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The literature emphasizes that motivations for having a child are an important factor in mother-child adaptation post-adoption. Unfortunately, there are no instruments on motivations to have a child adapted to this population that can contribute to new evidence with quantitative research. Therefore, this paper aimed to adapt and investigate evidence of validity and reliability of the MCS scale (Brenning et al., 2015) within a sample of expectant adoptive mothers. The transcultural adaptation followed eight rigorous steps, including experts, focus groups, back-translation, and a pilot study conducted with biological mothers and soon-to-be adoptive mothers. For evidence of reliability, the scale was applied to a sample of 267 women waiting to adopt a child, with an average age of 38.7 years. The five-factor structure was confirmed, and the factors correlated as in a continuum, supporting the Self-Determination Theory. The MCS is valid and reliable for assessing the quality and intensity of the motivation to have a child in Brazil and in the context of adoptive motherhood, and it is suitable for future empirical research and practical application. Highlights: This study validated the MCS scale to the context of adoptive motherhood and, by doing so, provided an efficient tool for future empirical research. The MCS scale has good psychometric properties for use in Brazil in the context of soon-to-be adoptive mothers. The five-factor structure was confirmed, supporting the Self Determination Theory in this sample. [ABSTRACT FROM AUTHOR]

Aim: The Health Gym Program is the main health promotion strategy in the Brazilian public health system. This paper aims to measure the impact of the Health Gym Program on hospital admission expenses for stroke in the state of Pernambuco, Brazil. Subject and methods: This public health impact evaluation used a panel of socioeconomic, demographic, and epidemiological data from 2007 to 2019 for all 185 municipalities in the state of Pernambuco. The empirical strategy used pre-tests, ordinary least-squares econometric modeling, and quantile regression as a robustness test. Results: The municipalities that implemented the Health Gym Program spent an average of 21.04% less on hospitalizations for stroke than the municipalities that did not, and this result was statistically significant at the 1% level. Further, the density of program coverage within the municipality also impacts the reduction of expenses. This saving is directly proportional to the number of hubs of the program in the municipalities. An increase of one program hub for every 10,000 inhabitants results in a 4.57% reduction in expenditure on stroke hospitalizations in the municipalities. Conclusion: The presence of the Health Gym Program led to a reduction in expenses related to hospital admissions for stroke, which may indicate that this program effectively expands the scope of health promotion actions in primary healthcare. The evidence generated from this study can be used to implement evidence-based policies aimed at preventing and controlling chronic diseases in Brazil. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to estimate the association between Protestantism and child mortality for Brazil. This paper employs data from the 1991, 2000, and 2010 Brazilian censuses. The association between Protestantism and child mortality was estimated using a conventional negative binomial regression model for women between the age of 20 and 34 years. This paper finds that the death rate of children born to Protestant mothers is around 5% lower compared to non-Protestant mothers, even after controlling for an extensive array of demographic and social characteristics. When Protestants are split into 'Traditional' and 'Pentecostal' groups, we find that the child mortality rate is substantially lower for Traditional Protestants. Our study contributes to the literature by providing recent empirical results on the association between child mortality and Protestantism in Brazil. [ABSTRACT FROM AUTHOR]

Introduction: RTXM83, a biosimilar of rituximab, was approved after physicochemical, functional, non-clinical, and clinical studies demonstrated their similarity; these studies included RTXM83-AC-01-11, a multicentric double-blind international prospective pivotal study. Long-term data on biosimilars can potentially elucidate their clinical robustness and facilitate their broader adoption. Methods: In this retrospective observational study, we analyzed a dataset from a Brazilian cohort previously randomized in the RTXM83-AC-01-11 study followed by the assessment of long-term outcomes in an observational extension phase from randomization in the RTXM83-AC-01–11 study to the last recorded evaluation. Patients with diffuse large B cell lymphoma (DLBCL) received either reference rituximab (R) or RTXM83 plus cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) as adjuvant treatment. Results: The median follow-up period was 77.0 months. Patients with initial DLBCL stages III and IV comprised 50% of the R-CHOP group and 40% of the biosimilar group. Five (18.5%) patients, including two RTXM83-CHOP-treated and three R-CHOP-treated individuals, experienced late adverse events (AEs) of interest. No new safety signs were established. At the final assessment, the progression-free survival (PFS) rates were 93.3% and 50.0% in the RTXM83-CHOP and R-CHOP groups, respectively. Median PFS was not achieved in the RTXM83-CHOP group, which was 40.5 months in the R-CHOP group. The overall survival (OS) rates were 100% and 66.7% in the RTXM83-CHOP and R-CHOP groups, respectively. The median OS was not reached in any group. Conclusion: This study demonstrated the long-term safety and effectiveness of RTXM83 in treating DLBCL; outcomes comparable to those of the reference product and potentially improved access to treatment have been indicated. However, further research with more diverse patient groups can validate these findings and advocate the broader adoption of biosimilars in cancer care. Trial Registration: ClinicalTrials.gov Identifier: NCT04928573. June 16, 2021, "retrospectively registered". [ABSTRACT FROM AUTHOR]

The goal of this paper is to assess the frequency of depression symptoms among Brazilian immigrants living in Massachusetts, the second largest Brazilian immigrant population in the United States, and to identify correlates of depression. A convenience sample of Brazilian immigrants aged 18 or older residing in Massachusetts was used. Data were collected from December 2013 to March 2014, in the Consulate General of Brazil in Boston and in three religious events, using a structure questionnaire and the Center for Epidemiological Studies Depression Scale (CES-D). Depression symptoms were observed in 35.3% of the respondents, with equal distribution by sex. Correlates of depression were low income, being single, poor English proficiency, and poor self-perception of health. These results suggest a need for community outreach, sensitization, and counseling, in Portuguese and adapted to the culture of Brazilian immigrants. [ABSTRACT FROM AUTHOR]

Background: The association between adverse childhood experiences (ACEs) and poor health outcomes is well-established in high-income countries. However, the evidence is limited for the association of ACEs, mental health, and risky behaviors for low- and middle-income countries. Moreover, studies often overlook prescription drug misuse and risky driving when examining the association of ACEs with risky behaviors. In our study, we examined the associations between ACEs, suicidal ideation, and risky behaviors (binge drinking, prescription drug misuse, and risky driving) among Brazilian college students. Methods: Participants consisted of a convenience sample of students recruited from undergraduate courses primarily in two states in Southern Brazil (93%). Data were collected via an online survey between December 2020 and August 2021. The analytical sample comprised 503 participants, most were female (71%), and the mean age was 24 years. Survey instrument included questions on ten different ACE types, mental health, and risky behaviors. Statistical analyses included univariate descriptive analysis, binary and multivariable regression models. Results: Across the ten ACE types assessed, only 14% of participants reported no ACEs, and 29% of participants experienced polyvictimization (i.e., four or more ACES). Multivariable models showed that, compared to those with no ACEs, participants who experienced polyvictimization had significantly increased odds of reporting suicide ideation (AOR = 6.21, p <.001), prescription drug misuse (AOR = 8.78, p <.01), and riding with an impaired driver (AOR = 3.58, p <.01). Conclusions: Our findings support the need for psychological support and services available for college students with multiple ACEs. [ABSTRACT FROM AUTHOR]

