in the adolescent cohort, can play a role in the long-term risk for developing chronic non-communicable diseases.

Perceived maternal care is associated with emotional eating in young adults.

INTRODUCTION: Early life adversity, including the perception of poor quality of maternal care, is associated with long-term metabolic and psychosocial consequences. The negative quality of mother/child relationship is associated with emotional overeating in young children, which is defined by eating in response to emotional arousal states such as fear, anger or anxiety. However, it is not known if this association persists through adolescence. Therefore, we aimed at verifying if maternal care during infancy can influence emotional eating in young adults. METHODS: Seventy-five adolescents, residents of Porto Alegre, who participated in the PROTAIA Program (anxiety disorder in childhood and adolescence program), answered the Parental Bonding Instrument (PBI - assessment of perceived maternal care), and the Dutch Eating Behavior Questionnaire (DEBQ). Regression analysis models were built to predict Emotional Eating, a domain of the DEBQ, using maternal care, gender, and anxiety as independent variables. RESULTS: The model was statistically significant when adjusted for potential confounders (r2 = 0.272; p < 0.0001). Emotional eating was significantly predicted by levels of maternal care, anxiety and gender (beta = -0.316; p = 0.006). CONCLUSION: The results demonstrated a negative association between the quality of maternal care and emotional eating in young adults, suggesting that the early environment could be involved on the development of eating disorders or on the differential eating behavior in adolescents with emotional disorders.

Decreased comfort food intake and allostatic load in adolescents carrying the A3669G variant of the glucocorticoid receptor gene.

BACKGROUND: The A3669G single nucleotide polymorphism (SNP) of the glucocorticoid receptor (GR) gene NR3C1 is associated with altered tissue sensitivity to glucocorticoids (GCs). GCs modulate the food reward circuitry and are implicated in increased intake of palatable foods, which can lead to the metabolic syndrome and obesity. We hypothesized that presence of the G variant of the A3669G SNP would affect preferences for palatable foods and alter metabolic, behavioural, and neural outcomes. METHODS: One hundred thirty-one adolescents were genotyped for the A3669G polymorphism, underwent anthropometric assessment and nutritional evaluations, and completed behavioural measures. A subsample of 74 subjects was followed for 5 years and performed a brain functional magnetic resonance imaging (fMRI) paradigm to verify brain activity in response to food cues. RESULTS: Sugar and total energy consumption were lower in A3669G G allele variant carriers. On follow-up, this group also had reduced serum insulin concentrations, increased insulin sensitivity, and lower anxiety scores. Because of our unbalanced sample sizes (31/37 participants non-G allele carriers/total), our imaging data analysis failed to find whole brain-corrected significant results in between-group t-tests. CONCLUSION: These results highlight that a genetic variation in the GR gene is associated, at the cellular level, with significant reduction in GC sensitivity, which, at cognitive and behavioural levels, translates to altered food intake and emotional stress response. This genetic variant might play a major role in decreasing risk for metabolic and psychiatric diseases.

Amygdala-based intrinsic functional connectivity and anxiety disorders in adolescents and young adults.

Anxiety disorders (AD) are the most prevalent group of psychiatric disorders in adolescents and young adults. Nevertheless, the pathophysiology of anxiety disorders is still poorly understood. This study investigated differences in the functional connectivity of intrinsic amygdala-based networks of participants with and without AD. Resting state fMRI data were obtained from 18 participants with an AD and 19 healthy comparison individuals. Psychiatric diagnosis was assessed using standardized structured interviews. The comparison between groups was carried out using functional connectivity maps from six seed regions defined using probabilistic maps bilaterally within the amygdala (basolateral, superficial and centromedial amygdala). We found significant between-group differences in five clusters, which showed aberrant functional connectivity with the left basolateral amygdala: right precentral gyrus, right cingulate gyrus, bilateral precuneus, and right superior frontal gyrus in subjects with AD as compared with the comparison subjects. For the comparison subjects, the correlations between the amygdala and the five clusters were either non-significant, or negative. The present study suggests there is an intrinsic disruption in the communication between left basolateral amygdala and a network of brain regions involved with emotion regulation, and with the default mode network in adolescents and young adults with anxiety disorders.

Interaction between perceived maternal care, anxiety symptoms, and the neurobehavioral response to palatable foods in adolescents.

