International Journal of Environmental Research and Public Health

2024

Jump to: 2023, 2022, 2021

11 pages, 285 KiB

Open AccessArticle

Recent Vaccination Against SARS-CoV-2 Is Associated with Less Severe Disease in Working-Age Adults

by Kailey Fischer, Joanne M. Langley, Robyn Harrison, Samira Mubareka, Jeya Nadarajah, Marek Smieja, Louis Valiquette, Curtis Cooper, Jeff Powis, CCS Working Group, Allison McGeer and Brenda L. Coleman

Int. J. Environ. Res. Public Health 2024, 21(11), 1501; https://doi.org/10.3390/ijerph21111501 - 12 Nov 2024

Viewed by 695

Abstract

Background: Essential workers, including those working in healthcare and education, are at higher risk of exposure to communicable diseases, including SARS-CoV-2. Reducing the rates of infection is important for their personal health and for the ongoing safe operation of essential services. Methods: Data [...] Read more.

Background: Essential workers, including those working in healthcare and education, are at higher risk of exposure to communicable diseases, including SARS-CoV-2. Reducing the rates of infection is important for their personal health and for the ongoing safe operation of essential services. Methods: Data from participants in two prospective cohort studies who tested positive for SARS-CoV-2 in 2020 through 2023 were used to determine whether vaccination against SARS-CoV-2 is associated with the severity of symptoms in working-age adults. Results: SARS-CoV-2-positive tests (N = 3757) were reported by 3093 participants (mean: 1.2 per person); 1229 (33%) illnesses did not interfere with regular activities, 1926 (51%) made participants too unwell for regular activities, and 602 (16%) required participant bed rest. Compared with vaccine receipt more than 12 months earlier, receipt within six months of an infection was associated with lower risk ratios for more severe illness (too unwell: 0.69 and bed rest: 0.67) compared with being able to conduct regular activities. More recent vaccination was also associated with lower odds reporting of systemic symptoms (fever, myalgia, arthralgia) and fewer solicited symptoms. Conclusion: Staying current with COVID-19 vaccinations should continue to be recommended since receiving a recent immunization lessened the severity of illness. Also, as symptoms of COVID-19 are now largely similar to other respiratory viruses, practitioners need to use this evidence to inform diagnostic testing and return-to-work policies. Full article

12 pages, 1530 KiB

Open AccessArticle

Wastewater-Based Surveillance Reveals the Effectiveness of the First COVID-19 Vaccination Campaigns in Assisted Living Facilities

by Katherine I. Brenner, Bryan Walser, Joseph Cooper and Sunny Jiang

Int. J. Environ. Res. Public Health 2024, 21(9), 1259; https://doi.org/10.3390/ijerph21091259 - 23 Sep 2024

Viewed by 946

Abstract

The COVID-19 pandemic has disproportionately affected vulnerable populations, including residents of assisted living facilities (ALFs). This study investigates the impact of non-pharmaceutical interventions (NPIs) and mass vaccination campaigns on SARS-CoV-2 transmission dynamics within four ALFs in Maricopa County, Arizona, United States from January [...] Read more.

The COVID-19 pandemic has disproportionately affected vulnerable populations, including residents of assisted living facilities (ALFs). This study investigates the impact of non-pharmaceutical interventions (NPIs) and mass vaccination campaigns on SARS-CoV-2 transmission dynamics within four ALFs in Maricopa County, Arizona, United States from January to April 2021. Initial observations reveal a significant SARS-CoV-2 prevalence in Maricopa County, with 7452 new COVID-19 cases reported on 4 January 2021. Wastewater surveillance indicates elevated viral loads within ALFs with peak concentrations reaching 1.35 × 10⁷ genome copies/L at Facility 1 and 4.68 × 10⁵ copies/L at Facility 2. The implementation of NPIs, including isolation protocols, resulted in a rapid decline in viral loads in wastewater. Following mass vaccination campaigns, viral loads reduced across all facilities, except Facility 4. Facility 1 demonstrated a mean viral load decrease from 1.65 × 10⁶ copies/L to 1.04 × 10³ copies/L post-vaccination, with a statistically significant U-statistic of 28.0 (p-value = 0.0027). Similar trends are observed in Facilities 2 and 3, albeit with varying degrees of statistical significance. In conclusion, this study provides evidence supporting the role of NPIs and vaccination campaigns in controlling SARS-CoV-2 transmission within ALFs. Full article

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11 pages, 312 KiB

Open AccessArticle

Hospital Mortality and Morbidity in Diabetic Patients with COVID-19: A Retrospective Analysis from the UAE

by Yehia S. Mohamed, Mamoun Mukhtar, Akrem Elmalti, Khalid Kheirallah, Debadatta Panigrahi, Eman Y. Abu-rish, Ibrahim Bani, Eiman Mohamed Nasor, Wafa Ahmed and Abdallah Alzoubi

Int. J. Environ. Res. Public Health 2024, 21(6), 697; https://doi.org/10.3390/ijerph21060697 - 29 May 2024

Cited by 1 | Viewed by 1087

Abstract

Background: Although we are four years into the pandemic, there is still conflicting evidence regarding the clinical outcomes of diabetic patients hospitalized with COVID-19. The primary objective of this study was to evaluate the in-hospital mortality and morbidity of diabetic versus nondiabetic patients [...] Read more.

Background: Although we are four years into the pandemic, there is still conflicting evidence regarding the clinical outcomes of diabetic patients hospitalized with COVID-19. The primary objective of this study was to evaluate the in-hospital mortality and morbidity of diabetic versus nondiabetic patients hospitalized with COVID-19 in the Northern UAE Emirates. Methods: A retrospective analysis was performed on clinical data from patients with or without diabetes mellitus (DM) who were admitted to the isolation hospital with COVID-19 during the first and second waves of the disease (March 2020 to April 2021). The assessed endpoints were all-cause in-hospital mortality, length of hospitalization, intensive care unit (ICU) admission, and mechanical ventilation. Results: A total of 427 patients were included in the analysis, of whom 335 (78.5%) had DM. Compared to nondiabetics, diabetic COVID-19 patients had a significantly longer in-hospital stay (odds ratio (OR) = 2.35; 95% confidence interval (CI) = 1.19–4.62; p = 0.014), and a significantly higher frequency of ICU admission (OR = 4.50; 95% CI = 1.66–7.34; p = 0.002). The need for mechanical ventilation was not significantly different between the two groups (OR: distorted estimates; p = 0.996). Importantly, the overall in-hospital mortality was significantly higher among diabetic patients compared to their nondiabetic counterparts (OR = 2.26; 95% CI = 1.08–4.73; p = 0.03). Conclusion: DM was associated with a more arduous course of COVID-19, including a higher mortality rate, a longer overall hospital stay, and a higher frequency of ICU admission. Our results highlight the importance of DM control in COVID-19 patients to minimize the risk of detrimental clinical outcomes. Full article

2023

Jump to: 2024, 2022, 2021

21 pages, 1142 KiB

Open AccessArticle

COVID-19 Effects on Environmentally Responsible Behavior: A Social Impact Perspective from Latin American Countries

by Leslier Valenzuela-Fernández, Manuel Escobar-Farfán, Mauricio Guerra-Velásquez and Elizabeth Emperatriz García-Salirrosas

Int. J. Environ. Res. Public Health 2023, 20(4), 3330; https://doi.org/10.3390/ijerph20043330 - 14 Feb 2023

Cited by 10 | Viewed by 2963

Abstract

The aim of the research is to examine the relationships between the following variables (a) Theory of Planned Behavior (TPB), composed of Attitudes (ATT), Subjective Norms (SN), and Perceived Behavioral Control (PBC); and (b) Consciousness (EC) on the dependent variable Environmentally Responsible Purchase [...] Read more.

The aim of the research is to examine the relationships between the following variables (a) Theory of Planned Behavior (TPB), composed of Attitudes (ATT), Subjective Norms (SN), and Perceived Behavioral Control (PBC); and (b) Consciousness (EC) on the dependent variable Environmentally Responsible Purchase Intention (ERPI) from the perspective of the Latin American consumer in a pandemic. Currently, the literature on the relationships proposed in the explanatory model is still scarce at a theoretical and practical level, without empirical evidence in Latin America. The data collection is from 1624 voluntary responses from consumers in Chile (n = 400), Colombia (n = 421), Mexico (n = 401), and Peru (n = 402) collected through online surveys. Using structural equation modeling (SEM) and multi-group to test invariance analysis and the moderating effects, we can determine the relationship between the variables in the proposed model, generating evidence from Latin American countries. The empirical analysis verified that Attitude (ATT), Perceived Behavioral Control (PBC), and Environmental Consciousness (CE) have a positive and significant effect on Environmentally Responsible Purchase Intention (ERPI). The results also show that the generation variable presents invariance. Therefore, the groups are not different at the model level for the generation variable, becoming relevant to the difference at the path level. Therefore, the results of this study become a relevant contribution, indicating a moderating effect on the generation variable. This research provides insights for understanding Latin American consumers, and managerial implications are also provided for developing strategies to promote sustainable consumption. Full article

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2022

Jump to: 2024, 2023, 2021

10 pages, 1156 KiB

Open AccessBrief Report

Demographic and COVID Experience Predictors of COVID-19 Risk Perception among Chinese Residents in Canada

by Mariah Lecompte, Alyssa Counsell and Lixia Yang

Int. J. Environ. Res. Public Health 2022, 19(21), 14448; https://doi.org/10.3390/ijerph192114448 - 4 Nov 2022

Cited by 3 | Viewed by 1509

Abstract

The current study aimed to identify demographic and COVID experience predictors for COVID-19 risk perception among Chinese residents in Canada. A final sample of 653 participants aged 18 and up completed an online survey in simplified Chinese during the peak of the first [...] Read more.

The current study aimed to identify demographic and COVID experience predictors for COVID-19 risk perception among Chinese residents in Canada. A final sample of 653 participants aged 18 and up completed an online survey in simplified Chinese during the peak of the first wave of COVID-19 (25 April–10 June 2020). After removing those with missing data on demographic covariates, as missing data cannot be imputed, 444 were included in the structural equation model, and COVID-19 risk perception was indexed by three outcome variables: self-infection risk perception (i.e., likelihood of personal infection of COVID-19); threat perception (i.e., whether the pandemic is a real threat); and future infection rate prediction (i.e., a latent variable for community, Ontario, Canada, and World infection rate predictions). Predictors included demographic (i.e., income, gender, education, age, household size, employment status, and life satisfaction) and COVID experience variables (i.e., personal connection with confirmed or suspected COVID-19 cases, self-isolation experience, perceived anti-Chinese discrimination, and confusion over COVID-19 information). In the structural equation model, we found increased risk perception for the following demographic and COVID experience predictors; women, relatively higher education, living alone, working in a medical field, lower in life satisfaction, having personal connection with confirmed or suspected COVID-19 cases, with perceived anti-Chinese discrimination, or showing high confusion over COVID-19 information. Full article

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9 pages, 374 KiB

Open AccessArticle

Knowledge about COVID-19 and Associated Factors Early in the Outbreak among the Brazilian Population

by Davi Amaral Cesario Rosa, Stéfanny Santos de Sousa, Murillo Nasser Rayol da Silva, Lauanda Raissa Reis Gamboge, Rodolfo Deusdará and Juliana Lapa

Int. J. Environ. Res. Public Health 2022, 19(21), 13824; https://doi.org/10.3390/ijerph192113824 - 24 Oct 2022

Cited by 2 | Viewed by 1327

Abstract

(1) Background: In Brazil, the first case of the novel coronavirus occurred on the 25 February 2020, and since then, it has spread rapidly over the entire country. During a pandemic, knowledge, attitudes, and practices are expected to largely influence the adherence to [...] Read more.

(1) Background: In Brazil, the first case of the novel coronavirus occurred on the 25 February 2020, and since then, it has spread rapidly over the entire country. During a pandemic, knowledge, attitudes, and practices are expected to largely influence the adherence to non-pharmacological interventions (NPIs). We evaluated the knowledge about COVID-19 and associated factors early in the outbreak among the Brazilian population. (2) Methods: A Brazilian cross-sectional study was carried out using an online questionnaire. The questionnaire consisted of the following topics: isolation, caring for someone sick at home, cleaning habits, disinfecting habits, and true and fake news. Logistic regression was conducted using sociodemographic and associated factors as the independent variables and a knowledge score as the dependent variable to estimate factors associated with knowledge about COVID-19. Crude, sex-, and age-adjusted odds ratios (OR) were calculated. (3) Results: Participants with a better educational status had higher odds of having a higher knowledge score (OR = 2.49, 95% CI = 1.15–5.37). Similarly, healthcare providers (health students and professionals) had higher odds of having higher scores regarding knowledge about COVID-19 (OR = 1.62, 95% CI = 1.05–2.48) than other counterparts. Of the wrong answers, the most frequent was the isolation period, followed by household recommendations to prevent COVID-19 and cleaning habits. (4) Conclusions: In conclusion, our study suggests that a higher educational status and being a healthcare provider are conditions associated with superior knowledge about COVID-19. In addition, inadequate knowledge related to isolation, COVID-19 prevention, and cleaning habits were found in our study. We believe that improving awareness to address these specific COVID-19 issues through a health education campaign is a significant approach for public health policymakers to fight against COVID-19 in Brazil. Full article

14 pages, 365 KiB

Open AccessArticle

Psychological Resilience and Adverse Mental Health Issues in the Thai Population during the Coronavirus Disease 2019 Pandemic

by Chidchanok Ruengorn, Ratanaporn Awiphan, Chabaphai Phosuya, Yongyuth Ruanta, Nahathai Wongpakaran, Tinakon Wongpakaran, Kednapa Thavorn and Surapon Nochaiwong

Int. J. Environ. Res. Public Health 2022, 19(20), 13023; https://doi.org/10.3390/ijerph192013023 - 11 Oct 2022

Cited by 7 | Viewed by 2147

Abstract

In light of the coronavirus disease 2019 (COVID-19) pandemic and the enormous amount of uncertainty caused by it, mental health issues have become a great concern. Evidence regarding the effects of psychological resilience on the Thai population is scarce. We evaluated psychological resilience [...] Read more.

In light of the coronavirus disease 2019 (COVID-19) pandemic and the enormous amount of uncertainty caused by it, mental health issues have become a great concern. Evidence regarding the effects of psychological resilience on the Thai population is scarce. We evaluated psychological resilience during the first wave of the COVID-19 pandemic and its association with the risk of mental health outcomes, such as depression, anxiety, stress, and health-related well-being. This cross-sectional study was a part of the HOME-COVID-19 project, which conducted an online survey of 4004 members of the general population in Thailand using the Brief Resilience Coping Scale. Logistic regression was performed to identify the association between psychological resilience and mental health issues and well-being. Groups with prevalence rates of 43.9%, 39.2%, and 16.9% were classified as low, moderate, and high resilient copers, respectively. Using high resilient copers as a reference group, the low resilient copers had a higher chance of having mental health adversities. The adjusted odds ratio (OR) was 1.89 (95% confidence interval [CI], 1.39–2.56; p < 0.001) for depression, 2.13 (95% CI, 1.45–3.14; p < 0.001) for anxiety, 4.61 (95% CI, 3.30–6.45; p < 0.001) for perceived stress, and 3.18 (95% CI, 2.31–4.38; p < 0.001) for low well-being. For the medium resilient copers, only low well-being was found to be statistically significant (OR, 1.60; 95% CI, 1.16–2.20; p = 0.004). It is important that resilience be considered in the development of strategies for managing the COVID-19 pandemic to prevent or reduce adverse mental health outcomes. Full article

13 pages, 390 KiB

Open AccessArticle

Sports Participation and Anti-Epidemic: Empirical Evidence on the Influence of Regular Physical Activity on the COVID-19 Pandemic in Mainland China

by Ruofei Lin, Xiaoli Hu, Shijun Chen and Junpei Huang

Int. J. Environ. Res. Public Health 2022, 19(17), 10689; https://doi.org/10.3390/ijerph191710689 - 27 Aug 2022

Cited by 2 | Viewed by 2136

Abstract

This study aims to investigate the effects and influencing mechanisms of regular physical activity (RPA) on the COVID-19 pandemic. Daily data from 279 prefecture-level cities in mainland China were collected from 1 January to 17 March 2020. A two-way fixed-effects model was used [...] Read more.

This study aims to investigate the effects and influencing mechanisms of regular physical activity (RPA) on the COVID-19 pandemic. Daily data from 279 prefecture-level cities in mainland China were collected from 1 January to 17 March 2020. A two-way fixed-effects model was used to identify the causal relationship between physical activity and COVID-19, while also considering factors such as patterns of human behavior and socioeconomic conditions. The instrumental variable (IV) approach was applied to address potential endogeneity issues for a more accurate causal identification, and the mediating effect model was applied to examine the mechanisms of the influence of physical activity on the epidemic. We found that regular physical activity significantly improves individual immunity, which, in turn, leads to a reduction in the probability of being infected with COVID-19. Furthermore, we investigated the heterogeneity of the influence, finding that the negative impact of physical activity on the pandemic is more pronounced in the absence of adequate medical resources, strong awareness of prevention among residents, and fully implemented public health measures. Our results provide empirical evidence for the mechanisms of influence of physical activity on the pandemic. We would suggest that not only should physical activity be actively practiced during the pandemic, but also long-term regular exercise habits should be consciously cultivated to improve the ability of the individual immune system to better cope with sudden outbreaks of emerging infectious diseases. Full article

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17 pages, 372 KiB

Open AccessArticle

Mobile Device Usage before and during the COVID-19 Pandemic among Rural and Urban Adults

by Livia Jonnatan, Cherisse L. Seaton, Kathy L. Rush, Eric P. H. Li and Khalad Hasan

Int. J. Environ. Res. Public Health 2022, 19(14), 8231; https://doi.org/10.3390/ijerph19148231 - 6 Jul 2022

Cited by 20 | Viewed by 3711

Abstract

Technology has played a critical role during the COVID-19 pandemic. Despite affording a safe way for people to connect with others, the potential for problematic device usage (e.g., overuse, addiction) should be considered. The goal of this study was to examine mobile device [...] Read more.

