Poverty-Food Insecurity Nexus in the Post-Construction Context of a Large Hydropower Dam in the Brazilian Amazon.

Within the 2030 Sustainable Development Agenda, large hydropower dams are positioned as a sustainable energy source, notwithstanding their adverse impacts on societies and ecosystems. This study contributed to ongoing discussions about the persistence of critical social issues, even after the investments of large amounts of resources in areas impacted by the construction of large hydropower dams. Our study focused on food insecurity and evaluated this issue in the city of Altamira in the Brazilian Amazon, which has been profoundly socially and economically impacted by the construction, between 2011 and 2015, of Brazil's second-largest dam, namely, Belo Monte. A survey in Altamira city featured a 500-household random sample. Structural equation modeling showed conditioning factors of 60% of the population experiencing varying food insecurity degrees. Poverty, female-led households, lower education, youth, and unemployment were strongly linked to higher food insecurity. Crowded, officially impacted, and resettled households also faced heightened food insecurity. Our findings underscore the food insecurity conditions in the region impacted by the Belo Monte dam, emphasizing the need to take into account this crucial issue while planning and implementing hydropower dams.

The EU-funded I3LUNG Project: Integrative Science, Intelligent Data Platform for Individualized LUNG Cancer Care With Immunotherapy.

Although immunotherapy (IO) has changed the paradigm for the treatment of patients with advanced non-small cell lung cancers (aNSCLC), only around 30% to 50% of treated patients experience a long-term benefit from IO. Furthermore, the identification of the 30 to 50% of patients who respond remains a major challenge, as programmed Death-Ligand 1 (PD-L1) is currently the only biomarker used to predict the outcome of IO in NSCLC patients despite its limited efficacy. Considering the dynamic complexity of the immune system-tumor microenvironment (TME) and its interaction with the host's and patient's behavior, it is unlikely that a single biomarker will accurately predict a patient's outcomes. In this scenario, Artificial Intelligence (AI) and Machine Learning (ML) are becoming essential to the development of powerful decision-making tools that are able to deal with this high-complexity and provide individualized predictions to better match treatments to individual patients and thus improve patient outcomes and reduce the economic burden of aNSCLC on healthcare systems. I3LUNG is an international, multicenter, retrospective and prospective, observational study of patients with aNSCLC treated with IO, entirely funded by European Union (EU) under the Horizon 2020 (H2020) program. Using AI-based tools, the aim of this study is to promote individualized treatment in aNSCLC, with the goals of improving survival and quality of life, minimizing or preventing undue toxicity and promoting efficient resource allocation. The final objective of the project is the construction of a novel, integrated, AI-assisted data storage and elaboration platform to guide IO administration in aNSCLC, ensuring easy access and cost-effective use by healthcare providers and patients.

[Validity of an instrument for screening households at risk of food insecurity in different strata of the Brazilian population]. / Validade do instrumento para triagem de domicílios em risco de insegurança alimentar em diversos estratos da população brasileira.

The absence of risk screening tools for food insecurity compromises the ability to assess, monitor, and provide immediate assistance to those in hunger, especially during emergencies such as the COVID-19 crisis. Hence, this study sought to test the validity of an instrument for Screening Households at Risk of Food Insecurity (TRIA) in different strata of the Brazilian population TRIA uses questions 2 and 4 of the Brazilian Food Insecurity Scale (EBIA), originally validated using data from the Brazilian National Survey of Demography and Health of Children and Women (PNDS 2006). In this study, using data from the Brazilian National Household Sample Survey (PNAD 2013), its reproducibility was tested by repeating the original combinatorial procedures, examining whether the parameters of sensitivity, specificity, accuracy, and positive predictive values (PPV) and negative values (NPV) would result in the same arrangement of questions. Moreover, convergent validity was analyzed by comparing the strength of association between food insecurity and dietary variables using two binomial regression models (TRIA x EBIA). Results indicated that the combination of questions 2 and 4 performed best among the population strata studied, and presented optimal convergent validity. PPV and NPV adjusted for food insecurity prevalence in states ranged from 42.8% (Santa Catarina) to 87.6% (Amazonas) and 95.8% (Amazonas) to 99.5% (Santa Catarina), respectively. In conclusion, besides being reproducible, TRIA presented excellent validity parameters, especially among vulnerable groups. It can thus be used in care practice and as an instrument of food and nutritional surveillance in Brazil.

