RESUMO
Studies indicate that ultra-processed food (UP) consumption correlates negatively with essential vitamin and mineral intake and positively with sodium and lipid intake. The objective of this study was to explore the relationship between UP consumption and deviations from nutritional guidelines. An observational, cross-sectional analytical study was conducted on a probability sample of manufacturing workers in the state of Rio Grande do Norte, Brazil. Food consumption was assessed with a 24 h recall survey, and nutrient intake inadequacies were calculated as the difference between individuals' intake of energy, macronutrients, minerals and vitamins, and the dietary reference intakes for individuals of the same sex and age group, and then analyzed for trends across the percentage contribution of UP to total energy intake with nonparametric multiple regression adjusted for covariates. The study included 921 workers from 33 industries, 55.9% male, with a mean age of 32 years. Overall, the study population exhibited deficits in energy, all macronutrients, and in some micronutrients. With increasing UP contribution to total energy intake, there is a trend towards a greater intake of energy (p < 0.001), total, saturated, monounsaturated, and trans fats (p < 0.001), n6-polyunsaturated fatty acids (p = 0.03), carbohydrates (p < 0.001), calcium (p = 0.008), and manganese (p < 0.001), thiamin (p < 0.001), and vitamin B6 (p = 0.01); however, this comes with a negative consequence in terms of reducing the protein consumption (p = 0.037), fiber (p = 0.035), copper (p = 0.033), and vitamin E (p = 0.002) intake. The results show that correcting energy and micronutrient deficiencies by increasing UP consumption can also lead to a decrease in diet quality.
Assuntos
Minerais , Nutrientes , Vitaminas , Humanos , Masculino , Feminino , Adulto , Estudos Transversais , Minerais/administração & dosagem , Vitaminas/administração & dosagem , Brasil , Adulto Jovem , Pessoa de Meia-Idade , Fast Foods/estatística & dados numéricos , Ingestão de Energia , Dieta/estatística & dados numéricos , Alimento ProcessadoRESUMO
The increasing intake of ultra-processed (UP) foods is causing changes in the profile of food and nutrient consumption, negatively influencing consumer behavior. The present study aimed to evaluate the influence of UP foods on the diet of Brazilian adults, verifying the association between its increasing contribution to total energy and trends in the consumption of other NOVA groups, food subgroups, energy consumption, and macro- and micronutrients. We conducted an observational, cross-sectional study of a probability sample of 921 manufacturing workers in the state of Rio Grande do Norte, Brazil, from a combined stratified and two-stage survey. Trends in consumption across quintiles of UP food contribution to the total energy intake were tested with linear regression. The results showed that higher UP food consumption is associated with a higher intake of energy, carbohydrates and total-, mono- and polyunsaturated fats, saturated fats and trans fats, and the micronutrients calcium, iron and thiamine; and higher consumption of ready-to-eat foods, accompanied by lower consumption of foods that require preparation, such as beans, tubers and roots, vegetables and fruits, which may represent a risk for the development of non-transmissible chronic diseases in this population.
Assuntos
Fast Foods , Alimento Processado , Adulto , Humanos , Brasil , Estudos Transversais , Valor Nutritivo , Manipulação de Alimentos , Dieta , Ingestão de Energia , MicronutrientesRESUMO
OBJECTIVE: Dural arteriovenous fistulas (DAVFs) are abnormal, acquired arteriovenous connections within the dural leaflets. Their associated symptoms may be mild or severe and are related to the patient's venous anatomy. With the hypothesis that the patient's venous anatomy determines the development of symptoms, the authors aimed to identify which venous anatomy elements are important in the development of major symptoms in patients with a DAVF. METHODS: A multicenter study was performed based on the retrospective analysis of cerebral angiographies with systematic assessment of brain drainage pathways (including fistula drainage) in patients over 18 years of age with a single DAVF. The patients were divided into two groups: those with minor (group 1, n = 112) and those with major (group 2, n = 89) symptoms. Group 2 was subdivided into two groups: patients with hemorrhage (group 2a, n = 47) and patients with severe nonhemorrhagic symptoms (group 2b, n = 42). RESULTS: The prevalence of stenosis in DAVF venous drainage and the identification of tiny anastomoses between venous territories were significantly higher in group 2 (32.6% and 19.1%, respectively) compared with group 1 (2.68% and 5.36%, respectively). Stenosis of DAVF venous drainage was significantly more frequent in group 2a than in group 2b (51.1% vs 11.9%, p < 0.001). Group 2b patients had increased prevalence of shared use of the cerebral main drainage pathway (85.0% vs 53.2%, p = 0.002), the absence of an alternative route (45.0% vs 17.0%, p = 0.004), and the presence of contrast stagnation (62.5% vs 29.8%, p = 0.002) compared with group 2a patients. In patients with high-grade fistulas, the group with major symptoms had increased prevalence of a single draining direction (31.3% vs 8.33%, p = 0.003), stenosis in the draining vein (35.0% vs 6.25%, p = 0.000), the absence of an alternative pathway for brain drainage (31.3% vs 12.5%, p = 0.017), and the presence of contrast stagnation (48.8% vs 22.9%, p = 0.004). CONCLUSIONS: Major symptoms were observed when normal brain tissue venous drainage was impaired by competition with DAVF (predominance in group 2b) or when DAVF venous drainage had anatomical characteristics that hindered drainage, with consequent venous hypertension on the venous side of the DAVF (predominance in group 2a). The same findings were observed when comparing two groups of patients with high-grade lesions: those with major versus those with minor symptoms.
