Effective recommendations towards healthy routines to preserve mental health during the COVID-19 pandemic

Objective: To assess the adherence to a set of evidence-based recommendations to support mental health during the coronavirus disease 2019 (COVID-19) pandemic and its association with depressive and anxiety symptoms. Methods: A team of health workers and researchers prepared the recommendations, formatted into three volumes (1: COVID-19 prevention; 2: Healthy habits; 3: Biological clock and sleep). Participants were randomized to receive only Volume 1 (control), Volumes 1 and 2, Volumes 1 and 3, or all volumes. We used a convenience sample of Portuguese-speaking participants over age 18 years. An online survey consisting of sociodemographic and behavioral questionnaires and mental health instruments (Patient Health Questionnaire-9 [PHQ-9] and Generalized Anxiety Disorder-7 [GAD-7]) was administered. At 14 and 28 days later, participants were invited to complete follow-up surveys, which also included questions regarding adherence to the recommendations. A total of 409 participants completed the study - mostly young adult women holding university degrees. Results: The set of recommendations contained in Volumes 2 and 3 was effective in protecting mental health, as suggested by significant associations of adherence with PHQ-9 and GAD-7 scores (reflecting anxiety and depression symptoms, respectively). Conclusion: The recommendations developed in this study could be useful to prevent negative mental health effects in the context of the pandemic and beyond.

Effective recommendations towards healthy routines to preserve mental health during the COVID-19 pandemic.

OBJECTIVE: To assess the adherence to a set of evidence-based recommendations to support mental health during the coronavirus disease 2019 (COVID-19) pandemic and its association with depressive and anxiety symptoms. METHODS: A team of health workers and researchers prepared the recommendations, formatted into three volumes (1: COVID-19 prevention; 2: Healthy habits; 3: Biological clock and sleep). Participants were randomized to receive only Volume 1 (control), Volumes 1 and 2, Volumes 1 and 3, or all volumes. We used a convenience sample of Portuguese-speaking participants over age 18 years. An online survey consisting of sociodemographic and behavioral questionnaires and mental health instruments (Patient Health Questionnaire-9 [PHQ-9] and Generalized Anxiety Disorder-7 [GAD-7]) was administered. At 14 and 28 days later, participants were invited to complete follow-up surveys, which also included questions regarding adherence to the recommendations. A total of 409 participants completed the study - mostly young adult women holding university degrees. RESULTS: The set of recommendations contained in Volumes 2 and 3 was effective in protecting mental health, as suggested by significant associations of adherence with PHQ-9 and GAD-7 scores (reflecting anxiety and depression symptoms, respectively). CONCLUSION: The recommendations developed in this study could be useful to prevent negative mental health effects in the context of the pandemic and beyond.

The association between region of birth and sexually transmitted infections among people of black Caribbean ethnicity attending sexual health services in England, 2015.

BACKGROUND/INTRODUCTION: In England, people of Black Caribbean (BC) ethnicity are disproportionately affected by sexually transmitted infections (STIs), but it is unclear whether this varies by their region of birth. AIM(S)/OBJECTIVES: To examine differences in STI diagnoses among UK- and Caribbean-born BC people. METHODS: Data on STI diagnoses in BC people attending specialist sexual health services (SHSs) during 2015 and living in England were obtained from the GUMCAD STI surveillance system, the national surveillance system for STIs in England. Associations between being UK- or Caribbean-born and each of several STI diagnoses were examined, using univariate and multivariable generalised estimated equations logistic regression models adjusted for sexual orientation, place of residence (London vs. non-London), HIV status, area-level deprivation, and STI diagnosis in the last year. All analyses were stratified by age (<25 vs. ≥25 years). RESULTS: In 2015, 63,568 BC people made 108,881 attendances at specialist SHSs; 81.9% of these attendances were made by UK-born BCs. The median age (years) was 26 for UK-born and 35 for Caribbean-born people (p≤0.001). Chlamydia, gonorrhoea and non-specific genital infection (NSGI) were the most commonly diagnosed STIs among UK- (5.8%, 2.1% and 2.8%) and Caribbean-born people (4.5%, 1.7% and 3.5%) respectively. Among BCs aged under 25, no significant differences in STIs were found between UK- and Caribbean-born people. Among BCs aged ≥25, compared to Caribbean-born people, those who were UK-born were more likely to be diagnosed with chlamydia (AOR 1.15 [95%C.I. 1.04-1.27]); gonorrhoea (AOR 1.23 [95%C.I. 1.06-1.45]) and genital herpes (AOR 1.23 [95% C.I. 1.10-1.56]) and less likely to be diagnosed with NSGI (AOR 0.89 [95% C.I. 0.80-0.99]) and Trichomoniasis (AOR 0.84 [95% C.I. 0.71-0.99]). DISCUSSION/CONCLUSION: STI diagnoses in BC people aged ≥25 attending specialist SHSs vary by region of birth. Country of birth may have an influence on social and sexual networks and therefore transmission of STIs.

