Epidemic Period Research Articles

The impact of COVID-19 epidemic on emergency department visits of older patients in Taiwan

BackgroundThe number of emergency department (ED) visits has significantly declined since the COVID-19 pandemic. In Taiwan, an aged society, it is unknown whether older adults are accessing emergency care during the COVID-19 epidemic. Therefore, this study aimed to investigate the impact of COVID-19 on the ED visits and triage, admission, and intensive care unit (ICU) hospitalization of the geriatric population in a COVID-19-dedicated medical center throughout various periods of the epidemic.MethodsA retrospective chart review of ED medical records from April 9 to August 31, 2021 were conducted, and demographic information was obtained from the hospital’s computer database. The period was divided into pre-, early-, peak-, late-, and post-epidemic stages. For statistical analysis, one-way analysis of variance followed by multiple comparison tests (Bonferroni correction) were used.ResultsA statistically significant decrease in the total number of patients attending the ED was noted during the peak-, late-, and post-epidemic stages. In the post-epidemic stage, the number of older patients visiting ED was nearly to that of the pre-epidemic stage, indicating that older adults tend to seek care at the ED earlier than the general population. Throughout the entire epidemic period, there was no statistically significant reduction in the number of the triage 1& 2 patients seeking medical attention at the emergency department. In the entire duration of the epidemic, there was no observed reduction in the admission of elderly patients to our hospital or ICU through the ED. However, a statistically significant decrease was observed in the admission of the general population during the peak epidemic stage.ConclusionsDuring the peak of COVID-19 outbreak, the number of ED visits was significantly affected. However, it is noteworthy that as the epidemic was gradually controlled, the older patients resumed their ED visits earlier that the general population as indicated by the surge in their number. Additionally, in the patient group of triage 1& 2, which represents a true emergency, the number did not show a drastic change.

Rational use of drugs to alleviate adverse outcomes caused by COVID-19 quarantine in women with intrahepatic cholestasis of pregnancy.

This study aimed to investigate the impacts of home quarantine on pregnancy outcomes of women with intrahepatic cholestasis of pregnancy (ICP) during the COVID-19 outbreak and whether the rational use of drugs will change these impacts. This multi-center study was conducted to compare the pregnancy outcomes in women with ICP between the home quarantine group and the non-home quarantine group in southwest China. Propensity score matching was performed to confirm the pregnancy outcomes of the medication group and the non-medication group in women with ICP during the epidemic period. A total of 3,161 women with ICP were enrolled in this study, including 816 in the home quarantine group and 2,345 in the non-home quarantine group. Women with ICP in the home quarantine group had worse pregnancy outcomes, such as a growing risk of gestational diabetes mellitus A1, fetal growth restriction, pre-eclampsia, preterm delivery, and even stillbirth. Drug therapy could alleviate some adverse pregnancy outcomes caused by home quarantine, including pre-eclampsia, preterm delivery, and meconium-stained amniotic fluid. COVID-19 quarantine would increase the incidence of ICP and lead to adverse pregnancy outcomes in women with ICP. The rational use of drugs reduced some obstetrical complications and improved partial pregnancy outcomes. Our findings suggested that the government and hospitals should enhance their management and life guidance for women with ICP and speed up developing home quarantine guidelines.

A study on the impact of COVID-19 class suspension on college students’ emotions based on affective computing model

Abstract This paper uses affective computing and mood measures to calculate the negative emotional status of college students during school closures. The psychological data of university students at the University of H were counted using the affective computing model and psychometric methods, the frequency of their negative emotion words was mined, and the changes of each psychometric index were analyzed in terms of the time dimension, stressor, anxiety status, and emotional state, respectively. The epidemic closure period had a great negative impact on students. From January 20 to December 20, 2021, college students’ positive mood characteristic value declined. The negative mood characteristic value increased, and the negative mood characteristic value was always higher than the positive mood characteristic value. Finally, the negative mood characteristic value of 0.27 was much higher than the positive mood characteristic value of 0.07, and there were various discomforts such as about 40% of people were nervous, depressed, lacked motivation, and had diminished interest; at the same time, feelings of difficulty in accomplishing goals, failure, fear, anxiety, and frustration emerged. The epidemic closure greatly impacted students’ psychology, and students’ psychological problems need to be taken seriously and receive timely guidance.

