The Aftermath of COVID-19: Exploring Long-Term Effects on the Organ Systems (preprint)

Background: Post-acute sequelae of SARS-CoV-2 infection (PASC) is a complicated disease that affects millions of people all over the world. Previous studies have shown that PASC impacts 10% of SARS-CoV-2 infected patients of which 50-70% are hospitalized. It has also been shown that 10-12% of those vaccinated against COVID-19 were affected with PASC and its complications. The severity and the later development of PASC symptoms is positively associated with the early intensity of the infection. Results: The generated health complications caused by PASC involve a vast variety of organ systems. Patients affected by PASC have been diagnosed with neuropsychiatric and neurological symptoms. Cardiovascular system also has been involved and several diseases such as myocarditis, pericarditis, and coronary artery diseases were reported. Chronic hematological problems such as thrombotic endothelialitis and hypercoagulability were described as a condition that could increase the risk of clotting disorders and coagulopathy in PASC patients. Chest pain, breathlessness, and cough in PASC patients were associated with respiratory system in long COVID-19 causing respiratory distress syndrome. The observed immune complications were notable, involving several diseases. Renal system also was impacted and result in raising the risk of diseases such as thrombotic issues, fibrosis, and sepsis. Endocrine gland malfunction can lead to diabetes, thyroiditis, and male infertility. Symptoms such as diarrhea, nausea, loss of appetite and taste were also among reported observations due to several gastrointestinal disorders. Skin abnormalities might be an indication of infection and long-term implications such as persistent cutaneous complaints were linked to PASC. Conclusions: Long COVID is a multidimensional syndrome with considerable public health implications, affecting several physiological systems and demanding thorough medical therapy as well as more study to address its underlying causes and long-term effects.

Long-term Effects of the COVID-19 Lockdown on Weight Status, Eating Habits, and Lifestyle Changes Related to School-aged Children in Bandar Abbas, Iran (preprint)

Background During the COVID-19 pandemic, school closures caused destructive changes in student weight status, eating habits, screen exposure, sleep patterns, psychological responses, and activity behaviors. Despite the end of the lockdown and reopening of schools, the long-term effects of quarantine on the lifestyle and weight status of children and adolescents remain unknown. On the other hand, there is a chance that these negative changes become more prominent during extended school holidays such as summer breaks. This study aimed to determine the long-term effects of the lockdown on the weight status and lifestyle of children and adolescents after the eighth wave of the disease in Iran.Method This descriptive cross-sectional study was conducted from April to May 2022. The target population comprises one hundred students aged between 10 and 16 years. Our study obtained students' weight and height data from records maintained by school principals or sports teachers before and after the quarantine period. The BMI z score (zBMI) was calculated for each time point. The researchers also provided a questionnaire to collect the students’ demographic and lifestyle status changes during school closures.Results We found that the zBMI increased significantly from − 0.02 ± 1.64 to 0.36 ± 1.12, and the statistics of the overweight and obese population increased by 3% during quarantine (P ≤ 0.05). These changes were more pronounced in males and students aged 14–16 years. We also found that eating habits, sleep time, sleep patterns, screen time, and physical activity had significant negative changes during quarantine, and a significant increase in zBMI was observed among students who experienced negative eating behaviors, altered sleep patterns, and decreased physical activity during school closures. Conclusion: As prolonged school closures due to the COVID-19 lockdown aggravated students’ health and lifestyle status, our findings can aid in proper planning to establish an appropriate framework for the diet, physical activity, and sleep quality of students during extended school closures.

