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Ozone pollution was widely reported along with PM 2.5 reduction since 2013 in China. However, the meteorological drivers for ozone varying with different regions of China remains unknown using explainable machine learning, especially during the COVID-19 pandemic. Here we first analyzed spatiotemporal variations of PM 2.5 and ozone from 2015 to 2022 in eleven urban agglomerations of China. PM 2.5 decreased in all regions, with the largest drop in Beijing-Tianjin-Hebei (BTH). In contrast, ozone declined initially but rose during the pandemic in most regions, especially in Cheng-Yu. Probability density curves showed pronounced increase (24.7%) and slight change in the proportion of PM 2.5 and ozone meeting the pollution criterions during the pandemic, respectively. Leveraging Random Forest with SHAP analysis, we further established ozone models in typical urban agglomerations with good performance (CV-R 2  = 0.80-0.90; CV-RMSE = 8.52-19.20 μg/m 3 ) during the pandemic, and compared their relative importance of meteorological variables. Particularly, temperature and incoming shortwave flux at top of atmosphere were identified with high importance in high-ozone regions such as Middle Plain and BTH. Increasing importance of PM (e.g., PM 10 ) was found in southern China, e.g., Yangtze River Delta and Pearl River Delta regions. The western China was characterized with more importance of meteorology, especially in Tibet. Surface albedo and sensible heat flux from turbulence were noted distinctively with high importance in Tibet, partly due to their impacts on ozone formation by generating heat source and sink. In addition, sea level pressure (SLP) was revealed with the highest importance (25.2%) in Cheng-Yu, consistent with the fact that synoptic patterns characterized by SLP field could affect ozone pollution in Sichuan Basin. Our results not only provide an understanding of meteorological factors in regional ozone formation in China, but also highlight the feasibility of explainable machine learning in ozone studies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Enhancing students' empathy is critical in medical school education. The COVID-19 pandemic necessitated a shift from in-person to online classes. However, the effectiveness of online classes for enhancing medical students' empathy has not been investigated sufficiently and the evidence is limited. This study compared the effectiveness of enhancing empathy between pre-pandemic in-person classes and during-pandemic online classes among medical students in Japan using pre-pandemic and during-pandemic data., Methods: This is a retrospective observational study. This study measured students' empathy using the Japanese translation of the Jefferson Scale of Empathy-Student Version (JSE-S) before and after the special programs for professional identity formation and clinical communication among first- and second-year students who matriculated from 2015-2021. This study categorized the matriculation year groups as "pre-pandemic" and "during-pandemic" groups for the first- and second-year students. This study estimated the adjusted mean score differences of the JSE-S and 95% confidence intervals (CIs) from the pre- to post-program between the pre-pandemic and during-pandemic groups in the first and second years using linear regression analysis., Results: This study's participants included 653 first-year students and 562 second-year students. In the first year, the during-pandemic group had a significantly higher mean score difference from the pre- to post-program compared to the pre-pandemic group. The adjusted regression coefficient (95% CI) was 7.6 (5.7 - 9.5), with the pre-pandemic group as the reference. In the second year, there were no significant differences between the two groups., Conclusions: The results suggest that online classes are not inferior to in-person classes or even slightly better in enhancing medical students' empathy, which should be clarified by further studies. This study's findings have important implications for medical education and implementing hybrid class formats to enhance students' empathy., Competing Interests: Declarations. Ethics approval and consent to participate: This study was conducted in accordance with the World Medical Association Declaration of Helsinki guidelines. The study protocol was approved by the ethics committee of Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University Hospital (Approval No. 826 and Ken 2207–024). The authors confirmed that all the methods were carried out in accordance with the relevant guidelines and regulations. Informed consent was obtained from all participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

The coronavirus disease 2019 (COVID-19) pandemic had a significant effect on mortality rates worldwide, with Thailand being no exception. Gaining insights into the impact of pandemic-related mortality is essential for assessing its broader consequences on public health. This study aimed to analyze excess deaths during the pandemic (January 1, 2020-September 30, 2022) and post-pandemic period (October 2022-December 2023) at regional and national levels in Thailand. Expected deaths were estimated using a negative-binomial model, utilizing 2015-2019 data to project deaths for 2020-2021, with adjustments for seasonality. We found that Thailand experienced 76,756 excess deaths during the COVID-19 pandemic, with a p-score of 5.24%, and 36,126 excess deaths with a p-score of 5.26% in the post-pandemic period. After the pandemic, excess deaths in some provinces were elevated but did not reach statistical significance. Pneumonia was the major contributor to the deaths. In conclusion, Thailand experienced excess mortality during both the pandemic and post-pandemic periods. The study has identified regional areas with excess deaths, and further investigation into these findings could support public health improvements and strengthen preparedness for future health crises., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics approval: The Human Research Ethics Committee of Bhumibol Adulyadej Hospital waived the need for obtaining informed consent due to the retrospective nature of the study. The study adhered to the ethical standards of both the institutional and national research committees, with approval granted by the Human Research Ethics Committee of Bhumibol Adulyadej Hospital in accordance to the Helsinki Declaration, its later amendments, comparable ethical standards, and the Good Clinical Practice Guidelines (IRB 65/67)., (© 2025. The Author(s).)

Background: In China many respiratory pathogens stayed low activities amid the COVID-19 pandemic due to strict measures and controls. We here aimed to study the epidemiological and clinical characteristics of pediatric inpatients with Mycoplasma pneumoniae pneumonia (MPP) after the mandatory COVID-19 restrictions were lifted, in comparison to those before the COVID-19 pandemic., Methods: We here included 4,296 pediatric patients with MPP, hospitalized by two medical centers in Jiangsu Province, China, from January 2015 to March 2024. Patients were divided into the pre-COVID (n = 1,662) and post-COVID (n = 2,634) groups. Their baseline characteristics, laboratory test results and radiological patterns were separately assessed and compared between the two groups to determine the substantial changes in the disease profile of MPP after the COVID-19 pandemic., Results: Epidemiological results suggested a higher annual incidence of MPP after the COVID-19 pandemic when the outbreak reached a peak in October, two months delayed in seasonality compared to that in the pre-COVID era. For pediatric patients with MPP, there was no difference in their median ages, gender ratios, and severe case percentages between the two groups, where most patients were younger than 14 years old. With significance, the post-COVID group had more occurrences of cough and expectoration and higher incidences of influenza A/B virus (IAV/IBV) co-infection than the pre-COVID group. Many hematological parameters and radiological features between the two groups displayed alteration, but comparatively there demonstrated no worsened severity in hospitalized children with MPP after COVID-19 pandemic. Concurrently, the post-COVID group was administered with fewer antibiotics but more corticosteroids for effective treatment than the pre-COVID group., Conclusion: Through the COVID-19 pandemic, the epidemiological and clinical characteristics of pediatric patients with MPP differed, but there was no evident change in the disease severity. After the COVID-19 pandemic, the increased incidence of IAV/IBV co-infection may contribute to the differences in clinical symptoms and hematological profiles, while the adding usage of corticosteroids might treat more effectively., Competing Interests: Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki and approved by the Research Ethics Committees of Affiliated Hospital of Jiangsu University and Affiliated Hospital of Xuzhou Medical University, respectively. The informed consents of patients were waived by both Research Ethics Committees due to the retrospective nature of this study. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Twitter (subsequently rebranded as X) is acknowledged by US health agencies, including the US Centers for Disease Control and Prevention (CDC), as an important public health communication tool. However, there is a lack of data describing its use by state health agencies over time. This knowledge is important amid a changing social media landscape in the wake of the COVID-19 pandemic., Objective: The study aimed to describe US state health agencies' use of Twitter from 2012 through 2022. Furthermore, we organized our data collection and analysis around the theoretical framework of the networked public to contribute to the broader literature on health communication beyond a single platform., Methods: We used Twitter application programming interface data as indicators of state health agencies' engagement with the 4 key qualities of communication in a networked public: scalability, persistence, replicability, and searchability. To assess scalability, we calculated tweet volume and audience engagement metrics per tweet. To assess persistence, we calculated the portion of tweets that were manual retweets or included an account mention. To assess replicability, we calculated the portion of tweets that were retweets or quote tweets. To assess searchability, we calculated the portion of tweets using at least 1 hashtag., Results: We observed a COVID-19 pandemic-era shift in state health agency engagement with scalability. The overall volume of tweets increased suddenly from less than 50,000 tweets in 2019 to over 94,000 in 2020, resulting in an average of 5.3 per day. Though mean tweets per day fell in 2021 and 2022, this COVID-19 pandemic-era low was still higher than the pre-COVID-19 pandemic peak. We also observed a more fragmented approach to searchability aligning with the start of the COVID-19 pandemic. More state-specific hashtags were among the top 10 during the COVID-19 pandemic, compared with more general hashtags related to disease outbreaks and natural disasters in years before. We did not observe such a clear COVID-19 pandemic-era shift in engagement with replicability. The portion of tweets mentioning a CDC account gradually rose and fell around a peak of 7.0% in 2018. Similarly, the rate of retweets of a CDC account rose and fell gradually around a peak of 5.4% in 2018. We did not observe a clear COVID-19 pandemic-era shift in persistence. The portion of tweets mentioning any account reached a maximum of 21% in 2013. It oscillated for much of the study period before dropping off in 2021 and reaching a minimum of 10% in 2022. Before 2018, the top 10 mentioned accounts included at least 2 non-CDC or corporate accounts. From 2018 onward, state agencies were much more prominent., Conclusions: Overall, we observed a more fragmented approach to state health agency communication on Twitter during the pandemic, prioritizing volume over searchability, formally replicating existing messages, and leaving traces of interactions with other accounts., (©Samuel R Mendez, Sebastian Munoz-Najar, Karen M Emmons, Kasisomayajula Viswanath. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 03.01.2025.)

