Quarantine during COVID-19 outbreak: Changes in diet and physical activity increase the risk of cardiovascular disease

COVID-19 Pandemic as an Equalizer of the Health Returns of Educational Attainment for Black and White Americans

BACKGROUND

COVID-19 pandemic has immensely impacted the social and personal lives of individuals around the globe. Marginalized-related diminished returns (MDRs) theory suggests that educational attainment shows a weaker protective effect for health and behavioral outcomes for Black individuals compared to White individuals. Previous studies conducted before the COVID-19 pandemic demonstrated diminished returns of educational attainment for Black individuals compared to White individuals.

OBJECTIVES

The study has three objectives: First, to test the association between educational attainment and cigarette smoking, e-cigarette vaping, presence of chronic medical conditions (CMC), self-rated health (SRH), depressive symptoms, and obesity; second, to explore racial differences in these associations in the USA during the COVID-19 pandemic; and third, to compare the interaction of race and return of educational attainment pre- and post-COVID-19 pandemic.

METHODS

This study utilized data from the Health Information National Trends Survey (HINTS) 2020. Total sample included 1313 adult American; among them, 77.4% (n = 1017) were non-Hispanic White, and 22.6% (n = 296) were non-Hispanic Black. Educational attainment was the independent variable operationalized as years of education. The main outcomes were cigarette smoking, e-cigarette vaping, CMC, SRH, depressive symptoms, and obesity. Age, gender, and baseline physical health were covariates. Race/ethnicity was an effect modifier.

RESULTS

Educational attainment was significantly associated with lower CMC, SRH, depressive symptoms, obesity, cigarette smoking, and e-cigarette vaping. Educational attainment did not show a significant interaction with race on any of our outcomes, suggesting that the health returns of education is similar between non-Hispanic White and non-Hispanic Black individuals.

CONCLUSION

COVID-19 may have operated as an equalizer of the returns of educational attainment. This observation may be because White may have more to lose; Black communities may be more resilient or have economic and social policies that buffered unemployment and poverty regardless of historical anti-Black oppression.

Biofeedback-Based Proprioceptive Training to Improve Functional Prerequisites of Dragon Boating in Breast Cancer Survivors

Breast cancer (BC)-related sequelae drastically impact the psychophysical functioning and quality of life of affected women. Adapted physical activity (APA) has proved to effectively counteract these impairments in a non-medicalized framework. In particular, dragon boats are able to promote body functionality, social interaction, and quality of life in BC survivors, but the literature on specific motor gestures is scarce and practice is still based more on a re-educative perspective than a performative one. In this context, the present longitudinal study investigated the benefits of an adapted biofeedback-based sensorimotor training intervention on upper body functionality in a team of dragon ladies. The 8-week intervention was conceived as integrated dry workout sessions led by an APA kinesiologist and applied a novel sensorized proprioceptive device, such as a Libra board. Post-protocol evaluation revealed a significant improvement in bilateral upper limb mobility, core endurance, and trunk stability along with a distress decrease and quality of life enhancement through validated assessment tools. Our findings suggest that integrating biofeedback-based workout sessions can effectively promote upper body functionality in BC survivors practicing dragon boating. Furthermore, our innovative approach could help spread methodological hints able to boost exercise adherence in this target population, thus counteracting cancer recurrence while promoting overall well-being.

Evaluation of blood pressure variation in recovered COVID-19 patients at one-year follow-up: a retrospective cohort study

BACKGROUND

Coronavirus disease 2019 (COVID-19) has various sequelae, one of which might be hypertension. We aimed to evaluate COVID-19's impact on blood pressure (BP) in non-hospitalized patients at one-year follow-up.

METHOD

A total of 7,950 consecutive COVID-19 patients regularly visiting our cardiology clinic were retrospectively screened. Patients' electronic medical records including demographics, comorbidities, vital signs, treatments, and outcomes, were reviewed by two physicians. Individuals with at least one BP measurement in the three months preceding COVID-19 and one measurement in 12 months or more following recovery were included. BP levels before and after COVID-19 were compared using the paired t-test.

RESULTS

5,355 confirmed COVID-19 patients (mean age 55.51 ± 15.38 years) were included. Hypertension (56.9%) and diabetes mellitus (34%) were the predominant comorbidities, and 44.3% had prior major adverse cardiovascular events. Both systolic (126.90 ± 20.91 vs. 139.99 ± 23.94 mmHg, P < 0.001) and diastolic BP (80.54 ± 13.94 vs. 86.49 ± 14.40 mmHg, P < 0.001) were significantly higher post-COVID-19 vs. pre-COVID-19. Notably, 456 (14%) hypertensive patients experienced exacerbated hypertension, while 408 (17%) patients developed new-onset hypertension, overall 864 (16%) of patients had exacerbation or new hypertension. Linear regression analysis revealed that advanced age, smoking, previous cardiovascular events, hypertension, and diabetes mellitus predict increased BP following COVID-19 (P < 0.001).

CONCLUSION

COVID-19 raised systolic and diastolic BP in the long term in non-hospitalized patients, with over one-sixth developing new-onset or exacerbated hypertension. All patients should be evaluated regarding BP, following COVID-19 recovery, particularly those with the mentioned predictive factors. (clinicaltrial.gov: NCT05798208).

Lifestyle and eating habits changes among adults during COVID-19 era in Egypt: a population-based study

BACKGROUND

The 2019 recent Coronavirus is without a doubt one of the most complicated viruses to ever pose a threat to humanity. Numerous viral containment strategies forced sedentary behaviors and dietary changes that would-otherwise- increase the chances of acquiring non-communicable diseases.

OBJECTIVES

The objectives of the current study are to identify any changes in eating behaviors through the Mediterranean Diet Adherence in a sample of Egyptians throughout the COVID-19 era.

METHODS

A cross-sectional study was done on a sample of 205 Egyptians by an online self-administered questionnaire. The questionnaire included socio-demographic factors, self-reported weights and heights, a validated Arabic form of the well-known International Physical Activity Questionnaire Short Form (IPAQ-SF), a validated Arabic version of 14-items Mediterranean Diet Adherence Screener (MEDAS), in addition to a section assessing dietetic changes. The data was then analyzed using the SPSS version 20 (Statistical Package for Social Sciences).

RESULTS

The majority of the study sample were females (74.6%); had a high level of education (93.2%); and about 75% were married. Most of the participants were non-smokers, with around a 7% increased frequency of smoking after the COVID-19 pandemic. Fast food consumption was also reported by a major percentage of study participants (60%). Low Mediterranean Diet Adherence was found in 52.7%. Moreover, Physical Activity (PA) decreased to 61%. Moreover, there was a statistically significant increase seen in the participants' BMI as well as the number of sleeping hours (p = 0.001 and 0.043 respectively) after the pandemic. Both changed hunger sensation and any changes in physical activity were significantly associated with increased BMI (p < 0.001).

CONCLUSION AND RECOMMENDATIONS

A substantial proportion of the participants showed unhealthy changes in their dietary habits as well as physical activity. Consequently, this calls for urgent public health policies and interventions to guard against the consequences of such unhealthy behaviors.

The Impact of Quarantine on Physical Activity, Body Weight, and Eating Behaviors During the COVID-19 Pandemic in Saudi Arabia

Background Since February 2020, the number of coronavirus disease 2019 (COVID-19) cases in Saudi Arabia has been rising. The Saudi Arabian government implemented strict lockdown measures in March 2020 in an effort to stop the spread of the virus. Globally, changes in socioeconomic levels and health during quarantine have been reported. Additional detrimental effects of the stay-at-home mandate include less physical activity among adult populations, anxiety, stress, and emotional eating. This study aimed to assess the impact of quarantine during the COVID‑19 pandemic on physical activity practice and weight. Methodology This cross-sectional study was conducted using a newly developed validated online questionnaire survey. The data were collected during quarantine in June 2020, including each adult who lived in Saudi Arabia during the quarantine. The data were reviewed and analyzed using SPSS version 21 (IBM Corp., Armonk, NY, USA). Results A total of 4,970 eligible participants completed the study survey. About 78.1% of the study participants performed physical activity inside the house during the pandemic. Overall, 30.9% reported increased body weight during the lockdown, and the most reported cause of increased body weight was feeling bored and empty. Regarding factors associated with physical activity and weight changes, 82.2% of participants aged 25-30 years performed physical activity during the pandemic. Increased weight was significantly higher among participants aged more than 30 years. Conclusions This study shows an increased level of physical activity among the study participants during the COVID-19 pandemic, especially among younger, female, and unmarried participants. More than half of the participants reported weight change, either weight gain or weight loss. Weight gain was higher in older participants. Regarding eating habits, there was an increased tendency toward eating a healthy diet.

