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The COVID-19 pandemic has disproportionately affected vulnerable populations, including residents of assisted living facilities (ALFs). This study investigates the impact of non-pharmaceutical interventions (NPIs) and mass vaccination campaigns on SARS-CoV-2 transmission dynamics within four ALFs in Maricopa County, Arizona, United States from January to April 2021. Initial observations reveal a significant SARS-CoV-2 prevalence in Maricopa County, with 7452 new COVID-19 cases reported on 4 January 2021. Wastewater surveillance indicates elevated viral loads within ALFs with peak concentrations reaching 1.35 × 10 7 genome copies/L at Facility 1 and 4.68 × 10 5 copies/L at Facility 2. The implementation of NPIs, including isolation protocols, resulted in a rapid decline in viral loads in wastewater. Following mass vaccination campaigns, viral loads reduced across all facilities, except Facility 4. Facility 1 demonstrated a mean viral load decrease from 1.65 × 10 6 copies/L to 1.04 × 10 3 copies/L post-vaccination, with a statistically significant U-statistic of 28.0 ( p -value = 0.0027). Similar trends are observed in Facilities 2 and 3, albeit with varying degrees of statistical significance. In conclusion, this study provides evidence supporting the role of NPIs and vaccination campaigns in controlling SARS-CoV-2 transmission within ALFs.

Many patients infected with the SARS-CoV-2 virus (COVID-19) continue to experience symptoms for weeks to years as sequelae of the initial infection, referred to as "Long COVID". Although many studies have described the incidence and symptomatology of Long COVID, there are little data reporting the potential burden of Long COVID on surgical departments. A previously constructed database of survey respondents who tested positive for COVID-19 was queried, identifying patients reporting experiencing symptoms consistent with Long COVID. Additional chart review determined whether respondents had a surgical or non-routine invasive procedure on or following the date of survey completion. Outcomes from surgeries on patients reporting Long COVID symptoms were compared to those from asymptomatic patients. A total of 17.4% of respondents had surgery or a non-routine invasive procedure in the study period. A total of 48.8% of these patients reported experiencing symptoms consistent with Long COVID. No statistically significant differences in surgical outcomes were found between groups. The results of this analysis demonstrate that Long COVID does not appear to have created a significant burden of surgical disease processes on the healthcare system despite the wide range of chronic symptoms and increased healthcare utilization by this population. This knowledge can help guide surgical operational resource allocation as a result of the pandemic and its longer-term sequelae.

During the rapid development of COVID-19 vaccines, concerns emerged about potential adverse effects on menstrual health. This study examines the association between COVID-19 vaccination-considering the number of doses and vaccine type-and menstrual disorders, specifically heavy menstrual bleeding (HMB) and amenorrhea (AM). Utilizing electronic health records from the Sistema d'Informació per al Desenvolupament de la Investigació en Atenció Primària (SIDIAP) database in Catalonia, Spain, the retrospective cohort included 1,172,621 vaccinated women aged 12-55 with no prior menstrual disorders observed from 27 December 2020 to 30 June 2023. The incidence rate of HMB and AM increased with the second and third doses of the vaccine. Notably, the AstraZeneca ® and Janssen ® vaccines were associated with higher odds of HMB (OR: 1.765, CI: 1.527-2.033; OR: 2.155, CI: 1.873-2.476, respectively) and AM (OR: 1.623, CI: 1.416-1.854; OR: 1.989, CI: 1.740-2.269, respectively) from the first to the second dose compared to Pfizer/BioNTech ® . Conversely, the Moderna ® vaccine appeared to offer a protective effect against HMB (OR: 0.852, CI: 0.771-0.939) and AM (OR: 0.861, CI: 0.790-0.937) between the second and third doses. These results were adjusted for potential confounders, such as age, previous COVID-19 infection, and other relevant covariates.

Background: A multidisciplinary approach is required for the management of long COVID. The aim of this study was to determine the feasibility (demand, implementation, practicality, acceptability, and limited efficacy) of an allied-health-led multidisciplinary symptom management service (ReCOV) for long COVID., Methods: A single-group observational cohort feasibility study was conducted to determine demand (referrals), acceptability (survey), implementation (waitlist times, health professions seen), practicality (adverse events), and limited efficacy (admission and discharge scores from the World Health Organization Disability Assessment Scale, Brief Illness Perception Questionnaire (BIPQ), Patient Health Questionnaire, and EuroQol 5D-5L). Data are presented as median [interquartile range] or count (percentage)., Results: During the study, 143 participants (aged 42.00 [32.00-51.00] years, 68% women) participated in ReCOV. Participants were waitlisted for 3.86 [2.14-9.86] weeks and engaged with 5.00 [3.00-6.00] different health professionals. No adverse events occurred. The thematic analysis revealed that ReCOV was helpful but did not fully meet the needs of all participants. Limited efficacy testing indicated that participants had improved understanding and control ( p < 0.001) of symptoms (BIPQ) and a small improvement in EQ VAS score (median difference 5.50 points [0.00-25.00], p = 0.004])., Conclusions: A multidisciplinary service was safe and mostly acceptable to participants for the management of long COVID. Further research should investigate the clinical and cost effectiveness of such a service, including optimal service duration and patient outcomes.

The COVID-19 vaccination campaign resulted in uneven vaccine uptake throughout the United States, particularly in rural areas, areas with socially and economically disadvantaged groups, and populations that exhibited vaccine hesitancy behaviors. This study examines how county-level sociodemographic and political affiliation characteristics differentially affected patterns of COVID-19 vaccinations in the state of Indiana every month in 2021. We linked county-level demographics from the 2016-2020 American Community Survey Five-Year Estimates and the Indiana Elections Results Database with county-level COVID-19 vaccination counts from the Indiana State Department of Health. We then created twelve monthly linear regression models to assess which variables were consistently being selected, based on the Akaike Information Criterion (AIC) and adjusted R-squared values. The vaccination models showed a positive association with proportions of Bachelor's degree-holding residents, of 40-59 year-old residents, proportions of Democratic-voting residents, and a negative association with uninsured and unemployed residents, persons living below the poverty line, residents without access to the Internet, and persons of Other Race. Overall, after April, the variables selected were consistent, with the model's high adjusted R 2 values for COVID-19 cumulative vaccinations demonstrating that the county sociodemographic and political affiliation characteristics can explain most of the variation in vaccinations. Linking county-level sociodemographic and political affiliation characteristics with Indiana's COVID-19 vaccinations revealed inherent inequalities in vaccine coverage among different sociodemographic groups. Increased vaccine uptake could be improved in the future through targeted messaging, which provides culturally relevant advertising campaigns for groups less likely to receive a vaccine, and increasing access to vaccines for rural, under-resourced, and underserved populations.

This study aimed to identify the influence of environmental risk exposure levels on the predictive factors of COVID-19 booster dose vaccination in an urban Thai population in the post-pandemic era. Six study locations, including the three provinces with the highest environmental risk levels and the three provinces with the lowest environmental risk levels, were selected by calculating the environmental risk exposure indexes. Participants from the capital district of each province were chosen via the simple random sampling technique and interviewed using a structured questionnaire. A total of 1315 individuals were included in a sample in this study, and the best predictors of booster dose vaccination were determined using multiple regression analysis. The results showed that a high level of environmental risk exposure occurred in the provinces with a high number of total days exceeding the limits set for PM10 and high rates of mortality for lung cancer. The number of COVID-19 booster vaccinations given amount to 43.4% of the population during the post-COVID-19 pandemic period. Our multivariate analysis indicated that individuals in the working age group (≥25 years old); those with higher education (diploma degree and above); full-time employment (government and private sectors); those with high monthly incomes (≥USD144.1); and those in areas with the lowest risk level of environmental exposure significantly contributed to the number of booster dose vaccinations given during the post-pandemic period. To summarize, the rate of COVID-19 booster dose vaccination acceptance in Thailand was influenced by socio-economic factors with environmental concerns. These findings improve our understating of both the global pandemic and how environmental exposure affects behavioral change patterns and could improve the effectiveness of post-pandemic management.