Ventricular septal defect (VSD) is a serious complication of myocardial infarction (MI), with its global incidence significantly reduced in recent years due to advances in coronary reperfusion techniques. However, during the COVID-19 pandemic, there was an unexpected rise in the incidence of post-MI VSD, likely driven by delays in seeking treatment. This study retrospectively analyzed 10 cases of post-MI VSD treated at our hospitals from March 2018 to August 2023, comparing incidence rates across pre-pandemic, pandemic, and post-pandemic periods. The findings revealed a notable increase in VSD cases during the pandemic, with six cases occurring in two years, compared to only two cases in each of the pre-pandemic and post-pandemic periods. Despite these fluctuations, surgical intervention remained a crucial and effective treatment, with 60% of patients surviving the 30-day follow-up. The study underscores the impact of delayed treatment on VSD incidence during the pandemic and highlights the critical need for timely medical intervention to manage severe MI complications effectively., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Institutional review board statement: The study conforms to the ethical principles of the Good Clinical Practice, the Helsinki Declaration, and is in compliance with the current Italian regulations. This study was approved by the Institutional Review Board of Anthea Hospital-Bari, code 011-2024, date 31 January 2024. Informed consent: Informed consent was obtained from all subjects involved in the study and written informed consent has been obtained from the patient(s) to publish this paper. Patient confidentiality was maintained by anonymizing data and using secure databases for data storage and analysis., (© 2025. The Author(s).)

Background: Physicians faced increased workloads during the COVID-19 pandemic, which exposed them to considerable physical and psychological stress. Gaining insight into shapers of job morale of physicians can help healthcare administrators assess the effectiveness of current work conditions and support systems, enabling them to develop policies that improve work environments and prepare healthcare systems for future resurgences of COVID-19 and other future unknown challenges. Therefore, the present study aimed to improve the understanding of physicians' experiences of job morale in Kazakhstan during the COVID-19 pandemic., Methods: This was an explanatory sequential mixed method study that adopted an online structured questionnaire and semi-structured individual interviews as tools for data collection. The Warr-Cook-Wall scale, Maslach Burnout Inventory Human Services Survey for Medical Personnel, and Beck Depression Inventory were used to measure job morale indicators. The interview topic guide, in turn, covered two key areas: general views on physicians' job morale during the COVID-19 pandemic and specific experiences which worsened or improved job morale during the COVID-19 pandemic. Descriptive statistics and regression models were utilised to analyse the quantitative data, while thematic analysis was employed for the qualitative data., Results: A total of 2086 survey responses and 30 interviews were analysed. Although job motivation was moderate, physicians were rather satisfied with their jobs. The prevalence of burnout was 30.97%, and signs of severe depression symptoms were detected among 3.69% of participants. Four themes emerged from the thematic analysis: (1) fear of uncertainty; (2) media scrutiny; (3) resurgence in appreciation; and (4) heightened sense of duty., Conclusions: Despite the significant challenges posed by the COVID-19 pandemic, physicians in Kazakhstan's public healthcare sector maintained generally positive job morale. This was mainly due to their strong sense of calling and a renewed appreciation for their role. Future research should rigorously examine longitudinal changes in job morale and the relationship between physicians' job morale and patient experiences., Competing Interests: Declarations. Ethics approval and consent to participate: The study was conducted according to the guidelines of the Declaration of Helsiniki, and approved by the ethics committee of First Multidisciplinary City Hospital of Astana (N2 25.11.2021). Informed consent was obtained from all subjects involved in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Vaccination is a key measure in influenza control, yet global coverage rates remain low, although previous research reported an increase in influenza vaccination coverage rates (VCR) after the onset of the COVID-19 pandemic. This study aims to assess whether these changes were sustained over time by analyzing VCR trends from 2012 to 2023 in the countries included in the FluCov project., Methods: Data on influenza VCR from 2012 to 2023 for different age and risk groups were extracted from national health organizations and international sources for countries included in the FluCov project. For coverage rates in the older adults, segmented regression models were used to test if 2020 marked a significant change in VCR trends. Moreover, polynomial regression models were fitted for each country with VCR in the period 2012 to 2020 to predict coverage rates for 2021 to 2023 and to compare these to the actual coverage rates for 2021 to 2023., Results: For the elderly, we retrieved influenza VCR data for 12 countries. In 2020, VCR among elderly increased in 10 countries, but the increase was statistically significant in Spain and England only. Moreover, all countries except Spain reverted to levels within the confidence intervals of trends modeled using pre-2020 data., Conclusions: Although influenza VCR increased in 2020, these changes were statistically significant in only two out of 12 countries, and no consistent, sustained increase was observed afterward, except in Spain. The findings suggest the need for continuous monitoring of VCR and the implementation of strategies to promote and maintain high vaccination coverage rates., (© 2025 The Author(s). Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd.)

Aim: Home care nurses support patients with COVID-19 with mild to moderate symptoms at home due to the lack of community-based support. Little is known about how nurses initiated and maintained support for patients with COVID-19. This study explored the experiences of home care nurses in supporting patients with COVID-19 at home., Methods: Using snowball sampling, 21 home care nurses participated in semi-structured interviews conducted either in person or online between September 2021 and February 2023. A qualitative study using a grounded theory approach was conducted., Results: Home care nurses faced a situation where "suffering patients are overflowing" due to inadequate support from public health centers and designated hospitals. Despite their anxiety, they acted as a "flexible safety net by quickly compensating for uncertain support systems" for patients, families, and local health workers. They "built tentative support systems immediately" and "updated tentative support systems, own knowledge, skills, and mindset." Home care nurses also "rushed to patient/family" to provide timely support and "avoided preventable death.", Conclusions: Home care nurses act as a flexible safety net, preventing patient deaths by quickly compensating for uncertain support systems before and after initiating care. Their efforts complemented the inadequacies of traditional infectious disease control systems, typically managed by public health centers. Strengthening secondary and tertiary prevention systems is essential for home care nurses to save lives while delivering individualized care during the COVID-19 pandemic., (© 2025 The Author(s). Japan Journal of Nursing Science published by John Wiley & Sons Australia, Ltd on behalf of Japan Academy of Nursing Science.)

The COVID-19 pandemic has been one of the most significant public health events in human history. Domestic violence cases surged globally during the COVID-19 pandemic. In Taiwan, this trend was particularly evident, with a year-over-year increase in reported cases. This study aims to investigate the complex dynamics of domestic violence in Taiwan during the COVID-19 pandemic through the lens of Complexity Theory. The researcher employed a qualitative case study method and conducted semistructured interviews with four participants. A cross-case analysis revealed four themes illustrating polymorphic correlations of factors and five themes related to self-organizing behaviors. This study amplifies the voices of domestic violence victims during the COVID-19 pandemic and offers insights into the intricate dynamics between domestic violence incidents and disasters, individuals, and systems. Implications for theory and practice are discussed., (© 2024 Wiley Periodicals LLC.)

This study analyzed changes in pneumonia hospitalizations in Japan before and after the COVID-19 pandemic using Diagnosis Procedure Combination data. The proportion of inpatients with non-aspiration pneumonia (non-AP) decreased by 48.8%, whereas that of inpatients with aspiration pneumonia (AP) decreased by only 8.8%. The proportion of AP among all pneumonia cases increased from approximately 33%-47% post-pandemic. The significant reduction in non-AP incidence likely reflects its sensitivity to external factors such as public health measures. Conversely, the limited decrease in AP demonstrates its stronger association with internal factors that are less affected by lifestyle changes. This study provides insights into the differential impact of the pandemic on pneumonia subtypes, revealing how external interventions may have varying effects on different forms of pneumonia. These findings highlight the complex interplay between public health measures and the epidemiology of respiratory infections in the context of a global pandemic., (Copyright © 2024 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.)

