Exposure to Instagram junk food content negatively impacts mood and cravings in young adults: A randomized controlled trial

Exposure to different types of images on social media is known to affect physical and mental wellbeing including changes in perception of body image (BI) and dietary behavior. The present study aimed to assess the effects of junk food-related Instagram content exposure on body image, overall mood, and cravings in young adults. A randomized crossover experimental design was used. After filling out a baseline survey, participants (n = 63, aged 18-24) browsed either a control Instagram account feed or an account rich in junk food images during 15 min. They then filled a short survey evaluating their state BI, mood, and cravings (T1). After a 1-week washout period (T2), participants browsed the other account type followed by the same short survey as in T1. Results showed that exposure to junk food content was associated with increased feelings of hunger, stress, sadness, and exhaustion, in addition to higher salty, savory, and fatty food cravings. Moreover, participants showed higher desire for junk food and lower desire for healthy food items from a virtual food tray after junk food content exposure. There was no impact of content type on state BI dissatisfaction. In conclusion, exposure to junk-food related content on social media negatively affects mood and cravings, subsequently influencing food choices. The present findings shed light on the need for interventions aimed at providing cognitive and emotional competencies for enhancing media literacy and promoting mindful social media use.

Is Problematic Physical Activity (PPA) a Uni- or Multi-Dimensional Concept? A Bifactor Analysis of the Exercise Dependence Scale-Revised (EDS-R)

The study of exercise dependence, or as we prefer, problematic physical activity (PPA), faces both theoretical and methodological challenges. Different factorial solutions were obtained for the widely used Exercise Dependence Scale-Revised (EDS-R), leading us to question both its latent underlying construct and the interpretation of its factor solutions. Through confirmatory factor analysis (CFA) and the use of a bifactor model (BCFA), we assessed the dimensionality of a French version of the EDS-R. We recruited 745 students from Paris Nanterre University, but we removed 88 responses (16.8%) to retain only those who (a) engaged in a moderate to high levels of physical activity, according to the Global Physical Activity Questionnaire (GPAQ; N = 494; 9.5%), and (b) completed the EDS-R. We used a final sample of 435 students (58.4% of the total population) for a factorial analysis of the EDS-R. We conducted a three-step CFA in Mplus, producing three models: (a) unidimensional, (b) second-order, and (c) bi-factor (BCFA). The results of the BCFA indicated that most EDS-R items were better indicators of a general factor than their respective group factors, except for the second factor measuring a withdrawal construct. These results add to an ongoing debate in the field of behavioral addiction as to how to better conceptualize and measure exercise dependence or PPA. Withdrawal appears to have a special position in this debate, since our BCFA suggested that it is the only specific sub-dimension of the EDS-R scale.

Nutrition and Physical Activity Interventions Provided by Nutrition and Exercise Practitioners for the General Population: An Evidence-Based Practice Guideline From the Academy of Nutrition and Dietetics and American Council on Exercise

A nutritious diet and adequate physical activity vitally contribute to disease prevention, but most adults do not meet population-based dietary and physical activity recommendations. Qualified nutrition and exercise practitioners can address challenges to adopting healthy lifestyle behaviors by providing consistent, individualized, and evidence-based education and programming within their professional scopes of practice to improve client outcomes. The objective of this evidence-based practice guideline is to inform practice decisions for nutrition and exercise practitioners providing nutrition and physical activity interventions for adults who are healthy or have cardiometabolic risk factors, but no diagnosed disease. Evidence from a systematic review was translated to practice recommendations using an evidence-to-decision framework by an interdisciplinary team of nutrition and exercise practitioners and researchers. This evidence-based practice guideline does not provide specific dietary or physical activity recommendations but rather informs nutrition and exercise practitioners how they may utilize existing guidelines for the general population to individualize programming for a range of clients. This evidence-based practice guideline provides widely applicable recommendation statements and a detailed framework to help practitioners implement the recommendations into practice. Common barriers and facilitators encountered when delivering nutrition and physical activity interventions, such as adherence to professional scopes of practice; methods to support behavior change; and methods to support inclusion, diversity, equity, and access, are discussed. Nutrition and exercise practitioners can consistently provide individualized, practical, and evidence-based interventions by seeking to understand their clients' needs, circumstances, and values and by co-creating interventions with the client and their allied health team.

Determinants of body image disturbance and disordered eating behaviors among self-identified LGBTQ individuals

It has been previously established that sexual minorities are more likely to suffer from mental health illnesses due to experiencing unique stressors such as fear, anxiety, stigma, harassment, and prejudice. Results revealed two noteworthy mental health disorders reported by lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals, disordered eating behaviors and disturbed body image. Yet, a-priori studies revealed inconsistent results with regards to body image concerns and eating disorder symptoms and attitudes among sexual minorities. Therefore, this cross-sectional study aimed at investigating the occurrence of disordered eating behaviors (DEB) and body image disturbance (BID) among sexual minorities in Lebanon. Additionally, the correlation between several determinants of DEB and BID including fear of negative evaluation, generalized anxiety, social support, and harassment levels have been examined. Generally, the present study revealed that LGBTQ population scored higher than cisgender and heterosexual individuals for the mean and global scores of the EDE-Q6.0 and BAS-2. Only generalized anxiety and fear of negative evaluation scales were significantly associated with DEB and BID among different sexual orientation and gender identity individuals. Therefore, it is very important that health professionals working with such vulnerable populations meticulously assess for disordered eating behaviors and body image disturbance for better communication and management.

Assessing the nutritional content and adequacy of food parcels among vulnerable Lebanese during a double crisis: COVID-19 pandemic and an economic meltdown

OBJECTIVES

This study aimed to explore the nutritional content and quality of food parcels distributed in Lebanon and assess their adherence to dietary guidelines during the COVID-19 pandemic and an unprecedented economic crisis.

DESIGN

Cross-sectional study (June-July 2020); phone survey (thirty items).

SETTING

Lebanon.

PARTICIPANTS

Food parcel providers (FPP; n 72) involved in food parcel distribution (FPD), mainly to Lebanese households.

RESULTS

FPP included international non-governmental organizations (INGO) (n 3), local non-governmental organizations (n 45) and personal initiatives (n 24). Overall, low adherence to the World Food Programme (WFP) food parcel guidelines were observed among FPP for specific food items, including vegetables, fish, legumes and cereals, whereas salt content significantly surpassed the guidelines (all P-values <0·001). On average, a food parcel provided 608·4 ± 55 kcal/d/person. The greatest contributors to total energy intake (TE) in the food parcel were carbohydrates (46·4 %) and fats (46·8 %), while protein contributed to 7 %TE. In addition, %TE from fats and sugars significantly surpassed the dietary reference intakes (DRI) for a single person per d (134-234 % and 185 % of DRI, respectively, P-values <0·001). Only 10-15 % of daily needs for key micronutrients, including Fe, Zn, thiamin, riboflavin and dietary folate, were met through the food parcels. Adequate food safety and hygiene practices were reported among FPP, yet dramatic changes in food costs due to overlapping crises affected the quality and quantity of food in parcels.

CONCLUSIONS

Findings highlight the need to improve the nutritional content of food parcels and adherence to dietary guidelines to alleviate food and nutrition insecurity while preventing diet-related diseases among vulnerable beneficiaries in Lebanon.

Impacts of social restrictions on mental health and health behaviours of individuals with multimorbidity during Covid-19 pandemic

Background

Social restrictions and their possible impact on lifestyle make people with multimorbidity (≥2 co-existing chronic conditions) more vulnerable to poor perceived mental health and health behaviours modifications during the COVID-19 pandemic.

Objective

To understand the mental health status and health behaviour modifications among individuals with multimorbidity during different levels of COVID-19 social restrictions.

Methods

Longitudinal multinational cohort study consisting of two online questionnaires with its first wave taken place while social restrictions were imposed (May 2020), and its second wave with less social restrictions in place (November 2020). Including 559 participants (wave 1) and 147 participants from wave 1 (wave 2) with an average age of 34.30±12.35 and 36.21±13.07 years old. Mostly females living in Canada, France, India and Lebanon.

