When one door closes: a qualitative exploration of women's experiences of access to sexual and reproductive health services during the COVID-19 lockdown in Nigeria

BACKGROUND

COVID-19 pandemic widely disrupted health services provision, especially during the lockdown period, with females disproportionately affected. Very little is known about alternative healthcare sources used by women when access to conventional health services became challenging. This study examined the experiences of women and adolescent girls regarding access to sexual and reproductive health (SRH) services during the COVID-19 lockdown in Nigeria and their choices of alternative healthcare sources.

METHODS

The study sites were two northern states, two southern states, and the Federal Capital Territory. Qualitative data were obtained through 10 focus group discussion sessions held with married adolescents, unmarried adolescents, and older women of reproductive age. The data were transcribed verbatim and analysed using a thematic approach and with the aid of Atlas ti software.

RESULTS

Women reported that access to family planning services was the most affected SRH services during the COVID-19 lockdown. Several barriers to accessing SRH services during COVID-19 lockdown were reported, including restriction of vehicular movement, harassment by law enforcement officers, fear of contracting COVID-19 from health facilities, and fear of undergoing compulsory COVID-19 tests when seeking care in health facilities. In the face of constrained access to SRH services in public sector facilities during the COVID-19 lockdown, women sought care from several alternative sources, mostly locally available and informal services, including medicine vendors, traditional birth attendants, and neighbours with some health experience. Women also widely engaged in self-medication, using both orthodox drugs and non-orthodox preparations like herbs. The lockdown negatively impacted on women's SRH, with increased incidence of sexual- and gender-based violence, unplanned pregnancy resulting from lack of access to contraceptives, and early marriage involving adolescents with unplanned pregnancies.

CONCLUSION

COVID-19 negatively impacted access to SRH services and forced women to utilise mostly informal service outlets and home remedies as alternatives to conventional health services. There is a need to ensure the continuity of essential SRH services during future lockdowns occasioned by disease outbreaks. Also, community systems strengthening that ensures effective community-based health services, empowered community resource persons, and health-literate populations are imperative for overcoming barriers to healthcare access during future lockdowns.

Nitrogen isotopic characteristics of aerosol ammonium in a Chinese megacity indicate the reduction from vehicle emissions during the lockdown period

The role of agricultural versus vehicle emissions in urban atmospheric ammonia (NH3) remains unclear. The lockdown due to the outbreak of COVID-19 provided an opportunity to assess the role of source emissions on urban NH3. Concentrations and δ15N of aerosol ammonium (NH4+) were measured before (autumn in 2017) and during the lockdown (summer, autumn, and winter in 2020), and source contributions were quantified using SIAR. Despite the insignificant decrease in NH4+ concentrations, significantly lower δ15N-NH4+ was found in 2020 (0.6 ± 1.0‰ in PM2.5 and 1.4 ± 2.1‰ in PM10) than in 2017 (15.2 ± 6.7‰ in PM2.5), which indicates the NH3 from vehicle emissions has decreased by∼50% during the lockdown while other source emissions are less affected. Moreover, a reversed seasonal pattern of δ15N-NH4+ during the lockdown in Changsha has been revealed compared to previous urban studies, which can be explained by the dominant effect of non-fossil fuel emissions due to the reductions of vehicle emissions during the lockdown period. Our results highlight the effects of lockdown on aerosol δ15N-NH4+ and the importance of vehicle emissions to urban atmospheric NH3, providing conclusive evidence that reducing vehicle NH3 emissions could be an effective strategy to reduce PM2.5 in Chinese megacities.

Machine learning insights into PM2.5 changes during COVID-19 lockdown: LSTM and RF analysis in Mashhad

This study seeks to investigate the impact of COVID-19 lockdown measures on air quality in the city of Mashhad employing two strategies. We initiated our research using basic statistical methods such as paired sample t-tests to compare hourly PM2.5 data in two scenarios: before and during quarantine, and pre- and post-lockdown. This initial analysis provided a broad understanding of potential changes in air quality. Notably, a low reduction of 2.40% in PM2.5 was recorded when compared to air quality prior to the lockdown period. This finding highlights the wide range of factors that impact the levels of particulate matter in urban settings, with the transportation sector often being widely recognized as one of the principal causes of this issue. Nevertheless, throughout the period after the quarantine, a remarkable decrease in air quality was observed characterized by distinct seasonal patterns, in contrast to previous years. This finding demonstrates a significant correlation between changes in human mobility patterns and their influence on the air quality of urban areas. It also emphasizes the need to use air pollution modeling as a fundamental tool to evaluate and understand these linkages to support long-term plans for reducing air pollution. To obtain a more quantitative understanding, we then employed cutting-edge machine learning methods, such as random forest and long short-term memory algorithms, to accurately determine the effect of the lockdown on PM2.5 levels. Our models' results demonstrated remarkable efficacy in assessing the pollutant concentration in Mashhad during lockdown measures. The test set yielded an R-squared value of 0.82 for the long short-term memory network model, whereas the random forest model showed a calculated cross-validation R-squared of 0.78. The required computational cost for training the LSTM and the RF models across all data was 25 min and 3 s, respectively. In summary, through the integration of statistical methods and machine learning, this research attempts to provide a comprehensive understanding of the impact of human interventions on air quality dynamics.

The impact of the COVID-19 pandemic on the mood and family relationships of runners

Introduction

The aim of this study was to analyze the impact of the COVID-19 lockdown on the mood of amateur runners and on their relationships with their partners and families.

Methods

Adult runners 18 years or older (N = 260) completed an online survey that included demographic information, standardized psychological assessments of Exercise Dependence (EDS-R) and mood (POMS), and, to measure relationship functioning, either the Dyadic Adjustment Scale (DAS) if they did not have children, or the Basic Family Evaluation Questionnaire (CERFB), measuring conjugal and parental relationships. Participants also answered questions about their exercise habits and the coping strategies they adopted during lockdown.

Results

The results suggest that runners who saw the largest reductions in time spent exercising during lockdown tended to feel significantly less energetic (p < 0.05) and friendly (p < 0.01). In addition, they recorded significantly lower scores in marital satisfaction with their peers (p < 0.05). The runners with a higher degree of dependence on physical exercise registered significantly higher levels of depression, tension and anger than non-dependent runners (p < 0.001). Runners whose partners were physically active and did not have children had significantly higher scores marital satisfaction than runners whose partners were not physically active and had children (p < 0.05).

Discussion

These findings seem to indicate that the psychological approach to athletes in the context of crises such as the pandemic should consider not only individual aspects, but also include the family perspective.

Quantifying the impact of urban road traffic on air quality: activity pre-pandemic and during partial and full lockdowns

The impact of partial and full COVID lockdowns in 2020 on vehicle miles traveled (VMT) in Kuwait was estimated using data extracted from the Directions API of Google Maps and a Python script running as a cronjob. This approach was validated by comparing the predictions based on the app to measuring traffic flows for 1 week across four road segments considered in this study. VMT during lockdown periods were compared to VMT for the same calendar weeks before the pandemic. NOx emissions were estimated based on VMT and were used to simulate the spatial patterns of NOx concentrations using an air quality model (AERMOD). Compared to pre-pandemic periods, VMT was reduced by up to 25.5% and 42.6% during the 2-week partial and full lockdown episodes, respectively. The largest reduction in the traffic flow rate occurred during the middle of these 2-week periods, when the traffic flow rate decreased by 35% and 49% during the partial and full lockdown periods, respectively. The AERMOD simulation results predicted a reduction in the average maximum concentration of emissions directly related to VMT across the region by up to 38%, with the maximum concentration shifting to less populous residential areas as a result of the lockdown.

Patterns and outcomes of acute toxicological cases before, during, and after COVID-19 lockdown in Sohag University hospitals, Egypt

Background

Toxicologists manage poisoning by preventing, detecting, and treating it, which requires continuous data collection and analysis of toxicological hazards.

Aim of the work

The study aims to report and compare the pattern and outcome of acute toxicological cases admitted to Sohag University Hospitals during the COVID-19 lockdown (2020-2021) with the year before (2019) and the year after (2022).

Methods

This comparative study reviewed the sociodemographic and clinical data in the medical records. The study showed that Sohag University Hospitals received 670 toxicological cases between 2019 and 2022; 105 cases in 2019, 347 cases in 2020-2021, and 218 cases in 2022.

Results

Most of patients were below seven years with no sex differences. Accidental poisoning was the most frequent toxicity. The oral route was the most common in the three studied periods. During the lockdown, metal phosphide was the most frequent (19.0%), while therapeutic agents were the most reported after the lockdown (23.9%). The delay time showed a significant difference between the studied periods (p-value < 0.001). In the three studied periods, complete recovery was achieved in more than 70% of cases; however, the mortality rate and the rate of complications during the lockdown period (10.4% and 9.5%, respectively) were almost twice those of the year before and the year after the pandemic with significant odds ratio of mortality during pandemic (OR) 0.07 CI 95% (0.02, 0.11).

Conclusion

The pandemic had a bad impact on outcomes as showed the highest percentage of mortality compared to before and after COVID-19 periods.

