Monitoramento das Produções

by Sayed Mostafa, Kathy Cousins-Cooper, Barbara Tankersley, Shea Burns, Guoqing Tang

The outbreak of the COVID-19 pandemic early in 2020 forced universities to shut down their campuses and transition to emergency remote instruction (ERI). Students had to quickly adapt to this new mode of instruction while dealing with all other distractions caused by the pandemic. This study integrates extensive data from students’ institutional records at a large Historically Black College and University (HBCU) institution with data from a students’ survey about the impact of COVID-19 on learning during the Spring 2020 semester to examine the impact of the transition to ERI on students’ performance and identify the main factors explaining variations in students’ performance. The main findings of our analysis are: (a) students’ university experience was positively correlated with performance (continuing students who spent at least one academic year at the university prior to the outbreak had better performance than freshman and new transfer students), (b) students’ perceived change in performance after the transition was positively associated with actual performance (students who perceived a decline in their performance after transition to ERI had significantly worse performance than other students), and (c) students’ prior online learning experiences and students’ emotional experiences with the COVID-19 disease were not significantly associated with performance. These results suggest that the approaches adopted by higher education institutions to support students during times of crisis should pay special attention to certain groups of students.

by Özlem Tekir
Objective This study was conducted to examine the relationship between fear of COVID-19, psychological well-being, and satisfaction with life in nursing students. Methods A descriptive and cross-sectional design was used in this study. The study was carried out at a university Faculty of Health Sciences Department of Nursing between May 17 and June 25, 2021. The JASP 0.14.1. Software was used for statistical analysis. Kruskal-Wallis test was used for the comparison of three or more groups, Mann-Whitney U test was used for the comparisons of two groups, and Bonferroni-corrected Mann-Whitney U test was used for post hoc analysis. To determine the risk factors for "The Fear of COVID-19 Scale," linear regression analysis with backward stepwise modeling was used. Results The mean score of the students was 18.48±6.87 from the Fear of COVID-19 Scale, 38.42±12.60 from the Psychological Well-Being Scale, and 13.12±4.97 from the Satisfaction with Life Scale. According to the results of the regression model established, independent variables explained 12.5% of the dependent variables, but the regression model established was found to be statistically significant. A one-unit increase in the satisfaction with life scale increased the fear of COVID-19 scale score by 0.224 units, and this increase was found statistically significant (p = 0.030) as a result of linear regression analysis used with backward stepwise modeling. Conclusion In conclusion, it was found that the students’ fear of COVID-19 was below the medium level, their psychological well-being was above the medium level, and that their life satisfaction was below the medium level.

Title: Replacement of Animals Used in the Maintenance of Aedes Aegypti by Alternative Methods. Refinement of Procedures That Minimize the Discomfort of Insect Maintenance by Swiss Webster Mice
Authors: Oliveira, Gabriel; Maria Julia, Rute

by Annika Brinkmann, Steven Uddin, Sophie-Luisa Ulm, Katharina Pape, Sophie Förster, Khalid Enan, Jalal Nourlil, Eva Krause, Lars Schaade, Janine Michel, Andreas Nitsche

Since December 2019 the world has been facing the outbreak of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Identification of infected patients and discrimination from other respiratory infections have so far been accomplished by using highly specific real-time PCRs. Here we present a rapid multiplex approach (RespiCoV), combining highly multiplexed PCRs and MinION sequencing suitable for the simultaneous screening for 41 viral and five bacterial agents related to respiratory tract infections, including the human coronaviruses NL63, HKU1, OC43, 229E, Middle East respiratory syndrome coronavirus, SARS-CoV, and SARS-CoV-2. RespiCoV was applied to 150 patient samples with suspected SARS-CoV-2 infection and compared with specific real-time PCR. Additionally, several respiratory tract pathogens were identified in samples tested positive or negative for SARS-CoV-2. Finally, RespiCoV was experimentally compared to the commercial RespiFinder 2SMART multiplex screening assay (PathoFinder, The Netherlands).

