Could poor glycaemic control be a predictor of walking speed decline in older adults? Evidence from the English Longitudinal Study of Ageing.

AIM: Although diabetes is a risk factor for walking speed decline in older adults, it remains unclear how glycaemic control [assessed by glycated haemoglobin (HbA1c)] might affect the long-term trajectories of walking speed. We investigated whether the glycaemic control status accelerates the walking speed decline and whether this decline differs depending on previous mobility conditions. MATERIALS AND METHODS: In total, 3202 individuals aged ≥60 years from the English Longitudinal Study of Ageing (ELSA) were classified at baseline and after 4 and 8 years of follow-up according to glycaemic control status as 'without diabetes' (no self-reported diabetes and HbA1c <6.5%), 'good glycaemic control' (self-reported diabetes and HbA1c ≥6.5% and <7.0%) and 'poor glycaemic control' (PGC) (self-reported diabetes and HbA1c ≥7.0%). The generalized linear mixed models verified the walking speed trajectories in m/s. A second analysis was performed, including only participants without slowness at baseline (>0.8 m/s). RESULTS: Compared with the status 'without diabetes', the annual walking speed decline was -0.015 m/s for PGC and -0.011 m/s for good glycaemic control, totalling -0.160 and -0.130 m/s, respectively, over 8 years. Among those without slowness at baseline, only PGC had a significant walking speed decline, corresponding to -0.014 m/s per year and -0.222 m/s over 8 years. CONCLUSIONS: Poor glycaemic control is a discriminator of walking speed decline in older adults, regardless of previous mobility conditions. It may serve as an early screening tool for those at risk of decreased functional performance later in life.

The action of endo-xylanase and endo-glucanase on cereal cell wall polysaccharides and its implications for starch digestion kinetics in an in vitro poultry model.

Endo-xylanase and endo-glucanase are supplemented to poultry diets in order to improve nutrient digestion and non-starch polysaccharide (NSP) fermentation. Here, the action of these enzymes on alcohol insoluble solids (AIS) from wheat and maize grains as well as its implications for starch digestion in milled grains were evaluated in vitro, under conditions mimicking the poultry digestive tract. For wheat AIS, GH11 endo-xylanase depolymerized soluble arabinoxylan (AX) during the gizzard phase, and proceeded to release insoluble AX under small intestine conditions. At the end of the in vitro digestion (480 min), the endo-xylanase, combined with a GH7 endo-ß-1,4-glucanase, released 30.5 % of total AX and 18.1 % of total glucan in the form of arabinoxylo- and gluco-oligosaccharides, as detected by HPAEC-PAD and MALDI-TOF-MS. For maize AIS, the combined enzyme action released 2.2 % and 7.0 % of total AX and glucan, respectively. Analogous in vitro digestion experiments of whole grains demonstrated that the enzymatic release of oligomers coincided with altered grain microstructure, as examined by SEM. In the present study, cell wall hydrolysis did not affect in vitro starch digestion kinetics for cereal grains. This study contributes to understanding the action of feed enzymes on cereal NSP under conditions mimicking the poultry digestive tract.

O baixo peso em pessoas vivendo com HIV/Aids e a percepção dos profissionais de saúde que as assistem / Low body weight in people living with HIV/Aids and the perception by healthcare professionals who assist them

Introdução: A epidemia do HIV ainda representa um problema mundial de saúde pública. No Brasil, o investimento em programas de prevenção, diagnóstico precoce e início imediato do tratamento, tem garantido uma redução na ocorrência da aids e um aumento da supressão viral. Isso se mostra importante pois, quanto maior for a carga viral de um indivíduo, maior a chance de contrair infecções relacionadas ao HIV. Essas infecções podem ter graves consequências nutricionais, as quais geralmente resultam em perda do apetite e redução de peso. Além disso, o baixo peso pode também estar associado à baixa ingestão alimentar, a alterações metabólicas, à escassez no acesso aos alimentos, à vulnerabilidade social, ao estigma, entre outros. Dessa maneira, viu-se a importância de se perceber o que, de fato, leva o paciente assistido à perda de peso e como os profissionais de saúde envolvidos nesse processo podem oferecer o melhor acolhimento e assistência. Objetivo: Levando em consideração o caráter multifatorial do estado nutricional, essa pesquisa tem como objetivo analisar, em um serviço de atendimento especializado, a percepção dos profissionais de saúde em relação ao baixo peso em pessoas vivendo com HIV e discutir as possibilidades de aprimorar as estratégias de atendimento para efetivar um cuidado integral desses pacientes. Metodologia: A pesquisa foi realizada em um Serviço Ambulatorial Especializado em IST/Aids. A população estudada é composta por profissionais da saúde que atuam diretamente na assistência à pessoa vivendo com HIV. Foi realizado um questionário aberto e autoadministrado com perguntas relacionadas à sua percepção sobre o cuidado do paciente com baixo peso. Os resultados obtidos foram analisados de maneira qualitativa através da análise de conteúdo proposta por Laurence Bardin. Resultados: Participaram da pesquisa 13 profissionais da saúde, sendo contempladas todas as categorias profissionais atuantes na época da coleta de dados. A amostra foi composta de 9 mulheres e 4 homens, com faixa etária entre 36 e 64 anos. O tempo de atuação no serviço variou entre 0 e 25 anos. Em relação às mudanças no perfil do paciente com baixo peso ao longo dos anos, além de perceber uma redução desses casos, os profissionais associaram principalmente à redução dos sintomas relacionados à infecção pelo HIV. Em relação à atuação profissional, foram destacadas a atenção com a integralidade do cuidado e a prioridade no atendimento desses pacientes. Os profissionais avaliados acreditam que, ainda hoje, há persistência do baixo peso principalmente por fatores socioeconômicos, falta de adesão ao tratamento e questões psicológicas. A atuação da equipe multiprofissional apresenta-se como uma das principais estratégias para auxiliar na melhora do estado nutricional. Em decorrência disso, muitos dos profissionais participantes da pesquisa entendem que é necessário um aumento das intervenções interdisciplinares e uma adequação dos recursos humanos e serviços ofertados. Conclusões: É possível destacar a multicausalidade do baixo peso em pessoas vivendo com HIV, a partir das vivências dos profissionais de saúde participantes da pesquisa e da literatura revisada. A integralidade do cuidado e as ações interprofissionais se mostram como as principais estratégias para o cuidado dessa população. Sendo assim, vê-se a importância de ações interdisciplinares que contemplem os principais aspectos abordados no decorrer dessa pesquisa e de investir em educação continuada para os profissionais que atuam nesses locais. Como desfecho, essa pesquisa propõe um produto educacional para futura intervenção com apopulação estudada.

