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Background: COVID-19 remains a significant public health threat. The primary purpose of this study was to test the health belief model (HBM) constructs in predicting COVID-19 booster intentions of college students., Methods: A total of 285 students enrolled at large public university in the Southeastern U.S., who were 18 years and older, completed an online survey to assess COVID-19 vaccination status, prior or current COVID-19 infection, demographics, and HBM constructs., Results: Over three quarters of the sample (81.4%, n  = 232) was fully vaccinated, 2.1% ( n  = 6) was partially vaccinated, and 16.5% ( n  = 47) was unvaccinated. Furthermore, 53.4% ( n  = 124) of students who self-reported being fully vaccinated also reported receiving the booster vaccine. Nearly half of the sample (49.1%, n  = 140) self-reported previously or currently testing positive for COVID-19. Results of the stepwise multiple regression indicated the HBM constructs of perceived benefits ( β =0.596; p  < 0.001) and cues to action ( β =0.275; p  < 0.001) were significant predictors of respondents' behavioral intention to receive the COVID-19 booster in the next 6 months. The significant predictors at step 2 accounted for 64.6% [ R 2  = 0.646, F  < 0.001)] of the variance in behavioral intention to get the COVID-19 booster in the next 6 months.p  < 0.001)] of the variance in behavioral intention to get the COVID-19 booster in the next 6 months., Conclusion: Practitioners developing HBM-based interventions to enhance COVID-19 booster intentions among college students should tailor health promotion strategies that target perceived benefits and cues to action. Although some of the HBM constructs were not statistically significant in the prediction model, they should not be entirely discounted in health promotion practice. Instead, practitioners should focus on supplemental strategies to improve those domains in college students., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Catalano, Christofora, Richards, Hyatt Hawkins Shaw and Kiser.)

Objective: To explore and describe the experiences of Haitians/Haitian Americans in Miami-Dade County, Florida during the COVID-19 pandemic, including their attitudes and practices towards vaccination., Design: We interviewed 15 community members and 15 stakeholders in the Haitian/Haitian American community in Miami-Dade County, Florida using a semi-structured interview guide. The qualitative interviews were conducted between February 4, 2021, and October 1, 2021. They were conducted in both English and Haitian Creole, audio recorded transcribed/translated, and coded using thematic content analysis., Results: The analyses revealed 9 major themes: (1) thoughts about the pandemic, (2) concerns about the COVID-19 vaccines, (3) healthcare access, February-October 2021, (4) intrapersonal relationship dynamics, (5) thoughts about individuals diagnosed with COVID-19, (6) thoughts about prevention measures (e.g., wearing masks, hand hygiene, social distancing, vaccination), (7) mental health struggles and coping, (8) food insecurity, and (9) overall experiences of the pandemic. The findings reveal that the COVID-19 public health emergency negatively affected Haitians/Haitian Americans across several domains, including employment, healthcare access, personal relationships, and food security., Conclusion: This research echoes the compounding negative experiences reported by multiple disadvantaged groups during the COVID-19 pandemic. From loss of employment to healthcare barriers, the pandemic forced many Haitians/Haitian Americans into greater economic and social instability. Interventions addressing these issues should recognize how these factors may interact and compound the experiences of this group. Health and public health agencies should work alongside community partners to build trust so that preventive efforts will be more readily accepted during public health emergencies., Competing Interests: AF was employed by Family Action Network Movement. MT is the President/CEO of the Community Health and Empowerment Network. SD is a co-investigator on a Merck & Co. funded project on “A Qualitative Study to Explore Biomedical HIV Prevention Preferences, Challenges and Facilitators among Diverse At-Risk Women Living in the United States” and has served as a workgroup consultant on engaging people living with HIV for Gilead Sciences, Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Sternberg, Richard, Daniel, Chery, Beauvoir, Marcelin, Francois, Titus, Mann, Alcaide and Dale.)

In September 2020, the National Institutes of Health acted in response to the COVID-19 pandemic, recognizing the critical need to combat misinformation, particularly in communities disproportionately affected by the crisis. The Community Engagement Alliance (CEAL) emerged as an initiative dedicated to fostering reliable, science-based information, diversity, and inclusion; aiming to implement effective strategies to mitigate the spread of COVID-19 nationwide. One of the teams participating in this initiative is Puerto Rico-CEAL (PR-CEAL). Our whose goal was to raise awareness about the coronavirus disease and advance research, mainly focusing on vulnerable and underserved populations. This concept paper seeks to outline PR-CEAL's infrastructure during its initial two cycles, providing insights into the research and community engagement activities designed to enhance prevention, counter misinformation, and foster awareness and uptake of COVID-19 vaccines. Ultimately, our objective is to reflect on the strengths and challenges encountered thus far as we endeavor to sustain this robust infrastructure, addressing ongoing public health issues with a forward-looking approach., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Pons-Calvo, Pérez, Canales-Birriel, Tamarit-Quevedo, Solís-Torres, López-Cepero, García-Rivera, Larriuz, Acosta-Pérez, Colón, Román, Ortiz, Rivera-Gastón and Colón-López.)

Background: In recent times, reports have emerged suggesting that a variety of autoimmune disorders may arise after the coronavirus disease 2019 (COVID-19) vaccination. However, causality and underlying mechanisms remain unclear., Methods: We collected summary statistics of COVID-19 vaccination and 31 autoimmune diseases from genome-wide association studies (GWAS) as exposure and outcome, respectively. Random-effects inverse variance weighting (IVW), MR Egger, weighted median, simple mode, and weighted mode were used as analytical methods through Mendelian randomization (MR), and heterogeneity and sensitivity analysis were performed., Results: We selected 72 instrumental variables for exposure ( p  < 5 × 10 -6 ; r2 < 0.001, genetic distance = 10,000 kb), and MR analyses showed that COVID-19 vaccination was causally associated with an increased risk of multiple sclerosis (MS) (IVW, OR: 1.53, 95% CI: 1.065-2.197, p  = 0.026) and ulcerative colitis (UC) (IVW, OR: 1.00, 95% CI: 1.000-1.003, p = 0.039). If exposure was refined ( p < 5 × 10 -8 ; r2 < 0.001, genetic distance = 10,000 kb), the associations became negative. No causality was found for the remaining outcomes. These results were robust to sensitivity and heterogeneity analyses., Conclusion: Our study provided potential evidence for the impact of COVID-19 vaccination on the risk of MS and UC occurrence, but it lacks sufficient robustness, which could provide a new idea for public health policy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Shan, Hu, Chen, Wang, Huang, Xin and Xu.)

Background: The COVID-19 pandemic has convoluted hesitancy toward vaccines, including the seasonal influenza (flu) vaccine. Because of COVID-19, the flu season has become more complicated; therefore, it is important to understand all the factors influencing the uptake of these vaccines to inform intervention targets. This article assesses factors related to the uptake of influenza and COVID-19 vaccines among adults in Tennessee., Methods: A cross-sectional, secondary data analysis of 1,400 adults was conducted in Tennessee. The adult sample came from two data sources: Data source 1 completed a baseline survey from January to March 2022, and data source 2 was completed from May to August 2022. Data on vaccine attitudes, facilitators and barriers, and communication needs were collected via random digit dial by Scientific Telephone Samples (STS). Two multivariable logistic regression models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to predict sociodemographic and overall vaccine-related factors associated with receipt or non-receipt (referent) of COVID-19 and influenza vaccines., Results: Approximately 78% of the adult sample had received the COVID-19 vaccination. A significant positive association for COVID-19 vaccine uptake was seen among those who were older (aged 50-65) (aOR = 1.9; 95% CI: 1.2-3.2), Black (aOR = 2.0; 95% CI:1.3-2.8), and had a college education and higher (aOR = 2.3; 95% CI: 1.5-3.6). However, there was a significant negative association for persons reporting they were extremely religious (aOR = 0.5; 95% CI:0.3-0.9). Over 56% of the adult sample had received the influenza vaccination this season. Those who had a higher annual household income ($80,000+) (aOR = 1.9; 95% CI: 1.3-2.6) and had health insurance (aOR = 2.6; 95% CI: 1.4-4.8) had a significant positive association with influenza vaccine receipt. However, those who were employed part-time or were unemployed had a significant negative association for influenza vaccine receipt (aOR = 0.7; 95% CI: 0.5-0.9). Both COVID-19 and influenza vaccine receipt had strongly significant positive trends with increasing belief in effectiveness and trust ( p  < 0.0001) and strongly significant negative trends with higher levels of overall vaccine hesitancy ( p  < 0.0001)., Conclusion: Strategies to increase COVID-19 and influenza vaccination should be age-specific, focus on increasing geographical and financial access, and offer tailored messages to address concerns about these vaccines., Competing Interests: JC-E is an educational consultant and advisory board member for MERCK. The company had no role in the study including the processes. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Cunningham-Erves, George, Sanderson, Stewart, Jin, Davis and Brandt.)

Background: People with structural vulnerabilities (including immigrants, people who use drugs, and those who are unhoused or uninsured) are more likely to experience COVID-19 testing disparities relative to other groups. We documented barriers and facilitators to COVID-19 testing and explored how structural vulnerabilities created and/or exacerbated COVID-19 testing barriers., Methods: Between 2021 and 2022, we conducted semi-structured interviews with 34 members of structurally vulnerable populations and 27 key informants who provide health and social services to them. Our abductive analysis was iterative, utilizing both inductive and deductive coding processes. Recognizing that adequate and appropriate testing for COVID-19 is a complex health behavior that involves both decision-making and issues related to access, we developed a hybrid model of COVID-19 testing behavior to organize reported barriers. We then used that model for more in-depth analysis of structural vulnerabilities in the context of testing., Results: Our model of testing behaviors provides a framework for understanding the many barriers and facilitators relevant to COVID-19 testing. After identifying locally-reported barriers, we found that specific conditions-economic precarity, legal precarity, the confusing U.S. healthcare landscape, English-exclusive environments, and stigmatizing medical encounters-make adequate and appropriate testing less likely by making COVID-19 testing feel riskier (entailing legal, financial, and psycho-social risks) and making healthcare, and thus vicariously testing, more difficult to access., Conclusion: The COVID-19 pandemic exposed disparities in health care delivery. To avoid under-testing and its associated health consequences during the next pandemic, public health efforts should address structural conditions to ameliorate risks and bolster testing infrastructure to improve access., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Kohut, Sclar, Nicoll, Fernandes, Volkers, Tucker, Jacobs and Fairfield.)

