Estudo transversal sobre ausências de pacientes em consultas médicas agendadas em ambulatórios de hospital terciário / Cross-sectional Study On Patient Absences In Medical Consultations Scheduled In Outpatient Clinics Of Tertiary Hospital / Estudio Transversal Sobre Ausencias de Pacientes Em Citas Médicas Programadas Em Pacientes Ambulatorios de Hospitales Terciarios

Objetivo: Analisar variáveis relacionadas ao agendamento de consultas ambulatoriais que não se realizaram pela ausência dos pacientes. Métodos: Estudo transversal produzido em hospital público terciário de referência para o Sistema Único de Saúde. Foram sorteados aleatoriamente 493 pacientes, e a amostra final totalizou 317 pacientes que faltaram a consultas médicas. Variáveis investigadas: recebimento de mensagens via celular informando a data da consulta, intervalo entre a data do agendamento e da consulta e a realização de reagendamento. Os dados foram oriundos de relatórios informatizados de faltosos a consultas agendadas e entrevistas telefônicas. Análises estatísticas realizadas no programa SAS® for Windows, versão 9.3. Resultados: 49.8% dos pacientes informaram não terem recebido mensagem lembrando sobre a data da consulta. O tempo entre o agendamento e a data da consulta ficou entre 180 e 365 dias para 36,6% dos pacientes. Reagendaram a consulta 24,6% dos pacientes. Conclusão: É necessário ampliar procedimentos para prevenção de faltas às consultas, independentemente do tempo entre o agendamento e a consulta. (AU)

Objective: To analyze variables related to the scheduling of outpatient appointments that did not take place due to patient no-show. Methods: Cross-sectional study conducted in a tertiary public referral hospital providing services to the Brazilian Unified Health System. A total of 493 patients were randomly selected, and the final sample totaled 317 no-show patients. Variables investigated: receipt of messages via cell phones informing the appointment date, interval between the scheduling date and the appointment date, and rescheduling. Data were obtained from computerized reports regarding absenteeism from scheduled appointments and telephone interviews. Statistical analyses were performed using the SAS® for Windows software, version 9.3. Results: 49.8% of patients reported not having received a message reminding them of the appointment dates. The interval between scheduling and the appointment dates was from 180 to 365 days for 36.6% of patients. A total of 24.6% of patients rescheduled their appointments. Conclusion: It is necessary to expand procedures to prevent missed appointments regardless of the time between scheduling and the appointment. (AU)

Objetivo: Analizar variables relacionadas con la programación de consultas externas que no se realizaron por ausencia del paciente. Métodos: Estudio transversal realizado en un hospital público terciario de referencia del Sistema Único de Salud. Se seleccionó aleatoriamente a 493 pacientes y la muestra final fue de 317 pacientes que faltaron a las citas médicas. Variables investigadas: recepción de mensajes vía celular informando la fecha de la cita, intervalo entre la cita y la fecha de la cita y reprogramación. Los datos provienen de informes computarizados de ausencias n citas programadas y entrevistas telefónicas. Análisis estadísticos realizados en SAS® para Windows versión 9.3. Resultados: En el 49.8% de los pacientes informaron no haber recibido un mensaje recordando la fecha de la cita. Conclusión: Es necesario ampliar los procedimientos para evitar citas perdidas independientemente del tiempo entre citas y citas. (AU)

Depression during pregnancy and gestational weight gain: A study of Brazilian pregnant women.

OBJECTIVES: The relationship between psychosocial factors/mental health/depressive symptoms and inadequate gestational weight (GW) change remains poorly understood. Thus, the aim of this study was to evaluate the association between depressive symptoms and inadequate GW change according to the criteria established by the Institute of Medicine in 2009. METHODS: This cross-sectional study was part of a prospective cohort, and conducted in Botucatu, São Paulo, Brazil. Pregnant women who received prenatal care at basic health care units in the city participated in the study (n = 297). The Edinburgh Postnatal Depression Scale was used to assess depressive symptoms during pregnancy, and the cutoff point used for the positive screening of depressive symptoms was ≥13. The association between depressive symptoms and two outcomes (insufficient and excessive weight change during second and third trimesters) was investigated using logistic regression models with adjustment for potential confounders. Crude and adjusted effect measures (odds ratios) and their relevant 95% confidence intervals were estimated. RESULTS: There was an association between a positive score for depression during pregnancy and insufficient GW gain. No association was observed between depressive symptoms and excessive GW gain. CONCLUSIONS: The presence of depressive symptoms significantly increased the chance of insufficient GW change. This finding enhances the need for screening for depression in prenatal care.

Presence of a companion in the delivery room and breastfeeding in the first hour of life: is there an association? / Presença de acompanhante na sala de parto e aleitamento materno na primeira hora de vida: há associação?

Abstract Objectives: to identify variables associated with the presence of a companion in the delivery room and its association with breastfeeding (BF) in the first hour of life. Methods: cross-sectional analysis of data from a cohort study (n=344). To investigate the factors associated with the presence of a companion during childbirth and breastfeeding in the first hour; we performed Poisson regression analyses, considering p<0.05 as the level of statistical significance. Results: 93.9% of the pregnant women had a companion in the delivery room, and no association was found between socioeconomic, obstetric and neonatal characteristics of the mother-child binomial and the presence of a companion. In a univariate analysis, the absence of a companion reduced the frequency of breastfeeding in the first hour (PR=0.64; CI95%=0.42-0.96), a result that was not confirmed in the adjusted analyses (PR=0.79; CI95%=0.54-1.15). Secondly, it was identified that the five minutes Apgar score was associated with first hour breastfeeding (PR=1.27; CI95%=1.14-1.40) regardless of the other factors. Conclusions: most women in the cohort had a companion in the delivery room, with no differences according to socioeconomic, obstetric and neonatal variables. The frequency of first hour breastfeeding was high; however, it was lower in the absence of a companion but this association was not independent of other factors.