by Natanya Meyer, Thomas Niemand, Andrés Davila, Sascha Kraus

by Tadesse Tolossa, Bizuneh Wakuma, Ebisa Turi, Diriba Mulisa, Diriba Ayala, Getahun Fetensa, Belayneh Mengist, Gebeyehu Abera, Emiru Merdassa Atomssa, Dejene Seyoum, Tesfaye Shibiru, Ayantu Getahun
Introduction Even though people of the world were eagerly waiting for the hope of vaccine development, vaccine hesitancy is becoming the top concern in both developed and developing countries. However, there is no adequate evidence regarding the attitude and perception of health professionals towards the COVID 19 vaccine in resource-limited settings like Ethiopia. The aim of this study was to assess health professionals’ attitudes and perceptions towards COVID 19 vaccine in Western Ethiopia. Methods An institution-based cross-sectional study was conducted among health care workers found in Nekemte town from April 14–21, 2021. A total of 439 health professionals present on duty during the study period was included in the study. The data were collected by using self-administered questionnaire. Epidata version 3.2 was used for data entry, and STATA version 14 was used for data analysis. The binary logistic regression model was employed to determine factors associated with the attitude towards COVID-19 vaccination. Adjusted Odds Ratio (AOR) with 95% confidence intervals was computed and statistical significance was declared at a 5% level (p-value 0.05). Result A total of 431 health professionals participated in the study yielding a response rate of 98.1%. The results indicated that 51.28% (95%CI: 45.12%, 57.34%) of health professionals had a favorable attitude towards COVID-19 vaccination. Having good knowledge about the COVID-19 vaccine (AOR = 0.38, 95%CI: 0.22, 0.64, P-value

by Iris F. Appelman, Suzanne M. Thompson, Lauri M. M. van den Berg, Janneke T. Gitsels van der Wal, Ank de Jonge, Martine H. Hollander
Introduction The Coronavirus SARS-CoV-2pandemic necessitated several changes in maternity care. We investigated maternity care providers’ opinions on the positive and negative effects of these changes and on potential areas of improvement for future maternity care both in times of crisis and in regular maternity care. Methods We conducted nineteen semi-structured in-depth interviews with obstetricians, obstetric residents, community-based and hospital-based midwives and obstetric nurses. The interviews were thematically analysed using inductive Thematic analysis. Results Five themes were generated: ‘(Dis)proportionate measures’, ‘A significant impact of COVID-19’, ‘Differing views on inter-provider cooperation’, ‘Reluctance to seek help’ and ‘Lessons learnt’. The Central Organizing Concept was: ‘It was tough but necessary’. The majority of participants were positive about most of the measures that were taken and about their proportionality. These measures had a significant impact on maternity care providers, both mentally and on an organizational level. Most hospital-based care providers were positive about professional cooperation and communication, but some community-based midwives indicated that the cooperation between different midwifery care practices was suboptimal. Negative effects mentioned were a higher threshold for women to seek care, less partner involvement and perceived more fear among women and their partners, especially around birth. The most significant positive effect mentioned was increased use of eHealth tools. Recommendations for future care were to consider the necessity of prenatal and postnatal care more critically, to replace some face-to-face visits with eHealth and to provide more individualised care. Conclusion Maternity care providers experienced measures and organizational changes during the first wave of the COVID19-pandemic as tough, but necessary. They believed that a more critical consideration of medically necessary care, increased use of e-health and more individualised care might contribute to making maternity care more sustainable during and after the pandemic.

Title: Implementation of a COVID-19 Genomic Surveillance Regional Network for Latin America and Caribbean region
Authors: Leite, Juliana Almeida; Vicari, Andrea; Perez, Enrique; Siqueira, Marilda; Resende, Paola; Motta, Fernando Couto; Freitas, Lucas; Fernandez, Jorge; Parra, Barbara; Castilho, Andrés; Fasce, Rodrigo; Caballero, Alexander Augusto Martinez; Gresh, Lionel; Aldighier, Sylvain; Gabastou, Jean-Marc; Franco, Leticia; Mendez-Rico, Jairo

by Zahra Olateju, Tolulope Olufunlayo, Christine MacArthur, Charlotte Leung, Beck Taylor
Background Community Health Workers are globally recognised as crucial members of healthcare systems in low and middle-income countries, but their role and experience during COVID-19 is not well-understood. This study aimed to explore factors that influence CHWs’ ability and willingness to work in the COVID-19 pandemic in Lagos. Design A generic qualitative study exploring Community Health Workers experiences and perceptions of working during the COVID-19 pandemic in Lagos, Nigeria. Methods 15 semi-structured, in-depth, video interviews were conducted with Community Health Workers purposively sampled across seven of Lagos’ Local Government Areas with the highest COVID-19 burden. Interviews explored Community Health Workers’ attitudes towards COVID-19, its management, and their experiences working in Lagos. Data was analysed thematically using the framework method. Results Three main themes were identified. 1. Influences on ability to undertake COVID-19 Role: Trust and COVID-19 knowledge were found to aid Community Health Workers in their work. However, challenges included exhaustion due to an increased workload, public misconceptions about COVID-19, stigmatisation of COVID-19 patients, delayed access to care and lack of transportation. 2. Influences on willingness to work in COVID-19 Role: Community Health Workers’ perceptions of COVID-19, attitudes towards responsibility for COVID-19 risk at work, commitment and faith appeared to increase willingness to work. 3. Suggested Improvements: Financial incentives, provision of adequate personal protective equipment, transportation, and increasing staff numbers were seen as potential strategies to address many of the challenges faced. Conclusion Despite Community Health Workers being committed to their role, they have faced many challenges during the COVID-19 pandemic in Nigeria. Changes to their working environment may make their role during disease outbreaks more fulfilling and sustainable. International input is required to enhance Nigeria’s policies and infrastructure to better support Community Health Workers during both current and future outbreaks.

