Effect of Face Masks on Interpersonal Communication During the COVID-19 Pandemic

Beyond the Whole: Reduced Empathy for Masked Emotional Faces Is Not Driven by Disrupted Configural Face Processing

Sharing of emotional states is reduced for individuals wearing face coverings, but the mechanism behind this reduction remains unknown. Here, we investigated if face occlusion by masks reduces empathy by disrupting configural processing of emotional faces. Participants rated their empathy for happy and neutral faces which were presented in upright or inverted orientation and wore opaque, clear, or no face masks. Empathy ratings were reduced for masked faces (opaque or clear) as well as for inverted faces. Importantly, face inversion disrupted empathy more for faces wearing opaque masks relative to those wearing clear or no masks, which stands in contrast to the predictions generated by the classic configural processing models. We discuss these data within the context of classic and novel configural face perception models, and highlight that studying inverted occluded faces presents an informative case worthy of further investigation.

Lower empathy for face mask wearers is not explained by observer's reduced facial mimicry

Facial occlusion alters social processes that rely on face visibility, including spontaneous mimicry of emotions. Given that facial mimicry of emotions is theorized to play an important role in how we empathize or share emotions with others, here we investigated if empathy was reduced for faces wearing masks because masks may reduce the ability to mimic facial expressions. In two preregistered experiments, participants rated their empathy for faces displaying happy or neutral emotions and wearing masks or no masks. We manipulated mimicry by either blocking mimicry with observers holding a pen in between their teeth (Experiment 1) or by producing a state of constant congruent mimicry by instructing observers to smile (Experiment 2). Results showed reduced empathy ratings for masked faces. Mimicry overall facilitated empathy, with reduced empathy ratings when mimicry was blocked and higher empathy ratings when it was instructed. However, this effect of mimicry did not vary with mask condition. Thus, while observers were impaired in sharing emotions with masked faces, this impairment did not seem to be explained by a reduction in facial mimicry. These results show that mimicry is an important process for sharing emotions, but that occluding faces with masks reduces emotion sharing via a different mechanism.

Masking the truth: the impact of face masks on deception detection

Because of the pandemic, face masks have become ubiquitous in social interactions, but it remains unclear how face masks influence the ability to discriminate between truthful and deceptive statements. The current study manipulated the presence of face masks, statement veracity, statement valence (positive or negative), and whether the statements had been practiced or not. Despite participants' expectations, face masks generally did not impair detection accuracy. However, participants were more accurate when judging negatively valenced statements when the speaker was not wearing a face mask. Participants were also more likely to believe positively rather than negatively valenced statements.

Duration of face mask exposure matters: evidence from Swiss and Brazilian kindergartners' ability to recognise emotions

Wearing facial masks became a common practice worldwide during the COVID-19 pandemic. This study investigated (1) whether facial masks that cover adult faces affect 4- to 6-year-old children's recognition of emotions in those faces and (2) whether the duration of children's exposure to masks is associated with emotion recognition. We tested children from Switzerland (N = 38) and Brazil (N = 41). Brazil represented longer mask exposure due to a stricter mandate during COVID-19. Children had to choose a face displaying a specific emotion (happy, angry, or sad) when the face wore either no cover, a facial mask, or sunglasses. The longer hours of mask exposure were associated with better emotion recognition. Controlling for the hours of exposure, children were less likely to recognise emotions in partially hideen faces. Moreover, Brazilian children were more accurate in recognising happy faces than Swiss children. Overall, facial masks may negatively impact children's emotion recognition. However, prolonged exposure appears to buffer the lack of facial cues from the nose and mouth. In conclusion, restricting facial cues due to masks may impair kindergarten children's emotion recognition in the short run. However, it may facilitate their broader reading of facial emotional cues in the long run.

Interpersonal Communication Strategies to Increase Iron-Folic Acid Supplement Consumption: Reduction in Anemia Through Normative Innovations (RANI) Project

More than half of women of reproductive age in India are anemic. This study investigates the role of interpersonal communication in increasing the consumption of iron-folic acid supplements. Interventions that increase interpersonal communication may influence and empower individuals and the larger community in promoting behavior change. This investigation uses data from a cluster randomized intervention to understand the pathways by which interpersonal communication mediates the consumption of iron-folic acid supplements. Longitudinal data from control and intervention arms in rural Odisha, India, were collected at baseline (N = 3,691) and 20 months later at end-line (N = 3,394). Structural equation models highlighted the positive role of interpersonal communication in mediating iron-folic acid supplement use. This study illustrates that even during social distancing due to COVID-19, strategic interpersonal communication can improve iron-folic acid supplement use. Our results elucidate two key interpersonal communication pathways at play, namely the ritualistic and instrumental pathways in improving health behavior change in the community.

Altered development of face recognition among infants born amid the COVID-19 pandemic

To effectively contain the spread of COVID-19, public health agencies mandated special regulations. Although they protected us from COVID-19, these restrictions have inevitably changed the environment around us. It remains unclear how these changes may have affected early cognitive development among infants born during the pandemic. Thus, this study examined how the COVID-19 restrictions have affected infants' face recognition ability, a hallmark of their cognitive capacities. Specifically, we used the familiarization and visual pair comparison paradigm to examine face recognition performance among infants aged 6 to 14 months amid the second wave of the pandemic (February to July 2021). Experiment 1 investigated the recognition of unmasked faces and found that only younger infants, but not older infants, recognized faces by showing a novelty preference. Experiment 2 examined the recognition of faces wearing masks and found that only older infants, but not younger ones, recognized faces by exhibiting a familiarity preference. These results suggest that with limited interactions during the pandemic, infants could have developed an overly specialized face processing ability that failed to recognize the faces of strangers. Moreover, infants could have obtained more information on masked faces during the pandemic and adapted to the current situation. In Expreiment 3, we further confirmed the restriction on infants' interpersonal experiences with a survey conducted both before and during the pandemic. Overall, these findings demonstrated how the pandemic altered early perceptual development and further confirmed that interpersonal experiences during infancy are critical in their cognitive development.

Empathy and redemption: Exploring the narrative transformation of online support for mental health across communities before and after Covid-19

This study examines the impact of the COVID-19 pandemic on individuals' mental health and their online interactions, particularly within Reddit's mental health communities. By analyzing data from 15 subreddits categorized into mental health and control groups from 2018 to 2022, we observed that forums dedicated to mental health exhibited higher levels of user engagement and received more supportive responses than those in other categories. However, as the pandemic evolved, a significant decrease in online support was noted, especially within these mental health groups. This decline hints at a risk of emotional burnout among users, which poses a particularly acute challenge for individuals grappling with mental health issues. Intimate relationships have also an impact on online expression of mental health. The research underscores the pandemic's effect on online support and interaction dynamics, signaling the necessity for a deeper understanding and the development of strategies to maintain support within online communities during times of crisis.

Challenges Faced by Cancer Patients during the COVID-19 Pandemic, a Vision for the Future: A Qualitative Study

OBJECTIVE

Cancer is a disease that affects various aspects of patients' lives. The COVID-19 pandemic has presented numerous challenges and difficulties for cancer patients, exacerbating their already vulnerable conditions. Identifying the challenges these patients face can be a practical step toward improving their quality of care in future pandemics. This qualitative study aims to identify the challenges cancer patients encounter during the COVID-19 pandemic.

