Novel quantitative structure-activity relationship model to predict activities of natural products against COVID-19

Currently, COVID-19 is spreading in a large scale while no efficient vaccine has been produced. A high-effective drug for COVID-19 is very necessary now. We established a satisfied quantitative structure-activity relationship model by gene expression programming to predict the IC50 value of natural compounds. A total of 27 natural products were optimized by heuristic method in CODESSA program to build a liner model. Based on it, only two descriptors were selected and utilized to build a nonlinear model in gene expression programming. The square of correlation coefficient and s2 of heuristic method were 0.80 and 0.10, respectively. In gene expression programming, the square of correlation coefficient and mean square error for training set were 0.91 and 0.04. The square of correlation coefficient and mean square error for test set are 0.86 and 0.1. This nonlinear model has stronger predictive ability to develop the targeted drugs of COVID-19.

Cognitive Impairment Among Older Adults With Diabetes Mellitus in Puducherry: A Community-Based Cross-Sectional Study

Background Cognitive impairment is a global public health problem in the elderly population. There is increasing evidence that diabetes mellitus predisposes to cognitive impairment. Early diagnosis and management of cognitive impairment can delay the onset of dementia, thereby improving self-care and quality of life of diabetic patients. This study intends to assess cognitive impairment, and the factors influencing cognitive impairment among older adults with diabetes mellitus in Puducherry. Methods A community-based cross-sectional study was conducted in field practice areas of a Government Medical College in Puducherry between April and June 2019. After obtaining ethical approval, 240 registered diabetic patients aged 55 years and above were randomly selected. Data on demographic profile and clinical variables were collected using a semi-structured questionnaire. Cognitive function was assessed using the Hindi Mental State Examination (HMSE) tool, and participants who scored below 26 were considered to have cognitive impairment. Results Among 240 participants, 67.9% were aged 60 years and above, 62.5% were females, and 83.8% were unemployed. The proportion of cognitive impairment among older adults with diabetes was 30.0% (95% confidence interval (CI): 24.5-36.03). The mean ± standard deviation of the HMSE Score was 26.13 ± 3.8, and the median score was 27. Female gender (P= 0.02, adjusted prevalence ratio (aPR) = 5.31, 95% CI: 1.34-21), widowhood status (P= 0.005, aPR= 2.71, 95% CI: 1.34-5.46), illiteracy (P<0.001, aPR= 3.55, 95% CI: 1.78-7.07), and presence of probable symptomatic hypoglycemia (P=0.02, aPR= 2.18, 95% CI: 1.13-4.20) were significant predictors of cognitive impairment in the study population by multivariate analysis. Conclusion Almost one-third of older adults with diabetes were found to be at risk of cognitive impairment. Older diabetic patients with identified risk factors may be prioritized for a screening of cognitive impairment at the primary care level.

Association between solid fuel use and cognitive impairment: A cross-sectional and follow-up study in a middle-aged and older Chinese population

BACKGROUND

To date, few studies have focused on the influence of indoor air pollution on cognitive impairment. Thus, we aimed to explore the association of household fuel use, the major cause of household air pollution, with cognitive functioning among a sample of middle-aged and older Chinese individuals.

METHODS

A total of 10,372 and 8,397 participants from the China Health and Retirement Longitudinal Study (CHARLS) were enrolled in the cross-sectional and follow-up analyses, respectively. Cognitive functioning was evaluated via a structured questionnaire in three dimensions: orientation and attention, episodic memory, and visuo-construction. The associations between household solid fuel use (for cooking and heating) and cognitive functioning were elucidated by generalized linear models. Furthermore, we explored the combined effect of solid fuel use in cooking and heating and examined the effects of switching cooking fuel types on a 4-year change in cognitive functioning.

RESULTS

In the cross-sectional study, solid fuel use for cooking or heating, separately or simultaneously, was positively associated with cognitive impairment, after adjusting for potential confounders. Similarly, in the follow-up study, solid cooking fuel use was associated with a greater decline in cognitive score overall (β = -0.24, 95% confidence interval [CI]: -0.45, -0.04), mostly in the episodic memory (β = -0.19, 95% CI: -0.34, -0.03) and visuo-construction (β = -0.03, 95% CI: -0.05, -0.01) dimensions; solid heating fuel use was associated only with a greater decrease in the orientation and attention dimension (β = -0.13, 95% CI: -0.25, -0.01). A combined effect of household fuel use was also observed (P < 0.05). Moreover, subjects who switched from solid to cleaner cooking fuel displayed a significantly lower degree of cognitive decline for all dimensions than did persistent solid fuel users over a 4-year period (P < 0.05).

CONCLUSION

Our findings show that household solid fuel use is a risk factor for the development of cognitive impairment. Improving the structure of cooking fuel may therefore have great public health value for the prevention of cognitive impairment.

Hyperactivation of P2X7 receptors as a culprit of COVID-19 neuropathology

Scientists and health professionals are exhaustively trying to contain the coronavirus disease 2019 (COVID-19) pandemic by elucidating viral invasion mechanisms, possible drugs to prevent viral infection/replication, and health cares to minimize individual exposure. Although neurological symptoms are being reported worldwide, neural acute and long-term consequences of SARS-CoV-2 are still unknown. COVID-19 complications are associated with exacerbated immunoinflammatory responses to SARS-CoV-2 invasion. In this scenario, pro-inflammatory factors are intensely released into the bloodstream, causing the so-called "cytokine storm". Both pro-inflammatory factors and viruses may cross the blood-brain barrier and enter the central nervous system, activating neuroinflammatory responses accompanied by hemorrhagic lesions and neuronal impairment, which are largely described processes in psychiatric disorders and neurodegenerative diseases. Therefore, SARS-CoV-2 infection could trigger and/or worse brain diseases. Moreover, patients with central nervous system disorders associated to neuroimmune activation (e.g. depression, Parkinson's and Alzheimer's disease) may present increased susceptibility to SARS-CoV-2 infection and/or achieve severe conditions. Elevated levels of extracellular ATP induced by SARS-CoV-2 infection may trigger hyperactivation of P2X7 receptors leading to NLRP3 inflammasome stimulation as a key mediator of neuroinvasion and consequent neuroinflammatory processes, as observed in psychiatric disorders and neurodegenerative diseases. In this context, P2X7 receptor antagonism could be a promising strategy to prevent or treat neurological complications in COVID-19 patients.

Screening for perinatal depression with the Patient Health Questionnaire depression scale (PHQ-9): A systematic review and meta-analysis

OBJECTIVES

Perinatal depression (PND) is a prevalent and disabling problem both during pregnancy and the postpartum period. The legacy screening measure has been the Edinburgh Postnatal Depression Scale (EPDS). This systematic review examines the validity of the PHQ-9 as a screener for PND.

METHODS

The following databases were searched from January 2001 (when the PHQ-9 was first published) through June 2020: MEDLINE, Embase, and PsychInfo. Studies that compared the PHQ-9 to a criterion standard psychiatric interview were used to determine the operating characteristics of sensitivity, specificity and area under the curve (AUC). Studies comparing the PHQ-9 to the EPDS and other depression scales evaluated convergent validity.

RESULTS

A total of 35 articles were eligible for criterion (n = 10) or convergent (n = 25) validity. Meta-analysis of the 7 criterion validity studies using the standard PHQ-9 cut point ≥10 showed a pooled sensitivity, specificity and AUC of 0.84, 0.81 and 0.89, respectively. Operating characteristics of the PHQ-9 and EPDS were nearly identical in head-to-head comparison studies. The median correlation between the PHQ-9 and EPDS was 0.59, and categorical agreement was moderate.

