Left atrial function in patients with rheumatic mitral stenosis: addressing prognostic insights beyond atrial fibrillation prediction.

Aims: Rheumatic mitral stenosis (MS) frequently leads to impaired left atrial (LA) function because of pressure overload, highlighting the underlying atrial pathology. Two-dimensional speckle tracking echocardiography (2D-STE) offers early detection of LA dysfunction, potentially improving risk assessment in patients with MS. This study aims to evaluate the predictive value of LA function assessed by 2D-STE for clinical outcomes in patients with MS. Methods and results: Between 2011 and 2021, patients with MS underwent LA function assessment using 2D-STE, with focus on the reservoir phase (LASr). Atrial fibrillation (AF) development constituted the primary outcome, with death or valve replacement as the secondary outcome. Conditional inference trees were employed for analysis, validated through sample splitting. The study included 493 patients with MS (mean valve area 1.1 ± 0.4 cm2, 84% female). At baseline, 166 patients (34%) had AF, with 62 patients (19%) developing AF during follow-up. LASr emerged as the primary predictor for new-onset AF, with a threshold of 17.9%. Over a mean 3.8-year follow-up, 125 patients (25%) underwent mitral valve replacement, and 32 patients (6.5%) died. A decision tree analysis identified key predictors such as age, LASr, severity of tricuspid regurgitation (TR), net atrioventricular compliance (C n), and early percutaneous mitral valvuloplasty, especially in patients aged ≤49 years, where LASr, with a threshold of 12.8%, significantly predicted adverse outcomes. Conclusion: LASr emerged as a significant predictor of cardiovascular events in this MS cohort, validated through a decision tree analysis. Patients were stratified into low- or high-risk categories for adverse outcomes, taking into account LASr, age, TR severity, and C n.

Association between calf circumference and mortality in people receiving home enteral nutrition: A retrospective cohort study.

BACKGROUND: Among the anthropometric measurements, calf circumference has been widely used as a simple and practical method to diagnose low muscle mass and sarcopenia. However, the association between this measurement and clinical outcomes in people receiving home enteral nutrition is still unknown. Therefore, this study aimed to investigate the association of calf circumference with mortality, discharge from home enteral nutrition, continuity in home enteral nutrition, and new hospitalizations in adult and older adult people. METHODS: This retrospective cohort study used secondary data, including people aged ≥18 years receiving home enteral nutrition. The association between calf circumference and the outcomes of mortality, discharge from home enteral nutrition, and continuity in home enteral nutrition was analyzed using multinomial logistic regression. The association between calf circumference and the occurrence of new hospitalizations was investigated using binary logistic regression. RESULTS: Among the 899 people included in the study, 470 were men (52.3%), the median age was 72 years (interquartile range, 56.5-82), and 850 had inadequate calf circumference (94.5%). As calf circumference increased, the odds of mortality decreased and the probability of discharge from home enteral nutrition and continuity in home enteral nutrition increased. Furthermore, in people with oncologic diagnoses, the odds of new hospitalizations were reduced by 71.9% for each additional centimeter in calf circumference. CONCLUSION: These findings underline the importance of using calf circumference as part of the nutrition assessment because it is a simple, easy, and cost-effective method that can also be used as a tool to predict clinical outcomes.

Ultra-processed food consumption during pregnancy and newborn weight / Consumo de alimentos ultraprocessados durante a gestação e peso ao nascer do recém-nascido

Abstract Objectives: to assess the association between pregnant women's consumption of ultra-processed foods and newborn body weight. Methods: prospective study with pregnant women (n=214) selected from all Basic Health Units in the city of Pinhais, Paraná. Socioeconomic, demographic, and health data were collected. Food consumption data were assessed using a 24-hour dietary recall and tabulated with GloboDiet software. Daily relative energy intake of ultra-processed food was estimated and logistic regression analysis was utilized. The infuence of covariates on the association analysis was also explored (e.g., income and education). Results: ultra-processed foods contributed to 26.9% of pregnant women's total energy intake. About 5.7% of newborns were classifed as small-for-gestational-age and 10.7% as large-for-gestational-age. A borderline statistically signifcant association was observed between large-for-gestational-age newborn weight and maternal consumption of ultra-processed foods (OR= 1.027; p=0.048). Additionally, family income was associated with the consumption of ultra-processed foods (OR= 0.144; p=0.008). With each additional 1% consumption of ultra-processed foods, mothers' likelihood of having large-for-gestational-age babies increased by about 2.7%. Conclusions: the study reveals a trend of positive association between the weight of large-for-gestational-age newborns and the consumption of ultra-processed foods by pregnant women, but not for small-for-gestational-age children.

