Coronavirus Disease 2019 Health Research Articles

COVID-19 health information system assessments in eight European countries: identified gaps, best practices and recommendations.

Global threats, such as the coronavirus disease 2019 (COVID-19) pandemic, have highlighted the critical importance of robust and well-functioning health information systems (HIS) in effectively addressing public health emergencies. To enhance the understanding and the functioning of such systems, it is crucial to perform HIS assessments. This article explores key gaps and identifies best practices in the COVID-19 HIS of eight European countries. Furthermore, it provides recommendations to strengthen European systems for better pandemic preparedness. Assessments were carried out in eight European countries using an adapted version of the WHO support tool to strengthen HIS and the Joint Action on Health Information assessment tool. The assessments took place between January 2022 and April 2023. Four main themes emerged regarding the gaps and best practices identified in the various HIS: organizational, technical, legal and resources. The results of these assessments show different approaches implemented by countries to improve their HIS and respond to the demands of the pandemic. It is imperative for countries to draw valuable insights from the COVID-19 pandemic and strengthen their HIS. This involves the adaptation or development of pandemic preparedness plans, strengthening legislative framework for data sharing and privacy protection, promotion of data standards and international definitions and implementation of a unique person identifier. Additionally, countries will have to act in this post-pandemic era and integrate the newly developed systems and innovations into existing structures, maintain and develop trust by citizens through transparent communication and engage in infodemic management and address resource gaps in the workforce.

Racial and ethnic disparities post-hospitalization for COVID-19: barriers to access to care for survivors of COVID-19 acute respiratory distress syndrome

Racial and ethnic health disparities in the incidence and severity of Coronavirus Disease 2019 (COVID-19) have been observed globally and in the United States. Research has focused on transmission, hospitalization, and mortality among racial and ethnic minorities, but Long COVID-19 health disparities research is limited. This study retrospectively evaluated 195 adults who survived COVID-19 associated acute respiratory distress syndrome (C-ARDS) in New York City from March–April 2020. Among survivors, 54% met the criteria for Long COVID syndrome. Hispanic/Latinx patients, were more likely to be uninsured (p = 0.027) and were less frequently discharged to rehabilitation facilities (p < 0.001). A cross-sectional telephone survey and interview were conducted with a subset of survivors (n = 69). Among these, 11% reported a lack of follow-up primary care post-discharge and 38% had subsequent emergency room visits. Notably, 38% reported poor treatment within the health care system, with 67% attributing this to racial or ethnic bias. Thematic analysis of interviews identified four perceived challenges: decline in functional status, discrimination during hospitalization, healthcare system inequities, and non-healthcare-related structural barriers. Sources of resilience included survivorship, faith, and family support. This study highlights structural and healthcare-related barriers rooted in perceived racism and poverty as factors impacting post-COVID-19 care.

The Impact of a Pandemic on a Military Oral and Maxillofacial Pathology Biopsy Service.

Coronavirus disease 2019 (COVID-19) and the resulting societal reaction presented new challenges to the medical community by limiting patient access to care in 2020 and 2021. The Navy Postgraduate Dental School (NPDS) oral and maxillofacial pathology biopsy service is dependent on in-office physician or dentist appointments and patient biopsies. The purpose of this study was to understand the regulatory and societal impacts of COVID-19 restrictions on biopsy service submissions by assessing NPDS biopsy submission quantities and disease distribution. All NPDS oral and maxillofacial pathology biopsy submissions from calendar years 2015 to 2016 and 2019 to 2021 were evaluated, and patient demographics and biopsy diagnoses were recorded in a biopsy registry. Data collected included age, sex, biopsy site, and diagnosis. Data from 2015, 2016, and 2019 were defined as pre-COVID and 2020 and 2021 as COVID. Biopsy reports for each year were organized in quarters. Diagnoses were categorized as malignant, pre-malignant, or benign. Categorical and continuous data were evaluated and presented as counts with percentages and means or medians with standard deviations, respectively. Significant differences in proportions or means were assessed using chi-square analysis or Student t-test, respectively. Cases were aggregated by quarter and year and assessed for temporal trends using linear regression analysis. The study evaluated 9,351 biopsy submission reports. The annual pre-COVID count mean (± standard deviation) and yearly counts for 2020 and 2021 were 2,063 ± 33.3, 1,421, and 1,742, respectively. The mean (± standard deviation) percentage of diagnoses classified as malignant from pre-COVID, 2020, and 2021 were 2.46 ± 0.005%, 3.59%, and 3.04%, respectively. Case counts and representation as a percentage of all biopsy diagnoses for Human Papillomavirus (HPV)-associated squamous cell carcinoma increased significantly during COVID compared to pre-COVID years (P < .05). Overall, preventative COVID-19 health measures and protocols resulted in a reduction in biopsy submission frequency, particularly during the second quarter (April to June) of 2020. However, case counts for malignant biopsies remained consistent between pre-COVID and COVID time intervals, suggesting that the identification and analysis of cases requiring follow-on care were unaffected by COVID-19 protocols.

