COVID-19, Wellness and Life Satisfaction in Adolescence: Individual and Contextual Issues.

During and in the aftermath of the COVID-19 pandemic, several works reflected on young people's physical and psychological health. The Dual Factor Model, which we refer to as the quadripartite model, is useful for understanding children's and adolescents' psychological health and differentiating them regarding their attitude toward the effects of the COVID-19 pandemic. In this investigation, students from the fifth to twelfth year of schooling enrolled in the DGEEC study "Psychological Health and Wellbeing in Portuguese schools" were considered. Four groups were created based on life satisfaction (low or high) and psychological distress (with or without symptoms). The study included 4444 students (M = 13.39 years ± 2.41), of whom 47.8% were male. Of the participants, 27.2% were in the second cycle of primary education, and 72.8% were in lower and upper secondary education. Differences in gender and education level (as a proxy for age) were observed. Additionally, when considering students' perceptions of changes in their lives following the COVID-19 pandemic (stayed the same, became worse, became better), these three groups were compared concerning personal and contextual variables, revealing significant differences at both the individual and contextual levels. Finally, the study discusses the influence of education and health professionals and the need for friendly public policies.

Relationship between Burden, Quality of Life and Difficulties of Informal Primary Caregivers in the Context of the COVID-19 Pandemic: Analysis of the Contributions of Public Policies.

The study aimed to characterize and understand the difficulties experienced by informal caregivers from a bio-psychosocial and environmental perspective, taking into account the socio-demographic and health characteristics of the informal caregiver and the person cared for, quality of life, perceived burden, social support, and the impact of the COVID-19 pandemic on the informal caregiver and the person cared for. The participants were 371 informal primary caregivers, 80.9% female, aged between 25 and 85 years, mean 53.17 (SD = 11.45) years. Only 16.4% of the informal caregivers benefited from monitoring and training for informal caregiver skills; 34.8% received information on the rights of the person being cared for; 7.8% received advice or guidance on the rights and duties of the informal caregiver; 11.9% of the caregivers benefited from psychological support; and 5.7% participated in self-help groups. A convenience sample was used, and data were collected via an online questionnaire. The main findings show that the major difficulties experienced by caregivers are related to social constraints, the demands of caring, and the reactions of the person cared for. The results reveal that the burden of the main informal caregivers is explained by the level of education, quality of life, level of dependence of the person cared for, level of difficulties, and social support. The COVID-19 pandemic impacted caregiving by increasing the perceived difficulty of accessing support services, such as consultations, services, and support; causing distress feelings in the caregiver, such as, anxiety and worry; increasing the needs and symptoms of the person cared for; and increasing the degree of isolation, for both, the informal caregiver and the person cared for.

Impact of COVID-19 on Management, Quality and Satisfaction of Health Organizations: A Case Study in a Portuguese Hospital.

The hospital health care professionals are the front-line fighting COVID-19 considering they are responsible for all the care provided to patients. The purpose of this study was to determine the impact of COVID-19 at the hospital management level and, also, to understand how psychosocial environment, and satisfaction of Health Professionals were affected. A case study was performed in a Portuguese Hospital. Data were collected at one hospital under study at two different occasions: the first before the pandemic (November 2019) and the second almost two years after the pandemic started (November 2021). Regarding data collection, 37.0% of participants responded in the occasion 1 (n = 296) and 63.0% responded in the occasion 2 (n = 503). The instrument for the Assessment of Global Management of Health Organizations (AGMHO) consists of 39 items organized into six dimensions (Gaspar et al. in J Occup Environ Med 63: 581-587, 2021). Comparing timings pre and during pandemic COVID-19, it was found that the participants in the pre-COVID-19 era showed stronger organizational culture, higher quality of life, better psychosocial environment regarding content/leadership and higher job satisfaction when compared to the participants during pandemic COVID-19. On the other hand, participants in the second occasion were found to have higher psychosocial risks related to mental health when compared to participants in the pre-COVID-19 phase. We conclude that the professionals' perception of the different dimensions of the health organization worsened after 2 years of the pandemic. With special focus on psychosocial risks at work and relationship with leadership.

Handwashing adherence during the COVID-19 pandemic: A longitudinal study based on protection motivation theory.