Results

The prevalence of multimorbidity was 27.68% (wave 1) and 35.37% (wave 2). While social restrictions were imposed, people with multimorbidity were 2 to 3 times more likely to experience psychological distress, depressive symptoms, increased stress or isolation than those without multimorbidity. Health behaviours were also modified during this period with people with multimorbidity being more likely to reduce their physical activity and increased their fruit and vegetable consumption. In wave 2, regardless of multimorbidity status, sexual desire continuously decreased while stress and psychological distress increased.

Conclusion

Mental health and health behaviours modifications occurred while social restrictions were imposed and people with multimorbidity were more severely impacted than those without multimorbidity, indicating a need for a more adapted approach of care during socially restrictive periods for this population.

Results from the Lebanese 2022 report card on physical activity for children and youth

Objective

The Lebanese Active Healthy Kids Work Group (LAHKWG) synthesized literature published on physical activity (PA) indicators among ages 5- to 17- year-olds, using a recommended harmonized process by the Active Healthy Kids Global Alliance (AHKGA), to explore Lebanon's performance since its previous report card publication.

Methods

Peer reviewed literature, national surveys, and gray literature published since 2017, on 10 common AHKGA and two LAHKWG recommended indicators were examined. Common indicators included overall PA, organized sport and PA, active play, active transportation, community and environment, sedentary behaviors, physical fitness, family and peers, school, and government. LAHKWG recommended indicators were sleep and weight status. LAHKWG members reviewed 764 records, of which 28 were selected for full review. A grade was assigned for each indicator using AHKGA's grading rubric and established benchmarks on data from nationally representative samples for children and youth.

Results

Data from one nationally representative sample were available for ages 13–17 years (i.e., no data <13 years). Five indicators received “Incomplete” (organized sport and PA; active Play; physical fitness; family and peers; community and environment); overall PA received a D-; active transportation and sleep received a D+; school and government received a D; sedentary behaviors received a C; and weight status received a B-.

Conclusion

The LAHKWG strongly encourages stakeholders to take concrete actions towards prioritizing PA promotion at a national level especially in the education sector. Offering more quality PA opportunities for Lebanese children and youth will be beneficial for their physical and mental health in any context.

Assessment of hospital malnutrition care practices: The case of a low middle income country

BACKGROUND & AIMS

To improve hospital malnutrition care, assessing actual malnutrition practices and knowledge is essential. Our objectives are to assess malnutrition care practices, evaluate dietitians' malnutrition knowledge, and explore barriers and facilitators to optimal malnutrition care in a LMIC hospitals.

METHODS

This is a national cross-sectional study of mixed-method design. Two questionnaires from the Malnutrition Quality Improvement Initiative were used to assess malnutrition care practices and dietitians' malnutrition knowledge. In-depth interviews were used to investigate barriers and facilitators to optimal malnutrition care.

RESULTS

Mean average for malnutrition care practices score was 20.96 out of 30 (N = 56). Factors affecting malnutrition practices were: (1) private/public affiliation of the hospital and (2) presence of a documented malnutrition protocol. Dietitians (N = 62) working at academic hospitals scored 57% for malnutrition knowledge which was higher than the score for those working at non-academic hospitals (44%). Gaps in malnutrition knowledge among hospital staff, shortage in hospital staff, and lack of financial coverage for nutrition therapy were the main barriers identified from eight in-depth interviews.

CONCLUSION

Efforts should be taken by decision makers to facilitate malnutrition care and increase malnutrition awareness among healthcare professionals.

Superusers of Self-Paced Online Learning on OpenWHO

INTRODUCTION

OpenWHO provides open-access, online, free and real-time learning responses to health emergencies, which includes capacitating healthcare providers, first liners, medical students and even the general public. During the pandemic and to date, an additional 40 courses for COVID-19 response have led to a massive increase in the number of learners and a change in user's trends. This paper presents initial findings on enrollment trends, use and completion rates of health emergency courses offered on OpenWHO.

METHODS

The enrolment data statistics were drawn from OpenWHO's built-in reporting system, which tracks learners' enrolments, completion rates, demographics and other key course-related data, This information was collected from the beginning of the OpenWHO launch in 2017 up until October 2021.

RESULTS

Average course completion rate on OpenWHO including all courses and languages was equal to 45.9%. Nearly half (46.4%) of all OpenWHO learners have enrolled in at least 2 courses and 71 000 superusers have completed at least 10 courses on the platform.

CONCLUSION

WHO's learning platform during the pandemic registered record high completion rates and repeat learners enrollment. This highlights the massive impact of the OpenWHO online learning platform for health emergencies and the tangible knowledge transfer and access to health literacy.

AND/ASPEN and GLIM Malnutrition Diagnostic Tools Identify Similar Malnutrition-Related Risk Factors

Objectives

Our aim is to determine whether different malnutrition diagnostic tools [European Society of Clinical Nutrition and Metabolism (ESPEN), Academy of Nutrition and Dietetics/American Society of Parenteral and Enteral Nutrition (AND/ASPEN) and the Global Leadership Initiative on Malnutrition (GLIM)] are associated with common malnutrition-related risk factors in a sample of newly admitted hospital patients.

Methods

This study is a prospective observational study. Newly admitted hospital patients were screened for nutritional risk. At-risk patients were then assessed for malnutrition using ESPEN, AND/ASPEN and GLIM criteria. Bivariate analyses were computed for all predictors and tested with the result of the nutritional assessment of each of the diagnostic tools. Similarly, a logistic regression was then conducted to determine the predictors associated with each malnutrition diagnostic criteria.

Results

578 patients were screened for malnutrition, of which 121(20.93%) were nutritionally at risk and were subjected to nutritional assessment. The regression model suggested that the presence of pressure ulcers (OR 21.252, 95% CI 4.495–100.485), higher Charlson Comorbidiy Index (CCI) score (OR 1.321, 95% CI 1.098–1.591), lower Body Mass Index (BMI) (OR 0.478, 95% CI 0.389–0.588), and older age (OR 1.035, 95% CI 1.005–1.065) were significant predictors of malnutrition diagnosed on ESPEN criteria. While female gender [(OR 2.406, 95% CI 1.446–4.004); (OR 2.300; 95% CI 1.397–3.786)], lower BMI [(OR 0.842, 95% CI 0.792–0.895); (OR 0.835 95% CI 0.785–0.888)], higher CCI score [(OR 1.323,95% 1.185–1.477); (OR = 1.294, 95% CI 1.164–1.438)] and pressure ulcers presence [(OR 15.501, 95% CI 3.650–66.661); (OR 15.816; 95%CI 3.683–67.926)] were significant predictors of malnutrition diagnosed through AND/ASPEN and GLIM criteria respectively. Admission to the orthopedics unit indicated 91% lower risk of malnutrition on both tools respectively [(OR 0.090, 95% CI 0.008–0.968); (OR 0.090, 95% CI 0.008–0.962)].

Conclusions

The presence of pressure ulcers, higher CCI score and lower BMI were the significant predictors that were associated with malnutrition on all tools. AND/ASPEN and GLIM diagnostic tools predicted the same risk factors.

Funding Sources

Lebanese American University.

Associations Between Food Literacy and Food Insecurity Among College Students in Lebanon: A Cross-Sectional Study

Objectives

The present study aims to explore the eating and food literacy behaviours of college students in Lebanon and to examine their associations with food insecurity (FI).

Methods

An online survey was administered among college students enrolled in public and private universities in Lebanon. FI was assessed using the Food and Drug Administration (FAO) eight-item Food Insecurity Experience Scale (FIES), previously validated and used in this context. The eating and food literacy behaviors of college students were assessed using the Eating and Food Literacy Behaviors (EFLBQ) tool. Multiple logistic regression analyses were conducted to investigate the associations of food literacy behaviors with FI.

