Comparison of COVID-19 Pandemic Waves in 10 Countries in Southern Africa, 2020-2021.

We used publicly available data to describe epidemiology, genomic surveillance, and public health and social measures from the first 3 COVID-19 pandemic waves in southern Africa during April 6, 2020-September 19, 2021. South Africa detected regional waves on average 7.2 weeks before other countries. Average testing volume 244 tests/million/day) increased across waves and was highest in upper-middle-income countries. Across the 3 waves, average reported regional incidence increased (17.4, 51.9, 123.3 cases/1 million population/day), as did positivity of diagnostic tests (8.8%, 12.2%, 14.5%); mortality (0.3, 1.5, 2.7 deaths/1 million populaiton/day); and case-fatality ratios (1.9%, 2.1%, 2.5%). Beta variant (B.1.351) drove the second wave and Delta (B.1.617.2) the third. Stringent implementation of safety measures declined across waves. As of September 19, 2021, completed vaccination coverage remained low (8.1% of total population). Our findings highlight opportunities for strengthening surveillance, health systems, and access to realistically available therapeutics, and scaling up risk-based vaccination.

Use of real-time cadence to prescribe aerobic physical activity intensity and its comparison with existing methods.

The purpose of this study was to determine the effectiveness of physical activity intensity prescription using real-time cadence on achieving the required intensities for health benefits. Forty adults (18-65 years) participated in the study. The intensity prescriptions included Rating of Perceived Exertion, Talk Test, Heart Rate, and Real-Time Cadence. The participants performed a2-min trial for both moderate- and vigorous-intensity according to each prescription. Atri-axial accelerometer was used as acriterion measure. After completion of the trials, participant's preference for the prescriptions was assessed by three domains (e.g., understanding, performing, maintaining). The compliance and achievement rates of RC were calculated and compared to other prescription methods. Coefficient of Variance was used to evaluate the extent of variation of intensity during the trials. Higher compliance rates were found in both moderate- (92.1%) and vigorous-intensity (94.9%) when using RC. When using RC, most participants (92.5%) were able to achieve the targeted moderate-intensity, but not for vigorous-intensity although asignificant difference was found between the two intensities (p < .001). Overall, RC was the most favoured method in all three domains. RC is apromising tool to prescribe moderate-intensity of physical activity for health benefits but still needs to be refined on prescribing vigorous-intensity.

The impact of initial social distancing measures on individuals' anxiety and loneliness depending on living with their romantic/sexual partners.

In response to the COVID-19 pandemic, large swaths of the U.S. were under stay-at-home orders, thus preventing many individuals from leaving their homes. While previous studies have shown that such orders can be detrimental to mental health, specific mental health outcomes, such as loneliness and anxiety, have yet to be fully explored, particularly among various living situation contexts (e.g., living alone, with romantic/sexual partners, without romantic/sexual partners). The current study explores this using a mixed-methods approach. Data were collected via Amazon's M-Turk (N = 85). Kruskal-Wallis tests revealed significant differences between the three groups with respect to loneliness. Statistically significant greater levels of loneliness were found in individuals living alone compared to those living with romantic/sexual partners and those living with non-romantic/sexual partners. No significant differences in anxiety levels were detected. Qualitative analysis revealed similar themes among all groups regarding anxiety. When asked about loneliness, however, those living alone shared more about feeling isolated, unwanted feelings of solitude, and how technology only mitigates a portion of these feelings. Those living with others and sexual partners shared desires to see friends and co-workers, yet not to the severity described by individuals living alone. Romantic/sex life themes are also discussed.

Validation of wearable activity monitors for real-time cadence.

