Pandemic Outbreak Research Articles

Global Health Priority Box─Proactive Pandemic Preparedness.

The coronavirus pandemic outbreak of 2019 highlighted the critical importance of preparedness for current and future public health threats (https://www.mmv.org/mmv-open/global-health-priority-box/about-global-health-priority-box). While the main attention for the past few years has been on COVID-19 research, this focus has reduced global resources on research in other areas, including malaria and neglected tropical diseases (NTDs). Such a shift in focus puts at risk the hard-earned progress in global health achieved over the past two decades (https://www.who.int/news-room/spotlight/10-global-health-issues-to-track-in-2021). To address the urgent need for new drugs to combat drug-resistant malaria, emerging zoonotic diseases, and vector control, Medicines for Malaria Venture (MMV) and Innovative Vector Control Consortium (IVCC) assembled a collection of 240 compounds and, in August 2022, launched the Global Health Priority Box (GHPB). This collection of compounds has confirmed activity against emerging pathogens or vectors and is available free of charge. This valuable tool enables researchers worldwide to build on each other's work and save precious time and resources by providing a starting point for the further development of treatments and insecticides. Furthermore, this open access box aligns with two of the many priorities outlined by the World Health Organization (WHO) (https://www.who.int/news-room/spotlight/10-global-health-issues-to-track-in-2021).

A comparative study of the growth indicators of infants born before and during the Covid-19 pandemic

IntroductionGrowth disorders pose significant mental and physical health challenges with long-term complications for children. As monitoring children's growth is of paramount importance, in the present study attempts are made to compare growth indicators of infants from birth to 12 months before and during the outbreak of COVID-19 pandemic. Material and methodThe present descriptive-analytical study was conducted using cluster sampling method in 10 comprehensive healthcare centers and on 200 infants in southwest of Iran during 2023. The infants’ health records and growth chart before and during the outbreak of COVID-19 pandemic served as data collection instruments. The collected data were analyzed using SPSS 21 software and descriptive and analytical statistics. ResultEconomic hardship, job loss, maternal disease and neonatal acquired disease were found to be significantly higher during the pandemic outbreak compared to the pre-pandemic time. the average weight and BMI of the infants in both groups showed no significant difference from birth to two months old, but the difference was found to be significantly higher from 4 months to 1-year-old among infants born during the pandemic (P-value<0.05). Result this study showed that during the pandemic trend of The age of word articulation by infants was increasing (P-value=0.022) and at this time 6 cases of missed vaccination were observed. ConclusionThe results indicate that the COVID-19 pandemic can affect the growth and development of infants, and may, in some cases, disrupt the growth and routine vaccination schedule during infancy and breastfeeding, which should be prevented by proper parental training.

Machine learning technology for good health and well-being for sustainable human security in South Africa

The failure to achieve sustainable development in South Africa is due to the inability to deliver quality and adequate health services that would lead to the achievement of sustainable human security. As we live in an era of digital technology, Machine Learning (ML) has not yet permeated the healthcare sector in South Africa. Its effects on promoting quality health services for sustainable human security have not attracted much academic attention in South Africa and across the African continent. Hospitals still face numerous challenges that have hindered achieving adequate health services. For this reason, the healthcare sector in South Africa continues to suffer from numerous challenges, including inadequate finances, poor governance, long waiting times, shortages of medical staff, and poor medical record keeping. These challenges have affected health services provision and thus pose threats to the achievement of sustainable security. The paper found that ML technology enables adequate health services that alleviate disease burden and thus lead to sustainable human security. It speeds up medical treatment, enabling medical workers to deliver health services accurately and reducing the financial cost of medical treatments. ML assists in the prevention of pandemic outbreaks and as well as monitoring their potential epidemic outbreaks. It protects and keeps medical records and makes them readily available when patients visit any hospital. The paper used a qualitative research design that used an exploratory approach to collect and analyse data.

