Importance of Sleep for Health and Wellbeing Amidst COVID-19 Pandemic

Bedtime procrastination related to loneliness among Chinese university students during post-pandemic period: a moderated chain mediation model

BACKGROUND

This study examined the relationship between loneliness and bedtime procrastination among Chinese university students, the mediating effects of COVID-19 risk perception and self-regulatory fatigue, and connectedness to nature's protective role, post pandemic.

METHODS

We recruited 855 students to complete the Loneliness, Perceived Risk of COVID-19 Pandemic, Self-Regulatory Fatigue, Bedtime Procrastination, and Connectedness to Nature Scales. Data for descriptive statistics, correlation analysis, and moderated chain mediation effects were analyzed using SPSS 24.0 and process 3.5 macros.

RESULTS

Loneliness positively correlated with bedtime procrastination, COVID-19 risk perception mediated the impact of loneliness on bedtime procrastination, self-regulatory fatigue mediated the effect of loneliness on bedtime procrastination, and COVID-19 risk perception and self-regulatory fatigue mediated the effect between loneliness and bedtime procrastination. Furthermore, connectedness to nature mediated the impact of COVID-19 risk perception on self-regulatory fatigue.

CONCLUSIONS

The results indicate the effects and potential mechanisms of loneliness on bedtime procrastination after the relaxation of the pandemic prevention and control policy in China from the perspective of self-regulatory resources and provide insights into improving university students' sleep routine and mental health post pandemic.

Daily Functional Characteristics and Health Among Older Adults During COVID-19: A Structural Equation Modeling Approach

Within a few years, 1 in 6 people will be aged 60 years or older. Extreme situations, such as the COVID-19 crisis, constitute a challenge to older adults. However, the literature on the daily functional characteristics of older adults in the past and during the COVID-19 crisis and their relationships to their physical and mental health is scarce. This study aimed to examine the past and present daily functional factors associated with physical and mental health in older adults. Using an online platform, 204 Israelis aged 60 years and older reported their physical health symptoms and anxiety levels. They completed questionnaires about past (negative life events and childhood daily functional self-actualization) and present (adulthood daily functional self-actualization, functional cognition and sleep quality) factors. Structural equation modeling revealed correlations between functional cognition and childhood daily functional self-actualization (β = -.18) and anxiety (β = .15); adulthood daily functional self-actualization and past negative life events (β = -.18), anxiety (β = -.50), and physical symptoms (β = -16); and sleep quality and past childhood daily functional self-actualization (β = -.19), negative life events (β = .22), anxiety (β = .18), and physical symptoms (β = .40). These findings shed light on potential functional factors for older adults' health, indicating that these functional factors play a vital role in reducing health problems in later life.

The relationship between sleep quality and daytime dysfunction among college students in China during COVID-19: a cross-sectional study

Objective

College Students' sleep quality and daytime dysfunction have become worse since the COVID-19 outbreak, the purpose of this study was to explore the relationship between sleep quality and daytime dysfunction among college students during the COVID-19 (Corona Virus Disease 2019) period.

Methods

This research adopts the form of cluster random sampling of online questionnaires. From April 5 to 16 in 2022, questionnaires are distributed to college students in various universities in Fujian Province, China and the general information questionnaire and PSQI scale are used for investigation. SPSS26.0 was used to conduct an independent sample t-test and variance analysis on the data, multi-factorial analysis was performed using logistic regression analysis. The main outcome variables are the score of subjective sleep quality and daytime dysfunction.

Results

During the COVID-19 period, the average PSQI score of the tested college students was 6.17 ± 3.263, and the sleep disorder rate was 29.6%, the daytime dysfunction rate was 85%. Being female, study liberal art/science/ engineering, irritable (due to limited outdoor), prolong electronic entertainment time were associated with low sleep quality (p < 0.001), and the occurrence of daytime dysfunction was higher than other groups (p < 0.001). Logistics regression analysis showed that sleep quality and daytime dysfunction were associated with gender, profession, irritable (due to limited outdoor), and prolonged electronic entertainment time (p < 0.001).

