Use of Artificial Nipples Among Brazilian Infants and Associated Factors.

Transversal study conducted in a Human Milk Bank to evaluate the factors associated with the use of artificial nipples (pacifier and/or nursing bottle) among Brazilian infants. Analyses were performed using the χ2 test and logistic regression analysis. A total of 6017 nursing mothers were evaluated and the use of artificial nipples was reported by 31.3%. The chance of using artificial nipples was higher among infants whose mothers attended antenatal care in private hospitals [odds ratio (OR): 1.61, 95% confidence interval (CI) 1.21-2.14], born in maternities without the Baby-Friendly Hospital Initiative (BFHI) (OR: 18.38, 95% CI 13.50-25.04) and those with adequate birth weight (OR: 2.83, 95% CI 1.99-4.03). A lower chance of using artificial nipples was observed among infants whose mothers had previous breastfeeding experience (OR: 0.76, 95% CI 0.61-0.95), received guidance on breastfeeding during antenatal care (OR: 0.80, 95% CI 0.65-0.98), practiced exclusive breastfeeding (OR: 0.36, 95% CI 0.28-0.45), breastfeeding on demand (OR: 0.66, 95% CI 0.52-0.85) and residents of inland cities/towns (OR: 0.38, 95% CI 0.20-0.72). The findings highlight the importance of breastfeeding guidance during antenatal care and the role of BFHI in clarifying risks associated with artificial nipple use.

Factors Associated with the Consumption of Food Markers of Unhealthy Diet Among School Children in Situations of High Health Vulnerability.

Cross-sectional study that aimed to investigate the factors associated with the consumption of food markers of unhealthy diet among school children with high health vulnerability in public schools of a Brazilian capital. Unhealthy food consumption was investigated through a simplified Food Frequency Questionnaire. Multivariate logistic regression was performed, considering excessive consumption of unhealthy foods as an outcome. A total of 299 students were evaluated, with a mean age of 11.0 ± 2.4 years, 54.8% female and 20.2% overweight. Excessive consumption of unhealthy foods was observed in 46.2% of the sampled population. The chance of excessive consumption of unhealthy foods was greater among school children who skip breakfast (OR = 2.80; 95% CI 1.38-6.48); and those who habitually eat in front of the screen (OR = 2.99; 95% CI 1.11-7.06). These findings can guide interventions to promote healthy habits among school children with high health vulnerability, preventing lifelong excess weight.

[School meals: planning, production, distribution, and adequacy]. / Alimentação escolar: planejamento, produção, distribuição e adequação.

OBJETIVE: To evaluate the planning, production, distribution, and nutritional adequacy of meals served at city schools. METHODS: This descriptive cross-sectional study was conducted between March 2011 and April 2012 and included a representative sample (n = 42 schools) of extended shift city schools from Belo Horizonte, Minas Gerais, Brazil. Five meals from each school were randomly selected and analyzed by direct weighing. Production indicators and nutritional adequacy were evaluated in contrast to the recommendations of the city food security bureau and the Brazilian National Program of School Meals (PNAE). RESULTS: Seventy-nine percent of the analyzed meals did not meet the recommendations of the city food security bureau. The rate of waste (food left on plates) was acceptable at 4,90%, but the rates of cooked and not served food (7,06%) and counter leftovers (5,30%) were high. Both the city planned meals and the meals served in the schools were nutritionally inadequate in terms of the PNAE, particularly for children aged 11-15 years. There was a relationship between consumption by school staff and the amount of food that was cooked (r = 0.353; P < 0.001) and the rate of cooked and not served food (r = 0.138; P = 0.045). Waste was positively correlated with the rate of counter leftovers (r = 0.145; P = 0.035), and inversely correlated with fiber intake (r = -0.143; P = 0.038). CONCLUSIONS: The results indicate the importance of monitoring the planning, production, and distribution of school meals and of food and nutrition education in order to improve the quality of food and to reduce waste in schools.

Effects of Holder Pasteurization on Immune Composition of Human Milk.

Background: Human milk (HM) is the ideal food for newborn (NB) nutrition, it provides all macro and micronutrients for human growth and development and also contains bioactive compounds, which influence the development of the neonatal digestive and immune systems. The holder pasteurization process is essential to prevent NB infection from donated milk. Therefore, the aim of this study was to check whether or not holder pasteurization could impact the concentration of immune components in HM and the capacity to induce epithelial cell growth. Materials and Methods: The study was performed on raw and holder pasteurized (62.5°C/30 minutes) paired milk samples after submission to the freezing process in both phases. For cytokine and adipokine measurements, ELISA was performed on 40 individual samples of HM from single donors. For analyzes of epithelial cell growth, HuTu-80 cells were cultivated in Minimum Essential Eagle medium with 15% of raw or pasteurized milk, eight pairs of milk were used. Results: The results showed that no alteration was observed in the concentration of cytokine after milk holder pasteurization, and leptin concentration was reduced in holder pasteurized milk. The heat treatment also did not impact the capacity of breast milk to promote intestinal epithelial cell growth. Conclusions: The results showed that donated breast milk pasteurization has a small impact on the HM bioactive concentration compounds. This technique is important to avoid NB infection.

[Factors associated with the self-rated health of elderly frequenters of low-budget community restaurants in Belo Horizonte]. / Fatores associados à autopercepção de saúde dos idosos usuários dos restaurantes populares de Belo Horizonte.

