On the impact of the COVID-19 pandemic on air quality in Florida

Since early 2020, the world has faced an unprecedented pandemic caused by the novel COVID-19 virus. In this study, we characterize the impact of the lockdown associated with the pandemic on air quality in six major cities across the state of Florida, namely: Jacksonville, Tallahassee, Gainesville, Orlando, Tampa, and Miami. Hourly measurements of PM_2.5, ozone, NO₂, SO₂, and CO were provided by the US EPA at thirty sites operated by the Florida Department of Environmental Protection during mid-February to mid-April from 2015 through 2020. To analyze the effect of the pandemic, atmospheric pollutant concentrations in 2020 were compared to historic data at these cities during the same period from 2015 to 2019. Reductions in NO₂ and CO levels were observed across the state in most cities and were attributed to restrictions in mobility and the decrease in vehicle usage amid the lockdown. Likewise, decreases in O₃ concentrations were observed and were related to the prevailing NO_x-limited regime during this time period. Changes in concentrations of SO₂ exhibited spatial variations, concentrations decreased in northern cities, however an increase was observed in central and southern cities, likely due to increased power generation at facilities primarily in the central and southern regions of the state. PM_2.5 levels varied temporally during the study and were positively correlated with SO₂ concentrations during the lockdown. In March, reductions in PM_2.5 levels were observed, however elevations in PM_2.5 concentrations in April were attributed to long-range transport of pollutants rather than local emissions. This study provides further insight into the impacts of the COVID-19 pandemic on anthropogenic sources from vehicular emissions and power generation in Florida. This work has implications for policies and regulations of vehicular emissions as well as consequences on the use of sustainable energy sources in the state.

Greatest changes in objective sleep architecture during COVID-19 lockdown in night owls with increased REM sleep

STUDY OBJECTIVES

The COVID-19 pandemic has had dramatic effects on society and people's daily habits. In this observational study, we recorded objective data on sleep macro- and microarchitecture repeatedly over several nights before and during the COVID-19 government-imposed lockdown. The main objective was to evaluate changes in patterns of sleep duration and architecture during home confinement using the pre-confinement period as a control.

METHODS

Participants were regular users of a sleep-monitoring headband that records, stores, and automatically analyzes physiological data in real time, equivalent to polysomnography. We measured sleep onset duration, total sleep time, duration of sleep stages (N2, N3, and rapid eye movement [REM]), and sleep continuity. Via the user's smartphone application, participants filled in questionnaires on how lockdown changed working hours, eating behavior, and daily life at home. They also filled in the Insomnia Severity Index, reduced Morningness-Eveningness Questionnaire, and Hospital Anxiety and Depression Scale questionnaires, allowing us to create selected subgroups.

RESULTS

The 599 participants were mainly men (71%) of median age 47 (interquartile range: 36-59). Compared to before lockdown, during lockdown individuals slept more overall (mean +3·83 min; SD: ±1.3), had less deep sleep (N3), more light sleep (N2), and longer REM sleep (mean +3·74 min; SD: ±0.8). They exhibited less weekend-specific changes, suggesting less sleep restriction during the week. Changes were most pronounced in individuals reporting eveningness preferences, suggesting relative sleep deprivation in this population and exacerbated sensitivity to societal changes.

CONCLUSION

This unique dataset should help us understand the effects of lockdown on sleep architecture and on our health.

Associations of the Initial COVID-19 Lockdown on Self-Reported Happiness and Worry about Developing Loneliness: A Cross-Sectional Analysis of Rural, Regional, and Urban Australian Communities

Australia adopted hard lockdown measures to eliminate community transmission of COVID-19. Lockdown imposes periods of social isolation that contributes to increased levels of stress, anxiety, depression, loneliness, and worry. We examined whether lockdowns have similar psychosocial associations across rural and urban areas and whether associations existed between happiness and worry of loneliness in the initial wave of the COVID-19 pandemic in Australia. Data were collected using the "COVID-19 Living Survey" between 13 and 20 May 2020 by BehaviourWorks Australia at the Monash Sustainable Development Institute. The mean self-reported feeling of happiness and anxiousness (N = 1593), on a 10-point Likert scale with 0 being least happy or highly anxious, was 6.5 (SD = 2.4) and 3.9 (2.9), respectively. Factors associated with happiness were older age and having a postgraduate education. Participants worried about becoming lonely also exhibited reduced happiness (estimate = -1.58, 95%CI = -1.84--1.32) and higher anxiousness (2.22, 1.93-2.51) scores, and these conditions remained associated after adjusting for demographics. Interestingly, worry about loneliness was greater in rural areas than in urban communities. The negative impact of the COVID-19 lockdown on rural youth and those less-educated was evident. Participants in rural Australia who were worried about becoming lonely were reportedly less happy than participants in major cities. This dataset provides a better understanding of factors that influence psychological well-being and quality of life in the Australian population and helps to determine whether happiness may be an associative factor that could mitigate self-feelings of anxiety and worry about loneliness.

Adjustment to COVID-19 Lockdown Among Italian University Students: The Role of Concerns, Change in Peer and Family Relationships and in Learning Skills, Emotional, and Academic Self-Efficacy on Depressive Symptoms

In Italy strict containment measures against COVID-19 pandemic were implemented from March to May 2020 with home confinement and schools and universities closed. Students shifted to remote learning, experienced a forced isolation from peers and an increased sharing of time and spaces with the family. The influence of these aspects on the psychological adjustment of university students is largely unexplored. This paper was aimed at investigating the role of some correlates of depressive symptoms specific to the lockdown condition experienced by young university students, namely contagion concern, perceived worsening of family, and peer relationships and perceived worsening of learning skills. Moreover, the possible mediating effects of emotional and academic self-efficacy in these relationships were examined. Data were collected from 296 Italian university students (aged 18–25 years; 83% female students) through an online survey by means of a snowball sampling methodology in May 2020. Significant depressive symptoms were reported by 67% of participants. Contagion concerns were related to depressive symptoms through the mediating effect of emotional self-efficacy. Worsening of learning skills was related to depressive symptoms through the mediating effect of academic self-efficacy. Depressive symptoms were directly related to worsening of family relationships but unrelated to worsening of peer relationships. Results are discussed in relation to the need of preventive interventions for this specific population in view of academic activities planning in the post-COVID 19 period.

Influence of meteorology, mobility, air mass transport and biomass burning on PM2.5 of three north Indian cities: phase-wise analysis of the COVID-19 lockdown

Recent studies concluded that air quality has improved due to the enforcement of lockdown in the wake of COVID-19. However, they mostly concentrated on the changes during the lockdown period, and the studies considering the consequences of de-escalation of lockdown are inadequate. Therefore, we investigated the changes in fine particulate matter (PM2.5) during the pre-lockdown, strict lockdown, unlocking, and post-lockdown scenarios. In addition, we assessed the influence of meteorology, mobility, air mass transport, and biomass burning on PM2.5 using Google's mobility data, back trajectory model, and satellite-based fire incident data. Average PM2.5 concentrations in Ghaziabad, Noida, and Faridabad decreased by 60.70%, 63.27%, and 60.40%, respectively, during the lockdown. When compared with the preceding year (2019), the reductions during the shutdown period (25 March-31 May) were within the range of 36.34-44.55%. However, considering the entire year, this reduction in PM2.5 is momentary, and a steady increase in traffic density and industrial operations within cities during post-lockdown reflects a potent recovery of aerosol level, during which the average mass of PM2.5 three- to four-folds higher than the lockdown period. Back trajectories and fire activity results showed that biomass burning in the nearby states (Haryana and Punjab) influence aerosol load. We conclude that a partial lockdown in the event of a sudden surge in pollution would be a beneficial approach. However, reducing fossil fuel consumption and switching to more environmentally friendly energy sources, developing green transport networks, and circumventing biomass burning are efficient ways to improve air quality in the long term.

Increased ozone pollution alongside reduced nitrogen dioxide concentrations during Vienna's first COVID-19 lockdown: Significance for air quality management

BACKGROUND

Lockdowns amid the COVID-19 pandemic have offered a real-world opportunity to better understand air quality responses to previously unseen anthropogenic emission reductions.

METHODS AND MAIN OBJECTIVE

This work examines the impact of Vienna's first lockdown on ground-level concentrations of nitrogen dioxide (NO₂), ozone (O₃) and total oxidant (O_x). The analysis runs over January to September 2020 and considers business as usual scenarios created with machine learning models to provide a baseline for robustly diagnosing lockdown-related air quality changes. Models were also developed to normalise the air pollutant time series, enabling facilitated intervention assessment.

CORE FINDINGS

NO₂ concentrations were on average -20.1% [13.7-30.4%] lower during the lockdown. However, this benefit was offset by amplified O₃ pollution of +8.5% [3.7-11.0%] in the same period. The consistency in the direction of change indicates that the NO₂ reductions and O₃ increases were ubiquitous over Vienna. O_x concentrations increased slightly by +4.3% [1.8-6.4%], suggesting that a significant part of the drops in NO₂ was compensated by gains in O₃. Accordingly, 82% of lockdown days with lowered NO₂ were accompanied by 81% of days with amplified O₃. The recovery shapes of the pollutant concentrations were depicted and discussed. The business as usual-related outcomes were broadly consistent with the patterns outlined by the normalised time series. These findings allowed to argue further that the detected changes in air quality were of anthropogenic and not of meteorological reason. Pollutant changes on the machine learning baseline revealed that the impact of the lockdown on urban air quality were lower than the raw measurements show. Besides, measured traffic drops in major Austrian roads were more significant for light-duty than for heavy-duty vehicles. It was also noted that the use of mobility reports based on cell phone movement as activity data can overestimate the reduction of emissions for the road transport sector, particularly for heavy-duty vehicles. As heavy-duty vehicles can make up a large fraction of the fleet emissions of nitrogen oxides, the change in the volume of these vehicles on the roads may be the main driver to explain the change in NO₂ concentrations.