Longitudinal association between cumulative ecological risk and eating disorders among Chinese adolescents during the COVID-19 pandemic: A Moderated Mediation Model (preprint)

Background The World Health Organization declared the ongoing COVID-19 outbreak a global pandemic on March 11, 2020. COVID-19 profoundly affects the work and life of individuals, and adolescents are no exception. Adolescents may experience risks from various sources, such as family and school; however, there is limited understanding of the mechanisms that connect these factors during the COVID-19 pandemic. This study aimed to investigate how cognitive avoidance mediates and intentional self-regulation moderates the link between cumulative ecological risk and adolescents’ eating disorders during the COVID-19 pandemic. Methods A sample of 769 Chinese adolescents completed questionnaires, including the Cumulative Ecological Risk Questionnaire, the Cognitive Avoidance Questionnaire, the Intentional Self-Regulation Questionnaire, and the Eating Attitude Test Questionnaire. Result Cumulative ecological risk had a direct predictive effect on eating disorders among Chinese adolescents. Cognitive avoidance partially mediated the link between cumulative ecological risk and eating disorders among Chinese adolescents. Intentional self-regulation moderated both the direct and indirect effects between cumulative ecological risk and eating disorders among Chinese adolescents. Conclusion Cumulative ecological risk and cognitive avoidance both increase the likelihood of Chinese adolescents’ eating disorders during the COVID-19 pandemic. And, intentional self-regulation serves as a protective factor in the relationship between cumulative ecological risk and cognitive avoidance in eating disorders.

Impact of COVID-19 on mental illness in vaccinated and unvaccinated people: a population-based cohort study in OpenSAFELY (preprint)

Background: COVID-19 is associated with subsequent mental illness in both hospital- and population-based studies. Evidence regarding effects of COVID-19 vaccination on mental health consequences of COVID-19 is limited. Methods: With the approval of NHS England, we used linked electronic health records (OpenSAFELY-TPP) to conduct analyses in a 'pre-vaccination' cohort (17,619,987 people) followed during the wild-type/Alpha variant eras (January 2020-June 2021), and 'vaccinated' and 'unvaccinated' cohorts (13,716,225 and 3,130,581 people respectively) during the Delta variant era (June-December 2021). We estimated adjusted hazard ratios (aHRs) comparing the incidence of mental illness after diagnosis of COVID-19 with the incidence before or without COVID-19. Outcomes: We considered eight outcomes: depression, serious mental illness, general anxiety, post-traumatic stress disorder, eating disorders, addiction, self-harm, and suicide. Incidence of most outcomes was elevated during weeks 1-4 after COVID-19 diagnosis, compared with before or without COVID-19, in each cohort. Vaccination mitigated the adverse effects of COVID-19 on mental health: aHRs (95% CIs) for depression and for serious mental illness during weeks 1-4 after COVID-19 were 1.93 (1.88-1.98) and 1.42 (1.24-1.61) respectively in the pre-vaccination cohort and 1.79 (1.68-1.91) and 2.21 (1.99-2.45) respectively in the unvaccinated cohort, compared with 1.16 (1.12-1.20) and 0.91 (0.84-0.98) respectively in the vaccinated cohort. Elevation in incidence was higher, and persisted for longer, after hospitalised than non-hospitalised COVID-19. Interpretation: Incidence of mental illness is elevated for up to a year following severe COVID-19 in unvaccinated people. Vaccination mitigates the adverse effect of COVID-19 on mental health. Funding: Medical Research Council (MC_PC_20059) and NIHR (COV-LT-0009).

Prevalence and factors associated with fear of COVID-19 in military personnel during the second epidemic wave in Peru (preprint)

There is few research in military members that provided protection and security during the COVID-19 crisis. We aimed to determine the prevalence and factors associated with fear of COVID-19 in military members. A cross-sectional study was conducted between November 02 and 09, 2021, during the second wave of the COVID-19 pandemic in the region of Lambayeque, Peru. The outcome was fear of COVID-19, measured with the Fear of COVID-19 Scale. The association with resilience (abbreviated CD-RISC), food insecurity (HFIAS), physical activity (IPAQ-S), eating disorder (EAT-26), and other socio-labor variables were assessed. Of 525 participants, the median age was 22, 95.8% were male, and 19.2% experienced fear of COVID-19. A higher prevalence of fear of COVID-19 was associated with age (PR=1.03; 95% CI: 1.01-1.06), religion (PP=2.05; 95% CI: 1.04-4.05), eating disorder (PR=2.95; 95% CI: 1.99-4.36), and having a relative with mental disorder (PR=2.13; 95% CI: 1.09-4.17). Overweight (PR=0.58; 95% IC: 0.37-0.90) and a high level of resilience (PR=0.63; 95% IC: 0.43-0.93) were associated with a lower prevalence of fear of COVID-19. Two out of ten military personnel were afraid of COVID-19. We recommend special attention to the factors associated with the development of suicide risk in military personnel.

