6/3 ratio as a quality indicator of the Brazilian diet and it relation with chronic diseases

Introdução: A carga de doenças crônicas está aumentando rapidamente em todo o mundo. A proporção de ácido graxo 6/3 é um indicador qualitativo da dieta e sua elevação tem se mostrado associada a doenças crônicas na idade adulta. Em diversos países os padrões alimentares modernos apresentam proporção elevada de ácido graxo 6/3, no Brasil esse dado é desconhecido. Objetivo: Identificar os padrões de consumo alimentar da população brasileira na faixa etária de 15 a 35 anos e investigar a associação desses padrões com fatores de risco biológicos para doenças crônicas. Métodos: Foram utilizados dados do inquérito de consumo alimentar individual (POF 7) da Pesquisa Orçamento Familiares (POF) 2008 a 2009. Para estimar os padrões alimentares utilizou-se a análise de componentes principais (ACP), com rotação varimax. Para determinar o número de componentes a serem retidos na análise, consideramos aqueles com eingenvalues 1 e, para caracterizá-los, as variáveis com loadings |0,20|. Realizou-se o teste de Kaiser-Meyer-Olkin (KMO) para indicar a adequação dos dados à ACP. As associações entre os padrões alimentares (escores fatoriais) e fatores de risco para doenças crônicas, sintetizados na razão 6/3 do consumo alimentar acima de 10:1, foram estimadas através de regressões linear e logística. Foram considerados estatisticamente significantes os valores com p 10:1 of food consumption were estimated by linear and logistic regressions. Values with p <0.05 were considered statistically significant. Analyses were performed in STATA 12 software. Results: In the sample of 12527 individuals we identified 3 dietary patterns (P). The P3 characterized by the use of mixed preparations, pizza / sandwiches, vitamins / yogurts, pastries, juices and soft drinks, was effective in reducing the 6/3 ratio; P1 \"pro inflammatory\" characterized by processed meats, bakery, dairy, oils and fats had an effect of increasing the 6/3ratio, this pattern is more practiced by the population of lower income in both sexes. We found a low consumption of fruits and 8 vegetables in all dietary patterns. Assuming an increase in the practice of the patterns 2 and 3 would be decreased the probability of the P1 practice by 5 per cent in both sexes. The PCA confidence index, estimated by KMO coefficient was 0.57. Conclusion: Dietary patterns characterized by the consumption of oils and fats, processed meats, dairy and bakery products contributed to the increase in 6/3 in the Brazilian diet and, by extension, the risk of developing chronic diseases. Complex and wide range of foods consumed in dietary patterns are more effective in reducing the ratio 6/3 diet of Brazilian adults, this effect is due to the role of synergy during digestion and absorption that food has on the body, since the consumption takes place by a variety of food and not by food consumption isolated. Nutrition public policies must take into account the 6/3 ratio as one of the markers of diet quality in the countrys food consumption

Padrões alimentares estimados por técnicas multivariadas: uma revisão da literatura sobre os procedimentos adotados nas etapas analíticas

Resumo: Objetivo: Descrever as soluções adotadas nas múltiplas etapas de utilização das técnicas multivariadas para obtenção de padrão alimentar (PA) no que tange: ao objetivo dos estudos, à escolha do método de aferição do consumo alimentar, aos critérios de grupamento dos alimentos, à quantidade de grupos alimentares utilizada, ao número de PA extraído e aos critérios para nomenclatura. Métodos: Foram selecionadas publicações das bases MEDLINE e Lilacs tendo como descritores: "padrão alimentar" versus "análise fatorial"; "análise de componentes principais"; "análise de cluster " e "reduced regression rank ". A busca inicial resultou em 1.752 artigos, que após critérios de inclusão e exclusão somaram 189 publicações. Resultados: Foram relevantes entre os estudos os seguintes aspectos: a predominância da análise de componentes principais (ACP); a predominância no uso de 4 a 5 PAs nos estudos de associação com desfechos de saúde; o uso de 30 ou mais grupos de alimentos provenientes do Questionário de Frequência Alimentar (QFA); a predominância de estudos que associaram PAs com desfechos de saúde e fatores socioeconômicos; a heterogeneidade de critérios adotados ao longo das etapas analíticas das técnicas multivariadas. Conclusão: A heterogeneidade entre as publicações se concentra nos critérios de agrupamento dos alimentos, na nomenclatura e no número de padrões alimentares extraídos, que variou em função do número de grupos alimentares presentes nas análises. Entender, aplicar e explorar em sua totalidade as técnicas multivariadas tem se tornado necessário para melhorar a confiabilidade dos resultados e, consequentemente, aprimorar as relações com desfechos de saúde e fatores socioeconômicos