INTERPRETATION AND IMPLICATIONS

A probable future with emissions of volatile organic compounds (VOCs) dropping slower than emissions of nitrogen oxides could risk worsened urban O₃ pollution under a VOC-limited photochemical regime. More holistic policies will be needed to achieve improved air quality levels across different regions and criteria pollutants.

Reduction of air pollutants and associated mortality during and after the COVID-19 lockdown in China: Impacts and implications

Although strict lockdown measurements implemented during the COVID-19 pandemic have dramatically reduced the anthropogenic-based emissions, changes in air quality and its health impacts remain unclear in China. We comprehensively described air pollution during and after the lockdown periods in 2020 compared with 2018-2019, and estimated the mortality burden indicated by the number of deaths and years of life lost (YLL) related to the air pollution changes. The mean air quality index (AQI), PM10, PM2.5, NO2, SO2 and CO concentrations during the lockdown across China declined by 18.2 (21.2%), 27.0 μg/m3 (28.9%), 10.5 μg/m3 (18.3%), 8.4 μg/m3 (44.2%), 13.1 μg/m3 (38.8%), and 0.3 mg/m3 (27.3%) respectively, when compared to the same periods during 2018-2019. We observed an increase in O3 concentration during the lockdown by 5.5 μg/m3 (10.4%), and a slight decrease after the lockdown by 3.4 μg/m3 (4.4%). As a result, there were 51.3 (95%CI: 32.2, 70.1) thousand fewer premature deaths (16.2 thousand during and 35.1 thousand after the lockdown), and 1066.8 (95%CI: 668.7, 1456.8) thousand fewer YLLs (343.3 thousand during and 723.5 thousand after the lockdown) than these in 2018-2019. Our findings suggest that the COVID-19 lockdown has caused substantial decreases in air pollutants except for O3, and that substantial human health benefits can be achieved when strict control measures for air pollution are taken to reduce emissions from vehicles and industries. Stricter tailored policy solutions of air pollution are urgently needed in China and other countries, especially in well-developed industrial regions, such as upgrading industry structure and promoting green transportation.

Real-life impact of COVID-19 pandemic lockdown on the management of pediatric and adult asthma: A survey by the EAACI Asthma Section

BACKGROUND

The restrictions imposed by the COVID-19 pandemic impact heavily the management of chronic diseases like asthma. This study aimed to evaluate the management of adults and children with asthma during COVID-19-related lockdown.

METHODS

A survey was launched by the European Academy of Allergy and Clinical Immunology (EAACI) via e-mail, website, and social media to EAACI members and members of peer societies.

RESULTS

The survey was completed by 339 healthcare professionals from 52 countries. 79% of follow-up consultations were replaced by phone calls, whereas 49% of newly referred patients attended the clinic. 62%, 76%, 66%, 76%, and 87% of responders did not conduct spirometry, impulse oscillometry, bronchodilator test, FeNO, or methacholine provocation, respectively, for asthma diagnosis in adults. The numbers were similar for children. 73% of responders based the initial asthma diagnosis and the prescription of inhaled therapy on clinical parameters only. Lung function tests were used in 29% of cases to monitor asthma worsening, and only 56% of participants were recommended to their patients ambulatory peak expiratory flow (PEF) measurements. Using a 1 (not at all) to 5 (very much) scale, the responders considered that the quality of healthcare provided and the patients' asthma status had deteriorated during the lockdown with 3.2 points and 2.8 points, respectively.

CONCLUSION

Collectively, these results suggest that all necessary resources should be allocated to ensure the performance of lung function tests for initial diagnosis, whereas digital remote monitoring should be reinforced for the follow-up of children and adults with asthma.

Observations on the particle pollution of the cities in China in the Coronavirus 2019 closure: Characteristics and lessons for environmental management

Particulate matter in the air seriously affects human health and has been a hot topic of discussion. Because of the coronavirus disease 2019 (COVID-19) lockdown in cities in China, sources of particulate matter, including gasoline-burning vehicles, dust-producing building sites, and coal-fired factories, almost all ceased at the end of January 2020. It was not until early April that outdoor activities recovered. Ten cities were selected as observation sites during the period from 19 December 2019 to 30 April 2020, covering the periods of preclosure, closure, and gradual resumption. A total of 11 720 groups of data were obtained, and 4 indicators were used to assess the characteristics of the particle pollution in the period. The quality of the atmospheric environment was visibly influenced by human activities in those 5 mo. The concentrations of particulate matter with particle sizes below 10 µm (PM10) decreased slightly in February and March and then began to increase slowly after April with the gradual recovery of production. The concentrations of particulate matter with particle sizes below 2.5 µm (PM2.5) decreased greatly in most regions, especially in northern cities, during closure and maintained a relatively stable level in the following 3 mo. The trends of PM10 and PM2.5 indicated that the reduced human activities during the COVID-19 lockdown decreased the concentrations of particulate matter in the air, and the difference between the PM10 and PM2.5 trends might be due to the different sources of the 2 particles and their different aerodynamics. However, during closure, the particulate matter pollution in the cities remained at a high level, which indicated that some ignored factors other than outdoor production activities, automobile exhaust, and construction site dust might have contributed greatly to the PM10 and PM2.5 concentrations, and the tracing of the particulate matter should be given further attention in environmental management. Integr Environ Assess Manag 2021;17:1014-1024. © 2021 SETAC.

Preparedness of medical students towards e-learning conducted during COVID-19 lockdown: A cross-sectional descriptive study

BACKGROUND

COVID-19 lockdown has mandated the medical colleges to start academics using electronic mode. Synchronous e-learning was started by our institute to replicate traditional classes in line with the routine academic schedule. the objective of this study attempted to assess the e-learning readiness of the students of our institute.

MATERIALS AND METHODS

A cross-sectional descriptive study was planned using the model proposed by Oketch et al. with local modifications. The questionnaire was designed in Google Forms and mailed to respond using Likert scale. The nonparametric data collected from the total 84 respondents were analyzed for validity and reliability of the questionnaire, mean values to know the readiness (mean = 3.4), and one-step multiple regression to know the predictors.

RESULTS

The mean eLR (e-learning readiness) as evaluated from attitudinal readiness (Mean_AR = 3.6), culture readiness (Mean_CR = 2.3), material and technological readiness (Mean_MTR = 3.7), and mental health readiness (Mean_MHR = 2.4) is 3.03 (60.6% with n = 84). Multiple regression analysis revealed that all the variables except MHR can significantly predict e-learning readiness linearly (P < 0.05).

CONCLUSION

The institute is ready for e-learning in terms of AR and MTR (mean values >3.4). CR and MHR still need a lot of improvisation to make it acceptable for e-learning. The model could explain 54.9% readiness level with CR as the most important predictor. More than 73% (n = 84) of the respondents have acknowledged the present form of online classes to be the best available option in COVID-19 lockdown and most of them are adapted to e-classes in the institute.

Examining factors that boost intention and loyalty to use Fintech post-COVID-19 lockdown as a new normal behavior

This study predicts factors affecting the tendency to use financial technology (Fintech) services post-COVID-19 lockdown as a new normal behavior. Fintech services have boosted the number of users during the COVID-19 lockdown. However, to maintain the loyal behavior of consumers after usage, firms need to predict key reasons to enhance their intention to use the service and maintain current consumers in the long term. This study offers a model to assess the components of the perceived usefulness toward Fintech. Data were collected via Mechanical Turk (MTurk), and structural equation modeling was used to predict the factors that influence the intention and loyalty to use Fintech post-COVID-19 lockdown. The findings reveal that the COVID-19 lockdown, trust, data security and privacy, and especially staff services are factors that enhance the intention to use through perceived usefulness. In return, it builds consumers' loyalty toward Fintech services and is considered a new normal behavior. This research sheds light on how Fintech firms develop their capabilities and increase their competitive advantages. Both theoretical and practical implications are also discussed.

Recreational behaviour, risk perceptions, and protective practices against ticks: a cross-sectional comparative study before and during the lockdown enforced by the COVID-19 pandemic in Romania

Background

Gaining insight into the risk perceptions and the knowledge evolution of the public about emerging or changing health risks is vital for the improvement of health promotion activities. Currently, scientific evidence regarding the attitudes of the Romanian public towards ticks is scanty. This study aimed to identify how the lockdown enforced by the COVID-19 pandemic in Romania impacted the recreational behaviour, risk perceptions, and protective practices of the Romanian population regarding ticks.

Methods

A cross-sectional, nationwide web-based questionnaire was designed and distributed via social media to evaluate if, and how, the COVID-19 lockdown impacted the behaviour of the Romanian public concerning ticks. The survey was available online from 6 May until 15 May 2020, which marked the last day of the travel ban in Romania. The collected data were processed by applying both uni- and multivariate methods.

