Self-reported anticipated compliance with physician advice to stay home during pandemic (H1N1) 2009: results from the 2009 Queensland Social Survey

Assessment of Qol among COVID-19 Patients in South India: A Tertiary Care Center Study: An Original Research

Introduction

The COVID-19 epidemic has brought about an unparalleled health disaster and fundamentally altered people's livelihoods. We intended to examine risk variables for "Health-Related Quality Of Life (HRQoL)" amid COVID-19 hospital discharged patients.

Materials and Techniques

For this cross-sectional study, 1000 discharged patients who tested positive at the tertiary care center before January 2022 were included. The HRQoL was measured using a 5-level EuroQoL survey. The complete health state was evaluated using an Indian value set. The correlation of HRQoL and the clinical, sociodemographic parameters were investigated using appropriate statistical tools. Finally, regression model was utilized to identify all factors that predict the HRQoL dimensions.

Results

It was found that 55% of patients said they had moderate or serious health issues. Forty percent of respondents said they had felt moderate-to-severe pain or discomfort, compared to 41% who said they had anxiety or sadness. The outcome of the logistic regression demonstrated the substantial influencers were "age, gender, occupation, location of care, heart conditions, and diabetes" on several HRQoL aspects.

Conclusion

The COVID-19 dramatically worsens the patients' physical and mental health conditions. Therefore, the government and policymakers must develop comprehensive ways to lessen the patients' mental and physical health problems.

The Impact of the COVID-19 Pandemic on Informal Caregivers of People With Parkinson's Disease Residing in the UK: A Qualitative Study

Informal caregivers can experience various demands when providing care and support for People with Parkinson's disease (PwP) in their own homes. The outbreak of SARS-CoV-2 and public health strategies employed to mitigate the spread of COVID-19 have presented challenges to the general populace on a global basis. The present study used a qualitative research design to explore how the COVID-19 pandemic has impacted informal caregivers in their role of providing care for PwP in their own homes. A series of 1:1 semi-structured interviews were conducted with 11 informal caregivers of PwP (M age = 72.64 years, SD = 8.94 years). A thematic analysis indicated that 1) vulnerabilities to COVID-19, 2) home maintenance & activities of daily living and 3) engagement with healthcare services were 3 themes that provided indications on how the COVID-19 pandemic impacted informal caregivers of PwP. The present study provides illustrations of how being an informal caregiver of PwP and being identified as high risk to COVID-19 can present challenges to the process of caring for loved ones who are also vulnerable to SARS-CoV-2. The results of the present study highlights the necessity to develop strategies to ensure that informal caregivers have the necessary resources to provide care for PwP in their homes and also maintain their own well-being in the post COVID-19 era.

Predictors of Self-Reported Compliance with COVID-19 Preventive Guidelines: A Quantile Regression Model

The research used an online, convenience cross-sectional sample of adults aged ≥18 years old recruited from Shahroud County, Northeast of Iran. We measured the contribution of multiple determinants for association with behavioral compliance, at the time of the COVID-19 pandemic. The compliance score measured with this questionnaire can be within a range of 5 and 100. Compliance was bounded between 19 and 80 that has been distributed J-shape, so quantile logistic regression model has been fitted for that. Variables related to people's knowledge, including self-reported knowledge and following the news related to COVID-19, were the two main factors that accompanied behavioral compliance at all of its levels in the period of pandemic.

Risk factors associated with respiratory infectious disease-related presenteeism: a rapid review

BACKGROUND

Workplace transmission is a significant contributor to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks. Previous studies have found that infectious illness presenteeism could contribute to outbreaks in occupational settings and identified multiple occupational and organisational risk factors. Amid the COVID-19 pandemic, it is imperative to investigate presenteeism particularly in relation to respiratory infectious disease (RID). Hence, this rapid review aims to determine the prevalence of RID-related presenteeism, including COVID-19, and examines the reported reasons and associated risk factors.