Constructing a Conformer–Explorer Identity in Pandemic Narratives: A Qualitative Study of Chinese Emerging Adults

Existing research indicates that social crises such as the COVID-19 pandemic reshaped young people’s sense of self, but little is known about what identities emerging adults construct in their pandemic narratives. Following propositions of narrative identity and Terror Management Theory, this qualitative study investigated Chinese emerging adults’ identity construction in their narratives of the national outbreak of the COVID-19 pandemic in late 2022. Participants were 62 college students invited to share their pandemic experiences with reflections. Thematic analysis of the data suggests that the participants shared their pandemic experiences as a process of managing their death terror activated in the pandemic which threatened their sense of self and meanwhile motivated them to reconstruct who they are in the world. Based on their meaning-making capacities, the participants disclosed death awareness and vulnerabilities, adopted a temporal perspective in storytelling, emphasized their interpersonal and social connections, and made meaning out of the pandemic experiences to defend against death terror. As an outcome of their narration, a conformer–explorer identity was constructed in their pandemic narratives and we proposed a dialectical model to capture the dynamics of the construction. Although with limitations, this study contributes to our understanding of the functions of mortality salience on narrative identity among emerging adults in collectivist cultures during crises such as the COVID-19 pandemic.

Ethics in social listening in infodemic management in health emergencies

Abstract Issue During the COVID-19 pandemic and subsequent outbreaks, health organizations have increased the use of social listening to inform infodemic management and outbreak response activities. This demonstrated the need to provide ethical guidance to organizations, and individuals engaging in social listening practices before, during and after public health emergencies, whilst protecting human rights. Description of the problem Social listening as a public health activity draws on analysis of conversations in social media, internet platforms, and feedback from geographically localized communities. Infodemic insights are generated rapidly, to support agile action by health organizations that improves outbreak response, health information delivery, community engagement, or reduction of unintended harm experiences by communities. Social listening involves use of social media and internet trace data, which were traditionally not used in public health for understanding community expressions, WHO convened a panel of experts to develop a framework on ethical considerations for social listening in infodemic management to provide recommendations for health authorities and researchers on practical tools that support setting up new data analysis and use of insights hereto not used in routine. Results The guidance framework has been structured into segments that vary from ethical principles and challenges in social listening and generation of infodemic insights, alignment with human rights, substantive principles, procedural principles, and practical guidance for translating these principles into real-world practice. Lessons This guidance aims to illuminate the intricate ethical dimensions of social listening and stress the urgent need for ethical guidance in this realm. The framework is a comprehensive inquiry of the ethical scope in social listening, providing valuable insights, practical guidance, and case studies to enhance understanding of this critical global health issue. Key messages • While essential, social listening and infodemic insights come with ethical risks, including potential harm to populations in vulnerable situations, erosion of trust, and misuse of data. • This ethical framework will govern social listening practices and ensure responsible and ethical social listening.

Training for outbreak response through the Global Outbreak Alert and Response Network

Abstract The WHO designated the Information Centre for International Health Protection (INIG/ZIG 1) at the Robert Koch Institute as the first WHO Collaborating Centre for Global Outbreak Alert and Response (WHO CC GOARN). Its mandate is to aid WHO’s efforts in improving the detection of public health events and enhancing preparedness, readiness, and capabilities for alerts and rapid responses. The main focus of WHO CC GOARN at RKI include supporting WHO in the development and implementation of the GOARN training programme on international outbreak alert and response, as well as facilitating knowledge exchange and information dissemination. GOARN’s extensive engagement in international public health response underscores the need to complement technical expertise with human-centred competencies like effective communication and teamwork, while respecting diversity. On 18 -22 September 2023, WHO CC GOARN at RKI hosted the first “GOARN Outbreak Response Leadership Training Programme”, inviting 24 public health leaders plus highly experienced mentors from all WHO. The training was designed to enhance leadership mind-sets and practices, including advanced interpersonal and situational awareness, managing polarised tension, establishing trusted relationships with stakeholders, and influencing collective decision-making. Alongside expert facilitators and experienced mentors from various fields, participants engaged in open discussion, shared experiences and reflected on lessons from the COVID-19 pandemic and other recent outbreaks. This course provided an opportunity to engage with diverse, experienced and highly regarded leaders, sharing their views and personal experiences on what it means to practise leadership in health emergency response. This training also aimed to build a network of diverse, well-trained and interconnected public health leaders, upholding the principles of diversity, equity and inclusion to ensure that our response efforts resonate with the communities we serve.

Did the COVID-19 Pandemic Affect Suicide Rates Differently in Urban and Rural South Korea?

