Lactation Assessment Tools: A Qualitative Analysis of Registered Nurses' Perceptions of Tool Limitations and Suggested Improvements.

Background Several lactation assessment tools are available for in-hospital assessment of breastfeeding dyads, and their components vary widely. To date, no research has evaluated the perceptions of registered nurses (RNs) regarding the limitations and future improvements of these tools. Research Aim The aim was to describe RNs' perceptions of the limitations of currently used lactation assessment tools and how these tools could be enhanced. Methods Focus groups ( n = 7) were conducted with RNs ( N = 28) whose current responsibilities included in-hospital breastfeeding assessment. Recruitment occurred from April through July 2015 at regional and international lactation conferences. Focus groups were audiotaped and transcribed verbatim. Two lactation researchers analyzed the transcripts to identify emerging themes and subthemes. Results RNs identified three key limitations of the tools included being too subjective and time-consuming, difficulty in assessing audible swallows, and missing the big picture (e.g., overemphasizing numbers, being a snapshot in time). Suggested improvements focused on maternal characteristics (evolving breasts and nipples, holding it together, "got milk?," risk factors, embracing the role), infant characteristics (day of life, latch/suck/swallow, baby's "driving the bus," risk factors for supplemental feeding), their interaction (two to tango, positioning, better qualitative descriptors), and tool organization (formatting and multiple versions). Conclusions RNs suggested novel components for consideration when developing future lactation assessment scales, including removing audible swallowing, adding mother/infant interactions, infant output, and expressible colostrum, and developing criteria specific to infant age. Future research should translate these suggestions into evidence-based indicators and evaluate the resulting proposed tools for reliability and validity.

Assessment for oral feeding in preterm infants. / Avaliação para o início da alimentação oral de recém-nascidos pré-termo.

PURPOSE: To assess the accuracy of the Preterm Oral Feeding Readiness Scale (POFRAS) on the beginning of oral feeding in preterm infants and to verify the concordance between this tool and the Oral Feeding Skill Level. METHODS: 82 preterm infants were assessed by POFRAS regarding their readiness to initiate oral feeding and by the oral feeding skill level evaluation during the first oral feeding. POFRAS's accuracy was estimated regarding proficiency by a Receiver Operating Characteristics (ROC) curve. The concordance between the tools was obtained by analysis of the Kappa coefficient. RESULTS: POFRAS's global accuracy was of 71.29%. The cut-off value of 29 was the one that presented most optimization of the sensitivity based on specificity. The Kappa coefficient has shown a weak concordance between the instruments to identify infants able and unable to oral feeding (k=0.281). CONCLUSION: POFRAS's accuracy to initiate oral feeding considering the proficiency was similar to that obtained with the technique of translactation. We observed a weak concordance between the instruments. We suggest that, in clinical practice, both instruments should be used in a complementary manner, since both present important aspects of the preterm feeding behavior that together will better guide the necessary conduct to provide an effective and quick transition to full oral feeding in this population.

Avaliação para o início da alimentação oral de recém-nascidos pré-termo / Assessment for oral feeding in preterm infants

RESUMO Objetivo avaliar a acurácia do Preterm Oral Feeding Readiness Scale - POFRAS para iniciar a alimentação oral de recém-nascidos pré-termo e verificar a concordância entre este instrumento e o instrumento de avaliação do Nível de Habilidade Oral. Métodos Foram avaliados 82 recém-nascidos pré-termo quanto à prontidão para o início da alimentação oral através do POFRAS e da avaliação do Nível de Habilidade Oral, durante a primeira alimentação oral. A acurácia do POFRAS foi estimada em relação à variável proficiência, por meio da Curva ROC (Receiver Operating Characteristic Curve). Para a análise da concordância entre os instrumentos, foi utilizado o coeficiente Kappa. Resultados A acurácia global do POFRAS foi de 71,29%. O ponto de corte 29 foi o que apresentou melhor equilíbrio entre sensibilidade e especificidade. O coeficiente Kappa mostrou fraca concordância entre os instrumentos na identificação dos RN aptos e inaptos a mamar por via oral (k=0.281). Conclusão a acurácia do POFRAS para o início da alimentação oral, estimada por meio da variável proficiência, foi semelhante à obtida com a técnica de translactação. Observou-se fraca concordância entre os instrumentos avaliados. Sugere-se, portanto, que estes instrumentos de avaliação sejam usados de forma complementar na prática clínica, uma vez que ambos apresentam aspectos importantes do comportamento alimentar do prematuro, que ao serem analisados conjuntamente permitirão orientar a conduta necessária para propiciar uma transição alimentar mais breve e eficaz para essa população.

