[Indigenous health in specialized care: perspective of healthcare professionals in a reference hospital in Mato Grosso do Sul State, Brazil]. / A saúde indígena na atenção especializada: perspectiva dos profissionais de saúde em um hospital de referência no Mato Grosso do Sul, Brasil.

This cross-sectional study aims to identify the perspective of healthcare professionals and residents regarding the challenges faced in providing care to Indigenous users in a reference hospital in Mato Grosso do Sul, a Brazilian state with the second-largest Indigenous population in the country. The study used a semi-structured online questionnaire emailed to each worker between June and August 2020. The discrete variables were summarized as mean and standard deviation and median and interquartile range (5% significance level). Two hundred thirty healthcare professionals and 29 residents participated in the study. Among the findings, only 14.7% of participants knew the ethnicities served, and 60.2% had never witnessed traditional practices in the hospital, indicating low articulation between biomedical and Indigenous forms of care. When comparing responses from residents and professionals, residents were noted to have a more positive view of approaching the Indigenous context, suggesting that they consider it essential to improve this articulation. When comparing professional categories, some differences of opinion among the medical category stand out concerning assistance. In addition, professionals and residents demonstrated some level of difficulty in caring for the Indigenous population. The results highlight the centrality of the biomedical model, the professionals' lack of knowledge about the context of the communities served, and the devaluation of their practices. The findings contribute to discussions about healthcare policies at different levels of care and management and the qualification of hospital care for Indigenous people.

Trata-se de estudo transversal com o objetivo de identificar a perspectiva dos profissionais de saúde e residentes acerca dos desafios enfrentados no atendimento aos usuários indígenas em um hospital referência no Mato Grosso do Sul, estado brasileiro que comporta a segunda maior população indígena do país. O estudo utilizou questionário semiestruturado online, enviado por e-mail a cada trabalhador(a) no período entre junho e agosto de 2020. As variáveis discretas foram sintetizadas em média e desvio padrão e mediana e intervalo interquartil (nível de significância de 5%). Participaram do estudo 230 profissionais de saúde e 29 residentes. Entre eles, apenas 14,7% conheciam as etnias atendidas, e 60,2% nunca havia presenciado práticas tradicionais no hospital, indicando baixa articulação entre as formas de cuidado biomédico e indígena. Ao confrontar respostas dos residentes e profissionais, observou-se que residentes têm uma visão mais positiva acerca da aproximação com o contexto indígena, sugerindo que consideram importante melhorar essa articulação. Na comparação entre categorias profissionais, destacam-se algumas divergências de opiniões da categoria médica em relação à assistência. Além disso, profissionais e residentes demonstraram sentir algum nível de dificuldade no atendimento à população indígena. Os resultados evidenciam a centralidade do modelo biomédico, o desconhecimento dos profissionais sobre o contexto das comunidades atendidas e a desvalorização de suas práticas. Além disso, contribuem para discussões sobre as políticas de saúde nos diversos níveis de atenção e gestão, bem como na qualificação da assistência hospitalar aos indígenas.

Se trata de un estudio transversal con el objetivo de identificar la perspectiva de los profesionales de la salud y los médicos residentes sobre los desafíos que enfrentan en la atención a los usuarios indígenas en un hospital de referencia en Mato Grosso del Sur, el estado brasileño que tiene la segunda población indígena más grande del país. El estudio utilizó un cuestionario semiestructurado en línea, enviado por correo electrónico para cada trabajador y trabajadora entre los meses de junio y agosto de 2020. Se sintetizaron las variables discretas en media y desviación estándar, y mediana y rango intercuartílico (nivel de significación del 5%). Participaron del estudio 230 profesionales de la salud y 29 médicos residentes. En los resultados, solo el 14,7% de los participantes conocían las etnias atendidas, y el 60,2% nunca había presenciado prácticas tradicionales en el hospital, lo que indica una baja articulación entre las formas de atención biomédica e indígena. Al confrontar respuestas de los médicos residentes y los profesionales, se constató que los médicos residentes tienen una perspectiva más positiva sobre el acercamiento al contexto indígena, lo que sugiere que ellos consideran importante mejorar esta articulación. Al comparar las categorías profesionales, se destacan algunas divergencias de opinión de la categoría médica en relación con la asistencia. Además, los profesionales y los médicos residentes demostraron un cierto nivel de dificultad en la atención a la población indígena. Los resultados demuestran la centralidad del modelo biomédico, la falta de conocimiento de los profesionales sobre el contexto de las comunidades atendidas y la desvalorización de sus prácticas. Los resultados contribuyen a las discusiones sobre las políticas de salud en varios niveles de atención y gestión, así como en la calificación de la atención hospitalaria a los indígenas.