METHOD

This is a qualitative study with a content analysis approach. Participants included 16 cancer patients hospitalized at Tabriz Shahid Ghazi Hospital in 2020. Sampling was conducted purposefully, and interviews were continued until data saturation was achieved. All interviews were recorded and transcribed at the earliest opportunity. The data were analyzed using content analysis based on the Lundman and Graneheim method.

RESULTS

Data analysis led to the identification of four categories of challenges faced by cancer patients during the pandemic: Mental derangement and fear (fear of premature death, fear of contracting COVID-19, fear of disease recurrence), ineffective nurse-patient communication (personal protective equipment and distant care from nursing stations), economic instability (difficulties in providing for the family's livelihood and increased medical expenses), and reduced access to services (Contracting of infection among doctors and nurses and redirection of resources and services to COVID-19 patients). Participants expressed that these challenges were additional to their pre-existing difficulties and were intensified by the COVID-19 pandemic.

CONCLUSION

Team support and interdisciplinary collaboration can be beneficial in addressing mental derangement and severe fears and solving problems comprehensively. Using various methods to facilitate safe and continuous communication between nurses and patients aside from their beds can give patients a greater sense of calmness. Financial facilitations can alleviate pressure on patients, and planning and communication strategies for accessing care and treatment services during a pandemic should be organized in advance.

Dissecting human anatomy learning process through anatomical education with augmented reality: AEducAR 2.0, an updated interdisciplinary study

Anatomical education is pivotal for medical students, and innovative technologies like augmented reality (AR) are transforming the field. This study aimed to enhance the interactive features of the AEducAR prototype, an AR tool developed by the University of Bologna, and explore its impact on human anatomy learning process in 130 second-year medical students at the International School of Medicine and Surgery of the University of Bologna. An interdisciplinary team of anatomists, maxillofacial surgeons, biomedical engineers, and educational scientists collaborated to ensure a comprehensive understanding of the study's objectives. Students used the updated version of AEducAR, named AEducAR 2.0, to study three anatomical topics, specifically the orbit zone, facial bones, and mimic muscles. AEducAR 2.0 offered two learning activities: one explorative and one interactive. Following each activity, students took a test to assess learning outcomes. Students also completed an anonymous questionnaire to provide background information and offer their perceptions of the activity. Additionally, 10 students participated in interviews for further insights. The results demonstrated that AEducAR 2.0 effectively facilitated learning and students' engagement. Students totalized high scores in both quizzes and declared to have appreciated the interactive features that were implemented. Moreover, interviews shed light on the interesting topic of blended learning. In particular, the present study suggests that incorporating AR into medical education alongside traditional methods might prove advantageous for students' academic and future professional endeavors. In this light, this study contributes to the growing research emphasizing the potential role of AR in shaping the future of medical education.

Physical Activity and Interpersonal Adaptation in Chinese Adolescents After COVID-19: The Mediating Roles of Self-Esteem and Psychological Resilience

Previous studies have implied that physical activity profoundly influences interpersonal adaptation. However, this effect and its mechanisms have not been directly verified, especially for adolescents. This study examines the association between physical activity and interpersonal adaptation in adolescents through self-esteem and psychological resilience after the coronavirus disease 2019 (COVID-19) pandemic. Participants included 542 Chinese adolescents (aged 13-18 years; 242 boys and 300 girls). Adolescents in China anonymously completed a series of questionnaires, including the PARS-3 Scale of PE Activity Grade (PARS-3), the Self-esteem Scale (SES), the Resilience Scale for Adolescents (RSCA), and the Interpersonal Adaptation Scale. The results showed that physical activity positively correlated with self-esteem, psychological resilience, and interpersonal adaptation. Additionally, self-esteem and psychological resilience serially mediated the impact of physical activity on interpersonal adaptation. The findings highlight the positive impact of physical activity on adolescent interpersonal adaptation by strengthening positive psychological resources in the post-pandemic era.

Impact of interventions to reduce nosocomial transmission of SARS-CoV-2 in English NHS Trusts: a computational modelling study

BACKGROUND

Prior to September 2021, 55,000-90,000 hospital inpatients in England were identified as having a potentially nosocomial SARS-CoV-2 infection. This includes cases that were likely missed due to pauci- or asymptomatic infection. Further, high numbers of healthcare workers (HCWs) are thought to have been infected, and there is evidence that some of these cases may also have been nosocomially linked, with both HCW to HCW and patient to HCW transmission being reported. From the start of the SARS-CoV-2 pandemic interventions in hospitals such as testing patients on admission and universal mask wearing were introduced to stop spread within and between patient and HCW populations, the effectiveness of which are largely unknown.

MATERIALS/METHODS

Using an individual-based model of within-hospital transmission, we estimated the contribution of individual interventions (together and in combination) to the effectiveness of the overall package of interventions implemented in English hospitals during the COVID-19 pandemic. A panel of experts in infection prevention and control informed intervention choice and helped ensure the model reflected implementation in practice. Model parameters and associated uncertainty were derived using national and local data, literature review and formal elicitation of expert opinion. We simulated scenarios to explore how many nosocomial infections might have been seen in patients and HCWs if interventions had not been implemented. We simulated the time period from March-2020 to July-2022 encompassing different strains and multiple doses of vaccination.

RESULTS

Modelling results suggest that in a scenario without inpatient testing, infection prevention and control measures, and reductions in occupancy and visitors, the number of patients developing a nosocomial SARS-CoV-2 infection could have been twice as high over the course of the pandemic, and over 600,000 HCWs could have been infected in the first wave alone. Isolation of symptomatic HCWs and universal masking by HCWs were the most effective interventions for preventing infections in both patient and HCW populations. Model findings suggest that collectively the interventions introduced over the SARS-CoV-2 pandemic in England averted 400,000 (240,000 - 500,000) infections in inpatients and 410,000 (370,000 - 450,000) HCW infections.

CONCLUSIONS

Interventions to reduce the spread of nosocomial infections have varying impact, but the package of interventions implemented in England significantly reduced nosocomial transmission to both patients and HCWs over the SARS-CoV-2 pandemic.

Treatment seeking experiences of ACS patients in Yogyakarta, Indonesia during COVID-19 pandemic: A qualitative study

Delay in treatment seeking is recognized as a major contributor for Acute Coronary Syndrome (ACS) mortality in Indonesia. Despite the significance of timely treatment, decline in admission and delay in presentation of patients with ACS were consistently reported during the COVID-19 pandemic. These suggested that treatment seeking performance of patients during the pandemic might be different from the previous period. This qualitative study aimed to explore treatment seeking behaviour, barriers in seeking medical treatment, and experiences of patients with ACS in Yogyakarta, Indonesia during COVID-19 pandemic. In depth-interviews were carried out with 30 patients, who were hospitalized with ACS at one of the three selected hospitals in Yogyakarta during the pandemic period. Thematic analysis was performed to create vital explanations for treatment seeking practices of patients with ACS during pandemic. Three significant themes were identified: treatment seeking decisions, barriers in seeking medical treatment during COVID-19, and experiencing both good and bad impression from entering and staying in the hospital. The intensity of ACS symptoms and fear of COVID-19 infection dominated the delay in seeking medical treatment. Strict safety measures, religious belief, and fear of ACS helped patients overcome barriers and seek medical treatment during pandemic. ACS patients also had convenient medical care during the pandemic and believed medical staff would provide excellent care to them. However, visit restriction policy could cause psychological discomfort. Increase awareness of ACS symptoms and the risk of delays ACS treatment are essential to support patients' decisions to seek medical helps in a timely manner at any situations including pandemic. Interventions aim at alleviating psychological distress should also be designed and implemented to improve treatment experiences of ACS patients, who sought medical treatment during the pandemic crisis.