Studies in rodents have shown that early life trauma leads to anxiety, increased stress responses to threatening situations, and modifies food intake in a new environment. However, these associations are still to be tested in humans. This study aimed to verify complex interactions among anxiety diagnosis, maternal care, and baseline cortisol on food intake in a new environment in humans. A community sample of 32 adolescents and young adults was evaluated for: psychiatric diagnosis using standardized interviews, maternal care using the Parental Bonding Inventory (PBI), caloric consumption in a new environment (meal choice at a snack bar), and salivary cortisol. They also performed a brain fMRI task including the visualization of palatable foods vs. neutral items. The study found a three-way interaction between anxiety diagnosis, maternal care, and baseline cortisol levels on the total calories consumed (snacks) in a new environment. This interaction means that for those with high maternal care, there were no significant associations between cortisol levels and food intake in a new environment. However, for those with low maternal care and who have an anxiety disorder (affected), cortisol was associated with higher food intake; whereas for those with low maternal care and who did not have an anxiety disorder (resilient), cortisol was negatively associated with lower food intake. In addition, higher anxiety symptoms were associated with decreased activation in the superior and middle frontal gyrus when visualizing palatable vs. neutral items in those reporting high maternal care. These results in humans mimic experimental research findings and demonstrate that a combination of anxiety diagnosis and maternal care moderate the relationship between the HPA axis functioning, anxiety, and feeding behavior in adolescents and young adults.

Musical intervention and food preferences in girls born with lower birth weight.

BACKGROUND: Children born after intrauterine growth restriction (IUGR), especially girls, show an increased intake of palatable foods in several developmental stages, which likely contributes to their increased risk for obesity later. Recently, neuroimaging studies suggested that musical exposure activates the mesolimbic region, which is also involved in the processing of food rewards. AIMS: We evaluated the impact of musical intervention in mother/infant pairs on feeding behavior during childhood with regard to birth weight. STUDY DESIGN: Cohort study. SUBJECTS: A total of 28 children exposed to a structured musical intervention in early life were invited for an anthropometric and nutritional evaluation, and were compared to a communitarian age-matched sample. OUTCOME MEASURES: A series of general linear models adjusted for socioeconomic status and maternal education were constructed to evaluate the interaction between music exposure, birth weight, and sex on the consumption of different types of foods, measured using a food frequency questionnaire. RESULTS: There was an interaction between birth weight, sex, and musical intervention on the consumption of sugar during childhood (Wald=7.87, df=2, p=0.02); control participants consumed more sugar as birth weight decreased (B=-8.673, p<0.0001). No such effect was found for the girls exposed to musical intervention (B=3.352, p=0.15) or for boys (exposed B=2.870, p=0.44; non-exposed B=3.706, p=0.236). The absence of other effects suggests that this finding is specific for sweet foods. CONCLUSION: Early music intervention in mother/infant pairs may moderate the effects of IUGR on palatable food preference in girls.

Poor infant inhibitory control predicts food fussiness in childhood - A possible protective role of n-3 PUFAs for vulnerable children.

Intrauterine growth restriction (IUGR) children are more impulsive towards a sweet reward and have altered feeding behavior in adulthood. We hypothesized that early life inhibitory control predicts feeding behaviors later on in childhood, and the consumption of n-3 PUFAs during infancy may protect IUGR children from developing problematic feeding behaviors. 156 children had information on the Early Childhood Behavior Questionnaire (ECBQ) at 18 months, Food Frequency Questionnaire at 48 months and Children׳s Eating Behavior Questionnaire (CEBQ) at 72 months. There was a significant negative correlation between inhibitory control at 18 months and food fussiness at 72 months. A GLM model predicting food fussiness at 72 months showed significant interaction between n-3 PUFAs, inhibitory control and IUGR, with higher intakes associated with decreased risk for fussiness in IUGR children with poor inhibitory control. Deficits in early inhibitory control predict later food fussiness, and higher intakes of n-3 PUFAs in infancy may protect IUGR children from developing such behavior later.

[Current debates on humanization and health: who are we?]. / Debates atuais em humanização e saúde: quem somos nós?

Bearing in mind that the Brazilian Unified Health System (SUS) is a social process in construction, and as health professionals are important individuals in this process, the role of permanent education as an important instrument to ensure humanized care is highlighted. The scope of this paper is to discuss the experience of the training course for health professionals of a public health outpatient unit, based on the prospect of humanized treatment, seeking the implementation of a sanitary model committed to the formal values contained in the SUS ideals. The teaching-learning methodology used is based on problem-solving, derived from the processing of a problem situation taken from the experience of teachers. The professionals identified that the standard established in the way of thinking and acting in health is unsatisfactory to meet the challenges faced in the sector. The strategies used contributed to systematize the content through reflection on the theoretical benchmarks submitted, by eliciting reflective and critical thought, which are fundamental aspects for broadening and increasing the process of empowerment of professionals. The course stimulated group action, placing the discussion on the humanization of health actions on the agenda.

