Lessons from the Netherlands for Australia: cross-country comparison of trends in antidepressant dispensing 2013-2021 and contextual factors influencing prescribing.

BACKGROUND: There is concern internationally about increasing antidepressant use. Most antidepressants are prescribed in general practice. The aim of this study was to compare trends in antidepressant dispensing in Australia and the Netherlands over the 9years from 2013 to 2021, and to explore reasons for differences. METHODS: A convergent mixed methods study including analysis of publicly available antidepressant dispensing data obtained from Australia's Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme and the Dutch Foundation for Pharmaceutical Statistics and a search of relevant literature to compare contextual factors influencing prescribing were undertaken. RESULTS: In 2013, antidepressant dispensing rates in Australia were nearly twice as high as those in the Netherlands (82.5 versus 44.3DDD/1000/day) and increased to be more than twice as high by 2021 (115.6 versus 48.8DDD/1000/day). Antidepressant dispensing increased by 40% in Australia over the nine study years, but by only 10% in the Netherlands. Our scan of the literature confirms that while population factors, health system structure, and clinical guideline recommendations are largely consistent across the two countries, a multifaceted approach in the Netherlands involving improved access to non-pharmacological alternatives, initiatives targeting safer antidepressant prescribing, and tight regulation of pharmaceutical industry influence on prescribers, has successfully curtailed increasing antidepressant use. CONCLUSIONS: Australia may learn from the Netherlands' approach to redress increasing antidepressant use.

A qualitative exploration of the experiences of shift workers participated in a low-calorie meal replacement dietary intervention.

OBJECTIVES: Shift work is associated with various health challenges, including obesity and metabolic disturbances. To address these concerns, a randomised controlled clinical trial was conducted to evaluate the efficacy of a low-calorie meal replacement (MR) dietary intervention for dinner among shift workers with obesity. This study focuses on the qualitative aspects of this intervention, aiming to explore the experiences and perceptions of shift workers who participated in the trial. DESIGN: Following the completion of the intervention, semi-structured face-to-face or telephone interviews were conducted with a purposive sample of trial participants. Data analysis was inductive, thematic using NVivo V.10 software. SETTING: The intervention was conducted among shift workers with obesity in a private hospital in Sri Lanka and resulted in a modest decrease in weight. PARTICIPANTS: Using purposeful maximum variation sampling, we recruited eight healthcare shift workers who took part in a weight loss intervention. RESULTS: All participants expressed satisfaction with the MR meal for dinner, highlighting its positive impact on their well-being. Despite initial difficulties, strong determination and motivation by results supported adherence. Some participants suggested that the MR could be improved with sweeter taste and more flavour options. Few reported mild bloating at the beginning, but no serious side effects were noted. Participants felt lighter in their bodies due to weight loss. The method's simplicity was the most frequently reported benefit, making it feasible even during busy night shifts. Overall, participants highly recommended the intervention to others in need. CONCLUSION: Participants experienced weight loss by replacing their dinner with the MR. This study offers valuable insights for tailoring future workplace-based dietary interventions for this vulnerable population. TRIAL REGISTRATION NUMBER: ACTRN12622000231741.

The effect of shift work on different hematological parameters among healthcare workers.

Shift workers frequently experience alterations in their circadian rhythms, which are correlated with variations in hematological parameters. Changes in blood cells may be related to an individual's health status. Therefore, this study aimed to compare the relationship between shift work and changes in blood cells among a group of healthcare workers in Sri Lanka. A comparative cross-sectional study was conducted among healthcare workers, recruited by a stratified random sampling technique. Socio-demographic data were collected using a structured questionnaire. Venous blood samples were obtained and analyzed for the determination of total and differential blood cell counts. Descriptive statistics were used for the analysis of sociodemographic and hematological parameters. A sample of 37-day workers and 39 shift workers were included in the analysis. The mean ages (years) were not significantly different between the groups (36.8 ± 10.8 vs 39.1 ± 12.0; P = 0.371). Shift employees showed a significantly higher total mean white blood cell count (WBC) of 7548.75 mm-3 compared to day workers' 6869.19 mm-3 (P = 0.027). They also had higher mean absolute counts for all different WBC types (Neutrophils: 3949.2 vs 3557.7 , Lymphocyte: 2756.5 vs 2614.2 , Eosinophil: 317.6 vs 233.4 , Monocytes: 491.63 vs 432.51 , Basophils: 31.68 vs 29.22 ). Shift employees exhibited higher WBC counts than day workers at the same level of work experience. The length of shift work exposure revealed a positive link with neutrophil (r = 0.225 ) and eosinophil counts (r = 0.262 ), whereas these correlations were negative for day workers. Shift workers were associated with higher WBC counts in healthcare workers compared to their day-working counterparts.