Resumo Objetivos: identificar variáveis associadas à presença de acompanhante na sala de parto e sua associação com o aleitamento materno (AM) na primeira hora de vida. Métodos: análise transversal de dados provenientes de um estudo de coorte (n=344). Para investigação dos fatores associados entre a presença de companhia durante o parto e o AM na primeira hora foram realizadas análises de regressão de Poisson, considerando p<0,05 como nível de significância estatística. Resultados: 93,9% das parturientes tiveram acompanhante na sala de parto, não sendo encontrada associação entre características socioeconômicas, obstétricas e neonatais do binômio mãe-filho e esta presença. Em análise univariada, a ausência de acompanhante reduziu a frequência de AM na primeira hora (RP=0,64; IC95%=0,42-0,96), resultado que não se confirmou nas análises ajustadas (RP=0,79; IC95%=0,54-1,15). Secundariamente, identificou-se que o Apgar no quinto minuto associou-se com AM na primeira hora (RP=1,27; IC95%=1,14-1,40) independentemente dos demais fatores. Conclusões: a maioria das mulheres da coorte contou com acompanhante na sala de parto, sem diferenças segundo variáveis socioeconômicas, obstétricas e neonatais. A frequência de AM na primeira hora também foi alta e menor na ausência de acompanhante, contudo, essa associação não se mostrou independente de outros fatores.

Factors associated with death among postpartum women with COVID-19: a Brazilian population-based study.

OBJECTIVE: to identify the factors associated with death due to COVID-19 among Brazilian postpartum women in the first five months of the pandemic and five subsequent months, and describe the sociodemographic and clinical characteristics of postpartum women who developed the disease. METHOD: cross-sectional population-based study using a secondary database available in the Sistema de Informação de Vigilância Epidemiológica da Gripe -SIVEP-Gripe (Influenza Epidemiological Surveillance Information System), Brazilian Ministry of Health. A total of 869 postpartum women were included, and the analysis considered the first five months of the pandemic and subsequent five months. Association between the variables of interest and outcome (death due to COVID-19/cure) was investigated using logistic regression. RESULTS: most participants were aged between 20 and 34, of mixed race or Caucasian, and lived in the urban/peri-urban area. The proportion of deaths was 20.2% in the first period and 11.2% in the second. The likelihood of death increased in both periods due to the presence of respiratory signs and symptoms: dyspnea, respiratory distress, and oxygen saturation below 95%, in addition to the need for ventilatory support and intensive care. CONCLUSION: the proportion of deaths among postpartum women was high and decreased in the second period under study. Respiratory signs and symptoms, mechanical ventilation, and intensive care were associated with death in both periods.

Do depressive symptoms among pregnant women assisted in Primary Health Care services increase the risk of prematurity and low birth weight?

OBJECTIVE: to investigate associations between depressive symptoms during pregnancy, low birth weight, and prematurity among women with low-risk pregnancies assisted in public Primary Health Care services. METHOD: prospective cohort with 193 pregnant women, using the Edinburgh Postnatal Depression Scale, telephone interviews, and medical records available in the health services. Associations of interest were obtained using the Cox regression model. RESULTS: the participants were aged 24.9 years old (median) and had 11 years of schooling (median); 82.4% lived with their partners, and gestational age at the birth was 39 weeks (median). Twenty-five percent of the participants scored ≥13 on the Edinburgh scale. Depressive symptoms did not appear associated with low birth weight (RR=2.06; CI95%=0.56-7.61) or prematurity (RR=0.86; CI95%=0.24-3.09) in the adjusted analysis. However, premature labor increased the risk of low birth weight (RR=4.81; CI95%=1.01-23.0) and prematurity (RR=7.70; CI95%=2.50-23.7). Additionally, each week added to gestational age decreased the risk of low birth weight (RR=0.76; CI95%=0.61-0.95). CONCLUSION: the presence of depressive symptoms among women with low-risk pregnancies was not associated with low birth weight or prematurity.

The influence of gestational age at term on breastfeeding: a cohort study.

OBJECTIVE: To identify the effect of the category gestational age at term on breastfeeding in he first hour of life, the duration of exclusive breastfeeding, and practice of breastfeeding twelve months from birth. METHOD: Single cohort, with a one-year prospective follow-up of 541 children. A hierarchical analysis was performed, with models adjusted per Cox regression, considering critical p < 0.05. RESULTS: During raw analysis there was a statistical difference on breastfeeding in the first hour of life (RR = 1.54; CI 95% = 1.12-2.12; p = 0.008). However, in the final analysis, there was no association between gestational age at term and breastfeeding in the first hour of life, duration of exclusive breastfeeding, and the practice of breastfeeding twelve months from birth. Secondarily, higher age and education, cesarean section, birth at private services, and the need for resuscitation were observed to have a negative influence. Duration of previous pregnancy favored breastfeeding in the first hour of life. Using baby bottle and pacifier was negative for breastfeeding in the first year of life. CONCLUSION: There was no association between the category gestational age at term and breastfeeding. The association of outcomes pointed out by the scientific literature have been confirmed.

Health care in the first year of life of a prospective cohort of late-preterm and full-term infants, in Botucatu, state of São Paulo, Brazil, 2015-2017. / Atenção à saúde no primeiro ano de vida de uma coorte prospectiva de lactentes prematuros tardios e a termo de Botucatu, São Paulo, 2015-2017.

OBJECTIVE: To assess association between late-preterm birth and use of referral health services in the first year of life. METHODS: This was a prospective cohort study, with data collected from infants at 1, 3, 6, 9 and 12 months old. Maternal and birth characteristics were compared between full-term and late preterm infants. The effect of late preterm birth on the use of specialized outpatient clinic, emergency room/emergency care center, hospitalizations and intensive care unit (ICU) admissions was evaluated by calculating adjusted odds ratios. RESULTS: 41 late preterm and 540 full-term infants differed as to frequency of low birth weight and in not staying in joint accommodation, both of which were higher in late-preterm infants, who were also more likely to be admitted to the neonatal ICU (OR=6.85 - 95%CI 2.56;18.34). Late preterm birth was not associated with the use of other referral health services. CONCLUSION: late preterm birth was not associated with greater use of referral health services after discharge from maternity hospital.

Effectiveness of an intervention focusing on diet and walking during pregnancy in the primary health care service.

