General Population Groups Research Articles

Prevalence and predictors of vitamin D deficiency among hospital staff in tertiary care center: a cross sectional study

Background: Vitamin D deficiency (VDD) is prevalent across all age groups in general population not sparing the health care workers. This study aimed to assess the prevalence and risk factors of VDD among the hospital workers of tertiary care center in Kashmir valley. Methods: In this cross-sectional study, a total of 216 apparently healthy subjects were screened for VDD from three groups, group A- minimal sunlight exposure (office employees), group B- moderate sunlight exposure (nursing students) and group C- abundant sunlight exposure (gardeners). Serum calcium, phosphorus, alkaline phosphatase, 25-hydroxy vitamin D [25(OH)D], PTH levels and urine calcium/creatinine was assessed in all subjects. Dietary assessment of vitamin D (VD) and calcium intake was done using three days dietary recall. The percent body surface area (BSA) exposed to sunshine was estimated by applying the Wallace rule of nine. Results: Serum 25(OH)D level was found to be lower in group A (17.29±10.87) as compare to group B (21.78±16.37) and group C (26.40±15.59). Prevalence of VDD was 71.6%, 70.6% and 50% in group A, group B and group C respectively. VDD was more prevalent in females and risk increased with age and BMI, decreased with duration of daily sunlight exposure, percentage BSA and dietary VD intake. Conclusions: Burden of VDD is high among hospital workers despite their direct contact with healthcare. Strategies should be made to screen them regularly and supplementation of VD should be provided to effectively counteract VDD.

Vulnerability to Suicide Ideation: Comparative Study between Adolescents with and without Psychosocial Risk.

Adolescents are characterized as a risk group for suicide, being the fourth leading cause of death in young people. The main aim was to compare vulnerability to suicidal ideation in a sample of young people with and without psychosocial risk. The total sample consisted of 137 adolescents, aged between 10 and 19 years (M = 14.76; SD = 1.40), and it was composed of two groups-the psychosocial risk group (n = 60) and general population group (n = 77). In both groups, suicidal ideation correlated positively with negative events and negatively with self-esteem and social support satisfaction. When comparing the two groups, the psychosocial risk group presented significantly higher mean values of negative life events (mainly separations/losses and physical and sexual abuse) and significantly lower mean values of satisfaction with social support (particularly with family and social activities). It was also found that, in the psychosocial risk group, negative life events were the only significant predictors of suicidal ideation. This study allowed identifying the role of risk and protective factors in suicidal ideation, according to the psychosocial risk of adolescents. The practical implications of the findings on adolescents' mental health and the promotion of their well-being are discussed.

Health status and health-care utilization among men recently released from a superjail: a matched prospective cohort study

PurposeContinuity of care and access to primary care have been identified as important contributors to improved health outcomes and reduced reincarceration among people who are justice-involved. While the disproportionate burden of health concerns among incarcerated populations is well documented, less is known about their health service utilization, limiting the potential for effective improvements to current policy and practice. This study aims to examine health status and health care utilization among men recently released from a superjail in a large metropolitan area to better understand patterns of use, risk factors and facilitators.Design/methodology/approachParticipants included adult men (n = 106) matched to a general population group (n = 530) in Ontario, Canada, linked to medical records (88.5% linkage) to examine baseline health status and health utilization three-months post-release. The authors compared differences between the groups in baseline health conditions and estimated the risk of emergency department, primary care, inpatient hospitalization and specialist ambulatory care visits.FindingsSuperjail participants had a significantly higher prevalence of respiratory conditions, mental illness, substance use and injuries. Substance use was a significant risk factor for all types of visits and emergency department visits were over three times higher among superjail participants.Originality/valueThis empirical case is illustrative of an emerging phenomenon in some regions of the world where emergency departments serve as de facto “walk-in clinics” for those with criminal justice involvement. Strategic approaches to health services are required to meet the complex social and health needs and disparities in access to care experienced by men released from custody.

