Changes in Diet, Sleep, and Physical Activity Are Associated With Differences in Negative Mood During COVID-19 Lockdown

Mental Health and Obesity During the COVID-19 Pandemic

PURPOSE OF REVIEW

The COVID-19 pandemic is associated with increased levels of stress, anxiety and depression in the population. These are associated with unhealthy eating patterns and sedentary behaviour. In turn, this may increase risk of obesity or aggravate it. This narrative review discusses the link between adverse mental health states and weight related behaviours. We present emerging evidence for this phenomenon during the COVID-19 pandemic in individuals with and without pre-existing obesity.

RECENT FINDINGS

A sizeable proportion of the population exhibits deterioration in mental health during the pandemic and those affected often report unhealthy weight-related behaviours such as "junk food" consumption and physical inactivity. Women, individuals with obesity, and those with pre-existing mental health conditions seem to be particularly at risk for overeating in response to stress (i.e. emotional eating). A number of psychological interventions including cognitive behavioural therapy and self-compassion may be effective in improving mental health and emotional eating patterns among the general population and particularly in individuals living with obesity. There is a need to complement efforts to improve mental health in the general population during the COVID-19 pandemic with targeted action to improve physical activity levels and healthy eating particularly among groups at-risk. This may be achieved by reducing disruptions to specialist and primary healthcare services and facilitating access to psychological interventions that address stress-related eating behaviours. Additional studies that examine such interventions, especially those that are delivered remotely, are urgently needed.

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.

Association between the Physical Activity Behavioral Profile and Sedentary Time with Subjective Well-Being and Mental Health in Chilean University Students during the COVID-19 Pandemic

OBJECTIVE

To analyze the association between the behavioral profile of physical activity and sedentary time with subjective well-being and mental health in university students during the COVID-19 pandemic in Chile.

METHODS

Cross-sectional study in a voluntary sample of 469 university students (22.4 ± 0.19 years; 66% women). According to students' self-reports of physical activity and sedentary time, four behavioral profiles were created to investigate their association with subjective well-being and mental health using one-factor ANOVA that was adjusted to a multifactorial model.

RESULTS

The physically inactive and sedentary behavior profile presents the lowest levels of subjective well-being (p < 0.001), positive affective experiences (p < 0.001) and general mental health (p = 0.001). When adjusting for confounding variables, it was observed that the physically active and non-sedentary profile was associated with better general mental health (p < 0.01) in contrast to those who are physically active and sedentary.

CONCLUSIONS

Chilean university students with a physically inactive and sedentary profile during the pandemic presented worse well-being and mental health, with a sedentary lifestyle being one of the variables that most affects the mental health of these students. Therefore, measures should be implemented to encourage this population to maintain adequate levels of physical activity and reduce sedentary times.

Why Physical Activity Should Be Considered in Clinical Trials for COVID-19 Vaccines: A Focus on Risk Groups

Since the World Health Organization declared the global COVID-19 state of emergency in early 2020, several vaccine candidates have emerged to control SARS-CoV-2, and some of them have been approved and implemented in vaccination campaigns worldwide. Although clinical trials for these vaccines have been carried out using highly controlled methods with accurate immunological tests, clinical questionnaires did not include questions concerning the physical activity profile among volunteers. It has been well established that physical activity plays a pivotal role in the immune response after vaccination, led by the activation of cytokines, antibodies, and cells. This concept should have been considered when evaluating the efficacy of COVID-19 vaccine candidates, particularly in elderly and obese people. Here, we discuss data from the literature providing strong evidence regarding the importance of analyzing physical activity parameters to improve the accuracy of clinical trials on assessing the efficacy of vaccine candidates.

Changes in alcohol use during COVID-19 and associations with contextual and individual difference variables: A systematic review and meta-analysis

OBJECTIVE

The present study meta-analyzed studies examining changes in alcohol consumption during the coronavirus disease (COVID-19) pandemic and systematically reviewed contextual and individual difference factors related to these changes.

METHOD

Following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) protocol, studies were gathered via PsycINFO, PubMed/MEDLINE, and preprint databases (published April 29, 2021) that examined individual-level changes in consumption during the initial COVID-19 mitigation measures (before October 2020). Next, sample proportion increases and decreases in consumption, in addition to mean change in consumption variables from pre- to during-COVID, were meta-analyzed, and contextual and individual difference variables related to consumption changes during the pandemic were summarized.

RESULTS

One hundred and twenty-eight studies provided data from 58 countries (M n = 3,876; Mdn n = 1,092; aggregate sample n = 492,235). The average mean change in alcohol consumption was nonsignificant (Cohen's d = -0.01, p = .68); however, meta-analysis revealed that 23% of participants reported increases in consumption and 23% reported decreases. These changes were moderated by per capita gross domestic product and country. Narrative synthesis revealed multiple predictors of increased drinking, including contextual changes (e.g., children at home, income loss, working remotely), individual difference variables (being female, a young-to-middle aged adult, or Black), and mental health/alcohol-related risk factors (e.g., depression).

CONCLUSIONS

The identified factors associated with increased alcohol consumption should be considered in planning behavioral health services during future crisis events that abruptly alter everyday environments in ways that increase stress and decrease access to naturally occurring rewards. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Mental Health and Wellbeing in Young People in the UK during Lockdown (COVID-19)

This study aimed to assess the levels of mental wellbeing and potential for clinical need in a sample of UK university students aged 18-25 during the COVID-19 pandemic. We also tested the dose-response relationship between the severity of lockdown restrictions and mental wellbeing. We carried out a prospective shortitudinal study (one month between baseline and follow up) during the pandemic to do this and included 389 young people. We measured a range of facets of mental wellbeing, including depression, depressogenic cognition (rumination), wellbeing, stress and sleep disturbance. Our primary outcome was 'probable depression' as indexed by a score of ≥10 on the patient health questionnaire (PHQ-8). The prevalence of probable depression was significantly higher than pre-pandemic levels (55%) and did not decrease significantly over time (52%). Higher levels of lockdown severity were prospectively associated with higher levels of depressive symptoms. Nearly all students had at least one mental wellbeing concern at either time point (97%). The evidence suggests that lockdown has caused a wellbeing crisis in young people. The associated long-term mental, social, educational, personal and societal costs are as yet unknown but should be tracked using further longitudinal studies.

Staying Physically Active Is Associated with Better Mental Health and Sleep Health Outcomes during the Initial Period of COVID-19 Induced Nation-Wide Lockdown in Jordan

Jordan, a Middle Eastern country, initially responded to an outbreak of COVID-19 cases within its own borders by imposing a 7-week strict lockdown and closure of international and domestic travel. Such measures drastically influenced lifestyle behaviors of the population. This study aimed to investigate the prevalence of physical activity, and its association with mental and sleep health outcomes among Jordanians during a period of COVID-19 induced lockdown. Validated questionnaires were administered using a web-based platform to evaluate moderate-to-vigorous physical activity (MVPA), anxiety and depressive symptoms, sleep health, and sociodemographic characteristics. A modified Poisson regression model with robust error variance was used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). Compared to participants who met the guidelines, those who did not had significantly higher prevalence of moderate or severe anxiety symptoms than that of minimal or mild anxiety symptoms and increased depressive symptoms. Insufficient MVPA was associated with higher prevalence of poor sleep quality, short sleep duration (<7 h) and sleep problems. Overall, sufficient MVPA was associated with better mental and sleep health during the COVID-19 induced nation-wide lockdown in Jordan. While further research is necessary, promoting physical activity during the lockdown could potentially improve mental and sleep health outcomes among the population.

