Association Between Dietary Patterns and Bullying Among Adolescents in Sao Paulo-Brazil

Previous studies have assessed the association between food consumption and bullying perpetration, but most of them have not broadly assessed food consumption, neither the distinction between forms of bullying. The aim of the study was to evaluate the association between dietary patterns with bullying roles and its different types of bullying perpetration among adolescents. Data on a representative sample of ninth-grade students (N = 2,163; mean age = 14.8 years) taken from Sao Paulo Project for the social development of children and adolescents (SP-PROSO) were used. The independent variables were healthy and unhealthy dietary patterns obtained by exploratory factor analysis. The dependent variables were bullying role (victim-only, bully-only, bully-victim) and bullying perpetration (any type, social exclusion, psychological/verbal aggression, physical aggression, property destruction, sexual harassment). Multinomial and logistic regression models were performed for the total sample and stratified by sex (only for association with sexual harassment), adjusting for covariates. Adolescents who engaged in a healthy dietary pattern were less likely to be bullies (RR 0.67 [0.49, 0.92]), while adolescents with an unhealthy dietary pattern were more likely to be bully-victims (RR 1.29 [1.12, 1.48]). Unhealthy dietary pattern was associated with any type of bullying perpetration (OR 1.24 [1.12, 1.38]), mainly with sexual harassment and physical aggression. Boys who had an unhealthy dietary pattern were more likely to sexually harass another adolescent (OR 2.10 [1.20, 3.66]). In conclusion, adolescents who had a healthy dietary pattern were less likely to perpetrate bullying. Unhealthy dietary pattern was associated with bullying perpetration, especially with sexual harassment by boys.

What have adolescents in Rio de Janeiro city, Brazil, done to reduce their community violence exposure?

This study aims to identify the individual community strategies to avoid violence exposure most used by adolescents from public and private schools in the IX Administrative Region of Rio de Janeiro and investigate the profile of co-occurrence and its prevalence in specific population subgroups. This is a cross-sectional study with 693 individuals. A multidimensional questionnaire collected information regarding strategies to avoid community violence exposure and was self-completed in the classroom. The most used strategies were avoiding walking close to armed people (55.5%), avoiding walking alone (30.5%), and avoiding returning home at dawn (24.7%). Girls adopt more of all (concurrently) the four limiting behaviors to reduce their community violence exposure (53% vs. 32%). Notably, the adoption of such strategies differed by socioeconomic indicators and was higher among adolescents from lower-income households. These findings point to the high frequency of use of such strategies by adolescents, which may hinder and limit the full development of their social and cultural skills.

Relationship between polyvictimization and overweight among adolescents from São Paulo city, Brazil

This study is to identify victimization patterns and analyze the association between the experience of polyvictimization and overweight or obesity among adolescent girls and boys. The sample consisted of 2680 Brazilian ninth-graders enrolled in public and private schools, taken from the São Paulo Project for the social development of children and adolescents (SP-PROSO). Victimization was explored in two ways: (i) as per Finkelhor and (ii) by latent class analysis (LCA). The interest outcomes were overweight and obesity. Multinomial logistic regression models were used to study the relationship between victimization and overweight or obesity, controlling for confounders. LCA grouped boys and girls adolescents into three classes. These classes received the same labels, but the patterns differed between sexes. Class 1 was characterized by fewer types of victimization suffered and lower endorsement values in the analyzed items and was named bullying and indirect victimization (♀: 42.7%, n = 546; ♂: 21.6%, n = 293). Class 2 included more victimization types than Class 1 and less than Class 3. This class was labeled family violence and peer victimization (♀: 29.1%, n = 356; ♂: 47.9%, n = 652). Class 3 was named high polyvictimization (♀: 28.2%, n = 345; ♂: 30.5%, n = 418). According to Finkelhor, polyvictimization was not associated with overweight or obesity in both sexes. Only the class of high polyvictimization was associated with being overweight (OR_adj: 1.60, 95%CI: 1.01-2.54) in girls. In this study, polyvictimization was associated with being overweight only among adolescent girls. Longitudinal studies in different contexts and populations are needed to understand this relationship.

The effect of obstetric violence during childbirth on breastfeeding: findings from a perinatal cohort "Birth in Brazil"

Background

Recent literature has shown that many women worldwide are victims of obstetric violence during childbirth. Despite that, few studies are exploring the consequences of such violence on women's and newborn's health. Thus, the present study aimed to investigate the causal association between obstetric violence during childbirth and breastfeeding.

Methods

We used data from the study "Birth in Brazil", a national hospital-based cohort of puerperal women and their newborns in 2011/2012. The analysis involved 20,527 women. Obstetric violence was a latent variable composed of seven indicators (physical or psychological violence, disrespect, lack of information, privacy and communication with the healthcare team, inability to ask questions, and loss of autonomy). We worked with two outcomes: 1) breastfeeding at the maternity and 2) breastfeeding 43-180 days after birth. We applied multigroup structural equation modelling, based on the type of birth.

Findings

Obstetric violence during childbirth may decrease the probability for women to leave the maternity ward breastfeeding exclusively, having a stronger effect on women who have vaginal birth. Also, being exposed to obstetric violence during childbirth could indirectly affect those women's ability to breastfeed 43-180 days after birth.

Interpretation

This research concludes that obstetric violence during childbirth is a risk factor for breastfeeding discontinuation. Such knowledge is relevant so interventions and public policies can be proposed in order to mitigate obstetric violence and provide a better understanding of the context that may lead a woman into discontinuing breastfeeding.

Funding

This research was funded by CAPES, CNPQ, DeCiT, and INOVA-ENSP.

Association between Community Violence, Disorder and School Environment with Bullying among School Adolescents in Sao Paulo - Brazil

The role of contextual-level factors in bullying is still not clear, and evidence is mostly from high-income countries. Our objective was to investigate the association between community violence, disorder, school environment and bullying among school adolescents. We used data from a representative sample of 9th grade Brazilian adolescents (n = 2108) from the Sao Paulo Project for the social development of children and adolescents (SP - PROSO). Multilevel logistic regression models stratified by sex were used to assess the association between variables at student and school/neighbourhood level and bullying victimization or perpetration. For both sexes, we found that adolescents who perceived high violence between students and high school disorder were more likely to be bullies and victims. Boys who perceived high community violence and disorder in their neighbourhood were more likely to be bullies (OR_3tertile = 2.73 CI95%: 1.57-4.74). Girls attending schools where the principal reported high community violence and disorder in the neighbourhood (OR_high = 10.24 CI95%: 2.11-49.59) and inside the school (OR_high = 6.83 CI95%: 1.48-31.56) were more likely to be bullies. Boys from schools whose principal perceived violence between students were less likely to be victims (OR_high = 0.35 CI95%: 0.16-0.78) and bullies (OR_high = 0.21 CI95%: 0.07-0.64). Girls attending schools with signs or posters about tolerance/gender equality and about violence were less (OR = 0.12 CI95%: 0.03-0.50) and more likely (OR = 25.88 CI95%: 4.28-156.63) to report being bullies, respectively. Community violence, disorder and school environment were associated with bullying victimization and perpetration among adolescents. Sex-specific associations should be further investigated. Prevention and management of school violence in adolescence should consider contextual-level characteristics.