Does wearing a mask promote consumer uniqueness seeking?

As a motivational factor, uniqueness drives individuals to seek and choose unique goods or experiences. The act of wearing masks obscures individuals' facial features and influences their desire for uniqueness. This study aims to explore how wearing masks promotes individual uniqueness- seeking behavior. Three experiments were performed using various product categories (Starbucks coffee cups, sweatshirts, suitcases, and baseball caps) and sample types (college student and adult samples). Experiment results show that wearing masks obscures individuals' facial features and weakens their self- perceived uniqueness, thereby increasing their willingness to actively purchase unique products. This study is the first to examine the effect of wearing masks on individuals' choice of unique products. Practically, the results suggest that customized products can compensate for the lack of self-perceived uniqueness brought about by facial occlusion, thus providing valuable guidance for companies and retailers that offer customized services in formulating and designing marketing strategies.

Pattern and Perception of Impact of Wearing Face Masks on Communication Among Health Care Workers During COVID-19 pandemic: An Observational Study

To assess the impact of wearing masks (KN95, surgical, cloth mask) due to COVID-19 pandemic on interpersonal communication among health care workers and with patients. The present observational study was conducted in tertiary care centre and also included participants from various other health care facilities from all over India over a period of one year from March 2022 to March 2023. 203 health care workers consented to participate in the study. The study was done as an online survey using the questionnaire which was adapted into a Google form consisting of a 15 closed set questions. Participants rated the question using a binary forced choice as either YES or NO. The mean age of participants consenting to the study was 30.9 ± 6.3 SD years,with male predominance (%). Among the choice of use of face mask, 76.35% used surgical mask, 14.77% used KN95 and 8.86% used cloth masks. 15 questions were divided in 5 categories; analysis showed that majority of questions had an affirmative "yes" response. This results of this study indicated that the sudden change in the existing communication situation due to use of face masks in the clinical setup affected interpersonal communication among healthcare workers and with patients, which may also have a bearing on both patient and clinician well being and could have a significant economic impact on health care systems globally. These results provide information about the clinical strain introduced from use of face masks in healthcare settings. Overall, results showed that in healthcare settings, there is increased cognitive load and listening effort for patients and health care providers, as well as changes in clinical efficiency for providers when utilizing masks. These effects are often greater with hearing loss.

Teaching Trainees Effective Patient Communication Skills in the Clinical Environment: Best Practices Under Crisis Conditions

ABSTRACT

Communication within the health care setting has significant implications for the safety, engagement, and well-being of patients and physicians. Evidence shows that communication training is variable or lacking in undergraduate and graduate medical education. Physician-patient communication presents a vulnerable point in patient care, which was heightened by the COVID-19 pandemic and its aftermath. Physicians have to adapt their strategies to meet new challenges, including communicating through the necessary barriers of personal protective equipment and telecommunication platforms. They also face uncharted challenges of facilitating discussions around proactive planning and scarce resources. Medical educators must be equipped to provide trainees with the skills needed to maintain empathy, facilitate trust and connection, and adapt communication behaviors under such crisis conditions. Using the Calgary-Cambridge model as a framework, the authors describe 3 new challenges to effective physician-patient communication for which COVID-19 was the impetus-face masks, visitor restrictions, and resource allocation/proactive planning discussions-and propose educational solutions.

Interpersonal distance perception during the normalization of an pandemic situation: Effects of mask-wearing and vaccination

This study aimed to evaluate the effect of anti-pandemic measures, including wearing a face mask and receiving vaccinations, on interpersonal distance (IPD) during the normalization stage of the COVID-19 pandemic. Virtual reality (VR) technology was used to simulate the experimental environment and a confederate in different conditions. Thirty-one participants were asked to approach the virtual confederate, who could exhibit three vaccination states and two mask-wearing conditions, actively and passively in both indoor and outdoor environments. ANOVA results showed that the participants kept a smaller IPD from the confederate wearing a face mask (IPD = 125.6 cm) than from the one without a face mask (IPD = 154.2 cm). The effects of vaccination states were significant, with the largest distance for an unvaccinated confederate (IPD = 182.3 cm) and the smallest distance for the confederate who had received a booster vaccine (IPD = 111.5 cm). Significant effects of environment were also found, with the participants maintaining a larger IPD in an outdoor environment (IPD = 143.4 cm) than in an indoor room (IPD = 136.4 cm). Additionally, the IPD collected when the participants were passively approached (IPD = 149.6 cm) was significantly larger than that obtained when they actively approached the confederate (IPD = 130.3 cm). Moreover, when the participants faced a confederate who had received a booster vaccine and wore a mask, the IPD was not significantly different from that collected before the COVID-19 pandemic in both the active and passive patterns. These findings help us to better understand the nature of IPD and human behaviors during the normalization stage of the pandemic and provide scientific suggestions for policymakers to develop pandemic-prevention measures.

Best practices for communication while wearing facemasks: A scoping review

INTRODUCTION

Facemasks are an important piece of personal protective equipment (PPE) to mitigate the spread of respiratory illnesses, but they can impede communication between patients and healthcare providers. The purpose of this scoping review is to identify effective communication practices while wearing facemasks.

DESIGN

Scoping review using a systematic search of articles from the PubMed, CINAHL, and Embase databases.

METHODS

The PEO (population, exposure, outcome) methodology was selected for this systematic scoping review. The population of interest (P) includes humans of all ages (children, adults, and older adults); the exposure of interest (E) is PPE that covers the mouth (i.e., facemasks); and the outcome of interest (O) is successful or unsuccessful communication practices. The Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals appraisal guidelines were used to determine the level and quality of the research.

RESULTS

Thirty-nine articles met the inclusion criteria. Seventeen of these were high- or good-quality research studies, and the remaining 22 were non-research articles included with separate analysis as part of the scoping review. The 17 articles encompassed 2656 participants. The highest quality evidence indicated that standard surgical masks have the least impact on speech perception compared to other non-transparent mask types, and that recognizing emotions is less accurate with facemasks, necessitating compensatory actions (i.e., reducing extraneous noise, using a microphone to amplify voice, and employing clear speech). Evidence was contradictory regarding the use of transparent masks. Evidence was of limited quality for other non-verbal and verbal communication strategies.

CONCLUSION

Awareness of communication challenges is crucial when wearing facemasks. More high-quality studies are needed to evaluate communication techniques when speakers are wearing facemasks. Basic strategies such as selecting an appropriate mask type, reducing extraneous noise, using microphones, verbalizing emotions, and employing clear speech appear to be beneficial.

CLINICAL RELEVANCE

The findings of this scoping review highlight the importance of considering communication challenges while wearing facemasks in the healthcare settings. The review suggests that selecting an appropriate mask type, reducing extraneous noise, verbalizing emotions, and employing clear speech are some strategies that may be effective in mitigating the impact of facemasks on communication between patients and healthcare providers.

