Prevalence of traumatic dental injuries and its association with binge drinking among 12-year-olds: a population-based study.

OBJECTIVE: To determine the prevalence of traumatic dental injuries and its association with binge drinking among 12-year-old schoolchildren. METHODS: A cross-sectional study was carried out involving 588 students from a medium-sized city in Brazil. Data were collected through a clinical examination and self-administered questionnaires. Andreasen's classification was used for the determination of traumatic dental injuries. The consumption of alcoholic beverages and binge drinking were evaluated using the Alcohol Use Disorders Identification Test--Consumption. Socio-economic status, overjet, and inadequate lip seal were also analysed. Associations were tested using the multivariate logistic regression analysis. RESULTS: The prevalence rates of traumatic dental injuries, alcohol consumption in one's lifetime, and binge drinking were 29.9%, 45.6%, and 23.1%, respectively. The prevalence of traumatic dental injuries was significantly higher among those who engaged in binge drinking (PR = 1.410; 95% CI: 1.133-1.754) and even higher among those with inadequate lip protection and accentuated overjet (PR = 3.288; 95% CI: 2.391-4.522 and PR = 1.838; 95% CI: 1.470-2.298, respectively). CONCLUSIONS: A higher prevalence rate of traumatic dental injuries was found among 12-year-olds who engaged in binge drinking. The high rate of alcohol intake among adolescents is worrisome considering the vulnerability of this population due to the intense transformations that occur in the transition from childhood to adulthood.

Association between different phases of menstrual cycle and body image measures of perceived size, ideal size, and body dissatisfaction.

The association between phases of the menstrual cycle and body image was investigated. 44 university women (M age = 23.3 yr., SD = 4.7) judged their perceived and ideal body size, and body dissatisfaction was calculated at each phase of the menstrual cycle, including premenstrual, menstrual, and intermenstrual. Participants selected one of nine figural drawings ranging from very thin to obese that represented their perceived size and ideal size. Body dissatisfaction was measured as the absolute difference between scores on perceived and ideal figural drawings. During each menstrual phase, anthropometric measures of weight, height, body mass index, circumference of waist and abdomen, and body composition were taken. There were no significant differences in any anthropometric measures between the three menstrual cycle phases. Perceived body size and body dissatisfaction were significantly different between menstrual phases, with the largest perceived body size and highest body dissatisfaction occurring during the menstrual phase. Ideal body size did not differ between menstrual phases, although participants desired a significantly smaller ideal size as compared to the perceived size.

Body fat, cardiovascular risk factors and polymorphism in the FTO gene: randomized clinical trial and different physical exercise for adolescents.

OBJECTIVE: To investigate the effects of different physical exercise programs and polymorphisms of the FTO (fat mass and obesity-associated gene) on body composition and cardiovascular risk factors in adolescents with overweight and obesity. METHODS: A randomized, parallel, double-blind clinical trial consisting of the adolescent overweight from the state public network, in a simple representative random sample, who participated in an aerobic exercise or weight training intervention for 10 weeks. Anthropometry, body composition, biochemical markers, sexual maturation, and rs9939609 polymorphism in the FTO gene were assessed. 347 adolescents had their characterization of nutritional status. 72 individuals with overweight and obesity were invited to participate. 39 remained for the start of the program and were randomly allocated to both types of intervention. In the end, 26 subjects participated in the intervention programs, with 12 and 14 in the aerobic and weight training programs, respectively. RESULTS: Heterozygous and homozygous bearers of risk allele A participating in the aerobic program showed improvements in glycemia (p = 0.002) and total cholesterol (p = 0.023) and a reduction in body fat mass (p = 0.041). The weight training program reduced glycemia in patients with the risk allele A (p = 0.027). Cameron's stage four sexual maturation participants were 2.1 times more likely to improve their body fat (CI = 1.31-3.39). CONCLUSION: Aerobic exercises produced exclusively a significant decrease in fat mass and total cholesterol in patients with risk allele A. Distinct physical exercise programs may cause diverse changes in risk variables related to the health of adolescents.