Changes in Influenza Activities Impacted by NPI Based on 4-Year Surveillance in China: Epidemic Patterns and Trends.

Since the Non-pharmaceutical Intervention (NPI) by COVID-19 emerged, influenza activity has been somewhat altered. The aim of this study was to explore changes in influenza activities in the context of COVID-19 based on the sentinel hospitals/units in Guangdong, southern China. The surveillance data in influenza-like illness (ILI) were collected from 21 cities in Guangdong between September 2017 and August 2021, while 43 hospitals/units were selected to analyze the predominant types of influenza, population characteristics, and seasonal features by three methods (the concentration ratio, the seasonal index, and the circulation distribution), based on a descriptive epidemiological approach. During the four consecutive influenza seasons, a total of 157345 ILIs were tested, of which 9.05% were positive for influenza virus (n = 14238), with the highest positive rates for both IAV (13.20%) and IBV (5.41%) in the 2018-2019 season. After the emergence of COVID-19, influenza cases decreased near to zero from March 2020 till March 2021, and the dominant type of influenza virus changed from IAV to IBV. The highest positive rate of influenza existed in the age-group of 5 ~ < 15years in each season for IAV (P < 0.001), which was consistent with that for IBV (P < 0.001). The highest annual positive rates for IBV emerged in eastern Guangdong, while the highest annual positive rates of IAV in different seasons existed in different regions. Furthermore, compared with the epidemic period (ranged from December to June) during 2017-2019, the period ended three months early (March 2020) in 2019-2020, and started by five months behind (April 2021) during 2020-2021. The highest positive rates in 5 ~ < 15 age-group suggested the susceptible in this age-group mostly had infected with infected B/Victoria. Influenced by the emergence of COVID-19 and NPI responses, the epidemic patterns and trends of influenza activities have changed in Guangdong, 2017-2021.

Age-specific severity of severe acute respiratory syndrome coronavirus 2in February 2020 to June 2021 in the Netherlands.

The severity of Severe Acute Respiratory Syndrome Coronavirus 2 infection varies with age and time. Here, we quantify how age-specific risks of hospitalization, intensive care unit (ICU) admission, and death upon infection changed from February 2020 to June 2021 in the Netherlands. A series of large representative serology surveys allowed us to estimate age-specific numbers of infections in three epidemic periods (late-February 2020 to mid-June 2020, mid-June 2020 to mid-February 2021, and mid-February 2021 to late-June 2021). We accounted for reinfections and breakthrough infections. Severity measures were obtained by combining infection numbers with age-specific numbers of hospitalization, ICU admission, and excess all-cause deaths. There was an accelerating, almost exponential, increase in severity with age in each period. The rate of increase with age was the highest for death and the lowest for hospitalization. In late-February 2020 to mid-June 2020, the overall risk of hospitalization upon infection was 1.5% (95% confidence interval [CI] 1.3-1.8%), the risk of ICU admission was 0.36% (95% CI: 0.31-0.42%), and the risk of death was 1.2% (95% CI: 1.0-1.4%). The risk of hospitalization was significantly increased in mid-June 2020 to mid-February 2021, while the risk of ICU admission remained stable over time. The risk of death decreased over time, with a significant drop among ≥70-years-olds in mid-February 2021 to late-June 2021; COVID-19 vaccination started early January 2021. Whereas the increase in severity of Severe Acute Respiratory Syndrome Coronavirus 2 with age remained stable, the risk of death upon infection decreased over time. A significant drop in risk of death among elderly coincided with the introduction of COVID-19 vaccination.