ABSTRACT Purpose To assess the accuracy of the Preterm Oral Feeding Readiness Scale (POFRAS) on the beginning of oral feeding in preterm infants and to verify the concordance between this tool and the Oral Feeding Skill Level. Methods 82 preterm infants were assessed by POFRAS regarding their readiness to initiate oral feeding and by the oral feeding skill level evaluation during the first oral feeding. POFRAS's accuracy was estimated regarding proficiency by a Receiver Operating Characteristics (ROC) curve. The concordance between the tools was obtained by analysis of the Kappa coefficient. Results POFRAS's global accuracy was of 71.29%. The cut-off value of 29 was the one that presented most optimization of the sensitivity based on specificity. The Kappa coefficient has shown a weak concordance between the instruments to identify infants able and unable to oral feeding (k=0.281). Conclusion POFRAS's accuracy to initiate oral feeding considering the proficiency was similar to that obtained with the technique of translactation. We observed a weak concordance between the instruments. We suggest that, in clinical practice, both instruments should be used in a complementary manner, since both present important aspects of the preterm feeding behavior that together will better guide the necessary conduct to provide an effective and quick transition to full oral feeding in this population.

Associação entre prematuridade, hábitos de sucção de chupeta e tipos de aleitamento infantil / Association between prematurity, pacifier sucking habit and types of infant feeding

Crianças prematuras podem estar mais propensas a apresentarem dificuldade de praticar o aleitamento natural e consequentemente ficam vulneráveis à introdução de chupetas e/ou mamadeiras no seu dia a dia. O objetivo do presente trabalho foi avaliar a associação entre a prematuridade, hábito de sucção de chupeta e tipos de aleitamento infantil, em crianças de 3 a 5 anos de idade, pertencentes a um ambulatório hospitalar universitário e duas escolas de educação infantil da cidade de Belo Horizonte, Brasil. Foi desenvolvido um estudo epidemiológico transversal retrospectivo comparativo, com 250 crianças na faixa etária de 3 a 5 anos. A amostra incluiu dois grupos: o grupo pré-termo, formado pelos prematuros acompanhados pelo projeto ACRIAR (Ambulatório da Criança de Risco, Hospital das Clinicas da Universidade Federal de Minas Gerais) e o grupo a termo, formado por pré-escolares nascidos a termo pertencentes a uma escola pública e uma particular, escolhidas por conveniência. Foi utilizado nas escolas, um questionário pré-testado para a seleção do grupo controle e preenchimento dos dados relacionados ao nascimento, aos métodos de aleitamento infantil, hábito de sucção de chupeta e aspectos sociodemográficos. Este questionário foi enviado junto ao para-casa das crianças, respondido pelos pais/responsáveis e devolvido à escola. Os dados dos prematuros foram coletados nos prontuários clínicos do projeto ACRIAR. O mesmo modelo de questões foi adotado para os dois grupos: prematuros e a termo. A análise dos dados foi realizada utilizando-se o software Statistical Package for the Social Sciences (SPSS), versão 21.0. Para verificar se houve associação entre a variável dependente idade gestacional ao nascimento (prematuro ou nascidos a termo) e as varáveis independentes, foi utilizado o Teste Qui-quadrado. Valores da razão de prevalência foram estimados para cada variável independente por Regressão de Poisson Múltipla. Variáveis com valor de p < 0,05 na análise de Poisson bivariada foram incluídas na análise multivariada. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa da UFMG (protocolo #49803115400005149). A maioria das crianças era do sexo feminino (54,8%), com 5 anos de idade (46,8%) e pertenciam a famílias com renda maior que 2 salários mínimos (48,4%). O grupo de mães de prematuros era mais jovem e (67,7%) tinha idade menor que 30 anos, diferente daquelas com filhos nascidos a termo cuja maioria (78,2) tinha idade maior que 30 anos. O modelo de regressão múltiplo final demonstrou que a renda mensal menor que 2 salários mínimos (RP= 2,068; 95%IC= 1,418- 3,016), o uso de chupeta (RP= 1,730; 95%IC= 1,100-2,721) e aleitamento no peito por menos de 6 meses (RP= 1,010; 95%IC= 1,302-2,829) foram mais prevalentes entre os prematuros. Concluiu-se que o uso de chupeta, o menor tempo de aleitamento materno e a baixa renda familiar foram fatores associados a prematuridade

