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OBJECTIVE: Patients with cancer often undergo multiple extended treatments that decrease their quality of life. However, the quality of life of women with breast cancer after they undergo treatment remains underexplored in Brazil. Therefore, this study determined sociodemographic, behavioral, and clinical factors related to the post-treatment quality of life of women with breast cancer. METHODS: This cross-sectional study involved 101 women diagnosed with breast cancer between 2014 and 2016 and treated at a Brazilian Oncology Reference Service. Data were collected from them using face-to-face surveys. Quality of life was evaluated using the European Organization for the Research and Treatment of Cancer Core Quality of Life questionnaire (EORTC QLQ-C30) and EORTC Breast Cancer-specific Quality of Life questionnaire (EORTC QLQ-BR23). The data collected were analyzed using Student's t-test and Mann-Whitney U test. RESULTS: The median score on the global health, functional, and symptom scales of the EORTC QLQ-C30 was 75.00 (Interquartile range=33.33), 75.99 (Standard deviation [SD]=19.26), and 19.67 (SD=16.91), respectively. The mean score on the functional and symptom scales of the EORTC QLQ-BR23 was 61.89 (SD=17.21) and 20.12 (SD=16.94), respectively. Furthermore, higher post-treatment quality of life was found to be associated with being aged 50 or more, being Black, having eight or more years of education, having a partner, having a paying job, receiving treatment from the private healthcare system, having a higher income, living in the municipality where healthcare services are availed, engaging in physical activity, not smoking, being more religious, having more social support, not being overweight, having no comorbidities, and undergoing lumpectomy. CONCLUSION: Sociodemographic, behavioral, and clinical factors significantly impact the quality of life of women who undergo breast cancer treatment. Implementing interventions that improve health and reducing inequalities in the access to healthcare services can improve the quality of life of these patients. BACKGROUND: Sociodemographic, clinical, and lifestyle factors impact the quality of life of breast cancer survivors. BACKGROUND: Breast cancer therapy may affect future perspectives and emotional, cognitive, and sexual function. BACKGROUND: Some aspects of quality of life still require attention from health professionals. BACKGROUND: Higher post-treatment quality of life of women with breast cancer is linked to being aged 50 or more, being Black, having 8 or more years of education, having a partner, having a paying job, receiving care from private healthcare, having a high per capita income, residing in the municipality where the service is availed, engaging in physical activity, not smoking, greater religiosity, having more social support, having a normal weight, having no comorbidities, and undergoing lumpectomy.
Subject(s)
Breast Neoplasms , Quality of Life , Humans , Female , Quality of Life/psychology , Breast Neoplasms/drug therapy , Cross-Sectional Studies , Surveys and Questionnaires , SurvivorsABSTRACT
ABSTRACT Objective Patients with cancer often undergo multiple extended treatments that decrease their quality of life. However, the quality of life of women with breast cancer after they undergo treatment remains underexplored in Brazil. Therefore, this study determined sociodemographic, behavioral, and clinical factors related to the post-treatment quality of life of women with breast cancer. Methods This cross-sectional study involved 101 women diagnosed with breast cancer between 2014 and 2016 and treated at a Brazilian Oncology Reference Service. Data were collected from them using face-to-face surveys. Quality of life was evaluated using the European Organization for the Research and Treatment of Cancer Core Quality of Life questionnaire (EORTC QLQ-C30) and EORTC Breast Cancer-specific Quality of Life questionnaire (EORTC QLQ-BR23). The data collected were analyzed using Student's t-test and Mann-Whitney U test. Results The median score on the global health, functional, and symptom scales of the EORTC QLQ-C30 was 75.00 (Interquartile range=33.33), 75.99 (Standard deviation [SD]=19.26), and 19.67 (SD=16.91), respectively. The mean score on the functional and symptom scales of the EORTC QLQ-BR23 was 61.89 (SD=17.21) and 20.12 (SD=16.94), respectively. Furthermore, higher post-treatment quality of life was found to be associated with being aged 50 or more, being Black, having eight or more years of education, having a partner, having a paying job, receiving treatment from the private healthcare system, having a higher income, living in the municipality where healthcare services are availed, engaging in physical activity, not smoking, being more religious, having more social support, not being overweight, having no comorbidities, and undergoing lumpectomy. Conclusion Sociodemographic, behavioral, and clinical factors significantly impact the quality of life of women who undergo breast cancer treatment. Implementing interventions that improve health and reducing inequalities in the access to healthcare services can improve the quality of life of these patients.