Conclusion

During the COVID-19 epidemic, the sleep quality of college students was affected, and different degrees of daytime dysfunction have appeared, both are in worse condition than before the COVID-19 outbreak. Sleep quality may was inversely associated with daytime dysfunction.

A Novel Sleep Staging Method Based on EEG and ECG Multimodal Features Combination

Accurate sleep staging evaluates the quality of sleep, supporting the clinical diagnosis and intervention of sleep disorders and related diseases. Although previous attempts to classify sleep stages have achieved high classification performance, little attention has been paid to integrating the rich information in brain and heart dynamics during sleep for sleep staging. In this study, we propose a generalized EEG and ECG multimodal feature combination to classify sleep stages with high efficiency and accuracy. Briefly, a hybrid features combination in terms of multiscale entropy and intrinsic mode function are used to reflect nonlinear dynamics in multichannel EEGs, along with heart rate variability measures over time/frequency domains, and sample entropy across scales are applied for ECGs. For both the max-relevance and min-redundancy method and principal component analysis were used for dimensionality reduction. The selected features were classified by four traditional machine learning classifiers. Macro-F1 score, macro-geometric mean, and Cohen kappa value are adopted to evaluate the classification performance of each class in an imbalanced dataset. Experimental results show that EEG features contribute more to wake stage classification while ECG features contribute more to deep sleep stages. The proposed combination achieves the highest accuracy of 84.3% and the highest kappa value of 0.794 on the support vector machine in the ISRUC-S3 dataset, suggesting the proposed multimodal features combination is promising in accuracy and efficiency compared to other state-of-the-art methods.

At-home wireless sleep monitoring patches for the clinical assessment of sleep quality and sleep apnea

Although many people suffer from sleep disorders, most are undiagnosed, leading to impairments in health. The existing polysomnography method is not easily accessible; it's costly, burdensome to patients, and requires specialized facilities and personnel. Here, we report an at-home portable system that includes wireless sleep sensors and wearable electronics with embedded machine learning. We also show its application for assessing sleep quality and detecting sleep apnea with multiple patients. Unlike the conventional system using numerous bulky sensors, the soft, all-integrated wearable platform offers natural sleep wherever the user prefers. In a clinical study, the face-mounted patches that detect brain, eye, and muscle signals show comparable performance with polysomnography. When comparing healthy controls to sleep apnea patients, the wearable system can detect obstructive sleep apnea with an accuracy of 88.5%. Furthermore, deep learning offers automated sleep scoring, demonstrating portability, and point-of-care usability. At-home wearable electronics could ensure a promising future supporting portable sleep monitoring and home healthcare.

The correlation between lifestyle health behaviors, coping style, and mental health during the COVID-19 pandemic among college students: Two rounds of a web-based study

Background

During the last months of 2019, worldwide attention has focused on a pandemic of COVID-19, and the pandemic spread rapidly, becoming a public health emergency of international concern. The Chinese government has quickly taken quarantine measures and the drastic measures incurred to curtail it, which could have harmful consequences for everyone's behavior and mental health.

Objective

This study aimed to investigate the correlation of influencing factors and mental health symptoms among Chinese college students according to two rounds of surveys during the COVID-19 pandemic.

Materials and methods

This study was divided into two stages of cross-sectional investigation. In February 2020 and May 2020, two cross-sectional surveys were conducted on college students in the above areas by means of cluster sampling. From February 4 to February 12, 2020, 14,789 college students completed the first round of online study from 16 cities and universities in 21 in China, excluding participants who completed the questionnaire, and finally included 11,787 college students. After 3 months, we also conducted a large-scale questionnaire survey based on the first study area to observe the behavioral changes and psychological symptoms of college students within 3 months. Using the convenience sampling method, a survey on the cognitive and psychological status of COVID-19 among college students was conducted in 21 universities in 16 regions in May 2020. The regions among the two surveys are divided into Wuhan (District 1), neighboring Hubei (District 2), first-tier cities, namely, Beijing, Shanghai and Guangzhou (District 3), and other provinces (District 4).

