COVID-19 Lockdown Research Articles

Touching Technology-Parents' Experiences of Remote Consultations for Children With Severe Congenital Cardiac Conditions: Quasi-Experimental Cohort Study.

Remote consultations (RCs) using videoconferencing was recommended by the General Medical Council as the method for clinicians to provide patient consultations during the COVID-19 pandemic. Facilitating this while providing high-quality care depends on the usability and acceptability of the technology. This project aimed to investigate parents' experiences of using videoconferencing technology for real-time RCs with children who had congenital heart defects during the COVID-19 pandemic lockdown. This study's design was quasi-experimental and was underpinned by the Unified Theory of Acceptance and Use of Technology model that seeks to explain and predict an individual's intention to use a technology. Parents were informed of this study by the medical team, posters were made available in the wards and clinics, and leaflets were left for browsing. Clinician screening of potential participants led to the identification of 33 children and parents who were enrolled on this study. The intervention was a web-based RC by medical staff using a secure, interactive videoconferencing platform (Pexip). Each child and their mother or father received 8 RCs with the same specialist doctor or nurse. Measurements were taken using web-based questionnaires pre and post consultation at the first, middle, and last events; questions were focused on the acceptability, usability, and clinical applicability of RCs. Parents' experiences were explored using recorded interviews and analyzed thematically. In total, 29 children aged 4-1052 (mean 95, SD 191.14) days completed the project, receiving a total of 189 RCs as part of their routine care. Parents' prior experience of consultation via videoconference was low; however, as time progressed, their use and acceptance of the technology increased. The intervention was warmly received by all parents who found the face-to-face component particularly useful for discussion with their child's medical team. Furthermore, parents noted the savings on time, money, and childcare. While in-person consultations are considered the gold standard of patient care, increasing pressures on health services and staff reduce availability. Given the ease of access and additional benefits experienced by parents and their children, it is proposed that hybrid models of consultation and care provision are equal, if not superior, to in-person consultations in the management of children with severe congenital heart defects while reducing costs and pressure on the health service and parents.

‘We’ve Done Our Bit’: Post-COVID Experiences of Precarious Privilege Among Western International School Teachers in Shanghai

In this article, we consider how the COVID-19 pandemic has affected migration experiences and decisions among transnationally mobile Western international school teachers in China. International school teachers are among the most numerous groups of Western ‘expats’ in the country, arriving from the beginning of China’s ‘Reform period’. Drawing on exploratory interviews with international school teachers, we examine experiences of precarious privilege against the backdrop of COVID-19 lockdowns. We analyse our participants’ decisions about onward migration or permanence in China. In spite of evidence showing erosion of privilege during the pandemic, international school teachers remain largely insulated from its impact due to the privileged nature of their employment. Of greater significance was the impact of the Shanghai lockdown on the participants’ mobility and emotions, which proved the catalyst for two of the three participants to return to the UK.

Narratives of Personhood and Caregiving in Ontario Long-Term Care Homes During COVID-19

Drawing on narratives recorded from family members of residents in long-term care homes in Ontario, Canada, during the 2020 COVID-19 lockdown, in this paper, I present a two-pronged argument. First, following Taylor (2008) and Seaman (2018, 2020) I suggest that family caregiving for residents of long-term care homes helps to sustain residents’ personhood: the recognition of their identity as an ongoing participant in their social universe. The second part of my argument is that caregiving is a multifaceted and paradoxical endeavour. While caregiving can be a transformative and reciprocal practice of self-actualization (cf. Kleinman 2012; Kleinman and van der Geest 2009), at times it can also be troubled, ambivalent, and stressful (Cook and Trumble 2020). At its best, caregiving is a two-way street, enabling the maintenance of personhood for the care recipient, and validating the caregiver’s sense of ‘moral agency,’ or what medical anthropologist Neely Myers (2015, 13) defines as the capacity to be recognized in one’s local sphere as a good person who can make intimate connections to others. When caregiving goes awry, however, it leads to frustration, despair, and a sense of moral failure for the caregiver. For the care recipient, non-recognition and the loss of personhood can lead to social death and may also hasten physical decline. I conclude that for both professional and family caregivers of long-term care residents, systemic improvement of social and material support is needed to mitigate the challenges inherent in the recognition of personhood in caregiving relationships.

