COVID-19 pandemic: the effects of quarantine on cardiovascular risk

The Potential Impact of COVID-19 Virus on the Heart and the Circulatory System

Heart attacks, arrhythmias, and cardiomyopathy are all linked to the 2019 coronavirus disease (COVID-19), which has been identified as a risk factor for cardiovascular disease. Nothing can be held accountable in the current state of affairs. Undiagnosed chronic systolic heart failure (CSHF) develops when the heart’s second half of the cardiac cycle does not function properly. As a result, the heart’s blood pumping function is interrupted. Stress-induced cardiomyopathy may be caused by a variety of factors inside the body (SICM). Cytokine storm and microvascular dysfunction are among the issues. There is inflammation in the heart muscle, which may lead to stress-induced cardiomyopathy. A major part of our study is going to be devoted to understanding the effects of coronavirus on the cardiovascular system and blood vessels. A lot of time and effort has been put into figuring out the health effects of radiation exposure. The heart and circulatory system are shown to be affected by the coronavirus in this research. COVID-19 is shown to influence persons with heart disease, heart failure, arrhythmias, microvascular angiopathy, and cardiac damage in this study.

The role of body mass index, healthy eating-related apps and educational activities on eating motives and behaviours among women during the COVID-19 pandemic: A cross sectional study

The COVID-19 related lockdown made it much more difficult for people to control their eating behaviours and body weight with the methods and means they had used before. This is reflected in reports that show that eating behaviours deteriorated significantly during the COVID-19 pandemic (including in Poland). Therefore, it is important to determine what factors may be conducive to healthy eating behaviours among people with different BMI. As previous studies show, the use of healthy eating related-apps and training programs may be a protective factor against the development of unhealthy eating behaviours. Therefore, it is worth checking whether their action will be a protective factor during COVID-19. The aim of this cross sectional study was to analyse whether the current use of healthy eating-related apps and previous participation in training in this field (educational activities) as well as body mass index may play a role in eating motives and behaviours among women during COVID-19. Our final sample included 1,447 women (age: M = 31.34 ± 11.05). Participants completed: the Eating Motivation Survey, the Emotional Overeating Questionnaire, the Mindful Eating Questionnaire, socio-demographic survey and questions about healthy eating-related apps and training (educational activities). Referring to the selected significant results, our study shows that during COVID-19, the use of healthy eating-related apps alone, as well as the use of apps and prior training participation promote healthy eating motives and behaviours. It suggests that promoting the use of healthy eating applications and the acquisition of knowledge and skills in this field could be one way of shaping resources that can be effectively used to deal with crisis situations.

Changes in Physical Activity and Depressive Symptoms During COVID-19 Lockdown: United States Adult Age Groups

This study investigates: (1) the changes in three major health-related factors—physical activity, non-physical-activity health behavior (i.e., diet quality, alcohol consumption, smoking, sleep quality), and depressive symptoms, and (2) how changes in physical activity were associated with changes in one’s depressive symptoms among young adults, middle-aged adults, and older adults while controlling non-physical-activity health behavior and sociodemographic characteristics among young, middle-aged, and older adults before and after the COVID-19 outbreak lockdown in the United States. A total of 695 participants completed an online questionnaire via MTurk, and participants were asked to recall their physical activity, depressive symptoms, and non-physical-activity health behavior status in January and May of 2020. The IPAQ-SF was used to evaluate individuals’ physical activity, while the CES-D-10 was used to assess depressive symptoms. Covariates included non-physical-activity health behavior and sociodemographic factors. A Bayesian significance testing of changes was used to examine significant changes in physical activity, non-physical-activity behavior, and depressive symptoms in each age group while Bayesian regression analysis was employed to examine how the changes in physical activity were associated with respondents’ depressive symptoms while controlling for individual NHB and sociodemographic characteristics. The results showed that the participants tended to maintain their physical activity levels after the lockdown despite significant increases in sitting time among young and older adults. Decreases in moderate physical activity frequency were associated with a higher level of depressive symptoms (R² = 17.1%). Although young and middle-aged cohorts experienced fewer differences in depressive symptoms compared to their counterparts in the older group, we found no significant heterogeneity effects in the relationships of interest across all age groups. Considering different influences of physical activity on depressive symptoms depending on different levels of activity and ages, more randomized clinical trials with program-based intervention studies should be conducted with different physical activity programs for different age populations.

COVID-19 vs. terrorism: Contribution of the COR theory to the process of coping with invisible threats

Two years have passed since the outbreak of the COVID-19 pandemic. The entire world is still struggling with the virus and its mutations, and governments have been imposing various restrictions, including social distancing and quarantine. This paper leans on the Conservation of Resources (COR) theoretical model in comparing the impact of COVID-19 with that of an ongoing threat of terror attacks, allowing us to understand the similarities and differences between them. Such exploration could result in an understanding that may guide devising psycho-social interventions to minimize the negative psychological consequences of a continuous life-threatening situation. By applying the extensive available literature on the aftermath of terrorist attacks to the little-known long-run consequences of the COVID-19 pandemic, this paper comes up with several guidelines such as increasing online social support and enhancing adaptive coping with stress, that are applicable on the individual, community, and societal levels.

Updated Recommendations on Cardiovascular Prevention in 2022: An Executive Document of the Italian Society of Cardiovascular Prevention

This executive document reflects and updates the key points of a Consensus document on Cardiovascular (CV) Prevention realized through the contribution of a number of Italian Scientific Societies and coordinated by the Italian Society of Cardiovascular Prevention (SIPREC). The aim of this executive document is to analyze and discuss the new recommendations introduced by international guidelines for the management of major CV risk factors, such as hypertension, dyslipidemias and type 2 diabetes, consisting in the identification of lower therapeutic targets, in the promotion of combination fixed drug therapies and in the introduction in routine clinical practice of new effective pharmacological classes. Moreover, the document highlights the importance of effective CV prevention strategies during the the coronavirus disease 2019 (COVID-19) outbreak which has dramatically changed the priorities and the use of available resources by the national healthcare systems and have caused a reduction of programmed follow-up visits and procedures and even of hospital admissions for severe acute pathologies. In addition, the pandemic and the consequent lockdown measures imposed have caused a widespread diffusion of unhealthy behaviors with detrimental effects on the CV system. In such a context, reinforcement of CV prevention activities may play a key role in reducing the future impact of these deleterious conditions.

The impact of COVID-19 on cardiovascular health behaviors in student veterans

BACKGROUND AND AIMS

Pandemics have previously resulted in increased cardiovascular morbidity and mortality. It is unclear if the effects of the COVID-19 pandemic will be amplified in individuals at high risk for cardiovascular disease, such as military populations, resulting in augmented cardiovascular events in Veterans. The purpose of this study was to determine if traditional behavioral risk factors for cardiovascular disease are amplified due to the COVID-19 pandemic and if risk factors are more prevalent in Veterans compared to non-Veterans.

METHODS AND RESULTS

Thirty-two student Veterans and 46 non-Veteran students between the ages of 18 and 35 completed a Qualtrics self-report questionnaire assessing health behaviors, physical activity, and mental health both before and during COVID-19. Veterans displayed worse pre-COVID cardiovascular health behaviors such as poor sleep habits, greater use of tobacco, alcohol, and energy drinks, and lower values of social engagement compared to non-Veterans. Many health behaviors remained unchanged in student Veterans during the pandemic. The non-Veteran group exhibited augmentation of cardiovascular health behaviors during COVID-19, shown through the worsening sleep habits, increased anxiety, and reduced physical activity.

CONCLUSION

Student Veterans demonstrate heightened risk for cardiovascular disease based on the pre-COVID elevation of behavioral risk factors. These behavioral factors continued to remain elevated during the COVID-19 pandemic. Non-Veteran students displayed amplification of behavioral risk factors for cardiovascular disease due to the COVID-19 pandemic. These results highlight the need for resources and interventions for our student veterans and suggest long-term cardiovascular consequences for all students who suffered through the COVID-19 pandemic.