Preterm infants might experience more difficult in breastfeeding and therefore are more vulnerable to the use of pacifiers and/or bottles in their life. This research aimed to evaluate the association between prematurity, pacifier sucking habit and types of infant feeding in children aged 3 to 5 years old attended at the University Hospital Clinic and two preschools in the city of Belo Horizonte, Brazil. Two hundred and fifty children took part in this retrospective crosssectional epidemiological study with control group. The sample was divided intro two groups: the case group was formed by preterm infants attended at ACRIAR project (Risk Child Clinic, Clinic Hospital of the Federal University of Minas Gerais- UFMG) and the control group were preschool children enrolled at a public school and a private school, chosen by convenience who were full term infants. A pre-tested questionnaire was used for collecting data of full term children. Parents answered a structured questionnaire related to prematurity, infant feeding methods, pacifier sucking habits and demographic aspects. Parents or responsible received the questionnaire attached to the children's homework. They answered it at home and sent it back to the school. Collection of data of the preterm children was based on the clinical records of ACRIAR project. The same questionnaires of questions were adopted for both groups: preterm and full term children. Data were entered the Statistical Package for the Social Sciences Software (SPSS) version 21.0 for statistical analysis. Chi-square test was used to test the association between the dependent variable (gestational age at birth: preterm or full term children) and the independent variables. Prevalence ratio values were estimated for each independent variable by using multiple Poisson regression. Variables with p <0.05 in the bivariate Poisson regression analysis were included in the multivariate analysis. The Research Ethics Committee of UFMG approved the research (protocol # 49803115400005149). Most of the children were female (n=137; 54.8%), aged 5 years old (n=117; 46.8%) and belonged to families with monthly income higher than 2 minimum wages (n=121; 48.4%). Mothers of preterm children were younger and the majority had less than 30 years old (n=44; 67.7%); while mothers of full term children were older than 30 years old (n=104; 78.2%). The final multiple Poisson regression model showed that monthly income lower than two minimum wages (PR = 2.068; 95% CI = 1.418-2.016), the use of pacifier (PR = 1.730; 95% CI = 1.100-2.721) and breastfeeding for less than 6 months (PR = 1.010; 95% CI = 1.302-2.829) were more prevalent among preterm infants. The use of pacifiers, the shorter breastfeeding duration and low family income were factors associated with prematurity in children

The "Interdisciplinary Orofacial Examination Protocol for Children and Adolescents": a resource for the interdisciplinary assessment of the stomatognatic system.

The Interdisciplinary Orofacial Examination Protocol for Children and Adolescents (Protocolo de exploración interdisciplinaria orofacial para niños y adolescents, Barcelona, 2008) is very useful in providing a fast, initial, expedient detection of possible morphological and functional disorders, and to guide the patient toward the appropriate professionals. With this tool it is possible to detect the risk factors which can negatively affect morphological and functional harmony and guide patients toward the necessary treatment as early as possible. This Protocol, developed by 4 orthodontists, 1 ENT and 3 speech language therapists, also contributes to the unification of concepts and nomenclature used by distinct specialists, thus making professional understanding easier and more dynamic.

A one-page orofacial myofunctional assessment form: a proposal.