Interventions during prenatal care can mitigate negative outcomes of a sedentary lifestyle and unhealthy diet during pregnancy. We aimed to evaluate the effectiveness of an intervention that promoted healthy diet and leisure-time walking during antenatal care in a pragmatic, controlled, non-randomized intervention study. Physicians and nurses from all health care units of the Family Health Strategy model of health assistance participated in educational training to promote leisure-time walking and healthy diet during antenatal care visits. Pregnant women who received health care from these professionals constituted the intervention group (n = 181). The control group (n = 172) included pregnant women who received routine antenatal care, in health care units of the traditional model of health assistance. Data were collected in each trimester of pregnancy. Diet was investigated using a food frequency questionnaire adapted from Risk and Protective Factors Surveillance System for Chronic Non-Comunicable Diseases Through Telephone Interview (Vigitel). Leisure-time walking in a typical week was assessed using questions from the Physical Activity in Pregnancy Questionnaire. There were positive effects on leisure-time walking during the second trimester and the third trimester of pregnancy and on the women who achieved 150 minutes per week of walking during the third trimester. The intervention reduced the risk of pregnant women consuming soft drinks and/or commercially prepared cookies in the third trimester. This lifestyle intervention was partially effective, tripling the proportion of pregnant women who achieved the recommended walking time and reducing by half the proportion of women who had a high weekly consumption of soft drinks and industrially processed cookies.

Connectedness to nature and its association with food choice motives among primary health care professionals. / Conexão com a natureza e associação com motivos de escolhas alimentares entre profissionais da atenção primária à saúde.

Connectedness to nature can boost well-being and lead to healthier and more sustainable food choices. Health professionals have the potential to be key agents in promoting environmental health. A cross-sectional study was conducted with 146 primary healthcare professionals to determine the association betweennature connectedness and food choicemotives considered important for human and environmental health. We used the 14-item Connectedness to Nature Scale (CNS) and the Food Choice Questionnaire (FCQ), consisting of 36 items distributed between nine factors, including "health", "natural content", and "ethical concern". The average CNS score was 53.8 (± 9). The highest scoring factors of the FCQ were sensory appeal and price.Ethical concern was ranked last. There was a significant positive association between degree of nature connectedness and scoring for the factors health (p = 0.031), natural content (p = 0.001), and ethical concern (p <0.001). The results of this unprecedented studyshow that increased connectedness to nature may lead to healthier and more sustainable food choices.

A conexão com a natureza pode favorecer o bem-estar e a adoção de práticas alimentares sustentáveis. Profissionais de saúde seriam agentes fundamentais nesta interface, promovendo a saúde ambiental. Estudo transversal com 146 profissionais da atenção primária avaliou a associação entre conexão com a natureza e os motivos para escolhas alimentares consideradas importantes à saúde humana e ambiental. Aplicou-se Escala de Conexão com a Natureza (ECN), contendo 14 itens que medem o quanto a pessoa se sente integrada ao meio ambiente, variando de 14 a 70 pontos; e o Questionário sobre Motivos para as Escolhas Alimentares (FCQ), com 36 itens distribuídos em nove fatores, dentre os quais elegeu-se para este estudo: "Saúde", "Conteúdo Natural" e "Preocupação Ética". A pontuação média na ECN foi de 53,8, (± 9). "Apelo Sensorial" e "Preço" foram os fatores mais pontuados; "Preocupação Ética" ocupou a última posição. Houve associação positiva significativa da ECN com a pontuação nos fatores "Saúde" (p = 0,031), "Conteúdo Natural" (p = 0,001) e "Preocupação Ética" (p < 0,001). Os resultados desta pesquisa inédita permitiram concluir que aumentar conexão com a natureza pode favorecer escolhas alimentares mais saudáveis e sustentáveis.

Conexão com a natureza e associação com motivos de escolhas alimentares entre profissionais da atenção primária à saúde / Connectedness to nature and its association with food choice motives among primary health care professionals

Resumo A conexão com a natureza pode favorecer o bem-estar e a adoção de práticas alimentares sustentáveis. Profissionais de saúde seriam agentes fundamentais nesta interface, promovendo a saúde ambiental. Estudo transversal com 146 profissionais da atenção primária avaliou a associação entre conexão com a natureza e os motivos para escolhas alimentares consideradas importantes à saúde humana e ambiental. Aplicou-se Escala de Conexão com a Natureza (ECN), contendo 14 itens que medem o quanto a pessoa se sente integrada ao meio ambiente, variando de 14 a 70 pontos; e o Questionário sobre Motivos para as Escolhas Alimentares (FCQ), com 36 itens distribuídos em nove fatores, dentre os quais elegeu-se para este estudo: "Saúde", "Conteúdo Natural" e "Preocupação Ética". A pontuação média na ECN foi de 53,8, (± 9). "Apelo Sensorial" e "Preço" foram os fatores mais pontuados; "Preocupação Ética" ocupou a última posição. Houve associação positiva significativa da ECN com a pontuação nos fatores "Saúde" (p = 0,031), "Conteúdo Natural" (p = 0,001) e "Preocupação Ética" (p < 0,001). Os resultados desta pesquisa inédita permitiram concluir que aumentar conexão com a natureza pode favorecer escolhas alimentares mais saudáveis e sustentáveis.

Abstract Connectedness to nature can boost well-being and lead to healthier and more sustainable food choices. Health professionals have the potential to be key agents in promoting environmental health. A cross-sectional study was conducted with 146 primary healthcare professionals to determine the association betweennature connectedness and food choicemotives considered important for human and environmental health. We used the 14-item Connectedness to Nature Scale (CNS) and the Food Choice Questionnaire (FCQ), consisting of 36 items distributed between nine factors, including "health", "natural content", and "ethical concern". The average CNS score was 53.8 (± 9). The highest scoring factors of the FCQ were sensory appeal and price.Ethical concern was ranked last. There was a significant positive association between degree of nature connectedness and scoring for the factors health (p = 0.031), natural content (p = 0.001), and ethical concern (p <0.001). The results of this unprecedented studyshow that increased connectedness to nature may lead to healthier and more sustainable food choices.

