Pre-lockdown Period Research Articles

Impact of COVID-19 lockdown on patient-provider electronic communications

Background SARS CoV-2 virus (COVID-19) impacted the practice of healthcare in the United States, with technology being used to facilitate access to care and reduce iatrogenic spread. Since then, patient message volume to primary care providers has increased. However, the volume and trend of electronic communications after lockdown remain poorly described in the literature. Methods All incoming inbox items (telephone calls, refill requests, and electronic messages) sent to providers from patients amongst four primary care clinics were collected. Inbox item rates were calculated as a ratio of items per patient encountered each week. Trends in inbox rates were assessed during 12 months before and after lockdown (March 1st, 2020). Logistic regression was utilized to examine the effects of the lockdown on inbox item rate post-COVID-19 lockdown as compared to the pre-lockdown period. Results Before COVID-19 lockdown, 2.07 new inbox items per encounter were received, which increased to 2.83 items after lockdown. However, only patient-initiated electronic messages increased after lockdown and stabilized at a rate higher than the pre-COVID-19 period (aRR 1.27, p-value < 0.001). In contrast, prescription refill requests and telephone calls quickly spiked, then returned to pre-lockdown levels. Conclusion Based on our observations, providers experienced a quick increase in all inbox items. However, only electronic messages had a sustained increase, exacerbating the workload of administrators, staff, and clinical providers. This study directly correlates healthcare technology adoption to a significant disruptive event but also shows additional challenges to the healthcare system that must be considered with these changes.

The Impact of Coronavirus Disease of 2019 (COVID-19) Lockdown Restrictions on the Criteria Pollutants

Air pollution is accountable for various long-term and short-term respiratory diseases and even deaths. Air pollution is normally associated with a decreasing life expectancy. Governments have been implementing strategies to improve air quality. However, natural events have always played an important role in the concentration of air pollutants. In Australia, the lockdown period followed the Black Summer of 2019–2020 and coincided with the season of prescribed burns. This paper investigates the changes in the concentration of criteria pollutants such as particulate matter, nitrogen dioxide, ozone, and sulphur dioxide. The air quality data for the lockdown period in 2020 was compared with the pre-lockdown period in 2020 and with corresponding periods of previous years from 2016 to 2019. The results were also compared with the post-lockdown scenario of 2020 and 2021 to understand how the concentration levels changed due to behavioural changes and a lack of background events. The results revealed that the COVID-19 restrictions had some impact on the concentration of pollutants; however, the location of monitoring stations played an important role.

Substantial changes in Gaseous pollutants and health effects during COVID-19 in Delhi, India.

Coronavirus disease has affected the entire population worldwide in terms of physical and environmental consequences. Therefore, the current study demonstrates the changes in the concentration of gaseous pollutants and their health effects during the COVID-19 pandemic in Delhi, the national capital city of India. In the present study, secondary data on gaseous pollutants such as nitrogen dioxide (NO2), carbon monoxide (CO), sulfur dioxide (SO2), ammonia (NH3), and ozone (O3) were collected from the Central Pollution Control Board (CPCB) on a daily basis. Data were collected from January 1, 2020, to September 30, 2020, to determine the relative changes (%) in gaseous pollutants for pre-lockdown, lockdown, and unlockdown stages of COVID-19. The current findings for gaseous pollutants reveal that concentration declined in the range of 51%-83% (NO), 40%-69% (NOx), 31%-60% (NO2), and 25%-40% (NH3) during the lockdown compared to pre-lockdown period, respectively. The drastic decrease in gaseous pollutants was observed due to restricted measures during lockdown periods. The level of ozone was observed to be higher during the lockdown periods as compared to the pre-lockdown period. These gaseous pollutants are linked between the health risk assessment and hazard identification for non-carcinogenic. However, in infants (0-1 yr), Health Quotient (HQ) for daily and annual groups was found to be higher than the rest of the exposed group (toddlers, children, and adults) in all the periods. The air quality values for pre-lockdown were calculated to be "poor category to "very poor" category in all zones of Delhi, whereas, during the lockdown period, the air quality levels for all zones were calculated as "satisfactory," except for Northeast Delhi, which displayed the "moderate" category. The computed HQ for daily chronic exposure for each pollutant across the child and adult groups was more than 1 (HQ > 1), which indicated a high probability to induce adverse health outcomes.

