Effect of the COVID-19 pandemic on the well-being of middle-aged and older Europeans.

The COVID-19 pandemic has been associated with a general decline in well-being. However, there is limited evidence on the effect of the pandemic on the general population, and especially among the ageing population. We assessed the overall impact of the pandemic on the well-being of middle-aged and older adults residing in 27 European countries, focusing on the time-period before summer 2021. We used a sample of 46,209 respondents from the two population-based longitudinal Corona Surveys collected during summer 2020 and summer 2021. To test our hypotheses, we used latent change score models. All analyses were stratified by sex. The COVID-19 pandemic affected middle-aged and older Europeans' well-being irrespective of their sex. Being infected by the COVID-19 virus at the start of the pandemic had a negative impact on well-being. As expected, adults with Long COVID experienced the most pronounced decline in well-being. A novel finding was the decline in the level of well-being among adults not infected by the COVID-19 virus. Support should be provided at community levels with specific attention towards individuals with Long COVID symptoms and those infected with COVID-19 at earlier stages of the pandemic.

Caring for Long Covid patients in primary healthcare: a cross-sectional study on general practitioners' knowledge, perception and experience in Belgium and Malta.

BACKGROUND: At least 10% of Covid-19 recovered individuals experience persistent symptoms (Long Covid). Primary healthcare and general practitioners (GPs) are at the forefront in their care. In this study, GPs' knowledge, perceptions and experiences with Long Covid, and the definition used in two countries, are investigated to provide insight into GPs' care for Long Covid patients at a cross-country level. METHODS: A cross-sectional study targeted towards GPs was conducted in Belgium and Malta during spring and early summer 2022. An online survey consisting of 15 questions on Long Covid was disseminated. Additionally, country-specific practice and demographic characteristics were collected. Descriptive and logistic regression analyses were performed. RESULTS: A total of 150 GPs (Belgium = 105; Malta = 45) responded. Female GPs represented 58.0%, median age was 49 years (IQR: 37-61). Concerning GPs' knowledge and perception on Long Covid, in both countries, most GPs reported insufficient scientific knowledge and information on Long Covid diagnosis and treatment. Access to educational material was limited and an awareness-rising campaign on Long Covid was deemed necessary. Moreover, two out of three GPs stated that Long Covid patients were not well followed up by primary healthcare in mid-2022. For diagnosing Long Covid, 54.7% required a positive Covid-19 test, more often among Belgian GPs than Maltese (64.3% vs. 45.2%, p = 0.036). To assess Long Covid, GPs mainly applied diagnostic criteria by themselves (47.3%) in combination with persistent symptoms (4 weeks to 5 months). Most GPs had experience with Long Covid patients in their practice, regardless of practice type and GPs' country, sex or age (p = 0.353; p = 0.241; p = 0.194; p = 0.058). Although most GPs (94.7%) stated that Long Covid patients should follow multidisciplinary approach, 48.3% reported providing care for these patients themselves or with GP colleagues and only 29.8% by multidisciplinary cooperation. CONCLUSIONS: GPs frequently provide (multidisciplinary) care to Long Covid patients and GPs' care showed similarities at cross-country level. Although GPs perceive lack of scientific knowledge and educational material on Long Covid, similar diagnostic criteria among GPs were noted. Uniform evidence-based guidelines, scientific support and training for GP across Europe must be a priority to enhance their treatment approach to Long Covid.

A comparative systematic review of risk factors, prevalence, and challenges contributing to non-communicable diseases in South Asia, Africa, and Caribbeans.

