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Prepregnancy body mass index (BMI) and gestational weight gain (GWG) are the most investigated indicators of maternal nutritional status, which is a modifiable factor that plays a vital role in maternal and infant health. This study describes prepregnancy BMI and GWG of 840,243 women with 2,087,765 weight observations in the Brazilian Food and Nutrition Surveillance System from 2008 to 2018. Prepregnancy BMI was classified according to the World Health Organization cut‐offs. Total GWG was calculated from weight measurements taken after 36 weeks of pregnancy and classified according to the Institute of Medicine guidelines. Temporal trends in prepregnancy BMI status were examined, and maps were used to evaluate changes in excessive GWG in each Brazilian federation unit. On overall, prepregnancy overweight and obesity increased from 22.6% to 28.8% and from 9.8% to 19.8%, respectively, between 2008 and 2018. The prevalence of excessive GWG rose from 34.2% to 38.7% during the same period and in 11 of the 27 Brazilian federation units between 2008 and 2016. Women with underweight showed the highest values for mean total GWG for all the compared years (overall variation from 12.3 to 13.1 kg), followed by those with normal weight (11.9 to 12.5 kg), overweight (10.1 to 10.9 kg) and obesity (from 8.2 to 8.9 kg). Within each BMI group, values remained fairly stable throughout the studied period for first‐ and second‐trimester GWG and total GWG. These results help to fill a significant gap in understanding the distribution of prepregnancy BMI and GWG in Brazilian women. [ABSTRACT FROM AUTHOR]

Depression and anxiety are common during pregnancy, but little is known about the influence of these disorders on gestational weight gain (GWG). Data from a prospective cohort of pregnant women followed in a public healthcare center in Rio de Janeiro, Brazil, were used to evaluate the association of depression, anxiety, and suicide risk with GWG. GWG was evaluated at 5–13, 20–26, 30–36, and 37–42 weeks, and GWG adequacy was determined. Statistical analyses included linear mixed-effect models and Poisson regression. We evaluated 206 women, in which 15% (n = 31) presented major depressive disorder, 19.4% (n = 34) suicide risk and 10% (n = 21) generalized anxiety disorder at baseline. Women with depression at the first trimester, persistent depressive symptoms, and anxiety symptoms at the second trimester presented significantly lower rates of GWG per week compared to those without depression or anxiety, respectively. Persistent depressive symptoms represented a 2.40 (95% CI 1.20; 4.81; p = 0.013) increase in the risk of insufficient GWG. There was no significant association between generalized anxiety disorder or suicide risk with GWG. The presence of depression, depressive symptoms, and anxiety during pregnancy were associated with lower GWG rates. Persistent depressive symptoms during pregnancy were directly associated with insufficient GWG. [ABSTRACT FROM AUTHOR]

Purpose: Little is known about the effects of leptin and leptin receptor polymorphisms on lipid changes during pregnancy. The aims of this study were to evaluate the associations between the single nucleotide polymorphisms (SNPs) of leptin and leptin receptor genes and the lipid concentrations during pregnancy; and to test whether dietary intake is a mediator in these associations. Methods: A prospective cohort of 154 pregnant women was followed up in Rio de Janeiro, Brazil during the following gestational periods: 5–13th, 20–26th and 30–36th weeks. HDL-C, total cholesterol (TC) and triglyceride (TG) were measured by the enzymatic colorimetric method, and LDL-C was calculated. DNA was extracted by the phenol–chloroform method, and leptin (G2548A, rs7799039) and leptin receptor SNPs (Q223R; rs1137101 and K109R; rs1137100) were genotyped using real-time PCR. Statistical analyses included linear mixed-effect models. Results: Women with the AA genotype of G2548A polymorphism reported a higher fat and total energy intake and had a higher increase in TG concentration during pregnancy than women with AG or GG genotype. The association between G2548A SNP and TG concentrations was not attenuated by adjusting for total lipid (g) and energy (kcal) intake. We did not observe significant associations between the Q223R and K109R SNPs and the lipid concentrations. Conclusions: Women homozygous for the A allele of the leptin SNP (G2548A) had a higher increase in TG concentrations per gestational week compared with women with the AG or GG genotype. This is an exploratory and hypothesis-generating study, and the results need confirmation in studies with larger sample sizes.' [ABSTRACT FROM AUTHOR]

The article focuses on the studies about biological features of breast cancer as according to age groups at diagnosis in southern Brazil. It discussed the statistical comparisons that were performed through the chi‐square test and Z test followed by Bonferroni adjustment and findings of study from southern Brazil that reveals women aged less than 40 years had longer disease‐free survival.

