Nutritional adequacy of commercial food products targeted at 0-36-month-old children: a study in Brazil and Portugal.

In the context of the global childhood obesity, it is essential to monitor the nutrition value of commercial foods. A cross-sectional study (November 2018 to April 2019) aimed to evaluate the nutritional adequacy of processed/ultra-processed food products targeted at 0-36-month-old children in Portugal and in Brazil. The nutrient profiling model developed by the Pan American Health Organization was used. A total of food 171 products were assessed (123 in Portugal and forty eight in Brazil). From the fifteen available meat- or fish-based meals in Brazil, 60 % exceeded the amount of Na and 100 % exceeded the target for total fat. Given the lack of specification of sugars within carbohydrates in the label of the foods in Brazil, it was not possible to calculate free sugars. In Portugal, from the seventeen fruit and vegetable purees and the six juice/smoothie/tea/drinks available, 82 % and 67 %, respectively, surpassed the level of free sugar, while total and saturated fat was excessive in all yogurt and yogurt-related products (n 21), 40 % of biscuit/wafer/crisps (two out of five) and 13 % meat- or fish-based meals (two out of sixteen). These findings demonstrate the relevance of improving the nutritional profile of some food products targeted to young children.

Commercial foods for infants under the age of 36 months: an assessment of the availability and nutrient profile of ultra-processed foods.

OBJECTIVE: Considering the negative impact of the consumption of ultra-processed foods on health, the current study assessed the availability and nutritional profile of commercial ultra-processed foods for infants in Natal, Brazil. DESIGN: A cross-sectional exploratory study. SETTING: Foods targeted at children under the age of 36 months sold in retail establishments located in high- and low-income areas of the one capital city of Brazil. PARTICIPANTS: 1645 food products consisting of ninety-five different types of food were available. The foods were assessed according to the NOVA classification: minimally processed, processed and ultra-processed. The nutritional content per 100 g was assessed according to processing classification. RESULTS: Half of foods founded were breast milk substitutes and cereal foods (31·6 and 26·3 %, respectively). The foods were predominantly ultra-processed (79 %) and only 4·2 % were minimally processed, with similar proportions of ultra-processed foods being found in both high- and low-income areas. After excluding breast milk substitutes and follow-up formulas, all cereals, food supplements and some of the fruit or vegetable purees were ultra-processed, higher in energy density, fat, carbohydrate and protein and low in fibre (P < 0·05). CONCLUSIONS: The findings reveal that ultra-processed foods for infants are widely available in Brazil, reaffirming the need to strengthen the regulation of foods for infants and young children by introducing complementary measures designed to promote the production and marketing of foods manufactured using lower levels of processing.

Degree of processing and nutritional value of children's food products.

OBJECTIVE: This study aimed to characterise the availability, the nutritional composition and the processing degree of industrial foods for 0-36-month-old children according to the neighbourhoods affluence. DESIGN: A cross-sectional exploratory study. SETTING: All food products available in retail stores for children aged 0-36 months were analysed. Data collection took place in two neighbourhoods, comparing two different sociodemographic districts (high v. low per capita income), Campanhã and Foz do Douro in Porto, Portugal. PARTICIPANTS: A total of 431 commercially processed food products for children aged 0-36 months which are sold in 23 retail stores were identified. Food products were classified according to their processing degree using the NOVA Food Classification System. RESULTS: For NOVA analysis, of the 244 food products that were included 82 (33·6 %) were minimally processed, 25 (10·2 %) processed and 137 (56·1 %) ultra processed. No food product was classified as a culinary ingredient. The products included mostly cereals, yogurts, prevailed in high-income neighbourhoods for the 0-6-month-old group. It was observed that some categories of ultra-processed food (UPF) presented higher amounts of energy, sugars, saturated fat and salt than unprocessed/minimally processed products. CONCLUSIONS: The high availability of UPF offered for 0-36-month-old children should be considered when designing interventions to promote a healthy diet in infancy.

Are serum brain-derived neurotrophic factor concentrations related to brain structure and psychopathology in late childhood and early adolescence?

