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This literature review provides an overview of the effectiveness of strategies and procedures used to extend breastfeeding duration. Interventions carried out during pregnancy and/or infant care conducted in primary health care services, community settings, or hospital clinics were included. Interventions covering only the delivery period were excluded. Interventions that were most effective in extending the duration of breastfeeding generally combined information, guidance, and support and were long term and intensive. During prenatal care, group education was the only effective strategy reported. Home visits used to identify mothers' concerns with breastfeeding, assist with problem solving, and involve family members in breastfeeding support were effective during the postnatal period or both periods. Individual education sessions were also effective in these periods, as was the combination of 2 or 3 of these strategies in interventions involving both periods. Strategies that had no effect were characterized by no face-to-face interaction, practices contradicting messages, or small-scale interventions. [ABSTRACT FROM AUTHOR]

Abstract Background Parasites of the Leishmania genus alternate between the flagellated extracellular promastigote stage and intracellular amastigotes. Here we report the characterization of a Leishmania isolate, obtained from a cutaneous leishmaniasis patient, which presents peculiar morphological features. Methods The parasite was cultured in vitro and characterized morphologically using optical and electron microscopy. Identification was performed based on monoclonal antibodies and internal ribosomal spacer typing. In vitro macrophage cultures, murine experimental models and sand fly infections were used to evaluate infectivity in vitro and in vivo. Results The isolate was identified as Leishmania (Viannia) braziliensis. In the atypical promastigotes grown in culture, a short flagellum surrounded or interrupted by a protuberance of disorganized material was observed. A normal axoneme was present close to the basal body but without elongation much further outside the flagellar pocket. A disorganized swelling at the precocious end of the axoneme coincided with the lack of a paraflagellar rod structure. The isolate was able to infect macrophages in vitro, induce lesions in BALB/c mice and infect Lutzomyia longipalpis. Conclusions Notwithstanding the lack of an extracellular flagellum, this isolate infects macrophages in vitro and produces lesions when inoculated into mice. Moreover, it is able to colonize phlebotomine sand flies. Considering the importance attributed to the flagellum in the successful infection and survival of Leishmania in the insect midgut and in the invasion of macrophages, these findings may bring new light into the infectious mechanisms of L. (V.) braziliensis.

Eukaryotic initiation factor 2B (eIF2B) controls translation initiation by recycling inactive eIF2-GDP to active eIF2-GTP. Under cellular stress, the integrated stress response (ISR) is activated inhibiting eIF2B activity resulting in the translation attenuation and reprogramming of gene expression to overcome the stress. The ISR can dictate cell fate wherein chronic activation has pathological outcomes. Vanishing white matter disease (VWMD) is a chronic ISR-related disorder with mutations in eIF2B targeting astrocyte and oligodendrocyte cells. Regulation of eIF2B localization (eIF2B bodies) has been implicated in the ISR. We present evidence that neuronal and glial cell types possess distinct patterns of eIF2B bodies which change in a manner correlating to acute and chronic ISR activation. We also demonstrate that while neural and glial cell types respond similarly to the acute induction of the ISR a chronic ISR exerts cell-type specific differences. These findings provide key insights into neural cell responses and adaptation to cellular stress., Competing Interests: For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) license to any Author Accepted article version of this article arising from this submission. The authors have no relevant financial or non-financial interests to disclose. The author Dr Filipe Hanson completed this work as part of his PhD studies at Sheffield Hallam University. He now works as a Research Scientist for UCB Pharma, Slough, UK. The author Dr Madalena deOliveira contributed to this work as part of her PhD studies at Sheffield Hallam University. She now works as a Postdoctoral Fellow for MSD, UK., (© 2024 The Author(s).)

Background: An assessment of the factors that interfere with serum levels and the persistence of anti-SARs-CoV-2 IgG antibodies is essential in order to estimate the risk of reinfection and to plan vaccination. We analyzed the impact of the severity of coronavirus disease 2019 (COVID-19) and the clinical and biological factors regarding the persistence of SARs-CoV-2 anti-spike protein (IgG-S) antibodies at 12 months., Methods: This was an observational, longitudinal study with individuals who had recovered from COVID-19 between August 2020 and June 2021. Peripheral blood samples were collected from volunteers who were hospitalized (SERIOUS COVID-19) and those who required no hospitalization (COVID-19 LIGHT). Samples were grouped according to days after symptom onset: up to 90, between 91 and 180, ≥ 180 days after symptom onset. A semiquantitative test for IgG anti-spike protein S1(IgG-S1) was used., Results: We analyzed 238 individuals who had recovered from COVID-19, of whom 87 had been hospitalized and 151 had not. They provided 148 and 220 samples, respectively. Among those hospitalized, males (65.5%), volunteers aged over 60 years (41.1%), comorbidities such as arterial hypertension (67.8%) and diabetes mellitus (37.9%) were most frequent. We observed higher median serum IgG-S1 titers among those who had recovered from COVID-19 and had been hospitalized, at all collection time intervals (p < 0.001). We observed a weak correlation of increasing age with humoral IgG-S1 response (Spearman correlation = 0.298). There was a greater probability of IgG-S1 antibody persistence over time among samples from hospitalized individuals compared to samples from non-hospitalized participants (p = 0.001)., Conclusion: This study has revealed higher titers and a higher probability of the persistence of IgG-S1 in severe cases after SARs-CoV-2 primary infection in unvaccinated recovered patients. Thus, in this study, the severe clinical presentation of COVID-19 was the main factor influencing serum levels and the persistence of IgG-S1 antibodies in COVID-19., (© 2023. The Author(s).)