The author presents her own proposal of a one-page orofacial myofunctional assessment and for each item on the list a brief rationale is provided. The protocol is an easy but comprehensive form that can be faxed or emailed to referral sources as needed. As science provides more objective assessment and evaluation tools, this one-page form can be easily modified.

A network approach to orthodontic diagnosis.

BACKGROUND: Network analysis, a recent advancement in complexity science, enables understanding of the properties of complex biological processes characterized by the interaction, adaptive regulation, and coordination of a large number of participating components. OBJECTIVE: We applied network analysis to orthodontics to detect and visualize the most interconnected clinical, radiographic, and functional data pertaining to the orofacial system. MATERIALS AND METHODS: The sample consisted of 104 individuals from 7 to 13 years of age in the mixed dentition phase without previous orthodontic intervention. The subjects were divided according to skeletal class; their clinical, radiographic, and functional features were represented as vertices (nodes) and links (edges) connecting them. RESULTS: Class II subjects exhibited few highly connected orthodontic features (hubs), while Class III patients showed a more compact network structure characterized by strong co-occurrence of normal and abnormal clinical, functional, and radiological features. Restricting our analysis to the highest correlations, we identified critical peculiarities of Class II and Class III malocclusions. CONCLUSIONS: The topology of the dentofacial system obtained by network analysis could allow orthodontists to visually evaluate and anticipate the co-occurrence of auxological anomalies during individual craniofacial growth and possibly localize reactive sites for a therapeutic approach to malocclusion.

Sucking patterns in fullterm infants between birth and 10 weeks of age.

OBJECTIVE: Coordinating sucking, swallowing and breathing to achieve effective sucking is a complex process and even though sucking is essential for nutrition, little is known about sucking patterns after birth. Our objective was to study sucking patterns in healthy fullterm infants and to describe the age-specific variations. METHOD: We studied the sucking patterns of 30 healthy, fullterm infants longitudinally from 2 or 3 days after birth to 10 weeks of age. During this time we recorded five to seven feeding episodes that we assessed off-line with the Neonatal Oral-Motor Assessment Scale (NOMAS). RESULTS: We found a normal sucking pattern on the second or third day after birth in 27 out of 30 infants. During the following weeks we found abnormal sucking patterns in 23 out of 171 feeding episodes (14%) and normal patterns in 148 episodes (86%). Altogether, between 38 and 50 weeks' postmenstrual age (10 weeks after birth), 10 infants displayed a deviating, arrhythmical sucking pattern. Dysfunctional sucking patterns and problems of coordinating sucking, swallowing and breathing did not occur. Birth weight, gestational age, type of labour and gender did not influence sucking patterns. Arrhythmical sucking was seen more often in bottle-fed infants. CONCLUSION: Our study demonstrated that practically all healthy fullterm infants started off with a normal sucking pattern soon after birth. One-third of the infants displayed one or more deviating episodes up to the age of 10 weeks. Apart from bottle-feeding, no other factors were found that influenced sucking patterns.

The reliability of the Neonatal Oral-Motor Assessment Scale.

OBJECTIVES: Sucking problems in preterm infants can be specified by means of visual observation. The Neonatal Oral-Motor Assessment Scale (NOMAS) is the visual observation method most commonly used to assess the non-nutritive sucking (NNS) and nutritive sucking (NS) skills of infants up to approximately 8 weeks postterm. During the first 2 min of a regular feeding the infant's sucking skill is assessed, either immediately or on video. Although NOMAS has been used since 1993, little is known about the method's reliability. The aim of our study was to determine the test-retest and inter-rater reliability of NOMAS. METHODS: The 75 infants included in this study were born at 26-36 weeks postmenstrual age (PMA). Four observers participated in the study. They were trained and certified to administer NOMAS in the Netherlands by M.M. Palmer between 2000 and 2002. RESULTS: We found the test-retest agreement of NOMAS to be 'fair' to 'almost perfect' (Cohen's kappa [kappa] between 0.33 and 0.94), whereas the inter-rater agreement with respect to the diagnosis was 'moderate' to 'substantial' (Cohen's kappa, between 0.40 and 0.65). As a diagnostic tool, however, the current version of NOMAS cannot be used for both full-term and preterm infants. For a measuring instrument such as NOMAS, one should aim at reliability coefficients for inter-rater and test-retest agreement of at least 0.8. A Cohen's kappa of 0.6 or less we find unacceptable. Nonetheless, by observing sucking and swallowing according to a protocol much useful information can be gathered about the development of an infant's sucking skills. For instance, whether the infant is able to co-ordinate sucking and swallowing, whether the infant can maintain sucking, swallowing and breathing during the continuous phase and whether the infant is able to suck rhythmically with equally long bursts. In addition, NOMAS offers useful aids for intervention. CONCLUSIONS: NOMAS should be re-adjusted in order to improve inter-rater agreement, and at the same time current insights into the development of sucking and swallowing should be incorporated in the method.

