Key factors affecting people's unwillingness to be confined during the COVID-19 pandemic in Spain: a large-scale population study

Emergency appointments and psychological distress during COVID-19 lockdown among orthodontic patients in Spain

Background

COVID-19 created an unexpected situation for dental patients. However, the impact of the lockdown on orthodontic patients is still unknown. Hence, this study was conducted to analyse the number and type of emergencies, distress and fear of getting infected among brackets and aligners orthodontic patients during the COVID-19 lockdown.

Material and Methods

A total of 324 questionnaires about emergency appointments during the lockdown and Kessler Psychological Distress Scale-K10 were distributed between March and December 2022 among patients who were on active orthodontic treatment during lockdown at the Master of Orthodontics at the University Alfonso X el Sabio during February and December 2022. Chi-square was used to compare groups.

Results

Emergency appointment was needed by 37.78% of patients during lockdown: 73.5% among those with aligners and 45.9% with brackets (p<.01). Loose bracket was the most prevalent emergency for bracket patients and lack of aligners among invisible orthodontic patients. Of those, 36.95% in need of orthodontic emergency appointments didn´t attend the clinic for fear of being infected; 21% of patients had high or very high anxiety levels.

Conclusions

Orthodontic patients had moderate levels of anxiety and fear of being infected during lockdown. Of these, 31.78% needed an emergency appointment. Key words:Orthodontics, COVID-19, dental healthcare, dentistry, emergency.

Sociodemographic effects on pandemic fatigue are multifaceted and context-specific: A longitudinal analysis of physical distancing adherence

Background

Pandemic fatigue emerged early during the COVID-19 pandemic and remains a concern as new variants emerge and ongoing public health measures are needed to control them. A wide range of factors can affect pandemic fatigue, but empiric research indicating which may be most important to adherence in specific populations is lacking.

Design & Methods

We conducted a longitudinal study of changes in physical distancing in two cohorts: adults living with children <18 years and adults ≥50 years old. Six types of non-work, non-household contacts were ascertained at six times from April to October 2020. We used generalized estimating equations Poisson regression to estimate the one-week change in contact rate and how this differed based on sociodemographic characteristics.

Results

The rate of all contact types increased during the middle of the study period and decreased toward the end. Changes in contact rates over time differed according to several sociodemographic characteristics, including age, gender, race/ethnicity, education, household composition, and access to transportation. Furthermore, the factors influencing the rate of change in contact rates differed by the type or setting of the contact, for example contacts as a result of visiting another person's home versus during a retail outing.

Conclusions

These results provide evidence for potential mechanisms by which pandemic fatigue has resulted in lower physical distancing adherence.

Understanding public support for COVID-19 pandemic mitigation measures over time: Does it wear out?

Background

COVID-19 mitigation measures intend to protect public health, but their adverse psychological, social, and economic effects weaken public support. Less favorable trade-offs may especially weaken support for more restrictive measures. Support for mitigation measures may also differ between population subgroups who experience different benefits and costs, and decrease over time, a phenomenon termed "pandemic fatigue."

Methods

We examined self-reported support for COVID-19 mitigation measures in the Netherlands over 12 consecutives waves of data collection between April 2020 and May 2021 in an open population cohort study. Participants were recruited through community panels of the 25 regional public health services, and through links to the online surveys advertised on social media. The 54,010 unique participants in the cohort study on average participated in 4 waves of data collection. Most participants were female (65%), middle-aged [57% (40-69 years)], highly educated (57%), not living alone (84%), residing in an urban area (60%), and born in the Netherlands (95%).

Results

COVID-19 mitigation measures implemented in the Netherlands remained generally well-supported over time [all scores >3 on 5-point scale ranging 1 (low)-5 (high)]. During the whole period studied, support was highest for personal hygiene measures, quarantine and wearing face masks, high but somewhat lower for not shaking hands, testing and self-isolation, and restricting social contacts, and lowest for limiting visitors at home, and not traveling abroad. Women and higher educated people were more supportive of some mitigation measures than men and lower educated people. Older people were more supportive of more restrictive measures than younger people, and support for more socially restrictive measures decreased most over time in higher educated people or in younger people.

