Incorporating social vulnerability in infectious disease mathematical modelling: a scoping review.

BACKGROUND: Highlighted by the rise of COVID-19, climate change, and conflict, socially vulnerable populations are least resilient to disaster. In infectious disease management, mathematical models are a commonly used tool. Researchers should include social vulnerability in models to strengthen their utility in reflecting real-world dynamics. We conducted a scoping review to evaluate how researchers have incorporated social vulnerability into infectious disease mathematical models. METHODS: The methodology followed the Joanna Briggs Institute and updated Arksey and O'Malley frameworks, verified by the PRISMA-ScR checklist. PubMed, Clarivate Web of Science, Scopus, EBSCO Africa Wide Information, and Cochrane Library were systematically searched for peer-reviewed published articles. Screening and extracting data were done by two independent researchers. RESULTS: Of 4075 results, 89 articles were identified. Two-thirds of articles used a compartmental model (n = 58, 65.2%), with a quarter using agent-based models (n = 24, 27.0%). Overall, routine indicators, namely age and sex, were among the most frequently used measures (n = 42, 12.3%; n = 22, 6.4%, respectively). Only one measure related to culture and social behaviour (0.3%). For compartmental models, researchers commonly constructed distinct models for each level of a social vulnerability measure and included new parameters or influenced standard parameters in model equations (n = 30, 51.7%). For all agent-based models, characteristics were assigned to hosts (n = 24, 100.0%), with most models including age, contact behaviour, and/or sex (n = 18, 75.0%; n = 14, 53.3%; n = 10, 41.7%, respectively). CONCLUSIONS: Given the importance of equitable and effective infectious disease management, there is potential to further the field. Our findings demonstrate that social vulnerability is not considered holistically. There is a focus on incorporating routine demographic indicators but important cultural and social behaviours that impact health outcomes are excluded. It is crucial to develop models that foreground social vulnerability to not only design more equitable interventions, but also to develop more effective infectious disease control and elimination strategies. Furthermore, this study revealed the lack of transparency around data sources, inconsistent reporting, lack of collaboration with local experts, and limited studies focused on modelling cultural indicators. These challenges are priorities for future research.

Understanding global research trends in the control and prevention of infectious diseases for children: Insights from text mining and topic modeling.

INTRODUCTION: The emergence of novel infectious diseases has amplified the urgent need for effective prevention strategies, especially ones targeting vulnerable populations such as children. Factors such as the high incidence of both emerging and existing infectious diseases, delays in vaccinations, and routine exposure in communal settings heighten children's susceptibility to infections. Despite this pressing need, a comprehensive exploration of research trends in this domain remains lacking. This study aims to address this gap by employing text mining and modeling techniques to conduct a comprehensive analysis of the existing literature, thereby identifying emerging research trends in infectious disease prevention among children. METHODS: A cross-sectional text mining approach was adopted, focusing on journal articles published between January 1, 2003, and August 31, 2022. These articles, related to infectious disease prevention in children, were sourced from databases such as PubMed, CINAHL, MEDLINE (Ovid), Scopus, and Korean RISS. The data underwent preprocessing using the Natural Language Toolkit (NLTK) in Python, with a semantic network analysis and topic modeling conducted using R software. RESULTS: The final dataset comprised 509 journal articles extracted from multiple databases. The study began with a word frequency analysis to pinpoint relevant themes, subsequently visualized through a word cloud. Dominant terms encompassed "vaccination," "adolescent," "infant," "parent," "family," "school," "country," "household," "community," "HIV," "HPV," "COVID-19," "influenza," and "diarrhea." The semantic analysis identified "age" as a key term across infection, control, and intervention discussions. Notably, the relationship between "hand" and "handwashing" was prominent, especially in educational contexts linked with "school" and "absence." Latent Dirichlet Allocation (LDA) topic modeling further delineated seven topics related to infectious disease prevention for children, encompassing (1) educational programs, (2) vaccination efforts, (3) family-level responses, (4) care for immunocompromised individuals, (5) country-specific responses, (6) school-based strategies, and (7) persistent threats from established infectious diseases. CONCLUSION: The study emphasizes the indispensable role of personalized interventions tailored for various child demographics, highlighting the pivotal contributions of both parental guidance and school participation. CLINICAL RELEVANCE: The study provides insights into the complex public health challenges associated with preventing and managing infectious diseases in children. The insights derived could inform the formulation of evidence-based public health policies, steering practical interventions and fostering interdisciplinary synergy for holistic prevention strategies.

Medication abortion during the COVID-19 pandemic in France: A research based on the French national health insurance database.

