Inequality on the frontline: A multi-country study on gender differences in mental health among healthcare workers during the COVID-19 pandemic

Healthcare workers (HCWs) were at increased risk for mental health problems during the COVID-19 pandemic, with prior data suggesting women may be particularly vulnerable. Our global mental health study aimed to examine factors associated with gender differences in psychological distress and depressive symptoms among HCWs during COVID-19. Across 22 countries in South America, Europe, Asia and Africa, 32,410 HCWs participated in the COVID-19 HEalth caRe wOrkErS (HEROES) study between March 2020 and February 2021. They completed the General Health Questionnaire-12, the Patient Health Questionnaire-9 and questions about pandemic-relevant exposures. Consistently across countries, women reported elevated mental health problems compared to men. Women also reported increased COVID-19-relevant stressors, including insufficient personal protective equipment and less support from colleagues, while men reported increased contact with COVID-19 patients. At the country level, HCWs in countries with higher gender inequality reported less mental health problems. Higher COVID-19 mortality rates were associated with increased psychological distress merely among women. Our findings suggest that among HCWs, women may have been disproportionately exposed to COVID-19-relevant stressors at the individual and country level. This highlights the importance of considering gender in emergency response efforts to safeguard women's well-being and ensure healthcare system preparedness during future public health crises.

COVID-19 Pandemic Factors and Depressive Symptoms Among Primary Care Workers in São Paulo, Brazil, October and November 2020

Objectives. To investigate associations between COVID-19-related factors and depressive symptoms among primary care workers (PCWs) in São Paulo, Brazil, and to compare the prevalence of probable depression among PCWs before and during the pandemic. Methods. In a random sample of primary care clinics, we examined 6 pandemic-related factors among 828 PCWs. We used multivariate Poisson regression with robust variance to estimate prevalence ratios for probable depression. We assessed the prevalence of probable depression in PCWs before and during the pandemic in 2 comparable studies. Results. Adjusted prevalence ratios were substantial for insufficient personal protective equipment; experiences of discrimination, violence, or harassment; and lack of family support. Comparisons between PCWs before and during the pandemic showed that the prevalence of probable depression among physicians, nurses, and nursing assistants was higher during the pandemic and that the prevalence among community health workers was higher before the pandemic. Conclusions. Our findings indicate domains that may be crucial to mitigating depression among PCWs but that, with the exception of personal protective equipment, have not previously been examined in this population. It is crucial that governments and communities address discriminatory behaviors against PCWs, promote their well-being at work, and foster family support. (Am J Public Health. 2022;112(5):786-794. https://doi.org/10.2105/AJPH.2022.306723).

Dor lombar e transtornos mentais comuns na Estratégia Saúde da Família: uma associação pouco reconhecida

Objetivo: Descrever o perfil sociodemográfico dos pacientes atendidos na Estratégia Saúde da Família de quatro capitais brasileiras (Rio de Janeiro, São Paulo, Porto Alegre e Fortaleza) com dor lombar e investigar a associação entre dor lombar e depressão, ansiedade e somatização. Métodos: Estudo de corte transversal com 1857 pacientes atendidos nos anos de 2009 (setembro a novembro) e 2010 (junho a agosto). Instrumentos: rastreio de somatização (SOMS-2), avaliação de ansiedade e depressão (HAD), Questionário Geral do Paciente, para dados sociodemográficos e o Formulário do Profissional Assistente, com as informações referentes as consultas. A dor lombar foi analisada a partir da frequência de três diferentes formas de apresentação: queixa autorreferida pelo paciente, sintoma registrado pelo médico e diagnóstico de lombalgia confirmado pelo médico. Resultados: 77,3% eram mulheres com mais de quatro anos de estudo e renda per capita inferior a um salário mínimo e meio. Encontramos associação significativa de queixa de dor lombar com ansiedade (OR=1,5, 95% IC 1,02-2,16) e somatização (OR=1,8, 95% IC 1,12-2,88), mas não com depressão. Pacientes que apresentavam queixa de dor lombar, porém sem registro do sintoma pelo médico, apresentaram associações ainda mais fortes com ansiedade (OR=1,6, 95% IC 1,03-2,63) e somatização (OR=2,3, 95% IC 1,33-3,99). A confirmação do diagnóstico de dor lombar pelo médico não se associou significativamente com nenhum transtorno. Conclusão: Considerando a dor lombar como uma das queixas de maior prevalência na Atenção Primária e sua associação significativa com ansiedade e somatização, recomenda-se a abordagem da ansiedade e somatização em pacientes com queixa de dor lombar.

Social support network, mental health and quality of life: a cross-sectional study in primary care

The objective of this study was to identify the association between emotional distress and social support networks with quality of life in primary care patients. This was a cross-sectional study involving 1,466 patients in the cities of São Paulo and Rio de Janeiro, Brazil, in 2009/2010. The General Health Questionnaire, the Hospital Anxiety and Depression Scale and the brief version of the World Health Organization Quality of Life Instrument were used. The Social Support Network Index classified patients with the highest and lowest index as socially integrated or isolated. A bivariate analysis and four multiple linear regressions were conducted for each quality of life outcome. The means scores for the physical, psychological, social relations, and environment domains were, respectively, 64.7; 64.2; 68.5 and 49.1. In the multivariate analysis, the psychological domain was negatively associated with isolation, whereas the social relations and environment domains were positively associated with integration. Integration and isolation proved to be important factors for those in emotional distress as they minimize or maximize negative effects on quality of life.

