Women are most affected by pandemics - lessons from past outbreaks

Anxiety symptoms and risk factors in patients with SARS-CoV-2 Omicron variant in Shanghai, China

OBJECTIVES

The psychological effects of the COVID-19 pandemic have been shown to include anxiety. However, the association between demographic and physiological factors in COVID-19-associated anxiety symptoms is poorly understood. Therefore, the present cross-sectional study was conducted to examine anxiety symptoms and associated factors among patients with the SARS-CoV-2 Omicron variant during the quarantine period in Shanghai.

METHODS

The study was conducted between April 16, 2022, and May 21, 2022, at Fangcang Shelter Hospital in Shanghai, China. Data were collected using an anonymous online questionnaire. Demographic characteristics, respiratory symptoms, vaccine dose, comorbidities (such as hypertension and diabetes), type of work, and mental health symptoms were evaluated. Logistic regression was used to examine the relationship between anxiety symptoms and risk factors. Stratified analyses were performed to investigate potential interactions.

RESULTS

A total of 2132 patients with confirmed Omicron variant SARS-CoV-2 infection were enrolled. The results demonstrated that female gender (OR = 1.47, 95% CI = 1.11-1.94), nonmanual labor (OR = 1.62, 95% CI = 1.25-2.09), respiratory symptoms (OR = 3.19, 95% CI = 2.30-4.43), and having other comorbidities (OR = 1.65, 95% = 1.09-2.50) were positively associated with anxiety symptoms. A significant interaction was found between gender and (a) nonmanual labor (OR = 1.54, 95% = 1.29-1.85), (b) respiratory symptoms (OR = 2.06, 95% = 1.72- 2.48), and (c) comorbidities (OR = 1.57, 95% = 1.16-2.12), such that the relationship with anxiety symptoms was stronger in women compared to men. There were also significant interactions between age group and (a) nonmanual labor (stronger in those ages >46) and (b) respiratory symptoms (stronger in those ages 36-45) regarding the association with anxiety symptoms.

CONCLUSIONS

Alleviation of respiratory symptoms, addressing comorbidities, and implementation of both psychological and psychopharmacological treatments may help reduce anxiety symptoms following infection with the SARS-CoV-2 Omicron variant in mainland China.

Assessing Military Mental Health during the Pandemic: A Five Country Collaboration

PURPOSE OF REVIEW

Members of a technical panel representing Australia, Canada, New Zealand, the UK, and the US collaborated to develop surveys designed to provide military leaders with information to guide decisions early in the COVID-19 pandemic. The goal of this paper is to provide an overview of this collaboration and a review of findings from the resulting body of work.

RECENT FINDINGS

While surveys pointed to relatively favorable mental health and perceptions of leadership among military personnel early in the pandemic, these observations did not reflect the experiences of personnel deployed in COVID-19 response operations, nor were these observations reflective of later stages of the pandemic. Establishing and leveraging networks that enable the rapid development of employee surveys and sharing of results can serve as a pathway for empowering military leaders in times of crisis. Organizational support and leadership decisions are especially critical for maintaining well-being among personnel during crises.

Women's mental health and COVID-19: increased vulnerability and inequalities

Introduction

The impact of COVID-19 on mental health has become a relevant object of research. Studies have demonstrated that women have experienced greater mental health challenges, highlighting the importance of public health systems to address women's specific needs.

Methods

This literature review explores the effects of the coronavirus pandemic on psychological distress among women, aiming to provide a comprehensive understanding of the subject and to explore how these research findings can guide public mental health care responses in crisis settings. A total of 131 studies were analyzed and four dimensions were discussed: study characteristics, factors impacting women's mental health in the pandemic setting, particularities of pregnancy and the postpartum period, and proposed interventions. Most studies exclusively addressed populations of adult women, predominantly during pregnancy and the postpartum period.

Results

Anxiety, depression, and stress were the most common outcomes. Lower education and income, preexisting mental health problems, and living alone or with children were risk factors for higher levels of anxiety and depression.

Discussion

A comprehensive care approach supported by public health policies and focused on intersectional factors, including race, socioeconomic status, and access to resources, is necessary to improve women's mental health care response in future crises.

Impact of SARS-CoV-2 infection on the cognitive functioning of patients institutionalized in nursing homes

BACKGROUND

COVID-19 disease affected the cognitive level of institutionalized patients in nursing homes, especially in the older subjects regardless of gender. This study aims to assess cognitive impairment using the Mini-Mental State Examination (MMSE) before and after COVID-19 infection, and to determine whether these changes varied based on gender.

METHODS

A pre- and post-COVID-19 study was conducted, involving 68 geriatric patients (34 men and 34 women) from two nursing homes. Cognitive impairment was assessed using the MMSE.

RESULTS

COVID-19 infection had a notable impact on the cognitive health of older adults residing in nursing homes, primarily attributed to the social isolation they experienced. This effect was more pronounced in older individuals. A comparison of the MMSE results by gender before and after contracting COVID-19 revealed significant differences in attention and calculation, with women obtaining the worst score before the virus. However, following their recovery from the virus, men demonstrated significantly lower scores in time and space orientation and evocation.

CONCLUSION

COVID-19 has led to a decline in cognitive functioning, significantly worsening the mental state of older individuals, even after recovery from the virus. Consequently, it is crucial to implement proactive measures to prevent isolation and safeguard the cognitive well-being of this vulnerable population.

Influence of the COVID-19 pandemic on the achievement of guideline targets for HbA1c, blood pressure, and LDL cholesterol in people with diabetes in Japan

Objective

In this study, we investigated whether the COVID-19 pandemic affected achievement of guideline targets for HbA1c, blood pressure (BP), and low-density lipoprotein (LDL) cholesterol in people with diabetes mellitus (DM).

Materials and methods

Data for 556 people with DM who were treated regularly for 4 years before and during the COVID-19 pandemic in Japan were analyzed in this retrospective study. Achieved targets were defined as HbA1c < 7.0%, BP < 130/80 mmHg, and LDL cholesterol < 100 or < 120 mg/dL depending on the presence or absence of coronary artery disease.

Results

In 2019, before the start of the COVID-19 pandemic, achievement rates of guideline targets for HbA1c, BP and LDL cholesterol were 53.4%, 45.9% and 75.7%, respectively. In 2020, the achievement rates for HbA1c and BP targets were significantly decreased to 40.8% and 31.3%, respectively. The achievement rates for the HbA1c target gradually recovered to 49.3% in 2021 and to 51.1% in 2022. However, recovery in achieving the BP target was slow, remaining at 40.5% even in 2022. On the other hand, the achievement rate for the LDL cholesterol target was not affected and remained relatively high during the COVID-19 pandemic.

Conclusions

The rates of achieving therapeutic targets for HbA1c and BP have not been high enough in people with DM, and the rates were further reduced by lifestyle changes due to the COVID-19 pandemic. Although there has been a trend toward improvement with the lifting of behavioral restrictions, more intensified treatment is necessary to achieve good control.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13340-024-00715-8.

Factors associated with domestic violence in pregnant women during the COVID-19 pandemic: Araraquara Cohort study

AIMS AND METHOD

This cross-sectional study, carried out from 2021 to 2022, investigated the factors associated with domestic violence in 400 Brazilian pregnant women during the COVID-19 pandemic. Violence was assessed with the World Health Organization's Violence Against Women questionnaire and the Abuse Assessment Screen. Demographic, socioeconomic, obstetric, lifestyle and mental health data were collected.

RESULTS

Violence at any time in their lives was reported by 52.2% of the women, and psychological violence was the most prevalent type (19.5%). Violence was associated with being single and mental health changes. Pregnant women exposed to any lifetime violence and psychological violence were, respectively, 4.67 and 5.93 times more likely to show mental health changes compared with women with no reported violence.

CLINICAL IMPLICATIONS

Training health professionals involved in prenatal care in the early detection of single women and women with mental health changes could be important in preventing domestic violence.

The Health and Safety Experiences of Precariously Employed Bangladeshi Immigrant Workers in Toronto During the COVID-19 Pandemic

Racialized immigrants in Canada have been disproportionately impacted by the COVID-19 pandemic. Our qualitative, community-based study with South Asian Women and Immigrants' Services examined the impact of the second and third waves of the pandemic on the work and health of precariously employed Bangladeshi immigrant women and men in Toronto. Our study is based on interviews and focus group discussions with 45 workers, all conducted in Bangla, and 11 key informants. Interviews reveal work transitions, an increase in precarity, work in essential sectors, exposures at work, home and in transit, workplace prevention and management gaps, and an inability to take time off, with significant impacts on workers' physical and mental health. We discuss the implications of our findings for prevention, preparedness, and response by workplaces and governments to decrease the risk and reduce the impact of infectious diseases emergencies in the precarious work sector.

