Depression,Anxiety,and Behavioural Changes during the COVID-19 Pandemic among Medical and Nursing Students

During the COVID-19 pandemic,medical and nursing students are faced with various challenges such as the need to attend online classes and juggling clinical postings under the new norm.This study aimed to assess the asso-ciation between depression,anxiety,and behavioural changes among medical and nursing students during the COVID-19 pandemic.An online self-administered questionnaire was distributed between March 2021 and July 2021 to 292 undergraduates medical and nursing students in a higher education institute on the East Coast of Malaysia.The questionnaires consisted of four parts:sociodemographic data,the Generalised Anxiety Disor-der-7,the Patient Health Questionnaire-9,and questions related to behaviours during the COVID-19 pandemic.This study found that 23.6%and 33.6%of the students experienced anxiety and depression respectively,possibly caused by the COVID-19 pandemic.Anxiety was associated with a high level of behavioural changes during the pandemic with a total of 87%of the students showing behavioural changes.Therapeutic interventions such as online counselling and consultation should be implemented by the university to reduce the prevalence of depres-sion and anxiety resulting from the COVID-19 pandemic among medical and nursing students.

The Experience and Impact of a Fitbit-Based Physical Activity and Sleep Hygiene Intervention for Older Adults Experiencing Cognitive Decline

Objectives: This study aimed to understand the experience and impact of a physical activity and sleep wrist-worn tracker (Fitbit)-based healthy lifestyle intervention for older patients attending a memory assessment service, who are experiencing cognitive impairment but do not receive a dementia diagnosis. Methods: A qualitative design was employed. Semi-structured interviews were conducted with a purposeful sample of thirteen participants recruited from a memory assessment service. Thematic analysis, that was data driven and inductive, was undertaken to analyse the data. Results: Two global themes were developed. “Understanding exercise and sleep as part of my lifestyle” was made up of themes representing how participants viewed exercise and sleep as part of their lifestyles in terms of acknowledging the positive impacts and the barriers to exercise and sleep. The second global theme “Understanding my experience of the healthy lifestyle intervention” was made up of themes that identified the positive impact of the intervention regarding improving health and wellbeing, enabling validation of proactive behaviours and motivation to engage in healthy lifestyle behaviours, so promoting positive behaviour change. Conclusion: Patients experiencing age-related cognitive impairment, applied and benefited from a healthy lifestyle Fitbit-based intervention to facilitate and promote physical activity, better sleep hygiene and healthy lifestyles.

Influence of lane change on stability analysis for two-lane traffic flow

This paper deals mainly with the influence of lane changing behaviours on the stability of two-lane traffic flow under a periodic boundary condition. Following the description of an optimal velocity model for two vehicle groups and the derivation of their stability conditions, the feedback signals, which involve information about vehicles from both lanes acting on the two-lane traffic system, are introduced into the optimal velocity model. The control signals play a role in alleviating the traffic jam only if the traffic state is in congestion, and their role will vanish if the traffic state is in the steady state. The numerical simulations show that lane changing behaviours can break the steady state of two-lane traffic flow and aggravate the traffic disturbance, but the control method would successfully suppress the traffic jam eventually, which implies that the conclusions obtained here have certain theoretical and practical significance.

Understanding the Underlying Mechanisms of Action for Successful Implementation of Social Prescribing

There is growing evidence for the use of social prescribing as a means of facilitating healthy lifestyle behavior changes by linking patients to sources of support in the community. However, there are gaps in understanding about what works to facilitate and enable this behavior change i.e. , the mechanisms of actions underpinning social prescribing delivery. This study used a qualitative approach involving interviews with 18 Social Prescription Link Workers (SPLWs). Reflective thematic analysis was used to analyze the data. Through this, an overall theme of “Theoretical underpinning: Solution-focused and strengths-based” was identified. This was made up of sub-themes relating to mechanisms underpinning: the SPLWs’ role (comprising asking questions, motivational interviewing and the therapeutic alliance);the patients’ role, (empowerment and active engagement);and the approach adopted (solution building, goal and action orientated). To formalize this, a framework could be developed for SPLWs that encapsulates the solution-focused strengths-based approach for application within social prescribing. This framework can then be embedded into practice facilitating more successful healthy lifestyle behavior change for social prescribing patients.

