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PURPOSE: The structural similarity index measure (SSIM) has become a popular quality metric to evaluate QSM in a way that is closer to human perception than RMS error (RMSE). However, SSIM may overpenalize errors in diamagnetic tissues and underpenalize them in paramagnetic tissues, resulting in biasing. In addition, extreme artifacts may compress the dynamic range, resulting in unrealistically high SSIM scores (hacking). To overcome biasing and hacking, we propose XSIM: SSIM implemented in the native QSM range, and with internal parameters optimized for QSM. METHODS: We used forward simulations from a COSMOS ground-truth brain susceptibility map included in the 2016 QSM Reconstruction Challenge to investigate the effect of QSM reconstruction errors on the SSIM, XSIM, and RMSE metrics. We also used these metrics to optimize QSM reconstructions of the in vivo challenge data set. We repeated this experiment with the QSM abdominal phantom. To validate the use of XSIM instead of SSIM for QSM quality assessment across a range of different reconstruction techniques/algorithms, we analyzed the reconstructions submitted to the 2019 QSM Reconstruction Challenge 2.0. RESULTS: Our experiments confirmed the biasing and hacking effects on the SSIM metric applied to QSM. The XSIM metric was robust to those effects, penalizing the presence of streaking artifacts and reconstruction errors. Using XSIM to optimize QSM reconstruction regularization weights returned less overregularization than SSIM and RMSE. CONCLUSION: XSIM is recommended over traditional SSIM to evaluate QSM reconstructions against a known ground truth, as it avoids biasing and hacking effects and provides a larger dynamic range of scores.

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ABSTRACT Purpose: To assess the impact of thinness on the outcome of the percutaneous nephrolithotomy (PCNL). Materials and Methods: A matched case-control study was performed using a prospectively collected database of all patients who underwent PCNL between June 2011 and October 2021. The patients were stratified into two groups according to their phenotypic characteristics, arbitrarily defined according to their body mass index (BMI): <20 kg/m2 (Group 1, very thin patients, G<20) and ≥25 kg/m2 (Group 2, non-thin patients, G≥25). Patients were randomly matched based on Guy's Stone Score (GSS) according to case complexity at a ratio of 1:3. Results: A total of 204 patients were enrolled in this study: 51 patients (G<20) and 153 controls (G≥25). Complications occurred in 15.2% of the patients, with 5.4% of these complications classified as major complications (Clavien grade ≥ 3). According to complications there were no significant differences between the groups. The overall complication rates were 17.6% in the G<20 and 14.4% in the G≥25 (p = 0.653). The major complication rates were 3.9% in the G<20 and 5.8% in the G≥25 (p=0.429). No differences in transfusion or urinary fistula rates were found. Conclusions: In this study, very thin patients were not at a higher risk of complications when submitted to PCNL than in those with a BMI of ≥25 kg/m2. Apparently, this technique can be used in these patients, just as it is used in any other type of patient, independently of their BMI.

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This study constitutes the first record of parasitism and associations between bat flies ectoparasite of the Streblidae family and bats (Chiroptera: Phyllostomidae) in the São Francisco Forest State Park (SFFSP). The bats were captured using mist nets set up at various points along the park's visitor trail. Following collection, the bats were inspected for ectoparasites, which when found were collected with metal tweezers and stored in vials with 70% alcohol to be identified later. The captured bats were subjected to morphometrics so that the information obtained could help identify which bat species was the host of the ectoparasite collected and then they were released. A total of 36 dipterans from the Streblidae family belonging to six species from four genera: Aspidoptera falcata Wenzel, 1976; Aspidoptera phyllostomatis (Perty, 1833); Megistopoda aranea (Coquillett, 1899); Megistopoda proxima (Séguy, 1926); Paratrichobius longicrus (Miranda Ribeiro, 1907) and Trichobius joblingiWenzel, 1966, infesting phyllostomids of four species: Artibeus lituratus (Olfers, 1818); Artibeus planirostris (Spix, 1823); Carollia perspicillata (Linneaus, 1758) and Sturnira lilium (E. Geoffroy, 1810). The most abundant species were Trichobius joblingi (38.89%) and Aspidoptera phyllostomatis(27.78%).