Objective: This study aimed to investigate the evidence regarding vaccine hesitancy including refusal rate, associated factors, and potential strategies to reduce it., Methods: This is a scoping review. Three main databases such as PubMed, Scopus, and Web of Science were searched from 1 January 2020 to 1 January 2023. All original studies in the English language that investigated one of our domains (vaccine hesitancy rate, factors associated with vaccine hesitancy, and the ways/interventions to overcome or decrease vaccine hesitancy) among the general population were included in this study. The data were charted using tables and figures. In addition, a content analysis was conducted using the 3C model of vaccine hesitancy (Confidence, Complacency, and Convenience) that was previously introduced by the WHO., Results: Finally, 184 studies were included in this review. Of these, 165, 181, and 124 studies reported the vaccine hesitancy rate, associated factors, and interventions to reduce or overcome vaccine hesitancy, respectively. Factors affecting the hesitancy rate were categorized into 4 themes and 18 sub-themes (contextual factors, confidence barriers, complacency barriers, and convenience barriers)., Conclusion: Vaccine hesitancy (VH) rate and the factors affecting it are different according to different populations, contexts, and data collection tools that need to be investigated in specific populations and contexts. The need to conduct studies at the national and international levels regarding the reasons for vaccine refusal, the factors affecting it, and ways to deal with it still remains. Designing a comprehensive tool will facilitate comparisons between different populations and different locations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Bahreini, Sardareh and Arab-Zozani.)

Background: During the COVID-19 pandemic, persons with disabilities (PWDs) have faced additional disadvantages that have exacerbated their physical and mental health challenges. In Nigeria, where cultural, religious, and informational barriers persist, understanding these factors is critical for improving health interventions, including vaccine uptake among PWDs., Methods: This study employed a qualitative descriptive-interpretive design to explore the perceptions of PWDs regarding the COVID-19 pandemic and the vaccine, alongside social workers' views on their roles in facilitating vaccine uptake. We conducted in-depth semi-structured telephone interviews with 20 participants, comprising 16 PWDs and four social workers in Nigerian rehabilitation homes. Data were analyzed using critical thematic analysis to identify key themes influencing attitudes toward the pandemic and vaccine uptake., Results: The study uncovered significant barriers to COVID-19 vaccine uptake among PWDs, primarily driven by mistrust in government initiatives, widespread conspiracy theories, and deeply held cultural and religious beliefs. Additionally, while social workers played crucial roles as community surveillance officers, in-house educators, and community referral agents, their interventions lacked specific strategies aimed at increasing vaccine uptake among PWDs. Their efforts were more focused on addressing the psychological impacts of the pandemic rather than fostering behavioral changes toward vaccine acceptance., Conclusion: To enhance COVID-19 vaccine uptake among PWDs in Nigerian rehabilitation homes, targeted interventions that address the identified barriers are essential. These should include trust-building measures, culturally and religiously sensitive communication strategies, and tailored educational programs by social workers. Moreover, training social workers in specific, evidence-based strategies to increase vaccine uptake is crucial for mitigating the pandemic's impact on this vulnerable population., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Rahman, Iwuagwu, Ngwu, Ebe Kalu, Kasherwa, Chowdhury and Kader.)

Younger adults, aged 18-39 years, exhibit low COVID-19 additional vaccine (i.e., vaccination beyond the original 2-dose series) uptake recommended in Canada. No study has examined how altruistic and individualistic messaging can influence COVID-19 additional dose intentions. The present study aimed to estimate the efficacy of altruism and individualism-based videos on vaccine intentions and to explore the multivariable associations between vaccine related individual psychosocial factors and intention to receive the COVID-19 vaccine. Using a web-based survey in a three-arm, pre-post randomized control trial design, we recruited Canadians aged 18-39 years in both English and French. Participants were randomly allocated in a 1:1:1 ratio to receive the active control (COVID-19 general information), control + altruism or control + altruism + individualism. The video interventions were developed with a media company, based on results of a focus group study conducted previously. The measurement of COVID-19 additional dosage intentions before and after completing the interventions was informed by the multistage Precaution Adoption Process Model. The McNemar Chi-square was used to evaluate within-group changes, and the Pearson Chi-square test was used to evaluate between-group changes post-intervention. The measurement of various psychosocial factors was informed by use of validated scale and self-report questions. We employed a generalized Structural Equation Model to evaluate the associations between COVID-19 vaccine intentions and the psychosocial factors. Analyses were performed on 3,431 participants (control: n  = 1,149, control + altruism: n  = 1,142, control + altruism + individualism: n  = 1,140). Within-group results showed that participants transitioned significantly in all three groups in the direction of higher intentions for receiving additional COVID-19 vaccine doses. The between-group differences in post intervention vaccine intentions were not significant. We found that psychosocial factors that include, collectivism, intellectual humility, intolerance to uncertainty, religiosity, identifying as gender diverse, and being indigenous were associated with higher vaccine intentions, whereas pandemic fatigue was associated with lower vaccine intentions. Our study highlighted that a short video that includes altruism and individualism messaging or general COVID-19 information can increase intentions to vaccine among young adults. Furthermore, we gained a comprehensive understanding of various psychosocial factors that influence ongoing COVID-19 vaccination. Our findings can be used to influence public health messaging around COVID-19 vaccination., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Batra, Tatar, Zhu, Perez, Haward, Zimet and Rosberger.)

Introduction: The COVID-19 pandemic, driven by SARS-CoV-2, has made vaccination a critical strategy for global control. However, vaccine hesitancy, particularly among certain age groups, remains a significant barrier to achieving herd immunity., Methods: This study uses Poisson regression and ARIMA time-series modeling to identify factors contributing to vaccine hesitancy, understand age-specific vaccination preferences, and assess the impact of bivalent vaccines on reducing hesitancy and fatality rates. It also predicts the time required to achieve herd immunity by analyzing factors such as vaccine dosing intervals, age-specific preferences, and changes in fatality rates., Results: The study finds that individuals recovering from COVID-19 often delay vaccination due to perceived immunity. There is a preference for combining BNT162b2 and CoronaVac vaccines. The BNT162b2 bivalent vaccine has significantly reduced vaccine hesitancy and is linked with lower fatality rates, particularly in those aged 80 and above. However, it tends to induce more severe side effects compared to Sinovac. Vaccine hesitancy is most prevalent among the youngest (0-11) and oldest (80+) age groups, posing a challenge to reaching 90% vaccination coverage., Conclusion: Vaccine hesitancy is a major obstacle to herd immunity. Effective strategies include creating urgency, offering incentives, and prioritizing vulnerable age groups. Despite these challenges, the government should have continued to encourage vaccinations while gradually lifting COVID-19 control measures, balancing public health safety with the return to normal life, as was observed in the transition period during the latter stages of the pandemic., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Hon, Chan, Ng and Lam.)

Introduction: We described how COVID-19 fatality and symptoms varied by dominant variant and vaccination in the US., Methods: Using the Restricted Access Dataset from the US CDC (1/1/2020-10/20/2022), we conducted a cross-sectional study assessing differences in COVID-19 deaths, severity indicators (hospitalization, ICU, pneumonia, abnormal X-ray, acute respiratory distress syndrome, mechanical ventilation) and 12 mild symptoms by dominant variant/vaccination periods using logistic regression after controlling for confounders., Results: We found the highest fatality during the dominant periods of Wild (4.6%) and Delta (3.4%). Most severe symptoms appeared when Delta was dominant (Rate range: 2.0-9.4%). Omicron was associated with higher mild symptoms than other variants. Vaccination showed consistent protection against death and severe symptoms for most variants (Risk Ratio range: 0.41-0.93). Boosters, especially the second, provided additional protection, reducing severe symptoms by over 50%., Discussion: This dataset may serve as a useful tool to monitor temporospatial changes of fatality and symptom for case management and surveillance., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Lin, Liu, Qi, Trees, Gao, Friedman, Xue and Lawrence.)

Background: This paper asks whether Dynamic Causal modelling (DCM) can predict the long-term clinical impact of the COVID-19 epidemic. DCMs are designed to continually assimilate data and modify model parameters, such as transmissibility of the virus, changes in social distancing and vaccine coverage-to accommodate changes in population dynamics and virus behavior. But as a novel way to model epidemics do they produce valid predictions? We presented DCM predictions 12 months ago, which suggested an increase in viral transmission was accompanied by a reduction in pathogenicity. These changes provided plausible reasons why the model underestimated deaths, hospital admissions and acute-post COVID-19 syndrome by 20%. A further 12-month validation exercise could help to assess how useful such predictions are., Methods: we compared DCM predictions-made in October 2022-with actual outcomes over the 12-months to October 2023. The model was then used to identify changes in COVID-19 transmissibility and the sociobehavioral responses that may explain discrepancies between predictions and outcomes over this period. The model was then used to predict future trends in infections, long-COVID, hospital admissions and deaths over 12-months to October 2024, as a prelude to future tests of predictive validity., Findings: Unlike the previous predictions-which were an underestimate-the predictions made in October 2022 overestimated incidence, death and admission rates. This overestimation appears to have been caused by reduced infectivity of new variants, less movement of people and a higher persistence of immunity following natural infection and vaccination., Interpretation: despite an expressive (generative) model, with time-dependent epidemiological and sociobehavioral parameters, the model overestimated morbidity and mortality. Effectively, the model failed to accommodate the "law of declining virulence" over a timescale of years. This speaks to a fundamental issue in long-term forecasting: how to model decreases in virulence over a timescale of years? A potential answer may be available in a year when the predictions for 2024-under a model with slowly accumulating T-cell like immunity-can be assessed against actual outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Bowie and Friston.)

