COVID-19 Confinement and Health Risk Behaviors in Spain

Surviving the COVID-19 pandemic: An examination of adaptive coping strategies

The mental health consequences of the COVID-19 pandemic have been significant in Australia. The aim of this study was to investigate coping strategies that individuals have adopted to assist them through this stressful period. Survey data collected in September and December 2020 as part of a larger study (the COLLATE project) were analysed. The number of adaptive coping strategies endorsed by respondents had a significant negative relationship with depression and a significant positive relationship with resilience. Females tended to use more of these strategies than men, as did people who said their mental health had improved rather than deteriorated because of the COVID-19 restrictions imposed by government. Specific adaptive coping strategies differed for those with and without a mental illness. People with a mental illness were more likely to seek professional and online help, while people without a mental illness were more likely to use self-help. Focusing on what one is grateful for and keeping oneself productively occupied ("using the time to do things around the house") were the most beneficial coping strategies in terms of alleviating depression, anxiety and stress. Public health messaging promoting adaptive coping strategies may be useful in bolstering the mental health of individuals during lockdown periods. In particular, the promotion of coping flexibility should be recommended rather than the frequent use of the same coping strategies.

Impact of COVID-19 on physical activity: A rapid review

Background

Physical activity is a commonly prescribed medicine for people with conditions such as obesity and diabetes who are also at increased risk of being hospitalized or severely ill from COVID-19. However, many people are reporting challenges in engaging in a healthy dose of physical activity amid the pandemic.

Objective

This rapid review synthesizes the current empirical evidence about the impacts of COVID-19 on people’s outdoor physical activity and sedentary behavior while highlighting the role of community environments in promoting or hindering physical activity during the pandemic.

Methods

Literature searches were conducted using keywords related to COVID-19: physical activity, mobility, and lifestyle behaviors. Eligibility criteria were peer-reviewed empirical and quantitative studies published in English, addressing COVID-19 and using physical activity and/or sedentary behavior as the study outcomes.

Results

Out of 61 eligible studies, the majority (78.3%) were conducted in Asian and European countries, with only four (6.7%) being US studies. The results showed that COVID-19 was linked with significant decreases in mobility, walking, and physical activity, and increases in sedentary activity. A few studies also reported contradicting results including increased uses of parks/trails and increased recreational activity among certain groups of population.

Conclusions

Evidence suggests an overall negative impact of COVID-19 on physical activity, with differential effects across different sub-populations. Significant knowledge gaps are also found in the roles of social and physical attributes that can promote physical activity during pandemics with reduced safety risks.

Psychological impact of the quarantine during the COVID-19 pandemic on the general European adult population: a systematic review of the evidence

AIMS

Due to the coronavirus disease 2019 (COVID-19) different countries implemented quarantine measures to limit the spread of the virus. Many studies analysed the mental health consequences of restrictive confinement, some of which focused their attention on specific populations. The general public's mental health also requires significant attention, however. This study aimed to evaluate the effects of the COVID-19 quarantine on the general population's mental health in different European countries. Risk and protective factors associated with the psychological symptoms were analysed.

METHODS

A systematic search was conducted on four electronic databases (PubMed, PsycINFO, Scopus and Google Scholar). Studies published up until 20th April 2021, and following eligibility criteria were selected for this review. One thousand three hundred thirty-five (1335) studies were screened, 105 of which were included. Via network analysis, the current study investigated the pathways that underlie possible risk factors for mental health outcomes.

RESULTS

Anxiety, depression, distress and post-traumatic symptoms are frequently experienced during the COVID-19 quarantine and are often associated with changes in sleeping and eating habits. Some socio-demographic and COVID-19-related variables were found to be risk factors for an individual's wellbeing. In particular, being female, young, having a low income, being unemployed and having COVID-19-like symptoms or chronic disorders, were found to be the most common risk factors for mental health symptoms.

CONCLUSIONS

The COVID-19 pandemic represented an unprecedented threat to mental health globally. In order to prevent psychological morbidity and offer support tailored to short-, medium- and long-term negative outcomes, it is essential to identify the direct and indirect psychosocial effects of the lockdown and quarantine measures, especially in certain vulnerable groups. In addition to measures to reduce the curve of viral transmission, policy makers should urgently take into consideration provisions to alleviate hazards to mental health.

Assessment of Insomnia Symptoms, Quality of Life, Daytime Sleepiness, and Psychoactive Substance Use among Polish Students: A Cross-Sectional Online Survey for Years 2016–2021 before and during COVID-19 Pandemic

Sleep disorders are a serious health problem worldwide, and insomnia is their most common manifestation. An increasing number of people have insomnia every year, young adults, especially. Due to the importance that sleep has in almost every aspect of our lives, the need to monitor disturbances in circadian rhythms has arisen. Therefore, this study aimed to assess the prevalence of sleep disorders among Polish students, including their quality of life (QOL) and drug use patterns. The study also investigated associations between sleep, QoL, and drug use. The study was conducted in 2016–2021 based on the self-made sociodemographic questionnaire, as well as standardized psychometric tools: Athens Insomnia Scale (AIS), Epworth Sleepiness Scale (ESS), and Manchester Short Assessment of quality of life (MANSA). A total of 14,844 students participated in the study. The majority were women (80.7%), of which 3425 (23.1%) were medical students, with the most numerous representing medical and dental faculties, 1884 (57.2%). Before the COVID-19 pandemic, 52.1% of the surveys were collected; 54.1% of respondents had insomnia as indicated by the AIS scores, and 26.1% displayed sleepiness during the day. Female students, the first-year college students, more often suffered from sleep disorders. Drug use was widespread among Polish students, correlating with sleep assessment results and QoL. In conclusion, sleep disorders are a significant clinical problem among Polish students. Female and junior students’ years are more prone to sleep deprivation. Insufficient sleep can be associated with a lower QoL score and psychoactive substance use. The effects of the COVID-19 pandemic on sleep are not conclusive, because there was decreasing quality for longer sleep durations. In order to analyze these associations, there is a need for further in-depth study.

Changes in Perceived Stress and Lifestyle Behaviors in Response to the COVID-19 Pandemic in The Netherlands: An Online Longitudinal Survey Study

The COVID-19 pandemic has substantial implications for physical and mental wellbeing. This study investigated changes, over time, in lifestyle behaviors and perceived stress during the initial phase of the pandemic and associations with COVID-19 symptoms, in the Dutch general population. An online longitudinal survey study was performed with pre-lockdown measurements in February, and subsequently in April and June 2020 (n = 259, mean age 59 ± 14 years, 59% women). Self-report questionnaires were used to assess weight, diet quality, physical activity, alcohol intake, and smoking. Perceived stress was measured using the validated perceived stress scale (PSS-10). The presence of COVID-19 symptoms (yes/no) was defined as fever, or >3 of the following symptoms: weakness/tiredness, muscle ache, dry cough, loss of smell/taste, and breathing difficulties. Data were analyzed using linear mixed models, adjusted for age, sex, educational level, marital status and (change in) employment status. Minimal increases over time were observed in alcohol intake (0.6 ± 0.7 to 0.7 ± 1.1 glasses/day, p = 0.001) and smoking (9.5 ± 8.7 to 10.9 ± 9.4 cigarettes/day among 10% smokers, p = 0.03), but other lifestyle behaviors remained stable. In April 2020, 15% reported COVID-19-related symptoms, and in June 2020, this was 10%. The presence of COVID-19 symptoms was associated with increased perceived stress (pinteraction = 0.003) and increased alcohol consumption (pinteraction = 0.03) over time. In conclusion, in this prospective study, COVID-19 symptoms were associated with increases in perceived stress and alcohol consumption. Future research on biopsychosocial determinants and underlying mechanisms of lifestyle changes, as a response to the COVID-19 pandemic, is needed.

The Association Between Men's Mental Health During COVID-19 and Deterioration in Economic Status

This study investigated associations among economic status deterioration, mental health, and gender during the COVID-19 pandemic. A total of 1,807 participants completed an online questionnaire that included demographic variables and questions measuring three mental health variables: psychological distress (as measured by symptoms of depression, anxiety, and stress), adjustment disorder, and emotional eating. Results indicated that women reported higher mental health impairment than men. Men and women whose economic status significantly deteriorated because of the COVID-19 pandemic reported greater mental health impairment than those whose economic status did not significantly deteriorate. However, men whose economic status significantly deteriorated reported high mental health impairment (emotional eating and adjustment difficulties) similar to women in the same situation. This change in men's reporting pattern suggests that the economic impact of COVID-19 severely impacted their mental health and affected how they view their masculinity, which, in turn, further impaired their mental health. As the COVID-19 outbreak has had a significant impact on mental health worldwide, it is important to identify individuals and groups who are at high risk of mental health impairment. The current study demonstrates that men's distress, which is frequently complex to identify, can be detected using standardized measures and analyzing these according to changes in reporting patterns as opposed to simply examining means and frequencies. The results suggest that the COVID-19 crisis may provide an opportunity to understand more about mental health, in particular, that of men.

