Osteopenia of prematurity and associated nutritional factors: case-control study.

BACKGROUND: Preterm newborn nutrition affects postnatal skeletal growth and bone mineralization, but studies have not yet fully concluded the relationship between nutrition and osteopenia. This study was intended to investigate the impact of nutritional factors on osteopenia in preterm newborns. METHODS: This is a case-control study with babies born with gestational age ≤ 32 weeks in a high-risk maternity hospital, between 2018 and 2019. The population consisted of 115 newborns, being 46 cases (40%) and 69 controls (60%). Disease outcome was based on serum alkaline phosphatase levels > 900UL/l and hypophosphatemia < 4 mg/dl. Gestational data at birth and clinical and nutritional follow-up data during 8 weeks postnatally were assessed. Variables were assessed using regressive logistic models. FINDINGS: Preterm infants who were fed pasteurized fresh human milk with acidity ≥ 4 ºDornic are 5.36 times more likely to develop osteopenia (p = 0.035). Higher calcium intake, compared to controls, also increased the probability of disease occurrence [OR 1.05 (CI 1.006-1.1); p = 0.025], while the presence of a partner [OR 0.10 (CI 0.02-0.59); p = 0.038] and the shortest time using sedatives [OR 0.89 (CI 0.83-0.98); p = 0.010] were protective factors associated with osteopenia. Extremely low birth weight [OR 5.49 (CI 1.20-25.1); p = 0.028], sepsis [OR 5.71 (CI 1.35-24.2); p = 0.018] and invasive ventilatory support [OR 1.09 (CI 1.03-1.18); p = 0.007] were risk factors. CONCLUSIONS: Acidity and high calcium intake are the main nutritional factors associated with osteopenia of prematurity. Further studies on the use of human milk with lower acidity, recommendation and nutritional supplementation of calcium should be accomplished to guide prevention strategies in newborns at risk for osteopenia during hospital stay.

Consultoria em amamentação durante a pandemia COVID-19: relato de experiência / Asesoría en lactancia materna durante la pandemia de COVID-19: informe de experiencia / Breastfeeding consultancy during the COVID-19 pandemic: experience report

Objetivo: relatar a experiência de consultoras em amamentação no atendimento às lactantes durante a pandemia de COVID-19. Método: relato de experiência de atendimentos de consultoria em amamentação, nas modalidades online e presencial, na cidade de Fortaleza-CE, Brasil, entre março e abril de 2020. Resultados: diante de sentimentos de medo e ansiedade das lactantes, as consultoras prestaram apoio por meio de aconselhamento, bem como orientações com equipe multiprofissional. Todas as lactantes estavam amamentando e realizando distanciamento social e cuidados de higiene pessoal, sendo reforçado pelas consultoras a importância do acesso às fontes confiáveis de informação. Quanto aos problemas mamários, foram realizadas intervenções preventivas e curativas. Percebeu-se a satisfação das lactantes pelo serviço. Conclusão e implicações para a prática: a consultoria em amamentação constitui-se como um dispositivo agregador na saúde das mulheres que favorece tanto a promoção do aleitamento materno quanto a saúde mental durante a pandemia de Covid-19. Este relato traz direcionamentos para uma prática holística, com vistas à melhoria da qualidade do cuidado prestado, levando-se em consideração os atuais desafios da promoção da saúde diante da pandemia e pode fomentar novas estratégias exitosas

Objective: to report the experience of breastfeeding consultants in caring for breastfeeding women during the Covid-19 pandemic. Method: an experience report of breastfeeding consultancy services, online and face-to-face modalities, in the city of Fortaleza­CE, between March and April 2020. Results: given the mothers' feelings of fear and anxiety, the consultants provided support through counseling, as well as guidance with a multidisciplinary team. All the women were breastfeeding and performing social distancing and personal hygiene care actions, the importance of access to reliable information sources being reinforced by the consultants. As for breast problems, preventive and curative interventions were carried out. The mothers' satisfaction with the consultant service was noticed. Conclusion and implications for practice: breastfeeding consultancy is an aggregating device in women's health that favors both the promotion of breastfeeding and mental health during the Covid-19 pandemic. This report provides directions for a holistic practice, to improve the provided care quality, considering the current challenges of health promotion given the pandemic, and can foster new successful strategies

