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Adoption of healthy dietary and snacking habits could support optimum physical and mental development in children as they define health in adulthood. This study assessed parameters associated with children’s snacking such as food home availability, parenting practices, and parents’ health beliefs. In this cross-sectional study 12, 039 children, 49.4% boys 5-12 years old, participating in the European Feel4Diabetes-Study were included. Children’s weekly consumption of sweets and salty snacks, home availability of snacks, food parenting practices, and health beliefs were assessed via questionnaires. Logistic regression was applied to explore associations of a) home availability of snacks, b) food parenting practices (permissiveness and rewarding with snacks) and c) parent’s opinions on deterministic health beliefs with children’s consumption of sweets and salty snacks. Results showed that home availability (sweets: ORadj 4.76, 95%CI: 4.32, 5.23; salty snacks: ORadj: 6.56, 95%CI: 5.64, 7.61), allowing to consume (sweets: ORadj: 3.29, 95%CI: 2.95, 3.67; salty snacks: ORadj: 3.41, 95%CI: 2.98, 3.90) and rewarding with sweets/salty snacks (sweets: ORadj: 2.69, 95%CI: 2.23, 3.24; salty snacks: ORadj: 4.34, 95%CI: 3.57, 5.28) ‘sometimes/or less frequently’ compared to ‘always/or often’ were associated with lower weekly consumption of sweets and snacks. Parents’ disagreement compared to agreement with deterministic health beliefs and inattentive eating were associated with lower consumption of salty snacks and sweets in children. Overall, the findings of this study indicate that attempts to promote healthy snacking habits in children should aim to improve parental dietary habits, food parenting practices, health beliefs, and reducing home availability of unhealthy foods and snacks.
We assess the effects of the Crianza Positiva text and audio e-messaging program on caregiver–child language interaction patterns. The program is a six-month-long intervention for families with children aged 0–2 aimed at strengthening parental competences. Its design exploits behavioral tools such as reminders, suggestions of action, and messages of encouragement to reinforce and sustain positive parenting practices. Families in 24 early childhood centers in Uruguay that completed an eight-week workshop were randomized into receiving or not receiving mobile messages. After the program, we videotaped 10-minute sessions of free play between the caregiver and the child, and decoded language patterns using automated techniques. The intervention was successful at improving the quality of parental vocalizations, as measured by the parent's pitch range. We also found suggestive evidence of increases in the duration of adult vocalizations. The results are consistent with more frequent parental self-reported involvement in reading, telling stories, and describing things to the child. Regarding the child, we find a nonrobust decrease in the duration of vocalizations, which we attribute to a crowding-out effect by the caregiver in the context of a fixed 10-minute suggested activity and a more proactive parental role.
Extensive and semi-extensive production based on local swine breeds such as Majorcan Black Pig, Cinta Senese, Gascon, Krškopolje and Turopolje is becoming extremely rare and on the verge of disappearing in Europe. In this context, the main aim of this study was to assess the potential feasibility of marketing strategies to act as guidelines for stakeholders along the supply chain to create and improve added value and match market demands. The sustainability of five production systems was evaluated together with 60 stakeholders representing five local swine breeds, using a World Café (WC) method combined with an Analytical Hierarchical Process (AHP). The results showed that the proposed strategies could differ slightly depending on each system, while the product strategy was a common marketing priority for most of the stakeholders and represented all the systems evaluated. Diversifying production toward quality, innovative products, enhanced standardization, and quality labeling or seals of guarantee, such as the protected geographical indication or the protected designation of origin, would contribute to the sustainability of these chains. Advertising the storytelling of the meat products and emphasizing their healthier properties were also considered as positive strategies. To this effect, promotion should involve improving knowledge of the local systems and raising the profile of the meat products via public relations (networks, web pages, food and gastronomic events, workshops and so on) in the Hotels, Restaurants and Catering (HORECA) sector, stores selling top-quality products and local food shops. Better showcasing of these products and keeping the price in the premium segment would indirectly help the primary sector. By way of conclusion, other more developed local swine systems could be strong competitors, hence it is extremely important to effectively identify and trace all autochthonous swine breed products throughout the production chain. Furthermore, the entire chain must place greater emphasis on grazing (extensive or semi-extensive), the origin of the swine and their meat products. However, of utmost importance is cooperation between farms, firms and institutions.
