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Purpose: To compare the prognostic value of imaging biomarkers derived from a quantitative analysis of baseline 18F-FDG-PET/CT in patients with mucosal melanoma (Muc-M) or cutaneous melanoma (Cut-M) treated with immune checkpoint inhibitors (ICIs). Methods: In this retrospective monocentric study, we included 56 patients with non-resectable Muc-M (n = 24) or Cut-M (n = 32) who underwent baseline 18F-FDG-PET/CT before treatment with ICIs between 2011 and 2017. Parameters were extracted from (i) tumoral tissues: SUVmax, SUVmean, TMTV (total metabolic tumor volume), and TLG (total lesion glycolysis) and (ii) lymphoid tissues: BLR (bone marrow-to-liver SUVmax ratio) and SLR (spleen-to-liver SUVmax ratio). Association with survival and response was evaluated using Cox prediction models, Student's t tests, and Spearman's correlation respectively. p < 0.05 was considered significant. Results: Majority of ICIs were anti-PD1 (92.9%, n = 52/56). All 18F-FDG-PET/CT were positive. Overall (Muc-M to Cut-M), ORR was 33%:42%, DCR was 56%:69%, median follow-up was 25.0:28.9 months, median PFS was 4.7:10.7 months, and median OS was 23.9:28.3 months. In Muc-M, increased tumor SUVmax was associated with shorter OS while it was not correlated with PFS, ORR, or DCR. In Cut-M, increased TMTV and increased BLR were independently associated with shorter OS, shorter PFS, and lower response (ORR, DCR). Conclusion: While all Muc-M and Cut-M were FDG avid, prognostic imaging biomarkers differed. For Muc-M patients treated with ICI, the only prognostic imaging biomarker was a high baseline maximal glycolytic activity (SUVmax), whereas for Cut-M patients, baseline metabolic tumor burden or bone marrow metabolism was negatively correlated to ICI response duration. [ABSTRACT FROM AUTHOR]

Background/Objectives: Several studies reported associations of the lactase gene (LCT) polymorphism -13910C>T (rs4988235) with obesity-related variables and obesity in adults. This study aimed to replicate previously reported associations in a population sample of Portuguese young adults. Subjects/Methods: We genotyped 447 subjects from central and northern regions of Portugal (mean age 20.81[plus or minus]4.24 years) for the lactase variant -13910C>T (rs4988235), using TaqMan probes. Anthropometric variables (weight, height and body fat) were measured using standardized procedures and body mass index (BMI) (kg/m.sup.2) was calculated. Results: Frequency of genotypes was 35.8% CC (lactase nonpersistent, LNP), 48.1% CT and 16.1% TT, consistent with Hardy-Weinberg equilibrium (P=1). The frequency for the minor -13910 T allele was 0.402. Assuming a dominance model for the lactase persistence (LP) minor T-allele, linear regression models showed statistically significant associations between the LP genotype CT/TT and BMI, fat mass and weight ([beta]=1.114, P=0.003; [beta]=1.309, P=0.007 and [beta]=2.67, P=0.021, respectively) after adjustment for age and sex. In concordance, logistic regression showed significant association between LP genotype CT/TT and overweight/obesity (OR=1.77; CI 1.08-2.92; P=0.023), as well as with high fat percentage ranges (OR=1.58; CI 1.01-2.46; P=0.041), when adjusting for age and sex. No significant interaction was obtained between the LCT polymorphism and physical activity for BMI (P.sub.int=0.454) or FAT % (P.sub.int=0.421). Conclusions: In the Portuguese sample of young adults, the lactase -13910C>T polymorphism revealed significant associations with the obesity-related anthropometric variables BMI, fat mass and weight, and previously observed associations with the obesity risk were also confirmed., Author(s): L Manco [sup.1] [sup.2] , H Dias [sup.1] , M Muc [sup.1] , C Padez [sup.1] [sup.2] Author Affiliations: (1) Department of Life Sciences, University of Coimbra, Coimbra, Portugal [...]

Aim: To observe the trends of overweight and obesity among Portuguese children from 2002 to 2016, before and during the years of the economic crisis, and compare these trends according to family's socio-economic position (SEP)., Methods: Prevalence rates were calculated using data from six studies providing comparable estimates from 2002, 2009, 2011, 2013 and 2016 for children aged 6-10-years living in the Portuguese Midlands (n = 7192; 50.2% girls). Height and weight were objectively measured; children and family characteristics were collected by standard questionnaires. A logistic regression was used to test the association between variables., Results: Between 2002 and 2016, there was a decrease in the prevalence of overweight and obesity, which reached a statistical significance for girls. The prevalence of overweight, including obesity, was high (low-SEP = 30.5%; high-SEP = 20.5%) and a widening of socio-economic inequalities was found. Socio-economically disadvantaged children had more than 2 times the odds of having obesity than children from higher-SEP, even after adjusting for sex, physical activity and screen-time., Conclusion: While a decrease in overall rates of overweight and obesity was observed from 2002 to 2016, the social inequalities have been widened which suggest the need for public efforts to promote healthy weight at a population level, especially in lower socio-economic classes., (© 2020 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Background: Home mechanical ventilation (HMV) is becoming more widely available in many countries., Objectives: The aim of this study was to measure the health-related quality of life and stress levels of patients ventilated mechanically at home. The relation between quality of life and stress levels was investigated including multiple regression analysis., Methods: 100 patients treated with HMV in Poland were surveyed with the WHOQOL-BREF questionnaire and Perceived Stress Scale (PSS-10)., Results: 26% of patients assessed their quality of life as bad or very bad and 34% as good or very good. Stress levels measured with PSS-10 Scale were high level. For the group of patients with neurological disorders, stress levels were significantly higher than for the group of patients with pulmonological disorders., Conclusions: The higher the stress levels of patients, the lower the quality of life in particular domains. Improving the living conditions of HMV patients can influence improving their quality of life.

