Psychosocial impact of COVID-19

Comparing counseling outcome for college students: Metaverse and in-person approaches

ABSTRACTObjective This study compared metaverse counseling with in-person counseling, using in-person counseling as a comparison group. To achieve this, we assessed whether metaverse counseling, a novel treatment approach, is comparable to traditional in-person counseling. Method: A total of 60 participants voluntarily participated in the study. Among the participants, 28 preferred in-person counseling, whereas 32 selected metaverse counseling as their preferred treatment option. Results and Conclusion: The findings indicated no statistically significant differences in the psychological symptom change patterns between the two counseling modalities. Both metaverse and in-person counseling demonstrated a common pattern of reduced symptom levels from pre-to post-session (Metaverse counseling Cohen's d = 1.04, In-person counseling Cohen's d = .62), which remained stable from post-session to follow-up regardless of the chosen counseling modality. Furthermore, the study revealed that the metaverse counseling group exhibited a higher level of working alliances than the in-person counseling group. Additionally, there was a slight tendency toward higher levels of counseling satisfaction in the metaverse counseling group than in the in-person counseling group. The results of this study support the use of synchronous metaverse programs to treat college students. The implications and limitations of this study are discussed. (195 words).

Differences in the Rates of Diagnoses of Mental and Behavioral Disorders Due to Psychoactive Substance Use by Sex and Age during Pre-Pandemic and COVID-19 Pandemic Periods in Kazakhstan

BACKGROUND

The COVID-19 pandemic had profound impacts worldwide on individuals with mental and behavioral disorders, including disorders due to psychoactive substance use. We investigated how the COVID-19 pandemic affected the trends in these disorders in the Republic of Kazakhstan.

METHODS

We researched and compared ICD-10 data on mental and behavioral disorders due to substance use in Kazakhstan that were diagnosed in 2018-2019 (pre-pandemic) versus 2020-2021 (the pandemic period).

RESULTS

The data for the pandemic period were significantly different from those of the pre-pandemic in that (i) 'other stimulant-related disorders (F15)' and 'other psychoactive substance-related disorders (F19)' were increased in the younger age groups, (ii) the risk of 'opioid-related disorders (F11)' was decreased in the 30-year-old group in both males and females, and (iii) the risk of 'alcohol-related disorders (F10)' was increased in the 30-year-old group and decreased in the 20- and 50-year-old groups. In only the males, (iv) the risk of 'other psychoactive substance-related disorders (F19)' was increased in almost all of the age groups, and (v) the risk of 'cannabis-related disorders (F12)' was increased in the ≥50-year-olds. The pre-pandemic and pandemic periods thus involved changes due to COVID-19 in both males and females that were especially notable in males.

CONCLUSIONS

These results indicate that further measures designed to prevent mental and behavioral disorders due to psychoactive substances are necessary at the primary, secondary, and tertiary levels, and personnel in medicine/nursing, the government, private organizations, and the public need to collaborate to devise such measures.

Impact of COVID-19 on Psychiatric Patients: The Role of Vaccination, Comorbidities, and Biomarkers in Clinical Outcomes

Background/Objectives: The COVID-19 pandemic has posed significant challenges, particularly for individuals residing in psychiatric facilities. This study aims to investigate the impact of COVID-19 on psychiatric patients, focusing on factors such as their vaccination status, comorbidities, medication regimens, and biomarkers like C-reactive protein (CRP) and ferritin. Methods: This retrospective study analyzed 100 patients with confirmed SARS-CoV-2 infections admitted to the private psychiatric clinic "Asclepius of Upper Volos" from March 2020 to March 2023. The data collected included sociodemographic characteristics, vaccination status, symptom severity, medication regimens, and levels of CRP and ferritin. Statistical analyses using IBM SPSS Statistics version 29 included Pearson's chi-square tests, Student's t-tests, and a survival time analysis via the log-rank test to assess associations between clinical characteristics and outcomes. Results: Among the participants, 64% were female and 74% received two doses of the COVID-19 vaccine. The majority experienced mild symptoms, with a survival rate of 74%. Statistically significant findings include a higher survival rate among vaccinated individuals (98.6%) versus unvaccinated individuals (1.4%, p < 0.001). Comorbidities like chronic obstructive pulmonary disease (COPD), coronary artery disease, and renal failure were associated with severe symptoms and higher mortality rates. Higher ferritin levels were significantly associated with poorer outcomes, with survivors having a mean ferritin level of 246.2 (SD = 150.3) compared to the 416.9 (SD = 215.9) seen in non-survivors (p < 0.001). Similarly, mean CRP levels were lower in survivors (1.58, SD = 1.96) than in non-survivors (3.46, SD = 2.92), with a p-value of 0.002. Conclusions: The findings underscore the importance of tailored health protocols and continued support for this vulnerable population. Enhanced strategies for managing comorbidities and utilizing biomarkers can aid in better predicting and improving psychiatric patient outcomes.

Long-term effects of the COVID-19 pandemic for patients with cancer

INTRODUCTION

Long COVID is defined as the continuation of symptoms, unexplainable by alternative diagnosis, longer than four weeks after SARS-CoV-2 infection. These symptoms might hinder daily activities and overall well-being, ultimately impacting quality of life (QoL). Several studies have reported fatigue as the most common symptom, followed by dyspnoea, headache and myalgia. Although it is assumed that long COVID affects 10-20% of SARS-CoV-2 infected individuals, recently numbers up to 60% were described for patients with cancer. This study uncovers the impact of the COVID-19 pandemic on QoL of patients with cancer and how long COVID manifests in this cohort.

METHODS

A group of 96 patients with cancer was followed from March 2022 till March 2023. Online questionnaires assessing symptoms associated with long COVID, anxiety and depression (HADS), quality of life (EORTC-QLQ-C30) and cognitive functioning (CFQ) were sent every three months during this period. Furthermore, a semi-structured focus group was organised for qualitative data collection.

RESULTS

Overall, these patients reported a negative impact of the enforced COVID-19 restrictions on the emotional and psychological wellbeing. Forty nine patients with cancer (51.0%) were infected with SARS-CoV-2 over the course of the study, of which 39 (79.6%) reported long COVID symptoms. The most commonly reported symptoms were myalgia (46.2%), fatigue (38.5%) and disturbed sleep (35.9%) and it was observed that male sex is associated with poor long COVID outcomes.

CONCLUSION

While patients with cancer experience similar long COVID symptoms as healthy controls, the prevalence is remarkably higher possibly due to their compromised immune system and weakened physiological reserve.

Integrated Community-Based Care for Dependent Older People Community Participation in Preparation for Recurrent Outbreaks of COVID-19

Background

The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted family caregivers of older dependents, leading to fatigue, anxiety, depression, and financial burdens, which in turn diminish their quality of life. This study investigated the integration of community participatory systems in older care to address potential COVID-19 recurrence and develop policy proposals for the integrated care of dependent older people.

Methods

An explanatory sequential design was used, with stratified random sampling across six provinces, resulting in a sample of 440 family caregiver dyads and 154 full-time community stakeholders (October 2021--May 2022). Five validated tools were employed, with a content validity of 0.91 and a Cronbach's alpha of 0.69. The data analysis included descriptive statistics and thematic analysis.

Results

Among the 440 primary caregiver households, 42.73% of the older people had moderate dependence, 30.00% had severe dependence, and 27.27% had complete dependence, with common health issues, including chronic illness and comorbidities. Most older adults lived with their children/grandchildren, had insufficient income, and were informed about COVID-19 prevention measures. Family caregivers, predominantly female (average age 54), had multiple underlying conditions and provided an average of 37 hours of care per week, primarily communicating via phones or apps. The 154 stakeholders included public health volunteers and professional nurses, with an average age of 55 years, and were predominantly female (74.55%). They adhered strictly to COVID-19 precautions during their caregiving duties. This study highlights the impact of trust and COVID-19 perceptions on older care, emphasizing the need for specific forms of care, community support, and resources. Perceptions of "trust", "stay home", "self-care", and "distance" significantly influenced care for dependents. The findings will inform health and social workers' planning, operation, and training, addressing the specific care needs of dependent older adults.

Conclusion

This study recommends policy interventions such as budget allocations for essential equipment, better compensation for community work, and the fostering of expertise in elder care. Emphasis is placed on fostering collaborative community agreements.

The impact of vaccine hesitancy on psychological impairment among healthcare workers in a Total Worker Health© approach

Introduction

Vaccination practice is a well-known individual protective measure for biological risk in healthcare. During the COVID-19 pandemic vaccine hesitancy has grown among healthcare workers (HCWs). The study aims to investigate how vaccine hesitancy influences the psychological burden experienced by healthcare workers.

Methods

This study aimed to explore attitudes of HCWs in acceptance or refusal of vaccinations related to the risk of psychological impairment (PI) and describe the associated occupational factors, during the seasonal flu/COVID-19 vaccination campaign of 2022-2023. 302 HCWs were enrolled in the study. A questionnaire was self-administered, including two scales on the risk of psychological impairment (Psychological Injury Risk Indicator, PIRI) and vaccine hesitancy (Adult Vaccine Hesitancy Scale, AVHS).