Results

Respondents reported a higher frequency of finding ticks on themselves and their dogs during the lockdown. Bathing/showering and checking the body for ticks were the two most used protective behaviours both before and during the lockdown. Nevertheless, an overall lower usage rate of protective measures was registered during the lockdown. Almost all dog owners used a form of ectoparasite control for their dogs, and only three stopped due to lockdown-associated reasons. Respondent characteristics that were found to be positively associated with risk perceptions were being female and living in peri-urban/suburban/rural environments.

Conclusions

Despite spending less time outdoors during the lockdown, more respondents reported finding ticks on themselves or their dogs. Changes in the preferences for recreational locations, rates of protective practices usage, amount of time spent in specific areas, or tick seasonal activity might have contributed to this outcome. Concerning risk groups, men of all ages, senior citizens, and rural inhabitants should be targeted by the relevant Romanian authorities when promoting local or nationwide tick awareness campaigns.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s13071-021-04944-7.

A longitudinal approach of lockdown effects on quality of life and the expression of anxiety-depressive disorders according to sensory processing sensitivity

The COVID-19 health crisis is perceived as an anxiety-provoking situation. In some cases, policy measures such as containment can generate psychological distress. High sensory processing sensitivity is an innate component of temperament that characterises individuals with higher sensory sensitivity than their peers. It can be understood either as an individual's ability to adapt to specific situations, or as a factor of vulnerability to certain negative stimuli, which may impact upon quality of life, or manifest itself in the expression of anxiety-depressive symptoms. In this study, we investigated the effects of confinement from a longitudinal perspective on these aspects, according to the degree of sensitivity of individuals.Data collection was carried out longitudinally during the lockdown of the French population. The sample was composed of 493 adults who were asked to respond twice, anonymously, to a research protocol hosted online. We used a tool composed of the French version of the Highly Sensitive Person Scale, the Hospital Anxiety and Depression Scale, and the French short version of the World Health Organisation Quality Of Life scale.The results did not show a significant change in anxiety and depression disorders and quality of life in general between the beginning and the end of lockdown. Furthermore, notable disparities were observed according to the degrees of sensitivity in relation to the type of lifestyle during lockdown.The data from the literature, based on cross-cutting approaches, was clarified by the results, as they did not show any negative effects of lockdown on anxiety-depressive disorders during the lockdown period. Moreover, the latter even seemed to have improved one aspect of quality of life.

Trends in Food Preferences and Sustainable Behavior during the COVID-19 Lockdown: Evidence from Spanish Consumers

The COVID-19 pandemic poses a threat to global food security, and it changes consumers' food buying and consumption behavior. This research not only investigates trends in Spanish consumers' general food shopping and consumption habits during the lockdown, but also investigates these trends from the perspective of sustainable purchasing. Specifically, total food consumption (C), food expenditure (E), and purchase of food with sustainable attributes (S) were measured. Data were collected from a semi-structured questionnaire which was distributed online among 1203 participants. The logit models showed that gender, age, employment status, and consumers' experiences were associated with total food consumption and expenditure during the lockdown. In addition, consumers' risk perceptions, shopping places, trust level in information sources, and risk preference were highly essential factors influencing consumers' preferences and sustainable behavior. Consumers' objective knowledge regarding COVID-19 was related to expenditure. Furthermore, family structure only affected expenditure, while income and place of residence influenced food consumption. Mood was associated with expenditure and the purchase of sustainable food. Household size affected purchasing behavior towards food with sustainable attributes. This research provides references for stakeholders that help them to adapt to the new COVID-19 situation.

Effects of COVID-19 pandemic lockdown on microbial and metals contaminations in a part of Thirumanimuthar River, South India: A comparative health hazard perspective

Twenty-two water samples from the Thirumanimuthar River course in southern India were collected before COVID-19 lockdown and during COVID-19 lockdown periods and were analyzed for microbiological parameters (fecal coliform bacteria, total coliform bacteria, Escherichia coli, and fecal streptococci) and heavy metals (Fe, Mn, Zn, Cu, Cd, Ni, Pb and Cr). The lockdown has decreased microbial populations and heavy metals. Fe, Cu, Cd, Ni, Pb and Cr exceeded the drinking water limits, respectively, in 77%, 45%, 27%, 18%, 9% and 91% of the pre-lockdown samples. During the lockdown period, Fe, Cu and Cd concentrations in 23% and Cr in 50% of the samples exceeded the limits. Heavy Metal Pollution Index (PI) expressed that 27%, 64% and 9% of the pre-lockdown samples represented 'low', 'medium' and 'high' pollution categories, respectively, but 68% and 32% of the lockdown period samples represented 'low' and 'medium' categories, respectively. The Metal Index (MI) exposed that all samples of pre-lockdown were under the seriously affected category, whereas 54% and 46% of lockdown samples were under strongly and seriously affected categories, respectively. Health risk evaluation predicted that 95%, 91% and 86% of pre-lockdown samples and 45%, 36% and 33% of lockdown period samples were at risk among children, teenagers and adults, respectively. As there is no integrated study on river water quality of COVID-19 lockdown this work is uniquely carried out by combining heavy metal pollution, microbial contamination and human health risk evaluation.

Changes in lifestyle, diet, and body weight during the first COVID 19 'lockdown' in a student sample

Changes in lifestyle and body weight were examined retrospectively in students at a German university during the first COVID-19 lockdown period (March 12- May 3, 2020) using an online survey. Data from a total of 827 participants was used. Almost half of the students reported perceived body weight changes with about 27% gaining weight and around 22% losing weight. Regression analyses showed that consumption changes in the following food categories: fruits, sweets and cakes, bread and bakery products, pasta, savoury snacks, and meats and sausages were predictive of weight changes. Additionally, changes in the frequency of cooking with fresh ingredients, physical activity, exercise, smoking, and alcohol consumption as well as pre-lockdown BMI were all predictive of weight changes. Given the continuous global pandemic, increased and innovative public health efforts to support this population group are needed.

Supporting Team Reflexivity During the COVID-19 Lockdown: A Qualitative Study of Multi-Vision Groups In-person and Online

Introduction: The professional self is often hindered by a lack of self-care and poor work-life balance, and cannot be considered an unlimited resource. Given this, the reflexive team is an important organizational tool for protecting workers' well-being. The non-profit organization Maestri di Strada (MdS) ("Street Teachers") conducts action research (AR) in the area of socio-education. The main tool used by the group to protect the well-being of its members is a guided reflexivity group, inspired by the Balint Group and termed the Multi-Vision Group (MG). In March 2020, because of the COVID-19 lockdown, the MdS team had to quickly revamp its working model, and MGs were held online for the first time. Aim: Through qualitative research that takes a longitudinal approach, the aim of this study is to evaluate the efficacy of the MG in supporting the team's reflexivity in this new online format. Methods: This article considers MGs during two different time periods: pre-pandemic (T1) and early pandemic (T2). During T1, the MdS team met 18 times in person, while during T2 the team met 12 times through an online platform (always under the guidance of a psychotherapist). During all sessions in both time periods, a silent observer was present in the meetings, and they subsequently compiled narrative reports. The textual corpora of the reports were submitted for a Thematic Analysis of Elementary Contexts through T-Lab Plus, in order to examine the main content of the groups' discourse. Results: The results (five clusters in T1; and five in T2) show that, during T2, the group devoted considerable time to experiences tied to the pandemic (T21: schools facing the pandemic crisis; T2.2: the pandemic: death, inner worlds, and thought resistance; T2.3: kids' stories involving physical distancing and emotional proximity). The group also came up with innovative educational initiatives that defied the lockdown (T2.4: fieldwork: the delivery of "packages of food for thought"; T2.5: the MdS group: identity and separation). Based on these findings, the MG most likely contributed to the emergence of MdS as a "resilient community," capable of absorbing the shock of the pandemic and realizing a fast recovery response.

Ticking time bomb: implications of the COVID-19 lockdown on e-waste management in developing countries

The COVID-19 pandemic has altered the course of events globally since the outbreak of coronavirus disease (COVID-19) in late 2019 giving further credence to the long-standing belief that the world is indeed a global village. There have been different responses by countries to the raging pandemic including the imposition of lockdowns, quarantine and isolation. The imposition of lockdowns, whether full or partial, has not been without major consequences, which has led to information, communication and technological (ICT)-based measures to minimise the effect of the lockdown and as an alternative to physical interactions. The use of ICT devices to bridge the gaps created by the lockdown on schools, businesses and other sectors has led to the increased use of electronic devices. The challenge of electronic waste (e-waste) management in developing countries has been around for a while and the increased use of electronic devices is likely to compound the challenge during and post COVID-19. Whilst the development of ICT-based options as viable alternatives to face-to-face interactions may not be a negative development, this article argues that the existing frameworks are inadequate to manage the resultant increase in e-waste in most developing countries and that there is need now more than ever before for developing countries to exercise caution in embracing these ICT-based options without putting in place measures to ensure that there is increased capacity to manage and dispose of the e-waste created.

