Undernutrition and short duration of breastfeeding association with child development: a population-based study

Abstract Objective: To explore the relationship of undernutrition and the short duration of breastfeeding with child development of children 0-66 months of age residing in Ceará, Brazil. Methods: The authors of the present study utilized population-based data from children enrolled in the Study on Maternal and Child Health in Ceará, Brazi (PESMIC). Children's development was assessed with the Ages and Stages Questionnaire third version, validated in Brazil. Undernutrition was accessed through anthropometric measures obtained by trained staff. Breastfeeding information was obtained through the mothers' report and confirmed in the child's governmental booklet. The authors used logistic regressions adjusted for sample clusters used in PESMIC design in a theoretical model for known determinants of child development following the World Health Organization nurturing framework. Results: A total of 3,566 children were enrolled in the sixth PESMIC study and had their development assessed. The authors found that 8.2%, 3.0%, 2.1%, and 3.6% of children were stunted, underweight, or wasted, at the time of the interview, respectively. All studied factors were associated with a higher prevalence of child development impairment in at least one of the assessed domains. Underweight was the factor with the strongest effect, with an adjusted odds ratio (AOR) of 4,14 (2,26-7,58), p < 0.001. Breastfeeding for up to two months compared to more than six months (AOR2,08 (1,38-3,12)) was also associated. Conclusions: The authors found that undernutrition and short duration of breastfeeding are associated with development outcomes among Brazilian children. As a result, integrated nutritional programs may improve child development outcomes.

Anxiety about dental treatment / Ansiedade em relação ao tratamento dentário

ABSTRACT This study compared prevalence and risk factors of dental anxiety between men and women. The sample consisted of 244 participants (n = 122 men) aged 18 years or older who sought dental care at a public Dental Education Institution from March 2018 to November 2019. The Modified Dental Anxiety Scale was used to determine presence of dental anxiety. The following risk factors were recorded: age, years of schooling, preoperative pain, and type of dental treatment. Bivariate analysis was used to assess the difference in dental anxiety between the sexes. Multivariate logistic regression was used to analyze the association between dental anxiety and gender, regardless of the influence of other variables. Total prevalence of dental anxiety was 18% (n = 44), 22.9% (28/122) in women and 13.1% (16/122) in men (p = 0.04). Gender (odds ratio: 1.83, 95% confidence interval: 0.92-3.62) and preoperative pain (odds ratio: 2.095, 95% confidence interval: 0.97-4.49) were associated with dental anxiety. We concluded that women had a higher prevalence of dental anxiety. Preoperative pain was associated with dental anxiety regardless of gender.

RESUMO Este estudo avaliou a prevalência e os fatores de risco da ansiedade odontológica entre homens e mulheres. O cálculo amostral foi composto por 244 participantes (n = 122 homens) com 18 anos ou mais que procuraram atendimento odontológico em uma instituição pública de Educação Odontológica no período de março de 2018 a novembro de 2019. A Escala de Ansiedade Odontológica Modificada foi utilizada para determinar a presença de ansiedade odontológica. Os seguintes fatores de risco também foram coletados: idade, anos de estudo, dor pré-operatória e tipo de tratamento odontológico. A análise bivariada foi usada para avaliar a diferença na ansiedade odontológica entre os gêneros. A regressão logística multivariada foi utilizada para analisar a associação entre ansiedade odontológica e gênero, independentemente da influência de outras variáveis. A prevalência total de ansiedade odontológica foi de 18% (n = 44), 22,9% (28/122) nas mulheres e 13,1% (16/122) nos homens (p = 0,04). O gênero (odds ratio: 1,83, intervalo de confiança de 95%: 0,92-3,62) e a dor pré-operatória (odds ratio: 2,095, intervalo de confiança de 95%: 0,97-4,49) foram associados à ansiedade odontológica. Concluímos que as mulheres apresentaram maior prevalência de ansiedade odontológica. A dor pré-operatória foi associada à ansiedade odontológica, independentemente do gênero.

