Key Factors Impacting a Medical Ventilator Supply Chain During the COVID- 19 Pandemic: Lessons for Pandemic Preparedness.

OBJECTIVES: Future pandemics may cause more severe respiratory illness in younger age groups than COVID-19, requiring many more mechanical ventilators. This publication synthesizes the experiences of diverse contributors to Medtronic's mechanical ventilator supply chain during the pandemic, serving as a record of what worked and what didn't, while identifying key factors affecting production ramp-up in this healthcare crisis. METHOD: In-depth, one-on-one interviews (n = 17) were held with key Medtronic personnel and suppliers. Template analysis was used, and interview content was analyzed for signals, initiatives, actions, and outcomes, as well as influencing forces. RESULTS: Key findings revealed many factors limiting ventilator production ramp-up. Supply chain strengths and weaknesses were identified. Political factors played a role in allocating ventilators and also supported production. Commercial considerations were not priority, but economic awareness was essential to support suppliers. Workers were motivated and flexible. Component shortages, space, production processes, and logistics were challenges. Legally based pressures were reported e.g., import and export restrictions. CONCLUSION: Crisis response alone is not enough; preparation is essential. Coordinated international strategies are more effective than individual country responses. Supply chain resilience based on visibility and flexibility is key. This research can help public health planners and the medical device industry prepare for future healthcare crises.

How COVID-19 is reshaping U.S. national security policy.

In the wake of the COVID-19 pandemic, the United States is actively reshaping parts of its national security enterprise. This article explores the underlying politics, with a specific interest in the context of biosecurity, biodefense, and bioterrorism strategy, programs, and response, as the United States responds to the most significant outbreak of an emerging infectious disease in over a century. How the implicit or tacit failure to recognize the political will and political decision-making connected to warfare and conflict for biological weapons programs in these trends is explored. Securitization of public health has been a focus of the literature over the past half century. This recent trend may represent something of an inverse: an attempt to treat national security interests as public health problems. A hypothesis is that the most significant underrecognized problem associated with COVID-19 is disinformation and the weakening of confidence in institutions, including governments, and how adversaries may exploit that blind spot.

Hospital capacities and response to COVID-19 pandemic surges in Iran: A quantitative model-based study.

The coronavirus 2019 (COVID-19) pandemic resulted in serious limitations for healthcare systems, and this study aimed to investigate the impact of COVID-19 surges on in-patient care capacities in Iran employing the Adaptt tool. Using a cross-sectional study design, our study was carried out in the year 2022 using 1-year epidemiologic (polymerase chain reaction-positive COVID-19 cases) and hospital capacity (beds and human resource) data from the official declaration of the pandemic in Iran in February 2020. We populated several scenarios, and in each scenario, a proportion of hospital capacity is assumed to be allocated to the COVID-19 patients. In most of the scenarios, no significant shortage was found in terms of bed and human resources. However, considering the need for treatment of non- COVID-19 cases, in one of the scenarios, it can be observed that during the peak period, the number of required and available specialists is exactly equal, which was a challenge during surge periods and resulted in extra hours of working and workforce burnout in hospitals. The shortage of intensive care unit beds and doctors specializing in internal medicine, infectious diseases, and anesthesiology also requires more attention for planning during the peak days of COVID-19.

Lessons Learned from Cross-Systems Approach to COVID-19 Pandemic Response in Juvenile Justice System, Colorado, USA.

The global COVID-19 pandemic illustrates the importance of a close partnership between public health and juvenile justice systems when responding to communicable diseases. Many setting-specific obstacles must be navigated to respond effectively to limit disease transmission and negative health outcomes while maintaining necessary services for youth in confinement facilities. The response requires multidisciplinary expertise and collaboration to address unique considerations. Public health mitigation strategies must balance the risk for disease against the negative effects of restrictions. Key aspects of the COVID-19 response in the juvenile justice system of Colorado, USA, involved establishing robust communication and data reporting infrastructures, building a multidisciplinary response team, adapting existing infection prevention guidelines, and focusing on a whole-person health approach to infection prevention. We examine lessons learned and offer recommendations on pandemic emergency response planning and managing a statewide public health emergency in youth confinement settings that ensure ongoing readiness.