The purpose of this study is to establish evidence of validity for wearable activity monitors providing real-time cadence against a criterion measure. Thirty-six healthy adults, aged 18-65 years, participated in the study. Four activity monitors including 2 watch-based monitors and 2 cadence sensors attaching to shoelaces were tested. Each participant completed the study protocol consisting of 2 distinct components: (1) treadmill protocol and (2) overground protocol. Lin's concordance correlation and mean absolute percentage error (MAPE) were calculated for the comparisons between the criterion and measures of the monitors. Bland-Altman analysis was performed to determine the mean bias and 95% limits of agreement. All activity monitors showed high correlations with the criterion measures (p < .01). Lower correlations were observed at slow walking speeds in the watch-based monitors. In contrast, consistent and strong correlations were found with both cadence sensors regardless of walking speeds (p < .01). Similar patterns were observed in the MAPE scores. Greater than 90% of the participants were able to maintain prescribed walking intensity using real-time cadence. The results suggest that the wearable activity monitors are an acceptable measure of real-time cadence and provide the potential to improve intensity-based prescription of physical activity using the monitors.

Gender and engineering aptitude: Is the color of science, technology, engineering, and math materials related to children's performance?

To investigate gender stereotypes, demonstrated engineering aptitude, and attitudes, children (N=105) solved an engineering problem using either pastel-colored or primary-colored materials. Participants also evaluated the acceptability of denial of access to engineering materials based on gender and counter-stereotypic preferences (i.e., a boy who prefers pastel-colored materials). Whereas material color was not related to differences in female participants' performance, younger boys assigned to pastel materials demonstrated lower engineering aptitude than did other participants. In addition, results documented age- and gender-related differences; younger participants, and sometimes boys, exhibited less flexibility regarding gender stereotypes than did older and female participants. The findings suggest that attempts to enhance STEM (science, technology, engineering, and math) engagement or performance through the color of STEM materials may have unintended consequences.

What's in a name? Group fitness class names and women's reasons for exercising.

The benefits of intrinsic exercise motivation are well recognized, yet extrinsically focused group-fitness class names/descriptions dominate the fitness industry. To explore the impact of how fitness classes are marketed, women (N = 389) were asked to indicate their preference for either intrinsically or extrinsically focused fitness classes based on title/description. Participants who favored intrinsic class names/descriptions were more likely to report greater interest/enjoyment, perceived competence, and greater effort and report exercising for health/fitness-related reasons. Those favoring extrinsic class names/descriptions were more likely to experience tension/pressure when exercising and report exercising for appearance/weight-related reasons. The results demonstrate the importance of wording when marketing fitness classes.

Compromised Vitamin D Status Negatively Affects Muscular Strength and Power of Collegiate Athletes.

Increasing evidence indicates that compromised vitamin D status, as indicated by serum 25-hydroxyvitamin D (25-OH D), is associated with decreased muscle function. The purpose of this study was to determine the vitamin D status of collegiate athletes residing in the southern U.S. and its effects on muscular strength and anaerobic power. Collegiate athletes (n = 103) from three separate NCAA athletic programs were recruited for the study. Anthropometrics, vitamin D and calcium intake, and sun exposure data were collected along with serum 25-OH D and physical performance measures (Vertical Jump Test, Shuttle Run Test, Triple Hop for Distance Test and the 1 Repetition Maximum Squat Test) to determine the influence of vitamin D status on muscular strength and anaerobic power. Approximately 68% of the study participants were vitamin D adequate (>75 nmol/L), whereas 23% were insufficient (75-50 nmol/L) and 9%, predominantly non-Caucasian athletes, were deficient (<50 nmol/L). Athletes who had lower vitamin D status had reduced performance scores (p < .01) with odds ratios of 0.85 on the Vertical Jump Test, 0.82 on the Shuttle Run Test, 0.28 on the Triple Hop for Distance Test, and 0.23 on the 1 RM Squat Test. These findings demonstrate that even NCAA athletes living in the southern US are at risk for vitamin D insufficiency and deficiency and that maintaining adequate vitamin D status may be important for these athletes to optimize their muscular strength and power.

Trust in and Use of COVID-19 Information Sources Differs by Health Literacy among College Students.