BACKGROUND: Non-communicable diseases (NCDs) are a global epidemic challenging global public health authorities while imposing a heavy burden on healthcare systems and economies. AIM: To explore and compare the prevalence of NCDs in South Asia, the Caribbean, and non-sub-Saharan Africa, aiming to identify both commonalities and differences contributing to the NCD epidemic in these areas while investigating potential recommendations addressing the NCD epidemic. METHOD: A comprehensive search of relevant literature was carried out to identify and appraise published articles systematically using the Cochrane Library, Ovid, Google Scholar, PubMed, Science Direct, and Web of Science search engines between 2010 and 2023. A total of 50 articles fell within the inclusion criteria. RESULTS: Numerous geographical variables, such as lifestyle factors, socio-economic issues, social awareness, and the calibre of the local healthcare system, influence both the prevalence and treatment of NCDs. The NCDs contributors in the Caribbean include physical inactivity, poor fruit and vegetable intake, a sedentary lifestyle, and smoking, among others. While for South Asia, these were: insufficient societal awareness of NCDs, poverty, urbanization, industrialization, and inadequate regulation implementation in South Asia. Malnutrition, inactivity, alcohol misuse, lack of medical care, and low budgets are responsible for increasing NCD cases in Africa. CONCLUSION: Premature mortality from NCDs can be avoided using efficient treatments that reduce risk factor exposure for individuals and populations. Proper planning, implementation, monitoring, training, and research on risk factors and challenges of NCDs would significantly combat the situation in these regions.

A Good Night's Sleep in Malta in 2023: A Cross-sectional Study Exploring Sleep Quality and its Determinants via Social Media.

BACKGROUND: Sleep quality is affected by a plethora of different factors, although its relationship with chronic diseases is still unclear. This study explored perceived sleep quality and its associated determinants among the adult population of Malta. Study Design: A cross-sectional study. METHODS: An anonymous online survey was distributed through social media targeting adults residing in Malta. Data pertaining to socio-demographic, medical history, lifestyle, well-being, sleep, and daytime sleepiness were gathered, and descriptive, univariant, and multiple binary logistic regression modelling analyses were performed. RESULTS: A total of 855 adults responded, out of whom 35.09% (95% confidence interval [CI]: 31.90, 38.41) reported sleep difficulties, especially females (81.33%; 95% CI: 76.36, 85.49), while 65.33% (95% CI: 59.61, 70.65) reported suffering from chronic disease(s). Sleep problems were positively associated with multimorbidity (odds ratio [OR]: 2.17; 95% CI: 1.38, 3.40; P=0.001), sleeping<6 hours (OR: 3.79; 95% CI: 1.54, 9.30; P=0.040), and the presence of moderate anxiety symptoms (OR: 1.99; 95% CI: 1.10, 3.59; P=0.020). They were also related to the presence of mild (OR: 2.25; 95% CI: 1.46, 3.45; P=0.001), moderate (OR: 2.40; 95% CI: 1.24, 4.64; P=0.010), and moderately severe (OR: 15.35; 95% CI: 4.54, 31.86; P=0.001) depressive symptoms after adjusting for confounders. CONCLUSION: Chronic conditions, including anxiety and depression, along with short sleep duration, appear to contribute to poor sleep quality in Malta. A multifaceted approach is required to deal with the issue holistically and safeguard the health of current and future generations.

National health examination surveys; a source of critical data.

The aim of this paper is to contribute technical arguments to the debate about the importance of health examination surveys and their continued use during the post-pandemic health financing crisis, and in the context of a technological innovation boom that offers new ways of collecting and analysing individual health data (e.g. artificial intelligence). Technical considerations demonstrate that health examination surveys make an irreplaceable contribution to the local availability of primary health data that can be used in a range of further studies (e.g. normative, burden-of-disease, care cascade, cost and policy impact studies) essential for informing several phases of the health planning cycle (e.g. surveillance, prioritization, resource mobilization and policy development). Examples of the use of health examination survey data in the World Health Organization (WHO) European Region (i.e. Finland, Italy, Malta and the United Kingdom of Great Britain and Northern Ireland) and the WHO Region of the Americas (i.e. Chile, Mexico, Peru and the United States of America) are presented, and reasons why health provider-led data cannot replace health examination survey data are discussed (e.g. underestimation of morbidity and susceptibility to bias). In addition, the importance of having nationally representative random samples of the general population is highlighted and we argue that health examination surveys make a critical contribution to external quality control for a country's health system by increasing the transparency and accountability of health spending. Finally, we consider future technological advances that can improve survey fieldwork and suggest ways of ensuring health examination surveys are sustainable in low-resource settings.