A ausência de instrumentos de triagem de risco para insegurança alimentar compromete a capacidade de avaliar, monitorar e ofertar assistência imediata a pessoas em situação de fome, especialmente durante emergências, como a crise da COVID-19. Assim, o objetivo deste estudo foi testar a validade do instrumento de Triagem para Risco de Insegurança Alimentar (TRIA), em diversos estratos da população brasileira. A TRIA é composta pelas questões 2 e 4 da Escala Brasileira de Insegurança Alimentar (EBIA), validada, originalmente, a partir de dados da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS 2006). Neste estudo, utilizando dados da Pesquisa Nacional por Amostra de Domicílios (PNAD 2013), testou-se sua reprodutibilidade por meio da repetição dos procedimentos combinatórios originais, examinando se os parâmetros de sensibilidade, especificidade, acurácia e valores preditivos positivo (VPP) e negativo (VPN) resultariam no mesmo arranjo de questões. Ainda, analisou-se a validade convergente comparando a força de associação entre insegurança alimentar e variáveis alimentares por meio de dois modelos de regressão binomial (TRIA x EBIA). Os resultados indicaram que a combinação das questões 2 e 4 apresentou melhor desempenho entre os estratos populacionais estudados, além de ótima validade convergente. O VPP e VPN ajustado pela prevalência de insegurança alimentar nos estados variou de 42,8% (Santa Catarina) a 87,6% (Amazonas) e 95,8% (Amazonas) a 99,5% (Santa Catarina), respectivamente. Em conclusão, além de ser reprodutível, a TRIA apresentou excelentes parâmetros de validade, sobretudo em grupos vulnerabilizados. Assim, seu uso pode ser recomendado na prática assistencial e como instrumento de vigilância alimentar e nutricional no Brasil.

La ausencia de instrumentos de triaje de riesgo para la inseguridad alimentaria compromete la capacidad de evaluar, monitorear y brindar asistencia inmediata a las personas en situación de hambre, especialmente durante emergencias como la crisis de la COVID-19. Por lo tanto, el objetivo de este estudio fue probar la validez del instrumento de Triaje para Riesgo de Inseguridad Alimentaria (TRIA) en diferentes estratos de la población brasileña. El TRIA consta de las preguntas 2 y 4 de la Escala Brasileña de Inseguridad Alimentaria (EBIA), originalmente validada con base en datos de la Encuesta Nacional de Demografía y Salud de la Mujer y el Niño (PNDS 2006). En este estudio, utilizando datos de la Encuesta Nacional por Muestra de Domicilios (PNAD 2013), se probó su reproducibilidad repitiendo los procedimientos combinatorios originales, examinando si los parámetros de sensibilidad, especificidad, exactitud y valores predictivos positivos (VPP) y negativo (VPN) resultarían en el mismo arreglo de preguntas. Además, se analizó la validez convergente comparando la fuerza de asociación entre la inseguridad alimentaria y las variables alimentarias por medio de dos modelos de regresión binomial (TRIA x EBIA). Los resultados indicaron que la combinación de las preguntas 2 y 4 presentó el mejor desempeño entre los estratos poblacionales estudiados, además de excelente validez convergente. El VPP y el VPN ajustado por la prevalencia de inseguridad alimentaria en los estados osciló entre el 42,8% (Santa Catarina) y el 87,6% (Amazonas) y entre el 95,8% (Amazonas) y el 99,5% (Santa Catarina), respectivamente. En conclusión, además de ser reproducible, el TRIA presentó excelentes parámetros de validez, especialmente en grupos en situación de vulnerabilidad. Por lo tanto, se puede recomendar su uso en la práctica asistencial y como instrumento para la vigilancia alimentaria y nutricional en Brasil.

National Trends and Disparities in Severe Food Insecurity in Brazil between 2004 and 2018.

Background: The Brazilian Household Food Insecurity Measurement Scale (EBIA) is the main tool for assessing household food insecurity (FI) in Brazil and facilitates the monitoring and improvement of national public policies to promote food security. Since 2004, the Brazilian government has conducted National Household Sample Surveys, and in 2018, the government carried out the last national evaluation of FI. Objectives: To describe trends in severe FI in Brazil from 2004 to 2018. Methods: Data from 3 cross-sectional Brazilian National Household Sample Surveys (sample sizes: 2004 = 112,530; 2009 = 120,910; 2013 = 116,196) and from the last Household Budget Survey (sample size = 57,920) that assessed the status of FI using the EBIA were analyzed. Changes in severe FI during 2 periods (2004-2013; 2013-2018) were estimated while considering sociodemographic factors. Results: The period between 2004 and 2013 was marked by a significant decrease in severe FI (-53.6%), but this trend reversed in 2013-2018 (+43.8%). The greatest decrease in severe FI occurred in the Northeast (-57.6%) among households where the reference person was a man (-57.6%) and self-identified as white (-58.1%) (2004-2013). In 2013-2018, households with children aged ≤4 y (+6.3%) and members aged ≥65 y (+12.5%) experienced the lowest increases in severe FI. Conclusions: After a significant reduction from 2004 to 2013, severe FI increased sharply from 2013 to 2018, likely due to disruptions in public policies aimed at reducing hunger and unemployment rates.

