Association between dyslipidemia and CCL2 in patients undergoing hemodialysis.

INTRODUCTION: Hemodialysis (HD) is associated with high risk for cardiovascular diseases including acute myocardial infarction, stroke and congestive heart failure. C-C Motif Chemokine Ligand 2 (CCL2), also known monocyte chemotactic protein-1 (MCP-1) can be produced by a variety of cells, reaching increased levels in dyslipidemic chronic kidney disease (CKD) patients undergoing HD treatment. The main of this study was to evaluate the association between of CCL2 plasma levels and dyslipidemia in CKD patients undergoing HD. METHODS: A cross-sectional study enrolled 160 Brazilian HD patients. CCL2 plasma levels were measured by capture ELISA. The association between CCL2 levels and dyslipidemia was investigated using linear regression, adjusted for classic and non-classical CVD risk factors. RESULTS: A significant association was observed between CCL2 levels and dyslipidemia (P = 0.029), even after adjustment for possible confounding variables, such as age, gender, body mass index, diabetes mellitus, HD time, urea pre-hemodialysis and interdialytic weight gain (P = 0.045). CONCLUSION: Our findings show that CCL2 levels are associated with dyslipidemia, which suggests a role of this cytokine in the pathogenesis of cardiovascular disease in HD patients. A better understanding of this pathogenesis could contribute to the discovery of new therapeutic targets that would reduce cardiovascular complications in these patients.

[Organic foods and human health: a study of controversies]. / Alimentos orgânicos e saúde humana: estudo sobre as controvérsias.

The study of controversies is a methodological tool that generates knowledge about the social and political dimensions of science. This approach can be used to understand and explore the topic of organic foods. The present study aimed to analyze the controversies regarding the status of organic foods. We carried out a review of studies published since 1990 in three websites: International Foundation for Organic Agriculture, Soil Association, and Food and Agriculture Organization. The following controversies were identified: 1) effects on human health of the presence of chemical contaminants in organic foods; 2) the quality of organic foods as compared to conventionally grown foods; and 3) price of organic foods. Based on this review, it is possible to conclude that, even though organic foods stand out for their low toxicity, higher durability, and nutritional content of some items, more comparative studies are required to confirm the nutritional superiority of organic foods and to solve the controversies. The discussion must be contextualized within a broad spectrum of health promotion, in which organic farming appears associated with the support for small farming, biodiversity, and local sustainable development, so as to increase offer and demand for organic products at fair prices for individual and institutional consumers.

Performance and reference intervals of thrombin generation test: results from the Brazilian longitudinal study of adult health (ELSA-Brasil). A cross-sectional study.

BACKGROUND: The thrombin generation test (TGT) has shown promise for investigation of hemorrhagic and thrombotic diseases. However, despite its potential, it still needs standardization. Moreover, few studies have established reference values for TGT parameters. In Brazil, these values have not yet been established. OBJECTIVE: To determine TGT performance and reference intervals for TGT parameters in healthy individuals. DESIGN AND SETTING: Cross-sectional study conducted among participants in the Brazilian Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto, ELSA-Brasil). METHODS: The reference sample consisted of 620 healthy individuals. The calibrated automated thrombogram (CAT) method, under low and high tissue factor (TF) conditions, was used to assess thrombin generation. Test performance was analyzed using intra and interassay coefficients of variation (CV) and reference intervals were calculated using the nonparametric method proposed by the International Federation of Clinical Chemistry and the Clinical and Laboratory Standards Institute. RESULTS: The intraassay CV ranged from 1.4% to 2.2% and the interassay CV, 6.8% to 14.7%. The reference intervals for TGT parameters under low and high TF conditions were, respectively: lagtime: 3.0-10.3 and 1.4-3.7 min; endogenous thrombin potential (ETP): 1134.6-2517.9 and 1413.6-2658.0 nM.min; normalized ETP: 0.6-1.3 and 0.7-1.4; peak: 103.2-397.7 and 256.4-479.0 nM; normalized peak: 0.3-1.3 and 0.7-1.2; and time-to-peak: 5.6-16.0 and 3.4-6.7 min. These parameters were categorized relative to sex. CONCLUSION: TGT performance was adequate and the proposed reference intervals were similar to those of other studies. Our findings may be useful for consolidating the TGT, through contributing to its standardization and validation.