Background: Healthcare workers play a central role in communicating information to the public regarding vaccines. Most of the literature has focused on healthcare workers' hesitancy and doubts about getting the flu vaccine themselves. However, few studies have dealt with how they perceive their role in communicating information regarding vaccines, especially following the COVID-19 pandemic., Objectives: (1) To identify the communication strategies used by the Israeli Ministry of Health regarding vaccines during epidemic crises (before and after the COVID-19 pandemic); (2) To identify the communication strategies used by healthcare workers regarding vaccines before and after the COVID-19 pandemic., Methods: A qualitative study based on in-depth interviews was conducted among healthcare workers and used a semi-structured protocol as a research tool. A total of 18 healthcare workers were sampled using purposeful and snowball sampling., Results: Despite healthcare workers' perception that there has been a decrease in trust in the Israeli Ministry of Health among the public following the COVID-19 outbreak, they still rely on the Israeli Ministry of Health as their primary source of information and use the same communication strategies (such as fear appeals and correcting information) as of the Israeli Ministry of Health to communicate with the public, healthcare providers, and other relevant stakeholders., Conclusion: Healthcare workers have been shaped by the professional socialization processes within the health system, leading to a predominant reliance on established communication strategies and informational channels. This reliance underscores the importance of evolving these methods to better engage with the public. To address this, there is a compelling need to innovate and adopt new communication techniques that emphasize effective dialogue and transparent interactions. By doing so, healthcare professionals can ensure that their outreach is not only informative but also responsive to the diverse needs and preferences of the community., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Hijazi, Gesser-Edelsburg and Mesch.)

Introduction: More than 3 years into the pandemic, there is persisting uncertainty as to the etiology, biomarkers, and risk factors of Post COVID-19 Condition (PCC). Serological research data remain a largely untapped resource. Few studies have investigated the potential relationships between post-acute serology and PCC, while accounting for clinical covariates., Methods: We compared clinical and serological predictors among COVID-19 survivors with ( n  = 102 cases) and without ( n  = 122 controls) persistent symptoms ≥12 weeks post-infection. We selected four primary serological predictors (anti-nucleocapsid (N), anti-Spike, and anti-receptor binding domain (RBD) IgG titres, and neutralization efficiency), and specified clinical covariates a priori ., Results: Similar proportions of PCC-cases (66.7%, n  = 68) and infected-controls (71.3%, n  = 87) tested positive for anti-N IgG. More cases tested positive for anti-Spike (94.1%, n  = 96) and anti-RBD (95.1%, n  = 97) IgG, as compared with controls (anti-Spike: 89.3%, n  = 109; anti-RBD: 84.4%, n  = 103). Similar trends were observed among unvaccinated participants. Effects of IgG titres on PCC status were non-significant in univariate and multivariate analyses. Adjusting for age and sex, PCC-cases were more likely to be efficient neutralizers (OR 2.2, 95% CI 1.11-4.49), and odds was further increased among cases to report deterioration in quality of life (OR 3.4, 95% CI 1.64-7.31). Clinical covariates found to be significantly related to PCC included obesity (OR 2.3, p  = 0.02), number of months post COVID-19 (OR 1.1, p  < 0.01), allergies (OR 1.8, p  = 0.04), and need for medical support (OR 4.1, p  < 0.01)., Conclusion: Despite past COVID-19 infection, approximately one third of PCC-cases and infected-controls were seronegative for anti-N IgG. Findings suggest higher neutralization efficiency among cases as compared with controls, and that this relationship is stronger among cases with more severe PCC. Cases also required more medical support for COVID-19 symptoms, and described complex, ongoing health sequelae. More data from larger cohorts are needed to substantiate results, permit subgroup analyses of IgG titres, and explore for differences between clusters of PCC symptoms. Future assessment of IgG subtypes may also elucidate new findings., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Collins, Galipeau, Arnold, Bhéreur, Booth, Buchan, Cooper, Crawley, McCluskie, McGuinty, Pelchat, Rocheleau, Saginur, Gravel, Hawken, Langlois and Little.)

Introduction: Long COVID affects health-related quality of life (HRQoL). Here, we investigate the extent to which symptoms experienced during the acute phase of COVID-19 are significant predictors of the presence of long COVID at 12 weeks., Methods: Post-hoc analysis of COMET-ICE trial data, which assessed sotrovimab vs. placebo for treatment of mild-to-moderate COVID-19 among high-risk patients. Patient-reported outcome measures were completed during the trial, including the inFLUenza Patient-Reported Outcome Plus (FLU-PRO Plus), the 12-Item Short Form (SF-12) Hybrid questionnaire, and the Work Productivity and Activity Impairment Questionnaire: General Health (WPAI:GH). COVID-19 symptoms and impacts (measured by the FLU-PRO Plus) and HRQoL (measured by SF-12 Hybrid and WPAI:GH) were compared between the acute phase (Days 1-21 and 29) and long-COVID phase (at Week 12) among patients with and without long COVID based on COMET-ICE data. Subgroups experiencing long COVID were derived using "All," "Returning," and "Persisting" symptomatic definitions. Long-COVID predictors were identified using a multivariate logistic regression model; odds ratios (ORs) and 95% CIs were calculated., Results: Long-COVID subgroups had significantly higher baseline scores for most FLU-PRO Plus domains and Total Score compared with the non-long-COVID group. WPAI:GH and SF-12 Hybrid scores generally showed significantly more impairment for the long-COVID subgroups at baseline and Week 12 vs. the non-long-COVID group. In the univariate analyses, all FLU-PRO Plus domains were significant predictors of long COVID (all p < 0.05), with the exception of the Sense domain. Older age increased the risk of long COVID (OR 1.02, 95% CI 1.00-1.04, p < 0.05). Non-White patients were significantly less likely to have long COVID by the Returning and Persisting definitions vs. White patients (all p < 0.05). In the multivariate analysis, higher scores for the Nose domain (ORs 3.39-5.60, all p < 0.01) and having COPD (ORs 3.75-6.34, all p < 0.05) were significant long-COVID predictors., Conclusion: Patients who progressed to long COVID had higher symptom severity during the acute disease phase and showed significantly greater negative impact on HRQoL over an extended time period from initial infection through at least the subsequent 3 months. The FLU-PRO Plus Nose domain and having COPD were significant predictors of long COVID., Competing Interests: HG, KC, and YS are employees of Evidera, which received funding from GSK and Vir Biotechnology, Inc. to conduct this study. PG, HB, EL, and W-HC are employees of, and/or shareholders in, GSK. SS is an employee of, and/or shareholder in, Vir Biotechnology, Inc., (Copyright © 2024 Gelhorn, Ghafoori, Cutts, Birch, Savva, Satram, Lloyd and Chen.)

There is an urgent need for increased understanding of COVID-19 and strategies for its prevention, treatment, and mitigation. All participants in the research enterprise, including institutional review boards, have an ethical duty to protect participants and ensure that the benefits gained from such research do not conflict with the core principles that guided researchers prior to the pandemic. In this review, we discuss the ethical issues surrounding initiation and conduct of clinical trials, focusing on novel COVID-19 therapeutic, vaccine, or biospecimen research, using the principles of autonomy, beneficence, and justice. We discuss strategies to manage the practical challenges associated with the conduct of clinical trials, with an emphasis on maintaining the rights and welfare of research participants., Competing Interests: RV, KC, and SM are employees of and own stock in Regeneron Pharmaceuticals Inc. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Vitti, Vitti, Chu and Mellis.)

Objective: To investigate how Chinese residents perceived changes in their protective behaviors in the early stage after the lifting of the dynamic zero-COVID policy, and to explore the associations between the overall perceived change and factors such as demographic and health-related information, COVID-19 related perceptions, negative emotions, and coping styles., Methods: This cross-sectional study involved 798 Chinese residents who completed an online questionnaire between 16 and 25 December 2022. The questionnaire covered demographic and health-related information, COVID-19 related perceptions, negative emotions, coping styles, and perceived changes in protective behaviors. Multiple linear stepwise regression analysis was used to determine the factors associated with the overall perceived change in protective behaviors., Results: The mean score for perceived protective behavioral change among participants was 61.38 (SD = 10.20), which was significantly higher than the hypothesized no-change value of 49 ( p  < 0.001). The mean scores for each of the 15 behaviors (excluding the two vaccination-related items) were significantly greater than the hypothesized no-change value of 3 ( p  < 0.001). The mean scores for the two vaccination-related items were significantly greater than the hypothesized no-change value of 2 ( p  < 0.001). Among all behaviors, avoiding dining out or gathering with friends had the highest mean score (Mean = 4.16), while engaging in regular physical activity had the lowest (Mean = 3.32). Avoiding dining out or gathering with friends had the highest percentage of individuals reporting an increase (71.3%), whereas maintaining a social distance of more than 1 m had the highest percentage of individuals reporting a decrease (17.5%). Regression analysis indicated that age, worry, positive coping, female sex, negative coping, and perceived severity were associated with the overall perceived change in protective behaviors, with worry being the most predictive variable., Conclusion: This study suggested that Chinese residents perceived an increase in their protective behaviors in the early stage after the policy change, with varying magnitudes across behaviors. We identified some potentially modifiable factors associated with perceived protective behavioral change, with worry emerging as the strongest predictor, followed by positive coping, negative coping, and perceived severity. These insights offer valuable information for developing effective communication strategies, psychological support, and comprehensive models in health behavior research., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Song, Xu, Liu, Feng, Yang, Jiang and Wu.)

Introduction: The COVID-19 pandemic led to major disruptions in the lives of university students, which is a population that is already at a greater risk of mental health concerns. Little is known about how the pandemic impacted distress and mental health services utilization among university students across the United States., Methods: Using survey data from the National College Health Assessment, both before the COVID-19 pandemic (pre-March 2020, n  = 88,986) and during the pandemic (Spring 2021, n  = 96,489), the present study examined mental health symptoms and utilization of mental health services among undergraduate students attending four-year universities in the United States., Results: There were notable increases in measures of psychological distress and reductions in well-being from before the pandemic to during the pandemic. However, overall utilization rates of mental health services slightly decreased from pre-pandemic to during the pandemic. Predictors of severe psychological distress included those who experienced loneliness, COVID-19 related stressors, and loss of a loved one from COVID-19. COVID-related stressors and loneliness were associated with higher utilization rates of mental health services, while well-being and resilience were associated with lower utilization rates., Discussion: Analyses revealed that several demographic groups were at an elevated risk for severe psychological distress, including non-binary, female, and sexual minority students, and especially those who identify as both non-binary and non-heterosexual. Results indicated that students of color, especially female students of color, were less likely to receive mental health services. Future research is needed to increase our understanding of the barriers to mental health service use among high-risk university students., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Russell, Abidogun, Lindley and Griffin.)