Manifestaciones mucocutáneas en pacientes hospitalizados por COVID 19 en un hospital de alta complejidad / Mucocutaneous manifestations in patients hospitalized with covid-19 in a high complexity hospital

Resumen Introducción: el SARS-CoV-2 es un virus ARN de cadena simple que compromete diferentes órganos, incluyendo la piel. Los pacientes que cursan con este virus pueden presentar diferentes manifestaciones mucocutáneas. Objetivo: determinar la prevalencia de las lesiones mucocutáneas en pacientes hospitalizados por infección SARS-CoV-2/COVID 19 en el Hospital San Vicente Fundación Rionegro entre abril y junio del 2021. Materiales y métodos: estudio descriptivo transversal en pacientes hospitalizados con diagnóstico de infección por COVID-19 confirmado por pruebas serológicas y con lesiones mucocutáneas. Resultados: de 600 pacientes hospitalizados por COVID-19, 16 presentaron lesiones mucocutáneas para una prevalencia del 2,6%, y entre estos, 13 requirieron manejo en unidad de cuidados intensivos por síndrome de dificultad respiratoria aguda severa o enfermedad severa (81,25%) asociado a marcadores de mal pronóstico elevados. Los más elevados fueron la PCR, LDH o la presencia de linfopenia. Las lesiones vasculares fueron las más frecuentes (42,9%), que se manifestaron como púrpuras, vasculitis, livedo racemosa, perniosis y pseudoperniosis. Las erupciones o exantemas fueron de tipo maculopapulares (28,6%), eritematosas (19%) y urticariales (9,5%); además de úlceras en cavidad oral (8,8%) y vesículas (2,9%). El 75% de estos pacientes presentaron lesiones cutáneas en la fase activa de la enfermedad y el 25% en la fase resolutiva. Las morbilidades más frecuentes fueron hipertensión arterial (30%) y diabetes (20%). Seis pacientes fallecieron (37,5%). Conclusiones: las manifestaciones mucocutáneas asociadas al COVID-19, especialmente las de tipo vascular como las púrpuras, vasculitis y livedo racemosa, se asocian a formas graves de la enfermedad, especialmente en pacientes con ventilación mecánica asistida con un alto índice de mortalidad.

Abstract Introduction: SARS-CoV-2 is a single-stranded RNA virus that affects different organs, including the skin. Patients with this virus can present different mucocutaneous manifestations. Objective: to determine the prevalence of skin lesions in patients hospitalized for SARS-CoV-2 / COVID 19 infection at the Hospital San Vicente Fundación Rionegro between April and June 2021. Materials and methods: descriptive cross-sectional study in hospitalized patients with a diagnosis of infection by COVID-19 confirmed by serological tests and with mucocutaneous lesions. Results: of 600 patients hospitalized for COVID-19, 16 presented mucocutaneous lesions for a prevalence of 2,6 %, and among these, 13 required management in the intensive care unit due to severe acute respiratory distress syndrome or severe illness (81,25%) associated with elevated markers of poor prognosis. The most increased were PCR, LDH and/or lymphopenia. Vascular lesions were the most frequent (42,9%), manifested as purples, vasculitis, livedo racemosa, perniosis and pseudoperniosis. The eruptions or rashes were maculopapular (28.6%), erythematous (19%) and urticarial (9,5%), and ulcers in the oral cavity (8,8%) and vesicles (2,9%). 75% of these patients had skin lesions in the active phase of the disease and 25% in the resolution phase. The most frequent morbidity was arterial hypertension (30%) and diabetes (20%). six patients (37,5%) died. Conclusions: the mucocutaneous manifestations associated with COVID-19, especially those of a vascular type such as purples, vasculitis and livedo racemosa, are associated with severe forms of the disease, especially in patients with assisted mechanical ventilation with a high mortality rate.

Validade do instrumento para triagem de domicílios em risco de insegurança alimentar em diversos estratos da população brasileira / Validity of an instrument for screening households at risk of food insecurity in different strata of the Brazilian population / Validez del instrumento de triaje de hogares en riesgo de inseguridad alimentaria en diferentes estratos de la población brasileña

A ausência de instrumentos de triagem de risco para insegurança alimentar compromete a capacidade de avaliar, monitorar e ofertar assistência imediata a pessoas em situação de fome, especialmente durante emergências, como a crise da COVID-19. Assim, o objetivo deste estudo foi testar a validade do instrumento de Triagem para Risco de Insegurança Alimentar (TRIA), em diversos estratos da população brasileira. A TRIA é composta pelas questões 2 e 4 da Escala Brasileira de Insegurança Alimentar (EBIA), validada, originalmente, a partir de dados da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS 2006). Neste estudo, utilizando dados da Pesquisa Nacional por Amostra de Domicílios (PNAD 2013), testou-se sua reprodutibilidade por meio da repetição dos procedimentos combinatórios originais, examinando se os parâmetros de sensibilidade, especificidade, acurácia e valores preditivos positivo (VPP) e negativo (VPN) resultariam no mesmo arranjo de questões. Ainda, analisou-se a validade convergente comparando a força de associação entre insegurança alimentar e variáveis alimentares por meio de dois modelos de regressão binomial (TRIA x EBIA). Os resultados indicaram que a combinação das questões 2 e 4 apresentou melhor desempenho entre os estratos populacionais estudados, além de ótima validade convergente. O VPP e VPN ajustado pela prevalência de insegurança alimentar nos estados variou de 42,8% (Santa Catarina) a 87,6% (Amazonas) e 95,8% (Amazonas) a 99,5% (Santa Catarina), respectivamente. Em conclusão, além de ser reprodutível, a TRIA apresentou excelentes parâmetros de validade, sobretudo em grupos vulnerabilizados. Assim, seu uso pode ser recomendado na prática assistencial e como instrumento de vigilância alimentar e nutricional no Brasil.