During the COVID-19 pandemic, hypertensive patients had increased infection and healthcare disruption in many low- and middle-income countries (LMICs) with limited vaccine access. The objective of this report is to describe COVID-19 experiences and vaccination uptake among hypertensive patients in Colombia and Jamaica. A cross-sectional study of patients with hypertension was conducted in primary care clinics in both countries between 2021 and 2022. Trained interviewers used a telephone-administered questionnaire to assess COVID-19 experiences (infection, vaccination, and healthcare access). A total of 576 patients (68.5% female, mean age: 67.5 years) participated. Health service disruption affecting access to care was low (<10%). Compared to Jamaica, more participants from Colombia reported testing positive for COVID-19, having family members or friends testing positive, losing family members or friends due to COVID-19, and being vaccinated. In logistic regression models, adjusted for age, sex, education, and rural/urban clinic status, fear of COVID-19 (OR 2.7, 95% CI: 1.2-6.1) and residence in Colombia (OR 5.9, 95% CI: 2.4-14.6) were associated with higher vaccination uptake. Disparities in access to COVID-19 testing and diagnosis may have influenced these country differences including fear of COVID-19 and vaccine uptake. Other factors need to be better understood to prepare for future pandemic responses.

Vaccine hesitancy, a pressing global challenge in vaccination programs, was significantly amplified during the COVID-19 pandemic. The proliferation of misinformation, including false claims and rumours, and the influence of anti-vaccine movements fuelled hesitancy. This study aims to explore the socio-economic determinants that influenced vaccine hesitancy and the impact of public health information sharing in Sri Lanka during the pandemic. The study employed a comprehensive mixed-method approach for data collection, administrating a household survey (n = 3330) and 206 semi-structured interviews. The survey results indicated that 37.8% ( n = 3113) of respondents delayed or rejected vaccines for various reasons, the leading cause being the fear of side effects of the vaccine. Although fear of side effects was the prime reason for rejection ( n = 1176, 46.29%), respondents demonstrated an extremely poor understanding of the potential side effects of vaccines, which was 55.39% ( n = 3113). Notably, 84.60% ( n = 3113) were unaware of the vaccine development process. Multivariate logistic regression analysis showed that middle-income people (AOR-0.42) and females (0.65) were less likely not to make decisions based on scientific information compared to underprivileged people and males. The survey also revealed that strong belief in the use of traditional medicines and remedies and religious beliefs ( n = 1176, 3.95%) were among the main reasons for hesitancy. The findings illustrate that misinformation, lack of health knowledge, and lack of understanding to seek scientific information have fuelled vaccine hesitancy in Sri Lanka.

The availability of an effective vaccine against COVID-19 virus marked a crucial moment in the fight against its pandemic spread. Although distribution of the vaccine began in December 2020, high acceptance rates and repeated administrations are needed to achieve widespread immunization, but hesitation toward the vaccine persists to this day. To identify psychological variables and other factors associated with vaccine hesitancy, we conducted a study from August 2021 to October 2022. An Internet-based survey gathered data from 137 Italian adults, exploring attitudes, sociodemographic characteristics, psychological variables, and immunization behavior. The results analysis showed that gender (69.2% of vaccine-adverse people were males), education (years of education was negatively correlated with vaccine hesitancy), and religion (not declaring oneself religious or atheist was more likely to be associated with hesitancy toward the vaccine) were the variables influencing attitudes toward the vaccine. Other psychological variables differentiated people with opposite attitudes toward the vaccine: high scores on the Conspiracy Mentality Questionnaire (CMQ) and Core Belief Inventory (CBI) were positively correlated with vaccine hesitancy, indicating that individuals with more pronounced core belief violation, due to the pandemic, tend to express higher levels of vaccine hesitancy. Finally, a linear regression analysis confirmed the role of participants' conspiracy mentality as a valid predictor for vaccine hesitancy.

For most individuals infected with SARS-CoV-2, the acute illness resolves completely. However, for millions of people, symptoms or sequelae from COVID-19 recur or persist for months to years after infection. Post-COVID-19 sequelae are wide-ranging, often affecting the musculoskeletal, pulmonary, and cardiovascular systems. All who experience post-COVID-19 sequelae face significant challenges navigating home and work life. Occupations such as firefighting, however, are of particular concern given the strenuous nature of a job that relies on a healthy musculoskeletal, pulmonary, and cardiovascular system. Research has documented significant musculoskeletal impairment (including muscle weakness, pain, and fatigue), respiratory dysfunction (including reduced lung function, interstitial disease, and diffusion abnormalities), cardiovascular conditions (including cardiac events, ischemic disease, dysrhythmias, and infectious diseases), and diminished cardiorespiratory fitness that continues for months to years in some individuals. These persistent post-COVID-19 conditions may affect a firefighter's ability to return to work, function at full capacity while at work, and potentially compromise firefighter health and public safety. This review, therefore, explores musculoskeletal, pulmonary, and cardiovascular sequelae post-COVID-19 and the impact of these sequelae on firefighter health and occupational readiness.

The COVID-19 pandemic has led to the adoption of rapid, complex, and changeable measures. These measures allowed effective care planning and implementation of emergency management strategies to meet the needs of the population., Objective: To analyze the influence of the strategies to cope with the COVID-19 pandemic, implemented by the Public Health Network of the State of Piauí, Brazil, as contributions to nursing, on the outcome of cases and deaths., Method: This is a descriptive and documentary study with a qualitative approach, carried out in the state of Piauí-Brazil, whose data were processed at IRAMUTEC and analyzed by the Descending Hierarchical Classification (DHC)., Results: Ninety-two normative acts were instituted as coping strategies, distributed in three classes: technical-operational protocols for preventing and combating COVID-19 in Piauí; Piauí strategic bases for social distancing against COVID-19; and management of services and economic activities in Piauí in the fight against COVID-19., Conclusions: The actions determined by and implemented in the normative acts were conducted according to the behavior of the epidemiological curve regarding the number of cases and deaths. The normative acts, which defined the technical-operational protocols for the prevention and control of COVID-19, were directly related to social distancing strategies and the use of protective equipment in the quality of life of the population.

We aimed to understand how risk (trauma history, health problems, financial problems, family problems) and protective (friend support, family support) factors influenced daily functioning (e.g., self-care, mobility, social participation) among Tunisian adults during the COVID-19 pandemic, directly and through their impact on depression, with a focus on gender differences. We recruited a representative sample of 2014 participants (1024 males, 990 females) using random digit dialing of mobile phone numbers across all 24 governorates in Tunisia. Females reported higher depression, greater impaired functioning, and a higher likelihood of having had COVID-19. Path analysis showed a good fit to the model when paths for males and females were allowed to vary, providing evidence for gender differences. Associations between trauma exposure and depression and depression and age with functioning were stronger among females. Social support from friends was a protective factor for males only. For males, all study variables were associated with functioning indirectly through their association with depression, except for support from friends. For females, family responsibilities and health problems had both direct and indirect effects, whereas other study variables were only linked with functioning through depression. Findings provide insights into factors that can be targeted in interventions aimed at reducing depression and improving daily functioning for males and females.

Besides their educational mission, public schools ground and support the health and psychological, emotional, and social development of students. The educational system is special because it combines multiple integrated responsibilities and duties that transcend the scope of any other social welfare program. Social workers are crucial constituents of educational systems and are expected to attend to the well-being of students while ensuring the effective performance of the educational system. Given such rigorous demands, this study assesses and compares the actual functions undertaken by social workers in schools in the United Arab Emirates during and after the COVID-19 pandemic. In so doing, it aims to help improve educational systems worldwide. The nuanced results of this study will better elucidate the crucial capabilities of social workers in the dynamic educational system and illuminate the challenges they confront during emergencies.