Este estudo constitui o primeiro registro de parasitismo e associações entre moscas ectoparasitas de morcegos da família Streblidae e morcegos (Chiroptera: Phyllostomidae) no Parque Estadual Floresta São Francisco (PEFSF). Os morcegos foram capturados usando redes de neblina instaladas em vários pontos ao longo da trilha de visitantes do parque. Após a coleta, os morcegos foram inspecionados em busca de ectoparasitas, que, quando encontrados, eram coletados com pinças metálicas e armazenados em frascos com álcool 70% para serem identificados posteriormente. Os morcegos capturados foram submetidos à morfometria para que as informações obtidas pudessem ajudar a identificar qual espécie de morcego era a hospedeira do ectoparasita coletado e, em seguida, foram liberados. Um total de 36 dípteros de Streblidae foram coletados, pertencentes a seis espécies de quatro gêneros: Aspidoptera falcata Wenzel, 1976; Aspidoptera phyllostomatis (Perty, 1833); Megistopoda aranea (Coquillett, 1899); Megistopoda proxima (Séguy, 1926); Paratrichobius longicrus (Miranda Ribeiro, 1907) e Trichobius joblingi Wenzel, 1966, infestando filostomídeos de quatro espécies: Artibeus lituratus(Olfers, 1818); Artibeus planirostris (Spix, 1823); Carollia perspicillata (Linneaus, 1758) e Sturnira lilium (E. Geoffroy, 1810). As espécies mais abundantes foram Trichobius joblingi (38,89%) e Aspidoptera phyllostomatis (27,78%).

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Abstract Objective Platelet to albumin ratio (PAR) and prognostic nutritional index (PNI) are potential indicators for evaluating nutritional and inflammatory status. This study aimed to examine the relationship between PAR and PNI and the acute complicated course of acute hematogenous osteomyelitis (AHO). Methods AHO patients were divided into the simple course group and the acute complicated course group. The patient's gender, age, site of infection, body temperature, laboratory results, and pathogen culture results were collected and compared. Multivariate logistic regression analysis was used to determine the independent risk factors of the acute complicated course group. The receiver operating characteristic curve was applied to determine the optimal cut-off value. Results In total, 101 AHO patients with a median age of 7.58 years were included. There were 63 cases (62.4 %) in the simple course group and 38 cases (37.6 %) in the complicated course group. Binary logistic regression analysis revealed that PAR and PNI were independent risk factors for predicting the acute complicated course of AHO (p = 0.004 and p < 0.001, respectively). Receiver operating characteristic curve analysis demonstrated that the combination of PAR and PNI had an area under the curve of 0.777 (95 % CI: 0.680-0.873, p < 0.001) with a cut-off value of 0.51. Conclusions The incidence of acute complicated courses was significantly higher in patients with high PAR and low PNI. A combined factor greater than 0.51, derived from PAR and PNI measurements within 24 h of admission, may be useful for predicting AHO patients who are likely to develop severe disease.

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INTRODUCTION: University students experienced significant changes in their routines with the implementation of remote learning during Covid-19 pandemic, including increase in sedentary behavior (SB) time and ultra-processed foods (UPF's) consumption, which may have influenced changes in body mass index (BMI). OBJECTIVE: To evaluate the association between the variation in SB time and UPF's consumption with the variation in BMI, before and during the pandemic, in university students. METHODS: This is a cross-sectional study, conducted between November 2020 and February 2021, with students from a public university of Southeast of Brazil, who answered an online questionnaire with questions regarding to the period before and during the pandemic. SB was assessed through questions about time spent on TV and electronic devices. A score of the frequency of UPF's consumption was estimated based on the Brazilian Food Guide. Self-reported information on height and body mass was used to calculate BMI. RESULTS: The sample comprised 3390 university students, with an average age of 28.7 (± 10.0) years. Among them, 65.4% were undergraduates, and 66.9% were women. SB time, UPF score, and BMI increased significantly during the pandemic, compared to the previous period. In this population, there was a significant association between increased SB time (ß = 0.06; SE = 0.01; p < 0.001) and UPF score (ß = 0.08; SE = 0.01; p < 0.001) with an increase in BMI. CONCLUSION: Changes in SB time and UPF score were associated with an increase in BMI before and during the COVID-19 pandemic in students from a Brazilian University.