Admissions for eating disorders and other mental health diagnoses during the COVID-19 pandemic (preprint)

Objective: To examine how hospital admissions for mental health and eating disorders changed at the beginning of the COVID-19 pandemic and with the return to fully in-person school with increased vaccine availability. Methods: Data from a tertiary care childrens hospital were examined for admissions to the hospital from March 2018 through March 2022, including children 6-20 years old admitted with ICD-10 codes for mental health and eating disorders. Interrupted time series (ITS) analyses were used to examine for changes at specific time points. Results: In the time between March 2018 through March 2022, 851 admissions met inclusion criteria for eating disorders and 1,505 admissions for other mental health diagnoses. In the first year of the pandemic, the ITS analysis showed a significant increase in admissions per month for eating disorders with a slope of 1.2 (95% CI: 0.2, 2.2) and for other mental health diagnoses, a slope of 1.9 (95% CI: 1.1, 2.7). In a longer-term ITS analysis, return to fully in-person school was associated with a subsequent decrease in admissions over time at -1.0 per month (95% CI: -2.1, 0.1). For other mental health diagnoses, return to school was associated with an initial drop and then an increase in admissions over time, slope of 2.2 (95% CI: -0.5, 3.8). Conclusion: The COVID-19 pandemic had an initial impact on admissions for eating disorders and other mental health that attenuated over time. We note differences in the association of return to school on eating disorders compared with other mental health diagnoses.

A Novel Site-Agnostic Multimodal Deep Learning Model to Identify Pro-Eating Disorder Content on Social Media (preprint)

Over the last decade, there has been a vast increase in eating disorder diagnoses and eating disorder-attributed deaths, reaching their zenith during the Covid-19 pandemic. This immense growth derived in part from the stressors of the pandemic but also from increased exposure to social media, which is rife with content that promotes eating disorders. This study aimed to create a multimodal deep learning model that can determine if a given social media post promotes eating disorders based on a combination of visual and textual data. A labeled dataset of Tweets was collected from Twitter, recently rebranded as X, upon which twelve deep learning models were trained and evaluated. Based on model performance, the most effective deep learning model was the multimodal fusion of the RoBERTa natural language processing model and the MaxViT image classification model, attaining accuracy and F1 scores of 95.9% and 0.959, respectively. The RoBERTa and MaxViT fusion model, deployed to classify an unlabeled dataset of posts from the social media sites Tumblr and Reddit, generated results akin to those of previous research studies that did not employ artificial intelligence-based techniques, indicating that deep learning models can develop insights congruent to those of researchers. Additionally, the model was used to conduct a time-series analysis of yet unseen Tweets from eight Twitter hashtags, uncovering that, since 2014, the relative abundance of content that promotes eating disorders has decreased drastically within those communities. Despite this reduction, by 2018, content that promotes eating disorders had either stopped declining or increased in ampleness anew on those hashtags.