Health care in the first year of life of a prospective cohort of late-preterm and full-term infants, 2015-2017 / Atención de la salud en el primer año de una cohorte prospectiva de infantes prematuros tardios y a término, 2015-2017 / Atenção à saúde no primeiro ano de vida de uma coorte prospectiva de lactentes prematuros tardios e a termo de Botucatu, São Paulo, 2015-2017

Objective: To compare late preterm and full-term infants and investigate the association between late preterm birth and the use of reference services. Methods: Prospective cohort study, with data collected from the first to twelfth months of life. Maternal and birth characteristics were compared between term and premature live births. The effect of late preterm birth on the usage of outpatient/emergency services, hospitalizations and intensive care unit admissions were evaluated by calculating odds ratios adjusted for potential confounding factors. Results: The 41 late preterm and 540 full-term infants differed in the frequencies of low weight at birth and in non-permanence in rooming-in wards, which were both higher in late-preterm infants. This group had a higher chance of being hospitalized in a neonatal intensive care unit (OR=6.85 ­ CI95% 2.56;18.34). Late preterm birth was not associated with the use of other health services. Conclusion: Negative effects of late preterm delivery were only found in the neonatal stage.

Objetivo: Avaliar associação entre prematuridade tardia e utilização de serviços de referência no primeiro ano de vida. Estudo de coorte prospectiva, com dados coletados no 1o, 3o, 6o, 9o e 12o meses dos lactentes. Características maternas e de nascimento foram comparadas entre nascidos a termo e prematuros tardios. Avaliou-se o efeito da prematuridade tardia sobre a utilização de ambulatório especializado e unidade de pronto-socorro/pronto atendimento, internação em unidade de terapia intensiva (UTI) e hospitalização, calculando-se razões de chances ajustadas. Resultados: Os 41 prematuros tardios e 540 nascidos a termo diferiram nas frequências de baixo peso ao nascer e não permanência em alojamento conjunto, maiores nos prematuros tardios, estes também com mais chance de internação em UTI neonatal (OR=6,85 ­ IC95% 2,56;18,34), condição que não se associou à utilização dos demais serviços de referência. Conclusão: Prematuridade tardia não se associou à maior utilização de serviços de referência após alta da maternidade.

Consumption of ultra-processed foods in the third gestational trimester and increased weight gain: a Brazilian cohort study.

OBJECTIVE: To investigate whether the consumption of ultra-processed foods (UPF) during pregnancy is associated with gestational weight gain (GWG). DESIGN: Cohort study with collection of two 24-h dietary recalls during each gestational trimester obtained on non-consecutive days and differentiating weekday v. weekend/holiday. The foods were classified according to the NOVA system into fresh or minimally processed foods and their culinary preparations, processed and UPF and subsequently analysed as a percentage contribution to dietary energy. The outcome was average GWG in the second and in the third trimesters, expressed in g/week. SETTING: Botucatu, a medium-sized Brazilian city. PARTICIPANTS: Pregnant women with regular obstetric risk (n 259) undergoing prenatal care in primary healthcare. RESULTS: In a multiple linear regression model, it was found that an increase of 1 percentage point in energy consumption from UPF in the third gestational trimester led to an average increase of 4·17 (95 % CI 0·55; 7·79) g in weekly GWG in this period. There was no association between second-trimester UPF consumption and GWG. CONCLUSIONS: Consumption of UPF in the third gestational trimester is positively associated with average weekly GWG in this period.

Effectiveness of an intervention focusing on diet and walking during pregnancy in the primary health care service / A efetividade de uma intervenção na atenção primária voltada para a dieta e caminhadas durante a gravidez / Efectividad de una intervención centrada en la dieta y paseos durante la gestación en el servicio de atención primaria en salud

Abstract: Interventions during prenatal care can mitigate negative outcomes of a sedentary lifestyle and unhealthy diet during pregnancy. We aimed to evaluate the effectiveness of an intervention that promoted healthy diet and leisure-time walking during antenatal care in a pragmatic, controlled, non-randomized intervention study. Physicians and nurses from all health care units of the Family Health Strategy model of health assistance participated in educational training to promote leisure-time walking and healthy diet during antenatal care visits. Pregnant women who received health care from these professionals constituted the intervention group (n = 181). The control group (n = 172) included pregnant women who received routine antenatal care, in health care units of the traditional model of health assistance. Data were collected in each trimester of pregnancy. Diet was investigated using a food frequency questionnaire adapted from Risk and Protective Factors Surveillance System for Chronic Non-Comunicable Diseases Through Telephone Interview (Vigitel). Leisure-time walking in a typical week was assessed using questions from the Physical Activity in Pregnancy Questionnaire. There were positive effects on leisure-time walking during the second trimester and the third trimester of pregnancy and on the women who achieved 150 minutes per week of walking during the third trimester. The intervention reduced the risk of pregnant women consuming soft drinks and/or commercially prepared cookies in the third trimester. This lifestyle intervention was partially effective, tripling the proportion of pregnant women who achieved the recommended walking time and reducing by half the proportion of women who had a high weekly consumption of soft drinks and industrially processed cookies.

Resumo: As intervenções durante o acompanhamento pré-natal podem mitigar os desfechos negativos do sedentarismo e da dieta não saudável durante a gravidez. Os autores buscaram avaliar a efetividade de uma intervenção de promoção de dieta saudável e caminhadas no lazer durante o acompanhamento pré-natal, através de um estudo de intervenção pragmático, controlado, não-randomizado. Médicos e enfermeiros de todas as unidades da Estratégia Saúde da Família participaram da capacitação na promoção de caminhadas e diet saudável, como parte do acompanhamento pré-natal. O grupo da intervenção consistia em gestantes que receberam cuidados desses profissionais (n = 181). O grupo controle (n = 172) incluía as gestantes que recebiam os cuidados pré-natais usuais, nas unidades do modelo assistencial tradicional. Os dados eram coletados em cada trimestre da gestação. A dieta era investigada com um questionário de frequência alimentar, adaptado do Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel). As caminhadas no lazer em uma semana típica eram avaliadas com perguntas do Physical Activity in Pregnancy Questionnaire. Houve efeitos positivos sobre o tempo de caminhada no segundo e terceiro trimestres da gestação e nas mulheres que atingiam 150 minutos semanais de caminhadas no terceiro trimestre. A intervenção reduziu o risco de gestantes consumirem refrigerantes e/ou biscoitos industrializados no terceiro trimestre. A intervenção no estilo de vida foi parcialmente efetiva, triplicando a proporção de gestantes que atingiam o tempo recomendado de caminhada e reduzindo pela metade a proporção de mulheres com alto consumo semanal de refrigerantes e biscoitos industrializados.