Impact of easing COVID-19 lockdown restrictions on traumatic injuries in Riyadh, Saudi Arabia: one-year experience at a major trauma centre

IntroductionLockdown restrictions due to the COVID-19 pandemic have reduced the number of injuries recorded. However, little is known about the impact of easing COVID-19 lockdown restrictions on the nature and outcome of injuries. This study aims to compare injury patterns prior to and after the easing of COVID-19 lockdown restrictions in Saudi Arabia.MethodData were collected retrospectively from the Saudi TraumA Registry for the period between March 25, 2019, and June 21, 2021. These data corresponded to three periods: March 2019–February 2020 (pre-restrictions, period 1), March 2020–June 2020 (lockdown, period 2), and July 2020–June 2021 (post easing of restrictions, period 3). Data related to patients’ demographics, mechanism and severity of injury, and in-hospital mortality were collected and analysed.ResultsA total of 5,147 traumatic injury patients were included in the analysis (pre-restrictions n = 2593; lockdown n = 218; post easing of lockdown restrictions n = 2336). An increase in trauma cases (by 7.6%) was seen in the 30–44 age group after easing restrictions (n = 648 vs. 762, p < 0.01). Motor vehicle crashes (MVC) were the leading cause of injury, followed by falls in all the three periods. MVC-related injuries decreased by 3.1% (n = 1068 vs. 890, p = 0.03) and pedestrian-related injuries decreased by 2.7% (n = 227 vs. 143, p < 0.01); however, burn injuries increased by 2.2% (n = 134 vs. 174, p < 0.01) and violence-related injuries increased by 0.9% (n = 45 vs. 60, p = 0.05) post easing of lockdown restrictions. We observed an increase in in-hospital mortality during the period of 12 months after easing of lockdown restrictions—4.9% (114/2336) compared to 12 months of pre-lockdown period—4.3% (113/2593).ConclusionThis is one of the first studies to document trauma trends over a one-year period after easing lockdown restrictions. MVC continues to be the leading cause of injuries despite a slight decrease; overall injury cases rebounded towards pre-lockdown levels in Saudi Arabia. Injury prevention needs robust legislation with respect to road safety measures and law enforcement that can decrease the burden of traumatic injuries.

Impact of COVID 19 lockdown on Medico Legal Cases in a Tertiary Care Hospital in North Kerala

Background: The consequence of Covid 19 lockdown on medicolegal cases was variable throughout the world.Methodology: A descriptive cross sectional study was conducted in a tertiary care hospital setting and otherpublic health institutions in the same district with the objective of comparing thetotal number of medico legalcases, any increase or decrease in the unnatural (accidental, suicidal and homicidal) versus natural deaths and alsowhether any increase or decrease of coronary artery disease among the brought dead natural cases during pre andthe lock down period.Results: Among the total number of medicolegal cases came for autopsy (237), 65.8% were during pre lock downperiod and 34.2% were during lockdown period. This indicates a significant reduction in the number of casesduring lockdown compared to pre lockdown in both type of institutions. This reduction in number of cases wereobserved in all the type of cases as indicated by reduction in unnatural deaths (30.2%versus 69.8%), small reductionin natural deaths (46.3% versus 53.7%), accidental deaths (26% versus 74%), suicidal deaths (36.2% versus 63.8%),reduction in Road traffic accidents(26.3%versus 73.7%), deaths following coronary artery disease (42.9%versus57.1%). The age distribution of deaths due to coronary artery disease during the pre lockdown period was in arange of 28 – 85 years and during lockdown period was 33- 78 years with a median of 48 years in both groups.Conclusion: Regardless of the type of, there is reduction in the number of medicolegal cases during lockdowncompared to pre lockdown in both the types of institutions.

