Does early introduction of solid feeding lead to early cessation of breastfeeding?

Mixed milk feeding increases the likelihood of breastfeeding cessation, but it is not known if solid feeding (SF) has the same effect. We have identified 10,407 infants breastfed for at least 8-10 weeks from three large U.K. studies (Avon Longitudinal Study of Parents and Children [ALSPAC; born 1990-1991], Southampton Woman's Survey [SWS; 1998-2008], and Infant Feeding Survey 2010 [IFS 2010]) to investigate the associations between early SF and breastfeeding cessation. In the earliest study (ALSPAC), 67% had started SF before the age of 4 months, but in the latest (IFS), only 23% had started before 4 months. Solid food introduction before 4 months was associated with stopping breastfeeding before 6 months in all three cohorts, with little effect of adjustment for maternal sociodemographic characteristics (Poisson regression, adjusted prevalence ratios: ALSPAC 1.55, [95% confidence interval 1.4, 1.8], SWS 1.13 [1.0, 1.3], IFS 1.10 [1.1, 1.3]). Using Cox regression, adjusted hazard ratios for breastfeeding cessation compared with SF after 5 months were 2.07 (1.8, 2.4) for SF before 4 and 1.51 (1.3, 1.8) at 4-5 months for ALSPAC and 1.25 (1.1, 1.5) and 1.15 (1.0, 1.3) for SWS. Earlier introduction of solids was associated with a shorter duration of breastfeeding, particularly in cohorts where earlier introduction of solids was the norm, with a dose-response relationship, which was not explained by background social characteristics. As mothers most commonly introduced solids in the month prior to the then recommended age, continuing to recommend deferring solids to the age of 6 months is important to support sustained breastfeeding.

Quality of healthcare services to reduce leprosy in Brazil: a trend analysis from 2001 to 2020.

OBJECTIVE: To analyze the temporal trend of healthcare services quality indicators to reduce leprosy in Brazil, over a 20-year period. METHODS: This is an epidemiological study with a temporal trend, whose data were extracted from the Notifiable Diseases Information System. Indicators were constructed from the Ministry of Health Technical-Operational Manual that presents the Guidelines for Surveillance, Care and Elimination of Leprosy as a Public Health Problem. For trend analysis of the selected indicators, the Prais-Winsten model was used and the Average Annual Growth Rate (AAGR) was also calculated. RESULTS: In the 20-year time series investigated here, 732,959 cases of leprosy were reported in Brazil. The trend was stationary for: new leprosy cases cure rate (ß=-0.000; p=0.196; AAGR=-0.2), new leprosy cases drop out rate (ß=-0.001; p=0.147; AAGR=-0.4), new leprosy cases contact tracing rate (ß=-0.001; p=0.112; AAGR=1.6), new cases of leprosy with degree physical disability assessment rate among new cases (ß=-0.000; p=0.196; AAGR=-0.2) and cases cured in the year with the degree of physical disability assessed (ß=0.002; p=0.265; AAGR=0.5); while the indicator of recurrence rate among cases reported in the year (ß=0.019; p<0.001; AAGR=0.5) showed an increasing trend. CONCLUSION: Based on the evaluation of indicators to assess the quality of healthcare services to reduce leprosy, it was evident that Brazil has major challenges for its full implementation, with improvements being necessary in the quality of care service offered to the population.

Mortality trend from falls in Brazilian older adults from 2000 to 2019. / Tendência de mortalidade por quedas em idosos, no Brasil, no período de 2000­2019.

OBJECTIVE: To analyze the trend of mortality from falls among older adults in Brazil from 2000 to 2019. METHODS: This is an epidemiological, analytical study with an ecological time-series design. A retrospective analysis was performed using secondary health data extracted from the Brazilian Mortality Information System in the specific period. Standardized rates of general and sex- and age-specific mortality were calculated. To observe the mortality trend, the Prais-Winsten model and the Annual Increase Rate (AIR) were used. RESULTS: We identified 135,209 deaths resulting from falls in older adults in the period from 2000 to 2019. Mortality from falls in general, during the study period, had an upward trend (ß=0.023; p<0.001; AIR=5.45%). We observed that both men (ß=0.022; p<0.001; AIR=5.19%) and women (ß=0.024; p<0.001; AIR=5.72%) had an upward trend. Regarding age group, the results also pointed to an upward mortality trend in all age strata, although higher in older people aged ≥80 years (ß=0.027; p<0.001; AIR=6.38%). CONCLUSION: There was an upward trend in mortality rates in Brazil during the time series studied. These findings suggest the importance of defining a line of care for this age group, focusing on promoting health in older adults and preventing the risk of falls, aiming at a reduction in the number of deaths from this cause and favoring the quality of life of this population.

OBJETIVO: Analisar a tendência da mortalidade por quedas entre idosos, no Brasil, no período de 2000 a 2019. MÉTODOS: Trata-se de um estudo epidemiológico, analítico, com delineamento ecológico de séries temporais. Realizou-se uma análise retrospectiva utilizando dados secundários em saúde, extraídos do Sistema de Informação sobre Mortalidade (SIM) no período específico. Foram calculadas taxas padronizadas de mortalidade geral e específicas por sexo e faixa etária. Para a observação da tendência de mortalidade, utilizou-se o modelo de Prais-Winsten e taxa de incremento anual (TIA). RESULTADOS: No período de 2000 a 2019, foram identificados 135.209 óbitos decorrentes das quedas em idosos. A mortalidade por queda em geral, no período estudado, foi crescente (ß=0,023; p<0,001; TIA=5,45%). Observou-se que tanto o sexo masculino (ß=0,022; p<0,001; TIA=5,19%) quanto o feminino (ß=0,024; p<0,001; TIA=5,72%) apresentaram tendência crescente. Com relação à faixa etária, os resultados apontaram também para tendência de mortalidade crescente em todos os estratos etários, porém maior em idosos com idade ≥80 anos (ß=0,027; p<0,001; TIA=6,38%). CONCLUSÃO: Observou-se tendência crescente nas taxas de mortalidade no Brasil durante a série histórica estudada. Esses achados sugerem a importância da definição de uma linha de cuidado para esse segmento etário, tendo como foco a promoção da saúde na pessoa idosa e a prevenção dos riscos de quedas, visando a uma redução no número de óbitos por essa causa e favorecendo a qualidade de vida dos idosos.

