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Objective: To analyse the trends and factors associated with anaemia in 6- to 59-month-old children in Northeast Brazil.Design: Cross-sectional study assessed information from the second and third Pernambuco State Health and Nutrition Surveys carried out in 1997 and 2006. A multiple regression analysis was performed from a conceptual model addressing biological and socio-economic factors, housing and sanitation conditions, maternal factors, health care and nutrition, consumption, morbidity and nutritional status. Poisson's regression with robust variance was used.Setting: Pernambuco, Brazil.Subjects: A total of 777 and 993 children, respectively, in the second and third Pernambuco State Health and Nutrition Surveys.Results: The prevalence of anaemia (Hb < 11 g/dl) decreased by 19·3 % (40·9 % down to 33·0 %) between surveys. Maternal education level (less than 8 years in school), households ranked in the lowest environmental index tertile and children between 6 and 23 months of age were the variables common to the final models in the surveys of 1997 and 2006. Elements like living in rural areas, household income less than two minimum official wages and low birth weight were still present in the final model of the 1997 survey. Households ranked in the lowest economic index tertile were associated with anaemia in the model of the 2006 survey.Conclusions: The study results are quite encouraging from the perspective of reducing the prevalence of anaemia. Maternal education level, environmental conditions and child age were determinant factors in both surveys, and economic factors were determinant in 2006. [ABSTRACT FROM AUTHOR]

Maternal vitamin A (VA) supplementation in risk areas for Vitamin A deficiency (VAD) was launched to improve the level of this nutrient in nursing mothers and in their breast milk. This longitudinal and randomized study aimed to evaluate the levels of retinol in breast milk after supplementation with VA in varying amounts (200,000 IU or 400,000 IU) and different postpartum intervals. Women were distributed into four intervention groups and given a single 200,000 IU postnatal dosage of VA at time 0 h (postnatal morning) (G200 0H); a single 200,000 IU dosage of VA in week four (G200 4W); 200,000 IU of VA at time 0 h + 200,000 IU of VA 24 h after the first supplementation (G400 24H); and 200,000 IU of VA at time 0 h + 200,000 IU of VA one week after the first supplementation (G400 1W). Breast milk samples were collected over a 12-week period (0 h, 24 h and 1, 4, 12 weeks post-natal). Retinol levels were determined by high-performance liquid chromatography. The Generalized Estimated Equation (GEE) assessed the different retinol levels. The G200 (0H), G400 (24H), and G400 (1W) groups presented higher retinol levels at 24 h than the G200 (4W) group (p < 0.001). The retinol levels of all groups were similar at times 1, 4 and 12 weeks after delivery (p > 0.05). Maternal VA supplementation increased retinol levels in the colostrum. Different supplementation dosages or postpartum administration times did not result in added benefit to retinol levels in mature breast milk.

Objective: Dietary lipid intake is associated with serum alpha-tocopherol levels; however, its impact on human milk is unknown. The objective of this study was to evaluate the relationship between maternal intake of vitamin E, lipids, and fatty acids and the concentration of alpha-tocopherol in human milk., Methods: We conducted a longitudinal observational study, including 143 lactating women on 7, 30, and 90 days postpartum. Dietary intake was collected using 24-hour recall. On day 90, a human milk sample was collected and analyzed for alpha-tocopherol concentration. The prevalence of inadequate vitamin E intake was determined by the Estimated Average Requirement (16 mg/day), and the alpha-tocopherol concentration was analyzed by high-performance liquid chromatography., Results: Dietary intake of vitamin E was associated with the intake of lipids (r = 0.237, P = 0.004) and fatty acids (P < 0.05), and 100% of the participants had inadequate vitamin intake. Mean alpha-tocopherol concentration in the human milk samples was 7.11 (standard deviation 3.95) μmol/L and was correlated with lipid (r = 0.201, P = 0.042) and polyunsaturated fatty acid intake (r = 0.235, P = 0.017). Higher vitamin E levels were found in participants with the highest quartile of polyunsaturated fatty acid intake., Conclusions: Alpha-tocopherol concentration was associated with the dietary intake of lipids and fatty acids, demonstrating that its bioavailability is associated with fats in the mammary gland. These results suggest development of appropriate strategies to increase the levels of vitamin E in breast milk that may help to prevent and treat vitamin E deficiency.