RATIONALE: The associations between the number of COVID-19 cases/deaths and subsequent uptake of protective behaviors may reflect cognitive and behavioral responses to threat-relevant information. OBJECTIVE: Applying protection motivation theory (PMT), this study explored whether the number of total COVID-19 cases/deaths and general anxiety were associated with cross-situational handwashing adherence and whether these associations were mediated by PMT-specific self-regulatory cognitions (threat appraisal: perceived vulnerability, perceived illness severity; coping appraisal: self-efficacy, response efficacy, response costs). METHOD: The study (#NCT04367337) was conducted in March-September 2020 among 1256 adults residing in 14 countries. Self-reports on baseline general anxiety levels, handwashing adherence across 12 situations, and PMT-related constructs were collected using an online survey at two points in time, four weeks apart. Values of COVID-19 cases and deaths were retrieved twice for each country (one week prior to the individual data collection). RESULTS: Across countries and time, levels of adherence to handwashing guidelines were high. Path analysis indicated that smaller numbers of COVID-19 cases/deaths (Time 0; T0) were related to stronger self-efficacy (T1), which in turn was associated with higher handwashing adherence (T3). Lower general anxiety (T1) was related to better adherence (T3), with this effect mediated by higher response efficacy (T1, T3) and lower response cost (T3). However, higher general anxiety (T1) was related to better adherence via higher illness severity (T1, T3). General anxiety was unrelated to COVID-19 indicators. CONCLUSIONS: We found a complex pattern of associations between the numbers of COVID-19 cases/deaths, general anxiety, PMT variables, and handwashing adherence at the early stages of the pandemic. Higher general anxiety may enable threat appraisal (perceived illness severity), but it may hinder coping appraisal (response efficacy and response costs). The indicators of the trajectory of the pandemic (i.e., the smaller number of COVID-19 cases) may be indirectly associated with higher handwashing adherence via stronger self-efficacy.

Impact of COVID-19 on Management, Quality and Satisfaction of Health Organizations: A Case Study in a Portuguese Hospital

The hospital health care professionals are the front-line fighting COVID-19 considering they are responsible for all the care provided to patients. The purpose of this study was to determine the impact of COVID-19 at the hospital management level and, also, to understand how psychosocial environment, and satisfaction of Health Professionals were affected. A case study was performed in a Portuguese Hospital. Data were collected at one hospital under study at two different occasions: the first before the pandemic (November 2019) and the second almost two years after the pandemic started (November 2021). Regarding data collection, 37.0% of participants responded in the occasion 1 (n = 296) and 63.0% responded in the occasion 2 (n = 503). The instrument for the Assessment of Global Management of Health Organizations (AGMHO) consists of 39 items organized into six dimensions (Gaspar et al. in J Occup Environ Med 63: 581–587, 2021). Comparing timings pre and during pandemic COVID-19, it was found that the participants in the pre-COVID-19 era showed stronger organizational culture, higher quality of life, better psychosocial environment regarding content/leadership and higher job satisfaction when compared to the participants during pandemic COVID-19. On the other hand, participants in the second occasion were found to have higher psychosocial risks related to mental health when compared to participants in the pre-COVID-19 phase. We conclude that the professionals' perception of the different dimensions of the health organization worsened after 2 years of the pandemic. With special focus on psychosocial risks at work and relationship with leadership. Article Highlights The systemic evaluation of professionals regarding the quality of the health organization worsened 2 years after the start of the pandemic. After two years of facing the pandemic, professionals were exposed to high levels of stress and higher psychosocial risks at work. The professionals' satisfaction reveals that it is more strongly influenced by the psychosocial environment related to the work content and leadership relationship, as well as the organisational culture. It is a priority to intervene in leadership relationships and psychosocial risks at work related to the physical and psychological demands of work, stress management and a more active and involved role for the professional. The importance and impact of organizational culture on processes and results was demonstrated. The relationship between QoL and psychosocial risks of work with other processes and outcomes of health care organizations was confirmed. A regular evaluation of health organizations is proposed, using systemic models that allow evaluating, monitoring and supporting evidence-based governance process.