Gender considerations in One Health: a framework for researchers

One Health research and intervention outcomes are strongly influenced by gender dynamics. Women, men, girls, and boys can be negatively affected by gender-based disadvantage in any of the three One Health domains (animal, human, and environmental health), and where this occurs in more than one domain the result may be a compounding of inequity. Evidence worldwide shows that women and girls are more likely to suffer from such gender-based disadvantage. A thoughtfully implemented One Health intervention that prioritizes gender equity is more likely to be adopted, has fewer unintended negative consequences, and can support progress toward gender equality, however there is limited evidence and discussion to guide using a gender lens in One Health activities. We propose a framework to identify key gender considerations in One Health research for development - with a focus on Low-and Middle-Income Countries. The framework encourages developing two types of research questions at multiple stages of the research process: those with a bioscience entry-point and those with a gender entry-point. Gender considerations at each stage of research, institutional support required, and intervention approaches is described in the framework. We also give an applied example of the framework as it might be used in One Health research. Incorporation of gender questions in One Health research supports progress toward more equitable, sustainable, and effective One Health interventions. We hope that this framework will be implemented and optimized for use across many One Health challenge areas with the goal of mainstreaming gender into One Health research.

Gender differences in receipt of telehealth versus in person behavioral therapy, medication for opioid use disorder (MOUD), and 90-day MOUD retention during the pandemic: A retrospective veteran cohort study

BACKGROUND

COVID-19 significantly negatively impacted access to care among patients with opioid use disorder (OUD). The Veterans Health Administration (VHA) enacted policies to expand telehealth and medication for OUD (MOUD) during the public health emergency, which offset risk of treatment disruption. In this study, we evaluated gender differences in utilization of behavioral therapy in person and via telehealth, MOUD utilization, and achieving 90-day MOUD retention pre-post pandemic onset, given known gender differences in treatment utilization between men and women. Secondarily, we examined MOUD receipt and retention as a function of in-person vs. telehealth behavioral therapy received over time.

METHODS

Using VHA's nationwide electronic health record data, we compared outcomes between men and women veterans, pre- to post-pandemic onset (January 2019-February 2020 vs. March 2020-April 2021). Primary outcomes included receipt of behavioral therapy (in person or telehealth), number of appointments attended, any MOUD, and whether patients achieved 90-day MOUD retention post-induction.

RESULTS

Veterans with OUD were less likely to receive behavioral therapy post-pandemic onset, which was driven by marked decreases in in-person care; these effects were strongest among women. The odds of receiving MOUD also decreased pre- to post-pandemic onset, particularly among men. Receipt of or achieving 90-day MOUD retention was differentially related to receipt of behavioral therapy via in person vs. telehealth; telehealth was more strongly associated with these utilization indicators post-pandemic onset-an effect that was more pronounced for men.

CONCLUSION

The likelihood of receiving behavioral therapy and MOUD were lower during COVID-19 and varied by gender, with men being less likely to receive MOUD over time and women being less likely to receive in-person behavioral therapy. Behavioral therapy received via telehealth was generally associated with improved MOUD utilization compared to in-person behavioral therapy, but this was less true for women than for men regarding utilization of or achieving 90-day MOUD retention. In addition to the need for further telehealth expansion for veterans with OUD, more research should explore how to better engage men in MOUD treatment and improve adherence to MOUD among women engaged in behavioral therapy.

Prevalence and associated risk factors for mental health problems among young adults in Fiji Island during COVID-19: a cross-sectional study

Introduction

The COVID-19 pandemic has had a significant impact on mental health globally. To understand the impact of the pandemic on mental health in Fiji, this study aimed to investigate the prevalence of anxiety disorder and depression among the young adults.

Method

An online survey was conducted to assess the prevalence of anxiety disorder and depression among the general population in Suva, Fiji during the COVID-19 pandemic. A total of 1,119 Fiji adults participated in the study. The study was conducted between May 20 to June 30, 2022, using a snowball sampling via social media platforms. The Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) scales were used to measure anxiety and depression, respectively. The COVID-19 related stressors was evaluated using the adapted SARS stressors assessment. Univariate and multivariate logistic regression analysis was performed to determine the factors influencing mental health among respondents.

Results

The result shows that a significant portion of individuals experienced each of the stressors, with the highest prevalence seen for hearing information about the severity of COVID-19. The prevalence of anxiety and depression was found to be 45% and 49%, respectively. Being female, having pre-existing illness and COVID-19 stressors were a risk factor to develop anxiety and depression. On the other hand, employed individuals and having high BMI was a protective factor against developing depression during COVID-19 lockdown.

Conclusion

These findings highlight the importance of addressing the mental health needs of the Fijian population during the COVID-19 pandemic and beyond.

Bushfires and Mothers' Mental Health in Pregnancy and Recent Post-Partum

BACKGROUND

The compounding effects of climate change catastrophes such as bushfires and pandemics impose significant burden on individuals, societies, and their economies. The enduring effects of such syndemics on mental health remain poorly understood, particularly for at-risk populations (e.g., pregnant women and newborns). The aim of this study was to investigate the impact of direct and indirect exposure to the 2019/20 Australian Capital Territory and South-Eastern New South Wales bushfires followed by COVID-19 on the mental health and wellbeing of pregnant women and mothers with newborn babies.

METHODS

All women who were pregnant, had given birth, or were within three months of conceiving during the 2019/2020 bushfires, lived within the catchment area, and provided consent were invited to participate. Those who consented were asked to complete three online surveys. Mental health was assessed with the DASS-21 and the WHO-5. Bushfire, smoke, and COVID-19 exposures were assessed by self-report. Cross-sectional associations between exposures and mental health measures were tested with hierarchical regression models.

RESULTS

Of the women who participated, and had minimum data (n = 919), most (>75%) reported at least one acute bushfire exposure and 63% reported severe smoke exposure. Compared to Australian norms, participants had higher depression (+12%), anxiety (+35%), and stress (+43%) scores. Women with greater exposure to bushfires/smoke but not COVID-19 had poorer scores on all mental health measures.

CONCLUSIONS

These findings provide novel evidence that the mental health of pregnant women and mothers of newborn babies is vulnerable to major climate catastrophes such as bushfires.

Influence of gender identity on the adoption of religious-spiritual, preventive and emotion-focused coping strategies during the COVID-19 pandemic in Pakistan

BACKGROUND

Academic research has highlighted the gendered impacts and amplifications of gender disparities of COVID-19. Traditionally, Pakistan is a patriarchal society, where it is a parenthood norm to socialize specific gender social roles.

OBJECTIVES

The current research asserts that these normative gender roles may influence individuals throughout their life course, even during the COVID-19 pandemic. Therefore, the present study explored the influence of gender identity in adopting different coping strategies such as religious-spiritual, preventive, emotion-focused and non-constructive coping against the COVID-19 pandemic.

METHODS

Due to the lockdown in various areas of Pakistan, data were collected through an online questionnaire using Qualtrics. In a cross-sectional study, 955 respondents completed responses. Factors analysis and reliability analysis were run to ensure the scales' reliability, validity and robustness for different coping strategies. Multivariate linear regression analysis was used to find model fitness.

CONCLUSIONS

For theoretical explanation, the current study used social role theory that argues that each gender benefits differently from distinct coping behaviours. The findings highlighted that women were more likely to adopt most coping strategies, with the most significant difference in religious-spiritual coping and preventative coping strategies even in the presence of control variables such as level of education, household monthly income, family structure, marital status and family size. There was no gender difference in adopting non-constructive strategies. The empirical evidence suggested that females might be at an increased risk of stress due to the burden of unbalanced household-based social norms and care responsibilities. The current research also expanded the base of coping to religious-spiritual coping, emotion-focused coping and non-constructive coping.

Characterizing the Gendered Twitter Discussion of COVID-19 Hoax

We collected data from Twitter and used content analysis to better understand the gendered discussion around COVID-19 as a hoax. We identified three main categories in the inductive stage of the research: (1) sympathetic to human rights & perceived injustice, (2) invincibility and superiority of COVID hoaxers, (3) conspiracies and/or hidden agendas. The findings of the study show that among all gender groups, the first category is the most dominant (44.4%), the third category is the second most frequent (35.6%), and the last category (19.9%) is the least frequent. However, when the discussion is centered on men (40.2%) and gender and sexual minorities (GSM; 69.6%) groups, the last category is the most dominant with regard to stigmatizing GSM groups by falsely associating them with progressive secret agendas. As for women's group, being sympathetic to human rights and the perceived injustice against them during the pandemic constitute the most dominant category (51.5%). We discuss the implications of the study in the conclusion.

Feminist Semiotics of "Safe": Intimate Violence in the Time of Pandemic

This article explores the discursive politics of intimate partner violence during the first COVID-19 lockdown in Israel. It asks how, despite greater awareness and recognition, intimate violence disappeared from the mindset of those managing the pandemic, even as it soars. The analysis traces the conditions that enable the dialectic of presence-disappearance, by reading the ideological prescriptions in policy papers, parliamentary debates, court appeals, and media debates. I argue that disregard of intimate violence is made possible by the idealization of home and family as spaces of security and protection, coupled with the mobilization of militaristic measures and discourses.