Performance analysis of interactive cascade ventilation combined with solar energy for the epidemic prevention and control

Increasing low-grade and renewable energy sources in the HVAC systems has become necessary to reduce heating energy consumption. Hence, seeking a new air conditioning system that can be combined with renewable energy is significant to maintain a healthy and comfortable indoor environment with a low cost. This paper proposes a novel air source heat pumps assisted solar hot water with interactive cascade ventilation system (shortened as SWAP-ICV). Taking the traditional air source heat pumps with mixing ventilation system (AP-MV) as a reference, the virus control performance and energy efficiency of SWAP-ICV is investigated through CFD and TRNSYS simulations. The results demonstrate that interactive cascade ventilation under full-fresh air operation mode and normal-epidemic linkage mode can make the annual infection risk reduce by 41.16% and 9.33% compared with mixing ventilation under full-fresh air operation mode. Meanwhile, the proposed system can reduce energy consumption by 59.92% and 69.8% during the normal period and epidemic period by introducing solar energy. The average system COP during the heating season indicates that SWAP-ICV can improve the system efficiency by 1.9–2.58 times than AP-MV system. The conclusions obtained from this research can provide new ideas for the design and operation of air conditioning systems in the post-epidemic era.

Assessing the competitiveness of solar photovoltaic products in comprehensive and progressive agreement for trans-pacific partnership countries.

Solar PV enables the conversion of solar energy into electricity and has become a clean energy technology for economic development. The advantages and disadvantages of solar photovoltaic vary among CPTPP member nations; nevertheless, since the CPTPP's implementation, fewer researchers have evaluated the member countries' solar photovoltaic goods' level of international competitiveness. In order to correct the flaw that the RCA index can only be studied from trade volume, this study adopts the IRCA index method and the revised CMS model, which integrates a number of variables to analyze the competitiveness of solar photovoltaic in each country. The study's findings indicate that: (1) the structural effect has a significant impact on export growth, particularly during the epidemic period, when Australia's contribution rate reached 106.58%; (2) the competitiveness effect has a lesser impact on export growth, and the epidemic led to a decline in competitiveness, with Japan's contribution rate reaching -262.85%; (3) the second-order effect has a declining trend in its contribution rate of export growth; (4) the export competitiveness of solar PV products differs between CPTPP countries, with power supply products having the most export competitiveness and solar cells having a steady comparative advantage in a weaker state. Apart than Japan, the remaining nations' comparative advantages for PV products are less than 1. Based on the above research findings, this paper puts forward the corresponding policy recommendations.

Health and safety challenges in medical entities and the powers of the social labor inspector: Lessons related to the COVID-19 outbreak in the context of internal control of employee health and safety

Employees in the medical profession in a situation where the life of a patient is at risk cannot refrain from working due to unsafe working conditions. Therefore, enforcing the right to safe and hygienic working conditions is particularly important so that employees can provide health care services without additional burdens. The purpose of the study is to determine how the social labour inspector can respond to Occupational Health and Safety (OHS) hazards and whether the current powers of the social labor inspectorate as the employer's internal OHS control body are sufficient. The study conducted a regulatory analysis and used relevant literature, including recent studies on law enforcement. In addition, a questionnaire survey was conducted among trade union representatives of medical professionals on the evaluation of social labour inspector activities and OHS hazards during the COVID-19 epidemic period. In this period characterized by many OHS risks in medical entities, the difficulties faced by employers in carrying out their duty to protect the health of their employees became apparent. The system of internal control with the participation of the social labour inspection in this context needs changes, due to the fact that it is used in an inefficient manner. The reasons for this are primarily incomplete legal regulations. The legislator should guarantee the social labour inspector the right to use both methods of rewarding the employer as an incentive for the proper performance of duties and measures to deter violations of the law. Despite the fact that Polish labour law guarantees mechanisms for OHS control by the social labour inspector, it would be appropriate to expand the catalog of measures used by him to effectively motivate employers to protect worker health. This study is a prelude to a broader discussion of OHS monitoring in the context of OHS hazards occurring in healthcare entities. Med Pr Work Health Saf. 2023;74(4):301-16.