by Guiliana Mas-Ubillus, Pedro J. Ortiz, Jorge Huaringa-Marcelo, Paola Sarzo-Miranda, Patricia Muñoz-Aguirre, Alejandra Diaz-Ramos, Kattia Arribasplata-Purizaca, Doris Mendoza, Juan Rojas-Poma, Cristian Marcelo-Ruiz, Pedro Ayala-Diaz, Edwin Hidalgo-Arroyo, Lourdes Tupia-Cespedes
Background Peru is the country with the world’s highest COVID-19 death rate per capita. Characteristics associated with increased mortality among adult patients with COVID-19 pneumonia in this setting are not well described. Methods Retrospective, single-center cohort study including 1537 adult patients hospitalized with a diagnosis of SARS-CoV-2 pneumonia between May 2020 and August 2020 at a national hospital in Lima, Peru. The primary outcome measure was in-hospital mortality. Results In-hospital mortality was 49.71%. The mean age was 60 ± 14.25 years, and 68.38% were males. We found an association between mortality and inflammatory markers, mainly leukocytes, D-dimer, lactate dehydrogenase, C-reactive protein and ferritin. A multivariate model adjusted for age, hypertension, diabetes mellitus, and corticosteroid use demonstrated that in-hospital mortality was associated with greater age (RR: 2.01, 95%CI: 1.59–2.52) and a higher level of oxygen requirement (RR: 2.77, 95%CI: 2.13–3.62). Conclusions: In-hospital mortality among COVID-19 patients in Peru is high and is associated with greater age and higher oxygen requirements.

by Chu-Yu Yen, I-Mo Fang, Huei-Fen Tang, Hsin-Jui Lee, Shang-Hsien Yang

The aim of this study was to determine the effect of Coronavirus disease 2019 (COVID-19) pandemic on ophthalmic outpatient numbers and ophthalmic diagnosis distribution in a community hospital (Taipei City Hospital Zhongxiao Branch) in Taiwan. The COVID-19 pandemic period in Taiwan was defined as May 1 to July 31, 2021. Demographic data, including age, gender, and top 10 diagnoses from ophthalmic outpatients during this period, were collected. A corresponding control group from the same time in 2020 was also collected. The distribution of different diagnoses was analyzed, and the data of 10 most prominent diagnoses with decreased percentage of case numbers during the COVID-19 pandemic period were obtained. The number of cases during the COVID-19 pandemic decreased by 46.9% compared to the control group. The top three most common diagnoses were dry eye syndrome, glaucoma, and macular diseases. The 10 most prominent diagnoses with decreased number of cases during the COVID-19 pandemic were cataract, refraction & accommodation, macular degeneration, conjunctivitis, retinal detachment, vitreous body disorders, ophthalmic complications of diabetes mellitus, glaucoma, dry eye, and retinal vein occlusion. Identifying and treating these patients as scheduled may yield the highest cost-benefit effect in preventing visual loss during the COVID-19 pandemic.