This paper aimed to examine prenatal alcohol exposure and neuropsychological parameters and its relationship to impulsivity and inattention. Longitudinal prospective case-control cohort study starting with the risk drinking assessment of 449 third-trimester pregnant women, and a follow-up phase with 56 mother-child pairs (28 alcohol-exposed versus 28 non-exposed), with 11-12 years old children. The cohort study was followed up for 11 years. Quantity-frequency structured questions as well as AUDIT and T-ACE questionnaires were used to assess maternal alcohol consumption. A comprehensive set of neuropsychological testing instruments was used, including d2 Test, RCFT, RAVLT, WISC-III, among others. To control low IQ effects and intellectual disability diagnoses, as well differences in school skills biasing the neuropsychological comparison assessment, children with IQ <70 or learning disabilities were excluded of the sample. The two groups showed to be very comparable regarding sex, age, schooling, global IQ, laterality and maternal and social risk factors. Significant statistical differences were found for higher speed processing, total errors, and number of omission errors in the d2 Test. Likewise, there were differences found on RCFT test (lower scores for copy, immediate and delayed recall), and on semantic verbal fluency tests with a lower score. Prenatal alcohol-exposed children seems to be more inattentive and impulsive; they have poorer skills in verbal fluency, visuospatial working memory, and executive processing when compared to non-exposed children who were part of the same cohort sample. [ABSTRACT FROM AUTHOR]

Health Level Seven (HL7) is one of the standards most used to centralize data from different vital sign monitoring systems. This solution significantly limits the data available for historical analysis, because it typically uses databases that are not effective in storing large volumes of data. In industry, a specific Big Data Historian, known as a Process Information Management System (PIMS), solves this problem. This work proposes the same solution to overcome the restriction on storing vital sign data. The PIMS needs a compatible communication standard to allow storing, and the one most commonly used is the OLE for Process Control (OPC). This paper presents a HL7-OPC Server that permits communication between vital sign monitoring systems with PIMS, thus allowing the storage of long historical series of vital signs. In addition, it carries out a review about local and cloud-based Big Medical Data researches, followed by an analysis of the PIMS in a Health IT Environment. Then it shows the architecture of HL7 and OPC Standards. Finally, it shows the HL7-OPC Server and a sequence of tests that proved its full operation and performance. [ABSTRACT FROM AUTHOR]

Introduction: The consumption of ultra-processed foods (UPF) has increased over the past few decades. However, few studies have investigated the association between UPF consumption and cardiometabolic risk factors in adolescents from developing countries. Objective: To evaluate the association between UPF consumption and cardiometabolic risk factors in Brazilian adolescents. Methods: This study included students aged 12–17 years who participated in the ERICA. Food consumption was assessed using a 24-h food recall, and the foods were classified based on their degree of processing, utilizing the NOVA classification. Participants' blood samples were collected after an overnight fast and exams were performed (triglycerides, total cholesterol, HDL-c, LDL-c, fasting glucose, insulin, and HbA1c). Overweight/obesity and blood pressure were also investigated. Associations were evaluated using Poisson regression models. Results: The analysis included a total of 36,952 adolescents. The energy consumption from UPF was 30.7% (95%CI: 29.7–31.6) per day. Adolescents with high UPF consumption, defined as the top tertile (≥38.7% per day), were observed to have higher intake of sodium, saturated and trans-fat, while having lower intake of proteins, fibers, polyunsaturated fats, vitamins and minerals. After adjusting for potential confounders, it was observed that higher UPF consumption was directly associated with high LDL-c (PR = 1.012; 95%CI: 1.005–1.029) and inversely with low HDL-c (PR = 0.972; 95%CI: 0.952–0.993). No associations were found between UPF consumption and other cardiometabolic risk factors. Conclusion: Brazilian adolescents have presented a high consumption of UPF, which is associated to poor diet quality and can contribute to elevated LDL-c levels. [ABSTRACT FROM AUTHOR]

Little is known about the mental health status of Brazilians living in the U.S. We assessed the prevalence and correlates of depression to guide the development of culturally relevant community-based mental health interventions. An online survey was conducted between July and August 2020 among a sample of Brazilian women living in the U.S. (age 18 and over, born in Brazil, English or Portuguese speaking) recruited through Brazilian social media pages and community organizations. The survey assessed depression using the Center for Epidemiological Study Depression Scale (CES-D-10), the Everyday Discrimination Scale (EDS), the Oslo Social Support Scale (OSSS), and community strengths (CS). We first assessed the correlation between CES-D-10 scores and EDS, OSSS, and CS. We found that half of the participants (52.2%) had CES-D-10 scores of 10 or greater, indicating the presence of depressive symptomatology. In a multivariable model controlling for significant covariates (age, time lived in U.S.), EDS was positively associated with CES-D-10 scores (β = 0.64, 95% CI = 0.45, 0.83), while OSSS was negatively associated with CES-D-10 scores (β = -0.53, 95% C I= -0.80, -0.27). No statistically significant relationship was observed between CES-D-10 and CS scores. In this sample of Brazilian immigrant women, depressive symptomatology was highly prevalent, and experiences of discrimination were associated with increased symptoms of depression. There is a need to understand and address mental health in Brazilian immigrant women. [ABSTRACT FROM AUTHOR]

Introduction: The physiological changes in mother-infant pairs during pregnancy increase the susceptibility to a series of infections, including those of the oral cavity. Therefore, the oral and systemic health of pregnant women is related to adverse pregnancy outcomes. Objective: This cross-sectional study aimed to evaluate the systemic profile and periodontal status of women with a high-risk pregnancy. Methods: Eighty-nine pregnant women at risk of preterm labor admitted to a hospital in southern Brazil were interviewed and received a periodontal examination. Data related to obstetric complications during pregnancy (pre-eclampsia, infections, medication use, and gestational diabetes) and systemic diseases were collected from medical records. The periodontal parameters of probing pocket depth, bleeding on probing, and clinical attachment level were evaluated. The data were tabulated, and statistical analysis was performed (p < 0.05). Results: The mean age of participants was 24 years (SD = 5.62). Gingival bleeding was recorded in 91% of the participants. The prevalence of gingivitis was 31.46%, and periodontitis was 29.21%. No association between systemic conditions and periodontal disease was observed. Conclusions and Implications for Practice: Periodontal inflammation was not associated with the systemic profile during pregnancy. However, women with high-risk pregnancies showed higher levels of gingival inflammation, emphasizing the importance of dental care during pregnancy. Significance: The gestational period is marked by a series of physiological changes that can be influenced by local and systemic conditions. Thus, investigating the periodontal status of pregnant women considered at risk for premature birth and evaluating associations with the systemic health of these patients can present important risk indicators for maternal and fetal health. [ABSTRACT FROM AUTHOR]