Study protocol: Project 2VIDA! SARS-CoV-2 vaccine intervention delivery for adults in Southern California.

To date, the United States (US) leads the world in the number of infections and deaths due to the Coronavirus Disease 2019 (COVID-19). Racial and ethnic disparities in COVID-19 morbidity and mortality are staggering. Age-adjusted data show that AA and Latino individuals have had higher rates of death over most of the pandemic and during surges. Project 2VIDA! is community-based participatory research (CBPR) that was developed to address individual, social, and contextual factors related to access and acceptance of the COVID-19 vaccine among African American and Latino communities in Southern California. This paper describes the study protocol and overarching objectives. Project 2VIDA! is a multilevel intervention that builds on the principals of CBPR and is designed to increase uptake of the COVID-19 vaccine among African American and Latino individuals (≥16 years and older) in San Diego County. The intervention was developed with a working group comprised of representatives from community and academia and centers on targeted COVID-19 individual awareness and education, linkage to medical and supportive services, COVID-19 community outreach and health promotion and offering the COVID-19 vaccine through community pop-up clinics. Findings from 2VIDA! will provide data on the impact, feasibility, and acceptability of the intervention which are all crucial for the adaptation, refinement, and improvement of vaccine outreach interventions for COVID-19 and other vaccine preventable infectious diseases that severely impact African American and Latino communities. https://clinicaltrials.gov/ct2/show/NCT05022472?term=Project+2VIDA&draw=2&rank=1, NCT05022472.

The mediating role of coping styles in the relationship between fear of COVID-19 and mental health problems: a cross-sectional study among nurses

Fear of being infected by coronavirus disease 2019 (COVID-19) could trigger mental health problems among nurses at the frontline. In such a situation, coping strategies are needed to deal with the imminent threat. The purpose of this study was to test the mediating effects of coping on relationships of fear of COVID-19 with anxiety, depression and post-traumatic syndrome among nurses who were in contact with COVID-19 patients. A cross-sectional and correlational research design was used to recruit a sample of 278 nurses who treated COVID-19 patients in four government referral hospitals in Indonesia. A bootstrap resampling procedure was used to test the significance of the total and specific indirect effects of coping on relationships of Fear of COVID-19 with anxiety, depression and post-traumatic syndrome. The nurses reported moderate levels of fear of COVID-19, considerable anxiety and depression, and a moderate level of coping. We found coping to be significantly negatively correlated with the reported levels of anxiety, depression and post-traumatic syndrome (p < 0.001). Coping mediated relationships of fear of COVID-19 on depression, anxiety and post-traumatic syndrome after controlling for relevant confounders for each dependent variable. This shows that enacting coping mechanisms is important to achieve an adaptive effect on nurses' mental health. Proper assessments and interventions should be tailored and implemented for nurses who have contact with COVID-19 patients to facilitate their use of coping strategies when needed in stressful situations.

Hospitalisation and mortality among privately insured individuals with COVID-19 in the United States: The role of intellectual disabilities and Neurogenetic disorders.