Resumo Objetivos: avaliar a associação entre o consumo de alimentos ultraprocessados por gestantes e o peso de recém-nascidos. Métodos: estudo prospectivo com gestantes (n=214) selecionadas em Unidades Básicas de Saúde em Pinhais, Paraná. Dados socioeconômicos, demográfcos e de saúde foram coletados. Dados de consumo alimentar foram coletados por recordatório de 24-horas físico e entrados no software GloboDiet. O consumo diário relativo de energia proveniente de alimentos ultraprocessados foi estimado e a análise de regressão logística foi utilizada, considerando covariáveis como renda familiar e escolaridade. Resultados: o consumo de alimentos ultraprocessados pelas gestantes representou 26,9% da energia total. Cerca de 5,7% de recém-nascidos foram classifcados como pequenos para idade gestacional (PIG) e 10,7% como grandes para idade gestacional (GIG). Foi observada uma associação estatisticamente signifcativa limítrofe entre o peso dos recém-nascidos GIG e o consumo materno de alimentos ultraprocessados (OR= 1,027; p=0,048). Além disso, a renda familiar esteve associada com o consumo de alimentos ultraprocessados (OR=0,144; p=0,008). A cada 1% adicional de consumo de alimentos ultraprocessados, a probabilidade de as mães terem recém-nascidos GIG aumentou cerca de 2,7%. Conclusões: o estudo revela uma tendência de associação positiva entre o peso de recém-nascidos GIG e o consumo de alimentos ultraprocessados por mulheres grávidas, mas não para crianças PIG.

Animal Welfare Science: Why and for Whom?

There are, in the literature, distinct ways to approach animal welfare. The objective of this work was to study the value attributed to farm animals in the scientific papers published in animal welfare and animal production journals at three different points in time, separated by a decade each. The first ten papers mentioning "animal welfare" or "animal well-being" in their objectives or hypotheses from each journal and each focus year were selected. The 180 papers were blindly scored by five assessors between 1 and 10, according to the degree of intrinsic value attributed to animals. The overall mean score and standard deviation were 5.60 ± 2.49, with 6.46 ± 2.29 and 4.74 ± 2.40 for AW and AP journals, respectively, and 5.37 ± 2.44, 5.68 ± 2.52 and 5.75 ± 2.41 for the focus years of 2000, 2010 and 2020, respectively. There was an interaction between focus year and publication area: papers from AW journals scored better over time, in contrast with papers from AP journals, for which scores remained similar over decades. The inter-assessor agreement is moderate, which may reflect the subject complexity, as the language used in the papers studied was ambiguous in relation to why and for whom it is performed. The low overall mean score evidenced that the animal welfare scientific publications are, on average, not prioritizing the interests of the animals. Thus, our results evidenced the presence of animal welfarism in animal welfare science, a problem that seems not to be intrinsic to animal welfare science itself, but rather to the way research is frequently conceived, conducted, interpreted, summarized and applied. Therefore, it seems urgent to further study the motivation for animal welfare research. The statement of the main justification for animal welfare papers, with an explicit declaration of the motivational priorities that constitute each scientific animal welfare study, may be an interesting recommendation for the improvement of animal welfare science.

Pre-Slaughter Stunning of Farmed Atlantic Halibut in CO2-Saturated Seawater: Assessment of Unconsciousness by Electroencephalography (EEG).

As fish welfare becomes a growing concern, it is important to ensure humane treatment during slaughter. This study aimed to assess the onset of unconsciousness in Atlantic halibut immersed in CO2-saturated seawater through electroencephalography (EEG). Of the 29 fish studied, 10 exhibited escape attempts, indicating aversion to CO2-saturated water despite its oxygenation. EEG signals showed four distinct phases: transitional, excitation (high amplitude-high frequency), suppressed, and iso-electric phases. The onset of the suppressed phase, indicative of unconsciousness, occurred on average 258.8 ± 46.2 s after immersion. The spectral analysis of the EEG signals showed a progressive decrease in median frequency, spectral edge frequency, and high frequency contribution, which corresponded to the gradual loss of consciousness. The study concludes that CO2-saturated water is not recommended for pre-slaughter handling of halibut due to the extended time required for the onset of unconsciousness and the observed aversive behaviour. Ensuring humane treatment during slaughter is important for addressing public concern and safeguarding fish welfare in all stages of production.

DEVELOPMENT AND VALIDATION OF A PSYCHOLOGICAL SCALE FOR BARIATRIC SURGERY: THE BARITEST.

BACKGROUND: It is recommended that bariatric surgery candidates undergo psychological assessment. However, no specific instrument exists to assess the psychological well-being of bariatric patients, before and after surgery, and for which all constructs are valid for both genders. AIMS: This study aimed to develop and validate a new psychometric instrument to be used before and after bariatric surgery in order to assess psychological outcomes of patients. METHODS: This is a cross-sectional study that composed of 660 individuals from the community and bariatric patients. BariTest was developed on a Likert scale consisting of 59 items, distributed in 6 constructs, which assess the psychological well-being that influences bariatric surgery: emotional state, eating behavior, quality of life, relationship with body weight, alcohol consumption, and social support. Validation of BariTest was developed by the confirmatory factor analysis to check the content, criteria, and construct. The R statistical software version 3.5.0 was used in all analyses, and a significance level of 5% was used. RESULTS: Adjusted indices of the confirmatory factor analysis model indicate adequate adjustment. Cronbach's alpha of BariTest was 0.93, which indicates good internal consistency. The scores of the emotional state, eating behavior, and quality of life constructs were similar between the results obtained in the community and in the postoperative group, being higher than in the preoperative group. Alcohol consumption was similar in the preoperative and postoperative groups and was lower than the community group. CONCLUSIONS: BariTest is a reliable scale measuring the psychological well-being of patients either before or after bariatric surgery.