Diet and physical activity (PA) have been studied extensively in epidemiology as single or combined lifestyle factors; however, their interaction has not been studied thoroughly. Studying potential synergisms between lifestyle components with a comprehensive interaction analysis, including additive measures of interaction, provides key insights into the nature of their joint effect and helps target interventions more effectively. First, a comprehensive review was conducted to assess the potential research gap regarding reported interaction analyses conducted in studies assessing the Mediterranean diet (MedDiet) in combination with PA on all-cause mortality. Thereafter, we prospectively assessed the joint association of the MedDiet with PA on all-cause mortality in the Seguimiento Universidad de Navarra (SUN) cohort, followed by both multiplicative and additive interaction analyses. The conjoint effect of low adherence to the MedDiet and low PA observed an increased risk greater than the individual risk factors, suggesting a potential additive interaction or synergism between both exposures, with relative risk due to interaction (RERI) and (95 % confidence interval (95 % CI)) = 0·46 (–0·83 to 1·75) and attributable proportion (95 % CI) due to interaction of 36 % (–0·62, 1·34). No multiplicative interaction was detected. Studying interactions between lifestyle factors, such as the MedDiet and PA, is particularly relevant given the current research gaps in studying the complexities of combined aspects of lifestyle in comparison with isolated behaviours. Our findings underline the important public health message of adhering to both the MedDiet and PA for the prevention of premature mortality.
Concerns have been raised about ecological momentary assessment (EMA) acceptability among patients with schizophrenia spectrum disorders (SSD), which is of major relevance during the e-Mental health-focused COVID-19 pandemic.
To investigate i) the levels of adherence to a passive smartphone-based EMA tool, the Evidence-Based Behavior (eB2), among SSD patients; and ii) putative predictors of this.
Sample: SSD (F20-29-ICD10) outpatients, age 18-64, without financial incentives, recruited over 17/06/2019-11/03/2020 at the Hospital Universitario Fundación Jiménez Díaz (Madrid, Spain). Those who accepted the eB2 installation -users- and those who did not -non-users- were compared in sociodemographic, clinical, premorbid adjustment, neurocognitive, psychopathological, insight and metacognitive variables by a multivariable binary logistic regression model.
Sample (N=77): n=41 males; age: 47.69±9.76 years, n=24 users (31.2%). n=14 users (70%) had the eB2 installed at follow-up (median=14.50 weeks).
Multivariable binary logistic regression model on ‘user’ as outcome
Acceptability of a smartphone-based EMA application among SSD patients was low. Age (young) and good premorbid adjustment predicted acceptability. e-Mental Health methods need to be tailored for patients with SSD. Otherwise, these highly vulnerable individuals may be neglected by e-health-based services in the post-COVID-19 years ahead.
The PSP has been implemented in Catalonia in 2006 in an attempt to improve the Primary Care treatment of the most common mental disorders and addictions. It’s based on a collaborative model, made up between Primary Care and Mental Health professionals.
To identify the strengths and limitations of the PSP from the perspective of Primary Care and Mental Health professionals.
Qualitative, exploratory and interpretive study based on Grounded Theory, made between 2018 and 2019 with Primary Care and Mental Health professionals. Group interviews were conducted with triangulated analysis. The study got the approval from the Research Ethics Committee of the Sant Joan de Deu’s foundation.
11 group interviews were conducted in 6 primary care centers and 5 mental health centers in Barcelona. Intrinsic and extrinsic factors impacting the programme functioning were detected. Within the extrinsic factors, elements related to professionals, patients and public health system have been observed. All the professionals agree that the PCSP has a favorable impact on inter-professional relationships and patients, facilitating the management of cases. In contrast the heterogeneity implementation, the lack of training, and the health care burden in is considered to negatively influence an optimal development of the programme. Professionals suggest communication and inter-professional collaboration would be improved by creating more a horizontal structure that eliminates vertical lines of command and disagreements in clinical judgement, thus facilitating shared decisions.
PrimaryCare and MentalHealth professionals value the PSP positively, but conclude there are communication and organizative barriers that should be addressed in order to improve the overall programme’s efficiency.