The fate of insoluble arabinoxylan and lignin in broilers: Influence of cereal type and dietary enzymes.

Insoluble fiber degradation by supplemented enzymes was previously shown to improve fermentation in poultry, and has been further postulated to disrupt the cereal cell wall matrix, thus improving nutrient digestion. Here, we characterized insoluble feed-derived polysaccharides and lignin in digesta from broilers fed wheat-soybean and maize-soybean diets without or with xylanase/glucanase supplementation. Enzyme supplementation in wheat-soybean diet increased the yield of water-extractable arabinoxylan (AX) in the ileum. Still, most AX (> 73 %) remained insoluble across wheat-soybean and maize-soybean diets. Analysis of so-far largely ignored lignin demonstrated that a lignin-rich fiber fraction accumulated in the gizzard, while both insoluble AX and lignin reaching the ileum appeared to be excreted unfermented. More than 20 % of water-insoluble AX was extracted by 1 M NaOH and 11-20 % was sequentially extracted by 4 M NaOH, alongside other hemicelluloses, from ileal digesta and excreta across all diets. These findings showed that enzyme-supplementation did not impact AX extractability by alkali, under the current experimental conditions. It is, therefore, suggested that the degradation of insoluble AX by dietary xylanase in vivo mainly results in arabinoxylo-oligosaccharide release, which is not accompanied by a more loose cell wall architecture.

Rock n' Seeds: A database of seed functional traits and germination experiments from Brazilian rock outcrop vegetation.

Advancing functional ecology depends fundamentally on the availability of data on reproductive traits, including those from tropical plants, which have been historically underrepresented in global trait databases. Although some valuable databases have been created recently, they are mainly restricted to temperate areas and vegetative traits such as leaf and wood traits. Here, we present Rock n' Seeds, a database of seed functional traits and germination experiments from Brazilian rock outcrop vegetation, recognized as outstanding centers of diversity and endemism. Data were compiled through a systematic literature search, resulting in 103 publications from which seed functional traits were extracted. The database includes information on 16 functional traits for 383 taxa from 148 genera, 50 families, and 25 orders. These 16 traits include two dispersal, six production, four morphological, two biophysical, and two germination traits-the major axes of the seed ecological spectrum. The database also provides raw data for 48 germination experiments, for a total of 10,187 records for 281 taxa. Germination experiments in the database assessed the effect of a wide range of abiotic and biotic factors on germination and different dormancy-breaking treatments. Notably, 8255 of these records include daily germination counts. This input will facilitate synthesizing germination data and using this database for a myriad of ecological questions. Given the variety of seed traits and the extensive germination information made available by this database, we expect it to be a valuable resource advancing comparative functional ecology and guiding seed-based restoration and biodiversity conservation in tropical megadiverse ecosystems. There are no copyright restrictions on the data; please cite this paper when using the current data in publications; also the authors would appreciate notification of how the data are used in publications.

O avanço da ecologia funcional depende fundamentalmente da disponibilidade de dados sobre traços reprodutivos, incluindo dados de plantas tropicais, que têm sido historicamente subrepresentados em bancos de dados de traços funcionais globais. Embora alguns bancos de dados valiosos tenham sido criados recentemente, eles são restritos principalmente a áreas temperadas e a traços vegetativos, como traços de folhas e madeira. Neste artigo apresentamos Rock n' Seeds, um banco de dados de traços funcionais de sementes e experimentos de germinação de vegetações associadas a afloramentos rochosos do Brasil, os quais são reconhecidos como centros notáveis de diversidade e endemismo. Os dados foram compilados através de uma revisão sistemática na literatura, resultando em 103 publicações das quais foram extraídos os traços funcionais das sementes. O banco de dados inclui informações de 16 traços funcionais para 383 taxa de 148 gêneros, 50 famílias e 25 ordens. Estes dezesseis traços incluem dois traços de dispersão, seis de produção, quatro morfológicos, dois biofísicos e dois germinativos; os eixos principais do espectro ecológico da semente. O banco de dados também fornece os dados brutos para 48 experimentos de germinação para um total de 10.187 registros para 281 taxa. Os experimentos de germinação no banco de dados avaliaram o efeito de uma ampla gama de fatores abióticos e bióticos sobre a germinação e diferentes tratamentos de quebra de dormência. Particularmente, 8.255 desses registros incluem a contagem diária da germinação. Estas informações facilitarão a síntese de dados de germinação e a utilização deste banco de dados para uma grande variedade de questões ecológicas. Dada a variedade de traços das sementes e as amplas informações sobre germinação disponibilizadas por este banco de dados, esperamos que ele seja um recurso valioso para o avanço da ecologia funcional comparativa e para orientar a restauração baseada em sementes e a conservação da biodiversidade em ecossistemas tropicais megadiversos. Não há restrições de direitos autorais sobre os dados; favor citar este artigo ao utilizar os dados nas publicações e os autores agradeceriam uma notificação de como os dados são utilizados nas publicações.