Results

PIRI scores revealed that 29.8% of participants were at risk of PI. Differences in sex, age, occupational seniority, professional category, and night shifts were found between HCWs at risk of PI and those not at risk. Females registered a four-fold higher risk than males (85.6% vs. 14.4%, χ2 = 4.450, p < 0.05). Nurses were the highest risk category, followed by physicians and technicians (54.4% vs. 30.0% vs. 12.2%, χ2 = 14.463, p < 0.001). 41.7% of participants received the flu vaccination, and 98.9% received the COVID-19 vaccine. HCWs were prone to being vaccinated to protect patients and family members. Conversely, vaccine refusal was attributed to the perception of flu vaccines as not beneficial and COVID-19 contagion at low risk. The latter was more frequently reported for HCWs at risk of PI (16.7% vs. 4.7%, χ2 = 11.882, p = 0.001). Finally, hesitant HCWs were at higher risk of psychological impairment than others.

Discussion

HCWs expressed vaccine acceptance considering their social role in the community as protectors. However, the underestimation of the risk of severity of COVID-19 was more relevant among HCWs at risk of PI than others. Psychological aspects need to be considered by healthcare providers when fighting vaccine hesitancy.

Effects of Lacticaseibacillus rhamnosus HN001 on Happiness and Mental Well-Being: Findings from a Randomized Controlled Trial

BACKGROUND/OBJECTIVES

Lacticaseibacillus rhamnosus HN001 (HN001) is a probiotic strain widely studied for its potential to improve human health. Previous studies have demonstrated promising results for HN001 in the improvement of mental well-being, particularly in terms of increased happiness and support for stress management in healthy adults.

METHODS

To further explore these findings, a double-blind, placebo-controlled trial was conducted with 120 participants aged ≥ 18 years with mild to high stress measured by the Perceived Stress Scale (PSS). The participants were randomly assigned to receive either HN001 or placebo for 28 days. Psychological assessments, including the Oxford Happiness Questionnaire (OHQ), were completed at baseline, day 14, and day 28. Secondary outcomes included changes in PSS scores, as well as depression, anxiety, stress, and total score levels measured by the DASS-21 questionnaire.

RESULTS

While not statistically significant, participants who received HN001 showed an improvement in OHQ (mean change, 13.3) and PSS total scores (mean change, -8.1) over time compared with the placebo group (mean change, 10.2 and -6.6, respectively). Furthermore, 39% of the participants moved from not happy to happy, compared with only 29% in the placebo group. Post-hoc analysis showed a statistically significant interaction between intervention and study day for OHQ and PSS total scores, with p-values of 0.014 and 0.043, respectively. No adverse effects were observed.

CONCLUSIONS

HN001 showed improvements in both happiness and PSS scores. Furthermore, sex subgroup analysis revealed statistically significant differences in both outcomes, emphasizing the need for larger and longer intervention studies.

Increasing prevalence of self-harm, suicidal behavior and suicidal ideation throughout a three-year period in the context of COVID-19 pandemic in Spain

The COVID-19 pandemic had a great impact on mental health both in the general population and in individuals with preexisting mental disorders. Lockdown, social restrictions, changes in daily habits and limited access to health services led to changes in consultations in mental health services. This study aimed to determine changing trends in psychiatric admissions by the inclusion of adult patients admitted to the Emergency Department (ED) of Hospital Clínic of Barcelona between 2019 and 2021. Acute admissions, social issues and psychiatric diagnoses were compared between years, seasons and considering the interaction between both years and seasons. A total of 13,677 individuals were included in the analysis. An overall reduction in consultations to the ED and a higher proportion of acute admissions was observed in 2020 in context of the COVID-19 outbreak. Increased prevalence of sleeping disorders and substance use disorders was found in 2020. Self-harming behavior, suicidal thoughts and suicidal behavior showed an increasing tendency over time, with their highest rates in 2021. Prevention and management strategies should be considered in order to address increasing needs in mental health care.

Dynamics of natural hazard risk awareness: Panel analysis insights from Switzerland

The analysis of risk awareness should be the initial stage in integrated natural hazard risk management to promote appropriate and effective measures for mitigating risks and strengthening social resilience inside the multi-risk framework. Nevertheless, earlier studies focused on cross-sectional data and overlooked the changes in risk awareness levels and associated independent variables with time. This study analyzes for the first time a balanced nationwide panel dataset of 1612 respondent-year observations from Switzerland (period 2015-2021, including the epidemic of COVID-19) to examine and compare the effects of potential independent variables on the four dimensions of natural hazard risk awareness (NHRA), ranging from the broadest dimension of Relevance to higher dimensions of Perceived Probability of an event, Perceived Threat to life and valuables, and Perceived Situational Threat. The analysis in this study incorporates multiple methods of Random-Effect Model (RE), Generalized Linear Model (GLM), and mediation analysis. Results show that NHRA increased in Switzerland to different extents (up to 23.24%) depending on the dimension. Event memory, perceived information impact and reported individual informed level appeared to be the most consistent independent variables positively influencing panel NHRA. Among these, perceived information impact as an important indicator of risk communication, was also found to serve as a mediator from risk preparedness to risk awareness. By encouraging residents to engage in "Begin Doing Before Thinking" (BDBT) programs to leverage subliminal effects and self-reflection, this study proposes that behavior-cognition feedback loops may facilitate a virtuous cycle. Our promising observations provide recommendations for an effective awareness-rising strategy design and suggest extensive insights from potential short-interval panel analysis in the future.

The impact of COVID-19 on livelihood assets: a case study of high-value crop farmers in North-West Bangladesh

The COVID-19 pandemic has had a catastrophic impact on public health, extending to the food system and people's livelihoods worldwide, including Bangladesh. This study aimed to ascertain the COVID-19 pandemic impacts on livelihood assets in the North-Western areas (Rajshahi and Rangpur) of Bangladesh. Primary data were collected from 320 farmers engaged in high-value agriculture using a multistage sampling method. The data were analysed using first-order structural equation modelling. The findings reveal a significant impact (p < 0.01) of the pandemic on all livelihood assets in Bangladesh. Notably, human assets exhibited the highest impact, with a coefficient of 0.740, followed sequentially by financial (0.709), social (0.684), natural (0.600), physical (0.542), and psychological (0.537) assets. Government-imposed lockdowns and mobility restrictions were identified as the major causes of the pandemic's negative effects on livelihoods, which included lost income, rising food prices, decreased purchasing power, inadequate access to food and medical supplies, increased social insecurity, and a rise in depression, worry, and anxiety among farmers. The effects of COVID-19 and associated policy measures on the livelihoods of high-value crop farmers have reversed substantial economic and nutritional advances gained over the previous decade. This study suggests attention to the sustainable livelihoods of farmers through direct cash transfer and input incentive programs to minimize their vulnerability to a pandemic like COVID-19 or any other crisis in the future.

The impact of resilience and coping strategies on depressive symptoms among Korean American older adults during COVID-19

OBJECTIVES

This study examined how resilience and coping strategies were associated with depressive symptoms among Korean American older adults during COVID-19. The prevalent depressive symptoms and low use of mental health services in this population have raised significant concerns among healthcare professionals. Therefore, this study aims to understand the relationships between resilience and coping types on depressive symptoms and provide valuable insights into addressing these issues within this ethnic group.

METHOD

A cross-sectional survey was conducted with 132 Korean American older adults. Hierarchical linear regression analyses were performed to assess the effect of sociodemographic factors (age, gender, marital status, years of living in the U.S., self-rated health, financial security), resilience, and coping strategies (problem-focused coping, emotion-focused coping, avoidant coping) on depressive symptoms. Next, the interactions between resilience and three coping strategies for depressive symptoms were tested.

RESULTS

The findings show that depressive symptoms were associated with financial security and avoidant coping. Also, resilience interacted with avoidant coping and emotion-focused coping. Among the participants with low resilience, depressive symptoms increased rapidly when avoidant and emotion-focused coping strategies increased, respectively.

CONCLUSION

This study emphasizes the importance of culturally tailored interventions to promote resilience and decrease avoidant and emotion-focused coping among Korean American older adults.

School Health Promotion, the Body Mass Index z-Score, and Psychosocial Health in Primary Schools of the Netherlands

Childhood overweight and psychosocial issues remain significant public health concerns. Schools worldwide implement health promotion programs to address these issues and to support the physical and psychosocial health of children. However, more insight is needed into the relation between these health-promoting programs and the Body Mass Index (BMI) z-score and psychosocial health of children, while taking into account how school factors might influence this relation. Therefore, we examined whether the variation between primary schools regarding the BMI z-score and psychosocial health of students could be explained by school health promotion, operationalized as Healthy School (HS) certification, general school characteristics, and the school population; we also examined to what extent the characteristics interact. The current study had a repeated cross-sectional design. Multilevel analyses were performed to calculate the variation between schools, and to examine the association between HS certification and our outcomes. Existing data of multiple school years on 1698 schools were used for the BMI z-score and on 841 schools for psychosocial health. The school level explained 2.41% of the variation in the BMI z-score and 2.45% of the variation in psychosocial health, and differences were mostly explained by parental socioeconomic status. Additionally, HS certification was associated with slightly lower BMI z-scores, but not with psychosocial health. Therefore, obtaining HS certification might contribute to the better physical health of primary school students in general. This might indicate that HS certification also relates to healthier lifestyles in primary schools, but further research should examine this.