Quantitative estimation of meteorological impacts and the COVID-19 lockdown reductions on NO2 and PM2.5 over the Beijing area using Generalized Additive Models (GAM)

Unprecedented travel restrictions due to the COVID-19 pandemic caused remarkable reductions in anthropogenic emissions, however, the Beijing area still experienced extreme haze pollution even under the strict COVID-19 controls. Generalized Additive Models (GAM) were developed with respect to inter-annual variations, seasonal cycles, holiday effects, diurnal profile, and the non-linear influences of meteorological factors to quantitatively differentiate the lockdown effects and meteorology impacts on concentrations of nitrogen dioxide (NO2) and fine particulate matters (PM2.5) at 34 sites in the Beijing area. The results revealed that lockdown measures caused large reductions while meteorology offset a large fraction of the decrease in surface concentrations. GAM estimates showed that in February, the control measures led to average NO2 reductions of 19 μg/m3 and average PM2.5 reductions of 12 μg/m3. At the same time, meteorology was estimated to contribute about 12 μg/m3 increase in NO2, thereby offsetting most of the reductions as well as an increase of 30 μg/m3 in PM2.5, thereby resulting in concentrations higher than the average PM2.5 concentrations during the lockdown. At the beginning of the lockdown period, the boundary layer height was the dominant factor contributing to a 17% increase in NO2 while humid condition was the dominant factor for PM2.5 concentrations leading to an increase of 65% relative to the baseline level. Estimated NO2 emissions declined by 42% at the start of the lockdown, after which the emissions gradually increased with the increase of traffic volumes. The diurnal patterns from the models showed that the peak of vehicular traffic occurred from about 12pm to 5pm daily during the strictest control periods. This study provides insights for quantifying the changes in air quality due to the lockdowns by accounting for meteorological variability and providing a reference in evaluating the effectiveness of control measures, thereby contributing to air quality mitigation policies.

Variation in chemical composition and sources of PM2.5 during the COVID-19 lockdown in Delhi

The Government of India (GOI) announced a nationwide lockdown starting 25th March 2020 to contain the spread of COVID-19, leading to an unprecedented decline in anthropogenic activities and, in turn, improvements in ambient air quality. This is the first study to focus on highly time-resolved chemical speciation and source apportionment of PM_2.5 to assess the impact of the lockdown and subsequent relaxations on the sources of ambient PM_2.5 in Delhi, India. The elemental, organic, and black carbon fractions of PM_2.5 were measured at the IIT Delhi campus from February 2020 to May 2020. We report source apportionment results using positive matrix factorization (PMF) of organic and elemental fractions of PM_2.5 during the different phases of the lockdown. The resolved sources such as vehicular emissions, domestic coal combustion, and semi-volatile oxygenated organic aerosol (SVOOA) were found to decrease by 96%, 95%, and 86%, respectively, during lockdown phase-1 as compared to pre-lockdown. An unforeseen rise in O₃ concentrations with declining NO_x levels was observed, similar to other parts of the globe, leading to the low-volatility oxygenated organic aerosols (LVOOA) increasing to almost double the pre-lockdown concentrations during the last phase of the lockdown. The effect of the lockdown was found to be less pronounced on other resolved sources like secondary chloride, power plants, dust-related, hydrocarbon-like organic aerosols (HOA), and biomass burning related emissions, which were also swayed by the changing meteorological conditions during the four lockdown phases. The results presented in this study provide a basis for future emission control strategies, quantifying the extent to which constraining certain anthropogenic activities can ameliorate the ambient air. These results have direct relevance to not only Delhi but the entire Indo-Gangetic plain (IGP), citing similar geographical and meteorological conditions common to the region along with overlapping regional emission sources. SUMMARY OF MAIN FINDINGS: We identify sources like vehicular emissions, domestic coal combustion, and semi-volatile oxygenated organic aerosol (SVOOA) to be severely impacted by the lockdown, whereas ozone levels and, in turn, low-volatility oxygenated organic aerosols (LVOOA) rise by more than 95% compared to the pre-lockdown concentrations during the last phase of the lockdown. However, other sources resolved in this study, like secondary chloride, power plants, dust-related, hydrocarbon-like organic aerosols (HOA), and biomass burning related emissions, were mainly driven by the changes in the meteorological conditions rather than the lockdown.

Impact of the COVID-19 pandemic lockdown on weight status and factors associated with weight gain among adults in Massachusetts

The study aims to examine the impact of the coronavirus disease-2019 (COVID-19) pandemic lockdown on weight, overweight and obesity, and identify factors associated with weight gain. At a safety net health system in Massachusetts, 11 534 adults were retrospectively followed within 3 months of the COVID-19 lockdown. Chi-square and 95% confidence intervals (CI) were reported for categorical and continues variables, respectively. Multivariate analyses were performed to identify factors associated with weight gain (≥0.01 kg and 5%). During the lockdown period, greater proportion of women gained weight compared to men (46.1% vs 40.6%, P < .01). The obesity rate after the lockdown increased among women (40.7%-41.7, P < .01) but decreased among men (39.6%-38.6, P < .01) compared to before the lockdown. Post-lockdown obesity rates increased among Haitian (51.2%-55.0%, P < .01) and Hispanic women (50.7%-51.8%, P < .01). More than 5% weight gain was associated with 18 to 39 vs ≥60 years of age (OR = 1.45, 95% CI = 1.07, 1.97), food and housing insecurity (OR = 1.44, 95% CI = 1.05, 1.97) and tobacco use (OR = 1.38, 95% CI = 1.07, 1.78) among men; and 18 to 39 vs ≥60 years of age (OR = 1.55, 95% CI = 1.25, 1.91), Hispanics (OR = 1.25, 95% CI = 1.01, 1.54), Brazilians (OR = 1.22, 95% CI = 1.03, 1.45), and tobacco use (OR = 1.36, 95% CI = 1.10, 1.69) among women. During the COVID-19 lockdown, significant proportion of participants gained weight, but subgroup variations existed. Our study can inform healthcare professionals about the impact of the lockdown on unhealthy weight gain and identify vulnerable populations. Strategies are needed to combat unhealthy weight gain during and beyond the pandemic.

Impact of the COVID-19 Pandemic on the Patient's Decision about Bariatric Surgery: Results of a National Survey

Background: the COVID-19 pandemic and the implemented restrictions have changed the functioning of healthcare systems worldwide. The purpose of the study was to evaluate the impact of the present epidemiological situation on patients' decisions about undergoing weight loss surgery. Methods: data were collected from 906 bariatric patients by the means of a national online survey, the majority of whom were women (87.9%). The survey started on 9 April 2020 and was open until 28 April 2020. The questionnaire included multiple choice and open questions, divided into three chapters: general information about the patient, life during the COVID-19 pandemic, and bariatric care during the COVID-19 pandemic. Results: despite the pandemic and the associated risk of COVID-19 infection, 443 responders (48.9%) would have decided to undergo bariatric surgery. Awareness of the negative impact of obesity on the course of COVID-19 illness had only marginable impact on patients' decision-making (76.6% vs. 75.3%; p < 0.80). Contact with COVID-19 prior to the survey had a negative impact on the willingness to undergo bariatric surgery (3.0% vs. 4.4%; p < 0.55). There was a positive correlation between the BMI and preference for bariatric surgery in the time of the pandemic (37.4 ± 9.0 vs. 34.9 ± 8.7; p < 0.001). Conclusions: the level of awareness about the advantages of operative treatment of obesity is high among bariatric patients. The majority of patients awaiting bariatric surgery at the moment of the survey were positive about undergoing bariatric surgery despite the increased risk of a serious course of COVID-19 infection. Therefore, a large proportion of patients was determined to have bariatric treatment even during the pandemic, being aware of the increased risk of worse pace of COVID-19 disease in case of obesity and related diseases.

The Playing Brain. The Impact of Video Games on Cognition and Behavior in Pediatric Age at the Time of Lockdown: A Systematic Review

A growing number of children and adolescents play video games (VGs) for long amounts of time. The current outbreak of the Coronavirus pandemic has significantly reduced outdoor activities and direct interpersonal relationships. Therefore, a higher use of VGs can become the response to stress and fear of illness. VGs and their practical, academic, vocational and educational implications have become an issue of increasing interest for scholars, parents, teachers, pediatricians and youth public policy makers. The current systematic review aims to identify, in recent literature, the most relevant problems of the complex issue of playing VGs in children and adolescents in order to provide suggestions for the correct management of VG practice. The method used searches through standardized search operators using keywords related to video games and the link with cognition, cognitive control and behaviors adopted during the pandemic. Ninety-nine studies were reviewed and included, whereas twelve studies were excluded because they were educationally irrelevant. Any debate on the effectiveness of VGs cannot refer to a dichotomous approach, according to which VGs are rigidly 'good' or 'bad'. VGs should be approached in terms of complexity and differentiated by multiple dimensions interacting with each other.

Impact of the COVID-19 Pandemic on Kidney Diseases Requiring Renal Biopsy: A Single Center Observational Study

Background

The coronavirus disease-2019 (COVID-19) pandemic impacted healthcare services for kidney disease patients. Lockdown and social distancing were mandated worldwide, resulting in closure of medical services. The diagnosis of various kidney diseases may have been delayed during the COVID-19 pandemic because non-urgent tests and visits were postponed due to closure of medical services during the lockdown.

Methods

We here report the impact of the COVID-19 pandemic on a total number of 209 native kidney diseases requiring renal biopsy for diagnosis in a retrospective observational study from a tertiary hospital in Germany.