Crop residue burning increased during the COVID-19 lockdown: A case study of rural India

The customary practice of crop residue burning (CRB) is a major policy concern across several developing economies because of the associated increase in air pollution and reduction in soil quality. CRB poses a hazard to public health and sustainable farmland management. We collected original survey data from a panel of 400 wheat farmers on CRB choices during April-May of 2019 and 2020 - with the latter coinciding with India's COVID-19 nationwide lockdown. This timeline of events facilitated a unique identification of changes in CRB that are attributable to the lockdown. Several studies find that lockdowns during 2020 had beneficial effects on the environment owing to reduced economic activity. However, our findings indicate that CRB may have unintentionally increased during the lockdown. A binary variable regression framework analyzes the determinants of CRB choices of farmers over two years. We control for farmers' opinions on various socioeconomic aspects of the pandemic lockdown to examine its effects on their CRB decisions. The lockdown significantly increased the likelihood of CRB by up to 12%. Furthermore, farmers who lost agricultural income and those compelled to sell assets during the lockdown were 22% and 19% more inclined, respectively, to choose CRB. Labor mobility ceased during the lockdown and increased the cost of environmentally friendly farmland management; this increased the likelihood of CRB by 6%. This study contributes to a growing literature on the unintentional consequences of pandemic lockdowns.

Comparative analysis of the pattern of intimate partner violence against women admitted to a tertiary hospital in Sri Lanka during and after the periods of COVID-19 lockdown

Lockdown measures during the COVID-19 pandemic resulted in restrictions on people's ability to move, allowing more time for intimate partners-this increased opportunities for intimate partner violence (IPV), especially against women. The study aimed to evaluate the characteristics of IPV against women during and after the lockdown period. A prospective, descriptive study on female victims of IPV presented from March 2020 to February 2022 to a leading teaching hospital in Sri Lanka. Out of the 876 patients admitted during the period, details could be obtained from 300 victims. Ninety-four (31%) were during the lockdown, while 206 (69%) were post-lockdown admissions. The mean age of the victim in both groups was 33.5 years. Even though physical abuse was high throughout, the prevalence of sexual abuse was significantly higher (p < 0.0001) during the lockdown period (31.9%) than during the post-lockdown period (3.4%). Financial problems (46.6%), followed by substance abuse (35%), were the most common risk factors during the post-lockdown period, while morbid jealousy (34%) was the most common risk factor, followed by extramarital relationships (33%) during the lockdown. Psychological consequences due to IPV were observed in 76.5% of victims during the lockdown period and only 11.2% during the post-lockdown period. The prolonged lockdown has significantly influenced mental and sexual health, changing the pattern of IPV against women. The need to have services to ensure the mental and sexual well-being of the community was highlighted.

Preoperative aerobic fitness and perioperative outcomes in patients undergoing cystectomy before and after implementation of a national lockdown

Background

Lower fitness is a predictor of adverse outcomes after radical cystectomy. Lockdown measures during the COVID-19 pandemic affected daily physical activity. We hypothesised that lockdown during the pandemic was associated with a reduction in preoperative aerobic fitness and an increase in postoperative complications in patients undergoing radical cystectomy.

Methods

We reviewed routine preoperative cardiopulmonary exercise testing (CPET) data collected prior to the pandemic (September 2018 to March 2020) and after lockdown (March 2020 to July 2021) in patients undergoing radical cystectomy. Differences in CPET variables, Postoperative Morbidity Survey (POMS) data, and length of hospital stay were compared.

Results

We identified 267 patients (85 pre-lockdown and 83 during lockdown) who underwent CPET and radical cystectomy. Patients undergoing radical cystectomy throughout lockdown had lower ventilatory anaerobic threshold (9.0 [7.9-10.9] vs 10.3 [9.1-12.3] ml kg-1 min-1; P=0.0002), peak oxygen uptake (15.5 [12.9-19.1] vs 17.5 [14.4-21.0] ml kg-1 min-1; P=0.015), and higher ventilatory equivalents for carbon dioxide (34.7 [31.4-38.5] vs 33.4 [30.5-36.5]; P=0.030) compared with pre-lockdown. Changes were more pronounced in males and those aged >65 yr. Patients undergoing radical cystectomy throughout lockdown had a higher proportion of day 5 POMS-defined morbidity (89% vs 75%, odds ratio [OR] 2.698, 95% confidence interval [CI] 1.143-6.653; P=0.019), specifically related to pulmonary complications (30% vs 13%, OR 2.900, 95% CI 1.368-6.194; P=0.007) and pain (27% vs 9%, OR 3.471, 95% CI 1.427-7.960; P=0.004), compared with pre-lockdown on univariate analysis.

Conclusions

Lockdown measures in response to the COVID-19 pandemic were associated with a reduction in fitness and an increase in postoperative morbidity among patients undergoing radical cystectomy.

Alternations of antibiotic resistance genes and microbial community dynamics on shared bicycles before and after pandemic lockdown

The prevalence of shared bicycles has raised concerns over their potential to transmit pathogens and microbes harboring antibiotic resistance genes (ARGs), which pose significant human health risks. This study investigated the impact of anthropogenic activities on the composition of ARGs and microbial communities on shared bicycles during the COVID-19 pandemic and subsequent lockdown when shared bicycle usage was altered. A total of 600 swab samples from shared bicycle surfaces were collected in Shanghai before and during COVID-19 lockdown periods. Even during lockdown, 12 out of 14 initially detected ARG subtypes persisted, indicating their tenacity in the face of reduced anthropogenic activities. These ARGs displayed significantly higher absolute and relative abundance levels before the lockdown. In addition, the percentage of potential pathogens in the total microbial abundance remained at 0.029 % during the lockdown, which was lower than the pre-lockdown percentage of 0.035 % and suggested that these risks persist within shared bicycle systems. Interestingly, although microbial abundance decreased without the consecutive use of shared bicycles during lockdown, the microbial diversity increased under the impact of restricted anthropogenic activities (p < 0.001). This emphasizes the need for continuous monitoring and research to comprehend microbial community behaviors in various environments. This study uncovered the underlying impacts of the COVID-19 lockdown on the microbial and ARG communities of shared bicycles, providing comprehensive insights into the health management of shared transportation. Although lockdown can decrease the abundance of ARGs and potential pathogens, additional interventions are needed to prevent their continued spread.

Face masks in action: Birds show reduced fear responses to people wearing face masks during the COVID-19 pandemic in three Asian countries

The 2019 zoonotic pandemic (COVID-19), has led to a massive global lockdown that provides a good opportunity to study how wildlife responds to changes in human activity. Wearing a mask after the COVID-19 outbreak was widely used to prevent the spread of the causative pathogen. It has been shown that tree sparrows (Passer montanus) at two sites in south China exhibit reduced fear responses to people with face masks after a period of heavy exposure to them, whereas European studies showed the opposite, with no changes in the behaviour of the birds towards mask wearers in either rural or urban areas. To further study this, from October 2021 to January 2022, we conducted a flight initiation distance (FID) survey in Pakistan, Bangladesh, and Xi'an, China for a variety of field bird species by comparing the FID for researchers wearing masks to that for researchers not wearing masks to assess whether wearing masks in public places caused birds to adjust their flight response. Results from the three Asian countries showed that after a period of sustained contact with people wearing masks, in both rural and urban areas, birds were significantly more adapted to them and had a shorter FID to people wearing masks. We suggest that the rapid habituation of birds to people wearing masks with a reduced fear response could have some fitness advantage, allowing them to adapt rapidly to the new environmental conditions induced by COVID-19.

[Impacts of Anthropogenic Emission Reduction on Urban Atmospheric Oxidizing Capacity During the COVID-19 Lockdown]

In recent years， regional compound air pollution events caused by fine particles （PM2.5） and ozone （O3） have occurred frequently in economically developed areas of China， in which atmospheric oxidizing capacity （AOC） has played an important role. In this study， the WRF-CMAQ model was used to study the impacts of anthropogenic emission reduction on AOC during the COVID-19 lockdown period. Three representative cities in eastern China （Shijiazhuang， Nanjing， and Guangzhou） were selected for an in-depth analysis to quantify the contribution of meteorology and emissions to the changes in AOC and oxidants and to discuss the impact of AOC changes on the formation of secondary pollutants. The results showed that， compared with that in the same period in 2019， the urban average AOC in Shijiazhuang， Nanjing， and Guangzhou in 2020 increased by 60%， 48.7%， and 12.6%， respectively. The concentrations of O3， hydroxyl radical （·OH）， and nitrogen trioxide （NO3·） increased by 1.6%-26.4%， 14.8%-73.3%， and 37.9%-180%， respectively. The AOC in the three cities increased by 0.06×10-4， 0.12×10-4， and 0.33×10-4 min-1， respectively， due to emission reduction. The meteorological change increased AOC in Shijiazhuang and Nanjing by 20% and 17.9%， respectively， but decreased AOC in Guangzhou by -9.3%. Enhanced AOC led to an increase in the nitrogen oxidation ratio （NOR） and VOCs oxidation ratio （VOR） and promoted the transformation of primary pollutants to secondary pollutants. This offset the effects of primary emission reduction and resulted in a nonlinear decline in secondary pollutants compared to emissions during the COVID-19 lockdown.

