Uma Apresentação Atípica e Não-Cardíaca de Cardiomiopatia Hipertrófica

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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

Meat or meatless meals at lunch and dinner - exploring the associated factors and transition between meals

This study aimed to explore the factors associated with the consumption of meat vs. meatless meals and to assess the applicability of a multi-state model to describe transitions between lunch and dinner. Fifteen thousand four hundred and eight main meals (lunch and dinner) from a sample of adults (18-84 years, n = 3852) from the Portuguese Food, Nutrition and Physical Activity Survey (IAN-AF 2015-2016) were categorised as meat, fish, ovolactovegetarian or snack. Adjusted generalised-mixed-effects models were used to explore the associations and a time-homogeneous Markov-multi-state model was applied to study the transitions. Women, older and higher educated individuals presented higher odds of consuming meatless meals and lower hazard of transitioning to meat in the following main meal. Strategies for replacing meat with more sustainable foods should be specific towards different population groups. Studying transitions across main meals, using multi-state models, can support the development of feasible, realistic and group-specific strategies to replace meat and promote dietary variety

Propriedades psicométricas do Eating Disorders Inventory em adolescentes portugueses

Introdução: Vários estudos sobre as perturbações do comportamento alimentar em adolescentes utilizam o Eating Disorders Inventory (EDI) apesar de este instrumento ter sido desenvolvido em adultos. No sentido de aumentar a sua utilidade clínica e em investigação, é importante analisar as qualidades psicométricas do EDI quando usado em indivíduos mais jovens do que aqueles em que foi desenvolvido. Neste estudo examinam-se as características psicométricas do EDI em adolescentes portugueses de 13 anos. Métodos: A amostra inclui 1184 adolescentes (641 raparigas e 543 rapazes), nascidos em 1990 e inscritos nas escolas públicas e privadas da cidade do Porto, que integram a coorte EPITeen. A auto-aplicação das escalas (EDI e Escala de Silhuetas de Stunkard) e as avaliações antropométricas foram realizadas nas escolas. Para análise das características psicométricas, foi avaliada a consistência interna e utilizada a análise de componentes principais seguida de rotação varimax. Na análise da validade de construto, as variáveis quantitativas foram comparadas com recurso aos testes de Mann-Whitney e Kruskal-Wallis. Resultados: Dos 64 itens que compõem o EDI, 17 mostraram-se inconsistentes. Após a sua exclusão, foi extraída uma solução com sete componentes principais, que explicaram 49,8% da variância total. Nesta solução foram definidas oito subescalas que apresentaram valores de alfa de Cronbach a variar de 0,53 a 0,87. As três subescalas que avaliam aspectos centrais nas perturbações do comportamento alimentar (Impulso para Emagrecer, Bulimia e Insatisfação Corporal) apresentaram boas características psicométricas e à excepção do item 1 (correlação item-total= 0,00), os itens mostraramse consistentes (correlação item-total a variar de 0,41 a 0,73; alfa de Cronbach a variar entre 0,77 a 0,87). Em consonância com os pressupostos teóricos previamente definidos, as raparigas em comparação com os rapazes (4,0 vs 1,7; p <0,001) e os adolescentes em risco de excesso de peso ou com excesso de peso em comparação com os normoponderais, apresentaram valores médios significativamente superiores na subescala Impulso para Emagrecer. Os adolescentes classificados como insatisfeitos ou muito insatisfeitos na escala de silhuetas apresentaram valores médios significativamente superiores na subescala Insatisfação Corporal. Conclusão: A versão portuguesa do EDI apresentou boas características psicométricas na avaliação de sintomatologia associada a perturbações do comportamento alimentar em adolescentes, em particular através das subescalas Impulso para Emagrecer, Bulimia, e Insatisfação Corporal, que se mantiveram consistentes com as subescalas originais. O instrumento é capaz de distinguir grupos de acordo com os construtos teóricos.Introduction: Although Eating Disorders Inventory (EDI) was developed with adults, a large amount of research about eating disorders in adolescents is usually conducted with EDI. The clinical and research utility of this instrument would be improved by analysing its psychometric properties when used with younger people than those in the original standardization samples. The main objective of our study is to analyse the psychometric properties of the Eating Disorders Inventory (EDI) among 13 year old Portuguese adolescents. Methods: A sample of 1184 adolescents (641 girls and 543 boys) born in 1990 and attending public and private schools in Porto completed EDI and was evaluated with Stunkard Figure Scale at school. Anthropometric measurements were also performed. Internal consistency was analysed trough item-total correlations and Cronbach's alpha coefficients. Mann-Whitney and Kruskal-Wallis tests were used to evaluate construct validity. Results: After the exclusion of 17 of the 64 items that showed low consistency, a correlation matrix of seven principal components, that explained 49.8% of the total variance, was obtained. In this matrix, 8 subscales with alpha ranging from 0.53 to 0.87 were defined. The three core EDI subscales (Drive for Thinness, Bulimia and Body Dissatisfaction) presented good psychometric properties and, except item 1 (itemtotal correlation= 0.00), items showed good internal consistency (item-total correlations ranging from 0.41 and 0.73, Cronbach's alpha ranging from 0.77 and 0.87). In accordance with theoretical constructs previously defined, girls presented higher mean scores than boys on Drive for Thinness subscale (4.0 vs. 1.7, p < 0.001). Also, adolescents with a healthy weight presented significantly lower scores than overweight adolescents in the same subscale. Boys and girls classified as dissatisfied or very dissatisfied with body image according to Stunkard Figure Rating Scale presented significantly higher scores on Body Dissatisfaction EDI subscale. Conclusion: The Portuguese version of EDI, with the proposed changes, showed good psychometric characteristics to evaluate symptoms associated with eating disorders among 13 year old adolescents. The subscales Drive for Thinness, Bulimia and Body Dissatisfaction, besides presenting good psychometric properties, remained similar to the same subscales in the original EDI. The instrument is able to distinguish groups according to theoretical constructs