Objetivo: relatar la experiencia de consultores de lactancia materna en el cuidado de mujeres en periodo de lactancia durante la pandemia de Covid-19. Método: informe de experiencia de los servicios de consultoría en lactancia materna en modalidades en línea y cara a cara, en la ciudad de Fortaleza-CE, entre marzo y abril de 2020. Resultados: ante los sentimientos de miedo y ansiedad de las mujeres lactantes, los consultores proporcionaron apoyo a través de asesoramiento, así como orientación con un equipo multidisciplinario. Todas las mujeres amamantaban y practicaban el distanciamiento social y cuidados de higiene personal, siendo que los consultores reforzaron la importancia del acceso a fuentes confiables de información. En cuanto a los problemas mamarios, se realizaron intervenciones preventivas y curativas. Se notó la satisfacción de las madres lactantes por el servicio. Conclusión e implicaciones para la práctica: la consultoría sobre lactancia materna es un dispositivo agregado en la salud de la mujer que favorece tanto la promoción de la lactancia materna como la salud mental frente a la pandemia de Covid-19. Este estudio proporciona instrucciones para una práctica holística, con miras a mejorar la calidad de la atención brindada, teniendo en cuenta los desafíos actuales de la promoción de la salud frente a la pandemia y puede fomentar nuevas estrategias exitosas

Interaction between vitamin A supplementation and chronic malnutrition on child development.

200 million pre-school age children are not developing properly. Delays in child development are associated with multiple factors. This study aims to analyze if vitamin A supplementation is associated with improved development and how this effect could be mediated by nutritional status. Population-based study surveyed a representative sample of 8000 households, 1232 children 0-35 months, in the state of Ceará, Brazil. The variables analysed included child developmental status, nutritional determinants and confounding factors. The main effects and interactions were evaluated using Cox regressive models. Vitamin A supplementation showed protective effect to delay in cognitive and motor development modified by interaction with nutritional status. While well-nourished supplemented children presented a 67% lower risk of cognitive delay (adjusted PRR = 0·33 [0·21-0·53]), stunted children had no benefit from supplementation (adjusted PRR = 0·97 [0·39-2·40]). Vitamin A supplementation has a protective effect on child development, but not in stunted children. This suggests that supplementation is effective in promoting child development, especially if associated to a joint effort to improve the nutritional status of children, given the importance of this mediator.

Interaction between vitamin A supplementation and chronic malnutrition on child development / Interação entre suplementação de vitamina A e desnutrição crônica no desenvolvimento infantil

Abstract 200 million pre-school age children are not developing properly. Delays in child development are associated with multiple factors. This study aims to analyze if vitamin A supplementation is associated with improved development and how this effect could be mediated by nutritional status. Population-based study surveyed a representative sample of 8000 households, 1232 children 0-35 months, in the state of Ceará, Brazil. The variables analysed included child developmental status, nutritional determinants and confounding factors. The main effects and interactions were evaluated using Cox regressive models. Vitamin A supplementation showed protective effect to delay in cognitive and motor development modified by interaction with nutritional status. While well-nourished supplemented children presented a 67% lower risk of cognitive delay (adjusted PRR = 0·33 [0·21-0·53]), stunted children had no benefit from supplementation (adjusted PRR = 0·97 [0·39-2·40]). Vitamin A supplementation has a protective effect on child development, but not in stunted children. This suggests that supplementation is effective in promoting child development, especially if associated to a joint effort to improve the nutritional status of children, given the importance of this mediator.

Resumo Duzentos milhões de crianças em idade pré-escolar não estão se desenvolvendo adequadamente. Os atrasos no desenvolvimento estão associados a múltiplos fatores. Este estudo pretende analisar se a suplementação de vitamina A está associada a melhor desenvolvimento e a forma como esse efeito pode ser mediado pelo estado nutricional. Estudo de base populacional com amostra de 8.000 famílias, 1.232 crianças 0-35 meses, no estado do Ceará, Brasil. As variáveis analisadas incluíram desenvolvimento, determinantes nutricionais e fatores de confusão. Os efeitos e as interações foram avaliados utilizando modelos regressivos de Cox. A suplementação de vitamina A foi protetora para atraso no desenvolvimento cognitivo e motor modificado pela interação com o estado nutricional. Crianças suplementadas bem nutridas apresentaram um risco 67% menor de atraso cognitivo (PRR ajustado = 0 33 [0 21-0 53]), já as crianças desnutridas não se beneficiaram (PRR ajustado = 0 97 [0 39-2 40]). A suplementação tem um efeito protetor sobre o desenvolvimento, mas não em crianças desnutridas. Isso sugere que a suplementação é eficaz na promoção do desenvolvimento, especialmente se associada a um esforço para melhorar o estado nutricional infantil, dada a importância desse mediador.