Quality of care in patients with hypertension: a retrospective cohort study of primary care routine data in Germany

BACKGROUND

Hypertension is a leading cause of morbidity and mortality if not properly managed. Primary care has a major impact on these outcomes if its strengths, such as continuity of care, are deployed wisely. The analysis aimed to evaluate the quality of care for newly diagnosed hypertension in routine primary care data.

METHODS

In the retrospective cohort study, routine data (from 2016 to 2022) from eight primary care practices in Germany were exported in anonymized form directly from the electronic health record (EHR) systems and processed for this analysis. The analysis focused on five established quality indicators for the care of patients who have been recently diagnosed with hypertension.

RESULTS

A total of 30,691 patients were treated in the participating practices, 2,507 of whom have recently been diagnosed with hypertension. Prior to the pandemic outbreak, 19% of hypertensive patients had blood pressure above 140/90 mmHg and 68% received drug therapy (n = 1,372). After the pandemic outbreak, the proportion of patients with measured blood pressure increased from 63 to 87%, while the other four indicators remained relatively stable. Up to 80% of the total variation of the quality indicators could be explained by individual practices.

CONCLUSION

For the majority of patients, diagnostic procedures are not used to the extent recommended by guidelines. The analysis showed that quality indicators for outpatient care could be mapped onto the basis of routine data. The results could easily be reported to the practices in order to optimize the quality of care.

Navigating sarcopenia in COVID-19 patients and survivors: Understanding the long-term consequences, transitioning from hospital to community with mechanisms and interventions for future preparedness

The coronavirus disease 2019 (COVID-19) pandemic has caused widespread devastation, with millions of confirmed cases and deaths worldwide. Although there were efforts made to develop treatments and vaccines for COVID-19, the coexistence of sarcopenia, a muscle disorder, has been largely overlooked. It is while new variants of this disease (eg, BA.2.86) are challenging the current protocols. Sarcopenia is associated with increased mortality and disability, and shares common mechanisms with COVID-19, such as inflammation, hormonal changes, and malnutrition. This can worsen the effects of both conditions. Furthermore, survived patients with COVID-19 who have elevated risk, as well as aging, which increases the process of sarcopenia. Therefore, addressing sarcopenia in patients with COVID-19 and surviving individuals can be crucial for improving outcomes and preventing long-term disability. During hospital stays, assessing sarcopenia through indicators like muscle wasting and malnutrition is important. Nutritional interventions, such as malnutrition screening and enteral feeding, play a critical role in preventing sarcopenia in hospitals. Mental health and physical activity evaluations and interventions are also necessary. Even after recovering from COVID-19, there is a risk of developing sarcopenia, requiring continued monitoring. Nutrition and physical activity considerations are vital for prevention and management, necessitating tailored training programs and diet therapy. Mental health should not be overlooked, with regular screening, and community-based interventions. Infrastructure should support physical activity, and mental health services must become more accessible. Community engagement through support groups and peer networks can foster resilience and social connection. Efforts are needed to promote healthy diets and ensure access to nutritious foods.

A systematic review of studies on stress during the COVID-19 pandemic by visualizing their structure through COOC, VOS viewer, and Cite Space software

Background

The COVID-19 epidemic generated different forms of stress. From this period, there has been a remarkable increase in the quantity of studies on stress conducted by scholars. However, few used bibliometric analyses to focus on overall trends in the field.

Purpose

This study sought to understand the current status and trends in stress development during COVID-19, as well as the main research drives and themes in this field.

Methods

2719 publications from the Web of Science(WOS) core repository on stress during COVID-19 were analyzed by utilizing Co-Occurrence (COOC), VOS viewer, and Cite Space bibliometric software. The overall features of research on stress during COVID-19 were concluded by analyzing the quantity of publications, keywords, countries, and institutions.

Results

The results indicated that the United States had the largest number of publications and collaborated closely with other countries with each other. University of Toronto was the most prolific institution worldwide. Visualization and analysis demonstrated that the influence of stress during COVID-19 on the work, life, mental and spiritual dimensions is a hot research topic. Among other things, the frequency of each keyword in research on stress during COVID-19 increased from 2021 to 2022, and the researchers expanded their scope and study population; the range of subjects included children, nurses, and college students, as well as studies focusing on different types of stress, and emphasizing the handling of stress.

Conclusion

Our findings reveal that the heat of stress research during COVID-19 has declined, and the main research forces come from the United States and China. Additionally, subsequent research should concern more on coping methods with stress, while using more quantitative and qualitative studies in the future.

Changes in emergency department visits and mortality during the COVID-19 pandemic: a retrospective analysis of 956 hospitals

BACKGROUND

During the COVID-19 pandemic, many non-COVID-19 emergency department (ED) visits were indirectly affected. ED visits and mortality were assessed during different pandemic time periods compared with pre-pandemic.

METHODS

The study used data from 41 million Iran Health Insurance Organization members. The outcomes were non-COVID-19 ED visits and associated mortality in 956 hospitals. An analysis of ED visits was conducted both for all-cause and cause-specific conditions: cardiovascular diseases (CVD), mental and substance use disorders, unintentional injuries, and self-harm. In addition, total in-hospital ED mortality was analyzed. A negative binomial regression and a Poisson regression with a log link were used to estimate the incidence rate ratio (IRR) of visits and mortality relative risk (RR).

RESULTS

1,789,831 ED visits and 12,377 deaths were reported during the study. Pre-pandemic (Sep 2019 to Feb 2020), there were 2,767 non-COVID-19 visits rate per million person-month, which decreased to 1,884 during the first COVID-19 wave with a national lockdown from Feb 20 to Apr 19, 2020 (IRR 0.68, [0.56-0.84]). The non-COVID-19 ED mortality risk was 8.17 per 1,000 visit-month during the pre-pandemic period, rising to 12.80 during the first wave of COVID-19 (RR 1.57, [1.49-165]). Non-COVID-19 ED visit rates decreased during the first pandemic year from Sep 2020 to Feb 2021 (IRR 0.73, [0.63-0.86]), but increased after COVID-19 vaccination two years later from Sep 2021 to Feb 2022 (IRR 1.11, [0.96-0.17]). The total ED mortality risk for non-COVID-19 was significantly higher after the COVID-19 outbreak in the first (RR 1.66, [1.59-1.72]) and second years (RR 1.27, [1.22-1.32]) of the pandemic. The visit incidence rate for mental health and substance use disorders declined from 8.18 per million person-month to 4.57 (IRR 0.53, [0.32 to 0.90]) in the first wave. In the second year, unintentional injury visits increased significantly compared with pre-pandemic (IRR 1.63, [1.30-2.03]). As compared to before the pandemic, there was no significant change in CVD and self-harm visit rates during the pandemic. Cardiac arrest was the leading cause of death in Iran hospitals' EDs.

CONCLUSION

In the first year of the COVID-19 pandemic, non-COVID-19 hospital ED visits declined and mortality risk increased. Despite two years since the COVID-19 outbreak, non-COVID-19 ED mortality risk remains high.

Interaction between Selected Adipokines and Musculoskeletal and Cardiovascular Systems: A Review of Current Knowledge

Adipokines are substances secreted by adipose tissue that are receiving increasing attention. The approach to adipose tissue has changed in recent years, and it is no longer looked at as just a storage organ but its secretion and how it influences systems in the human body are also looked at. The role of adipokine seems crucial in developing future therapies for pathologies of selected systems. In this study, we look at selected adipokines, leptin, adiponectin, chemerin, resistin, omentin-1, nesfatin, irisin-1, visfatin, apelin, vaspin, heparin-binding EGF-like growth factor (HB-EGF), and TGF-β2, and how they affect systems in the human body related to physical activity such as the musculoskeletal and cardiovascular systems.

