Association of electrical bioimpedance vectors with the nutritional classification of vulnerable multiethnic children.

BACKGROUND & AIMS: Monitoring growth and body composition in childhood is vital for early detection of health and nutrition problems during child development. The bioelectrical impedance vector analysis (BIVA) revealed its effectiveness as an indicator of nutritional status. This study aimed to measure the bioimpedance vectors of a sample of multiethnic children and evaluate the utility of BIVA for the classification of the nutritional status in a group of children with greater vulnerability, including in the presence of obesity. METHODS: This is a cross-sectional study that analyzed the bioelectrical impedance of a sample of 321 children from public daycare centers, aged 1-4 years, using the RXc graph method (tetrapolar analysis at 50 kHz frequency). The 95%, 75%, and 50% tolerance ellipses were plotted by age group. The Z-scores of bioimpedance parameters (Xc/H-Z and R/H-Z) were calculated regarding age, which were used to build reference tolerance ellipses for a single group, regardless of age. Such ellipses were evaluated for their ability to recognize the pattern and classify the deviations, using individual vectors of obese children. RESULTS: The mean impedance vectors showed progressively higher reactances and lower resistances with age. In the group of obese children, the individual vectors located outside the 95% baseline tolerance ellipse were 12.5%, 18.75%, and 11.1% of the cases for the WHZ, WAZ, and BMIZ criteria, respectively, all above the expected 5%, but much below expectations. This may be a problem with the obesity criteria used, as WHZ, WAZ, and BMIZ do not differentiate fat from lean mass. CONCLUSION: Bioimpedance vector analysis reflects differences in the bioelectric patterns of children classified as obese. Provided the obesity criteria are constructed based on fat measurements, rather than lean mass, the use of tolerance ellipses in the BIVA chart is promising as a tool for monitoring nutritional status where measuring body composition is difficult, because constant tissue hydration cannot be assumed.

Factors associated with neonatal near miss in Brazil.

OBJECTIVE: This study evaluates the association between sociodemographic factors, maternal characteristics, organization of health services and neonatal near miss in public and private maternity hospitals in Brazil. METHODS: This is a prospective cohort of live births from the Nascer no Brasil survey, carried out between 2011 and 2012. Variables were established from the literature and organized on three levels: distal, intermediate, and proximal. The assessment was performed based on results of the bivariate analyzes and their respective p-values, with a significance level <0.20, using the Wald test. For multivariate analysis, the variables contained at the distal level were inserted, preserved in the model when significant (p < 0.05). This was also done when adjusting the intermediate and proximal levels. RESULTS: At the distal level, no variable was significantly associated with the outcome. At the intermediate level, mother's age greater than or equal to 35 years (relative risk - RR = 1.32; 95%CI 1.04-1.66), cesarean delivery (RR = 1.34; 95%CI 1.07-1.67), smoking (RR = 1.48; 95%CI 1.04-2.10), gestational hypertensive syndrome (RR = 2.29; 95%CI 1.98-3.14), pre-gestational diabetes (RR = 2.63; 95%CI 1.36-5.05) and twin pregnancy (RR = 2.98; 95%CI 1.90-4.68) were variables associated with the outcome. At the proximal level, inadequate prenatal care (RR = 1.71; 95%CI 1.36-2.16) and the hospital/maternity being located in a capital city (RR = 1.89; 95%CI 1.40-2.55) were associated with neonatal near miss. CONCLUSIONS: The results show that neonatal near miss was influenced by variables related to the organization of health services and by maternal characteristics.

Contribution to the Journal Ciência & Saúde Coletiva on Food and Nutrition in Brazil. / Contribuição da Revista Ciência & Saúde Coletiva para a área de Alimentação e Nutrição no Brasil.

A systematic review conducted in January 2020 using SciELO database with the objective of analyzing the scientific production from 1996-2019, of the Journal Ciência & Saúde Coletiva in the area of food and nutrition. We selected 509 out of the 904 articles screened by titles and abstracts. We grouped the articles into ten themes and discussed the most frequent ones: Nutritional Status Assessment (n=142), Food Intake (n=111), Food and Nutrition Policies and Programmes (n=105) and Breastfeeding (n=35). The publications were mostly original articles (75.6%) employing quantitative method (81.6%) and, among these, 18.8% used a probabilistic sampling. We assembled a wide range of topics and subthemes, a relevant production and repository of data and knowledge for health professionals and managers. As gaps, there was a scarcity of publications focused on micronutrient deficiency; the promotion of the Food Guide for the Brazilian Population; supporting the rise of breastfeeding, the impact and analyses of the disruption of the National Food and Nutrition Security Policy and its multi sector interactions with social policies to fight hunger.