Drivers for a pandemic due to avian influenza and options for One Health mitigation measures.

Avian influenza viruses (AIV) remain prevalent among wild bird populations in the European Union and European Economic Area (EU/EEA), leading to significant illness in and death of birds. Transmission between bird and mammal species has been observed, particularly in fur animal farms, where outbreaks have been reported. While transmission from infected birds to humans is rare, there have been instances of exposure to these viruses since 2020 without any symptomatic infections reported in the EU/EEA. However, these viruses continue to evolve globally, and with the migration of wild birds, new strains carrying potential mutations for mammalian adaptation could be selected. If avian A(H5N1) influenza viruses acquire the ability to spread efficiently among humans, large-scale transmission could occur due to the lack of immune defences against H5 viruses in humans. The emergence of AIV capable of infecting mammals, including humans, can be facilitated by various drivers. Some intrinsic drivers are related to virus characteristics or host susceptibility. Other drivers are extrinsic and may increase exposure of mammals and humans to AIV thereby stimulating mutation and adaptation to mammals. Extrinsic drivers include the ecology of host species, such as including wildlife, human activities like farming practices and the use of natural resources, climatic and environmental factors. One Health measures to mitigate the risk of AIV adapting to mammals and humans focus on limiting exposure and preventing spread. Key options for actions include enhancing surveillance targeting humans and animals, ensuring access to rapid diagnostics, promoting collaboration between animal and human sectors, and implementing preventive measures such as vaccination. Effective communication to different involved target audiences should be emphasised, as well as strengthening veterinary infrastructure, enforcing biosecurity measures at farms, and reducing wildlife contact with domestic animals. Careful planning of poultry and fur animal farming, especially in areas with high waterfowl density, is highlighted for effective risk reduction.

Salud mental asociada a la pandemia de COVID-19 en estudiantes de fisioterapia de la Universidad Nacional Autónoma de México / Mental health associated with the COVID-19 pandemic in physiotherapy students at the National Autonomous University of Mexico

Antecedentes y objetivo: A nivel mundial la pandemia por el COVID-19 ha interrumpido el aprendizaje de más de mil millones de estudiantes, quienes reportan alteraciones en la salud mental, niveles altos de estrés académico y carga de trabajo. En la Licenciatura en Fisioterapia de la Universidad Nacional Autónoma de México, 331 estudiantes dejaron de asistir a clases presenciales indispensables para su formación académica y, tras un año de confinamiento, se desconoce el impacto psicológico y académico en esta población. El objetivo fue evaluar la salud mental, carga de trabajo y estrés académico de los estudiantes e identificar la asociación entre variables. Materiales y métodos: Se aplicó el Cuestionario de Salud Emocional por la Pandemia de COVID-19 - Fisioterapia, la escala de carga de trabajo UNIPSICO Battery y el Cuestionario de estrés estudiantil COVID-19. Se incluyeron los alumnos inscritos entre el primer y cuarto año de la Licenciatura en Fisioterapia de la Universidad Nacional Autónoma de México mayores de 18 años que contestaron la encuesta vía online y otorgaron su consentimiento informado. Resultados: El 62,7% de los estudiantes reportaron ansiedad, el 61,8% reportaron depresión, el 51,0% indicaron una percepción moderada del estrés académico y el 42,2% percibieron una carga de trabajo alta. La ansiedad y depresión tuvieron una asociación estadísticamente significativa con el estrés académico y carga de trabajo (p<0,05). Conclusiones: El estudio evidencia los efectos psicológicos y académicos derivados de la pandemia del COVID-19 en estudiantes de fisioterapia, que amerita medidas de intervención fisioterapéuticas y académicas que mitiguen los efectos del confinamiento.(AU)

