Impact of SARS-CoV-2 Virus (COVID-19) Preventative Measures on Communication: A Scoping Review

The impact of face coverings on audio-visual contributions to communication with conversational speech

The use of face coverings can make communication more difficult by removing access to visual cues as well as affecting the physical transmission of speech sounds. This study aimed to assess the independent and combined contributions of visual and auditory cues to impaired communication when using face coverings. In an online task, 150 participants rated videos of natural conversation along three dimensions: (1) how much they could follow, (2) how much effort was required, and (3) the clarity of the speech. Visual and audio variables were independently manipulated in each video, so that the same video could be presented with or without a superimposed surgical-style mask, accompanied by one of four audio conditions (either unfiltered audio, or audio-filtered to simulate the attenuation associated with a surgical mask, an FFP3 mask, or a visor). Hypotheses and analyses were pre-registered. Both the audio and visual variables had a statistically significant negative impact across all three dimensions. Whether or not talkers' faces were visible made the largest contribution to participants' ratings. The study identifies a degree of attenuation whose negative effects can be overcome by the restoration of visual cues. The significant effects observed in this nominally low-demand task (speech in quiet) highlight the importance of the visual and audio cues in everyday life and that their consideration should be included in future face mask designs.

Patient perspectives on infection prevention and control in cancer care: a survey of knowledge and attitudes among persons with cancer and their next of kin

BACKGROUND

With the growing prevalence of antimicrobial resistance, there may be a need to strengthen infection prevention and control (IPC) measures in cancer care. When developing clinical guidelines, it is important to incorporate patient perspectives.

AIM

To determine the knowledge of, and attitudes towards, IPC among persons with cancer and their next of kin in Norway.

METHODS

Through discussions in expert panels and a pilot study, a survey was developed consisting of 13 knowledge statements to be judged true/false and 40 attitude items to be judged using a Likert scale and was sent to a panel of people with cancer experience on August 22nd, 2023. The mean correct responses and attitude scores were reported.

FINDINGS

Of 551 respondents, the mean correct response to IPC-related knowledge questions was 79% (95% confidence interval: 78-80). Respondents were most knowledgeable about hand hygiene (99%, 546/551), but least knowledgeable about its role in preventing antibiotic resistance (41%, 225/551). Strong support was noted for IPC, especially within the patient responsibilities theme, with a mean score of 4.83. However, there was a notable reluctance towards some selected intrusive IPC measures, such as reducing contact with close relations.

CONCLUSION

This survey revealed a high level of knowledge and attitudes that support the importance of IPC among persons with cancer in Norway and their next of kin. We recommend including patient perspectives in future development of IPC guidelines.

Reporting of auditory symptoms over time: (in)consistencies, expectations and the nocebo effect

Objective: Consistent symptom reporting for conditions like tinnitus that do not have an associated sign is critical for evaluating severity and intervention effectiveness, and for interpreting research findings. There is little research examining reporting of tinnitus and hearing difficulty over time. We address this here by comparing reported hearing difficulty and tinnitus at two time-points.Design: A cross-sectional study comparing symptom reporting in March 2019 and August/September 2021 using data from two online surveys of the same cohort. Although each survey was designed to address a different question, both asked about symptoms of tinnitus and hearing difficulties and enabled this exploratory analysis.Study sample: 6881 members of the UK general public aged 18+ years.Results: Inconsistent reporting was evident - many participants who reported experiencing tinnitus and/or hearing difficulties in 2019, said in 2021 that they had never had such symptoms before. Additionally, reports of new tinnitus/hearing difficulties in 2021 were unexpectedly high, equating to 18-month incidence rates of 13.6% and 11.7%, respectively.Conclusions: Psychosocial factors, expectations and context impact symptom reporting. This should be considered when treating patients and interpreting research findings. Using real-time data collection methods could thus provide a better understanding of experiences of tinnitus and hearing.