Impact of Nationwide Lockdowns Resulting from the First Wave of the COVID-19 Pandemic on Food Intake, Eating Behaviors, and Diet Quality: A Systematic Review

The lockdowns resulting from the first wave of the coronavirus disease 2019 (COVID-19) pandemic impacted deeply on all life activities, including diet. We performed a systematic review to investigate changes in food intake, eating behaviors, and diet quality during lockdown as compared with before the lockdown. A literature search was performed using 3 electronic databases from inception until 13 June 2021. Observational studies evaluating changes in general populations during the COVID-19 pandemic lockdown were eligible. Of 1963 studies retrieved from the search strategy, 95 met inclusion criteria (85 in adults, 10 in children/adolescents), and the majority were of high quality (72.6%). Most of the studies were web-based surveys using convenience sampling, mainly focused on variations in the consumption of foods and eating behaviors during lockdown, whereas only 15 studies analyzed diet quality through dietary indices. On the basis of the definition of a healthful diet as reflected by a traditional Mediterranean diet, an increase in recommended foods such as fruit and vegetables, legumes, cereals, and olive oil was observed, although a sharp decrease in fish intake and an increase in dairy products were documented. Accordingly, a reduction in foods that should be eaten less frequently was reported-namely, red and processed meat. However, a higher consumption of unhealthy foods (e.g., snacks and sweets) was also observed. Results indicated improved diet quality in Europe, especially among Mediterranean countries, with the exception of France, while a switch to poor nutrient patterns was observed in Colombia and Saudi Arabia. Analyses of eating behaviors suggest an increase in food intake, number of daily meals, and snacking. In conclusion, changes in intake of major food groups, apart from fish intake, were in line with the definition of a traditional Mediterranean diet, indicating a consistent moderate improvement in dietary habits worldwide. This review protocol was registered at https://www.crd.york.ac.uk/prospero/ as CRD42020225292.

Impact of the COVID-19 pandemic on food and drink consumption and related factors: A scoping review

Background: The lockdown imposed due to the coronavirus disease (COVID-19) pandemic has caused several lifestyle changes. Aim: This scoping review aimed to report the present status of studies conducted on changes and factors related to food and drink consumption worldwide. Methods: Searches were performed in PubMed and EBSCO between August 6 and August 22, 2020 using the following criteria: (1) studies reporting changes in the current individual consumption of specific foods and snacks compared to that before the COVID-19 pandemic; (2) participants aged 18 years or older and without any diagnosable disease; and (3) articles that are peer-reviewed publications available in English. Studies were excluded if they involved an intervention related to diet or investigated the change in COVID-19 incidence. Results: Twelve articles were included in this review. The included studies revealed that there were various changes in food and drink consumption, such as the frequency and amount of consumption of snacks (n = 9), alcohol (n = 7), and vegetables and fruits (n = 5). These changes showed both increasing and decreasing trends. Of the 12 studies, 10 reported factors related to dietary changes, such as age, body mass index, psychological conditions, and residence; however, most of the results regarding these factors were inconsistent. Conclusions: Future studies should investigate long-term dietary changes and examine the factors that influence these changes to determine the pandemic's long-term impact.

God’s Benevolent Love in the Time of COVID-19 Pandemic: Articulations and Experiences of Select Filipino Youth

Current studies show that the Christian faith is still robust in Philippine society and culture despite the global health crisis. This study investigates how select Filipino Christian youths intuited God’s benevolent love in the time of “social distancing” and how their experience of God’s benevolence helped them to carry on despite the COVID-19 pandemic. The authors administered open-ended survey questions about God’s love to select Filipino Christian youths. The responses were analyzed using thematic analysis and categorizations. Using contextual analysis, the researchers critically reflected upon the respondents’ notions of God’s love and religious experiences from the two poles of Filipino culture and Judeo-Christian tradition. According to select Filipino Christian youths, God is present and faithful. God’s “kagandahang-loob” (benevolent love) for human persons is evinced in the care and kindness of family members and neighbors. God also enables human persons to prevail over challenges in life, such as the COVID-19 pandemic. Moreover, God is the ultimate source of Christian hope. This hope is firmly anchored in Jesus Christ and the Church. Furthermore, God is forgiving and merciful. He continues to bless and give graces to human persons despite their sinfulness. These contemporary conceptualizations of God’s perfect interior goodness helped the select Filipino Christian youths cope with the COVID-19 pandemic.

Changes in Spanish lifestyle and dietary habits during the COVID-19 lockdown

PURPOSE

The COVID-2019 pandemic forced many governments to declare the "to stay at home" which encouraged social distancing and isolation among citizens. The aim of this study was to assess the dietary and lifestyle habit changes that occurred during home confinement in Spain.

METHODS

An European online survey was launched in April 2020. This included 70 questions on sociodemographic characteristics, lifestyle, dietary habits, including key Mediterranean diet (MedDiet) foods. A total of 945 Spanish adults from 1268 European that completed the online survey were included in the analysis.

RESULTS

Most of the Spanish participants adopted healthier dietary habits during home lockdown, which was translated to a higher MedDiet adherence. However, a negative impact on physical activity levels, sleep quality or smoking rates was observed. Low MedDiet adherence was associated with a higher risk of weight gain (OR = 1.53, CI 1.1-2.1; p = 0.016), while no snacking between meals reduced the risk by 80% (OR = 0.20, CI 0.09-0.45, p < 0.001) and eating more quantity, considering portion size, increased body weight gain risk almost sixfold more.

CONCLUSION

To conclude, although dietary habits were improved during home lockdown, certain unhealthy behaviours (e.g. increased snacking between meals, increased food intake, and an increase in sedentary behaviour) were increased.

The Evaluation of Physical Activity Habits in North Italian People before and during COVID-19 Quarantine: A Pilot Study

COVID-19 caused a global pandemic state. Many governments enforced quarantines which had several negative effects on peoples’ health. The present study aimed to investigate the social restriction effects on the physical activity (PA) habits of north Italian people and understand whether PA was a healthy support during lockdown. Moreover, it analysed some possible strategies which could promote an active lifestyle when the pandemic ends. A new questionnaire was proposed (Cronbach’s alpha = 0.816), and 309 surveys were collected in people from two Italian regions (53.72% from Emilia-Romagna and 46.28% from Veneto; 62.46% were female and 37.54% were male; and the age range was 46.67 ± 15.45 years). The number of younger people (≤25 years) who practiced PA increased during lockdown (p < 0.01); in addition, they were more active than people who were 26–35 years old (p < 0.001). The training frequency before COVID-19 was higher in females than males (p = 0.01), and the frequency of weekly PA increased during lockdown in groups aged 26–35 years (p < 0.001). Despite the fact that PA was a psychological support during lockdown (p < 0.001), performing forced home-based PA demotivated people (p < 0.001). Finally, people thought to practice outdoor PA (OPA) at the end of lockdown because they wanted to retain contact with nature, which can improve psychological well-being. Future strategies to promote OPA may increase participation in PA, especially in older people.

Food Purchase Behavior during The First Wave of COVID-19: The Case of Hungary

Coronavirus disease (SARSCoV-2) appeared in 2019 was confirmed as pandemic by the WHO on 11 March 2020. Stay-at-home order had an impact on consumers’ food purchase habits, as people around the world were able to leave their homes solely in extremely severe or urgent cases. In our research, we delve into the impact of COVID-19 pandemic on consumers’ food purchase habits. The research involved 3000 consumers during the first wave of coronavirus. The sample represents the Hungarian population by gender and age. To achieve the research goals, we applied multivariate statistical tools. The findings suggest that the pandemic could not change consumer attitude significantly, but the order of factors influencing purchases changed. Consumer motivation factors were organized into four well-distinguished factors: Healthy, domestic, and environmentally friendly choice; Usual taste and quality; Reasonable price; Shelf life. Due to the lack of outstanding data during segmentation, we developed four segments by hierarchical cluster analysis: Health- and environment-conscious women; Price sensitive young people; Taste-oriented men; Quality-oriented intellectuals. The results confirm that food manufacturers and traders need to be prepared for further restrictions in the future.

Assessment of Impact of Containment During the COVID-19 Epidemic and Coping Behaviours Using Newly Developed Assessment Tools

Background: The confinement measures during COVID-19 had a massive effect on physical and psychological health in public. This study assessed the impact of containment and coping behaviour among the Malaysia public during the COVID-19 pandemic. Questions assessing the impact of containment and coping behaviours were developed and psychometrically tested. Methods: Exploratory factor analysis (EFA) was conducted with the items using principal component analysis extraction and Varimax rotation. Partial least squares structural equation modelling was used to determine the relationship between coping and impact. Results: The 13-item of impact and 10-item coping instruments were developed with three dimensions identified through EFA. Both scales demonstrated excellent composite reliability and good convergent validity. The survey findings revealed that the impact on individual psychological aspects was prominent, followed by well-being and lifestyle. Mindfulness and physical coping strategies were most commonly reported. Coping through seeking help from health professionals and hotlines had a positive direct effect on well-being and lifestyle (b = 0.231, p < 0.001), psychological (B = 0.132, p < 0.001), and employment-related (0.194, p < 0.001) impacts. Coping through mindfulness practise had a negative effect on well-being and lifestyle-related impact (B = -0.180, p < 0.001) and employment-related impact (B = -0.096, p = 0.008). Conclusions: Despite some limitation, the scales for measuring impact and coping behaviours have the potential to be used as a measurement tool in future studies. Findings highlight the enormous impact of the pandemic on psychological well-being and lifestyles. Health authorities should support individual coping as it was found to be an important resilience-related factor to mitigate the impacts of containment during the pandemic.

