Understanding Knowledge and Behaviors Related to CoViD-19 Epidemic in Italian Undergraduate Students: The EPICO Study

All hands on deck during the COVID-19 pandemic. Maintaining face-to-face medical education and clinical placements

Medical students must have robust educational experiences, graduate and commence timely employment. Here, we describe how the Royal College of Surgeons in Ireland (RCSI) delivered clinical placements in medical programmes over the first three waves of the COVID-19 pandemic in Ireland, including a student-centred, holistic approach to students' educational, social and health needs with strong student involvement, re-organising the university's primary care team, developing COVID-19 PCR testing on site and re-focusing communications and student services. This resulted in re-arranging the students into learning communities, and students and staff electronically recorded their COVID-19 symptom status daily. In-person observed structured clinical examination and other clinical exams progressed. No lockdown of any campus occurred. Over the two senior years, 693 students completed 15,000 weeks of clinical and experiential learning across 104 sites, similar to previous years, including anatomy practicals, procedural skills training, simulated ward rounds and patient encounters, case-based presentations and small group tutorials. The compliance rate with the daily symptom tracker was 91%. The percentage response rate and the number of students providing feedback from October 2020 to April 2021 was as high as 50%. The overall response rate was 33%. By mid-May, 93-95% of students in the two senior years had had at least one dose of the SARS-CoV-2 vaccine, with 99% fully vaccinated by the start of the next academic year in autumn 2021. Over the period of testing for SARS-CoV-2, just over 22,000 samples were processed, of which 0.79% were positive; no medical student acquired COVID-19 or was associated with nosocomial transmission. The total investment by the RCSI in Dublin, was €9.3m (€1.2 in capital expenditure and €8.1 in operational expenses). Continuing face-to-face clinical placements during a pandemic was possible through a multi-model approach that prioritised two-way communication, compliance with national public health advice and student screening.

Effects of Technology Use on Self-Reported Physical Activity: A Behavioral Change Perspective

Previous research finds initial evidence that affordances of interactivity, agency, and modality can help increase physical activity (PA). However, the cross-sectional nature of these studies provides a snapshot of behavior but does not assess the impact of affordances of technology on change in PA behavior. In this study, we bridge this gap and test if features of technology that afford interactivity, agency, and choice of modality will be associated with an increase in PA across time. Guided by the Motivational Technology Model (MTM), we scraped 784 user profiles from the BodySpace App (a social weightlifting smartphone application) at baseline and after 70 days and establish the relationship between the use of features that afford interactivity, agency, and modality and behavioral change. Theoretical and methodological implications are discussed.

Psychological predictors of physical activity intensity among college students

Objective: The purpose of this study was to investigate the association of mental health, subjective well-being, and the impact of COVID-19 on quality of life with PA intensity among college students. Participants: The sample included 1262 college students from a large Midwestern research university (mean age = 21.5 ± 3.6 years). Methods: Participants voluntarily and anonymously completed the Qualtrics questionnaires which included the Patient Health Questionnaire -Anxiety and Depression Scale, the Satisfaction with Life Scale, the Impact of COVID-19 on Quality of Life (QoL) Scale, and the International Physical Activity Questionnaire. Results: Multiple linear regression models indicated that COVID-19 QoL and life satisfaction were significant predictors of the total, vigorous, and moderate PA (p's < .05). Life satisfaction was also a significant predictor of walking. Conclusion: Higher level satisfaction and lower impact of COVID-19 on quality of life were related to higher total, vigorous, and moderate PA levels.

Nursing Students' Perceptions of Factors Influencing Nursing Intentions toward COVID-19 Patients

Coronavirus disease (COVID-19) is a pandemic to which nursing students are particularly susceptible. This study aims to comprehensively examine nursing students' knowledge, attitudes, risk perceptions, preventive behaviors related to COVID-19, and nursing intentions toward patients with the virus. A questionnaire was administered to 149 nursing students from two universities. Data on the respondents' general characteristics, knowledge levels, attitudes, perceived risk, preventive behaviors toward COVID-19, and nursing intentions toward COVID-19 patients were collected. The collected data were statistically analyzed using SPSS software (version 26.0). This involved descriptive statistics, independent t-tests, one-way ANOVA, Pearson's correlation coefficient, and stepwise multiple regression analyses. The analyses of the factors affecting nursing students' nursing intentions for COVID-19 patients showed that the most predictive factor was perceived risk (β = -0.38, p < 0.001), followed by attitudes (β = 0.29, p < 0.001) and preventive behaviors (β = 0.17, p = 0.017), which explained 26% of the variance in nursing intentions. Lowering the perceived risk of infectious diseases and cultivating positive attitudes and preventive behaviors can increase nursing students' intentions toward COVID-19 patients. Finally, infection management education programs and research on interventions for nursing students are necessary to enhance the quality of nursing care provided to patients with novel infectious diseases.

Changes in Nutrition, Physical Activity, and Body Weight among Lithuanian Students during and after the COVID-19 Pandemic

The long-term effect of the COVID-19 pandemic on lifestyle changes remains understudied. This cross-sectional study aimed to assess changes in nutrition, physical activity, and body weight among Lithuanian students during the pandemic and their post-pandemic persistence. Data were collected from 1430 first-year students (325 males, 1105 females) through an online self-administered questionnaire. The students indicated an increase in the consumption of snacks, fast food, home-made confectionery, and sweets. A decrease in physical activity during the pandemic was reported by 34.9% of males and 33.2% of females. Lifestyle changes during the pandemic were associated with post-pandemic habits. A higher proportion of females (38.7%) than males (31.1%) indicated an increase in BMI, which was more pronounced among students with overweight. A multivariate logistic regression analysis revealed that reduced physical activity; the increased consumption of red meat, snacks, fast food, and home-made confectionery during the pandemic; and post-pandemic BMI were linked with weight gain. After the pandemic, weight gain persisted in 40.9% of students who continued to follow unhealthy nutrition habits and had reduced physical activity. The study emphasizes that the promotion of a healthy diet and regular physical activity among university students is essential for developing lifelong habits that contribute to a healthy body weight and overall well-being.

Daily step counts before, during, and after COVID-19 pandemic: a smartphone-tracking study of university students in Egypt and Saudi Arabia

BACKGROUND

COVID-19 pandemic has drastically changed people's lifestyles and daily routines around the world. This study aimed to investigate changes in daily step counts - as an indicator of physical activity - before, during, and after the pandemic among university students in Egypt and Saudi Arabia and to identify regional and gender factors that may have influenced physical activity during these periods.

METHODS

A total of 1273 university students from Egypt (Assiut University and Zagazig University) and Saudi Arabia (Taif University, King Faisal University, and Imam AbdulRahman Bin Faisal University) provided valid data on their daily step counts recorded by a smartphone application (iPhone Health App) from January 2019 to December 2021. The data was divided and averaged based on three periods: the pre-pandemic year (January to December 2019), the first pandemic year (January to December 2020), and the second pandemic year (January to December 2021).

RESULTS

The results showed a significant decrease in daily steps from pre-pandemic to the first pandemic year, followed by an increase in the second pandemic year. However, daily step counts did not fully recover to pre-pandemic levels in male Egyptian and marginally in male Saudi participants. In both nationalities, female participants did not show a significant difference in daily steps between the pre-pandemic and second-pandemic years. Female Egyptian participants had significantly lower daily step counts than male Egyptian participants, and a gender difference in daily steps was also observed in Saudi female participants in the pre-pandemic and the second pandemic year but not during the first pandemic year.

CONCLUSION

These findings outline the need for strategies in Egypt and Saudi Arabia to promote physical activity and reduce sedentary behavior, especially among young women, to mitigate the negative consequences of COVID-19 and meet physical activity guidelines.

Social and Health Beliefs Related to College Students' COVID-19 Preventive Behavior

Coronavirus disease 2019 (COVID-19) infection prevention behaviors vary from individual to individual, and it is necessary to identify factors related to such behaviors. This study investigated how college students' social beliefs and health beliefs are related to their adherence to COVID-19 precautionary behaviors. An online survey was conducted among 200 Korean college students from 4 March to 30 June 2022. The variables associated with COVID-19 precautionary behaviors were evaluated, with social beliefs as the independent variable, health beliefs as the mediating variable, and COVID-19 precautionary behaviors as the dependent variable. A correlation analysis and confirmatory factor analysis were performed. The model fit was as follows: χ²/degrees of freedom = 1.64 (p < 0.001), Tucker-Lewis Index = 0.92, comparative fit index = 0.93, standardized root mean square residual = 0.06, and root mean square error of approximation = 0.06. Social complexity, as perceived by college students, was related to COVID-19 precautionary behaviors through mediating health beliefs (perceived benefits). To increase college students' compliance with COVID-19 precautionary behaviors, it is necessary to identify social beliefs and accordingly propose interventions that focus on personal health beliefs.

Health-related factors of the Iraqi adult population during the 2020 COVID-19 pandemic: physical activity, eating behavior, quality of life, general health, and mood states cross-talk

BACKGROUND

The lockdown and social distancing caused by Coronavirus disease 2019 (COVID-19) may have changed Physical Activity Level (PAL), eating behavior, and health habits due to long-term confinement worldwide.

