Home nutritional advice during the first year of life decreases caries incidence and severity at four years of age in a low income community.

ECC is a public health problem in that population. The home visits for dietary advice appear to help reducing dental caries in infants. Greater efforts are needed to tackle cariogenic dietary behaviours even further, as a relevant proportion of children of the intervention group were shown to present with dental caries. Further studies should examine the effect of the intervention in the longer term.

BackgroundDiagnosis of myalgic encephalomyelitis/chronic fatigue syndrome or ME/CFS is largely based on clinical history, and exclusion of identifiable causes of chronic fatigue. Characterization of cases and the impact of interventions have been limited due to clinical heterogeneity and a lack of reliable biomarkers for diagnosis and outcome measures. People with ME/CFS (PWME) often report high levels of disability, which are difficult to measure objectively. The well being of family members and those who care for PWME are also likely to be affected. This study aimed to investigate the functional status and well being of PWME and their lay carers, and to compare them with people with other chronic conditions.MethodsWe used a cross sectional design to study 170 people aged between 18 and 64 years with well characterized ME/CFS, and 44 carers, using SF-36 v2™. Mean physical and mental domains scores (scales and component summaries) were calculated and compared internally and externally with reference standards for the general population and for population groups with 10 chronic diseases.ResultsSF-36 scores in PWME were significantly reduced, especially within the physical domain (mean norm-based Physical Component Summary (PCS) score = 26.8), but also within the mental domain (mean norm-based score for Mental Component Summary (MCS) = 34.1). The lowest and highest scale scores were for "Role-Physical" (mean = 25.4) and "Mental Health" (mean = 36.7) respectively. All scores were in general lower than those for the general population and diseased-specific norms for other diseases. Carers of those with ME/CFS tended to have low scores in relation to population norms, particularly within the mental domain (mean = 45.4).ConclusionsME/CFS is disabling and has a greater impact on functional status and well being than other chronic diseases such as cancer. The emotional burden of ME/CFS is felt by lay carers as well as by people with ME/CFS. We suggest the use of generic instruments such as SF-36, in combination of other objective outcome measurements, to describe patients and assess treatments.

This study assesses the impact of an intervention known as the Ten Steps to Healthy Feeding: A Nutritional Guide for Children under Two on nutritional conditions and infant health in low-income families. Two hundred newborns were randomized to the intervention group and three hundred to the control group. Parents of the intervention group received nutritional orientation during the child's first year of life. Both groups received visits at 6 and 12 months and routine follow-up by their pediatricians. The results (n = 397) showed that the intervention was associated with a higher proportion of exclusive breastfeeding at 4 months (RR = 1.58; 95%CI: 1.21-2.06) and 6 months (RR = 2.34; 95%CI: 1.37-3.99) and breastfeeding at 12 months (RR = 1.26; 95%CI: 1.02-1.55) and a lower proportion of children with diarrhea (RR = 0.68; 95%CI: 0.51-0.90), respiratory problems (RR = 0.63; 95%CI: 0.46-0.85), use of medication (RR = 0.56; 95%CI: 0.34-0.91), and dental caries (RR = 0.56; 95%CI: 0.32-0.96) in the 12-16 month bracket. The intervention had no effect on the occurrence of anemia, hospitalization, or nutritional status. The results suggest that the nutritional orientation program led to positive changes in infant feeding practices and health conditions, but that it was insufficient to prevent iron deficiency anemia.

ResumoObjetivo: Examinar fatores socioeconômicos e outras condições de vida familiar associadas a excesso de peso, baixa estatura e baixo peso para a estatura em menores de 5 anos.Métodos: Estudo transversal avaliou 3.957 crianças entre 1 mês e 5 anos de idade durante campanha nacional de imunização no município de São Leopoldo (RS) em 2002. As condições socioeconômicas e de saneamento das áreas de abrangência das unidades de saúde foram agrupadas por análise de cluster dos setores do censo populacional de 2001.Resultados: Déficit de peso para estatura ocorreu em 2,6% das crianças, baixa estatura em 9,1% e excesso de peso em 9,8%. A regressão logística multivariada sugere que os fatores associados à chance de excesso de peso foram: área de condições socioeconômicas alta (RC = 1,47; IC95% 1,09-1,96), filhos únicos (RC = 1,44; IC95% 1,00-2,07) e peso ao nascer ≥ 2.500 g (RC = 2,21; IC95%1,27-3,83). A chance de déficit de peso associou-se ao baixo peso ao nascer (RC = 3,46; IC95% 2,06-5,80) e idade da mãe < 20 anos (RC = 1,99; IC95% 1,09-3,62). A baixa estatura associou-se à área de condições socioeconômicas baixas (RC = 2,36; IC95% 1,51-3,69), três ou mais irmãos (RC = 3,12; IC95% 2,18-4,47), peso ao nascer < 2.500 g (RC = 3,49; IC95% 2,53-4,80), idade < 36 meses (RC = 1,77; IC95% 1,37-2,29) e idade materna < 20 anos (RC = 1,60; IC95%1,09-2,35).Conclusões: Excesso de peso e baixa estatura foram os principais desvios antropométricos observados neste estudo, constituindo prioridades que devem ser consideradas nas políticas públicas atuais.J Pediatr (Rio J). 2008;84(3):251-257: Estado nutricional, criança, fatores de risco, antropometria, excesso de peso e insuficiência de crescimento. AbstractObjective: To explore whether socioeconomic and sanitary conditions, maternal and child factors are associated with overweight, stunting, and wasting in children under five year old in the city of São Leopoldo, southern Brazil. Methods:Cross-sectional study of 3,957 children aged 1 month to 5 years conducted in all primary care services of the city during the National Children's Vaccination Day in 2002. Maternal and child factors were assessed by a questionnaire. Children's height and weight were measured. Cluster analysis was used to group the areas served by the primary care services according to socioeconomic and sanitary conditions of the census tracts assessed by the 2001 National Census.Results: Wasting was observed in 2.6% of children, stunting in 9.1% and overweight in 9.8%. The multivariable logistic regression model suggests that overweight was associated with higher socioeconomic status and better sanitation of the area (OR = 1.47; 95%CI 1.09-1.96), single child (OR = 1.44; 95%CI 1.00-2.07) and birth weight ≥ 2,500 g (OR = 2.21; 95%CI 1.27-3.83). Wasting was associated with low birth weight (OR = 3.46; 95%CI 2.06-5.80) and mother's age < 20 years (OR = 1.99; 95%CI 1.09-3.62). Stunting was associated with low socioeconomic status and poor sanitation of the area (OR = 2.36; 95%CI 1.51-3.69), three or more siblings (OR ...