The Impact of COVID-19 on Sleep Quality in People Living With Disabilities

Background: Research exploring the impact of the COVID-19 pandemic on sleep in people with disabilities has been scarce. This study provides a preliminary assessment of sleep in people with disabilities, across two timepoints during the pandemic, with a focus on those with visual impairment (VI).

Methods: Two online surveys were conducted between April 2020 and March 2021 to explore sleep quality using the Pittsburgh Sleep Quality Index (PSQI). A convenience sample of 602 participants completed the first survey and 160 completed the follow-up survey.

Results: Across both timepoints, participants with disabilities reported significantly poorer global sleep quality and higher levels of sleep disturbance, use of sleep medication and daytime dysfunction than those with no disabilities. Participants with VI reported significantly higher levels of sleep disturbance and use of sleep medication at both timepoints, poorer global sleep quality, sleep duration and latency at time 1, and daytime dysfunction at time 2, than those with no disabilities. Global sleep quality, sleep duration, sleep efficiency, and self-rated sleep quality deteriorated significantly in participants with no disabilities, but daytime dysfunction increased in all three groups. Disability and state anxiety were significant predictors of sleep quality across both surveys.

Conclusion: While sleep was consistently poorer in people with disabilities such as VI, it appears that the COVID-19 pandemic has had a greater impact on sleep in people with no disabilities. State anxiety and, to a lesser extent, disability, were significant predictors of sleep across both surveys, suggesting the need to address anxiety in interventions targeted toward improving sleep.

Social Isolation and Sleep: Manifestation During COVID-19 Quarantines

Although researchers have investigated the impact of social isolation on well-being, the recent quarantines due to COVID-19 resulted in a social isolation environment that was unique to any examined in the past. Because sleep is one of the endogenous drives that impacts short and long-term health and well-being, it is important to consider how social isolation during the COVID-19 government-mandated quarantines affected sleep and sleep habits. A number of researchers have addressed this question during the last 2 years by examining several concepts related to possible changes in sleep during the quarantines. To best understand these recent results, the current mini review provides a background on the pre-pandemic literature on the effects of social isolation and loneliness with a focus on sleep and then summarizes the recent literature on sleep and sleep habits. In general, sleep was negatively impacted for many people during the pandemics but not all. One group that seemed to benefit from the pandemic in terms of sleep patterns, were younger people who could more easily adapt their sleep times to match their internal chronobiology. Given the potential broad impact of sleep on health and well-being, better understanding how social isolation impacts sleep is an important consideration for individuals, work organizations, and governments.

Factors Associated With Dietary Quality During Initial and Later Stages of the COVID-19 Pandemic in Mexico

Background: The COVID-19 pandemic disrupted the global economy and modified lifestyles. The aim of our study was to identify factors associated with dietary quality, and their frequency, in Mexican adults at the initial and later stages of the pandemic.

Methods: Two online surveys were conducted between June and July 2020 (n = 3,131) and between November and December 2020 (n = 1,703 including non-participants from 1st round). A diet quality score was estimated using a short instrument to measure the consumption of several healthy/unhealthy food items. Linear regression models were used to identify the association between pandemic related factors and the diet quality score, adjusted by sociodemographic characteristics. The 2nd round was weighted to represent the 1st round.

Results: During the 1st and 2nd rounds only ~12% of the sample perceived that their intake of healthy food decreased, relative to before the pandemic; ~20% perceived that their intake of unhealthy foods increased. Diet quality remained similar between the 1st and 2nd round. The following factors were negatively associated with diet quality: Eating food prepared away-from-home; going out to work ≥4 times/week; decreased time for food preparation; decreased interest in eating healthy; eating more due to anxiety, depression, or boredom; food insecurity; and stockpiling junk food. Purchasing food using a mixed modality of both in-store and home delivery was positively associated with diet quality. With the exception of eating more due to anxiety (reported by 47% of participants), all these factors were reported by a minority of participants during the first round (≤15%). During the 2nd round, there was an increase in the frequency of participants who reported eating food prepared away-from-home, going out to work ≥4 times/week, having less time to prepare food, being more interested in eating healthfully, and a decrease in participants eating more due to anxiety, depression or boredom, or stockpiling junk food.

Conclusions: Most participants perceived that their dietary intake improved during both initial and later stages of the pandemic. This might be related to factors associated with higher dietary quality, such as not going out to work, eating homemade food, and online grocery shopping.

Mothering and Stress during COVID-19: Exploring the Moderating Effects of Employment

Using primary data from the Assessing the Social Consequences of COVID-19 study, the authors examined how the pandemic affected the stress levels of women with and without coresiding minor children (mothers vs. nonmothers), paying special attention to the moderating role of employment status. The ordinary least squares regression results show that following the pandemic outbreak, among full-time working women, mothers reported smaller stress increases than nonmothers. In contrast, among part-time and nonemployed women, mothers and nonmothers experienced similar stress increases. Also, full-time working mothers reported smaller stress increases than women with most other mothering and employment statuses. Changes in women's employment status, following pandemic onset, had limited impacts on the patterns of stress change. This study contributes to research on parenting and health by showing that during times of crisis, full-time employment may be protective of mothers' mental health but may not buffer the mental health deterioration of women not raising children.

Sleep Pattern Changes and the Level of Fatigue Reported in a Community Sample of Adults During COVID-19 Pandemic

PURPOSE

The study aimed to (a) assess the sleep pattern changes and the level of fatigue among COVID positive adults (b) determine the association of sociodemographic and lifestyle factors (age, gender, marital status, occupation, income, exercise, nap, diet, and comorbidities) on sleep pattern and level of fatigue c) examine the relationship between sleep and fatigue, and between sleep problems, sleep quality and fatigue, among a community sample of COVID-19 affected adults.

METHODS

A non-experimental, descriptive, cross-sectional survey design was used. Participants were adults, between 18 and 63 years (n = 782), who tested positive for COVID-19 infection using RT-PCR or Antigen test, confined to home quarantine/under observation, and without any complications. Data was collected using the socio-demographic-sleep and related activity questionnaire, Fatigue Assessment Scale, and Sleep Quality Scale.

RESULTS

A majority of the participants reported either mild to moderate sleep quality problems (97.31%) and 377 of them (48.21%) reported fatigue levels. A significant association between sleep quality and fatigue with gender, and lifestyle factors such as sleep duration, food intake, napping, exercise pattern, and influence of COVID-19 on livelihood after being affected with COVID-19, and time of experiencing sleep problems after COVID-19 infection (all, p ˂ 0.01) were observed, as well as age with sleep quality. Poor sleep quality and fatigue were significantly correlated with each other, and also with sleep problems before being affected with COVID-19 (p = 0.000).

CONCLUSIONS

The study has shown that COVID-19 has an effect on an individual's demographic factors and a multitude of lifestyle factors, and highlights the need for post-COVID-19 monitoring even after recovery from the disease.

Feeding and Swallowing Issues in Autism Spectrum Disorders

Children with autism spectrum disorder (ASD) often experience difficulties related to communication and behaviour. However, their feeding issues are most distressing to their families and healthcare professionals as they impact on the children's adaptive function and health. In comparison to typically developing children, those with ASD experience significantly more feeding difficulties. Children with ASD may display distinctive feeding difficulties and atypical feeding behaviours that include picky eating, limited independent feeding, need for increased feeding times, and a highly restrictive food repertoire. Many of these feeding difficulties continue into childhood, persist in adolescence, and even spill over into adulthood. This proves to be a formidable challenge, as feeding is an essential component for healthy nutrition, growth, and development. This article will highlight how particular food items that are eaten and preferred by affected children may be contributing to their exhibited feeding difficulties. Next, it will be shown how the children's restrictive diets supplant more healthy food options. When this is combined with the children's noted reduced physical activity, the consequences are especially serious, as they include not only malnutrition but also give rise to childhood obesity. In sum, it will be demonstrated that feeding difficulties in young children with ASD are not well understood nor managed. The dearth of knowledge about feeding issues in this population affects both assessment choices and, specifically, management practices - aspects that will be elaborated on in this article. Conclusions will include suggested future directions for enhancing and complementing knowledge of these issues for stakeholders.

