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While prior studies have barely explored social interaction for COVID-19 across Asia, this study highlights how people interact with each other for the COVID-19 pandemic among India, Japan, and South Korea based on social network analysis by employing NodeXL for Twitter between July 27 and July 28, 2020. This study finds that the Ministry of Health and Prime Minister of India, news media of Japan, and the president of South Korea play the most essential role in social networks in their country, respectively. Second, governmental key players play the most crucial role in South Korea, whereas they play the least role in India. Third, the Indian are interested in COVID-19 deaths, the Japanese care about the information of COVID-19 patients, and the South Korean focus on COVID-19 vaccines. Therefore, governments and disease experts should explore their social interaction based on the characteristics of social networks to release important news and information in a timely manner.

Objectives: The emergency response capacity of nurses is quite important during the COVID-19 epidemic. This study aimed to determine the relationship of resilience with emergency response capacity and occupational stresses during COVID-19 re-outbreak., Methods: This is a cross-sectional study that involved 241 new nurses. Questionnaires (including demographic characteristics and self-report questionnaires) were sent via QR code and used to conduct an online survey of new nurses. Resilience, emergency response capacity, and occupational stressors were measured using questionnaires., Results: Mean resilience score was 62.68 ± 14.04, which corresponds to a moderate level. Age, marital status, and work experience were significantly associated with resilience ( P = 0.037, P = 0.046, P = 0.011) and emergency response capacity (P = 0.018, P = 0.045, P < 0.000). Total score and 3 dimensions of resilience were positively correlated with emergency response competency questionnaire and 3 dimensions (P < 0.01). Total scores of the nurse job stress scale and patient care dimension were negatively correlated with resilience scores (P < 0.05). Resilience played a partial mediating role in occupational stressors and emergency response capacity, and mediating effect accounted for 45.79% of the total effect., Conclusions: The nursing superintendent must pay more attention to the resiliency of new nurses to reduce occupational stressors and improve emergency response capacity while helping new nurses cope with COVID-19 re-outbreak.

Purpose: To understand changes in purchasing behaviors and use of tobacco products such as e-cigarettes and cigarettes among different tobacco user groups during the COVID-19 pandemic using a mixed methods approach., Methods: A quantitative online survey was conducted in October-November 2020 using a national probability sample of US adults (N = 1,460) comprising exclusive cigarette smokers (n = 1,080), dual users of both cigarettes and e-cigarettes (n = 143), and exclusive e-cigarette users (n = 237). Simultaneously, ten online focus groups were conducted with 61 adults in the Atlanta, GA area including exclusive smokers (n = 16), current E-cigarette users (n = 22), and transitioning (recently quit or currently quitting) smokers and/or E-cigarette users (n = 23)., Results: From the survey, dual users vs. exclusive smokers had higher odds of buying cheaper cigarette brands (adjusted odds ratio (aOR) 2.50, 95% confidence interval (CI) = 1.49, 4.20), buying cigarettes online (aOR = 2.79; 95% CI = 1.02, 7.69), buying from Indian Reservations (aOR = 3.99; 95% CI = 2.07, 7.69), buying fewer cigarettes than normal (aOR = 4.01; 95% CI = 2.42, 6.65) and buying other tobacco products (aOR = 4.44; 95% CI = 2.24, 8.79). From the focus groups, participants perceived reduced accessibility, fear of contracting COVID-19, rising prices, and convenience to influence their purchasing behaviors and tobacco use., Conclusions: Exclusive and dual users differed in their tobacco purchasing behaviors during the COVID-19 pandemic, such that dual users were more likely to change their purchasing behaviors (e.g., buying other tobacco products) than exclusive users. Educational campaigns and public health workers may promote interventions targeting dual users either to switch to reduced-risk products or quit smoking, particularly during stressful societal situations such as the COVID-19 pandemic., Implications: The findings inform public health educators and policymakers to develop policies and interventions carefully tailored for tobacco user groups targeting the perceived factors influencing purchasing behaviors during challenging situations affecting tobacco product availability., Competing Interests: We have read the journal’s policy, and the authors of this manuscript have the following competing interests: D.L.A. has received funds for work done at the World Health Organization Tobacco Free Initiative, as a Special Government Employee of the U.S. Food and Drug Administration, as a consultant for Pfizer, as an employee of Cherokee National Operational Systems and as an independent contractor for McKing Consulting. Other authors declare no conflicts of interests. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Kute et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study evaluates the impact of the COVID-19 pandemic on healthcare workers in Argentina, during the second wave in 2021. The aim is to assess stress and burnout, incorporating the assessment of hair cortisol levels as a biomarker of chronic stress. A total of 496 healthcare workers from three different hospitals were included in this study. Two of these hospitals depend on the Buenos Aires City Ministry of Health and the third hospital belongs to Buenos Aires University. Hair samples were obtained using scissors from the posterior vertex, as close to the scalp as possible. Each sample was weighed, and cortisol was extracted and then measured using an automated chemiluminescent method. Notably, 10% of the population exhibited hair cortisol levels above 128 pg/mg. Associations were found between high hair cortisol levels and age, workload, emotional exhaustion, and depersonalization. In addition, burnout, identified in 11% of participants, correlated with higher perceived stress and lower social support. Binary logistic regression revealed associations between burnout and perceived stress, and age. Finally, mediation analysis showed depersonalization as a mediating variable in the relationship between hair cortisol concentration and emotional exhaustion. In conclusion, this study highlights the complex relationships between stress, cortisol levels, and burnout. Prioritizing interventions and research is essential to support the well-being of frontline healthcare professionals, ensuring their resilience during challenging times., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Individuals reporting self-injury are at greater risk of several adverse outcomes, including suicide. There is reason to be concerned how these individuals cope when stressful life events increase. This study aimed to investigate the trajectories of anxiety and depressive symptoms and the predictive value of self-injury history in individuals with psychiatric symptoms during the unique and stressful conditions of the COVID-19 pandemic., Methods: In a longitudinal population cohort study (N = 1810) ranging from 2020 to 2022, anxiety (measured by Generalized Anxiety Disorder, GAD-7) and depressive symptoms (measured by Patient Health Questionnaire, PHQ-9) were self-reported monthly during 12 months. Latent growth curve models with and without self-reported self-injury history as predictors were conducted., Results: Overall, anxiety and depressive symptoms decreased from baseline, but remained at moderate severity at follow-up. Individuals reporting suicidal or nonsuicidal self-injury reported significantly higher symptom severity at baseline. In addition, individuals reporting suicidal self-injury demonstrated a slower rate of decline in the symptom load over the course of 12 months., Conclusions: Over the course of 12 months, anxiety and depressive symptoms decreased in individuals with psychiatric symptoms, but still indicate a psychiatric burden. Individuals with a history of self-injury could be more vulnerable in face of stressful conditions such as those experienced during the COVID-19 pandemic., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Ojala et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Adolescents exhibit a high prevalence of mental health disorders, with more than half of all cases emerging before the age of 14 years. Since the advent of the COVID-19 pandemic, there has been a marked upsurge in anxiety and depression among adolescents across several nations. Emotional disorders often lead to severe outcomes, including school absenteeism, self-harm, and suicidal tendencies. The suboptimal efficacy of pharmacotherapy, compounded by limited availability and substantial costs associated with individual psychotherapy, underscores the critical need for identifying simple yet efficacious psychotherapeutic interventions suitable for both individual and group settings. Tension and Trauma Release Exercise (TRE) is a mind-body therapeutic approach that efficiently alleviates symptoms of anxiety and depression. This randomized controlled trial (RCT) aims to evaluate the effectiveness of a mother-child intervention model using TRE in enhancing the clinical management of adolescent patients diagnosed with emotional disorders., Methods: This study recruits 140 dyads of adolescents with emotional disorders and their mothers, randomly assigned to intervention or control groups. The intervention arm combines eight weeks of standard pharmacotherapy with an eight-week TRE group therapy, assessing at baseline, post-8-week treatment, and three-month follow-up. Initially, controls receive eight weeks of standard medication with parallel assessments, later transitioning to the same TRE intervention while maintaining continuous evaluation. The study further examines the influence of maternal emotional health on adolescent treatment response and investigates associated neurophysiological and psychological mechanisms., Discussion: This research endeavors to identify a straightforward and potent body-oriented psychological intervention that could improve the clinical outcomes for adolescent patients with emotional disorders. Such findings would carry profound implications not only for the healthy development of teenagers but also for potentially mitigating the burden on families, educational institutions, and society as a whole., Trial Registration: ChiCTR2100044553, Registered March 24, 2021., Competing Interests: Declarations. Ethics approval and consent to participate: The research protocol was approved by the Ethics Committees of Beijing Huilongguan Hospital (approval number: 2019-39-Scientific Research-revised version 2, Date: December 21, 2023). Important protocol modifications of the protocol will be reported to the committee, trial registries, and the journals. This study protocol follows the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) checklist and the TIDieR checklist. It is per-registered at the Trial Register under registration number ChiCTR2100044553 ( http://www.chictr.org.cn/index.aspx ). Informed consent will be obtained from the adolescent participants, their parents and legally authorized representatives in this study. Participants in the project can get feedback reports of all test results and they were compensated for their participation. De-identified data will be used for statistical analysis and the results of this trial will be disseminated through publications in peer-reviewed journals and academic conferences. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: During the COVID-19 pandemic, the provision of quality care for behavioral and psychological symptoms in older adults with dementia may have been impeded due to physical distancing and infection control measures. Of particular concern is whether psychotropic medication use has increased despite its limited efficacy and adverse effects. This systematic review described the trajectory of psychotropic use for older adults with dementia across various settings, from community living to healthcare settings during the pandemic. Also, psychotropic use was explored in relation to patients, caregivers, and environment-related factors along with the occurrence of the pandemic., Methods: We conducted a comprehensive search across five databases: Embase, PubMed, PsycINFO, CINAHL, and Cochrane Library. Methodological quality was assessed using Joanna Briggs Institute Critical Appraisal tools. A random-effects model was used to estimate the pooled risk ratios (RRs) of psychotropic use in older adults with dementia, comparing the pandemic period to the pre-pandemic period. Subgroup analyses based on the class of psychotropics and sensitivity analyses also were conducted. A funnel plot and Egger's regression test were used to detect potential publication bias., Results: Of the 3,123 screened articles, 15 studies were included in this systematic review, with 10 of them being part of the meta-analysis. Our meta-analysis yielded an RR of 1.16 (95% CI = 1.05-1.26) for overall psychotropic medication use. Further subgroup analysis based on the type of psychotropic medication revealed a significantly greater prevalence in the use of antipsychotics (RR = 1.19, 95% CI = 1.08-1.30). However, no significant differences were observed in the use of anxiolytics and/or hypnotics (including benzodiazepines), antidepressants, and mood stabilizers. Among psychotropics, some studies on antipsychotic use additionally explored patients, caregivers, and environmental-related factors during the pandemic., Conclusions: The review indicates a higher risk of psychotropic use, especially antipsychotics, during the pandemic. Nonetheless, underlying reasons for the increased psychotropic use are not fully available from the reviewed studies. Therefore, further research is needed to identify the factors driving psychotropic use during the pandemic and facilitate the development of quality improvement interventions that can be implemented to minimize inappropriate psychotropic prescribing in future pandemics., 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).)

