Selection of quality indicators for nutritional therapy in pediatrics: a cross-sectional study conducted in Brazil

Background

Quality indicators for nutritional therapy (QINT) are important in assessing care and monitoring of resources. Among the 30 indicators proposed by International Life Sciences Institute, Brazil, there is still no evaluation of the most pertinent for Pediatrics.

Objective

To list the 10 main quality indicators for nutritional therapies (QINTs) for Pediatrics.

Methods

This was a two-phase cross-sectional study. Firstly, a questionnaire was answered by physicians, nutritionists, nurses, and pharmacists, all with having experience in nutritional therapy (NT) with Pediatrics, in Rio de Janeiro, Brazil. Participants assessed four attributes of QINT by using the Likert scale. A Top 10 ranked QINT list for Pediatrics was established. To verify the consistency of the questionnaire, Cronbach’s Alpha coefficient was calculated. Secondly, the opinions of the participants on the results that were obtained were requested and the percentages of the positive responses were calculated.

Results

A total of 33 professionals participated in the first phase and 92% (n = 23 of 25) in the second phase approved the results of the selected indicators. Among the Top 10 QINTs, the three main ones were: #1: “Frequency of diarrhea in those patients on enteral nutrition” (mean = 13.194; α = 0.827); #2: “Frequency of dietary nutritional prescriptions upon the hospital discharge of the NT patients” (mean = 12.871; α = 0.822); #3: “Frequency of the NT patients who recovered their oral intake” (mean = 12.839; α = 0.859).

Conclusion

When considering the consistency and the concordance that were obtained, it can be suggested that the list of Top 10 QINTs as proposed in this study will help in the evaluation of NT quality indicators for Pediatrics.

Development of Chatbot-Assisted Smoking Cessation Telehealth Intervention: A Case Report

Tobacco use is still a top preventable public health concern in the US. It causes serious health problems, including the cardiovascular system, lungs, mental issues, and cancers. To help tobacco users who want to quit, we developed a chatbot-assisted smoking cessation telehealth intervention targeting adults. This case report describes the development and evaluation of developed telehealth intervention. Utilizing rule-based chatbots and motivational interviewing principles, the study aimed to assess intervention efficacy. Data from four participants revealed varying impacts on motivation, nicotine dependency, and confidence to quit smoking. Most participants reported engaging in suggested strategies for handling tobacco cravings, indicating the potential advantage of chatbot assistance. However, the small sample size limits the generalizability of findings, necessitating further evaluation with a larger group. Despite limitations, this study demonstrates the feasibility and potential effectiveness of chatbot-assisted telehealth interventions in smoking cessation efforts, underscoring the need for future research.

Molecular mechanisms underlying fructose-induced cardiovascular disease: exercise, metabolic pathways and microRNAs

NEW FINDINGS

What is the central question of this study? What are the mechanisms underlying the cardiac protective effect of aerobic training in the progression of a high fructose-induced cardiometabolic disease in Wistar rats? What is the main finding and its importance? At the onset of cardiovascular disease, aerobic training activates the p-p70S6K, ERK and IRβ-PI3K-AKT pathways, without changing the miR-126 and miR-195 levels, thereby providing evidence that aerobic training modulates the insulin signalling pathway. These data contribute to the understanding of the molecular cardiac changes that are associated with physiological left ventricular hypertrophy during the development of a cardiovascular disease.

ABSTRACT

During the onset of cardiovascular disease (CVD), disturbances in myocardial vascularization, cell proliferation and protein expression are observed. Aerobic training prevents CVD, but the underlying mechanisms behind left ventricle (LV) hypertrophy are not fully elucidated. The aim of this study was to investigate the mechanisms by which aerobic training protects the heart from LV hypertrophy during the onset of fructose-induced cardiometabolic disease. Male Wistar rats were allocated to four groups (n = 8/group): control sedentary (C), control training (CT), fructose sedentary (F) and fructose training (FT). The C and CT groups received drinking water, and the F and FT groups received d-fructose (10% in water). After 2 weeks, the CT and FT rats were assigned to a treadmill training protocol at moderate intensity for 8 weeks (60 min/day, 4 days/week). After 10 weeks, LV morphological remodelling, cardiomyocyte apoptosis, microRNAs and the insulin signalling pathway were investigated. The F group had systemic cardiometabolic alterations, which were normalised by aerobic training. The LV weight increased in the FT group, myocardium vascularisation decreased in the F group, and the cardiomyocyte area increased in the CT, F and FT groups. Regarding protein expression, total insulin receptor β-subunit (IRβ) decreased in the F group; phospho (p)-IRβ and phosphoinositide 3-kinase (PI3K) increased in the FT group; total-AKT and p-AKT increased in all of the groups; p-p70S6 kinase (p70S6K) protein was higher in the CT group; and p-extracellular signal-regulated kinase (ERK) increased in the CT and FT groups. MiR-126, miR-195 and cardiomyocyte apoptosis did not differ among the groups. Aerobic training activates p-p70S6K and p-ERK, and during the onset of a CVD, it can activate the IRβ-PI3K-AKT pathway.