El avance de la ecología funcional depende fundamentalmente de la disponibilidad de datos sobre rasgos reproductivos-incluyendo los de las plantas tropicales-los cuales han estado poco representados en las bases de datos globales de rasgos. Aunque recientemente se han creado algunas bases de datos valiosas, estas se encuentran restringidas principalmente a las zonas templadas y a los rasgos vegetativos, como los de las hojas y la madera. En este artículo presentamos Rock n' Seeds, una base de datos de rasgos funcionales de semillas y experimentos de germinación de la vegetación asociada a afloramientos rocosos de Brasil, los cuales son destacados centros de diversidad y endemismo. Los datos se recopilaron mediante una búsqueda bibliográfica sistemática, que dio como resultado 103 publicaciones de las que se extrajeron los rasgos funcionales de las semillas. La base de datos incluye información de dieciséis rasgos funcionales para 383 taxones de 148 géneros, 50 familias y 25 órdenes. Estos rasgos incluyen dos rasgos de dispersión, seis de producción, cuatro morfológicos, dos biofísicos y dos de germinación; siendo estos los principales ejes del espectro ecológico de las semillas. La base de datos también proporciona los datos brutos de 48 experimentos de germinación, para un total de 10.187 registros de 281 taxones. Dichos experimentos de germinación evaluaron el efecto de una amplia gama de factores abióticos y bióticos sobre la germinación y de diferentes tratamientos para romper la dormancia. En particular, 8.255 de estos registros cuentan con conteos diarios de germinación. Esto facilitará la síntesis de los datos de germinación y el uso de esta base de datos para una gran diversidad de preguntas ecológicas. Dada la variedad de rasgos de las semillas y la amplia información sobre germinación que ofrece esta base de datos, esperamos que sea un recurso valioso para el avance de la ecología funcional comparativa y para orientar la restauración basada en semillas y la conservación de la biodiversidad en ecosistemas tropicales megadiversos. No hay restricciones de derechos de autor sobre los datos; se solicita citar este documento cuando se utilicen los datos en publicaciones y los autores agradecerán ser notificados sobre cómo se utilizan los datos en las publicaciones.

Are Serum 25-Hydroxyvitamin D Deficiency and Insufficiency Risk Factors for the Incidence of Dynapenia?

Epidemiological evidence showing the association between low 25(OH)D and age-related reduction in neuromuscular strength (dynapenia) is a paucity and controversial and, to date, the effect of osteoporosis and vitamin D supplementation on these associations has not been measured. Thus, we analyze whether serum 25(OH)D deficiency and insufficiency are risk factors for the incidence of dynapenia in individuals aged 50 or older and whether osteoporosis or vitamin D supplementation modify these associations. For that, 3205 participants of the ELSA study who were non-dynapenic at baseline were followed for 4 years. Vitamin D was measured at baseline by the serum concentration of 25(OH)D and classified as sufficient (> 50 nmol/L), insufficient (≥ 30 and ≤ 50 nmol/L) or deficient (< 30 nmol/L). The incidence of dynapenia was determined by a grip strength < 26 kg for men and < 16 kg for women at the end of the 4-year follow-up. Poisson regression models were adjusted by sociodemographic, behavioral, clinical and biochemical characteristics. Serum 25(OH)D deficient was a risk factor for the incidence of dynapenia (IRR = 1.70; 95% CI 1.04-2.79). When only individuals without osteoporosis and those who did not use vitamin D supplementation were analyzed, both serum 25(OH)D deficiency (IRR = 1.78; 95% CI 1.01-3.13) and insufficiency (IRR = 1.77; 95% CI 1.06-2.94) were risk factors for the incidence of dynapenia. In conclusion, a serum level of 25(OH)D < 30 nmol/L is a risk factor for the incidence of dynapenia. Among individuals without osteoporosis and those who do not take vitamin D supplementation, the threshold of risk is higher (≤ 50 nmol/L).

In vivo formation of arabinoxylo-oligosaccharides by dietary endo-xylanase alters arabinoxylan utilization in broilers.

Previously, arabinoxylan (AX) depolymerization by dietary endo-xylanase was observed in the broiler ileum, but released arabinoxylo-oligosaccharides (AXOS) were not characterized in detail. This study aimed at extracting and identifying AXOS released in vivo in broilers, in order to delineate the influence of endo-xylanase on AX utilization. Hereto, digesta from the gizzard, ileum, ceca and excreta of broilers fed a wheat-soybean diet without (Con) or with endo-xylanase supplementation (Enz) were assessed. Soluble AX content in the ileum was higher for Enz diet (26.9%) than for Con diet (18.8%), indicating a different type and amount of AX entering the ceca. Removal of maltodextrins and fructans enabled monitoring of AX depolymerization to AXOS (Enz diet) using HPSEC-RI and HPAEC-PAD. A recently developed HILIC-MSn methodology allowed AXOS (DP 4-10) identification in ileal digesta and excreta. Xylanase-induced AXOS formation coincided with decreased total tract AX recovery, which indicated improved AX hindgut utilization.

Cereal type and combined xylanase/glucanase supplementation influence the cecal microbiota composition in broilers.

Dietary fiber-degrading enzyme supplementation in broilers aims at off-setting the anti-nutritive effect of non-starch polysaccharides and at promoting broiler health. Recently, we demonstrated that xylanase/glucanase addition in wheat-based diet improved nutrient digestibility, arabinoxylan fermentability and broiler growth. Conversely, maize arabinoxylan was found to be recalcitrant to xylanase action. These findings suggested that enzyme-mediated improvement of nutrient digestion and carbohydrate fermentation depended on the cereal type present in the diet, and may have contributed to broiler growth. Hence, we aimed at further investigating the link between dietary enzymes and carbohydrate fermentation in broilers, by studying the impact of enzyme supplementation in cereal-based diets, to the microbial communities in the ileum and ceca of broilers. For that purpose, 96 one-day-old male broilers were randomly reared in two pens and received either wheat-based or maize-based starter and grower diets. At d 20, the broilers were randomly assigned to one out of four dietary treatments. The broilers received for 8 d the wheat-based or maize-based finisher diet as such (Control treatments; WC, MC) or supplemented with a xylanase/glucanase combination (Enzyme treatments; WE, ME). At d 28, samples from the digestive tract were collected, and the ileal and cecal microbiota composition was determined by 16S ribosomal RNA gene amplicon sequencing. A similar phylogenetic (alpha) diversity was observed among the four treatments, both in the ileal and the cecal samples. Furthermore, a similar microbial composition in the ileum (beta diversity) was observed, with lactobacilli being the predominant community for all treatments. In contrast, both cereal type and enzyme supplementation were found to influence cecal communities. The type of cereal (i.e., wheat or maize) explained 47% of the total variation in microbial composition in the ceca. Further stratifying the analysis per cereal type revealed differences in microbiota composition between WC and WE, but not between MC and ME. Furthermore, the prevalence of beneficial genera, such as Faecalibacterium and Blautia, in the ceca of broilers fed wheat-based diets coincided with arabinoxylan accumulation. These findings indicated that fermentable arabinoxylan and arabinoxylo-oligosaccharides released by dietary xylanase may play an important role in bacterial metabolism.

