A scoping review of the impacts of COVID-19 physical distancing measures on vulnerable population groups

Survive, revive, and thrive: The impact of COVID-19 on global park visitation

The COVID-19 pandemic has had detrimental effects on both the physical and psychological well-being of individuals. Throughout the pandemic and in response to various policies, such as lockdowns, movement restrictions and social distancing measures, parks and greenspaces received renewed attention as people used them to help cope with the adverse effects of the pandemic. This study explored the factors influencing park and greenspace visitation at different stages of the pandemic in 2020, 2021, and 2022, from both global and regional perspectives. Data were collected primarily from Our World in Data, Google's Community Mobility Reports and the Oxford Coronavirus Government Response Tracker, and a total of 125,422 park visits were processed. Stay-at-home mandates, vaccination availability, and school closures were the most influential factors globally affecting park and greenspace visitation in 2020, 2021, and 2022, respectively. Post-2021, vaccination-related policies began to play a significantly positive role in the increase in park and greenspace visits. Following a global analysis, countries were categorized into five clusters based on social, economic, and cultural indices. The analysis revealed varying patterns of factors influencing park visitation across these clusters. Notably, income support policies were positively correlated with higher park visitation, particularly in low-income countries. Recognizing the significance of parks and green spaces as essential green infrastructure, this study suggests how the use of parks might have better coped with the COVID-19 pandemic and how future health crises might be addressed. At the same time, it considers different social, economic, and cultural contexts. Additionally, this work provides insights and suggestions as to how parks and greenspaces might be used to reduce the social inequalities exacerbated during the pandemic, especially in low-income developing countries.

The impact of the COVID-19 pandemic on the socioeconomic gradient of hypertension

The COVID-19 pandemic has brought into sharp focus the impact of socioeconomic factors on hypertension outcomes. This review examines the implications of the pandemic on the socioeconomic gradient of hypertension and explores the physiological and pathophysiological processes underlying this relationship. Changes in socioeconomic factors have disproportionately affected individuals with lower socioeconomic status, leading to adverse hypertension outcomes. The pandemic-related stressors, coupled with social isolation and disrupted daily routines, have contributed to elevated stress levels among individuals, particularly those with lower socioeconomic status. Equitable access to healthcare, enhancing health literacy and patient empowerment, and addressing social determinants of health are essential components of hypertension management strategies. By recognizing the specific challenges faced by individuals with lower socioeconomic status and implementing targeted interventions, public health efforts can help reduce the socioeconomic gradient of hypertension.

The burden of infectious diseases throughout and after the COVID-19 pandemic (2020-2023) and Russo-Ukrainian war migration

Understanding how the infectious disease burden was affected throughout the COVID-19 pandemic is pivotal to identifying potential hot spots and guiding future mitigation measures. Therefore, our study aimed to analyze the changes in the rate of new cases of Poland's most frequent infectious diseases during the entire COVID-19 pandemic and after the influx of war refugees from Ukraine. We performed a registry-based population-wide study in Poland to analyze the changes in the rate of 24 infectious disease cases from 2020 to 2023 and compared them to the prepandemic period (2016-2019). Data were collected from publicly archived datasets of the Epimeld database published by national epidemiological authority institutions. The rate of most of the studied diseases (66.6%) revealed significantly negative correlations with the rate of SARS-CoV-2 infections. For the majority of infectious diseases, it substantially decreased in 2020 (in case of 83%) and 2021 (63%), following which it mostly rebounded to the prepandemic levels and, in some cases, exceeded them in 2023 when the exceptionally high annual rates of new cases of scarlet fever, Streptococcus pneumoniae infections, HIV infections, syphilis, gonococcal infections, and tick-borne encephalitis were noted. The rate of Clostridioides difficile enterocolitis was two-fold higher than before the pandemic from 2021 onward. The rate of Legionnaires' disease in 2023 also exceeded the prepandemic threshold, although this was due to a local outbreak unrelated to lifted COVID-19 pandemic restrictions or migration of war refugees. The influx of war migrants from Ukraine could impact the epidemiology of sexually transmitted diseases. The present analysis indicates that continued efforts are needed to prevent COVID-19 from overwhelming healthcare systems again and decreasing the control over the burden of other infectious diseases. It also identifies the potential tipping points that require additional mitigation measures, which are also discussed in the paper, to avoid escalation in the future.