CONCLUSIONS

The PHQ-9 appears to be a viable option for perinatal depression screening with operating characteristics similar to the legacy EPDS.

Adults living with irritable bowel syndrome (IBS): A qualitative systematic review

OBJECTIVE

To consolidate existing qualitative studies which examined the experiences and needs of adults living with IBS, and to gather a holistic insight for future directions and avenues to support these adults.

METHODS

A qualitative systematic review was conducted and six databases were searched for qualitative studies, beginning from each database's inception to July 2020. The qualitative data were meta-synthesised and thematic analysis was adopted. Any discrepancies that arose were discussed between the reviewers until a consensus was reached throughout the process of data screening, selection, critical appraisal and synthesis.

RESULTS

Seventeen studies with a total of 299 adults diagnosed with IBS were included. Four themes were identified: (1) physical, psychological, and social consequences; (2) impact of IBS on working adults; (3) dealing with IBS; and (4) sources of support and support needs.

CONCLUSION

Future research across geographically diverse locations are needed to gather a thorough perspective of the experiences and needs of adults living with IBS. The development and evaluation of technology-based, trained peer-led volunteers, and interventions that adopt mindfulness, active coping strategies, cognitive behavioural therapy and acceptance, and commitment therapy are needed. Ultimately, the collaboration between the relevant stakeholders is essential for standardised instruments and materials for accurate testing, diagnosis, assessment, treatment and management of IBS.

Memory complaints at primary care in a middle-income country: clinical and neuropsychological characterization

There are different causes of memory complaints in the elderly, such as subjective cognitive decline (SCD), mild cognitive impairment (MCI) or dementia.

OBJECTIVE

1) To characterize individuals with memory complaints in a mid-sized city in Brazil, through clinical, cognitive and functional assessment; 2) to compare SCD individuals with MCI and dementia patients in terms of clinical and cognitive variables.

METHODS

We consecutively included individuals aged ≥50 years, with memory complaints (spontaneous or inquired). Subjects who scored ≥25 on the Memory Complaint Questionnaire or who had spontaneous memory complaints were selected. Participants underwent a semi-structured interview, the Mini-Mental State Examination, Figure Memory Test for visual episodic memory, Clock Drawing Test, Category Fluency (Animals), Neuropsychiatric Inventory, and functional assessment. Individuals were classified as SCD, MCI or dementia. We did not include individuals with previous diagnosis of dementia.

RESULTS

The final sample consisted of 91 subjects (73.6% women; mean age 67.6±9.8 years): 14.3% had spontaneous complaints and 85.7% had inquired complaints. The most common comorbidities were hypertension (69.2%), diabetes (36.3%), and dyslipidemia (24.2%). Low levels of vitamin B12 and hypothyroidism were found in 26.4 and 16.5%, respectively. Regarding cognitive diagnosis, 16.5% of the sample were classified as SCD, 49.4% as MCI and 34.1% as dementia. MCI and dementia were identified in five (38.5%) and seven (53.4%) patients with spontaneous complaint, respectively.

CONCLUSIONS

MCI and dementia are frequently underdiagnosed. Potential reversible causes of cognitive decline are common. The diagnosis of dementia is highly frequent among individuals with spontaneous memory complaints.

COVID-19 Pandemic and Overall Mental Health of Healthcare Professionals Globally: A Meta-Review of Systematic Reviews

OBJECTIVE

This meta-review aimed to provide a comprehensive overview of overall mental health of healthcare professionals during the COVID-19 pandemic.

METHOD

We conducted a comprehensive literature search on Academic Search Premier, CINAHL, Cochrane Library, and MEDLINE. A predefined eligibility criterion was used to screen the articles. The methodology quality of eligible studies was assessed using Joanna Briggs Institute checklist for systematic reviews. The data were narratively synthesised in line with the meta-review aim.

RESULT

Forty systematic reviews (represented as K = 40), which reported data from 1,828 primary studies (N) and 3,245,768 participants, met the inclusion criteria. The findings from a pooled prevalence indicate that anxiety (16-41%, K = 30, N = 701), depression (14-37%, K = 28, N = 584), and stress/post-traumatic stress disorder (18.6-56.5%, K = 24, N = 327) were the most prevailing COVID-19 pandemic-related mental health conditions affecting healthcare workers. Other reported concerns included insomnia, burnout, fear, obsessive-compulsive disorder, somatization symptoms, phobia, substance abuse, and suicidal thoughts. Considering regions/countries, the highest anxiety was reported in the United-Kingdom [22.3, 95% Confidence Interval (CI):7-38, N = 4] compared to other countries, while the highest depression was in the Middle-East, (41, 95% CI:16-60, N = 5) and stress in the Eastern Mediterranean region (61.6, 95% CI:56.4-66.8, N = 2) compared to other regions. The most significant risk factors include female gender, younger age, being a nurse, and frontline professional. The most-reported coping strategies include individual/group psychological support, family/relative support, training/orientation, and the adequacy of personal protective equipment.

CONCLUSION

It was concluded that healthcare professionals (nurses, doctors, allied health) have experienced various mental health issues during COVID-19 pandemic. The meta-review, therefore, recommends targeted interventions and health policies that address specific mental health issues to support health professionals worldwide during the duration of the COVID-19 pandemic and similar future health crises.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD4202126200, identifier: CRD42021262001.

Lock-Down Effect on the Mental Health Status of Healthcare Workers During COVID-19 Pandemic

Background: The psychological impact that outbreaks and pandemics could inflict on healthcare workers has been widely studied; yet, little is known about the impact of the lockdown measures. Objectives: To assess the magnitude of depression and anxiety among healthcare professionals before and after lifting of the lockdown restrictions in Saudi Arabia. Methods: Surveys targeting healthcare workers were circulated twice: during the lockdown, and 8 weeks after lifting of lockdown. Anxiety and depressive symptoms were assessed using Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scales. Results: A total of 947 healthcare workers, with the mean age of (37 ± 8.9) responded to the surveys. Among these, 23-27% respondents reported clinically significant levels of anxiety and depression. Whereas, easing of the lockdown restrictions was shown to be associated with decreasing mean scores of PHQ-9 and GAD-7. The noted burden fell heavily on female workers, those with a current or a history of psychiatric disorders, suffering from chronic diseases, being in workplaces with high exposure to COVID-19 or in contact with COVID-19 patients, nurses, as well as those who were living with elderly and perceived their physical and mental health as "much worse" compared to the time before the pandemic. Conclusion: Our findings identified several predictors for anxiety and depression at different time-points of the pandemic. Thus, priority to psychological support measures might be needed for these groups.

