Prevalence of congenital anomaly and its relationship with maternal education and age according to local development in the extreme south of Brazil

Congenital anomalies (CA) contribute to disabilities and health conditions throughout life. Furthermore, they can cause emotional distress to the mothers and children, who may also experience limitations in individual and social development. This study investigated the prevalence of CA and the relationship with maternal education and age according to local development in the extreme south of Brazil. This is a retrospective observational study with birth data from the Live Birth Information System from 2000 to 2017. The association between age and maternal education with the presence of CA was verified using multiple Poisson regression for robust variances in models adjusted for those variables with a preliminary significant association. A total of 5131 (1.5%) had some CA identified at birth between 2000 and 2017. Only advanced age (≥36 years) was associated with CA regardless of macro-region development (p ≤ 0.001). The highest risk was observed in regions with medium development (RR = 1.60; 95% CI 1.30–1.97). Maternal education (<8 years of study) was associated with CA only in mothers from macro-regions with very high development (RR = 1.27; 95% CI 1.03–1.54). These analyses confirmed that women of advanced age are at greater risk of having children with a CA regardless of maternal education and local development, but social characteristics can also have an influence, as regions with higher development had lower prevalence of CA

Maternal diet quality and associations with body composition and diet quality of preschool children : a longitudinal study

Background: Nutrition, associated with nutritional status, influences the growth of children. This study aimed to identify the association between maternal diet quality and the diet and body composition of their children. Methods: This is a prospective longitudinal study with mother-child pairs. To assess diet quality, nutritional status, and socioeconomic data, two interviews in the children's first and third months of life (2011-2016) and one interview when children were of preschool age (2017-2019) were performed. Diet quality was assessed based on daily food consumption and frequency, considering: 1) food groups, based on the Brazilian food pyramid; 2) level of processing, according to the NOVA classification (unprocessed and/or minimally processed foods, processed foods and ultra-processed foods). One-way ANOVA with Tukey post hoc and Kruskal-Wallis with Dunn's post hoc tests were used to evaluate the influence of factors on children's diet quality. Pearson and Spearman's correlations were used to evaluate the relationship between maternal and children's diet quality, maternal schooling level, and child age. Along with the nutritional assessment of children, multiple linear regression models assessed the impact of covariables on maternal and children's diet quality. Results: Eighty-three mother-child pairs participated in this study. The more frequent the maternal consumption of unprocessed and/or minimally processed foods, the higher the consumption of these foods by children (r = +0.30; p = 0.006) and the lower their subscapular skinfold (SSF) thickness (p = 0.011; β = -0.278). On the other hand, the higher the maternal consumption of ultra-processed foods, the higher the children's tricipital skinfold (TSF) thickness (p = 0.010; β = +0.274) and SSF (p = 0.043; β = +0.222). Conclusion: Maternal diet quality was associated with the diet and body composition of children

One year of a pandemic : experience of the Nutrition and Dietetics Department of a referral hospital for COVID-19 care

Introdução: A pandemia de coronavírus 2019 (COVID-19) trouxe mudanças nas organizações de trabalho em todas as esferas, exigindo a reestruturação das rotinas e das equipes para atender essa nova demanda. O objetivo foi relatar a experiência do Serviço de Nutrição e Dietética (SND) do Hospital de Clínicas de Porto Alegre (HCPA) e as mudanças vivenciadas durante o primeiro ano de pandemia de COVID-19. Métodos: Trata-se de um relato de experiência referente à atuação do SND do HCPA de abril de 2020 a março de 2021. Resultados: Houve aumento do absenteísmo no SND, necessitando ajustes de processos e remanejos. Também houve aumento do consumo de dietas enterais pela gravidade da situação clínica dos pacientes internados, a redução da capacidade do refeitório de funcionários para seguir os protocolos de distanciamento, o uso de utensílios descartáveis, mensagens motivacionais aos pacientes, ajustes no processo do banco de leite humano, modificações nos protocolos de avaliação nutricional ao paciente internado e atendimento ambulatorial remoto. Conclusão: Esta experiência proporcionou ao SND um grande legado de aprendizagem e superação, exigindo importantes adaptações, mantendo a qualidade do atendimento e fortalecendo as relações de trabalho em equipe.Introduction: The 2019 coronavirus disease (COVID-19) pandemic brought changes in work organization in all spheres, requiring the restructuring of routines and teams to meet this new demand. The aim of study was to report the experience of the Nutrition and Dietetics Department (NDD) of Hospital de Clínicas de Porto Alegre (HCPA) and the changes that occurred during the first year of the COVID-19 pandemic. Methods: This is an experience report of the performance of HCPA NDD from April 2020 to March 2021. Results: There was an increase in absenteeism in the NDD, requiring process adjustments and relocations. There was also an increase in enteral nutrition delivery due to the severity of the clinical condition of hospitalized patients, a reduction in the capacity of employees’ cafeteria to meet distancing protocols, and a need to use disposable utensils, deliver motivational messages to patients, make adjustments to the human milk bank process, and implement changes in nutritional assessment protocols for inpatients and remote outpatient care. Conclusion: This experience provided the NDD with a great legacy of learning and overcoming by requiring the NDD to adapt while maintaining quality service and strengthening teamwork relationships