Outcomes of a Virtual 10-Week COVID-19 and Psychosis Program in an HMO: A Mixed Methods Quality Improvement Project

Virtual clinical services became the primary treatment modality in a large U.S. HMO psychiatry department during the COVID-19 pandemic. A mixed methods quality improvement project was developed to address psychosis, severe anxiety, and stressors unique to COVID-19 and sheltering in place. The purpose was to determine if a virtual 10-week pilot program combining psychoeducation, skills-based training, experiential exercises using third-wave CBT, and process questions would decrease symptoms and hospitalization rates and improve quality of life. Pre- and postmeasure scores on pandemic-related stress (the PRSF), perceived stress (PSS), and general patient health (PHQ-9) were gathered from five patients in the Department of Psychiatry at Kaiser Permanente in Oakland, California. Qualitative interviews explored patients' perceptions of program benefits. Mean, median, and range on the pre- and postprogram assessments and paired samples t tests for means were calculated. Quantitative results were not statistically significant: p = 0.32 (Revised PRSF), p = 0.34 (PSS), p = 0.94 (PHQ-9). In interviews, most participants reported a decrease in pandemic-related stress. Half reported a decrease in general perceived stress. Half reported no change. Self-assessment reflected perceptions of benefits from this 10-week program, using words such as useful and important. The virtual program helped relieve pandemic-related stress and improved overall quality of life. The results show promise for expanding the program to other hospitals providing services for this diagnostic population.

Effects of Psychogenic Stress Frequency during the Growth Stage on Oxidative Stress, Organ and Bone Development

BACKGROUND

This study aimed to examine the effects of psychogenic stress (PS) frequency on oxidative stress and organ development during growth and to gain fundamental insights into developmental processes during this period.

METHODS

Four-week-old male Wistar rats were randomly assigned to a control and three PS groups according to PS frequencies. PS was induced using restraint and water immersion techniques once daily for 3 hr at a time for a period of 4 weeks.

RESULTS

Oxidative stress increased with increasing PS frequency. The weights of organs other than the adrenal glands significantly decreased with increasing PS frequency, indicating growth suppression. Furthermore, bone morphology, weight, and length significantly decreased with increasing PS frequency.

CONCLUSIONS

High-frequency PS exposure during developmental growth significantly negatively affects oxidative stress and organ and bone development. In particular, increased oxidative stress due to excessive PS has detrimental effects on organ and bone growth.

Comparing Family Health Before and After a Family-Focused Nutrition Program during the Pandemic

INTRODUCTION

The COVID-19 pandemic affected child health behaviors, leading to worse physical health. Given the importance of good family health in improved child health outcomes, this secondary cohort analysis tested the hypothesis that family health would improve from baseline to 12-week follow-up after participation in a novel family nutrition program.

METHODS

Diverse parent-child dyads participated in a home-based virtual Teaching Kitchen Outreach (vTKO) program (11 weekly healthy, low-cost recipes, cooking videos, and associated groceries delivered). The primary outcome was the Family Healthy Lifestyle Subscale (FHLS). Secondary outcomes were parent and child nutrition, and food insecurity. Statistical testing and modeling were used to evaluate pre-post outcomes.

RESULTS

Of 123 enrolled dyads, 114 (93%) had sufficient data for analysis. Participants were 11% Hispanic, 54% Black, and 28% White; 31% completed high school or less; and 30% indicated food insecurity. Cohort mean pre-post FHLS scores significantly increased (25.5 vs. 27.3; p < 0.001). There were significant improvements in parent nutrition (p < 0.001) and child nutrition (p = 0.02 to < 0.001), but not in food security. After adjusting for baseline covariates, tobit regression found statistically significant pre-post FHLS differences (2.3; 95% CI=[1.4, 3.3]; p < 0.001).

DISCUSSION

Participants in the novel home-based vTKO program reported improved family health over 12 weeks.

Investigating the mode of transmission of COVID-19 through genital secretions, semen, the birth canal, and lactation: A systematic review

In a global pandemic, the coronavirus has brought new challenges to reproductive and sexual health. This systematic review has been conducted with the aim of investigating a) the transmission of coronavirus disease 2019 (COVID-19) through female-to-male sexual secretions and vice versa, b) vertical transmission to the fetus, c) transmission to the newborn through the birth canal, and d) transmission through breast milk. In this review study, to find related articles, databases were searched using English and Persian keywords from the beginning of 2019 to the end of 2023. Based on the entry and exit criteria and the qualitative evaluation of the studies based on the STROBE criterion, the final studies were summarized. According to the initial search, 5970 articles were reviewed. After removing duplicate articles and the inappropriateness of the title, the abstract of the article was not related to the objectives of the project, there was no relevant study, and retrospective studies were excluded. Finally, 120 articles were selected as final articles. The general results show that transmission of the virus through the vagina to the blood of the fetus causing septicemia, vertical transmission from the mother to the fetus, transmission through the water bag, genital secretions, and ejaculate fluid are considered rare and ruled out. Transmission through rectal secretions during anal or oral sex requires more extensive studies. It is not possible to transmit the virus through breast milk. The long-term reproductive impact of COVID-19 on the reproductive systems of women and men is unclear.

Effects of perceived risk of COVID-19 on fear among visiting workers: Mediating role of perceived stress

With the creation of a social distancing policy due to coronavirus disease 2019 (COVID-19), home visit workers are under mental stress as they are treated as the source of infection for COVID-19. Since door-to-door rental equipment examiners and gas inspectors must perform their duties even in the COVID-19 situation, they are being discriminated against so severely. The purpose of study was to examine the mediating role of perceived stress on the relationship between risk perception and fear. Data was collected data through labor unions among 275 home visiting workers who examine rental home appliance equipment or inspecting gas. On-line survey was conducted to assess COVID-19 risk perception, fear, perceived stress, and demographic characteristics. The data was analyzed using PROCESS Macro (Model 4). The results of the study showed that stress plays an important role in increasing COVID-19 fears when COVID-19 risk perception increases. Meanwhile, it was found that COVID-19 fear decreased when the level of perceived stress decreased. To reduce the impact of COVID-19 risk perception on COVID-19 fears, appropriate educational programs to reduce stress should be developed for home visit workers. Policymakers need to develop online or mobile Infectious disease education programs for COVID-19 risk at work and establish policies to apply legal education.

Interplay between Comorbidities and Long COVID: Challenges and Multidisciplinary Approaches

Long COVID, a name often given to the persistent symptoms following acute SARS-CoV-2 infection, poses a multifaceted challenge for health. This review explores the intrinsic relationship between comorbidities and autoimmune responses in shaping the trajectory of long COVID. Autoantibodies have emerged as significant players in COVID-19 pathophysiology, with implications for disease severity and progression. Studies show immune dysregulation persisting months after infection, marked by activated innate immune cells and high cytokine levels. The presence of autoantibodies against various autoantigens suggests their potential as comorbid factors in long COVID. Additionally, the formation of immune complexes may lead to severe disease progression, highlighting the urgency for early detection and intervention. Furthermore, long COVID is highly linked to cardiovascular complications and neurological symptoms, posing challenges in diagnosis and management. Multidisciplinary approaches, including vaccination, tailored rehabilitation, and pharmacological interventions, are used for mitigating long COVID's burden. However, numerous challenges persist, from evolving diagnostic criteria to addressing the psychosocial impact and predicting disease outcomes. Leveraging AI-based applications holds promise in enhancing patient management and improving our understanding of long COVID. As research continues to unfold, unravelling the complexities of long COVID remains paramount for effective intervention and patient care.

Evaluation of Telemedicine Consultations Using Health Outcomes and User Attitudes and Experiences: Scoping Review

BACKGROUND

Despite a recent rise in adoption, telemedicine consultations retention remains challenging, and aspects around the associated experiences and outcomes remain unclear. The need to further investigate these aspects was a motivating factor for conducting this scoping review.

OBJECTIVE

With a focus on synchronous telemedicine consultations between patients with nonmalignant chronic illnesses and health care professionals (HCPs), this scoping review aimed to gain insights into (1) the available evidence on telemedicine consultations to improve health outcomes for patients, (2) the associated behaviors and attitudes of patients and HCPs, and (3) how supplemental technology can assist in remote consultations.