Cet article a pour objet d'apporter des arguments techniques au débat sur l'importance des enquêtes de santé par examen et sur leur utilisation continue pendant la crise post-pandémique du financement de la santé et dans le contexte d'un essor de l'innovation technologique qui offre de nouvelles façons de collecter et d'analyser les données individuelles sur la santé (comme l'intelligence artificielle). Les considérations techniques démontrent que les enquêtes de santé par examen apportent une contribution irremplaçable à la disponibilité locale de données de santé primaires qui peuvent servir dans une série d'études complémentaires (telles que des études normatives, sur la charge de morbidité, la cascade des soins, les coûts et l'impact des politiques). Ces études sont essentielles pour renseigner plusieurs phases du cycle de planification sanitaire (par exemple: surveillance, priorisation, mobilisation de ressources et élaboration de politiques). Cet article présente des exemples d'utilisation des données d'enquêtes de santé par examen dans la Région OMS de l'Europe (Finlande, Italie, Malte et Royaume-Uni de Grande-Bretagne et d'Irlande du Nord) et dans la Région OMS des Amériques (Chili, États-Unis d'Amérique, Mexique et Pérou) et aborde les raisons pour lesquelles les données fournies par les prestataires de soins de santé ne peuvent pas remplacer les données d'enquêtes de santé par examen (par exemple la sous-estimation de la morbidité et la vulnérabilité aux biais). En outre, il soulignet l'importance de disposer d'échantillons aléatoires représentatifs de la population générale au niveau national, et nous soutenons que les enquêtes de santé par examen apportent une contribution essentielle au contrôle externe de la qualité du système de santé d'un pays en renforçant la transparence des dépenses de santé et l'obligation de rendre des comptes à leur sujet. Enfin, nous envisageons les futures avancées technologiques susceptibles d'améliorer le travail d'enquête sur le terrain et suggérons des moyens d'assurer la viabilité des enquêtes de santé par examen dans les environnements à faibles ressources.

El objetivo de este artículo es aportar argumentos técnicos al debate sobre la importancia de las encuestas de salud y su uso continuado durante la crisis de financiación sanitaria pospandémica y en el contexto de un auge de la innovación tecnológica que ofrece nuevas formas de recopilar y analizar datos sanitarios individuales (por ejemplo, la inteligencia artificial). Las consideraciones técnicas demuestran que las encuestas de salud contribuyen de manera insustituible a la disponibilidad local de datos sanitarios primarios que pueden utilizarse en toda una serie de estudios posteriores (por ejemplo, estudios normativos, de carga de morbilidad, de cascada asistencial, de costes y de impacto de las políticas) esenciales para fundamentar varias fases del ciclo de planificación sanitaria (por ejemplo, vigilancia, establecimiento de prioridades, movilización de recursos y elaboración de políticas). Se presentan ejemplos del uso de los datos de las encuestas de salud en la Región Europea de la Organización Mundial de la Salud (Finlandia, Italia, Malta y el Reino Unido de Gran Bretaña e Irlanda del Norte) y en la Región de las Américas de la OMS (Chile, Estados Unidos de América, México y Perú) y se analizan las razones por las que los datos obtenidos por los proveedores sanitarios no pueden sustituir a los de las encuestas de salud (por ejemplo, la subestimación de la morbilidad y la posibilidad de sesgo). Además, se destaca la importancia de contar con muestras aleatorias representativas de la población general a escala nacional y se argumenta que las encuestas de salud contribuyen de forma decisiva al control de calidad externo del sistema sanitario de un país, al aumentar la transparencia y la rendición de cuentas del gasto sanitario. Por último, se examinan los futuros avances tecnológicos que pueden mejorar el trabajo de campo de las encuestas y se sugieren métodos para garantizar que las encuestas de salud sean sostenibles en entornos con pocos recursos.

Exploring the determinants associated with adult mortality in Malta: A cohort study between 2014 and 2020.

