Family Health Strategy associated with increased dental visitation among preschool children in Brazil.

BACKGROUND: Early-life dental service utilization could improve child dental health. AIM: Identify contextual, socioeconomic, and child characteristics associated with dental visitation by age 3 years. DESIGN: Within a Brazilian birth cohort (N = 435), multivariable regression models were fitted to identify independent predictors of having made a dental visit at age 3 years. Contextual variables considered included health center type (Traditional vs. Family Health Strategy, which perform home visits) and composition of oral health teams at the heath center where mothers accessed prenatal care. RESULTS: Dental visitation was positively associated with Family Health Strategy health centers (36% vs. 23%) and with higher maternal education and family social class. Visitation was lowest among families served by a health center without a dentist, but number of dentists and oral health team composition were not associated with visitation among facilities with ≥1 dentists. Dental visitation was not statistically significantly associated with caries experience but was higher if parents reported worse oral health-related quality of life. The vast majority of dental decay remained untreated. CONCLUSIONS: Dental visits were underutilized, and socioeconomic inequalities were evident. Dental visitation was more common when mothers received prenatal care at Family Health Strategy health centers, suggesting a possible oral health benefit.

Introduction of inappropriate complementary feeding in the first year of life and associated factors in children with low socioeconomic status. / Introdução de alimentos não recomendados no primeiro ano de vida e fatores associados em crianças de baixo nível socioeconômico.

The study aimed to identify factors associated with the introduction of inappropriate complementary feeding in the first year of life in children living in municipalities (counties) with low socioeconomic statusl. This was a cross-sectional multicenter study in 1,567 children 12 to 59 months of age in 48 municipalities participating in the Brazil Without Poverty plan in the South of Brazil. A structured questionnaire was applied to the children's parents to obtain socio-demographic information and the age at which inappropriate complementary foods were introduced for the first time in complementary feeding. Prevalence of introduction of sugar before four months of age was 35.5% (n = 497; 95%CI: 33.1-38.0). The prevalence rates for the introduction of cookies/crackers, creamy yogurt, and jelly before six months of age were 20.4% (n = 287; 95%CI: 18.3-22.3), 24.8% (n = 349; 95%CI: 22.4-27.1), and 13.8% (n = 192; 95%CI: 12.0-15.7), respectively. Associations were identified between low maternal schooling (PR = 1.25; 95%CI: 1.03-1.51) and low monthly family income (PR = 1.22; CI95%: 1.01-1.48) and the introduction of inappropriate complementary feeding. The study identified the introduction of inappropriate complementary feeding in the first year of life among children in municipalities with high socioeconomic vulnerability in the South of Brazil, associated with low maternal schooling and low monthly family income.

Identificar os fatores associados à introdução de alimentos não recomendados no primeiro ano de vida, entre crianças residentes em municípios de baixo nível socioeconômico. Estudo multicêntrico transversal com 1.567 crianças de 12 a 59 meses de idade residentes em 48 municípios participantes do plano Brasil Sem Miséria da Região Sul do Brasil. Aplicou-se questionário estruturado aos responsáveis pelas crianças para a obtenção das informações sociodemográficas e idade na qual alimentos não recomendados foram introduzidos pela primeira vez na alimentação complementar. A prevalência de introdução de açúcar antes dos quatro meses de idade da criança foi de 35,5% (n = 497; IC95%: 33,1-38,0). As prevalências de introdução de biscoito doce/salgado, queijo petit suisse e gelatina antes do sexto mês de vida da criança foram de 20,4% (n = 287; IC95%: 18,3-22,3), 24,8% (n = 349; IC95%: 22,4-27,1) e 13,8% (n = 192; IC95%: 12,0-15,7), respectivamente. Identificou-se associação entre a menor escolaridade materna (RP = 1,25; IC95%: 1,03-1,51) e a menor renda mensal familiar (RP = 1,22; IC95%: 1,01-1,48) com a introdução de alimentos não recomendados. Verificou-se a introdução de alimentos não recomendados no primeiro ano de vida entre crianças residentes em municípios de alta vulnerabilidade socioeconômica da Região Sul do Brasil, e esta prática associou-se à menor escolaridade materna e menor renda familiar mensal.

El estudio tuvo como fin identificar los factores asociados a la introducción de alimentos no recomendados durante el primer año de vida, entre niños residentes en municipios con un bajo nivel socioeconómico. Se trata de un estudio multicéntrico transversal con 1.567 niños de 12 a 59 meses de edad, residentes en 48 municipios participantes en el plan Brasil Sin Miseria de la región Sur de Brasil. Se aplicó un cuestionario estructurado a los responsables de los niños para la obtención de la información sociodemográfica y la edad en la que los alimentos no recomendados se introdujeron por primera vez en la alimentación complementaria. La prevalencia de introducción del aúcar, antes de los cuatro meses de edad del niño, fue de un 35,5% (n = 497; IC95%: 33,1-38,0). Las prevalencias de la introducción de galletas dulce/saladas, queso petit suisse y gelatina antes del sexto mes de vida del niño fueron de un 20,4% (n = 287; IC95%: 18,3-22,3), un 24,8% (n = 349; IC95%: 22,4-27,1) y un 13,8% (n = 192; IC95%: 12,0-15,7), respectivamente. Se identificó una asociación entre la menor escolaridad materna (RP = 1,25; IC95%: 1,03-1,51) y la menor renta mensual familiar (RP = 1,22; IC95%: 1,01-1,48), con la introducción de alimentos no recomendados. Se verificó la introducción de alimentos no recomendados durante el primer año de vida entre niños residentes en municipios de alta vulnerabilidad socioeconómica de la región Sur de Brasil, y esta práctica se asoció a una menor escolaridad materna y una menor renta familiar mensual.