METHODS

PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guided the scoping review process. Inclusion criteria were (1) involving adults with nonmalignant, noncommunicable chronic conditions as the study population; (2) focusing on health outcomes and experiences of and attitudes toward synchronous telemedicine consultations between patients and HCPs; and (3) conducting empirical research. A search strategy was applied to PubMed (including MEDLINE), CINAHL Complete, APA PsycNet, Web of Science, IEEE, and ACM Digital. Screening of articles and data extraction from included articles were performed in parallel and independently by 2 researchers, who corroborated their findings and resolved any conflicts.

RESULTS

Overall, 4167 unique articles were identified from the databases searched. Following multilayer filtration, 19 (0.46%) studies fulfilled the inclusion criteria for data extraction. They investigated 6 nonmalignant chronic conditions, namely chronic obstructive pulmonary disease, diabetes, chronic kidney disease, ulcerative colitis, hypertension, and congestive heart failure, and the telemedicine consultation modality varied in each case. Most observed positive health outcomes for patients with chronic conditions using telemedicine consultations. Patients generally favored the modality's convenience, but concerns were highlighted around cost, practical logistics, and thoroughness of clinical examinations. The majority of HCPs were also in favor of the technology, but a minority experienced reduced job satisfaction. Supplemental technological assistance was identified in relation to technical considerations, improved remote workflow, and training in remote care use.

CONCLUSIONS

For patients with noncommunicable chronic conditions, telemedicine consultations are generally associated with positive health outcomes that are either directly or indirectly related to their ailment, but sustained improvements remain unclear. These modalities also indicate the potential to empower such patients to better manage their condition. HCPs and patients tend to be satisfied with remote care experience, and most are receptive to the modality as an option. Assistance from supplemental technologies mostly resides in addressing technical issues, and additional modules could be integrated to address challenges relevant to patients and HCPs. However, positive outcomes and attitudes toward the modality might not apply to all cases, indicating that telemedicine consultations are more appropriate as options rather than replacements of in-person visits.

COVID-19-Related Increases in Depressive and Anxious Symptoms Are Associated with Maladaptive Eating Among Patients up to 4 years Post-bariatric Surgery

INTRODUCTION

Depressive and anxious symptoms and maladaptive eating behaviors fluctuate with stressful events for patients seeking bariatric surgery. These associations are less clear for patients postoperatively. Using the COVID-19 pandemic as a frame, we examined associations between changes in depressive and anxious symptoms and maladaptive eating behaviors between up to four years postoperatively.

METHODS

Participants (N = 703) who underwent surgery between 2018 and 2021 completed web-based questionnaires between 2021 and 2022. Demographic and surgical data were obtained from electronic health records. Participants reported whether depressive and anxious symptoms increased or were stable/decreased during the COVID-19 pandemic, and completed eating behavior measures.

RESULTS

Many participants reported increased depressive (27.5%) and anxious (33.7%) symptoms during the COVID-19 pandemic. Compared to those who reported stable or decreased symptoms, these participants were as follows: (1) more likely to endorse presence of binge, loss-of-control, graze, and night eating; (2) reported higher emotional eating in response to anger and frustration, depression, and anxiety; and (3) reported higher driven and compulsive eating behaviors. Frequency of binge, loss-of-control, graze, and night eating episodes did not differ between groups (e.g., increased vs. stable/decreased anxious symptoms) among participants who endorsed any episodes.

CONCLUSION

A large portion of the sample reported increased depressive and anxious symptoms during the COVID-19 pandemic, and these increases were associated with maladaptive eating behaviors. Depressive and anxious symptoms and eating behaviors should be assessed postoperatively as significant stressors may be associated with increased distress and maladaptive eating behaviors that can affect postoperative outcomes. Postoperative interventions may be useful at simultaneously targeting these concerns.

Emotional State of Older Adults During the COVID-19 Pandemic: Insights from the Cognitive and Social Well-Being (CoSoWELL) Corpus

OBJECTIVES

In view of the fallout of the COVID-19 pandemic, psychologists face a challenge to document the pandemic-related change in emotional well-being of individuals and groups and evaluate the emotional response to this fallout over time.

METHODSP

We contribute to this goal by analyzing the new CoSoWELL corpus (version 2.0), an 1.8 million-word collection of narratives written by over 1,300 older adults (55+ y.o.) in eight sessions before, during and after the global lockdown. In the narratives, we examined a range of linguistic variables traditionally associated with emotional well-being and observed signs of distress, i.e., lower positivity and heightened levels of fear, anger, and disgust.

RESULTS

In most variables, we observed a characteristic timeline of change, i.e., a delayed (by 4 months) and abrupt drop in optimism and increase in negative emotions that reached its peak about 7 months after the lockdown and returned to pre-pandemic levels one year after. Our examination of risk factors showed that higher levels of self-reported loneliness came with elevated levels of negative emotions but did not change the timeline of emotional response to the pandemic.

CONCLUSIONS

We discuss implications of the findings for theories of emotion regulation.

"You always think the worst …" Family members' experiences during the COVID-19 emergency: A qualitative descriptive study

AIM

The aim of this study was to explore the experiences of family members of patients admitted to the intensive care unit (ICU) for COVID-19 during the first and second waves of the pandemic in Switzerland.

DESIGN

A qualitative descriptive approach was used in this study.

METHODS

Face-to-face in-depth semistructured interviews were used to explore the experiences of family members of surviving COVID-19 patients, who were admitted to the ICU. Interviews were transcribed verbatim and wereanalysed using Braun and Clarke thematic analysis. In our context, family visits were prohibited during the first and second waves of the pandemic.

FINDINGS

Fifteen family members participated. Interviews were conducted between October 2020 and March 2021. Data analysis identified three main themes: (i) becoming a pillar of support for all; (ii) dealing with uncertainty; and (iii) a trajectory of emotions. Five subthemes are reported within these themes. The primary concern was the need for information due to visitation restrictions. This led to stress as many became the main communication source for other family members and friends. Coping strategies to support the ongoing uncertainty included daily routines, work, and prayer. The inability to visit and the lack of information led to a range of conflicting emotions, such as feeling of helplessness, which were countered by the gratitude that their loved ones had survived.

CONCLUSION

This study highlights the profound impact of the COVID-19 pandemic on the family members of ICU patients. It emphasises their struggle for information, adaptation to new roles, and coping mechanisms amidst uncertainty. Although they experienced predominantly negative emotions, the recovery and return of their loved ones triggered a sense of gratitude. This study sheds light on the crucial role of social support. Such findings may have implications for nursing practice in effectively addressing the concerns and priorities of family members in similar emergency situations, thereby improving clinical outcomes.

Network analysis for inter-relationships of the suboptimal health status with depression and anxiety during the COVID-19 pandemic: A perspective of predictive, preventive, and personalized health

BACKGROUND

The Coronavirus Disease-2019 (COVID-19) pandemic has had a profound impact on suboptimal health status, depression, and anxiety, necessitating a comprehensive understanding of their inter-relationships at the national level. This study aims to investigate the inter-relationships among suboptimal health status, depression, and anxiety using a network analysis approach.

METHODS

We conducted a national survey between June 20 and August 31, 2022. Three network models were constructed and analyzed to independently examine the inter-relationships among suboptimal health status, depression, and anxiety.

RESULTS

A total of 26,152 participants were included in this study. The study network analysis indicated that item 9 (i.e., Slow response) exhibited the highest node strength within the suboptimal health status questionnaire-short form (SHSQ-SF) network, followed by item 5 (i.e., Breathlessness at rest). Additionally, positive correlations were observed between depression and anxiety severity and most of the SHSO-SF items.

CONCLUSIONS

This study provided valuable insights into inter-relationships between suboptimal health status, depression, and anxiety, informing the development of comprehensive intervention strategies for the general population. These findings have important implications for promoting the well-being and mental health of individuals during and beyond the COVID-19 pandemic.

Risk Groups and Psychosocial Factors for the Pandemic (COVID-19)

COVID-19, which started in 2019 and affected the whole world, has affected everyone at different intensities and in different ways. COVID-19, which is considered a pandemic, has turned into a major public health problem in terms of its consequences and has affected people biopsychosocially. However, people in risk groups may be affected more. This study was conducted to reveal the risk groups for the pandemic and to determine the psychosocial factors. Data were collected online using the relational screening model and snowball sampling methods. A Sociodemographic Information Form, COVID-19 Pandemic Psychosocial Impact Scale (C19-PPIS), and International Personality Inventory Short Form (IPISV) were sent online to 826 participants. Data were analysed using an independent sample t-test, a one-way ANOVA test, and the Pearson Correlation analysis. According to the results, young adults (X¯ = 2.77), women (X¯ = 2.79), singles (X¯ = 2.78), those who are unemployed (X¯ = 2.89), and those who had to change their home or city due to the pandemic (X¯ = 2.89) were more affected by the pandemic. Psychological support was the support system needed the most during the pandemic (X¯ = 3.04). In addition, a negative relationship was found between an extroverted personality and psychosocial impact from the pandemic (r = -0.148 and p < 0.01). A positive relationship was found between introversion (r = 0.183 and p < 0.01), agreeableness (r = 0.078 and p < 0.05), hostility (r = 0.094 and p < 0.01), disorganisation (r = 0.237 and p < 0.01), openness to development (r = 0.80 and p < 0.05), closed off to development (r = 0.070 and p < 0.05), emotional instability personality (r = 0.498 and p < 0.01), and psychosocial impact from the pandemic. This study has revealed important results regarding who has been most affected psychosocially by COVID-19. It is thought that the results obtained can guide state policies on what should be done in the field of preventive community mental health in another possible epidemic.