A comparison of the impact of the COVID-19 pandemic on communication among individuals with and without hearing impairment

Objective: This study assessed the impact of coronavirus disease-2019 (COVID-19) preventative measures on hearing and communication among individuals with normal and impaired hearing. We also evaluated the use of digital communication tools between these groups.Design: For this cross-sectional study, participants completed an online digits-in-noise test and survey. Survey topics included understanding through masks, behind plastic screens, from a 1.5-m distance, and use of social network sites/apps, direct messaging, and video calling. Logistic regressions assessed the odds of disagreeing versus agreeing with survey statements.Study Sample: A total of 880 adults from the National Longitudinal Study on Hearing completed a survey and hearing test. Based on speech reception threshold scores, participants were categorised into "good" (reference group for all analyses), "insufficient", or "poor" hearing groups.Results: Those with insufficient and poor hearing had more difficulty understanding others through facemasks, plastic screens, and from 1.5 m. Those with poor hearing had a higher odds of video calling more to contact family/friends/acquaintances during the pandemic, but also had more difficulty hearing sufficiently through video calls.Conclusions: This study addresses methodological weaknesses in previous studies. Results strengthen current evidence of the burden COVID-19 measures place on individuals with hearing impairment.

Perceptions of Adults With Hearing Loss About the Communication Difficulties Generated by the COVID-19 Preventive Measures: A Qualitative Study

PURPOSE

The COVID-19 pandemic led to the implementation of preventive measures that exacerbated communication difficulties for individuals with hearing loss. This study aims to explore the perception of adults with hearing loss about the communication difficulties caused by the preventive measures and about their experiences with communication 1 year after the adoption of these preventive measures.

METHOD

Individual semistructured interviews were conducted via videoconference with six adults who have hearing loss from the province of Québec, Canada. Data were examined using qualitative content analysis.

RESULTS

The study found that face masks and in-person work (i.e., in opposition to remote work) were important barriers to communication because of hindered lipreading and competing noise in many workplaces. In contrast, preventive measures that allowed visual information transmission (e.g., transparent face masks, fixed plastic partitions) were considered favorable for communication. Communication partners were perceived as playing an important role in communication success with preventive measures: Familiar communication partners improved communication, whereas those with poor attitude or strategies hindered communication. Participants found that videoconferences could provide satisfactory communication but were sometimes hindered by issues such as bad audiovisual quality or too many participants.

CONCLUSIONS

This study identified reduced access to speech reading and lack of general awareness about hearing issues as key barriers to communication during the pandemic. The decreased communication capabilities were perceived to be most problematic at work and during health appointments, and tended to cause frustration, anxiety, self-esteem issues, and social isolation. Suggestions are outlined for current and future public health measures to better consider the experience of people with hearing loss.

The COVID-19 burnout scale: development and initial validation

BACKGROUND

Research on the pandemic-related burnout has focused on work-related burnout especially among healthcare workers, but not in the general population.

AIM

To develop a valid and reliable instrument scale to measure pandemic-related burnout in the general population.

METHODS

We took several steps to develop the scale items and achieve content and face validity; literature review, panel of experts, calculation of content validity ratio, and cognitive interviews. We assessed structural and construct validity, and reliability of the COVID-19 burnout scale (COVID-19-BS).

RESULTS

Exploratory and confirmatory factor analysis identified three factors for the COVID-19-BS; emotional exhaustion, physical exhaustion, and exhaustion due to measures against the COVID-19. Cronbach's alpha coefficients for the three factors and the COVID-19-BS ranged from 0.860 to 0.921. Kaiser-Meyer-Olkin value was 0.945, and p-value for Bartlett test was <0.001. A significant positive correlation between the three factors and anxiety and depression indicated high concurrent validity. Cohen's kappa ranged from 0.848 to 0.957, while intraclass correlation coefficients ranged from 0.888 to 0.997.