Background and objective: Worldwide, the COVID-19 pandemic has disrupted the learning of over a billion students, who report mental health disorders, high levels of academic stress, and workload. In the bachelor's degree in physical therapy at the National Autonomous University of Mexico, 331 students stopped attending essential face-to-face classes for their academic training, and after a year of confinement, the psychological and academic impact on this population is unknown. The objective was to evaluate the mental health, workload, and academic stress of students in the bachelor's degree and identify the association between variables. Materials and methods: The Emotional Health Questionnaire for the COVID-19 pandemic – physical therapy was applied, including the UNIPSICO battery workload scale and the COVID-19 student stress questionnaire. Students enrolled between the first and fourth year of the Bachelor's degree in Physical Therapy at the National Autonomous University of Mexico over 18 years old who completed the survey online and provided informed consent were included. Results: 62.7% of students reported anxiety, 61.8% reported depression, 51.0% indicated a moderate perception of academic stress, and 42.2% perceived a high workload. Anxiety and depression had a statistically significant association with academic stress and workload (P<.05). Conclusions: The study demonstrates the psychological and academic effects of the COVID-19 pandemic on physical therapy students, which warrants physiotherapeutic and academic intervention measures to mitigate the effects of confinement.(AU)

Assessment of restriction measures implemented during COVID pandemics on community lifestyle choices via wastewater-based epidemiology.

SARS-CoV-2 pandemic affected lifestyle habits, and the mental health and wellbeing of people around the world. In this manuscript, two towns (Paulton and Radstock) and two cities (Bath and Bristol) in Southwest England (> 1 million people) were monitored for two years using Wastewater-Based Epidemiology to assess impacts of COVID (including management measures such as lockdowns and movement restrictions) on community lifestyle choices: illicit drugs, legal stimulants, abused pharmaceuticals and pain pharma usage. Results were triangulated with key dates captured during the pandemic (national lockdowns, restrictions and social distancing measures, etc.). This highlighted a reduction in cocaine intake (as benzoylecgonine) (community average: -36 %) during the first lockdown and an increase in illicit drugs usage after the 3rd national lockdown (community averages for amphetamine: +8 %, cocaine/benzoylecgonine: +39 %, ketamine:+70 %) when restrictions were removed, and social interaction and recreational activities increased. There was a reduction in the intake of caffeine (as 1,7-dimethylxanthine) (community average:-39 %) after 3rd national lockdown coinciding with pubs reopening while nicotine intake (via cotinine) remained stable indicating lack of impact of COVID on smoking habits. Pain pharma often used in pain management resulting from injuries linked with sport activities (naproxen and diclofenac) showed decrease in usage due to lockdown restrictions in physical exercise and access to gyms/sport facilities.

Understanding treatment of pain during SARS-CoV-2 pandemic in a two-year intercity longitudinal study using wastewater-based epidemiology.

SARS-CoV-2 pandemic had a significant impact on the society, economy, and health of people around the world with consequences that need to be better understood for future pandemic preparedness. This manuscript provides insights into the usage of pharmaceuticals for pain treatment management throughout SARS-CoV-2 pandemic. Four towns and cities with a total population of > 1 million people covering an area of 2000 km2 in South West England were monitored for twenty-four months. Results showed different patterns in pain pharma usage, with small towns having higher population normalised daily loads (PNDLs) than big cities for majority of pain killers studied. This is likely due to demographics of these cities with smaller cities having older population. Per capita consumption of non-steroidal anti-inflammatory drugs (NSAIDs) increased compared to pre-pandemic usage in line with SARS-CoV-2 infections (ibuprofen and acetaminophen), while body pain drugs (diclofenac and naproxen) decreased in line with restrictions and closure of sports facilities. Changes in population normalised daily intake (PNDI) of pain killers were particularly apparent during the 1st and 3rd national lockdown. Comparison of PNDIs with prescriptions highlighted differences related to medication availability (OTC drugs) and patients' nonadherence (prescribed drugs). In addition, several instances of direct disposal events across the catchments were observed which raises an issue of lack of pharma compliance and general understanding of potential environmental impacts from pharma usage.