Breastfeeding and obesity in Brazilian children.

BACKGROUND: The association between breastfeeding and obesity is inconsistent by the literature. This study aims to assess whether obesity is associated to occurrence of breastfeeding and to duration of total and exclusive breastfeeding in Brazilian children. METHODS: A cross-sectional study was conducted with 764 children enrolled in public and private schools from Viçosa, Minas Gerais, Brazil. Obesity (outcome variable) was defined as body mass index above the +2 standard deviations score using sex and age specific standards of World Health Organization. Exposure was the occurrence and duration of breastfeeding. Potential confounders were controlled by multiple logistic regression analysis and were divided in two groups: children (gender, age, birth weight, gestational age, order of birth, number of siblings, number of persons in the residence, type of school, physical activity patterns and time watching television) and mothers (age, nutritional status, level of education, weight gain during pregnancy, smokes currently and during the pregnancy). RESULTS: Prevalence of obesity was 10.7%; 6.8% of the children were not breastfed and 59.0% did not receive exclusive breastfeeding. After adjustment for confounding variables by logistic regression analysis, no statistically significant association was observed between obesity and the occurrence and/or duration of total and exclusive breastfeeding. There was no dose-response effect of duration of breastfeeding on prevalence of obesity. CONCLUSION: Our results do not support the hypothesis that breastfeeding promotion would reduce obesity in this population. Controversial findings regarding this association by literature indicate a need for further investigations.

Body fat location and cardiovascular disease risk factors in overweight female adolescents and eutrophic female adolescents with a high percentage of body fat.

BACKGROUND: Excessive body fat, mainly abdominal fat, is associated with higher cardiovascular risk. However, a fat localisation measurement that would be more indicative of risk in adolescents has not yet been established. OBJECTIVE: This study was conducted in order to evaluate the correlation between body fat location measurements and cardiovascular disease risk factors in female adolescents. MATERIALS AND METHODS: A total of 113 girls - 38 eutrophic according to their body mass index but with a high percentage of body fat, 40 eutrophic with adequate body fat, and 35 with excessive weight - were evaluated using 15 anthropometrical measurements and 10 cardiovascular risk factors. RESULTS: The central skinfold was the best measurement for predicting variables such as glycaemia and high-density lipoprotein; waist circumference for insulin and homeostasis model assessment; coronal diameter for total cholesterol and low-density lipoprotein; sagittal abdominal diameter for triglycerides and leptin; hip circumference for blood pressure; and the central/peripheral skinfold ratio for homocysteine. The correlation between the measurements and the number of risk factors showed that waist circumference and the waist/stature ratio produced the best results. CONCLUSIONS: The results suggest that the body fat distribution in adolescents is relevant in the development of cardiovascular risk factors. Simple measurements such as waist circumference and the waist/stature ratio were the best predictors of a risk of disease and they should therefore be associated with the body mass index in clinical practice in order to identify those adolescents at higher risk.

Exclusive breastfeeding and other foods in the first six months of life: effects on nutritional status and body composition of Brazilian children.

OBJECTIVE: To evaluate the effect of exclusive breastfeeding and consumption of other foods in the first six months of life in the nutritional status and body composition of children. METHODS: A retrospective cohort study with 185 children aged from 4 to 7 years was monitored during the first months of life in a program of support to breastfeeding. We evaluated weight, height, waist circumference, and body composition by using DEXA. The nutritional status was assessed by the BMI/age index. The parameters of adiposity were classified by using as the cutoff point, the 85th percentile of the sample itself, according to gender and age. Confounding factors considered were variables related to maternal, pregnancy, birth, sociodemographic, health, lifestyle, and diet. Bivariate and multivariate analyses were performed, the latter by means of multiple logistic regression. RESULTS: The median exclusive breastfeeding was 3 months. Of the children, 42.7% received cow's milk and 35.7% received infant formula. Regarding nutritional status, 21.1% of the children showed changes. The variables of infant feeding were not independently associated with nutritional status and body composition of the children and there were no differences between the groups studied. CONCLUSION: Breastfeeding was not a protective factor to overweight and body fat in children.