Impact of the COVID-19 pandemic on the self-care and health condition of the older adults. CUIDAMOS+75. A mixed methods study protocol

Aims

To assess the impact of the COVID-19 pandemic on the health condition of people ≥75 years of age and on their family caregivers in Spain.

Design

Multicentric, mixed method concurrent study.

Methods

This work, which will be conducted within the primary care setting in 11 administrative regions of Spain, will include three coordinated studies with different methodologies. The first is a population-based cohort study that will use real-life data to analyze the rates and evolution of health needs, care provision, and services utilization before, during, and after the pandemic. The second is a prospective cohort study with 18 months of follow-up that will evaluate the impact of COVID-19 disease on mortality, frailty, functional and cognitive capacity, and quality of life of the participants. Finally, the third will be a qualitative study with a critical social approach to understand and interpret the social, political, and economic dimensions associated with the use of health services during the pandemic. We have followed the SPIRIT Checklist to address trial protocol and related documents. This research is being funded by the Instituto de Salud Carlos III since 2021 and was approved by its ethics committee (June 2022).

Discussion

The study findings will reveal the long-term impact of the COVID-19 pandemic on the older adults and their caregivers. This information will serve policymakers to adapt health policies to the needs of this population in situations of maximum stress, such as that produced by the COVID-19 pandemic.

Trial Registration

Identifier: NCT05249868 [ClinicalTrials.gov].

Loneliness, Social Isolation, and Obsession with COVID-19 among Older Adults

During the COVID-19 pandemic, older people were socially isolated for their protection against the virus impacting their mental health. Aiming to explore the role of loneliness and social isolation in the obsession with COVID-19 among older adults, we conducted an anonymous online survey with 300 older adults aged 65-80 years in South Korea between January and February 2023. The survey collected demographic information, past psychiatric history, medical disease, current psychological distress, and experiences related to COVID-19. Rating scales were the Obsession with COVID-19 Scale (OCS), Coronavirus Reassurance-seeking Behaviors Scale (CRBS), Stress and Anxiety to Viral Epidemics-6 items (SAVE-6), and Loneliness and Social Isolation Scale (LSIS). The regression analysis revealed that CRBS (β = 0.55, p < 0.001) and SAVE-6 (β = 0.34, p < 0.001) were significant predictors of obsession with COVID-19 (adjusted R2 = 0.63, F = 126.9, p < 0.001). Mediation analysis showed that loneliness and social isolation had a positive total effect on obsession with COVID-19, mediated by reassurance-seeking behavior and viral anxiety (Standardized Estimator = 0.21, standard error = 0.05, p < 0.001, 95% confidence interval 0.20-0.41). Loneliness and social isolation were found to be indirectly linked to obsession with COVID-19 through reassurance-seeking behavior and viral anxiety. The findings highlight the importance of addressing loneliness and social isolation among older adults during the COVID-19 pandemic to prevent obsession with COVID-19.

Pandemic Effects on Stability of End-of-Life Preferences and Patient-Surrogate Dyad Congruence

CONTEXT

Whether a largescale disaster alters people's previous decisions about their end-of-life care is unknown.

OBJECTIVES

We examined the effects of a disaster, the COVID-19 pandemic, on stability of end-of-life care preferences among dialysis patients and on patient-surrogate goals-of-care congruence.

METHODS

We used a natural experimental design to examine goals-of-care preferences pre- and postexposure to the pandemic during a pragmatic trial testing SPIRIT (sharing patient's illness representations to increase trust), an evidence-based advance care planning (ACP) intervention. There were 151 patient-surrogate dyads who prior to the pandemic lockdown had completed baseline (T1) and postintervention assessments (T2) regarding their goals-of-care preferences in two end-of-life scenarios. Of those 151 dyads, 59 intervention, and 51 usual care dyads consented to be in the present study and completed the goals-of-care tool two additional times, at enrollment (T3) and six months later (T4), along with the COVID stress scale (CSS). Dyad congruence was ascertained by comparing patient and surrogate responses to the goals-of-care tool.

RESULTS

There were no changes over time in the proportions of patients who chose comfort-care-only in the goals-of-care tool. The proportion of patients who chose comfort-care-only and dyad congruence were higher in SPIRIT compared to usual care, but there was no interaction between that treatment effect and exposure to the pandemic. CSS was associated with neither patients' preferences nor dyad congruence.

CONCLUSIONS

The pandemic alone did not appear to influence patients' goals-of-care preferences or dyad congruence. This finding supports the stability of value-based end-of-life preferences in general, even during a disaster.

Covid-19 pandemic, social normative compliance, and sustainable consumption: Evidence from experiments

This research aims to investigate the causal effects of consumers' Covid-19 pandemic experiences on their preferences for sustainable consumption. Drawing on social identity theory, we argue that pandemic experiences heighten consumers' awareness of the importance of adhering to collective social norms, subsequently motivating them to adopt sustainable consumption practices that promote collective interests. Through three preregistered experiments, we demonstrate that: (i) Covid-19 pandemic experiences increase consumers' preferences for sustainable consumption; (ii) this effect is more pronounced for individuals with severer pandemic experiences and females; (iii) pandemic experiences influence sustainable consumption preferences by enhancing consumers' social normative compliance. This study contributes to the understanding of Covid-19's consequences from a micro-level perspective of consumer behavior and offers insights into the factors driving consumers' sustainable consumption preferences.

COVID-19-Related Treatment Cancellations and Oncology Patients' Psychological Health in Nigeria

Objective: To explore the association between COVID-19-related cancer treatment cancellations and the psychological health of cancer patients in Nigeria.Methods: We analyzed data collected from 15 outpatient cancer clinics, comprising 1,097 patients between April to July 2020. Study outcome was ten psychological impacts, including feeling down, stressed, and unable to access treatment due to COVID-19 (used as continuous and categorical variable (0-3,4-7,8+ events). The independent variable was treatment cancellations due to COVID-19 categorized as 0, 1, and 2+ cancellations. Confounders included religion, ethnicity, income, cancer diagnosis/type, and treatment received. Stata/SE.v.17 was used to perform all analyses. P values of ≤0.05 were deemed statistically significant.Results: Of the 1,097 cancer patients, 65.7% were female, with a mean age (SD) of 49.4 (13.8) years. Most patients (50.3%) reported four to seven psychological health events. Cancer patients who reported two/more treatment cancellations made up only 12.8% of the study sample but accounted for a greater proportion of psychological impacts (23.5%; P<0.001). In the adjusted model, cancer patients with one treatment cancellation (Coef: 0.195, 95%CI: 0.089-0.302) and those with two/more cancellations (Coef: 0.379, 95%CI: 0.255-0.504) had a significantly higher risk of psychological health impacts than those with no treatment cancellations.Conclusion: More than half of our sample of primarily adult female cancer patients reported major psychological health effects due to COVID-19. Cancer patients who experienced at least one treatment cancellation had a higher risk of psychological health consequences than those who did not. The implications of our findings and how to mitigate the impact of COVID-19 on oncology service disruptions are discussed.

From Crisis to Opportunity: A Qualitative Study on Rehabilitation Therapists' Experiences and Post-Pandemic Perspectives

Rehabilitation therapists (RTs) have developed substantial mental health problems since the pandemic. Our study aimed to understand the experience of COVID-19 on occupational therapists and physiotherapists practicing in Canada, how the pandemic may have affected care delivery, and to identify new learnings articulated by RTs. A qualitative descriptive study design guided data collection through one-on-one interviews, dyadic interviews, and focus groups. We recruited active RTs across Canada, advertising on professional practice networks and social media platforms and using snowball sampling. Forty-nine RTs representing seven Canadian provinces participated. The four overarching themes developed using thematic analysis were (1) navigating uncertainty along with ever-changing practices, policies, and attitudes, (2) morphing roles within a constrained system, (3) witnessing patients suffering and experiencing moral distress, and (4) recognizing the personal toll of the pandemic on self and others, as well as lessons learned. Our study demonstrated that many RTs suffered moral distress, poor mental health, and some from challenging financial situations, especially those in the private sector. They also expressed a resilient attitude in response to these stressors. Implications in the future include identifying promising communication strategies that could act as protective factors, addressing workforce constraints and diminishing resources through innovative models of care.

Explosion of research on psychopathology and social media use after COVID-19: A scientometric study

BACKGROUND

Despite advances in research on psychopathology and social media use, no comprehensive review has examined published papers on this type of research and considered how it was affected by the coronavirus disease 2019 (COVID-19) outbreak.

