Nutrition and malnutrition in kidney transplant recipients

Kidney transplantation is the preferred treatment for end-stage kidney disease, offering better quality of life and life-expectancy compared to dialysis. Nevertheless, life expectancy remains considerably lower compared to the general population. Nutrition is increasingly being recognized as an actionable risk-factor for the prevention and management of chronic diseases and we explored whether nutritional factors could serve as potentially modifiable risk-factors after kidney transplantation. We investigated the associations between dietary intake of marine-derived omega-3 fatty acids, fruit and vegetable intake, adherence to healthy dietary patterns such as the DASH- and Mediterranean diet and nutritional status with long-term outcomes after kidney transplantation. A higher intake of marine-derived omega-3 fatty acids and high vegetable intake were associated with lower mortality risk after kidney transplantation. Moreover, higher vegetable consumption was associated with a lower risk for development of diabetes after kidney transplantation, notwithstanding the use of diabetogenic medication, i.e steroids. Also, adherence to healthy dietary patterns such as the DASH- and Mediterranean diet was beneficial, as apparent from a lower risk for kidney function decline and graft failure after transplantation. Moreover, 1 out of 10 outpatient kidney transplant recipients were malnourished and that quality of life and life-expectancy was significantly worse in these patients, further underlining the importance of nutrition after kidney transplantation. In conclusion, evaluation of nutrition data revealed multiple targets for intervention, some hitherto unexpected, that can improve outcome in kidney transplant recipients. Monitoring of nutrition and nutritional status should become part of routine care after kidney transplantation, to guide better nutrition counseling, and eventually, better outcomes

Deteção e extinção de incêndios em Data Centers

São muitas as organizações que por todo o mundo possuem instalações deste tipo, em Portugal temos o exemplo da Portugal Telecom que recentemente inaugurou o seu Data Center na Covilhã. O desenvolvimento de um Data Center exige assim um projeto muito cuidado, o qual entre outros aspetos deverá garantir a segurança da informação e das próprias instalações, nomeadamente no que se refere à segurança contra incêndio

Reptos à Prática Docente - o Uso das TIC no Processo de Aprendizagem de Alunos com Necessidades Educativas Especiais

116 f.Este trabalho de investigação-acção teve como principal preocupação aferir em que medida as TIC podem contribuir no processo ensino-aprendizagem das crianças com Necessidades Educativas Especiais (NEE), bem como contribuir para uma nova prática educativa dos docentes envolvidos em contextos educativos que exigem pedagogias diferenciadas no trabalho com crianças com NEE. Partiu-se de uma investigação aprofundada sobre características inerentes às NEE, nomeadamente as de comunicação, de modo a conhecer de forma aprofundada quais as características das crianças portadoras de dificuldades de aprendizagem de carácter permanente. Procurou-se conhecer a legislação nacional, decreto-lei n.º3/2008, bem como referências de âmbito internacional, Declaração de Salamanca. Investigou-se também informação pertinente e actualizada sobre as TIC e a inclusão de crianças com NEE, nomeadamente através da consulta de relatórios da OCDE. De modo a conhecer melhor a sensibilidade dos docentes na utilização das TIC em contextos de aprendizagem, designadamente de crianças com NEE, procedeu-se à elaboração de um inquérito, tendo os resultados auferidos sido alvo de tratamento e análise. Perante os resultados obtidos e tiradas as respectivas conclusões, achou-se por bem elaborar um Projecto Educativo de Acção e Intervenção, onde se alude à problemática e sua contextualização, se apontam objectivos a seguir, metodologias de acção e intervenção, recursos humanos e materiais necessários, bem como a avaliação do projecto. Como forma de motivar os docentes para a inclusão das TIC nas aprendizagens dos alunos com NEE, procedeu-se à construção de um e-Portefólio de recursos educativos, disponível em http://www.esepf.pt/~p2007279/. De igual forma e visando a troca e a partilha de experiências educativas nesta área, concebeu-se um blogue, disponível em http://faz-secaminhocaminhando.blogspot.com

Perceção dos consumidores sobre as características sensoriais do queijo de Cabra Transmontano de cura extra longa