A retrospective cohort study on the impact of the COVID-19 global pandemic on assessments and hospital admissions within a specialist adolescent eating disorder service (preprint)

Eating disorder services worldwide were impacted by the COVID-19 pandemic experience, including its associated counter-measures. We examined the effect of the pandemic on sociodemographic and clinical characteristics of young people assessed and admitted by a specialist adolescent eating disorder service in the Northwest of England (UK). Routinely collected electronic data in the two years following the World Health Organisation declaration of a global pandemic in March 2020, was compared with data collected in the preceding two years. This service experienced a 21% increase in assessments from the two years pre-COVID (n=78) to the two years following the pandemic onset (n=120), Inpatient admissions also increased by 10%. The pandemic had no effect on admission setting, with approximately 20% admitted to specialist eating disorder units, 40% to paediatric wards and 40% to adolescent mental health units, consistently across the four years. No significant difference in sociodemographic characteristics of young people within the service before or during the pandemic was found. However, self-rated eating disorder pathology at assessment was significantly more severe following the pandemic. Fewer admission had a recorded comorbid diagnosis of an Autistic Spectrum Condition following the pandemic compared to those admitted pre-pandemic. These findings quantify the increase in demand for highly specialist adolescent eating disorder services since the start of the COVID-19 pandemic, with a higher severity of psychopathology managed outside of hospital. This has implications for service design, allocation of resources and future delivery of appropriate models of care to young people.

Complementary and Integrative Medicine and Eating Disorders in Youth: Traditional Yoga, Virtual Reality, Light Therapy, Neurofeedback, Acupuncture, Energy Psychology Techniques, Art Therapies, and Spirituality.

Eating disorders (EDs) are a non-heterogeneous group of illnesses with significant physical and mental comorbidity and mortality associated with maladaptive coping. With the exception of lisdexamfetamine (Vyvanse) for binge eating disorder, no medications have been effective for the core symptoms of ED. ED requires a multimodal approach. Complementary and integrative medicine (CIM) can be helpful as an adjunct. The most promising CIM interventions are traditional yoga, virtual reality, eye movement desensitization and reprocessing, Music Therapy, and biofeedback/neurofeedback.

Clinical and Epidemiological Risk Factors Associated with Hospitalization and Mortality Rate of COVID-19 Patients in Banja Luka County: Retrospective Observational Cohort Study on 40,000 patients (preprint)

Background and Objectives: Since the beginning of COVID-19 pandemic, the infection primarily affected patients with following chronic conditions: cardiovascular disease, hypertension, chronic obstructive pulmonary disease, diabetes mellitus, obesity and cancer. The aim of this study was to explore clinical and epidemiological characteristics associated with COVID-19 outcomes in patients at the primary health care centre from March 2020 to September 2022. Materials and Methods: The study included 40,692 citizens of Banja Luka County, Bosnia and Herzegovina, who were confirmed and registered as RT-PCR positive on COVID-19. Differences regarding the distributions of patients between groups were analysed using Pearson chi square test and Mantel-Haenszel chi square test for trends, while differences in mean values were compared using independent samples t test. Relationship between mortality and independent variables were examined using logistic regression. Results: Out of 40,692 COVID-19 positive patients, 7.76% were hospitalized. The average age of hospitalized patients was significantly higher than the age of non-hospitalized patients (64.2±16.1 vs. 45.4±18.7; p<0.001). The average age of patients with lethal outcome was nearly twice higher compared to patients with non-lethal outcome (74.6±11.5 vs. 45.7±18.6; p<0.001). Male patients had higher hospitalization and mortality rate, compared to females (9.8% vs. 5.9%, p<0.001; 4.8% vs. 3%, p<0.001, respectively). The highest hospitalization rate was in patients with chronic renal failure, diabetes and cardiovascular diseases, while the death rate was the highest among patients with CRF and hearth comorbidities. Fever, cough, fatigue, nausea and vomiting, chest pain, shortness of breath and appetite loss favoured hospitalization. Patients with fatigue and appetite loss had higher percentage of lethal outcome. Vaccinated patients had significantly lower rate of lethal outcome. Conclusions: Clinical symptoms, signs and outcomes, are posing as predictive parameters for further management of COVID-19. Vaccination has an important role in clinical outcomes of COVID-19.

Preventing Disordered Eating in Teenage Ballet Students: Evaluation of DancExcellent, a Combined CBT and Nutrition Education Intervention.

