Coronavirus Disease 2019 Lockdown Research Articles

Changes in inpatient medicine prescribing during COVID-19 lockdown.

New Zealand went into lockdown March 2020 successfully eliminating the circulation of the coronavirus disease 2019 (COVID-19) virus. During lockdown there were reduced rates of respiratory infections and hospital admission numbers were low. At the time, rumours of benefit and harm of medicines for COVID-19 were widespread in the lay and medical media. To describe changes in inpatient prescribing in an acute general medicine service during the New Zealand COVID-19 lockdown in 2020. Rates of prescribing of medicines during the 33 days of lockdown were compared with a 33-day control period before lockdown. Prescriptions, patients and bed days were calculated from the hospital patient administration and electronic prescribing and administration systems. In the general medicine service, acute admissions were 20% lower during lockdown (from 1216 pre-lockdown to 974). There was a small decrease in the rate of prescriptions per patient (10.1 vs 10.4, P = 0.01) during lockdown, and the average length of stay was shorter (3.2 vs 3.6 days). Nebulised administration decreased by 75% (1.3% vs 5.3% of admissions) but unexpectedly there was no change in the prescribing rates of antibacterial medicines, e.g.amoxicillin (26% vs 26%). There were no changes in rates of prescribing of medicines being rumoured to potentially improve (e.g. hydroxychloroquine) or worsen (e.g. angiotensin-converting enzyme inhibitors) COVID-19 outcomes. Acute medical admissions decreased 20% during lockdown for COVID-19, with a proportional decrease in prescriptions. Reduced rates of respiratory tract infections did not lead to decreased prescribing of antibacterial medicines. Rumour-based prescribing did not eventuate.

Incidence of Isolated Biliary Atresia during the COVID Lockdown in Europe: Results from a Collaborative Project by RARE-Liver.

Biliary atresia (BA) is a rare cholangiopathy where one of the proposed aetiological mechanisms is an infectious viral trigger. Coronavirus disease-19 (COVID) lockdown restrictions were implemented to reduce the transmission of infections. Strictness of lockdown varied across European countries. This study aimed to investigate if there was an association between strictness of lockdown and change in isolated BA (IBA) incidence in Europe. We approached European centres involved in the European Reference Network RARE-LIVER. We included IBA patients born between 2015 and June 2020. We calculated the number of IBA patients born per centre per month. The Stringency Index (SI) was used as lockdown strictness indicator. The association between percentage change of mean number of IBA patients born per month and the SI was assessed. We included 412 IBA patients from thirteen different centres. The median number of patients per month did not change: 6 (1-15) pre-lockdown and 7 (6-9) during lockdown (p = 0.34). There was an inverse association between SI and percentage change in IBA (B = -0.73, p = 0.03). Median age at Kasai portoenterostomy (days) did not differ between time periods (51 (9-179) vs. 53 (19-126), p = 0.73). In this European study, a stricter COVID-lockdown was seemingly accompanied by a simultaneous larger decrease in the number of IBA patients born per month in the lockdown. Results should be interpreted with caution due to the assumptions and limitations of the analysis.

Effect of social trust on health information exchange in social network sites

Background: The purpose of this study is to conduct a systematic literature review of the role of social trust in health information exchange on social network sites (SNSs). In the light of the confusion and panic about health information leading to and during the worldwide lockdown, in an attempt to control the spread and symptoms of coronavirus disease 2019 (COVID-19). Although the sharing of health information on SNS did not start during the COVID-19 lockdown, the concerns about health information interchange were highlighted during the lockdown. Objectives: This study investigates the nature of the association between health information exchange and social trust and how social trust has influenced health information exchange from 2005 to 2021. Method: In line with the purpose of the study, the researcher applied a systematic literature review to review conference articles, accredited journal articles and book chapters. The review process involved a rigorous procedure towards a definition of review protocol, extraction of articles, formulation of selection criteria and the review itself. Results: This study reveals a transactional interplay between the constructs of social trust (benevolence, integrity and competence) and social network site user roles (information seeker, information passer and information giver). Conclusion: In summary, the researcher argues that public health officials would benefit from setting up an SNS that proactively provides health information. The health information exchange experience should be designed in a way that takes into account how social trust can be used to moderate health information exchange in the SNS by different types.

What Can We Learn from the Street-Level Bureaucracy Approach Regarding Gender-Based Violence Support Services During the COVID-19 Lockdown Crisis?