Physician’s sociodemographic profile and distribution across public and private health care: an insight into physicians’ dual practice in Brazil

Abstract Background The intertwined relation between public and private care in Brazil is reshaping the medical profession, possibly affecting the distribution and profile of the country’s medical workforce. Physicians’ simultaneous engagement in public and private services is a common and unregulated practice in Brazil, but the influence played by contextual factors and personal characteristics over dual practice engagement are still poorly understood. This study aimed at exploring the sociodemographic profile of Brazilian physicians to shed light on the links between their personal characteristics and their distribution across public and private services. Methods A nation-wide cross-sectional study using primary data was conducted in 2014. A representative sample size of 2400 physicians was calculated based  on the National Council of Medicine database registries; telephone interviews were conducted to explore physicians’ sociodemographic characteristics and their engagement with public and private services. Results From the 2400 physicians included, 51.45% were currently working in both the public and private services, while 26.95% and 21.58% were working exclusively in the private and public sectors, respectively. Public sector physicians were found to be younger (PR 0.84 [0.68–0.89]; PR 0.47 [0.38–0.56]), less experienced (PR 0.78 [0.73–0.94]; PR 0.44 [0.36–0.53]) and predominantly female (PR 0.79 [0.71–0.88]; PR 0.68 [0.6–0.78]) when compared to dual and private practitioners; their income was substantially lower than those working exclusively for the private (PR 0.58 [0.48–0.69]) and mixed sectors (PR 0.31 [0.25–0.37]). Conversely, physicians from the private sector were found to be typically senior (PR 1.96 [1.58–2.43]), specialized (PR 1.29 [1.17–1.42]) and male (PR 1.35 [1.21–1.51]), often working less than 20 h per week (PR 2.04 [1.4–2.96]). Dual practitioners were mostly middle-aged (PR 1.3 [1.16–1.45]), male specialists with 10 to 30 years of medical practice (PR 1.23 [1.11–1.37]). Conclusion The study shows that more than half of Brazilian physicians currently engage with dual practice, while only one fifth dedicate exclusively to public services, highlighting also substantial differences in socio-demographic and work-related characteristics between public, private and dual-practitioners. These results are consistent with the international literature suggesting that physicians’ sociodemographic characteristics can help predict dual practice forms and prevalence in a country

Perceived Workload Using Separate (Filtering Facepiece Respirator and Face Shield) and Powered Air-Purifying Respirator and Integrated Lightweight Protective Air-Purifying Respirator: Protocol for an International Multisite Human Factors Randomized Crossover Feasibility Study

BackgroundThe design of personal protective equipment (PPE) may affect well-being and clinical work. PPE as an integrated item may improve usability and increase adherence by healthcare professionals. Human factors design and safety may reduce occupational-acquired diseases. As an integrated PPE, a lightweight protective air-purifying respirator (L-PAPR) could be used during health procedures where healthcare professionals are exposed to airborne pathogens. The human factors affecting the implementation of alternative PPE such as L-PAPR have not been thoroughly studied. The population of interest is health care professionals, the intervention is the performance by PPE during tasks across the three PPE types 1.) N95 respirators and face shields, 2.)traditional powered air-purifying respirator(PAPR), and 3.) L-PAPR. The outcomes are user error, communications, safety, and end-user preferences. ObjectiveThis study will assess whether the L-PAPR improves health care professionals’ comfort in terms of perceived workload and physical and psychological burden during direct patient care when compared with the traditional PAPR or N95 and face shield. This study also aims to evaluate human factors during the comparison of the use of L-PAPR with a combination of N95 respirators plus face shields or the traditional PAPRs. MethodsThis is an interventional randomized crossover quality improvement feasibility study consisting of a 3-site simulation phase with 10 participants per site and subsequent field testing in 2 sites with 30 participants at each site. The 3 types of respiratory PPE will be compared across medical tasks and while donning and doffing. We will evaluate the user’s perceived workload, usability, usage errors, and heart rate. We will conduct semistructured interviews to identify barriers and enablers to implementation across each PPE type over a single continuous wear episode and observe interpersonal communications across conditions and PPE types. ResultsWe expect the research may highlight communication challenges and differences in usability and convenience across PPE types along with error frequency during PPE use across PPE types, tasks, and time. ConclusionsThe design of PPE may affect overall well-being and hinder or facilitate clinical work. Combining 2 pieces of PPE into a single integrated item may improve usability and reduce occupational-acquired diseases. The human factors affecting the implementation of an alternative PPE such as L-PAPR or PAPR have not been thoroughly studied. International Registered Report Identifier (IRRID)PRR1-10.2196/3654