The variability of physical enjoyment, physiological responses, and technical-tactical performance according to the bout duration of small-sided games: a comparative study between female and male soccer players

BACKGROUND

This study aimed to compare various factors, namely perceived enjoyment (PE), percentage of peak heart rate (%HRpeak), blood lactate (La), rating of perceived exertion (RPE), and technical-tactical performance among soccer players across different bout durations (CB: continuous bout, MIB: medium intermittent bouts, and SIB: short intermittent bouts) and between male and female players during four-a-side (4vs4) small-sided games (SSGs) including goalkeepers.

METHODS

sixteen female soccer players (age: 20.1 ± 0.5 years old) and sixteen professional male adults (age: 20.7 ± 0.7 years old) participated in the study. SSGs (4vs4) were performed in a CB: (1 × 12 min), and in an interval format: MIB: (2 × 6 min), and SIB: (3 × 4 min) with 2 min of passive recovery. PE was collected after each SSGs. The players' heart rate (HR) was continuously measured, whereas ratings of perceived exertion (RPE) and, blood lactate concentration ([La]) were determined at the end of each SSGs. Technical-tactical performance were analyzed during each session of SSGs. Pitch dimensions were (length x width) (25 × 32 m), and relative space per players was 100 m2.

RESULTS

For female soccer players, medium intermittent bouts (MIB) elicited significantly higher perceived enjoyment (PE) compared to continuous bouts (CB) (p < 0.001) and short intermittent bouts (SIB) (p < 0.01). Conversely, for male soccer players, CB resulted in higher PE compared to MIB (p < 0.001) and SIB (p < 0.001). During CB and MIB, peak heart rate (PeakHR) and percentage of peak heart rate (%HRpeak) were significantly higher in female players compared to SIB (PeakHR: CB: p < 0.001; PeakHR: MIB: p < 0.01; %HRpeak: CB: p < 0.001; %HRpeak: MIB: p < 0.01). Blood lactate (La) and rating of perceived exertion (RPE) were significantly greater in CB compared to MIB (La: p < 0.001; RPE: p < 0.01) and SIB (La: p < 0.001; RPE: p < 0.001) for female players only. For male players, CB resulted in significantly higher PeakHR, %HRpeak, La, and RPE compared to MIB (peak HR: p < 0.01, dunb = 1.35; %HR: p < 0.01; La: p < 0.01; RPE: p < 0.01) and SIB (peak HR: p < 0,01; %HR: p < 0.01; RPE: md = 0.87, p < 0.05). Regarding technical-tactical performance, in female players, the % of successful passes, successful tackles, and successful duels were higher during SIB compared to CB (p < 0.01; p < 0.001; p < 0.001) and MIB compared to CB (p < 0.01; p < 0.001; p < 0.001), while ball loss was lower during SIB compared to CB (p < 0.001) and MIB compared to CB (p < 0.001). In male players, % of successful passes and tackles were higher during CB compared to MIB (p < 0.001 and p < 0.05) and SIB (p < 0.001 and p < 0.05), while CB had a lower % of ball loss compared to MIB (p < 0.01) and SIB (p < 0.001). There was no significant difference in the % of successful duels between the bouts for either gender.

CONCLUSION

This study showed a difference in physical enjoyment between male and female soccer players depending on the bout duration of SSGs. For that, trainers should consider intermittent bouts for female soccer players and continuous bouts for male soccer players when designing SSGs-based training in order to significantly improve PE, training load, and technical-tactical performance.

Using artificial intelligence for exercise prescription in personalised health promotion: A critical evaluation of OpenAI's GPT-4 model

The rise of artificial intelligence (AI) applications in healthcare provides new possibilities for personalized health management. AI-based fitness applications are becoming more common, facilitating the opportunity for individualised exercise prescription. However, the use of AI carries the risk of inadequate expert supervision, and the efficacy and validity of such applications have not been thoroughly investigated, particularly in the context of diverse health conditions. The aim of the study was to critically assess the efficacy of exercise prescriptions generated by OpenAI's Generative Pre-Trained Transformer 4 (GPT-4) model for five example patient profiles with diverse health conditions and fitness goals. Our focus was to assess the model's ability to generate exercise prescriptions based on a singular, initial interaction, akin to a typical user experience. The evaluation was conducted by leading experts in the field of exercise prescription. Five distinct scenarios were formulated, each representing a hypothetical individual with a specific health condition and fitness objective. Upon receiving details of each individual, the GPT-4 model was tasked with generating a 30-day exercise program. These AI-derived exercise programs were subsequently subjected to a thorough evaluation by experts in exercise prescription. The evaluation encompassed adherence to established principles of frequency, intensity, time, and exercise type; integration of perceived exertion levels; consideration for medication intake and the respective medical condition; and the extent of program individualization tailored to each hypothetical profile. The AI model could create general safety-conscious exercise programs for various scenarios. However, the AI-generated exercise prescriptions lacked precision in addressing individual health conditions and goals, often prioritizing excessive safety over the effectiveness of training. The AI-based approach aimed to ensure patient improvement through gradual increases in training load and intensity, but the model's potential to fine-tune its recommendations through ongoing interaction was not fully satisfying. AI technologies, in their current state, can serve as supplemental tools in exercise prescription, particularly in enhancing accessibility for individuals unable to access, often costly, professional advice. However, AI technologies are not yet recommended as a substitute for personalized, progressive, and health condition-specific prescriptions provided by healthcare and fitness professionals. Further research is needed to explore more interactive use of AI models and integration of real-time physiological feedback.

Artificial intelligence in sport: Exploring the potential of using ChatGPT in resistance training prescription

OpenAI's Chat Generative Pre-trained Transformer (ChatGPT) technology enables conversational interactions with applications across various fields, including sport. Here, ChatGPT's proficiency in designing a 12-week resistance training programme, following specific prompts, was investigated. GPT3.5 and GPT4.0 versions were requested to design 12-week resistance training programmes for male and female hypothetical subjects (20-years-old, no injury, and 'intermediate' resistance training experience). Subsequently, GPT4.0 was requested to design an 'advanced' training programme for the same profiles. The proposed training programmes were compared with established guidelines and literature (e.g., National Strength and Conditioning Association textbook), and discussed. ChatGPT suggested 12-week training programmes comprising three, 4-week phases, each with different objectives (e.g., hypertrophy/strength). GPT3.5 proposed a weekly frequency of ~3 sessions, load intensity of 70-85% of one repetition-maximum, repetition range of 4-8 (2-4 sets), and tempo of 2/0/2 (eccentric/pause/concentric/'pause'). GPT4.0 proposed intermediate- and advanced programme, with a frequency of 5 or 4 sessions, 60-90% or 70-95% intensity, 3-5 sets or 3-6 sets, 5-12 or 3-12 repetitions, respectively. GPT3.5 proposed rest intervals of 90-120 s, and exercise tempo of 2/0/2. GPT4.0 proposed 60-180 (intermediate) or 60-300 s (advanced), with exercise tempo of 2/1/2 for intermediates, and 3/0/1/0, 2/0/1/0, and 1/0/1/0 for advanced programmes. All derived programmes were objectively similar regardless of sex. ChatGPT generated training programmes which likely require additional fine-tuning before application. GPT4.0 synthesised more information than GPT3.5 in response to the prompt, and demonstrated recognition awareness of training experience (intermediate vs advanced). ChatGPT may serve as a complementary tool for writing 'draft' programme, but likely requires human expertise to maximise training programme effectiveness.

ChatGPT is not ready yet for use in providing mental health assessment and interventions

Background

Psychiatry is a specialized field of medicine that focuses on the diagnosis, treatment, and prevention of mental health disorders. With advancements in technology and the rise of artificial intelligence (AI), there has been a growing interest in exploring the potential of AI language models systems, such as Chat Generative Pre-training Transformer (ChatGPT), to assist in the field of psychiatry.

