Purpose: Transitioning into retirement may be a suitable period to help adults establish an active lifestyle. One innovative approach to promote PA may be through multimedia-based programs. This experiment aimed to explore the feasibility DVD and videogame-based exercise programs in promoting physical activity (PA) in adults transitioning into retirement. Underlying motivations, functional fitness, quality of life, and elicited beliefs from participating in the exercise programs were also explored. Methods: Twenty-seven adults were randomized into either a nine-week exercise DVD (n = 9), exergame (n = 9), or waitlisted control group (n = 9). Main outcomes include adherence was based on attendance during the in-lab component and participant logs during the in-home component. PA levels were measured through accelerometery and assessed at baseline, four-, nine- and 12-weeks. Secondary outcomes related to motivation were assessed at baseline, three- and nine-weeks. Tertiary outcomes such as physiological/functional fitness and quality of life outcomes were assessed at pre- and post-intervention. Results: During the in-lab portion, t-tests showed that adherence was slightly higher in the exergame group than the DVD group (t16 = -0.06, p = .96; d = .31). Repeated measures of analysis showed that the group x time interaction for moderate-to-vigorous physical activity (MVPA) (F2,24 = 0.87, p = .52; η2 = .05), while overall PA saw negligible changes (F2,24 = 0.16, p = .85; η2 = .01). At the end of the intervention, overall adherence was similar between both exercise groups (t16 = -0.06, p = .96; d = .03). The group by time interaction effect yielded a moderate effect size for MVPA (F2,24 = 1.07, p = .36; η2 = .08) and overall PA (F2,24 = 1.11, p = .35; η2 = .08). Overall PA only increased in the exergame group (d = .74). The exergame group saw major decreases in instrumental attitude (d = .64), injunctive norm (d = .79), perceived behavioural control (d = .40) and intention (d = .90). Both exercise groups enhanced strength, mobility, and aerobic endurance outcomes (d = .33-.98), as well as several quality of life domains (d = .32-.89). At the post-intervention follow-up, both exercise groups were more active than the control group (d = .49-1.03). Two-thirds of the DVD group adopted DVD-based exercise, while a third of exergame group adopted videogame-based exercise. Conclusions: With a high adoption rate, DVD-based exercise programs may be a feasible and acceptable approach to promote PA levels. Participants in both groups were generally satisfied, indicating that the exercise program was enjoyable, comprehensive, and a simple and convenient way to exercise at home. Improvements to important functional and quality of life domains were also identified. Further research will be required to fully test the effectiveness of exercise DVDs and exergames on adherence and PA behaviour in adults transitioning into retirement. / Graduate / 0384 / christopher.yao7@gmail.com

The overall aim of this thesis was to examine beliefs about human papillomavirus (HPV) prevention, especially vaccination, among parents, immigrant women, adolescents and school nurses, and to promote primary prevention among adolescents. The methods used in the thesis were focus group interviews, individual interviews, a web-based questionnaire, and finally, a randomised controlled intervention study. The immigrant women were largely in favour of HPV prevention, although barriers, such as logistic difficulties, and cultural or gender norms were found. Parents’ decision concerning vaccination of their daughters depended on several factors. Regardless of their final choice, they made the decision they believed was in the best interest of their daughter. The benefits outweighed the risks for parents choosing to vaccinate while parents declining made the opposite judgement. The majority of the school nurses reported that the governmental financial support given because of the vaccination programme had not been used for the intended purpose. Three out of four nurses had been contacted by parents who raised questions regarding the vaccine; most were related to side effects. The educational intervention had favourable effects on the adolescents’ beliefs regarding HPV prevention, especially among those with an immigrant background. Furthermore, the intention to use condom as well as actual vaccination rates among girls was slightly increased by the intervention. Trust in the governmental recommendations and the amounts of information given are important factors in the complex decision about HPV vaccination. Attention given to specific needs and cultural norms, as well as the possibility to discuss HPV vaccination with the school nurse and provision of extra vaccination opportunities at a later time are all strategies that might facilitate participation in the school-based HPV vaccination programme. School nurses need sufficient resources, knowledge and time to meet parents’ questions and concerns. The vaccinations are time-consuming and the governmental financial support needs to be used as intended, for managing the vaccination programme. A school-based intervention can have favourable effects on the beliefs and actual actions of young people and may possibly thus, in the long term, decrease the risk for HPV-related cancer.