Discrimination in the workplace, reported by people with major depressive disorder: a cross-sectional study in 35 countries

OBJECTIVE

Whereas employment has been shown to be beneficial for people with Major Depressive Disorder (MDD) across different cultures, employers' attitudes have been shown to be negative towards workers with MDD. This may form an important barrier to work participation. Today, little is known about how stigma and discrimination affect work participation of workers with MDD, especially from their own perspective. We aimed to assess, in a working age population including respondents with MDD from 35 countries: (1) if people with MDD anticipate and experience discrimination when trying to find or keep paid employment; (2) if participants in high, middle and lower developed countries differ in these respects; and (3) if discrimination experiences are related to actual employment status (ie, having a paid job or not).

METHOD

Participants in this cross-sectional study (N=834) had a diagnosis of MDD in the previous 12 months. They were interviewed using the Discrimination and Stigma Scale (DISC-12). Analysis of variance and generalised linear mixed models were used to analyse the data.

RESULTS

Overall, 62.5% had anticipated and/or experienced discrimination in the work setting. In very high developed countries, almost 60% of respondents had stopped themselves from applying for work, education or training because of anticipated discrimination. Having experienced workplace discrimination was independently related to unemployment.

CONCLUSIONS

Across different countries and cultures, people with MDD very frequently reported discrimination in the work setting. Effective interventions are needed to enhance work participation in people with MDD, focusing simultaneously on decreasing stigma in the work environment and on decreasing self-discrimination by empowering workers with MDD.

Brazilian multicentre study of common mental disorders in primary care: rates and related social and demographic factors

Mental health problems are common in primary health care, particularly anxiety and depression. This study aims to estimate the prevalence of common mental disorders and their associations with socio-demographic characteristics in primary care in Brazil (Family Health Strategy). It involved a multicenter cross-sectional study with patients from Rio de Janeiro, São Paulo, Fortaleza (Ceará State) and Porto Alegre (Rio Grande do Sul State), assessed using the General Health Questionnaire (GHQ-12) and the Hospital Anxiety and Depression Scale (HAD). The rate of mental disorders in patients from Rio de Janeiro, São Paulo, Fortaleza and Porto Alegre were found to be, respectively, 51.9%, 53.3%, 64.3% and 57.7% with significant differences between Porto Alegre and Fortaleza compared to Rio de Janeiro after adjusting for confounders. Prevalence proportions of mental problems were especially common for females, the unemployed, those with less education and those with lower incomes. In the context of the Brazilian government's moves towards developing primary health care and reorganizing mental health policies it is relevant to consider common mental disorders as a priority alongside other chronic health conditions.

Standardization of the MARISTÁN scale to measure needs in people with schizophrenia and related psychoses

OBJECTIVE

Existing measures of needs in severe mental illness have been developed mainly from professionals' viewpoints and are Eurocentric. Our aim was to standardize a measure of the needs of people with schizophrenia across several cultures and based on users' own viewpoints.

METHOD

An instrument to measure needs, based on qualitative data on users', carers' and professionals' views, was tested in 164 people with schizophrenia or related psychoses in six countries. Participants underwent face-to-face interviews, one third of which were repeated 30 days later. Principal axis factoring and Promax rotation evaluated scale structure; Horn's parallel combined with bootstrapping determined the number of factors; and intra-class correlation assessed test-retest reliability.

RESULTS

The instrument contained four factors: (1) health needs; (2) work and leisure needs; (3) existential needs; and (4) needs for support in daily living. Cronbach's α for internal consistency was 0.81, 0.81, 0.77 and 0.76 for factors 1-4 and 0.81 for the scale as a whole. Correlation between factors was of moderate range for the first three factors (0.41-0.50) and low for the fourth factor (0.14-0.29). Intra-class correlation coefficient for test-retest reliability was 0.74 (0.64-0.82) for the whole scale. Mean item score on needs for support in daily living was lower than for the other factors.

CONCLUSIONS

The MARISTÁN Scale of Needs evaluates needs from the patient perspective and it is a valid instrument to measure the needs of people with severe mental illness across cultures.