BACKGROUND: Disordered eating (DE) behaviors are relatively common among high-level dancers, especially in classical ballet. At the same time, interventions aimed at reducing DE behaviors in this population are scarce. METHODS: An 8-week exploratory preventive intervention for DE behaviors was carried out in a high-level ballet school for 40 teenagers aged 12-15 years (77.5% female). Both risk factors (perfectionism) and potentially protective factors (self-esteem, self-compassion) for the development of DE behaviors were considered. The intervention was created specifically for this study and consisted of five cognitive behavior therapy (CBT) workshops and four nutrition workshops. Additional components included newsletters for pupils and educational sessions and social media interactions with staff and parents. The intervention comprised two phases (control and intervention periods), with students acting as their own controls. Standardized questionnaires were completed before and after both phases. RESULTS: Questionnaire results did not indicate any changes in reported perfectionism, self-esteem, or self-compassion, nor were symptoms of DE affected during either the control or intervention periods. CONCLUSIONS: The intervention did not yield any discernible impact. However, it was affected by the onset of the COVID-19 pandemic, which limits our ability to draw conclusions about intervention effectiveness. Evaluations with pupils offer several considerations for future improvements.

Chinese university students showed less disordered eating during the COVID-19 campus lockdown.

OBJECTIVE: The rapid spread of the Omicron variant of COVID-19 in China had resulted in campus lockdown in many universities since February 2022, profoundly affecting students' daily lives. Campus lockdown conditions differ considerably from home quarantine, so that the eating patterns of university students may be different. Thus, the current study aimed to: (1) investigate university students' eating patterns during campus lockdown; (2) identify factors associated with their disordered eating. METHOD: An online survey about recent life changes, disordered eating, stress, depression, and anxiety was carried out from April 8th to May 16th, 2022. A total of 2541 responses from 29 provinces/cities of China were received. RESULTS: 2213 participants were included in the main analysis, and other 86 participants were analyzed separately as a subgroup due to their diagnosis of eating disorder. Participants who were undergoing campus lockdown (the lockdown group) showed less disordered eating than those who had never been in campus lockdown (the never-lockdown group), as well as those who had experienced campus lockdown before (the once-lockdown group). However, they perceived more stress and felt more depressed. Being female, higher BMI, gaining weight, increasing exercise, spending more time on social media, higher level of depression and anxiety were all related to disordered eating in the lockdown group. CONCLUSIONS: Disordered eating among Chinese university students was less prevalent during campus lockdown due to the strict and regular diet. However, there is a potential risk of "revenge eating" after campus lockdown ends. Thus, there should be further tracking and related prevention. LEVEL OF EVIDENCE: IV, uncontrolled trials without any interventions.

Knowledge and Perception of Adult Nigerian Men Towards Covid-19 Vaccination: A case study in Southwest Nigeria. (preprint)