COVID-19, Social Determinants of Health, and Opportunities for Preventing Cardiovascular Disease: A Conceptual Framework

The COVID-19 pandemic has disrupted the social, economic, and health care systems in the United States and shined a spotlight on the burden of disease associated with social determinants of health (SDOH). Addressing SDOH, while a challenge, provides important opportunities to mitigate cardiovascular disease incidence, morbidity, and mortality. We present a conceptual framework to examine the differential effects of the COVID-19 pandemic on SDOH across demographically diverse populations, focusing on the short- and long-term development of cardiovascular disease, as well as future research opportunities for cardiovascular disease prevention. The COVID-19 pandemic exerted negative shifts in SDOH and cardiovascular risk factors (ie, smoking, body mass index, physical activity, dietary behavior, cholesterol, blood pressure, and blood sugar). For example, evidence suggests that unemployment and food insecurity have increased, whereas health care access and income have decreased; changes to SDOH have resulted in increases in loneliness and processed food consumption, as well as decreases in physical activity and hypertension management. We found that policy measures enacted to mitigate economic, social, and health issues inadequately protected populations. Low-income and racial and ethnic minority communities, historically underserved populations, were not only disproportionately adversely affected by the pandemic but also less likely to receive assistance, likely attributable in part to the deep structural inequities pervasive in our society. Effective and culturally appropriate interventions are needed to mitigate the negative health impacts of historical systems, policies, and programs that created and maintain structural racism, especially for immigrants, racial and ethnic minorities, and populations experiencing social disadvantage.

Factors associated with preventive practices of COVID-19 among health care workers in Dilla University Hospital, Southern Ethiopia

Implementation of prevention measures is essential for decreasing COVID-19 morbidity and mortality. In health care settings, wearing face masks, avoiding handshakes and spitting, and thoroughly washing hands with soap and water or using an alcohol-based hand rub have been recommended as preventive measures to reduce the risk of COVID-19 transmission. Therefore, this study aimed to assess factors associated with COVID-19 prevention practices among health care workers at Dilla university hospital in Southern Ethiopia. An institutional-based cross-sectional study was conducted among 238 health care workers in Dilla university hospital from June 13, 2021- July 12, 2021. A stratified random sampling techniques were used to select study participants. Data were collected by using pre-tested structured self-administered questionnaires. A binary logistic regression analysis was used to identify factors related to COVID-19 prevention practice among health care professionals. For statistical significance factors with p-value less than 0.05, an Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was calculated and interpreted. One hundred thirty-four participants [56.3%, 95% CI: 50 - 60.3%] had good COVID-19 prevention practices. Being a frontline worker [AOR=12.6, 95% CI: 3.9-41.6], being female [AOR= 0.7, 95% CI: 0.35-0.84], being a nurse [AOR= 8, 95% CI: 2.4-27], and implementation of Infection Prevention and Control (IPC) guideline [AOR = 4.0, 95% CI: 1.56-10.08] were all factors associated with good COVID-19 prevention practice. COVID-19 prevention practices were low among healthcare professionals in the study settings. Being frontline worker, being a nurse, being female, and implementation of IPC guidelines were all associated with COVID-19 preventive measures practices among health care workers. Health care workers may need to improve the way and habit of practicing prevention methods towards COVID-19.

Health-Promoting Behaviors, Risk Perceptions, and Attention to COVID-19-Related Information: Comparing People's Responses to the COVID-19 Pandemic Across Times of Chinese New Year and Summer 2020 in Hong Kong

Background: Since the start of the COVID-19 pandemic, individuals have been encouraged to engage in health-promoting behaviors, namely actions taken to prevent infection and keep themselves healthy, such as maintaining social distancing. However, other factors, such as risk perception and feelings of fear, also might influence whether an individual takes such measures. This study compared people's responses to the pandemic in terms of their adoption of COVID-19 health-promoting behaviors, COVID-19 risk perceptions, and attention to COVID-19-related information during two periods: the 2020 Chinese New Year (CNY) in Hong Kong (HK), i.e., the very beginning of the COVID-19 outbreak (Time 1, T1), and summer 2020, i.e., before and during the third wave of COVID-19 infections in HK (Time 2, T2). Methods: Data were extracted from 180 HK participants, who were asked to recall and report their health-promoting behaviors, emotional and cognitive COVID-19 risk perceptions, and attention to COVID-19-related information during T1 and T2. A repeated-measures ANOVA series was conducted to investigate differences in public responses between the two aforementioned time points. Main Findings: After controlling for the effects from gender, age, and education levels, the participants reported practicing more infection-prevention behaviors, experiencing a lower level of fear as a psychological response, and paying less attention to COVID-19-related information during T2 than T1. Conclusions: This study addressed the need to monitor public responses to the COVID-19 pandemic, including changes in people's behaviors and psychological responses across time. The results also suggest that the HK public was steered toward striking a balance between strengthening their infection-prevention behaviors and reducing their fear of COVID-19 infection.

I'm alone but not lonely. U-shaped pattern of self-perceived loneliness during the COVID-19 pandemic in the UK and Greece

OBJECTIVES

In the past months, many countries have adopted varying degrees of lockdown restrictions to control the spread of the COVID-19 virus. According to the existing literature, some consequences of lockdown restrictions on people's lives are beginning to emerge yet the evolution of such consequences in relation to the time spent in lockdown is understudied. To inform policies involving lockdown restrictions, this study adopted a data-driven Machine Learning approach to uncover the short-term time-related effects of lockdown on people's physical and mental health.

STUDY DESIGN

An online questionnaire was launched on 17 April 2020, distributed through convenience sampling and was self-completed by 2,276 people from 66 different countries.

METHODS

Focusing on the UK sample (N = 325), 12 aggregated variables representing the participant's living environment, physical and mental health were used to train a RandomForest model to estimate the week of survey completion.

RESULTS

Using an index of importance, Self-Perceived Loneliness was identified as the most influential variable for estimating the time spent in lockdown. A significant U-shaped curve emerged for loneliness levels, with lower scores reported by participants who took part in the study during the 6th lockdown week (p = 0.009). The same pattern was replicated in the Greek sample (N = 137) for week 4 (p = 0.012) and 6 (p = 0.009) of lockdown.

CONCLUSIONS

From the trained Machine Learning model and the subsequent statistical analysis, Self-Perceived Loneliness varied across time in lockdown in the UK and Greek populations, with lower symptoms reported during the 4th and 6th lockdown weeks. This supports the dissociation between social support and loneliness, and suggests that social support strategies could be effective even in times of social isolation.

Simultaneous occurrence of a Takotsubo syndrome and paranoia delirium, related to Covid-19 pandemic: A case report

Some psychosomatic diseases, like Tako-tsubo cardiomyopathy, may occur because of exposure to a stressful event like COVID-19. The simultaneous development of psychosis and Tako-tsubo cardiomyopathy suggests a field of vulnerability. Specific measures need to be taken to help vulnerable people to manage these stressful events.

Life in a time of COVID: a mixed method study of the changes in lifestyle, mental and psychosocial health during and after lockdown in Western Australians

BACKGROUND

Since the beginning of the COVID-19 pandemic, the Western Australian government imposed multiple restrictions that impacted daily life activities and the social life. The aim of this study was to examine the effects of COVID-19 lockdown on the community's physical, mental and psychosocial health.

METHODS

Approximately 2 months after a three-month lockdown, a cross-sectional study was opened to Western Australian adults for an 8-week period (25th August - 21 October 2020). Participants competed a 25-min questionnaire adapted from the Western Australia Health and Wellbeing Surveillance system. Participants provided information on their socio-demographic status, lifestyle behaviours, mental health, and psychosocial health during and post-lockdown. Open-ended questions explored key issues in greater detail. Changes between the lockdown and post-lockdown period were assessed using Wilcoxon signed rank test and One-Sample Kolmogorov-Smirnov Normal tests as appropriate. Sex differences were examined using the Mann-Whitney U test. A content analysis approach examined responses to the open-ended questions with frequencies and variations in responses determined using Chi-Square tests.

RESULTS

A total of 547 complete responses were obtained. Compared to post-lockdown period, lockdown was associated with a significantly lower levels of physical activity, poorer mental well-being and sense of control over one's life, and a higher level of loneliness. Similarly, during lockdown, there was a significantly higher consumption of junk food, soft drinks and alcoholic drinks but no change in fruit and vegetable intake. Participants recalled health campaigns on hand washing and social distancing and there was a retrospective view that more timely and informative campaigns on physical activity, nutrition and mental well-being should have been available during lockdown.

CONCLUSIONS

While advice on infection control measures were appropriately provided, there is a need for concurrent health promotional information to help combat the changes in physical, mental and psychosocial well-being observed during quarantine to prevent negative health consequences in the community even if there are minimal effects of the pandemic itself.