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ABSTRACT Objective To estimate the prevalence of syphilis and its associated factors in women who were treated at public maternity hospitals and received prenatal care in a primary healthcare unit. Methods This cross-sectional study included 399 postpartum women. Interviews were conducted, and additional data were extracted from the pregnant woman's booklet, medical records, and printed tests. The dependent variable was a gestational syphilis diagnosis. The independent variables were grouped into socioeconomic and demographic, behavioral, reproductive, and prenatal blocks. The prevalence, prevalence ratios, and 95% confidence intervals (95%CI) were calculated. The χ 2 test was also performed (p≤0.05). Multivariate analysis was performed using Poisson regression models. Results The prevalence of gestational syphilis was 9.61% (95%CI: 7.14-12.83). We identified the following determining factors (adjusted prevalence ratios): history of sexually transmitted infections (2.3), first sexual intercourse by the age of 15 (2.42), partner having a history of syphilis (5.98), partner using crack/cocaine (6.42) and marijuana and others (3.02), not having a partner (3.07), low income (2.85), history of stillbirth (5.21), beginning prenatal care in the third trimester (3.15), and prenatal care received in a primary healthcare unit (without a Family Health Strategy team) (0.35). Conclusion Individual and prenatal factors were associated with gestational syphilis. To control congenital syphilis, targeted interventions are needed to control syphilis in the adult population including expansion of access to quality prenatal care with identification of risks for syphilis and connection between prevention and treatment actions, implementation of strategies focused on early sexual education, effective establish prenatal care involving both partners, and effective implementation of the National Men's Health Policy (PNAISH - Política Nacional de Atenção Integral à Saúde dos Homens ).
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Abstract Objective The study aimed to characterize the clinical, histological, and immunohistochemical profile of women with invasive breast cancer, according to the risk for Hereditary Predisposition Breast and Ovarian Cancer Syndrome in a Brazilian population. Methods This is a retrospective study performed from a hospital-based cohort of 522 women, diagnosed with breast cancer treated at an oncology referral center in the Southeast region of Brazil, between 2014 and 2016. Results Among the 430 women diagnosed with invasive breast cancer who composed the study population, 127 (29.5%) were classified as at increased risk for hereditary predisposition to breast and ovarian cancer syndrome. There was a lower level of education in patients at increased risk (34.6%) when compared with those at usual risk (46.0%). Regarding tumor characteristics, women at increased risk had higher percentages of the disease diagnosed at an advanced stage (32.3%), and with tumors > 2cm (63.0%), with increased prevalence for both characteristics, when compared with those at usual risk. Furthermore, we found higher percentages of HG3 (43.3%) and Ki-67 ≥ 25% (64.6%) in women at increased risk, with prevalence being about twice as high in this group. The presence of triple-negative tumors was observed as 25.2% in women at increased risk and 6.0% in women at usual risk, with the prevalence of absence of biomarkers being 2.5 times higher among women in the increased risk group. Conclusion From the clinical criteria routinely used in the diagnosis of breast cancer, the care practice of genetic counseling for patients at increased risk of hereditary breast cancer in contexts such as Brazil is still scarce.