Objective: The study set to explore the mortality causes across six years and identify potential mortality determinates at a population level in Malta. Study design and methods: A longitudinal follow-up of a Malta based cross-sectional national representative study across 6 years (2014-2020) was carried out. The study population was cross-linked to the mortality register and causes of death obtained. Population characteristics gathered during initial examination were analysed through univariant and multivariant logistic regressions. Results: A total of 66 adults, mostly male (65.15 % n = 43) died, with commonest cause being cancer (42.42 % CI95 %: 31.24-54.45) mostly due to malignant neoplasm of bronchus and lung. This was followed by cardiac pathologies including acute myocardial infarction, ischaemic cardiomyopathy, and cardiomegaly (25.76 % CI95 %: 16.67-37.51). Multivariant logistic regression analyses revealed positive associations between age (OR: 1.99 p = 0.02), history of coronary heart disease (OR: 11.78 p=<0.001), smoking for 31 years or more (OR: 8.22 p=<0.001) and presence of multimorbidity (OR: 1.32 p = 0.02). Conclusion: It is evident that occurrence of cancers is a concern in Malta, and it requires targeted action including the reduction of smoking habits. Understanding the mortality causes and the associated determining factors at a population level enable the institution of preventive actions while strengthening healthcare services to safeguard the population from premature mortality and co-morbidity.

The state of health in the European Union (EU-27) in 2019: a systematic analysis for the Global Burden of Disease study 2019.

BACKGROUND: The European Union (EU) faces many health-related challenges. Burden of diseases information and the resulting trends over time are essential for health planning. This paper reports estimates of disease burden in the EU and individual 27 EU countries in 2019, and compares them with those in 2010. METHODS: We used the Global Burden of Disease 2019 study estimates and 95% uncertainty intervals for the whole EU and each country to evaluate age-standardised death, years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs) rates for Level 2 causes, as well as life expectancy and healthy life expectancy (HALE). RESULTS: In 2019, the age-standardised death and DALY rates in the EU were 465.8 deaths and 20,251.0 DALYs per 100,000 inhabitants, respectively. Between 2010 and 2019, there were significant decreases in age-standardised death and YLL rates across EU countries. However, YLD rates remained mainly unchanged. The largest decreases in age-standardised DALY rates were observed for "HIV/AIDS and sexually transmitted diseases" and "transport injuries" (each -19%). "Diabetes and kidney diseases" showed a significant increase for age-standardised DALY rates across the EU (3.5%). In addition, "mental disorders" showed an increasing age-standardised YLL rate (14.5%). CONCLUSIONS: There was a clear trend towards improvement in the overall health status of the EU but with differences between countries. EU health policymakers need to address the burden of diseases, paying specific attention to causes such as mental disorders. There are many opportunities for mutual learning among otherwise similar countries with different patterns of disease.

Does Pre-existing Diabetes Correlate with Long COVID-19 in Europe? Evidence from the Analysis of the Survey of Health, Ageing and Retirement in Europe's Corona Surveys.

Background: A substantial proportion of those infected with COVID-19 are presenting with persistent symptoms, referred to as long COVID-19. Emerging evidence suggests that the presence of pre-existing chronic conditions, such as diabetes, may increase the risk of long COVID-19. Objectives: To investigate whether having pre-existing diabetes increases the risk of developing long COVID-19 in the population of middle-aged and older adults (≥50 years old) in Europe, while assessing if this relationship can be accounted for or is modified by the known long COVID-19 and diabetes risk factors (age, sex, hospitalization, pre-existing hypertension, and weight status). Methods: A population-based longitudinal prospective study involving a sample of respondents aged 50 years and older (n = 4,004) with probable or confirmed COVID-19 infection from 27 countries that participated in both waves 7 and 8 of the Survey of Health, Ageing and Retirement in Europe and its 2020 and 2021 Corona Surveys. Logistic regression modeling was performed. Results: Overall, 66.8% of the respondents affected by COVID-19 infection reported at least one long COVID-19 symptom; 55.2% were female, and the average age was 64.6 years; 13.2% had pre-existing diabetes. Respondents with pre-existing diabetes had significantly higher odds of developing long COVID-19, compared to those without diabetes (OR = 1.37; 95% CI = 1.12, 1.68). This relationship remained significant (OR = 2.00; 98% CI = 0.25, 1.14) after adjusting for sex (OR = 1.64 for females; 95% CI = 1.43, 1.88), hospitalization for COVID-19 illness (OR = 3.19; 95% CI = 2.41, 4.23), pre-existing hypertension (OR = 1.17; 95% CI = 1.01, 1.36), and overweight (OR = 1.31; 95% CI = 1.11, 1.56) and obese (OR = 1.77; 95% CI = 1.44, 2.19) weight status. The effect of pre-existing diabetes on the risk of long COVID-19 is moderated by age; it was highest at the age of 50 (OR = 2.00; 95% CI = 1.28, 3.14), and then, it declined with age. Conclusions: There is a relationship between pre-existing diabetes and long COVID-19, even after controlling for literature-based confounding factors, with age having a moderating effect on this relationship.