The Effects of the COVID-19 Pandemic on Pediatric Orthopedic Injuries: A Single-Center Retrospective Study.

The COVID-19 pandemic has had a profound effect on the pediatric population worldwide. The consequences of the lockdown and the reallocation of hospital resources have caused notable changes in the presentation of pediatric orthopedic injuries. Through our use of patient records, we were able to display the epidemiological trends, as well as analyze the changes in the type and mechanism of various injuries. Our purpose is to further understand the considerable effects of the COVID-19 pandemic on pediatric orthopedic trauma and help guide the allocation of future healthcare resources. We conducted a retrospective cohort study on pediatric patients admitted for any orthopedic injury over a 3-year period (September 2018 to August 2021) at a Midwest level 1 trauma center. Cases were stratified into two groups based on the United States' COVID-19 lockdown (19 March 2020): Pre-COVID-19 cases were any cases prior to the lockdown and Intra-COVID-19 which are cases following the lockdown. Numerical data and categorical variables were summarized and differences between the case groups were examined using either two-Proportion Z-Test, Independent Two-Sample t-test, Pearson's chi-squared, or Fisher's exact tests. A total of 3179 pediatric orthopedic referrals occurred between the Pre-COVID-19 and Intra-COVID-19 study periods. We observed a general decrease in orthopedic injuries following the COVID-19 lockdowns with 1235 injuries compared to 1606 Pre-COVID-19. Patterns in the locations of injuries changed; notably, fractures of the humerus, tibia, and fibula decreased significantly (p < 0.05). Several mechanisms of injuries decreased significantly following the onset of COVID-19 including injuries caused by monkey bars, basketball, and automobiles (p < 0.01). There was a significant increase in the overall injury severity during the Intra-COVID-19 period (p < 0.05). Although there was a reduction in acute orthopedic trauma referrals, many injury mechanisms displayed similar trends regardless of restrictions. We clinically observed an overall increase in the severity of pediatric orthopedic injuries during the COVID-19 pandemic.

Efficacy of community groups as a social prescription for senior health-insights from a natural experiment during the COVID-19 lockdown.

Loneliness and associated physical and cognitive health decline among the aging population is an important medical concern, exacerbated in times of abnormal isolation like the 2020-2021 Covid-19 pandemic lockdown. In this backdrop, recent "social prescribing" based health policy initiatives such as community groups as a support structure for the aging population assumes great importance. In this paper, we evaluate and quantify the impact of such social prescribing policies in combatting loneliness and related health degeneration of the aging population in times of abnormal isolation. To this end, we conduct a natural experiment across a sample of 618 individuals aged 65 and over with varying access to community groups during the Covid-19 lockdown period. Using a random-effects, probit model to compare the differences in health outcomes of participants with access to community groups (target) with those without access (control), we find that the target group was 2.65 times less likely to suffer from loneliness as compared to the control group, along with lower incidences of reported cardiovascular and cognitive health decline. These initial findings provide preliminary support in favor of the interventional power of social prescription tools in mitigating loneliness and its consequent negative health impact on the aging population.

Quantifying the impact of COVID-19 restrictions on air pollution in Ahvaz: a comparative dual-approach assessment of observed against baseline and forecasted criteria air pollutants.

In response to the COVID-19 pandemic, the Iranian government swiftly implemented immediate and decisive measures to control the spread of the infection. This study aims to demonstrate the impact of restriction measure on air pollution, also to highlight the potential variability in results that can arias from different methodological approach. A comprehensive dual-approach assessment was conducted to evaluate the effect of the lockdown measures on criteria air pollutants. Firstly, a traditional approach compared air quality during the pandemic period with baseline conditions from 2013 to 2019. Secondly, observed air pollution values during different periods with varying restrictions in 2020 were compared with expected values. This comprehensive analysis allows for a robust comparison and quantification of the impact of different lockdown measures in Ahvaz. The study revealed significant changes in air pollutant concentrations in Ahvaz during 2020, with variations observed across different pollutants. Notable reductions were observed in O3 levels, particularly in November (-54.44% compared to the baseline) and December (-63.58% compared to expected values). Decreases in CO levels were observed in multiple months, while substantial reductions in PM10 and PM2.5 were observed during various periods. Inconsistencies in the magnitudes and directions of changes were found when comparing baseline and forecasted values. The overall stringency index showed an inverse association with changes in O3, NO2, and CO, with international travel controls and restrictions on internal movement having significant impacts. This study provides valuable insights into the impact of COVID-19 lockdown measures on air pollution in Ahvaz, Iran, using a comprehensive dual-approach assessment. The findings highlight the effectiveness of these measures in reducing specific criteria air pollutants and emphasize the importance of implementing appropriate strategies for air quality management during similar public health emergencies.