Um ano de pandemia: experiência do Serviço de Nutrição e Dietética de um hospital de referência para atendimento de covid-19

Introduction: The 2019 coronavirus disease (COVID-19) pandemic brought changes in work organization in all spheres, requiring the restructuring of routines and teams to meet this new demand. The aim of study was to report the experience of the Nutrition and Dietetics Department (NDD) of Hospital de Clínicas de Porto Alegre (HCPA) and the changes that occurred during the first year of the COVID-19 pandemic. Methods: This is an experience report of the performance of HCPA NDD from April 2020 to March 2021. Results: There was an increase in absenteeism in the NDD, requiring processadjustments and relocations. There was also an increase in enteral nutrition delivery due to the severity of the clinical condition of hospitalized patients, a reduction in the capacity of employees’ cafeteria to meet distancing protocols, and a need to use disposable utensils, deliver motivational messages to patients, make adjustmentsto the human milk bank process, and implement changes in nutritional assessment protocols for inpatients and remote outpatient care.  Conclusion: This experience provided the NDD with a great legacy of learning and overcoming by requiring the NDD to adapt while maintaining quality service and strengthening teamwork relationships.Introdução: A pandemia de coronavírus 2019 (COVID-19) trouxe mudanças nas organizações de trabalho em todas as esferas, exigindo a reestruturação das rotinase das equipes para atender essa nova demanda. O objetivo foi relatar a experiência do Serviço de Nutrição e Dietética (SND) do Hospital de Clínicas de Porto Alegre(HCPA) e as mudanças vivenciadas durante o primeiro ano de pandemia de COVID-19.Métodos: Trata-se de um relato de experiência referente à atuação do SND do HCPA de abril de 2020 a março de 2021.Resultados: Houve aumento do absenteísmo no SND, necessitando ajustes de processos e remanejos. Também houve aumento do consumo de dietas enterais pelagravidade da situação clínica dos pacientes internados, a redução da capacidade do refeitório de funcionários para seguir os protocolos de distanciamento, o uso deutensílios descartáveis, mensagens motivacionais aos pacientes, ajustes no processo do banco de leite humano, modificações nos protocolos de avaliação nutricional ao paciente internado e atendimento ambulatorial remoto.Conclusão: Esta experiência proporcionou ao SND um grande legado de aprendizagem e superação, exigindo importantes adaptações, mantendo a qualidade do atendimento e fortalecendo as relações de trabalho em equipe

A comparação entre o índice de desenvolvimento humano da macrorregião de domicílio e a escolaridade materna com a mortalidade infantil no município de Porto Alegre

