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Benoit Pétré,1,* Marine Paridans,1,* Nicolas Gillain,1 Eddy Husson,1 Anne-Françoise Donneau,1– 3 Nadia Dardenne,1,3 Christophe Breuer,4 Fabienne Michel,2,5 Margaux Dandoy,6 Fabrice Bureau,6,7 Laurent Gillet,6,8,9 Dieudonné Leclercq,1 Michèle Guillaume1,2 1Department of Public Health, Faculty of Medicine, Liège University, Liège, Belgium; 2Risk Assessment Group COVID-19, Liège University, Liège, Belgium; 3University and Hospital Biostatistics Center (B-STAT), Faculty of Medicine, Liège University, Liège, Belgium; 4Governance Support Unit, Rectorate, Liège University, Liège, Belgium; 5Collection and Analysis of Data and Information of Strategic Utility (RADIUS), Liège University, Liège, Belgium; 6Covid-19 Platform, Liège University, Liège, Belgium; 7Laboratory of Cellular and Molecular Immunology, GIGA Institute, Liège University, Liège, Belgium; 8Fundamental and Applied Research for Animal and Health (FARAH) Center, Liège University, Liège, Belgium; 9Laboratory of Immunology-Vaccinology, Liège University, Liège, Belgium*These authors contributed equally to this workCorrespondence: Benoit Pétré, Department of Public Health, Faculty of Medicine, Liège University, Quartier Hôpital, Avenue Hippocrate 13 (B23), Liège, 4000, Belgium, Tel +32 4 366 2505, Email benoit.petre@uliege.beAbstract: Current public health debate centers on COVID-19 testing methods and strategies. In some communities, high transmission risk may justify routine testing, and this requires test methods that are safe and efficient for both patients and the administrative or health-care workers administering them. Saliva testing appears to satisfy those criteria. There is, however, little documentation on the acceptability of this method among beneficiaries. This article presents the lessons learned from a pilot study on the use of saliva testing for routine screening of nursing home and secondary school personnel in Wallonia (the French-speaking part of Belgium), conducted in December 2020 to April 2021, respectively. Administrators at the facilities in question seemed to think highly of saliva testing and wished to continue it after the pilot study was over. This result reinforces the criteria (the noninvasive aspect, in particular) supporting a key role for saliva testing in monitoring community spread of the virus. Nevertheless, wider-scale deployment of this particular method will only be possible if the testing strategy as a whole takes a health promotion approach.Keywords: pandemic, COVID-19, community monitoring, preventive health behavior, saliva testing

In mid-2020, the University of Liège (ULiège, Belgium) commissioned the ULiège Video Game Research Laboratory (Liège Game Lab) and the AR/VR Lab of the HEC-Management School of ULiège to create a serious game to raise awareness of preventive measures for its university community. This project has its origins in two objectives of the institutional policy of ULiège in response to the crisis caused by SARS-CoV-2 to raise awareness among community members of various preventive actions that can reduce the spread of the virus and to inform about the emergence and progression of a pandemic. After almost two years of design, the project resulted in the creation of SARS Wars, a decision-making management game for browsers and smartphones. This article presents the creative process of the game, specifically the integration of an adapted SEIR (susceptible-exposed-infectious-recovered) model, as well as the modeling of intercompartmental circulation dynamics in the game’s algorithm, and the various limitations observed regarding the game’s original missions and possibilities for future work. The SARS-CoV-2 video game project may be considered an innovative way to translate epidemiology into a language that can be used in the scope of citizen sciences. On the one hand, it provides an engaging tool and encourages active participation of the audience. On the other hand, it allows us to have a better understanding of the dynamic changes of a pandemic or an epidemic (crisis preparedness, monitoring, and control) and to anticipate potential consequences in the given parameters at set time (emerging risk identification), while offering insights for impact on some parameters on motivation (social science aspect).

