The nuts and bolts of multimodal anaesthesia in the 21st century: a primer for clinicians.

PURPOSE OF REVIEW: This review article explores the application of multimodal anaesthesia in general anaesthesia, particularly in conjunction with locoregional anaesthesia, specifically focusing on the importance of EEG monitoring. We provide an evidence-based guide for implementing multimodal anaesthesia, encompassing drug combinations, dosages, and EEG monitoring techniques, to ensure reliable intraoperative anaesthesia while minimizing adverse effects and improving patient outcomes. RECENT FINDINGS: Opioid-free and multimodal general anaesthesia have significantly reduced opioid addiction and chronic postoperative pain. However, the evidence supporting the effectiveness of these approaches is limited. This review attempts to integrate research from broader neuroscientific fields to generate new clinical hypotheses. It discusses the correlation between high-dose intraoperative opioids and increased postoperative opioid consumption and their impact on pain indices and readmission rates. Additionally, it explores the relationship between multimodal anaesthesia and pain processing models and investigates the potential effects of nonpharmacological interventions on preoperative anxiety and postoperative pain. SUMMARY: The integration of EEG monitoring is crucial for guiding adequate multimodal anaesthesia and preventing excessive anaesthesia dosing. Furthermore, the review investigates the impact of combining regional and opioid-sparing general anaesthesia on perioperative EEG readings and anaesthetic depth. The findings have significant implications for clinical practice in optimizing multimodal anaesthesia techniques (Supplementary Digital Content 1: Video Abstract, http://links.lww.com/COAN/A96 ).

Extracts Prepared from Feed Supplements Containing Wood Lignans Improve Intestinal Health by Strengthening Barrier Integrity and Reducing Inflammation.

Lignans are known to exhibit a broad spectrum of biological activities, indicating their potential as constituents of feed supplements. This study investigated two extracts derived from the feed supplements 'ROI' and 'Protect'-which contain the wood lignans magnolol and honokiol ('ROI'), or soluble tannins additional to the aforementioned lignans ('Protect')-and their impact on selected parameters of intestinal functionality. The antioxidant and anti-inflammatory properties of the extracts were determined by measuring their effects on reactive oxygen species (ROS) and pro-inflammatory cytokine production in vitro. The impact on intestinal barrier integrity was evaluated in Caco-2 cells and Drosophila melanogaster by examining leaky gut formation. Furthermore, a feeding trial using infected piglets was conducted to study the impact on the levels of superoxide dismutase, glutathione and lipid peroxidation. The Protect extract lowered ROS production in Caco-2 cells and reversed the stress-induced weakening of barrier integrity. The ROI extract inhibited the expression or secretion of interleukin-8 (IL-8), interleukin-6 (IL-6), interleukin-1ß (IL-1ß) and tumor necrosis factor α (TNFα). Moreover, the ROI extract decreased leaky gut formation and mortality rates in Drosophila melanogaster. Dietary supplementation with Protect improved the antioxidant status and barrier integrity of the intestines of infected piglets. In conclusion, wood lignan-enriched feed supplements are valuable tools that support intestinal health by exerting antioxidant, anti-inflammatory and barrier-strengthening effects.

Covid-19 pandemic effects on food safety - Multi-country survey study.

This study provides an important insight into the response of food safety systems during the first months of the pandemic, elevating the perspective of preventing Covid-19 within conventional food safety management systems. A multi-country survey was conducted in 16 countries involving 825 food companies. Based on the results of the survey, it is obvious that the level of maturity of a food safety system in place is the main trigger in classifying companies and their responses to the pandemic challenge. Staff awareness and hygiene are the two most important attributes in combating Covid-19, opposed to temperature checking of workers in food establishment and health protocols from the World Health Organization, recognized as attributes with limited salience and importance. Companies confirmed implementation of more restrictive hygiene procedures during the pandemic and the need for purchasing more additional personal protective equipment. Retailers were identified as the food supply chain link mostly affected by the pandemic opposed to food storage facilities ranked as least affected. During this challenging period, all companies declared that food safety has not been compromised at any moment. It is important to note that less than a half of the food companies had documented any emergency plans associated with pandemics and health issues in place.