Objective: To analyze the epidemiological characteristics, clinical manifestations, antimicrobial resistance and develop a predictive model for severe pertussis spanning five years - before, during, and after the COVID-19 pandemic - in Shenzhen children's hospital in southern China, aiming to provide insights into the pandemic impact and control measures on the pertussis disease profile., Methods: Demographic, clinical, vaccination, and laboratory data were collected for patients who tested positive for pertussis by polymerase chain reaction and/or culture from January 1, 2019, to March 30, 2024. Analysis included changes in demographic and clinical features, indicators of severe cases, and resistance patterns over the study period., Results: During this period, 3963 patients were diagnosed, with 79 severe (PICU admitted) cases; 1433 isolates underwent antimicrobial susceptibility testing. In late 2023, pertussis cases began to increase. From 2019 to 2024, the proportion of cases among 4-6 year olds rose from 4.9 % to 28.6 %, and among 7-11 year olds from 0.7 % to 21.2 %. Macrolide resistance surged from 46.5 % in 2019 to 97.3 % in 2024, with 80 % of resistant hospitalized cases initially treated with macrolides. Clinical severity and co-infection increased post-pandemic, with a larger number of cases necessitating antibiotic changes and enhanced supportive care. Vaccination protected against severe disease. Indicators such as white blood cell count, lymphocyte to neutrophil ratio, platelet count, cyanosis and pneumonia predicted disease severity., Conclusions: Post-pandemic, pertussis cases shifted from infants to school-aged children, with increased clinical severity and high macrolide resistance. Urgent measures are needed to optimize vaccination schedules and develop management strategies addressing and changing epidemiological patterns., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Aim: The primary aim of this study was to compare differences, if any, in missed infection prevention and control (IPC) activities before and after the pandemic, along with the related predictors. The secondary aim was to identify relationships between missed IPC activities and unfinished nursing care., Methods: A repeated cross-sectional design was conducted in 2019 (pre-pandemic, 184 nurses) and 2024 (post-pandemic, 240 nurses) in a large academic hospital following the Checklist for Reporting of Survey Studies guidelines. The Missed Nursing Care in Infection Prevention and Control Survey (MNC-IPC) (Part A: missed activities, Part B: reasons), the Unfinished Nursing Care Survey (UNCS), and professional data were collected homogeneously across both periods., Findings: Self-reported missed IPC activities decreased from 2.15 out of 5 (95% confidence interval (CI), 2.05-2.25) to 1.51 (95% CI, 1.45-1.58) (P<0.0005), as did the related reasons, which decreased from 2.35 out of 4 (95% CI, 2.24-2.46) to 2.20 (95% CI, 2.11-2.30) (P=0.046). The total variance in the MNC-IPC overall scores was explained by 22.8% (pre-) and 20.7% (post-pandemic) by different predictors: system-level issues (estimated value 0.409, P=0.008) and nurses' intention to leave (0.107, P=0.023) in the pre-pandemic and by the number of patients admitted in the last shift (0.015, P=0.053), organizational issues (0.186, P<0.0005) and priority-setting issues (0.092, P=0.053) in the post-pandemic period. MNC-IPC and UNCS scores have reported significant correlations in both periods., Conclusions: Missed IPC activities were less likely in the post-pandemic period possibly due to system efforts and lessons learned during the pandemic, which may have routinized IPC practices among nurses. Overall, predictors of missed IPC care changed after the pandemic, suggesting new patterns and the need for innovative interventions, particularly at the unit level and targeting younger nurses. The correlations between UNCS and MNC-IPC suggest that targeted improvements in one area are likely to yield positive outcomes in the other. However, despite their commonalities, these represent two distinct phenomena., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Patient advocacy must be understood as an ethical component of nursing practice that involves respecting and defending patients' rights and autonomy. During the COVID-19 pandemic, the vulnerability of patients in intensive care units (ICUs) increased requiring that nurses advocate for those patients more than ever in a context in which changes in daily nursing practices of care imposed by the pandemic deeply impacted nurses' advocacy. In this study, we examined ICU nurses' patient advocacy during the pandemic, using feminist ethics as a theoretical lens. Twenty-five ICU nurses from Brazil participated in individual interviews. Our findings reflect that advocacy is a moral component of nursing identity. This moral identity represents the identity of nurses as a profession as it represents their values and responsibilities which are social in nature. Although the pandemic challenged nurses' advocacy practices these professionals had an important role to give voice to patients and to preserve their autonomy and dignity, strengthening patient-centered care., (© 2024 John Wiley & Sons Ltd.)

Purpose: In Australia, adolescents are scheduled to receive vaccinations against diphtheria, tetanus, pertussis, human papillomavirus, and meningococcal disease, delivered via school vaccination programs and general practitioners (GPs). Public health measures implemented in response to the COVID-19 pandemic impacted uptake of some adolescent age-based vaccinations. Limited information is available on parents' approaches to vaccinating their adolescent children during the pandemic. We aimed to explore parents' experiences of adolescent age-based vaccinations during the pandemic, and factors they perceived as hindering or facilitating vaccination., Methods: In July 2022 we recruited 21 Australian parents of adolescent children eligible for age-based vaccinations in 2021. We recruited from metropolitan and regional settings, and from states where uptake was most and least affected by pandemic disruptions. We conducted 30-min virtual or phone interviews and analysed the data thematically., Results: Parents described how experiences before and during the COVID-19 pandemic influenced their perspectives on and experiences with adolescent age-based vaccinations. Motivation to vaccinate their children was informed by personal beliefs and experiences with the healthcare system. Parents described practical issues, including ease of access to the school vaccination program or a GP, and knowledge about vaccination schedules and services. Parents suggested enhancing promotion of adolescent vaccination benefits and information sharing, and recommended improving access to vaccination services outside the school program., Discussion: Findings have potential to improve delivery of adolescent age-based vaccinations, including during future pandemics. While this study was conducted in the Australian context, findings and recommendations have relevance to overseas adolescent age-based vaccination programs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Problem: Restrictions during the COVID-19 pandemic compromised maternal and newborn care., Background: Countries in the German speaking area share several clinical care guidelines but differed significantly in the strictness of COVID-19 protective measures., Aim: To investigate the quality of maternal and newborn care (QMNC) during the COVID-19 pandemic in the German-speaking area and explore associations between the reorganisational changes due to COVID-19 and QMNC, as described with WHO Standards-based Quality Measures., Methods: As part of the IMAgiNE EURO study (ClinicalTrials.gov: NCT04847336), we conducted an online survey on the QMNC in the German-speaking area, including women who gave birth in Germany, Switzerland, and Austria. Descriptive statistics, Spearman rank correlation coefficient and multivariable quantile regression were used., Findings: Out of a total of 70,721 women accessing the online questionnaire, 1,875 were included (Germany: n = 1,053, Switzerland: n = 494, Austria: n = 328). Significant differences across countries were found in Quality Measures. In Switzerland, women scored Quality Measures more favourable than in Germany and Austria in all four sub-indexes of QMNC. In Austria, Quality Measures gaps in the sub-index 'Experience of care' were higher. The sub-index 'Reorganisational changes due to COVID-19' correlated weakly to strongly with the other sub-indexes (between r = 0.33 and r = 0.62, p < 0.001 for all correlations)., Discussion: Midwives and other health professional should pay particular attention to the provision of respectful, high-quality care., Conclusion: To effectively improve QMNC, further research is essential to monitor the quality of care and develop targeted interventions beyond the COVID-19 pandemic addressing inherent challenges in the organisation and delivery of care., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Purpose: This study aimed to examine changes in mental health among adolescents by comparing data from the period following the onset of the COVID-19 pandemic with the period before the pandemic., Methods: We estimated the annual prevalence of stress perception, depressive symptoms, and suicidal ideation among middle and high school students using data from the Korean Youth Health Behavior Survey spanning from 2015 to 2022. We then compared mental health status across 2 periods-pre-COVID-19 (2015-2019) and during COVID-19 (2020-2022)-employing an interrupted time series analysis. We adjusted for covariates, such as household economic status, residence type, self-rated health, and history of hospitalization, due to violence., Results: We analyzed data from 472,385 adolescents (242,819 boys and 230,016 girls). Stress perception, depressive symptoms, and suicidal ideation showed an increasing trend during the pre-COVID-19 period, followed by a decrease in the first year of the pandemic and an increasing trend in the second and third years. Boys experienced a faster increase in stress and depressive symptoms during the second and third years of the pandemic compared with the pre-COVID-19 period, whereas girls showed trends similar to those observed before the pandemic. Middle school students experienced a more rapid increase in these indicators than high school students during the second and third years., Discussion: Adolescents' mental health initially improved in the first year of COVID-19 but worsened during the second and third years of the pandemic. This suggests a need for intervention policies and programs to support adolescent mental health., (Copyright © 2024 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: Human trafficking is a public health issue affecting young people across the United States, and trafficked young people frequently present to emergency departments (EDs). The identification of trafficked young people by pediatric EDs during the COVID-19 pandemic is not well understood. We examined trends in the identification of young people with current or lifetime experiences of trafficking in US pediatric EDs before and during the COVID-19 pandemic., Methods: We performed an interrupted time-series analysis using the Pediatric Health Information System database, which includes data from 49 US children's hospitals, to determine differences in rates of trafficked young people identified in pediatric EDs before and during the COVID-19 pandemic., Results: We included 910 patients; 255 prepandemic (October 1, 2018, through February 29, 2020) and 655 during the COVID-19 pandemic (March 1, 2020, through February 28, 2023). We found a 1.92-fold increase in the incidence rate of identified trafficked young people at the start of the COVID-19 pandemic in March 2020 (incidence rate ratio = 1.92; 95% CI, 1.47-2.51; P < .001), followed by a decrease over time., Conclusions: The observed increase in identified trafficked young people during the onset of the COVID-19 pandemic should alert pediatric ED providers to the opportunity to identify and provide services for trafficked young people as an important part of improving preparedness for future disease outbreaks. Our observed identification trends do not represent the true incidence of trafficked young people presenting to pediatric EDs during the COVID-19 pandemic. Future work should seek to better understand the true occurrence and the health and service needs of trafficked young people during emergencies., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: Public health emergencies can elevate the risk for intimate partner violence (IPV). Our objectives were 2-fold: first, to assess the prevalence of physical IPV and increased aggression from a husband or partner that occurred during pregnancy and was perceived to be due to the COVID-19 pandemic; second, to examine associations between these experiences and (1) COVID-19-related stressors and (2) postpartum outcomes., Methods: We used data from the Pregnancy Risk Assessment Monitoring System that were collected in 29 US jurisdictions among individuals with a live birth in 2020. We estimated the prevalence of violence during pregnancy by demographic characteristics and COVID-19-related stressors. We calculated adjusted prevalence ratios (APRs) to examine associations of physical IPV or increased aggression with COVID-19-related stressors, postpartum outcomes, and infant birth outcomes., Results: Among 14 154 respondents, 1.6% reported physical IPV during pregnancy, and 3.1% reported increased aggression by a husband or partner due to the COVID-19 pandemic. Respondents experiencing any economic, housing, or childcare COVID-19-related stressors reported approximately twice the prevalence of both types of violence as compared with those without COVID-19-related stressors. Physical IPV and increased aggression were associated with a higher prevalence of postpartum depressive symptoms (APRs, 1.73 and 2.28, respectively) and postpartum cigarette smoking (APRs, 1.74 and 2.19). Physical IPV was associated with a lower prevalence of attending postpartum care visits (APR, 1.84)., Conclusions: Our findings support the need for ongoing efforts to prevent IPV during pregnancy and to ensure the availability of resources during public health emergencies., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The COVID-19 pandemic differentially impacted individuals with hearing loss, likely in part due to increased communication difficulties from masking, a commonly implemented protective measure., Objective: This study examines the association between self-reported hearing loss and health during the pandemic., Methods: This study uses data from the COVID-19 Survey collected by the Survey of the Health of Wisconsin from February to March 2021. Hearing loss was defined as self-reported fair or poor hearing. The outcomes were self-reported symptoms of anxiety and depression, separately, and self-reported general health. Multivariable models adjusted for age, gender, and race/ethnicity were used to examine the associations between hearing loss with each outcome. Results are presented as prevalence ratios (PR) with corresponding 95 % confidence intervals (CI)., Results: There were 1857 participants (60.3 % female, 12.9 % non-white) with a mean age of 57.1 years in this cross-sectional study. In multivariable models, individuals with hearing loss (versus none) had higher prevalence of depression (PR: 1.22, 95 % CI: 1.06, 1.39), anxiety (PR: 1.13, 95 % CI: 1.02, 1.27), and self-reported fair or poor health (PR: 2.61, 95 % CI: 1.89, 3.61)., Conclusion: Hearing loss was associated with poorer self-reported health during winter 2021 of the COVID-19 pandemic, when mask use in public was newly mandated and vaccines were not widely available to the general public. Further research on the impact of public health policies on vulnerable populations, including those with hearing loss, is warranted. Such research could inform policy decisions that accommodate these populations., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: The COVID-19 pandemic had a major impact on medical care. This study evaluated the influence of the pandemic on blood pressure (BP) control and hypertension phenotypes as assessed by office and 24-hour ambulatory BP monitoring (ABPM)., Design and Methods: Data were collected from 33 centers including Excellence Centers of the European Society of Hypertension. Two groups of patients with treated hypertension were compared. Pandemic group: including participants who had ABPM twice - at visit 2 during the COVID-19 pandemic and visit 1 performed 9-15 months prior to visit 2. Pre-pandemic group: had ABPM at two visits, performed before the pandemic within 9-15 months interval. We determined the following hypertension phenotypes: masked hypertension, white coat hypertension, sustained controlled hypertension (SCH) and sustained uncontrolled hypertension (SUCH). We analyzed the prevalence of phenotypes and their changes between visits., Results: Data of 1419 patients, 616 (43 %) in the pandemic group and 803 (57 %) in the pre-pandemic group, were analyzed. At baseline (visit 1), the prevalence of hypertension phenotypes did not differ between groups. In the pandemic group, the change in hypertension phenotypes between two visits was not significant (p = 0.08). In contrast, in the pre-pandemic group, the prevalence of SCH increased during follow-up (28.8 % vs 38.4 %, p < 0.01) while the prevalence of SUCH decreased (34.2 % vs 27.8 %, p < 0.01). In multivariable adjusted analysis, the only factor influencing negative changes of hypertension phenotypes was the COVID-19 pandemic period., Conclusion: These results indicate a negative impact of the COVID-19 pandemic on BP control assessed by hypertension phenotypes., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Restrictions in daily activities due to coronavirus infection countermeasures reduced opportunities for physical activity and social participation in people of all ages. This study investigated the associations of restricted outings on locomotive function during the COVID-19 pandemic using a cohort of middle-aged and elderly community-dwelling residents., Methods: Registered citizens of 50-89 years old were targeted for this investigation. We established 8 groups based on age (50's, 60's, 70's, and 80's) and gender (male and female) after random sampling from the basic resident registry of Obuse town in 2014. All participants were surveyed by a 25-question geriatric locomotive function scale (GLFS-25) at the time of checkup before the COVID-19 pandemic. Then, in 2021 and 2022 after government restrictions on outings were lifted for COVID-19 pandemic, all participants were mailed questionnaires including the GLFS-25. A total of 296 (143 male and 153 female) participants who responded at least once were included. We evaluated the changes in opportunities to go out between pre- and post-pandemic time points and the impact on GLFS-25 scores., Results: In total, 128 (43.2%) respondents had fewer opportunities to go out than the previous year. Pre- and post-pandemic GLFS-25 scores in the decreased outing (+) group were significantly worse than in the decreased outing (-) group (both p < 0.01). The final multivariate model revealed GLFS-25 score worsening beta coefficient of 0.27 for age (+10 years), 3.97 for male, 4.54 for decreased outings, and 4.46 for spinal canal stenosis., Conclusions: In this randomly sampled Japanese cohort based on a resident registry, restricted outings during the COVID-19 pandemic was a significant independent factor associated with lower locomotive function., (Copyright © 2024 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Aims: To describe the process of breastfeeding relationships among stay-at-home mother and infant dyads at 1, 3, 5 and 6 months., Design: A longitudinal qualitative online survey design was used., Methods: Data were obtained at 1, 3, 5 and 6 months from 26 breastfeeding mothers who stayed home with their infants and directly breastfed at least once a day for the first 6 months between June 2022 and August 2023. Mothers' written responses to 3 open-ended questions were analysed to assess breastfeeding experiences at home, thoughts/comments while directly breastfeeding and breastfeeding concerns/problems and strategies they used. Based on grounded theory, inductive content analysis was used to analyse the data. Trustworthiness of results was established by coding to consensus, formal peer debriefing and maintaining an audit trail., Results: 'Breastfeeding Relationships at Home,' the core construct, was identified and organized the process of breastfeeding relationships into 5 domains: (1) mothers' emotional well-being while breastfeeding, (2) infant-led feeding, (3) alternatives to breastfeeding, (4) evaluation of breastfeeding and (5) changes in breastfeeding as infants grow older., Conclusion: Breastfeeding is not simply about feeding breast milk but also involves nurturing and developing a relationship between mother and infant. Across the domains, mutual responsiveness, a central element of the breastfeeding relationship was clear. Mothers who were committed to breastfeeding with embedded infant suckling reached emotional well-being in return for their engagement which has potential to reduce maternal stress and prevent postpartum depression., Impact: Findings from the current study add to nurses' knowledge about the relationship building process between stay-at-home mothers and their infants in the first 6 months of breastfeeding during the COVID-19 pandemic. Nurses must remain sensitive to aid the development of breastfeeding relationships in the home environment to maximize mutual responsiveness., Patient or Public Contribution: No patients or public involved., (© 2024 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Objective: This study investigated differences in stress, anxiety, and social support between collegiate student-athletes and nonathletes during the COVID-19 pandemic. Participants: College students enrolled at a NCAA Division III private liberal arts college in the Midwest. Methods: Participants (n = 58) completed a series of surveys each month for 4 months that included the Generalized Anxiety Disorder Questionnaire, Perceived Stress Scale Questionnaire, and Multidimensional Scale of Perceived Social Support Questionnaire. Results: There were significant main effects of time for stress and social support across the 4 months ( p  < 0.05), but not for anxiety. There was a significant difference in anxiety levels between athletes and nonathletes ( p  < 0.01), but not for social support or stress ( p  > 0.05). Conclusions: Nonathletes maintained support networks, or found alternate outlets of support, in addition to coping with anxiety and stress levels when compared to athletes.

