Effectiveness of a two-component nutritional strategy for blood pressure control in individuals with hypertension users of a public health system: a randomized controlled clinical trial.

OBJECTIVE: To evaluate the effectiveness of a nutritional strategy based on two components and adapted for the public health system on blood pressure, cardiometabolic features, self-care, qualify of life and diet quality in individuals with hypertension. METHODS: NUPRESS was an open-label, parallel-group, superiority randomized controlled clinical trial in which participants at least 21 years with hypertension and poorly controlled blood pressure were randomly assigned (1 : 1 allocation ratio) to either an individualized dietary prescription according to nutritional guidelines (control group, n  = 205); or a two-component nutrition strategy, including a goal-directed nutritional counseling and mindfulness techniques (NUPRESS [intervention] group, n  = 205). Primary outcomes were SBP (mmHg) after 24 weeks of follow up and blood pressure control, defined as either having SBP more than 140 mmHg at baseline and achieving 140 mmHg or less after follow-up or having SBP 140 mmHg or less at baseline and reducing the frequency of antihypertensive drugs in use after follow-up. RESULTS: In total, 410 participants were randomized and submitted to an intention-to-treat analysis regarding primary outcomes. Both groups decreased blood pressure, but after adjusting for baseline values, there was no significant difference between them on SBP [intervention-control difference: -0.03 (-3.01; 2.94); P  = 0.98] nor blood pressure control [odds ratio 1.27 (0.82; 1.97); P  = 0.28]. No differences between groups were also detected regarding secondary and tertiary outcomes. CONCLUSION: There was no difference between a two-component nutritional strategy and an established dietary intervention on blood pressure in participants with hypertension.

Food intake, plasma copeptin and cardiovascular risk in patients with type 2 diabetes: A cross-sectional analysis.

BACKGROUND AND AIM: Increased consumption of ultra-processed foods has been linked to both mortality and cardiovascular risk. Copeptin levels may serve as potential risk markers for cardiovascular death and events. This cross-sectional analysis seeks to assess the potential correlation between the intake of ultra-processed foods and copeptin levels in outpatients diagnosed with type 2 diabetes, based on estimates of cardiovascular risk. METHODS AND RESULTS: Outpatients underwent clinical and nutritional assessments. Dietary information was gathered using a validated quantitative food frequency questionnaire, and the consumption of all foods, beverages, and food products was assessed according to the NOVA food classification system. Fasting plasma-EDTA samples were collected and preserved at -80 °C. Plasma copeptin measurements were analyzed using an enzyme-linked immunosorbent assay based on the competition principle. Participants were categorized into two groups: high risk and very high risk, based on cardiovascular risk calculated by the HEARTS calculator. A total of 190 participants were included in the evaluation, with an average age of 60 ± 9 years, glycated hemoglobin of 8.4 ± 1.4%, and a diabetes duration of 11 (5-19) years. Patients at a very high cardiovascular risk exhibited higher plasma copeptin levels compared to those at high cardiovascular risk. Notably, 92.1% of patients reported consuming more than 10% of total energy intake from ultra-processed foods, although this proportion did not differ between the two groups. CONCLUSION: This patient sample reported elevated consumption of ultra-processed foods; nevertheless, the correlation between ultra-processed foods and plasma copeptin has not been substantiated.

Association between intuitive eating and health outcomes in outpatients with type 2 diabetes: a cross-sectional study.