Background Stress urinary incontinence (SUI) is the leakage of urine when coughing, sneezing, or on exertion. It affects 10-35% of women, and can impair quality of life (QOL). First-line treatment is pelvic floor muscle training (PFMT). However, access barriers and embarrassment may prevent women from seeking care. There is a need for new, easily accessible ways to provide treatment. Aim To evaluate the treatment outcome, patient satisfaction, and cost-effectiveness of an Internet- based treatment programme for SUI. Methods We recruited 250 community-dwelling women aged 18-70 years, with SUI ≥1/week via our website. Participants were randomised to 3 months of PFMT with either an Internet-based programme (n=124), or a programme sent by post (n=126). We had no-face-to face contact with the participants, but the Internet group received individually tailored e-mail support from an urotherapist. Treatment outcome was evaluated after 4 months with intention-to-treat analysis. After treatment, we telephoned a strategic selection of participants (Internet n=13, postal n=8) to interview them about their experiences, and analysed the results according to grounded theory principles. We also performed a cost-utility analysis with a 1-year societal perspective, comparing the treatment programmes with each other and with a no-treatment alternative. To scrutinize our measure of QOL, we performed a reliability study of the ICIQ-LUTSqol questionnaire. Results Participants in both intervention groups achieved highly significant improvements (p<0.001) with large effect sizes (>0.8) in the primary outcomes symptom score (ICIQ-UI SF: mean change Internet 3.4 [SD 3.4], postal 2.9 [3.1]), and condition-specific QOL (ICIQ-LUTSqol: mean change Internet 4.8 [SD 6.1], postal 4.6 [SD 6.7]); however, the differences between the groups were not significant. Compared with the postal group, more participants in the Internet group perceived they were much or very much improved after treatment (40.9%, vs. 26.5%, p=0.01), reduced their use of incontinence aids (59.5% vs. 41.4%, p=0.02), and indicated satisfaction with the treatment programme (84.8% vs. 62.9%, p<0.001). Results from the interviews fell into three categories: about life with SUI and barriers to seeking care; about the treatments and the patient-provider relationship; about the sense of empowerment many women experienced. A core category emerged: “Acknowledged but not exposed.” The extra cost per quality-adjusted life year (QALY) gained through use of the Internet-based programme compared with the postal programme was €200. The extra cost per QALY for the Internet-based programme compared with no treatment was €30,935. The condition-specific questionnaire ICIQ-LUTSqol is reliable in women with SUI, with high degrees of agreement between overall scores (Intraclass correlation coefficient 0.95, p<0.001). Conclusion Internet-based treatment for SUI is a new, effective, and patient-appreciated treatment alternative, which can increase access to care in a sustainable way.