Implementation of Well-Being for Cardiothoracic Surgeons

Well-being is a quality of positive physical, mental, social, and environmental experiences. Well-being enables thoracic surgeons to achieve their full potential across personal and work domains. Evidence-based guidelines to promote individual well-being include (1) progress toward a goal; (2) actions commensurate with experience, interest, mission; (3) interconnectivity with others; (4) social relatedness of the work one does; (5) safety; and (6) autonomy. Successful pursuit of well-being includes the development of individual skills of mindfulness, resilience, and connection with others. However, well-being among individuals cannot be achieved without support of workplace leaders and durable institutional infrastructure.

Evaluation of health worker acceptance and tolerance of respirators in clinical practice-An Australian perspective

BACKGROUND

One of the main infection prevention and control measures introduced during the COVID-19 pandemic was the focused application of respiratory protection to ensure health worker safety and the effective use of personal protective equipment. However, user acceptance of these strategies is paramount in sustainable compliance. This study explores various aspects of respirator use and provides recommendations to improve and maximize health worker safety. The aim of this study was to understand the relationship between respirator (P2/N95) comfort and user experience toward respiratory protection. The aim of this study was to understand the relationship between respirator (P2/N95) comfort and user experience toward respiratory protection.

METHODS

The nonexperimental cross-sectional design study was conducted in New South Wales, Australia between November and December 2022 using an anonymous self-administered online questionnaire in Microsoft Forms.

RESULTS

Of 2,514 respondents, 65% reported to have used a respirator every working day with only a few using a respirator once weekly or less (9%). Almost all respondents had completed at least one quantitative fit test (96%) prior to the survey. Fifty-nine percent reported to have experienced discomfort from wearing a respirator and the most reported adverse effect was difficulty communicating (64%), followed by skin irritation or acne (62%) and headache (56%).

CONCLUSIONS

Despite somewhat less favorable ratings on comfort and communication, health workers are in favor of respiratory protection. However, a focus on tolerance of respirators and strategies to address adverse effects from prolonged respirator use must be considered when implementing policies and procedures. Moreover, resources must be allocated to improve the design, breathability, and sustainability of a respirator along with education and training on how to use respiratory protection safely and effectively.

LeadinCare: A Qualitative Informed Digital Training Platform Development to Increase Physicians' Soft Communication Skills After COVID-19

The post-COVID-19 pandemic era has placed new demands on physicians. One of these demands is the need to use targeted knowledge and soft communication skills, to address the psychosocial problems (e.g. vaccine hesitancy, fears) of individuals with Chronic Physical Illnesses (CPIs). Focusing on training physicians in targeted soft communication skills can help health care systems to address psychosocial-type problems. Yet, such training programs are rarely implemented, effectively.This study aimed to (a) understand physicians' implementation challenges when using soft communication skills during the COVID-19 pandemic; (b) identify beliefs, barriers, and facilitators that can influence physicians' behaviours to use soft communication skills; and (c) inform the content of the LeadinCare; a new digital training platform, designed to improve physicians' soft communication skills, by leveraging the TDF Theoretical Domain Framework (TDF).We conducted 14 in-depth semi-structured interviews with physicians in Greece, supporting non-COVID-19 cases with CPIs. We analyzed their data using inductive and deductive approaches.Physicians highlighted time, inability to see patients in person, absence of space for non-COVID-19 cases, and poor organizational procedures as barriers to using soft communication skills. Five TDF domains (beliefs) were identified as the most salient to inform the LeadinCare platform: (1) practical and well-organized knowledge; (2) skills that support patients and their relatives; (3) physicians' beliefs about capabilities to use the skills; (4) beliefs about consequences of using the skills (job satisfaction); and (5) the use of digital, interactive, and on-demand platforms (environmental context & resources). We mapped the domains in six narrative-based practices that informed the content of the LeadinCare.Physicians need skills that go beyond talking and towards cultivating resilience and flexibility.

Effect of Face Masking on Transmission of SARS-CoV-2

The efficacy of face masking for the public is not convincing to prevent the transmission of respiratory tract viruses such as SARS-CoV-2 when the criteria of evidence-based medicine are applied. This finding is mainly explained by the results from randomized-controlled trials (RCTs) when a high prevalence of the infection and a high compliance in mask wearing was assured. Throughout these studies no significant protective effect was observed. Observational studies with surgical masks describe a significant protective effect, but are prone to confounders such as physical distance. Respirators do not provide an additional health benefit compared to surgical or medical masks (RCTs). Community masks can even increase the risk of infection (RCTs). Based on the categories of evidence-based medicine, the efficacy results can best be categorized as conflicting evidence. Many relevant adverse events are described when masks are worn for hours such as dyspnea (12.2-52.8%), headache (3.9-73.4%), pruritus (0.0-60.0%), and skin reactions (0.0-85.0%). Their frequency is often higher with respirators. In future pandemics, masks should only be recommended or mandated for settings in which a clinically relevant health benefit can be expected, defined as the prevention of severe, critical or fatal disease, that clearly outweighs the expectable associated adverse reactions.

Face coverings increase apparent honesty and cooperativeness

People readily make inferences about trait-like characteristics of another person's face. Since the recent global COVID-19 pandemic, the widespread use of hygienic face masks has led to large proportions of the face being covered. We investigated the effect of face masks on the inference of prosocially relevant characteristics, namely cooperativeness and honesty. Portraits of participants of previous studies from which we knew their "true" prosocial tendencies served as stimuli. These facial stimuli were presented once with and once without a hygienic face mask to 60 naïve participants who rated the faces for cooperativeness and honesty. Results revealed that wearing face masks made people generally appear more cooperative and more honest than without a mask, but that these ratings were unrelated to the true prosocial tendencies of these people. Together, these findings have important implications for social interactions, particularly in contexts where nonverbal communication is essential, such as in healthcare settings, job interviews, and social gatherings.

Predictability of Dental Distalization with Clear Aligners: A Systematic Review

The current review aims to evaluate the scientific evidence relating to the effectiveness of treatment with clear aligners (CAs) in controlling distalization orthodontic tooth movement. "Orthodontics, aligners" and "distalization" were the search terms used on the Scopus, Web of Science and Pubmed databases with the Boolean operator "AND". The results of the last ten years of research were 146 studies; of these, 19 publications were included for this review. The distalization movement is possible with invisible masks alone, but the risk of losing anchorage in the anterior sectors is very probable. The stability of the results and the reduction of unwanted effects can be guaranteed by the use of skeletal anchoring devices and interproximal enamel reduction (IPR), with which compensations are obtained to reduce the initial overjet. Temporary anchorage devices (TADs) can be used to manage posterior anchorage after distalization of maxillary molars with aligners. This hybrid approach has demonstrated the greatest orthodontic success. TADs are useful aids to provide direct and indirect skeletal anchorage. The opposite effect must be considered when planning dental distalization, especially of the molars, in patients with large overjet, and corrective measures or the use of auxiliaries may be necessary to prevent midcourse corrections. This systematic review provides a critical evidence-based assessment of the predictability of dental distalization with CAs, an ever-evolving orthodontic technique.

Effective communication between nursing professionals and patients after the implementation of mask-wearing requirements in the clinical setting: A cross-sectional study

This study aimed to evaluate staff nurses' perspectives on the use of face masks in effective communication and relationship management skills with patients in the hospital setting. The study surveyed registered nurses (RNs) who work with adult patients in different hospital units. An online survey was completed by RNs who were selected by convenience sampling. RNs' communication with patients was perceived as moderately affected by the use of face masks. Statistically significant differences were found when comparing communication with years of professional experience. Participants who had over 10 years of experience reported having greater difficulty in their communication with patients when using face masks. The effect of provider-patient relationship on effective nurse-patient face-mask communication was statistically significant and negative. This study shows that some participants found face masks used in the clinical setting may affect nurse-patient communication, as well as the nurses' ability to manage their relationships with patients. The findings of this study support the need for targeted research into effective communication strategies when face mask use is needed in the healthcare setting.