Impact of the economic crisis on food consumption of Sri Lankans: An online cross-sectional survey.

AIMS: This study investigated how the economic crisis has changed Sri Lankans' food consumption. METHODS: A web-based cross-sectional survey was carried out in the month of July 2022, using an e-questionnaire based on Google Forms. The questionnaire assessed respondents' socio-demographics, food consumption, and dietary patterns before and during the economic crisis. The changes were compared using descriptive statistics and inferential statistics. RESULTS: A total of 1095 respondents, aged ≥18 years were included in the survey. There was a significant reduction in the average consumption of main meals per day during the economic crisis (pre: 3.09 ± 0.42, post: 2.82 ± 0.47; P < 0.001). The intake of food items such as rice, bread, and snacks also reduced significantly (P < 0.001). The average daily milk intake frequency decreased from 1.41 ± 1.07 to 0.57 ± 0.80 meals/day (P < 0.001). On contrary, the intake of non-dairy beverages such as malted milk and "plain tea" has increased by several folds. Consumption of fruit and vegetables showed a significant reduction in both frequency and portion size. The consumption of meat, fish, eggs and dhal also decreased in around three-quarters of the study sample. During this period majority (81%) used food coping mechanisms and the most adopted strategy was buying less expensive food. CONCLUSION: Sri Lankans' food consumption have been adversely altered due to the country's economic crisis. There has been an overall reduction in the amount and frequency of intake of many common food items.

COVID-19 vaccine hesitancy in Sri Lanka: A national level survey.

Objective: It is important to understand the factors associated with vaccination hesitancy for a given population for successful coronavirus disease-2019 (COVID-19) immunization program. This survey aimed to examine the prevalence of vaccine hesitancy and associated sociodemographic factors. Methods: A cross-sectional online survey was undertaken by circulating through social media platforms. Survey questions included sociodemographics and vaccination acquisition-related questions. Results: The study comprised a total of 3621 respondents. Over one-fifth of the unvaccinated population were identified as vaccine hesitancy group. Ethnicity and district indicated significant associations with vaccine hesitancy (P < 0.05). Indian Tamils (Odds Radio [OR] 2.222; 95%Confidence interval [CI], 1.150-4.294; P = 0.018), Sri Lankan Tamils (OR 1.714; 95% CI, 1.181-2.488; P = 0.005), and Sri Lankan Moors (OR 1.913; 95% CI, 1.316-2.781; P = 0.001) had significantly higher odds of vaccine hesitancy when compared to the Sinhalese. People in rural areas also had greater odds of vaccine hesitancy (OR 1.339; 95% CI, 1.000-1.793; P = 0.05) compared to municipal council areas. Conclusion: Vaccine hesitancy was considerably high in this survey population. Our results emphasize the need of the Sri Lankan government taking appropriate efforts to establish a targeted COVID-19 vaccination campaign plan for rural and Colombo district residents. Attention should also be given to ethnic minority groups.

The effects of pyridoxine (vitamin B6) supplementation in nausea and vomiting during pregnancy: a systematic review and meta-analysis.