PURPOSE: To evaluate the association between intuitive eating and health outcomes in patients with type 2 diabetes in a cross-sectional study. METHODS: Consecutively, outpatients attending at university hospital underwent clinical, laboratory, lifestyle, and eating behavior evaluations. Intuitive eating was assessed using the Intuitive Eating Scale-2 (IES-2), and the Three Factor Eating Questionnaire-21 was adopted as a confirmatory tool for disordered eating behavior. Optimized health outcomes were considered according to the American Diabetes Association criteria for BMI, HbA1c, lipid profile, and blood pressure values, and the International Diabetes Federation criteria for waist circumference. Considering the answers of the IES-2 items, patients were grouped by latent class analysis, and their characteristics were compared by appropriate tests. RESULTS: In total, 267 patients were evaluated: 62.2% women, with 60 (53-65) years, BMI 31.9 ± 5.4 kg/m², diabetes duration of 16 ± 9 years, HbA1c 8.5 ± 1.5%, and an IES-2 total score of 58 (50-67)%. Three intuitive eating groups were identified: higher intuitive eating, nonemotional-oriented coping, and lower intuitive eating. Patients with higher intuitive eating have higher chances of having optimized BMI and serum triglycerides values compared to patients with lower intuitive eating. Also, the 10-point increase on IES-2 was associated with a 0.62 kg/m² reduction on BMI values (95%CI -1.18;-0.06), 1.90 cm on waist circumference (95%CI -3.26;-0.54), and 23 mg/dL in serum triglycerides values (95%CI -38.27;-7.40) after adjustment for age, sex, psychotropic drug use, medication effect score, smoking, and BMI. CONCLUSION: Intuitive eating seems to be associated with optimized health outcomes and may contribute to better personalized interventions in nutritional treatment that promote adaptive behaviors in diabetes management, but should be tested.

Could the Wheel of Cardiovascular Health Diet Be a Tool for Diet Quality in Nutritional Counseling? Comparison with Healthy Eating Index-2020.

OBJECTIVE: The Wheel of Cardiovascular Health Diet was recently elaborated based on current nutritional recommendations for healthy eating and was made for person-centered nutritional counseling, thus it may be an interesting tool to improve food awareness. However, its validity is yet to be tested. We hypothesized that the self-perception of patients diagnosed with chronic diseases, evaluated by the Wheel of Cardiovascular Health Diet, is satisfactory in assessing the quality of their diets, compared with the Healthy Eating Index-2020. METHODS: This is a cross-sectional analysis of adults with uncontrolled hypertension or type 2 diabetes. The patients answered the Wheel of Cardiovascular Health Diet, and then, based on the food frequency questionnaire, we analyzed the Healthy Eating Index-2020. RESULTS: A total of 330 patients were included in the study: 91.5% had hypertension, 58.5% had type 2 diabetes, and the median age was 58 (50-65) years. The mean difference observed between the percentage of the graphic area assessed by the patients' self-perception from the Wheel of Cardiovascular Health Diet and Healthy Eating Index-2020 was -10.0% (95%CI -35.3 to 15.3), and a moderate correlation was observed. Linear Regression models showed that a 10-point increase in patients' self-perception in the Wheel of Cardiovascular Health Diet is associated with a 2.9% increase (95%CI 2.08 to 3.70) in the diet quality by the Healthy Eating Index-2020 and is associated with lower BMI values: ß = -0.42 kg/m2 (95%CI -0.83 to -0.01). CONCLUSION: The Wheel of Cardiovascular Health Diet performed satisfactorily regarding validity and reliability by BMI and was associated with higher overall dietary quality, with the Healthy Eating Index-2020 as a relative reference.

Mindful eating questionnaire: Validation and reliability in Brazilian adults with type 2 diabetes mellitus.

OBJECTIVE: The objective was to evaluate the psychometric properties of the Mindful Eating Questionnaire (MEQ) in Brazilian subjects with type 2 diabetes mellitus (T2DM) and validate a Brazilian version of the MEQ for adults with T2DM (MEQ-DM). METHODOLOGY: Baseline data from the multicentre Nutritional Strategy for Glycaemic Control in Patients with Type 2 Diabetes Mellitus (NUGLIC) trial were used. Construct validity was assessed using exploratory factor analysis (EFA). The root mean square error of approximation (RMSEA), comparative fit index (CFI) and Tucker‒Lewis index (TLI) fit indices indicated the adequacy of the model. The reliability of the questionnaire was evaluated considering the different factor loadings. Criterion validity was tested by correlating the MEQ-DM with sociodemographic variables, body mass index (BMI) and physical activity levels. RESULTS: A total of 370 participants were included, who were mostly female (60.8 %) and had a median age of 61 (54-67) years. The EFA results supported the two-factor structure of the 25-item MEQ-DM: disinhibition and awareness. The results of the fit indices (RMSEA = 0.04; CFI = 0.95 and TLI = 0.94) and composite reliability (disinhibition = 0.84 and awareness = 0.81) were consistent. The criterion validity analysis indicated a significant association between MEQ-DM scores and age, sex, civil status, education level, BMI and physical activity (p < 0.05). CONCLUSION: When explored with Brazilian adults with T2DM, the MEQ-DM presented a factorial model with two dimensions: disinhibition and awareness. This model must be confirmed in future studies with Brazilians with T2DM.