Debates atuais em humanização e saúde: quem somos nós? / Current debates on humanization and health: who are we?

INTRODUÇÃO: Considerando ser o SUS um processo social em construção, e sendo os profissionais de saúde importantes sujeitos desse processo, destaca-se o papel da educação permanente como um relevante instrumento para a garantia do cuidado humanizado. OBJETIVO: discutir a experiência do curso de capacitação dos profissionais de saúde de uma Unidade de Saúde pública-ambulatorial, com base na perspectiva da humanização, visando a implementação de um modelo sanitário comprometido com os valores essenciais impressos nos ideais do SUS. MÉTODOS: A metodologia de ensino-aprendizagem utilizada baseou-se na problematização, utilizando-se do processamento de uma situação problema elaborada a partir da experiência dos docentes. RESULTADO: Os profissionais identificaram que o padrão instituído no modo de pensar e fazer em saúde é insatisfatório para suprir os desafios enfrentados no setor. As estratégias utilizadas contribuíram para sistematizar o conteúdo através da reflexão sobre os referenciais teóricos apresentados, ao estimular o pensamento reflexivo e crítico, aspectos estes fundamentais para ampliar e aprofundar o processo de empoderamento dos profissionais. CONCLUSÃO: o curso estimulou a grupalidade, colocando em pauta na agenda, a discussão sobre a humanização das ações em saúde.

Bearing in mind that the Brazilian Unified Health System (SUS) is a social process in construction, and as health professionals are important individuals in this process, the role of permanent education as an important instrument to ensure humanized care is highlighted. The scope of this paper is to discuss the experience of the training course for health professionals of a public health outpatient unit, based on the prospect of humanized treatment, seeking the implementation of a sanitary model committed to the formal values contained in the SUS ideals. The teaching-learning methodology used is based on problem-solving, derived from the processing of a problem situation taken from the experience of teachers. The professionals identified that the standard established in the way of thinking and acting in health is unsatisfactory to meet the challenges faced in the sector. The strategies used contributed to systematize the content through reflection on the theoretical benchmarks submitted, by eliciting reflective and critical thought, which are fundamental aspects for broadening and increasing the process of empowerment of professionals. The course stimulated group action, placing the discussion on the humanization of health actions on the agenda.

Perfil sociossanitário, gestacional e de aleitamento materno das gestantes cadastradas nas unidades de atenção primária à saúde de Viçosa - MG / Social-sanitary, pregnancy and breastfeeding profiles of pregnant women registered in Units of Primary Health Care in the town of Viçosa - Minas Gerais, Brazil

Introdução: o contexto de cada gestação é determinante para o seu desenvolvimento. Quando é favorável, fortalece os vínculos familiares, condição básica para o desenvolvimento saudável do ser humano, interferindo no processo de amamentação e cuidados com a mulher e a criança. Objetivo: traçar o perfil sociossanitário, gestacional e de aleitamento materno das gestantes cadastradas nas Unidades de Atenção Primária à Saúde (UAPS) de Viçosa-MG. Métodos: trata-se de estudo exploratório, longitudinal de intervenção, de abordagem quantiqualitativa. Participaram 70,97% (n=22) das gestantes cadastradas nas UAPS com data provável para o parto entre a primeira semana de agosto e a segunda de setembro de 2010. Para o presente estudo utilizaram-se os dados coletados no final da gestação por meio de entrevistas realizadas. Resultados: a mediana da idade das mulheres foi de 25 anos, oscilando entre 16 e 40 anos, e da renda per capita foi de 293,33 reais. A maioria (45,45%) possuía ensino fundamental incompleto e 45,45% estavam empregadas. A idade gestacional mediana foi de 38 semanas e 54,55% eram multíparas. Todas as participantes realizaram pré-natal na gestação atual, sendo que apenas 22,73% receberam orientações sobre aleitamento materno. A maioria das mulheres amamentou por menos de seis meses nas gestações anteriores e pretendia amamentar exclusivamente por quatro meses na atual. Conclusão: estes achados alertam para possível lacuna na atenção à saúde direcionada a esse grupo populacional, tornando-se necessário que se redimensionem as ações em prol da amamentação.