People's health information-seeking behaviors differ by their health literacy levels. This study assessed the relationship between health literacy and college students' levels of trust in and use of a range of health information sources of COVID-19. We collected data from August to December 2020 among college students (n = 763) through an online survey. We used a health literacy measure containing three self-reported survey questions, developed by the CDC. We assessed the extent to which participants trusted and used any of the sixteen different sources of information about COVID-19. Respondents reported high levels of trusting and using COVID-19 information from the CDC, health care providers, the WHO, state/county/city health departments, and official government websites when compared to other sources. After controlling for demographic characteristics (i.e., gender, age, race, ethnicity, and income), those who reported having lower health literacy were significantly less likely to trust and use COVID-19 information from these health authorities when compared to participants who reported having higher health literacy. Students with lower self-reported health literacy indicated not trusting or using official health authority sources for COVID-19 information. Relying on low-quality information sources could create and reinforce people's misperceptions regarding the virus, leading to low compliance with COVID-19-related public health measures and poor health outcomes.

COVID-19 information-seeking behaviors and preventive behaviors among college students in Oklahoma.

Objective: To explore experiences, beliefs, and information-seeking behavior around COVID-19 among college students in Oklahoma. Participants: Fifteen college students participated during the pandemic period from April to July 2020. Methods: An exploratory, qualitative research approach method was used to discover students' experiences, beliefs, and information-seeking behaviors around COVID-19. Exploration of beliefs was guided by the Health Belief Model. Results: Students engaged in COVID-19 information-seeking behaviors predominantly through Internet sites, broadcast news, health professionals, and governmental sources. Students experienced emotional burden as a result of COVID-19 misinformation in these sources. While most students perceived a low chance of acquiring the virus due to their lack of underlying medical conditions, they were still concerned about the consequences of becoming infected. Students noted the difficulty of physical distancing while on campus. Conclusions: Colleges/universities should maximize the dissemination of timely, valid health information for the safety of their students and the broader community.

COVID-19 Related Experiences Among College Students With and Without Disabilities: Psychosocial Impacts, Supports, and Virtual Learning Environments.

This cross-sectional analysis estimated differences, based on disability status, in college students' (n = 777) experiences during the COVID-19 pandemic. Data were modeled using t-tests and logistic regression. Most participants were white (86.2%), and women (66.4%). The mode age was 23. A third (35.6%) had at least one disability. Students reported high rates of psychosocial distress, like fear of contracting (59.7%) and spreading (74.3%) COVID-19, worry about friends and family (83.7%), and increased anxiety (72.5%), depression (59.9%), and substance use (24.7%). Forty-two percent (42.2%) were scared they would miss out on their education through virtual classes. About a third feared forgetting assignments (34.1%) and making mistakes (33.9%). Fewer students expressed apprehension about (27.9%) and intimidation by (26.3%) virtual learning. Only 17.2% would continue taking virtual classes after the pandemic. Students with disabilities (M = 12.4, SD = 4.1) experienced more psychosocial stressors compared to students without disabilities (M = 9.9, SD = 4.2), [t(775) = 7.86, p < 0.001]. In adjusted models, disabled students were more than twice as likely to experience worry about medical bills (OR = 2.29), loneliness (OR = 2.09), and increased anxiety (OR = 2.31). They were also more than three times as likely to report increased depression (OR = 3.51) and changes in sexual activity (OR = 3.12). However, students with disabilities (M = 1.5, SD = 1.1) also reported receiving more support compared to their non-disabled classmates (M = 1.1, SD = 1.1), [t(775) = 6.06, p < 0.001]. Disabled students were more likely to feel a sense of contributing to society by following precautions (OR = 1.80) and receive support from family and others (emotional support: OR = 2.01, financial support: OR = 2.04). Interestingly, no significant differences were found in students' feelings associated with online or virtual learning [t(526.08) = 0.42, p = 0.68]. Students with disabilities, though, trended toward reporting negative experiences with virtual learning. In conclusion, students with disabilities were disproportionately affected by COVID-19 stressors, but also expressed more support and a sense of contributing to the common good.

