Risk factors for and protective factors against breastfeeding interruption before 2 years : a birth cohort study

Background: Little is known about the factors associated with the World Health Organization (WHO) recommendation of breastfeeding for at least 2 years. The objective of this study was to identify risk factors for and protective factors against breastfeeding interruption before 2 years of age. Methods: In this live birth cohort, mother and infant dyads were followed for 2 years. Data collection was performed at the maternity ward and subsequently at the children’s homes, monthly during the first 6months of life and then at 9, 12, 18, and 24 months. The outcome of interest was breastfeeding interruption before 2years of age. Median duration of breastfeeding was estimated using Kaplan-Meier’s survival analysis, and the associations were tested using Cox’s hierarchical multivariate model. Significance was set at 5%. Results: Data from a total of 1344 dyads were assessed. Median breastfeeding duration was 385 days. The following risk factors for breastfeeding interruption were identified: white skin color (adjusted hazard ratio [HRa]: 1.31; 95% confidence interval [95%CI]: 1.10–1.56), primiparity (HRa: 1.21; 95%CI: 1.05–1.40), working outside the home (HRa: 1.52; 95%CI: 1.30– 1.77), child sex male (HRa: 1.18; 95%CI: 1.03–1.35) and use of a pacifier (HRa: 3.46; 95%CI: 2.98–4.01). Conversely, the following protective factors were identified: lower family income (HRa: 0.81; 95%CI: 0.71–0.94), mother-infant bed-sharing (HRa:0.61, 95%CI: 0.52–0.73), on-demand breastfeeding in the first month (HRa: 0.64; 95%CI: 0.47–0.89) and exclusive breastfeeding at 4 months (HRa: 0.58, 95%CI: 0.48–0.70). Conclusions: The findings allowed to identify both risk factors for and protective factors against breastfeeding interruption before 2 years of age. Knowledge of these factors may help prevent this event and aid in the development of programs that help women maintain breastfeeding for at least 2 years, as recommended by the WHO

Consulta puerperal sob a ótica das puérperas

Objetivo: analisar o conhecimento de puérperas sobre a consulta puerperal. Métodos: estudo qualitativo de análise descritiva. Participaram 30 gestantes acima de 18 anos, em pós-parto imediato e internadas em um hospital maternidade de Feira de Santana-Bahia, em 2016. Foi realizada uma entrevista, orientada por um roteiro semiestruturado, com o uso de mídia digital do tipo gravação de áudio. Resultados: a partir da análise temática de conteúdo de Bardin, definiram-se duas categorias empíricas: “o (des)conhecimento das puérperas em relação à consulta puerperal” e “consulta puerperal: informações referidas pelas puérperas”. A maioria das puérperas entrevistadas revelou desconhecimento em relação à consulta puerperal. Desta forma, reflete-se sobre a assistência prestada às mulheres no ciclo gravídico puerperal com vista a promover um cuidado integral e individualizado. Conclusão: percebe-se a necessidade de proporcionar às puérperas maiores esclarecimentos sobre a consulta puerperal. &nbsp

Associação entre perineorrafia e problemas perineais, atividades habituais e necessidades fisiológicas afetadas

Introdução: A mulher em processo de parto está exposta a ocorrência de traumas perineais que podem estar associados à assistência. Objetivo: Verificar a associação entre a presença de perineorrafia e problemas perineais, atividades habituais e necessidades fisiológicas afetadas em  puérperas no pós-parto vaginal. Materiais e Métodos: Estudo transversal, composto por 870 puérperas com algum tipo de trauma perineal durante o parto vaginal. Os dados foram coletados através da entrevista estruturada e exame físico da região vulvoperineal e submetidos a análise descritiva e inferencial. Resultados: Houve associação estatisticamente significativa entre a episiorrafia e a ocorrência de edema (p<0,001), ardor (p=0,002) e dor (p=0,002). Concernente às atividades habituais e necessidades fisiológicas, mulheres com episiorrafia apresentaram maior dificuldade para vestir-se, deambular, sentar e dormir. Em contrapartida, apresentaram menor dificuldade para urinar e realizar higiene íntima. Discussão: Dentre os problemas perineais, observou-se diferença estatisticamente significativa quanto a ocorrência de edema, ardor e dor entre os grupos, sendo que as mulheres com episiorrafia relataram menos ardor perineal em comparação ao grupo com perineorrafia devido a laceração espontânea. Nesse sentido, preservar a integridade perineal das parturientes é algo necessário e possível na assistência obstétrica, visto que esse tipo de intervenção, por vezes desnecessária, desencadeará desconfortos que irão interferir no seu bem-estar durante o período puerperal. Conclusões: Os dados deste estudo permitiram verificar que há associação entre a perineorrafia e a ocorrência de problemas perineais e alterações para realização de atividades habituais no puerpério imediato.Como citar este artigo: Santos LM, Santos LMS, Brandão MM, Cerqueira EAC, Ramos MSX, Carvalho ESS. Associação entre perineorrafia e problemas perineais, atividades habituais e necessidades fisiológicas afetadas. Rev Cuid. 2018; 9(2): 2233-44. http://dx.doi.org/10.15649/cuidarte.v9i2.53