Background: Vitamin A deficiency is still considered to be a nutritional problem during pregnancy, lactation and early childhood. The present study aimed to assess the vitamin A status of women and their newborns in the Brazilian Northeast and to determine the association between retinol in the maternal serum, umbilical cord blood and colostrum., Methods: Vitamin A status in 65 pairs of women and newborns was assessed from samples of the mother's serum, umbilical cord serum and colostrum using high-performance liquid chromatography. The inadequacy of the vitamin A status of mothers and infants was identified if the retinol values were <0.7 µmol L - 1 in maternal serum or umbilical cord blood or <1.05 µmol L -1 in colostrum., Results: The prevalence of inadequate maternal vitamin A status was 21.5% (95% CI: 11.5%-31.5%) and 13.8% [95% confidence interval (CI) = 5.4%-22.2%] based on maternal serum and colostrum, respectively. Among newborns, 41.5% (95% CI = 29.3%-53.5%) presented a low status of vitamin A based on cord serum. Multiple linear regression analysis identified that maternal serum retinol is a predictor of umbilical cord retinol (P = 0.005). Retinol in maternal serum was lower in mothers who were less educated (P = 0.04) and colostrum retinol was higher in older (P = 0.04) and multiparous (P = 0.002) mothers., Conclusions: Vitamin A deficiency is a common problem among mothers attended in public hospitals in Northeast Brazil and maternal retinol concentrations are associated with retinol status in newborns. Maternal age, parity and educational level were related to the maternal vitamin A status., (© 2019 The British Dietetic Association Ltd.)

The scope of this study was to analyze adherence to school food and associated factors among adolescents from public state schools in the municipality of Lapa, Paraná, in the Southern region of Brazil. The study uses a cross-sectional and analytical design and includes 492 male and female adolescents aged 10 to 19 years from five urban and five rural schools in the municipality. The students underwent anthropometric assessment and answered a questionnaire about school food and alternative food intakes (purchased or home-cooked). Their parents/guardians answered a questionnaire about their demographic and socioeconomic characteristics. An adjusted proportional odds regression model investigated the associations. The effective adherence to school food was 30.1% in rural schools and 23.7% in urban schools. Dislike of the food preparation was the main reason for non-adherence. The results showed lesser adherence among adolescents with higher per capita family income who consumed alternative food products four to five times per week. Adolescents who considered school food healthy showed higher adherence. Low adherence to school food indicates the inadequate universality of the program. The factors revealed may help to improve program planning and execution.

The support offered to mothers after hospital discharge can be decisive in maintaining exclusive breastfeeding during the first 6 months post-partum. The objective of this study was to assess the impact on the duration of exclusive breastfeeding of a participatory intervention using an online social network. A randomized clinical trial was performed involving 251 mother-child pairings in a university hospital in the Northeast of Brazil, 123 of which assigned to the intervention group and 128 to the control group. After hospital discharge, the intervention group was followed through a closed group of an online social network, where weekly posters were published on topics related to breastfeeding and an active communication was established with the mothers. The groups were interviewed monthly over the phone until the child reached 6 months of age. The duration of exclusive breastfeeding was calculated through survival analysis, and the effect of the intervention was estimated through the Cox regression model. The exclusive breastfeeding frequencies were higher in the intervention group in all follow-up months, reaching 33.3% in the sixth month versus 8.3% in the control group. The median exclusive breastfeeding duration was 149 days (95% CI [129.6, 168.4]) in the intervention group and 86 days (95% CI [64.9, 107.1]) in the control group (P < 0.0001). The proportional risk of early interruption of exclusive breastfeeding was 0.38 (95% CI [0.28, 0.51], P < 0.0001). This intervention had a positive impact on the duration and frequency of exclusive breastfeeding., (© 2019 John Wiley & Sons Ltd.)

Objective: To determine the concentration of alpha-tocopherol in umbilical cord serum of full-term and preterm newborns, in order to assess the nutritional status of both groups in relation to the vitamin and its possible correlation with intrauterine growth., Methods: A cross-sectional observational study conducted with 140 newborns, of which 64 were preterm and 76 were full-term. They did not have any malformations, they came from healthy mothers, who were nonsmokers, and delivered a single baby. Intrauterine growth was evaluated by weight-to-gestational age at birth, using Intergrowth-21st. Thealpha-tocopherol levels of umbilical cord serum were analyzed by High Performance Liquid Chromatography., Results: The mean concentration of alpha-tocopherol in umbilical cord serum for preterm and full-term infants was 263.3±129.5 and 247.0±147.6 µg/dL (p=0.494). In the preterm group, 23% were small for gestational age, whereas in the full-term group, this percentage was only 7% (p=0.017). Low levels of vitamin E were found in 95.3% of preterm infants and 92.1% of full-term infants. There was no correlation between alpha-tocopherol levels and weight to gestational age Z score (p=0.951)., Conclusions: No association was found between alpha-tocopherol levels and weight to gestational age at birth. Intrauterine growth restriction was more frequent in preterm infants and most infants had low levels of vitamin E at the time of delivery.

