Factors influencing preventive behavior against Middle East Respiratory Syndrome-Coronavirus among nursing students in South Korea

Patients' perception of lifestyle advice as a mechanism between health shocks and health behaviours: Evidence from a longitudinal study in China

Background

The heavy burden of non-communicable chronic diseases (NCDs) and the deficiency of health behaviours (HB) are threatening the middle- and older-aged population in China. However, little is known about the relational mechanism between health shocks (HS) and HBs, while the importance of patients' perception of lifestyle advice (PPLA) to initiate HB is insufficiently emphasised. In this study, we aimed to examine this perception as a mediator between HS and HB and the variety of mediation effects caused by the different contents of lifestyle advice.

Methods

We retrieved panel data from the two latest waves of a nationally representative cohort, the China Health and Retirement Longitudinal Study (CHARLS). After constructing well-balanced groups through propensity score matching, we conducted descriptive and multilevel logistic regression analyses to analyse the state of and factors influencing PPLA. We employed the Preacher's Sobel test with 1000 replications bootstrap to examine the mediating effect of PPLA.

Results

On a sample of 7922 respondents (post-propensity score matching), we found that HSs had a positive direct effect on HB, with observed decreases in smoking and drinking and increases in exercise. A limited and selected perception of lifestyle advice showed a gap between the advice given by providers and perceived by patients, with gender, education level, social support inside the family, self-reported health, comorbidity, treatment regimens, and utilisation of family doctors being significant influencing factors. Nevertheless, any content of lifestyle advice partially mediated the relationship in which HS increases non-addictive HB (exercise), while only the targeted and detailed content of lifestyle advice about corresponding behaviours partially mediated the effect between HS and addictive HB (smoking and drinking).

Conclusions

This study provides the first evidence that PPLA partially mediates the positive effect of HS on HB. Personalised chronic disease management; targeted advice and interventions; and multiple social resources COULD BE beneficial for patients with HS to initiate HB.

Nursing Students' Perceptions of Factors Influencing Nursing Intentions toward COVID-19 Patients

Coronavirus disease (COVID-19) is a pandemic to which nursing students are particularly susceptible. This study aims to comprehensively examine nursing students' knowledge, attitudes, risk perceptions, preventive behaviors related to COVID-19, and nursing intentions toward patients with the virus. A questionnaire was administered to 149 nursing students from two universities. Data on the respondents' general characteristics, knowledge levels, attitudes, perceived risk, preventive behaviors toward COVID-19, and nursing intentions toward COVID-19 patients were collected. The collected data were statistically analyzed using SPSS software (version 26.0). This involved descriptive statistics, independent t-tests, one-way ANOVA, Pearson's correlation coefficient, and stepwise multiple regression analyses. The analyses of the factors affecting nursing students' nursing intentions for COVID-19 patients showed that the most predictive factor was perceived risk (β = -0.38, p < 0.001), followed by attitudes (β = 0.29, p < 0.001) and preventive behaviors (β = 0.17, p = 0.017), which explained 26% of the variance in nursing intentions. Lowering the perceived risk of infectious diseases and cultivating positive attitudes and preventive behaviors can increase nursing students' intentions toward COVID-19 patients. Finally, infection management education programs and research on interventions for nursing students are necessary to enhance the quality of nursing care provided to patients with novel infectious diseases.

The Impact of Social Media on Preventive Behavior During the COVID-19 Outbreak in South Korea: The Roles of Social Norms and Self-Efficacy

Social media are important channels to propagate health information and influence preventive behavior during a public health crisis, as witnessed during the coronavirus pandemic (COVID-19). This study explored the association between social media use and preventive behavior during the outbreak of COVID-19 in South Korea. Using the national survey data (N = 1,500), the study examined the mediating role of social norms in the association between social media use for news and information about COVID-19 and preventive behavior. In addition, the study tested the moderating effect of self-efficacy on the mediating path of social media use for preventive behavior via social norms. Conducting a moderated mediation analysis method, this study found that social norms mediated the relationship between social media use and preventive behavior (b = 0.046). Moreover, the study revealed that the indirect relationship between social media use and preventive behavior through social norms becomes stronger as an individual's level of self-efficacy decreases (low: b = 0.044, middle: b = 0.036, and high: b = 0.030). The study provides empirical evidence of the beneficial impact of social media use on preventive behavior. The findings of the study recommend promoting messages on social norms through social media for facilitating preventive behavior.

Lifestyle and preventive behaviors among adults during the early phase of the COVID-19 movement control order (MCO) in Malaysia

BACKGROUND

Enforcement of the movement control order (MCO) in Malaysia caused by COVID-19 impacted people's health, social, behaviors, and economic consequences. Thus, this study aims to identify adults' lifestyle and preventive behaviors during the MCO's early phase.

MATERIALS AND METHODS

This study was conducted in April 2020 using a convenience sampling technique. A total of 9987 adults aged 18 years and above from all over Malaysia participated in the study. The questionnaire was distributed through online platforms, such as Facebook, Telegram, WhatsApp, and the official website. Descriptive statistics and Chi-square test were used to describe the categorical data and the independent T-test and one-way ANOVA tests were performed to compare continuous variables between two or more groups. The level of statistical significance was set at P < .05.

RESULTS

Selangor showed the highest participation (28.4%) and most of the respondents were females (68.2%), married (67.8%), and aged between 36 and 45 years old (34.1%). This study found that 10.3% were smokers, and 46.7% of the smokers intended to quit smoking. Most respondents took their three main meals daily (72.4%), but not even half completed daily food groups (45.1%). The frequent activities were internet surfing (18.8%) and house chores (18.2%). Almost 98% of the respondents agreed to implement preventive behaviors. This study also revealed that attitudes toward preventive behaviors significantly differed across genders, age groups, categories of marital status, and monthly income categories (P < .05). Furthermore, regarding readiness for behavior change after MCO end, only gender shows a significance difference (P < .05).

CONCLUSION

This study shed light on understanding public behavior during the early phase of the pandemic that may significantly impact public health in designing relevant regulations and policies to reduce the spread of COVID-19 infections and preparing strategies for future outbreaks or pandemics. As COVID-19 evolves, continuous efforts to promote positive behavioral changes in lifestyle and preventive behavior are needed to ensure the public practices a healthy lifestyle and complies with pandemic preventive measures.

Preisolation measures and clinical features for pediatric patients with suspicious COVID-19

Background

In December 2019, many cases of COVID-19 were reported in Wuhan City, Hubei Province, China. In the following 3 months, the disease out broke in China. Preisolation measures was used to screen out COVID-19 patients in the pediatric respiratory ward of our hospital.

