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The goal of this paper is to describe the baseline characteristics of Live Well (intervention to prevent weight gain in recent immigrant mother-child dyads from Brazil, Haiti, and Latin America) participants, and to explore self-reported changes in diet and physical activity post-immigration. Baseline data from 383 mothers were used for this study. Dyads attended a measurement day where they completed self-administered surveys collecting information about socio-demographics, diet, physical activity, other psychosocial variables, and height and weight. Haitian mothers' socio-demographic profile differed significantly from that of Brazilians' and Latinas': they have been in the US for a shorter period of time, have higher rates of unemployment, are less likely to be married, more likely to have ≥3 children, more likely to be obese, and have immigrated for family or other reasons. In multivariate models, self-reported changes in diet and physical activity since migrating to the US were significantly associated with BMI with non-linear relationships identified. Future research is needed to understand how diet and physical activity change while acculturating to the US and explore the adoption of both healthy and unhealthy dietary changes. [ABSTRACT FROM AUTHOR]

Falls are the fifth leading cause of death and are one of the main causes of hospitalization. The literature about falls prevalence among older adults living in rural/remote communities in South America is scarce. To compare falls prevalence among the elderly in the Andes, Peru, and in the rural area of the municipality of Rio Grande, Rio Grande do Sul state, Brazil. Two separate cross-sectional studies were conducted in Peru, Andes (N = 413), and Brazil, Rio Grande, Rio Grande do Sul state (N = 1029). We stratified all data analysis according to location (Andes/Rio Grande). Characteristics of the samples were compared and the chi square test for proportions was used. Falls prevalence was then calculated for each independent variable and crude and adjusted prevalence ratios were estimated using Poisson Regression with robust variance. Falls prevalence in the last year was much higher in the Andes (64.1%) than in Rio Grande (25.3%). For most characteristics assessed, falls prevalence in Peru was at least double that found in Rio Grande. According to the adjusted analysis for the Andes, age (80 or more), being married, divorced and alcohol intake were significantly associated with falls. In Rio Grande, female gender and being in the 70–79 and 80 or more age ranges were associated with falls as well as those who self-rated their health as poor. This paper contributes to knowledge about falls prevalence among the elderly from rural and remote communities in two South American countries. Longitudinal multicentre studies with standardized methodologies are recommended. [ABSTRACT FROM AUTHOR]

Objective to evaluate women's knowledge about the best baby sleeping position and to identify factors associated with a greater probability of putting infants to sleep in an unsafe position, in Rio Grande, Southern Brazil. Method This is a cross-sectional population-based study that included all women who bore children in 2013 in this municipality. A single, standardized questionnaire was given within 48 h after delivery in the only two local maternity hospitals. The outcome was that women reported the lateral and the ventral decubitus as the best sleeping positions for babies. A Chi square test was used for proportions and Poisson regression was used with robust variance adjustment in the multivariate analysis. The prevalence ratio was the measure of effect used. Results We included 2624 women in this study. Of these, 82.1% (95% CI 80.6-83.6) stated that the baby should sleep in the lateral or ventral decubitus positions. 76.4% reported having acquired this knowledge from their mothers and 34.7% were willing to adopt the correct (supine) sleeping position for their child if recommended by doctors. The adjusted analysis showed that the lower the schooling of the mothers and the greater the number of people per bedroom and number of children, the greater the probability of women choosing an unsafe baby sleeping position. Conclusions for Practice This study showed that the percentage of women who are unaware of the correct baby sleeping position is very high, that doctors should be convinced to recommend the supine baby sleeping position, and that campaigns on this subject should also include grandparents as a priority intervention group. [ABSTRACT FROM AUTHOR]