Childhood obesity: evidence of an association between plasminogen activator inhibitor-1 levels and visceral adiposity.

BACKGROUND: Plasminogen activator inhibitor-1 (PAI-1) has been considered as a cardiovascular risk factor, mainly because of its strong association with insulin resistance. METHODS: To detect independent predictors of circulating PAI-1 levels in obese pediatric patients, we evaluated 86 subjects (mean age 10.7 +/- 2.8 years), 42 of whom were male (49%). Subjects were divided in two groups according to body mass index (BMI): obese subjects (n=61) and healthy non-obese controls (n=25). They were also divided by pubertal status. Besides anthropometric data, levels of PAI-1, leptin and biochemical markers of metabolic syndrome were measured. RESULTS: The obese group had higher levels of PAI-1, leptin and biochemical markers of metabolic syndrome than nonobese controls (p<0.05). However, multivariate regression analysis showed that only puberty progression (p=0.005) and abdominal circumference/height index (p=0.002) remained independent predictors of PAI-1 levels. CONCLUSION: In pediatric obesity, fat mass accumulation, mainly of visceral fat, and puberty progression were related to high PAI-1 levels, which might in turn contribute to cardiovascular risk.

Measurements of adiposity and high blood pressure among children and adolescents living in Belo Horizonte.

OBJECTIVE: To verify an association, if it exists, between obesity and blood pressure raised beyond the 90th percentile in children and adolescents, and to determine the measure of adiposity that best correlates with blood pressure in these subjects. DESIGN: Cross-sectional study. SETTING: A school-based study in Belo Horizonte, Brazil. PARTICIPANTS: We selected randomly 1,403 students, aged from 6 to 18 years, from 545,046 students attending 521 public and private schools. Those selected completed the study. MAIN MEASURES OF OUTCOME: We recorded the weight, height, skin fold in the triceps, subscapular, and suprailiac areas, waist and hip circumference, body-mass index, and resting systolic and diastolic blood pressures using a mercury sphygmomanometer. RESULTS: In univariate analyses, body mass index greater or lesser than 85th percentile, measurements of skin thickness in the subscapular and suprailiac areas, and the sum of all measurements of skinfold thickness, were associated with both systolic and diastolic measurements of blood pressure. After multivariate analyses that adjusted for all measurements of adiposity except itself, and age, race, and socioeconomic state, we found that the increased body mass index was associated with a 3.6-fold increased frequency of elevated systolic measurements of blood pressure, with 95% confidence intervals from 2.2 to 5.8, and a 2.7-fold increased frequency of elevated measurements of diastolic blood pressure, with 95% confidence intervals from 1.9 to 4.0. CONCLUSIONS: Body-mass index serves as a better predictor of elevated blood pressure among children than do local measurements of adiposity.

Intra-abdominal fat measurement by ultrasonography: association with anthropometry and metabolic syndrome in adolescents.

OBJECTIVE: To associate intra-abdominal fat thickness measured by ultrasonography to the factors related to metabolic syndrome and to determine cutoff points of intra-abdominal fat measurement associated with a greater chance of metabolic syndrome in adolescents. METHODS: This was a cross-sectional study, with 423 adolescents from public schools. Intra-abdominal fat was measured by ultrasonography. Anthropometric data were collected, and biochemical analyses were performed. RESULTS: Intra-abdominal fat was measured by ultrasonography, showing a statistically significant association with the diagnosis of metabolic syndrome (p=0.037), body mass index (p<0.001), elevated triglyceride levels (p=0.012), decreased plasma HDL levels (p=0.034), and increased systemic blood pressure values (p=0.023). Cutoff values of intra-abdominal fat thickness measurements were calculated by ultrasound to estimate the individuals most likely to develop metabolic syndrome. In the logistic regression models, the cutoff values that showed the highest association with metabolic syndrome in males were 4.50, 5.35, 5.46, 6.24, and 6.50cm for the ages of 14, 15, 16, 17, and 18/19 years, respectively. In the female gender, the cutoff values defined for the same age groups were 4.46, 4.55, 4.45, 4.90, and 6.46cm. In an overall analysis using the ROC curve, without gender and age stratification, the cut-off of 3.67cm showed good sensitivity, but low specificity. CONCLUSION: Ultrasonography is a useful method to estimate intra-abdominal adipose tissue in adolescents, which is associated with the main factors related to obesity and metabolic syndrome.

