Normative spatiotemporal fetal brain maturation with satisfactory development at 2 years.

Maturation of the human fetal brain should follow precisely scheduled structural growth and folding of the cerebral cortex for optimal postnatal function1. We present a normative digital atlas of fetal brain maturation based on a prospective international cohort of healthy pregnant women2, selected using World Health Organization recommendations for growth standards3. Their fetuses were accurately dated in the first trimester, with satisfactory growth and neurodevelopment from early pregnancy to 2 years of age4,5. The atlas was produced using 1,059 optimal quality, three-dimensional ultrasound brain volumes from 899 of the fetuses and an automated analysis pipeline6-8. The atlas corresponds structurally to published magnetic resonance images9, but with finer anatomical details in deep grey matter. The between-study site variability represented less than 8.0% of the total variance of all brain measures, supporting pooling data from the eight study sites to produce patterns of normative maturation. We have thereby generated an average representation of each cerebral hemisphere between 14 and 31 weeks' gestation with quantification of intracranial volume variability and growth patterns. Emergent asymmetries were detectable from as early as 14 weeks, with peak asymmetries in regions associated with language development and functional lateralization between 20 and 26 weeks' gestation. These patterns were validated in 1,487 three-dimensional brain volumes from 1,295 different fetuses in the same cohort. We provide a unique spatiotemporal benchmark of fetal brain maturation from a large cohort with normative postnatal growth and neurodevelopment.

Pregnancy outcomes and vaccine effectiveness during the period of omicron as the variant of concern, INTERCOVID-2022: a multinational, observational study.

BACKGROUND: In 2021, we showed an increased risk associated with COVID-19 in pregnancy. Since then, the SARS-CoV-2 virus has undergone genetic mutations. We aimed to examine the effects on maternal and perinatal outcomes of COVID-19 during pregnancy, and evaluate vaccine effectiveness, when omicron (B.1.1.529) was the variant of concern. METHODS: INTERCOVID-2022 is a large, prospective, observational study, involving 41 hospitals across 18 countries. Each woman with real-time PCR or rapid test, laboratory-confirmed COVID-19 in pregnancy was compared with two unmatched women without a COVID-19 diagnosis who were recruited concomitantly and consecutively in pregnancy or at delivery. Mother and neonate dyads were followed until hospital discharge. Primary outcomes were maternal morbidity and mortality index (MMMI), severe neonatal morbidity index (SNMI), and severe perinatal morbidity and mortality index (SPMMI). Vaccine effectiveness was estimated, adjusted by maternal risk profile. FINDINGS: We enrolled 4618 pregnant women from Nov 27, 2021 (the day after WHO declared omicron a variant of concern), to June 30, 2022: 1545 (33%) women had a COVID-19 diagnosis (median gestation 36·7 weeks [IQR 29·0-38·9]) and 3073 (67%) women, with similar demographic characteristics, did not have a COVID-19 diagnosis. Overall, women with a diagnosis had an increased risk for MMMI (relative risk [RR] 1·16 [95% CI 1·03-1·31]) and SPMMI (RR 1·21 [95% CI 1·00-1·46]). Women with a diagnosis, compared with those without a diagnosis, also had increased risks of SNMI (RR 1·23 [95% CI 0·88-1·71]), although the lower bounds of the 95% CI crossed unity. Unvaccinated women with a COVID-19 diagnosis had a greater risk of MMMI (RR 1·36 [95% CI 1·12-1·65]). Severe COVID-19 symptoms in the total sample increased the risk of severe maternal complications (RR 2·51 [95% CI 1·84-3·43]), perinatal complications (RR 1·84 [95% CI 1·02-3·34]), and referral, intensive care unit (ICU) admission, or death (RR 11·83 [95% CI 6·67-20·97]). Severe COVID-19 symptoms in unvaccinated women increased the risk of MMMI (RR 2·88 [95% CI 2·02-4·12]) and referral, ICU admission, or death (RR 20·82 [95% CI 10·44-41·54]). 2886 (63%) of 4618 total participants had at least a single dose of any vaccine, and 2476 (54%) of 4618 had either complete or booster doses. Vaccine effectiveness (all vaccines combined) for severe complications of COVID-19 for all women with a complete regimen was 48% (95% CI 22-65) and 76% (47-89) after a booster dose. For women with a COVID-19 diagnosis, vaccine effectiveness of all vaccines combined for women with a complete regimen was 74% (95% CI 48-87) and 91% (65-98) after a booster dose. INTERPRETATION: COVID-19 in pregnancy, during the first 6 months of omicron as the variant of concern, was associated with increased risk of severe maternal morbidity and mortality, especially among symptomatic and unvaccinated women. Women with complete or boosted vaccine doses had reduced risk for severe symptoms, complications, and death. Vaccination coverage among pregnant women remains a priority. FUNDING: None.