METHODS

The review followed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) search approach and focused on studies published in English and Chinese. Database searches included MEDLINE, EMBASE, Web of Science, China Knowledge Resource Integrated Database (CNKI) and preprint databases MedRxiv and BioRxiv.

RESULTS

The search yielded 54 studies, of which four investigated COVID-19-related presenteeism. Prevalence of work presenteeism ranged from 14.1 to 55% for confirmed RID, and 6.6 to 100% for those working with suspected or subclinical RID. The included studies demonstrated that RID-related presenteeism is associated with occupation, sick pay policy, age, gender, health behaviour and perception, vaccination, peer pressure and organisational factors such as presenteeism culture.

CONCLUSIONS

This review demonstrates that presenteeism or non-adherence to isolation guidance is a real concern and can contribute to workplace transmissions and outbreaks. Policies which would support workers financially and improve productivity, should include a range of effective non-pharmaceutical inventions such as workplace testing, promoting occupational health services, reviewing pay and bonus schemes and clear messaging to encourage workers to stay at home when ill. Future research should focus on the more vulnerable and precarious occupational groups, and their inter-relationships, to develop comprehensive intervention programs to reduce RID-related presenteeism.

Determinants of health behaviours intended to prevent spread of respiratory pathogens that have pandemic potential: A rapid review

Effective public health messages to encourage behaviours to reduce the spread of COVID-19 should be informed by existing research that identifies the factors that are associated with these preventive behaviours. This rapid review summarises the existing research on the determinants of behaviours that aim to prevent the spread of COVID-19. The review focuses on the body of research (excluding research conducted with health care workers) that was produced in the context of viruses other than SARS CoV-2 that cause severe respiratory illness and are transmitted in a similar way. A total of 58 published peer-reviewed studies included in the review were identified through searches of Medline, Embase, PsychInfo and CINAHL. Most were conducted in the context of the influenza A (H1N1) pandemic in 2009. Most studies examined the determinants of wearing a face covering, handwashing and social or physical distancing. The findings suggest that public health messages to encourage preventive behaviours should emphasise the potential seriousness of COVID-19 to elicit appropriate concern, strengthen perceptions of risk or threat from COVID-19, enhance self-efficacy about preventive behaviours, and improve knowledge about SARS-CoV-2, how it is transmitted, and how preventive behaviours can reduce the risk of transmission.

Socio-economic determinants of mobility responses during the first wave of COVID-19 in Italy: from provinces to neighbourhoods

After more than 1 year into the COVID-19 pandemic, governments worldwide still face the challenge of adopting non-pharmaceutical interventions to mitigate the risks posed by the emergence of new SARS-CoV-2 variants and the lack of a worldwide equitable vaccine allocation. Thus, it becomes crucial to identify the drivers of mobility responses to mitigation efforts during different restriction regimes, for planning interventions that are both economically and socially sustainable while effective in controlling an outbreak. Here, using anonymous and privacy-enhanced cell phone data from Italy, we investigate the determinants of spatial variations of reductions in mobility and co-location in response to the adoption and the lift of restrictions, considering both provinces and city neighbourhoods. In large urban areas, our analysis uncovers the desertification of historic city centres, which persisted after the end of the lockdown. Such centre-periphery gradient was mainly associated with differences in educational attainment. At the province level, the local structure of the labour market mainly explained the variations in mobility responses, together with other demographic factors, such as the population's age and sex composition. In the future, targeted interventions should take into account how the ability to comply with restrictions varies across geographical areas and socio-demographic groups.

Canadian university students' perceptions of COVID-19 severity, susceptibility, and health behaviours during the early pandemic period

Objectives

We surveyed university students to assess their demographic factors, perceived severity, personal susceptibility, and the adoption of health behaviours in relation to COVID-19.

Study design

Ethics approval was obtained from the University of Toronto’s Research Ethics Board (#39169). Responses were collected between March 20 and April 17, 2020, capturing the first month of government-mandated social distancing in Ontario, Canada.

