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From October 1936, Mexico waged a growing legal campaign at the League of Nations (‘the League’) in favour of the Spanish Republic in the context of the Spanish civil war. The Mexican delegate at the League, Narciso Bassols, repeatedly denounced the intervention of Italy and Germany in the armed conflict, challenging the view that the war in Spain should be described solely as an internal issue.
Lack of knowledge about iodine has been suggested as a risk factor for iodine deficiency in pregnant women but no studies have addressed this issue in Portugal. So, the aim of this study was to investigate iodine knowledge among Portuguese pregnant women and its association with iodine status.
IoMum, a prospective observational study, included 485 pregnant women recruited at Centro Hospitalar e Universitário de S. João, Porto, between the 10th and 13th gestational weeks. Partial scores for knowledge on iodine importance, on iodine food sources or on iodised salt were obtained through the application of a structured questionnaire. Then, a total iodine knowledge score was calculated and grouped in low, medium and high knowledge categories. Urinary iodine concentration (UIC) was measured in spot urine samples by inductively coupled plasma mass spectrometry.
54% of pregnant women correctly recognized iodine as important to neurocognitive development, 32% were unable to identify any iodine rich food and 71% presented lack of knowledge regarding iodised salt. 61% of women had a medium total score of iodine knowledge. Knowledge on iodine importance during pregnancy was positively associated with iodine supplementation and also with UIC. Nevertheless, median UIC in women that correctly recognized the importance of iodine was below the cut-off for adequacy in pregnancy (150 µg/L).
In conclusion, knowledge on iodine importance associated positively with iodine status. Despite this, recognizing iodine importance during pregnancy may not be sufficient to ensure iodine adequacy. Literacy promoting actions are urgently needed to improve iodine status in pregnancy.
The consumption of fructose has increased in children and adolescents and is partially responsible for the high incidence of metabolic diseases. The lifestyle during postnatal development can result in altered metabolic programming, thereby impairing the reproductive system and fertility during adulthood. Therefore, the aim of this study was to evaluate the effect of a high-fructose diet in the male reproductive system of pubertal and adult rats. Male Wistar rats (30 d old) were assigned to four different groups: Fr30, which received fructose (20%) in water for 30 d and were euthanized at postnatal day (PND) 60; Re-Fr30, which received fructose (20%) for 30 d and were euthanized at PND 120; and two control groups C30 and Re-C30, which received water ad libitum and were euthanized at PND 60 and 120, respectively. Fructose induced an increase in abnormal seminiferous tubules with epithelial vacuoles, degeneration, and immature cells in the lumen. Moreover, Fr30 rats showed altered spermatogenesis and daily sperm production (DSP), as well as increased serum testosterone concentrations. After discontinuing high-fructose consumption, DSP and sperm number decreased significantly. We observed tissue remodeling in the epididymis, with a reduction in stromal and epithelial compartments that might have influenced sperm motility. Therefore, we concluded that fructose intake in peripubertal rats led to changes in the reproductive system observed both during puberty and adulthood.
The role of milk and dairy products in supplying iodine to pregnant women is unknown in Portugal. The aim of this study was to evaluate the association between milk and dairy consumption and the iodine status of pregnant women in the IoMum cohort of the Oporto region.
Pregnant women were recruited between 10 and 13 weeks of gestation, when they provided a spot urine sample and information on lifestyle and intake of iodine-rich foods. Urinary iodine concentration (UIC) was determined by inductively coupled plasma mass spectrometry. A total of 468 pregnant women (269 iodine supplement users and 199 non-supplement users) were considered eligible for analysis. Milk (but not yoghurt or cheese) intake was associated with UIC, in the whole population (p = 0.02) and in the non-supplement users (p = 0.002), but not in the supplement users (p = 0.29). In non-supplement users, adjusted multinomial logistic regression analysis showed that milk consumption < 3 times a month was associated with a 5 times increased risk of having UIC < 50 µg/L when compared to milk consumption ≥ 2 times a day (OR = 5.4; 95% CI: 1.55-18.78; p = 0.008). The highest UIC was observed in supplement users who reported consuming milk once a day (160 µg/L).