Intimate partner physical violence and inadequate weight gain in pregnancy

Abstract Objectives: to evaluate the association between intimate partner physical violence (IPPV) and inadequate gestational weight gain (GWG). Methods: cross-sectional study composed of 554 women who attended four Basic Health Units in the city of Rio de Janeiro between 2005 and 2009. The GWG was calculated through the difference between the final weight of pregnancy and pre-gestational weight. For the measurement of IPPV, the Portuguese version of the Conflict Tactics Scales (CTS-1) was used. Data analysis was based on multinomial logistic regression models, estimating odds ratios and respective 95% confidence intervals for associations between the variables of interest. Results: the prevalence of minor and severe IPPV was 31.6% and 16.3%, respectively. Almost two-thirds of the women had insufficient or excessive GWG. After adjusting the model, it was observed that the presence of IPPV increased by 1.66 (CI95%=1.05-2.64) times the chances of insufficient GWG, compared to couples who did not experience this type of violence. Concerning the excessive GWG, the associations with IPPV were not statistically significant. Conclusion: women who experience IPPV in their relationships are more likely to have insufficient GWG during pregnancy. From this perspective, prenatal care becomes an essential service for screening domestic violence and its possible repercussions.

Characterization and completeness of notification sheet of violence against the older adults in Niterói-RJ, 2011-2020

OBJECTIVE

to analyze the profile of violence against the elderly and the degree of completeness of event notification forms in Niterói, Rio de Janeiro, Brazil.

METHODS

this was a descriptive study having as its data source violence notification forms held on the Notifiable Health Conditions Information System for the period 2011-2020; analysis of form completeness was performed according to criteria proposed by the Ministry of Health.

RESULTS

of the 486 registered cases, physical violence was the most reported type of violence (48.1%), followed by psychological violence (22.2%) and self-harm (21.4%); the fields with the highest degree of incompleteness were victim's level of schooling (32.8%) and repeat violence (41.5%).

CONCLUSION

despite the increase in notifications in the period, predominantly of physical violence, completeness of some of the form fields continues to be poor, which reinforces the importance of training professionals to improve the reporting process and data quality.

Environment modification at school to promote physical activity among adolescents: a cluster randomized controlled trial

OBJECTIVE

To assess the effect of modifications of the school environment on physical activity in Brazilian adolescent students.

METHODS

Seven public schools in Duque de Caxias (Brazil) were randomized into control and intervention groups. The intervention group underwent modifications in the school environment (painting of hopscotch and school courts) and the provision of sports equipment (balls, basketball table, soccer goalpost, volleyball nets, and others) to stimulate physical activity. Additionally, footsteps towards the court and materials were painted, and a superhero character called Super Active was introduced. Total physical activity was measured using a validated questionnaire for adolescents. Generalized linear models were used to evaluate the effect of the intervention, adjusted by sex.

RESULTS

The sample consisted of 975 adolescents, with a mean age of 11.52 years (standard deviation - SD 1.43), and 56.7% were boys. After the one-month intervention, both groups' total physical activity time increased. The estimated changes from baseline were not different between the intervention and control groups (Δ=102.75 and Δ=99.76, respectively; p=0.52).

CONCLUSION

The painting, supply of equipment and other strategies to encourage physical activity in the school environment did not promote a positive effect on improving physical activity among adolescents. Future research is necessary to evaluate the effect of the intervention in the long-term period, particularly in other population contexts in middle-income countries.

Association Between Interpersonal Violence With Inadequate Nutritional Status Among Brazilian Adolescents

Research focusing on the relationship between interpersonal violence and nutritional status in adolescence is scarce and has distinct results. The objective of this study is to investigate the association of family physical and sexual violence with inadequate nutritional status in Brazilian adolescents. We used data from the 2015 Brazilian National Survey of School Health. This study includes 11.850 students, older than 13 years, attending from sixth to ninth grade of elementary school and from the 1st to the 3rd year of high school. The exposures were family physical violence and rape. The outcome was nutritional status, assessed through body mass index. The association between exposures and outcome were investigated using a multinomial logistic regression model. These analyses were adjusted for demographic, socioeconomic, and family variables. The prevalence of family physical violence victimization was approximately 14% among adolescents for both sexes. The prevalence of rape was 4.6% and 5.7% among male and female adolescents, respectively. Family physical violence was not associated with being underweight, overweight, or obese, in either crude or adjusted models for both sexes. Sexual violence was inversely associated with being underweight only for male adolescents (OR: 0.21, CI 95%: 0.06-0.75). In female adolescents, sexual violence was associated with overweight/obesity (OR: 1.64, CI 95%:1.15-2.33). In this study, rape, but not family physical violence victimization, was associated with nutritional status in adolescents of both sexes. Nonetheless, this association was different between boys and girls. Rape was inversely associated with being underweight in male adolescents, whereas, in female adolescents, it was associated with excess body weight.

Social vulnerabilities and sexual initiation of 10- to 14-year-old pupils in the city of Rio de Janeiro, Brazil

This study aimed to estimate the prevalence of sexual initiation of pupils aged 10 to 14 who attended the second year of public and private high school in the IX Administrative Region of the city of Rio de Janeiro, Brazil and to identify the most vulnerable subgroups. The sample consisted of 694 pupils who were selected through cluster-based and stratified sampling by considering school type (public or private) and course type (daytime or evening). Information was collected by means of a structured self-administered questionnaire. The chi-square test (χ2) and 95% confidence intervals were used to assess the heterogeneity of proportions among subgroups. The prevalence of the event was 18.4%; it was higher in boys, in subgroups of greater social vulnerability, among those who hooked up/dated up to 14 years of age, in victims of sexual violence in affective-sexual relationships and in pupils showing health risk behaviors. The high rate of sexual initiation in early adolescence, especially in more vulnerable groups, shows that the situation must be understood and addressed by means of intersectoral public policies that take into account a social context of multiple needs rather than reproductive health alone.

Structural validity of the Conflict in Adolescent Dating Relationships Inventory (CADRI): A reduced version for use on respondents as victims and perpetrators

OBJECTIVES

To evaluate CADRI's configural and metric structures and explore its performance from the perspective of the respondents as perpetrators and victims. In the process, we present shorter versions for both roles.