Purpose Asthma negatively impacts health-related quality of life (HRQL). The objective is to investigate the longitudinal relationship between HRQL in asthma and disease control, demographic and clinical objective parameters in an adult population in real-life settings. Methods We conducted a longitudinal study on adult asthmatics recruited from Liege University Hospital Asthma Clinic (Belgium) between 2011 and 2019. We selected those who had two visits and completed two patient-reported outcome measures (PROMs), the asthma control test (ACT) and the mini asthma quality of life questionnaire (AQLQ) (n = 290). AQLQ was the dependent variable. Demographic, functional and inflammatory characteristics, asthma control, and exacerbations were the independent variables. We applied generalized linear mixed models to identify the factors associated with change in AQLQ and its dimensions. Results Median (IQR) time interval between the two visits was 7 (5–19) months. Overall, median (IQR) global AQLQ increased from 4.1 (3–5.1) to 4.6 (3.4–5.9) (p p p p p Conclusion Asthma control and BMI are key predictors of asthma quality of life acting in an opposite direction. AQLQ may improve without step-up in the pharmacological treatment.

During the COVID-19 pandemic, barrier gestures such as mask wearing, physical distancing, greetings without contact, one-way circulation flow, and hand sanitization were major strategies to prevent the spread of SARS-CoV-2, but they were only useful if consistently applied. This survey was a follow-up of the first survey performed in 2020 at the University of Liège. We aim to evaluate the compliance with these gestures on campuses and examine differences in the extent of the compliance observed in different educational activities and contexts. During 3.5 months, the counting of compliant and non-compliant behaviors was performed each week in randomly selected rooms. Using data collected during both surveys (2020 and 2021), binomial negative regression models of compliance depending on periods (teaching periods and exam sessions), type of rooms, and campuses were conducted to evaluate prevalence ratios of compliance. The percentage of compliance in this second survey was the highest for mask wearing and physical distancing during educational activities (90% and 88%, respectively) and lowest for physical distancing outside educational activities and hand sanitization (45% and 52%, respectively). Multivariate analyses revealed that the compliance with most gestures was significantly higher in teaching rooms than in hallways and restaurants and during exam sessions. The compliance with physical distancing was significantly higher (from 66%) in auditoriums, where students had to remain seated, than during practical works that allowed or required free movement. Therefore, the compliance with barrier gestures was associated with contextual settings, which should be considered when communicating and managing barrier gestures. Further studies should specify and confirm the determining contextual characteristics regarding the compliance with barrier gestures in times of pandemic.

Objectif : decrire l'estime de soi des etudiants en soins infirmiers avant l'influence de la formation en soins infirmiers et explorer la relation entre l'estime de soi et l'abandon. Conception : Etude de cohorte. Methodes : Au debut de leur premiere annee d'etude, en octobre 2017, 464 etudiants en soins infirmiers ont rempli un questionnaire evaluant leur niveau d'estime de soi via l'echelle de Tafarodi & Swann et le profil d'estime de soi selon le modele de Mruk, ainsi que des informations sociodemographiques, l'anxiete d'etat, l'auto-efficacite, l'intention de continuer et le soutien social. Un an plus tard, des donnees sur les notes et la reinscription ont ete recueillies. Des analyses multivariees ont explore les facteurs influencant le niveau d'estime de soi (regression multiple), le profil d'estime de soi (regression logistique multinomiale) et l'abandon (regression logistique binaire). Resultats/Constatations : Le niveau moyen d'estime de soi etait de 50,8 (9,0), sur une echelle de 16 a 80. Quarante-neuf pour cent des profils d'estime de soi ont ete classes comme " eleves ", 20,1 % comme " bases sur l'acceptation defensive ", 11,2 % comme " bases sur la realisation defensive " et 19,6 % comme " faibles ". L'anxiete d'etat (p < 0,0001), l'auto-efficacite concernant l'achevement du programme de soins infirmiers (p < 0,0001) et l'auto-efficacite concernant l'internat (p < 0,0001) etaient associees a l'estime de soi. Le taux d'abandon etait de 21,5 %. Le niveau d'estime de soi (p = 0,039) et la performance academique (p < 0,0001) etaient associes a l'abandon. Conclusion : Bien que l'estime de soi des etudiants en soins infirmiers soit souvent decrite comme faible, nous savons peu de choses sur son niveau de base avant l'entree dans le programme de soins infirmiers et sur les facteurs qui l'influencent. Le taux d'abandon parmi les etudiants en premiere annee de soins infirmiers est eleve, mais l'estime de soi est rarement exploree comme une explication possible. Nous avons constate que les etudiants avaient une estime de soi moyenne, et potentiellement fragile, au debut de leur formation en soins infirmiers, et que l'estime de soi etait associee a l'abandon. Impact : Compte tenu de cette association et de l'impact de l'estime de soi sur le bien-etre et le comportement professionnel, les etablissements d'enseignement devraient favoriser l'estime de soi, a la fois de maniere generale et chez les etudiants souffrant d'anxiete ou d'une faible auto-efficacite. Les recherches futures devraient explorer l'estime de soi des etudiants en soins infirmiers en utilisant une approche longitudinale a methodes mixtes. La societe devrait valoriser les infirmieres et les etudiants en soins infirmiers. Traduit avec www.DeepL.com/Translator (version gratuite)