Type 2 diabetes is a global health problem. Evidence indicates that type 2 diabetes can lead to serious complications, such as a cardiac event, which usually require critical nursing care. Patients with type 2 diabetes and with a history of cardiac disease are at greater risk of a further cardiac event requiring readmission to hospital. Evidence indicates that improved diabetes management assists patients with type 2 diabetes to manage their condition efficiently, reduces risks of a further cardiac event, and therefore reduces hospitalisations. However, there is limited information found regarding a diabetes management program specifically for patients who have already had cardiac complications. Difficulties in developing patients' skills in managing and modifying their daily lives also present a challenge to coronary care staff. Therefore, there is a real need to develop a special diabetes management program for patients with diabetes who have experienced a critical cardiac event, which will be commenced in the Coronary Care Unit (CCU). The aim of this research is to gain a greater understanding of the characteristics, secondly to obtain in-depth understanding of needs and experiences of patients with type 2 diabetes hospitalised for a critical cardiac event. A further aim is to develop and pilot test a diabetes management program, specific to the patients with diabetes in the context of the CCU. The design of this research employed three studies: Study I was an exploratory study, which obtained patients' demographic and disease characteristics from the hospital records of all patients with diabetes admitted to the CCU of one public hospital between 1 January 2000 to 31 December 2003. Study II used a qualitative interpretative approach and aimed to gain an in-depth understanding of the perspectives of patients with type 2 diabetes who have experienced a critical cardiac event in managing their everyday lives with both diabetes and cardiac conditions. Study III included two parts. The first utilised the information from the first two studies and the literature (self-efficacy theory) to develop a diabetes self-management program specifically for patients with diabetes who have had a critical cardiac event. The second part pilot tested the newly-developed diabetes self-management program for patients with diabetes admitted to CCU following a critical cardiac event. The pilot study used a randomised controlled trial research design to evaluate the efficacy of the program. Study I collected data from one hospital's records retrospectively from 2000 to 2003. The results of Study I showed there were 233 (14.7%) patients admitted to CCU that had diabetes out of the total 1589 CCU admissions during the study period. More than 22% of CCU patients with diabetes were readmitted to hospital within 28 days, compared to 6% of CCU patients without diabetes. Patients with diabetes who had a longer CCU stay were more likely to be readmitted. These results indicate that a significant proportion of a CCU population had type 2 diabetes and is more likely to be readmitted to hospital. Study II used an interpretive approach comprising open-ended interviews to collect data from patients with type 2 diabetes experiencing a cardiac event who had a CCU admission in 2000-2003. The findings revealed that patients with diabetes who had a critical cardiac event experienced considerable feelings of hopelessness and fatigue. Patients also had concerns in the areas of self-confidence and confidence in health professionals. Patients indicated that greater self-confidence and confidence in health professionals would help their ability to manage their daily lives. Therefore, it is very important that intervention programs for these at-risk patients need to improve patients' confidence levels, and reduce their feelings of hopelessness and fatigue. The information gathered from Study I and Study II provided important insight into the development of an effective diabetes self-management specifically designed for patients with type 2 diabetes following a critical cardiac event, which is presented in Study III in this thesis. Study III also provided a preliminary evaluation of the newly developed program. The evaluation used a randomised controlled trial research design for the new program and the current educational program provided in the CCU. The results of the program indicate the feasibility of commencing the new diabetes self-management program in the CCU, and to be continued in wards or at home. The results also showed significant improvements in patients' knowledge in the experimental group, but not in other outcome variables (self-efficacy, vitality and mental health levels). However, as a small sample size was used in this pilot study, a larger study is needed to ensure adequate testing of the intervention. Future research is also recommended to incorporate the new diabetes self-management program into the current cardiac education program. Staff's further professional development in providing such a program also needs to be examined. Improvements in quality of care, and patients' quality of life are expected in the future.