Este trabalho baseia -se nos dados de um inquérito às preferências de consumo de queijo de cabra transmontana. O estudo teve como objetivos: identificar o perfil do consumidor, os seus hábitos de consumo de queijo e comparar a perceção dos consumidores face às características de queijos com diferentes tempos de cura (2, 7 e 12 meses). Para isso, desenvolveu -se um estudo baseado numa amostra de 157 consumidores que se deslocaram a um supermercado de Bragança nos dias 28 e 29 de maio de 2015. Para proceder à recolha de dados foi utilizado um questionário com questões acerca das características do consumidor, da frequência do consumo de queijo e das perceções sensoriais por parte dos consumidores (aspecto, aroma, sabor, perceção de teor de gordura, dureza, perceção de teor de sal) dos queijos. A maioria dos participantes consumia queijo mais de uma vez por semana, era do género masculino, tinha idade compreendida entre 25 e 64 anos, era casado, vivia em agregados familiares com duas pessoas e o rendimento líquido mensal do agregado familiar situava -se entre 1001 e 3000 €. Os resultados globais permitiram identificar diferenças, ao nível de significância de 1%, em todas as características consideradas com exceção da perceção do teor de sal. Relativamente ao aspecto, aroma, sabor, avaliação global e intenção de compra, o queijo com dois meses de cura foi o preferido. Os consumidores percecionaram um teor de gordura mais elevado no queijo com sete meses de cura. Finalmente, o queijo com 12 meses de cura foi considerado o mais duro. Verificou -se, ainda, que quando tido em consideração o género, a idade e a frequência do consumo, as diferenças foram encontradas no grupo dos indivíduos do género feminino, com idade entre 25 e 64 anos e que consumiam queijo mais frequentemente.This research is based on data from a survey about consumers’ preferences on consumption of Transmontano goat cheese. The study aimed to identify the consumer profile and cheese consumption habits, and to compare the characteristics of cheeses with different maturations (2, 7 and 12 months). To achieve these goals it was developed a study based on a sample of 157 consumers who went to a supermarket located in Bragança on 28th and 29th May 2015. To collect the data, it was used a questionnaire with questions about the consumer characteristics, the frequency of the cheese consumption and sensorial characteristics perceived by consumers (appearance, aroma, taste, perception of fat content, hardness, perception of salt content) of the cheeses. Most participants consumed cheese more than once a week, were males, aged between 17 and 86 years, were married, lived in households with two people and the monthly net income of the household was between 1001 and 3000 €. The results showed differences, at a significance level of 1%, in all the characteristics considered except for the perception of the salt content. Regarding the appearance, smell, taste, overall evaluation and purchase intention, cheese with two months of maturation was preferred. Consumers perceived a higher fat content in cheese with seven months of maturation. Finally, the cheese with 12 months of maturation was considered the hardest. Also, it was verified that when gender, age and consumption frequency were taken into account, the differences were found in the group of female subjects aged 25 -64 years who consumed cheese more frequently.Este trabalho foi financiado por: Fundos Europeus Estruturais e de Investimento, na sua componente FEDER, através do Programa Operacional Competitividade e Internacionalização (COMPETE 2020) [Projeto n.º 006971 (UID/SOC/04011)]; e por Fundos Nacionais através da FCT – Fundação para a Ciência e a Tecnologia, no âmbito do projeto UID/SOC/04011/2013.info:eu-repo/semantics/publishedVersio

Exploratory study on the sensory characteristics of the transmontano goat extra long maturation cheese: the perception of consumers in the Bragança region, Portugal

