Tobacco use by sexual and gender minorities: findings from a Brazilian national survey.

OBJECTIVE: The study aims to identify the prevalence of use of tobacco products by sexual and gender minorities (SGM) in Brazil, the users' profile and associations between tobacco use and social and behavioural variables. METHODOLOGY: The study used data from a representative nationwide household survey of the Brazilian population aged 12-65 years-the first one to address the issue of sexual orientation/gender identity. The study sample consisted of 15 801 individuals. Social and behavioural characteristics and the use of tobacco products were compared according to sexual orientation/gender identity. A multivariate logistic model was constructed to assess the association between tobacco use and sexual orientation/gender identity, as well as models stratified by SGM and non-SGM. RESULTS: Prevalence of any tobacco product use was 44.7% among SGM and 17.0% among non-SGM. Water pipe use was ~8 times higher for SGM than for non-SGM (13.5% vs 1.6%). SGM tobacco users were younger and had more schooling than non-SGM tobacco users. After adjusting for social and behavioural variables, the multivariate model showed that SGM were 150% more likely to use tobacco products than non-SGM (adjusted OR 2.52; 95% CI 1.61 to 3.95). In the model for SGM, schooling, alcohol consumption, illicit drug consumption, violence and anxiety/depression were significantly associated with tobacco use. CONCLUSION: Prevalence of tobacco use among SGM was higher than among non-SGM, and the profile of tobacco users differed between them. It is urgent to monitor health issues in SGM in Brazil and to adopt tobacco control strategies for this group.

Sponsorship of the LGBT parade by the tobacco industry and promotion of its heated tobacco product from the perspective of critical discourse analysis / Patrocínio da parada LGBT pela indústria tabagista e promoção de seu produto de tabaco aquecido sob a ótica da análise crítica do discurso

Abstract Brazil has advanced in tobacco control actions, with a significant decline in the prevalence of tobacco use. However, it is essential to identify more vulnerable populations, such as LGBT persons. This study aimed to analyze the discursive production sustaining the search for support and penetration of the tobacco industry among the LGBT population, taking the sponsorship of Philip Morris Brasil to the LGBT parade in São Paulo in 2019. We employed the critical discourse analysis of a report published on a blog. The analysis of the piece points to the use of vocabularies such as diversity, inclusion, modernity, and innovation, which concern the LGBT cause and the launch of its new product. The text conveys a high commitment and a courteous tone, using discursive resources that associate the company with technical and behavioral innovation ideas. It communicates intertextually with regulatory bodies about introducing its new product in the Brazilian market (prohibited in Brazil). It uses different ideological operators, such as the euphemism of the smokeless or smoke-free future. The work shows a tobacco industry strategy to promote its heated product while supporting LGBT cause and promoting a positive corporate image.

Resumo O Brasil tem avançado em ações de controle do tabaco, resultando em grande declínio da prevalência de tabagismo. Entretanto, é fundamental identificar populações mais vulneráveis, como as pessoas LGBT. Este estudo teve como objetivo analisar a produção discursiva que sustenta a busca de apoio e penetração da indústria tabageira junto à população LGBT, tomando o caso do patrocínio da Philip Morris Brasil à parada LGBT em São Paulo em 2019. A metodologia utilizada foi análise de discurso Crítica de notícia publicada em um blog. A análise da peça aponta para utilização de vocabulários como diversidade, inclusão, modernidade e inovação, que dizem respeito à causa LGBT e ao lançamento de novo produto. O texto traz alto grau de comprometimento e tom cortês, fazendo uso de recursos discursivos que associam a empresa às ideias de inovação técnica e comportamental. Comunica intertextualmente com órgãos regulatórios acerca da entrada no mercado brasileiro de seu novo produto (proibido no Brasil). Faz uso de diferentes operadores ideológicos, como o eufemismo do futuro sem fumaça ou futuro livre de fumaça. O trabalho apresenta uma estratégia da indústria do tabaco para promover seu produto de tabaco aquecido enquanto apoia a causa LGBT e promove imagem corporativa positiva.

Factors associated with infant formula supplementation in Brazilian hospitals: a cross-sectional study

Abstract Objective To analyze the factors associated with infant formula supplementation in newborns referred to rooming-in in Brazilian hospitals. Method Cross-sectional study with data from 14,531 postpartum women and newborns obtained from the "Birth in Brazil" survey, conducted in 2011-2012. The analysis used a logistic regression model with a hierarchical approach. Results In total, 21.2% newborns received infant formula during hospital stay. After adjustment, the following factors were associated with the use of infant formula: maternal age ≥ 35 years (OR = 1.51; IC95%:1.30-1.75), prenatal care in a private service (OR = 2,22; IC:1.72-2.85)/public and private service (OR = 1.67; IC:1.24-2.23), cesarean delivery (OR = 1.83; IC:1.41-2.38), multiple pregnancy (OR = 3.786; IC:2.02-7.06), non-breastfeeding in the delivery room (OR = 1.780; IC:1.43-2.21), birth in a private hospital (OR = 1.695; IC:1.02-2.79), prematurity (OR = 1.656; IC:1.32-2.06) and extremes of birth weight (< 2.500 g: OR = 2.084; IC: 1.585-2.741/ ≥4,000g: OR = 1.672; IC:1.31-2.11). Teenage age (OR = 0.651; IC:0.55-0.76), low maternal education (OR = 0.579; IC:0.43-0.77), multiparity (OR = 0.588; IC:0.510-0.678), and lower economic class (OR = 0.565; IC:0.41-0.76) significantly reduced the probability of using infant formula. Conclusions Of the associated factors, the authors highlight cesarean delivery and non-breastfeeding in the delivery room, showing that it is necessary to strengthen policies that encourage good practices during childbirth care in order to promote exclusive breastfeeding and protect mothers and newborns from all social classes against the misuse of infant formula.