Condições de vida e saúde de professoras da educação básica pública de Minas Gerais provedoras financeiras de suas famílias durante a pandemia de Covid-19 / Living and health conditions of public basic education teachers, economic providers for their families during the Covid-19 pandemic, in Minas Gerais / Condiciones de vida y salud de los docentes de educación básica pública en Minas Gerais, proveedores económicos de sus familias durante la pandemia de COVID-19

Resumo Este artigo busca analisar diferenças nas condições de vida e saúde das professoras principais provedoras do domicílio em comparação às coprovedoras, durante a pandemia de Covid-19. Trata-se de estudo transversal realizado em 2020, por meio de formulário on-line enviado aos professores da rede estadual de Minas Gerais. A variável dependente foi ser ou não a principal provedora da família (principal provedora vs. coprovedora) e as independentes foram agrupadas em sociodemográficas, ocupacionais, situação de saúde e comportamentos. Analisaram-se dados somente das mulheres e estimou-se a regressão logística. Entre as 12.817 professoras participantes, 47,2% declararam-se principais provedoras. Dentre elas, observou-se predomínio de mulheres mais velhas, que viviam sem companheiro(a), com filhos(as) e, no geral, apresentavam características que retrataram pior condição socioeconômica, maior acúmulo de trabalho e comportamentos menos saudáveis. Os resultados permitiram identificar desvantagens nas condições de vida e saúde das professoras principais provedoras financeiras de suas famílias em comparação às coprovedoras.

Abstract The objective was to analyze differences in living and health conditions of teachers who are the main providers for their household compared to co-providers during the COVID-19 pandemic. The cross-sectional study was carried out in 2020, through an online form sent to teachers of public schools in the state of Minas Gerais, Brazil. The dependent variable was whether or not they were their family's main provider (main provider vs. co-provider) and independent variables were grouped into sociodemographic, occupational, health status and behaviors. Only women's data were analyzed and logistic regression was estimated. Among the 12,817 participating female schoolteachers, 47.2% declared to be the main providers. In this subgroup, there was a predominance of older women, who lived without a partner, with children and, in general, these teachers presented worse socioeconomic conditions, greater accumulation of work and less healthy behaviors. The results of the present study allow to identify disadvantages in living and health conditions of female schoolteachers who are the main financial providers of their families compared to co-providers.

Resumen El objetivo fue analizar las diferencias en las condiciones de vida y salud entre las profesoras que son las principales proveedoras del hogar y las coproveedoras, durante la pandemia de COVID-19. Estudio transversal realizado en 2020, a través de un formulario en línea enviado a profesoras de escuelas públicas del estado de Minas Gerais, Brasil. La variable dependiente fue ser o no la proveedora principal de la familia (proveedora principal versus coproveedora) y las variables independientes se agruparon en sociodemográficas, ocupacionales, sanitarias y conductuales. Solo se analizaron los datos de las mujeres y se estimó una regresión logística. Entre las 12.817 maestras participantes, el 47,2 % se declaró proveedora principal. En este subgrupo predominaron las mujeres mayores, que vivían sin pareja, con hijos y, en general, estas profesoras tenían características que retrataban una peor condición socioeconómica, mayor acumulación de trabajo y conductas menos saludables. Los resultados del presente estudio permiten identificar desventajas en las condiciones de vida y salud de las profesoras de escuela que son las principales proveedoras económicas de sus familias en comparación con las coproveedoras.

Impact of Xylanase and Glucanase on Oligosaccharide Formation, Carbohydrate Fermentation Patterns, and Nutrient Utilization in the Gastrointestinal Tract of Broilers.

This study aimed at determining how the degradation of cereal non-starch polysaccharides (NSP) by dietary enzymes during feed digestion can influence nutrient digestibility and NSP fermentability in broilers. Ninety-six one-day-old male broilers were assigned to 4 different treatments: control and enzyme-supplemented wheat-based (WC, WE) or maize-based (MC, ME) treatments. Enzyme supplementation with endo-xylanase and endo-glucanase occurred from day 20 onwards. On day 28, digesta samples were collected. Nutrient digestibility, NSP recovery, oligosaccharide profile, and short-chain fatty acids (SCFA) content were determined. Enzyme supplementation in WE resulted in a higher starch (3%; p = 0.004) and protein (5%; p = 0.002) digestion in the ileum compared to WC. Xylanase activity in WE led to in situ formations of arabinoxylan-oligosaccharides consisting of 5 to 26 pentose units in the ileum. This coincided with decreased arabinose (p = 0.059) and xylose (p = 0.036) amounts in the ceca and higher acetate (p = 0.014) and butyrate (p = 0.044) formation in WE compared to WC. Conversely, complete total tract recovery of arabinoxylan in MC and ME suggested poor maize NSP fermentability. Overall, enzyme action improved nutrient digestibility and arabinoxylan fermentability in the wheat-based diet. The lower response of the maize-based diet to enzyme treatment may be related to the recalcitrance of maize arabinoxylan as well as to the high nutritive value of maize.