This prospective observational study examined changing trends of excess self-protective behavior (EPB), and their association with perceived risk, perceived severity, and irrational beliefs about prevention during the Chinese COVID-19 epidemic. Participants were recruited for an online panel survey. There are 150 participants for the baseline and 102 for the final survey. There were 5 waves of interviews. Perceptions of risk and disease severity were measured by single items. Irrational beliefs about prevention and EPB comprised 5 common prevention misconceptions. Descriptive statistics and the CATMOD program were used for data analysis. The prevalence of participants perceiving personal risk of contracting COVID-19 and severe consequences of the disease was 18.6% and 25.5%, respectively, at baseline, and declining to 4.9% and 17.6% at final observation. The 5 selected EPB also showed a diminishing trend. Belief in COVID-19 prevention myths trended upwards. Perceived risk was positively associated with each EPB, and perceived severity with disinfection of clothes and hoarding of products. Myth adherence was positively associated with disinfection of clothes and both hand washing and sanitization. This study yields new information about EPB among the Chinese public. Policy modifications and public education interventions are essential for minimizing the adverse health effects of subscribing to irrational beliefs.

Background: This study examines the impact of SARS-CoV-2 (i.e., coronavirus, COVID, COVID-19) using data from a measurement-based care (MBC) system utilized in an outpatient psychiatric clinic providing telemedicine care. A novel Patient Rated Outcome Measure (PROM), the COVID-19 Events Checklist (CEC) was administered in a hospital system based ambulatory clinic beginning April 2020 to track COVID-19-19's impact on patients' mental, emotional, and health-related behaviors during the pandemic. The study (1) provides descriptive CEC data, and (2) compares CEC results with PROMs evaluating anxiety (Generalized Anxiety Disorder-7; GAD-7), depression (Patient Health Questionnaire; PHQ-9), and psychological distress (Brief Adjustment Scale-6; BASE-6)., Methods: This retrospective observational study included patient intake data collected from April 2020 to March 2021. Patient (N = 842) reports on the CEC's five domain questions were aggregated to calculate average reports of COVID-19 related impacts at intake over the initial 12 months of the pandemic. Trends in COVID-19 related impacts were examined, and non-aggregated scores on the PHQ-9, GAD-7, and BASE-6 were compared to primary dichotomous (yes/no) CEC survey questions via Wilcoxon rand sum testing., Results: Results capture the relationship between COVID-19 exposure, COVID-19- related sequelae and behaviors, and psychological symptom severity. Specifically, Wilcoxon rank-sum tests indicate that social determinants of health (SDOH), negative mental health impacts, and positive coping skill use were significantly associated with psychological symptomatology including overall psychological functioning via the BASE-6, anxiety via the GAD-7, and depressive symptoms via the PHQ-9. Results regarding SDOH were as follows: BASE-6 (w = 44,005, p < 0.001), GAD-7 (w = 44,116, p < 0.001), and PHQ-9 (w = 43,299, p < 0.001). Regarding negative mental health outcomes, the results were: BASE-6 (w = 38,374, p < 0.001), GAD-7 (w = 39,511, p < 0.001), and PHQ-9 (w = 40,154, p < 0.001). As the initial year of the pandemic elapsed, incoming patients demonstrated increased rates of suspected or confirmed exposure to COVID-19, (+2.29%, t = 3.19, p = 0.01), reported fewer negative impacts of COVID-19 on SDOH (-3.53%, t= -2.45, p = 0.034), and less engagement in positive coping strategies (-1.47%, t = -3.14, p = 0.010)., Conclusions: Psychosocial factors related to COVID-19 are discussed, as well as opportunities for further research on the relationship between psychological symptomatology and the impact of COVID-19 on health-related behaviors., 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 Declaration and its later amendments or comparable ethical standards. The study was approved and designated IRB-exempt by the Carilion Clinic Institutional Review Board (IRB) as Protocol #IRB-20-905. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests., (© 2024. The Author(s).)

Background: The 2019 coronavirus disease (COVID-19) pandemic brings critical health problems to workers in many occupations, particularly healthcare providers. The aim of the study was to examine the feasibility and effectiveness of the mindfulness-based stress reduction (MBSR) program on relieving burnout of healthcare providers during the pandemic. The roles of positive and negative emotion as well as emotion regulation strategy in the intervention effects were also investigated., Methods: A sample of 112 healthcare providers in China were recruited and randomly assigned to the MBSR (n = 56) or the control condition (n = 56). Measures were collected at pre-intervention, mid-intervention, and post-intervention, assessing mindfulness level, emotion regulation strategy, positive and negative emotion, and burnout., Results: The MBSR program showed acceptable feasibility. Compared to the control group, healthcare providers in the MBSR group showed significant increase in personal accomplishment and decrease in emotional exhaustion after the intervention. No significant difference was detected on the dimension of depersonalization. Results of mediation analyses implied that cognitive reappraisal and positive affect partially mediated the intervention effects on personal accomplishment., Conclusions: The study provided preliminary evidence that the MBSR programs might be effective in reducing healthcare providers' burnout, even during the pandemic. Cognitive reappraisal and positive emotion might be important mechanisms of how the training took effect., Competing Interests: Declarations. Ethics approval and consent to participate: The study was reviewed and approved by the Academic Review Board of Zhejiang University Department of Psychology and Behavioral Sciences (register number: 1806). All participants provided written informed consent to participate. Consent for publication: Not applicable. Competing interests: No conflict of interest has been declared by the authors., (© 2024. The Author(s).)

Introduction: Resentment towards the Chinese population was perceived during the first months of the pandemic because the pandemic/disease started in that country., Objective: To determine the factors associated with the perception of resentment towards the Chinese in Latin America during the first wave of the COVID-19 pandemic., Methodology: Analytical cross-sectional study conducted during the second semester of the pandemic in more than a dozen countries. Four questions were asked about the perception of resentment towards the Chinese (Cronbach's Alpha: 0.88); those with the highest scores on the sum of the four questions were considered to have "more resentment towards the Chinese," and descriptive and analytical statistics were obtained., Results: Of the 7721 respondents, in the multivariate analysis, it was found that there was a difference according to the country; compared to Peru, those who had more resentment towards the Chinese were those residing in Paraguay (aPR: 1.29; 95%CI: 1.17-1.42; p-value < 0.001) and Bolivia (aPR: 1.52; 95%CI: 1.37-1.68; p-value < 0.001), while Chile (aPR: 0.78; 95%CI: 0.69-0.88; p-value < 0.001) had less resentment: 0.69-0.88; p-value < 0.001), Mexico (aPR: 0.68; 95%CI: 0.57-0.80; p-value < 0.001), Panama (aPR: 0.71; 95%CI: 0.59-0.86; p-value < 0.001) and Costa Rica (aPR: 0.64; 95%CI: 0.49-0.85; p-value = 0.002)., Discussion: There was a significant difference in resentment for each country., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved with resolution N°0014–2022-UPAO by the ethics committee of the Antenor Orrego Private University. Consent for publication: Since it was conducted during the pandemic, the data were collected online, which precluded informed consent; however, the purpose of the study is mentioned at the beginning of the online questionnaire. No personal details were requested from participants to ensure anonymity. The ethical principles of the Declaration of Helsinki conducted this research. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

The university student population is particularly vulnerable to depression, which was identified during the COVID-19 pandemic. Understanding how depressive symptoms are interrelated with mental and physical health in students is essential. The aim of this study was to reveal the network of depressive and anxiety symptoms with respect to well-being (life satisfaction, physical health, physical activity, and perceived stress) during a difficult situation-the COVID-19 pandemic-at two measurement points of different pandemic severities. A repeated cross-sectional study was conducted in June 2020 (T1) (lower pandemic severity) and March 2021 (T2) (higher pandemic severity) among 592 and 1230 Czech university students, respectively. The measurements used were the PHQ-9, GAD-7, PSS-10, SWLS, self-rated physical health (SRH), and sociodemographic survey. The network analysis approach was utilized. For the significance of differences, the χ 2 test, Student's t test, and ANOVA were performed. The results revealed that scale-level depression, stress, and worse SRH increased over time, whereas life satisfaction decreased. Scale-level anxiety and physical activity were stable over time. PHQ2 Sad mood was the most central and influential node at T1 and T2. PHQ9 Suicidal Ideation was closely related to other variables at T1, whereas PHQ1 Anhedonia was closely related to other variables at T2. The most influential risk factors were the PHQ-2 score and the GAD-2 score, which are associated with uncontrollable worrying, whereas life satisfaction, physical health, and physical activity were the most protective factors. It is crucial to recognize and decrease the PHQ2 score and increase life satisfaction to improve the mental health of university students., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics declarations: The University Research Committee at the University of Opole, Poland, approved the study protocol with decision no. 1/2020. The study received the Ethics Waiver from Mendel University in Brno, Czech Republic, as it followed the ethical standard of the 1964 Helsinki Declaration and its amendments and adhered to specific obligatory regulations in the Czech Republic. The study followed the ethical requirements of anonymity and voluntary participation. Each person provided written informed consent. In accordance with the Declaration of Helsinki, written informed consent was obtained from each participant before inclusion. All methods were carried out under relevant guidelines and regulations. This study was a part of the international project “Mental Health of Undergraduates during the COVID-19 Pandemic”53., (© 2024. The Author(s).)