Body fat, cardiovascular risk factors and polymorphism in the FTO gene: randomized clinical trial and different physical exercise for adolescents

Abstract Objective: To investigate the effects of different physical exercise programs and polymorphisms of the FTO (fat mass and obesity-associated gene) on body composition and cardiovascular risk factors in adolescents with overweight and obesity. Methods: A randomized, parallel, double-blind clinical trial consisting of the adolescent overweight from the state public network, in a simple representative random sample, who participated in an aerobic exercise or weight training intervention for 10 weeks. Anthropometry, body composition, biochemical markers, sexual maturation, and rs9939609 polymorphism in the FTO gene were assessed. 347 adolescents had their characterization of nutritional status. 72 individuals with overweight and obesity were invited to participate. 39 remained for the start of the program and were randomly allocated to both types of intervention. In the end, 26 subjects participated in the intervention programs, with 12 and 14 in the aerobic and weight training programs, respectively. Results: Heterozygous and homozygous bearers of risk allele A participating in the aerobic program showed improvements in glycemia (p = 0.002) and total cholesterol (p = 0.023) and a reduction in body fat mass (p = 0.041). The weight training program reduced glycemia in patients with the risk allele A (p = 0.027). Cameron's stage four sexual maturation participants were 2.1 times more likely to improve their body fat (CI = 1.31-3.39). Conclusion: Aerobic exercises produced exclusively a significant decrease in fat mass and total cholesterol in patients with risk allele A. Distinct physical exercise programs may cause diverse changes in risk variables related to the health of adolescents.

Fortification of drinking water to control iron-deficiency anemia in preschool children.

BACKGROUND: Iron-deficiency anemia is the most common type of micronutrient malnutrition in the world. Its etiology and control are well understood, but the problem persists and is increasing in some developing countries. Iron fortification of mass-consumption foods is considered one of the most viable approaches to deliver bioavailable iron to the population. OBJECTIVE: To review and analyze the use of drinking water as an iron vehicle to reduce ferropenic anemia in developing countries. METHODS: Drinking water with added iron compounds was offered to preschool children at day-care centers in Brazil. Iron solutions were prepared with 10 mg to 20 mg iron/L. Clinical and anthropometric measurements and blood hemoglobin concentrations were obtained at the beginning of each study and 4 to 8 months later. RESULTS: No problems with acceptability or side effects were observed. Daily water intake by children was around 500 mL. Iron-deficiency anemia was found in all studies. Control children not receiving iron supplementation mantained their initial hemoglobin level. Anemia was reduced in the groups receiving iron-fortified drinking water. CONCLUSIONS: Based on physical properties, tests in rats, and studies on preschool children at Brazilian day-care centers, we have shown that drinking water locally fortified with iron compounds should be considered and used as a worldwide available vehicle to control iron-deficiency anemia. Drinking water, besides being universally available, is a locally available vehicle, easily fortified, can be a vehicle for hydrosoluble iron, and reduces iron-deficiency anemia in preschool children.

Factors associated with duration of breastfeeding.