Deepening Depression in Women Balancing Work-Life Responsibilities and Caregiving during the COVID-19 Pandemic: Findings from Gender-Specific Face-to-Face Street Interviews Conducted in Italy

PURPOSE

This study investigated the impact of the COVID-19 pandemic on mental health, quality of life, and family functioning in a sample of the general female population, exploring difficulties encountered in managing family and work responsibilities and burden of care when taking care of a loved one. This study was, moreover, aimed at investigating factors capable of influencing severe depressive symptomatology in the context of socio-demographics, traumatic events, individual vulnerability, and family functioning.

METHOD

The sampling method used in this research was non-probability sampling. The survey took place during a Hospital Open Weekend (8-10 October 2021) organized by the National Gender Observatory on Women's Health "Fondazione Onda" on the occasion of the World Mental Health Day.

RESULTS

A total of 211 women were interviewed (mean age = 35.6, 53% living alone, more than 15% with financial difficulties, 47% exposed to the 2009 L'Aquila earthquake). More than 50% of the sample reported a higher complexity in managing their lives during the COVID-19 pandemic compared to their previous routine, with no statistically significant differences between working women and non-workers, although the latter obtained higher scores for depressive symptomatology and poorer quality of life. Compared to non-caregivers, female caregivers (22.3%) in charge of the care of loved ones affected by physical (10.9%) or psychiatric disabilities (11.4%) complained of a poorer quality of life, especially in general health perception (p = 0.002), physical function (p = 0.011), role limitations related to physical problems (p = 0.017), bodily pain (p = 0.015), mental health (p = 0.004), and social functioning (p = 0.007). Women caring for people affected by mental disorders seemed to experience a more significant worsening in vitality (p = 0.003) and social functioning (p = 0.005). Approximately 20% of the total sample reported severe depressive symptomatology. Previous access to mental health services (O.R. 10.923; p = 0.000), a low level of education (O.R. 5.410; p = 0.021), and difficulties in management of everyday lives during the COVID-19 pandemic (O.R. 3.598; p = 0.045) were found to be the main variables predictive of severe depressive psychopathology. Old age, good problem-solving skills, and ability to pursue personal goals were identified as protective factors.

CONCLUSIONS

The COVID-19 pandemic underlined the need for support amongst emotionally vulnerable women with pre-existing mental health conditions, partly reflecting the cumulative effects of traumas.

Adolescents and young adults' concerns under stress, the COVID-19 pandemic: a Portuguese cross-sectional study

Background

Adolescents and young adults are a critical target regarding reducing healthrisk behaviors' adoption, particularly in a stressful context such as the COVID-19 pandemic. Surveying their perceptions and behavioral changes may lead to a revised health promotion approach.

Objectives

This study aims to describe adolescents' and young adults' early reactions to a stressful event, the COVID-19 pandemic, characterizing their social determinants and preferences, such as sources of information, experienced symptoms, habits, and main concerns regarding themselves, their relatives, and the community. We intended to explore the association of their concerns and significant determinants such as age, gender, education, source of information, feelings of fear, prospecting the implications of communication, and individual and social determinants in managing stressful events.

Methods

We conducted a cross-sectional, population-based, self-report survey of 3,898 individuals aged between 16 and 24  years from Portugal.

Results

The main concerns about COVID-19 were the possibility of transmitting to someone and permanent social changes. Our findings present significant differences according to gender, education, age, and expressing fear.

Conclusion

The pandemic deteriorated baseline community inequalities. Young people appreciate official information and are available to contribute to society's safety. However, valuing official information is associated with deeper expressed concerns. Therefore, official information should include strategies to reach young people, promote healthier choices, and avoid distress and disinformation.

The Impact of COVID-19 Pandemic on Intimate Partner Violence (IPV) Against Women

Intimate partner violence (IPV) is a global public health crisis associated with adverse physical, psychological, economic, and social consequences. Studies on the impact of COVID-19 on IPV against women are scarce. This study aimed to understand the impact of COVID-19 on IPV against women. Google Scholar, PubMed, and the Cochrane Library were searched using the MeSH terms intimate partner violence, COVID-19, and women. Exclusion criteria were male-partner, elder, and child abuse and studies that targeted specific groups such as cancer, HIV, and substance abuse. Two independent reviewers completed the title, abstract screening, and review of selected articles. Thirteen out of 647 articles met the inclusion criteria. IPV against women increased in nine countries (Spain, United States, Nigeria, Ethiopia, Turkey, Peru, Bangladesh, Czech Republic, and the Democratic Republic of Congo); one country showed no change in gender-based violence among adolescent girls and young women (Kenya); and one study reported a decrease in IPV reporting by victims (United States). Policies made to mitigate the pandemic created unintended consequences that exacerbated risk factors for IPV against women. Lessons learned from COVID-19 must be used to develop policy-level support and response services to mitigate IPV against women amid a pandemic and other human crises.

Exploring media consumption and mental health among young adults during the second wave of COVID-19 in Bangladesh

Background

This study examined the association between media exposure and mental health during the second wave of lockdown among the general population of Bangladesh.

Methods

A total of 449 adult participants were enrolled in the study to evaluate their levels of exposure to total media, electronic media, and social media. Mental health was assessed using a 7-item generalized anxiety disorder (GAD-7) scale. A multivariate logistic regression model was constructed to explore the relationships between media exposure levels and anxiety. The models included covariates such as sex, daily working hours, health problems, media distraction, and income from social media.

Results

The results showed that 44.5%, 39.2%, and 16.3% of participants reported low, medium, and high levels of exposure to different media during the COVID-19 period, respectively. Additionally, 96.4%, 2.7%, and 0.9% of participants had low, medium, and high levels of exposure to electronic media, respectively, and 89.1%, 10.5%, and 0.4% of participants had low, medium, and high levels of exposure to social media, respectively. The overall prevalence of anxiety was 25.38% among the respondents. Participants with high levels of total media exposure were significantly more likely to experience anxiety, with an odds ratio of 2.75 (95% CI = 1.40-5.14, p < 0.01). Females were 2.26 times more likely to experience anxiety than males (95% CI = 1.37-3.74, p < 0.01), and participants with health problems were also more likely to develop anxiety compared to those who did not.

Conclusion

Our results show a positive relationship between increased media exposure and anxiety levels, providing useful insights for both academics and public health practitioners.

The prevalence of depression and its association with sociodemographic factors in menopausal women in South Korea

This study examined factors that may be associated with depression among middle-aged women in South Korea using data from the 2018 (7th) wave of the Korean Longitudinal Survey of Women and Families. A sample of 6,399 women aged 35-64 years was included. Multivariate logistic regression was performed to identify factors associated with depressive symptoms, as measured by the CES-D-10 scale (Center for Epidemiological Studies Depression), in pre- and post-menopausal women. Results indicated that being single, having poorer self-rated health, and having a lower economic background were associated with an increased risk of depression in both groups. Being unemployed also increased the risk of depressed mood in pre-menopausal women, while factors significantly associated with an increased risk of depressive symptoms in post-menopausal women included having a lower level of education, musculoskeletal pain, and having pain or discomfort. Thus, these factors should be considered when developing interventions to improve the mood and quality of life of middle-aged women. Interventions in the local community may include health services (hormone therapy), educational learning programs, counselling, and improved access to leisure activities.

Heatwaves and wildfires suffocate our healthy start to life: time to assess impact and take action

Adverse environmental exposures in utero and early childhood are known to programme long-term health. Climate change, by contributing to severe heatwaves, wildfires, and other natural disasters, is plausibly associated with adverse pregnancy outcomes and an increase in the future burden of chronic diseases in both mothers and their babies. In this Personal View, we highlight the limitations of existing evidence, specifically on the effects of severe heatwave and wildfire events, and compounding syndemic events such as the COVID-19 pandemic, on the short-term and long-term physical and mental health of pregnant women and their babies, taking into account the interactions with individual and community vulnerabilities. We highlight a need for an international, interdisciplinary collaborative effort to systematically study the effects of severe climate-related environmental crises on maternal and child health. This will enable informed changes to public health policy and clinical practice necessary to safeguard the health and wellbeing of current and future generations.