The present study aimed to inspect the serum levels of the soluble receptors, sTNFR1 and sTNFR2, in patients with COVID-19. The large production of inflammatory cytokines is an essential process in the pathogenesis of COVID-19. TNF is a multifaceted proinflammatory cytokine which has soluble and membrane receptors. Thus, knowing the role of these receptors will help better understand this disease's immunopathogenesis. We included 131 patients confirmed for SARS-CoV-2, separated into three groups: ward patients without O2 support, group A (n = 14); ward patients with O2 support, group B (n = 85), and patients in an intensive care unit (ICU), group C (n = 32), making up the receptors dosed by flow cytometry. The results showed that sTNFR1 and sTNFR2 are associated with disease severity, being higher in group C when compared to group A. As for the levels of receptors and their relationship with the degree of lung involvement, we found higher values of sTNFR1 in patients in group 1 (pulmonary involvement < 25%), suggesting that inflammatory processes related to TNF are not necessarily associated with the primary site of infection. When we analysed the patients who passed away compared to those who recovered, both receptors significantly increased the mortality numbers. These findings suggest a relevant influence of soluble receptors in the inflammatory processes involved in the pathogenesis of COVID-19. Wherefore, we suggest using these receptors as biomarkers of severity and mortality of the disease., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier GmbH.)

Grazing patterns, intake structure, and diet selection are dynamic responses to animals' feeding environment. This study uses video sequences from animal-borne cameras to capture time- and scale-dependent grazing behaviour variables related to sward explanatory conditions. We observed grazing 'through' the sheep's eyes using point-of-view (POV) cameras coupled with event logging software. Time-specific sward features were measured by sampling 'really' grazed patches identified by applying a global navigation satellite system (GNSS) precision-grazing approach. Sward variables on a Mediterranean native sward were measured for two years during the active spring plant-growth cycle. Overall, the results demonstrate that POV cameras were able to capture grazing behaviour fine-tuning to changes in sward characteristics. Sheep compensate for the decrease in sward quantity and nutritive value by increasing the size and duration at each behavioural scale (i.e., meal, bout, and station) while increasing the bout rate and decreasing the station rate. Diet composition also changed as sward matured. The proportion of forbs in the diet remained high in early and late spring, and forbs and legumes were preferred to grasses in early spring. Grazing selectivity was more pronounced in late spring, with sheep favouring the middle stratum of the sward's vertical structure, preferring green vegetative material, while enlarging the feeding niches' span and spending more time at each niche, consequently reducing the station rate. Although data collected by individual animal-borne POV cameras were representative of the flock behaviour, they may underestimate the total grazing time outside major meals. The results indicate that the use of animal-borne video cameras is suitable for assessing variations in sheep grazing behaviour patterns in complex swards., Competing Interests: The authors have declared that no competing interests exist.

We describe the internal oral morphology and chondrocranial anatomy for Boana crepitans tadpoles, and compare them with available descriptions for other species in the subfamily Cophomantinae. Among species of the Boana faber group, the chondrocranial anatomy has been reported only for one species internal oral morphology and cranial anatomy are similar to other described species of Boana and Cophomantinae. B. crepitans lacks unique features in the oral cavity and chondrocranium that would distinguish it from other congeneric species. We identify six characters from the internal oral anatomy of tadpoles unique for Cophomantinae. In addition, Boana has infralabial papillae projections, buccal floor arena papillae, and lateral ridge papillae projections shorter than those described for Aplastodiscus and Bokermannohyla., (© 2021 Wiley Periodicals LLC.)

Background: Many biological, social and cultural barriers for suboptimal breastfeeding practices have been identified in literature. Among these, excessive pre-pregnancy weight has been identified as a risk factor for not initiating breastfeeding early. Social support, coming from social networks (e.g. a partner, family or friends) or health care providers, has been positively associated with breastfeeding. This study aimed to examine the association between pre-pregnancy excessive weight and breastfeeding within the first hour after birth and if social support modifies this association., Design: National population-based study conducted with 21,086 postpartum women from February 1, 2011 to October 31, 2012 in 266 hospitals from all five regions of Brazil. Social support was defined as having a companion at the hospital. Main effects and interactions were tested with multivariable regression analyses., Results: Multivariate regression analyses indicated that class I and class II obese women had lower odds of breastfeeding within the first hour when a companion was not present (AOR = 0.59, 95% CI 0.42-0.82 and AOR = 0.59, 95% CI 0.36-0.97, respectively), but there was no association when the companion was present. Among overweight and obese women, the predicted probability of breastfeeding within the first hour was lower for those without a companion. This association was not found among those with normal pre-pregnancy BMI., Conclusions: Social support modifies the relationship between pre-gestational BMI and breastfeeding initiation among women who are overweight or obese, specifically it reduces the risk of delayed breastfeeding initiation., Competing Interests: The authors have declared that no competing interests exist.