O estudo teve como objetivos: identificar o perfil do consumidor de queijo de cabra transmontano, os seus hábitos de consumo, e comparar as características de três queijos com diferentes tempos de cura (2, 7 e 12 meses). Para atingir estes objetivos desenvolveu-se um estudo exploratório baseado numa amostra aleatória de 157 consumidores que se deslocaram a um supermercado de Bragança nos dias 28 e 29 de maio de 2015. Para proceder à recolha de dados foi utilizado um questionário com questões acerca das características do consumidor, da frequência do consumo de queijo e das características sensoriais (aspeto, aroma, sabor, teor de gordura, textura ou dureza, teor de sal) dos três queijos. Os dados recolhidos foram tratados no SPSS 22.0 com recurso ao uso da estatística descritiva com o objetivo de caracterizar a amostra e, consequentemente, definir o perfil do consumidor. Utilizou-se, ainda, o teste de Friedman para verificar se existiam diferenças, estatisticamente, significativas entre os três queijos com diferentes tempos de cura. A maioria dos participantes consome queijo mais de uma vez por semana (86,5%), era do género masculino (51,6%); tinha idades compreendidas entre 25 e 64 anos (67,9%); era casado (53,0%; vivia em agregados familiares com duas pessoas (30,3%); e, o rendimento líquido do agregado familiar situava-se entre 1001 a 3000 € (30,3%). Os resultados permitiram identificar diferenças com significância de 1% em todas as características consideradas com exceção do teor de sal. Relativamente ao aspeto, aroma e sabor, o queijo com menos tempo de cura foi o preferido, razão pela qual a avaliação global deste queijo tenha sido melhor. Por essa razão, a intenção de compra vai, naturalmente, para o queijo com menos tempo de cura. Relativamente à textura ou dureza, é o queijo com mais cura que, na opinião dos consumidores, é o mais duro.The study aimed to identify the profile of transmontano goat cheese consumer’s, their consumption habits, and to compare the characteristics of three cheeses with different maturations (2, 7 and 12 months). To achieve these goals it was developed an exploratory study based on a random sample of 157 consumers who went to Intermarché supermarket located in Bragança on 28th and 29th May 2015. To collect the data it was used a questionnaire with questions about the consumer characteristics, the frequency of the consumption of cheese and sensory characteristics (appearance, aroma, taste, fat, texture or hardness, salt) of the three cheeses. The collected data were analyzed using the SPSS 22.0 in order to compute descriptive statistics to characterize the sample and thus set the consumer’s profile. Also, it was used the Friedman test in order to verify the existence of statistically significant differences between the three cheeses with different maturations. Most participants consumed cheese more than once per week (86.5%); were male (51.6%); had ages between 25 and 64 years old (67,9%). Most respondents was married (53.0%); lived in households with two people (30.3%); and, the net household income was between 1001 and 3000 € (30.3%). The results showed significant differences at a significance level of 1% on all characteristics considered except for the salt content. Regarding the appearance, aroma and taste, the cheese with less maturation was the favorite. In fact, the overall evaluation of this cheese has been better than the others. For this reason, the purchase intention will go to the cheese with 2 moths of maturation. With regard to texture or hardness, the cheese with 12 months was, in the opinion of consumers, the hardest.Este trabalho é financiado por: Fundos Europeus Estruturais e de Investimento, na sua componente FEDER, através do Programa Operacional Competitividade e Internacionalização (COMPETE 2020) [Projeto nº 006971 (UID/SOC/04011)]; e por Fundos Nacionais através da FCT – Fundação para a Ciência e a Tecnologia, no âmbito do projeto UID/SOC/04011/2013.info:eu-repo/semantics/publishedVersio

Arthroscopic-Assisted Acromioclavicular Joint Dislocation Repair: A Modified Technique for Horizontal Stabilization Using Suture Anchors

Acromioclavicular (AC) dislocation is a common lesion often resulting from a sports injury. Nowadays, treatment is still controversial mainly in grade III lesions according to the Rockwood classification. For most surgically treated AC acute dislocations, treatment is performed with an arthroscopic procedure that anatomically reconstructs the coracoclavicular ligaments. Increasing knowledge about AC joint biomechanics has underlined the importance of its horizontal stability through the superior and inferior AC ligaments. Moreover, the pattern of lesion tends to repeat itself, with the superior AC ligament being torn most frequently from the clavicular side in a peeling fashion. Therefore, the purpose of this note is to describe the technical aspects of additional horizontal stability through superior AC ligament repair using suture anchors.info:eu-repo/semantics/publishedVersio

Members’ segmentation, service quality and behabioral intentions: a case study of a professional football team