The absence of risk screening tools for food insecurity compromises the ability to assess, monitor, and provide immediate assistance to those in hunger, especially during emergencies such as the COVID-19 crisis. Hence, this study sought to test the validity of an instrument for Screening Households at Risk of Food Insecurity (TRIA) in different strata of the Brazilian population TRIA uses questions 2 and 4 of the Brazilian Food Insecurity Scale (EBIA), originally validated using data from the Brazilian National Survey of Demography and Health of Children and Women (PNDS 2006). In this study, using data from the Brazilian National Household Sample Survey (PNAD 2013), its reproducibility was tested by repeating the original combinatorial procedures, examining whether the parameters of sensitivity, specificity, accuracy, and positive predictive values (PPV) and negative values (NPV) would result in the same arrangement of questions. Moreover, convergent validity was analyzed by comparing the strength of association between food insecurity and dietary variables using two binomial regression models (TRIA x EBIA). Results indicated that the combination of questions 2 and 4 performed best among the population strata studied, and presented optimal convergent validity. PPV and NPV adjusted for food insecurity prevalence in states ranged from 42.8% (Santa Catarina) to 87.6% (Amazonas) and 95.8% (Amazonas) to 99.5% (Santa Catarina), respectively. In conclusion, besides being reproducible, TRIA presented excellent validity parameters, especially among vulnerable groups. It can thus be used in care practice and as an instrument of food and nutritional surveillance in Brazil.

La ausencia de instrumentos de triaje de riesgo para la inseguridad alimentaria compromete la capacidad de evaluar, monitorear y brindar asistencia inmediata a las personas en situación de hambre, especialmente durante emergencias como la crisis de la COVID-19. Por lo tanto, el objetivo de este estudio fue probar la validez del instrumento de Triaje para Riesgo de Inseguridad Alimentaria (TRIA) en diferentes estratos de la población brasileña. El TRIA consta de las preguntas 2 y 4 de la Escala Brasileña de Inseguridad Alimentaria (EBIA), originalmente validada con base en datos de la Encuesta Nacional de Demografía y Salud de la Mujer y el Niño (PNDS 2006). En este estudio, utilizando datos de la Encuesta Nacional por Muestra de Domicilios (PNAD 2013), se probó su reproducibilidad repitiendo los procedimientos combinatorios originales, examinando si los parámetros de sensibilidad, especificidad, exactitud y valores predictivos positivos (VPP) y negativo (VPN) resultarían en el mismo arreglo de preguntas. Además, se analizó la validez convergente comparando la fuerza de asociación entre la inseguridad alimentaria y las variables alimentarias por medio de dos modelos de regresión binomial (TRIA x EBIA). Los resultados indicaron que la combinación de las preguntas 2 y 4 presentó el mejor desempeño entre los estratos poblacionales estudiados, además de excelente validez convergente. El VPP y el VPN ajustado por la prevalencia de inseguridad alimentaria en los estados osciló entre el 42,8% (Santa Catarina) y el 87,6% (Amazonas) y entre el 95,8% (Amazonas) y el 99,5% (Santa Catarina), respectivamente. En conclusión, además de ser reproducible, el TRIA presentó excelentes parámetros de validez, especialmente en grupos en situación de vulnerabilidad. Por lo tanto, se puede recomendar su uso en la práctica asistencial y como instrumento para la vigilancia alimentaria y nutricional en Brasil.

Validity of a 2-item screening tool to identify families at risk for food insecurity in Brazil.

This manuscript aimed to develop a brief 2-item screening tool to identify Brazilian households that include families with children at risk for food insecurity. Psychometric analyses including sensitivity, specificity, positive and negative predictive value, accuracy, and ROC curves were used to test combinations of questions to determine the most effective screener to assess households at risk for food insecurity when compared to a gold standard scale. Participants included Brazilian National Survey of Demography and Health on Women and Children (PNDS) surveyed households with a valid Brazilian Food Insecurity Scale (EBIA) response. The sample included 3,920 households representing 11,779,686 households when expanded using PNDS sample weights. With overall prevalence of food insecurity at 21%, a Brazilian 2-item food-insecurity screen showed sensitivity of 79.31%, specificity of 92.95%, positive predictive value of 74.62%, negative predictive value of 94.5% and ROC area 86.13%. This screen also presented high convergent validity for children's nutrition and health variables when compared with the gold standard, the EBIA full scale. Based on its ability to detect households at risk for food insecurity, a 2-item screening tool is recommended for widespread adoption as a screening measure throughout Brazil, especially when rapid decision-making has been made fundamental, as under the COVID-19 pandemic. This screener can enable providers to accurately identify families at risk for food insecurity and promptly intervene to prevent or ameliorate adverse health and developmental consequences associated with food insecurity and swiftly respond to crises.