METHODS

The sample consisted of 561 adolescents aged 15 and 19, enrolled in public and private schools in Rio de Janeiro, Brazil. Initially, confirmatory factor analyzes (CFA) tested the originally proposed dimensional structure. Since this model was rejected, the second step analyzed the data via Exploratory Structural Equation Models (ESEM) to reassess the instrument's structure. Applying a decision algorithm on a new dimensional structure, we proceeded to reduce the number of items to establish separate sets for victimization and perpetration. These final models were then analyzed via CFA to assess their psychometric properties.

RESULTS

The final solutions contained 15 items comprising four and three factors for victimization and perpetration, respectively. Thirteen items were common to both models, but two were unique to their respective sets. Regardless of their small differences, the final solutions fitted adequately, held factorial item pertinence and unambiguity, contained reliable and non-redundant items, and sustained factor-based convergent and discriminant validities.

CONCLUSION

The four and three-factor models were within the dimensional bounds proposed in the original CADRI, the shorter scales still succeeding in partially capturing what was envisaged in the first version of the instrument. However, the shorter versions suggested here are still tentative, thus requiring further examination.

Desrespeitos e abusos, maus tratos e violência obstétrica: um desafio para a epidemiologia e a saúde pública no Brasil

Resumo Estudos sobre desrespeitos e abusos/maus tratos/violência obstétrica durante gestação, parto e puerpério têm aumentado nas últimas décadas. Entretanto, os pesquisadores interessados na temática se deparam com muitas dificuldades teóricas e metodológicas. Nesse sentido, o objetivo do presente estudo consiste em discutir e refletir sobre como questões relacionadas a definição e terminologia, mensuração e políticas públicas no Brasil têm dificultado a pesquisa da temática, assim como a mitigação desses atos. O primeiro problema abordado foi a falta de consenso em relação a terminologia e definição desse construto. Essa situação provoca um efeito em cascata, com a utilização de instrumentos de aferição não validados que implicam falta de precisão e comparabilidade entre os estudos. Outra questão mencionada é a falta de estudos explorando as consequências desses atos na saúde da mulher e do recém-nascido, configurando uma das principais lacunas sobre o tema atualmente. A ausência de estudos causais impacta a tomada de decisão em saúde, prejudicando a elaboração de políticas públicas específicas.

Associação entre supervisão parental, vitimização e perpetração de bullying em adolescentes brasileiros, Pesquisa Nacional de Saúde do Escolar 2015

Resumo Objetivo: Analisar a associação entre características de supervisão parental e diferentes papéis de bullying entre adolescentes escolares brasileiros. Métodos: Estudo transversal, com dados da Pesquisa Nacional de Saúde do Escolar 2015. Realização frequente de refeições com os pais ou responsáveis, conhecimento sobre o tempo livre e verificação dos deveres de casa foram as práticas parentais avaliadas. Utilizou-se regressão logística para associação entre essas práticas e bullying (perpetração e vitimização), apresentada como razão de odds (RO) e intervalos de confianças de 95% (IC95%). Resultados: Entre 102.072 escolares, a realização frequente de refeições com os pais ou responsáveis [ROvitim = 0,86 (IC95% 0,84;0,89); ROperp = 0,85 (IC95% 0,82;0,88)], a verificação dos deveres de casa [ROvitim = 0,95 (IC95% 0,92;0,97); ROperp= 0,76 (IC95% 0,74;0,78)] e o conhecimento dos pais ou responsáveis sobre o tempo livre dos escolares [ROperp = 0,70 (IC95% 0,68;0,73)] foram inversamente associadas ao bullying. Conclusão: Maior supervisão parental reduziu a chance de vitimização e perpetração do bullying entre adolescentes escolares.

Social vulnerabilities and sexual initiation of 10- to 14-year-old pupils in the city of Rio de Janeiro, Brazil

Abstract This study aimed to estimate the prevalence of sexual initiation of pupils aged 10 to 14 who attended the second year of public and private high school in the IX Administrative Region of the city of Rio de Janeiro, Brazil and to identify the most vulnerable subgroups. The sample consisted of 694 pupils who were selected through cluster-based and stratified sampling by considering school type (public or private) and course type (daytime or evening). Information was collected by means of a structured self-administered questionnaire. The chi-square test (χ2) and 95% confidence intervals were used to assess the heterogeneity of proportions among subgroups. The prevalence of the event was 18.4%; it was higher in boys, in subgroups of greater social vulnerability, among those who hooked up/dated up to 14 years of age, in victims of sexual violence in affective-sexual relationships and in pupils showing health risk behaviors. The high rate of sexual initiation in early adolescence, especially in more vulnerable groups, shows that the situation must be understood and addressed by means of intersectoral public policies that take into account a social context of multiple needs rather than reproductive health alone.

[Distribution of scientific capital among tenured professors in the Social and Human Sciences and Epidemiology in the Collective Health field]

Scientific capital in the Collective Health field has been organized in three subfields: Epidemiology; Policy, Planning, and Management; and Social and Human Sciences. Based on Bourdieu's field theory as the sociological reference, the study analyzed the distribution of a set of scientific capital between two of these groups of scientific agents. The data were extracted from the Lattes database of resumés for 191 tenured faculty members of Graduate Studies Programs in Collective Health assessed as excellent by the Brazilian Graduate Studies Coordinating Board (CAPES), of which 38 were in the Social and Human Sciences and 153 in Epidemiology, all consolidated in an Excel database. The dimensions analyzed were inherited or acquired capital; academic capital; political or economic power capital; university power capital; scientific prestige capital; and intellectual notoriety capital. The results presented a profile of the study population in relation to the various forms of capital, as well as a stratified analysis of these forms of capital considering the two groups and a multiple correspondence analysis. The two groups present similar distribution in most of the forms of capital, shaping a group with major scientific prestige. The exception is precisely in publication and citation, considered central forms of capital for measuring high prestige and recognition. The numerical predominance of Epidemiology may also allow greater occupation of decision-making spheres for measuring prestige. The conclusion is that the field's balance occurs in the affirmation of otherness, allowing distinct forms of capital to have more outstanding space in the measurement of scientific prestige.