Who Benefits Most from the Family Education and Support Program in Cape Verde? A Cluster Analysis.

BACKGROUND/OBJECTIVES: Child parenting programs can enhance parental skills, prevent future issues in child development, and improve children's quality of life. The present research aimed to study the changes promoted by the Family Education and Support Program (FAF) implemented in Cape Verde, regarding parental educational practices, perceived parental efficacy, and attitudes and beliefs of Cape Verdean parents. METHODS: To this end, 37 participants were evaluated through a pretest-postest design. The evaluated dimensions were perceived parental competence, parenting practices, Parental attitudes and beliefs, mental health and perceived child quality of life. RESULTS: A cluster analysis was conducted, distinguishing two groups. Both groups benefited from the program. Cluster 1 reported more significant gains in dimensions of parental efficacy and satisfaction, inadequate expectations, affection and support, and reactivity, while cluster 2 showed a greater difference in regulation and reactivity. CONCLUSIONS: Overall, the FAF intervention contributed to an increase in positive parenting practices. By analyzing potential underlying profiles in the change process, this study suggests that there are participants who benefit more than others from the intervention, and this information may be relevant for professionals and researchers in the field.

Strengths and Limitations of BMI in the Diagnosis of Obesity: What is the Path Forward?

PURPOSE OF REVIEW: This review aims to discuss strengths and limitations of body mass index (BMI) in diagnosing obesity, the use of alternative anthropometric measurements, and potential new technology that may change the future of obesity diagnosis and management. RECENT FINDINGS: The diagnosis of obesity requires the anthropometric assessment of adiposity. In clinical settings, this should include BMI with confirmation that elevated BMI represents excess adiposity and a measure of fat distribution (i.e., waist circumference (WC), waist to height ratio (WHtR), or WC divided by height0.5 (WHR.5R). Digital anthropometry and bioelectric impedance (BIA) can estimate fat distribution and be feasibly employed in the clinic. In addition, the diagnosis should include a clinical component assessing the presence and severity of weight-related complications. As anthropometric measures used in the diagnosis of obesity, BMI is generally sufficient if confirmed to represent excess adiposity, and there are advantages to the use of WHtR over WC to assess fat distribution. BIA and digital anthropometry have the potential to provide accurate measures of fat mass and distribution in clinical settings. There should also be a clinical evaluation for the presence and severity of obesity complications that can be used to stage the disease.

Lower levels of plasma syndecan-4 are associated with loss of body weight and fat-free mass after bariatric surgery.

OBJECTIVE: Bariatric surgery induces a significant loss of both fat mass (FM) and fat-free mass (FFM). The proteoglycan receptor syndecan-4 (SDC4) plays a crucial role in adipose tissue and skeletal muscle functions. Thus, this study was performed (i) to assess plasma SDC4 levels after both Sleeve Gastrectomy (SG) and Roux-en-Y Gastric Bypass (RYGB) surgeries, and (ii) to explore potential associations with changes in body composition variables. RESULTS: Twenty-six patients (17 females) with severe obesity underwent SG (n = 13) or RYGB (n = 13) and were followed up to 1 year (1Y). Body weight, FM, FFM, and SCD4 were measured at baseline (BL), and at week 11 (W11) and 1Y after surgery. Independently of procedure, there was a significant body weight loss at W11, with an average FM and FFM reduction of 13.7 ± 0.6 kg and 5.3 ± 0.5 kg, respectively. Participants continued to lose weight afterwards, with a total weigth loss of 38.2 ± 1.5 kg at 1Y. No associations were found at BL between SDC4 levels and any anthropometric variable; however, SDC4 levels were lower than BL at both W11 and 1Y, independently of type of surgery. Additionally, changes in SDC4 between BL and 1Y were positively correlated with weight and FFM loss during the same period. TRIAL REGISTRATION: ClinicalTrials.gov NCT04051190 on 09/08/2019.

Piglets performance, nutrient digestibility and gut health in response to feeding Ulva lactuca seaweed supplemented with a recombinant ulvan lyase or a commercial carbohydrase mixture.