Revisão sistemática realizada em janeiro de 2020 na base de dados SciELO com o objetivo de analisar a produção científica da Revista Ciência & Saúde Coletiva na área de alimentação e nutrição no período 1996-2019. A busca resultou em 904 artigos e 509 foram selecionados após leitura dos títulos e resumos. Os artigos foram agrupados em dez temas, sendo discutidos os de maior frequência: Avaliação do Estado Nutricional (n=142), Consumo Alimentar (n=111), Políticas e Programas de Alimentação e Nutrição (n=105) e Aleitamento Materno (n=35). As publicações foram em sua maioria artigos originais (75,6%) com método quantitativo (81,6%) e, entre estes, 18,8% utilizaram amostra probabilística. Observou-se um amplo leque de temas e subtemas abordados, evidenciando uma produção relevante que constitui um repositório importante de dados e conhecimentos para profissionais e gestores da área da saúde. Como lacunas, observou-se a escassez de publicações voltadas para a deficiência de micronutrientes; a popularização do Guia Alimentar para População Brasileira; a promoção da ascensão do aleitamento materno; os diagnósticos da descontinuidade da Política Nacional de Segurança Alimentar e Nutricional e suas articulações intersetoriais com as políticas sociais de combate à fome.

Professional who attended childbirth and breastfeeding in the first hour of life.

OBJECTIVES: To investigate the association between the professionals who attended vaginal delivery and breastfeeding in the first hour of life. METHODS: This is a cross-sectional study with data from the Nascer no Brasil (Born in Brazil) survey, conducted in the 2011-2012 period. Data from 8,466 puerperae were analyzed using a logistic regression model with a hierarchical approach. RESULTS: The proportion of mothers who breastfed at birth was higher in deliveries attended by nurses (70%). A nurse-assisted delivery was 64% more likely to breastfeed in the first hour of life. Other factors associated with the outcome: residing in the North; age less than 35 years; multiparity; prenatal guidance on breastfeeding in the first hour of life; birth at Baby-Friendly Hospital; companion at birth; and female newborn. CONCLUSIONS: Obstetrician nurse/nurse-assisted delivery was a significant independent factor associated with breastfeeding in the first hour of life, suggesting the importance of strengthening the role of the obstetrician nurse.

High-resolution computed tomography findings in young infants with cystic fibrosis detected by newborn screening.

OBJECTIVE: High-resolution computed tomography (HRCT) allows the early detection of pathological changes in the lung structure, and reproducible scoring systems can be used to quantify chest computed tomography (CT) findings in patients with cystic fibrosis (CF). The aim of the study was to describe early HRCT findings according to a validated scoring system in infants with CF diagnosed by newborn screening (NBS). METHODS: This cross-sectional study included infants with CF diagnosed by NBS who were born between January 2013 and January 2017 and who underwent HRCT scanning within the first year after diagnosis when they were clinically stable. The CT scans were evaluated using the modified Bhalla score. RESULTS: Thirty-two subjects underwent HRCT scanning. The mean total-modified Bhalla score was 3.6±2.1, and 93.8% of the scans were abnormal. Pseudomonas aeruginosa airway colonization was associated with increased modified Bhalla score values. Bronchial wall thickening was the most common feature (90.6%), followed by bronchial collapse/consolidation (59.4%), mosaic attenuation/perfusion (50%), bronchiectasis (37.5%) and mucus plugging (15.6%). Bronchial wall thickening was diffuse in most of the patients. CONCLUSION: A substantial proportion of infants diagnosed with CF after detection by NBS already showed evidence of lung disease. P. aeruginosa colonization was associated with increased Bhalla scores, highlighting the importance of this CF pathogen in early structural lung disease. The presence of bronchial wall thickening at such a young age may reflect the presence of airway inflammatory processes. The detection and quantification of structural abnormalities with the modified Bhalla score may aid in the identification of lung disease before it is clinically apparent.

[Use of rehabilitation services by technology-dependent children and adolescents in a maternal and child hospital in Rio de Janeiro, Brazil]. / Utilização de serviços de reabilitação pelas crianças e adolescentes dependentes de tecnologia de um hospital materno-infantil no Rio de Janeiro, Brasil.