Lifestyle and eating habits before and during COVID-19 quarantine in Brazil

OBJECTIVE

To assess changes in daily habits, food choices and lifestyle of adult Brazilians before and during the COVID-19 pandemic.

DESIGN

This observational study was carried out with Brazilian adults through an online questionnaire 5 months after the social distance measures implementation. The McNemar, McNemar–Bowker and Wilcoxon tests were used to investigate differences before and during the COVID pandemic period, adopting the statistical significance of P < 0·05.

SETTING

Brazil.

PARTICIPANTS

Totally, 1368 volunteers aged 18+ years.

RESULTS

The volunteers reported a lower frequency of breakfast, morning and lunch snacks (P < 0·05) and a higher frequency of evening snacks and other meal categories during the pandemic period (P < 0·05). The results showed an increase in the consumption of bakery products, instant meals and fast food, while the consumption of vegetables and fruits decreased (P < 0·005). There was a significant increase in the frequency of consumption of alcoholic beverages (P < 0·001), but a reduction in the dose (P < 0·001), increased frequency of smoking (P = 0·007), an increase in sleep and screen time in hours and decrease in physical activity (P < 0·001).

CONCLUSIONS

It was possible to observe an increase in screen time, hours of sleep, smoking and drinking frequency. On the other hand, there was a reduction in the dose of alcoholic beverages but also in the practice of physical activity. Eating habits also changed, reducing the performance of daytime meals and increasing the performance of nighttime meals. The frequency of consumption of instant meals and fast food has increased, while consumption of fruits and vegetables has decreased.

Exploring the effects of COVID-19 restrictions on wellbeing across different styles of lockdown

Countries have instigated different restrictions in response to the COVID-19 pandemic. For instance, nationwide, strict "lockdown" in Scotland was enacted with breaches punishable by law, whereas restrictions in Japan allowed for travel and interaction, with citizens requested rather than required to conform. We explored the impact of these differential strategies on health behaviours and wellbeing. In February 2021, 138 Scottish and 139 Japanese participants reported their demographic information, pandemic-induced health behaviour-change (alcohol consumption, diet, perceived sleep quality, physical activity), negative mood, and perceived social isolation. Scottish participants' health behaviours were characterised by greater change (typically negative), most likely due to greater lifestyle disruption, whereas Japanese participants' behaviours were more-stable. Negative changes to health behaviours were typically associated with poorer mental wellbeing and isolation. Interestingly though, Japanese participants reported greater negative mood but not isolation despite the less-restrictive lockdown. Taken together, different lockdown styles led to different changes in health behaviours.

Pandemic decrease of in-person physiotherapy as a factor in parent perceived decline in function in children with neuromuscular disorders

PURPOSE

Restrictions related to the COVID-19 pandemic can negatively affect patients who require physiotherapy. This study aimed to analyze the consequences of limited physiotherapy on the functional state of children with neuromuscular diseases (NMD). In addition, the caregivers' well-being and caregiver opinions on physiotherapy were analyzed.

METHODS

A questionnaire was shared with parents of children with NMD immediately after the COVID-19 lockdown. The survey included questions regarding the physical and mental condition of children and parents before the pandemic and during lockdown as well as their views on physiotherapy and telephysiotherapy. Statistical analysis was performed using the Wilcoxon Matched-Pairs Signed Ranks test, Spearman's Rank Correlation test, McNemar test, and Chi-square test.

RESULTS

Parents of 235 children participated in the study. Results indicated that children devoted more time to physiotherapy before the pandemic than during the lockdown period, which was true for those living in cities and the countryside. The functional state of 50.2% of the children deteriorated during the lockdown, in the opinion of their parents. Significant correlations were found between limited physiotherapy time and the deterioration of children's functional condition, ability to maintain a standing position, and increased anxiety. The majority of parents reported increased levels of fear and anxiety (72.8%), fatigue (67.7%), and pain (53.2%). In-person physiotherapy was rated significantly higher than telephysiotherapy by parents.

CONCLUSIONS

Limited access to physiotherapy and shorter therapy times may lead to functional deterioration in children with NMD, but this assumption needs to be objectively confirmed. According to the parents' opinions, telephysiotherapy is less beneficial than direct physiotherapy but may support therapy conducted directly by a physiotherapist. Results based on subjective parental opinions may be helpful in planning future projects.

Mobility restrictions and mental health among young adults during the COVID-19 pandemic in Ecuador

OBJECTIVE

To study the association between mobility restriction and mental health outcomes among Ecuadorian young adults.

METHOD

The present is a cross-sectional study that included a non-probabilistic sample of mostly highly educated young adults. Socio-demographic and mental health data were collected through an online survey, between May and June 2020, when confinement was mandatory in Ecuador. Data on mobility was extracted from Google Community Mobility Reports. Four aspects of the participants' mental health were evaluated: eating behavior (emotional eating), depression, sleep quality and sense of coherence as a proxy of resilience, using previously validated instruments. Data were analyzed using multiple linear regression models in R.

RESULTS

Sample included 8426 young adults, with a mean age of 22.85 (standard deviation: 4.43), most of whom were women (n=5943, 70.53%). During mandatory confinement, in Ecuador mobility in general was reduced by nearly 50% in comparison to January/February, 2020. Less healthy eating behavior, depression, worse sleep quality and lower sense of coherence were associated with higher mobility restriction to workplaces and groceries/pharmacies. Women and youngsters more often showed depression, less healthy eating behavior, worse quality of sleep and lower sense of coherence in comparison with men and older respondents.

CONCLUSIONS

Mobility restrictions during COVID-19 pandemic were associated with worse self-reported mental health in a sample of young highly-educated Ecuadorian adults. Women and youngsters were the most affected. Our findings highlight the need of implementing health promotion measures directed to ameliorate the effects of confinement on mental health, focusing on women and youngsters.

Association of Delayed Sleep/Wake Rhythm with Depression During the First COVID-19 Lockdown in France

PURPOSE

The containment of the population during the COVID-19 pandemic led to the emergence or recurrence of psychiatric conditions and sleep disorders. The influence of sleep/wake rhythm on mental health is well known. The objective of our study was to evaluate the link between the shift in sleep/wake rhythm and the presence of depressive symptoms during the March to May 2020 lockdown in the French population.

PARTICIPANTS AND METHODS

Participants (n = 2513) were recruited via newspapers and social networks in March 2020. We evaluated i) the chronotype before and during the lockdown, assessed by the change in mid-sleep time on work-free days corrected for sleep debt on workdays (delta MSFsc); ii) morningness-eveningness circadian preference (Horne & Ostberg questionnaire); iii) depressive symptoms (Patient Health Questionnaire-9, PHQ-9). The delta MSFsc and the PHQ-9 score were compared between circadian preference types. A multivariate model adjusted for age, sex, circadian preference, housing type, and marital status was used to assess the influence of delta MSFsc on the PHQ-9 score in the whole population.