The scope of this paper was to evaluate the self-rated health among elderly frequenters of low-budget community restaurants (RP) in Belo Horizonte (BH) and the factors associated with this outcome. It involved a cross-sectional study in all RP and BH cafeteria. The self-rated health was classified as bad and very bad; average; good and very good. Sociodemographic and economic variables were considered to be possible associated factors, as well as those related to physical health and social resources. In the univariate analysis, the Chi-square test and Mann-Whitney tests were used. In the multivariate analysis a model of ordinal logistic regression was created. The sample consisted of 279 elderly people, the majority (68.5%) being male. Most of the elderly (57.5%) considered their health as being good or very good. Factors associated with better health perception in the multivariate analysis (p-value < 0.05) were satisfaction with relationships with friends, not having diabetes or any other cardiovascular disease and finally, the low frequency and lack of problems that hinder the elderly from doing the things they need or want to do. Such studies contribute to the understanding of the health perception of elderly people associated with several factors that can influence healthy aging.

O objetivo deste artigo foi avaliar a autopercepção de saúde entre idosos usuários dos Restaurantes Populares (RP) de Belo Horizonte (BH) e os fatores associados a esse desfecho. Trata-se de um estudo transversal realizado em todos os RP e refeitórios de BH. A autopercepção de saúde foi classificada como ruim e muito ruim; regular; boa e muito boa. Como possíveis fatores associados foram consideradas variáveis sociodemográficas, econômicas, aquelas relacionadas à saúde física e aos recursos sociais. Na análise univariada foram utilizados os testes Qui-quadrado e Mann-Whitney. Na análise multivariada foi construído um modelo de regressão logística ordinal. A amostra consistiu em 279 idosos, sendo a maioria (68,5%) do sexo masculino. A maioria dos idosos (57,5%) considerou sua saúde como boa ou muito boa. Foram fatores associados a uma melhor percepção de saúde na análise multivariada (valor-p < 0,05): a satisfação com o relacionamento com os amigos, não ter diabetes e também nenhuma outra doença cardiovascular e, por último, a baixa frequência e ausência dos problemas que dificultam os idosos de fazerem as coisas que precisam ou querem fazer. Estudos como este contribuem para o entendimento da percepção de saúde da população idosa associado a diversos fatores que podem influenciar no envelhecimento saudável.

[Healthcare and gestational factors associated with anemia in nursing mothers attended in a human milk bank]. / Fatores assistenciais e gestacionais associados à anemia em nutrizes atendidas em um banco de leite humano.

Anemia is a public health problem that affects about 30% of Brazilian women, which may cause deleterious effects on the health and quality of life of mother and child. This article seeks to evaluate the healthcare and gestational factors associated with anemia among mothers receiving care at a human milk bank (HMB) of reference. It is a cross-sectional study with secondary data about sociodemographic and pregnancy information on 12283 nursing mothers from 2009 to 2012. The Kolmogorov-Smirnov and chi-square or Fisher's exact tests were applied. The prevalence ratios (PR) and their 95% confidence intervals were estimated by Poisson regression with robust variance. Anemia was identified in 29.2% of the sample and the prevalence was higher among mothers who did not have prenatal appointments (PR = 3.84; 95% CI 3.26 to 4.54); those who made 3 or less antenatal visits (PR = 1.92; 95% CI 1.21 to 3.06) and those who have had multiple pregnancies (OR = 2.29, 95% CI 1.25 to 4.19). The results showed a higher prevalence of anemia among women who did not have the appropriate prenatal care and who have had multiple pregnancies, highlighting the importance of healthcare as a factor in the prevention of anemia and other complications during pregnancy.

A anemia é um problema de saúde pública que acomete cerca de 30% das gestantes brasileiras, podendo acarretar efeitos deletérios à saúde e qualidade de vida do binômio mãe-filho. O objetivo deste artigo é avaliar os fatores assistenciais e gestacionais associados à anemia entre nutrizes atendidas em um banco de leite humano (BLH) de referência. Estudo transversal com dados secundários referentes a informações sociodemográficas e gestacionais de 12283 nutrizes no período de 2009 a 2012. Aplicaram-se os testes Kolmogorov-Smirnov e Qui-quadrado ou exato de Fisher. Estimaram-se as Razões de Prevalência (RP) e respectivos Intervalos de Confiança-IC95%, por meio da Regressão de Poisson com variância robusta. Identificou-se a prevalência de anemia em 29,2% da amostra, sendo maior entre as mães que não realizaram o pré-natal (RP = 3,84; IC95% 3,26-4,54); as que realizaram até 3 consultas pré-natais (RP = 1,92; IC95% 1,21-3,06) e aquelas que tiveram gestação múltipla (RP = 2,29; IC95% 1,25-4,19). Os resultados apontaram maior prevalência de anemia entre as mulheres que não realizaram o pré-natal apropriado e as que tiveram gestações múltiplas, destacando-se a importância da assistência à saúde como fator de prevenção à anemia e demais intercorrências gestacionais.

[Educational practices in accordance with the "Ten steps to successful breastfeeding" in a Human Milk Bank]. / Práticas educativas segundo os "Dez passos para o sucesso do aleitamento materno" em um Banco de Leite Humano.