OBJECTIVE

This study aimed to evaluate the PAL, eating behavior, Quality of Life (QoL), General Health (GH), and mood states during COVID-19 confinement in a large sample of Iraqi adults.

METHODS

3738 healthy adults (age 18-70 years) residing in Halabjeh, Iraq answered the online questionnaires including the short form of international physical activity, GH, three-factor eating (TFEQ-R18), and a short form of the profile of mood states (POMS-SF) questionnaires. Data analysis was done by Chi-square, and Spearman's correlation using SPSS statistical software at a significant level of (P < 0.05).

RESULTS

The results showed unfavorable PAL, eating behavior, QoL, GH, and mood states in the total population. Low PAL was observed in 69.96% of the men and 75.99% of the women; only 3.60% of the men and 0.77% of the women had a high PAL. There was a significantly positive relationship between low PAL and the incidence of COVID-19 both in men and women (P = 0.801; r = 0.001; and P = 0.682; r = 0.011), respectively; While a significant negative relationship was observed between the moderate and high PAL and the incidence of COVID-19 in men (P = 0.011; r=-0.682 and P = 0.027, r=-0.589), and women (P = 0.001; r=-0.796 and P = 0.018, r=-0.623). No significant relationships were observed between PAL and eating behavior (men: P = 0.086; r = 0.256 and women: P = 0.365, r=-0.121); While, the results show significant positive relationships between PAL with QoL in men (P = 0.012; r = 0.623) and women (P = = 0.001; r = 0.837). based on the results, significant negative relationships between PAL with GH and mood state scores were observed in both men (P = 0.001; r=-0.837 and P = 0.001, r=-0.786) and women (P = 0.010; r=-0.652 and P = 0.001, r=-0.745), respectively.

CONCLUSIONS

The Iraqi adult population showed low PAL, GH, QoL, and mood state during COVID-19 which might be due to the confinement. Also, the significant relationships between low PAL with GH, and mood state recommends physical activity as a valuable health optimizing factor during the COVID-19 pandemic.

Sleep and Lifestyle Habits of Medical and Non-Medical Students during the COVID-19 Lockdown

It has been shown that the measures of social distancing and lockdown might have had negative effects on the physical and mental health of the population. We aim to investigate the sleep and lifestyle habits as well as the mood of Croatian medical (MS) and non-medical students (NMS) during the COVID-19 lockdown. The cross-sectional study included 1163 students (21.6% male), whose lifestyle and sleep habits and mood before and during the lockdown were assessed with an online questionnaire. The shift towards later bedtimes was more pronounced among NMS (~65 min) compared to MS (~38 min), while the shift toward later wake-up times was similar in both MS (~111 min) and NMS (~112 min). All students reported more frequent difficulty in falling asleep, night-time awakenings and insomnia (p < 0.001) during lockdown. A higher proportion of MS reported being less tired and less anxious during lockdown compared to pre-lockdown (p < 0.001). Both student groups experienced unpleasant moods and were less content during lockdown compared to the pre-lockdown period (p < 0.001). Our results emphasize the need for the promotion of healthy habits in the youth population. However, the co-appearance of prolonged and delayed sleep times along with decreased tiredness and anxiety among MS during lockdown reveals their significant workload during pre-lockdown and that even subtle changes in their day schedule might contribute to the well-being of MS.

Changes in Body Mass, Physical Activity, and Dietary Intake during the COVID-19 Pandemic Lockdowns in Canadian University Students

This study examined changes in body mass and body mass index (BMI), physical activity, and dietary intake in Canadian university students during the first year of the COVID-19 pandemic. Two self-reported recall surveys were conducted: after the first lockdown in September 2020 (T1) and following the second lockdown in March 2021 (T2). Eligible participants were full-time undergraduate students attending a Canadian university and residing in Canada during the first year of the pandemic. At T1, 510 students (99 male, 411 female) completed the survey, and of those, 135 (32 males, 103 females) completed the survey at T2 (73% attrition). At both T1 and T2, most participants were 18-24 years of age (93% and 90%, respectively), Caucasian (73% and 78%, respectively), and resided in the province of Ontario (79% and 80%, respectively). Body mass increased from T1 to T2 (+0.91 ± 3.89 kg t(132) = -2.7, p = 0.008). BMI also increased from T1 to T2 (+0.30 ± 1.33 kg/m² [t(130) = -2.5, p = 0.012), with a greater number of participants within the overweight range (19.8% versus 24.4%, respectively). At T1, 38% of the participants reported a decrease in physical activity, while the number of students reporting a decrease in activity increased to 56% at T2. Dietary energy intake decreased from 1678 ± 958 kcal/day at T1 to 1565 ± 842 kcal/day at T2 [c²(1) = 7.2, p = 0.007]. Diet quality also decreased, with participants not meeting the recommended daily allowance for essential macro and micronutrients. A decrease was observed in daily servings of fruits (-27%, p < 0.001), vegetables (-72%, p < 0.001), and grains (-68%, p < 0.001). In conclusion, despite a small decrease in dietary energy intake, a modest weight gain occurred during the first year of the COVID-19 pandemic in this cohort of Canadian university students, which was potentially related to decreased physical activity and diet quality.

Are changes in physical activity during COVID-19 associated with mental health among Danish university students?

Aims

The benefits associated with being physical active on mental health is well-established, but little is known on how rapid changes in physical activity are associated with mental health. This study investigated the association between changes in physical activity and mental health among Danish university students during the first COVID-19 lockdown.

Methods

Online survey data were collected among 2,280 university students at the University of Southern Denmark and University of Copenhagen in May-June 2020 as part the "COVID-19 International Student Well-being Study." Multiple linear regressions were used to analyze associations between changes in physical activity and mental health (depression and stress scores) adjusted for potential socio-economic confounders.

Results

During the first COVID-19 lockdown, 40% decreased their moderate and 44% their vigorous physical activity, while 16% increased their moderate and 13% their vigorous physical activity. Overall, students with a stable physical activity level had the lowest mean depressive and stress scores. Adjusted analyses showed that a decrease in vigorous and moderate physical activity level was significantly associated with a higher depression score (mean difference (vigorous): 1.36, p < 0.001 and mean difference (moderate): 1.55, p < 0.001). A decrease in vigorous physical activity and an increase in moderate physical activity was associated with a 1-point increase in the PSS-4 stress score (p < 0.001).

Conclusion

A substantial proportion of students changed their physical activity level during lockdown. Our findings emphasize the importance of staying physically active during COVID-19 lockdown. This knowledge might be important for relevant health authorities to bridle post-pandemic mental health challenges.

Food safety knowledge among pregnant women in the United Arab Emirates amid the COVID-19 pandemic

Studies have indicated shortcomings in food safety knowledge and practices among pregnant women in the Arab region. A high-risk group for having severe outcomes from foodborne illnesses. This study aimed to assess self-reported food safety knowledge and practices among pregnant women in the UAE during the COVID-19 pandemic. A total of 354 pregnant women residing in the UAE completed an online survey between October 2021 and January 2022. The questionnaire included socio-demographic information, food safety knowledge, and food practices during the COVID-19 pandemic. Correct answers for food safety knowledge were scored out of 50 and the total score was compared by sociodemographic characteristics. The total mean score for the study population was 26.7 ± 4.6 out of 50. Participants had good knowledge about foodborne diseases (81.3%) and personal hygiene practices (61.8%). While they were least knowledgeable about cross-contamination (43.3%) and temperature control practices (35.8%). Significantly higher knowledge scores were observed with higher levels of education and primigravida women (p<0.05). Knowledge about the COVID-19 virus and its relation to food safety was adequate for most participants. This study infers the need for food safety-related education and training programs to reduce the risk of foodborne disease among this vulnerable group. It also highlights the need to enhance the role of healthcare professionals as trusted sources of information in improving food safety during pregnancy.

Impact of COVID-19 on health risk behaviors in northern California: A cross-sectional survey

The COVID-19 pandemic has been disruptive, unevenly impacting health behaviors in different geographical regions and population groups. We examined how COVID-19 affected perceived changes in physical activity, sleep, and diet and the impact of socio-demographic variables on a calculated health risk behavior score. In this cross-sectional study, 505 residents of northern California completed a web-based survey from August to November of 2020. Chi-square and multivariable linear regression analyses examined the association between socio-demographic variables and the health risk behavior score. Approximately 84 % of respondents experienced at least one unfavorable behavior change after the pandemic, with 49.5 % indicating a reduction in physical activity, 29.7 % a decrease in sleep, 33.1 % an increase in sugary snack consumption, and 29.3 % a decrease in fruit and vegetable intake. Multivariate analyses indicated a higher health risk behavior score (less favorable) for females compared to males (male beta = -0.815, p < 0.0001) and Hispanics compared to Whites (Hispanics beta = 0.396, p = 0.033). The negative changes in health behavior observed in females could be attributed to a higher reduction in fruit and vegetable consumption, and a larger increase in sugary and salty snacks when compared to males. A higher reduction in exercise, sleep, and fruit and vegetable intake were the main drivers of the unfavorable results seen for Hispanics when compared to Whites. Findings highlight the detrimental behavioral changes during the COVID-19 pandemic and the disproportionate impact on Hispanics and women. These results are valuable to policymakers to identify ways to support those most affected by the pandemic and its potential long-term effects.