Does sex modify the effect of pre-pandemic body mass index on the risk of Long COVID? Evidence from the longitudinal analysis of the Survey of Health, Ageing and Retirement in Europe.

BACKGROUND: Research on Long COVID risk factors is ongoing. High body mass index (BMI) may increase Long COVID risk, yet no evidence has been established regarding sex differences in the relationship between BMI and the risk of Long COVID. Investigating the nature of this relationship was the main objective of this study. METHODS: A population-based prospective study involving a sample of respondents aged 50 years and older (n = 4004) from 27 European countries that participated in the 2020 and 2021 Survey of Health, Ageing and Retirement in Europe's (SHARE) Corona Surveys and in Waves 7 and 8 of the main SHARE survey. Logistic regression models were estimated to produce unadjusted and adjusted estimates of the sex differences in the relationship between BMI and Long COVID. RESULTS: Linear relationship for females, with probability of Long COVID increasing with BMI (68% at BMI = 18, 93% at BMI = 45). Non-linear relationship for males, with probability of Long COVID of 27% at BMI = 18, 68% at BMI = 33, and 40% at BMI = 45. Relationships remained significant after adjusting for known Long COVID risk factors (age and COVID-19 hospitalization), presence of chronic diseases, and respondents' place of residence. CONCLUSION: Sex differences appear to play an important role in the relationship between BMI and risk of Long COVID. Overall, females were more likely to have Long COVID, regardless of their BMI. Males at the higher end of the BMI spectrum had a lower risk of Long COVID as opposed to their female counterparts. Sex-specific research is recommended for better understanding of Long COVID risk factors.

Artificial intelligence in medicine and research - the good, the bad, and the ugly.

Artificial intelligence (AI) broadly refers to machines that simulate intelligent human behavior, and research into this field is exponential and worldwide, with global players such as Microsoft battling with Google for supremacy and market share. This paper reviews the "good" aspects of AI in medicine for individuals who embrace the 4P model of medicine (Predictive, Preventive, Personalized, and Participatory) to medical assistants in diagnostics, surgery, and research. The "bad" aspects relate to the potential for errors, culpability, ethics, data loss and data breaches, and so on. The "ugly" aspects are deliberate personal malfeasances and outright scientific misconduct including the ease of plagiarism and fabrication, with particular reference to the novel ChatGPT as well as AI software that can also fabricate graphs and images. The issues pertaining to the potential dangers of creating rogue, super-intelligent AI systems that lead to a technological singularity and the ensuing perceived existential threat to mankind by leading AI researchers are also briefly discussed.

The impact of the COVID-19 pandemic on Mediterranean diet adherence: A narrative systematic review.

BACKGROUND: The COVID-19 pandemic upended many aspects of daily life. For some individuals, this was an opportunity to re-evaluate their life and make better choices, while others were overwhelmed with stressors, leading to a deterioration in mental and physical health. AIM: The aim of this narrative systematic review is to explore the effects of the COVID-19 pandemic on Mediterranean diet adherence. METHODS: A systematic literature search was carried out on PubMed, Scopus and Web of Science electronic databases utilising the search terms 'Mediterranean diet' AND 'COVID-19'. This yielded 73 articles that fulfilled the inclusion criteria. RESULTS: The data suggests that a substantial proportion of individuals adhered less to the Mediterranean diet during the COVID-19 lockdown period. However, individuals receiving some form of lifestyle intervention had better adherence to the Mediterranean diet than their unassisted counterparts. CONCLUSION: This emphasises the importance of professional support during times of crisis to avoid deterioration of a population's health.