Objective

Our study aimed to evaluates the effectiveness, reliability and safeness of ChatGPT in assisting patients with mental health problems, and to assess its potential as a collaborative tool for mental health professionals through a simulated interaction with three distinct imaginary patients.

Methods

Three imaginary patient scenarios (cases A, B, and C) were created, representing different mental health problems. All three patients present with, and seek to eliminate, the same chief complaint (i.e., difficulty falling asleep and waking up frequently during the night in the last 2°weeks). ChatGPT was engaged as a virtual psychiatric assistant to provide responses and treatment recommendations.

Results

In case A, the recommendations were relatively appropriate (albeit non-specific), and could potentially be beneficial for both users and clinicians. However, as complexity of clinical cases increased (cases B and C), the information and recommendations generated by ChatGPT became inappropriate, even dangerous; and the limitations of the program became more glaring. The main strengths of ChatGPT lie in its ability to provide quick responses to user queries and to simulate empathy. One notable limitation is ChatGPT inability to interact with users to collect further information relevant to the diagnosis and management of a patient's clinical condition. Another serious limitation is ChatGPT inability to use critical thinking and clinical judgment to drive patient's management.

Conclusion

As for July 2023, ChatGPT failed to give the simple medical advice given certain clinical scenarios. This supports that the quality of ChatGPT-generated content is still far from being a guide for users and professionals to provide accurate mental health information. It remains, therefore, premature to conclude on the usefulness and safety of ChatGPT in mental health practice.

Comparative Study of the Long-Term Impact of the COVID-19 Pandemic on Mental Health and Nutritional Practices Among International Elite and Sub-Elite Athletes: A Sample of 1420 Participants from 14 Countries

BACKGROUND

Although several studies have shown that the Coronavirus Disease 2019 (COVID-19) lockdown has had negative impacts on mental health and eating behaviors among the general population and athletes, few studies have examined the long-term effects on elite and sub-elite athletes. The present study aimed to investigate the long-term impact of COVID-19 lockdown on mental health and eating behaviors in elite versus sub-elite athletes two years into the pandemic. A cross-sectional comparative study was conducted between March and April 2022, involving athletes from 14 countries, using a convenient non-probabilistic and snowball sampling method. A total of 1420 athletes (24.5 ± 7.9 years old, 569 elites, 35% women, and 851 sub-elites, 45% women) completed an online survey-based questionnaire. The questionnaire included a sociodemographic survey, information about the COVID-19 pandemic, the Depression, Anxiety and Stress Scale-21 Items (DASS-21) for mental health assessment, and the Rapid Eating Assessment for Participants (REAP-S) for assessing eating behavior.

RESULTS

The results showed that compared to sub-elite athletes, elite athletes had lower scores on the DASS-21 (p = .001) and its subscales of depression (p = .003), anxiety (p = .007), and stress (p < .001), as well as a lower REAP-S score indicating lower diet quality (p = .013).

CONCLUSION

In conclusion, two years into the pandemic, elite athletes were likelier to have better mental health profiles than sub-elite athletes but surprisingly had lower diet quality.

Enhancing scholarly discourse in the age of artificial intelligence: A guided approach to effective peer review process

The integrity of the peer-review process (PRP) is paramount in academic publishing and serves as a critical filter for scholarly output. This mini-review centers on the introduction of comprehensive guidelines, presented in tables format, aimed at streamlining the interactions between authors and reviewers during the PRP. These guidelines, derived from an in-depth exploration of the PRP, offer structured and practical advice to ensure constructive, transparent, and effective communication, especially related to the use of artificial intelligence. While this mini-review discusses the strengths and challenges of the current PRP, its primary focus is on providing tangible recommendations to enhance the quality and efficiency of the PRP. By providing explicit guidelines and emphasizing the cooperative essence of peer review, this mini-review aims to improve the PRP, ensuring that it remains a robust mechanism for upholding the highest standards of research and knowledge dissemination in an evolving academic setting.

ChatGPT for Sample-Size Calculation in Sports Medicine and Exercise Sciences: A Cautionary Note

PURPOSE

To investigate the accuracy of ChatGPT (Chat generative pretrained transformer), a large language model, in calculating sample size for sport-sciences and sports-medicine research studies.

METHODS

We conducted an analysis on 4 published papers (ie, examples 1-4) encompassing various study designs and approaches for calculating sample size in 3 sport-science and -medicine journals, including 3 randomized controlled trials and 1 survey paper. We provided ChatGPT with all necessary data such as mean, percentage SD, normal deviates (Zα/2 and Z1-β), and study design. Prompting from 1 example has subsequently been reused to gain insights into the reproducibility of the ChatGPT response.

RESULTS

ChatGPT correctly calculated the sample size for 1 randomized controlled trial but failed in the remaining 3 examples, including the incorrect identification of the formula in one example of a survey paper. After interaction with ChatGPT, the correct sample size was obtained for the survey paper. Intriguingly, when the prompt from Example 3 was reused, ChatGPT provided a completely different sample size than its initial response.

CONCLUSIONS

While the use of artificial-intelligence tools holds great promise, it should be noted that it might lead to errors and inconsistencies in sample-size calculations even when the tool is fed with the necessary correct information. As artificial-intelligence technology continues to advance and learn from human feedback, there is hope for improvement in sample-size calculation and other research tasks. However, it is important for scientists to exercise caution in utilizing these tools. Future studies should assess more advanced/powerful versions of this tool (ie, ChatGPT4).

Large-scale sporting events during the COVID-19 pandemic: insights from the FIFA World Cup 2022 in Qatar with an analysis of patterns of COVID-19 metrics

The 2022 FIFA World Cup (FIFA-WC) held in Qatar presented unique challenges, given the potential for rapid transmission of coronavirus disease 2019 (COVID-19) among over 1.4 million international fans attending the event. This study aimed to investigate the impact of the FIFA-WC 2022 on COVID-19 cases, deaths, and reproduction rate (R0) in Qatar. Additionally, it sought to understand the implications of hosting large-scale events during a pandemic without COVID-19 restrictive measures, providing critical insights for future decision-making. Data from "Our World in Data" were analysed for three distinct periods: one week before the FIFA-WC (week-preWC), the four weeks of the event (week-1WC to week-4WC), and one week after (week-postWC). The results revealed a significant increase in COVID-19 cases during week-3WC and week-4WC (compared to week-preWC) in Qatar, followed by a subsequent decrease during the week-postWC. Notably, Qatar experienced a more pronounced surge in positive cases than the global trend. Regarding COVID-19-related deaths, Qatar's peak occurred during week-2WC, while globally deaths peaked from week-3WC to week-postWC. Nevertheless, Qatar's death toll remained relatively low compared to the global trend throughout the event. The findings highlight that the FIFA-WC 2022 in Qatar demonstrated the feasibility of organizing large-scale sporting events during a pandemic with appropriate measures in place. They emphasize the importance of high vaccination coverage, continuous monitoring, and effective collaboration between event organizers, healthcare authorities, and governments. As such, the event serves as a valuable model for future gatherings, underlining the significance of evidence-based decision-making and comprehensive public health preparedness.