Abstract Background The influence of the COVID-19 pandemic on suicide rates remains a subject of debate. Despite increases in suicidal ideation and attempts reported during the pandemic, several recent meta-analyses have not demonstrated corresponding rises in suicide rates. Given the potential for substantial regional and demographic variability in the psychological consequences of COVID-19-related restrictions, this study explores differential suicide rates in urban versus rural contexts within South Korea subsequent to the pandemic outbreak. Methods This investigation employed age-standardized suicide rates from two periods, 2015-2019 and 2020-2022, across 234 administrative divisions (152 urban, 82 rural). A difference-in-differences approach was utilized to evaluate the pandemic’s impact on suicide rates, segmented by urban and rural classifications. A linear regression model was developed to examine the interaction between location (urban/rural) and time period, controlled for annual variations, perceived stress, and health status within each locale. Results Analysis revealed higher suicide rates in rural areas compared to urban counterparts (β = 1.247, p = 0.003), although no significant changes were observed during the pandemic period itself (β=-0.425, p = 0.682). Furthermore, the interaction between urban/rural status and the pandemic period did not reach statistical significance (p = 0.367). Conclusions The findings indicate no significant contribution of the COVID-19 pandemic to increased suicide rates, irrespective of the urban or rural setting. Further research is warranted to dissect the impact of more direct socioeconomic factors on this dynamic. Key messages • There in no evidence of increased suicide rates during the COVID-19 pandemic in South Korea. • The impact of the COVID-19 pandemic on suicide rates did not significantly different between urban and rural areas.

The Impact of Restaurant’s Online Food Delivery (OFD) Service Quality on Customers’ Repurchase Intention: A Conceptual Framework

The outbreak of the COVID-19 pandemic in 2020 had a profound impact on the food service industry, forcing many restaurants and eateries to pivot towards online food delivery (OFD) services to survive. This shift, driven by restrictions on dining-in, has persisted even as dine-in services resumed, positioning OFD as an integral part of restaurant operations. This paper explores the impact of service quality in OFD, proposing a conceptual framework that links service quality dimensions—such as delivery speed, order accuracy, customer service, and platform usability—to the customer’s repurchase intention of food from the restaurant via its OFD services. By addressing these dimensions, restaurants can enhance customer satisfaction, leading to improved financial outcomes. This study aims to provide actionable insights for restaurant operators and contribute to the existing literature on service quality within the OFD sector.

Evaluation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using a high figure-of-merit plasmonic multimode refractive index optical sensor

In recent years, following the outbreak of the COVID-19 pandemic, there has been a significant increase in cases of SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) and related deaths worldwide. Despite the pandemic nearing its end due to the introduction of mass-produced vaccines against SARS-CoV-2, early detection and diagnosis of the virus remain crucial in preventing disease progression. This article explores the rapid identification of SARS-CoV-2 by implementing a multimode plasmonic refractive index (MMRI) optical sensor, developed based on the split ring resonator (SRR) design. The Finite Difference Time Domain (FDTD) numerical solution method simulates the sensor. The studied sensor demonstrates three resonance modes within the reflection spectrum ranging from 800 nm to 1400 nm. Its material composition and dimensional parameters are optimized to enhance the sensor’s performance. The research indicates that all three resonance modes exhibit strong performance with high sensitivity and figures of merit. Notably, the first mode achieves an exceptional sensitivity of 557 nm/RIU, while the third mode exhibits a commendable sensitivity of 453 nm/RIU and a Figure of Merit (FOM) of 45 RIU−1. These findings suggest that the developed MMRI optical sensor holds significant potential for the early and accurate detection of SARS-CoV-2, contributing to improved disease management and control efforts.

The Critical Success Factors Towards Homestay Development in Penang

Since its introduction in 1988, the Homestay Programme in Malaysia has become an iconic rural tourism product. Tourists pay a reasonable price to stay with a host family and experience daily life alongside the local community. The pandemic outbreak in February 2020 severely impacted the tourism industry, causing many homestays to cease operations. In the post-pandemic period, the tourism industry, including homestays, is striving to regain momentum. Studies have been conducted to identify critical success factors influencing homestays' success. This study focuses on identifying these factors for homestays in Penang, Malaysia, considering perspectives from tourists, government agencies, institutions, industry players, and the community. A semi-structured interview and thematic analysis were used to process data collected from eleven informants with varying levels of involvement in homestays, ranging from those directly engaged in their development to those with little or no experience in visiting them. The interviews were conducted mainly in Bahasa Melayu, with the input translated into English. The data was then classified into several themes for further discussion.