This article sought to evaluate educational practices in line with the "Ten Steps to Successful Breastfeeding" in a Human Milk Bank. It involved a retrospective study using sociodemographic data about the pregnancy and the baby, obtained from a nursing mothers care protocol (2009-2012). These data were associated to steps related to educational practices from the "Ten Steps." Descriptive analysis, chi-square test and Poisson regression were performed. 12,283 mothers, with a median of 29 (12-54) years old, were evaluated. The guidelines about breastfeeding received during prenatal care (step 3) prevailed among mothers aged 30-39 years and the skin to skin contact (step 4) prevailed among oriented mothers. Breastfeeding training (step 5) predominated among those who breastfed exclusively. Higher prevalence of exclusive breastfeeding (step 6), breastfeeding on demand (step 8) and use of artificial nipples (step 9) were noted among infants whose mothers were oriented. These findings indicate the important role of health professionals on mother/child training about breastfeeding, on encouragement of the skin/skin contact, exclusive breastfeeding and breastfeeding on demand. The guidelines indicated the need to improve in order to reduce the use of artificial nipples and enhance exclusive breastfeeding.

Dimensões da escala brasileira de insegurança alimentar na atenção primária à saúde / Dimensions of the Brazilian food insecurity scale on primary health care

Objetivo: Analisar a relevância das dimensões da Escala Brasileira de Insegurança Alimentar (EBIA). Método: Conduziu-se estudo a partir da linha de base com amostra representativa de usuários do Programa Academia da Saúde de Belo Horizonte-MG. A mensuração da insegurança alimentar foi obtida pela EBIA. Utilizou-se análise fatorial para identificar as dimensões da EBIA relevantes para os usuários do Programa.Resultado: Verificou-se elevada prevalência de insegurança alimentar (31,1%), sobretudo entre as famílias com menores de 18 anos (41,0%). Foi identificada redução do percentual de respostas afirmativas segundo a gravidade de insegurança alimentar implicada na questão, sendo queitens relacionados à insegurança alimentar leve (preocupação e acesso à alimentação saudável) apresentaram maior percentual de respostas afirmativas, enquanto aqueles correlatos à insegurança alimentar severa (fome e perda de peso), menores percentuais. Foram identificados três fatores relevantes da EBIA para famílias com menores de 18 anos: preocupação, privação e crianças/adolescentes; e para as demais famílias: preocupação, privação e fome. Conclusão: Sugere-se, assim, o uso da EBIA na Atenção Primária, visando avaliar o risco de insegurança alimentar e o delineamento de ações de promoção da saúde mais abrangentes.

Objective:The aim of the current study is to analyze the relevance of dimensions of the Brazilian Food Insecurity Scale (EBIA). Methods:Baseline study conducted with sample representative of Health Academy Program (HAP) users in Belo Horizonte ­ MG. Food insecurity was measured based on EBIA. Factor analysis was used to identify EBIA dimensions relevant to HAP users.Results: There was high prevalence of food insecurity (31.1%), mainly among families with members younger than 18 years (41.0%). Affirmative response rates have decreaseddepending on the food insecurity severity level involved in the question.Items associated with mild food insecurity (concernedwith and access to healthy food) recorded higher affirmative response rates, whereasitems associated withsevere food insecurity (hunger and weight loss) recorded lower rates. Three relevant EBIA factors were identified for family members younger than 18 years, namely: concern, deprivation and children / adolescents, whereas relevant EBIA factors identified for other family members comprised concern, deprivation and hunger. Conclusion:EBIA should be used in Primary Care in order to assess the risk of food insecurity and the design of more comprehensive health promotion actions.

Telenovela como estratégia de educação nutricional no âmbito de uma política pública de acesso à alimentação adequada e saudável / Soap opera as a food and nutritional education strategy in the context of a public policy to promote access to adequate healthy food / Telenovela como estrategia de educación alimentaria y nutricional en el ámbito de una política pública de acceso a la alimentación adecuada y saludable

O presente estudo objetivou analisar a telenovela "O caminho do meio" como estratégia de educação alimentar nutricional e a sua relação com os processos de aprendizagem inventiva e com a produção de novos modos de subjetivação. Trata-se de um estudo com abordagem qualitativa, com 15 frequentadores de um restaurante popular, por meio de: (1) visualização da telenovela "O caminho do meio", com duração de 46 minutos; e (2) entrevista individual realizada com um roteiro previamente estruturado. Após gravação, transcrição e análise de conteúdo dos discursos emergiram três categorias: (1) a telenovela e as experiências de vida dos frequentadores do restaurante popular; (2) a telenovela: cenas, personagens e mensagem; (3) novas percepções e tendências relacionadas à alimentação e ao estilo de vida. A experimentação com a telenovela forneceu uma aprendizagem inventiva e a produção de novos modos de subjetivação. (AU)

This study analyzed the soap opera "O caminho do meio" (The Middle Way) as a food and nutritional education strategy and its relation with inventive learning and the production of new modes of subjectivation. We conducted a qualitative study with 15 people who eat at a "popular restaurant" involving the following: (1) Watching the soap opera "O caminho do meio", which lasts 46 minutes; and (2) Individual interviews administered using a previously prepared guide. Three thematic categories emerged after recording, transcribing and analyzing the content of the interviews: (1) "The soap opera and the life experiences of the respondents"; (2) "The soap opera: scenes, characters and message"; and (3) "New perceptions and trends related to eating and lifestyle. The experimentation with the soap opera stimulated inventive learning and the production of new modes of subjectivation. (AU)