Introduction  Corona virus illness 2019 (COVID-19), a pandemic event, began in the first quarter of 2020 and affected nearly every country on earth. Several researches on Covid-19 knowledge, attitude, and acceptance of religion in several Nigerian locations have been published. There is a scarcity of data on adult Nigerian men's perceptions and awareness of COVID-19 in relation to immunization. As a result, this study looks into the vaccination knowledge and attitudes of adult Nigerian men in south-west Nigeria.   Methods  The study is an analytic cross-sectional survey with structured online questionnaires Google form that was administered to the people of Oyo, Osun, and Lagos in Nigeria's south-western states. The study enlisted 309 participants, who were chosen at random after providing informed permission. The link between knowledge of COVID-19 and social demographics factors, knowledge of the vaccination, perception of the vaccine, and awareness and misinformation about COVID-19 was scored using percentages and subjects. The variable percentage scores were classified as good or poor.  Chi-Square was utilized to determine independent determinants of COVID-19 knowledge and perception, and SPSS was used for statistical analysis.  Results  According to the socio-demographic characteristics study, the mean age was 28.36.8 years, 52.4 percent of respondents were male, 28.5% were from Osun state, and (96.8%) had university education. 91.9% of responders had an excellent understanding of the COVID-19 vaccination. The general perception of the respondents was positive, with 240 (77.7%) of the respondents favoring the COVID-19 vaccination. The majority of respondents (88.3%) believe that developing a vaccine can aid in the fight against the pandemic, while 65.5% believe that the COVID-19 vaccine is safe based on what they know. Less than half of the respondents (45.6%) answered that if they knew the COVID-19 vaccination could influence their daily life activities after taking it, they would avoid taking it. They will still make themselves available for it, and the majority (64.1%) believe that COVID-19 will be successfully controlled with the vaccination. To the best of their knowledge, less than half of the respondents (44.0%) believe the Corona virus is a biological weapon designed by the Chinese government, while 15.2% believe it is a virus designed by the pharmaceutical industry to sell their drugs, and a similar (15.2%) believe the virus is an exaggeration by the news media to cause fear and panic. When asked how the virus is most commonly transmitted, 95.8% said they were exposed to airborne droplets through breathing, sneezing, or coughing, while 28.2% said they were exposed through kissing, hugging, sex, or other sexual contact. Another group of respondents (8.1%) indicated that HPV is spread by drinking contaminated water or eating infected food, while more than half (59.5%) stated that it can be spread by touching contaminated objects or surfaces. When asked how the virus can be prevented, fifty-six (18.1%) of respondents said that Africa's hot heat can prevent the transmission, while the majority (91.9%) said that frequent hand washing and social separation can. A few (6.8%) believe that consuming Chloroquine tablets and medicines can help avoid the illness. While fumigation and spraying bus stations and other public locations were mentioned as ways to prevent the virus by around one-third (31.4%) of those polled. Furthermore, twenty-seven (8.7%) listed ingesting gins, garlic, ginger, herbal mixture, traditional meals and soup as a means to prevent the infection.  In terms of COVID-19 disease perception, the majority of respondents (90.6%) believed that it is possible to die from the Coronavirus, while a comparable proportion (89.6%) agreed that the complete meaning of COVID-19 is Corona Virus Disease 19.  Conclusion  This study found that national public health information advocacy and campaigns in Southwest Nigeria were extremely effective in increasing understanding of COVID-19 and decreasing beliefs about disinformation, immunization, and mass medication administration programs. However, more can be done using social media and telecommunication to combat disinformation about immunization in more Nigerian and African regions and rural settings.      

COVID-19-Related Distress, Body Image, and Eating Behaviors: A Cross-sectional Explanatory Model (preprint)

Background: The COVID-19 pandemic has been associated with increased body dissatisfaction and disordered eating behaviors in adolescents. To better understand these associations, this study tested an explanatory model in which appearance-focused social media use, internalisation of social media pressure, and mindfulness abilities mediated the relationship between COVID-related distress and body dissatisfaction, which in turn was associated with dietary restraint and binge eating episodes.  Methods: Adolescents (N =498, Mage= 16.7, 47.2% girls) recruited within high schools completed online measures.  Results: A final well-adjusted model was revealed using path analyses, confirming the proposed mediational effects. Conclusions: Findings suggest that mindfulness, media use and the internalisation of social media pressure are potential key processes explaining body dissatisfaction and eating disorders among adolescents who experienced higher level of COVID-related distress. 

Using health administrative data to model associations and predict hospital admissions and length of stay for people with eating disorders.