This exploratory qualitative study involved semi-structured interviews with adults and caregivers of adults at high risk of severe COVID-19, addressing current COVID-19 avoidance and protective behaviors and how these behaviors impacted their lives. Results were interpreted in a separate think tank session. Insights were developed into a conceptual model of COVID-19 avoidance and protective behaviors and the associated impacts on health-related quality of life and overall functioning. Data were interpreted using a hybrid inductive and deductive thematic analysis. Twelve high-risk individuals and two caregivers were interviewed across four focus groups (April-July 2022). Major behavioral themes included physical distancing, physical and medical protection, quality of support services and networks, and information to make decisions. Major impacts included family, social, and emotional functioning; work and finances; and healthcare access. The final conceptual model comprised 13 behaviors to avoid COVID-19 categorized within four themes, and 13 impacts within five themes. Individuals at high risk of severe COVID-19 and their caregivers continue practicing COVID-19 avoidance behaviors post-lockdown and feel left behind by the general population. Our conceptual model may be used to inform health authorities and other governing bodies' decisions in executing strategies aimed at improving these individuals' lives., Competing Interests: Tiago Maia is an employee of IQVIA, the research organization contracted to conduct this study. Paul Willams was employed by IQVIA, which was under contract with AstraZeneca at the time of the study, and is now employed by AstraZeneca. Renata Yokota is an employee of P95, under a contract with AstraZeneca. Sofie Arnetorp and Gabriella Settergren are employees of, and own stocks or shares in, AstraZeneca. Marie Eckerd was an employee of AstraZeneca at the time of the study but is now retired from AstraZeneca. Gail Rae-Garwood is a patient advisor to both AstraZeneca and Otsuka. Joanne Smith and Gail Rae-Garwood received honoraria for participating in the &lsquo;think tank&rsquo; session of the current study, but did not receive payment for their time as co-authors on the manuscript.

Background: Although significantly increased mental health concerns were noted globally during the first year of the COVID-19 pandemic, much less is known about the mental health trends during the COVID-19 recovery period. We aimed to compare current anxiety or depression rates to those before and during the first year of the pandemic and to evaluate demographic differences., Methods: We analyzed Household Pulse Survey data prospectively collected from a representative U.S. population sample. We compared the anxiety or depression rates from the first pandemic year (04/2020-05/2021) and recovery period (06/2023-03/2024) from the national cohort and demographic subgroups using two-sided paired t -tests and regression analyses and compared these to pre-pandemic (01/2019-12/2019) rates using one-sided t -tests., Results: The national estimates for anxiety or depression improved during the recent COVID-19 recovery period as compared to the first year (29.5 ± 5.5 vs. 37.6 ± 3.1; p < 0.0001) but did not return to the pre-pandemic benchmark (29.5% vs. 10.8%; p < 0.001). Higher rates were noted in younger individuals aged 18-29 years ( p < 0.0001), in individuals with less than a high school diploma ( p < 0.0001), or with disabilities ( p < 0.0001). Non-Hispanic Asians reported the lowest rates ( p < 0.0001), and no significant gender differences were noted., Conclusion: The U.S. population's mental health concerns have improved since the first year of the pandemic but remain above pre-pandemic benchmarks. Certain demographic subgroups are at higher risk, indicating the need for targeted health care and economic policy interventions to address these disparities.

Taking due account of users' perspectives is crucial for improving the quality of healthcare services. This study aimed to analyse the representations and evaluation criteria that users of a public health agency express towards care and treatment services and to explore whether and how the content and meaning of their communications varied according to pre-pandemic, pandemic or post-pandemic periods. A total of 501 communications sent to the public relations office of an Italian health agency were collected. An automatic content analysis procedure was applied to the textual corpus. Four main thematic cores were identified concerning the request for care and respect, the value of the doctor-patient relationship and the difficulties in contacting services and accessing care. Two main latent dimensions of meaning were identified, which capture the dialectic between the demand for relationships and the demand for access to care, and between attention to the relational competence of health workers and attention to the needs and rights of users. Communications collected during the pre-pandemic and post-pandemic periods mainly concern the difficulty of access to care; those collected during the pandemic period mainly concern the doctor-patient relationship. Interpersonal aspects and timely access to care appear to be crucial in users' assessment of the quality of care.

Infectious diseases manifesting in the form of epidemics or pandemics do not only cause devastating impacts on public health systems but also disrupt the functioning of the socio-economic structure. Further, risks associated with pandemics and epidemics become exacerbated with coincident compound hazards. This study aims to develop a framework that captures key elements and components of epidemic and pandemic preparedness and response systems, focusing on a multi-hazard context. A systematic literature review was used to collect data through peer-reviewed journal articles using three electronic databases, and 17 experts were involved in the validation. Epidemiological surveillance and early detection, risk and vulnerability assessments, preparedness, prediction and decision making, alerts and early warning, preventive strategies, control and mitigation, response, and elimination were identified as key elements associated with epidemic and pandemic preparedness and response systems in a multi-hazard context. All elements appear integrated within three interventional phases: upstream, interface, and downstream. A holistic approach focusing on all interventional phases is required for preparedness and response to pandemics and epidemics to counter their cascading and systemic effects. Further, a paradigm shift in the preparedness for multi-hazards during an epidemic or pandemic is essential due to the multiple challenges posed by concurrent hazards.

The purpose of this study was to understand how the challenges and coping strategies among international students in the United States changed before and during the COVID-19 pandemic. We conducted a qualitative study through one-on-one in-depth interviews during April-June 2021. A total of 34 international students in the San Francisco Bay Area participated in this study. NVivo was used to analyze the qualitative data. Before COVID-19, the challenges were primarily related to a sense of belonging, such as culture shock, language barriers, and loss of identity. However, some positive experiences from school life and new culture were also found before COVID-19. During the pandemic, students faced difficulties with online learning and lockdown protocols that they had never experienced before. The ongoing challenges before and during COVID-19 were identity crisis, racism and discrimination, and financial struggles. Common coping strategies for overcoming these difficulties included engaging in physical activity, social exposure, self-improvement, and mental self-care. The frequency of online engagement and motivation for self-improvement were particularly highlighted during COVID-19. However, international students expressed a preference for improved support systems, including financial aid, paid research opportunities, and more accessible campus resources. Future research could focus on the strategies to support the psychological well-being of international students in coping with unexpected situations, such as disease outbreaks.

Background: This study explored whether opinions about the government's role in addressing the COVID-19 pandemic vary based on demographic characteristics and racial beliefs. We hypothesized that opinions about the United States (U.S.) government's response to COVID-19 would differ based on an individual's characteristics such as age, race, and racial beliefs., Methods: We utilized an Inter-University Consortium for Political and Social Research dataset to examine differences in opinion regarding the government's pandemic response, considering personal characteristics and racial beliefs. Descriptive statistics depicted respondents' characteristics, and a Chi-square test for independence assessed whether differences emerged based on racial attitude, self-reported racial identity, sex, income, education, and age. Logistic regression analyses were conducted to independently determine which characteristics were associated with differences in evaluating the government's pandemic response., Results: The sample consisted of 1028 respondents: 47.5% male and 52.5% female. Overall, the group viewed the government unfavorably, with only 40% reporting that the government responded correctly and 54% believing the government is almost always wasteful and inefficient. Hispanics or Latinos were more likely to view the government as wasteful or inefficient, while more Whites rated the government's pandemic response as appropriate. Individuals who believed that racial discrimination is the main reason why many Black people cannot get ahead generally regarded the government's pandemic response more favorably. Only 5% deemed the government's response excessive. Being Black, younger, and female was associated with the view that racial discrimination is the main reason why many Black people cannot get ahead. Individuals who felt this way viewed the government unfavorably by almost a 2:1 ratio., Conclusions: A majority of U.S. residents do not believe the government responded correctly to the pandemic and more than half viewed the government as wasteful and inefficient. Differences emerged by ethnicity and racial attitudes, with individuals of color holding more negative views of the government's response. Understanding this perspective can help develop messaging and strategies that resonate with communities where racial and minority groups live.