Securing the future of IoT-healthcare systems: A meta-synthesis of mandatory security requirements

INTRODUCTION

Healthcare-based Internet of Things (Healthcare-IoT) is a turning point in the development of health information systems. This emerging trend significantly contributes to enhancing users' awareness of their health, ultimately leading to an extension in life expectancy. Security and privacy are among the greatest challenges for H-IoT systems. To establish complete safety and security in these systems, the implementation of mandatory security requirements is imperative. For this reason, this study identifies the necessary security requirements for H-IoT systems using a Meta-Synthesis approach.

METHODS

Initially, following the Seven-Stage Sandelowski & Barroso approach, the existing literature was searched in the Scopus and Web of Science databases. Among the 844 extracted articles from the period of 2010 to 2020, 78 final articles were reviewed and analyzed, leading to the identification of 51 security requirements. Subsequently, to assess the quality of the identified requirements and their overlap, interviews were conducted with two experts.

RESULTS

Finally, 14 security requirements, predominantly with technical and quantitative aspects, were identified for designing a Healthcare-IoT system and implementing security mechanisms.

CONCLUSION

The findings of this study emphasize that addressing the identified 14 security requirements is crucial for safeguarding Healthcare-IoT systems and ensuring their robustness in the evolving health information landscape.

Metacognitive Management of Attention in Online Learning

Performance during training is a poor predictor of long-term retention. Worse yet, conditions of training that produce rapidly improving performance typically do not produce long-lasting, generalizable learning. As a result, learners and instructors alike can be misled into adopting training or educational experiences that are suboptimal for producing actual learning. Computer-based educational training platforms can counter this unfortunate tendency by providing only productive conditions of instruction-even if they are unintuitive (e.g., spacing instead of massing). The use of such platforms, however, introduces a different liability: being easy to interrupt. An assessment of this possible liability is needed given the enormous disruption to modern education brought about by COVID-19 and the subsequent widespread emergency adoption of computer-based remote instruction. The present study was therefore designed to (a) explore approaches for detecting interruptions that can be reasonably implemented by an instructor, (b) determine the frequency at which students are interrupted during a cognitive-science-based digital learning experience, and (c) establish the extent to which the pandemic and ensuing lockdowns affected students' metacognitive ability to maintain engagement with their digital learning experiences. Outliers in time data were analyzed with increasing complexity and decreasing subjectivity to identify when learners were interrupted. Results indicated that only between 1.565% and 3.206% of online interactions show evidence of learner interruption. And although classroom learning was inarguably disrupted by the pandemic, learning in the present, evidence-based platform appeared to be immune.

Experiences of male irregular migrants during their migration process and reception in Spain: lessons learned from the COVID-19 pandemic

Background

The causes behind migration movements are complex. The COVID-19 pandemic highlighted how several countries failed to respond to the virus adequately, while simultaneously infringing on people's rights. Male irregular migrants fled their countries of origin and embarked on a perilous migration journey to Spain. The highly restrictive COVID-19 measures and border closures affected the mobility of male irregular migrants, whose reception in the host country posed a challenge. It led to the establishment of emergency facilities to accommodate male irregular migrants affected by COVID-19, which had repercussions on their mental health. The aim of this study was to describe and understand the experiences of male irregular migrants throughout their migration process and reception in Spain during the COVID-19 pandemic.

Methods

Qualitative descriptive study. Sixteen male irregular migrants participated in this study. Data were collected between January and March 2023 through 16 one-on-one in-depth interviews. Thematic analysis was used to analyze the qualitative data using ATLAS.ti computer software.