Background: Assessing food consumption in adolescents is essential for the determination of an appropriate nutritional status. This study intended to assess dietary patterns and its associated factors in rural Mozambican adolescents., Methods: This was a cross-sectional study of 323 adolescents. A food frequency questionnaire was used and food was grouped into nine groups. An exploratory factorial analysis identified the food patterns. A principal component analysis provided food consumption scores in each factor, split into three groups. An adjustment of multinomial regression models was made., Results: Two diet patterns were identified: pattern 1 (fats, beans, meats and eggs, cereals and sugars) and pattern 2 (vegetables, roots and tubers, fruits, chestnuts and walnuts). The proportional model for pattern 1 indicated highest consumption for adolescents with per capita family income equal to or greater than 78.13 meticais (Mozambique's currency) and for adolescents whose parents had a formal job. For pattern 2, consumption was lower for adolescents whose guardians had high school education or more. The consumption in the first three quartiles was lower for individuals with an income between 1 and 78.12 meticais., Conclusions: For Mozambican adolescents, higher income, education and parents' jobs were predictive variables for consumption of fats, beans, meats and eggs, cereals, and sugars, while higher education and higher income implies lower consumption of vegetables, roots and tubers, fruits, chestnuts, and walnuts.

Objective: To characterize prenatal care and verify possible factors associated with its adequacy., Methods: This is a cross-sectional study based on interviews with health care professionals and consultations on official documents of women attending prenatal of the primary health care in the city of João Pessoa, capital of Paraíba, in the Northeast region of Brazil. Prenatal care was evaluated by an index with criteria referring to aspects of structure, process and outcome, denominated IPR/Prenatal. The multivariate logistic regression method revealed that demographic, socioeconomic, reproductive and maternal morbidity variables were possible determinants for prenatal adequacy., Results: The survey involved 130 services and 1,625 primary health care patients. Prenatal care was adequate in approximately 23% of the cases. Low prevalence of referral to maternity, educational strategies and examinations were observed. The analysis showed that non-adolescent women (OR = 1,390), with a longer period of schooling (OR = 1.750), higher per capita income (OR = 1,870) and primiparous women (OR = 1,230) were more likely to have an adequate prenatal., Conclusions: Prenatal care, when evaluated by broader criteria, showed a low percentage of adequacy. Strategies should be developed to ensure the referral to the maternity where the birth will take place and health education activities and examinations to provide adequate prenatal care in the municipality under study. In addition, factors associated with adequacy must be considered by managers and health professionals.

This study aimed to estimate the prevalence of adherence to school meals and associated factors among adolescent schoolchildren (N = 1,569). The adolescents completed an on-line questionnaire on adherence to school meals, and their parents answered another questionnaire on socioeconomic data. The chi-square test was used to assess the association between adherence to school meals and gender, nutritional status, per capita family income, maternal schooling, adolescents' opinions on the dining hall layout, whether they considered school meals healthy, and consumption of other foods. Variables with statistical significance for adherence to school meals were included in the multilevel proportional odds logistic regression model. The covariates for comprising the final model were defined by backward selection methods. The results of the adjusted model were presented as odds ratios with respective 95% confidence intervals (95%CI). Prevalence of adherence to school meals was low, especially effective adherence (19.8%). Adherence was associated with per capita family income less than one minimum wage, lower consumption of foods outside of school meals, the fact that adolescents considered the dining hall space adequate, and believing that school meals are healthy. Adherence to school meals in this study falls short of universal coverage for the program. Different factors contribute to incomplete program implementation, which may hinder achieving the food and nutritional security policy under the Brazilian National School Feeding Program (PNAE).

Objectives: To determine the alpha-tocopherol concentration in breast milk at different periods of lactation and to estimate the possible supply of vitamin E to the infant., Methods: A longitudinal observational study was carried out with 100 mothers at University Hospital Ana Bezerra (HUAB), at Universidade Federal do Rio Grande do Norte, in Santa Cruz (RN), Northeast Brazil. Samples of colostrum (n=100), transitional milk (n=77), and mature milk (n=63) were collected. Alpha-tocopherol was analyzed by high-performance liquid chromatography. Vitamin supply to the newborn was estimated by comparing the nutritional requirement of vitamin E (4 mg/day) with the potential daily intake of milk., Results: The mean alpha-tocopherol concentration found in colostrum, transitional, and mature milk was 40.5±15.0 µmol/L, 13.9±5.2 µmol/L, and 8.0±3.8 µmol/L, respectively (p<0.001). The possible effect of these milks offered to the infant 6.2 mg/day of vitamin E in colostrum, 4.7 mg/day in transitional milk, and 2.7 mg/day in mature milk (p<0.0001), shows that only the mature milk did not guarantee the recommended quantity of this vitamin., Conclusions: Alpha-tocopherol levels in human milk decrease through the progression of lactation, and the possible intake of colostrum and transitional milk met the nutritional requirement of the infant. Mature milk may provide smaller amounts of vitamin E. Thus, it is important to study the factors that are associated with such low levels.