Circadian rhythm of energy expenditure and oxygen consumption.

BACKGROUND: This study aimed to evaluate the effect of continuous and intermittent methods of enteral nutrition (EN) administration on circadian rhythm. MATERIALS AND METHODS: Thirty-four individuals, aged between 52 and 80 years, were fed through a nasoenteric tube. Fifteen individuals received a continuous infusion for 24 hours/d, and 19 received an intermittent infusion in comparable quantities, every 4 hours from 8:00 to 20:00. In each patient, 4 indirect calorimetric measurements were carried out over 24 hours (A: 7:30, B: 10:30, C: 14:30, and D: 21:30) for 3 days. RESULTS: Energy expenditure and oxygen consumption were significantly higher in the intermittent group than in the continuous group (1782 ± 862 vs 1478 ± 817 kcal/24 hours, P = .05; 257 125 vs 212 117 ml/min, P = .048, respectively). The intermittent group had higher levels of energy expenditure and oxygen consumption at all the measured time points compared with the continuous group. energy expenditure and oxygen consumption in both groups were significantly different throughout the day for 3 days. CONCLUSION: There is circadian rhythm variation of energy expenditure and oxygen consumption with continuous and intermittent infusion for EN. This suggests that only one indirect daily calorimetric measurement is not able to show the patient's true needs. Energy expenditure is higher at night with both food administration methods. Moreover, energy expenditure and oxygen consumption are higher with the intermittent administration method at all times.

Night eating patterns and chronotypes: a correlation with binge eating behaviors.

This cross-sectional study examined the association between the morningness/eveningness dimension and eating patterns. The sample consists of 100 subjects who were screened at a nutrition clinic and was composed of 77% women; mean age was 39.5 (±11.7) years; and 66% were overweight. Significant bivariate correlations were found between the Morningness-Eveningness Questionnaire (MEQ) total score and the Binge Eating Scale (BES) and the Night Eating Questionnaire (NEQ). The NEQ and BES were also significantly correlated. Body mass index (BMI) was correlated with the NEQ and BES, but it was not a confounding variable as no associations were found between the MEQ and BMI. To control for potential multicollinearity effects among variables, we also used multivariate regression analysis in which the values of the correlation coefficients were adjusted. Only the BES remained statistically associated with the MEQ. In conclusion, these results suggest that the study of chronotype may be an important issue to be considered when characterizing disordered eating. This study serves as an impetus for examining circadian intake patterns in more detail between those with binge eating disorder (BED) and night eating syndrome (NES) to help discern these important nosological questions.