Aims

To investigate the new measures for screening COVID-19 patients and to analyze the clinical features of children with suspicious COVID-19.

Methods

A total of 50 preisolated children with suspicious COVID-19 who were admitted to our hospital in Mianyang, China, between January 28 and March 5, 2020, were included. Patients presented with fever and cough or fever accompanied by vomiting and diarrhea. A detailed epidemiological history screening was performed. A real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) was used to detect SARS-COV-2 nucleic acid. Low-dose chest computed tomography (CT) was applied when pneumonia was suspicious. Routine blood tests were performed to rule out COVID-19. Patients' data were collected, and the basic clinical features, epidemiological history, clinical manifestations, auxiliary examination results, and outcomes were analyzed and summarized.

Results

No definite cases were detected, while two patients were suspected of having COVID-19. The pathogenic results of the 50 patients mainly included Mycoplasma pneumoniae, followed by Epstein-Barr virus, and rotavirus. Thirty-five patients suffered from bronchopneumonia. The preisolated patients had similar clinical and epidemiological characteristics as patients with fever, cough, vomiting, and diarrhea.

Conclusions

Preisolation measures combined with pathogen screening can minimize the risk of hospital-acquired infections by preventing patients with suspicious COVID-19 from contacting other patients before they are explicitly excluded. Clinical analysis of the patients was helpful for clinical nursing management.

Perceptions towards the COVID-19 Pandemic during Different Lockdown Levels among International Students in Taiwan

International students face many impediments under the COVID-19 pandemic. The objectives of this study are to assess the association between the perceptions of international students and the lockdown policy for COVID-19. In 2021, three different levels of lockdown policy were enforced, including level I from January to April, level III from May to July, and level II from August to December. We conducted three surveys for international graduate students using a validated questionnaire during the different lockdown levels. We collected 185, 119, and 83 valid questionnaires in level I, II, and III, respectively. There were linear trends in the correlations of lockdown policy with the knowledge (p = 0.052), attitudes (p = 0.002), and practices (p < 0.001) of COVID-19. In brief, the stricter the lockdown policy, the better the students adhered to sufficient knowledge, positive attitudes, and healthy practices. Furthermore, there were significant linear correlations of lockdown policy with the transportation, school study, leisure, family life, and diet behavior. In conclusion, lockdown policy had important impacts on the knowledge, attitudes, practices, and daily lives of international students. The findings indicated that the lockdown system and its corresponding measures appear to affect perceptions in a positive way.

Factors influencing emergency nurses' infection control practices related to coronavirus disease 2019 in Korea

BACKGROUND

When an infectious disease breaks out, emergency nurses are the front-line specialists. Infection control by emergency nurses is important to minimize the risk of infectious disease and to improve the infection control practices of emergency nurses. Therefore, it is crucial to identify the factors influencing infection control practice related to COVID-19.

METHODS

For this cross-sectional study design used survey methods for data collection, a questionnaire survey was conducted with 161 emergency nurses working in five hospitals selected through convenience sampling. Data were collected from November 10 to November 26 in 2020.

RESULTS

Infection control practice related to COVID-19 was affected by the infection prevention environment (β = 0.24, p = .002), monitoring of wearing Personal Protective Equipment (β = 0.19, p = .006), knowledge about COVID-19 (β = 0.18, p = .009), perceived severity related to COVID-19 (β = 0.18, p = .010), and perceived barrier related to COVID-19 (β = -0.15, p = .033).

CONCLUSION

Creating safe infection prevention measures and revitalizing personal protective equipment monitoring are necessary to improve infection control practices. A systematic infection control education program is needed to improve knowledge about COVID-19, emphasize its perceived severity, and identify and eliminate perceived barriers.

SARS-CoV-2 Omicron (B.1.1.529) Variant: A Challenge with COVID-19

Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, there have been multiple peaks of the SARS-CoV-2 (severe acute respiratory syndrome coronavirus virus 2) infection, mainly due to the emergence of new variants, each with a new set of mutations in the viral genome, which have led to changes in the pathogenicity, transmissibility, and morbidity. The Omicron variant is the most recent variant of concern (VOC) to emerge and was recognized by the World Health Organization (WHO) on 26 November 2021. The Omicron lineage is phylogenetically distinct from earlier variants, including the previously dominant Delta SARS-CoV-2 variant. The reverse transcription-polymerase chain reaction (RT-PCR) test, rapid antigen assays, and chest computed tomography (CT) scans can help diagnose the Omicron variant. Furthermore, many agents are expected to have therapeutic benefits for those infected with the Omicron variant, including TriSb92, molnupiravir, nirmatrelvir, and their combination, corticosteroids, and interleukin-6 (IL-6) receptor blockers. Despite being milder than previous variants, the Omicron variant threatens many lives, particularly among the unvaccinated, due to its higher transmissibility, pathogenicity, and infectivity. Mounting evidence has reported the most common clinical manifestations of the Omicron variant to be fever, runny nose, sore throat, severe headache, and fatigue. This review summarizes the essential features of the Omicron variant, including its history, genome, transmissibility, clinical manifestations, diagnosis, management, and the effectiveness of existing vaccines against this VOC.

Influence of social responsibility and pandemic awareness of nursing students on COVID-19 preventive behaviours: a cross-sectional online survey in South Korea

OBJECTIVES

Factors influencing COVID-19 preventive behaviour require exploration to strengthen the response competencies of prehealthcare professionals and reduce the pandemic's impact. This study aimed to identify the level of COVID-19 preventive behaviour among Korean nursing students and to determine the influence of social responsibility and pandemic awareness to present educational strategies for reducing disaster impact.

METHODS AND ANALYSIS

As a cross-sectional descriptive survey study using an online questionnaire, the participants were convenience sampled from one online community for nursing students and three nursing colleges located in Seoul, South Korea. The data from 590 participants were analysed by t-test, analysis of variance, Pearson's correlation and linear multiple regression using SPSS.

RESULTS

The factors influencing COVID-19 preventive behaviour were identified to be social responsibility (linear regression coefficient 0.354, 95% CI 0.243 to 0.464), pandemic awareness (linear regression coefficient 0.131, 95% CI 0.025 to 0.237), impact of COVID-19 on daily life (linear regression coefficient 0.085, 95% CI 0.019 to 0.152) and living in Daegu/Gyeong-buk area (linear regression coefficient 0.134, 95% CI 0.024 to 0.244).

CONCLUSION

Based on the findings that social responsibility and pandemic awareness are key predictors of COVID-19 preventive behaviour, customised educational programmes and additional studies are recommended for raising social responsibility and pandemic awareness among prehealthcare professionals as a part of disaster response.

