Life course path analysis of total and central adiposity throughout adolescence on adult blood pressure and insulin resistance

Background and aim: We aimed to study whether the effect of adolescent adiposity on adult blood pressure and insulin resistance was mediated by adult adiposity. Methods and results: Data from the EPITeen cohort at 13, 17 and 21 years was used (n = 2211). Sex- and age-specific body mass index z-scores (BMIz) and waist-to-hip ratio (WHR) were used as indicators of total and central adiposity, respectively. Systolic blood pressure (SBP), glucose and insulin were assessed at 21 years and the homeostasis model assessment (HOMA-IR) was used as a marker of insulin resistance. Path analysis was applied to evaluate direct and indirect effects of adiposity (13, 17 and 21y) on adult SBP and HOMA-IR, separately for total and central adiposity and for each outcome. Results are presented as standardized regression coefficients [β (95%CI)]. The total effect of BMIz at 13 years on SBP at 21 years was 0.211 (0.178; 0.244), totally mediated by adult BMIz. Total effect of BMIz 13y on HOMA-IR was 0.248 (0.196; 0.299). Although this effect was mostly mediated by BMIz 21y, an additional direct effect from BMIz 17y was found [β = −0.240 (−0.315; −0.164)]. Central adiposity was also positively associated with SBP and HOMA-IR at 21 years, and the effect of adolescent WHR was totally mediated by adult WHR for both outcomes. Conclusions: The effect of adolescent adiposity on adult SBP and HOMA-IR was mostly mediated by adult adiposity. However, for HOMA-IR an additional direct effect from total adiposity at 17 years was found.This study was supported by national funding from the Portuguese Foundation for Science and Technology (FCT) within the Epidemiology Research Unit e Institute of Public Health, University of Porto (UID/DTP/047507/2013). Individual grants to JA (SFRH/BD/78153/2011) and to SS (SFRH/BD/81123/2011) by the Portuguese Foundation for Science and Technology e FCT are gratefully acknowledged

Migrant and native women's perceptions of prenatal care communication quality: the role of host-country language proficiency

BackgroundDespite the potentially significant impact of women-prenatal care provider communication quality (WPCQ) on women's perinatal health, evidence on the determinants of those perceptions is still lacking, particularly among migrant women.MethodsWe aimed to examine the effect of women's host-country language proficiency on their perceived WPCQ. We analyzed the data of 1210 migrant and 1400 native women who gave birth at Portuguese public hospitals between 2017 and 2019 and participated in the baMBINO cohort study. Migrants' language proficiency was self-rated. Perceived WPCQ was measured as a composite score of 9 different aspects of self-reported communication quality and ranged from 0 (optimal) to 27.ResultsA high percentage of women (29%) rated communication quality as optimal. Zero-inflated regression models were fitted to estimate the association between language proficiency and perceived WPCQ. Women with full (aIRR 1.35; 95% CI 1.22,1.50), intermediate (aIRR 1.41; 95% CI 1.23,1.61), and limited (aIRR 1.72; 95% CI 1.45,2.05) language proficiencies were increasingly more likely to have lower WPCQ when compared to natives.ConclusionsFacilitating communication with migrant women experiencing language barriers in prenatal care could provide an important contribution to improving prenatal care quality and addressing potential subsequent disparities in perinatal health outcomes

Application of a Latent Transition Model to Estimate the Usual Prevalence of Dietary Patterns

Background: This study aims to derive habitual dietary patterns of the Portuguese adult population by applying two methodological approaches: a latent class model and a latent transition model. The novel application of the latent transition model allows us to determine the day-to-day variability of diet and to calculate the usual prevalence of dietary patterns. Methods: Participants are from the National Food, Nutrition and Physical Activity Survey of the Portuguese population, 2015-2016 (2029 women; 1820 men, aged >= 18 years). Diet was collected by two 24 h dietary recalls (8-15 days apart). Dietary patterns were derived by: (1) a latent class model using the arithmetic mean of food weigh intake, with concomitant variables (age and sex); (2) a latent transition model allowing the transition from one pattern to another, with the same concomitant variables. Results: Six dietary patterns were identified by a latent class model. By using a latent transition model, three dietary patterns were identified: "In-transition to Western" (higher red meat and alcohol intake; followed by middle-aged men), "Western" (higher meats/eggs and energy-dense foods intake; followed by younger men), and "Traditional-Healthier" (higher intake of fruit, vegetables and fish, characteristic of older women). Most individuals followed the same pattern on both days, but around 26% transited between "In-transition to Western" and "Western". The prevalence of the dietary patterns using a single recall day (40%, 27%, 33%, respectively) is different from the usual prevalence obtained by the latent transition probabilities (48%, 36%, 16%). Conclusion: Three dietary patterns, largely dependent on age and sex, were identified for the Portuguese adult population: "In-transition to Western" (48%), "Western" (36%), and "Traditional-Healthier" (16%), but 26% were transient between patterns. Dietary patterns are, in general, deviating from traditional habits

