Trends in Breastfeeding and Associated Factors in a Primary Healthcare Service in the South of Brazil: 2004 to 2015.

The aim was to monitor the frequency of Breastfeeding (BF) and Exclusive Breastfeeding (EBF) in a Primary Healthcare Service, between the years of 2004 to 2015. This is a historical series is composed of eight cross-sectional surveys that were carried out during the annual vaccination campaigns. A total of 6027 children were evaluated, with a mean age of 6.2 months. There was a significant increase in the rates of BF (7.2%) and EBF (9.5%) in children less than four months old. In infants from four to five months old, a substantial decline was observed in the EBF rate between 2010 and 2015 (6.3%). The frequency of BF had a 10.1% increase in infants from six to nine months old and remained stable in children from 10 to 11 months of age. Among children less than six months old, monitoring by the health service had a positive impact on the frequency of BF (p < 0.001) and EBF (p < 0.001). The better BF and EBF rates seen in this study in infants followed up by the primary healthcare centers reinforce the evidence on the importance of expanding and qualifying primary healthcare as support for mother and child healthcare.

Dermatite atópica em crianças e adolescentes durante a pandemia COVID-19: piora clínica associada ao medo de infecção / Atopic dermatitis in children and adolescents during the COVID-19 pandemic: disease exacerbation associated with fear of infection

Introdução: A dermatite atópica é uma doença crônica e recidivante, influenciada por fatores ambientais, que necessita prescrições médicas frequentes. O objetivo deste estudo foi investigar se crianças e adolescentes com dermatite atópica atendidos em um serviço público tiveram agravamento das lesões ou dificuldades no autocuidado durante a pandemia COVID-19.Métodos: Estudo longitudinal retrospectivo. Os dados foram coletados do prontuário de pacientes com dermatite atópica menores de 18 anos atendidos em um ambulatório público de referência do Rio Grande do Sul. A percepção sobre o agravamento das lesões foi avaliada pelos testes Qui-quadrado ou Exato de Fisher e regressão de Poisson foi utilizada para estimar o risco de agravamento das lesões conforme o medo da COVID-19.Resultados: Foram avaliados 33 pacientes, sendo 70% do sexo feminino e 57,6% residentes na capital. A média de idade foi de 9,6 ± 3,9 anos e o tempo médio de acompanhamento pelo serviço 4,6 ± 2,9 anos. A percepção de agravamento das lesões durante o período de suspensão dos atendimentos esteve presente em 81,8% das crianças/adolescentes. As crianças relataram com frequência o aumento de coceira (78,3%) e descamação (60,9%), enquanto os adolescentes referiram maior aumento da vermelhidão (60%). O medo de contrair o vírus foi associado a um risco oito vezes maior de apresentar agravamento das lesões.Conclusões: O alto percentual de crianças/adolescentes com agravamento das lesões e a associação da piora da doença com o medo relacionado à pandemia reforçam a importância do acompanhamento destes por equipe multidisciplinar que observe fatores fisiopatológicos e psicossociais.

Introduction: Atopic dermatitis is a chronic and recurrent condition, influenced by environmental factors, that requires frequent medical prescriptions. The aim of this study was to investigate if children and adolescents with atopic dermatitis treated at a public clinic reported exacerbation of the disease or self-care problems during the COVID-19 pandemic.Methods: We conducted a retrospective longitudinal study. Data were collected from the medical records of patients aged < 18 years with atopic dermatitis treated at a public outpatient clinic in Rio Grande do Sul, Brazil. The perception of disease exacerbation in children and adolescents was evaluated using the chi-square test or Fisher's exact test. Poisson regression was used to estimate the risk of worsening of skin lesions according to the fear of COVID-19. Results: The study sample included 33 patients, of whom 70% were female and 57.6% lived in the state's capital city. Mean patient age was 9.6 ± 3.9 years, and mean time of clinic follow-up was 4.6 ± 2.9 years. The perception of disease exacerbation during the pandemic was reported by 81.8% of children/adolescents. Children reported increased itching (78.3%) and desquamation (60.9%), whereas adolescents reported increased redness (60%). The fear of contracting COVID-19 was associated with an eight-fold increased risk of worsening of skin lesions.Conclusion: The high percentage of children/adolescents with worsening of skin lesions and the association between disease exacerbation and the fear of COVID-19 reinforce the importance of a multidisciplinary approach that focuses on pathophysiological and psychosocial factors in patients with atopic dermatitis.