Results

(1) In the first survey, the average age of the participants was 20.51 ± 1.88 years. One-third of the college students were male. In total, 25.9 and 17.8% of college students reported depression and anxiety symptoms, respectively. College students, who reported higher ST, lower PA, higher soda beverage and tea beverage intake, have Chinese herbal medicine and vitamin drinking, and decreased frequency of diet had higher depression and anxiety symptoms. Moreover, infection risk, perceived resistance to COVID-19, concerns about physical symptoms, family/friends directly/indirectly contacted with confirmed cases, and seeking psychological counseling had significant associations with anxiety and depression symptoms. (2) In the second round of surveys, 6803 males (41.7%) and 9502 females (58.3%) had a mean age of 20.58 ± 1.81 years. The prevalence of depressive symptoms and anxiety symptoms during COVID-19 was 30.7 and 23.9%, respectively. (3) In both surveys, college students who reported having higher ST, lower PA, higher soda beverage and tea beverage intake, Chinese herbal medicine and vitamin drinking, and decreased frequency of diet also had higher depression and anxiety symptoms. Coping styles with COVID-19 partially mediate the association between some related lifestyle behaviors and anxiety and depression. The results of the conditional process model analysis support our hypothesis that lifestyle behaviors, and coping styles are both predictors of anxiety and depression symptoms, with both direct and indirect effects moderated by gender level. In logistic regression analysis, the correlation of depression and anxiety in the second rounds of the survey was higher than that in the first survey. In two surveys, there was a correlation between lifestyle health behaviors and coping style, gender and mental health.

Conclusions

Our findings demonstrated that the prevalence of anxiety and depression in the two rounds of surveys was different, and the prevalence in the second round was higher than that in the first round, as well as that in the two rounds of surveys. All survey identified that unhealthy lifestyle behaviors were positively associated with depression and anxiety symptoms. Compared with the emerged city of risk areas, other pandemic regions have a lower risk of mental health problems. The survey findings complement each other. Lifestyle health behaviors and coping style alleviated mental health symptoms. COVID-19-related social stressors were positively associated with mental health symptoms. The study also suggests that at the beginning of the pandemic, the effective management of college students' mental health problems, corresponding coping measures and maintaining a good lifestyle play a key role in the prevention and control of other cities. Understanding the college students' lifestyle behaviors during COVID-19 lockdown will help public health authorities reshape future policies on their nutritional recommendations, in preparation for future pandemics.

COVID-somnia: anxiety, insomnia, and poor sleep among second-line healthcare workers during COVID-19 pandemic

Background

Little information is available about the linkage between sleep affection and COVID-19. Preliminary reports and clinical observations focused on the appearance of related mental health issues, especially in healthcare workers (HCWs).

Methods

A cross-sectional study is conducted on the COVID-19 second-line HCWs using an English online survey prepared via Google forms. The survey focused on sociodemographic and profession-related characteristics (age, sex, smoking, history of previous sleep disorders or medications affecting sleep, comorbidities specialty, years of experience, and number of hours worked per week) and COVID-19-associated risks (being on the second line of COVID-19 management, following updates and news about COVID-19, and getting an infection with COVID-19 or having a colleague/friend who was infected with or died of COVID-19). Assessment of anxiety, insomnia, and sleep quality was done using the relevant diagnostic scales.

Results

This study included 162 second-line HCWs with a mean age of 34.36 ± 8.49 years. Although being in second lines, there was a high prevalence of anxiety (49.38%), insomnia (56.17%), and poor sleep quality (67.9%) during the pandemic. One condition was recently developed after the pandemic: insomnia in 6.6%, anxiety in 5.7%, and poor sleep in 16%. Two conditions were developed: insomnia and poor sleep in 21.7%, anxiety and poor sleep in 7.5%, and insomnia and anxiety in 10.4%. The three conditions were de novo experienced in 19.8%. A total of 22.4% of those who followed daily COVID-19 updates developed de novo combined anxiety, insomnia, and poor sleep. A total of 38.5% of participants that had been infected with COVID-19 developed de novo combined anxiety, insomnia, and poor sleep. A total of 50% of participants who had a colleague/friend who died with COVID-19 developed de novo combined anxiety, insomnia, and poor sleep.