Wealth Inequalities in Different Types of Violence Among Brazilian Adolescents: National Survey of School Health 2015

Studies have assessed inequalities in violence by economic status, but few studies have been done with adolescents from middle-income countries. Our objective was to analyze inequalities in verbal bullying, family physical violence, sexual violence, and fights with weapons among Brazilian adolescents in school according to wealth and stratified by sex and skin color. We used data from the Brazilian National Survey of School Health (Pesquisa Nacional de Saúde do Escolar [PeNSE]), carried out in 2015, with a representative sample of Brazilian adolescents attending ninth grade in public and private schools. We created a wealth index based on questions about access to goods and services through principal component analysis; this index was later divided into quintiles. We calculated the slope index of inequality (SII), the concentration index (CIX), and simple measures of inequality, such as ratio and difference. To identify statistically significant differences in sex and skin color inequality, we used the t test. We found high prevalence values of verbal bullying and family physical violence, 23.9% and 14.5%, respectively. In general, when comparing the types of violence according to SII and CIX, we observed a higher prevalence of violence among adolescents in the lower income quintiles, for both sexes and skin colors. We observed higher wealth inequality in sexual violence among girls (CIX = -14.89) when compared with boys (CIX = -4.63) (p = .001). We also observed higher wealth inequality in sexual violence among Whites (CIX = -15.55) when compared with Brown (CIX = -6.23) (p = .009). Wealth inequality aggravates the occurrence of violence among poorer Brazilian adolescents. Also, the identification of vulnerable groups may contribute to target public policies for fighting violence.

Association Between Family Physical Violence Victimization and Food Consumption Among Brazilian Adolescents

Few studies have evaluated the relationship between stressful events, such as child abuse and food consumption. Thus, the objective of this study is to assess whether family physical violence victimization is associated with food consumption in adolescents. We used data from the Brazilian National Adolescent School-based Health Survey, carried out in 2015, in a representative sample of 102,072 students attending ninth grade from public and private schools. We used Venn diagrams and logistic regression analysis to, respectively, graphically represent and evaluate the association between the consumption of ultra-processed food (soft drinks, sweets/candies, and salty biscuits, packaged snacks, or processed meat) and in natura food (beans, fruits and vegetables) with victimization from family physical violence. We found a lower consumption of in natura and higher consumption of ultra-processed foods among adolescent victims when compared with nonvictims of family physical violence. The probability of consuming 4 or more times a week increased by 44% for salty biscuits, packaged snacks, or processed meats; 38% for soft drinks; and 22% for sweets among adolescents who reported violence. On the contrary, the probability of consuming 4 or more times a week decreased by 25% for beans, 19% for vegetables, and 13% for fruits among adolescent victims of family physical violence. We conclude that family physical violence victimization is associated with high consumption of ultra-processed food and low consumption of in natura food among Brazilian adolescents. Therefore, issues related to violence in childhood and adolescence should be addressed in interventions aimed at altering food consumption and consequent prevention, control, and treatment of nutrition-related outcomes to increase their effectiveness.

Prevalence and co-occurrence of Adverse Childhood Experiences: a school-based survey in Rio de Janeiro

This study aimed to estimate the prevalence of categories of adverse childhood experiences (ACE) among high school students in Rio de Janeiro, investigate the ACE co-occurrence profile, and examine the distribution of exposure to ACE according to individual, family, socioeconomic, and school characteristics. A cross-sectional study was conducted with 681 individuals selected using a complex random sampling design. Exposure to ACE categories was identified using a cross-culturally adapted version of the Childhood Trauma Questionnaire (CTQ) and direct questions. We calculated prevalence and correlation between ACE pairs and determined the co-occurrence profile of childhood adversities. The findings reveal that the most common adversities were emotional abuse and neglect and biparental family dissolution. Seventy percent of the sample reported having been exposed to at least one ACE and 9% had been exposed to four or more. Around 20% of respondents reported exposure to abuse and neglect and 9% to the co-occurrence of abuse, neglect, and absence of at least one parent during childhood. The most vulnerable subgroups were girls and respondents who were born to teenage mothers, not living with both parents, studying at public schools, and from low-income families. The high prevalence and co-occurrence profile of ACE reveals the need for wide-ranging intersectoral policies designed to prevent adverse childhood experiences and provide victim support.

Psychometric properties of a modified version of Brazilian household food insecurity measurement scale - Pró-Saúde study

We present results of initial steps of the psychometric evaluation of a proposed modified version of the Brazilian Household Food Insecurity Measurement Scale aimed at assessing adults' recall of food insecurity at age 12. Data were obtained through self-administered questionnaires from civil servants at university campuses in Rio de Janeiro, who participated in the first and fourth waves of the longitudinal Pró-Saúde Study. We evaluated test-retest reliability (n=58), internal consistency, factor structure, convergent, discriminant validity (n=3,253). Test-retest reliability kappa coefficients were above 0.65; Cronbach's α coefficient was 0.84. Factor loadings were above 0.800. The composite reliability was above 0.90. The square root values of the Average Variance Extracted were positive and statistically significant. Household food insecurity during childhood was strongly associated with larger family size and several sociodemographic conditions at age 12: female head of household, residence in rural area or small town, worse standard of living, and insufficient food due to lack of money. This initial evaluation suggests good performance. Further investigation should include additional psychometric properties and other population contexts.

Educational disparities in hypertension, diabetes, obesity and smoking in Brazil: a trend analysis of 578 977 adults from a national survey, 2007-2018

OBJECTIVES

Our study aimed to assess social inequality trends for hypertension, diabetes mellitus, smoking and obesity from 2007 to 2018 in adults from Brazilian capitals.

SETTING

Data from the Surveillance of Risk and Protection Factors for Chronic Diseases by Telephone Survey study, a cross-sectional telephone survey, conducted annually from 2007 to 2018.

PARTICIPANTS

We used data from 578 977 Brazilian adults (≥18 years).

DESIGN

Cross-sectional surveys conducted annually from 2007 to 2018.

PRIMARY OUTCOME MEASURES

Participants responded to a questionnaire about medical diagnosis of hypertension and diabetes, smoking status, weight and height. Educational inequalities (0-3, 4-8, 9-11 and 12 or more years of study) by sex and skin colour were assessed trough absolute, Slope Index of Inequality (SII) and relative measures of inequality, Concentration Index and trends were tested by Prais-Winsten.

RESULTS

All outcomes were more prevalent in the least educated. The largest absolute educational inequality was observed for hypertension (SII_total=-37.8 in 2018). During 2007-2018, the total educational disparity remained constant for hypertension, increased for diabetes and smoking, and decreased for obesity. Overall, inequality was higher among women and non-whites, compared with men and whites. We found a reduction in absolute inequality for hypertension among non-whites, an increase for diabetes in all strata, and an increase for smoking in women and non-whites. The relative inequality decreased in women and whites and increased for smoking in all strata, except among men.

CONCLUSION

The educational inequality reduced for obesity, remained constant for hypertension and increased for diabetes and smoking from 2007 to 2018 in Brazilian adults.

