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The Supplemental Nutrition Assistance Program-Education identified food pantries as a targeted setting for policy, system, and environmental (PSE) interventions to promote healthy eating among households who rely on pantries to supplement their food needs. The present study sought to identify factors influencing capacity and readiness to implement healthy eating PSE interventions in food pantries. Qualitative interviews were conducted via zoom with twenty-six community residents with experience receiving SNAP benefits and twelve SNAP-Ed staff in rural and urban counties in Ohio to identify themes and indicators related to community/organisational capacity and readiness to implement healthy eating PSE interventions in food pantries. Themes and related indicators generated based on inductive and deductive coding of interview transcripts were prioritised and weighted by eleven community nutrition experts during a virtual consensus conference. Five themes emerged; expert-derived weights (scaled low, 0 to high, 1) reflect the perceived importance of each to implementation of healthy eating PSE interventions in food pantries: food pantry capacity and logistics [0⋅252], networks and relationships [0⋅228], community nutrition practitioner capacity [0⋅212], food pantry user characteristics [0⋅156], and stigma and stereotypes [0⋅1⋅52]. Overall, seventeen indicators were identified reflecting these themes. Successful and sustained PSE interventions at food pantries will require a tailored approach that considers food pantries' capacity, needs and opportunities within the community, and capacity of community nutrition practitioners. The themes and indicators identified provide guidance for responsive PSE approaches in food pantries that meet communities where they are.

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BACKGROUND: Farm-to-school interventions are recommended strategies to improve dietary behaviors among school-aged children. Tools are needed to assess community readiness and capacity to optimize farm-to-school implementation. The objective of this study was to identify and prioritize factors to inform tailored farm-to-school implementation by practitioners working in diverse contexts. METHODS: Practitioners and community residents (N = 194) participated in semistructured interviews (N = 18) and focus groups (N = 23). Thematic analysis was conducted to identify themes and subthemes influencing farm-to-school implementation. The subthemes were operationalized into measureable indicators. The themes and their associated indicators were prioritized through a consensus conference with an expert panel (N = 18). RESULTS: The qualitative data analysis and consensus conference yielded 4 themes and 17 indicators associated with community readiness and capacity to implement farm-to-school. The themes represent school capacity, networks and relationships, organizational and practitioner capacity, and community resources and motivations. CONCLUSIONS: Findings highlight a range of indicators of community readiness and capacity needed to support farm-to-school implementation. Results offer guidance for tailoring intervention delivery based on levels of community, school, practitioner, and organizational readiness and capacity.

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OBJECTIVE: Identify factors perceived to influence implementation of healthy eating policy, systems, and environmental strategies (PSEs) in child care settings serving low-income children. DESIGN: This mixed-methods study, conducted in 2015-2016, used semi-structured interviews (n = 18), focus groups (n = 23), and an expert panel. PARTICIPANTS: Public health (n = 11) and Supplemental Nutrition Assistance Program-Education practitioners (n = 9) and community residents (n = 174) from 9 counties in Ohio. Expert panelists (n = 10) had experience implementing PSEs in child care settings. PHENOMENON OF INTEREST: Implementation factors influencing healthy eating PSEs in child care settings. ANALYSIS: Qualitative thematic analysis of 41 transcripts using a grounded theory approach. Indicators for each theme were operationalized. Consensus feedback from an expert panel weighted themes and indicators based on perceived importance for implementation. RESULTS: Identified themes relevant to implementation of PSEs included (1) organizational and practitioner capacity, (2) child care capacity, (3) networks and relationships, and (4) community resources and motivations. Nineteen indicators related to the 4 themes were identified and weighted. CONCLUSIONS AND IMPLICATIONS: Findings highlighted key factors within domains of influence and informed the operationalization of the indicators and the development of an assessment tool. The assessment tool is designed to tailor PSE implementation to the realities of different child care settings.