Results

Three main themes emerged: (1) How the COVID-19 pandemic drove male irregular migrants to leave their countries of origin, (2) How COVID-19 lockdown policies affected the migration journey, and (3) Receiving male irregular migrants in a pandemic: a housing labyrinth marked by isolation and loneliness.

Conclusion

The COVID-19 pandemic increased the social, employment and health inequalities experienced by male irregular migrants. Border closures exacerbated the migration journey and the social stigmatization of this group, who were seen as carriers of the virus in both transit and host countries. Strict control measures in emergency and reception facilities had a significant psychological impact on the male irregular migrants due to the social isolation they experienced. Health institutions should develop programs to guarantee the care needs of irregular migrants.

The impact of COVID-19 on young people's mental health, wellbeing and routine from a European perspective: A co-produced qualitative systematic review

BACKGROUND

The impact of the Covid-19 pandemic on young people's (YP) mental health has been mixed. Systematic reviews to date have focused predominantly on quantitative studies and lacked involvement from YP with lived experience of mental health difficulties. Therefore, our primary aim was to conduct a qualitative systematic review to examine the perceived impact of the Covid-19 pandemic on YP's (aged 10-24) mental health and wellbeing across Europe.

METHODS AND FINDINGS

We searched MEDLINE, PsycINFO, Embase, Web of Science, MEDRXIV, OSF preprints, Google, and voluntary sector websites for studies published from 1st January 2020 to 15th November 2022. European studies were included if they reported qualitative data that could be extracted on YP's (aged 10-24) own perspectives of their experiences of Covid-19 and related disruptions to their mental health and wellbeing. Screening, data extraction and appraisal was conducted independently in duplicate by researchers and YP with lived experience of mental health difficulties (co-researchers). Confidence was assessed using the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) approach. We co-produced an adapted narrative thematic synthesis with co-researchers. This study is registered with PROSPERO, CRD42021251578. We found 82 publications and included 77 unique studies in our narrative synthesis. Most studies were from the UK (n = 50; 65%); and generated data during the first Covid-19 wave (March-May 2020; n = 33; 43%). Across the 79,491 participants, views, and experiences of YP minoritised by ethnicity and sexual orientation, and from marginalised or vulnerable YP were limited. Five synthesised themes were identified: negative impact of pandemic information and restrictions on wellbeing; education and learning on wellbeing; social connection to prevent loneliness and disconnection; emotional, lifestyle and behavioural changes; and mental health support. YP's mental health and wellbeing across Europe were reported to have fluctuated during the pandemic. Challenges were similar but coping strategies to manage the impact of these challenges on mental health varied across person, study, and country. Short-term impacts were related to the consequences of changing restrictions on social connection, day-to-day lifestyle, and education set-up. However, YP identified potential issues in these areas going forward, and therefore stressed the importance of ongoing long-term support in education, learning and mental health post-Covid-19.

CONCLUSIONS

Our findings map onto the complex picture seen from quantitative systematic reviews regarding the impact of Covid-19 on YP's mental health. The comparatively little qualitative data found in our review means there is an urgent need for more high-quality qualitative research outside of the UK and/or about the experiences of minoritised groups to ensure all voices are heard and everyone is getting the support they need following the pandemic. YP's voices need to be prioritised in decision-making processes on education, self-care strategies, and mental health and wellbeing, to drive impactful, meaningful policy changes in anticipation of a future systemic crisis.

Insights from Avian Influenza: A Review of Its Multifaceted Nature and Future Pandemic Preparedness

Avian influenza viruses (AIVs) have posed a significant pandemic threat since their discovery. This review mainly focuses on the epidemiology, virology, pathogenesis, and treatments of avian influenza viruses. We delve into the global spread, past pandemics, clinical symptoms, severity, and immune response related to AIVs. The review also discusses various control measures, including antiviral drugs, vaccines, and potential future directions in influenza treatment and prevention. Lastly, by summarizing the insights from previous pandemic control, this review aims to direct effective strategies for managing future influenza pandemics.

