ENRICHED CEREAL BAR WITH RAY MEAT Hypanus guttatus (DASYATIDAE – MYLIOBATIFORMES) CAPTURED ON MARANHÃO STATE COASTAL

Rays are world-class fish stocks, predominantly marine and tropical. The Hypanus guttatus ray, commonly known as a stingray and is one of the most caught species of elasmobranchs on our coast, however, most catches are seen as companion fauna. The objective of this work was to develop formulations for cereal bar innovations with the use of Hypanus guttatus ray meat to incorporate fish protein in a differentiated way in human food. Two types of cereal bars were prepared, one with granola [WG] and another no granola [NG], both enriched with ray pulp. Analyzes of centesimal composition (lipids, carbohydrates, ashes and proteins) were also performed. The cereal bar enriched with ray meat presented high protein (10.21 and 6.71%), low lipid content (2.57 and 3.02%) and was well accepted by the sensory panel, which included judges Aged between 18 and 57 years, with the granola treatment receiving an acceptance of 54.84% and no granola 45,16%. There are diversified ingredients in these bars and contain functional properties that make them ideal to be consumed as a daily snack. Rays are world-class fish stocks, predominantly marine and tropical. The Hypanus guttatus ray, commonly known as a stingray and is one of the most caught species of elasmobranchs on our coast, however, most catches are seen as companion fauna. The objective of this work was to develop formulations for cereal bar innovations with the use of Hypanus guttatus ray meat to incorporate fish protein in a differentiated way in human food. Two types of cereal bars were prepared, one with granola [WG] and another no granola [NG], both enriched with ray pulp. Analyzes of centesimal composition (lipids, carbohydrates, ashes and proteins) were also performed. The cereal bar enriched with ray meat presented high protein (10.21 and 6.71%), low lipid content (2.57 and 3.02%) and was well accepted by the sensory panel, which included judges Aged between 18 and 57 years, with the granola treatment receiving an acceptance of 54.84% and no granola 45,16%. There are diversified ingredients in these bars and contain functional properties that make them ideal to be consumed as a daily snack.

Principais complicações gestacionais e obstétricas em adolescentes/ Main gestational and obstetric complications in adolescents

A adolescência é a fase que se inicia as principais mudanças físicas. Iniciar a vida sexual nem sempre é uma decisão consciente em que se é avaliado seus riscos e consequências. A gravidez pode acarretar prejuízos aos recém-nascidos. Identificar as principais complicações gestacionais e obstétricas em adolescentes. Trata-se de um estudo retrospectivo, descritivo exploratório de natureza quantitativa por meio de pesquisa em 230 prontuários. As principais complicações foram infecção urinaria com 15%, ruptura prematura de membranas 8,33%, parto prematuro 5%, e as obstétricas foram hemorragia com 2,5%, sendo que 90% não apresentaram complicações obstétricas e 50 % não obtiveram complicações gestacionais. As complicações que foram mais evidenciadas foram ITU e a hemorragia representam os principais riscos para este grupo