Technology has played a critical role during the COVID-19 pandemic. Despite affording a safe way for people to connect with others, the potential for problematic device usage (e.g., overuse, addiction) should be considered. The goal of this study was to examine mobile device use during the COVID-19 pandemic among rural and urban people in Canada. Based on an online survey conducted in the summer of 2021 in British Columbia (n = 465), participants self-reported spending more hours per day (M = 8.35 h) using technology during the pandemic compared to prior (M = 6.02 h), with higher increases among urban participants (p < 0.001). Mobile device usage scores were highest for reasons of social connectedness and productivity, with no rural/urban differences; however, urban participants reported higher use of mobile devices for their mental well-being (p = 0.001), but also reported higher, continuous use (p < 0.001), addiction (p < 0.001), and detrimental impacts on their physical health (p < 0.001) compared to rural participants. Because urban participants were more vulnerable to mobile device overuse and addiction during the pandemic, researchers and policy makers should consider the ongoing role and positive/negative impacts of mobile device use, paying particular attention to urban populations. Full article

22 pages, 3130 KiB

Open AccessReview

Inanimate Surfaces as a Source of Hospital Infections Caused by Fungi, Bacteria and Viruses with Particular Emphasis on SARS-CoV-2

by Agata Jabłońska-Trypuć, Marcin Makuła, Maria Włodarczyk-Makuła, Elżbieta Wołejko, Urszula Wydro, Lluis Serra-Majem and Józefa Wiater

Int. J. Environ. Res. Public Health 2022, 19(13), 8121; https://doi.org/10.3390/ijerph19138121 - 1 Jul 2022

Cited by 28 | Viewed by 5924

Abstract

The carriers of nosocomial infections are the hands of medical personnel and inanimate surfaces. Both hands and surfaces may be contaminated as a result of contact with the patient, their body fluids, and touching contaminated surfaces in the patient’s surroundings. Visually clean inanimate [...] Read more.

The carriers of nosocomial infections are the hands of medical personnel and inanimate surfaces. Both hands and surfaces may be contaminated as a result of contact with the patient, their body fluids, and touching contaminated surfaces in the patient’s surroundings. Visually clean inanimate surfaces are an important source of pathogens. Microorganisms have properties thanks to which they can survive in unfavorable conditions, from a few days to several months. Bacteria, viruses and fungi are able to transmit from inanimate surfaces to the skin of the patient and the medical staff. These pathogens include SARS-CoV-2, which can survive on various types of inanimate surfaces, being a potential source of infection. By following the recommendations related to washing and disinfecting hands and surfaces, and using appropriate washing and disinfecting agents with a broad biocidal spectrum, high material compatibility and the shortest duration of action, we contribute to breaking the chain of nosocomial infections. Full article

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12 pages, 1144 KiB

Open AccessArticle

A Macro-Level Association of Vaccination Rate with the Number of Confirmed COVID-19 Cases in the United States and Japan

by Hiroyuki Noda

Int. J. Environ. Res. Public Health 2022, 19(12), 7435; https://doi.org/10.3390/ijerph19127435 - 17 Jun 2022

Cited by 1 | Viewed by 1648

Abstract

Aiming to evaluate a macro-level association of vaccination rate as well as booster vaccination rate with the number of confirmed COVID-19 cases in the United States and Japan, a cross-sectional study was conducted using data in each jurisdiction. Data on the total number [...] Read more.

Aiming to evaluate a macro-level association of vaccination rate as well as booster vaccination rate with the number of confirmed COVID-19 cases in the United States and Japan, a cross-sectional study was conducted using data in each jurisdiction. Data on the total number of people who were fully vaccinated as of the end of December 2021, data on the total number of people who have received a booster dose as of the end of March 2022 and data on the cumulative number of confirmed COVID-19 cases were obtained from the website of the national governments. A generalized regression model was used to examine the association. This study showed that a higher vaccination rate was associated with a lower number of confirmed COVID-19 cases per year in 2021 for both the United States and Japan. The number of confirmed COVID-19 cases per 1000 population per year (95% confidence intervals) as a 1% increment of the vaccination rate was −0.74 (−1.29, −0.20), p = 0.007 for the United States and −1.48 (−1.95, −1.00), p < 0.0001 for Japan. A similar association was observed for the booster vaccination rate in 2022, although the association was attenuated in a multivariable model, particularly for the United States. This study provided macro-level evidence that vaccination may reduce the number of confirmed COVID-19 cases. Full article

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11 pages, 328 KiB

Open AccessArticle

The Pre-Vaccination Donated Blood Is Free from Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) but Is Rich with Anti-SARS-CoV-2 Antibodies: A Cross-Section Saudi Study

by Abdulrahman H. Almaeen, Abdulrahman A. Alduraywish, Amany A. Ghazy, Tarek H. El-Metwally, Mohammad Alayyaf, Fahad Hammad Alrayes, Ahmed Khalid M. Alinad, Saqer Bulayhid H. Albulayhid, Abdulrhman Rabea Aldakhil and Ahmed E. Taha

Int. J. Environ. Res. Public Health 2022, 19(12), 7119; https://doi.org/10.3390/ijerph19127119 - 10 Jun 2022

Cited by 3 | Viewed by 2030

Abstract

(1) Backgrounds and Objectives: Since its discovery, information about the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has spread rapidly. However, many issues remain unresolved. Coronaviruses are primarily transmitted through respiratory secretions. The possibility of transmission via donated blood transfusion deserves studying. This is the [...] Read more.

(1) Backgrounds and Objectives: Since its discovery, information about the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has spread rapidly. However, many issues remain unresolved. Coronaviruses are primarily transmitted through respiratory secretions. The possibility of transmission via donated blood transfusion deserves studying. This is the first study in Saudi Arabia to look at pre-vaccination donated blood anti-SARS-CoV-2 antibody content as a marker for virus transmission via viral RNA positive blood and/or the potential therapeutic value of convalescent plasma. (2) Methods: A total of 300 blood samples were sequentially collected from unvaccinated donors who donated blood to the blood bank of Prince Mutaib Bin Abdulaziz Hospital in Sakaka, Al-Jouf, Saudi Arabia. Specific ELISA was used to detect anti-SARS-CoV-2 IgG and IgM antibodies. SARS-CoV-2 was detected using specific real-time reverse-transcription PCR (rRT-PCR). (3) Results: The prevalence of anti-SARS-CoV-2 IgG was low (9%), whereas the prevalence of anti-SARS-CoV-2 IgM was high (65%). Relevant demographics, anthropometrics, and lifestyle factors revealed significant associations (p < 0.05) between IgM-positivity only vs. age (age group 21–30 years), postgraduate education, no history of international travel, IgG-negativity, and absence of experience with COVID-19-like symptoms. Furthermore, there are significant associations (p < 0.05) between IgG-positivity only vs. age (age group 21–30 years), postgraduate education, and being a non-healthcare worker. All donors in the anti-SARS-CoV-2 IgG-positive group (n = 27) had previously experienced symptoms similar to COVID-19 (p < 0.001) and most of them (n = 24) showed anti-SARS-CoV-2 IgM-positive test (p = 0.006). However, all the samples tested negative for SARS-CoV-2 RNA using rRT-PCR. (4) Conclusion: Our findings add to the growing body of evidence that donated blood is safe, with the added benefit of convalescent plasma rich in potentially neutralizing IgG and IgM against SARS-CoV-2. Full article

8 pages, 711 KiB

Open AccessArticle

Alteration of Inflammatory Parameters and Psychological Post-Traumatic Syndrome in Long-COVID Patients

by Irma Clemente, Gaia Sinatti, Antonio Cirella, Silvano Junior Santini and Clara Balsano

Int. J. Environ. Res. Public Health 2022, 19(12), 7103; https://doi.org/10.3390/ijerph19127103 - 9 Jun 2022

Cited by 17 | Viewed by 3250

Abstract

The aim of our study is to evaluate the correlation between the psychological status of patients recovered from SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection (long-COVID patients) and their inflammatory status. Three months after hospital discharge, ninety-three patients were recruited and categorized [...] Read more.

The aim of our study is to evaluate the correlation between the psychological status of patients recovered from SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection (long-COVID patients) and their inflammatory status. Three months after hospital discharge, ninety-three patients were recruited and categorized into two distinct populations: control and long-COVID (COrona VIrus Disease) group. Patients belonging to the control group presented with an entering diagnosis of cardiovascular, metabolic, or respiratory disease and a negative history of SARS-CoV-2 infection, whereas the long-COVID population presented with a severe SARS-CoV-2 infection treated in the sub-intensive Care Unit. Psychological evaluation was performed through the administration of the Symptom Checklist-90 (SCL90) and LDH (Lactate dehydrogenase), ferritin, CRPhs (C-high sensitivity Reactive Protein), NLR (Neutrophil-to-lymphocyte ratio), PLR (Platelet-to-lymphocyte ratio), and SII (systemic immune-inflammation index) were investigated. We highlighted that beyond the first three months after contagion, patients recovered from SARS-CoV-2 infection are characterized by the persistence of a systemic inflammatory state and are at high risk for developing somatization, depression, anxiety, and sleep disturbances. Interestingly, ferritin value was strongly correlated with sleep disorders (p < 0.05). Our study emphasizes how COVID-19 strategies for risk stratification, prognosis, and therapy management of patients should be implemented with a psychological follow-up. Full article

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13 pages, 805 KiB

Open AccessArticle

Disparities and Factors Associated with Coronavirus Disease-2019-Related Public Stigma: A Cross-Sectional Study in Thailand

by Chidchanok Ruengorn, Ratanaporn Awiphan, Chabaphai Phosuya, Yongyuth Ruanta, Kednapa Thavorn, Nahathai Wongpakaran, Tinakon Wongpakaran and Surapon Nochaiwong

Int. J. Environ. Res. Public Health 2022, 19(11), 6436; https://doi.org/10.3390/ijerph19116436 - 25 May 2022

Cited by 5 | Viewed by 2115

Abstract

Coronavirus disease 2019 (COVID-19)-related public stigma is a major challenge, with scarce available evidence. This study aimed to determine the disparities and factors associated with COVID-19-related public stigma in the Thai population. We conducted a cross-sectional study involving a voluntary online survey in [...] Read more.

Coronavirus disease 2019 (COVID-19)-related public stigma is a major challenge, with scarce available evidence. This study aimed to determine the disparities and factors associated with COVID-19-related public stigma in the Thai population. We conducted a cross-sectional study involving a voluntary online survey in Thailand from 21 April 2020 to 4 May 2020. We invited 4004 participants to complete a series of questionnaires, including the validated COVID-19 public stigma scale and questions on relevant COVID-19-related psychosocial issues. Multinomial logistic regression was performed to investigate the factors associated with COVID-19-related public stigma. The prevalence of COVID-19-related public stigma was 24.2% (95% confidence interval [CI], 22.2–26.2) for no/minimal, 35.5% (95% CI, 33.4–37.6) for moderate, and 40.3% (95% CI, 38.2–42.4) for high. We observed disparities in the prevalence of COVID-19-related public stigma according to participant characteristics and psychosocial factors. Using the no/minimal group as a reference group, the six predominant risk factors significantly associated with a moderate and high degree of COVID-19-related public stigma were middle-aged or older adults, male, divorced/widowed/separated, current quarantine status, moderate/severe fear of COVID-19, and medium/high perceived risk of COVID-19. Additional risk factors significantly related to a high degree of COVID-19-related public stigma were religion (Buddhist), region of residence (non-capital city), and exposure to COVID-19-related information. Disparities in COVID-19-related public stigma due to sociodemographic and psychosocial issues are frequent in the Thai population. To reduce public stigmatization, early identification of vulnerable groups and the development of tailored mitigation strategies should be implemented during the pandemic. Full article

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14 pages, 398 KiB

Open AccessArticle

Obstetric–Neonatal Care during Birth and Postpartum in Symptomatic and Asymptomatic Women Infected with SARS-CoV-2: A Retrospective Multicenter Study

by Rafael Vila-Candel, Víctor M. González-Chordá, Francisco Javier Soriano-Vidal, Enrique Castro-Sánchez, Noelia Rodríguez-Blanco, Ana Gómez-Seguí, Laura Andreu-Pejó, Cristina Martínez-Porcar, Carmen Rodríguez Gonzálvez, Patricia Torrent-Ramos, Nieves Asensio-Tomás, Yolanda Herraiz-Soler, Ramon Escuriet and Desirée Mena-Tudela

Int. J. Environ. Res. Public Health 2022, 19(9), 5482; https://doi.org/10.3390/ijerph19095482 - 30 Apr 2022

Cited by 5 | Viewed by 2705

Abstract

This study analyses the obstetric–neonatal outcomes of women in labour with symptomatic and asymptomatic COVID-19. A retrospective, multicenter, observational study was carried out between 1 March 2020 and 28 February 2021 in eight public hospitals in the Valencian community (Spain). The chi-squared test [...] Read more.

This study analyses the obstetric–neonatal outcomes of women in labour with symptomatic and asymptomatic COVID-19. A retrospective, multicenter, observational study was carried out between 1 March 2020 and 28 February 2021 in eight public hospitals in the Valencian community (Spain). The chi-squared test compared the obstetric–neonatal outcomes and general care for symptomatic and asymptomatic women. In total, 11,883 births were assisted in participating centers, with 10.9 per 1000 maternities (n = 130) infected with SARS-CoV-2. The 20.8% were symptomatic and had more complications both upon admission (p = 0.042) and during puerperium (p = 0.042), as well as transfer to the intensive care unit (ICU). The percentage of admission to the Neonatal Intensive Care Unit (NICU) was greater among offspring of symptomatic women compared to infants born of asymptomatic women (p < 0.001). Compared with asymptomatic women, those with symptoms underwent less labour companionship (p = 0.028), less early skin-to-skin contact (p = 0.029) and greater mother–infant separation (p = 0.005). The overall maternal mortality rate was 0.8%. No vertical transmission was recorded. In conclusion, symptomatic infected women are at increased risk of lack of labour companionship, mother–infant separation, and admission to the ICU, as well as to have preterm births and for NICU admissions. Full article

11 pages, 348 KiB

Open AccessArticle

The Relationship between Attitudes and Satisfaction Concerning the COVID-19 Vaccine and Vaccine Boosters in Urban Bangkok, Thailand: A Cross-Sectional Study

by Jadsada Kunno, Busaba Supawattanabodee, Chavanant Sumanasrethakul, Chuthamat Kaewchandee, Wachiraporn Wanichnopparat and Krit Prasittichok

Int. J. Environ. Res. Public Health 2022, 19(9), 5086; https://doi.org/10.3390/ijerph19095086 - 22 Apr 2022

Cited by 6 | Viewed by 2368

Abstract

Background: COVID-19 vaccine hesitancy is a global concern. Many individuals are concerned about the potential side-effects of the COVID-19 vaccine and vaccine boosters. The purpose of this study was to assess attitudes and satisfaction concerning COVID-19 vaccines and vaccine boosters in the population [...] Read more.

Background: COVID-19 vaccine hesitancy is a global concern. Many individuals are concerned about the potential side-effects of the COVID-19 vaccine and vaccine boosters. The purpose of this study was to assess attitudes and satisfaction concerning COVID-19 vaccines and vaccine boosters in the population in Bangkok, Thailand. Methods: A cross-sectional online survey measuring COVID-19 vaccine attitudes and satisfaction was distributed from September to December 2021. Multiple linear regression was used to explore associations between demographic variables and questionnaire results. Spearman’s correlation analysis was used to examine associations between attitude and satisfaction scores. Results: A total of 780 questionnaire responses were obtained. The largest groups of participants reported having obtained a first vaccination dose via viral vaccine (52.8%), a second vaccination booster via viral vaccine (49.5%), and a third vaccination booster via mRNA vaccine (28.8%). Multiple linear regression revealed a lower association between vaccine attitude scores and having earned less than a bachelor’s degree (β −0.109; 95% CI −2.541, −0.451) and infection risk without self-isolating (β −0.154; 95% CI −4.152, −0.670) compared with attaining a bachelor’s degree or higher and never having being at risk of infection, respectively. Higher vaccine satisfaction scores were more closely associated with being married than being single (β 0.074; 95% CI −0.073, 3.022), whereas lower vaccine satisfaction scores were less closely associated with non-healthcare workers (β −0.143; 95% CI −4.698, −0.831) and infection risk without self-isolating (β −0.132; 95% CI −6.034, −0.502) compared with non-healthcare workers and never being at risk of infection. There was weak but significant positive correlation between attitude and satisfaction scores (r = 0.338, p-value < 0.001). Hence, a gradual decline in protection following vaccination and the positive effects of a booster dose after primary vaccination have made the decision to administer booster doses. Conclusion: The results suggest that policymakers need to develop more effective strategies to raise awareness about the importance of vaccination. Full article

13 pages, 1859 KiB

Open AccessArticle

Irrational Consumption during the COVID-19 Period

by Wenhuan Yu, Lin He, Xianhao Lin, Thomas Freudenreich and Tao Liu

Int. J. Environ. Res. Public Health 2022, 19(9), 5031; https://doi.org/10.3390/ijerph19095031 - 21 Apr 2022

Cited by 2 | Viewed by 2980

Abstract

The outbreak of the COVID-19 pandemic has severely impacted the world economy and has, most presumably, exerted a great deal of stress on citizens, in turn leading to the call for timely assessments of how this period might actually impact individuals at the [...] Read more.

The outbreak of the COVID-19 pandemic has severely impacted the world economy and has, most presumably, exerted a great deal of stress on citizens, in turn leading to the call for timely assessments of how this period might actually impact individuals at the level of everyday well-being and in their behaviors such as consumer decisions. Through one pilot study and two online survey studies, we tentatively investigated this latter question, and demonstrated that the COVID-19 pandemic may increase perceived stress and impair individuals’ sleep quality, which in turn impels their irrational consumption. This research provides preliminary evidence for the impact of the present pandemic on irrational consumption and contributes to the literature on stress and consumer behavior. Full article

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11 pages, 863 KiB

Open AccessArticle

Sleep Quality, Insomnia, Anxiety, Fatigue, Stress, Memory and Active Coping during the COVID-19 Pandemic

by Jaber S. Alqahtani, Saad M. AlRabeeah, Abdulelah M. Aldhahir, Rayan Siraj, Yousef S. Aldabayan, Saeed M. Alghamdi, Abdullah S. Alqahtani, Sulaiman S. Alsaif, Abdallah Y. Naser and Hassan Alwafi

Int. J. Environ. Res. Public Health 2022, 19(9), 4940; https://doi.org/10.3390/ijerph19094940 - 19 Apr 2022

Cited by 24 | Viewed by 4538

Abstract

Background: The current study aimed to evaluate the impact of the coronavirus (COVID-19) pandemic on sleep quality, insomnia, anxiety, stress, fatigue and active coping in the United States. Methods: This was a cross-sectional study using a publicly available database taken from the Boston [...] Read more.