Effects of Vitamin A supplementation on child morbidity: a twenty-year time series analysis in the northeastern region of Brazil.

The present study aimed to determine the prevalence of supplementation between 1987 and 2007, and to measure the impact of this on morbidity. Five sequential cross-sectional studies in a 20-year time span were analyzed. Each had a sample of 8,000 domiciles representative of Ceará, in northeastern Brazil. Data were analyzed with descriptive statistics, followed by bivariate and multivariate analyses. Increases in coverage, ranging from 9.6 to 65.8 % were verified, and the study found that the impact of supplementation in reducing morbidity may not be significant. The study also found that supplementation may be associated with higher frequency of certain morbidities (OR 1.8, CI 95 % 1.20-2.95). When the supplementation variable was adjusted for socioeconomic factors, the risk was higher for diarrhea (OR 5.56, CI 95 % 2.63-11.75). The study concluded that in Brazil, vitamin A supplementation may have little benefit in reducing morbidity.

A percepção dos estudantes de graduação sobre a atuação do "doutor palhaço" em um hospital universitário / Ungraduate students view on the presence of clown-doctors at the University Hospital

Objetivos: Compreender como os estudantes percebem a humanização da saúde, bem como as contribuições do Projeto Y doutores-palhaços na formação acadêmica e na rotina hospitalar, identificando a relevância do grupo neste meio na construção de novos paradigmas. Métodos: Estudo envolveu dimensão qualitativa, com participação de acadêmicos de medicina/psicologia e estagiários da enfermaria pediátrica de um Hospital Universitário, Fortaleza CE, Brasil. Foram realizadas, no período de março a julho de 2009, dez entrevistas individuais gravadas e transcritas na íntegra que foram analisadas por rede interpretativa, composta pelas categorias: conhecendo o Projeto Y: diferentes formas percebidas; atuação do Projeto Y no ambiente hospitalar: a percepção dessa estratégia na visão dos espectadores; a humanização na saúde: o olhar do futuro profissional. O referencial interpretativo contempla concepções relativas a atividades de promoção à saúde, embasadas na humanização da assistência, desempenhadas por estudantes de graduação em formação. Resultados: Os estudantes conheceram o Projeto Y a partir da observação das atividades realizadas nas enfermarias e ao perceberem os sorrisos das crianças durante a integração com os palhaços. Relatam que as visitas diminuem o estresse das crianças, dos acompanhantes e auxiliam na recuperação dos doentes, atua também na formação humanizada do profissional de saúde, considerada essencial, e contribui para a prática da multidisciplinaridade. Conclusões: Os entrevistados acreditam que o Projeto Y pode influenciar positivamente na formação do profissional de saúde, ampliando a prática interdisciplinar e proporcionando alívio à dor integral do paciente. Dessa forma, aprimora a comunicação daqueles que partilham o ambiente hospitalar e alivia o sofrimento humano.

Objectives: To understand how students perceive the humanization of health, as well as the contributions of Project Y clown doctors in academic and hospital routine, identifying the relevance of this group through the construction of new paradigms. Methods: The study involved qualitative dimension, with the participation of medical students / interns in psychology and pediatric ward from a university hospital in Fortaleza - CE, Brazil. From March to July 2009, ten interviews were performed, recorded and fully transcribed and analyzed by interpretative network, comprising the categories: knowing the Project Y: different forms cognizable; role of Project Y in the hospital environment: the perception of this strategy in view of the spectators; humanization in health: the look of the future professional. The interpretive framework includes concepts related to health promotion activities, basedin the humanization of care performed by graduate students in training. Results: Students have known Project Y from the observation of the activities performed in the infirmaries and to realize the smiles of children during the integration with the clowns. Reported that the visits, as well as diminishing the stress of children, caregivers and assist in the recovery of patients, also act in humane training of health professionals and contributes to the practice of multidisciplinarity. Conclusions: The respondents believe that Project Y can positively influence the training of health professionals, expanding interdisciplinary practice and providing complete pain relief of the patient. Thus, enhances communication of those who share the hospital environment and relieve human suffering.