Aims Long-chain polyunsaturated fatty acids (PUFAs) generate diverse bioactive lipid mediators, which tightly regulate vascular inflammation. The effects of omega-3 PUFA supplementation in cardiovascular prevention however remain controversial. In addition to direct dietary intake, fatty acid desaturases (FADS) determine PUFA levels. Increased arterial stiffness represents an independent predictor of mortality and cardiovascular events. The aim of the present study was to determine the association of PUFA intake, FADS1 genotype, and FADS expression with arterial stiffness. Methods and results A cross-sectional population-based cohort study of 1464 participants without overt cardiovascular disease was conducted. Dietary intake was assessed using a food frequency questionnaire. Arterial stiffness was assessed by carotid–femoral pulse wave velocity (cfPWV), and the FADS1 locus variant was determined. Blood cell transcriptomics was performed in a subset of 410 individuals. Pulse wave velocity was significantly associated with the FADS1 locus variant. Differential associations between PWV and omega-3 PUFA intake were observed depending on the FADS1 genotype. High omega-3 PUFA intake attenuated the FADS1 genotype-dependent associations. Carriers of the minor FADS1 locus variant exhibited increased expression of FADS2, which is associated with PWV. Conclusion Taken together, these findings point to FADS1 genotype-dependent associations of omega-3 PUFA intake on subclinical cardiovascular disease. These findings may have implications for identifying responders and non-responders to omega-3 PUFA supplementation and open up for personalized dietary counselling in cardiovascular prevention.

Many studies exploring the factors associated with asthma-specific quality of life (QOL) have shown that asthma control is the main predictor of asthma-related QOL. However, to the best of our knowledge, no study has ever explored the individual impact of the five main symptoms of asthma (wheezing, dyspnea, chest tightness, cough and airway secretion) reported directly by the patient on asthma-related QOL. A cross-sectional study was conducted on untreated adult (≥18 years) asthmatics recruited from the Liege University Hospital Asthma Clinic (Belgium) for asthma diagnosis confirmation between 2018 and 2021 (n = 171). Multiple linear regression analysis demonstrated that dyspnea and chest tightness were the two leading factors associated with asthma-related QOL in a population of mild asthma.

To describe nursing student self-esteem changes over time and its impacts on learning strategies.Existential phenomenology.Interviews were conducted in Spring 2018 in a purposive sample of 39 nursing students, exploring events critical to self-esteem and their impacts. Transcriptions were analysed descriptively and interpretatively to decipher the process that links self-esteem, events and learning behaviour.What led to self-esteem changes were "relationships with nurses during internships" and "receiving evaluations." The students interpreted events and drew conclusions about their aptitude for nursing, which in turn prompted proactive or defensive learning behaviours. Their interpretations both depended on their self-esteem and impacted it, in a vicious or virtuous circle. Exploring self-esteem allows a better understanding of the importance of students' relationships with nursing teams, and of some of their defensive behaviours. Understanding the role of nursing student self-esteem in the learning process could help improve student well-being and competence.

Background In recent decades, asthma‐related quality of life questionnaires have joined objective clinical indicators as important outcome measures. In this study, we sought to investigate the predictors of asthma‐related quality of life in a large cohort of patients recruited from a secondary care center. Methods We conducted a cross‐sectional study on asthmatics (N = 1301) recruited from the Liège University Hospital asthma clinic (Belgium). After performing a descriptive analysis highlighting the distribution of scores from the Mini Asthma Quality of Life Questionnaire (Mini AQLQ) and its four dimensions (symptoms, activity limitation, emotional function, and environmental stimuli), we did multiple regression analysis to identify the independent predictors of AQLQ. Results Multiple regression beta analysis showed that AQLQ and its four dimensions were primarily associated with asthma control (p