Youth Voices and Social Participation during a Pandemic: Dream Teens Powered by Jovem Cascais

In an unprecedented scenario, much of the research and interventions during the COVID-19 pandemic, which focused on young people, found themselves suspended. (1) Background: The goals of this project were to investigate (Study 1) social participation and positive development among young people in Cascais, Portugal, and to investigate (Study 2-a case study) the implementation of a program promoting active citizenship, social participation, and social entrepreneurship. At the same time, it was intended to constitute a resource and strategy to diminish the social alienation exacerbated by the pandemic. (2) Methods: SPSS v.26 software was used to analyze quantitative data from questionnaires used in the study of social participation, as well as the pre- and post-test impacts, and MAXQDA 2020 software was used to analyze qualitative data from YouTube discussions about youth needs and strategies for their problems, as well as from focus groups. (3) Results: In S1, it was evident that young people's expectations of participation in the community were not defined and that their expected participation in the community was of a weekly nature. They considered themselves to have a good sense of belonging to the community or group and had reasonable social self-efficacy. Girls showed higher scores in Expectations of Community Participation and Active Participation. In their positive development, they did not have a defined evaluation of their competence, but their connection with others was evaluated as good. Boys showed higher levels of Competence. They said that every week they make 1 h of their day available to help others, and they did not frequently report feelings of social alienation. In S2, the evaluation of the impact of the project generally showed an improvement in the action research skills of the participants. At the end, six projects were proposed. In the analysis of the participants' voices, the themes related to Substance Use, Social Capital, and Love and Sexuality stood out with higher participation and lower participation in the themes of Diversity, Culture and Housing. (4) Conclusions: The results suggest a need to encourage social participation, active citizenship, and entrepreneurship, along with their knowledge and skills for action. The promotion of debate and knowledge on issues related to young people's lives seems to be a priority, especially issues related to Diversity, Culture and Housing. The Dream Teens model may prove to be an important strategy in this work, suggesting that this project may constitute a relevant model for future work.

Experience of discrimination during COVID-19 pandemic: the impact of public health measures and psychological distress among refugees and other migrants in Europe.

BACKGROUND: The COVID-19 pandemic has had a disproportionately hard impact on refugees and other migrants who are often exposed to the virus with limited means to protect themselves. We tested the hypothesis that during the COVID-19 pandemic, refugees and other migrants have suffered a negative impact on mental health and have been unjustly discriminated for spreading the disease in Europe (data collection from April to November 2020). METHODS: Participants in the ApartTogether Survey (N = 8297, after listwise deletion of missing items final N = 3940) provided data regarding to their difficulties to adhere to preventive recommendations against COVID-19 infection (CARE), self-perceived stigmatization (SS), and psychological distress (PD). Structural Equation Modeling was used to investigate PD as a mediator in the pathway linking CARE to SS, while adjusting for the housing and residence status. To improve confidence in the findings, single hold-out sample cross-validation was performed using a train/test split ratio of 0.8/0.2. RESULTS: In the exploratory set (N = 3159) SS was associated with both CARE (B = 0.200, p < 0.001) and PD (B = 0.455, p < 0.001). Moreover, PD was also associated with CARE (B = 0.094, p = 0.001) and mediated the effect of CARE on SS (proportion mediated = 17.7%, p = 0.001). The results were successfully replicated in the confirmation set (N = 781; total effect = 0.417, p < 0.001; proportion mediated = 29.7%, p < 0.001). Follow-up analyses also found evidence for an opposite effect (i.e., from SS to CARE, B = 0.132; p < 0.001), suggesting that there might be a vicious circle between the self-perceived stigmatization and the access to health care and the use of preventive measures against COVID-19 infection. CONCLUSIONS: Refugees and other migrants who had more difficulties in accessing health care and preventive measures against COVID-19 infection experienced worse mental health and increased discrimination. These negative effects appeared to be stronger for those with more insecure housing and residence status, highlighting from one side the specific risk of insecure housing in the impact of COVID-19 upon mental health and infection protection, and for another side the need to proper housing as a strategy to prevent both COVID-19 and mental distress.

Ecological Model Explaining the Psychosocial Adaptation to COVID-19.