PURPOSE: Nausea and vomiting during pregnancy (NVP) are common symptoms in pregnancy. Although no definitive treatment option for NVP, pyridoxine (Vitamin B6) supplementation has been used widely. The present study aims to systematically evaluate the current evidence regarding pyridoxine for the treatment of NVP. METHODS: Data were obtained using a stepwise search process using keywords in the following online medical databases; PubMed®, Web of Science®, and Scopus® for studies published before 1st May 2021. Studies reporting intervention with pyridoxine supplementation alone and/or with other active substances were included. A meta-analysis was performed on the PUQE score and Rhode's score for nausea and vomiting. FINDINGS: Initial database searching indicated 548 potentially eligible articles, of which 18 studies satisfying the inclusion criteria were selected. Eight studies showed beneficial effects with pyridoxine alone as the supplementation, while six others found that the supplementation of pyridoxine in combination with another active substance had favourable effects. Supplementation of pyridoxine alone as well as combined treatment of pyridoxine with an active ingredient as the intervention significantly improved the symptoms of nausea according to Rhode's score [0.78 [95% CI: 0.26, 1.31; p = 0.003; I2 = 57%, p = 0.10)] and PUQE score [0.75 (95% CI: 0.28, 1.22; p = 0.002; I2 = 0%, p = 0.51)], respectively. CONCLUSION: Supplementation of pyridoxine alone as well as with an active ingredient demonstrated beneficial effects for women suffering from NVP.

The impact of the Sri Lankan economic crisis on medication adherence: An online cross-sectional survey.

Background: The economic crisis in Sri Lanka has disarrayed the country's healthcare services, posing a challenge to people with chronic diseases on routine care. This study investigated the changes in medication adherence during the economic crisis. Methods: A web-based cross-sectional survey was undertaken in July-August 2022. It assessed socio-demographics, diseases, medication adherence, and reasons for changes in compliance of respondents and their family members during the economic crisis. Descriptive statistics and multivariable logistic regression analysis were used. Findings: A total of 1214 respondents, aged ≥18 years were included in the survey. The majority were females (60%). The main finding was that 39%, 41%, and 37% of participants, their family members, or children respectively have changed medication use during the crisis. Among those who changed their medication practices, the most significant change was the change in the brand, reported by 44.7% of the respondents. A similar pattern was observed among other family members, with 61.3% of adults and 53.8% of children switching brands. Respondents who lived outside the Colombo district had a significantly increased risk of changing medication (OR = 1.425, 95% CI = 1.020-1.992, P = 0.038). Respondents with monthly incomes of less than 100,000 LKR had a twofold greater risk of medication nonadherence compared to participants who earned more than 100,000 LKR per month (OR = 2.278, 95% CI = 1.37-3.78, P = 0.001). The most stated reason for changing medication among adults was the high cost of drugs, whereas among, children, the lack of access to drugs in the public or private sector was the leading cause of non-compliance. Interpretation: The population's adherence to medication is negatively impacted by the economic crisis in Sri Lanka.

Shift Work is Associated with an Elevated White Blood Cell Count: A Systematic Review and Meta-Analysis.

The white blood cell (WBC) count increases significantly in reaction to infections and certain chronic diseases. Shift employment increases the risk for chronic low-grade inflammation and the progression of several chronic diseases. The objective of this study was to systematically evaluate the evidence from studies on total and differential WBC counts in shift employees. A literature search was performed in PubMed®, Web of Science, and Scopus databases using keywords for research published before March 1, 2022. A meta-analysis was conducted for total and differential WBC counts using a random-effects approach. A total of 25 studies covering a sample of 37,708 day and shift employees were included in this review. The studies represented America, Europe, East Asia, and Middle East. A significant increase in the total counts (×109/L) of WBC [mean difference (MD) = 0.43; 95% confidence interval (CI): 0.34-0.52; P < 0.001], lymphocytes (MD = 0.16; 95% CI: 0.02-0.30; P = 0.02), monocytes (MD = 0.04; 95% CI: 0-0.07; P = 0.03), and eosinophils (MD = 0.01; 95% CI: 0-0.01; P = 0.03) was observed in shift workers compared to the day counterparts. However, neutrophils and basophils were not significantly different between the groups. Shift work significantly increases the total and differential blood counts in peripheral circulation. Therefore, total and differential WBC counts represent a relatively inexpensive biomarker for diagnostics and prognostics of diseases in shift workers.

Meal replacement as a weight loss strategy for night shift workers with obesity: a protocol for a randomized controlled trial.