Introduction: The pregnancy context is crucial to its development, when it is favorable, strengthens family relationships, which is fundamental for the healthy development of the human being, interfering in the process of feeding, and also women and children care. Objective: To describe the social-sanitary, pregnancy and breastfeeding profiles for pregnant women registered in the Units of Primary Health Care (UPHC) at the town of Viçosa, Minas Gerais (MG) state, Brazil. Methods: This was an exploratory, longitudinal intervention of quantitative and qualitative approach. Took part in this study 70.97% (n = 22) of the women enrolled in UPHC with estimated dates for delivery between August and first week of September, 2010. Data were collected for the present study through interviews, during late pregnancy. Results: The median age of women was 25 years ranging between 16 and 40 years, with median per capita income of R$ 293.33 (Brazilian Real). The majority (45.45%) did not complete primary education and 45.45% were employed. The median gestational age was 38 weeks and 54.55% were multiparous. All participants received prenatal care in the present pregnancy, and only 22.73% received guidance about breastfeeding. The majority of women breastfed for less than six months in the previous pregnancies and plan to breastfeed exclusively for four months at this current one. Conclusion: These findings call attention for a possible gap in health care targeted at this population, that makes it necessary to resize the actions in promote breastfeeding.

[Evaluating child healthcare in the context of Family Healthcare in the city of Teixeiras, Minas Gerais (MG, Brazil)]. / Avaliação da atenção à saúde da criança no contexto da Saúde da Família no município de Teixeiras, Minas Gerais (MG, Brasil).

The scope of this study was to analyze child healthcare in the Family Healthcare Program (FHP) in Teixeiras, MG, Brazil. A descriptive transversal study was conducted by applying a questionnaire to 161 mothers of children under 2 years of age. A specific score system was used to analyze the dimensions of structure, process and result and the respective attributes, classifying the town in the incipient, intermediary and advanced categories. The FHP was classified in the intermediary (49.6%) category, characterized by fragmented child healthcare, though with some advances in the organization of care for this group. The physical installations, the quality of care given to control of diarrhea and respiratory infection, community participation and interdisciplinarity were considered incipient. Progress was seen in receptivity to the program, though the scant preventive and promotional activities of the FHP means that it is viewed as an annex to the hospital and merely another place for medical care. The activities of the FHP in child healthcare are not in line with the proposal for reorientation of the hegemonic healthcare model for which it was created, thereby hampering disease prevention strategies and the promotion of healthcare.

Avaliação da atenção à saúde da criança no contexto da Saúde da Família no município de Teixeiras, Minas Gerais (MG, Brasil) / Evaluating child healthcare in the context of Family Healthcare in the city of Teixeiras, Minas Gerais (MG, Brazil)

The scope of this study was to analyze child healthcare in the Family Healthcare Program (FHP) in Teixeiras, MG, Brazil. A descriptive transversal study was conducted by applying a questionnaire to 161 mothers of children under 2 years of age. A specific score system was used to analyze the dimensions of structure, process and result and the respective attributes, classifying the town in the incipient, intermediary and advanced categories. The FHP was classified in the intermediary (49.6 percent) category, characterized by fragmented child healthcare, though with some advances in the organization of care for this group. The physical installations, the quality of care given to control of diarrhea and respiratory infection, community participation and interdisciplinarity were considered incipient. Progress was seen in receptivity to the program, though the scant preventive and promotional activities of the FHP means that it is viewed as an annex to the hospital and merely another place for medical care. The activities of the FHP in child healthcare are not in line with the proposal for reorientation of the hegemonic healthcare model for which it was created, thereby hampering disease prevention strategies and the promotion of healthcare.

Este estudo tem como objetivo analisar a atenção à saúde da criança pelo Programa de Saúde da Família (PSF) do município de Teixeiras, MG, Brasil. Foi aplicado um questionário a 161 mães de crianças menores de dois anos. Utilizou-se um sistema de escores específicos para análise das dimensões de estrutura, processo e resultado e seus respectivos atributos, classificando o município nos cenários incipiente, intermediário e avançado. Configurou-se, na síntese, um cenário intermediário (49,6 por cento) para o PSF, caracterizado por uma atenção à saúde da criança fragmentada, mas com avanços na organização da atenção para este grupo. Foram consideradas incipientes as instalações físicas, a qualidade do cuidado no controle da diarréia e das infecções respiratórias, a participação comunitária e a intersetorialidade. Os avanços estiveram relacionados ao acolhimento realizado pelo programa, no entanto, as atividades preventivas e promocionais do PSF demonstram que o programa surge como um suporte do hospital e mais um local de atendimento médico. A atuação do PSF na atenção a saúde das crianças distancia-se da proposta de reorientação do modelo assistencial hegemônico, pela qual foi criado, dificultando estratégias na prevenção de doenças e na promoção da saúde.