OBJECTIVES: During the COVID-19 pandemic in France, abortion was recognized as an essential service that cannot be delayed, and such care was therefore presumed to be maintained. The aim is to analyze the changes in the practice of abortion in 2020 to identify the consequences of the two lockdowns and the effects of the extension of the legal time limit. METHODS: We analyzed the data collected by the French national health insurance system, which covers 99% of the population. All women who had an elective abortion, either surgical or with medication, in France in 2019 and 2020 were included in the study. Trend changes in abortions were analyzed by comparing the ratio of the weekly number of abortions in 2020 with the weekly number in 2019. RESULTS: Both 2020 lockdowns were followed by a drop in abortions, particularly after the first and stricter lockdown. This may be explained not by an abrupt shutdown of access to abortion services, but rather by a decrease in conceptions during the lockdown weeks. The decrease was more marked for surgical abortions than for medication abortions in a hospital setting, and less so for medication abortions in non-hospital settings. Moreover, the proportion of the latter type of abortions continued to increase, showing the reinforcement of a previous trend. CONCLUSIONS: Our findings indicate that expanding the legal time limit for abortion, diversifying the settings where abortions can be performed and the range of abortion providers help to facilitate access to this fundamental reproductive care.

"Provided a window on the world and lessened my feeling of isolation": older adults' perceived COVID-19 impact and technology use in Australia during recurrent lockdowns.

BACKGROUND: An informed understanding of older adults' perceptions of the impact (positive or negative) of recurrent COVID-19 long lockdowns is important for the development of targeted interventions and resources for future restrictions. This study aimed to understand self-reported impacts of COVID-19 recurrent restrictions on older adults and how technology has been used to mitigate these. METHODS: A cross-sectional national study of 257 community-dwelling older Australians based in Victoria (mean age = 67.6 years [SD = 7.2]; 20.6% male) completed an online or postal survey as part of a larger study examining the physical and mental health impacts of a second extended COVID-19 lockdown period. This secondary analysis reports on the findings from free-text responses to two open-ended questions included in that survey that asked participants to comment on the greatest impacts of the COVID-19 lockdowns (positive or negative) and the role of technology in supporting their wellbeing during this time. Responses were collected between July and September 2020. Data were analysed using content (COVID-19 impacts) and thematic (role of technology) analysis. RESULTS: Respondents gave more negative responses (75.5%) than mixed (15.2%) and positive responses (6.2%) in reporting on the biggest impact of COVID-19 lockdowns. Inductive content analysis revealed two first-order main categories (Positive impacts and Negative impacts). Axial coding of main categories showed five second-order categories (Environmental, Physical Health, Social, Mental Health, and Personal) for both negative and positive main categories (totalling 10 second-order categories). Overall, respondents highlighted social loss as the key negative experience (70%), with acute feelings of social isolation contributing to negative impacts on mental wellbeing. The most commonly reported positive impact reported (11%) was having more time for relationships, relaxation, and new hobbies. Technology was primarily used to sustain socialisation and provide access to essential resources, services, and goods, which respondents perceived to contribute to maintaining their wellbeing. CONCLUSIONS: Findings suggest a critical need for interventions that address the social loss experienced by older adults during COVID-19 recurrent lockdowns, particularly to alleviate the associated negative impact on mental wellbeing. Recognising the positive aspect of increased time for relationships and leisure activities indicates potential areas for resilience-building strategies. The pivotal role of technology in mitigating adverse effects highlights its significance in building social connections and supporting overall wellbeing during challenging times. These implications can guide future efforts to enhance older adults' resilience, mental health, and holistic wellbeing in future public health crises.

COVID-19 and mental health services in Sub-Saharan Africa: A critical literature review.