The impact of COVID-19 on cardiovascular health behaviors in people living with HIV

The COVID-19 pandemic's impact on cardiovascular health behaviors including diet, physical activity, medication adherence, and self-care among people living with HIV (PLWH) remains unknown. Using qualitative analyses, we examined the impact of the COVID-19 pandemic on cardiovascular health behaviors among PLWH. Twenty-four PLWH were enrolled in this multisite study from September to October 2020. Individuals participated in semi-structured telephone interviews that were recorded, transcribed, and coded by 4 independent coders. Codes were adjudicated and analyzed for common themes. Participants were, on average, 59.2 years old (+/-9.4), 75% African American (n = 18) and 71% male (n = 17). The pandemic altered cardiovascular disease health behaviors. PLWH changed diet based on stay-at-home orders and food access. Alterations in physical activity included transitioning from gym and group class exercise to home-based exercise. Antiretroviral adherence was maintained, even when other health behaviors wavered, suggesting resilience in PLWH that may be harnessed to maintain other health behaviors.

The relationship between coronavirus anxiety level and emotional eating in individuals with metabolic syndrome

This study used a descriptive, cross-sectional and relational screening model. The full sampling method was used in this study. The study was completed with 105 individuals with MetS attending the outpatient nutrition clinic and 109 non-MetS individuals without MetS diagnosis, who also attended the outpatient nutrition clinic. The data included anthropometric measurements, biochemical findings, blood pressure, a survey form, the Coronavirus Anxiety Scale (CAS), and the Emotional Eating Scale (EES). The coronavirus anxiety scale scores of individuals with MetS were found to be statistically significantly higher than those of the non-MetS group (p <0.05). The difference in the emotional eating scale scores between the MetS and non-MetS groups was not significant (p <0.05). Individuals with MetS had higher coronavirus anxiety levels than those without MetS; however, there was no difference between participants with and without MetS in terms of emotional eating behavior.

Effects of COVID-19 home quarantine on pregnancy outcomes of patients with gestational diabetes mellitus: a retrospective cohort study

OBJECTIVE

This study aimed to evaluate the effects of the home quarantine on pregnancy outcomes of gestational diabetes mellitus (GDM) patients during the COVID-19 outbreak.

METHODS

The complete electronic medical records of patients with GDM with home quarantine history were collected and classified into the home quarantine group from 24 February 2020 to 24 November 2020. The same period of patients with GDM without home quarantine history were included in the control group from 2018 to 2019. The pregnant outcomes of the home quarantine and control groups were systematically compared, such as neonatal weight, head circumference, body length, one-minute Apgar score, fetal macrosomia, and pre-term delivery.

RESULTS

A total of 1358 patients with GDM were included in the analysis, including 484 in 2018, 468 in 2019, and 406 in 2020. Patients with GDM with home quarantine in 2020 had higher glycemic levels and adverse pregnancy outcomes than in 2018 and 2019, including higher cesarean section rates, lower Apgar scores, and higher incidence of macrosomia and umbilical cord around the neck. More importantly, the second trimester of home quarantine had brought a broader impact on pregnant women and fetuses.

CONCLUSION

Home quarantine has aggravated the condition of GDM pregnant women and brought more adverse pregnancy outcomes during the COVID-19 outbreak. Therefore, we suggested governments and hospitals strengthen lifestyle guidance, glucose management, and antenatal care for patients with GDM with home quarantine during public health emergencies.

The Association of Insomnia and Stress on Cardiovascular Risk Factors during COVID-19 Confinement in the Mexican Population

During the pandemic confinement, the WHO changed the term "social distancing" to "physical distancing", to help people deal with the lack of social contact. As a result, there was an increase in mental health problems, including insomnia and stress, with a negative impact on cardiovascular health. The objective of this research was to identify the association between insomnia and stress and cardiovascular risk (CVR) during the pandemic in a sample of the general population in Mexico; the participants were chosen using the non-probabilistic method. The data were obtained from an online questionnaire about medical histories focused on cardiovascular risk, according to the Official Mexican Standards and Regulations for patients' clinical records, NOM-004-SSA3-2012, along with an index for the severity of insomnia, measured with a seven-item guide, and an instrument to measure stress. The data were analyzed with descriptive statistics for several different variables: sociodemographics, stress, insomnia, and cardiovascular risk. Cardiovascular risk was compared to insomnia and stress variables, which led to statistically significant differences and correlations between the variables. Participants were divided into four groups with respect to CVR, from low to very high CVR. This research demonstrated that women were more susceptible to stress and cardiovascular risk. However, stress was a more major indicator of CVR than insomnia, but in the high and very high CVR groups, insomnia contributed along with stress; coping strategies reduced the risk in the high CVR group but did not function as expected with respect to reducing risk in the very high CVR group. These findings suggest that sleep patterns and mental health alterations present during the pandemic may persist even when the pandemic was declared as having ended and may contribute to increases in cardiovascular risk in the long-term.

Negative mood state in Kermanshah population during COVID-19 quarantine linked to low physical activity levels: a cross-sectional online survey study

One of the most significant consequences of the coronavirus disease (COVID-19) pandemic is the anxiety and stress it causes among the general population, which can be reduced by engaging in regular physical activity. The aim of this study was to estimate the levels of physical activity and mood state during the COVID-19 quarantine among the Kermanshah population. In this cross-sectional study, a total of 2471 subjects (1256 males and 1215 females) were selected in the population of Kermanshah in the west of Iran, using the convenience sampling method. Physical activity levels were assessed using the physical activity (PA) questionnaire short form (IPAQ-SF), and mood state was measured by the abbreviated form of the Iranian version of the standard POMS questionnaire (Bill Morgan 1979). Participants completed the online questionnaire between March 28th and May 20th, 2020. Descriptive statistics (mean, standard deviation, and percentage), and deductive (Chi-square and Spearman's correlation) were used for data analysis. our study found that the majority of participants reported decreased PA levels during the quarantine period. Specifically, 71.7% reported a decrease in moderate-intensity physical activity, 80.5% reported a decrease in high-intensity PA, and 71.3% reported a decrease in the total volume of PA. The results showed that there was a significant difference between the number of sessions (P=0.001), intensity (P=0.001), and duration of exercise (P=0.001) before and during the coronavirus. There was a significant positive relationship between low (r=0.93; P=0.001) and high (r=0.673; P=0.034) levels of PA and negative mood state. Additionally, there was a positive relationship between moderate PA level (r=0.82; P=0.001) and a positive mood states. The study suggests that the current quarantine has negatively affected the mood states of the participants. Overall, the study recommends regular PA to prevent COVID-19 while adhering to health and safety protocols.

Physical activity improves health-related quality of life, 6MWT, and VO2 peak before and during COVID-19 in patients with heart failure: A meta-analysis

OBJECTIVE

To compare the effects of physical activity on improving health-related quality of life (HRQOL), six minutes walking test (6MWT), and oxygen consumption (VO2) peak before and during Coronavirus disease (COVID-19) in patients with heart failure.

METHODS

Following PRISMA guidelines, we searched for relevant articles from five databases, including Embase, MEDLINE, CINAHL, PEDro, Cochrane, and additional resources. Study quality was assessed using Joanna Briggs Institution (JBI). RevMan 5.3 software was used to perform the meta-analysis.

RESULT

Fifteen randomized controlled trial studies met the criteria. Analysis of the subgroup before COVID-19 showed that PA had a significant effect on HRQOL, as measured by MLHFQ (SDM: -0.27, 95% CI: -0.47 to -0.07, n=590), KCCQ (SDM: 2.10, 95% CI: 0.74 to 3.46, n=53), 6MWT (SMD: 1.63, 95% CI: 0.80 to 2.46, n=284), and VO2 peak (SMD: 0.97, 95% CI: 0.00 to 1.93, n=106). Analysis of the subgroup during COVID-19 showed that PA resulted in a significant effect on HRQOL, MLHFQ (SDM: -0.62, 95% CI: -1.32 to 0.09, n=221), KCCQ (SDM: 0.33, 95% CI: 0.15 to 0.50, n=486), 6MWT (SMD: 0.47, 95% CI: 0.22 to 0.73, n=493), and VO2 peak (SMD: 0.35, 95% CI: 0.10 to 0.60, n=325).

CONCLUSION

The PA could increase HRQOL, 6MWT, and VO2 peak before and during COVID-19, and therefore should be considered as part of daily activities for patients with HF.

Physical activity as a mediator of the association of body mass index change with anxiety/depression symptoms in Brazilian adults during COVID-19

BACKGROUND

the COVID-19 pandemic has impacted people's behaviors and mental health around the world.

