The prevalence of suicidal behavior and ideation during pregnancy and postpartum period, its variation in the COVID-19 pandemic, and the related factors: A systematic review and meta-analysis of observational studies

Bacground Pregnancy and postpartum are sensitive periods for mental health problems due to increased stressors and demands, and the prevalence of intentional self-harming behaviors such as suicidal behavior and ideation may increase. Changes in the provision of prenatal care services and utilization of health services and adverse living conditions during the COVID-19 epidemic may also trigger or exacerbate mental illnesses. Aims To investigate the prevalence of suicidal behavior and ideation encountered during pregnancy and postpartum period, its change in the COVID-19 pandemic, and the related factors. Methods A systematic review and meta-analysis of observational studies was conducted. A search was conducted in April 2021 and updated in April 2023 on Web of Science, PubMed, PsycINFO, EBSCO, Turk Medline, Turkish Clinics, and ULAKBIM databases. Two authors independently conducted the search, selection of articles, data extraction, and quality assessment procedures, and an experienced researcher controlled all these steps. Joanna Briggs Institute's Critical Appraisal Checklists were used to assess the quality of the studies. Results The meta-analysis included 38 studies and the total sample size of the studies was 9 044 991. In this meta-analysis, the prevalence of suicidal behavior in women during pregnancy and postpartum periods was 5.1 % (95 % CI, 0.01–1.53), suicidal ideation 7.2 % (95 % CI, 0.03–0.18), suicide attampt 1 % (95 % CI, 0.00–0.07) and suicidal plan 7.8 % (95 % CI, 0.06–0.11). Rate of suicidal behavior, ideation/thought increased and attempts in the pandemic process (2.5% vs 19.7 %; 6.3% vs 11.3 %; 3.6% vs 1.4 %, respectively). Prevalences of suicidal behavior, ideation, attempts, and plan in the postpartum period was higher than during pregnancy (1.1% vs 23.4 %; 6.1% vs 9.2 %; 0.5% vs 0.7 %; 7.5% vs 8.8 %, respectively). ... (AU)

Respiratory pathogen and clinical features of hospitalized patients in acute exacerbation of chronic obstructive pulmonary disease after COVID 19 pandemic.

Respiratory infections are common causes of acute exacerbation of chronic obstructive lung disease (AECOPD). We explored whether the pathogens causing AECOPD and clinical features changed from before to after the coronavirus disease 2019 (COVID-19) outbreak. We reviewed the medical records of patients hospitalized with AECOPD at four university hospitals between January 2017 and December 2018 and between January 2021 and December. We evaluated 1180 patients with AECOPD for whom medication histories were available. After the outbreak, the number of patients hospitalized with AECOPD was almost 44% lower compared with before the outbreak. Patients hospitalized with AECOPD after the outbreak were younger (75 vs. 77 years, p = 0.003) and more often stayed at home (96.6% vs. 88.6%, p < 0.001) than patients of AECOPD before the outbreak. Hospital stay was longer after the outbreak than before the outbreak (10 vs. 8 days. p < 0.001). After the COVID-19 outbreak, the identification rates of S. pneumoniae (15.3 vs. 6.2%, p < 0.001) and Hemophilus influenzae (6.4 vs. 2.4%, p = 0.002) decreased, whereas the identification rates of P. aeruginosa (9.4 vs. 13.7%, p = 0.023), Klebsiella pneumoniae (5.3 vs. 9.8%, p = 0.004), and methicillin-resistant Staphylococcus aureus (1.0 vs. 2.8%, p = 0.023) increased. After the outbreak, the identification rate of influenza A decreased (10.4 vs. 1.0%, p = 0.023). After the outbreak, the number of patients hospitalized with AECOPD was lower and the identification rates of community-transmitted pathogens tended to decrease, whereas the rates of pathogens capable of chronic colonization tended to increase. During the period of large-scale viral outbreaks that require quarantine, patients with AECOPD might be given more consideration for treatment against strains that can colonize chronic respiratory disease rather than community acquired pathogens.

