Direct and indirect associations of experience of racial discrimination, dietary patterns and obesity in adults from southern Brazil.

OBJECTIVE: To analyse the direct and indirect associations of experience of racial discrimination on dietary patterns (DP), obesity and abdominal obesity. DESIGN: This is a cross-sectional population-based study. The main exposure was self-reported experiences of racial discrimination (Experiences of Discrimination scale). The mediator variables were the DP: healthy, Brazilian traditional, sugar and carbohydrates, and fast food. The outcomes were obesity (BMI ≥ 30 kg/m2) and abdominal obesity (waist circumference ≥ 88 cm for women; ≥ 102 cm for men). Structural equation modelling was applied. SETTING: Porto Alegre, Brazil. PARTICIPANTS: Totally, 400 adults aged between 20 and 70 years were participated. RESULTS: The mean age of participants was 47·2 years (sd = 13·9), and 75 % were women. Experiencing racial discrimination had a positive direct effect on obesity (healthy DP: ß = 0·153, P < 0·05; Brazilian DP: ß = 0·156, P < 0·05; sugar and carbohydrates DP: ß = 0·156, P < 0·05; and fast-food DP: ß = 0·153, P < 0·05) and abdominal obesity (healthy DP: ß = 0·206, P < 0·01; Brazilian DP: ß = 0·210, P < 0·01; sugar and carbohydrates DP: ß = 0·204, P < 0·01; and fast-food DP: ß = 0·204, P < 0·01). The experience of racial discrimination did not have a direct effect on DP, nor did it exert an indirect effect on obesity and abdominal obesity through any DP. CONCLUSIONS: A higher experience of racial discrimination is associated with obesity and abdominal obesity, independent of diet.

Association between perceived self-confidence and abilities to distinguish oral mucosal lesions amongst dental students.

INTRODUCTION: Dentists usually refer to difficulties in performing the diagnosis of oral mucosal lesions. This may be attributed to limited access to theoretical lectures and practical training on this subject along the graduation course. The primary aim of this cross-sectional study was to verify if there is an association between the perception of time dedicated to lectures/training and oral diagnosis abilities in oral medicine. The secondary aim was to evaluate the association between self--confidence to perform oral mucosal lesions diagnosis and performance in a diagnostic abilities test. MATERIALS AND METHODS: The sample comprised 36 final-year dental students of a South-Brazilian dental school. The participants answered a questionnaire on their perception of time dedicated to lectures on oral medicine along the course (sufficient or insufficient) and their self-confidence to diagnose oral mucosal lesions or oral cancer (yes or not). The students were also submitted to a diagnostic abilities test based on 30 clinical photos of oral lesions, which should be classified as benign, potentially malignant or malignant. Moreover, the participants had to inform their clinical impression for each case. Finally, the participants informed their decision making for the case (refer the patient to a specialist or not). RESULTS: Students with higher self-confidence showed a higher percentage of correct answers on classification of the nature of lesions (81.1% vs. 68.5%, p = .03, teste t de Student) and on their clinical impression (66.3% vs. 41.7%, p < .01, Student's t-test). The perception of time dedicated to theoretical lectures on oral medicine as sufficient did not influence the students' diagnostic abilities (p > .05, Student's t-test) CONCLUSION: It may be concluded that self-confidence to diagnose oral lesions is associated with dental students' diagnostic abilities.

Social environment perception and associations with overweight in the city of Porto Alegre, Brazil.