OBJECTIVE: Mental disorders can have a major impact on brain development. Peripheral blood concentrations of brain-derived neurotrophic factor (BDNF) are lower in adult psychiatric disorders. Serum BDNF concentrations and BDNF genotype have been associated with cortical maturation in children and adolescents. In 2 large independent samples, this study tests associations between serum BDNF concentrations, brain structure, and psychopathology, and the effects of BDNF genotype on BDNF serum concentrations in late childhood and early adolescence. METHODS: Children and adolescents (7-14 years old) from 2 cities (n = 267 in Porto Alegre; n = 273 in São Paulo) were evaluated as part of the Brazilian high-risk cohort (HRC) study. Serum BDNF concentrations were quantified by sandwich ELISA. Genotyping was conducted from blood or saliva samples using the SNParray Infinium HumanCore Array BeadChip. Subcortical volumes and cortical thickness were quantified using FreeSurfer. The Development and Well-Being Behavior Assessment was used to identify the presence of a psychiatric disorder. RESULTS: Serum BDNF concentrations were not associated with subcortical volumes or with cortical thickness. Serum BDNF concentration did not differ between participants with and without mental disorders, or between Val homozygotes and Met carriers. CONCLUSIONS: No evidence was found to support serum BDNF concentrations as a useful marker of developmental differences in brain and behavior in early life. Negative findings were replicated in 2 of the largest independent samples investigated to date.

Cystic fibrosis and jejunoileal atresia: A clinical case.

We present a case report of a fetal diagnosis of cystic fibrosis after ultrasound abnormalities. After delivery, a type 3A intestinal atresia was diagnosed. Segmental enterectomy with end-to-end anastomosis was performed. This case report highlights the diagnosis complexity of a fetal intestinal atresia associated with cystic fibrosis.

Tubulin Polymerization Promoting Protein (TPPP) gene methylation and corpus callosum measures in maltreated children.

The goal of the current study was to evaluate the impact of Tubulin Polymerization Promoting Protein (TPPP) methylation on structural and fractional anisotropy (FA) corpus callosum (CC) measures. TPPP is involved in the development of white matter tracts in the brain and was implicated in stress-related psychiatric disorders in an unbiased whole epigenome methylation study. The cohort included 63 participants (11.73 y/o ±1.91) from a larger study investigating risk and resilience in maltreated children. Voxel-based morphometry (VBM) was used to process the structural data, fractional anisotropy (FA) was determined using an atlas-based approach, and DNA specimens were derived from saliva in two batches using the 450 K (N = 39) and 850 K (N = 24) Illumina arrays, with the data from each batch analyzed separately. After controlling for multiple comparisons and relevant covariates (e.g., demographics, brain volume, cell composition, 3 PCs), 850 K derived TPPP methylation values, in interaction with a dimensional measure of children's trauma experiences, predicted left and right CC body volumes and genu, body and splenium FA (p < .007, all comparisons). The findings in the splenium replicated in subjects with the 450 K data. The results extend prior investigations and suggest a role for TPPP in brain changes associated with stress-related psychiatric disorders.

The posttraumatic stress disorder project in Brazil: neuropsychological, structural and molecular neuroimaging studies in victims of urban violence.

BACKGROUND: Life trauma is highly prevalent in the general population and posttraumatic stress disorder is among the most prevalent psychiatric consequences of trauma exposure. Brazil has a unique environment to conduct translational research about psychological trauma and posttraumatic stress disorder, since urban violence became a Brazilian phenomenon, being particularly related to the rapid population growth of its cities. This research involves three case-control studies: a neuropsychological, a structural neuroimaging and a molecular neuroimaging study, each focusing on different objectives but providing complementary information. First, it aims to examine cognitive functioning of PTSD subjects and its relationships with symptomatology. The second objective is to evaluate neurostructural integrity of orbitofrontal cortex and hippocampus in PTSD subjects. The third aim is to evaluate if patients with PTSD have decreased dopamine transporter density in the basal ganglia as compared to resilient controls subjects. This paper shows the research rationale and design for these three case-control studies. METHODS AND DESIGN: Cases and controls will be identified through an epidemiologic survey conducted in the city of São Paulo. Subjects exposed to traumatic life experiences resulting in posttraumatic stress disorder (cases) will be compared to resilient victims of traumatic life experiences without PTSD (controls) aiming to identify biological variables that might protect or predispose to PTSD. In the neuropsychological case-control study, 100 patients with PTSD, will be compared with 100 victims of trauma without posttraumatic stress disorder, age- and sex-matched controls. Similarly, 50 cases and 50 controls will be enrolled for the structural study and 25 cases and 25 controls in the functional neuroimaging study. All individuals from the three studies will complete psychometrics and a structured clinical interview (the Structured Clinical Interview for DSM-IV and the Clinician-Administered PTSD Scale, Beck Anxiety Inventory, Beck Depression Inventory, Global Assessment of Function, The Social Adjustment Scale, Medical Outcomes Study 36-Item Short-Form Health Survey, Early Trauma Inventory, Clinical global Impressions, and Peritraumatic Dissociative Experiences Questionnaire). A broad neuropsychological battery will be administered for all participants of the neuropsychological study. Magnetic resonance scans will be performed to acquire structural neuroimaging data. Single photon emission computerized tomography with [(99m)Tc]-TRODAT-1 brain scans will be performed to evaluate dopamine transporters. DISCUSSION: This study protocol will be informative for researchers and clinicians interested in considering, designing and/or conducting translational research in the field of trauma and posttraumatic stress disorder.