Vitamin E is important because of its antioxidant activity in situations of oxidative stress, especially postnatally. Hence, the objective was to verify whether maternal alpha-tocopherol level is associated with the alpha-tocopherol levels of the newborn and colostrum. This is a cross-sectional study of 58 women and their term newborns from a public hospital. Blood and colostrum were collected to measure alpha-tocopherol levels by high-performance liquid chromatography. Mothers with serum alpha-tocopherol levels <16.2 mmol L(-1) and newborns <11.6 mmol L(-1) were indicative of deficiency or low levels. Mothers were divided into two groups: <16.2 mmol L(-1) and those with levels ≥16.2 mmol L(-1) . The mean (95% confidence interval) serum alpha-tocopherol levels of mothers, umbilical cords and colostrum were 28 (24-32), 6 (5-8) and 39 mmol L(-1) (32-45), respectively (P < 0.001); 19% of the women and 90% of the newborns had low alpha-tocopherol levels. Maternal alpha-tocopherol level was associated with that of the umbilical cord. Newborns from mothers at risk of deficiency had low alpha-tocopherol levels (P < 0.001). Colostrum levels of vitamin E were not influenced by maternal serum. Maternal deficiency influenced the vitamin E level of the umbilical cord but does not in the colostrum, evidencing distinct transfer mechanisms via the mammary gland., (© 2016 John Wiley & Sons Ltd.)

This study aimed to analyze the impact of educational strategies developed in low-risk prenatal care on obstetric outcomes from a systematic literature review. This review consulted databases PubMed, Medline, SciELO and Lilacs, analyzing randomized clinical trials with the following birth outcomes: birth weight, prematurity and breastfeeding, using the following combination of keywords: pre-natal, antenatal visits, education, health education, pregnancy outcomes, birth weight, prematurity, breastfeeding and randomized clinical trial. Nine studies were included following quality evaluation. Actions prove to be more effective when extended to the postpartum period. Most of them occurred during home visits and had a positive impact on breastfeeding and birth weight. The establishment of groups of pregnant women contributed to lower prevalence of prematurity. Breastfeeding was found to be the outcome most sensitive to educational strategies. Educational practices during the prenatal period contributed to favorable obstetric outcomes as they minimized pregnant women concerns and anxiety during the pregnancy process, preparing them for childbirth and postpartum, and should be incorporated into health services' work process.

Objective: To identify the prevalence and factors associated with anemia in children attending Municipal Early Childhood Education Day Care Center (Centros Municipais de Educação Infantil [CMEI]) nurseries in Colombo-PR., Methods: Analytical, cross-sectional study with a representative sample of 334 children obtained by stratified cluster sampling, with random selection of 26 nurseries. Data collection was conducted through interviews with parents, assessment of iron intake by direct food weighing, and hemoglobin measurement using the finger-stick test. Bivariate association tests were performed followed by multiple logistic regression adjustment., Results: The prevalence of anemia was 34.7%. Factors associated with anemia were: maternal age younger than 28 years old (p=0.03), male children (p=0.02), children younger than 24 months (p=0.01), and children who did not consume iron food sources (meat+beans+dark green leafy vegetables) (p=0.02). There was no association between anemia and iron food intake in CMEI. However, iron intake was well below the recommended levels according to the National Education Development Fund resolution, higher prevalence of anemia was observed in children whose intake of iron, heme iron, and nonheme iron was below the median., Conclusions: In terms of public health, the prevalence of anemia is characterized as a moderate problem in the studied population and demonstrates the need for coordination of interdisciplinary actions for its reduction in CMEI nurseries., (Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

The objective in this article is to analyze how adolescents at a school in the interior of the State of Pernambuco, Brazil, perceive healthy eating. A descriptive and exploratory study was undertaken, based on the qualitative method. Forty adolescents between 10 and 14 years of age were investigated, using a semistructured interview. The interviews were analyzed using the software Alceste, which evidenced two thematic axes: Eating practices, divided in two classes (routine eating diary and Eating at weekends); and Education practices, consisting of four classes (Factors interfering in and facilitating the maintenance of healthy eating, Role of the school in the education process for healthy eating, Knowledge on healthy eating, The family and the promotion of healthy eating). Although the interviewed adolescents are familiar with healthy eating, they do not always put it in practice, due to the multiple factors that interfere in their preferred diet. The school and the family play a fundamental role in encouraging healthy eating. The school needs to accomplish eating education practices that encourage the consumption of locally produced foods.

