Determinants of the interruption of exclusive breastfeeding at the 30th day after birth.

OBJECTIVE: To estimate the prevalence of exclusive breastfeeding (EBF), introduction of water, herbal teas, or other milks, as well as to identify the factors associated with the interruption of EBF at the 30th day after birth. METHODS: This is a cross-sectional study using structured and pretested questionnaires applied to 310 mothers in two moments: in person, at the maternity ward; and at the time the infant was 30 days of age, by telephone call. Descriptive statistics and multivariate Poisson regression, following a multilevel hierarchical model according to the proximity to the outcome, were used to estimate the association between dependent and independent variables. RESULTS: The maintenance of EBF at 30 days of age of the infant occurred in 85.2% of the sample, 1.6% receiving water, 11.5% herbal teas, and 8.2% other milk. Predictors for EBF interruption in the univariate analysis were the mothers' return to work or study activities shortly after the baby's birth (IR 2.88; 95%CI 1.14-7.25) and the use of a pacifier (IR 3.29; 95%CI 1.52-6.22). The interruption of EBF was lower in the group of participants who received support from the infant's maternal grandmother (IR 2.71; 95%CI 1.11-6.56) and their partner (IR 4.78; 95%CI 1.90-12.06). After a multivariate analysis, only the use of a pacifier (IR 5.47; 95%CI 2.38-19.3) and the partner's support (IR 6.87; 95%CI 2.04-23.1) maintained the association with the outcome. CONCLUSIONS: The prevalence of EBF found in this study can be considered good, and future interventions aimed at increasing the duration of EBF in this population should take into account the participation of the partner and the reinforcement for not introducing the pacifier.

Determinants of the interruption of exclusive breastfeeding at the 30th day after birth / Determinantes para a interrupção do aleitamento materno exclusivo aos 30 dias de vida

ABSTRACT Objective: To estimate the prevalence of exclusive breastfeeding (EBF), introduction of water, herbal teas, or other milks, as well as to identify the factors associated with the interruption of EBF at the 30th day after birth. Methods: This is a cross-sectional study using structured and pretested questionnaires applied to 310 mothers in two moments: in person, at the maternity ward; and at the time the infant was 30 days of age, by telephone call. Descriptive statistics and multivariate Poisson regression, following a multilevel hierarchical model according to the proximity to the outcome, were used to estimate the association between dependent and independent variables. Results: The maintenance of EBF at 30 days of age of the infant occurred in 85.2% of the sample, 1.6% receiving water, 11.5% herbal teas, and 8.2% other milk. Predictors for EBF interruption in the univariate analysis were the mothers' return to work or study activities shortly after the baby's birth (IR 2.88; 95%CI 1.14-7.25) and the use of a pacifier (IR 3.29; 95%CI 1.52-6.22). The interruption of EBF was lower in the group of participants who received support from the infant's maternal grandmother (IR 2.71; 95%CI 1.11-6.56) and their partner (IR 4.78; 95%CI 1.90-12.06). After a multivariate analysis, only the use of a pacifier (IR 5.47; 95%CI 2.38-19.3) and the partner's support (IR 6.87; 95%CI 2.04-23.1) maintained the association with the outcome. Conclusions: The prevalence of EBF found in this study can be considered good, and future interventions aimed at increasing the duration of EBF in this population should take into account the participation of the partner and the reinforcement for not introducing the pacifier.

RESUMO Objetivo: Estimar a prevalência de aleitamento materno exclusivo (AME), introdução de água, chás ou outros leites, bem como identificar os fatores associados à interrupção do AME aos 30 dias de vida. Métodos: Estudo transversal que utilizou questionários estruturados e pré-testados, aplicados a 310 mães em dois momentos: presencialmente, na maternidade, e aos 30 dias de vida da criança, mediante ligação telefônica. Estatística descritiva e regressão multivariada de Poisson, seguindo modelo hierárquico multiníveis conforme a proximidade com o desfecho, estimaram a associação entre as variáveis dependentes e independentes. Resultados: A manutenção do AME aos 30 dias de idade da criança ocorreu em 85,2% da amostra, e 1,6 % receberam água, 11,5 % chás e 8,2% outro leite. Preditores para a interrupção do AME na análise univariada foram o retorno das mães ao trabalho ou estudo logo após o nascimento do bebê (razão de incidência — RI 2,88; intervalo de confiança — IC95% 1,14-7,25) e o uso de chupeta (RI 3,29; IC95% 1,52-6,22). A interrupção do AME foi menor no grupo de participantes que recebeu apoio da avó materna do lactente (RI 2,71; IC95% 1,11-6,56) e do companheiro (RI 4,78; IC95% 1,90-12,06). Após a análise multivariada, apenas o uso de chupeta (RI 5,47; IC95% 2,38-19,3) e o apoio do companheiro (RI 6,87; IC95% 2,04-23,1) mantiveram associação com o desfecho. Conclusões: A prevalência de AME encontrada neste estudo pode ser considerada boa, e futuras intervenções que visem ao aumento da duração do AME nessa população devem levar em consideração a participação do companheiro e o reforço para a não introdução da chupeta.

Pens versus syringes to deliver insulin among elderly patients with type 2 diabetes: a randomized controlled clinical trial.

BACKGROUND: Diabetes mellitus (DM) is a prevalent disease among elderly population. As the disease progresses, insulin may become necessary. The use of pens application seems to be more practical. However, the influence of this method on glycemic control needs to be defined in elderly people. METHODS: Randomized clinical trial comparing pens and syringes for insulin application among patients with type 2 DM over 60 years old and Glycated Hemoglobin > 8.5% at baseline. The follow-up was 24 weeks, with monthly medical visits to adjust the treatment. All patients received insulin NPH and, if necessary, insulin Regular. We assessed glycemic control, adherence to treatment, hypoglycemia occurrence, need for adjustment in treatment and impact on quality of life, RESULTS: We included 121 patients with mean age of 65.75 years. Sixty-one were randomized for pen group (PG) and 60 patients for syringe group (SG). At baseline, mean HbA1c was 10.34 ± 1.66% and 9.90 ± 1.25% (p = 0.103) in PG and SG respectively. Mean HbA1c was 8.39 ± 1.28% in PG and 8.85 ± 1.74% in SG (p = 0.101) at 24 weeks. However, there was a more significant reduction in PG (- 1.94 ± 1.93% in PG and - 1.04 ± 1.46% in SG, p < 0.05) during follow-up. We found no difference in treatment adherence rates, hypoglycemia, greater need for insulin doses or oral medication, and progression to basal-bolus insulin scheme. We also found no difference in the impact of the disease on quality of life between groups. CONCLUSION: Although we did not find any difference in the impact on quality of life, frequency of hypoglycemia or adherence, the PG showed a reduction in HbA1c higher in 24 weeks of follow-up. CLINICAL TRIAL REGISTRATION: NCT02517242.