This study aims to identify segments of members in a professional football team, and to compare service quality perceptions and behavioral intentions among these segments. The members registered in the club’s database were invited to complete a survey including demographic questions, measures of consumer behavior, service quality, and behavioral intentions. The results from a sample of 6820 participants allowed the identification of three distinct segments, named as ‘Occasional’, ‘Die-hard’, and ‘Weekend Lovers’. Results also indicate that these three segments of members showed statistically significant differences regarding service quality perceptions and behavioral intentions. Managerial implications of these results are discussed and suggestions for future research are provided.Este estudo teve como objetivos identificar diferentes segmentos de sócios de uma equipa de profissional de futebol e comparar a perceção da qualidade do serviço e as intenções comportamentais entre os segmentos. Os sócios registados na base de dados do clube foram convidados a responder a um questionário que incluía questões demográficas, variáveis de comportamento de consumo, qualidade do serviço e intenções comportamentais. Os resultados obtidos através de uma amostra de 6820 sócios permitiram identificar três segmentos distintos de sócios denominados por ‘Ocasionais’, ‘Fanáticos’ e ‘Domingueiros’. Os resultados indicaram ainda que os três segmentos de sócios apresentam diferenças estatisticamente significativas em relação à perceção da qualidade do serviço e intenções comportamentais. Implicações de gestão destes resultados são discutidas e sugestões para futuras pesquisas são apresentadas

Food Literacy Is Associated With Adherence to a Mediterranean-Style Diet in Kidney Transplant Recipients

Objectives Adherence to a Mediterranean-style diet is associated with improved health outcomes in kidney transplant recipients (KTR). However, poor dietary habits, including excessive sodium intake, are common in KTR, indicating difficulties with incorporating a healthy diet into daily life. Food literacy is identified as potential facilitator of a healthy diet, but the precise relationship between food literacy and dietary intake in KTR has not been investigated. This study examined food literacy levels in KTR and its association with adherence to a Mediterranean-style diet and sodium intake. Methods This cross-sectional study is part of the TransplantLines Cohort and Biobank Study. Food literacy was measured with the Self-Perceived Food Literacy (SPFL) questionnaire. Dietary intake assessment with food frequency questionnaires was used to calculate the Mediterranean Diet Score. Sodium intake was based on the 24-hour urinary sodium excretion rate. Associations of SPFL with Mediterranean Diet Score and sodium intake were assessed with univariable and multivariable linear regression analyses. Results In total, 148 KTR (age 56 [48-66]; 56% male) completed the SPFL questionnaire with a mean SPFL score of 3.63 ± 0.44. Higher SPFL was associated with a higher Mediterranean Diet Score in KTR (β = 1.51, 95% confidence interval 0.88-2.12, P ≤ .001). Although KTR with higher food literacy tended to have a lower sodium intake than those with lower food literacy (P = .08), the association of food literacy with sodium intake was not significant in a multivariable regression analysis (β = 0.52 per 10 mmol/24-hour increment, 95% confidence interval −1.79 to 2.83, P = .66). Conclusions Higher levels of food literacy are associated with better adherence to a Mediterranean-style diet in KTR. No association between food literacy and sodium intake was found. Further studies are needed to determine if interventions on improving food literacy contribute to a healthier diet and better long-term outcomes in KTR

Association of time-updated plasma calcium and phosphate with graft and patient outcomes after kidney transplantation

Disturbances in calcium-phosphate homeostasis are common after kidney transplantation. We aimed to assess the relationship between deregulations in plasma calcium and phosphate over time and mortality and death-censored graft failure (DCGF). In this prospective cohort study we included kidney transplant recipients with ≥2 plasma calcium and phosphate measurements. Data were analyzed using time-updated Cox regression analyses adjusted for potential confounders including time-updated kidney function. We included 2,769 patients (mean age 47±14 years, 42.3% female) with 138,496 plasma calcium and phosphate levels (median [IQR] 43 [31-61] measurements per patient). During follow-up of 16.3 [8.7-25.2] years, 17.2% developed DCGF and 7.9% died. Post-transplant hypercalcemia was associated with an increased risk of mortality (1.63 [1.31-2.00], P<0.0001), but not DCGF. Hyperphosphatemia was associated with both DCGF (2.59 [2.05-3.27], P<0.0001) and mortality (3.14 [2.58-3.82], P<0.0001). Only the association between hypercalcemia and mortality remained significant in sensitivity analyses censored by a simultaneous eGFR <45 mL/min/1.73 m2 . Hypocalcemia and hypophosphatemia were not consistently associated with either outcome. Post-transplant hypercalcemia, even in the presence of preserved kidney function, was associated with an increased mortality risk. Associations of hyperphosphatemia with DCGF and mortality may be driven by eGFR