‘I make a lot of the choices myself—I think I've taught myself that through the imbalance of support’: The internal conversations, reflexivity and post‐school educational achievement of care‐experienced young people

AbstractThe percentage of care‐experienced young people in England progressing to university by the age of 19 currently stands at around 12–13% with a further 10% of care‐experienced adults attending university during their 20s and 30s. This figure remains lower than both the general population and other groups of disadvantaged learners. It is well established that the educational attainment of care‐experienced young people can be impacted by a range of barriers to learning. Existing research often focuses on the importance of key adults and their role in supporting young people in care. A small number of studies examine the reflexive capacities of the young people themselves through the lens of sociologist Margaret Archer's model of modes of reflexivity and internal conversations. Archer's theory can be utilised to understand how care‐experienced young people navigate their circumstances. The notion of the internal conversation offers a way to understand how some young people growing up in care develop more stable modes of reflexivity, namely autonomous, communicative or meta‐reflexive. Here we contribute to new knowledge by considering care‐experienced young people who develop communicative and autonomous aspects to their day‐to‐day life functioning. This paper draws on findings and analysis from interviews conducted as part of the first author's PhD (2020) which considered the reflexive capacities of care‐experienced young people who self‐identified as higher achievers. We utilise Archer's modes of reflexivity to explore participants’ internal conversations and to develop our understanding of the relationships, experiences and personal skills that underpin successful educational journeys.

Medical events in SARS-Cov-2 infected psychiatric inpatients with and without pre-existing co-morbid medical conditions

SARS-CoV-2 (COVID-19) infection can be associated with significant medical complications. This risk could be even higher in psychiatric patients due to an increased risk of medical co-morbidity. In addition, psychiatric patients are also vulnerable to acquiring SARS-CoV2 infection due to homelessness, living in crowded areas, and poor adherence to recommended preventive measures. This retrospective study aims to compare two groups of patients, namely COVID-19 positive inpatient psychiatric patients with and without preexisting medical comorbidity on specific clinical and socio-demographic features and more importantly how many patients in the two groups subsequently developed medical complications. All COVID-19 positive psychiatric patients who were admitted to acute psychiatric inpatient units over a one-year period during the peri-pandemic phase were included for this study. Data was collected from the electronic medical records of 174 patients admitted to the inpatient psychiatric facility between January and December 2020.Among the COVID-19 positive patients, twenty individuals out of eighty-nine in the WC (with pre-existing medical comorbidity) group and two individuals out of eighty-five in the WOC (without pre-existing medical comorbidity) group developed COVID-related pneumonia. Ten WC patients and two WOC patients required supplemental oxygen, while only one patient in the WC group developed critical illness and required ventilatory support. The WC group had longer stay in both psychiatric and medical units compared to the WOC group. Consistent with existing literature that patients with comorbid medical condition are higher risk of COVID-19 complications, this study replicates the finding that in psychiatric inpatients pre-existing comorbid medical conditions create a higher risk of experiencing COVID-19 related medical complications. More interestingly, however that increased risk of developing new medical complications was not significantly different from the published rates observed in the general population which is surprising given how vulnerable psychiatric patients are, both medical, psychiatrically and psychosocially. In fact, in some ways and for reasons as yet unclear, the medical complication rate was slightly better in the WC compared to published data in the general population groups.