BACKGROUND: Eating disorders are serious mental illnesses requiring a whole of health approach. Routinely collected health administrative data has clinical utility in describing associations and predicting health outcome measures. This study aims to develop models to assess the clinical utility of health administrative data in adult eating disorder emergency presentations and length of stay. METHODS: Retrospective cohort study on health administrative data in adults with eating disorders from 2014 to 2020 in Sydney Local Health District. Emergency and admitted patient data were collected with all clinically important variables available. Multivariable regression models were analysed to explore associations and to predict admissions and length of stay. RESULTS: Emergency department modelling describes some clinically important associations such as decreased odds of admission for patients with Bulimia Nervosa compared to Anorexia Nervosa (Odds Ratio [OR] 0.31, 95% Confidence Interval [95%CI] 0.10 to 0.95; p = 0.04). Admitted data included more predictors and therefore further significant associations including an average of 0.96 days increase in length of stay for each additional count of diagnosis/comorbidities (95% Confidence Interval [95% CI] 0.37 to 1.55; p = 0.001) with a valid prediction model (R2 = 0.56). CONCLUSIONS: Health administrative data has clinical utility in adult eating disorders with valid exploratory and predictive models describing associations and predicting admissions and length of stay. Utilising health administrative data this way is an efficient process for assessing impacts of multiple factors on patient care and predicting health care outcomes.

Developing the "single-session mindset" in eating disorder research: Commentary on Schleider et al., 2023 "Realizing the untapped promise of single-session interventions for eating disorders".

Schleider and colleagues' paper on the application of single-session interventions (SSIs) to eating disorders is timely given the broader focus in mental health on flexible approaches to delivering support at the time the person needs it most. The eating disorder field needs to embrace these innovations including developing a "single-session mindset" with greater attention paid to testing the relevance of SSI for eating disorders. The use of well-powered trials of brief, focused and rapidly scalable interventions is an ideal vehicle for generation and evaluation of new and longer interventions. Our future research agenda needs to carefully consider our target audience, the primary outcome variable of most relevance, and the SSI topic that would be most likely to effect change. Research in prevention might focus on weight concern and evaluation of SSIs that focus on self-compassion or cognitive dissonance related to appearance ideals in the media. Work in early intervention could target denial and disordered eating using SSIs on growth mindset, behavioral activation, and imagery rescripting. Treatment waitlists provide another suitable opportunity, evaluating SSIs that aim to increase hope for change, treatment retention, and kick start early change in therapy, a robust predictor of better treatment outcome.

A Risk Profile for Disordered Eating Behaviors in Adolescents with Type 1 Diabetes: A Latent Class Analysis Study.

(1) Background: This multi-center study aimed to identify a risk profile for disordered eating behaviors (DEBs) in youth with type 1 diabetes (T1D) based on their dietary intake, lipid profile, body mass index (BMI-SDS), and glycometabolic control. (2) Methods: Adolescents aged 11 to 18 years from five centers across Italy were recruited. Lipid profile, HbA1c, BMI-SDS, and dietary intake data were collected. The risk for developing DEBs was assessed via the Diabetes Eating Problems Survey-R (DEPS-R) questionnaire. A latent class analysis (LCA) was performed using a person-centered approach. (3) Results: Overall, 148 participants aged 11-18 (12.1, ±3.34), 52% males with a mean diabetes duration of 7.2 (±3.4), were enrolled. Based on the results of the DEBS-R score, LCA allowed us to highlight two different classes of patients which were defined as "at-risk" and "not at-risk" for DEB. The risk profile for developing DEBs is characterized by higher BMI-SDS (23.9 vs. 18.6), higher HbA1c (7.9 vs. 7.1%), higher LDL cholesterol (99.9 vs. 88.8 mg/dL), lower HDL cholesterol (57.9 vs. 61.3 mg/dL), higher proteins (18.2 vs. 16.1%), and lower carbohydrates (43.9 vs. 45.3%). Adolescents included in the "at-risk" class were significantly older (p = 0.000), and their parents' SES was significantly lower (p = 0.041). (4) Conclusions: This study allowed us to characterize a risk profile for DEBs based on dietary behavior and clinical parameters. Early identification of the risk for DEBs allows timely intervention and prevention of behavior disorders.