Co-occurrence of Health Risk Behaviors Among Brazilian Adolescent Victims of Family Violence

Although recent studies have related the occurrence of violence in childhood and adolescence with the adoption of health risk behaviors, there are no studies that quantify this co-occurrence among adolescent victims of family violence. Our objective was, therefore, to investigate the co-occurrence of health risk behaviors in these adolescent victims. Data from the National School Health Survey, collected in 2015, were used. Co-occurrence of risk behaviors-involvement in fights, substance use (alcohol, drugs, and tobacco), not wearing seat belts and helmets, inadequate food consumption-was analyzed using Venn diagrams, according to the victim's status and sex. The association between the four risk behaviors and victimization was investigated using multiple logistic regression. All the analyses were performed using Stata®13. We found an excess of risk behaviors among victims of family violence in both sexes. The co-occurrence of the four risk behaviors analyzed was higher among male and female adolescents, who were victims of family violence than in nonvictims. Family violence was associated with the adoption of risk behaviors, regardless of sex. This association was stronger as the number of risk behaviors adopted increased. The chance of engaging in one risk behavior was 1.32 (95% confidence interval (CI) = [0.88, 1.98]) and 1.24 (95% CI = [0.90, 1.72]) higher for boys and girls, respectively, who had suffered family violence. This increased to 7.76 (95% CI = [5.33, 11.29]) and 7.28 (95% CI = [5.20, 10.20]) when considering engagement in four risk behaviors. Identifying the prevalence of co-occurrence of health risk behaviors in vulnerable subgroups (such as victims of domestic violence) could help target broader interventions focusing on multiple risk behaviors.

The association between mistreatment of women during childbirth and postnatal maternal and child health care: Findings from "Birth in Brazil"

BACKGROUND

The mistreatment of women during pregnancy, childbirth, and the puerperium is a global public health problem besides being a violation of human rights. However, research exploring the consequences of mistreatment of women and newborns is scarce.

QUESTION

To shed light on this issue, we investigated the association between the mistreatment of women during childbirth and the subsequent use of postnatal health services by women and their newborns.

METHODS

We used data from the study "Birth in Brazil", a national hospital-based survey of puerperal women and their newborns, carried out in 2011/2012. This analysis involved 19,644 women. Mistreatment was a latent variable composed of seven indicators. We assessed the attendance of women and newborns to a review consultation following birth, and the timing of this appointment. We applied multigroup structural equation modeling (based on childbirth payment source) and considered separate analysis for women (vaginal births and0 caesarean-sections) and newborns.

FINDINGS

We found a causal association between mistreatment during childbirth and decreased and/or delayed use of postnatal health services, for both women and their newborns. These results also revealed that women who use the public sector are affected more than those who pay for private healthcare.

CONCLUSION

Mistreatment during childbirth has broader implications than "maternal mental health", and it would be useful to understand that experience of care has vast implications for families. In Brazil, the mistreatment must be mitigated via the implementation of public policy. This is part of the path to dignified and respectful childbirth care for all women.

Feasibility in meeting nutrient amounts of the National School Feeding Program and its relationship with the menu cost

We evaluated the feasibility of the menu adequacy regarding the nutritional constraints established by the National School Feeding Program (PNAE) and its relation to the cost. Each menu accounted for a given food combination within each food group. A diet optimization model comprising each set of foods was designed to obtain food quantities in order to meet the exigences of the PNAE at the lowest cost (menus with 20% and 30% of dietary reference intake for energy, macronutrients, calcium, iron, magnesium, zinc, vitamins A and C, also restrictions for sodium, saturated and trans fats, and added sugar). There was no feasible solution that accommodated all nutrient targets. Limiting components were calcium, sodium, and carbohydrates; but the menus were adequate for the other nutrients. There was a positive correlation between the menu cost and the frequency of meat and fruits, and a negative correlation with the contents of sodium and carbohydrates, and with the frequencies of rice and beans. The probability of obtaining carbohydrate adequacy was close to zero when the meat frequency was higher than one serving per week. In conclusion, it is unlikely to obtain menus that meet all the requirements of the PNAE.

Violência contra idosos durante a pandemia de Covid-19 no Brasil: contribuições para seu enfrentamento

Resumo O distanciamento social tem sido usado pela maioria dos governos estaduais e municipais do Brasil como principal estratégia para a redução da velocidade de transmissão do novo coronavírus (SARS-CoV-2), agente etiológico da COVID-19. Entretanto, esse isolamento social tem tido várias repercussões negativas, dentre elas o aumento da violência intrafamiliar contra crianças, adolescentes e mulheres. Recentemente, a violência contra a pessoa idosa (VCPI) durante a pandemia também vem entrando na pauta das preocupações, embora a discussão sobre as possíveis estratégias de enfrentamento da VCPI durante a COVID-19 ainda seja inexpressiva em todo o mundo. Visando ampliar o debate sobre o tema no Brasil, este artigo pretende oferecer elementos teóricos e evidências de estudos anteriores para uma maior compreensão da situação de vulnerabilidade do idoso às situações de violência, das possíveis motivações para o aumento do número de casos de VCPI durante a COVID-19, bem como sugerir possíveis estratégias para o enfrentamento do problema.

Treatment of Childhood Obesity Based on Brazilian Dietary Guidelines Plus Energy Restriction (PAPPAS HUPE Study): Protocol for a Randomized Clinical Trial

Background

The Food Guide for the Brazilian Population relies on natural or minimally processed foods mainly of plant origin such as beans and rice with low oil, salt, and sugar content and limited consumption of ultraprocessed foods. Reduction of ultraprocessed foods improves diet quality and energy consumption.

Objective

The goal of this study is to evaluate the effectiveness of an intervention for the treatment of obesity in children, with counseling based on the Brazilian Food Guide plus control of total energy intake.

Methods

A parallel, randomized clinical trial will include children aged 7 to 12 years. Randomization will be performed in blocks of 10 individuals using computer-generated random sequence numbers. Both the control and intervention groups will participate in 6 standardized educational activities based on the 10 steps of the Brazilian Food Guide. These activities will be conducted at the University Hospital Toy Library, located in the pediatric outpatient clinic. For the intervention group, in addition to the educational activities, an individualized food plan based on the nutritional recommendations of the Brazilian Society of Pediatrics will be prescribed and discussed with the mothers and fathers. The primary outcome of the study will be variations in body mass index, and secondary outcomes will include analysis of insulin resistance, blood pressure, body fat percentage, and waist and neck circumference.

Results

This project was funded by the National Council for Scientific and Technological Development in December 2017 (grant no 408333/2017-0). Recruitment began in August 2018 and by September 2019, we had enrolled the 101 participants. In addition to the patients referred by the national system of regulation, recruitment was made by medical outpatient referral and external indication. This is an ongoing study. We expect the results to be published in November 2020.

Conclusions

At the end of the project, in case of a positive result, a protocol for the treatment of obesity based on the Brazilian Food Guide will be proposed to the Unified Health System. A successful method to reduce childhood obesity is expected.