Residual loneliness in the Netherlands after the COVID-19 pandemic: An application of the single interrupted time series design with pre-, peri- and post-pandemic observations

ObjectivesDuring the COVID-19 pandemic, many countries implemented policies to physically separate citizens. As a consequence, an increased prevalence of loneliness was observed. This article examined whether the prevalence of loneliness in the Netherlands has returned to pre-pandemic levels after the restrictive policy was ended. We studied age differences in the course of loneliness. Study designSingle interrupted time series design. MethodsData were from the Longitudinal Internet Studies for the Social Sciences (age range 16–102 years) and the Longitudinal Aging Study Amsterdam (age range 65–101 years). Both studies included respondents sampled from the Dutch population registers. Data collected relatively soon and later after the pandemic outbreak (nine and five observations in 2020–2023, respectively) were compared to extrapolated trend data based on a long period of time before the outbreak (since 2008 and 1992, respectively). ResultsWith two exceptions, the results of the two studies including five age categories and three types of loneliness measurement instruments showed that after an increased prevalence during the pandemic, prevalence at the last observation was at or below the level of the extrapolated trend. ConclusionsIt is highly likely that the pandemic was indeed an interruption and not a fundamental trend change in loneliness. This shows individuals’ resilience and the ability to reactivate social ties after the interruptive pandemic.

An effective non‐restarting control chart based on the joint judgment

AbstractThe cumulative sum (CUSUM) and exponentially weighted moving average (EWMA) control charts have been widely used in industry and public health applications. Still, few researchers have paid attention to the practical problem in public health applications, in which the control chart statistic cannot be reset to zero after an out‐of‐control (OC) signal. Some studies have addressed this issue by adding an upper limit to the statistic or using adaptive hypothesis testing (AHT). However, the control chart with an upper limit added to the testing statistic leads to a loss of information, and the post‐outbreak false alarm rate is still higher than the restarting control chart. The AHT control charts could not quickly alarm for the pandemic outbreak alarm as expected. To improve these drawbacks of control chart monitoring, two phase‐II non‐restarting (NR) CUSUM–EWMA control charts with the AHT framework, named NR–CUSUM–EWMA and AHUTNR–CUSUM–EWMA control charts, are proposed to well alarm for the pandemic outbreak. The AHTUNR–CUSUM–EWMA control chart uses the joint judgment of the UNR–CUSUM–EWMA (uncorrected NR–CUMSUM–EWMA) and NR–CUSUM–EWMA control charts, and the run rule to enhance the efficiency of the pandemic outbreak alarm. Simulation results show that the proposed NR–CUSUM–EWMA and AHUTNR–CUSUM–EWMA control charts can well maintain the outbreak alarm rate and post‐outbreak false alarm rate without losing cumulative information. Finally, the applicability and effectiveness of the proposed method are illustrated by an application to measles surveillance in North Rhine‐Westphalia, Germany.

Does Reputation Matter? Explaining China’s Evolving Strategy in South China Sea Disputes

What drives China’s approach to disputes in the South China Sea? While conventional wisdom often attributes Beijing’s actions primarily to material interests, this overlooks the possible influence of non-material factors such as China’s desire to uphold its national reputation. Contrary to the assumptions of traditional prospect theory, China’s behavior is not driven solely by calculations of gains and losses but also by considerations for its international reputation. Beijing may temper its assertiveness when its reputation is declining but still manageable, as demonstrated by its increased willingness to resolve disputes multilaterally after its global image was tarnished following the outbreak of the COVID-19 pandemic. Contrarily, China may resort to more assertive actions when these do not significantly hurt its reputation or when the damage seems irreversible, as seen in its unwavering stance during the 2012 Scarborough Shoal standoff with the Philippines.

Analysis and modelling of global online public interest in multiple other infectious diseases due to the COVID-19 pandemic.

Previous research has demonstrated the applicability of Google Trends in predicting infectious diseases. This study aimed to analyze public interest in other infectious diseases before and after the outbreak of COVID-19 via Google Trends data and to predict these trends via time series models. Google Trends data for 12 common infectious diseases were obtained in this study, covering the period from 1 February 2018 to 5 May 2023. The ARIMA, TimeGPT, XGBoost, and LSTM algorithms were then utilized to establish time series prediction models. Our study revealed a significant decrease in public interest in most infectious diseases at the beginning of the pandemic outbreak, followed by a rebound in the post-pandemic era, which is consistent with reported disease incidences. Furthermore, our prediction models demonstrated good accuracy, with TimeGPT showing unique advantages. Our study highlights the potential application value of Google Trends and large pre-trained models for infectious disease prediction.

