Imagem corporal e excesso de peso em adolescentes

Tese de mestrado. Biologia (Biologia Humana e Ambiente). Universidade de Lisboa, Faculdade de Ciências, 2010Em Portugal, têm vindo a aumentar a incidência e a prevalência da pré-obesidade e da obesidade, constituindo um importante problema de saúde pública. Esta situação está não só relacionada com padrões de comportamento alimentar caracterizados por elevado consumo de calorias (açúcares e gorduras) e por dietas cada vez menos ricas em cereais completos, hortaliças e frutos, mas também por reduzidos níveis de actividade física. A adolescência é uma etapa do desenvolvimento humano caracterizada por profundas transformações físicas, psicológicas e sociais e marcada pela aceleração de crescimento e, consequentemente, pelo aumento das necessidades de energia e, em geral, de todos os nutrientes. O elevado grau de insatisfação com a imagem corporal que caracteriza a população adolescente obesa e com excesso de peso, associado a um potencial isolamento social, poderá influenciar negativamente e de um modo determinante o seu desenvolvimento. O presente estudo é exploratório e o objectivo foi verificar de que modo a imagem corporal e o padrão alimentar dos adolescentes variam em função dos grupos de pertença (sexo e idade) e índice de massa corporal. Para tal, a nossa amostra foi constituída por 290 adolescentes de ambos os sexos com idades compreendidas entre os 14 anos e os 19 anos, matriculados no ano lectivo 2009/2010, estudantes do 3º ciclo do ensino básico e secundário de Escolas do concelho do Montijo. Os dados foram recolhidos através de um questionário de frequência alimentar, de uma Escala de Estima Corporal e um Inventário de Esquemas de Aparência. Os estudantes foram medidos e pesados e calculado o seu Índice de Massa Corporal, de acordo com as regras internacionais. Na análise dos dados, foram utilizadas as Análises de Componentes Principais para descrever a estrutura factorial das escalas utilizadas e realizaram-se várias análises de variância. Em termos de resultados, a pré-obesidade/obesidade associou-se positivamente com o Álcool, Fast-food, Bebidas saudáveis, Diet, Vulnerabilidade da Imagem Corporal, e com as Crenças e Estereótipos de Aparência Física. E associou-se negativamente com as dimensões Gorduras, Leites, Satisfação com o Corpo e com a Sexualidade. Salientou-se a necessidade de agir directamente sobre o ambiente, eventualmente através de regulamentos que definam as porções e o tipo de alimentos que podem ser consumidos. Os adolescentes com pré-obesidade e obesidade mostraram mais frequentemente insatisfação com a sua imagem corporal e sexualidade, e revelaram maior vulnerabilidade em relação à sua aparência, o que exige programas de prevenção que incluam questões relacionadas com a promoção da saúde, incluindo a satisfação com o corpo, a socialização, o estilo de vida e alimentação.In Portugal, the incidence and prevalence of both pre-obesity and obesity are increasing, representing a major public health problem. This situation is not only connected to eating behavior patterns, characterized by a high calorie intake (sugars and fat) and by diets that are low in whole cereals, green vegetables and fruit, but also to reduced physical activity levels. Adolescence is a stage of human development characterized by profound physical, psychological and social transformations and marked by an accelerated growth, accompanied consequently by an increase in energy needs and all nutrients in general. The overweight and obese adolescent population is prone to body image dissatisfaction, associated with a potential social isolation, which may in turn negatively and in a determinant way influence their development. The present study is exploratory and its objective was to assess how adolescent’s body image and eating patterns vary with gender and age and with body mass index. To this end, our sample consisted of 290 adolescents of both genders aged between 14 and 19 years-old enrolled in the 2009/2010 academic year, students in the 3rd cycle of primary and secondary schools of Montijo. Data were collected through a food frequency questionnaire, a Body Esteem Scale and an Appearance Schemas Inventory. Students were weighed and measured and their body mass index was calculated according to international rules. In data analysis, we used the Principal Component Analysis to describe the factorial structure of scales and Variance Analysis. Our results indicate that pre-obesity and obesity was: positively associated with Alcohol, Fast-food, Healthy beverages, Diet, Body Image Vulnerability, and the Beliefs and Stereotypes of Physical Appearance, and was negatively associated with dimensions Fats, Milks, Satisfaction with Body and with Sexuality. Therefore, we need to act directly on the environment, possibly through regulations which define the portions and types of foods that can be consumed. Adolescents with pre-obesity and obesity demonstrate more often dissatisfaction with their body image and sexuality, and showed greater vulnerability in relation to their appearance, which calls for prevention programs that contain issues related to health promotion, including satisfaction with body, socialization, lifestyle and food diet