Neurostructural imaging findings in children with post-traumatic stress disorder: brief review.

Child maltreatment has been associated with different psychiatric disorders. Studies on both animals and humans have suggested that some brain areas would be directly affected by severe psychological trauma. The pathophysiology of post-traumatic stress disorder (PTSD) appears to be related to a complex interaction involving genetic and environmental factors. Advanced neuroimaging techniques have been used to investigate neurofunctional and neurostructural abnormalities in children, adolescents, and adults with PTSD. This review examined structural brain imaging studies that were performed in abused and traumatized children, and discusses the possible biological mechanisms involved in the pathophysiology of PTSD, the implications and future directions for magnetic resonance imaging (MRI) studies. Published reports in refereed journals were reviewed by searching Medline and examining references of the articles related to structural neuroimaging of PTSD. Structural MRI studies have been performed in adults and children to evaluate the volumetric brain alterations in the PTSD population. In contrast with studies involving adults, in which hippocampus volumetric reduction was the most consistent finding, studies involving children and adolescents with PTSD have demonstrated smaller medial and posterior portions of the corpus callosum.

Influence of Time Interval from Bariatric Surgery to Conception on Pregnancy and Perinatal Outcomes.

INTRODUCTION: Pregnancy in women submitted to bariatric surgery is increasing. Recommendations for surveillance of these pregnancies have been suggested, but an adequate time interval from surgery to conception, to avoid perinatal negative outcomes, is still controversial. MATERIAL AND METHODS: Medical records of pregnancies in women with previous bariatric surgery were retrieved and outcomes were assessed according to three different time thresholds (12, 18 and 24 months). The association between time from surgery to conception and the presence of adverse outcomes was analysed. RESULTS: Eighty-six pregnancies were assessed. Weight gain was higher (p = 0.014) and more adequate (p = 0.041) when pregnancy occurred more than 12 months after surgery. Foetal growth percentile was lower when pregnancy was achieved before 24 months following surgery (p = 0.021). No differences among groups were found in other assessed outcomes (BMI, gestational age at delivery, type of delivery, gestational diabetes, pregnancy hypertensive disease, anaemia, preterm delivery, foetal weight, foetal growth restriction, Apgar score, admission to neonatal intensive unit) in all considered thresholds. No association between time from surgery to conception and the presence of adverse outcomes was found. CONCLUSION: Despite differences found in maternal weight gain and foetal growth percentile, our study does not support the recommendation to delay pregnancy based on a fixed deadline. Other factors, including a more individualised approach, need to be considered.

Effects of the brain-derived neurotropic factor variant Val66Met on cortical structure in late childhood and early adolescence.

BACKGROUND: The brain-derived neurotrophic factor (BDNF) Val66Met polymorphism (rs6265) has been associated with several neuropsychiatric disorders and regional structural brain changes in adults, but little is known about Val66Met's effect on brain morphology during typical or atypical neurodevelopment. Windows of vulnerability to psychopathology may be associated with the different alleles of the Val66Met polymorphism during childhood and adolescence. METHODOLOGY: We investigated the effect of Val66Met on cortical thickness in MRI scans of 718 children and adolescents (6-12 years old) with typical development, and in those meeting DSM criteria for a psychiatric disorder. RESULTS: Val66Met had a significant effect on cortical thickness. Considering the typically developing group, Met-carriers presented thicker parietal and occipital lobes and prefrontal cortices compared to Val homozygotes. Met-carriers with psychiatric disorders presented thicker medial and lateral temporal cortices than Val homozygotes. Furthermore, a significant genotype × psychiatric diagnosis interaction was found: Met-carriers with a psychiatric diagnosis presented thinner bilateral prefrontal cortices than Val homozygotes. CONCLUSION: This study provides evidence that Val66Met is associated with cortical maturation in children and adolescents with and without psychiatric disorders.