Impact of the COVID-19 Pandemic on the Use of Antidepressants by Young Adults in the ASL TO4 Regione Piemonte (Italy)

The association between younger age and poorer mental health during the COVID-19 pandemic has been documented. Whether these changes were associated with a change in antidepressant (AD) use is not well understood. This study aimed to estimate the impact of the COVID-19 pandemic on AD use by young adults in the ASL TO4 Regione Piemonte (Italy). The impact of the pandemic on the weekly prevalence of AD users was assessed using interrupted time-series analysis with autoregressive integrated moving average models. A total of 1071 subjects (18-22 years with ≥1 AD dispensation) were included in the study. The observed prevalence was lower than the predicted value for several weeks after the introduction of the lockdown. However, it was consistently higher than the predicted values from week 134. The maximum difference between observed and predicted values (25 subjects per 10,000 young adults) was found at week 170. Changes in AD use were observed in both genders and were more pronounced for selective serotonin reuptake inhibitors. In conclusion, the impact of the COVID-19 pandemic on the mental health of young adults is likely to be significant in the coming years, which may place a future burden on pharmaceutical public health and community health.

Impact of two COVID-19 lockdowns on HbA1c levels in patients with type 2 diabetes and associations with patient characteristics: a multicentre, observational cohort study over three years

Introduction

Glycemic effects of COVID-19 lockdowns on patients with type 2 diabetes (T2D) are controversial. In this long-term observation, we aimed (1) to analyze changes in HbA1c levels during lockdowns in Germany, and (2) to investigate whether diabetes medication, comorbidities, and sociodemographic data influenced these changes.

Materials and methods

This cohort study observed 1,089 patients aged ≥18 years over the years 2019 to 2021. Patients were recruited from 14 physicians specialized on diabetes. As dependent variable, 7,987 HbA1c values were analyzed by multivariable linear regression adjusted for random effects of physicians and patients.

Results

Patients had a median age of 68 (60/76) years and 623 (57.2%) were male. Before the pandemic, median HbA1c level (in %) was 6.9 (6.3/7.7). Average HbA1c level increased during first lockdown (0.21,0.11/0.31,p < 0.001), after first lockdown (0.23,0.18/0.28,p < 0.001), during second lockdown (0.40,0.33/0.47,p < 0.001) and after second lockdown (0.27,0.18/0.36,p < 0.001). The increase of HbA1c levels was more pronounced in male patients (0.08,0.01/0.15,p = 0.019), if patients did not have German as native language (0.12,0.01/0.23,p = 0.041) and if they were widowed (0.19,0.05/0.32,p = 0.008). End organ damages (0.12,0.01/0.23,p = 0.039), atherosclerotic cardiovascular disease (ASCVD; 0.23,0.10/0.36,p = 0.001) and cardiovascular events (0.25,0.10/0.40,p = 0.001) as well as oral medication (0.09,0.03/0.15,p = 0.002), intermediate- or long-acting insulins (0.24,0.16/0.32,p < 0.001), and fast-acting or mixed insulins (0.30,0.23/0.36,p < 0.001) were also related to a greater increase in HbA1c levels.

Conclusion

Both lockdowns resulted in a significant increase in HbA1c levels. In particular, patients with ASCVD, cardiovascular events, and insulin therapy appear to be at risk for worsening glycemic control in crisis and thus require special medical attention.

Clinical Trial Registration

ClinicalTrials.gov (NCT04821921).

Depression in medical students during the COVID-19 lockdown in Greece

The COVID-19 pandemic has caused a mental health crisis. The purpose of this study was to estimate the prevalence of depression in medical students in Greece during a nationwide lockdown. The secondary aims were to assess the association of depression with socio-demographic factors and students' attitudes regarding the quality of their studies. The data was gathered anonymously through a self-administered online questionnaire between January 11 and 27, 2021. The CES-D scale was used to measure depression rates. Multiple logistic regression was used to identify factors independently associated with depression. Analyses were conducted using Stata version 16.0 and the IBM® SPSS® software. In total, 978 sixth- and fifth-year medical students participated; their mean age was 23.2 years and 65.6% were females. The prevalence of clinical depression was 21.3% (95% CI: 18.7%, 24.0%), whereas 17.9% (95% CI: 15.5%, 20.4%) experienced severe distress. Depression was more prevalent in females (25.4% vs 13.1% in males, p<0.001). Approximately half (53.4%) of the participants reported a change in plans regarding their medical career due to the pandemic and 16.9% expressed a decreased willingness to practice medicine. Factors independently associated with depression were female gender, living alone or with housemates at high risk for COVID-19, being anxious about becoming infected with SARS-CoV-2, studying in one of the three largest medical schools, negatively evaluating the adjustment of the teaching personnel to online teaching and the university's response to the pandemic. The findings of this study report depression in one out of five medical students during the COVID-19 pandemic, highlighting the need to protect the most vulnerable medical students during a pandemic. Medical students must be able to seek professional mental health services, even in the era of a pandemic. Universities should increase accessibility to support services and provide a student-centered approach in their strategies, as the pandemic has placed a spotlight on an existing phenomenon.

Revisiting the dynamics of gaseous ammonia and ammonium aerosols during the COVID-19 lockdown in urban Beijing using machine learning models

The concentration of atmospheric ammonia (NH3) in urban Beijing substantially decreased during the COVID-19 lockdown (24 January to 3 March 2020), likely due to the reduced human activities. However, quantifying the impact of anthropogenic interventions on NH3 dynamics is challenging, as both meteorology and chemistry mask the real changes in observed NH3 concentrations. Here, we applied machine learning techniques based on random forest models to decouple the impacts of meteorology and emission changes on the gaseous NH3 and ammonium aerosol (NH4+) concentrations in Beijing during the lockdown. Our results showed that the meteorological conditions were unfavorable during the lockdown and tended to cause an increase of 8.4 % in the NH3 concentration. In addition, significant reductions in NOx and SO2 emissions could also elevate NH3 concentrations by favoring NH3 gas-phase partitioning. However, the observed NH3 concentration significantly decreased by 35.9 % during the lockdown, indicating a significant reduction in emissions or enhanced chemical sinks. Rapid gas-to-particle conversion was indeed found during the lockdown. Thus, the observed reduced NH3 concentrations could be partially explained by the enhanced transformation into NH4+. Therefore, the sum of NH3 and NH4+ (collectively, NHx) is a more reliable tracer than NH3 or NH4+ alone to estimate the changes in NH3 emissions. Compared to that under the scenario without lockdowns, the NHx concentration decreased by 26.4 %. We considered that this decrease represents the real decrease in NH3 emissions in Beijing due to the lockdown measures, which was less of a decrease than that based on NH3 only (35.9 %). This study highlights the importance of considering chemical sinks in the atmosphere when applying machine learning techniques to link the concentrations of reactive species with their emissions.

Sulfur isotope-based source apportionment and control mechanisms of PM2.5 sulfate in Seoul, South Korea during winter and early spring (2017-2020)

High level of particulate matter (PM) concentrations are a major environmental concern in Seoul, South Korea, especially during winter and early spring. Sulfate is a major component of PM and induces severe environmental pollution, such as acid precipitation. Previous studies have used numerical models to constrain the relative contributions of domestic and trans-boundary sources to PM2.5 sulfate concentration in South Korea. Because of the scarce measurement result of δ34S for PM2.5 sulfate in South Korea, poorly defined δ34S value of domestic sulfur sources, and no application of sulfur isotope fractionation during sulfate formation in previous observation-based studies, source apportionment results conducted by model studies have not been corroborated from independent chemical observations. Here, we examined the δ34S of PM2.5 in Seoul and domestic sulfur sources, and considered the sulfur isotope fractionation for accurate source apportionment constraint. Accordingly, domestic and trans-boundary sulfur sources accounted for approximately (16-32) % and (68-84) % of the sulfate aerosols in Seoul, respectively, throughout the winter and early spring of 2017-2020. Air masses passing through north-eastern China had relatively low sulfate concentrations, enriched δ34S, and a low domestic source contribution. Those passing through south-eastern China had relatively a high sulfate concentrations, depleted δ34S, and high domestic source contribution. Furthermore, elevated PM2.5 sulfate concentrations (>10 μg m-3) were exclusively associated with a weak westerly wind speed of <3 m s-1. From December 2019 to March 2020, Seoul experienced relatively low levels of PM2.5 sulfate, which might be attributed to favorable weather conditions rather than the effects of COVID-19 containment measures. Our results demonstrate the potential use of δ34S for accurate source apportionment and for identifying the crucial role of regional air mass transport and meteorological conditions in PM2.5 sulfate concentration. Furthermore, the data provided can be essential for relevant studies and policy-making in East Asia.

Functional and emotional impact of COVID-19 lockdown on older adults with sarcopenia living in a nursing home: A 15-month follow-up

This study aimed to detect the functional and emotional impact of COVID-19 lockdown on institutionalized older adults with sarcopenia during a 15-month follow-up. A prospective longitudinal cohort study was conducted in a nursing home. Participants were screened for sarcopenia, and those with a score of ≥4 points according to SARC-F questionnaire were included. Assessments were performed pre-lockdown (T1), 12 months (T2) after, and at a 15-month follow-up (T3). Functional measurements included chair stand test, handgrip, biceps brachii and quadriceps femoris strengths, appendicular skeletal mass, gait speed, Short Physical Performance Battery, and Timed Up-and-Go test. Emotional assessments included Short-Form Health Survey, Geriatric Depression Scale-Short Form, and the Mini-Mental State Examination. The analyzed sample showed a reduction in bicep strength, and other upper and lower limb strength variables showed a decreasing trend with no changes regarding muscle mass. Physical performance showed a change, specifically a deterioration in the subtest related to balance. Cognitive and emotional components were affected and quality of life was decreased. It is of paramount importance to focus on sarcopenic older adults since their characteristics can deteriorate when isolation measures are conducted.