Individuals with intellectual disabilities (IDs) and neurogenetic conditions (IDNDs) are at greater risk for comorbidities that may increase adverse outcomes for this population when they have coronavirus disease 2019 (COVID-19). The study aims are to examine the population-level odds of hospitalisation and mortality of privately insured individuals with COVID-19 with and without IDNDs IDs, controlling for sociodemographics and comorbid health conditions. This is a retrospective, cross-sectional study of 1174 individuals with IDs and neurogenetic conditions within a population of 752237 de-identified, privately insured, US patients diagnosed with COVID-19 between February 2020 and September 2020. Odds of hospitalisation and mortality among COVID-19 patients with IDNDs adjusted for demographic characteristics, Health Resources and Services Administration region, states with Affordable Care Act and number of comorbid health conditions were analysed. Patients with IDNDs overall had higher rates of COVID-19 hospitalisation than those without IDNDs (35.01% vs. 12.65%, P<.0001) and had higher rates of COVID-19 mortality than those without IDNDs (4.94% vs. .88%, P<.0001). Adjusting for sociodemographic factors only, the odds of being hospitalised for COVID-19 associated with IDNDs was 4.05 [95% confidence interval (CI) 3.56-4.61]. Adjusting for sociodemographic factors and comorbidity count, the odds of hospitalisation for COVID-19 associated with IDNDs was 1.42 (95% CI 1.25-1.61). The odds of mortality from COVID-19 for individuals with IDNDs adjusted for sociodemographic factors only was 4.65 (95% CI 3.47-6.24). The odds of mortality from COVID-19 for patients with IDNDs adjusted for sociodemographic factors and comorbidity count was 2.70 (95% CI 2.03-3.60). A major finding of the study was that even when considering the different demographic structure and generally higher disease burden of patients with IDNDs, having a IDND was an independent risk factor for increased hospitalisation and mortality compared with patients without IDNDs. Individuals with IDNDs had significantly higher odds of hospitalisation and mortality after adjusting for sociodemographics. Results remained significant with a slight attenuation after adjusting for sociodemographics and comorbidities. Adjustments for comorbidity count demonstrated a dose-response increase in odds of both hospitalisation and mortality, illustrating the cumulative effect of health concerns on COVID-19 outcomes. Together, findings highlight that individuals with IDNDs experience vulnerability for negative COVID-19 health outcomes with implications for access to comprehensive healthcare.

Epidemiological contemplation for a currently pragmatic COVID-19 health passport: a perspective.

The coronavirus disease 2019 (COVID-19) has caused a global pandemic that has wreaked havoc on the lives of millions of people around the world. Confinement measures aim to reduce the epidemic's spread and minimize the burden of morbidity and mortality. In response to the challenges caused by the pandemic, digital health passports have been developed exponentially. We highlight the latent epidemiological barriers to health passports to achieve standardized digital care platforms. This review paper not only highlights the epidemiological barriers but also articulates the possible infrastructure required to make the International Standard for a multi-factor authenticated and validated health passport.

A Survey on Respiratory and Neurological Symptoms in Alzheimer’s, Schizophrenia, Bipolar, and Migraine Patients Following COVID-19 Infection

Background: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2019 led to the global coronavirus disease 2019 (COVID-19) pandemic with a wide range of clinical symptoms. Neurological complications have been a significant concern, with diverse symptoms and potential neuroinvasive mechanisms. The pandemic has also impacted individuals with mental health conditions, such as migraines, bipolar disorder (BD), and schizophrenia, highlighting the complex interconnections between physical and mental health during these challenging times. Objectives: This retrospective report from the Iranian Network for Research in Viral Diseases (INRVD) study aimed to investigate the multifaceted interactions between COVID-19, neurological complications, and mental health disorders (e.g., migraines, BD, and schizophrenia) to better understand their collective impact on individuals’ health and well-being. Methods: This study involved 63 individuals who tested positive for COVID-19, including 32 females (50.8%) and 31 males (49.2%). The participants were categorized into different groups based on their underlying conditions: 7 individuals with schizophrenia, 8 with BD, 6 with migraines, 12 with Alzheimer's disease, and 30 with COVID-19 without any underlying neurologic disorder. This investigation was carried out in 12 hospitals supervised by the INRVD between March 2020 and May 2021. The study used frequencies and percentages to describe the data and employed chi-square tests, including the contingency coefficient, to explore associations between COVID-19 symptoms and disease groups. Results: The analysis of clinical manifestations revealed distinctive patterns. Cough was the most prevalent symptom across the entire sample, affecting over 79% of participants. Fever followed as the second most common symptom, with approximately 62% of individuals reporting it. Fatigue ranked third, impacting 57% of the subjects. In contrast, vomiting was the least frequently reported symptom, with an incidence of only 14.3%. In terms of specific conditions, a notable discrepancy was observed in the prevalence of headaches. Although present in 71.4% of individuals with schizophrenia, this symptom was reported by only 50% of those with BD, followed by 66.7% with migraines and 83.3% with Alzheimer’s. The patients without neurologic disorders exhibited a lower incidence of neurological manifestations, with only 23.3% reporting headaches. Conclusions: This study provides insights into the clinical manifestations of COVID-19 in individuals with distinct underlying conditions. The prevalence and presentation of symptoms varied significantly across the different groups, and neurological symptoms exhibited a higher prevalence in this patient group than those without any underlying neurologic disorders. This study aimed for a more comprehensive understanding of the probable intricate interplay between COVID-19, underlying health conditions, and clinical manifestations. Understanding these differences is crucial for tailoring effective clinical interventions.