Introdução de alimentos não recomendados no primeiro ano de vida e fatores associados em crianças de baixo nível socioeconômico / Introducción de alimentos no recomendados durante el primer año de vida y sus factores asociados en niños con bajo nivel socioeconómico / Introduction of inappropriate complementary feeding in the first year of life and associated factors in children with low socioeconomic status

Identificar os fatores associados à introdução de alimentos não recomendados no primeiro ano de vida, entre crianças residentes em municípios de baixo nível socioeconômico. Estudo multicêntrico transversal com 1.567 crianças de 12 a 59 meses de idade residentes em 48 municípios participantes do plano Brasil Sem Miséria da Região Sul do Brasil. Aplicou-se questionário estruturado aos responsáveis pelas crianças para a obtenção das informações sociodemográficas e idade na qual alimentos não recomendados foram introduzidos pela primeira vez na alimentação complementar. A prevalência de introdução de açúcar antes dos quatro meses de idade da criança foi de 35,5% (n = 497; IC95%: 33,1-38,0). As prevalências de introdução de biscoito doce/salgado, queijo petit suisse e gelatina antes do sexto mês de vida da criança foram de 20,4% (n = 287; IC95%: 18,3-22,3), 24,8% (n = 349; IC95%: 22,4-27,1) e 13,8% (n = 192; IC95%: 12,0-15,7), respectivamente. Identificou-se associação entre a menor escolaridade materna (RP = 1,25; IC95%: 1,03-1,51) e a menor renda mensal familiar (RP = 1,22; IC95%: 1,01-1,48) com a introdução de alimentos não recomendados. Verificou-se a introdução de alimentos não recomendados no primeiro ano de vida entre crianças residentes em municípios de alta vulnerabilidade socioeconômica da Região Sul do Brasil, e esta prática associou-se à menor escolaridade materna e menor renda familiar mensal.

El estudio tuvo como fin identificar los factores asociados a la introducción de alimentos no recomendados durante el primer año de vida, entre niños residentes en municipios con un bajo nivel socioeconómico. Se trata de un estudio multicéntrico transversal con 1.567 niños de 12 a 59 meses de edad, residentes en 48 municipios participantes en el plan Brasil Sin Miseria de la región Sur de Brasil. Se aplicó un cuestionario estructurado a los responsables de los niños para la obtención de la información sociodemográfica y la edad en la que los alimentos no recomendados se introdujeron por primera vez en la alimentación complementaria. La prevalencia de introducción del aúcar, antes de los cuatro meses de edad del niño, fue de un 35,5% (n = 497; IC95%: 33,1-38,0). Las prevalencias de la introducción de galletas dulce/saladas, queso petit suisse y gelatina antes del sexto mes de vida del niño fueron de un 20,4% (n = 287; IC95%: 18,3-22,3), un 24,8% (n = 349; IC95%: 22,4-27,1) y un 13,8% (n = 192; IC95%: 12,0-15,7), respectivamente. Se identificó una asociación entre la menor escolaridad materna (RP = 1,25; IC95%: 1,03-1,51) y la menor renta mensual familiar (RP = 1,22; IC95%: 1,01-1,48), con la introducción de alimentos no recomendados. Se verificó la introducción de alimentos no recomendados durante el primer año de vida entre niños residentes en municipios de alta vulnerabilidad socioeconómica de la región Sur de Brasil, y esta práctica se asoció a una menor escolaridad materna y una menor renta familiar mensual.

The study aimed to identify factors associated with the introduction of inappropriate complementary feeding in the first year of life in children living in municipalities (counties) with low socioeconomic statusl. This was a cross-sectional multicenter study in 1,567 children 12 to 59 months of age in 48 municipalities participating in the Brazil Without Poverty plan in the South of Brazil. A structured questionnaire was applied to the children's parents to obtain socio-demographic information and the age at which inappropriate complementary foods were introduced for the first time in complementary feeding. Prevalence of introduction of sugar before four months of age was 35.5% (n = 497; 95%CI: 33.1-38.0). The prevalence rates for the introduction of cookies/crackers, creamy yogurt, and jelly before six months of age were 20.4% (n = 287; 95%CI: 18.3-22.3), 24.8% (n = 349; 95%CI: 22.4-27.1), and 13.8% (n = 192; 95%CI: 12.0-15.7), respectively. Associations were identified between low maternal schooling (PR = 1.25; 95%CI: 1.03-1.51) and low monthly family income (PR = 1.22; CI95%: 1.01-1.48) and the introduction of inappropriate complementary feeding. The study identified the introduction of inappropriate complementary feeding in the first year of life among children in municipalities with high socioeconomic vulnerability in the South of Brazil, associated with low maternal schooling and low monthly family income.

Excessive maternal weight and practice of exclusive breastfeeding among women of low socioeconomic status / Excesso de peso gestacional e prática de aleitamento materno exclusivo entre mulheres de baixo nível socioeconômico

ABSTRACT Objective: To investigate the impact of excessive maternal weight on the early discontinuation of exclusive breastfeeding Methods: This is a longitudinal study including mother-infant dyads of low socioeconomic status receiving prenatal care in Health Care Centers in Porto Alegre, Rio Grande do Sul, Brazil. A structured questionnaire was administered to women in the last trimester of pregnancy, including weight measurements. Another interview was conducted six months after delivery, and data on infant feeding practices were collected and maternal height was measured. Maternal nutritional status was assessed using body mass index values according to gestational age. Discontinuation of exclusive breastfeeding before 4 months was considered a low duration rate Results: A total of 619 mother-infant dyads were evaluated. The prevalence of maternal overweight in the third trimester of pregnancy was 51%. The median duration of exclusive breastfeeding was 2.0 months. After adjustment for possible confounding factors, no association between maternal overweight and early discontinuation of exclusive breastfeeding was identified. Maternal smoking was identified as a risk factor (1.23, 95%CI=1.13-1.35) for early discontinuation of exclusive breastfeeding Conclusion: Excessive maternal weight was not confirmed as a risk factor for early discontinuation of exclusive breastfeeding. However, women who reported being smokers had a higher risk of early discontinuation of exclusive breastfeeding than those who did not smoke. This indicates the need for public health interventions to promote smoking cessation during pregnancy and in the postpartum period because of the deleterious effects of this habit on maternal and infant health.