Dietary patterns and associated factors of children under two years of age born prematurely.

OBJECTIVE: To identify the dietary patterns and associated factors of children aged between 6 and 23 months, born prematurely and assisted at a University Hospital in Curitiba, state of Paraná, Brazil. METHODS: The parents or guardians of the 135 children were asked about their children's eating habits and the family's socioeconomic and demographic conditions. Information regarding birth and health history were obtained from medical records. Data on food consumption were subjected to exploratory factor analysis and the principal component analysis method was used to estimate the factor loads. Multiple linear regression was performed to verify possible associations. RESULTS: Two dietary patterns were observed: "unhealthy" and "healthy." The "unhealthy" pattern was significantly associated with maternal age, the child's corrected age, and gestational age at birth. The "healthy pattern" was associated with the child's corrected age. Maternal age and child's corrected age remained significant after multiple regression analyses. For the "unhealthy" pattern, a positive effect was observed, suggesting that the consumption of this pattern is higher as the child's age increases and less intense for children with mothers aged 30 years or older. For the "healthy" dietary pattern, the same two variables showed statistical significance. The authors observed a direct proportion between the age and consumption of food groups in both patterns. CONCLUSIONS: These results indicate the importance of nutritional education for younger mothers regarding their children's eating practices, especially as the child grows.

Consumption of food groups and associated factors among children aged 6 to 23 months.

OBJECTIVE: To assess the consumption of food groups among children aged 6 to 23 months in day care centers and at home and its associated factors. METHODS: This is a population-based cross-sectional study conducted with children from nursery schools in Guaratuba, Paraná. Parents answered a socioeconomic and demographic questionnaire. Food consumption was assessed by directly weighing the meals offered at the day care center. At home, parents filled an estimated food record. The reported foods were classified into seven food groups. Minimum dietary diversity was calculated by the proportion of children who consumed foods from four or more groups. Data were analyzed by simple and multiple logistic regression, presented as odds ratios. RESULTS: A total of 213 children participated in this study. The average number of food groups consumed was 4.2±1.0 at home and 4.2±1.2 in day care centers. At the day care center, all children consumed grains, roots, and tubers, while at home, this rate was 99.1%. The egg group was the least consumed both at day care (6.6%) and at home (2.8%). At home, more than 60% of children consumed sweets and sugar-sweetened beverages. Children aged 12 to 23 months were more likely to consume milk and dairy products, as well as flesh foods. Higher income was associated with the consumption of legumes, and older maternal age with the consumption of fruits and vegetables. CONCLUSIONS: At home, children had a predominantly dairy-based diet and a high intake of ultra-processed foods. In day care centers, the consumption of healthy foods was higher, indicating the need for families to participate in the formation of healthy eating habits.

Development and validation of a psychological scale for bariatric surgery: the baritest / Desenvolvimento e validação de escala psicométrica para os pacientes de cirurgia bariátrica: o baritest

ABSTRACT BACKGROUND: It is recommended that bariatric surgery candidates undergo psychological assessment. However, no specific instrument exists to assess the psychological well-being of bariatric patients, before and after surgery, and for which all constructs are valid for both genders. AIMS: This study aimed to develop and validate a new psychometric instrument to be used before and after bariatric surgery in order to assess psychological outcomes of patients. METHODS: This is a cross-sectional study that composed of 660 individuals from the community and bariatric patients. BariTest was developed on a Likert scale consisting of 59 items, distributed in 6 constructs, which assess the psychological well-being that influences bariatric surgery: emotional state, eating behavior, quality of life, relationship with body weight, alcohol consumption, and social support. Validation of BariTest was developed by the confirmatory factor analysis to check the content, criteria, and construct. The R statistical software version 3.5.0 was used in all analyses, and a significance level of 5% was used. RESULTS: Adjusted indices of the confirmatory factor analysis model indicate adequate adjustment. Cronbach's alpha of BariTest was 0.93, which indicates good internal consistency. The scores of the emotional state, eating behavior, and quality of life constructs were similar between the results obtained in the community and in the postoperative group, being higher than in the preoperative group. Alcohol consumption was similar in the preoperative and postoperative groups and was lower than the community group. CONCLUSIONS: BariTest is a reliable scale measuring the psychological well-being of patients either before or after bariatric surgery.

