Saturated fat and human health: a protocol for a methodologically innovative systematic review and meta-analysis to inform public health nutrition guidelines.

BACKGROUND: The health effects of dietary fats are a controversial issue on which experts and authoritative organizations have often disagreed. Care providers, guideline developers, policy-makers, and researchers use systematic reviews to advise patients and members of the public on optimal dietary habits, and to formulate public health recommendations and policies. Existing reviews, however, have serious limitations that impede optimal dietary fat recommendations, such as a lack of focus on outcomes important to people, substantial risk of bias (RoB) issues, ignoring absolute estimates of effects together with comprehensive assessments of the certainty of the estimates for all outcomes. OBJECTIVE: We therefore propose a methodologically innovative systematic review using direct and indirect evidence on diet and food-based fats (i.e., reduction or replacement of saturated fat with monounsaturated or polyunsaturated fat, or carbohydrates or protein) and the risk of important health outcomes. METHODS: We will collaborate with an experienced research librarian to search MEDLINE, EMBASE, CINAHL, and the Cochrane Database of Systematic Reviews (CDSR) for randomized clinical trials (RCTs) addressing saturated fat and our health outcomes of interest. In duplicate, we will screen, extract results from primary studies, assess their RoB, conduct de novo meta-analyses and/or network meta-analysis, assess the impact of missing outcome data on meta-analyses, present absolute effect estimates, and assess the certainty of evidence for each outcome using the GRADE contextualized approach. Our work will inform recommendations on saturated fat based on international standards for reporting systematic reviews and guidelines. CONCLUSION: Our systematic review and meta-analysis will provide the most comprehensive and rigorous summary of the evidence addressing the relationship between saturated fat modification for people-important health outcomes. The evidence from this review will be used to inform public health nutrition guidelines. TRIAL REGISTRATION: PROSPERO Registration: CRD42023387377 .

The Use of Simulated Patients Is more Effective than Student Role Playing in Fostering Patient-Centred Attitudes during Communication Skills Training: A Mixed Method Study.

Objective: While simulated patients (SPs) are considered a standard tool in communication skills training, there is no evidence thus far of their comparative benefit to the more cost-effective option of student role playing. We compared the effectiveness of both approaches in developing patient-centred attitudes in students. Methods: We retrospectively compared students who participated in the clinical communication course (CCC), based on student role playing (CCCsp-, n = 160), to students who participated in the CCC with SPs (CCCsp+, n = 146), and students with no formal CCC (CCC-, n = 122). We used validated questionnaires to assess patient centredness. We also conducted focus group interviews (FGI) to better understand the impact of CCC with sp. Results: Students after the CCC with simulated patients achieved a significantly higher score in the patient-practitioner orientation scale than other groups (p < 0.001). Conclusions: There is a strong positive correlation between the implementation of simulated patients and patient-centred attitudes among students. Data from the FGI revealed that students perceived training with SP as more realistic, safe, and engaging than student role playing. Practice Implications. Our research provides evidence to justify costs and resources invested in simulated patient programs.

Meeting the Unmet Needs of Individuals With Mental Disorders: Scoping Review on Peer-to-Peer Web-Based Interactions.

BACKGROUND: An increasing number of online support groups are providing advice and information on topics related to mental health. OBJECTIVE: This study aimed to investigate the needs that internet users meet through peer-to-peer interactions. METHODS: A search of 4 databases was performed until August 15, 2022. Qualitative or mixed methods (ie, qualitative and quantitative) studies investigating interactions among internet users with mental disorders were included. The φ coefficient was used and machine learning techniques were applied to investigate the associations between the type of mental disorders and web-based interactions linked to seeking help or support. RESULTS: Of the 13,098 identified records, 44 studies (analyzed in 54 study-disorder pairs) that assessed 82,091 users and 293,103 posts were included. The most frequent interactions were noted for people with eating disorders (14/54, 26%), depression (12/54, 22%), and psychoactive substance use disorders (9/54, 17%). We grouped interactions between users into 42 codes, with the empathy or compassion code being the most common (41/54, 76%). The most frequently coexisting codes were request for information and network (35 times; φ=0.5; P<.001). The algorithms that provided the best accuracy in classifying disorders by interactions were decision trees (44/54, 81%) and logistic regression (40/54, 74%). The included studies were of moderate quality. CONCLUSIONS: People with mental disorders mostly use the internet to seek support, find answers to their questions, and chat. The results of this analysis should be interpreted as a proof of concept. More data on web-based interactions among these people might help apply machine learning methods to develop a tool that might facilitate screening or even support mental health assessment.