RESULTS

The population consisted of 77% women, of median (IQR) age 39 (30-48) years. Compared with the pre-lockdown period, the median (IQR) MSFsc was shifted by 30 (0-66) min during the lockdown, with a significant difference between evening [60 (15-120) min], morning [15 (0-46) min] and neutral [30 (0-70) min] circadian type individuals, p < 0.001. One-third of all participants had moderate to severe depressive symptoms (PHQ-9 ≥ 10). A 1-hour shift in MSFsc was associated with a 0.50-point increase [95% CI (0.28; 0.72), p < 0.001] in the PHQ-9.

CONCLUSION

A phase delay in the chronotype was observed in the general population during lockdown. Such disruption was associated with depressive symptoms but the direction of the relationship remains hypothetical. The impact on mental health of preventive measures targeting the sleep/wake rhythm in this context needs further evaluation.

Longitudinal Effects of Distress and Its Management During COVID-19 Lockdown in Spain

Introduction: The COVID-19 pandemic that hit Spain during March 2020 forced the strict confinement of the population for 2 months. The objectives of this study were (a) to assess the magnitude and duration of the influence of confinement on people's Distress, (b) to study the temporal sequence of stress, and (c) to show how different day-to-day activities and personal variables influence perceived Distress levels. Method: A daily registration was completed by 123 people, with ages ranging from 21 to 75 years old ( X ¯ = 43, SD = 10 years), of which there were 40 men (32%) and 83 females (68%). During 45 days of lockdown, from March 19th to May 3rd, participants were asked to respond to a socio-demographic survey and make daily records comprising the MASQ-D30 and some day-to-day behaviors. Pooled time series was applied to establish what effect time had on the dependent variable. Results: Distress has a 14-day autoregressive function and gender, physical activity, sexual activity, listening to music, and teleworking also influence Distress. It has been hypothesized that the intercept presents variability at level 2 (individual), but it has not been significant. Interactions between Gender-Telecommuting, and Gender-Physical Activity were observed. Approximately 66% of the variance of Distress was explained (R 2 = 0.663). Discussion: At the beginning of the lockdown, the average levels of Distress were well above the levels of the end (z = 3.301). The individuals in the sample have followed a very similar process in the development of Distress. During the lockdown, the "memory" of Distress was 2 weeks. Our results indicate that levels of Distress depend on activities during lockdown. Interactions exist between gender and some behavioral variables that barely influence Distress in men but decrease Distress in women. The importance of routine maintenance and gender differences must be considered to propose future interventions during confinement.

A qualitative exploration of the impact of COVID-19 on food decisions of economically disadvantaged families in Northern Ireland

Background

The first UK-wide lockdown to prevent the spread of COVID-19 had a serious financial impact on low-income households, a population already in higher risk of food insecurity and poor dietary choices. Qualitative data on the impact of COVID-19 lockdown on food decisions of UK families are scarce. This study aimed to explore how the measures to control the spread of COVID-19 influenced the food-related decisions of socioeconomically deprived families in Northern Ireland.

Methods

A qualitative study captured data from online individual interviews. Participation was open for parents of children 2–17 years old living on a tight budget in urban and rural areas of Northern Ireland. A sampling matrix enabled equal representation of single- and two-parent households, as well as parents of younger children (<12y) and adolescents (≥12y). Data were collected by using the methods of Photovoice and mapping exercise. Data were analysed through a thematic approach.

Results

Twelve online interviews were conducted and five distinct themes were identified reflecting families’ food-related decisions that were affected by the COVID-19 lockdown: 1) food planning; 2) food purchasing; 3) meal preparation; 4) eating and feeding behaviours and 5) eating food prepared outside the house.

Conclusions

The restrictions put in place to inhibit the spread of COVID-19 influenced all aspects of dietary decisions of low-income families. Changes observed during this period included frequent consumption of homemade meals, but also increased unhealthy snacking. Infrequent food shopping encouraged good meal planning, but was also a barrier to securing adequate fresh food. Food-related support including school meal assistance contributed to families’ food security, particularly those of single parents.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12307-1.

Social Distancing, Physical Activity, and COVID-19: Implications for Type 1 Diabetes Mellitus in Brazil

A lack of glycemic control and diabetes are risk factors for complications related to COVID-19, and social isolation can hinder adherence to physical activity. Thus, this study sought to assess the impacts of social distancing on the practice of physical activity of individuals with type 1 diabetes mellitus (T1DM). This was a transversal study carried out using an online form to collect sociodemographic, practice of physical activity, and social distancing data. Of the 472 participants, 85.6% reported that they were respecting the steps of social distancing. Social distancing affected the practice of physical activity in adherence to the habit of practicing in frequency, duration, and perception of change in intensity. An association was found between noticing a lot of stress in the home environment and stopping physical activity; lower levels of tolerance to social distancing were associated with less physical activity, and maintaining the habit of practicing physical activity was associated with decreasing the intensity of the practice. Hence, social distancing harmed the practice of physical activity as part of the treatment of individuals with T1DM, both in the habit of practicing and in the characteristics of these practices of physical activity, such as frequency, duration, and intensity.

Association of COVID-19 lockdown measures with changes in physical activity of the adult population of Russia

Aim. To assess the impact of lockdown measures during coronavirus disease 2019 (COVID-19) pandemic on physical activity (PA) of the adult population in Russia.

Material and methods. The online survey was conducted during the period of strict restrictions in Russia from April 26, 2020 to June 6, 2020. The survey involved respondents aged ≥18 years. Participants reported the frequency and duration of moderate to high-intensity PA, as well as walking and other types of exercise, before the pandemic and during the last seven days during the survey period.

Results. In the country as a whole, there was a decrease in all types of PA during the pandemic. The proportion of participants who met the World Health Organization recommendations for any type of PA decreased from 68 to 49% (p<0,001). Proportion of those who followed the World Health Organization recommendations for strength training for ≥2 days per week decreased from 53 to 45% (p<0,001).

Conclusion. The results of the study are the evidence base to substantiate the feasibility of measures aimed at correcting the lifestyle of the population in the context of the COVID-19 pandemic.

Did COVID-19 Pandemic Change People's Physical Activity Distribution, Eating, and Alcohol Consumption Habits as well as Body Mass Index?

This cross-sectional study aimed to evaluate whether COVID-19 had an impact on people’s (aged 18–74) physical activity distribution, eating, and alcohol consumption habits as well as body mass index. We interviewed 6369 people (4545 women and 1824 men) in Lithuania before the COVID-19 pandemic started and 2392 during COVID-19 (1856 women and 536 men). They were aged 18–74 years. We found that both genders had not stopped their physical activity (PA) completely because of lockdown imitations (for example, prohibition from attending sport clubs), but they started doing different physical exercises at sport clubs. We determined the PA distribution according to the Danish Physical Activity Questionnaire (DPAQ). Despite increases in independent PA and the quantity of light PA, the amount of total energy used in metabolic equivalent of task (MET) units per day decreased significantly for both genders irrespective of age. Although the amounts of sedentary behavior, moderate PA (MPA), vigorous PA (VPA) or a combination of MPA and VPA (MVPA) did not change significantly. Surprisingly, lockdown reduced the duration of sleep for older women but increased their amount of intense VPA (>6 METs). However, the amount of intense VPA decreased for men. Both genders reported overeating less during the pandemic than before it, but did not start consuming more alcohol, and their body mass index did not change. Thus, the COVID-19 in Lithuania represented ‘good stress’ that mobilized these individuals to exercise more independently and overeat less.