Introduction: Since sex-specific accumulated oxygen deficit (AOD) during high-intensity swimming remains unstudied, this study aimed to assess AOD during 50, 100, and 200 m front-crawl performances to compare the responses between sexes and analyse the effect of lean body mass (LBM). Methods: Twenty swimmers (16.2 ± 2.8 years, 61.6 ± 7.8 kg, and 48.8 ± 11.2 kg LBM—50% males) performed 50, 100, and 200 m to determine accumulated oxygen uptake (V̇O2Ac). The swimmers also performed an incremental test from which five submaximal steps were selected to estimate the oxygen demand (V̇O2demand) from the V̇O2 versus velocity adjustment. V̇O2 was sampled using a gas analyser coupled with a respiratory snorkel. AOD was the difference between V̇O2demand and V̇O2Ac, and LBM (i.e. lean mass not including bone mineral content) was assessed by dual-energy X-ray absorptiometry (DXA). Results: A two-way ANOVA evidenced an AOD increase with distance for both sexes: 19.7 ± 2.5 versus 24.9 ± 5.5, 29.8 ± 8.0 versus 36.5 ± 5.8, and 41.5 ± 9.4 versus 5.2 ± 11.9 ml × kg−1, respectively, for 50, 100, and 200 m (with highest values for females, P < 0.01). Inverse correlations were observed between LBM and AOD for 50, 100, and 200 m (r = − 0.60, − 0.38 and − 0.49, P < 0.05). AOD values at 10 and 30 s elapsed times in each trial decreased with distance for both sexes, with values differing when female swimmers were compared to males in the 200 m trial (at 10 s: 2.6 ± 0.6 vs. 3.4 ± 0.6; and at 30 s: 7.9 ± 1.7 vs. 10.0 ± 1.8 ml × kg−1, P < 0.05). Conclusion: LBM differences between sexes influenced AOD values during each trial, suggesting that reduced muscle mass in female swimmers plays a role on the higher AOD (i.e. anaerobic energy) demand than males while performing supramaximal trials. [ABSTRACT FROM AUTHOR]

Physical frailty has been described as a complex geriatric syndrome. Independent of frailty, older people have been showing an increased health care services utilization. The objective is to assess an interaction effect between frailty and education on the association with the use of health services in community-dwelling older Brazilians. This is a cross-sectional study. The study was conducted with community-dwelling older Brazilian individuals. The sample had 5,473 older adults derived from the FIBRA Study. The definition of frailty was made using the physical frailty phenotype. The level of education was assessed by complete years of schooling. The use of health services was assessed by the occurrence of hospitalization, for individuals receiving home visits and having attended four or more medical consults in the past 12 months. The robust Poisson regression model with a robust error variance was used to estimate the prevalence ratio (PR) and its 95% confidence intervals to set the association between frailty and use of health services, considering the interaction between frailty and education in final model. Considering all sample, 16.4% were hospitalized, 14.1% received home visits, and 48.2% attended four or more medical consults. The interaction term between frailty and education was statistically significant only for hospitalization, showing a higher prevalence of health services utilization among pre-frail (PR1.68 95% CI 1.15–2.47) and frail (PR1.77 95% CI 1.08–2.90) older individuals with low education compared to non-frail highly educated peers. Low-educated and frail older people were more likely to be hospitalized and should be carefully looked after by health professionals. [ABSTRACT FROM AUTHOR]

This study aimed to analyze the effects of exergaming and resistance training on reaction time in older adults and to investigate intraindividual variability in reaction time. Thirty-six participants (62.1 ± 7.1 years), randomly assigned to exergaming (n = 17) or resistance training (n = 19) groups, underwent two protocols of physical training carried out three times a week for 13 weeks. The exergaming program was based on games from Kinect Sports and Kinect Adventures collections using a console Xbox 360 Kinect. In the resistance-training program, each session consisted of ten full-body exercises using free weights and weight machines. Outcomes were reaction time in simple (finger-press test) and complex (Stroop test) tasks and intraindividual variability. A mixed model analysis of variance was conducted, and effects sizes were calculated. Interactions effects revealed no significant differences between groups before and after 13 weeks of training. Regarding the main effects, only the exergaming group showed a significant (p = 0.041) and relevant decrease in reaction time in a complex task (neutral test) when compared to the pre- (1854 ± 732 ms) and post-tests (1530 ± 521 ms). The resistance-training group showed a trend (relevant effect size) of improvement in intraindividual variability in reaction time. These results suggest that both interventions could benefit the cognitive function of older adults. Exergaming improves the reaction time in a complex task, and resistance training improves the intraindividual variability. However, exergaming was not superior to resistance training in any of the outcomes. Trial Registration: Brazilian Clinical Trials Registry (RBR-7fh22d/) on 06/07/2019, retrospectively registered. [ABSTRACT FROM AUTHOR]

Calls for refining the understanding of depression beyond diagnostic criteria have been growing in recent years. We examined the prevalence and relevance of DSM and non-DSM depressive symptoms in two Brazilian school-based adolescent samples with two commonly used scales, the Patient Health Questionnaire (PHQ-A) and the Mood and Feelings Questionnaire (MFQ). We analyzed cross-sectional data from two similarly recruited samples of adolescents aged 14–16 years, as part of the Identifying Depression Early in Adolescence (IDEA) study in Brazil. We assessed dimensional depressive symptomatology using the PHQ-A in the first sample (n = 7720) and the MFQ in the second sample (n = 1070). We conducted network analyses to study symptom structure and centrality estimates of the two scales. Additionally, we compared centrality of items included (e.g., low mood, anhedonia) and not included in the DSM (e.g., low self-esteem, loneliness) in the MFQ. Sad mood and worthlessness items were the most central items in the network structure of the PHQ-A. In the MFQ sample, self-hatred and loneliness, two non-DSM features, were the most central items and DSM and non-DSM items in this scale formed a highly interconnected network of symptoms. Furthermore, analysis of the MFQ sample revealed DSM items not to be more frequent, severe or interconnected than non-DSM items, but rather part of a larger network of symptoms. A focus on symptoms might advance research on adolescent depression by enhancing our understanding of the disorder. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to evaluate the time to diagnosis of pediatric cancer and associated comorbidities during cancer therapy. Subject and Methods: This was a prospective observational study with a 20-month follow-up of 146 pediatric patients diagnosed with cancer and treated in northeastern Brazil. Results: The mean age of the participants was 8.2 (± 5.4) years; most of them were males (n = 86; 58.9%) and had been diagnosed with hematologic neoplasms (n = 72; 49.3%). The initial signs and symptoms presented by the patients were associated with the cancer diagnosis (P < 0.05). The median time to diagnosis was 35.0 days. Deaths were more frequent in patients with acute lymphoid leukemia (P = 0.036), and the occurrence of metastasis was significantly related to death (P < 0.001). Conclusion: The pediatric cancer patients who participated in our study had their signs and symptoms misdiagnosed and treated as common childhood issues. However, while the cancer diagnosis was late, the time to diagnosis was not associated with the occurrence of metastasis, need for amputation/disarticulation, or death. [ABSTRACT FROM AUTHOR]