Fluorescence techniques have been widely used by scientists to reveal valuable information from biological samples, but in food science, small progress is known due to the complexity of the samples. In this study, two different biological samples, garlic skin (GS) and agave fibers (AF), were used to evaluate the techniques of confocal laser scanning microscopy (CLSM) and total internal reflection fluorescence (TIRF) microscopy, to obtain valuable information on the fiber size of the samples. A compositional characterization with calcofluor white in CLSM was achieved, but a superficial characterization of the samples with TIRF was made, evidencing fiber sizes of 398.67 ± 48.47 nm and 677.38 ± 76.88 nm for GS and AF, respectively. This work reveals that only an untreated sample can be used with the two techniques in the same microscope. In addition, it is possible to characterize the sample only using a spatial field of research and which valuable information about the structure of the material is found. This work provides the opportunity to use advanced fluorescence techniques for elucidation of structures shortly before studied with these techniques.
Within the last two decades, the international expansion of Latin American companies has undergone remarkable growth. This phenomenon has attracted scholarly attention, however, most of the available research is focused on companies that have already engaged in foreign direct investment (FDI), meanwhile, Latin American firms in pre-FDI stages remain mostly understudied. This article uses an explanatory case study design to analyze the corporate reputation and decision-making process related to international expansion of a set of ten Latin American companies. Both archival and primary data were used in the individual and cross-case analyses stages for 22 months. Our study identifies and establishes analytical generalizations when examining and contrasting the findings with the previously revised theoretical frameworks. More specifically, we identified that these companies exhibit similarities with the behavior of Jaguars, the Latin American wild feline; especially because of (i) their preference to remain in their regional market to exploit current capabilities and advantages, and eventually enter developed markets to upgrade capabilities and surpass strong competitors at home; (ii) their strategies to disguise their country of origin and lack of experience when operating internationally; and (iii) their solitary behavior and reluctance to engage in partnerships and/or strategic alliances unless they have a specific interest in building legitimacy and enhancing reputation.
The aim of this study was to assess the association between alcohol intake and premature mortality (younger than 65 years) and to explore the effect of potential alcohol underreporting by heavy drinkers. We followed-up 20 272 university graduates. Four categories of alcohol intake were considered (abstainer, light, moderate and heavy consumption). Repeated measurements of alcohol intake and updated information on confounders were used in time-dependent Cox models. Potential underreporting of alcohol intake by some heavy drinkers (likely misclassified as light or moderate drinkers) was explicitly addressed in an attempt to correct potential underreporting by using indirect information. During 12·3 years of median follow-up (interquartile range: 6·8–15·0), 226 participants died before their 65th birthday. A higher risk of early mortality was found for the highest category of alcohol intake (≥50 g/d) in comparison with abstention (multivariable-adjusted hazard ratio (HR) = 2·82, 95 % CI 1·38, 5·79). In analyses of alcohol as a continuous variable, the multivariable-adjusted HR was 1·17 (95 % CI 1·08, 1·26), for each 10 g/d of alcohol. This harmful linear association was present both in uncorrected models and in models corrected for potential underreporting. No significant inverse association between light or moderate alcohol intake and premature mortality was observed, even after correcting for potential misclassification. Alcohol intake exhibited a harmful linear dose–response association with premature mortality (<65 years) in this young and highly educated Mediterranean cohort. Our attempts to correct for potential misclassification did not substantially change these results.
Cognition heavily relies on social determinants and genetic background. Latin America comprises approximately 8% of the global population and faces unique challenges, many derived from specific demographic and socioeconomic variables, such as violence and inequality. While such factors have been described to influence mental health outcomes, no large-scale studies with Latin American population have been carried out. Therefore, we aim to describe the cognitive performance of a representative sample of Latin American individuals with schizophrenia and its relationship to clinical factors. Additionally, we aim to investigate how socioeconomic status (SES) relates to cognitive performance in patients and controls.
We included 1175 participants from five Latin American countries (Argentina, Brazil, Chile, Colombia, and Mexico): 864 individuals with schizophrenia and 311 unaffected subjects. All participants were part of projects that included cognitive evaluation with MATRICS Consensus Cognitive Battery and clinical assessments.