Resumo Objetivo O presente estudo buscou caracterizar o perfil clínico, histológico e imunohistoquímico de mulheres com câncer de mama invasivo segundo o risco para a Síndrome de Predisposição Hereditária ao Câncer de Mama e Ovário em uma população brasileira. Métodos Trata-se de um estudo retrospectivo realizado a partir de uma coorte hospitalar composta por 522 mulheres diagnosticadas com câncer de mama entre 2014 e 2016 assistidas em um centro de referência oncológica localizado na região sudeste brasileira. Resultados Entre as 430 mulheres diagnosticadas com câncer de mama invasivo que compuseram a população de estudo, 127 (29,5%) foram classificadas como de risco aumentado para a síndrome de predisposição hereditária ao câncer de mama e ovário. Verificou-se menor nível de escolaridade nas pacientes com risco aumentado (34,6%) quando comparadas àquelas consideradas como de risco habitual (46,0%). Quanto às características do tumor, as mulheres de risco aumentado apresentaram maiores percentuais de doença diagnosticada em estádio avançado (32,3%) e com tumores > 2cm (63,0%), com prevalência aumentada para ambas as características, quando comparadas àquelas de risco habitual. Ainda nas mulheres de risco aumentado, foram encontrados maiores percentuais de GH3 (43,3%) e Ki-67 ≥ 25% (64,6%), com prevalência cerca de duas vezes maior neste grupo. A presença de tumores triplo-negativos foi observada em 25,2% nas mulheres de risco aumentado e 6,0% nas mulheres de risco habitual, com prevalência de ausência de biomarcadores 2,5 vezes maior entre as mulheres do grupo de risco aumentado. Conclusão A partir dos critérios clínicos rotineiramente utilizados no diagnóstico do câncer de mama, a prática assistencial do aconselhamento genético para as pacientes com risco aumentado de câncer de mama hereditário em contextos como o do Brasil ainda é escarça.
Subject(s)
Humans , Female , Breast Neoplasms , Immunohistochemistry , Cohort Studies , Hereditary Breast and Ovarian Cancer Syndrome , Genetic CounselingABSTRACT
Abstract Objective: To describe Brazilian health professionals' perception about the Baby-Led Weaning (BLW) method use for complementary feeding. Methods: Cross-sectional, descriptive study including 458 health professionals graduated in Nursing, Speech Therapy, Medicine, Nutrition or Dentistry and working in Pediatrics, being directly or indirectly involved with pediatric nutrition. We used a convenience non-probability sampling. The questionnaire applied to participants addressed demographic characteristics, academic degree, workplace, knowledge about clinical practice and perceptions about the possible advantages of the BLW method. Results: Participants had a mean age of 34.5±8.5 years, 64.6% of them working in Southeast Brazil and 65.3% being nutritionists. Most participants reported being acquainted with the BLW method (82.0%). Regarding clinical practice, 38.3% mentioned having recommended the BLW some times, 37.5% often and 20.5% always. Most participants fully agreed that the BLW method could have advantages for babies, for example, having them more likely to share family meals, facilitating adaptation to food flavors and consistencies, enhancing chewing and favoring the development of motor skills. On the other hand, important disagreements were also expressed regarding the BLW convenience and the possibility to create less concerns or anxiety in parents. Conclusions: The BLW method reported as advantageous, but disagreements were also raised, probably because scientific evidences on the suject are scarse. Further investigation is needed so we can better understand the risks and benefits and health care professionals can feel effectively assisted to offer support and advice to parents and caretakers.