AIM

To explore the status of research on psychopathology and social media use before and after the COVID-19 outbreak.

METHODS

We used Bibliometrix (an R software package) to conduct a scientometric analysis of 4588 relevant studies drawn from the Web of Science Core Collection, PubMed, and Scopus databases.

RESULTS

Such research output was scarce before COVID-19, but exploded after the pandemic with the publication of a number of high-impact articles. Key authors and institutions, located primarily in developed countries, maintained their core positions, largely uninfluenced by COVID-19; however, research production and collaboration in developing countries increased significantly after COVID-19. Through the analysis of keywords, we identified commonly used methods in this field, together with specific populations, psychopathological conditions, and clinical treatments. Researchers have devoted increasing attention to gender differences in psychopathological states and linked COVID-19 strongly to depression, with depression detection becoming a new trend. Developments in research on psychopathology and social media use are unbalanced and uncoordinated across countries/regions, and more in-depth clinical studies should be conducted in the future.

CONCLUSION

After COVID-19, there was an increased level of concern about mental health issues and a changing emphasis on social media use and the impact of public health emergencies.

Digital Mass Hysteria during Pandemic? A Study of Twitter Communication Patterns in the US during the Stages of COVID-19 Vaccination

This study examined the public's sentiments about vaccines by analyzing Twitter data during the CDC's vaccination management planning stage in the United States. Sentiment scores were assigned to each tweet using a sentiment dictionary and the sentiment changes were analyzed over 52 weeks from November 2020 to November 2021. An interrupted time series model was used to analyze the difference in sentiment, which revealed that there was a shift. Initially, overall sentiments were negative but became positive as the stage of general vaccine supply approached. However, negative sentiments sharply rose when the vaccine supply transitioned to the phase of universalization. The results identified two dominant strategic action fields for vaccines providing polarized messages on Twitter and the negative trend was strong for most of the period. The findings highlight the importance of managing strategic action fields on social networks to prevent mass hysteria during vaccine policy implementation. This study stresses the significance of effectively managing strategic action fields on social media platforms to prevent mass hysteria while implementing vaccine policies.

Experiences of fetal care, social support, and emotional functioning during the COVID-19 pandemic in women carrying a fetus with CHD

OBJECTIVE

To explore how the COVID-19 pandemic affected fetal care, social support, and emotional functioning for women carrying a fetus with CHD.

METHOD

This was a single-centre qualitative study of 31 women who received a prenatal diagnosis of CHD during the pandemic. Patients completed semi-structured interviews about their experiences with fetal care, social support, and perceptions of risk to themselves and their fetus. Consistent themes regarding the impact of the pandemic were identified using an inductive thematic approach. Demographic data were collected via self-report and chart review.

RESULTS

Women generally reported consistent access to fetal care throughout the pandemic, with frequent use of telemedicine in addition to in-person care, but negative impacts resulting from restrictions on family support at appointments. Limited access to social support overall and a loss of pregnancy traditions were described. Many women reported feeling isolated and experiencing worries and fears about COVID-19 but also noted feeling supported by their healthcare team. Partner/family support during appointments and connection to peer-to-peer support were identified as recommendations to mitigate negative impacts.

CONCLUSION

Women carrying a fetus with CHD during the COVID-19 pandemic experienced unique stressors that may affect mental health. However, many also experienced unexpected supports that may mitigate effects of pandemic-related stressors. Results can inform efforts to promote positive family outcomes during and following the COVID-19 pandemic.

Responding to the call of the NHS Nightingale, but at what cost? An auto-ethnography of a volunteer frontline mental health trainer's experiences during the COVID-19 pandemic

Healthcare workers, globally, volunteered time and skills to the COVID-19 pandemic frontline response. In March 2020, the predicted high demand for extra critical care beds led to the rapid construction of the UK National Health Service (NHS) Nightingale field hospital, London. I volunteered to develop and deliver psychological preparedness training - coined 'Psychological PPE' - to over 2300 frontline staff over an 8-week period. Existing research has identified broad themes of the impact working on the COVID-19 frontline has on healthcare workers but does not capture in-depth accounts of individuals' experiences. Using autoethnographic enquiry, this research explores my frontline experience at the NHS Nightingale during this time, and the personal impact this had on me. Reflexive thematic analysis explored themes of recognition and sacrifice, emotional lability and fragility, and the impact of transitions. Findings inform personal recovery, as well as future research and policy development pertaining to the sustainable recovery of our NHS people.

COVID-19 and mental health services in Sub-Saharan Africa: A critical literature review

BACKGROUND

The COVID-19 pandemic has wrought a profound impact on mental health in Sub- Saharan Africa, exacerbating existing disparities and rendering individuals undergoing treatment particularly susceptible. This comprehensive critical review delves into the scope, nature, and extent of COVID-19 impact on mental health services in Sub- Saharan Africa, while concurrently elucidating pivotal lessons and exemplary practices learnt from periods of lockdown.

METHODS

The methodology was guided by Jesson & Laccy's guide on how to conduct critical literature reviews. Articles were comprehensively sought through two academic databases (PubMed and Google Scholar), complemented by targeted searches on the WHO website and official public health websites of relevant Sub-Saharan African countries.

RESULTS

The investigation reveals a surge in mental health challenges, notably marked by a significant escalation in anxiety, depression, and post-traumatic stress disorder. Disruptions to care services, financial hardships, and the pervasive effects of social isolation further compound this escalation. The pre-existing inequalities in access to and quality of care were accentuated during this crisis, with marginalized groups encountering heightened impediments to essential services. In navigating this unprecedented challenge, communities emerged as integral agents in establishing supportive networks and implementing culturally sensitive interventions. Technology, such as telemedicine and online resources, played a pivotal role in bridging access gaps, particularly in remote areas. The synthesis of best practices for supporting mental health patients during lockdowns encompasses targeted interventions for vulnerable groups, including adolescents and pregnant women. Empowering communities through economic support and mental health literacy programs was identified as crucial. The integration of technology, such as the development of robust telemedicine frameworks, virtual training in curricula, and the utilization of digital platforms for interventions and public messaging, emerged as a cornerstone in addressing access disparities. Community engagement and resilience-building strategies gained prominence, emphasizing the necessity of collaboration between healthcare providers and communities. Promotion of peer support groups, home-based care, and the preservation of traditional healing practices were underscored as essential components.

CONCLUSION

The study underscores the need to adapt and optimize mental health services during emergencies. This entails prioritizing mental health within emergency response frameworks, exploring alternative service delivery methods, and fortifying data collection and research efforts.

Lived Experiences of Critically Ill COVID-19 Patients About Death and Dying: A Descriptive Phenomenology

Thinking about death is one of the most common problems of critically ill patients with COVID-19 in ICUs. Therefore, this study aims to explore the experiences of critically ill patients with COVID-19 about death and dying. This is a descriptive phenomenology approach. Participants in this study had 12 participants who were purposefully selected. The data collection method was semi-structured through interviews. Data were analyzed based on Colaizzi's approach. Data analysis generated two main themes, including personal, and non-personal; challenge thinking about death, and eight sub-themes. Thinking about the death of critically ill COVID-19 patients is a significant challenge that affects the patient's health and prolongs the treatment process. Therefore, it should be careful in the patient's treatment and care program.

Outcomes and Management After COVID-19 Critical Illness

TOPIC IMPORTANCE

COVID-19 has caused > 7 million deaths worldwide since its onset in 2019. Although the severity of illness has varied throughout the pandemic, critical illness related to COVID-19 persists. Survivors of COVID-19 critical illness can be left with sequelae of both the SARS-CoV-2 virus and long-term effects of critical illness included within post-intensive care syndrome. Given the complexity and heterogeneity of COVID-19 critical illness, the biopsychosocial-ecological model can aid in evaluation and treatment of survivors, integrating interactions among physical, cognitive, and psychological domains, as well as social systems and environments.

REVIEW FINDINGS

Prolonged illness after COVID-19 critical illness generally can be classified into effects on physical, cognitive, and psychosocial function, with much interaction among the various effects, and includes a wide range of symptoms such as ICU-acquired weakness, prolonged respiratory symptoms, cognitive changes, post-traumatic stress disorder post-traumatic stress disorder, anxiety, and depression. Risk factors for COVID-19 critical illness developing are complex and include preexisting factors, disease course, and specifics of hospitalization in addition to psychological comorbidities and socioenvironmental factors. Recovery trajectories are not well defined, and management requires a comprehensive, interdisciplinary, and individualized approach to care.

SUMMARY

The onset of vaccinations, new therapeutics, and new strains of SARS-CoV-2 virus have decreased COVID-19 mortality; however, the number of survivors of COVID-19 critical illness remains high. A biopsychosocial-ecological approach is recommended to guide care of COVID-19 critical illness survivors.