INCIDÊNCIA DE CONSUMO DE BEBIDA ALCOÓLICA ENTRE AS VÍTIMAS DE SUICÍDIO NO DISTRITO FEDERAL

Suicide is motivated by multiple causes, and the abusive consumption of alcoholic beverages can be an important sign that individuals do not have physical and emotional control of themselves. To estimate the incidence of alcohol consumption, immediately before suicide, among people who died in 2018 in the Brazilian Federal District. This is a population-based study, of a descriptive and exploratory nature, of all deaths which occurred in the Brazilian Federal District from January 1 to December 31, 2018. Data were collected from the Mortality Information System and Police reports. The incidence and respective 95% confidence intervals were calculated. This study was approved by the Research Ethics Committee. The incidence of alcohol consumption just before the suicide was 18.6% (CI 95%: 18.56% to 18.62%). Males, blacks, trade workers, those without a partner, young people, and individuals with less than 8 years of study had the highest indicators. There was a greater percentage of alcohol consumption in the fall/winter, at the end of the month, in rural areas, in people who had never attempted suicide before and when the modus operandi was choking or hanging. The consumption of drugs, such as methamphetamine, ecstasy, amphetamine, and cannabis, was observed together with alcoholic beverages. The results of this research signaled an important public health problem, which is the use of alcohol to potentially encourage suicide. Effective public policies to tackle the abusive consumption of alcoholic beverages and suicide are necessary.O suicídio é motivado por múltiplas causas e o consumo abusivo de bebidas alcoólicas pode ser um sinal importante de que os indivíduos não têm controle físico e emocional de si mesmos. Estimar a incidência do consumo de álcool, imediatamente antes do suicídio, entre as pessoas que morreram em 2018 no Distrito Federal. Trata-se de um estudo de base populacional, de caráter descritivo e exploratório, de todos os óbitos ocorridos no Distrito Federal de 1º de janeiro a 31 de dezembro de 2018. Os dados foram coletados do Sistema de Informações sobre Mortalidade e relatórios policiais. Foram calculados os intervalos de confiança de 95%. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa. A incidência de consumo de álcool pouco antes do suicídio foi de 18,6% (IC 95%: 18,56% a 18,62%). Homens, negros, trabalhadores do comércio, aqueles sem parceiro, jovens e indivíduos com menos de 8 anos de estudo apresentaram os maiores indicadores. Houve maior percentual de consumo de álcool no outono/inverno, no final do mês, em áreas rurais, em pessoas que nunca haviam tentado suicídio antes e quando o modus operandi estava engasgando ou pendurado. O consumo de drogas, como metanfetamina, ecstasy, anfetamina e cannabis, foi observado juntamente com bebidas alcoólicas. Os resultados desta pesquisa sinalizaram um importante problema de saúde pública, que é o uso de álcool para potencialmente incentivar o suicídio. São necessárias políticas públicas eficazes para enfrentar o consumo abusivo de bebidas alcoólicas e o suicídio.El suicidio está motivado por múltiples causas, y el consumo abusivo de bebidas alcohólicas puede ser una señal importante de que las personas no tienen control físico y emocional de sí mismos. Estimar la incidencia del consumo de alcohol, inmediatamente antes del suicidio, entre las personas que murieron en 2018 en el Distrito Federal de Brasil. Se trata de un estudio poblacional, de carácter descriptivo y exploratorio, de todas las muertes ocurridas en el Distrito Federal de Brasil del 1 de enero al 31 de diciembre de 2018. Los datos se recopilaron del Sistema de Información de Mortalidad y de los informes de la Policía. Se calcularon la incidencia y los respectivos intervalos de confianza del 95%. Este estudio fue aprobado por el Comité de ética de la investigación. La incidencia del consumo de alcohol justo antes del suicidio fue del 18,6% (CI 95%: 18,56% a 18,62%). Los hombres, los negros, los trabajadores del comercio, los que no tienen pareja, los jóvenes y los individuos con menos de 8 años de estudio tenían los indicadores más altos. Había un mayor porcentaje de consumo de alcohol en otoño/invierno, a finales de mes, en las zonas rurales, en personas que nunca habían intentado suicidarse antes y cuando el modus operandi se estaba asfixiando o ahorcando. El consumo de drogas, como la metanfetamina, el éxtasis, la anfetamina y el cannabis, se observó junto con las bebidas alcohólicas. Los resultados de esta investigación indicaron un importante problema de salud pública, que es el uso del alcohol para fomentar potencialmente el suicidio. Las políticas públicas eficaces para hacer frente al consumo abusivo de bebidas alcohólicas y el suicidio so