Comparative study between deltoid split approach versus delto pectoral approach for proximal humerus fracture fixation

Background: Proximal humeral fracture is defined as fractures occurring at or proximal to the surgical neck of the humerus. It affects 2.4% of women over the age of 75 years. It is the commonest fracture affecting the shoulder girdle in adults and its incidence is rising. For displaced fractures that meet surgical indications, deltopectoral approach is the most common approach for plate fixation of proximal humeral fractures. Deltoid splitting approach offers advantages of better exposure and implant placement for fixation of the fracture and early mobilization of the shoulder joint. Methods: This is a comparative study of 30 cases of proximal humerus fractures treated by surgical fixation through deltoid splitting approach and 30 cases treated by delto pectoral approach. Patient of both sexes belonging to adult age group in general population presenting with proximal humerus fracture to the orthopaedic department of Bapuji Hospital and Chigateri General hospital attached to J.J.M. Medical College, Davangere. The period of survey extends from December 2020 to December 2022. The final results were evaluated using constant Murley score periodically. This constant Murley score ranges from 0 to 100 points representing worst and shoulder function respectively. Results: No statistically significant difference was observed in outcome with regard to mechanism of injury, side of fracture and type of fracture with both deltoid splitting approach and delto pectoral approach. Conclusions: The treatment of proximal humeral fractures with a proximal locking plate is reliable using both approaches. No significant difference found in functional outcome of proximal humerus fracture following deltoid split and deltopectoral approach on serial follow up.

Supplementing Vitamin D in Different Patient Groups to Reduce Deficiency.

Studies indicate a high prevalence of vitamin D deficiency in both the general population and at-risk groups. Given the association between vitamin D deficiency and various diseases, addressing this concern becomes crucial, especially in situations where routine monitoring is challenging. A systematic literature review of the current knowledge on vitamin D dosing in diverse at-risk populations and the application of the findings to a broader clinical perspective. The reviewed studies revealed a high prevalence of vitamin D deficiency among patients with musculoskeletal disorders, systemic connective tissue diseases, corticosteroid use, endocrine and metabolic conditions, malabsorption syndromes, obesity, chronic kidney disease, cancer, and central nervous system diseases. Vitamin D deficiency was often more severe compared to the general population. Higher dosages of vitamin D beyond the recommended levels for the general population were shown to be effective in improving vitamin D status in these at-risk individuals. Additionally, some studies suggested a potential link between intermittent vitamin D administration and improved adherence. Simplified dosing could empower clinicians to address vitamin D deficiency, particularly in high-risk populations, even without routine monitoring. Further research is needed to establish the optimal dosing regimens for specific at-risk populations.

The Italian Validation of the Beck Cognitive Insight Scale: Underlying Factor Structure in Psychotic Patients and the General Population.

Cognitive insight refers to the ability to question one's judgments and cognitive biases and is underpinned by specific metacognitive processes. The Beck Cognitive Insight Scale was developed to assess cognitive insight and includes two subscales, Self-Reflectiveness and Self-Certainty (SC). The present study aimed to investigate the underlying factor structure of the Italian version of the BCIS in patients with schizophrenia (SZ) and in the general population (GP) for the first time. A cross-sectional design was adopted and a GP sample of 624 subjects and an SZ sample of 130 patients were enrolled. In the SZ group, a two-factor solution was supported. The internal reliability of each factor was satisfactory. Two items were eliminated and one item moved from the SC to the SR subscale. In the GP group, a two-factor solution was highlighted. The internal reliability of each factor was satisfactory. However, four items of the SR subscale were deleted. The Italian-validated version of the BCIS shows different structures for the SZ and the GP and is characterized by different features concerning previous studies. This evidence suggests new interpretations of metacognitive processes in the two populations and implies specific therapeutic approaches.

Lactobacilli Profile in Faecal Samples of Tunisian Children Diagnosed with Autism Spectrum Disorder

Alterations in faecal lactobacilli in autistic children have been reported, but little is known related to age and disorder severity. We used a culture-based method and partial 16S rRNA gene sequencing to isolate and identify lactobacilli strains from faeces of Tunisian autistic children (ASD group) and compared them with strains isolated from siblings (SIB) and children from the general population (GP). The ASD group displayed an increased number of different species compared to SIB and GP. Differences in species abundance with age accounted for a significant decrease in the abundance of Lactiplantibacillus plantarum/Lactiplantibacillus pentosus isolates in the GP at the age of 8–10 years compared to the age of 4–7 years, and to a significantly lower abundance of Lacticaseibacillus rhamnosus in the ASD group with respect to SIB and the GP at the age of 8–10 years. Simpson’s and Shannon–Wiener indices showed a more pronounced species diversity increase with age in the GP group compared to the ASD and SIB groups. Minor differences were found in lactobacilli prevalence and in species diversity between children with severe and mild-to-moderate ASD. Overall, we found substantial differences in the profile of faecal lactobacilli species in the ASD and GP groups at the age of 8–10 years.