Background: The current study aimed to evaluate the impact of the coronavirus (COVID-19) pandemic on sleep quality, insomnia, anxiety, stress, fatigue and active coping in the United States. Methods: This was a cross-sectional study using a publicly available database taken from the Boston College COVID-19 Sleep and Well-Being Dataset. We have selected the most recent data that included information about sleep quality and other measures, including insomnia, anxiety, stress, fatigue and coping, collected between 22 February–8 March 2021. Results: A total of 476 subjects were included in the analysis. The mean (SD) age of the study population was 38.8 (17.8) years, and there were more females (85%) than males. The population had a mean (SD) score of the Pittsburgh Sleep Quality Index (PSQI) of 6 (3.2), with 65% having the prevalence of poor sleep quality (defined as PSQ ≥ 5; n = 311). The mean (SD) score for Insomnia Severity Index (ISI) was 6.9 (5.2), with 55 subjects (11.5%) having clinical insomnia (defined as ISI ≥ 15); of whom 9% had severe clinical insomnia. There were positive correlations between PSQI and ISI (r = 0.76, p < 0.001), PROMIS fatigue scale (r = 0.53, p < 0.001), Generalized Anxiety Disorder-7 (GAD-7) (r = 0.46, p < 0.001), and Perceived Stress Scale (PSS) (r = 0.44, p < 0.001). The PSQI was inversely correlated with the John Henryism Active Coping Scale (JHACS) and memory scale. In the multivariate regression model, JHACS, ISI, fatigue, PSS and GAD-7 were significant predictors of PSQI, and these variables accounted for 62% of the variance of PSQI, adjusted for age and gender. Conclusion: An important contribution to the literature is made by this research, which demonstrates the significant prevalence of poor sleep quality and its association with insomnia and other mental and physical well-being. It also underlines the need to prioritise policy and public health efforts to address sleep issues that have substantial health and economic effects for both individuals and the population at large. Full article

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20 pages, 559 KiB

Open AccessArticle

“Did You Bring It Home with You?” A Qualitative Investigation of the Impacts of the COVID-19 Pandemic on Victorian Frontline Healthcare Workers and Their Families

by Jade Sheen, Elizabeth M. Clancy, Julie Considine, Alison Dwyer, Phillip Tchernegovski, Anna Aridas, Brian En Chyi Lee, Andrea Reupert and Leanne Boyd

Int. J. Environ. Res. Public Health 2022, 19(8), 4897; https://doi.org/10.3390/ijerph19084897 - 18 Apr 2022

Cited by 13 | Viewed by 3797

Abstract

Concerns regarding the physical and mental health impacts of frontline healthcare roles during the COVID-19 pandemic have been well documented, but the impacts on family functioning remain unclear. This study provides a unique contribution to the literature by considering the impacts of the [...] Read more.

Concerns regarding the physical and mental health impacts of frontline healthcare roles during the COVID-19 pandemic have been well documented, but the impacts on family functioning remain unclear. This study provides a unique contribution to the literature by considering the impacts of the COVID-19 pandemic on frontline healthcare workers and their families. Thirty-nine frontline healthcare workers from Victoria, Australia, who were parents to at least one child under 18 were interviewed. Data were analysed using reflexive thematic analysis. Five superordinate and 14 subordinate themes were identified. Themes included more family time during lockdowns, but at a cost; changes in family responsibilities and routines; managing increased demands; healthcare workers hypervigilance and fear of bringing COVID-19 home to their family members; ways in which families worked to “get through it”. While efforts have been made by many healthcare organisations to support their workers during this challenging time, the changes in family functioning observed by participants suggest that more could be done for this vulnerable cohort, particularly with respect to family support. Full article

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16 pages, 1846 KiB

Open AccessArticle

A Cross-Sectional Study of Knowledge, Attitudes, and Practices concerning COVID-19 Outbreaks in the General Population in Malang District, Indonesia

by Sujarwoto Sujarwoto, Holipah Holipah and Asri Maharani

Int. J. Environ. Res. Public Health 2022, 19(7), 4287; https://doi.org/10.3390/ijerph19074287 - 3 Apr 2022

Cited by 6 | Viewed by 3236

Abstract

Lack of knowledge often leads to nonchalant attitudes and improper practices that expose people to greater risks during a pandemic. Therefore, improving the general public’s knowledge, attitudes, and practices (KAP) concerning coronavirus disease (COVID-19) can play a pivotal role in reducing the risks, [...] Read more.

Lack of knowledge often leads to nonchalant attitudes and improper practices that expose people to greater risks during a pandemic. Therefore, improving the general public’s knowledge, attitudes, and practices (KAP) concerning coronavirus disease (COVID-19) can play a pivotal role in reducing the risks, especially in a country such as Indonesia with its scarcity of health resources for testing and tracing. Using the case of Malang District, this study set out to evaluate KAP regarding COVID-19 and its risk factors immediately after the Malang health authorities implemented various preventive measures. A population-based survey involving 3425 individuals was carried out between 1 May and 20 May 2020. Our findings revealed that less than half of the respondents demonstrated accurate knowledge (25.3%), positive attitudes (36.6%), or frequent best practices (48.8%) with regard to COVID-19 prevention. The results of logistic regression analyses showed that more accurate knowledge was associated with more positive attitudes and more frequent best practices (OR = 1.603, p-value < 0.001; OR = 1.585, p-value < 0.001, respectively). More positive attitudes were also associated with more frequent best practices (OR = 1.126, p-value < 0.001). The level of KAP varied according to sociodemographic characteristics, access to the services of community health workers, and mobile health technology for COVID-19 screening. Some global health proposals to improve health behaviors among the general public in the context of the scarcity of health resource settings are suggested based on the study findings. Full article

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10 pages, 335 KiB

Open AccessArticle

Neurological and Mental Health Symptoms Associated with Post-COVID-19 Disability in a Sample of Patients Discharged from a COVID-19 Ward: A Secondary Analysis

by Martina Cacciatore, Alberto Raggi, Andrea Pilotto, Viviana Cristillo, Erika Guastafierro, Claudia Toppo, Francesca G. Magnani, Davide Sattin, Arianna Mariniello, Fabiola Silvaggi, Stefano Cotti Piccinelli, Nicola Zoppi, Giulio Bonzi, Stefano Gipponi, Ilenia Libri, Michela Bezzi, Paolo Martelletti, Matilde Leonardi and Alessandro Padovani

Int. J. Environ. Res. Public Health 2022, 19(7), 4242; https://doi.org/10.3390/ijerph19074242 - 2 Apr 2022

Cited by 18 | Viewed by 2984

Abstract

Recent studies suggest that COVID-19 survivors may experience long-term health consequences: in particular, neurological and mental health symptoms might be associated with long-term negative outcomes. This study is a secondary analysis of a larger cohort study and aims to determine the extent to [...] Read more.

Recent studies suggest that COVID-19 survivors may experience long-term health consequences: in particular, neurological and mental health symptoms might be associated with long-term negative outcomes. This study is a secondary analysis of a larger cohort study and aims to determine the extent to which neurological and mental health sequelae are associated with survivors’ disability. Participants include COVID-19 survivors, with no pre-morbid brain conditions, who were discharged from the COVID-19 Unit of the ASST Spedali Civili Hospital between February and April 2020. At an average of 3.5 months after discharge, they were submitted to a neurological examination and completed the WHO Disability Assessment Schedule (WHODAS-12), the Hospital Anxiety and Depression Score, the Pittsburgh Sleep Quality Index and the Montreal Cognitive Assessment. Multivariable regression analysis was carried out to analyze variables that explain WHODAS-12 variation. In total, 83 patients (63 males, average age 66.9, 95% CI: 64.2–69.7) were enrolled; average WHODAS-12 was 13.2 (95% CI: 9.7–16.6). Cognitive dysfunction, anxiety, fatigue, and hyposmia/hypogeusia explained 28.8% of WHODAS-12 variation. These findings underline the importance and need for longitudinal follow-up assessments after recovery from COVID-19 and suggest the need for early rehabilitation of residual symptoms to enhance patients’ functioning. Full article

12 pages, 363 KiB

Open AccessArticle

Changes in Health-Related Behaviours and Mental Health in a UK Public Sample during the First Set of COVID-19 Public Health Restrictions

by Jason J. Wilson, Lee Smith, Anita Yakkundi, Louis Jacob, Suzanne Martin, Igor Grabovac, Daragh T. McDermott, Rubén López-Bueno, Yvonne Barnett, Laurie T. Butler, Felipe B. Schuch, Nicola C. Armstrong and Mark A. Tully

Int. J. Environ. Res. Public Health 2022, 19(7), 3959; https://doi.org/10.3390/ijerph19073959 - 26 Mar 2022

Cited by 3 | Viewed by 3574

Abstract

Public health restrictions, in response to the COVID-19 pandemic, have had potentially wide-ranging, unintended effects on health-related behaviours such as diet and physical activity and also affected mental health due to reduced social interactions. This study explored how health-related behaviours and mental health [...] Read more.

Public health restrictions, in response to the COVID-19 pandemic, have had potentially wide-ranging, unintended effects on health-related behaviours such as diet and physical activity and also affected mental health due to reduced social interactions. This study explored how health-related behaviours and mental health were impacted in a sample of the UK public during the first set of COVID-19 public health restrictions. Two online surveys were administered in the UK, one within the first three months of the restrictions (Timepoints 1 (T1—involving pre-pandemic recall) and 2/T2) and another ten weeks later (Timepoint 3/T3). Moderate–vigorous physical activity (MVPA), outdoor time, sitting time, screen time and sexual activity were self-reported. Diet was assessed using the Dietary Instrument for Nutrition Education questionnaire. Mental health was measured using the short-form Warwick–Edinburgh Mental Wellbeing Scale and Becks’ Anxiety and Depression Inventories. Differences between timepoints were explored using the Friedman, Wilcoxon signed-rank, McNemar and McNemar–Bowker tests. Two hundred and ninety-six adults (74% under 65 years old; 65% female) provided data across all timepoints. Between T1 and T2, MVPA, time outdoors and sexual activity decreased while sitting, and screen time increased (p < 0.05). Between T2 and T3, saturated fat intake, MVPA, time outdoors, and mental wellbeing increased while sitting, screen time and anxiety symptoms decreased (p < 0.05). This study found that depending on the level of COVID-19 public health restrictions in place, there appeared to be a varying impact on different health-related behaviours and mental health. As countries emerge from restrictions, it is prudent to direct necessary resources to address these important public health issues. Full article

5 pages, 267 KiB

Open AccessCommentary

The Increasing Vulnerability of South Asians in Canada during the COVID-19 Pandemic

by Tijhiana Rose Thobani and Zahid Ahmad Butt

Int. J. Environ. Res. Public Health 2022, 19(5), 2786; https://doi.org/10.3390/ijerph19052786 - 27 Feb 2022

Cited by 4 | Viewed by 3975

Abstract

Canadian South Asians are being economically, socially, politically, and culturally impacted by the COVID-19 pandemic. There is currently a gap in the literature on the unique challenges faced by this specific group of individuals. People of color and ethnic minorities are being homogenized [...] Read more.

Canadian South Asians are being economically, socially, politically, and culturally impacted by the COVID-19 pandemic. There is currently a gap in the literature on the unique challenges faced by this specific group of individuals. People of color and ethnic minorities are being homogenized in the media and throughout the literature when addressing populations disproportionally impacted by the current situation. This commentary aims to add a new perspective to the current literature by specifically exploring factors that may contribute to the high rates of COVID-19 among South Asian communities in Canada. Another goal is to highlight the importance of providing tailored support and attention for this community and the negative consequences if this is not correctly done. Factors such as overrepresentation in essential work and financial instability are discussed. Pre-existing health conditions among South Asians such as diabetes, hypertension, anxiety, and mood disorder are considered, as well as how the history of these conditions within this population elevates the risk of severe health complications. This commentary presents suggestions for addressing this gap in research, as well as directions for future public health initiatives and policies. Full article

18 pages, 2065 KiB

Open AccessArticle

Are Sports Champions Also Anti-Epidemic Heroes? Quantitative Research on the Influence of Sports Champions’ Demonstration Effect on the COVID-19 Epidemic in China

by Junpei Huang, Shanlang Lin, Xiaoli Hu and Ruofei Lin

Int. J. Environ. Res. Public Health 2022, 19(4), 2438; https://doi.org/10.3390/ijerph19042438 - 20 Feb 2022

Cited by 3 | Viewed by 2675

Abstract

What kind of role do sports champions play in the COVID-19 epidemic? Do they contribute to the mitigation of the epidemic by some pathway? In this paper, we empirically explore the influence and mechanism of the demonstration effect of sports champions upon the [...] Read more.

What kind of role do sports champions play in the COVID-19 epidemic? Do they contribute to the mitigation of the epidemic by some pathway? In this paper, we empirically explore the influence and mechanism of the demonstration effect of sports champions upon the COVID-19 epidemic using COVID-19-related dataset of prefecture-level cities in China from 1 January 2020 to 17 March 2020. The two-way fixed effect model of econometrics is applied to estimate the result, the instrumental variable approach is adopted to address potential endogeneity issues, and socio-economic factors including public health measures, residents’ self-protection awareness, effective distance from Wuhan are also taken into consideration. The results show that the demonstration effect of champions in major sporting events increases the participation in physical exercise, which in turn reduces the possibility of being infected with the epidemic. An increase of one gold medal results in a 0.93% increase in the sports population, then leads to a 3.58% decrease in the cumulative case growth rate (p < 0.01). Further, we find that the effect is greater in regions with developed economies and abundant sports resources. Interestingly, it is greater in regions with less attention to sports, which again confirms the role of the demonstration effect. Full article

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19 pages, 1357 KiB

Open AccessArticle

Healthcare Workers’ SARS-CoV-2 Omicron Variant Uncertainty-Related Stress, Resilience, and Coping Strategies during the First Week of the World Health Organization’s Alert

by Mohamad-Hani Temsah, Shuliweeh Alenezi, Mohammed Alarabi, Fadi Aljamaan, Khalid Alhasan, Rasha Assiri, Rolan Bassrawi, Fatimah Alshahrani, Ali Alhaboob, Ali Alaraj, Nasser S. Alharbi, Abdulkarim Alrabiaah, Rabih Halwani, Amr Jamal, Naif Abdulmajeed, Lina Alfarra, Wafa Almashdali, Ayman Al-Eyadhy, Fahad AlZamil, Sarah Alsubaie, Mazin Barry, Ziad A. Memish and Jaffar A. Al-Tawfiq Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2022, 19(4), 1944; https://doi.org/10.3390/ijerph19041944 - 9 Feb 2022

Cited by 32 | Viewed by 5422

Abstract

Background: As the SARS-CoV-2 Omicron variant emerged and spread globally at an alarming speed, healthcare workers’ (HCWs) uncertainties, worries, resilience, and coping strategies warranted assessment. The COVID-19 pandemic had a severe psychological impact on HCWs, including the development of Post-Traumatic Stress symptoms. Specific [...] Read more.

Background: As the SARS-CoV-2 Omicron variant emerged and spread globally at an alarming speed, healthcare workers’ (HCWs) uncertainties, worries, resilience, and coping strategies warranted assessment. The COVID-19 pandemic had a severe psychological impact on HCWs, including the development of Post-Traumatic Stress symptoms. Specific subgroups of HCWs, such as front-line and female workers, were more prone to poor mental health outcomes and difficulties facing stress. Methods: The responses to an online questionnaire among HCWs in the Kingdom of Saudi Arabia (KSA) were collected from 1 December 2021 to 6 December 2021, aiming to assess their uncertainties, worries, resilience, and coping strategies regarding the Omicron variant. Three validated instruments were used to achieve the study’s goals: the Brief Resilient Coping Scale (BRCS), the Standard Stress Scale (SSS), and the Intolerance of Uncertainty Scale (IUS)—Short Form. Results: The online survey was completed by 1285 HCWs. Females made up the majority of the participants (64%). A total of 1285 HCW’s completed the online survey from all regions in KSA. Resilient coping scored by the BRCS was negatively and significantly correlated with stress as scored by the SSS (r = −0.313, p < 0.010). Moreover, intolerance of uncertainty scored by the IUS positively and significantly correlated with stress (r = 0.326, p < 0.010). Increased stress levels were linked to a considerable drop in resilient coping scores. Furthermore, being a Saudi HCW or a nurse was linked to a significant reduction in resilient coping ratings. Coping by following healthcare authorities’ preventative instructions and using the WHO website as a source of information was linked to a considerable rise in resilient coping. Conclusions: The negative association between resilient coping and stress was clearly shown, as well as how underlying intolerance of uncertainty is linked to higher stress among HCWs quickly following the development of a new infectious threat. The study provides early insights into developing and promoting coping strategies for emerging SARS-CoV-2 variants. Full article

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18 pages, 3108 KiB

Open AccessArticle

COVID-19: Regional Differences in Austria

by Hanns Moshammer, Michael Poteser and Lisbeth Weitensfelder

Int. J. Environ. Res. Public Health 2022, 19(3), 1644; https://doi.org/10.3390/ijerph19031644 - 31 Jan 2022

Cited by 2 | Viewed by 3043

Abstract

In the turbulent year 2020, overshadowed by the global COVID-19 pandemic, Austria experienced multiple waves of increased case incidence. While governmental measures to curb the numbers were based on current knowledge of infection risk factors, a retrospective analysis of incidence and lethality at [...] Read more.

