Fatores associados ao aleitamento materno exclusivo entre mães adolescentes

Gender differentiated score on the Falls Efficacy Scale International (FES-I Brazil) to assess self-efficacy in falls in community-dwelling older adults

BACKGROUND

Since fear of falling is associated with a history of falls and is more prevalent in women, it is important to define cut-off points differentiated between genders on the Falls Efficacy Scale International Brazil (FES-I Brazil) to implement early prevention and/or rehabilitation strategies.

AIMS

To determine cut-off points on the FES-I Brazil differentiated between genders which discriminate falls and verify their association with the history of falls.

METHODS

This was a cross-sectional study including 306 community-dwelling older adults. Fear of falling score from the FES-I Brazil was the independent variable and the outcome was the history of falls in the last 12 months. The cut-off points differentiated between genders were established according to sensitivity and specificity values evaluated by the Receiver Operating Characteristic Curves (ROC). The multivariable logistic regression was used to verify the association between fear of falling and history of falls.

RESULTS

The cut-off points on the FES-I Brazil to discriminate falls were > 25 points [AUC: 0.67 (95% CI 0.59-0.73)] for women, and > 19 points [AUC: 0.66 (95% CI 0.57-0.74) for men, suggesting that women present a greater fear of falling than men, due to the higher cut-off point found for women. Women and men with fear of falling, respectively, had 2.14 (95% CI 1.11-4.13) and 2.62 (95% CI 1.10-6.85) higher odds of suffering falls compared to those without this condition.

CONCLUSIONS

The FES-I can be used to discriminate falls in the elderly and shows that women have a higher cut-off point than men on the scale.

How Much Time in Sedentary Behavior Should Be Reduced to Decrease Fear of Falling and Falls in Community-Dwelling Older Adults?

Fear of falling and history of falls are frequent situations in older adults, which can be aggravated by sedentary behavior (SB). The objective was to establish SB cutoff values which discriminate falls and fear of falling in older adults and verify the association between these conditions. This was a cross-sectional study including 308 community-dwelling older adults. The SB was assessed by International Physical Activity Questionnaire. The outcomes were history of falling in the last 12 months and fear of falling (higher or equal than 23 points in Falls Efficacy Scale International-Brazil). The cutoff points found were >4.14 (area under curve = 0.60, 95% confidence intervals [CIs] [0.54, 0.65]) and >3.90 hr per day (area under curve = 0.59, 95% CI [0.53, 0.64]) for fear of falling and history of falls, respectively. Older adults with SB had 1.71 (95% CI [1.03, 2.84]) and 1.75 (95% CI [1.06, 2.89]) greater odds of having greater fear of falling and suffering falls, respectively.

Common Mental Disorder and early interruption of exclusive maternal breastfeeding in Quilombola women: a population-based study

Abstract Objectives: to investigate the prevalence of exclusive maternal breastfeeding (EMBF) and evaluate whether common mental disorder (CMD) and other predictors promote its early interruption (EI-EMBF4). Methods: a cross-sectional study involving all children <24 months (n=252) residing in 50% (n=34) of the Quilombola communities in Alagoas. The EI-EMBF4 was established when EMBF was ≤4 months. The Self-Reporting Questionnaire was used to identify the occurrence of CMD. Other predictors were obtained through interviews. The measure of association was the prevalence ratio calculated by the Poisson regression, following a hierarchical theoretical model. The prevalence of EMBF for 4 and 6 months, and its median duration (survival analysis) were calculated. Results: the prevalence of EI-EMBF4 and CMD was 57.6% and 42.9%, respectively. The risk factors independently associated with EI-EMBF4 were: living in a mud house, maternal age ≤18 years, low birth weight and the use of a pacifier or baby bottle. There was no association with CMD. The prevalence of EMBF for four and six months was 42.4% and 25.4%, respectively, and the median duration was 106 days. Conclusion: EMBF indicators are below the established recommendations, justifying the implementation of measures that prioritize women subjected to risk factors identified here. CMD is not configured among these.

Is the self-perception of the built neighborhood associated with fear of falling in community-dwelling older adults?

INTRODUCTION

Characteristics of a built neighborhood may aggravate agravett to fear of falling in older adults and this knowledge are important to contribute to developing strategies aimed at reducing fear of falling and their consequences.