Background: Psychological distress has significantly impacted students in Egypt and Jordan. These countries have faced many challenges, including the COVID-19 pandemic, the fallout from the conflict in Syria, and the war in Ukraine. These crises have had far-reaching consequences, affecting the economy, food security, and energy supplies, particularly with the increased number of refugees in these countries. Amid these existing complexities, the ongoing war in Gaza further exacerbates the situation, compounding mental health challenges. Therefore, this study aimed to analyze how the war in Gaza impacted the mental health of students in Egypt and Jordan., Methods: We conducted a cross-sectional study involving students from Egypt and Jordan between December 2023 and January 2024. The questionnaire incorporated the Brief Symptom Inventory 18 (BSI-18) to assess the overall general distress score, as well as the domains of anxiety, somatization, and depression., Results: A total of 1509 Jordanian and Egyptian students were included in the study, of which 66% were female. Approximately 18% of the students had an elevation (≥ 50) in their BSI-18 total score. Females scored significantly higher in general distress [30 (18-44.25) vs. 24 (11-41), p < 0.001], and all three dimensions. The univariate predictors for elevated general distress (≥ 50) were being Egyptian (OR 1.49, 95% CI 1.08 to 2.08, p = 0.014), watching social media multiple times a day (OR 3.04, 95% CI 1.97 to 4.69, p < 0.001), and having a Palestinian connection (friend, neighbor, colleague, or relative) (OR 1.63, 95% CI 1.23 to 2.16, p < 0.001). These three predictors were retained in the backward stepwise multivariate regression analysis model. The univariate predictors for moderate and marked general distress (≥ 57) were watching social media multiple times a day (OR 3.26, 95% CI 1.78 to 5.99, p < 0.001) and having a Palestinian connection (OR 1.49, 95% CI 1.05 to 2.14, p = 0.026). Only the former was retained in the backward stepwise multivariate regression analysis., Conclusion: General distress has increased among students in Egypt and Jordan throughout the War in Gaza. Mental, psychological, and social support activities are necessary for these students, particularly those watching social media multiple times daily. The development of coping skills to manage the additional stressors of war and socioeconomic status necessitates further research within this group of students., Competing Interests: Declarations. Ethics approval and consent to participate: Informed consent was obtained from all participants involved in the study. This study did not require ethical approval because it was not a clinical trial but was a surveillance of the population’s attitude. The Bioethics Committee of Deraya University has issued the ethical waiver. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: Socioeconomic inequalities have been associated with poorer mental health outcomes in children and adolescents during the COVID-19 pandemic. Despite numerous studies on individual risk factors, the impact of societal environment, such as neighborhood characteristics, on changes in mental health has rarely been investigated. This study investigates the effect of neighborhood deprivation on mental health problems and health-related quality of life (HRQoL) in children and adolescents during the COVID-19 pandemic in Hamburg, Germany., Methods: Data were derived from the prospective German COPSY Hamburg study. Children and adolescents aged between 11-20 years and their parents participated in the study, which took place in summer 2020 (T1) and summer 2022 (T2). Neighborhood deprivation was assessed by a neighborhood status index. Mental health problems and HRQoL were assessed using internationally validated and established instruments. The prevalence of mental health problems and impaired HRQoL was reported. Analysis of covariance was conducted to examine the effect of neighborhood deprivation of the districts in Hamburg on the (changes in) mental health problems and HRQoL while controlling for social individual-level indicators., Results: The total sample included in the statistical analysis consisted of N = 2,645 families. Children and adolescents living in more deprived areas had higher levels of general mental health problems and depressive symptoms during the COVID-19 pandemic. However, differences in neighborhood deprivation did not relate to the HRQoL and the averaged changes in children and adolescents' mental health problems and HRQoL from summer 2020 to summer 2022., Discussion: Neighborhood deprivation is associated with impaired mental health in youth during the COVID-19 pandemic. Children and adolescents' mental health and overall well-being should be addressed by health promotion measures to create a health-promoting living environment, including diverse neighborhoods. Future research should focus on uniform assessment methods and addressing additional neighborhood factors., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Li et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The COVID-19 pandemic has seriously affected older adults' social lives, physical activity, and cognitive functions. Additionally, the lockdowns have disrupted regular healthcare for patients with chronic illnesses or needing acute care. Furthermore, the pandemic has negatively affected different psychosocial influences in each country due to the various cultural characteristics, technology, health system, and financial opportunities. This study aimed to investigate the effects of COVID-19 on mood, social participation, and healthcare use in older adults living in Turkey., Methods: A cross-sectional study was conducted during the third wave of the COVID-19 pandemic (March-December 2021) in three medical centers in Turkey. Patients aged 60 + years without significant cognitive impairment were recruited by mail or at hospital admissions. Information on demographics, pandemic-related distancing measures, healthcare use, lifestyle, symptoms of anxiety, depression, and social participation were assessed., Results: A total of 343 participants were included in the study. Women had a higher rate of hypertension, symptoms of anxiety, depression, and fatigue compared to men (p < 0.05). Since the start of the pandemic, only 22.4% of non-acute healthcare appointments were conducted face-to-face. Time spent with family and friends, hope for the future, and physical activity decreased. At the same time, the experience of loneliness, the number of meals and unhealthy snacks, and the use of digital services increased. Women were also more concerned about getting coronavirus infection, transmitting the virus to others, and being discriminated against because of the infection (p < 0.05)., Conclusions: These pandemic days have had a significant psychosocial impact on Turkish older adults, especially women. As a strategy of the health care policy, easy access and follow-up to the health system should be provided, and the necessary support should be procured to minimize the detrimental effects of the pandemic on older people., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the Dokuz Eylul University of Non-Interventional Clinical Researches Ethics Board as a multicenter study and conformed to the Declaration of Helsinki. Permission was also obtained from the Turkish Ministry of Health for research on COVID-19. All participants provided written informed consent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objectives: Among nurse leaders, gender should receive particular attention, because life and work experiences and burnout during COVID-19 pandemic may vary between women and men, potentially requiring different strategies to achieve well-being. Thus, information about gender differences in burnout might be critical to burnout prevention in nurse leaders. Additionally, there has been a substantial call for attention to gender during the COVID-19 pandemic, reflecting a concern that responses to the pandemic that fail to consider gender differences and norms will be ineffective. Therefore, the objective of the current study is to examine personal burnout, client burnout and work-related burnout of nurse leaders while considering the impact of COVID-19 pandemic and work-life balance through a gender lens., Design: A cross-sectional study design was implemented in 2023 using a convenience sampling approach., Setting: Data on personal burnout, work-related burnout, client burnout, work-life balance and COVID-19 impact were collected electronically and assessed through a gender lens., Participants: A sample of 210 nurse leaders filled out the online surveys that were posted on the American Organization for Nursing Leadership and on Facebook., Conclusion: Females had significantly higher personal burnout than males (mean 56.2 vs 49.3, F=5.853, p=0.019). Males had significantly higher client-related burnout than females (mean 45.3 vs 34.8, F=7.014, p=0.008). Findings demonstrate the importance of addressing gender when examining how nurse leaders react to different factors leading to burnout. In employing a gender lens framework, future researchers might study how the pressures that working men and women nurse leaders face were intensified during the COVID-19 pandemic. To support nurse leaders in executing their roles, there is a need to widen the scope of conversations about including family-friendly policies and attention to the needs of men and women as nurse leaders. These policies might include but are not limited to paid childcare, flexible time off, access to paid time off and mandatory overtime laws., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The relationship between public health emergencies and psychological distress had been well known, yet none research had been conducted on the trend in psychological resilience and its longitudinal determinants during the pandemic. This study aimed to explore the changes of psychological resilience of university students during COVID-19 pandemic, and further clarify the longitudinal relationship between family factors, mental health, social mentality and psychological resilience., Methods: Questionnaires were distributed to students from five universities in Shandong Province, China during the COVID-19. A total of 1635 students were finally included in this three-wave follow-up study using stratified random sampling method. Mental health was assessed by Depression Anxiety Stress Scale, social mentality was measured by the Bi-Dimensional Structure Questionnaire of Social Mentality, psychological resilience was evaluated by the Chinese version of the Psychological Resilience Scale. Repeated-measures analysis of variance was used to analyze the longitudinal changes of psychological resilience, generalized estimating equation (GEE) was conducted to estimate the determinants of psychological resilience., Results: Psychological resilience changed from 28.37 in Wave 1, 29.10 in Wave 2, and 29.15 in Wave 3 among the university students. The students who majored in Art (β = 0.872, P = 0.032), parents (mother β = 0.546, P = 0.035; father β = 0.718, P = 0.012) had a greater influence on children's personality, and positive social mentality (β = 5.725, P < 0.001) were more likely to report a higher psychological resilience. Being female (β=-0.932, P < 0.001), not being a student leader (β=-0.911, P < 0.001), being anxious (β=-1.845, P < 0.001) and depressed (β=-1.846, P < 0.001), and negative social mentality (β=-0.803, P < 0.001) were less likely to report a higher psychological resilience., Conclusions: The psychological resilience of the university students in Shandong Province, China increased significantly from Wave 1 to Wave 3 during the COVID-19 pandemic. Majoring in Art, parents having a greater influence on children's personality, better mental health, positive social mentality were more likely to report a higher psychological resilience, while female, not student leader, worse mental health, and negative social mentality were less likely to report a higher the psychological resilience., Competing Interests: Declarations Ethics approval and consent to participate The study was designed in accordance with the tenets of the Declaration of Helsinki, 1996 and was approved by the ethical committee of Shandong University before data collection (Task No. LL20200201). Informed consent Informed consent was obtained from all subjects. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Multiple sclerosis (MS) is a chronic, inflammatory, and demyelinating disease of the central nervous system. The first presentation's possible triggers are still controversial among scientists. The objective of this study is to investigate and compare the potential social, environmental, and physical factors that may have contributed to the onset of MS before and during the Coronavirus Disease 2019 (COVID-19) pandemic., Methods: A questionnaire was designed in the MS research center of Sina Hospital and also distributed as an online Google Form on social media among Iranian MS patients. Demographic information, MS disease-related data, and possible patients reported MS triggers were recorded. They were containing stressful life events, COVID-19 and other infections, COVID-19 and other vaccines, pregnancy or labor, head trauma, surgery, and weight loss. Patients were divided into two groups regarding the time of MS diagnosis (before and during the COVID-19 pandemic)., Results: Of 920 participants, 670 (72.8%) were female, and the mean age ± SD was 35.63 ± 8.1. The majority of patients (69.2%) had non-progressive forms of MS, and only 7.6% needed assistance for ambulation. 69% of participants were diagnosed with MS before the onset of the COVID-19 pandemic. There was a statistically significant difference between the most common first MS symptom before and after the beginning of the pandemic (visual type (n: 317 (49.9%)) before and sensory type (n: 170 (59.6%)) after the COVID-19 pandemic). A stressful life event was the most common patient-reported trigger of MS first presentation in both groups. (56.1% before and 54% after the COVID-19 pandemic). Comparing two groups, economic problems (AOR: 1.81; 95% ACI: 1.23-2.65) and job losses (AOR: 2.89; 95% ACI: 1.37-6.08) were significantly more common triggers for the initial presentation of MS after the pandemic, while the stress of occupational or educational exams (AOR: 0.52; 95% ACI: 0.34-0.79) was more prevalent before the pandemic., Conclusion: Patients believe that stressful life events are closely linked to triggering their first MS symptoms. Since the beginning of the COVID-19 pandemic, economic problems and job losses have increased; however, occupational or educational exams stress decreased. Caring for social stress by societies may affect MS development or delay MS onset., Competing Interests: Declarations Ethics approval and consent to participate Informed consent was obtained from all participants. This study is approved by the Tehran University of Medical Sciences Ethical Committee with the ethical code IR.TUMS.MEDICINE.REC.1399.728. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Global mental health has been threatened by the COVID-19 pandemic, both directly through long-lasting neuropsychiatric disorders that occur during primary infection in affected individuals and indirectly through stressful and disruptive societal changes. Thus, this study determined the pooled prevalence of common mental disorders and associated factors among adults after COVID-19 pandemic in Ethiopia., Methods: This systematic review and meta-analysis were conducted using primary published and unpublished studies that were retrieved from various databases. Studies conducted on adults, published in English, and conducted in Ethiopia were included in this review. A standardized data extraction format developed from Excel was used to collect the data. A random effect meta-analysis model was used to estimate the pooled effect size of all included studies at a 95% confidence interval. The heterogeneity was evaluated by Cochran Q test and the I-squared. Funnel plot and egger tests were used to determine publication bias., Results: A total of 20 studies were eligible for this systematic review. The pooled prevalence of common mental disorders among adults was 40.44% (95%CI: 31.86-49.02%). Female gender (AOR = 1.88, 95% CI: 1.33-2.44), unemployed (AOR = 2.05, 95% CI: 1.12-2.98), poor social support (AOR = 3.12, 95% CI: 2.08-4.17), substance use (AOR = 2.5, 95% CI: 1.58-3.41), history of mental illness (AOR = 1.73, 95% CI: 1.01-2.44), family history of mental illness (AOR = 2.47, 95% CI: 1.54-3.41), and chronic medical illness (AOR = 1.6, 95%CI:1.02-2.17) were risk factors for common mental disorders., Conclusion: In this study, more than one-third of adults were affected by common mental disorders after the onset of the COVID-19 pandemic. This indicated that, in order to reduce the prevalence of common mental disorders, enhancing the provision of mental health services should be improved after the COVID-19 pandemic. Screening for common mental disorders should be given, especially to females, unemployed people, substance users, chronic medically ill people, those with a history of mental illnesses, and those with a family history of mental illness. Strengthening social support during the COVID-19 pandemic is also important., Prospero Protocol Registration: The registration ID for this systematic review is CRD42024496826., 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).)