Stress perception, coping behaviors and work-privacy conflict of student midwives in times of COVID-19 pandemic: the "Healthy MidStudents" study in Germany.

BACKGROUND: Student midwives deliver care for women under challenging job demands, which may affect their mental health- thus creating a high need for health promotion. Given the lack of research addressing this topic, the aim of this study is to examine the links between stress perception, coping behaviors, work-privacy conflict, and perception of COVID-19 pandemic impact on studies of student midwives in northern Germany. METHODS: Data were collected using a cross-sectional online-survey at nine midwifery study sites in northern Germany from October 2022 to January 2023. 342 student midwives (response rate: 61.3%) were surveyed on stress perception, coping behaviors, work-privacy conflict, and perceived impact of the COVID-19 pandemic on their studies. Descriptive, linear regression and moderation analyses were run to test explorative assumptions. RESULTS: Results revealed that higher levels of perceived stress were reported by 13.4% of student midwives. Social support (M = 13.76, SD = 2.19) and active stress coping (M = 10.72, SD = 2.01) were identified as most prevalent coping behaviors in the present sample. It was found that work-privacy conflict was positively associated with stress perception (ß = 0.53, p =.001) and maladaptive coping behaviors (alcohol and cigarette consumption: ß = 0.14, p =.015), and negatively associated with adaptive coping behaviors (positive thinking: ß = - 0.25, p =.001, social support: ß = - 0.23, p =.001). Students with children reported significantly lower levels of social support than students without children. 55.6% of student midwives perceived a negative impact of the COVID-19 pandemic on their studies (mostly on lectures, seminars, and contact with fellow students). CONCLUSIONS: Key findings highlighted moderate stress levels among student midwives during theoretical study stage. Based on current research, prevalence of high stress levels among student midwives remains unclear. Given the overall heterogeneous, limited research on student midwives' stress perception, coping behaviors, work-privacy conflict and perceptions of COVID-19 pandemic impact on studies, implications for research are suggested, e.g. longitudinal studies at different time points and settings and interventional studies. Findings provide a starting point for implementation of workplace health promotion in theoretical and practical stages of midwifery science study programs, e.g. training courses on stress prevention and adaptive coping, and for improvement of working conditions.

Crisis leadership behaviors in healthcare: survey validation and influence on staff outcomes in primary care clinics during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic triggered an unprecedented transition from in-person to virtual delivery of primary health care services. Leaders were at the helm of the rapid changes required to make this happen, yet outcomes of leaders' behaviours were largely unexplored. This study (1) develops and validates the Crisis Leadership and Staff Outcomes (CLSO) Survey and (2) investigates the leadership behaviours exhibited during the transition to virtual care and their influence on select staff outcomes in primary care. METHODS: We tested the CLSO Survey amongst leaders and staff from four Community Health Centres in Ontario, Canada. The CLSO Survey measures a range of crisis leadership behaviors, such as showing empathy and promoting learning and psychological safety, as well as perceived staff outcomes in four areas: innovation, teamwork, feedback, and commitment to change. We conducted an exploratory factor analysis to investigate factor structure and construct validity. We report on the scale's internal consistency through Cronbach's alpha, and associations between leadership scales and staff outcomes through odds ratios. RESULTS: There were 78 staff and 21 middle and senior leaders who completed the survey. A 4-factor model emerged, comprised of the leadership behaviors of (1) "task-oriented leadership" and (2) "person-oriented leadership", and select staff outcomes of (3) "commitment to sustaining change" and (4) "performance self-evaluation". Scales exhibited strong construct and internal validity. Task- and person-oriented leadership behaviours positively related to the two staff outcomes. CONCLUSION: The CLSO Survey is a reliable measure of leadership behaviours and select staff outcomes. Our results suggest that crisis leadership is multifaceted and both person-oriented and task-oriented leadership behaviours are critical during a crisis to improve perceived staff performance and commitment to change.