RESUMO RACIONAL: Recomenda-se que os candidatos à cirurgia bariátrica sejam submetidos a uma avaliação psicológica. Contudo, não existe nenhum instrumento específico para avaliar os pacientes bariátricos, e que todos os construtos sejam válidos para ambos os sexos. OBJETIVOS: Desenvolver e validar um novo instrumento psicométrico para avaliar o bem-estar psicológico dos pacientes antes e após a cirurgia bariátrica. MÉTODOS: O estudo foi transversal e composto por 660 indivíduos da comunidade e pacientes bariátricos. O BariTest foi desenvolvido numa escala Likert composta por 59 itens, distribuídos em seis construtos, que avaliam o bem-estar psicológico que influenciam a cirurgia bariátrica: estado emocional, comportamento alimentar, qualidade de vida, relação com o peso corporal, consumo de álcool, e suporte social. A validação do BariTest foi feita pela validação de conteúdo, critério e construto e utilizou-se análise fatorial confirmatória. O software estatístico R versão 3.5.0, foi utilizado em todas as análises, com um nível de significância de 5%. RESULTADOS: Os índices ajustados do modelo análise fatorial confirmatória indicam um ajustamento adequado. O alfa de Cronbach do BariTest foi 0,93, o que indica uma boa consistência interna. As pontuações de estado emocional, comportamento alimentar e qualidade de vida foram semelhantes na comunidade e no grupo pós-operatório, sendo mais elevados do que no grupo pré-operatório. O consumo de álcool foi semelhante nos grupos pré e pós-operatórios e foi inferior ao do grupo comunitário. CONCLUSÕES: O BariTest é uma escala confiável que mede o bem-estar psicológico dos pacientes antes e após a cirurgia bariátrica.

Dietary patterns and associated factors of children under two years of age born prematurely / Padrões alimentares e fatores associados de crianças menores de dois anos nascidas prematuramente

ABSTRACT Objective: To identify the dietary patterns and associated factors of children aged between 6 and 23 months, born prematurely and assisted at a University Hospital in Curitiba, state of Paraná, Brazil. Methods: The parents or guardians of the 135 children were asked about their children's eating habits and the family's socioeconomic and demographic conditions. Information regarding birth and health history were obtained from medical records. Data on food consumption were subjected to exploratory factor analysis and the principal component analysis method was used to estimate the factor loads. Multiple linear regression was performed to verify possible associations. Results: Two dietary patterns were observed: "unhealthy" and "healthy." The "unhealthy" pattern was significantly associated with maternal age, the child's corrected age, and gestational age at birth. The "healthy pattern" was associated with the child's corrected age. Maternal age and child's corrected age remained significant after multiple regression analyses. For the "unhealthy" pattern, a positive effect was observed, suggesting that the consumption of this pattern is higher as the child's age increases and less intense for children with mothers aged 30 years or older. For the "healthy" dietary pattern, the same two variables showed statistical significance. The authors observed a direct proportion between the age and consumption of food groups in both patterns. Conclusions: These results indicate the importance of nutritional education for younger mothers regarding their children's eating practices, especially as the child grows.

RESUMO Objetivo: Identificar os padrões alimentares e fatores associados de crianças entre seis e 23 meses de idade, nascidas prematuramente e assistidas em um Hospital Universitário de Curitiba, Paraná. Métodos: Os pais ou responsáveis pelas 135 crianças foram questionados quanto aos hábitos alimentares dos filhos e as condições socioeconômicas e demográficas da família. Informações relativas ao nascimento e ao histórico de saúde foram obtidas dos prontuários. Os dados de consumo alimentar foram submetidos a análise fatorial exploratória e o método dos componentes principais foi utilizado para estimar as cargas fatoriais. Regressão linear múltipla foi realizada para verificar possíveis associações. Resultados: Foram observados dois padrões alimentares distintos. Aquele denominado de "não saudável" apresentou associação significativa com a idade materna, a idade corrigida da criança e a idade gestacional ao nascer. Por sua vez, o padrão denominado de "saudável" esteve associado à idade corrigida da criança. As variáveis idade materna e idade corrigida da criança permaneceram significativas após as análises de regressão múltipla. Para o padrão "não saudável", observou-se um efeito positivo, o que sugere que seu consumo é maior conforme a idade da criança aumenta e menos intenso para crianças com mães de 30 anos de idade ou mais. Para o padrão "saudável", as mesmas duas variáveis mostraram significância estatística. Observamos uma proporção direta entre idade e consumo dos grupos alimentares em ambos os padrões. Conclusões: Esses resultados apontam para a importância da educação nutricional de mães mais jovens quanto às práticas alimentares de seus filhos, especialmente à medida que a criança cresce.

From the Point of View of the Chickens: What Difference Does a Window Make?