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Las enfermedades de la vía aérea superior en la infancia constituyen la causa más frecuente de consulta al pediatra y abarcan una diversidad de trastornos cuyo abordaje preciso y oportuno es fundamental. En este nuevo volumen de las Series de Pediatría Garrahan: El niño con problemas de la vía aérea superior se han reunido pediatras con amplia experiencia en el área ambulatoria del Hospital y prestigiosos especialistas en otorrinolaringología pediátrica para resumir y actualizar las claves en el manejo integral de esta problemática. Entre sus características se destacan: El estudio detallado de las patologías clínicas más frecuentes, como otitis media aguda, rinosinusitis, estridor, tos crónica, hipoacusia y faringoamigdalitis, y de las indicaciones de amigdalectomía o adenoidectomía. El abordaje, a través de casos clínicos y de manera dinámica, con la secuencia de presentación clínica, los estudios de diagnósticos, el tratamiento y la evolución de los niños con estas patologías y sus complicaciones. El cierre de cada capítulo con un recordatorio de puntos clave y lecturas recomendadas y, además, material complementario como videos o descripción de procedimientos disponibles en el sitio web. Comparte y transmite una modalidad de trabajo propia del hospital, con base en el rol central del pediatra como coordinador de la atención interdisciplinaria en el marco de su tarea cotidiana junto a los niños y sus familias. Una obra actualizada y práctica que aporta información científica y experiencia de los profesionales de una institución de prestigio. Este tomo y las Series de Pediatría, en su conjunto, serán de gran utilidad para todos aquellos miembros del equipo de salud que atienden y cuidan niños, dondequiera que trabajen al servicio de la salud infantil.

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Pediatricians should acquire multiple skills during their professional training, including procedural skills. Skill acquisition requires knowledge on theoretical bases, direct observation and, lastly, supervised repetitive practice. Training using simulators allows to learn procedures in a controlled setting, ensuring patients' safety, integrating this as a learning stage prior to the actual contact with patients. Here we report on the teaching experience of a simulated lumbar puncture procedure. Training was provided to 112 first year pediatric residents who entered Hospital Prof. Dr. Juan P. Garrahan in the 2013-2014 period. Educational contents included communication with parents regarding the procedure, material preparation, compliance with biosafety standards, sepsis and general patient care, puncture and subsequent cerebrospinal fluid collection, and specimen collection. Strategies included, in a sequential order, the introduction of theoretical aspects using the bibliography and audiovisual resources available at the hospital's online campus and subsequent practice of lumbar puncture in a 3-month-old infant phantom on a lateral recumbent position that allowed to make a puncture and collect cerebrospinal fluid. At each training session, the level of confidence was measured before and after the procedure, and a checklist was developed to verify an adequate compliance with each step of the procedure. The simulated lumbar puncture training model has been introduced as an educational strategy of our Pediatric Residency Program.

Las competencias que debe adquirir un pediatra durante su formación profesional son múltiples; entre ellas, las destrezas en la realización de procedimientos. El proceso para la adquisición de estas destrezas requiere del conocimiento de bases teóricas, de la observación directa y, finalmente, de la práctica repetitiva bajo supervisión. El entrenamiento en simuladores permite aprender procedimientos en un marco controlado que protege la seguridad de los pacientes y que se integra como una instancia de aprendizaje previa a la realidad con el paciente. Reportamos la experiencia en el proceso de enseñanza del procedimiento de punción lumbar mediante simulación. Participaron del entrenamiento 112 residentes de Pediatría, de 1er año, que ingresaron al Hospital Prof. Dr. Juan P. Garrahan durante el ciclo 2013 y 2014. Los contenidos educativos abarcaron la comunicación a los padres sobre el procedimiento, la preparación del material, el cumplimiento de las normas de bioseguridad, asepsia y cuidados generales del paciente, la punción con obtención del líquido cefalorraquídeo y la recolección del material. La estrategia incluyó, en forma secuencial, la incorporación de aspectos teóricos mediante recursos bibliográficos y audiovisuales accesibles en el campus virtual del Hospital y la posterior práctica de la punción en un maniquí correspondiente a un lactante de 3 meses en posición acostado, que permitió la punción y obtención de líquido cefalorraquídeo. En cada entrenamiento se midió el nivel de confianza antes y después, y se elaboró una lista de cotejo para verificar el cumplimiento adecuado de cada paso del procedimiento. El módulo de entrenamiento en punción lumbar con simulación ha sido incorporado como estrategia educativa de nuestro Programa de Residencia en Pediatría

