Breastfeeding knowledge and practice of health professionals in public health care services

Objetivou-se avaliar conhecimentos e práticas sobre aleitamento materno de profissionais que atendem lactentes em unidades de atenção básica, ou maternidades públicas, de município do interior paulista, Brasil. É estudo epidemiológico, sendo a população composta por 89 enfermeiros e médicos. Suas respostas a um questionário estruturado foram analisadas no total e segundo o local de trabalho, aplicando-se o teste de diferença de proporções (qui-quadrado), considerando-se p<0,05 como nível crítico. Como parâmetros de acertos foram consideradas as recomendações do Ministério da Saúde. As diferenças significativas para conhecimentos e práticas, segundo o local de trabalho, foram restritas a alguns aspectos, com resultados discretamente melhores dos escores médios de acertos dos profissionais das unidades de atenção básica. Independente do local de trabalho, verificou-se desempenho regular e ruim em diferentes aspectos estudados, indicando que possíveis intervenções para a capacitação nessa temática deverão incluir profissionais de todos os níveis de atenção à saúde.

ORGANOCHLORINE PESTICIDE-RESIDUES IN HUMAN-MILK IN THE RIBEIRAO-PRETO REGION, STATE OF SAO-PAULO, BRAZIL

Thirty-seven samples of human milk (colostrum) from donors living in the Ribeirao Preto region were analyzed to determine the levels of organochlorine pesticide residues. Donors were classified into two groups, i.e., occupationally exposed and non-exposed to pesticides. Other factors such as age, previous lactations, race, smoking habit, occupation, family income and educational level were also considered. Analysis was performed by preliminary lipid extraction followed by fractional partition on a column and finally by gas chromatography with an electron capture detector. Lindane was found in 32% of the samples in amounts of less than 0.001 mg/kg; heptachlor was found in 65% of the samples at mean levels of 0.001 mg/kg, i.e., a level five-fold lower than that established by FAO/WHO (1970) for cow's milk. Aldrin and endrin were not detected in any of the samples. Dieldrin was detected in only one sample at a level of 0.038 mg/kg, which is considered high. DDT and DDE amounts are reported as total DDT and at least one of these compounds was present in every sample. Amounts detected in donors occupationally exposed to pesticides ranged from 0.008 to 0.455 mg/kg (mean, 0.149 mg/kg), i.e., three times the limit established by FAO/WHO (1970), while values for donors who had not been exposed ranged from 0.002 to 0.072 mg/kg (mean, 0.025 mg/kg), i.e., half the limit. Considering the level of acceptable daily intake proposed by FAO/WHO (1973), lactents ingested 1% of the acceptable intake of lindane (all donors), 30% of the acceptable intake of heptachlor (all donors), 60% of the acceptable intake of DDT (non-exposed donors), and 3.7 times the acceptable intake of DDT (exposed donors). Comparing the present results with those obtained 10 years ago, the total DDT level in human milk is decreasing in this part of the country. The mean amount of organochlorine residues in non-exposed women's milk was one of the lowest levels among those recorded in the literature. DDT levels of occupationally exposed women's milk were comparable with those reported for developed countries and lower than those detected in Latin American countries. When the results of this survey are considered in relation to the advantages of breast-feeding, the risk-benefit balance is still favorable to breast-feeding. However, given the lack of long-term epidemiological studies, undesirable or harmful long-lasting effects cannot be excluded.

Incidence of sleep bruxism among children in Itanhandu, Brazil

Sleep bruxism (SB) in children may be related to headaches and causes extensive damage of primary teeth. This paper evaluates the incidence of SB in children from Itanhandu, MG, Brazil.The presence of teeth wear facets was verified through clinical examinations on a sample of children, whose parents answered a questionnaire about their children's behavior and habits. Analysis of variance and chi-square tests (p = 0.05) were applied to identify possible correlations between the presence of SB and the parents' responses to the questionnaire.The sample comprised of 170 children, 51.76% (n = 88) of which were girls, while the average age was 4.37 (+/- 1.69) years. A total of 15.29% (n = 26) had been diagnosed as bruxers, 46.47% displayed restless behavior, and only 10% used medication. The average duration of breastfeeding was 4.4 (+/- 0.25) months. A positive correlation was found between restless behavior and the presence of SB (p < 0.001). No correlation was found between SB and medication (p = 0.573), or between the duration of breastfeeding and restless behavior (p = 0.102), SB (p = 0.565) and medication (p = 0.794).Restless behavior was positively correlated with SB, although no correlation was found between SB and medication or duration of breastfeeding.

Anemia em crianças menores de dois anos atendidas nas unidades básicas de saúde no Estado de São Paulo, Brasil

The present study sought to determine the prevalence of anemia in 2,992 children, aged between 6 and 23 months, who voluntarily attended 160 Basis Health Care Units, located in 63 cities of the 5 Regional Health Coordinating areas of the State of S. Paulo, Brazil. Blood samples were collected by venous puncture and hemoglobin was measured by the cianometahemoglobin method. The WHO criteria for the diagnosis of anemia (Hb < 11.0 g/dl) were used: 59.1% of the children were shown to be anemic, with prevalence varying from 47.8% to 68.7% in the 5 RHCs. RHC 1, which comprises the Greater S. Paulo Region, presented a prevalence of anemia significantly lower than the other 4 RHCs, which cover the rest of the State. Hemoglobin levels 9.5 g/dl were found in 25.1% of the children. Anemia was more frequent in male children in male children, in those born, with a weight of less than 3,000 gr, in those who were breastfed for less than 2 months and in those that who presented some degree of energy deficient proteic malnutrition, according to Gomez's criteria. This is the first of a series of 4 articles whose purpose is the determining the prevalence of anemia in the State of S. Paulo and of testing the intervention alternatives with a view to curtailing the incidence of this pathology which today is the most prevalent nutritional disturbance in the world.

