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- Eating Attitudes of Patients with Celiac Disease in Brazil: A Nationwide Assessment with the EAT-26 InstrumentPublication . Franco, Luiza; Yoshio Nakano, Eduardo; Raposo, Antonio; Alturki, Hmidan; Alarifi, Sehad; Chaves, Claudia; Teixeira-Lemos, Edite; Romão, BernardoCeliac disease (CD) is an immune-mediated enteropathy triggered by the ingestion of gluten in genetically predisposed individuals. In this sense, a gluten-free diet is the only safe treatment available. Due to the restrictions resulting from this eating pattern, this treatment may impair the relationship of the people with CD with food, increasing the risk of a disordered eating attitude, which is associated with eating disorders. The EAT-26 is a validated instrument already applied worldwide in different populations, and higher scores are suggestive of eating attitudes prone to evolve into eating disorders. Studies carried out in other countries have already shown that people with CD are prone to developing eating disorders; however, no study has been carried out with this theme in the population with CD in Brazil. We carried out a nationwide cross-sectional study in three steps: (i) study design and instrument; (ii) recruitment of participants and ethics; (iii) statistical analysis. A total of 385 participants were included in our sample, 96.36% of them being women. The internal consistency of the applied self-administered Brazilian version of the EAT-26 online questionnaire presented a satisfactory Cronbach’s alpha of 0.812, and in total, 36.1% of the respondents were classified with a disordered eating attitude. No differences were found among the scores of participants when divided by categories regarding gender, average monthly income, age, and educational level. However, scores classified as a disordered eating attitude were found in respondents with a body mass index classified as overweight and obese. Our study highlights that disordered eating attitudes are present in overweight and obese women with celiac disease; thus, public health politics are needed to prevent and treat these attitudes.
- Exclusion Experiences in the academy: challenges to interculturalityPublication . Coutinho, Emília; Oliveira, A.; Reis, C.; Oliveira, Isabel; Maltez, L.; Osório, S.; Parreira, V.; Nelas, Paula; Margarida Correia Balula Chaves, Cláudia; Antunes, Sandra Maria Gouveia; Marques Dos Santos, Paula; Duarte, JoãoIntrodução Relatos de vivências de exclusão académica apresentam-se como desafios às instituições de ensino superior (IES) na sua capacidade de desenvolverem, mas também de aplicarem políticas promotoras de interculturalidade; Objetivos Conhecer as práticas institucionais interpretadas como barreiras à inclusão e desafios à interculturalidade; e desocultar os sentimentos vividos pela comunidade académica em contextos experienciados que considerem de exclusão; Métodos Estudo qualitativo, fenomenológico-hermenêutico com recurso à entrevista fenomenológica a trinta membros da comunidade académica (estudantes, docentes e não docentes) de uma IES de Portugal, de abril a julho de 2019, com suporte a análise qualitativa de dados apoiada pelo Nvivo12. Este trabalho insere-se num projeto mais alargado intitulado “Práticas inclusivas no Ensino Superior: O desafio de construir comunidade”, autorizado pela Comissão de Ética da Instituição envolvida; Resultados Apresentam-se as categorias “Barreiras à inclusão na instituição” e “Sentimentos vivenciados em experiências de exclusão”. As barreiras à inclusão na instituição mais referenciadas foram barreiras arquitetónicas e desunião hierárquica na instituição. No que concerne aos sentimentos vivenciados em experiências de exclusão, os participantes referenciaram essencialmente o sentir-se desvalorizado, a solidão e a tristeza; Conclusões. As barreiras arquitetónicas da instituição, o sentir-se desvalorizado, a solidão e a tristeza são os principais desafios institucionais à inclusão e interculturalidade.