Body adiposity markers and insulin resistance in patients with type 1 diabetes

ABSTRACT Objectives: Body composition changes are associated with adverse effects such as increased insulin resistance (IR) in individuals with diabetes mellitus. This study aims to evaluate the association between different body adiposity markers and IR in adults with type 1 diabetes (T1D). Subjects and methods: The cross-sectional study included outpatient adults with T1D from a university public hospital in southern Brazil. The body adiposity markers studied were waist circumference (WC), waist-height ratio (WHtR), body mass index (BMI), conicity index (CI), lipid accumulation product (LAP) and body adiposity index (BAI). IR was calculated using an Estimated Glucose Disposal Rate (EGDR) equation (analyzed in tertiles), considering an inverse relation between EGDR and IR. Poisson regression models were used to estimate the odds ratio (OR) and 95% CIs of association of adiposity markers with IR. Results: A total of 128 patients were enrolled (51% women), with a median EGDR of 7.2 (4.4-8.7) mg.kg−1.min−1. EGDR was negatively correlated with WC (r = −0.36, p < 0.01), WHtR (r = −0.39, p < 0.01), CI (r = −0.44, p < 0.01), LAP (r = −0.41, p < 0.01) and BMI (r = −0.24, p < 0.01). After regression analyses, WC (OR = 2.07; CIs: 1.12-3.337; p = 0.003), WHtR (OR = 2.77; CIs: 1.59-4.79; p < 0.001), CI (OR = 2.59; CIs: 1.43-4.66; p = 0.002), LAP (OR = 2.27; CIs: 1.25-4.11; p = 0.007) and BMI (OR = 1.78; CIs: 1.09-2.91; p = 0.019) remained associated with IR. Conclusions: The authors suggest using the studied adiposity markers as a routine since they were shown to be suitable parameters in association with IR.

Malnutrition screening tool and malnutrition universal screening tool as a predictors of prolonged hospital stay and hospital mortality: A cohort study.

BACKGROUND & AIMS: Different nutrition screening tools have been proposed to screen inpatients, although, there is still no consensus regarding the reference method for identifying patients at nutritional risk. This retrospective cohort study aimed to evaluate the concurrent and predictive validity of the Malnutrition Screening Tool (MST) and Malnutrition Universal Screening Tool (MUST) to identify inpatients at nutritional risk. METHODS: Data from electronic medical records were collected from adult and elderly inpatients in wards of a public tertiary hospital (Hospital de Clínicas de Porto Alegre, Brazil) over one year. Only the first nutritional evaluation was considered for each patient. GLIM criteria was used for malnutrition status (concurrent validity) and hospital stay length and mortality were outcomes to predictive validity. RESULTS: A total of 5270 patients were included in this study. The mean patient age was 59 ± 16 years old, and 50.7% were males. More than 60% of the patients (65.8%) were admitted to a surgical unit, 63.8% had mild disease-related metabolic stress, 50.7% experienced prolonged hospital stays (more than ten days), and 1.9% of the patients died. Considering the availability of nutritional data, it was possible to perform nutritional screening of 98.1% of patients by MST and 96.7% of patients by MUST. A higher proportion of patients at risk were identified by MUST (53.6%) as compared to MST (21.3%; P < 0.001). MST had 89.9% of Specificity, 60.4% of PPV, 94.6% of NPV, and a moderate agreement with malnutrition by GLIM criteria (κ = 0.591; P < 0.001). A prolonged hospital stay was positively associated with the classification of nutritional risk based on both screening tools. Death was positively associated with nutritional risk by MST (hazard ratio [HR] 2.09; 95% confidence interval [CI] 1.37-3.16) and by MUST (HR 1.79; 95% CI 1.00-3.18) after adjustment based on sex, age, admission type (surgical or clinical), and disease-related metabolic stress. CONCLUSIONS: MST may be good concurrent validity to malnutrition by GLIM criteria as compared to MUST. However, both risk nutritional tools were positively associated with predicting a prolonged hospital stay and mortality.