Changes in food sufficiency among Korean adults in urban and rural areas during the COVID-19 pandemic: an analysis of the 7th and 8th Korea National Health and Nutrition Examination Survey.

Objectives: Understanding changes in food sufficiency within various demographic groups during emergency situations, such as the global coronavirus disease 2019 (COVID-19) pandemic, is crucial in formulating public health policies for future preparedness. This study investigated potential differences between urban and rural residents in food sufficiency trends during the COVID-19 pandemic and examined how these changes varied according to sociodemographic factors. Methods: This cross-sectional study analyzed data from 19,724 adults aged 20 years and older, utilizing information from the 7th-8th Korea National Health and Nutrition Examination Survey (2018-2021). Results: In urban areas, across all subpopulations, food sufficiency improved significantly during the COVID-19 period relative to pre-pandemic levels (p<0.001). However, in rural regions, a significant increase in food sufficiency during the COVID-19 era was observed only among women, with an odds ratio of 1.42 (confidence interval, 1.06 to 1.89). Nevertheless, no significant interaction terms were found between region and various sociodemographic factors regarding changes in food sufficiency during the COVID-19 period. Conclusion: During the COVID-19 pandemic, food sufficiency among urban residents improved compared to the pre-pandemic era, whereas their rural counterparts saw no such improvement. Additionally, no significant interaction was detected between urban versus rural areas and changes in food sufficiency during the COVID-19 period. These findings indicate the need for targeted food policies to prepare for potential future pandemics, particularly in rural areas, where food sufficiency did not improve.

Health Literacy Among University Students in the COVID-19 Pandemic: A Systematic Review.

BACKGROUND: The purpose of this systematic review was to assess different studies that worked on university students' health literacy during covid19 pandemic and to make an overview of this issue to recognize possible determinants associated with health literacy. METHODS: This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Four databases (Google Scholar, Web of Science, Pubmed, and Scopus) were used for searching cross-sectional works that assessed the health literacy of university students. We searched papers from December 1st, 2019 up to June 10th, 2022. English language articles were used. Studies were done in countries including; Iran, Pakistan, the USA, Vietnam, China, Colombia, Germany, and Indonesia. RESULTS: The systematic review contains 12 research studies involving 17773 students. There was a relationship between health literacy and some determinants. Positive determinants included age, female gender, Urban background, cognitive maturity, Higher educational qualification, information source (Health workers), number of semesters, and parental education. Some negative determinants were male gender, Rural background, smoking, drinking, being able to pay for medication, lower conspiracy beliefs, and higher fear of COVID-19. CONCLUSION: University students around the world should have courses about health literacy according to university disciplines. These courses should be available for students of different fields to enhance their effectiveness, and training should be associated with students' needs and their subgroup traits.

Healthcare Access Worsened for Women in Precarious Housing During the COVID-19 Pandemic: A Qualitative Study.

This research aims to gain an in-depth understanding of precariously housed women's experiences related to health and access to health care during the COVID-19 pandemic using a grounded theory approach. Qualitative data were obtained through interviews with 17 precariously housed women from Izmir, Turkey. Poor health among most participants was primarily attributed to unfavorable living conditions and weakened community networks. The COVID-19 pandemic exacerbated existing health issues due to barriers in accessing basic needs. Food insecurity was widespread during the pandemic and the critical role of aid and the inadequacy of social assistance in securing food were emphasized. Women's health perceptions were significantly shaped by gender, and gendered caregiving duties have restricted women's healthcare access. Access to healthcare was also limited by financial challenges, with health insurance being a crucial determinant. Longer waiting times, often exacerbated by the appointment system, and language were significant barriers to healthcare access. The findings propose that the participants were precarized by the blindness of COVID-19 measures to vulnerabilities, which resulted in deeper inequalities in housing, food, employment, and healthcare access. This research addresses the political, commercial, and social determinants of precariously housed women's health. Improving precariously housed women's health and wellbeing requires implementation of public policies targeting to improve housing quality, provide targeted assistance to food insecurity, promote gender inclusiveness, and foster gender empowerment.