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(1) Background: This study aimed to evaluate the effect of an extruded whole-grain sorghum beverage containing L. paracasei on body composition, lipid profiles, and intestinal health in overweight and obese adults. (2) Methods: A chronic, single-blind randomized controlled pilot study was conducted with 30 volunteers allocated to three groups (n = 10/group): extruded sorghum beverage (ESB), extruded sorghum beverage with L. paracasei (ESPB), and control beverage (CB) (waxy maize starch). The chemical composition of the beverages was analyzed. Volunteers consumed the beverages for ten weeks at breakfast, along with individual dietary prescriptions. Body composition, biochemical markers, gastrointestinal symptoms, stool consistency, intestinal permeability, short-chain fatty acids, fecal pH, and stool L. paracasei DNA concentration were analyzed at the beginning and end of the intervention period. (3) Results: The ESB showed better composition than the CB, particularly in terms of resistant starch content, total phenolic compounds, condensed tannins, and antioxidant capacity. Both the ESB and the ESPB had an effect on body composition (estimated total visceral fat and waist volume), biochemical markers (Castelli index I), and intestinal health (Bristol scale, diarrhea score, valeric acid, and L. paracasei DNA concentration). No changes were observed in the CB group after the intervention. (4) Conclusions: Whole-grain sorghum beverages demonstrated good nutritional value, and consumption of these beverages, with or without L. paracasei, provided health benefits, including improvements in body composition, Castelli index I scores, and intestinal health, in overweight and obese adults.

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BACKGROUND: The visceral adiposity index (VAI) is a marker of visceral fat accumulation and metabolic dysfunction, but there is limited evidence of its association with cancer. The objective of this study was to investigate associations between the VAI and both incident cancer at 23 sites and all-cause cancer. METHODS: In total, 385,477 participants (53.3% women; mean age, 56.3 years) from the UK Biobank prospective cohort were included in this study. The median follow-up was 8.2 years (interquartile range, 7.3-8.9 years). The VAI was calculated using formula the published by Amato et al. and was categorized into sex-specific tertiles. Twenty-four incident cancers were the outcomes. Cox proportional hazard models were adjusted for sociodemographics, lifestyle factors, and multimorbidity counts. RESULTS: Over the follow-up period, 47,882 individuals developed cancer. In the fully adjusted models, the VAI was associated with a higher risk of six cancer sites. Individuals in the highest tertile, compared with those in the lowest tertile, had higher risks of uterine (hazard ratio [HR], 2.09; 95% confidence interval [CI], 1.76-2.49), gallbladder (HR, 1.83; 95% CI, 1.26-2.66), kidney (HR, 1.39; 95% CI, 1.18-1.64), liver (HR, 1.25; 95% CI, 1.00-1.56), colorectal (HR, 1.14; 95% CI, 1.05-1.24), and breast (HR, 1.11; 95% CI, 1.03-1.19) cancers and of all-cause cancer (HR, 1.05). There was no evidence of a nonlinear association between the VAI and cancer risk. CONCLUSIONS: The VAI was associated with six cancer sites and with all-cause cancer. The prognostic and etiologic roles of visceral fat accumulation and dysfunction in cancer warrant further research.