Síndrome do comer noturno: aspectos conceituais, epidemiológicos, diagnósticos e terapêuticos / Night eating syndrome: conceptual, epidemiological, diagnostic and therapeutic aspects

O comportamento e o padrão alimentar são complexos, envolvendo aspectos metabólicos, fisiológicos e ambientais, e apresentando ritmicidade circadiana, herdada e espécie específica, sendo a humana essencialmente diurna. Este estudo tem como objetivo descrever a Síndrome do Comer Noturno, caracterizada por um atraso circadiano do padrão alimentar, mediado por alterações neuroendócrinas ao estresse. Procedeu-se à revisão da bibliografia existente, a partir do exame de artigos publicados pela literatura internacional nas bases de dados dos sites Pubmed, Lilacs, Sirus, referentes ao período de 1955 até as últimas publicações em 2007. Realizou-se um levantamento bibliográfico usando os seguintes descritores: night eating syndrome, sleep, circadian rhythm, appetite, nocturnal eating. Foram localizados 74 artigos e destes foram selecionados 26, cujo tema central era a Síndrome do Comer Noturno. Apesar dos estudos realizados, ainda existe longo percurso a ser percorrido para compreender a gênese da Síndrome do Comer Noturno e as relações intrínsecas desta com outros processos fisiopatogênicos. Tendo em conta que esta síndrome está vinculada ao controle da fome e da saciedade e à dessincronização entre o ritmo alimentar e o ritmo sono/vigília, a compreensão do seu processo gênico poderá demonstrar o impacto da dessincronização dos ritmos circadianos da alimentação no processo saúde-doença, e auxiliar a compreensão de fatores implicados no índice crescente de obesidade da sociedade moderna.

Behavior and eating patterns are complex, involve metabolic, physiological and environmental aspects and have inherited and species-specific circadian rhythmicity, with humans being essentially diurnal. The aim of this study is to describe the night eating syndrome, characterized by a delay of the circadian eating patterns and mediated by neuroendocrine stress. A review of the literature found in the Pubmed, Lilacs and Sirus databases published between 1955 and 2007 was done. The keywords used were: night eating syndrome, sleep, circadian rhythm, appetite, nocturnal eating. A total of 74 articles were found of which 26 were selected, whose central theme was the night eating syndrome. Despite all the studies done, there is still long way to go to understand the genesis of the night eating syndrome and its intrinsic relation with other physiological and pathogenic processes. Given that this syndrome is linked to the control of hunger and satiety and to the desynchronization between the eating rhythm and sleep / wake rhythm, understanding its genetic process can reveal the impact that the desynchronization of circadian eating rhythms has on the health-disease process and help understand the factors involved in the rising rates of obesity in modern society.

Transtornos alimentares e padrão circadiano alimentar: uma revisão / Eating disorders and circadian eating pattern: a review

Este artigo tem como objetivo revisar aspectos relacionados a transtornos alimentares e suas relações com as alterações no ritmo circadiano. Realizou-se uma busca sistematizada das informações nas bases de dados PubMed usando os seguintes descritores: eating disorders, circadian rhythm, night eating syndrome, binge eating disorder e sleep patterns. Os transtornos alimentares, como a síndrome do comer noturno e o transtorno da compulsão alimentar periódica, têm sido considerados e relacionados a um atraso no ritmo circadiano da ingestão alimentar e saciedade prejudicada. Os ritmos circadianos são aqueles que apresentam um período de 24 h, como, por exemplo, o ciclo sono-vigília, temperatura corporal, atividade e comportamento alimentar. Distúrbios provocados pelas alterações nos horários de sono/vigília influenciam o apetite, a saciedade e, consequentemente, a ingestão alimentar, o que parece favorecer o aumento desses transtornos. Percebe-se que o comportamento alimentar pode ser influenciado por ritmos circadianos. Porém, mais estudos e o maior conhecimento sobre a ritmicidade alimentar podem contribuir com o melhor entendimento do comportamento alimentar atual, atuando na prevenção e/ou tratamento de transtornos alimentares.

