Obesity agenda in Brazil, conflicts of interest and corporate activity.

Obesity is a social and health problem of global dimensions that demands coordinated solutions from different sectors as well as intersectoral efforts to overcome it. However, policies to overcome obesity affect the interests of the commercial private sector. In Brazil, the Intersectoral Strategy for Obesity Prevention and Control (EIPCO) is the result of participative public action and integrates a set of policies in the field of food and nutrition security. Based on the premise that EIPCO expresses public interests to be protected, promoted and guaranteed by the federal government, this article aims to analyze corporate political activity (CPA) and conflict of interest (COI) situations involving the private commercial sector in the food and nutrition field in Brazil, using EIPCO as a reference. The methods include document analysis and identification of cases reported by the Brazilian civil society organizations that are part of the National Council on Food and Nutrition Security. The results highlighted the actors, actions, ideas and interests addressed by EIPCO and also indicated that EIPCO does not question the private commercial sector's practices in regard to obesity and some of its recommended actions reflect disputes about the concept of healthy eating. All cases analyzed involved CPA to promote ultra-processed food consumption, including lobbying and funding researchers. Those practices and goals are in the opposite direction from the objectives of EIPCO to overcome obesity which indicates potential COI once these representatives of the private sector are directly influencing the governmental political process and policies.

Fall prevention in hospitalized patients: Evaluation through the nursing outcomes classification/NOC.

OBJECTIVE: To evaluate the nursing outcomes of hospitalized patients at high risk for falls through NOC and correlate NOC outcomes called Knowledge: Fall Prevention and Fall Prevention Behavior with patients' sociodemographic and clinical variables. BACKGROUND: Falls represent one of the major safety incidents in the hospital setting. The role of nursing is fundamental in preventing these events, from risk assessment to outcome evaluation. One of the strategies for evaluating nursing outcomes is the use of Nursing Outcomes Classification (NOC). METHODS: A cross-sectional study conducted with a sample of 68 adult patients at high risk for falls admitted to clinical and surgical units. The patients received three evaluations. Data collect was prospective with an instrument containing five results and 28 NOC indicators. Descriptive and analytical analysis considered the NOC 5-point Likert scale. RESULTS: Evaluation of the Knowledge: Fall Prevention and Fall Prevention Behavior outcomes showed that patients have a limited level of knowledge and rarely demonstrated preventive behavior. Vital Signs (0802), Medication Response (2301) and Safe Health Care Environment (1934) pointed to the existence of adequate patient monitoring and safe environment. CONCLUSION: The evaluation of patient outcomes supported by a standardized classification system such as the NOC highlights the patient's clinical evolution and produces data that support the planning of care and management interventions, providing more effective and safer practices.

Coproduction of KPC-2 and IMP-10 in Carbapenem-Resistant Serratia marcescens Isolates from an Outbreak in a Brazilian Teaching Hospital.

We describe an outbreak caused by KPC-2- and IMP-10-producing Serratia marcescens isolates in a Brazilian teaching hospital. Tigecycline was the only active antimicrobial agent tested. The blaIMP-10 gene was located in a new class 1 integron, named In990, carried by a nonconjugative plasmid, in contrast to blaKPC-2.

Influence of Lentinus edodes and Agaricus blazei extracts on the prevention of oxidation and retention of tocopherols in soybean oil in an accelerated storage test.

This study aimed to evaluate the influence of the methanol extracts of mushrooms Lentinus edodes and Agaricus blazei on the retention of tocopherols in soybean oil, when subjected to an accelerated storage test. The following treatments were subjected to an accelerated storage test in an oven at 60 °C for 15 days: Control (soybean oil without antioxidants), TBHQ (soybean oil + 100 mg/kg of TBHQ), BHT (soybean oil + 100 mg/kg of BHT), L. edodes (soybean oil + 3,500 mg/kg of L. edodes extract) and A. blazei (soybean oil + 3,500 mg/kg of A. blazei extract). The samples were analyzed for tocopherols naturally present in soybean oil and mass gain. The results showed, the time required to reach a 0.5% increase in mass was 13 days for TBHQ and 15 days for A. blazei. The content of tocopherols for TBHQ was 457.50 mg/kg and the A. blazei, 477.20 mg/kg.