Results

The lockdown period in March and April 2020 primarily affected patients admitted to the normal medical ward with a compensatory increased rate of renal biopsies in the postlockdown phase. In addition, there was a shift toward more patients admitted with hemoglobinuria during the COVID-19 pandemic. This phenomenon of an increased number of patients with hemoglobinuria during the COVID-19 pandemic was specifically observed in a subgroup with hypertensive nephropathy requiring renal biopsy and associated with increased proteinuria, not attributed to the COVID-19 lockdown period itself.

Conclusion

To our knowledge, this is the first report of identifying a subpopulation susceptible to closure of medical services during the COVID-19 pandemic and diagnostic delay of specific kidney diseases. Therefore, the COVID-19 pandemic should be regarded as a risk factor especially in patients with diseases other than COVID-19 primarily admitted to the normal medical ward.

Psychological interventions during COVID pandemic: Telehealth for individuals with cystic fibrosis and caregivers

INTRODUCTION

Coronavirus disease 2019 (COVID-19) emerged in China, leading to worldwide morbidity and mortality, including depression and anxiety. As the pandemic spread throughout Italy, mental health concerns increased for people with cystic fibrosis (pwCF), who are at greater risk. The aim was to pilot a Telehealth Psychological Support Intervention for pwCF and caregivers to reduce stress, depression, and anxiety during the lockdown in Italy in March 2020.

METHODS

This intervention utilized cognitive behavioral skills (e.g., cognitive reframing). Participants included 16 pwCF and 14 parents, who completed four individual telehealth sessions with a psychologist. Stress ratings, Patient Health Questionnaire and General Anxiety Disorder, PHQ-8 and GAD-7, were completed, in addition to Feasibility and Satisfaction ratings.

RESULTS

Ratings of stress significantly decreased from pre- to post-testing for pwCF (paired t(14) = -4.06, p < .01) and parents (paired t = -5.2, p < .001). A large percentage of both groups scored in the clinical range for depression and anxiety at baseline (pwCF: depression/anxiety = 71%; parents: depression = 57%; anxiety = 79%); a large proportion (20%-40%) reported moderate to severe symptomatology. Significant reductions in depression for pwCF were found (pre: M = 8.0 to post: M = 4.7; paired t(14) = 2.8, p < .05) but not anxiety (pre: M = 6.9 to post: M = 5.6, t(14) = 1.2, p = NS-non-significant). Parental depression decreased for parents (pre: M = 6.4 to post: M = 5.1, t(14) = -2.5, p < .05), but not anxiety (pre: M = 8.1 to post: M = 7.9, t(14) = -0.2, p = NS). Feasibility and Satisfaction were positive.

CONCLUSION

This telehealth intervention yielded reductions in stress and depression for participants. Anxiety did not significantly decrease, possibly because COVID was ongoing. This feasible, satisfactory intervention was effective for improving mental health.

Habitability, Resilience, and Satisfaction in Mexican Homes to COVID-19 Pandemic

Following the 2020 confinement due to the COVID-19 pandemic, housing has become the only safe place and this has exposed inequity in habitability. This research on the reality of confined households and the perception of their homes in the Mexican republic is based on a mixed participatory study, combining quantitative and qualitative approaches. The online questionnaire consisted of 58 questions in the quantitative approximation. The qualitative part required the provision of an image of the workspace, with testimonies and personal reflections. During the lockdown, all participants saw an increase in overall energy consumption; more than half reported not being in thermal comfort; and a third declared deficiencies in noise insulation. Regarding the perception of the telework/tele-study space, we found the following categories: bedrooms, living/dining rooms, studies and others. In addition, respondents had often adapted the workspace for both individual and shared use. In general, the households were satisfied with the size of their houses but would like landscaped spaces or better views outside. Confinement made housing the protective element against the pandemic. The consequences will have an effect globally, so new architectural design paradigms need to be rethought.

Ripasudil Endgame: Role of Rho-Kinase Inhibitor as a Last-Ditch-Stand Towards Maximally Tolerated Medical Therapy to a Patient of Advanced Glaucoma

Purpose

To elucidate the use of Ripasudil in patients of advanced glaucoma on maximally tolerated medical therapy who could not be offered the option of surgery due to the global pandemic lockdown.

Materials and Methods

Only patients with primary open angle glaucoma (POAG), who had a cup-disc ratio (CDR) of 0.9 or a near total cupping on maximum tolerated medical therapy for at least 4 weeks and yet could not meet the target IOP were included. Target IOP was defined as ≤12 mm Hg. A total of 30 patients were enrolled. All patients in study cohort were started on E/D Ripasudil BD. Patients were followed up at 1 week, 2 weeks, 4 weeks and then monthly for 6 months for their best corrected visual acuity (BCVA), intraocular pressure (IOP), disc changes (slit lamp biomicroscopy), perimetry, and retinal nerve fibre layer analysis using optical coherence tomography (OCT-RNFL).

Results

Mean pre-treatment IOP on five drugs was 18.3 ± 2.1 mm Hg (range 14 to 22mmHg) on maximally tolerated medical therapy. At 1 week follow-up, mean post-treatment IOP was 15.1 ± 1.7 mm Hg (range 12 to 18mmHg) and at 2 week follow-up, mean post-treatment IOP was 12.5 ± 1.9 mmHg (range 10 to 16mmHg). Thus, target IOP ≤12mmHg was attained in 28 patients at 2 weeks. This target IOP was maintained throughout the 6 months of follow-up period. Of the 2 patients who could not meet target IOP, 1 patient needed rearrangement of their fixed-drug-combinations to achieve target IOP at 4 weeks. The second patient required unfixing of all fixed-drug-combinations to achieve target IOP at maximally tolerated medical therapy at 6 weeks.

Conclusion

Ripasudil not only provides a better IOP control but also has a high safety profile even when started as an add-on drug to already-existing yet inadequate maximally tolerated medical therapy.

Residents' Physical Activities in Home Isolation and Its Relationship with Health Values and Well-Being: A Cross-Sectional Survey during the COVID-19 Social Quarantine

The objective of the present study was to examine the associations between residents' physical activity, health values, and well-being during isolation. On the basis of the physical activity rating scale, health values scale, subjective well-being scale, and the satisfaction with life scale, we collected 505 valid questionnaires online from 31 provinces, municipalities, and autonomous regions in China. A series of multiple linear regression models were established to study the relationship between variables, and the bootstrap confidence interval was selected to test the mediating effect. The results showed that during the period of isolation, physical activity directly (b = 0.463, p < 0.001) or indirectly (b = 0.358, p < 0.001) had a positive impact on residents' well-being through the mediating effect of health values. There was a positive correlation between physical activity and health values (b = 0.710, p < 0.001), while health values had a direct positive association on well-being (b = 0.504, p < 0.001). In addition, a moderate amount of physical activity was found to be more associated with the well-being of residents during home isolation compared to small and large amounts of physical activity. This study shows the importance of residents' physical activities in home isolation. Moderate exercise at home and regular physical activity are beneficial to our physical and mental health, especially in terms of improving overall well-being.

Pay-as-you-go liquefied petroleum gas supports sustainable clean cooking in Kenyan informal urban settlement during COVID-19 lockdown

Approximately 2.8 billion people rely on polluting fuels (e.g. wood, kerosene) for cooking. With affordability being a key access barrier to clean cooking fuels, such as liquefied petroleum gas (LPG), pay-as-you-go (PAYG) LPG smart meter technology may help resource-poor households adopt LPG by allowing incremental fuel payments. To understand the potential for PAYG LPG to facilitate clean cooking, objective evaluations of customers' cooking and spending patterns are needed. This study uses novel smart meter data collected between January 2018-June 2020, spanning COVID-19 lockdown, from 426 PAYG LPG customers living in an informal settlement in Nairobi, Kenya to evaluate stove usage (e.g. cooking events/day, cooking event length). Seven semi-structured interviews were conducted in August 2020 to provide context for potential changes in cooking behaviours during lockdown. Using stove monitoring data, objective comparisons of cooking patterns are made with households using purchased 6 kg cylinder LPG in peri-urban Eldoret, Kenya. In Nairobi, 95% of study households continued using PAYG LPG during COVID-19 lockdown, with consumption increasing from 0.97 to 1.22 kg/capita/month. Daily cooking event frequency also increased by 60% (1.07 to 1.72 events/day). In contrast, average days/month using LPG declined by 75% during lockdown (17 to four days) among seven households purchasing 6 kg cylinder LPG in Eldoret. Interviewed customers reported benefits of PAYG LPG beyond fuel affordability, including safety, time savings and cylinder delivery. In the first study assessing PAYG LPG cooking patterns, LPG use was sustained despite a COVID-19 lockdown, illustrating how PAYG smart meter technology may help foster clean cooking access.

Risk factors for attempting suicide during the COVID-19 lockdown: Identification of the high-risk groups

Objectives

In the wake of the coronavirus disease 2019 (COVID-19) pandemic, we have witnessed a rise in the instances of mental health problems and the suicide-related mortality rates. This study aims to identify the suicide-related risk factors and stressors to determine the groups at a greater risk of attempting suicide during the COVID-19 lockdown.

Methods

This retrospective study examined 29 cases of attempted suicide during the 3-month COVID-19 lockdown in KSA. The suicide risk factors were evaluated using specific instrument the modified (SAD PERSONS) scale. It is an acronym for sex, age, depression, previous attempt, excess alcohol, rational thinking loss, social status, organized plan, no social supports and stated future intent.