RELATIONSHIP BETWEEN THE DIET QUALITY INDEX IN NURSING MOTHERS AND THE FATTY ACID PROFILE OF MATURE BREAST MILK.

OBJECTIVE: To evaluate the relationship between the maternal diet quality and the fatty acid composition of breast milk in the first trimester of lactation. METHODS: This is an observational cross-sectional epidemiological study of nursing mothers. The data collection instruments were a semi-structured questionnaire for sample characterization and a recall of usual intake. Diet quality was assessed based on the healthy eating index (HEI). Samples of mature breast milk were obtained by hand milking. Milk fat was extracted using the Bligh-Dyer method and methylated with 0.25 mol/L sodium methoxide in methanol diethyl ether. A gas chromatograph equipped with a flame ionization detector determined the milk fatty acid profile. Pearson's and Spearman's correlation tests evaluated association between the variables. Subsequently, a multiple linear regression model was built and multivariate regression analysis was applied. RESULTS: Our findings revealed an inverse relationship between the consumption of total fruits and the polyunsaturated fatty acid profile and a direct association of the intake of total fruits and total grains with monounsaturated and saturated fatty acids. CONCLUSIONS: The results of this study suggest that maternal diet quality affects the fatty acid composition of breast milk.

CONSUMPTION OF ULTRA-PROCESSED FOODS BY CHILDREN UNDER 24 MONTHS OF AGE AND ASSOCIATED FACTORS.

OBJECTIVE: To evaluate the intake of ultra-processed foods by children under 24 months of age from the city of Montes Claros and identify factors associated with this consumption. METHODS: This is a population-based cross-sectional study with data collected from households through interviews. A questionnaire assessed the sociodemographic conditions of the family, maternal and child characteristics, and food consumption. We adopted a multivariate model to identify factors associated with the intake of ultra-processed foods. RESULTS: A total of 545 children participated in this study, of whom 74.3% consumed some kind of ultra-processed food. The factors most strongly associated with this consumption were children older than six months, infants who were not breastfed, households with up to three residents, and the main caregiver of the child being someone other than the mother. CONCLUSIONS: Children under 24 months start consuming ultra-processed products at an early age, replacing foods considered natural and healthy. This study can contribute to guide health professionals in counseling families about feeding in the first years of life, emphasizing the proper introduction of complementary feeding and discouraging the consumption of ultra-processed products.

Quality of healthcare services to reduce leprosy in Brazil: a trend analysis from 2001 to 2020 / Qualidade dos serviços de atenção à saúde para redução da hanseníase no Brasil: análise de tendência de 2001 a 2020

ABSTRACT Objective: To analyze the temporal trend of healthcare services quality indicators to reduce leprosy in Brazil, over a 20-year period. Methods: This is an epidemiological study with a temporal trend, whose data were extracted from the Notifiable Diseases Information System. Indicators were constructed from the Ministry of Health Technical-Operational Manual that presents the Guidelines for Surveillance, Care and Elimination of Leprosy as a Public Health Problem. For trend analysis of the selected indicators, the Prais-Winsten model was used and the Average Annual Growth Rate (AAGR) was also calculated. Results: In the 20-year time series investigated here, 732,959 cases of leprosy were reported in Brazil. The trend was stationary for: new leprosy cases cure rate (β=-0.000; p=0.196; AAGR=-0.2), new leprosy cases drop out rate (β=-0.001; p=0.147; AAGR=-0.4), new leprosy cases contact tracing rate (β=-0.001; p=0.112; AAGR=1.6), new cases of leprosy with degree physical disability assessment rate among new cases (β=-0.000; p=0.196; AAGR=-0.2) and cases cured in the year with the degree of physical disability assessed (β=0.002; p=0.265; AAGR=0.5); while the indicator of recurrence rate among cases reported in the year (β=0.019; p<0.001; AAGR=0.5) showed an increasing trend. Conclusion: Based on the evaluation of indicators to assess the quality of healthcare services to reduce leprosy, it was evident that Brazil has major challenges for its full implementation, with improvements being necessary in the quality of care service offered to the population.