by Panchali Moitra, Jagmeet Madan
Objective This study attempted to address the limited knowledge regarding the impact of screen time (ST) on lifestyle behaviors in Indian adolescents during the ongoing COVID-19 pandemic. The objectives were to 1) evaluate frequency and duration of using screens, and screen addiction behaviors in 10–15 years old adolescents in Mumbai during the COVID-19 pandemic and 2) examine the association of ST with lifestyle behaviors- eating habits, snacking patterns, physical activity (PA) levels, sleep quality and depression symptoms. Methods An online survey was completed between January and March 2021. Eating habits, snacking patterns, time spent in different screen-based activities, and screen addiction behaviors were reported. The PA levels, sleep quality, and depression symptoms were evaluated using the Physical Activity Questionnaire for Children/Adolescents (PAQ C/A), Pittsburg Sleep Quality Index (PSQI), and Patient Health Questionnaire-2 (PHQ-2) respectively. Multiple linear regression analyses were performed to determine the impact of ST on lifestyle behaviors. Results Adolescents (n = 1298, Mage 13.2(1.1), 53.3% boys) reported the mean weekday and weekend ST as 442.3 (201.5) minutes/d and 379.9 (178.2) minutes/d respectively. Overall, 33.4% spent > 6hours/d for studying or doing homework, 65.4% used social networking sites for at least 2–3 hours/d, and 70.7% agreed that ST had taken up the majority of their leisure time. Only 12% engaged in moderate to vigorous PA (PAQ C/A scores 5 indicating poor sleep quality and 8.6% scored ≥ 3 on PHQ-2 to suggest a risk of depression. A higher ST was associated with lower PA and increased sleep problems and a greater screen addiction was inversely associated with the eating habit, PA, and sleep-related variables. Conclusion The study draws attention to a high prevalence of excess ST and its impact on eating habits, PA levels, and sleep quality in Indian adolescents during the COVID-19 pandemic. Targeted health promotion interventions that encourage judicious use of screens for education and entertainment and emphasize the adverse health effects of excess ST are required.

by Haiyan Yu, Ching-Chi Yang, Ping Yu, Ke Liu

Coronavirus disease 2019 (COVID-19) has triggered an enormous number of discussion topics on social media Twitter. It has an impact on the global health system and citizen responses to the pandemic. Multiple responses (replies, favorites, and retweets) reflect the followers’ attitudes and emotions towards these tweets. Twitter data such as these have inspired substantial research interest in sentiment and social trend analyses. To date, studies on Twitter data have focused on the associational relationships between variables in a population. There is a need for further discovery of causality, such as the influence of sentiment polarity of tweet response on further discussion topics. These topics often reflect the human perception of COVID-19. This study addresses this exact topic. It aims to develop a new method to unveil the causal relationships between the sentiment polarity and responses in social media data. We employed sentiment polarity, i.e., positive or negative sentiment, as the treatment variable in this quasi-experimental study. The data is the tweets posted by nine authoritative public organizations in four countries and the World Health Organization from December 1, 2019, to May 10, 2020. Employing the inverse probability weighting model, we identified the treatment effect of sentiment polarity on the multiple responses of tweets. The topics with negative sentiment polarity on COVID-19 attracted significantly more replies (69±49) and favorites (688±677) than the positive tweets. However, no significant difference in the number of retweets was found between the negative and positive tweets. This study contributes a new method for social media analysis. It generates new insight into the influence of sentiment polarity of tweets about COVID-19 on tweet responses.

by Anastasiya D. Kirichenko, Anastasiya A. Poroshina, Dmitry Yu. Sherbakov, Michael G. Sadovsky, Konstantin V. Krutovsky

The SARS-CoV-2 is the third coronavirus in addition to SARS-CoV and MERS-CoV that causes severe respiratory syndrome in humans. All of them likely crossed the interspecific barrier between animals and humans and are of zoonotic origin, respectively. The origin and evolution of viruses and their phylogenetic relationships are of great importance for study of their pathogenicity and development of antiviral drugs and vaccines. The main objective of the presented study was to compare two methods for identifying relationships between coronavirus genomes: phylogenetic one based on the whole genome alignment followed by molecular phylogenetic tree inference and alignment-free clustering of triplet frequencies, respectively, using 69 coronavirus genomes selected from two public databases. Both approaches resulted in well-resolved robust classifications. In general, the clusters identified by the first approach were in good agreement with the classes identified by the second using K-means and the elastic map method, but not always, which still needs to be explained. Both approaches demonstrated also a significant divergence of genomes on a taxonomic level, but there was less correspondence between genomes regarding the types of diseases they caused, which may be due to the individual characteristics of the host. This research showed that alignment-free methods are efficient in combination with alignment-based methods. They have a significant advantage in computational complexity and provide valuable additional alternative information on the genomes relationships.

by Mahdi Rezapour, Arash Dehzangi, Farzaneh Saadati

The pandemic has posed an intense threat to the mental health of younger adults. Despite significant efforts in studying various aspects of COVID-19, there is a dearth of evidence on how negative emotions are associated with behaviors. A comparison across associated factors to different negative emotions by means of a unified model is especially missing from the literature. This study was conducted by using the results of a survey conducted across 2,534 students enrolled in 7 states in the US. Various feelings such as sad, irritable, stress and guilt were analyzed in a unified model by means of seemingly unrelated regression (SUR). Questions were asked related to rationally limiting the spread of virus, and questions related to behaviors that seem to be extreme. Irrational behaviors, such as limiting exercise at home due to COVID-19 could be due to experiencing negative emotions, which distort the meaning of events for the students. That behavior, for instance, was found to be positively associated with various negative feelings. In addition, the results highlighted significant differences across emotions in terms of demographic characteristics such as gender and age, and various precautionary actions that students take, such as limiting outdoor activities or limiting social gathering. For instance, it was highlighted while avoiding a large group of people, in spite of its importance in curbing the spread of virus, is negatively associated with various negative emotions, taking a possible nonconsequential precaution of completely limiting all people outside the immediate family result in a higher level of negative emotions. Also, it was found that having a higher body mass index (BMI), self-rated worse health conditions, and limiting outdoor activities have detrimental effects on the mental health of students.