Milk, but not yoghurt or cheese, was positively associated with iodine status of pregnant women. Despite the observed positive association, daily milk consumption may not be sufficient to ensure adequate iodine intake in this population.
Few studies are focused on sugar consumption around the first 1,000 days of life. Thus, this work modelled the pathways linking the consumption of sugary drinks in pregnancy and maternal pre-gestational Body Mass Index (BMI) to early child’s exposure to products with high sugar content and to BMI z-score in the 2nd year of life.
BRISA Cohort, São Luís, Brazil were used from the baseline and to the follow-up at the 2nd year of life.
A theoretical model was constructed to analyse associations between variables from prenatal period (socioeconomic status, age, frequency of sugary drinks consumption during pregnancy and pre-gestational BMI), birth weight, exclusive breastfeeding and two outcomes: higher calories from products with added sugar as a percentage of the total daily energy intake and BMI z-score at follow-up at the first two years of life, using structural equation modelling.
Data of pregnant women (n=1,136) and their offspring.
Higher pre-gestational BMI (Standardized Coefficient - SC=0.100; p=0.008) and higher frequency of sugary drinks consumption during pregnancy (SC=0.134; p<0.001) resulted in high percentage of daily calories from products with added sugar in 2nd year of child, although, no yet effect was observed on offspring weight at that time.
Maternal obesity and sugary drinks consumption in pregnancy increased the risk of early exposure (before to 2 years) and high exposure of child to added sugar, showing perpetuation of the unhealth dietary behaviors in the first 1,000 days of life.
To examine the association between urban food environment and regular consumption of fruits and vegetables (FV) by older adults from a medium-sized Brazilian city.
Cross-sectional study based on data related to (1) objective assessment of establishments with predominant sale of unprocessed/minimally processed foods, mixed establishments and establishments with predominant sale of ultra-processed foods; (2) regular consumption of FV (≥ 5 times/week), health and socio-demographic variables of community-dwelling older adults. Tertiles of proximity between food establishments and older adults’ residence were calculated. Poisson generalised estimating equations with robust variance, adjusted for individual and contextual variables, were used to estimate the independent association between the proximity of establishments and regular consumption of FV.
Medium-sized Brazilian city.
Representative sample of community-dwelling older adults (n 549).
Older adults travelled the longest distances to establishments with predominant sale of unprocessed/minimally processed foods. The longer the distance to establishments with predominant sale of unprocessed/minimally processed foods, the lower the prevalence of regular consumption of FV (tertile 2: prevalence ratio (PR) = 0·86; 95 % CI = 0·74, 0·99; tertile 3: PR = 0·84; 95 % CI = 0·72, 0·97). Older adults living larger distance tertiles from establishments with predominant sale of ultra-processed foods, mixed establishments or all categories of establishments had 16 % (PR = 0·84; 95 % CI = 0·73, 0·96), 19 % (PR = 0·81; 95 % CI = 0·71, 0·93) and 19 % (PR = 0·81; 95 % CI = 0·70, 0·94) lower prevalence of regular consumption of FV, respectively.
The food environment is associated with regular consumption of FV among older adults. Longer distances from the residence of older adults to food establishments are independently associated with lower prevalence of regular consumption of FV.
Obesity is an epidemic associated with many diseases. The nutraceutical Zingiber officinale (ZO) is a potential treatment for obesity; however, the molecular effects are unknown. Swiss male mice were fed a high-fat diet (59 % energy from fat) for 16 weeks to generate a diet-induced obesity (DIO) model and then divided into the following groups: standard diet + vehicle; standard diet + ZO; DIO + vehicle and DIO + ZO. Those in the ZO groups were supplemented with 400 mg/kg per d of ZO extract (oral administration) for 35 d. The animals were euthanised, and blood, quadriceps, epididymal fat pad and hepatic tissue were collected. DIO induced insulin resistance, proinflammatory cytokines, oxidative stress and DNA damage in different tissues. Treatment with ZO improved insulin sensitivity as well as decreased serum TAG, without changes in body weight or adiposity index. TNF-α and IL-1β levels were lower in the liver and quadriceps in the DIO + ZO group compared with the DIO group. ZO treatment reduced the reactive species and oxidative damage to proteins, lipids and DNA in blood and liver in obese animals. The endogenous antioxidant activity was higher in the quadriceps of DIO + ZO. These results in the rat model of DIO may indicate ZO as an adjuvant on obesity treatment.
