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Evolução do uso de chupeta e sua influência no aleitamento materno exclusivo no Brasil, 1999-2008 / Temporal trends of pacifier use and its influence on the exclusive breastfeeding in Brazil, 1999-2008Buccini, Gabriela dos Santos 02 February 2017 (has links)
Introdução: O impacto positivo no curto e longo prazos do aleitamento materno exclusivo (AME) na saúde da criança, da mulher que amamenta e para a sociedade estão bem documentados. Apesar da tendência secular crescente do AME no Brasil, a prevalência de 36,6 por cento constatada na última Pesquisa Nacional de Saúde, realizada em 2013, está aquém dos 50 por cento considerados satisfatórios pela Organização Mundial da Saúde. Mediante esse cenário, faz-se importante identificar fatores de risco modificáveis para reduzir a interrupção precoce do AME. Embora o uso de chupeta seja apontado como um dos múltiplos determinantes do AME, não existe consenso sobre o efeito desse hábito na interrupção precoce dessa prática. Objetivo: Analisar a associação entre uso de chupeta e interrupção do AME, bem como a evolução do uso de chupeta e sua influência no AME em menores de 6 meses nas Capitais Brasileiras e no DF, 1999- 2008. Métodos: Foram produzidos 4 manuscritos. O primeiro consistiu de uma revisão sistemática e meta-análise para investigar a associação entre uso de chupeta e interrupção do AME nos menores de 6 meses. Para tanto, realizou-se uma busca ampla em cinco bases de dados (CINAHL, Scopus, Web of Science, LILACS, Medline) sem restrição de data ou idioma de publicação, o que resultou em 1.866 estudos submetidos à critérios de exclusão e inclusão previamente estabelecidos (Protocolo PROSPERO CDR42014014527). O segundo e o terceiro manuscritos utilizaram dados provenientes da I e II Pesquisa de Prevalência de Aleitamento Materno (PPAM) nas Capitais e DF realizadas em 1999 e 2008, respectivamente. Os inquéritos, metodologicamente equivalentes, utilizaram amostras representativas com sorteio em dois estágios. Os questionários foram compostos por questões fechadas relativas ao uso de chupeta e à alimentação da criança no dia anterior à pesquisa. No manuscrito 2, para testar a associação entre o uso de chupeta e o risco de interrupção do AME, foram utilizados modelos de regressão múltipla na amostra agrupada e para cada inquérito, ajustados por covariáveis socioeconômicas, demográficas e biomédicas da mãe da criança. No terceiro manuscrito, calculou-se a fração de impacto potencial (FIP) da influência da variação temporal do uso de chupeta no declínio da interrupção do AME. O manuscrito 4 resultou do aprofundamento na metodologia aplicada no manuscrito anterior, no qual se discute como as estimativas de FIP podem ser utilizadas na análise de mudanças em desfechos populacionais à luz de variações em seus fatores determinantes, tomando como exemplo os dados de AME e uso de chupeta no Brasil. Resultados: O efeito agrupado do uso de chupeta sobre a interrupção do AME em crianças menores de 6 meses dos estudos incluídos na meta-análise foi de OR 2,48 (IC95 por cento =2,16-2,85); entretanto, constatou-se alta heterogeneidade, explicada majoritariamente pelo delineamento do estudo (40,2 por cento ). Os dois ensaios clínicos randomizados incluídos apresentam validade externa limitada e encontraram associação nula; os 44 observacionais, incluindo 20 estudos de coorte prospectivos, encontraram associação consistente (OR=2,28; IC95 por cento =1,78-2,93). Essa associação foi confirmada pela análise agrupada das amostras da I e II PPAM (manuscrito 2), revelando o uso de chupeta como o fator mais fortemente associado à interrupção precoce do AME no Brasil no período de 1999 a 2008 (OR ajustado= 2,77; IC95 por cento =2,63-2,91). Nesse período, no Brasil, houve declínio de 15,2 pontos percentuais na prevalência de interrupção do AME (passando de 74,9 por cento para 59,7 por cento ) e uma redução de aproximadamente 17 pontos percentuais no uso de chupeta (passando de 58,5 por cento para 41,6 por cento ). Um terço do declínio na interrupção precoce do AME pôde ser atribuído à variação temporal do uso de chupeta (manuscrito 3). A redução no uso de chupeta como estratégia de prevenção para interrupção do AME no cenário 1999-2008 apresentou 41 por cento de eficácia potencial, 13,3 por cento de efetividade e 18,5 por cento de eficiência (manuscrito 4). Conclusões: O uso de chupeta é um fator de risco associado à interrupção do AME em crianças menores de 6 meses, sendo um forte determinante no declínio temporal da interrupção precoce dessa prática no Brasil. Como um fator de risco modificável, revelou-se seu potencial na prevenção da interrupção precoce do AME. Estratégias preventivas com abordagem universal e seletiva para redução do uso de chupeta em crianças amamentadas exclusivamente poderiam acelerar a melhoria das taxas da AME no Brasil, rumo às recomendações internacionais / Introduction: The