Validity of a 2-item screen to identify families at risk for food insecurity in Brazil

This manuscript aimed to develop a brief 2-item screening tool to identify Brazilian households that include families with children at risk for food insecurity. Psychometric analyses including sensitivity, specificity, positive and negative predictive value, accuracy, and ROC curves were used to test combinations of questions to determine the most effective screener to assess households at risk for food insecurity when compared to a gold standard scale. Participants included National Demographic Health Survey on Women and Children (PNDS-2006) surveyed households with a valid Brazilian Household Food Insecurity Measurement Scale (EBIA) response. The sample included 3,920 households representing 11,779,686 households when expanded using PNDS sample weights. With overall prevalence of food insecurity at 21%, a Brazilian 2-item food-insecurity screen showed sensitivity of 79.31%, specificity of 92.95%, positive predictive value of 74.62%, negative predictive value of 94.50% and ROC area 86.13%. This screen also presented high convergent validity for children's nutrition and health variables when compared with the gold standard, the EBIA full scale. Based on its ability to detect households at risk for food insecurity, a 2-item screening tool is recommended for widespread adoption as a screening measure throughout Brazil, especially when rapid decision-making has been made fundamental, as under the COVID-19 pandemic. This screener can enable providers to accurately identify families at risk for food insecurity and promptly intervene to prevent or ameliorate adverse health and developmental consequences associated with food insecurity and swiftly respond to crises.

Thiamine Deficiency Increases Intrinsic Excitability of Mouse Cerebellar Purkinje Cells.

Thiamine deficiency is associated with cerebellar dysfunction; however, the consequences of thiamine deficiency on the electrophysiological properties of cerebellar Purkinje cells are poorly understood. Here, we evaluated these parameters in brain slices containing cerebellar vermis. Adult mice were maintained for 12-13 days on a thiamine-free diet coupled with daily injections of pyrithiamine, an inhibitor of thiamine phosphorylation. Morphological analysis revealed a 20% reduction in Purkinje cell and nuclear volume in thiamine-deficient animals compared to feeding-matched controls, with no reduction in cell count. Under whole-cell current clamp, thiamine-deficient Purkinje cells required significantly less current injection to fire an action potential. This reduction in rheobase was not due to a change in voltage threshold. Rather, thiamine-deficient neurons presented significantly higher input resistance specifically in the voltage range just below threshold, which increases their sensitivity to current at these critical membrane potentials. In addition, thiamine deficiency caused a significant decrease in the amplitude of the action potential afterhyperpolarization, broadened the action potential, and decreased the current threshold for depolarization block. When thiamine-deficient animals were allowed to recover for 1 week on a normal diet, rheobase, threshold, action potential half-width, and depolarization block threshold were no longer different from controls. We conclude that thiamine deficiency causes significant but reversible changes to the electrophysiology properties of Purkinje cells prior to pathological morphological alterations or cell loss. Thus, the data obtained in the present study indicate that increased excitability of Purkinje cells may represent a leading indicator of cerebellar dysfunction caused by lack of thiamine.

Food insecurity, food expenses and consumption of sugar and soft drinks in households with and without children and/or adolescents / Insegurança alimentar, gasto com alimentos e consumo de açúcar e refrigerante em domicílios com e sem crianças e/ou adolescentes

ABSTRACT Objectives To estimate the frequency of food insecurity in households with and without children/adolescents; compare food expenses, sugar and soft drinks consumption in these households; and to analyze the relationship between food insecurity and demographic/socioeconomic variables with food expenses, and sugar and soft drinks consumption in households with and without children/adolescents. Methods Cross-sectional study with 628 households in Campinas, SP, Brazil. Food insecurity was estimated by the Brazilian Household Food Insecurity Measurement Scale. The dependent variables were the proportion of food expenses, and consumption of sugar and soft drinks; and the independent ones included food security/insecurity condition, monthly family income, gender, age and education of the household head. Results The frequency of food insecurity was higher in households with children/adolescents than in households without minors (41.4% vs. 27.9%). The proportion of food expenses was higher in households with children/adolescents and in all households it was associated with lower family income and, in households with minors, to the presence of a female householder. Soft drinks consumption was higher in households with children/adolescents; and was related to higher income in all households, and to the presence of male householder in households with minors. Sugar consumption in households with children/adolescents was associated with higher income, male gender and education level of the household head (<12 years). In households without children/adolescents, the higher sugar consumption was associated with food insecurity and the household head's education (<8 years). Conclusion In households with children/adolescents there was a greater frequency of food insecurity and a greater commitment of income with food. Food insecurity was associated with increased sugar consumption in households without children/adolescents.

