Explore the vast range of titles available.

The Mediterranean Diet Quality Index (KIDMED Index) is frequently used to evaluate adherence to the Mediterranean Dietary Pattern among children and adolescents, through sixteen questions with the associated total score ranging from −4 to 12. However, in the authors’ best knowledge, the psychometric properties of this index had not yet been investigated in Portugal. Thus, the main purpose of the present study was to investigate the reproducibility and the validity of the KIDMED Index in a sample of 185 Portuguese adolescents. The reproducibility was tested by comparing the application of the KIDMED Index at two different times (2-week interval), using McNemar test and Kappa statistics. There was moderate agreement (κw = 0·591; 95 % CI 0·485, 0·696) and no significant change (P-value = 0·201) in the KIDMED Index classification, between the two applications. The validity was explored by comparing the results obtained by the KIDMED Index and by the average of 3-d Dietary-Record (DR), using Spearman’s correlation coefficient and Kappa statistics. There was weak correlation (ρ = 0·317; P-value < 0·001) and slight agreement (κw = 0·167; 95 % CI 0·071, 0·262) between the KIDMED Index classification and the 3-d DR-derived KIDMED score, and moderate correlation (ρ = 0·423; P-value < 0·001) and fair agreement (κw = 0·344; 95 % CI 0·202, 0·486) between the terciles of the KIDMED Index and the Mediterranean Adequacy Index scores. The results suggested an acceptable reproducibility and validity of the Portuguese version of the KIDMED Index, in alignment with the few studies investigating psychometric properties of this index in other countries.

Background Despite 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. Methods We 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. Results A 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. Conclusions Facilitating 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.

Background/objectives The objective of this study was to evaluate the performance of a short food frequency questionnaire (FFQ) to assess dietary intake at 4 and 7 years of age, against 3d food diaries (FD) and serum biomarkers, using two methods to convert the FFQ to daily intake in grams and nutrients (standard and z -score method). Subjects/methods The present analysis comprises data from 2482 4-year-old children and 3511 7-year-old children, from the birth cohort Generation XXI (Porto, Portugal). To estimate daily consumption from the FFQ, the frequency response was multiplied by a standard mean portion (standard method) or adjusted with data from the FD ( z -score method). The dietary intake obtained from the FFQ was compared with the FD and serum biomarkers, using Intra-Class Correlation Coefficients (ICC), de-attenuated Pearson’s correlation coefficients and Bland Altman analysis. Results In general, the mean daily food intake estimated by the z -score method had a higher agreement with the FD, than the standard method. The highest ICC was obtained for “vegetable soup” (ICC = 0.536), using the z -score method, compared to an ICC of 0.373 using the standard method. Significant correlation coefficients were observed for all nutrients; the average of correlation coefficients was 0.39 at 4 years and 0.42 at 7 years of age. For the majority of nutrients, the correlation between mean and mean difference was lower using the z -score method, in comparison with the standard method. Conclusions The results suggest that the FFQ is a reasonably good instrument to estimate dietary intake in children. Moreover, adjusting the FFQ portion size, by using a z -score method, seems to increase the accuracy of dietary data in children.

Purpose Appetitive behaviours have been associated with body mass index (BMI). However, existing data were largely derived from cross-sectional studies and cannot provide insight into the direction of associations. We aimed to explore the bidirectionality of these associations in school-age children. Methods Participants are from the Generation XXI birth cohort, assessed at both 7 and 10 years of age ( n  = 4264; twins excluded). The Children’s Eating Behaviour Questionnaire (CEBQ) was used to measure appetitive behaviours (8 subscales). Anthropometrics were measured and WHO BMI z -score was calculated. Cross-lagged analyses were performed to compare the magnitude and direction of the associations (behaviours at 7 years to BMI z -score at 10 years and the reverse) (covariates: child’s sex, physical exercise, maternal age and education; plus BMI z -score at age 7 or, in the reverse direction, the subscale score). Results In cross-lagged analyses, appetitive behaviours at 10 years of age (apart from emotional undereating) were shown to be reactive to the child BMI z -score at 7 years of age. Only slowness in eating was significantly related to subsequent BMI. However, the strongest association was from the child BMI z -score to the behaviour ( β standardized  = − 0.028 compared with β standardized  = − 0.103, likelihood ratio test p  < 0.001). Conclusions BMI at age 7 was related to appetitive behaviours at 10 years of age, rather than the reverse. This suggests that children with a higher BMI in middle childhood are at increased risk of developing an avid appetite over time.