COVID-19 preventive behavior among university students in Southeast Asia: Effects of knowledge, concern, awareness, and perceived risk

The persistent rise of pandemics across the globe in recent times has led to the prescription of several collaborative preventive strategies to reduce the effect that the pandemic has on public health. Consistent monitoring and surveillance appear to be the only available approach to detecting and classifying the issues of public health threats. Global pandemic threats demand public co-operation to take preventive actions at a personal level so that the risk of infectious diseases can be contained. Said that, this study explored the influence of awareness of precaution measures (APM), concerns about coronavirus disease 2019 (COVID-19) (CAC), knowledge of COVID-19 (KOC), and perceived risk (PRK) on preventive behavior (PRB), as well as the effect of age and gender on the relationships among the studied variables. Quantitative data were collected from 551 university students across Malaysia and Vietnam through field survey and online survey, respectively. The data collection was performed from 13 March to 23 March 2020. Partial least square structural equation modeling (PLS-SEM) was employed for data analysis. The multiple group analysis (MGA) technique was applied to compare the data retrieved from the respondents based on age and gender. The results revealed that APM, CAC, KOC, and PRK on PRB significantly influenced PRB toward COVID-19. In light of the two personal factors, age and gender, significant variances were noted for age and KOC, while PRK on PRB on the PRB toward COVID-19. Based on the study outcomes, APM emerged as the most significant predictor of PRB, followed by PRK on PRB, and CAC. Since a large fraction of the world reside in rural areas and have high-level interaction with animals, the provision of education at all level can harness the attitude to adopt PRB toward COVID-19. As such, policymakers need to work with the young generation so that the latter may serve as change agents to spread the message of taking precautions and adopting effective PRB toward COVID-19.

Assessment of COVID-19–Associated Stress and Knowledge Among Iranian Population: A Web-Based Cross-sectional Survey

Background: The first COVID-19 case was reported in December 2019 in China. The number of infected cases increased rapidly, and COVID-19 became a public health issue worldwide. The high transmission rate and global spreading of COVID-19 caused public anxiety and may lead to unfavorable effects on psychological health. Objectives: This study evaluated the COVID-19 impact on the public anxiety, knowledge, and behavior of Iranians. Methods: We used a web-based cross-sectional survey and collected data from 1627 volunteers. Demographic information, anxiety self-reporting, Generalized Anxiety Disorder 7-Item Scale (GAD-7), and COVID-19–related knowledge were evaluated. Results: Among the participants, the dominant GAD-7 score was mild, and the self-reporting level of anxiety was 5.28/10. Women and younger people reported higher anxiety than men and older groups. Further, 69.76% of participants had good knowledge, and among them, the level of education had a positive effect on knowledge, while sex and age did not have any effect. Social media and applications were the most common source of information. Conclusions: Our study showed that Iranians’ anxiety was at the medium level, and their high knowledge level about COVID-19 could affect this reduction; however, we should not ignore that less anxiety makes the matter less essential.

Effects of Smoking on SARS-CoV-2 Positivity: A Study of in Northern and Central California

Introduction

COVID-19 continues to impact vulnerable populations disproportionally. Identifying modifiable risk factors could lead to targeted interventions to reduce infections. The purpose of this study is to identify risk factors for testing positive for SARS-CoV-2.

Methods

Using electronic health records collected from a large ambulatory care system in northern and central California, the study identified patients who had a test for SARS-CoV-2 between 2/20/2020 and 3/31/2021. The adjusted effect of active and passive smoking and other risk factors on the probability of testing positive for SARS-CoV-2 were estimated using multivariable logistic regression. Analyses were conducted in 2021.

Results

Of 556 690 eligible patients in our sample, 70 564 (12.7%) patients tested positive for SARS-CoV-2. Younger age, being male, racial/ethnic minorities, and having mild major comorbidities were significantly associated with a positive SARS-CoV-2 test. Current smokers (adjusted OR: 0.69, 95% CI: 0.66-0.73) and former smokers (adjusted OR: 0.92, 95% CI: 0.89-0.95) were less likely than nonsmokers to be lab-confirmed positive, but no statistically significant differences were found when comparing passive smokers with non-smokers. The patients with missing smoking status (25.7%) were more likely to be members of vulnerable populations with major comorbidities (adjusted OR ranges from severe: 2.52, 95% CI = 2.36-2.69 to mild: 3.28, 95% CI = 3.09-3.48), lower income (adjusted OR: 0.85, 95% CI: 0.85-0.86), aged 80 years or older (adjusted OR: 1.11, 95% CI: 1.07-1.16), have less access to primary care (adjusted OR: 0.07, 95% CI: 0.07-0.07), and identify as racial ethnic minorities (adjusted OR ranges from Hispanic: 1.61, 95% CI = 1.56-1.65 to Non-Hispanic Black: 2.60, 95% CI = 2.5-2.69).

Conclusions

Our findings suggest that the odds of testing positive for SARS-CoV-2 were significantly lower in smokers compared to nonsmokers. Other risk factors include missing data on smoking status, being under 18, being male, being a racial/ethnic minority, and having mild major comorbidities. Since those with missing data on smoking status were more likely to be members of vulnerable populations with higher smoking rates, the risk of testing positive for SARS-CoV-2 among smokers may have been underestimated due to missing data on smoking status. Future studies should investigate the risk of severe outcomes among active and passive smokers, the role that exposure to tobacco smoke constitutes among nonsmokers, the role of comorbidities in COVID-19 disease course, and health disparities experienced by disadvantaged groups.

Investigating preventive health behaviors against COVID-19 in elementary school students' parents: A cross-sectional study from Tehran - Capital of Iran

BACKGROUND

Parents act as a role model for children in showing health behaviors. This study investigated factors affecting the preventive behavior in elementary school students' parents based on protection motivation theory (PMT).

MATERIALS AND METHODS

This cross-sectional study was conducted in Tehran (Iran) in 2020. Multistage sampling was used to choose 660 elementary school students' parents. The data collection instrument was a multi-sectional questionnaire, including sections on demographic characteristics, PMT constructs, self-reported health, and information sources related to COVID-19. In this study, descriptive statistics (mean and standard deviation) and analytical statistical methods (Pearson correlation and path analysis) were used to analyze the data. The range of Cronbach's alpha of the study instrument varied from 0.71 to 0.97.

RESULTS

The results of the current study revealed significant association between all PMT constructs and preventive behaviors. Knowledge from both direct and indirect paths was related to preventive behaviors (B = 0.76). Preventive behaviors had the strongest, direct relationship with age (B = 0.76). Based on the final fitted model, knowledge had the greatest impact on preventive behaviors through indirect and direct routes.