Desnutrición infantil en menores de cinco años en Perú: tendencias y factores determinantes / Child malnutrition in children under 5 years of age in Peru: trends and determinants

OBJETIVO: Analizar las tendencias en materia de desnutrición y anemia en menores de 5 años peruanos y su asociación con algunos factores determinantes en el período 2000-2011. MÉTODOS: Se analizaron indicadores nutricionales de menores de 5 años de la Encuesta Demográfica y de Salud Familiar (ENDES) 2011 y su evolución a partir de datos de las ENDES 2000, 2005 y 2008. Se estimaron las tendencias de desnutrición crónica (DC) (talla/ edad ≤ 2DS), de desnutrición aguda (DA) (peso/talla ≤ 2DS) y de anemia. Se encontraron asociaciones con factores como sexo del niño, edad del niño, zona de residencia (urbana o rural), región de residencia, educación de la madre, quintil de riqueza, disponibilidad de red pública de agua, disponibilidad de cloacas, nivel de altitud, presencia de otros niños en el hogar, orden de los nacimientos, presencia de diarrea en los 15 días previos y presencia de tos en los 15 días previos. RESULTADOS: La DA, la DC y la anemia en menores de 5 años peruanos han descendido entre 2000 y 2011. Tal disminución no ha sido homogénea para las tres afecciones, registrando descensos de 1,1% a 0,4% para DA, de 31,6% a 19,6% para DC y de 50,4% a 30,7% para anemia. Si bien los factores analizados se relacionaron con las prevalencias de estos tres padecimientos, al calcular las razones de probabilidades ajustadas se encontraron diferencias significativas para DC (educación de la madre, región de Sierra, altitud por encima de 2 500 msnm, presencia de dos o más hijos en el hogar y ser el tercer hijo o sucesivo) y para anemia (sexo del niño [más en varones], niños menores de 2 años, región Resto de costa y región Selva, altitud por encima de 2 500 msnm, disponibilidad de red pública de agua, disponibilidad de cloacas, presencia de dos o más hijos en el hogar y presencia de diarrea en los 15 días previos a la encuesta). Para DA se observaron diferencias según algunos factores, pero no resultaron significativas en el modelo ajustado. CONCLUSIONES: En el período 2000-2011, Perú ha logrado disminuir sus tasas de DC, DA y de anemia. Las tasas de DA han descendido casi a un tercio, manteniéndose en cifras generales más bien bajas, y afecta en mayor medida a zonas y colectivos muy localizados del país. Sin embargo, las actuales tasas de desnutrición crónica y de anemia siguen siendo muy altas, lo que constituye un verdadero desafío para las políticas públicas, al igual que sucede en otros países de la región. Para superar ese reto será necesario modificar el enfoque, dejando de concebir a la desnutrición infantil como un problema exclusivamente alimentario y haciendo hincapié en los factores determinantes asociados. Por último, en las comunidades más pobres se deberán incentivar y fortalecer iniciativas integrales e integradas.

OBJECTIVE: Analyze malnutrition and anemia trends in Peruvian children under 5 years of age and their association with determinants in the 2000-2011 period. METHODS: Nutritional indicators for children under 5 years of age from the 2011 Demographic and Family Health Survey (ENDES), and their evolution based on data from the 2000, 2005, and 2008 ENDES, were analyzed. Chronic malnutrition (CM) (height/age ≤ 2 SD), acute malnutrition (AM), (height/weight ≤ 2 SD), and anemia trends were estimated. Associations were found with factors such as sex, age, area of residence (urban or rural), region of residence, mother's education, wealth quintile, availability of public water system, sewer availability, altitude, presence of other children in household, birth order, presence of diarrhea in previous 15 days, and presence of cough in previous 15 days. RESULTS: AM, CM, and anemia in Peruvian children under 5 years of age decreased from 2000-2011. This reduction was not uniform for the three conditions, with decreases of 1.1% to 0.4% recorded for AM, 31.6% to 19.6% for CM, and 50.4% to 30.7% for anemia. Although the factors analyzed were related to the prevalence of these three illnesses, calculation of the adjusted odds ratios showed significant differences for CM (mother's education, Sierra region, altitude greater than 2 500 m above sea level, presence of two or more children in household, and being the third or successive child) and anemia (child sex [higher in males], children under 2 years of age, Resto de costa region and Selva region, altitude greater than 2 500 m above sea level, availability of public water system, sewer availability, presence of two or more children in household, and presence of diarrhea within 15 days prior to the survey). For AM, differences were observed according to some factors but they were not significant in the adjusted model. CONCLUSIONS: In the 2000-2011 period, Peru achieved reduction of its CM, AM, and anemia rates. AM rates decreased to almost one-third, with overall figures remaining fairly low, and affecting to a greater extent highly localized areas and groups of the country. However, the current rates of chronic malnutrition and anemia continue to be very high, which represents a true challenge for public policy, as occurs in other countries of the region. In order to overcome this challenge it will be necessary to change the approach, no longer conceiving of child malnutrition exclusively as a nutritional problem and instead placing greater emphasis on the related determinants. Finally, comprehensive and integrated initiatives should be encouraged and strengthened in the poorest communities.