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Over recent decades, anthropogenic forest fires have significantly altered vegetation dynamics in the Amazon region. While human activities primarily initiate these fires, their escalation is intricately linked to climatic conditions, particularly droughts induced by the warm El Niño phase. This study investigates the impact of meteorological and hydrological drought on forest fires in the Amazon, focusing on the role of groundwater and El Niño events. Utilizing comprehensive drought indicators at various soil depths and standardized precipitation indexes, the research spans from 2004 to 2016, revealing a consistent decrease in humidity conditions across surface soil moisture, root zone soil moisture, and groundwater storage levels. With its slower response to precipitation changes, groundwater emerges as a crucial factor influencing hydrological drought patterns in the Amazon. The spatial distribution of drought conditions is explored, highlighting areas with lower humidity concentrations in the northeast and a correlation between forest fires and positive rates of change in burned area fraction during El Niño events. Notably, the study underscores the substantial increase in burned area during the 2015-2016, characterized by a very strong El Niño. This nuanced understanding of groundwater dynamics and its interplay with El Niño events provides critical insights for developing a tailored fire risk index in the ecologically significant and vulnerable Amazon basin, subsidizing strategies for mitigating fire risk and enhancing preparedness.

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This study investigated whether variations in climate and ocean drivers on global, regional, and local scales affected macrozooplankton communities in a coastal protected area in Tamandaré Bay (northeastern Brazil). For this purpose, bimonthly field campaigns were carried out from June 2013 to August 2019. A significant tipping point (point of change, p < 0.001), with an abrupt increase in SST, was detected in the TSA (Tropical South Atlantic) index. This indicates the existence of a climate regime shift in the Tropical South Atlantic during the 2015/16 El Niño (EN) event. Extreme rainfall events were observed in Tamandaré Bay after this EN event, in 2017, 2018, and in 2019 (and more recently, in 2022). This extreme rainfall led to low-salinity events, increased variability in salinity, and significantly lower abundances in the period after the strong EN event, for socioeconomically relevant penaeid shrimp postlarvae and several other zooplankton groups (e.g., copepods, appendicularians, anomuran hermit crab larvae, and chaetognaths). We found a significant relationship between SSTs in the TSA region and penaeid shrimp recruitment in the study area, located leewards of the TSA index area. The decline in shrimp postlarvae and other macrozooplankton may be due to a combination of factors, such as climate and ocean shifts (atmospheric easterly waves disturbances, winds, precipitation, salinity) and possibly increasing marine pollution (related to extreme rainfall events, that convey macro- and microplastics, and pollutants from the continent). Cnidarian medusae and fish eggs were among the few "winners" of this ecosystem regime shift. Changes in climate, ocean, macrozooplankton, and shrimp postlarvae abundance evidence a relevant climate, ocean and ecosystem regime shift in this region with a tipping point during 2015/16 "Godzilla" El Niño. Possible future consequences in the context of persistent warming in the TSA region and the currently ongoing record strength 2023/24 EN event are discussed.

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This study examines the influence of body mass index (BMI) on the relationship between quantitative sensory testing measures and clinical characteristics in fibromyalgia syndrome (FMS). Utilizing BMI as a categorical covariate (≥25 or ≥30 kg/m²) in associations between quantitative sensory testing metrics (pain-60, conditioned pain modulation, and temporal summation of pain [TSP]) and FMS clinical features, we explored BMI's role as both a confounder (change-in-estimate criterion-change equal or higher than 10%) and effect modifier (interaction term). Significant interactions revealed overweight/obese BMI as a modifier in the relationship between conditioned pain modification and both depression and symptom impact, with a homeostatic relationship between better clinical profile and pain inhibitory response observed solely in the normal-weight group. Similar results were found for pain-60 and depression. Additionally, BMI ≥30 kg/m² modified TSP's effect on pain, demonstrating lower pain with increased TSP, exclusively in the nonobese group. This study highlights the significant role of BMI in moderating the relationships of important pain inhibitory control processes and pain intensity, depression, and the overall impact of FMS symptoms. Our results suggest that high BMI states disrupt the homeostatic effects of pain inhibition, reducing its salutogenic response in FMS participants. We discuss the mechanistic and therapeutic implications of targeting BMI in FMS clinical trials and the potential impact of this important relationship. PERSPECTIVE: This investigation highlights the disruptive influence of high BMI on pain inhibitory control in fibromyalgia, unbalancing clinical symptoms such as pain and depression. It underscores the necessity of integrating BMI considerations into therapeutic approaches to enhance pain management and patient outcomes.