BACKGROUND: Shift work is considered a risk factor for a number of chronic health conditions including obesity. Weight reduction in obese patients lowers the risk for cardiovascular disease, diabetes, certain cancers, and mortality. Achieving a negative energy balance by providing low-calorie meal replacements is widely used for weight management. This study aims to evaluate the impact of a low-calorie "meal-replacement" on the weight and metabolic parameters of shift workers with obesity. METHODS: This trial will be conducted in a parallel, randomized controlled design for a period of 8 weeks. A total of 44 shift workers with body mass index over 25 kg/m2 will be recruited after assessing eligibility. Participants will be randomly assigned to the test and control groups on a 1:1 ratio. The intervention group (N = 22) will be provided with a low-calorie (~200 kcal) meal replacement shake as dinner, and the control group (N = 22) will continue their habitual diets. The visits and the evaluations will be done as follows: screening (visit 0), 4 weeks (visit 1), and 8 weeks (visit 2). Anthropometric measurements will be taken at 0, 4, and 8 weeks. Body composition, biochemical parameters, dietary intake, and physical activity will be assessed during the first and the last visit. OUTCOMES: The primary outcome will be the proportion of participants that had a 5% body weight loss from baseline. The secondary outcomes will be post-intervention changes in other metabolic parameters. DISCUSSION: To our knowledge, this is one of the first randomized controlled trials evaluating the effects of a meal replacement as the night meal for weight loss in shift workers with obesity. Moreover, improvement of metabolic parameters in shift workers will be an added benefit to this high-risk group. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12622000231741 . Registered on 09 February 2022.

The Effect of Shiftwork on Body Composition: A Comparative Cross-sectional Study Among Health Care Workers.

OBJECTIVE: This study compared the body composition parameters between shiftworkers and nonshiftworkers in a hospital setting in Sri Lanka. METHODS: A comparative cross-sectional study was carried out among a sample of 78 health care workers, recruited by a stratified random sampling technique. Subjects underwent anthropometric and bioimpedentiometric analysis for body composition parameters. RESULTS: The mean (SD) body fat percentage (BF%) of shiftworking women (40.8 [SD, 6.8%]) was significantly higher than day-working women (36.7% [SD, 5.9%]) ( P < 0.05). Mean BF% between day and shift groups did not significantly differ (33.0% [SD, 6.9%] vs 32.4% [SD, 10.7%]). Body mass index and waist circumference were significantly higher among shiftworking women ( P < 0.05), whereas male workers showed the opposite trend. CONCLUSION: Prolonged exposure to shiftwork was associated with a higher BF%. Therefore, interventions for shiftworkers must be addressed, focusing on improving body composition.

Shift work and the risk for metabolic syndrome among healthcare workers: A systematic review and meta-analysis.

Shift work, defined as work occurring outside typical daytime working hours, is associated with an increased risk for metabolic syndrome (MetS) due to several biological and environmental changes. The MetS refers to the clustering of several known cardiovascular risk factors, including insulin resistance, obesity, dyslipidemia, and hypertension. This systematic review aims to evaluate the literature on the association between shift work and the risk of MetS in employees of the health sector. A systematic search was conducted in PubMed, Web of Science, and Scopus databases using appropriate keywords for studies published before September 1, 2021. Eligible studies were those that compared the prevalence of MetS between day and shift healthcare workers; had a cross-sectional, case-control, or cohort study design; provided sufficient data for calculating odds ratios or relative risks with 95% confidence intervals; and articles in English. The Joanna Briggs Institute prevalence critical appraisal tool was used for quality analysis. Risk for MetS and related measures of effect size were retrieved from studies for meta-analysis. Twelve studies met the criteria for inclusion in the review and meta-analysis. Sample sizes ranged from 42 to 738, and the age range of subjects was between 18 and 65 years. Ten studies demonstrated high methodological quality, while two studies were of average quality. Ten out of 12 studies in the review demonstrated a higher risk in shift workers for developing MetS than day workers. The pooled OR of MetS in shift workers based on 12 studies was 2.17 (95% CI = 1.31-3.60, P = 0.003; I2  = 82%, P < 0.001). Shift workers exhibited more than a twofold increase in the chance of developing MetS in comparison with day workers.