Rhythms of the day: How electronic media and daily routines influence mood during COVID-19 pandemic

This study aims to investigate how daily activities affect mood in the context of social distancing guidelines enforced during the COVID‐19 pandemic. Using Ecological Momentary Assessment (EMA) administered four times a day during a 2‐week period, we asked participants (N = 91) about their mood and the activities they engaged in. Seven individuals were selected for a follow‐up, open‐ended questionnaire. Results show that a stable routine, including physical exercise, hobbies, regular sleep hours, and minimal time spent in front of the computer, helps maintain a good mood. Coping strategies such as planning and scheduling help keep routines and circadian rhythms stable. Face‐to‐face contact is associated with a more positive mood, while similar interaction through electronic communication has a less positive effect. We observe an effect related to the infodemic phenomenon: Daily reports on COVID‐19 cases and deaths affect mood fluctuations. This is an important consideration in shaping public information policies.

Chronic circadian phase advance in male mice induces depressive-like responses and suppresses neuroimmune activation

Altered working and sleeping schedules during the COVID-19 pandemic likely impact our circadian systems. At the molecular level, clock genes form feedback inhibition loops that control 24-hr oscillations throughout the body. Importantly, core clock genes also regulate microglia, the brain resident immune cell, suggesting circadian regulation of neuroimmune function. To assess whether circadian disruption induces neuroimmune and associated behavioral changes, we mimicked chronic jetlag with a chronic phase advance (CPA) model. 32 adult male C57BL/6J mice underwent 6-hr light phase advance shifts every 3 light/dark cycles (CPA) 14 times or were maintained in standard light/dark cycles (control). CPA mice showed higher behavioral despair but not anhedonia in forced swim and sucrose preferences tests, respectively. Changes in behavior were accompanied by altered hippocampal circadian genes in CPA mice. Further, CPA suppressed expression of brain-derived neurotrophic factor (BDNF) and pro-inflammatory cytokine interleukin-1 beta in the hippocampus. Plasma corticosterone concentrations were elevated by CPA, suggesting that CPA may suppress neuroimmune pathways via glucocorticoids. These results demonstrate that chronic circadian disruption alters mood and neuroimmune function, which may have implications for shift working populations such as frontline health workers.

Trajectories and Determinants of Physical Activity during COVID-19 Pandemic: A Population-Based Study of Middle-Aged and Elderly Individuals in The Netherlands

Physical inactivity is a major public health problem, and there are concerns this might have increased during the COVID-19 pandemic. We aimed to identify distinct trajectories of physical activity over a 6-week period after the first restrictive measures and to explore determinants of these trajectories in a population-based cohort of middle-aged and elderly in the Netherlands (n = 5777). We observed that at least 59% of participants did not meet the World Health Organization recommendations for physical activity. Using latent class trajectory analyses over three time points, we identified five distinct trajectories, including four steady trajectories at different levels (very low, low, medium and high) and one increasing trajectory. Using multinomial logistic regression analyses, we observed that, compared to the ‘steadily high’ trajectory, participants in the ‘steadily very low’ trajectory were more often older, lower educated, reporting poorer physical health, more depressive symptoms, consuming a less healthy diet, smoking, and lower alcohol use, and were less often retired. A similar pattern of determinants was seen for those in the increasing trajectory, albeit with smaller effect sizes. Concluding, we observed low levels of physical activity that generally remained during the pandemic. The determinants we described can help identify groups that require additional preventive interventions.

The impact of COVID-19 on self-management behaviours and healthcare access for people with inflammatory arthritis

BACKGROUND

Inflammatory arthritis (IA) patients have been identified as at greater risk of severe illness from COVID-19. It is likely that lockdown restrictions (enforced by the UK government in response to the COVID-19 pandemic) and subsequent changes made to healthcare provision could impact patients' abilities to effectively manage their condition. The aim of this study was to qualitatively explore the impact of COVID-19 on self-management behaviours and healthcare access for people with IA.

METHODS

Semi-structured interviews were conducted with 21 IA patients in June-July 2020, with nine follow-up interviews in November 2020. Interview schedules were developed with a Patient Research Partner and explored participants' experiences of the COVID-19 pandemic. Interviews were conducted via telephone and analysed using inductive thematic analysis.

RESULTS

Participants were aged between 24 and 79 years (mean = 50.1, SD = 15.8), largely female (71%) and White British (86%). Four initial themes were identified: (1) Impact of COVID-19 on medication adherence, (2) Impact of COVID-19 on physical activity, (3) Impact of COVID-19 on diet, and (4) Impact of COVID-19 on healthcare access and delivery. Subthemes focused on positive and negative changes made to these areas, as well as behaviours which remained consistent. Follow-up interviews highlighted differences in participants' experiences during the two lockdown periods.

CONCLUSION

COVID-19 has affected patients' abilities to manage their IA. Healthcare professionals need to recognise the ongoing impact of COVID-19 on patient self-management and healthcare access to ensure that adequate understanding and support is available to patients who may have inadequate disease control as a result.

Moving Forward: Understanding Correlates of Physical Activity and Sedentary Behaviour during COVID-19-An Integrative Review and Socioecological Approach

Population-level physical activity (PA) and sedentary time/behaviour estimates represent a significant public health issue exacerbated by restrictions enforced to control COVID-19. This integrative review interrogated available literature to explore the pandemic's impact on correlates of such behaviours in adults (≥18 years). Five electronic databases were systematically searched in January 2021. Data extracted from 64 articles were assessed for risk-of-bias using the Mixed Methods Assessment Tool, with correlates identified, coded, and themed via thematic analysis. A socioecological model of during-pandemic PA was conceptualized and mapped to the Capability, Opportunity, Motivation, and Behaviour (COM-B) model of behaviour change mechanisms, which illustrates influences over five levels: Individual (biological)-general health; Individual (psychological)-mental health, cognition, motivation, and behaviour; Social-domestic situation, sociodemographic factors, support, and lifestyle choices; Environmental-resources and area of residence; and Policy-COVID-19-related rules. For sedentary time/behaviour, individual level factors, namely general and mental health, may be important correlates. Neither age or sex were clearly correlated with either behaviour. As we transition into a new normal, understanding which behaviour mechanisms could effectively challenge physical inactivity is essential. Targeting capability on a psychological level may facilitate PA and limit sedentary time/behaviour, whereas, on a physical level, maximizing PA opportunities could be crucial.

Changes in Life Situations during the SARS-CoV-2 Virus Pandemic and Their Impact on Eating Behaviors for Residents of Europe, Australia as Well as North and South America

Many people’s life situations are changing as a result of restrictions being imposed by national governments to limit the spread of the virus. These may be associated with additional factors (emotional or financial, for example) that influence eating behavior and physical activity levels. Therefore, the aim of this study was to show whether there is a relationship between a changing life situation during the pandemic and eating behavior as well as physical activity. An online survey was conducted between 28 April and 16 July 2020 with 921 participants from European countries and countries outside Europe (South and North America, Australia). An analysis of the obtained results showed an unfavorable relationship between a change in life situation during the pandemic and eating behavior as well as physical activity. This was observed mainly among students who returned to their family homes and respondents whose working hours increased. Students were more likely to snack between meals (51.13%, p < 0.001) and to consume more sweets (45.11%, p < 0.001) and savory snacks (30.83%, p < 0.001). Those whose working hours had increased, consumed morefast foods (13.57%, p < 0.05) during that time. On the other hand, the study results indicated that a change in life situation during the pandemic can also have a positive impact on eating behavior and physical activity. This was exhibited by individuals who transitioned to remote working. An improvement in the regularity of eating (38.86%, p < 0.001) was recorded for this group. The relationship between a change in life situation and eating behavior was further emphasized by the fact that people whose life situation had not changed were more likely to declare no change in the regularity of eating (62.86%, p < 0.001) and snacking (61.71%, p < 0.001). At the same time, they were less likely to exhibit a higher intake of sweets (22.29%, p < 0.01) and salty snacks (13.14%, p < 0.01). The study results indicated that a change in the nutritional situation during the pandemic may have had both negative and positive effects on eating behavior and physical activity. Finding these relationships may help identify groups that are particularly vulnerable to reduced diet quality and reduced levels of physical activity. Considering the immunomodulating effects of diets and the fact that physical activity is essential for maintaining good health, further research in this area is needed.