Conclusion

Although being in second lines, there was a high prevalence of anxiety, depression, and poor sleep concerning COVID-19-related factors.

Lifestyle behaviors and mental health during the coronavirus disease 2019 pandemic among college students: a web-based study

Background

After emerging in China, the novel coronavirus disease 2019 (COVID-19) quickly spread to all parts of the country and became a global public health emergency. The Chinese government immediately took a series of protective and quarantine measures to prevent the spread of the virus, and these measures may have negative effects on behavior and psychological health. This study aimed to examine the associations between factors related to COVID-19 measures and mental health symptoms among Chinese college students in different pandemic areas.

Methods

An online survey was administered to 14,789 college students from February 4 to 12, 2020. After excluding the participants who did not complete the questionnaire, the quality of the questionnaire was checked. Finally, the sample included 11,787 college students from 16 cities and 21 universities in China. The areas included the city of Wuhan (Area 1), the neighboring province of Hubei (Area 2), first-tier cities (Beijing, Shanghai, and Guangzhou [Area 3]), and other provinces (Area 4).

Results

The average age of the participants was 20.51 ± 1.88 years. One-third of the participants were men. In total, 25.9 and 17.8% reported depression and anxiety, respectively. We also explored COVID-19-related factors, such as infection risk, perceived resistance to COVID-19 (or susceptibility to COVID-19 infection), perceived physical symptoms, family or friends, direct or indirect contact with confirmed cases, and having sought psychological counseling, which were significantly associated with anxiety and depression symptoms. Higher screen time, lower physical activity, higher soda and tea beverages (also called sugar sweetened beverages intake), use of alternative medicines or food supplements (including Chinese herbal medicines and vitamins), and decreased meal frequency were all correlated with higher depression and anxiety symptoms (depression: χ² = 25.57 and anxiety: χ² = 39.42). Coping with COVID-19 partially mediated the associations between some related lifestyle behaviors, anxiety, and depression. The conditional process model analysis results supported our hypotheses that lifestyle health behaviors and coping style were both predictors of anxiety and depression symptoms, and their direct and indirect effects were moderated by sex.

Conclusions

Compared with the city of Wuhan, other epidemic areas had a lower risk of mental health problems. Lifestyle health behaviors and coping styles alleviated mental health symptoms. COVID-19-related social stressors were positively associated with mental health symptoms.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14598-4.

Who reports insufficient and disturbed sleep? Results from a representative population-based health survey in Hong Kong

OBJECTIVES

To highlight the prevalence of sleep problems and identify associated risk factors among a representative sample recruited from the general population of Hong Kong.

DESIGN, SETTING AND PARTICIPANTS

Participants included 12 022 individuals (aged 15 or above) who took part in the Population Health Survey 2014/15, a territory-wide survey conducted by the Department of Health of the Government of the Hong Kong Special Administrative Region.

PRIMARY AND SECONDARY OUTCOME MEASURES

Outcomes were the prevalence of (1) insufficient sleep (<6 hours sleep per day) and (2) any sleep disturbance (difficulty initiating sleep, intermittent awakenings, early awakening) ≥3 times per week in the past 30 days. Multivariable logistic regression identified associations between sleep problems and sociodemographic, clinical and lifestyle factors.

RESULTS

9.7% of respondents reported insufficient sleep and 10.5% reported sleep disturbances ≥3 times a week. Female gender, monthly household income <$12 250 (Hong Kong dollar), lower education level, mental health condition and physical health condition were significantly associated with both insufficient and disturbed sleep (all p<0.05). Unemployment, homemaker, insufficient physical activity, current/former smoking status and harmful alcohol consumption were associated with sleep disturbances only (all p<0.01).