A confirmatory factor analysis of the Iranian version of the interpersonal communication skills scale among healthcare professionals

BACKGROUND

Identifying healthcare professionals' (HCPs) communication skills is crucial to improving patient outcomes. Iranian HCPs' interpersonal communication skills (ICS) were validated using a culturally appropriate and indigenous scale.

MATERIALS AND METHODS

In November and December 2021, convenience sampling was used to collect data from 170 HCPs. Seven factors were covered by the questionnaire, which consisted of 30 items. In order to validate the scale, first- and second-order confirmatory factor analyses (CFA) were performed. Various indices were used during the CFA, including Goodness of Fit Index (GFI), Adjusted Goodness of Fit (AGFI), Comparative Fit Index (CFI), Normed Fit Index (NFI), Standardized Root Mean Square Residual (SRMR), and Root Mean Square Error of Approximation (RMSEA). The Fornell-Larcker Criterion was used to assess discriminant validity. We analyzed the data in Lisrel 8.8 and SmartPLS 3.2.8.

RESULTS

According to the Q2-index obtained from the blindfold test, the model had 44% predictive power. First-order CFA results showed acceptable indices (χ2 = 767.17; DF = 375; CFI = 0.98; GFI = 0.82; AGFI = 0.80; NFI = 0.97; SRMR = 0.22; RMSEA = 0.068). Furthermore, the second-order measurement model demonstrated adequate and desirable fit indices (χ2 = 797.24; DF = 381; CFI = 0.98; GFI = 0.82; AGFI = 0.78; NFI = 0.97; SRMR = 0.059; RMSEA = 0.068). General and listening skills were ranked highest in the importance-performance map analysis (IPMA).

CONCLUSION

HCPs could benefit from this scale as it can assist them in developing ICS. It is recommended that skills training programs be replicated among different populations to evaluate their effectiveness.

End-of-life care in the patient's home

BACKGROUND

Providing end-of-life care in a patient's home is challenging, especially if the nurse is from a different ethnic background from the patient. Evidence shows that people from an ethnic minority background often experience poorer end-of-life care due to care providers not understanding their care needs.

AIM

To explore the experiences of community nursing staff caring for patients with an ethnic minority background at the end of their life.

METHOD

Using a qualitative descriptive approach, 16 semi-structured interviews were conducted and the data was thematically analysed.

FINDING

Participants dealt with large tight-knit families, paternalism and controlling behaviours. There was a mistrust of Western palliative medicine. Language barriers and challenges were faced by the nursing staff, resulting in difficult conversations with the families. Different levels of the nursing staff's spiritual/cultural competencies were also identified. The COVID-19 pandemic intensified the challenges.

CONCLUSION

This research has shed light on the challenges of individualising end-of-life care in a culturally diverse community in the UK. The nursing staff's cultural/spiritual competencies were challenged.

Nurses' experiences of the phenomenon 'isolation communication'

BACKGROUND

Communication with patients and relatives can be a challenge in the intensive care unit (ICU) setting because of the acute and critical situation. However, when caring for patients with infectious diseases like COVID-19, nurses' communication is challenged further due to the required use of personal protective equipment (PPE) and mandatory isolation regimes.

AIM

To explore nurses' experiences of communicating while wearing PPE during COVID-19 isolation precautions in the ICU.

STUDY DESIGN

A qualitative study within the phenomenological-hermeneutic tradition. Data were collected via 12 interviews with nurses working in a Danish ICU from September to November 2020. Data were analysed using a Ricoeur-inspired text interpretation method.

FINDINGS

Three themes emerged during the analysis: (1) communication was limited and distanced and nurses had to compromise; (2) the nurses' senses were reduced, and verbal and nonverbal communication practises changed; and (3) patients' and relatives' communicative vulnerability were exposed in an extraordinary situation.

CONCLUSION

The analysis revealed a phenomenon that can be described as 'isolation communication'. The isolation precautions and use of PPE had a profound impact on the nurses' caring and communicative practices, which were limited in this situation. The nurses found themselves physically, emotionally and socially distanced from the patients, relatives and their colleagues. However, to prevent the spread of the virus, isolation communication is something that the nurses have to endure.

RELEVANCE TO CLINICAL PRACTICE

As our findings show that the nurses' communicative practises had to change during isolation communication, it is important for clinical practise and education to focus on implementing communication methods that optimise message transmission between ICU clinicians, patients and relatives in conditions requiring PPE and isolation. We should also focus on how to optimise interdisciplinary health communication in this situation.

Effects of wearing an opaque or transparent face mask on the perception of facial expressions: A comparative study between Japanese school-aged children and adults

The negative side effects of mask-wearing on reading facial emotional cues have been investigated in several studies with adults post-2020. However, little is known about children. This study aimed to determine the negative influence of mask-wearing on reading emotions of adult faces by Japanese school-aged children, compared to Japanese adults. We also examined whether this negative influence could be alleviated by using a transparent face mask instead of an opaque one (surgical mask). The performance on reading emotions was measured using emotion categorization and emotion intensity rating tasks for adult faces. As per the findings, the accuracy of emotion recognition in children was impaired for various facial expressions (disgust, fear, happy, neutral, sad, and surprise faces), except for angry faces. Conversely, in adults, it was impaired for a few facial expressions. The perceived intensity for happy faces with a surgical mask was weaker in both children and adults than in those without the mask. A negative influence of wearing surgical masks was generally not observed for faces wearing a transparent mask in both children and adults. Thus, negative side effects of mask-wearing on reading emotions are observed for more facial expressions in children than in adults; transparent masks can help remedy these.

Effects on communication due to face mask use: an integrative review

OBJECTIVES

to integrate evidence from studies on auditory perceptual and speech production effects in communication situations with face mask use.

METHODS

an integrative literature review, in MEDLINE, Cochrane Library and Embase databases. The guiding question was: what effects on communication (perceptual-auditory and speech production) occur with face mask use?

RESULTS

searches in electronic databases resulted in 1,478 studies and filtering resulted in 29 final studies.

CONCLUSIONS

mask use has effects on communication, both in perception and speech production, factors that are also related to quality of life, stress and socio-emotional factors. These data can impact on indicators and alerts in favor of adopting strategies to manage mask use, involving speech production and perception when wearing a mask in health services.

Influence of child and adult faces with face masks on emotion perception and facial mimicry

Emotional mimicry, the imitation of others' emotion expressions, is related to increased interpersonal closeness and better interaction quality. Yet, little research has focused on the effect of face masks on emotional mimicry and none on (masked) child faces. To address this gap, we conducted an online experiment (N = 235, German sample, adult perceivers). Masks reduced emotion recognition accuracy for all expressions, except in the case of anger in masked child faces, where perceived anger was even increased. Perceived interpersonal closeness was reduced for masked happy and sad faces. For both child and adult expressers, masks reduced facial mimicry of happy expressions, with no mask effects for sadness and anger expression. A stronger mask effect on facial happiness mimicry of child faces was mediated by the degree of emotion recognition accuracy. Smiles shown by masked children were not recognized well, likely due to the absence of wrinkles around the eyes in child faces. Independent of masks, sadness shown by children was mimicked even more strongly than when shown by adults. These results provide evidence for facial mimicry of child expressions by adult perceivers and show that the effects of face masks on emotion communication may vary when children wear them.