The main objective of this study is to understand and characterize the adoption of an ecological perspective and the physical, psychological, social, and contextual health factors that may influence the adjustment to and mental health experiences during the COVID-19 pandemic. The study included 5479 participants, of which 3710 were female (67.7%), aged between 18 and 90 years old, with a mean age of 48.57 years (SD = 14.29), were considered three age groups: 21.5% up to 35 years old, 61.8% between 36 and 64 years old, and 16.7% 65 years old or more. The mental health and individual adjustment to the COVID-19 situation are explained by socio-demographic factors, health-related factors, lifestyles, attitudes and behaviors, lockdown experience, and place of residence. A better adaptation and mental health are observed among men, people with a higher educational level, people with lower sadness, nervousness, and burnout, and people whose health situation did not worsen with the pandemic. In terms of lifestyle, a better adaptation is related to a better quality of sleep, fewer nightmares, a higher practice of physical activity, and less consumption of processed foods and sweets. A better adaptation is also associated with lower levels of dependence on alcohol, TV, and SN (social networks) and a more positive experience of the lockdown imposed by the pandemic. Gender and age group differences in the described context were studied. Promoting a better adjustment and improved mental health when dealing with the COVID-19 requires an ecological understanding and multitarget interventions, targeting physical, mental, and social health together with the contextual environment.

The Interplay Between Strictness of Policies and Individuals' Self-Regulatory Efforts: Associations with Handwashing During the COVID-19 Pandemic.

BACKGROUND: Patterns of protective health behaviors, such as handwashing and sanitizing during the COVID-19 pandemic, may be predicted by macro-level variables, such as regulations specified by public health policies. Health behavior patterns may also be predicted by micro-level variables, such as self-regulatory cognitions specified by health behavior models, including the Health Action Process Approach (HAPA). PURPOSE: This study explored whether strictness of containment and health policies was related to handwashing adherence and whether such associations were mediated by HAPA-specified self-regulatory cognitions. METHODS: The study (NCT04367337) was conducted among 1,256 adults from Australia, Canada, China, France, Gambia, Germany, Israel, Italy, Malaysia, Poland, Portugal, Romania, Singapore, and Switzerland. Self-report data on cross-situational handwashing adherence were collected using an online survey at two time points, 4 weeks apart. Values of the index of strictness of containment and health policies, obtained from the Oxford COVID-19 Government Response Tracker database, were retrieved twice for each country (1 week prior to individual data collection). RESULTS: Across countries and time, levels of handwashing adherence and strictness of policies were high. Path analysis indicated that stricter containment and health policies were indirectly related to lower handwashing adherence via lower self-efficacy and self-monitoring. Less strict policies were indirectly related to higher handwashing adherence via higher self-efficacy and self-monitoring. CONCLUSIONS: When policies are less strict, exposure to the SARS-CoV-2 virus might be higher, triggering more self-regulation and, consequently, more handwashing adherence. Very strict policies may need to be accompanied by enhanced information dissemination or psychosocial interventions to ensure appropriate levels of self-regulation.

The trajectory of COVID-19 pandemic and handwashing adherence: findings from 14 countries.

BACKGROUND: The COVID-19 pandemic has affected people's engagement in health behaviors, especially those that protect individuals from SARS-CoV-2 transmission, such as handwashing/sanitizing. This study investigated whether adherence to the World Health Organization's (WHO) handwashing guidelines (the outcome variable) was associated with the trajectory of the COVID-19 pandemic, as measured by the following 6 indicators: (i) the number of new cases of COVID-19 morbidity/mortality (a country-level mean calculated for the 14 days prior to data collection), (ii) total cases of COVID-19 morbidity/mortality accumulated since the onset of the pandemic, and (iii) changes in recent cases of COVID-19 morbidity/mortality (a difference between country-level COVID-19 morbidity/mortality in the previous 14 days compared to cases recorded 14-28 days earlier). METHODS: The observational study (#NCT04367337) enrolled 6064 adults residing in Australia, Canada, China, France, Gambia, Germany, Israel, Italy, Malaysia, Poland, Portugal, Romania, Singapore, and Switzerland. Data on handwashing adherence across 8 situations (indicated in the WHO guidelines) were collected via an online survey (March-July 2020). Individual-level handwashing data were matched with the date- and country-specific values of the 6 indices of the trajectory of COVID-19 pandemic, obtained from the WHO daily reports. RESULTS: Multilevel regression models indicated a negative association between both accumulation of the total cases of COVID-19 morbidity (B = -.041, SE = .013, p = .013) and mortality (B = -.036, SE = .014 p = .002) and handwashing. Higher levels of total COVID-related morbidity and mortality were related to lower handwashing adherence. However, increases in recent cases of COVID-19 morbidity (B = .014, SE = .007, p = .035) and mortality (B = .022, SE = .009, p = .015) were associated with higher levels of handwashing adherence. Analyses controlled for participants' COVID-19-related situation (their exposure to information about handwashing, being a healthcare professional), sociodemographic characteristics (gender, age, marital status), and country-level variables (strictness of containment and health policies, human development index). The models explained 14-20% of the variance in handwashing adherence. CONCLUSIONS: To better explain levels of protective behaviors such as handwashing, future research should account for indicators of the trajectory of the COVID-19 pandemic. TRIAL REGISTRATION: Clinical Trials.Gov, # NCT04367337.