RESUMO
Motivations for food choices may determine consumption, and understanding that relationship may help direct strategies for formulating diets. This study aimed to identify associations between motivations for food choices and consumption of food groups. An observational cross-sectional survey was conducted in 921 manufacturing workers from 33 companies in Brazil, based on a stratified two-stage probability sample. Motivations for food choices were assessed with the Food Choice Questionnaire, and intake of food groups was measured using 24-h dietary recall. Consumption was classified into 31 food groups defined according to their nutritional value and the NOVA classification. Data were analyzed with multilevel mixed-effects regression. The results showed that sensory appeal and price were the most important motivations for food choices, while ethical concern was less important. Sensory appeal was positively associated with consumption of industrialized condiments (p = 0.022), price showed a negative correlation with consumption of plant oils (p = 0.022), ethical concern showed positive correlation within consumption white meat (p = 0.065) and negative correlation within pasta dishes (p < 0.001). Regarding the NOVA classification, health correlated with an increase in consumption of unprocessed foods (p = 0.017) and weight control with a decrease in consumption of processed culinary ingredients (p = 0.057).
Assuntos
Preferências Alimentares , Indústria Manufatureira , Motivação , Adulto , Brasil , Estudos Transversais , Dieta , Ingestão de Alimentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Nutritivo , Estudos Prospectivos , Adulto JovemRESUMO
BACKGROUND: The Brazilian Workers Food Program (WFP) is a public policy program of nutritional assistance to workers, with the main objective of improving nutritional conditions, which was implemented 40 years ago and serves over 21.4 million workers. OBJECTIVES: To compare the long-term change in anthropometric indicators of the nutritional status and dietary intake between workers of manufacturing industries adherent to and non-adherent to the WFP. METHODS: A prospective cohort study, based on a combined stratified and multistage probability sampling, was carried out, with two waves with a 4-year interval. The change in body mass index (BMI), waist circumference (WC) and dietary intake at lunch by the 24-hour recall method were compared between groups with analysis of covariance. RESULTS: A total of 273 workers in 16 industries from an initial cohort of 1069 workers in 26 industries of the State of Rio Grande do Norte in Brazil were evaluated in the two waves. The mean age was 37±10 years and 53.1% were male, with no differences between groups in age and sex distribution. BMI increased in both groups (0.44 kg/m2 in non-WFP, p = 0.003, and 0.56 kg/m2 in WFP, p = 0.0006) and WC increased in the WFP group (1.50 cm, p = 0.0006). BMI change over time did not show statistical differences between groups (p = 0.54) but WC had a greater increase in the WFP group (difference 1.37 cm, p = 0.047). There were no differences between groups in the change over time of the dietary intake. CONCLUSION: BMI and WC increased over time in manufacturing workers of industries both adherent and non-adherent to the WFP, but with a greater increase of WC in the WFP group. In order to achieve the objectives of the WFP, there will be a need for periodic evaluation and monitoring of nutritional indicators in these workers and implementation of monitoring and enforcement actions of the WFP.