Determinants for Mediterranean diet adherence beyond the boundaries: a cross-sectional study from Sharjah, the United Arab Emirates.

BACKGROUND: Substantial evidence embraced the nutrition competence of the Mediterranean diet (MD) as a healthy model for decreasing the risk of chronic diseases and increasing longevity, with the bonus of ensuring environmental sustainability. Measuring adherence to this diet is marginally investigated in the Arabian Gulf region, an area away from the Mediterranean region. The current study aimed to assess the MD adherence among adults in Sharjah/the United Arab Emirates (UAE), and to identify the most influential predictors for MD adherence among the study participants. METHODS: A cross-sectional study design was employed using a self-reported, web-based electronic questionnaire that questioned sociodemographics, lifestyle factors, and familiarity with the MD. The MD adherence was assessed by the Mediterranean Diet Adherence Screener validated questionnaire. The adherence level was classified as low for a total score of [0-5], medium [score 6-7], and high (8-13). RESULTS: The study included 1314 participants (age 25-52 years) comprised 822 (62.6%) females and 492 (37.4%) males. There was a moderate adherence score (5.9 ± 1.9) among the study participants. The food constituent expressed the lowest contribution to the MD was fish (9.3%), followed by fruits (12.3%), and legumes (18.3%). The multivariable linear regression analysis showed an overall significant linear trend for the association between the MD adherence score and physical activity, while nutrition information from dietitians and social media were the most two strongly related predictors for the higher adherence (ß = 0.747; 95% CI 0.51-0.98, and ß 0.60; 95% CI 0.269-0.93; p < 0.001, respectively). On the other side, being a smoker and from a non-Mediterranean country was associated with lower adherence scores (ß = 0.538; 95% CI 0.252-0.82, p < 0.001). CONCLUSION: The findings of the current study showed a moderate adherence, low proportion for high adherence, and a gap in the familiarity with the diet name. Being married, physically active, non-smoker, and getting nutrition information from dietitians and social media were the strongest predictors for higher adherence. It is warranted that public health and nutrition specialists/dietitians to tailor new modern approaches for promoting healthy dietary behaviours consistent with the MD.

Caffeine intake and its association with nutrition, sleep, and physical activity among schoolchildren in the United Arab Emirates: a national cross-sectional study.

PURPOSE: Recent surveys indicate a significant increase in total caffeine intake among schoolchildren. Limited research has been published concerning the total intake of caffeine among schoolchildren in the Middle East and Gulf Cooperation Council (GCC) countries, including the UAE. METHODS: This cross-sectional survey estimated the total caffeine intake from foods and beverages among 10,275 schoolchildren in the UAE. Caffeine intakes were related to the European Food Safety Authority's level of no safety concern (3.0 mg/kg BW) and level of effects on sleep (1.4 mg/kg BW). RESULTS: More than half (56.2%) of the students consumed more than 100 mg (the upper limit allowed) of caffeine from dietary sources. High intake of caffeine (> 100 mg/day) was significantly associated (p = 0.001) with reduced sleep duration, difficulty falling asleep, infrequent exercising, using smart devices for more than 2 h a day, getting a lower GPA, skipping breakfast, eating fewer servings of vegetables than recommended, frequent consumption of fast food and more frequent snack consumption. CONCLUSION: Excessive intake of caffeine from different dietary sources coexists with unhealthy dietary and lifestyle behaviors and sleep problems. Tailoring educational programs and intervention strategies is warranted to correct the unhealthy intake of caffeine and the associated unhealthy dietary and lifestyle behaviors among schoolchildren in the UAE.

Sustainable diets among youth: Validity and reliability of a questionnaire assessing knowledge, attitudes, practices, and willingness to change.