Results

FI was reported among 39% of study participants. Approximately half of college students in the study sample reported that they “never” or “seldom” ate a balanced diet (55.6%) and consumed healthy food (47.7%). Less frequent food literacy behaviors reported among college students included: “select healthy foods “(37.5%)”, and” plan what I will eat” (33.2%). However, most college students do “often” or “always” eat foods convenient to them (82.9%) and prepare food made quickly (71.9%). Significant differences were observed in several food literacy behaviors between food secure and insecure students. For instance, food insecure students less frequently buy foods that are healthy (p < 0.001), select healthy foods (p = 0.004), cook healthy foods (p = 0.020) and choose nutritionally balanced meals (p < 0.001) compared to food secure ones. Multiple logistic regression analyses showed that behaviors related to nutrition and food preparation were all statistically independently associated with FI. Food insecure participants were significantly less likely to “choose nutritionally balanced meals (OR = 2.10, 95% CI:1.45,3.03), “read nutrition information before” (OR = 1.93, 95% CI:1.31,2.84), or “buy foods that are healthy” (OR = 1.87, 95% CI:1.26,2.78). In terms of food preparation, food insecure participants were 1.85 times more likely to report that they “never” or “seldom” accurately measure dry food ingredients when preparing food (OR = 1.85, 95% CI:1.30,2.64).

Conclusions

Findings highlight the need for nutrition education interventions to improve food literacy and alleviate FI among college students in Lebanon.

Funding Sources

American University of Beirut.

Impact of Nutrition and Physical Activity Interventions Provided by Nutrition and Exercise Practitioners for the Adult General Population: A Systematic Review and Meta-Analysis

Healthy dietary intake and physical activity reduce the risk of non-communicable diseases. This systematic review and meta-analysis aimed to examine the effect of interventions including both nutrition and physical activity provided by nutrition and exercise practitioners for adults in the general population (those without diagnosed disease). The MEDLINE, CINAHL, Cochrane Central, Cochrane Database of Systematic Reviews and SportDiscus databases were searched for randomized controlled trials (RCTs) published from 2010 until April 2021. Outcomes included physical activity, fruit and vegetable intake, waist circumference, percent weight loss, quality of life (QoL) and adverse events. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods were used to synthesize and grade evidence. Meta-analyses were stratified according to participant health status. The database search identified 11,205 articles, and 31 RCTs were included. Interventions increased physical activity amount [standardized mean difference (SMD) (95% CI): 0.25 (0.08, 0.43)] (low certainty evidence); increased vegetable intake [SMD (95% CI): 0.14 (0.05, 0.23)] (moderate certainty evidence); reduced waist circumference [MD (95% CI): −2.16 cm (−2.96, −1.36)] (high certainty evidence); and increased likelihood of achieving 5% weight loss for adults with overweight and obesity [relative risk (95% CI): 2.37 (1.76, 3.19)] (high certainty evidence). Very low and low certainty evidence described little-to-no effect on QoL or adverse events. Nutrition and exercise practitioners play key roles in facilitating positive lifestyle behaviors to reduce cardiometabolic disease risk in adults.

AND/ASPEN and the GLIM Malnutrition Diagnostic Criteria have a High Degree of Criterion Validity and Reliability for the Identification of Malnutrition in a Hospital Setting: A Single-Center Prospective Study

BACKGROUND

Multiple malnutrition diagnostic tools are available in clinical practice yet evidence on their validity and reliability is limited. We aim to assess and compare the validity and reliability of the different combinations of indicators of the three diagnostic tools most used compared to two validated malnutrition screening tools.

METHODS

Nutritional risk screening was evaluated using the Mini-Nutritional Assessment Short Form (MNA-SF) and Nutrition Risk Screening-2002 (NRS-2002), and nutritional assessment was conducted using different combinations of the Academy of Nutrition and Dietetics/American Society of Parenteral and Enteral Nutrition (AND/ASPEN), The European Society of Clinical Nutrition and Metabolism (ESPEN), and Global Leadership Initiative on Malnutrition (GLIM). Concurrent criterion validity and inter-rater reliability of the overall and the different combinations of indicators in the diagnostic tools were evaluated and compared. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Cohen's kappa (ĸ) were calculated to determine tool validity and reliability.

RESULTS

AND/ASPEN [132(22.8%)] combination and GLIM-1 [133(23.0%)] (weight loss + compromised food intake) predicted the highest number of malnourished patients and reported a high degree of concurrent criterion validity, agreement, and reliability. On the contrary, overall ESPEN (using any combination) and GLIM-2 (reduced Body Mass Index-BMI + compromised food intake) reported only moderate criterion validity and low agreement and reliability.

CONCLUSION

Different combinations of diagnostic criteria led to varying validity and reliability, with the lowest validation results rising from the combinations of indicators using BMI as a criterion for malnutrition diagnosis. This article is protected by copyright. All rights reserved.

Multilingual Approach to COVID-19 Online Learning Response on OpenWHO.org

In pursuit of equitable access to emergency-related knowledge, the World Health Organization (WHO) translates COVID-19 and other infectious disease courses into multiple languages on its open-access online learning platform OpenWHO.org. Languages spoken by vulnerable or underserved populations in low- and middle-income countries and in outbreak-prone and affected areas are prioritized. Accessing learning in preferred languages enhances uptake and comprehension. In this study, we assess and compare the initial enrollment levels and global reach of these multilingual courses. On average, OpenWHO's 38 COVID-19 courses have each been translated into 4.8 languages. The platform hosts courses in 55 different languages with 10.4 million words translated. The findings identify which available languages were most utilized for COVID-19 learning to inform course production and outreach strategies. Languages were used differently across geographic regions, calling for localized learning offerings. A streamlined multilingual publishing scheme, ensuring quick and effective delivery of diverse languages, is critical to achieving greater equity of access to knowledge.

[Clarithromycin consumption at the University Hospital of Liege in 2019. Retrospective study]

Macrolides are one of the treatments of choice in community-acquired pneumonia, either when the clinical and/or biological elements suggest an infection by an intracellular bacteria (so-called atypical), or when the severity of the clinical picture justifies their empirical use. This work is a retrospective monocentric study carried out at the University Hospital of Liege on 25 consecutive patients hospitalized during the year 2019. It aims to specify whether the use of a particular macrolide, clarithromycin, actually meets the national recommendations both in terms of indication, dosage or duration. The results showed justified and adequate use in only 44 % of cases. Nevertheless, the indication was overwhelmingly mentioned in the medical record (96 %). Furthermore, the comparison with national data showed a much higher than average use at the University Hospital of Liege. An action plan is suggested to discuss these results within the Antibiotic Therapy Management Group and then communicate them to the prescribers who are concerned. The aim is to adapt the use of macrolides at the University Hospital of Liege to be more in line with national recommendations.

Changes in Users Trends Before and During the COVID-19 Pandemic on WHO's Online Learning Platform

OpenWHO provides open access, online, free and real time learning responses to health emergencies. Before the pandemic, courses on 18 diseases were provided. The increase to 38 courses in response to COVID-19 have led to a massive increase in the number of new learners. As a result, the COVID-19 pandemic affected learners' trends. This paper presents initial findings of changes perceived in the use and user groups' attendance to the World Health Organization's (WHO) health emergency learning platform OpenWHO. Enrolment statistics were based on data collected in December 2019 and March 2021. A descriptive analysis was conducted to explore changes in the usage pattern of the platform. Several user characteristics shifted between before and during the pandemic. More women, younger and older learners joined the learning during the pandemic. Public health education leaned toward a more equitable reach including previously underrepresented groups.

Is the Severity of the Clinical Expression of Anorexia Nervosa Influenced by an Anxiety, Depressive, or Obsessive-Compulsive Comorbidity Over a Lifetime?