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UNLABELLED: The Mini Clinical Evaluation Exercise (Mini-CEX) is an assessment tool, which emphasizes the educational value and is based on direct performance observation. The objective was to evaluate the reliability and feasibility of Mini-CEX using pediatric descriptors during its implementation in two pediatric residency programs. The design was observational, exploratory and feasibility in the use of this evaluation tool. Based on the original format, descriptors related to the pediatric consult for each Mini-CEX dimension's were agreed. Operators were trained in the use of this tool by means of descriptors as well as in debriefing strategies. Finally, there were two simultaneous and independent evaluations for each observation. ANALYSIS: a) Mini-CEX global and dimension score; b) Concordance between operators scores (mean differences and 95% CI); c) Non evaluable descriptors frequency; d) Duration and satisfaction in use. There were 80 observations in 40 pediatric consults. Overall score 7.5±0.9 (6.4±2 to 8.3±1.1 depending on dimension), with no significant differences between the two institutions. There was high agreement between observers (Mean, difference between 0.1 and 0.3, 95% CI -0.8 to 0.3). The frequency of non evaluable descriptors ranged 5-28 (9% to 51%) and it was not associated with the implementation stage. The average implementation time was 20 minutes, and satisfaction in use was high among both operators and residents. Mini-CEX tool using pediatric descriptors showed high reliability. The joint experience was satisfactory and simultaneously confirmed the value of debriefing.

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El Mini Clinical Evaluation Exercise (Mini-CEX) es una herramienta formativa de evaluación aplicada durante la observación directa del desempeño en la clínica. Nuestro objetivo fue evaluar la confiabilidad y factibilidad del Mini-CEX utilizando descriptores pediátricos en dos programas de residencia de pediatría. El diseño fue de tipo observacional y corte transversal. Se consensuaron descriptores de la consulta pediátrica para cada una de las dimensiones del Mini-CEX. Los operadores fueron capacitados en el uso de esta herramienta por medio de descriptores, así como en las estrategias informativas. Finalmente, se realizaron 2 evaluaciones independientes y simultáneas por cada observación de desempeño. Análisis: a) Puntaje global y por dimensión del Mini-CEX, b) Concordancia de puntajes entre operadores (promedios de diferencias e IC95%); c) Frecuencias de descriptores no evaluables y d) Duración y satisfacción en su uso. Se realizaron 80 observaciones en 40 consultas pediátricas. Puntaje global 7.5 ± 0.9 (6.4 ± 2 a 8.3 ± 1.1 según dimensión), sin diferencias significativas entre instituciones. Se observó alta concordancia entre observadores (Media, diferencia 0.1 a 0.3; IC 95% -0.8 a 0.3). La frecuencia de descriptores no evaluables fue 5 a 28 (9% a 51%) y no se asoció con el lugar de aplicación. El tiempo promedio de implementación fue 20 minutos. El uso resultó altamente satisfactorio para docentes y residentes. Se implementó el Mini-CEX luego de consensuar descriptores de la consulta pediátrica. La experiencia conjunta fue satisfactoria y a la vez confirmó el valor de la evaluación y entrega de sus resultados: la devolución formativa.