OBJECTIVES: To determine rates of exclusive breastfeeding and of complementary feeding and to identify variables that interfere with breastfeeding in the municipality of Itaúna, MG, Brazil. METHODS: A longitudinal study was undertaken enrolling 246 women who gave birth at the maternity unit of the Manoel Gonçalves Hospital, in Itaúna, MG. The mothers and their infants were seen monthly for the first 12 months after birth or until they stopped breastfeeding. Survival analysis procedures were used to study the duration of exclusive breastfeeding and of complementary feeding. The impact on breastfeeding duration of a series of co-variables was assessed by means of Cox regression modeling. RESULTS: The prevalence of exclusive breastfeeding at 6 months was 5.3%, and for breastfeeding at 12 months it was 33.7%. The median duration of exclusive breastfeeding was 40 days, and median breastfeeding duration was 237 days. Multivariate analysis demonstrated a negative association (p<0.05) between duration of exclusive breastfeeding and the following variables: intended breastfeeding duration (<12 months), birth weight of child (<2,500 g) and use of a pacifier. Shorter breastfeeding duration was associated (p<0.05) with maternal age (< 20 years), number of prenatal consultations (<5 and >9 consultations), use of alcohol or tobacco, delay before first feed (>6 hours) and use of a pacifier. CONCLUSIONS: Breastfeeding rates in Itaúna (MG) are well below those recommended by the World Health Organization. The principal variables with a negative relationship with duration of exclusive breastfeeding and of complementary feeding are related to mother and baby health care and, therefore, interventions are possible.

Biotechnological Patents Applications of the Deuterium Oxide in Human Health.

BACKGROUND: Deuterium oxide is a molecule that has been used for decades in several studies related to human health. Currently, studies on D2O have mobilized a "Race for Patenting" worldwide. Several patents have been registered from biomedical and technological studies of D2O showing the potential of this stable isotope in industry and health care ecosystems. METHODS: Most of the patents related to the applications of the deuterium oxide in human health have been summarized in this review. The following patents databases were consulted: European Patent Office (Espacenet), the United States Patent and Trademark Office (USPTO), the United States Latin America Patents (LATIPAT), Patent scope -Search International and National Patent Collections (WIPO), Google Patents and Free Patents Online. RESULTS: With this review, the information was collected on recent publications including 22 patents related to deuterium oxide and its applications in different areas. CONCLUSION: This review showed that deuterium oxide is a promising component in different areas, including biotechnology, chemistry and medicine. In addition, the knowledge of this compound was covered, reinforcing its importance in the field of biotechnology and human health.

[Additional cardiovascular risk factors associated with excess weight in children and adolescents: the Belo Horizonte heart study]. / Fatores adicionais de risco cardiovascular associados ao excesso de peso em crianças e adolescentes. O estudo do coração de Belo Horizonte.

OBJECTIVE: To examine the association of overweight and obesity with physical activity, blood pressure (BP) and serum lipid profiles. METHODS: Epidemiologic investigation of 1,450 students, between the ages of 6 and 18, in the city of Belo Horizonte, MG. DATA: weight, height, BP, skinfold thickness, waist circumference, physical activity, total cholesterol (TC), LDL-c, HDL-c, and dietary habits. RESULTS: The prevalence rates for overweight and obesity were 8.4% and 3.1%, respectively. In relation to the students in the lower quartile (Q1) of the distribution of subscapular skinfold, the students in the upper quartile (Q4) presented a 3.7 times higher risk (odds ratio) of having elevated TC levels. Overweight and obese students had a 3.6 times higher risk of having elevated systolic blood pressure, and a 2.7 times higher risk of elevated diastolic blood pressure when compared to normal weight students. The less active students in the Q1 of distribution of MET presented a 3.8 times higher risk of having elevated TC levels compared to those who were more active (Q4). CONCLUSION: Students who were overweight, obese or in the upper quartiles for other adiposity variables, as well as students with low levels of physical activity or a sedentary lifestyle presented higher blood pressure levels and a lipid profile indicative of an increased risk of developing atherosclerosis.

[Pulmonary lesions and total parenteral nutrition in children admitted to a pediatric intensive care unit]. / Lesões pulmonares e nutrição parenteral total em crianças internadas em unidade de terapia intensiva pediátrica.