Influenza viruses cause worldwide outbreaks and pandemics in humans and animals every year with considerable morbidity and mortality. The molecular diversity of secondary metabolites extracted from mollusks is a good alternative for the discovery of novel bioactive compounds with unique structures and diverse biological activities. Phyllocaulis boraceiensis is a hermaphroditic slug that exudes mucus, in which was detected hydroxy polyunsaturated fatty acids that exhibited potent antiviral activity against measles virus. The objective of this study was to evaluate this property against Influenza viruses. Cell viability and toxicity of the mucus were evaluated on Madin-Darby canine kidney (MDCK) cells by MTT assay. Antiviral activity from mucus against influenza viruses was carried out by determination of the virus infection dose and by immunofluorescence assays. The crude mucus and its fractions exhibited low cytotoxicity on MDCK cells. A significant inhibition of viral replication, reduced by the order of eight times, was observed in influenza-induced cytopathic effect. In immunofluorescence assay was observed a decrease of more than 80% of the viral load on infected MDCK cell treated with mucus and its fractions. The viral glycoproteins hemagglutinin and neuraminidase located on the surface of the virus are crucial for the replications and infectivity of the influenza virus. Some authors demonstrated that lipids, such as, polyunsaturated fatty acids exhibited multiple roles in antiviral innate and adaptive responses, control of inflammation, and in the development of antiviral therapeutics. As corroborated by other studies, hydroxy polyunsaturated fatty acids interfered with the binding of influenza virus on host cell receptor and reduced viral titers. The results obtained indicated that polyunsaturated fatty acids from P. boraceiensis crude mucus and fractions 39 exerted antiviral activity against influenza virus.

The aims of this study were to investigate the human bocavirus (HBoV) frequency and genotypes in hospitalized children <5 years presenting acute respiratory infections (ARI) within the São Paulo metropolitan area. Nasopharyngeal samples from 300 patients, previously screened for common respiratory viruses, were tested by qPCR for the NSP1 and NP-1 genes. The VP1/2 gene in positive samples was then amplified by PCR and sequenced. A total of 49 positive HBoV cases (16.3%; mean Ct value of 34.41) were detected with the mean age being 18.1 months (range 1 month to 5 years) and the median age being 1 year of age. Children aged between 0 and 12 months had higher detection rates of HBoV (69.4%; 34/49; mean Ct = 34.45) than children from other age groups (30.6%; 15/49; mean Ct = 34.34). No significant differences were observed between HBoV Ct levels and clinical illness. The occurrence was more frequently associated with fall (38.8%; 19/49) and spring (36.7%; 18/49). All 12 sequenced isolates were identified as HBoV-1, displaying minor genetic variation compared to the Swedish reference strains ST1 and ST2 (99.1-99.7% nt). The sole identification of HBoV-1 supports the hypothesis that this particular genotype is strongly related to ARI, and contributes to the role of this virus in the aetiology of respiratory diseases.

The study describes the morphological changes associated with parasitism by the intestinal acanthocephalan Neoechinorhynchus buttnerae in tambaqui juveniles Colossoma macropomum farmed in an excavated nursery, in Manaus (Amazon) in September 2013. After fish biometrics, analysis of macroscopic changes in morphology and counting of parasites, bowel fragments were fixed and submitted to histological and histochemical processing. All fish analyzed had acanthocephalans in the intestine; intestinal loops were milky white in color, with the presence of nodules with heavy parasitism. The changes in tissues that form the intestine varied according to the arrangement of the parasites: either free in the intestinal lumen or fixed by the proboscis on the organ wall. In the first case, the changes found were flaking, abrasion, compression, hypertrophy of goblet cells and disappearance of the villi on the mucosa, leukocytic cell infiltration in the submucosa, and muscle layer thickening. In the second case, in addition to these, other changes were observed as metaplasia in muscle tissue with its replacement by a loose connective tissue with severe leukocytic infiltration, edema in blood vessels, and necrotic foci. The histochemical analysis revealed that positive Alcian Blue mucosal cells (pH 2.5) were more expressive in parasitized intestines than in intestines not parasitized by N. buttnerae.