Background The role played by large-scale repetitive SARS-CoV-2 screening programs within university populations interacting continuously with an urban environment, is unknown. Our objective was to develop a model capable of predicting the dispersion of viral contamination among university populations dividing their time between social and academic environments. Methods Data was collected through real, large-scale testing developed at the University of Liège, Belgium, during the period Sept. 28th-Oct. 29th 2020. The screening, offered to students and staff (n = 30,000), began 2 weeks after the re-opening of the campus but had to be halted after 5 weeks due to an imposed general lockdown. The data was then used to feed a two-population model (University + surrounding environment) implementing a generalized susceptible-exposed-infected-removed compartmental modeling framework. Results The considered two-population model was sufficiently versatile to capture the known dynamics of the pandemic. The reproduction number was estimated to be significantly larger on campus than in the urban population, with a net difference of 0.5 in the most severe conditions. The low adhesion rate for screening (22.6% on average) and the large reproduction number meant the pandemic could not be contained. However, the weekly screening could have prevented 1393 cases (i.e. 4.6% of the university population; 95% CI: 4.4–4.8%) compared to a modeled situation without testing. Conclusion In a real life setting in a University campus, periodic screening could contribute to limiting the SARS-CoV-2 pandemic cycle but is highly dependent on its environment.

BACKGROUND: Associations between increased dietary fat and decreased carbohydrate intake with circulating HDL and non-HDL cholesterol have not been conclusively determined. OBJECTIVE: We assessed these relations in 8 European observational human studies participating in the European Nutritional Phenotype Assessment and Data Sharing Initiative (ENPADASI) using harmonized data. METHODS: Dietary macronutrient intake was recorded using study-specific dietary assessment tools. Main outcome measures were lipoprotein cholesterol concentrations: HDL cholesterol (mg/dL) and non-HDL cholesterol (mg/dL). A cross-sectional analysis on 5919 participants (54% female) aged 13-80 y was undertaken using the statistical platform DataSHIELD that allows remote/federated nondisclosive analysis of individual-level data. Generalized linear models (GLM) were fitted to assess associations between replacing 5% of energy from carbohydrates with equivalent energy from total fats, SFAs, MUFAs, or PUFAs with circulating HDL cholesterol and non-HDL cholesterol. GLM were adjusted for study source, age, sex, smoking status, alcohol intake and BMI. RESULTS: The replacement of 5% of energy from carbohydrates with total fats or MUFAs was statistically significantly associated with 0.67mg/dL (95% CI: 0.40, 0.94) or 0.99mg/dL (95% CI: 0.37, 1.60) higher HDL cholesterol, respectively, but not with non-HDL cholesterol concentrations. The replacement of 5% of energy from carbohydrates with SFAs or PUFAs was not associated with HDL cholesterol, but SFAs were statistically significantly associated with 1.94mg/dL (95% CI: 0.08, 3.79) higher non-HDL cholesterol, and PUFAs with -3.91mg/dL (95% CI: -6.98, -0.84) lower non-HDL cholesterol concentrations. A statistically significant interaction by sex for the association of replacing carbohydrates with MUFAs and non-HDL cholesterol was observed, showing a statistically significant inverse association in males and no statistically significant association in females. We observed no statistically significant interaction by age. CONCLUSIONS: The replacement of dietary carbohydrates with fats had favorable effects on lipoprotein cholesterol concentrations in European adolescents and adults when fats were consumed as MUFAs or PUFAs but not as SFAs.

Introduction Virtual reality (VR) is a recent topic in healthcare education. Little is known about the factors affecting the immersion and the sense of presence in VR. This study aimed to understand the elements that influence the sense of presence among undergraduate healthcare students and postgraduate (PG). Methods Undergraduate healthcare students (n = 42) and PG (n = 19) were immersed in a mass casualty incident–immersive simulation. Participants completed questionnaires before (immersion propensity, stress) and after immersion (sense of presence, stress, cybersickness, and satisfaction). The qualitative component of the study provided the context for the quantitative results. Results The sense of presence was high among both groups but higher among PG (p = .02) and was positively correlated to immersion propensity (r = 0.36; p Conclusion In accordance with the results, the mass casualty incident–immersive simulation induced a high level of sense of presence and a low level of cybersickness. The sense of presence was correlated with the individual immersion propensity.