Summary: Lower bone mineral density, vitamin D deficiency, lower lean body mass, greater loss of excess weight, and increased bone turnover are complications found after bariatric surgery correlated in the literature with increased risk of fractures. The prevention and treatment of such complications should begin immediately after surgery. Introduction: The aims of the study were to evaluate bone mass in patients undergoing bariatric surgery by the Wittgrove technique after 1 year of the procedure and correlate it with body composition, weight loss, 25OH vitamin D levels, and markers of bone metabolism. Methods: The operated group (OG) participated in a clinical consultation; a blood sample taken and a body composition; and bone mineral density assessment by dual energy X-ray absorptiometry (DXA). The results were compared with a control group (CG). Results: Fifty-six subjects in the OG and 27 in the CG were included. The bone mineral density (BMD), after the surgery, at the lumbar spine (LS) was lower in the OG than in the CG. There was a positive correlation between total body (TB) BMD with 25OHD, body mass index (BMI), and lean mass and an inverse correlation with percentage of excess weight loss (%EWL). Vitamin D deficiency was seen in 60.41 % (OG) and in 16.6 % (CG). PTH was higher in the OG, with secondary hyperparathyroidism in 41.7 %. In 26.5 % and 14.2 % of the OG, ALP and OC levels were above the reference values. In <50 years, elevated values of carboxy-terminal telopeptide (CTX) were found in 66.7 % of patients. A difference was observed in the variation of CTX between 12 and 18 months when compared to over 24 months. Conclusions: Lower BMD was observed, correlated with lower lean body mass and greater loss of excess weight. Vitamin D deficiency with high prevalence of secondary hyperparathyroidism and high bone turnover was detected. The prevention of bone loss should be initiated in the first months after surgery, which is a period associated with severe muscle loss and increased bone turnover. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the survival rate, pneumonia incidence, and hospital admissions among elderly patients with advanced dementia and to compare these outcomes between patients receiving enteral and oral nutrition. Design: An observational, prospective, non-randomized, and unblinded study, with a minimum follow up of 6 months. Setting: Inpatient wards as well as ambulatory and emergency units run by a Brazilian university. Participants: Dysphagic elderly patients aged ≥60 years with advanced dementia (classified as at least 7A according to the Functional Assessment Staging [FAST]). Both patients with gastrostomies and nasogastric feeding tubes were included in the alternative feeding group. Measurements: Following informed consent, a complete clinical examination was performed upon recruitment, and the primary caregiver was interviewed. Data concerning the major outcomes described above, as well as other demographic and clinical information, were recorded at admission and during follow-up phone calls. Survival analysis was performed using a Kaplan-Meier curve and a stepwise Cox regression analysis. Results: Sixty-seven elderly patients were recruited: 36 (53,7%) for oral feeding and 31 for alternative feeding (n=28 nasogastric tube). Of these, 57 (85.1%) were classified as at least FAST 7C. They were, on average, 84.79 years old, mostly women (85.1%), and with a low level of education (2.9 years). Mortality at 3 months was 11.1% among the oral feeding group and 41.9% among the alternative feeding group (p=0.004). At 6 months, the mortality rate increased to 27.8% and 58.1%, respectively (p=0.012). The following variables persisted in the regression model at the end of the analysis: feeding route (p =.018; RR = 2.33; CI: 1.158-4.667), duration of dementia (p =.014; RR =.88; CI:.786-.974) and number of pressure ulcers (p =.007; RR = 1.250; CI: 1.063-1.470). A higher incidence of aspiration pneumonia was observed in the alternative feeding group (p=0.006), but no difference in the number of hospital admissions was detected between the groups (p=0.365). Conclusion: The use of alternative feeding, along with the number of pressure ulcers were associated with an increased risk of death in elderly patients with advanced dementia. A higher incidence of aspiration pneumonia was also observed in the alternative feeding group. The number of hospital admissions was not different between the feeding routes. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present study was to examine the prevalence and factors associated with sarcopenia in older residents in São Paulo, Brazil. Design: Cross-sectional study. Setting: São Paulo, Brazil. Participants: 1,149 older individuals from the second wave of the Saúde, Bem-Estar e Envelhecimento (SABE) study from 2006. Measurements: The definition of sarcopenia was based on the consensus of the European Working Group on Sarcopenia in Older People (EWGSOP), which include three components: low muscle mass, assessed by a skeletal muscle mass index of ≤8.90kg/m for men and ≤6.37kg/m for women; low muscle strength, assessed by handgrip strength <30kg for men and <20kg for women; and low physical performance, assessed by gait speed <0.8m/s. Diagnosis of sarcopenia required presence of low muscle mass plus low muscle strength or low physical performance. Socio-demographic and behavioral characteristics, medical conditions and nutritional status were considered as independent variables to determine the associated factors using a logistic regression model. Results: The prevalence of sarcopenia was 16.1% in women and 14.4% in men. Advanced age with a dose response effect, cognitive impairment, lower income, smoking, undernutrition and risk for undernutrition (p<0.05) were factors associated with sarcopenia. Conclusions: The EWGSOP algorithm is useful to define sarcopenia. The prevalence of sarcopenia in the Brazilian elderly population is high and several associated factors show that this syndrome is affected by multiple domains. No differences were observed by gender in any age groups. [ABSTRACT FROM AUTHOR]