BACKGROUND: The COVID-19 pandemic has wrought a profound impact on mental health in Sub- Saharan Africa, exacerbating existing disparities and rendering individuals undergoing treatment particularly susceptible. This comprehensive critical review delves into the scope, nature, and extent of COVID-19 impact on mental health services in Sub- Saharan Africa, while concurrently elucidating pivotal lessons and exemplary practices learnt from periods of lockdown. METHODS: The methodology was guided by Jesson & Laccy's guide on how to conduct critical literature reviews. Articles were comprehensively sought through two academic databases (PubMed and Google Scholar), complemented by targeted searches on the WHO website and official public health websites of relevant Sub-Saharan African countries. RESULTS: The investigation reveals a surge in mental health challenges, notably marked by a significant escalation in anxiety, depression, and post-traumatic stress disorder. Disruptions to care services, financial hardships, and the pervasive effects of social isolation further compound this escalation. The pre-existing inequalities in access to and quality of care were accentuated during this crisis, with marginalized groups encountering heightened impediments to essential services. In navigating this unprecedented challenge, communities emerged as integral agents in establishing supportive networks and implementing culturally sensitive interventions. Technology, such as telemedicine and online resources, played a pivotal role in bridging access gaps, particularly in remote areas. The synthesis of best practices for supporting mental health patients during lockdowns encompasses targeted interventions for vulnerable groups, including adolescents and pregnant women. Empowering communities through economic support and mental health literacy programs was identified as crucial. The integration of technology, such as the development of robust telemedicine frameworks, virtual training in curricula, and the utilization of digital platforms for interventions and public messaging, emerged as a cornerstone in addressing access disparities. Community engagement and resilience-building strategies gained prominence, emphasizing the necessity of collaboration between healthcare providers and communities. Promotion of peer support groups, home-based care, and the preservation of traditional healing practices were underscored as essential components. CONCLUSION: The study underscores the need to adapt and optimize mental health services during emergencies. This entails prioritizing mental health within emergency response frameworks, exploring alternative service delivery methods, and fortifying data collection and research efforts.

Integrated Behavioral Health Adaptations During the COVID-19 Pandemic.

INTRODUCTION: COVID-19 pandemic lockdowns threatened standard components of integrated behavioral health (IBH) such as in-person communication across care teams, screening, and assessment. Restrictions also exacerbated pre-existing challenges to behavioral health (BH) access. METHODS: Semistructured interviews were completed with clinicians from family medicine residency programs on the impact of the pandemic on IBH care delivery along with adaptations employed by care teams to ameliorate disruption. RESULTS: Participants (n = 41) from 14 family medicine residency programs described the rapid shift to virtual care, creating challenges for IBH delivery and increased demand for BH services. With patients and care team members at home, virtual warm handoffs and increased attention to communication were necessary. Screening and measurement were more difficult, and referrals to appropriate services were challenging due to higher demand. Tele-BH facilitated continued access to BH services but was associated with logistic challenges. Participants described adaptations to stay connected with patients and care teams and discussed the need to increase capacity for both in-person and virtual care. DISCUSSION: Most practices modified their workflows to use tele-BH as COVID-19 cases increased. Participants shared key learnings for successful implementation of tele-BH that could be applied in future health care crises. CONCLUSION: Practices adapted readily to challenges posed by pandemic restrictions and their ability to sustain key elements of IBH during the COVID-19 pandemic demonstrates innovation in maintaining access when in-person care is not possible, informing strategies applicable to other scenarios.

Explaining the Impact of the COVID-19 Pandemic on Massage Therapists in Australia and Canada: A Mixed Methods Study.

Background: The COVID-19 pandemic was a time of rapid change and uncertainty, with individual jurisdictions within countries implementing a variety of preventative measures. At the onset of the pandemic, as little was known about how COVID-19 was transmitted, restrictions, such as lockdowns, were implemented to prevent further spread of this virus. In many jurisdictions, massage therapists were deemed as nonessential for a period. This disruption to their livelihood, as a professional group and without autonomy to decide, was unprecedented. This prompted the question as to whether this experience had impacted massage therapists' professional identity. Methods: A sequential explanatory mixed methods design was used and massage therapists in Australia and Canada were recruited to participate. Results from a quantitative questionnaire completed by 649 respondents and from 31 semistructured interviews from a subset of the questionnaire participants were used in the mixed analysis. Results: Massage therapists, impacted by the pandemic, experienced a discord between what it means to be a massage therapist, providing patient-centered care and the public health initiatives implemented during the pandemic. This discord occurred in multiple situations and the type of discord was influenced by a number of factors, including how therapists identified themselves within the workforce (i.e., as a health care provider or a service provider). Conclusion: This study sought to understand how the COVID-19 pandemic impacted massage therapists' professional identity. Massage therapists reported that the pandemic impacted their professional identity through a lack of congruence and discord between their identity-constituting beliefs and what it means to be a massage therapist. The sequela to this discord was therapists experiencing different types of moral distress and or moral injury. Future research is needed to determine the longer-term impacts of COVID-19 on massage therapists.

Impact of the COVID-19 lockdown on the vitamin D status of people in the West of Ireland.