Normative reference and cut-offs values of maximal aerobic speed-20 m shuttle run test and maximal oxygen uptake for Tunisian adolescent (elite) soccer players

This study aimed to develop reference curves of aerobic parameters of 20 m shuttle run test for Tunisian soccer players. The study was conducted in the 2022/2023 pre-season. The reference curves of the maximal aerobic speed (MAS) and the maximal oxygen uptake (VO2max) were developed according to the Lambda, Mu and Sigma (LMS) method, using data from 742 Tunisian premier league soccer players aged 11-18 years. Measured variables included: weight, height, body mass index and maximal heart rate (HRmax). HRmax was measured when the participants completed the maximal aerobic speed. VO2max was estimated using the 20 m shuttle run test protocol (speed increment every minute). Our results presented the smoothed percentiles (3rd, 10th, 25th, 50th, 75th, 90th and 97th) of MAS (km/h) and VO2max (ml/kg•min⁻1) according to age. In addition, raw data showed that VO2 max was positively correlated with age (r = 0.333; P < 0.001), height (cm) (r = 0.279; P < 0.001), weight (kg) (r = 0.266; P < 0.001), practice period (years) (r = 0.324; P < 0.001) and BMI (kg/m2) (r = 0.10; P < 0.05). However, it was negatively correlated to HRmax (bpm) (r = -0.247; P < 0.001). Only the measurements within the age group [12-12.99] are significantly higher (p < 0.001; ES = 0.63) compared with the previous age group [11-11.99]. Finally, regarding prevalence, our findings showed that 15.5 % of the players in our sample had VO2max values above the 87.7th percentile cut-off, while only 0.3 % exceeded the 99.18th percentile. The development of normative curves could help coaches and physical trainers to more accurately detect weaknesses in the aerobic performance of their players in order to sustain high-intensity repetitive actions during a soccer match.

Global trends of monkeypox-related articles: A bibliometric analysis over the last five decades (1964 - July 14, 2022)

BACKGROUND

The first human monkeypox (MPX) case was identified in the Democratic Republic of Congo (DRC) in 1970 with an outbreak in 2010 and the first human MPX case in the UK in 2022. In this study, we conducted a bibliometric analysis of the literature on monkeypox based on the Web of Science Core Collection (WOSCC) of the Institute for Scientific Information (ISI) to identify relevant topics and trends in monkeypox research.

METHODS

We searched the Web of Science from 1964 until July 14, 2022, for all publications using the keywords "Monkeypox" and "Monkeypox virus." Results were compared using numerous bibliometric methodologies and stratified by journal, author, year, institution, and country-specific metrics.

RESULTS

Out of 1170 publications initially selected, 1163 entered our analysis, with 65.26 % (n = 759) being original research articles and 9.37 % (n = 109) being review articles. Most MPX publications were in 2010, with 6.02 % (n = 70), followed by 2009 and 2022 at 5.67 % (n = 66) each. The USA was the country with the highest number of publications, with n = 662 (56.92 %) of total publications, followed by Germany with n = 82 (7.05 %), the UK with n = 74 (6.36 %), and Congo with n = 65 (5.59 %). Journal of Virology published the highest number of MPX publications, followed by Virology Journal and Emerging Infectious Diseases with n = 52 (9.25 %), n = 43 (7.65 %), and n = 32 (5.69 %) publications, respectively. The top contributing institutions were the Centers for Disease Control and Prevention (CDC), the US Army Medical Research Institute of Infectious Diseases, and the National Institutes of Health (NIH)National Institute of Allergy and Infectious Diseases (NIAID).

CONCLUSION

Our analysis provides an objective and robust overview of the current literature on MPX and its global trends; this information could serve as a reference guide for those aiming to conduct further MPX-related research and as a source for those seeking information about MPX.

Normative data in resting and maximum heart rates and a prediction equation for young Tunisian soccer players: a cross-sectional study

Heart rate (HR) is an important indicator of work intensity during physical activity. Maximum heart rate (MHR) is a physiological measure that is frequently used as a benchmark for maximal exercise intensity. The aim of this study was to establish reference curves for maximum heart rate (MHR) and resting heart rate (RHR) and to develop an estimated equation for Tunisian adolescent footballers. The study involved 801 adolescent players, aged 11 to 18, who belonged to five Tunisian first-division soccer teams. The LMS method was used for smoothing the curves and the multivariate linear regression to develop a prediction equation of MHR. Our results showed that MHR and RHR reference curves decrease with age. The values of the median curves of MHR and RHR ranged from 208.64 bpm (11 years) to 196.93 (18 years) and 73.86 (11 years) to 63.64 (18 years), respectively. The prediction equation obtained from the model was MHR= 225.08 - 1.55 X Age (years) (R2 = 0.317; P < 0.001; standard error of the estimate (SEE) = 5.22). The comparisons between the estimated values and the measured values have found that our model (- 0.004 ±5.22 bpm) was to be more accurate than two other widely known models. BOX's equation underestimates the measured MHR values by -3.17 ± 5.37 bpm and TANAKA's equation overestimates by + 4.33 ±5.5 bpm. The reference curves can be used by coaches and physical trainers to classify the resting heart rate (RHR) and maximum heart rate (MHR) of each adolescent player, track their evolution over time, and design tailored training programs with specific intensities for Tunisian soccer players.

The Impact of Training on Electronic Health Records Related Knowledge, Practical Competencies, and Staff Satisfaction: A Pre-Post Intervention Study Among Wellness Center Providers in a Primary Health-Care Facility

Background

The transition to electronic health records (EHR) has improved the quality of health-care delivery and patient safety. However, poor usability and incongruent workflow may impose a significant burden on documentation and time management, resulting in staff burnout. We aimed to (i) evaluate the effectiveness of personalized EHR training on wellness providers' knowledge and practical competencies, and (ii) assess staff satisfaction regarding the EHR usage post-training.

Methodology

An interventional study was conducted between July 15, 2021, and March 1, 2022, among 14 wellness staff (age: 38 ± 3.9 years; 7 males, 7 females) in the Wellness Center-Rawdat Al-Khail Health Center. Six months of blended training was delivered. The impact of training was assessed using a pre-post survey on the knowledge and practical competencies related to EHR usage. Staff satisfaction was assessed post-training.

Results

Majority of respondents had improvement in identifying the advantages of EHR: improve confidentiality of care (pre = 35.7% vs post = 100%, p = 0.001), reduce medical errors (pre = 35.7% vs post = 85.7%, p = 0.02), improve quality of health care (pre = 35.7% vs post = 100%, p = 0.001), and reduce wait time (pre = 42.9% vs post = 85.7%, p = 0.03). Time performing these tasks by massage therapists/receptionists was reduced: viewing/editing ambulatory organizer (pre = 20±0 s vs post = 10±0 s), access PM office (pre = 155±136 s vs post = 10±0 s), selection/access patient chart (pre = 75±30 s vs post = 30±20 s), check-in/out (pre = 120±0 s vs post = 60±0 s), and view/edit massage form (pre = 135±75.5 s vs post = 60±0 s). For gym instructors, time to access ambulatory organizer (pre = 30±0 s vs post = 10±0 s), view/edit the gym form (pre = 101±57 s vs post = 71±36 s), view patients' clinical data (pre = 60±70 s vs post = 10±3 s), and place referral orders (pre = 197±144 vs post = 82±23 s) was reduced. A mean percentage score of 65.4±38.7 indicated very good staff satisfaction.

Conclusion

This tailored, hands-on training has been well received and effectively improved wellness staff knowledge, competencies, and satisfaction relative to EHR functionalities.

Mental health, eating habits and physical activity levels of elite Iranian athletes during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has changed life styles of millions of people worldwide. This study investigated changes in the health, physical activity levels and eating habits of elite athletes during the COVID-19 pandemic lockdown in Iran.

METHODS

383 (248 female and 135 male) elite athletes (168.82 ± 0.07 cm; 63.92 ± 7.42 kg; the body mass index (BMI): 22.3 ± 0.78 kg/m²) participated in this study. The International Physical Activity Questionnaire (IPAQ), Depression Anxiety Stress Scales (DASS-21) and the Impact of Event Scale-Revised (IES-R) study tools were used to measure levels of physical activity and mental health status, respectively. The Emotional Eater Questionnaire (EEQ) was used to assess food consumption related to emotion. Pearson and Spearman correlation analysis test were used in data analysis.