Advances in research on medications for the treatment of alcohol use disorders: A review.

Alcohol use disorder (AUD) has become a global public health challenge, with the social and economic costs of alcohol abuse escalating, drawing widespread attention from healthcare professionals and the public worldwide. Particularly in recent years, the COVID-19 pandemic and associated lockdown measures have led to a significant increase in global alcohol consumption, further exacerbating the risk of AUD and sparking in-depth discussions on its prevention and treatment methods. Given that the current mainstay of AUD treatment relies on pharmacotherapy, the aim of this article is to review the progress of existing drug research for the treatment of AUD, and at the same time to focus on drug classes that have not yet been applied to the clinic, but have been shown in recent studies to be potentially exploitable for the treatment of AUD, in order to provide new ideas and directions for future drug research and development efforts.

A new normal? Streaming municipal assemblies on social media before, during and after the pandemic

This study aims at understanding the effects that the Covid-19 lockdowns had on the streaming of municipal assemblies via social media, whether those effects persisted after the pandemic, and what were the main determinants, motivations, and consequences of adopting that practice. To accomplish these goals, an exploratory mixed methods approach is used. Quantitative methods are used to assess the evolution of the number of municipalities streaming their assemblies and to identify determinants of adoption. Qualitative methods are used to capture the perception of relevant actors. Portugal is used as the case of study (308 municipalities). It was found that streaming of municipal assemblies was clearly triggered by the pandemic and the subsequent local elections, while being moderated by some of the factors that are known to be important for digital government development at the local level: demography, socioeconomic dynamism, citizen participation, and political environment. It was also found that streaming assemblies contributes to improve transparency, accountability, trust, proximity, and the public image of the bodies, albeit having no effect on the forms available for citizen participation. It also contributes to assembly members' interventions becoming more frequent, longer, targeted, and moderated. To the best of the authors knowledge, this is the first longitudinal study to address the streaming of municipal assemblies via social media.

The Impact of the COVID-19 Lockdown on Cancer Referrals in Primary Care in the UK: Two Years On

Background: Cancer is common, with most cancer patients presenting initially to a general practitioner. The COVID-19 pandemic led to changes in the delivery of primary care, which could have affected cancer referrals. This observational study looked at two-week cancer referrals (2WRs) made before, during and after the first UK COVID-19 lockdown in 2020, at a GP practice in the Wirral, England. Methods: A search was conducted to find the cancer referrals made between 23rd March 2020 - 1st July 2020, during the first lockdown. Using the same methodology, cancer referral data was collected for the corresponding time periods in 2019 and 2021. The number of 2WRs and positive diagnostic yields were then compared. Results: The number of cancer referrals decreased by 40.4% in 2020, compared to 2019. In 2021, the number of referrals then increased by 225%, compared to 2020. Overall, the number of cancer referrals increased between 2019-2021. The positive diagnostic yield for the 2020 2WRs increased by 251.4%, compared to that of 2019. The calculated yield for the 2021 data then decreased by 10.8% compared to 2020. Overall, the positive diagnostic yield increased between 2019-2021. Conclusion: The numbers and outcomes of cancer referrals at this Wirral GP practice have changed considerably following the first UK COVID-19 lockdown in 2020, and the influence of the pandemic was still affecting cancer referrals in 2021. A greater focus on early cancer detection in primary care could help overcome the ways in which the pandemic has affected primary care delivery.