Background. Heart failure (HF) which is a chronic, disabling disorder is mainly found in older people and is one of the leading causes of hospitalisation and readmission around the world. Unfortunately, the mortality and morbidity rates for HF remain high. HF is a complex combination of symptoms which are related to an inadequate perfusion of the body tissues caused by fluid and sodium retention. Hence, enhancing HF patients’ self-efficacy to change their behaviours to perform fluid & sodium control is one of the most important issues for the management of HF. A self-management program has the potential to raise self-efficacy and self-care which is a method to improve health for those with chronic illness and to decrease patients’ health service utilisation and also to enhance these patients’ health status. Aim. The study aims to examine the effectiveness of a self-management program, based on self-efficacy theory, in older people with heart failure in Taiwan. Methods. An experimental design was used to examine the effectiveness of a self-management program on diet and fluid control among HF patients. A total of 93 subjects from two medical centres in Taiwan were randomly assigned to the intervention and control groups. In order to examine the effectiveness of self-management, data were collected at baseline, week 4, and week 12 using the following instruments: self-efficacy for salt and fluid control, HF self-management behaviour, HF related symptoms, and body weight. Moreover, health service utilisation and patient’s evaluation of care received were collected on all patients for the 12 weeks prior to commencing the study and for the 12 week study period. Demographic and disease information was also collected including age, gender, marital state, education, and New York Heart Association (NYHA) functional classification. A structured, individualized self-management training program created by the investigator was implemented for the intervention group through home visits and telephone follow-ups. This program emphasized self-monitoring of diet control and body weight for the self-management of heart failure. The purpose was to improve patients’ self-efficacy in their diet control behaviour. The “diet control” in this study focussed on sodium and fluid restriction. Outcome measures were analysed using the Statistical Package for the Social Sciences (SPSS) 15.0 version, and the level of significance (á) was set at 0.05 for statistical analysis. Results. There were differences for older Taiwanese HF patients’ self-efficacy for salt and fluid control, self-management behaviour, and HF related symptoms for participants who received a self-management intervention compared to those who did not. However, there were no significant differences between the two groups in weight and health serves utilization (p>.001). Conclusion. The self-management program had a positive impact on the improvement of self-efficacy for salt and fluid control, HF related self-management behaviours and symptoms in older Taiwanese with HF. This program may bridge the gap between theory and practice. Health care providers need to provide older people in Taiwan with HF the appropriate skills for self-managing their condition and thereby promoting their health status. These patients with HF and their caregivers have to receive individualized education that emphasizes self-efficacy in the self-management of their disease, thus improving their quality of life.

Métodos convencionais para a confecção de próteses totais envolvem uma série de procedimentos técnicos complexos. No entanto, métodos simplificados podem ser tão efetivos quanto os convencionais, porém com menor gasto de tempo e recursos, sem representar prejuízos aos usuários. Assim, o objetivo deste estudo foi comparar um método simplificado de confecção de próteses totais a outro convencional, tendo como variáveis a qualidade de vida associada à saúde bucal (QVSB), a satisfação dos pacientes e qualidade das próteses. A amostra foi formada por pacientes desdentados solicitando tratamento com próteses totais bimaxilares. Os participantes foram divididos aleatoriamente em dois grupos: Grupo S (n=19), que recebeu próteses confeccionadas por um método simplificado, e Grupo C (n=20), que recebeu próteses confeccionadas de forma convencional. Antes dos tratamentos e após 3 e 6 meses da instalação das próteses, a QVSB foi avaliada por meio do questionário OHIPEDENT e a satisfação dos usuários por meio de um questionário específico e escala visual analógica. A qualidade das próteses foi avaliada após 3 meses por um especialista. Os dois grupos foram comparados por meio de testes adequados à distribuição dos dados (α=5%). A QVSB e qualidade das próteses foram similares nos grupos C e S. Não houve diferença entre os grupos quanto à satisfação geral avaliada pelos dois