The COVID-19 (coronavirus disease 2019) pandemic brought a new reality and created several complications and challenges for professionals working in gender-based violence (GBV) support networks. A gap has been found in the literature in terms of evidence on how best to operate GBV intervention and support services in times of crisis. Given this reality, this article analyses the situation caused by the pandemic, raising and highlighting relevant implications for the impact on the quality of the services provided, and emphasizing the concept of street-level bureaucracy in the face of the new reality. The article highlights how professionals are currently coping, making decisions, and adapting their ways of working. The literature review offers relevant conclusions on how to improve preparedness and prevention plans in support services for victims of violence in future crises.

Impact of COVID-19 on Infants followed after Discharge from the Neonatal Intensive Care Unit Using a Telemedicine Model.

Coronavirus disease 2019 (COVID-19) continues to have a profound impact on infant health care and health outcomes. In this study, we aimed to characterize the social impact of the first COVID-19 lockdown on families in a neonatal follow-up program (NFP). Given the ongoing increased use of telehealth across the medicine, we also evaluated for patient-level differences in virtual visit rates to identify patients at risk of follow-up challenges. To assess the impact of virtual health care utilization, we conducted a retrospective cohort study to describe challenges associated with telemedicine use in this vulnerable patient population during our telemedicine epoch (March 13, 2020-July 31, 2020). We also looked for patient-level factors associated with attending NFP visits as scheduled. Finally, we summarized caregiver responses to a COVID-19 Obstacles Assessment Survey and assessed for racial disparities in these responses. When comparing patients who completed their virtual visit to those who did not, we found no differences by infants' sex, birth weight, gestational age at birth, or caregiver self-reported race and ethnicity. However, infants whose visits did not occur were more often discharged with equipment or covered by public insurance. Nine percent of families reported food insecurity. During the initial COVID-19 lockdown, families with infants discharged from a neonatal intensive care unit (NICU) faced significant obstacles caring for their infants and attending scheduled follow-up visits. Infants in families with lower socioeconomic status or with increased medical complexity faced increased challenges in attending virtual follow-up visits during this epoch. Given the ongoing reliance on telemedicine in health care and the need to better prepare for future epidemics/pandemics, this study offers critical information that can assist neonatal teams in bolstering transitions to home and creating stronger safety nets for their patients after discharge. · Telemedicine works well for high-risk neonatal populations.. · Infant medical complexity may be a risk factor for challenges attending neonatal follow-up visits.. · NICUs should work to prevent food insecurity postdischarge..

Myopia progression in children before and after the coronavirus disease lockdown

Background: The worldwide spread of the coronavirus disease (COVID-19) pandemic in 2020, followed by lockdowns, forced children to be in home confinement with increased screen time, leading to rapid progression of myopia and an increase in the prevalence of myopia. This study was aimed at determining if myopia progression seen in evidence-based practice resulted from the COVID-19 lockdown or delayed follow-ups.
 Methods: A retrospective review of case sheets of patients visiting the pediatric department of a tertiary care eye hospital in Mumbai, India, was conducted from 2017 onwards. We enrolled all children with myopia who had attended at least one follow-up visit before the COVID-19 lockdown and at least one follow-up visit post-lockdown. The spherical equivalent (SEQ) of refractive error values at baseline and pre- and post-COVID-19 lockdown follow-ups (hereinafter referred to as the “first” and “second” follow-ups, respectively) were recorded. The duration between baseline and the first follow-up visit and between the first and second follow-up visits were noted.
 Results: We enrolled 112 eyes of 56 children, including 35 (62.5%) boys and 21 (37.5%) girls, with a mean (standard deviation [SD]) age of 9.54 (2.82) years. The mean (SD) SEQ values at baseline and first and second follow-ups were - 4.74 (3.83), - 5.46 (3.81), and - 6.42 (3.66) D, respectively. The mean change in SEQ, mean SEQ myopia progression, and rate of myopia progression per month differed significantly between the baseline and the first follow-up visit versus between the first and second follow-ups (all P < 0.05). However, the change in myopia degree did not differ significantly between these two periods in eyes with low, moderate, or high myopia (all P > 0.05). The mean (SD) duration between the baseline and the first follow-up visit was 14.57 (5.68) months, while that between the first and second follow-ups was 27.96 (9.18) months, showing a significant difference (P < 0.05).
 Conclusions: Our findings suggest that a longer gap between follow-up visits and myopia progression per month should be factored into the management of myopia. Considering that young children are more vulnerable, preventive measures and school reforms should be urgently implemented in India. Further retrospective multicenter studies with a larger sample size of eyes, including various refractive errors over a longer period, are required to verify these findings.