CONCLUSION

Knowledge was the most important variable which influenced preventive behavior, and it should be noticed in prevention programs.

Associations of COVID-19 Knowledge and Risk Perception with the Full Adoption of Preventive Behaviors in Seoul

This study explores the levels of COVID-19 knowledge, risk perception, and preventive behavior practice in Seoul, to determine whether knowledge and risk perception are significantly associated with the full adoption of preventive behaviors, for the delivery of a customized public campaign to Seoul's citizens. A total of 3000 Seoul residents participated in this study through an online questionnaire survey. They had a mean score of 84.6 for COVID-19 knowledge (range: 0-100 points) and 4.2 (range: 1-7 points) for risk perception. Of the participants, 33.4% practiced full adoption of all three preventive behaviors: hand hygiene, wearing a face mask, and social distancing; wearing a face mask was practiced the most (81.0%). Women significantly adopted these three preventive behaviors more often compared with men. Both COVID-19 knowledge and risk perception were found to be significantly associated with the full adoption of preventive behaviors; however, this association differed by the type of preventive behavior. This indicates that city-level information on the levels of COVID-19 knowledge, risk perception, and preventive behaviors should be clearly and periodically communicated among public officers and healthcare professionals to continually raise the public's awareness of the full adoption of non-pharmaceutical preventive behaviors.

Barriers and Drivers of Public Preventive Behavioral Responses to COVID-19 Outbreak: Evidence from Iran

Background: When an epidemic outspreads, the society engagement seems essential to make sure of the population’s preparedness for taking individual precautions. Objectives: The primary objective of this study was to examine public’s preventive behavioral responses to protective behaviors during the COVID-19 pandemic to provide a description of conceptual frameworks for deeper understanding of these behaviors. Methods: A self-administrated questionnaire was used in this online survey through social networks during March 19th to 26th, 2020 (n = 2550). A Likert scoring scale was employed to investigate barriers and drivers affecting the participants’ preventive behaviors. Using personal protective equipment and good hand hygiene practices were identified as person-based measures. Social distancing and the restriction of social and economic activities during the past two months were determined as community-based measures. Univariate logistic regression and multiple - logistic regression were used to identify and assess influencing factors. Results: The study results indicated that 2426 (95.1%) of the participants intended to restrict their social and economic activities, and 1968 (72.2%), 1637 (64.2%), and 2492 (97.7%) persons intended to observe social distancing, use personal protective equipment, and have good hand hygiene, respectively. The most important barriers for preventive behaviors were the lack of risk perception, economic and financial barriers, lack of access, and cultural barriers, respectively. The perceived benefit was among the most significant driver. Intention for person-based measures was less affected by demographic and economic characteristics in comparison with community-based measures. Conclusions: Considering the substantial impact of preventive behaviors on managing COVID-19 epidemic, this study findings have remarkable implications for governments to manage future communications as well as interventions during this ongoing outbreak and subsequent national risk events.

First-Year College Student Life Experiences during COVID-19 in South Korea

The purpose of this study is to examine the first-year students' experience in college during the COVID-19 pandemic to provide a better understanding of their daily life. Using inductive content analysis, this study examined the characteristics and experiences of students who started college during the COVID-19 period in South Korea. We analyzed 623 pieces of content, using data presented by a total of 81 study subjects. From this analysis, we derived 22 primary keywords, which we divided into eight categories, and then reclassified into three general topics: self-awareness (i.e., self-reflection), activities (i.e., engagement in activities), and resources (i.e., creating relationships or producing results). The results showed that, although first-year college students experienced difficulties in adapting to the COVID-19 situation, they tried to cope with them. Our findings shed light on the experiences of college students who experienced psychological problems during the COVID-19 pandemic and overcame related challenges.

Investigating the Effective Factors of Using Personal Protective Equipment from the Perspective of Nurses Caring for COVID-19 Patients: A Cross-Sectional Study

Considering the importance of appropriate personal protective equipment (PPE) for preventing COVID-19 transmission, the aim of this study was to investigate the factors affecting the use of PPE from the perspective of the nurses caring for COVID-19 patients. This descriptive cross-sectional study surveyed 240 nurses working in the central COVID-19 hospitals of Arak, Iran. Nurses were enrolled in the study by a convenience sampling method. The data collection tool was a validated questionnaire. Data were analyzed by SPSS 16 software using descriptive statistics, analysis of variance (ANOVA), and independent sample t-test. Environmental (4.24 ± 0.45), personal (4.16 ± 0.42), and organizational (4.04 ± 0.50) factors all contribute significantly to nursing attitudes about PPE use (p < 0.05). The average score, combining all identified factors, was 4.15 ± 0.31. The most influential factor contributing to appropriate use of PPE was environmental, while the least impactful parameters were related to rules and regulations. Environmental factors have the greatest impact on the use of PPE from the perspective of the nurses caring for patients with COVID-19. Managers and healthcare organizations should provide appropriate and adequate PPE to nurses, educate them on proper use, and monitor the process to resolve barriers.

The impact of the COVID-19 pandemic on stress, mental health and coping behavior in German University students - a longitudinal study before and after the onset of the pandemic

BACKGROUND

The COVID-19 pandemic has led to massive restrictions in public and private lives, including a shut-down of face-to-face teaching at universities in Germany. We aimed to examine the impact of these changes on perceived stress, mental health and (study-)related health behavior of students in a longitudinal study.

METHODS

For two timepoints - the year before the COVID-19 pandemic (2019, n = 1377) and the year during the COVID-19 pandemic (2020, n = 1867) - we surveyed students of all faculties at one German university for perceptions and preventive behavior regarding the COVID-19 pandemic using standard instruments for stress, anxiety, depression, and behavior and experience patterns.

RESULTS

About 90% of students (n = 1633) in 2020 did not have a known contact infected with SARS-CoV-2, while 180 (9.8%) did have one. Only 10 respondents (0.5%) reported an infection with SARS-CoV-2. Wearing masks and washing hands more often were practiced by ≥80% of students. Taking more care about cleanliness (51.8%) and using disinfectants (39.2%) were practiced much less. A higher percentage of female compared with male students and medical/health science students compared with science, technology, engineering, and mathematics students engaged more frequently in specific or nonspecific preventive measures. More than three quarters (77.1%) of all students rated their general health as (very) good. There were no significant differences in general health, stress, and depression between 2019 and 2020 in the students who responded at both timepoints. The distribution of behavior and experience patterns for this group showed a slight but significant difference from 2019 to 2020, namely decreasing proportions of students with a healthy pattern and a risk pattern for overexertion. Students with different behavior and experience patterns showed marked differences in perceptions and reaction to the COVID-19 pandemic as well as psychosocial stress and symptoms, with higher scores for mental health symptoms and lower scores in preventive behavior regarding risk patterns.