The effect of duration of youth/parent communication on depression and anxiety during COVID-19 isolation in China

The current study examines the mediating roles of self-efficacy and sleep disturbance and the moderating role of gender in the association between the duration of youth/parent communication on depression and anxiety during the COVID-19 isolation period in China. We used the self-designed demographic variable questionnaire, General Self-Efficacy Scale, the Pittsburgh Sleep Quality Index, the Self-Rating Depression Scale, and the Self-Rating Anxiety Scale with 1,772 youths aged 15-24 from 26 provinces in China during the COVID-19 lockdown. We performed demographic variable analysis, correlation analysis, mediation analysis, and moderated analysis. The duration of daily communication with parents was significantly positively correlated with self-efficacy and significantly negatively correlated with sleep disturbance, depression, and anxiety. The chain mediation analysis revealed that the duration of communication with parents directly affected depression and anxiety. Self-efficacy, sleep disturbance, and self-efficacy sleep disturbance had significant mediating and chain-mediating effects on the duration of communication with parents, depression, and anxiety. The interactions between sleep disturbance and gender (B = 0.35, 95% CI 0.06 to 0.64, p = .02 < .05) were significant. The duration of parent/youth communication directly affected depression and anxiety and indirectly affected depression and anxiety via the chain-mediating effect of self-efficacy and sleep disturbance. Gender moderates the relationships between sleep disturbance and depression.

The level of education is associated with an anxiety-depressive state among men and women - findings from France during the first quarter of the COVID-19 pandemic

CONTEXT

It is widely recognised that the COVID-19 pandemic has negatively impacted individuals' mental health. However, little emphasis has been put on the possible influence of socio-economic factors in the relationship. In the context of the COVID-19 pandemic, our objectives were (i) to assess the relationship between education level and mental health in French adults, and (ii) to study the influence of the economic, social, health and the COVID-19-related factors in men and women respectively.

METHOD

Data are from 32,581 individuals representative of the French population who responded to the weekly survey "Baromètre COVID-19" between April 7^th and May 31^st 2020. Education level was self-reported (university degree, high school qualification, vocational certificate/qualification, no diploma). Anxiety-depressive state was derived from four items related to the frequency of occurrence of depressive and anxiety symptoms, and summarized in an overall validated anxiety-depressive score. Multivariate linear regression analyses were carried out with nested adjustments of variables related to economic, social, health and COVID-19 contexts to assess the relationship between education and anxiety-depressive state.

RESULTS

In total, 45% of individuals reported symptoms of anxiety-depressive state (53% in women versus 36% in men). Among men, those with a vocational certificate/qualification and those with no diploma had a greater risk of having a higher anxiety-depressive state compared to those with a university degree (β_{Vocational certificate/qualification} = 0.16 [0.04; 0.27]; β_{No diploma} = 0.75 [0.43; 1.07]) while among women, the risk of anxiety-depressive state increased as education level decreased (β_{Baccalaureate} = 0.37 [0.25; 0.49]; β_{Vocational certificate/qualification} = 0.41 [0.28; 0.54]; β_{No diploma} = 0.8 [0.49; 1.12]). For both men and women, economic, health, and COVID-19 factors partly attenuate these associations while social factors marginally modified the relationship. After accounting for confounders and intermediate variables, the absence of a diploma remained associated with anxiety-depressive state among men, while the whole educational gradient of anxiety-depressive state persisted among women.

CONCLUSION

In France, at the end of the first wave of COVID-19, individuals with a lower level of education had a higher risk of anxiety-depressive state. This association was more pronounced for women, highlighting a process of social inequality in health possibly related to gender. This should be considered in future prevention and public health interventions.

Effects of the COVID-19 pandemic on sales of sexual and reproductive health products: an ecological study of pharmacies in Kenya

OBJECTIVES

To examine how sales of sexual and reproductive health (SRH) products varied among pharmacies in Kenya using administrative data, leveraging natural variation in the COVID-19 pandemic and accompanying policy restrictions between 2019 and 2021.

DESIGN AND SETTING

Ecological study of pharmacies in Kenya.

PARTICIPANTS

761 pharmacies using the Maisha Meds product inventory management system (capturing 572 916 products sold).

OUTCOMES

Sales quantity, price and revenue of SRH products sold per pharmacy per week.

RESULTS

COVID-19 deaths were associated with a -2.97% (95% CI -3.82%, -2.11%) decrease in sales quantity, a 1.09% (95% CI 0.44%, 1.72%) increase in sales price and a -1.89% (-1.00%, -2.79%) decrease in revenues per pharmacy per week. Results were similar when considering new COVID-19 cases (per 1000) and the Average Policy Stringency Index. Results differed substantially between individual SRH products-a large decrease in sales quantity in pregnancy tests, injectables and emergency contraception, a modest decrease in condoms and no change in oral contraception. Sales price increases were similarly varied; four of the five most sold products were revenue neutral.

CONCLUSIONS

We found a robust negative association between SRH sales at pharmacies in Kenya and COVID-19 reported cases, deaths and policy restriction. Although our data cannot definitively point to reduced access, existing evidence from Kenya regarding unchanged fertility intentions, increases in unintended pregnancies and reported reasons for non-use of contraceptives during COVID-19 suggests a prominent role of reduced access. While policymakers may have a role in sustaining access, their role may be limited by broader macroeconomic problems, such as global supply chain disruptions and inflation, during supply shocks.

Effects of social confinement during the first wave of COVID-19 in Mexico City

Background

The COVID-19 pandemic led to global social confinement that had a significant impact on people's lives. This includes changes such as increased loneliness and isolation, changes in sleep patterns and social habits, increased substance use and domestic violence, and decreased physical activities. In some cases, it has increased mental health problems, such as anxiety, depression, and post-traumatic stress disorder.

Objective

The objective of this study is to analyze the living conditions that arose during social confinement in the first wave of COVID-19 within a group of volunteers in Mexico City.

Methods

This is a descriptive and cross-sectional analysis of the experiences of volunteers during social confinement from 20 March 2020 to 20 December 2020. The study analyzes the impact of confinement on family life, work, mental health, physical activity, social life, and domestic violence. A maximum likelihood generalized linear model is used to determine the association between domestic violence and demographic and health-related factors.

Results

The findings indicate that social confinement had a significant impact on the participants, resulting in difficulties within families and vulnerable conditions for individuals. Gender and social level differences were observed in work and mental health. Physical activity and social life were also modified. We found that suffering from domestic violence was significantly associated with being unmarried (OR = 1.4454, p-value = 0.0479), lack of self-care in feeding habits (OR = 2.3159, p-value = 0.0084), and most notably, having suffered from a symptomatic COVID-19 infection (OR = 4.0099, p-value = 0.0009). Despite public policy to support vulnerable populations during confinement, only a small proportion of the studied population reported benefiting from it, suggesting areas for improvement in policy.

Conclusion

The findings of this study suggest that social confinement during the COVID-19 pandemic had a significant impact on the living conditions of people in Mexico City. Modified circumstances on families and individuals, included increased domestic violence. The results can inform policy decisions to improve the living conditions of vulnerable populations during times of social confinement.

COVID-19 challenges, responses, and resilience among rural Black women: a study protocol

Despite the aggregated burdens and challenges experienced by rural Black women during the COVID-19 pandemic, many likely also demonstrated strength and resilience to overcome challenges. A mixed methodology and a community-based participatory approach will be used to collect multilevel data on challenges, responses, resilience, and lessons during the pandemic from Black women, community health workers, and community leaders in rural areas in South Carolina (SC). Specifically, the unique circumstances and lived experiences of rural Black women during the COVID-19 pandemic will be documented to understand their needs regarding effective management of social, physical, and mental health challenges through focus group discussions and in-depth interviews with Black women, community health workers, and local community leaders recruited from rural SC communities. Barriers, facilitators, and potential impacts of multilevel resilience development will be identified through a survey administered among rural Black women recruited from 11 rural counties (with one as site for a pilot testing of the questionnaire). A report for public health practice will be developed, including recommended strategies to optimize health systems' emergency preparedness and responses through triangulation of qualitative and quantitative data from multiple sources. Findings in the proposed study will provide valuable references in terms of addressing social determinants of health factor challenges during the pandemic, fostering resilience, and informing evidence-based decision-making for policymakers. The study will contribute to the development of public health emergency preparedness plans, which can promote the resilience of women, their families, and local communities as well as optimize effective preparedness and response of health systems for rural Black women and their families during infectious disease outbreaks and other public health emergencies.

Inter(national) recommendations to face violence against women and girls in COVID-19 pandemic

This article is an integral part of the research "Violence in the context of COVID-19: global challenges and vulnerabilities", which proposes a critical reflection on situations of gender-based violence increased by social distancing protocols, required by the COVID-19 pandemic. Based on a 2020 literature survey, we have analyzed recommendations made by researchers and institutions from different countries around the world, with the aim of systematizing and disseminating strategies to deal with this scenario. The material is organized into two thematic areas, namely: gender policies and intersectoral actions; and strategies to face violence against women and children in the health and social work field. The recommendations are focused on the development of actions by States/governments, service networks and society in general. Part of the recommendations suggest increasing or adapting existing surveillance actions and part of them contribute with creative proposals, guiding promotional and preventive actions at an individual and collective level. The adoption of teleassistance, media campaigns raising awareness that violence is unjustifiable and the development of reporting strategies through signs and codes have been reiterated in the literature.