How the metabolic phenotype in adulthood is affected by long-lasting immunological trajectories since adolescence

A close relationship between immune and metabolic systems has been perceived in the recent past. We aimed to assess whether the immunological trajectories of circulating white blood cells (WBC) started in adolescence, affects the metabolic phenotype in adulthood. We used data from 1183 participants of the population-based EPITeen cohort, evaluated at 13, 17, 21, 24 and 27 years of age. The Immunological trajectories from 13 to 27 years old were identified by mixed-effects models, being their association with metabolic features at 27 years old measured by logistic regression. The Higher Inflammatory Activation trajectory (HIA trajectory) had the highest percentage of individuals with metabolic syndrome, while Lowest Levels of WBC trajectory (LLWBC trajectory) showed the lowest percentage. Participants with HIA trajectory had significantly higher triglycerides, waist circumference, serum uric acid and BMI. After adjustment for sex and sports practice and hs-CRP, the odds of having one or more metabolic features in adulthood was significantly lower in LLWBC trajectory. Individuals with immunological trajectories of WBC linked with a pattern of higher immune activation showed a less favorable metabolic profile, while those with the lowest levels of WBC were less likely to have metabolic risk factors in adulthood. © 2022, The Author(s).This study was financed by national funds through the Foundation for Science and Technology (Portuguese public agency that supports science, technology and innovation, in all scientific domains, under responsibility of the Ministry of Science, Technology and Higher Education), under the Project UIDB/04750/2020 and under the scientific Project PTDC/DTP-EPI/6506/2014 and the doctoral studentship PD/BD/149264/2019 (VC)

Immunological Trajectories of White Blood Cells from Adolescence to Adulthood: Description and Determinants

Background: The immune system gradually matures early in life in the face of internal and external stimuli. Whether the immune responses are lasting and stable during the course of life is still unclear. Methods: As part of the EPITeen cohort, 1183 adolescents were prospectively evaluated at the ages of 13, 17, 21, 24 and 27. Sociodemographic, behavioral and clinical data were collected by self- and face-to-face-administered questionnaires, along with a physical examination comprising anthropometric measurements and blood sample collections. Mixed-effects models were used to identify individual trajectories of white blood cells (WBC) and finite Gaussian mixture models were used to identify the clusters of individual trajectories. Results: Participants were allocated into six clusters based on the individual trajectories of WBC distribution. Higher Inflammatory Activation Cluster (11.4%) had the highest total WBC count and neutrophils percentage, as well as the lowest percentage of lymphocytes. These participants had significantly higher odds of being overweight [OR = 2.44, 95%CI:1.51-3.92]. Lowest Levels of WBC Cluster (24.1%) had the lowest total WBC count, being characterized by a higher participation on sports [OR = 1.54, 95%CI:1.12-2.13]. Highest Proportion of Eosinophils Cluster (20.1%) had the highest eosinophils percentage and the highest likelihood of having been diagnosed with a chronic disease [OR = 2.11, 95%CI:1.43-3.13], namely "asthma or allergies" [OR = 14.0 (1.73, 112.2]. Lowest Proportion of Eosinophils Cluster (29.1%) had the lowest percentage of eosinophils and basophils, as well as the highest lymphocyte proportion. Participants in the Undefined Cluster (13.8%) showed the highest percentage of monocytes and basophils and were also characterized by significant lower odds of having parents with 7-9 years of schooling [OR = 0.56, (0.32, 0.99]. Conclusions: In this study we identified distinct immunological trajectories of WBC from adolescence to adulthood that were associated with social, clinical and behavioral determinants. These results suggest that these immunological trajectories are defined early in life, being dependent on the exposures.This study was funded by FEDER through the Operational Programme Competitiveness and Internationalization and by national funding from the Foundation for Science and Technology—FCT (Portuguese Ministry of Science, Technology and Higher Education) (POCI-01-0145-FEDER-016829), under Unidade de Investigação em Epidemiologia—Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; Ref. info:eu-repo/grantAgreement/FCT/6817 - DCRRNI ID/UID/DTP/04750/2013/PT); and the individual PhD Grant to VC (PD/BD/149264/2019), co-funded by the FCT and the POPH/FSE Program