Introdução: a mortalidade infantil é um importante e sensível indicador de saúde em diversos países, sobretudo, nos subdesenvolvidos e naqueles em desenvolvimento. Por isso, o monitoramento constante das taxas de mortalidade infantil (MI) e dos seus fatores determinantes são fundamentais para a elaboração e planejamento de políticas públicas na área da saúde materno-infantil. Dessa forma, o presente estudo comparou o Índice de Desenvolvimento Humano Municipal (IDHM) da macrorregião de domicílio materno com a escolaridade materna e sua associação com a mortalidade infantil no município de Porto Alegre. Métodos: trata-se de um estudo de coorte retrospectivo com informações oriundas dos Sistemas de Informação em Saúde de Nascidos Vivos e de Mortalidade (SINASC e SIM). Posteriormente, se desenvolveu um linkage entre os dois bancos por intermédio do número da Declaração de Nascido Vivo, nome da mãe e data de nascimento. Adicionalmente foi incluída a variável IDHM das macrorregiões de domicílio materno e seus três componentes: IDHM Renda (IDHMR), IDHM Longevidade (IDHML) e IDHM Educação (IDHME), os quais, posteriormente, foram classificados em baixo, médio, alto e muito alto. A análise descritiva das variáveis foi apresentada como frequências absolutas e relativas. Para verificar a associação das variáveis qualitativas foi realizado o teste de Quiquadrado. A associação entre os fatores determinantes envolvidos (variáveis independentes) com o desfecho do estudo foi realizada por análise bivariada através da regressão de Poisson simples. Aquelas que demonstraram associação estatisticamente significativa (p<0,001) foram utilizadas numa regressão de Poisson múltipla para variâncias robustas – modelo ajustado. O estudo foi aprovado pelos Comitês de Ética em Pesquisa do Hospital de Clínicas de Porto Alegre (HCPA) e da Secretaria Municipal de Saúde de Porto Alegre (SMSPA) por intermédio, respectivamente, dos protocolos 2.940.235 e 3.153.671. Resultados: foram incluídos no estudo 311.361 crianças, das quais 2.271 foram a óbito. No presente estudo foram fatores de risco para a mortalidade infantil ser mãe solteira, separada ou viúva (RR= 1,95; IC95%: 1,77-2,15) ou com um pré-natal com um número inferior a sete consultas [nenhuma (RR=14,04 IC95%: 12,41-15,89) ou de 1 a 3 (RR= 7,53 IC95%: 6,73-8,43) ou de 4 a 6 (RR= 3,30; IC95%: 2,96-3,69)]; recém-nascidos com Índice de Apgar menor que sete no 5º minuto (RR= 42,82; IC95% 39,34-46,62), nascidos pré-termos [com idade gestacional igual ou menor que 27 semanas (RR=173,29; IC95% 159,58-188,17) ou de 28 a 21 (RR= 40,21; IC95%35,62-45,39) ou de 32 a 36 semanas (RR= 4,01; IC95% 3,53-4,55)] ou em hospital público (RR= 3,64; IC95% 3,15-4,21) ou misto (RR= 3,29; IC95% 2,82-3,84). Ao contrário, mães primíparas (RR=0,77; IC95% 0,71- 0,84) e recém-nascidos com peso maior que 2.500 gramas (RR=0,59; IC95% 0,05- 0,06) ou do sexo feminino (RR=0,88; IC95% 0,81-0,96) foram protetores. O IDHM da macrorregião de domicílio materno não apresentou associação com a MI, após ser controlado para escolaridade materna e ajustado para as demais variáveis confundidoras e/ou mediadoras. Diferentemente, a baixa escolaridade materna (<8 anos de estudo) demonstrou associação com a MI (p<0,001). Conclusão: o IDHM das macrorregiões do domicílio materno não mostrou associação com a MI, enquanto, ao contrário, a menor escolaridade materna mostrou influência. Assim, embora já consolidados na literatura, os fatores como o número de consultas pré-natais menor que sete, a idade gestacional menor que 37 semanas, o Índice de Apgar do recémnascido menor que sete, o baixo peso ao nascer (menor que 2.500 gramas) e o sexo masculino demonstraram associação com a mortalidade infantil em Porto Alegre. Nesse sentido, torna-se necessário reforçar a importância das políticas públicas existentes para o desenvolvimento de práticas assistenciais qualificadas na área da saúde materno-infantil.Background: infant mortality is an important and sensitive indicator of health in many countries, especially underdeveloped and developing countries. Therefore, constant monitoring of infant mortality rates and their determining factors are fundamental for the elaboration and planning of public policies in the area of maternal and child health. Thus, the present study compared the Municipal Human Development Index (MHDI) of the maternal household macro-region with maternal education and its association with infant mortality in the city of Porto Alegre. Methods: this is a retrospective cohort study with information from the Live Birth and Mortality Health Information Systems. Subsequently, a linkage between the two databases was developed through the Live Born Declaration number, mother's name and date of birth. Additionally, the MHDI variable of the maternal domicile macroregions and its three components were included: MHDI Income (MHDII), MHDI Longevity (MHDI) and MHDI Education (MHDIE), which were subsequently classified into low, medium, high and very high. The descriptive analysis of the variables was presented as absolute and relative frequencies. To verify the association of qualitative variables, the chisquare test was performed. The association between the determinant factors involved (independent variables) and the study outcome was performed by bivariate analysis using simple Poisson regression. Those that demonstrated a statistically significant association (p<0.001) were used in a multiple Poisson regression for robust variances - adjusted model. The study was approved by the Research Ethics Committees of the Hospital de Clínicas de Porto Alegre (HCPA) and the Secretaria Municipal de Saúde de Porto Alegre (SMSPA), respectively, through protocols 2,940,235 and 3,153,671. Results: the study included 311361 children, of whom 2271 died. In the present study were risk factors for infant mortality from being a single mother, separated or widowed (RR= 1.95; 95%CI: 1.77-2.15) or with a prenatal care with fewer than seven visits [ none (RR = 14.04 95% CI: 12.41-15.89) or from 1 to 3 (RR= 7.53 95%CI: 6.73-8.43) or from 4 to 6 (RR= 3.30; 95%CI: 2.96-3.69)]; newborns with an Apgar Index less than seven at the 5th minute (RR= 42.82; 95%CI 39.34-46.62), preterm infants [with a gestational age of 27 weeks or less (RR= 173.29; 95%CI 159.58-188.17) or 28 to 21 (RR= 40.21; 95%CI 35.62-45.39) or 32 to 36 weeks (RR = 4.01; 95% CI 3 , 53-4.55)] or in a public hospital (RR= 3.64; 95%CI 3.15-4.21) or mixed (RR= 3.29; 95%CI 2.82-3.84). In contrast, primiparous mothers (RR= 0.77; 95%CI 0.71-0.84) and newborns weighing more than 2,500 grams (RR= 0.59; 95%CI 0.05-0.06) or females (RR= 0.88; 95%CI 0.81-0.96) were protective. Conclusion: the MHDI of the macroregion of maternal domicile was not associated with infant mortality after being controlled for maternal education and adjusted for other confounding and/or mediating variables. In contrast, low maternal education (<8 years of schooling) was associated with infant mortality (p <0.001). Conclusion: The MHDI of the macroregions of the maternal domicile did not influence the IM, while, on the contrary, the lower maternal education showed an influence. Thus, although already consolidated in the literature, factors such as the number of prenatal consultations less than seven, gestational age less than 37 weeks, newborn Apgar score less than seven, low birth weight (less than 2,500 grams) and males showed an association with infant mortality at Porto Alegre. In this sense, it is necessary to reinforce the importance of existing public policies for the development of qualified care practices in the area of maternal and child health