Indoor particulate air pollution from open fires and the cognitive function of older people

Exposure to indoor air pollution is known to affect respiratory and cardiovascular health, but little is known about its effects on cognitive function. We measured the concentrations and magnetite content of airborne particulate matter (PM) in the indoor environment arising from burning peat, wood or coal in residential open fires. Highest indoor PM_2.5 concentrations (60 μg/m³ i.e. 2.4 times the WHO-recommended 24-h mean) occurred when peat was burned, followed by burning of coal (30 μg/m³) and wood (17 μg/m³). Conversely, highest concentrations of coarser PM (PM_10-2.5) were associated with coal burning (20 μg/m³), with lower concentrations emitted during burning of wood (10 μg/m³) and peat (8 μg/m³). The magnetic content of the emitted PM, greatest (for both PM size fractions) when coal was burned, is similar to that of roadside airborne PM. Exposure to PM, and to strongly magnetic airborne PM, can be greater for individuals spending ~5 h/day indoors with a coal-burning open fire for 6 months/year compared to those commuting via heavily-trafficked roads for 1 h/day for 12 months/year. Given these high indoor PM and magnetite concentrations, and the reported associations between (outdoor) PM and impaired neurological health, we used individual-level data from The Irish Longitudinal Study on Ageing (TILDA) to examine the association between the usage of open fires and the cognitive function of older people. Using a sample of nearly seven thousand older people, we estimated multi-variate models of the association between cognitive function and open fire usage, in order to account for relevant confounders such as socio-economic status. We found a negative association between open fire usage and cognitive function as measured by widely-used cognitive tests such as word recall and verbal fluency tests. The negative association was largest and statistically strongest among women, a finding explained by the greater exposure of women to open fires in the home because they spent more time at home than men. Our findings were also robust to stratifying the sample between old and young, rich and poor, and urban and rural.

Impact of Multiple Risk Factors on Vaccination Inequities: Analysis in Indian Infants Over 2 Decades

INTRODUCTION

Several authors have explored the effect of individual risk factors on vaccination inequity in Indian infants. This study explores the combined impact of >1 risk factor on the probability of full vaccination.

METHODS

The proportion of fully vaccinated infants (aged 1-2 years) was calculated from the National Family Health Survey conducted during 1997-1998 (National Family Health Survey-2, n=10,211), 2005-2006 (National Family Health Survey-3, n=9,582), and 2015-2016 (National Family Health Survey-4, n=48,715). Full vaccination was defined as receiving Bacille Calmette‒Guerin (1 dose); diphtheria, pertussis, tetanus (3 doses); oral polio (3 doses); and measles (1 dose) vaccines. The association between full vaccination status and 6 factors (infant sex, birth order, family wealth status, maternal education level, residence type, and religion) was analyzed individually, followed by the combined impact of ≥1 of the first 4, using logistic regression models.

RESULTS

The AORs for full vaccination in the 3 surveys, respectively, were 1.09, 1.13, and 1.00 for male versus female infants; 0.68, 0.71, and 0.88 for birth order >1 versus birth order 1; 1.54, 1.96, and 1.20 for greater wealth versus lowest wealth stratum; 2.21, 2.27, and 1.27 for any maternal education versus none; 1.08, 1.10, and 1.08 for Hindu versus other religion; and 1.51, 1.10, and 0.88 for urban versus rural residence. The respective ORs of full vaccination in the 3 surveys by the number of risk factors were as follows: 1.26, 1.54, and 1.27 for 3 risk factors; 2.41, 3.23, and 1.68 for 2 risk factors; 4.42, 6.45, and 2.18 for 1 risk factor; and 7.32, 9.84, and 2.61 for no risk factor.

CONCLUSIONS

The presence of multiple risk factors had a cumulative negative impact on infant vaccination in India. Despite an improvement over 2 decades, significant inequities persist.

SUPPLEMENT INFORMATION

This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health.

Anxiety, stress and depression levels among nurses of educational hospitals in Iran: Time of performing nursing care for suspected and confirmed COVID-19 patients

BACKGROUND

Following the global emergency of coronavirus disease 2019 (COVID-19), health-care workers, especially nurses were encountered with an increasing workload. Therefore, due to the importance of this issue, the present study aimed to examine stress, anxiety, and depression levels among nurses during the COVID-19 pandemic in Iran.

MATERIALS AND METHODS

This cross-sectional study was conducted in four educational hospitals affiliated to Kerman University of Medical Sciences in 2020. The standard Depression, Anxiety and Stress Scale-21 questionnaire was applied to assess the levels of stress, anxiety, and depression in nurse personnel with a census method (n = 403). Data were analyzed using descriptive statistics and analytic statistics such as Kolmogorov-Smirnov, Mann-Whitney, Kruskal-Wallis, and multiple linear regression tests through the version 20, SPSS Inc., Chicago, IL, USA, Software at the level of P < 0.05.

RESULTS

The results of the study showed that the mean scores of depressions (9.18 ± 4.45), stress (9.62 ± 4.94), and anxiety (10.32 ± 4.85) in nurses were at moderate level. A significant relationship was observed between stressed, anxious, and depressed participants in the gender, marital status, level of education, and working hours per month. No statistically significant relationship was found between other demographic variables including age, work experience, and employment status with anxiety, depression, and stress categories.

CONCLUSION

The results of this study can increase the awareness of health system managers, especially hospitals, about the level of stress, anxiety, and depression and can help in order to provide psychological support programs for improving the mental health of nurses during the COVID-19 pandemic.

Factors associated with psychological distress during the coronavirus disease 2019 (COVID-19) pandemic on the predominantly general population: A systematic review and meta-analysis

BACKGROUND

The Coronavirus Disease 2019 (COVID-19) outbreak has escalated the burden of psychological distress. We aimed to evaluate factors associated with psychological distress among the predominantly general population during the COVID-19 pandemic.

METHODS

We searched PubMed, EMBASE, Scopus, Cochrane Library, PsycINFO, and World Health Organization COVID-19 databases (Dec 2019-15 July 2020). We included cross-sectional studies that reported factors associated with psychological distress during the COVID-19 pandemic. Primary outcomes were self-reported symptoms of anxiety and depression. Random-effects models were used to pool odds ratios (OR) and 95% confidence intervals (CI). The protocol was registered in PROSPERO (#CRD42020186735).

FINDINGS

We included 68 studies comprising 288,830 participants from 19 countries. The prevalence of anxiety and depression was 33% (95% CI: 28%-39%) and 30% (26%-36%). Women versus men (OR: 1.48 [95% CI: 1.29-1.71; I2 = 90.8%]), younger versus older (< versus ≥35 years) adults (1.20 [1.13-1.26]; I2 = 91.7%), living in rural versus urban areas (1.13 [1.00-1.29]; I2 = 82.9%), lower versus higher socioeconomic status (e.g. lower versus higher income: 1.45 [1.24-1.69; I2 = 82.3%]) were associated with higher anxiety odds. These factors (except for residential area) were also associated with higher depression odds. Furthermore, higher COVID-19 infection risk (suspected/confirmed cases, living in hard-hit areas, having pre-existing physical or mental conditions) and longer media exposure were associated with higher odds of anxiety and depression.

INTERPRETATION

One in three adults in the predominantly general population have COVID-19 related psychological distress. Concerted efforts are urgently needed for interventions in high-risk populations to reduce urban-rural, socioeconomic and gender disparities in COVID-19 related psychological distress.

[Update on COVID-19 and mental health]

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiological agent of the coronavirus 2019 (COVID-19) disease, which has caused a pandemic in 2020. This healthcare crisis has had a significant repercussion on the mental health of people who have had the disease itself, those who have undergone restrictive lockdowns, and healthcare professionals who have been working directly or indirectly in patient care. Although the pathological mechanisms related to neuropsychiatric manifestations in patients with COVID-19 are currently unknown, different methods of action through which the central nervous system could be affected have been proposed, including direct or indirect methods. Among them, inflammatory activation through what is known as a "cytokine storm," which is present in both COVID-19 and some mental disorders, seems to play a fundamental role. We also analyze the effects the pandemic has had on the general population, which has had to be remain in lockdown, as well as on healthcare professionals who have been working.