questionários. Diferenças em relação à satisfação dos usuários com aspectos específicos das próteses só ocorreram na avaliação dos 3 meses, não persistindo na segunda avaliação. Conclui-se que métodos simplificados são capazes de produzir próteses totais de qualidade comparável às geradas por métodos convencionais, influenciando a QVSB e a satisfação de seus usuários de forma similar. / Complete denture fabrication involves a series of complex technical procedures. Nevertheless, simplified methods may be as effective as conventional ones albeit the lesser use of time and resources, without disadvantage to the denture wearer. Thus, the purpose of this study was to compare a simplified method for complete denture fabrication to a conventional protocol in a randomized controlled trial in terms of oral health quality of life (OHRQoL), patient satisfaction and denture quality. A sample was created by edentulous patients requesting treatment with maxillary and mandibular complete dentures. Participants were randomly allocated into two study groups. Group S (n=19), which received dentures fabricated by a simplified method, and Group C (n=20), which received conventionally fabricated dentures. Before the interventions and after 3 and 6 months following insertion, OHRQoL was evaluated by means of OHIP-EDENT questionnaire and patient satisfaction was analyzed by a visual analogue scale and a specific questionnaire. Denture quality was assessed 3 months after delivery by a prosthodontist. Groups were compared by means of statistical tests suitable for the distribution of data (α=5%). Groups presented no difference for OHRQoL, denture quality and patient general satisfaction. Differences regarding to patient satisfaction with specific aspects of the dentures were found after 3 months, but were insignificant at 6 months. It was concluded that the simplified method is able to produce complete dentures of a quality comparable to those produced by the conventional protocol, influencing the OHQoL and satisfaction of their wearers similarly

Submitted by SABRINA RAMIRES SAKAMOTO null (ramiressabrina@hotmail.com) on 2017-12-14T23:27:03Z No. of bitstreams: 1 Dissertação Sabrina Ramires Sakamoto (1) 2.pdf: 3962981 bytes, checksum: e28df22cb165cea511578dd6166c823f (MD5) / Approved for entry into archive by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br) on 2017-12-18T15:04:11Z (GMT) No. of bitstreams: 1 sakamoto_sr_me_bot.pdf: 3962981 bytes, checksum: e28df22cb165cea511578dd6166c823f (MD5) / Made available in DSpace on 2017-12-18T15:04:11Z (GMT). No. of bitstreams: 1 sakamoto_sr_me_bot.pdf: 3962981 bytes, checksum: e28df22cb165cea511578dd6166c823f (MD5) Previous issue date: 2017-11-21 / RESUMO Introdução. As metodologias ativas e os métodos inovadores de ensino-aprendizagem mostram uma movimentação do ensinar para o aprender e o desvio do foco do docente para o aluno, que assume a corresponsabilidade pelo seu aprendizado. A Aprendizagem Baseada em Equipes (ABE) é uma ferramenta relativamente nova, baseada em equipes, construtivismo, raciocínio aprofundado e no pensamento crítico. Objetivo. Analisar após 30 dias a apreensão do conhecimento em segurança cirúrgica em alunos de um curso de graduação em enfermagem, comparando aula expositiva dialogada presencial à aula com a utilização da ABE; Elaborar um produto e validar esse vídeo educativo direcionado aos professores do ensino superior. Método. O estudo foi realizado em duas etapas, (entre os meses de janeiro a março de 2017). A primeira, um ensaio clínico randomizado, desenvolvido na Universidade Estadual Paulista “Júlio de Mesquita Filho”, na Faculdade de Medicina de Botucatu, Curso de Graduação em Enfermagem junto à Disciplina de Enfermagem em Centro Cirúrgico. A amostra foram os alunos regularmente matriculados no 3º ano de graduação em enfermagem da disciplina. Foram randomizados em dois grupos, um com 14 alunos para intervenção experimental (ABE) e outro com 14 alunos para o grupo controle (aula expositiva dialogada). O desfecho primário foi a apreensão do conhecimento, após 30 dias da realização das aulas, comparando-se os grupos. A segunda etapa consistiu em uma pesquisa metodológica, de caráter descritivo, e no desenvolvimento e validação de um vídeo educativo, pelo Software Powtoon realizado no Núcleo de Educação a Distância Tecnologia Informação em Saúde (NEAD. TIS). O vídeo foi validado por 16 juízes especialistas na área de saúde e com experiência no uso de ABE, que responderam um questionário com 13 requisitos. Aspectos éticos e legais, foi cadastrado no Registro Brasileiro de Ensaios Clínicos ReBEC (número: RBR-4F32XY) e Resolução 466/12. Resultados. No ensaio clínico os alunos da avaliação do pré-teste mostraram no grupo ABE mais acertos do que no grupo da aula expositiva dialogada. Após 30 dias o grupo ABE também apresentou mais