In the turbulent year 2020, overshadowed by the global COVID-19 pandemic, Austria experienced multiple waves of increased case incidence. While governmental measures to curb the numbers were based on current knowledge of infection risk factors, a retrospective analysis of incidence and lethality at the district level revealed correlations of relative infection risk with socioeconomic, geographical, and behavioral population parameters. We identified unexpected correlations between political orientation and smoking behavior and COVID-19 infection risk and/or mortality. For example, a decrease in daily smokers by 2.3 percentage points would be associated with an increase in cumulative incidence by 10% in the adjusted model, and an increase in voters of the right-wing populist party by 1.6 percentage points with an increase in cumulative mortality by 10%. While these parameters are apparently only single elements of complex causal chains that finally lead to individual susceptibility and vulnerability levels, our findings might have identified ecological parameters that can be utilized to develop fine-tuned communications and measures in upcoming challenges of this and other pandemics. Full article

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15 pages, 545 KiB

Open AccessArticle

Fear and Attitude towards SARS-CoV-2 (COVID-19) Infection in Spanish Population during the Period of Confinement

by Ana María Recio-Vivas, Isabel Font-Jiménez, José Miguel Mansilla-Domínguez, Angel Belzunegui-Eraso, David Díaz-Pérez, Laura Lorenzo-Allegue and David Peña-Otero

Int. J. Environ. Res. Public Health 2022, 19(2), 834; https://doi.org/10.3390/ijerph19020834 - 12 Jan 2022

Cited by 7 | Viewed by 2324

Abstract

In January 2020, the WHO classified SARS-CoV-2 infection as a public health emergency and it was declared a pandemic on 11 March 2020. The media warned about the danger of infection, fuelling the population’s fear of the new situation and increasing the perception [...] Read more.

In January 2020, the WHO classified SARS-CoV-2 infection as a public health emergency and it was declared a pandemic on 11 March 2020. The media warned about the danger of infection, fuelling the population’s fear of the new situation and increasing the perception of risk. This fear can cause behaviour that will determine the course of the pandemic and, therefore, the purpose of this study was to analyse the fear of infection from COVID-19 among the Spanish population during the state of emergency. A cross-sectional, descriptive observational study was conducted with 16,372 participants. Data on sociodemographic factors, health factors, risk perception and fear were collected through an online survey. Level of fear is associated with older age, a lower level of education, having a person infected with SARS-CoV-2 in the immediate surroundings and living with and belonging to the most socioeconomically vulnerable group of people. Risk perception is associated with increased preventive behaviour. This paper provides relevant information for the public health sector since it contributes first-hand knowledge of population data that is highly useful in terms of prevention. Understanding the experiences of people in this pandemic helps to create more effective future intervention strategies in terms of planning and management for crisis situations. Full article

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2021

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13 pages, 373 KiB

Open AccessArticle

Sociodemographic and COVID-Related Predictors for Mental Health Condition of Mainland Chinese in Canada Amidst the Pandemic

by Linke Yu, Mariah Lecompte, Weiguo Zhang, Peizhong Wang and Lixia Yang

Int. J. Environ. Res. Public Health 2022, 19(1), 171; https://doi.org/10.3390/ijerph19010171 - 24 Dec 2021

Cited by 11 | Viewed by 3245

Abstract

The current study investigates the mental health condition of Mainland Chinese in Canada and identifies the associated sociodemographic and COVID-19-related predictors. A sample of 471 Mainland Chinese aged 18 or older completed an online survey that collected information on demographics, experience, cognition, and [...] Read more.

The current study investigates the mental health condition of Mainland Chinese in Canada and identifies the associated sociodemographic and COVID-19-related predictors. A sample of 471 Mainland Chinese aged 18 or older completed an online survey that collected information on demographics, experience, cognition, and behaviours related to the COVID-19 pandemic and mental health condition. Mental health condition was assessed with the Depression, Anxiety, and Stress Scale-21 (DASS-21) for the depression, anxiety, and stress levels of Mainland Chinese during the pandemic. Moderate to severe depression, anxiety, and stress levels were respectively reported by 11.30%, 10.83%, and 5.10% of respondents. Univariate analysis of variance models (ANOVAs) were conducted to assess mental health condition variance as stratified by independent sociodemographic- or COVID-19-related explanatory variables, to identify possible predictors to be entered into the subsequent regression models. The regression models identified age, income level, health status, and perceived discrimination as significant sociodemographic predictors (absolute value of βs = 1.19–7.11, ps < 0.05), whereas self-infection worry, attitude towards Canadian measures, information confusion, food/goods stocking, and room cleaning/sanitizing were identified as significant COVID-19-reltaed predictors (absolute value of βs = 1.33–3.45, ps < 0.05) for mental health outcomes. The results shed light on our understanding of the major factors associated with the mental health condition of Mainland Chinese in Canada during the COVID-19 pandemic. Full article

13 pages, 344 KiB

Open AccessArticle

Experiences of Online COVID-19 Information Acquisition among Persons with Type 2 Diabetes and Varying eHealth Literacy

by Anna Sjöström, Senada Hajdarevic, Åsa Hörnsten, Ulrika Öberg and Ulf Isaksson

Int. J. Environ. Res. Public Health 2021, 18(24), 13240; https://doi.org/10.3390/ijerph182413240 - 15 Dec 2021

Cited by 9 | Viewed by 3343

Abstract

During the COVID-19 pandemic, the Internet has been a major source of information for people to keep updated with news and guidelines. However, concerns have been raised about the ‘infodemic’, which includes the overabundance of online information and the spread of misleading information. [...] Read more.

During the COVID-19 pandemic, the Internet has been a major source of information for people to keep updated with news and guidelines. However, concerns have been raised about the ‘infodemic’, which includes the overabundance of online information and the spread of misleading information. Adequate eHealth literacy skills among world citizens have therefore been emphasized as vital during the pandemic. Persons with type 2 diabetes have been at increased risk of severe outcomes of COVID-19 disease. This study aimed to explore online COVID-19 information acquisition experiences among persons with type 2 diabetes and varying eHealth literacy. Fifty-eight participants filled out the eHealth Literacy Scale (eHEALS), along with a qualitative questionnaire with free-text questions. Additionally, 10 participants were interviewed. Thematic analysis was applied to identify patterns in participants’ experiences. Two domains were identified: perceived challenges with online information about COVID-19, and coping strategies to manage challenges. The perceived challenges were: being exposed to information overload, dealing with conflicting information, and being strongly emotionally affected. The related coping strategies were: protecting oneself, trusting authorities, taking command, and using common sense. These strategies often involved triangulation of the information obtained, including participants consulting their common sense, various sources, or family and friends. This paper highlights the crucial role of authorities in delivering online information, that according to health literacy principles, is easy to access, understand, and use. Furthermore, our results reinforce the importance of diabetes nurses, as well as healthcare professionals in general, in encouraging patients to share their Internet findings, promote information from reliable sources, and deliver tailored information that suits individual needs. Because our results underline the importance of social support in eHealth literacy and the assessment of online health information, the inclusion of family and friends needs to be increasingly considered in diabetes care. Due to the small homogenous sample, the results of this study cannot be generalized. However, the reader can assess the transferability to other situations and settings based on our contextual descriptions. Full article

20 pages, 3441 KiB

Open AccessArticle

Community Knowledge of and Attitudes towards COVID-19 Prevention Techniques in Saudi Arabia: A Cross-Sectional Study

by Amal Khalil AbuAlhommos, Fatimah Essa Alhadab, May Mohammed Almajhad, Rahmah Almutawaa and Sara Taleb Alabdulkareem

Int. J. Environ. Res. Public Health 2021, 18(23), 12783; https://doi.org/10.3390/ijerph182312783 - 3 Dec 2021

Cited by 3 | Viewed by 2530

Abstract

The purpose of the study was to assess the community knowledge of and to obtain a broad overview of attitudes towards appropriate prevention techniques that are recommended by the Ministry of Health to prevent COVID-19 transmission in Saudi Arabia. Methods: A cross-sectional study [...] Read more.

The purpose of the study was to assess the community knowledge of and to obtain a broad overview of attitudes towards appropriate prevention techniques that are recommended by the Ministry of Health to prevent COVID-19 transmission in Saudi Arabia. Methods: A cross-sectional study using an online survey was conducted in Saudi Arabia between 1 May and 30 November 2020 to assess the community knowledge of and attitudes towards appropriate COVID-19 prevention techniques in Saudi Arabia. The study tool was developed based on an extensive literature review. Results: A total of 577 individuals were involved in this study. The majority of the participants knew that COVID-19 is classified as a severe acute respiratory syndrome, is caused by viral infection, and that it is more common among the elderly and those who have a chronic illness. More than half of the participants were able to identify the symptoms of COVID-19 correctly, which are fever, dry cough, and loss of taste. Approximately half the study participants were knowledgeable about appropriate distancing, handwashing, and preventive measures (e.g., wearing a cloth mask, smoking cessation, avoiding dangerous cultural behaviors that increase the probability of disease transmission). More than half of the study participants were able to identify the appropriate actions that should be taken if common COVID-19 symptoms appear. Conclusion: A promising level of knowledge and positive attitudes towards COVID-19 was observed in Saudi Arabia. Continuous efforts should be maintained to sustain the level of awareness among the public. Further studies are warranted to explore the level of knowledge and attitudes after the introduction of COVID-19 vaccines. Full article

17 pages, 745 KiB

Open AccessArticle

Social Capital during the First Wave of the COVID-19 Outbreak: The Case of the Island of Menorca

by Ester Villalonga-Olives, Ichiro Kawachi and Ildefonso Hernández-Aguado

Int. J. Environ. Res. Public Health 2021, 18(23), 12720; https://doi.org/10.3390/ijerph182312720 - 2 Dec 2021

Cited by 6 | Viewed by 2845

Abstract

The rapidly evolving coronavirus pandemic has drastically altered the economic and social lives of people throughout the world. Our overall goal is to understand the mechanisms through which social capital shaped the community response to the pandemic on the island of Menorca, Spain, [...] Read more.

The rapidly evolving coronavirus pandemic has drastically altered the economic and social lives of people throughout the world. Our overall goal is to understand the mechanisms through which social capital shaped the community response to the pandemic on the island of Menorca, Spain, which was under a strict lockdown in 2020. Between April and June 2020, we performed qualitative interviews (n = 25) of permanent residents of the island. From the findings, it is evident that social capital is an important resource with the capacity to organize help and support. However, the dark sides of social capital, with lack of social cohesion and lack of trust, also emerged as an important negative issue. We identified sources of tension that were not resolved, as well as important sociodemographic differences that are primary drivers for health inequalities. The investment in social networks and social capital is a long-term need that should consider sociodemographic vulnerability. Full article

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18 pages, 1704 KiB

Open AccessArticle

The Impact of Information Sources on COVID-19-Related Knowledge, Attitudes, and Practices (KAP) among University Students: A Nationwide Cross-Sectional Study

by Israa Baker, Nizar Marzouqa, Bashar Nafe’ Yaghi, Samer Osama Adawi, Shahd Yousef, Tayseer Nedal Sabooh, Nataly Mazen Salhab, Hiba Mahmoud Khrishi, Yahya Qabaja, Abanoub Riad, Elham Kateeb and Sameh Attia

Int. J. Environ. Res. Public Health 2021, 18(23), 12462; https://doi.org/10.3390/ijerph182312462 - 26 Nov 2021

Cited by 16 | Viewed by 4049

Abstract

COVID-19 is an emerging respiratory disease caused by a novel coronavirus accompanied by a tsunami of misinformation and fake news. This can weaken the public health responses by affecting the COVID-19-related knowledge, attitudes, and practices (KAP) of the public. Therefore, this cross-sectional study [...] Read more.

COVID-19 is an emerging respiratory disease caused by a novel coronavirus accompanied by a tsunami of misinformation and fake news. This can weaken the public health responses by affecting the COVID-19-related knowledge, attitudes, and practices (KAP) of the public. Therefore, this cross-sectional study was designed during the early stage of the pandemic to evaluate the KAP of Palestinian university students and their commonly used information sources. We found that the most trusted information source among students was the World Health Organization (WHO), followed by the Palestinian Ministry of Health (MoH) briefings and healthcare workers, whereas social media was the most frequently used source of information. The participants exhibited a high level of COVID-19-related knowledge, having an average score of 8.65 (range: 0–10). In total, 76% avoided going to crowded places, and only 33% wore a mask while being outdoors. The vast majority (93%) checked the accuracy of COVID-19-related information before publishing it, 56% used the WHO and MoH briefings for fact-checking, and only 8% relied on healthcare workers. This was particularly the case for those who lived in refugee camps. This study provides an insight into the information sources used by Palestinian university students, the sources they trust, and the information formats they prefer. These results may help public health authorities to locate the information sources through which university students should be targeted. Efforts should be made to recommend healthcare workers as credible information sources. In this way, they will be able to prevent the spread of misleading information and provide high-quality information, especially within unconventional settings such as refugee camps. Full article

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8 pages, 323 KiB

Open AccessArticle

Motivation for COVID-19 Vaccination in Priority Occupational Groups: A Cross-Sectional Survey

by Ladislav Štěpánek, Magdaléna Janošíková, Marie Nakládalová, Kateřina Ivanová, Jakub Macík, Alena Boriková and Helena Vildová

Int. J. Environ. Res. Public Health 2021, 18(21), 11726; https://doi.org/10.3390/ijerph182111726 - 8 Nov 2021

Cited by 8 | Viewed by 2614

Abstract

Due to the limited availability of COVID-19 vaccines, occupational groups with priority access were identified prior to vaccination. The study aimed to analyze motives for vaccination in these occupational groups. Methods: Members of occupational groups, who were vaccinated at the vaccination center of [...] Read more.

Due to the limited availability of COVID-19 vaccines, occupational groups with priority access were identified prior to vaccination. The study aimed to analyze motives for vaccination in these occupational groups. Methods: Members of occupational groups, who were vaccinated at the vaccination center of University Hospital Olomouc before 30 April 2021, were asked to fill in an online questionnaire. Results: A total of 3224 completed questionnaires were obtained from 1332 healthcare workers, 1257 school employees, 363 social service workers, 210 security force members, and 62 critical infrastructure workers. The most frequent motive for vaccination was the effort to protect family members (76.2%), the effort to prevent the spread of COVID-19 in one’s profession (72.3%), followed by concerns about COVID-19 itself (49.1%) and exemptions from anti-epidemic measures (36.8%). Only for social services, the motive focused on one’s profession was mentioned more often (75.2%) than the motive focused on the family (71.1%). At the level of detailed profession-oriented motives, a collegial effort of security force members to protect co-workers and not to endanger the workplace was dominant. Conclusions: The effort to prevent the spread of COVID-19 in the professional environment is a strong motive for vaccination, and strongest among social service workers. Full article

12 pages, 340 KiB

Open AccessArticle

The Prevalence of Mental Distress and Social Support among University Students in Jordan: A Cross-Sectional Study

by Sawsan M. A. Abuhamdah, Abdallah Y. Naser, Ghada Mohammad Abdelwahab and Ahmad AlQatawneh

Int. J. Environ. Res. Public Health 2021, 18(21), 11622; https://doi.org/10.3390/ijerph182111622 - 5 Nov 2021

Cited by 15 | Viewed by 3510

Abstract

Objectives: To examine the prevalence of mental distress among university students in Jordan. Methods: An online cross-sectional study using a self-administered questionnaire was conducted between 12th of June and the 4th of August 2021 in Jordan to measure student mental stress using Self-Reporting [...] Read more.

Objectives: To examine the prevalence of mental distress among university students in Jordan. Methods: An online cross-sectional study using a self-administered questionnaire was conducted between 12th of June and the 4th of August 2021 in Jordan to measure student mental stress using Self-Reporting Questionnaire-20 (SRQ-20). Results: A total of 1063 university students participated in the study. One-third of the participating students reported that they had a history of COVID-19 infection. More than half of the participating university students (65.7%) were found to have mental distress (measured symptomatically by the SRQ-20 with a score of eight or more). The average mental distress score was 9.8 (SD: 5.5) out of 20. Female students, students from non-medical colleges, students in their last years of study, students with chronic diseases and those with low income were associated with high levels of mental distress (p < 0.05). With regards to social support, a moderate level of social support was received from three sources: persons considered as significant others, family members, and friends. The average social support score for the participating university students was 41.9 (SD: 10.3) out of 60 (equivalent to 69.8%). Conclusions: Mental distress is prevalent among university students in Jordan. There is a need for evidence-based governmental strategies and interventions that provide social support at universities such as self-help measures and professional mental health services as part of student health services that would be helpful to reduce the burden of mental distress of students and promote the mission of the integration of mental health in all university policies. Full article

31 pages, 5612 KiB

Open AccessArticle

The Impact of Large Mobile Air Purifiers on Aerosol Concentration in Classrooms and the Reduction of Airborne Transmission of SARS-CoV-2

by Finn F. Duill, Florian Schulz, Aman Jain, Leve Krieger, Berend van Wachem and Frank Beyrau

Int. J. Environ. Res. Public Health 2021, 18(21), 11523; https://doi.org/10.3390/ijerph182111523 - 2 Nov 2021

Cited by 42 | Viewed by 5835

Abstract

In the wake of the COVID-19 pandemic, an increased risk of infection by virus-containing aerosols indoors is assumed. Especially in schools, the duration of stay is long and the number of people in the rooms is large, increasing the risk of infection. This [...] Read more.