Evaluation of psychosocial status and nutritional awareness in municipal employees during the coronavirus disease 2019 outbreak: A cross-sectional study

Background: Coronavirus disease 2019 emerged in China in December 2019 as a disease spreading from person to person by rapid droplet transmission, and which eventually evolved into a pandemic. Aim: This study aims to examine the psychosocial state, nutritional awareness, and physical activity level of municipal employees who provided services under changing working conditions during the coronavirus disease 2019 pandemic. Methods: A total of 220 employees working in two different municipalities in Istanbul were included in this study during March and April of 2021. For data collection, a questionnaire form was used. The form consisted of questions about the demographics and nutritional awareness of individuals, the Coronavirus-19 Phobia Scale, and the International Physical Activity Questionnaire (short form). Results: The mean total coronaphobia score was 51.08 ± 14.47 with the mean score for women being significantly higher than that for men (p < 0.05). The mean score obtained by the responses of participants to questions about nutritional awareness during the pandemic was significantly higher than the mean score referring to the period before the pandemic. The examination of the physical activity level of employees revealed that 62.4% of the men and 60% of the women were physically inactive during the pandemic. Conclusion: It was found that the coronaphobia scores of municipal employees during the coronavirus disease 2019 pandemic were at an average level, their nutritional awareness levels increased in general compared to the pre-pandemic period, and municipal employees were mostly inactive physically during the pandemic.

How the COVID-19 Pandemic Has Impacted Daily Life? Assessing the Use of Web Resources for Recreational Activities in the Italian Adult Population

Restriction measures imposed during the COVID-19 pandemic led to changes in people's lives and behaviors. The aim of this paper is to assess the changes occurred in physical activity (PA), sleep, social and cultural activities and personal relationships of Italian adults during the pandemic and to evaluate the use of web-based resources to continue these activities. To this purpose, a cross-sectional study using a web-based questionnaire was carried out and both descriptive and regression analysis was performed. On a total of 1831 participants (61% females, age 18-93 years), the majority reported a decrease in PA, sleep, social and cultural activities and personal relationships, since the beginning of the pandemic. Sleep was notably affected by the use of new technologies. The regression analysis demonstrated that the use of web-based media for doing exercise was associated with being younger than 50 years and female; having a chronic condition was inversely related with the use of web resources for social and cultural activities and to maintain relationships; being employed was negatively related with the use of web media for continuing personal relationships and cultural activities; and being vaccinated against COVID-19 was positively associated with the use of the web for personal relationships. These findings confirm that the COVID-19 pandemic notably affected the daily life of Italian adults. Our results suggest that the use of technology to deal with these changes seems to be related with certain sociodemographic and health-related characteristics. These findings can be useful to identify those characteristics that can help people in copying with daily life modifications due to restriction measures.

Onset of the COVID-19 pandemic reduced active time in patients with implanted cardiac devices

BACKGROUND

Physical inactivity and sedentary behavior are modifiable risk factors for chronic disease and all-cause mortality that may have been negatively impacted by the COVID-19 shutdowns.

METHODS

Accelerometry data was retrospectively collected from 332 permanent pacemaker (PPM) and 244 implantable cardiac defibrillation (ICD) patients for 6 time points: March 15-May 15, 2020 (pandemic period), January 1-March 14, 2020, October 1-December 31, 2019, March 15-May 15, 2019, January 1-March 14, 2019, and October 1-December 31, 2018. Paired t-tests, with Bonferroni correction, were used to compare time periods.

RESULTS

Activity significantly decreased during the pandemic period compared to one year prior by an average of 0.53 ± 1.18h/day (P < 0.001) for PPM patients and 0.51 ± 1.2h/day (P < 0.001) for ICD patients. Stratification of subjects by active time (< 2 versus ≥ 2h/day) showed patients with < 2h, particularly those with ICDs, had modestly greater activity reductions with the pandemic onset. Logistical regression analyses suggest a trend toward a greater reduction in active time at the onset of the pandemic and an increased risk of hospital or emergency department (ED) admission for PPM patients, but not ICD patients.

CONCLUSION

The onset of the pandemic in the United States was associated with a significant drop in PPM and ICD patient active hours that was modestly more pronounced in less active patients and cannot be explained by one year of aging or seasonal variation. If sustained, these populations may experience excess cardiovascular morbidity.

"Monkeypox: What Do You Know about That?" Italian Adults' Awareness of a New Epidemic

In the course of 2022, an epidemic of monkeypox (MPX) arose worldwide. In order to assess the level of knowledge of the Italian adults regarding the new emerging disease, its prevention and their level of worrying and the acceptance of a possible vaccination, a web questionnaire was spread nationwide. A total of 1352 individuals (mean age 54.5 ± 13.4, 52.4% males) completed the questionnaire. Only 26. 7% of the sample wereaware of the burden of the epidemic at the moment of the investigation; 47.1% were not able to identify the transmission route, nor the main symptoms (48.9%); and 54.2% were hesitant toward a possible MPXV vaccination, mainly because of a lack of confident in vaccines (38.5%). A low level of worrying about the disease was registered (mean score 2.3 ± 1.2 on a 5-point scale). In the regression analysis performed considering MPX knowledge as outcome, a lower level of knowledge was associated with higher age (OR 1.378, CI95% 0.998-1.904), working or studying in a nonhealthcare setting (OR 0.046, CI95% 0.033-0.066), being single (OR 0.624, CI95% 0.455-0.856) and having mass media as the main source of information (OR 0.332, CI95% 0.158-0.696). These findings indicate as of the time of this investigation, the communication about the MPXV epidemic was not effective in determining a good level of knowledge about the disease and its transmission among Italian adults. This highlights the need to improve risk communication strategies.

Knowledge, attitude, and practice assessment toward COVID-19 among communities in East Nusa Tenggara, Indonesia: A cross-sectional study

Objective

This research aimed to assess the knowledge, attitude and practice toward COVID-19 among East Nusa Tenggara (NTT) population and identify associated sociodemographic factors.

Methods

A cross-sectional study was performed among communities in 22 regencies of NTT between October-November 2021 using a structured and validated questionnaire that consists of 22-items of knowledge, 6-items of attitude and 13-items of practice related COVID-19 questions. A cut off point of at least 70% was employed to categorize good knowledge, attitude, and practice.

Results

The percentages of survey respondents showing good knowledge, attitude and practice toward COVID-19 were 79.8, 72.7, and 94.6%, respectively. There was a significant positive, though weak, linear correlation between knowledge and practice scores (ρ = 0.097; p = 0.049). Knowledge was strongly associated with regency of residence (Cramer's V = 0.266; p = 0.010), education (Cramer's V = 0.312; p < 0.001), and occupation (Cramer's V = 0.313; p < 0.001). Attitude and practice had strong relationship with regency of residence (Cramer's V = 0.289; p = 0.024) and education (Cramer's V = 0.272; p < 0.001), respectively.

Conclusion

Nearly all survey participants showed good precautionary behaviors, but there was still a quarter of respondents indicated poor knowledge and attitude. There was also a positive relationship between knowledge and practice scores thereby indicating the importance of local public health advocates to distribute information uniformly especially to the groups with inadequate knowledge toward COVID-19 as a means to control the virus transmission.

Exploring changes in levels and patterns of physical activity in undergraduate medical and nursing students during the COVID-19 pandemic

This study reports the physical activity (PA) levels among medical and nursing students at a university in Bahrain during the COVID-19 pandemic. Through self-selection sampling of an online survey, participants' data on general demographics, PA levels before and during the COVID-19 pandemic and reasons for PA changes were collected. From the 110 valid responses, 70 participants (63%) experienced a decrease in PA during the COVID-19 lockdown. Fear of contracting COVID-19 and lack of motivation were two significant reasons for reduced PA levels (p < 0.001) compared to those who did not experience a decrease in PA. Other factors significantly associated with reduced PA levels include living alone (p < 0.018) or with roommates (p < 0.006) compared to living with family. Having more time available was associated with positive changes to PA levels (p < 0.001). Significant differences in MET-min/week were seen between students who experienced increased PA (median of 1605 MET-min/week) compared to those who experienced a decrease (424 MET-min/week) or no change (1070 MET-min/week) in PA levels (p < 0.001). In conclusion, low PA levels are prevalent within medical and nursing students in Bahrain (51% reported < 600 MET-min/week), with ~2 in 3 students reporting a decrease in PA levels during the COVID-19 pandemic. Support programs and strategies to increase engagement in PA within this population are warranted.