The reproductive biology of South American freshwater stingrays (family Potamotrygonidae) is still poorly studied compared to other marine species. In the present study, we examined the gross anatomy and histology of six species of potamotrygonids from the Amazon basin and described the structural asymmetry of the ovaries and their relationship between ovarian and uterine fecundities. Stereological techniques were used to quantify the volume of ovarian and epigonal organ tissue associated with the left and right sides of the Potamotrygon wallacei, a recently described species, locally known as the cururu ray. This species presented ovarian asymmetry; the left epigonal organ-ovary complex was 55 times larger than the right side. The right side was composed of, volumetrically, 7.3% ovarian tissue and 92.7% epigonal organ tissue whereas the left side was 51.2% of ovarian tissue and 48.8% epigonal organ tissue. In all species, six types of follicles were identified in both right and left ovaries. Uteri were symmetrical and the fecundity ratio between the right and left sides was 0.9:1.1, respectively. Despite the volumetric difference of ovarian tissue between the two sides, the uterine fecundity shows that both ovaries are functional and that ovarian fecundity alone is not an accurate measure to determine the reproductive potential of freshwater stingrays. Anat Rec, 300:265-276, 2017. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Objective: To identify the impact of training in breastfeeding on knowledge, skills, and professional and hospital practices., Data Source: The systematic review search was carried out through the MEDLINE, Scopus, and LILACS databases. Reviews, studies with qualitative methodology, those without control group, those conducted in primary care, with specific populations, studies that had a belief and/or professional attitude as outcome, or those with focus on the post-discharge period were excluded. There was no limitation of period or language. The quality of the studies was assessed by the adapted criteria of Downs and Black., Summary of Data: The literature search identified 276 articles, of which 37 were selected for reading, 26 were excluded, and six were included through reference search. In total, 17 intervention articles were included, three of them with good internal validity. The studies were performed between 1992 and 2010 in countries from five continents; four of them were conducted in Brazil. The training target populations were nursing practitioners, doctors, midwives, and home visitors. Many kinds of training courses were applied. Five interventions employed the theoretical and practical training of the Baby-Friendly Hospital Initiative. All kinds of training courses showed at least one positive result on knowledge, skills, and/or professional/hospital practices, most of them with statistical significance., Conclusions: Training of hospital health professionals has been effective in improving knowledge, skills, and practices., (Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Objective: to evaluate the conditions of functional health literacy of an elderly diabetics group., Method: cross-sectional and descriptive study, with diabetic's elderly assisted in the SUS (N = 114). The social and health conditions were evaluated as well as functional health literacy by S-TOFHLA test (short version); the simple proportions, average, standard deviation and Pearson's Chi-square were described by SPSS software (20.0) with α = 5% value., Results: the mean age was 67.4 years, 74.0% of the elderly were women, had up to four years of schooling; 29.8% had a long-standing illness, 64.0% reported having high blood pressure, 47.4% smoke or were smokers, 73.7% had low functional health literacy, which was associated with schooling p = 0.001., Conclusions: the low functional health literacy could be a self-care conditioning and can be influenced by low schooling because it implies to have skills to understand and make decisions aimed at self-management of health.

This study presents a new recombinant protein that acts as a powerful antiviral (rAVLO-recombinant Antiviral protein of Lonomia obliqua). It was able to reduce the replication by 10(6) fold for herpes virus and by 10(4) fold for rubella virus. RT-PCR of viral RNA rAVLO treated infected cells also showed similar rate of inhibition in replication. The analysis of this protein by bioinformatics suggests that this protein is globular, secreted with a signal peptide and has the ability to bind to MHC class I. It was found that there are several protein binding sites with various HLA and a prevalence of α-helices in the N-terminal region (overall classified as a α/β protein type). BLAST similarity sequence search for corresponding cDNA did not reveal a similar sequence in Genbank, suggesting that it is from a novel protein family. In this study we have observed that this recombinant protein and hemolymph has a potent antiviral action. This protein was produced in a baculovirus/Sf-9 system. Therefore, these analyses suggest that this novel polypeptide is a candidate as a broad spectrum antiviral.

Introduction: The World Health Organization recommends breastfeeding for two years or more and advises against bottle feeding and pacifier use., Objective: Investigate the association between bottle feeding and pacifier use, and breastfeeding in the second half-year of life., Methods: Survey in a municipality of Rio de Janeiro state, in 2006, interviewing those responsible for 580 children aged 6-11 months. Bottle feeding and pacifier use, and variables which in the bivariate analysis were associated with the outcome 'absence of breastfeeding' (≥ 0.20), were selected for multiple analysis. Adjusted prevalence ratios were obtained by a Poisson regression model., Results: 40% of the children 6-11 months were not being breastfed, 47% used a pacifier and 57% used a bottle. Pacifier use (PR = 3.245; CI95%: 2.490-4.228) and bottle feeding (PR = 1.605; CI95%: 1.273-2.023) were shown to be strongly associated with the outcome, and also with: mother's low schooling (PR = 0.826; CI95%: 0.689-0.990); low birth weight (PR = 1.488; CI95%: 1.159-1.910); mother not being the baby carer (PR = 1.324; CI95%: 1.080-1.622); and increasing age of the baby in days (PR = 1.004; CI95%: 1.002-1.006)., Conclusions: The use of pacifiers and bottles can reduce continued breastfeeding. Stronger discouragement of these artifacts should be adopted in public health policies.

The studies on chemical composition and biological activity of propolis had focused mainly on species Apis mellifera L. (Hymenoptera: Apidae). There are few studies about the uncommon propolis collected by stingless bees of the Meliponini tribe known as geopropolis. The geopropolis from Scaptotrigona postica was collected in the region of Barra do Corda, Maranhão state, Brazil. The chemical analysis of hydromethanolic extract of this geopropolis (HMG) was carried out through HPLC-DAD-ESI-MS/MS and the main constituents found were pyrrolizidine alkaloids and C-glycosyl flavones. The presence of alkaloids in extracts of propolis is detected for the first time in this sample. The antiviral activity of HMG was evaluated through viral DNA quantification experiments and electron microscopy experiments. Quantification of viral DNA from herpes virus showed reduction of about 98% in all conditions and concentration tested of the HMG extract. The results obtained were corroborated by transmission electron microscopy, in which the images did not show particle or viral replication complex. The antiviral activity of C-glycosyl flavones was reported for a variety of viruses, being observed at different points in the viral replication. This work is the first report about the antiviral activity of geopropolis from Scaptotrigona postica, in vitro, against antiherpes simplex virus (HSV).