The prevalence of overweight in Brazilian adults has grown in recent years. There is evidence indicating that environmental factors, especially social characteristics, may be involved in the aetiology of overweight, but few studies have investigated this association adequately. The main objective of this study was to identify residents' perception of their social environment (social cohesion, security and violence) and assess its relationship with overweight in a central area of Porto Alegre, Brazil. The associations between socioeconomic characteristics and social environment perception were also explored. This cross-sectional study conducted in 2018-19 had 400 participants aged from 20 to 70 years living in low- and high-income areas of the city of Porto Alegre. Participants' perception of social cohesion, security and violence were evaluated using a validated questionnaire. Participants' body mass index (BMI) was measured, and those with a BMI ≥25 kg/m2 were considered to be overweight. Unadjusted and adjusted prevalence ratios (PRs) and 95% confidence intervals (95% CIs) were estimated through Poisson regression analysis; level of significance was 5%. The prevalence of overweight in the sample was 68.8% (95% CI 64.0-73.2). Individuals with a more positive social cohesion perception had a higher prevalence of overweight (PR 1.06; 95% CI: 1.00-1.12; p=0.02) than those with a less positive perception. Brown individuals also had a higher prevalence of overweight (PR: 1.08; 95% CI: 1.02-1.15; p=0.03) than those of other skin colour/race. No association was found between overweight and perception of security or violence. Therefore, social cohesion may be an important factor in overweight and the findings highlight the importance of considering social factors, and their perceptions, when planning actions for the prevention and control of overweight in a population.

Perceived racial discrimination and eating habits: a systematic review and conceptual models.

CONTEXT: There is no systematic review on the relationship between racial discrimination and eating habits. OBJECTIVE: A systematic review was conducted to synthesize evidence on the association between perceived racial discrimination (PRD) and eating habits. A conceptual model was developed to depict the most common mechanisms used to explain this association. DATA SOURCES: Articles were retrieved from the PubMed, Embase, LILACS, and PsycINFO databases from inception to January 2021. STUDY SELECTION: Only observational studies were included, and there were no restrictions on age, racial group, or country. Two reviewers selected the articles independently. DATA EXTRACTION: Data were extracted independently by 2 reviewers. The assessment of methodological quality was conducted using the Newcastle-Ottawa Scale. RESULTS: All studies retrieved were conducted among the US population. Nineteen studies were included. On average, the studies showed a methodological quality of 66%. Forty-six associations were evaluated: 38 between PRD and negative eating habits, 29 between PRD and eating behavior, and 17 between PRD and food consumption. CONCLUSIONS: PRD negatively affects eating habits. A conceptual framework based on ecosocial theory is suggested as a guide for future research. Further studies in different countries (beyond the United States) should be conducted to understand how racial discrimination affects eating habits within different ethnic, cultural, social, and economic contexts. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42019142605.

Development and Assessment of a Brazilian Pilot Massive Open Online Course in Planetary Health Education: An Innovative Model for Primary Care Professionals and Community Training.

Introduction: Planetary health (PH) has emerged as a leading field for raising awareness, debating, and finding solutions for the health impacts of human-caused disruptions to Earth's natural systems. PH education addresses essential questions of how humanity inhabits Earth, and how humans affect, and are affected by, natural systems. A pilot massive open online course (MOOC) in PH was created in Brazil in 2020. This MOOC capitalized on the global online pivot, to make the course accessible to a broader audience. This study describes the process of course creation and development and assesses the impact evaluation data and student outcomes of the PH MOOC. Methods: The PH MOOC pilot was launched in Brazilian Portuguese, using the TelessaúdeRS-UFRGS platform on 4/27/2020 and concluded on 7/19/2020 with a total load of 80 h. It was composed of 8 content modules, pre and post-test, 10 topics in a forum discussion, and an optional action plan. This study analyzes the course database, profile of participants, answers to questionnaires, forum interaction, and action plans submitted. Results: Two thousand seven hundred seventy-seven participants enrolled in the course, of which 1,237 (44.54%) gave informed consent for this study. Of the 1,237 participants who agreed to participate in the research, 614 (49.8%) completed the course, and 569 (92.67%) were accredited by TelessaúdeRS-UFRGS. The majority of the participants were concerned with climate change, trained in the health area, and worked in primary health care in places that lacked ongoing sustainability programs. Two hundred forty-one action plans were submitted, major topics identified were food and nutrition, infectious diseases, and garbage and recycling. Discussion: The use of the PH lens and open perspective of the course centered the need to communicate planetary health topics to individuals. The local plans reflected the motto of "think global and act local." Brazil presents a context of an unprecedented social, political, and environmental crisis, with massive deforestation, extensive fires, and biomass burning altering the biomes, on top of an ongoing necropolitical infodemic and COVID-19 pandemic. In the face of these multiple challenges, this MOOC offers a timely resource for health professionals and communities, encouraging them to address planetary challenges as fundamental health determinants.