Health risk behaviors before and during COVID-19 and gender differences

Changes in routines and habits, fear of contamination from the coronavirus disease 2019 (COVID-19) virus, and economic crisis have resulted in significant impacts upon individuals' lives, health, and risk behaviors. The present study aims to analyze health risk behaviors and gender differences of Portuguese adults before and during the COVID-19 pandemic. A quantitative analysis using SPSS v. 26 software presents the evaluation of 5746 responses (M = 48.5 years, SD = 14.3), of which 67.7% were female. t Test was used to study differences in means before and during the pandemic and analysis of variance test to analyze gender differences. In the comparative study before and during the pandemic showed a decrease in the number of meals per day, physical activity and perception of sleep quality; an increase in tobacco use, beer consumption, and media use (TV, mobile phone, social networks, and online games). Gender differences study demonstrated that the number of meals per day suffered a decrease from pre to pandemic in women, while increasing in men, becoming prominent in the second moment under study. Both genders had an increase in consumption behaviors and substance use, but women revealed a decrease in the consumption of wine during the pandemic, while men revealed more consumption behaviors in the variables under study. The use of media also changed, with men showing a higher level in TV hours per day, social networks and online games before the pandemic and in TV hours per day and games/online during the pandemic. Women stand out in the use of mobile phone per day during the pandemic. Daily physical activity decreased during the pandemic, as did sleep quality. Males revealed a higher practice of physical activity at both periods, as well as sleep quality. Based on the results presented, it is expected that considerations and actions in the scope of public health policies and health prevention and promotion, will be rethought and adapted to the specificities of each gender.

Employment, Economic, and Sociodemographic Factors Associated with Changes in Smoking and Drinking Behaviors during the COVID-19 Pandemic in South Korea

The societal disruptions resulting from the coronavirus disease 2019 (COVID-19) pandemic may have caused changes in smoking and alcohol consumption. Using data from the Koreans’ Happiness Survey, a nationally representative survey in South Korea, we (1) described population-level smoking and drinking behaviors; (2) assessed changes in smoking and drinking behaviors during the COVID-19 pandemic; and (3) identified employment, economic, and sociodemographic factors associated with these changes using multinomial logistic regression. The overall amount of smoking and drinking decreased during the pandemic, but the changes were heterogeneous across subgroups. Male gender, receipt of the basic living allowance, self-employment, unemployment, and chronic disease status were associated with increased smoking, while higher household income, temporary worker status, living with someone (versus alone), and having fewer offline friends were associated with decreased smoking. Male gender, self-employment, living alone, having more offline friends, and chronic disease status were associated with increased drinking, while younger age, male gender, low and high household income (i.e., a U-shaped relationship), long-term rent with a deposit, temporary worker status, and chronic disease status were associated with decreased drinking. Our findings provide evidence on changes in smoking and drinking during the COVID-19 pandemic in South Korea and differential changes across subgroups.

Changes in alcohol use during the COVID ‐19 pandemic in Europe: A meta‐analysis of observational studies

Issues

Numerous studies have examined the impact of the COVID‐19 pandemic on alcohol use changes in Europe, with concerns raised regarding increased use and related harms.

Approach

We synthesised observational studies published between 1 January 2020 and 31 September 2021 on self‐reported changes in alcohol use associated with COVID‐19. Electronic databases were searched for studies evaluating individual data from European general and clinical populations. We identified 646 reports, of which 56 general population studies were suitable for random‐effects meta‐analyses of proportional differences in alcohol use changes. Variations by time, sub‐region and study quality were assessed in subsequent meta‐regressions. Additional 16 reports identified were summarised narratively.

Key Findings

Compiling reports measuring changes in overall alcohol use, slightly more individuals indicated a decrease than an increase in their alcohol use during the pandemic [3.8%, 95% confidence interval (CI) 0.00–7.6%]. Decreases were also reported more often than increases in drinking frequency (8.0%, 95% CI 2.7–13.2%), quantity consumed (12.2%, 95% CI 8.3–16.2%) and heavy episodic drinking (17.7%, 95% CI 13.6–21.8%). Among people with pre‐existing high drinking levels/alcohol use disorder, high‐level drinking patterns appear to have solidified or intensified.

Implications

Pandemic‐related changes in alcohol use may be associated with pre‐pandemic drinking levels. Increases among high‐risk alcohol users are concerning, suggesting a need for ongoing monitoring and support from relevant health‐care services.

Conclusion

Our findings suggest that more people reduced their alcohol use in Europe than increased it since the onset of the pandemic. However high‐quality studies examining specific change mechanisms at the population level are lacking.

A Comparative Cross-Sectional Study of the Consequences of the COVID-19 Lockdown on Women's Health Behaviors in Spain

Changes in health habits were observed during the COVID-19 pandemic. An unequal distribution of responsibilities may have generated unequal levels of stress in men and women, and, therefore, this may have led to different impacts on their health habits during lockdown. This study aimed to analyze the changes in eating habits, physical activity, sleep, and body weight in women, compared to men, because of lockdown. A comparative cross-sectional study was carried out. 2834 Spanish volunteers aged 19 to 76 completed an online survey on health habits. Descriptive and inferential analyses were performed using a cross-sectional methodology to explore gender differences. Results showed that men maintained their health habits to a greater extent, performing the same physical activity, while maintaining the quantity and quality of sleep, the quality of the diet, the quantity of the intake, and their mealtimes and body weight, whereas women's eating habits changed in relation to the quality of their diet and mealtimes, as their food intake and weight increased, and their sleep was poorer in quality and duration than it was before lockdown. This could be due to the higher levels of anxiety experienced by women as a result of working on essential jobs in addition to taking on more unpaid work associated with care and housework.

The differences of Slovenian and Italian daily practices experienced in the first wave of covid-19 pandemic

BACKGROUND

The COVID-19 pandemic situation with the lockdown of public life caused serious changes in people's everyday practices. The study evaluates the differences between Slovenia and Italy in health-related everyday practices induced by the restrictive measures during first wave of the COVID-19 pandemic.

METHODS

The cross-sectional cohort study examined changes through an online survey conducted in nine European countries from April 15-28, 2020. The survey included questions from a simple activity inventory questionnaire (SIMPAQ), the European Health Interview Survey, and some other questions. To compare difference in changes between European countries we examined Italy with severe and its neighbour country Slovenia with low incidence and victims of COVID-19 epidemic. 956 valid responses from Italy (N = 511; 50% males) and Slovenia (N = 445; 26% males) were investigated.

RESULTS

During the survey, there was a 4.7-fold higher incidence and 12.1-fold more deaths (per 100,000) in Italy than in Slovenia. Barring periods and measures were similar, the latter more stringent in Italy. We found more changes in Italy than in Slovenia: physical inactivity increased (Italy: + 65% vs. Slovenia: + 21%; p < 0.001), walking time decreased (Italy: -68% vs. Slovenia: -4.4%; p < 0.001); physical work increased by 38% in Slovenia (p < 0.001), and recreation time decreased by 37% in Italy (p < 0.001). Italians reported a decrease in quality of general health, fitness level, psychological well-being, quality of life and care for own health (p < 0.001); Slovenians showed a decline in psychological well-being and quality of life (p < 0.001) but generally had a higher concern for their own health (p = 0.005). In pooled participants, changes in eating habits (meal size and consumption of unhealthy food), age and physical inactivity were positively correlated with increases in body mass, while changes in general well-being and concern for health were negatively correlated.

CONCLUSION

The study shows that the negative impact of COVID -19 measures is greater in Italy where the pandemic COVID -19 was more prevalent than in Slovenia with low prevalence. Additional consideration should be given to the negative impact of COVID-19 measures on some health-related lifestyle variables when implementing further measures to mitigate the COVID-19 pandemic.