Background/ObjectivesThe usual definition of dietary patterns only accounts for the explanation of dietary choices and not a specific health outcome. This could partially explain the lack of consistent associations between diet and related diseases. This study aims to identify dietary patterns in 7 years olds explaining body mass index (BMI) at age 10 and to assess their association with early-life factors (sociodemographic, birth, and infancy characteristics).MethodsChildren from the birth cohort Generation XXI at ages 7 and 10 were included (n = 4698). Diet was assessed by a validated food-frequency questionnaire. Measured BMI z-scores (zBMI) were calculated. Principal component analysis (PCA) and partial least squares (PLS) were run to derive dietary patterns.ResultsThe component scores of PCA was able to explain 13.0% of food groups and only 0.2% of zBMI, while the PLS scores explained the variance of both food groups (10.1%) and zBMI at age 10 (4.2%). By using PLS, two dietary patterns were derived, but only one, higher in processed meats and energy-dense foods and lower in vegetable soup consumption, was significantly associated with an increased zBMI in 10 years olds (adjusted β̂ 0.032; 95% CI:0.017; 0.047). It was more likely followed by children from younger and less educated mothers and who were born heavier.ConclusionsA dietary pattern higher in processed and energy-dense foods and with lower vegetable soup intake in 7 years olds significantly explained zBMI of 10 years olds, and was predicted by early-life characteristics. The other dietary patterns were not significantly associated with zBMI at age 10.

Background The Pedagogic Surveys (IPUP) were validated and introduced in 2004 at the University of Porto to monitor and improve teaching quality. Despite the advancements and implementation of several revisions, the use of these tools for longitudinal analysis, and particularly in medical education, remains underexplored. This study seeks to address this gap by conducting a longitudinal analysis of medical students’ feedback over consecutive academic years. Methods This study analysed student responses to the IPUP questionnaire collected between the academic years of 2020 and 2023, aiming to characterise trends and patterns in the evaluation of the undergraduate curriculum of the Integrated Master’s in Medicine at the School of Medicine and Biomedical Sciences of the University of Porto (ICBAS). The IPUP is designed to assess nine subdomains of teaching and learning: appreciation and clarity, difficulty, support for autonomy, consistency and help, structure, relationship, effects of the unit course (UC), engagement, and assessment. A total of 221 observations from 74 curricular units across three academic years were included. The overall IPUP response rate ranged from 49.77% to 42.55% in the first semester and from 36.15% to 35.18% in the second semester across the analysed years. To assess temporal trends in the evaluation of each subdomain, linear mixed-effects models were employed. To facilitate interpretation and longitudinal analysis, three summary domains (Teacher, Unit Course and Difficulty) were created through principal component analysis (PCA), aggregating the original nine subdomains into broader dimensions. Results Student evaluation scores were overall positive across all subdomains (mean scores > 5 on a 7-point scale). Differences were found between curriculum years, with the 3rd year consistently presenting the lowest scores and the 4th year showing the highest (e.g., the assessment subdomain ranged from a mean of 4.98 ± 0.89 in the 3rd year to 5.76 ± 0.69 in the 4th year; p  < 0.001). When analysed by scientific domain, Pathology was the one with the highest scores, while Semiology and Pharmacology received the lowest scores (e.g., the assessment subdomain ranged from a mean of 6.57 ± 0.17 in Pathology to 4.15 ± 0.35 in Pharmacology; p  < 0.001). A positive correlation was observed between average final grade and subdomain evaluations (ranging from r  = 0.108 to r  = 0.260 across subdomains), except for difficulty, which showed a negative correlation ( r = -0.57, p  < 0.001). A higher number of credits of the European Credit Transfer System (ECTS) was also positively associated with student perceptions. During the evaluation period, a significant decline was observed in the Teacher domain (β = -0.147, CI95%: -0.260, -0.034), whereas the UC and Difficulty domains remained stable. Intraclass Correlation Coefficient (ICC) values ranged from 0.45 (Teacher) to 0.86 (Difficulty), indicating a high level of consistency in student perceptions. Conclusions This study provides important insights into the potential use of the IPUP as a tool for longitudinal assessment of the student perspectives on undergraduate medical education quality. The study showed that student evaluation of the course were overall very positive and highlights the stability of the scores’ trends over the three academic years analysed, with only a slight decline observed in the Teacher Domain. The overall consistency of results over the years suggests, on one hand, strong reliability and, on the other, that the opportunities for improvement were not taken into account nor led to the implementation of significant changes, denoting the missed opportunity provided by these tools for the refinement of teaching and learning processes.

Objective:To assess total sugar (TS), added sugar (AS) and free sugar (FS) intakes, dietary sources, adherence to recommendations and determinants of consumption, in a Portuguese national sample.Design:Cross-sectional study. Dietary assessment was obtained by two food diaries in children aged <10 years and two non-consecutive 24 h recalls for other age groups. TS, AS and FS intakes were estimated by using SPADE software. TS content in food was estimated at the ingredient level. AS content in food was assessed through a systematic methodology and FS was based on the WHO definition.Setting:National Food, Nutrition and Physical Activity Survey (IAN-AF 2015-2016), Portugal.Participants:Representative sample from the Portuguese population, aged from 3 months to 84 years (n 5811).Results:Mean daily intake and contribution to total energy intake (E%) were 84·3 g/d (18·5 E%) for TS, 32·1 g/d (6·8 E%) for AS and 35·3 g/d (7·5 E%) for FS. Of the population, 76 % adhered to the FS recommendation (FS < 10 E%). The lowest adherence was in children (51·6 %) and adolescents (51·3 %). The main dietary source of TS was fruit across all ages, except in adolescents which was soft drinks. In children, the main dietary sources of FS were yoghurts and sweets, soft drinks in adolescents and table sugar in adults/elderly. FS intake was lower in children with more educated parents and in adults who practised physical activity regularly, and higher among smokers.Conclusions:Interventions ought to be planned towards decreasing intakes of added and free sugars considering population-specific characteristics. (c) The Authors 2019.