Title: Case Report: Hantavirus Cardiopulmonary Syndrome Diagnostic in the Face of the COVID-19 Pandemic
Authors: Lemos, Elba Regina Sampaio de; Fernandes, Jorlan; Coelho, Thayssa Alves; Lumi, Liana Ogino; Rosa, José Antônio Rodrigues; Biasus, Letícia; Nunes, Zenaida Marion Alves; Brack, Dóris Bercht; Oliveira, Renata Carvalho de

by Mihaela Simionescu, Elena-Nicoleta Bordea, Angelo Pellegrini

In the light of the current COVID-19 pandemic, being considered a present challenge for public health, the main purpose of this work is to analyze the vulnerability to stress of a sample of nursing students in Romania considering their status on labour market (employed students in the medical system and non-employed students) before and during the COVID-19 pandemic. Employed students were more vulnerable to stress comparing to non-employed ones during the pandemic. In addition to this, the nursing students working in the medical system experienced medium vulnerability to stress during the pandemic comparing to those working before the pandemic who experienced a low vulnerability to stress. Excepting the non-employed students before the pandemic, the females were more vulnerable to stress comparing to the males in the sample and the students living in the country experienced a higher level of stress comparing to those living in the urban area. During the pandemic, most of the employed nursing students expressed their fear of getting infected with COVID-19, this representing the most stressful factor for them, while most of them mentioned the self-control as being the most proper strategy for them to cope with stress. These empirical findings have practical implications for stress control among present and future nurses, for management of medical units and for higher education nursing.

by Yupeng Luo, Kui Zhang, Mengxue Huang, Changjian Qiu
Background The prevalence of anxiety and depression in pregnant women has significantly increased after the spread of COVID-19 throughout the world. We carried out this meta-analysis to reveal the information about risk factors for depression and anxiety in pregnant women during the COVID-19 pandemic. Methods We searched the PubMed, Embase and CNKI (China National Knowledge Infrastructure) databases for all articles. The odds ratio (OR) corresponding to the 95% confidence interval (95% CI) was used to assess the risk factors for mental health. The statistical heterogeneity among studies was assessed with the Q-test and I2 statistics. Results We collected 17 studies including 15,050 pregnant women during the COVID-19 pandemic. Our results found that factors including decrease in the perception of general support and difficulties in household finances have damage effects on anxiety, and factors including undereducated, unemployed during pregnancy, with a chronic physical illness before pregnancy, decrease in the perception of general support, difficulties in household finances, disobey the isolation rules, and smoking during pregnancy have increased risk of depression. Conclusion Our meta-analysis revealed some risk factors for mental health in pregnant women during COVID-19 pandemic. Mental health interventions in pregnant women may involve targeted methods individually.

by Christoph Strupat, Zemzem Shigute, Arjun S. Bedi, Matthias Rieger
Background In low-income countries, vaccination campaigns are lagging, and evidence on vaccine acceptance, a crucial public health planning input, remains scant. This is the first study that reports willingness to take COVID-19 vaccines and its socio-demographic correlates in Ethiopia, Africa’s second most populous country. Methods The analysis is based on a nationally representative survey data of 2,317 households conducted in the informal economy in November 2020. It employs two logistic regression models where the two outcome variables are (i) a household head’s willingness to take a COVID-19 vaccine or not, and (ii) if yes if they would also hypothetically pay (an unspecified amount) for it or not. Predictors include age, gender, education, marital status, income category, health insurance coverage, sickness due to COVID-19, chronic illness, trust in government, prior participation in voluntary activities, urban residence. Results Willingness to take the vaccine was high (88%) and significantly associated with COVID-19 cases in the family, trust in government and pro-social behavior. All other predictors such as gender, education, income, health insurance, chronic illness, urban residence did not significantly predict vaccine willingness at the 5% level. Among those willing to take the vaccine, 33% also answered that they would hypothetically pay (an unspecified amount) for it, an answer that is significantly associated with trust in government, health insurance coverage and income. Conclusion The results highlight both opportunities and challenges. There is little evidence of vaccine hesitancy in Ethiopia among household heads operating in the informal economy. The role played by trust in government and pro-social behavior in motivating this outcome suggests that policy makers need to consider these factors in the planning of COVID-19 vaccine campaigns in order to foster vaccine uptake. At the same time, as the willingness to hypothetically pay for a COVID-19 vaccine seems to be small, fairly-priced vaccines along with financial support are also needed to ensure further uptake of COVID-19 vaccines.