The host contact network structure results from the movement and behaviour of hosts (e.g. degree of sociability; vagility and greater or lesser fidelity of shelters), which can generate heterogeneity in the transmission of parasites and influence the parasitic burden of individual hosts. In the current study, we tested the hypothesis that the burdens of Gigantolaelaps oudemansi mites are related to the characteristics of the transmission networks of individuals of Oecomys paricola, a solitary rodent. The study was carried out in a savannah habitat in north-eastern Brazil. In the dry season, the rodent network presented sub-groups of rodent individuals interacting with each other, whereas in the wet season, no modules were formed in the network. Mite burden was positively related to the number of connections that an individual host had with other host individuals in the dry season. The pairwise absolute difference between the mean mite burdens among individual rodents was negatively correlated with the similarities of node interactions. No relationships were observed during the wet season. There was a higher heterogeneity of mite burden among hosts in the dry season compare to that in the wet season. In solitary species, spatial organization may show seasonal variation, causing a change in the opportunities of host contacts, thereby influencing the transmission and dispersion of their ectoparasite burdens.
Porungo is a traditional pasta filata cheese produced using raw milk throughout the southwest region of the state of São Paulo, Brazil. The objectives of this Research Communication were to evaluate the quality of raw milk used to make Porungo cheese, to characterize its production process, and to determine its chemical composition. The results showed that the raw milk met both Brazilian and international quality requirements. Chemically, Porungo can be classified as a medium to full fat semi-hard fresh cheese. Our study has allowed the first standards and regulations for Porungo to be established in Brazil. By virtue of this, the local producers are able to formalize their activity while consumers can have access to a safe and certified product.
The term limbic encephalitis has been used with an oncological precedent for over 50 years and, since then, has been applied in relation to multiple antibodies found in its etiological process. Over the last decade, the psychiatric community has brought paraneoplastic autoimmune limbic encephalitis (PALE) to a new light, scattering the once known relationships between said screened antibodies responsible for causing limbic encephalitis. Due to the fact that some individuals with this condition have a psychiatric syndrome as an initial manifestation, the aim of this updated scoping review is to reestablish a causal relationship between the onconeuronal autoantibodies, both intracellular and extracellular, possible underlying malignancies and subsequent neuropsychiatric syndrome. In pair with it, there is the idea of sketching a cleaner thorough picture of what poses as psychiatric symptoms as well as possible therapeutics. Even though the always evolving epistemology of the neurosciences achieved a significant unveiling of what includes PALE in its relevant pathological subgroups, the amount of gray literature still is much superior, appealing to a further research with more randomized controlled trials, with larger populations, so that the results corroborate the small amount of data that already exist and posteriorly be applied in the general population.
Masiruddin Khadim was a relatively wealthy businessman in his early thirties who lived in Joygram, a village in West Bengal. He was a vocal proponent of the Deobandi reformist Islam and an occasional participant of the Tablighi Jamaat (TJ). One day I asked Masiruddin to tell me why he converted to reformist Islam and joined TJ. Masiruddin narrated that he was an ordinary boy, Muslim by name but did not give Islam much thought. He had been living the ‘lifestyle’, and although he was a tad embarrassed about his previously un-Islamic lifestyle, he showed me pictures to testify with a big smile on his face. Like many rural boys aspiring for urban masculinity, he had his pictures taken in a studio, wearing a transparent shirt, tight jeans, large sunglasses, and a clean-shaven chin.
At some point in his twenties, Masiruddin started on a quest for ethical guidance: despite how exciting his life was, he felt a moral void. Inspired by his Hindu friends he started to read the Hindu scriptures, and afterwards the Christian Bible. But he came to the realisation that the Quran, directly given by Allah, provided the most complete system for life, both scientific and ethical, and that he had to follow the ‘right path’ and immerse himself in Islam. Masiruddin spent four months at the global headquarters of TJ in Delhi and changed his lifestyle: he started wearing a white kurta and an untrimmed beard under a shaven upper lip, prayed five times a day, fasted during Ramadan and attended all important local Islamic congregations.
