To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The objective of this study was to assess sources of information about gestational weight gain (GWG), diet, and exercise among first-time pregnant Brazilian women in the United States (US).
Massachusetts, United States.
First-time pregnant Brazilian women.
Eighty-six women, the majority of whom were immigrants (96.5%) classified as having low-acculturation levels (68%), participated in the study. Approximately two-thirds of respondents had sought information about GWG (72.1%), diet (79.1%), and exercise (74.4%) via the internet. Women classified as having low acculturation levels were more likely to seek information about GWG via the internet (OR = 7.55; 95% CI: 1.41, 40.26) than those with high acculturation levels after adjusting for age and receiving information about GWG from healthcare provider (doctor or midwife). Moreover, many respondents reported seeking information about GWG (67%), diet (71%), and exercise (52%) from family and friends. Women who self-identified as being overweight pre-pregnancy were less likely to seek information about diet (OR = 0.32; 95% CI: 0.11, 0.93) and exercise (OR = 0.33; 95% CI: 0.11, 0.96) from family and friends than those who self-identified being normal weight pre-pregnancy.
This is the first study to assess sources of information about GWG, diet, and exercise among pregnant Brazilian immigrants in the US. Findings have implications for the design of interventions and suggest the potential of mHealth intervention as low-cost, easy access option for delivering culturally and linguistically tailored evidence-based information about GWG incorporating behavioral change practices to this growing immigrant group.
COVID-19, although a respiratory illness, has been clinically associated with non-respiratory symptoms. We conducted a negative case–control study to identify the symptoms associated with SARS-CoV-2-positive results in Portugal. Twelve symptoms and signs included in the clinical notification of COVID-19 were selected as predictors, and the dependent variable was the RT-PCR test result. The χ2 tests were used to compare notified cases on sex, age group, health region and presence of comorbidities. The best-fit prediction model was selected using a backward stepwise method with an unconditional logistic regression. General and gastrointestinal symptoms were strongly associated with a positive test (P < 0.001). In this sense, the inclusion of general symptoms such as myalgia, headache and fatigue, as well as diarrhoea, together with actual clinical criteria for suspected cases, already updated and included in COVID-19 case definition, can lead to increased identification of cases and represent an effective strength for transmission control.
To quantify the change in the risk of food insecurity and maternal mental disorder (MMD) before and during the coronavirus disease 2019 (COVID-19) pandemic.
Repeated cross-sectional survey. Between 17 July and 10 September 2020, mother–child pairs who were enrolled in a population-based survey in 2017 were re-contacted by telephone for consent and to complete a telephonic COVID-19 survey. We used the Brazilian Food Insecurity Scale to assess food security and the Self Reporting Questionnaire-20 to assess MMD. McNemar’s test for paired data that also accounted for clustering was used. Logistic regression was used to assess the relationship of unemployment and receipt of government assistance with food insecurity and MMD in 2020.
Five hundred and seventy-seven mother–child pairs completed the 2017 and 2020 surveys. At the time of the 2020 interview, the child cohort was 36–108 months of age.
The proportion of mothers reporting food insecurity was 15·5 % higher (95 % CI 5·9, 25·1, P value < 0·001) during the pandemic in July–August 2020 as compared with November 2017, while the prevalence of MMD was 40·2 % higher during the pandemic (95 % CI 32·6, 47·8, P value < 0·001). Loss of formal employment was associated with increased risk of food insecurity, but not with the risk of MMD.
The risk of food insecurity and MMD in Ceará increased during the COVID-19 pandemic. These findings highlight the need for policies and interventions to reduce the impact of the COVID-19 pandemic on maternal and child health, nutrition and well-being in Brazil.
There is still little knowledge of objective suicide risk stratification.
This study aims to develop models using machine-learning approaches to predict suicide attempt (1) among survey participants in a nationally representative sample and (2) among participants with lifetime major depressive episodes. We used a cohort called the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) that was conducted in two waves and included a nationally representative sample of the adult population in the United States. Wave 1 involved 43 093 respondents and wave 2 involved 34 653 completed face-to-face reinterviews with wave 1 participants. Predictor variables included clinical, stressful life events, and sociodemographic variables from wave 1; outcome included suicide attempt between wave 1 and wave 2.