Vaccine Hesitancy and COVID-19 Risk Behaviors Associated with Social Media Use in Japan

ABSTRACT We examined the associations between the use of different types of media and COVID-19 vaccine hesitancy, as well as risk behaviors of COVID-19 infection, in Japan in late 2021. Cross-sectional surveys were conducted using rapid online surveys of residents in Iwate Prefecture from February 5 to 7, 2021, and from October 1 to 3, 2021. Each individual’s risk of acquiring SARS-CoV-2 infection was calculated using a quantitative assessment tool (the microCOVID). Intention to get vaccinated for COVID-19 was assessed by self-report. Usage of five types of media for obtaining COVID-related information was assessed: (1) newspapers, (2) television or radio, (3) internet or news apps, (4) social network services (SNS) (excluding LINE, a popular messaging app), and (5) other. Reliance on SNS did not show significant associations with either intention to get vaccinated or engaging in risky behavior for acquiring COVID-19. Although users of the internet or news apps were marginally significantly less likely to engage in high-risk behavior, significant associations between vaccine hesitancy and the usage of the internet or news apps were found in the middle age and elderly groups (OR [95% confidence interval (CI)] in middle age: 1.55 [1.07–2.23]; in elderly; 9.24 [3.28–26.02]). The differential associations between different types of media use and COVID-19 prevention behaviors may assist in preparing for future pandemic outbreaks. One implication for public health risk communication is audience segmentation, such as emphasizing vaccine safety and effectiveness for older audiences.

The impact of the COVID-19 pandemic on the professional commitment of male nursing students in China: a descriptive comparative study.

The social culture, gender stereotypes, and social status of nursing in China impact the professional commitment of male nursing students. Increasing the professional commitment of male nursing students is critical for alleviating the shortage of nurses and addressing the gender gap. The outbreak of the COVID-19 pandemic has caused widespread public concern about the nursing profession and may have changed people's perception of the profession, which in turn may have a positive impact on the professional commitment of male nursing students in China. This research aimed to assess how the COVID-19 pandemic affected the professional commitment of male nursing students in China and to analyze the impact of the COVID-19 pandemic on potential factors that might affect their professional commitment. A descriptive comparative study was conducted. This study involved total 368 male nursing students from five 4-year universities in Henan Province, China. 190 male nursing students were included before the COVID-19 pandemic (October to November 2019) and 178 were included after the COVID-19 pandemic (April to May 2023). The data, such as the sociodemographic characteristics and professional commitment of the two samples, were collected using a paper-and-pencil questionnaire. The research instruments used included the Professional Commitment Scale, the Multidimensional Scale of Perceived Social Support and the General Self-efficacy Scale. The data analysis employed χ2-tests, t-tests and hierarchical regression models. The proportion of Chinese male nursing students who are interested in nursing and do not intend to leave the major has increased after the pandemic (65.17% vs. 29.47%, 61.80% vs. 39.47%, respectively). Male nursing students exhibited greater professional commitment (3.30 ± 0.63) after the pandemic compared to before the pandemic (2.77 ± 0.43). The various factors, such as grade, intend to leave the major, interest in nursing, social support, and general self-efficacy, were linked to professional commitment of male nursing students in China. Male nursing students in China exhibited greater professional commitment after the pandemic. This phenomenon may be attributed to the public's increased recognition of the significance of nursing work during the pandemic, and the social status and image of nursing profession have been improved. Given the changes brought about by the COVID-19, strategies should be considered by nursing decision makers and schools to strengthen the professional commitment of male nursing students and increase the number of male nurses in the post-pandemic era.

The impact of COVID- 19 on Primary and Secondary Schooling in Mogadishu

Background: Since December 2019, the COVID – 19 pandemic has been circulating in Somalia and other areas of the country. The disease has had a global impact on social, physical, psychological, and educational systems. The study examines how the COVID-19 pandemic impacted the educational process in Mogadishu, Somalia's primary and secondary schools. Aim: This study aims to explore the effect of COVID – 19 on Primary and Secondary Schooling in Mogadishu - Somalia. Methods: This study used a descriptive quantitative analysis design and was performed in a random sample of primary and secondary schools in Mogadishu. The survey data was obtained from 329 schools representing 274 head teachers. A self-administered questionnaire was used to gather information about the head teacher, including background information, activity, and student information. Findings: During the coronavirus, the most of the head teachers were concerned and stressed. The study also showed that the majority of schools are private and rent, that school income is dependent on student tuition, and that school income has declined as a result of the pandemic outbreak, and that the majority of schools have not obtained any financial aid from the government. Conclusion: The principals have learned a valuable lesson that they will apply in the future when dealing with unforeseen circumstances.