In response to the global COVID-19 pandemic, nations implemented lockdown measures to contain the virus. This study assessed air pollution levels during and after lockdowns, focusing on the following heavily affected locations: Oulu and Helsinki in Finland, Paris in France, Madrid in Spain, Milan in Italy, and Wuhan in China. Air Quality Index (AQI) data from these locations over two years were analyzed to understand the effects of lockdowns. The study compared COVID-19 lockdowns in these six cities with SARS-CoV-2 measurements using statistical methods. Variations in outdoor pollutants were evaluated through tests, revealing significant differences. Parametric analyses and regression were employed to study the impacts of lockdown measures on pollution and their relationships. The study comprehensively analyzed the effects of COVID-19 lockdowns on air quality, identifying differences, quantifying changes, and exploring patterns in each city. Pollutant correlations varied among cities during the lockdowns. Regression analysis highlighted the impact of independent variables on pollutants. Decreases in NO 2 were observed in Helsinki, Madrid, Oulu, Paris, and Milan, reflecting reduced traffic and industrial activities. Reductions in PM 2.5 and PM 10 were noted in these cities and in Wuhan, except for O 3 levels, which increased. The reduction in human activities improved air quality, particularly for NO 2 and PM 10 . Regional variations underscore the need for tailored interventions. The study observed a substantial decrease in both PM 2.5 and NO 2 levels during the COVID-19 lockdowns, indicating a direct correlation between reduced human activities, such as transportation and industrial operations, and improved air quality. This underscores the potential impact of environmental measures and suggests the need for sustainable practices to mitigate urban pollution.

The efficient recognition of symptoms in viral infections holds promise for swift and precise diagnosis, thus mitigating health implications and the potential recurrence of infections. COVID-19 presents unique challenges due to various factors influencing diagnosis, especially regarding disease symptoms that closely resemble those of other viral diseases, including other strains of SARS, thus impacting the identification of useful and meaningful symptom patterns as they emerge in infections. Therefore, this study proposes an association rule mining approach, utilising the Apriori algorithm to analyse the similarities between individuals with confirmed SARS-CoV-2 diagnosis and those with unspecified SARS diagnosis. The objective is to investigate, through symptom rules, the presence of COVID-19 patterns among individuals initially not diagnosed with the disease. Experiments were conducted using cases from Brazilian SARS datasets for São Paulo State. Initially, reporting percentage similarities of symptoms in both groups were analysed. Subsequently, the top ten rules from each group were compared. Finally, a search for the top five most frequently occurring positive rules among the unspecified ones, and vice versa, was conducted to identify identical rules, with a particular focus on the presence of positive rules among the rules of individuals initially diagnosed with unspecified SARS.

Introduction: Long COVID (LC) is a global public health crisis affecting more than 70 million people. There is emerging evidence of different pathophysiological mechanisms driving the wide array of symptoms in LC. Understanding the relationships between mechanisms and symptoms helps in guiding clinical management and identifying potential treatment targets., Methods: This was a mixed-methods systematic review with two stages: Stage one (Review 1) included only existing systematic reviews (meta-review) and Stage two (Review 2) was a review of all primary studies. The search strategy involved Medline, Embase, Emcare, and CINAHL databases to identify studies that described symptoms and pathophysiological mechanisms with statistical analysis and/or discussion of plausible causal relationships between mechanisms and symptoms. Only studies that included a control arm for comparison were included. Studies were assessed for quality using the National Heart, Lung, and Blood Institute quality assessment tools., Results: 19 systematic reviews were included in Review 1 and 46 primary studies in Review 2. Overall, the quality of reporting across the studies included in this second review was moderate to poor. The pathophysiological mechanisms with strong evidence were immune system dysregulation, cerebral hypoperfusion, and impaired gas transfer in the lungs. Other mechanisms with moderate to weak evidence were endothelial damage and hypercoagulation, mast cell activation, and auto-immunity to vascular receptors., Conclusions: LC is a complex condition affecting multiple organs with diverse clinical presentations (or traits) underpinned by multiple pathophysiological mechanisms. A 'treatable trait' approach may help identify certain groups and target specific interventions. Future research must include understanding the response to intervention based on these mechanism-based traits., Competing Interests: The authors declare no conflict of interest relating to this work.

The aim of this paper is to assess the influence of selected geographical factors on the diversity of the development of the COVID-19 pandemic in Europe's regions, and on its dynamics across the continent. The work took into account 250 of NUTS-2 regions. The datasets included the course of the COVID-19 pandemic (two dependent variables), intervening actions (four variables of the research background), and potential environmental and socio-economic conditioning (twelve independent variables). The dependent variables' set was composed of two indexes: morbidity and temporal inertia. The temporal scope of the research was 23 March 2020-15 May 2022, with weekly resolution. By means of multiple linear regression model, the influence of the administrative actions and of the selected natural and socio-economic factors was assessed. Finally, a synthetic Regional Epidemic Vulnerability Index (REVI) for each individual region was calculated. It allowed us to classify the regions into three categories: resistant, neutral, or sensitive. REVI's spatial distribution indicates that the zone of above-average vulnerability occurred in the western part of Europe and around the Alps. Therefore, focus ought to extend beyond regional statistics, towards spatial relationships, like contiguous or transit position. This research also validated the strong impact of national borders.

The relationship between COVID-19 infections and environmental contaminants provides insight into how environmental factors can influence the spread of infectious diseases. By integrating epidemiological and environmental variables into a mathematical framework, the interaction between virus spread and the environment can be determined. The aim of this study was to evaluate the impact of atmospheric contaminants on the increase in COVID-19 infections in the city of Quito through the application of statistical tests. The data on infections and deaths allowed to identify the periods of greatest contagion and their relationship with the contaminants O 3 , SO 2 , CO, PM 2.5 , and PM 10 . A validated database was used, and statistical analysis was applied through five models based on simple linear regression. The models showed a significant relationship between SO 2 and the increase in infections. In addition, a moderate correlation was shown with PM 2.5 , O 3 , and CO, and a low relationship was shown for PM 10 . These findings highlight the importance of having policies that guarantee air quality as a key factor in maintaining people's health and preventing the proliferation of viral and infectious diseases.

This article describes and reflects upon the work of a co-research team on the Healthy Ageing in Scotland (HAGIS) 'COVID-19 Impact and Recovery' study (January 2021 to November 2022). The co-research team (seven older adults and three academics) was constituted near the start of this project; the team contributed to the development of recruitment materials and research tools and undertook qualitative research and analysis with older adults living across Scotland. This article provides a collaborative autoethnography about the activities undertaken by the team, the impact of the co-research process on the individuals involved, and the research findings and reflects the realities of co-research during the COVID-19 pandemic. Team members describe benefits, including increased confidence, new skills, and social connections, and reflect on the increased validity of the findings through their close involvement in the co-creation of knowledge. The process of team building and the adoption of an 'ethics of care' in our practice underpinned the success of this project and the sustainability of the group during and after the challenging circumstances of the pandemic.

The beginning of the COVID-19 pandemic was marked by a sharp decline in syphilis infections in many countries worldwide, including Greece. However, a resurgence of positive cases started to appear in the second half of 2020. The aim of this study was to explore the impact of the pandemic on the incidence of new syphilis infections and reinfections and analyze the sociodemographic characteristics associated with recurrent episodes. We analyzed medical records from a 14-month period after the beginning of the pandemic and compared them with the respective period before the start of the pandemic. Our participants consisted mainly of men, with a median age of 43 years, homosexual orientation, and higher education. During COVID-19, more HIV patients presented for syphilis testing (38.0% vs. 34.6%, p = 0.025). Overall, we observed almost a two-fold increase in positive syphilis cases during COVID-19 (21.1% vs. 12.4%, p < 0.001), with new infections rising from 8.4% to 13.2% and reinfections from 4.0% to 7.9%. Multivariable logistic regression analysis revealed that the COVID-19 pandemic, among different parameters (such as age, gender, sexual orientation, HIV status, and educational level), was the only factor associated with higher positive syphilis rates (OR 1.47, 95% CI: 1.07-2.01, p = 0.003). Our results highlight the need to ensure enhanced prevention and undisrupted healthcare services, with a focus on future pandemics.