Knowledge about COVID-19 and Associated Factors Early in the Outbreak among the Brazilian Population

(1) Background: In Brazil, the first case of the novel coronavirus occurred on the 25 February 2020, and since then, it has spread rapidly over the entire country. During a pandemic, knowledge, attitudes, and practices are expected to largely influence the adherence to non-pharmacological interventions (NPIs). We evaluated the knowledge about COVID-19 and associated factors early in the outbreak among the Brazilian population. (2) Methods: A Brazilian cross-sectional study was carried out using an online questionnaire. The questionnaire consisted of the following topics: isolation, caring for someone sick at home, cleaning habits, disinfecting habits, and true and fake news. Logistic regression was conducted using sociodemographic and associated factors as the independent variables and a knowledge score as the dependent variable to estimate factors associated with knowledge about COVID-19. Crude, sex-, and age-adjusted odds ratios (OR) were calculated. (3) Results: Participants with a better educational status had higher odds of having a higher knowledge score (OR = 2.49, 95% CI = 1.15-5.37). Similarly, healthcare providers (health students and professionals) had higher odds of having higher scores regarding knowledge about COVID-19 (OR = 1.62, 95% CI = 1.05-2.48) than other counterparts. Of the wrong answers, the most frequent was the isolation period, followed by household recommendations to prevent COVID-19 and cleaning habits. (4) Conclusions: In conclusion, our study suggests that a higher educational status and being a healthcare provider are conditions associated with superior knowledge about COVID-19. In addition, inadequate knowledge related to isolation, COVID-19 prevention, and cleaning habits were found in our study. We believe that improving awareness to address these specific COVID-19 issues through a health education campaign is a significant approach for public health policymakers to fight against COVID-19 in Brazil.

Effects of the COVID-19 pandemic on diet and physical activity and the possible influence factors among Saudi in Riyadh

Background/Aim

The COVID-19 pandemic has been spreading throughout the world, having a significant impact on people’s lifestyles and health through social isolation and home confinement. The purpose of this study is to look into the impact of COVID-19 on diet and physical activity, as well as the possible influence factors, among ≥ 13-year-olds in Riyadh, Saudi Arabia.

Materials and methods

In the present study data were collected from 2,649 participants via an online survey. The Google online questionnaire was available from April 23 to May 6, 2020. During the COVID-19 lockdown, the survey asked respondents about their demographic characteristics (gender, age, education, economic income, and occupation), anthropometric data, physical activity, and diet habits.

Results

The study included 2,649 respondents, with 23.3% being male and 76.7% female. The majority of them were in good health and ranged in age from 21 to 29 years. 31% of those polled were overweight, and 14.3% were obese. The majority of respondents have a bachelor’s degree, diploma, or the equivalent, and a monthly family income of ≤ 25.000 SR. Those who were following a healthy diet (32.3%) were unable to maintain it during confinement, with males being affected more than females (42.7%, 29.3%, respectively, P = 0.004), and those most impacted were aged 21–29 years (38.0%, P = 0.046). Furthermore, 59.5% of males significantly failed to continue exercising during confinement compared to females who exercised consistently (P = 0.01). In terms of age, females aged less than 40 increased their exercise rate by about 23.4%, while males aged 40 and up decreased their exercise rate by 25.7% (P = 0.000). Moreover, 40.5% of the subjects’ weight increased, according to the findings. However, there was no significant effect on body mass index, despite the fact that 51% of participants were overweight or obese.

Conclusion

The data showed that the COVID-19 lockdown had a negative impact on maintaining a healthy diet (p = 0.023*) and physical activity (p = 0.000^**).

Does the intubation timeline affect the in-hospital mortality of COVID-19 patients? A retrospective cohort study

Background

Effective strategies for managing coronavirus disease 19 (COVID-19) patients suffering from acute respiratory distress are constantly evolving. The timeline and threshold for transitioning from non-invasive ventilation to intermittent mandatory ventilation in critical cases who develop COVID-19-related respiratory distress are undetermined. The present research intends to investigate if emergency room intubations in COVID-19 patients affect mortality.

Methods

Between January 1, 2021 and June 30, 2021, we retrospectively reviewed chart analysis on all patients with confirmed positive COVID-19 screening and who underwent endotracheal intubation. Depending on when the intubation was performed; early in the emergency room or delayed outside the emergency room, patients were separated into two cohorts. In addition to comorbid clinical manifestations, the quick sequential organ failure assessment (qSOFA) score, and in-hospital mortality were all recorded as demographic and clinical information.

Results

Fifty-eight of the 224 corona-positive patients who underwent intubation had their intubations performed in the emergency room. Age, sex, alcohol use, and smoking status did not significantly differ between the two categories at the baseline. The mean qSOFA score was higher in the early intubation cohort (3.5; p < 0.000) along with more underlying comorbidities (3.0; p < 0.000). When compared to the late intubation cohort (45.78%), patients treated with early intubation had a significantly greater death rate (67.24%).

Conclusion

In summary, we discovered that patients who underwent intubation in the emergency units exhibited a high quick SOFA score as well as maximum co-morbid conditions than patients intubated somewhere else in the hospital. The findings of our investigation imply that intubating patients too early might be risky.

Effects of quarantine on Physical Activity prevalence in Italian Adults: a pilot study

Background

COVID-19 is a respiratory disease that caused a global pandemic status in March 2020. Due to its fast diffusion, many governments adopted forced solutions including social restrictions, which could negatively affect citizens' habits as physical activity. Our study aimed to investigate how and why the physical activity prevalence varied from the period before the quarantine up to the period after it, and understand what citizens thought of physical inactivity COVID-19 related to and whether they were satisfied with physical activity promotion during the lockdown.

Methods

A new questionnaire was created and administered online. A sample of 749 interviews (female = 552 (73.7%), male = 197 (26.3%)) was collected and analysed.

Results

The prevalence of people who were older than 50 years reduced both during and after the lockdown (P < 0.05) and the most common reason for which they have quitted physical activity practice was related to psychological problems (lockdown = 64.57%; post-lockdown = 62.17%). In addition, youngers seemed to be more sensitive than elders to unhealthy consequences generated by forced isolation (P < 0.05), and they believed that children/adolescents and older adults practised an insufficient amount of physical activity and/or sport, which could negatively impact public health.

Conclusions

Although many strategies were implemented during the lockdown to promote regular physical activity practice, several results suggested that quarantine negatively affected citizens' habits. The future government should focus on adequate measures to improve health behaviours.

Knowledge, attitude, and practice toward the COVID-19 infection among adults Iran: A cross-sectional study

Background

Coronavirus illness (COVID-19) has spread globally and is affecting everyone severely. The evaluation of educational needs (knowledge, attitudes, and practices) is important in controlling COVID-19 situations. The goal of this study is to find out what adults in Ardabil City know, how they feel, and what they do about the COVID-19 infection.

Methods

In November 2021, a cross-sectional descriptive-correlational survey of 384 people was conducted using stratified-cluster sampling in Ardabil. The researchers created a self-reported questionnaire with 23 items as the data collection technique. The quantitative data were evaluated using descriptive statistics, the chi-square test, the correlation coefficient, and regression analysis.

Results

The correct answer rate for this research found that 73.17% of participants (n = 281) had appropriate knowledge, 61.19% (n = 235) had favorable attitudes, and 69.53% (n = 267) had enough practice behavior. However, knowledge was related to gender, employment, and location of residence. Age, marital status, education level, and location of residence were all connected with attitude. Age, gender, and marital status were all related to the behavior. The findings of linear regression analysis revealed that knowledge and attitude influence behavior.

Conclusion

The study findings revealed a high degree of understanding of COVID-19, a positive attitude, and a strong commitment to good practices. Knowledge, attitudes, and behaviors were influenced to varying degrees by age, marital status, education level, employment, and location of residence. Furthermore, knowledge and attitudes influenced behaviors.

Longitudinal associations between physical activity and other health behaviours during the COVID-19 pandemic: a fixed effects analysis

Government enforced restrictions on movement during the COVID-19 pandemic are likely to have had profound impacts on the daily behaviours of many individuals, including physical activity (PA). Given the associations between PA and other health behaviours, changes in PA during the pandemic may have been detrimental for other health behaviours. This study aimed to evaluate whether changes in PA during and after the first national lockdown in the United Kingdom (UK) were associated with concurrent changes in alcohol consumption, sleep, nutrition quality, diet quantity and sedentary time. Data were derived from the UCL COVID-19 Social Study, in which 52,784 adults were followed weekly across 22 weeks of the pandemic from 23rd March to 23rd August 2020. Fixed effects regression models showed that greater PA was positively associated with improved sleep and nutrition quality. However, increases in PA also showed modest associations with increased alcohol consumption and sedentary time. Encouraging people to engage in PA may lead to wider changes in other health behaviours in times of adversity. These associations could be a result of increases in available leisure time for many people during COVID-19 restrictions and are of ongoing importance given the emerging long-term changes to lifestyle and working patterns.

Climate Changes, Natural Resources Depletion, COVID-19 Pandemic, and Russian-Ukrainian War: What Is the Impact on Habits Change and Mental Health?