Conclusions

This study found no support for pandemic fatigue in terms of a gradual decline in support for all mitigation measures in the first year of the pandemic. Rather, findings suggest that support for mitigation measures reflects a balancing of benefits and cost, which may change over time, and differ between measures and population subgroups.

Vulnerability to violence against women or girls during COVID-19 in Uganda

At the height of the COVID-19 pandemic, gender-based violence (GBV) was reported to have increased worldwide. We build on existing literature to examine the factors that increased vulnerability to GBV during the COVID-19 pandemic in Uganda. We use data from the Rapid Gender Assessment (RGA) survey that was conducted during COVID-19, which was designed to provide information to guide policymaking and offer appropriate interventions that address the needs of people in Uganda during the pandemic. The results show that the following respondents are more likely to experience increased risk and vulnerability to gender-based violence: those with primary level of education (OR = 1.49; 95% CI = 1.10-2.01), those who received information about GBV (OR = 1.30; 95% CI = 1.08-1.57), and those who needed help or medical support as a prevention measure against GBV (OR = 1.29; 95% CI = 1.04-1.61). However, respondents who would need financial support to prevent GBV were less likely to experience increased GBV (OR = 0.83; 95% CI = 0.70-0.98). Our results align with evidence from other studies that risk and vulnerability to GBV in Uganda increased since the onset of COVID-19. The findings provide an understanding of the interrelationship between GBV and COVID-19,which can help with designing GBV preventive measures, particularly during pandemics among those most at-risk.

Perceptions of institutional performance and compliance to non-pharmaceutical interventions: How performance perceptions and policy compliance affect public health in a decentralized health system

Trust in institutions is a key driver to shape population attitudes and behavior, such as compliance of non-pharmaceutical interventions (NPI). During the COVID-19 pandemic, this was fundamental and its compliance was supported by governmental and non-governmental institutions. Nevertheless, the situation of political polarization in some countries with decentralized health systems increased the difficulty of such interventions. This study analyzes the association between non-pharmaceutical interventions' compliance and individual perception regarding institutions' performance during the COVID-19 pandemic in Brazil. A web survey was conducted in Brazil between November 2020 and February 2021. Bivariate analysis and ordered logit regressions were performed to assess the association between NPIs compliance and perceived institutions' performance. Results suggest a negative association between NPIs' compliance and Federal Government and Ministry of health perceived performance, which may reflect the political positioning of the respondents. Moreover, we find a positive association between NPI compliance and the perceived performance of the remaining institutions (state government, federal supreme court, national congress, WHO, media and SUS). Our contribution goes beyond the study of a relationship between non-pharmaceutical interventions' compliance and institutions' performance, by pointing out the importance of subnational and local governmental spheres in a decentralized health system, as well as highlighting the importance of social communication based on health organizations' information and scientific institutions.

Looking for COVID side effects in the EU through the analysis of health and behavioural profiles

More than two years after the great outbreak of COVID suffered in almost the whole world, and in particular in Europe, we have gradually learned about the direct effects of this virus on our health and what consequences it can have if we become infected. However, this pandemic also had great economic and social consequences that affected people in an indirect way, which we can call COVID side effects. In this work we carried out an innovative type of analysis based on the concept of archetypoids in order to find extreme observations in a database of mixed-type data and used them to classify individuals yielding to different health and behavioural profiles in coping with the COVID outbreak in the EU. We use data from the first COVID-19 Survey of the SHARE project (Survey on Health, Aging and Retirement in Europe). The resulting profiles are easier to interpret than others based on central observations, and help to understand how the situations of restrictions and lock-downs affected people since the outbreak of the pandemic. Another key point of the work was to analyse how determinant are some aspects such as gender, age group or even geographical location in how each person experienced the pandemic. The method that we propose is wide enough to be used in other health and wellbeing surveys.