Uncertain crisis time affects psychosocial dimensions in beta-thalassemia patients during Covid-19 pandemic: A cross-sectional study

Psychosocial variables are key factors influencing the delicate equilibrium of chronic patients during crisis time. In this study, we explored distress, anxiety, depression, loneliness, coping strategies, and changes in life habits in 43 beta-thalassemia patients and 86 controls during Covid-19 pandemic. Patients showed higher anxiety levels and a predominant transcendent coping profile compared to controls. Patients significantly differed from controls in outdoor habits. Social isolation and habits changes in uncertain life-threaten situations as Covid-19 pandemic are particularly detrimental in fragile beta-thalassemia patients. Structured support interventions are needed to promote well-being in the Covid-19 era.

Changes in Dietary Patterns and Clinical Health Outcomes in Different Countries during the SARS-CoV-2 Pandemic

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to an excess in community mortality across the globe. We review recent evidence on the clinical pathology of COVID-19, comorbidity factors, immune response to SARS-CoV-2 infection, and factors influencing infection outcomes. The latter specifically includes diet and lifestyle factors during pandemic restrictions. We also cover the possibility of SARS-CoV-2 transmission through food products and the food chain, as well as virus persistence on different surfaces and in different environmental conditions, which were major public concerns during the initial days of the pandemic, but have since waned in public attention. We discuss useful measures to avoid the risk of SARS-CoV-2 spread through food, and approaches that may reduce the risk of contamination with the highly contagious virus. While hygienic protocols are required in food supply sectors, cleaning, disinfection, avoidance of cross-contamination across food categories, and foodstuffs at different stages of the manufacturing process are still particularly relevant because the virus persists at length on inert materials such as food packaging. Moreover, personal hygiene (frequent washing and disinfection), wearing gloves, and proper use of masks, clothes, and footwear dedicated to maintaining hygiene, provide on-site protections for food sector employees as well as supply chain intermediates and consumers. Finally, we emphasize the importance of following a healthy diet and maintaining a lifestyle that promotes physical well-being and supports healthy immune system function, especially when government movement restrictions ("lockdowns") are implemented.

Influence of COVID-19 pandemic and related quarantine procedures on metabolic risk

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has changed the lives of many people across the globe. In addition to the effect of the virus on the biological functions in those infected individuals, many countries have launched government policy with additional impact of these quarantine procedures on the metabolic health of many people worldwide. This mini-review aimed to highlight current evidence regarding the influence of metabolic health due to these quarantine procedures including decrease in physical activity, changes in unhealthy eating habits, increase in stress, and provide recommendations of healthy lifestyle during COVID-19 pandemic.

Remote monitoring of patients with heart failure during the first national lockdown for COVID-19 in France

Background

Multiparametric remote monitoring of patients with heart failure (HF) has the potential to mitigate the health risks of lockdowns for COVID-19.

Aims

To compare health care use, physiological variables, and HF decompensations during one month before and during the first month of the first French national lockdown for COVID-19 among patients undergoing remote monitoring.

Methods

Transmitted vital parameters and data from cardiac implantable electronic devices were analyzed in 51 patients. Medical contact was defined as the sum of visits and days of hospitalization.

Results

The lockdown was associated with a marked decrease in cardiology medical contact (118 days before vs 26 days during, -77%, p = 0.003) and overall medical contact (180 days before vs 79 days during, -58%, p = 0.005). Patient adherence with remote monitoring was 84±21% before and 87±19% during lockdown. The lockdown was not associated with significant changes in various parameters, including physical activity (2±1 to 2±1 h/day), weight (83±16 to 83±16 kg), systolic blood pressure (121±19 to 121±18 mmHg), heart rate (68±10 to 67±10 bpm), heart rate variability (89±44 to 78±46 ms, p = 0.05), atrial fibrillation burden (84±146 vs 86±146 h/month), or thoracic impedance (66±8 to 66±9 Ω). Seven cases of HF decompensations were observed before lockdown, all but one of which required hospitalization, versus six during lockdown, all but one of which were managed remotely.

Conclusions

The lockdown restrictions caused a marked decrease in health care use but no significant change in the clinical status of HF patients under multiparametric remote monitoring.

lay summary

The first French COVID-19 lockdown had a huge detrimental impact on conventional health care use (-78% in cardiology medical contact). However the lockdown had little impact over the short-term, if any, on vital parameters and the clinical status of patients with heart failure who were adherent to multiparametric remote monitoring. This remote monitoring strategy allowed early identification and home management of most of the heart failure decompensations during the lockdown.

'It reminds me that I should stop for the little moments': Exploring emotions in experiences of UK Covid-19 lockdown

In this study, we explore how participants articulate experiences of emotions during Covid-19 lockdown in the UK. We posit that emotions fulfil experiential and interpersonal functions, which are construed and conveyed through language choices. An online narrative survey was carried out. About 88 responses were analysed. Participants were from England and Wales. The mean age was 48.9 years old (SD = 62). A mixed-method approach was used. This combined quantitative Corpus Linguistics analysis and qualitative Interpretative Phenomenological Analysis with linguistic analysis. The findings show similarities to the public health and medical literature that highlight negative emotions, such as fear, distrust and anger in participants. However, we also found positive emotions not considered elsewhere, including happiness, relaxation, safety, optimism for the future and connectedness arising from the thematic IPA analysis. Emotions were construed using language explicitly labelling emotions and language implicitly signalling emotions. Our study highlights implications for managing risk behaviours associated with transmission in public health practices such as social distancing, as indicated by negative emotions. We also bring to light implications with perceived benefits of engaging in protective behaviours and social support central to public health measures, as suggested by the communication of positive emotions.

The effect of COVID-19 pandemic and quarantine period on physical activity and dietary habits of college-aged students

The coronavirus disease 2019 (COVID-19) pandemic led to sudden extreme changes in lifestyle, potentially causing adverse changes in physical activity, sedentary behavior, and dietary habits. The objective of the study was to investigate the effects of COVID-19 quarantine on physical activity, dietary habits, and food insecurity among college students who were impacted by the quarantine periods and campus closures. The findings of the study will provide preliminary evidence on dietary, physical activity, and sedentary behavior changes induced by the pandemic among college students.

Participants (n ​= ​403) completed a cross-sectional self-report online questionnaire, evaluating the physical activity, sedentary behavior, and dietary behaviors before- and during-COVID-19 campus closures (March–May 2020). Sociodemographic and descriptive information was also obtained from each participant. Wilcoxon signed-rank test was used to assess changes in physical activity, sedentary behavior, and dietary habits. McNemar's test was used to compare food insecurity changes. Data were presented as median and interquartile range.

A total of 291 participants who met the inclusion criteria were enrolled in the study (college-aged, 18–24 years). Physical activity decreased at vigorous (2 days/week to 1 day/week, p ​< ​0.001), moderate (4 days/week to 1 day/week, p ​< ​0.001), and light (4 days/week to 2 days/week, p ​< ​0.001) intensity levels, while sedentary behavior increased (4 ​h/day to 7 ​h/day, p ​< ​0.001) from pre-to during-COVID-19 quarantine period. Frequencies of meals at home and alcohol consumption increased (Z ​= ​−3.911 and Z ​= ​−4.022, p ​< ​0.001), while frequency of fruit consumption decreased (Z ​= ​−2.116, p ​< ​0.001) from pre-to during-COVID-19 quarantine period. Daily alcohol intake also increased during COVID-19 quarantine period (Z ​= ​−4.442, p ​< ​0.001). Lastly, the percentage of individuals reporting food insecurity significantly increased during COVID-19 quarantine (p ​< ​0.001).

College-aged students in quarantine significantly decreased physical activity participation and increased sedentary behavior. Changes in dietary habits were observed, including increased meals at home, alcohol consumption, and decreased fruit consumption. Food insecurity also doubled among college-aged students during quarantine. Public health strategies to attenuate these changes in lifestyle habits should be implemented during a global pandemic.

Pain and satisfaction: the case of isolated COVID-19 patients of Pakistan

Background

Over 3 million people lost their lives across the globe due to the COVID-19 related pandemic. The unprecedented restrictions on mobility have imposed in the form of isolation, quarantines, and lockdowns to curb the profound effects of the pandemic and retain physical health. This study examined the relationship between various pain levels, demographic variables and patient satisfaction with COVID-19 during isolation.

Methods

The primary data in this study were collected from isolated patients during their isolation and treatment in a public hospital. We obtained information from patients with COVID-19 (N = 100) about their demographic characteristics, varying levels of pain, and satisfaction with the services provided during the isolation period. We computed the descriptive statistics to explain the profile of participants, ANOVA was used to find out the difference between various groups on patient satisfaction, and structural equation modeling was performed to examine the link between pain levels, demographic factors, and patient satisfaction. This analysis was performed with STATA and SmartPLS-3.