AIM

to verify the mediating role of physical activity (PA) level in the relationship between body mass index (BMI) and anxiety and depression symptoms.

METHODS

this is a cross-sectional study with Brazilian adults aged ≥ 18 years (n = 2,000, 59.6 % women) selected by the nonprobabilistic snowball method through digital means of communication (WhatsApp®, Telegram®, Facebook®, Twitter®, e-mails). Linear regression models were fitted for PA level mediation analyses in the relationship between BMI and anxiety/depression symptoms.

RESULTS

significant differences were found between the active/not overweight group and the other three groups (active/overweight, insufficiently active/not overweight and insufficiently active/overweight [p < 0.001]) for anxiety/depression after adjusting for age, gender, chronic diseases, alcohol consumption, and smoking. When testing the mediating role of daily PA in the association between BMI and anxiety/depression symptoms, BMI was negatively associated with daily PA in the first regression equation (p < 0.001); in the second, BMI was positively related to anxiety/depression symptoms (p < 0.001); and in the third, daily PA showed an inverse relationship with anxiety/depression symptoms (p < 0.001), and although BMI remained negatively associated with anxiety/depression symptoms, these associations maintained their statistical significance.

CONCLUSIONS

the results suggest that the effect of BMI on anxiety and depression was partially mediated by daily PA.

The Intersection Between COVID-19, Cardiovascular Disease, and Diet: a Review

PURPOSE OF REVIEW

Cardiovascular disease (CVD) is one of the top comorbidities associated with COVID-19-both pre- and post-infection. This review examines the relationships between COVID-19 infection and cardiovascular health, with a specific focus on diet as an important modifiable risk factor.

RECENT FINDINGS

Pandemic era studies of individuals battling and recovering from COVID-19 infection suggest a strong link between metabolic diseases, such as CVD, and SARS-CoV-2 infection susceptibility and severity. Other studies also demonstrate how COVID-19 lockdown policies and quarantine recommendations led to drastic lifestyle changes associated with increased CVD risk, such as reduced physical activity and lower diet quality. At the same time, new research is emerging that plant-based diets, which have previously been associated with lower CVD risk, may lower COVID-19 infection rates and severity of symptoms. Diet, COVID-19, and CVD intersect through complex biological mechanisms and related behavioral factors evidenced by clinical trials and epidemiological studies. Diet may be a critical tool for modifying risk of communicable and non-communicable conditions in the post-pandemic world.

Maintaining brain health across the lifespan

Across the lifespan, the human body and brain endure the impact of a plethora of exogenous and endogenous factors that determine the health outcome in old age. The overwhelming inter-individual variance spans between progressive frailty with loss of autonomy to largely preserved physical, cognitive, and social functions. Understanding the mechanisms underlying the diverse aging trajectories can inform future strategies to maintain a healthy body and brain. Here we provide a comprehensive overview of the current literature on lifetime factors governing brain health. We present the growing body of evidence that unhealthy alimentary regime, sedentary behaviour, sleep pathologies, cardio-vascular risk factors, and chronic inflammation exert their harmful effects in a cumulative and gradual manner, and that timely and efficient intervention could promote healthy and successful aging. We discuss the main effects and interactions between these risk factors and the resulting brain health outcomes to follow with a description of current strategies aiming to eliminate, treat, or counteract the risk factors. We conclude that the detailed insights about modifiable risk factors could inform personalized multi-domain strategies for brain health maintenance on the background of increased longevity.

Did the COVID-19 pandemic impact the dietary intake of individuals living with and beyond breast, prostate, and colorectal cancer and who were most likely to experience change?

PURPOSE

The present work investigated dietary changes amongst individuals living with and beyond cancer (LWBC) from before to during the pandemic. To identify those at greatest risk of unhealthy changes, it was further examined whether patterns varied by sociodemographic, health-related, and COVID-19-related characteristics.

METHODS

This longitudinal cohort study analysed data from 716 individuals LWBC participating in the Advancing Survivorship Cancer Outcomes Trial (ASCOT). Using data provided before and during the pandemic, changes in fruit and vegetable, snack, and alcohol intake were tested using mixed-effect regression models.

RESULTS

Fruit and vegetable (95%CI: - 0.30; - 0.04) and alcohol consumption (95%CI: - 1.25; - 0.31) decreased, whilst snacking increased (95%CI: 0.19; 0.53). Women and individuals with limited social contact were more likely to reduce fruit and vegetable intake during the pandemic. Women and individuals with poorer sleep quality, limited social contact, and shielding requirements and without higher education were more likely to increase snacking during the pandemic. Individuals with poorer sleep quality, poorer mental health, and regular social contact were more likely to decrease alcohol consumption during the pandemic.

CONCLUSIONS

Findings suggest decreased intake for fruit, vegetable, and alcohol consumption and increased snack intake in response to the pandemic amongst individuals LWBC. These changes appear to differ across various characteristics, suggesting the pandemic has not equally impacted everyone in this population. Findings highlight the need for targeted post-COVID strategies to support individuals LWBC most adversely affected by the pandemic, including women and socially isolated individuals. This encourages resources to be prioritised amongst these groups to prevent further negative impact of the pandemic. Whilst the findings are statistically significant, practically they appear less important. This is necessary to acknowledge when considering interventions and next steps.

A global research priority agenda to advance public health responses to fatty liver disease

BACKGROUND & AIMS

An estimated 38% of adults worldwide have non-alcoholic fatty liver disease (NAFLD). From individual impacts to widespread public health and economic consequences, the implications of this disease are profound. This study aimed to develop an aligned, prioritised fatty liver disease research agenda for the global health community.

METHODS

Nine co-chairs drafted initial research priorities, subsequently reviewed by 40 core authors and debated during a three-day in-person meeting. Following a Delphi methodology, over two rounds, a large panel (R1 n = 344, R2 n = 288) reviewed the priorities, via Qualtrics XM, indicating agreement using a four-point Likert-scale and providing written feedback. The core group revised the draft priorities between rounds. In R2, panellists also ranked the priorities within six domains: epidemiology, models of care, treatment and care, education and awareness, patient and community perspectives, and leadership and public health policy.

RESULTS

The consensus-built fatty liver disease research agenda encompasses 28 priorities. The mean percentage of 'agree' responses increased from 78.3 in R1 to 81.1 in R2. Five priorities received unanimous combined agreement ('agree' + 'somewhat agree'); the remaining 23 priorities had >90% combined agreement. While all but one of the priorities exhibited at least a super-majority of agreement (>66.7% 'agree'), 13 priorities had <80% 'agree', with greater reliance on 'somewhat agree' to achieve >90% combined agreement.

CONCLUSIONS

Adopting this multidisciplinary consensus-built research priorities agenda can deliver a step-change in addressing fatty liver disease, mitigating against its individual and societal harms and proactively altering its natural history through prevention, identification, treatment, and care. This agenda should catalyse the global health community's efforts to advance and accelerate responses to this widespread and fast-growing public health threat.

IMPACT AND IMPLICATIONS

An estimated 38% of adults and 13% of children and adolescents worldwide have fatty liver disease, making it the most prevalent liver disease in history. Despite substantial scientific progress in the past three decades, the burden continues to grow, with an urgent need to advance understanding of how to prevent, manage, and treat the disease. Through a global consensus process, a multidisciplinary group agreed on 28 research priorities covering a broad range of themes, from disease burden, treatment, and health system responses to awareness and policy. The findings have relevance for clinical and non-clinical researchers as well as funders working on fatty liver disease and non-communicable diseases more broadly, setting out a prioritised, ranked research agenda for turning the tide on this fast-growing public health threat.

Self-care behaviors, drinking, and smoking to cope with psychological distress during COVID-19 among Chinese college students: the role of resilience

OBJECTIVE

College students are vulnerable to psychological distress during COVID-19 due to pandemic-related stressors. In response to psychological distress, college students engage in various coping behaviors, such as self-care behaviors and substance use. The transactional model of stress and coping depicts a cognitive appraisal process in the stress-coping association. Psychological resilience is an essential factor for the cognitive appraisal. This study aimed to investigate the mediation effects of resilience on psycho-behavioral health in response to COVID-19 stressors.

DESIGN

Longitudinal data were collected from 1,225 Chinese college students via web-based anonymous surveys at wave 1 (T1, between Jan 31 and Feb 11, 2020) and wave 2 (T2, between Mar 20 and Apr 3, 2020).