Data from two health and nutrition surveys were used to analyze times trends in anemia and associated factors in children 6-23 and 24-59 months of age in Pernambuco State, Brazil. The samples totaled 777 and 993 children 6-59 months of age in the 2nd PESN/1997 and 3rd PESN/2006 surveys, respectively. The exploratory variables were grouped into five hierarchical levels: socioeconomic factors; economic index and environmental index; maternal factors; health and nutritional care; and morbidity and nutritional status, analyzed by Poisson logistic regression. From the first to the second survey, anemia prevalence decreased by 11.7% and 33.4%, respectively, for children 6-23 and 24-59 months of age. In the time trend analysis, only the lower tertile of the environmental index remained as a determinant factor for anemia in children 6-23 months of age, and the lower tertile of the economic index remained statistically significant in children 24-59 months of age. The study concludes that the decrease in anemia was more significant in the 24-59 month age group.

Objective: to understand the ways in which adolescent fathers participate in the breast feeding process in the family environment in North-eastern Brazil., Methods: a descriptive, exploratory, qualitative study was undertaken involving 10 couples with infants aged 6-8 months living in a single community in Recife, Pernambuco, Brazil. Data were collected using semi-structured interviews with questions to guide the interviewer. Data were analysed using thematic content analysis, and interpreted under the theoretical reference of being an adolescent father within the context of breast feeding., Findings: from the data collected, three themes were identified: knowledge of the benefits of breast feeding for the child's health; discontinued participation of the father in breast feeding during the pregnancy-childbearing cycle; and exclusion of the adolescent father from the breast feeding process. The adolescent fathers knew about the benefits of breast feeding in terms of the child's health, but did not mention benefits for the mother, the family or society. For some adolescent fathers, their participation in the breast feeding process started during pregnancy, whereas for others, it was only initiated after the infant was born. One of the fathers was prevented, by his wife and mother-in-law, from participating in the breast feeding process., Conclusions: the involvement of adolescent fathers in the breast feeding process oscillated during the pregnancy-childbearing cycle. This may be due to the patriarchal cultural heritage, Brazilian paternity laws, and the fact that these fathers were adolescents. This study showed that adolescent parents were knowledgeable about breast feeding. Finally, fathers want a new model of parenting in which the man participates in child care., (Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.)

Objective: Compare the scores resulting from the Comfort-B scale with the bispectral index in children in an intensive care unit., Methods: Eleven children between the ages of 1 month and 16 years requiring mechanical ventilation and sedation were simultaneously classified based on the bispectral index and the Comfort-B scale. Their behavior was recorded using digital photography, and the record was later evaluated by three independent evaluators. Agreement tests (Bland-Altman and Kappa) were then performed. The correlation between the two methods (Pearson correlation) was tested., Results: In total, 35 observations were performed on 11 patients. Based on the Kappa coefficient, the agreement among evaluators ranged from 0.56 to 0.75 (p<0.001). There was a positive and consistent association between the bispectral index and the Comfort-B scale [r=0.424 (p=0.011) to r=0.498 (p=0.002)]., Conclusion: Due to the strong correlation between the independent evaluators and the consistent correlation between the two methods, the results suggest that the Comfort-B scale is reproducible and useful in classifying the level of sedation in children requiring mechanical ventilation.

Malnutrition can lead to possible irreversible consequences in the development of muscle function and some of them are yet poorly characterized. The present study evaluated the mechanical properties of the triceps surae and motor performance in stunted (S) and eutrophic (E) prepubertal children (9 years ± 6 months). Height-for-age ratio was used as indicator of stunting due to early malnutrition, according to the World Health Organization. Torque was determined by maximal voluntary contractions (MVC) and musculotendinous (MT) stiffness was achieved through quick-release tests to obtain MT stiffness index (SI(MT)) and passive stiffness (K (p)) from linear MT stiffness-torque relationships. Percutaneous supramaximal electrically elicited contractions determined twitch torque (Pt) and electromechanical delay (EMD). Motor performance was evaluated by balance test. S group presented significantly lower MVC and a trend of lower Pt values indicating lower capacities to develop force under voluntary or induced conditions. Significantly higher SI(MT) and EMD values were observed, while K (p) and motor performance in balance were significantly lower. Higher SI(MT) values have been reported previously in youngest prepubertal children, indicating that immature activation capacities can mask MT stiffness assessment during voluntary contractions, taking into consideration the higher EMD values as a measure of muscle stiffness contribution. Lower K (p) may indicate a delay in the maturation of tendinous tissue in S group, influencing motor performance in balance. The present study shows that malnutrition leads to adaptation of intrinsic MT elastic properties, but depends on the level of the observed structure.

