Early flow cytometry studies revealed T cell activation in major depressive disorder (MDD) (Maes et al., 1990-1993). MDD is characterised by activation of the immune-inflammatory response system (IRS) and the compensatory immunoregulatory system (CIRS), including deficits in T regulatory (Treg) cells. This study examines the number of cannabinoid type 1 (CB1) and type 2 (CB2) receptor bearing T/B lymphocytes in MDD, and the effects of in vitro cannabidiol (CBD) administration on CB1/CB2-bearing immunocytes.

Using flow cytometry, we determined the percentage of CD20+CB2+, CD3+CB2+, CD4+CB2+, CD8+CB2+ and FoxP3+CB1+ cells in 19 healthy controls and 29 MDD patients in 5 conditions: baseline, stimulation with anti-CD3/CD28 with or without 0.1 µg/mL, 1.0 µg/mL or 10.0 µg/mL CBD.

CB2+ was significantly higher in CD20+ than CD3+ and CD4+, and CD8+ cells. Stimulation with anti-CD3/CD8 beads increases the number of CB2-bearing CD3+, CD4+, and CD8+ cells, as well as CB1-bearing FoxP3+ cells. There was an inverse association between the number of reduced CD4+CB2+ and IRS profiles, including M1 macrophage, T helper-(Th)-1 and Th-17 phenotypes. MDD is characterized by lowered basal FoxP3+CB1+% and higher CD20+CB2+%. 33.2% of the variance in the depression phenome (including severity of depression, anxiety, and current suicidal behaviors) is explained by CD20+CB2+% (positively) and CD3+CB2+% (inversely). All 5 immune cell populations were significantly increased by 10 µg/mL CBD administration.

reductions in FoxP3+CB1+% and CD3+/CD4+CB2+% contribute to deficits in immune homeostasis in MDD, while increased CD20+CB2+% may contribute to the pathophysiology of MDD by activating T-independent humoral immunity.

There are no conclusive findings about the possible protective role of religion on students’ mental health during the COVID-19 pandemic. Therefore, more research is needed.

The purpose of this study was to assess the relationship between the level of emotional distress and religiosity among students from 7 different countries during the COVID-19 pandemic.

Data were collected by an online cross-sectional survey that was distributed amongst Polish (N = 1196), Bengali (N = 1537), Indian (N = 483), Mexican (N = 231), Egyptian (N = 565), Philippine (N = 2062), and Pakistani (N = 506) students (N = 6642) from 12th April to 1st June 2021. The respondents were asked several questions regarding their religiosity which was measured by The Duke University Religion Index (DUREL), the emotional distress was measured by the Depression, Anxiety, and Stress Scale-21 (DASS-21).

Egypt with Islam as the dominant religion showed the greatest temple attendance (organizational religious activity: M=5.27±1.36) and spirituality (intrinsic religiosity: M=5.27±1.36), p<0.0001. On another hand, Egyptian students had the lowest emotional distress measured in all categories DASS-21 (depression: M=4.87±10.17, anxiety: M=4.78±10.13, stress: M=20.76±11.46). Two countries with the dominant Christian religion achieved the highest score for private religious activities (non-organizational religious activity; Mexico: M=3.94±0.94, Poland: M=3.63±1.20; p<0.0001) and experienced a moderate level of depressive symptoms, anxiety, and stress. Students from Mexico presented the lowest attendance to church (M=2.46±1,39) and spirituality (M=6.68± 3.41) and had the second highest level of depressive symptoms (M=19.13±13.03) and stress (M=20.27±1.98). Philippines students had the highest DASS-21 score (depression: M=22.77±12.58, anxiety: M=16.07±10.77, stress: M=4.87±10.08) and their level of religiosity reached average values in the whole group. The performed regression analysis confirmed the importance of the 3 dimensions (organizational religious activity, non-organizational religious activity, intrinsic religiosity) of religiosity for the well-being of students, except for the relationship between anxiety and private religious activities. The result was as presented for depression: R2=0.0398, F(3.664)=91.764, p<0.0001, SE of E: 12.88; anxiety: R2=0.0124, F(3.664)=27.683, p<0.0001, SE of E: 10,62; stress: R2= 0.0350, F(3.664)=80.363, p<0.0001, SE of E: 12.30.

The higher commitment to organizational religious activity, non-organizational religious activity, and intrinsic religiositywas correlated with the lower level of depressive symptoms, stress, and anxiety among students during the COVID-19 pandemic, but taking into account factors related to religiosity explains the level of emotional well-being to a small extent.