Results

The lockdown stressors that may have triggered suicidal behaviours were identified as follows: psychological distress, relationship problems, financial difficulties, and extreme fear of the COVID-19 infection. While all age groups carried the risk of attempting suicide during the lockdown, patients with psychiatric disorders and women accounted for 69% and 65.5% of the cohort, respectively. Factors like hopelessness and depression were highly related to suicide attempts, as well as the statement of future intent to repeat the attempt, at 72.4% and 65.5% respectively. Almost two-thirds of the attempts made were serious, and many women felt unsafe in their own homes during the lockdown.

Conclusion

Patients with pre-existing psychiatric disorders and women carry high risk of attempting suicide during the COVID-19 lockdown. This study offers insights on the greater outreach efforts that can be carried out for these patients by calling for the prioritization of mental health care, improvement of domestic violence services, and strengthening of suicide prevention strategies.

Pediatric asthma control during the COVID-19 pandemic

BACKGROUND

The lockdown imposed by the COVID-19 pandemic resulted in a completely different style of life with possible effects on the attitude toward their disease in patients with chronic lung disease, such as asthma. The aim of our study was to investigate in asthmatic children the level of asthma control and the maintenance therapy used during the lockdown.

METHODS

Among asthmatic children attending our clinic, we identified those who had been prescribed the same therapy in March-April 2019 and March-April 2020. The level of asthma control (GINA-score) and the maintenance therapy used during the lockdown (March-April 2020) were compared with those of March-April 2019. We separately analyzed a small group of children with severe asthma treated with Omalizumab during the lockdown.

RESULTS

We enrolled 92 asthmatic children (67 males). Compared to 2019, in 2020 a higher proportion of children modified their maintenance therapy (38% vs. 15.2%, p < .001), with a significant increase in both the proportion of children who increased (p = .033) and in that of children who decreased their therapy (p = .026). The level of control resulted as significantly higher in 2020 (March p = .023; April p = .007). Also, the 13 children treated with Omalizumab showed a good level of control in 2020.

CONCLUSIONS

In asthmatic children, the COVID-19 pandemic lockdown had a significant impact on their asthma control and on their attitude toward maintenance therapy.

Major Lower-Limb Amputation During the COVID Pandemic in South India

People with diabetes have a higher risk of lower-limb amputations than people without diabetes. The risk of avoidable lower-limb amputations has increased in the coronavirus disease 2019 (COVID-19) lockdown period. Hence, we conducted a retrospective, single-centered study on major amputations during the prepandemic period (March 25, 2019-December 31, 2019) and pandemic period (March 25, 2020-December 31, 2020). During the prepandemic period, 24 major amputations (below-knee and above-knee amputations) were performed and during the pandemic period, 37 major amputations were performed. There was a 54.1% increase in major amputations noted in the pandemic period more than the prepandemic period. This increase may also be due to irregular/missed hospital visits, improper diet, nonadherence to the medications, and physical inactivity. This study shows the indirect effect of the COVID-19 pandemic on people with diabetes, resulting in the increased incidence of lower-extremity amputations (below-knee and above-knee amputations) which might cause a drastic impact on their quality of life. This study also emphasizes the importance of easy and routine access to foot-care specialists to prevent avoidable amputations.

Low craving control predicts increased high energy density food intake during the COVID-19 lockdown: Result replicated in an Australian sample

This research aimed to replicate a previous UK-based finding that low craving control predicts increased intake of high energy density foods (HED) during the COVID-19 lockdown, and extend this finding to adults living in Victoria, Australia. The study also assessed whether acceptance coping moderates the relationship between craving control and increased HED food intake, and examined the associations between trait disinhibition, perceived stress and changes to HED food intake. An online survey completed by 124 adults living in Victoria, Australia (total eligible n = 147; 38.5 ± 12.9 years) during the COVID-19 lockdown showed that 49% of participants reported increased overall food intake, and 21-29% reported increased intake of HED sweet and savoury foods during the COVID-19 lockdown. Of the eating behaviour traits assessed, low craving control was the only significant predictor of increased HED sweet and savoury food intake (cognitive restraint, disinhibition and emotional eating were non-significant predictors). Perceived stress was associated with reported increases in overall savoury and sweet snack intake, but was not significantly associated with changes to specific HED food groups (sweet and savoury). In this sample, acceptance coping did not significantly moderate the relationship between craving control and increased HED food intake. Based on these replicated findings, further trials should now consider interventions targeting craving control to promote controlled food intake in individuals at-risk of weight gain during the current COVID-19 and future potential lockdowns.

China is facing serious experimental monkey shortage during the COVID-19 lockdown

This report aims to analyze the experimental monkey shortage generated by the COVID‐19 lockdown. The supply capability of the monkey breeding farms is insufficient to meet demand, and the sales prices have skyrocketed since 2018. The contradiction will be further aggravated with import prohibition although the countermeasures suggested.

Socio-demographic disparities in the eating behaviour of Malaysian children during the COVID-19 lockdown

Objective

This cross-sectional study aimed to investigate the eating behaviour of Malaysian children aged 2 to 11 years old during the Movement Control Order (MCO) due to the coronavirus disease 2019 pandemic.

Methods

A total of 204 Malaysian parents of children aged 2 to 11 years old were recruited for this study using a combination of purposive and snowball sampling approaches. Parents were required to fill an online questionnaire hosted on Google Forms, which consisted of socio-demographic characteristics (including child's gender, age, and ethnicity, as well as parental income during the MCO) and a 35-item list from the Children's Eating Behaviour Questionnaire (CEBQ). Data analysis was conducted by further stratifying the children's eating behaviour according to socio-demographic characteristics.

Results

No significant differences were observed in the eating behaviour of the children across age and parental income groups during the MCO. Malaysian Indian children had significantly lower mean scores for the food responsiveness (2.50±0.64) and emotional over-eating (2.13±0.72) subscales than Malaysian Chinese children. Girls had a significantly higher mean score for the slowness in eating subscale during the MCO than boys.

Conclusion

Children's eating behaviour were comparable across socio-demographic characteristics. Nonetheless, the findings of the current study provide an overview of Malaysian children's eating behaviour during the MCO.

Physical Activity during the First Lockdown of the COVID-19 Pandemic: Investigating the Reliance on Digital Technologies, Perceived Benefits, Barriers and the Impact of Affect

The measures to fight the spread of the COVID-19 pandemic have been concentrated on inviting people to stay at home. This has reduced opportunities to exercise while also shedding some light on the importance of physical health. Based on an online survey, this paper investigated physical activity behaviours of a Belgians sample (n = 427) during the lockdown period between the end of May 2020 and the beginning of June 2020 and found that, during this period, the gap between sufficiently and insufficiently active individuals widened even more. This paper analysed important moderators of physical activity behaviours, such as barriers and benefits to exercise, digital support used to exercise, and individuals’ emotional well-being. Descriptive analysis and analyses of variance indicated that, generally, individuals significantly increased their engagement in exercise, especially light- and moderate-intensity activities, mostly accepted the listed benefits but refused the listed barriers, increased their engagement in digital support and did not score high on any affective measures. A comparison between sufficiently active and insufficiently active individuals during the lockdown showed that the former engaged even more in physical activity, whereas the latter exercised equally (i.e., not enough) or even less compared to before the lockdown. By means of a logistic regression, five key factors of belonging to the sufficiently active group were revealed and discussed. Practical implications for government and policies are reviewed.

Confined Students: A Visual-Emotional Analysis of Study and Rest Spaces in the Homes

Confinement was adopted globally as a containment measure to face the COVID pandemic declared by WHO on March 2020. In Spain, the State of Alarm was established for three months. This implied the interruption of educational activities, having a higher incidence for children, since teaching would not be resumed until the following academic year, in September. This, together with the confusing initial information about COVID-19 transmission between children and their families, has made them one of the groups most vulnerable. In this study, a qualitative approach is made to secondary school students (aged 12). They were asked to share their experiences about confinement from the perspective of the home spaces, in relation to two main tasks relevant in this period: the tele-study and their relaxing time and well-being. Using images and narratives with an abstract and emotional description, the response of 46 children was obtained. A sentiment analysis was carried out from their testimonies. Results suggest a greater availability of tele-study spaces with daylighting, mainly in bedrooms, with laptops. For leisure and rest spaces, sofas, beds, and cohabitant gathering were preferred. Written testimonials were mainly positive. Housing features and family cohesion condition their resilience in situations of uncertainty, like confinement.

Impact of COVID-19 lockdown on the incidence and mortality of acute exacerbations of chronic obstructive pulmonary disease: national interrupted time series analyses for Scotland and Wales

BACKGROUND

The COVID-19 pandemic and ensuing national lockdowns have dramatically changed the healthcare landscape. The pandemic's impact on people with chronic obstructive pulmonary disease (COPD) remains poorly understood. We hypothesised that the UK-wide lockdown restrictions were associated with reductions in severe COPD exacerbations. We provide the first national level analyses of the impact of the COVID-19 pandemic and first lockdown on severe COPD exacerbations resulting in emergency hospital admissions and/or leading to death as well as those recorded in primary care or emergency departments.