El objetivo del presente estudio fue analizar la telenovela "O caminho do meio" como estrategia de educación alimentaria y nutricional y su relación con los procesos de aprendizaje inventivo y con la producción de nuevos modos de subjetivación. Se trata de un estudio con abordaje cualitativo, con 15 frecuentadores de un restaurante popular, por medio de: (1) Visionado de la telenovela "O caminho do meio", con duración de 46 minutos; y (2) Entrevista individual realizada a partir de un guion previamente estructurado. Después de la grabación, de la transcripción y del análisis de contenido de los discursos surgieron 3 categorías: (1) "La telenovela y las experiencias de vida de los frecuentadores del restaurante popular"; (2) "La telenovela: escenas, personajes y mensaje" (3) "Nuevas percepciones y tendencias relacionadas a la alimentación y al estilo de vida". La experimentación con la telenovela proporcionó un aprendizaje inventivo y la producción de nuevos modos de subjetivación. (AU)

Perfil alimentar e percepção de escolares sobre alimentação servida em escolas municipais segundo a vulnerabilidade à saúde / Food pattern and perception of students about food served in municipal schools according to health vulnerability

Objetivo: Analisar o perfil alimentar e a percepção de escolares sobre a alimentação servida nas escolas, segundo a vulnerabilidade à saúde. Métodos: Trata-se de estudo transversal, realizado com uma amostra representativa de alunos do Ensino Fundamental da rede municipal de Belo Horizonte. A vulnerabilidade à saúde foi determinada pelo Índice de Vulnerabilidade à Saúde dos setores censitários das escolas. Foram coletadas informações referentes ao perfil alimentar e à percepção sobre a alimentação escolar. Foi utilizado o Teste Qui-quadrado de Pearson para determinar diferenças segundo o Índice de Vulnerabilidade à Saúde. Resultados: Foram entrevistados 3.557 alunos. Os alunos das escolas com menor vulnerabilidade apresentaram o hábito de comprar alimentos em estabelecimentos próximos à escola (p=0,01); perceberam em menor proporção a alimentação escolar como variada (p<0,001), o tempo para comer como suficiente (p<0,001) e a importância da alimentação escolar (p=0,02). Conclusão: O perfil alimentar e a percepção da alimentação variaram segundo a vulnerabilidade das escolas. Nas escolas de menor vulnerabilidade, os alunos compraram mais alimentos no entorno e apresentaram menor aceitação e valorização da alimentação escolar. Sugere-se a investigação de fatores associados (socioeconômicos e ambientais) para compreensão das condições que influenciam o adequado fornecimento da alimentação escolar a todos os estudantes.

Objective: analyze the dietary profile and perception of students about the food served in schools, according to health vulnerability. Methods: This is a cross-sectional study, carried out with a representative sample of Elementary School students from the Municipal Network of Belo Horizonte. Health vulnerability was determined by the Health Vulnerability Index (HVI) of the census sectors of schools. Eating habits and perceptions of meals served in the school were collected. Pearson's Chi-squared test was used to determine differences according to the Health Vulnerability Index. Results: 3,557 students were interviewed. Students from schools with less vulnerability had the habit of buying food in stores close to the school (p = 0.01); a smaller proportion of the students perceived the school meals as varied (p <0.001), the eating time as sufficient (p<0.001), and the importance of food served in municipal schools (p=0.02). Conclusion: The food profile and perception of food varied according to the school's vulnerability. In schools with less vulnerability, students bought more food in the surroundings and showed less acceptance and appreciation of school food. The investigation of socio-economic and environmental factors is warranted to understand the conditions that may influence the adequate supply of school meals to all students.

[Factors associated with being overweight among adults using low-budget restaurants in Belo Horizonte, Brazil]. / Fatores associados ao excesso de peso em adultos usuários de restaurantes populares em Belo Horizonte, Brasil.

The scope of this article is to assess the nutritional status of users of low-budget restaurants and soup kitchens in Belo Horizonte and to identify factors associated with being overweight. It involved a cross-sectional analytical study conducted among adults of both sexes in low-budget restaurants and soup kitchens in Belo Horizonte. Being overweight was the dependent variable and was defined as body mass index (BMI) ≥ 25 kg/m2. This was correlated with socio-demographic variables and the level of physical activity. The data were obtained directly through weight and height measurement and a semi-structured questionnaire. The study involved 1334 individuals, the majority being male. The prevalence of being overweight was 42.9% among the men and 45.8% among the women. The following factors were positively associated with being overweight: being older for both sexes; having a partner for the women; taking less physical exercise and higher socioeconomic level for the men. Detection of factors associated with being overweight reveals that there is a need to implement an effective systematic program of dietary and nutritional education in order to prevent and remedy this condition, so that low-budget restaurants fulfill their objective.

[Determinants of food and nutrition insecurity: a study conducted in Low-budget Restaurants in Belo Horizonte in the state of Minas Gerais, Brazil]. / Fatores determinantes da insegurança alimentar e nutricional: estudo realizado em Restaurantes Populares de Belo Horizonte, Minas Gerais, Brasil.

The scope of this study is to evaluate the condition of household food and nutrition (in)security (IAN) of the users of low-budget restaurants in Belo Horizonte (BH). This is an analytical cross-sectional study carried out on all low-budget restaurants and cafeteria in BH with a sample of 1613 users. The IAN was assessed using the Brazilian Food Insecurity Scale and cross-checked with the socioeconomic profile of the users. The Chisquare and Mann-Whitney tests were applied. All p-value < 0.25 variables were included in the multivariate analysis. The groups most exposed to IAN among users of low-budget restaurants are those with a lower socioeconomic level and per capita income class and those with a large number of residents in the household. Also affected are those who admit to having different kinds of wants and needs, and those for whom price and living alone are the main reasons for frequenting low-budget restaurants. The factors affecting the IAN are varied and multifactorial, thus representing a major challenge for public policy makers and for those who live directly with these dietary restrictions. The low-budget restaurants serve as a strategy for promoting healthy eating habits.