A longitudinal study of risk and protective factors for symptoms of adjustment disorder during the COVID-19 pandemic

Background: The COVID-19 pandemic caused multiple stressors that may lead to symptoms of adjustment disorder.Objective: We longitudinally examined relationships between risk and protective factors, pandemic-related stressors and symptoms of adjustment disorder during the COVID-19 pandemic, as well as whether these relationships differed by the time of assessment.Method: The European Society for Traumatic Stress Studies (ESTSS) ADJUST Study included N = 15,169 participants aged 18 years and above. Participants from 11 European countries were recruited and screened three times at 6-month intervals from June 2020 to January 2022. Associations between risk and protective factors (e.g. gender), stressors (e.g. fear of infection), and symptoms of adjustment disorder (AjD, ADNM-8) and their interaction with time of assessment were examined using mixed linear regression.Results: The following predictors were significantly associated with higher AjD symptom levels: female or diverse gender; older age; pandemic-related news consumption >30 min a day; a current or previous mental health disorder; trauma exposure before or during the pandemic; a good, satisfactory or poor health status (vs. very good); burden related to governmental crisis management and communication; fear of infection; restricted social contact; work-related problems; restricted activity; and difficult housing conditions. The following predictors were associated with lower AjD levels: self-employment or retirement; working in healthcare; and face-to-face contact ≥ once a week with loved ones or friends. The effects of the following predictors on AjD symptoms differed by the time of assessment in the course of the pandemic: a current or previous mental disorder; burden related to governmental crisis management; income reduction; and a current trauma exposure.Conclusions: We identified risk factors and stressors predicting AjD symptom levels at different stages of the pandemic. For some predictors, the effects on mental health may change at different stages of a pandemic.

Predisposition and Working Conditions for the Occurrence of Lumbar Syndrome in Medical Workers of the Clinical Center of Montenegro during the COVID-19 Pandemic

Background: Lumbar pain is a condition of discomfort in the lower back caused by numerous factors, lasting for short or longer periods of time. Healthcare professionals, regardless of the type of care they are engaged in, are at risk of lumbar pain. This is the first study that deals with the problem of lumbar syndrome in health workers in Montenegro. Methods: This cross-sectional study included full-time health workers employed in the Clinical Center of Montenegro who were involved in the treatment of COVID-19 patients during 2020 and 2021. The survey consisted of general questions for collecting socio-demographic and COVID-19 engagement data; the Modified Nordic questionnaire was used for the analysis of musculoskeletal symptoms, and the EQ-5D-questionnaire was used to measure the quality of life associated with health. Results: The one-year prevalence of lumbar pain was 68.1%. Factors associated with lumbar pain were as follows: a higher degree of physical inactivity (each subject with a higher degree of physical inactivity had a 24% higher chance of occurrence of lumbar pain); a higher degree of load and over-engagement during the COVID-19 pandemic (each subject with a higher degree of workload had a nearly 50% higher chance of occurrence of lumbar pain); duration of engagement during the COVID-19 pandemic (subjects engaged up to a month were 4 times more likely to develop lumbar pain, and subjects engaged for 1-3 months were 3.5 times more likely to develop lumbar pain compared to those who were not engaged in COVID-19 treatment). This study also confirms that lumbar syndrome affects the quality of life of health workers. Conclusions: Lumbar syndrome is highly prevalent among healthcare professionals in the Clinical Center of Montenegro, especially in the population of nurses, where evidence-based preventive measures are needed.

Impact of the SARS-CoV-2 Pandemic on the Management and Prognosis of Infective Endocarditis

BACKGROUND

Infective endocarditis (IE) is a serious condition which is difficult to diagnose and to treat, both medically and surgically.

OBJECTIVES

The objective of this study was to evaluate the impact of the SARS-CoV-2 pandemic on the management of patients with IE.

METHODS

We conducted a single-centre retrospective study including patients hospitalized for IE during the pandemic (Group 2) compared with the same period the year before (Group 1). We compared clinical, laboratory, imagery, therapeutic, and patient outcomes between the two groups.

RESULTS

A total of 283 patients were managed for possible or definite IE (164 in Group 1 and 119 in Group 2). There were more intravenous drug-related IE patients in Group 2 (p = 0.009). There was no significant difference in surgery including intra-cardiac device extraction (p = 0.412) or time to surgery (p = 0.894). The one-year mortality was similar in both groups (16% versus 17.7%, p = 0.704). The recurrence rate was not significantly different between the two groups (5.9% in Group 2 versus 9.1% in Group 1, p = 0.311).

CONCLUSIONS

The SARS-CoV-2 pandemic did not appear to have had a negative impact on the management of patients with IE. Maintenance of the activities of the endocarditis team within the referral centre probably contributed to this result. Nevertheless, the high proportion of intravenous drug-addicted patients in the pandemic cohort suggests that the SARS-CoV-2 pandemic had a major psychosocial impact.

Prevalence of irritable bowel syndrome and other functional gastrointestinal disorders in Uruguay

INTRODUCTION AND AIMS

Irritable bowel syndrome (IBS) is one of the most frequent functional gastrointestinal disorders. Prevalence worldwide is estimated at 11%. There is little information on the prevalence of the other functional bowel disorders (FBDs). Our aim was to establish the prevalence of IBS and other FBDs according to the Rome IV criteria, in Uruguay.

MATERIALS AND METHODS

An observational, population-based prevalence study was conducted. Data were collected through an online questionnaire, utilizing the Rome IV criteria.

RESULTS

Of the 1,052 participants (79% women, mean patient age 44 years), 47.2% met the Rome IV diagnostic criteria for at least one of the FBDs analyzed. Functional constipation (FC) was the most frequent, at 18.7% (16.4-21.1), followed by IBS at 17.1% (14.9-19.4) and functional diarrhea (FD) at 15.4% (13.3-17.6). IBS with constipation (IBS-C) was the most frequent IBS subtype (35%) and the IBS with diarrhea (IBS-D) subtype predominated in men. All FBDs were more prevalent in women and youths. Of the survey participants with a FBD, 59% stated that they perceived no worsening of their symptoms related to the COVID-19 pandemic.

CONCLUSIONS

Ours is the first prevalence study on FBDs conducted on the Uruguayan general population. Half of the participants surveyed presented with a FBD analyzed in the study. FC was the most frequent, followed by IBS and FD. The prevalence rate of IBS was the highest, based on the Rome IV diagnostic criteria, and constipation was the most frequent subtype.

Impact of digital services on healthcare and social welfare: An umbrella review

BACKGROUND

Digital services can be effective and cost-efficient options for treating non-communicable diseases, but generalizability is limited due to heterogeneous treatment effects. This umbrella review aims to evaluate the impact of digital services on population health, costs, and patient and healthcare professional satisfaction, and to identify facilitators and barriers to using digital services in healthcare and social welfare.

METHODS

The protocol of the study was registered on the 4th of September 2022 to the International Prospective Register of Systematic Reviews, PROSPERO (CRD42022355635). The review was performed using the Centre for Reviews and Dissemination, Cochrane, Ovid Medline, Scopus, and Web of Science in June 2022. The methodological quality of the included reviews was assessed. The impact of digital services was categorized as no evidence, no dominance, and mixed and positive effect. Inductive content analysis was used to identify facilitators and barriers.

RESULTS

A total of 66 studies were included in the review, 64 % of which were evaluated as high quality. Studies on the impact of digital services in social welfare were not identified. Sixty-five percent of reviews evaluated the impact of digital services on population health with mixed effects; 21 % were on costs with mixed effects; 27 % were on patient satisfaction with positive effects; and 7.6 % were on healthcare professionals' satisfaction with mixed effects. Various features, allocation, end-user support, organized services, and service development facilitated the use of digital services. Correspondingly, barriers were related to service limitations, digital competency, funding- and service strategies, resources and change management.

CONCLUSIONS

Compared to usual care, digital services had a mixed impact on population health and costs with high satisfaction in patients. Mixed healthcare professionals' satisfaction was associated with the use of digital services, and it was less studied. To ensure successful implementation and sustainability of digital services, attention must be paid to address barriers and supporting facilitators at all levels.

Impact of COVID-19 on the development of major mental disorders in patients visiting a university hospital: a retrospective observational study

BACKGROUND

This study aimed to investigate the impact of coronavirus disease 2019 (COVID-19) on the development of major mental disorders in patients visiting a university hospital.

METHODS

The study participants were patients with COVID-19 (n=5,006) and those without COVID-19 (n=367,162) registered in the database of Keimyung University Dongsan Hospital and standardized with the Observational Medical Outcomes Partnership Common Data Model. Data on major mental disorders that developed in both groups over the 5-year follow-up period were extracted using the FeederNet computer program. A multivariate Cox proportional hazards model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for the incidence of major mental disorders.

RESULTS

The incidences of dementia and sleep, anxiety, and depressive disorders were significantly higher in the COVID-19 group than in the control group. The incidence rates per 1,000 patient-years in the COVID-19 group vs. the control group were 12.71 vs. 3.76 for dementia, 17.42 vs. 7.91 for sleep disorders, 6.15 vs. 3.41 for anxiety disorders, and 8.30 vs. 5.78 for depressive disorders. There was no significant difference in the incidence of schizophrenia or bipolar disorder between the two groups. COVID-19 infection increased the risk of mental disorders in the following order: dementia (HR, 3.49; 95% CI, 2.45-4.98), sleep disorders (HR, 2.27; 95% CI, 1.76-2.91), anxiety disorders (HR, 1.90; 95% CI, 1.25-2.84), and depressive disorders (HR, 1.54; 95% CI, 1.09-2.15).