RESULTS

Levels of depression and stress were mild and moderate, while levels of anxiety were severe and very severe in most elite athletes. There were levels of low emotional eating by elite athletes during the COVID-19 pandemic. Physical activity levels were negatively correlated with psychological mood measures (p≤0.05), while there were positive correlations between emotional eating behaviours and psychological mood measures (moderate correlation; p≤0.01) and light physical activity levels (weak correlation; p≤0.05).

CONCLUSION

 This study provides the first preliminary evidence showing that the COVID-19 lockdown conditions negatively influenced the eating habits and levels of physical activity and mental health in elite athletes. Regular high intensity physical activity as health strategy in elite athletes and the general population remains a strategy to improve overall health during the COVID-19 pandemic. Additionally, these findings suggest the need to devise strategies to improve the life styles of elite athletes during pandemics such as the Covid-19 pandemic.

Assessment Tools for Pulmonary Involvement in Patients with Ankylosing Spondylitis: Is Diaphragmatic Ultrasonography Correlated to Spirometry?

Objective

Spondyloarthritis (SpA) is a chronic inflammatory rheumatic disease that can lead to spinal ankylosis and consequently, restrictive pulmonary dysfunction. Thus, the present study aimed to assess the accuracy of diaphragm ultrasound compared to spirometry in the screening of restrictive pulmonary disorders in radiographic SpA patients.

Methods

We conducted a cross-sectional study of 50 patients with radiographic SpA, over six months. Sociodemographic data, clinical characteristics of the disease, as well as biological, radiological, and therapeutic data, were collected. Spirometry and diaphragm ultrasound were performed.

Results

The mean age of the study participants (N= 50) was 42.7±11 years [range: 25-66] with male predominance (N= 41). Spirometry showed a restrictive disorder in 32% of cases. The mean chest expansion (CE) value was 3.9±1.81cm [range: 1-9] with a median of 4 cm. A pathological value (<5cm) was observed in 72% of cases. A significant positive correlation was found between the right inspiratory diaphragmatic thickness and forced vital capacity (FVC) (r= 0.36; p = 0.02) and the supine FVC (r=0.29; p = 0.04). The left inspiratory diaphragmatic thickness was correlated with the percentage of the FVC decrease (r= 0.35; p = 0.01) defined as the percentage of difference between FVC and supine FVC. The right expiratory diaphragmatic thickness was associated with the FVC (r=0.32; p = 0.02). A significant positive correlation was found between the CE and the presence of B lines (r=0.32; p = 0.02), but not between the CE and the FVC.

Conclusion

The present study showed that diaphragm ultrasonography is correlated with spirometric findings in radiographic SpA patients. Further studies are required to assess its reliability, specificity, and sensitivity in this pathology.

Global Implications of COVID-19 Pandemic on Adults' Lifestyle Behavior: The Invisible Pandemic of Noncommunicable Disease

COVID-19 pandemic, with its subsequent lockdown and mobility restriction is a public health emergency that has obliged substantial modifications in daily routines and lifestyle of people worldwide. The drastic measures of social isolation and home confinement has impacted to a great extent the physical and psychological health. The resultant abrupt in lifestyle-related behavior such as physical inactivity, unhealthy dietary habit, sleep disturbance, stress, tobacco use, and alcohol intake, is directly linked to the rising global burden of non-communicable disease. This review aims at gaining a rich and extensive understanding of the potential negative impact triggered by COVID-19 on lifestyle-related behaviors that will influence long-term physical and mental wellbeing. Electronic database search was conducted on PubMed, ScienceDirect, Google Scholar, and Scopus from January 1, 2020 to March 15, 2021. Data related to COVID-19 impact on lifestyle habits were extracted from these studies. Articles were included if meeting the inclusion criteria (i.e., assessed the impact of COVID-19 on physical inactivity and sedentary behavior, dietary habits, sleep, mental health, vitamin D, and substance use among adults. Further search was conducted to address these behavioral changes among athletes. While physical isolation is a necessary public health measure to protect the population, outcomes of this review indicate that in light of adverse lifestyle changes brought by the pandemic, noncommunicable disease remains a critical concern. Hence, adopting healthy lifestyle behavior is essentially important especially during the current time to boost immunity and reduce the risk of COVID-19 infection. Recognizing the pandemic collateral effects offers a forward-looking perspective to guide the government and health authorities in planning prevention and control programs that focus on resilient and sustainable behavioral change.

Can melatonin reduce the severity of post-COVID-19 syndrome?

This short review aimed at (i) providing an update on the health benefits associated with melatonin supplementation, while (ii) considering future potential research directions concerning melatonin supplementation use relative to Coronavirus disease of 2019 (COVID-19). A narrative review of the literature was undertaken to ascertain the effect of exogenous melatonin administration on humans. Night-time melatonin administration has a positive impact on human physiology and mental health. Indeed, melatonin (i) modulates the circadian components of the sleep-wake cycle; (ii) improves sleep efficiency and mood status; (iii) improves insulin sensitivity; and (iv) reduces inflammatory markers and oxidative stress. Melatonin has also remarkable neuroprotective and cardioprotective effects and may therefore prevent deterioration caused by COVID-19. We suggest that melatonin could be used as a potential therapy in the post-COVID-19 syndrome, and therefore call for action the research community to investigate on the potential use of exogenous melatonin to enhance the quality of life in patients with post-COVID-19 syndrome. See also Figure 1(Fig. 1).

Effects of home confinement on physical activity, nutrition, and sleep quality during the COVID-19 outbreak in amateur and elite athletes

Introduction

Despite the progress in the management of the pandemic caused by COVID-19, it is necessary to continue exploring and explaining how this situation affected the athlete population around the world to improve their circumstances and reduce the negative impact of changes in their lifestyle conditions that were necessitated due to the pandemic. The aim of this study was to analyze the moderating influence of physical activity (PA) and dietary habits on the impact of the COVID-19 pandemic experience on sleep quality in elite and amateur athletes.

Materials and methods

A total of 1,420 elite (40.1%) and amateur (59.9%) athletes (41% women; 59% men) from 14 different countries participated in a cross-sectional design study. Data were collected using a battery of questionnaires that identified sociodemographic data, sleep quality index, PA levels, dietary habits, and the athletes' perception of their experience during the COVID-19 pandemic. Means and standard deviations were calculated for each variable. The analysis of variances and the correlation between variables were carried out with non-parametric statistics. A simple moderation effect was calculated to analyze the interaction between PA or dietary habits on the perception of the COVID-19 experience effect on sleep quality in elite and amateur athletes.

Results

The PA level of elite athletes was higher than amateur athletes during COVID-19 (p < 0.001). However, the PA level of both categories of athletes was lower during COVID-19 than pre-COVID-19 (p < 0.01). In addition, amateurs had a higher diet quality than elite athletes during the pandemic (p = 0.014). The perception of the COVID-19 experience as controllable was significantly higher (p = 0.020) among elite athletes. In addition, two moderating effects had significant interactions. For amateur athletes, the PA level moderated the effect of controllable COVID-19 experience on sleep quality [F _(3,777) = 3.05; p = 0.028], while for elite athletes, the same effect was moderated by dietary habits [F _(3,506) = 4.47, p = 0.004].

Conclusion

Elite athletes had different lifestyle behaviors compared to amateurs during the COVID-19 lockdown. Furthermore, the relevance of maintaining high levels of PA for amateurs and good quality dietary habits by elite athletes was noted by the moderating effect that both variables had on the influence of the controllable experience during the COVID-19 pandemic on sleep quality.

Is there a diurnal variation of COVID-19 patients warranting presentation to the health centre? A chronobiological observational cross-sectional study

BACKGROUND

The circadian clock regulates the function of the immune system, the replication of viruses, and the magnitude of infections. The aim of this study was to analyse whether hospital attendance in Coronavirus disease 2019 (COVID-19) patients presents a diurnal variation.