Tendencia y evolución de la lactancia materna en el norte de Lugo / Trends and course of breastfeeding in the north of Lugo

Introducción: La lactancia materna exclusiva es el mejor método de alimentación del niño durante los 6 meses, y la recomiendan la mayoría de los organismos e instituciones. Pero las tasas de inicio y su duración son todavía muy bajas y variables. Material y métodos: Se entrevistó tras el parto a las madres que dieron a luz en el hospital durante los años 2001-2003 para conocer el método elegido de alimentación del niño. Se siguió durante el primer semestre de vida a las que amamantaban al alta para conocer la duración de la lactancia y el motivo fundamental de abandono. Resultados: De 1.166 madres (1.185 recién nacidos vivos), el 69,9% tenía intención de amamantar. De 1.170 niños estudiados, el 31,5% recibió siempre leche artificial, del resto, el 17,4% abandonó la lactancia en la primera semana, el 3,8% entre las semanas 1 y 4, el 12,7% entre las semanas 4 y 12, el 20,8% entre las semanas 12 y 24, y el 13,8% siguió la lactancia tras la semana 24. Las causas fundamentales de abandono fueron: fallo de la técnica de amamantamiento (45,2%), abandono natural (22,1%), trabajo (11%) y enfermedades maternas (8,6%). En las primeras 4 semanas la causa fundamental de abandono es la mala técnica (el 58,1 frente al 41,3%), seguido de enfermedades maternas (el 17,4 frente al 6%) y enfermedades del niño (el 9,8 frente al 2,4%). Conclusiones: La lactancia materna es un método de alimentación sujeto a muchos factores externos, que se podrían modificar con una educación adecuada de las madres y su entorno, así como la puesta en marcha de medidas institucionales que la protejan

Introduction: Exclusive breastfeeding is the best meted during the first six months of life of the infant, and is recommended by the majority of organizations and institutions. However, the number of women who start and the duration are still very limited, and are easily influenced. Material and methods. Mothers who gave birth in the hospital between the years 2001 and 2003 were interviewed after the birth of their children to ask about their choice of feeding method. The breastfeeding mothers were followed for the first six months to establish the duration of breast feeding and main causes for discontinuing it. Results. In all, 69,9% of the 1166 mothers (1,185 live infants) intented to breastfeed, whereas 31,5% of 1,170 babies were bottle-fed with formula; 17,4% gave up breastfeeding during the first week; 3.8% gave it up between the first and fourth weeks; 12,7% between the fourth and twelveth weeks; and 13,8% continued breast feeding after week 24. The main causes for discontinuing were the failure of the breastfeeding technique (45,2%), natural causes (22,1%), return to work (11%) and diseases in the mother (8,6%). The main cause for discontinuing within the first 4 weeks was an incorrect technique (58,1% versus 41,3%), followed by diseases, in themother (17,4% versus 6%) and diseases in the infant (9,8% versus 2,4%). Conclusions: Breastfeeding is influenced by many external factors, which could be modified through proper education of mothers and those around them, and through introduction of institutional measures that support it

Patrones de succión en el recién nacido de término y pretérmino / Evolution of breast suckling in full-term and preterm newborn

El propósito de este trabajo es estudiar la evolución de la succión nutritiva con la finalidad de conocer la asociación de variables relacionadas con la succión que permitan una evaluación objetiva de la misma. Es un estudio longitudinal, prospectivo en dos grupos de niños. Un grupo de nacidos de término con peso adecuado al nacer, seguidos desde el primer día hasta los seis meses de edad. Se midió por doble pesada el volumen de la lactada y se realizó un registro de la presión intraoral.