Breast and cervical cancer programs' success in maintaining screening during periods of high COVID-19: A qualitative multi-case study analysis.

Objective: During the first year of the COVID-19 pandemic, most of the Centers for Disease Control and Prevention (CDC)'s National Breast and Cervical Cancer Early Detection Program (NBCCEDP) funded programs (recipients) experienced significant declines in breast and cervical cancer screening volume. However, 6 recipients maintained breast and/or cervical cancer screening volume during July-December 2020 despite their states' high COVID-19 test percent positivity. We led a qualitative multi-case study to explore these recipients' actions that may have contributed to screening volume maintenance. Methods: We conducted 22 key informant interviews with recipients, screening provider sites, and partner organizations. Interviews explored organizational and operational changes; screening barriers; actions taken to help maintain screening volume; and support for provider sites to continue screening. We documented contextual factors that may have influenced these actions, including program structures; clinic capacity; and state COVID-19 policies. Results: Thematic analysis revealed crosscutting themes at the recipient, provider site, and partner levels. Recipients made changes to administrative processes to reduce burden on provider sites and delivered tailored technical assistance to support safe screening. Provider sites modified clinic protocols to increase patient safety, enhanced patient reminders for upcoming appointments, and increased patient education on the importance of timely screening during the pandemic. Partners worked with provider sites to identify and reduce patients' structural barriers to screening. Conclusion: Study findings provide lessons learned to inform emergency preparedness-focused planning and operations, as well as routine operations for NBCCEDP recipient programs, other cancer screening initiatives, primary care clinics, and chronic disease prevention programs.

Emergency department responses to nursing shortages.

BACKGROUND: The COVID-19 pandemic exacerbated the nursing shortage, which is predicted to continue to worsen with significant numbers of nurses planning to retire within the next 5 years. There remains a lack of published information regarding recommended interventions for emergency departments (EDs) facing a sudden nursing shortage. METHODS: We queried emergency department leaders from the American College of Emergency Physicians to examine the impact of nursing shortages on EDs and to gather real-world interventions employed to mitigate the effects of the shortage. RESULTS: Most respondents (98.5%) reported nursing shortages, with 83.3% describing prolonged shortages lasting more than 12 months, with negative impacts such as misses/near-misses (93.9%) and increasing left without being seen rates (90.9%). ED leaders reported a range of interventions, including operational flow changes, utilizing alternative staff to fill nurse roles, recruitment of new nurses, and retention strategies for existing nurses. They employed temporary and permanent pay increases as well as efforts to improve the ED work environment and techniques to hire new nurses from atypical pipelines. CONCLUSION: We report a patchwork of solutions ED leaders utilized which may have variable efficacy among different EDs; personalization is essential when selecting interventions during a sudden nursing shortage.

Upskill training and preparedness of non-critical-care registered nurses deployed to intensive care units during the COVID-19 pandemic: A scoping review.