Methods

We distributed the online survey to the University of Toronto student population, yielding a total convenience sample of 592 participants. We summarised the results and conducted Mann-Whitney U and Kruskal-Wallis tests to explore relationships between demographic data and perceived severity of COVID-19. Pearson’s Chi-square tests were used to explore the relationship between demographic variables and perceived susceptibility, with phi being used to explore the strength of the association. A value of p ​< ​0.05 was used to determine significance.

Results

The majority of participants (60.1%) judged COVID-19 to be Very Severe; there was a significant relationship between being female and the adoption of new health behaviours. 57.4% indicated they felt susceptible to COVID-19, while 40.9% did not. Feeling susceptible was associated with studying a healthcare field or being personally affected by COVID-19. Individuals who stated they were not susceptible to COVID-19 declared mitigating factors such as new health behaviours to be a major driver in their perception.

Conclusion

University students believe COVID-19 is a severe disease and have adopted new and increased health behaviours to mitigate the spread. While this study demonstrates differing health behaviour adoption rates based upon demographic factors, overall this research finds young adults supportive and accepting of government policy as a protective and susceptibility-mitigating measure.

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The majority of participants judged COVID-19 to be very severe.

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Females more likely than other genders to adopt new health behaviours.

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Perceptions of personal susceptibility to COVID-19 varied.

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New health behaviours named as key mitigating factor for judged susceptibility.

Students' experience and adherence to containment measures during COVID-19 in Switzerland

BACKGROUND

Young adults are not considered a risk group, but the public health response to COVID-19 impacts all citizens. We investigated the impact on young adults' and their adherence to containment measures addressing potential gender differences.

METHODS

In April 2020 12 341 students of the Zurich University of Applied Sciences were invited to a longitudinal health survey. Survey topics spanned socio-demographic data, students' health status and behavior, COVID-19 specific impact, concerns, information sources, adherence to containment measures, and trust in government bodies. Group comparisons by gender and multivariate ordinal regression models assessing adherence to restrictions of mobility and social contacts were conducted (n = 2373).

RESULTS

Mean age was 26.4 (SD = 5.6), 70% were female. 43.5% reported some concern about their own health, 2.7% stated major worries. Women experienced more conflicts (p < 0.000) and, enjoyed time with the family more (p < 0.000). Men felt less locked up (p = 0.001). The most frequented COVID-19 information source was public media (48%) and confidence in government bodies was high (82%) for both genders. Men yielded lower adjusted odds (OR; 95%-CI) of adherence regarding the following measures: social distancing (0.68; 0.53-0.87), non-utilization of public transport (0.74; 0.56-0.97), 5-person limit for social gatherings (0.47; 0.35-0.64) and the stay at home rule (0.64; 0.51-0.82).

CONCLUSION

Early in the pandemic a high degree of adherence was observed in this young academic population. Containment measures restricting movement and social contact yielded considerable differences by gender, information source and perceived susceptibility to the virus. More targeted communication may increase adherence regarding mobility restrictions.

Why people comply with COVID-19 social distancing restrictions: Self-interest or duty?

On 11 March 2020 the World Health Organization declared the novel coronavirus outbreak (COVID-19) a global pandemic. At the time of writing, over 16 million cases of COVID-19 had been confirmed worldwide, and more than 650,000 people had died from the virus. A priority amongst governments globally is limiting the spread of the virus. In Australia, this response included mandatory ‘lockdown’ restrictions which limited citizens’ freedom of movement. This article uses survey data from 1595 Australians to examine compliance with COVID-19 lockdown restrictions in the early stages of the pandemic. Results revealed that a substantial number of Australians did not comply fully with the measures. Further, while self-interest and health concerns motivated compliance, normative concerns regarding duty to support the authorities dominated compliance decisions. The findings’ implications for both compliance research and for authorities wanting to nurture voluntary compliance with public health orders are discussed.