Single-pilot operations in commercial flight:Effects on neural activity and visual behaviour under abnormalities and emergencies

With cutting-edge technologies and considering airline human-resource-saving,a single pilot in commercial jets could be technically feasible.Investigating changes in captains’natural behaviours are initially required to comprehend the specific safe human performance envelope for safeguarding single-pilot flight,particularly in high-risk situations.This paper investigates how captains’performance transforms for fixing emergencies when operating from Dual-Pilot Operations(DPO)to Single-Pilot Operations(SPO)through a physiological-based approach.Twenty pilots flew an emergency-included flight with/without first officers’assistance.The neural activities and scanning behaviours were recorded using a 32-channel Electroencephalogram(EEG)and glasses-based eye tracker,with the observation and post-experiment questionnaires to evaluate the flight operations and pilots’perception.Flying alone,there was a significantly increased cortical activity in h and b waves over the frontal,parietal,and temporal lobes during the more complicated emergencies,and pilots focused less on the primary flight display while spending significantly more time scanning the other interfaces.The physiological fluctuating patterns associated with risky operations in SPO were highlighted by cross-correlating multimodal data.The experimental-based noteworthy insights may wish to inform commercial SPO measures to lessen the persistent physiological fluctuation,assisting airlines in creating SPO-oriented intelligent flight systems to give captains adequate support for assuring safer air transportation.

Incident prevention tools-incident investigations and pre-job safety analyses

Careful and thorough incident investigations and pre-job safety analyses completed by knowledgeable and competent individuals can significantly reduce workplace incidents. Working parties must act together to make these safety tools effective. To get the staff units to work together in a co-ordinated manner, they must be shown the value of their work in preventing accidents. Examples of actual accidents investigated during the author's 18 years as a mine inspector in Saskatchewan are discussed within the context of pre-job safety analyses. The causes of the accidents are explored with close reference to how pre-job safety analyses could have prevented their occurrence.

Social Prescribing through Primary Care: A Systematic Review of the Evidence

Background: In primary care, social prescribing (SP) is where a patient is referred to a “link worker”, who considers their needs and then “prescribes” or connects them to appropriate community-based resources and services. Recent policy and guidance in the UK has significantly expanded the provision of SP to improve patient health and wellbeing. Methods: This study conducted a systematic review of evidence for SP effectiveness and to report needs addressed, interventions provided, and behaviour change techniques employed. Inclusion criterion was patient referral from primary care to a SP link worker. Online databases were searched for studies published from February 2016 to July 2021. Searches were restricted to English language only. Risk of bias assessment and a narrative analysis were undertaken. Results: Eight studies were included. All studies reported some positive outcomes. There were weaknesses and limitations in study design and in reporting of results: a lack of comparative controls, short duration and single point follow-up, a lack of standardised assessments, missing data, and a failure to consider potential confounding factors. All studies had features which indicated a high risk of bias. Conclusion: Evidence for the value and positive impact of SP is accumulating, but evaluation design remains relatively weak. There is a need to improve evaluation through robust methodological design and the adoption of universal outcome measures and evaluation/analytical framework. SP should seek to assess patient wellbeing, self-management, and quality of lifeoutcomes systematically, and adopt behaviour change techniques to enable healthier lifestyles in the short and long term.

Integrated Review of Lifestyle Interventions Targeting Diet and Exercise in Early or First-Episode Psychosis