Adequate protein consumption in amount, food sources, and meals is important to maintain muscle mass and reduce the risk of sarcopenia in older adults. This study aimed to assess protein intake in terms of the amount consumed, food sources, and meals in a sample of 295 community-dwelling older adults in a city in southeastern Brazil. Protein intake was assessed in grams/day and the amount consumed per meal and food sources were calculated using the total value and relative contribution. Adequate protein consumption was considered 0.66 g/kg/day (Estimated Average Requirement-EAR) and amount per meal 25 g, as recommended by the PROT-AGE Study Group. Descriptive analysis was based on central trend and dispersion measures. Average protein intake was 67 g and 1.05 g/kg, with an 8.5% prevalence of inadequacy. The meal that provided the largest protein contribution was lunch and 98% of the group showed insufficient intake at breakfast. Concerning food sources, the greatest contribution came from the meat group (47.3%). The results indicated that median intake was at the lower end of the range recommended by PROT-AGE, with about 50% of subjects consuming less than 1.0 g/kg/day. Protein distribution among meals showed a high prevalence of adequate consumption, breakfast being the most critical meal. Strategies to optimize protein intake should consider the amount, quality, and distribution of protein consumed at meals that form part of a balanced healthy diet, in addition to dietary techniques and supplementation, to achieve maximum protein synthesis capacity. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to describe the development and analyze the content validity of an educational material with intervention strategies to promote a healthy consumer food environment according to the Dietary Guidelines for the Brazilian Population. Subject and methods: The recommendations of the Brazilian Dietary Guideline were used to develop the educational material. The content validity was performed by a panel of experts who assessed the aspects of clarity, pertinence, relevance, and representativeness for each of the 31 educational strategies included in the material. The content validity index (CVI > = 0.90) was used for the content validity analysis through item level-CVI and scale-CVI. The reliability was accessed by the percentage of the interrater agreement (IRA > 0.80 was considered great) to clarity and representativeness aspects. Results: The educational material was named Healthy Food Trade: A guide to action for public managers and retailers to promote a healthy food environment in the community (HFT). Ten experts participated in the content validation process; 20% worked in the public supply sector, 70% had academic experience in food retail environments, and 10% worked on communication strategies. The percentage of IRA was 0.93 to clarity and 0.94 to representativeness to the overall material. The S-CVI was 0.93. After the modifications, the final version presents intervention strategies that can be carried out in food retailers to make them healthier. Conclusion: The HFT Guide had intervention strategies validated by a panel of experts that could support public managers and food retailers in promoting a healthier consumer food environment. [ABSTRACT FROM AUTHOR]

Background: Little is known about how the interplay among health-related behaviors impacts self-rated health (SRH). We examined the clustering of physical activity (PA), sleep, diet, and specific screen-based device use, and the associations between the emergent clusters and SRH among Brazilian adolescents. Method: The data used in this cross-sectional study were from the baseline of the Movimente Program. Self-reported data were analyzed. SRH was recorded as a 5-point scale (from poor to excellent). Daily duration of exposure to the computer, the television, the cell phone, and games; PA; sleep; and weekly consumption of fruits and vegetables and ultra-processed foods were included in a Two-Step cluster analysis. Multilevel ordered logistic regressions assessed the associations between the clusters and SRH. Results: The data of 750 students (girls: 52.8%, 13.1 ± 1.0 years) were analyzed. Good SRH was more prevalent (52.8%). Three clusters were identified: the Phubbers (50.53%; characterized by the longest cell phone use duration, shortest gaming and computer use, lowest PA levels, and low consumption of fruits and vegetables), the Gamers (22.80%; longest gaming and computer use duration, PA < sample average, highest intake of ultra-processed foods), and a Healthier cluster (26.67%; physically active, use of all screen-based devices < sample average, and healthier dietary patterns). For both Gamers (−0.85; 95% CI −1.24, −0.46) and Phubbers (−0.71; 95% CI −1.04, −0.38), it was found a decrease in the log-odds of being in a higher SRH category compared with the Healthier cluster. Conclusion: Specific clusters represent increased health-related risk. Assuming the interdependence of health-related behaviors is indispensable for accurately managing health promotion actions for distinguishable groups. [ABSTRACT FROM AUTHOR]

Objectives: To describe the process of implementing a palliative care team (PCT) in a Brazilian public tertiary university hospital and compare this intervention as an active in-hospital search (strategy I) with the Emergency Department (strategy II). Methods: We described the development of a complex Palliative Care Team (PCT). We evaluated the following primary outcomes: hospital discharge, death (in-hospital and follow-up mortality) or transfer, and performance outcomes-Perception Index (difference in days between hospitalization and the evaluation by the PTC), follow-up index (difference in days between the PTC evaluation and the primary outcome), and the in-hospital stay. Results: We included 1203 patients—strategy I (587; 48.8%) and strategy II (616; 51.2%). In both strategies, male and elderly patients were prevalent. Most came from internal medicine I (39.3%) and II (57.9%), p < 0.01. General clinical conditions (40%) and Oncology I (27.7%) and II (32.4%) represented the majority of the population. Over 70% of all patients had PPS 10 and ECOG 4 above 85%. There was a reduction of patients identified in ICU from I (20.9%) to II (9.2%), p < 0.01, reduction in the ward from I (60.8%) to II (42.5%), p < 0.01 and a significant increase from I (18.2%) to II (48.2%) in the emergency department, p < 0.01. Regarding in-hospital mortality, 50% of patients remained alive within 35 days of hospitalization (strategy I), while for strategy II, 50% were alive within 20 days of hospitalization (p < 0.01). As for post-discharge mortality, in strategy II, 50% of patients died 10 days after hospital discharge, while in strategy I, this number was 40 days (p < 0.01). In the Cox multivariate regression model, adjusting for possible confounding factors, strategy II increased 30% the chance of death. The perception index decreased from 10.9 days to 9.1 days, there was no change in follow-up (12 days), and the duration of in-hospital stay dropped from 24.3 to 20.7 days, p < 0.01. The primary demand was the definition of prognosis (56.7%). Conclusion: The present work showed that early intervention by an elaborate and complex PCT in the ED was associated with a faster perception of the need for palliative care and influenced a reduction in the length of hospital stay in a very dependent and compromised old population. [ABSTRACT FROM AUTHOR]

Menopause can be defined as the complete interruption of menstrual cycles. The period which precedes this event is termed climacteric. Improvements in medical-care have brought an increase in the life expectancy of people with disabilities and increased the number of women with disabilities who experience climacteric and menopause. The objective of this review was to analyze available data on the health care, health status and symptoms perceived by women with disabilities during the climacteric and menopause period. A search in the literature was performed considering nine electronic databases-Medline, Cinahl, Scielo, Lilacs, SportDiscus, Web of Science, Academic Search Premier and PsycInfo. The inclusion criteria were: (a) field study with the participation of climacteric and/or post-menopausal women with some kind of disability; (b) evaluation of the health conditions of the participating women, with the care taken in order to maintain their health during this period and/or the symptoms perceived during climacteric. Seventeen studies were selected. Specific characteristics of the climacteric and menopause process in disabled women were found in all the studies. This review highlights the necessity to create a questionnaire and evaluation methods for assessing the health status and healthcare, as well as the specific climacteric symptoms of women with disabilities. [ABSTRACT FROM AUTHOR]