Background: COVID-19 pandemic had devastating socio-economic and health effects, including mental health. This study examines the intersectionality between gender and mental health outcomes among Kenyan adults in informal settlements of Nairobi, Kisumu, and Kilifi Counties during the COVID-19 crisis. This is necessary to inform mental health response in case of another pandemic., Methods: We analyzed data collected in a longitudinal survey between July 2020 (fourth round) and February 2021 (fifth round). The data covered COVID-19-related effects on job loss, food insecurity, access to health services, and mental health. Participants were randomly sampled from existing cohorts at the Population Council. The outcomes of interest were depressive and anxiety disorders, combined into a binary composite outcome variable. Descriptive statistics included means for continuous variables and frequencies and proportions for categorical variables. Chi-square tests were used to examine the differences between groups. The relationship between the gendered COVID-19 socio-economic effects and participants' mental health was examined using modified Poisson regression., Results: A total of 4,050 participants were interviewed, 66% female and median age 38 [interquartile range (IQR): 29-46]. Complete income loss was strongly associated with negative mental health outcomes in multiple intersections with varied magnitudes. The association was larger among older females (≥50 years) (PR = 1.33, 95% CI = 1.17-1.51, p  < 0.001) than older males (PR = 1.22, 95% CI = 1.17-1.27, p  < 0.001). Partial loss of income was protective against negative mental health outcomes among young males (18-29 years) (PR = 0.81, 95% CI = 0.76-0.87, p  < 0.001) but linked to negative outcomes among middle-aged males (30-49 years old) (PR = 1.14, 95% CI = 1.12-1.16, p  < 0.001). Skipping meals was associated with negative mental health outcomes for both genders particularly the married (married male: PR = 1.49, 95% CI = 1.22-1.83, p  < 0.001; married female: PR = 1.42, 95% CI = 1.26-1.60, p  < 0.001)., Conclusion: We observed significant gender differences in the prevalence of depressive symptoms and anxiety disorders during the COVID-19 pandemic, underscoring the importance of socio-economic factors and health services access in shaping mental health outcomes. Interventions targeting pandemic-related mental health issues should be gender-sensitive and address economic vulnerabilities such as job losses and food insecurity. Policies to mitigate these effects, especially for at-risk groups are crucial for reducing mental health burden in future crises., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Mwanga, Odero, Kadengye, Odunga, Muluve, Mugotitsa, Wafubwa, Austrian and Kiwuwa-Muyingo.)

Background: Intensive care unit (ICU) beds played a crucial role in reducing mortality rates of patients with severe COVID-19. The surge in the number of patients led to a shortage of ICU beds, which may have exacerbated inequity of healthcare utilization. However, most attention has been focused on the horizontal equity in healthcare utilization, where individuals with the same needs receive the same services. Vertical equity, where individuals with higher needs receive more healthcare is often neglected, which might overestimate the equity. This study analyzes the vertical equity of ICU utilization among hospitalized patients with COVID-19., Methods: In total, 18,547 hospitalized patients with COVID-19 in Maryland in 2020 were enrolled in this cross-sectional study. Logistic regression analysis was conducted to determine the independent factors affecting ICU utilization, and the Shapley value decomposition approach was implemented to assess the contribution of the independent variables to disparities in ICU admission. A concentration curve and concentration index were used to assess the vertical equity in healthcare utilization., Results: ICU utilization by patients with COVID-19 was significantly affected by Charlson Comorbidity Index (CCI), with odds ratios (OR) 1.09 [95% confidence intervals (CI): 1.07-1.10; p  < 0.001] in univariable analysis and 1.11 (95% CI: 1.09-1.13; p  < 0.001) in multivariable regression analysis. The most important contributors were household income (32.27%) and the CCI (22.89%) in the Shapley value decomposition analysis. The concentration curve was below the line of equity, and the concentration index was 0.094 (95% CI: 0.076-0.111; p  < 0.001), indicating that ICU utilization was concentrated among patients with a high CCI. These results were robust for all subgroup analyses., Conclusion: Among 18,547 hospitalized patients with COVID-19 in Maryland in 2020, ICU utilization was significantly affected by comorbid conditions. The concentration curve and concentration index also indicated that ICU utilization was more concentrated in patients with a higher CCI. The results was consistent with the principle of vertical equity, whereby healthcare resources are more concentrated on COVID-19 patients with higher health needs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zhu, Wang, Wu, Yu, Liu, Liu and Zhang.)

Introduction: COVID-19 has triggered significant disruptions globally, necessitating swift adaptations in individuals' health behaviors., Methods: This cross-sectional study was conducted during Phase Four of Malaysia's National Recovery Plan and examines how the pandemic has affected health behaviors among adult Malaysians. The study gathered data online using convenience sampling with 1,004 respondents aged 18 and above. The research focused on diverse health domains, including eating habits, physical activity, smoking, alcohol consumption, and sleep patterns. The Wilcoxon Signed Rank test and descriptive statistics were employed to compare health behaviors before and after COVID-19., Results: Findings indicate noteworthy shifts in eating behaviors, with increased water and fruit consumption ( p  < .001). The frequency of home-cooked meals stayed relatively stable despite declining dinner preference and increasing daily snacks. Physical activity declined, marked by increased sedentary behavior and screen time ( p  < .001). There were differences in the patterns of smoking and alcohol consumption; some had started these behaviors during the pandemic. Notably, intentions to quit smoking among respondents were more prominent than attempts to stop drinking. Respondents' sleep patterns also changed, with more sleeping fewer than seven hours daily ( p  < .001)., Conclusion: The study emphasizes the need for focused interventions to address new challenges by highlighting the impact on health behaviors. As Malaysia navigates the post-pandemic landscape, understanding and mitigating the persisting effects on health behaviors are crucial for promoting overall well-being., Competing Interests: The authors declare that the research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ithnain, Kassim, Amirudin, Aimanan, Krishnan and Panting.)

In June 2019, the Chinese government proposed the Healthy China Action Plan (2019-2030) development strategy, which focuses on disease prevention and health promotion. It is expected that by 2030, the national health literacy level will be significantly improved, premature mortality caused by major chronic diseases will be significantly reduced, the average healthy life expectancy will be greatly improved, and the main health indicators of residents will enter the ranks of high-income countries. Unfortunately, at the end of 2019, COVID-19 began to break out in Wuhan, China, which had a huge impact on China's economy and people's health. A series of problems in China's health care and medical education were exposed in the prevention and treatment of the epidemic. How to reform medical education and build a medical talent training system with Chinese characteristics is the key to achieving China's Health 2030 strategy. This article will explore the direction of medical education reform in China under the background of the "Healthy China 2030" strategy and the post pandemic era., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Han and Wu.)

Background: Primary healthcare workers in China were vital in controlling COVID-19, facing unprecedented challenges due to the pandemic's suddenness and transmissibility. This paper analyzed their work in Guangzhou, highlighting key difficulties in past epidemic control efforts., Methods: Semi-structured qualitative interviews were conducted with selected primary healthcare workers in Guangzhou City and audio-recorded until saturation of themes was reached. The data were analyzed independently for themes using NVivo V.12., Results: Thematic analysis of qualitative interview data revealed that challenges and difficulties encountered in grassroots epidemic prevention and control work during the COVID-19 pandemic were primarily categorized into seven dimensions: human resource allocation, material and vehicle support, epidemic prevention subsidies and compensation, humanistic care, upper-level management, horizontal collaboration, and resident cooperation., Conclusion: Based on the findings, the research team recommends that administrative departments and institutions related to primary healthcare should appropriately schedule personnel work and rest time, adjust work content flexibly, optimize the allocation of medical and logistical resources, and increase investment in primary healthcare work as well as staff protection., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Jin, Feng, Xiao, Tian, Yao, Zhang, Wu, Zhu, Zheng, Chen, Liu, Ma, Chen and Dong.)

Introduction: Intergenerational support is an important determinant of mental health. Due to limited access to formal care, the role of the family as provider of support became more prominent during the COVID-19 pandemic. To date, it remains unclear how intergenerational support from adult children to older parents was affected during the pandemic and whether this had consequences for the mental health of the parent generation., Methods: Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE) Corona Surveys, we explore whether changes in support going from non-coresident adult children to their parents are associated with parents' increase in depressive feelings. Additionally, we test whether the pandemic context and public health measures affected this relationship., Results: During the pandemic, families are found to provide more support. These changes in intergenerational support, however, were related to increased depressive feelings for the older parents. Furthermore, both the strictness of public health measures and the concurrent epidemiological situation affected this relationship., Conclusion: We conclude that the family is an essential source of late-life well-being, but stressful life events, such as public health crises, put pressure on these intergenerational relations with potential adverse mental health outcomes. Future policies should take into account the ambivalent nature of intergenerational relationships., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Van Herreweghe and Van Lancker.)

COVID-19 has profoundly impacted global daily life, emphasizing the need for effective virus suppression strategies. In response, China has established numerous nucleic acid testing sites to facilitate rapid testing and curb outbreaks. However, these sites often experience congestion, increasing transmission risks and reducing testing efficiency. This study focuses on the spatial-temporal analysis of testing site distribution and associated infection risks in Shenzhen, China. Data from all Shenzhen testing sites were analyzed for the week of October 24-30, 2022, noting the percentage of busy hours per site and incorporating a population size factor by district to assess regional infection risks. Findings indicate three daily peak testing times-primarily in the evening-with the highest risk of transmission in Longgang District, followed by Yantian and Luohu, and the lowest in Futian. The risk coefficient varied from 0.040 to 0.349, with most areas showing stable risk levels between 0.06 and 0.20. This research underlines the necessity for policymakers to alleviate congestion at testing sites and suggests increasing site availability in Longgang District to mitigate COVID-19 spread, offering methodological guidance for managing infection risks in other major Chinese cities., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Wang, Zhang, Zhang and Han.)