Influencia de las prácticas hospitalarias en el inicio y el mantenimiento de la lactancia materna / Influence of hospital practices on duration of breastfeeding

Objetivos. Determinar la prevalencia de lactancia materna en el hospital y a los 1, 3 y 6 meses de vida, así como la asociación existente entre las prácticas hospitalarias y el tipo de alimentación de los recién nacidos. Material y método. Estudio observacional longitudinal prospectivo realizado en los 3 grandes hospitales públicos de Sevilla. Participaron 584 mujeres que dieron a luz entre marzo y junio del 2001. En el proceso de selección se estratificó por hospitales y, posteriormente, se utilizó un procedimiento de muestreo aleatorio sistemático. El único criterio de exclusión fue la ausencia de teléfono. Se utilizó un cuestionario de elaboración propia basado en la bibliografía consultada, que las madres cumplimentaban al alta hospitalaria. Posteriormente la información se recogió telefónicamente. Se realizó un análisis descriptivo de los datos y se aplicó el test de la X2 para p < 0,05. Resultados. La prevalencia de lactancia materna al alta hospitalaria fue del 93,1 por ciento; al mes de vida, del 80,9 por ciento; a los 3 meses, del 57,4 por ciento, y a los 6 meses, del 31,7 por ciento. Conclusiones. La prevalencia de la lactancia materna fue similar a la de otros estudios españoles con representatividad nacional. Las rutinas hospitalarias ejercen una influencia notable en el inicio de la lactancia materna pero, a medida que transcurren los meses, van perdiendo relevancia (AU)

Análise evolutiva do padrão de sucção e da influência da estimulação através da sucção não-nutritiva em recém nascidos pré-termo / Sucking pattern evolution analysis and the influence of nonnutritive sucking stimulation in preterm newborns

Os recém-nascidos pré-termo (RNPT) têm uma imaturidade global, o que dificulta a realização da função de sucção e a alimentação por via oral. Para descrever a evolução do padrão de sucção e analisar a influência da estimulação da sucção não-nutritiva (SNN) foram estudados 95 RNPT, divididos em 3 grupos: controle/sem SNN; SNN com chupeta e SNN com dedo enluvado. Os resultados sugerem um aumento da probabilidade de ocorrência da maioria das características de sucção estudadas de acordo com o avanço da idade gestacional corrigida. A SNN e o tipo de estímulo oferecido influenciaram na evolução do padrão de sucção, sendo o dedo enluvado o estímulo mais eficaz.The preterm newborns (PT-NB) immaturity makes it difficult to accomplish an efficient sucking function and oral feeding. 95 PT-NB were divided into three groups: control/without nonnutritive sucking (NNS); NNS with pacifier and NNS with a gloved finger, with the objective of describing the sucking pattern and analyzing the influence of the type of NNS stimulation performed. The results suggest an increase of the probability of the major occurrence of the studied sucking characteristics according to the advance of corrected gestational age. NNS and the type of stimulation used influenced the sucking pattern evolution, being the gloved finger the most efficient manner of NNS stimulation...

Newborn rats' first suckling experience: taste differentiation and suckling plasticity.

The present study examined responsiveness of newborn rats to a surrogate nipple providing fluids with basic tastes (sweet, sour, bitter and salty) and assessed the effects of this first gustatory experience on subsequent responding to the nipple itself (empty nipple) or the nipple providing water. Responsiveness (attachment to and ingestion from a surrogate nipple providing saccharin, saline, quinine or ammonium chloride) was compared with that toward a nipple providing water. Compared to water, saline and quinine significantly reduced attachment to and ingestion from the nipple, while saccharin and milk significantly increased attachment behavior. Ammonium chloride increased attachment but not ingestive behavior. Suckling experience with saline, quinine and ammonium chloride attenuated both attachment and ingestive behaviors when subjects were tested 1 h later with an empty surrogate nipple or a nipple providing water. Experience with saccharin and milk (but not water) increased both measures. The data suggest that in newborn rats, as early as a few hours after birth, mechanisms of gustatory detection have control over suckling behavior. Initial experience with the tastants available from the nipple in the first suckling episode may alter further responsiveness to the nipple itself, mediated perhaps by mechanisms of appetitive and aversive conditioning.