Ulva lactuca, a green seaweed, may be an alternative source of nutrients and bioactive compounds for weaned piglets. However, it has a recalcitrant cell wall rich in a sulphated polysaccharide - ulvan - that is indigestible to monogastrics. The objective of this study was to evaluate the effect of dietary incorporation of 7% U. lactuca, combined with carbohydrases supplementation (commercial carbohydrase mixture or recombinant ulvan lyase), on growth performance, nutrient digestibility and gut health parameters (morphology and microbiota) of weaned piglets. The experiment was conducted over 14 days using 40 weaned piglets randomly allocated to one of four experimental diets: a control diet based on wheat-maize-soybean meal, a diet with 7% U. lactuca replacing the control diet (UL), a diet with UL supplemented with 0.005% Rovabio® Excel AP, and a diet with UL supplemented with 0.01% of a recombinant ulvan lyase. The dietary treatments had no major effects on growth performance, nitrogen balance and gut content variables, as well as histological measurements. Contrarily, dry matter and organic matter digestibility decreased with dietary seaweed inclusion, while hemicellulose digestibility increased, suggesting a high fermentability of this cell wall fraction independently of carbohydrases supplementation. Some beneficial microbial populations increased as a consequence of enzymatic supplementation (e.g., Prevotella), while seaweed diets as a whole led to an increased abundance of Shuttleworthia, Anaeroplasma and Lachnospiraceae_NK3A20_group, all related with a healthier gut. It also decreased Lactobacillus when compared to controls, which is possibly related to increased bioavailability of seaweed zinc. This study indicates that, under these experimental conditions, up to 7% dietary U. lactuca has no detrimental effect on piglet growth, despite decreasing acid detergent fibre digestibility. Carbohydrases supplementation of Ulva diets is not required at this incorporation level.

Different Sensitivity of Flower-Visiting Diptera to a Neonicotinoid Insecticide: Expanding the Base for a Multiple-Species Risk Assessment Approach.

Insects play an essential role as pollinators of wild flowers and crops. At the same time, pollinators in agricultural environments are commonly exposed to pesticides, compromising their survival and the provision of pollination services. Although pollinators include a wide range of species from several insect orders, information on pesticide sensitivity is mostly restricted to bees. In addition, the disparity of methodological procedures used for different insect groups hinders the comparison of toxicity data between bees and other pollinators. Dipterans are a highly diverse insect order that includes some important pollinators. Therefore, in this study, we assessed the sensitivity of two hoverflies (Sphaerophoria rueppellii, Eristalinus aeneus) and one tachinid fly (Exorista larvarum) to a neonicotinoid insecticide (Confidor®, imidacloprid) following a comparative approach. We adapted the standardized methodology of acute contact exposure in honey bees to build dose-response curves and calculate median lethal doses (LD50) for the three species. The methodology consisted in applying 1 µL of the test solution on the thorax of each insect. Sphaerophoria rueppelli was the most sensitive species (LD50 = 10.23 ng/insect), and E. aeneus (LD50 = 18,176 ng/insect) the least. We then compared our results with those available in the literature for other pollinator species using species sensitivity distribution (SSD). Based on the SSD curve, the 95th percentile of pollinator species would be protected by a safety factor of 100 times the Apis mellifera endpoint. Overall, dipterans were less sensitive to imidacloprid than most bee species. As opposed to most bee species, oviposition and fecundity of many dipteran species can be reliably assessed in the laboratory. We measured the number of eggs laid following exposure to different insecticide doses and assessed the potential trade-off between oviposition and survival through the sublethal sensitivity index (SSI). Exposure to imidacloprid had a significant effect on fecundity, and SSI values indicated that oviposition is a sensitive endpoint for the three dipteran species tested. Future studies should integrate this information related to population dynamics in simulation models for environmental risk assessment.

Effects of high dietary inclusion of Arthrospira platensis, either extruded or supplemented with a super-dosing multi-enzyme mixture, on broiler growth performance and major meat quality parameters.