Background: The timely management of rapidly evolving epidemiological scenarios caused by disease outbreaks is crucial to prevent devastating consequences. However, delayed laboratory diagnostics can hamper swift health policy and epidemic response, especially in remote regions such as the western Brazilian Amazon. The aim of the article is to analyze the impact of the COVID-19 pandemic on the volume and characteristics of emergency medical services (EMS) in Manaus, focusing on how the pandemic affected sensitive indicators such as response time and the use of advanced life support ambulances. Additionally, the study seeks to understand how changes in prehospital EMS patterns, triggered by the pandemic, could be utilized as health surveillance tools, enabling a more rapid response in epidemic scenarios., Methods: This retrospective, descriptive study included data from the SAMU (Serviço de Atendimento Móvel de Urgência) medical records between January and June 2020., Results: A total of 45,581 calls resulted in mobile units being dispatched during this period. These patients were predominantly male (28,227, 61.9%), with a median age of 47 years (IQR 30-67). The median response time significantly increased during the pandemic, reaching a median of 45.9 min (IQR 30.6-67.7) ( p < 0.001). EMS calls were reduced for trauma patients and increased for other medical emergencies, especially respiratory conditions, concomitantly to an escalation in the number of deaths caused by SARS and COVID-19 ( p < 0.001). The employment of advanced life support ambulances was higher during the pandemic phase ( p = 0.0007)., Conclusion: The COVID-19 pandemic resulted in a temporary disorder in the volume and reason for EMS calls in Manaus. Consequently, sensitive indicators like the response time and the employment of advanced life support ambulances were negatively affected. Sudden prehospital EMS pattern changes could play an important role in health surveillance systems, allowing for earlier establishment of countermeasures in epidemics. The impact of the COVID-19 pandemic on prehospital EMS and its role in health surveillance should be further explored.

The aims of this study were to analyze patient survival, identify the prognostic factors for patients with COVID-19 deaths considering the length of hospital stay, and evaluate the spatial distribution of these deaths in the city of Jundiaí, São Paulo, Brazil. We examined prognostic variables and survival rates of COVID-19 patients hospitalized at a reference hospital in Jundiaí, Brazil. A retrospective cohort of hospitalized cases from April to July of 2020 was included. Descriptive analysis, Kaplan-Meier curves, univariate and multivariate Cox regression, and binary logistic regression models were used. Among the 902 reported and confirmed cases, there were 311 deaths (34.5%). The median survival was 27 days, and the mean for those discharged was 46 days. Regardless of the length of hospital stay, desaturation, immunosuppression, age over 60, kidney disease, hypertension, lung disease, and hypertension were found to be independent predictors of death in both Cox and logistic regression models.

Coronavirus 2019 (COVID-19) is a major global public health threat that has impeded health infrastructures in low- and middle-income countries. This systematic review examines the impact of COVID-19 on maternal health service uptake and perinatal outcomes in Sub-Saharan Africa. We searched four databases in August 2020 and updated the search on 22 December 2023: PubMed/MEDLINE, CINAHL, Maternity and Infant Care, and EMBASE. Data extraction was performed using a standardised Joana Briggs Institute data extraction format for the eligibility of articles, and any discrepancies were solved through discussion and consensus. This systematic review includes 36 studies that met the inclusion criteria. Antenatal care attendance and institutional childbirth significantly decreased during the COVID-19 pandemic, and home births increased. Fear of contracting the virus, a lack of transport, a shortage of logistic supplies, a lack of personal protective equipment, lockdown policies, economic and food security, stigmatisation of sick persons, long waiting times in the hospital, and health system weakness were barriers to accessing maternity care. The findings of this review showed a significant decrease in antenatal care attendance and institutional birth during the COVID-19 pandemic. Based on our findings, we recommend that stakeholders ensure the availability of essential medical supplies in the hospital.

This study investigated the impacts of online and face-to-face Mat Pilates training in adults with persistent symptoms of long COVID on health outcomes. Forty-nine patients (52 ± 5.85 yr.) diagnosed with long COVID related to fatigue symptoms were randomly included in three groups: online Mat Pilates training (n = 16), face-to-face Mat Pilates training (n = 15), and a control group (n = 18) without training. Mat Pilates training was conducted three times a week for 12 weeks. Fatigue, functional capacity, anthropometrics, body composition, and cardiometabolic markers were assessed before and after the interventions. Two-factor Generalized Estimating Equation analyses identified significant differences with Bonferroni post hoc testing ( p < 0.05). After the intervention, only the face-to-face Mat Pilates training group had an improved total, physical and mental fatigue, trunk isometric strength, upper limb muscle endurance strength, and aerobic capacity ( p < 0.05). No changes were found in fat mass, muscle mass, free fat mass, % of fat, body mass, body mass index, or waist and hip circumferences. No significant changes were observed in blood glucose, glycated hemoglobin, triglycerides, total cholesterol, high-density lipoprotein, low-density lipoprotein, or blood pressure ( p > 0.05). Our results highlight the potential of face-to-face Mat Pilates training as an effective intervention to mitigate persistent symptoms of long COVID related to fatigue and functional capacities.

This study investigated whether a social-emotional learning program, implemented over a one-year period, could lead to gains in social-emotional competencies and to a reduction in internalizing and externalizing problems in the context of the COVID-19 pandemic. Furthermore, the program analyzed how students (boys vs. girls) with varying levels of social-emotional competencies and externalizing and internalizing problems, and from different socioeconomic backgrounds, were differently affected. The program was applied to 358 Portuguese third- and fourth-grade students (51.4% boys, M age = 8.56; SD = 0.82). Self-report (students) and hetero-report (teachers) questionnaires were administered before and after the intervention. Linear mixed-effects models were computed to test intervention impacts. Significant intervention gains were noted in social-emotional learning competencies, namely emotional knowledge, social competence, peer relations, self-management, and academic behavior, and in externalizing (social problems) and internalizing (anxiety) problems. No effects were found in aggressiveness. Students with lower social-emotional competencies and higher externalizing and internalizing problems at baseline profited more from the program. Gender moderated both emotional knowledge and social problems, and socioeconomic status only moderated social problems. Findings highlight the effectiveness of this social-emotional learning program, especially for students facing initial challenges. Recommendations for future research, acknowledging limitations and strengths, are discussed.

Background and Objective: The impairments and duration of PASC (post-acute sequelae of COVID-19) symptoms in mental health have, to date, not been comprehensively examined. Our objective is to provide longitudinal data on the mental health of Post-COVID patients and to identify risk and protective factors associated with a severe or prolonged course., Methods: The mental health of 265 Post-COVID patients of the outpatient Post-COVID centre of the University Hospital Erlangen was assessed 17.1 (T0) and 22.5 months after infection (T1). An online survey with validated questionnaires for Post-COVID symptoms (Post-COVID Syndrome Score), depression (Patient Health Questionnaire-9), somatic symptoms (Patient Health Questionnaire-15), anxiety (Generalized Anxiety Disorder-7), fatigue (Fatigue Severity Scale) and Post-Exertional Malaise (PEM) (DePaul Post-Exertional Malaise Screening) was conducted in the home environment., Results: In total, 80% of patients experienced severe PASC at follow-up. Clinically relevant symptoms of depression, persistent somatic symptoms, anxiety and fatigue were reported by 55.8%, 72.5%, 18.9% and 89.4% of patients, respectively. Depressive, anxiety and somatic symptom severity decreased significantly over time; fatigue and PEM remained at an unchanged high level. The risk factor for higher depression scores was older age; prior psychiatric illness treated with psychotherapy was associated with more severe depressive, somatic, anxiety and PASC symptoms. PEM symptoms were significantly associated with longer duration between acute infection and initial presentation in the Post-COVID centre., Conclusions: Our findings align with previous research, claiming severe mental health symptoms in PASC syndrome, lasting for months after infection. In-depth assessment of risk and protective factors for the mental health implications of PASC is needed for the planning of health services and disease prevention.