Postoperative neurological deficits remain a concern for patients undergoing cardiac surgeries. Even minor injuries can lead to neurocognitive decline (i.e., postoperative cognitive dysfunction). Dexmedetomidine may be beneficial given its reported neuroprotective effect. We aimed to investigate the effects of dexmedetomidine on brain injury during cardiac surgery anaesthesia. This prospective observational study analysed data for 46 patients who underwent coronary artery bypass graft surgery with extracorporeal circulation between August 2018 and March 2019. The patients were divided into two groups: control (CON) with typical anaesthesia and dexmedetomidine (DEX) with dexmedetomidine infusion. Concentrations of the biomarkers matrix metalloproteinase-12 (MMP-12) and myelin basic protein (MBP) were measured preoperatively and at 24 and 72 h postoperatively. Cognitive evaluations were performed preoperatively, at discharge, and 3 months after discharge using Addenbrooke's Cognitive Examination version III (ACE-III). The primary endpoint was the ACE-III score at discharge. Increased MMP-12 and MBP concentrations were observed in the DEX group 24 and 72 h postoperatively. No significant differences in ACE-III scores were observed between the groups at discharge; however, the values were increased when compared with initial values after 3 months ( p = 0.000). The current results indicate that the administration of dexmedetomidine as an adjuvant to anaesthesia can increase MMP-12 and MBP levels without effects on neurocognitive outcomes at discharge and 3 months postoperatively.

Background: Excessive salt consumption-associated with a range of adverse health outcomes-is very high in Portugal, and bread is the second largest source. Current Portuguese legislation sets a maximum limit of 1.4 g salt per 100 g bread, but imported and traditional breads are exempted. In 2017 the Ministry of Health proposed reducing the salt threshold to 1.0/100 g by 2022, however the legislation was vetoed by the European Commission on free-trade grounds., Aims: To estimate the health impact of subjecting imported and traditional breads to the current 1.4 g threshold, and to model the potential health impact of implementing the proposed 1.0 g threshold., Methods: We gathered bread sales, salt consumption, and epidemiological data from robust publicly available data sources. We used the open source WHO PRIME modeling tool to estimate the number of salt-related deaths that would have been averted in 2016 (the latest year for which all data were available) from; (1) Extending the 1.4 g threshold to all types of bread, and (2) Applying the 1.0 g threshold to all bread sold in Portugal. We used Monte Carlo simulations to generate confidence intervals., Results: Applying the current 1.4 g threshold to imported and traditional bread would have averted 107 deaths in 2016 (95% CI: 43-172). Lowering the current threshold from 1.4 to 1.0 g and applying it to all bread products would reduce daily salt consumption by 3.6 tons per day, saving an estimated 286 lives a year (95% CI: 123-454)., Conclusions: Salt is an important risk factor in Portugal and bread is a major source. Lowering maximum permissible levels and removing exemptions would save lives. The European Commission should revisit its decision on the basis of this new evidence., Competing Interests: Author FA was the Portuguese Secretary of State for Health until October 2018. Authors FG-d-S and DC-e-S were members of the Portuguese Secretary of State for Health office until October 2018. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Goiana-da-Silva, Cruz-e-Silva, Rito, Lopes, Muc, Darzi, Araújo, Miraldo, Morais Nunes and Allen.)

Background: There is convincing evidence that unhealthy food marketing is extensive on television and in digital media, uses powerful persuasive techniques, and impacts dietary choices and consumption, particularly in children. It is less clear whether this is also the case for outdoor food marketing. This review (i) identifies common criteria used to define outdoor food marketing, (ii) summarises research methodologies used, (iii) identifies available evidence on the exposure, power (i.e. persuasive creative strategies within marketing) and impact of outdoor food marketing on behaviour and health and (iv) identifies knowledge gaps and directions for future research., Methods: A systematic search was conducted of Medline (Ovid), Scopus, Science Direct, Proquest, PsycINFO, CINAHL, PubMed, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials and a number of grey literature sources. Titles and abstracts were screened by one researcher. Relevant full texts were independently checked by two researchers against eligibility criteria., Results: Fifty-three studies were conducted across twenty-one countries. The majority of studies (n = 39) were conducted in high-income countries. All measured the extent of exposure to outdoor food marketing, twelve also assessed power and three measured impact on behavioural or health outcomes. Criteria used to define outdoor food marketing and methodologies adopted were highly variable across studies. Almost a quarter of advertisements across all studies were for food (mean of 22.1%) and the majority of advertised foods were unhealthy (mean of 63%). The evidence on differences in exposure by SES is heterogenous, which makes it difficult to draw conclusions, however the research suggests that ethnic minority groups have a higher likelihood of exposure to food marketing outdoors. The most frequent persuasive creative strategies were premium offers and use of characters. There was limited evidence on the relationship between exposure to outdoor food marketing and eating behaviour or health outcomes., Conclusions: This review highlights the extent of unhealthy outdoor food marketing globally and the powerful methods used within this marketing. There is a need for consistency in defining and measuring outdoor food marketing to enable comparison across time and place. Future research should attempt to measure direct impacts on behaviour and health., (© 2022. The Author(s).)