Borosilicate glass as a surface finishing alternative for improving the mechanical properties of third-generation zirconia.

OBJECTIVE: This study evaluated the effect of an experimental borosilicate glass on the mechanical and optical behavior of 5Y-PSZ zirconia and comparing it to commercial glaze and as-sintered. METHODS: Disc-shaped specimens of a 5Y-PSZ (Zpex Smile) were prepared and sintered (1550 °C, 2 h). The zirconia discs were randomly divided according to the surface treatment: as-sintered (C), commercial glaze (G), and experimental borosilicate glass (SL). Glaze and experimental glass powders were mixed with building liquids and applied to zirconia with a brush. G specimens were fired at 950 °C and SL at 1200 °C. An extended dwell time of 20 min was applied to both groups. Biaxial flexural strength, roughness (Ra and Rz), translucency (TP00), color alteration (ΔE00), Vickers hardness, fracture toughness, residual stresses, and x-ray diffraction analyses were conducted. Statistical analyses were performed with Weibull statistics, Kruskal-Wallis, or ANOVA tests (α = 5%). RESULTS: SL yielded the highest flexural strength (799.35 MPa), followed by G (662.34 MPa), and C (485.38 MPa). The fracture origin of SL specimens was in the bulk zirconia, while G and C showed fractures starting at the surface. As-sintered reached the highest fracture toughness and hardness. Glaze and borosilicate glass provided surface compressive stresses. Borosilicate glass application led to phase transformation (t→m). SL and G showed the lowest roughness. TP00 and ΔE00 were similar among groups. SIGNIFICANCE: Borosilicate glass improved strength without harming the optical properties of third-generation zirconia. Toughness and roughness provided by the experimental glass were similar to those from commercial glaze.

The INFORMAS healthy food environment policy index in Brazil: Benchmarking, current policies, and determining priorities for the future.

INTRODUCTION: Obesity and non-communicable diseases are the most important cause of death and inability in Brazil and worldwide. Public policies are an important strategy to prevent obesity. This study analysed the scope of Brazilian public policies for preventing and controlling obesity using the INFORMAS/Food-EPI protocol. METHODS: The public policies evaluation was conducted based on the INFORMAS/Food-EPI protocol. Experts from academia, civil society, and government assessed the level of implementation of food policies compared with international best practices and proposed new actions to be developed nationally. The protocol consisted of five phases: (1) A comprehensive review of the implementation of food environment-related public policies; (2) validation with experts; (3) comparison of the national actions with the international best practice and due to the level of implementation; (4) list a set of actions to improve the current policies; and (5) evaluation of the actions due to their importance and achievability. RESULTS: Brazilian actions were focused on monitoring, leadership, governance, and resources and financing domains. CONCLUSION: The results will provide elements to support and improve the national policies that aim at the promotion of a healthy food environment and obesity prevention.

Boron-containing coating yields enhanced antimicrobial and mechanical effects on translucent zirconia.