Purpose: The relationship between anxiety or depressive comorbidities, their chronology of onset, and the severity of anorexia nervosa (AN) is not well-studied. We hypothesize that the existence of a comorbidity, particularly before the onset of AN, is associated with greater severity of AN. Methods: One hundred seventy-seven subjects were assessed. The prevalence of major depressive disorder (MDD), obsessive-compulsive disorder (OCD), generalized anxiety disorder (GAD), and social phobia (SP) as well as their chronology of onset were studied. The assessment criteria of AN severity were the overall clinical condition, body mass index (BMI) on admission, lowest BMI, intensity of the eating symptoms, age at the onset of AN, illness duration, number of hospitalizations, and quality of life. Results: Patients with AN had the greatest clinical severity when they had a comorbid disorder over their lifetime, such as MDD, GAD, or SP. These comorbidities along with OCD were associated with a higher level of eating symptoms and a more altered quality of life. A profile of maximum severity was associated with a higher prevalence of MDD and GAD. Concerning the chronology of onset, the age at the start of AN was later in cases of MDD or GAD prior to AN. Conclusion: There seems to be an association between severity of AN and both MDD and GAD. The chronology of onset of the comorbidity did not seem to be associated with the severity.

Food shopping and food hygiene related knowledge and practices during the COVID-19 pandemic: The case of a developing country

The aim of this study was to assess the level of food hygiene and food shopping knowledge and practices among residents of Lebanon during the COVID-19 pandemic, and to identify their socio-demographic determinants. A cross-sectional study was conducted through an online questionnaire composed of 13 questions about demographics, and 25 questions related to knowledge and practices in terms of hand maintenance, mask placing, and food shopping. A total of 1337 participants filled the survey. On average, participants scored 73±15 and 67±17% on food hygiene and knowledge and practices, respectively. In terms of best practices by section, they scored 77±22, 51±42, and 65±23% on hand maintenance, mask placing and shopping, respectively. Hand maintenance best practices score was significantly (p<0.05) affected by gender; mask placing best practices score was significantly affected by age and major of study; shopping best practices score was significantly affected by gender; overall best practices score was significantly affected by gender and major of study; food hygiene knowledge score was significantly affected by gender, age, marital status, educational level, and major of study. Food hygiene practices and knowledge scores were significantly (p<0.001) related with a weak correlation coefficient (R=0.114). No study has determined the food hygiene and shopping knowledge and practices during the COVID-19 pandemic in a developing country before.

The Use of Different Muscle Assessment Techniques to Assess Validity of Global Leadership Initiative on Malnutrition (GLIM)

Objectives

To assess which combination of indicators in the Global Leadership Initiative on Malnutrition (GLIM) diagnostic tool better predicts malnutrition. Additionally, to compare the validity of GLIM upon the use of different muscle assessment techniques for the assessment of muscle loss.

Methods

Nutritional screening was performed through the Nutrition Risk Screening-2002 (NRS-2002) or the Mini-Nutrition Assessment-Full Form (MNA-FF). Nutritionally at-risk patients were assessed for malnutrition using the GLIM criterion. Fat free muscle index (FFMI), nutrition focused physical examination (NFPE) and handgrip strength (HG) were used to identify muscle loss. Sensitivity, specificity, positive and negative predictive values were calculated for GLIM with each of the three muscle assessment tools.

Results

579 patients were screened for malnutrition and 121(20.90%) patients were considered nutritionally at risk. GLIM criterion showed close percentages of malnourished patients: 117(20.21%), 110(19.0%) and 110 (19.0%) when using NFPE, FFMI, and HG respectively. With three different muscle assessment techniques, 10 different combinations of indicators in GLIM were retrieved. The combination of muscle loss, assessed through NFPE, with either one of the two etiologic criteria yielded the highest numbers of malnourished patients among all three techniques [NFPE + reduced food intake/assimilation: 113(19.52%) and NFPE + Inflammation: 117(20.21%)], while the use of FFMI resulted in the lowest [FFMI + reduced food intake/assimilation: 37(6.39%) and FFMI + Inflammation: 40(6.91%)]. All three tools, GLIM + NFPE, GLIM + FFMI, and GLIM + HG reported high specificity [98.9% (97.45–99.64), 99.1% (97.76–99.76) and 99.1% (97.78–99.76) respectively]. However, results revealed moderate sensitivity for GLIM + FFMI [89.8% (82.91–94.63)]and GLIM + HG [89.1% (82.04–94.05)] yet a high sensitivity for GLIM + NFPE [93.3% (87.29–97.08)].

Conclusions

The combination of NFPE with either of the etiologic criteria identified more malnourished patients than the combinations including FFMI or HG. A high degree of validity was reported for all three muscle assessment tools in GLIM criterion.

Funding Sources

None.

Health in adulthood after severe anorexia nervosa in adolescence: a study of exposed and unexposed women

OBJECTIVE

To compare the global health status, frequency of somatic and psychological problems, and alcohol use in adulthood among women hospitalized in adolescence for severe anorexia nervosa (AN), with a matched control sample from the general population.

METHOD

Women (n = 86) who had been hospitalized for AN 9.31 ± 1.82 years previously were compared with 258 controls matched for gender, age, and socio-professional category. Data were retrieved from a French survey on health and social insurance coverage, and was mainly collected by self-report, except for the assessment of current eating disorders for those previously hospitalized for AN (assessed with the MINI).

RESULTS

The women who had been hospitalized for AN reported significantly poorer current health status compared to controls (OR 2.9, 95% CI 1.5-5.79). According to the MINI, 13 women previously hospitalized with severe AN still presented an eating disorder (ED). Women with past AN reported more frequent acute throat infections (OR 4.9, 95% CI 1.81-13.51), gastralgia (OR 3.6, 95% CI 1.9-6.83), gastro-oesophageal reflux (OR 5.279, 95%CI 2.11-13.22), excess blood cholesterol or triglyceride levels (OR 2.55, 95% CI 1.03-6.33), anxiety (OR 8.7, 95% CI 3.48-21.8) and depression (OR 5.02 (2.8-9.01). These differences remained significant and of the same order of magnitude in sensitivity analyses among subjects with previous AN but without current ED, except for perceived health status and excess cholesterol and triglyceride levels.

DISCUSSION

Women who had been hospitalized for severe AN reported more symptoms 10 years after treatment, implies psychological and somatic follow-up in the long term.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

The impact of COMT, BDNF and 5-HTT brain-genes on the development of anorexia nervosa: a systematic review

PURPOSE

The genetic aspect of anorexia nervosa (AN) involving specific genes of the central-nervous-system has not yet been clearly understood. The aim of this systematic review is to assess the impact of three candidate genes of the brain: catechol-O-methyltransferase, brain-derived neurotrophic factor (BDNF) and serotonin transporter protein, on the susceptibility to AN and identify whether a clear connection persists between each of the gene-polymorphisms and AN.

METHODS

A total of 21 articles were selected for this review conforming to the PRISMA guidelines. Detailed keyword combinations were implemented within specific databases such as MEDLINE, SCIENCEDIRECT and PUBMED.

RESULTS

The catechol-O-methyltransferase gene-polymorphism did not show any change in phenotypic variation between AN and control subjects; but the familial association was rather strong with an over-transmission of the H allele. The latter also correlated with several dimensions of the Temperament and Character Inventory (TCI) scale. A notable relation was indicated between BDNF gene-polymorphism and anorexia-restrictive in terms of phenotypic distribution; the Met66-allele also depicted high association with anorexic behavioral traits. The 5-HTTLPR gene-polymorphism was found to be significantly associated with AN susceptibility with an over-transmission of the S-allele from parents to offspring.

CONCLUSION

The systematic review distinctively emphasized the genetic contribution of the brain-genes on the development of AN. Despite significant study findings, no clear and standardized genetic route was determined to be the cause of AN development. Future research is needed on these specific genes to closely monitor the genetic polymorphisms and their mechanism on AN susceptibility.

LEVEL OF EVIDENCE

I, systematic review.

Development and evaluation of an adapted physical activity program in anorexia nervosa inpatients: A pilot study

BACKGROUND AND CONTEXT

Problematic use of physical activity is frequent in subjects with anorexia nervosa (AN). Although it increases resistance to therapeutic treatment, paradoxically, physical activity in AN can also improve mental and physical health. Based on the literature review we hypothesized that adding an adapted physical activity (APA) program to treatment programs could be more beneficial than a total suppression of physical activities. We designed this open study to evaluate the outcome of AN inpatients after an APA program implementation as well as the perceived effect of APA.