BACKGROUND: This investigation assessed the effects of high dietary inclusion of Spirulina (Arthrospira platensis) on broiler chicken growth performance, meat quality and nutritional attributes. For this, 120 male broiler chicks were housed in 40 battery brooders (three birds per brooder). Initially, for 14 days, a standard corn and soybean meal diet was administered. Subsequently, from days 14 to 35, chicks were assigned to one of the four dietary treatments (n = 10 per treatment): (1) control diet (CTR); (2) diet with 15% Spirulina (SP); (3) diet with 15% extruded Spirulina (SPE); and (4) diet with 15% Spirulina plus a super-dosing enzymes supplement (0.20% pancreatin extract and 0.01% lysozyme) (SPM). RESULTS: Throughout the experimental period, both SP and SPM diets resulted in decreased final body weight and body weight gain compared to control (p < 0.001), with the SPE diet showing comparable results to CTR. The SPE diet prompted an increase in average daily feed intake (p = 0.026). However, all microalga treatments increased the feed conversion ratio compared to CTR. Dietary inclusion of Spirulina notably increased intestinal content viscosity (p < 0.010), which was mitigated by the SPM diet. Spirulina supplementation led to lower pH levels in breast meat 24 h post-mortem and heightened the b* colour value in both breast and thigh meats (p < 0.010). Furthermore, Spirulina contributed to an increased accumulation of total carotenoids, n-3 polyunsaturated fatty acids (PUFA), and saturated fatty acids (SFA), while diminishing n-6 PUFA, thus altering the n-6/n-3 and PUFA/SFA ratios favourably (p < 0.001). However, it also reduced zinc concentration in breast meat (p < 0.001). CONCLUSIONS: The findings indicate that high Spirulina levels in broiler diets impair growth due to increased intestinal viscosity, and that extrusion pre-treatment mitigates this effect. Despite reducing digesta viscosity, a super-dosing enzyme mix did not improve growth. Data also indicates that Spirulina enriches meat with antioxidants and n-3 PUFA but reduces α-tocopherol and increases saturated fats. Reduced zinc content in meat suggests the need for Spirulina biofortification to maintain its nutritional value.

Association between insulin sensitivity and lean mass loss during weight loss.

OBJECTIVE: The study objective was to assess the relationship between insulin sensitivity and changes in total lean mass (LM) and appendicular LM (ALM) during weight loss. METHODS: Individuals were randomly assigned to either a standard or a moderately reduced carbohydrate diet for 16 weeks. Body composition was assessed using dual-energy x-ray absorptiometry and insulin sensitivity index (SI) using an intravenous glucose tolerance test. Multiple linear regression was used to determine whether baseline SI was predictive of changes in total LM and ALM. RESULTS: Participants (n = 57; baseline BMI 32.1 ± 3.8 kg/m2) lost an average of 6.8 ± 3.2 kg of body weight (p < 0.001), with 1.5 ± 2.6 kg coming from LM (p < 0.05) and 0.5 ± 0.73 kg from ALM (p < 0.05). Multiple regression analysis demonstrated that SI was inversely associated with changes in total LM (kilograms; ß = 0.481, p < 0.001), after adjusting for baseline LM, fat mass, acute insulin response to glucose, and weight loss. Similar results were seen when assessing ALM loss (ß = 0.359, p < 0.05). CONCLUSIONS: Identifying individuals with low insulin sensitivity prior to weight loss interventions may allow for a personalized approach aiming at minimizing LM loss.

Walking net V ˙ O2 rises with advancing age in older women: where to go from here?

PURPOSE: Walking net V ˙ O2 tends to increase with advancing age; however, factors contributing to this relationship have not been widely described. The implications of such findings could inform targeted strategies to promote independent mobility in older adults. Herein, we evaluated the relationship between net V ˙ O2 and age at two submaximal workloads while exploring potential moderators of this relationship. METHODS: Secondary analyses were performed on 35 older (65 ± 3 years) women who completed a battery of physical assessments including fixed-speed, non-graded and graded (+ 2.5%) treadmill walking with indirect calorimetry to determine net V ˙ O2. Maximal oxygen uptake ( V ˙ O2max), knee extensor maximal isometric voluntary contraction (MVC), peak rate of torque development (RTD), and plantar flexor range-of-motion (PFROM) were also measured. RESULTS: Bivariate correlations showed non-graded (r = 0.403, p = 0.017) and graded (r = 0.413, p = 0.014) net V ˙ O2 were positively related to age. Notably, these relationships strengthened after adjusting for V ˙ O2max. Regression modeling showed age, RTD:MVC ratio (composite of muscle performance), and PFROM together explained 49% and 34% of the variance in non-graded and graded net V ˙ O2, respectively. Further analyses suggested knee extensor MVC moderates the relationship between non-graded net V ˙ O2 and age, accounting for 9% of the variance [ΔR2 = 0.090, F (1,31) = 4.13, p = 0.05]. CONCLUSION: These data support the premise that, in older women, walking net V ˙ O2 rises with advancing age, and additionally, the RTD:MVC ratio and PFROM are independent correlates of non-graded net V ˙ O2. Exercise interventions with a high degree of training specificity including explosive, velocity-based elements may promote independent mobility in older women.

Effect of a low-carbohydrate diet on pain and quality of life in female patients with lipedema: a randomized controlled trial.