OBJECTIVES: To evaluate the mechanical and antimicrobial properties of boron-containing coating on translucent zirconia (5Y-PSZ). METHODS: 5Y-PSZ discs (Control) were coated with a glaze (Glaze), silver- (AgCoat), or boron-containing (BCoat) glasses. The coatings' antimicrobial potential was characterized using S. mutans biofilms after 48 h via viable colony-forming units (CFU), metabolic activity (CV) assays, and quantification of extracellular polysaccharide matrix (EPS). Biofilm architectures were imaged under scanning electron and confocal laser scanning microscopies (SEM and CLSM). The cytocompatibility was determined at 24 h via WST-1 and LIVE&DEAD assays using periodontal ligament stem cells (PDLSCs). The coatings' effects on properties were characterized by Vickers hardness, biaxial bending tests, and fractography analysis. Statistical analyses were performed via one-way ANOVA, Tukey's tests, Weibull analysis, and Pearson's correlation analysis. RESULTS: BCoat significantly decreased biofilm formation, having the lowest CFU and metabolic activity compared with the other groups. BCoat and AgCoat presented the lowest EPS, followed by Glaze and Control. SEM and CLSM images revealed that the biofilms on BCoat were thin and sparse, with lower biovolume. In contrast, the other groups yielded robust biofilms with higher biovolume. The cytocompatibility was similar in all groups. BCoat, AgCoat, and Glaze also presented similar hardness and were significantly lower than Control. BCoat had the highest flexural strength, characteristic strength and Weibull parameters (σF: 625 MPa; σ0: 620 MPa; m = 11.5), followed by AgCoat (σF: 464 MPa; σ0: 478 MPa; m = 5.3). SIGNIFICANCE: BCoat is a cytocompatible coating with promising antimicrobial properties that can improve the mechanical properties and reliability of 5Y-PSZ.

An artificial intelligence approach of feature engineering and ensemble methods depicts the rumen microbiome contribution to feed efficiency in dairy cows.

Genetic selection has remarkably helped U.S. dairy farms to decrease their carbon footprint by more than doubling milk production per cow over time. Despite the environmental and economic benefits of improved feed and milk production efficiency, there is a critical need to explore phenotypical variance for feed utilization to advance the long-term sustainability of dairy farms. Feed is a major expense in dairy operations, and their enteric fermentation is a major source of greenhouse gases in agriculture. The challenges to expanding the phenotypic database, especially for feed efficiency predictions, and the lack of understanding of its drivers limit its utilization. Herein, we leveraged an artificial intelligence approach with feature engineering and ensemble methods to explore the predictive power of the rumen microbiome for feed and milk production efficiency traits, as rumen microbes play a central role in physiological responses in dairy cows. The novel ensemble method allowed to further identify key microbes linked to the efficiency measures. We used a population of 454 genotyped Holstein cows in the U.S. and Canada with individually measured feed and milk production efficiency phenotypes. The study underscored that the rumen microbiome is a major driver of residual feed intake (RFI), the most robust feed efficiency measure evaluated in the study, accounting for 36% of its variation. Further analyses showed that several alpha-diversity metrics were lower in more feed-efficient cows. For RFI, [Ruminococcus] gauvreauii group was the only genus positively associated with an improved feed efficiency status while seven other taxa were associated with inefficiency. The study also highlights that the rumen microbiome is pivotal for the unexplained variance in milk fat and protein production efficiency. Estimation of the carbon footprint of these cows shows that selection for better RFI could reduce up to 5 kg of diet consumed per cow daily, potentially reducing up to 37.5% of CH4. These findings shed light that the integration of artificial intelligence approaches, microbiology, and ruminant nutrition can be a path to further advance our understanding of the rumen microbiome on nutrient requirements and lactation performance of dairy cows to support the long-term sustainability of the dairy community.

Oxidative stress in the kidney of reproductive female rats during aging.

Reproduction is a costly life process, and the reproductive investment by females appears to be greater than males in many species. We have analyzed the effects of reproductive investment during aging with respect to oxidative stress parameters in female Wistar rats. We measured the activity glutathione peroxidase, glutathione S-transferase, superoxide dismutase, consumption of hydrogen peroxide, protein carbonylation, lipid peroxidation, nitrite and nitrate levels, and Vitamin C (Vit. C) and E levels. We traced oxidative profiles at ages 3, 6, 12, and 24 months. Animals were grouped according to reproductive experience: experienced or naive with respect to reproductive activity. We measured aconitase activity and sex hormone levels. The naive animals exhibited an increase with respect to experienced in most parameters studied at 6 and 24 months, whereas experienced animals exhibited a similar increase at 3 and 12 months. At 6 months of age, during the period that would represent peak reproductive activity, naive animals showed higher levels of MDA, Vit. C, consumption of hydrogen peroxide and GPx, aconitase, and SOD activities. In naive elderly rats, we observed an increase in oxidative damage markers and an increase in enzymatic and non-enzymatic antioxidants, with the exception of consumption of hydrogen peroxide and Vit. C. In the long term, the reproductive investment was not sufficient to interfere with antioxidant capacity, and did not contribute to oxidative damage in kidneys of female Wistar rats.