Impact of Language Barriers on Outcomes and Experience of COVID-19 Patients Hospitalized in Quebec, Canada, During the First Wave of the Pandemic.

Language barriers (LB) contribute to coronavirus disease 2019 (COVID-19) health inequities. People with LB were more likely to be SARS-CoV-2 positive despite lower testing and had higher rates of hospitalization. Data on hospital outcomes among immigrants with LB, however, are limited. We aimed to investigate the clinical outcomes of hospitalized COVID-19 cases by LB, immigration status, ethnicity, and access to COVID-19 health information and services prior to admission. Adults with laboratory-confirmed community-acquired COVID-19 hospitalized from March 1 to June 30, 2020, at four tertiary-care hospitals in Montréal, Quebec, Canada were included. Demographics, comorbidities, immigration status, country of birth, ethnicity, presence of LB, and hospital outcomes (ICU admission and death) were obtained through a chart review. Additional socio-economic and access to care questions were obtained through a phone survey. A Fine-Gray competing risk subdistribution hazards model was used to estimate the risk of ICU admission and in-hospital death by immigrant status, region of birth and LB Among 1093 patients, 622 (56.9%) were immigrants and 101 (16.2%) of them had a LB. One third (36%) of immigrants with LB did not have access to an interpreter during hospitalization. Admission to ICU and in-hospital mortality were not significantly different between groups. Prior to admission, one third (14/41) of immigrants with LB had difficulties accessing COVID-19 information in their mother tongue and one third (9/27) of non-white immigrants with a LB had difficulties accessing COVID-19 services. Immigrants with LB were inequitably affected by the first wave of the pandemic in Quebec, Canada. In our study, a large proportion had difficulties accessing information and services related to COVID-19 prior to admission, which may have increased SARS-CoV-2 exposure and hospitalizations. After hospitalization, a large proportion did not have access to interpreters. Providing medical information and care in the language of preference of increasing diverse populations in Canada is important for promoting health equity.

Barriers to COVID-19 Prevention Measures Among People Experiencing Homelessness with Substance Use Disorder or Serious Mental Illness.

People experiencing homelessness (PEH) are at disproportionate risk of becoming infected and having severe illness from coronavirus disease 2019 (COVID-19), especially when residing in congregate settings like homeless shelters. Behavioral health problems related to substance use disorder (SUD) and severe mental illness (SMI) may have created additional challenges for PEH to practice prevention measures like mask wearing, physical distancing, handwashing, and quarantine and isolation. The study objective was to understand the perceived barriers PEH face regarding COVID-19 non-pharmaceutical prevention strategies and identify recommendations for overcoming barriers. From August-October 2020, qualitative phone interviews with 50 purposively selected behavioral health professionals across the United States serving PEH with SUD or SMI were conducted. Professionals described that PEH faced barriers to prevention that were structural (e.g., access to necessary resources), behavioral (related to SUD or SMI), or related to the priority of other needs. Recommendations to overcome these barriers included providing free prevention resources (e.g., masks and hand sanitizer), providing education about importance of prevention strategies, and prioritizing access to stable housing. Interviews took place before COVID-19 vaccines were available, so barriers to vaccination are not included in this paper. Findings can help support tailored approaches during COVID-19 and future public health threats.