A comprehensive review of the impact of COVID-19 on human reproductive biology, assisted reproduction care and pregnancy: a Canadian perspective

Currently, the world is in the seventh month of the COVID-19 pandemic. Globally, infections with novel SARS-CoV-2 virus are continuously rising with mounting numbers of deaths. International and local public health responses, almost in synchrony, imposed restrictions to minimize spread of the virus, overload of health system capacity, and deficit of personal protective equipment (PPE). Although in most cases the symptoms are mild or absent, SARS-CoV-2 infection can lead to serious acute respiratory disease and multisystem failure. The research community responded to this new disease with a high level of transparency and data sharing; with the aim to better understand the origin, pathophysiology, epidemiology and clinical manifestations. The ultimate goal of this research is to develop vaccines for prevention, mitigation strategies, as well as potential therapeutics.The aim of this review is to summarize current knowledge regarding the novel SARS CoV-2, including its pathophysiology and epidemiology, as well as, what is known about the potential impact of COVID-19 on reproduction, fertility care, pregnancy and neonatal outcome. This summary also evaluates the effects of this pandemic on reproductive care and research, from Canadian perspective, and discusses future implications.In summary, reported data on pregnant women is limited, suggesting that COVID-19 symptoms and severity of the disease during pregnancy are similar to those in non-pregnant women, with pregnancy outcomes closely related to severity of maternal disease. Evidence of SARS-CoV-2 effects on gametes is limited. Human reproduction societies have issued guidelines for practice during COVID-19 pandemic that include implementation of mitigation practices and infection control protocols in fertility care units. In Canada, imposed restrictions at the beginning of the pandemic were successful in containing spread of the infection, allowing for eventual resumption of assisted reproductive treatments under new guidelines for practice. Canada dedicated funds to support COVID-19 research including a surveillance study to monitor outcomes of COVID-19 during pregnancy and assisted reproduction. Continuous evaluation of new evidence must be in place to carefully adjust recommendations on patient management during assisted reproductive technologies (ART) and in pregnancy.

Mental Health of Pregnant and Postpartum Women During the Coronavirus Disease 2019 Pandemic: A Systematic Review and Meta-Analysis

Background: Prenatal and postnatal mental disorders can exert severe adverse influences on mothers, fetuses, and children. However, the effect of the coronavirus disease 2019 (COVID-19) pandemic on the mental health of pregnant and postpartum women remains unclear. Methods: Relevant studies that were published from January 1, 2019 to September 19, 2020 were identified through the systematic search of the PubMed, EMBASE, and Web of Science databases. Quality assessment of included studies, random-effects meta-analysis, sensitivity analysis, and planned subgroup analysis were performed. Results: A total of 23 studies conducted with 20,569 participants during the COVID-19 pandemic and with 3,677 pregnant women before the COVID-19 pandemic were included. The prevalence rates of anxiety, depression, psychological distress, and insomnia among pregnant women during the COVID-19 pandemic were 37% (95% confidence interval [CI] 25-49%), 31% (95% CI 20-42%), 70% (95% CI 60-79%), and 49% (95% CI 46-52%), respectively. The prevalence of postpartum depression was 22% (95% CI 15-29%). Multigravida women and women in the first and third trimesters of pregnancy were more vulnerable than other pregnant women. The assessment of the associations between the COVID-19 pandemic and mental health problems revealed that the pooled relative risks of anxiety and depression in pregnant women were 1.65 (95% CI: 1.25-2.19) and 1.08 (95% CI: 0.80-1.46), respectively. Conclusions: The prevalence rates of mental disorders among pregnant and postpartum women during the COVID-19 pandemic were high. Timely and tailored interventions should be applied to mitigate mental problems among this population of women, especially multigravida women and women in the first and third trimesters of pregnancy.

Dietary patterns and depression risk in older adults: systematic review and meta-analysis

CONTEXT

Diet may be one of the modifiable environmental factors that could reduce depressive symptoms or abate the development of depression without side effects. However, previous reviews mainly focused on general adult populations.

OBJECTIVE

The aim of this systematic review and meta-analysis was to explore the association between healthy dietary patterns and depression risk in older adults.

DATA SOURCES

Eight databases were searched up to September 2019. The inclusion criteria were older adults aged ≥ 65 years, healthy dietary patterns, depression assessed by a physician or by validated screening tools, and quantitative study design.

DATA EXTRACTION

Data were extracted independently by 2 researchers, and the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed.

DATA ANALYSIS

Meta-analysis was conducted by calculating the pooled odds ratio (OR) and 95% CIs. A total of 18 eligible studies were meta-analyzed. Results showed that a healthy dietary pattern is associated with a reduced risk of depression in older adults (OR, 0.85; 95%CI, 0.78-0.92; P < 0.001). There was high heterogeneity (I2 = 64.9%; P < 0.001) among the studies. Subgroup analyses indicated that sample size and depression screening tools were the main sources of study heterogeneity.

CONCLUSIONS

An inverse association between healthy dietary patterns and depression risk in older adults was found. However, the high heterogeneity among the studies should be considered.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD 42020169195.

Early Childhood Junk Food Consumption, Severe Dental Caries, and Undernutrition: A Mixed-Methods Study from Mumbai, India

In India, globalization has caused a nutrition transition from home-cooked foods to processed sugary snacks and drinks, contributing to increased early childhood caries (ECC). This mixed-methods study describes risk factors for ECC and associations with undernutrition in low-income communities in Mumbai. Interviews with mothers of 959 children, ages six-months through six-years, addressed maternal-child nutrition and oral health, and children received dental exams and anthropometric assessments. Focus groups with community health workers and mothers explored experiences and perceptions of oral health, nutrition, and ECC. Descriptive and logistic regression analyses of quantitative data, and content analysis of qualitative data were performed. Eighty percent of children lived 5 min from a junk-food store, over 50% consumed junk-food and sugary tea daily, 50% experienced ECC, 19% had severe deep tooth decay, 27% experienced mouth pain, and 56% experienced chronic and/or acute malnutrition. In children ages 3–6, each additional tooth with deep decay was associated with increased odds of undernutrition (Odds Ratio [OR] 1.10, Confidence Interval [CI] 1.02–1.21). Focus groups identified the junk-food environment, busy family life, and limited dental care as contributors to ECC. Policy interventions include limits on junk-food marketing and incorporating oral health services and counseling on junk-food/sugary drinks into maternal–child health programs.

Is Peer Support in Group Clinics as Effective as Traditional Individual Appointments? The First Study in Patients With Celiac Disease

INTRODUCTION

Celiac disease (CD) is common, affecting approximately 1% of the population. The cornerstone of management is a gluten-free diet, with dietetic advice being the key to aiding implementation. The aim of the study was to assess group clinics in comparison with traditional individual appointments.

METHODS

Patients with a new diagnosis of CD, confirmed histologically, were prospectively recruited over 18 months in Sheffield, United Kingdom. Patients received either a group clinic or traditional one-to-one appointment, led by a dietitian. Quality-of-life questionnaires were completed at baseline, as well as biochemical parameters being recorded. Patients were followed up at 3 months, where adherence scores were assessed as well as biochemical parameters and quality of life questionnaires being completed.

RESULTS

Sixty patients with CD were prospectively recruited and received either an individual (n = 30) or group clinic (n = 30). A statistically significant reduction in tissue transglutaminase was noted following group clinics (mean 58.5, SD 43.4 U/mL vs mean 13.2, SD 5.7 U/mL, P < 0.01). No significant differences in baseline and follow-up biochemical parameters between one-to-one and group clinics were noted. At follow-up, there was no statistically significant difference between mean gluten-free diet adherence scores (mean 3.1, SD 0.4 vs mean 3.1, SD 0.7, P = 0.66) between one-to-one and group clinics.