BACKGROUND: In light of the global commitment to promoting sustainable dietary choices and the pivotal role of young adults in the adoption of these choices, it is paramount to understand their perspectives of healthy and sustainable diets. The present study aimed to investigate the validity and reliability of a questionnaire examining the knowledge, attitudes, practices, and willingness to change regarding sustainable diets among young adults in the United Arab Emirates (UAE). METHODS: Male and female students attending University of Sharjah, UAE (n = 436), completed an online questionnaire consisting of four sections: knowledge, attitudes, practices, and willingness to change with regard to sustainable diets. Of the participants, 106 completed the questionnaire a second time, 1 month later. Factor analysis (FA) (both exploratory and confirmatory), Cronbach-α, interitem correlations, and intra class correlation (ICC) coefficients were used in the data analysis. RESULTS: Exploratory FA revealed four factors corresponding to the components of the questionnaire. Results of the confirmatory FA indicated a good fit: the χ2 df ratio was < 5 (2.3), root mean squared error of approximation was < 0.08 (0.048) and the comparative fit index was above 0.9 (0.901). Cronbach α and interitem correlations were: knowledge: 0.57 and 0.21; attitude: 0.70 and 0.28; practices: 0.76 and 0.39; willingness to change: 0.69 and 0.27. The ICC coefficients, assessing the reliability of the questionnaire, ranged between 0.48 and 0.92 for the various items. CONCLUSIONS: The developed questionnaire is a valid and reliable tool that could be used to identify the gaps and opportunities for the development of evidence-based interventions aiming to enhance the uptake of sustainable diets among young adults.

A Status Review on Health-Promoting Properties and Global Regulation of Essential Oils.

Since ancient times, essential oils (EOs) have been known for their therapeutic potential against many health issues. Recent studies suggest that EOs may contribute to the regulation and modulation of various biomarkers and cellular pathways responsible for metabolic health as well as the development of many diseases, including cancer, obesity, diabetes, cardiovascular diseases, and bacterial infections. During metabolic dysfunction and even infections, the immune system becomes compromised and releases pro-inflammatory cytokines that lead to serious health consequences. The bioactive compounds present in EOs (especially terpenoids and phenylpropanoids) with different chemical compositions from fruits, vegetables, and medicinal plants confer protection against these metabolic and infectious diseases through anti-inflammatory, antioxidant, anti-cancer, and anti-microbial properties. In this review, we have highlighted some targeted physiological and cellular actions through which EOs may exhibit anti-inflammatory, anti-cancer, and anti-microbial properties. In addition, it has been observed that EOs from specific plant sources may play a significant role in the prevention of obesity, diabetes, hypertension, dyslipidemia, microbial infections, and increasing breast milk production, along with improvements in heart, liver, and brain health. The current status of the bioactive activities of EOs and their therapeutic effects are covered in this review. However, with respect to the health benefits of EOs, it is very important to regulate the dose and usage of EOs to reduce their adverse health effects. Therefore, we specified that some countries have their own regulatory bodies while others follow WHO and FAO standards and legislation for the use of EOs.

The Role of Lifestyle Interventions in the Prevention and Treatment of Gestational Diabetes Mellitus.

Gestational diabetes mellitus (GDM) is one of the most common pregnancy-related endocrinopathies, affecting up to 25% of pregnancies globally. GDM increases the risk of perinatal and delivery complications, and the chance of developing type 2 diabetes mellitus and its complications, including cardiovascular diseases. This elevated risk is then passed on to the next generation, creating a cycle of metabolic dysfunction across generations. For many years, GDM preventive measures have had inconsistent results, but recent systematic reviews and meta-analyses have identified promising new preventative routes. This review aims to summarize the evidence investigating the efficacy of lifestyle treatments for the prevention of GDM and to summarize the effects of two lifestyle interventions, including physical activity and dietary interventions. Based on the present research, future studies should be conducted to investigate whether initiating lifestyle interventions during the preconception period is more beneficial in preventing GDM. In addition, research targeting pregnancy should be designed with a personalized approach. Therefore, studies should customize intervention approaches depending on the presence of modifiable and non-modifiable risk factors at the individual level.

Adherence to the Mediterranean diet and its association with environmental footprints among women of childbearing age in the United Arab Emirates.