CONCLUSIONS

Our findings indicate that the final 3-factor model with 13 items of COVID-19-BS is a brief, easy to administer, valid and reliable scale for assessing COVID-19-related burnout in the general public.

Impact of Face Masks on Speech in Parkinson's Disease: Effect of Clear and Loud Speech Styles

PURPOSE

The purpose of this study is to quantify the combined effects of face masks and effortful speech styles on speech intensity, spectral moments, and measures of spectral balance in talkers with Parkinson's disease.

METHOD

Fifteen people with Parkinson's disease and 15 healthy, older controls read aloud sentences in three face mask conditions and three speech style conditions. Mask conditions included no mask, surgical masks, and KN95 masks. Speech styles included habitual, clear, and loud. Acoustic measures of intensity, spectral moments, and spectral balance were modeled as a function of speaker group, mask, and speech style.

RESULTS

Overall, talkers with PD demonstrated lower concentrations of high-frequency spectral energy in their speech. Face masks attenuated high-frequency energy, whereas clear followed by loud speaking styles amplified high frequencies. Overall, the attenuation observed by face masks was preserved across speech styles, and both mask and speech patterns were observed to be similar across groups.

DISCUSSION

Clear and loud speech styles were effective in compensating for the damping effects of masks in talkers with and without PD. However, given that people with PD demonstrated poorer overall spectral balance compared to controls, the gains afforded by speaking clearly or loudly may be limited when wearing a face mask.

Combined hearing and vision screening programs: A scoping review

Background and aim

The World Health Organization (WHO) estimates that 1.5 billion and 2.2 billion people have hearing and vision impairment, respectively. The burden of these non-communicable diseases is highest in low- and middle-income countries due to a lack of services and health professionals. The WHO has recommended universal health coverage and integrated service delivery to improve ear and eye care services. This scoping review describes the evidence for combined hearing and vision screening programs.

Method

A keyword search of three electronic databases, namely Scopus, MEDLINE (PubMed), and Web of Science, was conducted, resulting in 219 results. After removing duplicates and screening based on eligibility criteria, data were extracted from 19 included studies. The Joanna Briggs Institute Reviewer Manual and the Preferred Reporting Items for Systematic Reviews and Meta-analyzes (PRISMA) Extension for Scoping Reviews were followed. A narrative synthesis was conducted.

Results

Most studies (63.2%) were from high-income countries, with 31.6% from middle-income and 5.2% from low-income countries. The majority of studies (78.9%) involved children and the four studies reporting on adults all included adults above 50 years of age. Vision screening was most commonly performed with the "Tumbling E" and "Snellen Chart," while hearing was typically screened using pure tone audiometry. Studies reported referral rates as the most common outcome with sensitivity and specificity rates not reported in any included articles. Reported benefits of combined vision and hearing screenings included earlier detection of vision and hearing difficulties to support functioning and quality of life as well as resource sharing for reduced costs. Challenges to combined screening included ineffective follow-up systems, management of test equipment, and monitoring of screening personnel.

Conclusions

There is limited research evidence for combined hearing and vision screening programs. Although potential benefits are demonstrated, especially for mHealth-supported programs in communities, more feasibility and implementation research are required, particularly in low- and middle-income countries and across all age groups. Developing universal, standardized reporting guidelines for combined sensory screening programs is recommended to enhance the standardization and effectiveness of combined sensory screening programs.

Assessing the impact of COVID-19 pandemic on the health of residents and the healthcare system in Alberta, Canada: an observational study-The Alberta POST-COVID Follow-up Study

INTRODUCTION

Very little is known about how the COVID-19 pandemic has affected the health of residents and the healthcare system in Alberta, Canada. The purpose of this study is to establish an observational study to characterise the health of residents in Alberta, Canada, over time, covering a population that tested negative or positive for COVID-19 during the pandemic. The primary outcome is to characterise 'long COVID-19' and the health status of residents during the COVID-19 pandemic. Secondary outcomes include the estimation of the risk of and risk factors associated with adverse health outcomes and healthcare utilisation and burdens.