RESUMO Objetivo: Analisar a tendência temporal dos indicadores de qualidade dos serviços de atenção à saúde para redução da hanseníase no Brasil, no período de 20 anos. Métodos: Trata-se de um estudo epidemiológico de tendência temporal, cujos dados foram extraídos do Sistema de Informação de Agravos de Notificação (SINAN). Foram construídos indicadores a partir do Manual Técnico-Operacional, que apresenta as Diretrizes para Vigilância, Atenção e Eliminação da Hanseníase como Problema de Saúde Pública do Ministério da Saúde. Para análise de tendência dos indicadores selecionados, utilizou-se o modelo de Prais-Winsten e calculou-se a Taxa de Incremento Anual (TIA). Resultados: Na série temporal de 20 anos aqui investigada, foram notificados no Brasil 732.959 casos de hanseníase. A tendência mostrou-se estacionária para cura de hanseníase entre os casos novos (β=-0,000; p=0,196; TIA=-0,2); casos de hanseníase em abandono de tratamento entre os casos novos (β=-0,001; p=0,147; TIA=-0,4); contatos examinados de casos novos de hanseníase (β=-0,001; p=0,112; TIA=1,6); casos novos de hanseníase com grau de incapacidade física avaliado no diagnóstico (β=-0,000; p=0,196; TIA=-0,2); e casos curados no ano com grau de incapacidade física avaliada (β=0,002; p=0,265; TIA=0,5); enquanto o indicador casos de recidiva entre os casos notificados no ano (β=0,019; p<0,001; TIA=0,5) apresentou tendência crescente. Conclusão: Com base na avaliação dos indicadores para mensurar a qualidade dos serviços de atenção à saúde para redução da hanseníase, ficou evidente que o Brasil possui grandes desafios para sua execução plena, sendo necessárias melhorias na qualidade do serviço ofertado à população.

Uso de psicofármacos por profissionais da Atenção Primária à Saúde e fatores associados / Use of psychotropic drugs by professionals in Primary Health Care and associated factors

RESUMO Objetivo: Identificar a prevalência do uso de psicofármacos entre profissionais da Atenção Primária à Saúde e os fatores associados. Métodos: Este é um estudo epidemiológico, de base populacional, transversal e analítico, realizado com 290 profissionais que atuam na Atenção Primária da Região de Saúde de Diamantina, Minas Gerais, Brasil. A coleta de dados foi realizada por meio de um questionário contendo informações sociodemográficas e econômicas, e sobre hábitos de vida, uso de medicamentos e condições de trabalho. Utilizou-se a regressão logística múltipla para obter estimativas do efeito das variáveis no uso de psicofármacos. Resultados: Observou-se prevalência de uso de psicofármacos em 10,7% (IC95%: 7-14) dos entrevistados. Entre os profissionais da Atenção Primária à Saúde, as variáveis associadas ao uso de psicofármacos foram ter idade > 31 anos ( odds ratio ajustado [ORA] = 2,33; IC95% = 1,06-5,09; p = 0,034) e ter realizado horas extras (ORA = 2,28; IC95% = 1,06-4,89; p = 0,034). Conclusão: As condições de trabalho, como carga horária excessiva, podem contribuir para o adoecimento e, consequentemente, a necessidade de uso de psicofármacos por profissionais de saúde. Assim, é importante abordar a questão, desde a assistência à saúde até o desenvolvimento de políticas de recursos humanos para o Sistema Único de Saúde (SUS) que atentem para as condições de trabalho.

ABSTRACT Objective: Identify the prevalence of psychotropic drug use among Primary Health Care professionals and associated factors. Methods: This is an epidemiological, population-based, cross-sectional and analytical study, carried out with 290 professionals working in Primary Care in the Health Region of Diamantina, Minas Gerais, Brazil. Data collection was carried out through a questionnaire containing sociodemographic and economic information, life habits, use of medication and working conditions. Multiple logistic regression was used to obtain estimates of the effect of variables on the use of psychotropic drugs. Results: A prevalence of psychotropic drug use was observed in 10.7% (CI95%: 7-14) of respondents. Among primary health care professionals, the variables associated with the use of psychotropic drugs were age > 31 years (adjusted odds ratio [ORA] = 2.33; 95%CI = 1.06-5.09; p = 0.034) and having performed overtime (ORA = 2.28; 95%CI = 1.06-4.89; p = 0.034). Conclusion: Working conditions, such as excessive workload, are conditions that can contribute to illness and, consequently, the need for the use of psychotropic drugs by health professionals. It is important to address the issue, from health care to the development of human resources policies in the Health System that meet the working conditions.

Tendência de mortalidade por quedas em idosos, no Brasil, no período de 2000-2019 / Mortality trend from falls in Brazilian older adults from 2000 to 2019

RESUMO Objetivo: Analisar a tendência da mortalidade por quedas entre idosos, no Brasil, no período de 2000 a 2019. Métodos: Trata-se de um estudo epidemiológico, analítico, com delineamento ecológico de séries temporais. Realizou-se uma análise retrospectiva utilizando dados secundários em saúde, extraídos do Sistema de Informação sobre Mortalidade (SIM) no período específico. Foram calculadas taxas padronizadas de mortalidade geral e específicas por sexo e faixa etária. Para a observação da tendência de mortalidade, utilizou-se o modelo de Prais-Winsten e taxa de incremento anual (TIA). Resultados: No período de 2000 a 2019, foram identificados 135.209 óbitos decorrentes das quedas em idosos. A mortalidade por queda em geral, no período estudado, foi crescente (β=0,023; p<0,001; TIA=5,45%). Observou-se que tanto o sexo masculino (β=0,022; p<0,001; TIA=5,19%) quanto o feminino (β=0,024; p<0,001; TIA=5,72%) apresentaram tendência crescente. Com relação à faixa etária, os resultados apontaram também para tendência de mortalidade crescente em todos os estratos etários, porém maior em idosos com idade ≥80 anos (β=0,027; p<0,001; TIA=6,38%). Conclusão: Observou-se tendência crescente nas taxas de mortalidade no Brasil durante a série histórica estudada. Esses achados sugerem a importância da definição de uma linha de cuidado para esse segmento etário, tendo como foco a promoção da saúde na pessoa idosa e a prevenção dos riscos de quedas, visando a uma redução no número de óbitos por essa causa e favorecendo a qualidade de vida dos idosos.