We aimed to investigate what broiler chickens prefer when given free choice between a barn side with artificial lighting only as opposed to the other barn side with natural light through glass windows and artificial light. Eighty-five 1 day-old male Cobb 500 broiler chickens were divided into 10 pens; half of each pen area was provided with only artificial light (OAL) and the other half with natural and artificial light (NAL), and birds were free to move across sides. Environmental indicators and external conditions such as temperature, relative humidity, air velocity, ammonia and illuminance were monitored inside and outside the barn. Chickens' preference was registered each three days, divided in categories: I (at 9, 12, and 15 days), II (at 18, 21, 24, and 27 days), and III (at 30, 33 and 36 days). The effect of the interaction between environmental indicators and week was statistically different only for illuminance. Chickens preferred NAL to OAL from 18 days onwards (II p < 0.001; III p = 0.016). Drinking (p = 0.034) and exploration or locomotion (p = 0.042) behaviours were more frequent, and "not visible" behaviours (p < 0.001) were less frequent, in NAL. Foraging was the only behaviour with an interaction effect between age category and light treatment, as birds during period II expressed this behaviour more frequently in NAL than OAL (p = 0.003). For our experimental conditions, the chickens preferred NAL from 18 days of age onwards, when the confounding effect of the heating light was removed, and their behavioural repertoire was also different according to each side of the barn and to their ages.

Mind the Gap: Animal Protection Law and Opinion of Sheep Farmers and Lay Citizens Regarding Animal Maltreatment in Sheep Farming in Southern Brazil.

We aimed to study the gaps between the law and sheep farmer and citizen opinions regarding animal maltreatment by discussing the risk of sheep maltreatment in regular farming practices in Southern Brazil. We surveyed the perception of 56 farmers and 209 citizens regarding general animal and specific on-farm sheep maltreatment issues. The main themes from these two groups about the key components of animal maltreatment were similar: failing to provide for the basic animal needs (27.0%; 96 of 355 total quotes) and aggression or physical abuse (23.9%; 85/355). However, citizens (19.8%; 60/303) were more sensitive than farmers (9.6%; 5/52) to animal stress, suffering, fear, pain or painful procedures (p < 0.05). The perspective of citizens was closer than that of farmers to expert definitions for three situations: emaciation, movement restriction and tail docking without anesthetic use (p < 0.05). More citizens (71.6%; 116/162) than sheep farmers (49.0%; 24/49) believed that animal maltreatment occurs in sheep farming (p < 0.05), but nearly half of the farmers recognized sheep maltreatment within regular production practices. Most citizens (86.4%; 140/162) and all farmers (100.0%; 0/51) were unaware of any Brazilian animal protection law. Most citizens (79%; 131/167) stated that they would not purchase products from animals exposed to maltreatment. We suggest painful procedures as a major risk of animal maltreatment in sheep farming and a priority issue. With the many decades of animal protection laws and scientific recognition of animal sentience and welfare requirements, the level of cognitive dissonance and practical contradictions observed in our results indicate that mitigation policies are urgently needed.

A Cross-Cultural Adaptation of the Collective Efficacy Questionnaire for Sports (CEQS): Validity Evidence for a Brazilian Version.

This three-part study aimed to translate, cross-culturally adapt, and validate the Collective Efficacy Questionnaire for Sports (CEQS) for Brazilian athletes. In Study 1, six translators and six specialists developed a Portuguese version of the CEQS (the CEQS-B), and 10 experts and 10 sports participants provided content validity evidence based on test content. In Study 2, 553 athletes completed the CEQS-B, and we provided evidence of construct and convergent validity for the test's internal structure through factor analysis and of reliability evidence based on the instrument's internal consistency and temporal stability. In Study 3, 79 athletes completed both the new CEQS-B and the Group Cohesion Questionnaire, and we provided evidence of concurrent validity for the CEQS-B, based on its relationship to other variables, with specific strong correlations between team task cohesion and collective efficacy among these participants. Overall, the results of this study support the use of the CEQS-B by researchers and professionals wishing to assess various sport athletes' self-perceived collective efficacy.

Effects of Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07 Supplementation on Nutritional and Metabolic Parameters in the Early Postoperative Period after Roux-en-Y Gastric Bypass: a Randomized, Double-Blind, Placebo-Controlled Trial.

Studies have suggested that Roux-en-Y gastric bypass (RYGB) causes changes in the intestinal microbiota composition and function due to anatomical and physiological modifications. The role of probiotic supplementation after bariatric procedures remains to be determined. PURPOSE: The aim of this study was to investigate the effects of Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07 supplementation on nutritional and metabolic parameters after RYGB. MATERIALS AND METHODS: This is a randomized, double-blind, placebo-controlled clinical trial. Patients were assigned to receive either a probiotic supplement (FloraVantage®) or placebo for three consecutive months, beginning 7 days after surgery. Anthropometric and biochemical indexes were evaluated in the preoperative period and at the end of the study. RESULTS: Following RYGB, serum 25-OH vitamin D increased in both groups compared to baseline; however, this increase was significant only in the probiotic group (p = 0.004). Vitamin B12 levels tended to be higher in the probiotic group compared to the placebo group (p = 0.063), and triglyceride levels showed a significant reduction in the probiotic group only (p < 0.001). In addition, a significant reduction was observed in the anthropometric parameters and glycemic profile (p < 0.05) in both groups. CONCLUSION: Probiotic supplementation after RYGB improves the vitamin and lipid profile.