The role of individual variation in flowering and pollination in the reproductive success of a crepuscular buzz-pollinated plant.

BACKGROUND AND AIMS: Plant individuals within a population differ in their phenology and interactions with pollinators. However, it is still unknown how individual differences affect the reproductive success of plants that have functionally specialized pollination systems. Here, we evaluated whether plant individual specialization in phenology (temporal specialization) and in pollination (pollinator specialization) affect the reproductive success of the crepuscular-bee-pollinated plant Trembleya laniflora (Melastomataceae). METHODS: We quantified flowering activity (amplitude, duration and overlap), plant-pollinator interactions (number of flowers visited by pollinators) and reproductive success (fruit set) of T. laniflora individuals from three distinct locations in rupestrian grasslands of southeastern Brazil. We estimated the degree of individual temporal specialization in flowering phenology and of individual specialization in plant-pollinator interactions, and tested their relationship with plant reproductive success. KEY RESULTS: Trembleya laniflora presented overlapping flowering, a temporal generalization and specialized pollinator interactions. Flowering overlap among individuals and populations was higher than expected by chance but did not affect the individual interactions with pollinators and nor their reproductive success. In contrast, higher individual generalization in the interactions with pollinators was related to higher individual reproductive success. CONCLUSIONS: Our findings suggest that individual generalization in plant-pollinator interaction reduces the potential costs of specialization at the species level, ensuring reproductive success. Altogether, our results highlight the complexity of specialization/generalization of plant-pollinator interactions at distinct levels of organization, from individuals to populations, to species.

The COVID-19 pandemic and the implementation of telehealth in speech-language and hearing therapy for patients at home: an experience report. / Pandemia do COVID-19 e implementação de telefonoaudiologia para pacientes em domicílio: relato de experiência.

We present an experience report on the implementation of real-time telehealth in speech-language and hearing therapy for patients who were previously seen on an outpatient basis in a primary health care service. The Speech-Language Therapy (SLT) team was monitoring twenty-five users when the first cases of COVID-19 were notified in southern Brazil. Of these, it was judged that twelve patients required at least a monitoring call every two weeks. Teleconsultations were available in this first stage, on an emergency basis, during the implementation of the project in this format. The idea was to guarantee, due to the suspension of the SLT sessions, the maintenance of the care service for patients who could suffer worsening of their cases or even comorbidities. The appointments were carried out by video calls by SLT students, therapists of the extension project, and supervised by a speech-language therapist, synchronously. All conversations and orientations during the teleconsultation were conducted as calmly as possible and, in the case of infant patients, permeated by some playful activities. Telehealth has shown to be an efficient resource for the care of patients with SLT demands, enabling remote care with the same quality as face-to-face care. Besides, it has relevant potential, once there is a significant number of patients, who need SLT assessment and live in regions where there is a shortage of qualified professionals.

Apresentamos um relato de experiência de implementação de telefonoaudiologia em tempo real para pacientes que anteriormente eram atendidos em ambulatório em um serviço de atenção primária em saúde. No total, 25 usuários estavam sendo acompanhados pela equipe de fonoaudiologia quando da notificação dos primeiros casos de COVID-19 no sul do Brasil. Destes, julgou-se que 12 pacientes demandavam teleatendimento, pelo menos, quinzenalmente. A teleconsulta disponibilizada nesta primeira etapa, em caráter emergencial na implementação do projeto neste formato, a fim de garantir a manutenção dos atendimentos de pacientes que poderiam sofrer agravamento ou mesmo comorbidades associadas à suspensão da fonoterapia, foram realizadas por telefone, com vídeo, por estudantes de fonoaudiologia, extensionistas do projeto e supervisionadas por um fonoaudiólogo, de forma síncrona. Todas as conversas e orientações durante a teleconsulta são encaminhadas com a maior calma possível e, no caso de pacientes infantis, permeadas por algumas atividades lúdicas. A telessaúde tem se mostrado um recurso eficiente para atendimento de pacientes com demandas fonoaudiológicas, possibilitando o atendimento remoto com a mesma qualidade que o atendimento presencial. Além disso, tem potencial relevante, considerando que há um número significativo de pacientes que precisam de avaliação fonoaudiológica e residem em regiões nas quais há escassez de profissionais qualificados.

Does undiagnosed diabetes mitigate the association between diabetes and cognitive impairment? Findings from the ELSI-Brazil study.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is associated with cognitive impairment. However, most of the evidence has been based on self-reported T2DM, and undiagnosed diabetes has not been considered as a separate category. We aimed to examine the extent to which undiagnosed diabetes modifies the association between diabetes and cognitive impairment in a representative sample of Brazilian adults aged 50 years and older. METHODS: We analyzed baseline data from 1944 participants of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) conducted from 2015 to 2016. Diabetes was evaluated based on self-reported doctor diagnosis and glycosylated hemoglobin levels. Participants were classified as diabetics (D), undiagnosed diabetics (UDD), or nondiabetics (ND). Cognitive function was assessed by word list learning and verbal fluency tests. Three multiple logistic regression models were used to evaluate the changes in the strength of the associations. RESULTS: Participants with diabetes had 49% greater odds of exhibiting impaired memory than nondiabetics (odds ratio [OR] = 1.49; 95% CI: 1.01-2.20). By combining UDD and ND, the association between diabetes and impaired memory was attenuated by 2.0%, losing its statistical significance (OR = 1.46; 95% CI: 0.98-2.17). By combining UDD and D, the association was attenuated by 7.4% (OR = 1.38; 95% CI: 1.01-1.90). No significant association was found between T2DM and impaired verbal fluency. CONCLUSION: This study found an association between T2DM and impaired memory but not with impaired verbal fluency. When UDD individuals are considered diabetics, this association is attenuated; when UDD individuals are considered as ND, this association is attenuated to the extent that it loses its statistical significance, affecting thus the clinical interpretation.