DISCUSSION

This first study assessing group clinics in CD demonstrates they are as effective as traditional one-to-one clinics, with the added benefits of peer support and greater efficiency, with an estimated 54% reduction of dietetic resources.

Prevalence of Psychiatric Morbidity and Cognitive Impairment among Patients Attending the Rural Noncommunicable Disease Clinic

Objective  This study aimed to assess the prevalence of cognitive impairment and psychiatric morbidity among the patients attending the rural noncommunicable disease clinic after controlling for various confounders (i.e., psychological morbidity, obesity, gender, level of education, duration of the illness and age).

Materials and Methods  One-hundred twenty-four patients were evaluated on the Hindi Mental State Examination for the cognitive function, Physical Health Questionnaire-9 for depression, and Generalized Anxiety Disorder-7 for anxiety disorders.

Results  About one-fourth (26.6%) of the participants had cognitive impairment. The prevalence of cognitive impairment was more among patients with hypertension (35.5%) as compared with the diabetes mellitus (13.6%) and those with comorbid hypertension and diabetes mellitus (26.6%). About one of the participants had depression (35.5%) and 29% of the patients had anxiety disorder. No significant difference was found in the level of cognitive deficits between those with hypertension and diabetes mellitus, when the confounding factors were not taken into account in the analysis. However, after controlling for psychiatric morbidity, obesity, gender, level of education, duration of the illness and age, those with hypertension were found to have significantly higher level of cognitive impairment compared with those with diabetes mellitus. A higher level of dysfunction was seen in the domains of orientation, registration, attention, recall, language, and visuospatial domains.

Conclusion  Present study suggests that patients of hypertension have higher level of cognitive impairment, when compared with those with diabetes mellitus, even after controlling for various confounders. Lack of difference between the two groups can be accounted by the confounding variables.

Evidence Base Update on Assessing Sleep in Youth

BACKGROUND

Sleep is vital to youth well-being and when it becomes disturbed - whether due to environmental or individual factors - mental and physical health suffer. Sleep problems can also be a symptom of underlying mental health disorders. Assessing different components of sleep, including quality and hygiene, can be useful both for identifying mental health problems and for measuring changes in well-being over time. However, there are dozens of sleep-related measures for youth and it can be difficult to determine which to select for a specific research or clinical purpose. The goal of this review was to identify sleep-related measures for clinical and/or research use in youth mental health settings, and to update the evidence base on this topic.

METHOD

We generated a list of candidate measures based on other reviews and searched in PubMed and PsycINFO using the terms "sleep" AND (measure OR assessment OR questionnaire) AND (psychometric OR reliability OR validity). Search results were limited to studies about children and adolescents (aged 2-17) published in English. Additional criteria for inclusion were that there had to be at least three publications reporting on the measure psychometrics in community or mental health populations. Sleep measures meeting these criteria were evaluated using the criteria set by De Los Reyes and Langer (2018).

RESULTS

Twenty-six measures, across four domains of sleep - insomnia, sleep hygiene, sleepiness, sleep quality - met inclusion criteria. Each measure had at least adequate clinical utility. No measure(s) emerged as superior across psychometric domains.

CONCLUSION

Clinicians and researchers must evaluate sleep measures for each use case, as the intended purpose will dictate which measure is best. Future research is necessary to evaluate measure performance in transdiagnostic mental health populations, including youth with serious mental illness.

Quality improvement activity in occupational healthcare associated with reduced need for disability retirement: A Bayesian mixed effects modelling study in Finland

Objectives There is evidence that occupational healthcare (OHC) may improve employees' work ability. This research was designed to study whether common quality improvement (QI) activities in the OHC quality network (OQN) - a voluntary collaborative forum - can reduce the need for disability pensions. Methods The study population comprised employees under the care of 19 OHC units in Finland affiliated with the OQN. The association of 12 QI activities with new disability pensions during the years 2011-2017 was analyzed by Bayesian mixed effects modelling. Results Patients of OHC units affiliated with the OQN have fewer full permanent disability pensions [odds ratio (OR) 0.77, 95% credible interval (CI) 0.60-0.98] and full provisional disability pensions (OR 0.68, 95% CI 0.53-0.87) than patients of unaffiliated units. Of the studied QI activities, the measurements of intervening in excessive use of alcohol had the strongest association with the incidence of all disability pensions (OR 0.53, 95% CI 0.41-0.68). Participation in the focus of work measurements and quality facilitator training was also associated with the reduced incidence of disability pensions (OR 0.84, 95% CI 0.71-0.98, and OR 0.92, 95 CI 0.84-0.99, respectively). Conclusions Affiliation with a quality network seemed to improve outcomes by reducing full disability pensions or replacing them by partial disability pensions. Some QI activities in the OQN were associated with a reduction of disability pensions.

Prevalence of Menopausal Symptoms and its Effect on Quality of Life among Rural Middle Aged Women (40-60 Years) of Haryana, India

Background

Demographic and epidemiological transitions have increased the life expectancy of middle aged women, resulting in higher burden of morbidities related to menopausal symptoms and also effect the quality of life (QOL).

Objectives

To study the prevalence of menopausal symptoms and its effect on QOL among rural middle aged women (40-60 years) of Haryana, India.

Materials and Methods

A community based cross-sectional study was conducted in 400 middle aged women (40-60 years) from April 2018 to March 2019 by random sampling technique. The menopause rating scale was used to assess the prevalence of menopausal symptoms and the QOL and data were collected for sociodemographic factors, relevant menstrual history and other variables.

Results

Prevalence of menopausal symptoms was found to be 87.7%. Majority of the study subjects had anxiety (80%), followed by physical and mental exhaustion (71.5%), sleep problem (61.2%), irritability (60.7%), Joint and muscular discomfort (56%) and heart problems (54%). The most classical symptom of menopause i.e., hot flushes were reported in 36.7%. The mean age of menopause was 47.53 standard deviation 4.5 years. Statistical significant difference was seen for the mean score of few symptoms i.e., hot flushes, sweating (P < 0.003) and joint and muscular discomfort (P < 0.014) between post and peri-menopausal groups. The QOL was impaired in 70.2% of study subjects. The psychological symptoms attributed 70.8% to the poor QOL.

Conclusion

To improve the QOL and to decrease the menopausal symptoms in these women, a holistic approach in the form of lifestyle and behavioral modification are required.

Is kidney function associated with cognition and mood in late life? : The Screening for CKD among Older People across Europe (SCOPE) study

Background

Chronic kidney disease (CKD), cognitive impairment and depression share common risk factors. Previous studies did not investigate the possible association between kidney function and cognitive and mood disorders in older persons in a broad range of kidney function. The present study explored associations between kidney function, cognition and mood in outpatients of 75 years and over.

Methods

Baseline data of 2252 participants of the SCOPE study, an international multicenter cohort observational study,were used in which community-dwelling persons of 75 years and over were enrolled to screen for CKD Kidney function was estimated with the BIS1-eGFR equation, cognition was assessed with the Mini-Mental State Examination (MMSE) and mood with the Geriatric Depression Scale 15 items (GDS-15). Characteristics were compared across stages of CKD. Mean eGFR values were also compared across categories of MMSE (< 24, 24–26, ≥27) and between groups with high and low score on the GDS-15 (> 5/≤5).