ABSTRACT Objective: To analyze the trend of mortality from falls among older adults in Brazil from 2000 to 2019. Methods: This is an epidemiological, analytical study with an ecological time-series design. A retrospective analysis was performed using secondary health data extracted from the Brazilian Mortality Information System in the specific period. Standardized rates of general and sex- and age-specific mortality were calculated. To observe the mortality trend, the Prais-Winsten model and the Annual Increase Rate (AIR) were used. Results: We identified 135,209 deaths resulting from falls in older adults in the period from 2000 to 2019. Mortality from falls in general, during the study period, had an upward trend (β=0.023; p<0.001; AIR=5.45%). We observed that both men (β=0.022; p<0.001; AIR=5.19%) and women (β=0.024; p<0.001; AIR=5.72%) had an upward trend. Regarding age group, the results also pointed to an upward mortality trend in all age strata, although higher in older people aged ≥80 years (β=0.027; p<0.001; AIR=6.38%). Conclusion: There was an upward trend in mortality rates in Brazil during the time series studied. These findings suggest the importance of defining a line of care for this age group, focusing on promoting health in older adults and preventing the risk of falls, aiming at a reduction in the number of deaths from this cause and favoring the quality of life of this population.

Influence of breastfeeding in the first months of life on blood pressure levels of preschool children.

OBJECTIVE: To investigate whether breastfeeding in early life affects blood pressure of preschoolers. METHODS: Cross-sectional study nested in a cohort from a municipality in the state of Minas Gerais, Brazil. All children in the cohort were invited for this study. Thus, between 2009 and 2010, blood pressure of 230 preschool children and their mothers, in addition to anthropometric variables, previous history, and socioeconomic status were evaluated. Blood pressure measurement was assessed in the morning, using automatic Omron® HEM-714INT and HEM-781INT devices to measure the blood pressure of preschool children and their mothers, respectively. Logistic regression was used to study the association between breastfeeding and blood pressure. The significance level was set at 5%. RESULTS: This study identified 19 (8.26%) preschool children with high blood pressure (values above the 90th percentile). High systolic blood pressure was associated with low birth weight (OR=5.41; 95% CI=1.45-20.23) and total breastfeeding duration of less than six months (OR=4.14; 95% CI=1.40-11.95). High diastolic blood pressure was not associated with any variable, whereas high systolic blood pressure/diastolic blood pressure ratio was associated with breastfeeding duration of less than six months (OR=3.48; 95% CI=1.34-9.1). CONCLUSION: The results of this study indicate that preschoolers breastfed for a period of less than six months were more likely to have high blood pressure when compared to those breastfed for a longer period, suggesting a protective effect of breastfeeding against high blood pressure in this population.

Influence of glycemic index and glycemic load of the diet on the risk of overweight and adiposity in childhood. / Influência do índice glicêmico e carga glicêmica da dieta sobre o risco de sobrepeso e adiposidade na infância.

OBJECTIVE: To investigate the association between the glycemic index and the glycemic load of the diet with the risk of overweight and high adiposity in children with 5 years of age. METHODS: Cross-sectional study nested in a cohort of 232 children born and living in Diamantina (MG, Brazil). Parents and/or guardians provided the food intake data, using a semiquantitative food frequency questionnaire, past history and socioeconomic conditions. Anthropometric and fatness data were collected from the children. The dietary glycemic index and the glycemic load were calculated from the food intake. The glycemic index and glycemic load effect on overweight and adiposity in children was assessed by the Poisson regression (p<0.05). RESULTS: The prevalence of overweight by body mass index was 17.3%, and high adiposity was observed in 3.4% and 6.9% by triceps skinfold and subscapular skinfold, respectively. No difference was reported between the mean body mass index, triceps skinfold and subscapular skinfold according to the glycemic index and glycemic load tertiles; however, the overweight group presented a higher carbohydrate intake (p=0.04). No association was found between glycemic index and glycemic load with overweight and adiposity among the children assessed. CONCLUSIONS: The glycemic index and glycemic load of the diet were not identified as risk factors for overweight and adiposity in this cross-sectional study.

Prevalência e fatores associados aos sintomas de depressão, ansiedade e estresse em professores universitários durante a pandemia da COVID-19 / Prevalence and factors associated with depression, anxiety, and stress symptoms among professors during COVID-19 pandemic

OBJETIVO: Estimar a prevalência e os fatores associados aos sintomas da depressão, ansiedade e estresse em professores universitários da área da saúde no período da pandemia da COVID-19. MÉTODOS: Trata-se de um estudo analítico, de caráter transversal e abordagem quantitativa com 150 professores universitários da área da saúde. Os instrumentos utilizados foram: um formulário de coleta de dados sociodemográficos, econômicos e trabalhistas. A saúde mental foi avaliada pela Escala de Depressão, Ansiedade e Estresse-21 (DASS-21). A associação entre as variáveis estudadas e a prevalência de sintomas da depressão, ansiedade e estresse foi verificada por análise bivariada seguida de regressão de Poisson, com variância robusta. RESULTADOS: A amostra final foi composta por 150 indivíduos, sendo a média de idade de 41,4 ± 7,9 anos, e a maioria da amostra investigada é do sexo feminino (74%). Entre os professores, 50% apresentaram sintomas de depressão, 37,4% relataram sintomas de ansiedade e 47,2% apresentaram sintomas de estresse. Após análise múltipla, observou-se que os sintomas da depressão estiveram associados à variável trabalhar em mais de uma instituição de ensino superior. As variáveis que se mostraram associadas à ansiedade foram: faixa etária ≥ 40 anos e pessoas sem companheiro fixo. Já o estresse se mostrou associado à variável estado civil sem companheiro fixo. CONCLUSÃO: A prevalência de sintomas da depressão, ansiedade e estresse em professores universitários da área da saúde foi elevada, e fatores sociodemográficos e trabalhistas se mantiveram associados aos desfechos investigados.