The model built with elastic net regularization distinguished individuals who had attempted suicide from those who had not with an area under the ROC curve (AUC) of 0.89, balanced accuracy 81.86%, specificity 89.22%, and sensitivity 74.51% for the general population. For participants with lifetime major depressive episodes, AUC was 0.89, balanced accuracy 81.64%, specificity 85.86%, and sensitivity 77.42%. The most important predictor variables were a diagnosis of borderline personality disorder, post-traumatic stress disorder, and being of Asian descent for the model in all participants; and previous suicide attempt, borderline personality disorder, and overnight stay in hospital because of depressive symptoms for the model in participants with lifetime major depressive episodes. Random forest and artificial neural networks had similar performance.
Risk for suicide attempt can be estimated with high accuracy.
To evaluate energetic contribution according to the degree of industrial food processing and its association with sociodemographic, anthropometric, biochemical, clinical and behavioural characteristics in adolescents.
Cross-sectional study (Adolescent Lifestyle Study). Food consumption was assessed using 24-h dietary recalls, with foods classified by degree of industrial progressing. The usual diet was estimated using the Multiple Source Method. In a linear regression model, the energy percentage (E %) was associated with sociodemographic, anthropometric, biochemical, clinical and behavioural characteristics, after adjustment for sex and age.
Juiz de Fora, Brazil.
Eight hundred and four adolescents, of both sexes, 14–19 years of age, enrolled in public schools.
The E % of unprocessed or minimally processed foods corresponded to 43·1 %, processed foods to 11·0 % and the ultraprocessed foods to 45·9 %. E % of unprocessed foods was associated with socio-economic stratum (adjusted β = −0·093; P = 0·032), neck circumference (adjusted β = 0·017; P = 0·049), screen time (adjusted β = −0·247; P = 0·036) and HDL-cholesterol (adjusted β = −0·156; P = 0·003). E % of ultraprocessed foods was associated with socio-economic stratum (adjusted β = 0·118; P = 0·011), screen time (adjusted β = 0·375; P = 0·003), BMI (adjusted β = −0·029; P = 0·025), neck circumference (adjusted β = −0·017; P = 0·028) and HDL-cholesterol (adjusted β = 0·150; P = 0·002).
There was a high E % of ultraprocessed foods in the diet of the adolescents. Actions are needed to raise the awareness of adopting healthy eating habits.
Accurate estimates of methane (CH4) production by cattle in different contexts are essential to developing mitigation strategies in different regions. We aimed to: (i) compile a database of CH4 emissions from Brazilian cattle studies, (ii) evaluate prediction precision and accuracy of extant proposed equations for cattle and (iii) develop specialized equations for predicting CH4 emissions from cattle in tropical conditions. Data of nutrient intake, diet composition and CH4 emissions were compiled from in vivo studies using open-circuit respiratory chambers, SF6 technique or the GreenFeed® system. A final dataset containing intake, diet composition, digestibility and CH4 emissions (677 individual animal observations, 40 treatment means) obtained from 38 studies conducted in Brazil was used. The dataset was divided into three groups: all animals (GEN), lactating dairy cows (LAC) and growing cattle and non-lactating dairy cows (GCNL). A total of 54 prediction equations available in the literature were evaluated. A total of 96 multiple linear models were developed for predicting CH4 production (MJ/day). The predictor variables were DM intake (DMI), gross energy (GE) intake, BW, DMI as proportion of BW, NDF concentration, ether extract (EE) concentration, dietary proportion of concentrate and GE digestibility. Model selection criteria were significance (P < 0.05) and variance inflation factor lower than three for all predictors. Each model performance was evaluated by leave-one-out cross-validation. The Intergovernmental Panel on Climate Change (2006) Tier 2 method performed better for GEN and GCNL than LAC and overpredicted CH4 production for all datasets. Increasing complexity of the newly developed models resulted in greater performance. The GCNL had a greater number of equations with expanded possibilities to correct for diet characteristics such as EE and NDF concentrations and dietary proportion of concentrate. For the LAC dataset, equations based on intake and animal characteristics were developed. The equations developed in the present study can be useful for accurate and precise estimation of CH4 emissions from cattle in tropical conditions. These equations could improve accuracy of greenhouse gas inventories for tropical countries. The results provide a better understanding of the dietary and animal characteristics that influence the production of enteric CH4 in tropical production systems.