Trial Registration

Brazilian Registry of Clinical Trials RBR-3st5sn; http://www.ensaiosclinicos.gov.br/rg/RBR-3st5sn

International Registered Report Identifier (IRRID)

DERR1-10.2196/16170

Quality of complementary feeding and its effect on nutritional status in preterm infants: a cross-sectional study

BACKGROUND

The first 2 years of life represent a critical phase for growth and development, with the quality of the diet at this stage having repercussions throughout adulthood. The present study aimed to develop an Index for Measuring the Quality of Complementary Feeding (IMQCF) for infants, as well as to evaluate diet quality and its effects on the nutritional status of preterm infants.

METHODS

This cross-sectional study was conducted at a Brazilian University Hospital. The data were extracted by care protocol of outpatient preterm infants at 2 years of corrected age (CA). Dietary data were collected from 24-h recalls. The diet quality was assessed by the IMQCF composed of nine items based on a Brazilian Food Guide for children aged <2 years. Response options were scored 0-100, with scores closer to 100 representing a better quality diet. Association with growth indicators (Z-scores for weight- and length-for-age (WAZ and LAZ) were evaluated via tests of mean difference and multiple linear regression.

RESULTS

The median complementary feeding (CF) score was 72.2 (61.1-77.8) A shorter breastfeeding duration or infant formula use and the early introduction of wheat-based foods, ultra-processed foods and cow's milk in the preterm's diet were the main factors interfering in the adequacy of diet. There was an association between the quality of the diet score and WAZ (0.44; 95% confidence interval = 0.03-0.85; P = 0.03).

CONCLUSIONS

The introduction of poor quality food in the first 2 years of life interfered with the CF quality of preterm infants and can affect nutritional status at 2 years of CA, possibly in the long term.

Food consumption and depression among Brazilian adults: results from the Brazilian National Health Survey, 2013

Abstract: Our study aimed to evaluate the association between food consumption and depression. We used data from the Brazilian National Health Survey; a cross-sectional study carried out in 2013 among 46,785 Brazilian adults. The exposures were regular consumption (≥ 5 times/week) of the markers of healthy (beans, vegetables, fruits, and natural fruit juices) and unhealthy food (sugar sweetened beverages; sweets and the substitution of lunch or dinner for snacks); and a nutritional score elaborated by combining the frequency of consumption of markers of healthy and unhealthy food, the higher the value, the better the diet. The outcome was depression, assessed through the PHQ-9 questionnaire answered by the participants. Those with PHQ-9 scores greater than or equal to 10 were classified as presenting depression. We performed logistic regression models adjusted for potential confounders. Regular consumption of sweets (OR = 1.53; 95%CI: 1.33-1.76) and regular replacement of meals for snacks (OR = 1.52; 95%CI: 1.21-1.90) were positively associated with depression. Regular consumption of sugar sweetened beverages was positively associated with depression among women (OR = 1.27; 95%CI: 1.10-1.48). Regular consumption of beans was negatively associated with depression (OR = 0.74; 95%CI: 0.65-0.84), consistent for both sexes. Comparing the top quintile of the nutritional score (healthier diet) to the bottom quintile (less healthy) we found a negative association with depression (OR = 0.63; 95%CI: 0.52-0.75). Our results add evidence on a possible role of food consumption in depression; future longitudinal studies should explore the mechanisms of these associations.

Women economic empowerment via cash transfer and microcredit programs is enough to decrease intimate partner violence? Evidence from a systematic review

Intimate partner violence (IPV) is a worldwide public health problem. Many proposals aiming to eliminate its occurrence include the empowerment of women through their socio-economic development. In this context, some studies suggested that microcredit programs (MP) and cash transfer programs (CTP) are initiatives that can also reduce the risk of IPV. Others pointed to an opposite effect. The objective of this study was to investigate the influence of women's economic empowerment in MP and CTP on the risk of physical, psychological and sexual violence through a systematic review. Papers/documents selection was conducted by two researchers according to the following criteria: published in English, Portuguese or Spanish; primary data; assessing the effect of MP or CTP on IPV; in heterosexual couples; on women beneficiaries of the intervention; using a comparator group eligible for an MP or CTP; and focusing on risk IPV as the outcomes. Our results showed that the impact of MP are mixed when it comes to physical and physical/sexual violence. Even so, the review suggests that the effect of MP on sexual violence is trivial or nonexistent. Regarding the impact of CTPs, the present study showed that the effects on physical, physical/sexual, psychological, and sexual violence were also heterogeneous. Women more empowered and with some autonomy could be at risk. Despite that, participation in the empowerment program should be encouraged for poor women and families. However, parallel interventions to lead with IPV should be addressed to the main actions to reduce the risk of increasing IPV prevalence in certain scenarios.

Tendência de bullying verbal, violência doméstica e envolvimento em brigas com armas entre adolescentes das capitais brasileiras de 2009 a 2015

Resumo: Objetivou-se analisar a tendência temporal de bullying verbal, a violência doméstica e o envolvimento em brigas com armas entre adolescentes, nas capitais brasileiras, entre 2009 e 2015. Fez-se estudo de tendência, com uso de dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) realizada em 2009, 2012 e 2015, com escolares do 9º ano do Ensino Fundamental de escolas públicas e privadas nas 26 capitais do país e no Distrito Federal. Analisou-se a ocorrência de violência doméstica e de bullying verbal, bem como o envolvimento em brigas com uso de armas branca e de fogo nos 30 dias anteriores à entrevista. Realizou-se regressão logística ajustada para características sociodemográficas e comportamentais, com análise de cada tipo de violência no Brasil e nas capitais, segundo sexo. As tendências foram espacializadas. Para o conjunto das capitais, houve aumento, entre 2009 e 2015, de 12% (IC95%: 1,11-1,14) para violência doméstica, de 10% (IC95%: 1,08-1,11) para bullying verbal, de 7% (IC95%: 1,05-1,09) para envolvimento em brigas com armas de fogo e de 7% (IC95%: 1,05-1,08) para envolvimento em brigas com arma branca. Em todas as capitais, houve aumento na violência doméstica. Em 96,3%, 70,4% e 62,9% dessas cidades, observou-se aumento de bullying verbal, envolvimento em briga com arma branca e envolvimento em briga com arma de fogo, respectivamente. Nas demais capitais, observou-se tendência estacionária. Identificou-se tendência de aumento das violências na maioria das capitais, evidenciando a necessidade de implementação de políticas públicas que contribuam para minimizar esse problema entre os adolescentes.

Effective strategies for prevention, control, and treatment of obesity in primary health care setting for adolescents, adults, and elderly people: A protocol for systematic review and meta-analysis

BACKGROUND

It is unquestionable that obesity is a global epidemic and one of the main public health problems in the world. The management of obesity in Primary Health Care has an important role if being considered the magnitude and serious consequence of this problem. Despite this, there is no effective standard protocol for the treatment of this disease. Studies that synthesize and assess the effectiveness of strategies for prevention, control, and treatment of obesity in Primary Health Care setting are still scarce. The objective of this study is review and synthesize study evidence for obesity management strategies among adolescents, adults and elderly developed at the Primary Health Care worldwide.