Factors associated with the adequacy of gestational weight gain among Brazilian teenagers. / Fatores associados à adequação do ganho de peso gestacional de adolescentes brasileiras.

The scope of this article is to evaluate the adequacy of total gestational weight gain (GWG) according to maternal characteristics of Brazilian adolescents. It involved a cross-sectional, hospital-based study. A total of 3,904 teenagers with a single fetus gestation and gestational age (GA) at birth ≥ 37 weeks were included. A hierarchical model was built to analyze the dependent and independent variables adequacy of GWG: sociodemographic, care, obstetric and behavioral characteristics. The chances of insufficient GWG were higher for adolescents from the North (OR = 1.50, 95%CI: 1.07-2.10) and Northeast (OR = 1.68, 95%CI: 1.27-2.21). Paid work increased the chances of insufficient (95%CI: 1.15-2.39) and excessive (95%CI: 1.01-1.86) GWG. The pre-pregnancy body mass index of overweight or obese adolescents was associated with excessive GWG (OR = 1.86, 95%CI: 1.19-2.92 and OR = 3.06, 95%CI: 2.10-4.45, respectively), as well as GA ≥ 42 weeks (OR = 2.23, 95%CI: 1.03-4.81). Living in the North and Northeast regions increases the chances of adolescents having insufficient GWG. Having paid work was associated with a greater chance of excessive and insufficient GWG. Furthermore, pre-pregnancy excess weight or obesity and GA ≥ 42 weeks increased the chances of excessive GWG.

O objetivo deste artigo é avaliar a adequação do ganho de peso gestacional total (GPT) segundo características maternas de adolescentes brasileiras. Estudo transversal e de base hospitalar. Foram incluídos 3.904 adolescentes com gestação de feto único e idade gestacional (IG) ao nascimento ≥ 37 semanas. Foi construído um modelo hierarquizado para analisar as variáveis dependentes e a adequação do GPT e das independentes: características sociodemográficas, assistenciais, obstétricas e comportamentais. As chances de GPT insuficiente foram maiores para as adolescentes do Norte (OR = 1,50; IC95%: 1,07-2,10) e Nordeste (OR = 1,68; IC95%: 1,27-2,21). O trabalho remunerado elevou as chances de GPT insuficiente (IC95%: 1,15-2,39) e excessivo (IC95%: 1,01-1,86). O índice de massa corporal pré-gestacional de sobrepeso ou obesidade associou-se ao GPT excessivo (OR = 1,86; IC95%: 1,19-2,92 e OR = 3,06; IC95%: 2,10-4,45, respectivamente), bem como a IG ≥ 42 semanas (OR = 2,23; IC95%: 1,03-4,81). Residir nas regiões Norte e Nordeste aumentou as chances de as adolescentes apresentarem GPT insuficiente. Exercer trabalho remunerado esteve associado a maior chance de GPT excessivo e insuficiente. Além disso, o sobrepeso ou obesidade pré-gestacional e IG ≥ 42 semanas ampliaram as chances de GPT excessivo.

Factors associated with infant formula supplementation in Brazilian hospitals: a cross-sectional study.

OBJECTIVE: To analyze the factors associated with infant formula supplementation in newborns referred to rooming-in in Brazilian hospitals. METHOD: Cross-sectional study with data from 14,531 postpartum women and newborns obtained from the "Birth in Brazil" survey, conducted in 2011-2012. The analysis used a logistic regression model with a hierarchical approach. RESULTS: In total, 21.2% newborns received infant formula during hospital stay. After adjustment, the following factors were associated with the use of infant formula: maternal age ≥ 35 years (OR = 1.51; IC95%:1.30-1.75), prenatal care in a private service (OR = 2,22; IC:1.72-2.85)/public and private service (OR = 1.67; IC:1.24-2.23), cesarean delivery (OR = 1.83; IC:1.41-2.38), multiple pregnancy (OR = 3.786; IC:2.02-7.06), non-breastfeeding in the delivery room (OR = 1.780; IC:1.43-2.21), birth in a private hospital (OR = 1.695; IC:1.02-2.79), prematurity (OR = 1.656; IC:1.32-2.06) and extremes of birth weight (< 2.500 g: OR = 2.084; IC: 1.585-2.741/ ≥4,000g: OR = 1.672; IC:1.31-2.11). Teenage age (OR = 0.651; IC:0.55-0.76), low maternal education (OR = 0.579; IC:0.43-0.77), multiparity (OR = 0.588; IC:0.510-0.678), and lower economic class (OR = 0.565; IC:0.41-0.76) significantly reduced the probability of using infant formula. CONCLUSIONS: Of the associated factors, the authors highlight cesarean delivery and non-breastfeeding in the delivery room, showing that it is necessary to strengthen policies that encourage good practices during childbirth care in order to promote exclusive breastfeeding and protect mothers and newborns from all social classes against the misuse of infant formula.