Masiruddin firmly believed that a better society begins with becoming a better person individually. For this reason, he spoke very highly of the Islamic Mission Schools. The most important and distinguishing aspect of these private boarding schools – the first of which emerged in Howrah in 1986 – is not its curriculum but its strict regimen and discipline, and the seamless inculcation of an Islamic disposition within the larger project of the making of the modern Muslim middle class. For Masiruddin, it is important that the mission education would not only benefit the Muslims, but the entire country.
Alterations in the circadian cycle are known to cause physiological disorders in the hypothalamic–pituitary–adrenal and the hypothalamic–pituitary–gonadal axes in adult individuals. Therefore, the present study aimed to evaluate whether exposure of pregnant rats to constant light can alter the reproductive system development of male offspring. The dams were divided into two groups: a light–dark group (LD), in which pregnant rats were exposed to an LD photoperiod (12 h/12 h) and a light–light (LL) group, in which pregnant rats were exposed to a photoperiod of constant light during the gestation period. After birth, offspring from both groups remained in the normal LD photoperiod (12 h/12 h) until adulthood. One male of each litter was selected and, at adulthood (postnatal day (PND) 90), the trunk blood was collected to measure plasma testosterone levels, testes and epididymis for sperm count, oxidative stress and histopathological analyses, and the spermatozoa from the vas deferens to perform the morphological and motility analyses. Results showed that a photoperiod of constant light caused a decrease in testosterone levels, epididymal weight and sperm count in the epididymis, seminiferous tubule diameter, Sertoli cell number, and normal spermatozoa number. Histopathological damage was also observed in the testes, and stereological alterations, in the LL group. In conclusion, exposure to constant light during the gestational period impairs the reproductive system of male offspring in adulthood.
The practice of assisted dying is increasingly being discussed in a growing number of countries and is progressively regarded as a last-resort option for those suffering from severe and irreversible diseases. Recently, euthanasia in patients with psychiatric disorders and dementia has taken a prominent place in the public debate, since little is known about the prevalence and practice of euthanasia in these particular cases. Remaining a controversial subject, this study aims to describe the evolution and characteristics in reported euthanasia cases, focusing in dementia patients and the perspective from different countries regarding the nature of suffering, the voluntariness of the request and the role of the physician in the process.
A non-systematic review was performed, searching Pubmed/MEDLINE and Google Scholar for articles using the keywords dementia, euthanasia and assisted dying. Resultant articles were cross-referenced for other relevant articles not identified in the initial search.
Physicians consider less likely to perform euthanasia in patients with dementia, compared to patients with a severe and life-limiting somatic illness such as cancer. Both physicians and members of the general public acknowledge difficulties in the assessment of the voluntariness of the request and the extent of suffering of patients with advanced dementia, considering that communication is compromised. While euthanasia on the grounds of unbearable suffering caused by dementia remains a comparatively limited practice, its prevalence has risen and is related to loss of dignity or the knowledge that the lasting memory of their loved ones will be of the decomposed version of oneself.
It is likely that the number of euthanasia requests from patients suffering from dementia and/or accumulation of health problems related to old age will continue to grow. The question of how policy makers and care providers should respond to these requests is, therefore, highly relevant, as welll as the development of practice guidelines, if medical staff is to respond adequately to these delicate requests.