Unmet needs in the management of schizophrenia

Studies on unmet needs during the last decades have played a significant role in the development and dissemination of evidence-based community practices for persistent schizophrenia and other severe mental disorders. This review has thoroughly considered several blocks of unmet needs, which are frequently related to schizophrenic disorders. Those related to health have been the first block to be considered, in which authors have examined the frequent complications and comorbidities found in schizophrenia, such as substance abuse and dual diagnosis. A second block has been devoted to psychosocial and economic needs, especially within the field of recovery of the persistently mentally ill. Within this block, the effects of the current economic difficulties shown in recent literature have been considered as well. Because no patient is static, a third block has reviewed evolving needs according to the clinical staging model. The fourth block has been dedicated to integrated evidence-based interventions to improve the quality of life of persons with schizophrenia. Consideration of community care for those reluctant to maintain contact with mental health services has constituted the fifth block. Finally, authors have aggregated their own reflections regarding future trends. The number of psychosocial unmet needs is extensive. Vast research efforts will be needed to find appropriate ways to meet them, particularly regarding so-called existential needs, but many needs could be met only by applying existing evidence-based interventions. Reinforcing research on the implementation strategies and capacity building of professionals working in community settings might address this problem. The final aim should be based on the collaborative model of care, which rests on the performance of a case manager responsible for monitoring patient progress, providing assertive follow-up, teaching self-help strategies, and facilitating communication among the patient, family doctor, mental health specialist, and other specialists.

Standardization of the Maristán Scale of Informal Care in people with schizophrenia and other psychoses

OBJECTIVE

No instrument has been developed and validated across cultures to measure the degree of support provided by informal carers to people with schizophrenia. We aimed to develop such a measure.

METHOD

The Maristán Scale of Informal Care was developed directly from the views of patients with schizophrenia in six countries. Face-to-face interviews were carried out with participants and 103 were repeated after 30 days. Principal Axis Factoring followed by Promax rotation evaluated the structure of the scale. Horn's parallel combined with bootstrapping determined the number of factors. Cronbach's alpha estimated the scale's internal consistency and intra-class correlation its test-retest reliability.

RESULTS

A total of 164 interviews were undertaken, 103 with re-test. The Horn's Parallel Analysis and the analysis of the Promax rotation revealed one factor. Cronbach's alpha was 0.89. Intra-class correlation coefficient was 0.56 (95% CI 0.42-0.68) and this increased to 0.64 (95% CI 0.51-0.75) after removing two outlying values. Patients from Argentina recorded the lowest scores (poor informal support/care).

CONCLUSION

The Maristán Scale of Informal Care is a reliable instrument to assess the degree of support provided by informal carers to people with schizophrenia across cultures. A confirmatory factor analysis is needed to evaluate the stability of its factor structure.

Evaluation of a mental health training intervention for multidisciplinary teams in primary care in Brazil: a pre- and posttest study

OBJECTIVES

The aim of this research was to investigate whether a training intervention to enhance collaboration between mental health and primary care professionals improved the detection and management of mental health problems in primary health care in four large cities in Brazil. The training intervention was a multifaceted program over 96 h focused on development of a shared care model.

METHOD

A quasiexperimental study design was undertaken with assessment of performance by nurse and general practitioners (GPs) pre- and postintervention. Rates of recognition of mental health disorders (compared with the General Health Questionnaire) were the primary outcome, while self-reports of patient-centered care, psychosocial interventions and referral were the secondary outcomes.

RESULTS

Six to 8 months postintervention, no changes were observed in terms of rate of recognition across the entire sample. Nurses significantly increased their recognition rates (from 23% to 39%, P=.05), while GPs demonstrated a significant decrease (from 42% to 30%, P=.04). There were significant increases in reports of patient-centered care, but no changes in other secondary outcomes.

CONCLUSIONS

Training professionals in a shared care model was not associated with consistent improvements in the recognition or management of mental health problems. Although instabilities in the local context may have contributed to the lack of effects, wider changes in the system of care may be required to augment training and encourage reliable changes in behavior, and more specific educating models are necessary.

Path entanglement of continuous-variable quantum microwaves

Path entanglement constitutes an essential resource in quantum information and communication protocols. Here, we demonstrate frequency-degenerate entanglement between continuous-variable quantum microwaves propagating along two spatially separated paths. We combine a squeezed and a vacuum state using a microwave beam splitter. Via correlation measurements, we detect and quantify the path entanglement contained in the beam splitter output state. Our experiments open the avenue to quantum teleportation, quantum communication, or quantum radar with continuous variables at microwave frequencies.

Standardised measures of needs, stigma and informal care in schizophrenia using a bottom-up, cross-cultural approach

Background There is a lack of instruments to measure the needs, stigma and informal care of people with schizophrenia that take account of sociocultural variation and patients' and formal and informal carers' opinions and experiences. Aims To develop questionnaires to measure stigma, needs and informal (non-professional) care for people with schizophrenia. Method We undertook the study in seven countries and in English, Spanish and Portuguese. We first held focus group discussions with patients, formal carers (professionals) and informal carers (family and friends) in Spain, the UK, Argentina, Brazil, Chile and Venezuela to elicit the main dimensions of needs, stigma and informal care. We then held nominal group discussions about these dimensions with patients, family members and professionals in Spain, Portugal and the UK, to develop the instruments. Results Three hundred and three people participated in 46 focus groups and results were discussed in three nominal groups, each involving eight participants. Three instruments were developed in this iterative process: needs for care (46 items), stigma (38 items) and informal care (20 items). Conclusions These instruments are based on service users' and carers' views and experiences and have cross-cultural validity. They will have application in assessment of outcomes for people with schizophrenia and their families.