The contribution of the Educational Program for Health Work in "being a SUS professional" / Contribuição do programa de educação pelo trabalho para saúde em "ser profissional do SUS''

The proposal of the Educational Program for Health Work (EPW - Health) provides opportunities for higher education institutions to train health professionals with a profile appropriate for social needs, based on skills and ability to work in teams, giving full attention to health, to interdisciplinarity and to humanistic aspects, besides favoring the implementation of health services that are more resolvable and adequate to the needs of the population. Against this background, the aim was to delineate social representations of "Being a SUS Professional" from the perspective of Health Sciences undergraduates. Secondary data were obtained from 234 candidates who entered the EPW-Health, the third time it was offered in the institution, from a free recall projective test through the inducing term "Being a SUS professional", applied by mentors of the Program. The EVOC® software was used for analysis, and the products were organized according to previous experience in the program. Between those people with previous experience (n=98) representational components aligned in the SUS, such as "Multi-professional service", "Universality", "Integrality" and "Humanization" were found. From the perspective of another group there was no direct allusion to the guidelines and principles of the SUS as the core elements of social representations. These results indicate that the experience in EPWHealth can contribute greatly for training of health professionals aware of the social demands of SUS

A proposta do Programa de Educação pelo Trabalho para a Saúde (PET - Saúde) vem oportunizar às instituições de ensino superior a formação de profissionais de saúde com perfil adequado às necessidades sociais, pautada em competências e habilidade para o trabalho em equipe, para a atenção integral à saúde, para a interdisciplinaridade e para os aspectos humanísticos, além de favorecer a efetivação de serviços de saúde mais resolutivos e adequados às necessidades da população. Em face desse cenário, objetivou-se delinear representações sociais sobre "Ser profissional do SUS" na perspectiva de graduandos de 12 cursos de Ciências da Saúde de uma Universidade Federal. Foram obtidos dados secundários de 234 candidatos à terceira oferta do PET-Saúde na instituição, a partir do teste projetivo de evocação livre por meio do termo indutor "Ser profissional do SUS", aplicado por professores tutores do Programa. O software EVOC® foi utilizado para as análises das representações sociais, sendo os produtos organizados conforme a vivência prévia no referido programa. Verificou-se dentre aqueles com experiência anterior no PET-Saúde (n=98) componentes representacionais pautados na proposta do SUS tais como "Atendimento multiprofissional", "Universalidade", "Integralidade" e "Humanização". Já na perspectiva do outro grupo, não houve alusão direta às diretrizes e princípios dos SUS como elementos do núcleo central das representações sociais. Esses resultados apontam que a experiência no PET-Saúde pode contribuir fortemente para a formação de profissionais de saúde atentos às demandas sociais do SUS.

Fatores associados à autopercepção de saúde dos idosos usuários dos restaurantes populares de Belo Horizonte / Factors associated with the self-rated health of elderly frequenters of low-budget community restaurants in Belo Horizonte

Resumo O objetivo deste artigo foi avaliar a autopercepção de saúde entre idosos usuários dos Restaurantes Populares (RP) de Belo Horizonte (BH) e os fatores associados a esse desfecho. Trata-se de um estudo transversal realizado em todos os RP e refeitórios de BH. A autopercepção de saúde foi classificada como ruim e muito ruim; regular; boa e muito boa. Como possíveis fatores associados foram consideradas variáveis sociodemográficas, econômicas, aquelas relacionadas à saúde física e aos recursos sociais. Na análise univariada foram utilizados os testes Qui-quadrado e Mann-Whitney. Na análise multivariada foi construído um modelo de regressão logística ordinal. A amostra consistiu em 279 idosos, sendo a maioria (68,5%) do sexo masculino. A maioria dos idosos (57,5%) considerou sua saúde como boa ou muito boa. Foram fatores associados a uma melhor percepção de saúde na análise multivariada (valor-p < 0,05): a satisfação com o relacionamento com os amigos, não ter diabetes e também nenhuma outra doença cardiovascular e, por último, a baixa frequência e ausência dos problemas que dificultam os idosos de fazerem as coisas que precisam ou querem fazer. Estudos como este contribuem para o entendimento da percepção de saúde da população idosa associado a diversos fatores que podem influenciar no envelhecimento saudável.

Abstract The scope of this paper was to evaluate the self-rated health among elderly frequenters of low-budget community restaurants (RP) in Belo Horizonte (BH) and the factors associated with this outcome. It involved a cross-sectional study in all RP and BH cafeteria. The self-rated health was classified as bad and very bad; average; good and very good. Sociodemographic and economic variables were considered to be possible associated factors, as well as those related to physical health and social resources. In the univariate analysis, the Chi-square test and Mann-Whitney tests were used. In the multivariate analysis a model of ordinal logistic regression was created. The sample consisted of 279 elderly people, the majority (68.5%) being male. Most of the elderly (57.5%) considered their health as being good or very good. Factors associated with better health perception in the multivariate analysis (p-value < 0.05) were satisfaction with relationships with friends, not having diabetes or any other cardiovascular disease and finally, the low frequency and lack of problems that hinder the elderly from doing the things they need or want to do. Such studies contribute to the understanding of the health perception of elderly people associated with several factors that can influence healthy aging.