Individual and contextual predictors of children's hemoglobin levels from Southern Brazilian municipalities in social vulnerability.

Few studies have investigated the simultaneous effect of individual and contextual factors on the occurrences of anemia. This study aims to evaluate the variability of children's hemoglobin levels from municipalities in social vulnerability and its association with factors of individual and municipal nature. This is a cross-sectional, multi-center study, with children data (12-59 months) collected from 48 municipalities of the Southern region of Brazil, that were included in the Brazil Without Poverty Plan. Individuals' data were collected using a structured questionnaire, and secondary and ecological data of children's municipalities were collected via national surveys and institutional websites. The outcome was defined as the hemoglobin level obtained by HemoCue. A multilevel analysis was performed using Generalized Linear Models for Location Scale and Shape using R, with a 5% significance level. A total of 1,501 children were evaluated. The mean hemoglobin level was 12.8g/dL (95%CI: 12.7-12.8), with significant variability between municipalities. Lower values of hemoglobin were observed in children who lived in municipalities with a higher urbanization rate and a lower number of Community Health Agents, in relation to the reference categories. At the individual level, lower hemoglobin values were identified for children under 24 months, not enrolled at daycares, who were beneficiaries of the conditional cash transfer program and diagnosed with underweight. The results shed light on important factors at the municipal and the individual levels that were associated to the hemoglobin levels of children living in municipalities in social vulnerability.

Effects of Probiotics Supplementation on Gastrointestinal Symptoms and SIBO after Roux-en-Y Gastric Bypass: a Prospective, Randomized, Double-Blind, Placebo-Controlled Trial.

Bariatric surgery may cause undesirable gastrointestinal symptoms due to anatomical, functional and intestinal microbiota changes. PURPOSE: The aim of this study was to evaluate the effect of probiotic supplementation on gastrointestinal symptoms and small intestine bacterial overgrowth (SIBO) in patients after Roux-en-Y gastric bypass (RYGB). MATERIALS AND METHODS: This is a prospective, randomized, double-blind, placebo-controlled trial. The patients were randomized into Control Group (CG) (n = 39) and Probiotic Group (PG) (n = 34). The PG received tablets containing Lactobacillus acidophilus and Bifidobaterium lactis (5 billion CFU/strain) for 90 days, and the CG received tablets with starch. Both the Gastric Symptom Rating Scale (GSRS) questionnaire and 3-day food record were answered before surgery (T0) and after 45 days (T1) and 90 days of surgery (T2). At T0 and T2, hydrogen breath test was used to verify the presence of SIBO. RESULTS: The prevalence of SIBO was similar among times, and the mean score of GSRS responses did not differ between groups at any time. However, PG patients reported less bloating compared to CG, more abdominal pain at T1 (which reduced at T2), more episodes of soft stools and nausea and less hunger pain after surgery, with no reports of urgent episodes to evacuate, even though they consumed more fat than the CG. CONCLUSIONS: The supplementation of L. acidophilus and B. lactis is effective in reducing bloating, but without influencing the development of SIBO in the early postoperative period.

[Adherence to school food and associated factors among adolescents in public schools in the Southern region of Brazil]. / Adesão à alimentação escolar e fatores associados em adolescentes de escolas públicas na região Sul do Brasil.

The scope of this study was to analyze adherence to school food and associated factors among adolescents from public state schools in the municipality of Lapa, Paraná, in the Southern region of Brazil. The study uses a cross-sectional and analytical design and includes 492 male and female adolescents aged 10 to 19 years from five urban and five rural schools in the municipality. The students underwent anthropometric assessment and answered a questionnaire about school food and alternative food intakes (purchased or home-cooked). Their parents/guardians answered a questionnaire about their demographic and socioeconomic characteristics. An adjusted proportional odds regression model investigated the associations. The effective adherence to school food was 30.1% in rural schools and 23.7% in urban schools. Dislike of the food preparation was the main reason for non-adherence. The results showed lesser adherence among adolescents with higher per capita family income who consumed alternative food products four to five times per week. Adolescents who considered school food healthy showed higher adherence. Low adherence to school food indicates the inadequate universality of the program. The factors revealed may help to improve program planning and execution.