Body adiposity markers and insulin resistance in patients with type 1 diabetes.

Objective: Body composition changes are associated with adverse effects such as increased insulin resistance (IR) in individuals with diabetes mellitus. This study aims to evaluate the association between different body adiposity markers and IR in adults with type 1 diabetes (T1D). Subjects and methods: The cross-sectional study included outpatient adults with T1D from a university public hospital in southern Brazil. The body adiposity markers studied were waist circumference (WC), waist-height ratio (WHtR), body mass index (BMI), conicity index (CI), lipid accumulation product (LAP) and body adiposity index (BAI). IR was calculated using an Estimated Glucose Disposal Rate (EGDR) equation (analyzed in tertiles), considering an inverse relation between EGDR and IR. Poisson regression models were used to estimate the odds ratio (OR) and 95% CIs of association of adiposity markers with IR. Results: A total of 128 patients were enrolled (51% women), with a median EGDR of 7.2 (4.4-8.7) mg.kg-1.min-1. EGDR was negatively correlated with WC (r = -0.36, p < 0.01), WHtR (r = -0.39, p < 0.01), CI (r = -0.44, p < 0.01), LAP (r = -0.41, p < 0.01) and BMI (r = -0.24, p < 0.01). After regression analyses, WC (OR = 2.07; CIs: 1.12-3.337; p = 0.003), WHtR (OR = 2.77; CIs: 1.59-4.79; p < 0.001), CI (OR = 2.59; CIs: 1.43-4.66; p = 0.002), LAP (OR = 2.27; CIs: 1.25-4.11; p = 0.007) and BMI (OR = 1.78; CIs: 1.09-2.91; p = 0.019) remained associated with IR. Conclusion: The authors suggest using the studied adiposity markers as a routine since they were shown to be suitable parameters in association with IR.

Association of Eating Patterns and Diabetic Kidney Disease in Type 2 Diabetes: A Cross-Sectional Study.

OBJECTIVE: The aim of this cross-sectional study was to evaluate the relationship between eating patterns and diabetic kidney disease in patients with type 2 diabetes. METHODS: Outpatients underwent clinical and nutritional evaluation. Dietary information was obtained through a validated quantitative food frequency questionnaire, and eating patterns were identified by cluster analysis. Diabetic kidney disease was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 and/or persistently elevated urinary albumin concentration (albuminuria ≥ 14 mg/L). Procedures involving patients were approved by the Hospital's Ethics Committee. Patients with type 2 diabetes treated at university hospital and tertiary referral center, southern Brazil. RESULTS: A total of 329 patients were evaluated: mean age 62 ± 10 years, body mass index 30.9 ± 4.2 kg/m2, glycated hemoglobin 8.7% ± 2.0, and 10 (5 to 19) years of diabetes duration. Four eating patterns were identified based on cluster analysis: healthy= dairy products, fruits, and vegetables; snacks= dairy products, whole breads, vegetables, and low-calorie products; processed foods= refined carbohydrates and processed meat, and red meat= red meat. Poisson regression models confirmed that snack eaters (PR = 1.48, 95% CI 1.10, 1.99; P = .010) and red meat eaters (PR = 1.93, 95% CI 1.29, 2.89; P = .001) were associated with diabetic kidney disease. CONCLUSION: In this sample of outpatients with type 2 diabetes, the patterns of snacks and red meat were associated with diabetic kidney disease as compared to a healthy pattern.

A quantitative analysis of the impact of explicit incorporation of recency, seasonality and model specialization into fine-grained tourism demand prediction models.