None Declared

Throughout the COVID-19 pandemic, students were vulnerable to mental health issues and dentistry students were no exception. All Iraqi universities were transitioning back to face-to-face learning in the last year. Acclimatization with all pandemic regulations that schools apply might increase the vulnerability to depression.

The current study aims to assess the levels of depression among Iraqi dentistry students after transitioning from online to onsite learning during the pandemic period.

A cross-sectional study was conducted online after transitioning from online to the onsite learning method during the pandemic period. Sociodemographic data and Patient Health Questionnaire-8 (PHQ-8) were included in the questionnaire.

A total of 307 respondents, 216 (70.4%) female and 91 (29.6%) male, 276 (90%) live with family, 20 (6.5%) live with friends and 11 (3.5%) live alone, 268 (87.3%) of student claimed that post-COVID-19 regulations face to face learning is more stressful while 39 (12.7%) answered no difference. 39 (12.7%) of dentistry student with normal level of depression, 199 (38.8%) have mild depression 101 (32.9%) moderate depression, 32 (10.4%) moderately severe, 16 (5.2%) severe. Depression level and students’ perception of teaching mode transition showed a significant association (p<0.05).However, there are no significant associations between gender, living conditions, or dentistry stages with depression levels (p>0.05).

A high prevalence of depression symptoms among Iraqi dentistry students was found during onsite learning, along with all educational institutions’ pandemic rules and regulations. Psychological supporting preventive programs are needed to apply for supporting students’ mental health.

None Declared

TDuring COVID-19 pandemic, it was noticed that it was students who were mostly affected by the changes that aroused because of the pandemic. The interesting part is whether students’ well-being could be associated with their fields of study as well as coping strategies.

In this study, we aimed to assess 1) the mental health of students from nine countries with a particular focus on depression, anxiety, and stress levels and their fields of study, 2) the major coping strategies of students after one year of the COVID-19 pandemic.

We conducted an anonymous online cross-sectional survey on 12th April – 1st June 2021 that was distributed among the students from Poland, Mexico, Egypt, India, Pakistan, China, Vietnam, Philippines, and Bangladesh. To measure the emotional distress, we used the Depression, Anxiety, and Stress Scale-21 (DASS-21), and to identify the major coping strategies of students - the Brief-COPE.

We gathered 7219 responses from students studying five major studies: medical studies (N=2821), social sciences (N=1471), technical sciences (N=891), artistic/humanistic studies (N=1094), sciences (N=942). The greatest intensity of depression (M=18.29±13.83; moderate intensity), anxiety (M=13.13±11.37; moderate intensity ), and stress (M=17.86±12.94; mild intensity) was observed among sciences students. Medical students presented the lowest intensity of all three components - depression (M=13.31±12.45; mild intensity), anxiety (M=10.37±10.57; moderate intensity), and stress (M=13.65±11.94; mild intensity). Students of all fields primarily used acceptance and self-distraction as their coping mechanisms, while the least commonly used were self-blame, denial, and substance use. The group of coping mechanisms the most frequently used was ‘emotional focus’. Medical students statistically less often used avoidant coping strategies compared to other fields of study. Substance use was only one coping mechanism that did not statistically differ between students of different fields of study. Behavioral disengagement presented the highest correlation with depression (r=0.54), anxiety (r=0.48), and stress (r=0.47) while religion presented the lowest positive correlation with depression (r=0.07), anxiety (r=0.14), and stress (r=0.11).

1) The greatest intensity of depression, anxiety, and stress was observed among sciences students, while the lowest intensity of those components was found among students studying medicine.

2) Not using avoidant coping strategies might be associated with lower intensity of all DASS components among students.

3) Behavioral disengagement might be strongly associated with greater intensity of depression, anxiety, and stress among students.

4) There was no coping mechanism that provided the alleviation of emotional distress in all the fields of studies of students.

None Declared

Burnout in the medical profession has garnered a lot of attention over the recent years. While it is reported across all specialties and all stages of medical education; resident physicians in particular are at high risk for burnout throughout their years of training.

This study aimed at evaluating the prevalence and correlates of burnout among resident physicians in Alberta.

Through a descriptive cross-sectional study design, a self-administered questionnaire was used to gather data from resident physicians at two medical schools in Alberta, Canada. Maslach Burnout Inventory was used as an assessment tool. Chi-squared and multivariate binary logistic regression analyses were used.