Results

In total, 63% of the population had an eGFR < 60 mL/min. In advanced stages of CKD, participants were older and more often men than in earlier stages (p < 0.001). Cardiovascular diseases and diabetes mellitus were more often found in those in advanced stages of CKD (p < 0.001), and also cumulative comorbidity scores were higher than in those in earlier stages (p < 0.001). Median MMSE was 29 in CKD stage 1–2 and 3, and 30 in CKD stage 4, whereas median GDS-15 score was 2 in all stages of CKD. Mean values of eGFR did not differ across categories of MMSE or between groups with high and low score on the GDS-15. Stratification for albuminuria did not change these results.

Conclusions

Older persons in more advanced stages of CKD did not have lower cognitive scores or higher rates of depressive symptoms than older persons in earlier stages. Future longitudinal studies might give information on the possible effect of kidney function on cognition and mood in late life.

Trial registration

This study was registered prospectively on 25th February 2016 at clinicaltrials.gov (NCT02691546).

Mobile-Enhanced Peer Support for African Americans with Type 2 Diabetes: a Randomized Controlled Trial

BACKGROUND

Peer support has been shown to improve diabetes self-management and control, but no standard exists to link peer support interventions to clinical care.

OBJECTIVE

To compare a community-based diabetes self-management education (DSME) plus mobile health (mHealth)-enhanced peer support intervention to community-based diabetes self-management education (DSME) alone for African American adults with poorly controlled type 2 diabetes.

DESIGN

A randomized controlled trial.

PARTICIPANTS

African American adults, age > 19 years, receiving care within a safety-net healthcare system in Jefferson County, Alabama, with a diagnosis of type 2 diabetes and a hemoglobin A1c (A1C) ≥ 7.5%.

INTERVENTIONS

Participants in the intervention group received community-based diabetes self-management education (DSME) plus 6 months of mHealth-enhanced peer support, including 12 weekly phone calls, then 3 monthly calls from community health workers, who used a novel web application to communicate with participants' healthcare teams. In the control group, participants received community-based DSME alone.

MAIN MEASURES

The primary outcome was A1C; secondary outcomes included diabetes distress, depressive symptoms, self-efficacy or confidence in their ability to manage diabetes, and social support. We used mixed models repeated measures analyses to assess for between-arm differences and baseline to follow-up changes.

KEY RESULTS

Of 120 participants randomized, 97 completed the study. Participants in intervention and control groups experienced clinically meaningful reduction in A1C, 10.1 (SD 1.7) to 9.6 (SD 1.9) and 9.8 (SD 1.7) to 9.1 (SD 1.9) respectively, p = 0.004. Participants in the intervention group experienced a significantly larger reduction in diabetes distress compared to the control, 2.7 (SD 1.2) to 2.1 (1.0) versus 2.6 (SD 1.1) to 2.3 (SD 1.0) p = 0.041.

CONCLUSIONS

Community-based DSME with and without peer support led to improved glycemic control. Peer support linked to clinical care led to a larger reduction in diabetes distress, which has important implications for the overall wellbeing of adults with type 2 diabetes.

Incidence of Post-Traumatic Stress Disorder After Coronavirus Disease

Background: The coronavirus disease (COVID-19) emerged from China and rapidly spread to many other countries. In this study, we investigated the prevalence of post-traumatic stress disorder (PTSD) among patients with COVID-19 who were treated and discharged from a university hospital in Daegu, Korea. Methods: In total, 64 patients who were diagnosed with COVID-19 and then hospitalized, treated and discharged from the university hospital between February and April 2020 participated in our study. We conducted telephone interviews with the participants and evaluated the presence of PTSD using the Post-Traumatic Stress Disorder Checklist-5 (PCL-5) based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; score range: 0-80). If a score of ≥33 was obtained, then a diagnosis of PTSD was made. We analyzed the association between PTSD and demographic and clinical characteristics using the Mann-Whitney U and chi-square tests. Results: In total, 13 patients had a PCL-5 score of ≥33, which indicated that 20.3% (n = 64) of the patients had PTSD. No significant differences were observed in demographic characteristics, including, sex, age, hospitalization time and duration after discharge, between patients with PTSD and those without PTSD. Conclusions: The prevalence rate of PTSD was 20.3% in patients with COVID-19 who had been hospitalized, treated and discharged. Accordingly, clinicians should be aware of the high possibility of PTSD among COVID-19 patients. Mental health interventions supporting the mental health of patients should be provided to affected patients.

Well-being in high-risk pregnancy: an integrative review

BACKGROUND

A prerequisite to the interventions for well-being improvement in high-risk pregnancy (HRP) is to make the concept clear, objective, and measurable. Despite the wealth of studies into the concept of well-being in HRP, there is no clear definition for it. This study aimed to explore the concept of well-being in HRP.

METHODS

This integrative review was conducted using the Whittemore and Knafl's approach. A literature search was done without any data limitation in dictionaries, thesauruses, encyclopedias, well-being-related textbooks, midwifery, psychology, and mental health journals, and Iranian and international databases. The most primary inclusion criterion was relevance to well-being in HRP. The full-texts of all these articles were assessed using the checklists of the Joanna Briggs Institute. Data were analyzed through the constant comparison method and were managed using the MAXQDA 10 software. Meaning units were identified and coded. The codes were grouped into subcategories and categories according to the attributes, antecedents, and consequences of well-being in HRP.

RESULTS

Thirty articles were included in the review, from which 540 codes were extracted. The codes were grouped into seven main attributes, eight main antecedents, and five main consequences of well-being in HRP. The four unique dimensions of well-being in HRP are physical, mental-emotional, social, and spiritual well-being. These dimensions differentiate well-being in HRP from well-being in low-risk pregnancy and in non-pregnancy conditions.

CONCLUSION

As a complex and multidimensional concept, well-being in HRP refers to the pregnant woman's evaluation of her life during HRP. It includes physical, hedonic, and eudaimonic components. The assessment of well-being in HRP should include all these components.

Emerging mental health issues during the COVID-19 pandemic: An Indian perspective

The current global health crisis, the COVID-19 pandemic, has posed an unprecedented challenge to our health systems, economy, socio-political organizations, and the infrastructure of most countries and the world. This pandemic has affected physical health as well as mental health adversely. Several recent evidence suggests that health systems across the world have to improve their preparedness in context to infectious pandemics. The research on mental health aspects of COVID-19 and other related pandemics is lacking due to obvious reasons. This narrative review article, along with our personal views, is on various current and future mental health issues in the context of the COVID-19 pandemic focusing on various challenges and suggested solutions. The aim is also to update mental health strategies in the context of such rapidly spreading contagious illness, which can act as a resource for such a situation, currently and in future. We recommend that there is a need to facilitate mental health research to understand the psychiatric aspects of the COVID-19 pandemic, include psychiatrists in the task force, and make available psychotropic and other medications with special attention to the deprived sector of the society.