Resumen: Las intervenciones durante el cuidado prenatal pueden mitigar los resultados negativos de un estilo de vida sedentario y una dieta insana durante el embarazo. Nuestro objetivo fue evaluar la efectividad de una intervención que promovió una dieta saludable y los paseos en el tiempo de ocio, durante el cuidado prenatal, en un estudio pragmático, controlado y de intervención no aleatoria. Médicos y enfermeras de todas las unidades de cuidado de la Estrategia de Salud de la Familia, modelo de asistencia a la salud, participaron en la formación educacional para promover los paseos durante el tiempo de ocio, así como una dieta saludable durante las visitas de cuidado prenatal. Las mujeres embarazadas que recibieron asistencia de estos profesionales constituyeron el grupo de intervención (n = 181). El grupo de control (n = 172) incluyó a mujeres embarazadas, con una rutina de cuidados prenatales, en unidades de atención del modelo tradicional de asistencia en salud. Los datos fueron recabados en cada trimestre de embarazo. La dieta fue investigada usando el cuestionario de frecuencia de comidas adaptado del Vigilancia de Factores de Riesgo y Protección para Enfermedades Crónicas No Transmisibles por Entrevista Telefónica (Vigitel). Los paseos en el tiempo de ocio en una semana típica se evaluaron usando preguntas del Physical Activity in Pregnancy Questionnaire. Hubo efectos positivos por los paseos durante el tiempo de ocio en el segundo y tercer trimestre de embarazo, así como en las mujeres que alcanzaron 150 minutos por semana de paseos durante el tercer trimestre. La intervención redujo el riesgo de mujeres embarazadas que consumían refrescos y/o galletas empaquetadas en el tercer trimestre. La intervención en el estilo de vida fue parcialmente efectiva, triplicando la proporción de mujeres embarazadas que lograron el tiempo de paseos recomendados y redujeron a la mitad la proporción de mujeres que tuvieron una alta frecuencia semanal de consumo de refrescos y galletas procesadas industrialmente.

Factors associated with death among postpartum women with COVID-19: a Brazilian population-based study / Factores asociados a la muerte entre puérperas con COVID-19: estudio brasileño de base poblacional / Fatores associados ao óbito entre puérperas com COVID-19: estudo brasileiro de base populacional

Objective: to identify the factors associated with death due to COVID-19 among Brazilian postpartum women in the first five months of the pandemic and five subsequent months, and describe the sociodemographic and clinical characteristics of postpartum women who developed the disease. Method: cross-sectional population-based study using a secondary database available in the Sistema de Informação de Vigilância Epidemiológica da Gripe -SIVEP-Gripe (Influenza Epidemiological Surveillance Information System), Brazilian Ministry of Health. A total of 869 postpartum women were included, and the analysis considered the first five months of the pandemic and subsequent five months. Association between the variables of interest and outcome (death due to COVID-19/cure) was investigated using logistic regression. Results: most participants were aged between 20 and 34, of mixed race or Caucasian, and lived in the urban/peri-urban area. The proportion of deaths was 20.2% in the first period and 11.2% in the second. The likelihood of death increased in both periods due to the presence of respiratory signs and symptoms: dyspnea, respiratory distress, and oxygen saturation below 95%, in addition to the need for ventilatory support and intensive care. Conclusion: the proportion of deaths among postpartum women was high and decreased in the second period under study. Respiratory signs and symptoms, mechanical ventilation, and intensive care were associated with death in both periods.

Objetivo: identificar los factores asociados a muerte por COVID-19 durante el puerperio en brasileñas, en los primeros cinco meses de la pandemia y en los cinco meses posteriores y, describir las características sociodemográficas y clínicas de puérperas que desarrollaron la enfermedad. Método: estudio transversal, de base poblacional, con datos secundarios del Sistema de Informação de Vigilância Epidemiológica da Gripe - SIVEP-Gripe (Sistema de Información de Vigilancia Epidemiológica de la Gripe), del Ministerio de la Salud de Brasil. Fueron incluidas 869 puérperas y el análisis consideró los primeros cinco meses de la pandemia y los cinco meses posteriores. La asociación entre las variables de interés y el resultado (muerte/cura por COVID-19) fue investigada por regresión logística. Resultados: la mayoría de las puérperas tenía entre 20 y 34 años, color de piel parda/blanca y residía en zona urbana/periurbana. La proporción de muertes fue de 20,2% en el primer período y 11,2% en el segundo. En los dos períodos - aumento más las probabilidades de morir - la presencia de señales y síntomas respiratorios (disnea, incomodidad respiratoria y saturación de oxígeno inferior a 95%), así como necesitar de soporte ventilatorio y terapia intensiva. Conclusión: la proporción de muertes entre puérperas fue elevada, con reducción en el segundo período estudiado. Se asociaron a la muerte señales y síntomas respiratorios, la necesidad de ventilación mecánica y de terapia intensiva, en los dos períodos analizados.

Objetivo: identificar os fatores associados ao óbito por COVID-19 entre puérperas brasileiras, nos primeiros cinco meses da pandemia e nos cinco meses posteriores e descrever as características sociodemográficas e clínicas de puérperas que desenvolveram a doença. Método: estudo transversal, de base populacional, com dados secundários do Sistema de Informação de Vigilância Epidemiológica da Gripe, disponibilizados pelo Ministério da Saúde do Brasil. Foram incluídas 869 puérperas e a análise considerou os primeiros cinco meses da pandemia e os cinco meses posteriores. A associação entre as variáveis de interesse e o desfecho (óbito/cura por COVID-19) foi investigada por regressão logística. Resultados: a maioria das puérperas tinha entre 20 e 34 anos, cor da pele parda/branca e residia em zona urbana/periurbana. A proporção de óbitos foi de 20,2% no primeiro período e 11,2% no segundo. Em ambos os períodos, aumentou a chance de evolução para óbito a presença de sinais e sintomas respiratórios: dispneia, desconforto respiratório e saturação de oxigênio inferior a 95%, assim como necessitar de suporte ventilatório e terapia intensiva. Conclusão: a proporção de óbitos entre puérperas foi elevada, com redução no segundo período estudado. Associaram-se ao óbito sinais e sintomas respiratórios, necessidade de ventilação mecânica e de terapia intensiva, em ambos os períodos analisados.