Background:Staphylococcus aureus is one of the leading pathogens isolated from bloodstream infections (BSIs), and vancomycin has been the main choice to treat MRSA (methicillin-resistant S. aureus) infections. Vancomycin-intermediate S. aureus (VISA) and heteroresistant-VISA (hVISA) have been described, limiting this antibiotic use. We evaluated aspects associated with the resistance and its clonality of the S. aureus isolated from BSIs, and we determined their association with clinical aspects of patients attended at Rio de Janeiro between 2016 and 2018. The detection of MRSA and trimethoprim-sulfamethoxazole resistant isolates was performed using the disk diffusion test, while the minimum inhibitory concentrations (MICs) were evaluated for 5 antimicrobials using the broth microdilution method. The MICs for ceftaroline and vancomycin of the MRSA isolates were determined using the E test. The presence of hVISA isolates was evaluated for isolates with vancomycin MICs of 1 and 2 μg/mL by screening on BHI agar added with vancomycin. The population profile was divided by the area under the curve (ie, PAP/AUC test). SCC mec was evaluated by PCR and the clonal profile by PFGE method. Among 123 S. aureus isolates from BSI, 31% were MRSA. MIC50 and MIC90 were daptomycin 2 and 2 μg/mL; linezolid, 1 and 1 μg/mL; oxacillin 1 and 256 μg mL; teicoplanin, 0.5 and 0.5 μg/mL and vancomycin 1 and 1 μg/ml. MIC values for ceftaroline and vancomycin were 0.75 and 2 μg/mL. The frequency of isolates not susceptible to daptomycin was 75%. The clonal lineages and SCCmec types found were USA100/ST5-II (50%), USA800/ST5-IV (22%), USA300/ST8-IV (15.8%), USA1100/ST30-IV (5.3%), BEC/ST239-III (5.3%), and 1 isolate carrying SCCmecV/ST1. We found 1 VISA isolate, and the PAP/AUC analysis detected 3 hVISA isolates that were associated with the USA100 and USA300 lineages. Overall, 85% of patients had a vascular catheter. More advanced age was associated with MRSA infection as was higher mortality. Patients with end-stage renal disease were more affected by MSSA infection. Daptomycin nonsusceptibility and VISA and hVISA phenotypes associated with prevalent clonal lineages were described. In addition, MRSA infections presented higher mortality, which emphasizes the importance of epidemiological studies.
Individuals with dementia usually have multiple chronic illnesses, most of whom are medicated with five or more medications. However, as dementia progresses and the goal of care moves from prolonging life to optimizing quality of life, the risk of taking certain medications may outweigh its benefit. Therefore, it is necessary to reassess the medication over time.
The objective of this work was to explore the barriers to optimising prescribing and deprescribing (withdrawing) of medications and the benefits of this procedure. Optimizing pharmacological treatment for people with dementia usually requires the prescription of inappropriate drugs and the initiation of other drugs. Several obstacles to the optimization of treatment have been identified in elderly people with multiple morbidities, related to the doctor, the health system, the patient and the caregiver, including: inadequate guidelines, incomplete medical history, prevention of negative consequences and established beliefs in the benefits and harms medication. Desprescribing older people with dementia is made even more difficult by the decrease in decision-making capacity, difficulties in understanding and communicating, increased involvement of caregivers and difficulties in setting goals.
Background: Antimicrobial resistance is a global public health threat. Integrated actions are necessary to reduce multidrug-resistant organisms (MDROs) in healthcare settings, including antimicrobial stewardship, infection prevention measures, and optimal environmental hygiene. We developed a project to improve hospital hygiene that involves 3 phases: (1) diagnostic, compounded by assessment of cleanliness and identification of barriers and facilitators for environment cleanliness improvement; (2) intervention, based on review of structure and processes followed by a training program focused on major weaknesses identified; and (3) evaluation, impact of the intervention assessment. Objectives: We performed group interviews to identify barriers and facilitators for improving environment cleanliness. Methods: The project was performed by the infection control team and the housekeeping manager in a 350-bed, private hospital located in the city of São Paulo (Brazil). Two group interviews were conducted, one involving supervisors and the other involving housekeeping cleaners. All professionals were invited to participate. A semistructured questionnaire was used to guide the discussion, which was compounded by the following topics: working process, availability of human and material resources, training on institutional norms and routines, perception regarding work conditions, and quality of cleanliness. Results: In total, 33 professionals attended the interviews: 12 were supervisors and 21 were housekeeping cleaners. The main facilitator identified was a good perception by the housekeeping team regarding the project. We identified several sets of barriers: (1) human resources, such as supervisor executing the cleaning, inadequate sizing of human resources in shifts, reduced scale on Sunday and holiday shifts, and lack of professional replacement for sick leave and vacation; (2) supplies and equipment, such as torn bed linen, insufficient mops, centralized and inadequate dilution of sanitizers causing delays and impacting quality of hygiene; (3) education, such as lack of training program perceived by supervisors (management) and housekeeping cleaners (basic procedures for cleaning) and knowledge regarding who cleans what; (4) motivation and relationships, such as supervisor perceptions that housekeeping cleaners are unmotivated, and this causes absenteeism. The team feels that they are disregarded by doctors, and they have relationship problems with nursing and hospital engineering staff. Also, they are afraid of being physically assaulted by coworkers. Finally, professionals reported the perception that the hospital is not clean enough and that this is related to the short time goals imposed on the staff. Conclusions: The main barriers identified were related to education strategies and management of human and material resources. The results will support the intervention phase.