Results

The findings of this study ascertained that respondent’s education (Beta, β = 2.961, p = 0.003), assets such as possession of a house (β = 4.563, p = 0.000), perception of income adequacy during the lockdown (=2.299, p = 0.022), and negligence in prevention (β = 1.975, p = 0.049) significantly affects patient satisfaction during the isolation period. Moreover, satisfaction with life, physicians and medicine, income adequacy, and fear of the participants was significantly linked to the pain level (Model F-stat = 86.323, p = 0.0001). Patients who were satisfied with their treatment had significantly lower odds of having pain (OR 0.023, 95% CI [0.001–0.0452]). Patients who had enough income to meet their basic necessities were found to have significantly lower odds of having pain (OR 0.155, 95% CI [0.032–0.740].

Discussion and Conclusion

We conclude that a higher level of education, low income, and living in a rented house contributes significantly to the feeling of more satisfaction with the provided services. This implies that people with more affluent backgrounds are less likely to be satisfied with the provided services as low-income and living in rented house groups are more satisfied during isolation than others. The pain level is also affected by subjective factors such as fear and satisfaction which need to be considered while doing patient management. This study can be helpful in improving the delivery of public services of isolation centers by considering various characteristics and demographic factors of patients.

Diabetes self-care practices and resilience in the Brazilian COVID-19 pandemic: results of a web survey: DIABETESvid

BACKGROUND

The world guidance on the measures of social distancing for prevention of COVID-19 has changed the daily habits of great part of the population, and this could influence the care and resilience with diabetes during situations of adversity. This study aimed at assessing the characteristics of diabetic individuals and self-care practices and resilience with diabetes in the context of the COVID-19 pandemic in Brazil.

METHODS

This is a cross-sectional web survey study carried out among adults with diabetes, in which a structured 43-item questionnaire was conducted on the REDCap plataform, including the Diabetes Self-Care Activities Questionnaire and Connor-Davidson Resilience Scale, to measure socio-demographic and clinical characteristics. The web survey was disseminated through the main social media and data were collected from September 1st to October 19th, 2020. Data analysis was performed according to type of diabetes mellitus (DM) and at a significance level of 5% (p < 0.05).

RESULTS

Of the 1633 participants, 67.5% were women, 43.2% aged between 35 and 59 years old, 68.0% lived in the south-eastern region of Brazil, 57.1% had a high education level, 49% reported to have DM1 and 140 participants reported to have had COVID-19. Diabetes care mostly involved the use of medications (93%), whereas the least used ones were physical activity (24.6%) and examination of the shoes (35.7%). About 40% of the participants reported to be followed up by telemedicine, 61.5% monitored the glycaemic levels, 61.2% followed a healthy diet and 43.4% left home only to go to the supermarket and drugstore. The mean resilience was 25.4 (SD = 7.7).

CONCLUSIONS

In Brazil, individuals with diabetes followed social distancing and maintained their medication treatment for DM. However, practice of physical activity and foot examination was little followed by the participants, who also had a low level of resilience. These findings showed the importance of patient follow-up in the healthcare services, meaning that telemedicine should be improved and support provided for adaptation in view of the therapeutic setbacks.

Effects of COVID-19 lockdown on the mental health of dental students: A longitudinal study

OBJECTIVES

Many countries have enforced lockdowns on their populations due to the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to assess the effects of the lockdown on dental students.

METHODS

A longitudinal, repeated cross-sectional study was conducted to evaluate psychological problems experienced by dental students during the COVID-19 lockdown in Saudi Arabia. The dental students were selected from different universities using 2-stage cluster sampling. The validated Arabic version of the 21-item depression, anxiety, and stress scale questionnaire was distributed at the beginning and end of the lockdown. Mann-Whitney U and Kruskal-Wallis tests were used as appropriate. Chi-square test was used to compare the proportions between the sociodemographic data, and logistic regression analysis was used to identify variables associated with the students' responses.

RESULTS

A total of 1287 respondents participated in this study (695 first-survey respondents, 592 second-survey respondents). There were longitudinally significant differences in the students' mental health outcomes based on gender, university, class year, and survey time during the COVID-19 lockdown. The lockdown increased the likelihood of female, single, and junior students experiencing stress. The students who lived alone recorded a high chance of elevated levels of depression, anxiety, and stress, which showed a significant longitudinal reduction during the lockdown. Moreover, the lockdown increased the likelihood of mental health problems among the students staying in households of two persons or two-five persons.

CONCLUSIONS

This study indicates the importance of considering the detrimental mental health consequences on dental students in the event of future pandemics.

The clinical utility of a comprehensive psychosomatic assessment in the program for colorectal cancer prevention: a cross-sectional study

Few studies have investigated psychosocial characteristics and lifestyle behaviors of participants at programs for secondary prevention of colorectal cancer (CRC). This study aimed, through a comprehensive psychosomatic assessment based on clinimetric principles, to evaluate psychosocial characteristics and lifestyle behaviors in participants at CRC secondary prevention program, and to investigate the associations between these variables and endoscopic outcomes. In this cross-sectional study, the first 150 consecutive asymptomatic participants at the CRC prevention program who resulted positive to fecal occult blood test (FOBT) and were thus referred to colonoscopy, underwent a psychosomatic assessment including psychiatric diagnoses (DSM-5), psychosomatic syndromes (DCPR-R), psychological distress, psychological well-being and lifestyle behaviors. Whereas only 5.3% of the sample showed at least one DSM-5 diagnosis, 51.3% showed at least one DCPR syndrome, such as allostatic overload, alexithymia, Type A behavior, and demoralization. Patients affected by psychosomatic syndromes presented with significantly higher psychological distress, lower psychological well-being and unhealthy lifestyle behaviors, such as tobacco smoking and unhealthy diet, in comparison with patients without DCPR syndromes. Among endoscopic outcomes, the presence of adenomas was significantly associated with DCPR irritable mood. In a clinical context of secondary prevention addressing asymptomatic patients with positive FOBT, a comprehensive psychosomatic assessment may provide relevant clinical information for those patients who present certain psychosomatic syndromes associated with high psychological distress, impaired psychological well-being, unhealthy lifestyle behaviors and colorectal precancerous lesions. The results of the present study indicate a road to the practice of "preventive" medicine at CRC screening program.

Impact of COVID-19 and Associated Preventive Measures on Cardiometabolic Risk Factors in South Korea

Background

During the coronavirus disease 2019 (COVID-19) pandemic, preventive measures mandated by government policies have included the closure of exercise facilities and movement restriction, which can lead to an unhealthy lifestyle. We investigated the effect of these preventive measures on metabolic parameters in individuals with cardiometabolic disorders.

Methods

In this retrospective, observational study of patients who visited the hospital at least twice a year for the past 4 years, changes in cardiometabolic factors during the COVID-19 pandemic (2019-2020) were compared with changes in the same cohort at the same annual time points during the previous seasons of 2016-2019.

Results

A total of 1,485 individuals with a mean age of 61.8±11.7 years were included in the analyses. During the COVID-19 pandemic, the number of patients whose metabolic syndrome worsened increased significantly by 21% compared with the 2018-2019 season. Body mass index increased by 0.09±1.16 kg/m² in the 2019-2020 pandemic period, whereas it decreased by -0.39±3.03 kg/m² in 2018-2019 and by -0.34±2.18 kg/m² in 2017-2018 (both P<0.05). Systolic blood pressure increased by 2.6±18.2 mmHg in the COVID-19 pandemic period, while it decreased in the three antecedent seasons (all P<0.05). Lipid profiles worsened in the pandemic period compared with the previous years. Framingham coronary heart disease risk score also increased significantly.

Conclusion

Nationwide strategies to maintain cardiometabolic health are necessary during contagious disease pandemics like COVID-19 to mitigate the adverse health effects of pandemic-preventative strategies.

Eating habits and lifestyle changes among higher studies students post-lockdown in Bangladesh: A web-based cross-sectional study

BACKGROUND

The Coronavirus is still exhibiting cases in Bangladesh thus educational institutes are still ceased over one year, it becomes burdens to students at post lockdown period.

OBJECTIVES

Identifying the changes in eating habits and lifestyles including, physical activity, sleeping hours, and sleep quality after the cancellation of lockdown than the period of restrictions.

METHODS

A quasi-experimental cross-sectional study was conducted among 394 students in Bangladesh using a structured questionnaire from February 3, 2021, to February 13, 2021.

RESULTS

Consuming homemade foods drops by 8.63% at post lockdown than lockdown period. At post lockdown, 26.67% of students gained weight whereas 47.46% of respondents never engaged in any physical works. There has been a significant correlation between weight gain and physical activities (p = 0.007). Not continuing the academic activities from home was significantly associated with weight changes (AOR = 1.73; 95% CI: 1.01, 2.95), meals per day (AOR = 3.25; 95% CI: 1.79, 5.92), screen time for entertainment (AOR = 3.08; 95% CI: 1.78, 5.33), sleeping hours (AOR = 2.23; 95% CI: 1.30, 3.83), and sleep quality (AOR = 2.38; 95% CI: 1.35, 4.23) whereas female gender was related to meals per day (AOR = 1.77; 95% CI: 1.06, 2.95) and sleep quality (AOR = 1.76; 95% CI: 1.09, 2.85). However, 43.91% of respondents never felt any sleep disturbances. The rates of students who always experienced mentally tired, resentment, and sadness at post lockdown was lower than lockdown period. All of these changes were significant (p < 0.000) in terms of the lockdown situation.