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The Argentinean Pampean region is essential for global food security, known for its extensive production of soybeans, corn, and wheat. The November to January (NDJ) trimester is critical for rainfed summer crops, as precipitation during this period directly affects soil moisture and crop yields. The El Niño-Southern Oscillation (ENSO), particularly its Oceanic Niño Index (ONI), plays a crucial role in influencing precipitation patterns in this region. This study investigates the spatial correlation between the ONI and NDJ precipitation from 1990 to 2021 sing a 20-year sliding window approach. We conducted Pearson correlation and cluster analyses to identify regions with consistent ONI-precipitation relationships. Our findings reveal notable temporal variability, with a general decrease in correlation strength since the window 1995-2014. This decline is likely driven by changes in ENSO dynamics and the influence of other climate variability modes, highlighting the need to consider factors modulating the ONI-precipitation relationship. Notably, the addition of the strong 2015 El Niño, which exhibited inconsistent precipitation behaviour compared to previous strong El Niño events such as 1997, contributed to this weakening. While the 1997 El Niño brought widespread positive rainfall anomalies, the 2015 event was marked by weaker and even negative precipitation anomalies in part of the region. This difference mirrors similar patterns reported in other parts of South America, such as Ecuador and Coastal Peru, and may be linked to a poleward shift in the jet streams during the 2015/2016 El Niño. The results underscore the complexity of ENSO's impact on regional climate and highlight the need for adaptive agricultural planning. By enhancing the understanding of ONI-precipitation dynamics, this study aims to improve long-term climate predictions and support sustainable agricultural practices in the Pampean region.

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The tropical maize breeding for low-P tolerance and good performance under low-P stress environments can be achieved through selection based on root morphology traits at seedling stage. Here, we assessed the genotypic variation and genetic diversity of a panel of 151 tropical maize inbred lines for root and shoot seedling traits, investigated the relationship among traits and selected a set of promising inbred lines for low-P tolerance and performance. We evaluated the inbred lines at seedling stage in a greenhouse experiment under two conditions: applied P (AP) and non-applied P (NAP). A mixed model approach was used to estimate variance components and predict the genotypic values of each inbred line. The genetic diversity among inbred lines based on root and shoot traits was assessed, and correlations were estimated between tested traits under AP and NAP. Our panel of inbred lines showed huge genetic variability for all traits and presented large genetic diversity under both P conditions. Variance components due to the inbred line × P condition interaction were also highly significant (P < 0.01) for all traits. Root dry weight (RDW) was positively associated with stalk dimeter (SD), shoot dry weight (SDW) and root length, volume, and area under both P conditions. Also, the SD and SDW were associated with most root traits under AP. Based on low-P tolerance and performance indices, we selected a set of top 20 inbred lines to be used in our maize breeding program. We therefore concluded that there is a significant genetic diversity in the tropical maize inbred lines which have the genetic potential to be use in association mapping studies and also to develop improved low-P tolerant and P-efficient hybrids and maize breeding populations for low-P stress environments.

