Delayed Development of Feeding Skills in Children with Feeding Difficulties-Cross-sectional Study in a Brazilian Reference Center.

BACKGROUND: Delays in gross motor development, sensory processing issues, and organic and behavioral problems are known to interfere in the development of feeding skills (FS); and-therefore-in the success of the process of feeding a child. Children with feeding difficulties (FD) commonly present inadequacy of FS. OBJECTIVES: Assessment of five FS in Brazilian children with FD, and search of associations with types of FD. METHODS: Cross-sectional study with 70 children below 10 years old. Data were obtained from medical records: age, gender, age at texture transitions, feeding phase (breastfeeding, weaning to solids or full solids) at first complaint; characteristics of the meal (duration, environment, and shared meals with adults), self-feeding practices, use of feeding equipment and bottle, mouthing, feeding position and FD diagnosis. Skills were categorized according to standards for age. Chi-Square, Anova Test (or non-parametric equivalent) and Multinomial logistic regression tests were used, with a significance level of 5%. RESULTS: There was no difference in FS (p > 0.05) or in the number of FS inadequateness (p = 0.84) according to FD diagnosis. The majority (94%) of children presented at least one delayed development of FS; 1/3 presented delays in more than half of the FS. The most prevalent inadequacies in FS were inadequate feeding position (73.5%), prolonged bottle feeding (56.9%), and inadequate self-feeding practices (37.9%). Feeding complaints first appeared at 10.9 ± 11.4 months, and picky eating was the most prevalent type of FD (37.1%). Most children were fed in inadequate environments (55.2%), without the company of adults (78%). Transition to solid foods occurred at 16 ± 5.6 months. Multinomial logistic regression showed no difference in likelihood of presenting any type of FD compared to picky eating, according to FS. Age at texture transition both from breastfeeding to complementary feeding (p = 0.95), and from complementary feeding to solid foods (p = 0.43) did not vary according to FD diagnosis. CONCLUSION: FS development or number of FS inadequateness did not vary according to FD diagnosis. Identification of these inadequacies could help the discussion for multi-professional treatment of patients with FD.

Does family mealtime have a protective effect on obesity and good eating habits in young people? A 2000-2016 review / Fazer refeições em família tem efeito protetor para a obesidade e bons hábitos alimentares na juventude? Revisão de 2000 a 2016

Abstract Objectives: to review the prevalence of family meals and its impact on BMI and eating habits during childhood and adolescence. Methods: reviews are from Bireme / Lilacs / Scielo / Cochrane and Pubmed, between 2000-2016 with descriptors "family meal or mealtime", "behavior", "nutrition or diet or consumption or eating", and "child or children or adolescence"; performed by two independent examiners, according to the systematic steps in English and Portuguese. The articles were selected based on prevalence and/ or discussion between nutritional variables. 2,319 articles were found, which 15 were selected all in English: systematic reviews (n=2), cross-sectional studies (n=8), longitudinal studies (n=8); all related to children (n=5), adolescents (n=6) and both (n=5). Results: the mean of shared meals was 1x/day, with a prevalence of 27 to 81%. Most studies (n=13) reported the beneficial impact on BMI, higher consumption of fruit and vegetables, protein, calcium and a lower consumption of sweets and sugar sweetened beverages, family union and self-regulation of appetite. Conclusions: having daily family mealtime has beneficial effect on the nutritional status and children and adolescents' eating behavior.

Resumo Objetivos: revisar a prevalência da prática de refeições em família e seu impacto no IMC e no comportamento alimentar durante a infância e adolescência. Métodos: revisão nas bases Bireme / Lilacs / Scielo / Cochrane e Pubmed, entre 2000 a 2016, com descritores "refeição em família", "comportamento", "alimentação ou dieta ou ingestão alimentar" e "criança/adolescentes"; realizada por dois examinadores independentes e segundo etapas sistemáticas, em inglês e português. Foram selecionados trabalhos que apresentassem a prevalência e/ou discussão de relações entre variáveis nutricionais. Foram encontrados 2319 artigos, dos quais 15 foram selecionados, todos na língua inglesa: revisões sistemáticas (n=2), estudos transversais (n=8), estudos longitudinais (n=8); todos com crianças (n=5), adolescentes (n=6) e ambos (n=5). Resultados: a média de compartilhamento de refeições foi de 1x/dia, com prevalência de 27 a 81%. A maioria dos estudos (n=13) descreveu impacto benéfico sobre o IMC, maior consumo de FLV, proteínas, fontes de cálcio e menor consumo de doces e bebida adoçadas, união familiar e auto regulação do apetite. Conclusões: a realização das refeições em família diariamente exerce efeito benéfico sobre o estado nutricional e comportamento alimentar de crianças e adolescentes.