The actual implementation status of self-isolation among Japanese workers during the COVID-19 outbreak

Background

Self-isolation is an important personal protective measure in inhibiting the transmission of coronavirus disease 2019 (COVID-19) as people carry out economic and social activities amid its spread. Yet few studies have clarified the actual implementation status of self-isolation during an outbreak. This study aimed to reveal the actual implementation of self-isolation among Japanese workers during the COVID-19 outbreak and the factors inhibiting this measure.

Methods

This was a cross-sectional study based on an internet survey completed by 1,226 workers (60.0% men) living in 7 prefectures (i.e., Tokyo, Kanagawa, Saitama, Chiba, Ibaraki, Tochigi, and Gunma) who were selected among registrants of an Internet research company, between May 12 and 17, 2020. Participants were asked whether they had experienced fever or other cold symptoms between February 17, 2020 and the date of the survey. Those who responded affirmatively were asked where they had visited (e.g., hospital, work, and shopping for groceries or necessities) to clarify whether they had left the house within 7 days after symptom onset. We performed multivariate logistic regression analysis to clarify the relationship between going to work within 7 days after symptom onset and both sociodemographic factors and employment-related constraints.

Results

Of the survey participants, 82 had experienced fever or other cold symptoms (6.7%). Among these participants, 51 (62.2%) went to work within 7 days after symptom onset. A mere 17.1% practiced strict self-isolation. Multivariate logistic regression analysis revealed that those living outside the metropolitan area (i.e., Ibaraki, Tochigi, and Gunma), working as a company employee, and being unable to work from home were associated with going to work within 7 days after symptom onset.

Conclusions

The prevalence of strict self-isolation among participants who experienced cold-like symptoms during the COVID-19 outbreak was extremely low, and 62.2% of these participants went to work within 7 days after symptom onset. This study highlights the need for further public awareness regarding self-isolation and countermeasures against factors that obstruct it.

Impact of international travel and border control measures on the global spread of the novel 2019 coronavirus outbreak

The novel coronavirus outbreak (COVID-19) in mainland China has rapidly spread across the globe. Within 2 mo since the outbreak was first reported on December 31, 2019, a total of 566 Severe Acute Respiratory Syndrome (SARS CoV-2) cases have been confirmed in 26 other countries. Travel restrictions and border control measures have been enforced in China and other countries to limit the spread of the outbreak. We estimate the impact of these control measures and investigate the role of the airport travel network on the global spread of the COVID-19 outbreak. Our results show that the daily risk of exporting at least a single SARS CoV-2 case from mainland China via international travel exceeded 95% on January 13, 2020. We found that 779 cases (95% CI: 632 to 967) would have been exported by February 15, 2020 without any border or travel restrictions and that the travel lockdowns enforced by the Chinese government averted 70.5% (95% CI: 68.8 to 72.0%) of these cases. In addition, during the first three and a half weeks of implementation, the travel restrictions decreased the daily rate of exportation by 81.3% (95% CI: 80.5 to 82.1%), on average. At this early stage of the epidemic, reduction in the rate of exportation could delay the importation of cases into cities unaffected by the COVID-19 outbreak, buying time to coordinate an appropriate public health response.

Baixas na linha de frente: absenteísmo entre bombeiros durante o combate à pandemia da COVID-19