Objective: This study aimed to describe the main characteristics of victims of suicide attempts treated at public health units of Fortaleza-Ceara, Brazil., Methods: With a quantitative approach, we used a questionnaire with structured questions and the Beck Scale for depression. We worked with a convenience sample of 360 victims in Psychosocial Care Centers (General/Alcohol-Drug/Infant to Teen), Doutor José Frota Hospital, and the Apoio à Vida Project ., Results: In the statistical analysis, the dependent variable of more than one suicide attempt was used, associated to the independent variables. Multivariate analysis, with more than one attempt and significance (p<0.05), maintained association: male OR=2,1 (IC95 %: 1,2-3,6), p=0,005; feeling rejected, RC=2,4, (IC95 %:1,4-3,9), p=0,001; admission to psychiatric hospital, RC=3,4 (IC95 %:2,0-5,7), p=0,000; believing to have disappointed someone, RC=2,4 (IC95 %:1,3-4,4), p=0,005; depression, RC=1,0 (IC95 %: 1,0-1,0), p=0,001., Conclusion: The data shows the need for greater attention to this population, in the sense of promoting differentiated service support, either psychological or psychiatric, to improve people's lives.

The aim of the present study was to identify the rubella virus (RV) and enterovirus (EV) genotypes detected during the Epidemiological Surveillance on Exanthematic Febrile Diseases (VIGIFEX) study and to perform phylogenetic analysis. Ten RV- and four EV-positive oropharyngeal samples isolated from cell culture were subjected to RT-PCR and sequencing. Genotype 1G and echovirus 9 (E-9) was identified in RV- and EV-positive samples, respectively. The RV 1G genotype has been persisting in Brazil since 2000-2001. No evidence of E-9 being involved in exanthematic illness in Brazil has been reported previously. Differential laboratory diagnosis is essential for management of rash and fever disease.

From the 86 species allocated in the genus Rhinella, 25 have their tadpoles described and only R. arenarum, R. chrysophora, R. icterica, R. ornata, R. schneideri and R. spinulosa have aspects of the internal oral morphology evidenced. Herein, the internal oral morphology from 12 species of Rhinella distributed between the morphological groups of R. crucifer, R. granulosa, R. marina and R margaritifera is described and compared. The internal oral morphology of Rhinella is little variable in many aspects. Despite the many similarities found between the tadpoles of Rhinella, the study showed that there are characteristics that exhibit interspecific variation that can be used in the taxonomy of the genus. Important features to distinguish species were: number of infrarrostral projections; number and shape of the infralabial papillae; size, arrangement, shape and apex of the lingual papillae; shape of the buccal floor arena papillae; number of projections of the ventral velum; shape of the prenarial ridge; choanae arrangement; number and apex of the postnarial papillae; number and shape of the secondary branches on the lateral ridge papilla; buccal roof arena papillae arrangement.

Involvement of the central nervous system is common in measles, but rare in rubella. However, rubella virus (RV) can cause a variety of central nervous system syndromes, including meningitis, encephalitis, Guillain-Barré syndrome and sub acute sclerosing panencephalitis. We report the occurrence of one fatal case of the encephalitis associated with measles-rubella (MR) vaccine during an immunization campaign in São Paulo, Brazil. A 31 year-old-man, previously in good health, was admitted at emergency room, with confusion, agitation, inability to stand and hold his head up. Ten days prior to admission, he was vaccinated with combined MR vaccine (Serum Institute of India) and three days later he developed 'flu-like' illness with fever, myalgia and headache. Results of clinical and laboratory exams were consistent with a pattern of viral encephalitis. During hospitalization, his condition deteriorated rapidly with tetraplegia and progression to coma. On the 3rd day of hospitalization he died. Histopathology confirmed encephalitis and immunohistochemistry was positive for RV on brain tissue. RV was also detected by qPCR and virus isolation in cerebrospinal fluid, brain and other clinical samples. The sequence obtained from the isolated virus was identical to that of the RA 27/3 vaccine strain., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Rubella virus (RV) infection during the early stages of pregnancy can lead to serious birth defects, known as congenital rubella syndrome (CRS). This retrospective study was conducted between 1996 and 2009 with surveillance specimens collected from patients suspected of congenital rubella infection (CRI) and CRS. The clinical samples (nine amminiotic fluid, eight urine, eight blood, one conception product, and one placenta) were sent for viral isolation and genotyping. Twenty-seven sequences were analysed and four genotypes (1a, 1B, 1G, and 2B) were identified in São Paulo that were involved in congenital infection. To our knowledge, this study is the first report that describes genetic diversity of the circulating rubella strains involved in CRI., (Copyright © 2013 Wiley Periodicals, Inc.)