In the wake of the COVID-19 pandemic, an increased risk of infection by virus-containing aerosols indoors is assumed. Especially in schools, the duration of stay is long and the number of people in the rooms is large, increasing the risk of infection. This problem particularly affects schools without pre-installed ventilation systems that are equipped with filters and/or operate with fresh air. Here, the aerosol concentration is reduced by natural ventilation. In this context, we are investigating the effect of large mobile air purifiers (AP) with HEPA filters on particle concentration and their suitability for classroom use in a primary school in Germany. The three tested APs differ significantly in their air outlet characteristics. Measurements of the number of particles, the particle size distribution, and the CO₂ concentration were carried out in the classroom with students (April/May 2021) and with an aerosol generator without students. In this regard, the use of APs leads to a substantial reduction of aerosol particles in the considered particle size range of 0.178–17.78 µm. At the same time, the three APs are found to have differences in their particle decay rate, noise level, and flow velocity. In addition to the measurements, the effect of various influencing parameters on the potential inhaled particle dose was investigated using a calculation model. The parameters considered include the duration of stay, particle concentration in exhaled air, respiratory flow rate, virus lifetime, ventilation interval, ventilation efficiency, AP volumetric flow, as well as room size. Based on the resulting effect diagrams, significant recommendations can be derived for reducing the risk of infection from virus-laden aerosols. Finally, the measurements were compared to computational fluid dynamics (CFD) modeling, as such tools can aid the optimal placement and configuration of APs and can be used to study the effect of the spread of aerosols from a source in the classroom. Full article

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10 pages, 353 KiB

Open AccessArticle

Factors Associated with Reduction in Physical Activity during the COVID-19 Pandemic in São Paulo, Brazil: An Internet-Based Survey Conducted in June 2020

by Gabriela Togni, Paulo José Puccinelli, Taline Costa, Aldo Seffrin, Claudio Andre Barbosa de Lira, Rodrigo Luiz Vancini, Douglas De Assis Teles Santos, Pantelis Theodoros Nikolaidis, Beat Knechtle and Marilia Santos Andrade

Int. J. Environ. Res. Public Health 2021, 18(21), 11397; https://doi.org/10.3390/ijerph182111397 - 29 Oct 2021

Cited by 9 | Viewed by 2402

Abstract

Background: The COVID-19 pandemic negatively affected physical activity levels. This study investigated the factors associated with the change in physical activity level in Brazilians residing in the city of São Paulo. Methods: A self-administered questionnaire, addressing personal data, restriction level, education level, family [...] Read more.

Background: The COVID-19 pandemic negatively affected physical activity levels. This study investigated the factors associated with the change in physical activity level in Brazilians residing in the city of São Paulo. Methods: A self-administered questionnaire, addressing personal data, restriction level, education level, family income, daily working hours, and physical activity level, was answered by 2140 volunteers, of which 1179 were excluded because the answers were either incomplete or the respondents were not from São Paulo. The total number of participants selected was 961 (581 female and 380 male). Results: The physical activity level adopted prior to the pandemic period (p < 0.001) and family income (p = 0.001) correlated significantly with physical activity level reduction during the pandemic. The proportion of people who reduced their physical activity was greater among those who were very active than those who were active (adjusted prevalence ratio [aPR]: 0.65 [confidence interval (CI): 0.52–0.80]) or insufficiently active [aPR: 0.39 (0.18–0.82)]. The proportion of people who reduced their physical activity was greater among those who received a salary less than minimum wage (MW) than those who received a salary between three to six times minimum wage [(aPR: 0.50 (CI 0.35–0.70)] or more than 6 MW [(aPR: 0.56 (CI 0.40–0.79)]. Conclusions: A higher prevalence of Brazilians residing in the city of São Paulo reduced their physical activity who had a vigorous level of physical activity prior to the pandemic and who received less than a MW. Full article

15 pages, 629 KiB

Open AccessReview

Risks of Infection with SARS-CoV-2 Due to Contaminated Surfaces: A Scoping Review

by Marjan Mohamadi, Awa Babington-Ashaye, Agnès Lefort and Antoine Flahault

Int. J. Environ. Res. Public Health 2021, 18(21), 11019; https://doi.org/10.3390/ijerph182111019 - 20 Oct 2021

Cited by 20 | Viewed by 3767

Abstract

The COVID-19 outbreak is a global health concern. Understanding the transmission modes of the SARS-CoV-2 virus is key to limit the spread of the pandemic. A lack of knowledge about the possibility of SARS-CoV-2 transmission and infection through contaminated surfaces is noticeable and [...] Read more.

The COVID-19 outbreak is a global health concern. Understanding the transmission modes of the SARS-CoV-2 virus is key to limit the spread of the pandemic. A lack of knowledge about the possibility of SARS-CoV-2 transmission and infection through contaminated surfaces is noticeable and recent studies have stated conflicting findings. This scoping review aims to understand the risks of contaminations via fomites better. Relevant publications were selected through Google Scholar, Web of Science, PubMed, Embase, Medline, and Cochrane Library, with related keywords. PRISMA-ScR guidelines were followed. Out of the 565 articles found, exclusion criteria were applied, duplicates removed, and a total of 25 articles were finally included in the study. The included documents were assessed by the contamination risk: “low” (37.5%), “high” (16.7%), “plausible” (8.3%), “unlikely” (8.3%) risk, and “insufficient evidence” (29.2%). Research in hospital settings was found as the main setting in the reviewed papers, which precisely indicated the risk of contaminated surfaces. This scoping review underscores the risk of SARS-CoV-2 infection via contaminated surfaces assessed as low in the majority of the reviewed articles. Further evaluation of the risk of the virus transmission by fomites and providing adequate information on its infectivity via contaminated surfaces in real-life conditions is essential. Full article

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28 pages, 2502 KiB

Open AccessArticle

The Relationships between Character Strengths and Subjective Wellbeing: Evidence from Greece under Lockdown during COVID-19 Pandemic

by Dimitra Vasileiou, Despina Moraitou, Vasileios Papaliagkas, Christos Pezirkianidis, Anastasios Stalikas, Georgia Papantoniou and Maria Sofologi

Int. J. Environ. Res. Public Health 2021, 18(20), 10868; https://doi.org/10.3390/ijerph182010868 - 15 Oct 2021

Cited by 6 | Viewed by 3757

Abstract

COVID-19 was first identified in December 2019. As long as this type of coronavirus was new, the main way for governments to avoid the spread of the infection was enforced quarantine. Besides public health protection, quarantine can have a psychological impact on the [...] Read more.

COVID-19 was first identified in December 2019. As long as this type of coronavirus was new, the main way for governments to avoid the spread of the infection was enforced quarantine. Besides public health protection, quarantine can have a psychological impact on the residents, with main symptoms being angst, anxiety, depressive, and PTSD symptoms. As it has been found that character strengths can promote subjective wellbeing, the purpose of the study was to examine this relationship under the new situation of quarantine in the Greek population in adults who were in quarantine for at least two weeks. The total sample consisted of 354 participants who were aged 18–72-years-old. A total of 263 participants were women (74.3%), 91 were men (25.7%), and 94.6% of them were highly educated. The sample was a convenience sample. The tools used were PANAS, PERMA and finally VIA-114GR. The data analysis was completed using SPSS software version 26.0 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY, USA: IBM Corp) and EQS 6.1 (Multivariate Software Inc.: Encino, CA, USA, 2006). The results showed that love, curiosity, persistence, hope, and zest are strongly associated with subjective wellbeing, even in conditions such as quarantine, and can support specific aspects of it. Full article

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12 pages, 3215 KiB

Open AccessArticle

Wearing a Surgical Face Mask Has Minimal Effect on Performance and Physiological Measures during High-Intensity Exercise in Youth Ice-Hockey Players: A Randomized Cross-Over Trial

by Keely A. Shaw, Scotty Butcher, Jong Bum Ko, Abdi Absher, Julianne Gordon, Cody Tkachuk, Gordon A. Zello and Philip D. Chilibeck

Int. J. Environ. Res. Public Health 2021, 18(20), 10766; https://doi.org/10.3390/ijerph182010766 - 14 Oct 2021

Cited by 13 | Viewed by 4771

Abstract

COVID-19 transmission is prevalent during ice-hockey; however, it is unknown whether wearing face masks as a mitigation strategy affects hockey players’ performance. We used a randomized cross-over study to compare wearing a surgical mask to a sham mask (control) in youth hockey players [...] Read more.

COVID-19 transmission is prevalent during ice-hockey; however, it is unknown whether wearing face masks as a mitigation strategy affects hockey players’ performance. We used a randomized cross-over study to compare wearing a surgical mask to a sham mask (control) in youth hockey players (21 males, 5 females, 11.7 ± 1.6 y) during a simulated hockey period (cycle ergometry; six shifts of 20 s of “easy” pedaling (40% peak power), 10 s of “hard” pedaling (95% peak power), 20 s of “easy” pedaling, with shifts separated by 5 min rests). A seventh shift involved two 20 s Wingate tests separated by 40 s rest. Heart rate, arterial oxygen saturation and vastus lateralis tissue oxygenation index (hemoglobin saturation/desaturation) was assessed each shift. On-ice testing was conducted with the maximal Yo-Yo intermittent recovery test. No differences between mask and control conditions for performance were found (Wingate average power: 245 ± 93 vs. 237 ± 93 W, Peak power: 314 ± 116 vs. 304 ± 115 W, on-ice distance: 274 ± 116 vs. 274 ± 110 m) and for heart rate or arterial oxygen saturation during simulated hockey shifts. Tissue oxygenation index was lower from shifts one to six for males (p < 0.05) and shift seven for females (p < 0.01) while wearing a mask. Wearing a face mask had no effect on performance in hockey players with only minor effects on muscle oxygenation. ClinicalTrials.gov (NCT04874766) (accessed on 6 May 2021). Full article

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16 pages, 1191 KiB

Open AccessArticle

COVID-19 Pandemic and Personality: Agreeable People Are More Stressed by the Feeling of Missing

by Stephan Getzmann, Jan Digutsch and Thomas Kleinsorge

Int. J. Environ. Res. Public Health 2021, 18(20), 10759; https://doi.org/10.3390/ijerph182010759 - 13 Oct 2021

Cited by 14 | Viewed by 3744

Abstract

The COVID-19 pandemic and the measures taken to contain it have substantial consequences for many people, resulting in negative effects on individual well-being and mental health. In the current study, we examined whether individual changes in perceived stress relative to pre-pandemic levels depended [...] Read more.

The COVID-19 pandemic and the measures taken to contain it have substantial consequences for many people, resulting in negative effects on individual well-being and mental health. In the current study, we examined whether individual changes in perceived stress relative to pre-pandemic levels depended on differences in behavior, appraisal, and experience of pandemic-related constraints. In addition, we tested whether this potential relationship was moderated by personality traits. We conducted an online survey during the end of the first lockdown in Germany in spring 2020, and assessed pandemic-related individual consequences as well as perceived stress. These data were related to the big five personality traits and to ratings of perceived stress obtained from the same participants in a study conducted before the outbreak of the pandemic, using the same standardized stress questionnaires. There was no overall increase, but a large interindividual variety in perceived stress relative to pre-pandemic levels. Increased stress was associated especially with strong feelings of missing. This relationship was moderated by agreeableness, with more agreeable people showing a higher association of the feeling of missing and the increase of perceived stress. In addition, openness and conscientiousness were positively correlated with an increase in stress. The results highlight the importance of considering personality and individual appraisals when examining the consequences of the COVID-19 pandemic on perceived stress and well-being. Full article

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9 pages, 340 KiB

Open AccessArticle

Changes in Physical Activity Are Associated with Corresponding Changes in Psychological Well-Being: A Pandemic Case Study

by Micael Dahlen, Helge Thorbjørnsen, Hallgeir Sjåstad, Petra von Heideken Wågert, Charlotta Hellström, Birgitta Kerstis, Daniel Lindberg, Jonas Stier and Maria Elvén

Int. J. Environ. Res. Public Health 2021, 18(20), 10680; https://doi.org/10.3390/ijerph182010680 - 12 Oct 2021

Cited by 12 | Viewed by 4577

Abstract

Societal crises and personal challenges are often followed by substantial changes in physical activity. Is there a link between such changes and psychological well-being? Seeking to answer this question, we conducted a correlational study on a representative sample in Sweden during the first [...] Read more.

Societal crises and personal challenges are often followed by substantial changes in physical activity. Is there a link between such changes and psychological well-being? Seeking to answer this question, we conducted a correlational study on a representative sample in Sweden during the first year of the COVID-19 pandemic (N = 1035). About 49% of the sample had decreased their physical activity compared to their self-reported activity level prior to the pandemic, whereas 32% had increased it. The results showed a positive and robust association between changes in daily activity level and corresponding changes in psychological well-being. Specifically, individuals who had reduced their physical activity over the last year reported lower life satisfaction than before, and individuals who had increased their physical activity reported higher life satisfaction than before. The amount of complete physical inactivity (sitting) showed a similar pattern as the exercise data, meaning that individuals who reported increasing inactivity per day also reported a greater decline in life satisfaction. Additional analyses showed that the association between daily activity level and life satisfaction was somewhat stronger for men than for women, but there was no difference when comparing individual versus organized activities. The current study was based on a cross-sectional design, measuring self-reported change over time. Recent work from other research teams have used longitudinal data and experience-sampling in different settings, finding similar results. We conclude that there is good reason to recommend physical exercise as a coping strategy in difficult times. Full article

9 pages, 315 KiB

Open AccessArticle

Political Ideologies, Government Trust, and COVID-19 Vaccine Hesitancy in South Korea: A Cross-Sectional Survey

by Hyun Kyung Park, Ji Hye Ham, Deok Hyun Jang, Jin Yong Lee and Won Mo Jang

Int. J. Environ. Res. Public Health 2021, 18(20), 10655; https://doi.org/10.3390/ijerph182010655 - 12 Oct 2021

Cited by 38 | Viewed by 4756

Abstract

This study aimed to assess the correlation between political ideologies, government trust, and COVID-19 vaccine hesitancy in South Korea during the COVID-19 pandemic. A cross-sectional survey was conducted among South Korea’s general population and 1000 respondents (aged 18 years and older) were included. [...] Read more.

This study aimed to assess the correlation between political ideologies, government trust, and COVID-19 vaccine hesitancy in South Korea during the COVID-19 pandemic. A cross-sectional survey was conducted among South Korea’s general population and 1000 respondents (aged 18 years and older) were included. We used multivariate logistic regression models to identify the factors associated with vaccine hesitancy. Respondents who self-identified as liberal or held “no political opinion” had higher rates of vaccine hesitancy than conservative respondents. People’s trust in the government’s countermeasures was associated with vaccination. Respondents who had risk perceptions (affective and cognitive) of COVID-19 had lower rates of vaccine hesitancy. Perceptions that the vaccine was not safe and being aged 18–29, 30–39, or 40–49 were associated with a higher probability of vaccine hesitancy. This study found that even if vaccine safety and risk perceptions toward COVID-19 were adjusted, self-rated political ideologies and government trust was associated with COVID-19 vaccine hesitancy. More effort to communicate with those who are *liberal or “no political opinion”, younger, and have lower level of trust in the government are required to dissolve vaccine hesitancy. Further studies should analyze the mechanism of COVID-19 vaccine uptake for effective herd immunity. Full article

11 pages, 303 KiB

Open AccessArticle

Burnout and the Psychological Impact among Physiatrists in Saudi Arabia during COVID-19

by Ahmad H. Alwashmi and Abdulmajeed A. Alkhamees

Int. J. Environ. Res. Public Health 2021, 18(18), 9621; https://doi.org/10.3390/ijerph18189621 - 13 Sep 2021

Cited by 10 | Viewed by 3348

Abstract

Background: Burnout is an emerging critical issue facing specialists and trainees in all disciplines and not particularly studied among physiatry specialists and trainees in Saudi Arabia during the COVID-19 pandemic. Objective: To assess physiatrist burnout, depression, anxiety, and stress during the current COVID-19 [...] Read more.

Background: Burnout is an emerging critical issue facing specialists and trainees in all disciplines and not particularly studied among physiatry specialists and trainees in Saudi Arabia during the COVID-19 pandemic. Objective: To assess physiatrist burnout, depression, anxiety, and stress during the current COVID-19 pandemic crisis in Saudi Arabia. Design: Cross-sectional study. Setting: By distributing an electronic survey, the researcher assessed burnout using the Maslach Burnout Inventory (MBI) Human Services Survey (HSS) in the midst of the curfew that Saudi authorities imposed. Participants: One hundred one participating trainees, specialists, and consultants. Results: Of the 101 study participants, the majority (73.3%) were between the ages of 24 and 34 years old, with the rest distributed within the age group ranging from 35 to 65 years old. Junior residents represented 34.7%, senior residents 22.8%, physiatrist specialists 26.7%, and consultants 15.8%. The sample included 55.4% males and 44.6% females; 64.4% of the participants were married, 29.7% were still single, and 5.9% were divorced. Among the total group participating, 25.7% were handling COVID-19 patients. In the total participant sample, 80.2% reported experiencing burnout, 10.9% experienced stress, and 22.8% and 6.9% experienced anxiety and depression, respectively. Conclusion: Burnout in Saudi Arabia exists among more than two-thirds of practicing physiatrists in Physical Medicine & Rehabilitation (PM&R), and that did not appear to have a statistically significant influence on stress, anxiety, or depression (p > 0.05). The current COVID-19 global pandemic might escalate burnout and influence mental health outcomes. The healthcare authority and administration should take the lead in identifying the challenges, overcoming the obstacles, and optimizing clinician well-being, delivering up-to-date solutions, and promptly checking their effectiveness. Full article

12 pages, 434 KiB

Open AccessArticle

Provision of Psychodynamic Psychotherapy in Austria during the COVID-19 Pandemic: A Cross-Sectional Study

by Andrea Jesser, Johanna Muckenhuber, Bernd Lunglmayr, Rachel Dale and Elke Humer

Int. J. Environ. Res. Public Health 2021, 18(17), 9046; https://doi.org/10.3390/ijerph18179046 - 27 Aug 2021

Cited by 9 | Viewed by 2769

Abstract

The COVID-19 pandemic has brought massive changes in the provision of psychotherapy. To avoid or reduce the risk of infection, many therapists switched from face-to-face sessions in personal contact to remote psychotherapy, i.e., psychotherapy delivered by telephone or videoconferencing. This study examined the [...] Read more.