"I do not hear you!": hearing-impaired cancer patients report their communication experiences

PURPOSE

Hearing impairment has a high impact on communication between cancer patients and their oncologists. What is the patient's perspective on this problem and how can physicians draw lessons from it?

METHODS

Together with otorhinolaryngologists and hearing-impaired patients, we developed a questionnaire including the sections: WHO (Five) Well-Being Index (5 items), Abbreviated Profile of Hearing Aid Benefit (APHAB) as established self-estimation of hearing function (24 items), use of hearing aid (4 items) as well as patients' experiences (15 items), difficulties (9 items) and wishes (7 items) regarding the communication with physicians. The experiences, difficulties, wishes, and life satisfaction of cancer patients were analyzed between groups based on participants' APHAB scores, well-being and use of hearing aids. A total of 104 cancer survivors (median age 76.5 years, range 32-90 years) were included.

RESULTS

Between the groups of subjectively hearing-impaired and normal hearing participants, we registered a significant difference in difficulties in conversation, wishes for physician-patient communication and psychological well-being. Depending on participants' well-being, wishes and difficulties differed. Differences were also found between participants with and without hearing aids in terms of difficulties in conversation, but not in terms of their wishes and well-being. A large proportion of participants classified as subjectively hearing-impaired according to APHAB already had a hearing aid.

CONCLUSIONS

Cancer patients with hearing loss are very restricted in their understanding of given information and hearing aid use cannot completely compensate for this. Consequently, communication guidelines should be considered and specific educational tools need to be developed for these groups.

Clearly transparent and air-permeable nanopaper with porous structures consisting of TEMPO-oxidized cellulose nanofibers

Optically transparent materials that are air permeable have potentially numerous applications, including in wearable devices. From the perspective of sustainable development, 2,2,6,6-tetramethylpiperidine-1-oxyl (TEMPO)-oxidized cellulose nanofibers with widths of 3-4 nm have attracted considerable attention as starting materials for the preparation of clearly transparent nanofiber paper (denoted as conventional nanopaper). However, conventional nanopaper that is prepared from a water dispersion of TEMPO-oxidized cellulose nanofibers by direct drying exhibits poor air permeability owing to its densely packed layered structure. In this study, we prepared a clearly transparent and air-permeable nanopaper by applying filtration-based solvent exchange from high-surface-tension water to low-surface-tension ethanol and hexane, followed by drying under continuous vacuum filtration. The resulting hexane-exchanged nanopaper had a porous structure with individually dispersed and thin nanofiber networks and interlayer pore spaces. Owing to the tailored porous structures, the hexane-exchanged nanopaper provides similar clear transparency (total light transmittance and haze at 600 nm: 92.9% and 7.22%, respectively) and 10⁶ times higher air permeability (7.8 × 10⁶ mL μm m^-2 day^-1 kPa^-1) compared to the conventional nanopaper. This study will facilitate the development of clearly transparent and air-permeable nanopapers to extend their functional applications.

The Role of Mass Media in Influencing the Lifestyle of the Elderly during the COVID-19 Pandemic

The elderly represent one of the categories that was most affected by the pandemic period. The purpose of this research was to analyze the ways in which mass media and very often contradictory information flows influenced the lives and personal communications of the Romanian elderly population during the COVID-19 pandemic. In order to conduct the research, we used a mixed-methods approach. For the quantitative research, we gave a questionnaire to the elderly population of Romania, and for the qualitative research, we conducted interviews. Our quantitative sample included 881 retired persons with an age between 55 and 94 years old; the mean age was 71.48 years old with 6.6 years standard deviation. The elderly described the pandemic period using negative words: fear, loneliness, anxiety, disaster; the channel they mostly watched and trusted was the TV; they were aware of the measures they had to take to protect themselves; they missed most of the meetings with the family and the main problems they had were represented by loneliness, the inability to be with their families or the lack of access to medical services. The elderly's mass media consumption during the pandemic was mostly represented by TV consumption; the information spread by mass media was sometimes contradictory; it influenced their behavior and may have generated feelings of anxiety among them.

Interdisciplinary and interprofessional communication intervention: How psychological safety fosters communication and increases patient safety

Background

Effective teamwork and communication are imperative for patient safety and quality care. Communication errors and human failures are considered the main source of patient harm. Thus, team trainings focusing on communication and creating psychologically safe environments are required. This can facilitate challenging communication and teamwork scenarios, prevent patient safety risks, and increase team performance perception. The sparse research concerning communication interventions calls for an understanding of psychological mechanisms. Therefore, this study investigated mechanisms of an interpersonal team intervention targeting communication and the relation of psychological safety to patient safety and team performance perception based on the applied input-process-output model of team effectiveness.

Methods

Before and after a 4-h communication intervention for multidisciplinary teams, a paper-pencil survey with N = 137 healthcare workers from obstetric units of two university hospitals was conducted. Changes after the intervention in perceived communication, patient safety risks, and team performance perception were analyzed via t-tests. To examine psychological mechanisms regarding psychological safety and communication behavior, mediation analyses were conducted.

Results

On average, perceived patient safety risks were lower after the intervention than before the intervention (M_T1 = 3.220, SD_T1 = 0.735; M_T2 = 2.887, SD_T2 = 0.902). This change was statistically significant (t (67) = 2.760, p =.007). However, no such effect was found for interpersonal communication and team performance perception. The results illustrate the mediating role of interpersonal communication between psychological safety and safety performances operationalized as perceived patient safety risks (α1∗β1 = -0.163, 95% CI [-0.310, -0.046]) and team performance perception (α1∗β1 = 0.189, 95% CI [0.044, 0.370]).

Discussion

This study demonstrates the psychological mechanisms of communication team training to foster safety performances and psychological safety as an important predecessor for interpersonal communication. Our results highlight the importance of teamwork for patient safety. Interpersonal and interprofessional team training represents a novel approach as it empirically brings together interpersonal communication and collaboration in the context of patient safety. Future research should work on follow-up measures in randomized-controlled trials to broaden an understanding of changes over time.

Face coverings differentially alter valence judgments of emotional expressions

Face masks that prevent disease transmission obscure facial expressions, impairing nonverbal communication. We assessed the impact of lower (masks) and upper (sunglasses) face coverings on emotional valence judgments of clearly valenced (fearful, happy) and ambiguously valenced (surprised) expressions, the latter of which have both positive and negative meaning. Masks, but not sunglasses, impaired judgments of clearly valenced expressions compared to faces without coverings. Drift diffusion models revealed that lower, but not upper, face coverings slowed evidence accumulation and affected differences in non-judgment processes (i.e., stimulus encoding, response execution time) for all expressions. Our results confirm mask-interference effects in nonverbal communication. The findings have implications for nonverbal and intergroup communication, and we propose guidance for implementing strategies to overcome mask-related interference.