The objective of this study was to describe the dependence on technology and use of rehabilitation services by children and adolescents in a maternal and child hospital in Rio de Janeiro, Brazil. Using a cross-sectional design, the following variables were analyzed: gender and age of the children and adolescents, socioeconomic characteristics of the family, technology dependence, and use of rehabilitation services. The majority of the study population consisted of preschoolers (56.3%), boys (58.3%), residing in Greater Metropolitan Rio de Janeiro (89.3%), from low-income families (70.9%), and cared for mainly by their mothers (93.8%), who in turn have low schooling (54.2%) and are unemployed (89.6%). Of the entire study population, 22.9% were dependent on more than three different technologies, with medication as the most prevalent. Government and nonprofit institutions fund the rehabilitation, and physical therapists are the most widely used health professionals during treatment (60.4%). The target hospital provides all of the specialized medical treatment and most of the rehabilitation.

Lack of association between iron status at birth and growth of preterm infants.

OBJECTIVE: To assess the association between iron status at birth and growth of preterm infants. METHODS: Ninety-five premature babies (26 to 36 weeks of gestational age) born from July 2000 to May 2001 in a public hospital in Rio de Janeiro, Southeastern Brazil, were followed up for six months, corrected by gestational age. Iron measurements at birth were available for 82 mothers and 78 children: hemoglobin, hematocrit, mean corpuscular volume and plasma iron. All children received free doses of iron supplement (2 mg/kg/day) during the follow-up period and up to two years of age. Multivariate linear regression analyses with repeated measurements were performed to assess factors associated to linear growth. RESULTS: Growth was more pronounced up to 40 weeks of gestational age, increasing about 1.0 cm/week and then slowing down to 0.75 cm/week. The multivariate analysis showed growth was positively associated with birth weight (0.4 cm/100 g; p<0.001) and negatively associated with gestational age at birth (-0.5 cm/week; p<0.001). There was no association between cord iron and mother iron measurements and growth (p>0.60 for all measures). Only two children had anemia at birth, whereas 43.9% of mothers were anemic (hemoglobin <11 g/dl). Also, there was no correlation between anemia indicators of mothers and children at birth (r<0.15; p>0.20). CONCLUSIONS: Maternal anemia was not associated with anemia in preterm infants and iron status of mothers and children at birth was not associated with short-term growth of preterm infants.

[Arterial prehypertension and elevated pulse pressure in adolescents: prevalence and associated factors]. / Pré-hipertensão arterial e pressão de pulso aumentada em adolescentes: prevalência e fatores associados.

OBJECTIVE: To estimate the prevalence of prehypertension and elevated pulse pressure in adolescents and assess the association between those two conditions and sex, age, sexual development, obesity and physical activity. METHODS: Anthropometrical data and blood pressure were measured in and a questionnaire was applied to 456 adolescents (aged 12 to 17 years) recruited from public and private schools, in the Fonseca district, in the city of Niterói, state of Rio de Janeiro, Brazil, from 2003 to 2004. RESULTS: Thirty nine (8.6%) presented prehypertension (PH) and 13.4%, elevated pulse pressure (PP). At bivariate analysis, PH was significantly associated with sex, age and obesity, with more prevalent in boys aged between 15 and 17 years, and in the obese. Elevated PP was associated with gender only, as it was more prevalent in boys. Sexual maturation did not show an association with PH or elevated PP. Similar correlations were found at logistic regression. PH prevalence odds ratio was 7.7 for sex, 4.3 for age and 4.6 for obesity. Elevated PP prevalence odds ratio was 10.8 for sex. The correlation between PP and physical activity was positive and significant. The elevation of PP was attributable to systolic blood pressure. CONCLUSION: PH and the elevated PP were shown to be present in adolescents from a population with a low prevalence of hypertension, mostly in boys. Further prospective studies are necessary to assess the persistence and the impact of those conditions.

[Abortion and stigma: an analysis of the scientific literature on the theme]. / Aborto e estigma: uma análise da produção científica sobre a temática.

This article analyzes the scientific output on abortion and social stigma and the potential of the stigma category for abortion care in Brazil. An integrative review of publications on scientific databases without a time limit was conducted. Sixty-five publications with the social representations of women who had an abortion and the professionals who attended them were analyzed. The obstacles to the implementation of abortion laws and the protocols and norms that facilitate access to quality services care was explored. The conceptual relevance of Erving Goffman was a key element for the understanding of the gender transgression stereotypes, the imperative of motherhood, sexual purity, which tarnishes women who have abortions as inferior, damaged, promiscuous, sinful and murderous. Groups most affected by stigmatization were identified, namely women having an abortion and health professionals. Female conflicts due to the duality of concealing/revealing their abortions, the professional's conscientious objection and the obstacles facing the implementation of public policies emerged from the study. Reflecting on the role of stigma may interfere in the cycle of clandestine abortion and contribute to the (re)design of interventions that help to reduce damage to the sexual and reproductive health of women.