Objective: To investigate how the 4thStep of the Baby-Friendly Hospital Initiative was applied, assess the prevalence of breastfeeding (BF) within the first hour after birth and analyze factors associated with non-BF in this period of life., Methods: Cross-sectional study conducted in a high-risk maternity-hospital in Rio de Janeiro City, Brazil, with interview to a sample of 403 rooming-in mothers. The prevalence ratio with its respective 95% confidence interval was estimated by the use of SPSS 15® from a model with complementary log log link function., Results: The prevalence of BF in the first hour of life was 43.9%. Multivariate analysis showed that were protected against non-BF in the first hour after birth non-black women (PR = 0.62, 95% CI: 0.42-0.90), multiparous women (PR = 0.66, 95% CI: 0.47-0.93), prenatal care (PR = 0.23, 95% CI: 0.08-0.67), vaginal delivery (PR =0 .41, 95% CI: 0.28-0.60), newborn with birthweight ≥ 2,500g (PR = 0.31, 95% CI: 0.11-0.86) and women who received help from the health team to BF in the delivery room (PR = 0.51, 95% CI: 0.36-0.72)., Conclusion: Help provided by the health team to breastfeeding at birth, Step 4 of the Baby-Friendly Hospital Initiative, as well as non black women, multiparous women, receiving pre-natal care, vaginal delivery and appropriate birthweight contributed to breastfeeding in the first hour of life.

Introduction: The pre and post-HIV test counseling is recommended by the Ministry of Health, and is a tool for reflection and joint decision-making., Objectives: To determine the proportion of women receiving counseling for submission to the HIV rapid test and to assess factors associated to not receiving counseling for this test., Method: A cross-sectional study was conducted in five "Baby-Friendly Hospitals" from the High Risk Pregnancy System in Rio de Janeiro City, Southeast Brazil. The study population were 955 rooming-in parturients, undergoing the HIV rapid test, between September 11thand December 11th, 2006. Semi-standardized questionnaires were applied to the mothers, and data were also obtained from laboratory and health archives. Binomial regression was performed in order to analyze the variables associated with non-counseling., Results: Were submitted to the HIV rapid test 28.5% of the parturients, and only 26.9% of them were counseled. Factors associated with non-counseling were: maternal education below 8 years of school (PR = 1.36; 95% CI: 1.15-1.62), 0 to 3 prenatal visits (RP = 0.73; IC 95%: 0.59-0.90) and hospitals with less than 50% of the parturients submitted to the HIV rapid test (PR = 1.65; 95% CI: 1.40-1.96)., Conclusion: Socially underprivileged women were not a target of counseling, and only the low number of prenatal visits proved to be a protective factor against non-counseling. Counseling was seldom practiced for HIV rapid testing, indicating that this test has been performed without the consent of women, in an imperative way.

This article aims to analyze factors associated with unawareness of prenatal HIV serostatus at admittance for delivery. A cross-sectional study was performed in 2006 in "Friends of Children" Hospitals from the High-risk Pregnancy System, belonging to the Unified Health System, in Rio de Janeiro City. Data were collected through interviews applied to 873 rooming-in mothers submitted to a rapid HIV test at the hospital. Prevalence ratios (PR) of the lack of HIV serologic status were estimated by Poisson regression with robust variance, controlled by maternal and familiar socio-demographic characteristics, pregnancy and prenatal care. Prevalence of unawareness of HIV status was 32.2%. Mothers with low educational level, low-income, more than one relationship in the last year, enrolling late in prenatal care, and low number of prenatal visits were more likely to have unknown HIV status. The main predictor for unawareness of HIV serostatus at hospital admittance was the low number of prenatal visits. It is recommended that coverage of HIV testing during prenatal care be broadened with timely delivery of results, improving early access of pregnant women and increasing the number of prenatal visits, focusing on clients with low socio-economic level.

The need of private insurers for information on the candidate's health risks is recognized by the law, which places pre-contractual duties of disclosure upon the candidates. When the risks are influenced by health factors, e.g. in the case of life- and health insurances, it implies the provision of health information by the candidates, who thus voluntarily limit their right to privacy. This consent, however, often happens in a context of factual coercion to contract. Next to this, from a legal standpoint, the collection of personal information must respond to the principle of proportionality. Against this background, this article assesses the compatibility of questionnaire techniques that rely on open-ended health related questions with the right to privacy, as protected by Portuguese and international law. It then analyses the extent of pre-contractual duties of disclosure as defined by the Portuguese Insurance Act, which requires the candidate to volunteer all the relevant information independently of being asked for it. In doing so, the article also refers to some other European countries. It concludes that the relevant Portuguese legislation is incompatible both with Portuguese constitutional law and with international law.

The objective of this study was to evaluate factors associated with functional capacity among the elderly attended in a public health program in Belém in the State of Pará. A sectional study was conducted with 259 elderly people attended in the Hiperdia/SUS program in the period from March to July 2010. The elderly were assessed using the modified physical performance test duly validated in Brazil. Pearson's Chi-square Test, in addition to variance analysis and logistic regression were used for the analysis. The elderly were 68.3 years on average (SD ± 6.2) and 71% were female. After adjustments for conflicting variables, it was seen that there were greater chances of worse performance on the test among women, the older and less educated individuals, and those complaining of knee pain and prior diagnosis of cataracts and fair/bad self-assessment of health. Functional capacity is an important health indicator to identify early risks of incapacity and requiring a periodic evaluation, in order to seek care strategies for maintaining the independence of the elderly.