Ultrafast quantum gates in circuit QED

We present a method to implement ultrafast two-qubit gates valid for the ultrastrong coupling and deep strong coupling regimes of light-matter interaction, considering state-of-the-art circuit quantum electrodynamics technology. Our proposal includes a suitable qubit architecture and is based on a four-step sequential displacement of the intracavity field, operating at a time proportional to the inverse of the resonator frequency. Through ab initio calculations, we show that these quantum gates can be performed at subnanosecond time scales while keeping a fidelity above 99%.

Dynamic properties of one-component strongly coupled plasmas: the sum-rule approach

The dynamic characteristics of strongly coupled one-component plasmas are studied within the moment approach. Our results on the dynamic structure factor and the dynamic local-field correction satisfy the sum rules and other exact relations automatically. A quantitative agreement is obtained with numerous simulation data on the plasma dynamic properties, including the dispersion and decay of collective modes. Our approach allows us to correct and complement the results previously found with other treatments.

[Profile and professional expectations for nursing students]

The authors describe the profile corresponding to students enrolled in first, second and third year courses to become registered nurses in Catalonia, along with their professional and job expectations; the authors examine students' perceptions of the university environment. This information will be a great aid to, on the one hand, update the performances and initiatives taken by those responsible for nursing schools, and on the other hand, to obtain a preliminary view on future nursing professionals. At the same time, this information will provide useful elements for students themselves to reflect on their studies and their future as professionals.

Single-photon excitation of surface plasmon polaritons

We provide the quantum-mechanical description of the excitation of surface plasmon polaritons on metal surfaces by single photons. An attenuated-reflection setup is described for the quantum excitation process in which we find remarkably efficient photon-to-surface plasmon wave-packet transfer. Using a fully quantized treatment of the fields, we introduce the Hamiltonian for their interaction and study the quantum statistics during transfer with and without losses in the metal.

Fast-projectile stopping power of quantal multicomponent strongly coupled plasmas

The Bethe-Larkin formula for the fast-projectile stopping power is extended to multicomponent plasmas. The results are to contribute to the correct interpretation of the experimental data, which could permit us to test existing and future models of thermodynamic, static, and dynamic characteristics of strongly coupled Coulomb systems.

Collective and static properties of model two-component plasmas

Classical MD data on the charge-charge dynamic structure factor of two-component plasmas (TCP) modeled in Phys. Rev. A 23, 2041 (1981) are analyzed using the sum rules and other exact relations. The convergent power moments of the imaginary part of the model system dielectric function are expressed in terms of its partial static structure factors, which are computed by the method of hypernetted chains using the Deutsch effective potential. High-frequency asymptotic behavior of the dielectric function is specified to include the effects of inverse bremsstrahlung. The agreement with the MD data is improved, and important statistical characteristics of the model TCP, such as the probability to find both electron and ion at one point, are determined.

[Distribution of capsular types and antimicrobial susceptibility of Streptococcus agalactiae causing infections in Argentina]

Streptococcus agalactiae is an endogenous bacterium that has emerged in the last 20 years as an etiological agent in both neonatal and perinatal infections, and in immunocompromised patients. The differentiation of the capsular polysaccharide, the presence of surface proteins c, X, R, and molecular methods allow classification in serotypes and genotypes. This identification is a useful tool for epidemiological purposes and virulence studies in this bacterium. The objective of this work was to study the serotypes and the antimicrobial susceptibility of isolates recovered from invasive diseases in different areas of Argentina. In the analyzed sample a fair predominance of Ia and III serotypes was recovered, followed by II and IV serotypes. All the isolates were found to be sensitive to penicillin. A 6% of resistance to erythromycin and a 4.5% to clindamycin were detected. In three of the isolates, constitutive MLS phenotype (resistance to macrolides, lincosamins and streptogramins) was founded, while in the remaining one, inducible MLS phenotype was detected. These results stress the importance of conducting a surveillance of the prevalent serotypes in our country with the goal of future prevention of this disease with an effective vaccine. The knowledge of the antimicrobial susceptibility profile will be also important to obtain therapeutic success in the treatment.

[Diagnostic reliability in mental disorders of the International Classification of Diseases in primary care]

INTRODUCTION

The objective is to evaluate the test version of Chapter V - "Mental and Behavioral Disorders reliability", of the 10th revision of the International Classification of Diseases, Version for Primary Care (ICD -10 PC), prepared by the Division of Mental Health of the World Health Organization (WHO).

METHODS

During September and October of 1994, Community General Physicians (CGP) from the Health and Environment Department of the State of Rio Grande do Sul were trained in the use of this version, prepared for the field trial, according to the design proposed by WHO.

RESULTS

The results refer to a study about reliability of diagnosis attributed by 9 pairs of CGP to 460 patients in their first appointments. Cohen's Kappa for Mental Health Disorder, present or absent, was 0,79 (CI 95%: 0,69 - 0,88).