High Levels of Anti-SARS-CoV-2 Receptor-Binding Domain (RBD) Antibodies One Year Post Booster Vaccinations among Hospital Workers in Indonesia: Was the Second Booster Needed?

In August 2022, Indonesia prioritized healthcare workers to receive the second booster dose. We conducted a sequential serosurvey to understand the dynamics of the antibody titers. The first serosurvey, which was conducted in June 2021, 1-6 months after Sinovac vaccination, showed a median antibody level of 41.4 BAU/mL (interquartile range (IQR): 10-629.4 BAU/mL). The second serosurvey was conducted one month (August 2021) after the first Moderna booster vaccine and showed a median level of 4000 BAU/mL (IQR: 3081-4000 BAU/mL). The last serosurvey was conducted a year (August 2022) after the booster and showed a median level of 4000 BAU/mL (IQR: 4000-4000 BAU/mL). In this last survey, only 39 (11.9%) of healthcare workers had antibody levels below the maximum level of 4000 BAU/mL. Thus, one year after the first booster dose, we did not observe the waning of antibody levels. The average increase was perhaps because of natural infection. Based on these considerations, we believe that a second booster dose was not necessary for this category of subjects at that time. Because vaccine supply is often limited, priority could be given to the general population or other high-risk patient groups with low antibody titers based on serological tests.

Finding a way forward with the community: qualitative inquiry in the generalized HIV epidemic in Mizoram, India.

Mizoram, the northeastern State of India bordering Myanmar, is presently witnessing a burgeoning generalized HIV epidemic along with the highest State-level HIV prevalence among female sex workers (FSWs, 24.7%) and people who inject drugs (PWID,19.8%) in the country. The present study was conducted against such background to understand the current situation of HIV prevention and care services in Mizoram, and capture community voices as well as concerns so that the way forward could be informed appropriately. The study period was October through December 2020 (in the midst of COVID-restrictions) in the districts of Aizawl, Mamit, Kolasib, Lunglei, and Champhai where HIV prevalence crossed 1% among ante-natal clinic (ANC) attending women. Contrastingly, the national average HIV prevalence among ANC attendees is 0.24%, which formed the basis for selecting the aforementioned five high burden districts for this current inquiry. In-depth-interviews were conducted with community members and youth leaders, vulnerable and general population groups as well as HIV-program officials. Interviews were recorded, transcribed, translated and later coded for analysis following thematic approach. The emerging issues were grouped in three thematic layers; (1) HIV vulnerability, (2) challenges pertaining to prevention and care services, and (3) program elements and future roadmap. Discrimination at the community level, unfriendly behavior of some of the HIV-service staff, occasional interruption in supplies of anti-retroviral treatment and sterile syringes and needles were voiced as deterrents to accessing HIV prevention and care services by the participants. Community engagement, based on restorative approach rather than retribution and ensuring enhanced performance of the district AIDS program control units emerged as necessary programmatic elements. This inquiry highlighted macro-social and structural forces contributing to stigma and discrimination toward people at risk of HIV. It is urgent that HIV-services are re-aligned through de-centralized district level innovations and creation of safer spaces at the physical, societal and familial level. These, even during the time of stress such as a pandemic, would help health services to remain resilient. HIV outreach, sensitization of the community leaders and health-care professionals through strategic communication and ownership of the communities in these endeavors appeared paramount.