Influence of sociodemographic factors on eating motivations - modelling through artificial neural networks (ANN).

This study aimed at investigating the influence of some sociodemographic factors on the eating motivations. A longitudinal study was carried conducted with 11960 participants from 16 countries. Data analysis included t-test for independent samples or ANOVA, and neural network models were also created, to relate the input and output variables. Results showed that factors like age, marital status, country, living environment, level of education or professional area significantly influenced all of the studied types of eating motivations. Neural networks modelling indicated variability in the food choices, but identifying some trends, for example the strongest positive factor determining health motivations was age, while for emotional motivations was living environment, and for economic and availability motivations was gender. On the other hand, country revealed a high positive influence for the social and cultural as well as for environmental and political and also for marketing and commercial motivations.

Oral and cranio-maxillofacial trauma in children and adolescents in an emergency setting at a Brazilian hospital.

BACKGROUND/AIMS: Very few studies have been performed to evaluate cranio-maxillofacial trauma diagnosed in hospitals in children and adolescents. The aim of this study was to perform an analysis of oral and cranio-maxillofacial trauma in the aforementioned population. MATERIALS AND METHODS: A hospital-based retrospective study, which reviewed 1438 patient records, was conducted at the "Teresina Emergency Hospital", Brazil. Data regarding demographics, day of the week on which trauma occurred, type of injury, etiology, anatomic trauma site, time of hospital admission, and associated comorbidities (or injuries) were collected. RESULTS: There were 1092 (75.9%) males and 346 (24.1%) females. The largest group was adolescents aged between 13 and 18 years (956, 66.5%). The majority lived in urban areas (69%). Trauma occurred most frequently during the week. The most prevalent etiology was road traffic accidents involving motorcycles (771, 53.6%) causing facial and skull fractures (598, 41%). The most prevalent soft tissue lesions were facial abrasions (49%), followed by injuries to the cheek (16.7%). Comorbidities associated with craniofacial trauma were present in 82%, with complications from traumatic brain injuries being the most prevalent (65.6%) Dental trauma was recorded in only 81 cases (5.6%). CONCLUSION: Male adolescents living in urban areas were most affected by craniofacial trauma. The most common cause was road traffic accidents involving motorcycles, resulting in facial and skull fractures. Complications from traumatic brain injuries were the most common associated injuries.

Knowledge about dietary fibre: a fibre study framework.

The objective of this work was to study the degree of knowledge about dietary fibre (DF), as influenced by factors such as gender, level of education, living environment or country. For this, a descriptive cross-sectional study was undertaken on a non-probabilistic sample of 6010 participants from 10 countries in different continents (Europe, Africa and America). The results showed that the participants revealed on average a positive but still low global level of knowledge, which alerts for the need to take some actions to further inform the population about DF and its role as a component of a healthy diet. The results also indicated differences between genders, levels of education, living environments and countries. The highest level of knowledge was revealed by the participants from female gender, with higher education and living in urban areas. Concerning the country, the best informed were the participants from Romania, followed by those from Portugal and Turkey while the least informed were from Egypt.

Migrant Pathology Screening in the Pediatric Population: A Five-Year Retrospective Study From a Level II Hospital.

INTRODUCTION: The migrant population residing in Portugal has been growing. In 2015, the pediatrics department at Professor Doutor Fernando Fonseca Hospital, a level II hospital, implemented a screening for endemic pathologies in asymptomatic migrant children to enable their timely diagnosis and treatment. This study aimed to identify and characterize the main findings in the migrant pathology screening. METHODS: This was a retrospective and descriptive study of asymptomatic children and adolescents who underwent opportunistic screening for migrant pathology in a hospital setting between January 2016 and April 2021. Data analysis was performed using Microsoft Excel®. RESULTS: A total of 256 individuals were included in the study; 53.5% (137/256) were female, with a median age of eight years and two months (minimum five months; maximum 17 years and 10 months). The majority of the participants were from Guinea-Bissau (29.7%, 76/256), Angola (19.1%, 49/256) and Cape Verde (12.1%, 31/256) and had been residents in Portugal for a median time of five months (minimum two days; maximum three years and five months). A total of 42.6% (109/256) participants did not have the Portuguese vaccination schedule updated. Screening was carried out in an outpatient setting in 71.9% (184/256) of individuals. A total of 38.7% (99/256) presented screening alterations, including 65 anemia cases (18 caused by iron deficiency and one by sickle cell anemia), 5 cases of tuberculosis infection and 1 case of pulmonary tuberculosis, 1 of human immunodeficiency virus infection, 3 hepatitis B virus infection cases, 20 of parasitic infections and 2 cases of female genital mutilations. CONCLUSION: The revised migrant pathology screening protocol enabled the detection of diseases with a significant impact on the health of individual children and adolescents. This protocol serves as a practical tool for accurately monitoring the health status of this population.

