Aleitamento materno: fatores de influência na sua decisão e duração

Os autores analisaram diferentes fatores que podem influenciar na decisão das mães de amamentar, na duração da amamentação e as principais razões do desmame. Foram selecionados artigos publicados entre 1990 e 2004 das bases de dados Lilacs, Medline, Scielo, Bireme, utilizando as palavras-chave: desmame e fatores de risco, bem como suas versões em inglês. Alguns fatores, como maternidade precoce, baixo nível educacional e socioeconômico maternos, paridade, atenção do profissional de saúde nas consultas de pré-natal, necessidade de trabalhar fora do lar, são freqüentemente considerados como determinantes do desmame precoce. Contudo, outros, como o apoio familiar, condições adequadas no local de trabalho e uma experiência prévia positiva, parecem ser parâmetros favoráveis à decisão materna pela amamentação. Apesar da relevância dos fatores mencionados acima, os aspectos culturais e a história de vida da mãe foram os mais importantes na decisão materna pelo aleitamento e pelo momento do desmame.

O ato de amamentar: um estudo qualitativo

O objetivo do estudo foi analisar, de forma qualitativa, o conhecimento e percepção de um grupo de mulheres, bem como analisar os determinantes que influenciam a prática do aleitamento materno. Foi adotada a metodologia da pesquisa qualitativa, utilizando como referencial a teoria de representações sociais. Foram entrevistadas 27 gestantes, por um único entrevistador, durante o pré-natal e acompanhadas até o sexto mês do bebê, quando já estavam completamente desmamados. A análise compreensiva das falas permitiu verificar os fatores que levam a mãe a amamentar seus filhos, como proteção do bebê e amor materno. Também foram verificados os motivos que levaram as mães a desmamarem seus filhos, sendo citados a falta de leite/leite secou e o trabalho. Verificou-se, a partir das representações das mães, que mesmo que elas demonstrassem conhecimento sobre as propriedades do leite, não foi garantido o sucesso da prática de amamentação natural.

Desempenho de cordeiros lactentes recebendo probióticos em comedouros privativos

The presente study was carried out to evaluate the performance of 40 lambs 7/8 Ile de France 1/8 Ideal (20 not castrated males and 20 females) raised with access to creep feeding, until get 17 kg of corporeal weight. The animals were divided in treatments, receiving isoproteic and isoenergetic diets, with diferent levels of probiotics (D1=0%, D2=0,8% e D3=12%). They were analysed in regart to born weight, weight at 30 days and weight gain at maternal independent (from 1th to 4th weeks) and maternal independent (from 5th to 8th week), the age of wean and daily weight gain. The average intake of dry matter by the lambs at D1, D2 and D3 was 0,27, 0,26 and 0,27 kg/day, respectively. On maternal dependent phase, there was no interaction and differences between diet and sex in the born weight (3.30 kg), weight at 30 days of age (11.79 kg) and in the average daily weight gain (0.28 kg). On maternal independent phase, there were no differences in the age of weam (53 days) and daily weight gain (0,26 kg) between diet and sex. It was concluded that probiotics inclusion in the diet of the suckling lambs (males not castrated and females) didn't improve their performance.

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

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Respostas zootécnicas, fisiológicas e comportamentais de ovelhas Santa Inês submetidas a diferentes fatores de estresse do início da lactação até o desmame

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Produção de vitelos de carne rosa com bezerros holandeses

Pós-graduação em Zootecnia - FMVZ

Probiótico em dietas de suínos sobre os parâmetros sanguíneos e digestibilidade de rações

Two assays were accomplished being, both using a randomized block design: Assay 1 the aimed was to evaluate the blood parameters of weaned recently pigs and receiving rations with and without probiotic. Twenty pigs with body weight of 6.99 +/- 0.42 kg were used and were collected samples of blood to the 0, 7, 14, 21 and 28 days after wean, for determinations of the bool parameters. Assay 2 the objective was to determine the rations digestibility for growth swine supplemented or not with probiotic in the rations. The rations and the ages of the animals influenced most of the variables of the blood parameters. The probiotic didn't alter the ration digestibility to exception for mineral matter. It is ended that the blood parameters were altered for the use of the probiotic and the age of the animals, both emphasized to challenges happened after wean and the mineral matter was better taken advantage with the use of the probiotic.