METHODS

Using data from Public Health Scotland and the Secure Anonymised Information Linkage Databank in Wales, we accessed weekly counts of emergency hospital admissions and deaths due to COPD over the first 30 weeks of 2020 and compared these to the national averages over the preceding 5 years. For both Scotland and Wales, we undertook interrupted time-series analyses to model the impact of instigating lockdown on these outcomes. Using fixed-effect meta-analysis, we derived pooled estimates of the overall changes in trends across the two nations.

RESULTS

Lockdown was associated with 48% pooled reduction in emergency admissions for COPD in both countries (incidence rate ratio, IRR 0.52, 95% CI 0.46 to 0.58), relative to the 5-year averages. There was no statistically significant change in deaths due to COPD (pooled IRR 1.08, 95% CI 0.87 to 1.33). In Wales, lockdown was associated with 39% reduction in primary care consultations for acute exacerbation of COPD (IRR 0.61, 95% CI 0.52 to 0.71) and 46% reduction in COPD-related emergency department attendances (IRR 0.54, 95% CI 0.36 to 0.81).

CONCLUSIONS

The UK-wide lockdown was associated with the most substantial reductions in COPD exacerbations ever seen across Scotland and Wales, with no corresponding increase in COPD deaths. This may have resulted from reduced transmission of respiratory infections, reduced exposure to outdoor air pollution and/or improved COPD self-management.

Leisure and Problem Gaming Behaviors Among Children and Adolescents During School Closures Caused by COVID-19 in Hong Kong: Quantitative Cross-sectional Survey Study

BACKGROUND

School closures during the COVID-19 pandemic may have exacerbated students' loneliness, addictive gaming behaviors, and poor mental health. These mental health issues confronting young people are of public concern.

OBJECTIVE

This study aimed to examine the associations between loneliness and gaming addiction behaviors among young people in Hong Kong and to investigate how familial factors, psychological distress, and gender differences moderate these relationships.

METHODS

This cross-sectional study was conducted in June 2020 when schools reopened after 6 months of school closures. Participants included 2863 children and adolescents in primary (Grades 4 to 6) and secondary (Grades 7 and 8) schools (female participants: 1502/2863, 52.5%). Chi-square tests, one-way analyses of variance, and independent-samples t tests were performed to compare the differences of distribution in gaming addiction behaviors across gender, age, and other sociodemographic characteristics. Multinomial logistic regression analyses were conducted to identify factors that relate to excessive or pathological gaming behaviors separately, in comparison with leisure gaming.

RESULTS

A total of 83.0% (2377/2863) of the participants played video games during the COVID-19 pandemic. The prevalence of excessive and pathological game addiction behaviors was 20.9% (597/2863) and 5.3% (153/2863), respectively. More male students had gaming addiction symptoms than female students. The multinomial logistic regressions showed that feeling lonely was associated with more problematic gaming behaviors, and the association was stronger for older female students. Low socioeconomic status, less parental support and less supervision, and poor mental health were risk factors for gaming addiction behaviors, especially among primary school students.

CONCLUSIONS

Loneliness was associated with gaming addiction behaviors; the findings from this study suggested that this association was similar across gender and age groups among young people. Familial support and supervision during school closures can protect young people from developing problematic gaming behaviors. Results of this study have implications for prevention and early intervention on behalf of policy makers and game developers.

COVID-19 lockdown and poor sleep quality: Not the whole story

A growing body of evidence consistently describes the side‐effects of coronavirus disease 2019 lockdown on mental health and sleep quality. We conducted a longitudinal web‐based survey of 217 Italian participants at two time points: lockdown and subsequent follow‐up. To thoroughly investigate lockdown‐related changes in sleep quality, we first evaluated variations in overall sleep quality assessed by the Pittsburgh Sleep Quality Index. We then examined sleep changes in specific components of sleep quality. Results revealed a clear dissociation of sleep effects, as a function of the specific domain considered, with longer sleep latency, worse sleep efficiency, and massive sleep medication use during forced confinement. On the other hand, we simultaneously observed an increased sleep duration and better daytime functioning. Our present findings highlight the importance of an accurate examination of sleep quality during lockdown, as the effects were not uniform across populations and different sleep domains.

Delayed health consequences of COVID-19 lockdown in an older adult

We report a case of a retired school teacher who presented with rapid cognitive and functional decline following the COVID-19 lockdown period that was diagnosed as worsening depression by referring physician. This highlights the potentially life-threatening consequences of delayed diagnosis and management of delirium, an often reversible syndrome, due to lockdown restrictions. As the pandemic outlives its initial projections, its downstream impact on an already vulnerable population continues to emerge.

Risk factors for prospective increase in psychological stress during COVID-19 lockdown in a representative sample of adolescents and their parents

BACKGROUND

COVID-19 lockdown measures imposed extensive restrictions to public life. Previous studies suggest significant negative psychological consequences, but lack longitudinal data on population-based samples.

AIMS

We aimed to prospectively identify increased psychological stress and associated risk factors in parent-child dyads.

METHOD

We conducted a prospective, observational online study on a representative German sample of 1221 adolescents aged 10-17 years and their parents. Psychological stress and psychosocial variables were assessed before the pandemic (baseline) and 1 month after the start of lockdown (follow-up), using standardised measures. We used multilevel modelling to estimate changes in psychological stress, and logistic regression to determine demographic and psychosocial risk factors for increased psychological stress.

RESULTS

The time of measurement explained 43% of the psychological stress variance. Of 731 dyads with complete data, 252 adolescents (34.5%, 95% CI 31.0-37.9) and 217 parents (29.7%, 95% CI 26.4-33.0) reported a significant increase in psychological stress. Baseline levels were lower than in dyads without increased psychological stress. Risk factors for increased psychological stress included sociodemographic (e.g. female parents, severe financial worries) and emotion regulation aspects (e.g. non-acceptance of emotional responses in parents, limited access to emotion regulation strategies in adolescents), explaining 31% of the adolescent (Nagelkerke R2 = 0.31) and 29% of the parental (Nagelkerke R2 = 0.29) model variance.

CONCLUSIONS

This study is the first to prospectively show an increase in psychological stress during COVID-19 lockdown in a representative family sample. Identified demographic and psychosocial risk factors lead to relevant implications for prevention measures regarding this important public health issue.

Impact of Singapore's COVID-19 confinement on atmospheric CO2 fluxes at neighborhood scale

Singapore entered a two-month partial lockdown in April 2020 to curb the spread of COVID-19. The imposed measures in addition to contain the virus spread, cut the emissions of greenhouse gases as many economic activities stopped across the city. The advice of stay-at-home changed the pattern of carbon dioxide (CO₂) emissions within the community. To examine how CO₂ emissions responded to the COVID-19 measures at neighborhood scale, anonymized mobility data released by Google and Apple, and traffic congestion information from TomTom were used to track daily and diurnal changes in emissions related to driving, cooking and metabolic breathing in a residential neighborhood of Singapore, in which the anthropogenic and biogenic fluxes of CO₂ have been widely characterized. During the lockdown, traffic emissions dropped 41%, but emissions from cooking and metabolic breathing increased 21% and 20%, respectively. The uptake of CO₂ by vegetation was not able to offset these emissions, and after adding the biogenic contribution from soil and plants, a net reduction of 24% was found. During the following six months the city got its pace back, with the rate of CO₂ emissions reaching similar or slightly higher levels than those predicted before the pandemic crisis. Unfortunately, the stark drop in emissions was just a temporary relief, which reduced only 3.5% the annual CO₂ flux over the studied neighborhood.

Caring for People With Dementia Under COVID-19 Restrictions: A Pilot Study on Family Caregivers

Introduction

The present pilot study examined to what extent the COVID-19 lockdown affected the behavioral and psychological symptoms of dementia (BPSD) in people with dementia and worsened their family caregivers’ distress. The associations between changes in the BPSD of relatives with dementia (RwD) and in their caregivers’ distress, and sense of social and emotional loneliness, and resilience were also investigated.

Materials and Methods

Thirty-five caregivers of RwD attending formal healthcare services before the COVID-19 lockdown volunteered for the study, and were interviewed by phone during the lockdown. Caregivers completed the NeuroPsychiatric Inventory (NPI) to assess their care recipients’ BPSD and their own distress, and two questionnaires assessing their social and emotional loneliness, and their resilience.

Results

No clear changes emerged in either the BPSD of the RwD or the caregivers’ distress during lockdown compared with before the pandemic. Caregivers reporting more frequent and severe BPSD in their RwD before the lockdown scored higher on emotional loneliness. Those reporting more frequent and severe BPSD under lockdown, especially men and those taking care of RwD with more advanced dementia, scored higher on both social and emotional loneliness. A significant negative correlation also emerged between caregivers’ resilience and changes in their level of distress due to the lockdown, with female caregivers reporting greater resilience.

Discussion

Our findings offer preliminary insight on the effects of loneliness and resilience, and on the influence of individual characteristics on the experience and consequences of informal caregiving for RwD in times of restrictions imposed by a pandemic.

