The Effects of Sleep Quality and Resilience on Perceived Stress,Dietary Behaviors,and Alcohol Misuse: A Mediation-Moderation Analysis of Higher Education Students from Asia,Europe, and North America during the COVID-19 Pandemic

Background: The coronavirus disease 2019 (COVID-19) pandemic has increased the already high levels of stress that higher education students experience. Stress influences health behaviors, including those related to dietary behaviors, alcohol, and sleep; yet the effects of stress can be mitigated by resilience. To date, past research studying the connections between dietary behaviors, alcohol misuse, sleep, and resilience commonly investigated singular relationships between two of the constructs. The aim of the current study was to explore the relationships between these constructs in a more holistic manner using mediation and moderation analyses. Methods: Higher education students from China, Ireland, Malaysia, South Korea, Taiwan, the Netherlands, and the United States were enrolled in a cross-sectional study from April to May 2020, which was during the beginning of the COVID-19 pandemic for most participants. An online survey, using validated tools, was distributed to assess perceived stress, dietary behaviors, alcohol misuse, sleep quality and duration, and resilience. Results: 2254 students completed the study. Results indicated that sleep quality mediated the relationship between perceived stress and dietary behaviors as well as the relationship between perceived stress and alcohol misuse. Further, increased resilience reduced the strength of the relationship between perceived stress and dietary behaviors but not alcohol misuse. Conclusion: Based on these results, higher education students are likely to benefit from sleep education and resilience training, especially during stressful events.     

Body composition in adults infected with human immunodeficiency virus in Khon Kaen, Thailand

A cross-sectional study of 77 patients infected with human immunodeficiency virus (HIV) in Khon Kaen, Thailand examined association of nutritional status with active opportunistic infections (AOIs)/HIV status and assessed degree of correlation between bioelectrical impedance analysis (BIA) and anthropometry. Many patients (41.3%) were malnourished using World Health Organization criteria for underweight, and malnutrition was associated with AOI status. Unconditional odds ratios (P < 0.05) for AOI as opposed to no AOI were 4.57 for underweight, 9.87 for severe underweight, 2.55 for triceps < 10th percentile, and 5.22 for mid-arm circumference < 10th percentile. Body fat composition from BIA, anthropometry, and body mass index were moderate to highly correlated (P < 0.001), with the highest correlation between BIA and subscapular skinfold (r = 0.86) and the lowest between BIA and triceps skinfold (r = 0.54). Insights were gained about relative value of using various measurements to assess nutritional status of HIV-infected populations.     

Gender Differences in the Relationships between Perceived Stress,Eating Behaviors,Sleep, Dietary Risk,and Body Mass Index

Background: Obesity is a growing epidemic among university students, and the high levels of stress reported by this population could contribute to this issue. Singular relationships between perceived stress; engagement in restrained, uncontrolled, and emotional eating; sleep; dietary risk; and body mass index (BMI) have been reported in the current body of literature; however, these constructs interact with each other, and the complex relationships among them are infrequently examined. Therefore, the aim of the present study was to explore the complex relationships between these constructs using mediation and moderation analyses stratified by gender. Methods: A cross-sectional study, enrolling university students from the United States (U.S.), the Netherlands, South Korea, Malaysia, Ireland, Ghana, and China, was conducted between October 2020 and January 2021 during the COVID-19 pandemic. Perceived stress; maladaptive eating behaviors including restrained, uncontrolled, and emotional eating; sleep duration and quality; dietary risk; and BMI were assessed using validated questionnaires, which were distributed through an online platform. Results: A total of 1392 students completed the online survey (379 male, 973 female, and 40 who self-identified as “other”). Uncontrolled and emotional eating mediated the relationship between perceived stress and dietary risk for both males and females; higher sleep quality weakened this relationship among female students but not males. Emotional eating mediated the relationship between perceived stress and BMI for both males and females, but higher sleep quality weakened this relationship only among females. Conclusions: Our findings suggest that students in higher education are likely to benefit from interventions to reduce uncontrolled and emotional eating. Programs that improve sleep quality, especially during highly stressful periods, may be helpful.     

Relationships between Dairy and Calcium Intake and Mental Health Measures of Higher Education Students in the United States: Outcomes from Moderation Analyses

Background: The prevalence of mental health concerns among university students in the United States (U.S.) continues to increase, while current treatments, including medication and counseling, present shortcomings. Higher dairy and calcium intakes are associated with protective effects on mental health; however, previous studies have focused on investigating singular relationships between dairy and calcium intakes and mental health measures. A more complex exploration of these relationships is warranted to better examine whether increasing dairy and calcium intakes could serve as an intervention to improve mental health. The present study sought to further characterize the relationships between dairy and calcium intake, perceived stress, and a variety of mental health measures using linear regression and moderation analyses. Methods: The present cross-sectional study involved students studying at three large U.S. universities, and data collection occurred from April to May 2020 when students were learning remotely due to the COVID-19 pandemic. An online survey comprising validated tools was distributed among students to assess dairy and calcium intake, perceived stress, anxiety, negative and positive moods, rumination, and resilience, sleep quality and duration, dietary risk, and physical activity. Results: A total of 1233 students completed the study. Higher dairy and calcium intake was coincident with lower perceived stress and higher positive mood scores, while higher calcium intake was also coincident with lower anxiety, rumination, and higher resilience scores. Additionally, as calcium intake increased, the relationship between perceived stress and anxiety and the relationship between perceived stress and negative mood weakened. Dairy intake did not have this effect. Conclusions: Based on the results, and considering that calcium is a shortfall nutrient, universities should consider initiating programs and public health campaigns to promote dairy and calcium intake among this population.     