OBJECTIVE: The primary objective of this study was to evaluate the effect of a low-carbohydrate diet (LCD) compared with a control diet on pain in female patients with lipedema. The secondary objectives were to compare the impact of the two diets on quality of life (QoL) and investigate potential associations of changes in pain with changes in body weight, body composition, and ketosis. METHODS: Adult female patients with lipedema and obesity were randomized to either the LCD or control diet (energy prescription: 1200 kcal/day) for 8 weeks. Body weight and body composition, pain (Brief Pain Inventory measured pain), and QoL (RAND 36-Item Health Survey [RAND-36], Impact of Weight on Quality of Life [IWQOL]-Lite, and Lymphoedema Quality of Life [LYMQOL]) were measured at baseline and at postintervention. RESULTS: A total of 70 female patients (age, mean [SD], 47 [11] years; BMI 37 [5] kg/m2) were included. The LCD group had greater weight loss (-2.8 kg; 95% CI: -4.1 to -1.0; p < 0.001) and larger reduction in pain now (-1.1; 95% CI: -1.9 to -0.3; p = 0.009) compared with the control group. No association was found between changes in pain now and weight loss. Both groups experienced improvements in several QoL dimensions. CONCLUSIONS: Diet-induced weight loss in women with lipedema can improve QoL. An energy-restricted LCD seems to be superior to a standard control diet in reducing pain.

Hedonic hunger, eating behavior, and food reward and preferences 1 year after initial weight loss by diet or bariatric surgery.

OBJECTIVE: The objective of this study was to investigate changes in hedonic hunger, eating behavior, and food reward and preferences at 1-year (1Y) follow-up after an initial weight loss (WL) induced by a 10-week, very low-energy diet alone (controls) or in combination with bariatric surgery. METHODS: Patients scheduled for sleeve gastrectomy or Roux-en-Y gastric bypass and controls were recruited. Body weight/composition, hedonic hunger (Power of Food Scale), eating behavior traits (Dutch Eating Behavior Questionnaire and Three-Factor Eating Questionnaire), and food reward and preferences (computerized behavioral task) were measured at baseline, 11 weeks, and 1Y follow-up. RESULTS: Changes in anthropometric variables were comparable across groups in the initial phase (week 11), and hedonic hunger decreased overall. The bariatric-surgery groups continued to lose body weight and fat mass, whereas weight regain was seen in controls at 1Y follow-up. Decreases in emotional eating, hunger, disinhibition, and food reward and increases in dietary restraint were seen at 1Y follow-up in the bariatric-surgery groups only. CONCLUSIONS: Continued WL with bariatric surgery is paralleled by favorable changes in eating behavior and food reward and preferences. By contrast, controls experienced weight regain at 1Y follow-up and no changes in eating behavior. These striking differences are likely to be important in the long-term WL management of individuals with severe obesity.

Adaptive thermogenesis, at the level of resting energy expenditure, after diet alone or diet plus bariatric surgery.

OBJECTIVE: The objective of this study was to compare the magnitude of adaptive thermogenesis (AT), at the level of resting energy expenditure (REE), after a very low-energy diet alone or combined with Roux-en-Y gastric bypass or sleeve gastrectomy, as well as to investigate the association between AT and changes in appetite. METHODS: A total of 44 participants with severe obesity underwent 10 weeks of a very low-energy diet alone or combined with Roux-en-Y gastric bypass or sleeve gastrectomy. Body weight and composition, REE, subjective appetite feelings, and plasma concentrations of gastrointestinal hormones were measured at baseline and week 11. AT, at the level of REE, was defined as a significantly lower measured versus predicted (using a regression model with baseline data) REE. RESULTS: Participants lost 18.4 ± 3.9 kg of body weight and experienced AT, at the level of REE (-121 ± 188 kcal/day; p < 0.001), with no differences among groups. The larger the AT, at the level of REE, the greater the reduction in fasting ghrelin concentrations and the smaller the reduction in feelings of hunger and desire to eat in the postprandial state. CONCLUSIONS: Weight-loss modality does not seem to modulate the magnitude of AT, at the level of REE. The greater the AT, at the level of REE, the greater the drive to eat following weight loss.

Impact of high Spirulina diet, extruded or supplemented with enzymes, on blood cells, systemic metabolites, and hepatic lipid and mineral profiles of broiler chickens.