OBJECTIVE: To estimate the prevalence and factors associated with symptoms of depression, anxiety and stress in university professors in the health field during the pandemic period of COVID-19. METHODS: This is an analytical, cross-sectional study with a quantitative approach with 150 university professors in the health field. The instruments used were: a form for collecting socio-demographic, economic and labor data. Mental health was assessed using the Depression, Anxiety and Stress Scale-21 (DASS-21). The association between the variables studied and the prevalence of symptoms of depression, anxiety and stress was verified by bivariate analysis followed by Poisson regression, with robust variance. RESULTS: The final sample consisted of 150 individuals with a mean age of 41.4 ± 7.9 years with the majority being female (74%). 50% of the teachers had symptoms of depression, 37.4% reported symptoms of anxiety and 47.2% had symptoms of stress. After multiple analysis, it was observed that the symptoms of depression were associated with the variable working in more than one institution of higher education. The variables that were shown to be associated with anxiety were: age group ≥ 40 years and people without a steady partner. Stress was associated with the variable marital status without a steady partner. CONCLUSION: The prevalence of symptoms of depression, anxiety and stress in university professors in the health area was high, and sociodemographic and labor factors remained associated with the investigated outcomes.

Relationship between the diet quality index in nursing mothers and the fatty acid profile of mature breast milk / Relação entre o índice de qualidade da dieta de nutrizes e o perfil de ácidos graxos do leite materno maduro

ABSTRACT Objective: To evaluate the relationship between the maternal diet quality and the fatty acid composition of breast milk in the first trimester of lactation. Methods: This is an observational cross-sectional epidemiological study of nursing mothers. The data collection instruments were a semi-structured questionnaire for sample characterization and a recall of usual intake. Diet quality was assessed based on the healthy eating index (HEI). Samples of mature breast milk were obtained by hand milking. Milk fat was extracted using the Bligh-Dyer method and methylated with 0.25 mol/L sodium methoxide in methanol diethyl ether. A gas chromatograph equipped with a flame ionization detector determined the milk fatty acid profile. Pearson's and Spearman's correlation tests evaluated association between the variables. Subsequently, a multiple linear regression model was built and multivariate regression analysis was applied. Results: Our findings revealed an inverse relationship between the consumption of total fruits and the polyunsaturated fatty acid profile and a direct association of the intake of total fruits and total grains with monounsaturated and saturated fatty acids. Conclusions: The results of this study suggest that maternal diet quality affects the fatty acid composition of breast milk.

RESUMO Objetivo: Avaliar a relação entre a qualidade da dieta materna e a composição do leite humano em ácidos graxos no primeiro trimestre de lactação. Métodos: Trata-se de um estudo epidemiológico observacional e transversal com nutrizes. Os instrumentos de coleta dos dados foram questionário semiestruturado para caracterização da amostra e o recordatório de ingestão habitual. A qualidade da dieta foi avaliada por meio do índice de alimentação saudável (IAS). Amostras de leite materno maduro foram obtidas por meio de ordenha manual. A extração da gordura do leite ocorreu mediante o método de Bligh-Dyer, e essa gordura foi metilada com metóxido de sódio 0,25 mol/L em metanol dietil éter. O perfil de ácidos graxos do leite foi determinado por um cromatógrafo a gás equipado com detector por ionização de chamas. Realizaram-se teste de correlação de Pearson e teste de Spearman para verificar associação entre as variáveis. Posteriormente se aplicaram o modelo de regressão linear múltiplo e a análise de regressão multivariada. Resultados: Foi possível observar relação inversa entre o consumo de frutas totais e o perfil de ácidos graxos poli-insaturados e relação direta entre o consumo de frutas totais e cereais totais e os ácidos monoinsaturados e saturados. Conclusões: Sugere-se que a qualidade da dieta reflete na composição de ácidos graxos do leite materno.

Preditores da síndrome de Burnout em técnicos de enfermagem de unidade de terapia intensiva durante a pandemia da COVID-19 / Predictors of Burnout syndrome in nursing technicians in an intensive care unit during the COVID-19 pandemic

RESUMO Objetivo: Avaliar a prevalência e a existência de fatores preditores da síndrome de Burnout em técnicos de enfermagem que atuam em unidade de terapia intensiva (UTI) durante a pandemia da COVID-19. Métodos: Trata-se de um estudo descritivo, de caráter transversal e abordagem quantitativa com 94 técnicos de enfermagem de terapia intensiva. Os instrumentos utilizados foram: um formulário de coleta de dados sociodemográficos, ocupacionais e comportamentais e o Maslach Burnout Inventory (MBI) em sua versão Human Services Survey (HSS). A associação entre as variáveis estudadas e a prevalência da síndrome de Burnout foi verificada por análise bivariada seguida de regressão de Poisson hierarquizada, com variância robusta. Resultados: Observou-se uma prevalência da síndrome em 25,5% da amostra analisada. As variáveis que, após análise múltipla, se mostraram como preditores associados a maior prevalência de síndrome de Burnout foram: idade > 36 anos, realizar hora extra, considerar a carga horária de trabalho rígida e ser etilista. Conclusão: Conclui-se que a prevalência da síndrome de Burnout em técnicos de enfermagem que atuam em UTIs e que estão na linha de frente na pandemia da COVID-19 foi alta e fatores sociodemográficos, ocupacionais e comportamentais se mostraram como preditores da síndrome.