Relation of oral yeast infection in Brazilian infants and use of a pacifier.

The frequency of oral yeast ingestion and its relationship with sucking and feeding habits was described in children from one to 18 months of age. Yeasts were detected in 58.3 percent of children and the most prevalent species were Candida parapsilosis and Candida albicans. The use of a pacifier was positively associated with the frequency of yeast infection and with the levels of these microorganisms in the mouth. No relationship was detected between the prevalence of yeast and breast-feeding or bottle-feeding habits. The results suggest that use of a pacifier is an important local factor in the colonization and proliferation of yeast in the oral cavity.

Factores maternos asociados a la duración de la lactancia en áreas periféricas de Guadalajara, México / Maternal factors related to duration of breast-feeding in areas surrounding Guadalajara, Mexico

Este estudio pretende caracterizar la duración de la lactancia materna en madres derechohabientes del Instituto Mexicano del Seguro Social residentes en Tlaquepaque y Tonalá, áreas conurbadas a la ciudad de Guadalajara, México; identificar posibles factores maternos asociados al destete precoz, y determinar su importancia social. Para ello, se seleccionó una muestra de niños de un mes a un año de vida nacidos en estas áreas entre mayo de 1990 y abril de 1991, y sus respectivas madres. El muestreo fue probabilístico y polietápico, y se seleccionaron al azar unidades de atención primaria de salud de las áreas analizadas, consultorios de medicina familiar de dichas unidades, y por último, a todos los niños con las características mencionadas en cada consultorio elegido. Después de visitar 166 viviendas, se entrevistaron 141 madres, 91 por ciento del tamaño muestral previsto (155). Para realizar la entrevista, se elaboró un cuestionario con 33 preguntas. Las encuestadoras fueron trabajadoras sociales previamente capacitadas para realizar dicho trabajo, que se llevó a cabo entre junio y julio de 1991. Mediante modelos de regresión logística se estimo el riesgo relativo (RR) asociado a cada variable y la probabilidad de que el lactante fuera destetado precozmente en presencia o ausencia de ciertas variables. Para garantizar la validez de los resultados obtenidos, se construyeron varios modelos de regresión, con el propósito de seleccionar el que mejor se ajustara a los datos

Maternal factors relating to breast-feeding duration in areas around Guadalajara, Mexico

To investigate breast-feeding patterns and factor encouraging early weaning, a survey was conducted in Tonalá and Tlaquepaque, Two suburbs within Guadalajara's metropolitan area, en 1991. For this purpose a multiphase probabilistic sample of infants born in these areas from May 1990 through April 1991 was selected. This was done by choosing at random primary health care units in the study areas, health posts associated with these units, and all infants meeting the above criteria at each selected post. A total of 166 homes was visited and interviews were conducted with 14l mothers (91 percent of the 155 predicted) in June and July 1991. These interviews made use of a 33-item questionnaire developed for the purpose; the interviewers were social workers previously trained in such activities. Logistic regression model were used to calculate the relative risk (RR) and probability of early weaning being associated with certain variables. To help ensure the validity of the results, several regression models were constructed for the purpose of selecting the one best fitting the data. In addition, the attributable population risk (APR) was calculated. The results indicate that failure to breast-feed and early weaning were prevalent in the study population, 34.8 percent of the study infants being breast-fed less than 1 month. Three risk factor were associated statistically (P 0.05) with early weaning, these being maternal age 20 years (RR = 3.75;95 percent CI = 1.53-9.19), maternal marital status single (RR = 2.88; 95 percent CI = 1.08-7.69), and social status of the main family provider other than "worker" -i.e., employee professional (RR = 2.72; 95 percent CI = 1.17-6.28)