[Use of a monitoring tool for growth and development in Brazilian children - systematic literature review]. / Uso de instrumento de acompanhamento do crescimento e desenvolvimento da criança no Brasil - Revisão sistemática de literatura.

OBJECTIVE: To assess the use of a health monitoring tool in Brazilian children, with emphasis on the variables related to growth and development, which are crucial aspects of child health care. DATA SOURCE: A systematic review of the literature was carried out in studies performed in Brazil, using the Cochrane Brazil, Lilacs, SciELO and Medline databases. The descriptors and keywords used were "growth and development", "child development", "child health record", "child health handbook", "health record and child" and "child handbook", as well as the equivalent terms in Portuguese. Studies were screened by title and summary and those considered eligible were read in full. DATA SYNTHESIS: Sixty-eight articles were identified and eight articles were included in the review, as they carried out a quantitative analysis of the filling out of information. Five studies assessed the completion of the Child's Health Record and three of the Child's Health Handbook. All articles concluded that the information was not properly recorded. Growth monitoring charts were rarely filled out, reaching 96.3% in the case of weight for age. The use of the BMI chart was not reported, despite the growing rates of childhood obesity. Only two studies reported the completion of development milestones and, in these, the milestones were recorded in approximately 20% of the verified tools. CONCLUSIONS: The results of the assessed articles disclosed underutilization of the tool and reflect low awareness by health professionals regarding the recording of information in the child's health monitoring document.

Factors associated with the nutritional status of children less than 5 years of age.

OBJECTIVE To analyze if the nutritional status of children aged less than five years is related to the biological conditions of their mothers, environmental and socioeconomic factors, and access to health services and social programs.METHODS This cross-sectional population-based study analyzed 664 mothers and 790 children using canonical correlation analysis. Dependent variables were characteristics of the children (weight/age, height/age, BMI/age, hemoglobin, and retinol serum levels). Independent variables were those related to the mothers' nutritional status (BMI, hemoglobin, and retinol serum levels), age, environmental and socioeconomic factors and access to health service and social programs. A < 0.05 significance level was adopted to select the interpreted canonical functions (CF) and ± 0.40 as canonical load value of the analyzed variables.RESULTS Three canonical functions were selected, concentrating 89.9% of the variability of the relationship among the groups. In the first canonical function, weight/age (-0.73) and height/age (-0.99) of the children were directly related to the mother's height (-0.82), prenatal appointments (-0.43), geographical area of the residence (-0.41), and household incomeper capita (-0.42). Inverse relationship between the variables related to the children and people/room (0.44) showed that the larger the number of people/room, the poorer their nutritional status. Rural residents were found to have the worse nutritional conditions. In the second canonical function, the BMI of the mother (-0.48) was related to BMI/age and retinol of the children, indicating that as women gained weight so did their children. Underweight women tended to have children with vitamin A deficiency. In the third canonical function, hemoglobin (-0.72) and retinol serum levels (-0.40) of the children were directly related to the mother's hemoglobin levels (-0.43).CONCLUSIONS Mothers and children were associated concerning anemia, vitamin A deficiency and anthropometric markers. Living in rural areas is a determining factor for the families health status.

Central obesity and other factors associated with uncontrolled asthma in women.

BACKGROUND: Asthma remains an uncontrolled disease. The Comorbidities, particularly obesity, and several other factors have been identified as being individually associated with asthma control, and these factors vary among different countries and between sexes. Studies have suggested that the harmful effects of these factors are greatest among women. The aim of the present study was to identify associated factors with uncontrolled asthma in women at the outpatient clinic of a Federal University Hospital in Rio de Janeiro, Brazil. METHODS: Cross-sectional study with asthmatic women, older than 18 years old. All subjects were included according to stringent criteria. The study used a structured questionnaire with data about demographic variables, education level, comorbid conditions, and disease history. Anthropometric and spirometric measurements were obtained. Asthma control was assessed by three different tools: the Asthma Control Test (ACT), the Asthma Control Questionnaire (ACQ) and the Global Initiative for Asthma (GINA) criteria. RESULTS: A total of 124 women were included, and 57%, 38% and 21% were totally controlled according to ACT, ACQ and GINA criteria, respectively. A total of 31.5% were obese. According to the CI (Conicity Index) and WC (waist circumference) respectively, 84% and 68% were centrally obese. There was no association between asthma control and age, education, duration of the disease or BMI (Body Mass Index) in the three models, but there was a significant association between central obesity and asthma control with the ACQ and GINA assessment tools, controlling for explanatory variables such as GERD (gastroesophageal reflux disease). Pre-bronchodilator percent predicted forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were significantly associated with age and FVC was also associated with central obesity. CONCLUSIONS: Asthma remains uncontrolled in women despite treatment, and central obesity seems to have a negative influence on the control of the disease. We believe that women should be studied as a separate group and suggest prospective studies with assessment of fat distribution and biomarkers, controlling for possible comorbidities associated with asthma control.