OBJECTIVE: Identify the impact of COVID-19 lockdown restrictions on the vitamin D status of individuals in the west of Ireland. DESIGN: Cross-sectional study. SETTING: Adults who had wintertime serum 25(OH)D analysis completed in Galway University Hospital. PARTICIPANTS: A total of 16,725 participants (2015-2020 (n = 13,449) and 2020-2021 (n = 3276)). Baseline demographics; sex, age, origin of the sample and the date of sample collection. RESULTS: Median serum vitamin D and serum vitamin D3 concentrations were higher in the 5-month period from October-February 2020-2021 (61 nmol/L (± 36-85 nmol/L) and 60 nmol/L (± 34-85 nmol/L)) respectively, than for the corresponding 5-month period (October-February) in 2015-2020 (53 nmol/L (± 32-78 nmol/L) and 51 nmol/L (± 30-77 nmol/L)) respectively. These changes coincided with a decline in the prevalence of deficiency. In the 5-month period October-February 2020-2021, 19.2% of the population were vitamin D deficient (< 30 nmol/L) compared to 22.5% in the corresponding 5-month period in 2015-2020, and 38.1% were vitamin D deficient (< 50 nmol/L) in the 5-month period October-February 2020-2021 compared to 46.6% in the corresponding 5-month period in 2015-2020. Males were more likely to be deficient at both thresholds (p < 0.001). For the total cohort, at the < 30 nmol/L threshold, inpatients (25.5%) and nursing home residents (34.1%) had higher prevalence of deficiency. CONCLUSIONS: Vitamin D levels were higher in the 5-month period of October-February 2020-2021, and this precipitated a decline in deficiency at both thresholds, indicating that lockdown coincided with enhanced vitamin D status. We postulate that it may be attributable to changes in diet and/or supplementation, or increased sun exposure, but further confirmatory studies are required.

Significance of Vitamin Supplementation in Reducing the Severity of COVID-19.

Coronavirus disease-19 (COVID-19), a serious pandemic due to the SARS-CoV-2 virus infection, caused significant lockdowns, healthcare shortages, and deaths worldwide. The infection leads to an uncontrolled systemic inflammatory response causing severe respiratory distress and multiple-organ failure. Quick development of several vaccines efficiently controlled the spread of COVID-19. However, the rise of various new subvariants of COVID-19 demonstrated some concerns over the efficacy of existing vaccines. Currently, better vaccines to control these variants are still under development as several new subvariants of COVID-19, such as omicron BA-4, BA-5, and BF-7 are still impacting the world. Few antiviral treatments have been shown to control COVID-19 symptoms. Further, control of COVID-19 symptoms has been explored with many natural and synthetic adjuvant compounds in hopes of treating the deadly and contagious disease. Vitamins have been shown to modulate the immune system, function as antioxidants, and reduce the inflammatory response. Recent studies have investigated the potential role of vitamins, specifically vitamins A, B, C, D, and E, in reducing the immune and inflammatory responses and severity of the complication. In this brief article, we discussed our current understanding of the role of vitamins in controlling COVID-19 symptoms and their potential use as adjuvant therapy.

Exploring the Lived Experiences of Vulnerable Females from a Low-Resource Setting during the COVID-19 Pandemic.

The onset of the Coronavirus disease 2019 (COVID-19) pandemic has affected the mental health and well-being of women in vulnerable settings. Currently, there is limited evidence that explores the wellness of elderly women under the associated restrictions. This study explores the lived experiences of elderly women in a vulnerable community in Durban, South Africa. A face-to-face, in-depth qualitative approach was implemented to interview 12 women aged 50 years and over. Thematic analysis was used to analyse the data. The findings suggest that social interactions, the effect of a high death rate, and financial strain predominantly affect stress and anxiety levels. Despite the women being in receipt of pensions and/or other grants, their supplementary income was reduced. This, together with the additional expenses incurred during the lockdown, resulted in anxiety over finances. The lack of social interaction, with limits on visiting family and other loved ones when they were ill, along with the limit on the number of people attending the funerals of loved ones were also stressful. This study also reports on the resulting coping mechanisms, which included using hobbies such as baking and sewing as a means of self-care. Religious beliefs also relieved stress while home remedies were used as preventative measures during the lockdown restrictions due to COVID-19.

Efficacy of an Electronic Cognitive Behavioral Therapy Program Delivered via the Online Psychotherapy Tool for Depression and Anxiety Related to the COVID-19 Pandemic: Pre-Post Pilot Study.