Fatores associados à adequação do ganho de peso gestacional de adolescentes brasileiras / Factors associated with the adequacy of gestational weight gain among Brazilian teenagers

Resumo O objetivo deste artigo é avaliar a adequação do ganho de peso gestacional total (GPT) segundo características maternas de adolescentes brasileiras. Estudo transversal e de base hospitalar. Foram incluídos 3.904 adolescentes com gestação de feto único e idade gestacional (IG) ao nascimento ≥ 37 semanas. Foi construído um modelo hierarquizado para analisar as variáveis dependentes e a adequação do GPT e das independentes: características sociodemográficas, assistenciais, obstétricas e comportamentais. As chances de GPT insuficiente foram maiores para as adolescentes do Norte (OR = 1,50; IC95%: 1,07-2,10) e Nordeste (OR = 1,68; IC95%: 1,27-2,21). O trabalho remunerado elevou as chances de GPT insuficiente (IC95%: 1,15-2,39) e excessivo (IC95%: 1,01-1,86). O índice de massa corporal pré-gestacional de sobrepeso ou obesidade associou-se ao GPT excessivo (OR = 1,86; IC95%: 1,19-2,92 e OR = 3,06; IC95%: 2,10-4,45, respectivamente), bem como a IG ≥ 42 semanas (OR = 2,23; IC95%: 1,03-4,81). Residir nas regiões Norte e Nordeste aumentou as chances de as adolescentes apresentarem GPT insuficiente. Exercer trabalho remunerado esteve associado a maior chance de GPT excessivo e insuficiente. Além disso, o sobrepeso ou obesidade pré-gestacional e IG ≥ 42 semanas ampliaram as chances de GPT excessivo.

Abstract The scope of this article is to evaluate the adequacy of total gestational weight gain (GWG) according to maternal characteristics of Brazilian adolescents. It involved a cross-sectional, hospital-based study. A total of 3,904 teenagers with a single fetus gestation and gestational age (GA) at birth ≥ 37 weeks were included. A hierarchical model was built to analyze the dependent and independent variables adequacy of GWG: sociodemographic, care, obstetric and behavioral characteristics. The chances of insufficient GWG were higher for adolescents from the North (OR = 1.50, 95%CI: 1.07-2.10) and Northeast (OR = 1.68, 95%CI: 1.27-2.21). Paid work increased the chances of insufficient (95%CI: 1.15-2.39) and excessive (95%CI: 1.01-1.86) GWG. The pre-pregnancy body mass index of overweight or obese adolescents was associated with excessive GWG (OR = 1.86, 95%CI: 1.19-2.92 and OR = 3.06, 95%CI: 2.10-4.45, respectively), as well as GA ≥ 42 weeks (OR = 2.23, 95%CI: 1.03-4.81). Living in the North and Northeast regions increases the chances of adolescents having insufficient GWG. Having paid work was associated with a greater chance of excessive and insufficient GWG. Furthermore, pre-pregnancy excess weight or obesity and GA ≥ 42 weeks increased the chances of excessive GWG.

Association of electrical bioimpedance vectors with the nutritional classification of vulnerable multiethnic children.

BACKGROUND & AIMS: Monitoring growth and body composition in childhood is vital for early detection of health and nutrition problems during child development. The bioelectrical impedance vector analysis (BIVA) revealed its effectiveness as an indicator of nutritional status. This study aimed to measure the bioimpedance vectors of a sample of multiethnic children and evaluate the utility of BIVA for the classification of the nutritional status in a group of children with greater vulnerability, including in the presence of obesity. METHODS: This is a cross-sectional study that analyzed the bioelectrical impedance of a sample of 321 children from public daycare centers, aged 1-4 years, using the RXc graph method (tetrapolar analysis at 50 kHz frequency). The 95%, 75%, and 50% tolerance ellipses were plotted by age group. The Z-scores of bioimpedance parameters (Xc/H-Z and R/H-Z) were calculated regarding age, which were used to build reference tolerance ellipses for a single group, regardless of age. Such ellipses were evaluated for their ability to recognize the pattern and classify the deviations, using individual vectors of obese children. RESULTS: The mean impedance vectors showed progressively higher reactances and lower resistances with age. In the group of obese children, the individual vectors located outside the 95% baseline tolerance ellipse were 12.5%, 18.75%, and 11.1% of the cases for the WHZ, WAZ, and BMIZ criteria, respectively, all above the expected 5%, but much below expectations. This may be a problem with the obesity criteria used, as WHZ, WAZ, and BMIZ do not differentiate fat from lean mass. CONCLUSION: Bioimpedance vector analysis reflects differences in the bioelectric patterns of children classified as obese. Provided the obesity criteria are constructed based on fat measurements, rather than lean mass, the use of tolerance ellipses in the BIVA chart is promising as a tool for monitoring nutritional status where measuring body composition is difficult, because constant tissue hydration cannot be assumed.

Contribution to the Journal Ciência & Saúde Coletiva on Food and Nutrition in Brazil. / Contribuição da Revista Ciência & Saúde Coletiva para a área de Alimentação e Nutrição no Brasil.