Pooled data analysis in the field of maternal and child nutrition rarely incorporates data from low- and middle-income countries and existing studies lack a description of the methods used to harmonize the data and to assess heterogeneity. We describe the creation of the Brazilian Maternal and Child Nutrition Consortium dataset, from multiple pooled longitudinal studies, having gestational weight gain (GWG) as an example. Investigators of the eligible studies published from 1990 to 2018 were invited to participate. We conducted consistency analysis, identified outliers, and assessed heterogeneity for GWG. Outliers identification considered the longitudinal nature of the data. Heterogeneity was performed adjusting multilevel models. We identified 68 studies and invited 59 for this initiative. Data from 29 studies were received, 21 were retained for analysis, resulting in a final sample of 17,344 women with 72,616 weight measurements. Fewer than 1% of all weight measurements were flagged as outliers. Women with pre-pregnancy obesity had lower values for GWG throughout pregnancy. GWG, birth length and weight were similar across the studies and remarkably similar to a Brazilian nationwide study. Pooled data analyses can increase the potential of addressing important questions regarding maternal and child health, especially in countries where research investment is limited. [ABSTRACT FROM AUTHOR]

Stereotactic radiosurgery is a procedure that primarily treats intracranial lesions to destroy tumour cells that are inaccessible surgically. Gamma Knife® is a stereotactic radiosurgery unit that can treat brain lesions using 60Co beams, non-invasively. Fields from Gamma Knife® helmets are considered small, therefore, in order to ensure accurate dosimetry, detectors for dose measurements have to be carefully chosen. The IAEA TRS 483 code of practice is a standardized guide for dosimetric procedures and indication of detectors for reference dosimetry of small fields used in radiotherapy beams. The objective of this work was to assess the implementation of the TRS 483 recommendations for Gamma Knife® dosimetry, using two micro-ionization chambers, Exradin A16 and PTW Pinpoint 3D 31016. An acrylic phantom with the same dimensions as those provided by Elekta, Gamma Knife's manufacturer, was built as an alternative. The phantom was characterized for its implementation for Gamma Knife® dosimetry and to be used as part of an audit kit by a Secondary Standard Dosimetry Laboratory (SSDL) in Brazil. Alanine pellets were used as reference detector. Dosimetry results for the acrylic phantom were compared with the ones obtained in phantoms specified by Elekta, which are made of Acrylonitrile Butadiene Styrene (ABS) and Solid Water materials. TRS 483 recommended correction factors were used to calculate the absorbed dose to the water taking into consideration the phantom material. Absorbed dose measurements performed using the designed acrylic phantom showed results comparable to the ones obtained with commercially available phantoms. The new phantom is suitable for Gamma Knife reference and relative dosimetry. The results of this work aim to contribute to the implementation of the TRS 483, mainly in the area of Gamma Knife dosimetry and the use of small volume ionization chambers. • Following TRS 483 this work aimed to design and build an acrylic phantom. • The purpose was to contribute to the implementation of TRS 483. • The acrylic phantom can be used in Gamma Knife® dosimetry. • Micro-ionization chambers and alanine can be used with the acrylic phantom. [ABSTRACT FROM AUTHOR]