Resumo Objetivo: Descrever as percepções de profissionais de saúde brasileiros acerca do método baby-led weaning (BLW) para alimentação complementar. Métodos: Estudo de corte transversal conduzido com 458 profissionais de saúde graduados em Enfermagem, Fonoaudiologia, Medicina, Nutrição ou Odontologia e que atuavam em pediatria, estando direta ou indiretamente envolvidos com nutrição infantil. A amostragem foi não probabilística, de conveniência. O questionário englobou características demográficas, titulação e local de trabalho dos participantes, além do conhecimento, da prática clínica e das percepções sobre possíveis vantagens do BLW. Resultados: Os profissionais de saúde tinham idade média de 34,5±8,5 anos, 64,6% atuavam no sudeste do Brasil e 65,3% eram nutricionistas. A maioria relatou conhecer o BLW (82,1%). Quanto à prática clínica, 38,3% mencionaram que costumavam recomendar o BLW às vezes, 37,5%, frequentemente, e 20,5%, sempre. Grande parte declarou que concordava totalmente que o método poderia trazer vantagens, tornando os bebês mais propensos a compartilharem refeições em família, facilitando a adaptação aos sabores e às consistências dos alimentos, potencializando a mastigação e favorecendo o desenvolvimento de habilidades motoras, porém manifestaram-se discordâncias importantes em relação à comodidade/conveniência e ao argumento de gerar menos preocupação ou ansiedade para os pais/cuidadores. Conclusões: Em geral, o BLW foi relatado como vantajoso, mas foram evidenciadas discordâncias, que são um provável reflexo da escassez de evidências científicas factuais sobre essa temática. São necessários mais estudos, para a melhor compressão de seus riscos e benefícios. Só assim os profissionais de saúde se sentirão efetivamente respaldados para fornecer suporte ou aconselhamento aos pais/cuidadores.
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ABSTRACT Objective: To analyze the time to diagnosis and treatment for breast cancer and the associated factors, according to the type of care (public vs. private). Methodology: Retrospective cohort study with 477 women diagnosed with breast cancer between 2014 and 2016. Data were collected in an oncology service in a municipality in Minas Gerais, in the 2018-2019 period. Analyzes were performed using the Kaplan-Meier method and Cox's proportional regression model. Results: The median time to diagnosis was 70 days, being shorter for women who discovered the disease through screening tests and who were diagnosed in early stages of the disease. The median time for treatment was 32 days, which was shorter for women assisted by private health service, with a high level of education and who were diagnosed in early stages. Conclusions: Private care and facilitators of access to breast cancer care were associated with shorter waiting times.
RESUMEN Objetivo: Analizar el tiempo de diagnóstico y tratamiento del cáncer de mama y los factores asociados, según el tipo de assistência (pública vs. privada). Metodología: Cohorte retrospectiva con 477 mujeres diagnosticadas de cáncer de mama entre 2014-2016. Los datos fueron recolectados en un servicio de oncología de Minas Gerais, en el período 2018-2019. Los análisis se realizaron mediante el método de Kaplan-Meier y el modelo de regresión de Cox. Resultados: Mediana de tiempo para el diagnóstico fue de 70 días - menor para las que descubrieron la enfermedad mediante pruebas de detección y que fueron diagnosticadas en etapas tempranas. Mediana de tiempo para tratamiento fue de 32 días - menor para las atendidas por la red privada, con alto nivel educativo y diagnosticadas en etapas tempranas. Conclusiones: Asistencia en la red privada y facilitadores de acceso a la atención del cáncer de mama asociados a tiempos de espera más cortos.
RESUMO Objetivo: Analisar o tempo para o diagnóstico e tratamento do câncer de mama e os fatores associados, segundo o tipo de assistência (pública vs. privada). Métodos: Coorte retrospectiva com 477 mulheres diagnosticadas com câncer de mama entre 2014-2016. Os dados foram coletados em um serviço de oncologia de um município de Minas Gerais, entre 2018-2019. As análises foram realizadas pelo método de Kaplan-Meier e pelo modelo de regressão de Cox. Resultados: O tempo mediano para diagnóstico foi de 70 dias, sendo menor para aquelas que descobriram a doença por exames de rastreamento e diagnosticadas em estádios iniciais. O tempo mediano para o tratamento foi de 32 dias, sendo menor para as mulheres assistidas pela rede privada, com alta escolaridade e diagnosticadas em estádios iniciais. Conclusões: Assistência na rede privada e facilitadores do acesso ao cuidado do câncer de mama associaram-se a menores tempos de espera.