- Exploring Lifestyle Factors and Treatment Adherence among Older Adults with Hypertension Attending a Mobile Health Unit (MHU) in a Rural Area of Central PortugalPublication . Pinto, Cátia; Margarida Correia Balula Chaves, Cláudia; Duarte, João; Raposo, António; Zandonadi, Renata Puppin; Monteiro, Sara; Teixeira-Lemos, EditeThis cross-sectional and analytical study aimed to characterize a sample of hypertensive older adults attending a Mobile Health Unit (MHU) in a rural area of central Portugal according to their lifestyle and to analyze the impact of lifestyles on treatment adherence. The sample comprised 235 Portuguese hypertense patients, mainly females (63.8%) with a mean age of 75 years (±8.14 years) and low level of education. The data collection was carried out through a questionnaire consisting of sociodemographic questions, dietary variables, an Alcohol Dependence Questionnaire, an International Physical Activity Questionnaire (Short Version), a Nutrition Health Determination Questionnaire, a Self-Care with Hypertension Scale, and an Adherence to Treatments Measurement Scale. Only 34.5% of the hypertensive patients have controlled blood pressure values (28.2% men and 38% women). However, more than half (56.2%) of the hypertensive patients are classified as adherent to therapeutic measures. The hypertensive individuals, who present higher levels of adherence to the treatment, do not present alcohol dependence, are frequent consumers of aromatic herbs, sporadically consume salt, present good nutritional health, and practice moderate physical activity. The predictor variables for treatment adherence are the self-care dimensions general dietary (p = 0.001), specific dietary (p = 0.034), physical activity (p = 0.031), and antihypertensive medication intake (p < 0.001). Hypertensive patients with healthier lifestyles present better levels of treatment adherence. Therefore, promoting physical activity and healthy dietary practices is necessary to improve treatment adherence and increase antihypertensive treatment’s effectiveness.
- A Pilot Study on Dietary Choices at Universities: Vending Machines, Canteens, and Lunch from HomePublication . Oliveira, Leandro; BinMowyna, Mona N.; Alasqah, Ibrahim; Zandonadi, Renata Puppin; Teixeira-Lemos, Edite; Margarida Correia Balula Chaves, Cláudia; Alturki, Hmidan A.; Albaridi, Najla A.; Alribdi, Fatmah Fahad; Raposo, AntónioAbstract Commercial environments and food acquisition methods significantly shape dietary practices and impact health. This study assesses dietary choices among Portuguese university students regarding vending machines, canteens, and lunches from home. It also evaluates their use of the university canteen and their tendency to bring lunch from home. This pilot cross-sectional study used a self-administered electronic questionnaire, made available in early 2023. Participants were recruited through snowball sampling. The study included 137 students from Portuguese higher education institutions, mainly women (74.5%), pursuing degrees or integrated Master’s degrees (83.2%), primarily in health-related fields (55.5%). The median age was 21 years (20 to 23.5 years). About 70.0% regularly consumed food from vending machines, while approximately 60.0% brought lunch from home, avoiding the canteen. Factors such as convenience (48.5%), price (47.5%), product availability (40.6%), and taste (39.6%) mainly influenced vending machine choices. Monthly, chocolates, water, coffee, cookies, treats, and soft drinks were the most commonly acquired items, with coffee being the most frequent daily purchase. These findings provide insights for creating policies and initiatives to promote healthier and more accessible food options for students and strategies to encourage positive eating behaviors.
- Risk of falls and social determinants in the elderly living in a rural community.Publication . Coimbra, Vera; Marques, Ermelinda; Chaves, Claudia; Saraiva, Renata JabourAbstract: Objective: To evaluate the risk of falls and to identify the social determinants associated with them in the elderly living in a rural community. Methodology: Quantitative, cross-sectional, descriptive, and correlational study, performed in a probabilistic sample, randomly selected, with an estimated frequency of 50% and with an acceptable margin of error of 5% and a confidence level of 95%. Study carried out at the Primary Health Care level, in a Personalized Health Care Unit, of the Northern Region of Portugal. The randomly selected sample consisted of 321 people over the age of 65, with a mean age of 76.11 ± 6.79, living in the community, of whom 175 (54.5%) were female and 146 (45.5%) were male. Data collection was done through the straightforward filling out of an evaluation protocol, using the Morse scale. Results: The Morse scale allowed us to verify that 33.0% of the sample presented a low risk of falling and 7.2% a high risk. The risk of falls was associated with age, sex, the fact that the elderly lives with other relatives, the unmarried, those with the lowest incomes and those who receive support. Conclusion: Social determinants have an impact on the risk of falls and should be considered in fall prevention programs.