by Cherry Kim, Ji-Yeon Kim, Eun Joo Lee, Yu Min Kang, Kyoung-Ho Song, Eu Suk Kim, Eun Jin Kim, Seungsoo Sheen, Yoo Ra Lee, BeoDeul Kang, Joon Ho Kim, Myoung Lyeol Woo, Chul Hee Park, Soohoon Kwon, Eun Ju Choo, Tark Kim, Donghoon Kim, Hong Sang Oh, Won Suk Choi

Reports detailing the clinical characteristics, viral load, and outcomes of patients with normal initial chest CT findings are lacking. We sought to compare the differences in clinical findings, viral loads, and outcomes between patients with confirmed COVID-19 who initially tested negative on chest CT (CT negative) with patients who tested initially positive on chest CT (CT positive). The clinical data, viral loads, and outcomes of initial CT-positive and CT-negative patients examined between January 2020 and April 2020 were retrospectively compared. The efficacy of viral load (cyclic threshold value [Ct value]) in predicting pneumonia was evaluated using receiver operating characteristic (ROC) curve and area under the curve (AUC). In total, 128 patients underwent initial chest CT (mean age, 54.3 ± 19.0 years, 50% male). Of those, 36 were initially CT negative, and 92 were CT positive. The CT-positive patients were significantly older (P .001) than the CT-negative patients. Only age was significantly associated with the initial presence of pneumonia (odds ratio, 1.060; confidence interval (CI), 1.020-1-102; P = .003). In addition, age (OR, 1.062; CI, 1.014–1.112; P = .011), fever at diagnosis (OR, 6.689; CI, 1.715–26.096; P = .006), and CRP level (OR, 1.393; CI, 1.150–1.687; P = .001) were significantly associated with the need for O2 therapy. Viral load was significantly higher in the CT-positive group than in the CT-negative group (P = .017). The cutoff Ct value for predicting the presence of pneumonia was 27.71. Outcomes including the mean hospital stay, intensive care unit admission, and O2 therapy were significantly worse in the CT-positive group than in the CT-negative group (all P .05). In conclusion, initially CT-negative patients showed better outcomes than initially CT-positive patients. Age was significantly associated with the initial presence of pneumonia, and viral load may help in predicting the initial presence of pneumonia.

by Piyoosh Kumar Singh, Anup Anvikar, Abhinav Sinha
Introduction This highly contagious zoonotic corona virus (SARS-CoV-2) spread to most parts of the world (200 countries) and created a public health emergency. Due to its novel nature and indistinctness, different sources of information and suggestions were developed to guide the individuals about its transmission and prevent its infection. Responses to the active intervention efforts have posed some relevant questions on population understanding and attitudes toward COVID-19. The present study is aims to assess the COVID-19 related knowledge, attitude, and practices (KAP) in a heterogeneous Indian population. Material and methods 501 respondents across India participated in a questionnaire-based online survey from April 2020 to May 2020. The questionnaire incorporated 56 questions about demographic characteristics and KAP dimensions. The mixed (quantitative and qualitative) methods were employed to evaluate KAP dimensions. Descriptive analysis was estimated as means, SD, and proportion. The bivariate (χ2), correlation, and regression analysis were utilized for the response analysis. In addition, qualitative analysis, including content and thematic analysis were done for open-ended questions. Result High knowledge and positive attitude were reported in more than half of the study population, with a proportion of 58.6% and 62.1%, respectively. Education shows a significant difference in the knowledge and attitude dimensions. The good practice (50.5% of the total population) reported a significant difference in age and gender categories with the test of independence (χ2). Prevention (56.89%) in knowledge domain and risk (17.56%), information-seeking (45.51%), prevention (51.50%), and treatment-seeking (54.29%) in attitude domains recorded low proportion. KAP variables were found in association in Pearson correlation analysis. In logistic regression analysis, knowledge was the strongest predictor for the positive attitude, whereas attitude was reported as the best predictor for good practice outcome. Conclusion The study presents a moderate level of covid related knowledge, Attitudes, and Practices in Indian population.