Background: The COVID-19 comorbid population is at higher risk of developing severe health issues like acute respiratory distress syndrome, coagulation syndrome, metabolic acidosis, and septic shock, potentially leading to patient death. Patients' knowledge, attitudes, and practices (KAP) significantly influence their response to the pandemic and aid in enhancing health policy implementation., Objective: To identify and evaluate the pattern and associated factors to COVID-19 knowledge, attitude, and practice among individuals with comorbidities., Methodology: The systematic review followed the PRISMA guidelines. Relevant studies assessing the KAP of comorbid patients were retrieved by carefully searching the PubMed and Google Scholar databases. The appraisal tool for cross-sectional studies was used to determine the quality of the included studies and the risk of biases., Results: Eighteen studies met the inclusion criteria and were included in the review. The pooled sample size of the included studies was 9,104. Different comorbidities reported in the studies include hypertension, diabetes, psychological disorders, and cancer. Pooled analysis showed that 65% of patients showed good knowledge, 57% of patients showed a positive attitude and 51% of patients followed good practices to manage the COVID-19 in presence of their comorbid condition. Significant factors impacting knowledge, attitude and practice in COVID-19 comorbid patients were ethnicity OR 1.78 [95% CI 1.35-2.32]; educational status 3.2 [2.79-3.58]; urban residence 2.43 [1.65-3.02]; employment Status 1.67[1.34-2.12]; financial Status 4.02[3.66-4.38]; occupation 3.65[3.31-4.25]; information Source 2.64[2.19-3.26]; comorbidity 3.28[2.78-3.61]; and duration of chronic illness 1.59[1.31-2.04]., Conclusion: Comorbid COVID-19 patients showed good knowledge, positive attitude and good practice towards the management of the disease., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Rehman, Tasleem, Muhammad, Rasool, Shah, Jabeen, Arif, Omar Babkair, Kadumi, Alghamdi, Almarzoky Abuhussain, Khayyat, Alharthi, Hossain, Abbas, Elrggal and Haseeb.)

The COVID-19 pandemic has spread widely around the world since 2019, wreaking havoc on social order in a global context. In China, the pandemic has not only provided new challenges to the government's capacity but also provided new issues for the Civil Code that is being compiled. The study adopts the research method of comparative analysis and combines the case study method, aiming to study the impact of the epidemic on the compilation of China's Civil Code. We found that the official Civil Code adds, deletes, and adjusts several articles compared to the Civil Code (Draft), five of which are relevant to the COVID-19 pandemic. The Civil Code was enacted at the time of the COVID-19 pandemic, which led to some of its provisions being affected by the COVID-19; the "COVID-19 provisions" not only provided legitimacy for the prevention and control of the pandemic but also improved China's system of governance of public health emergencies. This study exposes the legal loophole in the "COVID-19 provisions" in China's Civil Code and further suggests ways to fill the legal loophole., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zhai and Liu.)

Background: Prior to the development of COVID-19 vaccines, policymakers instituted various non-pharmaceutical interventions (NPIs) to limit transmission. Prior studies have attempted to examine the extent to which these NPIs achieved their goals of containment, suppression, or mitigation of disease transmission. Existing evidence syntheses have found that numerous factors limit comparability across studies, and the evidence on NPI effectiveness during COVID-19 pandemic remains sparse and inconsistent. This study documents the magnitude and variation in NPI effectiveness in reducing COVID-19 transmission (i.e., reduction in effective reproduction rate [R eff ] and daily contact rate) in Italy, the United States, the United Kingdom, and China., Methods: Our rapid review and narrative synthesis of existing research identified 126 studies meeting our screening criteria. We selected four contexts with >5 articles to facilitate a meaningful synthesis. This step yielded an analytic sample of 61 articles that used data from China, Italy, the United Kingdom, and the United States., Results: We found wide variation and substantial uncertainty around the effectiveness of NPIs at reducing disease transmission. Studies of a single intervention or NPIs that are the least stringent had estimated Reff reductions in the 10-50% range; those that examined so-called "lockdowns" were associated with greater Reff reductions that ranged from 40 to 90%, with many in the 70-80% range. While many studies reported on multiple NPIs, only six of the 61 studies explicitly used the framing of "stringency" or "mild versus strict" or "tiers" of NPIs, concepts that are highly relevant for decisionmakers., Conclusion: Existing evidence suggests that NPIs reduce COVID-19 transmission by 40 to 90 percent. This paper documents the extent of the variation in NPI effectiveness estimates and highlights challenges presented by a lack of standardization in modeling approaches. Further research on NPI effectiveness at different stringency levels is needed to inform policy responses to future pandemics., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Faherty, Nascimento de Lima, Lim, Roberts, Karr, Lawson and Willis.)

Background: The COVID-19 pandemic has profoundly affected mass gatherings (MGs) worldwide, necessitating the implementation of advanced decision support techniques. These techniques, including mathematical models and risk assessment tools, have played a critical role in ensuring the safe conduct of events by mitigating the spread of SARS-CoV-2., Aim: This mini-review aims to explore and synthesize the decision support methodologies employed in managing MGs during the COVID-19 pandemic., Methods: A scoping review was conducted following the PRISMA guidelines covering the period from 2020 to 2024. Studies were categorized by event type (e.g., academic, religious, political, sports) and decision-making tools applied. The review identified a range of decision support techniques, with risk assessment and simulation tools being the most commonly employed across various event types., Results: A total of 199 studies were initially identified, with 10 selected finally for inclusion based on relevance to decision support techniques. Case studies included the successful risk mitigation strategies during the 2020 Hajj, the 2021 Tokyo Olympics, and the 2022 FIFA World Cup in Qatar. Techniques such as fuzzy logic, Bayesian analysis, and multi-criteria decision-making were also highlighted, particularly in complex scenarios. These tools significantly contributed to reducing COVID-19 transmission risks at large-scale events., Conclusion: The review underscores the importance of decision support systems in the safe management of MGs during the pandemic. Further research should focus on the integration of emerging technologies and the long-term impacts of decision support tools on public health management., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Llorente-Nieto, Ramos-Rincón and González-Alcaide.)

Introduction: The COVID-19 pandemic affected adolescents' mental health diversely., Methods: Our objective was to examine the one-year change in well-being (WHO-5 well-being index) and self-esteem (Rosenberg self-esteem scale) among secondary school students affected by school lockdown (lockdown group) compared to control students unaffected by the pandemic (pre-pandemic group), utilizing data from a longitudinal survey study conducted in Hungary. We used linear mixed models stratified by sex and adjusted for family structure and family communication., Results: Two hundred twenty seven pre-pandemic (128 girls, 99 boys) and 240 lockdown (118 girls, 122 boys) students were included. Both boys' and girls' well-being declined in the pre-pandemic group but remained stable in the lockdown group. Post-hoc analyses on WHO-5 items revealed that the pre-pandemic and lockdown groups differed significantly on Item 4 (waking up feeling fresh and relaxed). Boys' self-esteem did not change over the observation period in neither groups. As for girls, self-esteem of girls during lockdown increased over the observation period, while it did not change in the pre-pandemic group. Better family communication was consistently associated with higher well-being and self-esteem scores for both sexes., Discussion: Our results suggested that students may have benefitted from altered academic circumstances due to lockdown (e.g., more sleep) and students struggling with waking up early benefitted the most from lockdown (as shown in our post hoc analysis). Additionally, our results also indicate that families should be involved in mental health promotion interventions, especially in time of adversities. This study underscores the multifaceted effects of pandemic-related factors on adolescent mental health and highlights the need to also investigate the unexpected benefits of pandemic-related restrictions to incorporate this knowledge in health promotion programs targeting the well-being of students., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Major, Falus, Árva, Eorsi, Terebessy, Tabak and Fazekas-Pongor.)

Introduction: Poverty is one of the macro factors that has been little studied in terms of its effect on death from COVID-19 since most studies have focused only on investigating whether the pandemic increased poverty or not. With that on mind, the present study aims to analyze how the social deprivations that comprise the measurement of municipal poverty in interaction with health comorbidities and sociodemographic characteristics, increased the probability of death from COVID-19., Methods: The study is cross-sectional and covers daily reports on the conditions of COVID-19 in the Mexican population for almost 2 years. Using data from the National Epidemiological Surveillance System and the National Council for Evaluation of the Social Development Policy ( N  = 5,387,981), we employ a Generalized Linear Mixed Model (GLMM), specifically a binomial generalized linear mixed model., Results: The findings indicate that, besides comorbidities, sociodemographic traits, and clinical aspects, living in a municipality where one or more of the social deprivations exist increases the probability of death. Specifically, in those municipalities where there is deprivation in education, social security, and food, as well as deprivation due to access to health services and deprivation in household services, the probability of death was greater., Discussion: Living in a municipality with one or more of the social deprivations that compose poverty generated a greater probability of death. Each one of them or together, shows that poverty is a substantial factor for a pandemic like COVID-19 to worsen contagion and death, becoming a circle from which it is difficult to escape., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Martínez-Martínez, Ramírez-López, Coutiñho and Reyes-Martínez.)

Background: As a real mortality salience, a public crisis would have a major impact on individual minds, behaviors, and lifestyles. COVID-19 provides us with a stark real-world example to understand these implications. Previous research has revealed that some individuals become more willing to help the infected at the risk of their own lives, while others become more self-centered and indifferent during COVID-19. To explain this paradoxical phenomenon, our study used two rival mediators in the relationship between mortality salience and helping behavior during COVID-19: death anxiety and death reflection., Methods: A cross-sectional survey was conducted among Chinese college students (N = 684) during the pandemic. We used a parallel mediation model to explore the mediating roles of death anxiety and death reflection in the relationship between mortality salience and helping behavior during COVID-19., Results: The results of our study indicate two key findings. First, mortality salience is negatively related to helping behavior during COVID-19 via death anxiety. This suggests that individuals with higher levels of mortality salience experienced increased death anxiety, which in turn led to a decrease in helping behavior. Second, mortality salience is positively related to helping behavior during COVID-19 via death reflection. This indicates that individuals with higher levels of mortality salience engaged in deeper reflection on death, which subsequently resulted in an increase in helping behavior., Conclusion: Our study provides valuable insights into the complex relationship between mortality salience and helping behaviors in the time of public crisis, and can help lead to more positive attitudes toward public crisis events such as COVID-19., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Xie, Yan, Lai and Wei.)