Factors associated with neonatal near miss in Brazil / Fatores associados ao near miss neonatal no Brasil

ABSTRACT OBJECTIVE: This study evaluates the association between sociodemographic factors, maternal characteristics, organization of health services and neonatal near miss in public and private maternity hospitals in Brazil. METHODS: This is a prospective cohort of live births from the Nascer no Brasil survey, carried out between 2011 and 2012. Variables were established from the literature and organized on three levels: distal, intermediate, and proximal. The assessment was performed based on results of the bivariate analyzes and their respective p-values, with a significance level <0.20, using the Wald test. For multivariate analysis, the variables contained at the distal level were inserted, preserved in the model when significant (p < 0.05). This was also done when adjusting the intermediate and proximal levels. RESULTS: At the distal level, no variable was significantly associated with the outcome. At the intermediate level, mother's age greater than or equal to 35 years (relative risk - RR = 1.32; 95%CI 1.04-1.66), cesarean delivery (RR = 1.34; 95%CI 1.07-1.67), smoking (RR = 1.48; 95%CI 1.04-2.10), gestational hypertensive syndrome (RR = 2.29; 95%CI 1.98-3.14), pre-gestational diabetes (RR = 2.63; 95%CI 1.36-5.05) and twin pregnancy (RR = 2.98; 95%CI 1.90-4.68) were variables associated with the outcome. At the proximal level, inadequate prenatal care (RR = 1.71; 95%CI 1.36-2.16) and the hospital/maternity being located in a capital city (RR = 1.89; 95%CI 1.40-2.55) were associated with neonatal near miss. CONCLUSIONS: The results show that neonatal near miss was influenced by variables related to the organization of health services and by maternal characteristics.

RESUMO OBJETIVO: Este estudo avalia a associação entre fatores sociodemográficos, características maternas, organização dos serviços de saúde e near miss neonatal em maternidades públicas e privadas do Brasil. MÉTODOS: Trata-se de uma coorte prospectiva de nascidos vivos da pesquisa Nascer no Brasil, realizada entre 2011 e 2012. As variáveis foram estabelecidas a partir da literatura e organizadas em três níveis: distal, intermediário e proximal. A avaliação foi realizada a partir dos resultados das análises bivariadas e de seus respectivos valores-p, com nível de significância < 0,20, pelo teste de Wald. Para a análise multivariada, foram inseridas as variáveis contidas no nível distal, conservadas no modelo quando significativas (p < 0,05). O mesmo foi feito no ajuste dos níveis intermediário e proximal. RESULTADOS: No nível distal, nenhuma variável apresentou associação significativa com o desfecho. No nível intermediário, idade da mãe maior ou igual a 35 anos (risco relativo - RR = 1,32; IC95% 1,04-1,66), parto cesáreo (RR = 1,34; IC95% 1,07-1,67), uso de fumo (RR = 1,48; IC95% 1,04-2,10), síndrome hipertensiva gestacional (RR = 2,29; IC95% 1,98-3,14), diabetes pré-gestacional (RR = 2,63; IC95% 1,36-5,05) e gestação gemelar (RR = 2,98; IC95% 1,90-4,68) foram variáveis associadas ao desfecho. No nível proximal, o pré-natal não adequado (RR = 1,71; IC95% 1,36-2,16) e a localização do hospital/maternidade na capital (RR = 1,89; IC95% 1,40-2,55) foram associados ao near miss neonatal. CONCLUSÃO: Os resultados mostram que o near miss neonatal foi influenciado pelas variáveis da organização dos serviços de saúde e pelas características maternas.

Professional who attended childbirth and breastfeeding in the first hour of life / Profesional que asistió al parto y amamantamiento en la primera hora de vida / Profissional que assistiu o parto e amamentação na primeira hora de vida

ABSTRACT Objectives: To investigate the association between the professionals who attended vaginal delivery and breastfeeding in the first hour of life. Methods: This is a cross-sectional study with data from the Nascer no Brasil (Born in Brazil) survey, conducted in the 2011-2012 period. Data from 8,466 puerperae were analyzed using a logistic regression model with a hierarchical approach. Results: The proportion of mothers who breastfed at birth was higher in deliveries attended by nurses (70%). A nurse-assisted delivery was 64% more likely to breastfeed in the first hour of life. Other factors associated with the outcome: residing in the North; age less than 35 years; multiparity; prenatal guidance on breastfeeding in the first hour of life; birth at Baby-Friendly Hospital; companion at birth; and female newborn. Conclusions: Obstetrician nurse/nurse-assisted delivery was a significant independent factor associated with breastfeeding in the first hour of life, suggesting the importance of strengthening the role of the obstetrician nurse.