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The duration of activities performed by healthcare providers are pivotal to Time-Driven Activity-Based Costing (TDABC) models. This study examines the use of a smartphone mobile application technology to record activity times. This study validates the accuracy of activity times recorded on a smartphone mobile application, dTool, compared to observed length of time recordings in the operating room. For analysis, we performed two one-sided tests for the measurements "Case Start" and "Case End". Equivalence bounds were specified in terms of raw mean difference of 1 min (upper) and –1 min (lower). The total number of comparisons in the observer protocol was 72 (32 "case start" patient comparisons and 40 "case end" patient comparisons measured over 45 individual OR cases). Given equivalence bounds of –1.000 and 1.000 (on a raw scale) and an alpha of 0.05, both equivalence tests were significant: provider and third-party observer protocol presented t(40) = 3.228 and p = < 0.001; observer timing protocol presented t(68.68) = 56.762, p = < 0.001. Conclusions: With this novel smartphone technology, a healthcare provider can reliably self-record activity LoT using dTool while providing patient care. Future TDABC studies incorporating this technology will reduce the potential operational barriers to implementation. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to measure the prevalence, to describe the trend over time, and to evaluate socioeconomic inequalities in the occurrence of episiotomies in 2007, 2010, 2013, and 2016 in the municipality of Rio Grande, in Southern Brazil. Methods: We included all women who had vaginal delivery in each of the studied years. All the information was obtained through a questionnaire applied at maternity wards within 48 h after delivery. The outcome consisted of episiotomy. A chi-square test was used to evaluate the linear trend. Absolute and relative inequalities were assessed from household income and schooling of the women through the Slope Index of Inequality and Relative Index of Inequality, respectively. Results: This study included 4,521 parturients. The episiotomy rate in the period fell from 71.0% (95%CI: 68.4–73.5) in 2007 to 40.1% (95%CI: 37.3–42.8) in 2016, and it was more frequent among women with higher income and higher schooling. We observed a reduction in the rate of episiotomy in all income and schooling levels, and this was more evident among women in the lowest socioeconomic levels. Absolute inequality declined, while relative inequality remained unchanged. Conclusions for Practice: Despite the significant reduction in the rate of episiotomy, its occurrence remains high. Women with higher income and education, therefore with lower risk for complications during childbirth, were the most frequently submitted to this procedure. Routine use of episiotomy must be reevaluated, especially among pregnant women with better socioeconomic status. [ABSTRACT FROM AUTHOR]

This qualitative study analyzed the life course of ten Brazilian spiritist mediums who presented anomalous experiences (AEs). A socio-demographic questionnaire and semi-structured interviews were carried out with a non-clinical group, focusing on spiritual background. The inicial AEs were frightening and anguishing, as mediums have related uncertainty and feeling of being controlled; however, after their contact to Spiritism a new positive context was provided, through acceptance and supportiveness, promoting resilience, altruism and self-knowledge, besides an omnipotence status related to mediumship. It was concluded that harmful spiritual experiences may be positively transformed by reframing processes driven by organized religious doctrines. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the internal structure (structural validity and internal consistency) and propose a classification for the distress caused by the presence of pelvic floor dysfunction (PFD) symptoms based on the total score of the Pelvic Floor Distress Inventory (PFDI-20). Methods: Cross-sectional study conducted with Brazilian women over 18 years of age. Exploratory and confirmatory factor analysis were performed with Parallel Analysis and to test three models to compare them with the Root Mean Square Error of Approximation (RMSEA) and Comparative Fit Index (CFI). Internal consistency was calculated using Cronbach's alpha. Partial credit model (PCM) was performed to classify the total score of the PFDI-20. Results: Data from 237 women (49.62 ± 16.95 years) were analyzed. The one-dimensional structure had 43.74% of the explained variance with α = 0.929. The one-dimensional model was the most appropriate (CFI = 0.987 and RMSEA = 0.022). The total PFDI-20 score was classified as the absence of symptoms (score zero), symptoms with mild distress (1 to 15 points), symptoms with moderate distress (16 to 34 points), and symptoms with severe distress (35 to 40 points). Conclusion: The PFDI-20 has an one-dimensional structure and the distress caused by the presence of PFD symptoms can be classified as mild, moderate and severe. Health professionals and future studies can use our classification to facilitate the understanding of the patient's health status and to obtain other analyses on the severity of the distress of the symptoms of PFD. Plain English summary: There are limitations regarding the meaning of the total score of the Pelvic Floor Distress Inventory (PFDI-20) in clinical practice and scientific research. Thus, the aims of this study were to evaluate the internal structure (structural validity and internal consistency) and propose a classification for the distress caused by the presence of pelvic floor dysfunction (PFD) symptoms from the total score of PFDI-20. Cross-sectional study conducted with Brazilian women over 18 years of age. Data from 237 women (49.62 ± 16.95 years) were analyzed. The PFDI-20 has one-dimensional structure and the distress caused by the presence of PFD symptoms can be classified as mild, moderate and severe. [ABSTRACT FROM AUTHOR]

Background: The use of small pediatric kidneys as single grafts for transplantation is controversial, due to the potential risk for graft thrombosis and insufficient nephron mass. Methods: Aiming to test the benefits of transplanting these kidneys, 375 children who underwent kidney transplantation in a single center were evaluated: 49 (13.1%) received a single graft from a small pediatric donor (≤ 15 kg, SPD group), 244 (65.1%) from a bigger pediatric donor (> 15 kg, BPD group), and 82 (21.9%) from adult living donors (group ALD). Results: Groups had similar baseline main characteristics. After 5 years of follow-up, children from the SPD group were comparable to children from BPD and ALD in patient survival (94%, 96%, and 98%, respectively, p = 0.423); graft survival (89%, 88%, and 93%, respectively, p = 0.426); the frequency of acute rejection (p = 0.998); the incidence of post-transplant lymphoproliferative disease (p = 0.671); the odds ratio for severely increased proteinuria (p = 0.357); the rates of vascular thrombosis (p = 0.846); and the necessity for post-transplant surgical intervention prior to discharge (p = 0.905). The longitudinal evolution of eGFR was not uniform among groups. The three groups presented a decrease in eGFR, but the slope of the curve was steeper in ALD children. At 5 years, the eGFR of the ALD group was 10 ml/min/1.73m2 inferior to the others. At that time, the eGFR from the SPD group was statistically similar to the BPD group (p = 0.952). Conclusion: In a specialized transplant center, the use of a single small pediatric donor kidney for transplantation is as successful as bigger pediatric or adult living donors, after 5 years of follow-up. A higher resolution version of the Graphical abstract is available as Supplementary information. [ABSTRACT FROM AUTHOR]

The objectives of this study were to identify the interaction between drug interaction risk, common mental disorders, use of psychiatric medication and quality of life in patients treated in primary health care settings in Brazil. In this quantitative research, 452 patients were interviewed in ten basic Brazilian health units. Sociodemographic and pharmacotherapeutic questionnaires, use of psychiatric medication, prevalence of common mental disorders, and quality of life were utilised. The structural equation model was used to evaluate the relationships among the variables. The prevalence of drug interaction risk was 66.59%. The variables associated with drug interaction risk were polypharmacy and income. The use of psychiatric medication was associated with diagnosis of common mental disorders, income and gender. The use of psychiatric medication and common mental disorders negatively influenced quality of life. [ABSTRACT FROM AUTHOR]