MAIN OUTCOME MEASURES

Participants reported their COVID-19 stressors (T1), resilience (T1), psychological distress (depression and anxiety; T2), and coping behaviors (self-care behaviors, drinking, and smoking; T2). Path analysis was used for data analyses.

RESULTS

Resilience mediated the association between COVID-19 stressors and psychological distress. Resilience together with psychological distress mediated the association of COVID-19 stressors with self-care behaviors or drinking.

CONCLUSIONS

Resilience appears to offer protection that promotes psycho-behavioral health in college students in the face of COVID-19 stressors. Interventions for college students should attend to resilience.

Mediation analysis of activities of daily living and kinesiophobia in association between cardiac function and health status of patients with chronic heart failure

AIMS

To explore the mediational effect of activities of daily living (ADL) and kinesiophobia on the cardiac function and health status of patients with chronic heart failure (CHF).

METHODS

From October 2021 to January 2022, a total of 244 CHF patients treated in the Department of Cardiology of general hospitals were recruited by the convenience sampling method. They were investigated with the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), the Barthel index for assessing ADL, and the EuroQol five-dimensional questionnaire (EQ-5D) for assessing the health status.

RESULTS

The cardiac function and kinesiophobia of CHF patients were both negatively correlated with their health status (r = -.390 and -0.410, respectively, both p < .01). Besides, the ADL of CHF patients was positively correlated with the health status (r = .320, p < .01). The cardiac function of CHF patients was negatively correlated with the ADL (r = -.412, p < .01), but positively correlated with kinesiophobia (r = .180, p < .01). The mediation proportion of ADL plus kinesiophobia between the cardiac function and health status of CHF patients was 43.48%. Both ADL and kinesiophobia partially mediated the effect of cardiac function on health status in CHF patients, but their mediational effects showed no significant difference (p = .777).

CONCLUSION

Both ADL and kinesiophobia exert obvious mediational effects between cardiac function and health status in CHF patients. Individualized cardiac rehabilitation (CR) programs based on the cardiac function, ADL and kinesiophobia of CHF patients may contribute to reduce the medical burden and improve the well-being of affected people.

Fuzzy entropy DEMATEL inference system for accurate and efficient cardiovascular disease diagnosis

The global population is at risk from both communicable and non-communicable deadly diseases, including cardiovascular disease. Early detection and prevention of cardiovascular disease require an accurate self-detection model. Therefore, this study introduces a novel fuzzy entropy DEMATEL inference system for accurate self-detection of cardiovascular disease. It combines fuzzy DEMATEL, entropy, and Mamdani fuzzy inference, utilizing innovative strategies like attribute reduction, entropy-based clustering, influential factor selection, and rule reduction. The system achieves high accuracy (98.69%) and sensitivity (98.62%), outperforming existing methods. Validation includes satisfactory factor analysis, performance measures and statistical analysis, demonstrating its effectiveness in addressing complexity and prioritizing factors.

Mental Wellbeing and Health-Risk Behaviours of University Students in Brunei: A Cross-Sectional Study during COVID-19 Pandemic

Background: The coronavirus disease discovered in 2019 (COVID-19) has impacted the health behaviour of university students in a range of western nations and had a number of detrimental effects on their mental wellbeing. However, little is known about the impact on university students in Southeast Asia, particularly in Brunei. This study aims to estimate the prevalence and factors related to poor mental wellbeing and engaging in health-risk behaviors among university students in Brunei during the COVID-19 pandemic. Methods: A cross-sectional online survey of students in all public universities was conducted from March to June 2021. Warwick-Edinburgh Mental Well-being Scale, Global Physical Activity Questionnaire, and WHO STEPs questionnaires were used to measure mental wellbeing, physical activity, and health behaviors, respectively. Logistic regressions were applied. Results: A total of 1020 university students participated in this study (57% response rate). Prevalence of poor mental wellbeing and physical inactivity were 30% and 42.8%, respectively. Excessive snacking (89.7%), sugar intake (81.7%), and salt intake (53.8%) were the most prevalent health-risk behaviors. Body mass index and participating in sports activities were the most common factors related to mental wellbeing and health-risk behaviors. Conclusions: Participating in certain sports activities appears to have protective effects against study outcomes. However, a high prevalence of physical inactivity and unhealthy diet among university students is a concern, as it could be indicative of future non-communicable disease trends.

Rational use of drugs to alleviate adverse outcomes caused by COVID-19 quarantine in women with intrahepatic cholestasis of pregnancy

Purpose

This study aimed to investigate the impacts of home quarantine on pregnancy outcomes of women with intrahepatic cholestasis of pregnancy (ICP) during the COVID-19 outbreak and whether the rational use of drugs will change these impacts.

Methods

This multi-center study was conducted to compare the pregnancy outcomes in women with ICP between the home quarantine group and the non-home quarantine group in southwest China. Propensity score matching was performed to confirm the pregnancy outcomes of the medication group and the non-medication group in women with ICP during the epidemic period.

Results

A total of 3,161 women with ICP were enrolled in this study, including 816 in the home quarantine group and 2,345 in the non-home quarantine group. Women with ICP in the home quarantine group had worse pregnancy outcomes, such as a growing risk of gestational diabetes mellitus A1, fetal growth restriction, pre-eclampsia, preterm delivery, and even stillbirth. Drug therapy could alleviate some adverse pregnancy outcomes caused by home quarantine, including pre-eclampsia, preterm delivery, and meconium-stained amniotic fluid.

Conclusion

COVID-19 quarantine would increase the incidence of ICP and lead to adverse pregnancy outcomes in women with ICP. The rational use of drugs reduced some obstetrical complications and improved partial pregnancy outcomes. Our findings suggested that the government and hospitals should enhance their management and life guidance for women with ICP and speed up developing home quarantine guidelines.

Planning engagement with web resources to improve diet quality and break up sedentary time for home-working employees: A mixed methods study

As home working becomes more common, employers may struggle to provide health promotion interventions that can successfully bridge the gap between employees' intentions to engage in healthier behaviors and actual action. Based on past evidence that action planning can successfully encourage the adoption of healthier behaviors, this mixed-methods study of a web-based self-help intervention incorporated a randomized planning trial that included quantitative measures of engagement and follow-up qualitative interviews with a subsample of participants. Participants either (a) selected a movement plan for incorporating a series of 2-min exercise videos into their work week to break up sedentary time and a balanced meal plan with recipe cards for a week's lunches and dinners or (b) received access to these resources without a plan. Selecting a movement plan was more effective at increasing engagement with the web resources compared to the no-plan condition. In the follow-up interviews, participants indicated that the plan helped to remind participants to engage with the resources and made it simpler for them to follow the guidance for exercises and meals. Ease of use and being able to fit exercises and meals around work tasks were key factors that facilitated uptake of the resources, while lack of time and worries about how colleagues would perceive them taking breaks to use the resources were barriers to uptake. Participants' self-efficacy was associated with general resource use but not plan adherence. Overall, including plans with online self-help resources could enhance their uptake. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Efficacy and Safety of Sodium-Glucose Cotransporter 2 Inhibitors to Decrease the Risk of Cardiovascular Diseases: A Systematic Review

Cardiovascular disorders are one of the most frequent causes of death in people throughout the world. These disorders can account for the deaths of 31% of people worldwide. This systematic review examines the effectiveness of sodium-glucose cotransporter 2 (SGLT2) inhibitors in lowering the likelihood of cardiovascular diseases. The study aimed to evaluate various types of research, including randomized controlled trials and observational studies, to analyze how SGLT2 inhibitors impact cardiovascular disorders and establish evidence-based recommendations for clinical practice. The data in this research study were collected from 19 relevant published research articles. The key findings emphasized the potential advantages of SGLT2 inhibitors in reducing major cardiovascular disorders, such as myocardial infarction and stroke. Nonetheless, the study had certain limitations, including reliance on existing literature, exclusion of articles published prior to 2018, and restriction to English-language studies. Despite these limitations, this study contributed significantly to understanding the role of SGLT2 inhibitors in decreasing cardiovascular risk.