Brazilians comprise a rapidly growing immigrant Latino group in the USA, yet little research has focused on health issues affecting Brazilian children in immigrant families. As increasing evidence is documenting fathers’ influential role in their children’s eating behaviours and ultimately weight status, the current study sought to explore the Brazilian immigrant fathers’ perspectives and practices related to child’s feeding practices and their preschool-aged children’s eating.
Qualitative study using in-depth, semi-structured interviews. Interviews were conducted in Portuguese by native Brazilian research staff using a semi-structured interview guide. Interviews were audio-recorded and transcribed verbatim. Transcripts were analysed thematically using a hybrid approach that incorporated deductive and inductive analytical approaches.
Twenty-one Brazilian immigrant fathers who had at least one child aged 2–5 years.
Results revealed fathers’ awareness of the importance of healthy eating for their children, their influence as role models and their involvement in feeding routines of their preschool-aged children. Moreover, fathers were receptive to participating in family interventions to promote their children’s healthy eating. Nearly all fathers reported wanting to learn more and to do ‘what’s right’ for their children.
The current study provides new information about Brazilian immigrant fathers’ views about factors influencing their children’s healthy eating behaviours and paternal feeding practices. Future research should quantify fathers’ feeding styles and practices and solicit fathers’ input in the design of culturally appropriate family interventions targeting the home environment of preschool-aged children of Brazilian immigrant families.
Herein, we report a synthetic route capable of producing superparamagnetic, stable and biocompatible glucosamine (GLU) nanocarriers, composed by colloidal iron oxide nanoparticles (ION, ~6 nm) surface-functionalized with GLU dispersed in physiological media (pH 7.2). The route consists first of the preparation of ION by aqueous alkaline co-precipitation of 1:2 Fe(II)/Fe(III) followed by surface treatment with citric acid, activation of acidic groups via carbodiimide intermediary and further amidation using GLU as the amine reactant. Results from cell viability tests performed with human dental pulp tissue cells suggest that ION–GLU nanocolloids are biocompatible and non-toxic for two different concentrations and several hours of incubation. Moreover, optical microscopy shows that ION–GLU adsorbs at the cells walls and also transposes them, reaching cytoplasm and nucleus as well. All findings point out the promising use of ION–GLU as biocompatible nanocarriers for GLU delivery such as in articulation diseases.
The co-infection between visceral leishmaniasis (VL) and human immunodeficiency virus (HIV) has increased in several countries in the world. The current serological tests are not suitable since they present low sensitivity to detect the most of VL/HIV cases, and a more precise diagnosis should be performed. In this context, in the present study, an immunoproteomics approach was performed using Leishmania infantum antigenic extracts and VL, HIV and VL/HIV patients sera, besides healthy subjects samples; aiming to identify antigenic markers for these clinical conditions. Results showed that 43 spots were recognized by antibodies in VL and VL/HIV sera, and 26 proteins were identified by mass spectrometry. Between them, β-tubulin was expressed, purified and tested in ELISA experiments as a proof of concept for validation of our immunoproteomics findings and results showed high sensitivity and specificity values to detect VL and VL/HIV patients. In conclusion, the identified proteins in the present work could be considered as candidates for future studies aiming to improvement of the diagnosis of VL and VL/HIV co-infection.
Behavioral and personality changes are the core symptoms of frontotemporal dementia. Suicide and suicide attempts have been reported in demented patients.
We present a case of an 80 years-old-male patient, with a suicide attempt at the age of 76 as the presentation symptom of FTD.