Outbreak of adenovirus D8 in a neonatal intensive care unit involving multiple simultaneous transmission pathways

Adenovirus (ADV) outbreaks in neonatal intensive care units (NICU) can lead to durable transmission and serious adverse outcomes. This study describes the investigation and control of an ADV-D8 outbreak in an NICU, associated with ophthalmologic equipment used during retinopathy of prematurity (ROP) screening. Cases were observed in neonates, parents and nurses. The outbreak investigation was performed including sampling patients, parents and health care workers as well as the environment for molecular detection of ADV DNA. The investigation was also conducted in the guest house where some parents were temporary residents. A retrospective cohort study focused on neonates hospitalized during the epidemic period to assess the risk associated with ROP examination. Fifteen cases were identified in neonates; all but one presented with conjunctivitis. Two healthcare workers and 18 parents acquired conjunctivitis. ADV DNA was identified on the RetCam and on the freezer shared by parents. All ADV-positive samples were typed as ADV-D8. ADV infections occurred more frequently in neonates who had ROP examinations (37.8% (14/37) vs (0.9% (1/110); P<0.001) (relative risk 41.6; (5.7-305.8)). The RetCam was disinfected between two examinations using a disinfectant that was virucidal on ADV after a 30-min contact. This outbreak was significantly associated with ROP examination with a RetCam that had a disinfection protocol ill-adapted to rapid patient turnover. In addition, nosocomial transmission via the parents to neonates and parent-to-parent transmission is likely to have played a role in the dissemination of cases. No further cases were observed after the new disinfection procedure was enforced.

FISCAL POSITION OF THE UNION BUDGET IN INDIA DURING COVID-19

The present study analyzes the fiscal position as an instrument to measure the amount of government borrowing to require the financial position and their budget shortfall. This study traces the major current changes in the Indian fiscal system during the period 2019-22, though the union's Government adopt the fiscal rule to reduce the financial crisis during the epidemic period of Covid-19. However, the current study also traces the percentage of GDP decrease because of the problem of lockdown during Covid-19 and also studies the budget position in India. The paper concludes with a discussion on the composition of union government receipts and expenditure position in the current scenario and indicated the situation of fiscal and revenue deficit of the government budget. Finally argue that subsidy rationalization is the way forward to fund the much-needed health expenditures and transfers while maintaining fiscal discipline.

Exclusion of pregnant people from emergency vaccine clinical trials: A systematic review of clinical trial protocols and reporting from 2009 to 2019

BackgroundExisting ethics guidance and regulatory requirements emphasize the need for pregnancy-specific safety and efficacy data during the development of vaccines in health emergencies. Our objective was to conduct a systematic review of vaccine clinical trials during active epidemic periods. MethodsWe searched for Phase II and Phase III vaccine clinical trials initiated during the H1N1 influenza, Middle East Respiratory Syndrome Coronavirus (MERS-CoV), Zika, and Ebola virus disease (EVD) outbreaks from 2009 to 2019. Data were extracted from clinical trial protocols identified in the following registries: ClinicalTrials.gov, Pan African Clinical Trial Registry (PACTR), and all primary registries indicated by the World Health Organization’s International Clinical Trials Registry Platform (ICTRP). Published studies from registered clinical trials were located through PubMed. Data was extracted on eligibility criteria and pregnancy outcomes. Data from this study is available in the Center for Open Science Data Repository: https://osf.io/nfk2p/?view_only=47deb3b206724af9b46c9c0c0083a267. ResultsWe identified 96 vaccine clinical trial protocols and included 84 in analysis. 5 records were excluded in screening for irrelevant abstracts, 7 were excluded in full-text assessment (1 for a therapeutic drug trial, 3 for enrolling elderly adults only, 3 for enrolling children/adolescents only). There were no eligible trials for MERS-CoV or Zika virus vaccines. Overall, 8 protocols explicitly included pregnant people; of these, 3 were completed trials with published results. Incidental pregnancies and outcomes of pregnant participants were reported in 2 studies, 10 studies reported serious adverse events related to pregnancy without mentioning total incidental pregnancies. A total of 411 recorded pregnancy outcomes were reported, with 293 from the 3 pregnancy-eligible studies with results. 71 serious adverse events pertaining to pregnancy were reported from all clinical trials with results. ConclusionPregnant people are underrepresented in vaccine clinical trials conducted during outbreaks, resulting in underreporting of pregnancy-related outcomes and a lack of protection for pregnant people and neonates from infectious diseases.