short- and long-term health positive impact that exclusive breastfeeding (EBF) confers to children are well documented. Despite the secular trend for EBF in Brazil has increased, the prevalence of 36 per cent observed in the last national survey conducted in 2013 is still below the 50 per cent considered satisfactory by the World Health Organization. In this scenario, it is important to identify relevant modifiable key risk factors for the premature interruption of EBF. Although pacifier use has been pointed as one of the multiple determinants of exclusive breastfeeding there is no consensus on the effect of this habit in the early interruption of EBF. Objective: To analyze the association between pacifier use and EBF interruption as well as the influence of temporal trends of pacifier use on the EBF in children under 6 months old in Brazilian state capitals and Federal District, 1999-2008. Methods: 4 manuscripts were produced. The first consisted in systematic review and meta-analysis to investigate the association between pacifier use and interruption of exclusive breastfeeding in infants less than 6 months. A wide search in 5 databases (CINAHL, Scopus, Web of Science, LILACS, Medline) from inception through 30 December 2104 without restriction of language yielded 1.866 publications submitted to predetermined inclusion/exclusion criteria peer reviewed (PROSPERO protocol CDR42014014527). In the second and third manuscripts data from 2 waves of infant feeding surveys conducted in 1999 and in 2008 in the Brazilian state capitals and Federal District (I and II PPAM) was used. Methodologically equivalent surveys used representative samples selected based on complex sampling procedures and systematic random selection of children in the queue of each selected immunization center. Questionnaires were composed of closed-ended questions regarding the pacifier use and infant feeding on the day before the survey. In the second manuscript, to find out whether or not pacifier use is an independent risk factor for the EBF interruption were used multivariate regression models in the pooled sample and for each survey wave adjusting for socioeconomic, demographic and biomedical confounders. In the third paper, we calculated the potential impact fraction (IF) of the influence of temporal trends of pacifier use on the decline of EBF interruption. Manuscript 4 resulted from methodological deepening for application of the analysis strategy applied in the previous manuscript, into it we present how estimates of IF that might be used in the analysis of variation in the population outcomes considering shift in its determinants, taking as an example the data about EBF interruption and pacifier in Brazil. Results: The meta-analysis pooled effect was OR 2.48 (CI95 per cent =2.16-2.85) for the association between pacifier use and EBF interruption. The majority heterogeneity was explained by study design (40.2 per cent ). Two RCTs with very limited external validity found a null association, but 44 observational studies, including 20 prospective cohort studies, did find a consistent association between pacifier use and EBF interruption (OR=2.28; CI95 per cent =1.78-2.93). This association was confirmed by the pooled analysis for I and II PPAM (manuscript 2) revealing pacifier use as the strongest risk factor for EBF interruption in Brazil between 1999-2008 (OR adjusted= 2.77; CI95 per cent =2.63-2.91). In this period was observed 15.2 per cent of decline in EBF interruption prevalence (from 74.9 per cent to 59.7 per cent ) and a reduction of approximately 17 per cent in pacifier use (from 58.5 per cent to 41.6 per cent ). A third of the total decline of EBF interruption could be attributed to the temporal trends of pacifier use (manuscript 3). The decrease in the pacifier use as a prevention strategy for EBF interruption in the scenario 1999-2008 showed 41 per cent of potential effectiveness, 13.3 per cent effective and 18.5 per cent efficiency (manuscript 4). Conclusion: Pacifier use is a risk factor associated with EBF interruption, being a strong determinant in the temporal trends of EBF in Brazil. As a modifiable risk factor, the pacifier proved its potential in preventing EBF interruption. Preventive public health strategies with ecological and selective approach to reduce the pacifier use in exclusive breastfed infants could accelerate the improvement of the EBF rates in Brazil, towards the international recommendations
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Avaliação da alimentação de lactentes menores de um ano nascidos com baixo peso: estudo transversal em 64 municípios brasileiros / Evaluation of the feeding of infants under one year old born with low birth weight: a cross-sectional study in 64 Brazilian municipalitiesOrtelan, Naiá 26 September 2018 (has links)