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Objetivo: Descrever a experiência de uso do enfoque estratégico-situacional para o rastreamento do câncer do colo do útero em um estudo de coorte. Métodos: A descrição desta experiência é relativa à segunda fase de um estudo de coorte, realizada no período de 2015-2016. A primeira fase da coleta de dados ocorreu em 2010-2012, contemplando 778 mulheres, entre 20 e 59 anos, residentes na área de abrangência de duas Unidades Básicas de Saúde (UBSs). Visando reavaliar as participantes, adotou-se o enfoque estratégico-situacional, concebido por quatro momentos de ação: explicativo (conduziu-se um diagnóstico do serviço das UBSs); normativo (definiram-se os objetivos a serem alcançados e formularam- se intervenções); estratégico (traçaram-se os mecanismos de viabilidade); tático- operacional (executaram-se, monitoraram-se e avaliaram-se as estratégias pré-estabelecidas). Ao final da segunda fase da coorte, após a realização de práticas educativas de promoção da saúde com orientações a respeito da pertinência do teste de Papanicolaou e a eliminação de barreiras de acesso à consulta ginecológica, do total de participantes elegíveis (n = 535), submeteram-se 479 às entrevistas e consultas ginecológicas, ou seja, obteve-se uma taxa de adesão equivalente a 89,5%. Conclusão: Apenas uma pequena parcela das mulheres se mostrou resistente à nova captação. O enfoque estratégico-situacional foi, portanto, elementar para a sistematização do processo de rastreamento do câncer do colo do útero. O reconhecimento de que todos os profissionais do serviço eram atores aptos a contribuir para o planejamento representou o ponto-chave na tomada de decisão e na delimitação de estratégias.
Objective: To describe the experience of the strategic-situational planning for cervical cancer screening in a cohort study. Methods: The description of this experience concerns the second phase of a cohort study, conducted in the period of 2015-2016. The first phase of the study was conducted in 2010-2012, comprising 778 women, aged 20-59, residing in areas covered by two Primary Health Care Units (PHCU). To re-evaluate the participants, we adopted a strategic-situational planning, with four steps: explanatory (conduced a diagnosis of the PHCU service); normative (defined the objectives to be achieved and formulated for interventions); strategy (outlining feasibility mechanisms); and tactical-operational (pre-established tasks were executed, monitored and evaluated). In the end of the second phase of the cohort, after educational practices for health promotion with orientations about the relevance of Papanicolaou test and also after the elimination of access barriers to gynecological appointments, 479 women were evaluated (out of a total of 535 eligible women). Therefore, the rate of adhesion was 89.5%. Conclusion: Just a small proportion of the eligible women was resistant to new uptake. The strategic-situational planning was considered elementary for the systematization of cervical cancer screening process. The recognition of the importance of all health professionals contributed to the planning and represented the key point in making decisions and in the delimitation of strategies.
Subject(s)
Mass ScreeningABSTRACT
Contexto: As informações autorreferidas são comumente utilizadas em pesquisas para estimar a cobertura do exame de Papanicolaou. Entretanto, não foram identificados estudos brasileiros que avaliem sua acurácia, o que pode comprometer os resultados encontrados. Objetivo: Avaliar a acurácia da informação autorreferida sobre a realização do último exame de Papanicolaou em mulheres assistidas pela Estratégia de Saúde da Família (ESF). Métodos: A informação autorreferida sobre a realização do exame foi obtida em estudo transversal com mulheres de 20 a 59 anos atendidas em unidades com ESF, mediante aplicação de questionário. A informação padrão-ouro foi obtida por meio da busca de registros médicos de exames de Papanicolaou. A acurácia entre o padrão-ouro e o autorrelato foi analisada por meio do cálculo do percentual de informação autorreferida adequada, da sensibilidade, da especificidade e dos valores preditivos positivos e negativos. Resultados: Foram incluídas na análise 572 mulheres. O percentual de informação autorreferida adequada foi de 92,3%, sensibilidade de 98,2% (IC95% 96,599,1), especificidade de 52,0% (IC95% 40,163,8) e valores preditivos positivos e negativos, respectivamente, de 93,3% (IC95% 90,895,2) e 80,8% (IC95% 66,390,3). Ressalta- se que não foi encontrada diferença nas medidas de acurácia em função das variáveis sociodemográficas. Conclusão: A partir dos dados apresentados, pode-se dizer que a informação autorreferida sobre realização do exame de Papanicolaou apresentou medidas de acurácia que garantem a credibilidade da informação e respaldam o uso do autorrelato na avaliação da cobertura do exame e programação do próximo exame de rastreio.