Objectives: Alzheimer's disease (AD) is the most common cause of dementia and it is associated with increased mortality. The use of antipsychotics is common among the elderly, especially in those with dementia. Evidence suggests an increased risk of mortality associated with antipsychotic use. Despite the short-term benefit of antipsychotic treatment to reduce the behavioral and psychological symptoms of dementia, it increases the risk of mortality in patients with AD. Our aim is to discuss the findings from the literature about risk of mortality associated with the use of antipsychotics in AD.
Methods: We searched Internet databases indexed at MEDLINE using following MeSH terms: "Antipsychotic Agents" AND "Alzheimer Disease" OR "Dementia" AND "Mortality" and selected articles published in the last 5 years.
Results: Antipsychotics are widely used in the pharmacological treatment of agitation and aggression in elderly patients with AD, but their benefit is limited. Serious adverse events associated with antipsychotics include increased risk of death. The risk of mortality is associated with both typical and atypical antipsychotics. Antipsychotic polypharmacy is associated with a higher mortality risk than monotherapy and should be avoided. The mortality risk increases after the first few days of treatment, gradually reducing but continues to increase after two years of treatment. Haloperidol is associated with a higher mortality risk and quetiapine with a lower risk than risperidone.
Conclusions: If the use of antipsychotics is considered necessary, the lowest effective dose should be chosen and the duration should be limited because the mortality risk remains high with long-term use. The risk / benefit should be considered when choosing the antipsychotic. Further studies on the efficacy and risk of adverse events with antipsychotics are needed for a better choice of treatment and adequate monitoring with risk reduction.
It has been speculated that some drugs can be used against SARS-CoV-2. As for antiretrovirals, the follow-up of pre-exposure prophylaxis (PrEP) users during the coronavirus disease 2019 (COVID-19) outbreak may help to understand the potential protective effect of PrEP against SARS-CoV-2. We aimed to identify associations between oral PrEP use and COVID-19-related symptoms self-reporting. Phone call interviews or digital investigation (through WhatsApp® or e-mail) about oral PrEP regular use, social distancing, exposure to suspected or confirmed cases of SARS-CoV-2 infection and COVID-19-related symptoms. Among 108 individuals, the majority were cisgender, white and gay men. Although most of the individuals engaged in social distancing (68.52%), they kept on taking PrEP (75.93%). Few people have had contact with suspected or confirmed cases of COVID-19 (12.04%), but some had COVID-19-related symptoms the month before the interview (27.78%) including rhinorrheoa (56.67%), cough (53.33%), asthaenia (50.00%) and headache (43.33%). Also, oral PrEP was associated with lower self-reporting COVID-19-symptoms (OR 0.26, 95% CI 0.07–0.96, P = 0.04; h = 0.92) even after controlling confounders as social distancing, age, body-mass index and morbidities . In our sample, the regular use of oral PrEP was associated with lower self-reporting of COVID-19-related symptoms during the outbreak in São Paulo, Brazil.
The carpenter ant Camponotus rufipes has intracellular bacteria in bacteriocytes scattered in the midgut epithelium, which have different amounts of endosymbionts, according to the developmental stages. However, there are no detailed data about the midgut cells in adult workers. The present work aimed to evaluate the morphology and cellular events that coordinate the abundance of endosymbionts in the midgut cells in C. rufipes workers. The midgut epithelium has digestive cells, bacteriocytes, and cells with intermediate morphology. The latter is similar to bacteriocytes, due to the abundance of endosymbionts, and similar to digestive cells, due to their microvilli. The digestive and intermediate cells are rich in autophagosomes and autolysosomes, both with bacteria debris in the lumen. These findings suggest that midgut cells of C. rufipes control the endosymbiont level by the autophagy pathway.