The Mini Clinical Evaluation Exercise (Mini-CEX) is an assessment tool, which emphasizes the educational value and is based on direct performance observation. The objective was to evaluate the reliability and feasibility of Mini-CEX using pediatric descriptors during its implementation in two pediatric residency programs. The design was observational, exploratory and feasibility in the use of this evaluation tool. Based on the original format, descriptors related to the pediatric consult for each Mini-CEX dimension´s were agreed. Operators were trained in the use of this tool by means of descriptors as well as in debriefing strategies. Finally, there were two simultaneous and independent evaluations for each observation. Analysis: a) Mini-CEX global and dimension score; b) Concordance between operators scores (mean differences and 95% CI); c) Non evaluable descriptors frequency; d) Duration and satisfaction in use. There were 80 observations in 40 pediatric consults. Overall score 7.5 ± 0.9 (6.4 ± 2 to 8.3 ± 1.1 depending on dimension), with no significant differences between the two institutions. There was high agreement between observers (Mean, difference between 0.1 and 0.3, 95% CI -0.8 to 0.3). The frequency of non evaluable descriptors ranged 5-28 (9% to 51%) and it was not associated with the implementation stage. The average implementation time was 20 minutes, and satisfaction in use was high among both operators and residents. Mini-CEX tool using pediatric descriptors showed high reliability. The joint experience was satisfactory and simultaneously confirmed the value of debriefing.

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Child labor is a complex problem that violates the fundamental rights of children and affects their psychophysical development. Child labor affects 215 million children in the world and 115 million perform activities defined as the "worst forms of child labor". Most child labor is in agriculture (60%), where the majority are unpaid family workers, compared to 26% in services and 7% in industry. Argentina has adopted the abolitionist position, promoting prevention and eradication within an inclusive public policy aimed to all children can exercise their rights. The Sociedad Argentina de Pediatría endorses this approach and proposes a course of action: the health team training, and dissemination of the risks of child labor and occupational teenager safety standards. As pediatricians we must be involved in defending children rights, and be able to detect any situation of child labor, and protect the health of children and adolescents. The joint interaction with family, community and other sectors of society will strengthen the network needed to implement child labor eradication policies.

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El trabajo infantil constituye una compleja problemática que vulnera los derechos fundamentales de la niñez y afecta el desarrollo psicofísico de niños y niñas. La Argentina ha adoptado la postura abolicionista, promoviendo su prevención y erradicación dentro de una política pública inclusiva, destinada a que todos los niños y las niñas puedan ejercer sus derechos. La Sociedad Argentina de Pediatría adhiere a esta postura y se propone, como línea de acción, la formación del equipo de salud y la difusión sobre los riesgos del trabajo infantil y las normas de seguridad del trabajo adolescente. Como pediatras debemos involucrarnos en la defensa de los derechos y capacitarnos para detectar cualquier situación de trabajo infantil, de modo de proteger la salud de los niños, niñas y adolescentes. La interacción conjunta con la familia, la comunidad y otros sectores de la sociedad fortalecerán la red necesaria que posibilite implementar las políticas de erradicación del trabajo infantil.

Child labor is a complex problem that violates the fundamental rights of children and affects their psychophysical development. Child labor affects 215 million children in the world and 115 million perform activities defined as the "worst forms of child labor". Most child labor is in agriculture (60%), where the majority are unpaid family workers, compared to 26% in services and 7% in industry. Argentina has adopted the abolitionist position, promoting prevention and eradication within an inclusive public policy aimed to all children can exercise their rights. The Sociedad Argentina de Pediatría endorses this approach and proposes a course of action: the health team training, and dissemination of the risks of child labor and occupational teenager safety standards. As pediatricians we must be involved in defending children rights, and be able to detect any situation of child labor, and protect the health of children and adolescents. The joint interaction with family, community and other sectors of society will strengthen the network needed to implement child labor erradication policies.

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El trabajo infantil constituye una compleja problemática que vulnera los derechos fundamentales de la niñez y afecta el desarrollo psicofísico de niños y niñas. La Argentina ha adoptado la postura abolicionista, promoviendo su prevención y erradicación dentro de una política pública inclusiva, destinada a que todos los niños y las niñas puedan ejercer sus derechos. La Sociedad Argentina de Pediatría adhiere a esta postura y se propone, como línea de acción, la formación del equipo de salud y la difusión sobre los riesgos del trabajo infantil y las normas de seguridad del trabajo adolescente. Como pediatras debemos involucrarnos en la defensa de los derechos y capacitarnos para detectar cualquier situación de trabajo infantil, de modo de proteger la salud de los niños, niñas y adolescentes. La interacción conjunta con la familia, la comunidad y otros sectores de la sociedad fortalecerán la red necesaria que posibilite implementar las políticas de erradicación del trabajo infantil.(AU)