A systematic review conducted in January 2020 using SciELO database with the objective of analyzing the scientific production from 1996-2019, of the Journal Ciência & Saúde Coletiva in the area of food and nutrition. We selected 509 out of the 904 articles screened by titles and abstracts. We grouped the articles into ten themes and discussed the most frequent ones: Nutritional Status Assessment (n=142), Food Intake (n=111), Food and Nutrition Policies and Programmes (n=105) and Breastfeeding (n=35). The publications were mostly original articles (75.6%) employing quantitative method (81.6%) and, among these, 18.8% used a probabilistic sampling. We assembled a wide range of topics and subthemes, a relevant production and repository of data and knowledge for health professionals and managers. As gaps, there was a scarcity of publications focused on micronutrient deficiency; the promotion of the Food Guide for the Brazilian Population; supporting the rise of breastfeeding, the impact and analyses of the disruption of the National Food and Nutrition Security Policy and its multi sector interactions with social policies to fight hunger.

Revisão sistemática realizada em janeiro de 2020 na base de dados SciELO com o objetivo de analisar a produção científica da Revista Ciência & Saúde Coletiva na área de alimentação e nutrição no período 1996-2019. A busca resultou em 904 artigos e 509 foram selecionados após leitura dos títulos e resumos. Os artigos foram agrupados em dez temas, sendo discutidos os de maior frequência: Avaliação do Estado Nutricional (n=142), Consumo Alimentar (n=111), Políticas e Programas de Alimentação e Nutrição (n=105) e Aleitamento Materno (n=35). As publicações foram em sua maioria artigos originais (75,6%) com método quantitativo (81,6%) e, entre estes, 18,8% utilizaram amostra probabilística. Observou-se um amplo leque de temas e subtemas abordados, evidenciando uma produção relevante que constitui um repositório importante de dados e conhecimentos para profissionais e gestores da área da saúde. Como lacunas, observou-se a escassez de publicações voltadas para a deficiência de micronutrientes; a popularização do Guia Alimentar para População Brasileira; a promoção da ascensão do aleitamento materno; os diagnósticos da descontinuidade da Política Nacional de Segurança Alimentar e Nutricional e suas articulações intersetoriais com as políticas sociais de combate à fome.

Factors associated with neonatal near miss in Brazil.

OBJECTIVE: This study evaluates the association between sociodemographic factors, maternal characteristics, organization of health services and neonatal near miss in public and private maternity hospitals in Brazil. METHODS: This is a prospective cohort of live births from the Nascer no Brasil survey, carried out between 2011 and 2012. Variables were established from the literature and organized on three levels: distal, intermediate, and proximal. The assessment was performed based on results of the bivariate analyzes and their respective p-values, with a significance level <0.20, using the Wald test. For multivariate analysis, the variables contained at the distal level were inserted, preserved in the model when significant (p < 0.05). This was also done when adjusting the intermediate and proximal levels. RESULTS: At the distal level, no variable was significantly associated with the outcome. At the intermediate level, mother's age greater than or equal to 35 years (relative risk - RR = 1.32; 95%CI 1.04-1.66), cesarean delivery (RR = 1.34; 95%CI 1.07-1.67), smoking (RR = 1.48; 95%CI 1.04-2.10), gestational hypertensive syndrome (RR = 2.29; 95%CI 1.98-3.14), pre-gestational diabetes (RR = 2.63; 95%CI 1.36-5.05) and twin pregnancy (RR = 2.98; 95%CI 1.90-4.68) were variables associated with the outcome. At the proximal level, inadequate prenatal care (RR = 1.71; 95%CI 1.36-2.16) and the hospital/maternity being located in a capital city (RR = 1.89; 95%CI 1.40-2.55) were associated with neonatal near miss. CONCLUSIONS: The results show that neonatal near miss was influenced by variables related to the organization of health services and by maternal characteristics.

Contribuição da Revista Ciência & Saúde Coletiva para a área de Alimentação e Nutrição no Brasil / Contribution to the Journal Ciência & Saúde Coletiva on Food and Nutrition in Brazil

Resumo Revisão sistemática realizada em janeiro de 2020 na base de dados SciELO com o objetivo de analisar a produção científica da Revista Ciência & Saúde Coletiva na área de alimentação e nutrição no período 1996-2019. A busca resultou em 904 artigos e 509 foram selecionados após leitura dos títulos e resumos. Os artigos foram agrupados em dez temas, sendo discutidos os de maior frequência: Avaliação do Estado Nutricional (n=142), Consumo Alimentar (n=111), Políticas e Programas de Alimentação e Nutrição (n=105) e Aleitamento Materno (n=35). As publicações foram em sua maioria artigos originais (75,6%) com método quantitativo (81,6%) e, entre estes, 18,8% utilizaram amostra probabilística. Observou-se um amplo leque de temas e subtemas abordados, evidenciando uma produção relevante que constitui um repositório importante de dados e conhecimentos para profissionais e gestores da área da saúde. Como lacunas, observou-se a escassez de publicações voltadas para a deficiência de micronutrientes; a popularização do Guia Alimentar para População Brasileira; a promoção da ascensão do aleitamento materno; os diagnósticos da descontinuidade da Política Nacional de Segurança Alimentar e Nutricional e suas articulações intersetoriais com as políticas sociais de combate à fome.

Abstract A systematic review conducted in January 2020 using SciELO database with the objective of analyzing the scientific production from 1996-2019, of the Journal Ciência & Saúde Coletiva in the area of food and nutrition. We selected 509 out of the 904 articles screened by titles and abstracts. We grouped the articles into ten themes and discussed the most frequent ones: Nutritional Status Assessment (n=142), Food Intake (n=111), Food and Nutrition Policies and Programmes (n=105) and Breastfeeding (n=35). The publications were mostly original articles (75.6%) employing quantitative method (81.6%) and, among these, 18.8% used a probabilistic sampling. We assembled a wide range of topics and subthemes, a relevant production and repository of data and knowledge for health professionals and managers. As gaps, there was a scarcity of publications focused on micronutrient deficiency; the promotion of the Food Guide for the Brazilian Population; supporting the rise of breastfeeding, the impact and analyses of the disruption of the National Food and Nutrition Security Policy and its multi sector interactions with social policies to fight hunger.