Brazil is among the world's top beef producers and exporters, and the Montana breed of livestock has gained popularity due to its exceptional meat quality and ability to adapt to the tropical climate. This differentiates it from other breeds, such as the Zebu and Taurine. A methodology that mapped sixteen farms across five Brazilian states was adopted to investigate the link between SNP genetic data and animal collection location. The data was georeferenced using the Geographic Information System and the ArcGIS 10.3 software, considering a geographic coordinate system and the WGS 84 datum. The Alleles in Space (AIS) software was used to study the relationship between the SNP genetic data and the animal collection location. Various analyses were conducted, including the Mantel correlation, genetic barrier identification, and spatial autocorrelation. The results suggest that there is a correlation between genetic and geographical distances, supporting the idea that geographical distance can affect genetic diversity. This information is vital to understand the genetic structure of populations concerning geographical space and is crucial for optimizing Brazilian agricultural production., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Orthopaedists are often the first point of contact for patients who present with low back pain (LBP) and chronic LBP in Brazil., Aim: To explore the views of orthopaedists on therapeutic approaches for chronic non-specific low back pain (CNLBP) with a view to gain insights into aspects of clinical practice considered important to them., Methods: A qualitative design underpinned by interpretivism was employed. Participants were (n = 13) orthopaedists with experience in treating patients with CNLBP. Following the pilot interviews, semi-structured interviews were conducted, audio-recorded, transcribed and de-identified. Interview data were thematically analysed., Results: Four themes were identified. (1) Biophysical aspects are important and predominate, but sometimes their relevance can be unclear; (2) Psychosocial aspects and lifestyle factors influence the therapeutic approach; (3) Treatment of CNLBP - including medication, physical activity, surgery and other invasive procedures and other therapeutic modalities; and (4) Nuances of clinical practice - "it goes beyond medicine"., Conclusion: Brazilian orthopaedists value identifying the biophysical cause(s) of chronic low back pain. Psychological factors were often discussed secondary to biophysical aspects, whereas social aspects were rarely mentioned. Orthopaedists highlighted their difficulties in navigating patients' emotions and reassuring patients without referrals to imaging tests. Orthopaedists may benefit from training that targets communication and other relational aspects of care in order to work with people who present with CNLBP., (© 2023 John Wiley & Sons Ltd.)