Background: The pandemic has disproportionately impacted rural communities with a higher burden of chronic disease and COVID-19 infection. West Virginia is a rural state with a high rate of diabetes, hypertension, and COPD, which are known risk factors for severe COVID-19 and long COVID. Yet, there is a significant hesitancy regarding COVID-19 vaccination uptake in the state. The purpose of this study was to use an educational intervention to increase vaccine knowledge and vaccine acceptance in rural patients with chronic disease(s) in West Virginia. This project used an academic-community partnership comprised of researchers, practitioners, community organizations, community-engaged partners, and patient stakeholders to increase COVID-19 health literacy and increase vaccine acceptance among rural West Virginians with chronic conditions., Materials and Methods: A quasi-experimental study design was used to deliver an educational intervention by trained Health Navigators using short videos to increase COVID-19 health literacy and address participants' vaccine concerns. Eligibility included adults (18 years and older) who have at least one chronic condition. A statewide community advisory board (CAB) guided the development of the educational training curriculum and implementation strategies. An adapted version of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework guided the development of the intervention. Health Navigators ( n = 45) delivered the educational intervention in their local communities between November 2022 and October 2023 (project implementation is still ongoing). Intervention fidelity checks, an adaptable script, and a flow chart allowed tailoring of brief videos to address participants' specific COVID-19 questions and vaccine concerns. A validated online survey, monitored by an online Research Electronic Data Capture (REDCap) database, assessed participants' knowledge, perceived susceptibility, and vaccine intention., Results: Health Navigators delivered the intervention to 1368 West Virginians in 52 counties (59.2% women; 61.8% without a college degree). Participants reported living with an average of 2.1 ± 1.4 chronic conditions. The mean age was 43.5 ± 18.8 years. The majority of participants (81.2%) had received the primary vaccination series, and 63.1% had at least one booster. However, 18% were unvaccinated or did not complete the primary COVID-19 vaccine series. Discussions to improve vaccine literacy focused on how the vaccine was so quickly developed and protects against variants, addressing concerns related to the safety, short- and long-term side effects, and importance of vaccine uptake for immunocompromised individuals. Participants with higher concerns were more likely to be unvaccinated and to have not completed their primary series or boosters ( p < 0.001). However, the educational intervention improved the willingness of individuals who were either unvaccinated or did not complete their primary vaccine series to get vaccinated (11.4%)., Discussion: Our findings highlight the importance of vaccine literacy in increasing vaccination rates among rural patients with chronic diseases. Using the EPIS framework allowed us to reflect upon the challenges, ensure resilience during changing local contexts, and plan and implement a promising, cost-effective intervention in rural areas., Conclusions: This study provides insights into the need for tailored educational interventions based on disease status, which has implications for public health and patient care in rural and underserved communities. Academic-community partnerships can be useful for successful knowledge transfer for vaccine acceptance to reduce rural health disparities.

Being pregnant during COVID-19 increases the risk of experiencing severe COVID-19 symptoms, which in turn increases the risk of complications. This study aimed to examine COVID-19-related beliefs, behaviors, and birth outcomes among users of Count the Kicks (CTK), a fetal movement tracking app. This study used the End of Pregnancy Survey data from 1037 CTK users. We used descriptive analyses to analyze COVID-19-related beliefs and behaviors and used the chi-square statistic and Z statistic to examine factors associated with vaccination and birth outcome. Nearly half of the survey respondents reported not being concerned that in-person prenatal visits might lead to COVID-19 exposure. Most respondents (65.9%) had already received the COVID-19 vaccine at the time of the survey. The vaccination rate was statistically significantly lower among African Americans than the remaining race/ethnicity groups (mostly white). The healthy birth rate is lower among respondents with high-risk pregnancies, while the stillbirth rate is highest among Hispanics. Vaccination status was not associated with the likelihood of a healthy birth. Our findings confirmed that vaccination does not compromise birth outcomes, further contributing to the existing evidence of COVID vaccine safety during pregnancy. This study also demonstrates an example of using data from a pregnancy app to facilitate research on app users in real-time.

Introduction: The COVID-19 pandemic challenged the scientific community to find and develop a vaccine to fight the disease. However, problems with achieving high vaccine coverage have emerged, even among high-risk groups such as healthcare workers (HCWs)., Objective: The objective of this study is to examine factors that influence HCW's and the general population's adherence to COVID-19 vaccination and national policies to vaccinate HCWs and other target groups., Methods: This study implemented a systematic review. The eligibility criterion for inclusion was being a HCW, target population for COVID-19 vaccination, or general population. Vaccination was the target intervention, and the COVID-19 pandemic was the context. We selected publications published between 1 January 2020 and 31 March 2022. Qualitative synthesis used a meta-aggregation approach., Results: Nineteen articles were included in the review, with study samples varying from 48 to 5708 participants. Most of the evidence came from cross-sectional and qualitative studies. The main findings were related to vaccine hesitancy rather than acceptance. Factors associated with HCW vaccine hesitancy included subjective feelings such as safety concerns, rapid vaccine development, and insufficient testing. Countries have adopted few public policies to address this problem, and the main concern is whether to enforce vaccination and the extent to which measures are legal., Conclusion: The quality of the evidence base remains weak. Skepticism, mistrust, and hesitancy toward vaccination are global issues that can jeopardize vaccination coverage.

Background: This study aimed to evaluate the incidence of lymphadenopathies after COVID-19 vaccination and their impact on the clinical management of gynecologic oncology patients., Methods: A retrospective observational study was conducted involving patients who underwent abdominopelvic or thoracoabdominopelvic CT scans during diagnosis or follow-up. Patients were classified into a vaccinated group (Vac group) and a non-vaccinated group (NoVac group). The radiological appearance of lymphadenopathies was categorized as low or high risk of malignancy, and management strategies were recorded as standard management or additional assessment., Results: 75 patients were included, with 44 in the Vac group and 31 in the NoVac group. The incidence of lymphadenopathies was similar between the groups: 34.1% in the Vac group and 32.3% in the NoVac group ( p = 0.868). High-risk lymphadenopathies were observed in 20.4% of the Vac group and 22.6% of the NoVac group, while low-risk lymphadenopathies were seen in 13.6% of the Vac group and 9.7% of the NoVac group ( p = 0.691). Standard management was the most common approach, used in 80.0% of the Vac group and 100.0% of the NoVac group ( p = 0.25)., Conclusions: COVID-19 vaccine does not increase the incidence of lymphadenopathies in imaging tests of gynecological cancer patients.

Within the USA, the uptake of the updated COVID-19 vaccines is suboptimal despite health authority recommendations. This study used qualitative methods to examine factors influencing COVID-19 vaccine decision making and the effects of anxiety and depression on these decisions within the CHASING COVID Cohort (C3). Between October and December 2023, we conducted 25 interviews with participants from 16 different US states, 14 of whom endorsed recent symptoms of anxiety and/or depression. Using grounded theory methodology for coding and thematic analysis, we categorized participants into "One-Shot Wonders" and "Booster Enthusiasts". Our findings indicate that the US COVID-19 vaccination environment has shifted from active promotion to a notable absence of COVID-19 discussions, leading to reduced worry about infection and severe illness, diminished perception of the benefits of the vaccine on personal and community levels, and fewer cues to action. Initially influential factors like family, personal experiences, and physician recommendations lost impact over time. Although the relationship between symptoms of depression and anxiety and vaccination was not prominent, one case highlighted a direct relationship. The study emphasizes the importance of timely and accurate public health messaging adaptable to individuals' needs and misconceptions, highlighting the need for dynamic communication strategies in future initiatives with rapidly changing landscapes.

Children with SARS-CoV-2 are mostly mild symptomatic, but they may develop conditions, such as persisting symptoms, that may put them at greater risk of complications. Our aim was to evaluate the frequency and the presence of risk factors for persisting COVID-19 symptoms in children. We carried out a prospective observational study of the clinical manifestation of Long COVID at the Department of Maternal Infantile Science of a tertiary University hospital in Rome. We included 697 children (0-18 years), with previous SARS-CoV-2 infection. Children and parents were asked questions regarding persistent symptoms of COVID-19. Children with symptoms 30 days after initial diagnosis were 185/697 (26.4%). Moreover, 81/697 (11.6%) patients presented symptoms 90 days after the diagnosis. Thirty-day-persisting symptoms were mostly present in children with anosmia, atopy, asthenia, and cough in the acute phase compared with the asymptomatic children 30 days after infection. After 90 days, symptoms described were mainly neurological (47/697 children, 6.7%), and headache (19/697; 2.7%) was the most frequent manifestation. In conclusion, a relatively large proportion of the patients reported persisting symptoms that seem to be related to the symptom burden and to the atopy. Ninety days after the infection, most of the children had recovered, showing that long-term effects are not frequent. Limitations of the study include the single-center design and the lack of a control group.