The impact of 15% dietary inclusion of Spirulina (Arthrospira platensis) in broiler chickens was explored, focusing on blood cellular components, systemic metabolites and hepatic lipid and mineral composition. From days 14 to 35 of age, 120 broiler chickens were divided and allocated into four dietary treatments: a standard corn and soybean meal-based diet (control), a 15% Spirulina diet, a 15% extruded Spirulina diet, and a 15% Spirulina diet super-dosed with an enzyme blend (0.20% porcine pancreatin plus 0.01% lysozyme). The haematological analysis revealed no significant deviations (p > 0.05) in blood cell counts across treatments, suggesting that high Spirulina inclusion maintains haematological balance. The systemic metabolic assessment indicated an enhanced antioxidant capacity in birds on Spirulina diets (p < 0.001), pointing toward a potential reduction in oxidative stress. However, the study noted a detrimental impact on growth performance metrics, such as final body weight and feed conversion ratio (both p < 0.001), in the Spirulina-fed treatments, with the super-dosed enzyme blend supplementation failing to alleviate these effects but with extrusion mitigating them. Regarding hepatic composition, birds on extruded Spirulina and enzyme-supplemented diets showed a notable increase in n-3 fatty acids (EPA, DPA, DHA) (p < 0.001), leading to an improved n-6/n-3 PUFA ratio (p < 0.001). Despite this positive shift, a reduction in total hepatic lipids (p = 0.003) was observed without a significant change in cholesterol levels. Our findings underscore the need for further exploration into the optimal inclusion levels, processing methods and potential enzymatic enhancements of Spirulina in broiler diets. Ultimately, this research aims to strike a balance between promoting health benefits and maintaining optimal growth performance in poultry nutrition.

Parental Involvement and Stress in Children's Quality of Life: A Longitudinal Study with Portuguese Parents during the COVID-19 Pandemic Period.

Parental involvement (PI) has particular relevance on children's academic adjustment and on children's general quality of life (QoL). QoL can be influenced by parental stress, specifically the stress suffered during the COVID-19 pandemic. Thus, this study aimed to analyze the differences during the pandemic period (before, after and with no lockdown), comparing these constructs with parental educational level to provide predictors of their children's quality of life. Data collection was performed with a non-probability convenience sampling procedure. It was composed of 129 parents, mainly women (71.8%), with children aged between 6 and 12 years. The family's sociodemographic characteristics were assessed, as well as the PI, parental stress, and children's QoL. The comparison between the three times revealed an increase in the children's QoL, but no differences were found in PI. Based on the parental educational level, as defined by academic qualifications and split into superior and non-superior levels, it is possible conclude that engagement in school activities and parents' meetings increased in the parents with superior education levels and decreased in the parents with lower education levels. This study concluded that despite this difficult and uncertain pandemic period, these parents were able to maintain important aspects of their children's lives.

The Volunteer Functions Inventory (VFI): Adaptation and Psychometric Properties among a Portuguese Sample of Volunteers.

The Volunteer Functions Inventory (VFI) is an instrument widely used to assess volunteers' motivation based on the Functionalist Model of Omoto and Snyder. It assesses six factors that reflect several motivational functions. The VFI has been translated into various languages and validated in different cultural contexts, but some studies have reported different factor structures (e.g., five or four factors). In the Portuguese context, previous studies have also shown inconsistent results. The aim of this study was to adapt and validate the VFI for Portuguese volunteers, testing several alternative models (nine models) using confirmatory factor analysis. The sample comprised 468 volunteers (76.3% women), aged from 13 to 81 years (M = 36.66, SD = 14.93). The results support the original interrelated six-factor model as the best-fitting one. The VFI showed good internal consistency and convergent validity. Significant correlations were found between the VFI factors, organizational commitment, and volunteers' satisfaction. Overall, the six-factor VFI is a valid and reliable tool for measuring the motivational functions of Portuguese volunteers, with implications for practice and research in the volunteering field.

Suboptimal Weight Loss 13 Years After Roux-en-Y Gastric Bypass Is Associated with Blunted Appetite Response.