PREVALENCE AND DETERMINANTS OF EXCLUSIVE BREASTFEEDING IN THE CITY OF SERRANA, SAO PAULO, BRAZIL

The objective of this cross-sectional and quantitative study was to identify the prevalence and determinants of exclusive breastfeeding among infants less than six months of age in the city of Serrana, Sao Paulo, Brazil in 2009. A validated semi-structured questionnaire was administered to the guardians of the children less than six months of age who attended the second phase of a Brazilian vaccination campaign against polio. Univariate and multivariate analysis presented in odds ratios and confidence intervals was accomplished. Of the total of 275 infant participants, only 29.8% were exclusively breastfed. Univariate analysis revealed that mothers who work outside the home without maternity leave, mothers who did not work outside the home, adolescent mothers, and the use of pacifiers have a greater chance of interrupting exclusive breastfeeding. In the multivariate analysis, mothers who work outside the home without maternity leave are three times more likely to wean their children early. Results provide suggestions for the redirection and planning of interventions targeting breastfeeding.

Dysfunction of respiratory muscles in critically ill patients on the intensive care unit.

Muscular weakness and muscle wasting may often be observed in critically ill patients on intensive care units (ICUs) and may present as failure to wean from mechanical ventilation. Importantly, mounting data demonstrate that mechanical ventilation itself may induce progressive dysfunction of the main respiratory muscle, i.e. the diaphragm. The respective condition was termed 'ventilator-induced diaphragmatic dysfunction' (VIDD) and should be distinguished from peripheral muscular weakness as observed in 'ICU-acquired weakness (ICU-AW)'. Interestingly, VIDD and ICU-AW may often be observed in critically ill patients with, e.g. severe sepsis or septic shock, and recent data demonstrate that the pathophysiology of these conditions may overlap. VIDD may mainly be characterized on a histopathological level as disuse muscular atrophy, and data demonstrate increased proteolysis and decreased protein synthesis as important underlying pathomechanisms. However, atrophy alone does not explain the observed loss of muscular force. When, e.g. isolated muscle strips are examined and force is normalized for cross-sectional fibre area, the loss is disproportionally larger than would be expected by atrophy alone. Nevertheless, although the exact molecular pathways for the induction of proteolytic systems remain incompletely understood, data now suggest that VIDD may also be triggered by mechanisms including decreased diaphragmatic blood flow or increased oxidative stress. Here we provide a concise review on the available literature on respiratory muscle weakness and VIDD in the critically ill. Potential underlying pathomechanisms will be discussed before the background of current diagnostic options. Furthermore, we will elucidate and speculate on potential novel future therapeutic avenues.

Consolidating Security and Development in Colombia: Lessons for Peru and Panama

Colombia's increasingly effective efforts to mitigate the power of the FARC and other illegitimately armed groups in the country can offer important lessons for the Peruvian government as it strives to prevent a resurgence of Sendero Luminoso and other illegal non-state actors. Both countries share certain particular challenges: deep economic, social, and in the case of Peru ethnic divisions, the presence of and/or the effects of violent insurgencies, a large-scale narcotics production and trafficking, and a history of weak state presence in large tracts of isolated and scarcely-populated areas. Important differences exist, however in the nature of the insurgencies in the two countries, the government response to them and the nature of government and society that affects the applicability of Colombia's experience to Peru. The security threat to Panama from drug trafficking and Colombian insurgents --often a linked phenomenon-- are in many ways different from the drug/insurgent factor in Colombia itself and in Peru, although there are similar variables. Unlike the Colombian and Peruvian cases, the security threat in Panama is not directed against the state, there are no domestic elements seeking to overthrow the government -- as the case of the FARC and Sendero Luminoso, security problems have not spilled over from rural to urban areas in Panama, and there is no ideological component at play in driving the threat. Nor is drug cultivation a major factor in Panama as it is in Colombia and Peru. The key variable that is shared among all three cases is the threat of extra-state actors controlling remote rural areas or small towns where state presence is minimal. The central lesson learned from Colombia is the need to define and then address the key problem of a "sovereignity gap," lack of legitimate state presence in many part of the country. Colombia's success in broadening the presence of the national government between 2002 and the presence is owed to many factors, including an effective national strategy, improvements in the armed forces and police, political will on the part of government for a sustained effort, citizen buy-in to the national strategy, including the resolve of the elite to pay more in taxes to bring change about, and the adoption of a sequenced approach to consolidated development in conflicted areas. Control of territory and effective state presence improved citizen security, strengthened confidence in democracy and the legitimate state, promoted economic development, and helped mitigate the effect of illegal drugs. Peru can benefit from the Colombian experience especially in terms of the importance of legitimate state authority, improved institutions, gaining the support of local citizens, and furthering development to wean communities away from drugs. State coordinated "integration" efforts in Peru as practiced in Colombia have the potential for success if properly calibrated to Peruvian reality, coordinated within government, and provided with sufficient resources. Peru's traditionally weak political institutions and lack of public confidence in the state in many areas of the country must be overcome if this effort is to be successful.

