Satisfação das mulheres com a amamentação no primeiro mês pós-parto : fatores associados e validação de instrumento

Introdução: O sucesso no aleitamento materno tem sido medido, basicamente, pela sua duração, desconsiderando a satisfação da mulher e da criança com a amamentação. Esse aspecto é muito importante, podendo impactar, inclusive, na duração dessa prática. Entretanto, são raros os estudos dedicados à pesquisa do grau de satisfação das mulheres com a amamentação, sobretudo no Brasil, e pouco se sabe sobre os seus determinantes. Atualmente, existe disponível na literatura apenas um instrumento para avaliar a percepção materna de sucesso na amamentação, o Maternal Breastfeeding Evaluation Scale (MBFES), proposto em 1994 por autoras norte-americanas. O instrumento foi publicado em inglês e validado nos Estados Unidos, sendo também utilizado em outros países de língua inglesa. Foi também traduzido e validado em outros países, mas não no Brasil. Objetivos: (1) validar o instrumento MBFES para a população brasileira; (2) medir o grau de satisfação das mulheres com a amamentação no primeiro mês de vida de seus filhos em uma população brasileira; e (3) identificar os fatores associados à satisfação dessas mulheres com a amamentação nesse período. População e Métodos: Foi realizado estudo transversal aninhado a uma coorte envolvendo 287 duplas mãe-bebê recrutadas em duas maternidades de Porto Alegre, RS, uma pública e outra privada, entre janeiro e julho de 2016. Foram incluídas aleatoriamente mulheres residentes no município de Porto Alegre que tiveram recém-nascidos vivos, não gemelares, com idade gestacional maior ou igual a 37 semanas e que tivessem iniciado a amamentação. Não foram incluídas as residentes em áreas com alto índice de violência. Na semana seguinte à criança completar 30 dias, as mulheres foram entrevistadas em seus domicílios ou outro local de sua preferência, sendo aplicado um questionário estruturado para obtenção de informações sobre características sociodemográficas, saúde da mulher, última gestação e atenção pré-natal, ao parto e no pós-parto, além de algumas informações sobre o primeiro mês de vida da criança. Para o processo de validação do instrumento foi realizada análise fatorial com rotação varimax. Para a validação de constructo, quatro hipóteses foram testadas pelo teste T não pareado. A análise de confiabilidade foi realizada utilizando o coeficiente alfa de Cronbach. A satisfação da mulher com a amamentação foi medida pelo MBFES. As associações entre satisfação da mulher com a amamentação e as diversas variáveis explanatórias avaliadas foram estimadas pela regressão multivariável de Poisson com variância robusta em abordagem hierarquizada com quatro níveis. O grau de satisfação da mulher foi categorizado tendo como ponto de corte a mediana da pontuação obtida no MBFES. As mulheres com pontuação igual ou acima da mediana foram consideradas as de maior satisfação e as com pontuação abaixo da mediana, as com menor satisfação. Resultados: Quanto à validação do instrumento de medição do grau de satisfação da mulher com a amamentação, os resultados da análise fatorial exploratória identificaram a necessidade de exclusão de um item e a reformulação das subescalas. A validação de constructo mostrou que todas as hipóteses propostas foram confirmadas: as mulheres que estavam amamentando, as que estavam em amamentação exclusiva, as que não apresentavam problemas relacionados à amamentação e aquelas com intenção de amamentar por pelo menos 12 meses apresentaram valores médios significativamente superiores na escala. O instrumento na sua íntegra apresentou consistência interna adequada (alfa de Cronbach = 0,88; IC 95%: 0,86-0,90), assim como as subescalas prazer e realização do papel materno (0,92; IC95%: 0,91-0,93), crescimento, desenvolvimento e satisfação infantil (0,70; IC 95%: 0,65-0,75) e aspectos físico, social e emocional materno (0,75; IC 95%: 0,70-0,79). A satisfação da mulher com a amamentação no primeiro mês pós-parto foi alta, pois a mediana da pontuação obtida no MBFES (124 pontos) se aproximou do escore máximo (145 pontos). A prevalência de maior satisfação com a amamentação, ou seja, de ter uma pontuação igual ou maior que a mediana, foi maior entre as mulheres pardas e pretas (razão de prevalência [RP] 1,33; IC 95%: 1,05- 1,69), as que moravam com o pai do bebê (RP=1,75; IC 95%: 1,05-2,94), as que tinham intenção de amamentar por 12 meses ou mais (RP=1,48; IC 95%: 1,02-2,17) e as que não relataram problemas com pouca produção de leite (RP=1,47; IC 95%: 1,03-2,10) ou fissura mamilar (RP=1,29; IC 95%: 1,01-1,65). Conclusões: Conclui-se que (1) o MBFES, após a exclusão de um item e a reformulação das subescalas, mostrou ser um instrumento válido e confiável para ser aplicado à população brasileira; (2) o grau de satisfação das mulheres com a amamentação na população estudada foi alto; e (3) os fatores associados à satisfação dessas mulheres com a amamentação incluem