Climate Change, Natural Resources Depletion, COVID-19, and Wars are some of the great challenges of our time. The consequences will affect psychological well-being and could have a harmful impact on mental health. This study aimed to assess the level of preoccupation and fears surrounding issues of the 21st-century and the implication for psychological well-being of the general population from Central/Southern Italy among different age groups. A questionnaire that included sociodemographic characteristics, topics formulated ad-hoc about preoccupation, fears, habits, and willingness to change habits in the future related to the 21st-century challenges, and the Depression Anxiety Stress Scales 21 (DASS-21) was administered online. A sample of 1831 participants (61% F; mean age 47.71 ± 17.30) was obtained. Results showed that young adults and older adults, respectively, reported greater and less psychological well-being. Young adults reported higher scores for preoccupation, changing habits, and willingness to change habits in the future, while older adults reported the lowest scores except for changing habits, also controlling for gender. Results for this variable, as well as correlations between the many variables described, rely on the specificity of age, and 21st-century challenges. Moreover, the main fears related to the 21st-century concerns were different based on both age and gender. In conclusion, the various stresses of the 21st-century discussed in this study have a relationship with personal well-being, and it is important to consider potential global mental health issues resulting from these stressors.

Resilience and Experience of the COVID-19 Pandemic among Italian University Students: A Mixed-Method Study

A vast amount of literature has highlighted that restrictions imposed by the COVID-19 pandemic, such as lockdowns and the resulting interruption of face-to-face academic activities, strongly disrupted students' daily routine and undermined their well-being. Through a mixed method approach, this study was aimed at investigating the association between students' experience of the health emergency and their resilience levels during the first pandemic outbreak. Between April and May 2020, 421 Italian university students attending Health Sciences, Humanities, and Political Sciences courses completed the Resilience Scale for Adults (RSA), provided narratives about the emergency by answering an open-ended question, and filled out a demographic questionnaire. Results showed that narratives about community/society issues were by far the most recurrent ones across disciplinary areas, while a significantly higher percentage of students from Humanities focused on study/university. Health Sciences students were more likely to provide narratives concerning social commitment, and they reported significantly higher resilience levels than Humanities students. A higher percentage of students with moderate resilience focused their narratives on the study/university domain, compared to students with high resilience. Findings suggest the importance of supporting students' resilience to counterbalance their academic concerns in both times of crisis and ordinary times.

Bibliometric analysis of the top-50 cited articles on COVID-19 and physical activity

Background

Since the 2019 novel coronavirus (COVID-19) pneumonia outbreak in late 2019, an endless stream of research has emerged surrounding physical activity. This study analyzes the 50 most influential articles on COVID-19 and physical activity over the past 2 years to describe the research landscape and hotspots from bibliometric citation analysis.

Methods

The top-50 cited articles were extracted from the Web of Science Core Collection database, and bibliometric citation analysis was performed by Excel 2019 and VOSviewer software.

Results

The top-50 articles were cited 160.48 ± 106.90 (range: 70-587). Most of the articles were from the United States (14), followed by Italy (11) and England (9). The International Journal of Environmental Research and Public Health (n = 10) is the journal with the top-50 cited articles. The collaboration between authors was mainly among three teams, including Smith L, Musumeci G, and Napoli C. The hotspot of research around COVID-19 and physical activity focused on lifestyle change (sedentary behavior, sitting time), mental health (depressive, anxiety, loneliness), the credibility of physical activity assessment tools (reliability, validity), and physical activity of different populations (gender, youth, children).

Conclusions

Based on a bibliometric analysis of high-impact articles on COVID-19 and physical activity highlights physical activity as an essential lifestyle change and developments and hotspots in this field. These data will provide insights for future researchers regarding the direction of physical activity research in the COVID-19 pandemic.

Impact of COVID-19 lockdown on smoking consumption in a large representative sample of Italian adults

OBJECTIVES

Italy is one of the first countries that imposed a nationwide stay-at-home order during the COVID-19 outbreak, inevitably resulting in changes in lifestyles and addictive behaviours. The aim of this work is to investigate the impact of lockdown restrictions on smoking habits using data collected within the Lost in Italy project.

METHODS

A web-based cross-sectional study was conducted on a representative sample of 6003 Italian adults aged 18-74 years. Study subjects were recruited from 27 April to 3 May 2020 and were asked to report changes in smoking habits before the lockdown and at the time of interview.

RESULTS

During the lockdown, 5.5% of the overall sample quit or reduced smoking, but 9.0% of the sample started, relapsed smoking or increased their smoking intensity. In total, the lockdown increased cigarette consumption by 9.1%. An improvement in smoking habits was associated with younger age, occasional smoking and unemployment, whereas a worsening was mainly associated with mental distress. In particular, an increase in cigarette consumption during lockdown was more frequently reported among those with worsening quality of life (OR: 2.05; 95% CI: 1.49 to 2.80), reduction in sleep quantity (OR: 2.29; 95% CI: 1.71 to 3.07) and increased anxiety (OR: 1.83; 95% CI: 1.38 to 2.43) and depressive symptoms (OR: 2.04; 95% CI: 1.54 to 2.71).

CONCLUSIONS

COVID-19 lockdown had a huge impact on smoking consumption of the Italian general population. The main concern is for smokers who increase their cigarette consumption due to an increased mental distress. Providing greater resources for cessation services capable of reducing mental health symptoms in smokers is urgently needed.

Food safety knowledge and risk perception among pregnant women: A cross-sectional study in Jordan during the COVID-19 pandemic

Background

Pregnant women are at a higher risk of food poisoning compared to the general population. This can be detrimental to both the mother and the fetus. This study aimed to assess the level of knowledge and risk perception of basic food safety and handling among pregnant women in Jordan amid the COVID-19 pandemic.

Methods

A descriptive cross-sectional quantitative study among pregnant women in Jordan was conducted using an online questionnaire between November 2020 and January 2021. The survey included socio-demographic data, food safety knowledge, and risk perception questions as well as COVID-19 related questions. A total score for food safety awareness out of 50 was derived for each participant based on the sum of scores from all domains. Student t-test and Analysis of Variance (ANOVA) were conducted using SPSS (Version 26) to compare the mean sum of correct responses of every section (knowledge score) by sociodemographic characteristics.

Results

A total of 325 participants completed the web-based survey. Most of the participants reported receiving food safety-related information during pregnancy (64.9%). The mean total score for the participants was 23.3 ± 4.6 out of 50 (score percentage 46.6%). Participants were mostly aware of foodborne diseases (82.7%) followed by cleaning and sanitation (51.2%), and personal hygiene (49.1%). The least amount of awareness was observed in the cross-contamination (35.0%), food consumption and safety (35.0%), and temperature control (32.8%) domains. Older participants and those with higher education had significantly higher mean scores (p &lt; 0.001). Most participants agreed that the pandemic had a positive impact on enhancing the measures taken to maintain food safety during the pandemic.

Conclusions

This study identified gaps in food safety-related knowledge. Educational programs for pregnant women need robust reinforcement within the community. Efficient educational approaches related to food safety should be provided by health care providers and local health authorities. While the COVID-19 pandemic persists, pregnant women must be well-educated about the virus and its prevention strategies to avoid being infected and ensure their baby's safety as well as their own.

University Students' Risk Perception, Protective Measures, and General Health During the COVID-19 Pandemic in Turkey

OBJECTIVE

This study aimed to investigate university students' risk perception, protective measures, and general health during the coronavirus disease 2019 (COVID-19) pandemic in Turkey.

METHODS

The research sample consisted of 1920 university students. The data were collected through an online questionnaire.

RESULTS

A total of 56.6% of the students considered their risk of being infected with the COVID-19. The number of measures taken by students was lower than expected. Students' increased anxiety perceived individual risk level, insufficient social support perceptions, and their perceptions of the current pandemic more serious than previous epidemics affect the number of measures they take. Students had sleep and study problems, and suicidal thoughts in the social isolation period. Sex, studying in medicine, anxiety related to COVID-19, feeling unconfident in coping with the pandemic, social support, were determined to be risk factors regarding general health, sleep and study problems, and suicidal thoughts.

CONCLUSIONS

The results of the study showed that the measures taken by university students were insufficient and the precautions were affected by many factors. It was determined that their health was adversely affected by the pandemic. University administrations and decision-makers should consider the risk factors to improve the students' experiences in such pandemics and emergencies.

University students' mental health amidst the COVID-19 pandemic in Georgia

AIMS

We aimed to identify the prevalence of anxiety, depression, and suicidality and identify relevant risk and protecting factors among university students during the COVID-19 pandemic in Georgia.

MATERIALS AND METHODS

We conducted an anonymous online survey (n = 984, convenience sample by approaching all universities in Georgia and some student organizations) using valid instruments (e.g., STAI to assess anxiety, CES-D for depression, and RASS to assess suicidality). We calculated frequencies and prevalence and applied regression analysis and Chi-square tests to identify risk and protecting factors.