National Health Examination Surveys: an essential piece of the health planning puzzle.

National health examination surveys (HESs) have been developed to provide important information that cannot be obtained from other sources. A HES combines information obtained by asking participants questions with biophysical measurements taken by trained field staff. They are observational studies with the highest external validity and make specific contributions to both population (public health) and individual health. Few countries have a track record of a regular wide-ranging HES, but these are the basis of many reports and scientific papers. Despite this, little evidence about HES usefulness and impact or the factors that influence HES effectiveness have been disseminated. This paper presents examples of HES contributions to society in both Europe and the Americas. We sought information by emailing a wide list of people involved in running or using national HESs across Europe and the Americas. We asked for examples of where examination data from their HES had been used in national or regional policymaking. We found multiple examples of HES data being used for agenda-setting, including by highlighting nutritional needs and identifying underdiagnosis and poor management of certain conditions. We also found many ways in which HES have been used to monitor the impact of policies and define population norms. HES data have also been used in policy formation and implementation. HES data are influential and powerful. There is need for global support, financing and networking to transfer capacities and innovation in both fieldwork and laboratory technology.

Inequalities in the burden of non-communicable diseases across European countries: a systematic analysis of the Global Burden of Disease 2019 study.

BACKGROUND: Although overall health status in the last decades improved, health inequalities due to non-communicable diseases (NCDs) persist between and within European countries. There is a lack of studies giving insights into health inequalities related to NCDs in the European Economic Area (EEA) countries. Therefore, the aim of the present study was to quantify health inequalities in age-standardized disability adjusted life years (DALY) rates for NCDs overall and 12 specific NCDs across 30 EEA countries between 1990 and 2019. Also, this study aimed to determine trends in health inequalities and to identify those NCDs where the inequalities were the highest. METHODS: DALY rate ratios were calculated to determine and compare inequalities between the 30 EEA countries, by sex, and across time. Annual rate of change was used to determine the differences in DALY rate between 1990 and 2019 for males and females. The Gini Coefficient (GC) was used to measure the DALY rate inequalities across countries, and the Slope Index of Inequality (SII) to estimate the average absolute difference in DALY rate across countries. RESULTS: Between 1990 and 2019, there was an overall declining trend in DALY rate, with larger declines among females compared to males. Among EEA countries, in 2019 the highest NCD DALY rate for both sexes were observed for Bulgaria. For the whole period, the highest DALY rate ratios were identified for digestive diseases, diabetes and kidney diseases, substance use disorders, cardiovascular diseases (CVD), and chronic respiratory diseases - representing the highest inequality between countries. In 2019, the highest DALY rate ratio was found between Bulgaria and Iceland for males. GC and SII indicated that the highest inequalities were due to CVD for most of the study period - however, overall levels of inequality were low. CONCLUSIONS: The inequality in level 1 NCDs DALYs rate is relatively low among all the countries. CVDs, digestive diseases, diabetes and kidney diseases, substance use disorders, and chronic respiratory diseases are the NCDs that exhibit higher levels of inequality across countries in the EEA. This might be mitigated by applying tailored preventive measures and enabling healthcare access.

Improving physiotherapy students' anatomy learning experience and short-term knowledge retention-An observational study in Malta.