Thrombin generation in vivo and ex vivo in sickle cell disease patients.

Activation of coagulation is an important hallmark of sickle cell disease (SCD) and it is believed that hypercoagulability plays a role to the disease pathophysiology. Studies have sought to identify how hemostatic biomarkers are expressed in SCD, however, the results are inconclusive. In this context, our objective was to evaluate the thrombin generation in vivo and ex vivo in SCD patients and the association between these biomarkers and the use of HU. This cross-sectional study was carried out with patients diagnosed with SCD, users or not of Hydroxyurea (HU), and healthy individuals as controls. D dimer (D-Di) was evaluated by ELISA and (TGT) thrombin generation test by CAT method. D-Di plasma levels were significantly higher in SCD patients when compared to the controls. TGT parameters such as peak, ETP and normalized ETP at low TF concentration and time-to-peak, peak, ETP and normalized ETP values at high TF concentration were lower in SCD patients than in controls. In contrast, the normalized activated protein C sensitivity ratio (nAPCsr) was higher in patients compared to controls, indicating resistance to the action of this natural anticoagulant. Regarding the use of HU, comparing users and non-users of this drug, no difference was observed in D-Di levels and in most TGT parameters. Our data analyzed together allow us to conclude that patients with SCD present a state of hypercoagulability in vivo due to the higher levels of D-Di and resistance to APC assessed ex vivo which is consistent with the coagulation imbalance described in SCD patients.

OVERWEIGHT AND ASSOCIATED FACTORS IN CHILDREN AND ADOLESCENTS WITH PHENYLKETONURIA: A SYSTEMATIC REVIEW.

OBJECTIVE: To verify the occurrence of overweight in children and adolescents with phenylketonuria and to identify possible causal factors. DATA SOURCES: A systematic review was performed in the SciELO, PubMed and VHL databases using the descriptors "Phenylketonurias", "Overweight", "Child" and "Adolescent". Original articles conducted with children and adolescents, published between 2008 and 2018 in Portuguese, English or Spanish languages were included. DATA SYNTHESIS: A total of 16 articles were identified and, after screening procedures, 6 studies were selected for the review. Overweight in children and adolescents with phenylketonuria was a frequent occurence in the studies included in this review, ranging from 7.8 to 32.6%. The female sex was the most affected by the nutritional disorder. Furthermore, a high caloric intake combined with a lack of stimuli to practice physical activities were main factors associated with the excessive weight in the population of interest. CONCLUSIONS: Excess weight can be considered a common outcome in children and adolescents with phenylketonuria. It is mainly caused by inadequate food consumption and sedentary lifestyle. The importance of early identification of nutritional disturbances in children and adolescents with phenylketonuria should be emphasized, in order to prevent associated chronic diseases and to promote health by encouraging continued healthy eating habits and the regular practice of physical exercises.

Performance and reference intervals of thrombin generation test: results from the Brazilian longitudinal study of adult health (ELSA-Brasil). A cross-sectional study

ABSTRACT BACKGROUND: The thrombin generation test (TGT) has shown promise for investigation of hemorrhagic and thrombotic diseases. However, despite its potential, it still needs standardization. Moreover, few studies have established reference values for TGT parameters. In Brazil, these values have not yet been established. OBJECTIVE: To determine TGT performance and reference intervals for TGT parameters in healthy individuals. DESIGN AND SETTING: Cross-sectional study conducted among participants in the Brazilian Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto, ELSA-Brasil). METHODS: The reference sample consisted of 620 healthy individuals. The calibrated automated thrombogram (CAT) method, under low and high tissue factor (TF) conditions, was used to assess thrombin generation. Test performance was analyzed using intra and interassay coefficients of variation (CV) and reference intervals were calculated using the nonparametric method proposed by the International Federation of Clinical Chemistry and the Clinical and Laboratory Standards Institute. RESULTS: The intraassay CV ranged from 1.4% to 2.2% and the interassay CV, 6.8% to 14.7%. The reference intervals for TGT parameters under low and high TF conditions were, respectively: lagtime: 3.0-10.3 and 1.4-3.7 min; endogenous thrombin potential (ETP): 1134.6-2517.9 and 1413.6-2658.0 nM.min; normalized ETP: 0.6-1.3 and 0.7-1.4; peak: 103.2-397.7 and 256.4-479.0 nM; normalized peak: 0.3-1.3 and 0.7-1.2; and time-to-peak: 5.6-16.0 and 3.4-6.7 min. These parameters were categorized relative to sex. Conclusion: TGT performance was adequate and the proposed reference intervals were similar to those of other studies. Our findings may be useful for consolidating the TGT, through contributing to its standardization and validation.