Consumers' Perceptions about Edible Insects' Nutritional Value and Health Effects: Study Involving 14 Countries.

Insects have been consumed for time immemorial in many regions of the globe. However, in other parts, they are not traditionally eaten. Because they are a more sustainable source of animal protein and provide valuable nutrients as well as bioactive compounds with beneficial effects on the human body, their consumption is encouraged. Knowledge can serve as a tool for better acceptance of insects as food. In this context, the present work investigated the knowledge about the nutritional value and health effects of edible insects in different countries. Data were collected by employing a questionnaire survey translated into the different languages of all participating countries and were treated using statistical tools. A total of 7222 responses were obtained. The results indicated that for many issues, the participants manifested a neutral opinion (neither agree nor disagree), but the participants who manifested agreement/disagreement were generally well informed. They were also able to identify untrue facts and answer accordingly by disagreeing. Factor analysis showed four groups of questions: nutritive value, negative perception and risks, safety and benefits of insects and contamination and harmful components. Finally, significant differences were observed according to the sociodemographic variables studies (sex, age, education, living environment and country), with age and country being the most influential of the sociodemographic factors on knowledge. Therefore, increasing knowledge is envisaged as an essential factor in augmenting the recognition of edible insects as a nutritional food, presenting health benefits apart from being a more sustainable source of animal protein when compared with beef or pork meats.

Effect of different storage conditions on the stability and safety of almonds.

Almond production in Portugal is of great importance for the economy of their main producing areas. However, the contamination of these nut fruits with fungi and mycotoxins poses a significant risk to food safety and security. This work intended to evaluate the influence of storage conditions on the microbial and mycotoxin stability and safety of almonds throughout long-term storage. Two almond varieties-Lauranne and Guara-were submitted to three different storage conditions, namely, 4°C with noncontrolled relative humidity (RH), 60% RH at 25°C, and 70% RH at 25°C, for a storage period of 9 months. Samples were collected after 0, 3, 6, and 9 months of storage and analyzed for microbial loads (aerobic mesophiles, yeasts, and molds), mold incidence and diversity, and mycotoxin contamination. In total, 26 species were identified belonging to 6 genera: Aspergillus, Cladosporium, Fusarium, Penicillium, Paecilomyces, and Talaromyces. For the variety Guara, mycotoxins related to Aspergillus sect. Flavi, such as aflatoxins, averufin, versicolorin C, and norsolorinic acid, were detected only after 9 months of storage at 70% and 60% RH. Penicillium mycotoxins, such as quinolactacin A and roquefortine C, were also detected. For the variety Lauranne, Penicillium mycotoxins were detected, such as citrinin, quinolactacins A and B, roquefortines C and D, cyclopenin, cyclopenol, penitrem A, viridicatin, and viridicatol. Mycotoxins related to Aspergillus, such as aspulvinone E, flavoglaucin, paspalin, asperglaucide, asperphenamate, cyclo(L-Pro-L-Tyr), and cyclo(L-Pro-L-Val), were also detected. PRACTICAL APPLICATION: (Optional, for JFS Research Articles ONLY) The quality of almonds depends on the storage period and the RH and temperature at which they are stored. Storage of almonds at 60% RH at 25°C is a good storage condition to maintain the stability and safety of nuts in terms of microbial and mycotoxin contaminations.