METHODS

Data from the electronic medical records of 1094 COVID-19 patients who presented to a Health Centre in Qatar during the month of July 2020 was retrospectively analysed. The following demographic (i.e. time of day (TOD), sex, age), clinical (i.e. cycle threshold (CT), temperature, oxy-haemoglobin saturation and resting heart-rate), biochemical (i.e. uraemia, glycaemia and albuminia) and haematological (i.e. leukocytes, erythrocytes ad platelets) parameters were collected.

RESULTS

Univariate analysis showed a significant effect of TOD on hospital admission (p < 0.001), with patients attending the health care centre more during the active behavioural phase (08h00-00h00) compared to the resting phase (00h00-08h00). COVID-19 infection blunted the circadian rhythms of core body temperature, neutrophils and leukocytes family and shifted the circadian rhythms of resting heart-rate and uraemia. Correlation analysis showed a near perfect negative correlation between the age of patients and the TOD (r=-0.97), with older patients attending the care centre earlier during the day.

CONCLUSION

COVID-19 infection affected the circadian rhythms of the host through disrupting the circadian rhythms of core temperature and innate immunity mediators. Old patients attend the health care centre earlier compared to younger ones. However, CT during polymerase chain reaction-test was unaffected by the TOD, which limits the conclusion that COVID-19 viral infection exhibits diurnal variation.

The effects of daytime melatonin ingestion on arousal and vigilance vanish after sub-maximal exercise: a pilot study

OBJECTIVE

Daytime melatonin ingestion is known to induce sleep at rest, which may affect arousal and vigilance. Physical exercise is known to produce an increase in core temperature and circulating cortisol which can enhance arousal and vigilance. The effect of submaximal exercise on vigilance and arousal following acute melatonin ingestion has not yet been studied. The present study aimed at investigating the effect of submaximal exercise on vigilance and arousal following daytime melatonin ingestion.

PATIENTS AND METHODS

Eight physical education students undertook 45 min of submaximal exercise (at 60% of maximal aerobic speed) on a treadmill after melatonin-(6 mg) or placebo ingestion, in a randomized and counterbalanced order.

RESULTS

Heart rate (HR), rectal temperature (Tre), felt arousal scale (FAS), and thermal sensations (TS) were recorded at baseline (pre-exercise), immediately after exercise (post-exercise), and after 30 min of recovery (30 min post-exercise). Blood was sampled for lactate and cortisol. At 30 min post-exercise, the Tre, HR, blood pressure, lactate, FAS, and TS were measured. The participants performed vigilance tests pre-exercise, post-exercise and 30 min post-exercise. Daytime melatonin ingestion affected arousal and vigilance in the pre-exercise period (p < 0.05) but had no effect on Tre, HR, blood pressure, lactate, TS, arousal, and vigilance measured 30 min post-exercise (p > 0.05).

CONCLUSIONS

The negative effects of melatonin ingestion on vigilance and arousal vanished after a 45 min of submaximal exercise. The hypnotic effect of melatonin observed in the pre-exercise dissipated in the post-exercise period, possibly due to the significant elevation of Tre, HR, and cortisol at the end of submaximal exercise.

The effects of cognitive behavioral therapy on selected physical, physiological parameters, exercise and nutritional behaviors in diabetic persons

OBJECTIVE

Due to the high prevalence of diabetes in the world, it seems that one of the most important strategies to prevent and treat this disease are lifestyle changes. The present study aimed to investigate the effects of cognitive behavioral therapy on selected physical and psychological parameters, exercise, and nutritional behaviors in diabetic patients.

PATIENTS AND METHODS

This was a cross-sectional study of volunteers with type 2 diabetes. Patients were randomized into two groups: an intervention (n=32) and a control group (n=31). The Beck Physical Activity Questionnaire was used to assess physical activity in combination with the Beck Depression Inventory and the Pittsburgh Sleep Quality Index to assess the levels of depression and the quality of sleep. Cognitive behavior therapy (CBT) training consisted of six sessions of cognitive behavioral therapy interventions. The intervention consisted of a face-to-face individual counseling session. The patients received a special diet according to their basal metabolic rate (BMR). At all sessions, dietary advice was reviewed, and during the treatment period, they were asked to record their diet and physical activity. Body composition and blood samples were measured before and after three months of the experiment for both groups.

RESULTS

Blood glucose, blood lipid profiles (except high-density lipoprotein), lifestyle, behavior patterns and body composition were significantly improved following CBT intervention (p≤0.05).

CONCLUSIONS

CBT can play a key role in improving physiological and psychological parameters in diabetic patients.

COVID-19 lockdown: Impairments of objective measurements of selected physical activity, cardiorespiratory and sleep parameters in trained fitness coaches

The COVID-19 outbreak resulted in the shutdown of athletic training facilities. Although the effects of these restrictions on daily activity and sleep patterns have been widely analyzed, the employed tools often lacked accuracy, and were based on subjective measures. This study assessed the effects of home confinement on objective physical activity (PA), physiological and sleep parameters in active individuals. Sixteen male elite fitness coaches (age: 29±3 years; height: 183±6 cm; body mass: 82±5 kg, body mass index: 24.7±1.8 kg/m²) participated in this retrospective study. One-way analysis of variance was conducted to analyze selected PA, physiological and sleep parameters collected by smartwatch (Garmin Fenix 6 pro, USA) data during four consecutive months [i.e., pre-confinement, 1^st and 2^nd months of confinement, and post-confinement, year 2020]. Ramadan intermittent fasting (RIF) month occurred during the 2^nd month of confinement. Compared to pre-confinement, significant changes were registered for almost all parameters during the 1^st and/or the 2^nd month of confinements (p<0.001), with (i) higher values for resting heart rate, sleep latency, and total, light and rapid eye movements sleep times (% change=7-523 %), and (ii) lower values for PA parameters, calories/day spent, average and highest respiratory rates, and deep sleep time during the home confinement period (% change=5-36 %). During the post-confinement month, all parameters regained pre-confinement values. In conclusion, home confinement-induced detraining negatively influenced the objective measurements of cardiorespiratory and sleep parameters among fitness coaches with a deeper effect during the 2^nd month of home confinement, possibly due to the effect of RIF.

Ramadan Observance Exacerbated the Negative Effects of COVID-19 Lockdown on Sleep and Training Behaviors: A International Survey on 1,681 Muslim Athletes

Objective

Disrupted sleep and training behaviors in athletes have been reported during the COVID-19 pandemic. We aimed at investigating the combined effects of Ramadan observance and COVID-19 related lockdown in Muslim athletes.

Methods

From an international sample of athletes (n = 3,911), 1,681 Muslim athletes (from 44 countries; 25.1 ± 8.7 years, 38% females, 41% elite, 51% team sport athletes) answered a retrospective, cross-sectional questionnaire relating to their behavioral habits pre- and during- COVID-19 lockdown, including: (i) Pittsburgh sleep quality index (PSQI); (ii) insomnia severity index (ISI); (iii) bespoke questions about training, napping, and eating behaviors, and (iv) questions related to training and sleep behaviors during-lockdown and Ramadan compared to lockdown outside of Ramadan. The survey was disseminated predominately through social media, opening 8 July and closing 30 September 2020.

Results

The lockdown reduced sleep quality and increased insomnia severity (both p < 0.001). Compared to non-Muslim (n = 2,230), Muslim athletes reported higher PSQI and ISI scores during-lockdown (both p < 0.001), but not pre-lockdown (p > 0.05). Muslim athletes reported longer (p < 0.001; d = 0.29) and later (p < 0.001; d = 0.14) daytime naps, and an increase in late-night meals (p < 0.001; d = 0.49) during- compared to pre-lockdown, associated with lower sleep quality (all p < 0.001). Both sleep quality (χ² = 222.6; p < 0.001) and training volume (χ² = 342.4; p < 0.001) were lower during-lockdown and Ramadan compared to lockdown outside of Ramadan in the Muslims athletes.