Purpose: While prevalence and value of nonclinical hospital workers, like quality or education professionals, increase, their work engagement is understudied. Work engagement of nonclinical and clinical hospital workers is critical considering the pressure of major challenges in healthcare. The pandemic was a natural experiment for this., Design/methodology/approach: We conducted an observational survey study among all nonclinical and clinical hospital workers of the Jeroen Bosch Hospital, the Netherlands. In an employee satisfaction survey, we measured work engagement under acute pressure (just after the first COVID-19 wave in July 2020) and chronic pressure (within the second COVID-19 wave in November 2020) and to what extent psychological demands and co-worker support were related to work engagement., Findings: For all hospital staff, "average" levels of work engagement were found under acute (response rate 53.9%, mean 3.94(0.81)) and chronic pressure (response rate 34.0%, mean 3.88(0.95)). Under acute pressure, nonclinical hospital workers scored lower on the subcategory dedication than clinical workers (mean 4.28(1.05) vs mean 4.45(0.99), p  < 0.001). Under chronic pressure, no differences were found. For both nonclinical and clinical hospital workers, co-worker support was positively related to overall work engagement (beta 0.309 and 0.372). Psychological demands were positively related to work engagement for nonclinical hospital workers (beta 0.130), whereas in clinical hospital workers, psychological demands were negatively related to vigor (beta -0.082)., Practical Implications: Hospitals face times of pressure. Fostering co-worker support under pressure may be vital for hospital management., Originality/value: Work engagement of nonclinical hospital workers is understudied., (© Emerald Publishing Limited.)

Background: Frontline health care staff are frequently exposed to traumatic events as part of their work. Although this study commenced before the emergence of COVID-19, levels of exposure were heightened by the pandemic. Many health care staff members report intrusive memories of such events, which can elicit distress, affect functioning, and be associated with posttraumatic stress disorder symptoms in the long term. We need evidence-based interventions that are brief, preventative, nonstigmatizing, suitable for the working lives of frontline health care staff, and effective for repeated trauma exposure. A brief, guided imagery-competing task intervention involving a trauma reminder cue and Tetris gameplay may hold promise in this regard, given evidence that it can prevent and reduce the number of intrusive memories following trauma across various settings., Objective: This case series aims to investigate the impact of a brief imagery-competing task intervention on the number of intrusive memories, general functioning, and symptoms of posttraumatic stress, anxiety, and depression, and examine the feasibility and acceptability of the intervention for UK National Health Service frontline health care staff. The intervention was delivered with guidance from a clinical psychologist., Methods: We recruited 12 clinical staff from the UK National Health Service, specifically from emergency departments, the intensive care unit, and the ambulance service. We evaluated the intervention using an AB single-case experimental design, where the baseline (A) was the monitoring-only phase and the postintervention (B) period was the time after the intervention was first administered. Methods were adapted once the COVID-19 pandemic began., Results: There was a decrease (59%) in the mean number of intrusive memories per day from baseline (mean 1.29, SD 0.94) to postintervention (mean 0.54, SD 0.51). There was a statistically significant reduction in the number of intrusive memories from baseline to postintervention, as shown by an aggregated omnibus analysis with a small effect size (τ-U=-0.38; P<.001). Depression, anxiety, and posttraumatic stress symptoms all significantly reduced from preintervention to postintervention. Participants also reported improvements in functioning based on both quantitative and qualitative measures. The intervention was feasible to deliver and rated as acceptable by participants., Conclusions: These preliminary findings suggest that this brief therapist-guided imagery-competing task intervention offers a potential approach to mitigating the impact of work-related traumatic events in frontline health care staff, both during a pandemic and beyond. Randomized controlled trials will be an important next step., (©Veronika Kubickova, Craig Steel, Michelle L Moulds, Marie Kanstrup, Sally Beer, Melanie Darwent, Liza Keating, Emily A Holmes, Lalitha Iyadurai. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 18.11.2024.)