Epidemiological characteristics of tick-borne infectious diseases in Hubei Province, 2016-2021

Objective: To understand the epidemiological characteristics of tick-borne infectious diseases (TBID) and the risk factors of severe illness and death in Hubei Province from 2016 to 2021. Methods: Based on the incidence data of fever with thrombocytopenia syndrome (SFTS), tsutsugamushi disease, typhus and other TBID reported during 2016-2021, the epidemiological analysis was conducted. Field investigation results of TBID in areas with high incidence in 2021, logistic regression analysis of population characteristics, epidemiological history and other factors were used to explore the risk factors of severe and fatal cases. In the field vector investigation, free ticks and surface ticks of the host animals in the cases' home and surrounding grassland were monitored and detected. Results: A total of 3 826 TBID cases were reported in Hubei from 2016 to 2021, of which 71.30% (2 728/3 826) were SFTS, 13.04% (499/3 826) were tsutsugamushi disease and 15.66% (599/3 826) were typhus. A total of 44 cases died in 6 years; the fatality rate was 1.15% (44/3 826). In the peak seasons of incidence from May to July, the cases in people engaged in agriculture related work accounted for 84.61% (3 237/3 826). The incidence rate in women was higher than that in men, and the cases aged ≥50 years accounted for 81.02% of the total (3 100/3 826), and the incidence rate increased with age (P<0.001). The TBID cases were distributed in 86 counties and districts in 16 prefectures (municipality). The incidence rates of different areas had significant differences (P<0.05), and there was a certain spatial-temporal clustering and expasion. Bovis microplus and Haemaphysalis longicornis were captured in the field, and the positive rates in host animals and grassland ticks were 10.94% (7/64) and 40.00% (2/5), respectively. Univariate logistic regression analysis results showed that age ≥50 years and leukocyte <2.0×109/L were risk factors for severe illness and death. Conclusions: The TBID reported in Hubei were mainly SFTS, tsutsugamushi disease and typhus. In order to reduce the incidence of TBID, it is necessary to strengthen the prevention and control in women aged ≥50 years and reduce field exposure and tick bites during the epidemic period.

Characteristics of VOCs and Assessment of Emission Reduction Effect During the Epidemic Lockdown Period in Shenzhen Urban Area

To prevent disease spreading during the COVID-19 epidemic, Shenzhen adopted lockdown measures in March of 2022. This provided an opportunity to study the response of changes in anthropogenic volatile organic compounds (AVOCs) in Shenzhen to emission reduction and to evaluate the effectiveness of current emission reduction measures. This study analyzed the variety of AVOCs before, during, and after the epidemic lockdown based on the online observation data of pollutants at Lianhua Station in Shenzhen from March 7, 2022 to March 27, 2022. Additionally, the sensitivity of ozone formation and the assessment of the reduction effect of precursors was conducted by an observation based model(OBM). The results showed that:affected by regional influences and the interference of meteorological conditions, the average value of AVOCs in Shenzhen urban areas did not drop significantly during the lockdown period compared to that before the lockdown. However, the peak of AVOCs at the morning peak time under the influence of "sea and land wind" during the epidemic lockdown period dropped by 46% on average compared with that during the non-lockdown period, and the aromatic hydrocarbon component dropped the most by 59%. Additionally, under the influence of continuous easterly wind, or during the accumulation and increase of AVOCs affected by regional transmission, aromatic components also decreased by an average of 25% and 21%, respectively. During the lockdown period of the epidemic in Shenzhen, the O3 formation in urban areas was still AVOCs-limited. Increasing the emission reduction ratio of AVOCs was the most effective measure to reduce O3 in the short term. In order to ensure the effectiveness of emission reduction, it was recommended that the coordinated emission reduction ratio of AVOCs and NOx should be greater than 1:2. It was only possible to enter the downward channel of O3 if the deep emission reduction was more than 60%. This study revealed that the emission reduction of AVOCs during the morning traffic peak during the epidemic lockdown period was conducive to inhibiting the formation of O3, whereas the control of NOx would promote it. Strengthening the control of local aromatic hydrocarbon components during the regional impact process could also significantly reduce O3 production. At this stage, Shenzhen should strengthen the management and control of industrial solvents, especially to reduce the aromatic hydrocarbon components in the solvent source that have a greater impact on the generation of O3. Further, Shenzhen should continue to promote the reform of the energy structure of motor vehicles to reduce the emission of VOCs in fuel combustion.