Prevention and Treatment of Retinal Vein Occlusion: The Role of Diet-A Review

Retinal vein occlusion (RVO) is the second most common retinal disorder. In comparison to diabetic retinopathy or age-related macular degeneration, RVO is usually an unexpected event that carries a greater psychological impact. There is strong evidence to suggest that cardiovascular diseases are the most common risk factors in this pathology and it has long been known that a higher consumption of fish, nuts, fruits, and vegetables has a protective effect against these types of conditions. In the last several years, interest in plant-based diets has grown in both the general population and in the scientific community, to the point to which it has become one of the main dietary patterns adopted in Western countries. The aim of this review is to investigate the potential impact of macro- and micronutrients on retinal vein occlusion.

Primary Care at the Intersection of Lifestyle Interventions and Unhealthy Substance Use

Primary care physicians are well-positioned to integrate lifestyle interventions into the management of patients with unhealthy substance use, who may also have mental and physical chronic health comorbidities. However, the COVID-19 pandemic exacerbated the U.S.'s poor state of health, revealing that its current approach to chronic disease management is neither effective nor sustainable. Today's full spectrum comprehensive care model requires an expanded toolkit. Lifestyle interventions broaden current treatment approaches and may enhance Addiction Medicine care. Primary care providers have the potential to have the greatest impact on unhealthy substance use care because they are experts in chronic disease management and their frontline accessibility minimizes healthcare barriers. Individuals with unhealthy substance use are at an increased risk of chronic physical conditions. Incorporating lifestyle interventions with unhealthy substance use care at every level of medicine, from medical school through practice, normalizes both as part of the standard care of medicine and will drive evidence-based best practices to support patients through prevention, treatment, and reversal of chronic diseases.

Diet Quality and Its Association with Lifestyle and Dietary Behaviors among Croatian Students during Two COVID-19 Lockdowns

The present study aims to assess the diet quality, the relationship between diet quality and lifestyle, and the association of diet quality with body mass index and students' field of study during COVID-19 lockdown periods (spring and winter) in 2020. Datasets were collected via an anonymous online self-reported questionnaire distributed during two time periods using social media. A total of 1939 Croatian students (82.4% women and 17.6% men) completed the questionnaire. Diet quality was assessed using the pro-healthy diet index (pHDI) and non-healthy diet index (nHDI). An increase in diet quality was noted during both lockdown periods but was lower during the winter lockdown. Cooking for oneself was associated with a high level of pHDI, while ordering or buying ready-to-eat food was linked to a low level of pHDI. Additionally, a decrease in screen time and increased physical activity was associated with high pHDI values. Furthermore, during both lockdown periods, students with a BMI above 30 kg/m² had the highest nHDI values compared to other students. Although positive changes were found during both lockdown periods, they were less pronounced throughout the winter lockdown. Further studies are needed to elucidate the real impact of these changes in the post-COVID period.

Assessing Food Access, Exercise, and Dietary History among Older African American Parishioners During the COVID-19 Pandemic (C-FED Study): Design, Opportunities, Challenges, and Lessons Learned

OBJECTIVES

Unhealthy diets and inadequate exercise are associated with chronic health conditions and excess mortality. Older African Americans do not meet dietary and exercise guidelines, and this may have worsened during the COVID-19 pandemic due to individual and environmental factors, including food insecurity. Studies evaluating these dynamics are essential for developing interventions. This narrative details a study protocol and data collection experiences during the pandemic.

METHODS

Participants > 55 years African American old completed detailed food frequency, exercise, and food access questionnaires between October 2020 and July 2021. Observations of the study administrators (authors of this manuscript) for the duration of the study are presented. Details on the study design and reflections on the opportunities, challenges, and lessons learned are summarized. Future manuscripts will report data analysis of study findings.

RESULTS

A total of 123 older African American adults participated in the study, and 118 (70% female) completed all three questionnaires. More than 50% of the participants had at least two primary chronic conditions. About 85% were fully vaccinated against COVID-19. Applying community-based participatory approaches, leveraging partnerships, and exercising flexibility approaches were pivotal to successfully implementing the study protocol.

CONCLUSIONS

Despite challenges related to the COVID-19 pandemic, detailed data on older African American adults' diet and exercise habits were obtained. Our study design and experiences will benefit future researchers. More importantly, results from our study will inform interventions and policies aimed at minimizing consequences associated with poor diet and exercise habits during the pandemic among this vulnerable population.

Recommendations for the care of patients with cardiovascular disease in health emergency situations: a call to action

COVID-19 has had a negative impact on the health care of patients with cardiovascular disease and patients at high risk of cardiovascular disease. The restrictions affecting access to the health care system have conditioned the care received, resulting in poorer control and a higher risk of events. Taking action to improve the care provided during health emergencies is mandatory. It is important to promote the development of telemedicine and patient empowerment by fostering health literacy and a higher degree of self-care. In addition, primary care and coordination between health care levels should be improved. Moreover, the simplification and optimization of treatment, for example, using the cardiovascular polypill, have led to an improvement in adherence, better control of vascular risk factors, and a reduced risk of events. The present document provides specific recommendations for improving the care provided to patients under a health emergency.

Physical activity and mental health during the COVID-19 pandemic among individuals with amputation

The isolating nature of various COVID-19 mandates may have reduced physical activity (PA) and increased mental health symptomology among individuals with amputation. However, an investigation of mental health across PA levels before and after the onset of COVID-19 among this group has not been conducted. Therefore, the objective of this study was to investigate group differences in depression, anxiety, and post-traumatic stress symptomology among individuals with amputation who reported being physically "active," "somewhat active," or "inactivate" before and during the pandemic. Individuals with an amputation at any level (n = 91; 51% female; age = 52.5±15.5) completed an online questionnaire to assess demographic information, PA levels, and mental health throughout the pandemic. Group differences in self-reported PA before and after COVID-19 onset were assessed by the PA Guidelines for Americans recommendations. The Center for Epidemiologic Studies Depression Scale (CES-D), Generalized Anxiety Disorder (GAD-7), and Posttraumatic Stress Disorder Checklist (PCL-5) scales were used to assess group differences in mental health status. Before and after the onset of COVID-19, 33% and 42.9% of respondents reported that they were inactive, respectively. 58.2% of respondents reported decreased PA since the pandemic's onset. Prior to the pandemic, active individuals reported lower CES-D (14.21 vs. 19.07; Cohen's d: -0.414), GAD-7 (3.82 vs. 5.47; Cohen's d: -0.359), and PCL-5 (15.92 vs. 21.03; Cohen's d: -0.319) scores compared to inactive individuals. After the onset of COVID-19, scores remained lower for active respondents CES-D (12.67 vs. 20.03; Cohen's d: 0.-669), GAD-7 (3.17 vs. 5.87; Cohen's d: -0.598), and PCL-5 (13.39 vs. 19.90; Cohen's d: -0.430). Individuals with amputation reported decreased PA after the onset of COVID-19. Individuals reporting that they were "active" exhibited improved depression and anxiety symptomology scores compared to those reporting that they were "inactive."

Comparing food consumption during the COVID-19 pandemic: analysis of household income and expenditure survey data in Iran

BACKGROUND

On March 11, 2020, the WHO declared the outbreak of the infectious disease COVID-19 as a pandemic. The health strategies of nations lead to possible changes in lifestyle and increase poor eating habits. Hence, the purpose of this study is to compare food consumption during COVID-19 pandemic in Iran.

METHODS

This cross-sectional study used secondary data from the Households Income and Expenditure Survey (HIES) conducted annually by the Statistical Centre of Iran. Food cost data of HIES included the amount of all food items in household food baskets during the last month. Then, they were classified into six food groups to evaluate their energy intake. The consequence of food consumption was analyzed as a function of socioeconomic status (SES) variables and residence pre- and post-COVID-19 pandemic.

RESULTS

In total, 75,885 households (83.5% male) were included in the study. Among the population of urban and rural areas as well as in different SES categories, people tended to increase the consumption of meat (P < 0.05) and fresh foods, especially vegetable groups (P < 0.001) and decrease the consumption of fruit (P < 0.001), fat and sweets groups (P < 0.05) and also in energy intake (P < 0.05). Macronutrient changes were different in the category of SES, urban and rural.

CONCLUSION

Our study indicated that the COVID-19 pandemic had different effects on food groups, energy and macronutrients consumption, which could be due to possible changes in food patterns as a result of the pandemic.