Effects of face masks on language comprehension in bilingual children

Due to the COVID-19 pandemic, many children receive language input through face coverings. The impact of face coverings for children's abilities to understand language remains unclear. Past research with monolingual children suggests that hearing words through surgical masks does not disrupt word recognition, but hearing words through transparent face shields proves more challenging. In this study, we investigated effects of different face coverings (surgical masks and transparent face shields) on language comprehension in bilingual children. Three-year-old English-Mandarin bilingual children (N = 28) heard familiar words in both English and Mandarin spoken through transparent face shields, surgical masks, and without masks. When tested in English, children recognized words presented without a mask and through a surgical mask, but did not recognize words presented with transparent face shields, replicating past findings with monolingual children. In contrast, when tested in Mandarin, children recognized words presented without a mask, through a surgical mask, and through a transparent face shield. Results are discussed in terms of specific properties of English and Mandarin that may elicit different effects for transparent face shields. Overall, the present findings suggest that face coverings, and in particular, surgical masks do not disrupt spoken word recognition in young bilingual children.

Correlation between psychological resilience and burnout syndrome in oncologists amid the Covid-19 pandemic

PURPOSE

Oncologists are predisposed to developing burnout syndrome. Like other health care professionals worldwide, oncologists have endured additional, extreme challenges during the Covid-19 pandemic. Psychological resilience presents a potential protective mechanism against burnout. This cross-sectional study examines whether psychological resilience eased burnout syndrome among Croatian oncologists during the pandemic.

METHODS

An anonymized self-reporting questionnaire was electronically distributed by the Croatian Society for Medical Oncology to 130 specialist and resident oncologists working in hospitals. Available for completion from September 6-24, 2021, the survey comprised demographic questions; the Oldenburg Burnout Inventory (OLBI), covering exhaustion and disengagement; and the Brief Resilience Scale (BRS). The response rate was 57.7%.

RESULTS

Burnout was moderate or high for 86% of respondents, while 77% had moderate or high psychological resilience. Psychological resilience was significantly negatively correlated with the OLBI exhaustion subscale (r =  - .54; p < 0.001) and the overall OLBI score (r =  - .46; p < 0.001). Scheffe's post hoc test showed that oncologists with high resilience scored significantly lower on the overall OLBI (M = 2.89; SD = 0.487) compared to oncologists with low resilience (M = 2.52; SD = 0.493).

CONCLUSION

The findings thus indicate that oncologists with high psychological resilience are at significantly lower risk of developing burnout syndrome. Accordingly, convenient measures to encourage psychological resilience in oncologists should be identified and implemented.

Undergraduate students' experiences of participating in a Danish respite programme for young carers-A mixed methods study

BACKGROUND

Age-appropriate communication and interaction are essential when meeting young carers, requiring in-depth knowledge and experience. Volunteer programmes may enhance undergraduate students' competencies in this regard. This pilot study evaluated undergraduate students' perceptions of volunteering on the Buddies for Children and Youngsters (BCY) programme by assessing the extent to which students experienced an improvement in their relational and communication competencies and/or felt better equipped for their future work.

METHODS

The researchers conducted a mixed methods study with a parallel design, focussing on undergraduate students from the University College of Northern Denmark within the field of nursing, teaching, pedagogy, physiotherapy, and occupational therapy. The students participated in the programme for at least 4 months.

RESULTS

Forty-two students responded to a questionnaire, and 17 students were selected to participate in four focus groups. The results showed that participation in the programme improved the students' communication and relational competencies to some degree. The programme provided the students with experience of age-related communication on both informal and difficult topics, and of building relationships and solving relational challenges. Also, the programme generally equipped students for future work with young carers and children.

CONCLUSION

In conclusion, the BCY programme is a relevant supplement to regular educational activities. Decision makers within politics of health, health planning and management, should therefore consider implementation of such programmes in relevant educational areas.

Impact of the COVID-19 Pandemic on Individuals With Hearing Loss and Audiology Practice in a Developing Country

OBJECTIVE

This study aimed to determine the challenges faced by individuals with hearing loss at a time when many nations were attempting to move from the COVID-19 pandemic to endemic.

DESIGN

A cross-sectional survey was conducted on Malaysian adults with hearing loss to determine the impact of the COVID-19 crisis on hearing aid management, communication difficulties, psychosocial challenges, and access to audiological services.

STUDY SAMPLE

One hundred forty-six individuals aged 18 years old and above with hearing loss were recruited from hearing health care centers to participate in the survey.

RESULTS

Many of the participants (54.2%) reported significant difficulties communicating with people wearing face masks. For hearing aid management, repairing (36.3%) and fine-tuning devices (30.2%) were considered more challenging than obtaining a battery (21.3%). The COVID-19 pandemic had a serious psychosocial impact on a small portion of the individuals surveyed. Remote services were rarely offered by the audiologists, and most participants preferred in-person treatment. However, the majority perceived that creating awareness and training on telehealth was important.

CONCLUSIONS

Effective management for people with hearing loss needs to consider the challenges faced by them, as the world prepares to live with the coronavirus. Clinical protocols should consider providing a service that is helpful for the clients as well as safe and sustainable in future pandemics.

The impact of the COVID-19 pandemic on undergraduate and postgraduate students: A cross-sectional survey

Background

The COVID-19 pandemic has impacted many facets of life. This study focuses on undergraduate and postgraduate students in China to explore how the pandemic has affected health status, daily life, learning situations, graduation-related situations, and their studies or work planning.

Methods

This study sent online questionnaires to 2,395 participants to investigate the extent to which they were affected by the epidemic in the various aspects mentioned above and to understand what help they tend to get in the face of these effects.

Results

A total of 2,000 valid questionnaires were collected. The physical health of 82.90% of the respondents was affected to varying degrees, with male students, non-medical students, and graduates being more affected than female students, students with medical majors, and non-graduates, respectively. The proportion of students affected by mental health, the total amount of physical exercise, emotional life, and interpersonal communication was 86.35, 88.65, 80.15, and 90.15%, respectively. Compared with medical students and non-graduates, non-medical students and graduates were more affected. In addition, students' learning and graduation conditions have also been affected to a certain extent: 13.07% of students may not be able to graduate on time, and the proportion of postgraduate students' graduations affected was higher than that of undergraduate students.

Conclusion

The COVID-19 pandemic has affected the health status of students, their daily lives, learning situations, and so on to varying degrees. We need to pay attention to the issues, provide practical solutions, and provide a basis for better responses to similar epidemics in the future.

Emotion recognition in individuals wearing facemasks: a preliminary analysis of age-related differences

COVID-19 is severely affecting individuals' lives worldwide. Previous research warned that facial occlusion may impair facial emotion recognition, whilst other findings suggested that age-related differences may be relevant in emotion recognition in others' faces. However, studies observing individuals' ability to interpret others' facial mimicry are heterogenous, thus precluding the generalizability of the findings. This preliminary study examined age-related differences and the influence of different covering types (with and without face masks) in determining different levels of facial emotion recognition. 131 participants were split into 3 age-groups (10-14; 15-17; 20-25) and were asked to complete an emotion recognition task. Participants were better able to recognize facial emotions without any occlusion, and happiness was the most recognizable emotion. Moreover, adolescent group performed better in recognizing anger and fear in stimuli depicting masked and unmasked faces. Current results suggest the importance of monitoring emotion recognition abilities in developing individuals during the COVID-19 pandemic.