Spatial prediction of PM[formula omitted] concentration using hyper-parameter optimization XGBoost model in China

High-fine particulate matter (PM2.5) pollution has become the main object of damaging the atmospheric environment and endangering human health. Accurate prediction of the spatial variability of PM2.5 concentrations using high-performance models is crucial for the prevention and control of atmospheric pollution. In this paper, in order to avoid the uncertainty caused by artificially setting the parameters of the prediction model, a new hyper-parameter optimization extreme gradient boosting (HPO-XGBoost) model for spatial prediction of PM2.5 concentration was proposed. We used aerosol optical depth (AOD) data of Himawari-8 satellite combined with the HPO-XGBoost model to predict and mapping the spatial variability of PM2.5 concentrations during the COVID-19 lockdown in China. The results showed that the maximum concentration of PM2.5 exhibited a downward trend and a significant seasonal fluctuation from 2015 to 2020. Compared with grid search (GS) and random grid search (RGS) optimization algorithms, the tree-structured Parzen estimator-XGBoost (TPE-XGBoost) approach has the highest prediction accuracy (R2) of 89.37% (January), 85.58% (February), 80.02% (March), and 83.68% (April) for PM2.5 concentrations in 2020, respectively. Spatial mapping of the monthly average PM2.5 concentration from January to April using the TPE-XGBoost model showed that the regions with higher PM2.5 concentrations are concentrated in northern China, eastern China and northeastern China, where PM2.5 concentrations exceed 150 μg m−3 in January. Furthermore, the spatial correlation analysis showed that factors with the highest driving effect of PM2.5 concentrations during the COVID-19 lockdown were factory (FAC) and traffic (TRA), and the strongest contribution of the double-factor synergy (q > 0.8) for all four months included factory-residence (FAC-RES) and factory-population (FAC-POP). The contribution source of PM2.5 transport showed a long-distance channel in Taiyuan, Xi’an and Shijiazhuang, while the cluster-like distribution and mixed distribution of contribution sources were embodied in Zhengzhou, Changchun and Harbin based on concentration-weighted trajectory (CWT) analysis. The above results showed that the TPE-XGBoost has strong nonlinear explanation and effective feasibility for spatial prediction of PM2.5 concentrations, and the transport of PM2.5 was dynamic effect which should be considered into account when developing prevention and control measures of atmospheric pollution in epidemic period.

A New Analysis of Real-Time Fatality Rate in the Initial Stage of COVID-19.

Mortality is one of the most important epidemiological measures and a key indicator of the effectiveness of potential treatments or interventions. In this paper, a permutation test method of variance analysis is proposed to test the null hypothesis that the real-time fatality rates of multiple groups were equal during the epidemic period. In light of large-scale simulation studies, the proposed test method can accurately identify the differences between different groups and display satisfactory performance. We apply the proposed method to the real dataset of the COVID-19 epidemic in mainland China (excluding Hubei), Hubei Province (excluding Wuhan), and Wuhan from 31 January 2020 to 30 March 2020. By comparing the differences in the disease severity for differential cities, we show that the severity of the early disease of COVID-19 may be related to the effectiveness of interventions and the improvement in medical resources.

The Impact of SARS-CoV-2 Lineages (Variants) and COVID-19 Vaccination on the COVID-19 Epidemic in South Africa: Regression Study.