PURPOSE: To examine the association of adherence to the Mediterranean Diet (MD) with Environmental Footprints (EFPs) among women of childbearing age in the United Arab Emirates (UAE). METHODS: Data belonging to a nationally representative sample of 482 women (19-50 years) were derived from a previous survey in the UAE. In face-to-face interviews, participants completed questionnaires addressing sociodemographic, physical activity, and dietary intake characteristics; the latter assessed using a multiple pass 24-h recall. The composite Mediterranean (c-MED) index was used to examine the adherence to the MD. Metrics for the EFPs (water use, energy use, and GHG emissions) were calculated using Life Cycle Analyses. Descriptive statistics and linear regressions were used in data analysis. RESULTS: In the study sample, the distribution of the c-MED scores was skewed to the right, indicating a low adherence to the MD. The lowest contributions to the total c-MED score were observed for legumes (2.9%) and olive oil (1.8%). The EFPs associated with food consumption per 1000 kcal were: water use: 1256.89 ± 544.95 L/day; energy use: 18.01 ± 7.85 MJ/day, and GHG: 2.46 ± 1.46 kg CO2 eq/day. After adjustment for age, energy intake, and potential confounders, being adherent to the MD was associated with 540.57 [95% CI (- 726.6; - 354.54)] units decrease in water use and 0.94 units decrease in GHG emissions [95% CI (- 1.45; - 0.43)]. CONCLUSIONS: The findings of this study revealed an inverse association between adherence to the MD and EFPs. As such, the MD may represent a promising dietary strategy to improve health outcomes and reduce the environmental impact. Public health programs addressing the low adherence to the MD among women of childbearing age in the UAE are warranted.

Eating habits are associated with subjective sleep quality outcomes among university students: findings of a cross-sectional study.

PURPOSE: This study investigated the relationships between eating habits and sleep quality among university students. METHODS: In a cross-sectional study, university students completed a self-report questionnaire to assess eating habits and meal timing. We assessed subjective sleep quality using the Pittsburgh Sleep Quality Index (PSQI) questionnaire and examined the associations between eating habits and overall sleep quality and its components. RESULTS: Four hundred ninety-eight students participated in the study. Students who used to skip breakfast, ate late-night snacks, and replaced meals with snacks were at 1.20 times, 1.24 times, and 1.25 times higher likelihood of having poor overall sleep quality, respectively. Multiple logistic regression analysis showed that skipping breakfast (r = - 0.111, P = 0.007), late-night snacks (r = - 0.109, P = 0.007), replacing meals with snacks (r = - 0.126, P = 0.002), and irregular mealtimes (r = - 0.094, P = 0.018) were the best correlates with poor sleep quality. After adjustment to demographic variables, replacing meals with snacks followed by skipping breakfast were the best independent associations with poor sleep quality by the PSQI. CONCLUSIONS: Eating habits and meal timing were significantly associated with sleep quality. We speculate that healthy eating habits may lead to improved sleep quality and sleep components among university students.

Nutritional status and adequacy of feeding Practices in Infants and Toddlers 0-23.9 months living in the United Arab Emirates (UAE): findings from the feeding Infants and Toddlers Study (FITS) 2020.

BACKGROUND: Infant and young child feeding practices (IYCF) impact the early and later health status of the population. Limited data is available regarding IYCF in the United Arab Emirates (UAE). This study aimed to evaluate the nutritional status and adequacy of feeding practices, energy, food, and nutrient intakes of UAE infants and toddlers ages 0-23.9 months. METHODS: This study is a population-based cross-sectional survey of 276 infants and toddlers aged 0-23.9 months of which 180 were nationals and 96 were Arab non-nationals living in the UAE. Data were collected from the three major emirates: Abu Dhabi, Dubai, and Sharjah. Anthropometry was collected and assessed using WHO Anthro-Survey Analyzer, and a multicomponent age-specific questionnaire was used to evaluate IYCF and sociodemographic characteristics. Usual intake of energy, micronutrients, and macronutrients, including supplements, were collected using multiple-pass 24-h dietary recall and analyzed using the PC-side software. IYCF practices were assessed using the WHO indicators. RESULTS: Overall, 4% of children were malnourished, 8% wasted, 15% stunted, 18% at risk of overweight, and 7% overweight and obese. 95% of infants were ever breastfed and 37% exclusively breastfed at 6 months. Around 98% of infants had a timely introduction of complementary food. Macronutrient intake exceeded AMDR for fat, carbohydrates, and protein for 27%, 8% and 2% of toddlers respectively. As for the percentage of those exceeding the ESPGHAN cut-off for free sugars set at 5% of energy intake, 28.6% had excessive intakes overall, 10% in 0-5.9, 21.9% in 6-11.9 and 56.7% in 12-23.9 month. Usual iron intake was below the Estimated Average Requirement (EAR) in 47% of infants 6-11.9 months. Above 12 months, the usual intake of iron and vitamin D were below EAR in 11% and 49% of toddlers respectively. Usual intake exceeded the tolerable upper intake levels (UL) for vitamin A (14 to 18%) and zinc (11 to 22%) across all ages. Approximately 93% of toddlers ages 12-23.9 months did not meet food groups' recommendations for vegetables, 87% for fruits, 48% for milk/dairy, 54% for lean meat and beans, and 33% for grains. CONCLUSIONS: This study revealed that a high percentage of infants and toddlers aged 0-23.9 m suffer from a double burden of malnutrition, which is the coexistence of both undernutrition, and overweight and obesity in the same population. In addition to suboptimal feeding practices and inadequate/overconsumption of various nutrients. The findings highlight the need for the development of culturally specific programs aiming to improve the nutritional status of infants and toddlers in the UAE.