ABSTRACT Objective: To evaluate the prevalence and existence of predictive factors for Burnout syndrome in nursing technicians who work in an intensive care unit during the COVID-19 pandemic. Methods: This is a descriptive, cross-sectional study with a quantitative approach with 94 intensive care nursing technicians. The instruments used were: a form for collecting sociodemographic, occupational, behavioral data and the Maslach Burnout Inventory (MBI) in its Human Services Survey (HSS) version. The association between the variables studied and the prevalence of Burnout syndrome was verified by bivariate analysis followed by hierarchical Poisson regression, with robust variance. Results: It observed a prevalence of the syndrome in 25.5% of the analyzed sample. The variables that, after multiple analysis, showed themselves as predictors associated with the higher prevalence of Burnout syndrome were: age > 36 years, working overtime, considering the workload as rigid and being alcoholic. Conclusion: It is concluded that the prevalence of Burnout syndrome in nursing technicians who work in intensive care units and who are in the front line in the COVID-19 pandemic was high and sociodemographic, occupational and behavioral factors were shown as predictors of the syndrome.

Consumption of ultra-processed foods by children under 24 months of age and associated factors / Consumo de alimentos ultraprocessados por crianças menores de 24 meses de idade e fatores associados

ABSTRACT Objective: To evaluate the intake of ultra-processed foods by children under 24 months of age from the city of Montes Claros and identify factors associated with this consumption. Methods: This is a population-based cross-sectional study with data collected from households through interviews. A questionnaire assessed the sociodemographic conditions of the family, maternal and child characteristics, and food consumption. We adopted a multivariate model to identify factors associated with the intake of ultra-processed foods. Results: A total of 545 children participated in this study, of whom 74.3% consumed some kind of ultra-processed food. The factors most strongly associated with this consumption were children older than six months, infants who were not breastfed, households with up to three residents, and the main caregiver of the child being someone other than the mother. Conclusions: Children under 24 months start consuming ultra-processed products at an early age, replacing foods considered natural and healthy. This study can contribute to guide health professionals in counseling families about feeding in the first years of life, emphasizing the proper introduction of complementary feeding and discouraging the consumption of ultra-processed products.

RESUMO Objetivo: Avaliar o consumo de alimentos ultraprocessados por crianças do município de Montes Claros, com idade inferior a 24 meses de idade, e identificar fatores associados a esse consumo. Métodos: Estudo transversal de base populacional, no qual a coleta de dados foi realizada nos domicílios, por meio de entrevistas. Aplicou-se um questionário para avaliar a situação sociodemográfica da família, as características materno-infantis e o consumo alimentar. Foi utilizado modelo multivariado para identificar fatores associados ao consumo de alimentos ultraprocessados. Resultados: Participaram do estudo 545 crianças, das quais 74,3% consumiam algum alimento ultraprocessado. Os fatores mais fortemente associados a esse consumo foram crianças com idade superior a seis meses de idade, que não faziam uso de leite materno, domicílios com até três habitantes e o principal cuidador da criança apontado como outros sem ser a mãe. Conclusões: O consumo de alimentos ultraprocessados está presente precocemente na alimentação das crianças menores de 24 meses de idade, substituindo alimentos considerados naturais e saudáveis. Este estudo poderá contribuir para a orientação dos profissionais de saúde no aconselhamento das famílias para a alimentação nos primeiros anos de vida, com ênfase na introdução adequada da alimentação complementar e desestimulando a introdução de produtos ultraprocessados.

Insatisfação com a imagem corporal e fatores associados em estudantes universitários / Dissatisfaction with body image and associated factors in university students

RESUMO Objetivo Avaliar a prevalência de insatisfação com a imagem corporal e os fatores associados entre universitários da área da saúde. Métodos Trata-se de um estudo descritivo, de caráter transversal e abordagem quantitativa, com 364 acadêmicos matriculados em cinco cursos da área da saúde. Para a obtenção dos dados, foram utilizados seis instrumentos autoaplicáveis: questionário socioeconômico, demográfico e de hábitos de vida adaptado do Vigitel, o Body Shape Questionnaire (BSQ), o Eating Attitudes Test (EAT-26), o Questionário Internacional de Atividade Física (IPAQ), o Inventário de Ansiedade de Beck (BAI) e o Inventário de Depressão de Beck (BDI). Foram coletadas, ainda, as medidas antropométricas. A associação entre as variáveis estudadas e a insatisfação com a imagem corporal foi verificada por análise bivariada seguida de regressão logística, com variância robusta. Resultados Houve prevalência de insatisfação com a imagem corporal de 9,1% entre os universitários. As variáveis que, após análise múltipla, se mostraram associadas a maior prevalência de insatisfação com a imagem corporal foram: cor da pele não branca, realização de tratamento para perder peso, presença de atitudes para transtorno alimentar, estado de saúde regular/ruim, ansiedade moderada/grave e circunferência abdominal. Conclusão A prevalência com a insatisfação com a imagem corporal nos universitários foi baixa, entretanto fatores sociodemográficos, estilo de vida, estado de saúde e condições clínicas e antropométricas mostraram-se associados com a prevalência da insatisfação com a imagem corporal.