BACKGROUND: The increase in intensive care unit (ICU) capacity compelled by the COVID-19 pandemic required the rapid deployment of non-critical-care registered nurses to the ICU setting. The upskill training needed to prepare these registered nurses for deployment was rapidly assembled due to the limited timeframe associated with the escalating pandemic. Scoping the literature to identify the content, structure, and effectiveness of the upskill education provided is necessary to identify lessons learnt during the COVID-19 pandemic response so that they may guide workforce preparation for future surge planning. AIM: The aim of this scoping review was to map the literature to identify the available information regarding upskill training and preparedness of non-critical-care registered nurses deployed to the ICU during the COVID-19 pandemic. METHODS: This scoping review was conducted in accordance with JBI methodology. A protocol outlined the review questions and used the participants, concept, and context framework to define the inclusion and exclusion criteria. A search of healthcare databases MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), Cochrane, and Scopus was supplemented with a grey literature search via Google. RESULTS: Screening and review found 32 manuscripts that met the inclusion criterion for examination. Analysis revealed variation in duration of programs, theoretical versus practical content, face-to-face or online mode of delivery, and duration of preparation time at the bedside in the ICU setting. Data on contributors to preparedness for deployment were sparse but included training, support, peer education, buddy time, and clarity around responsibilities and communication. DISCUSSION: Evaluation of upskill education was mostly limited to post-training surveys. Few studies explored the preparedness of deployed registered nurses as an outcome of their upskill training or described measures of effectiveness of ICU deployment. CONCLUSION: There is limited evidence describing preparedness of non-critical-care registered nurses on deployment to the ICU. Further research is needed to identify what elements of upskill education led to preparedness and effective deployment to the ICU setting.

Evaluating the metropolitan public health preparedness for pandemics using entropy-TOPSIS-IF.

Introduction: Metropolitan governance's efficacy is regularly gauged by its capability for public health preparedness, a critical component, particularly in the post-pandemic climate, as global cities reassess their mitigation abilities. This process has broader implications, curbing mortality rates and amplifying sustainability. Current methodologies for preparedness assessment lean primarily on either Subjective Evaluation-Based Assessment (SBA), predicated on experts' input on various capacity indicators, or they opt for Data-Based quantitative Assessments (DBA), chiefly utilizing public statistic data. Methods: The manuscript discusses an urgent need for integrating both SBA and DBA to adequately measure Metropolitan Public Health Pandemics Preparedness (MPHPP), thus proposing a novel entropy-TOPSIS-IF model for comprehensive evaluation of MPHPP. Within this proposed model, experts' subjective communication is transformed into quantitative data via the aggregation of fuzzy decisions, while objective data is collected from public statistics sites. Shannon's entropy and TOPSIS methods are enacted on these data sets to ascertain the optimal performer after normalization and data isotropy. Results and discussion: The core contribution of the entropy-TOPSIS-IF model lies in its assessment flexibility, making it universally applicable across various contexts, regardless of the availability of expert decisions or quantitative data. To illustrate the efficacy of the entropy-TOPSIS-IF model, a numerical application is presented, examining three Chinese metropolises through chosen criteria according to the evaluations of three experts. A sensitivity analysis is provided to further affirm the stability and robustness of the suggested MPHPP evaluation model.

Insufficient Answer During the Public Health Emergency: A Lesson from the Persistence of Food Insecurity in Low-Income Communities.

Cohort study in deprived communities to investigate the persistence of food insecurity (FI) during the COVID-19 was conducted. Sample were derived from a list of mobile phone numbers provided by community leaders and local nonprofit organizations. Temporal trends and prevalence ratios of FI persistence, categorized as "never," "occasional FI," "consistent FI," were calculated. A total of 302 households completed three assessments, the majority nonwhite women. During the follow-up, families covered by social assistance increased; however, their income decreased (p < 0.05). 33% were "consistent," and 46% "occasional" FI. Permanent difficulties accessing gas canisters, hygiene products, and hand sanitizers were observed.

Chemsex among men who have sex with men during the Mpox health crisis in Brazil: A nationwide web survey.