CONCLUSION

Despite massive alterations to students' lives in 2020, there were only moderate consequences for mental health compared with 2019 in the total student group of this German university. However, identifying students at risk would offer opportunities to foster mental health in relevant subgroups.

Public awareness and anxiety during COVID-19 epidemic in China: A cross-sectional study

OBJECTIVE

The study aims to investigate public awareness of coronavirus disease 2019 (COVID-19) and measure levels of anxiety during the outbreak.

METHOD

A total of 2115 subjects from 34 provinces in China were evaluated. A questionnaire was designed, which covers demographic characteristics, knowledge of COVID-19, and factors that influenced anxiety during the outbreak to test public awareness and determine the impact of the outbreak on people's lives. In addition, a generalized anxiety disorder (GAD) scale was utilized to assess anxiety levels during the outbreak. Lastly, the chi-square test and multiple logistic regression analysis were used to identify factors associated with levels of public anxiety.

RESULTS

A majority of respondents reported high levels of awareness of COVID-19. A total of 1107 (52.3%), 707 (33.4%), 154 (7.3%), and 147 (7%) respondents exhibited no, mild, moderate, and severe levels of anxiety, respectively. Results of the chi-square test and multiple logistic regression analysis demonstrated that respondents (a) with no college education, (b) are unaware of neighbors who may have been infected, (c) who spent considerable time collecting information and browsing negative information related to the virus, (d) are unhealthy, and (e) displayed low levels of awareness of the transmission routes were highly likely to be anxious.

CONCLUSION

During the outbreak, the majority of people exhibited high levels of awareness and knowledge regarding preventive measures from COVID-19. The absence of psychological anxiety was observed in more than half of the respondents. Adaptive responses to anxiety and high levels of awareness about COVID-19 may have protected the public during the outbreak.

Association between supportive attitude and adoptive practice of control strategy against COVID-19 amosng college students in China: a cross-sectional study

Background

We investigated college students’ attitude and compliance towards a prevention strategy involving use of non-pharmaceutical interventions (NPIs) against coronavirus disease 2019 (COVID-19).

Methods

We conducted a cross-sectional online survey in four universities in Guangdong Province (China) based on purposive sampling. A self-administered questionnaire was given to College students (CSs) to measure the supportive attitude towards an outbreak control strategy and adoption of NPIs in respondents.

Results

A total of 44,446 CSs participated between 31 January and 10 February 2020; 92.7% of respondents supported the outbreak control strategy. The proportion of respondents who avoided public places, wore a facemask, avoid gatherings, and washed hands more frequently than usual was 94.8, 92.8, 91.2 and 86.9%. respectively. A total of 76.5% respondents adopted all four measures. A supportive attitude was associated with NPI adoption. Students who were female, postgraduate, anxious, and not depressed tended to have a higher supportive attitude and higher chance of NPI adoption.

Conclusions

Higher supportiveness towards the disease control strategy for the Chinese public may lead to higher adoption rate of NPIs. Psychosocial factors were related to a supportive attitude and adoption of the NPI. We believe that our findings could aid policymakers to create NPIs to prevent and control emerging infectious diseases such as COVID-19.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10752-6.

Health care provider's risk perception, and preparedness towards COVID-19 pandemic in North Central Ethiopia, 2020

BACKGROUND

Risk perception, positive emotions, and preparedness are important parameters in predicting pandemic protective behaviors. Though, health care providers are required with sufficient knowledge, skills, preparedness and best practices towards corona virus 2019, there are limited studies in Ethiopia.

AIM

This study aimed to assess health care providers' level of risk perception, preparedness and its associated factors among HCWs in North Central Ethiopia, 2020.

METHODS

An institutional-based cross-sectional survey was conducted among 217 health care providers working in South Gondar zone Hospitals from May 15-30, 2020. Data were collected using a self-administered questionnaire. Data were coded, entered, cleaned and checked using Epi data statistical software version 4.2.0.0 and taken in STATA Version 14 statistical software for analysis. Binary logistic regression was used for the analysis. Odds ratio along with 95% CI were estimated to measure the strength of the association. Descriptive statistics are presented in figures, text, and tables.

FINDINGS AND CONCLUSION

The level of high risk perception among frontline health care workers was 57.6% (95% CI: 56.9, 58.3). Almost half, 49.8% health care providers were prepared for corona virus pandemic and only 43.78% of health care providers had good knowledge regarding COVID -19. Having good knowledge (Adjusted Odd Ratio (AOR) = 2.83; 95% CI: 1.49, 5.34), training on COVID -19 (AOR = 2.16; 95% CI:1.07, 4.39), and avoiding meeting suspected/confirmed of COVID -19 (AOR = 2.67; 95% CI:1.05, 6.83) were significantly associated with risk perception. Risk perception, knowledge and preparedness for corona virus pandemic were low. Ensuring the improvement of knowledge, preparedness, and encouragement is important.

Factors Influencing the Preventive Practice of International Students in South Korea against COVID-19 during the Pandemic

As the novel coronavirus disease (COVID-19) spreads worldwide, quarantine guidelines are being constantly updating to prevent the transmission of this virus. Regardless of which country international students live in, they might receive limited crucial quarantine guidelines from that country’s government. The purpose of this study was to identify factors influencing the preventive practice of international students in South Korea during the COVID-19 pandemic. This was a cross-sectional descriptive study. Data were collected from international students in three universities from July 10 to July 31 in 2020. A total of 261 international students participated in the survey, using an online questionnaire. Data were analyzed by independent t-test, one-way ANOVA, Pearson correlation coefficients, and multiple regression analysis. Preventive practice during the COVID-19 pandemic was affected by duration of stay in Korea (β = −0.21, p < 0.001), attitudes (β = 0.22, p = 0.001), and trust in Korea’s quarantine system (β = 0.33, p < 0.001). This study showed that attitudes and trust in the quarantine system could affect personal preventive practice during the outbreak of a highly contagious disease such as COVID-19.

Nursing students on the frontline: Impact and personal and professional gains of joining the health care workforce during the COVID-19 pandemic in Spain

BACKGROUND

Final-year nursing students in Spain augmented the health care workforce during the COVID-19 pandemic.

PURPOSE

To understand the lived experience of nursing students who joined the health care workforce during the first wave of the COVID-19 outbreak (March-May 2020).

METHOD

Qualitative content analysis of the reflective journals of 40 nursing students in Spain.

