Assédio da indústria de alimentos infantis a profissionais de saúde em eventos científicos

OBJETIVO Analisar o recebimento de patrocínios da indústria de substitutos do leite materno por profissionais de saúde em eventos científicos. MÉTODOS Inquérito multicêntrico (Multi-NBCAL) conduzido entre novembro de 2018 e novembro de 2019 em seis cidades de diferentes regiões brasileiras. Em 26 hospitais públicos e privados foram entrevistados pediatras, nutricionistas, fonoaudiólogos e um membro da chefia, mediante questionário estruturado. Foram realizadas análises descritivas do conhecimento dos profissionais de saúde sobre a Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância, Bicos, Chupetas e Mamadeiras (NBCAL), das empresas patrocinadoras de eventos científicos e dos patrocínios financeiros ou materiais recebidos, conforme a categoria profissional. RESULTADOS Foram entrevistados 217 profissionais de saúde, principalmente pediatras (48,8%). Pouco mais da metade dos profissionais (54,4%) afirmaram conhecer a NBCAL, principalmente em Hospitais Amigos da Criança. A maior parte (85,7%) dos profissionais de saúde havia participado de congressos científicos nos últimos dois anos, mais da metade, 54,3%, deles apoiados pela indústria de substitutos do leite materno, em especial pela Nestlé (85,1%) e Danone (65,3%). Patrocínios foram recebidos por esses profissionais nos eventos, como materiais de escritório (49,5%), refeições ou convites para festas (29,9%), brindes (21,6%), pagamento de inscrição (6,2%) ou de passagem para o congresso (2,1%). CONCLUSÃO As indústrias de alimentos infantis infringem a NBCAL ao assediar profissionais de saúde em congressos científicos, oferecendo patrocínios materiais e financeiros diversos.OBJECTIVE To analyze the receipt of sponsorships from breast-milk substitute companies by health professionals in scientific events. METHODS Multicenter study (Multi-NBCAL) performed from November 2018 to November 2019 in six cities in different Brazilian regions. In 26 public and private hospitals, pediatricians, nutritionists, speech therapists, and a hospital manager were interviewed using a structured questionnaire. Descriptive analyses were carried out regarding the health professionals’ knowledge about the Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância, Bicos, Chupetas e Mamadeiras (NBCAL – Brazilian Code of Marketing of Infant and Toddlers Food and Childcare-related Products), companies sponsoring scientific events, and material or financial sponsorships received, according to profession. RESULTS We interviewed 217 health professionals, mainly pediatricians (48.8%). Slightly more than half of the professionals (54.4%) knew NBCAL, most from Baby-friendly Hospitals. Most health professionals (85.7%) attended scientific events in the last two years, more than half of them (54.3%) sponsored by breast-milk substitute companies, especially Nestlé (85.1%) and Danone (65.3%). These professionals received sponsorships in the events, such as office supplies (49.5%), meals or invitations to parties (29.9%), promotional gifts (21.6%), payment of the conference registration fee (6.2%) or ticket to the conference (2.1%). CONCLUSION The infant food industries violate NBCAL by harassing health professionals in scientific conferences, offering diverse material and financial sponsorships

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Estratégias de marketing da indústria de alimentos infantis dirigido a profissionais de saúde que atuam em maternidades

Introdução: O marketing de alimentos infantis e produtos de puericultura correlatos é regulado no Brasil desde 1988 visando a proteção do aleitamento materno. A Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância, Bicos, Chupetas e Mamadeiras (NBCAL) veda o patrocínio de fabricantes desses produtos a pessoas físicas, sendo o mesmo permitido apenas a entidades científicas de ensino e pesquisa ou a entidades associativas reconhecidas nacionalmente. Objetivo: Avaliar o marketing da indústria de alimentos infantis e produtos de puericultura correlatos dirigido a profissionais de saúde que atuam em hospitais com leitos obstétricos. Métodos: Essa investigação é parte do “Estudo multicêntrico de avaliação do cumprimento da Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância, Bicos, Chupetas e Mamadeiras” (Multi-NBCAL). Um inquérito foi conduzido entre novembro de 2018 e novembro de 2019, em maternidades de seis cidades (Rio de Janeiro, São Paulo, Ouro Preto, Florianópolis, João Pessoa e Brasília) mediante entrevista a cerca de10 profissionais de saúde (direção, pediatras, nutricionistas e fonoaudiólogos) por hospital. Foi utilizado questionário eletrônico instalado no aplicativo Magpi, elaborado a partir de questões do NetCode (Network for Global Monitoring and Support for Implementation of the International Code of Marketing of Breastmilk Substitutes and subsequent relevant World Health Assembly Resolutions). A análide dos resultados foi descritiva. Resultados: Participaram da pesquisa 26 hospitais, sendo entrevistados 217 profissionais de saúde, em sua maioria pediatras (48,8%) que atuavam em UTI neonatal e alojamento conjunto. Dos profissionais entrevistados, apenas 23,0% afirmaram conhecer a NBCAL, e 30,0% tinham feito curso ou tiveram aula sobre o tema. Dentre os profissionais de saúde que participaram de congressos e eventos científicos nos últimos 2 anos, 54,3% relataramobservar patrocínio de indústrias de alimentos infantis nestes locais.Foram oferecidos aos profissionais,materiais de escritório (49,5%), refeições no local (29,9%), além de outras irregularidades. Nestlé e Danone foram as principais empresas de alimentos infantis patrocinadoras de congressos científicos. Conclusão: As indústrias de alimentos infantis assediam os profissionais de saúde oferecendo patrocínio e presentes em desacordo com a NBCAL, em congressos científicos, visando expandir a demanda por seus produtosIntroduction: The marketing of infant foods and related childcare products is regulated in Brazil since 1988, aiming to protect breastfeeding. The Brazilian Code for the Marketing of Infant and Toddlers Food, Nipples, Pacifiers and Baby Bottles (NBCAL) prohibits the sponsorship of manufacturers of these products to individuals, the same being allowed only to scientific teaching and research entities or associative entities nationally recognized. Objective: To evaluate the marketing of the infant food industry and related childcare products aimed at health professionals working in hospitals with obstetric beds. Methods: This investigation is part of the “Multicenter Study of Assessment of Compliance with the Brazilian Code for the Marketing of Infant and Toddlers Food, Nipples, Pacifiers and Baby Bottles” (Multi- NBCAL). A survey was conducted as between November 2018 and November 2019, in maternity hospitals from six cities (Rio de Janeiro, São Paulo, Ouro Preto,Florianópolis, João Pessoa and Brasília) by means of interviewing 10 health professionals (amongst the administrator, pediatricians, nutritionists and speech therapists) per hospital. An electronic questionnaire installed on the Magpi application, based on questions from the NetCode (Network for Global Monitoring and Support for Implementation of the International Code of Marketing of Breast milk Substitutes and subsequent relevant World Health Assembly Resolutions) was applied. Descriptive analysis was conducted. Results: 26 hospitals participated in the research, 217 health professionals being interviewed, mostly pediatricians (48.8%), who worked in the neonatal unit and in rooming-in wards. 23,0 % of the interviewed professionals claimed being familiar to NBCAL, but only 30,0% attended a course or had a class on the topic.Among health professionals who participated in scientific congresses and events in the last 2 years, 54.3% reported observing sponsorship of baby food industries in these locations. Professionals were offered office supplies (49.5%), on-site meals (29.9%), in addition to other irregularitiesConclusion: The infant food industries harass health professionals by offering sponsorship and gifts in disagreement with NBCAL, in scientific congresses, aiming to expand the demand for their products95 f