acertos, no entanto sem diferença significativa. Os índices de validação do vídeo tutorial criado variaram de 1,0 a 0,81, com média global de 0,89, valores considerados satisfatórios dentro do valor referencial teórico. Conclusões. Nesse estudo não houve diferença significativa entre os grupos. O vídeo foi construído embasado no referencial teórico de Falkembach e seu conteúdo foi validado por professores do ensino superior / ABSTRACT Introduction.As active methodologies and innovative teaching-learning methods, they show a move from teaching to learning and diverting the focus from the teacher to the student, who takes on a correspondence for their learning. Team-Based Learning (TBL) is a relatively new solution in equipment, constructivism, in-depth reasoning, and critical thinking. Objective. To analyze after 30 days the knowledge acquisition in surgical safety in students of a nursing undergraduate course, comparing the classroom with the use of TBL; Elaborate a product and validate this educational video directed to teachers of higher education. Method. The study was carried out in two stages (between January and March 2017). The first, a randomized clinical trial, developed at the Paulista State University "Júlio de Mesquita Filho", at the Faculty of Medicine of Botucatu, Undergraduate Degree following the course of Nursing in the Operating Room. A sample of the students regularly enrolled in the 3rd year of undergraduate nursing in the discipline. They were randomized into two groups, one with 14 students for the experimental intervention (TBL) and the other with 14 students for the control group (expository class). The primary endpoint was a knowledge seizure, 30 days after the classes, comparing the groups. The available information notice, technical description, categorized development, and no level and validation of an instrument warning, by our available numerical instrument powder. The video was validated by 16 expert judges in the area of health and experience without use of ABE, who answered a questionnaire with 13 requirements. Ethical and legal aspects, was registered in the Brazilian Registry of Clinical Trials ReBEC (number: RBR-4F32XY) and Resolution 466/12. Results. There is no clinical trial of the students of the pre-test evaluation showed any ABE group more successful than in the group of the dialogical expository class. After 30 days of the group ABE also presented more hits, however without significant difference. The validation indexes of the video tutorial created ranged from 1.0 to 0.81, with an overall mean of 0.89, values estimated within the theoretical reference value. Conclusions. In this study, there was no significant difference between groups. The video was built based on theoretical reference of Falkembach and its content to be validated by higher education teachers.

Bakgrund: Skolan är en av de bästa arenorna för att genomföra insatser som syftar till att främja fysisk aktivitet hos barn och ungdomar, då det går att nå samtliga barn och ungdomar som omfattas av skolplikt. Huruvida dessa insatser är verkningsfulla saknas det däremot information om. Trots att enskilda studier kan visa att insatserna leder till positiva förändringar i barnens aktivitetsnivåer så visar andra ingen effekt. För att få en bättre helhetsbild krävs en systematisk litteraturundersökning. Syfte: Syftet med översikten var att undersöka om skolbaserade interventioner främjar fysisk aktivitet på barn och ungdomar. Metod: En systematisk litteraturöversikt gjordes enligt PRISMA:s riktlinjer. Sökningen gjordes i sökmotorerna PubMed, Onesearch, ASSIA, SportDiscus, Cambridge, PMC mellan 2017-12-15-2018-03-02. Inklusionskriterierna innefattade svenska och engelska kontrollerade studier som var peer reviewed gällande barn och ungdomar i åldrarna 6–17 år. Manipuleringen av interventionsgruppens fysiska aktivitet mättes med accelerometer i minimum tre dagar. Studierna rapporterade medelvärde och standardavvikelse av antingen counts per minute (CPM) eller moderate-to-vigorous physical activity (MVPA) eller båda. Resultat: Totalt identifierades 11 artiklar som motsvarade de uppsatta inklusions- och exklusionskriterierna. I en artikel gav interventionen positiva effekter gällande den totala fysiska aktiviteten med en nettoökning på 50 CPM mellan baslinjen till uppföljningen. En metaanalys kunde dock inte genomföras då studierna var allt för heterogena avseende metodologiska val, typ av intervention och population. Slutsats: En obetydande till svag evidens för att skolbaserade interventioner främjar barn och ungdomars totala fysiska aktivitet gick att urskilja, dock är studierna överlag allt för heterogena för att några definitiva slutsatser kan dras. Detta är en indikation på att skolbaserade interventioner bör på ett bättre sätt standardiseras avseende utvärderingsmetod och rapportering.