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Lake Burlan, a lentic ecosystem artificially created by untreated runoff from adjacent rice fields, is located in the Amazon region within the dry forests of northern Peru. This body of water plays a fundamental role in agriculture and recreational activities in the area, which are fundamental to the local economy. This research aimed to evaluate the water quality of Lake Burlan using the Water Quality Index of Peru (WQI-PE). In addition, both spatial and depth variations of limnological parameters and trace elements were determined. The WQI-PE was calculated at seven sampling stations at two depths (surface level and one meter), using 18 limnological parameters and nine trace elements. The WQI-PE assessment indicated that the lake water quality ranged from poor to fair for both depths. Statistical analysis showed that nine limnological parameters and five trace elements showed spatial differences across seven sampling stations, while three limnological parameters and two trace elements showed depth-dependent variations. Concentrations of arsenic, cadmium, mercury, and lead were in exceedance of the national and international standards on environmental water quality. Therefore, the water quality of Lake Burlan is affected mainly by the impact of the surrounding rice fields and recreational activities. This research establishes a starting point for future monitoring to assist in the implementation of prevention and mitigation.

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Dietary supplementation of fat can be an important source of energy to compensate for the reduction in dry matter intake in dairy cows during heat stress periods. Studies have reported that supplementing dairy cow diets with linseed oil (LO) can increase milk yield and enhance the levels of beneficial fatty acids, such as omega-3 fatty acids, in the milk. The objective of this research was to evaluate the effect of LO supplementation on milk fatty acids profile, milk yield and composition, and physiological parameters of grazing cows. The study was conducted in two seasons, one in spring and one in summer. A 2 × 2 Latin square design was used in each experiment. Twelve Holstein and crossbred Holstein x Jersey cows were involved in each season. Cows were divided into two groups: control (TC) with no supplementation and treatment (TL) supplemented with 400 g/day of LO. The results showed that LO supplementation altered the milk fatty acid profile: decreased concentrations of short and medium-chain fatty acids (C10:0 - C17:1) except for C13:0 and increased concentrations of long-chain fatty acids (C18, C18:1 (both trans and cis isomers), C18:2 (specific conjugated linoleic acid - CLA isomers), and C18:3 n3 (omega-3)). Additionally, milk yield increased by 1.5 l per day during summer in LO-supplemented cows, while milk fat, protein, and casein content decreased. Milk stability increased by 2.2% in the LO-supplemented group. LO-supplemented cows reduced internal body temperature and heart frequency in the afternoon and increased daily rumination time by 20 min. In conclusion, LO supplementation can be an effective strategy to improve the nutritional profile of milk by altering fatty acid composition towards potentially healthier fats, mitigate the negative effects of heat stress on grazing cows during summer, as evidenced by reduced body temperature and heart frequency and increase milk yield.

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Effective pest population monitoring is crucial in precision agriculture, which integrates various technologies and data analysis techniques for enhanced decision-making. This study introduces a novel approach for monitoring lures in traps targeting the Mediterranean fruit fly, utilizing air quality sensors to detect total volatile organic compounds (TVOC) and equivalent carbon dioxide (eCO2). Our results indicate that air quality sensors, specifically the SGP30 and ENS160 models, can reliably detect the presence of lures, reducing the need for frequent physical trap inspections and associated maintenance costs. The ENS160 sensor demonstrated superior performance, with stable detection capabilities at a predefined distance from the lure, suggesting its potential for integration into smart trap designs. This is the first study to apply TVOC and eCO2 sensors in this context, paving the way for more efficient and cost-effective pest monitoring solutions in smart agriculture environments.

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INTRODUCTION: Elevated plantar pressure (PP) constitutes a risk factor for developing foot ulcers. Once present, elevated PP increases morbidity and mortality in patients with diabetes. Given the high prevalence of overweight and obesity in the Mexican population, this study aimed to describe the magnitudes and the distribution of the PP observed in a sample of newly diagnosed patients with diabetes, adjusting for body mass index (BMI) groups (normal weight, overweight, grade I obesity, and grade II and III obesity). MATERIALS AND METHODS: A total of 250 volunteers attending a comprehensive care program for the management of type 2 diabetes received foot assessments that included vascular and neurological evaluation, the identification of musculoskeletal changes, and measurements of PP. RESULTS: Diabetic neuropathy and peripheral arterial disease were present in 21.6% and 11.2% of all participants. Musculoskeletal alterations were present in 70.8% of participants. A positive and significant correlation (p<0.001) was observed between BMI and the peak PP of all anatomical regions assessed. After adjusting for BMI, significant differences (p<0.001) were seen between groups. The metatarsal region, particularly under the third metatarsal head, denoted the highest magnitudes across all BMI. CONCLUSIONS: Periodic PP assessment is recommended to identify the distribution of high-pressure points along the plantar surface. However, as a preventive measure, it is suggested to encourage patients with diabetes and overweight or obesity to wear appropriate footwear and pressure-relief insoles to relieve high-pressure areas - often seen in these populations - to help prevent foot complications.