Managing Diabetic Foot Complications During COVID-19 Lockdown in India: A Survey

To understand the management of diabetic foot complications by the Diabetic Foot Research India (DFRI) members during the lockdown period. An online survey link was created in "Survey Monkey", and the link was sent to all the members of Diabetic Foot Research India (DFRI) who are staying in different parts of India and data were collected from May 2020 to June 2020. The survey included questions on the type of consultation they provided to their patients, management of a patient with an active foot ulcer, and the various difficulties encountered by the doctors during the lockdown. A total of 33 diabetologists from all over the country participated in this survey. Among them, 26 doctors had attended to active diabetic foot infection at the time of the online survey. Almost three fourth of the (n = 24; 72.7%) doctors recorded difficulties during the inpatient consultations. Difficulty in regular follow-ups, the facility's workforce shortage was reported to be a significant concern. In managing active foot ulcer cases, 15 doctors (45.5%) opted for in-person consultation in their hospital as they felt the infection cannot be handled over a tele-consultation. Amputation was not performed by 78.7% of doctors, 15% (n = 5) of the doctors performed less than five amputations, and 6% (n = 2) of the doctors performed more than five amputations during the lockdown period. In the case of SMBG (Self-monitoring blood glucose) values, the regularity of patients reporting the values varied significantly. Only 8 (24.2%) doctors reported that 75% of their patients regularly shared their SMBG values while all the others mentioned that their patients were not performing SMBG regularly. Most of the physicians were able to manage the diabetic foot complications by tele-consultation during the lockdown and only a few asked the patients to get hospitalized for surgical intervention. All doctors should recommend SMBG to continuously monitor patients' blood glucose levels and prevent complications of hyperglycemia, particularly during pandemic situations.

Discovering the Learning Gradient of Students' Preferences for Learning Environment

The aim of this study was to examine the effects of online learning self-regulation on learning outcomes during the COVID-19 pandemic lockdown among university college students. Quantitative k-means cluster analysis was used to examine the relationship among students in three different clusters based on their preferences toward online learning. The results indicated that online learning self-regulation had a significant positive effect on learning outcomes due to the shift to online learning. Thus, we identified a "learning gradient" among students, showing that cluster 1 students (preferences for 100% online) have the most positive preferences toward online teaching and the highest degree of self-regulation and learning outcome, cluster 2 students (moderate preferences for both physical and online teaching) are mixed (both positive and negative experiences) and moderate self-regulation and learning outcomes while cluster 3 students (preferences for physical classroom teaching) have the most negative preferences and the lowest self-regulation and learning outcome. The results from this study show that students' self-regulated learning strategies during online teaching environments are important for their learning outcomes and that cluster 1 and 2 students especially profited from the more flexible online learning environment with organized and deep learning approaches. Cluster 3 students need more support from their educators to foster their self-regulation skills to enhance their learning outcomes in online teaching environments.

Factors Associated with Parenting Adaptability in Facing the First COVID-19 Lockdown: A Study on Portuguese Parents

Parenting was drastically challenged during the COVID-19 pandemic as families complied with the consequent containment for sanitary and social reasons. The purpose of this study is to explore the relationships among self-report measures (co-parenting, emotional experience and parental support network) and the employment condition (teleworking parents and at-home parents with governmental leave aid) that might be associated with the everyday life change, and their contribution towards family's daily routines during the first COVID-19 lockdown. A sample of 878 parents (90.2% mothers), aged from 21 to 61 years (39.58 ± 6.08), and mainly of Portuguese nationality (97.2%), was gathered through an online survey. Participants completed sociodemographic data and answered questions related to four positive parenting dimensions (Daily routines, Co-parenting, Emotional experience, and Support network) rating on a five-point Likert scale how much their behavior changed during the lockdown. Descriptive statistics and multilinear regression models were tested as well as a mediation model. The results showed that Emotional experience, Co-parenting, and Support network played an important role in family Daily routines, reinforcing that the first COVID-19 lockdown was lived differently by parents according to their employment conditions. Furthermore, the pathways model of factors associated with parental adaptability is suggestive that the direct effect of Emotional experience on Daily routines is partially mediated by Co-parenting and Support network. In line with previous studies on the complexity and dynamic ecology of parenting, the reported indicators showcase the interrelated facets of parenting and its corresponding support needs. Further, clear indicators for the design of family support interventions and family resilience enhancement to stressor events are discussed.

Multiscale mobility patterns and the restriction of human movement

From the perspective of human mobility, the COVID-19 pandemic constituted a natural experiment of enormous reach in space and time. Here, we analyse the inherent multiple scales of human mobility using Facebook Movement maps collected before and during the first UK lockdown. Firstly, we obtain the pre-lockdown UK mobility graph and employ multiscale community detection to extract, in an unsupervised manner, a set of robust partitions into flow communities at different levels of coarseness. The partitions so obtained capture intrinsic mobility scales with better coverage than nomenclature of territorial units for statistics (NUTS) regions, which suffer from mismatches between human mobility and administrative divisions. Furthermore, the flow communities in the fine-scale partition not only match well the UK travel to work areas but also capture mobility patterns beyond commuting to work. We also examine the evolution of mobility under lockdown and show that mobility first reverted towards fine-scale flow communities already found in the pre-lockdown data, and then expanded back towards coarser flow communities as restrictions were lifted. The improved coverage induced by lockdown is well captured by a linear decay shock model, which allows us to quantify regional differences in both the strength of the effect and the recovery time from the lockdown shock.

Reasons for Delayed Anti-VEGF Treatment During COVID-19 Lockdown and Clinical Impact in Neovascular Age-Related Macular Degeneration

INTRODUCTION

Timely anti-vascular endothelial growth factor (VEGF) treatment is crucial for visual function in neovascular age-related macular degeneration (nAMD). The aim of this study was to assess the reasons for anti-VEGF treatment delay during the COVID-19 lockdown and its clinical impact in patients with nAMD.

METHODS

A retrospective, observational, multicentre study in patients with nAMD treated with anti-VEGF therapy was performed in 16 centres nationwide. Data were retrieved from the FRB Spain registry, patient medical records and administrative databases. Patients were divided into two groups based on whether they received or missed intravitreal injections during the COVID-19 lockdown.

RESULTS

A total of 302 eyes from 245 patients were included (timely treated group [TTG] 126 eyes; delayed treatment group [DTG] 176 eyes). Visual acuity (VA; ETDRS letters) decreased from baseline to post-lockdown visit in the DTG (mean [standard deviation] 59.1 (20.8) vs. 57.1 (19.7); p = 0.020) and was maintained in the TTG (64.2 [16.5] vs. 63.6 [17.5]; p = 0.806). VA worsened by an average of - 2.0 letters in the DTG and by - 0.6 in the TTG (p = 0.016). A higher proportion of visits were cancelled due to hospital overload in the TTG (76.5%) than in the DTG (47%), and a higher proportion of patients missed visits in the DTG (53%) than in the TTG (23.5%, p = 0.021), with fear of COVID-19 infection being the main reason for missed visits (60%/50%).

CONCLUSIONS

Treatment delays were caused by both hospital saturation and patients' decision; the latter being mainly driven by fear of COVID-19 infection. These delays had a detrimental effect on the visual outcomes in nAMD patients.

Impact of COVID-19 lockdown on adolescents in treatment for obesity

OBJECTIVE

The aim of this study was to evaluate the impact of coronavirus disease 2019 (COVID-19) lockdown on body mass index (BMI) z-score of adolescents treated for obesity, and to assess the correlation between BMI z-score changes and lifestyle variables.

METHODS

This cross-sectional study recruited 66 participants aged 11-18 years with overweight or obesity who attended our obesity clinics before and after the lockdown. We assessed demographic and anthropometric characteristics as well as lifestyle variables.

RESULTS

The mean BMI z-score of the participants was stable during this period (p = 0.233). Balanced diet, snacking, and sweet beverage consumption improved in about half of the participants. Having at least one parent at home was associated with a significantly more balanced diet (p = 0.008) and an increase in family activities (p = 0.015). Physical activities decreased (51.5%) and screen time increased for most of the adolescents (86.4%). The BMI z-score decreased significantly when three or more lifestyle habits improved (p<0.001).

CONCLUSIONS

This study showed that BMI z-scores were stable for a majority of adolescents treated for obesity during the COVID19 lockdown, along with positive and negative changes on weight-related lifestyle habits. This extraordinary period may have created opportunities for lifestyle modification and has emphasized the importance of family support in the management of obesity in adolescents.

Lockdown's Silver Lining? Different Levels of Roadkill during the COVID-19 Times in Lithuania

The impact of COVID-19 restrictions on human and vehicular mobility on the number of roadkills of wild mammals, and roe deer in particular, was assessed in Lithuania. We statistically analyzed the distribution of all mammals and roe deer (Capreolus capreolus) as the most abundant species annually from 2002 to 2022 and monthly from 2020 to 2021, including during the two restriction periods. Notably, there was a marked decrease in roadkill incidents on main, national and regional roads, particularly in April-May 2020 (the beginning of lockdown period I) and November-December 2020 (the beginning of lockdown period II), 5.1-20.8% and 33.6-54.4%, respectively. During these months, collisions with mammals on the A14 main road were reduced by 75-90%. However, there was a significant increase in the number of roadkills in urban areas, resulting in the total number of mammal-vehicle and roe deer-vehicle collisions in 2020 and 2021 being higher than expected based on long-term trends. However, after restrictions were eased, collision numbers with wildlife on the main, national and regional roads increased again and became higher than expected.