Context: Self-reported information is commonly used in surveys to estimate coverage of the Pap Test. However, it was not found in Brazil studies that evaluated the accuracy of self-report. Objective: To assess the accuracy of self-reported cervical cancer screening in women assisted in Primary Health Care. Methods: The self-reported information about the test was obtained in a cross-sectional study with women aged 20 to 59 years old who attended Primary Health Care units, using a questionnaire. The gold-standard information was obtained through the search in medical records of Pap smears. The validity of the self-report was analyzed by calculating the percentage of adequate self-reported information, sensitivity, specificity, and positive and negative predict values. Results: A total of 572 women were included in the analysis. The percentage of adequate self-reported information was 92.3%, with sensitivity of 98.2% (95% CI 96.5 to 99.1), specificity of 52.0% (95% CI 40.1 to 63.8) and positive and negative predict values, respectively, of 93.3% (95% CI: 90.8-95.2) and 80.8% (95% CI: 66.3-90.3). No difference was found in validity measures between sociodemographics characteristics. Conclusion: The self- reported cervical cancer screening showed validity measures that guarantee the credibility of the information and supports the use of self-report in the evaluation of the exam coverage and in the scheduling of the next Pap test.
Subject(s)
Primary Health Care , Uterine Cervical Neoplasms , Mass Screening , Self Report , Papanicolaou TestABSTRACT
Resumo Introdução O letramento funcional em saúde (LFS) diz respeito à habilidade dos indivíduos em compreender as informações relacionadas à saúde e está relacionado a diversos desfechos de saúde. Objetivo Investigar a associação do LFS com fatores sociodemográficos, apoio social, autoavaliação do estado de saúde e perfil de acesso aos serviços de saúde em mulheres assistidas pela Estratégia de Saúde da Família (ESF). Método Estudo transversal, conduzido em 2015-2016, em duas Unidades de Atenção Primária à Saúde cobertas pela ESF, de um município da região Sudeste do Brasil. A amostra foi composta por 439 mulheres, entre 25 e 64 anos. O LFS foi avaliado por meio do Brief Test of Functional Health Literacy in Adults (B-TOFHLA). Efetuaram-se cálculos da razão de prevalência (RP). Posteriormente, construiu-se um modelo de regressão de Poisson de variância robusta, sendo admitida significância estatística quando p ≤0,05. Resultados Foi constatado que 53,5% das mulheres apresentaram um baixo LFS, o qual associou-se à idade superior aos 40 anos (RP = 1,18; IC 95%: 1,07-1,31), ao grau de instrução inferior ao ensino médio completo (RP = 1,26; IC 95%: 1,15-1,38), à baixa renda (RP = 1,13; IC 95%: 1,04-1,23) e à autodeclaração da cor parda ou preta (RP= 1,06; IC 95%: 1,01-1,12). Conclusão Os resultados acentuaram a importância do LFS como estratégia para a abordagem de populações com maior vulnerabilidade socioeconômica.