A musicoterapia pode aumentar os índices de aleitamento materno entre mães de recém-nascidos prematuros: um ensaio clínico randomizado controlado / Music therapy may increase breastfeeding rates among mothers of premature newborns: a randomized controlled trial

Objetivo: Avaliar o impacto da musicoterapia nos índices de aleitamento materno entre mães de recém-nascidos prematuros. Método: Neste ensaio clínico controlado, randomizado e aberto, mães de neonatos prematuros com peso ≤ 1.750 g foram submetidas a sessões de musicoterapia três vezes por semana durante 60 minutos. Os desfechos foram os índices de aleitamento materno na ocasião da alta hospitalar do bebê e em consultas de seguimento (7-15 dias, 30 e 60 dias após a alta). Resultados: Foram avaliadas 94 mães (48 no grupo da musicoterapia e 46 no grupo controle). O aleitamento materno foi significativamente mais frequente no grupo da musicoterapia na primeira consulta de seguimento [risco relativo (RR) = 1,26; intervalo de confiaba de 95% (IC95%) = 1,01-1,57; p = 0,03; número necessário para tratar (NNT) = 5,6]. Esse grupo também apresentou índices mais elevados de aleitamento materno na ocasião da alta do bebê (RR = 1,22; IC95% = 0,99-1,51; p = 0,06; NNT = 6,3), e 30 e 60 dias após a alta (RR = 1,21; IC95% = 0,73-5,66; p = 0,13 e RR = 1,28; IC95% = 0,95-1,71; p = 0,09, respectivamente), mas esses resultados não foram estatisticamente significativos. Conclusões: Este estudo demonstrou que a musicoterapia teve efeito significativo no aumento do índice de aleitamento materno entre mães de recém-nascidos prematuros na primeira consulta de seguimento, e uma influencia positiva (embora não significativa) que se estendeu até 60 dias depois da alta. A musicoterapia pode ser útil para elevar os índices de aleitamento materno entre mães de prematuros.

Objective: To evaluate the impact of music therapy on breastfeeding rates among mothers of premature newborns. Method: In this open randomized controlled trial, mothers of premature neonates weighting ≤ 1,750 g were submitted to music therapy sessions three times a week for 60 minutes. The endpoints were breastfeeding rates at the moment of infant hospital discharge and at follow-up visits (7-15 days, 30 and 60 days after discharge). Results: A total of 94 mothers (48 in the music therapy group and 46 in the comparison group) were studied. Breastfeeding was significantly more frequent in the music therapy group at the first followup visit [relative risk (RR) = 1.26; 95% confidence interval (95%CI) = 1.01-1.57; p = 0.03; number needed to treat (NNT) = 5.6]. Moreover, this group showed higher breastfeeding rates at the moment of infant discharge (RR = 1.22; 95%CI = 0.99-1.51; p = 0.06; NNT = 6.3) and at days 30 and 60 after discharge (RR = 1.21; 95%CI = 0.73-5.6; p = 0.13 and RR = 1.28; 95%CI = 0.95-1.71; p = 0.09, respectively), but those results were not statistically significant. Conclusions: This study demonstrated that music therapy had a significant effect in increasing breastfeeding rates among mothers of premature newborns at the first follow-up visit, and also a positive influence (although not significant) that lasted up to 60 days after infant discharge. Music therapy may be useful for increasing breastfeeding rates among mothers of premature newborns.