Child labor is a complex problem that violates the fundamental rights of children and affects their psychophysical development. Child labor affects 215 million children in the world and 115 million perform activities defined as the "worst forms of child labor". Most child labor is in agriculture (60%), where the majority are unpaid family workers, compared to 26% in services and 7% in industry. Argentina has adopted the abolitionist position, promoting prevention and eradication within an inclusive public policy aimed to all children can exercise their rights. The Sociedad Argentina de Pediatría endorses this approach and proposes a course of action: the health team training, and dissemination of the risks of child labor and occupational teenager safety standards. As pediatricians we must be involved in defending children rights, and be able to detect any situation of child labor, and protect the health of children and adolescents. The joint interaction with family, community and other sectors of society will strengthen the network needed to implement child labor erradication policies.(AU)

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The objective of this research is to assess the validity of a modified US Household Food Security Survey Module (HFSSM) through its correlation with food supply and demographic factors, and its fitness using Rasch model analysis in rural Ecuador. This study examines the relationship between household food insecurity and household food supplies in 52 Ecuadorian households. The sample was drawn from four rural communities participating in the project PLAN in Cantón Quijos. Questionnaires included a modified HFSSM, a household food shelf-inventory and demographic characteristics. Multiple ANOVA analysis resulted in statistically significant inverse relationships between household food insecurity and total food supply, as well as the supply of meat, vegetables, legumes, oils, and other food products (p=0.05). Rasch model measure values on the HFSSM illustrated food insecurity at different levels of severity. The majority of the items (>75%) presented adequate infit values. This study affirms that the proposed modified HFSSM may be useful to measure food insecurity and thus be used as a tool to monitor and evaluate programs aimed at improving quantity and variety of food items in rural Ecuador.

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Breast surgery can be highly stressful for women due to the high symbolic value that it represents in bio-psycho-social terms. Before setting up a nurses' breast disease clinic, nurses felt that women were being discharged after surgery with excessive worries and doubts. The aim of this study was to describe the organization, structure, functions, and activities of the nurses' breast disease clinic in Hospital Palmós (Gerona, Spain) between 2002-2005, as well as to promote this kind of clinic. The clinic provides postsurgical care, health education, and psychological support, thus contributing to the integral care of women with this important health problem. The clinic is a resource for the follow-up of patients with breast disease. Moreover, it facilitates outpatient surgical treatment and early discharge and reduces mean length of hospital stay.

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La cirugía de mama puede resultar muy estresante para la mujer por la elevada carga simbólica que representa a nivel biopsicosocial. Antes de la puesta en marcha de la consulta, la enfermera tenía la sensación de que la mujer era dada de alta, después del proceso quirúrgico, con excesivas preocupaciones y dudas. El objetivo de este trabajo es presentar la organización, estructura, funciones y actividad de la consulta de enfermería de patología mamaria durante los años 2002-2005 en el Hospital de Palamós (Girona), así como promover la existencia de este tipo de consultas. En la consulta se realizan cuidados posquirúrgicos, educación sanitaria y soporte psicológico que benefician la atención integral de la mujer que presenta este importante problema de salud. La consulta es un recurso para el seguimiento de las pacientes con patología mamaria, que facilita la cirugía ambulatoria, el alta precoz y la disminución de la estancia media hospitalaria

Breast surgery can be highly stressful for women due to the high symbolic value that it represents in bio-psycho-social terms. Before setting up a nurses' breast disease clinic, nurses felt that women were being discharged after surgery with excessive worries and doubts. The aim of this study was to describe the organization, structure, functions, and activities of the nurses' breast disease clinic in Hospital Palmós (Gerona, Spain) between 2002-2005, as well as to promote this kind of clinic. The clinic provides postsurgical care, health education, and psychological support, thus contributing to the integral care of women with this important health problem. The clinic is a resource for the follow-up of patients with breast disease. Moreover, it facilitates outpatient surgical treatment and early discharge and reduces mean length of hospital stay