RESUMO Objetivo: Investigar o impacto do excesso de peso gestacional na interrupção precoce do aleitamento materno exclusivo. Métodos: Estudo longitudinal com binômios mãe-filho de baixo nível socioeconômico atendidos em Unidades de Saúde de Porto Alegre, Brasil. Foi aplicado questionário estruturado às mulheres no último trimestre de gestação com mensuração de peso. Seis meses após o parto ocorreu nova entrevista onde foram obtidos dados sobre prática alimentar da criança e a altura materna foi mensurada. O estado nutricional gestacional foi avaliado por meio do índice de massa corporal de acordo com a idade gestacional. Foi considerada interrupção precoce do aleitamento materno exclusivo a interrupção anterior aos 4 meses de vida da criança. Resultados: Analisaram-se 619 binômios mãe-filho. A prevalência de excesso de peso no terceiro trimestre de gestação foi de 51%. A duração mediana do aleitamento materno exclusivo foi de 2,0 meses. Após análise ajustada, não foi identificado efeito do excesso de peso gestacional na interrupção precoce do aleitamento materno exclusivo. Em contrapartida, o tabagismo materno foi identificado como fator de risco (1,23, IC95%=1,13-1,35) para interrupção precoce do aleitamento materno exclusivo. Conclusão: O excesso de peso materno não confirmou-se como fator de risco para interrupção precoce do aleitamento materno exclusivo. Contudo, as mulheres que se declararam fumantes apresentaram maior risco de interromper a prática do que aquelas que não fumavam. Isso reforça a necessidade de ações de saúde pública as quais promovam a cessação do tabagismo no período gestacional e no puerpério em virtude das consequências deletérias deste hábito à saúde materno-infantil.

Oral health-related quality-of-life scores differ by socioeconomic status and caries experience.

OBJECTIVES: (i) Quantify the relative association between child dental caries experience and maternal-reported child oral health-related quality of life (OHRQoL); (ii) examine whether that association differed according to family socioeconomic status (SES); and (iii) explore whether absolute OHRQoL varied by family SES at similar levels of child caries experience. METHODS: This study was a cross-sectional analysis of children in southern Brazil (n=456, mean age: 38 months) participating in an existing health centre-based intervention study. OHRQoL impact was quantified as mean score on the Brazilian Early Childhood Oral Health Impact Scale (ECOHIS) and compared over categories of caries experience (dmft: 0, dmft: 1-4, dmft: ≥5). Adjusted ECOHIS ratios between caries categories were calculated using regression modelling, overall and within socioeconomic strata defined by maternal education, social class and household income. RESULTS: Caries prevalence (dmft >0) was 39.7%, mean ECOHIS score was 2.0 (SD: 3.5), and 44.3% of mothers reported OHRQoL impact (ECOHIS score >0). Increasing child caries experience was associated with worsening child and family quality of life: ECOHIS scores were 3.0 times greater (95% CI: 2.0, 4.4) for children with dmft ≥5 vs dmft=0, a pattern that persisted regardless of family socioeconomic status (P for interaction: all >0.3). However, adjusted for dental status and sociodemographic characteristics, mean ECOHIS scores were lower when reported by mothers of less educational attainment (ratio: 0.7; 95% CI: 0.5, 1.0), lower social class (ratio: 0.7; 95% CI: 0.5, 1.0) or in lower income households (ratio: 0.8; 95% CI: 0.6, 1.3). CONCLUSION: Dental caries was associated with negative child and family experiences and lower OHRQoL across all social groups; yet, families facing greater disadvantage may report lesser quality-of-life impact at the same level of disease experience. Thus, subjective quality-of-life measures may differ under varying social contexts, with possible implications for service utilization, evaluating oral health interventions, or quantifying disease morbidity in low-SES groups.

Iniquidades sociais influenciam a qualidade e a diversidade da dieta de crianças brasileiras de 6 a 36 meses / Social inequalities influence the quality and diversity of diet in Brazilian children 6 to 36 months of age / Desigualdades sociales influyen en la calidad y diversidad de la dieta de los niños brasileños con una edad de 6 a 36 meses

Resumo Avaliar práticas alimentares de crianças brasileiras e os fatores associados à qualidade e à diversidade da dieta. Foram utilizados dados de 2.477 crianças com idade de 6 a 36 meses da Pesquisa Nacional de Demografia e Saúde realizada no Brasil em 2006/2007. As dietas foram avaliadas e classificadas por meio de um índice composto. Apresentaram dieta de alta qualidade 28,2% e dieta diversificada 20% das crianças. Crianças pertencentes às classes socioeconômicas menos privilegiadas e residentes em domicílio em situação de insegurança alimentar grave apresentaram, aproximadamente, 40% menos chances de ter dieta de alta qualidade. A chance de ter dieta diversificada foi 71% menor para crianças residentes em domicílio em situação de insegurança alimentar grave e 43% menor se filhas de mães com baixa escolaridade. Crianças residentes na Região Norte do país apresentaram menos chances de ter dieta diversificada e dieta de alta qualidade. A qualidade da dieta de crianças brasileiras é inadequada, e a situação de vulnerabilidade social está fortemente associada a esse quadro alimentar desfavorável.

Abstract The objective of this study was to assess dietary patterns in Brazilian children and factors associated with better diet. The authors used data for 2,477 children 6 to 36 months of age from the Brazilian National Survey of Demographic and Health in 2006-2007. Diet was assessed and classified using a composite index. The results showed that 28.2% of the children received a high-quality diet and 20% had a diversified diet. Children from socioeconomically underprivileged families or with serious food insecurity were approximately 40% less likely to have high-quality diets. Children living in homes with food insecurity were 71% less likely to have diversified diets, and those whose mothers had limited education were 43% less likely. Children residing in the North of Brazil were less likely to have diversified and high-quality diets. The dietary quality of Brazilian children is inadequate, and social vulnerability is closely associated with this adverse dietary situation.