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BACKGRUOUND: This study investigated the prognostic importance of the hemoglobin glycation index (HGI) for macrovascular and microvascular outcomes, mortality, and hypoglycemia occurrence in a type 2 diabetes cohort and compared it to glycated hemoglobin (HbA1c). METHODS: Baseline and mean first-year HGI and HbA1c, and the variability thereof, were assessed in 687 individuals with type 2 diabetes (median follow-up, 10.6 years). Multivariable Cox regression was conducted to evaluate the associations of HGI and HbA1c parameters with macrovascular (total and major cardiovascular events) and microvascular outcomes (microalbuminuria, advanced renal failure, retinopathy, and peripheral neuropathy), mortality (all-cause and cardiovascular), and moderate/severe hypoglycemia occurrence. RESULTS: During follow-up, there were 215 total cardiovascular events (176 major) and 269 all-cause deaths (131 cardiovascular). Microalbuminuria developed in 126 patients, renal failure in 104, retinopathy in 161, and neuropathy in 177. There were 90 hypoglycemia episodes. Both HGI and HbA1c predicted all adverse outcomes, except microalbuminuria and hypoglycemia. Their adjusted risks were roughly equivalent for all outcomes. For example, the adjusted hazard ratios (HRs) with 95% confidence intervals (CIs), estimated for 1 standard deviation increments, of mean first-year HGI were 1.23 (1.05 to 1.44), 1.20 (1.03 to 1.38), 1.36 (1.11 to 1.67), 1.28 (1.09 to 1.67), and 1.29 (1.09 to 1.54), respectively, for cardiovascular events, all-cause mortality, renal failure, retinopathy, and neuropathy; whereas the respective HRs (95% CIs) of mean HbA1c were 1.31 (1.12 to 1.53), 1.28 (1.11 to 1.48), 1.36 (1.11 to 1.67), 1.33 (1.14 to 1.55), and 1.29 (1.09 to 1.53). CONCLUSION: HGI was no better than HbA1c as a predictor of adverse outcomes in individuals with type 2 diabetes, and its clinical use cannot be currently advised.

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OBJECTIVES: This study aimed to evaluate the change in the Dietary Diversity (DD) Index of Maya women of reproductive age living in rural areas of the Western Highlands of Guatemala after nutrition, health, and agroecology interventions. METHODS: This is a secondary analysis study on DD from two matched groups from three villages in the Lake Atitlan area in the department of Sololá. The first cohort was recruited in 2017 (sample of n = 77). The second cohort was recruited in 2020 (sample of n = 61). Both were followed until 2021. The program provided various resources for assistance for food production and home improvements (sessions from 2018 to 2022). Agroecology sessions were conducted in the test farm. Due to the COVID-19, adjustments were made to continue the education and training sessions. RESULTS: Both cohort samples had a statistically significant increase in participants who consumed at least 15 g from five groups of foods (2017: p = .00002; 2020: p = .045). There was a statistically significant increase in mean food groups consumed daily (2017: p < .00001; 2020: p = .005). CONCLUSIONS FOR PRACTICE: Implementing interventions that include nutrition, health, and agroecology practices in the long term has demonstrated a statistically significant increase in the Dietary Diversity Index of Maya women in their reproductive years living in rural villages in the Western Highlands.

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