by Sanmay Shelat, Thijs van de Wiel, Eric Molin, J. W. C. van Lint, Oded Cats
Introduction Unlike previous pandemics, COVID-19 has sustained over a relatively longer period with cyclical infection waves and numerous variants. Public transport ridership has been hit particularly hard. To restore travellers’ confidence it is critical to assess their risk determinants and trade-offs. Methods To this end, we survey train travellers in the Netherlands in order to: (i) quantify the impact of trip-specific, policy-based, and pandemic-related attributes on travellers’ COVID-19 risk perceptions; and (ii) evaluate the trade-off between this risk perception and other travel attributes. Adopting the hierarchical information integration approach, in a two-stage stated preference experiment, respondents are asked to first rate how risky they perceive different travel situations to be, and then to choose between different travel options that include their own perceived risk rating as an attribute. Perceived risk ratings and choices between travel options are modelled using a linear regression and a mixed multinomial logit model, respectively. Results We find that on-board crowding and infection rates are the most important factors for risk perception. Amongst personal characteristics, the vulnerability of family and friends has the largest impact—nearly twice that of personal health risk. The bridging choice experiment reveals that while values of time have remained similar to pre-pandemic estimates, travellers are significantly more likely to choose routes with less COVID-19 risk (e.g., due to lower crowding). Respondents making longer trips by train value risk four times as much as their shorter trip counterparts. By combining the two models, we also report willingness to pay for mitigating factors: reduced crowding, mask mandates, and increased sanitization. Conclusion Since we evaluate the impact of a large number of variables on route choice behaviour, we can use the estimated models to predict behaviour under detailed pandemic scenarios. Moreover, in addition to highlighting the importance of COVID-19 risk perceptions in public transport route choices, the results from this study provide valuable information regarding the mitigating impacts of various policies on perceived risk.

by Alonso Soto, Dante M. Quiñones-Laveriano, Johan Azañero, Rafael Chumpitaz, José Claros, Lucia Salazar, Oscar Rosales, Liz Nuñez, David Roca, Andres Alcantara
Objectives To determine the risk factors for in-hospital mortality in patients with COVID-19 from a Peruvian national hospital. Methods Retrospective cohort study of medical records of patients with COVID-19 hospitalized at Hospital Nacional Hipólito Unanue (HNHU) during the months of April to August 2020. The dependent variable was in-hospital mortality. Independent variables included sociodemographic and clinical characteristics, physical examination findings, oxygen saturation (SaO2) at admission, treatment received during hospitalization and laboratory results at admission. A Cox regression model was used to evaluate the crude and adjusted hazard ratios for associated factors. Results We included 1418 patients. Median age was 58 years (IQR 47–68 years) and 944 (66.6%) were male. The median length of hospitalization was 7 (4–13) days, and the mortality rate was 46%. The most frequent comorbidities were type 2 diabetes mellitus, hypertension, and obesity. In the adjusted analysis, mortality was associated with age (HR 1.02; 95%CI 1.02–1.03), history of surgery (HR 1.89; 95%CI 1.31–2.74), lower oxygen saturation at admission (HR 4.08; CI95% 2.72–8.05 for SaO294%), the presence of poor general condition (HR 1.81; 95% CI 1.29–2.53), altered state of consciousness (HR 1.58; 95%CI 1.18–2.11) and leukocyte levels (HR 1.01; 95%CI 1.00–1. 02). Treatment with ivermectin (HR 1.44; 95%CI 1.18–1.76) and azithromycin (HR 1.25; 95%CI 1.03–1.52) were associated with higher mortality. Treatment with corticosteroids at low to moderate doses was associated with lower mortality (HR 0.56 95%CI 0. 37–0. 86) in comparison to no steroid use. Conclusion A high mortality was found in our cohort. Low oxygen saturation at admission, age, and the presence of hematological and biochemical alterations were associated with higher mortality. The use of hydroxychloroquine, ivermectin or azithromycin was not useful and was probably associated with unfavorable outcomes. The use of corticosteroids at moderate doses was associated with lower mortality.