Quality of life (QOL) of a patient is usually computed as the (weighted) sum of items and analysed by means of multiple regressions to evaluate its relationships with various measured factors. The aim of the present study was to compare results derived under classical statistical method with those obtained under more appropriate statistical techniques for QOL. Analyses were applied to data from 4155 subjects participated in 2012 in a community based sample study in the French speaking part of Belgium and which completed a web-based questionnaire on their weight-related experience. Confirmatory factor analysis (CFA) and structural equation modeling (SEM) were carried out to derive QOL and to test direct/indirect effects of body mass index (BMI), age, body image discrepancy (BID), latent socio-economic (SOCIO) and latent subjective-norm (SN). No major differences were found under both SEM and the product of coefficients approach using SAS PROCESS macro developed by Hayes. Significant direct and indirect effects on physical and psychological dimensions of QOL were found for age, BMI and SOCIO while significant direct effects were found for BID and SN (p

Objectiven-3 PUFA during pregnancy have been subject to intense research interest, but also much controversy, creating a situation of confusion among patients and health-care providers. The present study was carried out to explore knowledge, attitude and practices regardingn-3 PUFA in two independent populations of pregnant women and gynaecologists–obstetricians in Belgium and to assess the relationship between the pregnant women’s attributes and theirn-3 PUFA status measured by the omega-3 index.DesignCross-sectional study. Knowledge, attitude and practices were collected by self-administered questionnaires while laboratory data were available for each pregnant woman.SettingDuring the first antenatal hospital appointment (for the pregnant women) and by email (for the gynaecologists–obstetricians).ParticipantsWomen in early pregnancy (n122) and gynaecologists–obstetricians (n67).ResultsMarked discrepancies in perception were evidenced between the pregnant women and health-care providers. While 82 % of the women attached high importance ton-3 PUFA during pregnancy, only a third of the gynaecologists–obstetricians did. About 35 % of the women declared paying particular attention to their consumption ofn-3 PUFA. After adjusting for sociodemographic characteristics, these positive dietary practices were significantly associated with higher omega-3 index (P=0·04). Overall, 43·3 % of professionals did not provide any information aboutn-3 PUFA to their pregnant patients and 46·3 % did not take any preventive actions.ConclusionsEvidence-based guidelines, refreshment training and communication tools are needed to improve awareness and clinical practices among caregivers regardingn-3 PUFA to benefit both mothers and their children.

(1) Background: Nutrition labels on the front of food packages have increasingly become the focus of research. However, too few studies have placed special emphasis on nutritionally at-risk subpopulations, such as young adults or those with low literacy/numeracy skills. The present study aimed to assess both the perception and objective understanding of three front-of-package labeling (FOPL) formats currently in use on the Belgian market, i.e., the Nutri-Score, Reference Intakes, and Multiple Traffic Lights, among students of varying health literacy (HL) levels. (2) Methods: A web-based survey was carried out among 2295 students of tertiary education in the province of Liège, Belgium. The questionnaire included questions related to general characteristics, objective understanding, and perception in response to the assigned FOPL format and level of HL. (3) Results: With respect to objective understanding, the Nutri-Score outperformed all other labels across all HL levels, and it was similarly understood in students of varying HL levels. Several students’ characteristics appeared to be associated with each cluster of perception, with the Nutri-Score cluster having the highest percentages of disadvantaged students, i.e., those with inadequate HL, from non-university institutions, with low self-estimated nutrition knowledge, and with low self-estimated diet quality. (4) Conclusion: Overall, the findings supported the Nutri-Score as particularly effective in guiding students in their food choices. Of particular importance is the fact that the summarized and graded color-coded nutritional label would be a useful strategy for those disadvantaged by limited HL.

Background: In recent decades, measures of asthma-related quality of life have become important outcomes alongside clinical objective outcomes. In this study we sought to investigate the predictors of asthma-related quality of life in a large cohort of patients recruited from a secondary care center. Methods: We conducted a cross-sectional study on asthmatics recruited from the asthma clinic of Chu Liège (Belgium). After carrying out a descriptive analysis highlighting the distribution of the mini asthma quality of life questionnaire (Mini-AQLQ) and its 4 dimensions (symptoms, activity limitation, emotional function and environmental stimuli), we performed a multiple regression analysis to identify the independent predictors of AQLQ.Results: The median score (IQR) of global AQLQ was 4,53 (3,47-5,6), while the median score of symptom dimension, activity dimension, emotional dimension and environmental dimension were 4,2(3,2-5,4), 4,8 (3,3-6), 4,7 (3,3-6) et 4,7 (3,7-6) respectively. Multiple regression beta analysis showed that AQLQ and its 4 dimensions were primarily associated with asthma control test (ACT) (pConclusion: Asthma control is the main predictor of asthma-related quality of life, but demographic factors like gender, smoking status and BMI may impact some dimensions of the asthma quality of life. FeNO is an independent predictor of the activity dimension of AQLQ and positively associated with it.