PURPOSE: Bariatric surgery remains the most efficient treatment to achieve a sustained weight loss. However, a large proportion of patients experience suboptimal weight loss (SWL). The exact mechanisms involved remain to be fully elucidated, but the homeostatic appetite control system seems to be involved. The aim of this study was, therefore, to compare the plasma concentration of gastrointestinal hormones, and appetite ratings, between those experiencing SWL and optimal weight loss (OWL) after Roux-en-Y gastric bypass (RYGB). MATERIALS AND METHODS: Fifty participants from the Bariatric Surgery Observation Study (BAROBS) experiencing either SWL or OWL (< or ≥ 50% of excess weight loss (EWL), respectively) > 13 years post-RYGB were compared to 25 non-surgical controls. Plasma concentrations of acylated ghrelin (AG), total glucagon-like peptide-1 (GLP-1), total peptide YY (PYY), cholecystokinin (CCK), and subjective ratings of hunger, fullness, desire to eat (DTE), and prospective food consumption (PFC) were assessed in the fasting and postprandial (area under the curve (AUC)) states. RESULTS: Those experiencing OWL presented with higher basal AG and GLP-1 iAUC, and lower AG iAUC compared with SWL and controls. Additionally, both bariatric groups presented with higher PYY and CCK iAUC compared to controls. PFC tAUC was also lower in OWL compared to the SWL group. Total weight loss was positively correlated with GLP-1 tAUC and negatively correlated with fasting and tAUC DTE and PFC tAUC. CONCLUSIONS: SWL > 13 years post-RYGB is associated with lower basal ghrelin, as well as a weaker satiety response to a meal. Future studies should investigate the causality of these associations.

A saúde indígena na atenção especializada: perspectiva dos profissionais de saúde em um hospital de referência no Mato Grosso do Sul, Brasil / Indigenous health in specialized care: perspective of healthcare professionals in a reference hospital in Mato Grosso do Sul State, Brazil / La salud indígena en la atención especializada: la perspectiva de los profesionales de la salud en un hospital de referencia en Mato Grosso do Sul, Brasil

Resumo: Trata-se de estudo transversal com o objetivo de identificar a perspectiva dos profissionais de saúde e residentes acerca dos desafios enfrentados no atendimento aos usuários indígenas em um hospital referência no Mato Grosso do Sul, estado brasileiro que comporta a segunda maior população indígena do país. O estudo utilizou questionário semiestruturado online, enviado por e-mail a cada trabalhador(a) no período entre junho e agosto de 2020. As variáveis discretas foram sintetizadas em média e desvio padrão e mediana e intervalo interquartil (nível de significância de 5%). Participaram do estudo 230 profissionais de saúde e 29 residentes. Entre eles, apenas 14,7% conheciam as etnias atendidas, e 60,2% nunca havia presenciado práticas tradicionais no hospital, indicando baixa articulação entre as formas de cuidado biomédico e indígena. Ao confrontar respostas dos residentes e profissionais, observou-se que residentes têm uma visão mais positiva acerca da aproximação com o contexto indígena, sugerindo que consideram importante melhorar essa articulação. Na comparação entre categorias profissionais, destacam-se algumas divergências de opiniões da categoria médica em relação à assistência. Além disso, profissionais e residentes demonstraram sentir algum nível de dificuldade no atendimento à população indígena. Os resultados evidenciam a centralidade do modelo biomédico, o desconhecimento dos profissionais sobre o contexto das comunidades atendidas e a desvalorização de suas práticas. Além disso, contribuem para discussões sobre as políticas de saúde nos diversos níveis de atenção e gestão, bem como na qualificação da assistência hospitalar aos indígenas.

Abstract: This cross-sectional study aims to identify the perspective of healthcare professionals and residents regarding the challenges faced in providing care to Indigenous users in a reference hospital in Mato Grosso do Sul, a Brazilian state with the second-largest Indigenous population in the country. The study used a semi-structured online questionnaire emailed to each worker between June and August 2020. The discrete variables were summarized as mean and standard deviation and median and interquartile range (5% significance level). Two hundred thirty healthcare professionals and 29 residents participated in the study. Among the findings, only 14.7% of participants knew the ethnicities served, and 60.2% had never witnessed traditional practices in the hospital, indicating low articulation between biomedical and Indigenous forms of care. When comparing responses from residents and professionals, residents were noted to have a more positive view of approaching the Indigenous context, suggesting that they consider it essential to improve this articulation. When comparing professional categories, some differences of opinion among the medical category stand out concerning assistance. In addition, professionals and residents demonstrated some level of difficulty in caring for the Indigenous population. The results highlight the centrality of the biomedical model, the professionals' lack of knowledge about the context of the communities served, and the devaluation of their practices. The findings contribute to discussions about healthcare policies at different levels of care and management and the qualification of hospital care for Indigenous people.