Objectives: The Health Resources and Services Administration (HRSA) began collecting data on intimate partner violence (IPV) and human trafficking (HT) in the 2020 Uniform Data System (UDS). We examined patients affected by IPV and HT served by HRSA-funded health centers in medically underserved US communities during the COVID-19 pandemic., Methods: We established a baseline and measured trends in patient care by analyzing data from the 2020 (N = 28 590 897) and 2021 (N = 30 193 278) UDS. We conducted longitudinal ordinal logistic regression analyses to assess the association of care trends and organization-level and patient characteristics using proportional odds ratios (PORs) and 95% CIs., Results: The number of clinical visits for patients affected by IPV and HT decreased by 29.4% and 88.3%, respectively, from 2020 to 2021. Health centers serving a higher (vs lower) percentage of pediatric patients were more likely to continuously serve patients affected by IPV (POR = 2.58; 95% CI, 1.01-6.61) and HT (POR = 6.14; 95% CI, 2.06-18.29). Health centers serving (vs not serving) patients affected by IPV were associated with a higher percentage of patients who had limited English proficiency (POR = 1.77; 95% CI, 1.02-3.05) and Medicaid beneficiaries (POR = 2.88; 95% CI, 1.48-5.62), whereas health centers serving (vs not serving) patients affected by HT were associated with a higher percentage of female patients of reproductive age (POR = 15.89; 95% CI, 1.61-157.38) and urban settings (POR = 1.74; 95% CI, 1.26-2.37)., Conclusions: The number of clinical visits for patients affected by IPV and HT during the COVID-19 pandemic declined. Delayed care will pose challenges for future health care needs of these populations., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Drinking more and drinking to cope increase undergraduates' likelihood of experiencing alcohol-related problems (ARP; e.g., driving intoxicated). In accordance with stress-coping models of addiction, anxiety about COVID-19 may motivate undergraduates to drink to cope, leading them to experience more ARP. However, this hypothesis has not been tested. Participants and methods: During fall 2020, 358 undergraduate drinkers ( M age = 21.18; 69.80% cis-women; 62.30% White) provided data regarding COVID-anxiety, alcohol consumption, drinking to cope, and ARP during an annual student survey. Results: Mediation analysis controlling for alcohol consumption revealed greater COVID-anxiety predicted higher levels of drinking to cope; in turn, higher levels of drinking to cope were associated with more ARP. Additionally, the positive relationship between greater COVID-anxiety and experiencing more ARP was explained entirely by higher levels of drinking to cope. Conclusion: During the pandemic and beyond, university prevention and intervention initiatives should target coping motives for alcohol use to help students avoid ARP.