RESUMEN Objetivos: investigar la asociación entre el profesional que asistió al parto vaginal y la lactancia en la primera hora de vida. Métodos: estudio transversal con datos de la investigación Nascer no Brasil (Nacer en Brasil), conducida en el periodo de 2011-2012. Se analizaron datos de 8.466 puérperas por medio de modelo de regresión logística con abordaje jerarquizado. Resultados: La proporción de madres que amamantaron al nacimiento fue mayor en los partos asistidos por el enfermero (70%). El parto asistido por enfermero presentó una probabilidad un 64% mayor de lactancia en la primera hora de vida. Otros factores asociados al desenlace: residir en el Norte; edad inferior a 35 años; multiparidad; orientación en el prenatal sobre lactancia materna en la primera hora de vida; nacimiento en el Hospital Amigo del Niño; acompañante en el parto; y el recién nacido de sexo femenino. Conclusiones: El parto asistido por el enfermero/enfermero obstetra fue un importante factor independiente asociado a la lactancia materna en la primera hora de vida, sugiriendo la importancia del fortalecimiento del papel del enfermero obstetra.

RESUMO Objetivos: investigar a associação entre o profissional que assistiu o parto vaginal e a amamentação na primeira hora de vida. Métodos: estudo transversal com dados da pesquisa Nascer no Brasil, conduzida em 2011/2012. Foram analisados dados de 8.466 puérperas por meio de modelo de regressão logística com abordagem hierarquizada. Resultados: A proporção de mães que amamentaram ao nascimento foi maior nos partos assistidos pelo enfermeiro (70%). O parto assistido por enfermeiro apresentou chance 64% maior de amamentação na primeira hora de vida. Outros fatores associados ao desfecho: residir no Norte; idade inferior a 35 anos; multiparidade; orientação no pré-natal sobre amamentação na primeira hora de vida; nascimento em Hospital Amigo da Criança; acompanhante no parto; e recém-nascido de sexo feminino. Conclusões: O parto assistido pelo enfermeiro/enfermeiro obstetra foi importante fator independente associado à amamentação na primeira hora de vida, sugerindo a importância do fortalecimento do papel do enfermeiro obstetra.

Professional who attended childbirth and breastfeeding in the first hour of life / Profesional que asistió al parto y amamantamiento en la primera hora de vida / Profissional que assistiu o parto e amamentação na primeira hora de vida

ABSTRACT Objectives: To investigate the association between the professionals who attended vaginal delivery and breastfeeding in the first hour of life. Methods: This is a cross-sectional study with data from the Nascer no Brasil (Born in Brazil) survey, conducted in the 2011-2012 period. Data from 8,466 puerperae were analyzed using a logistic regression model with a hierarchical approach. Results: The proportion of mothers who breastfed at birth was higher in deliveries attended by nurses (70%). A nurse-assisted delivery was 64% more likely to breastfeed in the first hour of life. Other factors associated with the outcome: residing in the North; age less than 35 years; multiparity; prenatal guidance on breastfeeding in the first hour of life; birth at Baby-Friendly Hospital; companion at birth; and female newborn. Conclusions: Obstetrician nurse/nurse-assisted delivery was a significant independent factor associated with breastfeeding in the first hour of life, suggesting the importance of strengthening the role of the obstetrician nurse.

RESUMEN Objetivos: investigar la asociación entre el profesional que asistió al parto vaginal y la lactancia en la primera hora de vida. Métodos: estudio transversal con datos de la investigación Nascer no Brasil (Nacer en Brasil), conducida en el periodo de 2011-2012. Se analizaron datos de 8.466 puérperas por medio de modelo de regresión logística con abordaje jerarquizado. Resultados: La proporción de madres que amamantaron al nacimiento fue mayor en los partos asistidos por el enfermero (70%). El parto asistido por enfermero presentó una probabilidad un 64% mayor de lactancia en la primera hora de vida. Otros factores asociados al desenlace: residir en el Norte; edad inferior a 35 años; multiparidad; orientación en el prenatal sobre lactancia materna en la primera hora de vida; nacimiento en el Hospital Amigo del Niño; acompañante en el parto; y el recién nacido de sexo femenino. Conclusiones: El parto asistido por el enfermero/enfermero obstetra fue un importante factor independiente asociado a la lactancia materna en la primera hora de vida, sugiriendo la importancia del fortalecimiento del papel del enfermero obstetra.