A comparação entre o índice de desenvolvimento humano da macrorregião de domicílio e a escolaridade materna com a mortalidade infantil no município de Porto Alegre

Introdução: a mortalidade infantil é um importante e sensível indicador de saúde em diversos países, sobretudo, nos subdesenvolvidos e naqueles em desenvolvimento. Por isso, o monitoramento constante das taxas de mortalidade infantil (MI) e dos seus fatores determinantes são fundamentais para a elaboração e planejamento de políticas públicas na área da saúde materno-infantil. Dessa forma, o presente estudo comparou o Índice de Desenvolvimento Humano Municipal (IDHM) da macrorregião de domicílio materno com a escolaridade materna e sua associação com a mortalidade infantil no município de Porto Alegre. Métodos: trata-se de um estudo de coorte retrospectivo com informações oriundas dos Sistemas de Informação em Saúde de Nascidos Vivos e de Mortalidade (SINASC e SIM). Posteriormente, se desenvolveu um linkage entre os dois bancos por intermédio do número da Declaração de Nascido Vivo, nome da mãe e data de nascimento. Adicionalmente foi incluída a variável IDHM das macrorregiões de domicílio materno e seus três componentes: IDHM Renda (IDHMR), IDHM Longevidade (IDHML) e IDHM Educação (IDHME), os quais, posteriormente, foram classificados em baixo, médio, alto e muito alto. A análise descritiva das variáveis foi apresentada como frequências absolutas e relativas. Para verificar a associação das variáveis qualitativas foi realizado o teste de Quiquadrado. A associação entre os fatores determinantes envolvidos (variáveis independentes) com o desfecho do estudo foi realizada por análise bivariada através da regressão de Poisson simples. Aquelas que demonstraram associação estatisticamente significativa (p<0,001) foram utilizadas numa regressão de Poisson múltipla para variâncias robustas – modelo ajustado. O estudo foi aprovado pelos Comitês de Ética em Pesquisa do Hospital de Clínicas de Porto Alegre (HCPA) e da Secretaria Municipal de Saúde de Porto Alegre (SMSPA) por intermédio, respectivamente, dos protocolos 2.940.235 e 3.153.671. Resultados: foram incluídos no estudo 311.361 crianças, das quais 2.271 foram a óbito. No presente estudo foram fatores de risco para a mortalidade infantil ser mãe solteira, separada ou viúva (RR= 1,95; IC95%: 1,77-2,15) ou com um pré-natal com um número inferior a sete consultas [nenhuma (RR=14,04 IC95%: 12,41-15,89) ou de 1 a 3 (RR= 7,53 IC95%: 6,73-8,43) ou de 4 a 6 (RR= 3,30; IC95%: 2,96-3,69)]; recém-nascidos com Índice de Apgar menor que sete no 5º minuto (RR= 42,82; IC95% 39,34-46,62), nascidos pré-termos [com idade gestacional igual ou menor que 27 semanas (RR=173,29; IC95% 159,58-188,17) ou de 28 a 21 (RR= 40,21; IC95%35,62-45,39) ou de 32 a 36 semanas (RR= 4,01; IC95% 3,53-4,55)] ou em hospital público (RR= 3,64; IC95% 3,15-4,21) ou misto (RR= 3,29; IC95% 2,82-3,84). Ao contrário, mães primíparas (RR=0,77; IC95% 0,71- 0,84) e recém-nascidos com peso maior que 2.500 gramas (RR=0,59; IC95% 0,05- 0,06) ou do sexo feminino (RR=0,88; IC95% 0,81-0,96) foram protetores. O IDHM da macrorregião de domicílio materno não apresentou associação com a MI, após ser controlado para escolaridade materna e ajustado para as demais variáveis confundidoras e/ou mediadoras. Diferentemente, a baixa escolaridade materna (<8 anos de estudo) demonstrou associação com a MI (p<0,001). Conclusão: o IDHM das macrorregiões do domicílio materno não mostrou associação com a MI, enquanto, ao contrário, a menor escolaridade materna mostrou influência. Assim, embora já consolidados na literatura, os fatores como o número de consultas pré-natais menor que sete, a idade gestacional menor que 37 semanas, o Índice de Apgar do recémnascido menor que sete, o baixo peso ao nascer (menor que 2.500 gramas) e o sexo masculino demonstraram associação com a mortalidade infantil em Porto Alegre. Nesse