Resumo Objetivos: descrever o absenteísmo relacionado a casos suspeitos (com infecção respiratória aguda) e confirmados da COVID-19 e a outros diagnósticos entre bombeiros de Minas Gerais, Brasil. Métodos: foram analisados os registros oficiais sobre afastamento do trabalho por problemas de saúde (licença-saúde). A análise foi organizada em: 1) gráficos estratificados por grupo de diagnóstico; 2) análises descritivas da proporção de licenças-saúde e do percentual de dias de trabalho perdidos por infecção respiratória aguda; 3) comparação (qui-quadrado) da proporção de licenças-saúde e do percentual de dias de trabalho perdidos por infecção respiratória aguda e por outros diagnósticos entre 2019 e 2020. Resultados: a análise gráfica mostrou um padrão regular de licenças-saúde antes do início da pandemia, um pico de licenças-saúde por infecção respiratória aguda após o início da pandemia e um novo padrão de licenças-saúde após o período de pico. A proporção de licenças-saúde e o percentual de dias de trabalho perdidos por infecção respiratória aguda aumentaram, respectivamente, 312% e 580% em 2020. Em contraste, o percentual de dias de trabalho perdidos por outros diagnósticos diminuiu 16%. Conclusão: a mudança no perfil de absenteísmo entre bombeiros reflete o vínculo formal de emprego, as políticas institucionais e a percepção de risco sobre a COVID-19.

Feedback Between Behavioral Adaptations and Disease Dynamics

We study the feedback processes between individual behavior, disease prevalence, interventions and social networks during an influenza pandemic when a limited stockpile of antivirals is shared between the private and the public sectors. An economic model that uses prevalence-elastic demand for interventions is combined with a detailed social network and a disease propagation model to understand the feedback mechanism between epidemic dynamics, market behavior, individual perceptions, and the social network. An urban and a rural region are simulated to assess the robustness of results. Results show that an optimal split between the private and public sectors can be reached to contain the disease but the accessibility of antivirals from the private sector is skewed towards the richest income quartile. Also, larger allocations to the private sector result in wastage where individuals who do not need it are able to purchase it but who need it cannot afford it. Disease prevalence increases with household size and total contact time but not by degree in the social network, whereas wastage of antivirals decreases with degree and contact time. The best utilization of drugs is achieved when individuals with high contact time use them, who tend to be the school-aged children of large families.

Value for Money in H1N1 Influenza: A Systematic Review of the Cost-Effectiveness of Pandemic Interventions

BACKGROUND

The 2009 A/H1N1 influenza pandemic generated additional data and triggered new studies that opened debate over the optimal strategy for handling a pandemic. The lessons-learned documents from the World Health Organization show the need for a cost estimation of the pandemic response during the risk-assessment phase. Several years after the crisis, what conclusions can we draw from this field of research?

OBJECTIVE

The main objective of this article was to provide an analysis of the studies that present cost-effectiveness or cost-benefit analyses for A/H1N1 pandemic interventions since 2009 and to identify which measures seem most cost-effective.

METHODS

We reviewed 18 academic articles that provide cost-effectiveness or cost-benefit analyses for A/H1N1 pandemic interventions since 2009. Our review converts the studies' results into a cost-utility measure (cost per disability-adjusted life-year or quality-adjusted life-year) and presents the contexts of severity and fatality.

RESULTS

The existing studies suggest that hospital quarantine, vaccination, and usage of the antiviral stockpile are highly cost-effective, even for mild pandemics. However, school closures, antiviral treatments, and social distancing may not qualify as efficient measures, for a virus like 2009's H1N1 and a willingness-to-pay threshold of $45,000 per disability-adjusted life-year. Such interventions may become cost-effective for severe crises.

CONCLUSIONS

This study helps to shed light on the cost-utility of various interventions, and may support decision making, among other criteria, for future pandemics. Nonetheless, one should consider these results carefully, considering these may not apply to a specific crisis or country, and a dedicated cost-effectiveness assessment should be conducted at the time.