Adolescents hospitalized in an acute psychiatric ward: a retrospective comparison between the pre-Covid-19 and pandemic periods (preprint)

BACKGROUND. Covid-19 pandemic has negatively impacted child and adolescent mental health. The primary outcome of this study was the evaluation of Covid-19 impact on minors’ hospitalizations in an acute psychiatric ward. METHOD. With an observational and retrospective design, we collected selected variables among adolescents hospitalized in an acute psychiatric ward from 01/07/2017 to 30/06/2022. Data were statistically processed. RESULTS. Our sample was composed of 118 minors with an average age of 15.7 ± 1.2 SD, mostly represented by females (61%) and Italians (60.2%), who had 204 hospitalizations. The number of admissions by years drastically decreased in 2020 concomitantly with Covid19 lockdown and increased in the first half of 2022. Admission rates were higher in winter and spring, except in 2020 when admissions decreased (p = 0.000). In our sample, females more frequently had suicidal behaviour and acute anxiety (p = 0.000) at admissions and more often were discharged with acute stress reactions, eating disorders and mood disorder diagnoses. Differently, males were more frequently hospitalized for aggressive behaviour (p = 0.000) and were more often discharged with ADHD diagnosis (p = 0.000). At multiple linear regression, the duration of hospitalization (dependent variable) was negatively associated with “pandemic period” (p = 0.017) and “absent aggressive behaviour” (p = 0.003), and positively with “autism” diagnosis (p = 0.000). CONCLUSIONS. We highlighted the more stressful impact of Covid-19 pandemic on female adolescents, who required more psychiatric hospitalizations, in particular for suicidal behaviour, anxiety and mood disorders.

The impact of the COVID-19 pandemic on eating disorders risk and symptoms: a retrospective study.

BACKGROUND: Social distancing and quarantine imposed by the authority during the COVID-19 pandemic caused restrictions, which had a negative impact on eating behavior, especially among adolescents. We proposed a retrospective study aimed to evaluate the effect of the COVID-19 pandemic on eating disorders risk and symptoms. METHODS: In this study, a group of 127 pediatric patients (117 females and 10 males) with eating disorders admitted to the Bambino Gesù Children's Hospital of Rome (Italy), in the period between August 2019 and April 2021, was analyzed. All patient data were collected from patients' electronic medical records. RESULTS: We found that 80.3% of patients were at the onset of eating disorders and that 26% of patients had familiarity for psychotic disorders. Often these patients had comorbidities and alterations in blood parameters such as leukocytopenia, neutropenia, hypovitaminosis and hormonal problems that could affect their future. CONCLUSIONS: Our findings could provide a framework for developing clinical and educational interventions to mitigate the short- and long-term negative impact of the pandemic on adolescent future health.

The impact of social media use on body image and disordered eating behaviors: Content matters more than duration of exposure.

Social media use is rapidly expanding in terms of frequency, duration, and the diversity of platforms available. Given evidence for associations between social media use, body image disturbances, and disordered eating it is important to identify potentially harmful aspects of social media use that could serve as intervention targets. This study surveyed two demographically diverse undergraduate student cohorts in 2015 and 2022 to compare patterns in social media use, body image, and disordered eating behaviors between samples, including as a function of the COVID-19 pandemic, and to test the hypothesized moderating role of specific content consumed in the association between social media use and maladaptive outcomes. Participants in 2022 reported greater body image disturbances, more frequent vomiting and laxative use, and more time spent on a greater number of social media accounts, with significantly greater use of image-based platforms such as Snapchat, TikTok, and YouTube. Moderated regression analyses suggest that type of content consumed, but not the amount of time spent on social media or diversity of platforms utilized, is associated with body image disturbances and disordered eating behaviors after controlling for gender and body mass index. Specifically, exposure to weight loss content was associated with lower body appreciation, greater fears of negative appearance evaluation, and more frequent binge eating. Contrary to initial hypotheses, exposure to body positivity/neutrality content did not have protective effects. Findings suggest that interventions targeting negative consequences of social media use should focus on addressing content consumed, rather than time spent on social media platforms.