Prevalence of bruxism in obstructive sleep apnea syndrome (OSAS) patients: A systematic review conducted according to PRISMA guidelines and the cochrane handbook for systematic reviews of interventions.

Sleep bruxism (SB) and obstructive sleep apnea syndrome (OSAS) are two sleep-related conditions that have been associated with significantly conflicting results in literature. Understanding the prevalence of bruxism among OSA patients is crucial for identifying possible comorbidities and optimising treatment strategies. This systematic review aimed at analysing the prevalence of SB in OSAS sufferers and understanding the association between the two. Five online databases were searched for relevant articles in accordance with the PRISMA guidelines for conduction of systematic reviews. Studies reporting the prevalence of bruxism in OSAS patients and diagnosed through clinical assessments or polysomnography were included. Data extraction and quality assessment were performed independently by two reviewers. Methodological quality of the included studies was assessed using Risk of Bias In Non-randomised Studies of Interventions (ROBINS-I). A thorough search of literature yielded only two studies were eligible for this review. SB was found to be significantly present in the OSAS group. Despite methodological variations, the majority of studies reported higher rates of bruxism in OSAS patients compared to the general population or control groups. The results of this systematic review point to a significant association between bruxism and obstructive sleep apnea. Further research is required to determine a more precise prevalence rate and investigate the potential therapeutic implications of the bruxism-OSAS association that uses a standardised assessment techniques and larger sample sizes.

Co-development among reading, math, science, and verbal working memory in the elementary stage.

With a focus on within-person effects, this study investigated mutualism among academic skills (reading, math, science) and between those skills and verbal working memory in a general population sample and groups with high or low skills from Grades 2 to 5 (2010-2016, N = 859-9040, age 6.27-13.13 years, 49% female, ethnically diverse). Mutualism was found between reading and science in all high-ability groups, and between reading/math and verbal working memory only in high-math students. These results remained the same when controlled for socioeconomic status and gender, and with sensitivity analyses. High-skill students (especially high-math students) may improve academic performance through accumulation of academic knowledge and mutualism between academic and cognition. Such mutualism may be driven by high-quality, intensive academic practice.

Estimating hepatitis B virus prevalence among key population groups for European Union and European Economic Area countries and the United Kingdom: a modelling study

BackgroundHepatitis B virus (HBV) epidemiology in Europe differs by region and population risk group, and data are often incomplete. We estimated chronic HBV prevalence as measured by surface antigen (HBsAg) among general and key population groups for each country in the European Union, European Economic Area and the United Kingdom (EU/EEA/UK), including where data are currently unavailable.MethodsWe combined data from a 2018 systematic review (updated in 2021), data gathered directly by the European Centre for Disease Control (ECDC) from EU/EEA countries and the UK and further country-level data. We included data on adults from the general population, pregnant women, first time blood donors (FTBD), men who have sex with men (MSM), prisoners, people who inject drugs (PWID), and migrants from 2001 to 2021, with three exceptions made for pre-2001 estimates. Finite Mixture Models (FMM) and Beta regression were used to predict country and population group HBsAg prevalence. A separate multiplier method was used to estimate HBsAg prevalence among the migrant populations within each country, due to biases in the data available.ResultsThere were 595 included studies from 31 countries (N = 41,955,969 people): 66 were among the general population (mean prevalence (stackrel{-}{p}) 1.3% [range: 0.0-7.6%]), 52 among pregnant women (stackrel{-}{p}=1.1% [0.1–5.3%]), 315 among FTBD (stackrel{-}{p}=0.3% [0.0-6.2%]), 20 among MSM (stackrel{-}{p}=1.7% [0.0-11.2%]), 34 among PWID (stackrel{-}{p}=3.9% [0.0-16.9%]), 24 among prisoners (stackrel{-}{p}=2.9% [0.0-10.7%]), and 84 among migrants (stackrel{-}{p}=7.0% [0.2–37.3%]). The FMM grouped countries into 3 classes. We estimated HBsAg prevalence among the general population to be < 1% in 24/31 countries, although it was higher in 7 Eastern/Southern European countries. HBsAg prevalence among each population group was higher in most Eastern/Southern European than Western/Northern European countries, whilst prevalence among PWID and prisoners was estimated at > 1% for most countries. Portugal had the highest estimated prevalence of HBsAg among migrants (5.0%), with the other highest prevalences mostly seen in Southern Europe.ConclusionsWe estimated HBV prevalence for each population group within each EU/EAA country and the UK, with general population HBV prevalence to be < 1% in most countries. Further evidence is required on the HBsAg prevalence of high-risk populations for future evidence synthesis.