Stakeholders' assessment of US Centers for Disease Control and Prevention's contributions to the development of National Public Health Institutes in seven countries.

National Public Health Institutes (NPHIs) can strengthen countries' public health capacities to prevent, detect, and respond to public health emergencies. This qualitative evaluation assessed the role of the US Centers for Disease Control and Prevention (CDC) in NPHI development and strengthening of public health functions. We interviewed NPHI staff (N = 43), non-NPHI government staff (N = 29), and non-governmental organization staff (N = 24) in seven countries where CDC has supported NPHI development: Cambodia, Colombia, Liberia, Mozambique, Nigeria, Rwanda, and Zambia. Participants identified four areas of support that were the most important: workforce capacity building, technical assistance for key public health functions, identifying institutional gaps and priorities, and funding to support countries' priorities. Participants underscored the need for capacity building directed toward country-driven priorities during planning and implementation. Continued support for NPHI development from CDC and other partners is vital to building stronger public health systems, improving population health, and strengthening global health security.

Reading between the lines: A qualitative case study of national public health institute functions and attributes in the Joint External Evaluation.

National Public Health Institutes (NPHIs) are national-level institutions that can lead and coordinate a country's public health system. The Africa Centres for Disease Control and Prevention (Africa CDC) considers NPHI development critical to strengthening public health systems in Africa. This paper describes how Joint External Evaluation (JEE) reports demonstrate the role NPHIs can play in supporting the goals of IHR compliance and global health security. This study is a secondary document-based qualitative analysis of JEE reports from 11 countries in the WHO AFRO region (Botswana, Ethiopia, Liberia, Mozambique, Namibia, Nigeria, Rwanda, Sierra Leone, South Africa, Uganda, and Zambia). Researchers found three distinct thematic areas: i) core public health functions, ii) governance, and iii) coordination, collaboration, and communication. These themes and their interlinkages, both in pairs and all three, were of importance in displaying the roles that NPHIs could play in the strengthening of health systems. The data suggests that NPHIs, though not always explicitly mentioned in the data, may have a vital role in strengthening health systems across Africa and their governments' goals of achieving IHR compliance.

Comparing Visual and Statistical Analysis of Multiple Baseline Design Graphs.

A growing number of statistical analyses are being developed for single-case research. One important factor in evaluating these methods is the extent to which each corresponds to visual analysis. Few studies have compared statistical and visual analysis, and information about more recently developed statistics is scarce. Therefore, our purpose was to evaluate the agreement between visual analysis and four statistical analyses: improvement rate difference (IRD); Tau-U; Hedges, Pustejovsky, Shadish (HPS) effect size; and between-case standardized mean difference (BC-SMD). Results indicate that IRD and BC-SMD had the strongest overall agreement with visual analysis. Although Tau-U had strong agreement with visual analysis on raw values, it had poorer agreement when those values were dichotomized to represent the presence or absence of a functional relation. Overall, visual analysis appeared to be more conservative than statistical analysis, but further research is needed to evaluate the nature of these disagreements.

Prior Knowledge of the Mediterranean Diet Is Associated With Dietary Adherence in Cardiac Patients.

CONTEXT: Cardiovascular disease (CVD) is the leading cause of death in the United States, and cardiovascular events have been shown to be reduced and prevented when patients follow the Mediterranean diet. OBJECTIVE: To understand how familiarity with the Mediterranean diet affects dietary habits in cardiology patients by using social cognitive theory. METHOD: This cross-sectional study included patients at a metropolitan outpatient cardiology clinic in Oklahoma. A survey was used to analyze patient knowledge of the Mediterranean diet. Patients were separated into low-, medium-, and high-diet adherence groups based on their daily consumption of fruits, vegetables, fish, whole grains, and nuts. Multinomial logistic regression was used to analyze patients' knowledge of Mediterranean diet principles with dietary adherence. RESULTS: A total of 337 patients were included in the study. Patients with a college education, patients reporting familiarity with the diet, and women were 6.7, 4.0, and 3.2 times as likely, respectively, to have strong adherence to the Mediterranean diet. CONCLUSION: The finding that familiarity with the Mediterranean diet was closely associated with adherence to its principles indicates that patient education on heart-healthy diets may improve the eating habits of patients, especially patients at risk for cardiac events.