OBJECTIVE: To describe lung injuries in autopsied pediatric patients (neonates through 15 years old) subjected or not to total parenteral nutrition, in an intensive care unit. METHODS: Sections from six paraffin-embedded lung fragments, from 114 children were studied by routine staining. Demographic, clinical and therapeutic data were retrieved from the records. Statistical analysis was performed using Statistical Package for the Social Sciences. RESULTS: The 114 patients were divided in two groups: 50 who were treated with total parenteral nutrition with lipid emulsion and 64 who did not receive total parenteral nutrition. The two groups did not differ in gender (p = 0.654), age (p = 0.682) or body weight (p = 0.175), but duration of hospital stay (p = 0.000), prematurity (p = 0.008) and treatment with blood products (p = 0.009) were all higher in the group treated with total parenteral nutrition. All patients received mechanical ventilation during hospitalization. Chi-square comparisons showed that diffuse alveolar injury (p = 0.022), pulmonary fibrosis (p = 0.019), pneumocyte hyperplasia (p = 0.004), microthromboembolism (p = 0.047) and thrombophlebitis (0.033) all exhibited a significant relationship with total parenteral nutrition. However, a multivariate analysis by logistic regression, taking into account prematurity and duration of hospital stay, demonstrated that total parenteral nutrition was an independent factor only with respect of pulmonary fibrosis. CONCLUSION: Although lung injuries were significantly more frequent in children who had received total parenteral nutrition, it was impossible to conclude that the lipid infusion had a direct relationship with these injuries, because prematurity and duration of hospital stay were significant co-factors.

[Emerging and reemerging rickettsiosis in an endemic area of Minas Gerais State, Brazil]. / Rickettsioses emergentes e reemergentes numa região endêmica do Estado de Minas Gerais, Brasil.

This article describes a serological survey for rickettsiosis in the county of Novo Cruzeiro, Minas Gerais State, Brazil, in 1998, testing schoolchildren and dogs. Sera included 331 samples from schoolchildren from an endemic area and 142 samples from schoolchildren from a non-endemic area in the county. All children examined were healthy and had not reported clinical symptoms of Brazilian spotted fever prior to the serological survey. Some 35 children in the endemic area were reactive to Rickettsia rickettsiiby indirect fluorescent antibody (IFA) with a titer of 1:64, corresponding to 10.6%. Sera from 73 dogs were tested, showing seroreactivity (IFA 1:64) to Rickettsia rickettsi, Ehrlichia chaffeensis, and Ehrlichia canisin 3 (4.11%), 11 (15.07%), and 13 (17.81%), respectively. The results in schoolchildren and the presence of canine seroreactivity to Ehrlichiaspecies that are potentially pathogenic to humans suggests the risk of transmission of other Rickettsiaein the study area.

[Breastfeeding and maternal medications]. / Uso de medicamentos durante a lactação.

OBJECTIVE: To contribute with information about the adequate administration of drugs during breastfeeding. SOURCES OF DATA: MEDLINE articles from 1993 to 2004, and Lilacs articles from 1995 to 2004 were selected in Portuguese, Spanish and English, by including the following keywords: breastfeeding, lactation, drugs and medicines. Other updated references found in articles and books were also included in this review, in order to provide additional information. SUMMARY OF THE FINDINGS: Most of the drugs are compatible with breastfeeding. Few were considered inadequate, such as antineoplastic drugs, radiopharmaceuticals and drugs of abuse. Some drugs require concern, as they may cause adverse effects in breastfed babies or reduce the mother's breast milk volume. However, further knowledge on some medicines during lactation is required. CONCLUSION: The fundamental principle in the prescription of medicines for lactating mothers is mostly based on the concept of risk and benefit. The option must be, as much as possible, for a drug that has already been studied, which is little released in the maternal milk or that does not mean an apparent risk for the infant's health. Medicines that reduce the mother's production of milk should be avoided during the lactation period. The use of galactogogos is reserved for particular situations. Therefore, only safety drugs should be administered during breastfeeding, which should rarely be discouraged or discontinued in such cases.

[Overweight and obesity prevalence among children and adolescents from Northeast and Southeast regions of Brazil]. / Prevalência de sobrepeso e obesidade em crianças e adolescentes das regiões Sudeste e Nordeste.