BACKGROUND: Lockdowns and social distancing resulting from the COVID-19 pandemic have worsened the population's mental health and made it more difficult for individuals to receive care. Electronic cognitive behavioral therapy (e-CBT) is a cost-effective and evidence-based treatment for anxiety and depression and can be accessed remotely. OBJECTIVE: The objective of the study was to investigate the efficacy of online psychotherapy tailored to depression and anxiety symptoms during the pandemic. METHODS: The pilot study used a pre-post design to evaluate the efficacy of a 9-week e-CBT program designed for individuals with depression and anxiety affected by the pandemic. Participants were adults (N=59) diagnosed with major depressive disorder and generalized anxiety disorder, whose mental health symptoms initiated or worsened during the COVID-19 pandemic. The online psychotherapy program focused on teaching coping, mindfulness, and problem-solving skills. Symptoms of anxiety and depression, resilience, and quality of life were assessed. RESULTS: Participants demonstrated significant improvements in symptoms of anxiety (P=.02) and depression (P=.03) after the intervention. Similar trends were observed in the intention-to-treat analysis. No significant differences were observed in resilience and quality-of-life measures. The sample comprised mostly females, making it challenging to discern the benefits of the intervention in males. Although a pre-post design is less rigorous than a controlled trial, this design was selected to observe changes in scores during a critical period. CONCLUSIONS: e-CBT for COVID-19 is an effective and accessible treatment option. Improvements in clinical symptoms of anxiety and depression can be observed in individuals whose mental health is affected by the COVID-19 pandemic. TRIAL REGISTRATION: ClinicalTrials.gov NCT04476667; https://clinicaltrials.gov/study/NCT04476667. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/24913.

Unintended consequences: Alcohol screening at urban Aboriginal Community Controlled Health Services was suppressed during COVID-19 lockdowns.

INTRODUCTION: Regular screening for risky drinking is important to improve the health of Aboriginal and Torres Strait Islander Australians. We explored whether the rate of screening for risky drinking using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questions was disrupted at Aboriginal Community Controlled Health Services (ACCHS) during state-wide and territory-wide COVID-19 lockdowns in 2020. METHODS: Retrospective analysis of screening data from 22 ACCHSs located in New South Wales, the Northern Territory, Queensland, South Australia, Victoria and Western Australia. These services provide holistic and culturally appropriate primary care. A multi-level Poisson regression, including AR(1) autocorrelation, was used to predict counts of AUDIT-C screening at ACCHSs. RESULTS: AUDIT-C screening was suppressed during state-wide and territory-wide lockdowns in 2020 (incident rate ratio [IRR] 0.42 [0.29, 0.61]). The effect of lockdowns differed by service remoteness. While there was a substantial reduction in AUDIT-C screening for urban and inner regional services (IRR 0.25 [95% confidence interval (CI) 0.15, 0.42]), there was not a statistically significant change in screening at outer regional and remote (IRR 0.60 [95% CI 0.33, 1.09]) or very remote services (IRR 0.67 [95% CI 0.40, 1.11]). DISCUSSION AND CONCLUSIONS: The COVID-19 lockdowns in Australia likely suppressed rates of screening for risky drinking in urban and inner regional regions. As harm from alcohol consumption may have increased during lockdowns, policymakers should consider implementing measures to enable screening for risky drinking to continue during future lockdowns.

Rebound in sexually transmitted infections after the COVID-19 pandemic.

Sexually transmitted infections (STIs) have become the second in the global rating of infectious diseases after respiratory infections. Globally, over 1 million, new STI is diagnosed every day. Although four conditions are the most representative and of obligatory declaration (gonorrhea, syphilis, chlamydia, and human immunodeficiency virus [HIV]), there are many other prevalent STI, including trichomona, herpes simplex, papillomavirus, and viral hepatitis. Herein, we perform a narrative and retrospective review, analyzing information from public databases from distinct Spanish government institutions. STI significantly declined in Spain during 2020 as a result of lockdown and social isolation measures dictated in response to the COVID-19 pandemic. After releasing restrictions, a major STI rebound occurred in 2021. Increases were 49% for gonorrhea, 45% for HIV, 39% for chlamydia, and 32% for syphilis. Based on nationwide statistics, we build a narrative review of the recent STI surge after COVID-19. In summary, we propose a holistic approach to confront the current re-emergence of STI. On one hand, new innovative medical advances must be implemented, including new rapid tests, novel vaccines, pre-exposure prophylaxis beyond HIV, and long-acting antivirals. On the other hand, information to citizens needs to be reformulated with interventions aimed to build a healthier society, alike it has been undertaken with tobacco, alcohol, diet, and lifestyle. STI determines important sexual, reproductive, and maternal-child health consequences. To promote human well-being or flourishing, the education of adolescents and young adults should be aligned with human ecology. Therefore, it is urgent to address new approaches in sexual health that represent a clear benefit for individual persons and society. In this way, favoring a cultural evolution aimed to delay the age of first sexual intercourse and the avoidance of multiple sex partners should be prioritized.

Decreased vitamin D levels in the pediatric population after COVID-19 lockdown.