Food price volatility and socio-economic inequalities in poor food consumption status during coronavirus disease-2019 lockdown among slum and non-slum households in urban Nansana municipality, Uganda

BackgroundThis study assessed staple food price volatility, household food consumption scores (FCS), poor household food consumption status and its association with socio-economic inequalities during enforcing and partial lifting of coronavirus disease-2019 (COVID-19) lockdown restrictions in slum and non-slum households (HHs) of Nansana municipality, Uganda.MethodsRepeated cross-sectional surveys were conducted during enforcing and partial lifting of COVID-19 lockdown restrictions. A total of 205 slum and 200 non-slum HHs were selected for the study. Telephone based interviews with HH heads were used to collect data on socio-economic factors. Data for FCS was collected using the World Food Programme FCS method. Prices for staple foods were collected by face-to-face interviews with food vendors from the local market. Mean staple food price differences before COVID-19 lockdown, during enforcing, and partial lifting of lockdown was tested by Analysis of variance with repeated measures. Multivariate logistic regression analysis was used to assess the association between socio-economic variables and poor food consumption status. A statistical test was considered significant at p < 0.05.ResultsMean staple food prices were significantly higher during enforcing COVID-19 total lockdown restrictions compared to either 1 week before lockdown or partial lifting of lockdown (p < 0.05). Mean FCS for staple cereals and legumes were significantly higher in slum HHs during COVID-19 lockdown compared to when the lockdown was partially lifted (p < 0.05). In slum HHs, the prevalence of poor food consumption status was significantly higher during partial lifting (55.1%) compared to total lockdown of COVID-19 (15.1%), p < 0.05. Among slum HHs during lockdown restrictions, food aid distribution was negatively associated with poor food consumption status (AOR: 0.4, 95% CI: 0.1–0.6), whilst being a daily wage earner was positively associated with poor food consumption status (AOR: 0.5, 95% CI: 0.1–0.6). During partial lifting of COVID-19 lockdown in slum HHs, poor food consumption status was positively associated with female headed HHs (AOR: 1.2, 95%CI: 1.1–1.6), daily wage earners (AOR: 3.2, 95% CI: 2.6–3.8), unemployment (AOR: 1.9, 95% CI: 1.5–2.1) and tenants (AOR: 2.4, 95% CI: 1.8–3.5). Female headed HHs, daily wage earners and tenants were positively associated with poor food consumption status either during enforcing or partial lifting of COVID-19 lockdown restrictions in non-slum HHs.ConclusionStaple food prices increased during enforcing either the COVID-19 lockdown or partial lifting of the lockdown compared to before the lockdown. During the lockdown, food consumption improved in slum HHs that received food aid compared to those slum HHs that did not receive it. Household heads who were females, daily wage earners, unemployed, and tenants were at risk of poor food consumption status either in slum or non-slum, and therefore needed some form of food assistance either during enforcing or partial lifting of the lockdown.

Lifestyle and Immunity Boosting Practices During COVID-19 Pandemic Among the Population of Rajshahi District, Bangladesh

Coronavirus disease 2019 (COVID-19) pandemic represents a massive impact on human health, causing sudden lifestyle changes, through social distancing and isolation at home, with social and economic consequences. The aim of the study was to determine both of community and gender-based distribution of perception, attitude, preventive measures, changing lifestyle regarding COVID-19 and to help the Government and policymakers to take indispensable steps. This cross-sectional survey self-administered online-based study was carried out after the declaration of strict initial lockdown enforced in Bangladesh. The study was conducted in Rajshahi district from 30 March 2020 to 31 August 2020, a very critical time of mental suffering and lockdown. A total of 651 respondents from Rajshahi district in Bangladesh participated in the survey, and by a self-administered questionnaire, designed in the language of English. Among the collected responses, 535 were considered for the analysis, which largely belonged to Rajshahi’s middle to upper socio-economic status (SES). The data analysis was performed using Microsoft Excel 2019 and SPSS version 25.0 (Chicago, IL, USA). The data were analyzed by using descriptive statistic, chi-square test and z-proportional test. In this empirical study, 278 males and 257 females participated. More than one-tenth of males and 35% of females were not conscious of the type of Coronavirus. A lot of misperception about the incubation period of COVID-19 existed among participants. The research observed that 34.2%, of males and 25.3% of the female study population had no opinion about the treatment of COVID-19 and 27.3% of males and 21.8% of females gave a verdict that COVID-19 had no available treatment. The study discovered more surprisingly that females (67.3%), greater than males (65.5%) did not want to stay at home during the lockdown. Positively 87.8% of males and 70.4% of females washed their hands with soap or used sanitizer after coming back from outside. The consumption of a balanced diet increased by males and females was 13.3% and 6.7% respectively. Z-proportional test showed that regarding COVID-19, there were significant difference between male and female’s conception and precaution (p&lt;0.0001). The study has used the first-time data based on the population’s lifestyle and eating habits during the COVID-19 lockdown, which will give assistance to the policy makers to develop the situation. J Bio-Sci. 30(1): 33-48, 2022 (June)

Why did air quality experience little improvement during the COVID-19 lockdown in megacities, northeast China?