Introduction: Anaesthesia and intensive care units are specific workplaces. The purpose of this study was to evaluate the level of the sense of self-efficacy and the intensification of personality traits in a group of nurse anaesthetists and to develop a regression model explaining the sense of self-efficacy., Method: The population of the questionnaire survey included nurse anaesthetists from five hospitals in south-eastern Poland. The NEO-FFI was used in assessing their personality traits. The general self-efficacy scale was employed for the self-efficacy assessment. A total of 143 correctly filled surveys were analyzed., Results: The respondents typically perceived their own self-efficacy level as upper moderate. The nurse anaesthetists participating in the study revealed a tendency to high scores in conscientiousness and extraversion, and low scores related to neuroticism. The persons characterized by high conscientiousness, extraversion and openness to experience revealed a tendency to high scores related to the sense of self-efficacy. The relationship between personality traits and experiencing the nuisance of selected stressful job factors was demonstrated. Regression analysis showed that conscientiousness and extraversion are most closely related to the sense of self-efficacy., Conclusions: It seems to be beneficial to implement occupational consulting for nurses, who are starting their work or/and taking into consideration working in anesthesiology and intensive care units. The importance of personality traits and self- efficacy in relation with well-being of medical personnel needs deeper investigations.

Background: High levels of stress among anaesthesiology and intensive care unit workers are commonly reported. Personnel in these units are prone to stress because of specific characteristics of their work. Their development of skills to cope with stress may affect their psychophysical condition and, consequently, patient safety., Objectives: The aim of this study was to define the coping styles of anaesthesiology and intensive care unit personnel and to evaluate the connections between the work environment as well as personal characteristics and the dominant coping styles., Methods: Anaesthesiology and intensive care unit personnel from 15 selected Polish hospitals were surveyed using the Coping Inventory for Stressful Situations, which examines task-oriented coping, emotion-oriented coping and avoidance-oriented coping. The Perceived Stress Scale was used to assess stress levels., Results: The analysis included 425 successfully completed surveys. The examined population was divided into two groups: Group N comprised 311 nurses (73.18%) and group P comprised 114 physicians (26.82%). For 167 participants (39.29%), the dominant coping style was defined. The most common style was the task-oriented coping style; it was dominant in 96 participants (22.58% of the entire examined population). This style was significantly predominant among men. The domination of some coping styles coexisted with marital status, number of children and financial situation. The occurrence of different coping styles did not significantly differ among workers at different-sized hospitals, with different job seniority or with different living locations. Perceived stress was correlated with all coping styles., Conclusions: Work-related stress among anaesthesiology and intensive care unit workers is an important problem. Further investigations of stress levels and the causes and effects of stress in this population are necessary., (© 2019 Nordic College of Caring Science.)

Background: An increasing number of patients included in home mechanical ventilation (HMV) care has been under observation for many years. The study aimed to assess the patients opinion concerning the expected and perceived quality of care in an HMV system and a patient's satisfaction with care., Methods: In 2017, patients treated with HMV were surveyed in Poland with the modified SERVQUAL questionnaire., Results: One hundred correctly completed surveys were analyzed. Patient Satisfaction Index was high. In every examined area, the expectations were statistically significant larger than the perception of the services. The biggest gap was in the tangibility dimension and the smallest gap was in the empathy dimension. Perceived respect and understanding for a patient's needs are close to the expectations., Conclusions: The level of satisfaction with health care among patients treated with HMV in majority of investigated components is high. Moreover, the difference between perceived and expected quality of health care in the HMV system was relatively small in the opinion of the patients themselves. Further investigations with alternative methods are needed.

Objective: To formally test a hierarchy of effects model linking exposure to television (TV) advertising for unhealthy foods with child body weight through purchase requests, purchases, and consumption., Design: A nationally representative cross-sectional online study in the United Kingdom., Participants: A total of 2,260 parent-child dyads (children aged 7-11 years) recruited via online research panel; 55.7% boys, mean age 8.9 ± 1.4 years, mean body mass index z-score 1.25 ± 2.1., Main Outcome Measures: Parents reported on child TV exposure and child height and weight. Children self-reported their frequency of (1) pestering for advertised foods, (2) purchase of unhealthy foods, and (3) consumption of unhealthy foods., Analysis: A structural equation model was applied to data., Results: As predicted, commercial TV exposure was indirectly associated with children's body mass index through purchasing and consumption through purchase requests. It was also directly associated with children's purchase requests, purchasing, and consumption of unhealthy foods. Associations between noncommercial TV and behavior or body weight outcomes, when found, were significantly weaker than for commercial exposure., Conclusions and Implications: This study provides insight into the likely behavioral pathways underpinning the effects of food marketing on diet and potentially body weight in children. Future longitudinal analyses would provide insight into causal inferences., (Copyright © 2020 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to investigate the effect of healthy mucosa on adhesive and invasive properties of AIEC reference strain Escherichia coli (E. coli) LF82. For this purpose, we had designed special medias that contained cell culture medium and mucosal content obtained from different regions (colon and ileum) of the digestive tract. Methods: We tested the infecting ability of AIEC reference strain E. coli LF82 on I-407 cells in the presence of mucosal media (Muc-M) under in vitro conditions. Muc-M composed of certain rates of cell culture medium or M63 minimal medium and mucosal contents obtained from different part of intestine were designed for cell-infection experiments and biofilm-formation assays. Results: The result showed that the mucosal media decreased the infection percentage of E. coli LF82 strain when compared with control group. It was seen that the mucosal media originating from ileum almost completely inhibited the invasion of LF82 strain. On the other hand, it was observed that the mucosal media prepared from colon) reduced the bacterial invasion only in half the rate when compared with control. Conclusion: The findings showed that these medias obtained from different regions of the intestinal tract affected LF82 invasion at different rates. Therefore, this study provided crucial information that could contribute to the future studies on the localization of bacteria [ABSTRACT FROM AUTHOR]