Oropharyngeal colostrum immunotherapy and nutrition in preterm newborns: meta-analysis

OBJECTIVE To investigated the effect of oropharyngeal colostrum immunotherapy in reducing the time required for very low birth weight preterm newborns (VLBW-PTNB: < 1,500g and < 37 weeks) to achieve full enteral nutrition. METHODS Literature search was conducted using four databases, including gray literature, with additional manual search of the references of selected articles. Eligibility criteria consisted of randomized clinical trials, without restriction regarding the date or language of the publication. Two independent reviewers performed the article selection and data extraction. The random-effects meta-analysis used a non-standard technique to assess the mean difference in days to achieve full enteral nutrition, carried out by the Stata 15 statistic program. RESULTS The systematic review comprised 10 studies, and five were selected for meta-analysis, with a population of 764 VLBW-PTNB and gestational age of birth between 25 and 32 weeks. The studies were conducted between 2011 and 2018 in North America, Asia and Africa, with only one conducted in South America. Altogether, they reported the number of days it took 708 VLBW-PTNB to achieve full enteral nutrition, with newborns treated with immunotherapy showing a shorter time in only three studies. Meta-analysis showed a mean difference of -4.26 days, (95% CI -7.44; -1.08d), with high heterogeneity (I2 = 83.1%). CONCLUSION The use of oropharyngeal colostrum immunotherapy can reduce the time for VLBW-PTNB to achieve full nutrition when compared to those who used a placebo or received routine care.

Maternal anemia and birth weight : a prospective cohort study

Objective To investigate the association between maternal anemia and low/insufficient birth weight. Design A prospective cohort study of pregnant women who underwent prenatal care at the healthcare units in a municipality of northeast Brazil together with their newborn infants was carried out. The pregnant women were classified as having anemia when the hemoglobin level was below 11 g/dl. Infants who were born full term weighing less than 2500 grams were classified as low birth weight, and those weighing between 2500 and 2999 grams were classified as insufficient weight. The occurrence of maternal anemia and its association with birth weight was verified using crude and adjusted Relative Risk (RR) estimates with their corresponding 95% confidence intervals (95%CIs). Results The final sample was comprised of 622 women. Maternal anemia was considered a risk factor for low/insufficient birth weight, after adjusting the effect measurement for maternal age, family income, urinary infection, parity, alcoholic beverage consumption during pregnancy and gestational body mass index: RRadjusted = 1.38 [95% CI: 1.07 to 1.77]. Conclusions Maternal anemia was associated with low/insufficient birth weight, representing a risk factor for the gestational outcomes studied

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Associação entre perineorrafia e problemas perineais, atividades habituais e necessidades fisiológicas afetadas