Coping strategies, resilience and quality of life: reaction to the COVID-19 pandemic among Romanian physicians.

BACKGROUND: The COVID-19 pandemic has presented multiple psychological challenges for healthcare workers, such as anxiety, depression, burnout, and substance use disorders. In this research, we investigate the different ways Romanian physicians dealt with the difficult period of the COVID-19 pandemic. We also analyze how positive and negative stress-reducing strategies, as well as demographic variables, affect their psychological resilience and quality of life. Our goal is to provide a comprehensive overview of how physicians coped with the unprecedented global health challenges. METHODS: We carried out a national cross-sectional study of 265 physicians in Romania between January 2021 and January 2022 using a web-based questionnaire. The study employed a web-based questionnaire to assess coping mechanisms using the COPE inventory, resilience through the Connor-Davidson Resilience Scale 25 (CD-RISC 25), and quality of life via the WHOQOL-BREF scale. The COPE inventory, consisting of 60 items across 15 subscales, categorizes coping strategies into problem-focused, emotion-focused, and dysfunctional types, with each item rated on a 4-point scale. The CD-RISC 25 measures resilience on a 5-point Likert scale, with total scores ranging from 0 to 100. WHOQOL-BREF assesses quality of life through 26 items in 4 domains: physical, mental, social relations, and environmental, scored from 1 to 5 and converted to a 0-100 scale for domain scores. Univariate and multivariate linear regression models were employed to discern the intricate relationships between coping strategies, resilience levels, quality of life dimensions, and pertinent demographic factors. RESULTS: The average CD-RISC score among participants was 66.2. The mean scores for the values for the QOL subscales were 64.0 for physical well-being, 61.7 for psychological well-being, 61.2 for social relationships, and 64.7 for environment. Individuals tend to use problem-focused and emotion-focused coping more than dysfunctional mechanisms, according to the COPE inventory. Problem-focused and emotion-focused coping are positively correlated with resilience, while dysfunctional coping is negatively correlated. Resilience is significantly influenced by gender and professional status, with males and senior specialists reporting higher levels while younger physicians and residents reporting lower levels. CONCLUSIONS: Our data points to specific protective characteristics and some detrimental factors on physicians' resilience and quality of life during the pandemic.

Evidence syntheses to support decision-making related to the Covid-19 pandemic.

The COVID-19 pandemic generated a large volume of scientific productions with different quality levels. The speed with which knowledge was produced and shared worldwide imposed on health management the challenge of seeking ways to identify the best available evidence to support its decisions. In response to this challenge, the Department of Science and Technology of the Brazilian Ministry of Health started offering a service to produce and provide scientific knowledge addressing priority public health issues in the pandemic scenario. Drug treatments, non-pharmacological measures, testing, reinfection and immunological response, immunization, pathophysiology, post-COVID syndrome and adverse events are among the topics covered. In this article, we discuss the strengths and lessons learned, as well as the challenges and perspectives that present a real example of how to offer the best scientific evidence in a timely manner in order to assist the decision-making process during a public health emergency.

Longitudinal prediction of primary school children's COVID-related future anxiety in the second year of the pandemic in Germany.

Although research has confirmed that the first COVID-19-related lockdown has increased stress and mental health problems in children, less is known about the longer-term effects of the pandemic on children's COVID-related future anxiety (CRFA). Because of CRFA's potentially debilitating effects, risk and resilience factors against this anxiety were investigated. To this end, n = 140 children (49% female) in 3rd and 4th grade classrooms in Germany were asked to perform a working memory task and to self-report about their CRFA and emotion regulation in December 2020 and in May 2021. More maladaptive emotion regulation in December 2020 contributed to the explanation of a high CRFA score in May 2021, whereas a better performance on working memory updating contributed a lower CRFA score later when controls were in place. These results were confirmed when children's CRFA in December 2020 was included in the prediction of their later CRFA. They suggest that maladaptive strategies of emotion regulation, such as rumination, may explain higher or increasing levels of CRFA, whereas efficient working memory updating may be an indicator of processing information in a way which shields children from CRFA-related thoughts. The concepts underlying these variables should be included in prevention and intervention efforts.