BACKGROUD: SARS-Cov2 infection began to spread worldwide since December 2019; on March 2020, the World Health Organization characterized its related disease, named COVID-19, as a pandemic. In Italy, to contain the spread of infection a severe lockdown in the spring 2020 was instituted. Other less severe restrictions were imposed in the winter 2020-2021 and in the spring 2021. The containment measures caused a series of consequences for the population and, in particular, for children and adolescents that presented psychophysical problems. The aim of this manuscript is to investigate the serum levels of vitamin D in children and adolescents before, during and after the lockdown consequent to COVID-19 pandemic. METHODS: This is a retrospective cross-sectional study, including all children and adolescents between 1 to 18 years referring to the Pediatric Endocrinology Service of the University Hospital of Verona, Italy, between January 2019 and December 2021. All patients affected by clinical conditions that involve vitamin D metabolism or assuming vitamin D supplementation were excluded. RESULTS: In total, 491 children (36.7% males and 63.3% females) were enrolled in this study. The vitamin D levels decreased over time: 28.3 ± 10.2 ng/mL in 2019; 28.2 ± 11.4 ng/mL in 2020 and 24.9 ± 10.1 ng/mL in 2021 (p < 0.05). The vitamin D levels are significant higher in summer and in autumn in comparison with the levels of winter and spring, regardless of the examined years. CONCLUSIONS: The measures adopted to contain the COVID-19 pandemic led to a reduction of serum levels of vitamin D in pediatric population, probably due to the reduced solar exposure. This may have severe consequences on the bone metabolism of those children who did not present optimal vitamin D levels even before the lockdown. Therefore, an adequate supplementation of vitamin D is necessary from the end of fall to the beginning of spring (November-April) in all children and adolescents living in Northern Italy.

Effect of age and gender on dietary patterns, mindful eating, body image and confidence.

The emergence of 'Diet Culture' came into existence with the era of pop culture, which emphasized the idea of body improvement by embracing the portrayal of unrealistic beauty standards set by the thin-ideal media. This growing and trending culture gained its popularity in India with the COVID pandemic and the imposed lockdown, wherein the prevalence of obesity and binge eating resulted from counter-regulatory eating behaviors and restrictive food intake to a greater extent of skipping meals to achieve the desired body type. The present empirical investigation focuses on understanding the gender and age-based differences (between the ages 18 to 55) among Indian population on dietary patterns, body image, mindful eating and physical appearance confidence using 2 × 3 factorial design. The tools used were Eating Behavior Pattern Questionnaire (EBPQ) [43], Body Self- image Questionnaire (BSIQ) [40], Mindful Eating Questionnaire (MEQ) [18] and Personal Evaluation Inventory (PEI) [44] were administered on a sample size of 120, selected using convenience sampling technique. The collected data was analyzed using SPSS Version 20.0. Results of the study reveal non-significant age and gender differences for mindful eating and appearance confidence. Significant age- differences were observed for Snacking and convenience F(2,114) = 6.22, p < .05; social dependence F(2,114) = 3.87, p < .05 and height dissatisfaction F(2,114) = 8.79, p < .05. And, significant gender differences were observed for Meal Skipping F(1,114) = 6.46, P < .05; snacking and convenience F(1,114) = 4.19, p < .05; fatness evaluation F(1,114) = 5.94, p < .05 and fitness evaluation F(1,114) = 5.33, p < .05. The only significant interaction effect observed was for social dependence dimension F(2, 114) = 3.96, p < .05. Thus, high exposure to social media and diet-related content contributed significantly to changing dietary patterns, and how they look, feel or perceive their body.

Can digital health researchers make a difference during the pandemic? Results of the single-arm, chatbot-led Elena+: Care for COVID-19 interventional study.