Although adolescents living on the street tend to have unprotected sex with many partners and substance abuse, little is known about this reality in Brazil. To estimate the prevalence and factors associated with risky sexual behavior among children and adolescents living on the street in Porto Alegre and Rio Grande. A cross-sectional study was carried out using the Respondent-Driven Sampling (RDS) sampling method to quickly and efficiently access populations of difficult access. Poisson regression with robust adjustment of variance was used in the multivariate analysis. The sample consisted of 231 participants aged 10–21 years. Most were male and aged 16- 21 years. More than half (66.7%) of the respondents did not have a school bond, and 64.5% did not live with the family. Half of the sample had been living on the street for at least four years, spending 15 h or more on the street. Most (86.6%) responded that they had already used illicit drugs in their lives, and unprotected sex prevalence was 61.9%. The variables independently associated with unprotected sex were years living on the street, hours spent on the street, having a steady partner, illicit drug use, and sexual intercourse without a condom under the influence of drugs. The high prevalence of unprotected sex points to the need for intervention policies for this population to prevent the main risk factors. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: APOL1 high-risk genotypes (HRG) are associated with increased risk of kidney disease in individuals of African ancestry. We analyzed the effects of APOL1 risk variants on an ethnically diverse Brazilian pediatric nephrotic syndrome (NS) cohort. Methods: Multicenter study including 318 NS patients, categorized as progressors to advanced CKD [estimated glomerular filtration rate (eGFR)] < 30 mL/min/1.73 m2] and slow/non-progressors (eGFR > 30 mL/min/1.73 m2 through the study). We employed Cox regression with progression time as the outcome and APOL1 genotype as the independent variable. We tested this association in the entire cohort and three subgroups; (1) focal segmental glomerulosclerosis (FSGS), (2) steroid-resistant NS (SRNS), and (3) those who underwent kidney biopsy. Results: Nineteen patients (6%) had an HRG. Of these, 47% were self-reported White. Patients with HRG manifested NS at older ages and presented higher frequencies of FSGS and SRNS. HRG patients progressed to advanced CKD more often than low-risk-genotype (LRG) children in the whole NS cohort (p = 0.001) and the three subgroups. In SRNS and biopsied patients, a single risk variant was associated with trends of higher CKD progression risk. Conclusions: Novel discoveries include a substantial prevalence of HRG among patients self-reported White, worse kidney outcomes in HRG versus LRG children in the FSGS subgroup, and a trend of higher CKD progression risk associated with a single risk variant in the SRNS cohort. These findings suggest APOL1-associated NS extends beyond patients self-reported non-White, the HRG effect is independent of FSGS, and a single risk variant may have a detrimental impact in children with NS. [ABSTRACT FROM AUTHOR]

Purpose: The establishment of candidate genetic determinants associated with tuberculosis (TB) is a challenge, considering the divergent frequencies among populations. The objective of this study was to evaluate the association between MIF − 794 CATT 5−8 polymorphism and susceptibility to TB. Methods: Case–control study. Patients > 18 years, with pulmonary TB were included. The control group consisted of blood donors and household contacts, not relatives, healthy and > 18 years. MIF − 794 CATT 5−8 were genotyped using sequencing of PCR and capillary electrophoresis. Results: 126 patients and 119 controls were included. The genotype 5/5 was more frequent among cases (15.1%) than in controls (5.9%) (p = 0.019). Cases had more frequently the allele 5 (29.4%) as compared with controls (19.3%) (p = 0.010). Prevalence of 7/X + 8/X genotypes was not different between cases and controls (p = 0.821). There was no difference between patients with alleles 7 and 8 and those with alleles 5 and 6 (p = 0.608). Conclusions: The genotype 5/5 and the allele 5 of MIF − 794 CATT 5−8 were more frequent among TB patients than in controls. [ABSTRACT FROM AUTHOR]

The present study aims to investigate how religious/spiritual (R/S) beliefs are associated with depressive, anxious and stress symptoms and quality of life (QOL) of 160 Brazilian women in early pregnancy. In this cross-sectional study, religiosity/spirituality (DUREL, Daily Spiritual Experiences, Brief-RCOPE), mental health (DASS-21) and quality of life (WHOQOL-Bref) were assessed. Negative R/S coping was associated with higher levels of depressive, anxious and stress symptoms and worse physical and psychological QOL. On the other hand, positive R/S coping, intrinsic religiosity, and spirituality were associated with better psychological QOL, while only spirituality was associated with better social QOL. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: A previous qualitative assessment of the psychosocial consequences of labelling hypertension describes the diagnosis of hypertension as a labelling event with potential unintended negative long-term psychosocial consequences (labelling effects). Until now, the benefits of diagnosing hypertension have been far more reported than the harms. To obtain the net result of the preventive interventions for cardiovascular disease, such as diagnosing and treating mild hypertension, assessing benefits and harms in the most comprehensive way possible is necessary, including the psychosocial consequences of labelling. When measuring psychosocial consequences of labelling hypertension, a questionnaire with high content validity and adequate psychometric properties is needed. Objectives: The aim of this study was to describe the psychometric parameters of face and content-validated pool of items. Other objectives were also to screen the item pool by using Rasch model analysis and confirmatory factor analysis (CFA) for identifying such items with sufficient fit to the hypothesised models. Methods: We surveyed the pool of items as a draft questionnaire to Brazilians recruited via social networks, sending e-mails, WhatsApp® messages and posting on Facebook®. The inclusion criteria were to be older than 18 years old, to be healthy and to have only hypertension. We used Rasch model analysis to screen the item pool, discarding items that did not fit the hypothesised domain. We searched for local dependence and differential item functioning. We used CFA to confirm the derived measurement models and complementarily assessed reliability using Cronbach's coefficient alpha. Results: The validation sample consisted of 798 respondents. All 798 respondents completed Part I, whereas 285 (35.7%)—those with hypertension—completed Part II. A condition-specific questionnaire with high content validity and adequate psychometric properties was developed for people labelled with hypertension. This measure is called 'Consequences of Labelling Hypertension Questionnaire' and covers the psychosocial consequences of labelling hypertension in two parts, encompassing a total of 71 items in 15 subscales and 11 single items. Conclusion: We developed a tool that can be used in future research involving hypertension, especially in scenarios of screening, prevention, population strategies and in intervention studies. Future use and testing of the questionnaire may still be required. [ABSTRACT FROM AUTHOR]