Abstract Background Functional health literacy (FHL) concerns the ability of individuals to understand health-related information, which is related to various health outcomes. Objective Investigate the association between FHL and socio-demographic factors, social support, self-assessment of health status and access to health services in women assisted by the Family Health Strategy (FHS). Method A cross-sectional study, conducted in 2015-2016, in two Primary Health Care Units covered by the FHS of a municipality in the Southeast region of Brazil. The sample consisted of 479 participants, aged between 24 and 64 years. FHL was evaluated by the Brief Test of Functional Health Literacy in Adults (B-TOFHLA). Prevalence Ratio (PR), with Confidence Interval (CI) of 95%, was performed. Subsequently, a Poisson regression model of robust variance was constructed, and statistical significance was accepted when p≤0.05. Results It was found that 53.5% of the women had a low FHL, which was associated with age over 40 (RP = 1.18, 95% CI: 1.07-1.31), low education level (RP = 1.26, 95% CI: 1.15-1.38), low income (RP = 1.13, 95% CI 1.04-1.23) and self-declaration brown or black skin color (PR = 1.06, 95% CI 1.01-1.12). Conclusion The results reinforce the importance of FHL use as a strategy for the management of populations with greater socioeconomic vulnerability.
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RESUMO Objetivo: Revisar as constatações científicas a respeito do método baby-led weaning (BLW) no âmbito da alimentação complementar. Fontes de dados: Buscas conduzidas na base de dados Sistema Online de Busca e Análise de Literatura Médica (MEDLINE)/PubMed em agosto de 2016 por dois examinadores independentes, sem delimitação de período. Foram utilizados os descritores: "baby-led weaning" OR "baby-led" OR "BLW". Critérios de inclusão: estudos originais, disponibilizados em inglês, que abordaram o tema do método BLW. Critérios de exclusão: referências em outros idiomas, artigos de opinião e de revisão da literatura, editoriais e publicações que não discorreram sobre o assunto pretendido. Das 97 referências identificadas, 13 foram incluídas na síntese descritiva. Síntese dos dados: Os bebês adeptos ao BLW, quando comparados aos do grupo em conduta alimentar tradicional, foram menos propensos ao excesso de peso, menos exigentes em relação ao alimento e consumiam os mesmos alimentos da família. Os episódios de engasgo não diferiram entre os grupos. As mães que optaram pela implementação do BLW exibiram mais escolaridade, ocupavam um cargo gerencial no trabalho e apresentaram maior probabilidade de terem amamentado até o sexto mês. Foram mencionados preocupações com bagunça nas refeições, desperdício de comida e engasgo/asfixia, mas a maioria recomendava a adoção do método. Os profissionais da saúde demonstraram receio em indicá-lo. Conclusões: O BLW foi sugerido pelas mães que o seguiram com seus filhos, todavia relataram-se preocupações, que, somadas ao receio dos profissionais acerca da capacidade dos bebês de se autoalimentarem, refletem escassez de conhecimento sobre o método.
ABSTRACT Objective: To review the scientific findings on the baby-led weaning method (BLW) in the context of complementary feeding. Data sources: Two independent examiners searched the Medical Literature Analysis and Retrieval System Online (MEDLINE)/PubMed database in August 2016. No time-period was defined for the publication dates. The following descriptors were used: "baby-led weaning" OR "baby-led" OR "BLW". Inclusion criteria were: original studies that were available in English, and which addressed the BLW method. Exclusion criteria were: references in other languages, opinion articles and literature reviews, editorials and publications that did not elaborate on the intended subject. Of the 97 references identified, 13 were included in the descriptive synthesis. Data synthesis: The BLW group of babies, when compared to the traditional eating group, were less prone to being overweight, less demanding of food, and ate the same foods as the family. The number of choking episodes did not differ between groups. Mothers who opted for the implementation of BLW had higher levels of schooling, held managerial positions at work, and were more likely to have breastfed until the sixth month of the child's life. Concerns were raised about messes made during meals, wasting food, and choking, but most of the mothers recommended adopting the method. Health professionals were hesitant to indicate this method. Conclusions: BLW was recommended by mothers who followed the method with their own children. However, concerns have been reported, which, coupled with professionals' fears about the inability of infants to self-feed, reflect a lack of knowledge about the method.