Prevalence of Chronic Hepatitis B Virus Infection in Sierra Leone, 1997-2022: A Systematic Review and Meta-Analysis.

Hepatitis B virus (HBV) infection is a major public health problem in Sierra Leone, yet reliable estimates of cases are lacking. This study aimed to provide an estimate of the national prevalence of chronic HBV infection in the general population and select groups in Sierra Leone. We used the electronic databases PubMed/MEDLINE, Embase, Scopus, ScienceDirect, Web of Science, Google Scholar, and African Journals Online to systematically review articles reporting hepatitis B infection surface antigen seroprevalence estimates in Sierra Leone during 1997-2022. We estimated pooled HBV seroprevalence rates and assessed potential sources of heterogeneity. Of 546 publications screened, 22 studies with a total sample size of 107,186 people were included in the systematic review and meta-analysis. The pooled prevalence of chronic HBV infection was 13.0% (95% CI, 10.0-16.0) (I2 = 99%; Pheterogeneity < 0.01). During the study period, the HBV prevalence rates were as follows: 17.9% (95% CI, 6.7-39.8) before 2015, 13.3% (95% CI, 10.4-16.9) during 2015-2019, and 10.7% (95% CI, 7.5-14.9) during 2020-2022. The use of the 2020-2022 HBV prevalence estimates corresponded to 870,000 cases of chronic HBV infection (uncertainty interval, 610,000-1,213,000), or approximately one in nine people. The highest HBV seroprevalence estimates were among adolescents aged 10-17 years (17.0%; 95% CI, 8.8-30.5), Ebola survivors (36.8%; 95% CI, 26.2-48.8), people living with HIV (15.9%; 95% CI, 10.6-23.0), and those in the Northern Province (19.0%; 95% CI, 6.4-44.7) and Southern Province (19.7%; 95% CI, 10.9-32.8) regions. These findings may help inform national HBV program implementation in Sierra Leone.

#4437 ASSESSMENT OF THE PSYCHOLOGICAL EXPERIENCE OF KIDNEY TRANSPLANT PATIENTS DURING THE COVID-19 PANDEMIC

Abstract Background and Aims The coronavirus (COVID 19) pandemic has caused a major health crisis, and quarantined half of the world's population, therefore it contributed to the appearance or aggravation of mental distress such as anxiety, depressive disorders and deterioration of the quality of sleep especially in the immunocompromised population and especially in the kidney transplant patients. Among the causes of these disorders are the risk of infection and the relatively high mortality rate associated with this virus. The aim of our study is to investigate anxiety and depression scores in renal transplant patients during the COVID 19 pandemic and compare them to those of the general population to highlight the impact that the pandemic has had on this vulnerable population. Method This is a descriptive and analytical case-control study of a group of 113 patients divided into 2 groups: group of kidney transplant patients and that of the general population. A questionnaire collecting sociodemographic data was used. Anxiety symptoms were assessed by the GAD anxiety scale. Depressive symptoms were assessed using the Beck's scale abbreviated. Results In our study, the rates of anxiety and depression in the general population group were around 33.3% and 18.3% respectively. This rate was significantly higher in subjects with previous psychiatric history. These rates were higher in women with an anxiety rate of 18.3% versus 15% in men and a depression rate of 11% in women versus 7% in men and were significantly higher in subjects with previous psychiatric history. In the group of kidney transplant patients the rates of anxiety and depression were high compared to the general population, with a rate of anxiety at 66% and depression at 26.4% (p&amp;lt;0.001). Conclusion This study raised the major negative impact of the covid 19 pandemic on the increase of psychiatric disorders in this at-risk population compared to the general population. This requires a multidisciplinary and adapted management of these vulnerable patients, associating a joint nephrological and psychiatric follow-up in order to preserve their quality of life and their mental health.

