Maria João Fonseca

Association between dietary patterns and metabolic syndrome in a sample of portuguese adults

BackgroundThere is scarce evidence regarding the association between diet and metabolic syndrome (MetS) in Portuguese population. We aim to evaluate the association between a posteriori dietary patterns (DPs) and MetS and its features.MethodsUsing random digit dialing, a sample of 2167 adults was selected between 1999 and 2003, in Porto. During a face-to-face interview, a questionnaire was applied, anthropometric measures were taken, blood pressure measured and a fasting blood sample collected. Diet was assessed using a validated food frequency questionnaire, and four DPs were identified in each sex by multivariate finite mixture models.ResultsAfter adjustment for age and daily energy intake, comparing to the “healthy” DP, women with the “low fruit and vegetables” DP had a higher odds of high waist circumference (OR = 1.88 95% CI 1.17-3.01) and low HDL-cholesterol (OR = 1.78 95% IC 1.12-2.82) and women in the “red meat and alcohol” DP had higher odds of high waist circumference (OR = 1.45 95% CI 1.01-2.07) and of MetS (OR = 1.57 95% CI 1.07-2.29); men with the “fish” DP had a higher odds of high triglycerides (OR = 1.57 95% CI 1.05-2.35). After further adjustments (education, physical activity, smoking, alcohol drinking, BMI, and menopausal status) no significant associations remained.ConclusionsFour distinct DPs were identified in a community sample of Portuguese adults and there was no association with the prevalence of MetS.

A new approach to estimating weight change and its reference intervals during the first 96 hours of life

We aimed to apply a novel model to estimate weight change and its reference intervals during the first 96 h of life and the time of weight nadir.

Determinants of weight changes during the first 96 hours of life in full-term newborns.

BACKGROUND Newborn weight loss (NWL) in the first 3 days of life is around 6 percent of birthweight (BW). We aim to describe the determinants of an excessive and insufficient NWL in the first 96 hours of life. METHODS A sample of 1,288 full-term singletons without congenital abnormality belonging to Generation XXI birth cohort was selected. Newborns were recruited in 2005-2006 at all public units providing obstetrical and neonatal care in Porto, Portugal. Information was collected by face-to-face interview and additionally abstracted from clinical records. Anthropometrics were obtained by trained examiners and newborn weight change (NWC) was estimated as (weight-BW)/BW × 100. We categorized NWL as excessive (below 10th percentile of the sample distribution of NWC: ≤-9.4% of BW), normal (between 10th and 90th percentiles: -9.3 to -4.2%) and insufficient (above 90th percentile: ≥ -4.1%). Adjusted odds ratios (OR) and 95 percent confidence intervals (CI) were calculated using multinomial regression models. RESULTS Excessive NWL was positively associated with maternal age ≥40 years (OR = 3.32, 95%CI 1.19-9.25), maternal education (OR = 1.04, 95% CI 1.00-1.09), cesarean delivery (OR = 2.42, 95% CI 1.12-5.23), and phototherapy-treated jaundice (OR = 1.69, 95% CI 1.00-2.87). Insufficient NWL was positively associated with low BW (OR = 2.68, 95% CI 1.13-6.33), and formula/mixed feeding (OR = 1.74, 95% CI 1.13-2.66). CONCLUSION Excessive NWL was positively associated with maternal age and education, cesarean delivery, and phototherapy-treated jaundice. Insufficient NWL reflected childs feeding. As breastfed newborns did not lose weight excessively, but newborns with formula/mixed feeding had insufficient NWL, our study supports that breastfeeding provides excellent nutrition during this period.

Maternal Smoking: A Life Course Blood Pressure Determinant?