A Meta-Analysis of the Association between Gender and Protective Behaviors in Response to Respiratory Epidemics and Pandemics

Respiratory infectious disease epidemics and pandemics are recurring events that levy a high cost on individuals and society. The health-protective behavioral response of the public plays an important role in limiting respiratory infectious disease spread. Health-protective behaviors take several forms. Behaviors can be categorized as pharmaceutical (e.g., vaccination uptake, antiviral use) or non-pharmaceutical (e.g., hand washing, face mask use, avoidance of public transport). Due to the limitations of pharmaceutical interventions during respiratory epidemics and pandemics, public health campaigns aimed at limiting disease spread often emphasize both non-pharmaceutical and pharmaceutical behavioral interventions. Understanding the determinants of the public’s behavioral response is crucial for devising public health campaigns, providing information to parametrize mathematical models, and ultimately limiting disease spread. While other reviews have qualitatively analyzed the body of work on demographic determinants of health-protective behavior, this meta-analysis quantitatively combines the results from 85 publications to determine the global relationship between gender and health-protective behavioral response. The results show that women in the general population are about 50% more likely than men to adopt/practice non-pharmaceutical behaviors. Conversely, men in the general population are marginally (about 12%) more likely than women to adopt/practice pharmaceutical behaviors. It is possible that factors other than pharmaceutical/non-pharmaceutical status not included in this analysis act as moderators of this relationship. These results suggest an inherent difference in how men and women respond to epidemic and pandemic respiratory infectious diseases. This information can be used to target specific groups when developing non-pharmaceutical public health campaigns and to parameterize epidemic models incorporating demographic information.

Influenza in workplaces: transmission, workers' adherence to sick leave advice and European sick leave recommendations

Background: Knowledge about influenza transmission in the workplace and whether staying home from work when experiencing influenza-like illness can reduce the spread of influenza is crucial for the design of efficient public health initiatives. Aim: This review synthesizes current literature on sickness presenteeism and influenza transmission in the workplace and provides an overview of sick leave recommendations in Europe for influenza. Methods: A search was performed on Medline, Embase, PsychINFO, Cinahl, Web of Science, Scopus and SweMed to identify studies related to workplace contacts, -transmission, -interventions and compliance with recommendations to take sick leave. A web-based survey on national recommendations and policies for sick leave during influenza was issued to 31 European countries. Results: Twenty-two articles (9 surveys; 13 modelling articles) were eligible for this review. Results from social mixing studies suggest that 20–25% of weekly contacts are made in the workplace, while modelling studies suggest that on average 16% (range 9–33%) of influenza transmission occurs in the workplace. The effectiveness of interventions to reduce workplace presenteeism is largely unknown. Finally, estimates from studies reporting expected compliance with sick leave recommendations ranged from 71 to 95%. Overall, 18 countries participated in the survey of which nine (50%) had issued recommendations encouraging sick employees to stay at home during the 2009 A(H1N1) pandemic, while only one country had official recommendations for seasonal influenza. Conclusions: During the 2009 A(H1N1) pandemic, many European countries recommended ill employees to take sick leave. Further research is warranted to quantify the effect of reduced presenteeism during influenza illness.

Perceptions and behavioral responses of the general public during the 2009 influenza A (H1N1) pandemic: a systematic review

The public plays an important role in controlling the spread of a virus by adopting preventive measures. This systematic literature review aimed to gain insight into public perceptions and behavioral responses to the 2009 influenza A (H1N1) pandemic, with a focus on trends over time and regional differences. We screened 5498 articles and identified 70 eligible studies from PubMed, Embase, and PsychINFO. Public misconceptions were apparent regarding modes of transmission and preventive measures. Perceptions and behaviors evolved during the pandemic. In most countries, perceived vulnerability increased, but perceived severity, anxiety, self-efficacy, and vaccination intention decreased. Improved hygienic practices and social distancing were practiced most commonly. However, vaccination acceptance remained low. Marked regional differences were noted. To prevent misconceptions, it is important that health authorities provide up-to-date information about the virus and possible preventive measures during future outbreaks. Health authorities should continuously monitor public perceptions and misconceptions. Because public perceptions and behaviors varied between countries during the pandemic, risk communication should be tailored to the specific circumstances of each country. Finally, the use of health behavior theories in studies of public perceptions and behaviors during outbreaks would greatly facilitate the development of effective public health interventions that counter the effect of an outbreak.