FINDINGS

Respondents' mental health had been significantly affected (with a high prevalence of depression (46.7%) and anxiety (79%)) during the pandemic (which coincided with political turmoil and caused an economic crisis) in Georgia. Some of the critical factors affecting mental health were: female sex (p = .000), bad general health condition (anxiety p = .001, depression p = .004), finances (anxiety and depression p < .001), reduced physical activity (anxiety p < .001, depression p = .014), and a history of self-harming (suicidality p < .001). Less family conflicts (anxiety and depression p < .05), absence of nightmares (anxiety and depression p < .001), moderate or low fears of COVID-19 (anxiety p < .001), and lower substance use (anxiety p = .023) were among the potentially protective factors. International students coped better, despite vulnerability. Medical students had a lower risk of depression.

CONCLUSIONS

In the complex socioeconomic context, mental health of students in Georgia suffered a lot during the COVID-19 pandemic, requiring thorough planning and delivery of student support services in higher educational institutions during and after the pandemic.

Knowledge, attitudes, and practices towards COVID-19 among undergraduates during emergency remote learning

Background

The coronavirus disease 2019 (COVID-19) pandemic paralyzes the education sector. To minimize the interruption of teaching and learning, most universities in Malaysia shifted to virtual mode during this unprecedented period of the pandemic. With an ever-increasing number of Malaysians fully vaccinated against COVID-19, the education system is expected to switch back to face-to-face mode this year. It is crucial to assess the knowledge, attitudes, and practices (KAP) of COVID-19 among emergency remote learning undergraduates before reverting to physical teaching and learning. Hence, a study was conducted with this aim in mind.

Methods

A total of 299 Malaysian undergraduates were recruited through a snowball sampling approach. The online questionnaire encompassed three main segments: informed consent, sociodemographic information, and KAP questions on COVID-19.

Results

The mean scores for knowledge, attitude, and practice were 4.05/6, 11.14/12, and 5.07/7, respectively. The results of the present study showed that year 1 respondents had significantly higher levels (p < 0.05) of KAP scores than year 4 respondents. In addition, the attitude score of science majors respondents was significantly greater (p < 0.05) than those of nonscience majors. The KAP scores showed no significant difference among groups with different sexes, ethnicities, and COVID-19 histories. Partial correlation analysis revealed that the overall knowledge score was positively correlated with attitude (r = 0.193, p = 0.001) and practice (r = 0.343, p < 0.001) scores whereas the total attitude score was positively correlated with the total practice score (r = 0.149, p = 0.010).

Conclusion

Our current results suggest that COVID-19 workshops, seminars, or training programs for year 4 students could be conducted to enhance their KAP levels.

Lifestyle behaviors in Swedish university students before and during the first six months of the COVID-19 pandemic: a cohort study

Background

Changes in Swedish university students’ lifestyle behaviors during the COVID-19 pandemic are unknown. This study aimed to assess physical activity, sitting time, meal frequency and risk substance use (alcohol, tobacco, and illicit use of drugs) in Swedish university students before and during the first six months of the COVID-19 pandemic, for all and stratified by age and sex.

Methods

Data were obtained from the Sustainable University Life cohort study in which web-based surveys were sent to university students repeatedly for one year. Baseline assessment (before the pandemic) was between August 2019-March 2020, follow-up 1 (FU1) between March-June 2020, and follow-up 2 (FU2) between June–September 2020. Participants reported weekly minutes of physical activity, daily sitting hours, meal frequency by weekly intake of different meals, and motivation for eating irregularly, if so. Also, harmful use of alcohol, tobacco and illicit drugs was assessed. Population means and differences with 95% confidence intervals (95% CI) in lifestyle behaviors between time points were calculated with Generalized Estimating Equations.

Results

1877 students (73% women, mean age 26.5 years) answered the baseline survey. Weekly exercise decreased by -5.7 min (95% CI: -10.0, -1.5) and -7.7 min (95% CI: -12.6, -2.8) between baseline and FU1 and FU2, respectively. Weekly daily activities increased by 5.6 min (95% CI: 0.3, 11.7) and 14.2 min (95% CI: 7.9, 20.5) between baseline and FU1 and FU2. Daily sitting time decreased by -1.4 h (95% CI: -1.7, -1.2) between baseline and FU2. Breakfast intake increased by 0.2 days per week (95% CI: 0.1, 0.3) between baseline and FU2. Lunch intake decreased by -0.2 days per week (95% CI: -0.2, -0.1) between baseline and FU1 and by -0.2 days per week (95% CI: -0.3, -0.0) between baseline and FU2. Dinner intake decreased by -0.1 days per week (95% CI: -0.2, -0.0) between baseline and both FU1 and FU2. Only minor differences in risk substance use were observed. Similar changes were observed in analyses stratified by age and sex.

Conclusions

Lifestyle behaviors in Swedish university students slightly improved during the first six months of the COVID-19 pandemic compared to before.

Trial registration

ClinicalTrials.gov, NCT04465435. 10/07/2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13553-7.

Lockdown Due to COVID-19 and Its Consequences on Diet, Physical Activity, Lifestyle, and Other Aspects of Daily Life Worldwide: A Narrative Review

The novel coronavirus, termed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is responsible for the disease called coronavirus disease 2019 (COVID-19). Besides the important rates of mortality and morbidity directly attributed to the infection itself, many studies detected an important shift towards mostly unhealthy lifestyle patterns in previously healthy non-infected populations all around the world. Although most of the changes in lifestyle had or will have a negative impact on general population health status, some findings are encouraging. Notwithstanding that there was an obvious necessity for governments to apply national lockdowns, it is also necessary to identify and comprehend the consequences they have caused. A narrative literature review was performed, based on scientific articles and previous reviews. An accurate description of changes in eating habits and alcohol consumption, physical activity, mental health, daily routines, economic impacts, and broader effects on society is provided for each continent and different age groups through this review. The volume of selected scientific surveys encompasses approximately 400,000 persons.

Impact of COVID-19 on physical activity: A rapid review

Background

Physical activity is a commonly prescribed medicine for people with conditions such as obesity and diabetes who are also at increased risk of being hospitalized or severely ill from COVID-19. However, many people are reporting challenges in engaging in a healthy dose of physical activity amid the pandemic.

Objective

This rapid review synthesizes the current empirical evidence about the impacts of COVID-19 on people’s outdoor physical activity and sedentary behavior while highlighting the role of community environments in promoting or hindering physical activity during the pandemic.

Methods

Literature searches were conducted using keywords related to COVID-19: physical activity, mobility, and lifestyle behaviors. Eligibility criteria were peer-reviewed empirical and quantitative studies published in English, addressing COVID-19 and using physical activity and/or sedentary behavior as the study outcomes.

Results

Out of 61 eligible studies, the majority (78.3%) were conducted in Asian and European countries, with only four (6.7%) being US studies. The results showed that COVID-19 was linked with significant decreases in mobility, walking, and physical activity, and increases in sedentary activity. A few studies also reported contradicting results including increased uses of parks/trails and increased recreational activity among certain groups of population.

Conclusions

Evidence suggests an overall negative impact of COVID-19 on physical activity, with differential effects across different sub-populations. Significant knowledge gaps are also found in the roles of social and physical attributes that can promote physical activity during pandemics with reduced safety risks.

Differential impacts of COVID-19 pandemic on physical activity involvements and exercise habits in people with and without chronic diseases: A systematic review and meta-analysis

Objective

To conduct a systematic review and meta-analysis to summarize evidence regarding differential changes in physical activity (PA) involvements and exercise habits in people with and without chronic diseases during the COVID-19 outbreak.

Data Sources

MEDLINE, Embase, SPORTDiscus, Cumulative Index to Nursing and Allied Health, PsycINFO, Cochrane Library, and Physiotherapy Evidence Database were searched from November 2019 to May 2021.

Study Selection

Two reviewers independently screened cross-sectional and longitudinal studies that investigated changes in PA-related outcomes in people with and without chronic diseases during the pandemic.

Data Extraction

PA-related outcomes and sedentary time were extracted from the included studies. Relevant risk of bias were assessed. Meta-analyses were conducted for each PA-related outcome, if applicable. Quality of evidence of each PA-related outcome was evaluated by Grading of Recommendations Assessment, Development, and Evaluation.

Data Synthesis

Of 1226 identified citations, 36 articles (28 with and 8 without chronic diseases) with 800,256 participants were included. Moderate evidence from wearable sensors supported a significant reduction in pooled estimates of step count (standardized mean differences [SMD]=−2.79, P<.01). Very limited to limited evidence substantiated significant decreases in self-reported PA-related outcomes and significant increases in sedentary behaviors among people with and without chronic diseases. Specifically, pooled estimates of metabolic equivalent-minute per week (SMD=−0.16, P=.02) and PA duration (SMD=−0.07, P<.01) were significantly decreased, while sedentary time (SMD=0.09, P=.04) showed significant increases in the general population (small to large effects). Very limited evidence suggested no significant PA changes among people in a country without lockdown.