Overall burnout prevalence among residents was 58.2%. Working more than 80 hours/week (OR= 16.437; 95% CI: 2.059 – 131.225), being dissatisfied (OR= 22.28; 95% CI: 1.75– 283.278) or being neither satisfied nor dissatisfied with a career in medicine [(OR= 23.81; 95% CI: 4.89 – 115.86) were significantly associated with high depersonalization. Dissatisfaction with efficiency and resources (OR= 10.83; CI: 1.66- 70.32) or being neither satisfied nor dissatisfied with a career in medicine (OR= 5.14; CI: 1.33- 19.94)] were significantly associated with high emotional exhaustion. Working more than 80 hours/week (OR= 5.36; CI: 1.08- 26.42) and feeling that the residency program is somewhat having enough strategies aimed at resident well-being in place (OR= 3.70; CI: 1.10- 12.46) were significantly associated with high work exhaustion and interpersonal disengagement. Young age of the residents (≤ 30 years) (OR= 0.044; CI: 0.004- 0.445) was significantly associated with low professional fulfillment.

Burnout is a serious occupational phenomenon that can degenerate to other conditions or disrupts one’s professional performance. Significant correlates were associated with high rates of burnout. Leaders of medical schools and policy makers need to acknowledge, design, and implement various strategies capable of providing continuous effective mental health support to improve the psychological health of the medical resident across Canada.

None Declared

The aim of this study was to determine the proportion of patients who had fasting plasma glucose and glycosylated haemoglobin (HbA1c) blood tests done on admission to an older people's inpatient ward at Kingfisher Court, Hertfordshire. Patients undergo a physical health assessment when they are admitted to the ward. This consists of a physical examination, an electrocardiogram and a panel of blood tests, which include a fasting plasma glucose and HbA1c. Given that people with severe mental illness have a greater burden of physical health conditions, such as diabetes, this physical health assessment can aid in optimising patients’ physical health and reducing this health inequality.

A sample of 40 patients who were most recently discharged from the older people's inpatient ward were included in the audit. Four authors each independently reviewed 10 patient case notes and blood results. An audit collection tool was produced and data logged for each patient. The data collected were reviewed by all authors.

57.5% (23) of the study population had admission blood tests that included a HBA1c level or plasma glucose. An individual with diet-controlled type 2 diabetes mellitus had a HBA1c of 55 mmol/mol and was subsequently started on metformin. Only 15% (6) of the study population had a plasma glucose test on admission. Their case notes did not specify whether these were fasted or random plasma glucose tests. 42.5% (17) of the study population did not have either a plasma glucose test or HBA1c test done.

There was poor overall compliance with the trust protocol for blood tests on admission to the older people's inpatient ward. Plasma glucose tests were rarely done and it was not specified whether they were fasted or random tests, thus limiting their utility. The team therefore suggest that the fasting plasma glucose test be removed from the panel of admission blood tests. The focus should be on obtaining a HbA1c test. Amendments to the clerking proforma and doctors’ induction presentation should be made to emphasise the importance of the HbA1c test.

Seclusion is a psychiatric treatment that is used as a “last resort” in light of deteriorating mental state. It involves the supervised confinement and isolation of a patient, away from other patients, in an area where the patient is not allowed to leave due to possible risk they pose to themselves and others in order to manage severe agitation and chaotic behaviour. The Trust policy defines a procedure for seclusion which encourages decision making in line with the Mental Health Code of Practice 2015 (MHCoP 2015) and encourages the clinicians to adhere to the policy, making decisions and care which should be duly documented following an assessment of ongoing concern, mental state, assessment of physical health, medication review, risk assessment in a timely fashion as stipulated in the policy.

This was a retrospective review of patients based on incidence reports completed at the commencement of seclusion on the Derbyshire Healthcare Trust between May and November 2022 . The electronic records were reviewed, and data analysed via Microsoft Excel, against trust standards:

• • Timing of seclusion review: 1hour and 4hourly medical review

• • Independent Multidisciplinary Team meeting within 12hours on seclusion

• • Documentation of seclusion

• • Review of ongoing concerns

• • Mental state examination

• • Physical health review

• • Medication review

• • Risk assessment

• • Review of need for seclusion

• • Intervention

107 incidences of seclusion that took place involving 61 patients were reviewed.