Online teaching experience of the healthcare faculty during the pandemic: A cross sectional analysis

BACKGROUND

COVID-19 pandemic had disrupted the teaching in most of the educational institutes worldwide. It has tested the readiness of educational institutes in their ability to deal with crisis.

OBJECTIVE

This study aimed to determine the perception of health sciences faculty toward online education during the period of pandemic in Pakistan.

METHODS

This cross-sectional research determined the perception using online survey which had been taken from the study conducted by Almahasees et al. Questions related to faculty's perception regarding IT skills, online classes taking more effort than on-campus learning, online platforms having adequate tools to facilitate teaching. Data was analyzed using SPSS. Statistical tests comprised of descriptive statistics and Kruskal-Walli's test.

RESULTS

From a total of 318 participants, there were 234 females and 84 males. A statistically significant association was identified between field of specialization and competency to teach online (p = 0.022). Faculty stated that more efforts were required to teach online (p <  0.001). Most of the tutors reported virtual sessions helped improved the interaction with their students (p <  0.001). Most of the time faculty had to prompt students to complete their assignments on time (p <  0.001). Many of the faculty members disagreed that delivering virtual sessions from home was quite ineffective (p = 0.221) and reported experiencing distractions (p <  0.001).

CONCLUSION

This study showed that online learning proved less effective than face-to-face learning. The main drawback of distance learning was the lack of teacher-student interaction. Online learning promotes student-centered learning and could be applied in situations of crisis like the COVID-19 pandemic.

Interactive changes in depression and loneliness symptoms prior to and during the COVID-19 pandemic: A longitudinal network analysis

OBJECTIVES

Depression and loneliness co-occur frequently. This study examined interactive changes between depression and loneliness among older adults prior to and during the COVID-19 pandemic from a longitudinal network perspective.

METHODS

This network study was based on data from three waves (2016-2017, 2018-2019, and 2020) of the English Longitudinal Study of Ageing (ELSA). Depression and loneliness were measured with the eight-item version of the Center for Epidemiologic Studies Depression Scale (CESD-8) and three item version of the University of California Los Angeles (UCLA) Loneliness Scale, respectively. A network model was constructed using an Ising Model while network differences were assessed using a Network Comparison Test. Central symptoms were identified via Expected Influence (EI).

RESULTS

A total of 4,293 older adults were included in this study. The prevalence and network of depression and loneliness did not change significantly between the baseline and pre-pandemic assessments but increased significantly from the pre-pandemic assessment to during COVID-19 assessment. The central symptom with the strongest increase from pre-pandemic to pandemic assessments was "Inability to get going" (CESD8) and the edge with the highest increase across depression-loneliness symptom communities was "Lack companionship" (UCLA1) - "Inability to get going" (CESD8). Finally, "Feeling depressed" (CESD1) and "Everything was an effort" (CESD2) were the most central symptoms over the three assessment periods.

CONCLUSIONS

The COVID-19 pandemic was associated with significant changes in the depression-loneliness network model. The most changed symptoms and edges could be treatment targets for reducing the risk of depression and loneliness in older adults.

The Ongoing Impact of COVID-19 on Pediatric Obesity

In the developed world, pediatric obesity (PO) has been a major health concern since the last century, and this condition may lead to detrimental life-long physical and mental comorbidities. Currently, its prevalence has increased in low- and middle-income countries and in many high-income countries. Thus, the provision of effective and tailored care for children and their families has become vital. The social consequences of the COVID-19 pandemic are known everywhere, and among these, it has been argued that the COVID-19 pandemic has had a major impact on PO. Overall, the growth of PO over the last decade has been enhanced by the pandemic. During the COVID-19 pandemic, children, adolescents and young adults gained weight as the pediatric population dealt with sedentary lifestyles and changes in food habits. In this review, we want to highlight the impact that the COVID-19 pandemic had on PO.

The mechanisms of nature-based therapy on depression, anxiety, stress, and life satisfaction: examining mindfulness in a two-wave mediation model

Background

Nature-based therapy (NBT), which centers around engaging in activities within natural surroundings, has consistently demonstrated therapeutic benefits for mental health. While NBT highlights the potential of nature as a therapeutic resource for promoting mental health, there is limited knowledge regarding its underlying mechanisms.