Introdução: O baixo peso ao nascer (BPN) representa risco crucial para as crianças. Em contrapartida, a amamentação é considerada a estratégia de maior impacto na redução da mortalidade em crianças menores de cinco anos. O aleitamento materno exclusivo (AME) é recomendado até o sexto mês de vida, devendo ser complementado até dois anos de idade ou mais. Crianças com consumo alimentar inadequado desde a infância tendem ao desenvolvimento precoce de sobrepeso e obesidade, além de outras doenças crônicas associadas. Objetivo: Verificar o padrão de aleitamento materno (AM) e as práticas de alimentação complementar de lactentes menores de um ano nascidos com baixo peso e analisar a influência de determinantes individuais e contextuais. Métodos: Estudo transversal com dados de 64 municípios brasileiros (incluindo as capitais e Distrito Federal) que abrangeu 5115 lactentes menores de um ano com BPN da Pesquisa de Prevalência de Aleitamento Materno (PPAM) em Municípios Brasileiros, 2008. O questionário continha questões sobre a prática de AM e sobre o consumo de todos os grupos alimentares nas últimas 24 horas. A tese gerou três manuscritos: 1) Descreve as práticas de aleitamento materno, o consumo de líquidos e alimentos semi-sólidos nas últimas 24 horas e os indicadores de consumo alimentar de lactentes entre seis e 11,9 meses segundo estratos de BPN. 2) Avalia os determinantes individuais e contextuais do AME. 3) Analisa a influência de determinantes individuais e contextual sobre a dieta diversificada e sobre o consumo de alimentos ultraprocessados em lactentes de seis a 11,9 meses com BPN. Nos manuscritos 2 e 3, os determinantes individuais corresponderam às características socioeconômicas (representadas pela proxy escolaridade materna), dos lactentes (idade; sexo), maternas (faixa etária; situação de trabalho; paridade) e aos serviços de saúde (local de acompanhamento ambulatorial). No manuscrito 2 foi incluído também o \'nascimento em Hospital Amigo da Criança (HAC)\'. Os determinantes contextuais corresponderam às características dos municípios, representadas pelas variáveis \'número de Bancos de Leite Humano (BLH) por mil nascidos vivos\' e \'Índice de Desenvolvimento Humano do município\' no manuscrito 2, e \'prevalência estimada de desnutrição infantil\' como proxy de pobreza, no manuscrito 3. Para análise, utilizou-se regressão de Poisson com estrutura multinível e adotou-se nível de significância de 5%. Resultados: Descritos de acordo com cada manuscrito produzido: 1) No estrato de muito BPN o AME até 60 dias e 90 dias foi mais elevado do que nos demais, mas com intervalos de confiança superpostos. A prevalência de AME em menores de seis meses apresentou patamar semelhante nos três estratos de peso ao nascer. A prevalência de AM na primeira hora de vida e o AM foram mais prevalentes entre os nascidos com 2000 a 2499g. Observou-se consumo elevado de alimentos ultraprocessados (AUP) em lactentes de 6|-9 e de 9|-12 meses, sendo esta prevalência maior quanto maior o PN. As prevalências dos indicadores de consumo alimentar estão aquém do recomendado. 2) O AME foi mais prevalente entre lactentes cujas mães tinham de 20 a 35 anos (RP=1,35; IC95%=1,09-1,69), não trabalhavam fora (RP=1,36; IC95%=1,08-1,71) ou estavam em licença maternidade(RP=1,30; IC95%=1,06-1,59); lactentes que nasceram em HAC (RP=1,22; IC95%=1,09-1,37) e que residiam em municípios com maior número de BLH por mil nascidos vivos (RP=1,42; IC95%=1,14-1,76). 3) Aproximadamente 59% dos lactentes consumiram alimentos ultraprocessados, enquanto 29% apresentaram dieta diversificada. Crianças cujas mães residiam em municípios com prevalência de desnutrição infantil inferior a 10% (RP=1,66; IC95%=1,23-2,24), tinham escolaridade superior (RP=1,37; IC95%=1,18-1,60) e trabalhavam fora de casa (RP=1,29; IC95%=1,12-1,49) foram mais propensas a oferecer uma alimentação diversificada. O consumo de alimentos ultraprocessados foi maior entre lactentes cujas mães residiam em municípios com prevalência de desnutrição infantil inferior a 10% (RP=1,17; IC95%=1,04-1,31), eram mais jovens (RP=1,30; IC95%=1,15-1,46) e multíparas (RP=1,16; IC95%=1,03-1,30). Conclusões: A tese evidenciou o efeito independente de estratégias que integram a Política Nacional de Aleitamento Materno. Nascer em HAC, residir em município com maior disponibilidade de BLH e o direito à licença maternidade remunerada exercem influência positiva sobre a prática de AME. Este resultado aponta para a necessidade de expansão da cobertura dessas estratégias com vistas ao cumprimento das metas de AM propostas pela OMS. Foi detectado impacto de fatores individuais e contextuais sobre a qualidade da dieta que demandam o desenvolvimento de estratégias eficazes para aumentar o consumo de alimentos in natura ou minimamente processados e diminuir o consumo de ultraprocessados nesta população vulnerável. / Introduction: Low birth weight (LBW) represents a major risk to children. On the other hand, breastfeeding is recognized as the strategy with the greatest impact on reducing childhood