CONCLUSIONS

This study shows notable changes in eating habits and lifestyles after lockdown which may indicate the tendency to adopt normal life than restrictions.

Changes in ultra-processed food consumption during the first Italian lockdown following the COVID-19 pandemic and major correlates: results from two population-based cohorts

OBJECTIVE

To evaluate changes in ultra-processed food (UPF) intake and its major correlates during the first Italian lockdown (9 March-3 May 2020).

DESIGN

Retrospective observational study.

SETTING

Italy.

PARTICIPANTS

We analysed 2992 subjects (mean age 57·9 ± 15·3 years, 40·4 % men). Individual participant data were pooled from two retrospective cohorts: (1) The Moli-LOCK cohort consists of 1501 adults, a portion of the larger Moli-sani study (n 24 325; 2005-2010) who were administered a phone-based questionnaire to assess lifestyles and psychological factors during confinement and (2) the Analysis of Long Term Risk of Covid-19 Emergency is a web-based survey of 1491 individuals distributed throughout Italy who self-responded to the same questionnaire by using Google forms.UPF was defined according to NOVA classification based on degree of food processing. An UPF score was created by assigning 1 point to increased consumption, -1 to decreased and 0 point for unchanged intakes of nineteen food items, with higher values indicating an increase in UPF during confinement.

RESULTS

Overall, 37·5 % of the population reported some increase in UPF (UPF score ≥1). Adults were more likely to decrease UPF (multivariable regression coefficient β = -1·94; 95 % CI -2·72, -1·17 for individuals aged >75 years as compared with 18-39 years) as did individuals from southern Italian regions as compared with Northern inhabitants (β = -1·32; 95 % CI -1·80, -0·84), while UPF lowering associated with increased exercise (β = -0·90; 95 % CI -1·46, -0·35) and weight loss (β = -1·05; 95 % CI -1·51, -0·59) during confinement.

CONCLUSIONS

During the first Italian lockdown, about 40 % of our population switched to unfavourable eating as reflected by increased UPF intake and this may have long-term effects for health.

How the Wakamola chatbot studied a university community's lifestyle during the COVID-19 confinement

This work aimed to study the effect of confinement on weight and lifestyle using the Wakamola chatbot to collect data from 739 adults divided into two groups (341 case-control, 398 confinement). Nutrition score (0-100 scale) improved for men (medians 81.77-82.29, p < 0.05), with no difference for women (medians 82.29 in both cases). Both genders reduced the consumption of sweetmeats and sugared drinks (p < 0.01); men increased their consumption of vegetables, salad, and legumes (p < 0.01). Both genders reduced their physical activity score (men 100-40.14, p < 0.01, women 80.42-36.12, p < 0.01). Women sat less hours/week, men's medians 28.81-28.27, women's medians 35.97-23.33, p = 0.03. Both genders slept longer (hours/day), men 7-7.5, women 7-8 (p < 0.01) (medians). Their overall health score was significantly reduced (men 85.06-74.05, p < 0.01, women 84.47-72.42, p < 0.01), with no significant weight difference in either gender. Wakamola helped to contact participants and confirm changes in their lifestyle during confinement.

Smartphone Use Among University Students During COVID-19 Quarantine: An Ethical Trigger

To reduce the spread of COVID-19, Jordan enforced 10 weeks of home quarantine in the spring of 2020. A cross-sectional study was designed to assess this extended quarantine's effect on smartphone addiction levels among undergraduates. A random sample of 6,157 undergraduates completed an online questionnaire (mean age 19.79 ± 1.67 years; males 28.7%). The questionnaire contains different sections to collect socio-demographic, socio-economic, academic, quarantine-related information, and smartphone usage. The smartphone addiction scale-short version was used to assess the degree of addiction during the quarantine. The mean addiction score across the whole sample was 35.66 ± 12.08, while the prevalence of addiction among participants was 62.4% (63.5% in males and 61.9% in females). The majority of the participants (85%) reported that their smartphone usage during the quarantine increased or greatly increased (27.6 and 57.2%, respectively), with some 42% using their smartphones for more than 6 h a day. Nevertheless, three-quarters of the students wished to reduce their smartphone usage. Several demographic and quarantine factors have been assessed, and students' gender, the field of study, parental education, household income in addition to the location of quarantine (urban, rural) and the house specifications (apartment, independent house, with/without a garden) showed statistically significant associations with smartphone addiction during the quarantine. Female students, students studying scientific- and medical-related majors compared to those studying humanity majors, those with higher incomes, those who had been quarantined in an apartment without a garden, and those who lived in urban areas showed significantly higher addiction scores.

Smartphone-Based Interventions for Physical Activity Promotion: Scoping Review of the Evidence Over the Last 10 Years

Background

Several reviews of mobile health (mHealth) physical activity (PA) interventions suggest their beneficial effects on behavior change in adolescents and adults. Owing to the ubiquitous presence of smartphones, their use in mHealth PA interventions seems obvious; nevertheless, there are gaps in the literature on the evaluation reporting processes and best practices of such interventions.

Objective

The primary objective of this review is to analyze the development and evaluation trajectory of smartphone-based mHealth PA interventions and to review systematic theory- and evidence-based practices and methods that are implemented along this trajectory. The secondary objective is to identify the range of evidence (both quantitative and qualitative) available on smartphone-based mHealth PA interventions to provide a comprehensive tabular and narrative review of the available literature in terms of its nature, features, and volume.

Methods

We conducted a scoping review of qualitative and quantitative studies examining smartphone-based PA interventions published between 2008 and 2018. In line with scoping review guidelines, studies were not rejected based on their research design or quality. This review, therefore, includes experimental and descriptive studies, as well as reviews addressing smartphone-based mHealth interventions aimed at promoting PA in all age groups (with a subanalysis conducted for adolescents). Two groups of studies were additionally included: reviews or content analyses of PA trackers and meta-analyses exploring behavior change techniques and their efficacy.

Results

Included articles (N=148) were categorized into 10 groups: commercial smartphone app content analyses, smartphone-based intervention review studies, activity tracker content analyses, activity tracker review studies, meta-analyses of PA intervention studies, smartphone-based intervention studies, qualitative formative studies, app development descriptive studies, qualitative follow-up studies, and other related articles. Only 24 articles targeted children or adolescents (age range: 5-19 years). There is no agreed evaluation framework or taxonomy to code or report smartphone-based PA interventions. Researchers did not state the coding method, used various evaluation frameworks, or used different versions of behavior change technique taxonomies. In addition, there is no consensus on the best behavior change theory or model that should be used in smartphone-based interventions for PA promotion. Commonly reported systematic practices and methods have been successfully identified. They include PA recommendations, trial designs (randomized controlled trials, experimental trials, and rapid design trials), mixed methods data collection (surveys, questionnaires, interviews, and focus group discussions), scales to assess app quality, and industry-recognized reporting guidelines.

Conclusions

Smartphone-based mHealth interventions aimed at promoting PA showed promising results for behavior change. Although there is a plethora of published studies on the adult target group, the number of studies and consequently the evidence base for adolescents is limited. Overall, the efficacy of smartphone-based mHealth PA interventions can be considerably improved through a more systematic approach of developing, reporting, and coding of the interventions.

Impact of Activity Monitoring on Physical Activity, Sedentary Behavior, and Body Weight during the COVID-19 Pandemic

Decreases in individuals' physical activity and increases in sedentary behavior and bodyweight have been reported during the COVID-19 pandemic. The present study assessed the ability of physical activity monitoring, which may promote physical activity and discourage sedentary behavior, to mitigate these negative outcomes. An evaluation of university samples (N = 404, 40.5 ± 15.4 years) of self-reported physical activity, sedentary behavior, and bodyweight prior to the closure of campus due to the pandemic in March of 2020 and again at the time of the survey administration (May-June 2020) during pandemic-related restrictions was performed. Participants also reported whether they did (n = 172) or did not (n = 232) regularly use physical activity monitoring technology. While physical activity was unchanged during the pandemic (p ≥ 0.15), participants significantly increased sitting by 67.8 ± 156.6 min/day and gained 0.64 ± 3.5 kg from pre-campus to post-campus closure (p < 0.001). However, the use of activity monitoring did not moderate these changes. In conclusion, while physical activity was not affected, participants reported significant increases in sedentary behavior and bodyweight during the COVID-19 pandemic. These changes occurred regardless of whether participants regularly used physical activity monitoring or not.

