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

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

Perfil nutricional e bioquímico dos pacientes HIV positivos em atendimento no ambulatório de infectologia do Hospital Universitário Antônio Pedro em Niterói - RJ

Desde 1980 ano da identificação do primeiro caso da aids no Brasil, mais de meio milhão de novos casos foram notificados no país. A região Sudeste foi a mais atingida, com mais de 300 mil casos. No estado do Rio de Janeiro foram identificados 81.606 casos da doença, 48.061 dos quais na capital apenas. No município de Niterói foram notificados, no mesmo período, 4.130 casos. Aproximadamente 180 mil pessoas infectadas fazem uso de medicamentos antirretrovirais no Brasil. Com isso, as infecções oportunistas e as neoplasias deixaram de ser as principais causas de morte, sendo substituídas pela insuficiência hepática, e por complicações associadas aos pára-efeitos dos antirretrovirais. O advento do HAART (tratamento antirretroviral de alta potência) redundou no aparecimento de novas complicações, até então inexistentes, relacionadas aos efeitos adversos do uso prolongado desses medicamentos. O aumento substancial da sobrevida permitiu o aparecimento de condições crônicas de comorbidade, tradicionalmente não relacionadas ao HIV, ou o estabelecimento de um maior risco para certas complicações, entre as quais a redistribuição da gordura corporal, a obesidade, o aumento de massa gorda, as alterações dos lipídios circulantes e as alterações do metabolismo da glicose, relacionadas, todas elas, a um maior risco cardiovascular, à intolerância à glicose e ao diabetes melito. Este é um estudo descritivo que visa identificar o perfil nutricional e bioquímico de portadores de HIV/aids em acompanhamento no ambulatório do Serviço de Infectologia do Hospital Universitário Antônio Pedro. Os pacientes estudados foram entrevistados e examinados por ocasião de seu comparecimento ao Serviço, para coleta de sangue destinado à medida da carga viral e à contagem dos linfócitos T CD4. Foram coletados dados antropométricos e bioquímicos, além de informações referentes à história social e patológica, com especial atenção ao uso de medicamentos. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa do HUAP. Num período de 13 meses, foram estudados 235 pacientes, sendo a maioria do sexo masculino (55,3%). A média da idade dos pacientes foi de 43,1 anos, com predomínio da raça não branca (50,6%). Em relação ao estado nutricional 5,5% da população estuda apresentava baixo peso, 54,4% apresentavam classificação normal, 26% sobrepeso e 11,1% obesidade. Os exames de glicemia de jejum estavam alterados em 13,7% dos indivíduos, o colesterol total em 40,8%, o LDL em 33,5% e o HDL em 47,9% deles. Este estudo mostra elevado sobrepeso e obesidade na população com HIV/aids, identificando a necessidade em se conhecer o perfil nutricional desses pacientes e tomando as medidas necessárias para o seu controle precoceMore than half million cases of acquired immunodeficiency syndrome (aids) have been reported in Brazil since the recognition of the first case in 1980. The Southeast region is the most affected one, with more than 300 thousand reported cases. In the state of Rio de Janeiro 81.606 cases were identified, of which 48.061 in the capital alone. In Niteroi 4.130 cases were reported in the same period. Nearly 180 thousand infected people use antiretroviral drugs in Brazil. Opportunistic infections and cancers lost therefore the first place in the list of death causes, being replaced by hepatic insufficiency, and complications associated with the adverse effects of antiretrovirals. The advent of HAART (highly active anti-retroviral therapy) brought in new and nonexistent complications related to the adverse effects of prolonged use of these drugs. The substantial increase in survival led to the appearance of chronic co-morbid conditions traditionally not related to HIV, or to a greater risk for these conditions. These complications include body fat redistribution, obesity, increased fat mass, changes in circulating lipids and glucose metabolism all of them related to a greater cardiovascular risk, and to glucose intolerance and diabetes melito. This is a descriptive study which aimed to identify the nutritional and biochemical profile of patients with HIV/aids being accompanied as outpatients in the Infectology Department of Antonio Pedro University Hospital in Niteroi, RJ. The patients studied were interviewed during visits for collecting blood for viral load measurements and CD4 cell counts. We collected anthropometric and biochemical data, and information regarding the pathological and social history, with special attention to the use of the ARV. This study was approved by the Ethics Committee of HUAP. Two hundred thirty-five patients were studied along a 13 months period, mostly male (55.3%). The average age of the patients was 43.1 years, with a predominance of non-white race (50.6%). In relation to the nutritional diagnosis 5.5% of the population studied were malnourished, 54.4% were classified as normal, 26% overweight and 11.1% were obese. The fasting plasma glucose were abnormal in 13.7% of the subjects, the total cholesterol in 40.8%, LDL in 33.5% and HDL in 47.9% of them. This study shows high prevalence of the overweight and obesity in the population with HIV/Aids, identifying the necessity to meet the nutritional profile of these patients to control it early150f