BackgroundWe aimed to review systematically the needs for support in managing illness and maintaining social inclusion expressed by people with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)MethodsWe carried out a systematic review of primary research and personal ('own') stories expressing the needs of people with CFS/ME. Structured searches were carried out on Medline, AMED, CINAHL, EMBASE, ASSIA, CENTRAL, and other health, social and legal databases from inception to November 2007. Study inclusion, data extraction and risk of bias were assessed independently in duplicate. Expressed needs were tabulated and a conceptual framework developed through an iterative process.ResultsThirty two quantitative and qualitative studies, including the views of over 2500 people with CFS/ME with mainly moderate or severe illness severity, met the inclusion criteria. The following major support needs emerged: 1) The need to make sense of symptoms and gain diagnosis, 2) for respect and empathy from service providers, 3) for positive attitudes and support from family and friends, 4) for information on CFS/ME, 5) to adjust views and priorities, 6) to develop strategies to manage impairments and activity limitations, and 7) to develop strategies to maintain/regain social participation.ConclusionsAlthough the studies were heterogeneous, there was consistent evidence that substantial support is needed to rebuild lives. Gaining support depends - most importantly - on the ability of providers of health and social care, colleagues, friends and relatives, and those providing educational and leisure services, to understand and respond to those needs.

Resumo ObjetivoInvestigar o efeito das desigualdades sociais nas taxas de cesariana em primíparas, com gravidez única e parto hospitalar. Métodos Estudo realizado no Estado do Rio Grande do Sul em 1996, 1998 e 2000. Foram utilizados dados do Sistema de Informação de Nascidos Vivos no cálculo das taxas anuais e das razões de chance de cesariana (RC) brutas e ajustadas para condições sociais (escolaridade e idade maternas, etnia/cor da pele e macro-regional de saúde), duração da gestação e número de consultas pré-natal. Resultados A taxa de cesarianas foi de 45%, e acima de 37% para todas as macro-regionais. As taxas aumentaram entre: mulheres de etnia indígena e negra, mulheres com mais de 30 anos, residentes nas macro-regiões Metropolitana, Vales e Serra, e com mais de seis consultas no pré-natal. Razões brutas e ajustadas indicaram taxas negativamente associadas para todas as categorias de etnia/cor, quando comparadas à cor branca da pele do recém-nascido, em especial para etnia indígena (RC aj =0,43; IC 95%: 0,31-0,59), positivamente associadas à escolaridade (RC aj =3,52; IC 95%: 3,11-3,99) e idade maternas mais elevadas (RC aj =6,87; IC 95%: 5,90-8,00), e maior número de consultas pré-natal (RC aj =2,16; IC 95%: 1,99-2,35). Os efeitos de idade e escolaridade mostraram estar parcialmente mediados pelo maior número de consultas pré-natal nas mulheres com idade e escolaridade mais elevadas. As taxas variaram entre as macroregionais, sendo maiores na região da Serra, economicamente mais rica. Conclusões Altas taxas de cesariana no sul do Brasil constituem problema de saúde pública e estão associadas a fatores sociais, econômicos e culturais, os quais podem levar ao mau-uso da tecnologia médica na atenção ao parto. Abstract ObjectiveTo investigate the effect of social inequalities in cesarean section rates among primiparae having single pregnancy and delivering in maternity hospitals.

The questionnaire is concise, easy to complete and simple to analyse, and appears to be a reliable and valid measure of staff perceptions of quality of clinical group supervision. Further studies with larger sample sizes and including other groups of health professionals are needed to confirm the validity and reliability of the CSEQ.