METHOD

Forty-one women with AN (17.2 (±2.5) years old, BMI of 16.86 (±2.0)) were included. An eight-session (1 h30/session/week) standardized APA program was delivered and evaluated by structured questionnaires assessing exercise dependence, perceived physical activity, eating disorder (ED) symptoms, body mass index (BMI), along with an interview before and after the APA program.

RESULTS

Twenty-nine women complete the PA program and evaluation. BMI and perceived PA score significantly increased, ED and exercise dependence scores significantly decreased (p < .01). Participants appreciated the program.

DISCUSSION/CONCLUSION

The inpatient program which included APA program helped AN inpatients in decreasing their ED symptoms and their dependence to PA, without any deleterious effect on BMI. Furthermore, APA was appreciated by participants.

Screening and Diagnosis of Malnutrition in a Hospital Care Setting Prior and After Multidisciplinary Educational Intervention

Objectives

To compare initial malnutrition screening performed by nursing staff to that of the dietitians’, pre and post educational intervention

To determine the knowledge and practice, of nurses regarding malnutrition

Methods

The study is a quasi-experimental design which included pre and post interventional malnutrition screening and diagnosis, and three multidisciplinary educational interventions, accompanied with pre and post knowledge assessments, for nurses, physicians and pharmacists. Admitted patients were screened for malnutrition using the NRS-2002 or MNA. Patients at risk of malnutrition or malnourished at screening were diagnosis for the latter using ASPEN, ESPEN and GLIM malnutrition diagnostic tools. Nutrition focused physicals examination, functional status and body composition analysis were also conducted. The nurses’ initial screenings of malnutrition (NRS-2002) was recorded for comparison with the dietitians’ screenings.

Results

A total of 269 patients were screened prior to the intervention out of which 37 (13.75%) were either at risk of malnutrition or malnourished. Post intervention, 311 patients were screened and 84 (27.01%) were either at risk or malnourished. Hundred and one registered nurses attended the educational session, and a repeated measure ANOVA showed that the nurses’ knowledge significantly improved (P &lt; 0.001) but not practice. A significant difference within (pre and post intervention) and between groups (dietitians versus nurses), was detected in the sections related to BMI and weight loss in the NRS initial screening (P &lt; 0.001). Also a significant difference (P &lt; 0.001) in the reported food intake was revealed between the dietitians and nurses. Reporting severity of illness showed a significant difference (P &lt; 0.001) pre but not post intervention.

Conclusions

The knowledge of the nurses regarding malnutrition screening improved right after the educational intervention. Despite a significant difference between the dietitians’ screening and that of the nurses’ in some parts of the NRS-2002, the latter didn't change post educational intervention except for the “severity of illness” assessment.

Funding Sources

None.

Movie violence acutely affects food choices in young adults

BACKGROUND

Extensive research has been conducted to investigate the effects of media violence on attitudes, behaviors, and cardiovascular health; however, only few studies have examined its effect on appetite, eating behavior and food preferences. Little attention has been given to understand how movie genre manipulates the physiology and the eating behavior of individuals. The present study aimed at investigating the acute effect of violence content in movies on appetite perception, heart rate and blood pressure, along with food preferences and intake in young individuals.

METHODS

Participants (n = 84) were randomly assigned to either watch a violent movie or a non-violent narrative movie. Measurements including anthropometry, heart rate, blood pressure and grip strength were taken and appetite as well as stress perception were assessed. Subjects were then provided with an individual snack tray containing various items to be consumed ad libitum.

RESULTS

Post intervention, the experimental group (EG) had a higher consumption of fatty (t (82) = 2.28, p = 0.025, d = 1.52) and salty (t (82) = 2.61, p = 0.01, d = 0.71) food items compared to the control group (CG). Out of the 42 participants in the EG 62% consumed >2 fatty items and 71.4% consumed >2 salty food items. No significant difference in the consumption of sugary items was observed between the two groups.

CONCLUSION

Movie violence affects eating behavior and may promote weight gain.

Determinants of Exclusive and Mixed Breastfeeding Durations and Risk of Recurrent Illnesses in Toddlers Attending Day Care Programs Across Lebanon

PURPOSE

Breastfeeding rates continue to decrease in Lebanon. Studies addressing the relationship between breastfeeding duration and health outcomes in Middle Eastern countries are scarce. This study is the first in Lebanon to have investigated the determinants of both exclusive and mixed breastfeeding durations and the relationship with health in infants and toddlers.

DESIGN AND METHODS

Our sample of 1051 toddlers is nationwide and representative of all toddlers enrolled in daycare centers, and aged between 12 and 36 months.

RESULTS

Median of exclusive breastfeeding duration was 15 days and mean age of formula introduction was 2.03 (±3.22) months. Exclusive breastfeeding was initiated at a mean age of 10.56 (±27.12) hours and half of the toddlers (51.6%) were exposed to formula milk since day one following birth. Determinants of both exclusive and total breastfeeding durations were related to several parents' socio-demographic and behavioral factors. A longer duration of exclusive breastfeeding was associated with a lower frequency of pediatrician visits, antibiotic prescriptions, absence from daycare, and a lower risk of otitis, colic and UTI occurrence, after adjusting for cofounders. Similarly, a longer duration of total breastfeeding was associated with less antibiotic prescriptions and a lower risk of otitis.

CONCLUSIONS

Our study highlights the health benefits of extending exclusive breastfeeding duration. It is urgent to address alarmingly low breastfeeding rates in Lebanon. Policy implementation and enforcement along with raising awareness and creating a supportive environment for breastfeeding mothers should involve the various stakeholders in order to succeed in increasing breastfeeding rates and duration.

High-intensity exercise is associated with a better nutritional status in anorexia nervosa

OBJECTIVE

Our aim is to investigate the links between duration and intensity of exercise and the nutritional status in terms of body composition in acute anorexia nervosa (AN) patients.

METHOD

One hundred ninety-one hospitalized women suffering from AN were included. Exercise duration and intensity were assessed using a semistructured questionnaire. Body composition was measured using bioelectrical impedance. Linear multiple regression analyses were carried out using body mass index, fat-free mass index, and fat mass index as dependent variables and including systematically exercise duration, exercise intensity, and other confounding variables described in the literature that were significantly associated with each dependent variable in univariate analysis.

RESULTS

A lower BMI was linked to lower exercise intensity, AN restrictive type, and presence of amenorrhea. A lower FFMI was linked to lower exercise intensity, older age, AN restrictive type, and premenarchal AN. Duration of exercise was not linked to the nutritional status.

CONCLUSIONS

Exercising at higher intensity in AN is associated with a better nutritional status, thus, a better resistance to starvation. The impact of therapeutic physical activity sessions, adapted in terms of exercise intensity and patient's clinical status, should be evaluated during nutrition rehabilitation.

Evaluation of nutrition support practices: Results from a nationwide survey

BACKGROUND

Multiple clinical guidelines are available to improve and standardize the delivery of nutrition support. However, recommendations are not being universally applied at the bedside due to challenges of resources and barriers of knowledge. Assessing the current level of nutrition support practice is the first step to understand the barriers and ultimately implement potential strategies to increase guideline adherence and promote quality nutrition support in hospitals. There are no published data concerning the practice of nutrition support in Lebanese hospitals.

OBJECTIVES

The objective of our study is to investigate for the first time the current clinical practice pertinent to nutrition support across Lebanon.

METHODS

A survey was developed by The Nutrition Board of the Lebanese Society of Critical Care Medicine (LSCCM) to determine nutrition support practices in hospitals with an Intensive Care Unit (ICU) across Lebanon. The 28-question survey assesses the delivery of feeding methods such as oral nutrition supplements (ONS), enteral nutrition (EN), and parenteral nutrition (PN).