Shiftwork and the Risk of Metabolic Syndrome Among Health Care Workers: A Comparative Cross-Sectional Study.

OBJECTIVE: This study evaluated the association between shiftwork and metabolic syndrome (MetS) among a group of health care workers in Sri Lanka. METHODS: This study was in comparative cross-sectional design with 78 shiftworkers and nonshiftworkers 18 years and older. Data were collected through questionnaires, anthropometric measures, and blood tests. Metabolic syndrome was diagnosed based on the International Diabetes Federation and modified National Cholesterol Education Program, Adult Treatment Panel III criteria. RESULTS: The prevalence of MetS according to the International Diabetes Federation criteria was 16.2% and 36.6% among day workers and shiftworkers ( P = 0.043). According to modified National Cholesterol Education Program, Adult Treatment Panel III, 18.9% of day workers and 36.6% of shiftworkers had MetS ( P = 0.083). The best predictors of MetS were age (odds ratio, 1.07; 95% confidence interval, 1.02-1.12; P = 0.008) and shiftwork (odds ratio, 2.78; confidence interval, 0.90-8.72; P = 0.076). CONCLUSION: Shiftworkers had a more than twofold increased risk of developing MetS than day workers. Intervention targeting diet, physical activity, awareness sessions, and health screenings should be promoted.

Usage of nutritional supplements to improve immunity during the COVID-19 pandemic: An online survey.

Background and aims: Proper nutrition to optimise immune function is mandatory as at present there is no specific medicine to cure COVID-19. Our study aimed to investigate the use of nutritional supplements and their key immunity enhancing components among Sri Lankans. Methods: This current study was an online survey conducted during the period from 27th May to 2nd June 2021 disseminated via various social media platforms. Details were collected on highlighting the frequency and composition of nutritional supplements consumed. Results: In a total of 3707 responders, a proportion of 25.5% (944) of the participants took supplements regularly, and 32.6% (1210), 14.5% (538), 27.4% (1015) intake were occasionally, rarely and never respectively. Older participants (>40 years of age) had a significantly higher intake of supplements than the younger counterpart of 31-35 years age group (OR: 0.604; 95% CI, 0.451-0.809; p < 0.001). Almost half (46.0%) took vitamin C supplements and females tend to take more (OR: 1.325; 95% CI, 1.120-1.567; p < 0.001) of vitamin C when compared to males. Comparatively to the other groups regarding monthly income, the participants with the highest income category are more likely to take vitamin D (OR:1.899; 95% CI, 1.034-3.490; p = 0.039) and multivitamin (OR: 3.222; 95% CI, 1.737-5.977; p < 0.001). The most commonly used main ingredient in home-made remedy was coriander in Sri Lanka. Conclusion: The use of nutritional supplements and natural products to improve immunity during the pandemic were frequent among Sri Lankan adults. In general, older, female gender and high income was significantly associated with increased intake of the nutrient supplements.

Fruit and vegetable consumption during the COVID-19 lockdown in Sri Lanka: an online survey.

Purpose: The COVID-19 pandemic has drastically altered the dietary patterns of individuals. This study aimed to investigate the changes in the purchase and consumption of fruit and vegetables in Sri Lanka during the COVID-19 pandemic. Methods: An online cross-sectional survey assessed the self-reported changes in fruit and vegetable consumption and purchase using Google forms. Logistic regression analyses were performed to assess the association between decreased consumption of imported fruits and increased home-grown food intake with socio-demographic variables. Results: Among the 3621 survey respondents, 63.0% and 43.3% reported a decreased intake of imported and local fruits purchased from the market, respectively. Although the overall vegetable consumption has declined, the leafy vegetable consumption has increased by 40.7%. Imported fruit intake has significantly reduced among youngsters, males, respondents living in municipal areas, employed, and those with lower monthly incomes. Among the respondent, 48.9% declared an increased consumption of home-grown fruits or vegetables. Responders living away from Colombo and rural areas were more likely to report a higher intake of home-grown fruits and vegetables (OR 2.021; 95% CI, 1.762-2.318, P < 0.001). Employed males residing in municipal areas were less likely to report an increased intake (OR 0.689; 95% CI, 0.574-0.827, P < 0.001). Conclusion: Purchase of imported and local fruits from the market has reduced. Although the overall vegetable consumption was decreased, there has been an increase in the consumption of leafy vegetables. Furthermore, consumption of home-grown fruits and vegetables has increased considerably. Well-established food distribution programs are essential in future pandemics to promote healthy eating.