Artificial Intelligence Applications and Self-Learning 6G Networks for Smart Cities Digital Ecosystems: Taxonomy, Challenges, and Future Directions.

The recent upsurge of smart cities' applications and their building blocks in terms of the Internet of Things (IoT), Artificial Intelligence (AI), federated and distributed learning, big data analytics, blockchain, and edge-cloud computing has urged the design of the upcoming 6G network generation, due to their stringent requirements in terms of the quality of services (QoS), availability, and dependability to satisfy a Service-Level-Agreement (SLA) for the end users. Industries and academia have started to design 6G networks and propose the use of AI in its protocols and operations. Published papers on the topic discuss either the requirements of applications via a top-down approach or the network requirements in terms of agility, performance, and energy saving using a down-top perspective. In contrast, this paper adopts a holistic outlook, considering the applications, the middleware, the underlying technologies, and the 6G network systems towards an intelligent and integrated computing, communication, coordination, and decision-making ecosystem. In particular, we discuss the temporal evolution of the wireless network generations' development to capture the applications, middleware, and technological requirements that led to the development of the network generation systems from 1G to AI-enabled 6G and its employed self-learning models. We provide a taxonomy of the technology-enabled smart city applications' systems and present insights into those systems for the realization of a trustworthy and efficient smart city ecosystem. We propose future research directions in 6G networks for smart city applications.

Influence of Religiosity on Youths' Attitudes Towards People with Disabilities in the United Arab Emirates.

This cross-sectional survey investigates the influence of youths' religiosity on their attitude towards people with disabilities. The Muslim religiosity questionnaire and multidimensional attitudes scale towards persons with disabilities were used to survey 733 youths from the federal university in the United Arab Emirates. The results indicated that the youths were religious and had positive attitudes towards people with disabilities. An increase in religiosity is associated with a positive attitude towards disability, and both religiosity and total family income positively impacted the attitude towards people with disabilities. Reducing inequalities by including persons with disabilities is one of the UN 2030 Agenda for Sustainable Development objectives. Policies should aim to enhance curriculum, improvise public guidelines and partner with associated faith-based leaders to build an inclusive society for people with disabilities, thus helping to achieve sustainable development goals.

International gestational age-specific centiles for blood pressure in pregnancy from the INTERGROWTH-21st Project in 8 countries: A longitudinal cohort study.