The prevalence of breastfeeding has increased over the past two decades in Brazil, as a result of public breastfeeding policies. The scope of this paper is to analyze the correlation between the increase in the prevalence of breastfeeding and hospitalization rates due to diarrhea. It is an epidemiological ecological study, based on secondary data from Brazilian Capital Cities and the Federal District. The prevalence of breastfeeding, the number of live births, and cases of hospitalization due to diarrhea were compared for the years 1999 and 2008 and the Spearman non-parametric test was used to correlate the variables. During the period, 1,329,618 children under one year of age in 1999 and 2008 were studied. The increase in the prevalence of exclusive breastfeeding among children under 4 months old had a negative correlation with hospitalization rates due to diarrhea (Rho=-0.483, p=0.014). This correlation was stronger for girls (Rho=-0.521, p=0.008) than for boys (Rho=-0.476, p=0.016). The increase in the prevalence of breastfeeding between 1999 and 2008 appears to be correlated to a reduction in hospitalization rates due to diarrhea over the same period, corroborating the importance of public policies to protect, support and promote breastfeeding.

Objective: To identify the maternal characteristics and welcoming actions towards mothers of infants aged less than six months associated with early liquid offer., Methods: Cross-sectional study performed in 2007, with a representative sample of mothers of infants aged less than six months (n=1,057), users of Primary Health Care (PHC) Units, in the city of Rio de Janeiro, Southeastern Brazil. A multivariate logistic regression model was used to estimate the association between explanatory variables and liquid offer, with weighing and design effect and controlled for infant age., Results: Of all mothers, 32% did not receive the welcoming card in the maternity hospital, 47% did not receive guidance on breastfeeding at their first visit to the PHC unit after childbirth and 55% reported they had offered liquids to their infants. Women without at least six months of previous breastfeeding experience were more likely to offer liquids than those with such experience (OR=1.57; 95% CI: 1.16;2.13). Mothers who had not received guidance on breastfeeding at their first visit to the UBS after childbirth were 58% more likely to offer liquids than those who had received it. Liquid offer was positively associated with adolescence among women with a partner (OR=2.17; 95% CI: 1.10;4.30) and negatively associated with adolescence among those without a partner (OR=0.31; 95% CI: 0.11;0.85). Among women with less than eight years of education, those who had not received guidance on breastfeeding after childbirth were 1.8 times more likely to offer liquids than others who had received it., Conclusions: Age, marital status and previous breastfeeding experience are maternal characteristics associated with liquid offer to infants aged less than six months. Receiving early guidance on breastfeeding could reduce liquid offer to infants.

Acute liver failure is a syndrome with a wide range of etiologic possibilities in children, but in up to 50% of the cases in the literature no diagnosis is established. This case report adds rubella virus to the list of possible causes of acute liver failure. This association was made by serologic, cell culture, molecular, histopathologic, and immunohistochemical methods.

This article aims at understanding the meanings expressed by women concerning the breastfeeding support received at primary health care (PHC) units. A study was conducted in 24 PHC units in the State of Rio de Janeiro for the purpose of investigating why pregnant women and mothers felt supported (or not) by these units regarding breastfeeding. Heidegger's phenomenological approach was used to develop five structures of meaning, evincing the breastfeeding support provided as "none", "dubious", "incentive", "guidance", and "partnership". When the mothers were asked for suggestions about how the unit could help them breastfeed, their answers generated a new structure of meaning: "continuous support". Some women gave no suggestions, stating that they had none or were satisfied with the support provided. The women indicated possibilities for care based on the singularity of the clientele and on the authenticity of the health-care staff/user relationship. In that process, solicitude needs to be incorporated into the practice of PHC units, so that they can be an effective space for breastfeeding promotion, protection, and support.

Objective: To evaluate patient profiles and factors associated with successful treatment., Methods: A retrospective study of patients enrolled in the smoking cessation program at the Hospital de Messejana, located in the state of Ceará, Brazil, from October of 2002 to April of 2005. The treatment was evaluated based on patient profile, type of medication prescribed and time on that medication., Results: Of the 320 patients enrolled, 65.5% were women. The mean age at the outset of treatment was 48 years, and the mean duration of the smoking habit was 33 years. More than 90% of the patients had started smoking before the age of 20. Of the 258 individuals who had enrolled in the program at least one year prior, 50.8% had achieved treatment success; 17.8% had relapsed, and 31.4% had not quit smoking. On average, partial success was achieved in the fifth week of the treatment, and relapse occurred predominantly in the fourth month. Approximately 60% of the patients were treated with medication., Conclusion: Quitting smoking was significantly associated with the use of medication, regardless of the profile of the smoker evaluated. In the second year of the program, quitting smoking was more strongly associated with the use of bupropion and nicotine replacement, resulting in a higher success rate and a trend toward a reduction in the relapse rate.