Methods

Two hundred seventy-six Korean participants (204 women, mean age = 54.99 ± 23.25 years) participated in a 30-session gardening program held twice weekly for 15 weeks. Structural equation modeling with a two-wave autoregressive cross-lagged model was used to investigate the mediating effects of mindfulness.

Results

NBT significantly improved the mean scores of all psychological variables. The mediation model was partially confirmed, with mindfulness at post-intervention (T2) mediating the relationship between baseline (T1) depression and anxiety and post-intervention (T2) life satisfaction. However, no significant indirect effect was observed between the path from stress (T1) to life satisfaction (T2).

Conclusion

Mindfulness is a crucial component for improving mental health outcomes. This study underscores the need to prioritize and emphasize mindfulness practices in NBT.

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.

"if we don't regroup, hunger will kill us…": a qualitative study on measures of physical distancing during covid-19 among internally displaced persons in Burkina Faso

This study contributes to the body of knowledge on IDPs in the context of security crisis related to terrorism. Very little research has been done on covid-19 amongst IDPs in Africa and this is one of the first studies in Burkina Faso. Our diversified sample allowed us to consider the discourses of humanitarian actors working with IDPs, but also the discourses of IDPs in a context of aggravated health and security crisis. The challenges encountered by IDPs in implementing physical distancing and the coping strategies have been documented. It showed some possible solutions that decision-makers could use in order to facilitate the appropriation of this measure by IDPs. This is a contribution to the field of applied human and social science research They will help to anticipate solutions in the event of a resurgence of covid-19 cases. In the current context, where the spread of the disease seems to be under control, concerted action should now be taken in the event of the detection of a case of covid-19 in the various IDP sites.

Self-rated health impact of COVID 19 confinement on inmates in Southeastern of Europe: a qualitative study

INTRODUCTION

The COVID-19 pandemic necessitated the implementation of various measures within closed institutions like prisons to control the spread of the virus. Analyzing the impact of these measures on the health of inmates is crucial from a public health perspective. This study aimed to explore inmates' subjective perception of the COVID-19 lockdown, the implemented measures, their physical self-perception, and their views on the vaccination process.

METHOD

Between April 2021 and January 2022, 27 semi-structured individual interviews and 1 focus group were conducted with inmates in a prison located in northwest Spain. The interviews were conducted in person and audio-recorded. Thematic content analysis was employed, utilizing methodological triangulation to enhance the coherence and rigor of the results.

RESULTS

The analysis revealed two main themes and nine subthemes. The first theme focused on inmates' perception of the implementation of protective measures against COVID-19 within the prison and its impact on their well-being. The second theme explored the pandemic's emotional impact on inmates. All participants reported negative consequences on their health resulting from the measures implemented by the institution to contain the pandemic. However, they acknowledged that measures like lockdowns and mass vaccination helped mitigate the spread of the virus within the prison, contrary to initial expectations.

CONCLUSION

COVID-19 and related measures have directly affected the health of inmates. To improve their health and minimize the impact of pandemic-induced changes, community participation and empowerment of individuals are essential tools, particularly within closed institutions such as prisons.

Child Rights during the COVID-19 Pandemic: Learning from Child Health-and-Rights Professionals across the World

The COVID-19 pandemic underscores the importance of a child rights-based approach to policymaking and crisis management. Anchored in the United Nations Convention on the Rights of the Child, the 3P framework-provision, protection, and participation-forms the foundation for health professionals advocating for children's rights. Expanding it with two additional domains-preparation and power-into a 5P framework has the potential to enhance child rights-based policies in times of crisis and future pandemics. The study aimed to (1) gather perspectives from child health-and-rights specialists on how children's rights were highlighted during the early phase of the pandemic in their respective settings; and (2) evaluate the usefulness of the 5P framework in assessing children's visibility and rights. A qualitative survey was distributed among child health-and-rights professionals; a total of 68 responses were analysed in Atlas.ti 9 from a multi-disciplinary group of policymakers and front-line professionals in eight world regions. As framed by the 5Ps, children's rights were generally not safeguarded in the initial pandemic response and negatively impacted children's health and wellbeing. Further, children lacked meaningful opportunities to raise their concerns to policymakers. The 5P framework holds the potential to shape an ethical child rights-based decision-making framework for future crises, both nationally and globally.