BACKGROUND: Gestational hypertensive and acute hypotensive disorders are associated with maternal morbidity and mortality worldwide. However, physiological blood pressure changes in pregnancy are insufficiently defined. We describe blood pressure changes across healthy pregnancies from the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) Fetal Growth Longitudinal Study (FGLS) to produce international, gestational age-specific, smoothed centiles (third, 10th, 50th, 90th, and 97th) for blood pressure. METHODS AND FINDINGS: Secondary analysis of a prospective, longitudinal, observational cohort study (2009 to 2016) was conducted across 8 diverse urban areas in Brazil, China, India, Italy, Kenya, Oman, the United Kingdom, and the United States of America. We enrolled healthy women at low risk of pregnancy complications. We measured blood pressure using standardised methodology and validated equipment at enrolment at <14 weeks, then every 5 ± 1 weeks until delivery. We enrolled 4,607 (35%) women of 13,108 screened. The mean maternal age was 28·4 (standard deviation [SD] 3.9) years; 97% (4,204/4,321) of women were married or living with a partner, and 68% (2,955/4,321) were nulliparous. Their mean body mass index (BMI) was 23.3 (SD 3.0) kg/m2. Systolic blood pressure was lowest at 12 weeks: Median was 111.5 (95% CI 111.3 to 111.8) mmHg, rising to a median maximum of 119.6 (95% CI 118.9 to 120.3) mmHg at 40 weeks' gestation, a difference of 8.1 (95% CI 7.4 to 8.8) mmHg. Median diastolic blood pressure decreased from 12 weeks: 69.1 (95% CI 68.9 to 69.3) mmHg to a minimum of 68.5 (95% CI 68.3 to 68.7) mmHg at 19+5 weeks' gestation, a change of -0·6 (95% CI -0.8 to -0.4) mmHg. Diastolic blood pressure subsequently increased to a maximum of 76.3 (95% CI 75.9 to 76.8) mmHg at 40 weeks' gestation. Systolic blood pressure fell by >14 mmHg or diastolic blood pressure by >11 mmHg in fewer than 10% of women at any gestational age. Fewer than 10% of women increased their systolic blood pressure by >24 mmHg or diastolic blood pressure by >18 mmHg at any gestational age. The study's main limitations were the unavailability of prepregnancy blood pressure values and inability to explore circadian effects because time of day was not recorded for the blood pressure measurements. CONCLUSIONS: Our findings provide international, gestational age-specific centiles and limits of acceptable change to facilitate earlier recognition of deteriorating health in pregnant women. These centiles challenge the idea of a clinically significant midpregnancy drop in blood pressure.

Fetal growth velocity standards from the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project.

BACKGROUND: Human growth is susceptible to damage from insults, particularly during periods of rapid growth. Identifying those periods and the normative limits that are compatible with adequate growth and development are the first key steps toward preventing impaired growth. OBJECTIVE: This study aimed to construct international fetal growth velocity increment and conditional velocity standards from 14 to 40 weeks' gestation based on the same cohort that contributed to the INTERGROWTH-21st Fetal Growth Standards. STUDY DESIGN: This study was a prospective, longitudinal study of 4321 low-risk pregnancies from 8 geographically diverse populations in the INTERGROWTH-21st Project with rigorous standardization of all study procedures, equipment, and measurements that were performed by trained ultrasonographers. Gestational age was accurately determined clinically and confirmed by ultrasound measurement of crown-rump length at <14 weeks' gestation. Thereafter, the ultrasonographers, who were masked to the values, measured the fetal head circumference, biparietal diameter, occipitofrontal diameter, abdominal circumference, and femur length in triplicate every 5 weeks (within 1 week either side) using identical ultrasound equipment at each site (4-7 scans per pregnancy). Velocity increments across a range of intervals between measures were modeled using fractional polynomial regression. RESULTS: Peak velocity was observed at a similar gestational age: 16 and 17 weeks' gestation for head circumference (12.2 mm/wk), and 16 weeks' gestation for abdominal circumference (11.8 mm/wk) and femur length (3.2 mm/wk). However, velocity growth slowed down rapidly for head circumference, biparietal diameter, occipitofrontal diameter, and femur length, with an almost linear reduction toward term that was more marked for femur length. Conversely, abdominal circumference velocity remained relatively steady throughout pregnancy. The change in velocity with gestational age was more evident for head circumference, biparietal diameter, occipitofrontal diameter, and femur length than for abdominal circumference when the change was expressed as a percentage of fetal size at 40 weeks' gestation. We have also shown how to obtain accurate conditional fetal velocity based on our previous methodological work. CONCLUSION: The fetal skeleton and abdomen have different velocity growth patterns during intrauterine life. Accordingly, we have produced international Fetal Growth Velocity Increment Standards to complement the INTERGROWTH-21st Fetal Growth Standards so as to monitor fetal well-being comprehensively worldwide. Fetal growth velocity curves may be valuable if one wants to study the pathophysiology of fetal growth. We provide an application that can be used easily in clinical practice to evaluate changes in fetal size as conditional velocity for a more refined assessment of fetal growth than is possible at present (https://lxiao5.shinyapps.io/fetal_growth/). The application is freely available with the other INTERGROWTH-21st tools at https://intergrowth21.tghn.org/standards-tools/.