This review aims at reviewing aspects related to eating disorders arising from changes in circadian rhythm. There was a systematic search in PubMed databases, using the following descriptors: eating disorders, circadian rhythm, night eating syndrome, binge eating disorder, and sleep patterns. Eating disorders, such as night eating syndrome and binge eating disorder, have been considered and related to a delay in circadian rhythm in food intake and impaired satiety. Circadian rhythms are those that show a period of 24 h, for example, sleep-wake cycle, body temperature, activity and eating behavior. Disorders related to changes in sleep-wake schedules influence the appetite, satiety and consequently food intake, which seems to increase such disorders. Circadian rhythm can influence eating behavior. However, more studies and knowledge about food rhythmicity might contribute to better understanding the current eating behavior, acting in prevention and/or treatment of eating disorders.

[Translation and adaptation of the Brazilian version of the Night Eating Questionnaire]. / Tradução e adaptação da versão brasileira do Night Eating Questionnaire.

The goal of this study was to translate and adapt the Night Eating Questionnaire to Portuguese and assess the reliability of the Portuguese-language version. The study included two phases. The first consisted of: (1) translation into Portuguese; (2) back-translation into English; (3) correction and semantic adaptation; (4) content validation; and (5) assessment of the understanding of the questionnaire by means of 10 cm Visual Analogue Scales with 30 adult users of a nutritional support clinic. In the second phase, the questionnaire's reliability was assessed in 100 subjects with similar demographic characteristics to the first sample. In the fifth step, understanding of the instrument assessed by the visual analogue scales was 8.20+/-1.55 cm. The instrument showed satisfactory internal consistency, with an overall Cronbach alpha of 0.78. The Portuguese version proved to be easily understandable, with good semantic validation and consistency, suggesting that the questionnaire may be a good instrument for screening the night eating syndrome. However, other psychometric characteristics of this instrument need to be assessed in samples with different social and educational levels.

Tradução e adaptação da versão brasileira do Night Eating Questionnaire / Translation and adaptation of the Brazilian version of the Night Eating Questionnaire

O objetivo deste estudo foi traduzir e adaptar o conteúdo do Night Eating Questionnaire e avaliar a confiabilidade da versão em português. O estudo envolveu duas fases. A primeira constituiu-se da: (1) tradução; (2) retradução para o Inglês; (3) correção e adaptação da semântica; (4) validação do conteúdo; e (5) avaliação da clareza do questionário por meio de escalas analógico-visuais de 10cm com trinta adultos de uma clínica de suporte nutricional. Na segunda, avaliou-se a confiabilidade com 100 sujeitos, cujo perfil foi similar ao da primeira etapa. Na quinta etapa, a compreensão do instrumento aferida pela escalas analógico-visuais teve média de 8,20 ± 1,55cm. Este instrumento demonstrou consistência interna satisfatória, com um coeficiente geral alfa de Cronbach = 0,78. A versão mostrou ser de fácil compreensão, obtendo-se adequada validação semântica e de consistência. Isso sugere que o instrumento pode ser adequado para screening da síndrome do comer noturno. No entanto, é necessário avaliar as características psicométricas deste instrumento em amostra com diferentes níveis sociais e educacionais.

The goal of this study was to translate and adapt the Night Eating Questionnaire to Portuguese and assess the reliability of the Portuguese-language version. The study included two phases. The first consisted of: (1) translation into Portuguese; (2) back-translation into English; (3) correction and semantic adaptation; (4) content validation; and (5) assessment of the understanding of the questionnaire by means of 10cm Visual Analogue Scales with 30 adult users of a nutritional support clinic. In the second phase, the questionnaire's reliability was assessed in 100 subjects with similar demographic characteristics to the first sample. In the fifth step, understanding of the instrument assessed by the visual analogue scales was 8.20±1.55cm. The instrument showed satisfactory internal consistency, with an overall Cronbach a of 0.78. The Portuguese version proved to be easily understandable, with good semantic validation and consistency, suggesting that the questionnaire may be a good instrument for screening the night eating syndrome. However, other psychometric characteristics of this instrument need to be assessed in samples with different social and educational levels.