Overweight and associated factors in children and adolescents with phenylketonuria: a systematic review / Excesso de peso e fatores associados em crianças e adolescentes com fenilcetonúria: uma revisão sistemática

ABSTRACT Objective: To verify the occurrence of overweight in children and adolescents with phenylketonuria and to identify possible causal factors. Data sources: A systematic review was performed in the SciELO, PubMed and VHL databases using the descriptors "Phenylketonurias", "Overweight", "Child" and "Adolescent". Original articles conducted with children and adolescents, published between 2008 and 2018 in Portuguese, English or Spanish languages were included. Data synthesis: A total of 16 articles were identified and, after screening procedures, 6 studies were selected for the review. Overweight in children and adolescents with phenylketonuria was a frequent occurence in the studies included in this review, ranging from 7.8 to 32.6%. The female sex was the most affected by the nutritional disorder. Furthermore, a high caloric intake combined with a lack of stimuli to practice physical activities were main factors associated with the excessive weight in the population of interest. Conclusions: Excess weight can be considered a common outcome in children and adolescents with phenylketonuria. It is mainly caused by inadequate food consumption and sedentary lifestyle. The importance of early identification of nutritional disturbances in children and adolescents with phenylketonuria should be emphasized, in order to prevent associated chronic diseases and to promote health by encouraging continued healthy eating habits and the regular practice of physical exercises.

RESUMO Objetivo: Verificar a ocorrência de excesso de peso em crianças e adolescentes com fenilcetonúria e identificar possíveis fatores causais. Fontes de dados: Revisão sistemática realizada nas bases de dados Scientific Eletronic Library Online (SciELO), Publisher Medline (PubMed) e Biblioteca Virtual em Saúde (BVS) com os descritores "Phenylketonurias", "Overweight", "Child" e "Adolescent". Foram incluídos artigos originais sobre crianças e adolescentes, publicados entre 2008 e 2018 nos idiomas português, inglês ou espanhol. Síntese dos dados: Foram identificados 16 artigos e, após aplicação dos procedimentos de seleção, 6 estudos foram selecionados para compor a revisão. O excesso de peso em crianças e adolescentes com fenilcetonúria foi evento frequente nos estudos incluídos na presente revisão, variando de 7,8 a 32,6%. Aponta-se o sexo feminino como o grupo mais acometido pelo distúrbio nutricional. O principal fator associado ao excesso de peso na população de interesse na população de interesse foi o consumo calórico elevado aliado à falta de estímulos para a prática de atividades físicas. Conclusões: O excesso de peso pode ser considerado um desfecho comum em crianças e adolescentes com fenilcetonúria, sendo ocasionado principalmente pelo consumo alimentar inadequado e pelo sedentarismo. Salienta-se a importância da identificação precoce de agravos nutricionais em crianças e adolescentes fenilcetonúricos, a fim de prevenir doenças crônicas associadas e promover a saúde, com incentivo à manutenção de hábitos alimentares saudáveis e à prática regular de exercícios físicos.

[Panorama of purchasing food products from family farmers for the Brazilian School Nutrition Program]. / Panorama da compra de alimentos da agricultura familiar para o Programa Nacional de Alimentação Escolar.

This article seeks to describe the viewpoint of purchasing food products from family farmers, analyzing their performance within the new guidelines of the Brazilian School Nutrition Program (PNAE). It is a critical assessment based on a review of the literature and the official data provided by the National Fund for the Development of Education/Ministry of Education relating to 2010. The program budget in 2010 was approximately R$2.5 billion and attended 45.6 million children, adolescents and adults. From the total amount, R$150,397,052.68 was allocated for the purchase of agricultural products from family farmers. In Brazil, 47.4% of the local councils acquired food products from family farmers for the Brazilian School Nutrition Program and the purchase percentage was, on average, 22.7%. Given the nature of recent legislation, other aspects should be explored in order to strengthen the compliance with the regulations in different Brazilian contexts and thus contribute both to local economic development and the provision of school meals which fulfill the principles of a healthy and adequate diet.