Caffeine and cerebral palsy: A systematic review of randomized controlled trials and cohort studies.

OBJECTIVE: To systematically review the effects of caffeine on the development of cerebral palsy (CP). DESIGN: Systematic review. SETTING: A search of five databases was performed to identify randomized controlled trials (RCT) or cohort studies published through May 2022. Studies conducted on newborns at risk of developing CP upon receiving caffeine in the first days of life were included as well. Two independent researchers assessed the screening, data extraction, and methodological quality assessment. MAIN OUTCOME MEASURES: Percentage of children with CP. RESULTS: Four studies met our inclusion criteria. The only RCT found a decreased risk (approximately 40 %) of developing CP with 20 mg/kg caffeine citrate (OR 0.59, 95 % CI 0.39, 0.89). In addition, when comparing the period over which caffeine citrate was administered, one retrospective cohort study reported that infants who received caffeine up to the second day of life were also less likely to develop CP. Some methodological issues should be highlighted: in the RCT, the differences between the groups with respect to loss to follow-up were not explored. Similarly, intention-to-treat analyses were not performed. Most cohort studies have not adequately identified the primary confounding factors. CONCLUSIONS: Caffeine could be an important intervention in preventing CP. However, few studies have assessed the effects of caffeine on the risk of CP development. Due to methodological differences, no recommendation regarding its use can be safely made. The findings suggest a positive effect of caffeine citrate in the early stages of life with approximately 20 mg/kg of weight; however, well-designed RCTs with adequate sample size and power, randomization process, outcome measurement, and data analysis are still required.

Food Consumption of People with Sickle Cell Anemia in a Middle-Income Country.

Sickle cell anemia (SCA) is a genetic and hemolytic disease globally characterized by social vulnerability. Food consumption has been insufficiently analyzed in SCA. Secondary iron overload is often observed. This leads to unreliable recommendations for dietary iron restriction. We assessed food consumption and iron intake among adults with SCA. Considering the guidelines for healthy eating, foods were grouped according to the NOVA classification. This transversal study included 74.4% of eligible patients who were registered in the reference center for SCA treatment in Rio de Janeiro, Brazil, in 2019. Data on food consumption were collected through 24 h recall. The monthly household income of 82.3% of patients was less than $770. The consumption of fresh or minimally processed foods was directly associated with monthly household income (p < 0.0001; η2 = 0.87). Ultra-processed foods provided more than one-third of the total energy intake (35.2%). The prevalence of inadequate iron intake was about 40% among women, while that of iron intake above the tolerable upper limit was 0.8%. People from lower socioeconomic classes had the lowest iron intake. Strategies to encourage the consumption of fresh or minimally processed foods are needed considering the requirement of an antioxidant diet in SCA. These findings highlight the need for health equity to ensure food security and healthy eating in SCA.

Metabolomics to Understand Alterations Induced by Physical Activity during Pregnancy.