CONCLUSION

The use of ICD-10 CP will give more specificity to the information and will allow a better communication between health workers at the level of primary care

Nutrition and education. III. Educational achievement and food habits of Chilean elementary and high school graduates

The objective of this study was to correlate the educational achievement (EA) of Chilean elementary and high-school graduates with their food habits. For this purpose, a random sample of 550 schoolers from the Metropolitan Area of Santiago, Chile, graduating from elementary and high school (1:1) of both sexes (1:1), from public and private schools and from high, medium and low socioeconomic status (SES) (1:1:1), was selected. Food habits were determined through a specially designed questionnaire and defined as the frequency of consumption of the food groups, expressed as days per week. The EA was established through the Achievement Evaluation Program (AEP) and Academic Aptitude Test (AAT) in elementary-and high-school graduates-, respectively. Results revealed that EA was found significantly and positively correlated with the frequency of consumption of dairy products, meat products and eggs, in both elementary and high school graduates. A significant and inverse correlation between EA and the frequency of vegetables and fruits consumption was observed in both educational levels, and with miscellaneous products, only in elementary school graduates. Food habits explained 24.4% and 16.6% of the EA variance, in elementary and high school graduates, respectively. The frequency of consumption of dairy products was the independent variable with the greatest explanatory power in EA variance (approximately above 70% of the explained variance). These results are important to consider for educational planning focused on the School Feeding Program.

Nutrition and education. II. Educational achievement and nutrient intake of Chilean elementary and high school graduates

The interrelationships between educational achievement (EA) and nutrient intake were investigated in 550 Chilean adolescent schoolers graduating from elementary and high school. The random sample included schoolers from both educational levels (1:1), from public and private schools (1:1), and from high, medium, and low socioeconomic status (SES) (1:1:1). Standard procedures for 24-hour dietary recall interviews were used to collect data, and adequacy of intake was assessed by the FAO/WHO Pattern. EA was measured by means of the Achievement Evaluation Program (AEP) and Academic Aptitude Test (AAT) in elementary and high school, respectively. In elementary school graduates, results showed a significant and positive correlation between EA (AEP) and energy, protein, riboflavin, ascorbic acid, calcium and vitamin A intake (Multiple r = 0.456 p less than 0.01; r2 = 0.208). The School Feeding Program beneficiaries who belonged to the low SES presented the lowest EA (AEP) together with a deficient nutrient intake, especially for energy, riboflavin, niacin, vitamin A and calcium, at the same time that they registered the lowest values for those anthropometric parameters, indicators of past nutrition, that is to say height-for-age, weight-for-age, head circumference-for-age and a higher upper-to-lower segment ratio, as compared with non-beneficiaries from the same SES and with those from the higher strata. In high-school graduates, EA (AAT) was found to be significantly and positively correlated with protein, calcium, riboflavin and iron intake (Multiple r = 0.438 p less than 0.001; r2 = 0.192). Nevertheless, these interrelationship are strongly related to SES and sex. Results showed that educational achievement (EA) is significantly and positively associated with nutrient intake, this fact being important for educational planning related to the School Feeding Program.

[Protein complementation of defatted hazelnut flour with pea flour]

A great deal of research has been carried out to increase the availability of naturally-occurring proteins, or obtained from secondary products derived through industrial processes. As a result of the industrial exploitation of the native hazelnut (Gevuina avellana) in Chile, a defatted residue is obtained which eventually could be utilized as a human food. To determine the complementary potential capacity of the defatted hazelnut flour and pea flour, a study was carried out in weaning rats of the Wistar strain, as follows. The biological evaluation considered diet formulation with defatted hazelnut flour and pea flour in the 30:70, 50:50, 60:40 and 70:30 proportions, respectively. The NPR values obtained in this evaluation of the assay diets were: 3.4, 3.5, 3.9, 4.1 and 4.1, in comparison with 3.7 for casein. In percentage terms, the 4.1 NPR value was 11% higher than that obtained for casein. The maximum protein quality was observed when the two protein sources were mixed in the 60:40 and 70:30 (w/w) ratios. In regard to true digestibility, there were no significant differences among the experimental diets, but were lower than casein. The results of this study demonstrate that the defatted hazelnut flour constitutes an attractive nutritional alternative for the amino acid supplementation of cereal and legumes, the latter being of habitual consumption by the Chilean population.

[Chemical composition and biological quality of defatted hazelnut flour]

The results of the chemical composition and biological quality of deffated hazel nut flour are shown. The samples analyzed contained significant amounts of proteins (19%) comparable to legume flour, higher than cereals and lower than deffated oleaginous flours. The oil extracted from the seed was analyzed and the average results obtained were the following: Refraction index, 1.47; saponification No. 184.8; iodine No. 85.0. The average composition of the fatty acids obtained by gas liquid chromatography was: Palmitic acid 2.3% Palmitoleic acid 37.0% Stearic acid 0.5% Oleic acid 39.5% Linoleic acid 6.9% Linolenic acid 1.1% Eicosanoic acid 2.3% Eicosaenoic acid 4.6% Docosenoic acid 3.4% Tetraeicosanoic acid 0.3% These results indicate a good-quality oil due to the low content of linolenic acid. The nutritive value of the deffated meal measured in the rats gave a net protein ratio (NPR) of 3.58, lower than the corresponding casein value (4.10). The true protein digestibility measured in the rat gave a value of 7.3%, compared to 95% for casein. The amounts of iron and phosphorous are comparatively lower than those reported for rape-seed meal and sunflower meal.