To inhibit the COVID-19 (Coronavirus disease 2019) outbreak, unprecedented nationwide lockdowns were implemented in China in early 2020, resulting in a marked reduction of anthropogenic emissions. However, reasons for the insignificant improvement in air quality in megacities of northeast China, including Shenyang, Changchun, Jilin, Harbin, and Daqing, were scarcely reported. We assessed the influences of meteorological conditions and changes in emissions on air quality in the five megacities during the COVID-19 lockdown (February 2020) using the WRF-CMAQ model. Modeling results indicated that meteorology contributed a 14.7% increment in Air Quality Index (AQI) averaged over the five megacities, thus, the local unfavorable meteorology was one of the causes to yield little improved air quality. In terms of emission changes, the increase in residential emissions (+15%) accompanied by declining industry emissions (−15%) and transportation (−90%) emissions resulted in a slight AQI decrease of 3.1%, demonstrating the decrease in emissions associated with the lockdown were largely offset by the increment in residential emissions. Also, residential emissions contributed 42.3% to PM2.5 concentration on average based on the Integrated Source Apportionment tool. These results demonstrated the key role residential emissions played in determining air quality. The findings of this study provide a scenario that helps make appropriate emission mitigation measures for improving air quality in this part of China.

A machine learning approach to address air quality changes during the COVID-19 lockdown in Buenos Aires, Argentina

Abstract. Having a prediction model for air quality at a low computational cost can be useful for research, forecasting, regulatory, and monitoring applications. This is of particular importance for Latin America, where rapid urbanization has imposed increasing stress on the air quality of almost all cities. In recent years, machine learning techniques have been increasingly accepted as a useful tool for air quality forecasting. Out of these, random forest has proven to be an approach that is both well-performing and computationally efficient while still providing key components reflecting the nonlinear relationships among emissions, chemical reactions, and meteorological effects. In this work, we employed the random forest methodology to build and test a forecasting model for the city of Buenos Aires. We used this model to study the deep decline in most pollutants during the lockdown imposed by the COVID-19 (COronaVIrus Disease 2019) pandemic by analyzing the effects of the change in emissions, while taking into account the changes in the meteorology, using two different approaches. First, we built random forest models trained with the data from before the beginning of the lockdown periods. We used the data to make predictions of the business-as-usual scenario during the lockdown periods and estimated the changes in concentrations by comparing the model results with the observations. This allowed us to assess the combined effects of the particular weather conditions and the reduction in emissions during the period when restrictions were in place. Second, we used random forest with meteorological normalization to compare the observational data from the lockdown periods with the data from the same dates in 2019, thus decoupling the effects of the meteorology from short-term emission changes. This allowed us to analyze the general effect that restrictions similar to those imposed during the pandemic could have on pollutant concentrations, and this information could be useful to design mitigation strategies. The results during testing showed that the model captured the observed hourly variations and the diurnal cycles of these pollutants with a normalized mean bias of less than 6 % and Pearson correlation coefficients of the diurnal variations between 0.64 and 0.91 for all the pollutants considered. Based on the random forest results, we estimated that the lockdown implied relative changes in concentration of up to −45 % for CO, −75 % for NO, −46 % for NO2, −12 % for SO2, and −33 % for PM10 during the strictest mobility restrictions. O3 had a positive relative change in concentration (up to an 80 %) that is consistent with the response in a volatile-organic-compound-limited chemical regime to the decline in NOx emissions. The relative changes estimated using the meteorological normalization technique show mostly smaller changes than those obtained by the random forest predictive model. The relative changes were up to −26 % for CO, up to −47 % for NO, −36 % for NO2, −20 % for PM10, and up to 27 % for O3. SO2 is the only species that had a larger relative change when the meteorology was normalized (up to 20 %). This points out the need for accounting not only for differences in emissions but also in meteorological variables in order to evaluate the lockdown effects on air quality. The findings of this study may be valuable for formulating emission control strategies that do not disregard their implication on secondary pollutants. We believe that the model itself can also be a valuable contribution to a forecasting system in the city and that the general methodology could also be easily applied to other Latin American cities as well. We also provide the first O3 and SO2 observational dataset in more that a decade for a residential area in Buenos Aires, and it is openly available at https://doi.org/10.17632/h9y4hb8sf8.1 (Diaz Resquin et al., 2021).