Resumen Evaluar las prácticas alimentarias de los niños brasileños y los factores asociados con mejores prácticas dietéticas. Se utilizaron los datos de 2.477 niños de 6 a 36 meses de la Encuesta Nacional de Demografía y Salud, llevada a cabo en Brasil en 2006/7. Las dietas fueron evaluadas y calificadas por un índice compuesto. Presentaron una dieta de alta calidad el 28,2% y una dieta variada el 20% de los niños. Niños pertenecientes a clases socioeconómicas menos privilegiadas, y que viven en domicilios en situación de inseguridad alimentaria grave, presentaron aproximadamente un 40% menos de probabilidad de tener una dieta de alta calidad. La probabilidad de tener una dieta diversificada fue un 71% menor en los niños que viven en domicilios en situación de inseguridad alimentaria grave y un 43% menor, si son hijas de madres con bajo nivel de escolaridad. Los niños que viven en el norte del país tenían menos probabilidad de tener una dieta diversificada y de alta calidad. La calidad de la dieta de los niños es inadecuada y la situación de vulnerabilidad social está asociada con el panorama alimentario desfavorable.

[Social inequalities influence the quality and diversity of diet in Brazilian children 6 to 36 months of age]. / Iniquidades sociais influenciam a qualidade e a diversidade da dieta de crianças brasileiras de 6 a 36 meses.

The objective of this study was to assess dietary patterns in Brazilian children and factors associated with better diet. The authors used data for 2,477 children 6 to 36 months of age from the Brazilian National Survey of Demographic and Health in 2006-2007. Diet was assessed and classified using a composite index. The results showed that 28.2% of the children received a high-quality diet and 20% had a diversified diet. Children from socioeconomically underprivileged families or with serious food insecurity were approximately 40% less likely to have high-quality diets. Children living in homes with food insecurity were 71% less likely to have diversified diets, and those whose mothers had limited education were 43% less likely. Children residing in the North of Brazil were less likely to have diversified and high-quality diets. The dietary quality of Brazilian children is inadequate, and social vulnerability is closely associated with this adverse dietary situation.

Positive impact of child feeding training program for primary care health professionals: a cluster randomized field trial / Atualização sobre alimentação da criança para profissionais de saúde: estudo de campo randomizado por conglomerados

OBJECTIVE: To assess the impact of a child feeding training program for primary care health professionals about breastfeeding and complementary feeding practices. METHODS: Cluster-randomized field trial conducted in the city of Porto Alegre, (RS), Brazil. Twenty primary health care centers (HCC) were randomized into intervention (n = 9) and control (n = 11) groups. The health professionals (n = 200) at the intervention group centers received training about healthy feeding practices. Pregnant women were enrolled at the study. Up to six months of child's age, home visits were made to obtain variables related to breastfeeding and introduction of foods. RESULTS: 619 children were evaluated: 318 from the intervention group and 301 from the control group. Exclusive breastfeeding prevalence in the first (72.3 versus 59.4%; RR = 1.21; 95%CI 1.08 - 1.38), second (62.6 versus 48.2%; RR = 1.29; 95%CI 1.10 - 1.53), and third months of life (44.0% versus 34.6%; RR = 1.27; 95%CI 1.04 - 1.56) was higher in the intervention group compared to the control group. The prevalence of children who consumed meat four or five times per week was higher in the intervention group than in the control group (36.8 versus 22.6%; RR = 1.62; 95%CI 1.32 - 2.03). The prevalence of children who had consumed soft drinks (34.9 versus 52.5%; RR = 0.66; 95%CI 0.54 - 0.80), chocolate (24.5 versus 36.7% RR = 0.66 95%CI 0.53 - 0.83), petit suisse (68.9 versus 79.7; 95%CI 0.75 - 0.98) and coffee (10.4 versus 20.1%; RR = 0.51; 95%CI 0.31 - 0.85) in their six first months of life was lower in the intervention group. CONCLUSION: The training of health professionals had a positive impact on infant feeding practices, contributing to the promotion of child health. .

OBJETIVO: Avaliar o impacto de um programa de atualização em alimentação infantil para profissionais da atenção primaria à saúde nas práticas de aleitamento materno e alimentação complementar. MÉTODOS: Ensaio de campo randomizado por conglomerados realizado em Porto Alegre (RS), Brasil. Vinte unidades de saúde foram randomizadas em grupo intervenção (n = 9) e controle (n = 11). Os profissionais das unidades de saúde do grupo intervenção (n = 200) receberam orientações quanto às diretrizes alimentares para lactentes do Ministério da Saúde. Aos seis meses de idade da criança, realizou-se visita domiciliar às mães participantes para obtenção das variáveis relacionadas a aleitamento materno e introdução de alimentos. RESULTADOS: Avaliaram-se 619 crianças, 318 do grupo intervenção e 301 do controle. A prevalência de aleitamento materno exclusivo no primeiro (72,3 versus 59,4%; RR = 1,21; IC95% 1,08 - 1,38), segundo (62,6 versus 48,2%; RR = 1,29; IC95% 1,10 - 1,53) e terceiro mês de vida (44,0 versus 34,6; RR = 1,27; IC95% 1,04 - 1,56) foi maior no grupo intervenção em relação ao controle. A prevalência de crianças que consumiram carne quatro ou mais vezes na semana foi superior no grupo intervenção em relação ao controle (36,8 versus 22,6%; RR = 1,62; IC95% 1,30 - 2,03). A prevalência de crianças que já haviam consumido refrigerante (34,9 versus 52,5%; RR = 0,66; IC95% 0,54 - 0,80), chocolate (24,5 versus 36,7%; RR = 0,66; IC95% 0,53 - 0,83) e petit suisse (68,9 versus 79,7%; IC95% 0,75 - 0,98) e café (10,4 versus 20,1%; RR = 0,51; IC95% 0,31 - 0,85) nos primeiros seis meses de vida, foi menor no grupo intervenção. CONCLUSÃO: A atualização dos profissionais ...

Positive impact of child feeding training program for primary care health professionals: a cluster randomized field trial.