Monitoring myeloablative therapy-induced small bowel toxicity by serum citrulline concentration: a comparison with sugar permeability tests

BACKGROUND: Intestinal mucositis is an important cause of cancer treatment-related morbidity and mortality, carrying a serious economic burden. Currently, objective parameters are lacking that would enable the monitoring of gut damage in routine clinical practice, thus hindering the development of clinical studies designed to investigate potential new strategies aimed at reducing or preventing this side effect. The authors investigated the characteristics of serum citrulline concentration compared with sugar permeability tests with respect to its use as a marker for cancer treatment-induced small bowel injury. METHODS: In this prospective study, 10 patients with hematologic malignancies who were receiving myeloablative therapy had gut toxicity assessed with sugar permeability tests. Serum citrulline concentrations also were determined using archival serum samples. The association between both parameters and their respective characteristics were analyzed and compared with data from the literature. RESULTS: Sensitivity and specificity were better for the citrulline assay compared with sugar permeability tests. Maximum gut damage assessed with the citrulline assay was observed 1-2 weeks earlier compared with the sugar permeability test. Similarly, citrulline indicated recovery of gut damage at 3 weeks after transplantation, whereas most sugar permeability tests remained abnormal. CONCLUSIONS: The simplicity of the method, the low costs, and the lack of drawbacks to the method make the citrulline assay the first choice for measuring and monitoring treatment-related gut damage and provides an objective parameter for cancer treatment-related gut toxicity.     

Sustained Dyskinesias Following Elective Cessation and Reactivation of Chronic Subthalamic Nucleus Deep Brain Stimulation for a Surgical Procedure

Objectives: Subthalamic nucleus deep brain stimulation (STN DBS) is effective for treatment of levodopa‐induced dyskinesias in patients with Parkinson's disease (PD). Medical or surgical procedures requiring electrocautery may require inactivation of the pulse generators to avoid damage to the lead or extension wire or possible reprogramming of the stimulators. This generally causes only mild and temporary disability. We report a patient with previously well‐controlled dyskinesias who had severe and prolonged dyskinesias following reactivation of deep brain stimulation (DBS) following an orthopedic procedure. Materials and Methods: Retrospective chart review. Results: The patient underwent two orthopedic procedures, each requiring inactivation of DBS. After reactivation of DBS, the patient experienced severe dyskinesias that ultimately required sedation and ventilation to control large‐amplitude dyskinesias. Conclusions: Clinicians caring for PD patients treated with STN DBS should be aware of the possible reappearance of severe dyskinesias arising from routine inactivation and reactivation of pulse generators for medical or surgical procedures.     

Noxious Stimuli Sensitivity in Regular Spicy Food Users and Non-Users: Comparison of Visual Analog and General Labeled Magnitude Scaling

The visual analog scale (VAS) and the general labeled magnitude scale (gLMS) are common response formats for assessing chemosensory sensation. The gLMS is recommended when comparing sensations between individuals whose perceptual experiences vary in a manner that may not be accurately captured on the VAS. This may occur when one group has a wider range of perceived intensity (e.g., bitterness in 6-n-propylthiouracil (PROP) tasters and non-tasters). The purpose of this study was to compare responses generated by the VAS and the gLMS following exposure to chemical, thermal, tactile, and auditory stimuli at intensity levels encountered in daily activities. Subjects were 25 healthy, lean men and women (13 regular spicy food users and 12 non-users). PROP taster prevalence was equal among regular spicy food users and non-users. Replicating a well-documented phenomenon, the slope of the function describing the growth of sensation with stimulus strength was greater for PROP in tasters than non-tasters (41.4% and 7.6% gLMS usage, respectively). The slope was greater with the VAS compared to the gLMS for all other noxious stimuli (50.1% and 29.3% scale usage, respectively). However, the slopes of both scales were moderately to highly correlated both within (all subjects) and between groups (users versus non-users and men versus women; most >0.65). These findings suggest that scale selection is context-dependent. While the VAS and the gLMS generated similar results after exposure to potentially noxious stimuli at concentrations likely to be experienced in daily life, the gLMS is more appropriate when ratings of stimuli perceived as extreme are expected.     

Bacterial growth in secretions and on suctioning equipment of orally intubated patients: a pilot study.

BACKGROUND: Contamination of equipment, colonization of the oropharynx, and microaspiration of secretions are causative factors for ventilator-associated pneumonia. Suctioning and airway management practices may influence the development of ventilator-associated pneumonia. OBJECTIVES: To identify pathogens associated with ventilator-associated pneumonia in oral and endotracheal aspirates and to evaluate bacterial growth on oral and endotracheal suctioning equipment. METHODS: Specimens were collected from 20 subjects who were orally intubated for at least 24 hours and required mechanical ventilation. At baseline, oral and sputum specimens were obtained for culturing, and suctioning equipment was changed. Specimens from the mouth, sputum, and equipment for culturing were obtained at 24 hours (n=18) and 48 hours (n=10). RESULTS: After 24 hours, all subjects had potential pathogens in the mouth, and 67% had sputum cultures positive for pathogens. Suctioning devices were colonized with many of the same pathogens that were present in the mouth. Nearly all (94%) of tonsil suction devices were colonized within 24 hours. Most potential pathogens were gram-positive bacteria. Gram-negative bacteria and antibiotic-resistant organisms were also present in several samples. CANCLUSIONS: The presence of pathogens in oral and sputum specimens in most patients supports the notion that microaspiration of secretions occurs. Colonization is a risk factor for ventilator-associated pneumonia. The equipment used for oral and endotracheal suctioning becomes colonized with potential pathogens within 24 hours. It is not known if reusable oral suction equipment contributes to colonization; however, because many bacteria are exogenous to patients' normal flora, equipment may be a source of cross-contamination.