fatores individuais e expectativas da mulher, constituição familiar e problemas relacionados com a amamentação.Introduction: Breastfeeding success has been measured basically based on its duration, disregarding mother and child satisfaction with the experience. This aspect is very important and may have impacts even on breastfeeding duration. Notwithstanding, studies aimed to investigate levels of maternal satisfaction with breastfeeding are rare, especially in Brazil, and little is known about their determinants. Currently, only one instrument is available in the literature to assess maternal perception of breastfeeding success, namely the Maternal Breastfeeding Evaluation Scale (MBFES), developed in 1994 by American authors. The instrument was originally published in English and validated for use in the United States, and has been used in other English-speaking countries. It has also been translated and validated in other countries, but not in Brazil. Objectives: The objectives of the present study were: (1) to validate the MBFES instrument for use in the Brazilian population; (2) to measure the level of maternal satisfaction with breastfeeding in the first month postpartum in a Brazilian population; and (3) to identify factors associated with the satisfaction of these women with breastfeeding in this period. Patients and methods: A cross-sectional study nested within a cohort was conducted with 287 mother-child dyads recruited at two maternity wards in the municipality of Porto Alegre, state of Rio Grande do Sul, one public and one private, between January and July 2016. Women residing in the municipality of Porto Alegre who had given birth to a healthy newborn, singleton, with gestational age ≥ 37 weeks, and who had initiated breastfeeding, were randomly included. Women residing in areas considered to be dangerous were not included. The week after the child completed 30 days of life, the women were interviewed at their homes or at a location of their choice, and a structured questionnaire was used to collect data on sociodemographic characteristics, maternal health, latest pregnancy, prenatal, labor and postpartum care, in addition to some data on the first month of life of the baby. For the instrument validation process, factor analysis with varimax rotation was conducted. For construct validation, four hypotheses were tested using the unpaired t test. Reliability analysis was performed using Cronbach’s alpha coefficient. Maternal satisfaction with breastfeeding was measured using the MBFES. Associations between maternal satisfaction with breastfeeding and the different explanatory variables assessed were estimated using multivariate Poisson regression with robust variance in a four-level hierarchical approach. Maternal satisfaction level was categorized using as cutoff point the median score obtained with the MBFES. Women with scores equal to or above the median were considered to have higher levels of satisfaction, whereas those scoring below the median were considered to be less satisfied. Results: With regard to MBFES validation, the results of the exploratory factor analysis identified the need to exclude one item and to reformulate the subscales. Construct validation showed that all proposed hypotheses were confirmed: women who were breastfeeding, who were exclusively breastfeeding, who did not present breastfeeding-related problems, and who planned to breastfeed for at least 12 months showed significantly higher mean scores. The instrument as a whole showed adequate internal consistency (Cronbach’s alpha = 0.88; 95%CI 0.86-0.90), as did the subscales pleasure and fulfillment of the maternal role (0.92; 95%CI 0.91-0.93), child growth, development, and satisfaction (0.70; 95%CI 0.65-0.75), and maternal physical, social, and emotional aspects (0.75; 95%CI 0.70-0.79). Maternal satisfaction with breastfeeding in the first month postpartum was high: the median score obtained with MBFES (124 points) was close to the maximum score (145 points). The prevalence of higher levels of satisfaction with breastfeeding, i.e., of scoring above the median, was higher among women with brown (pardo) and black skin color (prevalence ratio [PR] 1.33, 95%CI 1.05-1.69), who lived with the baby’s father (PR 1.75, 95%CI 1.05-2.94), planned to breastfeed for 12 months or more (PR 1.48, 95%CI 1.02-2.17), and did not report problems such as low milk supply (PR 1.47, 95%CI 1.03-2.10) or cracked nipples (PR 1.29, 95%CI 1.01-1.65). Conclusions: The present findings suggest that (1) following exclusion of one item and reformulation of subscales, the MBFES can be considered a valid and reliable instrument for use in the Brazilian population (2) the level of maternal satisfaction with breastfeeding in the studied population was high; and (3) factors associated with maternal satisfaction with breastfeeding include individual factors and maternal expectations, family constitution, as well as breastfeeding-related problems