METHODS

Seven electronic databases (Medline, Lilacs, Embase, Psycinfo, Cochrane, WHOLIS and Open Gray) will be searched with no date limit for identification of clinical trials examining the effectiveness of prevention, control and treatment of obesity in Primary Health Care. As primary outcome will be changes in body weight. As secondary outcomes will be body mass index, body adiposity, waist circumference, and waist-hip ratio. Two independent authors will perform the selection of studies, data extraction, and the assessment of risk of bias.

RESULTS

The results will be published in a peer-reviewed journal.

CONCLUSION

This systematic review will be first to synthesize scientific evidence for obesity management strategies at Primary Health Care among adolescents, adults, and elderly. The review will benefit healthcare professionals and policymakers.

ETHICS AND DISSEMINATIONS

Ethical approval is not required in this study because the data used include peer-reviewed publications, which do not comprise any information that could identify subjects.

TRIAL REGISTRATION NUMBER

PROSPERO (CRD42018092416).

Design of a school randomized trial for nudging students towards healthy diet and physical activity to prevent obesity: PAAPAS Nudge study protocol

OBJECTIVE

To evaluate the effectiveness of nudge activities at school on the students' body mass index (BMI).

DESIGN

School-based factorial randomized community trial.

SETTING

Eighteen public schools in the municipality of Duque de Caxias, metropolitan area of Rio de Janeiro, Brazil.

PARTICIPANTS AND INTERVENTION

The 18 schools will be randomized into 4 group arms: group 1-control (without any activity); group 2-will receive educational activities in the classroom; group 3-will receive changes in the school environment (nudge strategies); group 4-will receive educational activities and changes in the school environment. Activities will occur during the 2018 school-year.

MAIN OUTCOME MEASURE(S)

The primary (BMI) and secondary (body fat percentage) outcomes will be assessed at baseline and after the study using a portable electronic scale with a segmental body composition monitor. The height will be measured by a portable stadiometer.

ANALYSIS

Statistical analyses for each outcome will be conducted through linear mixed models that took into account the missing data and cluster effect of the schools.

First cytotoxic, genotoxic, and antigenotoxic assessment of Euterpe oleracea fruit oil (açaí) in cultured human cells

Euterpe oleracea Mart., popularly known as "açaí", is a tropical fruit from the Amazon region where it has considerable economic importance. Açaí has been used as food and for several medicinal purposes. Despite the widespread use of this fruit, there is a lack of data regarding the safety of using this fruit oil exclusively. Therefore, we evaluated the in vitro cytotoxic, genotoxic, and antigenotoxic effects of E. oleracea fruit oil (EOO) in cultured human lymphocytes (non-metabolizing cells) and HepG2 cell line (human hepatoma) (metabolizing cells) by using MTT, comet, and micronucleus assays. A wide range of EOO concentrations was tested with a preliminary MTT assay, which allowed selecting five concentrations for comet and micronucleus assays: 2.5, 10, 100, 500, and 1000 µg/mL. The results showed that none of the EOO tested concentrations presented cytotoxic effects. The genotoxic assessment revealed an absence of significant DNA and chromosome damage in human lymphocytes and HepG2 cells but did not show chemoprotection against the DNA damage induced by methyl methanesulfonate and benzo[a]pyrene, used as DNA-damaging agents.

Evaluation of the genotoxicity of Euterpe oleraceae Mart. (Arecaceae) fruit oil (açaí), in mammalian cells in vivo

E. oleracea is a tropical plant from the Amazon region, with its fruit used for food, and traditionally, as an antioxidant, anti-inflammatory, hypocholesterolemic, for atherosclerotic disease, and has anticancer properties. The oil of the fruit has antidiarrheic, anti-inflammatory and antinociceptive activities, but without genotoxicity evaluation. Therefore, the aim of this study was to evaluate the genotoxic potential of E. oleracea fruit oil (EOO), in rat cells. Male Wistar rats were treated with EOO by gavage at doses of 30, 100 and 300 mg/kg, for 14 days, within a 24 h interval. The DNA damage in the leukocytes, liver, bone marrow and testicular cells, was assessed by the comet assay, and the clastogenic/aneugenic effects in the bone marrow cells, by the micronucleus test. Our phytochemicals characterization of the EOO showed the presence of vanillic, palmitic, γ-linolenic, linoleic, oleic, cinnamic, caffeic, protocatechuic, ferulic, syringic acids, and flavonoids quercetin and kaempferol rutinoside as the main constituents. Both cytogenetic tests performed showed that EOO presented no significant genotoxic effects in the analyzed cells, at the three tested doses. These results indicate that, under our experimental conditions, E. oleracea fruit oil did not reveal genetic toxicity in rat cells.

Effect of physical intimate partner violence on body mass index in low-income adult women

This study aimed to assess whether physical intimate partner violence affects the nutritional status of adult women with different levels of body mass index (BMI). This was a population-based cross-sectional study with 625 women selected through complex multistage cluster sampling. Information on physical intimate partner violence was obtained with the Revised Conflict Tactics Scales, and nutritional status was measured as BMI (kg/m2). A quantile regression model was used to assess the effect of physical intimate partner violence at all percentiles of BMI distribution. Physical intimate partner violence occurred in 27.6% of the women (95%CI: 20.0; 35.2). Mean BMI was 27.9kg/m2 (95%CI: 27.1; 28.7). The results showed that physical intimate partner violence was negatively associated with BMI between the 25th and 85th percentiles, corresponding to 22.9 and 31.2kg/m2. The findings support previous studies indicating that physical intimate partner violence can reduce BMI in low-income women.

[Social representations on the diet of nursing mothers]

This is a qualitative study that sought to establish the significance attributed by women to adequate eating habits with respect to prohibited, permitted and breastmilk-enhancing products during breastfeeding. It was based on the Theory of Social Representations described by Moscovici (2003) and Minayo (2006). 58 mothers of children up to 2 years of age living in the city of Coimbra in Minas Gerais state participated in the survey. Comprehensive analysis of feeding revealed that the new mothers interviewed understood the need for a special diet during postpartum based on healthy, fortified and lactose-rich food, as well as the need for ingesting liquids. Breatfeeding mothers appreciated the need to avoid hot, creamy and fatty food. In this perspective, feeding during this physiological phase implies an understanding of cultural, social and historical aspects which dictate eating habits. This assists in understanding customs and beliefs in order to provide professional assistance geared to the group being assisted in its proper context.