Objective: During pandemic periods, mental health issues are highly prevalent, particularly among healthcare workers who are at a higher risk of developing psychiatric disorders. The aim of this study is to evaluate the mental health status of the intensive care unit (ICU) healthcare workers, who play a vital role in managing the COVID-19 pandemic, in terms of the quality of sleep, levels of depressive and anxiety symptoms, stress and to determine the factors that affect their mental health., Methods: The research was conducted in April 2020 and incorporated a total of 79 participants working in an university hospital ICUs in Turkey. Pittsburgh Sleep Quality Index (PSQI), Depression Anxiety Stress Scale 42 (DASS-42), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were applied., Results: Among the participants, 58 individuals comprising 73.4% of the cohort were working in the ICUs, managing patients infected with COVID-19. Those working in ICUs with COVID-19 patients had significantly higher DASS-S, BAI, and BDI scores. Doctors' BDI scores were significantly lower compared to both nurses and other healthcare workers. Participants exhibiting COVID-19 symptoms manifested significantly higher BAI scores in compared to those without such symptoms., Conclusion: Healthcare workers involved in ICUs with COVID-19 patients were more significantly affected psychologically, doctors had lower depressive symptoms as compared to other healthcare workers. In addition, individuals with COVID-19 symptoms demonstrated significantly higher levels of anxiety. The findings of our study emphasize the significance of providing psychological support to healthcare workers throughout pandemics., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Meriç Özgündüz, Bıçakçıoğlu, Sahin Tutak and Özgündüz.)

The COVID-19 pandemic has brought unprecedented challenges to the wellbeing of the older adults worldwide. Both social isolation and loneliness are associated with decreased subjective wellbeing, but it is uncertain whether their effects are independent or if loneliness represents the affective pathway through which social isolation impairs subjective wellbeing. We therefore assessed the extent to which the association between social isolation and subjective wellbeing is mediated by loneliness. We utilized data from the 2020 China Family Panel Studies (CFPS) and focused on a sample of 3,821 individuals aged 60 and above as the participants for our study. The results revealed a significant negative association between social isolation and subjective wellbeing among the older adults during the COVID-19 pandemic. Furthermore, loneliness was found to mediate this relationship, indicating that social isolation led to increased feelings of loneliness, which in turn negatively impacted subjective wellbeing. These findings highlight the detrimental effects of social isolation and loneliness on the wellbeing of the older adults in China during the pandemic. The implications of these results emphasize the need for interventions and support systems that address social isolation and loneliness among the older adults, promoting their wellbeing and overall mental health during challenging times such as the COVID-19 pandemic., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Hao, Du and Yue.)

Background: COVID-19 disruptions including lockdowns and prioritization of COVID-19 control programs in Africa in 2020-2022 contributed to reductions in malaria control activities including malaria diagnosis, treatment and resistance monitoring. This study investigated the malaria burden and distribution on the background of active transmission of SARS-CoV-2 in Southern Ghana; utilizing community health education and medical screening (CHEMS) approach to determine epidemiological overlaps in COVID-19 and malaria., Methods: Between October-December 2022, prospective cross-sectional surveys, with CHEMS were conducted in Greater Accra and Central regions, where 994 participants enrolled either at a hospital or community setting provided demographic and clinical data including history of clinical malaria infection and antimalarial treatment in the past 2 weeks. Of this study population, 953 provided nasal/throat swabs for COVID-19 RT-PCR testing, with a subset of 136 participants also providing finger-prick blood for malaria RDT testing., Results: The study population comprised of 73.6% adults, with 54.6% COVID-19 vaccination rate. Overall, 18.1% of participants had a history of clinical malaria, which was associated (adjusted odds ratio > 1.50, p -value ≤0.022) with COVID-19 symptoms and positivity, study area and hospital setting, suggestive of overlaps in the epidemiological risk for malaria. On a background of widespread SARS-CoV-2 infections (12-37%), malaria parasitaemia was detected in 6%, with 2% being co-infections with SARS-CoV-2. Among the malaria positives, 9.5% had a history of antimalarial treatment, which suggested that their infections were recrudescent parasitaemia., Conclusion: The epidemiological and clinical overlap between malaria and COVID-19 within the hospital and community settings underscores the need for accurate case diagnosis to inform effective clinical treatments. Innovative surveillance programs, with community engagement are needed to maximize control interventions including treatment of asymptomatic malaria infections., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Amegatcher, Acquah, Tetteh, Obeng, Debrah, Quist, Acquah-Jackson, Boateng, Twieku, Armoo, Awandare, Mosi and Narh.)

Background: Mortality among people with dependency to perform basic activities of daily living (ADL) is higher than that of non-dependent people of the same age. Understanding the evolutionary course and factors involved in non-institutionalized ADL dependency, including the influence of the family structure that supports this population, would contribute to improved health planning., Methods: A longitudinal study carried out in the ADL-dependent population of the Orcasitas neighborhood, Madrid (Spain), between June 2020, when the nationwide COVID-19 lockdown ended, and June 2023. A total of 127 patients participated in the study, 78.7% of whom were women and 21.3% were men. Risk analysis was performed via odds ratios (OR) and hazard ratios (HR). Survival analysis was performed using Cox regression., Results: A total of 54.33% of the ADL-dependent persons did not live with their adult children and 45.67% did, being associated living independently with economic capacity and the married marital status but not with the dependency level. In women, being married increased the probability of living independently of their adult children (OR = 12.632; 95% CI = 3.312-48.178). Loss of mobility (OR = 0.398; 95% CI = 0.186-0.853), economic capacity of the dependent (HR = 0.596; 95% CI = 0.459-0.774), and living independently and having better economic capacity (HR = 0.471; 95% CI = 0.234-0.935) were associated with 3-year survival. Those who lived with their adult children had a worse autonomy profile and higher mortality (HR = 1.473; 95% CI = 1.072-2.024). Not being employed, not being married, and not owning a home were significantly associated with being an essential family caregiver. Caregivers were mostly women (OR = 1.794; 95% CI = 1.011-3.182)., Conclusion: Among ADL-dependent persons, economic capacity influenced the ability to living independently and affected survival after 3 years. Loss of mobility (wheelchair use) was a predictor of mortality. Social inequalities promote that adult children end up as essential family caregivers. This generates reverse dependency and maintains a vulnerability that is transmitted from generation to generation, perpetuating social and gender inequalities. Dependent parent care in this cohort maintained an archaic pattern in which the eldest daughter cared for her parents. This study made it possible to show that ADL dependence is accompanied by complex interrelationships that must be considered in socio-health planning., Competing Interests: NS was employed by Senex. ES was employed by Frezent Biological Solutions. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Martín Moreno, Martínez Sanz, Martín Fernández, Sánchez Rodríguez, Sánchez González, Herranz Hernando, Fernández Gallardo, Recuero Vázquez, Benítez Calderón, Sevillano Fuentes, Pérez Rico, Calderón Jiménez, Guerra Maroto, Alonso Samperiz and León Saiz.)

Background: The COVID-19 pandemic prompted a range of studies on mental health, with mixed results. While numerous studies reported worsened conditions in individuals with pre-existing mental disorders, others showed resilience and stability in mental health. However, longitudinal data focusing on the German population are sparse, especially regarding effects of age and pre-existing mental disorders during the early stages of the pandemic., Objectives: To assess the interplay between psychiatric history, age, and the timing of the pandemic, with a focus on understanding how these factors relate to the severity of depression and anxiety symptoms., Methods: Exploratory analyses were based on 135,445 individuals aged 20-72 years from the German National Cohort (NAKO). Depressive and anxiety symptoms were assessed before and after the first wave of the pandemic. Inferential statistical analyses and negative binomial regression models were calculated., Results: Persons with a self-reported psychiatric history exhibited comparable levels of depression and anxiety symptom severity after the first wave of the pandemic compared to the time before. In contrast, individuals without a psychiatric history, particularly those in their 20s to 40s, experienced an increase in mental health symptom severity during the first wave of the pandemic., Limitations: Analyses focuses on the first wave of the pandemic, leaving the long-term mental health effects unexplored., Conclusion: Future research should consider age-specific and mental-health-related factors when addressing global health crises. Additionally, it is important to explore factors influencing resilience and adaptation, aiming to develop targeted interventions and informed policies for effective mental health management during pandemics., Competing Interests: HG has received travel grants and speakers honoraria from Fresenius Medical Care, Neuraxpharm, Servier and Janssen Cilag as well as research funding from Fresenius Medical Care. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Stein, Pabst, Berger, Karch, Teismann, Streit, Grabe, Mikolajczyk, Massag, Lieb, Castell, Heise, Schulze, Gastell, Harth, Obi, Peters, Huemer, Bohmann, Leitzmann, Schipf, Meinke-Franze, Hebestreit, Fuhr, Michels, Jaskulski, Stocker, Koch-Gallenkamp, Willich, Keil, Löffler, Wirkner and Riedel-Heller.)