How the COVID-19 pandemic affects the moral reasoning of pediatric residents and the general population

BackgroundKohlberg’s theory of moral development asserts that people progress through different stages of moral reasoning as their cognitive abilities and social interactions mature. Individuals at the lowest stage of moral reasoning (preconventional stage) judge moral issues based on self-interest, those with a medium stage (conventional stage) judge them based on compliance with rules and norms, and those at the highest stage (postconventional stage) judge moral issues based on universal principles and shared ideals. Upon attaining adulthood, it can be considered that there is stability in the stage of individuals’ moral development; however, the effect of a global population crisis such as the one experienced in March 2020, when the World Health Organization (WHO) declared the COVID-19 pandemic, is unknown. The purpose of this study was to evaluate the changes in the moral reasoning of pediatric residents before and after one year of the COVID-19 pandemic and compare them with a general population group.MethodsThis is a naturalistic quasi-experimental study conducted with two groups, one comprised 47 pediatric residents of a tertiary hospital converted into a COVID hospital during the pandemic and another group comprised 47 beneficiaries of a family clinic who were not health workers. The defining issues test (DIT) was applied to the 94 participants during March 2020, before the pandemic initiated in Mexico, and later during March 2021. To assess intragroup changes, the McNemar-Bowker and Wilcoxon tests were used.ResultsPediatric residents showed higher baseline stages of moral reasoning: 53% in the postconventional group compared to the general population group (7%). In the preconventional group, 23% were residents and 64% belonged to the general population. In the second measurement, one year after the start of the pandemic, the group of residents had a significant decrease of 13 points in the P index, unlike the general population group in which a decrease of 3 points was observed. This decrease however, did not equalize baseline stages. Pediatric residents remained 10 points higher than the general population group. Moral reasoning stages were associated with age and educational stage.ConclusionsAfter a year of the COVID-19 pandemic, we found a decrease in the stage of moral reasoning development in pediatric residents of a hospital converted for the care of patients with COVID-19, while it remained stable in the general population group. Physicians showed higher stages of moral reasoning at baseline than the general population.

Dietary assessment of 101 para‐athletes from team and individual sports

Assessing the usual food intake of para-athletes enables knowledge and description of nutrient intakes, providing insight into the potential nutritional status of para-athletes and may help tailor dietary intake to their specific training needs. This study aimed to evaluate the usual intake of macronutrients and food groups and meal food patterns of athletes with a disability. We also compared dietary intake data between team and individual sport para-athletes. One hundred and one athletes with a disability from 13 Paralympic disciplines living in Brasília, Federal District, Brazil were included. Food intake was estimated from two or four non-consecutive 24-h food recalls in which para-athletes reported all food, beverages, and supplements consumed in the previous 24-h. Dietary intake analysis was performed by implementing the National Cancer Institute (NCI) method to calculate the macronutrient and food group usual intake. Macronutrient intakes were compared to Acceptable Macronutrient Distribution Ranges for the general population and food group intakes were compared to the 2008 Brazilian National Dietary Guidelines. Para-athletes consumed a low-carbohydrate, adequate protein, high-fat diet. There was no significant difference in macronutrient intake distribution between team sport and individual sport para-athletes. Most para-athletes had three main meals during the day. The prevalence of inadequate fruit servings in the middle and highest energy intake tertiles was significantly higher in team sport para-athletes (92.5% and 98.4%) than in individual sport para-athletes (90.8% and 65.5%), respectively. The prevalence of inadequate vegetable servings was significantly higher between team and individual para-athletes for the middle energy intake tertiles. Para-athletes generally consumed an imbalanced diet, which is a cause for concern given their additional physiological demands and specific training needs.