Cardápios e sustentabilidade: ensaio sobre as diretrizes do Programa Nacional de Alimentação Escolar / Menus and sustainability: Essay on the guidelines of the National School Food Program

O Programa Nacional de Alimentação Escolar é uma das políticas públicas brasileiras que têm estabelecido estreito diálogo com os princípios da Política Nacional de Segurança Alimentar e Nutricional e da Agroecologia. Diretrizes de execução, alinhadas com a temática da sustentabilidade, foram estabelecidas pela Lei nº 11.947, promulgada em julho de 2009, que estipula recursos para a compra de alimentos produzidos pela agricultura familiar, preferencialmente orgânicos, revelando preocupações ambientais e sociais, voltadas ao desenvolvimento da economia local. Este artigo objetivou refletir sobre a elaboração do cardápio instituído nas diretrizes de execução do Programa, com ênfase nos elementos que podem indicar a alimentação escolar como promotora de sistemas alimentares ecológicos e de desenvolvimento local sustentável. Ressalta-se que, apesar do avanço das diretrizes, é necessário fortalecer estratégias para resgatar hábitos alimentares e produzir alimentos compatíveis com tais diretrizes, além de planejar cardápios que contemplem a diversidade e sazonalidade de alimentos regionais e o mapeamento de agricultores ecológicos para nortear a demanda e a oferta programadas. A gestão da compra e da logística, assim como o apoio governamental ao Programa e o controle social por parte da comunidade escolar, além da sensibilização e educação continuada de técnicos e profissionais da área de alimentação escolar, são fundamentais para que os cardápios escolares dialoguem com a sustentabilidade. Experiências exitosas e pesquisas com base na análise dessas diretrizes devem ser incentivadas, para possibilitar o fortalecimento do Programa.

The National School Food Program is one of the Brazilian public policies which has established an intimate dialog with the principles of the National Food and Nutrition Security Policy and Agroecology. Execution guidelines aligned with the theme of sustainability were established in the program via Law nº 11.947, enacted in July 2009, which stipulates resources for the purchasing of food (preferentially organic) produced by family farms, demonstrating environmental and social concerns as well as those related to the development of the local economy. The aim of this paper is to reflect on the theme of menu design incorporated in the execution guidelines of the School Food Program with emphasis on the elements that can highlight school meals as a promoter of ecological food systems and local sustainable development. It is noted that despite the advance represented by the guidelines, there is a need to strengthen the strategies to recover food habits and for the production of foods compatible with these guidelines, along with actions related to menu planning considering the diversity and seasonality of regional food products and the mapping of ecological farmers to guide the programmed demand and supply of these products. The management of the purchasing and logistics, government support of the program and its social control by the school community, along with constant raising of awareness and training for professionals acting in the area of school meals are fundamental for school meals to enter a dialog with sustainability. Successful experiences and research based on the analysis of these guidelines should be encouraged to enable the strengthening of the program.

Alimentos orgânicos da agricultura familiar no Programa Nacional de alimentação Escolar do Estado de Santa Catarina, Brasil / Organic foods from family farms in the National School Food Program in the State of Santa Catarina, Brazil

OBJETIVO: Analisar a demanda e a oferta de alimentos orgânicos para a alimentação escolar no estado de Santa Catarina de acordo com a regulamentação do Programa Nacional de Alimentação Escolar. MÉTODOS: Estudo descritivo e exploratório. No ano de 2010 foi realizado um censo nos 293 municípios do estado por meio de questionário eletrônico para conhecer o percentual de compras de alimentos da agricultura familiar e de alimentos orgânicos. Posteriormente, foram entrevistados in loco alguns atores sociais da alimentação escolar de 52 municípios que compravam alimentos orgânicos da agricultura familiar. Os dados foram apresentados em números absolutos e relativos, com detalhamento por municípios. RESULTADOS: O destino da produção, em sua maioria, foi local e 17,7% dos municípios compraram alimentos orgânicos da agricultura familiar no ano de 2010. Foram relatadas dificuldades tanto do nutricionista quanto dos agricultores familiares e das cooperativas. A maioria dos agricultores e cooperativas não tinha certificação de seus produtos e enfrentava problemas de produção, revelando a necessidade de apoio técnico. Os nutricionistas ressaltaram a falta de certificação de agricultores e a baixa oferta de alimentos orgânicos. Para agricultores e cooperativas, as limitações na comercialização para a alimentação escolar foram a baixa procura por parte dos municípios, as dificuldades no transporte e a sazonalidade da produção. Apesar das dificuldades relatadas, os municípios catarinenses já adquirem frutas, verduras, legumes e outros alimentos. CONCLUSÃO: Os alimentos da agricultura familiar orgânica produzidos localmente, já estão sendo incluídos na alimentação escolar. No entanto, ainda há necessidade de diálogo entre nutricionistas e agricultores familiares...