Amiodarone-Induced Electrical Storm: A Nightmare in the Emergency Room

Drug-induced long QT syndrome (LQTS) is defined as prolonged corrected QT interval (QTc ≥460 ms) plus polymorphic ventricular arrhythmia fitting the description of torsades de pointes temporally associated with the administration of a drug or combination of drugs. Amiodarone therapy is a known uncommon cause of acquired QT interval prolongation that should not be underestimated. We present a case of an iatrogenic electrical storm with atrial fibrillation (AF) in which amiodarone was administered to attempt chemical cardioversion, resulting in an unnoticed prolongation of the QT interval, with subsequent repeated polymorphic ventricular tachycardia, managed with isoproterenol. Concomitant drugs and slight electrolyte disturbances potentiated this phenomenon. Given the widespread use of this drug in the emergency department, our case highlights a pertinent matter for all medical emergency practitioners. Additionally, it stresses the significance of potential precipitating factors, such as electrolyte imbalances, which are clinical conditions very frequent in the emergency context, along with the importance of recognizing drug interactions. Finally, this case also emphasizes the vital importance of closely monitoring the patient's receiving amiodarone.info:eu-repo/semantics/publishedVersio

Cardiovascular rehabilitation in patients aged 70-year-old or older: benefits on functional capacity, physical activity and metabolic profile in younger vs. older patients

Background: The benefits of exercise-based cardiac rehabilitation (EBCR) programs in post-acute myocardial infarction (AMI) patients have been demonstrated. Our aim was to assess the impact of EBCR in ≥ 70-years-old vs. younger post-AMI patients. Methods: We retrospectively evaluated patients who underwent a supervised EBCR protocol, twice a week during 6-12 weeks. We evaluated changes in several outcomes based on pre- and post-CRP assessments. Results: Of a total of 1607 patients, 333 (21%) were ≥ 70-years-old. After the EBCR, an overall improvement on functional capacity, daily physical activity, lipid profile, body mass index, glycated hemoglobin (HbA1c), N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and C-reactive protein was observed in both younger and older patients (P < 0.05). Older patients showed a smaller benefit on the increment of daily physical activity and lipid profile improvement, but a larger reduction in NT-pro-BNP. In the multivariate analysis, only improvements on daily physical activity and HbA1c were dependent on age. Conclusion: As their younger counterparts, older patients, significantly improved functional capacity, metabolic parameters and level of daily physical activity after EBCR.info:eu-repo/semantics/publishedVersio

Dirección escolar : gestión de la complejidad y diversidad de la institución educativa. Texto 1

Diplomado en Gestión Escolar y Segunda Especialidad en Gestión Escolar con Liderazgo PedagógicoAnaliza los desafíos, retos y alternativas de solución de la gestión escolar teniendo en cuenta las fuentes de los contextos macro y micro de la política educativa, y reflexiona sobre la influencia de la dirección como factor clave para la transformación de su institución educativa centrada en procesos de enseñanza y aprendizaje