[Preparation and chemical and nutritional evaluation of an infant food based on sweet lupine, wheat and milk]

This paper deals with the development of a food for infants and young children based upon a mixture of 27.5% wheat flour, 20% sweet lupin flour and 20% powdered milk (GL) (18% fat content) with added vitamins and minerals. The blend of wheat and lupin flour was processed in an extrusion-cooker (Wenger X 25) before mixing with the other ingredients. The proximate chemical analysis performed on the wheat-lupin-milk blend (LTL) showed 18.7% protein and 12.5% fat with a calculated caloric value of 427 kcal/100 g. Amino acid analysis indicated a deficiency of methionine + cystine and of threonine in the blend. Nevertheless, studies with rats on the biological quality of the protein, such us protein efficiency ratio and apparent digestibility, revealed that this blend was as good as the reference diet (powdered egg). It is therefore felt that the LTL blend may be a useful substitute in food programs directed to infants and school children.

[Food intake of students graduating from basic education in the metropolitan area of Santiago, Chile]

This study pursued to evaluate the adequacy of the dietary intake of students graduating from Basic Education in the Metropolitan Area of Santiago, Chile. A random sample of 258 students from public and non-public schools (1:1), of both sexes (1:1) and from high, medium and low socioeconomic level (SEL) (1:1:1), was selected. Standard procedures for 24-hr dietary recall individual interviews were used to collect data. The students' dietary intake was then compared with the FAO/WHO 1973 Recommended Dietary Allowances. Results revealed that 53.5% and 62.0% of the sample registered a deficient and excessive intake for energy and protein, respectively. Protein contributed 13.2% of the dietary energy, fat, 27.1%, and carbohydrates, 59.8%. Animal and vegetable protein intake was found in the proportion of 1:1. As findings indicated, the dietary intake of students differed significantly according to SEL. Deficiencies in energy, vitamin A, riboflavin, niacin and calcium intake were observed, in both sexes, besides iron deficiency in the female group. It is considered that results could be useful for food and nutrition planning in school feeding programs.

[Food habits of high school graduates in the metropolitan area of Santiago, Chile]

The purpose of this study was to determine the food habits of Chilean high-school graduates, and measure the effect that socioeconomic level (SEL), type of school (public and private school), sex and age exerts on those habits. A random and stratified sample of 283 schoolers, according to type of school, sex and SEL, measured through the Graffar Modified Scale was selected for the study. Food habits were defined by the frequency of consumption of food, expressed as days per week and were compared with the Model Allowance established by the Ministry of Health of Chile. A food habits questionnaire was administered to students by duly trained interviewers, and were defined by the frequency of consumption of food groups. Data were analyzed by the chi-square procedure, analysis of variance and Student's "t" test. In accordance with the results, the most consumed foods (over 90% of students) were meat, poultry, eggs, potatoes, apples, bread, rice, oil and butter or margarine. On the other hand, the most disliked foods (40% and more of students) were fresh cheese, viscera, radish and chickpeas. The high SEL students showed a significantly greater frequency of consumption of dairy products, and of meat products and eggs (p less than 0.001). No differences were found according to type of school, sex and age of students. We conclude, therefore, that SEL exerts a significant effect on food habits, in spite of which they were adequate according to the Model Allowance.

[Sensory evaluation and acceptability study, at the consumer level, of bread supplemented with sweet lupine flour]

The purpose of this study was to determine the effect of incorporating sweet lupine flour (SLF) to bread, upon the organoleptic characteristics and acceptability of the product. The substitution levels were 3, 6, 9 and 12%. The sensory evaluation test was done by 25 trained judges using the hedonic scaling method (9 to 1 scoring). Internal and external characteristics of appearance, color, aroma, texture, bitterness and flavor, as well as general acceptability, were measured. Sensory evaluation results of the external characteristics were significant at the 9 and 12% SLF levels for color (p less than 0.05) while the other parameters did not show significant differences. In regard to the internal characteristics, a significant difference for color was found at the 3% level of SLF (p less than 0.05); and at 6, 9 and 12% SLF levels, for appearance (p less than 0.05). The general acceptability was good at all the levels tested, with no significant differences among them. An acceptability study at the consumer level for 9% lupine flour bread was carried out in a group of 90 girls, aged 10-12 years, during a 10-day period. The results showed a very good acceptability of the product (p less than 0.01). The results of this study indicate that the incorporation of 6% SLF to the bread, did not affect adversely its sensory properties. Moreover, the acceptability of bread containing up to 12% SLF was excellent.