Anatomy is physiotherapy's foundation. However, undergraduate classroom learning and knowledge acquisition-retention remain questionable. This study explored the possibility of improving this learning experience and evaluates the gross anatomy of abdomen and pelvis short-term knowledge retention among first-year physiotherapy students in Malta. The online Kahoot! game-based quiz platform was used through an instructor-designed best-of-four multiple-choice questions. Correctly answered questions and Kahoot! scores generated by the platform were utilized to measure knowledge retention. Kahoot! sessions 1 and 3 shared similar attendance and response rate and were compared together. The Mann-Whitney U test was used to compare Kahoot! scores and Chi test for trend to compare correctly answered questions. Students' perceived learning experiences before and after the introduction of the Kahoot quizzes were gathered through Likert scores and analyzed using McNamar's chi-square test. Overall, a significantly increased trend in correctly answered questions (χ2 : 23.38, p-value: <0.001) across the Kahoot! sessions were evident. Four questions out of 12 exhibited significant Kahoot! scores differences. Students reported better learning experiences following the initiation of Kahoot! (χ2 : 5.1, p-value: 0.02). Indeed, all students agreed that the use of the interactive quiz improved their anatomy short term knowledge retention. Introducing an online interactive quiz as part of the lecture program may be useful to improve the learning experience and anatomy knowledge retention among physiotherapy students.

A glimpse into Long COVID characteristics and the mental health impact within a highly vaccinated population: a Malta observational study.

BACKGROUND: Post-acute COVID-19 consequences are gaining global recognition. This study explores Long COVID characteristics and associated mental health impact/s among the highly vaccinated adult population of Malta. METHODS: A social media survey gathered demographics, vaccination, and COVID-19 data. Generalised Anxiety Disorder and Patient Health Questionnaire-9 assessment tools were used for anxiety and depression. Quantitative analyses were performed. RESULTS: 41% reported Long COVID, mostly female, 30-39 years, absence of chronic disease/s and vaccinated. Shortness of breath commonest persistent symptom among males, and fatigue for females. Significantly higher depression scores were present in Long COVID cohort compared to no persistent symptoms (p=0.001) and never acquiring COVID-19 (p=<0.01). A significant higher anxiety scores was present for Long COVID cohort than never acquiring COVID-19 (p=<0.01). CONCLUSIONS: Long COVID occurs even in healthy individuals and vaccinated, while exacerbating mental health burdens. Urgent action is required to manage Long COVID and preventing the sequela.

Allied Health Professional Students' Perceptions on Research: A Multi-disciplinary Mixed-Methods Study.

Introduction: Modern medicine necessitates evidence-based interdisciplinary patient care. Research is at the centre of fostering an evidence-based mindset in healthcare teams. Studies have demonstrated that exposing students to research translates into better patient care. Studies investing the perceptions of students towards research have focused on the views of medical students, leaving the perceptions of allied health professional (AHP) students unaccounted for. Methods: A mixed-methods, anonymous online questionnaire was distributed to 837 AHP students studying at the University of Malta, across five different courses. The collected data was then statistically analysed through descriptive statistics and chi-square testing. Qualitative results were coded, triangulated and subsequently analysed. Results: An overall response rate of 28.43% was achieved. Only 2.49% of respondents managed to publish research, despite many participants stating that research is important for their future careers. Career progression and lack of opportunity were identified as the major motivating and stumbling factors, respectively. Students pursuing research-focused degrees considered their curriculum to sufficiently equip them with research skills, compared to students studying clinically oriented degrees (p < 0.01). Conclusion: The results obtained from this study indicate that the perceptions of AHP students towards research are on par with the already established medical students. AHP students face the same stumbling blocks, are driven by the same motivating factors and experience a similar disparity between interest in research and research being produced, as medical students. Thus, a joint effort, between stakeholders in medical and AHP students' education, should be taken to address the factors limiting undergraduate students from conducting research. This will enable the implementation of an evidence-based mindset in the clinic, ultimately resulting in better patient care. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01715-6.

Analysing the Impact of an Elective Research Experience on Medical Students' Research Perceptions.