Subject(s)
Humans , Infant, Newborn , Infant , Weaning , Feeding Behavior , Infant Behavior , Infant Nutritional Physiological PhenomenaABSTRACT
Objetivo: analisar os fatores associados ao risco de apresentar alterações no exame citopatológico do colo do útero. Métodos:Estudo transversal, que contemplou mulheres entre 25 a 64 anos. O risco para um exame alterado foi calculado a partir de quatro critérios: primeira relação sexual antes dos 18 anos; mais de quatro parceiros sexuais ao longo da vida; história anterior de doença sexualmente transmissível; mais de três partos. As análises foram efetuadas utilizando-se os testes Qui-quadrado de Pearson, razão de prevalência (RP) e Regressão de Poisson com variância robusta e intervalo de confiança (IC) de 95%. Resultados: A amostra foi composta por 479 mulheres, das quais 30% apresentaram alto risco para um exame citopatológico alterado. Constatou-se que as mulheres com baixa renda (RP = 1,12; IC95%: 1,04-1,21), com percepção negativa da própria saúde (RP = 1,13; IC95%: 1,06-1,20),que faziam uso de tabaco (RP = 1,14; IC95%: 1,05-1,23) ou álcool (RP = 1,09; IC95%: 1,02-1,18) apresentaram alto risco de apresentar um exame alterado, ao passo que a idade elevada (RP = 0,83; IC95%: 0,730,95) associou-se à diminuição desse risco.Conclusão: As mulheres jovens, de baixa renda, com percepção negativa da própria saúde e que usavam tabaco ou álcool tinham maior probabilidade de apresentar alterações no exame citopatológico do colo do útero.
Objective: to analyze the factors associated with the risk of presenting changes in the cervical cytopathology examination. Methods: Cross-sectional study that included women between 25 and 64. The risk for an altered examination was calculated fromfour criteria: first sexual intercourse before the age of 18; more than four lifetime sexual partners; previous history of sexually transmitted disease; more than three childbirths. The analyses were performed using Pearsons Chi-square test, prevalence ratio(PR) and Poisson Regression with gross variance and confidence interval (CI) of 95%. Results: The sample consisted of 479 women,of whom 30% had a high risk for an altered cytopathological examination. The study found that women with low income (PR = 1.12,95%CI: 1.04-1.21), with a negative perception of their own health (PR = 1.13, 95%CI: 1.061.20), who used tobacco (PR = 1.14, CI95%: 1.05-1.23) or alcohol (PR = 1.09, CI 95%: 1.02-1.18) presented a high risk for an altered cytopathological examination, whereasthe high age (PR = 0.83, CI 95%: 0.73-0.95) was associated with decrease in this risk. Conclusion: Young, low-income women with anegative perception of their own health, who used tobacco or alcohol, were more likely to present alterations in cervical cytopathology examination.
Objetivo: analizar los factores asociados al riesgo de presentar alteraciones en el examen citopatológico del cuello del útero.Métodos: Estudio transversal que contempló mujeres entre 25 y 64 años. El riesgo para un examen alterado fue calculado segúncuatro criterios: primera relación sexual antes de 18 años; más de cuatro parejas sexuales en la vida; historia de enfermedad de transmisión sexual; más de tres partos. Los análisis se efectuaron utilizando las pruebas Qui-cuadrado de Pearson, razón de prevalencia (RP) y Regresión de Poisson con varianza robusta e Intervalo de Confianza (IC) del 95%. Resultados: Participaron 479 mujeres, siendo que 30% presentó alto riesgo para un examen alterado. Se constató que mujeres con bajos ingresos (RP = 1,12, IC95%: 1,04-1,21), con percepción negativa de la salud (RP = 1,13; IC 95%: 1,01-1,20), que hacían uso de tabaco (RP = 1,14, IC 95%:1,05-1,23) o alcohol (RP = 1,09, IC95%: 1,02-1,18 ) presentaron alto riesgo de presentar un examen modificado, mientras que laedad elevada (RP = 0,83, IC 95%: 0,73-0,95) se asoció a la disminución de este riesgo. Conclusión: Las mujeres jóvenes, de bajarenta, con percepción negativa de la salud, que usaban tabaco o alcohol tenían mayor probabilidad de presentar alteraciones en los exámenes citopatológicos del cuello del útero.