Based on the Health Belief Model (HBM), this study examined what messages about COVID-19 were presented on the World Health Organization (WHO)'s Facebook posts, and evaluated WHO's health promotion strategies by examining the public engagement and sentiment stimulated by different health promotion constructs. One issue with previous studies on HBM and social networking sites is that many researchers considered positive "online engagements" as evidence of "effective health promotion". However, online engagement measures such as shares and comments cannot reflect the sentiment's valence. Another limitation in previous studies is that they often failed to differentiate between sentiments towards health measures and sentiments towards the disease. We utilized Facebook's emojis to explore the public's distinct sentiments towards the WHO's COVID-19-related health measures and sentiments towards COVID-19. We used content analysis to examine the all the COVID-19-related Facebook posts published by the WHO in 2020, the first year of the pandemic when the COVID-19 vaccines were not generally available to the public. In general, the use of HBM constructs was successful in capturing users' attention and generating engagement. However, regarding the effect of the use of HBM constructs on the beliefs in COVID-19-related health measures, the results were complex. The mentioning of the beliefs about a disease (perceived susceptibility and severity) tend to induce people's negative sentiments. The mentioning of ways to increase self-efficacy and cues to actions significantly reduced people's online engagements and sentiment (either positive or negative). Benefits only stimulated users' negative reactions while barriers could not stimulate any reactions. Video and text posts generally attracted more Facebook engagement than image and text posts, while text-only posts generally received the least Facebook engagement. We demonstrated that certain health promotion strategies can backfire and even induce negative reactions. Policymakers should be alert to this phenomenon when mentioning certain constructs during health promotions., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Recent research has shown significant individual differences in COVID-19 psychosomatic symptoms. However, there has been a lack of studies investigating the influence of physical and psychological factors on these symptoms and their underlying mechanisms. This study aims to fill this gap by investigating the predictive role of self-compassion and social support on COVID-19 psychosomatic symptoms, as well as the potential mediating role of sleep quality., Methods: Data were collected from 636 participants infected with COVID-19 during the early post-pandemic reopening phase in China. The measurement tools used in the current study included the Self-Compassion Scale, the Perceived Social Support Scale, Self-Rating Scale of Sleep, and a COVID-19 Psychosomatic Symptom Diary., Results: A structural equation model revealed that: (1) social support directly predicts COVID-19 psychosomatic symptoms; (2) sleep quality fully mediates the relationship between self-compassion and COVID-19 psychosomatic symptoms; and (3) sleep quality partially mediates the relationship between social support and COVID-19 psychosomatic symptoms., Conclusions: These findings not only confirm previous research but also provide new insights into the intricate interplay between psychological and physical factors and their influence on COVID-19 psychosomatic symptoms. The implications of these findings may inform the development of targeted rehabilitation programs in the post-pandemic era of the "new normal"., Clinical Trial Number: Not applicable., Competing Interests: Declarations Ethics approval and consent to participate The study was approved by the Human Research Ethics Committee for Non-clinical Faculties at School of Psychology, Qingdao University, QDU-PSY-20231101. This study was conducted in accordance with the Declaration of Helsinki. All participants provided signatures of informed consent. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objective: Long COVID is a condition characterised by persistent symptoms after a SARS-CoV-2 infection, with neurological manifestations being particularly frequent. Existing research suggests that long COVID patients not only report cognitive symptoms but also exhibit measurable cognitive impairment. Neuroimaging studies have identified structural alterations in brain regions linked to cognitive functions. However, most of these studies have focused on patients within months of their initial infection. This study aims to explore the longer-term cognitive effects and brain structural changes in long COVID patients, approximately two years post-infection, in a cohort from San Martín, Buenos Aires, Argentina., Methods: We conducted a cross-sectional study involving 137 participants: 109 with long COVID symptoms and 28 healthy controls. The participants underwent an initial clinical assessment, completed a structured questionnaire and standardised scales, underwent a cognitive assessment, and had a brain MRI scan. Structural MRI images were processed via FreeSurfer and FSL to obtain volumetric measures for subcortical and cortical regions, along with regional cortical thickness. Differences between groups for these variables were analysed using ANCOVA, with permutation tests applied to correct for multiple comparisons., Results: Long COVID patients reported persistent cognitive symptoms such as memory problems and brain fog, with higher levels of fatigue and reduced quality of life compared to controls. Despite subjective cognitive complaints, cognitive tests did not reveal significant differences between groups, except for the TMT-A (p = 0.05). MRI analysis revealed decreased volume in the cerebellum (p = 0.03), lingual gyrus (p = 0.04), and inferior parietal regions (p = 0.03), and reduced cortical thickness in several areas, including the left and right postcentral gyri (p = 0.02, p = 0.03) and precuneus (p = 0.01, p = 0.02)., Conclusions: This study highlights the enduring impact of long COVID on quality of life and physical activity, with specific brain structural changes identified two years post-infection. Although cognitive tests did not show clear impairment, the observed brain atrophy and significant reduction in quality of life emphasize the need for comprehensive interventions and further longitudinal studies to understand the long-term effects of long COVID on cognition and brain health., Competing Interests: Declarations Ethics approval and consent to participate The study was approved by the HIGA Eva Peron Research Bioethics Committee (OHRP registration number IRB00002792). All subjects provided written informed consent. All methods were performed in accordance with the relevant guidelines and regulations. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Cognitive symptoms are often reported by those with a history of COVID-19 infection. No comprehensive meta-analysis of neurocognitive outcomes related to COVID-19 exists despite the influx of studies after the COVID-19 pandemic. This study meta-analysed observational research comparing cross-sectional neurocognitive outcomes in adults with COVID-19 (without severe medical/psychiatric comorbidity) to healthy controls (HCs) or norm-referenced data., Methods: Data were extracted from 54 studies published between January 2020 and June 2023. Hedges' g was used to index effect sizes, which were pooled using random-effects modelling. Moderating variables were investigated using meta-regression and subgroup analyses., Results: Omnibus meta-analysis of 696 effect sizes extracted across 54 studies (COVID-19 n=6676, HC/norm-reference n=12 986; average time since infection=~6 months) yielded a small but significant effect indicating patients with COVID-19 performed slightly worse than HCs on cognitive measures (g=-0.36; 95% CI=-0.45 to -0.28), with high heterogeneity (Q=242.30, p<0.001, τ=0.26). Significant within-domain effects was yielded by cognitive screener (g=-0.55; 95% CI=-0.75 to -0.36), processing speed (g=-0.44; 95% CI=-0.57 to -0.32), global cognition (g=-0.40; 95% CI=-0.71 to -0.09), simple/complex attention (g=-0.38; 95% CI=-0.46 to -0.29), learning/memory (g=-0.34; 95% CI=-0.46 to -0.22), language (g=-0.34; 95% CI=-0.45 to -0.24) and executive function (g=-0.32; 95% CI=-0.43 to -0.21); but not motor (g=-0.40; 95% CI=-0.89 to 0.10), visuospatial/construction (g=-0.09; 95% CI=-0.23 to 0.05) and orientation (g=-0.02; 95% CI=-0.17 to 0.14). COVID-19 samples with elevated depression, anxiety, fatigue and disease severity yielded larger effects., Conclusion: Mild cognitive deficits are associated with COVID-19 infection, especially as detected by cognitive screeners and processing speed tasks. We failed to observe clinically meaningful cognitive impairments (as measured by standard neuropsychological instruments) in people with COVID-19 without severe medical or psychiatric comorbidities., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To investigate how post-traumatic growth (PTG) and moral sensitivity influence service behaviour among healthcare workers (HCWs) in mainland China post-COVID-19, with a focus on the mediating role of moral sensitivity., Design: Cross- sectional survey design., Setting: This study was conducted in 27 provinces across mainland China, from 16 March to 2 April 2023., Participants: 1,193 HCWs, including 378 physicians and 815 nurses, were selected using convenience and snowball sampling methods., Methods: The survey included the Post-traumatic Growth Inventory-Chinese version (PTGI-C), the Moral Sensitivity Questionnaire-Revised Chinese Version (MSQ-R-CV) and a service behaviour scale. Structural equation modelling was employed to analyse the data, focusing on the associations between PTG, moral sensitivity, and service behaviours., Results: The study found significant associations between PTG and moral sensitivity (r=0.49, p<0.01), with both factors positively influencing HCWs' service behaviours. Specifically, PTG had a direct effect on service behaviours ( β =0.172, p<0.01) and an indirect effect through moral sensitivity ( β =0.333, p<0.01), with moral sensitivity mediating 65.8% of PTG's impact on service behaviours. The model explained 56.0% of the variance in service behaviours, indicating a substantial influence of these psychological factors on professional conduct., Conclusions: The findings highlight the significant role of PTG and moral sensitivity in shaping the service behaviours of HCWs in the aftermath of the COVID-19 pandemic. The study suggests that enhancing PTG and moral sensitivity through targeted interventions could improve HCWs' service delivery and resilience, emphasising the importance of incorporating psychological and ethical training into healthcare practices to prepare for future public health crises., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Healthcare workers (HCWs) have been of particular relevance for overcoming the SARS-CoV-2 pandemic. At the same time they have been affected by SARS-CoV-2 infections with above average probability. Around 6.5% of the overall infected persons are likely to develop persistent symptoms resulting from the infection, known as long-COVID or post-COVID syndrome (PCS). The aim of this study is (1) to investigate the prevalence, course and characteristics of PCS in German HCWs, (2) to examine its effects on psychosocial variables, (3) to identify rehabilitation and healthcare needs and (4) to analyse treatment experiences., Methods and Analysis: In a cohort study with a randomised selection of participants (N=20 000) from the Employer's Liability Insurance Association for Health and Welfare Care, the health status of HCWs, who had COVID-19 in their professional context will be examined. There will be two measurement points: baseline (T 1 ) and a 12-month follow-up (T2). The outcome measures are the health status with a particular focus on persistent or newly occurring symptoms after a SARS-CoV-2 infection, health-related quality of life, functional capacity, the subjective need for and utilisation of healthcare services. Pre-existing conditions, the course of the acute infection and sociodemographic factors are considered as predictors. An advisory board made up of affected HCWs supports the study by contributing to the surveys' contents., Ethics and Dissemination: The study has been approved by the Local Ethics Committee of the Center for Psychosocial Medicine at the University Hospital Hamburg-Eppendorf (LPEK-0518). For dissemination, the results will be published in peer-reviewed journals, presented at conferences and communicated to relevant stakeholders in general and rehabilitation medicine., Trail Registration Number: https://drks.de/search/de/trial/DRKS00029314., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Telehealth, including video consultation (VC), has become prevalent during the COVID-19 pandemic. However, the experience and concern of women using VC for postpartum care has yet to be adequately studied but is crucial for their adoption. The study aimed to assess the experience and attitude of postpartum mothers (PPM) towards using VC as a novel model of care delivery and the factors that could potentially affect their adoption., Method: Data were gathered from PPM participating in VC using Zoom platform for postpartum care using mixed method. In-depth interviews (IDI) of twenty-five PPM were audio-recorded, transcribed verbatim and audited for accuracy. Thematic analysis was conducted to identify themes relating to perceived threat, usefulness, ease of use, and attitudes toward using VC in postpartum care. The themes are reported based on the "Health Information Technology Acceptance Model" framework. Preliminary quantitative data on the acceptability of VC were collected using structured surveys., Results: PPMs valued convenience, accessibility, and personalised care VC offered to address their immediate postpartum concerns. They perceived VC as suitable for seeking medical opinions, improving confidence in parent crafting, and providing better care access. They recognised the lack of physical examination as a major limitation in VC and proposed a hybrid postpartum care model, combining VC and in-person consultation to cater to individual needs and preferences. PPMs alluded to trust in the care providers, flexibility in VC appointment timings and enhanced interface of remote platforms as enablers for VC adoption. Preliminary quantitative data shows that PPMs found VC saved time (100%), energy (98%), and money (90%) and was appropriate (94%), easy to use (96%), acceptable (96%) for postpartum care., Conclusion: PPMs favoured combining VC and in-person consultation to mitigate their concerns and personalise their care needs., Competing Interests: Declarations Ethics approval and consent to participants The study was approved by the SingHealth Centralised Institutional Review Board (CIRB 2021/2732). The research was conducted according to International Conference on Harmonisation Guidelines for Good Clinical Practice. All participants signed written informed consent before study activities. Consent for publication Not applicable. Author information The research team included four female PCP, one male PCP, two female nurses and one female student. The nurses are qualified lactational counselors. ASM and PZ are trained in qualitative and quantitative research. NCT is a trainer and experienced researcher in both qualitative and quantitative research. The PCPs and nurses manage and counsel patients in polyclinics, including mothers, during antenatal and postnatal periods. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

The COVID-19 epidemic not only impacted China's economy but also induced periodic anxiety among employees, especially during its peak. Even as governmental controls relaxed, enterprises seemed unaffected externally. However, beneath the surface, the lingering effects on employee mental health persisted. Many faced dual stressors concerning their job and personal well-being due to the epidemic, heightening work-related anxieties. This research, a year after China resumed work, delves into the psychological stress influencing this sustained anxiety. A survey of 516 employees helped test the hypothesis using a multiple regression model. Findings indicated heightened continuous work anxiety due to the epidemic, particularly in hard-hit areas. However, individual resilience, organizational, and social support were found to mitigate these effects. The study underscores the sustained psychological aftermath of the epidemic on employees, urging health authorities to address it.

Background: When there is limited access to primary care or end-of-life services for patients with chronic diseases, caregivers often need to bring their loved ones to emergency departments (EDs) to solve or control distressing physical and psychosocial-spiritual problems. There is limited literature about the experiences of primary caregivers of patients with nononcologic chronic diseases who are at the end of life and are evaluated in EDs in Latin America., Methods: We conducted in-depth interviews with primary caregivers of adult patients with advanced and terminal chronic nononcologic diseases who were evaluated in the ED of a hospital in Lima, Peru. This qualitative study employed a phenomenological approach. Themes, categories, codes, and quotes were analyzed using ATLAS.ti 9.1.4., Results: Twelve primary caregivers, aged 38 to 76 years old, mostly female immediate family members (daughter or wife), participated. They described their experiences in the ED, including feelings of despair and anguish due to prolonged waiting times, insufficient resources, incomplete information regarding the patient's problems, and "insensitive" treatment by the staff. Some also expressed gratitude for "saving patient's lives." They also experienced deficiencies in home care follow-up and patient transfers, which worsened during the COVID-19 pandemic; many times they felt that "they were ignored." When caring for patients at home, caregivers felt sad, helpless, and frustrated as they observed patients' progressive deterioration. As patients approached death, caregivers expressed that they tried to "give them all the love" and to have them present for as long as possible, although at the same time caregivers did not want patients to continue to suffer and hoped for "a better place" after this life. Caregivers found their faith to be a source of strength as they continued to care for and be with their loved one until the end., Conclusion: Caregivers reported "traumatic" and "shocking" experiences during ED care, as well as conflict between wanting the patient's suffering to end and wanting to prolong their lives. They also expressed feelings of gratitude, resignation, love, faith, and hope., Competing Interests: Declarations Ethics approval and consent to participate The research was conducted with the approval of the Ethics Committee of Rebagliati Hospital (Note 206-CE-GHNERM-GRPR-ESSALUD-2020). All Participants signed an informed consent document, in this study there was not any participant below the age of 16. All methods were performed in accordance with the relevant guidelines and regulations (Declaration of Helsinki). Consent to publish Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objectives: To investigate the relationships between life events and psychological distress in the postepidemic era as well as the effects of fear of COVID-19 (FCV-19) and impermanence on these relationships to enrich the study of the underlying psychological mechanisms of postepidemic psychological distress and to provide a theoretical basis for scientific prevention and intervention in individuals with psychological distress., Methods: A survey of 504 adults (71.3% female; age M = 26.87, SD = 10.70) was conducted via the Social Readjustment Rating Scale, the FCV-19 Scale, the Impermanence Scale, the Anxiety Scale and the Depression Scale, and a structural equation model was established to explore the relationships between variables., Results: The present study revealed the following: (1) there is a significant positive correlation between life events and psychological distress; (2) FCV-19 completely mediates the relationship between life events and psychological distress; and (3) impermanence moderates the mediation, regulating the path by which life events affect FCV-19 and the path by which FCV-19 affects psychological distress., Conclusions: In the postepidemic era, impermanence can effectively mitigate the impact of life events on FCV-19 and the impact of FCV-19 on psychological distress., Competing Interests: Declarations Ethics approval and consent to participate The study was performed in line with the ethical standards set out in the 1964 Declaration of Helsinki and its later amendments. The Ethics Committee of the Third Affiliated Hospital of Chongqing Medical University reviewed and approved all procedures used in this study on April 9, 2021. Informed consent was obtained from all participants. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: The COVID-19 pandemic created stressors to daily living, leading to increased mental health problems. It is important to assess the influence of COVID-19 pandemic on mental health, specifically anxiety., Objectives: The goal was to determine the prevalence and sociodemographic, clinical, and other correlates of likely Generalized Anxiety Disorder (GAD) among study subjects in Ghana., Design: This study employed a cross-sectional approach, using an online survey administered primarily through social media platforms. The survey questions included the GAD-7 scale, which was used to assess likely GAD in respondents. Data were analyzed using descriptive statistics, chi-square tests, and logistic regression analysis., Participants: Overall, 756 respondents completed the survey, mainly from Ashanti and Greater Accra, which were the hardest hit by COVID-19., Results: The prevalence of likely GAD in our sample was 7.6%. Gender, loss of job due to COVID-19, and seeking mental health counseling were independently associated with increased likelihood of GAD., Conclusions: The findings suggest that women, those who lost their jobs due to the COVID-19 pandemic, and those who sought mental health counseling were more likely to experience moderate to high anxiety symptoms as a result of the COVID-19 pandemic. Priority must be attached to psychological support measures for members of these groups.