In Aotearoa New Zealand, there has been a marked decrease in the uptake of routine childhood vaccinations since the onset of the COVID-19 pandemic, particularly among Māori and Pacific children. This Māori and Pacific-centered research used an interpretive description methodology. We undertook culturally informed interviews and discussions with Māori and Pacific caregivers ( n  = 24) and healthcare professionals ( n  = 13) to understand their perceptions of routine childhood vaccines. Data were analyzed using reflexive thematic analysis and privileged respective Māori and Pacific worldviews. Four themes were constructed. " We go with the norm " reflected how social norms, health personnel and institutions promoted (and sometimes coerced) participants' acceptance of routine vaccines before the pandemic. "Everything became difficult" explains how the pandemic added challenges to the daily struggles of whānau (extended family networks) and healthcare professionals. Participants noted how information sources influenced disease and vaccine perceptions and health behaviors. "It needed to have an ethnic-specific approach" highlighted the inappropriateness of Western-centric strategies that dominated during the initial pandemic response that did not meet the needs of Māori and Pacific communities. Participants advocated for whānau-centric vaccination efforts. "People are now finding their voice" expressed renewed agency among whānau about vaccination following the immense pressure to receive COVID-19 vaccines. The pandemic created an opportune time to support informed parental vaccine decision-making in a manner that enhances the mana (authority, control) of whānau. Māori and Pacific-led vaccination strategies should be embedded in immunization service delivery to improve uptake and immunization experiences for whānau.

There is a continued need for research to better understand the influence social media has on parental vaccination attitudes and behaviors, especially research capturing the effects of the COVID-19 pandemic. The goal of this study was to explore parents' perspectives related to the impact the pandemic had on 1) social media engagement, 2) vaccine messaging on social media, and 3) factors to guide future intervention development. Between February and March 2022, 6 online, synchronous, text-based focus groups were conducted with parents of adolescents aged 11 to 17 years. Participants who all utilized social media were recruited from across the United States. Qualitative data were analyzed using content analysis. A total of 64 parents participated. Average age was 47 years, and participants were predominantly White (71.9%), female (84.3%), and engaged with social media multiple times per day (51.6%). Participants (95.3%) viewed obtaining all recommended vaccines as important or very important; however, overall vaccination rates for their adolescents were varied (50% ≥1 dose HPV; 59.4% MenACWY; 78.1% Tdap; 65.6% Flu; 81.3% COVID-19). Three themes emerged highlighting the pandemic's impact on parent's (1) general patterns of social media use, (2) engagement about vaccines on social media and off-line behaviors related to vaccination, and (3) perspectives for developing a credible and trustworthy social media intervention about vaccination. Participants reported fatigue from contentious vaccine-related content on social media and desired future messaging to be from recognizable health institutions/associations with links to reputable resources. Plus, providers should continue to provide strong vaccine recommendations in clinic.

The coronavirus disease 2019 (COVID-19) caused several impacts. Focusing on 360 participants (178 males, 182 females), this study explored the association between COVID-19 related distress, risk perception, stigma, and vaccine hesitancy and acceptance in the general population. Measures used included the Hospital Anxiety and Depression Scale (HADS) and COVID Stress Scale (CSS) to evaluate anxiety, depression, and COVID-19 related distress, the COVID-19 Risk Perception Scale and COVID-19 Stigma Discrimination Scale to assess risk perception and stigma, and the Oxford COVID-19 Vaccine Hesitancy Scale and Vaccine Acceptance Instrument to measure vaccine hesitancy and acceptance. The findings revealed that 66.9% of participants exhibited vaccine hesitancy, and stress and risk perception were significant predictors of both vaccine hesitancy and acceptance, even after controlling for demographic factors. This study highlights the importance of understanding the factors mentioned above that will contribute to vaccine hesitancy and acceptance, which will contribute to promoting vaccine acceptance.

Since the World Health Organization declared COVID-19 no longer a public health emergency in 2023, over a year has passed. However, there has been insufficient research into whether the physical health of adolescents has recovered post-Pandemic. The COVID-19 Pandemic profoundly impacted the lives and health of adolescents globally, with prolonged lockdowns and social isolation measures potentially causing adverse effects on their physical health. This study aims to systematically evaluate the long-term impact of the Pandemic on the physical health of adolescents in a city in southern China. By analyzing data from over 48,000 tests, changes in various physical performance metrics, including Body Mass Index (BMI), Lung Capacity, endurance, speed, flexibility, and strength, were examined before, during, and after the Pandemic.The findings indicate that during and after the Pandemic, adolescents experienced an increase in BMI, while Lung Capacity and endurance significantly declined. Specifically, the average BMI for both Males and FeMales peaked after the Pandemic. Male Lung Capacity continuously decreased during and after the Pandemic, while FeMales saw a slight increase during the Pandemic but a significant drop afterward. In terms of endurance, male 1000-meter running times increased during the Pandemic and slightly improved afterward; however, female 800-meter running times increased during and after the Pandemic. Speed performance in the 50-meter sprint was best pre-Pandemic, worst during the Pandemic, and showed recovery post-Pandemic. Strength indicators, such as standing long jump, pull-ups (Males), and sit-ups (FeMales), displayed varying degrees of change, reflecting a decline in physical strength during the Pandemic. Additionally, flexibility improved throughout the period, peaking post-Pandemic.The study reveals the complex and multifaceted effects of Pandemic control measures on adolescent physical health. These findings are crucial for informing future public health policies and interventions aimed at supporting adolescent health during crises. The novelty of this research lies in its comprehensive and quantitative analysis of the Pandemic's impact on various physical health metrics, providing valuable insights for subsequent studies and policy formulation., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Mental health consequences of the COVID-19 pandemic have been a major research focus since its beginning. A specific vulnerability of patients with borderline personality disorder (BPD) following social distancing measures has been reported, however there is a lack of adequately sized studies that provide evidence of this vulnerability. Suicide attempts may reflect mental health effects of the COVID-19 pandemic in psychiatric settings., Methods: Retrospective follow-up analysis of clinical documentation in a psychiatric emergency department (pED) of a major academic psychiatric hospital in Berlin, Germany. Observation periods include the first- (3/2/2020-5/24/2020) and second-wave (9/15/2020-3/1/2021) of the COVID-19 pandemic in Germany and respective periods one year earlier as control-periods. Poisson-regression was used for statistical modelling of individual counts of pED presentations after a suicide attempt., Results: N = 4110 patients attended the pED during the four observation periods. BPD patients were associated with elevated risk of pED presentation after a suicide attempt during COVID-periods (RR = 3.4; p = .014). Schizophrenia and psychotic disorders showed lower risk of pED presentation after a suicide attempt during COVID-periods (RR = 0.4; p = .048). Other diagnostic groups did not show significant interaction effects with COVID-periods. The first-wave was a risk factor for pED presentation after a suicide attempt affecting the sample across all diagnostic groups (RR = 3.1; p = .006)., Conclusions: BPD patients seem to be particularly vulnerable during the COVID-19 pandemic showing increased rates of suicide attempts during both COVID-periods. This should be addressed in future health crises by ensuring availability of psychosocial help. There is a need for further research regarding BPD patients in public health crisis situations., Competing Interests: Declarations. Ethics approval and consent to participate: This retrospective study was approved by the local ethics committee ​(Ethikkommission der Charité – Universitätsmedizin Berlin; number of approval: EA 110/20). As only retrospective and pseudonymised routinely assessed data was concerned, informed consent was waived by the ethics committee of Charité – Universitätsmedizin Berlin (Ethikkommission der Charité – Universitätsmedizin Berlin; number of approval: EA 110/20). The study was conducted following the declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Globally, the Coronavirus disease 2019 (COVID-19) pandemic had a significant impact on mental health. Sudden lifestyle changes, threatening information received through various sources, fear of infection and other stressors led to sleep disturbances such as insomnia. The current study aimed to assess the prevalence of insomnia and its associated risk factors during the first wave of COVID-19 pandemic among Singapore residents., Methods: A cross-sectional study conducted online and in person, from May 2020 to June 2021, recruited Singapore citizens and permanent residents, aged 21 years and above, fluent in English, Chinese or Malay language. Respondents answered an interviewer-administered questionnaire, including Insomnia Severity Index (ISI), Generalised Anxiety Disorder-7 (GAD-7), Physical Health Questionnaire (PHQ-9), stress scale of the Depression, Anxiety and Stress Scales (DASS), chronic conditions checklist and COVID-19 related stressors (exposure to COVID-19, current and future perceived risk of infection). Chi-squared test followed by stepwise logistic regression analysis were conducted to determine factors associated with insomnia., Results: The study recruited 1129 respondents. Prevalence of insomnia was noted to be 7.4% in the sample. Insomnia was significantly associated with psychological distress- depression (p < 0.001) and anxiety (p < 0.001), financial loss as a source of stress (p < 0.012), ever been diagnosed with asthma (p < 0.001) and backache (p < 0.002)., Conclusion: Insomnia was prevalent and associated with higher level of psychological distress among Singapore residents. These findings can be utilised to design effective targeted interventions like cognitive behavioural therapy, therapist assisted relaxation and meditation programs to improve sleep and reduce psychological distress. Interventions like these can be delivered via smartphone applications enabling easy access, delivery, and utilization by the vulnerable groups. Overall, these strategies would not only help people maintain better mental health and sleep quality during a pandemic but also build resilience, enhancing society's ability to cope with future crises., Competing Interests: Declarations. Ethics and consent to participate: Ethics approval (DSRB 2020/00462) was obtained from the Domain Specific Review Board of the National Healthcare Group, Singapore. The current research study involving human participants is performed in accordance with the declaration of Helsinki. The ethical approval for the study was obtained from National Healthcare Group Domain Specific Review Board. All the participants completed the informed consent prior to the survey and all participants were provided with a copy of the consent online or in person. Consent for publication: Not applicable. Competing interests: None., (© 2024. The Author(s).)