Evaluating the Performance of Low-cost PM Sensors over Multiple COALESCE Network Sites

Air quality is a global concern, with particulate matter receiving considerable attention due to its impact on human health and climate change. Recent advances in low-cost sensors allow their deployment in large number to measure spatio-temporal and real-time air quality data. Low-cost sensors need careful evaluation with both regulatory approved methods and other data sets to understand their efficacy. In this work, PM concentrations measured by deploying low-cost sensors at four regional sites are evaluated through comparison with satellite-based model MERRA-2 and the SASS reference instrument. Daily PM2.5 mass concentration variation was analyzed at four regional sites of India from January 2020 to July 2020, including pre-lockdown and six different lockdown periods. Higher PM2.5 concentration was observed at Rohtak (119 µg/m3) compared to Mahabaleshwar (33 µg/m3), Bhopal (45 µg/m3) and Kashmir sites during the pre-lock down period. During the lockdown period, the PM2.5 mass concentration was reduced significantly compared to the pre-lockdown period at every location, although the PM2.5 concentration was different at each location. The air quality trend was quite similar in both the measurements, however, MERRA-2 reconstructed PM2.5 was significantly lower in the pre-lockdown period compared to the lockdown periods. Significant differences were observed between low-cost sensor measurements and MERRA-2 reanalysis data. These are attributed to the MERRA-2 modelling analysis that measures less PM2.5 concentration as compared to ground-based measurements, whereas low-cost sensor are ground-based measurements but needs corrections as it is subject to the calibration dependencies and biases.

Physical activity and asthma symptom control in children during COVID-19 lockdown: A feasibility study.

The aim was to evaluate the impact of the COVID-19 lockdown on physical activity (PA) and asthma symptom control in children. We conducted a single-cohort observational study on 22 children with a median age of 9 (8-11) years with a diagnosis of asthma being included in the study. Participants were asked to wear a PA tracker for 3 months; during the same 3-month period, the Paediatric Asthma Diary (PAD) was administered daily and the Asthma Control (AC) Questionnaire together with the mini-Paediatric Asthma Quality of Life (AQoL) Questionnaire administered at weekly intervals. Compared with the pre-lockdown period, there was a significant reduction in PA levels after the lockdown began. Daily total steps reduced by about 3000 steps (p < 0.001), very active minutes by 9 min (p < 0.001) and fairly active minutes almost halved (p < 0.001); while asthma symptom control marginally improved, with the AC and AQoL score improving by 0.56 (p < 0.005) and 0.47 (p < 0.05), respectively. Further, for those with AC score higher than 1, PA was positively associated with asthma control both before and after the lockdown. This feasibility study suggests that PA engagement of children with asthma is negatively affected during the pandemic, but the beneficial effect of PA on asthma symptom control potentially sustains even during a lockdown period. These findings emphasize the importance of wearable device to monitor longitudinal PA and thus better management of PA for achieving the best outcome of asthma symptom control.

COVID-19 lockdown has indirect, non-equivalent effects on activity patterns of Reeves’s Pheasant (Syrmaticus reevesii) and sympatric species

The outbreak of the COVID-19 pandemic has brought massive shifts in human activities through a global blockade, directly affecting wildlife survival. However, the indirect impacts of changes in human activities are often easily overlooked. We conducted surveys of Reeves’s Pheasant (Syrmaticus reevesii) and its sympatric species by camera traps in forest-type nature reserves in three different scenarios: pre-lockdown, lockdown and post-lockdown. An increase in livestock activities observed during the lockdown and post-lockdown period in our study area provided us an opportunity to investigate the indirect impact of the lockdown on wildlife. The pre-lockdown period was used as a baseline to compare any changes in trends of relative abundance index, activity patterns and temporal spacing of targeted species and livestock. During the lockdown period, the relative abundance index of livestock increased by 50% and there was an increase in daytime activity. Reeves's Pheasant showed avoidance responses to almost all sympatric species and livestock in three different periods, and the livestock avoidance level of Reeves's Pheasant during the lockdown period was significantly and positively correlated with the relative abundance index of livestock. Species-specific changes in activity patterns of study species were observed, with reduced daytime activities of Hog Badger and Raccoon Dog during and after the confinement periods. This study highlights the effect of the COVID-19 lockdown on the responses of wildlife by considering the changes in their temporal and spatial use before, during and after lockdown. The knowledge gained on wildlife during reduced human mobility because of the pandemic aids in understanding the effect of human disturbances and developing future conservation strategies in the shared space, to manage both wildlife and livestock.

The Impact of COVID-19 National Lockdown on Myocardial Infarction (MI) Hospitalizations in Northern Jordan.