Tracking continuous positive airway pressure adherence in obstructive sleep apnea patients before, during, and after the COVID-19 lockdown

Abstract: BACKGROUND: This study aimed to examine the impact of the COVID-19 lockdown on adherence to continuous positive airway pressure (CPAP) therapy among Saudi patients with obstructive sleep apnea (OSA). It also sought to assess the influence of demographic variables and comorbidities on CPAP adherence. METHODS: A prospective cohort study was conducted at the University Sleep Disorders Center at King Saud University Medical City. The study included 67 OSA patients who exclusively used CPAP for treatment across three distinct intervals prelockdown, during lockdown, and postlockdown. Adherence to CPAP therapy was objectively measured using “mask-on on-time monitoring” data from the CPAP machines. RESULTS: The study found a significant decrease in the number of days with CPAP usage during the lockdown period, which persisted postlockdown. Approximately half of the patients adhered to CPAP treatment throughout the three study intervals. The decrease in CPAP usage days during lockdown was particularly noticeable among patients younger than 50 and older than 65 years of age. The presence of comorbidities, body mass index, and sex did not significantly influence CPAP treatment adherence. CONCLUSION: The COVID-19 lockdown significantly impacted CPAP treatment adherence among OSA patients, with a decrease in adherence persisting postlockdown. This highlights the need for interventions to support CPAP adherence during challenging times such as a pandemic. Further research is needed to understand the long-term effects of the pandemic on CPAP therapy adherence.

Increased adult movements and decreased juvenile apparent survival of urban crows during COVID-19 lockdowns

The increasing abundance of animal species thriving in urban environments is a source of conflicts with managers and users of public spaces. Although opportunistic urban species often use resources originating from human food leftovers, the potential impact of a reduction in these resources on their demography is hard to quantify. The COVID-19 epidemic, which led many countries to set up lockdowns, gave us the opportunity to estimate the impact of a drastic reduction in such food resources and human activities on the demography of an urban bird population. Based on 7 years (2015–2021) of capture-mark-recapture of carrion crows (Corvus corone) in the city of Paris, France, we used multi-state models to examine the intra-annual (3-month time steps) apparent survival and movement patterns of crows during and outside COVID-19 lockdowns. We showed that the apparent survival of juvenile carrion crows decreased down during lockdown, while adult movements increased during this period, with more adult crows moving out of the urban district. Lockdown modified the demography of this urban crow population, suggesting that the reduction in food resources was sufficient to affect fitness and reduce carrying capacity.

Impact of COVID-19 lockdown on water quality of major rivers in Sri Lanka

ABSTRACT The COVID-19 lockdown resulted in a reduction in human activities, lowering pollution levels in these rivers. Nevertheless, limited research can be found on the impact of COVID-19 on river water quality in Sri Lankan rivers. Therefore, this research was carried out to investigate the water quality index (WQI) of four major rivers (Mahaweli, Nilwala, Kelani, and Kalu) in Sri Lanka in three consecutive time slots spanning from 2019 to 2022 (before, during, and after the lockdown). In-depth WQI analysis has unveiled nuanced dynamics in river health. While the lockdown period contributed to positive alterations in key parameters, subsequent periods demonstrated declining water quality post-lockdown. This decline underscores the direct correlation between human activity and river water quality deterioration. Several parameters showed positive changes during the lockdown, indicating an improvement in river water quality. When comparing the periods before, during, and after the lockdown, pH, colour, turbidity, total iron, sulphate, chloride, total coliform, and E. coli all showed a significant positive impact. However, some parameters, such as fluoride and electrical conductivity (EC), had a neutral effect. This study sheds light on the positive effects of the COVID-19 lockdown on reducing river pollution in Sri Lanka.

The Effects of Air Quality and the Impact of Climate Conditions on the First COVID-19 Wave in Wuhan and Four European Metropolitan Regions