Práticas de aleitamento materno: lacuna entre o conhecimento e a incorporação do saber / Practices of breastfeeding: A gap between knowledge and knowledge application

Introdução: a Organização Mundial da Saúde recomenda a prática de aleitamento materno exclusivo por seis meses e a partir dessa idade introduzir alimentos complementares até os dois anos. Objetivo: avaliar o nível de conhecimento e incorporação do saber sobre aleitamento materno de gestantes e nutrizes usuárias da Estratégia Saúde da Família, Teixeiras-MG. Casuística e método: foi realizado estudo transversal descritivo cuja coleta de dados se deu por meio de entrevistas individuais utilizando-se questionário semiestruturado, nas Unidades de Atenção Primária de Saúde, antes das consultas pré-natais e puericulturas e em visitas domiciliares. Resultados: a duração de aleitamento materno exclusivo relatado foi de quatro meses. Destaca-se que 66% das entrevistadas já haviam recebido algum tipo de orientação, 34% por meio de consultas pré-natais e 31% por palestras realizadas pela equipe de Nutrição da Universidade Federal de Viçosa. Observou-se que as mulheres que receberam orientação acerca do aleitamento materno apresentaram 99,93% menos de chance de responder que o leite é fraco, obtendo resultado estatisticamente significante. Conclusão: ressalta-se a importância das informações sobre aleitamento materno serem transmitidas à população de modo eficaz, estimulando a prática do aleitamento em todas as classes sociais.

Introduction: The World Health Organization recommends exclusive breastfeeding over the six months after birth, and complementary food should be provided after this period until age of 2 years. Objective: To assess breastfeeding knowledge and knowledge application among women assisted by the Family Health Strategy in Teixeiras, State of Minas Gerais, Brazil. Casuistics and method: A descriptive cross-sectional study of data collected by means of individual semi-structured interviews carried out before prenatal and childcare appointments at Primary Health Care Units as well as in domiciliary visits. Results: Exclusive breastfeeding was reported to take place for four months. Among the interviewees, 66% had had some orientation: 34% at prenatal appointments, and 31% at lectures organized by the Nutrition team of the Federal University of Viþosa. Women that had had breastfeeding orientation were 99,93% less likely to report that breast milk is weak ? a figure that is statistically significant. Conclusion: It is important that information on breastfeeding be given to population efficiently in order to encourage breastfeeding among all the social classes.

Hábitos e práticas alimentares de hipertensos e diabéticos: repensando o cuidado a partir da atenção primária / Dietary habits of hypertensive and diabetic patients: rethinking patient care through primary care

OBJETIVO: Identificar hábitos e práticas alimentares inadequados apresentados por hipertensos e diabéticos usuários da Estratégia Saúde da Família, de Teixeiras (MG), visando ao desenvolvimento de estratégias de intervenção em saúde. MÉTODOS: Estudo descritivo de delineamento transversal, utiliza questionários semi-estruturados para entrevistar 10,3 por cento dos hipertensos e 15,0 por cento dos diabéticos, selecionados de forma probabilística e aleatória. RESULTADOS: Houve uma predominância de mulheres (74,4 por cento), de idosos (média=63,59, DP=13,12 anos) e de pessoas com baixa renda (mediana=0,5 salário-mínimo). Os hipertensos e os diabéticos apresentaram, respectivamente, pequeno fracionamento das refeições (mediana=3,0/4,0), elevado consumo per capita diário de açúcar (M=165,63g, DP=118,93 e 105,13g, DP=48,7), sal (M=22,63g, DP=22,26 e M=12,96g, DP=16,73), óleo (M=64,13mL, DP=38,09 e M=61,29mL, DP=35,57) e banha de porco (18,8 por cento e 13,3 por cento). Entretanto, 97,3 por cento e 96,7 por cento não adicionavam sal às preparações prontas, 72,5 por cento e 86 por cento utilizavam somente óleo vegetal para preparar as refeições e 15,4 por cento e 90,0 por cento utilizavam adoçante artificial. CONCLUSÃO: Estratégias de cuidado em saúde devem ser desenvolvidas para incentivar mudanças nestes hábitos, objetivando a prevenção e o controle das complicações relacionadas a estas morbidades.