During COVID-19 lockdown periods, several studies reported decreased numbers of myocardial infarction (MI) admissions. The lockdown impact has not yet been determined in developing countries. The aim of this study was to investigate the impact that of the lockdown measures might have had on the mean number of MI hospital admissions in Northern Jordan. A single-center study examined consecutive admissions of MI patients during COVID-19 outbreak. Participants' data was abstracted from the medical records of King Abdullah University Hospital between 2018 and 2020. Mean and percentages of monthly admissions were compared by year and by lockdown status (pre-lockdown, lockdown, and post-lockdown time intervals). A total of 1380 participants were admitted with acute MI symptoms: 59.2% of which were STEMI. A decrease in number of MI admissions was observed in 2020, from 43.1 (SD: 8.017) cases per month in 2019 to 40.59 (SD: 10.763) in 2020 (P < 0.0001) while an increase in the numbers during the lockdown was observed. The mean number during the pre-lockdown period was 40.51 (SD: 8.883), the lockdown period was 44.74 (SD: 5.689) and the post-lockdown was 34.66 (SD: 6.026) (P < 0.0001 for all comparisons). Similar patterns were observed when percentages of admissions were used. Upon comparing the lockdown period both to the pre- and post-lockdown periods separately, we found a significant increase in MI admissions during the lockdown period. This suggests that lockdown-related stress may have increased the risk of myocardial infarction.

Analysis of COVID-19 Lockdown Effects on Urban Air Quality: A Case Study of Monterrey, Mexico

The COVID-19 pandemic has caused several millions of deaths and forced the world population to a new normality. This study aims to analyze the air quality variation of several gaseous pollutants (CO, NO2, SO2, O3, PM10, and PM2.5) during the pre-lockdown, lockdown, and unlock period in the city of Monterrey using ground-based measurements. In this research, we proposed to use a control period of previous years to identify parameter variation due to local climate. The results showed a drastic decrease in measured contaminants during the lockdown period as follows: SO2 (−41.9%) &gt; PM10 (−30.5%) &gt; PM2.5 (−25.6%) &gt; NO2 (−14.9%) &gt; CO (−9.8%) compared to the control period (2017–2019). The O3 was the only air pollutant that showed an opposite trend, increasing during lockdown (+15%) and unlock (+2.2%), whereas CO (−16.6%) and NO2 (−30.6%) were further decreased. Moreover, using OMI/AURA satellite data, we detected a NO2 tropospheric column reduction by −1.9% during lockdown concerning the same period in the control interval. Moreover, we found a significant improvement in the Air Quality Index (AQI) due to the lockdown. Our findings indicate an association between air pollutants and economic activity and can be used in future strategies to improve urban air quality.

The Effect of COVID-19 Lockdown on Cerebrovascular Accidents, Acute Coronary Syndrome, and Diabetic Ketoacidosis Visits the Emergency Department: A Retrospective Study.

Objective This study aims to assess the effect of the COVID-19 lockdown on acute coronary syndrome (ACS), cerebrovascular accident (CVA), and diabetic ketoacidosis (DKA) visits the emergency department (ED). Methods We compared two groups of patients attending King Abdulaziz University Hospital (KAUH) ED diagnosed with one of the following ACS, CVA, or DKA; patients presenting from 21 December 2019 to 23 March 2020 and patients presenting from 23 March 2020 to 21 June 2020, representing COVID-19 pre-lockdown and during-lockdown period, respectively. The variables we analyzed were age, nationality (Saudi/non-Saudi), and gender. Results Our total sample size was 285 patient visits, ACS (n=130), CVA (n=98), and DKA (n=57). Results showed a statistically significant relationship between the number of patients with ACS and the period of visitation to ED (45.24% reduction, p-value <0.001), while CVA (18.5% reduction, p-value 0.312) and DKA (16% reduction, p-value 0.508) showed no statistically significant relationship. Conclusion A lockdown may be necessary to control a pandemic. However, it may carry potential collateral damage, such as a decrease and delay in the presentation of life-threatening conditions, which may lead to worsening outcomes. A clinical presentation of these conditions should warrant comprehensive evaluation by healthcare workers regardless of an ongoing pandemic while implementing infection control guidelines.