METHODS AND ANALYSIS

This is a population-level provincial observational study which will follow-up with Alberta residents who underwent testing for COVID-19 and completed surveys adapted from the ISARIC COVID-19 long-term follow-up survey. The survey data will be linked with medical records. Statistical analyses will be carried out to characterise 'long COVID-19' and the health status of residents during the pandemic. The outcomes of this study will inform strategies for primary care and rehabilitation services to prevent chronic consequences; contribute to healthcare management, interventional studies, rehabilitation and health management to reduce overall morbidity and improve long-term outcomes of COVID-19 and the COVID-19 pandemic and potentially guide a self-evaluation of a remote monitoring system to manage individuals' health.

ETHICS AND DISSEMINATION

This study was reviewed and approved by the University of Alberta ethics committee (Study ID: Pro00112053 & Pro00113039) on 13 August 2021 and adheres to the Alberta Health Services research information management policy. Study results will be used to manage clinical care, published in peer-reviewed journals and presented at local, national and international conferences.

PROTOCOL VERSION

6 June 2022 EUROQOL ID: 161 015.

Speaking with mask in the COVID-19 era: Multiclass machine learning classification of acoustic and perceptual parameters

The intensive use of personal protective equipment often requires increasing voice intensity, with possible development of voice disorders. This paper exploits machine learning approaches to investigate the impact of different types of masks on sustained vowels /a/, /i/, and /u/ and the sequence /a'jw/ inside a standardized sentence. Both objective acoustical parameters and subjective ratings were used for statistical analysis, multiple comparisons, and in multivariate machine learning classification experiments. Significant differences were found between mask+shield configuration and no-mask and between mask and mask+shield conditions. Power spectral density decreases with statistical significance above 1.5 kHz when wearing masks. Subjective ratings confirmed increasing discomfort from no-mask condition to protective masks and shield. Machine learning techniques proved that masks alter voice production: in a multiclass experiment, random forest (RF) models were able to distinguish amongst seven masks conditions with up to 94% validation accuracy, separating masked from unmasked conditions with up to 100% validation accuracy and detecting the shield presence with up to 86% validation accuracy. Moreover, an RF classifier allowed distinguishing male from female subject in masked conditions with 100% validation accuracy. Combining acoustic and perceptual analysis represents a robust approach to characterize masks configurations and quantify the corresponding level of discomfort.

Effects of widespread community use of face masks on communication, participation, and quality of life in Australia during the COVID-19 pandemic

The objective was to document the influence of face mask use by other people on communication experiences, participation in activities, and quality of life. Australian adults (n = 665) completed an online survey; 90.8% resided in a state with mandatory mask use outside the home and 44.1% self-reported hearing difficulties. Mask use was reported as negatively affecting communication quality in the community (90.2%) and workplace (91.8%), and with household members (59.1%), including an increased requirement for clarification and repetition, increased difficulty communicating, and decreased understanding. Masks influenced feelings when communicating in the community (74.1%) and workplace (76.7%), and with household members (43.6%), including increased fatigue and frustration, and decreased connection to others. Masks influenced the time spent communicating in the community (68.8%) and workplace (67.9%), and with household members (42.3%), including a decrease in the number of individuals communicated with, and the time spent communicating with each individual. Masks influenced participation in activities in the community (50.9%) and workplace (59.7%), and with household members (41.3%), including reduced participation in health-related activities, shopping, and socialising. Influences on quality of life included reduced physical and mental health, including increased loneliness. Female gender and greater self-reported hearing difficulties were significantly associated with increased influence of mask use. The wide-ranging influences of face mask use have implications for physical health and mental health, including social connectedness, and for employers and the economy. As an important measure for combatting disease spread, the negative impacts of mask use must be considered during policy formulation, and appropriate mitigating measures, such as educational campaigns, enacted.