Background: Mental health disorders are currently the main contributor to poor quality of life and years lived with disability. Symptoms common to many mental health disorders lead to impairments or changes in the use of language, which are observable in the routine use of social media. Detection of these linguistic cues has been explored throughout the last quarter century, but interest and methodological development have burgeoned following the COVID-19 pandemic. The next decade may see the development of reliable methods for predicting mental health status using social media data. This might have implications for clinical practice and public health policy, particularly in the context of early intervention in mental health care., Objective: This study aims to examine the state of the art in methods for predicting mental health statuses of social media users. Our focus is the development of artificial intelligence-driven methods, particularly natural language processing, for analyzing large volumes of written text. This study details constraints affecting research in this area. These include the dearth of high-quality public datasets for methodological benchmarking and the need to adopt ethical and privacy frameworks acknowledging the stigma experienced by those with a mental illness., Methods: A Google Scholar search yielded peer-reviewed articles dated between 1999 and 2024. We manually grouped the articles by 4 primary areas of interest: datasets on social media and mental health, methods for predicting mental health status, longitudinal analyses of mental health, and ethical aspects of the data and analysis of mental health. Selected articles from these groups formed our narrative review., Results: Larger datasets with precise dates of participants' diagnoses are needed to support the development of methods for predicting mental health status, particularly in severe disorders such as schizophrenia. Inviting users to donate their social media data for research purposes could help overcome widespread ethical and privacy concerns. In any event, multimodal methods for predicting mental health status appear likely to provide advancements that may not be achievable using natural language processing alone., Conclusions: Multimodal methods for predicting mental health status from voice, image, and video-based social media data need to be further developed before they may be considered for adoption in health care, medical support, or as consumer-facing products. Such methods are likely to garner greater public confidence in their efficacy than those that rely on text alone. To achieve this, more high-quality social media datasets need to be made available and privacy concerns regarding the use of these data must be formally addressed. A social media platform feature that invites users to share their data upon publication is a possible solution. Finally, a review of literature studying the effects of social media use on a user's depression and anxiety is merited., (©David Owen, Amy J Lynham, Sophie E Smart, Antonio F Pardiñas, Jose Camacho Collados. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 15.11.2024.)

Background: A significant number of coronavirus disease 2019 (COVID-19) survivors are experiencing long COVID, with symptoms lasting beyond three months. While diverse long COVID symptoms are established, there are gaps in understanding its long-term trends, intensity, and risk factors, requiring further investigation., Aims: This study aimed to investigate the long COVID characteristics and associated factors by following COVID-19 survivors for one year post-infection and comparing them with healthy counterparts., Main Methods: In this longitudinal, correlational study, COVID-19 survivors diagnosed between November 2021 and February 2023 were monitored every three months for a year. Participants aged ≥18 years who had reported a positive COVID-19 test were recruited via social media and healthcare provider referrals., Key Findings: Out of 182 survivors who initially agreed to participate, 176 completed the study. The mean age was 47.56 years (SD = 16.2), and 51.1 % were female. There was a clinically significant decline in cognitive function and health-related quality of life over time, with symptoms like shortness of breath, reduced physical fitness, and increased health concerns. Those with severe acute COVID-19 symptoms experienced greater cognitive and physical declines and more shortness of breath a year later. Lower financial status was linked to poorer health-related quality of life and increased health concerns., Significance: A year post-infection, COVID-19's impact on cognitive function and health-related quality of life remains significant, affecting individuals and communities. Survivors with severe initial symptoms and economic disadvantages need more attention. Future research should identify additional predictors of severe long COVID., Competing Interests: Declaration of competing interest None to declare., (Copyright © 2024. Published by Elsevier Inc.)

Cognitive dysfunction is a commonly reported feature of Long COVID (LC). With the overlap of assessment and treatment for cognitive concerns across multiple disciplines, coupled with current guidelines supporting interdisciplinary care, the aim of this clinically focused article is to provide a review of current guidelines and research related to assessment and interventions to address LC-related cognitive concerns within clinical practice from a multidisciplinary perspective, incorporating best practices for collaboration among Clinical Neuropsychologists, Rehabilitation Psychologists, and Speech-Language Pathologists. Current guidelines for assessment and interventions for cognitive functioning are provided, with clinical suggestions for best practices offered. Additional considerations related to diversity and variable patient presentations are identified. This article provides guidance based on current research and practice standards regarding the utilization of a multidisciplinary, collaborative approach to provide comprehensive assessment and treatment for individuals with LC-related cognitive concerns., Competing Interests: Declaration of competing interest The authors declare that there are no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: This study aimed to examine acute and chronic stressors, and perceived lack social support, and their associations with depression and suicidal ideation in adolescents during the COVID-19 pandemic., Methods: Deidentified data from (N = 270,153) U.S. adolescents aged 11 to 17 who completed the Patient Health Questionnaire 9-item tool (PHQ-9) in the years 2020 and 2021 were sourced from a collection of online screening tools that are free, confidential, anonymous, and scientifically validated. In addition to depression, the survey included questions about suicidality, past/chronic stressful events, and contributors to mental health problems and sociodemographic variables. SPSS software version 28 for descriptive analyses, and Mplus version 7.31 for confirmatory factor analysis (CFA) and structural equation modeling (SEM), were respectively used., Results: Participants were predominantly female, White, and heterosexual, and exhibited a high prevalence of severe depression and a significant frequency of suicidal thoughts. Significant associations were found between past/chronic stressful events, and lack of social support, with suicidality and depression. Mental health stress due to the COVID-19 pandemic itself presented no significant associations with depression and suicidality and was weakly and negatively associated with lack of social support and past/chronic stressors., Discussion: These findings reinforce the notion that prior traumatic events can create vulnerabilities in the face of acute stressors, while social support can enhance resilience in adolescents. Factors that increase resilience, such as preventing traumatic events, reducing social stressors, and increasing social support, can serve as valuable guidelines for clinical and public health interventions., Competing Interests: Declaration of competing interest Dr. Vidal receives funding from the NIDA/AACAP Physician Scientist Training Program in Substance Abuse Research, supported by NIDA Career Development Award (K12)., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: The literature on the trajectories of NSSI behavior during the pandemic is scarce and mainly short-term. Furthermore, studies have not explored the buffering mechanisms that may have altered risk trajectories during this vulnerable period. This study aims to analyze the univariate change of NSSI during adolescence and to examine the alteration of the univariate growth due to the time-varying effect of COVID-19-related stress, parenting dimensions (i.e., positive and negative parenting), and their interaction., Methods: Participants included 830 Italian adolescents (44.2 % females; M age  = 14.52; SD = 0.80), who participated in at least one time point of data collection, from a three-wave longitudinal study (T1: from December 2019 to January 2020; T2: December 2020; T3: December 2021)., Results: The Latent Growth Curve Analyses show a linear increase in NSSI over time. In regards to time-varying, at T1, the results highlight that higher levels of negative parenting are associated with higher levels of NSSI at the same time point. Instead, at T2, results show that pandemic stress is associated with higher levels of NSSI at T2. Regarding the interaction effect, positive parenting significantly buffered the effect of COVID-19 stress on NSSI at both T2 and T3., Limitations: Only some dimensions of parenting style (i.e., positive and negative parenting) are included., Conclusions: This study attempts to deepen the trajectory of NSSI behavior during the two years of the pandemic and examine the changes caused by the time-varying effects, thus providing suggestions for designing programs to prevent engagement in NSSI., Competing Interests: Declaration of competing interest The authors declare that there are no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: During the COVID-19 pandemic, hospitals implemented visitor restrictions to curtail the spread of the virus. The study aims to understand the perspectives of hospitalized patients and their family visitors on visitation restrictions and the factors influencing their willingness to adhere to these restrictions., Methods: This cross-sectional survey invited 1,200 participants, with 1,032 valid responses received, including 460 hospitalized patients and 572 family visitors., Results: The survey indicated that 88.91% of hospitalized patients and 93.00% of family visitors complied and adhered to the visitor restrictions. The predominant mode of communication was via phone (77.62%), with emotional support (56.40%) recognized as the primary purpose of visitation. Visitor restrictions significantly affected hospitalized patients, with 51.65% reporting feelings of loneliness and 42.44% reporting anxiety. After adjusting for age, gender, and other factors, hospitalized patients' willingness to follow visitation restrictions was linked to their awareness of the restrictions (odds ratio [OR] = 0.20, 95% confidence interval [CI]: 0.09-0.44) and their desire to protect (OR = 0.32, 95% CI: 0.14-0.76). Family members' willingness to follow the restrictions was related to their awareness of them (OR = 0.34, 95% CI: 0.12-0.95) and how well they communicated (OR = 0.23, 95% CI: 0.09-0.58)., Conclusions: Participants generally followed visitation restrictions, but these measures negatively impacted the psychological and social well-being of patients and their families, leading to increased feelings of loneliness and anxiety. Healthcare providers, hospital administrators, and policymakers should acknowledge the complex effects of these restrictions and focus on improving patient experiences in the future., Competing Interests: Declarations Ethical approval and consent to participate The Ningbo Medical Center LiHuili Hospital approved the study protocols for collecting and analyzing the survey data (No: KY2022SL246). Written informed consent was obtained from all participants. All procedures were performed following the relevant guidelines and regulations. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Aims: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on the risk of self-harming behaviours warrants further investigation. Here, we hypothesized that people with a history of hospitalization for self-harm may be particularly at risk of readmission in case of SARS-CoV-2 hospitalization., Methods: We conducted a retrospective analysis based on the French national hospitalization database. We identified all patients hospitalized for deliberate self-harm (10th edition of the International Classification of Diseases codes X60-X84) between March 2020 and March 2021. To study the effect of SARS-CoV-2 hospitalization on the risk of readmission for self-harm at 1-year of the inclusion, we performed a multivariable Fine and Gray model considering hospital death as a competing event., Results: A total of 61,782 individuals were hospitalized for self-harm. During the 1-year follow-up, 9,403 (15.22%) were readmitted for self-harm. Between inclusion and self-harm readmission or the end of follow-up, 1,214 (1.96% of the study cohort) were hospitalized with SARS-CoV-2 (mean age 60 years, 52.9% women) while 60,568 were not (mean age 45 years, 57% women). Multivariate models revealed that the factors independently associated with self-harm readmission were: hospitalization with SARS-CoV-2 (adjusted hazard ratio (aHR) = 3.04 [2.73-3.37]), psychiatric disorders (aHR = 1.61 [1.53-1.69]), self-harm history (aHR = 2.00 [1.88-2.04]), intensive care and age above 80., Conclusions: In hospitalized people with a personal history of self-harm, infection with SARS-CoV-2 increased the risk of readmission of self-harm, with an effect that seemed to add to the effect of a history of mental disorders, with an equally significant magnitude. Infection may be a significantly stressful condition that precipitates self-harming acts in vulnerable individuals. Clinicians should pay particular attention to the emergence of suicidal ideation in these patients in the aftermath of SARS-CoV-2 infection.