FINDINGS

The analysis identified four main themes: 1) Willingness to help; 2) Safety and protective measures: Impact and challenges; 3) Overwhelming experience: Becoming aware of the magnitude of the epidemic; and 4) Learning and growth.

DISCUSSION

The wish to help, the sense of moral duty, and the opportunity to learn buffered the impact of the students' lived experience. Despite the challenges they faced, they saw their experiences as a source of personal and professional growth, and they felt reaffirmed in their choice of career. Promoting opportunities for reflection and implementing adequate support and training strategies is crucial for building a nursing workforce that is capable of responding to future health crises.

Investigating Preventive Behaviors Toward COVID-19 Among Iranian People

Background: Considering the importance of preventive behaviors in reducing the transmission of COVID-19, this study was conducted to determine the preventive behaviors toward the spread of COVID-19. Methods: This cross-sectional study was performed 7 weeks after the confirmation of the first case of Covid-19 by the Ministry of Health and Medical Education in Iran. Data were completed online using a researcher-made questionnaire, the validity and reliability of which were confirmed, for 1,200 Iranians from 8 April 2020 to 9 May 2020. Results: The mean age of study participants was 37.77 ± 11.20 years. The mean score of preventive behaviors was 62.67 ± 8.53. The results showed that there was a significant relationship between the variables of gender, education, economic status, and preventive behaviors of COVID-19. The highest frequency is related to not using hookah and cigarettes and then avoiding losing and rubbing (78%) and the lowest percentage is related to exercising behavior (16%). Conclusion: Due to the low level of prevention behaviors during the outbreak of the disease, it is important to design educational and supportive interventions to improve and perform coronavirus prevention behaviors with more focus on men, illiterate people, and poor economic status.

Psychological Predictors of COVID-19 Prevention Behavior in Hungarian Women Across Different Generations

BACKGROUND

Age related differences were found in prevention behavior, showing that older individuals tend to be the most proactive. The aim of the study was the identification of psychological predictors on COVID-19 prevention behavior in women, across four generations. In addition, the predictive role of the psychological variables was explored through the lens of negative and positive information processing perspective on total and domain-specific COVID-19 prevention behavior.

METHODS

A cross-sectional research was conducted. The sample included 834 Hungarian speaking women. The assessed variables were: COVID-19 knowledge, risk perception, COVID-19 health anxiety, negative automatic thoughts, psychological flexibility, and four domains of COVID-19 prevention behavior (social distancing, general hygiene, information seeking, health behavior). A three-level hierarchical linear regression analysis was conducted to investigate the predictors of preventive behavior in each generation.

RESULTS

A diversity across generations was found. In case of baby boomer generation, the final model explained 32.4% of the variance for total prevention behavior [F(14,215) = 8.847, p < 0.001], and only perceived risk made a significant contribution. For Gen X the final model accounted for 21.1% of variance of total prevention behavior [F(14,341) = 7.788, p < 0.001], marital status, perceived risk, COVID-19 health anxiety, and negative automatic thoughts made significant contributions. In case of Gen Y the final model accounted for 6.2% of variance on total prevention behavior [F(14,147) = 1.761, p = 0.05], only perceived risk had a contribution to the final model. For Gen Z the final model accounted for 23.4% of variance on total preventive behavior [F(13,71) = 2.979, p = 0.002], and only psychological flexibility made a contribution to the model. The results on the distinct domains of COVID-19 prevention behavior emphasized details in the dissimilarity among generations.

CONCLUSION

The role of generational identity on COVID-19 prevention behavior is relevant. The coexistence of negative and positive information processing may have its beneficial role in certain areas of prevention.

Knowledge, attitude, and preventive behaviors of Hormozgan residents toward COVID-19, one month after the epidemic in Iran

Aim

COVID-19 has become prevalent in the world since December 2019. The further prevalence of the disease can be prevented by correct management of society and increasing knowledge, practices, and attitudes of the people. The present research aimed to evaluate the knowledge, attitudes, and preventive behaviors of people in Hormozgan in the south of Iran toward COVID-19.

Subject and methods

The present cross-sectional research was conducted over 2 months (March 2020–April 2020). The online questionnaire comprised four sections: demographic information, knowledge, attitude, and behavior toward COVID-19. Knowledge included 36 items, attitude eight items, and behavior ten items. The collected data were analyzed statistically using SPSS ver. 22. The split-half method was used to test the reliability of knowledge and the estimated value was 0.84. That of attitude and behavior was estimated via Cronbach’s alpha and was found to be 0.81 and 0.75, respectively.

Results

A total number of 2024 participants with an average age of 33.94 years took part in this research. Of all participants, 64.4% were female. According to the results, 65.8% enjoyed a good level of knowledge and 34.2% enjoyed an average level. In addition, 63.2% demonstrated a good attitude and 36.8% an average level. A large percentage of participants (90.6%) had good practices and only 9.4% had an average level of practices.

Conclusion

The present findings show that participants had a relatively good level of knowledge, positive attitude, and good behavior concerning COVID-19.

Nursing Students' Perceptions, Knowledge, and Preventive Behaviors Toward COVID-19: A Multi-University Study

Background: Knowledge, perception, and preventive behavior should be considered in the planning of effective educational interventions for the coronavirus disease of 2019 (COVID-19) pandemic and in increasing awareness about the health risks brought about by this disease. This research aimed to assess knowledge, perceptions, and preventive behavior toward the COVID-19 infection among student nurses.

Methods: The study has quantitative, descriptive, and cross-sectional design. A convenience sample of 1,226 student nurses from seven universities in Saudi Arabia was surveyed from March 22 to April 4, 2020. A four-part online survey on demographic characteristics, perceptions, knowledge, and preventive behavior of Saudi student nurses was carried out.

Results: Nearly all students were aware of the outbreak (99.2%), and most of them received information on COVID-19 primarily from social media (71.0%). Over three-fourths of the students were confident that the government (89.1%) and Ministry of Health (MOH) (86.5%) were doing a good job responding to the COVID-19 outbreak in the country. The overall average score in the knowledge questionnaire was 9.85 (SD = 1.62, range = 0–12), which is equivalent to 82.1%. The majority of the students always performed most of the preventive behavior identified in the survey, except “washing hands with soap and water for at least 20 s after blowing my nose, coughing, or sneezing” (39.2%) and “daily cleaning and disinfecting frequently touched surfaces” (41.6%). Being female, being in the fourth year, and gaining good perceived knowledge were associated with high actual COVID-19 knowledge. University, gender, age, academic level, and perceived COVID-19 knowledge were the associated factors.