Sixty pregnant women with clinical signs of rubella and specific rubella antibodies were studied between January 1999 and December 2002 in order to determine the intrauterine rubella transmission rate and the presence of the virus in amniotic fluid and fetal tissues by nested PCR. Thirty-three patients presented rubella before 12 weeks of gestation and 27 after 12 weeks. Gestational age at the time of acute rubella was determined on the basis of the date of last menstruation and the first trimester ultrasound scan. Thirteen patients with clinical features of rubella before 12 weeks of gestation were submitted to amniocentesis. Three products of conception were analyzed. The presence of the rubella virus was determined by nested PCR. IgM and IgG antibodies were analyzed in neonatal samples at birth and at 3 months of age using a capture immunoassay. Newborn follow-up was based on the presence of congenital rubella syndrome-compatible defects, anti-rubella antibodies, echocardiographic alterations, brainstem evoked response audiometry, and ophthalmological pathology. Five miscarriages and four fetal deaths were observed in the group of patients presenting clinical features before 12 weeks of gestation. IgM antibodies were detected in seven neonates at birth and at 3 months of age. Deafness was observed in three cases and pigmentary retinopathy in one case. Fourteen of the 16 samples (13 amniotic fluid and 3 fetal tissue samples) submitted to virological analysis tested positive. Four fetal deaths, five miscarriages (one with negative virology) and seven newborns with anti-rubella IgM at birth and/or at 3 months age were observed in the group with rubella before 12 weeks of gestation. There were three cases in which virological analysis of the amniotic fluid samples was positive (infected) while the newborn showed no signs of congenital rubella syndrome and anti-rubella IgM were absent. When maternal rubella occurred after 12 weeks of gestation, no fetal or neonatal rubella signs were observed. Eradication of congenital rubella syndrome is possible since vaccination campaigns continue and all services related to the health care of children, adolescents and women have become aware of the significance of the problem and are collaborating. All pregnant women in Brazil should be screened for the rubella antibody and the susceptible group should be vaccinated after giving birth.

This article evaluates a policy for breastfeeding promotion, protection, and support in primary health care units in Rio de Janeiro State, Brazil, analyzing the assumptions, interventions, and results based on a log-frame model. A systematic review sought to identify effective procedures and strategies for extending breastfeeding duration, constituting the basis for creating "Ten Steps" in the "Breastfeeding-Friendly Primary Care Initiative" launched in Rio de Janeiro State in 1999. A corresponding evaluation method was developed and applied to verify the performance of 24 primary health care units from different parts of the State. A direct association was found between the practical implementation of these steps and prevalence of exclusive breastfeeding, as well as with mothers' satisfaction. An analysis of meanings ascribed by pregnant women and mothers to the support provided for breastfeeding identified five categories: "no support", "doubtful support", "encouragement", "guidance", and "partnership". The evaluation model allowed staff at the health care units to recognize opportunities for improving the program, in order to reverse the current low prevalence of exclusive breastfeeding.

A method to assess the effectiveness of primary health care (PHC) units in enabling mothers to breastfeed was developed from the tool used for accreditation of baby-friendly hospitals. A 10-step scoring system assessed the extent to which procedures known to be effective at extending breastfeeding duration were applied within PHC units. Using this method, 13 PHC units showed a fair performance, whereas 11 performed poorly in the state of Rio de Janeiro. More babies younger than 6 months were being exclusively breastfed in fair performance than in poor performance units (38.6% vs 23.6%, respectively, P < .001). Twice as many pregnant women and mothers in fair performance units (61.9%) were satisfied with the support provided for breastfeeding than in poor performance units (31.4%). The differences were not explained by hospital care or working status of the women. The association found between structure, process, and outcomes support the validity of the method.

This literature review provides an overview of the effectiveness of strategies and procedures used to extend breastfeeding duration. Interventions carried out during pregnancy and/or infant care conducted in primary health care services, community settings, or hospital clinics were included. Interventions covering only the delivery period were excluded. Interventions that were most effective in extending the duration of breastfeeding generally combined information, guidance, and support and were long term and intensive. During prenatal care, group education was the only effective strategy reported. Home visits used to identify mothers' concerns with breastfeeding, assist with problem solving, and involve family members in breastfeeding support were effective during the postnatal period or both periods. Individual education sessions were also effective in these periods, as was the combination of 2 or 3 of these strategies in interventions involving both periods. Strategies that had no effect were characterized by no face-to-face interaction, practices contradicting messages, or small-scale interventions.

The Brazilian Association of Nursing (ABEn) was founded in 1926. The association has been the source for the creation of new professional organizations and the motivator of the development of the nursing profession in the country. The creation, implantation and development of the nursing boards are important achievements of ABEn. Twenty-eight years of struggle to approve the law number 5.905 of 12 July 1973, which created the nursing boards. Implantation of the Federal Board of Nursing (COFEn) and CORENS done under the leadership of ABEn. ABEn's participation in the development of the federal and regional boards of nursing. Current situation of the relationship between ABEn, syndicates, and nursing boards.

The case of a 5 years old child with association of "moyamoya" and Down syndrome with permeability of internal carotid, of medial and anterior cerebral arteries is reported. The authors postulate the possibility of a microcirculatory disorder in view of the distal lesion including the action of any distribution of the alterations.