Patients showed worse cognitive performance than controls across all domains. Age and diagnosis were independent predictors, indicating similar trajectories of cognitive aging for both patients and controls. The SES factors of education, parental education, and income were more related to cognition in patients than in controls. Cognition was also influenced by symptomatology.
Patients did not show evidence of accelerated cognitive aging; however, they were most impacted by a lower SES suggestive of deprived environment than controls. These findings highlight the vulnerability of cognitive capacity in individuals with psychosis in face of demographic and socioeconomic factors in low- and middle-income countries.
Caring for a relative with dementia is associated with adverse consequences for cardiovascular health. Cognitive and behavioral factors, such as high perceived activity restriction and low frequency of pleasant events have been found to be associated with higher levels of blood pressure, but the role these variables play in the stress and coping process remains understudied. The objective of this study is to analyze the associations between behavioral and psychological symptoms of dementia, activity restriction, frequency of pleasant events, and mean arterial pressure.
Face-to-face interviews and cross-sectional analyses.
Social services, healthcare centers, and adult day services of Comunidad de Madrid, Spain.
One hundred and two family caregivers of a spouse or parent with dementia.
Apart from various sociodemographic and health-related variables, behavioral and psychological symptoms of dementia, activity restriction, and frequency of leisure activities were assessed. In addition, measurement of blood pressure levels was conducted through an electronic sphygmomanometer.
The obtained model suggests that there is a significant indirect association between behavioral and psychological symptoms of dementia and mean arterial pressure through activity restriction and frequency of pleasant events.
The findings of this study provide preliminary support for a potential indirect effect between behavioral and psychological symptoms of dementia and blood pressure, through the effects of behavioral and psychological symptoms of dementia on the caregivers’ levels of activity restriction and frequency of pleasant activities. Our manuscript provides additional support for the pleasant events and activity restriction model (Mausbach et al., 2011; Chattillion et al., 2013), by highlighting the importance of considering caregiving stressors as a source of caregivers’ activity restriction in the theoretical framework of the model.
Bolivia has disseminated several improved technologies in the rice sector, but the average rice productivity in the country is far below the average trend in Latin America in recent years. Although the economic literature has highlighted the role of agricultural technology adoption in increasing agricultural productivity, gaps remain in understanding how rice growers are deciding to adopt and benefit from available improved rice technologies. Most previous adoption studies have evaluated the uptake of individual technologies without paying attention to the complementarities that alternative improved rice technologies may offer to farmers who face multiple marketing and production needs. This study uses data from a nationally representative sample of Bolivian rice growers to analyze farmers' joint decisions in adopting complementary agricultural technologies controlling for potential correlations across these decisions, as well as the extent of adoption of these practices. Evidence suggests that the decisions on multiple technology adoption are closely related, with common factors affecting both adoption and the extent of adoption. Furthermore, there is a need to better target resource-poor farmers, improve information-diffusion channels on agricultural practices, and better use existing farmers' organizations to enhance rice technology adoption.
Lung cancer (LC) is the most frequent and deadly neoplasm in the world, and patients have shown a tendency to have more emotional distress than other cancer populations. Dignity Therapy (DT) is a brief intervention aimed to improve emotional well-being in patients facing life-threatening illness.
To analyze the effect of DT on anxiety, depression, hopelessness, emotional distress, dignity-related distress, and quality of life (QoL) in a group of Mexican patients with stage IV LC undergoing active medical treatment with baseline emotional distress.
In this preliminary pretest–posttest study, patients received three sessions of DT and were evaluated with the HADS, Distress Thermometer, Patient Dignity Inventory, single-item questions, and QLQ-30.
In total, 24 out of 29 patients completed the intervention. Statistically significant improvements were found in anxiety, depression, emotional distress, hopelessness, and dignity-related distress with large effect sizes. Patients reported that DT helped them, increased their meaning and purpose in life, their sense of dignity, and their will to live, while it decreased their suffering. No changes were found in QoL.
Significance of results
DT was well accepted and effective in improving the emotional symptoms of LC patients with distress that were undergoing medical treatment. Although more research is warranted to confirm these results, this suggests that DT can be used in the context of Latin-American patients.