Health, Transport and the Environment: The Impacts of the COVID-19 Lockdown on Air Pollution

Lockdown measures were initiated in Italy on March 9th after the start of the SARS-CoV-2 epidemic to flatten the epidemic curve. The aim of the present study was to assess the impact of restrictive measures in the Apulia Region, southern Italy, on air quality from March to April 2020. We applied a dual-track approach. We assessed citizen mobility and vehicle traffic with mobility network data and information obtained from satellite tracking, and we evaluated and compared pollutant concentration data as measured by monitoring stations maintained by the Regional Agency for Environmental Protection and Prevention of Apulia (ARPA). The results showed a decrease in the weekly mean NO₂ concentration recorded by urban traffic stations during the lockdown period. In particular, in the city of Bari, the average NO₂ concentration decreased from 62.2 μg/m³ in March 2019 to 48.2 μg/m³ in March 2020. Regarding PM10 levels, the average concentrations at the individual traffic stations showed no particular variation compared to those in the same months of the previous year, except for Bari-Caldarola Station in March 2019/2020 (p-value < 0.001) and in April 2019/2020 (p-value = 0.04). In particular the average in March 2019 was ~26.9 μg/m³, while that in March 2020 was ~22.9 μg/m³. For April, the average concentration of PM10 in 2019 was 27.9 μg/m³, while in 2020, the average was ~22.4 μg/m³. This can be explained by the fact that PM10 levels are influenced by multiple variables such as weather and climate conditions and desert dust advections.

Barriers and coping mechanisms to accessing healthcare during the COVID-19 lockdown: a cross-sectional survey among patients with chronic diseases in rural Rwanda

BACKGROUND

Large scale physical distancing measures and movement restrictions imposed to contain COVID-19, often referred to as 'lockdowns', abruptly and ubiquitously restricted access to routine healthcare services. This study describes reported barriers and coping mechanisms to accessing healthcare among chronic care patients during the nationwide COVID-19 lockdown in Rwanda.

METHODS

This cross-sectional study was conducted among chronic care patients enrolled in pediatric development, HIV/AIDS, non-communicable diseases, mental health, and oncology programs at 3 rural Rwandan districts. Active patients with an appointment scheduled between March-June 2020 and a phone number recorded in the electronic medical record system were eligible. Data were collected by telephone interviews between 23rd April and 11th May 2020, with proxy reporting by caregivers for children and critically ill-patients. Fisher's exact tests were used to measure associations. Logistic regression analysis was also used to assess factors associated with reporting at least one barrier to accessing healthcare during the lockdown.

RESULTS

Of 220 patient respondents, 44% reported at least one barrier to accessing healthcare. Barriers included lack of access to emergency care (n = 50; 22.7%), lack of access to medication (n = 44; 20.0%) and skipping clinical appointments (n = 37; 16.8%). Experiencing barriers was associated with the clinical program (p < 0.001), with oncology patients being highly affected (64.5%), and with increasing distance from home to the health facility (p = 0.031). In the adjusted logistic regression model, reporting at least one barrier to accessing healthcare was associated with the patient's clinical program and district of residence. Forty (18.2%) patients identified positive coping mechanisms to ensure continuation of care, such as walking long distances during suspension of public transport (n = 21; 9.6%), contacting clinicians via telephone for guidance or rescheduling appointments (n = 15; 6.8%), and delegating someone else for medication pick-up (n = 6; 2.7%). Of 124 patients who reported no barriers to accessing healthcare, 9% used positive coping mechanisms.

CONCLUSION

A large proportion of chronic care patients experienced barriers to accessing healthcare during the COVID-19 lockdown. However, many patients also independently identified positive coping mechanisms to ensure continuation of care - strategies that could be formally adopted by healthcare systems in Rwanda and similar settings to mitigate effects of future lockdowns on patients.

Diet and physical activity during the coronavirus disease 2019 (COVID-19) lockdown (March-May 2020): results from the French NutriNet-Santé cohort study

BACKGROUND

Since December 2019, coronavirus disease 2019 (COVID-19) has been spreading steadily, resulting in overwhelmed health-care systems and numerous deaths worldwide. To counter these outcomes, many countries, including France, put in place strict lockdown measures, requiring the temporary closure of all but essential places and causing an unprecedented disruption of daily life.

OBJECTIVES

Our objective was to explore potential changes in dietary intake, physical activity, body weight, and food supply during the COVID-19 lockdown and how these differed according to individual characteristics.

METHODS

The analyses included 37,252 adults from the French web-based NutriNet-Santé cohort who completed lockdown-specific questionnaires in April-May 2020. Nutrition-related changes and their sociodemographic, lifestyle, and health-status correlates were investigated using multivariable logistic regression models. Clusters of participants were defined using an ascending hierarchical classification of change profiles derived from multiple correspondence analyses.

RESULTS

During the lockdown, trends of unfavorable changes were observed: decreased physical activity (reported by 53% of the participants), increased sedentary time (reported by 63%), increased snacking, decreased consumption of fresh food (especially fruit and fish), and increased consumption of sweets, cookies, and cakes. Yet, the opposite trends were also observed: increased home cooking (reported by 40%) and increased physical activity (reported by 19%). Additionally, 35% of the participants gained weight (mean weight gain in these individuals, 1.8 kg ± SD 1.3 kg) and 23% lost weight (2 kg ± SD 1.4 kg weight loss). All of these trends displayed associations with various individual characteristics.

CONCLUSIONS

These results suggest that nutrition-related changes occurred during the lockdown in both unfavorable and favorable directions. The observed unfavorable changes should be considered in the event of a future lockdown, and should also be monitored to prevent an increase in the nutrition-related burden of disease, should these diet/physical activity changes be maintained in the long run. Understanding the favorable changes may help extend them on a broader scale. This trial was registered at clinicaltrials.gov as NCT03335644.

Short-term impact of COVID-19 lockdown on metabolic control of patients with well-controlled type 2 diabetes: a single-centre observational study

AIMS/HYPOTHESIS

The strict rules applied in Italy during the recent COVID-19 pandemic, with the prohibition to attend any regular outdoor activity, are likely to influence the degree of metabolic control in patients with type 2 diabetes. We explored such putative effect immediately after the resolution of lockdown rules, in the absence of any variation of pharmacologic treatment.

METHODS

One-hundred and fourteen patients with adequate metabolic control took part in this single-centre, prospective, observational study. The metabolic profile tested 1 week after the end of the lockdown was compared with the last value and the mean of the last three determinations performed before the pandemic emergency (from 6 months to 2 years before).

RESULTS

After 8 weeks of lockdown, an increase of HbA1c > 0.3% (mean +0.7%) was observed in 26% of the participants; these were also characterized by a persistent elevation in serum triglycerides able to predict the worsening of glucose control.

CONCLUSIONS

Lockdown determined a relevant short-term metabolic worsening in approximately one-fourth of previously well-controlled type 2 diabetic individuals; pre-lockdown triglycerides were the only parameter able to predict such derangement of glucose control.

Associations between feelings/behaviors during COVID-19 pandemic lockdown and depression/anxiety after lockdown in a sample of Chinese children and adolescents

BACKGROUND

Children and adolescents may be more susceptible to mental disorders due to COVID-19 pandemic than adults. This study aimed to identify correlated factors for depression/anxiety among children and adolescents after COVID-19 pandemic lockdown.

METHODS

An online survey by cluster sampling was conducted after lockdown in 5175 Chinese children and adolescents with informed consents from their parents. The 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder scales with 10-point cutoff were used to measure depression and anxiety, separately. Stepwise logistic regression was conducted. Stata 15.1 Version was used.

RESULTS

12.33% and 6.26% of all participants reported depression and anxiety after lockdown, separately. Suicidal ideation, quarreling with parents, insomnia, difficulty in concentrating during online learning, and anxious and depressed mood during lockdown were positively associated with depression and anxiety after lockdown. Missing teachers was negatively associated with both depression and anxiety. Living in urban and not living with parents were positively associated with depression.

LIMITATIONS

The past history and familial history of mental disorders have not been collected. The recall biases for collecting self-reporting information might exist, and the causal inferences cannot be drawn.

CONCLUSIONS

The prevalence of depression and anxiety in children and adolescents might decline a bit after lockdown but is still at a high level after lockdown. Gatekeepers should pay more attention to modifiable factors of psychological well-being in children and adolescents, including family and school contexts and even feelings and behaviors during COVID-19 pandemic lockdown.

Impacts of the COVID-19 lockdown on energy consumption in a Canadian social housing building

The COVID-19 pandemic hit societies in full force in 2020 and compelled people all around the world to change their lifestyle. The time spent at home significantly surged during the pandemic and this change in occupancy can have a direct impact on building energy consumption. COVID-19 lockdowns also accelerated the transition towards telework, a trend that many expect to last. Changes in energy consumption under lockdown is thus a valuable asset to forecast how energy could be consumed in buildings in the future. Here, we aim to quantify the impacts of the COVID-19 lockdown on the energy consumption (electricity, hot water and space heating) in residential buildings by answering these two questions: (i) Did the lockdown lead to changes in total energy consumption?, and (ii) Did the lockdown lead to changes in consumption patterns (i.e. time of the day at which energy is consumed)? To do so, we compared the energy consumption measured in a 40-dwelling social housing building located in Quebec City (Canada) during four months of lockdown to those of the months that preceded the lockdown. It is found that consumption patterns for electricity and hot water changed for the first two months of the lockdown, when the most intensive lockdown measures were applied. Overall consumption slightly increased for these two energy expenditures, but the more important change was that consumption occurred throughout the day instead of being concentrated in the evening as observed before the lockdown. Results shed light on the impact of lockdown on energy bills for consumers and on how energy utilities might be solicited during this kind of episode.