Conclusions: The findings of this study have provided baseline information on the current state of Saudi nursing students' perceptions, knowledge, and preventive behavior toward COVID-19 as the crisis is happening. The findings revealed some areas that should be focused on by nursing education, as well as health agencies, to ensure that the students have adequate knowledge and correct preventive behavior.

Experiences and needs of nursing students during pandemic outbreaks: A systematic overview of the literature

Background

Recent epidemics have placed overwhelming demands on health systems, leading at times to the deployment of nursing students during the crisis. Little is known about the impact this experience has on students. Although studies have explored nursing students' knowledge about infection control, there are no specific recommendations regarding how these issues should be addressed in nurse education.

Purpose

To conduct a comprehensive systematic overview of the literature concerning nursing students in the context of emerging infectious disease epidemics or pandemics caused by zoonotic viruses.

Methods

Systematic overview.

Results

Forty-eight articles were included. Five themes were identified: education; knowledge, concern about risk and preventive behaviour; willingness to work during a pandemic outbreak; experiences and emotional impact; and ethical dilemmas.

Conclusions

There is a need to enhance nurse education to ensure that students have adequate education in infection prevention and control and the opportunity to develop the skills and attitudes required to provide care to infected patients during a pandemic. The outcomes of these education programmes would need to be evaluated using valid and reliable instruments so as to enable comparisons to be made to prepare future nurses to deal with new pandemics in an increasingly globalized world.

The impacts of knowledge, risk perception, emotion and information on citizens' protective behaviors during the outbreak of COVID-19: a cross-sectional study in China

BACKGROUND

Individual protective behaviors play an important role in the control of the spread of infectious diseases. This study aimed to investigate the adoption of protective behaviors by Chinese citizens amid the COVID-19 outbreak and its associated factors.

METHODS

An online cross-sectional survey was conducted from 22 January to 14 February 2020 through Wenjuanxing platform, measuring their knowledge, risk perception, negative emotion, response to official communication, and protective behaviors in relation to COVID-19. A total of 3008 people completed the questionnaire, of which 2845 were valid questionnaires.

RESULTS

On average, 71% of respondents embraced protective behaviors. Those who made no error in the knowledge test (AOR = 1.77, p < 0.001) perceived the high severity of the epidemic (AOR = 1.90, p < 0.001), had high negative emotion (AOR = 1.36, p = 0.005), reported good health (AOR = 1.94, p < 0.001), paid high attention to the governmental media (AOR = 4.16, p < 0.001) and trusted the governmental media (AOR = 1.97, p < 0.001) were more likely to embrace protective behaviors after adjustments for variations in potential confounding factors. Women and older people were also more likely to embrace protective behaviors. No regional or educational differences were found in the adoption of protective behaviors.

CONCLUSION

The majority of Chinese citizens embraced protective behaviors. Higher levels of protective behaviors are associated with higher knowledge, perceived severity, negative emotion, and attention to and trust in the official governmental media. Official governmental communication is the largest single predictor of protective behaviors.

COVID-19: Perspectives for the management of dental care and education

The rapid and abrupt transmission pattern of the SARS-CoV-2 unleashed the current COVID-19 pandemic, as recognized by the World Health Organization in March 2020. Considering the high risk of transmission of the virus in dental environments and the specificities in clinical practice, COVID-19 posed immediate challenges for dental care and education. Due to the need to establish infection prevention and control guidance in dental health settings to enable a safe clinical practice, this review aims to list the challenges and perspectives in managing dental care in services and schools. This review employed materials collected from PubMed and the main guidelines and studies on the novel coronavirus to provide an overview of the clinical procedures and decisions made by health care personnel in dental offices and dental schools. We expect the COVID-19 scenario to promote significant changes in clinical practice and dental education; dentists should seek specific and particular regulations for dental practice established by their state or country. Biosafety checklists are strongly recommended for appointments at dental services and face-to-face activities in dental schools.

Studying During the COVID-19 Pandemic: A Qualitative Inductive Content Analysis of Nursing Students’ Perceptions and Experiences

Coronavirus disease 2019 (COVID-19) is the latest pandemic with a high rate of morbidity and mortality worldwide. Crises like these can harm the academic functioning and psychophysical health of nursing students. With this qualitative study, we aim to explore how students perceive the COVID-19 crisis and what their personal experiences were while studying during the global pandemic. In the study, data saturation was achieved after analyzing the reports of 33 undergraduate nursing students, using the inductive thematic saturation method. Data were collected using an online form, which students filled out, describing their perceptions and experiences. Qualitative inductive content analysis of students’ reports resulted in 29 codes, indicating different student perceptions of the efficiency of state institutions in crises. All students described the spread of misinformation on social networks and the risky behavior of the population. Most are afraid of infection and worried about the well-being of their family, so they constantly apply protective measures. Students recognize their responsibility to the community and the importance and risks of the nursing profession. They also describe negative experiences with public transportation and residence in the student dorm. The fear of possible infection in the classroom is not significant, however, students are afraid of the clinical settings. Thirteen students reported difficulty in concentrating and learning, while all students praised teacher support and faculty work in this crisis.

A Bibliometric Analysis of Corona Pandemic in Social Sciences: A Review of Influential Aspects and Conceptual Structure

Corona pandemic has affected the whole world, and it is a highly researched area in biological sciences. As the current pandemic has affected countries socially and economically, the purpose of this bibliometric analysis is to provide a holistic review of the corona pandemic in the field of social sciences. This study aims to highlight significant, influential aspects, research streams, and themes. We have reviewed 395 journal articles related to coronavirus in the field of social sciences from 2003 to 2020. We have deployed 'biblioshiny' a web-interface of the 'bibliometrix 3.0' package of R-studio to conduct bibliometric analysis and visualization. In the field of social sciences, we have reported influential aspects of coronavirus literature. We have found that the 'Morbidity and Mortality Weekly Report' is the top journal. The core article of coronavirus literature is 'Guidelines for preventing health-care-associated pneumonia'. The most commonly used word, in titles, abstracts, author's keywords, and keywords plus, is 'SARS'. Top affiliation is 'The University of Hong Kong'. Hong Kong is a leading country based on citations, and the USA is on top based on total publications. We have used a conceptual framework to identify potential research streams and themes in coronavirus literature. Four research streams are found by deploying a co-occurrence network. These research streams are 'Social and economic effects of epidemic disease', 'Infectious disease calamities and control', 'Outbreak of COVID 19,' and 'Infectious diseases and the role of international organizations'. Finally, a thematic map is used to provide a holistic understanding by dividing significant themes into basic or transversal, emerging or declining, motor, highly developed, but isolated themes. These themes and subthemes have proposed future directions and critical areas of research.