Old age constitutes a vulnerable stage for developing gambling-related problems. The aims of the study were to identify patterns of gambling habits in elderly participants from the general population, and to assess socio-demographic and clinical variables related to the severity of the gambling behaviours. The sample included N = 361 participants aged in the 50–90 years range. A broad assessment included socio-demographic variables, gambling profile and psychopathological state. The percentage of participants who reported an absence of gambling activities was 35.5 per cent, while 46.0 per cent reported only non-strategic gambling, 2.2 per cent only strategic gambling and 16.3 per cent both non-strategic plus strategic gambling. Gambling form with highest prevalence was lotteries (60.4%), followed by pools (13.9%) and bingo (11.9%). The prevalence of gambling disorder was 1.4 per cent, and 8.0 per cent of participants were at a problematic gambling level. Onset of gambling activities was younger for men, and male participants also reached a higher mean for the bets per gambling-episode and the number of total gambling activities. Risk factors for gambling severity in the sample were not being born in Spain and a higher number of cumulative lifetime life events, and gambling severity was associated with a higher prevalence of tobacco and alcohol abuse and with worse psychopathological state. Results are particularly useful for the development of reliable screening tools and for the design of effective prevention programmes.
A cumulative environmental exposure score for schizophrenia (exposome score for schizophrenia [ES-SCZ]) may provide potential utility for risk stratification and outcome prediction. Here, we investigated whether ES-SCZ was associated with functioning in patients with schizophrenia spectrum disorder, unaffected siblings, and healthy controls.
This cross-sectional sample consisted of 1,261 patients, 1,282 unaffected siblings, and 1,525 healthy controls. The Global Assessment of Functioning (GAF) scale was used to assess functioning. ES-SCZ was calculated based on our previously validated method. The association between ES-SCZ and the GAF dimensions (symptom and disability) was analyzed by applying regression models in each group (patients, siblings, and controls). Additional models included polygenic risk score for schizophrenia (PRS-SCZ) as a covariate.
ES-SCZ was associated with the GAF dimensions in patients (symptom: B = −1.53, p-value = 0.001; disability: B = −1.44, p-value = 0.001), siblings (symptom: B = −3.07, p-value < 0.001; disability: B = −2.52, p-value < 0.001), and healthy controls (symptom: B = −1.50, p-value < 0.001; disability: B = −1.31, p-value < 0.001). The results remained the same after adjusting for PRS-SCZ. The degree of associations of ES-SCZ with both symptom and disability dimensions were higher in unaffected siblings than in patients and controls. By analyzing an independent dataset (the Genetic Risk and Outcome of Psychosis study), we replicated the results observed in the patient group.
Our findings suggest that ES-SCZ shows promise for enhancing risk prediction and stratification in research practice. From a clinical perspective, ES-SCZ may aid in efforts of clinical characterization, operationalizing transdiagnostic clinical staging models, and personalizing clinical management.
Previous echocardiographic studies failed to show residual alterations of heart function in paediatric patients that have received treatment for Chagas disease. While the echocardiogram is the fundamental front-line tool for evaluating heart function, the appearance of new techniques allows a more detailed analysis. We aimed to evaluate systolic and diastolic function with new techniques in a paediatric population with Chagas disease several years after treatment completion.
Material and methods:
Echocardiograms were obtained from 84 Chagas disease patients (48 female) and 27 healthy controls. All patients had received treatment concluding on average 10 years prior to the study. The prospective analysis considered cardiac dimensions and cardiac function using two-dimensional, M-mode, Doppler and tissue Doppler imaging with emphasis on measuring longitudinal strain in the left ventricle by speckle tracking. Ejection fraction was measured with three-dimensional echocardiography.
Patients had an age of 14.2 ± 5.7 years (6–33) at the time of evaluation. Global and segmental motility of the left ventricle was normal in all patients. Ejection fraction was 59.2 ± 6.5 and 57.4 ± 6.5% (p = 0.31) in patients and controls respectively. Left ventricular global longitudinal systolic strain was −19 ± 2.4% in patients and −19 ± 3.6% (p = 0.91) in controls. No significant differences were found in remaining systolic and diastolic function measurements.
Paediatric patients that have received treatment for Chagas disease, evaluated with either conventional techniques or new tools, do not show significant long-term alterations of ventricular function.