Predictors of IV behaviors during and after the 2009 influenza pandemic in France

BACKGROUND

Controversies about the 2009 H1N1 pandemic influenza vaccination might have impacted the motivational processes that underlie individual immunization against seasonal influenza. The purpose of this article is to investigate correlates of vaccine uptake during and after the pandemic.

METHODS

Data from the 1174 subjects of the CoPanFlu France cohort aged 15 and over were used. We used logistic regression models to identify social and behavioral predictors of getting vaccinated against seasonal influenza in 2009-2010 and in 2010-2011 and against H1N1 influenza in 2009-2010.

RESULTS

This study points out that correlates of vaccination behaviors varied according to the vaccine. Respondents under 65 years who adopted the seasonal influenza vaccine were, as usual, more likely to belong to a target group and have a lower education, contrary to subjects who chose the pandemic vaccine. Exceptionally during the pandemic, a higher socioeconomic status also led to adoption of either vaccine. Motivational processes differed by vaccine. Uptaking the "new" pandemic vaccine was the result of a deliberative decision-making process, influenced by cognitive factors related to the pandemic context (such as perceived severity of the H1N1 flu strain and trust in public health authorities). In contrast, respondents got the seasonal flu vaccine without relying on explicit justifications, but instead through habit of performing this behavior in the past.

CONCLUSIONS

Target groups for seasonal influenza but not those for pandemic influenza were more likely to adopt the pandemic vaccine, which is a cause for great concern. This may be due to large extent to the automatic and habitual nature of influenza vaccination decisions. Public health authorities, should pay more attention to situational than informational cues to facilitate vaccine uptake among priority groups, especially in case of mild pandemic influenza.

Community knowledge, behaviours and attitudes about the 2009 H1N1 Influenza pandemic: a systematic review

Background

Effectiveness of pandemic plans and community compliance was extensively researched following the H1N1 pandemic. This systematic review examined community response studies to determine whether behavioural responses to the pandemic were related to level of knowledge about the pandemic, perceived severity of the pandemic and level of concern about the pandemic.

Methods

Literature databases were searched from March 2009 to August 2011 and included cross‐sectional or repeated population surveys undertaken during or following the H1N1 pandemic which reported on community response to the pandemic. Studies using population subgroups and other respiratory diseases were excluded, as were mathematical modelling and qualitative studies.

Results

Nineteen unique studies were included. Fourteen reported pandemic knowledge, 14 reported levels of concern and risk perception and 18 reported pandemic behaviours. Awareness of the pandemic was high, and knowledge was moderate. Levels of concern and risk were low moderate and precautionary behavioural actions lower than intentions. The most commonly reported factors influencing adopting recommended behaviours were increased risk perception and older age, increased pandemic knowledge and being female.

Conclusions

Important implications for future pandemic planning were identified. A remarkable lack of intercountry variability in responses existed; however, differences between populations within a single country suggest one‐size‐fits‐all plans may be ineffective. Secondly, differences between reported precautionary intentions and preventive behaviours undertaken may be related to people's perceived risk of infection.

Medical students' knowledge, perceptions, and behavioral intentions towards the H1N1 influenza, swine flu, in Pakistan: a brief report

This study was conducted to assess the knowledge of H1N1 among medical students, their perceptions, and behavioral intentions in the wake of the H1N1 pandemic influenza. There were significant gaps in important self-isolation protocols and preventive measures. Increased contact with both patients and colleagues can lead to unintentional transmission and contraction of influenza. Universities should introduce and encourage infection control guidelines into routine curriculum.