The emergence of the COVID-19 pandemic in 2020 led to the implementation of legal restrictions on individual activities, significantly impacting traffic and air pollution levels in urban areas. This study employs a state-space intervention method to investigate the effects of three major COVID-19 lockdowns in March 2020, November 2020, and January 2021 on London's air quality. Data were collected from 20 monitoring stations across London (central, ultra-low emission zone, and greater London), with daily measurements of NO x , PM 10 , and PM 2.5 for four years (January 2019-December 2022). Furthermore, the developed model was adjusted for seasonal effects, ambient temperature, and relative humidity. This study found significant reductions in the NO x levels during the first lockdown: 49% in central London, 33% in the ultra-low emission zone (ULEZ), and 37% in greater London. Although reductions in NO x were also observed during the second and third lockdowns, they were less than the first lockdown. In contrast, PM 10 and PM 2.5 increased by 12% and 1%, respectively, during the first lockdown, possibly due to higher residential energy consumption. However, during the second lockdown, PM 10 and PM 2.5 levels decreased by 11% and 13%, respectively, and remained unchanged during the third lockdown. These findings highlight the complex dynamics of urban air quality and underscore the need for targeted interventions to address specific pollution sources, particularly those related to road transport. The study provides valuable insights into the effectiveness of lockdown measures and informs future air quality management strategies.

While pandemics have long been a topic of discussion in public health, COVID-19 placed healthcare leaders in a completely new and challenging situation. This qualitative study sought to understand the personal experiences of healthcare professionals in leadership roles at the beginning of the COVID-19 pandemic. Sixteen in-depth interviews were conducted and recorded via Zoom. Most participants were men ( n = 8, 57.1%) and had a doctorate or master's degree ( n = 8, 57.1%). The themes of mental health, dynamic infrastructure, and transformative experience emerged from our participants' narratives. Most respondents reported heightened stress during that time and shared the institutional and personal mechanisms they used to deal with the situation. They were proud of their profession and their work. They discussed the "dynamic infrastructure" they experienced at the time that helped them lead. Feeling overworked was a common experience for them. Most considered leading during COVID-19 a "transformative experience" that taught them valuable lessons. They also witnessed acts of heroism as their colleagues continued to work during difficult times, even though some succumbed to COVID-19. Despite all the challenges and uncertainties healthcare professionals in leadership positions faced at the onset of COVID-19, their resilience, dedication, and commitment to their profession prevailed. In conclusion, the firsthand experiences recounted by healthcare leaders in this study shed light on the multifaceted nature of leadership during a global health crisis. Their unwavering resilience, dedication, and commitment stand as a testament to the fortitude required in such demanding circumstances. As the COVID-19 pandemic continues to evolve, the insights gleaned from this research bear significant implications for informing future strategies and support systems aimed at bolstering healthcare leadership worldwide.

Globally, the COVID-19 pandemic has presented serious mental health challenges for healthcare professionals. This study investigated the mental health, mental fatigue, quality of life, and stigma of social discrimination among healthcare workers in the United Arab Emirates (UAE) during the COVID-19 pandemic. A correlational, cross-sectional, multi-centric design was employed to collect data from 1383 healthcare workers across various healthcare settings. Participants were recruited using combined cluster and purposive sampling techniques. Standardized questionnaires, including the COVID-19 Pandemic Mental Health Questionnaire (CoPaQ), the Mental Fatigue Scale (MFS), the Social Discrimination Scale-Stigma Subscale (SDS), and the WHO Quality of Life Questionnaire-Brief (WHOQOL-BREF), were administered to assess the study variables. The results indicated significant mental health impacts, with high average scores for post-traumatic stress disorder (PTSD) (9.37 ± 6.74) and positive coping by inner strengths (17.63 ± 5.72). Mental fatigue was prevalent (8.15 ± 8.62), and stigma of social discrimination scored notably (23.83 ± 7.46). Quality of life was the highest in the social domain (65.38 ± 24.58). Significant correlations were observed between mental health subscales, mental fatigue, and quality of life domains. These findings highlight the critical need for targeted mental health support programs, improved social support networks, and personalized interventions to mitigate the mental health challenges faced by healthcare workers. Healthcare organizations can guarantee a resilient workforce that can handle future health crises by giving mental health resources and support systems top priority., Competing Interests: The authors declare no conflicts of interest.

Understanding COVID-19's effects on susceptible populations remains essential for clinical implementations. Our review aimed to examine whether the pandemic significantly impacted the stress levels in the mothers of premature infants in NICUs. The review of the literature from Google Scholar and PubMed resulted in identifying specific stressors such as the disruption of healthcare systems, limited access to neonatal care, uncertainty due to frequent changes in restrictions, the risk of COVID-19 infection, social isolation, and financial stress. While some quantitative studies concerning this topic did not show a significant increase in the perception of stress in this population compared to the pre-pandemic group, various research has indicated that the COVID-19 pandemic may result in enduring impacts on the emotional and neurological development of children. This article demonstrates a correlation between the repercussions of the COVID-19 pandemic and an elevated incidence of depressive symptoms among the mothers of premature infants. Further studies are needed to assess the long-term impact of pandemic-induced stress.

Multiple factors, from socioeconomic development to genetic background, can affect the regional impact of some diseases, and this has also been seen during the COVID-19 pandemic. The objective of this retrospective study was to characterize a population in the interior of Portugal regarding health status and COVID-19 epidemiology. Between October 2021 and January 2023, 1553 subjects residing in Beira Baixa, Portugal, were included. Using a self-report approach, demographic and clinical data were obtained. Blood group, blood pressure, peripheral oxygen saturation and anti-spike protein immunoglobulin concentration were also analyzed. Statistical analysis was performed using IBM SPSS Statistics. The average age of the participants was 48.95 (±14.43) years, with 64% being male and 36% being female. The most prevalent comorbidities were hypertension (19.2%), dyslipidemia (12.6%) and diabetes mellitus (6.6%). Half of the population was overweight, and more than half of the subjects had no history of tobacco consumption. Among the participants, 33% were infected with SARS-CoV-2: 70.1% had mild disease, 14.1% moderate disease and 1.4% severe disease. There was a very significant adherence to vaccination (97%). Previously infected or vaccinated people had higher anti-spike protein immunoglobulin values; this value depended on the vaccine administered ( p < 0.001). Patients with autoimmune diseases and smokers had lower levels of anti-S IgG antibodies ( p = 0.030 and p = 0.024, respectively). The severity of COVID-19 did not affect the concentration of anti-S IgG ( p = 0.430). This study highlights the general health statuses and the impact of COVID-19 on a population in the Portuguese interior. Knowledge of the circulation and impact of the virus in this specific population can alert and assist in better interventions being conducted by health authorities.