Objective: To estimate the prevalence of anemia and to identify its associated factors in children aged 6-59 months., Methods: This was a cross-sectional study on data from the Third Health and Nutrition Survey of the State of Pernambuco, Northeastern Brazil, with a representative sample of 1,403 children from urban and rural areas. Anemia was diagnosed by means of hemoglobin assays. Multivariate analysis was performed though a hierarchical model, using robust-variance Poisson regression to estimate the prevalence ratio as a function of the following variables: biological factors, morbidity, child nutritional state, socioeconomic factors, housing, sanitation and maternal factors., Results: The weighted prevalence of anemia was 32.8% overall: 31.5% in urban areas and 36.6% in rural areas. In urban areas, anemia was significantly associated with maternal education, consumer goods, number of children less than five years old in the home, drinking water treatment, maternal age, maternal anemia and the child's age. In rural areas, only maternal age and the child's age were significantly associated with anemia., Conclusions: The prevalence of anemia in children in Pernambuco was similar in urban and rural areas. The factors associated with anemia that are presented here should be taken into consideration in planning effective measures for its control.

The objective of this study was to determine the prevalence of anemia and vitamin A deficiency and to analyze the association of food insecurity with hemoglobin levels and serum retinol in children under 5 years of age. This was a cross-sectional study with 501 families from Gameleira and 458 families from São João do Tigre. Food insecurity was assessed according to the Brazilian Food Insecurity Scale. Hemoglobin and serum retinol levels were classified according to the WHO. Socioeconomic and environmental conditions and biological indicators of children were analyzed as hemoglobin and serum retinol determinants. The prevalence of anemia and vitamin A was higher in Gameleira compared to São João do Tigre. Moderate and severe food insecurity of families was 75% in Gameleira and 64% in São João do Tigre. Maternal education, per capita family income, not having a color TV, untreated water supply, type of flooring (dirt), and child age (< 2 years) in Gameleira were associated with hemoglobin levels in the linear regression analysis. In São João do Tigre the association with hemoglobin levels was only for (no) motorcycle and child age. Variables per capita family income and sex in Gameleira and no mobile phone and lack of sanitation in São João do Tigre were statistically associated with serum retinol levels. The nutritional status of these populations is similar in terms of food insecurity but may present great differences in terms of the prevalence of specific nutritional deficits and their determinants.

The objective this study was to evaluate the perceptions of obese adolescents about the repercussions of obesity on their health. This study was based on the statements of fifteen obese adolescents, monitored at the Ambulatory Clinic of the 'Hospital das Clínicas' of the Federal University of Pernambuco, using a semi-structured interview, during the period between April and July of 2007. The statements that resulted from the transcriptions of the recordings were submitted to content analysis--transversal thematic modality. Four topics related to the objectives of the study were identified: (1) the perception of the concept of obesity; (2) obesity affecting the self-image of the individual; (3) obesity versus health and (4) the difficulty in returning to health. The adolescents perceived obesity as a sickness that was negatively affecting their health, and which contributed to their low self-esteem and made them feel isolated. They recognized that being healthy means following a balanced diet and participating in physical activity, and that it is imperative to have formal and informal support to overcome the difficulties in order to maintain a satisfactory quality of life.

The transition from tube feeding to exclusive breastfeeding represents an important period for preterm babies because of their clinical fragility and immature development. This study describes this transition in preterm infants in relation to different feeding approaches: relactation, translactation, and breast-orogastric (OG) tube, considering the duration of the transition, weight gain in the transition, feeding-related problems, and breastfeeding status at discharge. This is a descriptive study of a series of 432 babies using retrospective data from the medical records at the IMIP Kangaroo Mother Care Unit, in the northeast of Brazil. At discharge, the percentage of babies who were exclusively breastfed in the relactation, translactation, and breast-OG tube groups were 85%, 100%, and 100%, respectively, with a satisfactory transition time and weight gain and with 1.6% of cases with feeding-related problems. The results showed that the relactation, translactation, and breast-OG tube seem to be efficient methods in the feeding transition of preterm infants.

The objective of this work was to analyze the occurrence of suicidal attempts and deaths that happened in the district of Independência, Ceará State, Brazil, in 2005. A case study was carried out, including attempts and deaths by suicide. A data gathering source was composed out of the SIS (Mortality Information System) and of the SIH (Hospital Admittance System), regarding the year 2005, besides documentary research on district hospital records. Out of six recorded obits, two happened in the age group of 10 to 19, three from 20 to 29, and one from 30 to 59. One half of the suicide victims were male, and the prevailing method was hanging. Considering the attempts, most of them concentrated in the age group of 10 to 19, prevailing females (seven cases). The main signs and symptoms presented by victims, before exerting suicidal attempt were: sadness, loss of sleep, anorexia, nervousness, will to cry, and aggressiveness; there also was some kind of affective relationship among those persons. It was concluded that the events recorded in the district of Independência must be analyzed as a social fact, highlighting the small time interval between the deaths and attempts and, the existence of relational links among the victims.