Changing patterns of bacterial profile and antimicrobial resistance in high-risk patients during the COVID-19 pandemic at a tertiary oncology hospital.

The widespread evolution of phenotypic resistance in clinical isolates over the years, coupled with the COVID-19 pandemic onset, has exacerbated the global challenge of antimicrobial resistance. This study aimed to explore changes in bacterial infection patterns and antimicrobial resistance during the COVID-19 pandemic. This study involved the periods before and during COVID-19: the pre-pandemic and pandemic eras. The surveillance results of bacterial isolates causing infections in cancer patients at an Egyptian tertiary oncology hospital were retrieved. The Vitek®2 or Phoenix systems were utilized for species identification and susceptibility testing. Statistical analyses were performed comparing microbiological trends before and during the pandemic. Out of 2856 bacterial isolates, Gram-negative bacteria (GNB) predominated (69.7%), and Gram-positive bacteria (GPB) comprised 30.3% of isolates. No significant change was found in GNB prevalence during the pandemic (P = 0.159). Elevated rates of Klebsiella and Pseudomonas species were demonstrated during the pandemic, as was a decrease in E. coli and Acinetobacter species (P < 0.001, 0.018, < 0.001, and 0.046, respectively) in hematological patients. In surgical patients, Enterobacteriaceae significantly increased (P = 0.012), while non-fermenters significantly decreased (P = 0.007). GPB species from either hematological or surgical wards exhibited no notable changes during the pandemic. GNB resistance increased in hematological patients to carbapenems, amikacin, and tigecycline and decreased in surgical patients to amikacin and cefoxitin (P < 0.001, 0.010, < 0.001, < 0.001, and 0.016, respectively). The study highlights notable shifts in the microbial landscape during the COVID-19 pandemic, particularly in the prevalence and resistance patterns of GNB in hematological and surgical wards.

The Changing Face of Public Services in Health Sciences Libraries Post-Pandemic.

Health sciences library public services underwent profound changes due to the COVID-19 pandemic. Circulation, reference services, instruction, interlibrary loan, and programming were all significantly affected. Libraries adapted by moving to virtual services, featuring online workshops, video consultations, and digital information sharing. Reference services moved to virtual consultations for a streamlined experience, and instruction transitioned to interactive video tutorials. Interlibrary loan services saw a decrease in print material lending but an increase in electronic subscriptions. Library programming shifted from in-person to virtual, focusing on wellness activities. This post-pandemic transformation underscores the importance of ongoing adaptation to meet changing user needs.

Preparing for future pandemics while responding to the current ones in the midst of a planetary climate crisis: Can we face this triple global health challenge?

Global health faces the triple challenge of preparing for future pandemics while responding to current ones in the midst of a climate crisis. In this commentary, we discuss the heightened focus on pandemic preparedness after the COVID-19 pandemic and the risks that this may pose to addressing the elimination of AIDS, tuberculosis, hepatitis and malaria, established in the Sustainable Development Goals as target 3.3. Considering their interconnections with the climate crisis and advocating for global health justice, we identify impasses that such a dispute over priorities can imply, and comment on four fronts of actions that could contribute convergently to both agendas as well as to facing the consequences of climate change to health: strengthening health systems, global commitment to equitable access to strategic medicines, addressing social inequalities and joining efforts for health and climate justice We conclude that addressing these fronts safeguards the health rights of the most vulnerable to existing epidemics while enhancing readiness for future pandemics. Moreover, solutions must transcend technocratic approaches, necessitating the confrontation of inequalities perpetuated by systems of power and privilege fueling both health and climate crises. Ultimately, health justice should guide responses to this intricate triple global health challenge.

Transmission dynamics, complications and mitigation strategies of the current mpox outbreak: A comprehensive review with bibliometric study.