Deferral of Non-Emergency Cardiovascular Interventions Triggers Increased Cardiac Emergency Admissions-Analysis of the COVID-19 Related Lockdown.

Data on the relation between non-emergency and emergency cardiac admission rates during the COVID-19 lockdown and post-lockdown period are sparse. Consecutive cardiac patients admitted to our tertiary heart center between 1 January and 30 June 2020 were included. The observation period of 6 months was analyzed in total and divided into three defined time periods: the pre-lockdown (1 January-19 March), lockdown (20 March-19 April), and post-lockdown (20 April-30 June) period. These were compared to the reference periods 2019 and 2022 using daily admission rates and incidence rate ratios (IRR). Over the observation period from 1 January to 30 June, cardiac admissions (including non-emergency and emergency) were comparable between 2019, 2020, and 2022 (n = 2889, n = 2952, n = 2956; p = 0.845). However, when compared to the reference period 2019, non-emergency admissions decreased in 2020 (1364 vs. 1663; p = 0.02), while emergency admissions significantly increased (1588 vs. 1226; p < 0.001). Further analysis of the lockdown period revealed that non-emergency admissions dropped by 82% (IRR 0.18; 95%-CI 0.14-0.24; p < 0.001) and 42% fewer invasive cardiac interventions were performed (p < 0.001), whereas the post-lockdown period showed a 52% increase of emergency admissions (IRR 1.47; 95%-CI 1.31-1.65; p < 0.001) compared to 2019. We demonstrate a drastic surge of emergency cardiac admissions post-COVID-19 related lockdown suggesting that patients who did not keep their non-emergency appointment had to be admitted as an emergency later on.

Pregnancy trends and associated factors among Kenyan adolescent girls and young women pre- and post-COVID-19 lockdown

Globally, COVID-19 has had a negative impact on health systems and health outcomes, with evidence of differential gender impacts emerging. The COVID-19 timeline of events spanning from closures and restrictions to phased reopenings is well-documented in Kenya. This unique COVID-19 situation offered us the opportunity to study a natural experiment on pregnancy trends and outcomes in a cohort of Kenyan adolescent girls and young women (AGYW), enrolled in the KENya Single-dose HPV-vaccine Efficacy (KEN SHE) Study. The KEN SHE Study enrolled sexually active AGYW aged 15–20 years from central and western Kenya. Pregnancy testing was performed at enrollment and every 3 months. We determined pregnancy incidence trends pre- and post-COVID-19 lockdown, pregnancy outcomes (delivery, spontaneous, or induced abortion), and postabortion and postpartum contraceptive uptake. Kaplan–Meier survival estimates of incidence rates were used to estimate the cumulative probability of pregnancy during the study period. Cox regression was used to investigate factors associated with pregnancy incidence. Of the 2,223 AGYW included in the analysis, median age was 18.6 IQR (17.6–20.3), &amp;gt;90% had at least secondary school education, 95% were single at the time of enrollment, and 82% had a steady/primary sexual partner. Pregnancy incidence peaked at 2.27 (95% CI [1.84, 2.81])/100 women-years of observation at the end of the first quarter of 2020, a period coinciding with the government-imposed lockdown. AGYW had 60% increased risk of being pregnant during the lockdown when compared to prelockdown period (HR = 1.60, 95% CI [1.25, 2.05]). Among the 514 pregnancies reported, 127 (25%) ended in abortion, of which 66 (52%) were induced abortions. Our findings demonstrate the adverse sexual and reproductive health (SRH) consequences of the COVID-19 pandemic and the lockdown measures among AGYW. As services continue to be disrupted by the pandemic, there is an urgent need to strengthen and prioritize AGYW-centered SRH services, including contraception and safe abortion.

COVID-19 among health care workers and their impact on the health care system in a teaching hospital in Pakistan: A cross sectional observational study.