The negative consequences of the COVID-19 pandemic and the subsequent restrictive measures on the mental health and well-being of the population and psychiatric patients have been widely recognized. Patients' treatment attendance and engagement with mental health services had been negatively affected by the pandemic, whereas patients were less likely to receive timely outpatient care. The pandemic also impacted the use of inpatient services. The aim of the present study was to explore the variability of attendance and admissions to a general hospital psychiatric ward over a 12-month interval after the onset of the pandemic (March 2020), compared to the respective 12-month pre-pandemic interval. A retrospective, observational pre/post study was performed, involving a general hospital psychiatric ward in Corfu, Northwest Greece, which serves an insular catchment area of approximately 100,000 inhabitants. For data analysis, c- and u-charts of statistical process control charts were employed, using monthly data (March 2019 to February 2021). Overall, a significant decline in attendance rates was observed, mostly accounted for by a 26.5% reduction in voluntary attendance rates (1516 patients prior vs. 1114 patients after the onset of the pandemic). The involuntary commitment of patients did not differ between the two periods (106 prior vs. 100 after the onset of the pandemic). Admission rates did not change significantly between the two periods. Diagnoses that exhibited significant variance in examinations between the two study periods were mood disorders and personality disorders, whereas there was no significant variation in the number of admissions across different diagnoses. Length of hospital stay increased significantly by 13.2% over the first year of the pandemic, from 25.57 days (Md= 13, IQR= 22) during the pre-COVID-19 period to 28.95 days (Md= 22, IQR= 28) during the COVID-19 period. Patients with schizophrenia and related disorders (Mean= 34.25 days, SD= 43.19) and mood disorders (Mean= 26.26, SD= 33.48) had prolonged hospital stays compared to other diagnoses. These findings highlight significant shifts in psychiatric care delivery during the pandemic and underscore the need for targeted interventions to address the evolving demands on mental health services during public health crises.

Background: COVID-19 drastically affected healthcare services world-wide. In the UK, many cancer services were overwhelmed as oncology staff were reassigned, and cancer diagnoses and treatments were delayed. The impact of these pressures on end-of-life care for patients with advanced cancer and their relatives is not well understood., Methods: Secondary thematic analysis of qualitative survey and interview data, collected from family members and close friends bereaved by cancer, as part of a national COVID-19 bereavement study (Survey N = 156; Interview N = 10)., Results: Four key themes were identified: The impact of COVID-19 on contact with patients towards the end of life; Mixed experiences of support for family members; Variable communication quality from health and social care professionals; Prioritisation of COVID-19 and its impact on patient care. Hospital care was perceived more negatively than community care in almost all areas, while support from cancer charities and district nurses was appreciated the most. Almost all participants felt that COVID-19 was detrimentally prioritised over care for their relative/friend., Conclusions: People bereaved by cancer were uniquely affected by pandemic-restrictions and disruptions to services. As services re-build post-pandemic, improvements in palliative care in hospitals, investment into community care, and ensuring compassionate communication with patients and families must be prioritised, alongside preparedness for future pandemics or similar events., Competing Interests: Declarations. Ethics approval and consent to participate: The study protocol and supporting documentation was approved by Cardiff University School of Medicine Research Ethics Committee (SMREC 20/59). The study was conducted in accordance with the Declaration of Helsinki and all respondents provided informed consent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: There is a lack of data support and scientific validation of the Exemption Approach policy for responding to the COVID-19 pandemic, in terms of protecting the health of flight crews and meeting the requirements for passenger and cargo transportation in emergencies, in terms of its safety and the circumstances that contribute to pilots' symptoms of jet lag and the risk of fatigue., Methods: To assess pilots' sleep issues related to jet lag symptoms and fatigue, this study evaluated an example of risk management for flight crews on flights across time zones during the COVID-19 pandemic. To evaluate the crew's sleep status, variations in sleep index changes between before and after the flights, variations in sleepiness levels, and data on sleep indexes recorded by ActiGraph bracelets were collected from 146 crew members before and after flights eastward or westward across time zones. Sleepiness levels predicted by applying the SAFE model were also determined., Results: Whether flying east or west across time zones, the crew's sleep indexes were relatively similar at the end of a flight during a layover. However, a comparison with the pre-flight period showed that the sleep indexes of the crew were slightly more disturbed after the eastward flight compared with those after the westward one. In addition, the SAFE model predicted a higher rate of change in crew mean sleepiness levels between before and after the flight for the eastward flight than for the westward one; however, the Karolinska Sleepiness Score (KSS) of the pilots on either eastward or westward flights did not exceed 5 ("not alert or sleepy")., Conclusion: Flight crew adaptation to the Exemption Approach policy during the COVID-19 pandemic was assessed by evaluating the sleep problems of crews flying eastward or westward across time zones., Competing Interests: Declarations. Ethics approval and consent to participate: Approval was obtained from the Ethics Committee of the Civil Aviation University of China (approval no. 2022AUCT 110–01, approval date: 3/20/2022). Consent for publication: All authors agree to publication. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: The prevalence of domestic abuse is greater in times of humanitarian crisis, and the COVID-19 pandemic has been no different. Considerable evidence indicates that domestic abuse disproportionately impacts the mental health and wellbeing of racially Minoritised women. The present study aimed to explore racially Minoritised women's experiences of domestic abuse and mental health in the COVID-19 pandemic in the UK., Method: An online cross-sectional survey was used with racially Minoritised women (n = 1202) in the UK during the third national lockdown., Results: Results demonstrate complex interplay of psychosocial factors, such as the roles of autonomy, resilience, self-silencing, family functioning, and social support as predictors of mental health and wellbeing during the 'shadow pandemic'., Conclusion: Implications such as incorporating culturally competent mental health support, exploring the complex and multiple underpinnings of mental health in racially Minoritised victim-survivors of domestic abuse for future pandemic preparedness and support provision are discussed., Competing Interests: Declarations. Ethics approval and consent to participate: Ethics approval was obtained from the Department of Psychology Ethics Committee, University of Sheffield. Consent for publication: NA. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Introduction and Objective: The aim of the study was to evaluate the effect of the COVID-19 pandemic on health behaviours of students of medical specialities from the aspect of psychological support in Poland., Material and Methods: A study was conducted from 6 June - 16 December, 2022 among students of the Collegium Medicum at the Jan Kochanowski University in Kielce (CM UJK), Poland, and the Medical University of Warsaw (WUM). The final analysis covered 517 students of full-time studies - 265 (51.06%) students from CM UJK and 253 (48.94%) from WUM. Health behaviours as a result of the COVID-19 pandemic from the aspect of psychological support were investigated using the standardized questionnaire Health Behaviour Inventory (HBI), and an author-constructed questionnaire. Positive mental attitude, preventive behaviours, and proper eating habits were taken into consideration., Results: The results indicated greater care for own health among students from CM UJK. It was found that every fifth respondent (178; 34.43%) reported the need for psychological support. A statistically significant relationship was observed between the need for psychological support and low health behaviour in terms of positive mental attitude (p<0.001) and health practices (p<0.001) of the examined students. Those who declared the need for psychological support were characterized by low psychological attitude (p<0.001) and felt lonely during the pandemic, which was the result of isolation and remote classes (p<0.001)., Conclusions: The COVID-19 pandemic exerted a negative effect on the health behaviours of students of medical specialities in the area of psychological health. The feeling of loneliness and lack of social contacts exposed the health behaviours of the examined students.

Background: We have held a 'trouble-shooting' clinic for Rett syndrome patients from 2003 until the COVID pandemic in 2020. The clinic was multidisciplinary, including clinical genetics, paediatric neurology, adult learning disability psychiatry and physiotherapy. Access to specialist communication support and eye-gaze equipment was also often available. We have reviewed the files of patients seen in the clinic and conducted a survey of parents' and carers' satisfaction with the clinic and their experiences during COVID., Results: Of the 117 patients seen in the clinic, records were reviewed of 103 (97 female, six male) who attended a total of 123 appointments. The records were unavailable for 14 patients. The most common reasons for referral were assessment of 'episodes' of uncertain nature (possibly epileptic, possibly autonomic), the wish for a general review by an experienced team, and questions about the diagnosis. We discuss the nature of the advice we were able to provide and offer some brief case vignettes. We wrote to the parents or carers of all patients seen and 63 respondents were willing to be interviewed about the clinic and their experiences during COVID. Respondents were generally complimentary about the clinic team, emphasising the value of a specialist clinic for those affected by a rare condition. Respondents gave insight into the range of problems experienced during COVID, especially the isolation resulting from the withdrawal of services, demonstrating the value of community support. Some respondents mentioned the shift to remote consultations, which they hoped would continue after COVID for its convenience. However, others talked about how difficult it is in a remote consultation to explain the problems of the affected family member to professionals who do not know the patient or know about Rett syndrome., Conclusions: Our findings demonstrate the value of a disease-specific clinic provided by staff experienced with the particular rare condition. Meeting the needs of patients with ultra-rare conditions presents additional challenges. We have also found that the shift to holding a virtual clinic during COVID brought the benefit of convenience but was unsatisfactory in other ways, as it makes clinical assessment more difficult and fails to overcome the sense of isolation during a pandemic., Competing Interests: Declarations. Ethics approval and consent to participate: There were two main elements to this review of the RTT clinic. First was a retrospective case note review by the clinical team. Second was a medical student project that involved contacting families to obtain feedback from carers. Both elements were classified as service evaluations so that, under the rules of practice of the NHS Wales, they did not require research ethics review. The latter element was also classified as a student project and approved as such through Cardiff University School of Medicine. During COVID-19, when this project was started, the NHS Wales research ethics committees were only assessing COVID-related proposals so no research ethics committee documentation is available. Consent to publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Context: Since the outbreak of COVID-19 in late 2019, the transmission dynamics and clinical presentation patterns of influenza A (Flu A) virus have undergone changes., Objectives: This article conducted a comparative analysis in clinical characteristics and laboratory results of pediatric patients with Flu A before, during, and after the COVID-19 pandemic., Methods: The medical records of 885 children hospitalized with Flu A virus infection at a tertiary hospital in Guangdong Province, China, were retrospectively analyzed. Flu A was confirmed in these cases using a direct immunofluorescence antigen assay. The clinical data for this study span from January 1, 2018, to May 31, 2023., Results: In our study, we observed a total of 340 cases before the COVID-19 pandemic, 196 cases during the pandemic, and 349 cases after the pandemic. Patients after the pandemic had a higher median age on admission (5.66 years, range 3.41-7.70) and exhibited more respiratory symptoms such as cough, sore throat, and nasal stuffiness. The length of hospital stay was longer, and there was a higher percentage of patients with fever duration ≥ 5 days among Flu A patients during the pandemic. Compared to before and during the COVID-19 pandemic, Flu A patients after the pandemic showed significantly reduced white blood cell (WBC) and platelet (PLT) counts (P < 0.001), along with elevated levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in laboratory indexes (P < 0.001). Furthermore, more hospitalized children after the pandemic were diagnosed with benign acute childhood myositis (BACM)., Conclusion: Our research results indicates a significant decrease in Flu A cases during the COVID-19 pandemic, and hospitalized children with Flu A have more severe clinical symptoms after the COVID-19 pandemic. These findings have implications for public health policy and clinical management of Flu A cases., Clinical Trial Number: Not applicable., Competing Interests: Declarations. Ethics approval and consent to participate: The studies involving humans were approved by the Institute Ethics Committee of Chaozhou Central Hospital (No. 2023009) and People’s Hospital of Yangjiang (No. 20230003). The studies were conducted in accordance with the local legislation and institutional requirements. The Ethics Committee/Institutional Review Board waived the requirement of written informed consent for participation from the participants or the participants’ legal guardians/next of kin. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