Impact of covid-19 pandemic over depressive symptoms among mothers from a population-based birth cohort in southern brazil

PURPOSE

Our aim was to assess the impact of COVID-19 on depressive symptoms among mothers from a population-based birth cohort in Pelotas, Southern Brazil.

METHODS

A subgroup of mothers from the Pelotas 2004 Birth Cohort was assessed pre-pandemic (November,2019 to March,2020) and mid-pandemic (August-December,2021). In both follow-ups, depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Pre-pandemic (T₁) and pandemic-related predictors (T₂) were analyzed. Prevalence of depression (EPDS score ≥ 13) at T₁ and T₂ were compared with chi-square test. Changes in EPDS from T₁ to T₂ were estimated by multivariate latent change score modelling.

RESULTS

1,550 women were assessed. Prevalence of depression increased 38.1% (from 18.9% at T₁ to 26.1% at T₂) (p < 0.001). At T₁, higher schooling, higher family income and being employed or working were related to lower EPDS, whereas being beneficiary of a cash transfer program and a larger number of people living in the household predicted higher EPDS. The deterioration of ones' own perception of quality of overall health (β = 0.191; SE = 0.028; p < 0.001) and worst family financial situation due to the pandemic (β = 0.083; SE = 0.024; p = 0.001) predicted the increase in EPDS from T₁ to T₂.

CONCLUSION

Almost two years after the beginning of the pandemic, the prevalence of depressive symptoms among the women was higher than before the pandemic. The deterioration of ones' own perception of quality of overall health and worst family financial situation due to the pandemic are proxies for the effect of COVID-19 pandemic (the true exposure of interest) in the women mental health.

The effects of the pandemic on mental health in persons with and without a psychiatric history

BACKGROUND

Prospective studies are needed to assess the influence of pre-pandemic risk factors on mental health outcomes following the COVID-19 pandemic. From direct interviews prior to (T1), and then in the same individuals after the pandemic onset (T2), we assessed the influence of personal psychiatric history on changes in symptoms and wellbeing.

METHODS

Two hundred and four (19-69 years/117 female) individuals from a multigenerational family study were followed clinically up to T1. Psychiatric symptom changes (T1-to-T2), their association with lifetime psychiatric history (no, only-past, and recent psychiatric history), and pandemic-specific worries were investigated.

RESULTS

At T2 relative to T1, participants with recent psychopathology (in the last 2 years) had significantly fewer depressive (mean, M = 41.7 v. 47.6) and traumatic symptoms (M = 6.6 v. 8.1, p < 0.001), while those with no and only-past psychiatric history had decreased wellbeing (M = 22.6 v. 25.0, p < 0.01). Three pandemic-related worry factors were identified: Illness/death, Financial, and Social isolation. Individuals with recent psychiatric history had greater Illness/death and Financial worries than the no/only-past groups, but these worries were unrelated to depression at T2. Among individuals with no/only-past history, Illness/death worries predicted increased T2 depression [B = 0.6(0.3), p < 0.05].

CONCLUSIONS

As recent psychiatric history was not associated with increased depression or anxiety during the pandemic, new groups of previously unaffected persons might contribute to the increased pandemic-related depression and anxiety rates reported. These individuals likely represent incident cases that are first detected in primary care and other non-specialty clinical settings. Such settings may be useful for monitoring future illness among newly at-risk individuals.

Hypertension management before and under the COVID-19 pandemic: lessons and future directions

Hypertension is a significant risk factor for cardiovascular diseases. The prevalence of hypertension and its complications is increasing yearly, yet it remains inadequately controlled worldwide. It has already been recognized that self-management, including self-measured blood pressure monitoring at home, is more important than office blood pressure monitoring. The practical application of telemedicine using digital technology was already underway. COVID-19 has promoted the popularization of these management systems in primary care, although the COVID-19 pandemic disrupted lifestyle and healthcare access. At the beginning of the pandemic, we were at the mercy of information on whether certain antihypertensive drugs, for example, might pose a risk of infection in the face of unknown infectious diseases. Over the past three years, however, much knowledge has been accumulated. It has been scientifically proven that there is no serious problem in managing hypertension in the same way as before the pandemic. That is to control blood pressure mainly through home blood pressure monitoring and continuing conventional drug therapy while modifying lifestyle. On the other hand, in the New Normal era, it is necessary to accelerate digital hypertension management and the establishment of new social networks and medical systems to prepare for the re-emergence of future pandemics while continuing to protect against infection. This review will summarize the lessons and future directions we learned from the impact of the COVID-19 pandemic on hypertension management. The COVID-19 pandemic has disrupted our daily life, restricted access to healthcare, and altered some of the conventional management of hypertension.

Gender inequity and COVID-19 vaccination policies for pregnant women in the Americas

The region of the Americas has been the epicenter of the COVID-19 pandemic’s worst outcome in terms of number of deaths due to COVID-19. SARS-CoV-2 infection during pregnancy and the postpartum period has been found to be associated with increased risk of mortality and severe disease. Several Latin American and Caribbean countries have disproportionally high maternal mortality rates due to COVID-19. Although this region achieved relatively high vaccination rates among the general adult population, there were differing restrictions regarding the vaccination of those who were pregnant. In a pandemic, policies reflect political priorities in responses to the threats posed to populations and play an important role in promoting gender equity. This paper reports the results of an ethical analysis of 45 national COVID-19 vaccination public policies from seven countries – Argentina, Brazil, Canada, Colombia, Mexico, Peru, and United States. The analysis drew on reproductive justice and feminist bioethics frameworks, paying close attention to whether and how gender and social and economic inequities were addressed. It found that exclusionary approaches in immunization policies which restricted access to vaccination during pregnancy were often justified on the basis of a lack of evidence about the effects of immunization of pregnant persons, and on the grounds of medical expertise, to the detriment of women’s autonomy and agency. As such these policies reiterate patriarchal moral understandings of women, pregnancy and motherhood. In practice, they counter human rights gender equity and equality principles, and became lethal, particularly to racialized women in Latin America. During an emerging lethal disease, policies and policy development must consider the intersection of oppressive structures to protect and guarantee rights of women, girls, and pregnant persons.

Prevalence and Related Factors of Depression Before and During the COVID-19 Pandemic: Findings From the Korea National Health and Nutrition Examination Survey

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has greatly altered the daily lives of people in unprecedented ways, causing a variety of mental health problems. In this study, we aimed to evaluate the prevalence of depression among Korean adults during the COVID-19 pandemic and explore the factors associated with depressive mood using data from the Korea National Health and Nutrition Survey (KNHANES).

METHODS

We analyzed participants aged ≥ 19 years from KNHANES 2018 (n = 5,837) and 2020 (n = 5,265) to measure and compare the prevalence of depression before and during the COVID-19 pandemic. Depression was defined as a score ≥ 10 on the Patient Health Questionnaire-9. Furthermore, we performed a multivariate logistic regression analysis to investigate the independent predictors of depressive mood during the COVID-19 pandemic.

RESULTS

The prevalence of depression was notably higher during the COVID-19 pandemic than in the pre-pandemic period (5.2% vs. 4.3%, P = 0.043). In a multivariate model, female sex (adjusted odds ratio [aOR], 1.63; 95% confidence interval [CI], 1.10-2.41), age < 50 years (19-29 years: aOR, 7.31; 95% CI, 2.40-22.21; 30-39 years: aOR, 7.38; 95% CI, 2.66-20.47; 40-49 years: aOR, 4.94; 95% CI, 1.84-13.31 compared to ≥ 80 years), unemployment (aOR, 2.00; 95% CI, 1.41-2.85), upper-middle class household income (aOR, 1.83; 95% CI, 1.18-2.85 compared to upper-class income), being a beneficiary of Medicaid (aOR, 2.35; 95% CI, 1.33-4.14), poor self-rated health (aOR, 4.99; 95% CI, 1.51-3.47 compared to good self-rated health), and current smoking (aOR, 2.29; 95% CI, 1.51-3.47) were found to be significant risk factors for depression during the pandemic.

CONCLUSION

Depression was significantly more prevalent among Korean adults during the COVID-19 pandemic than in the pre-pandemic era. Therefore, more attention should be paid to individuals vulnerable to depression during pandemics. Implementing psychological support public policies and developing interventions to prevent the adverse outcomes of COVID-19-related depression should be considered.