Impact of Bean Consumption on Nutritional Outcomes amongst Adolescents.

Brazilian adolescents have undergone a noteworthy nutritional epidemiological transition. There is an increase in the prevalence of overweight and high consumption of ultra-processed foods in parallel with patterns of traditional meals that include beans. This study analyzed associations between bean consumption in the diet of adolescents and nutrition outcomes. Multiple regression analysis showed a significant reduction in body mass index (BMI), body fat percentage (%BF) and LDL-cholesterol (LDL-c) values among those with bean consumption equal to or greater than five times a week. Adolescents who had lunch outside the home and those who did not have the habit of having lunch showed a significantly higher BMI. There was an increase in the %BF among married adolescents and those who did not have lunch. There was a reduction of LDL-c among those with intermediate per capita income and those who consumed processed juice less than 5 times a week, and an increase among those who did not have breakfast. There were significant interactions between sexual maturation, energy consumption, physical activity and energy consumption. Thus, in the context of this study, the presence of beans in the diet, at frequencies equal to or greater than five times a week, can be considered a proxy for healthy eating.

Professional who attended childbirth and breastfeeding in the first hour of life.

OBJECTIVES: To investigate the association between the professionals who attended vaginal delivery and breastfeeding in the first hour of life. METHODS: This is a cross-sectional study with data from the Nascer no Brasil (Born in Brazil) survey, conducted in the 2011-2012 period. Data from 8,466 puerperae were analyzed using a logistic regression model with a hierarchical approach. RESULTS: The proportion of mothers who breastfed at birth was higher in deliveries attended by nurses (70%). A nurse-assisted delivery was 64% more likely to breastfeed in the first hour of life. Other factors associated with the outcome: residing in the North; age less than 35 years; multiparity; prenatal guidance on breastfeeding in the first hour of life; birth at Baby-Friendly Hospital; companion at birth; and female newborn. CONCLUSIONS: Obstetrician nurse/nurse-assisted delivery was a significant independent factor associated with breastfeeding in the first hour of life, suggesting the importance of strengthening the role of the obstetrician nurse.

The importance of bioelectrical impedance in the critical pediatric patient.

BACKGROUND & AIMS: Sepsis is still a significant cause of death in the Intensive Care Unit and its early diagnosis is vital. Changes in cell permeability have been observed early in sepsis. Lower values of bioelectrical impedance (BIA) such as reactance adjusted by height (Xc/H) and phase angle (PA) have already been studied as a prognostic biomarker for many diseases and may indicate cell injury. BIA is a low cost, practical, noninvasive method that can be measured at bedside. This study investigated the utility of PA and Xc/H raw values in the pediatric critical care unit as predictors of progression to septic shock, as a clinical monitoring tool and to support the diagnosis of septic shock. METHODS: We prospectively analyzed bioelectrical impedance in 145 children aged between one month and six years who were not in septic shock on admission to the intensive care unit Serial bioelectrical impedance analysis (BIA) measures were analyzed to determine the sensitivity and specificity of accurately identifying children who subsequently developed septic shock. Kaplan-Meier septic shock-free survival curves modeled by Xc/H and PA were done. RESULTS: The free-septic shock survival curve analysis showed that patients with the lowest median values of Xc/H and PA were associated with the highest percentage of occurrence of septic shock (p = 0.0001 for Xc/H and <0.0006 for PA) and longest length of stay in the intensive care unit (p < 0.0011 for Xc/H and p < 0.004 for PA). Values of Xc/H below 48.63 Ohm/m at admission showed statistically significant odds ratio (OR) of 3.72 for developing septic shock any time during the hospitalization period, with a 87% sensitivity, 35% specificity and an area under the curve (AUC) of 0.62. The PA at admission did not show significant results. During hospitalization, patients with Xc/H below 35.72 Ohm/m were 3.38 times more likely to develop septic shock in the next day, with a sensitivity of 66.7%, a specificity of 62.3% and AUC of 0.65. PA values below 3.27 had an OR of 9.58 for a septic shock the next day with a sensitivity of 95.8%, specificity of 29.4% and AUC of 0.62. The presence of a value of Xc/H below 33 Ohm/m showed a strong association with the occurrence of septic shock on the same day of the measurement, with an OR of 11.7, as well as a value of PA below 2.64, showed an OR of 14.2. CONCLUSIONS: The bioelectrical parameters Xc/H and phase angle have limitations in predicting septic shock as isolated biomarkers, but have a potential role as a monitoring tool in the pediatric intensive care unit. The comparative value with other biomarkers remains to be elucidated.