Introduction: Adolescent girls and young women (AGYW) in India face additional health inequities compared to their male peers, as gender norms constrain agency for prevention and self-care. The onset of the COVID-19 pandemic and associated lockdowns deepened health inequities and often worsened mental health, but the impacts on agency are unclear. This exploratory sequential mixed methods paper examined mental health and COVID-19 elements that exacerbated or mitigated adverse consequences for AGYW in low-income communities in Mumbai., Methods: We conducted semi-structured interviews with AGYW (aged 15-25 years; N = 60) and adults (parents, healthcare providers, community-based organization representative; N = 30). We administered a structured survey to AGYW (N = 150) to assess health concerns, depression and anxiety symptoms (using the PHQ-8 and GAD-7 scales), and experiences during COVID-19. We analyzed qualitative data using the constant comparative approach in Atlas.ti, and quantitative data using R and SPSS., Results: Qualitative data revealed that AGYW faced stressors and had limited agency during lockdowns due to limited access to education, financial insecurity, and community violence. Quantitative data indicated that limited agency in the context of COVID-19 was significantly associated with depression and anxiety. Financial resources to address COVID-19 created new employment and leadership opportunities for AGYW to become COVID educators and preschool teachers; participation in these opportunities was associated with less anxiety., Discussion: Pandemic stress was difficult for low-income AGYW in Mumbai. Mitigating programs for COVID-19 control helped address acute needs and enable capabilities. Exploring similar themes among a broader population of youth can help design strategies and opportunities for young people in low-income communities during health emergencies.

The aim of this study was to assess whether the psychological impact of the COVID-19 pandemic on children and adolescents had decreased four years after the initial assessment. This study aimed to determine if children with an active lifestyle and participation in sports activities were protected against this traumatic stress. This study included a total of 284 Italian participants assessed at two different time points: the first assessment was conducted in 2020 when the children were aged 9-12 years, and a second assessment was carried out four years later when the participants were aged 13-16. Participants completed the Impact of Event Scale-Revised questionnaire (IES-R), with the IES-8 and IES-15 versions used accordingly based on age group. In the 2020 assessment, 146 (51.4%) reported a score higher than the cut-off for significant traumatic stress, while in 2024, only 49 participants (17.2%). The chi-square analysis indicated that this decrement was statistically significant ( p < 0.001). RM-ANOVA showed a significant reduction for both Intrusion Score and Avoidance Score ( p < 0.001). A statistical interaction between gender and time was observed. There were weak correlations between the level of children's sport practice, and no differences between those who engage in individual or team sports. Despite this study showing that young people are overcoming the pandemic crisis and its consequences, identifying potential modifiable risk factors and empowering protective factors remains crucial, especially for those who continue to experience psychological issues. The restrictions particularly impacted active children by disrupting their routine, which may have compromised the universally recognized protective value of sports.

Healthcare personnel experienced unprecedented stressors and risk factors for burnout, anxiety, and depression during the COVID-19 pandemic. This may have been particularly true for spiritual health clinicians (SHCs), also referred to as healthcare chaplains. We administered a daily pulse survey that allowed SHCs to self-report burnout, depression, and well-being, administered every weekday for the first year of the pandemic. We used a series of linear regression models to evaluate whether burnout, depression, and well-being were associated with local COVID-19 rates in the chaplains' hospital system (COVID-19 admissions, hospital deaths from COVID-19, and COVID-19 ICU census). We also compared SHC weekly rates with national averages acquired by the U.S. Census Bureau's Household Pulse Survey (HPS) data during the same timeframe. Of the 840 daily entries from 32 SHCs, 90.0% indicated no symptoms of burnout and 97.1% were below the cutoff for depression. There was no statistically significant relationship between any of the COVID-19 predictors and burnout, depression, or well-being. Mean national PHQ-2 scores were consistently higher than our sample's biweekly means. Understanding why SHCs were largely protected against burnout and depression may help in addressing the epidemic of burnout among healthcare providers and for preparedness for future healthcare crises.

Long-haul truck drivers are responsible for transporting goods valued at millions of dollars of the world economy, and may have their health affected by living and working conditions. This study analyzed and synthesized scientific findings about risk factors for the development of chronic non-communicable diseases in long-haul truck drivers. An integrative literature review was conducted. We identified 23 studies that met the inclusion criteria and evaluated the health of 7363 drivers. The biological risk factors identified were age, gender, race/ethnicity, genetics, and comorbidities, and were considered to be non-modifiable for chronic diseases. The behavioral risks considered to be modifiable were sedentary lifestyle, smoking, alcohol consumption, overweight, diet, stress, anxiety, and unfavorable socioeconomic conditions. Environmental risks involved working conditions such as the following: number of working hours per day, week, and month; time away from home; risk of musculoskeletal injury; and opportunities for rest, hours of sleep, and access to health services. The results were presented in two categories: (1) biological, behavioral, and environmental risks, and (2) general recommendations to promote physical, cognitive, and emotional health. Macro-structural changes are needed to reorganize work and rest, improve access to health services to control modifiable risk factors, and to support behavioral and environmental changes to reduce chronic non-communicable diseases and deaths.

Background: The COVID-19 pandemic has exacerbated fears and anxieties, potentially influencing maternal perinatal mental health. This study addresses a gap in the literature on fear of COVID-19 in pregnant women, aiming to identify contributing factors., Method: Participants were 401 primiparous women with an average age of 34 years (SD = 4.56) who were recruited through the National Health System during birth support courses. They completed a series of self-reported instruments via an online survey, providing information on their levels of reflective functioning, dyadic consensus, perinatal maternal affectivity, and fear of COVID-19. Pearson's correlation and mediation analysis via a generalized linear model were implemented to analyze the collected data., Results: The relationship between dyadic consensus and fear of COVID-19 was significant and negative. Furthermore, a significant parallel mediation involving perinatal maternal affectivity and reflective functioning was found to the extent that, when these factors were inserted into the model, the direct association between dyadic consensus and fear of COVID-19 became non-significant (total mediation)., Conclusions: The results highlight the importance of dyadic adjustment in alleviating maternal COVID-19 fear, emphasizing interventions promoting couple functioning, mentalization, and addressing affective difficulties. Such approaches are vital for supporting expecting mothers during challenging times like the COVID-19 pandemic.

Background: Reports of escalated discrimination experiences among Asian American and Native Hawaiian Pacific Islanders (AANHPI) continue., Methods: Using the original and follow-up surveys of the COVID-19 Effects on the Mental and Physical Health of AAPI (Asian American and Pacific Islanders) Survey Study (COMPASS I and COMPASS II) (n = 3177), we examined changes over approximately a 1-year period in discrimination experiences attributable to being AAPI and factors associated with worse mental health outcomes., Results: Experiences of discrimination remained high in COMPASS II with 60.6% (of participants (compared to 60.2% among the same people in COMPASS I) reporting one or more discrimination experiences, and 28.6% reporting worse mental health outcomes. Experiences of discrimination were associated with modest but significant increase in the odds of worse mental health: adjusted OR 1.02 (95% CI 1.01-1.04). Being younger, being of Native Hawaiian/Pacific Islander or Hmong descent (relative to Asian Indian), and having spent 50% or less of their lifetime in the US (vs. US born), were significantly associated with worse mental health., Conclusions: The fall-out from the pandemic continues to adversely impact AANHPI communities. These findings may help influence policy initiatives to mitigate its effects and support interventions designed to improve mental health outcomes.

Due to the high prevalence and persistence of long COVID, it is important to evaluate the safety and efficacy of pulmonary rehabilitation (PR) for patients who experience long-lasting symptoms more than six months after initial COVID-19 onset. Enrolled patients were admitted for a four-week in-patient-PR due to long COVID symptoms (n = 47). The safety of PR was confirmed by the absence of adverse events. Symptom-related outcomes were evaluated pre- and post-PR with significant score changes for: 6 min walking distance (61 [28 to 103] m), quality of life (mental Short Form-12: 10 [6 to 13], and physical: 9 [6 to 12]), Montreal Cognitive Assessment (1 [0 to 3]), fatigue (MFI-20: -19 [-28 to -8]), dyspnea (DYSPNEA-12: -7 [-9 to -2] and mMRC; -1 [-1 to 0]), Nijmegen questionnaire (-8 [-11 to -5]), anxiety and depression (HADS:-4 [-5 to -2] and -2 [-4 to -1], respectively) and posttraumatic stress disorder checklist scale (-8 [-12 to -4]). At the individual level, the percentage of symptomatic patients for each outcome decreased, with a high response rate, and the number of persistent symptoms per patient was reduced from six at PR initiation to three at the end of the program. Our results show that in-PR is safe and efficient at decreasing long-lasting symptoms experienced by long COVID patients at more than six months after initial disease onset.