OBJECTIVE: This study aims to identify inappropriate dietary habits shown by hypertensive and diabetic patients registered in the Family Health Strategies Program, in the city of Teixeiras (MG), Brazil, aiming towards the development of health intervention strategies. METHODS: In this descriptive, cross-sectional study, semi-structured questionnaires were used to interview 10.3 percent of the hypertensive and 15.0 percent of the diabetic patients, which were probabilistically and randomly selected. RESULTS: Most (74.4 percent) of these patients were older women (mean age of 63.59, SD=13.12 years) with low income (an average of 0.5 minimum wage). These hypertensive and diabetic patients had a small number of daily meals (mean=3.0/4.0) and consumed high amounts of sugar (M=165.63g, SD=118.93 and M=105.13g, SD=48.7), salt (M=22.63g, SD=22.26 and M=12.96g, SD=16.73), oil (M=60g, SD=43.23), and lard (18.8 percent and 13.3 percent) daily. However, 97.3 percent and 96.7 percent respectively did not add salt to the ready-to-eat preparations, 72.5 percent and 86 percent respectively used only vegetable oil to prepare their meals, and 15.4 percent and 90 percent respectively of the interviewed patients used artificial sweetener. CONCLUSION: Heath care strategies need to be developed to stimulate changes in these habits to prevent and control the complications related to these morbidities.

[Social-sanitary and lifestyle profile of hypertense and/or diabetics, users of the Family Health Program in the city of Teixeiras, Minas Gerais State]. / Perfil sociossanitário e estilo de vida de hipertensos e/ou diabéticos, usuários do Programa de Saúde da Família no município de Teixeiras, MG.

The objective of this study was to outline the social-sanitary profile and the lifestyle of hypertense and/or diabetic people from the city of Texeiras- MG. Semi-structured household interviews were conducted with hypertensive and/or diabetic people randomly selected from the Family Health Program of the city of Teixeiras--MG. A total of 150 hypertensive (10% of the hypertensive population) and 30 diabetics (12.98% of the diabetic population) people were interviewed. There were a predominance of elder people (average age = 63.59 + 13.12 years old), mostly women (74.4%), with low literacy (40.9% of illiterates) and low income (average = 0.5 minimum wage). The treatment was basically the use of medication (96.6%), and there was a high prevalence of sedentary people (67.4%). Besides that, there was a daily high intake per capita of sugar (153 g + 110.66 g), salt (18 g + 21.26 g) and oil (60 g + 43.23 g) . The results of this study showed the importance of a multi-professional intervention by means of the Family Health Program with the objective of promoting the adoption of healthy habits and lifestyle in order to prevent complications of these morbidities, and to provide a better life quality to these people.

Aspectos relacionados aos hábitos e práticas alimentares de gestantes e mães de crianças menores de dois anos de idade: o programa saúde da família em pauta / Aspects related to alimentary practices and habits of pregnant women and mothers of children less than two years of age: the program health of the family in focus / Aspectos relacionados con las prácticas y los hábitos alimenticios de mujeres embarazadas y de madres de niños con menos de dos años de edad: el programa salud de la familia en foco

A nutrição materna exerce grande impacto no resultado da gestação e sobre a saúde da mulher e da criança durante a lactação. O artigo relata um estudo transversal, realizado de abril a julho de 2007, com 80,76 por cento (n igual a 21) das gestantes e 55,53 por cento (n igual a 62) das mães do meio urbano,atendidas no Programa Saúde da Família do município de Teixeiras-MG, com o objetivo de conhecer aspectos relacionados aos seus hábitos e práticasalimentares. Os dados foram levantados com auxílio de questionários durante visitas domiciliares e analisados no programa SPSS for Windows versão 11.5. Os resultados mostraram inadequações em aspectos como: consumo hídrico médio abaixo das recomendações (3,0 L por dia e 3,8 L por dia) em 90,47 por cento das gestantes e em 100 por cento das mães, respectivamente. Observou-se um elevado consumo per capita diário de sal, açúcar e óleo; com médias equivalentesa 7,33 g, 73,25 g e 33,94 mL nas gestantes e 6,51 g, 63,7 g e 25,59 mL nas mães. Diante disso, percebe-se a necessidade de estratégias de atenção à saúde a esse grupo populacional referente ao cuidado nutricional, destacando-se a educação para a saúde com conscientização da necessidade de adoção de hábitos e estilos de vida saudáveis visando à promoção da saúde e prevenção de agravos e enfermidades.