Physical activity, well-being, and priorities of older women during the COVID-19 pandemic: a survey of Women's Health Initiative Strong and Healthy (WHISH) intervention participants

Sheltering-in-place, social distancing, and other strategies to minimize COVID-19 transmission may impact physical activity (PA) and well-being in older adults. To assess self-reported PA changes, well-being, and priorities of older women across the USA early in the COVID-19 pandemic. In May 2020, a 10-question survey was emailed to 5,822 women, aged over 70 years, who had been assigned to the Women’s Health Initiative (WHI) Strong and Healthy (WHISH) trial PA intervention and had provided email addresses. The survey assessed general and physical well-being, current priorities, and PA levels before and during the COVID-19 pandemic. Demographic and physical function data were collected previously. Descriptive analyses characterized participants’ priorities and PA changes from before the pandemic to the time of data collection during the pandemic. Differences in PA change by age, physical function, and geographic region were assessed by Kruskal-Wallis and post hoc Dunn tests. Among 2,876 survey respondents, 89% perceived their general well-being as good, very good, or excellent, despite 90% reporting at least moderate (to extreme) concern about the pandemic, with 18.2% reporting increased PA levels, 27.1% reporting no changes, and 54.7% reporting decreased PA levels. Top priorities “in the midst of the COVID-19 outbreak” were staying in touch with family/friends (21%) and taking care of one’s body (20%). Among priorities related to physical well-being, staying active was selected most frequently (33%). Support for maintaining PA in older populations should be a priority during a pandemic and similarly disruptive events.

Criterion Validity and Psychometric Properties of a Malay Version of the Short Multidimensional Inventory Lifestyle Evaluation-Confinement (SMILE-C) in a Sample of University Staff with Weight Problems

The aim of this study was to validate the Short Multidimensional Inventory Lifestyle Evaluation-Confinement (SMILE-C) in a Malaysian context. The SMILE-C, which is a respondent-generated instrument, was used to ask participants questions on their lifestyle during the COVID-19 pandemic. The indices of seven sub-scores were then calculated. A total of 121 university staff members completed the Malay version of the SMILE-C as well as instruments for measuring well-being, family life satisfaction, mindfulness and awareness, work engagement, and quality of life. The Cronbach's alpha values and Pearson correlation coefficients were satisfactory in this initial validation of the instrument. The SMILE-C showed positive correlations with all the variables being studied. The results supported the criterion-related validity and psychometric properties of the Malay version of the SMILE-C as an instrument for assessing lifestyle changes during the COVID-19 pandemic.

Physical Activity, Sedentary Behavior, and Satisfaction With Life of University Students in Qatar: Changes During Confinement Due to the COVID-19 Pandemic

This study explored the effects of home confinement on physical activity (PA) and satisfaction with life (SL) among university students during the COVID-19 pandemic. A total of 531 subjects participated [male: n=203; female: n=328; age: 33.1±5.2years; mass: 72.1±17.5kg; height: 1.67±0.12m; and body mass index (BMI): 25.7±5.06 kg/m2]. Online survey questions considered "before" and "during" confinement. Confinement reduced all PA intensities (ηp 2=0.09-0.45, p<0.001) and increased daily sitting time (ηp 2=0.58, p<0.001). The largest reduction was in moderate intensity PA [metabolic equivalent of task-minutes/week (MET), ηp 2=0.45, p<0.001]. SQL decreased, with the score for "I am satisfied with my life" (ηp 2=0.42, p<0.001) decreasing from 28.4±5.7 to 20.6±9.7 arbitrary units (AU). Concerning SL, the largest change was detected for "the conditions of my life are excellent" (ηp 2=0.54, p<0.001). Time changes in all variables were demonstrative of large negative changes in both sexes. The difference in change between sexes was largest in terms of magnitude for the variable "the conditions of my life are excellent" (difference between groups, Δd=0.98). In sum, COVID-19 confinement reduced PA, heightened sitting time, and reduced SL in Qatar University students. This investigation could have a significant impact in developing PA guidelines for health maintainance during COVID-19 and successive pandemics in university students.

Depression as Compared to Level of Physical Activity and Internet Addiction among Polish Physiotherapy Students during the COVID-19 Pandemic

OBJECTIVES

The aim of the survey was to assess the level of depression correlated with physical activity and internet addiction among physiotherapy students of Polish universities during the COVID-19 pandemic.

METHODS

The survey was carried out via the internet among Polish physiotherapy students (141 respondents). The level of depression was assessed by the Beck Depression Inventory, physical activity by the International Physical Activity Questionnaire (IPAQ) in Polish and the level of internet addiction by the Kimberly Young Questionnaire.

RESULTS

It was found that 31% of those surveyed stated that they suffered from moderate or severe depression. The overwhelming majority of the respondents (92%) considered the level of their internet addiction as low. More physical activity had a positive effect on mental health. The overuse of the internet exacerbated depressive symptoms.

CONCLUSIONS

The prevalence of depression observed in students is mainly related to distant learning systems. Therefore, regular physical activity is recommended as it is associated with a lower level of depression. It is also advisable to provide students with necessary psychological care. Excessive use of social media is not recommended to elevate mood as it makes depression symptoms worse.

Mood and Changes in Alcohol Consumption in Young Adults during COVID-19 Lockdown: A Model Explaining Associations with Perceived Immune Fitness and Experiencing COVID-19 Symptoms

The aim of this study was to explore the effects of the 2019 Coronavirus (COVID-19) lockdown on mood states, stress, alcohol consumption and perceived immune fitness in a Dutch sample. Analysis included a subsample from the “Corona Lockdown: how fit are you?” (CLOFIT) study, comprising N = 761 participants who reported consuming alcohol in 2020. Results show that, compared to pre-lockdown, the first COVID-19 lockdown (March 2020) was associated with experiencing poorer mood (e.g., anxiety, depression, loneliness, fatigue) and increased stress levels. Among younger participants (18 to 35 years old), a significant decrease in weekly alcohol consumption was found during COVID-19 lockdown, which was not significant in older individuals. For the younger age cohort (18 to 35 years old), increased stress significantly correlated to increased weekly alcohol consumption (r = 0.163, p = 0.003), which in turn, correlated significantly to reporting a poorer perceived immune fitness (r = −0.165, p = 0.002). Poorer perceived immune fitness correlated significantly with increases in the presence and severity of COVID-19 symptoms (r = −0.313, p < 0.001, and r = −0.325, p < 0.001, respectively). The data provides evidence for significant relationships between changes in mood, stress and alcohol consumption during COVID-19 lockdown, and supports a model that links these changes to perceived immune fitness and susceptibility to experiencing COVID-19 symptoms.