Persistent organic pollutants (POPs) are compounds that are recalcitrant and ubiquitous that bioaccumulate in human milk (HM) and can impact infant growth and development. We explore the association between POP concentration in HM at 2-50 days postpartum and infant growth and development trajectory throughout the first year of life. A cohort of 68 healthy adult Brazilian women and their infants were followed from 28 to 35 gestational weeks to 12 months postpartum. HM samples were collected between 2 and 50 days postpartum, and POP concentrations were analyzed using gas chromatography with mass spectrometry. Concentrations of POPs >limit of quantification (LOQ) were defined as presence, and concentrations ≤LOQ as an absence. Growth z-scores were analyzed according to WHO growth charts and infant development scores according to Age & Stages Questionnaires at 1 (n = 66), 6 (n = 50), and 12 months (n = 45). Linear mixed effects (LME) models were used to investigate the association of POPs in HM with infant growth and development. Benjamini-Hochberg (BH) correction for multiple testing was performed to reduce the false discovery ratio. P < 0.1 was considered for models with the interaction between POPs and time/sex. After BH correction, adjusted LME models with time interaction showed (1) a positive association between the presence of β hexachlorocyclohexane and an increase in head circumference-for-age z-score (β = 0.003, P = 0.095); (2) negative associations between total POPs (β = -0.000002, P = 0.10), total organochlorine pesticides (β = -0.000002, P = 0.10), and dichlorodiphenyldichloroethylene concentrations in HM (β = -0.000002, P = 0.10) and fine motor scores. No statistical difference between the sexes was observed. Postnatal exposure to organochlorine pesticides in HM shows a positive association with the trajectory of head circumference-for-age z-score and a negative association with the trajectories of fine motor skills scores. Future studies on POP variation in HM at different postpartum times and their effect on infant growth and development should be encouraged., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Vitamins B6, B12, and folate are essential for the formation and maintenance of the human brain, but studies evaluating these vitamins with early childhood development (ECD) in children under 5 y are limited and controversial., Objectives: To evaluate the association between vitamins B6, B12, and folate concentrations/status and ECD., Methods: Data regarding 6520 children aged 6-59 mo from the ENANI-2019 (the Brazilian National Survey on Child Nutrition) were analyzed. ECD was assessed using the Survey of Well-being of Young Children's milestones questionnaire. Vitamin B6 concentration (nmol/L) was classified according to the tertile of the distribution and with the cutoff <20 nmol/L. Folate concentrations >45.3 nmol/L were classified as high, and vitamin B12 <150 pmol/L was deficient. The graded response model was used to estimate developmental age, and the developmental quotient (DQ) was calculated as the developmental age divided by chronological age. Multiple linear regression models were adjusted for confounders., Results: The DQ mean (95% confidence interval) for Brazilian children was 0.99 (0.97-1.01). Children aged 6-23 mo [1.13 (1.10-1.16)] had a higher DQ mean than those aged 24-35 [0.99 (0.95-1.03)] and 36-59 mo [0.89 (0.86-0.92)]. Child age was inversely associated with DQ (β = -0.007; P < 0.001). An interaction between child age and vitamin B12 deficiency in the DQ (β = -0.005; P < 0.001) indicated that, in children aged 36-59 mo, the DQ was markedly lower in children with vitamin B12 deficiency than in those without vitamin B12 deficiency. Vitamin B6 concentrations were directly associated with the DQ (β = 0.0004; P = 0.031) among children aged 24-59 mo in the adjusted model. No association was observed between folate status and DQ., Conclusions: In Brazil, the DQ is lower among older children and those with vitamin B12 deficiency. Vitamin B6 status was directly associated with the DQ in children aged 24-59 mo., (Copyright © 2023 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Persistent organic pollutants (POPs) are toxic chemical compounds that can bioaccumulate, adhere to lipid matrices, and affect human health. This study aimed to investigate the association between maternal pre-pregnancy overweight/obesity and dietary intake during pregnancy and POP concentrations in the human milk of women from Rio de Janeiro, Brazil. One hundred and forty-seven women were followed from the third trimester of pregnancy until 119 days postpartum, and 77 human milk samples were analyzed between 2 and 119 days postpartum. POP concentrations were analyzed using gas chromatography-triple quadrupole mass spectrometry. Pregnancy dietary intake was estimated using a semi-quantitative food frequency questionnaire, and pre-pregnancy body mass index at baseline was classified as normal or overweight/obesity. Multiple logistic and linear regression models were performed to investigate the association between pre-pregnancy overweight/obesity, dietary intake during pregnancy, and POP concentrations in human milk. The models were adjusted for maternal age, maternal schooling, total cholesterol serum concentrations, and time postpartum. The analyses were corrected for multiple comparisons using the Benjamini-Hochberg test. Significant associations were observed between pre-pregnancy overweight/obesity and dichlorodiphenyldichloroethane (ppDDE), polychlorinated biphenyl (PCB)74, PCB138, PCB153, PCB170, PCB180, total PCBs, total 4PCBs, total 2 organochlorine pesticides (OCPs), and total POP concentrations. Higher daily lipid intake during pregnancy increased human milk hexachlorobenzene (HCB). This study showed that pre-pregnancy overweight/obesity and total lipid intake during pregnancy were associated with POP concentrations in the milk of women from Rio de Janeiro, Brazil. To promote adequate nutritional status since preconception and surveillance and control of POP in the environment could be essential to ensure binomial mother-infant health and biomonitoring studies and programs for these POPs should be stimulated., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The lack of gestational weight gain (GWG) recommendations for low- and middle-income countries is a significant concern., Objectives: To identify the ranges on the Brazilian GWG charts associated with lowest risks of selected adverse maternal and infant outcomes., Methods: Data from 3 large Brazilian datasets were used. Pregnant individuals aged ≥18, without hypertensive disorders or gestational diabetes were included. Total GWG was standardized to gestational age-specific z-scores according to Brazilian GWG charts. A composite infant outcome was defined as the occurrence of any of small-for-gestationa lage (SGA), large-forgestationa lage (LGA), or preterm birth. In a separate sample, postpartum weight retention (PPWR) was measured at 6 and/or 12 mo postpartum. Multiple logistic and Poisson regressions were performed with GWG z-scores as the exposure and individual and composite outcomes. GWG ranges associated with the lowest risk of the composite infant outcome were identified using noninferiority margins., Results: For the neonatal outcomes, 9500 individuals were included in the sample. For PPWR, 2602 and 7859 individuals were included at 6 and 12 mo postpartum, respectively. Overall, 7.5% of the neonates were SGA, 17.6% LGA, and 10.5% were preterm. Higher GWG z-scores were positively associated with LGA birth, whereas lower z-scores were positively associated with SGA births. The risk of the selected adverse neonatal outcomes were lowest (within 10% of lowest observed risk) when individuals with underweight, normal weight, overweight, or obesity gained between 8.8-12.6; 8.7-12.4; 7.0-8.9; and 5.0-7.2 kg, respectively. These gains correspond to probabilities of PPWR ≥5 kg at 12 mo of 30% for individuals with under and normal weight, and <20% for overweight and obesity., Conclusions: This study provided evidence to inform new GWG recommendations in Brazil., (Copyright © 2022 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Background: Self-reported pre-pregnancy weight and weight measured in the first trimester are both used to estimate pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) but there is limited information on how they compare, especially in low- and middle-income countries, where access to a weight scale can be limited. Thus, the main goal of this study was to evaluate the agreement between self-reported pre-pregnancy weight and weight measured during the first trimester of pregnancy among Brazilian women so as to assess whether self-reported pre-pregnancy weight is reliable and can be used for calculation of BMI and GWG., Methods: Data from the Brazilian Maternal and Child Nutrition Consortium (BMCNC, n = 5563) and the National Food and Nutritional Surveillance System (SISVAN, n = 393,095) were used to evaluate the agreement between self-reported pre-pregnancy weight and weights measured in three overlapping intervals (30-94, 30-60 and 30-45 days of pregnancy) and their impact in BMI classification. We calculated intraclass correlation and Lin's concordance coefficients, constructed Bland and Altman plots, and determined Kappa coefficient for the categories of BMI., Results: The mean of the differences between self-reported and measured weights was < 2 kg during the three intervals examined for BMCNC (1.42, 1.39 and 1.56 kg) and about 1 kg for SISVAN (1.0, 1.1 and 1.2 kg). Intraclass correlation and Lin's coefficient were > 0.90 for both datasets in all time intervals. Bland and Altman plots showed that the majority of the difference laid in the ±2 kg interval and that the differences did not vary according to measured first-trimester BMI. Kappa coefficient values were > 0.80 for both datasets at all intervals. Using self-reported pre-pregnancy or measured weight would change, in total, the classification of BMI in 15.9, 13.5, and 12.2% of women in the BMCNC and 12.1, 10.7, and 10.2% in the SISVAN, at 30-94, 30-60 and 30-45 days, respectively., Conclusion: In Brazil, self-reported pre-pregnancy weight can be used for calculation of BMI and GWG when an early measurement of weight during pregnancy is not available. These results are especially important in a country where the majority of woman do not initiate prenatal care early in pregnancy.