Uncertainties of Economic Policy and Government Management Stability Played Important Roles in Increasing Suicides in Japan from 2009 to 2023.

Standardized suicide mortality rates per 100,000 (SMRs) in Japan consistently decreased from 2009 to 2019 but increased from 2020. The causes of these temporal SMR fluctuations remain to be clarified. Therefore, this study was conducted to identify the causalities underlying the recently transformed fluctuations of suicide mortality in Japan. Monthly suicide numbers disaggregated by sex and social standing, and political uncertainty indices, such as economic policy uncertainty (EPU) and government management instability (AENROP), were obtained from Japanese government databases. Interrupted time-series analysis was performed to analyze temporal fluctuations of SMRs disaggregated by sex/social standing associated with the three General Principles of Suicide Prevention Policy (GPSPP) periods and the COVID-19 pandemic. Panel data and vector autoregressive analyses were conducted to investigate causalities from political uncertainties to SMRs. During the first and second GPSPPs (2009-2017), all SMRs disaggregated by sex and social standing decreased, whereas those of unemployed females did not change. During the third GPSPP (2017-2022), decreasing trends in all SMRs were attenuated compared to previous periods. All female SMRs, except unemployed females, showed sharp increases synchronized with the pandemic outbreak. No male SMRs showed sharply increasing at the pandemic outbreak. SMRs of unemployed males/females drastically increased in the later periods of the pandemic, while SMRs of employed and multiple-person/single-person household males did not increase during the pandemic. SMR of unemployed males was positively related to AENROP but not EPU. Other male SMRs were positively related to EPU/AENROP. On the contrary, not all female SMRs were related to EPU/AENROP. Increasing AENROP generally contributed to increasing male SMRs throughout the observation period; however, susceptibility to AENROP and/or political information might have unexpectedly contributed to suppressing the sharply increasing male SMRs induced by large-scale social shocks (the COVID-19 pandemic outbreak) in Japan.

Oral Health Related Factors Predicting Severe COVID-19 Disease in Elderly Swedes.

To analyse different background factors that may serve as predictors for acquiring symptoms of severe COVID-19 disease. A postal questionnaire was sent to the total population of individuals born between 1942 (80 years, n = 6299) and 1932 (90 years, n = 1904) living in the Örebro and Östergötland counties, Sweden, in 2017 and repeated in 2022. Tentative predictive factors for self-reported severe COVID-19 disease were based on the responses from the 2017 questionnaire related to general and oral health and prior to the outbreak of the COVID-19 pandemic. Response rate to the main questionnaire in 2022 was 66% (5375/8203), and 577 reported having been sick with COVID-19 out of which 359 agreed to answer a separate questionnaire on COVID-19. This questionnaire was returned by 278/359 of the participants corresponding to a response rate of 77%. Information gleaned from the 2017 pre-COVID-19 survey revealed a relatively large number of associations between severity of subsequently self-reported COVID-19 disease and several diverse tentative related factors found in unadjusted regression analyses. Based on statistically significant correlations in the adjusted regression analysis, significant predictive factors (based on self-reports from 2017) for contracting severe COVID-19 were in decreasing order of odds ratios (OR): reported removable partial or complete denture usage (OR 6.2, CI 2.2-17.2); reported periodontal problems in the past year (OR 3.4, CI 1.1-10.4); and reported daytime dry mouth (OR 2.5, CI 1.2-5.2). Removable dentures, periodontal problems and daytime dry mouth were predictors for developing symptoms of severe COVID-19 disease.

Uncertainty tolerance moderates the link between job insecurity and service performance: evidence from China’s hotel frontline employees

The pandemic crisis outbreak has impacted the hospitality industry tremendously. This study investigated the effect of job insecurity on service performance and examined the mediating role of cognitive appraisal and the moderating effect of uncertainty tolerance from the perspectives of cognitive appraisal theory of stress. The study collected a questionnaire from 316 hotel employees at three time points, with a one-month interval between the two time points. The SPSS PROCESS macro and MPLUS are used to test the research hypotheses. The results highlighted that the mediating role of challenge-hindrance appraisal, affirming that job insecurity positively impacts service performance via increasing challenge appraisal, and job insecurity negatively impacts service performance via increasing hindrance appraisal. Furthermore, the results show that uncertainty tolerance moderates the relationship between job insecurity and cognitive appraisal and also moderated the indirect effect of job insecurity on service performance through cognitive appraisal. The research results provide implications for human resource management in the hospitality industry.