Mothers’ nutrition has a great impact in gestation and on pregnant women health and children during lactation. The article reports atransversal study carried through from April to July 2007 with 80,76 per cent (n iqual for equal for 21) of urban pregnant women and 55,53 per cent (n equal for 62) of mothers assistedby the Program Health of the Family in Teixeiras-MG aiming to know aspects related to alimentary practices and habits. Data were collected bydomiciliary questionnaires during visits and analyzed by the SPSS for Windows program, version 11.5. Results show inadequate habits regarding anaverage hydric substances’ consumption below the recommendations (3,0 L for day and 3,8 L for day) in 90.47 per cent of pregnant women and 100 per cent of mothers, respectively. One observed a high daily per capita consumption of salt, sugar and oil; with averages of 7,33 g, 73,25 g and 33,94 mL in pregnant womenand 6,51 g, 63,7 g and 25,59 mL in mothers. This proves the necessity of developing strategies of health assistance directed to this population group as regards nutritional care, mainly education for health with awareness of the necessity of adopting healthful habits and styles of life aiming to thepromotion of health and the prevention of aggravations and diseases.

La nutrición de las madres tiene un gran impacto en la gestación y en la salud de niños y mujeres embarazadas durante la lactancia.El artículo relata un estudio transversal ejecutado de abril a julio de 2007 con 80,76 por ciento (n = 21) mujeres embarazadas urbanas y 55,53 por ciento (n = 62) madres asistidas por el programa Salud de la Familia en Teixeiras-MG que apunta identificar aspectos relacionados con las prácticas y los hábitosalimenticios. Los datos fueron recogidos con cuestionarios domiciliarios durante visitas y analizados por el programa SPSS for Windows, versión 11.5. Los resultados demuestran hábitos inadecuados respecto el consumo de sustancias hídricas en medias abajo las recomendaciones (3,0L por día y 3,8L por día) en 90,47 por ciento para mujeres embarazadas y 100 por ciento de madres, respectivamente. Uno observó un consumo del individual diariamente de sal,del azúcar y del aceite; con medias de 7,33 g, 73,25 g y 33,94 mL en mujeres embarazadas y 6,51 g, 63,7 g y 25,59 mL en madres. Esto demuestra sernecesario crear estrategias de ayuda a la salud dirigidas a este grupo de la población en lo que concierne al cuidado alimenticio, principalmenteeducación para la salud con el conocimiento de la necesidad de adoptar hábitos y estilos de la vida saludables que apuntan a la promoción de lasalud y a la prevención de agraves y de enfermedades.

Perfil sociossanitário e estilo de vida de hipertensos e/ou diabéticos, usuários do Programa de Saúde da Família no município de Teixeiras, MG / Social-sanitary and lifestyle profile of hypertense and/or diabetics, users of the Family Health Program in the city of Teixeiras, Minas Gerais State

O objetivo deste estudo foi traçar o perfil sociossanitário e estilo de vida da população hipertensa e/ou diabética do município de Teixeiras (MG). Foram realizadas entrevistas semi-estruturadas nos domicílios de hipertensos e/ou diabéticos cadastrados no Programa de Saúde da Família de Teixeiras (MG), selecionados aleatoriamente. Foram entrevistados 150 hipertensos (10,33 por cento da população hipertensa) e 30 diabéticos (15 por cento da população diabética), havendo uma predominância de indivíduos idosos (idade média=63,59 + 13,12 anos), do sexo feminino (74,4 por cento), de baixa escolaridade (40,9 por cento de analfabetismo) e de baixa renda (mediana de 0,5 salário mínimo). O tratamento destas morbidades foi basicamente medicamentoso (96,6 por cento); houve uma elevada prevalência do sedentarismo (67,4 por cento). Além disso, houve um grande consumo per capita diário de açúcar (153g + 110,66g), sal (18g + 21,26g) e óleo (60g + 43,23g). Os resultados obtidos apontam para a importância de intervenções multiprofissionais, por meio do Programa de Saúde da Família, com o objetivo de promover a adoção de hábitos e estilos de vida saudáveis, prevenir complicações dessas doenças e proporcionar melhoria da qualidade de vida.