OBJECTIVE: To analyze the supply and demand of organic foods for the schools of Santa Catarina according to the National School Food Program regulation. METHODS: This is a descriptive and exploratory study. In 2010 an electronic questionnaire was used to investigate the percentage of organic and conventional foods purchased from family farms by 293 municipalities of Santa Catarina. Later, the school food buyers from 52 municipalities who bought organic foods from family farms were interviewed on-site. The data were expressed as absolute and relative numbers by municipality. RESULTS: Most foods were consumed locally, and 17.7% of the municipalities bought organic foods from family farms in 2010. Dieticians, farmers, and cooperatives experienced difficulties. Most farmers' and cooperatives' products were not certified, and the farmers experienced production problems, requiring technical support. Dieticians complained about the lack of product certification and low supply of organic foods. According to farmers and cooperatives, the limitations of selling to schools were the low demand, transportation difficulties, and product seasonality. Despite the difficulties, the municipalities in Santa Catarina are purchasing some fruits, vegetables, and other foods from family farms. CONCLUSION: Organic locally-produced family farm products are included in school meals. However, dieticians and family farmers need to dialogue...

Panorama da compra de alimentos da agricultura familiar para o Programa Nacional de Alimentação Escolar / Panorama of purchasing food products from family farmers for the Brazilian School Nutrition Program

O artigo tem por objetivo apresentar um panorama da compra de alimentos provenientes da agricultura familiar, analisando o seu cumprimento frente às novas diretrizes de execução do Programa Nacional de Alimentação Escolar (PNAE). Trata-se de ensaio crítico realizado com base em revisão da literatura e em dados oficiais fornecidos pelo Fundo Nacional de Desenvolvimento da Educação/Ministério da Educação/PNAE, referentes às prestações de contas dos órgãos gestores municipais relativas ao exercício 2010. O orçamento do PNAE em 2010 foi de aproximadamente R$ 2,5 bilhões e beneficiou 45,6 milhões de estudantes da educação básica e de jovens e adultos. Deste montante, R$ 150.397.052,68 foram destinados para a compra da agricultura familiar. No Brasil, 47,4% dos municípios adquiriram alimentos da agricultura familiar para o PNAE e o percentual médio de compra nestes municípios foi de 22,7%. Em função do caráter recente da legislação, destaca-se a necessidade de organização de gestores e agricultores para a efetivação desta normativa nos diferentes contextos brasileiros e assim contribuir tanto para o desenvolvimento econômico local, como para o fornecimento de refeições aos escolares que atendam aos princípios de uma alimentação saudável e adequada.

This article seeks to describe the viewpoint of purchasing food products from family farmers, analyzing their performance within the new guidelines of the Brazilian School Nutrition Program (PNAE). It is a critical assessment based on a review of the literature and the official data provided by the National Fund for the Development of Education/Ministry of Education relating to 2010. The program budget in 2010 was approximately R$2.5 billion and attended 45.6 million children, adolescents and adults. From the total amount, R$150,397,052.68 was allocated for the purchase of agricultural products from family farmers. In Brazil, 47.4% of the local councils acquired food products from family farmers for the Brazilian School Nutrition Program and the purchase percentage was, on average, 22.7%. Given the nature of recent legislation, other aspects should be explored in order to strengthen the compliance with the regulations in different Brazilian contexts and thus contribute both to local economic development and the provision of school meals which fulfill the principles of a healthy and adequate diet.