Professional who attended childbirth and breastfeeding in the first hour of life / Profesional que asistió al parto y amamantamiento en la primera hora de vida / Profissional que assistiu o parto e amamentação na primeira hora de vida

ABSTRACT Objectives: To investigate the association between the professionals who attended vaginal delivery and breastfeeding in the first hour of life. Methods: This is a cross-sectional study with data from the Nascer no Brasil (Born in Brazil) survey, conducted in the 2011-2012 period. Data from 8,466 puerperae were analyzed using a logistic regression model with a hierarchical approach. Results: The proportion of mothers who breastfed at birth was higher in deliveries attended by nurses (70%). A nurse-assisted delivery was 64% more likely to breastfeed in the first hour of life. Other factors associated with the outcome: residing in the North; age less than 35 years; multiparity; prenatal guidance on breastfeeding in the first hour of life; birth at Baby-Friendly Hospital; companion at birth; and female newborn. Conclusions: Obstetrician nurse/nurse-assisted delivery was a significant independent factor associated with breastfeeding in the first hour of life, suggesting the importance of strengthening the role of the obstetrician nurse.

RESUMEN Objetivos: investigar la asociación entre el profesional que asistió al parto vaginal y la lactancia en la primera hora de vida. Métodos: estudio transversal con datos de la investigación Nascer no Brasil (Nacer en Brasil), conducida en el periodo de 2011-2012. Se analizaron datos de 8.466 puérperas por medio de modelo de regresión logística con abordaje jerarquizado. Resultados: La proporción de madres que amamantaron al nacimiento fue mayor en los partos asistidos por el enfermero (70%). El parto asistido por enfermero presentó una probabilidad un 64% mayor de lactancia en la primera hora de vida. Otros factores asociados al desenlace: residir en el Norte; edad inferior a 35 años; multiparidad; orientación en el prenatal sobre lactancia materna en la primera hora de vida; nacimiento en el Hospital Amigo del Niño; acompañante en el parto; y el recién nacido de sexo femenino. Conclusiones: El parto asistido por el enfermero/enfermero obstetra fue un importante factor independiente asociado a la lactancia materna en la primera hora de vida, sugiriendo la importancia del fortalecimiento del papel del enfermero obstetra.

RESUMO Objetivos: investigar a associação entre o profissional que assistiu o parto vaginal e a amamentação na primeira hora de vida. Métodos: estudo transversal com dados da pesquisa Nascer no Brasil, conduzida em 2011/2012. Foram analisados dados de 8.466 puérperas por meio de modelo de regressão logística com abordagem hierarquizada. Resultados: A proporção de mães que amamentaram ao nascimento foi maior nos partos assistidos pelo enfermeiro (70%). O parto assistido por enfermeiro apresentou chance 64% maior de amamentação na primeira hora de vida. Outros fatores associados ao desfecho: residir no Norte; idade inferior a 35 anos; multiparidade; orientação no pré-natal sobre amamentação na primeira hora de vida; nascimento em Hospital Amigo da Criança; acompanhante no parto; e recém-nascido de sexo feminino. Conclusões: O parto assistido pelo enfermeiro/enfermeiro obstetra foi importante fator independente associado à amamentação na primeira hora de vida, sugerindo a importância do fortalecimento do papel do enfermeiro obstetra.

Professional who attended childbirth and breastfeeding in the first hour of life / Profesional que asistió al parto y amamantamiento en la primera hora de vida / Profissional que assistiu o parto e amamentação na primeira hora de vida

ABSTRACT Objectives: To investigate the association between the professionals who attended vaginal delivery and breastfeeding in the first hour of life. Methods: This is a cross-sectional study with data from the Nascer no Brasil (Born in Brazil) survey, conducted in the 2011-2012 period. Data from 8,466 puerperae were analyzed using a logistic regression model with a hierarchical approach. Results: The proportion of mothers who breastfed at birth was higher in deliveries attended by nurses (70%). A nurse-assisted delivery was 64% more likely to breastfeed in the first hour of life. Other factors associated with the outcome: residing in the North; age less than 35 years; multiparity; prenatal guidance on breastfeeding in the first hour of life; birth at Baby-Friendly Hospital; companion at birth; and female newborn. Conclusions: Obstetrician nurse/nurse-assisted delivery was a significant independent factor associated with breastfeeding in the first hour of life, suggesting the importance of strengthening the role of the obstetrician nurse.

RESUMEN Objetivos: investigar la asociación entre el profesional que asistió al parto vaginal y la lactancia en la primera hora de vida. Métodos: estudio transversal con datos de la investigación Nascer no Brasil (Nacer en Brasil), conducida en el periodo de 2011-2012. Se analizaron datos de 8.466 puérperas por medio de modelo de regresión logística con abordaje jerarquizado. Resultados: La proporción de madres que amamantaron al nacimiento fue mayor en los partos asistidos por el enfermero (70%). El parto asistido por enfermero presentó una probabilidad un 64% mayor de lactancia en la primera hora de vida. Otros factores asociados al desenlace: residir en el Norte; edad inferior a 35 años; multiparidad; orientación en el prenatal sobre lactancia materna en la primera hora de vida; nacimiento en el Hospital Amigo del Niño; acompañante en el parto; y el recién nacido de sexo femenino. Conclusiones: El parto asistido por el enfermero/enfermero obstetra fue un importante factor independiente asociado a la lactancia materna en la primera hora de vida, sugiriendo la importancia del fortalecimiento del papel del enfermero obstetra.