The outbreak of coronavirus disease in China: Risk perceptions, knowledge, and information sources among prenatal and postnatal women

BACKGROUND

The COVID-19 pandemic has created anxiety among members of the public, including all women over the childbirth continuum, who are considered to be at a greater risk of contracting most infectious diseases. Understanding the perspectives of health care consumers on COVID-19 will play a crucial role in the development of effective risk communication strategies. This study aimed to examine COVID-19-related risk perceptions, knowledge, and information sources among prenatal and postnatal Chinese women during the initial phase of the COVID-19 pandemic.

METHODS

A cross-sectional survey design was adopted, and a four-section online questionnaire was used to collect data. Using a social media platform, the online survey was administered to 161 participants during the outbreak of COVID-19 in Nanjing, China, in February 2020.

RESULTS

The participants perceived their risk of contracting and dying from COVID-19 to be lower than their risk of contracting influenza, however many of them were worried that they might contract COVID-19. The participants demonstrated adequate knowledge about COVID-19. The three major sources from which they obtained information about COVID-19 were doctors, nurses/midwives, and the television, and they placed a high level of confidence in these sources. There was no significant relationship between the perceived risk of contracting COVID-19 and knowledge about this disease.

CONCLUSION

The present findings offer valuable insights to healthcare professionals, including midwives, who serve on the frontline and provide care to pregnant women. Although the participants were adequately knowledgeable about COVID-19, they had misunderstood some of the recommendations of the World Health Organisation.

Preventive Behavioral Responses to the 2015 Middle East Respiratory Syndrome Coronavirus Outbreak in Korea

This study examined the public’s preventive behavioral responses during the 2015 Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in Korea and the influencing factors. Two cross-sectional telephone surveys were conducted by Gallup Korea using random digit dialing in June 2015 (n = 2004). The main outcome variables were nonpharmaceutical preventive measures (survey (1): Measures for reducing transmission (handwashing, face masks); and survey (2): Measures for avoiding contact with others). Multiple logistic regression was used to identify the factors influencing preventive behaviors. In survey (1), 60.3% of respondents reported more frequent handwashing and 15.5% reported wearing face masks at least once due to the MERS-CoV epidemic. In survey (2), 41–56% of respondents reported practicing avoidance measures. The concerned group was more likely to practice reducing transmission measures (odds ratio (OR) 4.5; 95% confidence interval (CI) 3.3–6.1) and avoidance measures (OR = 9.6; 95% CI, 6.4–14.4). The respondents who had low trust in president or ruling party had a higher practice rate of reducing transmission measures (OR = 1.7; 95% CI, 1.2–2.6) and avoidance measures (OR = 2.1; 95% CI, 1.2–3.5). Cooperative prevention measures need appropriated public concern based on effective risk communication.

Nurses' experiences of care for patients with Middle East respiratory syndrome-coronavirus in South Korea

BACKGROUND

This study aimed to identify nurses' experiences of care for patients with Middle East respiratory syndrome-coronavirus (MERS-CoV). Their experiences can be useful to establish a safer healthcare system in preparation for infectious disease outbreaks.

METHODS

Data were collected through in-depth individual interviews and analyzed using Colaizzi's phenomenological method. Participants were 12 nurses.

RESULTS

Nurses' experiences of care for patients with MERS-CoV were categorized as follows: "Going into a dangerous field," "Strong pressure because of MERS-CoV," "The strength that make me endure," "Growth as a nurse," and "Remaining task."

CONCLUSIONS

It is necessary to examine the difficulties and demands of healthcare providers for establishing a safe healthcare system to respond effectively when national disasters occur. In addition, it is necessary to develop strategies to protect healthcare providers from severe physical and psychological stress.

MERS transmission and risk factors: a systematic review

Background

Since Middle East respiratory syndrome (MERS) infection was first reported in 2012, many studies have analysed its transmissibility and severity. However, the methodology and results of these studies have varied, and there has been no systematic review of MERS. This study reviews the characteristics and associated risk factors of MERS.

Method

We searched international (PubMed, ScienceDirect, Cochrane) and Korean databases (DBpia, KISS) for English- or Korean-language articles using the terms “MERS” and “Middle East respiratory syndrome”. Only human studies with > 20 participants were analysed to exclude studies with low representation. Epidemiologic studies with information on transmissibility and severity of MERS as well as studies containing MERS risk factors were included.

Result

A total of 59 studies were included. Most studies from Saudi Arabia reported higher mortality (22–69.2%) than those from South Korea (20.4%). While the R₀ value in Saudi Arabia was < 1 in all but one study, in South Korea, the R₀ value was 2.5–8.09 in the early stage and decreased to < 1 in the later stage. The incubation period was 4.5–5.2 days in Saudi Arabia and 6–7.8 days in South Korea. Duration from onset was 4–10 days to confirmation, 2.9–5.3 days to hospitalization, 11–17 days to death, and 14–20 days to discharge. Older age and concomitant disease were the most common factors related to MERS infection, severity, and mortality.

Conclusion

The transmissibility and severity of MERS differed by outbreak region and patient characteristics. Further studies assessing the risk of MERS should consider these factors.

MERS transmission and risk factors: a systematic review

BACKGROUND

Since Middle East respiratory syndrome (MERS) infection was first reported in 2012, many studies have analysed its transmissibility and severity. However, the methodology and results of these studies have varied, and there has been no systematic review of MERS. This study reviews the characteristics and associated risk factors of MERS.

METHOD

We searched international (PubMed, ScienceDirect, Cochrane) and Korean databases (DBpia, KISS) for English- or Korean-language articles using the terms "MERS" and "Middle East respiratory syndrome". Only human studies with > 20 participants were analysed to exclude studies with low representation. Epidemiologic studies with information on transmissibility and severity of MERS as well as studies containing MERS risk factors were included.

RESULT

A total of 59 studies were included. Most studies from Saudi Arabia reported higher mortality (22-69.2%) than those from South Korea (20.4%). While the R₀ value in Saudi Arabia was < 1 in all but one study, in South Korea, the R₀ value was 2.5-8.09 in the early stage and decreased to < 1 in the later stage. The incubation period was 4.5-5.2 days in Saudi Arabia and 6-7.8 days in South Korea. Duration from onset was 4-10 days to confirmation, 2.9-5.3 days to hospitalization, 11-17 days to death, and 14-20 days to discharge. Older age and concomitant disease were the most common factors related to MERS infection, severity, and mortality.

CONCLUSION

The transmissibility and severity of MERS differed by outbreak region and patient characteristics. Further studies assessing the risk of MERS should consider these factors.