The Effect of the COVID-19 Lockdown on the Frequency of Acute Poisoning Presentation to Adult and Pediatric Emergency Departments.

Background The coronavirus type 2 that causes severe acute respiratory syndrome (SARS-CoV-2) was detected in December 2019 in Wuhan, China. A worldwide emergency response has been initiated because of the fast rise in the number of cases and fatalities during the early stages of the pandemic when vaccinations and efficient medical care were unavailable.Misinformation spread quickly in the early phases of the pandemic, leading to the inappropriate use of medications, chemicals, and traditional remedies for their claimed preventive or therapeutic purposes. Thus, our aim is to identify the impact of the coronavirus disease 2019 (COVID-19) lockdown on the patterns of intoxicated patients presenting to King Abdulaziz Medical City's adult and pediatric emergency departments. Methods A retrospective cohort study was conductedin the adult emergency department at King Abdulaziz Medical City and the pediatric emergency department at King Abdullah Specialized Children's Hospital in Riyadh, Saudi Arabia.All patients presented with poisoning as a chief complaint between March 23 to June 21 in 2019 (pre-lockdown), 2020 (the lockdown), and 2021 (post-lockdown) were included. Cases of registered poisoning complaints were reviewed and assessed with respect to patient demographics, the causative agent/substance responsible for the poisoning, management of poisoning, and particular outcomes on the approved data collection form by the research team.The data were entered and analyzed by using SPSS v26 (IBM Corp, Armonk, NY). The descriptive statistics are presented as frequency and percentage for the categorical data variables and mean and standard deviation for the numerical data. The data were further analyzed by using cross-tabulation (chi-square test), for the data that are both the predictor and the outcome was categorical. A p-value of < 0.05 was considered significant for allstatistical tests. Results Out of 318 patients identified, 164 were adults and 154 were pediatric patients. The mean age of adult and pediatric patients was 33.3±15.5 years and 4±3.6 years, respectively. The majority of patients (115; 70.1%) were males in the adult group and females (90; 58.4%) in the pediatric.The majority of self-harm cases were accidental among both adults and pediatrics, 109 (66.5%) and 144 (93.5%), respectively. The dispositionfrom the emergency department was discharged for 113 (68.7%) adult patients and134 (87.0%) pediatric patients.The number of cases presented to ER with poisoning cases during the lockdown decreased. This was further tested inferentially, but no significant association was seen among study variables, i.e., p > 0.05. Conclusion The lockdown and pandemic had a significant impact on the rate and patterns of ED visits. The establishment and operation of Drug and Poison Information Centers (DPIC) across the Kingdom, in addition to increasing awareness through campaigns addressing drug and substance safety, is recommended.

Body composition and physical activity of university students during COVID-19 lockdowns.

[Purpose] Behavioral restrictions during the corona virus disease 2019 (COVID-19) pandemic may have affected the physical activity levels of college students. We aimed to characterize the body composition and physical activity of college students during these behavioral restrictions. [Participants and Methods] The body composition (height, weight, body mass index, body fat mass, body fat percentage, total body muscle mass, free-fat muscle index [FFMI], and fat mass index [FMI]), physical activity, amount the of walking, amount of daily activity, and the number of steps were measured in 52 university students. [Results] For both male and females, the number of steps taken was lower than the average steps reported by the Ministry of Health, Labour and Welfare. In males, FFMI had a strong positive correlation with physical activity, amount of walking, and the number of steps taken. In females, FFMI had a strong positive correlation with physical activity and the amount of walking, as well as a moderate positive correlation with the amount of daily activity. [Conclusion] Since physical activity and walking of university students during COVID-19 affect FFMI, it is necessary to develop an exercise program that considers behavioral patterns.

COVID-19 pandemic and lockdown: impact on parents' stress level and infant care in a tertiary neonatal unit.