Background: Excessive consumption of sugar has a well-established link with obesity. Preliminary results show that a tax levied on sugar-sweetened beverages (SSBs) by the Portuguese government in 2017 led to a drop in sales and reformulation of these products. This study models the impact the market changes triggered by the tax levied on SSBs had on obesity incidence across various age groups in Portugal., Methods and Findings: We performed a national market analysis and population-wide modelling study using market data for the years 2014-2018 from the Portuguese Association of Non-Alcoholic Drinks (GlobalData and Nielsen Consumer Panel), dietary data from a national survey (IAN-AF 2015-2016), and obesity incidence data from several cohort studies. Dietary energy density from SSBs was calculated by dividing the energy content (kcal/gram) of all SSBs by the total food consumption (in grams). We used the potential impact fraction (PIF) equation to model the projected impact of the tax-triggered change in sugar consumption on obesity incidence, through both volume reduction and reformulation. Results showed a reduction of 6.6 million litres of SSBs sold per year. Product reformulation led to a decrease in the average energy density of SSBs by 3.1 kcal/100 ml. This is estimated to have prevented around 40-78 cases of obesity per year between 2016 and 2018, with the biggest projected impact observed in adolescents 10 to <18 years old. The model shows that the implementation of this tax allowed for a 4 to 8 times larger projected impact against obesity than would be achieved though reformulation alone. The main limitation of this study is that the model we used includes data from various sources, which can result in biases-despite our efforts to mitigate them-related to the methodological differences between these sources., Conclusions: The tax triggered both a reduction in demand and product reformulation. These, together, can reduce obesity levels among frequent consumers of SSBs. Such taxation is an effective population-wide intervention. Reformulation alone, without the decrease in sales, would have had a far smaller effect on obesity incidence in the Portuguese population., Competing Interests: The authors have declared that no competing interests exist.

Background: High stress levels have been commonly reported among ICU workers. Currently, anaesthesiology is safer for the patient but more stressful for the staff working in this branch of medicine. ICU and anaesthesiology personnel are prone to stress because of the specific character of their work., Objectives: Our objectives were to assess stress prevalence among anaesthesiology and ICU workers to compare this stress prevalence in relation to professional groups, sex, job seniority, and type of hospital and describe the importance of major stressors at work., Methods: The ICU and anaesthesiology workers of 15 randomly selected Polish hospitals were surveyed. To assess stress prevalence, the Perceived Stress Scale (PSS-10) was used. The analysis included 544 surveys., Results: The examined population was divided into two groups. Group N consisted of 406 nurses (74.60%) and group P of 138 physicians (25.40%). The mean result in the PSS-10 scale for the N group was 19.00 and for the P group 17.00. Both group results were related to a 6 sten score, which implied a medium level of stress. In the N group, the PSS-10 results were significantly higher than in the P group. Women showed higher levels of stress than men., Conclusions: Stress levels among ICU and anaesthesiology personnel were of a medium range. Nurses showed significantly higher levels of stress than physicians. Female personnel showed higher levels of stress than male personnel. Age, job seniority and type of hospital did not have an influence on stress levels. The most stressful circumstances for anaesthesiology and ICU personnel included night shifts and duty overload., (Copyright © 2017 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Type 2 diabetes mellitus (DM) and HIV increase the risk of tuberculosis (TB). The frequency of DM among patients with TB with and without HIV is poorly documented in many low- and middle-income countries., Methods: This was a cross-sectional hospital-based study performed in Abuja, Nigeria. Adults with presumptive TB were screened consecutively. Sputum culture was used for TB screening and blood was used for HIV screening, as well as fasting plasma glucose (FPG) and glycated haemoglobin (HbA1c) assessment for the diagnosis of DM. HbA1c was measured using the D-10 Haemoglobin Testing System and a point-of-care test (A1C Now+ system) for comparison. Patients were classified as having DM or pre-diabetes using the D-10 reference test., Results: Four hundred and ten individuals had TB culture, FPG, and HbA1c results. Participants had a mean (±standard deviation) age of 37.8±12.6 years and 217 (54.8%) were male. One hundred and thirteen (27.6%) patients were culture-positive, 62 (15.1%) had DM, and 46 (11.2%) had pre-diabetes. One hundred and eighty-four (53.3%) participants were HIV-positive and 95 (51.6%) were on antiretroviral therapy (ART). Patients with pre-diabetes and DM were more likely to have TB (odds ratio (OR) 1.94, 95% confidence interval (CI) 0.01-3.74, and OR 2.39, 95% CI 1.35-4.24, respectively). After adjustment for HIV, age, and sex, only DM was statistically associated with TB (adjusted OR (AOR) 3.10, 95% CI 1.62-5.94). HIV-negative patients with DM had a higher risk of TB (AOR 4.32, 95% CI 1.57-11.92) than HIV-positive patients with DM (AOR 3.31, 95% CI 1.29-8.54), but the difference was not statistically significant. A1C Now+ HbA1c measurements correlated poorly with the D-10 HbA1c reference test., Conclusion: A high proportion of patients in Abuja have markers of DM and pre-diabetes at the time of TB diagnosis., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Obesity is a risk factor for asthma, and obese asthmatics have lower disease control and increased symptom severity. Several putative links have been proposed, including genetics, mechanical restriction of the chest and the intake of corticosteroids. The most consistent evidence, however, comes from studies of cytokines produced by the adipose tissue called adipokines. Adipokine imbalance is associated with both proinflammatory status and asthma. Although reverse causation has been proposed, it is now acknowledged that obesity precedes asthma symptoms. Nevertheless, prenatal origins of both conditions complicate the search for causality. There is a confirmed role of neuro-immune cross-talk mediating obesity-induced asthma, with leptin playing a key role in these processes. Obesity-induced asthma is now considered a distinct asthma phenotype. In fact, it is one of the most important determinants of asthma phenotypes. Two main subphenotypes have been distinguished. The first phenotype, which affects adult women, is characterised by later onset and is more likely to be non-atopic. The childhood obesity-induced asthma phenotype is characterised by primary and predominantly atopic asthma. In obesity-induced asthma, the immune responses are shifted towards T helper (Th) 1 polarisation rather than the typical atopic Th2 immunological profile. Moreover, obese asthmatics might respond differently to environmental triggers. The high cost of treatment of obesity-related asthma, and the burden it causes for the patients and their families call for urgent intervention. Phenotype-specific approaches seem to be crucial for the success of prevention and treatment.