Health care workers (HCWs) are thought to be high-risk population for acquiring coronavirus disease (COVID-19). The COVID-19 emergence has had a profound effect on healthcare system. We sought to investigate the COVID-19 among HCWs and their effects on the healthcare system. A cross sectional observational study was conducted at Timergara teaching hospital. The study included HCWs with positive real time polymerase chain reaction (Q-PCR) for severe acute respiratory syndrome coronavirus (SARS-CoV-2). The study duration was from April to September, 2020. The demographic profile of each recruited subject was collected through structured interview. The patient's admissions to hospital were collected for the 5 months before (October 2019-February 2020) and 5 months after lockdown (March-July 2020). A total of 72 out of 689 (10%) HCWs were tested positive for SARS-CoV-2, of whom 83% were front-liners. The majority were male (72%), with comorbidities (14%) and no mortality. The structured interview of all participants showed that the healthcare setting was the major possible source of infection (97%). The patient admissions into the hospital were reduced by 42% during lockdown than prelockdown period. The patients admission was significantly decreased in the medical ward during lockdown (60% decrease; p < 0.01) with slightly similar trends in other departments. In conclusion, we found increased risk of COVID-19 for front-line HCWs. Lack of mortality was the favorable outcome. Lack of replacing the infected HCWs possibly explained the marked decrease in hospital admissions, and potential inadequate healthcare delivery during the lockdown. Understanding SARS-CoV-2 among HCWs and their impact on health-care system will be crucial for countries under COVID-19 crises or in case of future pandemic to deliver proper health services.

The impact of COVID lockdown on glycaemic control in paediatric patients with type 1 diabetes: A systematic review and meta-analysis of 22 observational studies.

The COVID lockdown has posted a great challenge to paediatric patients with type 1 diabetes (T1D) and their caregivers on the disease management. This systematic review and meta-analysis sought to compare the glycaemic control among paediatric patients with T1D (aged under 18 years) pre- during, and post-lockdown period. We did a systematic search of three databases (PubMed, Embase, and the WHO COVID-19 Global literature) for the literature published between 1 Jan 2019 to 10 Sep 2022. Studies meeting the following inclusion criteria were eligible for this study: (1) a COVID-19 related study; (2) inclusion of children aged 18 years old or under with established T1D; (3) comparing the outcomes of interest during or after the COVID lockdown with that before the lockdown. Study endpoints included mean difference (MD) in HbA1c, blood glucose, time in range (TIR, 70-180 mg/dl), time above range (TAR, >180mg/dl), time below range (TBR,<70mg/dl) and glucose variability (coefficient of variation [CV]) between pre-lockdown and during lockdown and/or between pre- and post-lockdown period. The MD and its corresponding 95% CI of each endpoint were pooled using random-effect model considering the potential between-study heterogeneity in COVID restrictions and T1D management. Initial search identified 4488 records and 22 studies with 2106 paediatric patients with T1D were included in the final analysis. Compared with pre-lockdown period, blood glucose was significantly decreased by 0.11 mmol/L (95%CI: -0.18, -0.04) during lockdown period and by 0.42 mmol/L (95%CI: -0.73, -0.11) after lockdown. The improvement was also found for TIR, TAR, TBR, and CV during and post-lockdown (all p values<0.05) except for the post-lockdown TBR (p =0.35). No significant change in HbA1c was observed during and post- lockdown period when compared with the pre-lockdown value. There was moderate to high between-study heterogeneity for most of the analyses. Compared with pre-lockdown period, there was significant improvement in T1D paediatric patients' glucose metrics during and post-lockdown. The underlying reasons for this positive impact warrant further investigation to inform future paediatric diabetes management. https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022359213.

Hand sanitizer-related calls at the National Poisons Information Centre, India during the lockdown period of the Covid-19 pandemic

Background Hand sanitizer (HS) has been increasingly used during the Covid-19 pandemic. We compared the telephonic calls received by the National Poisons Information Centre (NPIC), New Delhi, India, related to its unsafe exposure and inappropriate use during the lockdown and prelockdown periods. Methods We analysed and compared telephonic call records of 3 months of pre-lockdown and 3 months of the lockdown and HS-related calls in different age groups and zones during these periods. Results The centre received 4000 calls; of these 1583 (40%) were related to household products of which only 63 (4%) were related to HS. There was an 8-fold increase in the number of calls received at the NPIC during the lockdown compared to the pre-lockdown period seeking medical attention following unsafe exposure or inappropriate use of HS. More calls were received from the south and north zones and, in the majority of these cases, HS was ingested accidentally. In some cases, HS was ingested intentionally for suicide during the lockdown. Conclusions Our study shows that unsafe exposure of HS is common under conditions of stress as seen during the lockdown period of the Covid-19 pandemic. It should be kept out of reach of small children. Further, providing psychological help and counselling to older age groups under conditions of stress are important issues of concern.