The COVID-19 pandemic has brought massive changes in the provision of psychotherapy. To avoid or reduce the risk of infection, many therapists switched from face-to-face sessions in personal contact to remote psychotherapy, i.e., psychotherapy delivered by telephone or videoconferencing. This study examined the attitudes toward and practice of remote psychotherapy among Austrian therapists with a psychodynamic orientation at the onset of the pandemic as well as changes in the therapeutic process that were experienced by the therapists due to switching to a remote setting. A total of 161 therapists with psychodynamic orientation took part in an online survey. The results show that attitudes toward remote psychotherapy changed positively in psychodynamically orientated therapists and most are willing to switch to remote settings, if necessary. However, many therapists reported negative effects of remote psychotherapy and prefer seeing their patients in-person. The strongest changes were experienced with regard to transference/countertransference, the therapeutic process and the intensity of session. The analysis further revealed an overall decrease in the number of patients treated, indicating an undersupply of psychotherapy, at least during the first wave of COVID-19 infection in Austria. In summary, the experience during the first COVID-19 lockdown has led to an increase in remote psychotherapy and more openness toward these treatment modalities among psychodynamically oriented therapists. However, in-person therapy will remain the first choice for most therapists. Full article

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11 pages, 349 KiB

Open AccessArticle

Mental Health of Apprentices during the COVID-19 Pandemic in Austria and the Effect of Gender, Migration Background, and Work Situation

by Rachel Dale, Teresa O’Rourke, Elke Humer, Andrea Jesser, Paul L. Plener and Christoph Pieh

Int. J. Environ. Res. Public Health 2021, 18(17), 8933; https://doi.org/10.3390/ijerph18178933 - 25 Aug 2021

Cited by 19 | Viewed by 5482

Abstract

This study assessed the mental health of apprentices during the COVID-19 pandemic in Austria and the effect of gender, migration background, work situation, and work sector. An online survey via REDCap was performed with a sample of 1442 apprentices (female: 53.5%, male: 45.4%, [...] Read more.

This study assessed the mental health of apprentices during the COVID-19 pandemic in Austria and the effect of gender, migration background, work situation, and work sector. An online survey via REDCap was performed with a sample of 1442 apprentices (female: 53.5%, male: 45.4%, diverse: 1.1%, migration background: 28.4%) from 29 March to 18 May 2021. Indicators of mental health were depression (PHQ-9), anxiety (GAD-7), well-being (WHO-5), disordered eating (EAT-8), and insomnia (ISI-7). There was a high prevalence of clinically relevant depression (cut-offs ≥11 for adolescents, ≥10 for adults: 48.3%), anxiety (cut-offs ≥11 for adolescents, ≥10 for adults: 35.4%), insomnia (cut-off ≥15: 27%), and disordered eating (cut-offs ≥2 for men, ≥3 for women: 50.6%). Linear models revealed that apprentices with female and diverse gender, migration background, and unemployed status showed the poorest scores on all mental health measures (all p-values < 0.05) except disordered eating. These findings emphasize the need for intersectional strategies to reduce and prevent adverse mental health consequences of the COVID-19 pandemic for apprentices. Full article

22 pages, 2840 KiB

Open AccessArticle

Changes in Adolescents’ Psychosocial Functioning and Well-Being as a Consequence of Long-Term COVID-19 Restrictions

by Nóra Kerekes, Kourosh Bador, Anis Sfendla, Mohjat Belaatar, Abdennour El Mzadi, Vladimir Jovic, Rade Damjanovic, Maria Erlandsson, Hang Thi Minh Nguyen, Nguyet Thi Anh Nguyen, Scott F. Ulberg, Rachael H. Kuch-Cecconi, Zsuzsa Szombathyne Meszaros, Dejan Stevanovic, Meftaha Senhaji, Britt Hedman Ahlström and Btissame Zouini

Int. J. Environ. Res. Public Health 2021, 18(16), 8755; https://doi.org/10.3390/ijerph18168755 - 19 Aug 2021

Cited by 42 | Viewed by 9415

Abstract

This work studied self-reports from adolescents on how the COVID-19 pandemic has changed their behaviors, relationships, mood, and victimization. Data collection was conducted between September 2020 and February 2021 in five countries (Sweden, the USA, Serbia, Morocco, and Vietnam). In total, 5114 high [...] Read more.

This work studied self-reports from adolescents on how the COVID-19 pandemic has changed their behaviors, relationships, mood, and victimization. Data collection was conducted between September 2020 and February 2021 in five countries (Sweden, the USA, Serbia, Morocco, and Vietnam). In total, 5114 high school students (aged 15 to 19 years, 61.8% females) responded to our electronic survey. A substantial proportion of students reported decreased time being outside (41.7%), meeting friends in real life (59.4%), and school performance (30.7%), while reporting increased time to do things they did not have time for before (49.3%) and using social media to stay connected (44.9%). One third of the adolescents increased exercise and felt that they have more control over their life. Only a small proportion of adolescents reported substance use, norm-breaking behaviors, or victimization. The overall COVID-19 impact on adolescent life was gender-specific: we found a stronger negative impact on female students. The results indicated that the majority of adolescents could adapt to the dramatic changes in their environment. However, healthcare institutions, municipalities, schools, and social services could benefit from the findings of this study in their work to meet the needs of those young people who signaled worsened psychosocial functioning, increased stress, and victimization. Full article

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19 pages, 2940 KiB

Open AccessArticle

Empirical Evaluation of Alternative Time-Series Models for COVID-19 Forecasting in Saudi Arabia

by Isra Al-Turaiki, Fahad Almutlaq, Hend Alrasheed and Norah Alballa

Int. J. Environ. Res. Public Health 2021, 18(16), 8660; https://doi.org/10.3390/ijerph18168660 - 16 Aug 2021

Cited by 15 | Viewed by 3613

Abstract

COVID-19 is a disease-causing coronavirus strain that emerged in December 2019 that led to an ongoing global pandemic. The ability to anticipate the pandemic’s path is critical. This is important in order to determine how to combat and track its spread. COVID-19 data [...] Read more.

COVID-19 is a disease-causing coronavirus strain that emerged in December 2019 that led to an ongoing global pandemic. The ability to anticipate the pandemic’s path is critical. This is important in order to determine how to combat and track its spread. COVID-19 data is an example of time-series data where several methods can be applied for forecasting. Although various time-series forecasting models are available, it is difficult to draw broad theoretical conclusions regarding their relative merits. This paper presents an empirical evaluation of several time-series models for forecasting COVID-19 cases, recoveries, and deaths in Saudi Arabia. In particular, seven forecasting models were trained using autoregressive integrated moving average, TBATS, exponential smoothing, cubic spline, simple exponential smoothing Holt, and HoltWinters. The models were built using publicly available daily data of COVID-19 during the period of 24 March 2020 to 5 April 2021 reported in Saudi Arabia. The experimental results indicate that the ARIMA model had a smaller prediction error in forecasting confirmed cases, which is consistent with results reported in the literature, while cubic spline showed better predictions for recoveries and deaths. As more data become available, a fluctuation in the forecasting-accuracy metrics was observed, possibly due to abrupt changes in the data. Full article

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22 pages, 5802 KiB

Open AccessReview

The Early Stage of the COVID-19 Outbreak in Tunisia, France, and Germany: A Systematic Mapping Review of the Different National Strategies

by Khouloud Laffet, Fatma Haboubi, Noomene Elkadri, Rita Georges Nohra and Monique Rothan-Tondeur

Int. J. Environ. Res. Public Health 2021, 18(16), 8622; https://doi.org/10.3390/ijerph18168622 - 15 Aug 2021

Cited by 7 | Viewed by 3721

Abstract

The multitude of national strategies used against the COVID-19 pandemic makes it necessary to review and synthesize them in order to identify potential gaps and shortcomings, and to help prioritize future control efforts. This systematic mapping review is aimed at identifying the coronavirus [...] Read more.

The multitude of national strategies used against the COVID-19 pandemic makes it necessary to review and synthesize them in order to identify potential gaps and shortcomings, and to help prioritize future control efforts. This systematic mapping review is aimed at identifying the coronavirus pandemic management strategies adopted by France, Tunisia, and Germany during the early stage of the COVID-19 outbreak. A set of government websites in addition to the PubMed and Google Scholar databases were searched to identify scientific articles and institutional documents related to the national strategies of the three countries up until July 2020. The references included were mapped and narratively synthesized based on the pillars of the Monitoring and Evaluation Framework of the Strategic Preparedness and Response Plan defined by the World Health Organization. Of the 2765 records screened, 65 documents were included in the study. The analysis of these documents showed that Germany was the first country to implement mass screening of cases and that France was the first country to implement measures to impose general containment at the national level. It also showed that Tunisia was the only country to have imposed the confinement of passengers on repatriation flights in dedicated containment centers and at the expense of the state. Full article

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9 pages, 297 KiB

Open AccessArticle

Assessing the Knowledge and Attitude toward COVID-19 Vaccination in Saudi Arabia

by Heba M. Zahid and May A. Alsayb

Int. J. Environ. Res. Public Health 2021, 18(15), 8185; https://doi.org/10.3390/ijerph18158185 - 2 Aug 2021

Cited by 18 | Viewed by 3724

Abstract

COVID-19 was declared a pandemic by the WHO in March 2020. The most promising strategy to control the pandemic was to develop a vaccine. However, vaccination hesitancy is a major threat to world public health. Understanding the reasons behind this hesitancy might help [...] Read more.

COVID-19 was declared a pandemic by the WHO in March 2020. The most promising strategy to control the pandemic was to develop a vaccine. However, vaccination hesitancy is a major threat to world public health. Understanding the reasons behind this hesitancy might help in developing encouragement strategies. This cross-sectional study aimed to assess the knowledge and attitude toward the COVID-19 vaccine in Saudi Arabia. A total of 1599 responses were received; the overall vaccine acceptancy was 79.2%. Age, sex, and nationality of participants significantly predicted the vaccination status. A significantly higher proportion of participants, who reported being vaccinated, or intended to receive the vaccine, stated that the COVID-19 infection is dangerous, or varies from person to person; the vaccine is safe, and think there is a definite need for the vaccine (p < 0.001). The major encouragement factors to receive the vaccine were either confidence in the government decisions (54.8%), or the feeling of responsibility to stop the pandemic (48.7%), whereas the main discouraging factors were concerns about the insufficient clinical trials (11.4%), or the undiscovered side effects (11%). The results of this study indicate good acceptance toward the COVID-19 vaccine among residents of Saudi Arabia. Full article

13 pages, 1971 KiB

Open AccessArticle

Differential Impacts of Multimorbidity on COVID-19 Severity across the Socioeconomic Ladder in Hong Kong: A Syndemic Perspective

by Gary Ka-Ki Chung, Siu-Ming Chan, Yat-Hang Chan, Terry Cheuk-Fung Yip, Hon-Ming Ma, Grace Lai-Hung Wong, Roger Yat-Nork Chung, Hung Wong, Samuel Yeung-Shan Wong, Eng Kiong Yeoh, Michael Marmot and Jean Woo

Int. J. Environ. Res. Public Health 2021, 18(15), 8168; https://doi.org/10.3390/ijerph18158168 - 2 Aug 2021

Cited by 16 | Viewed by 4954

Abstract

The severity of COVID-19 infections could be exacerbated by the epidemic of chronic diseases and underlying inequalities in social determinants of health. Nonetheless, there is scanty evidence in regions with a relatively well-controlled outbreak. This study examined the socioeconomic patterning of COVID-19 severity [...] Read more.

The severity of COVID-19 infections could be exacerbated by the epidemic of chronic diseases and underlying inequalities in social determinants of health. Nonetheless, there is scanty evidence in regions with a relatively well-controlled outbreak. This study examined the socioeconomic patterning of COVID-19 severity and its effect modification with multimorbidity in Hong Kong. 3074 local COVID-19 cases diagnosed from 5 July to 31 October 2020 were analyzed and followed up until 30 November 2020. Data on residential addresses, socio-demographic background, COVID-19 clinical conditions, and pre-existing chronic diseases of confirmed cases were retrieved from the Centre for Health Protection and the Hospital Authority. Results showed that, despite an independent adverse impact of multimorbidity on COVID-19 severity (aOR = 2.35 [95% CI = 1.72–3.19]), it varied across the socioeconomic ladder, with no significant risk among those living in the wealthiest areas (aOR = 0.80 [0.32–2.02]). Also, no significant association of the area-level income-poverty rate with severe COVID-19 was observed. In conclusion, the socioeconomic patterning of severe COVID-19 was mild in Hong Kong. Nonetheless, socioeconomic position interacted with multimorbidity to determine COVID-19 severity with a mitigated risk among the socioeconomically advantaged. Plausible explanations include the underlying socioeconomic inequalities in chronic disease management and the equity impact of the public-private dual-track healthcare system. Full article

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10 pages, 561 KiB

Open AccessStudy Protocol

COVID-19 Vaccines Safety Tracking (CoVaST): Protocol of a Multi-Center Prospective Cohort Study for Active Surveillance of COVID-19 Vaccines’ Side Effects

by Abanoub Riad, Holger Schünemann, Sameh Attia, Tina Poklepović Peričić, Marija Franka Žuljević, Mikk Jürisson, Ruth Kalda, Katrin Lang, Sudhakar Morankar, Elias Ali Yesuf, Mohamed Mekhemar, Anthony Danso-Appiah, Ahmad Sofi-Mahmudi, Giordano Pérez-Gaxiola, Arkadiusz Dziedzic, João Apóstolo, Daniela Cardoso, Janja Marc, Mayte Moreno-Casbas, Charles Shey Wiysonge, Amir Qaseem, Anna Gryschek, Ivana Tadić, Salman Hussain, Mohammed Ahmed Khan, Jitka Klugarova, Andrea Pokorna, Michal Koščík and Miloslav Klugar Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2021, 18(15), 7859; https://doi.org/10.3390/ijerph18157859 - 25 Jul 2021

Cited by 54 | Viewed by 12566

Abstract

Background: Coronavirus disease (COVID-19) vaccine-related side effects have a determinant role in the public decision regarding vaccination. Therefore, this study has been designed to actively monitor the safety and effectiveness of COVID-19 vaccines globally. Methods: A multi-country, three-phase study including a cross-sectional survey [...] Read more.

Background: Coronavirus disease (COVID-19) vaccine-related side effects have a determinant role in the public decision regarding vaccination. Therefore, this study has been designed to actively monitor the safety and effectiveness of COVID-19 vaccines globally. Methods: A multi-country, three-phase study including a cross-sectional survey to test for the short-term side effects of COVID-19 vaccines among target population groups. In the second phase, we will monitor the booster doses’ side effects, while in the third phase, the long-term safety and effectiveness will be investigated. A validated, self-administered questionnaire will be used to collect data from the target population; Results: The study protocol has been registered at ClinicalTrials.gov, with the identifier NCT04834869. Conclusions: CoVaST is the first independent study aiming to monitor the side effects of COVID-19 vaccines following booster doses, and the long-term safety and effectiveness of said vaccines. Full article

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15 pages, 762 KiB

Open AccessArticle

The Impact of the COVID-19 Pandemic on Independent Creative Activities in Two Large Cities in Romania

by Nicolae Popa, Ana-Maria Pop, Alexandra-Camelia Marian-Potra, Pompei Cocean, Gheorghe-Gavrilă Hognogi and Nicoleta Afrodita David

Int. J. Environ. Res. Public Health 2021, 18(14), 7674; https://doi.org/10.3390/ijerph18147674 - 19 Jul 2021

Cited by 11 | Viewed by 4554

Abstract

The COVID-19 pandemic has had both financial and activity-related effects on a number of areas of activity, among which those involving the creative industries have proved to be weak in their capacity to survive the halting of all events held in physical spaces. [...] Read more.

The COVID-19 pandemic has had both financial and activity-related effects on a number of areas of activity, among which those involving the creative industries have proved to be weak in their capacity to survive the halting of all events held in physical spaces. The long-term effects of the current health crisis are bringing about changes in cultural demand and offer and highlighting the need to adapt and to think of new ways of functioning. Taking its cue from this situation, the research underlying our article set out to investigate the ways in which Romania’s independent creative sector is adapting. We achieved this by means of conducting 25 semi-structured interviews and undertaking case studies of two cities that are among the most effervescent from the point of view of cultural and creative industries, Timișoara and Cluj-Napoca. With the strengthening of this sector as the aim in view, the forms of early social resilience we identified are capable in the short term of taking action to ensure the survival of some of the spaces; in the medium term, through activating mechanisms that encourage entrepreneurial spirit, they will be able to adapt to any external shock. Full article

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10 pages, 777 KiB

Open AccessArticle

Pre-Vaccination COVID-19 Vaccine Literacy in a Croatian Adult Population: A Cross-Sectional Study

by Ivana Gusar, Suzana Konjevoda, Grozdana Babić, Dijana Hnatešen, Maja Čebohin, Rahela Orlandini and Boris Dželalija

Int. J. Environ. Res. Public Health 2021, 18(13), 7073; https://doi.org/10.3390/ijerph18137073 - 2 Jul 2021

Cited by 38 | Viewed by 4715

Abstract

Despite world-level efforts and the endeavors of scientists and medical professionals in suppressing the COVID-19 pandemic, inadequate levels of vaccine literacy of the general population can represent a grave obstacle. The aim of this study was to evaluate COVID-19 vaccine literacy in the [...] Read more.

Despite world-level efforts and the endeavors of scientists and medical professionals in suppressing the COVID-19 pandemic, inadequate levels of vaccine literacy of the general population can represent a grave obstacle. The aim of this study was to evaluate COVID-19 vaccine literacy in the Croatian adult general population before vaccination began. The specific objectives were to test differences regarding socio-demographic characteristics and to examine perceptions and attitudes about vaccination against COVID-19 considering the level of VL against COVID-19. A cross-sectional study with a translated and psychometrically tested questionnaire was conducted in 1227 participants before the start of vaccination, from 15 to 31 January 2021. The results show a medium level of vaccine literacy (M = 2.37, SD = 0.54) and a significant difference between functional and interactive-critical vaccine literacy (p < 0.001). The level of vaccine literacy grew with the level of education (p = 0.031) and reduced with age (p < 0.001). Participants who were employed, had chronic diseases, took medicine, or consumed alcohol daily had a lower level of vaccine literacy. There is room for progress in the COVID-19 VL level for the adult population in Croatia, especially at the interactive-critical VL, which could have an important role in people accepting the vaccine against the COVID-19 disease. A satisfactory level of vaccine literacy in the population is necessary because it can contribute to the fight against the pandemic. Full article

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10 pages, 462 KiB

Open AccessArticle

Assessing the Level of Awareness of COVID-19 and Prevalence of General Anxiety Disorder among the Hail Community, Kingdom of Saudi Arabia

by Bandar Alsaif, Najm Eldinn Elsser Elhassan, Ramaiah Itumalla, Kamal Elbassir Ali and Mohamed Ali Alzain

Int. J. Environ. Res. Public Health 2021, 18(13), 7035; https://doi.org/10.3390/ijerph18137035 - 30 Jun 2021

Cited by 8 | Viewed by 3509

Abstract

Background: The COVID-19 pandemic has caused a major public health problem around the world. Therefore, the aim of the study was to assess the awareness and prevalence of General Anxiety Disorder (GAD) with regard to COVID-19 among the Hail community, in the Kingdom [...] Read more.