RESUMO Objetivos: investigar a associação entre o profissional que assistiu o parto vaginal e a amamentação na primeira hora de vida. Métodos: estudo transversal com dados da pesquisa Nascer no Brasil, conduzida em 2011/2012. Foram analisados dados de 8.466 puérperas por meio de modelo de regressão logística com abordagem hierarquizada. Resultados: A proporção de mães que amamentaram ao nascimento foi maior nos partos assistidos pelo enfermeiro (70%). O parto assistido por enfermeiro apresentou chance 64% maior de amamentação na primeira hora de vida. Outros fatores associados ao desfecho: residir no Norte; idade inferior a 35 anos; multiparidade; orientação no pré-natal sobre amamentação na primeira hora de vida; nascimento em Hospital Amigo da Criança; acompanhante no parto; e recém-nascido de sexo feminino. Conclusões: O parto assistido pelo enfermeiro/enfermeiro obstetra foi importante fator independente associado à amamentação na primeira hora de vida, sugerindo a importância do fortalecimento do papel do enfermeiro obstetra.

Factors associated with neonatal near miss in Brazil / Fatores associados ao near miss neonatal no Brasil

ABSTRACT OBJECTIVE: This study evaluates the association between sociodemographic factors, maternal characteristics, organization of health services and neonatal near miss in public and private maternity hospitals in Brazil. METHODS: This is a prospective cohort of live births from the Nascer no Brasil survey, carried out between 2011 and 2012. Variables were established from the literature and organized on three levels: distal, intermediate, and proximal. The assessment was performed based on results of the bivariate analyzes and their respective p-values, with a significance level <0.20, using the Wald test. For multivariate analysis, the variables contained at the distal level were inserted, preserved in the model when significant (p < 0.05). This was also done when adjusting the intermediate and proximal levels. RESULTS: At the distal level, no variable was significantly associated with the outcome. At the intermediate level, mother's age greater than or equal to 35 years (relative risk - RR = 1.32; 95%CI 1.04-1.66), cesarean delivery (RR = 1.34; 95%CI 1.07-1.67), smoking (RR = 1.48; 95%CI 1.04-2.10), gestational hypertensive syndrome (RR = 2.29; 95%CI 1.98-3.14), pre-gestational diabetes (RR = 2.63; 95%CI 1.36-5.05) and twin pregnancy (RR = 2.98; 95%CI 1.90-4.68) were variables associated with the outcome. At the proximal level, inadequate prenatal care (RR = 1.71; 95%CI 1.36-2.16) and the hospital/maternity being located in a capital city (RR = 1.89; 95%CI 1.40-2.55) were associated with neonatal near miss. CONCLUSIONS: The results show that neonatal near miss was influenced by variables related to the organization of health services and by maternal characteristics.

RESUMO OBJETIVO: Este estudo avalia a associação entre fatores sociodemográficos, características maternas, organização dos serviços de saúde e near miss neonatal em maternidades públicas e privadas do Brasil. MÉTODOS: Trata-se de uma coorte prospectiva de nascidos vivos da pesquisa Nascer no Brasil, realizada entre 2011 e 2012. As variáveis foram estabelecidas a partir da literatura e organizadas em três níveis: distal, intermediário e proximal. A avaliação foi realizada a partir dos resultados das análises bivariadas e de seus respectivos valores-p, com nível de significância < 0,20, pelo teste de Wald. Para a análise multivariada, foram inseridas as variáveis contidas no nível distal, conservadas no modelo quando significativas (p < 0,05). O mesmo foi feito no ajuste dos níveis intermediário e proximal. RESULTADOS: No nível distal, nenhuma variável apresentou associação significativa com o desfecho. No nível intermediário, idade da mãe maior ou igual a 35 anos (risco relativo - RR = 1,32; IC95% 1,04-1,66), parto cesáreo (RR = 1,34; IC95% 1,07-1,67), uso de fumo (RR = 1,48; IC95% 1,04-2,10), síndrome hipertensiva gestacional (RR = 2,29; IC95% 1,98-3,14), diabetes pré-gestacional (RR = 2,63; IC95% 1,36-5,05) e gestação gemelar (RR = 2,98; IC95% 1,90-4,68) foram variáveis associadas ao desfecho. No nível proximal, o pré-natal não adequado (RR = 1,71; IC95% 1,36-2,16) e a localização do hospital/maternidade na capital (RR = 1,89; IC95% 1,40-2,55) foram associados ao near miss neonatal. CONCLUSÃO: Os resultados mostram que o near miss neonatal foi influenciado pelas variáveis da organização dos serviços de saúde e pelas características maternas.

High-resolution computed tomography findings in young infants with cystic fibrosis detected by newborn screening.

OBJECTIVE: High-resolution computed tomography (HRCT) allows the early detection of pathological changes in the lung structure, and reproducible scoring systems can be used to quantify chest computed tomography (CT) findings in patients with cystic fibrosis (CF). The aim of the study was to describe early HRCT findings according to a validated scoring system in infants with CF diagnosed by newborn screening (NBS). METHODS: This cross-sectional study included infants with CF diagnosed by NBS who were born between January 2013 and January 2017 and who underwent HRCT scanning within the first year after diagnosis when they were clinically stable. The CT scans were evaluated using the modified Bhalla score. RESULTS: Thirty-two subjects underwent HRCT scanning. The mean total-modified Bhalla score was 3.6±2.1, and 93.8% of the scans were abnormal. Pseudomonas aeruginosa airway colonization was associated with increased modified Bhalla score values. Bronchial wall thickening was the most common feature (90.6%), followed by bronchial collapse/consolidation (59.4%), mosaic attenuation/perfusion (50%), bronchiectasis (37.5%) and mucus plugging (15.6%). Bronchial wall thickening was diffuse in most of the patients. CONCLUSION: A substantial proportion of infants diagnosed with CF after detection by NBS already showed evidence of lung disease. P. aeruginosa colonization was associated with increased Bhalla scores, highlighting the importance of this CF pathogen in early structural lung disease. The presence of bronchial wall thickening at such a young age may reflect the presence of airway inflammatory processes. The detection and quantification of structural abnormalities with the modified Bhalla score may aid in the identification of lung disease before it is clinically apparent.