Background: The current paper details findings from Elena+: Care for COVID-19, an app developed to tackle the collateral damage of lockdowns and social distancing, by offering pandemic lifestyle coaching across seven health areas: anxiety, loneliness, mental resources, sleep, diet and nutrition, physical activity, and COVID-19 information. Methods: The Elena+ app functions as a single-arm interventional study, with participants recruited predominantly via social media. We used paired samples T-tests and within subjects ANOVA to examine changes in health outcome assessments and user experience evaluations over time. To investigate the mediating role of behavioral activation (i.e., users setting behavioral intentions and reporting actual behaviors) we use mixed-effect regression models. Free-text entries were analyzed qualitatively. Results: Results show strong demand for publicly available lifestyle coaching during the pandemic, with total downloads (N = 7'135) and 55.8% of downloaders opening the app (n = 3,928) with 9.8% completing at least one subtopic (n = 698). Greatest areas of health vulnerability as assessed with screening measures were physical activity with 62% (n = 1,000) and anxiety with 46.5% (n = 760). The app was effective in the treatment of mental health; with a significant decrease in depression between first (14 days), second (28 days), and third (42 days) assessments: F2,38 = 7.01, p = 0.003, with a large effect size (η2G = 0.14), and anxiety between first and second assessments: t54 = 3.7, p = <0.001 with a medium effect size (Cohen d = 0.499). Those that followed the coaching program increased in net promoter score between the first and second assessment: t36 = 2.08, p = 0.045 with a small to medium effect size (Cohen d = 0.342). Mediation analyses showed that while increasing number of subtopics completed increased behavioral activation (i.e., match between behavioral intentions and self-reported actual behaviors), behavioral activation did not mediate the relationship to improvements in health outcome assessments. Conclusions: Findings show that: (i) there is public demand for chatbot led digital coaching, (ii) such tools can be effective in delivering treatment success, and (iii) they are highly valued by their long-term user base. As the current intervention was developed at rapid speed to meet the emergency pandemic context, the future looks bright for other public health focused chatbot-led digital health interventions.

Midwife-led pandemic telemedicine services for maternal health and gender-based violence screening in Bangladesh: an implementation research case study.

BACKGROUND: The COVID-19 pandemic disrupted maternal and newborn health services in Bangladesh, exacerbating the large gaps in service utilization that existed prior to the pandemic. As part of its response, Bangladesh initiated remote antenatal and postnatal care telemedicine services led by midwives in 36 sub-district hospitals across five of Bangladesh's 64 districts. Gender-based violence screening and referral were integrated into the service to address a reported rise in violence following the country's pandemic lockdown. METHODS: Mixed-methods implementation research was used to develop an intrinsic case study describing the design and implementation of the telemedicine program. Qualitative analysis comprised document review, key informant interviews, and focus group discussions. Quantitative analysis employed an interrupted time series analysis with segmented multi-variate regression to compare maternity care service use trends before and after implementation. Poisson regression analysis was used to examine the trend in number of gender-based violence remote screenings, sessions held, and cases identified. RESULTS: A statistically significant change in trend for onsite antenatal and postpartum care as well as women seeking care at the hospital as a result of postpartum hemorrhage arising in the community was observed following the introduction of telemedicine. Facility births and cases of eclampsia appropriately identified and managed also had significant increases. In addition, over 6917 women were screened for GBV, 223 received counseling and 34 referrals were made, showing a statistically significant increase in frequency over time following the implementation of the telemedicine program. Challenges included that not all midwives adopted GBV screening, some women were reluctant to discuss GBV, there was an unanticipated need to introduce a patient visit scheduling system in all intervention hospitals, and many women were not reachable by phone due to lack of access or network coverage. CONCLUSIONS: Maternal health and gender-based violence telemedicine led by midwives was an effective, low-cost intervention in Bangladesh for addressing pandemic and pre-pandemic gaps in service use. Other low and middle-income countries planning to implement remote maternal health interventions via midwives should consider whether a patient visit scheduling system needs to be introduced, as well as limitations around mobile phone access and connectivity. Future research should include care quality oversight and improvement, and a more well-informed strategy for facilitating effective GBV screening.

To support the continuation of sexual and reproductive health services following pandemic lockdowns, Bangladesh introduced a midwife-led telemedicine program. Through the program, midwives who were already employed within the health system delivered remote antenatal and postnatal care, including gender-based violence screening and referral. The program operated in 36 sub-district hospitals across five of Bangladesh's 64 districts. Intrinsic implementation research was used to develop a case study describing the design and implementation of the telemedicine program. Qualitative and quantitative methods comprised document review, key informant interviews, focus group discussions, and service use trends. Analysis of the data identified a statistically significant trend increase for most maternity care services. Although they did increase significantly over time, referrals for GBV were less than expected, which may have been related to some midwives not screening for GBV, and/or that many women were reluctant to discuss GBV. In addition, there was an unanticipated need to introduce a patient visit scheduling system in all intervention hospitals, and many women were not reachable by phone due to lack of access or network coverage. In spite of this, 6197 women were screened for GBV. Of those, 223 received counseling and 34 received referrals. Overall, telemedicine led by midwives was an effective, low-cost intervention for maternal health, and a step toward stronger GBV response in Bangladesh. Other low and middle-income countries planning to implement remote maternal health interventions via midwives should consider what is needed to facilitate comfort for both providers and women as related to GBV screening, as well as practical issues regarding introducing scheduling systems and limitations of mobile phone access and connectivity.