Assuntos
Assistência Alimentar/normas , Abastecimento de Alimentos/estatística & dados numéricos , Estado Nutricional , Recursos Humanos , Local de Trabalho , Adulto , Antropometria , Índice de Massa Corporal , Brasil/epidemiologia , Dieta , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Masculino , Indústria Manufatureira , Pessoa de Meia-Idade , Saúde Ocupacional , Serviços de Saúde do Trabalhador/normas , Estudos Prospectivos , Circunferência da CinturaRESUMO
BACKGROUND: Mammographic breast density is an important predictor of breast cancer, but its measurement has limitations related to subjectivity of visual evaluation or to difficult access for automatic volumetric measurement methods. Herein, we describe the design and clinical validation of Aguida, a software program for automated quantification of breast density from flat mammography images. MATERIALS AND METHODS: The software program was developed in MatLab. After image segmentation separating the background from the breast image, the operator positions a cursor defining a region of interest on the pectoralis major muscle from the mediolateral oblique view. Then, in the craniocaudal view, the threshold for separation of the dense tissue is based on the optical density of the pectoral muscle, and the proportion of dense tissue is calculated by the program. Mammograms obtained from 2 different occasions in 291 women were used for clinical evaluation. RESULTS: The intraclass correlation coefficient (ICC) between breast density measurements by the software and by a radiologist was 0.96, with a bias of only 0.67 percentage points and a 95% limit of agreement of 13.5 percentage points; the ICC was 0.94 in the interobserver reliability assessment by two radiologists with different experience; and the ICC was 0.98 in the intraobserver reliability assessment. The distribution among the density classes was close to the values obtained with the volumetric software. CONCLUSIONS: Measurement of breast density with the Aguida program from flat mammography images showed high agreement with the visual determination by radiologists, and high inter- and intra-observer reliability.
Assuntos
Densidade da Mama , Neoplasias da Mama/prevenção & controle , Mamografia , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Validação de Programas de Computador , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Feminino , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: To identify patient factors and medications associated with the occurrence of drug-related problems (DRPs) in neonates admitted to neonatal intensive care units (NICUs). DESIGN: Prospective, longitudinal study. SETTING: NICU of a teaching hospital in Brazil. PARTICIPANTS: Data were collected from the records of the clinical pharmacy service of all neonates admitted between April 2014 and January 2017, excluding neonates with length of stay in the NICU <24 hours or without prescribed drugs. PRIMARY OUTCOME MEASURES: Occurrence of one or more DRP (conditions interfering in the patient's pharmacotherapy with potential undesired clinical outcomes). RESULTS: The study observed 600 neonates who had a median length of stay in the NICU of 13 days (range 2-278 days). DRPs were identified in most neonates (60.5%). In a multivariate logistic regression model, the factors independently associated with DRP were gestational age (adjusted OR (AOR) 0.85, 95% CI 0.81 to 0.89), 5 min Apgar <7 (AOR 1.74, 95% CI 1.00 to 3.13), neurological disease (AOR 2.49, 95% CI 1.09 to 5.69), renal disease (AOR 5.75, 95% CI 1.85 to 17.8) and cardiac disease (AOR 2.36, 95% CI 1.31 to 4.24). The medications with greater risk for DRP were amphotericin B (AOR 4.80), meropenem (AOR 4.09), alprostadil (AOR 3.38), vancomycin (AOR 3.34), ciprofloxacin (AOR 3.03), gentamicin (AOR 2.43), cefepime (AOR 1.88), amikacin (AOR 1.82) and omeprazole (AOR 1.66). These medicines represented one-third of all prescribed drugs. CONCLUSIONS: Gestational age, 5 min Apgar <7, and neurological, cardiac and renal diseases are risk factors for DRP in NICUs. Alprostadil, omeprazole and several anti-infectives were associated with greater risk of DRP.