Physical activity (PA) and exercise have been associated with a reduced risk of cancer, obesity, and diabetes. In the context of pregnancy, maintaining an active lifestyle has been shown to decrease gestational weight gain (GWG) and lower the risk of gestational diabetes mellitus (GDM), hypertension, and macrosomia in offspring. The main pathways activated by PA include BCAAs, lipids, and bile acid metabolism, thereby improving insulin resistance in pregnant individuals. Despite these known benefits, the underlying metabolites and biological mechanisms affected by PA remain poorly understood, highlighting the need for further investigation. Metabolomics, a comprehensive study of metabolite classes, offers valuable insights into the widespread metabolic changes induced by PA. This narrative review focuses on PA metabolomics research using different analytical platforms to analyze pregnant individuals. Existing studies support the hypothesis that exercise behaviour can influence the metabolism of different populations, including pregnant individuals and their offspring. While PA has shown considerable promise in maintaining metabolic health in non-pregnant populations, our comprehension of metabolic changes in the context of a healthy pregnancy remains limited. As a result, further investigation is necessary to clarify the metabolic impact of PA within this unique group, often excluded from physiological research.

Applying mucosal barrier injury laboratory-confirmed bloodstream infection criteria in patients with solid tumors and hematologic malignancies: A retrospective cohort study looking for the real source of infection.

We evaluated the interference of the mucosal barrier injury (MBI) laboratory-confirmed bloodstream infection (MBI-LCBI) criteria on the central-line-associated bloodstream infection (CLABSI) incidence density, and the proportion of catheter-related bloodstream infections (CRBSIs) among those classified as MBI. We detected 339 CLABSIs: 15.0% were classified as MBI-LCBIs, and among these, 19.6% were classified as CRBSIs.

Long-term treatment with roflumilast improves learning of fear extinction memory and anxiety-like response in a type-1 diabetes mellitus animal model.

Diabetic encephalopathy is related to serious damage to the Central Nervous System leading to several disturbances in memory processing and emotions. It is known that the cyclic adenosine 3',5'-monophosphate (cAMP) responsive element-binding protein (CREB) pathway participates in neuronal plasticity and prevention of neuroinflammation, as well as the mediation of learning/memory processes and emotions in brain areas such as the hippocampus (HIP) and prefrontal cortex (PFC). We aimed to investigate the effect of acute (one injection) and long-term treatment (21 days) with roflumilast (ROF; i.p.; 0, 0.01, 0.03, 0.1 mg/kg), a drug able to inhibit the enzyme phosphodiesterase-4 (PDE-4) responsible for cAMP hydrolysis, on parameters related to the acquisition of fear extinction memory and anxiety-like responses in animals with type-1 diabetes mellitus (T1DM) induced through one injection of streptozotocin (60 mg/kg; ip; STZ animals). When we performed acute treatment, no difference was observed between all the groups when resubmitted to the same context paired with an aversive stimulus (footshock) or to a neutral context. In contrast, long-term treatment was able to improve learning of extinction fear memory and discriminating between a conditioned and neutral context. Moreover, this treatment decreased the pronounced anxiety-like response of STZ animals. In addition, there was an increase in the product of the CREB signaling pathway, the pro brain-derived neurotrophic factor, in the HIP and PFC of these animals. The treatment did not impair glycemic control, whereas it decreased the animal's blood glucose levels. To conclude, these findings suggest that ROF treatment repositioning has potential for future translational investigations involving diabetic patients considering its beneficial effects on emotional processes related to fear memory and anxiety, in addition to improvement of glycemic control.

How do distinct facets of tree diversity and community assembly respond to environmental variables in the subtropical Atlantic Forest?