sentido, torna-se necessário reforçar a importância das políticas públicas existentes para o desenvolvimento de práticas assistenciais qualificadas na área da saúde materno-infantil.Background: infant mortality is an important and sensitive indicator of health in many countries, especially underdeveloped and developing countries. Therefore, constant monitoring of infant mortality rates and their determining factors are fundamental for the elaboration and planning of public policies in the area of maternal and child health. Thus, the present study compared the Municipal Human Development Index (MHDI) of the maternal household macro-region with maternal education and its association with infant mortality in the city of Porto Alegre. Methods: this is a retrospective cohort study with information from the Live Birth and Mortality Health Information Systems. Subsequently, a linkage between the two databases was developed through the Live Born Declaration number, mother's name and date of birth. Additionally, the MHDI variable of the maternal domicile macroregions and its three components were included: MHDI Income (MHDII), MHDI Longevity (MHDI) and MHDI Education (MHDIE), which were subsequently classified into low, medium, high and very high. The descriptive analysis of the variables was presented as absolute and relative frequencies. To verify the association of qualitative variables, the chisquare test was performed. The association between the determinant factors involved (independent variables) and the study outcome was performed by bivariate analysis using simple Poisson regression. Those that demonstrated a statistically significant association (p<0.001) were used in a multiple Poisson regression for robust variances - adjusted model. The study was approved by the Research Ethics Committees of the Hospital de Clínicas de Porto Alegre (HCPA) and the Secretaria Municipal de Saúde de Porto Alegre (SMSPA), respectively, through protocols 2,940,235 and 3,153,671. Results: the study included 311361 children, of whom 2271 died. In the present study were risk factors for infant mortality from being a single mother, separated or widowed (RR= 1.95; 95%CI: 1.77-2.15) or with a prenatal care with fewer than seven visits [ none (RR = 14.04 95% CI: 12.41-15.89) or from 1 to 3 (RR= 7.53 95%CI: 6.73-8.43) or from 4 to 6 (RR= 3.30; 95%CI: 2.96-3.69)]; newborns with an Apgar Index less than seven at the 5th minute (RR= 42.82; 95%CI 39.34-46.62), preterm infants [with a gestational age of 27 weeks or less (RR= 173.29; 95%CI 159.58-188.17) or 28 to 21 (RR= 40.21; 95%CI 35.62-45.39) or 32 to 36 weeks (RR = 4.01; 95% CI 3 , 53-4.55)] or in a public hospital (RR= 3.64; 95%CI 3.15-4.21) or mixed (RR= 3.29; 95%CI 2.82-3.84). In contrast, primiparous mothers (RR= 0.77; 95%CI 0.71-0.84) and newborns weighing more than 2,500 grams (RR= 0.59; 95%CI 0.05-0.06) or females (RR= 0.88; 95%CI 0.81-0.96) were protective. Conclusion: the MHDI of the macroregion of maternal domicile was not associated with infant mortality after being controlled for maternal education and adjusted for other confounding and/or mediating variables. In contrast, low maternal education (<8 years of schooling) was associated with infant mortality (p <0.001). Conclusion: The MHDI of the macroregions of the maternal domicile did not influence the IM, while, on the contrary, the lower maternal education showed an influence. Thus, although already consolidated in the literature, factors such as the number of prenatal consultations less than seven, gestational age less than 37 weeks, newborn Apgar score less than seven, low birth weight (less than 2,500 grams) and males showed an association with infant mortality at Porto Alegre. In this sense, it is necessary to reinforce the importance of existing public policies for the development of qualified care practices in the area of maternal and child health