The effect of PM2.5 exposure and risk perception on the mental stress of Nanjing citizens in China

The multidimensional characteristics and temporal dynamics of environmental risks have stimulated a social-scientific approach towards air pollution issues in recent decades. It's now widely acknowledged that air pollution has an ineligible influence on the psychological wellbeing of citizens beyond its well-established physical impact. We explored how fine particulate matter (PM_2.5), an essential air pollutant associated with morbidity and mortality, interacted with aspects of risk perception to influence citizen's mental stress level. Questionnaire data from 508 Nanjing citizens in China were collected across four seasons within an 18-month period. We found no evidence that mental stress was directly influenced by real-time PM_2.5 exposure. However, path analysis revealed that mental stress was subjected to the indirect influence of physical symptoms (β = 0.076, p = 0.11), by increasing perceived effect on health and increasing attribution to indoor pollution sources (β = 0.038, p = 0.005). Indoor attribution of PM_2.5 pollution was associated with perceived familiarity with risk (β = -0.095, p = 0.033), whereas outdoor attribution was associated with perceived control of risk (β = 0.091, p = 0.041). Public risk acceptable rate (PRAR) decreased as PM_2.5 concentration increased. In females, but not males, greater trust for government was associated with the increased acceptance of PM_2.5 (Year₂₀₁₇: β = -0.19, p = 0.003; Year₂₀₂₂: β = -0.21, p < 0.001). Using psychological statistical methods, our study implied that air pollution has a substantial association with psychological wellbeing in various ways, which might provide some references for public healthcare and risk communication.

The difference in sleep, depression, anxiety, and Internet addiction between Korean adolescents with different circadian preference

OBJECTIVES

Compared to adults, adolescents tend to prefer evening times developmentally. The orientation toward evening times is associated with behavioral and emotional problems. Thus, this study examined the association of circadian preference with sleep-related variables, depression, anxiety, and Internet addiction in Korean adolescents.

MATERIALS AND METHODS

Participants completed the questionnaires measuring sleep pattern, sleep problem, depression, anxiety, and Internet addiction.

RESULTS

Among 765 students (age range: 13-17 years), 211 students (N _male= 134) were allocated into morning types (MT) and 258 adolescents (N _male= 147) were allocated into evening types (ET) based on scores of the Morningness-Eveningness Scale. Adolescents without circadian preference (N = 296) were defined as neither type (NT). ET, compared to MT and NT, woke up later in the weekend, showed delays in bedtimes, and spent shorter time sleeping. They also reported a higher level of daytime sleepiness, insomnia, and depression than NT. However, the group difference in wake time on school days was not significant, and adolescents showed mild insomnia regardless of their circadian preference. Although smartphone using time in the weekend was significantly different between groups, group difference in Internet addiction was significant only when gender was adjusted.

CONCLUSION

Circadian preference was associated with sleep patterns and sleep problems in Korean adolescents. ET showed significantly different sleep patterns compared to MT and NT. ET not only reported a higher level of daytime sleepiness and insomnia but also more depressive symptoms compared to NT. These findings suggest that the uniqueness of adolescence and environmental factors seemed to influence the association of circadian preference with mental problem.

Pneumococcal Vaccination for Children in Asian Countries: A Systematic Review of Economic Evaluation Studies

Background: Evidence on costs and health benefits of pneumococcal conjugate vaccine (PCV) for children in Asian countries is limited but growing. As a region with a considerably high burden of pneumococcal disease, it is prominent to have a comprehensive overview on the cost-effectiveness of implementing and adopting a PCV vaccination program. Methods: We conducted a systematic review from Pubmed and Embase to identify economic evaluation studies of PCV for children in Asian countries up to May 2020. Data extraction included specific characteristics of the study, input parameters, cost elements, cost-effectiveness results, and key drivers of uncertainty. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statement was followed for this systematic review. The reporting quality of the included studies was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Results: After the screening process on both the title and abstract and full text of 518 records, a total of 25 studies fulfilled the inclusion criteria, and were included in the review. The majority of included studies demonstrates that PCV for children is cost-effective in most of the Asian region, and even cost-saving in some countries. Most of the included studies implemented cost utility analysis (CUA) using either quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs). Overall, the main drivers affecting the cost effectiveness were vaccine price, burden regarding pneumonia-related parameters, and the inclusion of herd effects. Conclusion: The children pneumococcal vaccination program appears to be a cost-effective intervention in Asia, and even cost-saving in certain conditions. Vaccine price, pneumonia-related disease burden, and the inclusion of the herd effect are observed as important key drivers in estimating cost-effectiveness in this region. Incorporating PCV in vaccination programs in this region was found to be highly favorable.

National survey evaluating the provision of gastroenterology dietetic services in England

AIMS

The aim of the study was to assess the provision of dietetic services for coeliac disease (CD), irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD).

METHODS

Hospitals within all National Health Service trusts in England were approached (n=209). A custom-designed web-based questionnaire was circulated via contact methods of email, post or telephone. Individuals/teams with knowledge of gastrointestinal (GI) dietetic services within their trust were invited to complete.

RESULTS

76% of trusts (n=158) provided GI dietetic services, with responses received from 78% of these trusts (n=123). The median number of dietitians per 100 000 population was 3.64 (range 0.15-16.60), which differed significantly between regions (p=0.03). The most common individual consultation time for patients with CD, IBS and IBD was 15-30 min (43%, 44% and 54%, respectively). GI dietetic services were delivered both via individual and group counselling, with individual counselling being the more frequent delivery method available (93% individual vs 34% group). A significant proportion of trusts did not deliver any specialist dietetic clinics for CD, IBS and IBD (49% (n=60), 50% (n=61) and 72% (n=88), respectively).

CONCLUSION

There is an inequity of GI dietetic services across England, with regional differences in the level of provision and extent of specialist care. Allocated time for clinics appears to be insufficient compared with time advocated in the literature. Group clinics are becoming a more common method of dietetic service delivery for CD and IBS. National guidance on GI dietetic service delivery is required to ensure equity of dietetic services across England.

Pediatric Sleep Tools: An Updated Literature Review

Since a thorough review in 2011 by Spruyt, into the integral pitfalls of pediatric questionnaires in sleep, sleep researchers worldwide have further evaluated many existing tools. This systematic review aims to comprehensively evaluate and summarize the tools currently in circulation and provide recommendations for potential evolving avenues of pediatric sleep interest. 144 "tool"-studies (70 tools) have been published aiming at investigating sleep in primarily 6-18 years old per parental report. Although 27 new tools were discovered, most of the studies translated or evaluated the psychometric properties of existing tools. Some form of normative values has been established in 18 studies. More than half of the tools queried general sleep problems. Extra efforts in tool development are still needed for tools that assess children outside the 6-to-12-year-old age range, as well as for tools examining sleep-related aspects beyond sleep problems/disorders. Especially assessing the validity of tools has been pursued vis-à-vis fulfillment of psychometric criteria. While the Spruyt et al. review provided a rigorous step-by-step guide into the development and validation of such tools, a pattern of steps continue to be overlooked. As these instruments are potentially valuable in assisting in the development of a clinical diagnosis into pediatric sleep pathologies, it is required that while they are primary subjective measures, they behave as objective measures. More tools for specific populations (e.g., in terms of ages, developmental disabilities, and sleep pathologies) are still needed.

Process Evaluation of a Nutrition and Lifestyle Behavior Peer Support Program for Adults with Metabolic Syndrome

Metabolic Syndrome (MetS) is a cluster of risk factors that increases the risk for diabetes and cardiovascular diseases. Lifestyle intervention is the gold standard of MetS management and prevention. Despite the growing positive influence of peer support-based interventions on management of various chronic diseases, its potential among adults with MetS has not been elucidated. We describe the development and process evaluation of a nutrition and lifestyle behavior “PEeR SUpport program for ADults with mEtabolic syndrome” (PERSUADE) using a systematic five-step approach—(i) review of evidence; (ii) focus group discussions; (iii) behavioral matrix development; (iv) module development; and (v) feasibility and process evaluation. High program adherence was recorded with 81.3% of participants attending all peer sessions. Participants’ content satisfaction score was high (93.3%) while peer leadership score was satisfactory (70.0%). There were significant reductions in all anthropometric and metabolic parameters assessed post intervention, except for diastolic blood pressure. Significant correlations were found between reductions in body fat and triglyceride, and content satisfaction. Peer leadership was only significantly correlated with reduction in triglyceride. Future studies can explore aspects of module interactivity, use of social media, and other means to stimulate consistent engagement of participants, as well as extending the implementations to other lifestyle-related diseases.