When Peppa Pig and Confucius meet, joining forces on the battlefield of health literacy-a qualitative analysis of COVID-19 educational materials for children and adolescents from China, the USA, and Europe.

In times of pandemic, health literacy (HL) is very important, as it helps to find, understand, and use essential health information and services. According to WHO, HL is pivotal in fighting infodemic effectively, and education is a vital tool for developing it. In the presented work, we analyze 247 educational materials dedicated to children, adolescents, and their carers explaining the pandemic, prepared by the Chinese, American, German, Italian and Polish governments and international non-governmental organizations. Focusing on the textual and visual side of the documents, we investigated how the pandemic is explained and what discursive measures were used to inform young citizens about the risks and consequences of pandemic restrictions. Additionally, we verified whether the materials helped developing critical thinking, which is crucial to prevent spreading fake news and conspiracy theories. Although the analyzed materials were prepared in different cultural contexts, we identified that all of them contained simple instructions on the desired behaviours during the pandemic. Key messages relating to the importance of hygienic behaviors were often supplemented with guidelines on how to successfully complete each action. While the cultural particularities in presenting the state of the pandemic are visible, the challenges of dealing with the emotional and social crises were dominant all around the world. In our study, we argue that the possibilities of building HL were not fully exploited by the national and international institutions. Citizens were taught how to behave in unusual circumstances but not why they should behave differently. The educational materials lacked reliable knowledge that would allow them to deal with infodemic and develop critical thinking. We conclude that health education expertise worldwide should be focused on enhancing individuals' ability to make informed health decisions and provide three recommendations regarding the process of development of health educational resources for children and the youth.

Values and preferences influencing willingness to change red and processed meat consumption in response to evidence-based information: a mixed methods study.

OBJECTIVES: (1) to assess the extent to which omnivores are willing to stop or reduce their consumption of red and processed meat in response to evidence-based information regarding the possible reduction of cancer mortality and incidence achieved by dietary modification; (2) to identify sociodemographic categories associated with higher willingness to change meat consumption; (3) to understand the motives facilitating and hindering such a change. DESIGN: During an initial computer-assisted web interview, respondents were presented with scenarios containing the estimates of the absolute risk reduction in overall cancer incidence and mortality tailored to their declared level of red and processed meat consumption. Respondents were asked whether they would stop or reduce their average meat consumption based on the information provided. Their dietary choices were assessed at 6-month follow-up. Additionally, we conducted semi-structured interviews to better understand the rationale for dietary practices and the perception of health information. PARTICIPANTS: The study was conducted among students and staff of 3 universities in Krakow, Poland. RESULTS: Most of the 513 respondents were unwilling to change their consumption habits. We found gender to be a significant predictor of the willingness. Finally, we identified 4 themes reflecting key motives that determined meat consumption preferences: the importance of taste and texture, health consciousness, the habitual nature of cooking, and persistence of omnivorous habits. CONCLUSIONS: When faced with health information about the uncertain reduction in the risk of cancer mortality and incidence, the vast majority of study participants were unwilling to introduce changes in their consumption habits.

People's Values and Preferences about Meat Consumption in View of the Potential Environmental Impacts of Meat: A Mixed-methods Systematic Review.

BACKGROUND: Health is not the only aspect people consider when choosing to consume meat; environmental concerns about the impact of meat (production and distribution) can influence people's meat choices. METHODS: We conducted a mixed-methods systematic review, searched six databases from inception to June 2020, and synthesised our findings into narrative forms. We integrated the evidence from quantitative and qualitative data sets into joint displays and assessed the confidence in the evidence for each review finding following the GRADE-CERQual approach. RESULTS: Of the 23,531 initial records, we included 70 studies: 56 quantitative, 12 qualitative, and 2 mixed-methods studies. We identified four main themes: (1) reasons for eating meat; (2) reasons for avoiding meat; (3) willingness to change meat consumption; and (4) willingness to pay more for environmentally friendly meat. The overall confidence was low for the reasons for eating and/or buying meat, for avoiding meat, and for willingness to change meat consumption, and was moderate for willingness to pay more for environmentally friendly meat. CONCLUSIONS: Regardless of people's general beliefs about meat and its impact on the environment, most people may be unwilling to change their meat consumption. Future research should address the current limitations of the research evidence to assess whether people are willing to make a change when properly informed.