OBJECTIVE: To understand the factors associated with the practice of chemsex among MSM in Brazil, especially during the Mpox health crisis, and to design effective prevention and intervention strategies specifically for this population. DESIGN: A cross-sectional and analytical study using an electronic survey, conducted from September to December 2022, during the peak of the Mpox outbreak in Brazil. SAMPLE: A total of 1452 MSM aged 18 and older. MEASUREMENTS: Data were collected via the REDCap platform through a survey with 46 questions. These addressed demographic data, sexual affiliations, practices, experiences with Mpox, healthcare service usage, and stigma or fear related to Mpox. RESULTS: The prevalence of chemsex was 19.42% (n = 282). Multivariate Poisson modeling indicated a high incidence of chemsex among those diagnosed with Mpox and those involved in high-risk behaviors. The practice of chemsex was six times higher among those diagnosed with Mpox (95% CI: 4.73-9.10). MSM who engage in bugchasing had a prevalence twice that of the main outcome (95% CI: 1.31-3.16). CONCLUSION: There is a significant need for targeted interventions for MSM in Brazil, especially given the Mpox outbreak. This study highlights the strong relationships between chemsex, experiences with Mpox, and various sexual behaviors, underscoring the importance of effective public health initiatives.

Pandemic Effects on Stability of End-of-Life Preferences and Patient-Surrogate Dyad Congruence.

CONTEXT: Whether a largescale disaster alters people's previous decisions about their end-of-life care is unknown. OBJECTIVES: We examined the effects of a disaster, the COVID-19 pandemic, on stability of end-of-life care preferences among dialysis patients and on patient-surrogate goals-of-care congruence. METHODS: We used a natural experimental design to examine goals-of-care preferences pre- and postexposure to the pandemic during a pragmatic trial testing SPIRIT (sharing patient's illness representations to increase trust), an evidence-based advance care planning (ACP) intervention. There were 151 patient-surrogate dyads who prior to the pandemic lockdown had completed baseline (T1) and postintervention assessments (T2) regarding their goals-of-care preferences in two end-of-life scenarios. Of those 151 dyads, 59 intervention, and 51 usual care dyads consented to be in the present study and completed the goals-of-care tool two additional times, at enrollment (T3) and six months later (T4), along with the COVID stress scale (CSS). Dyad congruence was ascertained by comparing patient and surrogate responses to the goals-of-care tool. RESULTS: There were no changes over time in the proportions of patients who chose comfort-care-only in the goals-of-care tool. The proportion of patients who chose comfort-care-only and dyad congruence were higher in SPIRIT compared to usual care, but there was no interaction between that treatment effect and exposure to the pandemic. CSS was associated with neither patients' preferences nor dyad congruence. CONCLUSIONS: The pandemic alone did not appear to influence patients' goals-of-care preferences or dyad congruence. This finding supports the stability of value-based end-of-life preferences in general, even during a disaster.

Community Members' Perceptions of a Resource-Rich Well-Being Website in California During the COVID-19 Pandemic: Qualitative Thematic Analysis.

BACKGROUND: To address needs for emotional well-being resources for Californians during the COVID-19 pandemic, the Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos) website was developed in collaboration with multiple community partners across California, funded by the California Department of Health Care Services Behavioral Health Division federal emergency response. OBJECTIVE: This qualitative study was designed to explore and describe the perspectives of participants affiliated with California organizations on the T4W/Juntos website, understand their needs for web-based emotional health resources, and inform iterative website development. METHODS: After providing informed consent and reviewing the website, telephone interviews were conducted with 29 participants (n=21, 72% in English and n=8, 28% in Spanish) recruited by partnering community agencies (October 2021-February 2022). A 6-phase thematic analysis was conducted, enhanced using grounded theory techniques. The investigators wrote reflexive memos and performed line-by-line coding of 12 transcripts. Comparative analyses led to the identification of 15 overarching codes. The ATLAS.ti Web software (ATLAS.ti Scientific Software Development GmbH) was used to mark all 29 transcripts using these codes. After examining the data grouped by codes, comparative analyses led to the identification of main themes, each with a central organizing concept. RESULTS: Four main themes were identified: (1) having to change my coping due to the pandemic, (2) confronting a context of shifting perceptions of mental health stigma among diverse groups, (3) "Feels like home"-experiencing a sense of inclusivity and belonging in T4W/Juntos, and (4) "It's a one-stop-shop"-judging T4W/Juntos to be a desirable and useful website. Overall, the T4W/Juntos website communicated support and community to this sample during the pandemic. Participants shared suggestions for website improvement, including adding a back button and a drop-down menu to improve functionality as well as resources tailored to the needs of groups such as older adults; adolescents; the lesbian, gay, bisexual, transgender, and queer community; police officers; and veterans. CONCLUSIONS: The qualitative findings from telephone interviews with this sample of community members and service providers in California suggest that, during the COVID-19 pandemic, the T4W/Juntos website was well received as a useful, accessible tool, with some concerns noted such as language sometimes being too "professional" or "clinical." The look, feel, and content of the website were described as welcoming due to pictures, animations, and videos that showcased resources in a personal, colorful, and inviting way. Furthermore, the content was perceived as lacking the stigma typically attached to mental health, reflecting the commitment of the T4W/Juntos team. Unique features and diverse resources, including multiple languages, made the T4W/Juntos website a valuable resource, potentially informing dissemination. Future efforts to develop mental health websites should consider engaging a diverse sample of potential users to understand how to tailor messages to specific communities and help reduce stigma.