HIV post-exposure prophylaxis in vulnerable populations: a retrospective longitudinal study in a public health outpatient clinic in Rio Grande do Sul, Brazil, 2015-2018. / Profilaxia pós-exposição ao HIV em populações vulneráveis: estudo longitudinal retrospectivo em um ambulatório da rede pública do Rio Grande do Sul, 2015-2018.

OBJECTIVE: To describe the profile of people who initiated HIV post-exposure prophylaxis (PEP) in a public health service, evaluating the use of this technology by key populations as recommended by the Brazilian Ministry of Health. METHODS: This was a retrospective longitudinal study using secondary data on service users receiving care between 2015-2018. Absolute and relative frequencies were calculated and Pearson's chi-square test was used to compare behavioral characteristics. RESULTS: Of the 270 people evaluated, there was a higher frequency of young adults (45.4%), males (74.7%), people of white race/skin color (76.3%), with a high level of education (65.7%) and with multiple sex partners (40.7%). Among the key populations, there was a higher frequency of people who use alcohol and/or other drugs (49.6%) and men who have sex with men (38.1%), while transgender people (2.2%) and sex workers (4.8%) used PEP less. CONCLUSION: The use of PEP was not homogeneous among the vulnerable groups evaluated, with low frequency of transgender people and sex workers.

HIV post-exposure prophylaxis in vulnerable populations: a retrospective longitudinal study in a public health ambulatory in Rio Grande do Sul, Brazil, 2015-2018 / Profilaxis post exposición al VIH en poblaciones vulnerables: estudio longitudinal retrospectivo en un ambulatorio de salud pública en Rio Grande do Sul, Brasil, 2015-2018 / Profilaxia pós-exposição ao HIV em populações vulneráveis: estudo longitudinal retrospectivo em um ambulatório da rede pública do Rio Grande do Sul, 2015-2018

Objective: To describe the profile of people who initiated post-exposure prophylaxis (PEP) in a public health service, evaluating the use of this technology among the key populations preconized by the Ministry of Health of Brazil. Methods: Retrospective longitudinal study, with secondary data of people attended between 2015-2018. Absolute and relative frequencies were calculated and Pearson's chi-square test was used to compare behavioral characteristics. Results: From 270 people evaluated, there was a higher frequency of white (76.3%) young adults (45.4%), male (74.7%), highly educated (65.7%) and with multiple sex partners (40.7%). Among the key populations, there was a higher frequency of people who use alcohol and/or other drug (49.6%) and men who have sex with men (38.1%), while lower frequency of transgender people (2.2%) and sex workers (4.8%) used PEP. Conclusion: The use of PEP was not homogeneous among the vulnerable groups evaluated, with lower frequency of transgender people and sex workers.

Objetivo: Descrever o perfil de usuários que iniciaram a profilaxia pós-exposição ao HIV (PEP) em um serviço público, avaliando o uso dessa tecnologia pelas populações-chave recomendadas pelo Ministério da Saúde do Brasil. Métodos: Estudo longitudinal retrospectivo, com uso de dados secundários de usuários atendidos entre 2015 e 2018. Foram calculadas frequências absolutas e relativas e o teste qui-quadrado de Pearson foi utilizado para comparar características comportamentais. Resultados: Dos 270 usuários, foram mais frequentes adultos jovens (45,4%), homens (74,7%), raça/cor da pele branca (76,3%), alta escolaridade (65,7%) e múltiplas parcerias sexuais (40,7%). Entre as populações-chave, observou-se maior frequência de usuários de álcool e/ou outras drogas (49,6%) e homens que fazem sexo com homens (38,1%), enquanto pessoas transgênero (2,2%) e profissionais do sexo (4,8%) fizeram menor uso da PEP. Conclusão: O uso de PEP não foi homogêneo entre os grupos vulneráveis avaliados, com baixa frequência de pessoas transgênero e profissionais do sexo.