Health Related Values and Preferences Regarding Meat Intake: A Cross-Sectional Mixed-Methods Study.

BACKGROUND: In addition to social and environmental determinants, people's values and preferences determine daily food choices. This study evaluated adults' values and preferences regarding unprocessed red meat (URM) and processed meat (PM) and their willingness to change their consumption in the face of possible undesirable health consequences. METHODS: A cross-sectional mixed-methods study including a quantitative assessment through an online survey, a qualitative inquiry through semi-structured interviews, and a follow-up assessment through a telephone survey. We performed descriptive statistics, logistic regressions, and thematic analysis. RESULTS: Of 304 participants, over 75% were unwilling to stop their consumption of either URM or PM, and of those unwilling to stop, over 80% were also unwilling to reduce. Men were less likely to stop meat intake than women (odds ratios < 0.4). From the semi-structured interviews, we identified three main themes: the social and/or family context of meat consumption, health- and non-health-related concerns about meat, and uncertainty of the evidence. At three months, 63% of participants reported no changes in meat intake. CONCLUSIONS: When informed about the cancer incidence and mortality risks of meat consumption, most respondents would not reduce their intake. Public health and clinical nutrition guidelines should ensure that their recommendations are consistent with population values and preferences.

Values and Preferences Related to Cancer Risk among Red and Processed Meat Eaters: A Pilot Cross-Sectional Study with Semi-Structured Interviews.

Introduction: Over the last decade, the possible impact of meat intake on overall cancer incidence and mortality has received considerable attention, and authorities have recommended decreasing consumption; however, the benefits of reducing meat consumption are small and uncertain. As such, individual decisions to reduce consumption are value- and preference-sensitive. Consequently, we undertook a pilot cross-sectional study to explore people's values and preferences towards meat consumption in the face of cancer risk. Methods and analysis: The mixed-method pilot study included a quantitative questionnaire followed by qualitative evaluation to explore the dietary habits of 32 meat eaters, their reasons for eating meat, and willingness to change their meat consumption when faced with a potential risk reduction of cancer over a lifetime based on a systematic review and dose-response meta-analysis. We recruited a convenience sample of participants from two Canadian provinces: Nova Scotia and Prince Edward Island. This project was approved by the Research Ethics Board for Health Sciences research at Dalhousie University, Canada. Results: The average weekly consumption of red meat was 3.4 servings and the average weekly consumption of processed meat was 3 servings. The determinants that influenced meat intake were similar for both red and processed meat. Taste, cost, and family preferences were the three most commonly cited factors impacting red meat intake. Taste, cost, and (lack of) cooking time were the three most commonly cited factors impacting processed meat intake. None of the participants were willing to eliminate red or processed meat from their diet. About half of participants were willing to potentially reduce their meat consumption, with one third definitely willing to reduce their consumption. Strengths and limitations: This study is the first that we are aware of to share data with participants on the association of red meat and processed meat consumption and the risk of cancer mortality and cancer incidence, including the certainty of evidence for the risk reduction. The limitations of this study include its small sample size and its limited geographic sampling. Conclusions: When presented explicit information about the small uncertain cancer risk associated with red and processed meat consumption, study participants were unwilling to eliminate meat, while about one-third were willing to reduce their meat intake.

Experience of courtesy stigma among relatives of individuals with schizophrenia - a qualitative study. / Doswiadczenie pietna przeniesionego wsród krewnych osób ze schizofrenia ­ badanie jakosciowe.