Background/Objectives: We aimed to identify the factors associated with clinically important changes in quality of life (QoL) of real-world heart failure (HF) patients. Methods: This is a single-centre, prospective cohort study including 419 patients at an HF clinic between January 2013 and February 2020. QoL was assessed regularly using Minnesota Living with Heart Failure Questionnaire (MLHFQ). We used five nested linear mixed-effects models to account for QoL measurements between patients and within-patient. Models were adjusted for time, sociodemographic factors, comorbidities, self-care adherence, and HF severity factors. Results: Median age was 78 years, 54.4% of patients were female, and 49.6% had left ventricle ejection fraction ≥ 50%. At baseline, 62.5% of patients were New York Heart Association (NYHA) class II. Median N-terminal-pro-B type natriuretic peptide level was 1454 pg/mL. Mean MLHFQ total score at baseline was 25 points (95%CI: 22.97–27.60). Having an implanted cardiac resynchronization therapy-pacemaker (CRT-P) was associated with moderate to large improvement in QoL (−13.55 points, 95%CI: −22.45–−4.65). NYHA class II and estimated glomerular filtration rate < 30 mL/min/1.73 m2 were associated with small to moderate QoL deterioration (9.74 points, 95%CI: 6.74–12.75 and 5.82 points, 95%CI: 1.17–10.47, respectively). NYHA classes III or IV and a recent HF hospitalization were associated with large to very large QoL deterioration (28.39 points, 95%CI: 23.82–32.96; 60.59 points, 95%CI: 34.46–86.72; and 26.91 points, 95%CI: 21.80–32.03, respectively). Conclusions: CRT-P implantation, NYHA class and HF hospitalization are associated with the most clinically important QoL changes.

Purpose Given the variability in adiposity despite ubiquitous exposure to obesogenic food environments, it has been suggested that individuals respond in divergent ways to the environment they live in. The food environment becomes more ‘permissive’ as children age; therefore, genetic predisposition for a more avid appetite can be better expressed, influencing dietary quality, energy intake and weight gain. Our aim was to explore the genetic and environmental contribution of variations on appetitive traits in a sample of 10-year-old Portuguese children. Methods Participants were twins enrolled in the Generation XXI birth cohort ( n  = 86 pairs). Parents reported twin’s zygosity and child appetitive traits at 10 years of age through the Children’s Eating Behavior Questionnaire. Intra-class correlations (ICCs) for all appetitive traits were calculated for monozygotic and dizygotic twins separately to examine patterns of resemblance, and structural equation modeling was conducted aiming to estimate the genetic ( A ), shared ( C ) and non-shared ( E ) environmental variances. Results Moderate to strong heritability were found for child appetitive traits, with higher ICCs among monozygotic twin pairs. For all appetitive traits, with the exception of emotional undereating, genetic and non-shared environmental effects contributed to appetite variability. For emotional undereating, environmental effects seem to be more important than genetic effects ( C : 0.81; 95% CI 0.71; 0.88 and E : 0.19; 95% CI 0.12; 0.29). Conclusion There was a significant genetic contribution, followed by non-shared environmental contribution, towards variation in appetitive traits in school-age children. Variation in emotional undereating was primarily explained by shared and non-shared environmental factors. Level of evidence Evidence obtained from well-designed cohort or case–control analytic studies.

To assess the relationship between socioeconomic deprivation and health-related quality of life in urban neighbourhoods, using a multilevel approach. Of the population-based cohort EPIPorto, 1154 georeferenced participants completed the 36-Item Short-Form Health Survey. Neighbourhood socioeconomic deprivation classes were estimated using latent-class analysis. Multilevel models measured clustering and contextual effects of neighbourhood deprivation on physical and mental HRQoL. Residents from the least deprived neighbourhoods had higher physical HRQoL. Neighbourhood socioeconomic deprivation together with individual-level variables (age, gender and education) and health-related factors (smoking, alcohol consumption, sedentariness and chronic diseases) explained 98% of the total between-neighbourhood variance. Neighbourhood socioeconomic deprivation was significantly associated with physical health when comparing least and most deprived neighbourhoods (class 2-beta coefficient: -0.60; 95% confidence interval:-1.76;-0.56; class 3 -beta coefficient: -2.28; 95% confidence interval:-3.96;-0.60), and as neighbourhood deprivation increases, a decrease in all values of physical health dimensions (physical functioning, role physical, bodily pain and general health) was also observed. Regarding the mental health dimension, no neighbourhood clustering or contextual effects were found. However, as neighbourhood deprivation increases, the values of vitality and role emotional dimensions significantly decreased. Neighbourhood socioeconomic deprivation is associated with HRQoL, affecting particularly physical health. This study suggests that to improve HRQoL, people and places should be targeted simultaneously.