Insufficient choline intake during pregnancy: cohort study / Ingestão insuficiente de colina durante a gestação: estudo de coorte

ABSTRACT Objective To investigate the intake of choline during pregnancy and associated factors. Methods Cohort study with 353 pregnant women recruited from the primary health care network in an inland city of the State of São Paulo. In-house interviews were conducted in each of the gestational trimesters. In each of these points in time, a 24-hour dietary recall was collected. Subsequently, a new dietary recall collection was performed by telephone in the same trimester on a non-consecutive day, differentiating weekday versus weekend/holiday. Dietary intake data were included in the Nutrition Data System for Research software, and the habitual food intake throughout pregnancy was determined, with intra-individual variation correction in the MSM software. The influence of socioeconomic, obstetric and lifestyle factors, and of the actual diet, on choline intake during pregnancy was assessed using linear regression models, that were developed with the Stata software version 14.2, at a significance level of 95%. Results Choline intake (281.1±68.6 milligrams) was below the recommended adequate intake, and only energy was positively associated with this micronutrient intake. Conclusion Choline intake in the population studied fell far short of current recommendations, and only higher energy intake was found as a factor associated with a higher intake.

RESUMO Objetivo Investigar a ingestão de colina durante a gestação e fatores associados. Métodos Estudo de coorte com 353 gestantes recrutadas na rede de assistência primária à saúde de cidade paulista. Foram realizadas entrevistas presenciais, no domicílio, em cada um dos trimestres gestacionais. Em cada momento foi coletado um recordatório alimentar de 24 horas, seguido por nova coleta via telefone no mesmo trimestre, em dia não consecutivo, diferenciando dia de semana versus final de semana/feriado. Os dados de consumo alimentar foram incluídos no software Nutrition Data System for Research, sendo obtida a ingestão habitual, durante toda a gestação, com correção da variação intraindividual, no software MSM. A influência de fatores socioeconômicos, obstétricos, de estilo de vida e da própria dieta sobre a ingestão de colina na gestação foi avaliada por modelos de regressão linear, realizados no software Stata versão 14.2, ao nível de significância de 95%. Resultados A ingestão diária de colina (281,1±68,6 miligramas) mostrou-se abaixo do recomendado, sendo que apenas a energia mostrou-se como positivamente associada à ingestão desse micronutriente. Conclusão A ingestão de colina na população estudada ficou muito aquém das recomendações atuais, sendo que apenas a maior ingestão energética foi encontrada como fator associado à maior ingestão de colina.

Do depressive symptoms among pregnant women assisted in Primary Health Care services increase the risk of prematurity and low birth weight? / Sintomas depressivos em gestantes assistidas na rede de Atenção Primária à Saúde aumentam o risco de prematuridade e baixo peso ao nascer? / Los síntomas depresivos en embarazadas atendidas en la red de Atención Primaria ¿Aumentan el riesgo de prematuridad y bajo peso alnacer?

Objective: to investigate associations between depressive symptoms during pregnancy, low birth weight, and prematurity among women with low-risk pregnancies assisted in public Primary Health Care services. Method: prospective cohort with 193 pregnant women, using the Edinburgh Postnatal Depression Scale, telephone interviews, and medical records available in the health services. Associations of interest were obtained using the Cox regression model. Results: the participants were aged 24.9 years old (median) and had 11 years of schooling (median); 82.4% lived with their partners, and gestational age at the birth was 39 weeks (median). Twenty-five percent of the participants scored ≥13 on the Edinburgh scale. Depressive symptoms did not appear associated with low birth weight (RR=2.06; CI95%=0.56-7.61) or prematurity (RR=0.86; CI95%=0.24-3.09) in the adjusted analysis. However, premature labor increased the risk of low birth weight (RR=4.81; CI95%=1.01-23.0) and prematurity (RR=7.70; CI95%=2.50-23.7). Additionally, each week added to gestational age decreased the risk of low birth weight (RR=0.76; CI95%=0.61-0.95). Conclusion: the presence of depressive symptoms among women with low-risk pregnancies was not associated with low birth weight or prematurity.

Objetivo: investigar a associação entre sintomas depressivos na gestação, baixo peso ao nascer e prematuridade entre gestantes de baixo risco obstétrico, atendidas em serviços públicos de Atenção Primária à Saúde. Método: coorte prospectiva com 193 gestantes, mediante aplicação da Escala de Depressão Pós-natal de Edimburgo, entrevista telefônica e consulta aos prontuários dos serviços de saúde. As associações de interesse foram obtidas por regressão múltipla de Cox. Resultados: as participantes tinham idade mediana de 24,9 anos e escolaridade mediana de 11 anos; 82,4% viviam com companheiro e a idade gestacional mediana no parto foi 39 semanas. Auferiram escore ≥13 na Escala de Edimburgo 25,4% delas. Na análise ajustada, sintomas depressivos não se associaram ao baixo peso ao nascer (RR=2,06; IC95%=0,56-7,61) e à prematuridade (RR=0,86; IC95%=0,24-3,09). Secundariamente, identificouse que trabalho de parto prematuro aumentou o risco de baixo peso ao nascer (RR=4,81; IC95%=1,01-23,0) e de prematuridade (RR=7,70; IC95%=2,50-23,7). Além disso, cada semana a mais na idade gestacional diminuiu o risco de baixo peso ao nascer (RR=0,76; IC95%=0,61-0,95). Conclusão: a presença de sintomas depressivos entre gestantes de baixo risco obstétrico não se associou ao risco de baixo peso ao nascer e prematuridade.

Objetivo: investigar la asociación entre síntomas depresivos en la gestación con bajo peso al nacer y prematuridad entre embarazadas, de bajo riesgo obstétrico, atendidas en servicios públicos de Atención Primaria a la Salud. Método: cohorte prospectiva en 193 embarazadas, utilizando la Escala de Depresión Posparto de Edimburgo, por medio de entrevista telefónica y consulta en las fichas médicas de los servicios de salud. Las asociaciones de interés fueron obtenidas con la regresión múltiple de Cox. Resultados: las participantes tuvieron edad mediana de 24,9 años y escolaridad mediana de 11 años; 82,4% vivían con compañero y la edad gestacional mediana en el parto fue 39 semanas. 25,4% de las mujeres obtuvieron un puntaje ≥13, en la Escala de Edimburgo. En el análisis ajustado, los síntomas depresivos no se asociaron al bajo peso al nacer (RR=2,06; IC95%=0,56-7,61) y a la prematuridad (RR=0,86; IC95%=0,24-3,09). Secundariamente, se identificó que el trabajo de parto prematuro aumentó el riesgo de bajo peso al nacer (RR=4,81; IC95%=1,01-23,0) y de prematuridad (RR=7,70; IC95%=2,50-23,7). Además de eso, se encontró que cada semana a más en la edad gestacional disminuye el riesgo de bajo peso al nacer (RR=0,76; IC95%=0,61-0,95). Conclusión: la presencia de síntomas depresivos entre embarazadas de bajo riesgo obstétrico no se asoció al riesgo de bajo peso al nacer y a la prematuridad.