The COVID-19 pandemic has significantly challenged healthcare systems worldwide, particularly in India, a country already burdened with a high prevalence of Neglected Tropical Diseases (NTDs). This perspective examines the pandemic's direct and indirect impacts on the prevalence, diagnosis, and management of NTDs in India. Using a narrative review approach, we analyzed literature published between January 2020 and September 2023 from databases such as PubMed, Scopus, and Google Scholar, along with grey literature. The focus was on studies reporting the pandemic's influence on NTDs, especially among vulnerable populations in both rural and urban settings. The review incorporated 49 studies, revealing a twofold impact of COVID-19 on India's healthcare. Directly, the surge in COVID-19 cases strained healthcare resources, disrupted services, and overwhelmed healthcare personnel. Indirectly, the pandemic exacerbated the burden of NTDs by delaying diagnoses, limiting access to treatment, and redirecting resources toward pandemic response efforts. These findings highlight the urgent need for resilient healthcare strategies that address both the immediate and long-term impacts of the pandemic on NTDs. By understanding and mitigating these effects, policymakers and public health experts can better protect vulnerable populations from the compounded challenges posed by these neglected diseases., 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 Zaidi, Vardha, Khayum, Anjum, Chaudhary, Bakshi and Gill.)

Background: Using the perspective of the recent COVID-19 pandemic, which represents a public health challenge that also affects education and the psychological well-being of students, this paper aims to assess the vulnerability to anxiety and stress of the Romanian students from the Faculty of Administration and Business of the University of Bucharest pursuing their degrees in administration and business., Methods: Our study is based on the results of the survey that was administered to a sample of 422 students (39.6% females and 60.4% males) selected from the pool of 2000 recruited respondents. We employed the ANOVA/linear Dependent Dirichlet Process mixture model to explain the causes of stress and anxiety after various grouping variables represented by gender, specialisation, as well as labour market status., Results: Our results revealed that more than 80% of the students in the sample yielded medium and high vulnerability to stress, while 64% of the respondents were affected by severe anxiety (high frequency of psychological, social, and physical problems that were difficult for them to control). The most important stressors were the fear of getting infected and social distancing, while self-control was considered the most effective coping strategy by 62.6% of employed students., Conclusions: These results allow us to provide practical recommendations for effectively coping with stress and anxiety among students in Romania and beyond and to help stakeholders and policymakers design strategies for strengthening students' resilience, mental health, and well-being in case of future pandemics or other extreme contexts., Competing Interests: Declarations. Ethics approval and consent to participate: Ethical review and approval were provided by the ethics committee from the Faculty of Administration and Business, University of Bucharest (ethical approval no. 52/2022 signed by the ethical committee of the University of Bucharest). Informed consent was obtained electronically from all participants in the study, ensuring they were fully aware of the research scope, procedures, and their right to withdraw at any time. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: The COVID-19 pandemic from 2020 to 2022 prompted governments worldwide to enforce lockdowns and social restrictions, alongside the rapid adoption of digital health and care services. However, there are concerns about the potential exclusion of older adults, who face barriers to digital inclusion, such as age, socioeconomic status, literacy level, and ethnicity., Objective: This study aims to explore the experiences of older adults from the 3 largest minoritized ethnic groups in England and Wales-people of South Asian, Black African, and Caribbean backgrounds-in the use of digitalized primary care services since the beginning of the COVID-19 pandemic., Methods: In total, 27 individuals participated in 4 focus groups (April and May 2023) either in person or via online videoconferencing. Patient and public involvement and engagement were sought through collaboration with community organizations for focus group recruitment and feedback on the topic guide. Data were analyzed using framework analysis., Results: This paper summarizes the perspectives of 27 older adults from these 3 minoritized ethnic groups and identifies four key themes: (1) service accessibility through digital health (participants faced difficulties accessing digital health care services through online platforms, primarily due to language barriers and limited digital skills, with reliance on younger family members or community organizations for assistance; the lack of digital literacy among older community members was a prominent concern, and digital health care services were felt to be tailored for English speakers, with minimal consultation during the development phase), (2) importance of face-to-face (in-person) appointments for patient-clinician interactions (in-person appointments were strongly preferred, emphasizing the value of physical interaction and connection with health care professionals; video consultations were seen as an acceptable alternative), (3) stressors caused by the shift to remote access (the transition to remote digital access caused stress, fear, and anxiety; participants felt that digital health solutions were imposed without sufficient explanation or consent; and Black African and Caribbean participants reported experiences of racial discrimination within the health care system), and (4) digital solutions (evaluating technology acceptance; participants acknowledged the importance of digitalization but cautioned against viewing it as a one-size-fits-all solution; they advocated for offline alternatives and a hybrid approach, emphasizing the need for choice and a well-staffed clinical workforce)., Conclusions: Digital health initiatives should address the digital divide, health inequalities, and the specific challenges faced by older adults, particularly those from minoritized ethnic backgrounds, ensuring accessibility, choice, and privacy. Overcoming language barriers involves more than mere translation. Maintaining in-person options for consultations, addressing sensitive issues, and implementing support systems at the practice level to support those struggling to access services are vital. This study recommends that policy makers ensure the inclusivity of older adults from diverse backgrounds in the design and implementation of digital health and social care services., (©Nisar Ahmed, Alex Hall, Brenda Poku, Jane McDermott, Jayne Astbury, Chris Todd. Originally published in JMIR Formative Research (https://formative.jmir.org), 18.12.2024.)

Background: There have been reports of sharp declines in acute coronary syndrome (ACS) during the COVID-19 pandemic. The study aims to assess nationwide ACS emergency department (ED) visit rates across age and sex subgroups and the general population, with a comparison before and throughout the pandemic's various phases., Methods: A multiple interrupted time series analysis was used to assess 61 349 ACS nationwide hospital visits from January 2018 to December 2021 at monthly intervals. The study period was divided into three periods: January 2018-February 2020 (pre-pandemic period); March 2020-January 2021 (early-pandemic period); February 2021-December 2021 (late-pandemic period). Segmented regression with a seasonally adjusted autoregressive moving average structure was used to build predictive models with an estimated reference trendline (counterfactual)., Results: Over 11 months of the early-pandemic period (lockdowns), the largest decrease in visits was seen in women aged 65 and above, of 18.4% [incidence rate ratio (IRR) 0.82; 95% confidence interval (CI) 0.77-0.86]. The lowest decrease was observed in men aged 25-64, of 7.2% (IRR 0.93; 0.91-0.94). During the late-pandemic period, which included high vaccination coverage and no lockdowns, the largest further decrease was in women aged 25-64 of 20.1% (IRR 0.80; 0.75-0.84) on average., Conclusions: The pandemic influenced ACS ED visits variably, with substantial declines during phases of high COVID-19 morbidity and mortality. Older individuals, particularly women, demonstrated the largest decrease in ACS ED visits, highlighting the need for tailored public health strategies to maintain public confidence in access to critical care during future health emergencies., (© The Author(s) 2024; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.)

Introduction: The COVID-19 pandemic has underscored the health benefits of green spaces, yet research on how specific elements of natural infrastructure affect well-being during the pandemic has been limited., Methods: This study, conducted at Sichuan Agricultural University with 300 students in 2022, investigated how urban natural infrastructure impacts physical and psychological well-being during the pandemic. Different aspects of natural infrastructure, such as thermal comfort, air quality (negative ion concentration), and noise and light levels, varied in their positive effects on students' health., Results: The findings revealed that 65.6% of university students felt reduced stress when engaging with outdoor spaces, and 72.8% of them renewed recognized the therapeutic value of nature., Discussion: The study emphasizes the importance of incorporating natural elements into urban planning to enhance outdoor activity and well-being, especially in post-pandemic settings. Recommendations are provided for future urban design to address the therapeutic needs of specific populations., Competing Interests: Qiao Qin was employed by the China Construction Third Bureau First Construction Engineering Company. 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 Peng, He, Lv, Wang, Qin, Song, Liu, Su, Song and Chen.)