ABSTRACT Objective To assess the prevalence of dissatisfaction with body image and associated factors among university students in the health field. Methods This is a descriptive, cross-sectional study with a quantitative approach, with 364 students enrolled in five health courses. To obtain the data, six self-administered instruments were used: socioeconomic, demographic and lifestyle habits adapted from Vigitel, the Body Shape Questionnaire (BSQ), the Eating Attitudes Test (EAT-26), the International Physical Activity Questionnaire (IPAQ), the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI). Anthropometric measurements were also collected. The association between the studied variables and dissatisfaction with body image was verified by bivariate analysis followed by logistic regression, with robust variance. Results There was a prevalence of body image dissatisfaction of 9.1% among university students. The variables that, after multiple analysis, were associated with a higher prevalence of dissatisfaction with body image were: non-white skin color, undergoing treatment to lose weight, presence of attitudes towards eating disorder, regular/poor health status, moderate/severe anxiety and waist circumference. Conclusion It is concluded that the prevalence of dissatisfaction with body image in university students was low, however, sociodemographic factors, lifestyle, health status and clinical and anthropometric conditions were shown to be associated with the prevalence of dissatisfaction with body image.

[Comparison of nutritional status of low-income children in the second year of life, before and after primary health care program implantation]. / Comparaçõo da situação nutricional de crianças de baixa renda no segundo ano de vida, antes e após a implantação de programa de atenção primária à saúde.

The so-called "Slum Project" or Projeto Favela at the São Paulo School of Medicine, Federal University in São Paulo, conducts numerous primary health care activities in low-income communities in the city of S o Paulo to prevent and control nutritional deficiencies. The aim of this study was to compare the nutritional status of children from 12 to 26 months of age before and after preventive intervention. The study was conducted with two groups, before and after intervention, with 57 and 65 children, respectively. Anthropometric measures and hemoglobin values were obtained. In the before-intervention group, the prevalence of malnutrition as measured by weight for age and weight for height was 12.3% and 1.8% respectively, whereas there were no cases of malnutrition in the after-intervention group. There was a reduction in the prevalence of anemia, especially the severe form, from 33% to 7%. Mean hemoglobin increased from 10.1 to 11.0 g/dl, and the duration of breastfeeding was greater (> 180 days) after intervention.

Avaliação da cultura de segurança do paciente em um hospital filantrópico / Evaluating patient safety culture in a philanthropic hospital / Evaluación de la cultura sobre seguridad del paciente de un hospital filantrópico

Objetivo: avaliar a cultura de segurança do paciente da equipe multidisciplinar em um hospital filantrópico brasileiro. Método: trata-se de estudo quantitativo, transversal, realizado com 209 profissionais, em 12 setores do hospital. Para a coleta de dados, utilizou-se o Hospital Survey On Patient Safety Culture, desenvolvido pela Agency for Health Research and Quality, traduzido e validado para a língua portuguesa. A confiabilidade do instrumento foi verificada pelo coeficiente Alfa de Cronbach. A análise de dados se deu por estatística descritiva. Resultados: as dimensões com maiores percentuais de respostas positivas foram: expectativas e ações de promoção da segurança do paciente pelo supervisor/chefe; aprendizado organizacional e melhoria contínua; trabalho em equipe no âmbito das unidades. Por outro lado, as dimensões com menores percentuais de respostas positivas foram: respostas não punitivas aos erros; profissionais e percepção geral de segurança do paciente. Conclusão: esses achados revelaram que todas as dimensões da cultura de segurança do paciente devem ser trabalhadas com os profissionais da equipe de saúde, uma vez que nenhuma das dimensões superou 75% de respostas positivas.(AU)

Objective: to evaluate patient safety culture on the part of the multidisciplinary team in a Brazilian philanthropic hospital. Method: this is a quantitative cross-sectional study carried out with 209 professionals in 12 hospital sectors. For the data collection, the Hospital Survey On Patient Safety Culture, developed by the Agency for Health Research and Quality, was used, translated and validated for the Portuguese language. The reliability of the instrument was verified by the Cronbach's Alpha coefficient. Data analysis was accomplished by descriptive statistics. Results: the dimensions with the highest percentages of positive responses were: expectations and actions to promote patient safety by the supervisor/chief; organizational learning and continuous improvement; team work within the units. On the other hand, the dimensions with lower percentages of positive responses were: non-punitive responses to errors; professional and general perception on patient safety. Conclusion: these findings revealed that all dimensions of the patient safety culture should be worked out with the healthcare professionals, since that none of the dimensions exceeded 75% of positive responses.(AU)

Objetivo: evaluar la cultura sobre seguridad del paciente del equipo multidisciplinario de un hospital filantrópico de Brasil. Método: estudio cuantitativo transversal llevado a cabo con 209 profesionales en 12 sectores del hospital. La recogida de datos se efectuó mediante el cuestionario Hospital Survey On Patient Safety Culture, desarrollado por la Agency for Health Research and Quality, traducido y adaptado al idioma portugés. La confiabilidad del instrumento se verificó con el coeficiente Alfa de Cronbach. El análisis de datos se efectuó por estadística descriptiva. Resultados: las dimensiones...(AU)

Composition in fatty acids of mature milk of nursing mothers / Composição em ácidos graxos do leite maduro de nutrizes

Abstract Objectives: to determine the fatty acid composition of mature milk of nursing mothers and its distribution according to some maternal variables. Methods: this is a cross-sectional observational epidemiological study based on the eva-luation of the fatty acid profile of mature human milk. Samples of mature breast milk were taken from 106 nursing mothers, by manual milking and who were after the 5th postpartum week. The milk fat extraction was carried out by using the Bligh and Dyer method and methy-lated with 0.25 mol/L sodium methoxide in methanol diethyl ether. The fatty acid of the milk profile was determined by a Gas Chromatograph equipped with a flame ionization detector. Results: among the saturated fatty acids, the highest values were observed for palmitic (C16:0), stearic (C18:0), myristic (C14:0) and lauric (C12:0) fatty acids, respectively. Among the monounsaturated fatty acids, there was a higher contribution of oleic (C18:1) and palmi-toleic (C16:1) fatty acids, respectively. The total essential fatty acids (linoleic and α-linolenic) was 14.94%. Conclusions: a low content of essential fatty acids in the breast milk of the nursing mothers was observed in the present study, which are important for infant growth and deve-lopment. We suggest the need to implement nutrition education strategies aimed for pregnant women and nursing mothers who should be advised to eat healthier foods.