CONCLUSION

This study showed that the major mental disorders associated with COVID-19 were dementia and sleep, anxiety, and depressive disorders.

The effect of fear on health information searching behavior during the pandemic: The case of COVID-19

BACKGROUND AND OBJECTIVES

Fear can cause people to panic, lead to erroneous decisions, and trigger inappropriate behavior. This study aims to investigate the effects of fear of COVID-19 on the perception of the reliability and the use of health information sources.

METHODS

This study is both a cross-sectional and explanatory study. The participants selected by convenience sampling method were 323 students attending a state university in Turkey. The Fear of COVID-19 Scale (FCV-19S) and the Health Information Sources Survey were used as data collection tools. Descriptive statistics, correlation coefficients, and linear regression analyses were used.

RESULTS

The participants' mean FCV-19S score was 2.30 ± 0.93 on a five-point Likert scale. In the range of 0-10, the information source with the highest reliability perception mean score was the doctor (8.05 ± 2.54), whereas that with the highest usage was the Internet (7.98 ± 2.77). Although the fear of COVID-19 had a negative effect on Internet use (b = -0.38; p < 0.05), the effects on the use of other health information sources were positive (b = 0.37-0.83; p < 0.05). Trust in radio (b = 0.60; p < 0.05) and newspapers/magazines (b = 0.49; p < 0.05) also increased with fear.

CONCLUSIONS

These results showed that as university students' fear of COVID-19 increased, the use of the Internet for health information decreased; however, the use of doctors, nurses, pharmacists, other health workers, scientific articles, television, radio, and newspapers/journals increased. Nurses were the source of information whose use increased the most, along with increased fear. The findings can guide health policies to be followed. Not only doctor talks but also nurse talks and scientific videos should be increased on the Internet, social media, and other mass media.

Impact of a Public Health Emergency on Behavior, Stress, Anxiety and Glycemic Control in Patients With Pancreas or Islet Transplantation for Type 1 Diabetes

A public health emergency such as the COVID-19 pandemic has behavioral, mental and physical implications in patients with type 1 diabetes (T1D). To what extent the presence of a transplant further increases this burden is not known. Therefore, we compared T1D patients with an islet or pancreas transplant (β-cell Tx; n = 51) to control T1D patients (n = 272). Fear of coronavirus infection was higher in those with β-cell Tx than without (Visual Analogue Scale 5.0 (3.0-7.0) vs. 3.0 (2.0-5.0), p = 0.004) and social isolation behavior was more stringent (45.8% vs. 14.0% reported not leaving the house, p < 0.001). A previous β-cell Tx was the most important predictor of at-home isolation. Glycemic control worsened in patients with β-cell Tx, but improved in control patients (ΔHbA1c +1.67 ± 8.74 vs. -1.72 ± 6.15 mmol/mol, p = 0.006; ΔTime-In-Range during continuous glucose monitoring -4.5% (-6.0%-1.5%) vs. +3.0% (-2.0%-6.0%), p = 0.038). Fewer patients with β-cell Tx reported easier glycemic control during lockdown (10.4% vs. 22.6%, p = 0.015). All T1D patients, regardless of transplantation status, experienced stress (33.4%), anxiety (27.9%), decreased physical activity (42.0%), weight gain (40.5%), and increased insulin requirements (29.7%). In conclusion, T1D patients with β-cell Tx are increasingly affected by a viral pandemic lockdown with higher fear of infection, more stringent social isolation behavior and deterioration of glycemic control. This trial has been registered in the clinicaltrials.gov registry under identifying number NCT05977205 (URL: https://clinicaltrials.gov/study/NCT05977205).

Impact of COVID-19 on people living with HIV and HIV care: A qualitative study in the Volta Region of Ghana

The COVID-19 pandemic caused significant social changes and challenges globally, including economic slowdown and limitation of essential services. Our study explored the impact of the COVID-19 pandemic on the HIV treatment experiences and lives of people living with HIV in Ghana. Between October 2021 and January 2022, we conducted four focus group discussions with 24 people living with HIV and six in-depth interviews with healthcare providers to understand the impact of the COVID-19 epidemic on their lives and HIV treatment and care. Transcribed interviews were analyzed using thematic analysis. The COVID-19 pandemic most impacted people living with HIV economically and psychosocially. Economic challenges included loss of income/economic support, financial hardship, and material insecurities. The psychosocial impact included fear of the health impact of COVID-19 on people living with HIV and social isolation. The pandemic also impacted participants' HIV treatment and care services including change in their site of care and non-adherence to antiretroviral therapy. Clinics in particular modified HIV care services to maintain treatment and care during the pandemic. Healthcare providers also implemented direct antiretroviral therapy service delivery to clients, which reduced patient overcrowding but increased providers' workload and expenses. The COVID-19 pandemic caused economic hardship, social isolation, and changes in HIV treatment and care services for people living with HIV. It also imposed a work and financial burden on healthcare providers. However, service changes made by providers helped sustain HIV care and treatment for clients and should inform future pandemic responses in HIV services.

A latent class analysis of dissociative PTSD subtype among Chinese adolescents following the COVID-19 pandemic and lockdown

BACKGROUND

The COVID-19 pandemic and related policies have amplified the vulnerability of adolescents to the development of posttraumatic stress disorder (PTSD) and dissociation symptoms. This study sought to explore the profile patterns and psychopathological characteristics of co-occurring PTSD and dissociation symptoms in Chinese adolescents.

METHODS

A total of 57,984 junior and senior high school students in Deyang City, China were recruited between July 13 and July 19, 2020. PTSD and dissociation symptoms, risk factors, and functional impairment variables were assessed using the Global Psychotrauma Screen for Teenagers (GPS-T) instrument. Latent class analysis (LCA) was employed to examine the phenomenology and risk factors of co-occurring PTSD and dissociation symptoms. Analysis of Variance (ANOVA) was utilized to investigate differences in COVID-19 pandemic-related exposure and functional impairment across distinct symptom profiles.

RESULTS

A 4-class model was selected as the optimal solution, comprising subgroups of low symptom, predominant PTSD symptom, predominant dissociation symptom, and PTSD-dissociation symptom. Class membership could be significantly predicted by other stressful experiences, social support, childhood maltreatment and psychiatric histories. The PTSD-dissociation symptom class exhibited the most severe COVID-19 pandemic-related exposure and functional impairment among all classes.

LIMITATIONS

The cross-sectional design, Chinese cultural background, online survey method and oversimple measurements were the limitations.

CONCLUSIONS

Our findings extend existing knowledge about the coexisting patterns of PTSD and dissociation symptoms in adolescents, which could assist in identifying high-risk youths. Furthermore, our findings offer recommendations for shaping public health policies and formulating effective clinical interventions for adolescents following the COVID-19 pandemic and lockdown.

Children and adolescents' quality of life in repeated cross-sectional studies during the COVID-19

During the COVID-19 pandemic, internalizing and externalizing symptoms have impacted the quality of life of children and adolescents. This cross-sectional study evaluated children's quality of life using parental reports, observing associations with mental health problems and sociodemographic variables. Some behavioral measures were linked to lower quality of life, particularly depression symptoms, relationship problems, and inattention. Multiple regression models indicated that reduced children's quality of life (R2 = 36%) was associated with higher levels of internalizing (r = -0.46) and externalizing (r = -0.23) behavioral problems and younger parents (r = -0.08). Children with previous mental disorder diagnoses had lower quality of life than those without (p < 0.001). In summary, children's quality of life during the COVID-19 pandemic was linked to current mental health, parental age, and previous history of mental disorders.

Caregiving experiences of primary family caregivers caring for family members affected by COVID-19 during home isolation: A phenomenology study

During home isolation due to the coronavirus disease, family caregivers assumed the responsibility of caring for infected family members; however, the full extent of the difficulties and challenges they encountered remains unclear. This study applied a descriptive phenomenology approach, using semi-structured, one-on-one, in-depth interviews to explore the experiences of 16 primary family caregivers during home isolation amid the coronavirus disease. The key themes identified were as follows: (1) protecting family, comprising anxiety over preventing infection and bearing the responsibility of caregiving and a concern about the diagnosis; (2) seeking stability, encompassing the impact of epidemic control policies on daily routines, strategies to overcome obstacles caused by quarantine measures, and gathering resources and receiving support; and (3) reflections on life, including favoring love over discrimination, rediscovering oneself, cherishing family, and acknowledging personal growth and dedication. This study highlights that family members who took on caregiving roles due to obstacles or health risks faced significant pressure to protect their family members during isolation and actively sought professional consultation and acquired caregiving skills to enhance their confidence and adaptability.