Background: Examining mental health among nurses in the later stages of the COVID-19 pandemic could offer valuable information for addressing these symptoms in the long term. Therefore, the current study aimed to assess the mental health and well-being of Chinese nurses, as well as investigate the impact of psychological flexibility and night shifts on this relationship., Method: In cross-sectional, hospital-based, multicenter study, 422 Chinese nurses were selected by multistage stratified cluster random sampling. The mental health status, psychological flexibility, and wellbeing were assessed via 12-item General Health Questionnaire (GHQ-12), Chinese version of Personalized Psychological Flexibility Index, and Chinese version of the 5-item WHO Well-Being Index, respectively. To examine the proposed theoretical model, we conducted structural equation modeling using SPSS Amos 26 version. The age, gender, night shift, psychological flexibility, mental health, and well-being data were entered into the model. Pearson correlation and chi-square were used to explore the correlation between variables., Results: The high night shifts, being young and low psychological flexibility significantly had a direct effect on worse mental health (night shifts: ES, 95% CI: 0.619, 0.328-0.725; age: ES, 95% CI: 0.542, 0.226-0.993; psychological flexibility: ES, 95% CI: 0.675, 0.369-1.466). The low psychological flexibility and worse mental health were able to directly effect on worse wellbeing (psychological flexibility: ES, 95% CI: 0.419, 0.757-1.519; mental health: ES, 95% CI: 0.719, 1.109-2.607). In addition, psychological flexibility through the mediation of mental health also had an indirect effect on wellbeing (ES, 95% CI: 0.269, 0.957-2.165)., Conclusions: Being young, having more night shifts and having less psychological flexibility can be related to the deterioration of mental health and well-being in nurses. Therefore, it is recommended that nurses use the shift routine program with the least focus on the night shifts. Also, interventions to teach younger nurses how to face work stress and interventions to improve the psychological flexibility of all nurses are needed., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Li et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: To describe delirium incidence before and during the COVID-19 pandemic and examine factors associated with delirium incidence in the long-term care setting., Methods: We conducted a retrospective cohort study of Ontario long-term care residents without severe cognitive impairment or baseline delirium with an assessment between February 1, 2019, and March 31, 2021. Data were collected from the interRAI Minimum Data Set (MDS) 2.0. The outcome of interest was delirium development. Selected independent variables were entered into univariate longitudinal generalized estimating equations, followed by multivariate analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) are reported., Results: A total of 63,913 residents were included within the comparison sample from February 2019 to February 2020. The pandemic sample consisted of 54,867 residents from March 2020 to March 2021. Incidence of delirium in the comparison sample was 3.4% (2158 residents) compared to 3.2% (1746 residents) in the pandemic sample (P = 0.06). Residents who were older, cognitively impaired, and increasingly frail had greater odds of developing delirium. Increased odds were associated with a diagnosis of bipolar disorder (OR 1.27, 95% CI 1.07-1.51) and anxiolytic use (OR 1.12, 95% CI 1.01-1.25). Residents who were newly admitted (OR 0.65, 95% CI 0.60-0.71) and those dependent for activities of daily living (OR 0.46, 95% CI 0.33-0.64) had lower odds of delirium development., Conclusions and Implications: The incidence of delirium did not differ between the year prior to and the first year of the COVID-19 pandemic, indicating that preventative interventions employed by long-term care homes may have been effective. Long-term care residents who are older, frail, cognitively impaired, or had unstable health would benefit from targeted interventions to prevent delirium. Newly admitted residents or those dependent in activities of daily living had lower odds of developing delirium, which could indicate under detection in these groups., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Kennedy et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: In palliative care, it is important for family caregivers to spend time with and care for the patient, and to receive (in)formal support. These elements were compromised during the Covid-19-pandemic. This study investigates what family caregivers of non-Covid-19-patients in the palliative phase shared online during the first wave of the pandemic, and what their communicative intentions were with posting online., Methods: To investigate what family caregivers shared online, a reflexive thematic analysis was performed on online newspaper articles and posts on Twitter, Facebook and online forums. To investigate family caregivers' communicative intentions with social media posts, content analysis was conducted guided by Speech Act Theory., Results: In total, 412 posts and articles were included, the majority being Tweets (86.7%). Four themes were constructed: 1) 'Being out of touch', 2) 'Fear, worries and uncertainties, 3) 'Disbelief, anger and resistance', and 4) 'Understanding, acceptance and gratitude'. Family caregivers felt overwhelmed with anger, sadness and anxiety, yet some expressing milder or positive attitudes towards the new circumstances. Family caregivers mostly posted online to share their personal experiences and emotions, and to express their opinions about the restrictions., Conclusions: The pandemic had distinct implications for family caregivers of non-Covid-19-patients in the palliative phase. In future similar circumstances, restrictions should be tailored to individual conditions and interventions should be in place to facilitate contact between patients, family caregivers and healthcare professionals and to support family caregivers., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Hoffstädt et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Physical inactivity is an ongoing problem throughout the lifespan. For older people, inactivity has a negative impact on wellbeing, which worsened during the COVID-19 pandemic. Digital technologies can be employed to encourage uptake of social and physical activity through remotely delivered interventions to improve wellbeing, however, we need to understand older people's perceptions and experiences of using digital technologies before implementing these interventions., Aims: To explore the perceptions and experiences of older people on the use of digital technologies during the COVID-19 pandemic., Methods: Qualitative semi-structured interviews were conducted with 16 community dwelling older people from Hertfordshire, United Kingdom who were all programme participants in a remotely delivered mind-body physical activity programme called Positive Movement. Interviews were conducted before programme participation. The audio recorded interviews were transcribed and analysed using thematic analysis., Results: Four themes emerged from the data. The perceived impact of COVID-19 on social contact, perceived impact of COVID-19 on mental wellbeing, using digital platforms for health or exercise and using digital platforms for social contact., Discussion: Participants reported reduced social contact due to COVID-19. Most participants reported using digital technologies for social inclusion rather than health reasons, and there were mixed views on the willingness to use digital technologies for physical activity., Conclusion: Digital technologies offered a lifeline during COVID-19 to maintain social contact and their use was found acceptable by older people. Digital platforms such as Zoom can be further employed to conduct remotely delivered interventions with the aim to increase uptake of social and physical activity interventions within this population., Competing Interests: Declarations Competing interests The authors declare no competing interests. Ethical standard Study approved by the Ethical Committee at the University of Bedfordshire (IHREC939). Informed consent Participants gave their informed consent. No identifiable details are included. All respondents aware of the intention to publish findings., (© 2024. The Author(s).)

Background: Some public health professionals have expressed concern that the COVID-19 pandemic has increased vaccine hesitancy about routine childhood vaccines; however, the differential prevalence of vaccine hesitancy about specific vaccines has not been measured., Methods: Data from the National Immunization Survey-Child COVID-19 Module (NIS-CCM) were analyzed to assess the proportion of children ages 6 months-17 years who have a parent with hesitancy about: COVID-19, influenza, human papillomavirus (HPV) (for children ≥ 9 years) vaccines, and "all other childhood shots." Interviews from October 2022 through April 2023 were analyzed., Results: The percentage of children with a vaccine-hesitant parent varied by vaccine. 55.9% of children had a parent hesitant about COVID-19 vaccine, 30.9% hesitant about influenza vaccine, 30.1% hesitant about HPV vaccine, and 12.2% had a parent hesitant about other vaccines such as measles, polio, and tetanus., Conclusion: The study findings suggest that differential interventions and communications to parents be used to educate about COVID-19, influenza, HPV, and routine childhood vaccinations because the hesitancy levels differ widely., 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., (Published by Elsevier Ltd.)