Retrospective Study on the Impact of COVID-19 Lockdown on Patients with Type 2 Diabetes in Northern Taiwan

Background

During the COVID-19 pandemic, the national lockdown had a significant impact on healthcare systems and diabetes management. The results of relevant studies were inconsistent. The aim of the study was to investigate the impact of lockdown on glycemic control among patients with type 2 diabetes mellitus(T2D) in Taiwan.

Methods

This was a retrospective study conducted in a single regional hospital in Northern Taiwan. The clinic characteristics of the patients were summarized. Anthropometric and biochemical data before and after the lockdown were collected and analyzed. Stepwise multiple regression analysis was performed to identify the independent determinants of variables, including baseline characteristics and laboratory parameters, for the changes in glycated hemoglobin(HbA1c).

Results

A total of 943 (females 48.5%) patients with T2D were enrolled. The mean age of the patients was 60.6±12.3years, with a mean HbA1c of 7.0±1.0%, a mean diabetes duration of 7.3±4.6years, and a mean body mass index(BMI) of 26.5±4.5kg/m2. The overall means of HbA1c and fasting blood glucose were significantly improved after the lockdown compared to before (7.0±1.0 vs 6.8±0.9, p<0.001 and 132.2±33.3 vs 124.4±30.0, p<0.001, respectively). The proportion of patients achieving HbA1c target (≤7%) was higher after the lockdown compared to before (61.5% vs 68.9%, p<0.001). Stepwise multiple regression analysis revealed that baseline HbA1c before the lockdown was a positive contributor to the change in HbA1c after the lockdown, whereas BMI and co-morbidity with dyslipidemia were negative contributors (standardized coefficient +0.16, p<0.001; -0.07, p=0.025; -0.12, p=0.001, respectively).

Conclusion

Our study highlights the benefits of lockdown measures on diabetic control in Northern Taiwan as a single-center experience with the improvement of HbA1c and fasting blood glucose. Understanding these consequences of national lockdown can help healthcare providers to improve diabetes care during the pandemic.

Sleep, social media use and mental health in female adolescents aged 12 to 18 years old during the COVID-19 pandemic

BACKGROUND

Adolescents with high social media (SM) use experienced poor sleep quality and high anxiety and depression levels. The study aimed to investigate the characteristics of sleep, use of SM, mental health in female aged 12 to 18 years old, and to assess the association between poor sleep, SM usage, and mental health.

METHODS

In total, 219 Thai female adolescents were recruited between December 2019 and September 2020 and completed self-administrative questionnaires three periods of time (baseline, 3 months and 6 months later). The questionnaires included: the Pittsburgh Sleep Quality Index (PSQI), depression screening (PHQ-9), Screen for Child Anxiety Related Emotional Disorders (SCARED). Demographic and use of social media data were also included. Cochran's Q test, correlation coefficient, and binary logistic regression were performed.

RESULTS

Participants' mean age was 14.52 (range 12-17) years. Average Thai-PSQI global scores did not differ during 3 periods (p = 0.13) but average time of sleep latency, sleep duration, and SM usage were significant different (p = 0.002, p = 0.001, and p = < 0.001, respectively). There were positive correlations between PSQI scores and total SM usage at baseline (r = 0.14; P < 0.05) and 6 months (r = 0.20; P < 0.05). Anxiety, depression, and self-perception of poor sleep were significantly related to poor sleep quality during the 3 periods. After adjusting for confounding factors, depression and self-reported poor sleep were the only significant factors predicting poor sleep quality.

CONCLUSIONS

Poor sleep was associated with SM usage, depression, and anxiety in this population. Time-limited SM usage should be implemented for Thai female adolescents to improve sleep-related outcomes.

Changes in the Prevalence of Infection in Pregnant Women during the COVID-19 Lockdown

BACKGROUND

During the outbreak of SARS-CoV-2, strict mitigation measures and national lockdowns were implemented. Our objective was to investigate to what extent the prevalence of some infections in pregnancy was altered during different periods of the COVID-19 pandemic.

METHODS

This was a single centre retrospective cohort study conducted in the Netherlands on data collected from electronic patient files of pregnant women from January 2017 to February 2021. We identified three time periods with different strictness of mitigation measures: the first and second lockdown were relatively strict; the inter-lockdown period was less strict. The prevalence of the different infections (Group B Streptococcus (GBS)-carriage, urinary tract infections and Cytomegalovirus infection) during the lockdown was compared to the same time periods in previous years (2017-2019).

RESULTS

In the first lockdown, there was a significant decrease in GBS-carriage (19.5% in 2017-2019 vs. 9.1% in 2020; p = 0.02). In the period following the first lockdown and during the second, no differences in prevalence were found. There was a trend towards an increase in positive Cytomegalovirus IgM during the inter-lockdown period (4.9% in 2017-2019 vs. 12.8% in 2020; p = 0.09), but this did not reach statistical significance. The number of positive urine cultures did not significantly change during the study period.

CONCLUSIONS

During the first lockdown there was a reduction in GBS-carriage; further studies are warranted to look into the reason why.

Feasibility, clinical efficacy, and well-being outcomes of an online singing intervention for postnatal depression in the UK: SHAPER-PNDO, a single-arm clinical trial

BACKGROUND

Postnatal depression (PND) affects over 12% of mothers, with numbers rising during COVID-19. Singing groups can support mothers with PND; however, online delivery has never been evaluated. SHAPER-PNDO, a single-arm clinical trial, evaluated the feasibility, clinical efficacy, and well-being outcomes of a 6-week online version of Breathe Melodies for Mums (M4M) singing intervention developed for mothers with PND during COVID-19 lockdowns.

METHODS

The primary objective of this study was to assess the feasibility of a group online singing intervention for new mothers with postnatal depression. This was ascertained through recruitment rates, study retention rates, attendance rates to the singing sessions, and study completion rates. The secondary objective of the study was to assess the clinical efficacy and well-being outcomes of the singing intervention. Specifically, we measured change in Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS), and Office for National Statistics Wellbeing Scale (ONS) scores from baseline to end-of-intervention (week 6); follow-up assessments were completed at weeks 3, 16, and 32. Mothers were eligible if they scored ≥10 on the baseline EPDS.

RESULTS

Eighty-seven percent of the 37 recruited mothers completed the study, attending, on average, 5 of the 6 group singing sessions. With regard to secondary outcomes, at end-of-treatment, mothers experienced significant reductions in depression (EPDS, 16.6 ± 3.7 to 11.2 ± 5.3, 95% CI [0.79,1.65]), anxiety (STAI-S, 48.4 ± 27.1 to 41.7 ± 26.8, 95% CI [4.96, 17.65]) and stress (PSS, 29.0 ± 5.7 to 19.7 ± 5.3, 95% CI [1.33, 7.07]); and, furthermore, significant improvements in life satisfaction (ONS, 50.5 ± 23.0 to 72.8 ± 11.7, 95% CI [- 39.86, - 4.64]) and feelings of worthwhileness (ONS, 51.7 ± 30.4 to 78.6 ± 15.1, 95% CI [- 52.79, - 0.85]). Reduction on the EPDS correlated with a reduction on the BDI and the STAI-S and maternal childhood maltreatment was predictive of a smaller treatment response.

CONCLUSIONS

M4M online was feasible to mothers who partook in the programme. Furthermore, M4M online supports the mental health and well-being of new mothers experiencing PND, especially when barriers to in-person treatment are present.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04857593 . Registered 22 April 2021, retrospectively registered.

The impact of COVID-19 lockdown on the quality of life of Chinese football referees: the chain mediating role of occupational stress and job burnout

BACKGROUND

COVID-19 lockdown measures have had a great negative impact on the development of sports competition in China, as well as on the quality of life of football referees. This study aims to explore the impact of lockdown measures implemented in response to the COVID-19 pandemic on the quality of life of football referees in China and its mechanism of action.

METHODS

The Impact of Event Scale-Revised (IES-R), the Effort-Reward Imbalance Scale (ERI), the Maslach Burnout Inventory General Survey (MBI-GS), and the World Health Organization Quality of Life Brief Version (WHOQOL-BREF). The scale was used from August to September 2022. Using an online questionnaire, 350 questionnaires were sent out and 338 were returned, for a return rate of 96.57%. Invalid questionnaires were excluded, and 307 football referees with referee grades in 29 provinces registered with the CFA were surveyed. SPSS 24.0 and Mplus 8.0 were used for data analysis and structural equation model testing in this study.

RESULTS

The results showed that the COVID-19 lockdown had no significant impact on the quality of life of Chinese football referees. However, the COVID-19 lockdown can affect the quality of life of Chinese football referees through occupational stress or job burnout. Occupational stress and job burnout also play a chain intermediary role between the COVID-19 lockdown and the quality of life of Chinese football referees. In addition, this study further explores the quality of life by dividing it into four dimensions (physical, social, psychological, and environmental). The results show that all four dimensions satisfy the chain mediation model.

CONCLUSIONS

Therefore, the quality of life of Chinese football referees can be improved by reducing their occupational stress and job burnout during the COVID-19 lockdown.