Nutritional profile of newborns with microcephaly and factors associated with worse outcomes.

OBJECTIVE: To describe the nutritional profile of newborns with microcephaly and factors associated with worse outcomes during the first 14 days of life. METHODS: This investigation is a longitudinal, descriptive study carried out in 21 full-term neonates exposed vertically to the Zika virus and hospitalized in a neonatal intensive care unit from February to September 2016. Patients receiving parenteral nutrition were excluded. Data analysis was performed using a generalized estimating equation model and Student's t-test to evaluate the association between worsening weight-for-age z-scores and independent clinical, sociodemographic and nutritional variables during hospitalization, with p<0.05 indicating significance. RESULTS: During hospitalization, there was a decrease in the mean values of the weight-for-age z-scores. The factors associated with worse nutritional outcomes were symptomatic exposure to the Zika virus, low maternal schooling, absence of maternal income and consumption of infant formula (p<0.05). Calcification and severe microcephaly were also associated with poor nutritional outcomes. Energy and macronutrient consumption remained below the recommendations and had an upward trend during hospitalization. CONCLUSION: The presence of cerebral calcification, the severity of microcephaly and symptomatic maternal exposure to Zika virus affected the nutritional status of newborns. In terms of nutritional factors, human milk intake had a positive impact, reducing weight loss in the first days of life. Other known factors, such as income and maternal schooling, were still associated with a poor nutritional status.

External evaluation and self-monitoring of the Baby-friendly Hospital Initiative's maternity hospitals in Brazil.

Background: In Brazil, the Baby-Friendly Hospital Initiative (BFHI) proposes following the criteria, the "Ten Steps to Successful Breastfeeding", International Code of Marketing of Breast-milk Substitutes and Good birth and delivery practices. Brazilian Baby-Friendly Hospitals are reassessed triennially by external evaluators and annually by self-monitoring. This study aimed to verify if the self-monitoring system fulfills its role of enabling accredited hospitals to assess and improve their compliance with the BFHI criteria. In this sense, we will analyze the self-monitoring evaluation results and compare them with those of the external reassessment. Methods: This descriptive evaluation study of the compliance with the BFHI criteria by the Brazilian Baby-Friendly Hospitals by self-monitoring evaluators from 2010 to 2015 and by external evaluators in 2015. Results: Self-monitoring was performed in all years from 2010 to 2015 by 143 BFHI accredited hospitals. The trend of the levels of compliance with BFHI's criteria according to self-monitoring evaluations was stable over the assessed period. Most criteria presented compliance above 70%, except Step 4 (skin-to-skin contact and breastfeeding in the first hour of life), with mean compliance of 67%. Steps 1 (written policy), 7 (rooming-in) and 9 (give no artificial teats) showed mean compliance above 90%. Regarding the external evaluation carried out in 2015, the criteria with lowest compliance were Step 4 and Woman-Friendly care, both below 50%. Steps 9 and 10 (refer mothers to breastfeeding support groups) reached levels of compliance above 90%. For 2015, self-monitoring provided significant higher compliance levels than those from external evaluations in most criteria, except Step 3 (prenatal information on breastfeeding) and Step 10. There was a difference of more than 30% points between evaluations of Steps 1 (written policy), 2 (training), 5 (show mothers how to breastfeed), Woman-Friendly Care and father or mother stay with their newborn. Conclusions: The self-monitoring system fulfilled partially its role of allowing accredited hospitals to self-assess and improve rates of compliance with BFHI criteria. Future trainings of hospital managers need to address difficulties and identify solutions to improve implementation of Steps 4 and 6.

Infants with microcephaly due to ZIKA virus exposure: nutritional status and food practices.

BACKGROUND: Children with microcephaly due to vertical exposure to Zika virus are an interesting population for investigation. Highlighted among their unique aspects are those related to nutrition due to its impact on child growth and development. Knowledge about the nutrition of microcephalic infants can help mothers and caregivers provide better care. Thus, this study aimed to describe the nutritional status and feeding practices of infants with microcephaly due to Zika virus exposure at birth and 12-23 months of age. METHODS: This is a descriptive study developed from a cohort of patients attending a public institution of reference. A total of 65 infants attended outpatient nutrition clinics. The food practices were described using the 24-h food recall and food consumption indicators. Anthropometric measurements and consultations were made using the Child Health Handbook to obtain information on the nutritional status (weight, height and head circumference) at the time of consultation and birth. RESULTS: There was a significant decrease in z-scores for weight, height and head circumference (HC) from birth to the time of the consultation. However, most infants did not show weight-for-height deficits. Additionally, HC was correlated with the anthropometric indices weight-for-age, height-for-age, body mass index-for-age and weight-for-height. CONCLUSION: Infants exhibited a worsening of their nutritional status between birth and the time of their consultation, notably when we evaluated the indices of height and head circumference for age. The main inadequacies regarding dietary practices were low food diversity, use of ultra-processed products and low lipid intake.