CONCLUSIONS

Sleep problems are highly prevalent in Hong Kong. As such problems are associated with a range of health conditions, it is important to facilitate improvements in sleep. Our results show that harmful alcohol consumption, insufficient physical activity and current smoking are modifiable risk factors for sleep disturbances. Public health campaigns should focus on these risk factors in order to promote a healthy lifestyle and ultimately reduce sleep disturbances. Targeted interventions for high-risk groups may also be warranted, particularly for those with doctor-diagnosed physical and mental health conditions.

The Gendered impact of the COVID-19 pandemic on academics working in Medical Imaging and Radiation Therapy

Introduction

Healthcare workers have been particularly impacted by the COVID-19 pandemic, as have those educating them, albeit differently. Several papers have identified a gendered difference in the impact of the pandemic. This study aims to determine impact of COVID-19 on the health and wellbeing of Medical Imaging and Radiation Therapy (MIRT) academics.

Methods

An electronic survey was designed in English on Qualtrics and distributed via email and online platforms to MIRT academics. Fifty-one questions were used; demographic (n = 9), work patterns (n = 11), general health (n = 8), mental health (n = 2), physical health (n = 10), and workload (n = 11). Overall, 46 were quantitative and five were qualitative ‘open-ended’ questions. The survey was open between 3rd March 2021 to 1st May 2021. Quantitative analysis was carried out using MS Excel v 16.61.1ss and SPSS v26.

Results

The survey reached 32 countries globally and 412 participants; 23.5% identified as men (n = 97) and 76.5% as women (n = 315). Women reported worse sleep quality than men and overwhelmingly felt they would not like to work remotely again if given a choice. A higher percentage of males, 73% versus 40.5% of females reported getting outdoors less. The CORE-10 validated questionnaire found that 10.3% of males (n = 42) and 2.7% of females (n = 11) experienced severe psychological distress the week immediately before the survey was conducted.

Conclusion

While the study has identified some gender-related differences in the impact of COVID-19 on the mental and physical health of MIRT academics, both males and females have experienced significant deterioration in health and wellbeing due to the pandemic.

Implication for practice

Developing mental health support for MIRT academics and defining optimum methods for raising awareness is recommended.

Social Integration and Sleep Quality during the COVID-19 Pandemic: Prospective Evidence from a Study of Retired Older Adults

BACKGROUND

Growing evidence has documented the adverse impact of the global COVID-19 pandemic on sleep quality among older adults. Given the negative consequences of poor sleep, it is critical to identify factors that provide older adults with resilience against worsening sleep quality. Social integration may represent one such resilience factor.

PURPOSE

This study evaluated the association of social integration and sleep quality during the COVID-19 pandemic.

METHODS

113 retired older adults completed assessments of their social integration after the onset of the COVID-19 pandemic, and of their sleep quality before and after the onset of the COVID-19 pandemic.

RESULTS

Higher levels of social integration were associated with better sleep quality during the COVID-19 pandemic, even when statistically controlling for pre-pandemic sleep quality. Sex-stratified analyses showed that this association was driven by women in our sample.

CONCLUSIONS

Social integration may confer resilience against poor sleep quality, especially in older adult women. Additional research is warranted to assess candidate mechanisms and moderators of the link between social integration and sleep quality.

Subjective sleep quality before and during the COVID-19 pandemic in a Brazilian rural population

OBJECTIVES

Prior studies have examined sleep during the coronavirus disease 2019 (COVID-19) pandemic, but have few compared sleep measured both during and prior to COVID. We examined the impact of the COVID-19 pandemic on subjective sleep quality in general and separately by gender and age (<50 vs. ≥50 years). Further, we compared sleep quality between those who did and did not follow quarantine orders.

METHODS

This sample is from the Baependi Heart Study, a family-based cohort of adults in South-eastern Brazil. Longitudinal data were from 417 individuals who completed the Pittsburgh Sleep Quality Index (PSQI) twice: between January 2010 and September 2014 (pre-COVID) and during the COVID-19 stay-at-home order March-June, 2020. Cross-sectional analysis included 800 participants.