Health risk behaviors before and during COVID-19 and gender differences.

Changes in routines and habits, fear of contamination from the coronavirus disease 2019 (COVID-19) virus, and economic crisis have resulted in significant impacts upon individuals' lives, health, and risk behaviors. The present study aims to analyze health risk behaviors and gender differences of Portuguese adults before and during the COVID-19 pandemic. A quantitative analysis using SPSS v. 26 software presents the evaluation of 5746 responses (M = 48.5 years, SD = 14.3), of which 67.7% were female. t Test was used to study differences in means before and during the pandemic and analysis of variance test to analyze gender differences. In the comparative study before and during the pandemic showed a decrease in the number of meals per day, physical activity and perception of sleep quality; an increase in tobacco use, beer consumption, and media use (TV, mobile phone, social networks, and online games). Gender differences study demonstrated that the number of meals per day suffered a decrease from pre to pandemic in women, while increasing in men, becoming prominent in the second moment under study. Both genders had an increase in consumption behaviors and substance use, but women revealed a decrease in the consumption of wine during the pandemic, while men revealed more consumption behaviors in the variables under study. The use of media also changed, with men showing a higher level in TV hours per day, social networks and online games before the pandemic and in TV hours per day and games/online during the pandemic. Women stand out in the use of mobile phone per day during the pandemic. Daily physical activity decreased during the pandemic, as did sleep quality. Males revealed a higher practice of physical activity at both periods, as well as sleep quality. Based on the results presented, it is expected that considerations and actions in the scope of public health policies and health prevention and promotion, will be rethought and adapted to the specificities of each gender.

Sleep and Awakening Quality during COVID-19 Confinement: Complexity and Relevance for Health and Behavior.

OBJECTIVE: The aim of this study was to evaluate sleep and awakening quality (SQ and AQ) during COVID-19 in a large and diversified population in order to identify significant associations and risks in terms of demography, health and health-related behaviors, sleep variables, mental health, and attitudes. METHODS/RESULTS: Online surveys were used for data collection, received from 5479 individuals from the general population, sleep disorder patients, and COVID-involved (medical doctors (MDs) and nurses) and COVID-affected professionals (teachers, psychologists, and dentists). SQ and AQ were worse in adults, females, and high-education subjects. Feeling worse, having economic problems, depression, anxiety, irritability, and a high Calamity Experience Check List (CECL) score during COVID were significantly associated with poor SQ and AQ. Shorter sleep duration, increased latency, poor nutrition, low physical activity, increased mobile and social network use, more negative and less positive attitudes and behaviors were associated with poor AQ. CONCLUSIONS: The SQ logistic regression showed gender, morbidities, CECL, and awakenings as relevant, whereas, for AQ, relevant variables further included age and physical activity. Aiming to have a high stress compliance, each individual should sleep well, have important control of their mood, practice positive behaviors while dismissing negative behaviors and attitudes, practice exercise, have adequate nutrition, and beware of technologies and dependences.

Impact of Covid-19 in Global Health and Psychosocial Risks at Work.

OBJECTIVE: The main objective is to understand and characterize the impact of Covid-19 pandemic on mental health and psychosocial risks at work in professionally active adults. METHODS: This specific work includes 4708 professionally active participants from all over the country, of which 3354 are women (71.2%), aged between 19 and 86 years, with an average age of 45.8 years (SD = 12.56). RESULTS: The global impact of Covid-19 is explained by socio-demographic factors (sex, age, and education), by work-related and volume of work and health that is reflected in most symptoms. We found sex, age, education level, and professional area differences related to global impact of Covid-19. CONCLUSION: The Covid-19 pandemic accounts for the challenge to identify the important factors to promote resilience of citizens, professionals, and organizations.