Weaning from ventilation

Aims/purpose: Getting off the ventilator is an important patient-centred outcome for patients with acute respiratory failure. It signifies an improvement in patient condition, enables easier communication, reduces fear and anxiety and consequently a reduced requirement for sedatives. Weaning from ventilation therefore is a core ICU nursing task that is addressed in this presentation.
Presentation description: There are different schools of thought on when ventilator weaning begins including: (a) from intubation with titration of support; and (b) only when the patient’s condition improves. There are also different schools of thought on how to wean including gradual reductions in ventilator support to: (a) a low level consistent with extubation; or (b) to a level to attempt a spontaneous breathing trial followed by extubation if successful. Regardless of the approach, what is patient-relevant is the need to determine early when the patient may be ‘ready’ to discontinue ventilation. This time point can be assessed using simple criteria and should involve all ICU staff to the level of their experience. This presentation challenges the notion that only senior nurses or nurses with a ‘weaning course’ should be involved in the weaning process and proposes opportunities for engaging nurses with all levels of experience.
Conclusion: An ICU nursing taskforce that is focused and engaged in determining patient readiness for weaning can make a strong contribution to patient-relevant outcomes.

Incidencia de síndrome de abstinencia secundario a opioides y/o benzodiacepinas en dos unidades de cuidados intensivos pediátricos

• Introducción: El síndrome de abstinencia (SA) es el conjunto de síntomas y signos que se producen al suspender bruscamente la administración de un fármaco una vez se haya establecido dependencia física. • Objetivos: Caracterizar los pacientes que presentan SA secundario a opiodes (OP) y/o benzodiacepinas(BZ) durante la hospitalización en las unidades de cuidados intensivos pediátricos de la Clínica Infantil Colsubsidio (CIC) y Hospital del Niño de Panamá (HDN) del 1 de abril al 30 de septiembre del 2016. • Materiales y métodos: se realizó un estudio descriptivo, longitudinal, prospectivo. Incluimos 189 pacientes en la CIC y 144 pacientes en el HDN. Se utilizó la escala SOPHIA para el diagnóstico de SA, las escalas COMFORT para evaluar la sedación en pacientes ventilados no relajados y la escala FLACC para evaluar la analgesia. Se utilizó software StataV12® para el análisis estadístico. • Resultados: se reportó una incidencia global de SA de 6.1/100 días personas. La incidencia acumulada de SA fue de 56.08% y 29.86% para la CIC y el HDN respectivamente. En la CIC el 69.81% de los pacientes que requirieron infusión de OP y BZ desarrollaron SA. Se reportó una dosis acumulada de fentanyl de 530.34 ± 276.49 mcg/kg. Con respecto al HDN, de los pacientes que recibieron opioides y benzodiacepinas el 53.49 % desarrollaron SA. • Conclusión: El SA secundario a opioides y/o benzodiacepinas es frecuente en nuestras unidades con una incidencia variable, es mayor la presentación del SA al usar ambos fármacos, mayores dosis acumuladas y más días de infusión continua.