INCIDÊNCIA DE CONSUMO DE BEBIDA ALCOÓLICA ENTRE AS VÍTIMAS DE SUICÍDIO NO DISTRITO FEDERAL

Suicide is motivated by multiple causes, and the abusive consumption of alcoholic beverages can be an important sign that individuals do not have physical and emotional control of themselves. To estimate the incidence of alcohol consumption, immediately before suicide, among people who died in 2018 in the Brazilian Federal District. This is a population-based study, of a descriptive and exploratory nature, of all deaths which occurred in the Brazilian Federal District from January 1 to December 31, 2018. Data were collected from the Mortality Information System and Police reports. The incidence and respective 95% confidence intervals were calculated. This study was approved by the Research Ethics Committee. The incidence of alcohol consumption just before the suicide was 18.6% (CI 95%: 18.56% to 18.62%). Males, blacks, trade workers, those without a partner, young people, and individuals with less than 8 years of study had the highest indicators. There was a greater percentage of alcohol consumption in the fall/winter, at the end of the month, in rural areas, in people who had never attempted suicide before and when the modus operandi was choking or hanging. The consumption of drugs, such as methamphetamine, ecstasy, amphetamine, and cannabis, was observed together with alcoholic beverages. The results of this research signaled an important public health problem, which is the use of alcohol to potentially encourage suicide. Effective public policies to tackle the abusive consumption of alcoholic beverages and suicide are necessary.O suicídio é motivado por múltiplas causas e o consumo abusivo de bebidas alcoólicas pode ser um sinal importante de que os indivíduos não têm controle físico e emocional de si mesmos. Estimar a incidência do consumo de álcool, imediatamente antes do suicídio, entre as pessoas que morreram em 2018 no Distrito Federal. Trata-se de um estudo de base populacional, de caráter descritivo e exploratório, de todos os óbitos ocorridos no Distrito Federal de 1º de janeiro a 31 de dezembro de 2018. Os dados foram coletados do Sistema de Informações sobre Mortalidade e relatórios policiais. Foram calculados os intervalos de confiança de 95%. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa. A incidência de consumo de álcool pouco antes do suicídio foi de 18,6% (IC 95%: 18,56% a 18,62%). Homens, negros, trabalhadores do comércio, aqueles sem parceiro, jovens e indivíduos com menos de 8 anos de estudo apresentaram os maiores indicadores. Houve maior percentual de consumo de álcool no outono/inverno, no final do mês, em áreas rurais, em pessoas que nunca haviam tentado suicídio antes e quando o modus operandi estava engasgando ou pendurado. O consumo de drogas, como metanfetamina, ecstasy, anfetamina e cannabis, foi observado juntamente com bebidas alcoólicas. Os resultados desta pesquisa sinalizaram um importante problema de saúde pública, que é o uso de álcool para potencialmente incentivar o suicídio. São necessárias políticas públicas eficazes para enfrentar o consumo abusivo de bebidas alcoólicas e o suicídio.El suicidio está motivado por múltiples causas, y el consumo abusivo de bebidas alcohólicas puede ser una señal importante de que las personas no tienen control físico y emocional de sí mismos. Estimar la incidencia del consumo de alcohol, inmediatamente antes del suicidio, entre las personas que murieron en 2018 en el Distrito Federal de Brasil. Se trata de un estudio poblacional, de carácter descriptivo y exploratorio, de todas las muertes ocurridas en el Distrito Federal de Brasil del 1 de enero al 31 de diciembre de 2018. Los datos se recopilaron del Sistema de Información de Mortalidad y de los informes de la Policía. Se calcularon la incidencia y los respectivos intervalos de confianza del 95%. Este estudio fue aprobado por el Comité de ética de la investigación. La incidencia del consumo de alcohol justo antes del suicidio fue del 18,6% (CI 95%: 18,56% a 18,62%). Los hombres, los negros, los trabajadores del comercio, los que no tienen pareja, los jóvenes y los individuos con menos de 8 años de estudio tenían los indicadores más altos. Había un mayor porcentaje de consumo de alcohol en otoño/invierno, a finales de mes, en las zonas rurales, en personas que nunca habían intentado suicidarse antes y cuando el modus operandi se estaba asfixiando o ahorcando. El consumo de drogas, como la metanfetamina, el éxtasis, la anfetamina y el cannabis, se observó junto con las bebidas alcohólicas. Los resultados de esta investigación indicaron un importante problema de salud pública, que es el uso del alcohol para fomentar potencialmente el suicidio. Las políticas públicas eficaces para hacer frente al consumo abusivo de bebidas alcohólicas y el suicidio so

Dynamics and determinants of SARS-CoV-2 RT-PCR testing on symptomatic individuals attending healthcare centers during 2020 in Bahia, Brazil

RT-PCR testing data provides opportunities to explore regional and individual determinants of test positivity and surveillance infrastructure. Using Generalized Additive Models, we explored 222,515 tests of a random sample of individuals with COVID-19 compatible symptoms in the Brazilian state of Bahia during 2020. We found that age and male gender were the most significant determinants of test positivity. There was evidence of an unequal impact among socio-demographic strata, with higher positivity among those living in areas with low education levels during the first epidemic wave, followed by those living in areas with higher education levels in the second wave. Our estimated probability of testing positive after symptom onset corroborates previous reports that the probability decreases with time, more than halving by about two weeks and converging to zero by three weeks. Test positivity rates generally followed state-level reported cases, and while a single laboratory performed ~90% of tests covering ~99% of the state's area, test turn-around time generally remained below four days. This testing effort is a testimony to the Bahian surveillance capacity during public health emergencies, as previously witnessed during the recent Zika and Yellow Fever outbreaks

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570