mortality. Thus, exclusive breastfeeding (EBF) is recommended up to the sixth month of the child\'s life and should be complemented up to two years of age or more. Inadequate nutrition during early childhood is associated with early development of overweight, obesity, and other chronic diseases. Objectives: 1) To verify the breastfeeding pattern and complementary feeding practices of infants under one year of age who were born with low weight and, 2) to assess the influence of its individual and contextual determinants. Methods: This cross-sectional analysis included 5,115 infants less than one year of age born with LBW from the Second National Survey of Breastfeeding Prevalence (IIPPAM). The survey evaluated the situation of breastfeeding and complementary feeding in 64 Brazilian municipalities (including capitals and the Federal District). Dietary data was collected using a questionnaire with dichotomous questions about breastfeeding practices and consumption of foods from all food groups in the previous 24 hours. The thesis generated three manuscripts as follows: 1) The first one describes breastfeeding practices, consumption of any liquids (including non-human milk) and semi-solid foods in the last 24 hours, and indicators of young child feeding practices of infants between six and 11.9 months according to birth weight strata. 2) The second manuscript evaluates individual and contextual determinants of exclusive breastfeeding. 3) The third one assesses the influence of individual and contextual factors on dietary diversity and on consumption of ultraprocessed foods in LBW infants between six and 11.9 months of age. The individual-level-factors studied on manuscripts 2 and 3 were: socioeconomic (represented by the proxy maternal education), infants (age, sex), maternal (age range, work situation, parity), and health services (type of outpatient follow-up). The individual-level-factor \'being born in a Baby-Friendly Hospital (BFH)\' was also studied on manuscript 2. The community-level factors studied at the second level in the manuscript 2 included municipalities\' characteristics (number of Human Milk Banks (HMB) per thousand live births in each municipality in 2007, and Human Development Index of the municipality, used as proxy of poverty). The community-level factor studied at the second level in manuscript 3 was municipal prevalence of childhood malnutrition, used as a proxy for poverty. The individualized effect of the study factors on the outcome was evaluated using multilevel Poisson regression analysis. For all manuscripts, a significance level of 5% was adopted. Results: Summary of the findings of each manuscript produced: 1) In the stratum of very LBW, the rates EBF up to 60 and 90 days were higher among very LBW infants compared to others, however with overlapping confidence intervals. The overall prevalence of breastfeeding in infants under six months was similar among the groups. The rates of breastfeeding in the first hour of life and total breastfeeding were both higher among those born with weight between 2000 and 2499g. A high consumption of ultraprocessed foods was observed among infants aged 6|-9 and 9|-12 months, and it was noted that the higher the birth weight the higher was the prevalence of consumption. The prevalence of food groups consumption indicators are below the recommended. 2) EBF was more prevalent among infants born with LBW whose mothers were 20-35 years old, those who did not work outside the home or were on paid maternity leave; those born in a BFH; and those who lived in municipalities with the highest number of HMB per thousand live births. 3) Approximately 59% of infants consumed ultraprocessed foods, while 29% achieved dietary diversity. Mothers with the highest education level, those who worked outside the home, and who lived in municipalities with a prevalence of child malnutrition below 10% were more likely to offer a diverse diet. Consumption of ultra-processed foods was higher among infants whose mothers were younger, multiparous, and who lived in municipalities with a prevalence of child malnutrition below 10%. Conclusions: The thesis augments the evidence that integrated actions of the National Breastfeeding Program already implemented in Brazil - BFH Initiative, Brazilian Network of HMB, and adoption of labor laws for paid maternity leave - are associated with EBF even in the vulnerable population of infants born with LBW. Our results also suggest the need to expand and intensify the coverage of these strategies in order to meet the goals of breastfeeding proposed by the World Health Organization. Our findings also indicate the effects of individual and community-level factors on the dietary quality of this population, suggesting a need for developing effective strategies to increase consumption of unprocessed or minimally processed foods, while decreasing the ultra-processed counterpart for this vulnerable population.
