Women's sense of coherence and its association with early weaning / Senso de coerência da mulher e sua associação com o desmame precoce

Abstract Objective: To investigate whether there is an association between sense of coherence levels and early weaning. Method: This study had a quantitative nature and a cross-sectional design. Factors associated with early weaning (interruption of maternal breastfeeding) were investigated in a sample of 425 women older than 18 years, mothers of children up to 36 months of age who were not twins, with no sensory or motor deficiencies, without distinction of ethnicity or social class. The chi-squared test, with a significance level of 5%, was used to evaluate the association between the dependent variable (early weaning) and the independent variables (socioeconomic, demographic factors and sense of coherence level). Variables with p ≤ 0.20 were tested by the multiple logistic regression model. Odds ratio and the respective 95% confidence intervals were estimated. All statistical tests were performed using the SAS 9.2 software. Results: The results showed that mothers with greater sense of coherence were 1.82 times more likely to maintain breastfeeding for longer periods (p = 0.02). Conclusions: The identification of mothers with low sense of coherence allows the early intervention of health professionals, contributing to decrease the rates of early weaning in the population.

Resumo Objetivo: Investigar se há associação entre níveis de senso de coerência e desmame precoce. Método: O presente estudo tem natureza quantitativa e delineamento transversal. Foram investigados fatores associados ao desmame precoce (interrupção da oferta do leite materno à criança) em uma amostra de 425 mulheres com idade superior a 18 anos, sem distinção de etnia ou classe social, mães de crianças com até 36 meses, que não fossem gêmeos ou apresentassem deficiências sensoriais ou motoras. Foi feito o teste de qui-quadrado, com nível de significância de 5%, para testar a associação entre a variável dependente (desmame precoce) e as variáveis independentes (socioeconômicas, demográficas e nível de senso de coerência). As variáveis que apresentaram p ≤ 0,20 foram testadas no modelo de regressão logística múltipla. Os odds ratio e os respectivos intervalos de 95% de confiança foram estimados. Todos os testes estatísticos foram feitos com o programa SAS 9.2. Resultados: Os resultados apontaram que mães com maior senso de coerência possuem 1,82 vez mais chance de manter o aleitamento por mais tempo (p = 0,02). Conclusões: A identificação de mães com baixo senso de coerência permite a intervenção precoce dos profissionais de saúde, contribui para diminuir as taxas de desmame precoce na população.

Geographic information system and multilevel analysis: gingival status among 12-year-old schoolchildren in São Paulo, Brazil / Sistema de información geográfica y análisis de niveles múltiples: estado gingival en escolares de 12 años de edad en São Paulo, Brasil

OBJECTIVE: To evaluate gingival and calculus status among schoolchildren 12 years of age using a geographic information system and multilevel analysis. METHODS: A total of 1 002 schoolchildren were selected from 18 municipal districts by means of cluster sampling, from among 25 public and private schools in Piracicaba, São Paulo, Brazil, in 2005. Examinations were carried out by a single calibrated examiner utilizing the criteria of the World Health Organization, as well as the Community Periodontal Index. Social, economic, and behavioral variables were recorded with the use of a questionnaire and were used in the individual analysis (first level). The variables "percentage of heads of families without income" and "percentage of illiterate heads of families" were used in the contextual analysis (second level). RESULTS: A geographic information system was constructed for mapping the distribution of gingival bleeding. The variables were visually distinguished in the maps and demonstrated a tendency toward better gingival health in the central areas of the city, which are recognized as more privileged. On the contextual level, only the "percentage of illiterate heads of families" was significantly associated to gingival bleeding. CONCLUSIONS: The study confirms better oral health status among schoolchildren from privileged families, but does not confirm the data regarding "income." The individuals from areas in which the heads of family did not have income were not associated to a higher prevalence of gingival problems. This suggests that these individuals are reasonably protected from the impact of social privation due to the actions of public health care services in the municipality.

OBJETIVO: Evaluar el estado gingival y la presencia de sarro en escolares de 12 años de edad mediante el empleo de un sistema de información geográfica y análisis de niveles múltiples. MÉTODOS: En el año 2005, se seleccionó a un total de 1 002 escolares de 18 distritos municipales mediante muestreo por grupos, con la participación de 25 escuelas públicas y privadas de Piracicaba, en el estado de São Paulo, Brasil. Un único examinador calibrado, que utilizó los criterios de la Organización Mundial de la Salud, así como el Índice Periodontal Comunitario, llevó a cabo los exámenes. Mediante un cuestionario, se registraron las variables sociales, económicas y conductuales, y estas se emplearon en el análisis individual (primer nivel). En el análisis contextual (segundo nivel), se utilizaron las variables "porcentaje de cabezas de familia sin ingresos" y "porcentaje de cabezas de familia analfabetas". RESULTADOS: Se construyó un sistema de información geográfica para elaborar mapas de la distribución de la hemorragia gingival. Los mapas, donde se pueden distinguir visualmente las variables, demostraron una tendencia hacia una mejor salud gingival en las zonas del centro de la ciudad, consideradas como privilegiadas. En el nivel contextual, únicamente el "porcentaje de cabezas de familia analfabetas" se asoció significativamente con el sangrado gingival. CONCLUSIONES: El presente estudio confirma una mejor salud bucodental en los escolares pertenecientes a familias privilegiadas, pero no confirma los datos en cuanto a "ingresos". Las personas residentes en zonas donde las cabezas de familia no tenían ingresos no presentaron una mayor prevalencia de problemas gingivales. Esto indica que estas personas, como consecuencia de las actividades de los servicios de atención de salud pública del municipio, están razonablemente protegidas de la repercusión de la privación social.