Pandemia do COVID-19 e implementação de telefonoaudiologia para pacientes em domicílio: relato de experiência / The COVID-19 pandemic and the implementation of telehealth in speech-language and hearing therapy for patients at home: an experience report

RESUMO Apresentamos um relato de experiência de implementação de telefonoaudiologia em tempo real para pacientes que anteriormente eram atendidos em ambulatório em um serviço de atenção primária em saúde. No total, 25 usuários estavam sendo acompanhados pela equipe de fonoaudiologia quando da notificação dos primeiros casos de COVID-19 no sul do Brasil. Destes, julgou-se que 12 pacientes demandavam teleatendimento, pelo menos, quinzenalmente. A teleconsulta disponibilizada nesta primeira etapa, em caráter emergencial na implementação do projeto neste formato, a fim de garantir a manutenção dos atendimentos de pacientes que poderiam sofrer agravamento ou mesmo comorbidades associadas à suspensão da fonoterapia, foram realizadas por telefone, com vídeo, por estudantes de fonoaudiologia, extensionistas do projeto e supervisionadas por um fonoaudiólogo, de forma síncrona. Todas as conversas e orientações durante a teleconsulta são encaminhadas com a maior calma possível e, no caso de pacientes infantis, permeadas por algumas atividades lúdicas. A telessaúde tem se mostrado um recurso eficiente para atendimento de pacientes com demandas fonoaudiológicas, possibilitando o atendimento remoto com a mesma qualidade que o atendimento presencial. Além disso, tem potencial relevante, considerando que há um número significativo de pacientes que precisam de avaliação fonoaudiológica e residem em regiões nas quais há escassez de profissionais qualificados.

ABSTRACT We present an experience report on the implementation of real-time telehealth in speech-language and hearing therapy for patients who were previously seen on an outpatient basis in a primary health care service. The Speech-Language Therapy (SLT) team was monitoring twenty-five users when the first cases of COVID-19 were notified in southern Brazil. Of these, it was judged that twelve patients required at least a monitoring call every two weeks. Teleconsultations were available in this first stage, on an emergency basis, during the implementation of the project in this format. The idea was to guarantee, due to the suspension of the SLT sessions, the maintenance of the care service for patients who could suffer worsening of their cases or even comorbidities. The appointments were carried out by video calls by SLT students, therapists of the extension project, and supervised by a speech-language therapist, synchronously. All conversations and orientations during the teleconsultation were conducted as calmly as possible and, in the case of infant patients, permeated by some playful activities. Telehealth has shown to be an efficient resource for the care of patients with SLT demands, enabling remote care with the same quality as face-to-face care. Besides, it has relevant potential, once there is a significant number of patients, who need SLT assessment and live in regions where there is a shortage of qualified professionals.

Causality and Speech, Language and Hearing Sciences: epidemiological approach. / Causalidade e Fonoaudiologia: abordagem epidemiológica.

PURPOSE: To review the Speech-Language Pathology literature studies from the epidemiology and causality perspective. RESEARCH STRATEGIES: A national and international literature survey was carried out with searches from PubMed, SciELO and gray literature bases, conducted according to the instructions of the Cochrane Collaboration and published until January 9th, 2019. The review guiding question asks if Speech-Language Pathology uses methods in their evidence to infer causality. SELECTION CRITERIA: All studies that presented a causal epidemiological approach in speech therapy were included, as well as excluded those that did not present an appropriate methodological approach for cause and effect analysis. DATA ANALYSIS: Two authors of this study independently reviewed all citations. A priori determined form was used to extract the following data: author, year of publication, country of origin, theoretical conception, application or not of the study and central discussion addressed in the article. RESULTS: From the search performed 3842 articles were found. However, none of them investigated their outcomes from the causality point of view, not allowing cause and effect inference. CONCLUSION: There is a shortage of studies that evidence causality in Speech-Language Pathology, which may alter the effectiveness and reliable handling of diagnosis and speech-language therapy, since it is still based on association and not on cause and effect based on studies designed to that.

OBJETIVO: Revisar a literatura dos estudos fonoaudiológicos sob a ótica da epidemiologia, segundo a perspectiva da causalidade. ESTRATÉGIA DE PESQUISA: Realizou-se um levantamento nas literaturas nacional e internacional com buscas realizadas nas bases PubMed, SciELO e literatura cinzenta, conduzido segundo as instruções da Colaboração Cochrane e publicados até 8 de janeiro de 2019. A pergunta norteadora da revisão indaga se a Fonoaudiologia faz uso dos métodos epidemiológicos em suas evidências para inferir causalidade. CRITÉRIOS DE SELEÇÃO: Foram incluídos todos os trabalhos que apresentassem abordagem epidemiológica de causalidade em fonoaudiologia, assim como se excluíram os que não apresentassem abordagem metodológica adequada à análise de causa e efeito. ANÁLISE DOS DADOS: Dois autores deste estudo, de maneira independente, revisaram todas as citações. Utilizou-se um formulário determinado a priori para extrair os seguintes dados: autor, ano de publicação, país de origem, concepção teórica, aplicação ou não do estudo e discussão central abordada no artigo. RESULTADOS: Mediante a busca realizada, foram encontrados 3.842 artigos. Contudo, destes nenhum investigou seus desfechos a partir da ótica da causalidade, não permitindo a inferência de causa e efeito. CONCLUSÃO: Há escassez de estudos que evidenciem a causalidade na Fonoaudiologia, o que pode alterar a efetividade e o manuseio confiável do diagnóstico e a terapêutica fonoaudiológica, visto que ainda se baseia na associação e não na causa nem no efeito de delineamentos apropriados para tal.

