Factors associated with breastfeeding abandonment in the first month after the mother's return to work.

The return to work of lactating mothers has been identified as an important risk factor for breastfeeding interruption. We proposed to identify factors associated with breastfeeding abandonment in the first month after return. 252 women working at a hospital who had children aged 12 to 36 months and who were still breastfeeding when returned to work answered a questionnaire containing questions on sociodemographic characteristics, pregnancy, childbirth, breastfeeding and work-related factors. The associations were estimated using adjusted prevalence ratio (aPR), calculated with the hierarchical Poisson multivariable regression model. The following factors showed a significant association with breastfeeding abandonment: using a pacifier (aPR 4.58), cohabiting with someone other than partner (aPR 3.77), having no intention or having doubts about maintaining breastfeeding after returning (aPR 3.39), having a college degree (aPR 2.66), having no support from the infant's caregiver (aPR 2.26), and infant being older when the woman returned to work (PR 1.16 for each additional month of infant age). Longer duration of exclusive breastfeeding was a protective factor (aPR 0.990). Most of the factors associated with discontinuation of breastfeeding in the first month after the mother's return to work are not directly related to the woman's work.

Factors associated with breastfeeding abandonment in the first month after the mother's return to work / Fatores associados ao abandono do aleitamento materno no primeiro mês após o retorno da lactante ao trabalho

Abstract The return to work of lactating mothers has been identified as an important risk factor for breastfeeding interruption. We proposed to identify factors associated with breastfeeding abandonment in the first month after return. 252 women working at a hospital who had children aged 12 to 36 months and who were still breastfeeding when returned to work answered a questionnaire containing questions on sociodemographic characteristics, pregnancy, childbirth, breastfeeding and work-related factors. The associations were estimated using adjusted prevalence ratio (aPR), calculated with the hierarchical Poisson multivariable regression model. The following factors showed a significant association with breastfeeding abandonment: using a pacifier (aPR 4.58), cohabiting with someone other than partner (aPR 3.77), having no intention or having doubts about maintaining breastfeeding after returning (aPR 3.39), having a college degree (aPR 2.66), having no support from the infant's caregiver (aPR 2.26), and infant being older when the woman returned to work (PR 1.16 for each additional month of infant age). Longer duration of exclusive breastfeeding was a protective factor (aPR 0.990). Most of the factors associated with discontinuation of breastfeeding in the first month after the mother's return to work are not directly related to the woman's work.

Resumo O retorno da lactante ao trabalho é apontado como importante fator de risco para interrupção da amamentação. Nós nos propusemos a identificar fatores associados ao abandono da amamentação no primeiro mês após o retorno. Compuseram a amostra 252 servidoras de um hospital com filhos entre 12 e 36 meses e que estavam amamentando quando retornaram ao trabalho, fornecendo informações sobre características sociodemográficas, gestação, parto, amamentação e fatores relacionados ao trabalho. As associações foram estimadas pela razão de prevalência ajustada (RPa), obtida usando modelo hierárquico de regressão multivariada de Poisson. Os seguintes fatores mostraram associação significativa com abandono da amamentação: uso de chupeta (RPa 4,58), coabitação com outra pessoa que não o companheiro (RPa 3,77), não ter intenção ou ter dúvidas sobre amamentar após retorno (RPa 3,39), ter curso superior (RPa 2,66), não ter apoio do cuidador da criança (RPa 2,26) e maior idade da criança quando a mãe retornou ao trabalho (RPa 1,16 para cada mês de idade a mais da criança). Maior duração da amamentação exclusiva foi fator de proteção (RPa 0,990). A maioria dos fatores associados à descontinuidade da amamentação no primeiro mês após retorno da lactante ao trabalho não está diretamente relacionada ao seu trabalho.

An Exploratory Study of the Metabolite Profiling from Pesticides Exposed Workers.