Conclusion

Muslim athletes reported lower sleep quality and higher insomnia severity during- compared to pre-lockdown, and this was exacerbated by Ramadan observance. Therefore, further attention to Muslim athletes is warranted when a circadian disrupter (e.g., lockdown) occurs during Ramadan.

A Narrative Review on Prevention and Early Intervention of Challenging Behaviors in Children with a Special Emphasis on COVID-19 Times

Background

COVID-19 and the measures stemming from efforts to control it have affected the psychosocial wellbeing of children and adolescents. The increasing trend of challenging behavior has exerted further pressure on parents and schools. Understanding socioemotional development and interrelating triggers is the key to management. Early interventions prevent the future threat of mental illness and risky acts. Effective strategies are ones that primarily focus on strengthening parent-child interactions.

Aim

The purpose of this paper is to review the literature on the (i) psychosocial and behavioral impacts of COVID-19 on children/adolescents and (ii) approaches to identify determinants of challenging behaviors as a principal guide to effective interventional strategies for children and their families.

Methodology

Electronic database searches of PubMed, ScienceDirect, Medline, and Scopus were conducted to identify studies meeting the inclusion criteria that address the impact of COVID-19 on behaviors, contributing factors, and management in the context of families/schools. The content of the selected articles was themed under five categories, namely the developmental milestones, the Pyramid Model, the Positive Behavioral Support, the management strategies, and the impact of COVID-19 on children/adolescents' behavior.

Results

The present review demonstrates considerable influence of COVID-19 on children and adolescents' behavior and mental wellbeing. It stresses the importance of early family-based interventions focusing on the triggers of challenging behavior. Functional Behavioral Assessment and Behavioral Intervention Plan provide a systematic analysis with a strategic plan that support children's self-regulation and socioemotional intelligence. Regular behavioral screening is vital to promote prevention and early management.

Conclusion

Managing behavioral difficulties remains an area of deficit for parents, teachers, and health care providers. With a quality support, parents and schools will be able to clearly characterize the challenging behavior, understand the causes, reinforce parent-child interactions, and consequently, gain the strategic skills required to apply it within natural settings. Timely interventions will limit the risk of future misconduct and mental disorders.

Lockdown Duration and Training Intensity Affect Sleep Behavior in an International Sample of 1,454 Elite Athletes

Objective: To investigate the effect of 1) lockdown duration and 2) training intensity on sleep quality and insomnia symptoms in elite athletes.

Methods: 1,454 elite athletes (24.1 ± 6.7 years; 42% female; 41% individual sports) from 40 countries answered a retrospective, cross-sectional, web-based questionnaire relating to their behavioral habits pre- and during- COVID-19 lockdown, including: 1) Pittsburgh sleep quality index (PSQI); 2) Insomnia severity index (ISI); bespoke questions about 3) napping; and 4) training behaviors. The association between dependent (PSQI and ISI) and independent variables (sleep, napping and training behaviors) was determined with multiple regression and is reported as semi-partial correlation coefficient squared (in percentage).

Results: 15% of the sample spent < 1 month, 27% spent 1–2 months and 58% spent > 2 months in lockdown. 29% self-reported maintaining the same training intensity during-lockdown whilst 71% reduced training intensity. PSQI (4.1 ± 2.4 to 5.8 ± 3.1; mean difference (MD): 1.7; 95% confidence interval of the difference (95% CI): 1.6–1.9) and ISI (5.1 ± 4.7 to 7.7 ± 6.4; MD: 2.6; 95% CI: 2.3–2.9) scores were higher during-compared to pre-lockdown, associated (all p < 0.001) with longer sleep onset latency (PSQI: 28%; ISI: 23%), later bedtime (PSQI: 13%; ISI: 14%) and later preferred time of day to train (PSQI: 9%; ISI: 5%) during-lockdown. Those who reduced training intensity during-lockdown showed higher PSQI (p < 0.001; MD: 1.25; 95% CI: 0.87–1.63) and ISI (p < 0.001; MD: 2.5; 95% CI: 1.72–3.27) scores compared to those who maintained training intensity. Although PSQI score was not affected by the lockdown duration, ISI score was higher in athletes who spent > 2 months confined compared to those who spent < 1 month (p < 0.001; MD: 1.28; 95% CI: 0.26–2.3).

Conclusion: Reducing training intensity during the COVID-19-induced lockdown was associated with lower sleep quality and higher insomnia severity in elite athletes. Lockdown duration had further disrupting effects on elite athletes’ sleep behavior. These findings could be of relevance in future lockdown or lockdown-like situations (e.g., prolonged illness, injury, and quarantine after international travel).

COVID-19 and screen-based sedentary behaviour: Systematic review of digital screen time and metabolic syndrome in adolescents

Aim

The COVID-19 pandemic has prompted governments around the globe to implement various restriction policies, including lockdown, social distancing, and school closures. Subsequently, there has been a surge in sedentary behaviour particularly screen time (ST) together with a significant decline in physical activity that was more marked amongst children and adolescents. Excessive screen exposure in adolescents has been correlated with cardio-metabolic risk factors including obesity, hypertension, high cholesterol, and glucose intolerance that may have adverse morbidity and mortality implications in adulthood. Thus, the current study aimed to synthesize the literature on the relationship between ST of various types and the risk of metabolic syndrome (MetS) in adolescents in the context of the COVID-19 pandemic.

Methods

In August 2021, a systematic search of the literature was undertaken using electronic databases: PubMed, PsycINFO, and the Cochran library. Studies were considered if they met the following key eligibility criteria: (i) Measure of ST as an exposure (TV, computer, videogames, internet, smartphone, tablet), using quantified duration/frequency either self-reported or observed; (ii) Measure of MetS as an outcome with standard definition and/or criteria required to establish MetS diagnosis. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess the risk of bias.

Results

A total of ten studies met the inclusion criteria, and the majority were cross sectional studies. Most studies met fair bias scoring. Overall, the review revealed considerable evidence that suggests a significant negative association between ST and components of MetS among adolescents with dose-response association.

Conclusion

During the pandemic, screen usage may become more prevalent through periods of school closures, lockdowns, social isolation, and online learning classes. Public health policies and health promotion strategies targeting parents are needed to raise awareness of the adverse health effects associated with screen-based sedentary behaviour as a precursor of NCDs. Parent or home focused interventions might be effective in limiting adolescents’ screen exposure, alternatively substituted with an appropriate level of physical activity.

PROSPERO registration number

PROSPERO 2021 CRD42021272436.

Effects of dry cupping therapy and creatine supplementation on inflammatory and cardiovascular responses to the Wingate test in handball players

AIM

To evaluate the effects of dry cupping therapy (DCT) and creatine supplementation (CS) on cardiovascular and inflammatory responses to the Wingate test.

METHODS

In this quasi-experimental study, 12 male handball young players were selected in a crossover design. Players were studied in four conditions: DCT; CS; CS+DCT, control. In all conditions, blood pressure, heart-rate, and body composition were measured pre- and post- Wingate test. Players were assessed by the Wingate test in two 30-second phases with a 1-minute break between the phases. Blood [lactate-dehydrogenase (LDH), creatine phosphokinase (CK)] was drawn pre- and immediately post- the Wingate test. In players with CS condition, 60 g of creatine was consumed per day in three consecutive days prior to the study (3 meals of 20 g in morning, noon, and night). The DCT was performed after Wingate test to consider its possible effects for alleviating the muscle injury markers. Data were evaluated using analysis of covariance followed by a post-hoc Bonferoni test.

RESULTS

The heart-rate' means in DCT, CS and CS+DCT conditions were lower compared to the control-condition (p.