Salmonellosis in Children at a Portuguese Hospital: A Retrospective Study.

INTRODUCTION: Salmonellosis represents a considerable health, social and economic burden in both high- and low-income countries. Recently, in Portugal, most cases of Salmonella infections have been reported in children under 15 years of age. The main aim of this study was to characterize, from an epidemiological, microbiological, and clinical perspective, cases of Salmonella isolation among children. MATERIAL AND METHODS: The authors performed a descriptive study using retrospective analysis of cases of salmonellosis, in pediatric age, at a Portuguese Level II Hospital, between January 2015 and July 2020. RESULTS: The population included a total of 63 children, of which 81% were Portuguese. Ethnicity was identified in 13 children, most of whom were African. The median age at diagnosis was four years old (3.5 - 9 years old). Despite the small number of cases per year in our study (11), one-third were severe enough to require hospitalization. Overall, 13% of patients were treated with antibiotics. In 63% of the isolates, serotype was identified: Salmonella Enteriditis (38%), Salmonella Typhimurium (22%), and Salmonella Typhi (3%). Antibiotic resistance rates were 19% for ampicillin and 6.4% for amoxicillinclavulanic acid and cotrimoxazole. No resistance to third-generation cephalosporins was found. CONCLUSION: Given the obtained results, we intend to improve knowledge on salmonellosis in Portugal and, consequently improve prevention strategies, treatment and its notification. Although the incidence of salmonellosis has been decreasing in recent years it is the second most frequent gastrointestinal infection in the European Union, contributing to significant rates of hospitalizations and use of antibiotics in Portugal.

The Reflux Symptom Score-12: Cross-cultural Adaptation and Validation for European Portuguese Speakers With Laryngopharyngeal Reflux.

OBJECTIVES: To translate and cross-culturally adapt the 12-item reflux symptom score (RSS-12) to European Portuguese (EP) and determine its clinimetric properties for symptomatic individuals with laryngopharyngeal reflux (LPR). STUDY DESIGN: Multinational cross-sectional cohort study. METHODS: The English RSS-12 was cross-culturally adapted according to the recommendations of the international guidelines. The validation study included the completion of the RSS-12, reflux symptom index, and voice handicap index by symptomatic and asymptomatic subjects with LPR. The RSS-12 was completed a second time by symptomatic subjects. Nine clinimetric properties were analyzed according to the international guidelines for validation of patient-reported outcome measures. RESULTS: The EP RSS-12 is equivalent to the English version (content, depth, and scoring). A total of 155 adults (84 with LPR symptoms) aged 21-78 years participated in the validation study. Statistical analyses revealed high internal consistency (Cronbach alpha >0.90), high test-retest reliability (intraclass correlation coefficient > 0.70, P < 0.001), low measurement error (Standard measure error of 5.21 for RSS and 1.59 for quality of life), good content validity (omission data <1% and item-total correlations > 0.652), good construct validity (61.9% of the total item variance with moderate item loadings), strong concurrent validity with reflux symptom index (rp = 0.772, P < 0.001) and moderate validity with voice handicap index (rp = 0.531, P < 0.001), and significantly known-groups validity (P < 0.001). The EP RSS-12 showed cross-cultural validity with French and Persian versions and high predictive validity with a cut-off value >8 for a sensitivity of 91.7% and a specificity of 91.5%. CONCLUSIONS: The EP RSS-12 retained the features of the English version and is a reliable and valid patient-reported outcome measure for EP individuals with LPR in the study.

Prospective study of loss of health-related quality adjusted life years in children and their families due to uncomplicated and hospitalised varicella.