Neonatal intensive care unit (NICU) admission increases parents' stress levels and it might be even higher in the crisis of coronavirus disease 2019 (COVID-19) pandemic and lockdown. This study was done to identify the stress levels of parents of admitted neonates and the difficulties encountered in neonatal care and follow-up during the COVID-19 pandemic and lockdown. The Parental Stressor Scale (PSS:NICU) and Perceived Stress Scale (PeSS) were used to identify the stress levels of parents of admitted neonates. Online survey form with a structured questionnaire comprising PeSS and NICU:PSS was sent through messaging app (Google form) after informed consent. PSS score of <14 was considered low stress, 14-26 moderate and >26 as high. A total of 118 parental responses (mother /father in 26, both in 46) for 72 admitted neonates, were obtained. The mean (SD) PeSS score was 19.7 (5.8%) and 92 (78%) had moderate stress while 11 (9%) had high stress. In NICU:PSS, sights-sounds and parental role had more median scores: 2.25 (1-3.75) and 2.21 (1-3.57), respectively. Maternal and paternal NICU:PSS (p-0.67) and PeSS (p-0.056) scores were not statistically different. Keeping nil per oral, invasive ventilation, culture-positive sepsis, fathers' transport difficulty and longer duration of mothers' and neonates' hospital stay was associated with increased NICU: PSS scores. Twenty (29%) parents could not bring their child for follow-up and there was a delay in immunisation in 21 (30%). The pandemic and the lockdown might have disrupted antenatal and postnatal follow-ups further adding to the parental stress.

Dietary habits, lifestyle changes, and glycemic control in patients with type 2 diabetes mellitus during coronavirus disease 2019 (COVID-19): A cross-sectional study in Egypt.

The coronavirus disease 2019 (COVID-19) lockdown had a significant effect on people's lifestyles and dietary habits resulting in a possible negative health impact, particularly for patients with type-2 diabetes mellitus (T2DM). The objective of the study was to assess the changes in dietary habits and lifestyle and how these relate to glycemic control in patients with type 2 diabetes (T2D), who attended Zagazig Diabetes Clinic, Sharkia Governorate, Egypt, during the COVID-19 pandemic. A total of 402 patients with T2D were included in this cross-sectional study. A semistructured questionnaire was used to collect information on socioeconomic status, dietary habits, lifestyle changes, and previous medical history. Weight and height were also measured, and hemoglobin A1C levels before and after lockdown were compared. Data analysis was performed using the SPSS. To determine statistical significance, Chi-square test was used for categorical variables whereas, paired t-test or McN-Nemar test, as appropriate, was used to compare change in HbA1c before and after lockdown. Ordinal logistic regression was used to determine factors associated with weight change, whereas binary logistic regression was used to determine factors related with glycemic control. During the COVID-19 pandemic, 43.8% of the studied groups consumed more than their usual diet with an increase in fruits, vegetables, and immunity-boosting food; 57% depended on home-cooked food, 48.3% did not practice exercise. About 57% reported to have gained weight, 70.9% suffered from mental stress, and 66.7% reported inadequate sleep. Collectively, there was a statistically significant decrease in the percentage of good glycemic control in the studied groups (28.1% vs. 15.9%) before and after the COVID-19 lockdown, respectively (P < 0.001). Weight gain, physical inactivity, mental stress, and inadequate sleep were significantly associated with poor glycemic control. COVID-19 pandemic has had a negative impact on the lifestyle and dietary habits of the studied groups. Therefore, it is very important to ensure better diabetes management in this critical period.

Dietary Supplement Use among Iranian Households during COVID-19 Epidemic Lockdown: Less Access in Those Who May Need More National Food and Nutrition Surveillance.

The coronavirus disease 2019 (COVID-19) pandemic elicited the general population to use various dietary supplements (DSs) and nutraceuticals as a protective means against the disease. The present study aimed to evaluate changes and certain determinants of DS intake during the COVID-19 lockdown among Iranian households. This nationwide cross-sectional study was conducted from April 4 to April 25, 2020, during which Iran was in lockdown. To collect data, a web-based electronic self-administered questionnaire was created. The data were compared among provinces based on their food security situations. A total of 21,290 households were included in the analyses. Approximately 27% of the households were using DSs after the epidemic. The most common DSs used were vitamin D (42%) and vitamin C (20%), followed by multi-vitamin (16%), zinc (9%), omega-3 (6%), vitamin A (4%), and probiotics (3%). Logistic regression analysis revealed that DS intake was directly associated with the household income but inversely with household size and the food security status of the provinces. DS intake was positively associated with the presence of high-risk persons in the households, the education of the households' head, and the presence of a person with a history of COVID-19 within the household. During epidemic lockdown, DS use was remarkably increased among the Iranian households. Apart from the debatable usefulness of DSs against COVID-19, the inverse association of DS use with a household's income and provincial food security well indicates inequity in accessibility to DS. Actions to improve the nutritional status of the under-privileged populations including targeted supplementation are strongly recommended.