Screening for cognitive impairment among the elderly attending the noncommunicable diseases clinics in a rural area of Punjab, North India

BACKGROUND

Amongst all the ailments among the elderly persons, cognitive impairment has significant impact on the quality of life. Non-communicable diseases (NCDs) like diabetes and hypertension increase the risk of cognitive impairment and dementia. Little is known about the prevalence and correlates of cognitive impairment in elderly with NCDs.

AIM

The present study aimed to evaluate the prevalence and correlates of cognitive impairment among elderly patients living with NCDs.

METHODOLOGY

297 patients attending the chronic disease clinic of two Community Health Centres were evaluated using Hindi mini-mental scale (HMSE), University of California Los Angeles Loneliness Scale (UCLA LS), Geriatric Depression Scale, Generalized Anxiety Disorder (GAD-7 scale) and Vulnerability to Abuse Screening Scale.

RESULTS

More than one-fourth (27.3 %) of participants had cognitive impairment as per the HMSE scores. The mean HMSE score was lowest (23.90+6.61) among patients with hypertension followed by patients with diabetes alone (26.90+4.46). People with hypertension had lower mean scores on all the domains of HMSE. Multivariable binary logistic regression depicted younger age, high education status, per capita income, long duration of diseases, loneliness, and hypertension emerged as the significant risk factors associated with cognitive impairment.

CONCLUSION

Older adults with non-communicable diseases have high prevalence of cognitive impairment. Physicians should make the patients and their family members aware about the association of non-communicable diseases with cognitive impairments and should encourage these persons to use remedial measures to reduce the risk of future development of dementia.

Altered adipocytokine profile predicts early stage of left ventricular remodeling in hypertensive patients with type 2 diabetes mellitus

BACKGROUND AND AIM

Adipocytokine dysfunction is considered as causative factor of target organ damage in metabolic disease. The aim of the study was to investigate whether altered adipocytokine profile predicts left ventricular (LV) remodeling in hypertensive patients with type 2 diabetes mellitus (T2DM).

METHODS

A total of 186 patients (125 hypertensive and 61 non-hypertensive individuals) with established T2DM and 20 healthy volunteers were enrolled in the study. LV remodeling was determined at baseline. Concentrations of adipocytokines were measured with ELISA at baseline.

RESULTS

The most important predictors of LV hypertrophy in T2DM patients were serum levels of omentin-1 (B-coefficient = -0.64, p = 0.001), Zinc-α2-glycoprotein [ZA2G] (B-coefficient = -0.57, p = 0.002), visfatin (B-coefficient = 0.26, p = 0.034), hs-CRP (B-coefficient = 0.38, p = 0.002), HOMA-IR (B-coefficient = 0.34, p = 0.001), age (B-coefficient = 0.31, p = 0.022), glypican-4 (B-coefficient = -0.23, p = 0.042), and male sex (B-coefficient = 0.11, p = 0.048). After entering combined depending variable (LV hypertrophy and LV diastolic dysfunction) to the model the significant predictors remained serum levels of omentin-1 (B-coefficient = -0.82, p = 0.001), ZA2G (B-coefficient = -0.54, p = 0.001) and HOMA-IR (B-coefficient = 0.44, p = 0.001). Regression analyses showed that the most influential determinants of depending variable (LV hypertrophy + LV diastolic dysfunction) in T2DM patients were omentin-1 (B-coefficient = -1.6, p = 0.001) and ZA2G (B-coefficient = -0.78, p = 0.044).

CONCLUSION

We found that serum levels of omentin-1 and ZA2G were the most important predictors for LV hypertrophy + LV diastolic dysfunction in T2DM patients. Large clinical trials are required to confirm this assumption and get clear explanation of issues unveiled.

Validation of the Arabic Version of the Epworth Sleepiness Scale among the Yemeni Medical Students

The study was conducted with the aim to assess the psychometric measures of an adapted Arabic version of the Epworth Sleepiness Scale (ESS) among medical students at Sana'a University, Yemen. The cross-sectional study targeted 360 students (males: 176; females: 184) from the preclinical 3^rd year (N: 197) and the final clinical year (N: 163). Participants self-filled an Arabic and slightly modified version of the 8-item Epworth Sleepiness Scale. Exploratory Principal Component Analysis (PCA) and Confirmatory Factor Analyses (CFA) were conducted on two equal subsets of the sample (N: 180 each). The PCA yielded a two-dimension model subsequently confirmed by factor analysis. The first dimension was grouped on three items while the second dimension had five items reflecting the respondents' propensity to sleep during “interactive situations” and “sitting and lying,” respectively. The model had an acceptable goodness of fit measures for the overall ESS (CMINDF = 2.362, CFI = 0.91, IFI = 0.92) and acceptable reliability indicators (factor 1 α = 0.65, factor 2 α = 0.62). However, due to weak variance explanation (0.07) of item 6 (sitting and talking) in factor 1, analysis was repeated excluding this item. The 7-item model was also two-dimensional, valid, and reliable. The reliability indicators were acceptable with α = 0.65 for factor 1 (4 items of interactive situations) and 0.62 for factor 2 (3 items of sitting) and overall α = 0.68. Overall, the ESS is a useful tool. Factor analysis produced a two-factor model of 7 items with good validity and reasonable reliability that can be used in diagnosing daytime sleepiness among young Yemeni adults.

Risky Alcohol Consumption and Heavy Episodic Drinking among Parents in Germany: Results of a Nationwide Cross-Sectional Study

Introduction

Risky alcohol consumption (RAC) and heavy episodic drinking (HED) by parents can have negative effects on their children. At present, little is known about these forms of alcohol consumption among parents in Germany. The aim of this analysis is to estimate the percentage of parents living in Germany who practise RAC and HED and to study associations between these consumption patterns and sociodemographic factors.

Material and Methods

The data basis comprises the data of the nationwide studies "Gesundheit in Deutschland aktuell" (GEDA) of 2009, 2010, and 2012. The data were collected by means of computer-assisted telephone interviews (CATI). Our analysis included all participants living in a household with at least one child of their own under 18 years of age (n = 16,224). Information on RAC and HED was collected using the AUDIT-C screening instrument. Logistic regression models were used to study the relationship between parental alcohol consumption and sociodemographic variables.

Results

18.4% of the mothers and 29.6% of the fathers exhibited RAC; 8.4% of the mothers and 21.0% of the fathers practised HED. After mutual adjustment, RAC showed a significant association with the level of education, income (only mothers), employment status (only mothers), migration background, relationship status (only mothers), and the age of the youngest child. HED showed a significant association with income (only mothers), the age of the youngest child (only mothers), and the level of education (only fathers).

Conclusions

The presented analysis emphasizes the relevance of preventive measures to reduce parental alcohol consumption. In addition to universal interventions, risk group-specific measures (e.g., for parents with high income) are needed to reduce parental alcohol consumption and thus support a healthy development of children.