Association between parental and offspring BMI: results from EPACI Portugal 2012

Objective: To assess the longitudinal association between parental BMI and offspring's BMI, in EPACI Portugal 2012. Design: Longitudinal study with retrospective collection of children's anthropometry data since birth. Children's anthropometric data were gathered from individual child health bulletins, and parents' anthropometrics were self-reported. Children's and parents' BMI were classified according to WHO cut-offs. Linear mixed models with random intercept and slope for age were applied to quantify the association between parental BMI and children BMI Z-score (zBMI). Setting: EPACI Portugal 2012. Participants: Representative sample from the Portuguese population (n 2230) aged from 12 to 36 months. Results: 58·9 % of the fathers and 35·6 % of the mothers were overweight (OW) or obese. Prevalence of infants who were, at least, at risk of OW increased from 17·0 % to 30·3 % since birth to 12 months. About half of the mothers with pre-pregnancy OW and obesity (OB) gained gestational weight above the recommendations. The children from mothers with gestational weight gain (GWG) below the recommendations showed a -0·15 SD lower zBMI (95 % CI -0·23, -0·06) in early life, comparing with mothers within GWG recommendations. Children of obese mothers were more likely to present a higher zBMI (0·24 SD, 95 % CI 0·13, 0·35) throughout the first months of life. Conclusions: A high prevalence of OW and OB was observed in Portuguese young adults and toddlers. Mothers' pre-pregnancy BMI and insufficient GWG had a direct effect on offspring BMI. Early effective interventions are needed in order to prevent the transgenerational transmission of OB.EPACI Portugal 2012 was funded by Nutricia Early Life Nutrition. The work of M.N. was supported by FCT – Fundação para a Ciência e a Tecnologia through the PhD Grant SFRH/BD/89293/2012. This work was supported by National Funds from FCT through project UIDB/Multi/50016/2020. Nutricia Early Life Nutrition and FCT had no role in the article elaboration, as well as in its design or analysis

Políticas Públicas de Saúde no Brasil: Dos Problemas que Existem pela Falta de Compensação ao SUS e pelo SUS

Health is a fundamental social right that, to be optimized, needs the positive role of the State in order to ensure the quality of life and respect for human dignity. Will be demonstrated the problems that exist because of the lack of compensation to SUS and from SUS, where specific principles of SUS control will be addressed, the reimbursement procedure, the conflict between the health insurance providers about the compensation and the creation of a proposal of a compensation system as a solution. Thus, it is a matter that needs systematization and deepening, in which the main aim is to demonstrate the issues involving health plans, among them, the need for the regulatory agency to establish a compensation mechanism of credits and debits related to the reimbursement to SUS and from SUS. The theme of the proposed study will be based on the legislation (Law nº 9.656 from 1998, Law nº. 9,661, from January 28, 2000 - which created the National Health Agency and the Normative Resolutions), in Law nº 8.080, from September 19, 1990 (which implemented the SUS) and in cases decided by the Brazilian Courts.A saúde é um direito fundamental social que, para ser otimizado, precisa da atuação positiva do Estado, a fim de assegurar a qualidade de vida dos cidadãos e respeito à dignidade humana. Demonstrar-se-ão os problemas que existem pela falta de compensação ao SUS e pelo SUS, onde serão abordados os princípios específicos de controle do SUS, o procedimento do ressarcimento, o conflito entre as operadoras de plano de saúde quanto ao ressarcimento e a criação de um sistema de compensação como proposta de solução. Desse modo, trata-se de uma questão carecedora de sistematização e aprofundamento, em que o escopo principal é demonstrar as principais questões envolvendo planos de saúde, dentre elas, a necessidade da agência reguladora estabelecer um mecanismo de compensação dos créditos e débitos relacionados aos ressarcimentos para o SUS e pelo SUS. O estudo do tema ora proposto far-se-á com base na legislação (Lei n. 9.656 de 1998, Lei n. 9.661, de 28 de janeiro de 2000 – que criou a Agência Nacional de Saúde, bem como nas Resoluções Normativas), na Lei 8.080 de 19 de setembro de 1990 (que implantou o SUS) e nos casos decididos pelos Tribunais de Primeira ou Segunda Instâncias