There are few studies of suicide or selfharm in frontotemporal dementia where such behavior might be expected to be more common. We are conducting a clinical study in FTD patients about the relation between FTD and suicide. The results of such study will be presented and discussed.
To our knowledge, there are no reliable data or reports about suicide in FTD patients. Also, we didn’t find any case report of a suicide attempt as the first presentation symptom of FTD. We discuss the known data about this issue considering our clinical study and report.
Pasture management that considers pasture growth dynamics remains an open question. Conceptually, such management must allow for grazing only after the recuperation of the pasture between two separate timely grazing periods when pasture reaches optimum recovery, as per the first law of Voisin’s rational grazing system. The optimum recovery period not only implies a pasture with better nutritional value and higher biomass yield but one that also reduces the production of enteric methane (CH4) to improve the grazing efficiency of cattle. Therefore, this study aimed to evaluate three different recovery periods (RP) of mixed grasses on the grazing behaviour of heifers, as well as herbage selectivity, herbage yield and nutritional value, in vitro degradability and CH4 production. Based on these criteria, three pasture RPs of 24 (RP24), 35 (RP3) and 46 (RP46) days were evaluated in six blocks using a randomized block design. At each predetermined RP, samples of the pasture were taken before the animals were allowed to graze. Right after collecting the pasture samples, heifers accessed the pasture during 4 h consecutively for grazing simulation and behavioural observations. We also measured the bite rate of each animal. The pasture growing for 24 days had the highest biomass production, best nutritional value, best efficiency of in vitro CH4 relative emission (ml) per DM degraded (g) and bite rate of the three RPs. Heifers all selected their herbage, irrespective of RP, but with different nutritional value and higher in vitro degradability. However, this did not change the production of in vitro CH4. Considering the growth conditions of the area where the study was performed, we recommend the shorter RP24 as the most suitable during the summer season. The study’s findings support the idea of management intervention to increase the quality of grazing systems.
Compared to anorexia nervosa, bulimia nervosa has received less attention on neuroimaging research. However, in the past decade, more functional resonance imaging studies were done to study bulimia nervosa, by using different types of paradigms, namely symptom-related paradigms.
To review functional magnetic resonance imaging (fMRI) studies in bulimia nervosa using food stimuli.
To discuss recent contributions of functional neuroimaging to the understanding of bulimia nervosa.
MEDLINE and PubMed databases were searched for peer-reviewed articles, published between 2000 and 2012, by using combinations of the Medline Subject Heading terms functional neuroimaging and bulimia nervosa. A selection of relevant papers to the aim of this review was carried out. The selected studies were reviewed with respect to type of paradigm, participant characteristics, main results, strengths and limitations.
Most studies reported altered functional activation in the frontal, cingulate, temporal, and parietal cortical regions secondary to food-related fMRI paradigms in bulimia nervosa.
The reviewed studies suggest that bulimia nervosa is associated with functional imaging brain abnormalities.
Bulimia nervosa is one the main subtypes of eating disorders. Recent neurobiological research is greatly contributing to the understanding of eating disorders.
To review and discuss current topics under investigation with neuroimaging studies in bulimia nervosa, as well as future interesting lines of research in this area.
To analyze the state of the art of neuroimaging research in bulimia nervosa.
MEDLINE and PubMed databases were searched for peer-reviewed studies, published between 2000 and 2012, by using combinations of the Medline Subject Heading terms neuroimaging and bulimia nervosa. A selection of relevant articles to the study aim was carried out. An analysis of the reviewed studies including current topics of research and future suggestions was also done.
Articles reviewed encompassed functional and structural neuroimaging or clinical reviews, connectivity and neurotransmitter studies, as well as debate or opinion articles. The main topics addressed were cerebral activation secondary to food stimuli, neuropsychological paradigms, diagnosis and classification of eating disorders based on neurobiological findings, neurobiology of eating disorders, and disordered eating mechanisms. The main future research avenues proposed were development of eating disorder psychopathology-related fMRI paradigms, as well as connectivity-based and molecular imaging studies.
The neurobiology of eating disorders is a growing exciting field of research. Neurobiological studies, namely neuroimaging studies in bulimia nervosa, may provide an important research framework for a better knowledge of psychopathological mechanisms of eating disorders.