As the mankind counters the ongoing COVID-19 pandemic by the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), it simultaneously witnesses the emergence of mpox virus (MPXV) that signals at global spread and could potentially lead to another pandemic. Although MPXV has existed for more than 50 years now with most of the human cases being reported from the endemic West and Central African regions, the disease is recently being reported in non-endemic regions too that affect more than 50 countries. Controlling the spread of MPXV is important due to its potential danger of a global spread, causing severe morbidity and mortality. The article highlights the transmission dynamics, zoonosis potential, complication and mitigation strategies for MPXV infection, and concludes with suggested 'one health' approach for better management, control and prevention. Bibliometric analyses of the data extend the understanding and provide leads on the research trends, the global spread, and the need to revamp the critical research and healthcare interventions. Globally published mpox-related literature does not align well with endemic areas/regions of occurrence which should ideally have been the scenario. Such demographic and geographic gaps between the location of the research work and the endemic epicentres of the disease need to be bridged for greater and effective translation of the research outputs to pubic healthcare systems, it is suggested.

Best Practices and Recommendations for Research Using Virtual Real-Time Data Collection: Protocol for Virtual Data Collection Studies.

BACKGROUND: The COVID-19 pandemic and the subsequent need for social distancing required the immediate pivoting of research modalities. Research that had previously been conducted in person had to pivot to remote data collection. Researchers had to develop data collection protocols that could be conducted remotely with limited or no evidence to guide the process. Therefore, the use of web-based platforms to conduct real-time research visits surged despite the lack of evidence backing these novel approaches. OBJECTIVE: This paper aims to review the remote or virtual research protocols that have been used in the past 10 years, gather existing best practices, and propose recommendations for continuing to use virtual real-time methods when appropriate. METHODS: Articles (n=22) published from 2013 to June 2023 were reviewed and analyzed to understand how researchers conducted virtual research that implemented real-time protocols. "Real-time" was defined as data collection with a participant through a live medium where a participant and research staff could talk to each other back and forth in the moment. We excluded studies for the following reasons: (1) studies that collected participant or patient measures for the sole purpose of engaging in a clinical encounter; (2) studies that solely conducted qualitative interview data collection; (3) studies that conducted virtual data collection such as surveys or self-report measures that had no interaction with research staff; (4) studies that described research interventions but did not involve the collection of data through a web-based platform; (5) studies that were reviews or not original research; (6) studies that described research protocols and did not include actual data collection; and (7) studies that did not collect data in real time, focused on telehealth or telemedicine, and were exclusively intended for medical and not research purposes. RESULTS: Findings from studies conducted both before and during the COVID-19 pandemic suggest that many types of data can be collected virtually in real time. Results and best practice recommendations from the current protocol review will be used in the design and implementation of a substudy to provide more evidence for virtual real-time data collection over the next year. CONCLUSIONS: Our findings suggest that virtual real-time visits are doable across a range of participant populations and can answer a range of research questions. Recommended best practices for virtual real-time data collection include (1) providing adequate equipment for real-time data collection, (2) creating protocols and materials for research staff to facilitate or guide participants through data collection, (3) piloting data collection, (4) iteratively accepting feedback, and (5) providing instructions in multiple forms. The implementation of these best practices and recommendations for future research are further discussed in the paper. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/53790.

The Risk Of Waiting Up To One Year For Cardiac Surgery.