Introduction: Data on the mental health of university students in Germany during the later stages of the pandemic is still limited. This study aimed to determine (1) the prevalence of anxiety and depressive symptoms among university students 1.5 years after the first COVID-19 restrictions and (2) which factors were associated with these outcomes., Methods: The cross-sectional COVID-19 German Student Well-being Study (C19 GSWS) collected data of 6,996 students at five German universities. Associations between anxiety and depressive symptoms with sociodemographic and other factors were analyzed using multivariable logistic regression models., Results: The mean age of the participants was 23.9 years (SD = 4.8), 67% were female and 31% male. The prevalence for depressive symptoms was 29 and 32% for anxiety. The lack of a trusted person and financial difficulties were associated with anxiety and depressive symptoms. Being worried that someone in one's personal network had become severely ill with COVID-19 and concern about (re)infection with COVID-19 were associated with anxiety symptoms. Those with pre-existing health conditions had an up to 1.98-times higher chance for reporting depressive symptoms (OR, 95% CI: 1.01-3.88) and an up to 2.27-times higher chance for anxiety symptoms, respectively (OR, 95% CI: 1.15-4.46)., Conclusion: Concepts for prevention and counseling to tackle mental health problems in students are needed and programs should take specific stressors in times of crises into account., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Heumann, Helmer, Busse, Negash, Horn, Pischke, Niephaus and Stock.)

Introduction: Adolescence is a dynamic developmental phase in which contact with peers is crucial for socio-emotional development and wellbeing. Depression and social anxiety show patterns of high onset during this period, and more for girls than boys. Here we examine this development among Dutch adolescents, as well as how desire for more peer contact as a result of social distancing measures during the COVID-19 pandemic contributed to this increase., Methods: We used a longitudinal three-wave design to examine 406 typically developing Dutch adolescents across two consecutive cohorts; Cohort 1: 2016-2019 ( N  = 138, 53.6% girls, age at T0 M  = 13.00, SD  = 0.42), Cohort 2: 2017-2020 ( N  = 268, 63.1% girls, age at T0 M  = 13.05, SD  = 0.39), final wave during spring 2020 during the first COVID-19 lockdown. Self-report questionnaires were used to measure depression and social anxiety symptoms, desire for change in the amount of peer contact during lockdowns, and emotion regulation. Parallel process dual latent growth models and autoregressive cross-lagged models were used to test the hypotheses., Results: Results showed that symptoms of both depression and social anxiety increase during adolescence. Gender analysis reveal a higher initial level and increase in depression symptoms for girls, while levels for boys decreased. Adolescents exposed to the pandemic showed a steeper increase in depression but not in social anxiety. Desire for more peer contact was related to an increase in depression and social anxiety, though only in girls. No evidence was found for moderation of emotion regulation skills concerning COVID evoked emotions on the association between desire for peer contact and anxiety and depression symptom development., Discussion: Symptoms of social anxiety increased during adolescence in boys and girls. Symptoms of depression increased for girls, but decreased for boys. The increase in depression was greater in a cohort who experienced the COVID-19 pandemic. For girls, a desire for more peer contact was associated with an increase of depression and social anxiety symptoms in times of social restrictions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Pinkse-Schepers, Buil, Sijtsma, Hollarek, Walsh, van Buuren, Krabbendam and Lee.)

Introduction: Public concern for the mental health of university students has been rising over recent years. Newly arising stressors associated with the COVID-19 pandemic could contribute to further mental health burden for students. This study aimed to understand the mental health status of university students at an early stage in the pandemic and to identify academic, non-academic, and COVID-19-related predictors of common mental health difficulties at this time., Methods: This study examined how academic and non-academic predictors relate to common mental health difficulties using a cross-sectional sample of university students ( n  = 3817)., Results: There were high levels of depression and anxiety during the pandemic, with more than 50% experiencing levels above the clinical cut offs. Academic stress, social isolation, intolerance of uncertainty, and more negative attitudes towards remote teaching and learning predicted higher levels of depression and anxiety. University identification predicted lower levels of depression whereas receiving a diagnosis of COVID-19 was associated with higher levels of depression., Discussion: This study identified COVID-19-related factors that uniquely contributed to students' distress during the pandemic, over and above social connectivity variables. As COVID-19 factors, such as the uncertainty surrounding the pandemic, may have driven an increase in distress levels among students, these findings provide insights that could help universities and policymakers develop targeted interventions to support the mental health and well-being of university students during future crises., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Worsley, Dryburgh, McIntyre and Corcoran.)

Objective: Childhood hearing impairment has potential repercussions on the mental well-being of both children and their parents. As a vulnerable population in accessing health care services, they may face specific challenges, especially during the COVID-19 pandemic. This cross-sectional study aims to investigate the association between childhood hearing impairment and the mental health of children and their parents, and to assess health care utilization of hearing-impaired children and its impact on mental outcomes for both during the COVID-19 pandemic., Methods: Using the National Health Interview Survey (NHIS) database, we analyzed data for 15,989 children aged 5-17 and their corresponding parents. The correlations between childhood hearing impairment and mental outcomes were examined using logistic regression models. The 2020 (quarter 3 and quarter 4)-2021 NHIS data was singled out and re-analyzed, focusing on the utilization of medical care during the COVID-19 pandemic., Results: After accounting for covariates, hearing-impaired children exhibited a higher frequency of anxiety (OR 2.33, 95% CI 1.79-3.02) or depression (OR 2.14, 95% CI 1.59-2.88). Parents of hearing-impaired children had significantly higher odds of a higher frequency of anxiety (OR 1.55, 95% CI 1.20-2.01) or depression (OR 1.73, 95% CI 1.30-2.29). Interaction effect of hearing impairment with survey year on parents' mental health outcomes was observed ( p for interaction <0.1). Children with hearing loss had higher odds of reporting delayed medical care (OR 2.00, 95% CI 1.11-3.59) or canceled medical care (OR 1.96, 95% CI 0.98-3.96, p  = 0.059) due to the pandemic. Delayed medical care (OR 12.41, 95% CI 2.78-55.46) or canceled medical care (OR 6.26, 95% CI 1.28-30.75) due to the COVID-19 pandemic significantly contributed to the increase of anxiety frequency in hearing-impaired children., Conclusion: Childhood hearing impairment exhibits a substantial impact on children's and parental mental health, which is further exacerbated by the COVID-19 pandemic. Families of hearing-impaired children appear to be in a vulnerable position during public health emergencies such as the COVID-19 pandemic, which can further exacerbate their mental outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Li, Lin, Cen, Fan, Hong, Wu, Chen and Zhong.)

Background: Several social determinants of health and other structural factors drive racial and ethnic disparities in COVID-19 risk, morbidity, and mortality. Public-private collaborations with community pharmacies have been successful in expanding access to COVID-19 testing and reaching historically underserved communities. The objectives of this study were to describe individuals who sought testing for COVID-19 at a national community pharmacy chain and to understand potential racial and ethnic inequities in testing access, positivity, and infection with emerging variants of concern., Methods: We conducted a cross-sectional study of individuals aged ≥18 who were tested for COVID-19 (SARS-CoV-2) at a Walgreens pharmacy or Walgreen-affiliated mass testing site between May 1, 2021 and February 28, 2022. Positivity was defined as the proportion of positive tests among all administered tests. A geographically balanced random subset of positive tests underwent whole genome sequencing to identify specific viral variants (alpha, delta, and omicron). Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) to compare the likelihood of testing positive and testing positive with an emerging variant of concern across race and ethnicity groups., Results: A total of 18,576,360 tests were analyzed (16.0% tests were positive for COVID-19; 59.5% of tests were from White individuals and 13.1% were from Black individuals). American Indian or Alaska Native (OR = 1.12; 95%CI = 1.10-1.13), Hispanic or Latino (1.20; 95%CI = 1.120, 1.21), and Black (1.12; 95%CI = 1.12, 1.13) individuals were more likely to test positive for COVID-19 compared to White individuals. Non-White individuals were also more likely to test positive for emerging variants of concern (e.g., Black individuals were 3.34 (95%CI = 3.14-3.56) times more likely to test positive for omicron compared to White individuals during the transition period from delta to omicron)., Discussion: Using a national database of testing data, we found racial and ethnic differences in the likelihood of testing positive for COVID-19 and testing positive for emerging viral strains. These results demonstrate the feasibility of public-private collaborations with local pharmacies and pharmacy chains to support pandemic response and reach harder to reach populations with important health services., Competing Interests: TS, AS, RLS-R, and EO were employed by the company Walgreen Co. DAH has received consulting fees from the company Sanofi for consulting and research unrelated to the present study. KNH has received grant funding paid directly to Brown University for collaborative research from Insight Therapeutics, Sanofi, and Genentech for research on complex insulin regimens, influenza outbreak control, and influenza vaccination in nursing homes. KNH has also served as a consultant for the Canadian Agency for Drugs and Technologies in Health. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Singh, Smith-Ray, Ogunkoya, Shah, Harris, Hayes and Mor.)

Objective: We aimed to examine the direct effects of exposure to media information about infection-preventing behavior and its indirect effects via interpersonal communication at two time points during the pandemic., Methods: In August 2020 and August 2021, a web-based survey of Japanese people under a declared state of emergency was conducted. We collected sociodemographic data and data on seven types of exposure to media information, three types of exposure to interpersonal communication, and six types of infection-preventing behavior., Results: A total of 784 participants completed both surveys. Exposure to information in the mass media decreased over the year, while interpersonal communication about COVID-19-related topics increased. The direct effect of exposure to information in the media about preventive behaviors was statistically significant in the pandemic's early stages, but this was no longer true after 1 year. The indirect effect via interpersonal communication was statistically significant at both time points., Conclusion: Our results suggest that the influence of media information on infection-preventing behavior during the pandemic was maintained over time as an indirect effect via interpersonal communication. For risk communication media strategies during pandemics, adopting strategies to generate interpersonal communication will have a sustained effect on preventive behavior., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Okada, Okuhara and Kiuchi.)