Introduction Exposure to maternal smoking early in life may affect blood pressure (BP) control mechanisms. We examined the association between maternal smoking (before conception, during pregnancy, and 4 years after delivery) and BP in preschool children. Methods We evaluated 4295 of Generation XXI children, recruited at birth in 2005-2006 and reevaluated at the age of 4. At birth, information was collected by face-to-face interview and additionally abstracted from clinical records. At 4-year follow-up, interviews were performed and childrens BP measured. Linear regression models were fitted to estimate the association between maternal smoking and childrens BP. Results Children of smoking mothers presented significantly higher BP levels. After adjustment for maternal education, gestational hypertensive disorders, and childs body mass index, children exposed during pregnancy to maternal smoking presented a higher systolic BP (SBP) z-score (β = 0.08, 95% confidence interval [CI] 0.04 to 0.14). In crude models, maternal smoking was associated with higher SBP z-score at every assessed period. However, after adjustment, an attenuation of the association estimates occurred (β = 0.08, 95% CI 0.03 to 0.13 before conception; β = 0.07, 95%CI 0.02 to 0.12; β = 0.04, 95%CI -0.02 to 0.10; and β = 0.06, 95%CI 0.00 to 0.13 for the first, second, and third pregnancy trimesters, respectively; and β = 0.07, 95%CI 0.02 to 0.12 for current maternal smoking). No significant association was observed for diastolic BP z-score levels. Conclusion Maternal smoking before, during, and after pregnancy was independently associated with systolic BP z-score in preschool children. This study provides additional evidence to the public health relevance of maternal smoking cessation programs if early cardiovascular health of children is envisaged. Implications Using observational longitudinal data from the birth cohort Generation XXI, this study showed that exposure to maternal smoking-before pregnancy, during pregnancy, and 4 years after delivery-was associated with a systolic BP-raising effect in children at the age of 4. The findings of this study add an important insight into the need to support maternal smoke-free environments in order to provide long-term cardiovascular benefit, starting as early as possible in life.

Effect of birth weight and weight change during the first 96 h of life on childhood body composition--path analysis.

Background:It is established that growth during early life is predictive of several health outcomes later in life, including body composition. The role of fetal vs postnatal growth remains controversial. We aimed to evaluate the effect of birth weight (BW) and newborn weight change (NWC) during the first 96 h of life on body composition during childhood, measured by: body mass (BMI), fat mass (FMI), and fat-free mass indexes (FFMI), waist circumference (WC) and waist-to-height ratio (WHtR).Methods:As part of the Generation XXI birth cohort, children were recruited in 2005/2006 at all public units providing obstetrical and neonatal care in Porto, Portugal. Information was collected by face-to-face interview and abstracted from clinical records. Newborn’s anthropometrics were obtained by trained examiners and NWC was estimated as (weight−BW)/BW × 100, adjusted for age in hours. At age 4 and 7, children were re-evaluated and anthropometric measurements were taken according to standard procedures. Life course data for 717 full-term singletons were presented. Path analysis was used to compute adjusted regression coefficients (β) and 95% confidence intervals.Results:BW had a direct effect on body composition at age 4: for each 100 g increase in BW, there was an increase of 0.043 (0.024; 0.062) on BMI, 0.037 (0.020; 0.055) on FMI, 0.024 (0.007; 0.042) on FFMI, 0.048 (0.031; 0.066) on WC, and 0.022 (0.004; 0.039) on WHtR z-scores. At age 7, BW was positively associated with body composition measures, but this effect was mediated by body composition at age 4. NWC had no effect on body composition at ages 4 or 7. Positive associations were found between body composition at ages 4 and 7.Conclusion:It appears that childhood body composition is programmed by fetal growth and this intra-uterine period seems more important to the development of body composition than immediate postnatal period.

Editorial: Health Education: fostering public health literacy through innovative educational activities and resources