The influence of sardine consumption on the omega-3 fatty acid content of mature human milk

Objectives: The purpose of this study was to investigate what effect the ingestion of sardines, rich in omega-3 series polyunsaturated fatty acids, has on the composition of breastmilk. Methods: This was a prospective study of 31 nursing mothers under observation at the Hospital Guilherme Álvaro. Each was given 2 kg of fresh sardines twice with a 15-day interval. Milk was sampled and a 24-hour dietary recall questionnaire was applied on days 0, 15 and 30. Milk was assayed for fatty acid content by gas chromatography. Statistical analysis of the results was performed using nonparametric tests with significance set at p < 0.05. Results: The results demonstrate that the nutritional intake of the nursing mothers was adequate at all three sample points. With regard to the omega-3 series fatty acid content of the breastmilk, it was observed that regular consumption and shorter intervals between ingestion and milk collection resulted in higher concentrations of docosapentaenoic acid and docosahexaenoic acid at 15 and 30 days into the study. Fatty acids from the omega-3 and omega-6 series exhibited a significant correlation, r 2 was 0.58 and 0.59 at 15 and 30 days, respectively. Conclusion: These results suggest that incorporating fish into the diets of nursing mother during lactation, in the form of 100 g of sardines two or three times a week, contributes to an increase in omega-3 series fatty acids. Copyright © 2006 by Sociedade Brasileira de Pediatria.

Deficiência de ferro: Conseqüências biológicas e propostas de prevenção

Iron deficiency is the commonest nutritional deficiency in the world. Although it affects adults, particularly women of reproductive age and during gestation, the most vulnerable group is children under two years of age. It affects mainly people living in developing countries, who have less access to balanced diets and health services and are exposed to precarious sanitary conditions. Iron deficiency has an impact on the immunity, adult work capacity and the cognitive development of children. Combating and preventing iron deficiency is one of the priorities in promoting public health. The strategies to achieve this end include the evaluation and correction of iron deficiency in pregnant women, the encouragement of breast feeding, oral iron supplementation in premature and newborn babies of low birth-weight, food enrichment and mobilization of the community.

Efeito do raloxifeno sobre a densidade mamográfica em mulheres na pós-menopausa

PURPOSE: to evaluate changes in mammographic breast density in postmenopausal women using raloxifene. METHODS: in this clinical trial, 80 women (mean age=61.1 years) were studied prospectively. Forty patients received 60 mg/day raloxifene, and 40 women comprised the non-treated group (control), paired by age and time of menopause. The treated group was composed of patients with osteoporosis of the lumbar spine. Those with history of breast surgery and users of hormone therapy up to six months prior to the study were excluded. The breast density was assessed qualitatively (subjective) and quantitatively (objective) in two moments, initial and final, after a 6-month follow-up. The 320 mammograms (craniocaudal and oblique) were interpreted qualitatively by the Breast Imaging Reporting and Data System (BI-RADS) classification and quantitatively by digital scanning and computer-assisted segmentation. For statistical analysis t-test, Wilcoxon Mann-Whitney, Spearman correlation and the kappa index were used. RESULTS: on the initial statistical comparison, the groups were considered homogenous for the variables: analyzed age, time of menopause, parity, breast feeding, previous hormonal therapy and body mass index. Baseline breast density, by qualitative and quantitative methods, correlated negatively with the age in both groups (p<0.05). Concerning the other variables, there was no correlation. After six months, no alteration was observed in the mammographic breast density in 38 women of raloxifene group and 38 of the control group, by qualitative method. However, by quantitative method, no alteration was observed in 30 women of the raloxifene group and 27 controls (p>0.05). It was observed a weak agreement rate (kappa=0.25) between the BI-RADS classification and digital scanning/computer-assisted segmentation. CONCLUSIONS: in post-menopausal women with osteoporosis, submitted to raloxifene treatment for six months, no alterations were observed on the mammographic breast density.

Efeito do raloxifeno na densidade mamográfica em mulheres na pós-menopausa

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Isótopos estáveis do carbono como indicativo da fase lactente-ruminante em bubalinos Murrah

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Estudo longitudinal sobre a prática de aleitamento materno: fatores associados e causas de desmame

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Interrelação entre o tempo de amamentação, introdução de hábitos bucais deletérios, cárie precoce e a ocorrência de maloclusão em crianças com deficiência e de crianças fenotipicamente normais: estudo comparativo

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efeitos a longo prazo de alterações de dieta numa fase precoce da vida sobre o crescimento posterior: estudo experimental em ratos jovens

Pós-graduação em Pediatria - FMB

Impacto de uma intervenção dirigida à capacitação de agentes comunitários da saúde em aleitamento materno

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)