Changes in Physical Activity Patterns Due to the Covid-19 Pandemic: A Systematic Review and Meta-Analysis

With the outbreak of the Corona Virus Disease 19 (Covid-19) in late 2019, governments increasingly imposed containment strategies, including social distancing as well as restricted population movement, potentially having negative impacts on mental and physical health. A growing number of studies have examined the impact of the pandemic on different facets of physical activity (PA); an overview combining these (mixed) results, however, is missing. Thus, the objective of this systematic review and meta-analysis was to investigate whether and to which extent PA changed from before to during the Covid-19 pandemic, taking age, gender, and measurement method into account. The literature search was conducted using PubMed, Web of Science, and Scopus. Results of the main characteristics were descriptively synthesized and analyzed in a meta-analysis quantifying effects of the pandemic on PA divided by age groups, with additional subgroup analyses of the characteristics age, gender, and measurement method being narratively synthesized. Overall, 57 studies with a total sample size of 119,094 participants (N between 10 and 60,560 subjects) from 14 countries worldwide with participants aged between four and 93 years were included. Thirty-two studies revealed a significant decline in PA, whereas only five studies found a significant increase in PA during the Covid-19 pandemic. Fourteen studies revealed mixed results. PA decreased in all age groups, independent of gender. Most self-reported and all device-based measurement methods showed a reduction in PA. However, effects were not found to be significant in all age groups. Nevertheless, the declining trend should be noted and governments should strive to enable PA within periods of pandemic restrictions, or promote alternatives such as digital training to avoid negative health consequences within the population.

The social and occupational consequences of the COVID-19 pandemic among patients with multiple sclerosis in three distinct populations: A web-based cross-sectional survey

Background

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes the disease COVID-19, has caused a pandemic that has rapidly affected the whole world and caused a significant threat to public health. The aim of this study was to investigate and analyze the social and occupational effects of the COVID-19 pandemic on patients with multiple sclerosis (MS) in three different countries: China, Spain, and Cuba.

Methods

A cross-sectional survey was designed to assess the social and occupational effects of the COVID-19 pandemic in MS patients in these three countries, using a 25-item anonymous online questionnaire, structured into three sections. Quantitative data are expressed as mean (standard deviation), and quantitative data as absolute frequency and percentage.

Results

A total of 361 participants responded to the questionnaire: 194 from China, 104 from Spain, and 63 from Cuba. We found no cases of COVID-19 among Chinese patients with MS, and few cases in Spain and Cuba. Respondents reported different levels of impact on relationships with friends, family, and colleagues, and patients in all three countries described increased use of digital or social media platforms. Spanish patients reported a significantly less negative impact than those in Cuba and China. Mental and cognitive effects were similar in all three countries, although China seemed to have a better situation. We also found that the time spent exercising decreased at specific points during the pandemic, but with few changes in dietary habits. Patients reported little or no change in their means of transport in all three countries. Most patients in all three countries reported little or no physical deterioration, especially in Chinese patients (82.47%), compared to the Spanish (70.20%) and Cuban respondents (73.02%). In general, patients from all three countries demonstrated confidence in overcoming the COVID-19 pandemic, although to a lesser extent among Spanish respondents.

Conclusions

During the pandemic, family support was more effective in China than in Cuba and Spain. Neither COVID-19 infections nor the number of MS relapses increased significantly during lockdown in any of the three countries. Regarding their economic situation, Spanish MS patients reported a significantly less severe negative impact than those in Cuba and China. Patients from all three countries used digital or social media platforms more frequently, probably to maintain personal relationships. Chinese and Cuban respondents were more confident of the control of the pandemic than the Spanish, who were more pessimistic.

Lifestyle changes during the first and second waves of the COVID-19 pandemic in medical college students: are there gender-related differences?

BACKGROUND AND AIMS

The COVID-19 pandemic has seriously affected young people. The present study aims to explore the effects of COVID-19 on lifestyle in 500 undergraduate students both during the acute phase of the pandemic (so-called "first wave") and during the second spread of infections (so-called "second wave"). Gender differences were also explored.  Methods and results. During the first wave we found weight gain in 48.6% of subjects, a switch to an unhealthy diet (43%), and an increase in the amount of food introduced (35%). Interestingly, women showed higher intake of food in order to cope, while men privileged higher wine consumption as a coping mechanism. We observed a sharp reduction in physical activity, increased sedentary behaviours and deterioration in sleep quality. Stress correlates with eating to cope (r=0.86; p<0.001); drinking to cope (r=0.83; p<0.001). Contrary to expectations, the second wave led to a situation similar to the first. We have detected a further deterioration in quality of sleep (67% vs 77%; p<0.01) and also a reduction in sleeping time (68.6% vs 77.7; p<0.01).

CONCLUSIONS

The long pandemic has led to unhealthy lifestyle changes in the student population of our municipality in Northern Italy. There are gender differences in lifestyle modifications developed during the pandemic that suggest a different response to stress. Moreover, the persistence of pandemic-related stress due to the "second wave" has severely affected the lifestyle habits of undergraduate student.

90-day mortality and clinical outcomes of patients with solid tumours and COVID-19 infection during the first pandemic outbreak in Catalonia, Spain: a multicentre retrospective study

To describe the clinical outcomes and risk factors for 90-day mortality in patients with solid tumours (ST) and COVID-19 during the first outbreak in Catalonia. This is a multicentre retrospective study including adults with ST and COVID-19 confirmed by RT-PCR between March 13 and April 30, 2020. Clinical and survival data were collected. Follow-up ended on July 30, 2020. Multivariate and survival analysis were performed. A hundred and fifteen patients were included. 42.6% had advanced disease and were receiving anticancer treatment. 7% were admitted to the ICU and 22.6% died during hospitalization. 30-day mortality was 27.8%, which increased to 33.9% at 90 days. 90-day mortality was associated with current smoker status (HR: 2.91, 95% CI: 1.03-8.33, p=0.044), baseline ECOG-PS 2-3 (HR: 3.88, 95% CI: 1.77-8.46, p<0.001]), dyspnoea (HR: 3.02, 95%CI: 1.31-6.96, p= 0.009), a respiratory rate ≥24 (HR: 2.24, 95% CI: 1.02-4.92, p=0.046), and sepsis (HR: 3.97, 95% CI: 1.78-8.88, p<0.001). Of the 76 survivors, 73.6% had a follow-up visit. Of those, 33.9% had their cancer controlled and 23.2% had progressed. 35 survivors were receiving anticancer treatment before COVID-19 diagnosis though 14 had to discontinue treatment. 8 survivors without previous anticancer therapy started therapy. The median time to start anticancer therapy after COVID-19 was 45 days (IQR: 28-61). In conclusion, 90-day mortality in patients with ST and COVID-19 was 33.9%; current smoker status, poor ECOG-PS, dyspnoea, respiratory rate ≥24 and sepsis were independent risk factors for mortality; and survivors did not restart their anticancer treatment until 1.5 months after COVID-19 diagnosis. This article is protected by copyright. All rights reserved.

Influence of socioeconomic variables on physical activity and screen time of children and adolescents during the COVID‑19 lockdown in Germany: the MoMo study

The COVID‑19 (coronavirus disease 2019) pandemic created a multitude of natural experiments about the change of human behavior in a widely unfamiliar situation. Besides physical and mental health, physical activity (PA) and people’s movement behaviors were of particular interest to researchers all over the world. In a recent study, we found that among youth in Germany, sports activity declined, whereas recreational screen time and habitual activity increased during the first COVID‑19 lockdown. In the present study, we analyze the influence of the socioeconomic status and the housing situation on the changes in PA behavior and recreational screen-time before and during the first COVID‑19 lockdown among children and adolescents living in Germany. We found an alignment of PA behavior among youth from families with different socioeconomic backgrounds during the first lockdown and identified the housing situation to be a meaningful predictor of the increase in habitual activity. We conclude that restriction policies, communities, and in the last instance parents need to enable access to nonorganized PA to all children and adolescents every day and especially during potential future lockdowns.

Alcohol and other substance use during the COVID-19 pandemic: A systematic review

BACKGROUND

Although evidence suggests substance and alcohol use may change during the Covid-19 pandemic there has been no full review of the evidence around this.

METHODS

A systematic review of all available evidence was carried out to document and interpret the frequency and severity of alcohol and other substance use during the Covid-19 pandemic and their relationship to demographic and mental health variables that may suggest further clinical implications. Peer reviewed articles in MEDLINE, Embase, PsycINFO, CINAHL complete and Sociological Abstracts were searched from December 2019 until November 2020.

RESULTS

The search and screening identified 45 articles from 513 deduplicated records. The evidence suggests a mixed picture for alcohol use. Overall, there was a trend towards increased alcohol consumption. The proportion of people consuming alcohol during the pandemic ranged from 21.7% to 72.9% in general population samples. Unlike alcohol use, there was a clear trend towards increased use of other substances use during the COVID-19 pandemic. The proportion of people consuming other substances during the pandemic ranged from 3.6% to 17.5% in the general population. Mental health factors were the most common correlates or triggers for increased use of both alcohol and other substances.