This study assessed the impact of altitude, precipitation, and soil conditions on species richness (SR), phylogenetic diversity (PD), and functional diversity (FD) standardized effect sizes in subtropical Brazilian Atlantic Forest tree communities. We considered specific trait information (FDs) for FD, reflecting recent adaptive evolution, contrasting with deeper phylogenetic constraints in FD. Three functional traits (leaf area-LA, wood density-WD, and seed mass-SM) were examined for their response to these gradients. Generalized least squares models with environmental variables as predictors and diversity metrics as response variables were used, and a fourth-corner correlation test explored trait-environmental relationships. SR decreased with altitude, while PD increased, indicating niche convergence at higher altitudes. Leaf area and seed mass diversity also decreased with altitude. For LA, both FD and FDs were significant, reflecting filtering processes influenced by phylogenetic inheritance and recent trait evolution. For SM, only the specific trait structure responded to altitude. LA and SM showed significant trait-environmental relationships, with smaller-leaved and lighter-seeded species dominant at higher altitudes. Soil gradients affect diversity. Fertile soils have a wider range of LA, indicating coexistence of species with different nutrient acquisition strategies. WD variation is lower for FDs. SM diversity has different relationships with soil fertility for FDs and FD, suggesting phylogeny influences trait variation. Soil pH influences WD and LA under acidic soils, with deeper phylogenetic constraints (FD). Environmental factors impact tree communities, with evidence of trait variation constraints driven by conditions and resources. Subtropical Atlantic forests' tree assemblies are mainly influenced by altitude, pH, and soil fertility, selecting fewer species and narrower trait spectra under specific conditions (e.g., higher altitudes, pH). Functional diversity patterns reflect both phylogenetic and recent evolution constraints, with varying strength across traits and conditions. These findings highlight the intricate processes shaping long-lived species assembly across diverse environments in the Southern Brazilian Atlantic Forest.

Evolution of nutritional status and associated factors among formula-fed infants with cow's milk protein allergy in a government program.

BACKGROUND: Cow's milk protein allergy (CMPA) is a common allergy in infants and can affect proper growth and development. This study verified factors associated with the evolution of the nutritional status (NS) among infants with CMPA fed with hypoallergenic formulas (HF). METHODS: This is a longitudinal study of infants (n = 1036) participating on a governmental program in Brazil. Researchers assessed Nutritional status before HF treatment (T1) and after HF treatment (T2). The causality of exposure variables on the evolution of NS was verified by Multinomial Logistic Regression (MLR). RESULTS: We observed an increase in anthropometric indexes analyzed with statistically significant results (p < 0.01). The weight/age and height/age scores showed a significant reduction in infants with nutritional deficit. The Body Mass Index (BMI) showed a decrease in the number of infants with nutritional deficit (< -2 z-score). On the other hand, there was an increase in those classified as at risk of overweight, overweight and obese. MLR showed that those who remained < 12 months in the program had a lower odds ratio (95% CI = 0.355-0.906; p = 0.018) to have inadequate NS with increasing BMI. Preterm infants were 4 times more likely (CI 95% = 1.520-10.694; p = 0.005) to have their BMI decreased and those who received nutritional counseling had a lower odds ratio (CI 95% = 0.411-0.953; p = 0.029) to maintain adequate NS. CONCLUSION: The program has a significant impact on the NS of infants with CMPA. The constant management and implementation of differentiated criteria according to the evolution of NS for the supply of HF is fundamental in the continuity of this public policy.

Detection of cocaine crystals dispersed on non- Erythroxylum herbs.

This case report deals with an unusual seized drugs case, in which cocaine, more commonly found in powder form or as crack cocaine, was found in herbs similar to those used to deliver synthetic cannabinoids. A comparison with expected physical appearance and chemical results for a genuine coca leaf is also presented.

Global relationships in tree functional traits.

Due to massive energetic investments in woody support structures, trees are subject to unique physiological, mechanical, and ecological pressures not experienced by herbaceous plants. Despite a wealth of studies exploring trait relationships across the entire plant kingdom, the dominant traits underpinning these unique aspects of tree form and function remain unclear. Here, by considering 18 functional traits, encompassing leaf, seed, bark, wood, crown, and root characteristics, we quantify the multidimensional relationships in tree trait expression. We find that nearly half of trait variation is captured by two axes: one reflecting leaf economics, the other reflecting tree size and competition for light. Yet these orthogonal axes reveal strong environmental convergence, exhibiting correlated responses to temperature, moisture, and elevation. By subsequently exploring multidimensional trait relationships, we show that the full dimensionality of trait space is captured by eight distinct clusters, each reflecting a unique aspect of tree form and function. Collectively, this work identifies a core set of traits needed to quantify global patterns in functional biodiversity, and it contributes to our fundamental understanding of the functioning of forests worldwide.