Introduction: Physicians are at the centre of bench-to-bedside research, yet the number of physicians engaging in research is declining. One solution to overcome this alarming trend is exposing medical students to research. This study aims to assess the impact of engaging medical students in research, and the feasibility of conducting research solely using online communication. Methods: A pilot elective research opportunity was offered to medical students enrolled to the University of Malta Doctor of Medicine and Surgery course by a resident academic (summer 2021) of the same institute to assess the epidemiology of COVID-19 in Europe. An anonymous survey was distributed to seventy medical students recruited to participate in this elective research project. The data collected was analysed and interpreted. Results: A response rate of 88.73% was achieved. "Career progression" and "lack of time" were the most reported motivating and hindering factors towards conducting research, respectively, before engaging in a research experience. Research experience helped overcome reported barriers (p < 0.01), while also challenging students' perceptions towards research. An increase in positive perceptions towards research was observed after conducting research. An overwhelming majority (90.47%) of participants reported that mentorship played an influential role in their overall experience, and 95.24% commented that they would like research opportunities to be made available by their faculty. Discussion and Conclusion: Giving students the opportunity to conduct research demonstrated how research experience improves students' soft skills and the understanding of research. This study also portrayed how remote research opportunities are effective in engaging students and increased the number of students who would consider a career in research. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01727-w.

Burden of infectious disease studies in Europe and the United Kingdom: a review of methodological design choices.

This systematic literature review aimed to provide an overview of the characteristics and methods used in studies applying the disability-adjusted life years (DALY) concept for infectious diseases within European Union (EU)/European Economic Area (EEA)/European Free Trade Association (EFTA) countries and the United Kingdom. Electronic databases and grey literature were searched for articles reporting the assessment of DALY and its components. We considered studies in which researchers performed DALY calculations using primary epidemiological data input sources. We screened 3053 studies of which 2948 were excluded and 105 studies met our inclusion criteria. Of these studies, 22 were multi-country and 83 were single-country studies, of which 46 were from the Netherlands. Food- and water-borne diseases were the most frequently studied infectious diseases. Between 2015 and 2022, the number of burden of infectious disease studies was 1.6 times higher compared to that published between 2000 and 2014. Almost all studies (97%) estimated DALYs based on the incidence- and pathogen-based approach and without social weighting functions; however, there was less methodological consensus with regards to the disability weights and life tables that were applied. The number of burden of infectious disease studies undertaken across Europe has increased over time. Development and use of guidelines will promote performing burden of infectious disease studies and facilitate comparability of the results.

A cross-sectional study exploring the Covid-19 vaccination landscape in Malta through social media: An insight into experiences, attitudes, and perspectives.

Background and Aims: Covid-19 vaccines were disseminated across Europe from the end of 2020. Malta had one of the fastest vaccination rollouts in Europe and by March 2022 most adults had their booster dose. The aim was to investigate adult's perspectives, experiences, and attitudes regarding vaccination in Malta. Methods: An anonymous online survey targeting adult social media users living in Malta was disseminated through social media, with a snowball technique. Demographic information, vaccination uptake, side-effects, perceptions, and experiences were gathered through quantitative and qualitative means. Participants were sub-grouped according to their vaccination status and descriptive analysis through frequency was performed. χ 2/Fisher test testing followed by logistic regressions were performed to assess the vaccination perspectives according to vaccination status. Results: Out of 611 participants 79.87% had the booster, 4.91% had two doses awaiting booster, 6.55% refused booster while, 8.67% refused any dose. Booster sub-group when compared to vaccine hesitant sub-group exhibited an association with the perception for the need to "continue wearing masks, maintaining physical distance and hand washing following vaccination" (odds ratio [OR]: 5.97 confidence interval [CI] 95%: 1.09-32.36 p = 0.04). Those waiting for the booster dose when compared to those refusing booster, exhibited an association with the perspective that "COVID-19 vaccine is the solution to returning to normality" (OR: 5.00 CI 95%: 1.12-22.35 p = 0.04). The commonest reason for inoculation was to protect against severe disease (63.08% CI 95%: 58.91-67.07). More pronounced booster adverse effects raised concern about future booster doses uptake. Unwillingness among anti-booster and vaccine hesitant arose among high socioeconomic background participants, with concern for vaccine safety and adverse effects. Conclusion: Vaccine hesitancy is low yet, vaccination unwillingness even among highly educated may act as a barrier to control the pandemic. Clear, transparent public health communication which targets concerns is crucial, with unified messages from governing bodies optimizing population safety.