The influence of the municipal human development index and maternal education index and maternal education on infant mortality : an investigagion in a retrospective cohort study in the extreme south of Brazil

Background: Infant mortality is considered an important and sensitive health indicator in several countries, especially in underdeveloped and developing countries. Most of the factors influencing infant mortality are interrelated and are the result of social issues. Therefore, this study performed an investigation of the influence of the MHDI and maternal education on infant mortality in a capital in the extreme south of Brazil. Methods: It is a retrospective cohort study with data on births and deaths in the first year of life for the period of 2000–2017. The association between the independent variables and the outcome was done by bivariate analysis through simple Poisson regression. The variables that can potentially be considered confounding factors were used in a multiple Poisson regression for robust variances - adjusted model. Results: The study included 317,545 children, of whom 3107 died. The medium MHDI showed associated with infant death in the first year of life. Maternal education, individually and jointly analyzed with the MHDI, showed association with the outcome of infant death in the first year of life, particularly for children of mothers with lower maternal education (p < 0.001). In relation to other related factors, maternal age; number of Prenatal Care Consultations; gestational age, weight, gender and Apgar Index (5th minute) of the newborn showed association with IM (p < 0.001). Conclusions: The HDI is considered a good predictor of infant mortality by some authors and the analyzes of the present study also confirm an association of the medium MHDI and its low MHDIE component with infant mortality. In addition, it was maternal education with less than 8 years of study that that demonstrated a higher risk of death, revealing itself to be a social determinant with a relevant impact on infant mortality. Thus, it is possible to conclude that maternal education is available information, and it is superior to the MHDI to assess the infant mortality outcome