In a rapidly evolving scientifically grounded and technology-driven society, the development of health literacy is essential to ensure that the public is motivated and capable of retrieving, making sense, and applying accurate health-related information in their daily lives and professional activities. Accordingly, the investment in a sustainable public health education requires integrated actions addressed not only to lay people but also to health-specialist audiences. With the purpose of highlighting current topics in health education research, this Research Topic on “Health education: fostering public health literacy through innovative education activities and resources” brings together six articles aimed at the education of both the lay community and health professionals. Educational interventions targeting younger population segments tend to be regarded as effective, as they increase the chance of nurturing a healthy lifestyle throughout life (1, 2). The articles by Pais et al. (3), Raved and Yarden (4), and Horn et al. (5) address key interacting challenges aimed at younger generations through school health programs. Pais et al. focus on improving the capacity of individuals and the community to deal with health-related issues (3). Raved and Yarden consider the development of the knowledge base and the system thinking skills required to process the complexity and vast amount of information about those issues (4). Horn et al. study the promotion of informed decision-making about health-related behaviors (5). Each article examines the impact of innovative methodologies and perspectives that can boost the effectiveness of health education initiatives. Pais et al. (3) discuss the role played by the community in yielding the success of formal and informal health education initiatives. Drawing on previous studies supporting the relevance of taking on pluralistic approaches and collaborative research efforts to promote health education (6, 7), the authors present the outcomes of two mixed-methods studies carried out in a youth community organization and in a school in Portugal. By conceptualizing health according to socio-political and ecological dimensions that surpass individual and biomedical points of view and take into account the community influence, they demonstrate that young people are eager to improve their knowledge about health rights and healthcare access mainly because they perceive the great relevance of these sensitive public issues in a wider social context. In their article, Raved and Yarden (4) present a unified model for designing teaching and learning materials and characterizing students’ systems thinking skills concerning the circulatory system, based on three well-known models: systems thinking hierarchical model, competence for cell biology education, and structure–behavior-function model (8–10). The data gathered by the implementation of this model in a sample of 75 seventh grade students (12–13 years old) in Israel suggests that this may be an efficient tool to assist educators in promoting and improving understanding about dynamic relationships established between system components at different levels of organization. Moving beyond formal and informal educational contexts, Horn et al. (5) address the potential of large-scale evidence-based dissemination programs aimed at fostering healthy behaviors. The authors conceptualize a nine-phase dissemination model based on the Not-On-Tobacco Program, a youth smoking cessation program designed for 14–19 year olds developed in 1998 in West Virginia, USA (11), illustrating how it can be operationalized and demonstrating its applicability in other contexts. The development of proper training actions, educational tools, and resources for health professionals must not be neglected, as they are the social actors who harness the advancements in science and technology and convert them into practices that can benefit the population’s quality of life and wellbeing (12). Two contributions are presented by Kohzaki (13, 14). These articles focus on the skills and knowledge required to fully grasp the concepts and procedures that underlie genetic testing and counseling and allow practitioners to meet the challenges presented by the rapid technological advancements in the plethora of fields that make up the health sector. Kohzaki uses the example of the typical clinical genetics education of Japanese medical professionals to outline valuable recommendations that can help promote genetic literacy and enhance the quality of the services provided. In their opinion article, Zilberter and Zilberter (15) turn attention to healthy eating habits. Specifically, they focus on breakfast eating behavior, arguing that scarce evidence supports the assumption that this is the most important meal of the day. By reviewing relevant literature in the field, the authors conclude that the importance of this meal cannot be regarded as independent from an individual’s integrated dietary regime. The findings provide a scientific background to promote healthy eating behaviors in a wide educational context, especially in what comes to the need to critically interpret health-related information. Taken together, these articles provide interesting insights about how to advance health education and improve health literacy to empower both lay consumers and health professionals to foster high quality decisions-making and healthy behaviors.

A Multi-state Model for Analysing Transitions between Body Mass Index Categories During Childhood - Generation XXI Birth Cohort Study

Prevalences of overweight and obesity in young children have risen dramatically in the last several decades in most developed countries. Childhood overweight and obesity are known to have immediate and long-term health consequences and are now recognized as important public health concerns. We used a Markov 4-state model with states defined by 4 body mass index (BMI; weight (kg)/height (m)2) categories (underweight (<-2 standard deviations (SDs) of BMI z score), normal weight (-2 ≤ SD ≤ 1), overweight (1 < SD ≤ 2), and obese (>2 SDs of BMI z score)) to study the rates of transition to higher or lower BMI categories among children aged 4-10 years. We also used this model to study the relationships between explanatory variables and their transition rates. The participants consisted of 4,887 children from the Generation XXI Birth Cohort Study (Porto, Portugal; 2005-2017) who underwent anthropometric evaluation at age 4 years and in at least 1 of the subsequent follow-up waves (ages 7 and 10 years). Children who were normal weight were more likely to move to higher BMI categories than to lower categories, whereas overweight children had similar rates of transition to the 2 adjacent categories. We evaluated the associations of maternal age and education, type of delivery, sex, and birth weight with childhood overweight and obesity, but we observed statistically significant results only for sex and maternal education with regard to the progressive transitions.

Readmission to an Adolescent Psychiatry Inpatient Unit: Readmission Rates and Risk Factors

INTRODUCTION Most mental disorders have a chronic evolution and therefore a certain amount of psychiatric readmissions are inevitable. Several studies indicate that over 25% of child and adolescent inpatients were readmitted within one year of discharge. Several risk factors for psychiatric readmissions have been reported in the literature, but the history of repeated readmissions is the most consistent risk factor. Our aim is to calculate the readmission rates at 30 days and 12 months after discharge and to identify associated risk factors. MATERIAL AND METHODS The authors consulted the clinical files of patients admitted to the Inpatient Unit between 2010 and 2013, in order to calculate the readmission rates at 30 days and at 12 months. The demographic and clinical characteristics of the readmitted patients were analyzed and compared with a second group of patients with no hospital readmissions, in order to investigate possible predictors of readmission. RESULTS A total of 445 patients were admitted to our inpatient unit between 2010 and 2013. Six adolescents were readmitted in a 30 days period (1.3%) and 52 were readmitted in a 12 month period after discharge (11.5%). Duration of the hospitalization and the previous number of mental health admissions were significant predictors of future hospital readmissions (p = 0.04 and p = 0.014). DISCUSSION The low readmission rates may reflect the positive clinical and sociofamilial support being provided after discharge. CONCLUSION Rehospitalisation is considered a fundamental target for intervention concerning prevention and intervention in mental healthcare. Thus, knowledge regarding their minimisation is crucial.