The objective of this study was to outline the social-sanitary profile and the lifestyle of hypertense and/or diabetic people from the city of Texeiras- MG. Semi-structured household interviews were conducted with hypertensive and/or diabetic people randomly selected from the Family Health Program of the city of Teixeiras - MG. A total of 150 hypertensive (10 percent of the hypertensive population) and 30 diabetics (12.98 percent of the diabetic population) people were interviewed. There were a predominance of elder people (average age = 63.59 + 13.12 years old), mostly women (74.4 percent), with low literacy (40.9 percent of illiterates) and low income (average = 0.5 minimum wage). The treatment was basically the use of medication (96.6 percent), and there was a high prevalence of sedentary people (67.4 percent). Besides that, there was a daily high intake per capita of sugar (153g + 110.66g), salt (18 g + 21.26g) and oil (60 g + 43.23g) . The results of this study showed the importance of a multi-professional intervention by means of the Family Health Program with the objective of promoting the adoption of healthy habits and lifestyle in order to prevent complications of these morbidities, and to provide a better life quality to these people.

Reflexões sobre o conhecimento dos usuários no contexto do Programa de Saúde da Família: a lacuna entre o saber técnico e o popular / Reflections on the knowledge of patients from the Family Health Program: the gap between technical and popular knowledge

Tem por objetivo avaliar o conhecimento dos hipertensos e diabéticos cadastrados no Programa de Saúde daFamília do município de Teixeiras-MG, sobre suas patologias, visando ao desenvolvimento de estratégias de empoderamento/ libertação deste grupo populacional, essenciais na viabilizaçãode políticas de promoção da saúde, prevenção e controle destas enfermidades. Estudo transversal, realizado por meio da aplicação de questionários semi-estruturados através de entrevistas a uma amostra de 10,33% dos hipertensos e 15% dos diabéticos. Houve predominância de indivíduos idosos, do sexo feminino, de baixa escolaridade e renda; 40,0% dosdiabéticos e 69,14% dos hipertensos não souberam conceituar as doenças. Em relação ao nível de conhecimento sobre as causas e sintomas, 50% dos diabéticos as desconheciam; dos hipertensos, 37,14% desconheciam as causas e 12,57%, os sintomas. Em relação às complicações decorrentes das doenças, 33,33% dos diabéticos e 33,14% dos hipertensos as desconheciam. Quanto às formas de tratamento, 16,67% dos diabéticos e 10,86% dos hipertensos não souberam informar. Destaca-se a importância da implementação de estratégias de cuidado em saúde a estes grupos populacionais, voltadas à conscientização sanitária e aos fatores condicionantes e complicadores das enfermidades, visando a proporcionar uma educação em saúde mais efetiva, visto que a mudança de hábitos e a conscientização jamais se separam - toda transformação deve estar intimamente associada à tomada deconsciência da situação real vivida pelo sujeito. Para isto é necessário o comprometimento dos profissionais de saúde, visando a uma participação livre e crítica dos usuários, contribuindo para o empoderamento/libertação deste grupo populacional, questões essenciais para a viabilização de políticas de promoção da saúde e prevenção de agravos e controle de enfermidades.

This paper aims to evaluate the knowledge of the diabetic and high blood pressure patients from the Family Health Program in the city of Teixeiras-MG, about their illnesses, aiming to develop their empowering/freedom strategies, essential to promote health, to prevent and control such diseases. It is a cross-sectional study, with semistructured questionnaires, interviewing 10.33% of the high bloodpressure and to 15% of the diabetic patients. Most patients were aged individuals, female, with low educational level and income. A total of 40.0% of the diabetic, and 69.14% of the high blood pressure patients could not define these diseases; 50% of the diabetic could not tell the cause and symptoms of their disease; 37.14% of the high blood pressure patients were unaware of the cause and 12.57% were unaware of their symptoms. In terms of the complications associated to their diseases, 33.14% of the diabetic and 33.33% of the high blood pressure patients were unaware of them. About 16.67% of the diabetic and 10.86% of the high blood pressure patients could not inform how to treat these diseases. It is important to implement health carestrategies for these population groups, aiming awareness of health, its conditioning factors, and factors that complicate the diseases, so as to have a more effective health education process, once the changes in habits and awareness should always together be side by side - every transformation should be closely associated to the awareness of the situation which the subject lives. The latter takes the commitment of the health care staff, aiming a free and critical participation of the users, contributing to the empowering/freedom of this population, essential to the development of health promotion policies, prevention of disorders and diseases control.