Profilaxia pós-exposição ao HIV em populações vulneráveis: estudo longitudinal retrospectivo em um ambulatório da rede pública do Rio Grande do Sul, 2015-2018 / Profilaxis post exposición al VIH en poblaciones vulnerables: estudio longitudinal retrospectivo en un ambulatorio de salud pública en Rio Grande do Sul, Brasil, 2015-2018 / HIV post-exposure prophylaxis in vulnerable populations: a retrospective longitudinal study in a public health outpatient clinic in Rio Grande do Sul, Brazil, 2015-2018

Objetivo: Descrever o perfil de usuários que iniciaram a profilaxia pós-exposição ao HIV (PEP) em um serviço público, avaliando o uso dessa tecnologia pelas populações-chave recomendadas pelo Ministério da Saúde do Brasil. Métodos: Estudo longitudinal retrospectivo, com uso de dados secundários de usuários atendidos entre 2015 e 2018. Foram calculadas frequências absolutas e relativas e o teste do qui-quadrado de Pearson foi utilizado para comparar características comportamentais. Resultados: Dos 270 usuários, foram mais frequentes adultos jovens (45,4%), homens (74,7%), raça/cor da pele branca (76,3%), alta escolaridade (65,7%) e múltiplas parcerias sexuais (40,7%). Entre as populações-chave, observou-se maior frequência de usuários de álcool e/ou outras drogas (49,6%) e homens que fazem sexo com homens (38,1%), enquanto pessoas transgênero (2,2%) e profissionais do sexo (4,8%) fizeram menor uso da PEP. Conclusão: O uso de PEP não foi homogêneo entre os grupos vulneráveis avaliados, com baixa frequência de pessoas transgênero e profissionais do sexo.

Objetivos: Describir el perfil de los usuarios que comenzaron la profilaxis post exposición al VIH (PEP) en un servicio público, evaluando el uso de esta tecnología por las poblaciones clave recomendadas por el Ministerio de Salud de Brasil. Métodos: estudio longitudinal retrospectivo, con datos secundarios de usuarios atendidos entre 2015-2018. Se calcularon frecuencias absolutas y relativa y se utilizó chi-cuadrado de Pearson para comparar características de comportamiento. Resultados: De los 270 usuarios estudiados, hubo mayor frecuencia de adultos jóvenes (45,4%), blancos (76,3%), hombres (74,7%), con educación superior (65,7%) y múltiples parejas sexuales (40,7%). Entre las poblaciones clave, hubo mayor frecuencia de usuarios de alcohol y/u otras drogas (49,6%) y hombres que tienen sexo con hombres (38,1%), mientras que personas transgénero (2,2%) y trabajadoras sexuales (4,8%) hizo menos uso de PEP. Conclusión: El uso de PEP no fue homogéneo entre los grupos vulnerables evaluados, con baja frecuencia de personas transgénero y trabajadoras sexuales.

Objective: To describe the profile of people who initiated HIV post-exposure prophylaxis (PEP) in a public health service, evaluating the use of this technology by key populations as recommended by the Brazilian Ministry of Health. Methods: This was a retrospective longitudinal study using secondary data on service users receiving care between 2015-2018. Absolute and relative frequencies were calculated and Pearson's chi-square test was used to compare behavioral characteristics. Results: Of the 270 people evaluated, there was a higher frequency of young adults (45.4%), males (74.7%), people of white race/skin color (76.3%), with a high level of education (65.7%) and with multiple sex partners (40.7%). Among the key populations, there was a higher frequency of people who use alcohol and/or other drugs (49.6%) and men who have sex with men (38.1%), while transgender people (2.2%) and sex workers (4.8%) used PEP less. Conclusion: The use of PEP was not homogeneous among the vulnerable groups evaluated, with low frequency of transgender people and sex workers.