This paper investigates the impact of air quality and climate variability during the first wave of COVID-19 associated with accelerated transmission and lethality in Wuhan in China and four European metropolises (Milan, Madrid, London, and Bucharest). For the period 1 January–15 June 2020, including the COVID-19 pre-lockdown, lockdown, and beyond periods, this study used a synergy of in situ and derived satellite time-series data analyses, investigating the daily average inhalable gaseous pollutants ozone (O3), nitrogen dioxide (NO2), and particulate matter in two size fractions (PM2.5 and PM10) together with the Air Quality Index (AQI), total Aerosol Optical Depth (AOD) at 550 nm, and climate variables (air temperature at 2 m height, relative humidity, wind speed, and Planetary Boundary Layer height). Applied statistical methods and cross-correlation tests involving multiple datasets of the main air pollutants (inhalable PM2.5 and PM10 and NO2), AQI, and aerosol loading AOD revealed a direct positive correlation with the spread and severity of COVID-19. Like in other cities worldwide, during the first-wave COVID-19 lockdown, due to the implemented restrictions on human-related emissions, there was a significant decrease in most air pollutant concentrations (PM2.5, PM10, and NO2), AQI, and AOD but a high increase in ground-level O3 in all selected metropolises. Also, this study found negative correlations of daily new COVID-19 cases (DNCs) with surface ozone level, air temperature at 2 m height, Planetary Boundary PBL heights, and wind speed intensity and positive correlations with relative humidity. The findings highlight the differential impacts of pandemic lockdowns on air quality in the investigated metropolises.

Understanding the impact of pandemics on long-term medication adherence: directly observed therapy in a tuberculosis treatment cohort pre- and post-COVID-19 lockdowns

BackgroundThe COVID-19 pandemic negatively impacted tuberculosis (TB) treatment services, including directly observed therapy (DOT) programs used to promote medication adherence. We compared DOT adherence embedded in a research study before and after COVID-19 lockdowns in South Africa.MethodsWe analyzed data from 263 observational study participants undergoing drug susceptible (DS)-TB DOT between May 2017 to March 2022. Participants enrolled before October 2019 were considered ‘pre-COVID-19’ and those enrolled after September 2020 were considered ‘post-COVID-19 lockdown groups. Negative binomial regression models were used to compare DOT non-adherence rates between the two lockdown groups. We then conducted a sensitivity analysis which only included participants enrolled in the immediate period following the first COVID-19 lockdown.ResultsDOT non-adherence rate was higher in the post-COVID-19 lockdown group (aIRR = 1.42, 95% CI = 1.04–1.96; p = 0.028) compared to pre-COVID-19 lockdown period, adjusting for age, sex, employment status, household hunger, depression risk, and smoked substance use. DOT non-adherence was highest immediately following the initial lockdown (aIRR = 1.74, 95% CI = 1.17–2.67; p = 0.006).ConclusionThe COVID-19 lockdowns adversely effected adherence to TB DOT in the period after lockdowns were lifted. The change in DOT adherence persisted even after adjusting for socioeconomic and behavioral variables. We need a better understanding of what treatment adherence barriers were exacerbated by COVID-19 lockdowns to improve outcomes in post-pandemic times.Trial registrationClinicalTrials.gov Registration Number: NCT02840877. Registered on 19 July 2016.

Adolescent and young adult sleep and sleep-related behaviour change before and during the COVID-19 pandemic lockdown in Canada

ABSTRACT Background Sleep disturbance is common in adolescents and young adults (AYAs), impacted by stress and academic/scheduling demands that conflict with biological phase delay. COVID-19 lockdowns allowed us to study sleep in AYAs when there are lessened scheduling demands. Additionally, we could test whether a sleep self-management app was helpful during lockdowns. Method AYAs (ages 15–24 years) before (Pre-Lockdown; n = 65) and during lockdowns in Canada (Lockdown; n = 40) completed sleep diaries on the app; set goals based on generated feedback; and completed more sleep diaries pursuing whatever post-feedback goals they set. Results The Lockdown group reported later and less variable rise times (RT) and spent more time in bed (TIB), both awake and asleep. Pre-Lockdown set a goal to reduce RT variability whereas Lockdown set a goal to decrease TIB, and AYAs made behaviour changes to meet their goals. For both groups, sleep onset, duration of awakenings, sleep duration and efficiency, and insomnia severity significantly improved at endpoint. Conclusions AYAs slept differently during lockdowns, perhaps due to decreased scheduling. The pandemic revealed the need for accessible strategies to improve sleep health. Findings support the feasibility of using evidence-based apps, and that AYAs can effectively use self-management tools across variable global and social contexts to improve their sleep.