CONCLUSION

There is an increased need for treatment for alcohol and other substance use related problems during the pandemic. Increased targeting and evidence-based interventions will also be important in the period which follows this pandemic, to improve the quality of life for individuals and families, but also to prevent additional costs to society and health systems.

Remotely Supervised Exercise during the COVID-19 Pandemic versus in-Person-Supervised Exercise in Achieving Long-Term Adherence to a Healthy Lifestyle

The World Health Organization's global action plan on workers' health establishes that occupational health services should carry out lifestyle interventions within the workplace, to prevent the development of non-communicable diseases. The objective of the study was to compare adherence to a healthy lifestyle six months after completion of a multi-component intervention with remotely supervised physical activity during the COVID-19 pandemic versus a multi-component intervention with in-person supervised physical exercise before the COVID-19 pandemic in university employees with unhealthy habits and predisposed to change. A prospective cohort study following the "Strengthening the Reporting of Observational studies in Epidemiology" (STROBE) guidelines was conducted, with two arms. Each multi-component intervention lasted for 18 weeks, and consisted of education on healthy habits, Mediterranean Diet (MedDiet)-based workshops, and a physical exercise program. Twenty-one middle-aged sedentary university employees with poor adherence to the MedDiet completed the study. Six months after completion of the intervention, both groups increased physical activity levels, adherence to the MedDiet, eating habits, health-promoting lifestyle, health responsibility, and health-related quality of life. There were no differences between groups in any of the variables analyzed. Therefore, remotely supervised physical exercise could be adequate to achieve long-term adherence to a healthy lifestyle in the same way as conventional face-to-face intervention, at least in a population willing to change.

Influence of a Virtual Exercise Program throughout Pregnancy during the COVID-19 Pandemic on Perineal Tears and Episiotomy Rates: A Randomized Clinical Trial

The complications associated with COVID-19 confinement (impossibility of grouping, reduced mobility, distance between people, etc.) influence the lifestyle of pregnant women with important associated complications regarding pregnancy outcomes. Therefore, perineal traumas are the most common obstetric complications during childbirth. The aim of the present study was to examine the influence of a supervised virtual exercise program throughout pregnancy on perineal injury and episiotomy rates during childbirth. A randomized clinical trial design (NCT04563065) was used. Data were collected from 98 pregnant women without obstetric contraindications who attended their prenatal medical consultations. Women were randomly assigned to the intervention (IG, N = 48) or the control group (CG, N = 50). A virtual and supervised exercise program was conducted from 8-10 to 38-39 weeks of pregnancy. Significant differences were found between the study groups in the percentage of episiotomies, showing a lower episiotomy rate in the IG (N = 9/12%) compared to the CG (N = 18/38%) (χ² (3) = 4.665; p = 0.031) and tears (IG, N = 25/52% vs. CG, N = 36/73%) (χ² (3) = 4.559; p = 0.033). A virtual program of supervised exercise throughout pregnancy during the current COVID-19 pandemic may help reduce rates of episiotomy and perineal tears during delivery in healthy pregnant women.

Risk Perception, Perception of Collective Efficacy and Sleep Quality in Chinese Adults during COVID-19 Pandemic in Hong Kong: A Cross-Sectional Study

Background: Only a few studies have studied the link between risk perception and sleep in the context of the COVID-19 pandemic. The purpose of our study is to propose and test a theoretical model to understand the relationships between COVID-19 risk appraisals—risk perception and perception of collective coordinated defense (PCCD) in particular—and subjective sleep quality in Chinese adults in Hong Kong during the COVID-19 pandemic. COVID-19-related fear and rumination were examined as potential mediators of the relationships. Methods: Data were collected using a self-report online questionnaire from a convenience sample of 224 Chinese adults during the fourth wave of the COVID-19 pandemic in Hong Kong. Results: Risk perception and PCCD were found to predict poor sleep quality. Mediation analysis showed that both fear and rumination mediated the relationship between risk perception and sleep quality, whereas only fear mediated the relationship between PCCD and sleep quality. The model was an excellent fit to the data and accounted for 44% of the variance in sleep quality in Chinese adults. This study indicated that both perception of high risks of contracting COVID-19 and anticipations of collective disease preventive efforts had adverse effects on subjective sleep quality via increasing COVID-19-related fear. Conclusions: These findings underscore the need for addressing sleep problems induced by psychological consequences of the pandemic. While policy makers often deliver public messaging campaigns that frame disease prevention as a collective goal, developing evidence-based coping strategies to combat COVID-19 adverse impacts on psychological health is equally important.

The early impact of COVID-19 on the incidence, prevalence, and severity of alcohol use and other drugs: A systematic review

BACKGROUND

The aim of this paper was to examine the early impact of COVID-19 on substance use to assess implications for planning substance use treatment and support systems.

METHOD

A systematic review of literature published up to March 2021 was conducted to summarize changes in prevalence, incidence, and severity of substance use associated with COVID-19 and the accompanying public health measures, including lockdown, stay-at-home orders, and social distancing.

RESULTS

We identified 53 papers describing changes to substance use at the population level. The majority of papers described changes related to alcohol use and most relied on self-reported measures of consumption during the COVID-19 pandemic, compared with pre-pandemic use. There was less evidence to support changes in non-alcohol substance use. In general, risky pre-pandemic alcohol use, caregiving responsibilities, stress, depression, anxiety, and current treatment for a mental disorder were found to be associated with increased substance use.

CONCLUSION

This review provides preliminary data on changes in substance use, indicating that certain segments of the population increased their alcohol use early on in the COVID-19 pandemic and may be at greater risk of harm and in need of additional services. There is a need for additional population-level information on substance use to inform evidence-based rapid responses from a treatment system perspective.

Impact of the COVID-19 Pandemic on Sedentary Time and Behaviour in Children and Adults: A Systematic Review and Meta-Analysis

The aim of this meta-analysis was to quantify the change in sedentary time during the COVID-19 pandemic and its effect on health outcomes in the general population. One thousand six hundred and one articles published after 2019 were retrieved from five databases, of which 64 and 40 were included in the systematic review and meta-analysis, respectively. Studies were grouped according to population: children (<18 years), adults (18–64 years) and older adults (>65 years). Average sedentary time was calculated, with sub-analyses performed by country, behaviour type and health outcomes. Children were most affected, increasing their sedentary time by 159.5 ± 142.6 min day⁻¹, followed by adults (+126.9 ± 42.2 min day⁻¹) and older adults (+46.9 ± 22.0 min day⁻¹). There were no sex differences in any age group. Screen time was the only consistently measured behaviour and accounted for 46.8% and 57.2% of total sedentary time in children and adults, respectively. Increases in sedentary time were negatively correlated with global mental health, depression, anxiety and quality of life, irrespective of age. Whilst lockdown negatively affected all age groups, children were more negatively affected than adults or older adults, highlighting this population as a key intervention target. As lockdowns ease worldwide, strategies should be employed to reduce time spent sedentary. Trial registration: PROSPERO (CRD42020208909).

Behavioural Difficulties in Children and Adolescents with Mental Disorders under Extreme Situations

In 2020, the Governments of many countries maintained different levels of confinement of the population due to the pandemic that produced the COVID-19. There are few studies published on the psychological impact in the child and adolescent population diagnosed with mental disorders, especially during the home confinement stage. Explanatory models based on socio-demographic and clinical variables provide an approximation to level changes in different dimensions of behavioural difficulties. A categorical-response logistic ordinal regression model, based on a cross-sectional study with 139 children and adolescents diagnosed with mental disorders is performed for each dimension under analysis. Most of the socio-demographic and clinical explanatory variables considered (24 of 26) were significant at population level for at least one of the four dimensions of behavioural difficulties (15 response variables) under analysis. Odds-ratios were interpreted to identify risk or protective factors increasing or decreasing severity in the response variable. This analysis provides useful information, making it possible to more readily anticipate critical situations due to extreme events, such as a confinement, in this population.