Political attitude change over time following COVID-19 lockdown: Rallying effects and differences between left and right voters

Restrictions to curb the spread of COVID-19 have required widespread compliance over long periods, but citizens' attitudes to these often change over time. Here, we examine the time course of political attitudes in New Zealand over the months before and after the announcement of the country's first nationwide COVID-19 lockdown in 2020 using a large-scale national survey (Ns = 41,831-42,663). Government satisfaction increased immediately following the lockdown announcement and remained elevated 5 months later. Trust in institutions and political efficacy also increased gradually over the same period. However, these trends varied by political party vote: Compared to center-left voters who supported the largest governing party, center-right voters who supported the opposition party returned to baseline levels of government satisfaction quicker and showed more pronounced dips in their satisfaction with the economy. These same attitudes also predicted compliance with COVID-19 guidelines. Results illustrate a rally-around-the-flag effect during the pandemic and suggest that support wanes faster among center-right (opposition party) voters.

Social isolation during the COVID-19 pandemic in Spain: a population study

Since March of 2020, billions of people worldwide have been asked to limit their social contacts in an effort to contain the spread of the SARS-CoV-2 virus. However, little research has been carried out to date on the impact of such social distancing measures on the social isolation levels of the population. In this paper, we study the impact of the pandemic on the social isolation of the Spanish population, by means of 32,359 answers to a citizen survey collected over a period of 7 months. We uncover (1) a significant increase in the prevalence of social isolation in the population, reaching almost 26%; (2) gender and age differences, with the largest prevalence of isolation among middle-aged individuals; (3) a strong relationship between economic impact and social isolation; and (4) differences in social isolation, depending on the number of COVID-19 protection measures and on the perception of coronavirus infection risk by our participants. Our research sheds quantitative light on the sociological impact of the pandemic, and enables us to identify key factors in the interplay between the deployment of non-pharmaceutical interventions to contain the spread of an infectious disease and a population’s levels of social isolation.

Predictors for adherent behavior in the COVID-19 pandemic: A cross-sectional telephone survey

Background

During the COVID-19 pandemic, protective measures have been prescribed to prevent or slow down the spread of the SARS-CoV-2 virus and protect the population. Individuals follow these measures to varying degrees. We aimed to identify factors influencing the extent to which protective measures are adhered to.

Methods

A cross-sectional survey (telephone interviews) was undertaken between April and June 2021 to identify factors influencing the degree to which individuals adhere to protective measures. A representative sample of 1,003 people (age >16 years) in two Austrian states (Carinthia, Vorarlberg) was interviewed. The questionnaire was based on the Health Belief Model, but also included potential response-modifying factors. Predictors for adherent behavior were identified using multiple regression analysis. All predictors were standardized so that regression coefficients (β) could be compared.

Results

Overall median adherence was 0.75 (IQR: 0.5-1.0). Based on a regression model, the following variables were identified as significant in raising adherence: higher age (β = 0.43, 95%CI: 0.33-0.54), social standards of acceptable behavior (β = 0.33, 95%CI: 0.27-0.40), subjective/individual assessment of an increased personal health risk (β = 0.12, 95%CI: 0.05-0.18), self-efficacy (β = 0.06, 95%CI: 0.02-0.10), female gender (β = 0.05, 95%CI: 0.01-0.08), and low corona fatigue (behavioral fatigue: β = -0.11, 95%CI: -0.18 to -0.03). The model showed that such aspects as personal trust in institutions, perceived difficulties in adopting health-promoting measures, and individual assessments of the risk of infection, had no significant influence.