Aims: Life expectancy is reduced by 10 - 20 years in psychotic disorders compared with the general population, largely due to high incidence of physical health disorders: heart attack, stroke, obesity, cardiovascular disease (CVD), and type 2 diabetes. Early or first-episode psychosis patients can be especially vulnerable to physical health, psychological and social consequences of antipsychotic medication weight gain. The aim of this paper is to review diet and exercise lifestyle interventions employed to address these issues. Method: A review of research evidence on lifestyle interventions (diet and exercise) for individuals with early or first-episode psychosis (2000 to 2020) was undertaken. An internet-based literature search employed Medline, PsycINFO, Embase, PubMed and Web of Science. Results: Nine studies meeting the criteria were identified: comprising of three exercise intervention studies, one diet intervention study, and five combined diet and exercise intervention studies. Only one study used a RCT design with prior power analysis to determine participant numbers, two had a RCT design, two had a comparison group and four had no control group. Overall, these studies show that exercise and diet focused interventions may provide beneficial physical and mental health outcomes, but participant engagement and behaviour change may be difficult to achieve in early or first-episode psychosis due to individual factors associated with the experience of psychosis and medication prescribed, and health service related factors. Conclusion: There is a need for evidence-based lifestyle programmes in early or first-episode psychosis that includes individually targeted evidence based exercise and diet interventions. Further appropriately powered RCTs are required to strengthen the evidence base.

Efficacy of telemedicine on glycaemic control in patients with type 2 diabetes:A meta-analysis

BACKGROUND Telemedicine is defined as the delivery of health services via remote communication and technology.It is a convenient and cost-effective method of intervention,which has shown to be successful in improving glyceamic control for type 2 diabetes patients.The utility of a successful diabetes intervention is vital to reduce disease complications,hospital admissions and associated economic costs.AIM To evaluate the effects of telemedicine interventions on hemoglobin A1c(HbA1c),systolic blood pressure(SBP),diastolic blood pressure(DBP),body mass index(BMI),post-prandial glucose(PPG),fasting plasma glucose(FPG),weight,cholesterol,mental and physical quality of life(QoL)in patients with type 2 diabetes.The secondary aim of this study is to determine the effect of the following subgroups on HbA1c post-telemedicine intervention;telemedicine characteristics,patient characteristics and self-care outcomes.METHODS PubMed Central,Cochrane Library,Embase and Scopus databases were searched from inception until 18th of June 2020.The quality of the 43 included studies were assessed using the PEDro scale,and the random effects model was used to estimate outcomes and I2 for heterogeneity testing.The mean difference and standard deviation data were extracted for analysis.RESULTS We found a significant reduction in HbA1c[-0.486%;95%confidence interval(CI)-0.561 to-0.410,P<0.001],DBP(-0.875 mmHg;95%CI-1.429 to-0.321,P<0.01),PPG(-1.458 mmol/L;95%CI-2.648 to-0.268,P<0.01),FPG(-0.577 mmol/L;95%CI-0.710 to-0.443,P<0.001),weight(-0.243 kg;95%CI-0.442 to-0.045,P<0.05),BMI(-0.304;95%CI-0.563 to-0.045,P<0.05),mental QoL(2.210;95%CI 0.053 to 4.367,P<0.05)and physical QoL(-1.312;95%CI 0.545 to 2.080,P<0.001)for patients following telemedicine interventions in comparison to control groups.The results of the meta-analysis did not show any significant reductions in SBP and cholesterol in the telemedicine interventions compared to the control groups.The telemedicine characteristic subgroup analysis revealed that clinical treatment models of intervention,as well as those involving telemonitoring,and those provided via modes of videoconference or interactive telephone had the greatest effect on HbA1c reduction.In addition,interventions delivered at a less than weekly frequency,as well as those given for a duration of 6 mo,and those lead by allied health resulted in better HbA1c outcomes.Furthermore,interventions with a focus on biomedical parameters,as well as those with an engagement level>70%and those with a drop-out rate of 10%-19.9%showed greatest HbA1c reduction.The patient characteristics investigation reported that Hispanic patients with T2DM had a greater HbA1c reduction post telemedicine intervention.For self-care outcomes,telemedicine interventions that resulted in higher postintervention glucose monitoring and self-efficacy were shown to have better HbA1c reduction.CONCLUSION The findings indicate that telemedicine is effective for improving HbA1c and thus,glycemic control in patients with type 2 diabetes.In addition,telemedicine interventions were also found to significantly improved other health outcomes as well as QoL scores.The results of the subgroup analysis emphasized that interventions in the form of telemonitoring,via a clinical treatment model and with a focus on biomedical parameters,delivered at a less than weekly frequency and 6 mo duration would have the largest effect on HbA1c reduction.This is in addition to being led by allied health,through modes such as video conference and interactive telephone,with an intervention engagement level>70%and a drop-out rate between 10%-19.9%.Due to the high heterogeneity of included studies and limitations,further studies with a larger sample size is needed to confirm our findings.