Representações sociais sobre a alimentação da nutriz

Trata-se de uma pesquisa qualitativa, que buscou compreender os significados atribuídos pelas mulheres ao hábito alimentar, no que se referem às proibições, permissões e lactogogos durante o aleitamento materno. Como fundamentação teórica, utilizou-a Teoria das Representações Sociais descrita por Moscovici (2003) e Minayo (2006). Participaram do estudo 58 mães de crianças até 2 anos residentes no município de Coimbra (MG). A análise compreensiva da alimentação revelou que para as mães entrevistadas havia a necessidade de uma alimentação especial durante o puerpério, sendo esta composta de alimentos considerados saudáveis, fortes, lactogênicos, além da ingestão de líquido. Ainda, em relação à dieta da lactante, os alimentos quentes, reimosos, gordurosos deveriam ser evitados. Nessa perspectiva, pensar em alimentação nesta fase fisiológica da mulher implica conhecer os aspectos histórico, social e cultural que interferem na escolha alimentar, permitindo assim entender seus hábitos e crenças para que a atuação profissional seja adequada ao grupo atendido e ao contexto no qual ele se insere.

Mitos e crenças sobre o aleitamento materno

Objetivou-se analisar os principais mitos e crenças relacionados ao aleitamento materno na perspectiva teórico-prática dos diferentes estudos presentes na literatura. Os estudos foram obtidos através de revisão bibliográfica nas principais bases de dados (Medline, Lilacs, Scielo), utilizando os seguintes descritores: "Aleitamento materno", "Desmame", "Mitos" e "Crenças" (e suas versões em inglês e espanhol). Foram consultados também livros, teses, dissertações, publicações em órgãos internacionais e nacionais. Observa-se através dos séculos a existência de questionamentos quanto à forma correta de alimentação do bebê pautados em concepções que tangem o biológico e os determinantes socioculturais. Verifica-se que diversos mitos e crenças que norteiam a lactação geram na nutriz sentimentos de culpa, ansiedade, ou de confiança e apoio quanto à sua capacidade de produção láctea. Nesse sentido, faz-se necessário que os profissionais de saúde compreendam a lactação sob o olhar materno, desvendando seus mitos e crenças, mudando sua forma de atendimento, de modo a contemplar os diversos fatores presentes na lactação, atuando de modo mais eficaz para o prolongamento e a manutenção da amamentação.

A influência da rede social da nutriz no aleitamento materno: o papel estratégico dos familiares e dos profissionais de saúde

Objetivou-se levantar e categorizar trabalhos científicos sobre a influência da rede social da lactante no contexto da amamentação. Para isto, realizou-se uma revisão bibliográfica nas principais bases de dados em saúde (MEDLINE, LILACS, SciELO), utilizando como palavras chaves os descritores: aleitamento materno, desmame e família (e suas versões em inglês e espanhol). Foram consultados também livros, teses, dissertações, publicações em órgãos internacionais e nacionais (OMS, UNICEF, Ministério da Saúde). Pode-se observar que os atores que compõem a rede social da nutriz são capazes de exercer interferência na decisão de amamentar, através de diferentes âmbitos, tais como o incentivo/apoio à iniciativa; o repasse de conhecimentos e valores culturais; a tradição familiar e o cultivo do desinteresse/desestímulo e da pressão exercida sobre a lactante em relação à forma de alimentar a criança. Destarte, pode-se inferir sobre a necessidade de implementação de novas práticas de saúde no que tange à forma de cuidado a este grupo populacional. Vale ressaltar a importância de que os profissionais se capacitem para uma escuta sensível sobre o significado da lactação desde o olhar da nutriz. Por fim, destaca-se o papel importante da rede social da lactante, principalmente a família, para o sucesso da amamentação.

Representações sociais de mulheres que amamentam sobre a amamentação e o uso de chupeta

Objetivou-se identificar os diferentes significados que envolvem o aleitamento materno e o uso de chupetas de um grupo de mães de crianças menores de seis meses de idade. Adotou-se os preceitos metodológicos da pesquisa qualitativa. Foram realizadas entrevistas semi-estruturadas e individuaism, transcritas na íntegra e analisadas segundo a técnica de análise de conteúdo de Bardin. A análise compreensiva dos discursos revelou a presença de representações que podem exercer interferência na decisão de amamentar - tanto positiva, quanto negativamente. Nesse sentido, é importante que os profissionais de saúde, conheçam os contextos nos quais estas nutrizes estão inseridas, principalmente suas dúvidas, angústias, mitos e crenças em relação à amamentação, atuando assim em prol da lactação.

[Assessment of sanitation and housing conditions: the importance of home visits in the Family Health Program context]

Knowledge of health-related environmental conditions - such as basic sanitation and housing - are of singular importance for establishing measures designed to upgrade the quality of life at the individual, family and community levels. Through home visits, this paper evaluates families enrolled in the Family Health Program (FHP) in Teixeiras, Minas Gerais State, Brazil, including their housing and basic sanitation conditions. A transverse observational study, its semi-structured questionnaire was applied to 10% (n=364) of the families enrolled in this Program. The net water supply coverage reached 83% of homes in urban areas and 11.7% in rural areas. The public water supply was the final disposal point for the water used in 82.2% of urban dwellings and 10.9% of rural homes. Home visits offer inside glimpses into the lives of the beneficiaries of this Program, particularly in view of the unequal distribution of the sanitation infrastructure between urban and rural areas, constituting an important tool for the Family Health Strategy, by helping identify the key factors in the health x disease processes noted in the settings within which these families live, and paving the way to better health through Health Education.

Calcium-activated sodium and chloride fluxes modulate platelet volume: role of Ca2+ stores

An increase in cytosolic ionized Ca2+ concentration ([Ca2+]i) initiates volume changes in various types of cells. In response to increases in [Ca2+]i most cell types contract by efflux of K+ and Cl-, whereas platelets expand in response to rises in [Ca2+]i. This study examined the importance of the source of Ca2+, the flux of ions responsible for the volume change, and the role of Ca(2+)-dependent protein kinases in regulating these ionic fluxes. The baseline platelet volume was independent of extracellular Ca2+ but when stimulated by the Ca2+ ionophore A-23187 (50 nM) the volume increased in both the presence and absence of extracellular Ca2+ (1.18 +/- 0.08 vs. 0.83 +/- 0.06 fl, respectively). The increased volume was caused by the gain of Na+ and Cl-. Na+ entered through both conductive and nonconductive (Na+/H+ exchange) pathways, whereas the influx of Cl- was conductive and inhibited by the Cl- channel blocker 4,4'-diisothiocyanostilbene-2,2'-disulfonic acid. The Ca(2+)-induced volume change was blocked by both calmodulin and protein kinase inhibitors. Thus the activation of Ca(2+)-dependent protein kinases promotes platelet swelling by stimulating Na+ and Cl- influx.