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This study examined the association between food insecurity, determined by a modified version of the U.S. Household Food Security Survey Module (US HFSSM), and total daily per capita (DPC) consumption (measured as household expenditures) in Bolivia, Burkina Faso, and the Philippines. Household food insecurity was determined by an adapted 9-item US HFSSM version. A short version of the World Bank's Living Standards Measurement Study (LSMS) consumption module measured household expenditures. Focus groups were used to adapt the survey instrument to each local context. The sample (n approximately 330 per country) includes residents of urban and rural areas. A 12-month food expenditure aggregate was generated as part of the total household expenditures calculation. DPC food expenditure, which represented over 60% of the total household consumption, as well as expenditures on specific food groups correlated with food insecurity both as a continuous Food Insecurity Score (FinSS) and a tricategorical food insecurity status variable. ANOVA and regression analysis were executed adjusting for social and demographic covariates. Food-secure households have significantly higher (P < 0.05) total DPC food expenditures as well as expenditures on animal source foods, vegetables, and fats and oils than moderately and severely food-insecure households. The results offer evidence that the US HFSSM is able to discriminate between households at different levels of food insecurity status in diverse developing world settings.

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Human milk provides infants with proteins that aid in the prevention of infections and facilitate the digestion and absorption of other nutrients. Maternal diet is not believed to affect the protein concentration of breast milk. However, the maternal factors that regulate the expression of genes for specific milk proteins are not well characterized. We hypothesized that nutrition could be one of the factors. We fed Sprague-Dawley rats five diets representing common nutrient deficiencies and energy deficiency during pregnancy and lactation: low-zinc (Zn; 7 microg/g), low-iron (Fe; 6 microg/g), low-protein (12.5% albumin), pair-fed control diet (lactation only, 20% less kcal) and control diet (Zn, 25 microg/g; Fe, 100 mug/g; protein, 21%) ad libitum. At day 10 of lactation, the mammary gland was removed for RNA extraction. Northern blots of mRNA from the different groups were performed by hybridization with beta-casein and whey acidic protein (WAP) cDNA probes. The expression of beta-casein mRNA in rat mammary gland was significantly (P<.005) increased in the pair-fed group when compared to the control group. The expression of WAP mRNA was also significantly (P<.005) increased in the pair-fed group as well as in the low-Fe group when compared to the control group. The concentration of beta-casein in milk was significantly higher for the low-zinc and the pair-fed groups only. The concentration of WAP in milk was not different among groups. These results suggest that compromised maternal nutrition can affect the expression of two individual milk proteins and may have functional implications with regard to bioactive proteins in milk.

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OBJETIVO: Validar una versión de la Escala de Seguridad Alimentaria (FSS) en comunidades de la Sierra de Manatlán, Jalisco. MATERIAL Y MÉTODOS: Usando grupos focales se modificó la FSS. Posteriormente se aplicó una encuesta a mujeres con niños preescolares. La FSS se validó correlacionándola con el inventario de alimentos del hogar y con la variedad de dieta de la entrevistada. La encuesta incluyó un cuestionario socio-económico. RESULTADOS: El 44 por ciento de los hogares indicaron inseguridad alimentaria leve, 33 por ciento hambre moderada y 19.7 por ciento hambre severa. La inseguridad alimentaria estuvo inversamente correlacionada con el inventario de alimentos (r=-0.36**), alimentos de origen animal (r=-0.28**), lácteos (r=-0.25**), alimentos procesados (r=-0.37**), frutas (r=-0.21*) y verduras (r=-0.28**); *p<0.05, **p< 0.01. La inseguridad alimentaria estuvo asociada a la baja variedad de dieta (r=-0.23; p=0.02). Estas asociaciones se mantuvieron en modelos multivariados. CONCLUSIONES: La FSS es un instrumento útil para vigilar la inseguridad alimentaria en zonas rurales de Jalisco.