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Estrutura da população, crescimento e reprodução de Maurolicus stehmanni Parin & Kobylianski, 1993 (Teleostei: Sternoptychidae) na zona econômica e exclusiva do sul e sudeste do Brasil. / Population structure, growth and reproduction of Maurolicus stehmanni Parin & Kobyliansky, 1993 (Teleostei: Sternoptychidae) in south-eastern and south Brazilian economic exclusive zone.Eduardo Machado de Almeida 19 February 2001 (has links)
Maurolicus é um gênero representado por peixes mesopelágicos, com elevada biomassa na Zona Econômica Exclusiva sudeste sul brasileira. O material deste estudo provém de arrastos com rede de meia água efetuados com o N/Oc. Atlântico Sul, entre as isóbatas de 100 e 1500 m e entre as latitudes 22° e 35° S, realizados no inverno de 1996; outono de 1997 e primavera de 1997. A análise das características merísticas e morfológicas de 120 exemplares, coletados em 4 pontos distintos, indicou que na região ocorre M. stehmanni Parin & Kobyliansky, 1993. Através da análise da distribuição vertical e horizontal das capturas, verificou-se que a espécie está associada à região de quebra de plataforma continental, permanecendo em profundidades maiores que 200 metros durante o dia, migrando para camadas superiores a noite, com a diminuição da intensidade luminosa. Pela distribuição de freqüência de comprimento e proporção entre jovens e adultos constatou-se que ocorreu recrutamento em todos os períodos estudados. A partir da análise da proporção entre peixes jovens e adultos por comprimento estimou-se o L50médio em 32 mm. As análises da relação gonadossomática, da freqüência dos estádios de maturidade gonadal e do ∆K (diferença entre o fator de condição total e somático) indicaram que a espécie apresentou atividade reprodutiva em todas as áreas e épocas analisadas. A relação entre o raio do otólito e o tamanho dos indivíduos é linear, porém não foi possível identificar a periodicidade de formação dos anéis, impossibilitando estimativas adequadas dos parâmetros de crescimento. Aplicando-se a rotina ELEFAN I, do pacote computacional FISAT, aos dados de freqüência de comprimento foi estimado o L∞ em 53 mm e k em 0,9 ano-1, indicando que a espécie atinge o tamanho médio da 1 a maturação gonadal em torno do 1º ano de vida. / Maurolicus is a genus of mesopelagic fish very abundant in the south-eastern and south Brazilian Economic Exclusive Zone. The material of this study was sampled by mid water trawl during cruises of R/V Atlântico Sul in winter of 1996, autumn of 1997 and spring of 1997, between 100 and 1500 meters depth, from latitudes of 22° to 35° S. The meristic and morphological analysis of 120 specimens collected in 4 distinctive points, has indicated the occurrence of M. stehmanni Parin & Kobyliansky, 1993 in the area. Through the vertical and horizontal distribution of the catches it was verified that this species is associated with the shelf break, staying in depths higher than 200 m during the day, migrating to lower depths at night as the luminous intensity falls. The length frequency and the proportion between youngs and adults showed that the recruitment occured during the periods surveyed. By means of young-adult proportion by length a value of L50 about 32 mm was estimated. The study of gonadossomatic relationship, gonadal maturity frequency and ∆K (difference between total and somatic condition factor) indicated that M. stehmanni presented reproductive activity in the area during all the sampled seasons. There is a linear relationship between the standard length and the otolith radius, however the periodicity of the zone formation was not identified, which did not permit appropriate estimates of the growth parameters. The L∞ of 53 mm and k of 0,9 year1 were estimated using ELEFAN I routine (FISAT) based on length frequency data, indicating that M. stehmanni attains maturity around its first year of life.
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Ihokontaktin, ensi-imetyksen, vierihoidon ja täysimetyksen toteutuminen synnytyssairaaloissaHakala, M. (Mervi) 29 October 2019 (has links)
Abstract
This study describes skin-to-skin contact, initial breastfeeding, rooming-in, and exclusive breastfeeding in accordance with the Baby-Friendly Hospital Initiative (BFHI) program. Furthermore, it addresses the connection of these factors in Finnish maternity hospitals and gathers information about the daily work of maternity ward staff, which is useful to develop ways to increase exclusive breastfeeding of infants and to plan the introduction of BFHI.
The study uses a cross-sectional design that includes questionnaires. Random data came from mothers (n=111), midwives (n=272), and maternity ward staff (f=1554) in maternity hospitals during the spring of 2014. The questionnaires include background questions, questions concerning the implementation of skin-to-skin contact, initial breastfeeding, rooming-in, exclusive breastfeeding according to the BFHI, and open-ended questions about implementation barriers. The analysis used statistical methods to interpret the data and content specifications to explain the answers to open questions.