'Women in the front': Psychological impact of the COVID-19 pandemic: Depression, anxiety, loneliness, and somatization in the Israel population

The COVID-19 pandemic has generated a high level of psychological distress in the general population. The aims of this study were to examine the mental health of men and women in the general population in Israel during the first lockdown. The sample comprised 587 participants (426 females and 161 males), whose age ranged between 16 and 85. They completed the Patient Health Questionnaire-4 (PHQ-4), the Psychosomatic Symptoms Scale, and the Connor-Davidson Resilience Scale (CD-RISC2). Psychological distress was expressed in our measures of depression, anxiety, loneliness, and somatization, in conjunction with high resilience. Women exhibited higher levels of these symptoms than men-but this fluctuates with age, and can match the levels of these symptoms reported by men. Specifically, no difference between the genders was found for loneliness, in age groups 24-39 and 56-85; and for depression, in age groups 40-55 and 56-85. For somatization, the difference is reversed for age group 56-85. In contrast, while women generally scored lower than the men for resilience, this was specifically for age group 16-23. Our findings suggest that young women report more mental health problems, and that men and women may be differentially vulnerable to disaster-related stressors, such as experienced during the pandemic.

Exploring the impact of emissions trading schemes on income inequality between urban and rural areas

While the Paris Agreement and 2030 Agenda for Sustainable Development are the two most important global governance agendas, in practice they have been implemented in isolation. This calls for the need to focus on the potential policy synergies between emission reduction policies and Sustainable Development Goals (SDGs). This paper therefore aims to explore whether the emissions trading scheme (ETS) policy-one of the most effective ways to fulfill the target determined by the Paris Agreement, would facilitate reducing income inequality (SDG10). By combining a difference-in-difference estimation and propensity score matching technique based on a balanced panel dataset for 31 Chinese provinces from 2010 to 2018, we quantify the impact of ETS policy on income inequality between urban and rural areas in China. The results demonstrate that compared with the regions without ETS, the Theil index between rural and urban areas with ETS decreased by 0.018 on average in China. In addition, the ETS would perform better in regions with low urbanization level and high coal dependence. Hence it is vital to speed up the establishment of a unified ETS market in China. This is particularly true for inner underdeveloped regions in China. These findings proven to be robust according to a series of tests challenge the view that SDG 10 has the least relevance to climate action and suggest rethinking the effectiveness and applicability of ETS. Therefore, our research can not only serve as a reference for the development of ETS in China and elsewhere, but also inform decision makers who are seeking for policy synergies between the Paris Agreement and SDGs.

cMIND Diet, Indoor Air Pollution, and Depression: A Cohort Study Based on the CLHLS from 2011 to 2018

This study aims to explore the interaction between a Chinese version of the Mediterranean-DASH intervention for neurodegenerative delay (cMIND) diet and indoor air pollution and its effect on depression among older adults. This cohort study used 2011-2018 data from the Chinese Longitudinal Healthy Longevity Survey. Participants included 2724 adults aged 65 and older without depression. The Chinese version of the Mediterranean-DASH intervention for neurodegenerative delay (cMIND) diet scores ranged from 0 to 12 based on validated food frequency questionnaire responses. Depression was measured using the Phenotypes and eXposures Toolkit. Cox proportional hazards regression models were used to explore the associations, and the analysis was stratified using the cMIND diet scores. A total of 2724 participants (54.3% males and 45.9% 80 years and older) at baseline were included. Living with severe indoor pollution was associated with a 40% increase in the risk of depression (HR: 1.40, 95% CI: 1.07, 1.82) compared to living without indoor pollution. Indoor air pollution exposure was significantly associated with cMIND diet scores. Participants with a lower cMIND diet score (HR: 1.72, 95% CI: 1.24, 2.38) had a greater association with severe pollution than those with a higher cMIND diet score. The cMIND diet may alleviate depression caused by indoor pollution among older adults.

Promoting Women's Health and Gender Equality

Inequities increase the marginalization of women in society and negatively affect the health of women.

No social distancing from food: How the COVID-19 pandemic shaped student food-related activities in the Western Balkans

BACKGROUND

The COVID-19 pandemic has influenced food preparation and consumption habits, as well as food wastage. The pandemic also affected the lives of university students worldwide; their learning and living environments changed, influencing their eating habits.

AIM

The purpose of this study was to evaluate the repercussions of the COVID-19 pandemic on students' food-related activities in four countries in the Western Balkans: Bosnia and Herzegovina, Serbia, North Macedonia, and Montenegro.

METHODS

The research draws upon an online survey gathered through the SurveyMonkey platform in four Balkan countries-viz. Bosnia and Herzegovina, Serbia, North Macedonia, and Montenegro-and used a structured questionnaire. The information was collected during the second wave of COVID-19 in October-November 2020. A total of 1658 valid responses were received. Descriptive statistics and nonparametric tests were used to analyze the survey findings.

RESULTS

The research results suggest that the pandemic influenced students' food purchase habits, diets, and food-related behaviors and practices such as food preparation, cooking, and food waste management at the household level. In particular, students have been eating healthier and shopping less frequently during the pandemic. Meanwhile, the pandemic improved their attitude toward food wastage.

CONCLUSION

This study is the first to examine how students in the Balkan region perceive the impact of the COVID-19 pandemic on their eating habits, laying the groundwork for future studies into the disease's consequences. This and other studies will assist in preparing students and education institutions for future calamities and pandemics. The findings will also help develop evidence-based postpandemic recovery options targeting youth and students in the Western Balkans.

Gender Differences in Coping and Psychological Adaptation during the COVID-19 Pandemic

This population-based study investigated gender differences in the use of coping strategies and their relationship to anxiety symptoms during the initial COVID-19 lockdown period in the United States. A national online survey was administered between 13 April 2020 and 8 June 2020. The study sample comprised 1673 respondents (66% women). Overall, 46% reported high levels of anxiety, and women experienced significantly (p < 0.001) higher levels of anxiety than men. Women were significantly (p < 0.05) more likely to use acceptance, self-distraction, positive reframing, and emotional support than men. Significant interactions between gender and coping strategies were also identified. Women engaging in high (+1SD) vs. low (−1SD) levels of active coping were not found to have significantly different anxiety levels. In contrast, men reported higher levels of anxiety when they engaged in high levels of active coping and lower levels of anxiety when they engaged in low levels of active coping (b2 = 0.88, t = 3.33, p = 0.001). Additionally, women engaging in high levels of acceptance and positive reframing reported significantly lower anxiety levels than when engag-ing in low levels of acceptance (b1 = −1.03, t = −4.58, p < 0.001) and positive reframing (b1 = −0.72, t = −3.95, p < 0.001). No significant associations between acceptance and positive reframing levels and anxiety levels were found with men. Overall, these findings extend our understanding of the nature of gender differences in stress responsivity during periods of high psychological distress and can inform the development of mental health interventions to respond to the COVID-19 pandemic and future infectious disease outbreaks.

Overlooked sex and gender aspects of emerging infectious disease outbreaks: Lessons learned from COVID-19 to move towards health equity in pandemic response

Sex and gender issues are especially important in emerging infectious diseases (EIDs) but are routinely overlooked despite data and practice. Each of these have an effect either directly, via the effects on vulnerability to infectious diseases, exposures to infectious pathogens, and responses to illness, and indirectly through effects on disease prevention and control programs. The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the viral agent of coronavirus disease 2019 (COVID-19) has underscored the importance of understanding the sex and gender impacts on pandemics. This review takes a broader looks at how sex and gender impact vulnerability, exposure risk, and treatment and response that affect incidence, duration, severity, morbidity, mortality, and disability of EIDs. And although EID epidemic and pandemic plans need to be "pro-women", they need to be broader and include all sex and gender factors. Incorporation of these factors are a priority at the local, national, and global policy levels to fulfil the gaps in scientific research, public health intervention programs and pharmaceutical service strengthening to reduce emerging disease inequities in the population during pandemics and epidemics. A failure to do so creates acceptance of the inequities and infringes on fairness and human rights norms.

Impact of COVID-19 pandemic on the mental health of university students in the United Arab Emirates: a cross-sectional study

BACKGROUND

The COVID-19 pandemic had a significant impact on the mental well-being of students worldwide. There is a scarcity of information on the mental health impact of the COVID-19 pandemic on university students in the United Arab Emirates (UAE). This study aimed to investigate the mental health impact of the COVID-19, including depression, anxiety and resilience among a sample of university students in the UAE.

METHODS

A cross-sectional study using an online survey was conducted from September to November 2021. The patient health questionnaire (PHQ-9), generalized anxiety disorder-7 (GAD-7) and Connor-Davidson Resilience Scale (CD-RISC-10) were used to assess depression, anxiety, and resilience. The COVID-19 impact was assessed using a list of questions.