The study aimed to explore associations between socioeconomic position (SEP) indicators, early child stimulation (ECS) and attention-related executive functions (EF) at age 11. Children born in Pelotas, Brazil, in 2004, were recruited to a birth cohort (n = 4231, non-response rate at recruitment < 1%) and followed from birth to age 11. SEP variables were family income and maternal schooling. At the 24 and 48-month follow-ups, five markers of cognitive stimulation and social interaction were recorded and positive answers were summed to a score ranging from 0 to 5. At age 11, attentional-switching and control, and selective-attention were assessed using the adapted Test-of-Everyday-Attention-for-Children (TEA-Ch). We used multivariable logistic regression models and mediation analysis to investigate potential mediator role of ECS in the association between SEP and EF. 3106 children were included in the analyses. Less than 7% of the more stimulated individuals showed low performance in attention-related EFs at age 11 compared with almost 20% in the bottom groups of stimulation. Higher child stimulation scores were associated with fewer impairments in attentional-control (OR adj 0.84; CI 95% 0.72–0.98) and attentional-switching (OR adj 0.85; CI 95% 0.73–0.99). Mediation analysis suggested that for attentional-switching, ECS mediated almost 20% of the total protective effect of maternal schooling for impaired EF. Assuming causal relationships, if maximum stimulation was provided to all children, the advantageous effect of maternal schooling on EF would be reduced by 47%. ECS may represent a protective factor for cognitive impairments in childhood and can be easily implemented at relatively low cost. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to evaluate the association between dental pain and both child irritability and family distress. Subject and methods: A cross-sectional study was conducted among 833 children aged 3 to 5 years from preschools in the city of Campina Grande, Brazil. The parents answered questionnaires addressing socio-demographic data and history of dental pain. Child irritability and family distress were evaluated using questions from the Early Childhood Oral Health Impact Scale (ECOHIS). The children were submitted to clinical examinations by dentists who had undergone training and calibration exercises. All children were diagnosed with regard to dental caries, caries activity, traumatic dental injury, and malocclusion. Descriptive analysis was performed, followed by Poisson regression analysis (α = 5%). Results: The prevalence of child irritability due to oral problems was 16.1%. The prevalence of family distress was 19.1%. After the data analysis, only a history of dental pain remained associated in the final model for child irritability [prevalence ratio (PR) = 9.77; 95% confidence interval (CI): 6.22–15.33] and family distress due to oral problems (PR = 3.18; 95% CI: 2.34–4.31). Conclusion: Dental pain can make a child irritable and cause family distress. Socio-economic factors do not exert an influence on the emergence of these feelings. [ABSTRACT FROM AUTHOR]

Background: Malnutrition is frequent in older cancer patients, with a prevalence that ranges from 25% to 85%. The aging process is associated with several physiological changes, which may have implications for nutritional status. Screening tools can be useful for identifying malnutrition status among older patients with cancer. Methods: A hospital-based multicenter cohort study that included 44 institutions in Brazil. The Mini Nutritional Assessment-Short Form (MNA-SF) was administered to 3061 older hospitalized cancer patients within 48 hoursof admission. The Kolmogorov-Smirnov test was used to test the sample distribution, considering sex, age range, calf circumference, body mass index, and MNA-SF score and classification. The categorical data were expressed by frequencies (n) and percentages (%)and compared using the chi-square test or Tukey test. Results: According to the results of the MNA-SF, 33.4% of the patients were malnourished, 39.3% were at risk of malnutrition, and 27.3% were classified as having normal nutritional status. Length of hospital stay (in days) was found to be longer for those patients with a poorer nutritional status (malnourished: 7.07±7.58; at risk of malnutrition: 5.45±10.73; normal status: 3.9±5,84; p <0.001). Conclusions: The prevalence of malnutrition and nutritional risk is high in older hospitalized cancer patients in all the regions of Brazil and a worse nutritional status is associated with a longer hospital stay. Using a low-cost, effective nutritional screening tool for older cancer patients will enable specialized nutritional interventions and avoid inequities in the quality of cancer care worldwide. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to describe the distribution of ultra-processed food and drink products (UPP) consumption according to sociodemographic characteristics in adults from southern Brazil, and to investigate which are the most-consumed UPP subtypes in the different social strata. Methods: Cross-sectional analysis of the second wave of a population-based cohort of 1720 adults. The usual caloric intake and the caloric contribution of UPP to total energy intake (%CTEI) were estimated by the application of two 24-h dietary recalls (adjusted by intra- and inter-individual variability). Data were analyzed according to gender, age, marital status, schooling, and family income. Linear regression models were used to estimate the adjusted means. Results: Consumption data were obtained from 1206 adults (70.1% of the original cohort). Mean UPP consumption was higher in males than females (829.6 kcal vs 694.3 kcal, p value < 0.001), but the %CTEI from UPP increased in females (34.7% vs 39.3%, p value < 0.001), even after adjusting for sociodemographic variables. In the full model, which included all sociodemographic variables, %CTEI from UPP was inversely associated with age (difference between extreme categories 7.1 pp., 95 CI% 7.7–6.5) and directly associated with schooling (difference between extreme categories 6.3 pp., 95 CI% 5.5–7.1). The subtypes of UPP that contributed most to the observed differences were processed breads, fast food, and ultra-processed pies and sweets. Conclusions: UPP account for a third of the calories normally consumed, with women, young people, and better educated individuals being the most vulnerable groups. These results can help when planning public policies to reduce UPP consumption. [ABSTRACT FROM AUTHOR]

Parenthood represents a major biological, social and environmental life change. Mental health disorders are common in parents and impact both the parent and their offspring. However, the relationship between parenthood and mental health and the direction of these effects are poorly understood. Longitudinal data from the Pelotas 1982 birth cohort, Southern Brazil, on 3701 individuals was used to investigate the association between number of children by age 30 years and mental health disorders using DSM-IV diagnoses at age 30 years, suicidal risk and the change in symptoms using repeated measures (using the SRQ-20) from age 19 to 30 years. Mothers, but not fathers, with higher number of children by age 30 years, were at a substantially increased risk of a wide range of mental health disorders compared to women with no children. There was evidence that motherhood was associated with an increase in symptoms over time rather than higher symptoms at baseline. Younger age at first child was also a risk factor for mental health disorders. Mothers, particularly those with multiple children, are at risk of a wide range of mental health disorders. The mechanisms to explain these risks are yet to be elucidated; however, the risk of mental health disorders was not replicated in fathers, which would be expected if residual confounding explained observed associations. Thus, multiparous mothers represent a high-risk group and should be prioritised for supportive interventions. [ABSTRACT FROM AUTHOR]

We examined motivations for migration to the United States (US) among 482 Brazilian, Colombian, and Dominican men who have sex with men (MSM). Participants' most common reason for migration was to improve their financial situation (49%), followed by sexual migration in order to affirm their sexual orientation (40%). Fewer endorsed sexual migration motivated by avoiding persecution due to being gay (13%). We conducted further analyses among 276 participants who migrated after age 15 and were HIV-negative at the time of migration. We hypothesized that sexual migration would be associated with greater likelihood of HIV acquisition post-migration. Hierarchical logistic regression analysis indicated that sexual migration motivated by avoiding persecution due to being gay was associated with increased odds of contracting HIV after arrival in the US whereas sexual migration to lead a gay life was not. Our findings highlight the importance of addressing the negative impact of anti-gay discrimination in countries of origin. [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]