Emerging SARS-CoV-2 variants have been attributed to the occurrence of secondary, tertiary, quaternary, and quinary COVID-19 epidemic waves threatening vaccine efforts owing to their immune invasiveness. Since the importation of SARS-CoV-2 in South Africa, with the first reported COVID-19 case on March 5, 2020, South Africa has observed 5 consecutive COVID-19 epidemic waves. The evolution of SARS-CoV-2 has played a major role in the resurgence of COVID-19 epidemic waves in South Africa and across the globe. We aimed to conduct descriptive and inferential statistical analysis on South African COVID-19 epidemiological data to investigate the impact of SARS-CoV-2 lineages and COVID-19 vaccinations in South African COVID-19 epidemiology. The general methodology involved the collation and stratification, covariance, regression analysis, normalization, and comparative inferential statistical analysis through null hypothesis testing (paired 2-tailed t tests) of South African COVID-19 epidemiological data. The mean daily positive COVID-19 tests in South Africa's first, second, third, fourth, and fifth COVID-19 epidemic wave periods were 11.5% (SD 8.58%), 11.5% (SD 8.45%), 13.3% (SD 9.72%), 13.1% (SD 9.91%), and 14.3% (SD 8.49%), respectively. The COVID-19 transmission rate in the first and second COVID-19 epidemic waves in South Africa was similar, while the COVID-19 transmission rate was higher in the third, fourth, and fifth COVID-19 epidemic waves than in the aforementioned waves. Most COVID-19 hospitalized cases in South Africa were in the general ward (60%-79.1%). Patients with COVID-19 on oxygen were the second-largest admission status (11.2%-16.8%), followed by patients with COVID-19 in the intensive care unit (8.07%-16.7%). Most patients hospitalized owing to COVID-19 in South Africa's first, second, third, and fourth COVID-19 epidemic waves were aged between 40 and 49 years (16.8%-20.4%) and 50 and 59 years (19.8%-25.3%). Patients admitted to the hospital owing to COVID-19 in the age groups of 0 to 19 years were relatively low (1.98%-4.59%). In general, COVID-19 hospital admissions in South Africa for the age groups between 0 and 29 years increased after each consecutive COVID-19 epidemic wave, while for age groups between 30 and 79 years, hospital admissions decreased. Most COVID-19 hospitalization deaths in South Africa in the first, second, third, fourth, and fifth COVID-19 epidemic waves were in the ages of 50 to 59 years (15.8%-24.8%), 60 to 69 years (15.9%-29.5%), and 70 to 79 years (16.6%-20.7%). The relaxation of COVID-19 nonpharmaceutical intervention health policies in South Africa and the evolution of SARS-CoV-2 were associated with increased COVID-19 transmission and severity in the South African population. COVID-19 vaccination in South Africa was strongly associated with a decrease in COVID-19 hospitalization and severity in South Africa.

Dynamics of parainfluenza virus among hospitalized children with acute respiratory tract infection under two-child policy and COVID-19 pandemic in Hubei Province, China, 2014-2022.

To analyze changes in the detection of parainfluenza virus (PIV) in children hospitalized with acute respiratory tract infection (ARTI) during 2014-2022 in Hubei Province, and explore the impact of the universal two-child policy and the public health measures against COVID-19 epidemic on the prevalence of PIV in China. The study was conducted at the Maternal and Child Health Hospital of Hubei Province. Children aged <18 years with ARTI admitted from January 2014 to June 2022 were enrolled. The infection of PIV was confirmed by the direct immunofluorescence method in nasopharyngeal specimens. Adjusted logistic regression models were used to analyze the influence of the universal two-child policy implementation and public health measurements against COVID-19 on PIV detection. Totally 75 128 inpatients meeting the criteria were enrolled in this study from January 2014 to June 2022 with an overall PIV positive rate of 5.5%. The epidemic seasons of PIV prevalence lagged substantially in 2020. A statistically significant higher positive rate of PIV was observed in 2017-2019 compared to that in 2014-2015 (6.12% vs 2.89%, risk ratio = 2.12, p < 0.001) after the implementation of the universal two-child policy in 2016. A steep decline occurred in PIV positive rate during the COVID-19 epidemic in 2020 (0.92% vs 6.92%, p < 0.001) and it rebounded during the regular epidemic prevention and control period in 2021-2022 (6.35%, p = 0.104). In Hubei Province, the implementation of the universal two-child policy might have led to an increase of PIV prevalence, and public health measures during the COVID-19 epidemic might have influenced the fluctuation in PIV detection since 2020.

Psychiatric conditions in the practice of National Emergency Medical Services teams in eastern Poland during the SARS-CoV2 pandemic.