Impact of the COVID-19 pandemic on exercise habits among cancer patients

Purpose There is limited information on how the COVID-19 pandemic has changed health behaviors among cancer patients. We examined the impact of the pandemic on changes in exercise behaviors and identified characteristics associated with these changes among cancer patients. Methods Cancer patients (n  =  1,361) completed a survey from August-September 2020 to assess COVID-19 pandemic-related changes in health behaviors and psychosocial factors. Patients were categorized into 3 groups: exercising less, exercising did not change, and exercising more. Patient characteristics were compared by exercise groups. Results One-third of the patients reported a decreased amount of regular exercise, while 11% reported exercising more during the pandemic. Patients who exercised less were more likely to be unemployed/retired, undergoing active treatment, and had increased pandemic-related alcohol consumption and psychosocial stressors such as loneliness and financial stress (all p  < 0.05). In contrast, patients who exercised more were younger, female, full-time employed, did not consume alcohol, and had good health status and more social interactions (all p  < 0.05). Patients who were living in rural areas and did not experience changes in daily life, were also more likely not to experience changes in exercise habits (all p  < 0.05). Conclusion Our results indicate that a significant proportion of cancer patients experienced changes in exercise habits during the first 6 months of the COVID-19 pandemic. Age, sex, employment status, health status, alcohol consumption, and psychosocial factors were associated with changes in exercise behaviors. Providers should monitor for changes in health behaviors, such as exercise, because of their importance in improving cancer survivorship.

Challenges in Feeding Children Posed by the COVID-19 Pandemic: a Systematic Review of Changes in Dietary Intake Combined with a Dietitian's Perspective

PURPOSE OF REVIEW

To examine the evidence that the dietary quality of children changed between the period preceding the COVID-19 pandemic and the first year during the pandemic.

RECENT FINDINGS

A systematic review of the evidence for dietary changes occurring as a result of the pandemic-related restrictions, in Part I of this article, yielded 38 original research articles. These articles had conflicting results, some describing improvements in overall quality and some describing deteriorations. As a whole the studies were characterized by a low study quality, and children were poorly represented. Taken together, these studies do not provide enough evidence to draw conclusions about whether dietary habits changed or not as a result of the pandemic. However, in a wider, narrative review of the psychosocial changes occurring as a result of the COVID-19 pandemic, and the known associations of these factors with a dietary intake in Part II, we conclude that there is a reason to expect that the dietary quality of children might have been adversely affected by the COVID-19 pandemic. One the one hand, the literature fails to provide conclusive evidence on changes in the dietary quality of children resulting from the COVID-19 pandemic. On the other hand, the broader literature supports the hypothesis that children's dietary quality will have declined during the pandemic. Taken together, we urgently need more high-quality research on children's changes in dietary intake occurring over the pandemic. This will provide important information on whether any potential long-term consequences of such changes, if they exist, need to be examined and ameliorated.

The COVID-19 Lockdown and Changes in Routine-Oriented Lifestyle Behaviors and Symptoms of Depression, Anxiety, and Insomnia in South Africa

BACKGROUND

The authors assessed the impact of lockdown in response to the COVID-19 pandemic on routine-oriented lifestyle behaviors and symptoms of depression, anxiety, and insomnia in South Africans.

METHODS

In this observational study, 1048 adults (median age = 27 y; n = 767 females; n = 473 students) responded to an online survey on work, exercise, screen, alcohol, caffeine and sleep behaviors, depression, anxiety, and insomnia before and during lockdown. Comparisons were made between males and females, and students and nonstudents.

RESULTS

During lockdown, males reported larger reductions in higher intensity exercise and alcohol use than females, while depressive symptoms increased more among females, more of whom also reported poorer sleep quality. Students demonstrated larger delays in work and sleep timing, greater increases in sitting, screen, sleep duration, napping, depression and insomnia and larger decreases in work hours, exercise time, and sleep regularity compared with nonstudents.

CONCLUSIONS

Students experienced more changes in their routine-oriented behaviors than nonstudents, coupled with larger increases in depression and insomnia. The dramatic change in their work and sleep timing suggests habitual routines that are at odds with their chronotype, with their sleep changes during lockdown likely reflecting "catch-up" sleep in response to accumulated sleep debt under usual routines.

When Social Interaction Backfires: Frequent Social Interaction During the COVID-19 Pandemic Is Associated With Decreased Well-Being and Higher Panic Buying

The present research investigated a backfiring effect of social interaction on well-being and general confidence in Western populations during the COVID-19 pandemic. Across two studies, we observed that stronger self-other connectedness and frequent social communication with others during the first few weeks into the quarantine period were associated with worsened well-being and decreased general confidence. In Study 1 (n = 331), we showed that people who reported higher social connectedness and more frequent social interaction experienced declined well-being. In Study 2 (n = 327), we replicated the backfiring effect and showed that those who engaged in frequent social interaction, especially in COVID-19 related conversations, reported decreased general confidence, which mediated the accelerating effect of social interaction on panic buying. Overall, our findings indicated that frequent social interaction under a highly novel and uncertain crisis can relate to negative consequences on mental health and behavior.

Personality Traits and Changes in Health Behaviors and Depressive Symptoms during the COVID-19 Pandemic: A Longitudinal Analysis from Pre-pandemic to Onset and End of the Initial Emergency Conditions in Finland

The COVID-19 pandemic and social distancing measures targeting the transmission of the virus impacted everyday life in 2020. This study investigated pre- to in-pandemic changes in health behaviors and depressive symptoms during the COVID-19 pandemic and the role of personality traits in these changes in Finland. Data from a larger population-based cohort study of 51-59-year-old Finnish women were used (n = 358). Self-reported questionnaires gathered information about depressive symptoms, eating behavior, physical activity, and alcohol consumption before the pandemic time, at the onset, and at the end of the COVID-19 emergency conditions. Information about personality traits (extraversion and neuroticism) and sociodemographic factors was available from the pre-pandemic baseline. Women reported more depressive symptoms and unhealthier eating habits at the end of the emergency conditions compared to the pre-pandemic time. An increase in depressive symptoms was associated with changing to unhealthier eating habits. Higher extraversion was associated with a perceived decrease in alcohol consumption and with changing to healthier eating habits. Women with higher neuroticism reported changing to either healthier or unhealthier eating habits. In general, some women reported healthier lifestyle changes while other women reported the opposite. Personality traits help to understand these individual differences in adaptation to the pandemic situation.

The impact of the COVID-19 epidemic on hospital admissions for alcohol-related liver disease and pancreatitis in Japan

During the coronavirus disease 2019 (COVID-19) pandemic, there have been health concerns related to alcohol use and misuse. We aimed to examine the population-level change in cases of alcohol-related liver disease and pancreatitis that required admission during the COVID-19 epidemic by interrupted time series (ITS) analysis using claims data. We defined the period from April 2020, when the Japanese government declared a state of emergency, as the beginning of the COVID-19 epidemic. This ITS analysis included 3,026,389 overall admissions and 10,242 admissions for alcohol-related liver disease or pancreatitis from 257 hospitals between July 2018 and June 2020. The rate of admissions per 1000 admissions during the COVID-19 epidemic period (April 2020-June 2020) was 1.2 times (rate ratio: 1.22, 95% confidence interval: 1.12-1.33) compared to the pre-epidemic period. Analyses stratified by sex revealed that the increases in admission rates of alcohol-related liver disease or pancreatitis for females were higher than for males during the COVID-19 epidemic period. The COVID-19 epidemic in Japan might associates an increase in hospital admissions for alcohol-related liver disease and pancreatitis. Our study could support the concern of alcohol consumption and health problems during the COVID-19 pandemic.