Insertion of the father in the care of the hospitalized preterm infant: perception of the multiprofessional team / Inserção do pai nos cuidados ao filho prematuro hospitalizado: percepção da equipe multiprofissional

ABSTRACT Objective: To understand the perception of the multiprofessional health care team regarding the inclusion of fathers in the care of preterm infants who are in Intensive Care Units (ICUs). Methods: This is a descriptive study with a qualitative approach, using a semi-structured interview with 12 health care professionals of a neonatal ICU, from February to July 2017. The data were analyzed according to the Discourse of the Collective Subject. Results: Seven main ideas (MI) emerged from the text analysis, which were grouped into two themes: 1) the role of the father according to the multiprofessional health care team views (MI1: parent provider, MI2: shared care, MI3: supportive father); 2) perception of the father caring for the hospitalized preterm infant (MI4: father does not change diapers; MI5: father conquering new spaces; MI6: strengthening the bonding; MI7: father providing maternal security. Conclusions: The results of this study point out to the importance of including the father figure in the humanized care of preterm infants. Professional health care team should be more aware of fathers' importance in the care of hospitalized preterm infants.

RESUMO Objetivo: Compreender a percepção da equipe multiprofissional referente à inserção do pai no cuidado ao filho prematuro hospitalizado na Unidade de Terapia Intensiva (UTI). Métodos: Estudo descritivo de abordagem qualitativa, por meio de entrevista semiestruturada feita com 12 profissionais que atuam na UTI neonatal, realizado no período de fevereiro a julho de 2017. Os dados foram trabalhados de acordo com o Discurso do Sujeito Coletivo. Resultados: Emergiram sete ideias centrais (IC), que foram agrupadas em dois temas: 1) o papel do pai na visão da equipe multiprofissional (IC1: pai provedor; IC2: o cuidado compartilhado; IC3: pai apoiador); 2) percebendo o pai no cuidado do prematuro hospitalizado (IC4: pai não troca fraldas; IC5: o pai conquistando novos espaços; IC6: fortalecendo o vínculo; IC7: o pai proporcionando segurança à mãe). Conclusões: Os resultados deste estudo apontam para a importância da inserção da figura paterna como proposta de assistência humanizada, estando os profissionais mais conscientes da importância do pai no cuidado do filho prematuro hospitalizado.

INSERTION OF THE FATHER IN THE CARE OF THE HOSPITALIZED PRETERM INFANT: PERCEPTION OF THE MULTIPROFESSIONAL TEAM.

OBJECTIVE: To understand the perception of the multiprofessional health care team regarding the inclusion of fathers in the care of preterm infants who are in Intensive Care Units (ICUs). METHODS: This is a descriptive study with a qualitative approach, using a semi-structured interview with 12 health care professionals of a neonatal ICU, from February to July 2017. The data were analyzed according to the Discourse of the Collective Subject. RESULTS: Seven main ideas (MI) emerged from the text analysis, which were grouped into two themes: 1) the role of the father according to the multiprofessional health care team views (MI1: parent provider, MI2: shared care, MI3: supportive father); 2) perception of the father caring for the hospitalized preterm infant (MI4: father does not change diapers; MI5: father conquering new spaces; MI6: strengthening the bonding; MI7: father providing maternal security. CONCLUSIONS: The results of this study point out to the importance of including the father figure in the humanized care of preterm infants. Professional health care team should be more aware of fathers' importance in the care of hospitalized preterm infants.

Desenvolvimento de iogurte batido com preparado de manga (Mangifera indica L) e maracujá (Passiflora edulis) / Development of stirred yogurt with prepared of mango (Mangifera indica L) and passionfruit (Passiflora edulis)

O mercado consumidor de iogurtes vem crescendo de forma significativa, devido a diversificação de marcas, sabores e ingredientes. Incorporar polpas de frutas regionais contribui para essa diversificação, além de agregar valor nutricional e econômico ao produto. O presente trabalho objetivou elaborar um iogurte batido saborizado por uma combinação de frutas tipicamente brasileiras, manga e maracujá, e caracterizar sua estabilidade físico-química em um período de 10 dias, por meio das análises de pH, acidez e sólidos solúveis. O iogurte apresentou pH acidificado, com diferença significativa apenas no décimo dia de armazenamento e a acidez atendeu ao padrão estabelecido na legislação. A qualidade físico-química do iogurte batido com preparado de manga e maracujá (3:1) foi satisfatória durante o intervalo de tempo analisado.

Causalidade e Fonoaudiologia: abordagem epidemiológica / Causality and Speech, Language and Hearing Sciences: epidemiological approach

RESUMO Objetivo Revisar a literatura dos estudos fonoaudiológicos sob a ótica da epidemiologia, segundo a perspectiva da causalidade. Estratégia de pesquisa Realizou-se um levantamento nas literaturas nacional e internacional com buscas realizadas nas bases PubMed, SciELO e literatura cinzenta, conduzido segundo as instruções da Colaboração Cochrane e publicados até 8 de janeiro de 2019. A pergunta norteadora da revisão indaga se a Fonoaudiologia faz uso dos métodos epidemiológicos em suas evidências para inferir causalidade. Critérios de Seleção Foram incluídos todos os trabalhos que apresentassem abordagem epidemiológica de causalidade em fonoaudiologia, assim como se excluíram os que não apresentassem abordagem metodológica adequada à análise de causa e efeito. Análise dos dados Dois autores deste estudo, de maneira independente, revisaram todas as citações. Utilizou-se um formulário determinado a priori para extrair os seguintes dados: autor, ano de publicação, país de origem, concepção teórica, aplicação ou não do estudo e discussão central abordada no artigo. Resultados Mediante a busca realizada, foram encontrados 3.842 artigos. Contudo, destes nenhum investigou seus desfechos a partir da ótica da causalidade, não permitindo a inferência de causa e efeito. Conclusão Há escassez de estudos que evidenciem a causalidade na Fonoaudiologia, o que pode alterar a efetividade e o manuseio confiável do diagnóstico e a terapêutica fonoaudiológica, visto que ainda se baseia na associação e não na causa nem no efeito de delineamentos apropriados para tal.