Addressing COVID-19 inequities using bidirectional crisis and emergency risk communication and vaccine clinic interventions: a descriptive study

BackgroundIm/migrants (immigrants and migrants, including refugees, asylum seekers, and individuals without legal documentation) experience unique assets and needs in relation to coronavirus disease 2019 (COVID-19). Community-based participatory research (CBPR) is one way to engage im/migrant communities. Rochester Healthy Community Partnership (RHCP) is a CBPR partnership in Rochester, Minnesota. RHCP partners noted that credible COVID-19 information was not available to their communities. In response, RHCP formed a COVID-19 Task Force and adapted the Centers for Disease Control and Prevention’s Crisis and Emergency Risk Communication (CERC) framework to create an intervention that prioritized im/migrant groups experiencing health disparities. In the CERC intervention, communication leaders delivered COVID-19 health messages to their social networks and documented related concerns. RHCP relayed these concerns to regional leaders to ensure that im/migrant experiences were included in decision making. Once vaccines were available, RHCP continued to deploy the CERC intervention to promote vaccination equity. The aims of this paper are to (1) describe the implementation of a bidirectional CERC intervention for vaccination equity, and (2) describe a community-engaged and community-based vaccine clinic intervention.MethodsFirst, we surveyed participants (n = 37) to assess COVID-19 experiences, acceptability of the CERC intervention, and motivation to receive a COVID-19 vaccination. Second, we collaborated with community partners to hold vaccine clinics. We report descriptive statistics from each intervention.ResultsWhen asked about the acceptability of the CERC intervention for vaccine equity, most participants either reported that they ‘really liked it’ or ‘thought it was just ok’. Most participants stated that they would recommend the program to family or friends who have not yet received the COVID-19 vaccine. Almost all participants reported that they felt ‘much more’ or ‘somewhat more’ motivated to receive a COVID-19 vaccine after the intervention. We administered 1158 vaccines at the vaccination clinics.ConclusionsWe found that participants viewed the CERC intervention for vaccination equity as an acceptable way to disseminate COVID-19-related information. Nearly all participants reported that the intervention convinced them to receive a COVID-19 vaccine. In our experience, community-engaged and community-based clinics are a successful way to administer vaccines to im/migrant communities during a pandemic.

Knowledge, attitudes, and practices regarding COVID-19 and mental health status among college students in China: a cross-sectional study.

During the prevalence of coronavirus disease 2019 (COVID-19), little was known about the knowledge, attitudes, practices (KAP) about COVID-19 and psychological status of college students in minority areas. This study aimed to evaluate the KAP of college students in minority areas of China toward COVID-19 and to provide a scientific basis for health education and policy formulation. From October 28th to November 6th, 2021, a cross-sectional study was conducted with 5,272 college students to examine KAP and its effects on mental health. Regarding COVID-19 knowledge, the overall awareness rate was 24.11% (1,271). Regarding health attitudes, most students had positive attitudes about COVID-19 prevention and control (94.95%), and females had higher positive attitudes than males (OR: 1.920; CI: 1.494-2.469). Regarding preventive behaviors, more than half of the students took preventive measures (53.48%), and freshmen had the highest health behavior scores. In terms of psychological status, there were fewer females with depression and stress than males. College students in minority areas have positive health attitudes; however, their knowledge of COVID-19 prevention and control is low. Moreover, their precautionary behaviors are insufficient, and they have many negative emotions.

The Effect of the COVID-19 Crisis on Vascular Surgery Training in France.