Loneliness and happiness in the face of the COVID-19 lockdown: Examining the pathways through somatic symptoms and psychological distress

Studies show that loneliness was higher during the pandemic than in the pre-pandemic periods, with negative consequences on individual happiness. This study extends current knowledge by investigating the indirect effects of somatic symptoms and psychological distress in the loneliness-happiness relationship during the COVID-19 lockdown. The cross-sectional sample comprises 538 Nigerian adults (Meanage = 36.48 ± 12.03) with 43% females. Data were collected using structured self-report instruments and subjected to path analyses in SPSS AMOS. Results showed that loneliness and happiness were negatively related. Loneliness and happiness were indirectly related through the successive association between somatic symptoms and psychological distress. Specifically, greater loneliness was associated with increased somatic symptoms, which in turn were associated with greater psychological distress and reduced happiness levels. Clinicians can manage the decline in happiness from loneliness during the pandemic lockdown by administering treatments that mitigate somatic symptoms and psychological distress in concerned clients.

The impact of the first COVID-19 lockdown on weight management practices in UK adults: A self-regulation perspective

This study aimed to identify the impact of the first UK COVID-19 lockdown on individuals' weight management attempts (WMA). A self-regulation theoretical framework was used to identify predictors of continuing with a WMA, and weight change during the lockdown. An online retrospective cross-sectional study was conducted after the first UK COVID-19 lockdown. The sample consisted of 166 UK adults (M:31.08, SD:12.15) that were trying to manage their weight before the lockdown started. The survey assessed changes in WMA and practices, and measured perceived stress, flexible/rigid restraint, uncontrolled eating, craving control, and self-compassion. Results showed that 56% of participants reported disruption to their WMA during the lockdown. Participants with lower levels of perceived stress and higher flexible restraint were more likely to continue their WMA. Flexible restraint was a significant predictor of weight change. Interventions that promote flexibility in weight management may be beneficial for at-risk individuals under lockdown conditions.

Gastroesophageal reflux in lockdown

Aim

This study examines the changes in gastroesophageal reflux disease (GERD) symptom frequency among patients with GERD throughout the COVID-19 pandemic.

Methods

A structured questionnaire was distributed among 198 GERD patients. The questionnaire consisted of a demographic characteristic assessment, the GerdQ questionnaire, and a reflux symptom index (RSI) questionnaire.

Result & conclusion

A statistically significant increase in GerdQ score was identified among participants during the COVID-19 pandemic (t = 7.055, df = 209, p < 0.001), who had experienced an increase in the frequency of positive predictors of GERD and a decrease in the frequency of negative predictors of GERD. The COVID-19 pandemic and its related lockdown countermeasures may have led to exacerbating and worsening GERD symptoms.

Worse sleep and increased energy expenditure yet no movement changes in sub-urban wild boar experiencing an influx of human visitors (anthropulse) during the COVID-19 pandemic

Expansion of urban areas, landscape transformation and increasing human outdoor activities strongly affect wildlife behaviour. The outbreak of the COVID-19 pandemic in particular led to drastic changes in human behaviour, exposing wildlife around the world to either reduced or increased human presence, potentially altering animal behaviour. Here, we investigate behavioural responses of wild boar (Sus scrofa) to changing numbers of human visitors to a suburban forest near Prague, Czech Republic, during the first 2.5 years of the COVID-19 epidemic (April 2019-November 2021). We used bio-logging and movement data of 63 GPS-collared wild boar and human visitation data based on an automatic counter installed in the field. We hypothesised that higher levels of human leisure activity will have a disturbing effect on wild boar behaviour manifested in increased movements and ranging, energy spent, and disrupted sleep patterns. Interestingly, whilst the number of people visiting the forest varied by two orders of magnitude (from 36 to 3431 people weekly), even high levels of human presence (>2000 visitors per week) did not affect weekly distance travelled, home range size, and maximum displacement of wild boar. Instead, individuals spent 41 % more energy at high levels of human presence (>2000 visitors per week), with more erratic sleep patterns, characterised by shorter and more frequent sleeping bouts. Our results highlight multifaceted effects of increased human activities ('anthropulses'), such as those related to COVID-19 countermeasures, on animal behaviour. High human pressure may not affect animal movements or habitat use, especially in highly adaptable species such as wild boar, but may disrupt animal activity rhythms, with potentially detrimental fitness consequences. Such subtle behavioural responses can be overlooked if using only standard tracking technology.

[Impacts of COVID-19 Lockdown on Air Quality in Shenzhen in Spring 2022]

The short-term reduction of air pollutant emissions is an important emergency control measure for avoiding air pollution exceedances in Chinese cities. However, the impacts of short-term emission reductions on the air qualities in southern Chinese cities in spring has not been fully explored. We analyzed the changes in air quality in Shenzhen, Guangdong before, during, and after a city-wide lockdown associated with COVID-19 control during March 14 to 20, 2022. Stable weather conditions prevailed before and during the lockdown, such that local air pollution was strongly affected by local emissions. In-situ measurements and WRF-GC simulations over the Pearl River Delta (PRD) both showed that, due to reductions in traffic emissions during the lockdown, the concentrations of nitrogen dioxide (NO₂), respirable particulate matter (PM₁₀), and fine particulate matters (PM_2.5) in Shenzhen decreased by (-26±9.5)%, (-28±6.4)%, and (-20±8.2)%, respectively. However, surface ozone (O₃) concentration did not change significantly[(-1.0±6.5)%]. TROPOMI satellite observations of formaldehyde and nitrogen dioxide column concentrations indicated that the ozone photochemistry in the PRD in spring 2022 was mainly controlled by the volatile organic compound (VOCs) concentrations and was not sensitive to the reduction in nitrogen oxide (NO_x) concentrations. Reduction in NO_x may even have increased O_3, because the titration of O₃ by NO_x was weakened. Due to the small spatial-temporal extent of emission reductions, the air quality effects caused by this short-term urban-scale lockdown were weaker than the air quality effects across China during the widespread COVID-19 lockdown in 2020. Future air quality management in South China cities should consider the impacts of NO_x emission reduction on ozone and focus on the co-reduction scenarios of NO_x and VOCs.

An Exploration of Australian Online Government Portals for Women Experiencing Domestic Violence During the COVID-19 Pandemic

Domestic violence against women increased during COVID-19 lockdowns. This inaugural study examined the content of Australian government online portals, for women seeking support and help for domestic violence, during the 2021 COVID-19 pandemic. This mixed methods study incorporated four phases: a search; measurement of portal quality standard using DISCERN; enumeration of portal items; and a qualitative exploration of portal text. Australian governments must continue to work alongside domestic violence services as we found some portals were better than others. Continued review, revision, and funding are needed to meet the demands associated with this evolving public health emergency.

Biological effects of particulate matter samples during the COVID-19 pandemic: a comparison with the pre-lockdown period in Northwest Italy

In 2020, during the COVID-19 pandemic, containment measures were applied inducing potential changes in air pollutant concentrations and thus in air toxicity. This study evaluates the role of restrictions on biological effects of particulate matter (PM) in different Northwest Italy sites: urban background, urban traffic, rural, and incinerator. Daily PM samples collected in 2020 were pooled according to restrictions: January/February (no restrictions), March and April (first lockdown), May/June and July/August/September (low restrictions), October/November/December (second lockdown). The 2019 samples (pre-pandemic period) were pooled as 2020 for comparison. Pools were extracted with organic solvents and extracts were tested to assess cytotoxicity (WST-1 assay) and genotoxicity (comet assay) on BEAS-2B cells, mutagenicity (Ames test) on TA98 and TA100 Salmonella typhimurium strains, and estrogenic activity (gene reporter assay) on MELN cells. Pollutant concentrations were also analyzed (PM10, PM2.5, polycyclic aromatic hydrocarbons). No difference was observed for PM and polycyclic aromatic hydrocarbon concentrations between 2020 and 2019. During lockdown months (2020), PM cytotoxicity/genotoxicity was significantly lower in some sites than during 2019, while considering PM mutagenicity/estrogenic activity some differences were detected but without statistical significance. PM extract effects decreased in some sites during 2020; this may be due to lockdowns that reduced/modified pollutant emissions and may be related also to complex PM origin/formation and to meteorological conditions. In conclusion, the study confirms that PM biological effects cannot be assessed considering only the PM concentration and suggests to include a battery of bioassay for air quality monitoring in order to protect human health from air pollution effects.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s11869-023-01381-6.

The comorbidity of somatic symptom and major depressive disorders in the times of COVID-19 lockdown in adolescence: A case-report study

Physical symptoms with normal clinical examinations have been reported without detectable structural or biochemical abnormalities in the comorbidity of somatic symptom disorder and major depressive disorder. This association can have a debilitating effect on their academic and social performance. This case report is about a 13-year-old Afghani immigrant boy with no previous psychiatric history who developed severe body pain leading to a disability during the COVID-19 lockdown and social isolation. During further evaluation, all his clinical examinations were normal, and the diagnosis of major depressive disorder and somatic symptom disorder was confirmed. Cognitive behavioral therapy includes cognitive therapy, changing lifestyle, and a motivational support method. Medical treatment with olanzapine, fluvoxamine, and gabapentin was started. During follow-up, there was improvement in the patient's mood, and the patient began to walk and communicate. It is important to suspect an association of somatic symptom disorder and major depressive disorder in patients with severe body pain and multiemotional factors. Psychiatrists should keep in mind that emotional factors can play a significant role in causing and maintaining physical symptoms.