[The prevalence of anemia and its association with socio-demographic and anthropometric aspects in children living in Vitória, State of Espírito Santo, Brazil]. / Prevalência de anemia e sua associação com aspectos sociodemográficos e antropométricos em crianças de Vitória, Espírito Santo, Brasil.

The high prevalence of iron deficiency in the population is widely acknowledged, but there are not yet sufficient studies that explain the reasons for this problem at local and national level. Thus, the scope of this study was to evaluate the prevalence of anemia and its relation with socio-demographic and anthropometric aspects of children living in Vitoria, Espírito Santo. This is a cross-sectional study conducted among 12- to 72-month-old children. Data were collected in Primary Healthcare Units and involved the hemoglobin dosage, height and weight measurement, in addition to the application of a semi-structured questionnaire to gather socio-demographic information. The evaluation included 980 children, 51.1% of which were female with a median age of 46.00 (95%CI: 45.52 - 48.09) months. Anemia was found in 37%, with a hemoglobin median of 11.4 (95%CI: 11.15 - 11.36) g/dL. The children's' height/age ratio (p = 0.049) and the number of people in the family (p < 0.001) were found to be determinants of anemia, and age was a factor of protection for this deficiency (p = 0.010). The high prevalence of anemia and its strong relation with demographic and anthropometric data suggest the need for more effective public policies than just food fortification and supplementation.

Fatores assistenciais e gestacionais associados à anemia em nutrizes atendidas em um banco de leite humano / Healthcare and gestational factors associated with anemia in nursing mothers attended in a human milk bank

Resumo A anemia é um problema de saúde pública que acomete cerca de 30% das gestantes brasileiras, podendo acarretar efeitos deletérios à saúde e qualidade de vida do binômio mãe-filho. O objetivo deste artigo é avaliar os fatores assistenciais e gestacionais associados à anemia entre nutrizes atendidas em um banco de leite humano (BLH) de referência. Estudo transversal com dados secundários referentes a informações sociodemográficas e gestacionais de 12283 nutrizes no período de 2009 a 2012. Aplicaram-se os testes Kolmogorov-Smirnov e Qui-quadrado ou exato de Fisher. Estimaram-se as Razões de Prevalência (RP) e respectivos Intervalos de Confiança-IC95%, por meio da Regressão de Poisson com variância robusta. Identificou-se a prevalência de anemia em 29,2% da amostra, sendo maior entre as mães que não realizaram o pré-natal (RP = 3,84; IC95% 3,26-4,54); as que realizaram até 3 consultas pré-natais (RP = 1,92; IC95% 1,21-3,06) e aquelas que tiveram gestação múltipla (RP = 2,29; IC95% 1,25-4,19). Os resultados apontaram maior prevalência de anemia entre as mulheres que não realizaram o pré-natal apropriado e as que tiveram gestações múltiplas, destacando-se a importância da assistência à saúde como fator de prevenção à anemia e demais intercorrências gestacionais.

Abstract Anemia is a public health problem that affects about 30% of Brazilian women, which may cause deleterious effects on the health and quality of life of mother and child. This article seeks to evaluate the healthcare and gestational factors associated with anemia among mothers receiving care at a human milk bank (HMB) of reference. It is a cross-sectional study with secondary data about sociodemographic and pregnancy information on 12283 nursing mothers from 2009 to 2012. The Kolmogorov-Smirnov and chi-square or Fisher's exact tests were applied. The prevalence ratios (PR) and their 95% confidence intervals were estimated by Poisson regression with robust variance. Anemia was identified in 29.2% of the sample and the prevalence was higher among mothers who did not have prenatal appointments (PR = 3.84; 95% CI 3.26 to 4.54); those who made 3 or less antenatal visits (PR = 1.92; 95% CI 1.21 to 3.06) and those who have had multiple pregnancies (OR = 2.29, 95% CI 1.25 to 4.19). The results showed a higher prevalence of anemia among women who did not have the appropriate prenatal care and who have had multiple pregnancies, highlighting the importance of healthcare as a factor in the prevention of anemia and other complications during pregnancy.

Práticas educativas segundo os "Dez passos para o sucesso do aleitamento materno" em um Banco de Leite Humano / Educational practices in accordance with the "Ten steps to successful breastfeeding" in a Human Milk Bank

Resumo Este artigo objetivou avaliar práticas educativas segundo os “Dez Passos para o Sucesso do Aleitamento Materno” em Banco de Leite Humano. Estudo retrospectivo com informações sociodemográficas e gestacionais maternas e referentes ao bebê, obtidas de protocolo de atendimento de nutrizes (2009-2012). Tais dados foram associados aos passos relacionados a práticas educativas dentre os “Dez Passos”. Realizou-se análise descritiva, teste qui-quadrado e regressão de Poisson. Foram avaliadas 12.283 mães, com mediana de 29 (12-54) anos de idade. As orientações recebidas sobre amamentação no pré-natal (passo 3) prevaleceram entre mães de 30-39 anos e o contato pele/pele (passo 4) entre as orientadas. O treinamento sobre amamentação (passo 5) predominou entre aquelas que amamentaram exclusivamente. Notou-se maior prevalência de amamentação exclusiva (passo 6) e sob livre demanda (passo 8) e uso de bicos artificiais (passo 9) entre os lactentes de mães orientadas. Os achados apontam importante papel do profissional da saúde no treinamento mãe/filho sobre aleitamento materno e incentivo ao contato pele/pele, amamentação exclusiva e sob livre demanda. As orientações ofertadas necessitam aprimoramento a fim de reduzir o uso de bicos artificiais e potencializar a amamentação exclusiva.