In Finland, successful skin-to-skin contact, initial breastfeeding, and rooming-in results in multiparas and vaginally births women. After vaginally births, exclusive breastfeeding increases when skin-to-skin contact, initial breastfeeding, and rooming-in starts at an early stage. Rooming-in does not take place for many different reasons. Maternity staff state that 72% implement exclusive breastfeeding, and mothers state that 55% exclusively breastfeed. Primiparous mothers and those who underwent cesarean are the populations that least use exclusive breastfeeding mostly due to infant medical issues and to non-medical reasons.
The results of the study bring to light that practices with skin-to-skin contact, initial breastfeeding, and rooming-in in Finnish maternity units are similar to BFHI steps. Exclusive breastfeeding during hospitalization, as well as implementation barriers, should receive special attention. Furthermore, maternity staff should have a clearer medical understanding. / Tiivistelmä
Tutkimuksen tarkoituksena oli kuvata äitien ja hoitohenkilökunnan näkökulmista ihokontaktin, ensi-imetyksen, vierihoidon ja täysimetyksen toteutumista Vauvamyönteisyysohjelman mukaisesti ja niihin yhteydessä olevia tekijöitä Suomen synnytyssairaaloissa. Tavoitteena oli tuottaa synnytysosastojen henkilökunnan päivittäiseen hoitotyöhön tietoa, jota voidaan hyödyntää kehitettäessä menetelmiä vastasyntyneiden täysimetyksen lisäämiseen ja Vauvamyönteisyysohjelman käyttöönoton suunnitteluun.
Tutkimus oli poikkileikkaustutkimus, joka toteutettiin kyselytutkimuksena. Aineisto kerättiin satunnaisesti valituissa synnytyssairaaloissa äideiltä (n=111), synnytyssalikätilöiltä (n=272) ja vuodeosastojen hoitajilta (f=1554, f=hoitoraporttien/kyselylomakkeiden määrä) keväällä 2014. Kyselylomakkeessa oli taustatietokysymysten lisäksi ihokontaktin, ensi-imetyksen, vierihoidon ja täysimetyksen toteutumisesta Vauvamyönteisyysohjelman mukaisesti mittaavia kysymyksiä sekä avoimia kysymyksiä niiden toteutumista estävistä tekijöistä. Aineisto analysoitiin tilastollisin menetelmin ja avoimet kysymykset sisällön erittelyllä.
Ihokontakti, ensi-imetys ja vierihoito toteutuivat Suomessa hyvin alateitse synnyttäneillä uudelleensynnyttäjillä. Täysimetys lisääntyi ihokontaktin ja ensi-imetyksen alkaessa varhain ja vierihoidon toteutuessa. Vierihoidon toteutumista estivät useat eri syyt. Täysimetys toteutui Suomessa hoitajien arvioimana 72 %:lla ja äitien arvioimana 55 %:lla. Se toteutui vähiten ensisynnyttäjillä ja keisarileikatuilla ja estyi enimmäkseen lääketieteellisistä syistä.
Tutkimus osoittaa, että Suomen synnytyssairaaloiden hoitokäytännöt ihokontaktin, ensi-imetyksen ja vierihoidon toteutumisessa eivät poikkea suuresti Vauvamyönteisyysohjelman suosituksista. Täysimetys sairaalassa vaatii lisätarkastelua ja sen osalta sairaaloissa tulee kiinnittää huomiota lisäruoan antamisen syihin ja selkiyttää hoitohenkilökunnalle sen antamisen lääketieteellisiä syitä.