The Effect of Daytime Ingestion of Melatonin on Thyroid Hormones Responses to Acute Submaximal Exercise in Healthy Active Males: A Pilot Study

It is well known that exercise increases the activity of thyroid glands and raises the blood level of melatonin. The increase of melatonin during exercise may be linked to a rise in thyroid-stimulating hormone (TSH). No previous study has investigated the combined effects of melatonin ingestion and acute submaximal exercise on thyroid hormones’ responses. The purpose of this pilot study was to explore the effects of daytime ingestion of melatonin on thyroid hormones’ responses to acute submaximal exercise. After 50 min of either melatonin (6 mg) or placebo ingestion, eight physical education students (mean ± standard deviation of age: 22 ± 1 years) were asked to run for 45 min at 60% of their maximum aerobic speed. Free thyroxine (fT4) and TSH were measured in plasma samples before and immediately after exercise. After submaximal exercise, TSH increased by 54% in both placebo and melatonin conditions. There was no significant (Condition × Exercise) interaction, and no significant condition effect for TSH. The fT4 remained unchanged before/after submaximal exercise in both placebo [15.2 (1.9) and 15.0 (1.6) pmol/L, respectively, p > .05], and melatonin [16.7 (2.7) and 16.3 (2.7) pmol/L, respectively, p > .05] conditions. There was no significant (Condition × Exercise) interaction, no significant exercise effect, and no significant condition effect for fT4. To conclude, acute melatonin ingestion did not affect thyroid hormones’ responses to submaximal exercise.

Age and clinical signs as predictors of COVID-19 symptoms and cycle threshold value

Many COVID-19 infected people remain asymptomatic, and hence the diagnosis at first presentation remains a challenge. Assessment at a presentation in primary care settings is usually done by visual triaging and basic clinical examination. This retrospective study involved investigating the medical e-records of COVID-19 positive patients who presented to a COVID-19 centre in Qatar for July 2020. The presence (symptomatic group) or the absence (asymptomatic group) of symptoms along with objective vital examination (ie; heart-rate (HR), temperature, haemoglobin saturation (SpO₂)) were analysed and linked to the viral load (ie; cycle threshold (Ct)) of COVID-19 positive patients. Four hundred eighty-one symptomatic (230 males) and 216 asymptomatic (101 males) patients were included. Compared to the asymptomatic male group, the symptomatic male group was older, had lower Ct value and SpO₂, and higher temperature and HR. Compared to the females asymptomatic group, the symptomatic females group had lower Ct value, and higher temperature. Compared to the asymptomatic group, the symptomatic group had lower Ct value and SpO₂, and higher temperature and HR. Compared to the asymptomatic group, the symptomatic group had lower Ct values (age groups [21–30], [31–40], [41–50] and [51–60]), higher temperature (age groups [21–30] and [31–40], Ct ranges [20.01–25.00] and [25.01–30.00]), higher HR (age groups [21–30] and [31–40], Ct range [15.01–20.00]); and lower SpO₂ (age groups [41–50] and [51–60], Ct ranges [15.01–20.00] and [35.01–40.00]). Compared with asymptomatic patients, symptomatic patients with COVID-19 are most likely to be febrile, tachycardic, hypoxic and having higher viral load. Higher viral load was associated with higher HR, higher temperature, lower SpO₂, but there was no relation between viral load and age.

How physical activity behavior affected well-being, anxiety and sleep quality during COVID-19 restrictions in Iran

OBJECTIVE

The Islamic Republic of Iran has displayed one of the highest rates of COVID-19 infection in the world and the highest rate of mortality in the Middle East. Iran has used a stringent package of preventive health measures to mitigate the spread of infection, which however has negatively affected individuals' physical and psychological health. This study aimed at examining whether physical-activity (PA) behavior, anxiety, well-being, and sleep-quality changed in response to the COVID-19-related public health restrictions enforced in Iran.

PATIENTS AND METHODS

An online questionnaire was disseminated to adults residing in Iran from November 17, 2020, to February 13, 2021 (~88 days), during Iran's strictest public health restrictions. Main outcome measures included Godin-Shephard Leisure-Time Exercise Questionnaire, General Anxiety Disorder-7, Mental Health Continuum-Short Form, and Pittsburgh Sleep Quality Index.

RESULTS

A total of 3,323 adults (mean age 30±11 years, 54.3% female) participated in the survey. Firstly, the restrictions generally reduced PA behavior: (a) among inactive participants (IPs), 60.6% became less active vs. 5.1% who became more active; and (b) among active participants (APs), 49.9% became less active vs. 22.8% who became more active. Secondly, PA behavior was associated with higher well-being and sleep quality during the restrictions: (a) APs reported higher (or lower) levels of well-being and sleep quality (or anxiety) than did IPs; and (b) among IPs as well as among APs, the more active the participants, the greater (or lower) the levels of well-being and sleep quality (or anxiety).

CONCLUSIONS

This study showed the beneficial role of PA behavior for well-being, anxiety, and sleep quality during the COVID-19 restrictions, whereas such restrictions appeared to decrease PA participation. Active lifestyle should be then encouraged during the COVID-19 outbreak while taking precautions.

BNT162b2 COVID-19 Vaccine Hesitancy among Parents of 4023 Young Adolescents (12-15 Years) in Qatar

Parental vaccine hesitancy (VH) remains a barrier to full population inoculation, hence herd immunity against the SARS-CoV-2 virus. We aimed to determine parental VH rate, subgroups and influencing factors related to the BNT162b2 COVID-19 vaccine among their young adolescents (12-15 years old) in Qatar. A retrospective, cross-sectional study was conducted from 17 May to 3 June using vaccination booking records of 4023 young adolescents. Sociodemographic characteristics (i.e., age, sex, and nationality), health status and BNT162b2 COVID-19 vaccination booking status were analysed. Among respondents, the VH rate was 17.9%. Parents of 12-years adolescents were more hesitant (21.6%) as compared to the 13- (16.0%) and 15- (15.2%) years groups (p < 0.05). Parents of adolescents belonging to Gulf Countries (97% Qatari) were more hesitant (35.2%) as compared to the four remaining groups of nationalities (Asiatic; excluding Gulf Countries), North-African, African (excluding North-African), and European/American/Oceanian, 13.3-20.4%, (p < 0.001). Parental VH rates were higher when adolescents suffered from chronic disease as compared to those without the chronic disease (21.3% vs. 17.4%, p < 0.05) or who previously were COVID-19 infected as compared to non-previously COVID-19 infected (24.1 vs. 17.5%, p < 0.01). Results of logistic regression revealed that age groups, nationalities, and recovery from COVID-19 were the main predictors of VH level. Precisely, parents of 12 years old adolescents were 38% more likely to be hesitant as compared to the parents of the 15 years old adolescents (OR = 1.38; 95%CI: 1.12-1.70). Compared with the Gulf countries, parents of adolescents belonging to the other nationality categories; namely North-African, African, Asiatic and European/American/Oceanian were 48% (95%CI: 0.36-0.65), 41% (95% CI: 0.27-0.62), 38% (95%CI: 0.29-0.50) and 34% (95% CI 0.21-0.56) less likely to be hesitant, respectively. Furthermore, parents of young adolescents being previously COVID-19 infected were 37% more likely to be hesitant as compared to those with no previous COVID-19 infection (OR = 1.37; 95%CI: 1.02-1.84). Effective communication strategies specifically targeting Gulf Country populations, parents of younger children aged 12 years and of those with chronic disease or have been previously infected with COVID-19 are crucial to build community trust and vaccine confidence, thereby increasing COVID-19 vaccine uptake.