OBJECTIVE

To verify the association between self-perception of built neighborhood characteristics and fear of falling in community-dwelling older adults.

MATERIALS AND METHODS

This was a cross-sectional study including 308 community-dwelling older adults. The outcome was fear of falling evaluated through Falls Efficacy Scale International. Older adults were classified with high fear of falling when they obtained values ≥ 23 points and classified as low fear of falling with score < 23 point. The built neighborhood variables were evaluated by the adapted Neighborhood Environment Walkability Scale. Multivariable logistic regression was performed to verify associations between the variables.

RESULTS

The prevalence of fear of falling was 48.40%. Significant negative associations were observed between residing near a bus stop, outdoor gyms, safe places to walk during the day, and positive associations between garbage accumulation and/or open sewers and high crime rates and fear of falling.

CONCLUSION

The association between self-perceived characteristics of built neighborhoods and fear of falling points to the need for improvements in urban infrastructure, especially public spaces, in order to reduce fear of falling in community-dwelling older adults.

Maternal-child nursing care for adolescent mothers: health education

OBJECTIVES

to develop an educational intervention through a game that addresses aspects related to adolescent motherhood and child care.

METHODS

this is an action research based on diagnosis, intervention and apprehension stages.

RESULTS

the situational diagnosis was based on a literature review on adolescent motherhood and child care. In the intervention stage, the educational game's first version was elaborated. In the third stage constituted by apprehension, the game was submitted to assessment of interdisciplinary experts. Suggestions of experts were adopted and the game had its second version.

FINAL CONSIDERATIONS

the educational intervention in the present study appears a care technology that adds knowledge and practices to the work of nurses in Primary Health Care, focusing on adolescent women and children health care.

Avaliação do aleitamento materno em crianças até dois anos assistidas na atenção básica do Recife, Pernambuco, Brasil

Resumo O presente estudo teve por objetivo avaliar o aleitamento materno exclusivo (AME) e total em crianças até 2 anos de idade atendidas em Unidades Básicas de Saúde (UBS) do Recife-PE. Estudo descritivo transversal, realizado nas Unidades Básicas de Saúde da Mustardinha, Jardim Uchôa, Fernandes Figueira e Upinha Novo Prado. A população foi composta por crianças de 0 a 24 meses de idade. Foram avaliadas 141 crianças, das quais 54,6% eram do sexo feminino, 22% tinham idade ≤ 6 meses, 21,3% entre 7 a 12 meses e 56,7% entre 13 e 24 meses. Ao analisar a prevalência de aleitamento materno exclusivo e total, verificou-se a mediana de 60,84 e 182,52 dias, respectivamente. Crianças do sexo masculino, uso de chupeta e mamadeira foram associados ao menor tempo de aleitamento materno exclusivo.

Fatores relacionados ao desmame precoce do aleitamento materno

Objetivos: Investigar os fatores relacionados ao desmame precoce antes dos seis meses de vida. Métodos: Trata-se de uma pesquisa exploratória, descritiva de abordagem quantitativa, baseada em questionário semiestruturado, com amostra de 52 mulheres com filhos de 0 a 6 meses de vida que não estavam mais em aleitamento materno exclusivo (AME), pertencentes às Estratégias de Saúde da Família urbanas do município de Santo Antônio do Monte, centro-oeste de Minas Gerais. Resultados: Apontaram mães jovens, casadas, primíparas, inseguras, com gravidez não planejada, realização das consultas de pré-natal periodicamente, desmame do AME entre o quarto e quinto mês de vida da criança. Conclusão: As atividades laborais, as crenças quanto ao leite materno ser fraco ou insuficiente para o bebê e a má interpretação do choro do recém-nascido estão entre as causas encontradas para o desmame precoce. Salienta-se a implementação de estratégias e ações educativas que priorizem a resolutividade quanto aos fatores destacados, e que, especialmente, busquem melhorar o vínculo com esse público.

Factors associated with the maintenance of breastfeeding for 6, 12, and 24 months in adolescent mothers

BACKGROUND

Previous studies have demonstrated that adolescent mothers present a higher risk of not breastfeeding or of early interruption of this practice. Considering the scarcity of studies investigating the determining factors of breastfeeding in adolescent mothers, and the absence of studies exploring the determining factors of breastfeeding maintenance for different periods of time in a single population of adolescent mothers, the aim of this research was to identify factors associated with breastfeeding maintenance for at least 6, 12, and 24 months in adolescent mothers.