This paper analyses the relationship between working from home (WFH) and mental well-being at different stages during the first two critical years of the COVID-19 pandemic, when governments repeatedly imposed lockdowns and enacted WFH mandates to contain the spread of the virus. Using data from a representative survey conducted at four different time periods in 2020 (first lockdown, subsequent gradual reopening), 2021 (further lockdown) and 2022 (restrictions widely lifted) in the 27 EU member states, it examines the changing role of several mediators over time: work-family conflict, family-work conflict, stability, resilience, isolation, the importance of different support networks, workload, physical risk of contracting COVID-19 at work and housing conditions. For the first lockdown, it also differentiates by previous WFH experience, in terms of WFH novices and experienced WFH workers. It likewise differentiates by gender, in order to take the potential gendered nature of COVID-19 measures into account. The results point to several important mediators: for those who work from home, less family-work conflict and isolation, but greater stability, resilience, network support from family and friends, and superior housing conditions were associated with better mental well-being. The relevance of mediators was specific to certain stages of the pandemic. Stability was the most important mediator during the first lockdown. Work-family conflict and family-work conflict were only relevant during the first lockdown, while resilience and isolation mattered especially towards the end of the pandemic. Unlike established WFH workers, WFH novices had an advantage during the first lockdown, benefiting from lower family-work conflict and more helpful networks of family and friends. Our results differ by gender: for females who undertook WFH, important mediators were work-family conflict and family-work conflict. Both were related to adjustments they had to make in work and non-work hours in response to the enforced closure of schools and childcare facilities. For males who undertook WFH, support from networks of family and friends was an important mediator during the first lockdown., Competing Interests: The author has declared that no competing interests exist., (Copyright: © 2024 Sandra M. Leitner. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The COVID-19 pandemic's "Great Online Transition" significantly impacted teachers. Existing research on Emergency Remote Teaching (ERT) lacks longitudinal designs and consideration of subject-specific contexts. This study, using the Stressor-Strain-Outcome framework, investigates psychological needs thwarting (PNT) during ERT on teachers' well-being and online teaching intentions, considering subject of instruction as a potential factor., Methods: Data were collected from 1,369 Chinese primary and middle school teachers of Chinese literature, mathematics, and English as a Foreign Language (EFL) at two time points: two weeks after ERT implementation (Time 1, mid-November 2021) and two months later, after returning to face-to-face teaching (Time 2, mid-January 2022). PNT, emotional exhaustion, psychological distress, and intention towards online teaching were evaluated., Results: Among the types of PNT, competence thwarting emerged as the strongest predictor of emotional exhaustion, which was, in turn, associated with reduced online teaching intention and increased psychological distress. EFL teachers showed stronger associations between PNT, emotional exhaustion, and adverse outcomes, indicating higher susceptibility to strain during ERT., Conclusion: Subject of instruction, particularly for EFL teachers, significantly influences the relationship between PNT and teacher outcomes during ERT. Our findings underscore the need for subject-specific support strategies in online teaching environments., Competing Interests: Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board (IRB) of the Jiangxi Psychological Consultant Association (IRB ref: JXSXL-2020-J013). The electronically informed consent was obtained from all of the participants, where the purpose of the study, researcher’s affiliation, and privacy guarantee were explained. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: During the COVID-19 pandemic, the global incidence of non-suicidal self-injury (NSSI) has been increasing year by year, especially among adolescents, and it is highly correlated with the level of anxiety among teenagers, particularly within Chinese cultural contexts where parenting styles significantly influence adolescent behavior., Objective: This study examines the role of culturally-influenced parenting styles and adolescent coping strategies in relation to anxiety and NSSI behavior, aiming to clarify these multivariate interactions for better understanding and intervention., Methods: A cross-sectional survey was conducted with NSSI-diagnosed adolescents from Affiliated Kangning Hospital, Ningbo, China, and healthy adolescents from urban schools. Data on background, parenting styles, coping strategies, and anxiety levels were analyzed using chi-square tests, independent sample t -tests, MANOVA, and regression analysis., Results: Adolescents with NSSI reported higher anxiety levels, more punishment and interference, and less emotional warmth from their fathers compared to the non-NSSI group ( p  < 0.001). The NSSI group also relied more on emotion-oriented coping strategies, while the non-NSSI group favored problem-oriented approaches ( p  < 0.001). Multivariate analyses confirmed significant effects of NSSI behavior, parenting styles, and coping strategies on anxiety levels., Conclusion: This study found that the anxiety levels of NSSI adolescents were significantly higher than those of non-NSSI adolescents in China, which was closely related to less emotional warmth from parents, more punishment and interference, and emotion-focused coping strategies. The results demonstrate that family environment and coping strategies play a critical role in NSSI behavior and anxiety levels, highlighting the importance of emphasizing emotional support and positive coping strategies in the prevention and intervention of NSSI behavior., Competing Interests: The authors declare there are no competing interests., (©2024 Liu et al.)

Background: Co-use of alcohol and e-cigarettes (often called vaping) has been linked with long-term health outcomes, including increased risk for substance use disorder. Co-use may have been exacerbated by the COVID-19 pandemic. Social networking sites may offer insights into current perspectives on polysubstance use., Objective: The aims of this study were to investigate concurrent mentions of vaping and alcohol on Twitter (subsequently rebranded X) during a time of changing vaping regulations in the United States and the emergence of the COVID-19 pandemic., Methods: Tweets including both vape- and alcohol-related terms posted between October 2019 and September 2020 were analyzed using latent Dirichlet allocation modeling. Distinct topics were identified and described., Results: Three topics were identified across 6437 tweets: (1) flavors and flavor ban (n=3334, 51.8% of tweets), (2) co-use discourse (n=1119, 17.4%), and (3) availability and access regulation (n=1984, 30.8%). Co-use discussions often portrayed co-use as positive and prosocial. Tweets focused on regulation often used alcohol regulations for comparison. Some focused on the perceived overregulation of vaping (compared to alcohol), while others supported limiting youth access but not at the expense of adult access (eg, stronger age verification over product bans). Across topics, vaping was typically portrayed as less harmful than alcohol use. The benefits of flavors for adult smoking cessation were also discussed. The distribution of topics across time varied across both pre- and post-regulatory change and pre- and post-COVID-19 pandemic declaration periods, suggesting shifts in topic focus salience across time., Conclusions: Co-use discussions on social media during this time of regulatory change and social upheaval typically portrayed both vaping and alcohol use in a positive light. It also included debates surrounding the differences in regulation of the 2 substances-particularly as it related to limiting youth access. Emergent themes from the analysis suggest that alcohol was perceived as more harmful but less regulated and more accessible to underage youth than vaping products. Frequent discussions and comparisons of the 2 substances as it relates to their regulation emphasize the still-evolving vaping policy landscape. Social media content analyses during times of change may help regulators and policy makers to better understand and respond to common concerns and potential misconceptions surrounding drug-related policies and accessibility., (©Lynsie R Ranker, David Assefa Tofu, Manyuan Lu, Jiaxi Wu, Aruni Bhatnagar, Rose Marie Robertson, Derry Wijaya, Traci Hong, Jessica L Fetterman, Ziming Xuan. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 12.11.2024.)

Background: Acceptance of health care professionals is of paramount importance for the uptake and implementation of eHealth. The Unified Theory of Acceptance and Use of Technology (UTAUT) model is a widely used framework for studying health care professionals' acceptance and actual use of eHealth among general client populations. However, there is limited understanding of the eHealth acceptance of health care professionals working with people with intellectual disabilities (ID)., Objective: This study aimed to explore the applicability of the UTAUT model toward understanding the acceptance, intention to use, and actual use of eHealth among support staff and therapists working with people with ID., Methods: A total of 2 cross-sectional survey studies were conducted among health care professionals from 5 health care organizations for people with ID in the Netherlands in 2018 (n=311) and in 2021 during the COVID-19 pandemic (n=326). In addition to confirmatory and exploratory factor analyses to evaluate both the original UTAUT model and an extended version, descriptive analysis was used to explore participants' characteristics, acceptance levels, and eHealth usage. Moderator analysis and multiple regression analysis were also used., Results: A confirmatory factor analysis indicated a poor fit for both the original 4-factor UTAUT model and the extended version. An exploratory factor analysis was then conducted, resulting in a more satisfactory 5-factor model after removing 1 item with a factor loading <.40. Internal consistency of the 5 factors ranged from acceptable to good (Cronbach α=.76-.85). Collectively, all factors predicted the intention to use eHealth in 2018 (R 2 =0.47; F 5,305 =54.885; P<.001) and in 2021 (R 2 =0.43; F 5,320 =49.32; P<.001). Participants scored moderately on all 5 acceptance factors in both 2018 and 2021. Moderator analysis indicated that age and voluntariness influence the relationship between factors that determined acceptance and intention to use eHealth., Conclusions: The findings from 2 cross-sectional studies conducted in 2018 and 2021, using an extended UTAUT model, gave a deeper understanding of eHealth acceptance among health care professionals who work with people with ID., (©Cathelijn Oudshoorn, Noud Frielink, Heleen Riper, Petri Embregts. Originally published in JMIR Formative Research (https://formative.jmir.org), 12.11.2024.)

Background: COVID-19 is known to cause psychological problems. Psychological rehabilitation can be performed to reduce anxiety, depression, and insomnia. Facing patients with infectious diseases can be difficult for medical staff. Therefore, this study compared the effects of psychiatric tele-rehabilitation (TR) and conventional psychiatric rehabilitation (CR) in isolated patients with COVID-19., Methods: This randomized controlled study, conducted at a single community-based hospital, included 40 patients (24 in the psychiatric tele-rehabilitation group [TRG] and 16 in the conventional psychiatric rehabilitation group [CRG]) with COVID-19 were recruited from November 18, 2021, to April 7, 2022. Psychiatric rehabilitation is an occupation-based intervention in which patients perform meaningful activities and tasks. Patients in the TRG selected activities, received counseling, and underwent monitoring over the phone, while those in the CRG participated in face-to-face sessions. The interventions were conducted for 50 min each day during an isolation period of 7 days in both groups, and all participants received the interventions individually. The primary outcome was anxiety assessed using the Visual Analog Scale (VAS) and the Zung Self-Rating Anxiety Scale (SAS). Secondary outcomes include the Visual Analog Scale (VAS) and the Patient Health Questionnaire-9 (PHQ-9) to evaluate depression, the Multidimensional State Boredom Scale-8 (MSBS-8) to assess boredom. The Korean version of the Insomnia Severity Index (ISI-K) was used to assess the quality of sleep, and the World Health Organization Quality of Life Assessment Instrument-BRIEF (WHOQOL-BREF) was used to evaluate quality of life. Questionnaires were administered at admission, discharge, and at the 6-month follow-up., Results: In the time × group analysis, the SAS total score (p = .033) and the VAS score for depression (p = .012) in the CRG were significantly lower than those in the TRG at the time of discharge. The VAS score for anxiety (p = .007), total SAS score (p = .050), and VAS score for depression (p = .003) in the CRG were also significantly lower than those in the TRG at the 6-month follow-up. The PHQ-9, MSBS-8, ISI-K, and WHOQOL-BREF scores showed no significant interactions in the time × group analysis., Conclusions: TR was effective in reducing anxiety and improving quality of life during hospitalization, but had no remained effects after discharge. Otherwise, CR was more effective than TR for anxiety and depression during hospitalization and had remained effects at 6-month follow-up. However, considering the characteristics of infectious conditions that involve risk in contact, TR will still play an important role, and efforts will be needed to improve the effect that remained., Trial Registration: The trial was registered with the Korea Clinical Trials Registry (KCT0006714, Date of registration 08/11/2021)., Competing Interests: Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Seoul National University Bundang Hospital (B-2111-719-302). The requirement for obtaining written informed consent was waived by the Institutional Review Board of Seoul National University Bundang Hospital (B-2111-719-302). Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)