The Variability of Vitamin D Concentrations in Short Children with Short Stature from Central Poland-The Effects of Insolation, Supplementation, and COVID-19 Pandemic Isolation.

The aim of the study was to investigate the effects of seasonal variability of insolation, the implementation of new recommendations for vitamin D supplementation (2018), and the SARS-CoV-2 pandemic lockdown (2020) on 25(OH)D concentrations in children from central Poland. The retrospective analysis of variability of 25(OH)D concentrations during the last 8 years was performed in a group of 1440 children with short stature, aged 3.0-18.0 years. Significant differences in 25(OH)D concentrations were found between the periods from mid-2014 to mid-2018, from mid-2018 to mid-2020, and from mid-2020 to mid-2022 (medians: 22.9, 26.0, and 29.9 ng/mL, respectively). Time series models created on the grounds of data from 6 years of the pre-pandemic period and used for prediction for the pandemic period explained over 80% of the seasonal variability of 25(OH)D concentrations, with overprediction for the first year of the pandemic and underprediction for the second year. A significant increase in 25(OH)D concentrations was observed both after the introduction of new vitamin D supplementation guidelines and during the SARS-CoV-2 pandemic; however, the scale of vitamin D deficiency and insufficiency was still too high. Time series models are useful in analyzing the impact of health policy interventions and pandemic restrictions on the seasonal variability of vitamin D concentrations.

From ToyBox Study to eToyBox: Advancing Childhood Obesity Reduction in Malaysian Kindergartens.

Prevention and treatment of childhood obesity is a global concern, and in Malaysia, it is considered a national public health priority. Determinants of childhood obesity are multifactorial and include factors that directly and indirectly influence energy balance-related behaviours, including energy intake and energy expenditure. Interventions to address childhood obesity that have multiple components at different levels have been shown to be the most influential. The ToyBox-study is a childhood obesity intervention aimed at preschool-aged children and their families that had been shown to be effective in several European countries and so was chosen for adaption for the Malaysian setting. Materials were translated and adjusted for the Malaysian context and audience and implemented in kindergartens in Peninsular Malaysia and Sarawak. However, during the COVID-19 pandemic and lockdown, teaching transitioned to being online. This brought an opportunity to reach a wider audience and consider the long-term sustainability of the intervention, and thus eToybox was born. eToybox aims to bring support for healthy energy balance behaviours directly to the teachers, into kindergartens and homes, to encourage families to be active and eat healthily, and prevent or reduce obesity. Through online innovation, the Toybox Study Malaysia programme has been expanded to enhance its potential to impact the promotion of healthy lifestyles among preschoolers and their families, highlighting the importance of a holistic approach to preventing and treating childhood obesity in Malaysia.

Efficacy of Yoga for COVID-19 Stress Prophylaxis.

BACKGROUND: The global COVID-19 lockdown restricted daily routines due to the psychological fear of infection, which imposed an unknown universal threat on female college students, affecting physiological health and well-being. However, scant information concerning the efficacy of yogic practice on female college students during the stressful COVID-19 pandemic situation is available. METHODS: In a randomized controlled trial (n = 74, age = 21.65 [4.05] y), a study was conducted with a well-conceptualized yogic module for 5 days/week for 3 months (40 min daily in the morning) among yogic volunteers. Pre-post analysis of anthropometric, physiological, and biochemical indices in pandemic-stressed female college students was done for the control and yoga groups. RESULTS: After 3 months of yogic practice, significant reduction (P < .05) in heart rate (d = 0.64, meandiff = 5.43), systolic blood pressure (d = 0.59, meandiff = 5.32), cortisol (d = 0.59, meandiff = 6.354), and triglycerides (P < .01, d = 0.45, meandiff = 13.95) was observed. After yogic follow-up significant improvement (P < .01) in high-frequency (d = 0.56, meandiff = -7.3), total power (d = 0.46, meandiff = -1150) and time domain parameters of heart rate variability led to ameliorate the stress index. Superoxide dismutase (P < .01, d = 0.78, meandiff = 0.69), catalase (P < .05, d = 0.48, meandiff = -7.37), glutathione (P < .001, d = 0.83, meandiff = -4.15), high-density lipoprotein (P < .05, d = 0.48, meandiff = -11.07), and dopamine (P < .001, d = 0.97, meandiff = -135.4) values along with inflammatory markers (P < .001) significantly improved among yogic volunteers after regular practice. CONCLUSIONS: Our findings suggest that a 3-month well-conceptualized yogic intervention during COVID-19 may be considered as a prophylactic tool to improve female college students' universal psychophysiological health by ameliorating autonomic functions, cardiometabolic risk factors, and immune metabolisms in an economical and environment-friendly manner.