In France, since March 2020, the healthcare system has experienced a significant decrease or even suspension of surgical activity and admissions due to the coronavirus disease 2019 (COVID-19). This activity is essential to the acquisition of technical skills for all trainees enrolled in the Vascular and Endovascular Surgery Training Program either as residents or fellows. The crisis may have affected the training of vascular surgery trainees. We describe the consequences and effects of the COVID-19 crisis on the training of vascular surgery trainees. A cross-sectional study using an anonymous survey of 12 items was sent to all surgeons in training, registered at the French College of Vascular and Endovascular Surgery (CFCVE). Responses were collected between July and November 2021. Fifty-two responses were collected from trainees (residents=48%; fellows=52%), seven of who contracted COVID-19 disease. The crisis affected their scheduled and emergency surgical activities, in 96% and 77%, respectively. Thirty-one percent of responders stopped all activity, for an average of 1.5 months. Eighteen percent of responders were reassigned to other services (emergency department, ICU, vascular access unit, etc...) for an average duration of two months. Sixty-seven percent of responders believe that their level of surgical training was affected due to the crisis. Fifty-six percent of responders do not think they have achieved their training objectives (55% for fellows, 65% for senior vascular surgery residents (4th, 5th, and 6th year), and 92% for junior vascular surgery residents (year 1, 2, and 3), contributing that to the COVID-19 crisis and its effect on the flow of patients during the crisis.Additional training time (> 3 months) and the utilization of simulation training to reduce the gap produced by the COVID-19 crisis were favored in 60% and 73% of cases respectively. The COVID-19 health crisis has affected the training of surgical trainees in vascular and endovascular surgery in France. Endovascular and vascular surgical French students in training are waiting now, for additional educational proposals, allowing them to make up for their lack of practice.

A multiple case study of older adults' internal resiliency and Quality of life in COVID-19 health emergency.

Few studies have been conducted on unique conditions such as coronavirus disease 2019 (COVID-19) as an emerging health emergency, despite the strong link between resilience and quality of life in older persons. This study validated the expanded need-threat internal resiliency theory, which claims that an older person who establishes a strong sense of internal resiliency adapts to the situation by maintaining a better disposition. The underlying methodology in this study was a qualitative design using multiple case studies with non-probability purposive sampling to choose the target participants aged 60 years and above. The results of the cross-case analysis showed two major themes that explained and described the similarities and differences between the internal resiliency and quality of life of older adult participants with their respective sub-themes. Furthermore, this study concluded that older adults who have developed a strong sense of internal resilience, as manifested in the participants' coping strategies during the COVID-19 pandemic, have sustained quality of life and better life satisfaction. This study proposes a shift in the perspective of aging by emphasizing the importance of resilience as a dynamic process helping in the coping process and adapting to new emerging pandemics, leading to improved quality of life amid adversity.

A population-based assessment of avoidable hospitalizations and resource use of non-vaccinated patients with COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic has precipitated a prolonged public health crisis. Numerous public health protections were widely implemented. The availability of effective and safe vaccines for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presented an opportunity to resolve this crisis; however, vaccine uptake was slow and inconsistent. This study evaluated the potential for preventable hospitalizations and avoidable resource use among eligible non-vaccinated persons hospitalized for COVID-19 had these persons been vaccinated. This was a retrospective, population-based cohort study. The population-at-risk were persons aged ≥ 12years in Alberta (mid-year 2021 population ~ 4.4 million). The primary exposure was vaccination status. The primary outcome was hospitalization with confirmed SARS-CoV-2, and secondary outcomes included avoidable hospitalizations, avoidable hospital bed-days, and the potential cost avoidance related to COVID-19. The study inception period was 27 September 2021 to 25 January 2022. Data on COVID-19 hospitalizations, vaccination status, health services, and costs were obtained from the Government of Alberta and from the Discharge Abstract Database. Hospitalizations occurred in 3835, 1907, and 481 persons who were non-vaccinated, fully vaccinated, and boosted (risk of hospitalization/100,000 population: 886, 92, and 43), respectively. For non-vaccinated persons compared with fully vaccinated and boosted persons, the risk ratios (95%CI) of hospitalization were 9.7 (7.9-11.8) and 20.6 (17.9-23.6), respectively. For non-vaccinated persons, estimates of avoidable hospitalizations and bed-days used were 3439 and 36,331 if fully vaccinated and 3764 and 40,185 if boosted. Estimates of cost avoidance for non-vaccinated persons were $101.46 million if fully vaccinated and $110.24 million if boosted. Eligible non-vaccinated persons with COVID-19 had tenfold and 21-fold higher risks of hospitalization relative to whether they had been fully vaccinated or boosted, resulting in considerable avoidable hospital bed-days and costs.