OBJECTIVES: The aim of the study was to describe the experience of stigma as experienced by individuals accompanying their relatives with schizophrenia in Poland. METHODS: Four qualitative techniques were triangulated in the study: participant observation, content analysis, expert-interviews, and in-depth interviews. Collected data were analyzed in accordance with M.B. Miles and A.M. Huberman's model. RESULTS: Development of schizophrenia in a family member poses a risk for his/hers family caregivers to enter ?the zone of stigma'. They encounter a discursive invisibility of the mental health problems as well as missing comprehension and empathy. The stereotype-based social grid of convictions about schizophrenia, psychiatry and the lack of social clues of how to proceed, lead to the development of caregivers' sense of constant uncertainty and feeling lost. The common misconceptions about mental disorders create a greater distance and reluctance between caregivers and their distant relatives, neighbours and friends.The prevalence of the disadvantageous discourse on mental illness stimulates the relatives' anticipation of exclusion, evokes shame. Relatives often experience reluctance in their contact with psychiatric staff, ignorance of their needs and as well as professionals' therapeutic pessimism. Such components of ?the zone of stigma' pose a threat to the realization of what is at stake for family caregivers, and give way to their powerlessness. CONCLUSIONS: This article presents the results of the first qualitative study on the phenomenon conducted in Poland and characterizes the impact of stigmatizing character of schizophrenia on lives of afflicted individual's family caregivers. In-depth comprehension of the social context of accompanying a relative is crucial for addressing family caregivers' needs in a better way and developing models of cooperation between psychiatric staff and patient's family.

Evaluating adults' health-related values and preferences about unprocessed red meat and processed meat consumption: protocol for a cross-sectional mixed-methods study.

Background: People need to choose from a wide range of foods, and in addition to availability and accessibility, people's values and preferences largely determine their daily food choices. Given the potential adverse health consequences of red and processed meat and the limited knowledge on individuals' health-related values and preferences on the topic, such data would be useful in the development of recommendations regarding meat consumption. Methods and analysis: We will perform an international cross-sectional mixed methods study in four countries across two continents. The study population will consist of adult omnivores currently consuming a minimum of three weekly servings of either unprocessed red meat or processed meat. We will explore participants' willingness to stop or reduce their unprocessed red meat, or their processed meat consumption through a direct-choice exercise. This exercise will consist of presenting a scenario tailored to each individual's average weekly consumption. That is, based on a systematic review and meta-analysis of the best estimate of the risk reduction in overall cancer mortality and cancer incidence, we will ask participants if they would stop their consumption, and/or reduce their average consumption. We will also present the corresponding certainty of the evidence for the potential risk reductions. Finally, for all included participants, we will measure their meat consumption three months after the interview and determine if they have made any changes to their average consumption. Ethics and dissemination: The research protocol was approved by the ethics committees in Canada (Research Ethics Board, Dalhousie University), Spain (Comitè Ètic d'Investigació Clínica de l'IDIAP Jordi Gol), Poland (The Bioethics Committee of the Jagiellonian University), and Brazil (National Research Ethics Commission). The study is based on voluntary participation and informed written consent. Results from this project will be disseminated through publications and presentations.

Red and Processed Meat Consumption and Risk for All-Cause Mortality and Cardiometabolic Outcomes: A Systematic Review and Meta-analysis of Cohort Studies.

This article has been corrected. The original version (PDF) is appended to this article as a Supplement. Background: Dietary guidelines generally recommend limiting intake of red and processed meat. However, the quality of evidence implicating red and processed meat in adverse health outcomes remains unclear. Purpose: To evaluate the association between red and processed meat consumption and all-cause mortality, cardiometabolic outcomes, quality of life, and satisfaction with diet among adults. Data Sources: EMBASE (Elsevier), Cochrane Central Register of Controlled Trials (Wiley), Web of Science (Clarivate Analytics), CINAHL (EBSCO), and ProQuest from inception until July 2018 and MEDLINE from inception until April 2019, without language restrictions, as well as bibliographies of relevant articles. Study Selection: Cohort studies with at least 1000 participants that reported an association between unprocessed red or processed meat intake and outcomes of interest. Data Extraction: Teams of 2 reviewers independently extracted data and assessed risk of bias. One investigator assessed certainty of evidence, and the senior investigator confirmed the assessments. Data Synthesis: Of 61 articles reporting on 55 cohorts with more than 4 million participants, none addressed quality of life or satisfaction with diet. Low-certainty evidence was found that a reduction in unprocessed red meat intake of 3 servings per week is associated with a very small reduction in risk for cardiovascular mortality, stroke, myocardial infarction (MI), and type 2 diabetes. Likewise, low-certainty evidence was found that a reduction in processed meat intake of 3 servings per week is associated with a very small decrease in risk for all-cause mortality, cardiovascular mortality, stroke, MI, and type 2 diabetes. Limitation: Inadequate adjustment for known confounders, residual confounding due to observational design, and recall bias associated with dietary measurement. Conclusion: The magnitude of association between red and processed meat consumption and all-cause mortality and adverse cardiometabolic outcomes is very small, and the evidence is of low certainty. Primary Funding Source: None. (PROSPERO: CRD42017074074).