Biological Responses to Short-Term Maximal Exercise in Male Police Officers

The specifics of short-term physical exercise are similar to the immediate reaction demands placed on police officers. Identifying the physiological predisposition to short-term high-intensity exercise in male law enforcement officers will assist in understanding their metabolism and make a significant contribution to a much more personal and individualized workout program. This will improve physical fitness of individual officers, improving their preparedness for such times of emergency. This cross-sectional study was conducted to investigate the responses of hematological (erythrocytes, hemoglobin, hematocrit, leucocytes, monocytes, neutrophils, lymphocytes), hormonal (testosterone, cortisol, melatonin), biochemical (glucose, uric-acid, lactate, creatine-phosphokinase) data to short-term maximal exercise in male police officers (n = 20). Blood samples were collected before- and after- the running-based anaerobic sprint test (RAST), and biological values were corrected for fluid shifts. Data were mean ± standard deviation of differences (= after minus before RAST). After the RAST, values of cortisol, lactate, neutrophils, lymphocytes, and monocytes increased significantly by 7.01 ± 37.36 mmol/l, 7.55 ± 1.67 mmol/l, 0.17 ± 0.26 103/µl, 0.61 ± 0.28 103/µl, and 0.10 ± 0.13 103/µl, respectively. After the RAST, values of melatonin, uric-acid, creatine-phosphokinase, hemoglobin, and hematocrit decreased significantly by -13.24 ± 4.60 pg/ml, -13.28 ± 14.35 µmol/l, -10.23 ± 10.13 IU/l, -2.01 ± 0.81 g/dl, and -4.46 ± 0.59%, respectively. Biological data of male police officers were affected by sprint test. Understanding changes in biological data following short-term maximal exercise can further assist in a better understanding of anaerobic metabolism, which will be helpful to find available methods for coaches to quantify training loads.

Covid-19 and diabetes in primary care - How do hematological parameters present in this cohort?

Objectives: Changes in hematological parameters are becoming evident as important early markers of COVID-19. Type 2 Diabetes Mellitus (T2DM) has been shown to be associated with increased severity of COVID-19. In this study, we aim to explore the various hematological variables in COVID-19 positive patients with T2DM, so as to act early and improve patient outcomes.Methods: Medical e-records of seventy adult patients with T2DM who were COVID-19 positive have been analyzed in this retrospective cohort study. Demographic, clinical and laboratory parameters for these patients were examined.Results: Of the seventy patients with T2DM, 48.88% had poorly controlled diabetes. 70.69% were pyrexial, 56.25% were tachycardic and 38.58% were asymptomatic on presentation. Amongst the hematological parameters, anemia was seen in 10% of males and 15.38% of females. 20% had a high red-blood-cell-distribution-width (RDW). 7.27% had thrombocytosis and 3.64% had thrombocytopenia. 73.3% had a high platelet-distribution-width (PDW) and 44.44% had an increased mean-platelet-volume (MPV). 16.36% were neutropenic and 16.67% had lymphocytopenia.Conclusion: Diabetic COVID-19 positive patients have been shown to have prominent manifestations of the hemopoietic-system with varied hematological profiles. Recognizing the implications of these variables early in primary-care, can help clinicians aid management decisions and dictate early referral to secondary-care services, to help improve prognosis.

Sleep Quality and Physical Activity as Predictors of Mental Wellbeing Variance in Older Adults during COVID-19 Lockdown: ECLB COVID-19 International Online Survey

BACKGROUND

The COVID-19 lockdown could engender disruption to lifestyle behaviors, thus impairing mental wellbeing in the general population. This study investigated whether sociodemographic variables, changes in physical activity, and sleep quality from pre- to during lockdown were predictors of change in mental wellbeing in quarantined older adults.

METHODS

A 12-week international online survey was launched in 14 languages on 6 April 2020. Forty-one research institutions from Europe, Western-Asia, North-Africa, and the Americas, promoted the survey. The survey was presented in a differential format with questions related to responses "pre" and "during" the lockdown period. Participants responded to the Short Warwick-Edinburgh Mental Wellbeing Scale, the Pittsburgh Sleep Quality Index (PSQI) questionnaire, and the short form of the International Physical Activity Questionnaire.

RESULTS

Replies from older adults (aged >55 years, n = 517), mainly from Europe (50.1%), Western-Asia (6.8%), America (30%), and North-Africa (9.3%) were analyzed. The COVID-19 lockdown led to significantly decreased mental wellbeing, sleep quality, and total physical activity energy expenditure levels (all p < 0.001). Regression analysis showed that the change in total PSQI score and total physical activity energy expenditure (F(2, 514) = 66.41 p < 0.001) were significant predictors of the decrease in mental wellbeing from pre- to during lockdown (p < 0.001, R2: 0.20).

CONCLUSION

COVID-19 lockdown deleteriously affected physical activity and sleep patterns. Furthermore, change in the total PSQI score and total physical activity energy expenditure were significant predictors for the decrease in mental wellbeing.

Does lunar cycle affect biological parameters in young healthy men?

This study aimed to assess the effects of the lunar cycle on diurnal variation of biological, i.e, hormonal, biochemical, and hematological, profiles of diurnally active healthy men. Blood samples of 20 males were collected on four occasions [full moon (FM) and new moon (NM), in the morning (06:00-07:00 h) and evening (19:00-20:00 h)]. The results showed that melatonin and testosterone levels and neutrophils count were lower during the FM as compared to the NM in the morning (p < .001; d = 4.13, p < .001; d = 3.84, p < .01; d = 0.77, respectively) and evening (p < .001; d = 6.36, p < .001; d = 4.03, p < .05; d = 1.07, respectively) samples. However, cortisol level was higher during the FM compared to the NM, in the morning (p < .001; d = 0.74) and evening (p < .001; d = 3.54). Hemoglobinemia was higher only in the evening during the FM compared to the evening of the NM (p < .01; d = 1.22). In summary, this study confirmed that lunar cycle can affect human biological parameters independently of time of day.

Covid-19: "Drive thru swabbing hubs" – safe and effective testing for travellers

Background: With increasing number of international travellers taking flights and the need of stringent quarantine regulations across the globe in view of the COVID-19 pandemic, it has become a mandatory requirement for many airlines and countries to have a COVID-19 RT-PCR Negative certificate for travellers within a time-specific period prior to boarding flights. Method: As the demand for RT-PCR testing in this group of asymptomatic well individuals who are planning to travel is increasing, they present to COVID testing centres for their swab tests, where suspected COVID patients also attend, thereby increasing the risk of exposure of these healthy people to possibly infected individuals. Hence, the Ministry of Public Health (MOPH) in Qatar implemented “Drive-Thru” swabbing hubs to address this potential issue. We analysed the usefulness of this MOPH initiative and how it has helped tackle the challenge. Results and Conclusion: With a reduced risk of exposure for travellers to potentially suspected COVID-19 patients in COVID centres, the “Drive-Thru” swabbing hubs have been a pragmatic, welcome and wonderful initiative. This has contributed to curb the spread of COVID-19 by facilitating easy testing thereby alleviating anxiety in travellers as well as reducing the burden of an exponentially increasing number of travellers presenting to COVID centres.

Extensive Saliva based COVID-19 testing – the way forward to curtail the global pandemic?

With over 36 million people infected with COVID-19 since the beginning of the pandemic, testing has been most challenging process to identify and isolate individuals who are COVID-positive. The RT-PCR testing method has been the gold standard testing tool with a sensitivity and specificity of 95.2% and 98.9% respectively. However, this comes at a huge cost of the stress and anxieties of the testing process itself, especially for children as well as the requirements of health care professionals with PPE kits and the dangers of an aerosol generating procedure. We hence recommend the saliva testing kits as the suggested way forward to testing for the general population, especially for children, as they are highly sensitive and specific (98% and 91% respectively) as well as can be a much effortless process to test for COVID-19 and could certainly pave the way forward to mass testing as some countries are already planning to implement.