Some of the devices in the public health system in our country that perform an integral approach to people with severe mental illness (SMI) are the Rehabilitation Unit (RU) and the Day Hospital (DH). A peculiarity of our Healthcare Area is that both units share resources and location, so this fact could change health care rates expected for each of them.
To evaluate the differences and similarities between both devices to level of care.
The sample consisted of all patients who came in the last year to both, the DH and to the RU in Algeciras (Spain). the variables studied were “new cases”, “patients treated” and “ratio of admissions/discharges” in those units. the information was collected from the database system from the Mental Health Information of Andalusia.
We recorded 46% of new cases in the RU, compared to 54% in DH. of all patients treated, 47% underwent rehabilitative activities, while 53% participated in the workshops of DH. On the other hand, the percentage of patients diagnosed with SMI was 84% in RU and 67% in DH. with respect to admissions/discharges ratio, the RU recorded 0.94 and the DH 0.83.
No significant differences in the level of care between RU and DH. Welfare rates could be quantitatively different if the devices had been physically separated.
Health care processes for people with severe mental illness (SMI) include an integral approach to the disorder, understanding as such the addition of various interventions destined to improve patient's biopsychosocial role.
To evaluate the type of intervention received by patients with SMI in two mental health care devices that look after this group: A Day Hospital (DH) and a Rehabilitation Unit (RU).
A sample of patients had attended the devices mentioned in the last year was selected and it was collected data on the number and type of interventions received (pharmacological, individual, family and group) through the Information System of Andalusia Mental Health.
Regarding DH, most interventions performed were type group (65.5%), followed by pharmacological interventions (26.1%), individual psychotherapy (6.4%) and interventions with families (2%). Similarly, in the RU was registered an 80% of group interventions, a 16.1% of pharmacological interventions, a 2.6% and a 1.3% of individual and family interventions, respectively.
While most of the proceedings are group interventions, it is expected due to the framing of this type of device, other types of interventions that contribute to an integral approach to SMI are also performed.
The understanding of neurobiology of eating disorders has received a remarkable contribution from neuroimaging research.
To review the literature on structural neuroimaging in bulimia nervosa.
To discuss recent contributions of structural neuroimaging to the understanding of bulimia nervosa.
MEDLINE and PubMed databases were searched for peer-reviewed studies, published between 2000 and 2012, by using combinations of the Medline Subject Heading terms structural neuroimaging and bulimia nervosa. A selection of relevant articles to the aim of this review was carried out.
Relatively few articles on structural neuroimaging were found in bulimia nervosa, and the studies showed conflicting results. Some studies reported evidence of brain volume loss in patients with bulimia nervosa, possibly related to associated chronic dietary restriction. Other studies have found increased grey matter volumes in frontal and ventral striatal areas. Finally, further studies did not find any structural abnormality at all in patients with bulimia nervosa, compared to healthy control subjects.
The scarce literature available on structural neuroimaging in bulimia nervosa provides conflicting results. Further studies are, therefore, warranted.
Bulimia is a psychopathological disorder characterized by the presence of episodes of binge eating, followed by compensatory mechanisms that aim to prevent weight gain. These episodes of uncontrolled ingestion of food are related with deficits in the inhibitory control of behavior (Fairburn & Harrison, 2003). The basal ganglia namely the Nucleus Accumbens (NA) and the Caudate nucleus (CN) are involved in the fronto-striatal circuits that allow the control of impulses.
The main goal of this study was to investigate the presence of structural alterations in the NAc and the CN in a sample of bulimic patients, when compared to normal controls.
Our sample was composed by 41 female participants, 21 diagnosed with bulimia and 20 healthy controls (CG) matched in socio-demographic features. The participants were submitted to the clinical assessment and to a structural magnetic resonance imaging (MRI) acquisition. The NA and the CN of the 41 MRIs were manually segmented using the software Slicer 3D.
No differences between patients with bulimia and healthy controls were found for the volume of the NA. However, the NC volume is significantly decreased in BN.