METHODS

Data analysis from a randomised control trial involving adolescent mothers recruited at a university hospital in southern Brazil. Participants were followed through the first year of life of their infants and reassessed at 4-7 years. Factors associated with any breastfeeding for at least 6, 12, and 24 months were assessed using multivariate Poisson regression.

RESULTS

Data for 228, 237, and 207 mothers were available, respectively. Breastfeeding maintenance for at least 6, 12, and 24 months was observed in 68.4, 47.3, and 31.9% of the sample, respectively. Only one factor was associated with breastfeeding maintenance at all outcomes: infant not using a pacifier showed a higher probability of breastfeeding maintenance in the first 2 years. Maternal grandmother breastfeeding support and exclusive breastfeeding duration were associated with breastfeeding maintenance for 6 and 12 months. The other factors evaluated were associated with breastfeeding maintenance at only one of the time points assessed: 6 months, maternal skin color (black/brown); 12 months, female infant and partner breastfeeding support; and 24 months, older paternal age and multiparity.

CONCLUSIONS

The present findings shed light upon barriers and facilitators of breastfeeding practices among adolescent mothers. In order to contribute to the challenge of increasing BF duration among adolescent mothers interventions aimed at boosting breastfeeding maintenance among this population should take into consideration the determining factors here identified. Additionally, breastfeeding education and support should be provided continuously as factors influencing these practices vary with time. Thus, support for adolescent mothers during the different stages of breastfeeding need to be tailored to have a positive impact on breastfeeding experience.

Autoeficácia na amamentação e duração do aleitamento materno exclusivo entre mães adolescentes

Resumo Objetivo Verificar a associação entre a autoeficácia na amamentação de mães adolescentes e a duração do aleitamento materno exclusivo. Métodos Estudo longitudinal e prospectivo. Para avaliação da autoeficácia na amamentação foi utilizada a versão brasileira da Breastfeeding Self-Efficacy Scale na maternidade, e para avaliação da alimentação da criança foi aplicado um questionário, por meio de contato telefônico, com 30, 60 e 180 dias pós-parto. Resultados 56,90% das participantes apresentaram alto nível de autoeficácia para amamentar. A prevalência AME foi de 62% em 30 dias, 52,59% em 60 dias e 16% em 180 dias pós-parto. Não houve associação significativa entre a confiança com a duração do aleitamento materno exclusivo. Conclusão A confiança não foi um fator preditivo da prevalência do aleitamento materno exclusivo. entre as mães adolescentes. No entanto, evidencia-se a necessidade de novas estratégias para que as adolescentes que passam por intercorrências nestes períodos sejam acolhidas e auxiliadas.

Agentes comunitários de saúde e o aleitamento materno: desafios relacionados ao conhecimento e à prática

RESUMO Objetivo: identificar o conhecimento de Agentes Comunitários de Saúde sobre as práticas e a promoção do aleitamento materno. Métodos: estudo transversal, descritivo, inquérito, quanti-qualitativo realizado com amostra de 148 agentes. A coleta de dados foi realizada por meio da aplicação de um questionário semiestruturado, com questões abertas e fechadas. Foram analisadas as variáveis: sociodemográficas, capacidade para orientação sobre o aleitamento, participação em treinamentos/cursos, conhecimentos sobre vantagens do aleitamento para mãe e bebê. Realizou-se análise estatística descritiva, foram empregados os testes Qui-quadrado, Exato de Fisher e G, ao nível de significância 5%. As questões abertas foram analisadas segundo a técnica de pesquisa qualitativa. Resultados: aproximadamente, 45,95% dos agentes não foram capacitados para realizar orientação prática das nutrizes sobre o aleitamento e 63,30% nunca participaram de cursos sobre amamentação. A maioria citou vantagens do aleitamento relacionadas, somente, ao bebê, emergindo as categorias: nutrição do bebê, imunológica, desenvolvimento/saúde do bebê, dentição/ossos. Houve associação estatisticamente significante entre capacidade de orientar as mães na amamentação e participação em treinamentos (p<0,001). Conclusão: os agentes não haviam participado de cursos de capacitação para acompanhar as nutrizes, apresentaram conhecimento limitado sobre a prática e a promoção do aleitamento, e as visitas domiciliares realizadas pós-parto ocorreram tardiamente.