Caring for People with Rare Diseases: A Systematic Review of the Challenges of, and Strategies for Dealing with, COVID-19

The COVID-19 pandemic took a toll on everyone's lives, and patients with rare diseases (RDs) had to pay an even higher price. In this systematic review, we explored the impact of the COVID-19 pandemic on individuals with RDs from a psychological perspective. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we retrieved articles from the Google Scholar, Scopus, and PubMed databases focusing on 'COVID-19,' 'psychology,' and 'rare diseases.' Seventeen primary articles were identified (mainly from continental Europe). The results revealed the psychological effects of the pandemic on rare disease patients, including increased anxiety, stress, and depressive moods. This review also highlighted the increased vulnerability and reduced quality of life of rare disease patients during the pandemic, as well as the importance of telecare and psychological support as critical interventions for improving their well-being. There is an urgent need for multidisciplinary research and stronger healthcare systems to meet the unique challenges of rare disease patients, who represent 3.5-5.9% of the global population.

Immunophenotyping characteristics and outcome of COVID-19 patients: peripheral blood CD8+T cell as a prognostic biomarker for patients with Nirmatrelvir

Background

Nirmatrelvir has been authorized for the treatment of both hospitalized and non-hospitalized COVID-19 patients. However, the association between T lymphocyte subsets and the outcome of hospitalized COVID-19 patients treated with oral Nirmatrelvir has not been investigated. The objective of this study was to examine whether lymphocyte subsets could serve as biomarkers to assess the risk of mortality in COVID-19 patients undergoing Nirmatrelvir treatment, with the aim of enhancing medication management for COVID-19 patients.

Methods

We conducted a retrospective cohort study at the Xiangya Hospital of Central South University in China between December 5, 2022 and January 31, 2023. The study reported demographic, clinical, T lymphocyte subsets, and inflammatory cytokine data of COVID-19 patients. We evaluated the associations of T lymphocyte subsets on admission with the composite outcome or death of patients using univariate and multivariable Cox regression analyses with hazards ratios (HRs) and 95% confidence intervals (CIs).

Results

We identified 2118 hospitalized COVID-19 patients during the study period, and conducted a follow-up of up to 38 days. Of these, 131 patients received Nirmatrelvir, with 56 (42.7%) in the composite outcome group, and 75 (57.3%) in the non-composite outcome group. Additionally, 101 (77.1%) patients were discharged, while 30 (22.9%) died. Our results showed a significant decrease in the CD3+, CD4+, and CD8+ T cell counts of patients in the composite outcome group and mortality group compared to the non-composite outcome group and discharged group, respectively. Multivariate Cox regression analysis showed that the significant decrease in CD8+ T cell count in peripheral blood was independently associated with the composite outcome in COVID-19 patients treated with Nirmatrelvir, with an HR of 1.96 (95%CI: 1.01-3.80). The significant decrease in CD4+ and CD8+ T cell counts in peripheral blood increased the hazard of developing mortality, with HRs of 6.48 (95%CI: 1.47-28.63) and 3.75 (95%CI: 1.27-11.11), respectively.

Conclusion

Our study revealed a significant positive correlation between a decrease in CD8+ T cell counts and progression and mortality of hospitalized COVID-19 patients treated with Nirmatrelvir. Lower counts (/μL) of CD8+ T cell (<201) were associated with a higher risk of in-hospital severity and death. Our findings may provide valuable references for physicians in optimizing the use of Nirmatrelvir.