Challenges and Dilemmas for Dental Undergraduate Teaching with the Advent of COVID-19

Since the 1980s, the development of neoliberalism has been observed in Brazil, which has led to the progressive weakening of public policies (including those of education) and the population's impoverishment. In the field of education, there was an increase in the privatization of higher education, inadequate to the requirements of national development, characterizing it more as a commodity than as a right. This article aims to discuss some challenges, risks, and possible strategies to face the impact of the COVID19 pandemic in undergraduate dental education. This pandemic had an immediate and dramatic impact on dental education in more than 130 countries, prompting teachers and students to adopt remote teaching activities. In Brazil, theoretical classes were offered remotely, mainly in private institutions where there was an intensification of academic work for both teachers and students. This process requires support in technological and pedagogical aspects, including tools, resources, and training courses. In the resumption of clinical education, changes in biosafety actions are being proposed to preserve the health of the actors involved. The application of these measures will imply a great mobilization of students, teachers, and technicians and extra attention so that the constitutive dimensions of the teaching-learning process in health are not minimized or forgotten

Challenges and Dilemmas for Dental Undergraduate Teaching with the Advent of COVID-19

Since the 1980s, the development of neoliberalism has been observed in Brazil, which has led to the progressive weakening of public policies (including those of education) and the population's impoverishment. In the field of education, there was an increase in the privatization of higher education, inadequate to the requirements of national development, characterizing it more as a commodity than as a right. This article aims to discuss some challenges, risks, and possible strategies to face the impact of the COVID19 pandemic in undergraduate dental education. This pandemic had an immediate and dramatic impact on dental education in more than 130 countries, prompting teachers and students to adopt remote teaching activities. In Brazil, theoretical classes were offered remotely, mainly in private institutions where there was an intensification of academic work for both teachers and students. This process requires support in technological and pedagogical aspects, including tools, resources, and training courses. In the resumption of clinical education, changes in biosafety actions are being proposed to preserve the health of the actors involved. The application of these measures will imply a great mobilization of students, teachers, and technicians and extra attention so that the constitutive dimensions of the teaching-learning process in health are not minimized or forgotten

Hidden Comorbidities in Asthma: A Perspective for a Personalized Approach

: Bronchial asthma is the most frequent inflammatory non-communicable condition affecting the airways worldwide. It is commonly associated with concomitant conditions, which substantially contribute to its burden, whether they involve the lung or other districts. The present review aims at providing an overview of the recent acquisitions in terms of asthma concomitant systemic conditions, besides the commonly known respiratory comorbidities. The most recent research has highlighted a number of pathobiological interactions between asthma and other organs in the view of a shared immunological background underling different diseases. A bi-univocal relationship between asthma and common conditions, including cardiovascular, metabolic or neurodegenerative diseases, as well as rare disorders such as sickle cell disease, α1-Antitrypsin deficiency and immunologic conditions with hyper-eosinophilia, should be considered and explored, in terms of diagnostic work-up and long-term assessment of asthma patients. The relevance of that acquisition is of utmost importance in the management of asthma patients and paves the way to a new approach in the light of a personalized medicine perspective, besides targeted therapies

Fatal asthma; is it still an epidemic?

Asthma mortality has declined since the 1980s. Nevertheless the World Health Organization (WHO) identified asthma as responsible for 225.000 deaths worldwide in 2005, and 430.000 fatal cases are expected by 2030. Some unexpected and concentrated fatal asthma events all occurred between 2013 and 2015 in Veneto, a North Eastern region of Italy, which prompted a more in-depth investigation of characteristics and risk factors

Maternal satisfaction with breastfeeding in the first month postpartum and associated factors

Background:Breastfeeding success has been measured based on its duration, disregarding satisfaction with thematernal experience. Studies to investigate maternal satisfaction with breastfeeding are rare, especially in Brazil, andlittle is known about their determinants. The aim of this study was to measure the level of satisfaction withbreastfeeding in a group of women in the first month of their child’s life, and to identify factors associated withhigher maternal satisfaction.Methods:A cross-sectional study nested within a cohort was conducted with 287 women recruited at two (onepublic, one private) maternity services in the city of Porto Alegre, southern Brazil, from January to July 2016. Womenresiding in the municipality who had given birth to a healthy singleton born at term, were rooming in, and hadinitiated breastfeeding were randomly included. During the week after the child was 30 days old, women wereinterviewed at their homes to measure the level of maternal satisfaction with breastfeeding, using the MaternalBreastfeeding Evaluation Scale (MBFES), validated for use in the Brazilian population. Associations between maternalsatisfaction and explanatory variables were estimated using multivariate Poisson regression with robust variance ina four-level hierarchical approach. Satisfaction level was categorized using as cutoff point the median scoreobtained with the MBFES. Women with scores equal to or above the median were considered to have higher levelsof satisfaction, whereas those scoring below the median were considered to be less satisfied.Results:Maternal satisfaction with breastfeeding in the first month postpartum was high, with a median score of124 on MBFES, close to the maximum score (145 points). The prevalence of more elevated levels of satisfactionwith breastfeeding was higher among women with brown (pardo) and black skin color (prevalence ratio [PR] 1.33,95%CI 1.05;1.69), those who lived with the partner (PR 1.75, 95%CI 1.05;2.94), who planned to breastfeed for 12months or more (PR 1.48, 95%CI 1.02;2.17), and who did not report low milk supply (PR 1.47, 95%CI 1.03;2.10) orcracked nipples (PR 1.29, 95%CI 1.01;1.65).Conclusions:The factors associated with maternal satisfaction with breastfeeding in the first month postpartuminclude individual factors and maternal expectations, family constitution, as well as breastfeeding-related problems