Assessment of eating habits and lifestyle during the coronavirus 2019 pandemic in the Middle East and North Africa region: a cross-sectional study.

Coronavirus disease 2019 (COVID-19) has rapidly spread globally, forcing countries to apply lockdowns and strict social distancing measures. The aim of this study was to assess eating habits and lifestyle behaviours among residents of the Middle East and North Africa (MENA) region during the lockdown. A cross-sectional study among adult residents of the MENA region was conducted using an online questionnaire designed on Google Forms during April 2020. A total of 2970 participants from eighteen countries participated in the present study. During the pandemic, over 30 % reported weight gain, 6·2 % consumed five or more meals per d compared with 2·2 % before the pandemic (P < 0·001) and 48·8 % did not consume fruits on a daily basis. Moreover, 39·1 % did not engage in physical activity, and over 35 % spent more than 5 h/d on screens. A significant association between the frequency of training during the pandemic and the reported change in weight was found (P < 0·001). A significantly higher percentage of participants reported physical and emotional exhaustion, irritability and tension either all the time or a large part of the time during the pandemic (P < 0·001). Although a high percentage of participants reported sleeping more hours per night during the pandemic, 63 % had sleep disturbances. The study highlights that the lockdown due to the COVID-19 pandemic caused a variety of lifestyle changes, physical inactivity and psychological problems among adults in the MENA region.

Impact of coronavirus 2019 on mental health and lifestyle adaptations of pregnant women in the United Arab Emirates: a cross-sectional study.

BACKGROUND: In light of the pandemic, pregnant women are particularly vulnerable to increased psychological distress and in need of imperative preventive measures. This study aimed to investigate the impact of the pandemic on mental health, lifestyle adaptations, and their determinants among pregnant women in the United Arab Emirates. METHODS: A survey was conducted electronically between June and August 2020. Pregnant women were recruited from prenatal clinics in the UAE and invited to participate in an online survey developed on Google Forms. The questionnaire included socio-demographic characteristics, the Impact of Event Scale- Revised, the Perceived Support Scale and lifestyle-related factors. RESULTS: A total of 384 pregnant women completed the questionnaire of whom 20.6% were in their 1st trimester, 46.1% in their 2nd and 33.3% in their 3rd trimester. The mean IES-R score for the respondents was 26.15 ± 13.55, corresponding to a mild stressful impact, which did not differ significantly among trimesters of pregnancy. Pregnant women expressed increased stress from staying home (64%), work (40%), feeling frightened (66%) and apprehensive (59%). Women reported increased support and sharing their feelings with family members (59%), mainly in the 1st and 3rd trimester of pregnancy (P < 0.05). There was a greater attention to mental health (48%), resting time (55.3%), and relaxing time (57.3%); while a decreased amount of time was spent engaging in physical activities (53.6%), which differed significantly between trimesters (P = 0.02). CONCLUSIONS: The COVID-19 pandemic was associated with a mild stressful impact among pregnant women in the UAE, braced by strong family support and self-care mental health behaviors.

Practices and resilience of dieticians during the COVID-19 pandemic: a national survey in the United Arab Emirates.

BACKGROUND: The COVID-19 pandemic impacted the practices and resilience of most healthcare workers, including dieticians. In addition to offering critical care to COVID-19 patients, dieticians play a major role in preventing and managing conditions known to affect COVID-19, such as obesity and metabolic disorders. The objective of this study was to examine the conditions and changes in the work environment as well as resilience and its correlates among dieticians during the COVID-19 pandemic in the United Arab Emirates (UAE). METHODS: A cross-sectional national survey was conducted among dieticians practicing in the UAE (n = 371), using a web-based questionnaire. The questionnaire addressed, in addition to the sociodemographic information, the practice-related characteristics and resilience of participants. For the latter the Connor-Davidson Resilience Scale© was used. Descriptive statistics as well as simple and multiple linear regressions were used in the statistical analysis. RESULTS: Of participants, 26.4% reported not having access to personal protective equipment and 50% indicated being concerned for their safety and health. Furthermore, considerable proportions of participants were not satisfied (45%) with the support nor with the appreciation (37.7%) they received during the pandemic. One in four dieticians considered quitting his/her job. While 65.8% of participants reported counseling COVID-19 patients, a third did not use any online platform for counseling. The most cited challenge to dietetic practice during the pandemic was 'maintaining work-life balance' (43.1%). The mean CD-RISC score was 72.0 ± 14.0. After adjustment, working in a hospital or public clinic (as opposed to private clinic), having a condition preventing face-to-face counseling, considering quitting job and feeling neutral or dissatisfied with the appreciation were associated with lower resilience scores, while counseling COVID-19 patients was associated with higher scores. CONCLUSIONS: Despite the fairly high resilience among dieticians practicing in the UAE during the COVID-19 pandemic, the findings of this study highlighted a few challenges, mainly related to safe practice environment, support for online counseling, and maintaining work-life balance. Concerted efforts of policy and decision makers ought to develop targeted programs for dieticians to ensure their retention and wellbeing during the COVID-19 pandemic.