Smoking Behaviors, Mental Health, and Risk Perceptions during the Beginning of the COVID-19 Pandemic among Mexican Adult Smokers

Mexico is one of the countries most affected by COVID-19. Studies have found that smoking behaviors have been impacted by the pandemic as well; however, results have varied across studies, and it remains unclear what is causing the changes. This study of an open cohort of smokers recruited from a consumer panel (n = 2753) examined changes in cigarettes per day (CPD), daily vs. non-daily smoking, recent quit attempts, perceived stress, depression, and perceived severity of COVID-19 at two points during the pandemic: March and July 2020. Differences in CPD between waves were estimated with Poisson regression using generalized estimating equations (GEE). Differences in perceived stress were estimated with linear regression using GEE, and differences in recent quit attempts, depression, and perceived severity of COVID-19 were estimated using separate logistic regression GEE models. Rates of depression were higher in July compared to March (AOR = 1.55, 95% C.I. 1.31-1.85), and the likelihood of recent quit attempt was lower in July compared to March (AOR = 0.85, 95% C.I. 0.75-0.98). There was no statistically significant change in CPD, daily smoking, or perceived stress. Perceived COVID-19 severity for oneself increased significantly (AOR: 1.24, 95% C.I. 1.02-1.52); however, the perceived COVID-19 severity for smokers remained constant. Our study suggests that as the COVID-19 pandemic expanded in Mexico, smoking frequency remained stable, and quit attempts decreased, even as adult smokers increasingly perceived infection with COVID-19 for themselves as severe. These results can aid in the development of health communication strategies to educate smokers about their risk for COVID-19, potentially capitalizing on concerns that stem from this syndemic of communicable and smoking-related non-communicable disease.

Health risk behaviours among people with severe mental ill health during the COVID-19 pandemic: Analysis of linked cohort data

BACKGROUND

People with severe mental ill health (SMI) experience a mortality gap of 15-20 years. COVID-19 has amplified population health inequalities, and there is concern that people with SMI will be disproportionately affected. Understanding how health risk behaviours have changed during the pandemic is important when developing strategies to mitigate future increases in health inequalities.

METHODS

We sampled from an existing cohort of people with SMI. Researchers contacted participants by phone or post to invite them to take part in a survey about how the pandemic had affected them. We asked people about their health risk behaviours and how these had changed during the pandemic. We created an index of changed behaviours, comprising dietary factors, smoking, lack of exercise, and drinking patterns. By creating data linkages, we compared their responses during pandemic restrictions to responses they gave prior to the pandemic.

OUTCOMES

367 people provided health risk data. The mean age of the participants was 50.5 (range = 20 to 86, SD ± 15.69) with 51.0% male and 77.4% white British. 47.5% of participants reported taking less physical activity during the pandemic and of those who smoke 54.5% reported smoking more heavily. Self-reported deterioration in physical health was significantly associated with an increase in health risk behaviours (adjusted OR for physical health 1.59, 95%CI 1.22-2.07; adjusted OR for Age 0.99, 95%CI 0.98-1.00).

INTERPRETATION

COVID-19 is likely to amplify health inequalities for people with SMI. Health services should target health risk behaviours for people with SMI to mitigate the immediate and long lasting impacts of the COVID-19 pandemic.

Coronavirus Disease 2019: Psychological Stress and Cardiovascular Diseases

Minimising deaths due to coronavirus disease 2019 (COVID-19) is a global priority. However, the harmful effects are not limited to those directly related to the infection. The COVID-19 pandemic has also had a serious impact on the mental health of the general population. An increasing number of people are exhibiting signs of depression and an increase in suicides has also been noted around the world. Mental health issues may be linked to starting or increasing the use of addictive substances, such as tobacco, alcohol and drugs, along with increased overweight and obesity resulting from changes in eating habits. These issues can impact cardiovascular diseases because of worsened risk factor control. This review discusses the impact of the COVID-19 pandemic on mental health and cardiovascular risk factors. It will also summarise the measures that can be taken to maintain good mental health and their importance in mitigating cardiovascular disease.

Green or clean? Perception of clean label plant-based products by omnivorous, vegan, vegetarian and flexitarian consumers

Consumers are increasingly interested in health and sustainability aspects of their diets. Meat reduction diets have gained popularity with some consumers, leading to an increase in plant-based products in the markets. Additionally, the demand for more natural and healthier products is associated with the clean label trend. But how these two trends relate to each other, has not yet been widely investigated. The aim of the present research was to explore the perception of different consumers (vegans, vegetarians, flexitarians and omnivores), towards clean label, plant-based products in order to better understand their motivations and attitudes. Consumers in Spain, followers of these four diets, participated in a projective mapping task - categorisation of twenty plant-based products (ten clean label and ten original products) - and answered a health and sustainability attitudes survey. The results showed that according to the diet followed by the consumers, they categorised and perceived the products differently, in line with their attitudes. Meat-reducer and avoider consumers paid more attention to quality and health and presented a greater concern for animal welfare and sustainability. Also, they focused on the clean label status for product categorization, while omnivores did not separate between original and clean label products. The present study shows a first exploration of how consumers with different relation to meat (frequent consumption-reduction-avoidance) perceive clean label plant-based products, in relation to their attitudes to health and sustainability, a building block on the way to support consumers in the transition to healthier, more sustainable diets.

Alcohol use, cannabis use, and psychopathology symptoms among college students before and after COVID-19

College students have experienced significant disruptions related to COVID-19, and limited international data suggest they may be at elevated risk for mental health symptom increases related to COVID. Given their potentially elevated risk, our aim was to evaluate differences from pre-college closures to post-closure in mental health symptoms, alcohol, and cannabis use. Participants (N = 4749) were from seven U.S. public universities/colleges. They were 70.1 % female and 48.5 % white, non-Hispanic/Latino, with 48.1 % in their first college/university year. 30-day retrospective assessments of alcohol and cannabis use, and past 2-week retrospective assessments of anxiety, depression, anger, and insomnia were captured at the time of the survey. We examined differences between those providing data pre- and post-university closure via linear and negative binomial regressions. Alcohol and cannabis use days were 13 % and 24 % higher, respectively, from pre-to post-university closure; also, prevalence of any 30-day alcohol use and alcohol use consequences were both higher in the post-closure sample (odds ratios = 1.34 and 1.31, respectively). In contrast, days of binge alcohol use were 4 % lower in the post-closing sample. Depressive symptoms and anger were both modestly higher in post-closing participants (d < 0.1), with no differences in anxiety symptoms or insomnia. The modest differences in substance use and mental health from pre-closure through two months post-college closure suggest unexpected resilience in a large and diverse sample of students. College health providers will need to identify those students experiencing the greatest increases in mental health symptoms and substance use, using innovative outreach and treatment.

COVID-19 pandemic and its impact on service provision: A cardiology prospect

Coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the availability of cardiology services and management of cardiac conditions. Elective surgeries, outpatient appointments and cardiac imaging have been largely cancelled across the world due to the risk of infection transmission and the need for reallocation of resources to deal with the increasing number of COVID-19 patients. The impact on patients with cardiac co-morbidities during these times may be drastic. However, cardiologists and hospitals across the world have implemented measures to ensure on-going monitoring and care of patients remotely. In this review, we discuss the impact of COVID-19 on cardiac services including interventional cardiology services, cardiac imaging and outpatient appointments. In addition, implications for future research and clinical practice are also discussed.

How has COVID-19, lockdown and social distancing changed alcohol drinking patterns? A cross-cultural perspective between britons and spaniards

During the early months of 2020, the world experienced a novel, violent, and relentless pandemic era. By the end of the year more than seventy-seven million cases of COVID-19 had been reported around the globe. Due to it being a highly contagious disease, the recommended measures adopted by most nations to prevent infection include social distancing and quarantine. How did these measures affect people's relationship with alcohol consumption in cultures where alcohol plays an important social role? A questionnaire-based study, designed to follow the drinking behaviour of people before and during lockdown was applied to two different cultural groups impacted by the pandemic during the strict phase of lockdown. These are the British and Spanish populations (179 participants from each country were interviewed). Considering the frequency of consumption of the alcoholic beverages evaluated (wine, beer, cider, whisky and spirits), the results showed that a significant lockdown*country interaction was observed. Overall, Spanish participants consumed alcoholic beverages less frequently during lockdown than before, while British participants reported no change in their consumption habits. Spaniards’ decrease in alcohol consumption is related to the absence of a social contexts while Britons seems to have adapted their consumption to the modified context. Results suggest that, alcohol consumption is a central core of the British culture, while for the Spanish, socialization is more a cultural characteristic than the alcohol itself.

The Influence of COVID-19 Lockdown on Physical Activity, Sedentary Behavior and Social Support Specific to Physical Activity Among Belgian Adults

In Belgium, lockdown measures were taken to counter the spread of COVID-19. This major life-change event may disrupt a person's daily routine and influence health behaviors. Although measures were restrictive, citizens were encouraged to engage in physical activity (PA) behavior in order to maintain well-being. Social support specific to PA (SSPA) had been highlighted as an important psychosocial factor in initiating and/or maintaining active behavior. The main aims of this study were to explore the influence of COVID-19 lockdown on PA and sedentary behavior, and on SSPA from family and from friends; and investigate the potential differences in terms of professional status. An online survey was distributed during the 1st weeks of the lockdown. A total of 272 Belgian adults responded to the survey. The findings show no significant difference between prior to and during lockdown with regard to the amount of PA. The results show a significant increase in sedentary behavior among the entire sample, workers and retirees. The findings also suggest that the support of other individuals is particularly useful for certain population groups such as retirees. Given the importance of the levels of PA and sedentariness as health behaviors preceding a major life-change event such as a lockdown, there is a need to promote these health behaviors during normal life in order for the population to remain active throughout their lifespan.