The Technology and Innovation Unit of the National Institute of Health: A sequencing and bioinformatics core facility specializing in public health genomics

The National Institute of Health (INSA) has a long tradition in investigating the molecular etiology of genetic and complex diseases. These activities greatly benefit from centralized sequencing services provided by the Technology and Innovation Unit (UTI). Its mission is to perform sequencing and genotyping assays in the framework of research, diagnosis and epidemiological surveillance, as well as to implement data analysis pipelines for the study of human gene variants. The equipment portfolio includes a NextSeq 550, a MiSeq, two 3500 AB Genetic Analyzers, a Fragment Analyzer and a 7500 Real-time PCR system. UTI provides results for average of 36.000 sequencing/fragment samples per year. The team has already performed >300 small genome, amplicon, gene panel (including clinical exome), 16S rRNA gene and RNA/microRNA next-generation sequencing assays for INSA and for several Universities in the scope of scientific collaborations. Technical procedures are conducted under a quality control system that includes external quality assessment for next-generation sequencing/Sanger sequencing and ISO 15189 accreditation for Sanger sequencing. UTI plays a key role in public health genomics, providing state-of-the-art equipment, centralized resources, technical expertise and short response times.This work was supported by Centre for Toxicogenomics and Human Health - UID/BIM/00009/2019 - and GenomePT project – POCI-01-0145-FEDER-022184info:eu-repo/semantics/publishedVersio

QnrS1- and Aac(6')-Ib-cr-Producing Escherichia coli among Isolates from Animals of Different Sources: Susceptibility and Genomic Characterization

Salmonella enterica and Escherichia coli can inhabit humans and animals from multiple origins. These bacteria are often associated with gastroenteritis in animals, being a frequent cause of resistant zoonotic infections. In fact, bacteria from animals can be transmitted to humans through the food chain and direct contact. In this study, we aimed to assess the antibiotic susceptibility of a collection of S. enterica and E. coli recovered from animals of different sources, performing a genomic comparison of the plasmid-mediated quinolone resistance (PMQR)-producing isolates detected. Antibiotic susceptibility testing revealed a high number of non-wild-type isolates for fluoroquinolones among S. enterica recovered from poultry isolates. In turn, the frequency of non-wild-type E. coli to nalidixic acid and ciprofloxacin was higher in food-producing animals than in companion or zoo animals. Globally, we detected two qnrS1 and two aac(6')-Ib-cr in E. coli isolates recovered from animals of different origins. The genomic characterization of QnrS1-producing E. coli showed high genomic similarity (O86:H12 and ST2297), although they have been recovered from a healthy turtle dove from a Zoo Park, and from a dog showing symptoms of infection. The qnrS1 gene was encoded in a IncN plasmid, also carrying bla TEM-1-containing Tn3. Isolates harboring aac(6')-Ib-cr were detected in two captive bottlenose dolphins, within a time span of two years. The additional antibiotic resistance genes of the two aac(6')-Ib-cr-positive isolates (bla OXA-1, bla TEM-1,bla CTX-M-15, catB3, aac(3)-IIa, and tetA) were enclosed in IncFIA plasmids that differed in a single transposase and 60 single nucleotide variants. The isolates could be assigned to the same genetic sublineage-ST131 fimH30-Rx (O25:H4), confirming clonal spread. PMQR-producing isolates were associated with symptomatic and asymptomatic hosts, which highlight the aptitude of E. coli to act as silent vehicles, allowing the accumulation of antibiotic resistance genes, mobile genetic elements and other relevant pathogenicity determinants. Continuous monitoring of health and sick animals toward the presence of PMQR should be strongly encouraged in order to restrain the clonal spread of these antibiotic resistant strains.These work was supported by Fundação para a Ciência e a Tecnologia (grant numbers PTDC/CVT/65713 and PEst-OE/AGR/UI0211/2011-2014).info:eu-repo/semantics/publishedVersio