INTRODUCTION: Cardiac disease is associated with a risk of death, both by the cardiac condition and by comorbidities. The waiting time for surgery begins with the onset of symptoms and includes referral, completion of the diagnosis and surgical waiting list (SWL). This study was conducted during the COVID-19 pandemic, which affected surgical capacity and patients' morbidities. METHODS: The cohort includes 1914 consecutive adult patients (36.6% women, mean age 67 ±11 years), prospectively registered in the official SWL from January 2019 to December 2021. We analyzed waiting times ranging from 4 days to one year to exclude urgencies and outliers. Priority was classified by the national criteria for non-oncologic or oncology surgery. RESULTS: During the study period, 74% of patients underwent surgery, 19.2% were still waiting, and 4.3% dropped out. Most cases were valvular (41.2%) or isolated bypass procedures (34.2%). Patients were classified as non-priority in 29.7%, priority in 61.8%, and high priority in 8.6%, with significantly different SWL mean times between groups (p<0.001). The overall mean waiting time was 167 ± 135 days. Mortality on SWL was 2.5%, or 1.1 deaths per patient/weeks. There were two mortality independent predictors: age (HR 1.05) and the year 2021 versus 2019 (HR 2.07) and a trend toward higher mortality in priority patients versus non-priority (p=0.065). The overall risk increased with time with different slopes for each year. Using the time limits for SWL in oncology, there would have been a significant risk reduction (p=0.011). CONCLUSION: The increased risk observed in 2021 may be related to the pandemic, either by increasing waiting time or by direct mortality. Since risk stratification is not entirely accurate, waiting time emerges as the most crucial factor influencing mortality, and implementing stricter time limits could have led to lower mortality rates.

Dental research related to COVID-19 in Brazil: research presented at the 38th SBPqO Meeting.

The aim of this study was to identify and describe the characteristics of coronavirus (COVID-19)-disease related dental research in Brazil presented at the 38th Annual Meeting of the Brazilian Division of the International Association for Dental Research (SBPqO). A search was carried out in the proceedings of the meeting to retrieve all abstracts. Those containing the term "COVID-19" in titles, abstracts, or keywords, and/or those of which the scope approached a COVID-19-related topic were included. The variables extracted from abstracts were: presenter category, field of study, design, data collection method, population, affiliation, and authors' gender. Descriptive and inferential statistics were used, with a significance level of α = 0.05. The search retrieved 185 abstracts, 5 did not meet study eligibility criteria and were excluded. COVID-19-related research was presented by either aspiring/associate members (67.8%) or beginner members (32.2%). Data collection methods were predominantly digitally mediated (65%), followed by secondary data use (25%), and in-person data collection (7.2%). Irrespective of the role of authorship, there were a ratio of two female authors to each male. Among the last authors, the ratio was three females to each male. Female lead authors more frequently came from the Southeast region (71.8%; p = 0.470). There was an association between presenter category and study design (p = 0.012), clinical and epidemiological studies were more concentrated among experienced presenters. In conclusion, female dental researchers affiliated to southeastern institutions approached the topic of pandemic more frequently than male colleagues. The use of digital technology for data collection may have long-lasting impacts on the teaching and publication of dental research.

The coronavirus disease 2019 infodemic: a concept analysis.

Aim: This study aimed to analyze the coronavirus disease 2019 (COVID-19) infodemic phenomenon in the medical field, providing essential data to help healthcare professionals understand it. Methods: This study utilized a hybrid model for concept analysis. In the theoretical phase (first phase), a literature review was conducted using ScienceDirect, PubMed, CINAHL, ProQuest, Scopus, Web of Science, DBpia, RISS, and KISS. Semi-structured interviews, involving eight physicians and six nurses, were used in the fieldwork phase (second phase). In the final analysis phase (third phase), the results of the preceding phases were combined. Results: Based on the findings of these phases, the COVID-19 infodemic can be defined as "the phenomenon of information flood, reproduction, dissemination, and asymmetry, which occurred during the pandemic through social networks among the public lacking essential knowledge of infectious disease, and is associated with negative and positive effects." Conclusion: Our findings can help the Ministry of Health and Welfare and healthcare professionals to understand the phenomenon of the infodemic and prepare necessary strategies and education programs for the public. Therefore, the provision of basic data is important for developing influential roles for healthcare professionals during infectious disease outbreaks.

K-Track-Covid: interactive web-based dashboard for analyzing geographical and temporal spread of COVID-19 in South Korea.