Introduction: Women in the labor process are exposed to perineal traumas that may be associated with the care. Objective: The work sought to verify the association among the presence of perineorrhaphy and perineal problems, habitual activities and physiological needs affected in puerperae women during vaginal postpartum. Materials and Methods: A cross-sectional study, comprising 870 puerperal women with some type of perineal trauma during vaginal delivery. The data were collected through a structured interview and physical examination of the vulvoperineal region and submitted to descriptive and inferential analyses. Results: A statistically significant association was found between episiorrhaphy and the occurrence of edema (p <0.001), burning (p = 0.002), and pain (p = 0.002). Concerning the habitual activities and physiological needs, women with episiorrhaphy had greater difficulty getting dressed, ambulating, sitting, and sleeping. On the other hand, they had less difficulty urinating and performing intimate hygiene. Discussion: Among the perineal problems, a statistically significant difference was noted in the occurrence of edema, burning, and pain between the groups, given that women with episiorrhaphy reported less perineal burning compared to the group with perineorrhaphy due to spontaneous laceration. In this sense, preserving the perineal integrity of parturients is necessary and possible in obstetric care because this type of intervention, sometimes unnecessary, will trigger discomfort that will interfere with their well-being during the puerperal period. Conclusions: The data from this study permitted verifying association between the perineorrhaphy and the occurrence of perineal problems and alterations to carry out habitual activities during immediate puerperium.Introdução: A mulher em processo de parto está exposta a ocorrência de traumas perineais que podem estar associados à assistência. Objetivo: Verificar a associação entre a presença de perineorrafia e problemas perineais, atividades habituais e necessidades fisiológicas afetadas em puérperas no pós-parto vaginal. Materiais e Métodos: Estudo transversal, composto por 870 puérperas com algum tipo de trauma perineal durante o parto vaginal. Os dados foram coletados através da entrevista estruturada e exame físico da região vulvoperineal e submetidos a análise descritiva e inferencial. Resultados: Houve associação estatisticamente significativa entre a episiorrafia e a ocorrência de edema (p<0,001), ardor (p=0,002) e dor (p=0,002). Concernente às atividades habituais e necessidades fisiológicas, mulheres com episiorrafia apresentaram maior dificuldade para vestir-se, deambular, sentar e dormir. Em contrapartida, apresentaram menor dificuldade para urinar e realizar higiene íntima. Discussão: Dentre os problemas perineais, observou-se diferença estatisticamente significativa quanto a ocorrência de edema, ardor e dor entre os grupos, sendo que as mulheres com episiorrafia relataram menos ardor perineal em comparação ao grupo com perineorrafia devido a laceração espontânea. Nesse sentido, preservar a integridade perineal das parturientes é algo necessário e possível na assistência obstétrica, visto que esse tipo de intervenção, por vezes desnecessária, desencadeará desconfortos que irão interferir no seu bem-estar durante o período puerperal. Conclusões: Os dados deste estudo permitiram verificar que há associação entre a perineorrafia e a ocorrência de problemas perineais e alterações para realização de atividades habituais no puerpério imediato.Introducción: La mujer en proceso de parto está expuesta a la ocurrencia de traumas perineales que pueden estar asociados a la asistencia. Objetivo: Verificar la asociación entre la presencia de perineorrafia y problemas perineales, actividades habituales y necesidades fisiológicas afectadas en puérperas en el posparto vaginal. Materiales y Métodos: Estudio transversal, compuesto por 870 puérperas con algún tipo de trauma perineal durante el parto vaginal. Los datos fueron recolectados a través de entrevista estructurada y examen físico de la región vulvoperineal y sometidos a análisis descriptivo e inferencial. Resultados: Hubo asociación estadísticamente significativa entre la episiorrafia y la ocurrencia de edema (p <0,001), ardor (p = 0,002) y dolor (p = 0,002). En cuanto a las actividades habituales y necesidades fisiológicas, las mujeres con episiorrafia presentaron mayor dificultad para vestirse, deambular, sentarse y dormir. En contrapartida, presentaron menor dificultad para orinar y realizarse higiene íntima. Discusión: En los problemas perineales, se observó una diferencia estadísticamente significativa en cuanto a la ocurrencia de edema, ardor y dolor entre los grupos, siendo que las mujeres con episiorrafia refirieron menos ardor perineal en comparación al grupo con perineorrafia debido a la laceración espontánea. En este sentido, preservar la integridad perineal de las parturientas es algo necesario y posible en la asistencia obstétrica, dado que este tipo de intervención, a veces innecesaria, desencadenará en molestias que irán a interferir en su bienestar durante el período puerperal. Conclusiones: Los datos de este estudio permitieron verificar que hay asociación entre la perineorrafia y la ocurrencia de problemas perineales y alteraciones para la realización de actividades habituales en el puerperio inmediato