RESULTS

Only, 798 students completed the survey and were analyzed for this study. Overall, 74.8% of the students were females, 91.2% were never married, and 66.3% were UAE-nationals. Based on PHQ-9 and GAD-7 cut-off scores (≥ 10), four out of ten of the students self-reported moderate to severe depression (40.9%) and anxiety (39.1%). Significantly higher mean PHQ-9 and GAD-7 scores were found among students who were impacted by COVID-19 than those non-impacted (mean PHQ-9 = 9.51 ± 6.39 and 6.80 ± 6.34; p = 0.001, respectively) and (mean GAD-7 = 9.03 ± 6.00 and 8.54 ± 6.02; respectively, p < 0.001). Female students who were impacted by COVID-19 had statistically significant higher depression and anxiety scores (mean PHQ-9 of 9.14 ± 5.86 vs. 6.83 ± 6.25, respectively; p < 0.001) than the non-impacted females (mean GAD-7 of 9.57 ± 6.32 vs. 5.15 ± 3.88, respectively; p = 0.005). Never married students had significantly higher PHQ-9 and GAD-7 scores than ever-married (9.31 ± 6.37 vs. 6.93 ± 5.47, P = 0.003) and (8.89 ± 6.11 vs. 7.13 ± 5.49, respectively; p = 0.017).

CONCLUSIONS

The results of this study demonstrate that the COVID-19 pandemic has negatively impacted the mental health of this sample of university students in terms of depression and anxiety. The results highlight the need to adopt culturally appropriate interventions for university students and focus on vulnerable groups.

Impacts of COVID-19 on contraceptive and abortion services in low- and middle-income countries: a scoping review

The COVID-19 pandemic has disproportionate effects on people living in low- and middle-income countries (LMICs), exacerbating weak health systems. We conducted a scoping review to identify, map, and synthesise studies in LMICs that measured the impact of COVID-19 on demand for, provision of, and access to contraceptive and abortion-related services, and reproductive outcomes of these impacts. Using a pre-established protocol, we searched bibliographic databases (December 2019-February 2021) and key grey literature sources (December 2019-April 2021). Of 71 studies included, the majority (61%) were not peer-reviewed, and 42% were based in Africa, 35% in Asia, 17% were multi-region, and 6% were in Latin America and the Caribbean. Most studies were based on data through June 2020. The magnitude of contraceptive service-related impacts varied widely across 55 studies (24 of which also included information on abortion). Nearly all studies assessing changes over time to contraceptive service provision noted declines of varying magnitude, but severe disruptions were relatively uncommon or of limited duration. Twenty-six studies addressed the impacts of COVID-19 on abortion and postabortion care (PAC). Overall, studies found increases in demand, reductions in provision and increases in barriers to accessing these services. The use of abortion services declined, but the use of PAC was more mixed with some studies finding increases compared to pre-COVID-19 levels. The impacts of COVID-19 varied substantially, including the country context, health service, and population studied. Continued monitoring is needed to assess impacts on these key health services, as the COVID-19 pandemic evolves.

Differential associations of homelessness with emergency department visits and hospitalizations by race, ethnicity, and gender

OBJECTIVE

To investigate the differential associations of homelessness with emergency department (ED) visits and hospitalizations by race, ethnicity, and gender.

DATA SOURCES

California Medicaid enrollment and claims.

STUDY DESIGN

We identified beneficiaries experiencing homelessness (BEH) and those who did not (NBEH) using diagnosis and place of service codes and residential addresses. Outcomes include four ED visit measures and four hospitalization measures. We compared the use of these services by BEH to NBEH overall and by race, ethnicity, and gender groups in regression models controlling for covariates.

DATA COLLECTION

We used a sample of Medicaid beneficiaries who met eligibility criteria for a California Medicaid demonstration program in 2017 and 2018 but were not enrolled in the program. We identified 473,069 BEH, and the rest (1,948,422) were considered NBEH. We used the 2018 data for utilization analyses and most covariates. We constructed lagged measures of health conditions using 2017 data.

PRINCIPAL FINDINGS

We found that homelessness was significantly associated with 0.34 more ED visits (p < 0.01) and a higher likelihood of frequent ED visits (2.77 percentage points [pp], p < 0.01), any ED visits due to mental health conditions (0.79 pp, p < 0.01), and any ED visits due to substance use disorders (1.47 pp, p < 0.01). Experiencing homelessness was also significantly associated with 0.03 more hospitalizations (p < 0.01), a higher likelihood of frequent hospitalizations (0.68 pp, p < 0.01) and high frequent hospitalizations (0.28 pp, p < 0.01), and a longer length of stay (0.53 days, p < 0.01). We found a larger association for American Indian and Alaska Native, Black, Native Hawaii or Pacific Islander, and White populations than that for Asian and Hispanic populations. The associations are larger for males than females.

CONCLUSIONS

Our findings identified distinct utilization patterns by race, ethnicity, and gender. They indicated the need for developing race, ethnicity, and gender-specific strategies to reduce ED visits and hospitalizations of BEH.

COVID-19, nutrition, and gender: An evidence-informed approach to gender-responsive policies and programs

In addition to the direct health impacts of COVID-19, government and household mitigation measures have triggered negative indirect economic, educational, and food and health system impacts, hitting low-and middle-income countries the hardest and disproportionately affecting women and girls. We conducted a gender focused analysis on five critical and interwoven crises that have emerged because of the COVID-19 crisis and exacerbated malnutrition and food insecurity. These include restricted mobility and isolation; reduced income; food insecurity; reduced access to essential health and nutrition services; and school closures. Our approach included a theoretical gender analysis, targeted review of the literature, and a visual mapping of evidence-informed impact pathways. As data was identified to support the visualization of pathways, additions were made to codify the complex interrelations between the COVID-19 related crises and underlying gender relations. Our analysis and resultant evidence map illustrate how underlying inequitable norms such as gendered unprotected jobs, reduced access to economic resources, decreased decision-making power, and unequal gendered division of labor, were exacerbated by the pandemic's secondary containment efforts. Health and nutrition policies and interventions targeted to women and children fail to recognize and account for understanding and documentation of underlying gender norms, roles, and relations which may deter successful outcomes. Analyzing the indirect effects of COVID-19 on women and girls offers a useful illustration of how underlying gender inequities can exacerbate health and nutrition outcomes in a crisis. This evidence-informed approach can be used to identify and advocate for more comprehensive upstream policies and programs that address underlying gender inequities.

A Cross-Sectional Study on the Prevalence of Depressive Symptoms and Its Associated Sociodemographic Factors in Peru during the COVID-19 Pandemic

The present study aims to analyze the prevalence of depressive symptoms and its sociodemographic-associated factors in Peruvian adults. Data was extracted from a nation-wide representative survey in which depression symptoms were measured with the PHQ-9 and sociodemographic information was extracted from household data. Depression severity rates were estimated for each symptom, and responses were modeled through the Rating Scale Model to obtain a depression measure used as dependent variable on a Generalized Mixed Linear Model. The most frequent depression symptoms were emotional, such as discouragement, sad mood, hopelessness, and lack of pleasure when doing activities. Our model showed that, after controlling the effects of all the variables considered, the most relevant predictors were gender, education level, physiographic region, age, marital status, and number of coresidents. Higher depression levels were found in women, people who did not complete higher education, participants living in the Highlands, older adults, single participants, and people living alone. Thus, interventions to promote or prevent depression severity during similar situations as the pandemic should focus on specific sociodemographic groups and their particular needs.

Sex disparities in food consumption patterns, dietary diversity and determinants of self-reported body weight changes before and amid the COVID-19 pandemic in 10 Arab countries

Background

The COVID-19 pandemic along with its confinement period boosted lifestyle modifications and impacted women and men differently which exacerbated existing gender inequalities. The main objective of this paper is to assess the gender-based differentials in food consumption patterns, dietary diversity and the determinants favoring weight change before and amid the COVID-19 pandemic among Arab men and women from 10 Arab countries.

Methods

A cross-sectional study was conducted based on a convenience sample of 12,447 households' family members (mean age: 33.2 ± 12.9; 50.1% females) and information from participants aged 18 years and above was collected about periods before and during the pandemic.

Results

Findings showed that, during the COVID-19 period, the dietary diversity, declined by 1.9% among females compared to males (0.4%) (p < 0.001) and by 1.5% among overweight participants (p < 0.001) compared to their counterparts.

Conclusions

To conclude, gender-sensitive strategies and policies to address weight gain and dietary diversity during emergent shocks and pandemics are urgently needed in the region.

Disruptions to the procurement of medical abortion medicines during COVID-19: a scoping review

OBJECTIVES

This scoping review aimed to systematically search, retrieve and map the extent and characteristics of available literature on the evidenced disruptions to medical abortion (MA) medicine procurement caused by the COVID-19 outbreak.

DESIGN

Scoping review using Arksey and O'Malley's methodology and Levac et al's methodological enhancement with adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews.

DATA SOURCES

PubMed, Embase, PMC, Science Direct, the Cochrane Library and Google Scholar were searched from January 2020 to April 2022.

ELIGIBILITY CRITERIA

We included articles in English that: (1) contained information on MA medicines; (2) included descriptions of procurement disruptions, including those with examples, characteristics and/or statistics; (3) documented events during the COVID-19 pandemic; and (4) presented primary data.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently screened search results, performed a full-text review of preliminarily included articles and completed data extraction in a standard Excel spreadsheet. Extracted data from was compared for validation and synthesised qualitatively.