Background: From medication usage to the time of day, a number of external factors are known to alter human body temperature (BT), even in the absence of underlying pathology. In select cases, clinical guidance already suggests the consideration of clinical and demographic factors when interpreting BT, such as a decreased threshold for fever as age increases. Recent work has indicated factors impacting BT extend to environmental conditions including ambient temperature. However, the effect sizes of these relationships are often small, and it remains unclear if such relationships result in a meaningful impact on real-world health care practices., Objective: Temperature remains a common element in public health screening efforts. Leveraging the unique testing and reporting infrastructure developed around the COVID-19 pandemic, this paper uses a unique resource of daily-level statewide testing data to assess the relationship between ambient temperatures and positivity rates. As fever was a primary symptom that triggered diagnostic testing for COVID-19, this work hypothesizes that environmentally mediated BT increases would not reflect pathology, leading to decreased COVID-19 test positivity rates as temperature rises., Methods: Statewide COVID-19 polymerase chain reaction testing data curated by the California Department of Public Health were used to obtain the daily number of total tests and positivity rates for all counties across the state. These data were combined with ambient temperature data provided by the National Centers for Environmental Information for a period of 133 days between widespread testing availability and vaccine approval. A mixed-effects beta-regression model was used to estimate daily COVID-19 test positivity rate as a function of ambient temperature, population, and estimates of COVID prevalence, with nested random effects for a day of the week within unique counties across the state., Results: Considering over 19 million tests performed over 4 months and across 45 distinct counties, adjusted model results highlighted a significant negative association between daily ambient temperature and testing positivity rate (P<.001). Results of the model are strengthened as, using the same testing data, this relationship was not present in a sensitivity analysis using random daily temperatures drawn from the range of observed values (P=.52)., Conclusions: These results support the underlying hypothesis and demonstrate the relationship between environmental factors and BT can impact an essential public health activity. As health care continues to operate using thresholds of BT as anchor points (ie, ≥100.4 as fever) it is increasingly important to develop approaches to integrate the array of factors known to influence BT measurement. Moreover, as weather data are not often readily available in the same systems as patient data, these findings present a compelling case for future research into when and how environmental context can best be used to improve the interpretation of patient data., (© Nicholas Wing-Ping Kwok, Joshua Pevnick, Keith Feldman. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org).)

Premature dropout from psychotherapy can harm patients and increase mental health costs. This study identified predictors of dropout in brief online psychotherapy for essential workers during the COVID-19 pandemic. This was a secondary analysis of a randomized trial on 4-week CBT or IPT protocols. Participants provided sociodemographic data and completed the Patient-Reported Outcomes Measurement Information System and Burnout Assessment Tool Short-Form. Predictors were analyzed in three blocks: sociodemographic, clinical, and therapist characteristics using bivariable and multivariable analyses. The sample included 804 individuals who attended at least the first session of either CBT (n = 403) or IPT (n = 401). A total of 17.2% (n = 138) of the participants dropped out during the protocol. Significant predictors of dropout included having children (IRR = 1.48; 95% CI: 1.07-2.05; p = 0.016), residing in specific regions of Brazil (Northeast IRR = 1.44; 95% CI:1.04-2.00; p = 0.02 and Midwest IRR = 1.73; 95%CI: 1.13-2.64; p = 0.01), therapist male sex (IRR = 2.04; 95% CI: 1.47-2.83; p = < 0.001), second wave of Covid-19 (IRR = 1.54; 95% CI: 1.01-2.34; p = 0.04) and low life satisfaction (IRR = 1.63; 95% CI: 1.06-2.50; p = 0.02). Our findings underscore the necessity for culturally tailored strategies, support for those with children, and targeted therapy for individuals with low life satisfaction. Implementation of these strategies may reduce dropout rates and improve treatment outcomes for essential workers in crisis., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Vaccinations are a cornerstone of public health. However, reluctance to accepting vaccines is common. Using longitudinal data, we investigated which individual and contextual factors were associated with switching preferences from initial hesitancy or unwillingness toward acceptance of a first COVID-19 vaccination., Methods: 12,512 participants of a Dutch cohort study who initially indicated being hesitant or unwilling to get vaccinated were included (December 2020-June 2022). Cox regression was used to determine what sociodemographic factors (e.g., age), vaccination-specific beliefs (e.g., perceived efficacy) and contextual factors (e.g., stringency of COVID-19 measures) were associated with switching toward getting vaccinated. Analyses were stratified into (1) the active campaign phase (over time more people became eligible for vaccination), versus (2) the residual phase (everyone was eligible and could still get vaccinated)., Results: Over time, 86% of initially hesitant and 34% of initially unwilling participants got vaccinated or intended to do so. Switching was less likely for people aged 40-54y (adjusted hazard ratio [aHR] 0.76 [95%CI = 0.69-0.84]) in phase 1, while in phase 2 they were more likely to do so (aHR = 1.44; 95%CI = 1.08-1.92). In both phases, people were more likely to switch if they had positive beliefs about its efficacy (phase 1: aHR = 1.76; 95%CI = 1.70-1.83; phase 2: aHR = 1.65; 95%CI = 1.54-1.77), and perceived getting vaccinated as the descriptive norm (phase 1: aHR = 1.30; 95%CI = 1.26-1.34; phase 2: aHR = 1.19; 95%CI = 1.13-1.25). During stricter lockdown measures people were also more likely to switch (phase 1: aHR = 1.26; 95%CI = 1.25-1.28; phase 2: aHR = 1.09; 95%CI = 1.08-1.09)., Conclusion: A majority of initially hesitant people changed their minds about vaccination during the pandemic. Preference switches in favor of vaccination were most strongly associated with beliefs about the vaccine's efficacy in preventing illness. This study underlines the importance of providing up-to-date, balanced information and decisional support for people to weigh the benefits and risks of getting vaccinated versus not getting vaccinated., Competing Interests: Declarations. Ethics approval and consent to participate: The cohort study did not meet the requirements for ethical review as laid down in the Dutch Law for Research Involving Human Subjects (WMO) and was therefore exempted by the Centre for Clinical Expertise at RIVM from formal ethical review (Study number G&M-561). Written informed consent was provided by all participants. After completing their first questionnaire, participants were asked for consent to receive follow-up invitations. Participants were informed that they could withdraw from the study at any time. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Video played an important role in health communication throughout the COVID-19 pandemic. It was used to communicate pandemic information to the public, with a variety of formats, presenters, and topics. Evidence regarding the effectiveness of video features is available, while how individual characteristics of recipients influence communication comprehension is still limited., Objective: This study aimed to test 6 individual characteristics and assess their effect on the comprehension of pandemic video communication., Methods: Short health communication videos were presented to a large sample of subjects, receiving questionnaire responses from 1194 participants. Individual characteristics consisted of age, sex, living area, education level, income level, and belief in science. Communication comprehension consisted of both perceived and objective comprehension. The data were analyzed by multiple linear regression., Results: Age had a negative effect on both perceived and objective comprehension-age was negatively associated with comprehension. There were sex differences, with higher perceived comprehension and lower objective comprehension among female than male individuals. Living in an urban or a rural area had no significant effect (all P>.05). The level of education and income had a positive effect on both subjective and objective comprehension. Finally, the belief in science had a positive effect on perceived comprehension (P<.001) but did not have a statistically significant effect on objective comprehension (P=.87)., Conclusions: The main differences between those who think they understand pandemic communication and those who comprehend it better are sex (female individuals have a higher perception of having comprehended, while male individuals have higher levels of objective comprehension) and belief in science (higher belief in science leads to higher perceived comprehension, while it does not have any impact on objectively understanding the message conveyed)., (©Daniel Adrian Lungu, Jo Røislien, Ionica Smeets, Siri Wiig, Kolbjørn Kallesten Brønnick. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 04.12.2024.)

Background: Short-term exposure to air pollution has been demonstrated in previous studies to correlate with respiratory disease (RD) in children. Due to regional heterogeneity, our objective was to explore the correlation between short-term exposure to ambient air pollution and hospital admissions for respiratory ailments in children in Suzhou City from January 1, 2017, to December 31, 2022, alongside assessing the influence of the COVID-19 pandemic on this relationship., Methods: We collected data on air pollutant levels and hospital admissions for childhood respiratory disease (RD) in Suzhou, China, from 2017 to 2022. We utilized a time-stratified case-crossover design along with a conditional logistic regression model to assess the short-term impacts of air pollutants on RD in children through stratified analysis and sensitivity analysis., Results: A total of 13,408 children with respiratory diseases were included in the study. The findings revealed significant associations between hospitalization for respiratory diseases in children and exposure to PM 2.5 , PM 10 , SO 2 , NO 2 , and CO. The maximum effect values (95%CI, best lag days) for each 10 µg/m 3 increase in the concentrations of PM 2.5 , PM 10 , SO 2 , and NO 2 were as follows: 1.017 (1.003-1.031, lag0-2), 1.015 (1.004-1.026, lag0-2), 1.117 (1.001-1.247, lag0-1), and 1.036 (1.009-1.064, lag0-7). Additionally, the maximum effect value (95%CI, best lag days) for each 1 mg/m 3 increase in CO concentration was found to be 1.267 1.017-1.579, lag0-7). Stratified analysis indicated that sex, season of admission, and stage of admission did not modify these correlations significantly; however, differential effects on various age groups and sexes were primarily observed among school-age and older children as well as boys., Conclusions: The short-term exposure to PM 2.5 , PM 10 , SO 2 , NO 2 , and CO in Suzhou, China, exhibited a positive correlation with RD hospitalization. Prior to the COVID-19 pandemic, the adverse impacts of air pollutants on hospitalizations for childhood respiratory disease were mitigated compared to the period following the pandemic. Local governments should continue promoting decisions and measures for air pollution prevention and control to reduce further pollutant concentration, which is crucial for public health in reducing the burden of childhood respiratory diseases., Competing Interests: Declarations. Ethics approval and consent to participate: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki. This study was approved by the Ethics Committee of Children’s Hospital Affiliated to Soochow University (approval number :2021CS163). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)