RESUMO Objetivos: investigar a associação entre o profissional que assistiu o parto vaginal e a amamentação na primeira hora de vida. Métodos: estudo transversal com dados da pesquisa Nascer no Brasil, conduzida em 2011/2012. Foram analisados dados de 8.466 puérperas por meio de modelo de regressão logística com abordagem hierarquizada. Resultados: A proporção de mães que amamentaram ao nascimento foi maior nos partos assistidos pelo enfermeiro (70%). O parto assistido por enfermeiro apresentou chance 64% maior de amamentação na primeira hora de vida. Outros fatores associados ao desfecho: residir no Norte; idade inferior a 35 anos; multiparidade; orientação no pré-natal sobre amamentação na primeira hora de vida; nascimento em Hospital Amigo da Criança; acompanhante no parto; e recém-nascido de sexo feminino. Conclusões: O parto assistido pelo enfermeiro/enfermeiro obstetra foi importante fator independente associado à amamentação na primeira hora de vida, sugerindo a importância do fortalecimento do papel do enfermeiro obstetra.

Fatores associados ao near miss neonatal no Brasil / Factors associated with neonatal near miss in Brazil

OBJETIVO: Este estudo avalia a associação entre fatores sociodemográficos, características maternas, organização dos serviços de saúde e near miss neonatal em maternidades públicas e privadas do Brasil. MÉTODOS: Trata-se de uma coorte prospectiva de nascidos vivos da pesquisa Nascer no Brasil, realizada entre 2011 e 2012. As variáveis foram estabelecidas a partir da literatura e organizadas em três níveis: distal, intermediário e proximal. A avaliação foi realizada a partir dos resultados das análises bivariadas e de seus respectivos valores-p, com nível de significância < 0,20, pelo teste de Wald. Para a análise multivariada, foram inseridas as variáveis contidas no nível distal, conservadas no modelo quando significativas (p < 0,05). O mesmo foi feito no ajuste dos níveis intermediário e proximal. RESULTADOS: No nível distal, nenhuma variável apresentou associação significativa com o desfecho. No nível intermediário, idade da mãe maior ou igual a 35 anos (risco relativo ­ RR = 1,32; IC95% 1,04­1,66), parto cesáreo (RR = 1,34; IC95% 1,07­1,67), uso de fumo (RR = 1,48; IC95% 1,04­2,10), síndrome hipertensiva gestacional (RR = 2,29; IC95% 1,98­3,14), diabetes pré-gestacional (RR = 2,63; IC95% 1,36­5,05) e gestação gemelar (RR = 2,98; IC95% 1,90­4,68) foram variáveis associadas ao desfecho. No nível proximal, o pré-natal não adequado (RR = 1,71; IC95% 1,36­2,16) e a localização do hospital/maternidade na capital (RR = 1,89; IC95% 1,40­2,55) foram associados ao near miss neonatal. CONCLUSÃO: Os resultados mostram que o near miss neonatal foi influenciado pelas variáveis da organização dos serviços de saúde e pelas características maternas.

Contribuição da Revista Ciência & Saúde Coletiva para a área de Alimentação e Nutrição no Brasil / Contribution to the Journal Ciência & Saúde Coletiva on Food and Nutrition in Brazil

Resumo Revisão sistemática realizada em janeiro de 2020 na base de dados SciELO com o objetivo de analisar a produção científica da Revista Ciência & Saúde Coletiva na área de alimentação e nutrição no período 1996-2019. A busca resultou em 904 artigos e 509 foram selecionados após leitura dos títulos e resumos. Os artigos foram agrupados em dez temas, sendo discutidos os de maior frequência: Avaliação do Estado Nutricional (n=142), Consumo Alimentar (n=111), Políticas e Programas de Alimentação e Nutrição (n=105) e Aleitamento Materno (n=35). As publicações foram em sua maioria artigos originais (75,6%) com método quantitativo (81,6%) e, entre estes, 18,8% utilizaram amostra probabilística. Observou-se um amplo leque de temas e subtemas abordados, evidenciando uma produção relevante que constitui um repositório importante de dados e conhecimentos para profissionais e gestores da área da saúde. Como lacunas, observou-se a escassez de publicações voltadas para a deficiência de micronutrientes; a popularização do Guia Alimentar para População Brasileira; a promoção da ascensão do aleitamento materno; os diagnósticos da descontinuidade da Política Nacional de Segurança Alimentar e Nutricional e suas articulações intersetoriais com as políticas sociais de combate à fome.