The Association between Lifestyle Changes and Psychological Distress during COVID-19 Lockdown: The Moderating Role of COVID-Related Stressors

The COVID-19 pandemic and the accompanying circumstances (lockdown and social distancing) have been found to cause lifestyle habit changes. While negative changes (adopting risky behaviors) are known to be associated with high psychological distress, the effect of positive changes (adopting health-enhancing behaviors) has yet to be investigated. This study examined the association between the nature of changes and psychological distress, in addition to the moderating effect of “COVID-related stressors”. Online questionnaires, completed by 1969 participants, assessed the following: lifestyle changes due to COVID-19 with regard to cigarette smoking, alcohol consumption, physical activity, sleep quality, and eating habits; COVID-related stressors; Depression, Anxiety, and Stress Scale. Positive and negative changes were associated with higher psychological distress compared to no lifestyle change, and there was a moderating effect of COVID-related stressors in the association between COVID-related lifestyle changes and distress. In conclusion, to reduce psychological distress in overwhelming circumstances such as the COVID-19 pandemic, people should carefully consider whether to make changes in their lifestyle habits before doing so, even if these changes are perceived as positive and health-enhancing. Furthermore, efforts should be focused on reducing the perception of stress from COVID-19 by working on personal and mental perceptions of the situation.

Factors Related to Mental Health During the COVID-19 Lockdown in Spain

The COVID-19 disease has forced governments to adopt exceptional measures. The lockdown decreed in Spain in 2020 required citizens to stay confined at home, which might have affected their mental health. The objective is to identify factors that influenced adults' mental health during this period. A sample of 3,508 adults from the Spanish general population completed an online survey that collected sociodemographic data and information about daily planning and activities, healthy habits, loneliness, coping humor and mental health. Data were analyzed using Structural Equation Modeling. According to the results, the proposed model showed good fit values, and latent variables explained 30% of the variance in mental health. Loneliness, coping humor, healthy habits, age and gender had a significant weight in the prediction of mental health during lockdown. Area of residence, number of days of confinement and number of people in the household were not related to mental health. This study addresses the effect of COVID-19 and social distancing measures by identifying risk and protective factors for the development of mental health difficulties. There is a need to target specific and early interventions aimed at mitigating the psychological impact of the pandemic while increasing well-being, especially in more vulnerable groups.

The Persistence of Slowed Time Experience During the COVID-19 Pandemic: Two Longitudinal Studies in France

The home confinement imposed on people to fight the COVID-19 pandemic interrupted the flow of time by disrupting daily life, making them feel that time was passing slowly. The aim of this longitudinal study was to evaluate the evolution over time of this subjective experience of time and its significant predictors (boredom, decreased happiness, life rhythm, and sleep quality). Twso samples of French participants were followed up: the first for several weeks during the first lockdown (April 2020) and then 1year later (April 2021; Study 1), and the second during the first lockdown (April 2020) and then 6months (November 2020) and 1year later (April 2021; Study 2). Our study shows that the French participants have the feeling that time has passed slowly since the beginning of the first lockdown and that it has not resumed its normal course. This is explained by a persistent feeling of boredom characteristic of a depressive state that has taken hold in the population. The findings therefore suggest that the repeated contexts of confinement did not contribute to re-establishing a normal perception of time, to which a subjective acceleration of time would have testified.

Development and Preliminary Italian Validation of the Emergency Response and Psychological Adjustment Scale

Evaluating the personal adaptation response to the emergency situations is very important for the prevention of mental distress, for the activation of network and community synergies and for the planning and implementation of appropriate psycho-social interventions. So far there are no short tools for the overall assessment of cognitive, emotional and behavioral responses of psychological adaptation to the emergency in the psychometric panorama. The Emergency Response and Psychological Adjustment Scale (ERPAS) was administered to a sample of 1,088 participants, while the concurrent validity was tested through a second administration to 600 participants along with the GSE (Generalized Self-Efficacy Scale) and the BDI-II (Beck Depression Inventory-II). Confirmatory factor analysis bore out a five-factor solution (including 18 items) with good fit indices of adaptation to data, χ²/df = 1.440, RMSEA = 0.028, RMSEA 90% CI = 0.018–0.038, GFI = 0.996, AGFI = 0.959, CFI = 0.982, and NFI = 0.944. Evidence of convergent validity was provided by the significant correlations with variables such as cognitive and somatic depression, and perceived general self-efficacy. The analyses also showed a strong invariance across gender. The ERPAS tool prefigures application during the assessment in multiple emergency contexts (e.g. earthquakes, floods, pandemics, terrorist attacks, war events, major accidents, major fires). This validation study of the ERPAS has shown that this version is a reliable and valid measurement for assessing people's modes of personal response (cognitive, emotional, behavioral) in emergency contexts.

The 2008 Financial Crisis and Changes in Lifestyle-Related Behaviors in Italy, Greece, Spain, and Portugal: A Systematic Review

Italy, Greece, Spain, and Portugal have all been strongly affected by the 2008 financial crisis, which has had a negative impact on health. We systematically evaluated the effects of the crisis on lifestyle and socioeconomic inequalities. We conducted a literature search using MEDLINE, Embase, the Cochrane Library, and health economics databases for studies reporting quantitative comparisons before and after (or during) the crisis on the following risk behaviors: alcohol consumption, smoking habit, healthy diet, physical activity, and psychotropic drugs and substance abuse, without setting any age restrictions. We selected 34 original articles published between 2011 and 2020. During/after the crisis, alcohol consumption and substance abuse decreased, while psychotropic drug use increased. We also observed a deterioration in healthy eating behavior, with a reduction in fruit and vegetable consumption. Smoking habit and physical activity showed a more complex, controversial trend. Socioeconomic inequalities were affected by the recession, and the negative effects on unhealthy lifestyle tended to be more pronounced among the disadvantaged. These results suggest the need to implement health policies and interventions aimed at monitoring risk behaviors, with special regard to disadvantaged people, and considering the potential additional impact of the COVID-19 pandemic.

Estimating changes in physical behaviour during lockdowns using accelerometry-based simulations in a large UK cohort

To contain the recent COVID-19 outbreak restrictions have been imposed, which has limited outdoor activity. These physical behaviour changes can have serious health implications, but there is little objective information quantifying these changes. This study aimed to estimate the change in physical behaviour levels during full lockdown conditions using objective data collected from a thigh-worn activity monitor. Data used was from 6,492 individuals in the 1970 British Cohort Study, collected between 2016 and 2018. Using walking bout characteristics, days were classified as either "indoor only" (n=861), "indoor and exercise" (n=167) and "outdoor active" (n=31,934). When compared to "outdoor active" days, "indoor only" days had 6,590 fewer steps per day (2,320 vs 8,876, p < 0.001), a longer sedentary time (1.5 hours, p < 0.001), longer lying time (1.4 hours, p < 0.001) and shorter standing (1.9 hours, p < 0.001) and stepping (1.3 hours, p < 0.001) times. The "indoor and exercise" days had a smaller number of steps compared to "outdoor active" (7,932 vs 8,876, p < 0.05). There is a strong relationship between reduced daily stepping, and increased sedentary time, with a range of poor health outcomes. This has important implications for public health policy and messaging during pandemics.

Current and Future Implications of COVID-19 among Youth Wheelchair Users: 24-Hour Activity Behavior

Preventative measures taken worldwide to decrease the transmission of COVID-19 have had a tremendous impact on youth. Following social restrictions, youth with and without physical disabilities are engaging in less physical activity, more increased sedentary behavior, and poor sleep habits. Specifically, youth wheelchair users (YWU) are likely disproportionately affected by COVID- 19 and have a higher risk of contraction due to underlying comorbidities. While we cannot control all of the negative long-term implications of COVID-19 for YWU, participation in positive 24-h activity behaviors can decrease chronic disease risk and the likelihood of long-term complications resulting from infection. This commentary is to extend the discourse on the importance of 24-h activity behaviors by focusing on YWU. Specifically, we discuss the importance of chronic disease prevention, provide a brief overview of 24-h activity behaviors, and outline some of the lessons that can be learned from the COVID-19 pandemic.