Forecasting is of utmost importance for the Tourism Industry. The development of models to predict visitation demand to specific places is essential to formulate adequate tourism development plans and policies. Yet, only a handful of models deal with the hard problem of fine-grained (per attraction) tourism demand prediction. In this paper, we argue that three key requirements of this type of application should be fulfilled: (i) recency-forecasting models should consider the impact of recent events (e.g. weather change, epidemics and pandemics); (ii) seasonality-tourism behavior is inherently seasonal; and (iii) model specialization-individual attractions may have very specific idiosyncratic patterns of visitations that should be taken into account. These three key requirements should be considered explicitly and in conjunction to advance the state-of-the-art in tourism prediction models. In our experiments, considering a rich set of indoor and outdoor attractions with environmental and social data, the explicit incorporation of such requirements as features into the models improved the rate of highly accurate predictions by more than 320% when compared to the current state-of-the-art in the field. Moreover, they also help to solve very difficult prediction cases, previously poorly solved by the current models. We also investigate the performance of the models in the (simulated) scenarios in which it is impossible to fulfill all three requirements-for instance, when there is not enough historical data for an attraction to capture seasonality. All in all, the main contributions of this paper are the proposal and evaluation of a new information architecture for fine-grained tourism demand prediction models as well as a quantification of the impact of each of the three aforementioned factors on the accuracy of the learned models. Our results have both theoretical and practical implications towards solving important touristic business demands.

Infodemics and health misinformation: a systematic review of reviews.

Objective: To compare and summarize the literature regarding infodemics and health misinformation, and to identify challenges and opportunities for addressing the issues of infodemics. Methods: We searched MEDLINE®, Embase®, Cochrane Library of Systematic Reviews, Scopus and Epistemonikos on 6 May 2022 for systematic reviews analysing infodemics, misinformation, disinformation and fake news related to health. We grouped studies based on similarity and retrieved evidence on challenges and opportunities. We used the AMSTAR 2 approach to assess the reviews' methodological quality. To evaluate the quality of the evidence, we used the Grading of Recommendations Assessment, Development and Evaluation guidelines. Findings: Our search identified 31 systematic reviews, of which 17 were published. The proportion of health-related misinformation on social media ranged from 0.2% to 28.8%. Twitter, Facebook, YouTube and Instagram are critical in disseminating the rapid and far-reaching information. The most negative consequences of health misinformation are the increase of misleading or incorrect interpretations of available evidence, impact on mental health, misallocation of health resources and an increase in vaccination hesitancy. The increase of unreliable health information delays care provision and increases the occurrence of hateful and divisive rhetoric. Social media could also be a useful tool to combat misinformation during crises. Included reviews highlight the poor quality of published studies during health crises. Conclusion: Available evidence suggests that infodemics during health emergencies have an adverse effect on society. Multisectoral actions to counteract infodemics and health misinformation are needed, including developing legal policies, creating and promoting awareness campaigns, improving health-related content in mass media and increasing people's digital and health literacy.

On network backbone extraction for modeling online collective behavior.

Collective user behavior in social media applications often drives several important online and offline phenomena linked to the spread of opinions and information. Several studies have focused on the analysis of such phenomena using networks to model user interactions, represented by edges. However, only a fraction of edges contribute to the actual investigation. Even worse, the often large number of non-relevant edges may obfuscate the salient interactions, blurring the underlying structures and user communities that capture the collective behavior patterns driving the target phenomenon. To solve this issue, researchers have proposed several network backbone extraction techniques to obtain a reduced and representative version of the network that better explains the phenomenon of interest. Each technique has its specific assumptions and procedure to extract the backbone. However, the literature lacks a clear methodology to highlight such assumptions, discuss how they affect the choice of a method and offer validation strategies in scenarios where no ground truth exists. In this work, we fill this gap by proposing a principled methodology for comparing and selecting the most appropriate backbone extraction method given a phenomenon of interest. We characterize ten state-of-the-art techniques in terms of their assumptions, requirements, and other aspects that one must consider to apply them in practice. We present four steps to apply, evaluate and select the best method(s) to a given target phenomenon. We validate our approach using two case studies with different requirements: online discussions on Instagram and coordinated behavior in WhatsApp groups. We show that each method can produce very different backbones, underlying that the choice of an adequate method is of utmost importance to reveal valuable knowledge about the particular phenomenon under investigation.

The AHA Recommendations for a Healthy Diet and Ultra-Processed Foods: Building a New Diet Quality Index.