To assess the impact of the COVID-19 epidemic in Poland on the number of visits by National Medical Rescue teams to patients with mental disorders. The study included a retrospective analysis of EMT departures from the Łuków district (northern part of the Lublin province) in the two-year period 3.2019-2.2021 (one year before epidemic -period I, the year of the epidemic -period II). The material consisted of Departure Request Cards and Medical Rescue Cards. In 2-year period were 862 events that met the criteria for inclusion in the analysis, 442- period I and 420- period II, respectively. In both periods, men were analyzed more often (68.7% Pre-Pan; 71.1% Pan). Interventions were more frequent in cities (60.3% Pre-Pan; 60.7% Pan). The share of alcohol and psychoactive substances as a cause of EMS interventions in psychiatric conditions was higher in pandemic. 1. The COVID-19 pandemic did not have a significant impact on the number of EMS interventions related to mental disorders in the area covered by the analysis 2. The average duration of EMS interventions to psychiatric conditions slightly increased during the epidemic period 3. Both in the period before and during the pandemic, in the interventions covered by the analysis, men were much more likely to be EMT patients 4. The age of the patients included in the analysis did not change significantly before and during the pandemic 5. Events caused by alcohol abuse and exacerbations of schizophrenia symptoms both before and during the pandemic have the largest share in the analysis.

Difference in determinants of ICU admission and death among COVID-19 hospitalized patients in two epidemic waves in Portugal: possible impact of healthcare burden and hospital bed occupancy on clinical management and outcomes, March-December 2020.

Identify factors associated with COVID-19 intensive care unit (ICU) admission and death among hospitalized cases in Portugal, and variations from the first to the second wave in Portugal, March-December 2020. Determinants of ICU admission and death for COVID-19 need further understanding and may change over time. We used hospital discharge data (ICD-10 diagnosis-related groups) to identify factors associated with COVID-19 outcomes in two epidemic periods with different hospital burdens to inform policy and practice. We conducted a retrospective cohort study including all hospitalized cases of laboratory-confirmed COVID-19 in the Portuguese NHS hospitals, discharged from March to December 2020. We calculated sex, age, comorbidities, attack rates by period, and calculated adjusted relative risks (aRR) for the outcomes of admission to ICU and death, using Poisson regressions. We tested effect modification between two distinct pandemic periods (March-September/October-December) with lower and higher hospital burden, in other determinants. Of 18,105 COVID-19 hospitalized cases, 10.22% were admitted to the ICU and 20.28% died in hospital before discharge. Being aged 60-69 years (when compared with those aged 0-49) was the strongest independent risk factor for ICU admission (aRR 1.91, 95%CI 1.62-2.26). Unlike ICU admission, risk of death increased continuously with age and in the presence of specific comorbidities. Overall, the probability of ICU admission was reduced in the second period but the risk of death did not change. Risk factors for ICU admission and death differed by epidemic period. Testing interactions, in the period with high hospital burden, those aged 80-89, women, and those with specific comorbidities had a significantly lower aRR for ICU admission. Risk of death increased in the second period for those with dementia and diabetes. The probability of ICU admission was reduced in the second period. Different patient profiles were identified for ICU and deaths among COVID-19-hospitalized patients in different pandemic periods with lower and higher hospital burden, possibly implying changes in clinical practice, priority setting, or clinical presentation that should be further investigated and discussed considering impacts of higher burden on services in health outcomes, to inform preparedness, healthcare workforce planning, and pandemic prevention measures.

A cross-sectional and longitudinal study of how two intervention methods affect the anxiety, sleep quality, and physical activity of junior high school students under quarantine.

This study investigated levels of anxiety and sleep quality and their association with physical activity in junior high school students under quarantine during the COVID-19 pandemic. It also tests the effectiveness of physical activity and psychological nursing interventions in alleviating anxiety 'and improving sleep quality. In July 2021, 14,000 home-quarantined junior high school students in Yangzhou City (China) were selected by random cluster sampling to complete an online survey. We then selected 95 junior high school students for an 8-week longitudinal experiment exploring whether the two types of intervention made positive contributions to students' anxiety, sleep quality, and physical activity. The cross-sectional study revealed that physical activity was significantly related to anxiety and sleep quality. In the longitudinal study, students who underwent the exercise intervention or the psychological nursing intervention experienced significant improvement in their anxiety levels. The exercise intervention also promoted improved sleep quality. Overall, the exercise intervention was more effective than the psychological nursing intervention in reducing levels of anxiety and sleep disorders. During the epidemic period, junior high school students should be encouraged to spend more time engaging in physical activity, and their sleep quality and anxiety shouldbe focused on.