Background: Epidemiological data regarding the prevalence of bacterial multidrug-resistant (MDR) Gram-negative infections in patients with COVID-19 in Iran are still ambiguous. Thus, in this study we have investigated the epidemiology, risk factors for death, and clinical outcomes of bacterial infections among patients with COVID-19 in the intensive care unit (ICU)., Method: This retrospective cohort study included patients with COVID-19 hospitalized in the ICU of a university hospital in Iran between June 2021 and December 2021. We evaluated the epidemiological, clinical, and microbiological features, outcomes and risk factors associated with death among all COVID-19 patients. Data and outcomes of these patients with or without bacterial infections were compared. Kaplan-Meier plot was used for survival analyses., Results: In total, 505 COVID-19 patients were included. The mean age of the patients was 52.7 ± 17.6 years and 289 (57.2%) were female. The prevalence of bacterial infections among hospitalized patients was 14.9%, most of them being hospital-acquired superinfections (13.3%). MDR Klebsiella pneumoniae and Staphylococcus aureus were the most common pathogens causing respiratory infections. Urinary tract infections were most frequently caused by MDR Escherichia coli and K. pneumoniae . The overall in-hospital mortality rate of COVID-19 patients was 46.9% (237/505), while 78.7% (59/75) of patients with bacterial infections died. Infection was significantly associated with death (OR 6.01, 95% CI = 3.03-11.92, p -value <0.0001) and a longer hospital stay ( p  < 0.0001). Multivariate logistic regression analysis showed that Age (OR = 1.04, 95% CI = 1.03-1.06, p -value <0.0001), Sex male (OR = 1.70, 95% CI = 1.08-2.70, p -value <0.0001), Spo2 (OR = 1.99, 95% CI = 1.18-3.38, p -value = 0.010) and Ferritin (OR = 2.33, 95% CI = 1.37-3.97, p -value = 0.002) were independent risk factors associated with in-hospital mortality. Furthermore, 95.3% (221/232) of patients who were intubated died., Conclusion: Our findings demonstrate that bacterial infection due to MDR Gram-negative bacteria associated with COVID-19 has an expressive impact on increasing the case mortality rate, reinforcing the importance of the need for surveillance and strict infection control rules to limit the expansion of almost untreatable microorganisms., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Akbari, Dehghani, Shirzadi, Pourajam, Hosseinzadeh, Sajadi, Alenaseri, Siavash, Jafari and Solgi.)

Background/purpose: Poor oral hygiene and periodontal disease have been identified as potential risk factors for the coronavirus disease 2019 (COVID-19). The present study aimed to determine the association between periodontitis and COVID-19 severity, nature of symptoms, mortality, and hospital stay., Methods: In total, 163 COVID-19-positive patients (men: 93; women: 70) were categorized into two groups: the control group, consisting of 120 patients with asymptomatic or mild symptoms, and the case group, consisting of 43 patients with moderate-to-severe symptoms. The severity of periodontal disease, oral hygiene status (OHI), pocket depth (PD), bleeding on probing (BOP), number of decayed/missing/filled teeth, mortality, duration of stay in the hospital, oxygen requirement, and nature of COVID-19 symptoms were assessed in both groups. The association between periodontitis and COVID-19 was analyzed with other confounding factors such as age, sex, comorbidities, oral hygiene, and smoking status., Results: The presence of periodontitis increases the severity of COVID-19 by 3.7 times ( p = 0.002). A statistically significant difference was noted for symptoms such as dizziness ( p = 0.036), running nose/cold ( p = 0.009), and headache ( p = 0.005) in the presence of periodontitis. The risk estimate for death associated with periodontitis was 1.03. Additionally, the average duration of stay was longer for individuals with periodontitis than for those in the control group., Conclusion: There is a positive association between periodontal disease and COVID-19. Periodontitis increases the severity of COVID-19 and alters the symptoms. Hence, periodontal disease management should be an integral part of managing patients with coronavirus infection., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Macherla, Chopra, Ramanarayanan, Das and Garg.)

Introduction: Several COVID-19 outbreaks have been reported in meat processing plants in different countries. The aim of this study was to assess the environmental and socio-economic risk factors favouring the transmission of SARS-CoV-2 in meat processing plants and to describe the prevention measures implemented., Methods: Data from epidemiological investigations of COVID-19 clusters in France, the scientific literature, structured interviews and site visits were collected and summarised to investigate the main risk factors for SARS-CoV-2 infection in meat processing plants, including determinants within and outside the workplace., Results: An increased risk of infection was identified among workers with unfavourable socio-economic status (temporary/non-permanent workers, migrants, ethnic minorities, etc.), possibly related to community activities (house-sharing, car-sharing, social activities). Working conditions (proximity between workers) and environmental factors (low temperatures and inadequate ventilation) also appear to be important risk factors. These environmental conditions are particularly prevalent in cutting and boning plants, where the majority of reported cases are concentrated. Preventive measures applied included screening for COVID-19 symptoms, testing, wearing masks, increased hygiene and sanitation, physical and temporal distancing, control of ventilation. Certain food safety hygiene measures were compatible with protecting workers from SARS-CoV-2. The hygiene culture of agri-food workers made it easier to implement preventive measures after adaptation., Conclusion: This study made it possible to identify the environmental and socio-economic factors conducive to the transmission of SARS-CoV-2 in meat processing plants. The knowledge gained from this work was used in simulations to understand the transmission of the virus in the plants., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Kooh, Guillois, Federighi, Pivette, Maillard, Luong and Chaix.)

Introduction: The COVID-19 pandemic has been characterized by disparities in disease burden and medical care provision. Whether these disparities extend to long COVID awareness and receipt of medical care is unknown. We aimed to characterize awareness of long COVID and receipt of medical care for long COVID symptoms among populations who experience disparities in the United States (US)., Methods: We conducted a cross-sectional survey among a national sample of US adults between January 26-February 5, 2023. We surveyed approximately 2,800 adults drawn from the Ipsos probability-based KnowledgePanel® who identify as White, Black, or Hispanic, with over-sampling of Black, Hispanic, and Spanish-proficient adults. Awareness of long COVID was assessed with the question, "Have you heard of long COVID? This is also referred to as post-COVID, Long-haul COVID, Post-acute COVID-19, or Chronic COVID." Respondents reporting COVID-19 symptoms lasting longer than 1 month were classified as having long COVID and asked about receipt of medical care., Results: Of the 2,828 respondents, the mean age was 50.4 years, 52.8% were female, 40.2% identified as Hispanic, 29.8% as Black, and 26.7% as White. 18% completed the survey in Spanish. Overall, 62.5% had heard of long COVID. On multivariate analysis, long COVID awareness was lower among respondents who identified as Black (OR 0.64; 95% CI 0.51, 0.81), Hispanic and completed the survey in English (OR 0.59; 95% CI 0.46, 0.76), and Hispanic and completed the survey in Spanish (OR 0.31, 95% C.I. 0.23, 0.41), compared to White respondents (overall p < 0.001). Long COVID awareness was also associated with educational attainment, higher income, having health insurance, prior history of COVID-19 infection, and COVID-19 vaccination. Among those reporting symptoms consistent with long COVID ( n = 272), 26.8% received medical care. Older age, longer symptom duration and greater symptom impact were associated with receipt of medical care for long COVID symptoms. Of those who received care, most (77.8%) rated it as less than excellent on a 5-point scale., Discussion: This survey reveals limited awareness of long COVID and marked disparities in awareness according to race, ethnicity, and language. Targeted public health campaigns are needed to raise awareness., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer RS declared a shared parent affiliation, with the authors JM and BL to the handling editor at the time of the review., (Copyright © 2024 Fisher, Mazor, Epstein, Goldthwait, Abu Ghazaleh, Zhou, Crawford, Marathe and Linas.)

The global emergence of coronavirus disease 2019 (COVID-19) posed unprecedented challenges, jeopardizing decades of progress in healthcare systems, education, and poverty eradication. While proven interventions such as handwashing and mass vaccination offer effective means of curbing COVID-19 spread, their uptake remains low, potentially undermining future pandemic control efforts. This systematic review synthesized available evidence of the factors influencing vaccine uptake and handwashing practices in Kenya, Uganda, and Tanzania in the context of COVID-19 prevention and control. We conducted an extensive literature search across PubMed, Science Direct, and Google Scholar databases following Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Out of 391 reviewed articles, 18 were eligible for inclusion. Some of the common barriers to handwashing in Kenya, Uganda, and Tanzania included lack of trust in the government's recommendations or messaging on the benefits of hand hygiene and lack of access to water, while some of the barriers to vaccine uptake included vaccine safety and efficacy concerns and inadequate awareness of vaccination sites and vaccine types. Enablers of handwashing practices encompassed hand hygiene programs and access to soap and water while those of COVID-19 vaccine uptake included improved access to vaccine knowledge and, socio-economic factors like a higher level of education. This review underscores the pivotal role of addressing these barriers while capitalizing on enablers to promote vaccination and handwashing practices. Stakeholders should employ awareness campaigns and community engagement, ensure vaccine and hygiene resources' accessibility, and leverage socio-economic incentives for effective COVID-19 prevention and control. Clinical trial registration : [https://clinicaltrials.gov/], identifier [CRD42023396303]., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Muchangi, Mturi, Mukasa, Kithuki, Kosgei, Kanyangi, Moraro and Nankanja.)

Introduction: Long COVID patients experience a decrease in their quality of life due to the symptomatology produced by the disease. It is also important to understand how long COVID affects both men and women. The objective of this study is to examine the impact of long COVID symptomatology on the quality of life of Spanish adults from a gender perspective., Methods: An observational and cross-sectional study was carried out. Participants were able to complete an online questionnaire using an online platform. A sample of 206 people participated in the study., Results: The 80.6% of the sample were women with a mean age of 46.51 (±8.28) and the 19.4% were men with a mean age of 48.03 (±9.50). The medium score in the PAC19-QoL test was 141.47 (±24.96) and segmented by gender, 141.65 (±23.95) for women and 140.82 (±28.66) for men. The most common symptoms in women were muscle and joint pain (94.6%), fatigue (94.0%), discomfort (92.2%), difficulty concentrating (91.0%), and memory loss (88.6%). For men the symptoms included muscle and joint pain (97.5%) and fatigue (97.5%) both occupying first position, discomfort (92.0%), difficulty concentrating (90.0%), mood disturbances (90.0%), and memory loss (87.5%). The chi-square test showed statistical significance ( p  < 0.005) for socio-demographic information, quality of life scores, and long COVID symptoms by intensities., Conclusion: This study shows that there are gender differences in the way that long COVID is experienced., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Marcilla-Toribio, Moratalla-Cebrián, Notario-Pacheco, Escudero-Lopez, Morales-Cuenca and Martinez-Andres.)