Meta-analysis of KAP toward COVID-19 in Chinese residents.

Background: During the coronavirus disease-2019 (COVID-19) pandemic, there have been many studies on knowledge, attitudes, and practices (KAP) toward prevention of COVID-19 infection in China. Except for symptomatic treatment and vaccination, KAP toward COVID-19 plays an important role in the prevention of COVID-19. There is no systematic evaluation and meta-analysis of KAP toward COVID-19 in China. This study is the earliest meta-analysis of KAP toward COVID-19 in China's general population. Hence, this systematic review aimed to summarize the knowledge, attitudes, and practices (KAP) of Chinese residents toward COVID-19 during the pandemic. Methodology: Following the PRISMA guidelines, articles relevant to COVID-19 KAP that were conducted among the Chinese population were found in databases such as Scopus, ProQuest, PubMed, EMbase, Web of Science, Cochrane Library, China Biology Medicine, China National Knowledge Infrastructure, CQVIP, Wanfang and Google Scholar. A random-effect meta-analysis is used to summarize studies on knowledge, attitudes, and practice levels toward COVID-19 infection in China's general population. Results: Fifty-seven articles published between August 2020 and November 2022 were included in this review. Overall, 75% (95% CI: 72-79%) of Chinese residents had good knowledge about COVID-19, 80% (95% CI: 73-87%) of Chinese residents had a positive attitude toward COVID-19 pandemic control and prevention (they believe that Chinese people will win the battle against the epidemic), and the aggregated proportion of residents with a correct practice toward COVID-19 was 84% (95% CI: 82-87%, I2 = 99.7%).In the gender subgroup analysis, there is no significant difference between Chinese men and Chinese women in terms of their understanding of COVID-19. However, Chinese women tend to have slightly higher levels of knowledge and a more positive attitude toward the virus compared to Chinese men. When considering the urban and rural subgroup analysis, it was found that Chinese urban residents have a better understanding of COVID-19 compared to Chinese rural residents. Interestingly, the rural population displayed higher rates of correct behavior and positive attitudes toward COVID-19 compared to the urban population. Furthermore, in the subgroup analysis based on different regions in China, the eastern, central, and southwestern regions exhibited higher levels of knowledge awareness compared to other regions. It is worth noting that all regions in China demonstrated good rates of correct behavior and positive attitudes toward COVID-19. Conclusion: This study reviews the level of KAP toward COVID-19 during the pandemic period in China. The results show that the KAP toward COVID-19 in Chinese residents was above a favorable level, but the lack of translation of knowledge into practice should be further reflected on and improved. A subgroup analysis suggests that certain groups need more attention, such as males and people living in rural areas. Policy makers should pay attention to the results of this study and use them as a reference for the development of prevention and control strategies for major public health events that may occur in the future. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=348246, CRD42022348246.