Conclusions

This study reveals that several factors significantly influence adherence to measures aimed at controlling the COVID-19 pandemic. To enhance adherence, the government, media, and other relevant stakeholders should take the findings into consideration when formulating policy. By developing social standards and promoting self-efficacy, individuals can influence the behavior of others and contribute toward coping with the pandemic.

COVID-19 pandemic fatigue and its sociodemographic and psycho-behavioral correlates: a population-based cross-sectional study in Hong Kong

Pandemic fatigue is a growing public health concern of the lingering COVID-19 pandemic. Despite its widespread mass media coverage, systematic empirical investigations are scarce. Under the Hong Kong Jockey Club SMART Family-Link Project, we conducted online and telephone surveys amid the pandemic in February to March 2021 to assess self-reported pandemic fatigue (range 0-10) in Hong Kong adults (N = 4726) and its associations with sociodemographic and psycho-behavioral (high vs low to moderate) variables. Data were weighted by sex, age, and education of the general population. Binary logistic regression models yielded adjusted odds ratios (aORs) for high pandemic fatigue (score ≥ 7) for sociodemographic and psycho-behavioral variables. 43.7% reported high pandemic fatigue. It was less common in older people (55-64 years: aOR 0.56, 95% CI 0.39-0.82; 65 + years: 0.33, 0.21-0.52) versus age group 18-24 years, but more common in those with tertiary education (1.36, 1.15-1.62) versus secondary or below. High pandemic fatigue was positively associated with depressive symptoms (aOR 1.83, 95% CI 1.55-2.17), anxiety symptoms (1.87, 1.58-2.20), loneliness (1.75, 1.32-2.31), personal fear of COVID-19 (2.61, 2.12-3.23), family fear of COVID-19 (2.03, 1.67-2.47), and current alcohol use (1.16, 1.00-1.33), but negatively associated with self-rated health (0.79, 0.68-0.92), personal happiness (0.63, 0.55-0.72), personal adversity coping capability (0.71, 0.63-0.81), family adversity coping capability (0.79, 0.69-0.90), family well-being (0.84, 0.73-0.97), family communication quality (0.86, 0.75-0.98), and frequent home exercise (0.82, 0.69-0.96; versus less frequent). We first used a single-item tool to measure COVID-19 pandemic fatigue, showing that it was common and associated with worse mental health, lower levels of personal and family well-being and alcohol use.

Psychometric Properties of the COVID-19 Pandemic Fatigue Scale: Cross-sectional Online Survey Study

Background

Pandemic fatigue is defined as feelings of demotivation to follow preventive measures against COVID-19, together with decreased trust in government and frequency of information-seeking behaviors.

Objective

This study aims to analyze the psychometric properties of the COVID-19–specific pandemic fatigue scale according to classical test theory (CTT) and Rasch model approaches in the general Spanish population.

Methods

This was a cross-sectional study in a representative sample of 1018 adults who completed an online survey in November 2020 in the framework of the COVID-19 Snapshot Monitoring (COSMO)-Spain project. The assessments included the 6-item COVID-19 Pandemic Fatigue Scale (CPFS) and other COVID-19–related variables: COVID-19 infection, adherence to preventive behaviors, information-seeking behavior, self-efficacy, worry, and cognitive and affective risk perception. Data quality, acceptability, reliability, and validity were analyzed according to CTT, and the fit to the Rasch model, unidimensionality, appropriateness of the response scale, item local independency, reliability (person-separation index [PSI]), and item-person distribution were also calculated.

Results

The mean CPFS score was 17.06 (SD 5.04, range 6-30), with higher scores for women, younger participants, participants who never seek information on COVID-19, those who think they would contract a mild disease in case of infection, those with higher level of worry about coronavirus/COVID-19, and those who felt depressed or felt the coronavirus/COVID-19 is spreading slowly (all P<.01). The Cronbach alpha for the CPFS was 0.74. In the confirmatory factor analysis, one factor was identified (root mean square error of approximation [RMSEA]=.02; comparative fit index [CFI]=.99; χ²₅=8.06, P=.15). The CPFS showed good fit to the Rasch model (χ ²₂₄=42.025, P=.01, PSI=.642), unidimensionality (binomial 95% CI –.005 to .045), and item local independency.