Prevalence of Congenital Anomaly and Its Relationship with Maternal Education and Age According to Local Development in the Extreme South of Brazil

Congenital anomalies (CA) contribute to disabilities and health conditions throughout life. Furthermore, they can cause emotional distress to the mothers and children, who may also experience limitations in individual and social development. This study investigated the prevalence of CA and the relationship with maternal education and age according to local development in the extreme south of Brazil. This is a retrospective observational study with birth data from the Live Birth Information System from 2000 to 2017. The association between age and maternal education with the presence of CA was verified using multiple Poisson regression for robust variances in models adjusted for those variables with a preliminary significant association. A total of 5131 (1.5%) had some CA identified at birth between 2000 and 2017. Only advanced age (&ge;36 years) was associated with CA regardless of macro-region development (p &le; 0.001). The highest risk was observed in regions with medium development (RR = 1.60; 95% CI 1.30&ndash;1.97). Maternal education (&lt;8 years of study) was associated with CA only in mothers from macro-regions with very high development (RR = 1.27; 95% CI 1.03&ndash;1.54). These analyses confirmed that women of advanced age are at greater risk of having children with a CA regardless of maternal education and local development, but social characteristics can also have an influence, as regions with higher development had lower prevalence of CA

Um ano de pandemia: experiência do Serviço de Nutrição e Dietética de um hospital de referência para atendimento de covid-19

Introduction: The 2019 coronavirus disease (COVID-19) pandemic brought changes in work organization in all spheres, requiring the restructuring of routines and teams to meet this new demand. The aim of study was to report the experience of the Nutrition and Dietetics Department (NDD) of Hospital de Clínicas de Porto Alegre (HCPA) and the changes that occurred during the first year of the COVID-19 pandemic. Methods: This is an experience report of the performance of HCPA NDD from April 2020 to March 2021. Results: There was an increase in absenteeism in the NDD, requiring processadjustments and relocations. There was also an increase in enteral nutrition delivery due to the severity of the clinical condition of hospitalized patients, a reduction in the capacity of employees’ cafeteria to meet distancing protocols, and a need to use disposable utensils, deliver motivational messages to patients, make adjustmentsto the human milk bank process, and implement changes in nutritional assessment protocols for inpatients and remote outpatient care.  Conclusion: This experience provided the NDD with a great legacy of learning and overcoming by requiring the NDD to adapt while maintaining quality service and strengthening teamwork relationships.Introdução: A pandemia de coronavírus 2019 (COVID-19) trouxe mudanças nas organizações de trabalho em todas as esferas, exigindo a reestruturação das rotinase das equipes para atender essa nova demanda. O objetivo foi relatar a experiência do Serviço de Nutrição e Dietética (SND) do Hospital de Clínicas de Porto Alegre(HCPA) e as mudanças vivenciadas durante o primeiro ano de pandemia de COVID-19.Métodos: Trata-se de um relato de experiência referente à atuação do SND do HCPA de abril de 2020 a março de 2021.Resultados: Houve aumento do absenteísmo no SND, necessitando ajustes de processos e remanejos. Também houve aumento do consumo de dietas enterais pelagravidade da situação clínica dos pacientes internados, a redução da capacidade do refeitório de funcionários para seguir os protocolos de distanciamento, o uso deutensílios descartáveis, mensagens motivacionais aos pacientes, ajustes no processo do banco de leite humano, modificações nos protocolos de avaliação nutricional ao paciente internado e atendimento ambulatorial remoto.Conclusão: Esta experiência proporcionou ao SND um grande legado de aprendizagem e superação, exigindo importantes adaptações, mantendo a qualidade do atendimento e fortalecendo as relações de trabalho em equipe