Incidence, Antibiogram, and Comorbid Conditions of Nontyphoidal Salmonella Infections Before and After the COVID-19 Outbreak: A Retrospective, Cross-sectional Study

Abstract Background: The number of patients with diarrheal diseases admitted to the hospital was reduced during the COVID-19 lockdown. Following the relaxation of the lockdown, admissions of nontyphoidal Salmonella (NTS) infection showed a two-fold rise compared to pre-COVID-19 years. This retrospective study aimed to detect the incidence of NTS in the pre-COVID-19 and post-COVID-19 outbreak periods, along with describing the antibiogram and comorbid conditions of the patients. Materials and Methods: Using a retrospective design, from January 2015 to December 2022, we studied stool samples for the presence of NTS. Antibiogram with ampicillin, co-trimoxazole, ceftriaxone, chloramphenicol, and ciprofloxacin were studied. The presence of comorbid conditions was noted. Results: We examined 2312 and 937 stool samples collected during the pre-COVID-19 and post-COVID-19 outbreak period, respectively. The number of samples collected during the outbreak (2020) was 273. During the pre-COVID-19 period (2015–2019), the average annual isolation rate of NTS was 5.63%. During the lockdown of 2020, the corresponding rate was 5.49%. The isolation rate showed a significant rise (11.45%) during the relaxation of the lockdown (P &lt; 0.001). No significant change in resistance to antibiotics other than ciprofloxacin was noted in the present study. Malignancy was the leading comorbid condition (11.91%) followed by chronic liver diseases (10.31%). Conclusions: A significant rise in NTS diarrheal cases was detected following the COVID-19 outbreak. During this period, people were attending more celebrations and feasts. No significant change in antibiotic resistance was noted when comparing pre-COVID-19 and COVID-19 periods. Malignancy was the leading comorbid condition.

The Value of a Peer Mentorship Programme for Postgraduate Students in New Zealand: A Qualitative Study

AbstractPostgraduate students face significant challenges such as feelings of isolation, lack of guidance, and negotiating multiple identities. Navigating these challenges can adversely impact wellbeing, self-efficacy, and achievement. To combat these issues, a peer mentorship ‘buddy’ programme was piloted. This buddy programme formed buddy groups, consisting of one doctoral student (as the buddy group leader) with three to four pre-doctoral postgraduate students (as the buddies), which met fortnightly during the semester. Ten participants engaged in semi-structured interviews, and the transcripts were analysed using a thematic analysis approach. Identified benefits to participants of the buddy programme included improved social resources, expanded skillsets, improved confidence, increased enjoyment and motivation, career advancement, improved ability to navigate postgraduate applications, improved sense of belonging, improved coping through COVID-19 lockdowns, and increased collegiality. More specifically, benefits of the buddy programme, as voiced by the participants, included gains in wellbeing, academic attainment, and resilience. Given the estimated cost of NZD$400 per buddy group, as well as the openly provided resources developed from this study, tertiary institutions may consider implementing similar low-cost programmes to support their postgraduate student populations.

The complex chemical effects of air pollutants, meteorology and dust on the concentrations of criteria and non-criteria air pollution in Kuwait

Air pollution is the leading environmental health risk factor globally. A number of cities experienced improvements in air quality during the COVID-19 lockdown; however such changes depend on the contributions from natural and anthropogenic sources and meteorological factors pertaining to each city. This study investigated the effects of anthropogenic and meteorological factors on air quality in Kuwait during the COVID-19 lockdown (22 March–10 May 2020) using mixed-effect regression and machine learning models. Criteria (PM2.5, PM10, NO2, O3, SO2, CO) and non-criteria (C6H6, NH3, H2S, NMHC) air pollutants were compared between the lockdown period, and the same period in the preceding and the following years, 2019 and 2021, respectively. The results showed that during the lockdown three criteria air pollutants (PM2.5, NO2, CO) were reduced by 38, 40, 26%, respectively. All no-criteria air pollutants were reduced, except for H2S. The arid region’s harsh desert conditions have major contributions to particulate pollution. Although PM levels are overwhelmed by meteorological and natural dust, stringent abatement measures on oil/gas hydrocarbon and power plant emissions can significantly reduce PM and other pollutants. Abatement measures on traffic pollution can further reduce the NO2 levels. This study highlights Kuwait's ongoing struggle with elevated levels of particulate and gaseous pollution, driven by hydrocarbon emissions and dust. Effectively tackling air quality requires a nuanced understanding of the interplay between air pollutants, meteorological, and dust covariates.

