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The authors wish to clarify some misrepresenting remarks arising from the reading of the Manual of the Dir. 92/43/EEC Ann. I habitats monitoring (Angelini et al. 2016) published in the editorial notes of Forest@ (October 2016). Some aspects of the habitat monitoring protocol for the habitat type 9210* “Apennine beech forests with Taxus and Ilex” are here discussed. The reported comments are intended to provide a useful contribution towards a clarification of any content that, for obvious reasons of brevity, may have been explained in a non-exhaustive way.

To assess the impact on child growth of the nutrition-counseling component of the Integrated Management of Childhood Illnesses (IMCI) strategy, a randomized trial was implemented. All 28 government health centers in a Southern Brazil city were paired according to baseline nutritional indicators. One center from each pair was randomly selected and its doctors received 20-h training in nutrition counseling. Thirty-three doctors were included and 12-13 patients < 18 mo of age from each doctor were recruited. The study included testing the knowledge of doctors, observing consultations and visiting the children at home 8, 45 and 180 d after the initial consultation. Maternal knowledge, practices and adherence to nutritional recommendations were assessed, and anthropometric measurements were taken. Day-long dietary intake was evaluated on a subsample of children. Doctors in the intervention group had better knowledge of child nutrition and improved assessment and counseling practices. Maternal recall of recommendations was higher in the intervention than in the control group, as was satisfaction with the consultation. Reported use of recommended foods was also increased. Daily fat intake was higher in the intervention than in the control group; mean daily intakes of energy and zinc also tended to improve. Children 12 mo of age or older had improved weight gain and a positive but nonsignificant improvement in length. Nutrition-counseling training improved doctors' performances, maternal practices and the diets and weight gain of children. The randomized design with blind outcome evaluation strongly supports a causal link. These results should be replicated in other settings. [ABSTRACT FROM AUTHOR]

The effect of lactation on maternal nutrition is controversial. Some studies have shown that breast-feeding reduces maternal weight, whereas some have not. All studies have been restricted to the first 2 y after delivery. We investigated the effect of lactation on maternal nutrition 5 y after delivery. All mothers giving birth in the city of Pelotas, Brazil, in 1993 were interviewed and weighed soon after delivery; information was also obtained on prepregnancy weight. In 1994, information on breast-feeding duration and pattern was collected for a 20% subsample. They were seen again in 1998, and those eligible (nonsmokers, no subsequent pregnancy, last birth weight > or = 2500 g) underwent measurements for weight, height, waist, hip and arm circumferences, triceps and subscapular skinfolds. The following indices were calculated in 312 women: body mass index, waist/hip ratio, arm fat area, the percentage of body fat assessed through skinfolds, and weight and body mass index change since before conception. The percentage of body fat was also measured through bioimpedance for half of the sample. After adjustment for confounding, all outcomes generally showed a similar pattern, i.e., mothers who breast-fed for 6-11.9 mo had lower measurements than those with shorter or longer durations. However, only the association with bioimpedance was significant (P < 0.03), and that for arm fat area tended to be significant (P = 0.06). Exclusive or predominant breastfeeding at 4 mo was associated with lower waist circumference (P = 0.05) and the percentage of body fat measured through skinfolds (P = 0.04). This study suggests that the relationship between breast-feeding and long-term changes in maternal weight is complex and, in this population, not particularly strong. [ABSTRACT FROM AUTHOR]

Objective: To describe and evaluate the structure, course of action, and the outcome of diabetic patient care delivered at primary health care level in Pelotas, Southern Brazil., Methods: Through a cross-sectional study all of 32 health centers in the region were assessed, along with the 61 doctors who were managing diabetic patients. A sample of 378 diabetic patients who attended these health centers was also included. Patients were interviewed at home and their glucose capillary blood level, blood pressure and body mass index were assessed and compared with standard parameters. Course of action and structure components were compared against the basic recommendations for the care of diabetic patients., Results: Most centers didn't meet the basic recommendations. Blood pressure measurement was the most reported action in the physical examination in the first visit. As part of the management plan set in the first visit, almost 85% of the doctors reported to prescribe a special diet and 72% referred recommending physical exercise. For laboratory monitoring, all doctors reported asking for fasting blood glucose and 60% of them reported checking their patients' glycated hemoglobin. The rate of disease control ranged from 6 to 11%, according to the Latin American Diabetes Association and the Ministry of Health parameters, respectively., Conclusions: Although currently undersupplied, the primary health sector is potentially able to improve in its three components (structure, course of actions and outcome) by training medical doctors and their compliance with established guidelines.

Introduction: Anthropometry is frequently used for evaluating nutritional status of individuals and populations. In recent years, community surveys have been conducted by health professionals in various regions of Brazil with the objective of complementing the data obtained through nutritional surveillance programs. One important difficulty in conducting these assessments has been measuring height during visits to the homes of survey participants., Methods: Thirty-eight anthropometric surveys of Brazilian children aged up to 5 years using the National Center for Health Statistics (NCHS) reference were identified. The percentage of children with a Z-score below standard deviations was used to define deficits of weight for age and height for age., Results: Correlation between prevalences of height for age and weight for age deficits were examined. Due to the low prevalence of deficits in weight for height in all surveys, there was a strong correlation between weight for age and height for age at the population level. Approximately 90% of the height for age (H/A) variation was accounted for by that of weight for age (W/A)., Conclusions: Using the equation, (Prevalence H/A) = 0.74 + 2.34 (Prevalence W/A) -0.03 (Prevalence W/A)2 it is possible to estimate the prevalence of height deficits on the basis of prevalence of weight deficits. These results suggest that anthropometric surveys as conducted in Brazil, in the context of health services, can be simplified by measuring weight only, instead of both weight and height.

Introduction: A population-based cross-sectional study was conducted in Pelotas, Southern Brazil, with the objective of determining the prevalence of obesity and identify associated, variables as this condition increased markedly in the country between 1974 and 1989., Material and Methods: One thousand and thirty-five adults between 20 and 69 years of age were studied. Obesity was defined as a Body Mass Index--BMI--equal to or over 30 Kg/square meter). The multivariate analyses took into account the hierarchical model of the variables associated with obesity for both men and women., Results: The prevalence for the overall population was of 21% (CI 18-23). It was higher among women--25% (CI 22-29) than for men--15% (CI 12-18). Socioeconomic status was positively associated with obesity among men, whereas the opposite situation was reported for women, with those belonging to the poorest social strata presenting increased BMI. Reported obesity in their parents was associated with increased BMI in the subjects, and this association remained statistically significant even after compensating for the effect of possible confounding variables. Self-reported diabetes and arterial hypertension doubled the risk of obesity, whereas non-smoking was associated with obesity only among women. Variables which were not associated with obesity after adjusting for confounders were alcohol consumption, marital status and parity. Women having more daily meals were less prone to obesity, even after controlling for confounders, and this association was not quite significant for men (p = 0.07)., Conclusions: The prevalence of obesity was higher among women, and important differences in risk factors were noticed when the population was considered by sex.

Food intake and morbidity are the two main proximal determinants of childhood malnutrition. Intake is usually assessed through the 24-h recall method. Few studies, however, have evaluated the accuracy of this method; in particular, it is not known whether accuracy varies according to the child's nutritional status. The intake of 50 children (< 2 y old), of whom 25 were underweight (weight-for-age more than 2 SD below the National Center for Health Statistics reference), as evaluated through weighing of all foods (gold standard) and through recall. The overall intakes of energy, fat and protein were significantly greater according to the recall method than by weighing. The trend towards overestimation was more marked for malnourished children than for well-nourished children. The possibility of such bias should be taken into account in future studies.