Background: The COVID-19 pandemic has caused a major public health problem around the world. Therefore, the aim of the study was to assess the awareness and prevalence of General Anxiety Disorder (GAD) with regard to COVID-19 among the Hail community, in the Kingdom of Saudi Arabia, in order to help health authorities to effectively control the pandemic. Methods: A cross-sectional online survey was completed by 412 participants living in Hail, Saudi Arabia. The questionnaire assessed demographic characteristics, knowledge, attitudes, and practices for the prevention of COVID-19, as well as psychological feelings in terms of GAD as an impact of the COVID-19 pandemic. Results: The study found that most of the respondents demonstrated good knowledge, attitudes, and practice for COVID-19 prevention. The elderly and employed demonstrated significant positive attitudes and practices (p < 0.05). Participants with a positive attitude were almost two and a half times (OR = 2.4; 95% CI: 1.54–3.99) more likely to have good practices. Additionally, the rural respondents were less likely (OR = 0.45; 95% CI: 0.21–0.96) to have a positive attitude. Married participants were more than one and a half (OR = 1.60; 95% CI: 1.04–2.44) times more likely to have a positive attitude. The prevalence of GAD was 21.8% and was significantly increased among participants with inadequate knowledge (OR = 2.01; 95% CI: 1.25–3.22), females (OR = 1.92; 95% CI: 1.19–3.09), individuals with chronic diseases (OR = 1.71; 95% CI: 1.02–2.86), and non-Saudi participants (OR = 2.44; 95% CI: 1.02–5.85). Conclusions: Ensuring a sufficient combination of relatively good levels of knowledge, positive attitudes, and desired practices serves as a good approach to preventing the spread of COVID-19. However, the increased prevalence of GAD requires the attention of policymakers. Therefore, a great emphasis should be placed on health awareness campaigns, with a focus on misconceptions and the provision of counseling. Full article

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20 pages, 385 KiB

Open AccessArticle

Self-Isolation and Quarantine during the UK’s First Wave of COVID-19. A Mixed-Methods Study of Non-Adherence

by Yolanda Eraso and Stephen Hills

Int. J. Environ. Res. Public Health 2021, 18(13), 7015; https://doi.org/10.3390/ijerph18137015 - 30 Jun 2021

Cited by 16 | Viewed by 3757

Abstract

Self-isolation and quarantine measures were introduced by the UK Government on 12 March 2020 as part of the ‘delay’ phase to control the spread of SARS-CoV-2. Non-adherence to self-isolation for 7 days after the development of symptoms is considered suboptimal and little is [...] Read more.

Self-isolation and quarantine measures were introduced by the UK Government on 12 March 2020 as part of the ‘delay’ phase to control the spread of SARS-CoV-2. Non-adherence to self-isolation for 7 days after the development of symptoms is considered suboptimal and little is known about adherence to quarantine for 14 days if a co-habitant developed symptoms. This study aims to analyse non-adherence behaviours to self-isolation and quarantine measures by identifying their potential psycho-social and demographic predictors and by exploring people’s accounts of their experiences with these measures. A mixed-methods convergent design was used, comprising an online survey (n = 681) completed by residents in six North London boroughs and qualitative interviews with a subsample of participants (n = 16). Findings identified not accessing community support, lack of control over leaving the house, and lack of perceived benefit and need to follow the rules as behaviours associated with non-adherence to quarantine (42.7%). Non-adherence to self-isolating measures (24.4%) was associated with individuals’ perceived lack of control over responsibilities, lack of control over leaving the house, uncertainty about symptoms experienced, lack of access to tests, and distrust in the Government. Adherence to self-isolation and quarantine could be improved through strengthening perceived benefit to self-isolate with messages emphasising its effectiveness, by implementing a two-way information system to support symptoms identification, and with Government-funded, locally supported packages at different levels (financial, food, and practical needs). Full article

12 pages, 644 KiB

Open AccessArticle

Knowledge, Attitudes, and Practices Regarding COVID-19 among Healthcare Workers in Uganda: A Cross-Sectional Survey

by Onesmus Kamacooko, Jonathan Kitonsa, Ubaldo M. Bahemuka, Freddie M. Kibengo, Anne Wajja, Vincent Basajja, Alfred Lumala, Ayoub Kakande, Paddy Kafeero, Edward Ssemwanga, Robert Asaba, Joseph Mugisha, Benjamin F. Pierce, Robin J. Shattock, Pontiano Kaleebu and Eugene Ruzagira

Int. J. Environ. Res. Public Health 2021, 18(13), 7004; https://doi.org/10.3390/ijerph18137004 - 30 Jun 2021

Cited by 34 | Viewed by 6801

Abstract

Healthcare workers (HCWs) are at high risk of COVID-19. However, data on HCWs’ knowledge, attitudes, and practices (KAP) toward COVID-19 are limited. Between September and November 2020, we conducted a questionnaire-based COVID-19 KAP survey among HCWs at three hospitals in Uganda. We used [...] Read more.

Healthcare workers (HCWs) are at high risk of COVID-19. However, data on HCWs’ knowledge, attitudes, and practices (KAP) toward COVID-19 are limited. Between September and November 2020, we conducted a questionnaire-based COVID-19 KAP survey among HCWs at three hospitals in Uganda. We used Bloom’s cut-off of ≥80% to determine sufficient knowledge, good attitude, and good practice, and multivariate Poisson regression with robust variance for statistical analysis. Of 717 HCWs invited to participate, 657 (91.6%) agreed and were enrolled. The mean age (standard deviation) of enrollees was 33.2 (10.2) years; most were clinical HCWs (64.7%) and had advanced secondary school/other higher-level education (57.8%). Overall, 83.9% had sufficient knowledge, 78.4% had a positive attitude, and 37.0% had good practices toward COVID-19. Factors associated with KAP were: Knowledge: being a clinical HCW (aRR: 1.12; 95% CI: 1.02–1.23) and previous participation in health research (aRR: 1.10; 95% CI: 1.04–1.17); Attitude: age > 35 years (aRR: 0.88; 95% CI: 0.79–0.98); Practice: being a clinical HCW (aRR: 1.91; 95% CI: 1.41–2.59). HCWs in Uganda have good knowledge and positive attitude but poor practices towards COVID-19. Differences in COVID-19 KAP between clinical and non-clinical HCWs could affect uptake of COVID-19 interventions including vaccination. Full article

15 pages, 1141 KiB

Open AccessArticle

Is There a Temporal Relationship between COVID-19 Infections among Prison Staff, Incarcerated Persons and the Larger Community in the United States?

by Danielle Wallace, John M. Eason, Jason Walker, Sherry Towers, Tony H. Grubesic and Jake R. Nelson

Int. J. Environ. Res. Public Health 2021, 18(13), 6873; https://doi.org/10.3390/ijerph18136873 - 26 Jun 2021

Cited by 16 | Viewed by 6660

Abstract

Background: Our objective was to examine the temporal relationship between COVID-19 infections among prison staff, incarcerated individuals, and the general population in the county where the prison is located among federal prisons in the United States. Methods: We employed population-standardized regressions with fixed [...] Read more.

Background: Our objective was to examine the temporal relationship between COVID-19 infections among prison staff, incarcerated individuals, and the general population in the county where the prison is located among federal prisons in the United States. Methods: We employed population-standardized regressions with fixed effects for prisons to predict the number of active cases of COVID-19 among incarcerated persons using data from the Federal Bureau of Prisons (BOP) for the months of March to December in 2020 for 63 prisons. Results: There is a significant relationship between the COVID-19 prevalence among staff, and through them, the larger community, and COVID-19 prevalence among incarcerated persons in the US federal prison system. When staff rates are low or at zero, COVID-19 incidence in the larger community continues to have an association with COVID-19 prevalence among incarcerated persons, suggesting possible pre-symptomatic and asymptomatic transmission by staff. Masking policies slightly reduced COVID-19 prevalence among incarcerated persons, though the association between infections among staff, the community, and incarcerated persons remained significant and strong. Conclusion: The relationship between COVID-19 infections among staff and incarcerated persons shows that staff is vital to infection control, and correctional administrators should also focus infection containment efforts on staff, in addition to incarcerated persons. Full article

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22 pages, 4334 KiB

Open AccessArticle

Impact of the COVID-19 Pandemic on Patients Affected by Non-Communicable Diseases in Europe and in the USA

by Catherine Pécout, Emilie Pain, Michael Chekroun, Claire Champeix, Claudie Kulak, Rita Prieto, Joris van Vugt, Kim Gilchrist and Anne-Félice Lainé-Pellet

Int. J. Environ. Res. Public Health 2021, 18(13), 6697; https://doi.org/10.3390/ijerph18136697 - 22 Jun 2021

Cited by 26 | Viewed by 8196

Abstract

An international online patient community, Carenity, conducted a patient study in two independent waves among adults affected by non-communicable diseases (NCDs) in Europe and in the United States of America (USA). The study aimed to assess the real time impact of the coronavirus [...] Read more.

An international online patient community, Carenity, conducted a patient study in two independent waves among adults affected by non-communicable diseases (NCDs) in Europe and in the United States of America (USA). The study aimed to assess the real time impact of the coronavirus disease 2019 (COVID-19) on the medical conditions of patients with NCDs, their access to health care, and their adaptation to daily life as well as to describe their sources of information on COVID-19 and their needs for specific information and support. During the pandemic, 50% of the patients reported a worsening of their medical condition, and 17% developed a new disease. Additionally, 26% of the respondents reported an impact of the pandemic on regular/long-term treatment intake. 54% of the patients felt very or completely socially isolated and reported a strong impact of the COVID-19 pandemic on their stress level and state of mind, with higher levels observed in the USA compared to Europe. 59% of the respondents wished to have received additional information regarding the risks associated to their medical condition during the pandemic. Television was the most used source of information, whereas physicians were the most trusted one. This study describes the substantial impact of the COVID-19 pandemic on NCD patients. Full article

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20 pages, 1645 KiB

Open AccessArticle

Modeling Provincial Covid-19 Epidemic Data Using an Adjusted Time-Dependent SIRD Model

by Luisa Ferrari, Giuseppe Gerardi, Giancarlo Manzi, Alessandra Micheletti, Federica Nicolussi, Elia Biganzoli and Silvia Salini

Int. J. Environ. Res. Public Health 2021, 18(12), 6563; https://doi.org/10.3390/ijerph18126563 - 18 Jun 2021

Cited by 20 | Viewed by 3156

Abstract

In this paper, we develop a forecasting model for the spread of COVID-19 infection at a provincial (i.e., EU NUTS-3) level in Italy by using official data from the Italian Ministry of Health integrated with data extracted from daily official press conferences of [...] Read more.

In this paper, we develop a forecasting model for the spread of COVID-19 infection at a provincial (i.e., EU NUTS-3) level in Italy by using official data from the Italian Ministry of Health integrated with data extracted from daily official press conferences of regional authorities and local newspaper websites. This data integration is needed as COVID-19 death data are not available at the NUTS-3 level from official open data channels. An adjusted time-dependent SIRD model is used to predict the behavior of the epidemic; specifically, the number of susceptible, infected, deceased, recovered people and epidemiological parameters. Predictive model performance is evaluated using comparison with real data. Full article

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10 pages, 912 KiB

Open AccessArticle

Impact of the COVID-19 Pandemic on Healthcare-Seeking Behaviors among Frequent Emergency Department Users: A Cohort Study

by Yi-Chang Chou, Yung-Feng Yen, Dachen Chu and Hsiao-Yun Hu

Int. J. Environ. Res. Public Health 2021, 18(12), 6351; https://doi.org/10.3390/ijerph18126351 - 11 Jun 2021

Cited by 11 | Viewed by 3787

Abstract

In 2020, Taiwan’s healthcare system faced a notable burden imposed by the coronavirus disease (COVID-19) pandemic. Emergency department (ED) is a high-risk area for severe acute respiratory syndrome coronavirus 2 transmission. The effect of COVID-19 on the utilization of ED services among frequent [...] Read more.

In 2020, Taiwan’s healthcare system faced a notable burden imposed by the coronavirus disease (COVID-19) pandemic. Emergency department (ED) is a high-risk area for severe acute respiratory syndrome coronavirus 2 transmission. The effect of COVID-19 on the utilization of ED services among frequent ED users remains unknown. This cohort study determined the impact of the COVID-19 pandemic on healthcare-seeking behaviors among frequent ED users at Taipei City Hospital, Taiwan. We included ED users aged ≥ 18 years admitted to Taipei City Hospital during February 2019–January 2020 (before the pandemic) and February 2020–January 2021 (during the pandemic). Frequent ED users were patients with four or more ED visits per year. Stepwise logistic regression was performed to identify predictors of frequent ED use during the COVID-19 pandemic. Frequent ED users had shorter hospital stays in the ED during the pandemic. After adjusting for sociodemographic factors and other covariates, patients with a triage status of level 4–5, pneumonia diagnosis, giddiness, or dyspnea were more likely frequent ED visitors during the COVID-19 pandemic. To reduce the risk of acquiring COVID-19, it is important to utilize territorial healthcare or telehealth to avoid inappropriate ED visits for patients with a low level of risk or chronic disease. Full article

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11 pages, 296 KiB

Open AccessArticle

Pregnancy and COVID-19 Pandemic Perception in Malaysia: A Cross-Sectional Study

by Sharifah Aminah Syed Anwar Aly, Rahana Abdul Rahman, Shalisah Sharip, Shamsul Azhar Shah, Zaleha Abdullah Mahdy and Aida Kalok

Int. J. Environ. Res. Public Health 2021, 18(11), 5762; https://doi.org/10.3390/ijerph18115762 - 27 May 2021

Cited by 12 | Viewed by 4300

Abstract

Pregnant women are susceptible to COVID-19 complications due to gestation-related physiological changes. We aimed to evaluate the level of maternal knowledge, perception, and practice during the pandemic. A cross-sectional study was conducted during the Malaysian Movement Control Order (MCO) between April and June [...] Read more.

Pregnant women are susceptible to COVID-19 complications due to gestation-related physiological changes. We aimed to evaluate the level of maternal knowledge, perception, and practice during the pandemic. A cross-sectional study was conducted during the Malaysian Movement Control Order (MCO) between April and June 2020. A self-administered electronic questionnaire that included the knowledge and practice domains was distributed. A newly designed set of questions was used to evaluate (1) women’s perception of MCO and (2) maternal experience, which was subdivided into clinical care provision and maternal anxiety. The survey response rate was 93% with the final number for analysis of 415. The majority of women (95%) demonstrated an adequate level of knowledge on COVID-19, whilst 99% had a good practice. We found that tertiary education (p < 0.001), employment status (p = 0.03), higher household income (p < 0.001), and multiple sources of information (p < 0.001) were independent predictors of adequate maternal knowledge on COVID-19. Women with adequate knowledge also reported a more positive perception of MCO (p < 0.001) and better obstetric care experience (p = 0.037), as did those of Malay ethnicity. Younger (p < 0.001) and nulliparous (p = 0.01) women demonstrated greater anxiety levels. The majority of our women reported good practice and adequate knowledge, which contributed to a positive perception of MCO and better maternal obstetric experience. First-time mothers may benefit from extra support and reassurance during the pandemic to alleviate maternal anxiety. Full article

7 pages, 604 KiB

Open AccessArticle

Pregnancy Outcome, Antibodies, and Placental Pathology in SARS-CoV-2 Infection during Early Pregnancy

by Won-Kyu Jang, Su-Yeon Lee, Sunggyun Park, Nam Hee Ryoo, Ilseon Hwang, Ji Min Park and Jin-Gon Bae

Int. J. Environ. Res. Public Health 2021, 18(11), 5709; https://doi.org/10.3390/ijerph18115709 - 26 May 2021

Cited by 12 | Viewed by 2977

Abstract

There are reports that pregnant women infected with SARS-CoV-2 not only have increased morbidity but also increased complications and evidence of maternal and fetal vascular malperfusion on placental pathology. This was a retrospective study of pregnant women diagnosed with SARS-CoV-2 infection after March [...] Read more.

There are reports that pregnant women infected with SARS-CoV-2 not only have increased morbidity but also increased complications and evidence of maternal and fetal vascular malperfusion on placental pathology. This was a retrospective study of pregnant women diagnosed with SARS-CoV-2 infection after March 2020. The results of reverse transcription polymerase chain reaction testing and IgM and IgG antibody testing of the amniotic fluid, cord blood, placenta, and maternal blood were confirmed at delivery. Placentas were evaluated histopathologically. The study included seven pregnant women diagnosed with SARS-CoV-2 infection during pregnancy at a mean gestational age of 14.5 weeks. Out of the seven women, five were infected during the first trimester. The mean gestational age at delivery was 38.4 weeks. The reverse transcription polymerase chain reaction results for maternal plasma, cord blood, placenta, and amniotic fluid were negative and IgG antibodies were detected in maternal plasma and cord blood. On placental pathology, maternal vascular malperfusion was found in only one case, fetal vascular malperfusion in four cases, and inflammatory changes were found in two cases. Pregnancy outcomes for women diagnosed with SARS-CoV-2 infection during early pregnancy are positive and it is likely that maternal antibodies are passed to the fetus, which results in a period of immunity. Full article

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19 pages, 4020 KiB

Open AccessArticle

Disposal Behavior of Used Masks during the COVID-19 Pandemic in the Moroccan Community: Potential Environmental Impact

by Nezha Mejjad, El Khalil Cherif, Antonio Rodero, Dorota Anna Krawczyk, Jauad El Kharraz, Aniss Moumen, Mourad Laqbaqbi and Ahmed Fekri

Int. J. Environ. Res. Public Health 2021, 18(8), 4382; https://doi.org/10.3390/ijerph18084382 - 20 Apr 2021

Cited by 50 | Viewed by 11242

Abstract

The spread of coronavirus disease-2019 (COVID-19) levied on the Moroccan authorities to increase their mask production capacity, which reached up to 12 million facemask units produced per day. This increase in personal protective equipment (PPE) production and consumption is an efficient tool to [...] Read more.