34% of patients were reviewed within the 1hour, 41% reviewed 4hourly and 47% had an internal MDT.

57% of medical reviews were documented with 50% clearly stating ongoing concerns, 47% carrying out a mental state examination and 42% had physical health reviews done. 44% had medication review done, 44% had risk assessment, 58% reviewed the need for seclusion and 52% had an intervention recorded.

The audit showed poor adherence to the Trust guidelines both in terms of the frequency of the review and the vital aspects of the review as included in the seclusion review template. There seemed to be poor use of the seclusion template among medics, which is meant to serve as a prompt for the expected standards, hence more awareness is to be created.

The areas of improvement also identified include the education and training of staff about the stipulation of the policy and clear documentation, with emphasis on the frequency as well as the quality of the reviews done.

The evidence shows that the need for emergency evacuation in hospitals has arisen. Designing an emergency evacuation decision making tool increases the confidence of hospital managers in the decision made. Therefore, this study was aimed at the development, and the psychometric properties, of the decision-making scale for emergency hospital evacuation in disasters.

This study was done in 2 phases of qualitative study and literature review and designing and psychometric properties of the instrument. After development of the primary item pool, the psychometric properties of the questionnaire were evaluated. In this regard, face and content validity, internal consistency (Alpha’s Cronbach), reliability (ICC), and stability were assessed.

In the validity stage of the instrument, 4 items were removed. Also, 4 items were modified and 2 items were merged. The number of items was thus decreased to 64. After CVI calculation, 5 items were removed, 4 items were modified, and 2 items were merged. As a result of this, the number of items decreased to 58 items. The scale has good reliability and stability.

It seems that the instrument could be useful in decision-making for emergency hospital evacuation in disasters.

Specialty on-call clinicians cover large areas and complex workloads. This study aimed to assess clinical communication using the mixed-reality HoloLens 2 device within a simulated on-call scenario.

This study was structured as a randomised, within-participant, controlled study. Thirty ENT trainees used either the HoloLens 2 or a traditional telephone to communicate a clinical case to a consultant. The quality of the clinical communication was scored objectively and subjectively.

Clinical communication using the HoloLens 2 scored statistically higher than telephone (n = 30) (11.9 of 15 vs 10.2 of 15; p = 0.001). Subjectively, consultants judged more communication episodes to be inadequate when using the telephone (7 of 30) versus the HoloLens 2 (0 of 30) (p = 0.01). Qualitative feedback indicates that the HoloLens 2 was easy to use and would add value during an on-call scenario with remote consultant supervision.

This study demonstrated the benefit that mixed-reality devices, such as the HoloLens 2 can bring to clinical communication through increasing the accuracy of communication and confidence of the users.

The performance of diagnostic health technologies is usually assessed by comparing them with standard care using the kappa statistic. These comparisons are made based on comprehensive clinical information (e.g., anamnesis and complementary tests). However, not all digital applications (DAs) execute over complete information, which leads to work under non-uniform distribution of values. Using kappa statistic in this situation has serious methodological limitations. Kappa assumes that the marginal values are uniformly distributed and highly weights the discordant values when calculating concordance, which underestimates the real effectiveness of DAs (i.e., observed concordance). We aimed to present the application of the B statistic to WtsWrng, a symptom triage DA for individuals.

WtsWrng was used by 382 patients at the emergency department of a hospital. Diagnoses provided by WtsWrng, given 19 symptoms, were compared with those logged in the hospital’s electronic clinical records at discharge. Observed concordance was calculated using contingency tables. The concordance using the kappa and B statistics were compared for the 12 most frequent diagnoses at hospital discharge. Sensitivity and specificity were also calculated.

Real observed concordance fluctuated from 0.4 to 0.98 for the 12 most frequent diagnoses, eight of which had a concordance greater than 0.8. The results ranged from -0.005 to 0.37 when using the kappa statistic and from 0.36 to 0.99 when using the B statistic. The sensitivity and specificity of WtsWrng were greater than 0.8 for three and eight of the 12 diagnoses, respectively.

The results show that the B statistic is closer to the real observed concordance when kappa statistic assumptions are not fulfilled by a DA. Therefore, the B statistic is better suited for assessing the effectiveness of this type of technology. Analysis of WtsWrng using the B statistic showed that its diagnoses were close to those provided by clinicians, which were arrived at using complete clinical information. Moreover, the high specificity of the WtsWrng DA suggests that it is a good tool for determining the appropriate use of healthcare resources.