A Narrative Review on the Potential Role of Vitamin D3 in the Prevention, Protection, and Disease Mitigation of Acute and Long COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic has challenged global health systems and economies from January 2020. COVID-19 caused by the infectious severe acute respiratory syndrome coronavirus (SARS-CoV-2) has acute respiratory and cardiometabolic symptoms that can be severe and lethal. Long-term physiological and psychological symptoms, known as long COVID-19, persist affecting multiple organ systems. While vaccinations support the fight against SARS-CoV-2, other effective mechanisms of population protection should exist given the presence of yet unvaccinated and at-risk vulnerable groups, global disease comorbidities, and short-lived vaccine responses. The review proposes vitamin D3 as a plausible molecule for prevention, protection, and disease mitigation of acute and long COVID-19. Epidemiological studies have shown that individuals who were deficient in vitamin D3 had worse COVID-19 health outcomes and mortality rates. Higher doses of vitamin D3 supplementation may improve health and survivorship in individuals of various age groups, comorbidities, and severity of disease symptoms. Vitamin D3's biological effects can provide protection and repair in multiple organ systems affected by SARS-CoV-2. Vitamin D3 supplementation can potentially support disease-mitigation in acute and long COVID-19.

HUBUNGAN PENGETAHUAN DAN SIKAP MASYARAKAT TERHADAP KEPATUHAN PENERAPAN PROTOKOL KESEHATAN PADA MASA PANDEMI COVID-19 DI KABUPATEN JEMBRANA

Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by the Acute Respiratory Syndrome Coronavirus 2 (SARS Cov-2). The community has a role in breaking the chain of transmission of COVID-19 and does not create a source of transmission as a result of interactions between individuals and groups at a point in the location. The purpose of the study was to determine the relationship between individual characteristics knowledge and attitudes towards compliance with the application of health protocols during the COVID-19 pandemic in Jembrana Regency. The design of this study was observational, with adesign cross sectional. The number of samples is 117 people. The sampling technique in this study used non probability sampling, which is a combination of snowballing and voluntary sampling which was conducted in Jembrana Regency in April-June 2021. The results showed that 77.78% complied with the application of health protocols and 22.22% did not comply. Variables of age, gender, income, last education and attitude have no relationship, age group 18-25 (p = 0.8941; OR = 1.14; 95%CI = 0.42-3.11), age group 26-45 (p= 0.8941;OR= 0.90; 95%CI=0.42-3.11), gender (p=0.2496,OR=1.68;95%CI:0.69-4.03 ), income (p=0.1574;OR=2.2;95%CI :0.69-4.03), last education (p= 0.6508; OR=1.26; 95%CI: 0.45- 3.50). The related variables were knowledge and public attitudes, knowledge (p=0.0032; OR=4.4;95% CI: 1.66-11.66), attitudes (p=&lt;0.001; OR=7, 27; 95%CI: 2.69-19.65). It can be concluded that there is a relationship between knowledge and attitudes towards compliance with the implementation of COVID-19 health protocols. It is recommended to mobilize cadres in each of the Neighborhood Associations to maximize IEC, information communication and education to the public regarding COVID-19 and the implementation of the COVID-19 health protocol which is carried out online.&#x0D; Keywords: Knowledge, Attitude, COVID-19, Health Protocol &#x0D;