RESUMO Objetivos Estimar a frequência de insegurança alimentar em domicílios com e sem crianças/adolescentes; comparar o gasto com alimentos e o consumo de açúcar e de refrigerante nestes domicílios; e analisar a relação da insegurança alimentar e de variáveis demográficas/socioeconômicas com o gasto com alimentos e com o consumo de açúcar e de refrigerante em domicílios com e sem crianças/adolescentes. Métodos Estudo transversal com 628 domicílios de Campinas, SP, Brasil. A insegurança alimentar foi estimada pela Escala Brasileira de Insegurança Alimentar. As variáveis dependentes foram proporção de gasto com alimentos e consumo de açúcar e refrigerante; as independentes incluíram condição de segurança/insegurança alimentar, renda familiar mensal, sexo, idade e escolaridade do chefe da família. Resultados A frequência de insegurança alimentar foi maior nos domicílios com crianças/adolescentes do que nos domicílios sem menores (41,4% vs. 27,9%). A proporção de gasto com alimentos foi superior nos domicílios com crianças/adolescentes; em todos esteve associada ao menor rendimento familiar e, nos domicílios com menores, à presença de chefe da família do sexo feminino. O consumo de refrigerante foi maior em domicílios com crianças/adolescentes, relacionou-se à maior renda em todos os domicílios e à presença de chefe da família do sexo masculino em domicílios com menores. O consumo de açúcar nos domicílios com crianças/adolescentes associou-se à maior renda, sexo masculino e escolaridade do chefe <12 anos. Nos domicílios sem crianças/adolescentes, o maior consumo de açúcar esteve associado à insegurança alimentar e à escolaridade do chefe da família <8 anos. Conclusão Nos domicílios com crianças/adolescentes, houve maior frequência de insegurança alimentar e maior comprometimento da renda com a alimentação. A insegurança alimentar associou-se ao aumento do consumo de açúcar em domicílios sem crianças/adolescentes.

Validity of a 2-item screening tool to identify families at risk for food insecurity in Brazil / Validade de um instrumento de triagem com dois itens para identificar famílias em risco de insegurança alimentar no Brasil / Validez de un instrumento de 2-ítems para identificar a familias en riesgo de inseguridad alimentaria en Brasil

This manuscript aimed to develop a brief 2-item screening tool to identify Brazilian households that include families with children at risk for food insecurity. Psychometric analyses including sensitivity, specificity, positive and negative predictive value, accuracy, and ROC curves were used to test combinations of questions to determine the most effective screener to assess households at risk for food insecurity when compared to a gold standard scale. Participants included Brazilian National Survey of Demography and Health on Women and Children (PNDS) surveyed households with a valid Brazilian Food Insecurity Scale (EBIA) response. The sample included 3,920 households representing 11,779,686 households when expanded using PNDS sample weights. With overall prevalence of food insecurity at 21%, a Brazilian 2-item food-insecurity screen showed sensitivity of 79.31%, specificity of 92.95%, positive predictive value of 74.62%, negative predictive value of 94.5% and ROC area 86.13%. This screen also presented high convergent validity for children's nutrition and health variables when compared with the gold standard, the EBIA full scale. Based on its ability to detect households at risk for food insecurity, a 2-item screening tool is recommended for widespread adoption as a screening measure throughout Brazil, especially when rapid decision-making has been made fundamental, as under the COVID-19 pandemic. This screener can enable providers to accurately identify families at risk for food insecurity and promptly intervene to prevent or ameliorate adverse health and developmental consequences associated with food insecurity and swiftly respond to crises.

O estudo teve como objetivo desenvolver um instrumento de triagem breve com dois itens para identificar famílias brasileiras com filhos em risco de insegurança alimentar. Foram utilizadas análises psicométricas, inclusive sensibilidade, especificidade, valor preditivo positivo e negativo, acurácia e curvas ROC, para testar as combinações de perguntas e determinar o instrumento mais eficaz para avaliar as famílias com risco de insegurança alimentar, comparado a uma escala padrão-ouro. Os participantes pertenciam aos domicílios da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS), usando a resposta à Escala Brasileira de Insegurança Alimentar (EBIA). A amostra incluiu 3.920 domicílios, representando 11.779.686 domicílios quando expandida com os pesos amostrais da PNDS. Com uma prevalência geral de insegurança alimentar de 21%, o instrumento brasileiro de dois itens para avaliação de insegurança alimentar mostrou sensibilidade 79,31%, especificidade 92,95%, valor preditivo positivo 74,62%, valor preditivo negativo 94,5% e área ROC 86,13%. O instrumento também apresentou validade convergente alta para as variáveis de nutrição e saúde das crianças, comparado ao padrão-ouro, a EBIA completa. Com base na capacidade de detectar domicílios com risco de insegurança alimentar, esse instrumento de triagem com dois itens é recomendado para adoção geral, enquanto medida de triagem em todo o Brasil, sobretudo durante a pandemia da COVID-19, quando as decisões rápidas são fundamentais. O instrumento pode permitir que os profissionais identifiquem com precisão as famílias em risco de insegurança alimentar e intervenham prontamente para prevenir ou mitigar as consequências adversas para a saúde e o desenvolvimento, associadas à insegurança alimentar, respondendo rapidamente às crises.