Objective: to analyse the opinions of men and women on the father's participation in breast feeding., Design: a qualitative and exploratory study, using the content analysis method, on its thematic modality. Data were collected at discussion groups that answered the following questions: which meanings and feelings are related to father's involvement in breast feeding? Which factors help or obstruct the act of breast feeding? How do fathers participate in breast feeding?, Setting: three discussion groups took place during the event 'The man as an ally in breast feeding process: is that the question?', supported by the Federal University of Pernambuco, Brazil., Participants: 11 men and nine women attended the event. Of the men, two had more than one child and five had babies who were being breast fed. Among the women, all were mothers and three were breast feeding., Findings: four thematic nuclei emerged from the performed analysis, which was also based in the historical, social and cultural process of fatherhood: involvement in the pregnancy-puerperal cycle; feelings and meanings of breast feeding; meanings of breast feeding in public; and ways to include father in the breast-feeding process., Key Conclusions and Implications for Practice: fathers participating in breast feeding considered it to be a brief period in the process of fatherhood. Behaviours of ambivalence, conflict, exclusion, insecurity and concern towards breast feeding were revealed. There was a perception of the nursing mother as a sexless being. However, the participants also suggested ways of including fathers in the process of breast feeding. According to the participants, they could (1) provide a favourable environment for the mother and baby; (2) participate more during pregnancy and birth; (3) help with domestic chores; (4) develop parenthood; and (5) be present during breast feeding. These suggestions may function as foundations for health staff to develop programmes, in order to involve fathers in breast feeding. This could result in a contribution to improve the practice and duration of that process.

Objective: To identify the experiences, knowledge, behaviors and emotions of fathers with relation to the process of breastfeeding., Methods: This is a descriptive, explorative and qualitative study involving 17 couples resident in a favela in the city of Recife, PE, in the Northeast of Brazil, whose most recent child was aged between 6 and 8 months. A semi-structured interview employing leading questions was used for data collection. These data were analyzed in the light of theoretical references, the historical, social and cultural construction of fatherhood, by means of thematic content analysis., Results: Four themes emerged from this analysis: faint/ambiguous memories of breastfeeding during childhood; knowledge about breastfeeding is focused on the child's health, mother's responsibility and savings for father; breastfeeding-related behavior of father during his participation in the pregnancy-child care cycle; and interconnected feelings of fragility when breastfeeding., Conclusions: The knowledge and emotions involved in fathers' participation in breastfeeding are the products of socialization of both men and women, centered on the biological body and reinforcing the belief that breastfeeding is the preserve of women.

Objective: The objective of this study was to use statistical modeling to identify risk factors for anemia in children aged 6 to 59 months in the state of Pernambuco, covering socioeconomic and dietary aspects., Methods: The sample comprised 746 children aged between 6 and 59 months from the state of Pernambuco. Their hemoglobin was assayed and a 24-hour dietary recall performed. Risk of anemia was analyzed with relation to socioeconomic variables and to dietary intakes, using multivariate analysis models., Results: The risk factors for anemia were: a high proportion of calories from cow's milk, low density of nonheme iron, low age and low maternal educational level; age was the most prominent factor, with children under 24 months exhibiting 3.61 times greater risk of being anemic than the older children., Conclusions: This study confirms the need for a clear picture of the dietary intake of children in Brazil, in order that associations with anemia can be better understood. Our results revealed that the dietary factors which were most responsible for risk of anemia were a greater proportion of calories from cow's milk and lower density of nonheme iron, in addition to age below 24 months and low maternal educational level.

This study aimed to assess hemoglobin level and anemia prevalence and their association with food-consumption and socioeconomic variables. A cross-sectional survey was conducted in the State of Pernambuco, Brazil, in 1997, using three-stage sampling which included 746 6-to-59-month-old children. Hemoglobin testing and a 24-hour food recall interview were performed. The anemia rate was 40.6% and was higher in the rural area and inversely proportional to age, income, and maternal schooling. Most children (88.9%) consumed cow's milk. Anemia was associated directly with the proportion of calories from cow's milk and indirectly with the iron level. Child's age, geographic area, per capita family income, maternal schooling, iron density (total, heme, and non-heme), and the proportion of calories from cow's milk in the diet were determinants for anemia.