Cardiovascular prevention in women: an update by the Italian Society of Cardiology working group on 'Prevention, hypertension and peripheral disease'

The recent pandemic has substantially changed the approach to the prevention of cardiovascular diseases in women. Women have been significantly impacted by the changes that occurred during the pandemic and the quarantine adopted to prevent the spread of the disease. Changes involved prevention both through the reduction of visits and preventive screening and through social and economic changes. It is necessary to adopt new cardiovascular prevention approaches focused on returning to healthy lifestyles, reducing stress and depression also using modern tools such as telemedicine, mobile phone applications and the web. These tools convey messages in a persuasive way especially in young and adult women. There is less impact of these new tools on older women towards whom it is important to adopt a more traditional approach. This review focuses on the new approach to cardiovascular prevention in women in light of the lifestyle changes recorded during the pandemic and which led to an increase in obesity examines the effects on the cardiovascular system induced by stress and depression and analyses the new high blood pressure guidelines and indications that are specific to women.

Environmental factors and their impact on the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic has resulted in numerous cases of illness and death worldwide. Research has shown that there are associations between transmission, as well as the severity of SARS-CoV‑2 (severe acute respiratory syndrome coronavirus 2) infections, and various environmental factors. For example, air pollution with particulate matter is thought to play a crucial role, and both climatic and geographical aspects must be considered. Furthermore, environmental conditions such as industry and urban lifestyle have a significant impact on air quality and thus on health aspects of the population. In this regard, other factors such as chemicals, microplastics, and diet also critically impact health, including respiratory and cardiovascular diseases. Overall, the COVID-19 pandemic has highlighted how closely health and the environment are linked. This review discusses the impact of environmental factors on the COVID-19 pandemic.

Increased Depression and the Worsening of Depressive Symptoms Associated with Physical Inactivity during the COVID-19 Pandemic: A Two-Phase Cross-Sectional Study

The COVID-19 pandemic has increased the incidence of depression and other mental disorders in the general population, influenced by various individual and contextual factors. Physical activity (PA) interventions offer a promising approach to mitigating the negative mental health effects of the pandemic. This study aims to analyze the association between PA and depressive symptoms. A total of 785 individuals aged 37.4 ± 13.2 years (72.5% female) were evaluated at two different time points: the first between 2018 and 2019, and the second during the COVID-19 pandemic in 2020. Depressive symptoms, demographic, and socioeconomic data were assessed using the Beck Depression Inventory to estimate depressive symptoms. Frequency analysis and binary and multinomial regression were employed for data analysis. The prevalence of mild depressive symptoms increased from 23.1% before the pandemic to 35.1% during the pandemic. Our findings reveal that practicing PA before the pandemic was a protective factor (OR: 0.19; 95% CI: 0.13, 0.30; p < 0.001) against mild depressive symptoms. Additionally, individuals who continued to practice PA during the pandemic had a lower chance of presenting mild (OR: 0.21; 95% CI: 0.15, 0.30) and moderate/severe (OR: 0.15; 95% CI: 0.08, 0.27) symptoms. Furthermore, our study shows that PA, which was already a protective factor before the pandemic, remained protective during the pandemic, even for those with the highest levels of depression.

A united approach to promoting healthy living behaviours and associated health outcomes: a global call for policymakers and decisionmakers

Chronic disease pandemics have challenged societies and public health throughout history and remain ever-present. Despite increased knowledge, awareness and advancements in medicine, technology, and global initiatives the state of global health is declining. The coronavirus disease 2019 (COVID-19) pandemic has compounded the current perilous state of global health, and the long-term impact is yet to be realised. A coordinated global infrastructure could add substantial benefits to public health and yield prominent and consistent policy resulting in impactful change. To achieve global impact, research priorities that address multi-disciplinary social, environmental, and clinical must be supported by unified approaches that maximise public health. We present a call to action for established public health organisations and governments globally to consider the lessons from the COVID-19 pandemic and unite with true collaborative efforts to address current, longstanding, and growing challenges to public health.

Effects of early-life voluntary exercise and fructose on adult activity levels, body composition, aerobic capacity, and organ masses in mice bred for high voluntary wheel-running behavior

Fructose (C₆H₁₂O₆) is acutely obesogenic and is a risk factor for hypertension, cardiovascular disease, and nonalcoholic fatty liver disease. However, the possible long-lasting effects of early-life fructose consumption have not been studied. We tested for effects of early-life fructose and/or wheel access (voluntary exercise) in a line of selectively bred High Runner (HR) mice and a non-selected Control (C) line. Exposures began at weaning and continued for 3 weeks to sexual maturity, followed by a 23-week "washout" period (equivalent to ∼17 human years). Fructose increased total caloric intake, body mass, and body fat during juvenile exposure, but had no effect on juvenile wheel running and no important lasting effects on adult physical activity or body weight/composition. Interestingly, adult maximal aerobic capacity (VO₂max) was reduced in mice that had early-life fructose and wheel access. Consistent with previous studies, early-life exercise promoted adult wheel running. In a 3-way interaction, C mice that had early-life fructose and no wheel access gained body mass in response to 2 weeks of adult wheel access, while all other groups lost mass. Overall, we found some long-lasting positive effects of early-life exercise, but minimal effects of early-life fructose, regardless of the mouse line.

Impact of COVID-19 Pandemic on Women's Health and Obstetric Outcomes after Assisted Reproduction: A Survey from an Italian Fertility Center

BACKGROUND

the restrictive measures that were adopted during three waves of the COVID-19 pandemic had an impact on both the emotional state and lifestyle of the general population. We evaluated the impact of COVID-19 pandemic on lifestyles and emotional states of women planning assisted reproductive technology (ART), and whether these changes affected ART outcomes.

METHODS

quantitative research, using a web-based survey, was performed on 289 Caucasian women.

RESULTS

In preconception, we observed higher percentage of women with positive obstetric outcomes who reduced body weight (52.4% vs. 27.2%, p = 0.09). Over 60% of women with positive outcomes practiced physical activity vs. 47% of women with negative outcomes (p = 0.03), as well as having better quality of sleep (45% vs. 35%), and a more solid relationships with their partners (65.1% vs. 51.7%, p = 0.03). Women who increased their intake of whole grains, fruits, vegetables, and legumes (p < 0.05), according to the Mediterranean diet, showed positive outcomes. We observed that participants who experienced "very much" or "extreme" anxiety, sadness, and fear (p < 0.05) during pandemic were clearly more numerous in the group with negative pregnancy outcomes.

CONCLUSIONS

healthy lifestyle together with a positive emotional state in preconception can positively influence the obstetric outcomes after ART.

The relationship between physical activity pre COVID-19 pandemic with mental health, depression, and anxiety in COVID-19 patients: a cross-sectional study

Purpose

Covid-19 pandemic has gained a growing trend and affected mental health in several aspects. Physical activity guidelines was strongly associated with a reduced risk for severe COVID-19 outcomes among infected adults. The purpose of this study was to evaluate the association between physical activity pre COVID-19 pandemic with mental health, depression, and anxiety in COVID-19 patients.

Methods

206 hospitalized patients diagnosed with covid-19 (140 male and 66 female, aged 34.5 ± 12) were selected and completed physical activity questionnaire (IPAQ) and hospital anxiety and depression questionnaire (HADS). For physical activity status assessment, a self-completed IPAQ questionnaire was taken and patients were divided into: (1) low active, (2) moderate active and (3) high active groups according to their physical activity experience. One-way ANOVA test was recruited and Tukey post hoc test was taken to assess difference among means. Pearson correlation was used to evaluate the association between physical activity level and mental health status (p < 0.05).

Results

The results from this study showed that anxiety and depression was significantly higher in low active patients (p = 0.001) and there was a negative correlation between physical activity level and HADS (p = 0.001). However, patients with high physical activity pre COVID-19 pandemic have a lowest levels of anxiety and depression compare to other groups (p < 0.001).

Conclusion

It seems that adequate physical activity as a part of a healthy lifestyle may have a beneficial effect on mental health during the current outbreak of covid-19. Therefore, it is suggested that we perform exercise training every day to preconditioning effects.

Reshaping care in the aftermath of the pandemic. Implications for cardiology health systems

In the last two years, the COVID-19 pandemic has undeniably changed everyday life and significantly reshaped the healthcare systems. Besides the direct effect on daily care leading to significant excess mortality, several collateral damages have been observed during the pandemic. The impact of the pandemic led to staff shortages, disrupted education, worse healthcare professional well-being, and a lack of proper clinical training and research. In this review we highlight the results of these important changes and how can the healthcare systems can adapt to prevent unprecedented events in case of future catastrophes.