Impact of the COVID-19 Lockdown on Physical Activity Levels and Health Parameters in Young Adults with Cancer

The lockdown of the COVID-19 pandemic impacted physical activity (PA) levels around the world, affecting health parameters in young adults with cancer (YAC). To our knowledge, there is no evidence of the impact of the lockdown on the Spanish YAC. To analyse the changes in PA levels before, during, and after the lockdown of the YAC and its impact on health metrics in Spain, in this study, we utilized a self-reported web survey. PA levels decreased during the lockdown, and a significant increase in PA was observed after the lockdown. Moderate PA had the largest reduction (49%). Significant increases in moderate PA were noted after the lockdown (85.2%). Participants self-reported more than 9 h of sitting per day. HQoL and fatigue levels were significantly worse during the lockdown. The impact of the COVID-19 pandemic in this cohort of Spanish YAC showed a decrease in PA levels during the lockdown, affecting sedentarism, fatigue and HQoL. After lockdown, PA levels partially recovered, while HQoL and fatigue levels remained altered. This may have long-term physical effects such as cardiovascular comorbidities associated with sedentarism and psychosocial effects. It is necessary to implement strategies such as cardio-oncology rehabilitation (CORE), an intervention that can be delivered online, potentially improving participants' health behaviours and outcomes.

The COVID-19 lockdown: a unique perspective into heterogeneous impacts of transboundary pollution on snow and ice darkening across the Himalayas

The Tibetan Plateau holds the largest mass of snow and ice outside of the polar regions. The deposition of light-absorbing particles (LAPs) including mineral dust, black carbon and organic carbon and the resulting positive radiative forcing on snow (RFSLAPs) substantially contributes to glacier retreat. Yet how anthropogenic pollutant emissions affect Himalayan RFSLAPs through transboundary transport is currently not well known. The COVID-19 lockdown, resulting in a dramatic decline in human activities, offers a unique test to understand the transboundary mechanisms of RFSLAPs. This study employs multiple satellite data from the moderate resolution imaging spectroradiometer and ozone monitoring instrument, as well as a coupled atmosphere-chemistry-snow model, to reveal the high spatial heterogeneities in anthropogenic emissions-induced RFSLAPs across the Himalaya during the Indian lockdown in 2020. Our results show that the reduced anthropogenic pollutant emissions during the Indian lockdown were responsible for 71.6% of the reduction in RFSLAPs on the Himalaya in April 2020 compared to the same period in 2019. The contributions of the Indian lockdown-induced human emission reduction to the RFSLAPs decrease in the western, central, and eastern Himalayas were 46.8%, 81.1%, and 110.5%, respectively. The reduced RFSLAPs might have led to 27 Mt reduction in ice and snow melt over the Himalaya in April 2020. Our findings allude to the potential for mitigating rapid glacial threats by reducing anthropogenic pollutant emissions from economic activities.

Trajectories of Parental Daily Stress: An Ecological Momentary Assessment Study during the COVID-19 Lockdown

The COVID-19 pandemic was a source of significant stress due to health and safety concerns and measures to control the virus' spread, such as mobility restrictions. This measure was especially demanding for parents with school aged children, who had to find new work-family balance as their children participate in online education while attempting to work remotely. To evaluate parents' stress trajectories during the pandemic, we conducted Ecological Momentary Assessments (EMAs) during lockdown for 29 days in 68 families in Santiago, Chile. In addition, we evaluated the role of educational level and income, co-parenting, and number of children in parents' stress trajectories. Our results showed that during the first weeks of lockdown expected protective factors (i.e., income and co-parental support) were not able to influence parents' daily stress management. Moreover, parents with higher educational levels reported worse stress adaptation than less educated parents. On the other hand, co-parental conflict was significantly associated with parent's stress. Our study captured an acute response to COVID-19 related challenges. This study contributes to understanding how parents adjust to stress during adverse circumstances such as the COVID-19 pandemic.

Mindfulness, Subjective Cognitive Functioning, Sleep Timing and Time Expansion during COVID-19 Lockdown: A Longitudinal Study in Italy

During the COVID-19 lockdown, a distortion of time passage has been widely reported in association with a change in daily rhythm. However, several variables related to these changes have not been considered. The purpose of the present study was to assess the changes in dispositional mindfulness, time experience, sleep timing and subjective memory functioning. A longitudinal study was conducted on 39 Italian adults (53.85% males; 35.03 ± 14.02 years) assessing mindfulness, ad hoc questions of sleep habits during workdays and free days, chronotypes, subjective time experience, and memory functioning before (December 2019-March 2020) and during (April 2020-May 2020) the first Italian COVID-19 lockdown. Participants reported delayed sleep timing, a slowdown in the perception of the present time, a decrease of time pressure, and an increase in the feeling of time expansion/boredom. In addition to correlations between mindfulness, memory functioning, and subjective sleep duration during workdays, a mediation model showed that changes in the dispositional mindfulness determined a delay of bedtime during workdays through the mediation effect of increased feeling of time expansion/boredom. This finding highlighted the role of mindfulness in reducing the feeling of time expansion/boredom for regulating the sleep timing. The theoretical and practical implications of the findings are discussed.

Changes in air pollution, land surface temperature, and urban heat islands during the COVID-19 lockdown in three Chinese urban agglomerations

COVID-19 has notably impacted the world economy and human activities. However, the strict urban lockdown policies implemented in various countries appear to have positively affected pollution and the thermal environment. In this study, Moderate Resolution Imaging Spectroradiometer (MODIS) land surface temperature (LST) and aerosol optical depth (AOD) data were selected, combined with Sentinel-5P images and meteorological elements, to analyze the changes and associations among air pollution, LST, and urban heat islands (UHIs) in three urban agglomerations in mainland China during the COVID-19 lockdown. The results showed that during the COVID-19 lockdown period (February 2020), the levels of the AOD and atmospheric pollutants (fine particles (PM_2.5), NO₂, and CO) significantly decreased. Among them, PM_2.5 and NO₂ decreased the most in all urban agglomerations, by >14 %. Notably, the continued improvement in air pollution attributed to China's strict control policies could lead to overestimation of the enhanced air quality during the lockdown. The surface temperature in all three urban agglomerations increased by >1 °C during the lockdown, which was mainly due to climate factors, but we also showed that the lockdown constrained positive LST anomalies. The decrease in the nighttime urban heat island intensity (UHIInight) in the three urban agglomerations was greater than that in the daytime quantity by >25 %. The reduction in surface UHIs at night was mainly due to the reduced human activities and air pollutant emissions. Although strict restrictions on human activities positively affected air pollution and UHIs, these changes were quickly reverted when lockdown policies were relaxed. Moreover, small-scale lockdowns contributed little to environmental improvement. Our results have implications for assessing the environmental benefits of city-scale lockdowns.

Characteristics and sources of carbonaceous aerosols in a semi-arid city: Quantifying anthropogenic and meteorological impacts

Carbonaceous aerosols have great adverse impacts on air quality, human health, and climate. However, there is a limited understanding of carbonaceous aerosols in semi-arid areas. The correlation between carbonaceous aerosols and control measures is still unclear owing to the insufficient information regarding meteorological contribution. To reveal the complex relationship between control measures and carbonaceous aerosols, offline and online observations of carbonaceous aerosols were conducted from October 8, 2019 to October 7, 2020 in Hohhot, a semi-arid city. The characteristics and sources of carbonaceous aerosols and impacts of anthropogenic emissions and meteorological conditions were studied. The annual mean concentrations (± standard deviation) of fine particulate matter (PM_2.5), organic carbon (OC), and elemental carbon (EC) were 42.81 (±40.13), 7.57 (±6.43), and 2.25 (±1.39) μg m^-3, respectively. The highest PM_2.5 and carbonaceous aerosol concentrations were observed in winter, whereas the lowest was observed in summer. The result indicated that coal combustion for heating had a critical role in air quality degradation in Hohhot. A boost regression tree model was applied to quantify the impacts of anthropogenic emissions and meteorological conditions on carbonaceous aerosols. The results suggested that the anthropogenic contributions of PM_2.5, OC, and EC during the COVID-19 lockdown period were 53.0, 15.0, and 2.36 μg m^-3, respectively, while the meteorological contributions were 5.38, 2.49, and -0.62 μg m^-3, respectively. Secondary formation caused by unfavorable meteorological conditions offset the emission reduction during the COVID-19 lockdown period. Coal combustion (46.4% for OC and 35.4% for EC) and vehicular emissions (32.0% for OC and 50.4% for EC) were the predominant contributors of carbonaceous aerosols. The result indicated that Hohhot must regulate coal use and vehicle emissions to reduce carbonaceous aerosol pollution. This study provides new insights and a comprehensive understanding of the complex relationships between control strategies, meteorological conditions, and air quality.

The Effects of COVID-19 Lockdown on the Sleep Quality of Children

INTRODUCTION

The COVID-19 lockdown has caused important changes in children's routines, especially in terms of nutrition, physical activity, screen time, social activity, and school time. Regarding these changes, recent studies show that the COVID-19 lockdown is associated with higher levels of anxiety and depression in children. The objective of this study was to assess changes in sleep quality in Spanish children during the lockdown decreed by the Spanish government between March and June 2020.