The reduction of volume in the CN of bulimic patients that was found in this study may be possibly associated with a lower functional activation of this brain structure, contributing to a lack of control of the excessive eating behavior of these patients.
Binge eating shares some similar clinical features with addictive disorders, such as impulsivity, altered reward sensitivity, and compulsive behavior. Some authors support the concept of food addiction for both conditions, whereas others argue against it.
To review arguments in favor or against the concept of food addiction, and its relation with bulimia nervosa and binge-eating disorder.
To discuss and explore the concept of food addiction, and how it may be related to bulimic-type behaviors.
MEDLINE and PubMed databases were searched for peer-reviewed studies undertaking analyses of evidence in favor or against the concept of food addiction, published between 2000 and 2012, by using combinations of the Medline Subject Heading terms addictive behavior and bulimia.
Several arguments in favor of the concept of addictive properties of food are present in many of the reviewed articles. However, many differences between substance addiction disorders and the so-called “behavioral addictions” are reported in the literature, underlining different neurobiological, psychological, and environmental mechanisms.
There is no consensus in the current literature regarding the concept of food addiction. Further studies concerning the issue are, therefore, warranted.
Substance use disorder (SUD) is a growing health problem which needs a very complex range of care due to the chronic and relapsing nature of the disorder and the multiple psychosocial problems involved. There are often difficulties in current outpatient programs to deliver and coordinate ongoing care and access to different health care providers. To improve treatment outcomes various case management (CM) models have been developed, at first in other psychiatric domains but also for patients with SUD.
The aim was to assess the effectiveness of CM for patients with SUD using existing studies.
Systematic review of CM interventions for patients with SUD by analyzing randomized controlled studies on this matter found on the electronic database PubMed published between 1996 and 2016.
Results and conclusions
Most of the analyzed studies showed improvement on the chosen outcome measures, although, these varied in the different studies. Mainly the treatment adherence improved, but substance use only reduced in a third of the studies. Overall functioning improved in about half of the studies. Further, studies are necessary to determine inclusion criteria for CM treatment for patients suffering from SUD in order to orientate patients most likely to benefit from this approach to the specific CM programs. There are still only few studies on this intervention and SUD. Further, studies are needed to examine the effect of treatment intensity of the CM intervention. Also longitudinal studies are needed to ensure the effectiveness of these treatments.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
In the context of untimely access to community formal services, unmet needs of persons with dementia (PwD) and their carers may compromise their quality of life.
The Actifcare EU-JPND project (www.actifcare.eu) focuses on access to and (non) utilization of dementia formal care in eight countries (The Netherlands, Germany, United Kingdom, Sweden, Norway, Ireland, Italy, Portugal), as related to unmet needs and quality of life. Evaluations included systematic reviews, qualitative explorations, and a European cohort study (PwD in early/intermediate phases and their primary carers; n = 453 days; 1 year follow-up). Preliminary Portuguese results are presented here (FCT-JPND-HC/0001/2012).
(1) extensive systematic searches on access to/utilization of services; (2) focus groups of PwD, carers and health/social professionals; (3) prospective study (n = 66 days from e.g., primary care, hospital outpatient services, Alzheimer Portugal).
In Portugal, nationally representative data is scarce regarding health/social services utilization in dementia. There are important barriers to access to community services, according to users, carers and professionals, whose views not always coincide. The Portuguese cohort participants were 66 PwD (62.1% female, 77.3 ± 6.2 years, 55.5% Alzheimer's/mixed subtypes, MMSE 17.8 ± 4.8, CDR1 89.4%) and 66 carers (66.7% female, 64.9 ± 15.0 years, 56.1% spouses), with considerable unmet needs in some domains.
All Actifcare milestones are being reached. The consortium is now analyzing international differences in (un) timely access to services and its impact on quality of life and needs for care (e.g., formal community support is weaker in Portugal than in many European countries). National best-practice recommendations in dementia are also in preparation.
Abstract submitted on behalf of the Actifcare Eu-JPND consortium.
Disclosure of interest
The authors have not supplied their declaration of competing interest.