Este trabajo tuvo el objetivo de desarrollar un instrumento breve de 2 ítems para identificar a los hogares brasileños que incluyen a familias con niños en riesgo de inseguridad alimentaria. Los análisis psicométricos incluyendo sensibilidad, especificidad, valor predictivo positivo y negativo, precisión, y curvas ROC fueron usados para probar combinaciones de preguntas, con el fin de determinar el instrumento más efectivo para evaluar hogares en riesgo de inseguridad alimentaria, cuando se compararon con una escala de estándar de oro. Los participantes incluyeron a los hogares encuestados de la Encuesta Nacional Demográfica sobre la Salud de Mujeres y Niños (PNDS) con una respuesta válida en la Escala de Brasileña de Inseguridad Alimentaria (EBIA). La muestra incluyó 3.920 hogares, representando 11.779.686 hogares, cuando se amplió usando las ponderaciones de la muestra del PNDS. Con la prevalencia general de la inseguridad alimentaria a un 21%, el instrumento de 2 ítems brasileño sobre inseguridad alimentaria mostró una sensibilidad de un 79,31%, especificidad de un 92,95%, un valor predictivo positivo de 74,62%, un valor negativo predictivo de un 94,50% y un área ROC de 86,13%. Este instrumento también presentó una validez convergente alta para la nutrición de los niños y variables de salud, cuando se comparó la escala completa EBIA, el estándar de oro. Basada en su habilidad para detectar hogares en riesgo por inseguridad alimentaria, la herramienta de instrumento de 2 ítems está recomendada para su amplia adopción, como medida de cribado en todo Brasil, especialmente cuando la toma de decisiones rápidas se ha hecho fundamental, como ante la pandemia de COVID-19. Este método de cribado puede permitir a los proveedores de cuidados identificar con precisión a las familias en riesgo de inseguridad alimentaria e intervenir prontamente para prevenir o mejorar salud adversa y las consecuencias en el desarrollo, relacionadas con la inseguridad alimentaria, así como responder con prontitud a las crisis.

Angiotensin-converting enzyme 2 activator, DIZE in the basolateral amygdala attenuates the tachycardic response to acute stress by modulating glutamatergic tone.

The basolateral amygdala (BLA) is critical in the control of the sympathetic output during stress. Studies demonstrated the involvement of the renin-angiotensin system components in the BLA. Angiotensin-(1-7) [Ang-(1-7)], acting through Mas receptors, reduces stress effects. Considering that angiotensin-converting enzyme 2 (ACE2) is the principal enzyme for the production of Ang-(1-7), here we evaluate the cardiovascular reactivity to acute stress after administration of the ACE2 activator, diminazene aceturate (DIZE) into the BLA. We also tested whether systemic treatment with DIZE could modify synaptic activity in the BLA and its effect directly on the expression of the N-methyl-d-aspartate receptors (NMDARs) in NG108 neurons in-vitro. Administration of DIZE into the BLA (200 pmol/100 nL) attenuated the tachycardia to stress (ΔHR, bpm: vehicle = 103 ± 17 vs DIZE = 49 ± 7 p = 0.018); this effect was inhibited by Ang-(1-7) antagonist, A-779 (ΔHR, bpm: DIZE = 49 ± 7 vs A-779 + DIZE = 100 ± 15 p = 0.04). Systemic treatment with DIZE attenuated the excitatory synaptic activity in the BLA (Frequency (Hz): vehicle = 2.9 ± 0.4 vs. DIZE =1.8 ± 0.3 p < 0.04). NG108 cells treated with DIZE demonstrated decreased expression of l subunit NMDAR-NR1 (NR1 expression (a.u): control = 0.534 ± 0.0593 vs. DIZE = 0.254 ± 0.0260) of NMDAR and increases of Mas receptors expression. These data demonstrate that DIZE attenuates the tachycardia evoked by acute stress. This effect results from a central action in the BLA involving activation of Mas receptors. The ACE2 activation via DIZE treatment attenuated the frequency of excitatory synaptic activity in the basolateral amygdala and this effect can be related with the decreases of the NMDAR-NR1 receptor expression.

Food and nutritional security of semi-arid farm families benefiting from rainwater collection equipment in Brazil.

The objective of this study was to identify and describe the experience of family farmers and their respective families after using the Boardwalk Cistern rainwater collection system and consequent impacts on nutrition profile and food security. This is a qualitative-quantitative study conducted in two municipalities in the semi-arid region of the state of Alagoas, northeastern Brazil. A structured questionnaire was applied to collect information on demographic and socioeconomic status and household access to food, based on the Brazilian Food Insecurity Scale of 29 family farmers' households. Food intake was assessed by food intake markers of the Ministry of Health, while nutritional status was determined by measuring the weight and height of all family members and waist circumference of adults. Nutrition diagnosis was performed using the cutoff points of body mass index for age. Three focus groups were conducted, and the information collected was analyzed through Content Analysis with the aim of knowing the participants' perception of the effects of the received water equipment. The study showed a high prevalence of excess weight (52.7%) and high risk for cardiovascular diseases (35.9%) marked by a high salt and sugar in the food intake. Food Insecurity Scale showed that food insecurity is a problem occurring in 75% of these families. However, focus groups showed that families have a positive perception of Boardwalk Cisterns for their food security. They believe that agricultural production has improved, thereby offering a wider range of foods and, consequently, improving food security. In conclusion, this study highlights the importance of water access programs for food production within public policies to guarantee FNS.