Lockdown Fatigue in Pediatric Respiratory Patients: Lessons from the First COVID-19 Year.

Lockdown policies have been implemented worldwide to limit the spread of COVID-19. "Lockdown fatigue" is a state of exhaustion related to the accumulating effects of repeated lockdowns. The aim of the current study was to examine the effects of repeated lockdowns on children with respiratory disorders. Data on children aged 0-18 years old with respiratory disorders were collected by an electronic survey during the third lockdown in Israel. The retrieved information included demographics and baseline medical status, respiratory clinical status during the third lockdown compared to pre-lockdown periods, lockdown adherence, lifestyle modifications and caregiver emotional status. The results were compared to those of a similar questionnaire distributed during the first lockdown. A total of 234 patients (62% males, 37% females, mean age 6.8 years (confidence interval 6.1-7.5)) were enrolled. Respiratory symptoms and exacerbation frequency were reduced in 76 (35.5%) and 58 (27.4%) patients, respectively, compared to the pre-lockdown period and similar to the first lockdown (p = 0.840 and p = 0.063, respectively). However, compared to the first lockdown, the third lockdown was associated with greater use of reliever medications (p = 0.006), less use of inhaled corticosteroids as routine treatment (p = 0.027), and more pediatric emergency room visits and hospitalizations (p = 0.001 and p &lt; 0.001, respectively). The results also showed an increase in sedentary lifestyle (e.g., reduced physical activity (p = 0.025), less healthy eating habits (p = 0.001)) and reduced adherence to lockdown policies (p &lt; 0.001). These data show that the continuing stability of clinical improvement during lockdown was accompanied by deleterious sequelae that potentially indicate "lockdown fatigue" among children with respiratory disorders.

University Students' Well-Being and Engagement in Activities in the Early Days of Covid-19.

Governments worldwide took measures to contain the spread of the coronavirus COVID-19. Universities moved to online teaching almost overnight. This paper explores Belgian university students' perceptions, behaviors, and emotional well-being during the first weeks of strict preventive measures. We conducted a survey with 614 business administration students at the University of Antwerp. The results indicate that, in comparison to the pre-lockdown period, students feel less productive, engage less in healthy behaviors (e.g., healthy snacking, exercising alone), and report more study problems. Based on the emotional quality of their everyday experience, students can be clustered into two groups. One group (54.5%) experiences mostly negative affect, while the other reports experiencing mostly positive affect and personal optimism. The "negative affect" group consists of more women and students in the early years of their bachelor's. This group experiences more financial difficulties and spends more time on social media. These students seem to have a more challenging time coping with the lockdown: they perceive higher study load increase and more significant reduction of social contacts while facing more study problems, studying fewer hours, and perceiving a lower study efficiency. They also engage in less healthy behaviors (e.g., unhealthy snacking more, drinking more alcohol, and exercising alone less) to a greater extent than the positive affect group. These results confirm previous research, demonstrating a positive relationship between emotional well-being and the engagement in and the intensity of productive and healthy activities. Several recommendations are provided in light of these findings.

Prevalence of Text Neck Syndrome among Doctors

Purpose: The aim of this study was to investigate the prevalence of text neck syndrome (TNS) among doctors of North India and to assess the impact of increase in duration of time spent with mobile phones on TNS. Methods: The present study is an observational cross-sectional questionnaire based survey that included doctors practicing in North India. An electronic survey of 28 questions consisting of open-ended, closed-ended questions, and five-point Likert scale questions was developed using Google Form, which was sent to all the participants on October 19, 2020 through social media. Logistic regression analysis was performed to find relationship between discrete variables. The independence of attributes was measured through chi-squared test. Results: There was significant increase in the duration of mobile usage after lockdown as compared with pre lockdown period [ c2 = 68.87; df = 16; p &lt; 0.001]. There were more complaints of neck pain in respondents whose duration of mobile usage per day was greater than 5-6 hr [odds ratio = 9.6; p = 0.005]. There was no significant difference between time duration of mobile usage across gender [c2 = 8.41; df = 4; p &lt; 0.08]. Similarly, There was no significant difference between time duration of mobile usage across gender in prelockdown period [c2 = 3.97; df = 4; p &lt; 0.41], while males reported to spend more time on mobile during post lockdown period [c2 = 8.41; df = 4; p &lt; 0.08]. Conclusion: We ascertained a statistically significant increase in TNS after lockdown during unrivaled era of COVID-19 pandemic which was associated with more exposure to mobile phones. Additionally we confirmed that, there was no significant difference between time duration of mobile usage across gender.