Abdominal obesity and metabolic syndrome in South Asians: prevention and management.

INTRODUCTION: The prevalence of metabolic syndrome (MetS) and abdominal obesity are escalating in South Asian countries. It is well established that MetS is associated with increased risk for both Type 2 diabetes mellitus and cardiovascular diseases. South Asians have an increased risk of MetS due to a variety of factors including unhealthy lifestyle and their unique body composition. AREAS COVERED: In this review, we discuss the prevalence, associated risk factors, and evidence-based preventive and curative strategies for MetS and abdominal obesity in South Asians. A literature search through PubMed®, Web of Science®, and Scopus® was performed for studies published before 31st April 2021. A combination of the following keywords was used with the names of the individual South Asian countries: 'metabolic syndrome,' 'syndrome X,' 'abdominal obesity,' 'central obesity,' 'visceral obesity,' 'prevention,' and 'management.' EXPERT OPINION: According to current evidence, MetS and abdominal obesity are highly prevalent among South Asians. Several risk factors, such as lifestyle, socio-demography, cultural, and body composition, are associated with MetS. Limited research shows culturally tailored lifestyle interventions are effective in preventing and managing MetS and abdominal obesity among South Asians.

Impact of vitamin D deficiency on COVID-19.

BACKGROUND & AIMS: COVID-19 has emerged as a global pandemic affecting millions of people. Vitamin D deficiency is one of the risk factors for increased susceptibility to COVID-19. This study aimed to examine the correlation between the prevalence of vitamin D deficiency and COVID-19 infection and mortality rates among the adult population in European and Asian continents. METHODS: Prevalence of vitamin D deficiency in each country was retrieved through literature searching on PubMed® database for the last ten years. As of December, 31st 2020, COVID-19 infections and mortalities per million population were extracted from the 'real time' statistics of the Worldometer website. The association between both vitamin D deficiency and COVID-19 infections and mortalities were explored. RESULTS: Forty seven countries were included in the analysis. The prevalence of vitamin D deficiency ranged from 6.9 to 81.8% in European countries and 2.0-87.5% in Asian countries. Significantly positive correlations were observed for both COVID-19 infection (r = 0.76; p < 0.001) and mortality rates (r = 0.75; p < 0.001) in the Asian continent. The correlation values for the infections and mortality rates in the European continent were (r = 0.37; p = 0.08) and (r = 0.43; p = 0.04) respectively. When both the continents were combined, the correlation results for both infection (r = 0.42; p = 0.003) and mortality (r = 0.35; p = 0.016) rates with vitamin D deficiency values remained significant. CONCLUSION: Prevalence of vitamin D deficiency was significantly associated with the mortality rate of COVID-19 in Europe and Asia. The association between the infection rate and prevalence of vitamin D deficiency was significant for Asia only. Both the associations were significant when the two continents were combined in the analysis. Therefore we suggest that vitamin D supplementation could play a key role in the prevention and/or treatment of the COVID-19 patients.

Shift work and body composition: a systematic review and meta-analysis.

INTRODUCTION: There has been a dramatic increase in the practice of shift work throughout the world. It is known to associate with several adverse health outcomes including increased adiposity. The present study aims to systematically evaluate the literature to find the associations between exposure to shift work and body composition. EVIDENCE ACQUISITION: Data were obtained using a stepwise search process using keywords in the following online medical databases; PubMed®, Web of Science® and Scopus® for studies published before 31st March 2020. Studies which compared the outcome related to the body composition of shift workers and regular day workers were included. A meta-analysis was performed on body fat percentage (BF%). EVIDENCE SYNTHESIS: Initial database searching indicated 2311 potentially eligible articles, of which 7 studies satisfying the inclusion criteria were selected. The number of participants ranged between 17 to 7318, and the age range of the subjects was between 20-65 years. The studies reported diverse shift schedules including rotating shifts, night, evening shifts, alternate shifts, and regular shifts. Four out of seven studies revealed a higher BF% in shift workers when compared to the non-shift group. The pooled mean difference for BF % between shift workers and regular workers was 1.77% (95% CI: 0.18, 3.35; p=0.03; I2=52%, p >0.12). CONCLUSIONS: The meta-analysis of the review showed a significant increase in BF% of shift workers when compared to the non-shift group. However, individual studies showed considerable heterogeneity. Therefore in order to further clarify the underlying mechanisms, more and better quality studies on this field are necessary.