The COVID-19 pandemic has necessitated the development of robust tools for tracking and modeling the spread of the virus. We present 'K-Track-Covid,' an interactive web-based dashboard developed using the R Shiny framework, to offer users an intuitive dashboard for analyzing the geographical and temporal spread of COVID-19 in South Korea. Our dashboard employs dynamic user interface elements, employs validated epidemiological models, and integrates regional data to offer tailored visual displays. The dashboard allows users to customize their data views by selecting specific time frames, geographic regions, and demographic groups. This customization enables the generation of charts and statistical summaries pertinent to both daily fluctuations and cumulative counts of COVID-19 cases, as well as mortality statistics. Additionally, the dashboard offers a simulation model based on mathematical models, enabling users to make predictions under various parameter settings. The dashboard is designed to assist researchers, policymakers, and the public in understanding the spread and impact of COVID-19, thereby facilitating informed decision-making. All data and resources related to this study are publicly available to ensure transparency and facilitate further research.

Paving the way for COVID survivors' psychosocial rehabilitation: Mining topics, sentiments, and their trajectories over time from Reddit.

Objective: This study examined major themes and sentiments and their trajectories and interactions over time using subcategories of Reddit data. The aim was to facilitate decision-making for psychosocial rehabilitation. Materials and Methods: We utilized natural language processing techniques, including topic modeling and sentiment analysis, on a dataset consisting of more than 38,000 topics, comments, and posts collected from a subreddit dedicated to the experiences of people who tested positive for COVID-19. In this longitudinal exploratory analysis, we studied the dynamics between the most dominant topics and subjects' emotional states over an 18-month period. Results: Our findings highlight the evolution of the textual and sentimental status of major topics discussed by COVID survivors over an extended period of time during the pandemic. We particularly studied pre- and post-vaccination eras as a turning point in the timeline of the pandemic. The results show that not only does the relevance of topics change over time, but the emotions attached to them also vary. Major social events, such as the administration of vaccines or enforcement of nationwide policies, are also reflected through the discussions and inquiries of social media users. In particular, the emotional state (i.e., sentiments and polarity of their feelings) of those who have experienced COVID personally. Discussion: Cumulative societal knowledge regarding the COVID-19 pandemic impacts the patterns with which people discuss their experiences, concerns, and opinions. The subjects' emotional state with respect to different topics was also impacted by extraneous factors and events, such as vaccination. Conclusion: By mining major topics, sentiments, and trajectories demonstrated in COVID-19 survivors' interactions on Reddit, this study contributes to the emerging body of scholarship on COVID-19 survivors' mental health outcomes, providing insights into the design of mental health support and rehabilitation services for COVID-19 survivors.

Excess Fatal Overdoses in the United States During the COVID-19 Pandemic by Geography and Substance Type: March 2020-August 2021.

Objectives. To assess heterogeneity in pandemic-period excess fatal overdoses in the United States, by location (state, county) and substance type. Methods. We used seasonal autoregressive integrated moving average (SARIMA) models to estimate counterfactual death counts in the scenario that no pandemic had occurred. Such estimates were subtracted from actual death counts to assess the magnitude of pandemic-period excess mortality between March 2020 and August 2021. Results. Nationwide, we estimated 25 668 (95% prediction interval [PI] = 2811, 48 524) excess overdose deaths. Specifically, 17 of 47 states and 197 of 592 counties analyzed had statistically significant excess overdose-related mortality. West Virginia, Louisiana, Tennessee, Kentucky, and New Mexico had the highest rates (20-37 per 100 000). Nationally, there were 5.7 (95% PI = 1.0, 10.4), 3.1 (95% PI = 2.1, 4.2), and 1.4 (95% PI = 0.5, 2.4) excess deaths per 100 000 involving synthetic opioids, psychostimulants, and alcohol, respectively. Conclusions. The steep increase in overdose-related mortality affected primarily the southern and western United States. We identified synthetic opioids and psychostimulants as the main contributors. Public Health Implications. Characterizing overdose-related excess mortality across locations and substance types is critical for optimal allocation of public health resources. (Am J Public Health. 2024;114(6):599-609. https://doi.org/10.2105/AJPH.2024.307618).