Self-reported Medication Adherence in Schizophrenia and Bipolar Disorder Patients during COVID-19 Pandemic in a COVID Care Hospital: A Cross-sectional Study

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic has made it difficult for patients with Schizophrenia and Bipolar Affective Disorder (BPAD) to receive ongoing care, which has led to non adherence to medication and undesirable health outcomes. Lower treatment adherence in severe mental illness might lead to symptom exacerbation and relapses and might cause a strain on the health system during COVID-19 pandemic. Aim: To assess the treatment adherence in Schizophrenia and BPAD patients during prevailing COVID-19 situation in India. Materials and Methods: This cross-sectional study was conducted among 92 patients with Schizophrenia and BPAD through a questionnaire between January to September 2021 in a COVID-19 care hospital Government Medical College Palakkad/District hospital Palakkad, Kerala, India. Demographic and clinical data, adherence to treatment, along with Brief Psychiatric Rating Scale (BPRS), Young Mania Rating Scale (YMRS), Hamilton Rating Scale for Depression (HAM-D). Clinical Global impression (CGI S&amp;I), Work and Social Adjustment Scale (WSAS), Modified COVID Threat Scale (CTS) and Medication Adherence Rating Scale (MARS) were collected. The outcomes included adherence to medication, deterioration of the psychopathology, improvement in severity, social functioning. Descriptive statistics was used to define the sample characteristics and presented as mean and standard deviation and frequency and percentages. Spearman’s Correlation coefficient was used to find the correlation between MARS and other variables: CTS, BPRS, YMRS, HAM-D, CGI and WSAS. Results: A total of 92 patients were interviewed which comprised of 43 patients with Schizophrenia and 49 patients with Bipolar disorder. As assessed by MARS rating scale 19 patients (20.65%) had a MARS score less than six suggesting poor adherence and 73 (79.35%) had MARS score 6 and greater suggesting better adherence to the treatment. This was supported by negative correlation with BPRS, YMRS, HAM-D and CGI-S and CGI-I scales which implies that the COVID-19 pandemic did not hinder the patients to take the medication. The mean MARS score was 7.31±2.11. A total of 37 (40.2%) patients had acute exacerbation of the illness during the COVID-19 related lockdown and 37 (40.2%) had exacerbation during the six months prior to COVID-19 lockdown. There was negative correlation between MARS scores and the CTS but was not statistically significant. Conclusion: Despite the COVID-19 pandemic related restriction, patients with Schizophrenia and BPAD were adherent to the medication and the number of relapses during COVID19 pandemic was similar to the period before the pandemic. COVID-19 related anxiety didn’t have an impact on medication adherence and relapse in this study.

Impact of lockdown during COVID-19 on glycaemic control in children with type 1 diabetes mellitus following at diabetes clinic, Omdurman, Sudan.

Corona Virus Disease-2019 (COVID-19) is a novel pandemic disease. There have been many challenges for diabetic patients, which might have resulted in an increased risk of complications and significant lifestyle changes, including physical inactivity and psychological distress. This study evaluated the effects of lockdown on paediatric patients with type 1 diabetic mellitus (T1DM) in terms of acute metabolic complications and psychological deterioration. A questionnaire-based cross-sectional study was conducted between November 2020 and February 2021 at Mohammed Alamin Hamid Diabetic Clinic, Omdurman, Sudan. Data was collected from direct interviews with patients and their caregivers. Out of 208 children with T1DM aged from 1-18 years, 48.1% had persistent hyperglycaemia, and 20.6% had hypoglycaemia. Insulin doses were missed in 20.2% of them, glucose monitoring was not done in 28.8%, and 20.6% reported decreased physical activity during the lockdown. Mean HbA1c levels were the same in pre and post-lockdown periods. There was an insignificant relationship between physical activity, dietary changes, and glycaemic control (p values = 0.519 and 0.146, respectively). On the other hand, there was a significant weak positive correlation between psychological and behavioural disorders such as aggression, anxiety, isolation, and glycaemic control (p-value = 0.032, 0.002, and <0.0001; r = 0.115, 0.135, and 0.169, respectively). The negative impact of the COVID-19 lockdown found on blood glucose measures and psychological status may correlate with glucose monitoring equipment shortage, lifestyle changes, and mood deterioration.

Emergency department presentations during the COVID-19 pandemic in Queensland (to June 2021): interrupted time series analysis.