Conclusions

During the pandemic, objective and self-reported assessments showed significant reductions in PA in people with and without chronic diseases globally. This mainly occurred in countries with lockdowns. Although many countries have adopted the “live with the coronavirus” policy, authorities should implement population-based strategies to revert the potential lockdown-related long-term deleterious effects on people's health.

Modeling COVID-19 Mortality Across 44 Countries: Face Covering May Reduce Deaths

INTRODUCTION

Despite ongoing efforts to vaccinate communities against COVID-19, the necessity of face mask use in controlling the pandemic remains subject to debate. Several studies have investigated face masks and COVID-19, covering smaller and less diverse populations than this study's sample. This study examines a hypothesized association of face-covering mandates with COVID-19 mortality decline across 44 countries in 2 continents.

METHODS

In a retrospective cohort study, changes in COVID-19‒related daily mortality rate per million population from February 15 to May 31, 2020 were compared between 27 countries with and 17 countries without face mask mandates in nearly 1 billion (911,446,220 total) people. Longitudinal mixed effect modeling was applied and adjusted for over 10 relevant demographic, social, clinical, and time-dependent confounders.

RESULTS

Average COVID-19 mortality per million was 288.54 in countries without face mask policies and 48.40 in countries with face mask policies. In no mask countries, adjusted average daily increase was 0.1553 - 0.0017 X (days since the first case) log deaths per million, compared with 0.0900 - 0.0009 X (days since the first case) log deaths per million in the countries with a mandate. A total of 60 days into the pandemic, countries without face mask mandates had an average daily increase of 0.0533 deaths per million, compared with the average daily increase of 0.0360 deaths per million for countries with face mask mandates.

CONCLUSIONS

This study's significant results show that face mask mandates were associated with lower COVID-19 deaths rates than the rates in countries without mandates. These findings support the use of face masks to prevent excess COVID-19 deaths and should be advised during airborne disease epidemics.

Sleep, Diet, Physical Activity, and Stress during the COVID-19 Pandemic: A Qualitative Analysis

The COVID-19 pandemic has changed routines and habits, raising stress and anxiety levels of individuals worldwide. The goal of this qualitative study was to advance the understanding of how pandemic-related changes affected sleep, diet, physical activity (PA), and stress among adults. We conducted semi-structured, qualitative interviews with 185 participants and selected 33 interviews from a represented sample based on age, race, and gender for coding and analysis of themes. After coding for thematic analysis, results demonstrated four primary themes: sleep, diet, PA, and stress. Sleep sub-themes such as poorer sleep quality were reported by 36% of our participants, and 12% reported increased an frequency of vivid dreams and nightmares. PA was decreased in 52% of our participants, while 33% experienced an increase and 15% experienced no change in PA. Participants also reported having an improved diet, mostly among women. Stress was elevated in 79% of our participants and was more likely to be discussed by women. Many participants reported how stress was involved in precipitating health behavior change, especially for sleep. Increased stress was also linked to elevated anxiety and depression among participants. The results of this qualitative study demonstrate how managing stress could have a beneficial effect on promoting health behaviors and mental health during the COVID-19 pandemic and beyond.

Analyzing the factors affecting the attitude of public toward lockdown, institutional trust, and civic engagement activities

The early 2020 witnessed Coronavirus disease 2019 (COVID-19) pandemic followed by a nationwide lockdown in the whole history for the first time. The entire world had to go for nationwide lockdown to curb the spread of such contagious and deadly disease. In short, the coronavirus outbreak and the subsequent lockdown had created a storm in the world giving rise to change in public with respect to parameters like trust in the government institutions, civic engagement, and so on. In this raising dilemma, multiple countries have acknowledged the significance of trusting institutions, especially during lockdown. It is also widely accepted that lives of individuals had been undergoing change ever since the spread of COVID-19. Likewise, public's trust in the institutions is directly related to the civic engagement. Civic engagement is commonly understood as a phenomenon that develops a difference in an individual's civic life by combining values, skills, motivation, as well as knowledge. Different forms of civic engagement include national service, volunteering, societal services, and so forth. The main focus of this article is to examine the influence of COVID-19 outbreak on general attitude of the citizens of Malaysia and India, their trust on the governing institutions, and the civic engagement. In other words, this study tries to assess the impact of the pandemic on variables such as attitude toward the lockdown, trust in institutions, and civic engagement. For this, the study adopted cross-sectional community questionnaire survey in two countries-Malaysia and India. The respondents selected for the study was 1437. The respondent's demographics, attitude toward lockdown, trust in institutions, and civic engagement during the lockdown were collected by means of convenience sampling technique. Later the collected data were measured in terms of descriptive statistics and regression analysis. Findings of the study stated that public's trust in the institution can be increased by enhancing the civic activities and implementing policies that govern and build the society.

The impact of the COVID-19 pandemic on the lifestyle and behaviours, mental health and education of students studying healthcare-related courses at a British university

BACKGROUND

The COVID-19 pandemic has affected most industries, including health education. In this study, we surveyed students studying healthcare-related courses at our university on how their lifestyles and behaviours, mental health and education had been affected by the pandemic.

METHODS

Mixed methods cross-sectional study.

RESULTS

Two hundred thirty-three students responded to the questionnaire. Lifestyle and behaviours: 51.5% of the participants changed their diet (n=120); 45.5% (n=106) exercised less; 66.5% (n=155) experienced a change in sleep; 51.1% (n=119) reported a change in appetite. Mental health: 84.2% (n=196) reported worrying too much about different things; 61.9% (n=144) could not stop or control worrying; 71.2% experienced trouble relaxing on several days or more (n=166). At least sometimes, 72.1% (n=168) felt unable to cope with things they had to do; 8.5% (n=20) never, or almost never, felt confident about handling personal problems. Education: 65.7% (n=153) struggled to complete learning outcomes with online delivery; 82% (n=191) worried about practical skills being affected; 60.5% (n=141) worried about the impact of COVID-19 on their future career. Almost half (48.9%, n=114) believed that online teaching should be part of the standard curriculum.

CONCLUSION

In general, there was a negative impact on behaviours, lifestyle and mental health and virtual education was perceived as necessary in making up for the loss of face to face experiences. Students' mental health and educational needs have been affected by the current pandemic and healthcare educational facilities must respond to these needs to ensure students continue to receive the support they need.

Variability in Physical Inactivity Responses of University Students during COVID-19 Pandemic: A Monitoring of Daily Step Counts Using a Smartphone Application

This study investigated the changes in physical inactivity of university students during the COVID-19 pandemic, with reference to their academic calendar. We used the daily step counts recorded by a smartphone application (iPhone Health App) from April 2020 to January 2021 (287 days) for 603 participants. The data for 287 days were divided into five periods based on their academic calendar. The median value of daily step counts across each period was calculated. A k-means clustering analysis was performed to classify the 603 participants into subgroups to demonstrate the variability in the physical inactivity responses. The median daily step counts, with a 7-day moving average, dramatically decreased from 5000 to 2000 steps/day in early April. It remained at a lower level (less than 2000 steps/day) during the first semester, then increased to more than 5000 steps/day at the start of summer vacation. The clustering analysis demonstrated the variability in physical inactivity responses. The inactive students did not recover daily step counts throughout the year. Consequently, promoting physical activity is recommended for inactive university students over the course of the whole semester.

Effects of Health Belief, Knowledge, and Attitude toward COVID-19 on Prevention Behavior in Health College Students

This study aimed to identify the factors affecting the practice of COVID-19 prevention behaviors among college students as future medical workers. A cross-sectional online survey was conducted in September 2021. A total of 526 health college students were included in this study. A hierarchical regression analysis was performed to examine the effect on the practice of COVID-19 prevention behavior. As a result of the analysis, experiences of education on infectious diseases had significant positive effects on the practice of prevention behavior (β = 0.22, p < 0.001). Additionally, a higher COVID-19 health belief had a significant positive effect on the practice of prevention behavior (β = 0.15, p = 0.004). Increased smoking and drinking among lifestyle changes after COVID-19 had significant negative effects on the practice of prevention behavior compared with decreased physical activity (β = -0.12, p = 0.007). Based on these findings, the study discussed the importance of education on the prevention of infectious diseases among health college students, promotion of health beliefs related to infectious diseases, and formation of healthy lifestyle habits in daily life.

The COVID-19 Conundrum: Keeping safe while becoming inactive. A rapid review of physical activity, sedentary behaviour, and exercise in adults by gender and age

Background

Coronavirus (COVID-19) has severely impacted lifestyles worldwide. Responses to COVID-19 have intentionally restricted the factors that encourage regular and frequent PA; opportunity, capability and motivation. However, the effects of these restrictions are likely to have differed by gender and age and different intensities of PA. This rapid review builds on previous evidence by synthesising the global impact of COVID-19 on adult PA through specific intensities and types of PA and evaluating this by gender and age.

Methods

A rapid systematic search of seven electronic databases (PubMed, MEDLINE, CINAHL, SPORTDiscus, Academic Search Complete, APA PsycInfo, and APA PsycArticles) was performed from December 2019 to January 2021. Studies investigating adult change in PA, exercise or sedentary behaviour due to COVID-19 were included.