Impact of natural disasters on HIV risk behaviors, seroprevalence, and virological supression in a hyperendemic fishing village in Uganda.

Understanding the impact of natural disasters on the HIV epidemic in populations with high HIV burden is critical for the effective delivery of HIV control efforts. We assessed HIV risk behaviors, seroprevalence, and viral suppression in a high HIV prevalence Lake Victoria fishing community before and after COVID-19 emergence and lockdown and a severe lake flooding event, both of which occurred in 2020. We used data from the largest Lake Victoria fishing community in the Rakai Community Cohort Study, an open population-based HIV surveillance cohort in south-central Uganda. The data were collected both prior to (September-December 2018) and after (October-December 2021) COVID-19 emergence and a severe flooding event. Households impacted by flooding were identified via drone data and through consulting village community health workers. The entire study population was subject to extensive COVID-19-related lockdowns in the first half of 2020. Differences in HIV-related outcomes before and after COVID, and between residents of flooded and non-flooded households, were assessed using a difference-in-differences statistical modeling approach. A total of 1,226 people participated in the pre- and post-COVID surveys, of whom 506 (41%) were affected by flooding. HIV seroprevalence in the initial period was 37% in flooded and 36.8% in non-flooded households. After the COVID-19 pandemic and lockdown, we observed a decline in HIV-associated risk behaviors: transactional sex declined from 29.4% to 24.8% (p = 0.011), and inconsistent condom use with non-marital partners declined from 41.6% to 37% (p = 0.021). ART coverage increased from 91.6% to 97.2% (p<0.001). There was 17% decline in transactional sex (aPR = 0.83, 95% CI: 0.75-0.92) and 28% decline in the overall HIV risk score (aPR = 0.83, 95% CI: 0.75-0.92) among HIV-seronegative participants. We observed no statistically significant differences in changes of HIV risk behavior, seroprevalence, or viral suppression outcomes when comparing those affected by floods to those not affected by floods, in the periods before and after COVID-19, based on difference-in-differences analyses. Despite a high background burden of HIV, the COVID-19 pandemic, and severe flooding, we observed no adverse impact on HIV risk behaviors, seroprevalence, or virologic outcomes. This may be attributed to innovative HIV programming during the period and/or population resilience. Understanding exactly what HIV programs and personal or community-level strategies worked to maintain good public health outcomes despite extreme environmental and pandemic conditions may help improve HIV epidemic control during future natural disaster events.

Effect of stressors during COVID-19 lockdown on malnutrition and health-risk behaviors among Jordanian college students: A cross-sectional study.

A stressful condition such as the emergence of the coronavirus and its related lockdown measures might trigger alterations in college students' behaviors. This cross-sectional study aimed to identify the changes in college students' dietary and lifestyle behaviors during the lockdown and the effect of lockdown-related stressors on health-risk behaviors. A web-based survey was conducted among undergraduate college students in Jordan. Weight and height were reported by the students. The students' dietary and lifestyle behaviors and their changes during 1 month of the countrywide lockdown were assessed. The Perceived Stress Scale-4 was utilized to assess stress levels. Results indicated that 77.2% of the students reported weight changes. Notably, 45.9% increased their intake of unhealthy food, while and 38% opted for healthier food choices. Most students experienced alterations in physical activity (80.0%), screen time (86.2%), smoking, and sleep patterns (85.4%), with a higher tendency toward adopting health-risk behaviors. Perceptions of curfew-related stress were associated with distance learning-related stress (OR = 2.73, CI: 1.08-6.90, P = .034), and a greater change in physical activity (OR = 3.59, CI: 1.36-9.48, P = .010). Additionally, weight changes were associated with perception of other types of stressors (OR = 3.39, CI: 1.39-8.28, P = .007). Overall, there was a considerable increase in malnutrition and health-risk behaviors among students during the lockdown. Understanding students' responses to these stressful conditions and the role of stress in driving behavioral changes are crucial for developing interventions that enhance college students' adaptation to such changes and maintaining healthy dietary and lifestyle behaviors in the future.