Objectives: To investigate the association of polymorphisms in SLC6A4 and MAOA genes with overweight (including obesity)., Material and Methods: Young adults (n = 535) of Portuguese origin were genotyped for the SLC6A4 polymorphisms 5-HTTLPR and STin2 and a MAOA VNTR. BMI and body fat percentage were measured and a questionnaire was used to assess individual's sport practicing habits., Results: In whole study sample, haplotype-based analysis revealed significant association with overweight/obesity for the individual 5-HTTLPR/Stin2 haplotype L10 (p = 0.04). In men, the MAOA 3R genotype was nominally associated with body fat (p = 0.04). In inactive individuals, overweight/obesity was found significantly associated with 5-HTTLPR L-allele (p = 0.01) and nominally associated with STin2 10-allele (p = 0.03). A significant association was also found testing for all haplotype effects (χ(2 )= 8.7; p = 0.03)., Conclusions: We found some evidences for the association of SLC6A4 and MAOA genes with measures of obesity. Our results suggest physical inactivity accentuates the influence of SLC6A4 polymorphisms on obesity risk.

Breast milk long-chain PUFA (LCPUFA) have been associated with changes in early life immune responses and may modulate T-cell function in infancy. We studied the effect of maternal fatty acid desaturase (FADS) genotype and breast milk LCPUFA levels on infants' blood T-cell profiles and ex vivo-produced cytokines after anti-CD3/CD28 stimulation of peripheral blood mononuclear cells in 6-month-old infants from the Copenhagen Prospective Study of Asthma in Childhood birth cohort. LCPUFA concentrations of breast milk were assessed at 4 weeks of age, and FADS SNP were determined in both mothers and infants (n 109). In general, breast milk arachidonic acid (AA) levels were inversely correlated with the production of IL-10 (r -0.25; P=0.004), IL-17 (r -0.24; P=0.005), IL-5 (r -0.21; P=0.014) and IL-13 (r -0.17; P=0.047), whereas EPA was positively correlated with the counts of blood regulatory T-cells and cytotoxic T-cells and decreased T-helper cell counts. The minor FADS alleles were associated with lower breast milk AA and EPA, and infants of mothers carrying the minor allele of FADS SNP rs174556 had higher production of IL-10 (r -0.23; P=0.018), IL-17 (r -0.25; P=0.009) and IL-5 (r -0.21; P=0.038) from ex vivo-activated immune cells. We observed no association between T-cell distribution and maternal or infant FADS gene variants. We conclude that increased maternal LCPUFA synthesis and breast milk AA are associated with decreased levels of IL-5, IL-13 (type-2 related), IL-17 (type-17 related) and IL-10 (regulatory immune responses), but not with interferon-γ and TNF-α, which could be due to an effect of the maternal FADS variants on the offspring immune response transferred via breast milk LCPUFA.

Objectives: To investigate in a population sample of Portuguese young adults the association of the FTO variant rs9939609 with obesity, BMI, and body-fat and interaction with physical activity (PA) on obesity-susceptibility., Methods: SNP rs9939609 A/T was genotyped in 550 subjects (231 males and 319 females; 18-36 years old; mean age 21 years old) by TaqMan assay. PA was assessed with a validated self-reported questionnaire of IPAQ., Results: We replicated the association of rs9939609-A risk allele with BMI (P = 0.04) and fat-mass (P = 0.031), and with overweight (including obesity) under a recessive model (P = 0.034). Stratified analyses showed (i) a significant association with overweight/obesity in inactive individuals (P = 0.02) but not in a group reporting participation in sports (P = 0.97). Spearman's correlation test suggested that the impact of a successive increase in PA was a decrease in the body-fat percentage (r = -0.16; P = 0.0002), which is accentuated for homozygous AA (r = -0.34; P = 0.002), and an increase in BMI (r = 0.14; P = 0.001), with a statistically significant correlation for homozygous TT (r = 0.22; P = 0.002)., Conclusions: This study reveals interactions between rs9939609 and PA on obesity indices in Portuguese young adults, suggesting a change in the different body components (lean and fat mass) depending on the FTO genotypes., (© 2015 Wiley Periodicals, Inc.)