Abstract This article sought to evaluate educational practices in line with the “Ten Steps to Successful Breastfeeding” in a Human Milk Bank. It involved a retrospective study using sociodemographic data about the pregnancy and the baby, obtained from a nursing mothers care protocol (2009-2012). These data were associated to steps related to educational practices from the “Ten Steps.” Descriptive analysis, chi-square test and Poisson regression were performed. 12,283 mothers, with a median of 29 (12-54) years old, were evaluated. The guidelines about breastfeeding received during prenatal care (step 3) prevailed among mothers aged 30-39 years and the skin to skin contact (step 4) prevailed among oriented mothers. Breastfeeding training (step 5) predominated among those who breastfed exclusively. Higher prevalence of exclusive breastfeeding (step 6), breastfeeding on demand (step 8) and use of artificial nipples (step 9) were noted among infants whose mothers were oriented. These findings indicate the important role of health professionals on mother/child training about breastfeeding, on encouragement of the skin/skin contact, exclusive breastfeeding and breastfeeding on demand. The guidelines indicated the need to improve in order to reduce the use of artificial nipples and enhance exclusive breastfeeding.

Soup kitchen users' social representations of healthy eating associated with their household food security status / Representações sociais de usuários de restaurantes populares sobre alimentação saudável associadas à sua condição domiciliar de (in)segurança alimentar

Objective: To verify whether what users of soup kitchens in Belo Horizonte, Minas Gerais, Brazil, think about a healthy diet and the challenges they face to eat healthy are associated with their household food security status. Methods: This cross-sectional study included 1,656 users of soup kitchens in Belo Horizonte. Socioeconomic and household food security data, and healthy-eating discourses were collected by a semi-structured questionnaire. The data were submitted to descriptive analyses for constructing frequency distribution tables, and to univariate analysis. Discourse analysis was based on the social representation theory. Results: To cut, reduce, avoid, not eat, eat less, and decrease carbohydrates, salt, meats, various beverages, and other foods are the most frequent changes (71.4%) that food-secure users have made or intend to make. Food-insecure users intended to eat more fruits, non-starchy vegetables, and other foods (34.4%). The main obstacles food-secure and food-insecure users face to adopt a healthier diet are lack of time (82.9%) and low income (53.5%), respectively (p<0.001). Conclusion: What users of soup kitchens in Belo Horizonte think about food and the obstacles they face to adopt a healthier diet are related to their household food security status. The results provide valuable data for effective proposals of food and nutrition education, which should act on the producers of subjectivity in this group and consider this group's food and nutrition security status.

Objetivo: Verificar a associação entre a forma como os usuários dos restaurantes populares de Belo Horizonte, Minas Gerais, pensam sobre alimentação saudável, bem como as dificuldades para adotá-la; e a sua condição domiciliar de (in)segurança alimentar. Métodos: Estudo transversal conduzido com 1.656 usuários dos restaurantes populares de Belo Horizonte. A coleta de dados, com emprego de um questionário semiestruturado, contemplou a situação socioeconômica, a condição domiciliar de (in)segurança alimentar e discursos sobre alimentação saudável. Realizou-se análises descritivas para a construção de tabelas de distribuição de frequências e análise univariada. A análise dos discursos fundamentou-se na teoria das representações sociais. Resultados: Cortar, reduzir, evitar, não comer, comer menos, diminuir carboidratos, gorduras, sal, carnes, bebidas diversas e outros alimentos é a mudança mais frequente (71,4%) que os usuários, em condição domiciliar de segurança alimentar, realizam ou pretendem realizar. Já para aqueles em condição domiciliar de insegurança alimentar é comer mais frutas, verduras, legumes e outros alimentos (34,4%). Para os usuários em segurança alimentar nutricional a dificuldade determinante é a falta de tempo (82,9%) e para aqueles em insegurança alimentar nutricional é a condição financeira (53,5%), p<0,001. Conclusão: O que os usuários dos restaurantes populares de Belo Horizonte pensam sobre alimentação, bem como as dificuldades para se alimentar de maneira mais saudável, estão associadas à condição domiciliar de (in)segurança alimentar. Os resultados são subsídios relevantes para a elaboração de propostas educativas efetivas em alimentação e nutrição, que atuem sobre os dispositivos produtores de subjetividade desse público e que considere a sua situação de segurança alimentar e nutricional.

Fatores associados ao contato pele a pele entre mãe/filho e amamentação na sala de parto / Factors associated with skin to skin contact between mother/son and breastfeeding in the delivery room

RESUMO Objetivo Investigar fatores associados ao contato pele a pele entre mãe e filho e à amamentação na sala de parto entre nutrizes atendidas em um banco de leite humano. Métodos Foram avaliadas 12.283 mães em estudo retrospectivo (2009-2012) com dados secundários obtidos de protocolo estruturado. Adotou-se modelo de Poisson com abordagem hierarquizada em níveis distal, intermediário e proximal para dados sociodemográficos maternos; pré-natais e gestacionais; do bebê; e atenção hospitalar. Resultados Estiveram associados, respectivamente, à maior prevalência do contato pele a pele e da amamentação na sala de parto: parto normal (RP=1,34; IC95% 1,27-1,41 e RP=1,63; IC95% 1,45-1,83) e sem complicação (RP=1,24; IC95% 1,12-1,38 e RP=1,27; IC95% 1,03-1,56), peso ao nascer adequado (RP=1,23; IC95% 1,11-1,36 e RP=1,92; IC95% 1,48-2,48) e a termo (RP=1,18; IC95% 1,10-1,28 e RP=1,40; IC95% 1,17-1,67). Conclusão A forte influência da atenção hospitalar e as condições ao nascer do recém-nascido explicaram os desfechos em estudo. Ressalta-se a necessidade da adoção de medidas que priorizem o contato pele a pele e a amamentação na sala de parto nos grandes hospitais da capital, como a redução ou adiamento de intervenções na assistência pós-parto. Estudos longitudinais poderão esclarecer outras questões sobre o tema.