RESULTS

Fourty-one hospitals from 116 total completed the survey. The majority of the hospitals (92.6%) do not systematically use a screening system for malnutrition. Seventy six percent of hospitals reported less than 5% of their patients are kept for more than 7 days with no nutrition support. Early EN is used in preference over PN in ICUs, as 72% of hospitals start early EN (within 48 h) in more than 10% of cases while only 30% of hospitals start early PN (within the first week) in more than 10% of cases. Fifty-one percent of the hospitals use ready prepared formula while the rest (49%) use kitchen prepared formula.

CONCLUSIONS

Our study is the first of its kind in Lebanon aiming at describing the current clinical practice in nutrition support at a national level. Working toward the use of a nutritional screening tool on admission and the exclusive use of ready made formula for enteral feeding will have the most significant and immediate impact on improving quality of nutritional care for hospitalized patients. This can be achieved mainly through the education of the concerned staff.

Effect of 7-minute workout on weight and body composition

BACKGROUND

The 7-minute workout composed of aerobic and resistance exercises is becoming a very popular workout. It targets individuals with time constrains and low motivation to commit to lengthy and extensive workout programs. The objective of the study is to investigate if the 7-minute workout has a 6 week effect on body weight and composition.

METHODS

The training group (N.=29, age 18-30) did the 7-minute workout 7 days a week during 6 weeks while the control group (N.=29) did not perform the workout. Measurements such as height, weight, body mass index, circumferences (middle upper arm, hip, and waist), blood pressure, heart rate, hand grip, and bioelectrical impedance were collected and recorded at week 1, 3 and 6.

RESULTS

Mean BMI was 24.4kg/m2 at week 1, 24.01kg/m2 at week 3 (P=0.003). Waist circumference decreased between week 1 and 3 (P=0.003) and week 6 (P=0.01) by 4 cm on average. Hip circumference followed the same trend between week 1 and week 3 (P=-0.001). There was a decrease in fat mass and % fat mass between week 1, 3, and 6 (P=0.001). No changes were noted for mid-upper arm circumference or hand grip.

CONCLUSIONS

The findings of this research show that even a very short duration workout affect the nutritional status in normal weight individuals who did not change any of their eating habits. This implies that even in normal weight individuals who perform the 7-minute workout, improvement through a decrease in waist circumference can be achieved thus leading to a better cardio-protective nutritional status. The 7 minutes workout can be a great solution for people to get started and to plan on continuing exercising, as it is simple and of minimal constraints.

Symptoms of depression and anxiety in anorexia nervosa: links with plasma tryptophan and serotonin metabolism

Depressive, anxiety and obsessive symptoms frequently co-occur with anorexia nervosa (AN). The relationship between these clinical manifestations and the biological changes caused by starvation is not well understood. It has been hypothesised that reduced availability of tryptophan (TRP) could reduce serotonin activity and thus trigger these comorbid symptoms. The aim of this study, during re-feeding in individuals with AN, was to analyse covariations across measures of nutritional status, depressive and anxiety symptoms, and peripheral serotonin markers. Depressive and anxiety symptoms, nutritional status and serotonin markers--whole blood serotonin content, plasma TRP and the ratio between TRP and large neutral amino acids--were assessed for 42 AN participants at admission to inpatient treatment and after re-feeding. Biological measures were compared to those obtained in 42 non-eating disordered subjects. For those with AN, psychological, nutritional and biological parameters improved significantly during hospitalisation. Levels of serotonin markers were significantly lower in the AN group compared to the control group, at admission and at discharge. Increase in the TRP/LNAA ratio was correlated with a decrease in depressive symptoms. In addition, there was a positive correlation between serotonin levels and symptoms of both anxiety and depression at discharge. We speculate that enhanced TRP availability during re-feeding, as a result of the increase in the TRP/LNAA ratio, could restore serotonin neurotransmission and lead to a decrease in depressive symptoms. The association between serotonin and anxiety and depressive symptoms would be consistent with numerous observations indicating abnormal functioning of the serotoninergic system in AN.

Relationship between affective symptoms and malnutrition severity in severe Anorexia Nervosa

Background

Very few studies have investigated the relationship between malnutrition and psychological symptoms in Anorexia Nervosa (AN). They have used only body weight or body mass index (BMI) for the nutritional assessment and did not always report on medication, or if they did, it was not included in the analysis of results, and they did not include confounding factors such as duration of illness, AN subtype or age. The present study investigates this relationship using indicators other than BMI/weight, among which body composition and biological markers, also considering potential confounders related to depression and anxiety.

Methods

155 AN patients, (DSM-IV) were included consecutively upon admission to inpatient treatment. Depression, anxiety, obsessive behaviours and social functioning were measured using various scales. Nutritional status was measured using BMI, severity of weight loss, body composition, and albumin and prealbumin levels.

Results

No correlation was found between BMI at inclusion, fat-free mass index, fat mass index, and severity of weight loss and any of the psychometric scores. Age and medication are the only factors that affect the psychological scores. None of the psychological scores were explained by the nutritional indicators with the exception of albumin levels which was negatively linked to the LSAS fear score (p = 0.024; beta = −0.225). Only the use of antidepressants explained the variability in BDI scores (p = 0.029; beta = 0.228) and anxiolytic use explained the variability in HADs depression scores (p = 0.037; beta = 0.216).

Conclusion

The present study is a pioneer investigation of various nutritional markers in relation to psychological symptoms in severely malnourished AN patients. The clinical hypothesis that malnutrition partly causes depression and anxiety symptoms in AN in acute phase is not confirmed, and future studies are needed to back up our results.

Can birth weight predict later body composition in anorexia nervosa?

BACKGROUND/OBJECTIVES

The relationship between birth weight and body composition at later stages in life was not studied previously in anorexia nervosa (AN). The aim of the following brief report is to present results concerning the relationship between birth weight and later body composition specifically in AN, and to check if the programming of body composition from birth weight is still detected in severely emaciated AN patients.

SUBJECTS/METHODS

One hundred and fifty-one female AN patients aged between 13 and 44 were recruited from 11 inpatient treatment facilities in France. Birth weight, body weight and height were obtained. Body composition was measured using bioelectrical impedance. Birth weight was significantly correlated to lifetime maximum body mass index (BMI; r=0.211, P=0.009) and significantly correlated to fat-free mass index (r=0.190, P=0.027) but not to fat mass index (FMI).

RESULTS

This report confirms that even in AN when patients are severely emaciated and where fat-free mass (FFM) and fat mass (FM) are low, a link between birth weight and FFM and BMI can still be identified, independently from age.

CONCLUSION

Further studies are needed on larger samples exploring other factors, such as gender, puberty and ethnicity.

Relationship between malnutrition and depression or anxiety in Anorexia Nervosa: a critical review of the literature

BACKGROUND

Depression, anxiety and obsessive-compulsive disorder (OCD) frequently co-occur with Anorexia Nervosa (AN). Clinical consensus admits that depressive symptoms and anxiety are the sequelae of malnutrition in AN. This review presents a critical assessment of the literature that looked into the link between depression/anxiety symptoms in relation to malnutrition and their improvement throughout the treatment.

METHODS

We performed a systematic search of literature in Medline and PsychInfo for all the studies done to investigate psychological factors in relation to malnutrition in AN using the keywords "Anorexia Nervosa", "depression", "anxiety", "obsessive-compulsive disorder" and "malnutrition". Only articles published between 1980 and 2010 in English or French were reviewed. From the articles on AN and depression, anxiety, and/or OCD, only the ones which investigated on the relation with malnutrition were kept. This search was complemented by a manual search. We also checked the reference lists of the articles we found.

RESULTS

Seven papers were analyzed and critically reviewed for their methods and results. Results are contradictory and inconsistent at all levels of assessment.

CONCLUSIONS

Evidence based data is very rare. From the 7 reviewed studies, none of them draw the same conclusion. This is mainly due to the large differences in the samples' populations and the studies' protocols. Future studies are needed to focus on the relationship between depression/anxiety symptoms and malnutrition. A more critical nutritional assessment should be undertaken with multiple psychological assessment scales.