Objective: To thoroughly investigate the association between the consumption of cow's milk and anemia in childhood., Sources of Data: The information was gathered from papers catalogued in Lilacs and MEDLINE and published during the last two decades, and also from textbooks and publications by international organizations., Summary of the Findings: Iron deficiency anemia is a severe public health problem in developing countries. Breast milk contains adequate iron for full term babies in the first 6 months. Thereafter, an additional iron-rich diet becomes essential. In recognition of the importance of the diet in triggering anemia, this paper discusses the relationship in children between a high intake of cow's milk and iron deficiency anemia. Gastrointestinal and allergic problems may be caused by early introduction of cow's milk or by its substitution for breast milk. Furthermore, cow's milk has decreased iron density and bioavailability, excess protein and minerals, notably calcium, and thus interferes in the absorption of iron from other foods, and is also linked to small intestinal hemorrhage in young children., Conclusions: The use of cow's milk in lieu of other foods rich in bioavailable iron was shown to be a risk factor for anemia. Exclusive breastfeeding during the first 6 months of life, discretionary weaning only after the 24th month, and a complementary diet rich in iron are highly important to avoid anemia and its consequences.

This study aimed to assess the validity and reproducibility of clinical signs (palmar and conjunctival pallor) in the diagnosis of anemia in children 6-23 months of age in Northeast Brazil. This was a cross-sectional study with a sample of 421 children in the child care and pediatric outpatient wards at the Mother and Child Care Institute of Pernambuco. Two examiners evaluated clinical signs using the Kappa coefficient, and validation (sensitivity and specificity) was performed using hemoglobin as the standard. Clinical signs demonstrated low reproducibility (kappa 0.24-0.25). The highest sensitivity for diagnosing anemia (Hb < 11 g/dl) and moderate/ severe anemia (Hb < 9 g/dl), respectively, was provided by combining palmar and conjunctival pallor (39.7% and 53.5%), followed by palmar pallor alone (29.9% and 40.0%). The highest specificity was provided by palmar pallor in the child as compared to the mother (95.5% and 90.1%, Hb < 11 g/dl and Hb < 9 g/dl, respectively). Sensitivity of clinical signs was better in diagnosing moderate/severe anemia, especially when combining palmar and conjunctival pallor, suggesting that their utilization does not provide a good instrument for diagnosing mild anemia.

Objective: To present a review about the main determining factors of anemia in children under 5 years old., Source of Data: Information was used from articles published in indexed national and international scientific journals, technical books and publications from international organizations., Summary of the Findings: Anemia constitutes the world's nutritional problem of the greater magnitude, and children under 5 years old represent one of the highest risk population groups. As with any public health problem, the origin of anemia is multi-causal and thus in this article the attempt is to interpret its direct or indirect relation with possible determinant factors and the main concordant or discordant findings in epidemiological studies. Among these factors are the social and economic conditions, the conditions of child health care, the child's nutritional state, the presence of morbidity, food consumption and biological factors. The role of the diet is emphasized with respect to the consumption and bioavailability of iron, and age of the child as the main determinants., Conclusions: Bearing in mind the magnitude of the problem and the breadth of its risk factors reviewed in this study, the implementation of urgent prevention and treatment measures for iron-deficiency anemia becomes necessary. It is important to stress that a single strategy may have little success if other measures are not taken simultaneously; the role of nutritional education being relevant, together with other implemented actions. Children under 2 years old and children who live in rural and deprived areas should be priorities in programs to combat anemia.

Objective: To determine the prevalence of anemia in children 6-59 months old in Pernambuco, a state in northeastern Brazil, so as to help guide health and nutrition policies there., Methods: In 1997 a representative sample of 777 young children had their hemoglobin concentration measured. The sampling process was in three stages. First, 18 municipalities were randomly selected to represent the state and its three geographic areas (metropolitan region of Recife, urban interior, and rural interior). Next, using census lists, 45 census sectors were randomly chosen. Finally, 777 children aged 6-59 months old were selected. Blood was collected by venipuncture, and hemoglobin was measured with a portable hemoglobinometer. In the analysis, prevalence was weighted to reflect the census age distribution., Results: The prevalence of anemia among children 6-59 months old was 40.9% for the state as a whole. Prevalence in the metropolitan region of Recife was 39.6%, and it was 35.9% in the urban interior. The rural interior had the highest prevalence, 51.4%. Prevalence was twice as high in children aged 6-23 months as among those 24-59 months old, 61.8% vs. 31.0% (chi 2 = 77.9, P < 0.001). The mean hemoglobin concentrations in the younger and older age groups were 10.4 g/dL (standard deviation (SD) = 1.5) and 11.4 g/dL (SD = 1.4), respectively. There was no statistically significant difference between the sexes in terms of prevalence., Conclusions: This is the first statewide assessment of anemia prevalence among young children in Brazil. Given the very high prevalence of anemia among the children studied in Pernambuco, especially those in the age group of 6-23 months, public health interventions are needed.