Pesticides constitute a category of chemical products intended specifically for the control and mitigation of pests. With their constant increase in use, the risk to human health and the environment has increased proportionally due to occupational and environmental exposure to these compounds. The use of these chemicals is associated with several toxic effects related to acute and chronic toxicity, such as infertility, hormonal disorders and cancer. The present work aimed to study the metabolic profile of individuals occupationally exposed to pesticides, using a metabolomics tool to identify potential new biomarkers. Metabolomics analysis was carried out on plasma and urine samples from individuals exposed and non-exposed occupationally, using liquid chromatography coupled with mass spectrometry (UPLC-MS). Non-targeted metabolomics analysis, using principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA) or partial least squares discriminant orthogonal analysis (OPLS-DA), demonstrated good separation of the samples and identified 21 discriminating metabolites in plasma and 17 in urine. The analysis of the ROC curve indicated the compounds with the greatest potential for biomarkers. Comprehensive analysis of the metabolic pathways influenced by exposure to pesticides revealed alterations, mainly in lipid and amino acid metabolism. This study indicates that the use of metabolomics provides important information about complex biological responses.

Metabolomic Study of Urine from Workers Exposed to Low Concentrations of Benzene by UHPLC-ESI-QToF-MS Reveals Potential Biomarkers Associated with Oxidative Stress and Genotoxicity.

Benzene is a human carcinogen whose exposure to concentrations below 1 ppm (3.19 mg·m-3) is associated with myelotoxic effects. The determination of biomarkers such as trans-trans muconic acid (AttM) and S-phenylmercapturic acid (SPMA) show exposure without reflecting the toxic effects of benzene. For this reason, in this study, the urinary metabolome of individuals exposed to low concentrations of benzene was investigated, with the aim of understanding the biological response to exposure to this xenobiotic and identifying metabolites correlated with the toxic effects induced by it. Ultra-efficient liquid chromatography coupled to a quadrupole-time-of-flight mass spectrometer (UHPLC-ESI-Q-ToF-MS) was used to identify metabolites in the urine of environmentally (n = 28) and occupationally exposed (n = 32) to benzene (mean of 22.1 µg·m-3 and 31.8 µg·m-3, respectively). Non-targeted metabolomics analysis by PLS-DA revealed nine urinary metabolites discriminating between groups and statistically correlated with oxidative damage (MDA, thiol) and genetic material (chromosomal aberrations) induced by the hydrocarbon. The analysis of metabolic pathways revealed important alterations in lipid metabolism. These results point to the involvement of alterations in lipid metabolism in the mechanisms of cytotoxic and genotoxic action of benzene. Furthermore, this study proves the potential of metabolomics to provide relevant information to understand the biological response to exposure to xenobiotics and identify early effect biomarkers.

Factors associated with breastfeeding continuation for 12 months or more among working mothers in a general hospital. / Fatores associados à continuidade do aleitamento materno por 12 meses ou mais em mulheres trabalhadoras de um hospital geral.

This article aims to identify factors associated with breastfeeding continuation for at least 12 months among working mothers in a hospital in the south of Brazil. We conducted a cross-sectional study, interviewing 251 women who breastfed after returning to work. Eligibility criteria included non-twin biological children aged between 12 and 36 months and the absence of an illness (mother and/or child) that could affect breastfeeding. The association between breastfeeding continuation and the exposure variables was tested using Poisson multivariate regression. Only one work-related variable showed a significant association with the outcome. Working only during the day increased the prevalence of BF continuation for at least 12 months by 37%. The following non-work-related factors showed a positive association with the outcome: mothers without a college degree; mothers with at least 12 months' prior breastfeeding experience; child not given milks other than breast milk when the mother returned to work, and not using a pacifier. The following variables showed a negative association with the outcome: older maternal age; older gestational age; mother receiving support from the child's caregiver; and mother receiving professional breastfeeding support. Non-work-related factors had a greater influence on breastfeeding continuation for at least 12 months among working mothers.