RESULTS

Mean (±SD) PSQI scores were significantly higher during than before COVID-19 (5.7 ± 3.8 vs. 5.0 ± 3.3, p < .01). This increase was significant among women and among adults ≥50 years but not in men or younger adults. The significant increase in PSQI was only observed in those who quarantined during COVID-19 (5.9 ±3.7 vs. 5.2 ±3.4, p < .01) and not those who did not quarantine (5.0 ± 3.7 vs. 4.5 ± 3, p = .12). In cross-sectional analyses, individuals who quarantined had higher PSQI scores than nonquarantined individuals (6.1 ± 3.9 vs. 5.0 ± 3.5, p < .01). The quarantine status-dependent differences were significant for women (6.4 ± 4 vs. 5.2 ± 3.7, p < .01) and older adults (6.6 ± 0.1 vs. 5.5 ± 3.3, p = .04). Differences by quarantine status were attenuated after adjusting for age and gender.

CONCLUSIONS

Subjective sleep quality declined during the COVID-19 pandemic, particularly among women, older adults, and those compliant to quarantine orders.

Relationship between self-care activities, stress and well-being during COVID-19 lockdown: a cross-cultural mediation model

OBJECTIVES

To examine the mediation role of self-care between stress and psychological well-being in the general population of four countries and to assess the impact of sociodemographic variables on this relationship.

DESIGN

Cross-sectional, online survey.

PARTICIPANTS

A stratified sample of confined general population (N=1082) from four Ibero-American countries-Chile (n=261), Colombia (n=268), Ecuador (n=282) and Spain (n=271)-balanced by age and gender.

PRIMARY OUTCOMES MEASURES

Sociodemographic information (age, gender, country, education and income level), information related to COVID-19 lockdown (number of days in quarantine, number of people with whom the individuals live, absence/presence of adults and minors in charge and attitude towards the search of information related to COVID-19), Perceived Stress Scale-10, Ryff's Psychological Well-Being Scale-29 and Self-Care Activities Screening Scale-14.

RESULTS

Self-care partially mediates the relationship between stress and well-being during COVID-19 confinement in the general population in the total sample (F (3,1078)=370.01, p<0.001, R²=0.507) and in each country. On the other hand, among the evaluated sociodemographic variables, only age affects this relationship.

CONCLUSION

The results have broad implications for public health, highlighting the importance of promoting people's active role in their own care and health behaviour to improve psychological well-being if stress management and social determinants of health are jointly addressed first. The present study provides the first transnational evidence from the earlier stages of the COVID-19 lockdown, showing that the higher perception of stress, the less self-care activities are adopted, and in turn the lower the beneficial effects on well-being.

Are Sleep Problems Related to Psychological Distress in Healthy Aging during the COVID-19 Pandemic? A Review

The SARS-CoV-2 pandemic, characterized by home confinement and other restrictive measures to reduce the spread of the infection, led to significant changes in people's habits and lifestyle. One of the most common problems is the worsening of sleep quality or quantity, which could have negative effects on psychological wellbeing, particularly in older adults. The purposes of the present literature review considering healthy aging subjects are (a) to examine the existing research on sleep alterations during the current pandemic and (b) to highlight possible relationships between sleep problems and psychological distress. A systematic search strategy was implemented according to PRISMA guidelines in the international literature online databases, up to 1 July 2021. After identification and screening phases, 11 articles were included in this review. The studies found possible associations between sleep problems and mood changes-particularly in terms of depression and anxiety. In addition, altered sleep patterns seemed to be related to changes in individual aspects, lifestyle, and attitudes adopted by older adults during the COVID-19 lockdown. Thus, the pandemic could affect the sleep and psychological wellbeing of the older population, even in healthy aging.