To assess emergency department (ED) presentation numbers in Queensland during the coronavirus disease 2019 (COVID-19) pandemic to mid-2021, a period of relatively low COVID-19 case numbers. Interrupted time series analysis. All 105 Queensland public hospital EDs. Numbers of ED presentations during the COVID-19 lockdown period (11 March 2020 - 30 June 2020) and the period of easing restrictions (1 July 2020 - 30 June 2021), compared with pre-pandemic period (1 January 2018 - 10 March 2020), overall (daily numbers) and by Australasian Triage Scale (ATS; daily numbers) and selected diagnostic categories (cardiac, respiratory, mental health, injury-related conditions) and conditions (stroke, sepsis) (weekly numbers). During the lockdown period, the mean number of ED presentations was 19.4% lower (95% confidence interval, -20.9% to -17.9%) than during the pre-pandemic period (predicted mean number: 5935; actual number: 4786 presentations). The magnitudes of the decline and the time to return to predicted levels varied by ATS category and diagnostic group; changes in presentation numbers were least marked for ATS 1 and 2 (most urgent) presentations, and for presentations with cardiac conditions or stroke. Numbers remained below predicted levels during the 12-month post-lockdown period for ATS 5 (least urgent) presentations and presentations with mental health problems, respiratory conditions, or sepsis. The COVID-19 pandemic and related public restrictions were associated with profound changes in health care use. Pandemic plans should include advice about continuing to seek care for serious health conditions and health emergencies, and support alternative sources of care for less urgent health care needs.

Has Lockdown and COVID-19 Led to a Change in the Characteristics of Deep Vein Thrombosis and Patients Who Are Afflicted With It?

There is growing evidence identifying coronavirus disease 2019 (COVID-19) as a significant risk factor for thrombosis in inpatients. However, it remains uncertain if patients in the community have been influenced during the COVID-19 pandemic and national lockdown. This study, across four centres in the United Kingdom (UK), reviewed outpatients with deep vein thrombosis (DVT). This study aims to find out whether lockdown and COVID-19 led to a change in the characteristics of DVT and patients who are afflicted with it, alongside a review of DVT service. Data was collected retrospectively from electronic patient records system for the following periods: April 1 to June 30, 2019, and April 1 to June 30, 2020. These were the key months during the first national lockdown in UK. Data were analysed for patient demographics, risk factors, characteristics of DVT, management, and DVT reoccurrence. Statistical analyses were performed using GraphPad Prism 8 (Dotmatics, Boston, Massachusetts, United States). During the study periods, 227 outpatients from the community sustained DVT in 2019 and 211 in 2020. Of these patients, 13 in 2020 were COVID-19 positive. There was a difference in gender distribution with 128 males and 99 females in 2019, and 93 males and 118 females in 2020 (p= 0.0128). No significant difference was noted in the incidence of thrombophilia with nine in 2019 and three in 2020 (p=0.1437). Fewer long-haul journeys were made in 2020 (only two), compared to 16 in 2019 (p=0.012). Fewer patients had immobility as a risk factor in 2020 (n=55) compared to 2019 (n=79) (p=0.0494). However, there were more patients using oral contraceptive pills, with one in 2019 and nine in 2020 (p=0.0086) . There is no significant difference in the characteristics, extent, and management of DVT prior to and during the COVID-19 lockdown. National lockdowns do not affect DVT in the community; however, it is important to highlight the surrounding inpatient numbers.

The greatest air quality experiment ever: Policy suggestions from the COVID-19 lockdown in twelve European cities.

COVID-19 (Coronavirus disease 2019) hit Europe in January 2020. By March, Europe was the active centre of the pandemic. As a result, widespread "lockdown" measures were enforced across the various European countries, even if to a different extent. Such actions caused a dramatic reduction, especially in road traffic. This event can be considered the most significant experiment ever conducted in Europe to assess the impact of a massive switch-off of atmospheric pollutant sources. In this study, we focus on in situ concentration data of the main atmospheric pollutants measured in twelve European cities, characterized by different climatology, emission sources, and strengths. We propose a methodology for the fair comparison of the impact of lockdown measures considering the non-stationarity of meteorological conditions and emissions, which are progressively declining due to the adoption of stricter air quality measures. The analysis of these unmatched circumstances allowed us to estimate the impact of a nearly zero-emission urban transport scenario on air quality in 12 European cities. The clearest result, common to all the cities, is that a dramatic traffic reduction effectively reduces NO2 concentrations. In contrast, each city's PM and ozone concentrations can respond differently to the same type of emission reduction measure. From the policy point of view, these findings suggest that measures targeting urban traffic alone may not be the only effective option for improving air quality in cities.