Intraplacental Choriocarcinoma: Rare or Underdiagnosed? Report of 2 Cases Diagnosed after an Incomplete Miscarriage and a Preterm Spontaneous Vaginal Delivery.

Intraplacental choriocarcinoma is a rare malignant tumor diagnosed after an abortion, an ectopic pregnancy, or a term or preterm pregnancy or following the diagnosis of a hydatidiform mole. During pregnancy, it may be more common than reported, as most patients are asymptomatic and placental choriocarcinomas are usually inconspicuous macroscopically and are often mistaken for an infarct. Based upon a case study methodology, we describe 2 cases of intraplacental choriocarcinoma: the first case was identified in the product of a uterine curettage following an incomplete miscarriage and the second in one of the placentas of a bichorionic twin pregnancy. Maternal investigation did not reveal evidence of metastatic disease and neither did the infants' one in the second case. The two cases underwent maternal surveillance with serum hCG and remained disease-free until the present. In conclusion, intraplacental choriocarcinoma is easily underdiagnosed but with current treatment, even in the presence of metastasis, the prognosis is excellent. A routine microscopic examination of all the placentas and products of miscarriage can increase the real incidence of this entity and consequently improve its management.

[STUDY ABOUT PATIENT'S RELIGIOUS NEED IN PRESURGICAL STAGE]. / ESTUDO SOBRE A NECESSIDADE RELIGIOSA DE PACIENTES EM FASE PRÉ-CIRÚRGICA.

A study of problems related to nursing assistance of patient's religious need in presurgical stage. Two hundred adult patients of both sexes admitted in three hospitals of São Paulo were interviewed. One hospital was a governmental institution, and two were private. Patient's interviews were made by means of a form containing open questions, which were filled out by the researcher according the patient's answers. Therefore it was able to reinforce the existent thought of the human being having a theological instinct, for almost the totality of the studied patients believed in God and showed their beliefs with unlike religious practices. Patients belonged to different denominations, most of them roman catholics. The common problem found among patients was the fear of surgery, which decreased with religious practices. In such a way, it was pointed out the significance of nursing service of admission, for this was the main nursing problem found in this study: large number of patients were unable to realize their practices while in hospital, given the lack of orientation the main reazon for that. Patients also suggested what they would like to receive from the hospital to attend their religious need. All the suggestions could be solved through the application of nursing process, considering the patient's dependence degree.

[Words related to health psychological meaning for nursing students]. / PALAVRAS RELACIONADAS À SAÚDE - SIGNIFICADO PSICOLÓGICO PARA ESTUDANTES DE ENFERMAGEM.

Semantic Differential Scales technique of Charles Osgood was applied to 246 nursing students at their first week of professional course, to measure the psychological meaning of the words: Health, Physician, Pain, Hospital, Nurse and Illness In almost all words studied was found a high index of stereotipy related to valorative, potential and activity factors. Index of internal con-tradition were found related with Illness, Nurse and Hospital words.

[Teaching medical-surgical nursing in especialization course - University of São Paulo's Nursing School - General aspects of medical-surgical nursing II discipline]. / ENSINO DA HABILITAÇÃO EM ENFERMAGEM MÉDICO-CIRÜRGICA DA ESCOLA DE ENFERMAGEM DA USP Aspectos da disciplina Enfermagem Médico-Cirúrgica II.

The authors present general aspects about planning a program in Medical-Surgical Nursing II in Especialization Course, since it's start in 1973 at University of São Paulo's Nursing School. It is presented the actual program including an esquematic plan regarding the teaching of the subject.

[Teaching Medical Surgical Nursing in Specialization Course at the School of Nursing of the University of São Paulo - Evaluation about the program developed in 1976]. / ENSINO DA HABILITAÇÃO EM ENFERMAGEM MÉDICO-CIRÚRGICA DA ESCOLA DE ENFERMAGEM DA UNIVERSIDADE DE SÃO PAULO ­ Análise do programa de Enfermagem Médico-Cirúrgica II desenvolvido em 1976.