Effect of nitrate withdrawal on quality of life and adherence to treatment in patients with stable angina: evidence from a randomized clinical trial.

BACKGROUND: Long-term nitrate treatment of stable angina is associated with side effects that can interfere with health-related quality of life (HRQoL) and medication adherence. The aim of the present study was to compare HRQoL and adherence to treatment in patients with stable angina undergoing nitrate withdrawal or maintenance. METHODS: This study is a randomized clinical trial. Patients were allocated to an intervention group (nitrate withdrawal followed by introduction of placebo) or a control group (nitrate maintenance). The assessments were made at baseline and 30 and 120 days using the Short Form Health Survey and the Seattle Angina Questionnaire. Treatment adherence was measured on the basis of the Morisky scale and pill count. RESULTS: A total of 105 patients with stable angina were randomized for replacement of nitrate with placebo (n=51) and for maintenance of treatment with nitrate (n=54). After 4 months, Short Form Health Survey scores increased for bodily pain (P=0.005) and general health (P=0.004) in the nitrate maintenance group. Decreased Seattle Angina Questionnaire scores were also noted for physical limitations (P=0.039) and angina frequency (P=0.011) in the nitrate maintenance group. However, the effect size was small (≤0.44) when the intervention and control groups were compared. At the end of the study, adherence was significantly higher in the placebo group (P=0.041), but no difference was detected between the groups with the pill count method. CONCLUSION: HRQoL was similar in patients with stable angina using nitrate regularly as compared with patients undergoing nitrate withdrawal. However, adherence to treatment was lower in nitrate users according to the Morisky scale.

Evaluation of strategies of care in the secondary prevention of heart disease: critical appraisal of a cluster randomized trial.

Evaluation of: Murphy AW, Cupples ME, Smith SM, Byrne M, Myrne MC, Newell J; for the SPHERE study team: Effect of tailored practice and patients care plans on secondary prevention of heart disease in general practice: cluster randomized controlled trial. BMJ 339, B4220 (2009). Coronary heart disease is the main cause of morbidity/mortality in developed countries and the costs of this epidemic are a major concern and a focus of public health policies. The cornerstone in controlling the incidence of coronary heart disease is the management of risk factors and an evaluation of the best strategy is of the greatest importance. Murphy et al. conducted a cluster randomized trial to evaluate the strategies of tailored practice and patient care plans on secondary prevention of heart disease in general practice. The study found that at 18 months of follow-up, there were no significant differences between intervention and control groups in the proportion of patients above the recommended limits of systolic blood pressure, diastolic blood pressure and total cholesterol concentrations. The number of patients admitted to hospital significantly decreased in the intervention group. Although secondary prevention programs have positive impacts on the process of care, the benefit was clear after a longer period of follow-up in many studies. The practice of preventive cardiology in patients with coronary heart disease is difficult to achieve, particularly when the population already had a lower prevalence of uncontrolled risk factors, as Murphy et al. found in their study. It is possible that the patients included in this and other studies were at a sufficiently low risk that the likelihood of detecting a beneficial effect in a short period of time was small. There is good evidence that healthcare professionals can help patients; nonetheless, they also need guidance and programs to help them. Some questions regarding these multidisciplinary programs also remain to be answered, and their cost-effectiveness remains unclear. The incremental benefit of secondary prevention programs may be very small in the settings in which those trials were performed, but they certainly will be beneficial in settings where usual care is less optimal; these scenarios are often found around the world.