Lifestyle Behaviour Changes and Associated Risk Factors During the COVID-19 Pandemic: results of the Canadian COVIDiet Online Cohort Study

BACKGROUND

The COVID-19 pandemic and related lockdowns have impacted lifestyle behaviours including eating habits and physical activity; yet few studies identified emerging patterns of such changes and associated risk factors.

OBJECTIVE

To identify patterns of weight and lifestyle behaviour change, and potential risk factors, resulting from the pandemic in Canadian adults.

METHODS

Analyses were conducted on 1,609 adults (18-89 y; 90.1% women; 81.8% White) of the Canadian COVIDiet study baseline data (May-Dec 2020). Self-reported current and pre-pandemic weight, physical activity, smoking status, perceived eating habits, alcohol intake and sleep quality were collected by online questionnaires. Based on these 6 indicator variables, latent class analysis (LCA) was used to identify lifestyle behaviour change patterns. Associations with potential risk factors including age, gender, ethnicity, education, income, chronic diseases, body image perception, and changes in stress level, living situation and work arrangement were examined with logistic regressions.

RESULTS

Participants' mean BMI was 26.1 ± 6.3 kg/m2; 60.9% had >= bachelor's degree. Since the pandemic, 35% had decreased income and 49% changed work arrangement. Most participants reported unchanged weight, sleep quality, physical activity level, smoking and alcohol consumption, yet 44% reported a perceived decrease in eating habits quality. From LCA, 2 classes of lifestyle behaviour change emerged; "healthy" and "less healthy" (probability: 0.605 and 0.395; BIC=15574.3, entropy=4.8). "Healthy" class participants more frequently reported unchanged weight, sleep quality, smoking and alcohol intake, unchanged/improved eating habits and increased physical activity. The "less healthy" class reported significant weight gain, deteriorated eating habits and sleep quality, unchanged/increased alcohol intake and smoking, and decreased physical activity. Among risk factors, body image dissatisfaction OR=8.8, 95%CI (5.3-14.7), depression OR=1.8, 95%CI (1.3, 2.5), increased stress level OR=3.4, 95%CI (2.0, 5.8) and of gender minority identity OR=5.5, 95% CI (1.3-22.3) were associated with adopting "less healthy" behaviours in adjusted models.

CONCLUSIONS

The COVID-19 pandemic appeared to have influenced lifestyle behaviours unfavorably in some, but favorably in others. Body image perception, change in stress level and gender identity were factors associated with behaviour change patterns; whether these will sustain overtime remains to be studied. Findings provide insights to develop strategies in supporting adults with poorer mental well-being in the post-pandemic context and promoting healthful behaviours during future disease outbreaks.

CLINICALTRIAL

This study was registered on ClinicalTrials.gov (NCT04407533).

Psychological responses and dietary changes of residents during the local outbreak of COVID-19 in the post-epidemic era: A cross-sectional study

The coronavirus disease 2019 (COVID-19) pandemic has had a dramatic impact on the psychological state and dietary behavior of individuals. Many previous studies have discussed the psychological and dietary problems during the first COVID-19 pandemic. However, few papers have discussed them during the local COVID-19 outbreak in the post-epidemic era. To explore the psychological responses and the influencing factors, dietary changes and the relationship with psychological responses during the local COVID-19 outbreak in the post-epidemic era. Methods: A total 3790 residents were surveyed by online questionnaire to collect information about social demography, health status, local outbreak related information, lifestyle changes, anxiety and depression. Binary logistic regression was used to discuss the influencing factors of anxiety and depression. Kendall tau-b correlation coefficient was used to discuss the relationship between anxiety, depression and dietary changes. Self-perceived physical condition, chronic disease, lockdown or quarantine, fear of COVID-19, changes in smoking, drinking and physical activity were the influencing factors of anxiety and depression. The top 3 foods with increased intake were drinking water, fresh fruits and fresh vegetables, while the top 3 foods with reduced intake were puffed foods, fried foods and sugary foods. Dietary changes were correlated with generalized anxiety disorder-7 and patient health questionnaire-9 scores. These findings provide experience and clues for local governments to improve the psychological status and dietary habits of residents during the local COVID-19 outbreak in the post-pandemic era.

Cognitive decline among older adults with heart diseases before and during the COVID-19 pandemic: A longitudinal cohort study

Background

Little is known about the impact induced by the COVID-19 pandemic on the cognitive function of older adults with heart diseases. This study aimed to examine whether older adults with heart diseases suffered larger cognitive deterioration during the COVID-19 pandemic.

Methods

This study leveraged longitudinal data from the Health and Retirement Study (HRS), a nationally representative U.S. aging cohort with objective cognitive assessments measured before and during the pandemic. The interval from HRS waves 13 to 14 (April 2016 to June 2019) was defined as the pre-pandemic period to control the pre-existed cognitive difference between participants with and without heart diseases, and the interval from waves 14 to 15 (June 2019 to June 2021) was defined as the pandemic period. The HRS wave 14 survey was considered the baseline. The heart disease status was defined by a self-reported diagnosis. Linear mixed models were performed to evaluate and compare the cognitive differences during different periods.

Results

A total of 9,304 participants (women: 5,655, 60.8%; mean age: 65.8 ± 10.8 years) were included, and 2,119 (22.8%) had heart diseases. During the pre-pandemic period, there was no significant difference (-0.03, 95% CI: -0.22 to 0.15, P = 0.716) in the changes in global cognitive scores between participants with and without heart disease. During the pandemic period, a larger decreased change in the global cognitive score was observed in the heart disease group compared with the non-heart disease group (-0.37, 95% CI: -0.55 to -0.19, P < 0.001). An enlarged difference in global cognitive score was observed during the pandemic period (-0.33, 95% CI: -0.65 to -0.02, P = 0.036).

Conclusion

The findings demonstrated that the population with heart diseases suffered more cognitive decline related to the pandemic, underscoring the necessity to provide immediate cognitive monitoring and interventions for the population with heart diseases.

Change in eating habits during the Spanish COVID-19 pandemic lockdown: evidence for a sample of university community

Background

The stress and anxiety caused by COVID-19 lockdown may have changed the eating habits of the population. Our aim is to assess the eating changes that have taken place due to the pandemic.

Methods

Data were collected through an electronic survey created by the Health Economics Research Group of the University of Cantabria and IDIVAL and conducted between 14/01/2021 and 19/02/2021. A total of 1,417 responses were recorded, but only 507 complete observations were considered. We carried out a cross-sectional analysis through ordered probit regressions.

Results

The improvement in post-confinement eating habits is associated with higher income level, better self-assessed health status and more physical activity. The worsening of eating habits is associated with having a certain level of nomophobia or the fear of contagion.

Conclusions

Our analysis can be used for designing and implementing new strategies to overcome the negative spill overs of the COVID-19 pandemic and improve the dietary patterns.

Changes in diet quality and its association with students' mental state during two COVID-19 lockdowns in Croatia

Background: The COVID-19 pandemic has left substantial consequences on the mental health of the student population, primarily through an increase in the symptoms of acute stress and anxiety. Aim: This study evaluated diet quality and its association with mental state among Croatian students during the spring and winter COVID-19 lockdowns in 2020. Methods: Data were collected using an anonymous online self-reported questionnaire taken on two occasions. During the spring lockdown (from May 18 to June 7, 2020) and the winter lockdown (from December 14-22, 2020), 751 and 1188 students completed the questionnaire, respectively. Diet quality was determined using the pro-healthy diet index (pHDI) and non-healthy diet index (nHDI). Results: Although to the greatest extent associated with increased white meat, fish, and legumes intake, an increase in pHDI was also linked to increased consumption of water and sweets and decreased intake of processed meat products and nuts. Increased nHDI was mainly due to increased intake of processed meat products, alcohol, and sweets. Moreover, diet quality was higher during the lockdowns than in the periods before. However, diet quality increased to a lesser extent during the winter lockdown and was associated with a poorer mental state, shown as type D (Distressed) personality. Type D personality positively correlated with nHDI and sweets intake but negatively with pHDI, fruit, and vegetable consumption. Conclusion: These results indicate the need to alleviate further students' diet quality and mental state impairment. Also, further investigation of the association between diet quality and mental state should be provided.