ABSTRACT Objective To investigate factors associated with skin to skin contact between mother and child and breastfeeding at the delivery room in mothers who visit a human milk bank. Methods This retrospective study (2009 to 2012) assessed the secondary data of 12,283 mothers obtained by a structured protocol. A distal-, intermediate-, and proximal-level hierarchical Poisson regression model analyzed the sociodemographic, maternal, prenatal, gestational, infant, and hospital care data. Results The following items were associated with a higher prevalence of skin to skin contact and breastfeeding in the delivery room: vaginal delivery (RP=1.34; 95%CI 1.27-1.41 and PR=1.63; 95%CI 1.45-1.83), uneventful delivery (PR=1.24; 95%CI 1.12-1.38 and PR=1.27; 95%CI 1.03-1.56), appropriate birth weight (PR=1.23; 95%CI 1.11-1.36 and PR=1.92; 95%CI 1.48-2.48), and term birth (PR=1.18; 95%CI 1.10-1.28 and PR=1.40; 95%CI 1.17-1.67). Conclusion The strong influence of hospital care and newborn birth conditions explained the study outcomes. Actions that promote skin to skin contact and breastfeeding in the delivery room of large hospitals in capital cities are needed, such as reduction or postponement of interventions during postnatal care. Longitudinal studies may clarify other issues on this subject.

Influência do uso de chupeta e mamadeira no aleitamento materno exclusivo entre mães atendidas em um Banco de Leite Humano / Influence of pacifier use and bottle in exclusive breastfeeding among mothers treated at a Human Milk Bank

OBJETIVO: Avaliar o uso de chupeta e mamadeira e sua influência na prevalência do aleitamento materno exclusivo entre lactentes de mães atendidas em um Banco de Leite Humano. MÉTODOS: Estudo transversal com mães atendidas em um Banco de Leite Humano entre 2009 e 2011 a partir de informações (sociodemográficas, antecedentes obstétricos, dados sobre aleitamento materno exclusivo, mamadeira e chupeta) obtidas por meio de questionário estruturado. Realizaram-se análise descritiva, teste de Qui-quadrado e regressão de Poisson. RESULTADOS: Avaliaram-se 9 474 mães, 65,2% com escolaridade até o ensino médio e 60,6% referiram aleitamento materno exclusivo. A prevalência de uso de mamadeira e chupeta foi de 22,9 e 25,0%, respectivamente. A amamentação exclusiva foi menor entre os lactentes que usavam chupeta (38,4 versus 43,2%; p<0,001) e mamadeira (13,5 versus 46,6%; p<0,001). O uso de mamadeira se associou à menor prevalência de aleitamento exclusivo (RP=0,43; IC95%=0,35-0,53), em contraste com a amamentação sob livre demanda (RP=5,5; IC95%=4,17-7,3), maior nível de escolaridade materna (RP=1,2; IC95%=1,08-1,35), pré-natal (RP=1,25; IC95%=1,13-1,38) e a mãe orientada sobre amamentação (RP=1,10; IC95%=1,02-1,18), que favoreceram esta prática. O uso de chupeta não se associou à prevalência de aleitamento materno exclusivo (RP=1,10; IC95%=1,00-1,21). CONCLUSÃO: O uso de mamadeira exerceu influência negativa na prevalência do aleitamento materno exclusivo e deve ser considerado alvo de estratégias para incremento dessa prática.

OBJECTIVE: To evaluate the use of pacifiers and bottles and their influence on the prevalence of exclusive breastfeeding among children of mothers attending a human milk bank. METHODS: This cross-sectional study included mothers seen at a human milk bank from 2009 to 2011. The following information was collected by a structured questionnaire: sociodemographic data, obstetric history, and information about exclusive breastfeeding, bottle use, and pacifier use. The data were analyzed descriptively and by the Chi-square test and Poisson's regression. RESULTS: A total of 9,474 mothers were assessed. Of these, 65.2% had completed high school, and 60.6% reported having done exclusive breastfeeding. The prevalences of bottle and pacifier use were 22.9 and 25.0%, respectively. Exclusive breastfeeding was less prevalent in children who used pacifier (38.4 versus 43.2%; p<0.001) and bottle (13.5 versus 46.6%; p<0.001). Use of bottle was associated with a smaller prevalence of exclusive breastfeeding (PR=0.43; 95%CI=0.35-0.53), unlike feeding on demand (PR=5.5; 95%CI=4.17-7.3), higher maternal education level (PR=1.2; 95%CI=1.08-1.35), prenatal care (PR=1.25; 95%CI=1.13-1.38), and mother having received counseling on breastfeeding (PR=1.10; 95%CI=1.02-1.18), which favored the practice. Pacifier use was not associated with the prevalence of exclusive breastfeeding (PR=1.10; 95%CI=1.00-1.21). CONCLUSION: Bottle use had a negative impact on the prevalence of exclusive breastfeeding, thus it should be considered a target of strategies that promote it.