Health-Related Values and Preferences Regarding Meat Consumption: A Mixed-Methods Systematic Review.

This article has been corrected. The original version (PDF) is appended to this article as a Supplement. Background: A person's meat consumption is often determined by their values and preferences. Purpose: To identify and evaluate evidence addressing health-related values and preferences regarding meat consumption. Data Sources: MEDLINE, EMBASE, Web of Science, Centre for Agriculture and Biosciences Abstracts, International System for Agricultural Science and Technology, and Food Science and Technology Abstracts were searched from inception to July 2018 without language restrictions. Study Selection: Pairs of reviewers independently screened search results and included quantitative and qualitative studies reporting adults' health-related values and preferences regarding meat consumption. Data Extraction: Pairs of reviewers independently extracted data and assessed risk of bias. Data Synthesis: Data were synthesized into narrative form, and summaries were tabulated and certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Of 19 172 initial citations, 41 quantitative studies (38 addressed reasons for meat consumption and 5 addressed willingness to reduce meat consumption) and 13 qualitative studies (10 addressed reasons for meat consumption and 4 addressed willingness to reduce meat consumption) were eligible for inclusion. Thirteen studies reported that omnivores enjoy eating meat, 18 reported that these persons consider meat an essential component of a healthy diet, and 7 reported that they believe they lack the skills needed to prepare satisfactory meals without meat. Omnivores are generally unwilling to change their meat consumption. The certainty of evidence was low for both "reasons for meat consumption" and "willingness to reduce meat consumption in the face of undesirable health effects." Limitation: Limited generalizability of findings to lower-income countries, low-certainty evidence for willingness to reduce meat consumption, and limited applicability to specific types of meat (red and processed meat). Conclusion: Low-certainty evidence suggests that omnivores are attached to meat and are unwilling to change this behavior when faced with potentially undesirable health effects. Primary Funding Source: None. (PROSPERO: CRD42018088854).

Medicine Goes Female: Protocol for Improving Career Options of Females and Working Conditions for Researching Physicians in Clinical Medical Research by Organizational Transformation and Participatory Design.

BACKGROUND: All European countries need to increase the number of health professionals in the near future. Most efforts have not brought the expected results so far. The current notion is that this is mainly related to the fact that female physicians will clearly outnumber their male colleagues within a few years in nearly all European countries. Still, women are underrepresented in leadership and research positions throughout Europe. OBJECTIVES: The MedGoFem project addresses multiple perspectives with the participation of multiple stakeholders. The goal is to facilitate the implementation of Gender Equality Plans (GEP) in university hospitals; thereby, transforming the working conditions for women working as researchers and highly qualified physicians simultaneously. Our proposed innovation, a crosscutting topic in all research and clinical activities, must become an essential part of university hospital strategic concepts. METHODS: We capture the current status with gender-sensitive demographic data concerning medical staff and conduct Web-based surveys to identify cultural, country-specific, and interdisciplinary factors conducive to women's academic success. Individual expectations of employees regarding job satisfaction and working conditions will be visualized based on "personal construct theory" through repertory grids. An expert board working out scenarios and a gender topic agenda will identify culture-, nation-, and discipline-specific aspects of gender equality. University hospitals in 7 countries will establish consensus groups, which work on related topics. Hospital management supports the consensus groups, valuates group results, and shares discussion results and suggested measures across groups. Central findings of the consensus groups will be prepared as exemplary case studies for academic teaching on research and work organization, leadership, and management. RESULTS: A discussion group on gender equality in academic medicine will be established on an internationally renowned open-research platform. Project results will be published in peer-reviewed journals with high-impact factors. In addition, workshops on gender dimension in research using the principles of Gendered Innovation will be held. Support and consulting services for hospitals will be introduced in order to develop a European consulting service. CONCLUSIONS: The main impact of the project will be the implementation of innovative GEP tailored to the needs of university hospitals, which will lead to measurable institutional change in gender equality. This will impact the research at university hospitals in general, and will improve career prospects of female researchers in particular. Simultaneously, the gender dimension in medical research as an innovation factor and mandatory topic will be strengthened and integrated in each individual university hospital research activity. Research funding organizations can use the built knowledge to include mandatory topics for funding applications to enforce the use and implementation of GEP in university hospitals.