BROAD PECTUS EXCAVATUM TREATMENT: LONG TERM RESULTS OF A BRAZILIAN TECHNIQUE.

OBJECTIVE: This study aims the treatment results of broad pectus excavatum after a long-term follow-up and skeletal maturity. METHODS: Eighty-four children and adolescents with broad-type pectus excavatum were selected for evaluation after treatment with a dynamic orthosis that applies compression to the lower rib projections and prescription of exercises. The broad pectus excavatum was defined as a deformity that the depressed area was greater and covered the area above and below the nipple line. All patients were evaluated for more than 1 year after the end of treatment and skeletal maturity. Post-treatment results were categorized as mild, moderate and severe. Statistic correlations between results and deformity flexibility, deformity severity, and adherence to treatment were assessed. RESULTS: The mean age at the beginning of treatment was 13.3 years, and the follow-up duration was 25.7 months after suspension of orthosis use. Forty-eight percent of patients showed good results. With regular use of orthoses and performance of exercises, this rate increased to 70% (p < 0,001). Mild cases showed more success than severe cases (p = 0,007). Initial flexibility didn't influence the results (p = 0,63). CONCLUSION: Treatment of broad pectus excavatum with orthoses and exercises led to good definitive results in most resilient patients, especially in those with mild deformities. Level of Evidence V, Expert Opinion.

OBJETIVO: Estudar os resultados de longo prazo e com seguimento até a maturidade esquelética do tratamento do pectus excavatum amplo. MÉTODOS: 84 crianças e adolescentes foram tratados com uma órtese que aplicacompressão nas saliências costais inferiores, associada a exercícios específicos. A deformidade foi classificada como ampla quando a depressão tem maior extensão e abrange uma área acima e abaixo da linha mamilar. Os resultados foram categorizados em ruim, regular ou bom, sendo correlacionados estatisticamente com a flexibilidade, a gravidade da deformidade e a adesão ao tratamento, com avaliação um ano após o fim do tratamento e na maturidade esquelética. RESULTADOS: A idade média no início do tratamento foi de 13,7 anos e o seguimento médio foi de 25.7 meses após a suspensão do uso da órtese. 48% dos casos apresentaram sucesso com o tratamento, mas quando os exercícios e o uso da órtese foram regulares, esta taxa aumentou para 70% (p < 0,001). Os casos mais leves tiveram maior sucesso que os de maior gravidade (p = 0,007), mas a flexibilidade inicial não influenciou os resultados (p = 0,63). CONCLUSÃO: O tratamento do pectus excavatum amplo com o uso de órtese e exercícios apresentou bons resultados definitivos na maioria dos pacientes resilientes, em especial nos casos mais leves. Nível de Evidência V, Opinião do Especialista.

Interventions to increase adherence to micronutrient supplementation during pregnancy: a systematic review.

Prenatal micronutrient supplements are cost-effective in reducing nutritional deficiencies and adverse pregnancy and birth outcomes. However, poor adherence remains a potential barrier to the successful implementation of these supplementation programs. This systematic review assessed the effectiveness of interventions designed to increase adherence to prenatal micronutrient supplementation. Following the Cochrane Collaboration Methodology, literature searches were conducted in six electronic databases and gray literature (on July 24, 2020), and abstract screening, data extraction, and risk of bias assessment were conducted independently by two reviewers. We included 22 studies. Interventions that resulted in increased adherence were most of the education-based strategies, consumption monitoring by volunteer health workers or family members, SMS reminders, free provision of supplements, a multicomponent intervention with community mobilization, and a participatory action research intervention. In several studies, increased adherence was accompanied by beneficial effects on pregnancy and birth outcomes. Given the heterogeneity of study designs and methods used to define and measure adherence, a meta-analysis was not appropriate. We identified several potentially effective strategies to improve supplementation adherence, which may need to be adapted to specific contexts when considered for program implementation. However, additional high-quality studies are critically needed to effectively guide policies and programs.