Maternal pre-pregnancy overweight/obesity and gestational diabetes interaction on delayed breastfeeding initiation.

BACKGROUND: Cumulative evidence indicates an association between maternal overweight and gestational diabetes with delayed breastfeeding initiation; however, the presence of both conditions simultaneously has been little explored. This study aims to investigate the interaction between maternal overweight/obesity and gestational diabetes on breastfeeding initiation. METHODS: This study comprises data from the IVAPSA Birth Cohort, a prospective follow-up of mothers and their newborns. Two of the five groups from IVAPSA were evaluated, considering women with and without gestational diabetes. These women were further categorized according to their pre-pregnancy body mass index as normal weight or overweight/obese. RESULTS: 219 women were evaluated, 53.4% of them had pre-pregnancy overweight/obesity and 32% had gestational diabetes. Most women were able to initiate breastfeeding within 12 hours from delivery (92.7%) and only eight (3.7%) women had not breastfed in the first 24 hours postpartum. Of these, seven were overweight/obese (77.8%) and five had gestational diabetes (66.7%), with four of them having overweight/obesity and gestational diabetes concomitantly. Women with both adverse conditions had an adjusted relative risk of delayed breastfeeding initiation of 1.072 (95% CI 1.006; 1.141), p = 0.032. CONCLUSIONS: The results indicate an additive interaction between maternal pre-pregnancy overweight/obesity and gestational diabetes on delayed breastfeeding initiation.

Excesso de peso materno e início da amamentação ­ revisão analítica de estudos observacionais / Maternal overweight and breastfeeding initiation ­ an analytic review of observational studies

Este artigo tem o objetivo de realizar uma revisão analítica de estudos observacionais que avaliaram a relação entre o excesso de peso materno e o tempo de início do aleitamento materno, com enfoque nos fatores que podem atuar como mediadores da associação. Extensa revisão foi realizada nas bases de dados PubMed/MEDLINE, Google Acadêmico e Bireme/Lilacs utilizando um conjunto de termos relacionados ao início do aleitamento materno e ao excesso de peso materno. As referências dos artigos incluídos foram manualmente revisadas para identificar artigos não revelados anteriormente. Os critérios de seleção foram: idioma português, inglês ou espanhol; estudos originais, e estudo realizado em humanos. Vinte e nove artigos, provenientes de 24 diferentes estudos foram incluídos nas análises. A avaliação desses estudos indica que o excesso de peso materno atua como fator de risco importante para o não início do aleitamento materno e que esse risco se acentua com o aumento no grau de excesso de peso materno. Fatores psicológicos, raça, formas corporais e complicações gestacionais/obstétricas são variáveis maternas que parecem interagir com o excesso de peso, influenciando o início da amamentação. (AU)

This paper aims to propose an analytic review of observational studies that addressed the influence of maternal overweight on breastfeeding initiation, with emphasis on the factors that can act as mediators on this association. A search on PubMed/MEDLINE, Google Scholar and Bireme/Lilacs databases was conducted applying a number of descriptors related to breastfeeding and maternal body mass index. The reference lists of included articles were handsearched to identify further relevant studies. Selection criteria were: original articles, with human subjects, published in Portuguese, English or Spanish. A total of 29 papers from 24 different studies were included in the analysis. Maternal overweight was an important risk factor for failure to initiate breastfeeding. The risk was accentuated by the increase in maternal body mass index. Psychological factors, ethnicity, body shape and obstetric complications seem to interact with maternal overweight to interfere in breastfeeding initiation. (AU)

Gender and social mobility modify the effect of birth weight on total and central obesity.