The influence of gestational age at term on breastfeeding: a cohort study / Influencia de la edad gestacional a término en la lactancia materna: un estudio de cohorte / Influência da idade gestacional no termo sobre o aleitamento materno: estudo de coorte

ABSTRACT Objective: To identify the effect of the category gestational age at term on breastfeeding in he first hour of life, the duration of exclusive breastfeeding, and practice of breastfeeding twelve months from birth. Method: Single cohort, with a one-year prospective follow-up of 541 children. A hierarchical analysis was performed, with models adjusted per Cox regression, considering critical p < 0.05. Results: During raw analysis there was a statistical difference on breastfeeding in the first hour of life (RR = 1.54; CI 95% = 1.12-2.12; p = 0.008). However, in the final analysis, there was no association between gestational age at term and breastfeeding in the first hour of life, duration of exclusive breastfeeding, and the practice of breastfeeding twelve months from birth. Secondarily, higher age and education, cesarean section, birth at private services, and the need for resuscitation were observed to have a negative influence. Duration of previous pregnancy favored breastfeeding in the first hour of life. Using baby bottle and pacifier was negative for breastfeeding in the first year of life. Conclusion: There was no association between the category gestational age at term and breastfeeding. The association of outcomes pointed out by the scientific literature have been confirmed.

RESUMEN Objetivo: Identificar el efecto de la categoría de edad gestacional a término sobre la lactancia materna en la primera hora de vida, la duración de la lactancia materna exclusiva y la práctica de la lactancia materna a los doce meses. Método: Cohorte única, con un año de seguimiento prospectivo de 541 niños. Se realizó un análisis jerárquico, con modelos ajustados por regresión de Cox, considerando el p crítico < 0,05. Resultados: El análisis bruto presentó una diferencia estadística en la práctica de la lactancia materna en la primera hora de vida (RR = 1,54; IC 95% = 1,12-2,12; p = 0,008). Sin embargo, en el análisis final, no hubo asociación entre la edad gestacional a término y la lactancia materna en la primera hora de vida, la duración de la lactancia materna exclusiva y la práctica de la lactancia materna a los doce meses. En segundo lugar, se encontró que el aumento de la edad y la educación, la cesárea, el nacimiento en servicios privados y la necesidad de reanimación influyeron negativamente. El embarazo previo favoreció la lactancia materna en la primera hora de vida. Usar biberón y chupete fue negativo para la lactancia en el primer año de vida. Conclusión: No hubo asociación entre la edad gestacional a término y la lactancia materna. Se confirmó la asociación de los resultados apuntados en la literatura científica.

RESUMO Objetivo: Identificar o efeito da categoria idade gestacional no termo sobre o aleitamento materno na primeira hora de vida, a duração do aleitamento materno exclusivo e a prática do aleitamento materno aos doze meses. Método: Coorte única, com acompanhamento prospectivo de um ano de 541 crianças. Foi realizada uma análise hierarquizada, com modelos ajustados por regressão de Cox, considerando-se p crítico < 0,05. Resultados: Na análise bruta houve diferença estatística na prática do aleitamento materno na primeira hora de vida (RR = 1,54; IC95% = 1,12-2,12; p = 0,008). Porém, na análise final, não houve associação entre idade gestacional no termo e aleitamento materno na primeira hora de vida, duração do aleitamento materno exclusivo e prática do aleitamento materno aos doze meses. Secundariamente, encontrou-se que o aumento na idade e escolaridade, a cesárea, o nascimento em serviços privados e a necessidade de reanimação influenciaram negativamente. A vigência de gestação prévia favoreceu o aleitamento na primeira hora de vida. Usar mamadeira e chupeta foi negativo para o aleitamento no primeiro ano de vida. Conclusão: Não houve associação entre a categoria idade gestacional no termo e aleitamento materno. Confirmou-se a associação de desfechos já apontados na literatura cientifica.

Atenção à saúde no primeiro ano de vida de uma coorte prospectiva de lactentes prematuros tardios e a termo de Botucatu, São Paulo, 2015-2017 / Atención a la salud en el primer año de vida de una cohorte prospectiva de bebés prematuros tardíos y a término, Botucatu, São Paulo, Brasil, 2015-2017 / Health care in the first year of life of a prospective cohort of late-preterm and full-term infants, in Botucatu, state of São Paulo, Brazil, 2015-2017

Objetivo: Avaliar associação entre prematuridade tardia e utilização de serviços de referência no primeiro ano de vida. Métodos: Estudo de coorte prospectiva, com dados coletados no 1º, 3º, 6º, 9º e 12º meses dos lactentes. Características maternas e de nascimento foram comparadas entre nascidos a termo e prematuros tardios. Avaliou-se o efeito da prematuridade tardia sobre a utilização de ambulatório especializado e unidade de pronto-socorro/pronto atendimento, internação em unidade de terapia intensiva (UTI) e hospitalização, calculando-se razões de chances ajustadas. Resultados: Os 41 prematuros tardios e 540 nascidos a termo diferiram nas frequências de baixo peso ao nascer e não permanência em alojamento conjunto, maiores nos prematuros tardios, estes também com mais chance de internação em UTI neonatal (OR=6,85 - IC95% 2,56;18,34), condição que não se associou à utilização dos demais serviços de referência. Conclusão: Prematuridade tardia não se associou à maior utilização de serviços de referência após alta da maternidade.