Increased physical inactivity and weight gain during the COVID-19 pandemic in Sri Lanka: An online cross-sectional survey.

AIMS: This study aimed to investigate the immediate impact of COVID-19 quarantine measures on physical inactivity and weight gain among Sri Lankans. METHODS: An online cross-sectional survey was conducted from the 27th of May to 2nd of June 2021 using Google forms. The questionnaire including socio-demographics and physical activity related questions was distributed through social media platforms. RESULTS: A total of 3707 respondents were included in the analysis (59.6% females). The majority were employed, resided in Colombo district and, as a minimum, had a degree. More than half of the respondents (52.4%) reported decreased exercise levels, 63.5% increased sitting time and 82.7% increased screen time. Adults of 31-35 (OR 1.96; 95% CI,1.321-2.894, p < 0.001) and 36-40 (OR 1.67; 95% CI, 1.099-2.524, p < 0.016) had increased sitting times compared to other age groups. A weight gain was reported by 38.5% with a mean (SD) increase of 3.61 (±2.35) kg. There was a significant difference in weight gain between genders (p < 0.001) and ethnic groups (p < 0.001). CONCLUSIONS: An overall increase in physical inactivity such as reduced exercises, increased sitting time and screen time were observed. Furthermore, a considerable proportion of the population has increased body weight.

The inside story of fruits; exploring the truth behind conventional theories.

BACKGROUND AND AIMS: Consumption of fruits and vegetables are important to prevent several diet related diseases. Many dietary guidelines including world health organization (WHO) recommend at least two fruits per day. Our aim here is to highlight theoretical deficiencies in the field of nutritional science that would possibly cause misinterpretations to assess the fruit intake worldwide. METHODS: Information regarding fruits and vegetables serving sizes were obtained from WHO, National Health Service UK, American Heart Association and the United States Department of Agriculture (USDA). Nutritional compositions of fruits were collected from the USDA, FoodData Central database. RESULTS: Three main problems causing misinterpretations to the measurement of global fruit intake were identified. First, the absence of a clear definition to classify a fruit; second, lacking a scientific justification for the nutritional composition of servings of fruits; and thirdly, absence of a standard amount or size for a serving of fruits. Since the carbohydrates are the main nutrient in the fruits, it was suggested to determine the serving size according to the 15 g. CONCLUSIONS: Nutrition experts and other reputed international organizations must focus their attention on scientifically backed definitions and serving size estimations of fruits.

Methods to develop figure rating scales (FRS): A systematic review.

BACKGROUND AND AIMS: Figure Rating Scales (FRS) are psychometric instruments developed to measure individual's perception of physical appearance and subsequently, to determine the level of body dissatisfaction. The following systematic review summarizes existing FRSs and the techniques used to development them. METHODS: A systematic search was conducted in the following databases; PubMed®, Web of Science®, Scopus® using key words "figure rating scale" AND "Stunkard". RESULTS: From 466 potentially relevant articles, 24 publications were included, 22 publications reporting original FRSs with the other two scales being modifications of the original for children and babies. Fifteen were figural drawings or silhouettes and nine were developed by photographic techniques, video methods or using computer software. Most of the figural scales were applicable for adults and consisted of nine images. Ten of the 15 figural scales were without facial features and four scales had minimal facial features. Technological advancements including 3D modeling have played a pivotal role in the development of FRSs. CONCLUSIONS: FRSs have been developed by a mix of traditional and modern techniques. The development and validation of ethnic specific FRSs using modern technology should be the priority for future studies.