OBJECTIVE: To study the prevalence of obesity and overweight among children and adolescents from Northeast and Southeast regions of Brazil. METHODS: Data was collected form Life Pattern Research conducted by the Brazilian Institute of Geography and Statistics (IBGE) in 1997. A sample of 3,317 children and 3,943 adolescents was studied according age groups. Overweight (adolescents) and obesity (adolescents and children) were defined according to World Health Organization recommendations. Z-test was used to compare prevalence among age groups, sex and geographic region. The cut-off point for statistical significance was 0.05. RESULTS: Overweight prevalence in adolescents was 1.7% in Northeast and 4.2% in Southeast. Obesity prevalence in adolescents was 6.6% and 8.4% in children and 8.2% and 11.9% in Northeast and Southeast, respectively. Considering both regions prevalence of obese female children was 10.3%, the rate of obese adolescents was 9.3% and overweight adolescents represented 3.0%. Among males prevalence was 9.2%, 7.3% and 2.6%, respectively. CONCLUSIONS: Obesity prevalence is lower in Northeast than Southeast among children with age from 2 to 17 years old. Overweight prevalence among adolescents was also lower in Northeast than in Southeast. The prevalence of obesity among younger than 2 and older than 18 years old was the same. Obesity prevalence is higher among breast-fed females. Among other age groups prevalence of obesity and overweight was the same for males and females. It is difficult to compare these results with other studies, since there are few populational studies and the criteria used to define overweight and obesity in children and adolescents varies in each study.

[Recommendations for breastfeeding during maternal infections]. / Recomendações quanto à amamentação na vigência de infecção materna.

OBJECTIVE: To make a literature review on breastfeeding and maternal infectious diseases in order to contribute with knowledge and information that can aid the pediatrician to decide upon allowing infected mothers to breastfeed their babies or not. SOURCES OF DATA: Lilacs and MEDLINE databases were searched for books, technical rules and articles on the issue of breastfeeding and infected mothers. SUMMARY OF THE FINDINGS: Infected lactating mothers can transmit pathogenic agents to their infants. Although breastfeeding protects the child it can also be a dangerous source of infection. Maternal diseases caused by bacteria, virus, fungi and parasites may sometimes be transmitted via human milk. The literature points out that mothers infected with HIV and T-lymphotropic human viruses (type I) should not breastfeed. With other diseases a careful approach should be taken, but in general breastfeeding is maintained. CONCLUSION: The mother who is exposed to infectious diseases may transmit pathogenic agents through the human milk, attention should also be made to milk from milk banks. The healthcare provider must take his/her decision upon suspending breastfeeding -- or not, what can be distressful, once he/she has a fundamental role in promoting and stimulating breastfeeding.

[The impact of a breastfeeding promotion program at a health center]. / Impacto de um programa para promoção da amamentação em um centro de saúde.

OBJECTIVES: To determine the impact on breastfeeding sustained beyond two months of the "Seventeen Steps" breastfeeding maintenance program consisting of seventeen strategies used to promote, support and protect breastfeeding and implemented for ten months at a medical center. METHODS: Nonrandomized clinical trial, involving 147 children born between 01/01/99 and 31/12/2001, who had attended their first medical appointment before two months; 67 children who had passed through the traditional program were studied retrospectively and 80 that had the "17 steps" applied to them were studied prospectively. Maximum follow up period was ten months. The program's impact on breastfeeding was evaluated through survival analysis techniques. The survival curves were described by the Kaplan Meier method and compared with the log-rank test. The Cox regression model was used for covariate adjustment. The initial group comparison was done through the t, Kruskal-Wallis and Chi-squared tests. The significance level adopted was 5%. RESULTS: Adjusting for mother-child covariates, a significant difference was observed in breastfeeding duration between the two groups (p = 0.047). The relative risk of interrupting breastfeeding for the "17 steps" group was RR = 0.54 (95CI = 0.30-0.99), indicating that there was an 85% greater risk that children on the traditional program would be weaned before completing a year than there was that children on the "17 steps" program would be. CONCLUSION: The program had a positive impact on the duration of breastfeeding from two to twelve months of age.