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L’influence du droit français sur le droit chinois des sûretés mobilières / The influence of French law on the Chinese law of security interestZhang, Zhouxi 07 December 2016 (has links)
Cette recherche comparative entre le droit français et le droit chinois est particulièrement consacrée au dixième anniversaire de l’ordonnance française du 23 mars 2006 et de la LDR (Loi chinoise sur les droits réels) du 16 mars 2007 qui représente la première réforme chinoise complète du droit des sûretés réelles. A partir des principes directeurs des sûretés réelles, tant préférentielles qu’exclusives, une analyse approfondie de l’influence de la simplification sur le droit des sûretés réelles, en France comme en Chine, s’est poursuivie tout en prenant compte la renaissance des propriétés-sûretés et la prospective du droit de la rétention. D’ailleurs, certaines institutions ou techniques d’autres pays occidentaux ont été inclues dans l’analyse comparative pour montrer les divers aspects et aussi l’attractivité du droit français.En se basant sur une même théorie juridique, les législateurs français et chinois ont, certes, choisi des techniques différentes pour contourner des difficultés identiques. Mais la tendance de simplification du droit des sûretés réelles mobilières, qui favorise la sécurité de la « contractualisation » des sûretés réelles mobilières, dans les deux pays, restera une convergence indéniable. Ainsi, il y aurait lieu de croire que le législateur chinois va prendre en compte les techniques françaises dans les futures réformes portant sur les sûretés réelles mobilières qui doivent toujours caractérisées par la sécurité, la simplicité et la rapidité. / This comparative research between French law and Chinese law is particularly devoted to the tenth anniversary of the French ordinance of 23 March 2006 and the LDR (Chinese property law) of 16 March 2007 which is the first complete Chinese law which reforms the Chinese Security Interest. Departure from guiding principles of different security interest, both preferential than exclusive, an in-depth analysis of the impact of simplification on the security laws, in France as in China, continued while taking account of the rebirth of the properties-securities and the prospective of liens. Moreover, some institutions or techniques of other Western countries have been included in the comparative analysis to show the different aspects and also the attractiveness of the French law.Based on the same legal theory, French and Chinese legislators have certainly chosen different techniques to overcome the same difficulties. But the simplification of guarantee laws, which promotes the safety of "contractualization" of security interest in both countries will remain an undeniable convergence. Thus, there is reason to believe that the Chinese legislator will take into account the French techniques in future reforms in the security rights that are always characterized by safety, simplicity and speed.
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Of the CricketsLien, Kathryn 01 January 2018 (has links)
Of the Crickets imagines the overlapping worlds of ethical ecological solutions to climate changed sustenance and the potential for collective excellence in female exclusive environments. Using garments, furniture, site-specific installation and directed performance, the project harnesses social and material sensitivity to mine solutions for idealized living.
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島嶼在海疆劃界中效力問題之研究 / The Effect of Islands on the Delimitation of Maritime Boundaries程宜宜, Cheng, Yi-yi Unknown Date (has links)
每一個沿岸國皆多多少少擁有島嶼,不論是近岸島嶼或洋中島嶼。而全球島嶼面積共3,823,000平方英里,佔地表的百分之七(不包括內陸河流及湖泊中之島嶼),有些國家甚至完全由島嶼構成。據統計,全球島嶼中,大於1,000平方英里者(相當於牙買加或賽浦路斯的大小)者至少有123個,其中共有61個面積達4,000平方英里(相當於盧森堡的大小)者。這些數據顯示了島嶼地位的重要性,因為在今日,島嶼的存在已不再只是一個單純的地理問題,在國際海洋法上,它不僅可以影響一國海域管轄權(領海、鄰接區、專屬經濟區和大陸礁層)的劃定,甚至足以引起海岸相鄰或相向國家海域管轄權的衝突。解決海域管轄權衝突的最基本辦法,即為針對重疊
區域的「平均分攤」。但此一「平均分配」有時反會因島嶼的存在而導致「不公平劃界」或「疆界線的扭曲」。由於上述結果易使當事國之一方劃得不成比例的海域,[甚至引發更複雜的海域糾紛,因此有必要在海疆劃界中適當控制島嶼的海域管轄權,即---藉賦與島嶼適當之效力,以達公平劃界之目的。本文之研究動機即在於此。而研究目的,則在於就公約規定、學者意見、國際司法判例及國家實踐四者,探討島嶼對海疆劃界的影響,找出解決島嶼造成劃界不公平之方,以及賦與島嶼適當效力之道。本文第一章為「島嶼」的概念性介紹,即何謂島嶼,其定義、種類、存在的形式及形成的過程為何?而一般所謂的島嶼與國際法上的島嶼又有何分別?
此皆為本章重點。第二章為島嶼與領海的關係,討論的焦點包括:(一)領海基線的劃定與島嶼的關係、(二)海灣島嶼的效力、(三)島嶼對領海劃界原則的影響以及(四)島嶼在海岸相鄰或相向國家領海劃界中可得之效力程度等等。三章重點在於介紹島嶼與大陸礁層、專屬經濟區劃界原則之關係,並從公約規定、學者意見、國際司法判例及國家實踐等方面探討島嶼存在時,大陸礁層與專屬經濟區的衡平劃界,以及島嶼在「衡平考量﹞U應得的效力。第四章除介紹「群島制度」的內涵,主要重點則為(一)關於劃定群島基線的國家實踐,以及(二)群島基線的劃定對劃界的影響。此外
南海問題亦是本章重點之一。
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涉外專利法之國際裁判管轄及適用法 / Jurisdiction and applicable law on European patent disputes藍彗甄, Lan, Hui Chen Unknown Date (has links)
European Patents are granted through the European Patent Office. Although such right is unitary, the European patents will break down into a bundle of national patents; each governed by the domestic law of the States which the holder of the right has designated.