Salmonella Enteritidis Isolate Harboring Multiple Efflux Pumps and Pathogenicity Factors, Shows Absence of O Antigen Polymerase Gene.

BACKGROUND: Salmonella enterica is one of the most important causes of gastrointestinal infection in humans, being the great majority of infections related to the consumption of poultry meat and eggs (Foley and Lynne, 2008; EFSA/ECDC, 2015). In animals, infections caused by serotype Enteritidis are rarely responsible for severe disease with animals frequently becoming asymptomatic carriers, except in the case of young chicks and poults, where outbreaks exhibiting clinical disease are often accompanied by high mortality rates (Foley et al., 2008, 2013). Indeed, S. enterica subsp. enterica serovar Enteritidis (S. Enteritidis) has been responsible for severe disease in industrial poultry farming facilities worldwide, posing a potential hazard for public health (Lutful Kabir, 2010). In order to be infectious, Salmonella needs to adapt to different niches and conditions, where virulence and heavy-metal-tolerance factors play an important role, through co-selection events and the formation of pathogenicity islands, respectively (Hensel, 2004; Medardus et al., 2014). Furthermore, antibiotic resistance determinants can also facilitate their survival, with ubiquitous chromosomally encoded efflux mechanisms, playing an important role in both intrinsic, and acquired multidrug resistance. Other resistance mechanisms, such as changes in the membrane permeability, enzymatic modification, and target alterations may increase the levels of bacterial resistance, contributing to the success of the infection (Poole, 2004; Delmar et al., 2014; Li et al., 2015). Both antibiotic susceptibility determination and serotyping constitute very useful tools for the epidemiologic classification of S. enterica isolates. Indeed, in S. enterica, the resistance rates fluctuate according to the serotype and with the antibiotic (Clemente et al., 2015). Classically, serotyping is based on the antigenic reactivity of lipolysaccharide (O antigen) and flagellar proteins (H antigen), followed by a designation using names or formulas (Grimont and Weill, 2007). In this study, we aimed to analyze the genome of a S. Enteritidis isolate responsible for omphalitis in chicks, exploring the molecular features associated with antibiotic resistance and pathogenicity, as well as the ability to spread the respective determinants.DJ has received research funding from Fundação para a Ciência e a Tecnologia (FCT, grant number SFRH/BD/80001/2011). VM was supported by FCT fellowship (grant SFRH/BPD/77486/2011), financed by the European Social Funds (COMPETE-FEDER) and national funds of the Portuguese Ministry of Education and Science (POPH-QREN). We thank the support of FCT grant number PEst-OE/AGR/UI0211/2011-2014 and UID/MULTI/00211/2013.info:eu-repo/semantics/publishedVersio

Molecular epidemiology of aspergillosis in Magellanic penguins and susceptibility patterns of clinical isolates