INTRODUCTION AND AIMS: Although usually benign, varicella can lead to serious complications and sometimes long-term sequelae. Vaccines are safe and effective but not yet included in immunisation programmes in many countries. We aimed to quantify the impact on health-related quality of life (HRQoL) in terms of quality-adjusted life years (QALY) in children with varicella and their families, key to assessing cost-utility in countries with low mortality due to this infection. METHODS: Children with varicella in the community and admitted to hospitals in Portugal were included over 18 months from January 2019. Children's and carers' HRQoL losses were assessed prospectively using standard multi-attribute utility instruments for measuring HRQoL (EQ-5D and CHU9D), from presentation to recovery, allowing the calculation of QALYs. RESULTS: Among 109 families with children with varicella recruited from attendees at a pediatric emergency service (community arm), the mean HRQoL loss/child was 2.0 days (95 % CI 1.9-2.2, n = 101) (mean 5.4 QALYs/1000 children (95 % CI 5.3-6.1) and 1.3 days/primary carer (95 % CI 1.2-1.6, n = 103) (mean 3.6 QALYs /1000 carers (95 % CI 3.4-4.4). Among 114 families with children admitted to hospital because of severe varicella or a complication (hospital arm), the mean HRQoL loss/child was 9.8 days (95 % CI 9.4-10.6, n = 114) (mean 26.8 QALYs /1000 children (95 % CI 25.8-29.0) and 8.5 days/primary carer (95 % CI 7.4-9.6, n = 114) (mean 23.4 QALYs/1000 carers (95 % CI 20.3-26.2). Mean QALY losses/1000 patients were particularly high for bone and joint infections [67.5 (95 % CI 43.9-97.6)]. Estimates for children's QALYs lost using the CHU9D tool were well correlated with those obtained using EQ-5D, but substantially lower. CONCLUSIONS: The impact of varicella on HRQoL is substantial. We report the first measurements of QALYs lost in hospitalised children and in the families of children both in the community and admitted to hospital, providing important information to guide vaccination policy recommendations.

Synergic Effect of Brachyspira hyodysenteriae and Lawsonia intracellularis Coinfection: Anatomopathological and Microbiome Evaluation.

Brachyspira hyodysenteriae and Lawsonia intracellularis coinfection has been observed in the diagnostic routine; however, no studies have evaluated their interaction. This study aimed to characterize lesions and possible synergisms in experimentally infected pigs. Four groups of piglets, coinfection (CO), B. hyodysenteriae (BRA), L. intracellularis (LAW), and negative control (NEG), were used. Clinical signals were evaluated, and fecal samples were collected for qPCR. At 21 days post infection (dpi), all animals were euthanized. Gross lesions, bacterial isolation, histopathology, immunohistochemistry, and fecal microbiome analyses were performed. Diarrhea started at 12 dpi, affecting 11/12 pigs in the CO group and 5/11 pigs in the BRA group. Histopathological lesions were significantly more severe in the CO than the other groups. B. hyodysenteriae was isolated from 11/12 pigs in CO and 5/11 BRA groups. Pigs started shedding L. intracellularis at 3 dpi, and all inoculated pigs tested positive on day 21. A total of 10/12 CO and 7/11 BRA animals tested positive for B. hyodysenteriae by qPCR. A relatively low abundance of microbiota was observed in the CO group. Clinical signs and macroscopic and microscopic lesions were significantly more severe in the CO group compared to the other groups. The presence of L. intracellularis in the CO group increased the severity of swine dysentery.

Edible Insects: Perceptions of Marketing, Economic, and Social Aspects among Citizens of Different Countries.

Because edible insects (EI) have been, in recent years, recommended as a nutritious animal protein food with enormous environmental advantages over other sources of animal protein for human consumption, studies aimed at investigating the consumer perspective have become more prominent. Hence, this study intended to examine the perceptions of participants from different countries about the commercialization and economic and social impacts of edible insects. The study was made using a questionnaire survey, and data were collected in Brazil, Croatia, Greece, Latvia, Lebanon, Lithuania, Mexico, Poland, Portugal, Romania, Serbia, Slovenia, Spain, and Turkey. The final number of received answers was 7222 participants. For the treatment of the results, different statistical techniques were used: factor analysis, internal reliability by Cronbach's alpha, cluster analysis, ANOVA to test differences between groups, and Chi-square tests. The results obtained confirmed the validity of the scale, constituted by 12 out of the 14 items initially considered, distributed by 4 factors: the first related to the economic impact of EIs, the second related to the motivation for consumption of EIs, the third related to the places of purchase of EIs, and the fourth corresponding to a question presented to the participants as a false statement. A cluster analysis allowed identifying three clusters, with significant differences between them according to all the sociodemographic variables tested. Also, it was found that the participants expressed an exceptionally high level of agreement with aspects such as the difficulty in finding EIs on sale, knowledge acting as a strong motivator for EI consumption, and the role of personalities and influencers in increasing the will to consume EIs. Finally, practically all sociodemographic variables were found to be significantly associated with perceptions (country, sex, education, living environment, and income), but not age. In conclusion, the perceptions about EI commercialization were investigated and revealed differences among samples originating from different countries. Moreover, the sociodemographic characteristics of the participants were found to be strongly associated with their perceptions.