Conclusions

Our results suggest that the CPFS has moderate reliability and internal consistency and it is composed of a single dimension. It is a useful tool to ascertain the level of pandemic fatigue in the general population, which may help to guide the communication and information strategies to face the COVID-19 pandemic.

Prevalence and factors associated with not receiving the booster dose of the COVID-19 vaccine in adults in Latin America and the Caribbean

Background

Booster doses have been described as effective in reducing hospitalizations and deaths from the new variants. However, its coverage is heterogeneous in Latin America and the Caribbean (LAC), one of the regions most affected by the pandemic. We aimed to assess the factors associated with not receiving a coronavirus disease 2019 (COVID-19) vaccine booster dose in adults from LAC.

Methods

We analyzed a secondary database compiled by the University of Maryland and Facebook assessing the global impact of COVID-19. We included Facebook users over 18 years of age who resided in LAC and responded to the survey between February 13, 2022, and March 14, 2022. We evaluated sociodemographic characteristics, comorbidities, food, and economic insecurity, mental health, and vaccination-related practices. We calculated crude (cPR) and adjusted (aPR) prevalence ratios with their respective 95% confidence intervals (95%CI).

Results

The sample included 154,841 adults from 20 LAC countries. 33.7% (n = 46,459) reported not receiving the COVID-19 booster vaccine. Being under 75 years old, having a college, high school, pre-university, primary, or lower education, having no or 1 to 2 comorbidities, living in a town, having food insecurity, depressive symptoms, and having had COVID-19, were associated with a higher prevalence of not receiving the booster dose. In contrast, being female or non-binary and having anxiety symptoms were associated with a lower prevalence of not receiving the booster dose.

Conclusions

Approximately three out of 10 adults surveyed in LAC reported not having received the booster vaccine. Authorities must design campaigns that promote receiving a booster dose considering the factors found.

Factors Associated with Not Receiving a Booster Dose of COVID-19 Vaccine in Peru

To determine the factors associated with not receiving the booster dose for COVID-19 in Peru, a cross-sectional study by secondary analysis of a University of Maryland and Facebook survey database assessing the global impact of COVID-19 was conducted. Data of Peruvian users of this social network over 18 years of age who answered the survey between 13 February 2022 and 14 April 2022 were analyzed. We evaluated the association between sociodemographic characteristics, comorbidities, and history of COVID-19 with having received a booster dose for COVID-19. Crude (cPR) and adjusted (aPR) prevalence ratios with their respective 95% confidence intervals (95%CI) were calculated. A sample of 20,814 adults, 21.5% of whom reported not receiving the booster dose, was analyzed. People under 75 years of age had a higher prevalence of not having received the booster dose. Likewise, having a university education (aPR = 1.03; 95%CI: 1.02–1.05), secondary, or pre-university education (aPR = 1.07; 95%CI: 1.05–1.09), or having a primary level or less (aPR = 1.11; 95%CI: 1.05–1.18), were associated with a higher prevalence of not receiving the booster, compared to individuals with a postgraduate education. Being employed (aPR = 1.01; 95%CI: 1.00–1.02), having had COVID-19 (aPR = 1.03; 95%CI: 1.01–1.04) and living in a town (aPR = 1.05; 95%CI: 1.02–1.07) or in a rural area (aPR = 1.06; 95%CI: 1.03–1.10), compared to living in the city, had a similar association. On the contrary, the female gender was associated with a lower prevalence of not receiving the booster (aPR = 0.97; 95%CI: 0.96–0.99). Sociodemographic characteristics and a history of having had COVID-19 were associated with the probability of not having received the booster dose for COVID-19 in the Peruvian population.