Brazil is one of the world's largest milk producers. Several scientific studies have been developed related to landscape analyses that combine genetic with landscape structure data. In the present study, we aimed to analyze the relationship between genetic, environmental, and socioeconomic aspects of production in Girolando cattle in Brazil, as well as verify the spatial patterns of its genetic diversity. Genetic values and accuracy of 46,289 animals were used as well as information from DNA of 310 Girolando animals. Canonic, discriminant, and cluster analyses were conducted in SAS® and K-means method in ArcGIS 10.3 software. The relationship between genetic and geographic distance was analyzed using different methods in software Alleles in Space®. Clusters with animals with higher genetic values for milk production are located in municipalities with lower gross domestic product, fewer family-based establishments, and lower human development index. These clusters are associated with regions with higher area planted with crops, lower percentage of pastures that were less degraded, higher humidity, lower temperature range, and lower normalized difference vegetation index (NDVI) values. The greater the geographical distance between groups of animals, the greater the genetic distance between them with a significant distinction over 504 km. There is high genetic heterogeneity among animals. From these results, it will be possible to develop methodologies for better evaluation of the animals within the production systems.

Objective: To compare the renal outcome in patients submitted to two different regimens of glycemic control, using the RIFLE criteria to define acute kidney injury., Introduction: The impact of intensive insulin therapy on renal function outcome is controversial. The lack of a criterion for AKI definition may play a role on that., Methods: Included as the subjects were 228 randomly selected, critically ill patients engaged in intensive insulin therapy or in a carbohydrate-restrictive strategy. Renal outcome was evaluated through the comparison of the last RIFLE score obtained during the ICU stay and the RIFLE score at admission; the outcome was classified as favorable, stable or unfavorable., Results: The two groups were comparable regarding demographic data. AKI developed in 52% of the patients and was associated with a higher mortality (39.4%) compared with those who did not have AKI (8.2%) (p<0.001). Renal function outcome was comparable between the two groups (p=0.37). We observed a significant correlation between blood glucose levels and the incidence of acute kidney injury (p=0.007). In the multivariate logistic regression analysis, only APACHE III scores higher than 60 were identified as an independent risk factor for unfavorable renal outcome. APACHE III scores>60, acute kidney injury and hypoglycemia were risk factors for mortality., Conclusion: Intensive insulin therapy and a carbohydrate-restrictive strategy were comparable regarding the incidence of acute kidney injury evaluated using RIFLE criteria.