Salud sexual y reproductiva de los pacientes con esquizofrenia y trastorno afectivo bipolar / Sexual and Reproductive Health in Patients with Schizophrenia and Bipolar Disorder

RESUMEN Introducción: Las personas con esquizofrenia y trastorno afectivo bipolar (TAB) tienen alto riesgo de embarazos no deseados y abortos, debido a su condición de vulnerabilidad o comportamientos hipersexuales (frecuentes en este último trastorno); a esto se asocia dificultad en la planeación de sus actos y escasez de educación sexual y consejos del personal médico, lo cual lleva a resultados obstétricos negativos e incapacidad para cuidar adecuadamente a sus hijos. Objetivo: Describir las características de una muestra de pacientes con trastorno bipolar y esquizofrenia en Medellín, Colombia, sobre salud sexual y reproductiva, el uso de anticoncepción y el asesoramiento al respecto en las consultas de psiquiatría. Métodos: Se realizó un estudio observacional de corte transversal. Se incluyó a los 160 participantes del ensayo clínico «Los Efectos de un Programa de Intervención Multimodal en Pacientes con Trastorno Afectivo Bipolar y Esquizofrenia¼, captados de la consulta del grupo de trastornos del ánimo y psicosis del Hospital Universitario San Vicente Fundación de Medellín. Un residente de tercer año de Psiquiatría contactó con ellos vía telefónica y les aplicó una encuesta acerca de las características de su vida sexual y reproductiva y la anticoncepción. Resultados: Casi todos los pacientes con esquizofrenia estaban solteros, no tenían estudios de pregrado y se encontraban desempleados. No se encontraron diferencias significativas en cuanto a la edad de inicio de las relaciones sexuales al comparar por diagnóstico y por sexo. Casi todos los pacientes con esquizofrenia y casi la mitad de los pacientes con TAB reportaron no tener vida sexual activa. Casi todos los que reconocieron tenerla afirmaron que usaban siempre algún método anticonceptivo; del grupo de TAB, solo el 48,8% de las mujeres solteras reconocieron estar planificando y poco más de la mitad de los varones afirmaron que se servían del condón en sus relaciones sexuales. Una cuarta parte de los embarazos fueron no planeados. El 57,4% de los pacientes con TAB y el 78,8% de los que tenían esquizofrenia se consideraban bien informados sobre planificación familiar, a pesar de que la mayoría afirmaba que nunca habían recibido información sobre este tema durante las consultas con su psiquiatra. Conclusiones: Los pacientes con enfermedad mental tienen alteraciones cognitivas y conductuales que afectan a su vida sexual y reproductiva, por lo cual los psiquiatras deben abordar este tema para garantizar la educación en cuanto a anticoncepción, planeación de la natalidad y riesgo de enfermedades de transmisión sexual, entre otras, y así velar por la seguridad y la calidad de vida de sus pacientes.

ABSTRACT Introduction: People with schizophrenia and bipolar disorder (BD) have a high risk of unwanted pregnancies and abortions, due to their condition of vulnerability or hypersexuality (common in BD). This is associated with difficulty in planning their actions and lack of sex education and counselling by medical personnel, and can lead to adverse obstetric outcomes and inability to care adequately for their children. Objective: To describe the characteristics in terms of sexual and reproductive health, and the use of contraception and counselling in psychiatric consultations, in a sample of patients with BD and schizophrenia in Medellin, Colombia. Methods: Observational cross-sectional study. We included the 160 participants from the clinical trial, "The effects of a multimodal intervention programme in patients with bipolar disorder and schizophrenia", who were recruited from the mood and psychosis disorders group clinic at Hospital Universitario de San Vicente Fundación in Medellin. They were contacted by phone by a third-year psychiatry resident, who applied a survey about the characteristics of their sex life, contraception and reproduction. Results: Almost all of the patients with schizophrenia were single, had no undergraduate studies and were unemployed. No significant differences were found regarding the age of starting sexual relations when comparing by diagnosis and gender. Almost all patients with schizophrenia and almost half of the patients with BD reported not having an active sexual life. Almost all of those who admitted to having an active sexual life claimed to always use contraception; in the BD group, only 48.8% of single women admitted to using contraception and a little over half of men stated that they used a condom when having sex. A quarter of the pregnancies were unplanned. Although the majority of the patients stated that they had never received information about family planning in the consultations with their psychiatrist, 57.4% of the patients with BD and 78.8% of those who had schizophrenia, considered themselves to be well informed on the subject. Conclusions: Patients with mental illness have cognitive and behavioural alterations that affect their sexual and reproductive lives. Psychiatrists should therefore address this issue, to ensure education in areas such as contraception, family planning and sexually transmitted diseases and help safeguard the safety and quality of life of their patients.