A statistical approach to quantitative data validation focused on the assessment of students’ perceptions about biotechnology

Student awareness levels are frequently used to evaluate the effectiveness of educational policies to promote scientific literacy. Over the last years several studies have been developed to assess students’ perceptions towards science and technology, which usually rely on quantitative methods to achieve broad characterizations, and obtain quantifiable and comparable data. Although the usefulness of this information depends on its validity and reliability, validation is frequently neglected by researchers with limited background in statistics. In this context, we propose a guideline to implement a statistical approach to questionnaire validation, combining exploratory factor analysis and reliability analysis. The work focuses on the psychometric analysis of data provided by a questionnaire assessing 1196 elementary and high school students’ perceptions about biotechnology. Procedural guidelines to enhance the efficiency of quantitative inquiry surveys are given, by discussing essential methodological aspects and relevant criteria to integrate theory into practice.

I, microbiologist: a discovery-based course in microbial ecology and molecular evolution

Inquiry and discovery-based approaches to science education emphasise the importance of engaging students in scientific inquiry, prompting their scientific reasoning, and providing them with an insightful perspective about scientific practice and about limitations and constraints encountered in scientific research. In I, microbiologist, we find a textbook conveying an outstanding collection of instructional materials that can be explored in order to meet these goals. As the title elegantly describes, in I, microbiologist, Erin Sanders, Jeffrey Miller and contributors provide learners and educators with a complete course in modern microbiology, comprising state-of-theart techniques and procedures that mimic investigations taking place in real research laboratories. Building up from the concept of biodiversity, specifically focusing on rhizospheric bacterial diversity, the authors guide students through an investigation addressing the impressive diversity of bacteria that can be found in a single soil sample, making use of microbiology and molecular biology approaches. I find this to be a very interesting topic, particularly considering that soil microorganisms hold a wealth of resources with important benefits for humans. But the most valuable feature of this textbook pertains to the authors’ concern to structure the contents and tasks in a most practical and educationally meaningful fashion. The textbook is organised in seven units, each comprising an introductory section followed by a literature review, reading and homework assignments, an experimental overview and experimental protocols. The text is accompanied by high-quality, appealing and informative illustrations. In total, there are 34 proposed experiments, 29 of which involve wet-lab exercises and five that include dry-lab activities. The units evolve from fundamental microbiology to innovative bioinformatic procedures and cutting-edge molecular biology methods. I am particularly pleased that an experimental overview articulating theory with practice is consistently provided, as this clarifies the goals set and the tasks involved. The project depicted throughout the book’s 438 pages is intended for undergraduate students attending microbiology, microbial ecology, molecular evolution, and genomics courses, with a background in biology and previous laboratory experience. Whilst the demanding nature of the knowledge and procedures required to fully take advantage of the materials leads me to believe that it does not adjust to lower instructional levels, some of the more basic protocols, particularly in Units 1, 2 and 4, may be used in upper-secondary biology classes. Further exploration of the book makes it a valuable tool to use in project-based interventions, although it is also possible to select and develop one or more individual activities, instead of conducting the project from start to finish. Finally, I must highlight several special features that demonstrate the authors’ attention to detail and the intention to make this a useful and usable resource. The two most interesting aspects relate to: (1) the I, microbiologist database – an online platform that allows students to share their research findings with a broader community of peers – while projecting the project’s impact to a larger scale, this enables students to communicate their work in a sophisticated technological environment; (2) the ‘budget worksheet’ – allocating a budget to students that requires them to make decisions as to which experiments to conduct and, if necessary, repeat – this cleverly crafted strategy illustrates the demands faced by real investigators in managing external research funding. Other seemingly minor features, such as the detachable sheets, the list of media, supplies and equipment, the safety recommendations, the key terms presented in the introductory sections, and the extended lists of references, become very useful when the book is actually being used. In short, I would describe this as a very interesting and useful hands-on book for anyone who chooses to teach and learn what microbiology is all about nowadays.