Aspergillus section Fumigati is reported in up to 99% of aspergillosis cases in penguins. So far, no data regarding molecular epidemiology and azole resistance are available for A. fumigatus isolates collected from Magellanic penguins. The aim of this work was to perform molecular identification of Aspergillus section Fumigati at species level, to genotype those isolates using microsatellite markers, to evaluate the in vitro susceptibility patterns of A. fumigatus sensu stricto, and to characterize the cyp51A gene in clinical A. fumigatus strains isolated from Magellanic penguins with proven aspergillosis. All 34 isolates included in the study were identified as A. fumigatus sensu stricto. Analyzing the genetic diversity of the isolates of A. fumigatus sensu stricto, we identified two possible outbreaks in the rehabilitation center and we also observed the maintenance of clonal strains through the years. One A. fumigatus sensu stricto isolate was resistant to posaconazole, but the mutations found in the cyp51A gene of this isolate have not been described as conferring phenotypic resistance, suggesting that other mechanisms of resistance could be involved in the resistance of this isolate. With this study, we were able to understand the molecular diversity of Aspergillus fumigatus isolates collected from Magellanic penguins, to characterize them and to associate them with the described global population of Aspergillus fumigatus.Plain Language Summary: A. fumigatus sensu stricto is of great importance in penguins’ aspergillosis. We could identify two outbreaks in the rehabilitation center and the maintenance of clonal strains through the years. Regarding antifungal prophylaxis, it may proceed, but preferably with surveillance for azole resistance.This study was supported by the International Cooperation Program financed by the Brazilian Federal Agency for Support and Evaluation of Graduate Education within the Ministry of Education of Brazil (CAPES), under the PDSE Program - Finance Code 001.info:eu-repo/semantics/publishedVersio

Draft genomic analysis of an avian multidrug resistant Morganella morganii isolate carrying qnrD1

Morganella morganii is a commensal bacterium and opportunistic pathogen often present in the gut of humans and animals. We report the 4.3Mbp draft genome sequence of a M. morganii isolated in association with an Escherichia coli from broilers in Portugal that showed macroscopic lesions consistent with coliseptisemia. The analysis of the genome matched the multidrug resistance phenotype and enabled the identification of several clinically important and potentially mobile acquired antibiotic resistance genes, including the plasmid-mediated quinolone resistance determinant qnrD1. Mobile genetic elements, prophages and pathogenicity factors were also detected, improving our understanding towards this human and animal opportunistic pathogen

Development and testing of microsatellite loci for the study of population genetics of Ixodes ricinus Linnaeus, 1758 and Ixodes inopinatus Estrada-Peña, Nava and Petney, 2014 (Acari: Ixodidae) in the western Mediterranean region

International audienceIxodes ricinus is an important vector of several human and veterinary infectious agents. Its wide geographical distribution and permissive feeding behaviour have prompted earlier studies on its population genetics. Results were, nevertheless, not conclusive. Furthermore, no research has fully focused on the south-western distribution range of I. ricinus, where exchanges between European and North African populations are more likely to occur. The presence of an additional species, Ixodes inopinatus, in the area further confuses the topic, as the two species are hard to differentiate morphologically. The present work describes the testing of microsatellite markers previously described for I. ricinus using Portuguese and Tunisian tick populations of both species. In addition, new microsatellite loci were developed to complement the available marker toolbox. Loci showed different amplification successes across subpopulations, with Tunisian DNA less readily amplified. Altogether, 15 loci were considered suitable for genetic analyses of Portuguese subpopulations, 10 for Tunisian samples, and seven, common to both populations, were considered to be informative at the inter-continental level. A preliminary analysis of both datasets revealed two isolated populations, which can correspond to two different species. Furthermore, Tunisian specimens identified by sequencing of 16S rDNA as having I. ricinus or I. inopinatus sequence profiles all clustered together in one single population using the proposed microsatellites. This confirms that taxonomic decisions based only on 16S rRNA gene sequencing can be misleading. The application of the proposed set of microsatellite markers to a larger sample, representative of the south-western Ixodes’ distribution range, will be crucial to clarify the distribution of both species

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research