Resumen: Se trata de un estudio transversal con el objetivo de identificar la perspectiva de los profesionales de la salud y los médicos residentes sobre los desafíos que enfrentan en la atención a los usuarios indígenas en un hospital de referencia en Mato Grosso del Sur, el estado brasileño que tiene la segunda población indígena más grande del país. El estudio utilizó un cuestionario semiestructurado en línea, enviado por correo electrónico para cada trabajador y trabajadora entre los meses de junio y agosto de 2020. Se sintetizaron las variables discretas en media y desviación estándar, y mediana y rango intercuartílico (nivel de significación del 5%). Participaron del estudio 230 profesionales de la salud y 29 médicos residentes. En los resultados, solo el 14,7% de los participantes conocían las etnias atendidas, y el 60,2% nunca había presenciado prácticas tradicionales en el hospital, lo que indica una baja articulación entre las formas de atención biomédica e indígena. Al confrontar respuestas de los médicos residentes y los profesionales, se constató que los médicos residentes tienen una perspectiva más positiva sobre el acercamiento al contexto indígena, lo que sugiere que ellos consideran importante mejorar esta articulación. Al comparar las categorías profesionales, se destacan algunas divergencias de opinión de la categoría médica en relación con la asistencia. Además, los profesionales y los médicos residentes demostraron un cierto nivel de dificultad en la atención a la población indígena. Los resultados demuestran la centralidad del modelo biomédico, la falta de conocimiento de los profesionales sobre el contexto de las comunidades atendidas y la desvalorización de sus prácticas. Los resultados contribuyen a las discusiones sobre las políticas de salud en varios niveles de atención y gestión, así como en la calificación de la atención hospitalaria a los indígenas.

The Dark Side of Multimedia Devices: Negative Consequences for Socioemotional Development in Early Childhood.

There is growing concern about the relationship between screen use by young children and negative effects on their development, as children with developmental and socioemotional impairments tend to have difficulties in their relationships and increased academic problems. The aim of our study was to analyse the relationship between the use of multimedia devices and paediatric symptoms in children below 5 years old. Data from 534 Portuguese parents of children aged from 18 to 57 months were collected via a self-report questionnaire. Children's daily exposure to multimedia devices was nearly 2 h per day. Paediatric symptoms were positively associated with watching television and screen time and negatively associated with parents' working hours. Touchscreen use was more frequent among girls and older children. Parents' working hours comprised the most significant predictor of paediatric symptoms. Our findings reinforce past findings on the adverse links between the use of multimedia devices and paediatric symptoms and also highlight the influence of other variables like the child's age and gender, as well as parental factors. The need to both create a more comprehensive framework regarding the long-term effects of multimedia device use and delineate effective strategies for prevention and intervention with parents and children is discussed.

Metabolic adaptation is associated with a greater increase in appetite following weight loss: a longitudinal study.

BACKGROUND: Weight loss is associated with a disproportionate reduction in energy expenditure, along with increases in hunger feelings and ghrelin concentrations. These changes are presumed to be homeostatic mechanisms to counteract the energy deficit. The possibility that these 2 components of the energy balance equation are mechanistically linked has never been examined. OBJECTIVE: This study aimed to determine if the disproportionate reduction in resting metabolic rate (RMR) seen with weight loss is associated with changes in the plasma concentration of gastrointestinal hormones involved in appetite regulation and subjective appetite ratings. METHODS: This was a longitudinal study with repeated measurements. Fifty-six individuals with obesity (body mass index [BMI]: 34.5±0.5 kg/m2; age: 47±1 y; 26 males) underwent an 8 wk low-energy diet, followed by 4 wk of refeeding and weight stabilization. The RMR, respiratory quotient (RQ), body composition, plasma concentrations of ghrelin, glucagon-like peptide 1, peptide YY, cholecystokinin, insulin, and appetite ratings in the fasting and postprandial states were measured at baseline, Wk9 and 13. Metabolic adaptation was defined as significantly lower when measured versus the predicted RMR (pRMR) (from own regression model using baseline data). RESULTS: A 14.2±0.6 kg weight loss was seen at Wk9 and maintained at Wk13. RQ was significantly reduced at Wk9 (0.82±0.06 vs. 0.76±0.05, P< 0.001) but returned to baseline at Wk13. Metabolic adaptation was seen at Wk9, but not Wk13 (-341±58, P <0.001 and -75±72 kJ/d, P = 0.305, respectively). The larger the difference between measured and predicted RMR at both timepoints, the greater the increase in hunger, desire to eat, and composite appetite score (fasting and postprandial at Wk9, postprandial only at Wk13), even after adjusting for weight loss and RQ. CONCLUSION: A larger metabolic adaptation during weight loss is accompanied by a greater drive to eat. This might help explain the interindividual differences in weight loss outcomes to dietary interventions.