Background The extent to which patients are involved in their care can be influenced by hospital policies and interventions. Nevertheless, the implementation of patient participation and involvement (PPI) at the organisational (meso) level has rarely been assessed systematically. The aim of this study was to assess the occurrence of PPI practises in hospitals in Belgium, France, Germany and Luxembourg and to analyze if, and to what extent, the hospital vision and the presence of a patient committee influence the implementation of PPI practises. Methods A cross-sectional study was carried out using an online questionnaire in hospitals in the border regions of the four countries. The data were analyzed for differences between regions and the maturity of PPI development. Results Full responses were obtained from 64 hospitals. A wide range of practices were observed, the degree of maturity was mixed. A majority of hospitals promoted patient partnership in the hospital’s philosophy of care statement. However, the implementation of specific interventions for PPI was not found uniformly and differences could be observed between the countries. Conclusions Hospitals in the region seem to be motivated to include patients more fully, however, implementation of PPI interventions seems incomplete and only partially integrated into the general functioning of the hospitals. The implementation of the concept seems to be more mature in the francophone part of the region perhaps due, in part, to a more favourable political context.

When conducting research on polyphenols and their effects on health, it is of primary importance to use standardised and validated dietary assessment tools. This paper aims at assessing the validity of a food frequency questionnaire (FFQ) for quantifying dietary polyphenol exposure among healthy adults using the method of triads. Fifty-three healthy adults, aged 20-60, were included in the study. Total dietary polyphenol intake (TDP) estimated by the FFQ was compared with TDP measured by a 3-day food record (FR) and with urinary excretion levels of total polyphenols (TUP). Pearson correlations were calculated between methods. Validity coefficients (VC) were estimated between the three measurements and the 'unknown' true intake. There was a strong correlation between both dietary methods (r = 0.70, p 0.0001). A moderate but significant association was observed between FFQ-derived TDP and TUP (r = 0.32, p = 0.020). The method of triads yielded a VC for the FFQ of 0.63 (95%CI: 0.41-0.84), indicating a strong relationship between FFQ-derived TDP and the true polyphenol intake. This study shows that the FFQ is an adequate tool not only for measuring dietary polyphenol exposure in nutrition epidemiological studies but also for guiding clinicians in dietary advice and counselling.

Background Overweight and obesity are major public health problems of growing concern. Few studies have investigated the representations and perceptions of subjects with overweight and obesity, especially in the general population, as compared to people in a medical weight loss process. The objective of this study was to fill this gap by enabling participants to express their feelings and experience about their overweight, and to assess the extent of the body mass index (BMI) as a determinant of these perceptions. Methods A total of 4155 persons participated in an exploratory study conducted in Wallonia (Belgium). Data were collected by means of a web-based questionnaire. This study investigated the following parameters: sociodemographic and anthropometric factors, perceived health, quality of life, diet perception, enrolment in a weight loss process and weight loss target. The influence of BMI was considered, on one hand, looking at how the above variables evolve according to BMI category, secondly, as a mediation factor in the relationship between socioeconomic level and these same variables. Results A large majority (87.5%) of subjects were overweight (32.2%) or obese (obese class I 29.9%, class II 14.8%, class III 10.6%). Perceived health was found to deteriorate with the BMI (P