Active Coping and Anxiety Symptoms during the COVID-19 Pandemic in Spanish Adults

The features of the COVID-19 pandemic and the social operations to contain the spread of the virus might have limited or altered coping, including healthy habits such as exercise, this contributing to a myriad of negative consequences for the mental health of the global population. We explored the contribution of coping and physical activity to the management of anxiety in Spanish adults during an active phase of the epidemic, as well as the relationship between these strategies. A total of 200 young and adult individuals (70% women) voluntarily completed an anxiety inventory, a coping skills self-report and a personal data section including exercise practice. The participants reported in average a mild yet existing level of anxiety symptoms; a third reported noticeable symptoms. At the time of the study, the participants used more adaptive than maladaptive coping styles. Participants' anxiety was inversely correlated with an active coping style, and positively with an avoidant style; physical activity correlated positively with an active coping style, and regular exercisers used more frequently active coping. Controlling for confounders, active coping, avoidant coping and exercise during the pandemic predicted anxiety symptoms. Other findings indicated that exercise was used as a coping strategy for dealing with emotional distress. Our results highlight the positive impact of functional coping and exercise for the management of negative states such as anxiety during the pandemic, and underline the importance of developing interventions aimed at enhancing coping skills for promoting physical and mental well-being of the population during health and social crises.

The Effect of Pre-Quarantine Physical Activity on Anxiety and Depressive Symptoms during the COVID-19 Lockdown in the Kingdom of Saudi Arabia

The outbreak of COVID-19 and the changes to normal societal function and in particular quarantine has increased mental distress in many nations. A survey of 22,112 COVID-19-negative quarantined participants in the Kingdom of Saudi Arabia (age: 18–40 years, 42.6%; 40–60 years, 53.3%; over 60 years, 4.1%; mass, 78.9 ± 14.8 kg; stature, 167 ± 8.7 cm) were assessed for depressive symptoms using the online Beck Depression Inventory self-report questionnaire. The relationship between pre-quarantine physical activity and mental health and wellbeing during lockdown has been investigated. A significant difference in body mass index (BMI) between active and inactive participants (p = 0.03) was observed; with females also recording a 3% higher BMI than males. All participants showed a decrease in mental health compared to pre-quarantine. However, pre-quarantine inactivity was found to result in a greater negative impact on mental health and well-being than those active pre-quarantine (p < 0.01). The sedentary population had a 4-fold greater incidence of mild-depression than the active population. This suggests that activity level plays an important role in shielding people from anxiety and stress, whilst it builds mental strength in individuals that can be called upon in trying and difficult situations. Nevertheless, pre-quarantine activity levels did not lead to any significant change in levels of extreme depression in the sample population.

Body Mass Index, Practice of Physical Activity and Lifestyle of Students During COVID-19 Lockdown

Purpose

Several factors influence the student’s physical activity and lifestyle. The coronavirus disease (COVID‐19) lockdown has restricted student’s activity and altered their routine lifestyle. This prospective cohort study aimed to determine the significant changes in body mass index (BMI), physical activity, and lifestyle of the students including diet, sleep, and mental health before and during COVID-19 lockdown.

Methods

The study participants were 628 students studying bachelor’s degree programs, between 18 and 30 years of age, both genders from the university of Al-Ahsa, Saudi Arabia. The lockdown began on 23 March and ended on 21 June 2020 in Saudi Arabia. The students were interviewed before (March 2020) and during (June 2020) lockdown. The structured tool included baseline information of the students, anthropometric data, global physical activity questionnaire (GPAQ), dietary recall, Pittsburgh sleep quality index (PSQI), and perceived stress scale (PSP). Chi-square tests were used to associate the baseline information with BMI changes during the lockdown.

Results

BMI of the students showed that 32% increased their weight, 22% lost their weight and 46% maintained the same weight during COVID-19 lockdown. The physical activity significantly decreased and sedentary time increased (p = 0.0001). Regarding the lifestyle components, fast and fried food consumption decreased, and calorie intake increased significantly (p = 0.001). Stress level (p = 0.001) significantly decreased, and sleep level (p = 0.001) increased during lockdown. The variables associated with weight changes were the level of students (p < 0.05) and time spent on social media per day (p < 0.0001).

Conclusion

Though half of the students maintained the same BMI during the lockdown, students who increased BMI were associated with physical activity and lifestyle. Hence, health awareness on weight maintenance, active physical activities, and a healthy lifestyle must be created among the students, which help in creating and implementing policies in the future.

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Adherence to a Lifestyle Exercise and Nutrition Intervention in University Employees during the COVID-19 Pandemic: A Randomized Controlled Trial

Healthy lifestyles should be encouraged in the workplace through the occupational health teams of the companies. The objective of the present study was to evaluate the adherence to a lifestyle intervention carried out in university employees during the COVID-19 pandemic and its impact on health-related quality of life (HrQoL). A randomized controlled trial following the CONSORT guidelines was performed, consisting of three supervised interventions lasting for 18 weeks: an educational intervention on healthy habits, a nutritional intervention, and a telematic aerobic and strength exercise intervention. Lifestyle and HrQoL were analyzed six months post-intervention to assess adherence. Twenty-three middle-aged participants completed the study. The intervention group significantly improved their lifestyle according to the Health Promoting Lifestyle Profile II questionnaire, especially in the categories of Health Responsibility, Physical Activity, and Nutrition, with a large effect size. Sitting time was reduced by 2.5 h per day, with a moderate effect size. Regarding HrQoL, the intervention group showed a clinically significant improvement in the Physical Component Summary. Despite the lockdown and the mobility restrictions caused by the COVID-19 pandemic, this intervention performed on university employees achieved adherence to a healthier lifestyle and improved their HrQoL, which is of great clinical relevance.

Auswirkungen des Lockdowns im Frühjahr 2020 während der COVID-19-Pandemie auf das Ess- und Sportverhalten – Ergebnisse einer Onlinebefragung

Einleitung Die Ausgangseinschränkungen und Kontaktverbote während der COVID-19-Pandemie haben mit dem Wegfall vieler beruflicher und privater Verpflichtungen und Strukturen massive Auswirkungen auf den Alltag der Allgemeinbevölkerung. Gleichzeitig verstärken sich für viele Menschen die Sorgen vor allem bezüglich ihrer finanziellen und beruflichen Zukunft. Eine vermehrte Nahrungsaufnahme stellt in dieser Situation eine mögliche Bewältigungsstrategie im Umgang mit den als unangenehm erlebten Gefühlen dar. Gleichzeitig fallen wegen der Ausgangs- und Kontaktbeschränkungen viele Möglichkeiten zur sportlichen Betätigung weg. Dies birgt die Gefahr einer Zunahme der kardiovaskulären Risikofaktoren in der Allgemeinbevölkerung und insbesondere für die Entstehung von Adipositas sowie Diabetes mellitus Typ 2. In dieser Studie untersuchten wir daher die Veränderungen des Ess- und Sportverhaltens in der Allgemeinbevölkerung in Deutschland während des Lockdowns im Frühjahr 2020.

Material und Methodik An der Onlinebefragung zu Veränderungen des Ess- und Sportverhaltens während des Lockdowns im Frühjahr 2020 konnten Frauen und Männer zwischen 18 und 80 Jahren aus der Allgemeinbevölkerung teilnehmen. Die Umfrage war online verfügbar zwischen dem 8. April und dem 11. Mai 2020.

Ergebnisse Von 3259 Teilnehmern gaben 40,3 % an, während des Lockdowns mehr als vor dessen Beginn gegessen zu haben, 38,3 % berichteten, während des Lockdowns weniger Sport gemacht zu haben als in der Zeit davor. Bei einer kombinierten Betrachtung der Verhaltensänderungen zeigten 58,5 % der Teilnehmer mindestens eine Verhaltensänderung, die dauerhaft potenziell negative gesundheitliche Folgen für sie haben könnte und die Entwicklung eines Diabetes mellitus Typ 2 fördert. Mit 18,5 % aller Studienteilnehmer gab die größte Gruppe an, weniger Sport gemacht und gleichzeitig mehr gegessen zu haben während des Lockdowns.

Schlussfolgerungen Diese Ergebnisse weisen darauf hin, dass es sowohl in der ambulanten als auch in der stationären Patientenversorgung in den nächsten Monaten wichtig sein wird, die Patienten auf die Gesundheitsrisiken, die sich durch eine Reduktion von sportlicher Aktivität und eine vermehrte Nahrungsaufnahme ergeben, hinzuweisen und ihr Ess- und Sportverhalten sowie die Veränderung des Körpergewichts zu beobachten, um eine Zunahme des Risikos für Diabetes mellitus Typ 2 in der Allgemeinbevölkerung zu verhindern.