Objetivou-se analisar o índice de adesão à alimentação escolar e os fatores associados entre adolescentes matriculados em escolas públicas estaduais do município da Lapa, Paraná, sul do Brasil. De caráter transversal e analítico, incluiu 492 adolescentes de 10 a 19 anos de cinco escolas urbanas e cinco rurais do município. Foi aplicado um questionário sobre o consumo da alimentação escolar e de alimentos competitivos (aqueles comprados ou trazidos de casa) e realizada a avaliação antropométrica nos adolescentes. Os seus pais/responsáveis responderam um questionário demográfico e socioeconômico. Foi utilizado modelo de regressão de "odds" proporcionais ajustado para verificar as associações. O índice de adesão efetiva à alimentação escolar foi de 30,1% nas escolas rurais e de 23,7% nas urbanas. Não gostar das preparações servidas foi o principal motivo apontado para a não adesão. Observou-se menor adesão entre os adolescentes que possuíam maior renda familiar per capita e entre os que consumiam alimentos competitivos de 4 a 5x/semana. A adesão foi maior entre aqueles que consideravam a alimentação escolar saudável. Diante do baixo índice de adesão à alimentação escolar, a universalidade do atendimento não está sendo atingida. Os fatores apontados podem auxiliar em melhoras na execução do programa.

Adesão à alimentação escolar e fatores associados em adolescentes de escolas públicas na região Sul do Brasil / Adherence to school food and associated factors among adolescents in public schools in the Southern region of Brazil

Resumo Objetivou-se analisar o índice de adesão à alimentação escolar e os fatores associados entre adolescentes matriculados em escolas públicas estaduais do município da Lapa, Paraná, sul do Brasil. De caráter transversal e analítico, incluiu 492 adolescentes de 10 a 19 anos de cinco escolas urbanas e cinco rurais do município. Foi aplicado um questionário sobre o consumo da alimentação escolar e de alimentos competitivos (aqueles comprados ou trazidos de casa) e realizada a avaliação antropométrica nos adolescentes. Os seus pais/responsáveis responderam um questionário demográfico e socioeconômico. Foi utilizado modelo de regressão de "odds" proporcionais ajustado para verificar as associações. O índice de adesão efetiva à alimentação escolar foi de 30,1% nas escolas rurais e de 23,7% nas urbanas. Não gostar das preparações servidas foi o principal motivo apontado para a não adesão. Observou-se menor adesão entre os adolescentes que possuíam maior renda familiar per capita e entre os que consumiam alimentos competitivos de 4 a 5x/semana. A adesão foi maior entre aqueles que consideravam a alimentação escolar saudável. Diante do baixo índice de adesão à alimentação escolar, a universalidade do atendimento não está sendo atingida. Os fatores apontados podem auxiliar em melhoras na execução do programa.

Abstract The scope of this study was to analyze adherence to school food and associated factors among adolescents from public state schools in the municipality of Lapa, Paraná, in the Southern region of Brazil. The study uses a cross-sectional and analytical design and includes 492 male and female adolescents aged 10 to 19 years from five urban and five rural schools in the municipality. The students underwent anthropometric assessment and answered a questionnaire about school food and alternative food intakes (purchased or home-cooked). Their parents/guardians answered a questionnaire about their demographic and socioeconomic characteristics. An adjusted proportional odds regression model investigated the associations. The effective adherence to school food was 30.1% in rural schools and 23.7% in urban schools. Dislike of the food preparation was the main reason for non-adherence. The results showed lesser adherence among adolescents with higher per capita family income who consumed alternative food products four to five times per week. Adolescents who considered school food healthy showed higher adherence. Low adherence to school food indicates the inadequate universality of the program. The factors revealed may help to improve program planning and execution.

Individual and contextual predictors of children's hemoglobin levels from Southern Brazilian municipalities in social vulnerability / Preditores individuais e contextuais dos níveis de hemoglobina em crianças de municípios do Sul do Brasil com vulnerabilidade social / Predictores individuales y contextuales de los niveles de hemoglobina en niños socialmente vulnerables de municipios del Sur de Brasil

Abstract: Few studies have investigated the simultaneous effect of individual and contextual factors on the occurrences of anemia. This study aims to evaluate the variability of children's hemoglobin levels from municipalities in social vulnerability and its association with factors of individual and municipal nature. This is a cross-sectional, multi-center study, with children data (12-59 months) collected from 48 municipalities of the Southern region of Brazil, that were included in the Brazil Without Poverty Plan. Individuals' data were collected using a structured questionnaire, and secondary and ecological data of children's municipalities were collected via national surveys and institutional websites. The outcome was defined as the hemoglobin level obtained by HemoCue. A multilevel analysis was performed using Generalized Linear Models for Location Scale and Shape using R, with a 5% significance level. A total of 1,501 children were evaluated. The mean hemoglobin level was 12.8g/dL (95%CI: 12.7-12.8), with significant variability between municipalities. Lower values of hemoglobin were observed in children who lived in municipalities with a higher urbanization rate and a lower number of Community Health Agents, in relation to the reference categories. At the individual level, lower hemoglobin values were identified for children under 24 months, not enrolled at daycares, who were beneficiaries of the conditional cash transfer program and diagnosed with underweight. The results shed light on important factors at the municipal and the individual levels that were associated to the hemoglobin levels of children living in municipalities in social vulnerability.