Results

From an initial database search identifying 3,863 articles, 66 remained for synthesis after applying eligibility criteria. Results demonstrate decreases among all intensities and types of PA—walking (6 out of 7 papers), moderate-only (5 out of 6 papers), vigorous-only (5 out of 6 papers) and MVPA (4 out of 5 papers); as well as overall PA (14–72% participants reported a decrease). Reflecting that COVID-19 responses were designed to have universal effects, they also achieved whole-society decreases in PA behaviour, accented in older age groups.

Conclusion

There is a universal need to address the low levels of PA post-COVID-19. The consequences of decreased PA across all intensities has powerful, potentially recoverable, impacts. Universal declines have implications for public health officials and PA advocates for post-COVID-19 initiatives to promote PA.

A cross-sectional virtual survey to evaluate the outcome of online dental education system among undergraduate dental students across India amid COVID-19 pandemic

PURPOSE

A questionnaire-based study was conducted to understand the pros and cons of online education among undergraduate dental students across India. The study was also proposed to assess the mental and physical well-being of the students amid the COVID-19 pandemic lockdown.

METHODS

A total of 533 undergraduate dental students across India participated in a cross-sectional study by means of virtual survey. A self-designed questionnaire was created using google forms. The questionnaire consisted of 25 questions and was divided into two parts, first, regarding the academic outcome of online dental education and second, psychological and physical well-being of the students in reference to online dental education. A descriptive statistical analysis was done using IBM SPSS statistics software.

RESULTS

In the present study, 91.6% students reported that the format of dental education was shifted to online lectures due to the COVID-19 pandemic. 86.4% students suggested that they preferred offline lectures rather than online lectures. Psychological and physical well-being were affected in both male and female students; however, male students were affected more significantly than females.

CONCLUSION

The study concluded that the education of dental students was adversely affected as a result of COVID-19 pandemic. The physical and psychological well-being of the students has also been affected, with males being affected in a higher proportion. The study concluded that the quality of online education should be enhanced and must be student centred to meet their education requirements. Also, there is a need of regular counselling and other measures to alleviate the students from the psychological stresses.

The Evaluation of Physical Activity Habits in North Italian People before and during COVID-19 Quarantine: A Pilot Study

COVID-19 caused a global pandemic state. Many governments enforced quarantines which had several negative effects on peoples’ health. The present study aimed to investigate the social restriction effects on the physical activity (PA) habits of north Italian people and understand whether PA was a healthy support during lockdown. Moreover, it analysed some possible strategies which could promote an active lifestyle when the pandemic ends. A new questionnaire was proposed (Cronbach’s alpha = 0.816), and 309 surveys were collected in people from two Italian regions (53.72% from Emilia-Romagna and 46.28% from Veneto; 62.46% were female and 37.54% were male; and the age range was 46.67 ± 15.45 years). The number of younger people (≤25 years) who practiced PA increased during lockdown (p < 0.01); in addition, they were more active than people who were 26–35 years old (p < 0.001). The training frequency before COVID-19 was higher in females than males (p = 0.01), and the frequency of weekly PA increased during lockdown in groups aged 26–35 years (p < 0.001). Despite the fact that PA was a psychological support during lockdown (p < 0.001), performing forced home-based PA demotivated people (p < 0.001). Finally, people thought to practice outdoor PA (OPA) at the end of lockdown because they wanted to retain contact with nature, which can improve psychological well-being. Future strategies to promote OPA may increase participation in PA, especially in older people.

Systematic review of the effects of pandemic confinements on body weight and their determinants

Pandemics and subsequent lifestyle restrictions such as ‘lockdowns’ may have unintended consequences, including alterations in body weight. This systematic review assesses the impact of pandemic confinement on body weight and identifies contributory factors. A comprehensive literature search was performed in seven electronic databases and in grey sources from their inception until 1 July 2020 with an update in PubMed and Scopus on 1 February 2021. In total, 2361 unique records were retrieved, of which forty-one studies were identified eligible: one case–control study, fourteen cohort and twenty-six cross-sectional studies (469, 362 total participants). The participants ranged in age from 6 to 86 years. The proportion of female participants ranged from 37 % to 100 %. Pandemic confinements were associated with weight gain in 7·2–72·4 % of participants and weight loss in 11·1–32·0 % of participants. Weight gain ranged from 0·6 (sd 1·3) to 3·0 (sd 2·4) kg, and weight loss ranged from 2·0 (sd 1·4) to 2·9 (sd 1·5) kg. Weight gain occurred predominantly in participants who were already overweight or obese. Associated factors included increased consumption of unhealthy food with changes in physical activity and altered sleep patterns. Weight loss during the pandemic was observed in individuals with previous low weight, and those who ate less and were more physically active before lockdown. Maintaining a stable weight was more difficult in populations with reduced income, particularly in individuals with lower educational attainment. The findings of this systematic review highlight the short-term effects of pandemic confinements.

Self-Assessment of Health Status and Willingness to Be Vaccinated in Adolescents from the Niigata Prefecture and the Khabarovsk Region during COVID-19

This study examined the self-assessment of Niigata’s and Khabarovsk’s adolescents’ health status and their willingness to be vaccinated during the COVID-19 pandemic. A self-reported questionnaire was administered to 735 boys and girls (aged 15 years) from Niigata, Japan (n = 387), and Khabarovsk, Russia (n = 394), between May and July 2021. Specifically, this questionnaire focused on COVID-19, including a self-assessment of health status, adaptation to a new lifestyle, and impressions about the COVID-19 vaccination. The self-assessment was based on a 4-point scale: “Got very bad”; “Got a little bit bad”; “Did not change”; “Got better/I don’t know”. Additionally, binomial logistic regression was conducted to determine the association between the self-assessment of health status and the factors exacerbating their responses. Based on the findings, 25.7 and 29.9% of Niigata and Khabarovsk’s adolescents, respectively, selected “Got very bad” and “Got a little bit bad” for their self-assessments, while the binomial logistic regression showed that the difficulty of adapting to a new lifestyle was a factor worsening the boys’ subjective health. However, the items could not explain the deterioration of their subjective health in girls. Moreover, 76.9% of Niigata’s adolescents were positive about the COVID-19 vaccination, compared to 35.5% of the adolescents in Khabarovsk.

Student-, Study- and COVID-19-Related Predictors of Students' Smoking, Binge Drinking and Cannabis Use before and during the Initial COVID-19 Lockdown in The Netherlands

Tobacco, alcohol and cannabis are commonly used among university students. However, student lives and their substance use have changed dramatically since the start of the COVID-19 pandemic. This study investigated the impact of COVID-19 on (trends in) weekly smoking, weekly binge drinking and weekly cannabis use in Dutch university students and investigated associated student-, study- and COVID-19-related characteristics. Between April and June 2020, several Dutch higher educational institutes invited their students to participate in an online survey. Data of 9967 students (M_age = 22.0 (SD = 2.6); N_female = 7008 (70.3%)) were available for analyses. Overall, weekly smoking remained stable (±11.5%), weekly binge drinking decreased (from 27.8% to 13.9%) and weekly cannabis use increased (from 6.7% to 8.6%). Male gender, not living with parents, being a bachelor student, having less financial resources and less adherence to the COVID-19 measures were found to increase the risk of substance use (before/during the first COVID-19 lockdown). Additionally, male gender, not living with parents, being a bachelor student, not being born in the Netherlands and having a student loan contributed to the likelihood of increased substance use during COVID-19. Patterns of characteristics contributing to the likelihood of decreased weekly substance use during COVID-19 were less clear. The risk factors male gender, not living with parents and being a bachelor student do not only contribute to the likelihood of using substances but also contribute to the likelihood of increased use during a lockdown. Prevention and intervention programs should especially target these risk groups.

Knowledge, Perceived Risk, and Preventive Behaviors amidst Covid-19 Pandemic among Dental Students in Malaysia

PURPOSE

Coronavirus disease 19 (COVID-19) has affected dental education in Malaysia. However, studies on dental students' knowledge, perception, and behaviors with regards to COVID-19 are very limited. Thus, this study aims to determine the knowledge status, perceived risk, and preventive behaviors of dental students in Malaysia regarding COVID-19.

METHODS

A cross-sectional study was conducted among students from 13 dental schools across Malaysia using online questionnaires.

RESULTS

From 355 respondents, 93.5% obtained a high score of knowledge of COVID-19. Female respondents scored higher than males in perceived risks and preventive behaviors. Chinese respondents scored highest in knowledge, while Malay respondents had the highest perceived risk score. The mean preventive behavior score did not vary across ethnicity. On-campus students scored higher in knowledge and perceived risk whereas off-campus students practiced more preventive behaviors. Clinical students' knowledge score was higher than preclinical students. Final year students scored higher in knowledge and perceived risk compared to their juniors.

CONCLUSION

The majority of dental students have good knowledge and a high perceived risk of COVID-19, and they practiced most of the preventive behaviors. However, the latest information on this disease should be incorporated into dental schools' curriculums and updated periodically.