Objetivo: Evaluar la asociación entre nacidos prematuros tardíos y nacidos a término y la utilización de servicios de derivación. Métodos: estudio de cohorte prospectivo, con datos recolectados desde el primero hasta el duodécimo mes de vida de los lactantes. Se evaluaron características maternas y de nacimiento que fueron comparadas entre nacidos a término y prematuros tardíos. Fue evaluado el efecto de la prematuridad tardía sobre el uso de los servicios de derivación especializado y las unidades de Atención Temprana, internación en centro de terapia intensiva (CTI) y hospitalización calculando las razones de probabilidades ajustadas. Resultados: Los 41 nacidos prematuros tardíos y los 540 nacidos a término difirieron en la frecuencia de bajo peso al nacer y en no permanecer en alojamiento conjunto, mayor en los nacidos prematuros tardíos. Hubo más posibilidades de ingreso a la unidad de cuidados intensivos neonatales en nacidos prematuros tardíos (OR=6,85 - IC95% 2,56;18,34), condición que no se asoció con el uso de otros servicios de referencia. Conclusión: La prematuridad tardía no se asoció a una mayor utilización de los servicios de derivación luego del alta de la maternidad.

Objective: To assess association between late-preterm birth and use of referral health services in the first year of life. Methods: This was a prospective cohort study, with data collected from infants at 1, 3, 6, 9 and 12 months old. Maternal and birth characteristics were compared between full-term and late preterm infants. The effect of late preterm birth on the use of specialized outpatient clinic, emergency room/emergency care center, hospitalizations and intensive care unit (ICU) admissions was evaluated by calculating adjusted odds ratios. Results: 41 late preterm and 540 full-term infants differed as to frequency of low birth weight and in not staying in joint accommodation, both of which were higher in late-preterm infants, who were also more likely to be admitted to the neonatal ICU (OR=6.85 - 95%CI 2.56;18.34). Late preterm birth was not associated with the use of other referral health services. Conclusion: late preterm birth was not associated with greater use of referral health services after discharge from maternity hospital.

Longer duration of exclusive breastfeeding reduces maternal weight retention: results from the CLaB study / Maior duração do aleitamento materno exclusivo reduz retenção de peso materno: resultados do estudo CLaB

Abstract Objectives: to evaluate the relation between breastfeeding and postpartum weight reten-tion. Methods: this prospective cohort study involved 641 newborns and their mothers, followed up to twelve months postpartum. Data were collected from June 2015 to February 2017. In the first interview, we investigated data regarding socioeconomic and demographic characteristics, obstetric history, weight, and gestational age of the infant at birth. Maternal weight and breastfeeding status were obtained at 3, 6, 9 and 12 months postpartum at the mother's home. A descriptive analysis of maternal weight retention according to the lactation status was performed. Multiple linear regression models evaluated the effect on exclusive breastfeeding and total breastfeeding duration on maternal weight retention at 6 and 12 months postpartum, considering potential confounders. Results: 512 and 490 mothers were evaluated at six months and at twelve months post-partum, and the mean weight retention was 1.79 (SD=5.52) and 1.69 (SD=6.69) kg, respectively. Regardless of the confounders, the mean postpartum weight reduction for each day of exclusive breastfeeding was 11 (CI95%= -0.019 to -0.003) and 16 grams (CI95%= -0.026 to -0.007) for 6 and 12 months, respectively. The total maternal breastfeeding duration had the same effect. Conclusions: longer periods of exclusive breastfeeding and total breastfeeding are associated with lower postpartum weight retention.

Resumo Objetivos: avaliar a relação entre aleitamento materno e retenção de peso pós-parto. Métodos. estudo de coorte prospectiva com 641 recém-nascidos/mães acompanhados até doze meses pós-parto. Os dados foram coletados de junho/2015 a fevereiro/2017; na primeira entrevista, investigou-se dados socioeconômicos, demográficos, história obstétrica, peso e idade gestacional do lactente ao nascer. Pesos maternos e situação de aleitamento dos lactentes foram obtidos aos 3, 6, 9 e 12 meses pós-parto, em domicílio. Realizou-se análise descritiva da retenção de peso materno segundo situação de aleitamento nesses períodos. Modelos de regressão linear múltiplos avaliaram o efeito da duração do aleitamento materno exclusivo e aleitamento materno sobre retenção de peso materno aos 6 e 12 meses pós-parto, considerando confundidores. Resultados: seis e doze meses pós-parto foram avaliadas 512 e 490 mães, com retenção ponderal média de 1,79 (DP=5,52) e 1,69 (DP=6,69) quilos, respectivamente. Independentemente de confundidores, cada dia a mais de aleitamento materno exclusivo reduziu, em média, 11 (IC95%= -0,019; -0,003) e 16 (IC95%= -0,026; -0,007) gramas a retenção de peso nos dois períodos. A duração do aleitamento materno total teve efeito semelhante. Conclusões: maior duração do aleitamento materno exclusivo e aleitamento materno associam-se com menor retenção de peso pós-parto.

The association of dietary glycaemic index and glycaemic load with gestational weight gain and newborn birth weight.

Diet during pregnancy is related to several maternal and infant health outcomes; however, the relationship between maternal dietary glycaemic index (GI) and glycaemic load (GL) and gestational weight gain (GWG) or newborn birth weight is controversial. The purpose of the present study was to investigate the relationship between maternal dietary GI and GL and GWG and birth weight. A cohort of adult pregnant women with usual obstetric risk was followed in Botucatu, SP, Brazil. Two 24-h dietary recalls were collected in each gestational trimester (<14, 24-27, 31-34 weeks), one in person and the other by telephone. GI and GL were determined using the software Nutrition Data System for Research. GWG was obtained from medical records and evaluated as the weekly GWG between the second and third gestational trimesters. Newborn birth weight z-score in relation to gestational age was evaluated according to Intergrowth-21st Project recommendations. A multiple linear regression model, adjusted for potential confounders, showed a one-point increase in the GI resulted in a mean decrease of 12·9 (95 % CI -21·48, -4·24) g in weekly GWG; GL was not associated with this outcome. The birth weight z-score was not associated with GI (P = 0·763) or GL (P = 0·317). In conclusion, in a cohort of pregnant women considered at usual risk for obstetric complications, maternal dietary GI was negatively associated with weekly GWG in the second and third gestational trimesters. No association was observed between GL and GWG, and neither GI nor GL was associated with birth weight z-score.