Beyond the Educational Context: Relevance of Intrinsic Reading Motivation During COVID-19 Confinement in Spain

What role could have intrinsic motivation toward reading in an extraordinary situation like the recent confinement? This research examines the relationship between intrinsic reading motivation (IRM) and reading habits in an adult population considering types of reading (for leisure, work/study, social networks, and news), gender, and distress generated by the coronavirus disease 2019 (COVID-19) pandemic. Participants were 3,849 adults from Spain who were surveyed about their reading practices: before, during the first weeks, and after several weeks of confinement. Linear mixed effects models (LMMs) were used to analyze data. Results showed a three-way interaction between reading frequency, IRM, and type of reading. Also, distress seems to pose a differential impact depending on the type of reading. The higher the IRM, the lesser the time devoted to study/work reading and the more to social and news reading (at the beginning of confinement). In this sense, IRM can function as a protective factor of reading behavior but only for leisure reading. Results support previous findings of the importance of consciously promoting this type of motivation in all individuals beyond educational contexts, since it seems to be positively related to well-being. Other results and implications are discussed.

Social media use informing behaviours related to physical activity, diet and quality of life during COVID-19: a mixed methods study

BACKGROUND

This mixed methods study explored how social media use informed physical activity and diet-related behaviours, and self-perceived Quality of Life (QoL) during COVID-19, and assessed the contextual factors that drive social media use for health-related behaviour change in diverse groups. During the COVID-19 lockdown periods there were reported changes to social media use and health behaviours, and this gave an opportunity to investigate potential relationships.

METHODS

An explanatory sequential research design of two parts was used: (1) An online survey that assessed social media use in relation to physical activity levels, diet quality and QoL (n = 786; Mage 45.1 ± 19.1 (range 16-88) years; Female =69%); (2) 20 purposive focus groups (n = 69; Mage = 52.88 ± 18.45 years, Female n = 68%) to understand the contextual factors that drive social media use for health-related behaviour change. Descriptive and thematic analysis were conducted.

RESULTS

Participants in this study reported that social media facilitated the self-management of behaviours related to physical activity, diet and QoL, through access to information to inform workouts and dietary quality, and the opportunities for interaction with peers, family members and within social groups. Contextual factors including work, home and lifestyle arrangements, pre-existing health-related knowledge and behaviours, and the perceived value of social media for health influenced the relationship between social media use and self-reported outcomes. Social media influencers, peers/family members, and official organisations influenced the application of health-related information accessed via social media.

CONCLUSIONS

The evidence shows that participants were critical users of social media and were able to use social media to derive benefit for their health and wellbeing. Detailed guidance for those who use social media, as well as those who recommend and endorse social media content is required to maximise the potential of social media to support health behaviours. Future public health strategies and social media interventions should acknowledge diversity in contextual factors driving social media use for health behaviour change.

Lifestyle and behavioral changes during nationwide lockdown in India-A cross-sectional analysis

INTRODUCTION

After almost two months of reporting the first case of the novel coronavirus disease (COVID-19) in the country, the nationwide lockdown in India was initiated on 24th of March 2020, to curtail the spread of the SARS-CoV-2 infection in the country. While this lockdown had been in place for almost 3 months, the people of the nation have experienced changes in their routine lives in a wide range of activities, including personal behaviours. This study was conducted to identify the impacts that the lockdown had on the lifestyle and behavioural aspects of Indians during the lockdown.

METHODS

It was a cross sectional study, conducted by online survey. Data collection was done for the period of 3 months.

RESULTS

The study found that a huge number of participants had significant changes in their diet, sleep, bowel habits and also their personal traits. Also, the lockdown had improved interpersonal relationships and helped people explore their hobbies or even acquire a new skill (about 25% of the participants). More than 90% of the participants perceived decrease in air pollution and a majority reported increase in personal hygiene (74.2%), perceived decrease in crime rates (67.3%) as benefits of lockdown.

CONCLUSIONS

It would be recommended to include variables to screen for mental health issues among the general population.

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.

Eating Habits during the COVID-19 Lockdown in Italy: The Nutritional and Lifestyle Side Effects of the Pandemic

To limit the spread of coronavirus SARS-CoV-2, a nationwide lockdown started in Italy in March 2020. In this unpredictable situation, a cross-sectional study using an online questionnaire was carried out by the Observatory on Food Surplus, Recovery and Waste of CREA Food and Nutrition Centre. The aim of this work was to evaluate how Italian habits changed during this period, the determinants of changes, and the effect on food waste prevention. In a sample of 2678 respondents, 62% showed low Adherence to the Mediterranean Diet (AMD). During lockdown many of participants improved the quality of their diet, increasing their consumption of fruit (24.4%), vegetables (28.5%), legumes (22.1%), nuts (12%), and fish or shellfish (14%). Unfavorable changes were observed with the excessive consumption of sweets or pastries (36.9%) and comfort foods (22.7%), and a lack of physical activity (37.2%). The main novelty of this study was the examination of dietary changes identified by a cluster analysis. Respondents with generally high AMD improved their eating habits, while the habits of the respondents with generally low AMD remained unchanged. In addition, nearly 80% of respondents were sensitive to food waste. The study provides a useful contribution to the debate on nutritional recommendations in case of further lockdown.

Stress levels among an international sample of pregnant and postpartum women during the COVID-19 pandemic

BACKGROUND

Stress is a complex condition that can have a profound effect on an individual's sense of wellbeing and their ability to live a happy and healthy life. COVID-19 and its associated stressors have the potential to disrupt numerous facets of our everyday lives. Pregnant and postpartum women are especially vulnerable to changes in the availability of routine health and social care services and of their support networks. The current study sought to explore stress levels and their influencers among an international cohort of pregnant and postpartum women during the COVID-19 pandemic.

METHODS

We conducted an anonymous, online, cross-sectional survey in 64 countries between May and June 2020. The survey was hosted on the Pregistry platform and made available in 12 languages, with respondents sought through a variety of social media platforms and parenting forums. In addition to levels of stress, we collected data related to demographics, COVID-19 exposure and worries, lifestyle changes, traditional and social media use, precautionary measures related to COVID-19, and mental health.

RESULTS

In total, 7185 women were included in our sample. We found statistically significant (p-value <0.05) reductions in stress score among older women (≥35 years of age), those either living with a partner or married, those who had graduated from college, and those with medical coverage. Higher stress scores were found among women who resided in Africa, Asia and the Pacific, the Middle East, and North America compared with those in Europe. When race and ethnicity were included in the model, black women were found to have higher stress compared to white women. Level of family and community support was inversely associated with level of stress.

CONCLUSION

Our study is one of the first to explore stress levels among pregnant and postpartum women during the COVID-19 pandemic. We found statistically significant differences in stress levels by age, education, marital status, region of residence, race/ethnicity and level of support. Understanding stress during the COVID-19 pandemic, and exploring ways to address it, will be key to contributing to the mental and physical health of expectant and new mothers, as well as their children, in both the short and long term.

Chronic Back Condition and the Level of Physical Activity as Well as Internet Addiction among Physiotherapy Students during the COVID-19 Pandemic in Poland

Objectives: The aim of this study was to assess back pain and its relation to physical activity as well as Internet addiction among Polish university students during the COVID-19 pandemic. Methods: The research was conducted via the Internet in student groups of three universities in Poland (141 people). Back pain was examined by ODI—The Oswestry Disability Index and NDI—Neck Disability Index. The Polish-language International Physical Activity Questionnaire (IPAQ) was used to assess physical activity and the level of Internet addiction was tested using the Kimberly Young Questionnaire. Results: The respondents mostly suffered from pain originating in the cervical spine. In the study group, only every fifth person had a high level of physical activity. Sex differentiates the level of the measures considered. Sitting in front of the computer affects the pain in the spine. Conclusions: Research results suggest that the pandemic is negatively affecting students. Frequent occurrence of back pain is observed with a simultaneous low level of physical activity. Maintaining regular activity during a pandemic, at least at home, is an indispensable preventive measure for physical health.