Estimation of Sleep Stages Analyzing Respiratory and Movement Signals

The scoring of sleep stages is an essential part of sleep studies. The main objective of this research is to provide an algorithm for the automatic classification of sleep stages using signals that may be obtained in a non-obtrusive way. After reviewing the relevant research, the authors selected a multinomial logistic regression as the basis for their approach. Several parameters were derived from movement and breathing signals, and their combinations were investigated to develop an accurate and stable algorithm. The algorithm was implemented to produce successful results: the accuracy of the recognition of Wake/NREM/REM stages is equal to 73%, with Cohen's kappa of 0.44 for the analyzed 19324 sleep epochs of 30 seconds each. This approach has the advantage of using the only movement and breathing signals, which can be recorded with less effort than heart or brainwave signals, and requiring only four derived parameters for the calculations. Therefore, the new system is a significant improvement for non-obtrusive sleep stage identification compared to existing approaches.

Recent advances in wearable sensors and portable electronics for sleep monitoring

Despite the increasing awareness of the importance of sleep, the number of people suffering from insufficient sleep has increased every year. The gold-standard sleep assessment uses polysomnography (PSG) with various sensors to identify sleep patterns and disorders. However, due to the high cost of PSG and limited availability, many people with sleep disorders are left undiagnosed. Recent wearable sensors and electronics enable portable, continuous monitoring of sleep at home, overcoming the limitations of PSG. This report reviews the advances in wearable sensors, miniaturized electronics, and system packaging for home sleep monitoring. New devices available in the market and systems are collectively summarized based on their overall structure, form factor, materials, and sleep assessment method. It is expected that this review provides a comprehensive view of newly developed technologies and broad insights on wearable sensors and portable electronics toward advanced sleep monitoring as well as at-home sleep assessment.

Strategy for COVID-19 vaccination in India: the country with the second highest population and number of cases

Free vaccination against COVID-19 commenced in India on January 16, 2021, and the government is urging all of its citizens to be immunized, in what is expected to be the largest vaccination program in the world. Out of the eight COVID-19 vaccines that are currently under various stages of clinical trials in India, four were developed in the country. India’s drug regulator has approved restricted emergency use of Covishield (the name employed in India for the Oxford-AstraZeneca vaccine) and Covaxin, the home-grown vaccine produced by Bharat Biotech. Indian manufacturers have stated that they have the capacity to meet the country’s future needs for COVID-19 vaccines. The manpower and cold-chain infrastructure established before the pandemic are sufficient for the initial vaccination of 30 million healthcare workers. The Indian government has taken urgent measures to expand the country’s vaccine manufacturing capacity and has also developed an efficient digital system to address and monitor all the aspects of vaccine administration.

Sleep Quality and Physical Activity as Predictors of Mental Wellbeing Variance in Older Adults during COVID-19 Lockdown: ECLB COVID-19 International Online Survey

BACKGROUND

The COVID-19 lockdown could engender disruption to lifestyle behaviors, thus impairing mental wellbeing in the general population. This study investigated whether sociodemographic variables, changes in physical activity, and sleep quality from pre- to during lockdown were predictors of change in mental wellbeing in quarantined older adults.

METHODS

A 12-week international online survey was launched in 14 languages on 6 April 2020. Forty-one research institutions from Europe, Western-Asia, North-Africa, and the Americas, promoted the survey. The survey was presented in a differential format with questions related to responses "pre" and "during" the lockdown period. Participants responded to the Short Warwick-Edinburgh Mental Wellbeing Scale, the Pittsburgh Sleep Quality Index (PSQI) questionnaire, and the short form of the International Physical Activity Questionnaire.

RESULTS

Replies from older adults (aged >55 years, n = 517), mainly from Europe (50.1%), Western-Asia (6.8%), America (30%), and North-Africa (9.3%) were analyzed. The COVID-19 lockdown led to significantly decreased mental wellbeing, sleep quality, and total physical activity energy expenditure levels (all p < 0.001). Regression analysis showed that the change in total PSQI score and total physical activity energy expenditure (F(2, 514) = 66.41 p < 0.001) were significant predictors of the decrease in mental wellbeing from pre- to during lockdown (p < 0.001, R2: 0.20).