ABSTRACT Purpose To review the Speech-Language Pathology literature studies from the epidemiology and causality perspective. Research strategies A national and international literature survey was carried out with searches from PubMed, SciELO and gray literature bases, conducted according to the instructions of the Cochrane Collaboration and published until January 9th, 2019. The review guiding question asks if Speech-Language Pathology uses methods in their evidence to infer causality. Selection criteria All studies that presented a causal epidemiological approach in speech therapy were included, as well as excluded those that did not present an appropriate methodological approach for cause and effect analysis. Data analysis Two authors of this study independently reviewed all citations. A priori determined form was used to extract the following data: author, year of publication, country of origin, theoretical conception, application or not of the study and central discussion addressed in the article. Results From the search performed 3842 articles were found. However, none of them investigated their outcomes from the causality point of view, not allowing cause and effect inference. Conclusion There is a shortage of studies that evidence causality in Speech-Language Pathology, which may alter the effectiveness and reliable handling of diagnosis and speech-language therapy, since it is still based on association and not on cause and effect based on studies designed to that.

Previous behaviors of "Study texts in academic context" / Conductas previas al "Estudio de textos en ámbito académico" / Comportamentos pré-requisitos do "estudar textos em contexto acadêmico"

Resumo Muitos estudantes ingressam no ensino superior com repertório de comportamentos de estudar incompatível com as exigências desse nível de ensino, o que pode produzir prejuízos para seu desempenho e para sua qualidade de vida. A descoberta dos comportamentos pré-requisitos do estudar possibilita aperfeiçoar o repertório de estudo dos alunos. Este trabalho teve como objetivos identificar e sistematizar os comportamentos pré-requisitos do "estudar textos em contexto acadêmico" com base no exame de 18 obras sobre estratégias de estudo. Trata-se de uma pesquisa bibliográfica descritiva que consistiu na transcrição de trechos dessas obras cujas sentenças gramaticais continham verbos e complementos que designassem comportamentos de estudo. Foram identificados 625 comportamentos que estão classificados em 12 categorias, envolvendo manejo do tempo e ambiente, leitura funcional, motivação e automonitoramento, os quais foram organizados em um diagrama de acordo com as relações de pré-requisito entre eles. Estudar se caracteriza como uma classe de comportamentos altamente complexa que não se restringe à aplicação de técnicas de estudo. Envolve comportamentos de pré-estudo (planejamento de tempo e ambiente, estabelecimento de objetivos) e pós-estudo (monitoramento do processo, avaliação da funcionalidade das estratégias utilizadas). A maioria dos comportamentos identificada implica no desenvolvimento da capacidade de resolução de problemas e de autonomia do estudante. Esses dados podem servir de base para gestores e professores planejarem condições de ensino desses comportamentos. Esse planejamento poderia, inclusive, se configurar como uma prática integrada à formação profissional, incluindo esses comportamentos como objetivos dos próprios currículos dos cursos e não apenas como uma iniciativa isolada de alguns professores ou gestores.

Abstract Many students initiate higher education with a series of study behaviors that are inconsistent with the requirements of that education level, which can produce damages to their performance and quality of life. Finding the previous study behaviors allows improvement to the students' study repertoire. This study aims to identify and systematize the previous behaviors of "Study texts in academic context" based on 18 texts regarding to study strategies. This is a descriptive and bibliographic study that comprised the transcription of excerpts from these texts which contain grammatical sentences with verbs and predicates related to study behaviors. 625 behaviors were identified and classified in 12 categories that involve time and environment management, functional reading, motivation and self-monitoring. Studying is characterized as a very complex type of behavior that is not reduced to application of study techniques. It involves pre-study behaviors (e.g. time and environment planning, goal setting) and post-study behaviors (e.g. process monitoring, evaluation of the functionality of the strategies used). The majority of behaviors identified involve the development of problem solving skills and students' autonomy. These behaviors were organized in a diagram according to the previous relationship among them. Studying is characterized as a very complex class of behavior that is not reduced to application of study techniques. It involves pre-study behaviors (e.g. time and environment planning, goal setting) and post-study behaviors (e.g. process monitoring, evaluation of the functionality of the strategies used). The majority of behaviors identified involve the development of problem solving skills and students' autonomy. This data can be used by directors and teachers to plan teaching conditions for these behaviors. Such planning could also be seen as an integrated practice for professional training, including these behaviors as learning objectives of the curricula themselves and not just as an isolated initiative of some teachers or directors.

Resumen Muchos estudiantes inician la educación superior con un repertorio de comportamientos para el estudio incompatible con las exigencias de ese nivel de enseñanza, lo que puede perjudicar su desempeño y su calidad de vida. La identificación de comportamientos que son prerrequisitos para el estudio permite mejorar el repertorio de los estudiantes. Este trabajo tiene como objetivo identificar y sistematizar estos comportamientos previos al "estudio de textos en el ámbito académico", basados en la revisión de 18 textos sobre estrategias de estudio. Se trata de una investigación bibliográfica descriptiva que consistió en la transcripción de fragmentos de eses textos cuyas oraciones gramaticales contenían verbos y suplementos que nombraban comportamientos de estudio. Se identificaron 625 comportamientos que se clasificaron en 12 categorías, que implican la gestión del tiempo y del ambiente, la lectura funcional, la motivación y el autocontrol; los cuales se organizaron en un diagrama según su relación con el comportamiento previo. El estudio se caracteriza como una clase de comportamiento de gran complejidad que no se restringe a la aplicación de técnicas de estudio. Implica comportamientos previos al estudio (planificación del tiempo y del ambiente, establecimiento de objetivos) y posteriores (monitoreo del proceso, evaluación de la funcionalidad de las estrategias utilizadas). La mayoría de los comportamientos identificados implican el desarrollo de capacidades de resolución de problemas y la autonomía de los estudiantes. Estos datos pueden servir de base para que los gestores y profesores planeen las condiciones de enseñanza de estos comportamientos. Esta planeación podría, incluso, configurarse como una práctica integrada a la formación profesional, incluyendo estos comportamientos como objetivos de aprendizaje de los propios currículos y no sólo como una iniciativa aislada de algunos profesores o gestores.