Sleep quality and Dietary Inflammatory Index among university students: a cross-sectional study.

PURPOSE: Evidence indicates that most college students face reduced sleep quality due to unhealthy dietary habits and hectic daily schedules. While the relationship between sleep quality and general health has been the subject of intensive research, little is known about the association between sleep and its relation with the inflammatory potential of the diet until recently. This study aimed to investigate the association between Energy-Adjusted Dietary Inflammatory Index (E-DII®) scores and sleep quality in a group of students from the University of Sharjah (UOS). METHODS: A cross-sectional study design was followed, and convenience sampling was used. Participants were assessed for sleep quality using the Pittsburgh Sleep Quality Index (PSQI), E-DII scores were derived from a semi-quantitative food frequency questionnaire (FFQ), and physical activity level was measured using the International Physical Activity Questionnaire (IPAQ). Chi-square tests and two-sample t tests were used to find an association between E-DII scores and sleep quality. RESULTS: A total of 379 college students were included in the study of whom 64 % were female and 81% were between 18 and 21 years of age. Two-thirds of participants experienced poor sleep quality. Although results were trending in the hypothesized direction, no significant association was found between E-DII scores and sleep quality. Among the individual components of sleep quality, a direct significant association was found between E-DII scores and day dysfunction (P = 0.03). CONCLUSIONS: These results suggest that a pro-inflammatory diet maybe related to increased day dysfunction among UOS students. Consuming a more anti-inflammatory diet may reduce daytime dysfunction. Further prospective and controlled studies are required to confirm this association, and to explore other attributes and their sequelae on sleep quality.

ESCOVE: Energy-SLA-Aware Edge-Cloud Computation Offloading in Vehicular Networks.

The vehicular network is an emerging technology in the Intelligent Smart Transportation era. The network provides mechanisms for running different applications, such as accident prevention, publishing and consuming services, and traffic flow management. In such scenarios, edge and cloud computing come into the picture to offload computation from vehicles that have limited processing capabilities. Optimizing the energy consumption of the edge and cloud servers becomes crucial. However, existing research efforts focus on either vehicle or edge energy optimization, and do not account for vehicular applications' quality of services. In this paper, we address this void by proposing a novel offloading algorithm, ESCOVE, which optimizes the energy of the edge-cloud computing platform. The proposed algorithm respects the Service level agreement (SLA) in terms of latency, processing and total execution times. The experimental results show that ESCOVE is a promising approach in energy savings while preserving SLAs compared to the state-of-the-art approach.

A Scoping Review of Integrated Blockchain-Cloud (BcC) Architecture for Healthcare: Applications, Challenges and Solutions.

Blockchain is a disruptive technology for shaping the next era of a healthcare system striving for efficient and effective patient care. This is thanks to its peer-to-peer, secure, and transparent characteristics. On the other hand, cloud computing made its way into the healthcare system thanks to its elasticity and cost-efficiency nature. However, cloud-based systems fail to provide a secured and private patient-centric cohesive view to multiple healthcare stakeholders. In this situation, blockchain provides solutions to address security and privacy concerns of the cloud because of its decentralization feature combined with data security and privacy, while cloud provides solutions to the blockchain scalability and efficiency challenges. Therefore a novel paradigm of blockchain-cloud integration (BcC) emerges for the domain of healthcare. In this paper, we provide an in-depth analysis of the BcC integration for the healthcare system to give the readers the motivations behind the emergence of this new paradigm, introduce a classification of existing architectures and their applications for better healthcare. We then review the development platforms and services and highlight the research challenges for the integrated BcC architecture, possible solutions, and future research directions. The results of this paper will be useful for the healthcare industry to design and develop a data management system for better patient care.