The American Heart Association (AHA) has developed the concept of "ideal cardiovascular health" (ICH), a seven-component score, which includes health dietary metrics. Higher ultra-processed foods intake is related with several cardiometabolic and cardiovascular diseases. We propose to develop and validate the Cardiovascular Health Diet Index (CHDI), a diet quality index that combines the AHA's recommendations of a healthy diet for cardiovascular health and ultra-processed foods. We used dietary data obtained through a 114-item FFQ from 14,779 participants of the Brazilian Longitudinal Study of Adults Health (ELSA-Brasil). The CHDI had 11 components and a total score ranging from 0 to 110 points. Validation and reliability analyses were performed, including principal component analyses, association with selected nutrients, means differences between groups (for example, smokers vs. non-smokers), Cronbach's alpha, and linear regression analyses between CHDI and overall dietary quality. The mean CHDI was 57.1 points (95% CI 47.9:66.0). The CHDI had four dimensions; in addition, it was associated with nutrients related to cardiovascular health, and the points were significantly (p < 0.001) lower in smokers (52.1) than in non-smokers (57.8). Cronbach's alpha value was 0.50. After age and sex adjustment, the CHDI score remained associated with a higher overall dietary quality (ß 0.87, 95%CI 0.84:0.89, p < 0.001). The CHDI proved to be valid and reliable for use, in addition to being associated with higher overall dietary quality. The use of CHDI is expected to assess the population's compliance with dietary recommendations for promoting cardiovascular health and preventing cardiovascular disease.

Avaliação do consumo de frutas em pacientes com diabetes mellitus tipo 2 / Fruit consumption in patients with type 2 diabetes mellitus

Introdução: O impacto do consumo de frutas sobre a saúde de pacientes com diabetes mellitus tipo 2 (DM2) requer investigações. O objetivo deste estudo foi avaliar o consumo de frutas em pacientes com DM2 e identificar a sua associação com parâmetros de controle glicêmico.Métodos: Foram incluídos 197 pacientes ambulatoriais com DM2, submetidos à avaliação clínica, sociodemográfica, antropométrica, laboratorial e de consumo alimentar. A ingestão alimentar total e o consumo de frutas foram avaliados por questionário quantitativo de frequência alimentar. Os pacientes com menor e maior consumo de frutas (de acordo com a mediana) foram comparados.Resultados: A média do consumo de frutas foi de 593,66 ± 330,74 g/dia. Entre os menores e maiores consumidores de frutas, os valores de glicemia (169,42 ± 70,83 vs. 158,62 ± 64,56 mg/dL; p = 0,273) e hemoglobina glicada (8,39 ± 1,68 vs. 8,68 ± 2,38%; p = 0,319) não foram diferentes, assim como as demais variáveis. Os pacientes com maior consumo de frutas apresentaram maior ingestão de energia (p < 0,001), carboidratos (p < 0,001) e fibras (p = 0,006) e uma menor ingestão de proteínas (p = 0,015), lipídeos totais (p = 0,040) e seus tipos. O grupo que mais consumiu frutas apresentou uma maior ingestão de vitamina C (p < 0,001) e potássio (p < 0,001) e um menor consumo de sódio (p = 0,001). Foi observado ainda uma correlação negativa entre o consumo de frutas e o índice glicêmico da dieta (p = 0,05).Conclusão: Não houve diferença na glicemia em jejum e no valor de hemoglobina glicada entre os pacientes com DM2 com maior e menor consumo de frutas.

Introduction: The impact of fruit consumption on the health of patients with type 2 diabetes mellitus (T2DM) warrants investigation. The aim of this study was to evaluate fruit consumption in patients with T2DM and to identify its association with glycemic control parameters.Methods: We included 197 outpatients with T2DM who underwent clinical, sociodemographic, anthropometric, laboratory, and food consumption assessments. A food frequency questionnaire was used to assess total food intake and fruit consumption. Patients with lower and higher fruit consumption (according to the median) were compared.Results: Average fruit consumption was 593.66 ± 330.74 g/day. Blood glucose (169.42 ± 70.83 vs. 158.62 ± 64.56 mg/dL; p = 0.273) and glycated hemoglobin (8.39 ± 1.68% vs. 8.68 ± 2.38%; p = 0.319) levels did not differ between the lower and higher fruit consumption groups, nor did the other variables. Patients with higher fruit consumption had a higher intake of energy (p < 0.001), carbohydrates (p < 0.001), and fibers (p = 0.006) but a lower intake of proteins (p = 0.015) and total and different types of lipids (p = 0.040). The higher consumption group had higher vitamin C (p < 0.001) and potassium (p < 0.001) intake and lower sodium intake (p = 0.001). We identified a negative correlation between fruit consumption and the diet's glycemic index (p = 0.05).Conclusion: Fasting blood glucose and glycated hemoglobin levels did not differ between the higher and lower fruit consumption groups.