Objetivo: Avaliar a eficácia de sessões de aconselhamento em amamentação dirigidas a mães adolescentes e avós maternas sobre o uso desnecessário de água e/ou chás em crianças amamentadas. Métodos: Foi conduzido um ensaio clínico randomizado envolvendo 323 mães adolescentes, seus recém-nascidos e as avós maternas das crianças, alocadas para quatro grupos distintos: mãe e avó não coabitando, sem intervenção e com intervenção direcionada apenas à mãe; e mãe e avó coabitando, sem intervenção e com intervenção direcionada a ambas. A intervenção consistiu de seis sessões de aconselhamento em amamentação, na maternidade e aos sete, 15, 30, 60 e 120 dias. As informações sobre as práticas alimentares das crianças foram coletadas mensalmente nos primeiros 6 meses de idade por telefone. O impacto da intervenção foi medido, comparando-se as medianas e as curvas de sobrevida da introdução desses líquidos e a regressão de Cox estimou a sua magnitude. Resultados: A intervenção teve impacto positivo significativo tanto para o grupo em que apenas as mães adolescentes a receberam (RDI=0,48; IC95%=0,31-0,76) quanto para o grupo em que as avós foram incluídas (RDI=0,53; IC95=0,35-0,80). Ela postergou em 44 dias o uso desses líquidos no primeiro grupo (78 dias versus 122 dias) e em 67 dias no grupo em que as avós foram incluídas na intervenção (63 dias versus 130 dias). Conclusões: Múltiplas sessões de aconselhamento nos primeiros 4 meses dirigidas a mães adolescentes e avós maternas, quando estas coabitavam, mostraram ser uma estratégia eficaz em postergar a introdução desnecessária de água e/ou chás em crianças amamentadas. / Objective: To evaluate the efficacy of counselling sessions on breastfeeding for adolescent mothers and maternal grandmothers on the reduction of unnecessary water and/ or herbal teas intake on breastfed infants. Methods: A randomized clinical trial was conducted involving 323 adolescent mothers, their newborn infants and respective maternal grandmothers allocated into four distinct groups: mother and grandmother not cohabitating, without or with intervention directed only towards mother; and mother and grandmother cohabitating without or with intervention directed towards both (mother and grandmother). The intervention consisted of six counselling sessions on breastfeeding, in the maternity ward and on days 7, 15, 30, 60 and 120 after birth. The data about feeding practices were collected monthly until the end of the sixth month of life by telephone. The impact of the intervention was measured by comparing the medians and the survival curves for initiation of water/tea intake in the first six months of life between the groups and Cox regression was used to estimate its magnitude. Results: The intervention had a significant positive impact for both the group in which only adolescent mothers received the intervention (HR=0,48; 95%CI=0,31-0,76) and for the group in which grandmothers were also included (HR=0,53; 95%CI=0,35-0,80). It postponed in 44 days the use of these liquids on first group (78 days versus 122 days) and in 67 days on the group in which the grandmother was also included in the intervention (63 days versus 130 days). Conclusions: Multiple counselling sessions on infant feeding in the first 4 months postpartum for adolescent mothers and maternal grandmothers, when they cohabitate, demonstrated to be an effective strategy to postpone the unnecessary water and/or teas intake on breastfed infants.

No description available.