Development of Innovative Candied Chestnuts from Three Chestnut Cultivars Grown in Portugal.

The main purpose of this work is the development of a value-added product (candied chestnuts) from Portuguese chestnut (Castanea sativa) cultivars (Martainha, Longal and Judia), as a way to minimize product loss and wastes. To accomplish this goal, the effects of rehydration, cooking, and syrup conditions on composition, textural properties, and colour parameters of candied chestnuts were investigated. The obtained results revealed that the optimal conditions to prepare candied chestnuts with a sweet taste, dark brown colour, with a crispy texture on the outside and smooth texture in the inner flesh were rehydration at 45 °C for a period of 5 h, cooking in a pressure pan for 15 min, and an immersion process with sucrose syrup for two days (syrup with 25% of sucrose on the first day and syrup of 50% of sucrose on the second day). During the process, the drying loss, hydration ratio, and cooking gain of the different cultivars were about 90%, 79%, and 130%, respectively. The total colour difference of candied chestnuts ranged from 24.18 (Longal) to 29.95 (Judia), the stickiness was moderately intense, and the adhesiveness was high for the three varieties. Longal candied chestnuts were the softest and Martainha candied chestnuts were the hardest, the most elastic, and cohesive. Moreover, the candied chestnuts presented a moisture content ranging from 52.70% and 54.23%, amounts of carbohydrates in the range of 88.58 to 91.87 g/100 g d.m, values of protein (6.55-9.51 g/100 g d.m.), values of ash (0.78-1.98 g/100 g d.m.), and fat (0.87-1.58 g/100 g d.m.). In conclusion, the chestnuts of Portuguese cultivars Martainha, Longal and Judia reveal a good potential to produce candied products with high added value.

Recent Advances in Drumstick (Moringa oleifera) Leaves Bioactive Compounds: Composition, Health Benefits, Bioaccessibility, and Dietary Applications.

Based on the availability of many nutrients, Moringa oleifera tree leaves have been widely employed as nutrients and nutraceuticals in recent years. The leaves contain a small amount of anti-nutritional factors and are abundant in innumerable bioactive compounds. Recently, in several in vivo and in vitro investigations, moringa leaves' bioactive components and functionality are highlighted. Moringa leaves provide several health advantages, including anti-diabetic, antibacterial, anti-cancer, and anti-inflammatory properties. The high content of phytochemicals, carotenoids, and glucosinolates is responsible for the majority of these activities as reported in the literature. Furthermore, there is growing interest in using moringa as a value-added ingredient in the development of functional foods. Despite substantial study into identifying and measuring these beneficial components from moringa leaves, bioaccessibility and bioavailability studies are lacking. This review emphasizes recent scientific evidence on the dietary and bioactive profiles of moringa leaves, bioavailability, health benefits, and applications in various food products. This study highlights new scientific data on the moringa leaves containing nutrient and bioactive profiles, bioavailability, health benefits, and uses in various food items. Moringa has been extensively used as a health-promoting food additive because of its potent protection against various diseases and the widespread presence of environmental toxins. More research is needed for utilization as well as to study medicinal effects and bioaccesibility of these leaves for development of various drugs and functional foods.

Honey Bee (Apis mellifera L.) Broods: Composition, Technology and Gastronomic Applicability.