Effects of population mobility on the COVID-19 spread in Brazil.

This article proposes a study of the SARS-CoV-2 virus spread and the efficacy of public policies in Brazil. Using both aggregated (from large Internet companies) and fine-grained (from Departments of Motor Vehicles) mobility data sources, our work sheds light on the effect of mobility on the pandemic situation in the Brazilian territory. Our main contribution is to show how mobility data, particularly fine-grained ones, can offer valuable insights into virus propagation. For this, we propose a modification in the SENUR model to add mobility information, evaluating different data availability scenarios (different information granularities), and finally, we carry out simulations to evaluate possible public policies. In particular, we conduct a case study that shows, through simulations of hypothetical scenarios, that the contagion curve in several Brazilian cities could have been milder if the government had imposed mobility restrictions soon after reporting the first case. Our results also show that if the government had not taken any action and the only safety measure taken was the population's voluntary isolation (out of fear), the time until the contagion peak for the first wave would have been postponed, but its value would more than double.

Association of specialized enteral nutrition with glycemic control and clinical outcomes in critically ill patients: A meta-analysis of randomized controlled trials.

OBJECTIVE: To evaluate the association of glycemic-control formulae (GCF) with measurements of glycemic control and clinical outcomes compared to standard enteral formulae (SF) in critically ill patients. DATA SOURCES: MEDLINE, EMBASE, Scopus and the Cochrane Central Register of Controlled Trials were searched from inception up to January, 2021. STUDY SELECTION: RCTs that assessed the effects of GCF relative to SF in adult critically ill patients. DATA EXTRACTION: Measurements of glycemic control were the primary outcomes. Secondary outcomes included insulin requirements, mechanical ventilation (MV), length of intensive care unit (ICU) stay and mortality. Two authors independently extracted data and assessed risk of bias using the Cochrane's RoB 2 tool and the GRADE approach was used to assess the quality of evidence. DATA SYNTHESIS: Ten studies (12 reports, 685 patients) were included. The use of GCFs was associated with lower blood glucose (WMD, -16.06 mg/dL; 95% CI -23.48 to -8.63; I2 = 47%) and lower daily administered insulin (WMD, -7.20 IU; 95% CI -13.92 to -0.48; I2 = 53%). Glycemic variability, measured by the coefficient of variation, was also associated with the use of GCFs (WMD, -6.84%; 95% CI, -13.57 to -0.11; I2 = 95%). In contrast, analyses for length of ICU stay (WMD, -0.12, 95% CI -1.77 to 1.52; I2 = 0%), duration of MV (WMD, -0.34 days; 95% CI, -1.72 to 1.04; I2 = 0%) and mortality (RR, 1.13; 95% CI 0.82 to 1.56; I2 = 0%) were not statistically significant. Quality of evidence ranged from low to very low, and only one study was judged as at low risk of bias. CONCLUSIONS: In this meta-analysis, GCFs were significantly associated with lower insulin requirements and improved glycemic control. Although results for clinical outcomes were not statistically significant, there is insufficient evidence to confirm or exclude important differences due to serious imprecision in the effect estimates and overall low quality of evidence. The effects of GCFs on clinical outcomes require confirmation in larger randomized trials.