CONCLUSION

COVID-19 lockdown deleteriously affected physical activity and sleep patterns. Furthermore, change in the total PSQI score and total physical activity energy expenditure were significant predictors for the decrease in mental wellbeing.

Can Melatonin Be a Potential "Silver Bullet" in Treating COVID-19 Patients?

The therapeutic potential of melatonin as a chronobiotic cytoprotective agent to counteract the consequences of COVID-19 infections has been advocated. Because of its wide-ranging effects as an antioxidant, anti-inflammatory, and immunomodulatory compound, melatonin could be unique in impairing the consequences of SARS-CoV-2 infection. Moreover, indirect evidence points out to a possible antiviral action of melatonin by interfering with SARS-CoV-2/angiotensin-converting enzyme 2 association. Melatonin is also an effective chronobiotic agent to reverse the circadian disruption of social isolation and to control delirium in severely affected patients. As a cytoprotector, melatonin serves to combat several comorbidities such as diabetes, metabolic syndrome, and ischemic and non-ischemic cardiovascular diseases, which aggravate COVID-19 disease. In view of evidence on the occurrence of neurological sequels in COVID-19-infected patients, another putative application of melatonin emerges based on its neuroprotective properties. Since melatonin is an effective means to control cognitive decay in minimal cognitive impairment, its therapeutic significance for the neurological sequels of SARS-CoV-2 infection should be considered. Finally, yet importantly, exogenous melatonin can be an adjuvant capable of augmenting the efficacy of anti-SARS-CoV-2 vaccines. We discuss in this review the experimental evidence suggesting that melatonin is a potential "silver bullet" in the COVID 19 pandemic.

Elderly as a High-risk Group during COVID-19 Pandemic: Effect of Circadian Misalignment, Sleep Dysregulation and Melatonin Administration

The association of age with a higher vulnerability to COVID-19 infection is a subject of major importance. Several factors, including higher stress due to social isolation, diminished melatonin levels with age, and higher exposure of individuals to light at the evening, which reduces melatonin levels and disrupts circadian rhythmicity are relevant for maintaining the circadian health in aged individuals. Properly administered, chronotherapy restores the optimal circadian pattern of the sleep–wake cycle in the elderly. It involves adequate sleep hygiene, timed light exposure, and the use of a chronobiotic medication like melatonin, which affects the output phase of circadian rhythms thus controlling the biological clock. Besides, the therapeutic potential of melatonin as an agent to counteract the consequences of COVID-19 infections has been advocated due to its wide-ranging effects as an antioxidant, anti-inflammatory, and as an immunomodulatory agent, as well as to a possible antiviral action. This article discusses how chronotherapy may reverse the detrimental circadian condition of the elderly in the COVID-19 pandemic.

Depression, Anxiety and Stress during COVID-19: Associations with Changes in Physical Activity, Sleep, Tobacco and Alcohol Use in Australian Adults

The novel coronavirus (COVID-19) has enforced dramatic changes to daily living including economic and health impacts. Evidence for the impact of these changes on our physical and mental health and health behaviors is limited. We examined the associations between psychological distress and changes in selected health behaviors since the onset of COVID-19 in Australia. An online survey was distributed in April 2020 and included measures of depression, anxiety, stress, physical activity, sleep, alcohol intake and cigarette smoking. The survey was completed by 1491 adults (mean age 50.5 ± 14.9 years, 67% female). Negative change was reported for physical activity (48.9%), sleep (40.7%), alcohol (26.6%) and smoking (6.9%) since the onset of the COVID-19 pandemic. Significantly higher scores in one or more psychological distress states were found for females, and those not in a relationship, in the lowest income category, aged 18-45 years, or with a chronic illness. Negative changes in physical activity, sleep, smoking and alcohol intake were associated with higher depression, anxiety and stress symptoms. Health-promotion strategies directed at adopting or maintaining positive health-related behaviors should be utilized to address increases in psychological distress during the pandemic. Ongoing evaluation of the impact of lifestyle changes associated with the pandemic is needed.