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Purpose: Despite the advances in asthma therapeutics, there are few data on the use and determinants of anti-asthmatic drugs in the general population of children. This study describes the use of asthma medications among children in the general population and in children with current asthma, living in a large urban center in Brazil. Methods: A population-based cross-sectional survey, aimed at analyzing asthma determinants, was conducted with 1,382 children aged 4-11 years, between February and May 2006, in Salvador, Brazil. At baseline, an extensive questionnaire was applied, including questions about the use of asthma medications in the last 12 months. Results: In all studied children ( n = 1,382) aged 4-11 years, oral beta2-agonists were the drugs most frequently used (9.8%), followed by short-acting inhaled beta2-agonists (4.3%) and systemic corticosteroids (1.6%). Anti-asthmatic drug use was higher among males than females, and it significantly decreased with age in both genders. A total of 312 children (22.6%) reported current asthma, and 62% of them were not being treated with any anti-asthmatic drugs. Of all those who reported following a certain type of treatment, 20% used oral beta2-agonists alone; 6.1%, short-acting inhaled beta2-agonists alone; and 4.8%, a combination of both drugs. Anti-asthmatic drug use did not differ according to socioeconomic status, except for the use of inhaled beta2-agonists and systemic corticosteroids. Conclusions: An overwhelming majority of asthmatic children were not using long-term medications for asthma, in particular inhaled corticosteroids, regardless of the severity of their disease. This result points to the deficiencies of the Brazilian public health system in recognizing this important pharmacological need for child care and thereby limiting the access of these children to a group of efficacious, available, and low risk therapeutic medications. [ABSTRACT FROM AUTHOR]

Food security is an important social determinant of health. The 2004 Canadian Community Health Survey, Cycle 2.2 reported high prevalence of food insecurity among low income households and those formed by recent immigrants. Exploration of the extent and correlates of food insecurity among recent Latin Americans (LA) immigrants is essential considering they encompasses an increasing number of young immigrants, many of whom, despite relatively high education, are unemployed or have low wage positions. This study examines the extent of food insecurity and its correlates among recent Latin American (LA) immigrants in Toronto. A cross-sectional study was conducted with a convenience sample of 70 adult LA recent immigrants. Participants were recruited from selected community health centres across Toronto using snow ball sampling. Data were collected using questionnaires in face-to-face interviews with primary household care givers. A considerably high rate of food insecurity (56%) was found among participants. Household food insecurity was highly related to: being on social assistance; limited proficiency in English; and the use of foodbanks. Our findings indicate that the primary correlate of a household's food security status is income, which suggests the potential for strategies to improve the financial power of new immigrants to purchase sufficient, nutritious, and culturally acceptable food. Enhancing the employability of new immigrants, reforming the income structure for working adults beyond social assistance, and providing more subsidized English language and housing programs may be effective. [ABSTRACT FROM AUTHOR]