MULTIPLE SCLEROSIS MSJ JOURNAL1258 journals.sagepub.com/home/msj BackgroundCognitive impairment (CI) is known to be present in all stages of multiple sclerosis (MS); however, the prevalence estimates vary considerably between studies, ranging from 40% to 65%. 1 The profile of CI in the overall MS population is now relatively well known, involving mainly complex attention, information processing speed, episodic memory, and executive functions. 1,2 Therefore, brief neuropsychological batteries for MS 3 and newly developed assessment tools 4 mainly focus on the assessment of these functions. However, few studies investigated the differences in the prevalence and profile of CI between the different MS disease subtypes, providing heterogeneous results. [5][6][7][8][9] Many of these studies included small clinical samples and focused mainly on relapsing remitting (RR) or progressive forms. Moreover, the association of CI with several clinical features, such as physical disability, sex, and disease duration, is not well established, since inconsistent results have been reported in the literature. [10][11][12][13] The heterogeneity of the published literature could be, at least in part, attributable to small sample size and dissimilarities in the clinical characteristics of the studies' samples. Exploring the independent effects of age, physical disability, disease duration, and disease subtype could prove central to provide a better understanding of the potential role and interaction of cognitive reserve, brain aging, and disease severity for determining CI in MS. The severity of impairment and the number of involved domains were significantly higher in SP and primary progressive multiple sclerosis (PPMS) than in CIS and RR. In multivariable logistic regression analysis, the presence of CI was significantly associated with higher Expanded Disability Status Scale (EDSS) and older age. Conclusion: CI is present in all MS subtypes since the clinical onset and its frequency is increased in the progressive forms, but these differences seem to be more associated with patient age and physical disability than to disease subtype per se.

Background: Evidence of the association between parental childfeeding practices and the child's body mass index (BMI) is controversial, and bidirectional effects have been poorly studied. Objective: We aimed to examine bidirectional associations between parental child-feeding practices and BMI at 4 and 7 y of age. Design: This study included 3708 singleton children from the Generation XXI birth cohort with data on parental child-feeding practices and BMI at 4 and 7 y old. Feeding practices were assessed through a self-administered questionnaire by combining the Child Feeding Questionnaire and the Overt/Covert Control scale and then adapting it to Portuguese preschool children. Weight and height were measured according to standardized procedures, and age-and sex-specific BMI z scores were computed based on the WHO Growth References. Linear regression models were used to estimate the bidirectional associations between each practice and BMI z score. Crosslagged analyses were performed to compare the directions of those associations (the mean score of each practice and BMI z score at both ages were standardized to enable effect size comparisons). Results: After adjustments, pressure to eat and overt control at 4 y of age were associated with a lower BMI z score 3 y later (b: 20.05; 95% CI: 20.08, 20.03 and b: 20.05; 95% CI: 20.09, 20.01, respectively). Regarding the opposite direction of association, a higher BMI z score at 4 y of age was significantly associated with higher levels of restriction and covert control at 7 y of age (b: 0.06; 95% CI: 0.03, 0.08 and b: 0.06; 95% CI: 0.04, 0.08, respectively) and with lower levels of pressure to eat (b: 20.17; 95% CI: 20.20, 20.15). The only bidirectional practice, pressure to eat, was more strongly influenced by the BMI z score than the reverse (b standardized : 20.17 compared with b standardized : 20.04; likelihood ratio test: P , 0.001). Conclusions: We found that parents both respond to and influence the child's weight; thus, this child-parent interaction should be considered in future research.Am J Clin Nutr 2016;103:861-7.

Background: The increasing diversity of population in European Countries poses new challenges to national health systems. There is a lack of data on accessibility and use of health care services by migrants, appropriateness of the care provided, client satisfaction and problems experienced when confronting the health care system. This limits knowledge about the multiple determinants of the utilization of health services. The aim of this study was to describe the access of migrants to health care and its determinants in Portugal.

The National Food, Nutrition and Physical Activity Survey of the Portuguese general population aimed to collect nationwide and regional data on dietary intake and physical activity, and their relation with health determinants, namely socioeconomic factors. Results from this project were obtained from a representative sample of the Portuguese population, aged between three months to 84 years of age, selected from the National Heath Registry, by multistage sampling (a sample size of 5068 individuals was estimated and 5811 participants with two dietary assessments were achieved). To accomplish the EFSA requirements, a minimum, of 260 individuals in each age group (130 by sex) was planned. Two face-to-face interviews were conducted at a health care centre or participant's home. Dietary intake was obtained by two non-consecutive days of food diaries for children (<10 years old) and two nonconsecutive 24-hours recalls for the older age groups, with a time interval between 8 and 15 days, complemented with a Food Propensity Questionnaire. An electronic platform based on a client-server architecture was used to manage the field work and to assist the data collection. The Electronic Assessment Tool for 24-hours recall (eAT24) allowed the collection of dietary data by an Automated Multiple-Pass Method for 24-hours. This interview-based dietary assessment instrument allowed obtaining a very detailed description and quantification of foods, recipes, and food supplements consumed in the course of the preceding day, and it had several adaptations, described in detail in this report. The survey outcomes support solid evidence-based information covering all age groups of the population, using harmonized methodologies at the European level, and will contribute to develop a national infrastructure for monitoring progress of specific targets supporting national and European policies and future interventions on diet, physical activity and food safety.