Abstract A systematic review conducted in January 2020 using SciELO database with the objective of analyzing the scientific production from 1996-2019, of the Journal Ciência & Saúde Coletiva in the area of food and nutrition. We selected 509 out of the 904 articles screened by titles and abstracts. We grouped the articles into ten themes and discussed the most frequent ones: Nutritional Status Assessment (n=142), Food Intake (n=111), Food and Nutrition Policies and Programmes (n=105) and Breastfeeding (n=35). The publications were mostly original articles (75.6%) employing quantitative method (81.6%) and, among these, 18.8% used a probabilistic sampling. We assembled a wide range of topics and subthemes, a relevant production and repository of data and knowledge for health professionals and managers. As gaps, there was a scarcity of publications focused on micronutrient deficiency; the promotion of the Food Guide for the Brazilian Population; supporting the rise of breastfeeding, the impact and analyses of the disruption of the National Food and Nutrition Security Policy and its multi sector interactions with social policies to fight hunger.

Early postnatal growth in preterm infants and cord blood leptin.

Although circulating leptin and insulin concentration is linked to intrauterine growth, fetal development and birth weight in full-term infants, there has been no enquiry into the influence of cord blood insulin and leptin for catch-up growth in preterm infants. The study evaluated the association of cord blood leptin with growth and weight gain of 96 premature babies during 6 months (corrected age). The temporal changes of anthropometric indexes over this period were calculated by repeated random regression (PROC MIXED) using SAS. Cord blood leptin was negatively associated with the rate of change in BMI (p=0.01) and length (p<0.001), from birth until 64 postnatal weeks. Insulin was positively associated with the change rate in BMI (p=0.03); however, this disappeared when adjusted for birth weight. For the first time, the association between lower leptin levels with greater catch up growth is shown for both BMI and length among preterm children. In conclusion, leptin levels at birth, but not insulin levels, predict growth rates.

High-resolution computed tomography findings in young infants with cystic fibrosis detected by newborn screening

OBJECTIVE: High-resolution computed tomography (HRCT) allows the early detection of pathological changes in the lung structure, and reproducible scoring systems can be used to quantify chest computed tomography (CT) findings in patients with cystic fibrosis (CF). The aim of the study was to describe early HRCT findings according to a validated scoring system in infants with CF diagnosed by newborn screening (NBS). METHODS: This cross-sectional study included infants with CF diagnosed by NBS who were born between January 2013 and January 2017 and who underwent HRCT scanning within the first year after diagnosis when they were clinically stable. The CT scans were evaluated using the modified Bhalla score. RESULTS: Thirty-two subjects underwent HRCT scanning. The mean total-modified Bhalla score was 3.6±2.1, and 93.8% of the scans were abnormal. Pseudomonas aeruginosa airway colonization was associated with increased modified Bhalla score values. Bronchial wall thickening was the most common feature (90.6%), followed by bronchial collapse/consolidation (59.4%), mosaic attenuation/perfusion (50%), bronchiectasis (37.5%) and mucus plugging (15.6%). Bronchial wall thickening was diffuse in most of the patients. CONCLUSION: A substantial proportion of infants diagnosed with CF after detection by NBS already showed evidence of lung disease. P. aeruginosa colonization was associated with increased Bhalla scores, highlighting the importance of this CF pathogen in early structural lung disease. The presence of bronchial wall thickening at such a young age may reflect the presence of airway inflammatory processes. The detection and quantification of structural abnormalities with the modified Bhalla score may aid in the identification of lung disease before it is clinically apparent.

[Healthy eating, schooling and being overweight among low-income women]. / Alimentação saudável, escolaridade e excesso de peso entre mulheres de baixa renda.

The scope of this study was to analyze the factors associated with the prevalence of being overweight and obesity in a population of low-income adult women living in a metropolitan region and its association with socioeconomic, demographic, reproductive and lifestyle variables, highlighting the importance of healthy eating. A population-based, cross-sectional study was conducted with a random sample of 758 women aged 20 or older living in Campos Elíseos - Duque de Caxias - State of Rio de Janeiro. Bivariate and multivariate hierarchical regression was used to identify factors associated with overweight and obesity. A prevalence of 23% of obesity was found, and a prevalence of 56% of being overweight and obesity combined. An inverse association was found between years of study, being overweight and obesity. Most of the women reported having a healthy diet (73.6%) that increased positively with income, education and age. Failure to consume vegetables weekly was associated with being overweight and not having a healthy diet was associated with obesity. The results of this study demonstrate that even in low-income populations, a higher level of education has an impact on prevention of this problem and in food choices.