Aim: This study aimed to investigate the sensitivity and responsiveness to change for the Brazilian version of the Child Perceptions Questionnaire (CPQ8–10) after dental caries treatment.Subject and methods: Thirty children aged 8 to 10 years old with untreated dental caries were randomly selected from public schools. They responded to the CPQ8–10 before and 1 month after finishing treatment for dental caries. Sensitivity was assessed by determining distribution changes using paired t-tests and Wilcoxon signed-rank tests. Responsiveness to change was evaluated by effect size (ES) and standardized response mean (SRM). Minimally important differences (MIDs) were also evaluated.Results: Mean/median pre-treatment values for the total CPQ8–10 score and subscales were significantly higher than the post-treatment values (p < 0.05). ES was large (effect size ≥ 0.8) for the total CPQ8–10 score and oral symptoms (OS), functional limitations (FL) and emotional wellbeing (EW) subscales and moderate (effect size 0.3–0.7) for the social wellbeing (SW) subscale. SRM values were moderate (0.3–0.7) for the total CPQ8–10 score and FL, EW and SW subscales and high (≥ 0.8) for the OS subscale. MID values for the total CPQ8–10 score and all subscales were lower than the mean score change.Conclusion: The Brazilian version of the CPQ8–10 is sensitive and responsive enough to detect changes brought about by dental caries treatment. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the association between nutritional risk and quality of life in community-dwelling elderly.Method: A cross-sectional study of individuals aged 60 years or older living in the Brazilian state of Minas Gerais was conducted. Nutritional status was evaluated using the Mini Nutritional Assessment, and quality of life was determined using the WHOQOL-bref and WHOQOL-old. The absolute and relative frequency distributions for each domain were calculated, and chi-square tests were used to examine the association between nutritional risk and quality of life (dichotomous variables). Poisson regression was used to perform univariate and multivariate analyses.Results: 789 (27.9%) of the 2823 elderly patients in the sample were at nutritional risk. The risk of malnutrition was associated with the physical, environment, psychological, sensory abilities, social participation and intimacy domains of quality of life [(PR= 1.42, 95%CI 1.23-1.63); (PR= 1.28, 95%CI 1.12-1.47); (PR= 1.18, 95%CI 1.03-1.36); (PR= 1.36, 95%CI 1.20-1.54); (PR= 1.29, 95%CI 1.13-1.46); (PR= 1.14, 95%CI 1.01-1.29); respectively].Conclusion: The present findings contribute to the understanding of nutritional risk, and support the association between quality of life and nutritional status. These factors should be considered in the diagnosis, monitoring and treatment of nutritional disorders, and may contribute to the prevention and reduction of nutritional risk in this especially vulnerable population. [ABSTRACT FROM AUTHOR]

Given the shortage of medical providers and the need for medical decisions to be responsive to community needs, including lay health providers in health teams has been recommended as essential for the successful management of global health care systems. Brazil's Unified Health System (UHS) is a model for delivering community-based care through Family Health Strategy (FHS) interdisciplinary teams comprised of medical and lay health providers-Community Health Agents (CHAs), nurses, and physicians. This study aims to understand how medical and lay health providers' perceptions and attitudes could impact the delivery of community-based care. The study compares perceptions and attitudes of 168 CHAs, 62 nurses, and 32 physicians across their job context, professional capacities, professional skills, and work environment. Descriptive and bivariate analysis were performed. CHAs reported being the most efficacious amongst the providers. Physicians reported incorporating consumer-input to a lesser degree than nurses and CHAs. CHAs reported using a lesser variety of skills than physicians. A significant proportion of physicians compared to CHAs and nurses reported that they had decision-making autonomy. Providers did not report differences that lack of resources and poor work conditions interfered with their ability to meet consumer needs. This study offers technocratic perspectives of medical and lay health providers who as an inter-professional team provide community-based primary health care. Implications of the study include proposing training priorities and identifying strategies to integrate lay health providers into medical teams for Brazil's Unified Health System and other health systems that aim to deliver community-based care through inter-professional health teams. [ABSTRACT FROM AUTHOR]

Aim: To describe the intake of macro- and micronutrients, verify its adequacy, and analyze their distribution by the socioeconomic and demographic profile of adults. Subject and methods: Longitudinal population-based study with a sample of 1222 people aged 22-63 years from Florianópolis, Southern Brazil. The dietary intake data were collected with a 24-h recall in the total sample, plus a second recall applied on a sub-sample of participants with subsequent adjustment of regular consumption. Diet composition and adequacy of intake were compared between the different educational groups and stratified by sex. Results: The mean energy consumption was 1851 Kcal [standard error (SE) = 15.0 Kcal] and 2259 Kcal (SE = 27.8 Kcal) in females and males, respectively ( p-value <0.001). With increasing education, women showed an increasing trend in energy consumption, carbohydrates, proteins, lipids, saturated, polyunsaturated and monounsaturated fat, cholesterol, and fiber. In men, the same differences were found only in saturated fat and cholesterol ( p-value <0.05 for all). Analyzing the adequate consumption of nutrients, differences were found regarding saturated fat and cholesterol in women and carbohydrates, saturated and polyunsaturated fat in men. The prevalence of inadequacy was up to 47% comparing the different educational groups. Conclusion: A lower percentage of adequacies in food consumption was found in both sexes for those with more years of schooling. Public policy should also target the group with higher education. [ABSTRACT FROM AUTHOR]

The objective of this cross-sectional study is to examine the association between religious involvement and tobacco use in a large representative sample of users of primary healthcare units of Ribeirão Preto, Southeast Brazil. Current and past smoking habits were determined among 1055 users of primary healthcare units. Participants' religiosity was measured using the DUREL questionnaire. The prevalence of smoking among men was 16.8% [95% confidence interval (CI) 12.0-22.5] and among women was 12.6% (95% CI 10.4-15.0). Among the current smokers, 40.9% were light smokers, 24.6% were moderate smokers, and 34.5% were heavy smokers. The mean number of cigarettes smoked per day was 13.5. Respondents who have a religion had a lower smoking prevalence than people who had no religion. Current smoking prevalence tended to be higher among people who do not practice their religion than people who practice their religion. Smoking status is also associated with self-reported religiosity, organizational religious activity and some aspects of intrinsic religiosity. Religiosity is an important factor in influencing the smoking behavior in Brazilian users of the public health services. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the influence of spirituality, religiosity, personal beliefs, and previous contact with health issues on the level of empathy in medical students. Jefferson Scale of Empathy-Student Version, WHOQOL-Spirituality, Religiousness and Personal Beliefs, and Duke University Religion Index were applied to 285 Brazilian medical students. The findings suggest that meaning of life and previous mental health treatment but not Religiosity were positively related to empathy. We suggest that more attention should be given for prevention and treatment of mental health issues, and further studies are needed to understand and replicate these findings. [ABSTRACT FROM AUTHOR]

Background Length of residence in the United States (US), changes in dietary and physical activity behaviors, and economic and social barriers contribute to high childhood obesity rates among children from immigrant families in the US. Brazilians comprise a fast-growing immigrant population group in the US, yet little research has focused on health issues affecting Brazilian children in immigrant families. Understanding sociocultural and environmental influences on parents' beliefs and practices related to child feeding and weight status is essential to altering obesity trends in this group. Methods Qualitative study consisting of five focus groups with a convenience sample of 29 Brazilian immigrant mothers. Results Analyses revealed that the sociocultural and environment transitions faced by Brazilian immigrant mothers' influence their beliefs and practices related to child feeding and weight status. Additionally, acculturation emerged as a factor affecting mothers' feeding practices and their children's eating habits, with mothers preferring Brazilian food environments and that their children preferring American food environments. Mothers viewed themselves as being responsible for promoting and maintaining their children's healthy eating and feeding behaviors, but changes in their social and cultural environments due to immigration and the pressures and demands of raising a family in a new country make this difficult. Conclusions Health promotion interventions to improve healthful eating and feeding practices of Brazilian children in immigrant families must account for social and cultural changes and daily life demands due to immigration as well as potential variation in the levels of acculturation between mothers and their children. [ABSTRACT FROM AUTHOR]