DAS PRÁTICAS CONCORRENCIAIS ILÍCITAS: AS DIFERENÇAS ENTRE CONCORRÊNCIA DESLEAL E INFRAÇÃO À ORDEM ECONÔMICA

The differences between the violation of the economic order and unfair competition must be clarified on the basis of principles and peculiar regimes. The law rejects two forms of competition: unfair competition and the use of abuse of power. It will be realized that there are doubts about such concepts and it's the doctrine responsibility to clarify these issues, since the works of Economic Law and Business Law address the issue indirectly, without the deserved depth. It must be emphasized that unfair competition is suppressed in civil and criminal crops involving only the private interests of competing entrepreneurs; while competition involving abuse of power is also repressed in administrative harvest, compromises the free market structures and is called a violation of economic order. Unfair competition differs substantially from the violation of the economic order, particularly bearing in mind that the lesions produced by unfair competition does not reach other interests than those of businessman victim of malpractice.As diferenças entre infração à Ordem Econômica e concorrência desleal devem ser esclarecidas com base em princípios e regimes peculiares. O Direito repudia duas formas de concorrência: a concorrência desleal e a utilizada com o abuso de poder. Perceber-se-á que há dúvidas acerca de tais conceitos e compete à doutrina esclarecer tais questões, uma vez que as obras de Direito Econômico e Direito Empresarial tratam do assunto de forma incidental, sem a profundidade merecida. Há que ressaltar que a concorrência desleal é reprimida nas searas civil e penal envolvendo apenas os interesses particulares dos empresários concorrentes; enquanto a concorrência que envolve abuso de poder é reprimida também na seara administrativa, compromete as estruturas de livre mercado e é denominada de infração da Ordem Econômica. A concorrência desleal se diferencia substancialmente da infração da Ordem Econômica, principalmente levando-se em conta que as lesões produzidas pela concorrência desleal não alcançam outros interesses além dos do empresário vitimado pela prática irregular.

Interplay between intrinsic plasma rotation and magnetic island evolution in disruptive discharges

The behavior of the intrinsic toroidal rotation of the plasma column during the growth and eventualsaturation of m/n = 2/1 magnetic islands, triggered by programmed density rise, has been carefully investigatedin disruptive discharges in TCABR. The results show that, as the island starts to grow and rotate at aspeed larger than that of the plasma column, the angular frequency of the intrinsic toroidal rotation increasesand that of the island decreases, following the expectation of synchronization. As the island saturates at alarge size, just before a major disruption, the angular speed of the intrinsic rotation decreases quite rapidly,even though the island keeps still rotating at a reduced speed. This decrease of the toroidal rotation is quitereproducible and can be considered as an indicative of disruption

Relationship between dietary vitamin D and serum 25-hydroxyvitamin D levels in Portuguese adolescents

Objective: To understand the relationship between vitamin D intake and serum 25-hydroxyvitamin D (25(OH)D) levels in a sample of Portuguese adolescents. Design: Cross-sectional evaluation carried out in the 2003/2004 school year. Vitamin D intake was assessed by an FFQ and 25(OH)D was measured in a fasting blood sample. Setting: Public and private schools in Porto, Portugal. Subjects: Adolescents aged 13 years (n 521) enrolled at school (EPITeen cohort). Results: Both mean (sd) intake and serum 25(OH)D level were far below the recommended, 4·47 (2·49) µg/d and 16·5 (5·7) ng/ml, respectively. A significant difference in serum level was found according to season, with lower values in winter than summer (14·8 (4·6) v. 17·3 (5·9) ng/ml, P<0·001). Vitamin D intake was weakly correlated with serum 25(OH)D (r=0·056, P=0·203). Conclusions: Dietary vitamin D and serum 25(OH)D levels were positively but weakly correlated and the error was higher among those with higher serum 25(OH)D concentration. Our results support the need for strategies that promote increase of the most important food sources of vitamin D to reduce the high prevalence of low vitamin D status