O objetivo deste estudo é identificar fatores associados à continuidade da amamentação por 12 meses ou mais em mulheres trabalhadoras. Estudo transversal realizado por meio de entrevista com 251 trabalhadoras de um hospital, com filhos biológicos entre 12 e 36 meses de idade, não gemelares e sem doença que afetasse a amamentação, e amamentando quando do seu retorno ao trabalho. Para a associação entre a continuidade da amamentação e as variáveis de exposição utilizou-se a regressão multivariável de Poisson. Apenas uma variável relacionada ao local de trabalho da mulher mostrou associação significativa com o desfecho. Trabalhar durante o dia aumentou em 37% a prevalência da amamentação por 12 meses ou mais. Os fatores não relacionados ao trabalho da mulher que mostraram associação positiva com o desfecho: mãe sem curso superior, experiência de amamentação superior a 12 meses; criança não receber outro leite quando a mãe retornou ao trabalho e não ter usado chupeta. Por outro lado, maior idade da mãe, maior idade gestacional, apoio do cuidador da criança e apoio profissional na amamentação associaram-se negativamente ao desfecho. Fatores não relacionados diretamente ao trabalho materno tiveram maior participação na continuidade da amamentação por 12 meses ou mais.

Fatores associados à continuidade do aleitamento materno por 12 meses ou mais em mulheres trabalhadoras de um hospital geral / Factors associated with breastfeeding continuation for 12 months or more among working mothers in a general hospital

Resumo O objetivo deste estudo é identificar fatores associados à continuidade da amamentação por 12 meses ou mais em mulheres trabalhadoras. Estudo transversal realizado por meio de entrevista com 251 trabalhadoras de um hospital, com filhos biológicos entre 12 e 36 meses de idade, não gemelares e sem doença que afetasse a amamentação, e amamentando quando do seu retorno ao trabalho. Para a associação entre a continuidade da amamentação e as variáveis de exposição utilizou-se a regressão multivariável de Poisson. Apenas uma variável relacionada ao local de trabalho da mulher mostrou associação significativa com o desfecho. Trabalhar durante o dia aumentou em 37% a prevalência da amamentação por 12 meses ou mais. Os fatores não relacionados ao trabalho da mulher que mostraram associação positiva com o desfecho: mãe sem curso superior, experiência de amamentação superior a 12 meses; criança não receber outro leite quando a mãe retornou ao trabalho e não ter usado chupeta. Por outro lado, maior idade da mãe, maior idade gestacional, apoio do cuidador da criança e apoio profissional na amamentação associaram-se negativamente ao desfecho. Fatores não relacionados diretamente ao trabalho materno tiveram maior participação na continuidade da amamentação por 12 meses ou mais.

Abstract This article aims to identify factors associated with breastfeeding continuation for at least 12 months among working mothers in a hospital in the south of Brazil. We conducted a cross-sectional study, interviewing 251 women who breastfed after returning to work. Eligibility criteria included non-twin biological children aged between 12 and 36 months and the absence of an illness (mother and/or child) that could affect breastfeeding. The association between breastfeeding continuation and the exposure variables was tested using Poisson multivariate regression. Only one work-related variable showed a significant association with the outcome. Working only during the day increased the prevalence of BF continuation for at least 12 months by 37%. The following non-work-related factors showed a positive association with the outcome: mothers without a college degree; mothers with at least 12 months' prior breastfeeding experience; child not given milks other than breast milk when the mother returned to work, and not using a pacifier. The following variables showed a negative association with the outcome: older maternal age; older gestational age; mother receiving support from the child's caregiver; and mother receiving professional breastfeeding support. Non-work-related factors had a greater influence on breastfeeding continuation for at least 12 months among working mothers.

Exploring the experiences of individuals with an insertable cardiac monitor: Making the decision for device insertion.

BACKGROUND: Little is known about the decision-making process for insertable cardiac monitors (ICM) in those with suspected arrhythmias. OBJECTIVE: The purpose of this qualitative study was to describe how individuals make a decision to insert an ICM. METHODS: A qualitative descriptive design was used. Data were analyzed using content analysis and constant comparison. NVivo 10 was used for data grouping and patterns. RESULTS: Participants (N = 12) ranged in age from 41to 95. Most (n = 7) had the device inserted because of syncope or atrial fibrillation (AF), and others (n = 5) for cryptogenic stroke. Three categories emerged: pre-decision, definitive decision, and deliberated decision. Event symptoms, including physical, cognitive and emotional, and trust emerged as factors in decision-making. CONCLUSIONS: Those who perceived their experience as life-threatening, trusted the healthcare provider and assented to the ICM insertion. Conversely, those who perceived symptoms as episodic, used other strategies to resolve symptoms prior to making the decision for insertion.