Acupuntura: conhecimento e percepção de professores universitários / Acupuncture: knowledge and perception of university professors

Esta pesquisa teve por objetivo identificar o conhecimento e percepção de professores universitários, médicos, sobre a acupuntura. Utilizou-se a abordagem qualitativa, realizando-se 15 entrevistas individuais com professores da Faculdade de Medicina da Universidade Federal do Ceará (UFC), em Fortaleza, Ceará, de junho a dezembro de 2010. O tempo médio de ensino desses professores na UFC foi de 22 anos, e a idade média de 55 anos.Observou-se que a maior parte dos entrevistados não buscava espontaneamente informações sobre acupuntura; poucos conheciam alguma contraindicação;e os que indicavam a acupuntura o faziam para alívio de dores; a quase totalidade apresentou opinião favorável ao oferecimento da acupunturaa usuários do SUS, bem como à sua inclusão na grade curricular como disciplina optativa ou como assunto coadjuvante em disciplinas afins. No entanto, poucos entrevistados admitem abordar este tema em sala de aula como terapêutica equivalente às opções alopáticas. Constatou-se que os professores demonstram interesse em práticas não convencionais e reconhecem a importância da inserção dessa temática nos currículos dos cursos de Medicina.

This study aimed to identify the knowledge and perception of medical school lecturers in relation to acupuncture. Qualitative methodology was employed, involving individual interviews with 15 teachers from various departments of the Ceará Federal University School of Medicine, held in Fortaleza, Ceará, between June and December 2010. The average teaching experience of the lecturers was 22 years and average age,55. It was found that most respondents did not spontaneously seek information about acupuncture; few knew any contraindications and those who recommended acupuncture, did so for the purposes of pain relief; almost all the respondents were in favor of acupuncture being offered to SUS patients, and of including acupuncture in the curriculum as an optional subject or supporting topic in related disciplines. However, few respondents admit addressing this topic in the classroom as form of treatment equivalent to allopathic options. We found that teachers demonstrate interest in unconventional practices and they acknowledge the importance of integrating this theme into the medical curriculum.

A community perspective on changes in health related to diarrhea in northeastern Brazil.

BACKGROUND: Diarrhea is a major cause of death in children in developing countries. However, in Brazil, diarrhea-related morbidity and mortality have declined over the past decades. OBJECTIVE: To explore community perspectives in Brazil on changes in health related to diarrhea and factors that may have contributed to these changes. METHODS: This qualitative study included 12 focus group sessions held with 50 mothers and 42 grandmothers in the state of Ceará. RESULTS: Most grandmothers reported having lost at least one child to diarrhea, and all participants had witnessed children dying from diarrhea in the past. The participants saw a clear decline in diarrhea over the past 20 years. They felt that this was due to social, economic, and cultural progress. The participants also considered government-supported outreach programs very important for health improvement. CONCLUSIONS: Knowledge of diarrhea and its causes in the community is broad, but many traditional beliefs about the illness still prevail. The Brazilian experience is an example of the critical effect that policies to promote income redistribution and universal access to education, health, water supply, and sanitation services may have on the reduction of undernutrition and diarrhea among children.

Avaliação qualitativa do sistema de vigilância epidemiológica do Ceará: (Nota Prévia) / Qualitative evaluation of Ceará´s epidemiological surveillance system