Dietary patterns of adults with asthma treated at a referral center for asthma

Introduction: Consumption of foods with anti-inflammatory and antioxidant components could contribute to a better control of the asthma. The aim of this study was to assess the association between dietary patterns, nutritional status, and asthma control in patients treated at an asthma referral center in Porto Alegre, Brazil. Methods: This is a cross-sectional study with 198 adult asthma patients. Participants completed a 24-hour food recall and a questionnaire on disease history, degree of control, and severity, as well as pulmonary and anthropometric assessments. We used exploratory factor analysis and principal component analysis as an extraction method to derive the dietary patterns. Results: The mean body mass index was 29.6 (SD, 5.7) kg/m2, and 41.9% were classified as obese. Regarding disease severity, 72.7% were classified as having severe persistent asthma, and concerning the degree of control, 59.6% of the patients had uncontrolled asthma. Three dietary patterns were identified: "Sugars", "Healthy", and "Fats and Alcohol". It was observed that the Fats and Alcohol pattern was significantly associated with men. However, no associations were observed between the other variables and dietary patterns. Conclusion: This was the first study to identify the dietary patterns in asthmatics in Brazil. Patterns found in the present study were "Sugars", "Healthy" and "Fats and Alcohol". However, there was no significant association between the 3 patterns and nutritional status or disease control. (AU)

FISETIO: A FIne-grained, Structured and Enriched Tourism Dataset for Indoor and Outdoor attractions.

This paper aims to introduce our publicly available datasets in the area of tourism demand prediction for future experiments and comparisons. Most of the previous works in the area of tourism demand forecasting are based on coarse-grained analysis (level of countries or regions) and there are very few works and consequently datasets available for fine-grained tourism analysis (level of attractions and points of interest). In this article, we present our fine-grained enriched datasets for two types of attractions - (I) indoor attractions (27 Museums and Galleries in U.K.) and (II) outdoor attractions (76 U.S. National Parks) enriched with official number of visits, social media reviews and environmental data for each of them. In addition, the complete analysis of prediction results, methodology and exploited models, features' performance analysis, anomalies, etc, are available in our original paper, "Fine-grained tourism prediction: Impact of social and environmental features"[2].

Diet Quality and Glycemic Control in Patients with Type 2 Diabetes.

BACKGROUND: The overall diet quality of individuals and populations can be assessed by dietary indexes based on information from food surveys. Few studies have evaluated the diet quality of individuals with type 2 diabetes or its potential associations with glycemic control. OBJECTIVE: To evaluate the relationship between diet quality and glycemic control. DESIGN: Cross-sectional study with consecutive enrollment from 2013 to 2016. PARTICIPANTS: Outpatients with type 2 diabetes treated at a university hospital in southern Brazil. MAIN OUTCOME MEASURES: Dietary information was obtained by a quantitative food frequency questionnaire validated for patients with diabetes. Overall diet quality was evaluated by the Healthy Eating Index 2010. Glycemic control was assessed by fasting plasma glucose and glycated hemoglobin. STATISTICAL ANALYSES: A receiver operating characteristic curve was constructed to find the optimal Healthy Eating Index cutoff point to discriminate diet quality, considering good glycemic control as glycated hemoglobin level <7%. Patients were then classified as having lower vs higher diet quality, and the two groups were compared statistically. Logistic regression models were constructed with glycated hemoglobin level ≥7% as the dependent variable, adjusted for age, current smoking, diabetes duration and treatment, physical activity, body mass index, high-density lipoprotein cholesterol level, and energy intake. RESULTS: A total of 229 patients with type 2 diabetes (median age=63.0 years [interquartile range=58.0 to 68.5 years]; diabetes duration=10.0 years [interquartile range=5 to 19 years]; body mass index 30.8±4.3; and glycated hemoglobin=8.1% [interquartile range=6.9% to 9.7%]) were evaluated. A Healthy Eating Index score >65% yielded the best properties (area under the receiver operator characteristic curve=0.60; sensitivity=71.2%; specificity=52.1%; P=0.018). Patients with lower-quality diets were younger and more likely to be current smokers than patients with higher-quality diets. After adjusting for confounders, patients with lower-quality diets had nearly threefold odds of poorer glycemic control (2.92; 95% CI 1.27 to 6.71; P=0.012) than those in the higher-quality diet group. CONCLUSIONS: Lower diet quality, defined as an Healthy Eating Index 2010 score <65%, was associated with poor glycemic control in this sample of outpatients with type 2 diabetes.