METHODOLOGY

We compared the BEAR (bedtime, excessive daytime sleepiness, awakening during the night, and regularity and duration of sleep) scores of 478 participants (median age = 7.5 years; 48% girls) in the SENDO project during the periods before, during, and after lockdown. The questionnaires were filled out by one of the parents. We used hierarchical models with two levels of clustering to account for the intra-cluster correlation between siblings. The interaction of time with a set of a priori selected variables was assessed by introducing the interaction term into the model and calculating the likelihood ratio test.

RESULTS

The mean scores in the BEAR questionnaire referred to the periods before, during, and after lockdown were 0.52 (sd 1.25), 1.43 (sd 1.99), and 1.07 (sd 1.55), respectively. These findings indicate a deterioration in sleep quality during the period of confinement. Parental level of education was found to be an effect modifier (p for interaction = 0.004). Children whose parents had higher education (university graduates or higher) showed a smaller worsening than those without.

CONCLUSION

Our study shows that the COVID-19 lockdown was associated with a significant worsening of sleep quality. Moreover, although the end of the lockdown brought about a slight improvement, mean scores on the BEAR scale remained significantly higher than before the lockdown, suggesting that the consequences for sleep quality could persist over time. This worsening was higher in children whose parents had lower educational degrees. Helping children maintain healthy sleeping habits despite the circumstances and providing early psychological support when needed is important to prevent negative psycho-physical symptoms due to lockdown that could persist over the years.

The Relationship Between Screen Time and Symptom Severity in Children with ADHD during COVID-19 Lockdown

OBJECTIVES

To investigate the relationship between screen time and symptom severity in children with ADHD during the COVID-19 lockdown.

METHODS

Caregivers of children with ADHD aged 7 to 16 years completed the screen time questionnaire and ADHD rating scales of the SNAP-IV-Thai version during and after the COVID-19 lockdown. The correlation between screen time and ADHD scores was assessed.

RESULTS

Of the 90 children, aged 11.31 ± 2.29 years, enrolled, 74.4% were male, 64.4% were in primary school, and 73% had electronic screens in their bedrooms. After adjusting with other factors, recreational screen time, both on weekdays and on weekend days, were positively correlated with ADHD scores (both inattention and hyperactive/impulsive scores). Studying screen time, on the other hand, was not associated with ADHD symptom severity. Compared to during the lockdown, studying screen time decreased after the lockdown, but recreational screen time and ADHD scores were not changed.

CONCLUSION

Increasing recreational screen time was associated with worsening ADHD symptoms.

Spatial variability of trace gases (NO2, O3 and CO) over Indian region during 2020 and 2021 COVID-19 lockdowns

COVID-19 lockdown has given us an opportunity to investigate the pollutant concentrations in response to the restricted anthropogenic activities. The atmospheric concentration levels of nitrogen dioxide (NO₂), carbon monoxide (CO) and ozone (O₃) have been analysed for the periods during the first wave of COVID-19 lockdown in 2020 (25th March-31st May 2020) and during the partial lockdowns due to second wave in 2021 (25th March-15th June 2021) across India. The trace gas measurements from Ozone Monitoring Instrument (OMI) and Atmosphere InfraRed Sounder (AIRS) satellites have been used. An overall decrease in the concentration of O₃ (5-10%) and NO₂ (20-40%) have been observed during the 2020 lockdown when compared with business as usual (BAU) period in 2019, 2018 and 2017. However, the CO concentration increased up to 10-25% especially in the central-west region. O₃ and NO₂ slightly increased or had no change in 2021 lockdown when compared with the BAU period, but CO showed a mixed variation prominently influenced by the biomass burning/forest fire activities. The changes in trace gas levels during 2020 lockdown have been predominantly due to the reduction in the anthropogenic activities, whereas in 2021, the changes have been mostly due to natural factors like meteorology and long-range transport, as the emission levels have been similar to that of BAU. Later phases of 2021 lockdown saw the dominant effect of rainfall events resulting in washout of pollutants. This study reveals that partial or local lockdowns have very less impact on reducing pollution levels on a regional scale as natural factors like atmospheric long-range transport and meteorology play deciding roles on their concentration levels.

Subgroups of perceptions and related behaviors during the COVID-19 lockdown: experience of adolescents in the PARIS birth cohort

BACKGROUND

Adolescents may not all have reacted similarly to the COVID-19 lockdown. This study aimed to identify subgroups of perceptions in adolescents from the PARIS cohort during the first French lockdown, and to investigate whether adolescent behaviors differed according to these subgroups.

METHODS

Online questionnaires were sent to 1,549 PARIS adolescents aged 13-17 years who reported on possible infection with SARS-CoV-2, their perceptions, and behaviors during lockdown. Ascending hierarchical clustering was performed on the perception variables. Associations of behaviors with perception clusters were analyzed using multivariable multinomial logistic regression.

RESULTS

Three perception clusters were identified among 791 adolescents (response rate 51%). One cluster "happy" (39%) had good mental health and did not feel stressed during lockdown. Another cluster "unhappy" (19%) was mainly unhappy, felt stressed, suffered from overcrowded living conditions, and experienced deteriorating relationships with family members. A further cluster "intermediate" (42%) experienced moderate well-being and stress, felt more supported by family, and worried about the health of their relatives. Compared with the "happy" cluster, the unhappy adolescents were more affected by COVID-19, had difficulty doing school activities, spent more time on social networks and less time on video games, slept less, and reported a deterioration in their diet. Adolescents "intermediate" with moderate well-being were more often girls, spent more time on social networks, were more physically active, slept less, and more often reported eating fruit and vegetables and drinking alcohol.

CONCLUSIONS

Not all adolescents experienced lockdown in the same way. This study highlighted subgroups that differed in terms of well-being and health-related behaviors. These results should motivate public authorities to consider the benefit/risk ratio of implementing strict lockdowns by taking into account family disparities and inequities among adolescents.

Monitoring ambient air pollution and pulmonary function in asthmatic children by mobile applications in COVID-19 pandemic

BACKGROUND

Several public health measures were implemented during the COVID-19 pandemic. However, little is known about the real-time assessment of environmental exposure on the pulmonary function of asthmatic children. Therefore, we developed a mobile phone application for capturing real-time day-to-day dynamic changes in ambient air pollution during the pandemic. We aim to explore the change in ambient air pollutants between pre-lockdown, lockdowns, and lockdowns and analyze the association between pollutants and PEF mediated by mite sensitization and seasonal change.

METHOD

A prospective cohort study was conducted among 511 asthmatic children from January 2016 to February 2022. Smartphone-app used to record daily ambient air pollution, particulate matter (PM2.5, PM10) Ozon (O₃), nitrogen dioxide (NO₂), Carbon Monoxide (CO), sulfur dioxide (SO₂), average temperature, and relative humidity, which measured and connected from 77 nearby air monitoring stations by linking to Global Positioning System (GPS)-based software. The outcome of pollutants' effect on peak expiratory flow meter (PEF) and asthma is measured by a smart peak flow meter from each patient or caregiver's phone for real-time assessment.

RESULTS

The lockdown (May 19th, 2021, to July 27th, 2021) was associated with decreased levels of all ambient air pollutants aside from SO₂ after adjusting for 2021. NO₂ and SO₂ were constantly associated with decreased levels of PEF across lag 0 (same day when the PEF was measured), lag 1 (one day before PEF was measured), and lag 2 (two days prior when the PEF was measured. Concentrations of CO were associated with PEF only in children who were sensitized to mites in lag 0, lag 1, and lag 2 in the stratification analysis for a single air pollutant model. Based on the season, spring has a higher association with the decrease of PEF in all pollutant exposure than other seasons.

CONCLUSION

Using our developed smartphone apps, we identified that NO₂, CO, and PM10 were higher at the pre-and post-COVID-19 lockdowns than during the lockdown. Our smartphone apps may help collect personal air pollution data and lung function, especially for asthmatic patients, and may guide protection against asthma attacks. It provides a new model for individualized care in the COVID era and beyond.

How does COVID-19 lockdown affect air quality: Evidence from Lanzhou, a large city in Northwest China

Coronavirus disease (COVID-19) has disrupted health, economy, and society globally. Thus, many countries, including China, have adopted lockdowns to prevent the epidemic, which has limited human activities while affecting air quality. These affects have received attention from academics, but very few studies have focused on western China, with a lack of comparative studies across lockdown periods. Accordingly, this study examines the effects of lockdowns on air quality and pollution, using the hourly and daily air monitoring data collected from Lanzhou, a large city in Northwest China. The results indicate an overall improvement in air quality during the three lockdowns compared to the average air quality in the recent years, as well as reduced PM_2.5, PM₁₀, SO₂, NO₂, and CO concentrations with different rates and increased O₃ concentration. During lockdowns, Lanzhou's "morning peak" of air pollution was alleviated, while the spatial characteristics remained unchanged. Further, ordered multi-classification logistic regression models to explore the mechanisms by which socioeconomic backgrounds and epidemic circumstances influence air quality revealed that the increment in population density significantly aggravated air pollution, while the presence of new cases in Lanzhou, and medium- and high-risk areas in the given district or county both increase the likelihood of air quality improvement in different degrees. These findings contribute to the understanding of the impact of lockdown on air quality, and propose policy suggestions to control air pollution and achieve green development in the post-epidemic era.