BACKGROUND: In 1976 the Ministry of Health started the implementation of the National Epidemiological Surveillance System. The implantation of the Brazilian Unified Health System (1988) proposed a new model of management, represented by decentralization and municipalization. After 1998, the structuring of the National System for Health Surveillance was proposed. The objective of this study is to evaluate the Epidemiological Surveillance System of Ceará State Health Department, at the central, regional and municipal levels, in the context of institutional development. MATERIAL AND METHODS: The study was carried out in the Ceará State Health Department in 2001. A qualitative research methodology was used which included focus group and non structured open individual interviews. A total of 32 health professionals who work in the epidemiological surveillance at the central, regional and municipal levels participated (intentional sample). They were considered key-informants and 13 participated in focus groups, and 19 were interviewed. Interviews were taped, transcribed and analysed using the "Ethnograph 4.0" program. The following analytic categories were used: surveillance structure, data analyses, human resources, integration activities, surveillance decentralization, conceptualization and health surveillance structure process. RESULTS: Advances in operational infrastructure, in computerization, data transfer, and availability of human resources dedicated to epidemiological surveillance were observed at the central, regional and municipal levels in the state of Ceará. Due to decentralization, the municipalities were incorporated into the epidemiological surveillance system, mainly in the collection and transfer of information. Some activities had a greater institutional development, such as epidemiological notification and investigation. Data analysis continues to be a serious bottleneck in all levels of the system. Another bottleneck is human resources rotativity at the local level. The present conceptualization of health surveillance implies the integration of various types of surveillance. The organization of environmental surveillance suffers from limited financial assistance and the lack of qualified professionals with technical competence to act in the field. The incorporation of new areas of surveillance did not promote the creation of a more inclusive or integrated health surveillance. CONCLUSIONS: Due to municipalization, an important operational development occurred in the epidemiological surveillance system in the state of Ceará. However, qualitative advancement in its most important activities, analysis of data, and the creation of a broader health surveillance, was not achieved. There remains a necessity for team capacity building and implementation of careers for permanent and stable technicians at the municipalities.

DELINEAMENTO DO PROBLEMA: O Ministério da Saúde iniciou a implementação do Sistema Nacional de Vigilância Epidemiológica em 1976. A implantação do SUS (1988) propiciou um novo modelo de gestão, representado pela descentralização e municipalização. A partir de 1998, foi proposta a estruturação do Sistema Nacional de Vigilância em Saúde. Objetiva-se avaliar o Sistema de Vigilância Epidemiológica da Secretaria de Saúde do Ceará, nos níveis central, regional e municipal, nesse contexto de desenvolvimento institucional. MATERIAL E MÉTODOS: O estudo foi realizado na Secretaria de Saúde do Ceará, em 2001. Utilizou-se metodologia de pesquisa qualitativa, com a realização de grupo focal e entrevistas individuais abertas não estruturadas. Participaram 32 profissionais de saúde (amostra intencional) que atuam na vigilância epidemiológica a nível central, nas microregiões e municípios do estado (13 no grupo focal e 19 através de entrevistas), considerados "informantes-chave". As entrevistas foram gravadas, transcritas e analisadas utilizando o programa "The Ethnograph 4.0". As categorias analíticas utilizadas foram: estruturação da vigilância, análise de dados, recursos humanos, integração das ações, descentralização da vigilância, concepção e estruturação da vigilância em saúde. RESULTADOS: Observou-se um avanço na infraestrutura operacional, na informatização, fluxo de dados e disponibilidade de recursos humanos vinculados à vigilância epidemiológica no nível central estadual, nas regionais e nos municípios do Ceará. Fruto da descentralização, os municípios foram incorporados ao Sistema de Vigilância Epidemiológica, principalmente na coleta e fluxo de informação. Algumas atividades tiveram um maior desenvolvimento institucional, como a notificação e a investigação epidemiológica. A análise de dados continua sendo um importante ponto de estrangulamento em todos os níveis do sistema. Outro ponto de estrangulamento se refere aos recursos humanos, submetidos a alta rotatividade no nível local. A concepção de vigilância à saúde presente se vincula à integração das várias vigilâncias. A estruturação da vigilância ambiental sofre limitações de financiamento e inexistência de profissionais com competência técnica para atuar na área. A incorporação de novas áreas de atuação na vigilância não promoveu a constituição de uma vigilância à saúde mais abrangente e integrada. CONCLUSÕES: Ocorreu um importante desenvolvimento operacional da vigilância epidemiológica no Ceará, decorrente da municipalização. Entretanto, não se logrou um avanço qualitativo em sua atividade nuclear mais importante, a análise de dados, nem na constituição de uma área de vigilância à saúde mais abrangente. Permanece a necessidade de capacitação das equipes e a implementação de carreiras com técnicos permanentes e estáveis nos municípios.