- Risk of Gluten Cross-Contamination Due to Food Handling Practices: A Mini-ReviewPublication . Damasceno, Renatta Pereira B.; Zandonadi, Renata Puppin; Mendes, Marcela; Cunha Junior, Luis Carlos; Raposo, António; Teixeira-Lemos, Edite; Margarida Correia Balula Chaves, Cláudia; Farage, PriscilaAbstract Celiac disease (CD) is an autoimmune disease triggered by the ingestion of gluten in genetically predisposed individuals, affecting 1.4% of the world population. CD induces an inflammatory reaction that compromises small intestine villi, leading to nutrient malabsorption, and gastro and extraintestinal manifestations. Although other treatment approaches are being studied, adherence to a gluten-free diet (GFD) is the only effective intervention to date. Despite this, about 50% of patients experience persistent inflammation, often associated with unintentional gluten ingestion through contaminated food. There are regulations for labeling gluten-free foods which specify a limit of 20 mg/kg (20 ppm). The risks of gluten cross-contamination above that level are present throughout the whole food production chain, emphasizing the need for caution. This review explores studies that tested different procedures regarding the shared production of gluten-containing and gluten-free food, including the use of shared equipment and utensils. A literature review covering PubMed, Scielo, Web of Science, VHL and Scopus identified five relevant studies. The results indicate that shared environments and equipment may not significantly increase gluten cross-contamination if appropriate protocols are followed. Simultaneous cooking of gluten-containing and gluten-free pizzas in shared ovens has demonstrated a low risk of contamination. In general, shared kitchen utensils and equipment (spoon, ladle, colander, knife, fryer, toaster) in controlled experiments did not lead to significant contamination of samples. On the other hand, cooking gluten-free and gluten-containing pasta in shared water resulted in gluten levels above the established limit of 20 ppm. However, rinsing the pasta under running water for a few seconds was enough to reduce the gluten content of the samples to less than 20 ppm.
- Significados atribuídos ao programa de mentoria implementado numa instituição de ensino superiorPublication . Coutinho, Emília; Santos, Elisa; Esteves, Inês; Tavares, Rita; Margarida Correia Balula Chaves, Cláudia; Correia, Paula; Marques Dos Santos, PaulaIntrodução: O presente trabalho parte do interesse pelo acompanhamento dos processos desenvolvidos e vivenciados no âmbito do Programa de Mentoria de uma Instituição de Ensino Superior, no decorrer do ano letivo 2019/2020. A implementação dos princípios da educação inclusiva no ensino superior é um desafio à própria instituição, professores e estudantes, o que pode ser concretizado na implementação de Programas de Mentoria/Tutoria. Objetivos: Compreender o significado da implementação do Programa de Mentoria para os estudantes da instituição; Reconhecer os principais papéis desempenhados na mentoria. Métodos: Este estudo parte da entrada em campo no Projeto da Mentoria existente numa Instituição de Ensino Superior, através das ferramentas metodológicas do estudo descritivo e exploratório, de natureza qualitativa. Foi utilizada a metodologia sociopoética na abordagem dos dados recolhidos na base de dados do estudo: “Práticas inclusivas na instituição: Perceções sobre a Implementação de um Programa de Mentoria”. Resultados: Os resultados, obtidos subjetiva e empiricamente, permitiram concluir que, do tema desocultado “Significado Atribuído ao Programa de Mentoria Implementado”, emergiram nove categorias, nomeadamente: “Significado atribuído ao momento em que foi iniciado”; “Significado atribuído à forma de seleção do par mentor-mentorado”; “Significado atribuído às orientações recebidas”; “Significado conferido às funções atribuídas ao tutor”; “Significado atribuído às funções atribuídas ao mentor”; “Significado atribuído à frequência e duração dos encontros”; “Significado atribuído à relação de Mentoria estabelecida”; “Significado atribuído à continuidade do Programa na instituição” e “Significado atribuído ao valor atribuído ao Programa”. Conclusão: Este trabalho de investigação proporcionou outra abordagem à Mentoria quanto à forma e ao estilo. Não devem, contudo, restar dúvidas de que a Mentoria é sempre um instrumento para a inclusão de todos os estudantes, independentemente das suas características individuais, devendo o mentor ser solidário, uma fonte de apoio, um suporte, não assumindo protagonismos, pois o centro do Programa de Mentoria são os estudantes e a sua plena inclusão no universo institucional e académico.
- Brazilian Front-of-Package Labeling: A Product Compliance Analysis 12 Months after Implementation of RegulationsPublication . Senda, Marcos Vinícius Garcia; Raposo, António; Teixeira-Lemos, Edite; Margarida Correia Balula Chaves, Cláudia; Alturki, Hmidan A.; Alsharari, Zayed D.; Romão, BernardoThis study investigated the presence of front-of-package labeling on food products in major retailers in Brazil after its implementation in 2022. Carried out from May to October 2023, we analyzed 2145 products of brands present in five Brazilian states. A total of 541 products presented front-of-package warnings. The categories varied in their adherence to front-of-package labeling, highlighting a prevalence of combined warnings, such as high in added sugar and high in saturated fat on sweet biscuits and chocolates. Sausages showed a high prevalence of high in sodium and high in saturated fat warnings. Beverages stood out as high in added sugar, while fats, dairy products, frozen preparations, seasonings, and sauces presented diversity in the warnings. Other products, such as panettone, showed a high presence of alerts. The study demonstrated the widespread presence of front-of-package labeling on ultra-processed products highly consumed by the Brazilian population. Considering the alarming presence of these foods in the Brazilian diet, it is concluded that front-of-package nutrition labeling is crucial to inform and raise awareness among consumers, allowing healthier choices and potentially contributing to a reduction in chronic diseases and the costs associated with treatment in the health system.