OBJECTIVE: To assess the impact of a child feeding training program for primary care health professionals about breastfeeding and complementary feeding practices. METHODS: Cluster-randomized field trial conducted in the city of Porto Alegre, (RS), Brazil. Twenty primary health care centers (HCC) were randomized into intervention (n = 9) and control (n = 11) groups. The health professionals (n = 200) at the intervention group centers received training about healthy feeding practices. Pregnant women were enrolled at the study. Up to six months of child's age, home visits were made to obtain variables related to breastfeeding and introduction of foods. RESULTS: 619 children were evaluated: 318 from the intervention group and 301 from the control group. Exclusive breastfeeding prevalence in the first (72.3 versus 59.4%; RR = 1.21; 95%CI 1.08 - 1.38), second (62.6 versus 48.2%; RR = 1.29; 95%CI 1.10 - 1.53), and third months of life (44.0% versus 34.6%; RR = 1.27; 95%CI 1.04 - 1.56) was higher in the intervention group compared to the control group. The prevalence of children who consumed meat four or five times per week was higher in the intervention group than in the control group (36.8 versus 22.6%; RR = 1.62; 95%CI 1.32 - 2.03). The prevalence of children who had consumed soft drinks (34.9 versus 52.5%; RR = 0.66; 95%CI 0.54 - 0.80), chocolate (24.5 versus 36.7% RR = 0.66 95%CI 0.53 - 0.83), petit suisse (68.9 versus 79.7; 95%CI 0.75 - 0.98) and coffee (10.4 versus 20.1%; RR = 0.51; 95%CI 0.31 - 0.85) in their six first months of life was lower in the intervention group. CONCLUSION: The training of health professionals had a positive impact on infant feeding practices, contributing to the promotion of child health.

[The impact of health workers' training on breastfeeding and complementary feeding practices]. / Impacto da atualização de profissionais de saúde sobre as práticas de amamentação e alimentação complementar.

This study aimed to evaluate the impact on feeding practices for infants (<1 year of age) resulting from update training for health workers in the Ten Steps to Healthy Feeding of Children Under Two. Health Care Centers (HCC) in Porto Alegre, Rio Grande do Sul State, Brazil, were randomized into a control group (n=11) and an intervention group (n=9). Health centers organized according to Brazil's Family Health Program (FHP) were included as an intervention cluster (n=12). Infant feeding practices were evaluated at the health centers at 6 months (n=918) and again at 12 months of age (n=799). The results showed that mean duration of exclusive breastfeeding was significantly longer in the two groups that received the intervention (2.56±1.91 months in the FHP intervention and 2.32±1.63 months in the HCC intervention) compared to the HCC control group (1.91±1.60 months). There was a positive impact on the quality of complementary feeding of infants treated at the health centers that participated in the intervention, especially those with the FHP.

Impacto da atualização de profissionais de saúde sobre as práticas de amamentação e alimentação complementar / The impact of health workers? training on breastfeeding and complementary feeding practices / Impacto de la formación de los profesionales de la salud en la práctica de la lactancia materna y la alimentación complementaria

O objetivo foi avaliar o impacto da atualização de profissionais de saúde em relação aos Dez Passos da Alimentação Saudável para Crianças Menores de Dois Anos sobre as práticas alimentares no primeiro ano de vida. Participaram do estudo unidades básicas de saúde (UBS) do Município de Porto Alegre, Rio Grande do Sul, Brasil, randomizadas em controle (n = 11) e intervenção (n = 9). Unidades de saúde que possuem serviço de saúde comunitária como Estratégia Saúde da Família (ESF) foram incluídas como um cluster de intervenção (n = 12). As práticas alimentares das crianças incluídas no estudo foram avaliadas quando elas tinham 6 (n = 918) e 12 meses (n = 799) de idade. Os resultados mostraram que o tempo médio de duração do aleitamento materno exclusivo foi significativamente maior nos dois grupos que receberam a intervenção (2,56 ± 1,91 mês nas US-ESF e 2,32 ± 1,63 mês nas UBS-intervenção) comparados às UBS-controle (1,91 ± 1,60 meses). Houve impacto positivo na qualidade da alimentação complementar das crianças atendidas nos serviços de saúde que participaram da intervenção, especialmente naqueles com ESF.

This study aimed to evaluate the impact on feeding practices for infants (< 1 year of age) resulting from update training for health workers in the Ten Steps to Healthy Feeding of Children Under Two. Health Care Centers (HCC) in Porto Alegre, Rio Grande do Sul State, Brazil, were randomized into a control group (n = 11) and an intervention group (n = 9). Health centers organized according to Brazil’s Family Health Program (FHP) were included as an intervention cluster (n = 12). Infant feeding practices were evaluated at the health centers at 6 months (n = 918) and again at 12 months of age (n = 799). The results showed that mean duration of exclusive breastfeeding was significantly longer in the two groups that received the intervention (2.56 ± 1.91 months in the FHP intervention and 2.32 ± 1.63 months in the HCC intervention) compared to the HCC control group (1.91 ± 1.60 months). There was a positive impact on the quality of complementary feeding of infants treated at the health centers that participated in the intervention, especially those with the FHP.

El objetivo fue evaluar el impacto de la actualización de los profesionales de la salud, en relación con los diez pasos de la alimentación saludable en niños con menos de dos años, dentro de las prácticas de alimentación durante el primer año de vida. Participaron en el estudio las unidades básicas de salud (UBS) de Porto Alegre, Río Grande do Sul, Brasil, distribuidas aleatoriamente en control (n = 11) e intervención (n = 9). Las unidades de salud con Estrategia de Salud de la Familia (ESF) fueron incluidas como un clúster de intervención (n = 12). Las prácticas alimentarias de los niños, cuyo seguimiento se realizó en los servicios de salud fueron evaluadas a los seis meses (n = 918) y, luego, a los 12 meses (n = 799). Los resultados mostraron que el tiempo medio de duración de la lactancia materna exclusiva fue considerablemente mayor en los dos grupos que recibieron la intervención (2,56 ± 1,91 meses en las US-ESF; 2,32 ± 1,63 meses en las UBS-intervención), comparados con las UBS-control (1,91 ± 1,60 meses). Hubo un impacto positivo en la calidad de la alimentación complementaria de los niños atendidos en los servicios de salud que participaron en la intervención, especialmente, en aquellos con ESF.