A musicoterapia pode aumentar os índices de aleitamento materno entre mães de recém-nascidos prematuros: um ensaio clínico randomizado controlado / Music therapy may increase breastfeeding rates among mothers of premature newborns: a randomized controlled trial

OBJETIVO: Avaliar o impacto da musicoterapia nos índices de aleitamento materno entre mães de recém-nascidos prematuros. MÉTODO: Neste ensaio clínico controlado, randomizado e aberto, mães de neonatos prematuros com peso < 1.750 g foram submetidas a sessões de musicoterapia três vezes por semana durante 60 minutos. Os desfechos foram os índices de aleitamento materno na ocasião da alta hospitalar do bebê e em consultas de seguimento (7-15 dias, 30 e 60 dias após a alta). RESULTADOS: Foram avaliadas 94 mães (48 no grupo da musicoterapia e 46 no grupo controle). O aleitamento materno foi significativamente mais frequente no grupo da musicoterapia na primeira consulta de seguimento [risco relativo (RR) = 1,26; intervalo de confiança de 95 por cento (IC95 por cento) = 1,01-1,57; p = 0,03; número necessário para tratar (NNT) = 5,6]. Esse grupo também apresentou índices mais elevados de aleitamento materno na ocasião da alta do bebê (RR = 1,22; IC95 por cento = 0,99-1,51; p = 0,06; NNT = 6,3), e 30 e 60 dias após a alta (RR = 1,21; IC95 por cento = 0,73-5,66; p = 0,13 e RR = 1,28; IC95 por cento = 0,95-1,71; p = 0,09, respectivamente), mas esses resultados não foram estatisticamente significativos. CONCLUSÕES: Este estudo demonstrou que a musicoterapia teve efeito significativo no aumento do índice de aleitamento materno entre mães de recém-nascidos prematuros na primeira consulta de seguimento, e uma influência positiva (embora não significativa) que se estendeu até 60 dias depois da alta. A musicoterapia pode ser útil para elevar os índices de aleitamento materno entre mães de prematuros.

OBJECTIVE: To evaluate the impact of music therapy on breastfeeding rates among mothers of premature newborns. METHOD: In this open randomized controlled trial, mothers of premature neonates weighting < 1,750 g were submitted to music therapy sessions three times a week for 60 minutes. The endpoints were breastfeeding rates at the moment of infant hospital discharge and at follow-up visits (7-15 days, 30 and 60 days after discharge). RESULTS: A total of 94 mothers (48 in the music therapy group and 46 in the comparison group) were studied. Breastfeeding was significantly more frequent in the music therapy group at the first follow-up visit [relative risk (RR) = 1.26; 95 percent confidence interval (95 percentCI) = 1.01-1.57; p = 0.03; number needed to treat (NNT) = 5.6]. Moreover, this group showed higher breastfeeding rates at the moment of infant discharge (RR = 1.22; 95 percentCI = 0.99-1.51; p = 0.06; NNT = 6.3) and at days 30 and 60 after discharge (RR = 1.21; 95 percentCI = 0.73-5.6; p = 0.13 and RR = 1.28; 95 percentCI = 0.95-1.71; p = 0.09, respectively), but those results were not statistically significant. CONCLUSIONS: This study demonstrated that music therapy had a significant effect in increasing breastfeeding rates among mothers of premature newborns at the first follow-up visit, and also a positive influence (although not significant) that lasted up to 60 days after infant discharge. Music therapy may be useful for increasing breastfeeding rates among mothers of premature newborns.

Breastfeeding and pacifier use in Brazil.