- Enhancing life with celiac disease: unveiling effective tools for assessing health-related quality of lifePublication . Falcomer, Ana Luísa; de Lima, Bernardo Romão; Farage, Priscila; Fabris, Samantha; Ritter, Ruth; Raposo, António; Teixeira-Lemos, Edite; Margarida Correia Balula Chaves, Cláudia; Zandonadi, Renata PuppinAbstract Celiac disease (CD) is an autoimmune chronic enteropathy provoked by gluten ingestion in genetically predisposed individuals. Considering it´s only safe treatment is a lifelong gluten-free diet, the burden of living with the disease becomes evident, as well as the need to assess CD health-related quality of life (HRQOL). This review aims to identify and analyze the instruments used to evaluate the HRQOL of adults with CD. This integrative review using a systematic approach was designed to achieve high scientific standards. Accordingly, the search strategy was developed and executed as recommended by the guideline of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Detailed individual searches were developed to Pubmed, Science Direct, Scopus, Web of Science, and Google Scholar. After careful analysis of the papers, 43 studies were included, in which seven instruments were identified: Celiac Disease Questionnaire (CDQ) (n=21), Celiac Disease Specific Quality of Life Instrument (CD-QOL) (n=17), Celiac Disease Assessment Questionnaire (CDAQ) (n=4), CeliacQ-7 (n=1), CeliacQ-27 (n=1), Black and Orfila´s self-developed instrument (n=1) and the Coeliac Disease Quality of Life Questionnaire (CDQL) (n=1). The CDQ and CD-QOL were the two most applied instruments. Since the first focuses on the physical and mental symptoms related to the disease and the second focuses on the emotional repercussions of adhering to the GFD treatment for life (dysphoria), the CDQ application is an interesting option for countries that struggle with public policies for CD patients and patients with active CD. The CD-QOL could be used for countries with strict regulations for CD and gluten-free products and populations in remission. When comparing results among different populations, it is preferable to utilize culturally validated instruments, which have been applied across multiple countries, providing greater comparability between study findings.
- Health-related quality of life among celiacs in Portugal: a comparison between general and specific questionnairesPublication . Margarida Correia Balula Chaves, Cláudia; Zandonadi, Renata Puppin; Raposo, António; Nakano, Eduardo Yoshio; Ramos, Fernando; Farage, Priscila; Teixeira-Lemos, EditeObjective: This study aimed to compare the 36-Item Short Form Survey Instrument version 2 (SF-36-v2) (generic) and Celiac Disease Questionnaire (CDQ) (specific) questionnaires used to evaluate the quality of life (QoL) in celiac Portuguese adult individuals. Methods: This cross-sectional study used non-probabilistic sampling based on Portuguese celiac patients who accessed the online survey in 2022. The online data collection used a self-reported instrument composed of three parts: (i) socioeconomic, health, and gluten-free diet (GFD) adherence questions; (ii) SF-36 v2 - Portuguese version (generic questionnaire) and (iii) Celiac Disease Questionnaire (CDQ) (specific questionnaire). Results: A total of 234 individuals who accessed the survey completed the questionnaire. Seven of the eight SF-36 domains positively correlated to the specific questionnaire CDQ. The "General Health" domain (domain 4) showed a negative correlation with the CDQ. Differences in content between the two instruments might be able to explain this finding since the CDQ explores issues regarding the specificities of celiac disease (CD) and the lifelong GFD burden. About half of the sample from this study displayed poor diet adherence, it is possible that the SF-36 could not reflect the impact of CD treatment - the complete elimination of gluten from the diet - on patients' health. Therefore, this issue should be carefully evaluated in future research. Conclusion: Specific validated questionnaires for CD individuals, such as the CDQ, contemplate social, economic, and clinical variables that permeate the patient's life context. Therefore, these instruments may be more suitable for evaluating QoL in this public. However, using a general questionnaire such as the SF-36 would be indicated for comparing QOL between celiac patients and the general population or even between CD and other disease individuals. In this case, we recommend assessing GFD compliance for control parallelly.