Honey bee broods (larvae and pupae) can be consumed as human food, offering a rich nutritional value. Therefore, the objective of this work was to present an overview of the nutritional value of the honey bee brood and its gastronomic potential. The results indicated that honey bee broods are rich in protein (including essential amino acids), fat (essentially saturated and monounsaturated fatty acids), carbohydrates, vitamin C and those of the B complex, and minerals such as potassium, magnesium, calcium, and phosphorous. The results further highlight some variability according to the stage of development, with increasing content of fat and protein and decreasing carbohydrates from the larval to the pupal stages. The production of the honey bee brood in the hive, as well as its removal, can impact the wellbeing of the hive. This limits the production potential of the brood aimed at application for gastronomic purposes. The consumption and purchase of honey bee broods as food may be accessible in specialised markets where, for example, ethnic communities consume this type of food. However, in some markets, insects or products produced from insects are not readily accepted because of neophobia and disgust. The role of culinary chefs allied to traditional ways of preparing culinary dishes that include honey bee broods are relevant to motivate more people in western societies to consume of these types of food products.

The Motivations for Consumption of Edible Insects: A Systematic Review.

The consumption of edible insects (EI) is traditional in many parts of the world, but not in others. In fact, despite globalization and the multiple advantages pointed out about the consumption of EI, there are still many countries where entomophagy is seen with disgust and aversion. This systematic review aimed to examine the motivations that influence the consumption of EI in diverse cultures and understand if there are differences between Western countries (WC) and insect-eating countries (IEC). It further evaluated whether the degree of acceptability was influenced by the form of consumption of the insects (eating whole insects or foods containing insects). This literature review was conducted in November 2021 within three databases, Web of Science, PubMed and Scopus, according to the Preferred Reporting of Items for Systematic Reviews and Meta-analysis and using PRISMA directives. From a total of 245 studies, 31 were selected to be included in this review, based on the inclusion criteria defined: only original research articles, from 2010 or beyond, and written in English. The results indicated that the main motivations that determine the consumption of EI are related to gender, age, sustainability, nutritional value, sensory attributes, tradition/culture, food neophobia, disgust and familiarity/past experiences. Moreover, whereas in IEC, there is a greater focus on factors related to sensory attributes, availability, affordability and preferences, in WC, there is a bigger emphasis on determinants such as nutritional value, sustainability, benefits, familiarity/past experience, tradition/culture, food neophobia and disgust. Finally, it was observed that people in WC are more willing to accept food products containing insects rather than the whole insect, which is one of the most promising points to be addressed in the future. Overall, this review highlights that there are numerous factors influencing the consumption of edible insects, and differences between WC and IEC are clear in what concerns the motivations of consumers. Hence, targeting market segments and consumers' characteristics has to be present when designing strategies to incentivize the consumption of EI in WC as a part of a global strategy for sustainability of food systems.

Edible Insects: Preliminary Study about Perceptions, Attitudes, and Knowledge on a Sample of Portuguese Citizens.

This study investigated the knowledge, attitudes, consumption habits, and degree of acceptability of edible insects (EI) or derived products among Portuguese consumers. This work consisted of a questionnaire survey, undertaken on a sample of 213 participants. For the treatment of data, basic descriptive statistics were used, complemented with chi-square tests to assess some associations between categorical variables. Moreover, a tree classification analysis was carried out using a classification and regression tree (CRT) algorithm with cross-validation. The results indicated that people tend to have correct perceptions about the sustainability issues associated with the use of insects as alternative sources of protein; however, the level of knowledge and overall perception about their nutritive value is low. Regarding the consumption of EI, it was found that only a small part of the participants had already eaten them, doing it mostly abroad, by self-initiative, in a restaurant or at a party or event. Additionally, it was found that the reluctance to consume insects is higher if they are whole, but when they are transformed into ingredients used in food formulations, the level of acceptance increases. Furthermore, men have shown to have a better perception about EI, be more informed about sustainability, and have a higher level of acceptability when compared to women. As a final conclusion, it was observed that the Portuguese still show some resistance to adhere to the use of insects as replacements for meat products, but the market of insect based products can be a good alternative to overpass the neophobia associated with this type of food.