The authors analyse the program of Medical Surgical Nursing II of the School of Nursing of the University of São Paulo, developed in 1976. Based on the evaluation made by teachers, students and nurses of the clinical practice units, they concluded that the program seems to attempt its main finality contributing in nurse's formation with specialized prepare to an eficient action in recovery room and emergency and intensive care units.

[Vomiting and hematemesis: generals aspects and nursing care]. / VÔMITO E HEMATÊMESE : aspectos gerais e conduta de enfermagem.

The authors describe succintly concept, physiopathology and most common causes of vomiting and hematemesis and the needed nursing care when such conditions are present.

[Urine exam: all strictness in collecting samples]. / EXAME DE URINA: TODO O RIGOR NA COLHEITA DE AMOSTRAS.

Urine Type I laboratorial exam anl it's physical, chemical and microscopic characteristics are presented, as novell as the care needed for it's collection, order to oftain accurate results in the analysis of urianry elements.

Effect of new criteria on the diagnosis of gestational diabetes in women submitted to gastric bypass.

BACKGROUND: Bariatric surgery has been shown to improve many obesity related co-morbidities, including gestational diabetes mellitus (GDM). Recently, new diagnostic criteria for GDM following the International Association of Diabetes and Pregnancy Study Group recommendations were implemented. The objective of this study was to compare the use of 2 different GDM criteria in diagnostic and pregnancy outcome after Roux-en-Y gastric bypass (RYGB). METHODS: Pregnant women who had previously undergone RYGB (n = 30) were screened for GDM with Carpenter and Coustan (C&C) criteria (n = 18) or the new diagnostic criteria (n = 12). RESULTS: None of the patients screened using C&C criteria where diagnosed with GDM, while 50% of the patients screened with the new criteria had GDM. Among women that underwent oral glucose tolerance tests (OGTT) (n = 19) as required for the new diagnostic criteria, 57.9% developed reactive hypoglycemia. All women diagnosed with GDM had excellent metabolic control during pregnancy and comparing the outcome of these pregnancies and those of women without GDM, there were no significant differences regarding the age at time of surgery or at pregnancy, body mass index before surgery and pregnancy, parity, previous history of GDM, time from surgery to conception, weight lost until pregnancy, weight gain during pregnancy, gestational age at delivery, and birth weight adjusted for gestational age. CONCLUSION: New GDM diagnostic criteria in post-RYGB pregnant women increased the prevalence of GDM diagnostic without changing pregnancy outcomes. In addition, OGTTs were associated with a high rate of reactive hypoglycemia. These data suggest that alternative GDM diagnostic criteria are needed for these postbariatric patients.

The impact of healthy parenting as a protective factor for posttraumatic stress disorder in adulthood: a case-control study.

BACKGROUND: Early life social adversity can influence stress response mechanisms and is associated with anxious behaviour and reductions in callosal area later in life. OBJECTIVE: To evaluate the association between perceptions of parental bonding in childhood/adolescence, hypothalamic-pituitary-adrenal (HPA) axis response, and callosal structural integrity in adult victims of severe urban violence with and without PTSD. METHODS: Seventy-one individuals with PTSD and 62 without the disorder were assessed with the Parental Bonding Instrument (PBI). The prednisolone suppression test was administered to assess cortisol levels, and magnetic resonance imaging was used to assess the total area of the corpus callosum (CC), as well as the areas of callosal subregions. RESULTS: The PBI items related to the perception of 'not having a controlling mother' (OR 4.84; 95%CI [2.26-10.3]; p=0.01), 'having a caring father' (OR 2.46; 95'%CI [1.18-5.12]; p=0.02), and 'not having controlling parents' (OR 2.70; 95%CI [1.10-6.63]; p=0.04) were associated with a lower risk of PTSD. The PTSD group showed a blunted response to the prednisolone suppression test, with lower salivary cortisol levels upon waking up (p=0.03). Individuals with PTSD had smaller total CC area than those without the disorder, but these differences were not statistically significant (e-value =0.34). CONCLUSIONS: Healthy parental bonding, characterized by the perception of low parental control and high affection, were associated with a lower risk of PTSD in adulthood, suggesting that emotional enrichment and the encouragement of autonomy are protective against PTSD in adulthood.