Why people were less compliant with public health regulations during the second wave of the Covid-19 outbreak: The role of trust in governmental organizations, future anxiety, fatigue, and Covid-19 risk perception

Trust in governmental organizations is a crucial factor in terms of encouraging people to conform to public health regulations, such as those recommended to slow down the spread of SARS-CoV-2. However, trust in governmental organizations tends to decline over time, reducing the compliance with public health regulations. This study aimed at exploring, first, the role of future anxiety and fatigue as serial mediators of the relationship between trust in governmental organizations and protective behaviors, and, secondly, the role of Covid-19 risk perception as a moderator between fatigue and protective behaviors. A total of 948 Italian participants (302 males and 646 females), ranged from 18 to 80 years (M = 27.20, SD = 11.01), answered an online survey during the second wave of the Covid-19 outbreak. A moderated serial mediation model was performed using a structural equation modeling. The results indicate that: (1) a higher trust in Italian governmental organizations was associated with a greater compliance in terms of adopting protective behaviors; (2) a lower trust in Italian governmental organizations increased anxiety about the future which, in turn, raised levels of fatigue, leading, finally, to a reduction in the levels of protective behaviors; and (3) as the perceived risk related to Covid-19 increased, the effect of fatigue on protective behaviors decreased. The findings of the current study may provide indications for public health policy on how to increase compliance with the recommended behaviors to be adopted in order to decrease the spread of the SARS-CoV-2.

A Personalized Mobile Health Program for Type 2 Diabetes During the COVID-19 Pandemic: Single-Group Pre-Post Study

Background

With increasing type 2 diabetes prevalence, there is a need for effective programs that support diabetes management and improve type 2 diabetes outcomes. Mobile health (mHealth) interventions have shown promising results. With advances in wearable sensors and improved integration, mHealth programs could become more accessible and personalized.

Objective

The study aimed to evaluate the feasibility, acceptability, and effectiveness of a personalized mHealth-anchored intervention program in improving glycemic control and enhancing care experience in diabetes management. The program was coincidentally implemented during the national-level lockdown for COVID-19 in Singapore, allowing for a timely study of the use of mHealth for chronic disease management.

Methods

Patients with type 2 diabetes or prediabetes were enrolled from the Singapore Armed Forces and offered a 3-month intervention program in addition to the usual care they received. The program was standardized to include (1) in-person initial consultation with a clinical dietitian; (2) in-person review with a diabetes specialist doctor; (3) 1 continuous glucose monitoring device; (4) access to the mobile app for dietary intake and physical activity tracking, and communication via messaging with the dietitian and doctor; and (5) context-sensitive digital health coaching over the mobile app. Medical support was rendered to the patients on an as-needed basis when they required advice on adjustment of medications. Measurements of weight, height, and glycated hemoglobin A_1c (HbA_1c) were conducted at 2 in-person visits at the start and end of the program. At the end of the program, patients were asked to complete a short acceptability feedback survey to understand the motivation for joining the program, their satisfaction, and suggestions for improvement.

Results

Over a 4-week recruitment period, 130 individuals were screened, the enrollment target of 30 patients was met, and 21 patients completed the program and were included in the final analyses; 9 patients were lost to follow-up (full data were not available for the final analyses). There were no differences in the baseline characteristics between patients who were included and excluded from the final analyses (age category: P=.23; gender: P=.21; ethnicity: P>.99; diabetes status category: P=.52, medication adjustment category: P=.65; HbA_1c category: P=.69; BMI: P>.99). The 21 patients who completed the study rated a mean of 9.0 out of 10 on the Likert scale for both satisfaction questions. For the Yes-No question on benefit of the program, all of the patients selected “Yes.” Mean HbA_1c decreased from 7.6% to 7.0% (P=.004). There were no severe hypoglycemia events (glucose level <3.0 mmol/L) reported. Mean weight decreased from 76.8 kg to 73.9 kg (P<.001), a mean decrease of 3.5% from baseline weight. Mean BMI decreased from 27.8 kg/m² to 26.7 kg/m² (P<.001).

Conclusions

The personalized mHealth program was feasible, acceptable, and produced significant reductions in HbA_1c (P=.004) and body weight (P<.001) in individuals with type 2 diabetes. Such mHealth programs could overcome challenges posed to chronic disease management by COVID-19, including disruptions to in-person health care access.

Interventions to Support Mental Health among Those with Health Conditions That Present Risk for Severe Infection from Coronavirus Disease 2019 (COVID-19): A Scoping Review of English and Chinese-Language Literature

This study aimed to address knowledge gaps related to the prevention and management of mental health responses among those with a condition that presents risk of severe COVID-19 infection. A scoping review that mapped English and Chinese-language studies (2019-2020) located in MEDLINE (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, Sociological Abstracts, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Data, and Airiti Library was undertaken. Search terms related to COVID-19, mental health, and physical health were used and articles that included all three of these factors were extracted (n = 77). With the exception of one hospital-based pilot study, there were no intervention studies targeting mental health in those at risk of severe COVID-19 infection. Promising practices such as integrated care models that appropriately screen for mental health issues, address health determinants, and include use of digital resources were highlighted. Patient navigator programs, group online medical visits, peer support, and social prescribing may also support those with complex needs. Future policies need to address digital health access inequities and the implementation of multi-integrated health and social care. Furthermore, research is needed to comprehensively assess multi-integrated interventions that are resilient to public health crises.

Impact of Covid-19 on the Visit of Pediatric Patients with Injuries to the Emergency Department in Korea

The total number of pediatric emergency department (PED) visitors has decreased worldwide since the coronavirus disease (COVID-19) outbreak. We hypothesized that this might also affect the number of PED visits due to injuries. Therefore, we investigated these changes in PED visits after the COVID-19 outbreak through a long-term multicenter observational study. We assessed the changes in the proportion of injured pediatric patients’ weekly visits and the trend in the rate changes since the COVID-19 epidemic began by segmented regression analysis. We also evaluated the weekly change in the distribution of detailed diagnostic codes among pediatric patients with injuries before and after the COVID-19 pandemic. The proportion of injury-related PED visits increased when COVID-19 was first confirmed in Korea. After the COVID-19 epidemic, the proportion of foreign body ingestions and fracture patients among all pediatric patients with injuries increased significantly every week. The changes in the proportion of injured pediatric patients after the COVID-19 outbreak may have been the result of social distancing to prevent the spread of the virus. The risk of pediatric infections decreased but the risk of injury remained. Therefore, parents should take precautions to prevent infectious diseases and be careful to prevent children’s injuries at home.

About anxiety levels and anti-anxiety drugs among quarantined undergraduate Jordanian students during COVID-19 pandemic

OBJECTIVE

This study was conducted to study the anxiety scores among undergraduate university students in Jordan during COVID-19 pandemic and to assess the relationship between quarantine and shifting to distance learning resulted from the governmental strict isolation measures and severity of anxiety among students.

METHODS

A cross-sectional design was conducted to meet the study objectives. A convenience sample of 736 undergraduate university students in Jordan was recruited, and anxiety was assessed using the Hamilton Anxiety Scale.

RESULTS

The results indicated that anxiety score was 22.76 and 40.6% of the participant experienced moderate to severe anxiety, whereas 23.5% experienced mild to moderate anxiety and 35.9% experienced mild anxiety. Factors like suffering from chronic illnesses, having chronic medications, grade point average, shifting to distance learning, quarantine during the pandemic, study duties, the newly developed evaluation methods and the experience of students towards the use of anti-anxiety drugs and herbs had significantly increased the anxiety scores.

CONCLUSION

Our findings indicate that quarantine and shifting to distance learning during COVID-19 pandemic have negatively affected the anxiety scores of the university students which should be taken in consideration by the policymakers in Jordan in order to support this vulnerable group.

SARS-CoV-2 transmission during rugby league matches: do players become infected after participating with SARS-CoV-2 positive players?

OBJECTIVES

To examine the interactions between SARS-CoV-2 positive players and other players during rugby league matches and determine within-match SARS-CoV-2 transmission risk.

METHODS

Four Super League matches in which SARS-CoV-2 positive players were subsequently found to have participated were analysed. Players were identified as increased-risk contacts, and player interactions and proximities were analysed by video footage and global positioning system (GPS) data. The primary outcome was new positive cases of SARS-CoV-2 within 14 days of the match in increased-risk contacts and other players participating in the matches.

RESULTS

Out of 136 total players, there were 8 SARS-CoV-2 positive players, 28 players identified as increased-risk contacts and 100 other players in the matches. Increased-risk contacts and other players were involved in 11.4±9.0 (maximum 32) and 4.0±5.2 (maximum 23) tackles, respectively. From GPS data, increased-risk contacts and other players were within 2 m of SARS-CoV-2 positive players on 10.4±18.0 (maximum 88) and 12.5±20.7 (maximum 121) occasions, totalling 65.7±137.7 (maximum 689) and 89.5±169.4 (maximum 1003) s, respectively. Within 14 days of the match, one increased-risk contact and five players returned positive SARS-CoV-2 reverse transcriptase PCR (RT-PCR) tests, and 27 increased-risk contacts and 95 other participants returned negative SARS-CoV-2 RT-PCR tests. Positive cases were most likely traced to social interactions, car sharing and wider community transmission and not linked to in-match transmission.