Mediterranean Diet Adherence in Cardiac Patients: A Cross-sectional Study.

Objective We analyzed the constructs of social cognitive theory that explain adherence to the Mediterranean diet in patients diagnosed with cardiovascular disease. Methods A cross-sectional study of 337 cardiac patients using a validated questionnaire was conducted and analyzed at an outpatient cardiology clinic, employing social cognitive theory (SCT) as the theoretical framework. Results Dietary adherence was associated with statistically significant improvements in the SCT constructs. Self-regulation to consume healthy diet groups, negative perceived outcomes, and self-efficacy had the most influence on patient ability to maintain the Mediterranean diet. Self-regulation to avoid unhealthy food options like processed, sugary foods and positive perceived outcomes had smaller associations with patient ability to maintain the Mediterranean diet. Conclusions SCT constructs should be utilized by physicians when educating patients on heart healthy dieting as they are highly associated with improved dietary behaviors. Self-efficacy, self-regulation in choosing healthy diet options, and negatively perceived expected outcomes predicted diet quality in cardiac patients. Improvements in these constructs might yield positive results in cardiac patients attempting diet modifications.

Walk Texas! 5-A-Day intervention for Women, Infant, and Children (WIC) clients: a quasi-experimental study.

This study was conducted to evaluate the Walk Texas! Clinical Counseling Guide for Nutrition, which is a brief, stage-based nutritional counseling guide designed for use in clinical settings. This study utilized a pre-test post-test quasi-experimental design, with two intervention and two comparison clinics that were matched for size and ethnicity. Intervention participants were staged for readiness to meet the 5-A-Day criteria for fruits and vegetables (F&V) and provided stage-based counseling. Women, Infant, and Children (WIC) counselors were trained to utilize the Walk Texas! brief staging instrument and to provide all counseling. Primary measures included: stage of change, barriers to change, attitudes toward F&V, self-efficacy, and self-reports of F&V consumption. These were collected at baseline and during follow-up visits to the WIC clinic. A total of 433 participants completed pre-test data across the four sites. A number of individuals transferred from their original clinic or did not return to their clinic during the study (n=62). Of the remaining 371 participants, a total of 225 participants returned at least two surveys, for a response rate of 60.6%. These were primarily native Spanish speaking, Hispanic women, of low educational level. Results were mixed. Although there was no significant increase in the cognitive constructs (self-efficacy, attitudes, etc.), participants in the intervention clinics reported a significant increase in stage of change and a composite measure of F&V in-take. In contrast, participants in the control clinics reported no change in these variables. Thus, there appears to be some utility in the use of the Walk Texas! Clinical Counseling Guide for Nutrition in this population.

Affective responses to an aerobic dance class: the impact of perceived performance.

The current study tests the mastery hypothesis as an explanation for the affective benefits of acute exercise. Participants were 204 undergraduate women who were participating in self-selected aerobic dance classes. Following the class, participants were asked to rate their exercise performance on a 5-point, Likert-type scale. Affect questionnaires were completed prior to and at 5 and 20 min following the aerobic dance class. Results indicated an overall improvement in affect following exercise. Negative valenced subscales were unaffected by performance ratings. Both groups showed similar reductions in these states. There was, however, a significant Group x Time interaction for the positive valenced subscales. High-performance participants reported greater increase in these variables throughout recovery than did low-performance participants. These data support the mastery hypothesis as an explanation for the exercise-induced change in positive affective states.