Environmental Assessment and Evaluation of Oxidative Stress and Genotoxicity Biomarkers Related to Chronic Occupational Exposure to Benzene.

Environmental and occupational exposure to benzene from fuels is a major cause for concern for national and international authorities, as benzene is a known carcinogen in humans and there is no safe limit for exposure to carcinogens. The objective of this study was to evaluate the genotoxic effects of chronic occupational exposure to benzene among two groups of workers: filling station workers (Group I) and security guards working at vehicles entrances (Group II), both on the same busy highway in Rio de Janeiro, Brazil. Sociodemographic data on the workers were evaluated; the concentration of benzene/toluene (B/T) in atmospheric air and individual trans,trans-muconic acid (ttMA) and S-phenylmercapturic acid (S-PMA) were measured; oxidative stress was analyzed by catalase (CAT), glutathione S-transferase (GST), superoxide dismutase (SOD), thiol groups (THIOL) and malondialdehyde (MDA); genotoxicity was measured by metaphases with chromosomal abnormalities (MCA) and nuclear abnormalities, comet assay using the enzyme formamidopyrimidine DNA glycosylase (C-FPG), and methylation of repetitive element LINE-1, CDKN2B and KLF6 genes. Eighty-six workers participated: 51 from Group I and 35 from Group II. The B/T ratio was similar for both groups, but Group I had greater oscillation of benzene concentrations because of their work activities. No differences in ttMA and S-PMA, and no clinical changes were found between both groups, but linearity was observed between leukocyte count and ttMA; and 15% of workers had leukocyte counts less than 4.5 × 109 cells L-1, demanding close worker's attention. No differences were observed between the two groups for THIOL, MDA, MCA, or nuclear abnormalities. A multiple linear relationship was obtained for the biomarkers MCA and C-FPG. A significant correlation was found between length of time in current job and the biomarkers C-FPG, MCA, GST, and MDA. Although both populations had chronic exposure to benzene, the filling station workers were exposed to higher concentrations of benzene during their work activities, indicating an increased risk of DNA damage.

An efficient analytical method for determination of S-phenylmercapturic acid in urine by HPLC fluorimetric detector to assessing benzene exposure.

Benzene is an important occupational and environmental contaminant, naturally present in petroleum and as by-product in the steel industry. Toxicological studies showed pronounced myelotoxic action, causing leukemic and others blood cells disorders. Assessing of benzene exposure is performed by biomarkers as trans, trans-muconic acid (AttM) and S-phenylmercapturic acid (S-PMA) in urine. Due to specificity of S-PMA, this biomarker has been proposed to asses lower levels of benzene in air. The aim of this study was to validate an analytical method for the quantification of S-PMA by High-Performance Liquid Chromatography with fluorometric detector. The development of an analytical method of S-PMA in urine was carried out by solid phase extraction (SPE) using C-18 phase. The eluated were submitted to water bath at 75°C and nitrogen to analyte concentration, followed by alkaline hydrolysis and derivatization with monobromobimane. The chromatography conditions were reverse phase C-18 column (240mm, 4mm and 5µm) at 35°C; acetonitrile and 0.5% acetic acid (50:50) as mobile phase with a flow of 0.8mL/min. The limits of detection and quantification were 0.22µg/L and 0.68µg/L, respectively. The linearity was verified by simple linear regression, and the method exhibited good linearity in the range of 10-100µg/L. There was no matrix effect for S-PMA using concentrations of 40, 60, 80 and 100µg/L. The intra- and interassay precision showed coefficient of variation of less than 10% and the recovery ranged from 83.4 to 102.8% with an average of 94.4%. The stability of S-PMA in urine stored at -20°C was of seven weeks. The conclusion is that this method presents satisfactory results per their figures of merit. This proposed method for determining urinary S-PMA showed adequate sensitivity for assessment of occupational and environmental exposure to benzene using S-PMA as biomarker of exposure.