BACKGROUND: Little is known about the interaction between gender and low birth weight (LBW) and lifelong social mobility as an explanation of the etiology of obesity. The aim of the present study was to evaluate total and central obesity according to gender, LBW and social mobility, within the context of the epidemiological transition in middle-income countries. We hypothesize that there are more pronounced metabolic consequences of social mobility for women born with LBW. METHODS: We used data from a birth cohort study conducted in Ribeirão Preto, São Paulo, Brazil. Data regarding anthropometric measurements, schooling and smoking status were collected at 23-25 years of age. Social mobility was determined based on maternal and adult offspring schooling and categorized as Low-Low, Low-High and High-High. Analysis of covariance was performed to assess the association between social mobility and body mass index (BMI) or waist circumference (WC) in adulthood, stratified by LBW and gender. RESULTS: Data on 6827 singleton pregnancies were collected at birth in 1978/79 and a sample was followed up in 2002/04. A total of 2063 subjects were included in the study. Mean age was 23.9 ± 0.7 years, 51.8% (n = 1068) were female and the LBW was 6.2% (n = 128). There was a triple interaction between social mobility, LBW and gender. Among women born without LBW, BMI and WC were higher in the Low-Low group compared to High-High schooling group. Among LBW women, BMI and WC were higher in the Low-Low group compared to the Low-High group. CONCLUSIONS: Women born with LBW belonging to the low schooling group in early adulthood had high BMI and WC, compared to the Low-High social mobility group.

Cesarean delivery and metabolic risk factors in young adults: a Brazilian birth cohort study.

BACKGROUND: Cesarean delivery (CD) perturbs the assembly of the neonatal gut microbiome and has been associated with child and adult obesity. However, it is still unknown whether CD is associated with metabolic risk factors in young adults. OBJECTIVE: We investigated the association of CD and metabolic risk factors in young adults in a cohort study who were 23-25 y of age at follow-up. DESIGN: We used data from a cohort study in Ribeirão Preto, Brazil. Baseline data on 6827 singleton pregnancies were collected in 1978-1979, and a sample of 2063 subjects were followed up 23-25 y later (2002-2004). Information on the type of delivery, birth weight, maternal age, parity, maternal schooling, and maternal smoking was obtained after birth. Anthropometric data, biochemical measurements, and information on participant schooling and smoking history were collected at 23-25 y of age. A linear regression was performed to assess the association between CD and biochemical measurements in early adulthood, controlling for a minimum set of confounders that were identified in a directed acyclic graph. RESULTS: The mean ± SD age of the subjects was 23.9 ± 0.71 y, and 51.8% of the sample were women. The CD rate was 32.0% and was more common in older (P < 0.001) and more educated mothers (P < 0.001). Compared with vaginal delivery, CD was associated with higher body mass index (BMI) after multivariable adjustment (P < 0.001) but not with glucose, homeostasis model assessment of insulin resistance, the quantitative insulin-sensitivity check index, total cholesterol, LDL cholesterol, HDL cholesterol, or triglycerides (all P > 0.05). CONCLUSION: In our sample of Brazilian adults, CD was associated with higher BMI but not with other metabolic risk factors.

Promoção de saúde e prevenção de doenças na atenção primária: uma análise de percepção de usuários

Mais de 30 anos após sua constituição, o Sistema Único de Saúde já teve muitos avanços, mas segue tendo desafios importantes para sua consolidação absoluta. Neste estudo, usuários de uma Unidade de Saúde do município de Porto Alegre foram questionados à respeito da satisfação com os serviços prestados e da percepção das atividades de promoção de saúde e prevenção de doenças. Apesar da satisfação geral com o serviço, foram relatadas dificuldades em relação ao acesso, à longitudinalidade e à divulgação dos potenciais do serviço de saúde. A percepção dos usuários quanto as atividades de promoção de saúde e prevenção de doenças foi bastante variada, sendo que nem todos os usuários percebem sua importância e sua relação com o tema saúde. Sugere-se, para auxiliar na superação dessas dificuldades, que a equipe da Unidade de Saúde em estudo modifique alguns processos de trabalho, como a inclusão de acolhimento multiprofissional e a subdivisão dos profissionais de acordo com o território