[Formulation and nutritive value of 2 milk substitutes based on sweet lupine (Lupinus albus, var. multolupa)]

Two protein mixtures, A and B, based on sweet lupine, wheat flour and dried skim milk powder were formulated, bearing in mind the chemical and nutritional standards set by the National System of Health Services for protein mixtures used through the National Program of Complementary Feeding (PNAC) for preschool children. Both formulas contained 12% of sweet lupine flour, but they differed in their skim milk content, which was 15% in mixture A, and 10% in mixture B. Taking as reference value a content of 2% moisture, formula A contains 17.6% protein and mixture B, 16.4%, with a caloric content of 420 kcal/100 g for both of them. The amino acid score was 0.80 for both mixtures. The biological quality of the proteins of A and B, measured as protein efficiency ratio (PER), was 2.2 and 2.1, respectively. These values are not statistically different, although they are lower than the value of 2.5 obtained for casein (p less than 0.01).

[Sensory evaluation of bread with potato flour]

A sensory evaluation test was conducted in breads containing 2, 4, 6, 8 and 10% potato flour. The samples were sliced into equally sized pieces and served as coded randomized duplicates. All-wheat bread was used as a standard. The comparative preferences were rated on a 7-point hedonic scale (7 = very good, 1 = very bad) for appearance, flavor, texture and overall quality. The scores were statistically analyzed by the analysis of variance and the Chi square test. No significant differences were found in regard to flavor between the standard bread and bread containing from 2-10% potato flour. In the test of organoleptic quality, the bread containing 8% potato flour was rated as "good", as compared to "very good" for the all-wheat bread. However, this difference was not statistically significant. The values obtained in this study show that the incorporation of 6-8% potato flour in bread is perfectly feasible. This was obtained from a local food industry that in manufacturing the flour, used the Spartan variety potato produced in the southern region of Chile.

Chemical and nutritional evaluation of sweet lupines

Sweet lupines are presently being cultivated at the Experimental Station in Gorbea (Chile). Four cultivars, Lupinus albus cv Astra, L. albus cv Multolupa, Lupinus luteus cv Aurea and Lupinus angustifolius, were examined for the chemical composition of whole and dehulled seeds and testa. Whole seeds contain 34-35% protein. The varieties of L. albus contain 13% oil. L. luteus and L. angustifolius contain about 5% ether extract. Crude fiber ranged from 11 to 17% in the whole seed. Unsaturated fatty acids, especially oleic and linoleic, make up about 80% of total fatty acids. The alkaloid content of the seed was 0.02%. The amino acid composition of the protein indicated that the main deficiency corresponds to the sulfur-containing amino acids, i.e. methionine + cystine. The protein efficiency ratio values for L. albus cv Multolupa was 1.08 and 2.50 for casein. Supplementation with DL-methionine at 0.1, 0.2, 0.3 and 0.4% of the diet significantly increased the basal value from 1.08 to 2.14, for the supplemented diet with 0.1% (p less than 0.01). Higher levels of supplementation did not cause significant increases in the protein efficiency ratio. Apparent protein digestibility for the rat was 75% for unsupplemented lupine. This value increased to about 79% (p less than 0.01) for the supplemented diets (casein 88.7%).

[Enrichment of bread with soy flour]

A series of laboratory studies was conducted to test the effect of the inclusion of soy flour in bread at the levels of 2, 4, 6, 8, 10 and 12%. The farinographic tests showed that several changes occurred with the incorporation of soy flour to the wheat flour, such as an increase in water absorption and weakening of the dough, and a decrease in the dough developing time. The mixing time remained unchanged up to the level of 8% substitution. Higher levels produced an increasing stickiness of the dough that made its handling more difficult. Soy-containing breads were slightly darker than wheat bread with a score of 71 points (scale 100) for the 12% level of substitution. The texture became coarser with increasing substitution of soy flour. Starting with the level of 4% of soy flour a volume decrease was observed, but this was corrected by the addition of 0.5% sodium stearoyl-2-lactylate (SSL). At the levels of 10 and 12% of soy flour, SSL was not effective in preventing the reduction of volume. The chemical composition of bread showed a regular increase in its protein content from 13.4, to 18% in the bread containing 12% soy flour. The protein efficiency ratio of bread improved from 1.17 for the wheat bread, to 2.13 for the bread containing 6% soy flour (casein, 2.54). Our results confirm the observation made by other workers in that the inclusion of soy flour in bread improves both the protein concentration and quality of this basic food.

Comparative effects of semisynthetic D-5-vinyl-2-thiooxazolidone and water-extracted rapeseed meal in the rat

The toxic effect of two levels of semisynthetic D-5-vinyl-2-thiooxazolidone (VTO) (0.006 and 0.0012%) was compared in rats with that of 0.005% of the same substance present in 'detoxified' rapeseed meal (DRSM). Diets containing 10% protein as casein (control group) or DRSM were tested. Growth rates and protein efficiency ratio with DRSM were slightly less than in the controls. VTO did not affect the growth rate and seems to increase the protein efficiency ratio. Liver and thyroid weights were normal in rats fed DRSM. VTO increased liver weight independently of the concentration in the diet. The The effect on thyroid weight was proportional to VTO concentration, and the glands reached weights twice or three times that of normal. Both levels of semisynthetic VTO led to damage of the hepatic parenchyma. Liver weight was increased. Animals receiving DRSM did not show differences either in liver weight or histology compared to the controls. Thyroid histology of animals fed VTO or DRSM showed smaller follicles lined by tall cells and reduction of lumenal colloid. These changes were more severe in animals fed VTO. It is postulated that both VTO and isothiocyanate may decrease thyroid hormone production which in turn stimulates TRH and TSH release leading to glandular hyperplasia and hypertrophy.