Socioeconomic, behavioral, and anthropometric risk factors for traumatic dental injuries in childhood: a cohort study.

AIM: To investigate risk factors for the occurrence of traumatic dental injuries (TDI) at 4 years of age. DESIGN: Prospective cohort study. METHODS: A birth cohort (n = 500) was recruited from the public healthcare system in São Leopoldo, Brazil. Demographic, socioeconomic, anthropometric, and behavioral variables were collected at 6 months, 1 year, and 4 years of age. Clinical examinations at 4 years of age were carried out by a single examiner using the Andreasen classification. Poisson regression was used to determine risk factors for the occurrence of TDI at 4 years of age. RESULTS: A total of 23.7% of the children (80/337) exhibited TDI at 4 years of age. The risk of TDI was 35% lower among children who had been breastfeed for ≥6 months relative risk (RR 0.65; 95% CI 0.43-0.97) and more than twofold higher among those who were bottle fed ≥ three times a day (RR 2.37; 95% CI 1.10-5.11) at 12 months of age. Higher household income in the first year of life and greater height at 4 years of age were significantly associated with the outcome. CONCLUSIONS: The identification of behavioral, socioeconomic, and anthropometric risk factors for TDI in early childhood can contribute to the elaboration of prevention strategies.

Advising mothers about breastfeeding and weaning reduced pacifier use in the first year of life: a randomized trial.

OBJECTIVE: To assess the effectiveness of home visits for advising mothers about breastfeeding and weaning on pacifier use in the first year of life. METHOD: A randomized field trial was conducted on mothers who gave birth within the public health system in the Brazilian city of Sao Leopoldo (intervention group = 200; controls = 300). The intervention group received the advice 10 days after the child's birth, monthly up to 6 months, at 8, 10, and 12 months, based on the 'Ten Steps for Healthy Feeding', a Brazilian national health policy for primary care, which follows WHO guidelines. Relative risk (RR) was used to estimate the effects of the intervention on the risk of using a pacifier. RESULTS: 55.4% of the children in the intervention group and 66.1% of the controls used a pacifier in the first year of life. The risk of using a pacifier was 16% lower for the intervention group (RR = 0.84; 95% CI, 0.71-0.99). A multivariable Poisson regression model showed higher adjusted risk of using a pacifier for children who had breastfeeding interrupted in the first month of life (RR = 1.43; 95% CI, 1.21-1.69) and whose mothers presented higher level of depression (RR = 1.40; 95% CI, 1.17-1.66). CONCLUSIONS: Pacifier use is highly prevalent in the population studied. The home visits for dietary advice appear to help in reducing pacifier use in infants. These findings suggest the need for public health strategies that address early advice on pacifier use to promote child oral and general health.

Velocidade de ganho de peso e práticas alimentares no primeiro ano de vida em lactentes de baixo nível socioeconômico / Weight gain rate and feeding practices of low-socioeconomic status infants

OBJETIVO: Avaliar a velocidade do ganho de peso e sua associação com as práticas alimentares no primeiro ano de vida em crianças de baixo nível socioeconômico. MÉTODOS: Utilizaram-se dados de peso e comprimento ao nascer obtidos dos registros hospitalares e as medidas antropométricas aferidas aos 6 e 12 meses para o cálculo do ganho de peso no primeiro e no segundo semestres de vida. Dados das práticas alimentares das crianças foram obtidos por meio de entrevistas com as mães aos 6 e 12 meses de idade das crianças. RESULTADOS: Avaliaram-se 328 crianças: 184 meninos e 144 meninas. As meninas apresentaram maior ganho de peso em relação ao padrão da Organização Mundial de Saúde nos primeiros 6 meses de vida (4.452kg versus 4.079kg, p=0,000). Dos 6 aos 12 meses, o ganho de peso das crianças avaliadas foi significativamente maior em comparação ao padrão da Organização Mundial de Saúde para os dois sexos (1.929kg versus 1.688kg, p=0,000 para os meninos e 1.900kg versus 1.618kg, p=0,001 para as meninas). As crianças do sexo masculino que receberam aleitamento materno exclusivo por período menor que quatro meses apresentaram maior ganho de peso entre 6 e 12 meses de idade em relação àquelas que receberam somente leite materno por período igual ou superior a quatro meses (M=2,077, DP=0,777 versus M=1,814, DP=0,669 p=0,02). CONCLUSÃO: Este estudo evidenciou que as crianças avaliadas apresentaram ganho de peso excessivo no primeiro ano de vida, e que o aleitamento materno exclusivo apresentou papel protetor.

OBJECTIVE: This study assessed weight gain rate during the first year of life of lowsocioeconomic status infants and verified its association with feeding practices. METHODS: Weight gain during the first 6 and 12 months of life was calculated using birth weight and length data obtained from hospital records and anthropometric measurements done when the infants were 6 and 12 months old. Dietary data were collected during interviews with the mothers when the children were 6 and 12 months old. RESULTS: A total of 328 children were assessed, 184 boys and 144 girls. The girls gained more weight from birth to 6 months, as compared with the World Health Organization data (4,452kg versus 4,079kg p=0,000). From 6 to 12 months of age, the children's weight gain was significantly higher than that of the World Health Organization data for both sexes (1,929kg versus 1,688kg, p=0,000, for boys and 1,900kg versus 1,618kg, p=0,001, for girls). The boys who were exclusively breastfed for less than 4 months gained more weight from 6 to 12 months of age than those who were exclusively breastfed for 4 months or more (M=2,077, SD=0,777 versus M=1,814, SD=0,669, p=0.02). CONCLUSION: The children in this study showed excessive weight gain during the first year of life. Exclusive breastfeeding was a protective factor.

Sleep duration and body mass index among southern Brazilian preschoolers.