Since infringement stands in the crossroads between patent enforcement and patent validity, infringement litigation generally touches on the issue of validity as it is impossible to infringe a right that does not exist or no longer exists. The nullity component in infringement litigation gives rise to additional difficulties with respect to the selection of the forum and the applicable law. As a result, the validity challenge is discussed in detail with respect to the application of the relevant rules on international jurisdiction and with respect to the identification of the relevant applicable laws.
Cross border litigation in relation to registered intellectual property rights in Europe has been extremely controversial over the years. The jurisdiction of the courts to deal with foreign intellectual property rights is after all not entirely obvious or straightforward in the light of the exclusive jurisdiction provision in the Brussels system. The judgment which the Court of Justice delivered on 13th July 2006 in case Roche and GAT result substantial conflicts. Divergent views had been expressed concerning cross border jurisdiction over intellectual property cases on Article 6(1) of the Brussels I Regulation; and Article 16(4) of the Brussels Convention 1968, what is now Article 22(4) of the Brussels I Regulation.
This thesis focuses on the jurisdiction and applicable law on European patent disputes.
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Breastfeeding and introduction of other foods : A prospective longitudinal study in SwedenHörnell, Agneta January 2000 (has links)
<p>This study, based on daily recordings of infant feeding, comprised 506 infants from Uppsala, Sweden. All mothers had had previous breastfeeding experience of at least 4 months, and were planning to breastfeed the index child for ≥6 months.</p><p>Among exclusively breastfed infants there were wide variations in breastfeeding frequency and suckling duration per 24 hours both between infants and in the individual infant over time in the first 6 months. Most infants had an average of 1.0-2.9 feeds per night. Infants using a pacifier had fewer feeds and a shorter total suckling duration per 24 hours, and stopped breastfeeding earlier than infants not using a pacifier. These associations were not found for thumb sucking.</p><p>Accustoming the infants to solids was a lengthy process, the longer the younger the infant at introduction, and was associated with small changes in pattern and duration of breastfeeding. In contrast, formula was usually given in large amounts from the beginning, and when formula was given regularly the daily breastfeeding frequency and suckling duration declined swiftly. The younger an infant at the start of regular formula feeds, the shorter the breastfeeding duration. Occasional formula feeds did not affect the breastfeeding duration.</p><p>It is important for health personnel and parents to keep in mind that exclusively breastfed infants are not a homogeneous group, but rather members of distinct 'breastfeeding entities'. Moreover, if the aim is to introduce other foods 'under the protection of breast milk' it is important to realise that formula is also 'another food' and needs to be treated as such.</p>
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Det villkorade tillståndet : Centralförbundet för Socialt Arbete och liberal politisk rationalitet 1901–1921 / The State of Suspension : National Association of Social Work and Governmentality 1901–1921Kaveh, Shamal January 2006 (has links)
<p>This is a dissertation about Swedish liberalism as a political rationality and, more specifically, the conditions that made the transition from an exclusionary society to an inclusive one possible at the beginning of the 20th century. I have made a case study of National Association of Social Work (Centralförbundet för Socialt Arbete, CSA), an association that played a significant role in the institutionalization of social politics in Sweden. The objectives are threefold. Firstly, to analyze CSA as a liberal political rationality. Secondly, to analyze its political ontology. Thirdly, to examine its motives for defending an including society.</p><p>One of the main arguments in this dissertation is that the political rationality of CSA is characterized by a form of government that works in and through society, as well as through freedom. By using the concept of ”the state of suspension” I try to capture and analyze the ontological ambiguity of the individual in liberal thought; an ambiguity expressed in biopolitical categorizations of the population according to perceived capacities for rational thought. The inclusion of the excluded part, which I describe through the notion of “the social”, was possible due to a new political ontology, which considered the individual as being a product of social circumstances, and as someone possible to shape and govern in and through society. </p><p>I argue that the political struggle of the excluded not only served to revise the political ontology of CSA, but also provided the rationale for the efforts to create an including society with universal suffrage. CSA did not regard citizenship as a right, but as a political technology and as a solution. Furthermore, I argue that citizenship shouldn’t be seen as a prerequisite for the politization of the excluded. On the contrary, this part of the population was already, at least partially, politicized and they became political subjects through their participation in the struggle for political rights.</p>
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