Benoit Pétré,1 Remi Gagnayre,2 Vincent De Andrade,2 Olivier Ziegler,3 Michèle Guillaume1 1Department of Public Health, University of Liège, Liège, Belgium; 2Educations and Health Practices Laboratory (LEPS), (EA 3412), UFR SMBH, Paris 13 University, Sorbonne Paris Cite, Bobigny, 3Department of Diabetes, Metabolic diseases and Nutrition, Nancy University Hospital, Nancy, France Abstract: Educative attitude is an essential, if implicit, aspect of training to acquire competency in therapeutic patient education (TPE). With multiple (or nonexistent) definitions in the literature, however, the concept needs clarification. The primary aim of this study was to analyze the representations and transformations experienced by health care professionals in the course of TPE training in order to characterize educative attitude. We conducted an exploratory qualitative study using several narrative research-based tools with participants of two TPE continuing education courses. We then performed an inductive thematic analysis. Thirty-three people participated in the study; the majority were women (n=29), nurses (n=17) working in a hospital setting (n=28). Seven categories of statements were identified: time-related (“the right moment, how much time it takes”), the benefits of TPE (to health care professionals’ personal well-being), emotions and feelings (quality of exchanges, sharing), the professional nature of TPE (educational competencies required), the holistic, interdisciplinary approach (complexity of the person and value of teamwork), the educational nature of the care relationship (education an integral part of care) and the ethical dimension (introspection essential). The first three components appear fairly innovative, at least in formulation. The study’s originality rests primarily in its choice of participants – highly motivated novices who expressed themselves in a completely nontheoretical way. Health models see attitude as critical for adopting a behavior. Best TPE practices should encourage personal work on this, opening professionals to the social, experiential and emotional aspects of managing chronic illness. Keywords: therapeutic patient education, attitude of health personnel, competence, professional

OBJECTIVE Frailty is a dynamic state of vulnerability in the elderly. We examined whether individuals with overt diabetes or higher levels of HbA1c or fasting plasma glucose (FG) experience different frailty trajectories with aging. RESEARCH DESIGN AND METHODS Diabetes, HbA1c, and FG were assessed at baseline, and frailty status was evaluated with a 36-item frailty index every 2 years during a 10-year follow-up among participants from the English Longitudinal Study of Ageing (ELSA). Mixed-effects models with age as time scale were used to assess whether age trajectories of frailty differed as a function of diabetes, HbA1c, and FG. RESULTS Among 5,377 participants (median age [interquartile range] 70 [65, 77] years, 45% men), 35% were frail at baseline. In a model adjusted for sex, participants with baseline diabetes had an increased frailty index over aging compared with those without diabetes. Similar findings were observed with higher levels of HbA1c, while FG was not associated with frailty. In a model additionally adjusted for income, social class, smoking, alcohol, and hemoglobin, only diabetes was associated with an increased frailty index. Among nonfrail participants at baseline, both diabetes and HbA1c level were associated with a higher increased frailty index over time. CONCLUSIONS People with diabetes or higher HbA1c levels at baseline had a higher frailty level throughout later life. Nonfrail participants with diabetes or higher HbA1c also experienced more rapid deterioration of frailty level with aging. This observation could reflect a role of diabetes complications in frailty trajectories or earlier shared determinants that contribute to diabetes and frailty risk in later life.

To examine the association between maternal erythrocyte long-chain omega-3 PUFA (n-3 LCPUFA), measured in early pregnancy, and pregnancy and birth outcomes. One hundred and eight healthy women with a singleton pregnancy were included. Erythrocyte fatty acids were analyzed using gas chromatography. Gestational length, birth anthropometric measures, and pregnancy-associated complications were collected from hospital medical records. We observed significant positive associations between maternal docosahexaenoic acid (DHA) levels (p = 0.024) and omega-3 index values (p = 0.021) and gestational length in adjusted linear regression models. Each point in maternal DHA level was associated with 2.19 days longer gestational duration (β = 2.19; 95% CI 0.29–4.09). No consistent associations were found between n-3 PUFA levels and composite pregnancy outcome. These findings suggest that the gestational length is positively affected by maternal n-3 LCPUFA status as soon as the early stages of pregnancy.

While studies revealed that the omega-3 polyunsaturated fatty acids (n-3 PUFA) and their mediators would be able to regulate several biological processes involved into the development of postpartum depression (PPD), evidence from observational studies remains mixed. The aim of the present study was to investigate the association between maternal erythrocyte n-3 PUFA, measured in early pregnancy, and the risk of PPD. A Belgian cohort of 72 healthy women was screened. Erythrocyte fatty acids were analysed using gas chromatography. PPD was assessed using the Bromley Postnatal Depression Scale by phone interview one year after delivery. We observed a significant negative association between docosahexaenoic acid (DHA) levels and the risk of postpartum depression in the adjusted model (p = 0.034). Higher n-6/n-3 and arachidonic acid (AA)/eicosapentaenoic acid (EPA) ratios were significantly associated with an increased odds of PPD (p = 0.013 and p = 0.043, respectively). Women with an omega-3 index