Background: Burnout syndrome is marked by three primary domains: emotional exhaustion, depersonalization, and low personal accomplishment. This study assessed the prevalence of burnout syndrome among anesthesiologists, anesthesia technicians, and intensive care unit (ICU) nurses in Palestinian hospitals. In addition, this study also sought to assess associations and identify the factors that can predict higher burnout among anesthesiologists, anesthesia technicians, and ICU nurses. Methods: This study was conducted in a cross-sectional design using a questionnaire between October 2023 and December 2023. The questionnaire collected the demographic variables of the healthcare providers, their living conditions, lifestyle, working conditions, job satisfaction, and intention to change the profession. The healthcare providers were included from 12 different hospitals. Burnout syndrome was assessed using the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS-MP). Results: A total of 250 healthcare providers were invited to participate in this study, of those, 212 completed the questionnaire, giving a response rate of 84.8%. Of the healthcare providers, 72 (34.0%) were anesthesiologists, 41 (19.3%) were anesthesia technicians, and 99 (46.7%) were ICU nurses. Of all healthcare providers, 151 (71.2%) reported emotional exhaustion, 125 (59%) reported depersonalization and 145 (68.4%) reported a lack of personal achievement based on the MBI-HSS-MP criteria for burnout. Multiple linear regression showed that higher emotional exhaustion scores could be predicted by the number of working hours per day (p-value = 0.039) and higher depersonalization scores could be predicted by having children (p-value = 0.001). On the other hand, lower personal achievement scores could be predicted by having children (p-value = 0.006), not owning a car (p-value = 0.036), and having more night shifts (p-value = 0.049). Conclusions: The findings of this study indicated that burnout syndrome was prevalent among anesthesiologists, anesthesia technicians, and ICU nurses in Palestinian hospitals. Healthcare authorities and professional bodies should consider designing interventions to reduce burnout and improve the psychological well-being of anesthesiologists, anesthesia technicians, and ICU nurses. Further studies are required to identify the most effective interventions for reducing burnout among anesthesiologists, anesthesia technicians, and ICU nurses in Palestine. [ABSTRACT FROM AUTHOR]

Background: Obesity has become a significant global health issue. This multifaceted condition is influenced by genetic, environmental, and lifestyle factors, significantly influenced by nutrition. Aim: The study's objective is to elucidate the relationship between obesity-related genes, nutrient intake, and the development of obesity and the importance of other metabolic diseases. Methods: A comprehensive literature review spanning the past two decades was conducted to analyze the contributions of genetic variants—including FTO, MC4R, and LEPR—and their associations with dietary habits, highlighting how specific nutrients affect gene expression and obesity risk and how the coexistence of metabolic diseases such as type 2 diabetes and osteoporosis may modulate these factors. Moreover, the role of epigenetic factors, such as dietary patterns that encourage the development of obesity, was explored. Discussion and Conclusions: By understanding the intricate relationships among genetics, nutrients, and obesity development, this study highlights the importance of personalized dietary strategies in managing obesity. Overall, an integrated approach that considers genetic predispositions alongside environmental influences is essential for developing effective prevention and treatment methodologies, ultimately contributing to better health outcomes in diverse populations. [ABSTRACT FROM AUTHOR]

Background: Medical students entering postgraduate training often feel ill-prepared for clinical practice. This has implications for physician well-being and the quality of patient care. Self-efficacy represents an important contributing factor in the transition process. Identifying student characteristics associated with self-efficacy is important in order to design possible interventions to enhance self-efficacy. Therefore, we assessed the relationship between final-year medical students' general self-efficacy with their personality traits, need for cognitive closure, and medical knowledge in order to identify factors contributing to the assessment and improvement of self-efficacy. Methods: Self-assessed data regarding general self-efficacy was collected from 188 final-year medical students who participated in a first day of residency simulation between March and September 2023. We also assessed several personal factors including the HEXACO Personality Inventory Revised (HEXACO-PI-R), a short scale to measure Need for Cognitive Closure (16-NCCS), and students' medical exam grades (M2). We ran multiple correlation and multiple linear regression analyses across all variables. We then added a second analysis each with general self-efficacy and HEXACO domains Emotionality and Extraversion on facet level, which both showed significant associations with self-efficacy in the respective first analysis. Results: Across all variables, self-efficacy correlated significantly negatively with Emotionality and positively with Extraversion. Both domains also significantly predicted self-efficacy accordingly in the regression model. On a facet analysis, Sentimentality (Emotionality) and Sociability (Extraversion) did not correlate significantly with self-efficacy. In the regression model only the facets Sociability (Extraversion) and Fearfulness (Emotionality) significantly predicted lower self-efficacy. Furthermore, self-efficacy correlated significantly and negatively with the Need for Cognitive Closure (NCC). Additionally, significant positive and negative correlations of the NCC with both Emotionality and Extraversion, respectively, as well as a significant positive correlation for exam grades (M2) and Extraversion were found. Conclusions: Self-efficacy contributes to medial students' preparedness for clinical practice and can be predicted by several personal factors. Students should learn and reflect about these factors and need to be supported in increasing their self-efficacy and its self-assessment towards their transition to postgraduate training. Construction of a specific instrument for self-efficacy assessment utilizing the insight provided by the findings is proposed as a next step. [ABSTRACT FROM AUTHOR]