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OBJECTIVE: To validate a version of the Food Security Scale (FSS) in communities located in Sierra de Manantlán, Jalisco. MATERIAL AND METHODS: Using focus groups, the FSS was modified to fit the Mexican context. Subsequently, a survey was applied to women with pre-school aged children. The FSS was validated in correlation with a household food inventory and the dietary variety of the individual being interviewed. The interview also included a socioeconomic questionnaire. RESULTS: Forty-four percent of the households reported mild food insecurity, 33% reported moderate hunger and 19.7% reported severe hunger. Food insecurity was significantly and inversely correlated with the number of food items in the household (r=-0.36**), animal source foods (r=-0.28**), dairy products (r=-0.25*), processed foods (r=-0.37**), fruits (r=-0.21*), and vegetables (r=-0.28**); *p<0.05, **p< 0.01. Food insecurity was also associated with low dietary variety (r=-0.23, p=0.02). These associations were maintained in multivariate models. CONCLUSIONS: The FSS is a useful tool for monitoring food insecurity in rural regions of Jalisco.

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OBJECTIVES: To know the prevalence of maternal breastfeeding over distinctive ages of a child's life, in our ward, and to analyze the factors which bear an influence on its start, duration and stop. MATERIAL AND METHODS: In our study, we included 549 newborns who were born in and released in good health from the Palamos Hospital between March 1999 and March 2000. We carried out telephone surveys upon release from the hospital and at ages of one, three and six months. We compiled 82 variable which we processed and analyzed on Microsoft Excel. We defined the value p < 0.05 as statistically significant. RESULTS: 90.71% of newborns breastfed upon hospital release, 78.4% at one month, 58.28% at three months, and 32.8% at six months; of the latter, 53.6% belonged to immigrant families and 29.3% to European families. 54.43% of mothers from the European families studied attended Maternal Education. 83.13% of mothers who breastfed their babies had made their decision to do so before conceiving their child. CONCLUSIONS: We consider the rate of breastfeeding mothers to be satisfactory. Its prevalence progressively decreases as the child gets older without any important changes in any period. These are factors related to a higher rate of breast-feeding: immigrant families, full term pregnancy, low educational level, Maternal Education attendance, first births, decision to breastfeed made before conception, not giving any supplements, perception of milk production before hospital release and no to use nipple-shields nor pacifiers. Hypogalactia and mothers return to work are the main reasons for stopping breastfeeding.

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Objetivos: Conocer la prevalencia de la lactancia materna (LM) a lo largo de distintas edades del niño, en nuestra área, y analizar los factores que puedan influir en su inicio, duración o abandono. Material y métodos: Incluimos 549 neonatos, nacidos y dados de alta en el Hospital de Palamós entre marzo del 1999 y marzo del 2000. Realizamos encuestas al alta, uno, tres y seis meses telefónicamente. Recogemos 82 variables procesadas y analizadas mediante Microsoft Excel. Definimos el valor p<0,05 como estadísticamente significativo. Resultados: Realizan lactancia materna el 90,71 por ciento al alta, 78,4 por ciento al mes, 58,28 por ciento a los tres meses y 32,8 por ciento a los seis meses; de estos últimos el 53,6 por ciento pertenece a población inmigrante y un 29,3 por ciento a la europea. Entre un 25 y un 30 por ciento de las madres deciden cambiar la lactancia sin consultar a los profesionales. Asisten a Educación Maternal (EM) un 54,43 por ciento de la población europea estudiada. El 83,13 por ciento de las madres que dan LM han tomado la decisión antes del embarazo. Conclusiones: Consideramos satisfactorios los índices de LM. La prevalencia disminuye progresivamente con la edad del niño sin cambios importantes en ningún período. Son factores asociados a mayor índice de LM: población inmigrante, gestación a término, nivel educativo bajo, asistencia a EM, primíparas, decidir dar LM antes del embarazo, no dar suplementos, percepción de lactopoyesis antes del alta y no uso de pezoneras o chupetes. La hipogalactia y la incorporación de las madres al trabajo son los principales motivos de abandono de la LM (AU)

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