Capacity of the Chilean mixed diet to meet the protein and energy requirements of young adult males

1. The capacity of the Chilean mixed diet to meet the daily protein and energy needs was tested in eight subjects aged from 20 to 31 years using the nitrogen balance method. This diet was tested at the protein levels of 0.40, 0.55 and 0.70 g/kg body-weight per d. 2. An egg reference diet providing 0.30, 0.45 and 0.60 g protein/kg per d was also assayed. 3. The mean daily energy intake was 207 kJ/kg per d according to subjects' previous intake and activity pattern. 4. The N balance response to each dietary protein level was taken as a measure of adequacy of protein intake, and regression analyses of N balance (Y) v. N intake (X) were calculated to estimate protein needs. The equations found were Y = 0.70X - 68.7 for the egg diet, and Y = 0.74X - 92 for the mixed diet. 5. From these equations the mean protein requirements for equilibrium were estimated to be 0.61 g/kg for egg and 0.78 g/kg for the mixed diet. 6. If the coefficient of variation is 15, the protein requirement for N equilibrium of 97.5% of the population would be 0.8 g/kg per d for egg and 1.0 g/kg per d for the mixed diet.

Obligatory urinary and faecal nitrogen losses in young Chilean men given two levels of dietary energy intake

1. The obligatory nitrogen losses were measured in young adult males of the low socio-economic group, consuming an N-free diet at 192 kJ (46 kcal)/kg per d from day 1 to 10 and 243 kJ (58 kcal)/kg per d from day 11 to 18. 2. All subjects, except one, lost weight compatible with N loss. 3. A kinetic evaluation of the results showed that the asymptotically derived urinary N loss after stability had been reached was 35.8 mg N/kg per d. The mean time to stability was 6.5 d. The subjects showed a trend toward decline in N loss while consuming the high-energy N-free diet. 4. The obligatory faecal N loss for days 1-10 was 16.1 mg N/kg per d and 8 mg N/kg per d for days 11-18. 5. Based on the factorial approach the total obligatory N loss of our subjects, for the initial 10 d, was 57.5 mg N/kg per d.

[Nutritive value of lupine and its potential as human food]

The chemical composition and some indices of protein quality were measured in two species of sweet lupine Lupinus albus and Lupinus luteus grown at the Experimental Station in Gorbea, Chile: both samples showed a high protein content (39.5 and 44.6%). The protein efficiency ratio (PER) was measured in the rat and found to be 0.48 and 0.71, respectively, as compared to 2.57 for casein. Supplementation with 0.3% DL-methionine increased significantly those values, thus indicating that lupine protein is deficient in said amino acid. In another experiment the effect of cooking-extrusion on lupine flour (L. albus) was investigated and the chemical composition, protein efficiency ratio, methionine supplementation and digestibility of the protein were measured. The chemical composition was not changed but PER increased from 0.50 for raw lupine to 0.76 for processed lupine (P less than 0.05). Both values increased significantly with the addition of 0.3% DL-methionine. The protein digestibility of the supplemented lupine was not affected by the cooking extrusion process (76.5 and 77.8%, respectively). Supplementation of wheat flour with 5, 10, 15 and 20% lupine flour increased the PER of wheat flour from 0.92, to 1.39 for wheat flour supplemented with 10% lupine flour, and to 1.60 for the 15% level of the supplement. These studies seem to support the conclusion that sweet lupine is an interesting protein resource for human nutrition.

Protein-rich mixtures for human consumption based on fish flour, sunflower presscake meal, dried skim milk and wheat flour

1. The quality of the protein in five high-protein mixtures intended for human consumption and made from materials that are available in Chile is reported.

2. The ingredients were fish flour, bread, wheat (Triticum sativum Lam.) flour, roasted whole wheat flour, a wheat flour made from a variety of durum wheat (T. durum Desf.), skim milk and sunflower presscake, mixed in different proportions.

3. The net protein utilization when fed to rats in diets at the 10% level of protein calories gave values in the range 66–76, which compare well with that (67), found for Incaparina, an all-vegetable mixture produced by the INCAP Group and used in Colombia, and are higher than the values (55 and 56) obtained for Peruvitas, which are mixtures made up basically from cottonseed and quinoa reinforced with dried skim milk.

4. The protein values of the mixtures, expressed as net dietary protein calories %, were calculated from their biologically determined net protein utilization (operative), and gave values that ranged from 10·5 to 12·8, which are higher than the recommended values in diets for infants and toddlers.