RESULTS

The two articles included are unpublished grey literature demonstrating evidence of short-lived disruptions in sexual and reproductive health commodity procurement, including MA medicines, in sub-Saharan Africa during the early months of the pandemic. Findings from the two included grey literature articles show that in sub-Saharan contexts, emergency preparedness, stockpiling, adaptations and flexibility of key actors, including donors, alleviated COVID-19 disruptions allowing for resumption of services within weeks.

CONCLUSION

There is a need for increased empirical evidence of MA procurement challenges to understand which barriers to MA procurement may persist and impact continuity of supply while others can fuel resilience and preparedness efforts at the country and subregional levels. The lack of evidence from social marketing organisations and their networks is a significant gap as these actors constitute a vital artery in the distribution of MA commodities in low-income and middle-income countries.

Violence against women from partners and other household members during COVID-19 in Burkina Faso and Kenya

Background

Global evidence indicates increases in gender-based violence (GBV) during the COVID-19 pandemic following mitigation measures, such as stay at home orders. Indirect effects of the pandemic, including income loss, strained social support, and closed or inaccessible violence response services, may further exacerbate GBV and undermine help-seeking. In Kenya and Burkina Faso, as in many settings, GBV was prevalent prior to the COVID-19 pandemic. Studies specific to COVID-impact on GBV in Kenya indicate mixed results and there remains a lack of evidence from Burkina Faso. Our study takes a comprehensive lens by addressing both intimate partner violence (IPV) and non-partner household abuse through the COVID-19 pandemic in two priority settings.

Methods

Annual, national cross-sections of women ages 15–49 completed survey data collection in November–December 2020 and December 2020–March 2021; the GBV module was limited to one woman per household [Kenya n = 6715; Burkina n = 4065]. Descriptive statistics, Venn diagrams, and logistic and multinomial regression characterized prevalence of IPV and other household abuse, frequency relative to the COVID-19 pandemic, help-seeking behaviors, and predictors of IPV and household abuse across the socioecological framework.

Results

In both settings, past-year IPV prevalence exceeded non-partner household abuse (Kenya: 23.5%_IPV, 11.0%_household; Burkina Faso: 25.7%_IPV, 16.2%_household). Over half of those affected in each setting did not seek help; those that did turned first to family. Among those with past-year experiences, increased frequency since COVID-19 was noted for IPV (16.0%_{Burkina Faso}; 33.6%_Kenya) and household violence (14.3%_{Burkina Faso}; 26.2%_Kenya). Both context-specific (i.e., financial autonomy in Burkina Faso) and universal (i.e., COVID-related income loss) risk factors emerged.

Conclusion

Past-year IPV and household violence against women in Kenya and Burkina Faso were prevalent, and in some cases, intensified during the COVID-19 pandemic. Across settings, help-seeking from formal services was notably low, likely reflecting shame, blame, and stigmatization identified as barriers in pre-COVID literature. Both primary prevention and survivor-centered support services, including those related to economic empowerment, should be integrated within COVID-recovery efforts, and extended into the post-pandemic period to fully meet women’s safety needs.

Impact of the COVID-19 pandemic on access to and utilisation of services for sexual and reproductive health: a scoping review

INTRODUCTION

The COVID-19 pandemic has negatively impacted health systems globally and widened preexisting disparities. We conducted a scoping review on the impact of the COVID-19 pandemic on women and girls' access to and utilisation of sexual and reproductive health (SRH) services for contraception, abortion, gender-based and intimate partner violence (GBV/IPV) and sexually transmitted infections (STIs).

METHODS

We systematically searched peer reviewed literature and quantitative reports, published between December 2019 and July 2021, focused on women and girls' (15-49 years old) access to and utilisation of selected SRH services during the COVID-19 pandemic. Included studies were grouped based on setting, SRH service area, study design, population and reported impact. Qualitative data were coded, organised thematically and grouped by major findings.

RESULTS

We included 83 of 3067 identified studies and found that access to contraception, in-person safe abortion services, in-person services for GBV/IPV and STI/HIV testing, prevention and treatment decreased. The geographical distribution of this body of research was uneven and significantly less representative of countries where COVID-19 restrictions were very strict. Access was limited by demand and supply side barriers including transportation disruptions, financial hardships, limited resources and legal restrictions. Few studies focused on marginalised groups with distinct SRH needs.

CONCLUSION

Reports indicated negative impacts on access to and utilisation of SRH services globally, especially for marginalised populations during the pandemic. Our findings call for strengthening of health systems preparedness and resilience to safeguard global access to essential SRH services in ongoing and future emergencies.

Increases in depression and anxiety symptoms in adolescents and young adults during the COVID-19 pandemic

BACKGROUND

The coronavirus [coronavirus disease 2019 (COVID-19)] pandemic has introduced extraordinary life changes and stress, particularly in adolescents and young adults. Initial reports suggest that depression and anxiety are elevated during COVID-19, but no prior study has explored changes at the within-person level. The current study explored changes in depression and anxiety symptoms from before the pandemic to soon after it first peaked in Spring 2020 in a sample of adolescents and young adults (N = 451) living in Long Island, New York, an early epicenter of COVID-19 in the U.S.

METHODS

Depression (Children's Depression Inventory) and anxiety symptoms (Screen for Child Anxiety Related Symptoms) were assessed between December 2014 and July 2019, and, along with COVID-19 experiences, symptoms were re-assessed between March 27th and May 15th, 2020.

RESULTS

Across participants and independent of age, there were increased generalized anxiety and social anxiety symptoms. In females, there were also increased depression and panic/somatic symptoms. Multivariable linear regression indicated that greater COVID-19 school concerns were uniquely associated with increased depression symptoms. Greater COVID-19 home confinement concerns were uniquely associated with increased generalized anxiety symptoms, and decreased social anxiety symptoms, respectively.

CONCLUSIONS

Adolescents and young adults at an early epicenter of the COVID-19 pandemic in the U.S. experienced increased depression and anxiety symptoms, particularly amongst females. School and home confinement concerns related to the pandemic were independently associated with changes in symptoms. Overall, this report suggests that the COVID-19 pandemic is having multifarious adverse effects on the mental health of youth.

Anxiety among Adolescents and Young Adults during COVID-19 Pandemic: A Multi-Country Survey

(1) Background: Adolescents-and-young-adults (AYA) are prone to anxiety. This study assessed AYA's level of anxiety during the COVID-19 pandemic; and determined if anxiety levels were associated with country-income and region, socio-demographic profile and medical history of individuals. (2) Methods: A survey collected data from participants in 25 countries. Dependent-variables included general-anxiety level, and independent-variables included medical problems, COVID-19 infection, age, sex, education, and country-income-level and region. A multilevel-multinomial-logistic regression analysis was conducted to determine the association between dependent, and independent-variables. (3) Results: Of the 6989 respondents, 2964 (42.4%) had normal-anxiety, and 2621 (37.5%), 900 (12.9%) and 504 (7.2%) had mild, moderate and severe-anxiety, respectively. Participants from the African region (AFR) had lower odds of mild, moderate and severe than normal-anxiety compared to those from the Eastern-Mediterranean-region (EMR). Also, participants from lower-middle-income-countries (LMICs) had higher odds of mild and moderate than normal-anxiety compared to those from low-income-countries (LICs). Females, older-adolescents, with medical-problems, suspected-but-not-tested-for-COVID-19, and those with friends/family-infected with COVID-19 had significantly greater odds of different anxiety-levels. (4) Conclusions: One-in-five AYA had moderate to severe-anxiety during the COVID-19-pandemic. There were differences in anxiety-levels among AYAs by region and income-level, emphasizing the need for targeted public health interventions based on nationally-identified priorities.

Gender and professionalism: Still a black box a call for research, debate and action. Suggestions from and beyond the pandemic crisis

The gender-professionalism nexus is the source of persistent inequalities in our society. Its continuing relevance emerges even more in the pandemic crisis as a revealing context of social dynamics, showing a “differential in visibility” among welfare professionals, associated with gender, status and power. The attribution of “masculine” and “feminine” connotations (re)produces structures of inequality: there are male/dominant and female/subordinate professions. The exploration of this nexus reveals the existence of two polar meanings of care and body work, as well as two conceptions of professionalism and citizenship. Caring as “therapy” is related to “work on the body” and reflects a classical conception of professionalism aimed at client-citizens; whereas caring as “to care for” is related to “work with and between bodies” and meets better new professionalism aimed at active citizens. Considering gender as professional practice ideology highlights how “gender commonality” is not a solution to inequalities. Furthermore, it can contribute to the deconstruction of the dominance structures. In a such research agenda, narratives of professionals are the key to open the black box. Taking up the challenge to open the gender-professionalism black box is not just a matter of research, but of political action, starting from academia itself.