Using the ELF test, FIB-4 and NAFLD fibrosis score to screen the population for liver disease

There is a need for accurate population screening biomarkers for alcohol-related and non-alcoholic fatty liver disease (ALD, NAFLD). We evaluated the Enhanced Liver Fibrosis (ELF) test compared to FIB-4 and NAFLD fibrosis score (NFS) using transient elastography (TE) as fibrosis screening reference. We prospectively included participants from the general population, and people at risk of ALD or NAFLD. Screening positive participants (TE ≥8kPa) were offered a liver biopsy. We measured concomitant ELF, FIB-4, and NFS using validated cut-offs: ≥9.8, ≥1.3, ≥-1.45, respectively. We included 3,378 participants (1,973 general population, 953at risk of ALD, 452at risk of NAFLD), with a median age of 57 years (IQR: 51-63). Two hundred-and-forty-two were screening positive (3.4% in general population, 12% in ALD, 14% in NAFLD). Most participants with TE <8kPa also had ELF <9.8 (88%) despite a poor overall correlation between ELF and TE (Spearman´s rho=0.207). ELF had significantly fewer false positives (11%) than FIB-4 and NFS (35% and 45%), while retaining a low rate of false negatives (<8%). A screening strategy of FIB-4 followed by ELF in indeterminate cases resulted in 8% false positives, 4% false negatives and 88% correctly classified. We performed a liver biopsy in 155/242 (64%) screening positives, of those 54 (35%) had advanced fibrosis (≥F3). ELF diagnosed advanced fibrosis with significantly better diagnostic accuracy than FIB-4 and NFS: AUROC 0.85 (95% CI 0.79-0.92) versus 0.73 (0.64-0.81) and 0.66 (0.57-0.76). The ELF test alone or combined with FIB-4 for liver fibrosis screening in the general population and at-risk groups reduces the number of futile referrals compared to FIB-4 and NFS, without overlooking true cases. We need referral pathways that are efficient at detecting advanced fibrosis from alcohol-related and non-alcoholic fatty liver disease in the population, but without causing futile referrals or excessive use of resources. This study indicates that a sequential test strategy of FIB-4, followed by the ELF test in indeterminate cases leads to few patients referred for confirmatory liver stiffness measurement, while retaining a high rate of detected cases, and at low direct costs. This two-step referral pathway could be used by primary care for mass, targeted, or opportunistic screening for liver fibrosis in the population. Clinicaltrials.gov number NCT03308916.

“Looking beyond Mental Health Stigma”: An Online Focus Group Study among Senior Undergraduate Nursing Students

Evidence highlights the need for professionals to be aware of their stigmatizing attitudes and discriminatory practices in order to minimize the negative impact on the people they take care of. However, nursing students' perceptions of these issues have been poorly studied. This study explores the perspective of senior undergraduate nursing students on mental health and the stigma around it, by considering a simulated case vignette of a person with a mental health problem. A descriptive qualitative approach was chosen and involved three online focus group discussions. The findings show various manifestations of stigma, both at an individual and collective level, which indicates that it is an obstacle to the wellbeing of people with mental illness. Individual manifestations of stigma concern its effect on the person with mental illness, while at the collective level they concern the family or society in general. Stigma is a multifactorial, multidimensional, and complex concept, in terms of identifying and fighting it. Thus, the strategies identified involve multiple approaches at the individual level, aimed at the patient and family, namely through education/training, communication, and relationship strategies. At the collective level, to intervene with the general population and specific groups, such as groups of young people, strategies suggested include education/training, use of the media, and contact with people with mental disorders as ways to fight stigma.