Impact of Facemasks Use on Interpersonal Communication in a Clinical Setup: A Questionnaire Based Study

Precautionary measures such as physical distancing, wearing a mask, and hand hygiene to suppress virus transmission necessitated a shift in the communication paradigm.The study aimed to check the effects of wearing masks (N95, surgical, and cloth) due to the COVID-19 pandemic on interpersonal communication in audiology-speech-language pathology clinical setup from a clinician perspective. A total of 105 participants, 17 males, and 88 females, in the age range of 19 to 29 years (Mean age = 21.41 years; S.D = 1.6), participated in the study. A questionnaire consisting of 15 close-ended questions grouped into five major categories, Communication Effectiveness (3 questions), Visual Cues (5 questions), Physiological Effect (4 questions), Palliative Effect (1 question), and Environment Effect (2 questions) was framed. Procedure: Participants rated the questions using a binary forced-choice as either Yes or No adapted into a google form. Results showed that most questions in all five categories received an above-average "yes" response. A significant association between questions in communication effectiveness with visual cues and physiological effects was noticed, leading to the conclusion that wearing face masks impacted overall communication by affecting various parameters of speech, majorly, the voice. It was also seen that of all the participants, 60% used N95, 32.4% used cloth, and only 7.6% used surgical face masks. Speech-language pathologists have a significant role in facilitating oral/ verbal communication when such barriers are encountered in clients with communication disorders and fellow professionals with strategies to strengthen oral/ verbal communication.

Lay theories about emotion recognition explain cultural differences in willingness to wear facial masks during the COVID-19 pandemic

Given that mask-wearing proved to be an important tool to slow the spread of infection during the COVID-19 pandemic, investigating the psychological and cultural factors that influence norms for mask wearing across cultures is exceptionally important. One factor that may influence mask wearing behavior is the degree to which people believe masks potentially impair emotion recognition. Based on previous research suggesting that there may be cultural differences in facial regions that people in Japan and the United States attend to when inferring a target's emotional state, we predicted that Americans would perceive masks (which cover the mouth) as more likely to impair emotion recognition, whereas Japanese would perceive facial coverings that conceal the eye region (sunglasses) to be more likely to impair emotion recognition. The results showed that Japanese participants reported wearing masks more than Americans. Americans also reported higher expected difficulty in interpreting emotions of individuals wearing masks (vs. sunglasses), while Japanese reported the reverse effect. Importantly, expectations about the negative impact of facial masks on emotion recognition explained cultural differences in mask-wearing behavior, even accounting for existing social norms.

Social anxiety and academic performance during COVID-19 in schoolchildren

The purpose of the present study was to determine the perception of schoolchildren whether their academic performance improved or worsened during the pandemic, analyzing their social anxiety, gender, use of masks in the classroom, and school year. The total sample was 107 primary school students (25 in the fourth, 40 in the fifth and 42 in the sixth grade), with a mean age of 10.51 years old (SD = 1). The gender were 58 girls and 49 boys, from a school in the province of La Coruña (Spain). The study was based on a quantitative methodology, and the design was cross-sectional, descriptive, observational and correlational. The social anxiety questionnaire (CASO-N24) was used to assess social anxiety, and an ad hoc self-report register was elaborated to evaluate sociodemographic variables. The results indicated that 44.8% of the schoolchildren considered that the pandemic had neither improved nor worsened their academic performance. Although 38.3% considered that high and very high social anxiety increased progressively as the school year progressed, both in boys and girls. Besides, the schoolchildren who presented very low and low social anxiety improved their grades in Physical Education, while those who presented high social anxiety worsened them. In conclusion, having a low social anxiety, lower grades before the pandemic and higher grades after, makes children perceive an improvement in their academic performance during the pandemic.

COVID-19: Implications for Nursing and Health Care in the United States

PURPOSE

COVID-19 and other recent infectious disease outbreaks have highlighted the urgency of robust, resilient health systems. We may now have the opportunity to reform the flawed health care system that made COVID-19 far more damaging in the United States (U.S.) than necessary.

DESIGN AND METHODS

Guided by the World Health Organization (WHO) Health System Building Blocks framework (WHO, 2007) and the socio-ecological model (e.g., McLeroy et al., 1988), we identified challenges in and strengths of the U.S.' handling of the pandemic, lessons learned, and policy implications for more resilient future health care delivery in the U.S. Using the aforementioned frameworks, we identified crucial, intertwined domains that have influenced and been influenced by health care delivery in the U.S. during the COVID-19 pandemic through a review and analysis of the COVID-19 literature and the collective expertise of a panel of research and clinical experts. An iterative process using a modified Delphi technique was used to reach consensus.

FINDINGS

Four critically important, inter-related domains needing improvement individually, interpersonally, within communities, and for critical public policy reform were identified: Social determinants of health, mental health, communication, and the nursing workforce.

CONCLUSIONS

The four domains identified in this analysis demonstrate the challenges generated or intensified by the COVID-19 pandemic, their dynamic interconnectedness, and the critical importance of health equity to resilient health systems, an effective pandemic response, and better health for all.

CLINICAL RELEVANCE

The novel coronavirus is unlikely to be the last pandemic in the U.S. and globally. To control COVID-19 and prevent unnecessary suffering and social and economic damage from future pandemics, the U.S. will need to improve its capacity to protect the public's health. Complex problems require multi-level solutions across critical domains. The COVID-19 pandemic has underscored four interrelated domains that reveal and compound deep underlying problems in the socioeconomic structure and health care system of the U.S. In so doing, however, the pandemic illuminates the way toward reforms that could improve our ability not only to cope with likely future epidemics but also to better serve the health care needs of the entire population. This article highlights the pressing need for multi-level individual, interpersonal, community, and public policy reforms to improve clinical care and public health outcomes in the current COVID-19 pandemic and future pandemics, and offers recommendations to achieve these aims.

The labor of talking to stay healthy and socially connected: Communication work during the COVID-19 pandemic

One of the primary means through which people protect themselves and their loved ones from COVID-19 is by communicating with others, as they discuss preventive health behaviors and make decisions about safe social interaction. These conversations are sometimes quite challenging. Guided by the conceptual lens of communication work, this study was an investigation of how communication during the pandemic was experienced by people as work. Findings validated and extended the communication work construct. Communication during the pandemic is effortful because it is high stakes, relentless, and takes an emotional toll. Nonetheless, many people feel a sense of responsibility and obligation to have these conversations. Communication about COVID-19 is divisible labor that can be shared. People engage in strategic preparation and message design to accomplish multiple goals before, during, and after discussions about pandemic topics.

The impact of facemasks on blood donation process: The professionals' perspective

Facemasks represent an essential measure of prevention against the spread of COVID-19; however, they lessen the ability to convey and understand emotions through facial expressions. In blood donation settings, facemasks may interfere with professionals' tasks. This qualitative study aims to describe healthcare staff's experiences, beliefs, and attitudes toward facemask wearing and strategies used to overcome communication and relational barriers along the blood donation process. Semistructured qualitative interviews were conducted with 25 healthcare professionals (14 physicians and 11 nurses) working in Italian blood donation centers. The framework analysis method was used to organize the data and identify emerging themes. More than 70% of participants reported discomfort and a negative impact on communicating effectively with donors and building empathic relationships. The difficulty to detect early signs of adverse reactions was reported by almost all nurses, and physicians were concerned that facemasks limited the identification of donors and the detection of deferral criteria. Facemasks have changed the blood donation process, reducing the healthcare professionals' ability to build empathic relationships and communicate with donors effectively. New strategies should be developed to overcome these limitations.