Resumo: Poucos estudos investigaram o efeito simultâneo dos fatores individuais e contextuais sobre a ocorrência da anemia. O estudo procura avaliar a variabilidade dos níveis de hemoglobina em crianças de municípios com vulnerabilidade social e a associação com fatores individuais e municipais. Foi realizado um estudo transversal com dados de crianças de idade pré-escolar (12-59 meses) de um estudo multicêntrico em 48 municípios do Sul do Brasil, incluídos no Plano Brasil Sem Miséria. Os dados dos indivíduos foram coletados com um questionário estruturado, e os dados secundários e ecológicos dos municípios das crianças foram obtidos através de inquéritos nacionais e websites institucionais. O desfecho foi definido como o nível de hemoglobina, obtido com o sistema HemoCue. Foi realizada análise multinível usando modelos lineares generalizados para posição, escala e forma, no R, com nível de 5% de significância . Foram avaliadas 1.501 crianças. O nível médio de hemoglobina foi 12,8g/dL (IC95%: 12,7-12,8), com variabilidade significativa entre os municípios. Níveis de hemoglobina mais baixos foram observados nas crianças em municípios com taxas de urbanização mais altas e menor número de agentes comunitários de saúde, comparado com as categorias de referência. Em nível individual, níveis de hemoglobina mais baixos foram identificados em crianças abaixo de 24 meses, não matriculadas em creches, beneficiárias do Programa Bolsa Família e diagnosticadas com baixo peso. Os resultados destacam fatores importantes nos níveis municipal e individual que estão associados com os níveis de hemoglobina em crianças de municípios com vulnerabilidade social.

Resumen: Pocos estudios han investigado el efecto simultáneo de los factores individuales y contextuales en la incidencia de anemia. El objetivo de este estudio fue evaluar la variabilidad de los niveles de hemoglobina en niños socialmente vulnerables en municipios del sur de Brasil y su asociación con factores en el nivel individual y municipal. Se trata de un estudio trasversal con datos de niños (12-59 meses), procedentes de un estudio multicéntrico, realizado en 48 municipios de la región sur de Brasil, incluidos en el Plan Brasil sin Pobreza. Se recogieron los datos de los participantes, usando un cuestionario estructurado, así como datos secundarios y ecológicos de los municipios de los niños, a través de encuestas nacionales y sitios web institucionales. El resultado se definió como el nivel de hemoglobina obtenido por HemoCue. Se realizó un análisis multinivel, usando modelos lineales generalizados para la escala de localización y forma usando R, con un nivel de un 5% de significancia. Un total de 1.501 niños fueron evaluados. La media de nivel de hemoglobina fue 12,8g/dL (95%CI: 12,7-12,8), con una significativa variabilidad entre municipios. Los valores más bajos de hemoglobina se observaron en niños que vivían en municipios con unas tasas más altas de urbanización, y un número de agentes de salud comunitario más bajo, en relación con las categorías de referencia. En el nivel individual, los valores de hemoglobina más bajos fueron identificados en niños con menos de 24 meses, no matriculados en guarderías, beneficiarios de ayudas económicas, enmarcadas en programas de ayuda económica, y diagnosticados como con bajo peso. Los resultados aclararon importantes factores en el nivel municipal e individual que estaban asociados a los niveles de hemoglobina de niños residentes en municipios, así como vulnerables socialmente.

FOOD INTAKE EVALUATION DURING THE FIRST YEAR OF POSTOPERATIVE OF PATIENTS WITH TYPE 2 DIABETES MELLITUS OR GLYCEMIC ALTERATION SUBMITTED TO ROUX-EN-Y GASTRIC BYPASS.

BACKGROUND: : Obesity is one of the main causes of glycemic change. Failure of clinical obesity treatment may lead to an increase in bariatric surgery. Dietary guidance, in conjunction with disabsorptive and hormonal factors resulting from the anatomical and physiological changes provoked by the surgery, is associated with changes in food intake. AIM: To analyze food intake evolution during the first postoperative year of Roux-en-y gastric bypass in patients with type 2 diabetes mellitus or glycemic alteration. METHODS: : This was a longitudinal and retrospective observational study. For food intake evolution analysis, linear regression models with normal errors were adjusted for each of the nutrients. RESULTS: At 12 months, all patients presented improvement in glycemic levels (p<0.05). During the first postoperative year, there was a reduction in energy intake, macronutrients, consumption of alcoholic beverages and soft drinks. Conversely, there was an increase in fiber intake and diet fractionation. It was observed that, despite gastric restrictions, the micronutrient intake specifically recommended for glycemic control was greater up to six months postoperatively. CONCLUSION: There was change in the quantity and quality of food intake. It was the most prevalent glycemic control contributor up to six months postoperatively. At the end of one year, the diet underwent a change, showing a similar tendency to the preoperative food intake pattern.