OBJECTIVE: To determine the relationship between pacifier use and the duration of exclusive breast-feeding in the first six months of age, among poor children with unfavourable birth weight, from an underdeveloped region in Brazil. METHOD: Prospective cohort study with infants followed from birth to 6 months of age. Healthy children born with unfavourable birth weight (< 3,000), being exclusively breastfed, were selected from 8 maternity hospitals in the city of Fortaleza (Brazil) between November 1996 and April 1997. Two main outcome measures were used: (i) time to stop exclusive breast-feeding at the 1st and (ii) at the 6th month of life. Main exposures were pacifier use at 1st and 6th month of age. Data were collected at maternity hospitals and during home interviews, using structured questionnaires, by trained data collectors unaware of the study aims, and analyzed using survival analysis and the Cox Proportional Hazard Model. RESULTS: 500 children were enrolled and 13% were lost to follow up at the 1st month. Most of the families had a monthly income less than five times the minimum wage. One third of the mothers were adolescents, one fifth were working outside the home by the 6th month and most attended prenatal care visits. Approximately 60% of the children were using pacifiers by the 1st month. The average number of days for exclusive breast-feeding for pacifier use by the 6th month was 125.3 compared to 87.0 among non-users (p=0.0001). Children using pacifiers were 1,9 more likely to have stopped exclusive breastfeeding by the 6th month compared to non-users, even after controlling potential confounders. CONCLUSION: Pacifier use was associated with the early termination of breast-feeding in Brazil, among poor children with unfavourable birth weight, living in an underdeveloped area. As a possible marker of early weaning, pacifier use can help health workers identify those mothers in need of extended counselling to reinforce breast-feeding practices.

Knowledge about STD/AIDS and sexual behavior among high school students in Rio de Janeiro, Brazil

The incidence of AIDS and other sexually transmitted diseases (STDs) is increasing among adolescents. In order to better understand high-risk sexual behavior among students, a cross-sectional study based on a self-answered anonymous questionnaire was conducted in 10 public and private high schools in Rio de Janeiro, Brazil. Data were obtained on sociodemographics, knowledge of STD/AIDS, and sexual behavior. Among 945 students aged 13-21, 59 percent were sexually initiated, and the median age at first sexual intercourse was 15 years (range: 7-19). Although 94 percent reported being aware of the need for condom use for protection, only 34 percent informed always using condoms during sex. Low family income was associated with unsatisfactory knowledge (OR = 9.40; 95 percent CI = 6.05-14.60) and inconsistent condom use (OR = 11.60; 95 percent CI = 5.54-24.30). However, unsatisfactory knowledge was not associated with inconsistent condom use. School-based educational programs should focus on sexual behavior more than on transmission of knowledge, as well as targeting low-income students

Pneumonias de repetição em ambulatório de pneumologia pediátrica: conceito e prevalência / Recurrent penumonia in a pediaatric pulmonology outpatient unit: concept and prevalence

Objetivo: Determinar a prevalência de pneumonias de repetição na demanda de consultas de primeira vez encaminhadas ao ambulatório de Penumologia Pediátrica do Instituto de Puericultura e Pediaatria Martagão Gesteira da UFRJ para esclarecimentos diagnóstico e revisar o conceito de pneumonias de repetição na literatura pediátrica. Método: Os dados foram obtidos através da avaliação de consultas desse tipo no período de 01/01/95 a 30/04/97. Resultados: De um total de 638 consultas, 101 foram encaminhadas com o diagnóstico presuntivo de pneumonias de repetição. Em apenas 39,6 por cento, o motivo do encaminhamento coincidiu com o conceito de pneumonias de repetição adotado pelo Serviço. Conclusão; Os autores concluíram que o conceito de pneumonias de repetição deve ser melhor esclarecido e difundido entre os médicos pediatras, pois cabe a eles a decisão de encaminhar ao especialista os pacientes com essa queixa. Cabe ressaltar a valorização do exame radiológico normal entre os episódis agudos para a caracterização do quadro de pnemonias de repetição, visando melhor determinação dos pacientes que posteriormente necessitarão de encaminhamento ao especialista para prosseguimento da investigação diagnóstica