Assuntos
Uso de Medicamentos/estatística & dados numéricos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Unidades de Terapia Intensiva Neonatal , Erros de Medicação/estatística & dados numéricos , Serviço de Farmácia Hospitalar/organização & administração , Brasil , Feminino , Hospitais de Ensino , Humanos , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Estudos Longitudinais , Masculino , Análise Multivariada , Estudos Prospectivos , Medição de Risco , Fatores de RiscoRESUMO
Sedentary behavior (SB) has emerged as an important risk factor for poor health. Evidence showed that patients with heart failure (HF) exhibit high levels of SB, and that high SB increases mortality among such patients. We aimed to identify factors associated with SB in HF patients. Methods: A cross-sectional study was carried out with adults with HF and categorized under New York Heart Association (NYHA) functional class I-III. Sociodemographic, clinical, and health information were gathered. Evaluation of SB (by sitting time) and moderate-to-vigorous physical activity (MVPA) was performed by self-reported measures. Functional capacity was assessed using the Duke Activity Status Index. Simple and multivariate linear regression analyses were performed to identify the most suitable predictive model. Results: The sample (n = 80) comprised predominantly of patients in functional class I, men, and with an average age of 50.8 years. Time spent on SB totaled to 7.69 ± 2.35 h/day. Weekly volume of MVPA, functional capacity, and previous stroke were predictors of higher SB. Using simple linear regression analysis, the variables body mass index, quality of life, NYHA functional class, total comorbidities, dyslipidemia, MVPA in the leisure domain, and the use of diuretics, statins, and sildenafil were shown to have a statistically significant association with SB. Conclusion: In patients with HF, a longer time spent in SB was associated with low volumes of MVPA, low functional capacity, and history of stroke. More studies are needed to corroborate these findings.(AU)
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Acidente Vascular Cerebral/complicações , Comportamento Sedentário , Insuficiência Cardíaca/complicações , Fatores de RiscoRESUMO
PURPOSE: To confirm that prostatic artery embolization (PAE) has a positive medium- and long-term effect in symptomatic benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Between March 2009 and October 2014, 630 consecutive patients with BPH and moderate-to-severe lower urinary tract symptoms refractory to medical therapy for at least 6 months or who refused any medical therapy underwent PAE. Outcome parameters were evaluated at baseline; 1, 3, and 6 months; every 6 months between 1 and 3 years; and yearly thereafter up to 6.5 years. RESULTS: Mean patient age was 65.1 years ± 8.0 (range, 40-89 y). There were 12 (1.9%) technical failures. Bilateral PAE was performed in 572 (92.6%) patients and unilateral PAE was performed in 46 (7.4%) patients. The cumulative clinical success rates at medium- and long-term follow-up were 81.9% (95% confidence interval [CI], 78.3%-84.9%) and 76.3% (95% CI, 68.6%-82.4%). There was a statistically significant (P < .0001) change from baseline to last observed value in all clinical parameters: International Prostate Symptom Score (IPSS), quality-of-life (QOL), prostate volume, prostate-specific antigen, urinary maximal flow rate, postvoid residual, and International Index of Erectile Function. There were 2 major complications without sequelae. CONCLUSIONS: PAE had a positive effect on IPSS, QOL, and all objective outcomes in symptomatic BPH. The medium- (1-3 y) and long-term (> 3-6.5 y) clinical success rates were 81.9% and 76.3%, with no urinary incontinence or sexual dysfunction reported.
Assuntos
Embolização Terapêutica/métodos , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artérias/diagnóstico por imagem , Brasil , Embolização Terapêutica/efeitos adversos , Disfunção Erétil/etiologia , Disfunção Erétil/fisiopatologia , Humanos , Calicreínas/sangue , Estimativa de Kaplan-Meier , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Ereção Peniana , Antígeno Prostático Específico/sangue , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/fisiopatologia , Qualidade de Vida , Radiografia Intervencionista , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia , UrodinâmicaRESUMO
BACKGROUND: Although there is a conflict between the treatment benefits for a single individual and society, restrictions on antibiotic use are needed to reduce the prevalence of resistance to these drugs, which is the main result of irrational use. Brazil, cataloged as a pharmemerging market, has implemented restrictive measures for the consumption of antibiotics. The objective of this study was to investigate the quality of antimicrobial prescriptions and user knowledge of their treatment with these drugs. METHODS AND FINDINGS: A two-stage cross-sectional, combined and stratified survey of pharmacy users holding an antimicrobial prescription was conducted in the community between May and November 2014. A pharmacist analyzed each prescription for legibility and completeness, and applied a structured questionnaire to the users or their caregivers on their knowledge regarding treatment and user sociodemographic data. An estimated 29.3% of prescriptions had one or more illegible items, 91.3% had one or more missing items, and 29.0% had both illegible and missing items. Dosing schedule and patient identification were the most commonly unreadable items in prescriptions, 18.81% and 12.14%, respectively. The lack of complete patient identification occurred in 90.53% of the prescriptions. It is estimated that 40.3% of users have used antimicrobials without prescription and that 46.49% did not receive any guidance on the administration of the drug. CONCLUSIONS: Despite the measures taken by health authorities to restrict the misuse of antimicrobials, it was observed that prescribers still do not follow the criteria of current legislation, particularly relating to items needed for completion of the prescription. Moreover, users receive little information about their antimicrobial treatment.