Mitigating the impacts of the COVID-19 pandemic on vulnerable populations: Lessons for improving health and social equity

The COVID-19 pandemic had an inequitable and disproportionate impact on vulnerable populations, reversing decades of progress toward healthy populations and poverty alleviation. This study examines various programmatic tools and policy measures used by governments to support vulnerable populations during the pandemic. A comparative case study of 15 countries representing all World Health Organization's regions offers a comprehensive picture of countries with varying income statuses, health system arrangements and COVID-19 public health measures. Through a systematic desk review and key informant interviews, we report a spectrum of mitigation strategies deployed in these countries to address five major types of vulnerabilities (health, economic, social, institutional and communicative). We found a multitude of strategies that supported vulnerable populations such as migrant workers, sex workers, prisoners, older persons and school-going children. Prioritising vulnerable populations during the early phase of COVID-19 vaccination campaigns, direct financial subsidies and food assistance programmes were the most common measures reported. Additionally, framing public health information and implementing culturally sensitive health promotion interventions helped bridge the communication barriers in certain instances. However, these measures remain insufficient to protect vulnerable populations comprehensively. Our findings point to the need to expand fiscal space for health, enlarge healthcare coverage, incorporate equity principles in all policies, leverage technology, multi-stakeholder co-production of policies and tailored community engagement mechanisms.

Pathway through which COVID-19 exacerbates energy poverty and proposed relief measures

Increased residential energy consumption and reduced income caused by the lockdown measures invoked to combat the COVID-19 pandemic have deepened energy poverty, particularly in vulnerable communities. In this context, the pathway through which COVID-19 impacts energy poverty is constructed, and six relief measures are proposed: consistent financing of energy suppliers and consumers, developing various forms of socio-economic aids, leveraging fiscal stimuli to promote renewable energy transition, identifying vulnerable populations to improve policy effectiveness, designing equitable resource allocation mechanisms, and rethinking socio-economic transition in the post-pandemic era.

Impact of the COVID-19 pandemic on adherence to positive airway pressure treatment in patients with obstructive sleep apnea: systematic review and meta-analysis

BACKGROUND

The adverse effects of the COVID-19 pandemic on sleep have been well studied. However, whether the COVID-19 pandemic impacted positive airway pressure (PAP) adherence in patients with obstructive sleep apnea (OSA) remains unclear.

OBJECTIVES

To evaluate the impact of the COVID-19 pandemic on adherence to PAP therapy in patients with OSA.

DESIGN

A retrospective cohort study, systematic review, and meta-analysis.

DATA SOURCES AND METHODS

The retrospective study included adults with OSA who received PAP prescriptions within the year before and the year after the start date of COVID-19 social distancing (22 March 2020) in South Korea. The threshold of clinical significance for PAP adherence was defined as 0.5 h/day. We also searched for relevant studies published up to 15 January 2023 using the MEDLINE and Embase databases. We performed a random-effects meta-analysis of our findings with the identified studies regarding the standardized mean change (SMC) with a 95% CI of PAP adherence.

RESULTS

Our study included a total of 306 patients (mean age, 59.7 years; men, 73.5%). The average daily PAP usage was 5.10 ± 1.63 h before the COVID-19 pandemic and 4.79 ± 1.96 h during the pandemic (mean difference, -0.31 h/day; 95% CI, -0.46 to -0.15 h/day; p < 0.001 using paired t-test). After identifying 10 observational before-and-after studies through a systematic review, we conducted a meta-analysis that included our original data and showed that adherence to PAP treatment was not different before and during the COVID-19 pandemic (SMC, 0.01; 95% CI, -0.18 to 0.19; p = 0.952).

CONCLUSION

Although the COVID-19 pandemic had a statistically negative impact on adherence to PAP treatment in South Korea, the effect was not clinically relevant in patients with OSA. According to our meta-analysis, adherence to PAP treatment was not different before and during the COVID-19 pandemic in patients with OSA.

TRIAL REGISTRATION

PROSPERO database; No.: CRD42023414268; URL: https://www.crd.york.ac.uk/PROSPERO.