Shifts in Multiple Myeloma Care Utilization of Veterans in the COVID-19 Era: Interrupted Time Series Analysis of Veterans Health Administration Data

Introduction The COVID-19 pandemic profoundly impacted medical care delivery and ushered in an era of telemedicine and virtual care. However, shifts in multiple myeloma (MM) care utilization patterns as a consequence of the COVID-19 pandemic are poorly characterized. We utilized electronic medical records from the Veterans Health Administration (VA), America's largest integrated health system, to study MM care utilization during the first year of the COVID-19 pandemic. Methods We retrospectively analyzed medical records of veterans with MM who received care in the VA system and were prescribed MM oral medications from Jun 2019 to Dec 2020. We examined the following outcomes: proportion of in-person visits over all outpatient visits, number of oral MM prescriptions, number of laboratory tests (hemoglobin, creatinine, serum protein electrophoresis [SPEP], free light chain [FLC] ratio), and number of inpatient admissions. As state lockdowns commenced in Mar 2020, we defined the pre-lockdown period as Jun 2019 to Feb 2020 and the post-lockdown period as Apr 2020 to Dec 2020. We performed interrupted time series (ITS) analysis on each outcome to assess for the step change between the pre- and post-lockdown periods via autoregressive moving average modeling. There were 9 time points in each period that corresponded to month. The counterfactual outcome was no observed change in defined outcomes in the post-lockdown compared to the pre-lockdown period. Results We identified 3679 veterans with MM who met inclusion criteria; they received care in all 50 states. The median age was 72 years; 67% were white and 31% were black. We assessed 93,455 outpatient visits attended by all 3679 veterans (Figure 1). Email, phone, and telehealth visits were considered virtual care. In the pre-lockdown period, in-person appointments stably accounted for approximately 93% of all visits, sharply dropping to 68% in Apr 2020. ITS showed a significant decrease of 26% in the percentage of in-person outpatient appointments (-0.26, [95% confidence interval (CI): -0.23 to -0.28], p<0.0001) comparing the post-lockdown to the pre-lockdown period. We examined 37,388 oral MM medication prescriptions of all 3679 veterans (Figure 2). ITS showed no significant changes in the monthly number of ixazomib (+27, [95% CI: +60 to -6], p=0.12), lenalidomide (+22, [95% CI: +112 to -68], p=0.65), and pomalidomide (+58, [95% CI: +5 to +111], p=0.05) prescriptions comparing the post-lockdown to the pre-lockdown period. We analyzed 326,415 laboratory tests collected from 3612 veterans (98% of study group). ITS showed significant decreases in the monthly number of performed creatinine (-1106, [95% CI: -395 to -1816], p<0.01), hemoglobin (-1096, [95% CI: -341 to -1851], p<0.01), and SPEP (-98, [95% CI: -39 to -157], p<0.01) tests comparing the post-lockdown to the pre-lockdown period. FLC testing was non-significant (-37, [95% CI: +147 to -221], p=0.70). We evaluated 2857 admissions in 1286 veterans (35% of study group). ITS showed no significant change in the monthly number of admissions (-24, [95% CI: +9 to -57], p=0.18) comparing the post-lockdown to the pre-lockdown period. Discussion We retroactively evaluated shifts in MM care utilization of veterans in the first year of the COVID-19 pandemic. After statewide lockdowns began in Mar 2020, in-person visits and laboratory testing significantly decreased as medical care quickly shifted to virtual care. However, prescriptions for MM oral medications were not affected. Similarly, inpatient admissions of veterans with MM did not increase. The impact on clinical outcomes as a result of increasing virtual care in MM remain to be fully assessed, although the lack of major observed shifts in outpatient scripts and inpatient admissions is encouraging. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal