Malnutrition is a major contributor to mortality and is increasingly recognized as a cause of, potentially lifelong, functional disability. Yet, a rate-limiting step in achieving normal nutrition may be impaired absorptive function due to multiple repeated enteric infections. This is especially problematic in children whose diets are marginal. In malnourished individuals, the infections are even more devastating. This review documents the evidence that intestinal infections lead to malnutrition and that malnutrition worsens intestinal infections. The clinical data presented here derive largely from long-term cohort studies that are supported by controlled animal studies. Also reviewed are the mechanisms by which enteric infections lead to undernutrition and by which malnutrition worsens enteric infections, with implications for potential novel interventions. Further intervention studies are needed to document the relevance of these mechanisms and, most importantly, to interrupt the vicious diarrhea-malnutrition cycle so children may develop their full potential.

DESCRITORES Parto humanizadoApoio social Tecnologia Enfermagem obstétrica Estudos de validação ABSTRACTObjective: the article describes the steps in producing and validating an educational booklet for childbirth companions. Method: methodological study conducted in 2011 consisting of the following steps: situational assessment; establishing brochure content; content selection and referencing; drafting the text; design of illustrations; layout; consultation of specialists; consultation of target audience; amendments; proofreading; evaluation using the Flesch Reading Ease Formula. The topics portrayed the sequence of events involving support from gestation to the postpartum period. Results: the concordance rate among companions was greater than or equal to 81.8% for the topics organisation, writing style, presentation and motives. The overall Content Validity Index of the booklet was 0.94. The booklet was classified as easy reading or very easy reading according to the results of the Flesch Reading Ease Formula. Conclusion: the presentation and content of the manual were validated for use with the target audience by the specialists and representatives of the target audience.

Resumo Objetivo Descrever processo de construção e validação de cartilha educativa para prevenção da transmissão vertical do HIV. Método: Estudo metodológico em três etapas: levantamento bibliográfico, elaboração da cartilha e validação do material por especialistas no assunto e representantes do público-alvo. Realizou-se a validação por 9 juízes e 30 representantes do público-alvo. Considerou-se o Índice de Validade de Conteúdo (IVC) mínimo de 0,78, para validação de conteúdo e concordância mínima de 75% para validação de aparência. Resultados A cartilha apresentou IVC global de 0,87 pelos juízes e nível de concordância excelente entre os juízes (91,1%-100%) e representantes do público-alvo (98,1%-100%). Entretanto, os juízes propuseram sugestões de melhorias da cartilha, que foram acatadas e modificadas para versão final do material. Conclusão A cartilha foi validada quanto ao conteúdo e aparência, devendo-se ser considerada no contexto das atividades educativas como instrumento capaz de favorecer para prevenção da transmissão vertical do HIV.

Objectives: Translate and adapt the Breastfeeding Self-Efficacy Scale (BSES) to the cultural reality of Brazil and evaluate the content validity of the Portuguese version, so that it can be used in the Brazilian population. Methods: The study was made in two phases (1-Protocol translation and cultural adaptation, and 2-Validity of Content). Results: The total score ranged from 93 to 162 points (M = 127.03, SD = 19.62). When considering only women who bore many children, the score scale ranged from 106 to 156 (M = 131.66, SD = 15.91). The translated version proved to be easy to understand, showing good consistency and semantic validation. The Index for the Validation of Content was 0.84 and the Cronbach's alpha = 0.90. Conclusions: The findings suggest that the BSES is suitable for screening the maternal confidence in its potentiality to breastfeed. However, it is necessary to evaluate the psychometric properties of this instrument in samples with different social and educational levels, and in other regions of Brazil Keywords: Self efficacy; Breast feeding; Validation studies RESUMO Objetivos: traduzir e adaptar a Breastfeeding Self-Efficacy Scale ( BSES), para a realidade cultural do Brasil e avaliar a validade de conteúdo da versão em português, para que possa ser utilizada na população brasileira. Métodos: O estudo envolveu duas fases (1. protocolo de tradução e adaptação cultural e 2. validade de conteúdo). Resultados: O escore total variou de 93 a 162 pontos (M = 127,03; DP = 19,62). Quando considerado apenas as multíparas, a pontuação da escala variou de 106 a 156 (M = 131,66; DP = 15,91). A versão mostrou ser de fácil compreensão, obtendo-se adequada validação semântica e de consistência. O Índice de Validação de Conteúdo foi 0,84 e o coeficiente alfa de Cronbach = 0,90. Conclusões: Os achados sugerem que a BSES é adequada para screening da confiança materna no seu potencial para amamentar. No entanto, é necessário avaliar as propriedades psicométricas deste instrumento em amostra com diferentes níveis sociais e educacionais e em outras regiões do Brasil. Descritores: Auto-eficácia; Aleitamento materno; Estudos de validação RESUMEN Objetivos: traducir y adaptar la escala Breastfeeding Self-Efficacy Scale (BSES), para la realidad cultural de Brasil y evaluar la validez de contenido de la versión en portugués para que pueda ser utilizada en la población brasileña. Métodos: El estudio se realizó en dos fases (1-protocolo de traducción y adaptación cultural, y 2-Validación del contenido). Resultados: El puntaje total varió de 93 a 162 puntos (P = 127,03; DE = 19,62). Cuando fueron consideradas apenas las multíparas, la puntuación de la escala varió de 106 a 156 (P = 131,66; DE = 15,91). La versión mostró ser de fácil comprensión, obteniéndose una adecuada validación semántica y de consistencia. El Índice de Validación de Contenido fue 0,84 y el coeficiente alfa de Cronbach = 0,90. Conclusiones: Los hallazgos sugieren que la BSES es adecuada para detectar la confianza materna en su potencialidad para ...

Objectives: This study was developed to psychometrically assess the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) among women living in Fortaleza-CE-Brazil and to examine the relationship between breastfeeding self-efficacy and maternal demographic variables. Methods:This methodological study replicated the original psychometric assessment of the BSES-SF conducted in Canada. A convenience sample of 294 postpartum women were recruited.Results: The Cronbach's alpha coefficient for the BSES-SF was 0.74. Significant relationship was found between breastfeeding self-efficacy and maternal age (r=0.138; p=0.018). No relationship was found between breastfeeding self-efficacy and maternal occupation, educational level, marital status, family income or number of pregnancy suggesting BSES-SF may be a unique tool to identifying women at risk to prematurely discontinue breastfeeding. Conclusions:The BSES-SF is a valid, instrument for measuring Brazilian women's confidence in their ability to breastfeed. Study results can be used by health workers to plan interventions targeting women in most need of support to reduce premature discontinuation.

Abstract. Understanding the complex relationship between early childhood infectious diseases, nutritional status, poverty, and cognitive development is significantly hindered by the lack of studies that adequately address confounding between these variables. This study assesses the independent contributions of early childhood diarrhea (ECD) and malnutrition on cognitive impairment in later childhood. A cohort of 131 children from a shantytown community in northeast Brazil was monitored from birth to 24 months for diarrhea and anthropometric status. Cognitive assessments including Test of Nonverbal Intelligence (TONI), coding tasks (WISC-III), and verbal fluency (NEPSY) were completed when children were an average of 8.4 years of age (range = 5.6-12.7 years). Multivariate analysis of variance models were used to assess the individual as well as combined effects of ECD and stunting on later childhood cognitive performance. ECD, height for age (HAZ) at 24 months, and weight for age (WAZ) at 24 months were significant univariate predictors of the studies three cognitive outcomes: TONI, coding, and verbal performance (P < 0.05). Multivariate models showed that ECD remained a significant predictor, after adjusting for the effect of 24 months HAZ and WAZ, for both TONI (HAZ, P = 0.029 and WAZ, P = 0.006) and coding (HAZ, P = 0.025 and WAZ, P = 0.036) scores. WAZ and HAZ were also significant predictors after adjusting for ECD. ECD remained a significant predictor of coding (WISC III) after number of household income was considered (P = 0.006). This study provides evidence that ECD and stunting may have independent effects on children's intellectual function well into later childhood.

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Objective:To identify the most frequent type of urinary incontinence in women assisted in two outpatient clinics of urogynecology, and to compare general and specific quality of life among the different types of incontinence measured through validated questionnaires. Method: Cross-sectional study conducted at the urogynecology outpatient clinic. The following questionnaires were used for quality of life assessment: Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), International Consultation Incontinence Questionnaire Short-Form (ICIQ-SF), King's Health Questionnaire (KHQ), and Pelvic Organ Prolapse Incontinence Sexual Questionnaire (PISQ-12). Results: The study included 556 women. Mixed Urinary Incontinence was the most frequent type (n=348/62.6%), followed by Stress Urinary Incontinence (n=173/31.1%) and Urge Urinary Incontinence (n=35/6.3%). Women with mixed urinary incontinence had greater impact on the general (SF-36) and specific quality of life (KHQ and ICIQ-SF) compared to the others (p<0.05). In the evaluation of sexual function (PISQ-12), there was no difference between groups (p=0.28). Conclusion: All types of urinary incontinence interfere both in the general and specific quality of life, but women with mixed urinary incontinence are the most affected.