Underweight patients with anorexia nervosa: comparison of bioelectrical impedance analysis using five equations to dual X-ray absorptiometry

BACKGROUND & AIMS

Body weight changes do not reflect the respective changes of body compartments, namely fat-free mass (FFM) and fat mass (FM). Both bioelectrical Impedance Analysis (BIA) and the Dual X-ray absorptiometry (DXA) measure FFM and FM. This study in underweight patients with anorexia nervosa (AN) aims to compare measurements of FM and FFM done by DXA and BIA using 5 different BIA equations already validated in healthy population and to identify the most suitable BIA equation for AN patients.

METHODS

Fifty female patients with AN (BMI=14.3 ± 1.49, age=19.98 ± 5.68yrs) were included in the study. Body composition was measured by DXA (Delphi W, Hologic, Bedford, MA) and by 50 kHz BIA (FORANA, Helios) using 5 different BIA equations validated in healthy population (Sun, Geneva, Kushner, Deurenberg and Roubenoff equations). Comparison between the DXA and the 5 BIA equations was done using the sum of the squares of differences and Bland-Altman plots.

RESULTS

The Deurenberg equation gave the best estimates of FFM when compared to the measurements by DXA (FFM(dxa)=35.80 kg versus FFM(deurenberg)=36.36 kg) and very close estimates of FM (FM(dxa)=9.16 kg and FM(deurenberg)=9.57 kg) The Kushner equation showed slightly better estimates for FM (FM(kushner)=9. 0kg) when compared to the DXA, but not for FFM. Sun equation gave the broadest differences for FM and FFM when compared with DXA.

CONCLUSION

The best available BIA equation to calculate the FFM and the FM in patients with AN is the Deurenberg equation. It takes into account the weight, height and age and is applicable in adults and adolescents AN patients with BMI of 12.8-21.0, and for ages between 13.4 and up to 36.9 years.

Glutaraldehyde-treated homologous vein graft as a vein substitute: experimental study in rabbits

AIM

Vein reconstruction using grafts may prevent sequelae of venous interruption or lesion. Autologous vein is sometimes unsuitable or absent for a vascular restoration. The aim of this study was to study glutaraldehyde-treated homologous vein graft as vein substitute and compare it with autologous vein as a substitute for a vena cava segment in rabbits.

METHODS

Sixty rabbits were allocated into two groups: autologous vein graft (AG), and glutaraldehyde-treated homologous vein graft (HG). Each group was subdivided into three subgroups (N.=10) to be studied at: 24 hours, 14 days, and 28 days. The veins were treated in 0.19% glutaraldehyde, pH=7.4, for 1 hour and kept at 4 degrees C in saline with added gentamicin and amphotericin B. The animals received benzanthine penicillin on the day of graft implantation and heparin only during surgery. The grafts were implanted into the vena cava. Anastomosis was performed with interrupted sutures. Cavography was performed, after surgery, and at the time the animals were killed. Evaluation of the veins was made macroscopically and by light and scanning electron microscopy.

RESULTS

Fibrosis was seen around the grafts at 14 and 28 days, with no difference in intensity between the groups. Cavography performed before euthanasia of the animals showed 4 partial thrombi in AG (2 at 24 hours and 2 at 14 days), 3 in HG (2 at 24 hours and 1 on day 14), and 4 occlusive thombi in HG (3 at 14 days and 1 at 28 days). Macroscopic examination did not show any thrombus in AG. In HG, two partial thrombi were confirmed at 24 hours and three occlusive thrombi at 14 days. There was no statistical difference in relation to patency between the two groups. At 14 and 28 days, the histological sections showed intimal hyperplasia of similar intensity and variable distribution in both groups. Evaluation by electron microscopy showed at 24 hours lesion areas characterized by absence of the endothelium on the graft surface, presence of inflammatory cells, and, at some sites, presence of mural thrombi in AG and HG. Both groups at 14 and 28 days showed endothelial cells covering the lesion area on the graft surface, this covering being larger in AG than in HG.

CONCLUSIONS

In the studied model, both grafts behaved similarly in relation to patency and morphological characteristics. This suggests that the glutaraldehyde-treated graft can be a promising alternative for vein reconstruction, justifying further animal studies with the aim of using it in human surgery.

Insufficient flow reduction during LBNP in both splanchnic and lower limb areas is associated with orthostatic intolerance after bedrest

We quantified the impact of a 60-day head-down tilt bed rest (HDBR) with countermeasures on the arterial response to supine lower body negative pressure (LBNP). Twenty-four women [8 control (Con), 8 exercise + LBNP (Ex-LBNP), and 8 nutrition (Nut) subjects] were studied during LBNP (0 to −45 mmHg) before (pre) and on HDBR day 55 (HDBR-55). Left ventricle diastolic volume (LVDV) and mass, flow velocities in the middle cerebral artery (MCA flow) and femoral artery (femoral flow), portal vein cross-sectional area (portal flow), and lower limb resistance (femoral resistance index) were measured. Muscle sympathetic nerve activity (MSNA) was measured in the fibular nerve. Subjects were identified as finishers or nonfinishers of the 10-min post-HDBR tilt test. At HDBR-55, LVDV, mass, and portal flow were decreased from pre-HDBR ( P < 0.05) in the Con and Nut groups only. During LBNP at HDBR-55, femoral and portal flow decreased less, whereas leg MSNA increased similarly, compared with pre-HDBR in the Con, Nut, and NF groups; 11 of 13 nonfinishers showed smaller LBNP-induced reductions in both femoral and portal flow (less vasoconstriction), whereas 10 of 11 finishers maintained vasoconstriction in either one or both regions. The relative distribution of blood flow in the cerebral versus portal and femoral beds during LBNP [MCA flow/(femoral + portal flow)] increased or reduced <15% from pre-HDBR in 10 of 11 finishers but decreased >15% from pre-HDBR in 11 of 13 nonfinishers. Abnormal vasoconstriction in both the portal and femoral vascular areas was associated with orthostatic intolerance. The vascular deconditioning was partially prevented by Ex-LBNP.

Type Curves for Dry CBM Reservoirs With Equilibrium Desorption

Abstract

The purpose of this work is to model the single-phase radial gas flow in coalbed methane including equilibrium sorption phenomena in the coal matrix and Darcy flow in the natural fracture network. Considering a control volume, the gas desorption rate as a function of time and space is incorporated into the radial continuity equation as a source term. Using a Langmuir-type sorption isotherm, the gas desorption rate is determined at any radius of the reservoir. Introducing the definition of pseudo-pressure and pseudo-time, the resulting continuity equation is converted into the linearized diffusivity equation by modification of total gas compressibility. It is shown how the traditional definition of the material balance pseudo-time is modified for dry CBM reservoirs. With the help of these transformations, the traditional (PTA and RTA) type curves can be employed for analysis of production data of dry CBM reservoirs. The model developed here is validated against Fekete's numerical CBM simulator over a wide range of reservoir parameters. In addition, one set of field data from Horseshoe Canyon coals of the Western Canadian Sedimentary Basin is analyzed using the solution procedure presented in this paper.

Introduction

Coalbed methane (CBM) is natural gas produced from coal seams. Coal is both the source rock and the reservoir for methane production. The world total CBM resource potential is evaluated at about 143.2 trillion cubic metres(1).

CBM reservoirs are naturally fractured reservoirs that are characterized by two distinct porosity systems including:micropores (matrix) with extremely low permeability andmacropores (natural fractures or cleats).

Due to the small pore diameter of less than 10 Å, the coal matrix has a large internal surface area of 100 to 300 m(2)/g(2, 3). As a result, substantial quantities of gas can be adsorbed on the surface of the coal grains. Micropores are impermeable to gas and inaccessible to water. However, the desorbed gas can be transported through the primary porosity system by diffusion. The macropores act as a sink to the micropores and provide permeability to fluid flow.