Normas ocupacionais do benzeno: uma abordagem sobre o risco e exposição nos postos de revenda de combustíveis / Occupational regulation for benzene: an approach on risk and exposure in gas stations

Resumo Introdução: trabalhadores estão sujeitos a riscos decorrentes da exposição ambiental e ocupacional ao benzeno, situação ainda mais crítica quando associada a fatores como desigualdade social, múltipla exposição, suscetibilidade individual, degradação ambiental e às possíveis interações entre os contaminantes ambientais. Além disso, nem sempre as regulamentações são estabelecidas e/ou atualizadas apenas a partir de achados científicos, pois são processos permeados por conflitos de interesses. Objetivo: realizar análise crítica sobre a identificação de risco e avaliação da exposição ao benzeno. Métodos: revisão bibliográfica e documental do marco normativo brasileiro e internacional sobre exposição ao benzeno, com relação aos aspectos toxicológicos, de exposição ocupacional e ambiental e de avaliação de risco. Discussão: o controle da exposição ao benzeno permeia o campo da disputa técnico-política de saúde e segurança, constituindo-se em marco regulatório resultante de consenso de entendimentos. Esses entendimentos são marcados pela disputa entre a proteção à saúde e a gestão empresarial das condições de trabalho, em detrimento das evidencias científicas. Em tal contexto, os Limites de Exposição Ocupacional podem variar significativamente entre os países e agências, apesar do reconhecimento universal de que não há limites seguros para exposição ao benzeno, por ser um composto carcinogênico.

Abstract Introduction: workers are subject to risks from environmental and occupational exposure to benzene. This situation is even more critical when combined with social inequality, multiple exposure, individual susceptibility, environmental degradation, and possible interactions between environmental contaminants. In addition, regulations are not always established and/or updated only from scientific evidences, because they are processes permeated by conflicts of interest. Objective: to produce a critical analysis on risk identification and benzene exposure evaluation. Methods: literature and documentary review of the Brazilian and international regulatory standards on benzene exposure, toxicological aspects, occupational and environmental exposure, and risk evaluation. Discussion: benzene exposure control permeates the technical-political dispute of health and safety, resulting in a regulatory standard from consensus of understandings. These understandings are shaped by the dispute between health protection and business management of working conditions, to the detriment of scientific evidence. In this context, the Occupational Exposure Limits can vary significantly between countries and agencies, despite the universal recognition that there are no safe limits for benzene exposure, because it is a carcinogenic compound.

Partnership With Parents of Technology-Dependent Children: Clarification of the Concept.

A strategy based on the Hybrid Model of Concept Development was used to integrate previous concept analyses and research with data from interviews with parents and nurses caring for children dependent on technology to clarify the concept. Partnership was generally described positively in the literature, but some cautions were noted. Six characteristics of partnering were identified from the fieldwork data: respect, flexibility, caring professionalism, communication, acknowledgment of parental control, and support for parents. The concept of participation is clarified and extended to a unique area of nursing practice, the care of children dependent on technology in the home.

Parents' descriptions of ideal home nursing care for their technology-dependent children.

Home care for technology-dependent children is one of the fastest growing segments of the U.S. health care industry, but nursing literature lacks clear directions to guide home care nurses in planning a family-centered practice. The purpose of this study was to address this gap in the literature by eliciting descriptions of ideal home nursing care for technology-dependent children from the perspective of their parents. A qualitative, descriptive design with formal, semi-structured interviews was used. Seven participants (three couples and one mother) were interviewed. Data analysis revealed four components of ideal home nursing care: 1) competence in technical, assessment, clinical decision-making, and problem-solving skills; 2) a caring manner; 3) relinquishing control of the child's care to the parents; and 4) fitting in with the family and their routines. These findings have implications for both home care nurses and the care managers who supervise the care of children who are technology dependent and their families.

A concepção de técnicos e auxiliares de enfermagem em relação ao cuidar de idosos / The understanding of nursing technicians and a auxiliaries of how to care for the elderley / La concepción de técnicos y auxiliares de enfermería respecto los cuidados a personas mayores