Behavior of Adult Influenza Patients during the 2009 Pandemic after Outpatient Clinic Presentations at a Hospital in Tokyo, Japan

The 2009 pandemic of novel swine-origin influenza A (H1N1) highlighted the importance of community mitigation measures such as voluntary isolation. During the pandemic, we investigated the voluntary isolation behavior of patients with influenza during the 7-day period after they visited an outpatient clinic at a hospital in Tokyo, Japan. A questionnaire-based survey was conducted on patients diagnosed with influenza. Of a total of 14 patients, 13 (93%) visited a workplace, school or other potentially crowded setting at least once in the 7-day period after presentation. Five patients (36%) visited a potentially crowded setting either with a fever or on the day after having a fever. The voluntary isolation behavior of Japanese people with influenza did not necessarily adhere to the Japanese government recommendation that people with influenza-like illness stay home for 7 days following the onset of symptoms.

Recommendations for and compliance with social restrictions during implementation of school closures in the early phase of the influenza A (H1N1) 2009 outbreak in Melbourne, Australia

Background

Localized reactive school and classroom closures were implemented as part of a suite of pandemic containment measures during the initial response to influenza A (H1N1) 2009 in Melbourne, Australia. Infected individuals, and those who had been in close contact with a case, were asked to stay in voluntary home quarantine and refrain from contact with visitors for seven days from the date of symptom onset or exposure to an infected person. Oseltamivir (Tamiflu^®) was available for treatment or prophylaxis.

Methods

We surveyed affected families through schools involved in the closures. Analyses of responses were descriptive. We characterized recommendations made to case and contact households and quantified adherence to guidelines and antiviral therapy.

Results

Of the 314 respondent households, 51 contained a confirmed case. The prescribed quarantine period ranged from 1-14 days, reflecting logistic difficulties in reactive implementation relative to the stated guidelines. Household-level compliance with the requirement to stay at home was high (84.5%, 95% CI 79.3,88.5) and contact with children outside the immediate family infrequent.

Conclusions

Levels of compliance with recommendations in our sample were high compared with other studies, likely due to heightened public awareness of a newly introduced virus of uncertain severity. The variability of reported recommendations highlighted the difficulties inherent in implementing a targeted reactive strategy, such as that employed in Melbourne, on a large scale during a public health emergency. This study emphasizes the need to understand how public health measures are implemented when seeking to evaluate their effectiveness.

Influenza: Critique of the contemporary challenges for pandemic planning, prevention, control, and treatment in emergency health services

The 2009 H1N1 influenza pandemic was a major challenge to health services around the world. Previous experiences with Severe Acute Respiratory Syndrome (SARS) and Avian Influenza A (H5N1) prompted initiation of formal pandemic planning. Essential and desirable features of pandemic plans include preparation for surveillance, investigation of cases, treatment modalities, prevention of community spread, maintenance of essential services, research and evaluation, and implementation, testing and revision of the plan. The experience of 2009 H1N1 influenza pandemic for emergency departments and their staff was problematic. The pace of the pandemic, coupled with untested pandemic plans, presented a unique range of challenges. In this paper, the contemporary challenges with respect to pandemic influenza prevention, control, and treatment are examined. The lessons learned are critical to our response to future pandemics, which are inevitable.

Nurses' ability and willingness to work during pandemic flu

AIM

The present study reports factors affecting nurses' ability and willingness to work during pandemic flu (PF).

BACKGROUND

Previous studies suggest some nurses may be unable or unwilling to work during PF.

METHOD

A questionnaire was mailed to nurses during October to December 2009, the second wave of the 2009 A/H1N1 flu pandemic.

RESULTS

Most (90.1%) reported they would work. Willingness decreased primarily as personal protective equipment (PPE) dwindled, family or nurse were perceived to be at risk and when vaccine or antiviral medication was not provided to both nurse and family although many other factors also affected willingness to work. Ability decreased primarily when the nurse was sick, a loved one needed care at home or transportation problems existed although many other factors also affected ability to work.

CONCLUSION

Certain factors can decrease willingness and ability of nurses to work during a flu pandemic.

IMPLICATIONS FOR NURSING MANAGEMENT

Managers can anticipate factors that may decrease nurse's ability and willingness to work during pandemic flu. Preparing for staffing during emergencies can retain the health care workforce when it is needed most.