Purpose: A learning-focused culture promotes creativity, innovativeness and the acquisition of novel insights and competencies. The study aims to explore the relationship between human resource development (HRD) practice and employee competencies using organizational learning culture as a mediating variable. Design/methodology/approach: Data were collected from 828 employees of 37 health care institutions comprising 24 (internationally-owned) and 13 (indigenously-owned). Construct reliability and validity was established through a confirmatory factor analysis. The proposed model and hypotheses were evaluated using structural equation modeling. Findings: Data supported the hypothesized relationships. The results show that training and development and employee competencies were significantly related. Career development and employee competencies were significantly related. Organizational learning culture mediates the relationship between training and development and employee competencies. However, organizational learning culture did not mediate the relationship between career development and employee competencies. Research limitations/implications: The generalizability of the findings will be constrained due to the research's health care focus and cross-sectional data. Practical implications: The study's findings will serve as valuable pointers to policy makers and stakeholders of health care institutions in developing system-level capacities that promote continuous learning and adaptive learning cultures to ensure sustainability and competitive advantage. Originality/value: By evidencing empirically that organizational learning culture mediates the relationship between HRD practices and employee competencies the study extends the literature. [ABSTRACT FROM AUTHOR]

Background: As rates of obesity and overweight continue to increase in the UK, calorie labels have been introduced on menus as a policy option to provide information to consumers on the energy content of foods and to enable informed choices. This study tested whether the addition of calorie labels to items in a simulated food delivery platform may reduce the energy content of items selected. Methods: UK adults (n = 8,780) who used food delivery platforms were asked to use the simulated platform as they would in real life to order a meal for themselves. Participants were randomly allocated to a control condition (no calorie labels) or to one of seven intervention groups: (1) large size calorie labels adjacent to the price (LP), (2) large size label adjacent to the product name (LN), (3) small label adjacent to price (SP), (4) small label adjacent to product name (SN), (5) LP with a calorie label switch-off filter (LP + Off), (6) LP with a switch-on filter (LP + On), or, (7) LP with a summary label of the total basket energy content (LP + Sum). Regression analysis assessed the impact of calorie labels on energy content of foods selected compared to the control condition. Results: The mean energy selected in the control condition was 1408 kcal (95%CI: 93, 2719). There was a statistically significant reduction in mean energy selected in five of the seven intervention trial arms (LN labels (-60 kcal, 95%CI: -111, -6), SN (-73, 95%CI: -125, -19), LP + Off (-110, 95%CI: -161, -57), LP + On (-109, 95%CI: -159, -57), LP + Sum (-85 kcal, 95%CI: -137, -30). There was no evidence the other two conditions (LP (-33, 95%CI: -88, 24) and SP (-52, 95%CI: -105, 2)) differed from control. There was no evidence of an effect of any intervention when the analysis was restricted to participants who were overweight or obese. Conclusion: Adding calorie labels to food items in a simulated online food delivery platform reduced the energy content of foods selected in five out of seven labelling scenarios. This study provides useful information to inform the implementation of these labels in a food delivery platform context. [ABSTRACT FROM AUTHOR]

The interplay between asthma and glucose metabolism disorders, such as hyperglycemia, has gained increasing attention due to the potential exacerbation of asthma symptoms and severity. This review explores the complex relationship between hyperglycemia and asthma, emphasizing the pathophysiological links, the impact of glucose metabolism disorders on asthma, and the effects of asthma medications on glucose levels. Hyperglycemia, often induced by asthma treatments like corticosteroids, has been associated with an increased risk of asthma exacerbations. This review delves into the pathophysiology underlying this association, highlighting the role of insulin resistance, metabolic syndrome, and obesity in both the development and management of asthma. Metabolic syndrome, characterized by abdominal obesity and hyperglycemia, independently increases the risk of worsening respiratory symptoms and asthma. Furthermore, this review examines the influence of various antidiabetic medications on asthma outcomes. Biguanides, like metformin, have shown promise in improving asthma outcomes in patients with type 2 diabetes mellitus and asthma. However, other medications have mixed results regarding their impact on asthma control and lung function. Considering these findings, this review advocates for further research into the role of metabolic pathways in asthma management. It calls for comparative studies and the inclusion of asthma-related outcomes in clinical trials of antidiabetic drugs to better understand their potential benefits for individuals with obesity and concurrent asthma. [ABSTRACT FROM AUTHOR]

Despite the prevalence of digital food marketing to teenagers and its potential impact on food preferences and consumption, little is known about the specific food advertisements teenagers see in Canada and how they perceive them. Further, few studies consult teenagers directly about their perceptions of teen-specific food marketing content. To shed light on such issues, this study examines perceptions of food marketing and self-reported media use of Canadian teenagers via an online survey. Four hundred and sixty-four teenagers (ages 13–17) participated. Overall, teenagers identified Instagram and TikTok as the most popular social media platforms. The top food or beverage brands that teens felt specifically targeted them were McDonald's, Starbucks, Coca-Cola and Tim Hortons, while Instagram was deemed the most important media platform when it comes to teen-targeted food marketing. Teens deemed "celebrity" and "visual style" as the most important (food and beverage) advertising techniques when it comes to persuading teenagers to buy. Overall, the study provides insights into teen media use and brand preference, including the brands teens feel target them most directly and what they consider to be salient in terms of the food advertising they see. It also provides valuable details for researchers seeking to further identify and measure elements of teen-targeted food marketing. [ABSTRACT FROM AUTHOR]