INCIDÊNCIA DE SEPSE TARDIA ENTRE RÉCEM-NASCIDOS PREMATUROS EM UMA MATERNIDADE NO INTERIOR DA BAHIA

Introdução/Objetivo: A sepse neonatal é uma síndrome clínica caracterizada por sinais sistêmicos de infecção, quando iniciada após 48 horas de vida é considerada como tardia1. Esse estudo objetivou avaliar o efeito da Imunoterapia Orofaríngea de Colostro (IOC) na redução da incidência de sepse dos Recém-nascidos Pré-Termo (RNPT) de Muito Baixo Peso (MBP) em hospital público do interior da Bahia. Método: Trata-se de uma coorte, ambispectivo realizado com grupo intervenção composto por RNPT de MBP em uso de IOC e grupo controle sem uso de IOC. O grupo intervenção foi tratado com a IOC, 4 gotas (0,2 mL) na mucosa orofaríngea direita e esquerda do RN, totalizando 8 administrações a cada 24 horas até 7° dia de vida completo e grupo controle constituído por RNPT de MBP nascidos nos três últimos anos antes da implementação da terapia (controle histórico). Dados coletados em 156 prontuários de mãe/filho (70 grupo tratamento/86 grupo controle). As variáveis consideradas foram sepse tardia, peso ao nascer, idade gestacional, tempo de uso de cateteres de inserção periférica (PICC) e tempo de ventilação mecânica (VM) invasiva. Análise dos dados feita com SPSS 24.0. Realizadas análises descritiva e bivariada. Aprovado pelo Comitê de Ética sob o CAAE:93056218.0.0000.0053 e registrado no ReBEC. Resultados: A incidência de sepse tardia foi de 20,0% no grupo controle e 22,9% no grupo tratamento (OR bruto = 0,844; 0,390-1,823; p-valor 0,697). As menores taxas de sepse podem ser explicadas a partir das características neonatais de idade gestacional maior que 28 semanas (72,6% vs 60,9%, p-valor 0,139) e peso ao nascer maior que 1.000 gramas (60,5% vs 58,6%, p-valor 0,801) no grupo controle e tratamento, respectivamente. Neste estudo, o grupo tratamento apresentou maior tempo de uso PICC e tempo de VM invasiva com medianas de 14 (4-23, p-valor 0,002) e 6 (1-24, p-valor 0,280) dias, respectivamente, em relação ao controle. Conclusão: De todo o exposto, não foi comprovado redução de sepse em recém-nascidos em uso de imunoterapia orofaríngea de colostro. Foi observado maior tempo de uso de PICC dos pacientes em uso de IOC. Novos estudos podem ajudar a avaliar o papel de terapia com colostro para os RNPT

Hearing Loss in the Elderly: A Proposal for Intervention in Primary Health Care

To evaluate the performance of professionals regarding knowledge about hearing loss in the elderly, through theoretical and practical training by a speech therapist. An intervention study was carried out with 87 Primary Health Care professionals in a municipality of Brazil. A survey of the participants’ knowledge related to hearing loss was performed using a data collection instrument composed of items related to both sociodemographic conditions and specific questions concerning the topic. This instrument was applied in two stages: before training and after training. The participants’ performance in relation to knowledge about hearing health was estimated by subtracting the post-training score from that obtained in pre-training. Participants were classified in higher performance (≥4 points) and lower performance (<4 points) groups. Other variables were collected: sex, age, occupation, schooling level, and length of professional service in health. The performance comparison estimated mean and the 95% confidence interval were calculated by the aforementioned variables using Student’s t -test. A comparison of these variables with higher performance was conducted using the X 2 test with a significance level of 5%. After training, there was an increase in the average performance of about 30% ( p  < .01). The highest performance was more frequent among professionals who reported having high school and below levels of education ( p  < .01) and who were community health agents ( p  = .01). The performance of the professionals regarding their knowledge about screening for hearing loss increased. The training showed low complexity and was feasible for health professionals

Association between hearing loss and cognitive decline in the elderly: A systematic review with meta-analysis study.

ObjectiveHearing loss has been pointed out as a potential predictor for cognitive decline. This study conducted a systematic review to evaluate the scientific evidence on the association between hearing loss in the elderly and cognitive decline, as well as whether race/color influences this relationship.MethodThe search for studies was performed in the following electronic databases: MedLine/PubMed Web of Science, Scopus and Virtual Health Library, and MedRkiv up to August 2022. Studies with epidemiological designs that assess the association between hearing loss and cognitive decline in the elderly were eligible for inclusion. Three independent reviewers performed the selection, data extraction and evaluation of the quality of the studies using the Newcastle-Ottawa Scale. A meta-analysis using a random effects model estimated the global association measurements (Beta coefficient: β) and their 95% confidence intervals (95%CI), and the Higgins and Thompson indicator (I2) was also estimated to assess statistical heterogeneity among the studies.Results5,207 records were identified in the database surveys, of which only 18 were eligible studies, totaling 19,551 individuals. Hearing loss was associated with cognitive decline in the elderly, with statistical significance: β = -0.13; 95%CI = -0.23 to -0.04; I2 = 98.70%). For black individuals, the magnitude of the association increased: β = -0.64; 95%CI = -3.36 to 2.07; I2 = 95.65%, but it was not statistically significant.ConclusionThe findings of this systematic review showed the existence of a significant relationship between hearing loss and cognitive decline in the elderly, as well as signaling that among black individuals the magnitude of the association can be increased