Lifestyle Habits among Pregnant Women in Denmark during the First COVID-19 Lockdown Compared with a Historical Period-A Hospital-Based Cross-Sectional Study

The first national lockdown in Denmark due to the COVID-19 pandemic was declared on 11 March 2020. From this date, national restrictions were imposed. We aimed to assess the potential influence of this first nationwide lockdown on exercise, alcohol consumption, and smoking in early pregnancy. Using a cross-sectional study based on routinely collected patient-reported data, we compared the lifestyle habits of women who were pregnant during the first phase of the pandemic (COVID-19 group) (n = 685) with those of women who were pregnant the year before (Historical group) (n = 787). We found a reduction in any exercise (PR = 0.91, 95% CI (0.84 to 0.99), in adherence to national recommendations of exercise (PR = 0.89, 95% CI (0.80 to 0.99), in cycling (15% vs. 28%, p < 0.0001), and swimming (0.3% vs. 3%, p = 0.0002) in the COVID-19 group compared with the Historical group. The prevalence of binge drinking was reduced in the COVID-19 group compared with the Historical group (PR = 0.80, 95% CI (0.68 to 0.93). In contrast, the prevalence of any weekly alcohol consumption and smoking cessation during pregnancy was similar between groups. Our findings indicate that national restrictions due to the COVID-19 pandemic influenced the lifestyle habits of pregnant women and should be addressed in antenatal counseling.

Changes in Health Behaviors, Mental and Physical Health among Older Adults under Severe Lockdown Restrictions during the COVID-19 Pandemic in Spain

We used data from 3041 participants in four cohorts of community-dwelling individuals aged ≥65 years in Spain collected through a pre-pandemic face-to-face interview and a telephone interview conducted between weeks 7 to 15 after the beginning of the COVID-19 lockdown. On average, the confinement was not associated with a deterioration in lifestyle risk factors (smoking, alcohol intake, diet, or weight), except for a decreased physical activity and increased sedentary time, which reversed with the end of confinement. However, chronic pain worsened, and moderate declines in mental health, that did not seem to reverse after restrictions were lifted, were observed. Males, older adults with greater social isolation or greater feelings of loneliness, those with poorer housing conditions, as well as those with a higher prevalence of chronic morbidities were at increased risk of developing unhealthier lifestyles or mental health declines with confinement. On the other hand, previously having a greater adherence to the Mediterranean diet and doing more physical activity protected older adults from developing unhealthier lifestyles with confinement. If another lockdown were imposed during this or future pandemics, public health programs should specially address the needs of older individuals with male sex, greater social isolation, sub-optimal housing conditions, and chronic morbidities because of their greater vulnerability to the enacted movement restrictions.

Effects of the COVID-19 pandemic and lockdown on alcohol use disorders and complications

PURPOSE OF REVIEW

To understand the effect of COVID-19 pandemic and lockdown on persons with alcohol use disorders.

RECENT FINDINGS

From a total of 455 titles on COVID-19 and alcohol, 227 abstracts were screened, and 95 articles were reviewed (on November 25th, 2020). The immediate effect was an increase in alcohol related emergencies including alcohol withdrawal, related suicides, and methanol toxicity. Although there are mixed findings with respect to changes in the quantity of drinking, there are reports of binge/heavy drinking during the lockdown as well as relapse postlockdown. Psychological, social, biological, economic and policy-related factors appear to influence the changes in drinking. Although preliminary data suggest no change in alcohol use among persons with comorbid mental illness, findings in this population are presently limited. Among patients with alcohol related liver disease, outcomes appear worse and caution is warranted with the use of medications. Alcohol also appears to increases the risk of COVID-19 infection and complicates its course.Although some nations banned alcohol sales completely during lockdown, others declared it as an essential commodity, resulting in different problems across countries. Alcohol use has added to the burden of the problem particularly among vulnerable groups like the adolescents, elderly, patients with cancer, as well as health professionals. Services for patients with alcohol use disorders have been affected.

SUMMARY

The COVID-19 pandemic has had considerable impact on alcohol use, with an increase in alcohol related emergencies, changes in alcohol use patterns, increased risk of contracting COVID-19, effect on alcohol policies and sales, and an effect on vulnerable groups. It is essential to understand and respond to the current situation, intervene early, and prevent further repercussions of the pandemic.Video abstract link: https://drive.google.com/file/d/1IJWtIs6e554PryKWhdma4VB--mjSZq1C/view?usp=sharing.

Detecting Emotional Evolution on Twitter during the COVID-19 Pandemic Using Text Analysis

Early in 2020, an unexpected and hazardous situation occurred threatening and challenging all of humankind. A new coronavirus called SARS-CoV-2 was first identified in Wuhan, China, and its related disease, called COVID-19, has induced one of the most dangerous crises at a global level since World War II. The ultra-fast transmission rate of the virus and the high mortality rate led the World Health Organization (WHO) to officially declare the situation a pandemic. Governments, for their part, were forced to implement unprecedented mobility restrictions and cease a large part of their economic activities. These facts triggered multiple reactions from people who expressed their feelings mainly through social networks (like Twitter), using them as vectors of information and opinion. In this paper, a study carried out in different Spanish speaking countries (Chile, Mexico, Peru, and Spain) is presented, which addresses the manner in which the evolution of the pandemic outbreak has affected the emotions expressed by individuals on Twitter over the last 13 months (from March 2020 to March 2021). We used a total of 3 million tweets to achieve this task. We made use of a well-known framework called EmoWeb to capture the dynamic variation in the sentimental value of pandemic-related words. The results reflect to what degree the pandemic and its derived problems have influenced and affected the population of the selected countries in different ways. The outcomes also illustrate the evolution over time of opinions published on Twitter regarding several topics related to COVID-19.

Coping strategies adapted by Ghanaians during the COVID-19 crisis and lockdown: A population-based study

BACKGROUND

The COVID-19 pandemic and control measures adopted by countries globally can lead to stress and anxiety. Investigating the coping strategies to this unprecedented crisis is essential to guide mental health intervention and public health policy. This study examined how people are coping with the COVID-19 crisis in Ghana and identify factors influencing it.

METHODS

This study was part of a multinational online cross-sectional survey on Personal and Family Coping with COVID-19 in the Global South. The study population included adults, ≥18 years and residents in Ghana. Respondents were recruited through different platforms, including social media and phone calls. The questionnaire was composed of different psychometrically validated instruments with coping as the outcome variable measured on the ordinal scale with 3 levels, namely, Not well or worse, Neutral, and Well or better. An ordinal logistic regression model using proportional odds assumption was then applied.

RESULTS

A total of 811 responses were included in the analysis with 45.2% describing their coping level as well/better, 42.4% as neither worse nor better and 12.4% as worse/not well. Many respondents (46.9%) were between 25-34 years, 50.1% were males while 79.2% lived in urban Ghana. Having pre-existing conditions increased the chances of not coping well (aOR = 1.86, 95%CI: 1.15-3.01). Not being concerned about supporting the family financially (aOR = 1.67, 95%CI: 1.06-2.68) or having the feeling that life is better during the pandemic (aOR = 2.37, 95%CI: 1.26-4.62) increased chances of coping well. Praying (aOR: 0.62, 95%CI: 0.43-0.90) or sleeping (aOR: 0.55, 95%CI: 0.34-0.89) more during the pandemic than before reduces coping.

CONCLUSION

In Ghana, during the COVID-19 pandemic, financial security and optimism about the disease increase one's chances of coping well while having pre-existing medical conditions, praying and sleeping more during the pandemic than before reduces one's chances of coping well. These findings should be considered in planning mental health and public health intervention/policy.

Psychological Effects of Home Confinement and Social Distancing Derived from COVID-19 in the General Population-A Systematic Review

(1) Background: Home confinement and social distancing are two of the main public health measures to curb the spread of SARS-Cov-2, which can have harmful consequences on people’s mental health. This systematic review aims to identify the best available scientific evidence on the impact that home confinement and social distancing, derived from the SARS-CoV-2 pandemic, have had on the mental health of the general population in terms of depression, stress and anxiety. (2) Methods: A systematic search was conducted on PubMed, Scopus, Web of Science and ScienceDirect between 2 January 2021 and 7 January 2021, in accordance with the recommendations of the PRISMA Declaration. The selection of studies and the evaluation of their methodological quality were performed in pairs, independently and blindly, based on predetermined eligibility criteria. (3) Results: The 26 investigations reviewed were developed in different regions and countries. Factors that are associated with poor mental health were female gender, young ages, having no income and suffering from a previous psychiatric illness. Inadequate management of the pandemic by authorities and a lack or excess of information also contributed to worse mental health. (4) Conclusions: There are groups of people more likely to suffer higher levels of anxiety, depression and stress during the restrictive measures derived from COVID-19.