Resumo Objetivos: determinar a composição em ácidos graxos do leite maduro de nutrizes e sua distribuição segundo algumas variáveis maternas. Métodos: trata-se de um estudo epidemiológico observacional, transversal realizado a partir da avaliação do perfil de ácidos graxos do leite humano maduro. Amostras de leite materno maduro foram obtidas de 106 nutrizes, a partir da 5ª semana pós-parto, por meio de ordenha manual. A extração da gordura do leite foi realizada através do método de Bligh e Dyer, e metiladas com metóxido de sódio 0,25 mol/L em metanol dietil - éter. O perfil de ácidos graxos do leite foi determinado por um Cromatógrafo a Gás equipado com detector por ionização de chamas. Resultados: dentre os ácidos graxos saturados, foram observados valores mais elevados para os ácidos graxos palmítico (C16:0), esteárico (C18:0), mirístico (C14:0) e láurico (C12:0), respectivamente. Entre os ácidos graxos mono-insaturados, verificou-se maior contribuição dos ácidos graxos oleico (C18:1) e palmitoleico (C16:1), respectivamente. O total de ácidos graxos essenciais (linoleico e α- linolênico) foi de 14,94%. Conclusões: foi observado baixo teor de ácidos graxos essenciais no leite materno das nutrizes do presente estudo, que são importantes para o crescimento e desenvolvimento do lactente, sugerindo-se a necessidade de implementação de estratégias de educação nutricional direcionadas a gestantes e nutrizes que devem ser orientadas a consumir alimentos mais saudáveis.

Early determinants of overweight and obesity at 5 years old in preschoolers from inner of Minas Gerais, Brazil.

INTRODUCTION: Brazil is experiencing a nutritional transition characterized by a reduction in the prevalence of nutritional deficits and an increase in overweight and obesity, not only in adults but also in children and adolescents. OBJECTIVES: This study was designed to evaluate the factors associated with overweight and obesity in Brazilian 5-year-old preschoolers. METHODS: A cross-sectional study of a cohort of 232 preschoolers born in Diamantina/Minas Gerais, Brazil, was undertaken. The data, including socioeconomic status, anthropometry, diet, previous history of the preschoolers and family history, were collected between July of 2009 and July of 2010. To identify the factors associated with overweight and obesity, a logistic regression and a hierarchical model were undertaken. RESULTS: Overweight and obesity occurred in 17.2% of the preschoolers. After adjusting for mother's obesity, per capita income, protective food intake, weight gain at age 0-4 months and time spent playing, the factors associated with overweight and obesity that reached statistical significance were mother's obesity [OR = 3.12 (95%CI 1.41-6.91), P = 0.01], weight gain of more than 0.85 kg/month in the first four months of life [OR = 2.16 (95%CI 1.01-4.64), P = 0.04] and lower per capita income [OR = 0.32 (95%CI 0.13-0.79), P = 0.01]. CONCLUSION: The results show that more weight gain during the first four months of life and being born of mothers with obesity increased the odds of overweight/ obesity in the preschoolers, while lower per capita income was a protective factor.

Introducción: Brasil está experimentando una transición nutricional caracterizada por una reducción en la prevalencia de deficiencias nutricionales y un aumento del sobrepeso y la obesidad, no sólo en los adultos sino también en los niños y los adolescentes. Objetivos: Este estudio se diseñó para evaluar los factores asociados con el sobrepeso y la obesidad en preescolares brasileños de 5 años de edad. Métodos: Se realizó un estudio transversal de una cohorte de 232 preescolares nacidos en Diamantina/ Minas Gerais, Brasil. Los datos, que incluían situación socioeconómica, antropometría, dieta, antecedentes de los preescolares y familiares, se recogieron entre julio de 2009 y julio de 2010. Para identificar los factores asociados con sobrepeso y obesidad, se realizaron una regresión logística y un modelo jerárquico. Resultados: El sobrepeso y la obesidad ocurrieron en el 17,2 % de los preescolares. Tras ajustar para obesidad materna, la renta per cápita, la ingesta de alimentos, la ganancia de peso entre los 0-4 meses de edad y el tiempo dedicado al juego, los factores asociados con el sobrepeso y la obesidad que alcanzaban una significación estadística fueron la obesidad materna [OR = 3,12 (IC al 95 % 1,41- 6,91), P = 0,01], la ganancia de peso de más de 0,85 kg/mes en los primeros 4 meses de vida [OR = 2,16 (IC al 95 % 1,01-4,64), P = 0,04] y una menor renta per cápita [OR = 0,32 (IC al 95 % 0,13-0,79), P = 0,01]. Conclusión: Los resultados muestran que la mayor ganancia de peso durante los 4 primeros meses de vida y tener una madre obesa aumentan las probabilidades de sobrepeso/obesidad en los preescolares, mientras que una menor renta per cápita es un factor de protección.