CONCLUSION

Despite tackle involvements and close proximity interactions with SARS-CoV-2 positive players, in-match SARS-CoV-2 transmission was not confirmed. While larger datasets are needed, these findings suggest rugby presents a lower risk of viral transmission than previously predicted.

Dietary practices of adult Egyptians before and during the COVID-19 lockdown

Aim

The aim of this study was to describe dietary practices of adult Egyptians, estimate changes in their body mass index (BMI), and identify possible determinants of such changes before and during the COVID-19 lockdown.

Subject and methods

A cross-sectional web-based survey was conducted during the nationwide COVID-19 partial lockdown. Data were obtained from 430 Egyptian adults regarding their personal and socio-demographic characteristics, routine daily physical activities, dietary patterns, practices related to food purchase and food handling, and weight and BMI before and during the lockdown using an online web-based questionnaire.

Results

The number of daily meals and daily snacks significantly increased during the lockdown. Moreover, the consumption of all types of snacks increased, except for chocolate and sweets, whose consumption decreased. Eating of fast food decreased, whereas the number of individuals practicing indoor physical activities increased during the lockdown. During the lockdown, no significant changes in the mean BMI were observed. The mean weekly consumption of starch, meat, milk, fat, and free foods decreased, whereas the mean weekly consumption of fruits and vegetables increased. Food handling practices improved during the lockdown. Based on the results of the linear regression analysis, age, the number of daily meals, practicing of physical activities during lockdown, and mean weekly consumption of meat were the independent predictors of BMI during the lockdown.

Conclusion

During the lockdown, no significant changes in the BMI of adult Egyptians were observed, whereas dietary practices and food handling practices changed.

Atrial fibrillation burden during the coronavirus disease 2019 pandemic

Aims

The aim of this study is to determine the association between the coronavirus disease 2019 (COVID-19) pandemic and atrial fibrillation (AF) occurrence in individuals with cardiac implantable electronic devices (CIEDs).

Method and results

Multi-centre, observational, cohort study over a 100-day period during the COVID-19 pandemic (COVID-19) in the USA. Remote monitoring was used to assess AF episodes in patients with a CIED (pacemaker or defibrillator; 20 centres, 13 states). For comparison, the identical 100-day period in 2019 was used (Control). The primary outcomes were the AF burden during the COVID-19 pandemic, and the association of the pandemic with AF occurrence, as compared with 1 year prior. The secondary outcome was the association of AF occurrence with per-state COVID-19 prevalence. During COVID-19, 10 346 CIEDs with an atrial lead were monitored. There were 16 570 AF episodes of ≥6 min transmitted (16 events per 1000 patient days) with a significant increase in proportion of patients with AF episodes in high COVID-19 prevalence states compared with low prevalence states [odds ratio 1.34, 95% confidence interval (CI) 1.21–1.48, P < 0.001]. There were significantly more AF episodes during COVID-19 compared with Control [incident rate ratio (IRR) 1.33, 95% CI 1.25–1.40, P < 0.001]. This relationship persisted for AF episodes ≥1 h (IRR 1.65, 95% CI 1.53–1.79, P < 0.001) and ≥6 h (IRR 1.54, 95% CI 1.38–1.73, P < 0.001).

Conclusion

During the first 100 days of COVID-19, a 33% increase in AF episodes occurred with a 34% increase in the proportion of patients with AF episodes observed in states with higher COVID-19 prevalence. These findings suggest a possible association between pandemic-associated social disruptions and AF in patients with CIEDs.

Clinical TRIAL registration

Australian New Zealand Clinical Trial Registry: ACTRN12620000692932.

Health Perceptions and Adopted Lifestyle Behaviors During the COVID-19 Pandemic: Cross-National Survey

BACKGROUND

Social isolation measures are requisites to control viral spread during the COVID-19 pandemic. However, if these measures are implemented for a long period of time, they can result in adverse modification of people's health perceptions and lifestyle behaviors.

OBJECTIVE

The aim of this cross-national survey was to address the lack of adequate real-time data on the public response to changes in lifestyle behavior during the crisis of the COVID-19 pandemic.

METHODS

A cross-national web-based survey was administered using Google Forms during the month of April 2020. The settings were China, Japan, Italy, and India. There were two primary outcomes: (1) response to the health scale, defined as perceived health status, a combined score of health-related survey items; and (2) adoption of healthy lifestyle choices, defined as the engagement of the respondent in any two of three healthy lifestyle choices (healthy eating habits, engagement in physical activity or exercise, and reduced substance use). Statistical associations were assessed with linear and logistic regression analyses.

RESULTS

We received 3371 responses; 1342 were from India (39.8%), 983 from China (29.2%), 669 from Italy (19.8%), and 377 (11.2%) from Japan. A differential countrywise response was observed toward perceived health status; the highest scores were obtained for Indian respondents (9.43, SD 2.43), and the lowest were obtained for Japanese respondents (6.81, SD 3.44). Similarly, countrywise differences in the magnitude of the influence of perceptions on health status were observed; perception of interpersonal relationships was most pronounced in the comparatively old Italian and Japanese respondents (β=.68 and .60, respectively), and the fear response was most pronounced in Chinese respondents (β=.71). Overall, 78.4% of the respondents adopted at least two healthy lifestyle choices amid the COVID-19 pandemic. Unlike health status, the influence of perception of interpersonal relationships on the adoption of lifestyle choices was not unanimous, and it was absent in the Italian respondents (odds ratio 1.93, 95% CI 0.65-5.79). The influence of perceived health status was a significant predictor of lifestyle change across all the countries, most prominently by approximately 6-fold in China and Italy.

CONCLUSIONS

The overall consistent positive influence of increased interpersonal relationships on health perceptions and adopted lifestyle behaviors during the pandemic is the key real-time finding of the survey. Favorable behavioral changes should be bolstered through regular virtual interpersonal interactions, particularly in countries with an overall middle-aged or older population. Further, controlling the fear response of the public through counseling could also help improve health perceptions and lifestyle behavior. However, the observed human behavior needs to be viewed within the purview of cultural disparities, self-perceptions, demographic variances, and the influence of countrywise phase variations of the pandemic. The observations derived from a short lockdown period are preliminary, and real insight could only be obtained from a longer follow-up.

The Janus-faced effects of COVID-19 perceptions on family healthy eating behavior: Parent's negative experience as a mediator and gender as a moderator

This research examines the effects of COVID‐19 perceptions and negative experiences during the pandemic time on parental healthy eating behavior and whether these relationships interact with a parent’s gender. We ran a survey of parents who had at least one child aged 3 to 17 years old living in the United Kingdom. We received 384 valid responses, which were analysed via a variance‐based structural equation modeling approach to test our hypotheses. The results revealed that COVID‐19 perceptions effects were Janus‐faced. While they indirectly and negatively impact healthy eating behavior mediated by triggering negative experiences during the pandemic, COVID‐19 perceptions, however, directly get parents, especially fathers, more engaged into healthy eating behavior – making COVID‐19 perceptions total effects positive on healthy eating behavior. This explorative model is novel in the sense that it is the first of its kind to cast light on how parental healthy eating behavior can be shaped in pandemic time. The research is particularly timely due to the uncertain times in which the research is situated, that is, the worldwide pandemic (also termed COVID‐19); the paper highlights how family eating practices can undergo dramatic shifts during acute crises.

Worse Cardiac Arrest Outcomes During The COVID-19 Pandemic In Boston Can Be Attributed To Patient Reluctance To Seek Care

Delays in seeking emergency care stemming from patient reluctance may explain the rise in cases of out-of-hospital cardiac arrest and associated poor health outcomes during the COVID-19 pandemic. In this study we used emergency medical services (EMS) call data from the Boston, Massachusetts, area to describe the association between patients' reluctance to call EMS for cardiac-related care and both excess out-of-hospital cardiac arrest incidence and related outcomes during the pandemic. During the initial COVID-19 wave, cardiac-related EMS calls decreased (-27.2 percent), calls with hospital transportation refusal increased (+32.5 percent), and out-of-hospital cardiac arrest incidence increased (+35.5 percent) compared with historical baselines. After the initial wave, although cardiac-related calls remained lower (-17.2 percent), out-of-hospital cardiac arrest incidence remained elevated (+24.8 percent) despite fewer COVID-19 infections and relaxed public health advisories. Throughout Boston's fourteen neighborhoods, out-of-hospital cardiac arrest incidence was significantly associated with decreased cardiac-related calls, but not with COVID-19 infection rates. These findings suggest that patients were reluctant to obtain emergency care. Efforts are needed to ensure that patients seek timely care both during and after the pandemic to reduce potentially avoidable excess cardiovascular disease deaths.