Prevention and treatment of overweight are particularly complex, reinforcing the importance of studies aimed at clarifying their range of causes and effects. Thus, the objective of this study was to evaluate the relationship between night sleep duration and anthropometric measurements. A cross-sectional analysis was performed from data from 348 children aged 3 and 4 years in São Leopoldo/RS. Night sleep duration was reported by their mothers and body mass index, waist circumference and skinfold thickness were measured according to standard protocol. The analyses were adjusted for energy intake and hours of television watching. Overweight children had, on average, 0.39 hours less sleep than those with normal weight (9.77 ± 1.44 versus 10.17 ± 1.34; 95% CI 0.03 to 0, 76). We observed an inverse association between night sleep duration and z score values of body mass index for age (B = -0.12 95% CI -0.22 - -0.02). Waist circumference and skinfold thickness showed an inverse relationship with sleep duration, but without any statistic differences. Among preschool children in southern Brazil, smaller night sleep duration was associated with higher body mass index.

Risk factors for discontinuing breastfeeding in southern Brazil: a survival analysis.

To identify risk factors for discontinuing breastfeeding during an infant's first year of life. A cohort study recruited mothers in a hospital in São Leopoldo, Brazil, which mainly serves the low-income population. In order to obtain socioeconomic, environmental, and behavioral information, face-to-face interviews with mothers were conducted after birth, and when their infants were 6 and 12 months old. The duration of breastfeeding was investigated at 6 and 12 months, and recorded separately for each month. Depressive symptoms were assessed using the Beck Depression Inventory. The multivariate model for predicting the discontinuation of breastfeeding, adjusted Kaplan-Meier survival curves and Cox regression were used. Of the 360 participants, 201 (55.8%) discontinued breastfeeding within the first 12 months. A multivariate Cox regression model revealed that symptoms of maternal depression (low levels: RR = 1.59, 95% CI 1.02-2.47; moderate to severe: RR = 2.03, 95% CI 1.35-3.01), bottle feeding (RR = 2.07, 95% CI 1.31-3.28) and pacifier use in the first month of life (RR = 3.12, 95% CI 2.13-4.57) were independently associated with the outcomes after adjusting for confounders. Breastfeeding cessation rates were lower for children who did not use bottle feeding or a pacifier in the first month of life and for the children whose mothers presented with minimal depression. Early pacifier use and bottle feeding must be strongly discouraged to support long-term breastfeeding. In addition, screening maternal depression at a primary care service can be a step forward in promoting a longer duration of breastfeeding.

Frequency of public child care service use and associated factors.

OBJECTIVE: Assess the maternal socio-demographic factors associated with the frequency of use of child care services by low income families. METHODS: Cross-sectional analysis of 393 children between 12 and 16 months old who participated in a randomized field trial during their first year of life in a program of nutritional intervention. The study began in the Brazilian Unified Health System (Sistema Unico de Saúde, SUS) of the maternity hospital in the city of São Leopoldo, state of Rio Grande do Sul, Brazil. Children were examined regarding child care follow-up and vaccination schedule by checking the immunization chart. Data were analyzed using statistical tests Pearson's chi square and prevalence ratio (PR) with respective 95% confidence interval. RESULTS: The frequency of children who were not continuously taken to the child care service was 53.2%. Multivariate analysis suggests that the factors associated with the lack of continuous use of the service were: mother's educational level

Frequência de utilização do serviço público de puericultura e fatores associados / Frequency of public child care service use and associated factors

Objetivo: Avaliar os fatores sociodemográficos associados à frequência da utilização do serviço de puericultura por famílias de baixo nível socioeconômico. Métodos: Análise transversal de 393 crianças, com idades entre 12 e 16 meses, que participaram de um ensaio de campo randomizado no primeiro ano de vida em um programa de intervenção nutricional. O estudo iniciou nos setores de atendimento do Sistema Único de Saúde da maternidade da cidade de São Leopoldo (RS). As crianças foram avaliadas quanto ao acompanhamento na puericultura e calendário de vacinação. Para análise dos dados utilizou-se teste qui-quadrado de Pearson e razão de prevalência (RP) com respectivo intervalo de confiança de 95 por cento (IC95 por cento). Resultados: A frequência de crianças que não foram levadas regularmente foi de 53,2 por cento. A análise multivariada sugere que os fatores associados à ausência de utilização regular do serviço foram: escolaridade materna < 8 anos (RP 1,32; IC95 por cento 1,02-1,71), estrutura familiar não nuclear (RP 1,32; IC95 por cento 1,10-1,59) e não ser filho único (RP 1,38; IC95 por cento 1,10-1,72). Os motivos relatados para o não acompanhamento da criança na puericultura foram: 66,2 por cento consideraram desnecessário, 21,7 por cento referiram insatisfação com o serviço, 6,05 por cento impossibilidade devido ao emprego e 6,05 por cento outros motivos. Conclusão: A elevada frequência de crianças que não são levadas para acompanhamento no serviço de puericultura está associada à baixa escolaridade materna e à estrutura familiar, além da percepção de que é desnecessário na ausência de doença da criança.

Objective: Assess the maternal socio-demographic factors associated with the frequency of use of child care services by low income families. Methods: Cross-sectional analysis of 393 children between 12 and 16 months old who participated in a randomized field trial during their first year of life in a program of nutritional intervention. The study began in the Brazilian Unified Health System (Sistema Único de Saúde, SUS) of the maternity hospital in the city of São Leopoldo, state of Rio Grande do Sul, Brazil. Children were examined regarding child care follow-up and vaccination schedule by checking the immunization chart. Data were analyzed using statistical tests Pearsons chi square and prevalence ratio (PR) with respective 95 percent confidence interval. Results: The frequency of children who were not continuously taken to the child care service was 53.2 percent. Multivariate analysis suggests that the factors associated with the lack of continuous use of the service were: mothers educational level < 8 years (PR 1.32 95 percentCI 1.02-1.71), non-nuclear family structure (PR 1.32 95 percentCI 1.10-1.59) and not being an only child (PR 1.38 95 percentCI 1.10-1.72). The reasons for lack of follow-up, according to the mothers were: the fact that they thought it unnecessary for 66.2 percent, problems with the service for 21.7 percent, difficulties related to their jobs for 6.05 percent, and other reasons for 6.05 percent. Conclusion: The high frequency of children who were not taken to the child health care service for follow-up is associated with low maternal educational level and family structure, as well as the perception that follow-up visits are not necessary when the child does not have a disease.