COVID-19 and Pediatric Mental Health Hospitalizations

To analyze Australian national data to examine the impact of the coronavirus disease 2019 (COVID-19) pandemic on mental health-related hospital presentations among children and adolescents during the pandemic period with restrictions, and the period after the restrictions eased. We analyzed the monthly mental health-related inpatient admissions and emergency department (ED) attendances data from 6 large pediatric hospitals across Australia, using the Bayesian structural time series models. The COVID-19 restriction period was from March 2020 to December 2021 and the COVID-19 restriction-eased period from January to June 2022. A total of 130 801 mental health-related hospital admissions (54 907) and ED attendances (75 894) were analyzed. During the COVID-19 restriction period, there was a significant increase in inpatient admissions related to deliberate self-harm behaviors (82%, 95% credible interval [CrI], 7%-160%) and ED attendances related to overall mental health disorders (15%, 95% CrI, 1.1%-30%) and eating disorders (76%, 95% CrI, 36%-115%). The increase was higher among females and those living in the least socioeconomically disadvantaged areas, suggesting a widening gap between mental health-related presentations by sex and socioeconomic status. After the restrictions eased, there were slight declines in mental health-related hospital presentations; however, the numbers remained higher than the pre-COVID-19 levels. The increase in mental health-related hospital presentations during the COVID-19 period calls for additional support for pediatric mental health care, particularly for eating disorders and deliberate self-harm among female adolescents. It is important to monitor pediatric mental health service use as we enter "COVID-19 normal" period.

The COVID-19 pandemic and health-related quality of life across 13 high- and low-middle-income countries: A cross-sectional analysis.

Most research on the Coronavirus Disease 2019 (COVID-19) health burden has focused on confirmed cases and deaths, rather than consequences for the general population's health-related quality of life (HRQoL). It is also important to consider HRQoL to better understand the potential multifaceted implications of the COVID-19 pandemic in various international contexts. This study aimed to assess the association between the COVID-19 pandemic and changes in HRQoL in 13 diverse countries. Adults (18+ years) were surveyed online (24 November to 17 December 2020) in 13 countries spanning 6 continents. Our cross-sectional study used descriptive and regression-based analyses (age adjusted and stratified by gender) to assess the association between the pandemic and changes in the general population's HRQoL, measured by the EQ-5D-5L instrument and its domains (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), and how overall health deterioration was associated with individual-level (socioeconomic, clinical, and experiences of COVID-19) and national-level (pandemic severity, government responsiveness, and effectiveness) factors. We also produced country-level quality-adjusted life years (QALYs) associated to COVID-19 pandemic-related morbidity. We found that overall health deteriorated, on average across countries, for more than one-third of the 15,480 participants, mostly in the anxiety/depression health domain, especially for younger people (<35 years old) and females/other gender. This translated overall into a 0.066 mean "loss" (95% CI: -0.075, -0.057; p-value < 0.001) in the EQ-5D-5L index, representing a reduction of 8% in overall HRQoL. QALYs lost associated with morbidity were 5 to 11 times greater than QALYs lost based on COVID-19 premature mortality. A limitation of the study is that participants were asked to complete the prepandemic health questionnaire retrospectively, meaning responses may be subject to recall bias. In this study, we observed that the COVID-19 pandemic was associated with a reduction in perceived HRQoL globally, especially with respect to the anxiety/depression health domain and among younger people. The COVID-19 health burden would therefore be substantially underestimated if based only on mortality. HRQoL measures are important to fully capture morbidity from the pandemic in the general population.

Gender Differences of the Effect of Vaccination on Perceptions of COVID-19 and Mental Health in Japan.

Vaccination has been promoted to mitigate the spread of the coronavirus disease 2019 (COVID-19). Vaccination is expected to reduce the probability of and alleviate the seriousness of COVID-19 infection. Accordingly, this might significantly change an individual's subjective well-being and mental health. We observed the same individuals on a monthly basis from March 2020 to September 2021 in all parts of Japan. Then, large sample panel data (N = 54,007) were independently constructed. Using the data, we compared the individuals' perceptions of COVID-19, subjective well-being, and mental health before and after vaccination. Furthermore, we compared the effect of vaccination on the perceptions of COVID-19 and mental health for females and males. We used the fixed-effects model to control for individual time-invariant characteristics. The major findings were as follows: First, the vaccinated people perceived the probability of getting infected and the seriousness of COVID-19 to be lower than before vaccination. This was observed not only when we used the whole sample but also when we used subsamples of males and a subsample of females. Second, subjective well-being and mental health improved. The same results were also observed using the subsample of females, whereas the improvements were not observed when using a subsample of males. This implies that females' quality of life was more likely to be improved by vaccination than males' one. The novelty of the work is to show the gender difference in the vaccination effects.