This study provides a big picture of research in the field of food marketing communication targeting children. It aims to identify conceptual and methodological gaps, and set future research agenda for investigating less-explored aspects of food marketing communication effects on children's food choices. A content analysis of the most influential scientific literature related to food marketing communication targeting children was conducted. Each eligible paper was analyzed based on lines of research and methodology. Analysis of 495 eligible papers revealed that "advertising" was the dominant line of research, followed by "sales promotion". The most common research method was content analysis, and the most common analysis technique was comparison tests. Among data gathering methods, two categories of "structured questionnaires and surveys" and "nonreactive measures" had the most frequencies. One of the main findings of this study is the scarcity of research within the domains of "personal selling", "direct marketing" and "public relations", all of which have significant potential in influencing children's food behaviors, both unhealthy and healthy. Additionally, there is the lack of studies using methods to consider children's voices that will be discussed based on the United Nations Convention on the Rights of the Child. [ABSTRACT FROM AUTHOR]

Background: Intraoperative awareness (IA) is diagnosed when patients can recall their surroundings or an event related to the surgery that occurred while they were under general anaesthesia. The female gender and Caesarean section are considered to be contributing factors. The aim of the present study was to analyse the frequency of IA in patients undergoing general anaesthesia either for Caesarean section or gynaecological procedures., Methods: ASA I and II women were included into the study. Patients were randomly allocated to 4 groups: A, B and C included patients qualified for elective gynaecological surgery, and group D comprised Caesarean section patients. Premedication was not given. Group A received total intravenous anaesthesia with TCI, and groups B, C and D received balanced anaesthesia. The depth of anaesthesia was monitored with an AEP monitor. Blinded structured interviews were conducted 2 hours after anaesthesia and on postoperative days 7 and 30., Results: 337 patients were enrolled into the study. 45 patients reported diverse sensations connected to the anaesthesia (Group A - 7 patients, B - 9 patients, C - 2 patients, D - 28 patients). There were mainly dream sensations, but IA was present in 3 cases. In all of the cases, IA was recognised during the first interview. One episode of awareness appeared in group B, and the other two appeared in group D. One Caesarean section was complicated by intraoperative haemorrhage. The patient from group B had similar sensations during previous anaesthesia. Two women enrolled in the study reported awareness in the past, which did not occur this time., Conclusion: Awareness during general anaesthesia occurs occasionally. The frequency of occurrence in a group of patients undergoing general anaesthesia for uncomplicated Caesarean section is not higher than for other procedures. The anaesthesia for Caesarean section, as well as for other procedures, may be accompanied by pleasant dreams.

Background: The social status of physicians has been traditionally high in Poland, over recent years, we have noticed increased patient expectations in relation to the newest technology and the highest possible competence. The patient s image of medical personnel may influence his or her opinion about the quality of the service and of the medical centre. At the same time, we have noticed signs of decreasing trust, and an increased number of legal claims against doctors. The purpose of this study was to compare the image of anaesthesiologists, as perceived by patients who underwent Caesarean section either with general or spinal anaesthesia., Methods: Five hundred and thirteen parturients were asked to complete a questionnaire about their view of the attending anaesthesiologist, assessing the doctors attitude with 7-degree visual-analogue scale., Results: Four hundred and twelve valid forms were returned. Women who received spinal anaesthesia rated their anaesthesiologist higher than those who had general anaesthesia. Among the most important factors that influenced their opinion were: competence, calmness, trustfulness, accurate and detailed information, patience and kindness. Feelings of intimacy and privacy were less important, but the length of the preoperative visit was found to be a relevant factor. Anaesthesiologists providing spinal anaesthesia were rated higher, probably because they were spending more time with awake patients than those who had chosen general anaesthesia. The latter may also have been in a hurry, because of co-existing emergencies., Conclusion: We conclude that patients satisfaction depends mainly on the time spent with their doctors before anaesthesia and during the procedure. Regional anaesthesia may increase the patients trust and satisfaction, when compared with general anaesthesia.

Background: Modern medicine is becoming increasingly aware of economic-organizational aspects. In the field of anaesthesiology, the number of agents used markedly increases due to continuous pharmacological progress. A high proportion of them are expensive. The aim of the study was to compare hospital costs of general vs. subarachnoid anaesthesia for Caesarean section., Methods: Costs were assessed from the perspective of a service provider. Direct costs were measured using the micro-cost method based on detailed data of the resources used during anaesthetic procedures. Non-medical costs were calculated by the direct allocation method (costs of auxiliary units). Unit costs of hospitalization were determined using the "top-to-bottom" assessment. Costs related to anaesthetic staff work were calculated by the micro-cost method based on duration of anaesthesia. Sensitivity analysis was performed., Results: Mean direct cost of general anaesthesia for Caesarean section was lower than of subarachnoid anaesthesia. Mean personnel cost of subarachnoid anaesthesia was found to be higher compared to general anaesthesia. Costs of pharmaceuticals for general anaesthesia were lower than for subarachnoid one. Costs of medical materials related to the method used were significantly higher in subarachnoid anaesthesia., Conclusions: Subarachnoid anaesthesia takes more time than general one, which results in higher costs of medical staff work. Avoiding inhalation anaesthetics (sevoflurane) makes indirect costs of general anaesthesia lower compared to subarachnoid anaesthesia.