Biodisponibilidade do ferro como fator de proteção contra anemia entre crianças de 12 a 16 meses / Iron bioavailability as a protective factor against anemia among children aged 12 to 16 months

OBJETIVO: Este estudo investiga os fatores dietéticos determinantes da ausência de anemia entre lactentes de famílias de baixo nível socioeconômico submetidos a um programa de intervenção nutricional, bem como a adequação do consumo de ferro de acordo com as recomendações. METODOLOGIA: O estudo compreendeu 369 crianças pertencentes a uma coorte do município de São Leopoldo (RS), as quais foram randomizadas ao nascimento para constituírem dois grupos: intervenção e controle. O grupo intervenção foi submetido a orientações dietéticas no primeiro ano de vida, com visitas domiciliares mensais, e o grupo controle foi visitado aos 6 e 12 meses, sem intervenção dietética. Ao final do primeiro ano de vida, realizou-se inquérito alimentar recordatório de 24 horas. O diagnóstico de anemia foi determinado pelo nível de hemoglobina inferior a 11 g/dL. As dietas das crianças foram classificadas de acordo com a biodisponiblidade do ferro presente. RESULTADOS: A prevalência de anemia encontrada neste estudo foi de 63,7 por cento. A proporção de crianças com consumo adequado em relação às recomendações foi estatisticamente mais elevada no grupo sem anemia (26,8 por cento) do que no grupo com anemia (17,7 por cento). As crianças que não apresentaram anemia mostraram maior consumo de ferro (p = 0,019), vitamina C (p = 0,001), densidade energética no jantar (p = 0,006), densidade de ferro por 1.000 calorias (p = 0,045), e 16,3 por cento delas apresentaram dieta com alta biodisponibilidade em ferro (p = 0,002). CONCLUSÕES: A prática alimentar que garante alta biodisponibilidade de ferro protege a criança contra anemia e pode ser usada como proposta de intervenção na rede básica de saúde e no âmbito das secretarias municipais de educação infantil.

OBJECTIVE: This study investigates the nutritional factors that determine the absence of anemia in infants from families with a low socioeconomic background submitted to a nutrition intervention program, as well as iron intake according to recommendations. METHODS: The study included 369 children from a cohort of inhabitants of São Leopoldo, state of Rio Grande do Sul, Brazil, who were randomized at birth into an intervention group and into a control group. The intervention group had nutritional guidance in the first year of life, with monthly follow-up home visits, whereas the control group was visited at 6 and 12 months, without nutritional intervention. At the end of the first year of life, a 24-hour recall was used. Anemia was diagnosed based on a hemoglobin level less than 11 g/dL. The children's diets were classified according to iron bioavailability. RESULTS: The prevalence of anemia amounted to 63.7 percent in this study. The proportion of children with adequate iron intake relative to the recommendations was statistically higher in the nonanemic group (26.8 percent) than in the anemic one (17.7 percent). Nonanemic children had a greater intake of iron (p = 0.019), vitamin C (p = 0.001), energy density at dinner (p = 0.006), iron density per 1,000 calories (p = 0.045); and 16.3 percent of them had a diet with high iron bioavailability (p = 0.002). CONCLUSIONS: A diet with high iron bioavailability protects children from anemia and can be used as an intervention measure by basic health services and by the municipal departments of children's education.

Depressão e suas implicações no aleitamento materno / Depression and its implications in breast feeding

OBJETIVO: O objetivo deste estudo foi avaliar a prevalência de sintomas depressivos num grupo de mães de crianças entre 12 e 16 meses do município de São Leopoldo (RS) e suas associações com tempo de aleitamento materno e aspectos do desenvolvimento da criança. MÉTODO: Foram avaliadas 263 mães de crianças recrutadas ao nascimento em uma maternidade que atende população de baixo nível socioeconômico. Os sintomas depressivos foram avaliados por meio do Inventário para Depressão de Beck. RESULTADOS: Foi observado que 35,7 por cento das mães apresentaram sintomas de depressão. Quanto à classificação, 18,3 por cento apresentaram depressão leve, 11 por cento, depressão moderada, e 6,5 por cento, grave. As mães sem companheiros (razão de prevalência - RP = 1,70; IC95 por cento = 1,20-2,38) e provenientes de famílias não-nucleares apresentaram mais sintomas depressivos (RP = 1,38; IC95 por cento = 0,99-1,92). As freqüências de aleitamento materno exclusivo por 6 meses (RP = 1,86; IC95 por cento = 0,94-3,68) e aleitamento materno aos 12 meses (RP = 1,80; IC95 por cento = 1,26-2,58) foram maiores no grupo de mães sem sintomas depressivos. CONCLUSÃO: É necessária maior atenção à saúde mental das mulheres, considerando a alta prevalência de sintomas depressivos nessa população e a forte associação com o menor tempo de aleitamento materno.

OBJECTIVE: This study aimed at verifying the incidence of depressive symptoms in a group of mothers of children between 12 and 16 months in the municipality of São Leopoldo (RS, Brazil) and their associations with breast feeding and overall child development. METHOD: This study included 263 mothers who delivered at a hospital providing services to a population of low socioeconomic level. Depressive symptoms were assessed using Beck Depression Inventory. RESULTS: It was observed that 35.7 percent of mothers presented depressive symptoms. As to classification, 18.3 percent had mild, 11 percent moderate and 6.5 percent severe depression. Mothers without partners (prevalence ratio - PR = 1.70; IC95 percent = 1.20-2.38) and mothers from non-nuclear families presented more depressive symptoms (PR = 1.38; IC95 percent = 0.99-1.92). Exclusive breast feeding at 6 (PR = 1.86; IC95 percent = 0.94-3.68) and 12 months (PR = 1.80; IC95 percent = 1.26-2.58) was more frequent in the group of mothers without depressive symptoms. CONCLUSION: More attention should be given to women's mental health, considering the high prevalence of depressive symptoms in this population and the strong association with less breastfeeding time.