Neste estudo de natureza qualitativa, o objetivo é identificar as concepções de velhice na ótica de auxiliares e técnicos de enfermagem e analisar as implicações de tais concepções para o cuidar/cuidado de enfermagem ao idoso. Os dados, colhidos em uma instituição que cuida de pessoas idosas na cidade de Juiz de Fora-MG, mediante a aplicação de entrevista semi-estruturada, foram submetidos à análise temática de conteúdo, que levou às seguintes categorias e suas respectivas subcategorias: Categoria 1: Concepções sobre a velhice: envelhecer como privilégio, envelhecer como perda; Categoria 2: Concepções do cuidado ao idoso: motivação para o cuidar, desenvolvendo o cuidado. Os sujeitos deste estudo apresentaram concepções que abarcam as duas faces do envelhecimento, os ganhos e as perdas, mostrando a dialética do processo de envelhecimento. A experiência de cuidar de pessoas idosas torna-se uma oportunidade de aprendizado, de trocas e de reflexão, no entanto, ressalte-se que ainda é marcante a maneira fragmentada de cuidar desenvolvida pelos auxiliares e técnicos de enfermagem participantes do estudo. O cuidado visto como desenvolvimento de procedimentos mostra o modo como o serviço de enfermagem está organizado, o que baliza a necessidade de uma nova reorientação que envolva todos os requisitos para o processo de cuidar. O cuidado ao idoso deve ser permeado por qualidades humanas como empatia, sensibilidade e paciência.

This research tries to comprehend better the actions related to elderly cares. Our objectives are both to identify old age conceptions from auxiliaries and technicians as well as the relation between these conceptions and the elderly nursing care. The data were collected from an institution which cares elderly from Juiz de Fora - MG, through the application of a semi structured interview. After submitting the data gathered to a thematic content analysis, the results leaded us to two categories which are: 1) old conceptions - to become older as a privilege, to become older as a loss; 2) elderly care conceptions - motivation to care, developing the care. The interviewed group presented conceptions that involve two aging faces: the gains and the wastages showing the aging dialect. Taking care of old people becomes a great opportunity of learning, change and reflection as well. Despite of this the ways used by the interviewed group are still fragmented. The care as a procedure development shows the way as nursing service is organized. It makes clear the necessity of a reorientation which involves all the care process steps. The elderly care should be full of human qualities as sensibility and patience, sensibility and geniality.

Buscamos comprender las acciones que participan del cuidado de mayores. Los objetivos de este estudio son identificar las concepciones de vejez a partir de la óptica de auxiliares y técnicos de enfermería y analizar las implicaciones de tales concepciones en el cuidado de enfermería al anciano. Los datos fueron recogidos en una institución que cuida de personas mayores en la ciudad de Juiz de Fora - MG, a través de la aplicación de encuesta semiestructurada. Estos datos fueron sometidos a análisis de contenido temático, que llevó a las siguientes categorías y sus respectivas subcategorías: 1) Concepciones sobre la vejez - envejecerse como privilegio, envejecer como pérdida; 2) Concepción del cuidado al mayor - motivación para cuidar, desarrollando el cuidado. Los sujetos del estudio presentaron concepciones que abarcan los dos lados del envejecimiento: las ganancias y las pérdidas, enseñando la dialéctica del proceso de envejecimiento. La experiencia de cuidar de personas mayores se convierte en una oportunidad de aprendizaje, de cambios y de reflexión, sin embargo se resalta que todavía es marcado el modo fragmentado de cuidar desarrollado por auxiliares y técnicos de enfermería participantes del estudio. El cuidado visto como desarrollo de procedimientos enseña el modo como el servicio de enfermería está organizado, lo que apunta hacia la necesidad de uma nueva reorientación que envuelve todos los requisitos para el proceso de cuidar. El cuidado al anciano debe ser atravesado por cualidades humanas como simpatía, sensibilidad y paciencia.

Evaluation of Short-term Exposure to Rosmarinus officinalis on Male Swiss Mice's Organs and Reproductive System

Rosemary (Rosmarinus officinalis L. - Labiatae) is a plant in the treatment of urinary disorders, dysmenorhea and respiratory problems. Rosemary toxicity was evaluated in famale rats and an anti-implantation effect was reported after treatment with an aqueous extract of this plant. This works analyzes the effect of a short-term administration of R. officinalis aqueous extract on vital organs, on the organs of the reproductive system and sperm concentration of mature male Swiss mice. Treated animals received 260 mg/kg of body weight for five days. Body and organs weights, sperm production and food consumption were evaluated. This preliminary investigation reports that no body weight reduction and no toxic effect on the organd, gamete production or food intake were detected in any of the groups analyzed, given the experimental protocol used.