Sintomas de estresse em concluintes do curso de psicologia de uma faculdade privada do norte do País / Stress symptoms in psychology undergraduate students from a private college in northern Brazil

Discute-se o estresse na vida acadêmica de estudantes concluintes de um curso de Psicologia da Região Norte do País. Metodologicamente, é uma pesquisa exploratória, de abordagem quantitativa, procedimento de campo e transversal, com amostra composta por 25 acadêmicos do décimo período do curso de psicologia de uma faculdade privada. O instrumento utilizado foi o Inventário de Sintomas de Estresse de Lipp (ISSL). Os resultados foram analisados de forma quantitativa por meio da frequência simples e percentual, apontando que 72% dos acadêmicos entrevistados apresentam sintomas de estresse em um ou mais níveis (alerta, resistência e exaustão), enquanto o restante (28%) não apresentou sintomas de estresse em nenhum nível. Foi feito ainda recorte de gênero: o sexo feminino apareceu com maiores níveis de estresse. Em relação à faixa etária, os sujeitos com idades entre 36 a 42 anos mostraram-se os mais prejudicados. Faz-se recomendação de acompanhamento psicológico dos referidos acadêmicos.

This paper discusses the presence of stress in the academic life of students finishing a Psychology course in the North of Brazil. Methodologically, this cross-sectional study made use of an exploratory, quantitative approach, with field research. The sample was composed of 25 students of the tenth semester of a Psychology course of a private college. The study made use of the Lipp’s Inventory of Stress Symptoms (LISS). The results were quantitatively analyzed through simple frequency and percentage, indicating that 72% of the surveyed students display symptoms of stress in one or more levels (alarm, resistance and exhaustion), while the rest (28%) showed no stress symptoms at any level. As to gender, females appeared with higher levels of stress, and subjects aged 36-42 years were the most affected. It is recommended that the said students seek counseling.

Alimentos orgânicos e saúde humana: estudo sobre as controvérsias / Organic foods and human health: a study of controversies

O estudo das controvérsias é uma ferramenta metodológica para o conhecimento das dimensões sociais e políticas da ciência. O tema dos alimentos orgânicos pode ser compreendido e explorado a partir dessa abordagem. O objetivo deste artigo foi analisar as controvérsias referentes ao status do alimento orgânico. A pesquisa foi realizada com base em referências a partir de 1990, citadas nos sites da International Foundation for Organic Agriculture, da Soil Association e da Food and Agriculture Organization. Foram identificadas controvérsias acerca 1) das repercussões sobre a saúde humana da existência de contaminantes químicos nos alimentos orgânicos; 2) da qualidade dos alimentos orgânicos em comparação aos convencionais; e 3) da temática referente ao preço dos alimentos orgânicos. O artigo conclui que, embora os alimentos orgânicos se destaquem por sua baixa toxicidade, maior durabilidade e teor de alguns nutrientes em alguns alimentos, mais estudos comparativos devem ser realizados para comprovar a superioridade do seu valor nutricional e para que as controvérsias se dissolvam. E preciso contextualizar a discussão em um amplo espectro de promoção da saúde, no qual a produção orgânica aparece vinculada ao fomento ao pequeno agricultor, à biodiversidade e ao desenvolvimento local sustentável, de modo a garantir o aumento da demanda e da oferta de produtos orgânicos a preços justos para consumidores individuais e institucionais.

The study of controversies is a methodological tool that generates knowledge about the social and political dimensions of science. This approach can be used to understand and explore the topic of organic foods. The present study aimed to analyze the controversies regarding the status of organic foods. We carried out a review of studies published since 1990 in three websites: International Foundation for Organic Agriculture, Soil Association, and Food and Agriculture Organization. The following controversies were identified: 1) effects on human health of the presence of chemical contaminants in organic foods; 2) the quality of organic foods as compared to conventionally grown foods; and 3) price of organic foods. Based on this review, it is possible to conclude that, even though organic foods stand out for their low toxicity, higher durability, and nutritional content of some items, more comparative studies are required to confirm the nutritional superiority of organic foods and to solve the controversies. The discussion must be contextualized within a broad spectrum of health promotion, in which organic farming appears associated with the support for small farming, biodiversity, and local sustainable development, so as to increase offer and demand for organic products at fair prices for individual and institutional consumers.