Prediabetes and cardiovascular complications study:Highlights on gestational diabetes, self-management and primary health care

International collaboration on the prediabetes and cardiovascular complications study started in 2013.In 2017,a reflection was reported.Incompleteness of documentation and screening of antenatal cases for gestational diabetes mellitus(GDM)was concerning.Hence,further observations have been made that warrant an update.The objective of this review is to highlight gaps between clinical knowledge and practice in GDM,diabetes self-management and primary health care(PHC)for rural dwellers.We followed a descriptive field notes method.Antenatal records of patients screened for GDM with incomplete documentation were examined to determine incompleteness of data in those that also met the criteria for GDM risk assessment.Experiences on development of a diabetes register and education and notes on behavioural change wheel were also reviewed.Other data included cross-sectional evaluation of activities of daily living at two private hospitals.Up to 29%had high GDM risk factors,which fulfilled selection criteria for laboratory screening.Demographic data was complete in all women;however,incomplete documentation was observed with as much as 98%of basic data.High levels of physical activity were found in the population,and health lectures proved effective in food choices.The workforce need for diabetes care seems underestimated,but this may be better understood with reactivation of PHC services.The observations highlight behavioural change wheel issues on GDM and PHC services that need concerted focus.Two proposals are to advance the use of a‘risk assessment and screening sheet’for GDM screening and enlightenment of stakeholders on the central hub role of PHC in diabetes management.

Acute Toxicity and Behavioural Responses of African Catfish,Clarias gariepinus to Amine Salt of 2,4-D

Fingerlings of African catfish,Clarias gariepinus [mean total length,(7.0±1.0) cm SD;mean weight,(3.0±0.7) g SD] were exposed to acute concentrations of amine salt of 2,4-D(0,50,200,250,350,and 400 mg/L) to determine the behavioural responses and mortality.When raised in aquaria the fish became hyperactive.The beat frequencies(opercular and tail beat frequency per minute,OBF and TBF) of the exposed fish declined with increase in the exposure duration and concentration,but the reverse was the case with percent mortality.These variables signifi cantly differed at both the exposure duration and concentration of the toxicant(P<0.05).Anova of the linear regression between variables-OBF,TBF and mortality on exposure duration indicated a strong positive relationship(P<0.001) with the entire variables except mortality and exposure duration.OBF and TBF were inversely correlated with exposure duration(r=-0.99;P<0.05).The 96 h lethal concentration was 165.36(133.29～190.51,C.L.) mg/L and the median lethal time at the highest concentration was 20.41(11.87～27.46) h.The results from this study revealed that 2,4-D was very toxic to C.gariepinus under laboratory conditions and its application should therefore,be restricted in the field.

Neglected tropical diseases activities in Africa in the COVID-19 era:the need for a"hybrid" approach in COVID-endemic times

With the coronavirus disease 2019(COVID-19)pandemic showing no signs of abating,resuming neglected tropical disease(NTD)activities,particularly mass drug administration(MDA)Z is vital.Failure to resume activities will not only enhance the risk of NTD transmission,but will fail to leverage behaviour change messaging on the importance of hand and face washing and improved sanitation--a common strategy for several NTDs that also reduces the risk of COVID-19 spread.This so-called"hybrid approach"will dem on strate best practices for mitigating the spread of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)by incorporating physical distancing,use of masks,and frequent hand-washing in the delivery of medicines to endemic communities and support action against the transmission of the virus through water,sanitation and hygiene interventions promoted by NTD programmes.Unless MDA and morbidity management activities resume,achievement of NTD targets as projected in the WHO/NTD Roadmap(2021-2030)will be deferred,the aspirational goal of NTD programmes to enhance universal health coverage jeopardised and the call to leave no one behind'a hollow one.We outline what implementing this hybrid approach,which aims to strengthen health systems,and facilitate integration and cross-sector collaboration,can achieve based on work undertaken in several African countries.