The spread of coronavirus disease-2019 (COVID-19) levied on the Moroccan authorities to increase their mask production capacity, which reached up to 12 million facemask units produced per day. This increase in personal protective equipment (PPE) production and consumption is an efficient tool to address the spread of COVID-19. However, this results in more plastic and microplastic debris being added into the land and marine environments, which will harm the ecosystem, wildlife, and public health. Such a situation needs deep individual behavior observation and tracking, as well as an assessment of the potential environmental impact of this new type of waste. For this reason, we assessed the Moroccan population’s behavior regarding the use and disposal of facemasks and gloves. An exploratory survey was prepared and shared via social media and email with the population of Rabat-Salé-Kénitra and Casablanca-Settat regions. Additionally, we calculated the estimated number and weight of daily and weekly PPE used and generated by the studied regions. The survey showed that 70% of the respondents threw their discarded masks and gloves in house trash or trash bins after their first use, whereas nearly 30% of respondents admitted that they did not wear masks because they did not leave their homes during the lockdown, while from the 70% of facemask users, more than five million (equivalent to 40,000 kg) of facemasks would be generated and disposed of daily by the community of these regions, which presents 35% of the total engendered facemask waste in Morocco. Accordingly, the environment impact of facemasks showed that the greenhouse gas footprint is about 640 kT CO₂ eq./year for the whole of Morocco, while the energy footprint is around 60,000 GWh/year. Furthermore, an urgent multidisciplinary environmental assessment of the potential impact of PPE must be conducted among the 12 Moroccan regions. This study demonstrated the real impact of the COVID-19 PPE on human behavior and the environment and suggests a need for providing new didactic management of facemasks and gloves. Full article

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17 pages, 1919 KiB

Open AccessArticle

Does International Travel Frequency Affect COVID-19 Biosecurity Behavior in the United States?

by Myung Ja Kim, C. Michael Hall and Mark Bonn

Int. J. Environ. Res. Public Health 2021, 18(8), 4111; https://doi.org/10.3390/ijerph18084111 - 13 Apr 2021

Cited by 11 | Viewed by 4339

Abstract

High-quality biosecurity practices are critical to restarting international tourism. Effective market segmentation improves the communication and efficacy of health advice. Travel frequency is an important basis for health-related consumer segmentation, as it is closely related to risk of greater exposure to infectious diseases. [...] Read more.

High-quality biosecurity practices are critical to restarting international tourism. Effective market segmentation improves the communication and efficacy of health advice. Travel frequency is an important basis for health-related consumer segmentation, as it is closely related to risk of greater exposure to infectious diseases. Theoretically grounded studies of tourist biosecurity behavior and travel frequency have largely been neglected, although insights into practices and attitudes are especially relevant for coronavirus disease of 2019 (COVID-19 (coronavirus disease of 2019) health responses. Therefore, this research constructed and tested a conceptual model applying Value–Attitude–Behavior theory to US travelers to see whether the frequency of international travel affected tourist COVID-19 related biosecurity behavior. US respondents were drawn from a panel using a quota sampling technique according to the age and gender of American outbound tourists. An online survey was administered in September 2020. The responses (n = 395) of those who traveled internationally within five years were analyzed utilizing partial least squares-structural equation modeling (PLS-SEM) with multi-group analysis. Travel frequency significantly affects biosecurity behavior. High travel frequency (≥8 trips) has the strongest effect of value on biosecurity attitudes, personal norms, social norms, and biosecurity social norms, leading to biosecurity behaviors. Biosecurity behaviors pertaining to medium travel frequency (4–7 trips) are significantly influenced by personal norms. At low travel frequency (1–3 trips) levels, biosecurity behaviors are stimulated by biosecurity attitudes and social norms, showing the highest predictive power among the three groups. This work provides insights into international travel consumer biosecurity practices and behavior. From a market segmentation perspective, the levels of international travel frequency have various influences on biosecurity values, attitudes, personal norms, social norms, and behaviors. The biosecurity behaviors of low-frequency travelers are found to be the most significant of the three groups, suggesting that individuals who travel less frequently are more likely to practice responsible COVID-19 biosecurity behavior. Full article

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11 pages, 521 KiB

Open AccessArticle

Knowledge, Attitudes, and Practices Related to COVID-19 Among Malawi Adults: A Community-Based Survey

by Yutong Li, Guangqi Liu, Robert Okia Egolet, Runqing Yang, Yangmu Huang and Zhijie Zheng

Int. J. Environ. Res. Public Health 2021, 18(8), 4090; https://doi.org/10.3390/ijerph18084090 - 13 Apr 2021

Cited by 17 | Viewed by 4642

Abstract

Introduction: It is well-recognized that containing COVID-19 successfully is determined by people’s prevention measures which are related to their knowledge, attitudes, and practices (KAP). This perception has attracted attention in low- and middle-income countries (LMIC) due to their fragile health systems and economies. [...] Read more.

Introduction: It is well-recognized that containing COVID-19 successfully is determined by people’s prevention measures which are related to their knowledge, attitudes, and practices (KAP). This perception has attracted attention in low- and middle-income countries (LMIC) due to their fragile health systems and economies. The objective of this study was to understand how residents in Malawi perceived COVID-19, to determine the factors related to KAP. Methods: A semi-structured questionnaire was used for the data collection. A field-based survey was conducted among adult residents in Lilongwe, Malawi. Descriptive statistic, linear regression, the Chi-square test, and Pearson’s correlation statistics were used for data analysis. Results: A total of 580 questionnaires were involved. The mean knowledge, attitude, and practice (KAP) scores were 10 (SD = ±3, range: 3–19), 16 (SD = ±4, range: 5–25), and 2 (SD = ±1, range: 0–5), respectively. Lack of money and resources (39%) was the biggest challenge for people who practice prevention measures. Among the participants, the radio (70%) and friends/family (56%) were the main sources of information. A higher economic status was associated with better KAP. Conclusions: A low level of KAP was detected among the population. The people faced challenges regarding a lack of necessary preventive resources and formal information channels. The situation was worse considering vulnerable population who had low economic status. Further all-round health education is urgently needed along with providing adequate health supplies and ensuring proper information management. Full article

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20 pages, 358 KiB

Open AccessArticle

Public KAP towards COVID-19 and Antibiotics Resistance: A Malaysian Survey of Knowledge and Awareness

by Chee Tao Chang, Ming Lee, Jason Choong Yin Lee, Nicholas Chor Teng Lee, Tsu Yin Ng, Asrul Akmal Shafie and Kah Shuen Thong

Int. J. Environ. Res. Public Health 2021, 18(8), 3964; https://doi.org/10.3390/ijerph18083964 - 9 Apr 2021

Cited by 22 | Viewed by 6298

Abstract

This study aimed to assess the knowledge of the Malaysian public on the coronavirus disease 2019 (COVID-19) and antibiotics, the practice of preventive measures and attitude towards the new norms. The web-based questionnaire was disseminated online from 1 to 31 October 2020. Out [...] Read more.

This study aimed to assess the knowledge of the Malaysian public on the coronavirus disease 2019 (COVID-19) and antibiotics, the practice of preventive measures and attitude towards the new norms. The web-based questionnaire was disseminated online from 1 to 31 October 2020. Out of 2117 respondents, 1405 (66.4%) knew that transmission of COVID-19 virus could happen in asymptomatic people. In term of antibiotics knowledge, 779 (36.8%) respondents were aware that taking antibiotics could not speed up the recovery process of all infections. Less than half of the respondents (49.0%) knew that antibiotics are effective against bacterial infection only. Majority (92.3%) practiced good preventive measures. Majority of the respondents strongly agreed that quarantine should be made mandatory for all arrival from overseas (97.2%) and wearing face masks should be made mandatory in all public areas (94.0%). Respondents of Chinese ethnicity (p = 0.008), middle-aged (p = 0.002), with tertiary education (p = 0.015) and healthcare related education (p < 0.001), from the higher income groups (p = 0.001) were more likely to have better knowledge on COVID-19. The Malaysian public demonstrated good knowledge towards COVID-19, adequate practice of preventive measures and high acceptance towards the new norm. Knowledge on antibiotics use and resistance was poor, which warrants attention from the health authorities. Full article

11 pages, 293 KiB

Open AccessArticle

Fluctuations in National Resilience during the COVID-19 Pandemic

by Shaul Kimhi, Yohanan Eshel, Hadas Marciano and Bruria Adini

Int. J. Environ. Res. Public Health 2021, 18(8), 3876; https://doi.org/10.3390/ijerph18083876 - 7 Apr 2021

Cited by 23 | Viewed by 3071

Abstract

The current study measured national resilience (NR) in three different time frames during the coronavirus disease 2019 (COVID-19) pandemic in Israel (N = 804). We investigated two main issues: first, the direction and extent of NR changes during the crisis, and second, [...] Read more.

The current study measured national resilience (NR) in three different time frames during the coronavirus disease 2019 (COVID-19) pandemic in Israel (N = 804). We investigated two main issues: first, the direction and extent of NR changes during the crisis, and second, the predictors of NR. The results show the following: (a) the average NR score declined significantly across the three repeated measures, with a medium-size effect. (b) Three of the four identified NR factors declined significantly across the three measurements: belief in the government and the prime minister (large effect size); belief in civil society; and patriotism (medium effect size); while trust in Israeli national institutions was the lowest and did not weaken significantly. (c) Analyzing the prediction of NR factors indicated that the levels of the three NR factors mainly reflected one’s political attitudes, sense of political and economic threats, rather than health threats. One conclusion concerns the importance of trust in leadership as the most sensitive component in the decline of national resilience following a crisis. Full article

14 pages, 1242 KiB

Open AccessArticle

Knowledge and Perception of COVID-19 Pandemic during the First Wave (Feb–May 2020): A Cross-Sectional Study among Italian Healthcare Workers

by Caterina Rizzo, Ilaria Campagna, Elisabetta Pandolfi, Ileana Croci, Luisa Russo, Sara Ciampini, Francesco Gesualdo, Alberto Eugenio Tozzi, Lara Ricotta, Massimiliano Raponi and Marta Luisa Ciofi Degli Atti

Int. J. Environ. Res. Public Health 2021, 18(7), 3767; https://doi.org/10.3390/ijerph18073767 - 4 Apr 2021

Cited by 8 | Viewed by 3163

Abstract

Italy was the first country in Europe to face the coronavirus pandemic. The aim of the study was to analyze healthcare workers’ (HCWs) level of information, practice, and risk perception towards COVID-19. We set up a cross-sectional study through SurveyMonkey^® and distributed [...] Read more.

Italy was the first country in Europe to face the coronavirus pandemic. The aim of the study was to analyze healthcare workers’ (HCWs) level of information, practice, and risk perception towards COVID-19. We set up a cross-sectional study through SurveyMonkey^® and distributed the link through Facebook and Whatsapp closed groups. The research instrument was a 31 items questionnaire distributed using Facebook and Whatsapp. It was conducted in Italy from February to May 2020. The study participants were general practitioners, pediatricians and other health professionals. A total of 958 participants were included: 320 (33.4%) general practitioners, 248 (25.9%) pediatricians and 390 (40.7%) other health professionals. The highest response rate was from Northern Italy (48.1%), followed by Central Italy (29.9%) and Southern Italy (22.0%). Less than a half (46%) of respondents felt they had a good level of information of COVID-19 case definition and of national prevention guidelines. Respondents reported to have changed their clinical practice; particularly, they increased the use of masks (87.1%, p < 0.001), disinfection and sanitization of doctors’ offices (75.8%, p < 0.001), the use of protective glasses (71.2%, p < 0.001), alcoholic hand solution (71.2%, p < 0.001), and hand washing (31.8%, p = 0.028). HCWs are at high risk of infection; less than a half of them felt adequately prepared to face COVID-19 pandemic, so they need extensive information and awareness of the disease to take adequate precautionary measures, and they are crucial to disseminate good practices. Full article

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12 pages, 912 KiB

Open AccessArticle

COVID-19 Pandemic Is Associated with an Adverse Impact on Burnout and Mood Disorder in Healthcare Professionals

by Yu-Yin Lin, Yu-An Pan, Yi-Ling Hsieh, Meng-Hsuan Hsieh, Yun-Shiuan Chuang, Hsiu-Yi Hsu, Ya-Hsiu Huang, Chia-En Hsu, Yi-Chen Cheng, Shih-Feng Cho and Chao-Ling Wang

Int. J. Environ. Res. Public Health 2021, 18(7), 3654; https://doi.org/10.3390/ijerph18073654 - 1 Apr 2021

Cited by 19 | Viewed by 4141

Abstract

The coronavirus disease 2019 (COVID-19) pandemic results in a profound physical and mental burden on healthcare professionals. This study aims to evaluate burnout status and mood disorder of healthcare workers during this period. An online questionnaire was voluntarily answered by eligible adult employees [...] Read more.

The coronavirus disease 2019 (COVID-19) pandemic results in a profound physical and mental burden on healthcare professionals. This study aims to evaluate burnout status and mood disorder of healthcare workers during this period. An online questionnaire was voluntarily answered by eligible adult employees in a COVID-19 specialized medical center. The major analysis included the burnout status and mood disorder. Factors related to more severe mood disorder were also identified. A total of 2029 participants completed the questionnaire. There were 901 (44.4%) and 923 (45.5%) participants with moderate to severe personal and work-related burnout status, respectively. Nurses working in the emergency room (ER), intensive care unit (ICU)/isolation wards, and general wards, as well as those with patient contact, had significantly higher scores for personal burnout, work-related burnout, and mood disorder. This investigation identified 271 participants (13.35%) with moderate to severe mood disorder linked to higher personal/work-related burnout scores and a more advanced burnout status. Univariate analysis revealed that nurses working in the ER and ICU/isolation wards were associated with moderate to severe mood disorder risk factors. Multivariate analysis demonstrated that working in the ER (OR, 2.81; 95% CI, 1.14–6.90) was the only independent risk factor. More rest, perquisites, and an adequate supply of personal protection equipment were the most desired assistance from the hospital. Compared with the non-pandemic period (2019), employees working during the COVID-19 pandemic (2020) have higher burnout scores and percentages of severe burnout. In conclusion, this study suggests that the COVID-19 pandemic has had an adverse impact on healthcare professionals. Adequate measures should be adopted as early as possible to support the healthcare system. Full article

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10 pages, 503 KiB

Open AccessArticle

Is It Possible to Be Happy during the COVID-19 Lockdown? A Longitudinal Study of the Role of Emotional Regulation Strategies and Pleasant Activities in Happiness

by María José Gutiérrez-Cobo, Alberto Megías-Robles, Raquel Gómez-Leal, Rosario Cabello and Pablo Fernández-Berrocal

Int. J. Environ. Res. Public Health 2021, 18(6), 3211; https://doi.org/10.3390/ijerph18063211 - 19 Mar 2021

Cited by 17 | Viewed by 3550

Abstract

This study aimed to longitudinally analyze the role played by two emotional regulation strategies (cognitive reappraisal and expressive suppression), through the mediating effect of engagement in pleasant activities during lockdown, in changes in affective and cognitive happiness in comparison with pre-pandemic levels. Eighty-eight [...] Read more.

This study aimed to longitudinally analyze the role played by two emotional regulation strategies (cognitive reappraisal and expressive suppression), through the mediating effect of engagement in pleasant activities during lockdown, in changes in affective and cognitive happiness in comparison with pre-pandemic levels. Eighty-eight participants from a community sample were evaluated at two timepoints. At timepoint 1 (before the COVID-19 pandemic), participants were evaluated on emotional regulation and cognitive and affective happiness. At timepoint 2 (during the COVID-19 lockdown), participants were evaluated on cognitive and affective happiness and the frequency with which they engaged in pleasant activities. We found an optimal fit of the proposed model in which cognitive reappraisal was significantly related to engagement in more pleasant activities during the lockdown. In turn, these pleasant activities were related to more affective happiness during the lockdown (compared with pre-pandemic levels), and this affective happiness was associated with greater cognitive happiness. In conclusion, cognitive reappraisal was a protective factor for affective and cognitive happiness through the mediating role of engagement in pleasant activities during lockdown. Limitations and future lines of investigation are discussed. Full article

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11 pages, 3193 KiB

Open AccessArticle

Experimental Investigation of Aerosol and CO₂ Dispersion for Evaluation of COVID-19 Infection Risk in a Concert Hall

by Wolfgang Schade, Vladislav Reimer, Martin Seipenbusch and Ulrike Willer

Int. J. Environ. Res. Public Health 2021, 18(6), 3037; https://doi.org/10.3390/ijerph18063037 - 16 Mar 2021

Cited by 37 | Viewed by 6481

Abstract

The dispersion of small aerosols in a concert hall is experimentally studied for estimating the risk of infection with SARS-CoV-2 during a concert. A mannequin was modified to emit an air stream containing aerosols and CO₂. The aerosols have a size [...] Read more.

The dispersion of small aerosols in a concert hall is experimentally studied for estimating the risk of infection with SARS-CoV-2 during a concert. A mannequin was modified to emit an air stream containing aerosols and CO₂. The aerosols have a size distribution with a peak diameter

(δ)

close to 0.3 µm and a horizontal initial particle velocity (

v_{p, x}

) of 2.4 m/s. The CO₂-concentration (c) emitted simultaneously is 7500 ppm. It is investigated, if the spatial dissipation of aerosols and CO₂ can be correlated. This would allow the use of technically easier CO₂ measurements to monitor compliance with aerosol concentration limits. Both aerosol and CO₂ concentrations are mapped by different sensors placed around the mannequin. As a result, no significant enrichment of aerosols and CO₂ was obtained outside a radius of 1.5 m when the fresh air ventilation in the concert hall has a steady vertical flow with a velocity of

v_{g, z} = 0.05 m / s

and the installed ventilation system was operating at an air change rate per hour (ACH) of 3, corresponding to an air exchange rate of 51,000 m³/h. A Pearson correlation coefficient of 0.77 was obtained for CO₂ and aerosol concentrations measured simultaneously at different positions within the concert hall. Full article

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