In porous media with larger pore size distributions, mass transfer is driven by pressure gradients, whereas in coal, mass transfer is driven by concentration gradients(4, 5). The diffusion through the micropores can be the result of three distinct mechanisms that may act individually or simultaneously(6):bulk diffusion, where molecule/molecule interactions dominate;Knudsen diffusion, where molecule/surface interactions dominate; andtwo-dimensional surface diffusion of the adsorbed gas layer.

The steady state diffusion coefficient of methane for most coals is on the order of 10−4 to 10−5 cm(2)/s(6). These experimentally determined diffusion coefficients represent averaged values including the contributions of the bulk, Knudsen and surface diffusion processes.

Diffusion effects can be quantified by determining a sorption time. The sorption time is equal to the time required to desorb 63.2% of the initial gas volume. It is determined from whole core canister desorption test. This time is related to fracture spacing and the diffusion coefficient(7).

Gas production from the CBM reservoirs is controlled by a four-step process that includes:

WISE-2005: tibial and gastrocnemius vein and calf tissue response to LBNP after a 60-day bed rest with and without countermeasures

The objective of this study was to quantify by echography the changes in the intramuscular [gastrocnemius (Gast)] and nonintramuscular [posterior tibial (Tib)] calf veins cross-sectional area (CSA) and the superficial tissue thickness (STth) in response to lower body negative pressure (LBNP) after 60-day head-down bed rest (HDBR). Twenty-four healthy women (25–40 yr) were divided into three groups: control (Con), treadmill-LBNP and flywheel (Ex-Lb), nutrition (Nut; protein supplement). All underwent a LBNP (0 and −45 mmHg) before and on day 55 of HDBR. Subjects were identified as finisher (F) or nonfinisher (NF) of a 10-min tilt test after 60 days of HDBR. There were no differences in resting CSA of the Tib and Gast veins on HDBR day 55 compared with pre-HDBR for the Ex-Lb, Con and Nut, or the F groups; however, for NF both the Tib and Gast vein CSA at rest were significantly smaller after HDBR. At −45 mmHg LBNP, Tib and Gast CSAs were not significantly different from before HDBR in all groups (Ex-Lb, Con, Nut, F, NF). However, percent change in CSA of both veins from rest to −45 mmHg LBNP was significantly greater in the Con and Nut groups compared with Ex-Lb, and also NF compared with F. Similarly, the percent increase in STth on going from rest to −45 mmHg was higher after HDBR in the Con and Nut groups compared with Ex-Lb, as well as NF compared with F. These results showed that the Ex-Lb countermeasure minimized the bed rest effect on leg vein capacitance (CSA percent change) and STth increase during LBNP, whereas Nut had no effect and that higher leg vein and superficial tissue capacitance were associated with reduced orthostatic tolerance.

WISE 2005: vascular responses to 60-day bed rest in women

WISE-2005 studied 24 women during a 60-day head down bed rest (HDBR) who look part in an exercise countermeasure (LBNP-treadmill plus flywheel, EX) and no-exercise (No-EX). We conducted a series of experiments to explore changes in cardiovascular function and the ability of EX to prevent these changes. Resting arterial diameter in the arm was not affected but the leg arteries (femoral and popliteal) were significantly reduced in Np-EX, but was increased in EX. In this study we report on drug stimulated responses with sublingual nitroglycerin and infused isoproterenol. Heart rate increased in response to nitroglycerin with larger increases in No-EX after HDBR. Likewise during isoproterenol infusion the HR increase was greater after HDBR in the No-EX group. In all cases, the higher HR was associated with lower stroke volume in No-EX while stroke volume was protected in EX. These data do not support a change in sensitivity of beta-adrenergic receptors after HDBR. The leg vascular resistance decreased in response to isoproterenol and it decreased to a greater extent in No-EX than EX. These data were consistent with observations of lower leg vascular resistance during orthostatic challenge tests after HDBR. We conclude that consistent changes in cardiovascular function in the No-EX were detected by different methods that point to mechanisms contributing to orthostatic intolerance after HDBR.

WISE 2005: stroke volume changes contribute to the pressor response during ischemic handgrip exercise in women

The mechanism of the pressor response to small muscle mass (e.g., forearm) exercise and during metaboreflex activation may include elevations in cardiac output (Q) or total peripheral resistance (TPR). Increases in Q must be supported by reductions in visceral venous volume to sustain venous return as heart rate (HR) increases. Therefore, this study tested the hypothesis that increases in Q, supported by reductions in splanchnic volume (portal vein constriction), explain the pressor response during handgrip exercise and metaboreflex activation. Seventeen healthy women performed 2 min of static ischemic handgrip exercise and 2 min of postexercise circulatory occlusion (PECO) while HR, stroke volume and superficial femoral artery flow (Doppler), blood pressure (Finometer), portal vein diameter (ultrasound imaging), and muscle sympathetic nerve activity (MSNA; microneurography) were measured followed by the calculation of Q, TPR, and leg vascular resistance (LVR). Compared with baseline, mean arterial blood pressure (MAP) (P < 0.001) and Q (P < 0.001) both increased in each minute of exercise accompanied by a approximately 5% reduction in portal vein diameter (P < 0.05). MAP remained elevated during PECO, whereas Q decreased below exercise levels. MSNA was elevated above baseline during the second minute of exercise and through the PECO period (P < 0.05). Neither TPR nor LVR was changed from baseline during exercise and PECO. The data indicate that the majority of the blood pressure response to isometric handgrip exercise in women was due to mobilization of central blood volume and elevated stroke volume and Q rather than elevations in TVR or LVR resistance.

Effect of diclofenac sodium on the healing process of end-to-end anastomosis in carotid arteries of rabbits. Histopathological and biomechanical studies

AIM

Diclofenac sodium is a non-steroidal anti-inflammatory drug commonly used to attenuate painful inflammatory reactions in surgery. However, it may delay healing in the skin and gastrointestinal tract. The aim of this study was to evaluate the influence of Diclofenac in vascular healing.

METHODS

Ninety rabbits had their carotid arteries sectioned and reconstructed by end-to-end anastomosis with interrupted sutures. The animals were randomly allocated into 3 groups of 30 each and treated by intramuscular route with saline (control), 5 mg/kg/day of diclofenac sodium (DS-5), and 10 mg/kg/day of diclofenac sodium (DS-10). Treatment began on the day of surgery and lasted 4 days. Angiography, biomechanical properties (failure load, failure elongation, yield point, yield point elongation, and stiffness were obtained from the load/elongation curve), macroscopic and histological examinations (hematoxylin-eosin, Masson, Calleja, Picrossirius-red), and scanning electron microscopy were studied in both arteries on the 3rd and 15th postoperative days.

RESULTS

No significant differences in biomechanical properties were observed either in the 3 groups or the experimental times. The carotid artery healing process was similar in the 3 groups.

CONCLUSION

Diclofenac sodium did not cause alterations nor delayed carotid artery healing.

Antithrombotic effect of Lonomia obliqua caterpillar bristle extract on experimental venous thrombosis

The venom of Lonomia obliqua caterpillar may induce a hemorrhagic syndrome in humans, and blood incoagulability by afibrinogenemia when intravenously injected in laboratory animals. The possible antithrombotic and thrombolytic activities of L. obliqua caterpillar bristle extract (LOCBE) were evaluated in this study. The minimal intravenous dose of the extract necessary to induce afibrinogenemia and anticoagulation was 3.0 and 10.0 microg protein/kg body weight for rabbits and rats, respectively. In rabbits, this dose induced total blood incoagulability for at least 10 h and did not reduce the weight of preformed venous thrombi, in contrast to streptokinase (30,000 IU/kg). In rats, pretreatment with 5.0 and 10.0 microg/kg LOCBE prevented the formation of thrombi induced by venous stasis or by injury to the venous endothelium. The dose of 5.0 microg/kg LOCBE did not modify blood coagulation assay parameters but increased bleeding time and decreased plasma factor XIII concentration. When the extract was administered to rats at the dose of 10.0 microg/kg, the blood was totally incoagulable for 6 h. These data show that LOCBE was effective in preventing experimental venous thrombosis in rats, justifying further studies using purified fractions of the extract to clarify the mechanisms of this effect.