Association between maternal satisfaction with breastfeeding and postpartum depression symptoms

Background Due to the multiple health benefits of breastfeeding, it is essential to identify factors that may negatively interfere with this healthy practice. Among such factors are postpartum depression (PPD) and maternal satisfaction with breastfeeding. The objective of this study was to evaluate the association between maternal satisfaction with breastfeeding and symptoms of PPD in the first month after childbirth. Methods This cross-sectional study nested in a cohort study was conducted in Porto Alegre, Brazil, with 287 puerperal women selected at two maternity hospitals, one public and one private. Women were interviewed at their homes the week after the infant completed 30 days of life. A structured questionnaire was applied, as well as instruments to evaluate maternal satisfaction with breastfeeding (Maternal Breastfeeding Evaluation Scale) and to screen for PPD (Edinburgh Postnatal Depression Scale). The association between higher satisfaction with breastfeeding (outcome) and negative PPD screening test was assessed using Poisson regression with robust variance, adjusting for specific covariables. Adjusted prevalence ratios (aPR) and respective 95% confidence intervals (95%CI) were estimated. Results The prevalence of increased satisfaction with breastfeeding (defined as women with scores above the median) was 47% higher among women who screened negative for PPD when compared to those with a positive result (aPR 1.47; 95%CI 1.01–2.16). This result was adjusted for maternal age and skin color, cohabitation with the infant’s father, planned pregnancy, type of delivery, exclusive breastfeeding, and occurrence of breastfeeding problems. Conclusions The findings of this study showed an association between higher maternal satisfaction with breastfeeding and absence of PPD symptoms, reinforcing the importance of caring for the mental health of pregnant and puerperal women and paying attention to their satisfaction with breastfeeding.Telemedicin

Drop-out rate among patients treated with omalizumab for severe asthma: Literature review and real-life experience

In patients with asthma, particularly severe asthma, poor adherence to inhaled drugs negatively affects the achievement of disease control. A better adherence rate is expected in the case of injected drugs, such as omalizumab, as they are administered only in a hospital setting. However, adherence to omalizumab has never been systematically investigated. The aim of this study was to review the omalizumab drop-out rate in randomized controlled trials (RCTs) and real-life studies. A comparative analysis was performed between published data and the Italian North East Omalizumab Network (NEONet) database

The relationship between facial skeletal class and expert-rated interpersonal skill: an epidemiological survey on young Italian adults

BACKGROUND: The facial region plays a major role in determining physical attractiveness, so we assessed the hypothesis that the capability of successfully managing interpersonal relationships in young adults might be related to the facial skeletal class. METHODS: 1,014 young subjects applying to the Military Academy of Pozzuoli, Italy, were enrolled and the cephalometric evaluation was performed by calculating the angular relationships between skeletal points localized by the lateral cephalogram of the face, sorting the subjects in three groups corresponding to each major facial skeletal class. Concurrently, the subjects were evaluated by a team of psychiatrists administering the MMPI-2 test followed by a brief colloquium with each candidate, in order to identify those subjects characterized by low skills for managing interpersonal relationships. RESULTS: According to the psychiatric evaluation about 20% of the subjects were considered potentially unable to manage successfully interpersonal relationships (NS). Males displayed an about two-fold increased risk of being NS. No differences were shown in the distribution of the NS male subjects among the three different facial skeletal classes. On the other hand, NS females displayed a different distribution among the three facial skeletal classes, with a trend of about two-fold and four-fold, respectively, for those subjects belonging to classes II and III, respect to those belonging to class I. CONCLUSION: Females may be more sensitive to physical factors determining beauty, such as the facial morphology certainly is. This finding appears to be interesting especially when thinking about possible orthodontic interventions, although further study is certainly needed to confirm these results