by Salah AbuRuz, Ahmad Al-Azayzih, Sham ZainAlAbdin, Rami Beiram, Mohammed Al Hajjar
Background The relationship between COVID-19 patient’s clinical characteristics and disease manifestation remains incompletely understood. The impact of ethnicity on mortality of patients with COVID-19 infection is poorly addressed in the literature. Emerging evidence suggests that many risk factors are related to symptoms severity and mortality risk, emphasizing the necessity of fulfilling this knowledge gap that may help reducing mortality from COVID-19 infections through tackling the risk factors. Aims To explore epidemiological and demographic characteristics of hospitalized COVID-19 patients from different ethnic origins living in the UAE, compare them to findings reported across the globe and determine the impact of these characteristics and ethnicity on mortality during hospitalization. Methods A single center, retrospective chart review study of hospitalized COVID-19 patients was conducted in a large COVID-19 referral hospital in UAE. The following outcomes were assessed: patients’ clinical characteristics, disease symptoms and severity, and association of ethnicity and other risk factors on 30-day in hospital mortality. Results A total of 3296 patients were recruited in this study with an average age of 44.3±13.4 years old. Preliminary data analysis indicated that 78.3% (n = 2582) of cases were considered mild. Average duration of hospital stay was 6.0±7.3 days and 4.3% (n = 143) were admitted to ICU. The most frequently reported symptoms were cough (32.6%, n = 1075) and fever (22.2%, n = 731). The 30-day mortality rate during hospitalization was 2.7% (n = 90). Many risk factors were associated with mortality during hospitalization including: age, respiratory rate (RR), creatinine, and C-reactive protein, oxygen saturation (SaO2), hemoglobin, hematocrit, ferritin, creatinine, C-reactive protein, anemia, COPD, Chronic kidney disease, dyslipidemia, Vitamin-D Deficiency, and ethnic origin (p

by Wubedle Zelalem Temesgan, Mastewal Belayneh Aklil, Henok Solomon Yacob, Esubalew Tsega Mekonnen, Elias Derso Tegegne, Esubalew Binega Tesfa, Eshetie Melkie Melese, Tewodros Seyoum
Background Coronavirus disease 2019 (COVID-19) causes more than five million deaths worldwide. Pregnant women are at high risk for infection due to the physiologic change in the immune and cardiopulmonary system and also it increases the risk of severe disease, intensive care unit admission, and receive mechanical ventilation when compared with non-pregnant women. It is associated with adverse maternal and neonatal outcomes. So pregnant women need to have adhered to preventive measures to prevent COVID-19 related consequences. Therefore, this study aimed to assess adherence toCOVID-19 preventive practice and associated factors among pregnant women in Gondar city, northwest Ethiopia. Methods A community-based cross-sectional study was conducted from July 1st to 30th, 2021, in Gondar city. A cluster sampling technique was employed to select 678 pregnant women. Data were collected using a pre-tested, face-to-face interviewer-administered questionnaire. Data were entered into EPI DATA version 4.6 and exported to SPSS version 25 for analysis. Both bivariable and multivariable logistic regression analysis was fitted to identify associated factors. Adjusted odds ratio with a 95% confidence interval was used to report the association between covariates and the outcome variable. Results The prevalence of good adherence to COVID-19 preventive practice was 44.8% (95% CI: 41.3, 48.7). Maternal age (≤24 years) [AOR = 2.89, 95% CI: 1.37, 6.10], maternal education (secondary school) [AOR = 2.95, 95% CI: 1.58, 5.53] and (college and above) [AOR = 4.57,95% CI: 2.42, 8.62], having ANC follow up [AOR = 2.95, 95% CI: 1.35, 6.46] and adequate knowledge towards COVID-19 [AOR = 1.70, 95% CI: 1.20, 2.41] were significantly associated with good adherence to COVID-19 preventive practice. Conclusion In this study, adherence towards COVID-19 preventive practice in pregnant women is low. Hence, it is important to strengthen women’s awareness about COVID-19 through different media and health education. In addition, empowering women to attain ANC and special consideration should be given to women who had no formal education.

by Colleen E. Reid, Emma S. Rieves, Kate Carlson
Background The COVID-19 pandemic has impacted both physical and mental health. This study aimed to understand whether exposure to green space buffered against stress and distress during the COVID-19 pandemic while taking into account significant stressors of the pandemic. Methods We leveraged a cross-sectional survey on green space exposure and mental health among residents of Denver, CO that ran from November 2019 through January 2021. We measured objective green space as the average NDVI (normalized difference vegetation index) from aerial imagery within 300m and 500m of the participant’s residence. Perceived green space was measured through Likert scores on five questions about vegetation near the home that captured perceived abundance, visibility, access, usage, and quality of green space. We used generalized linear models to assess the relationship between each green space exposure variable and perceived stress (PSS-4), depression (CES-D-10), or anxiety (MMPI-2) adjusted for sociodemographic and COVID-19 impact variables. Results We found significantly higher depression scores for all covid periods compared to the “before covid” period, and significantly higher anxiety scores during the “fall wave” compared to earlier periods. Adjusted for sociodemographic and pandemic stressors, we found that spending a lot of time in green space (usage) was significantly associated with lower anxiety and depression. We also observed significantly lower depression scores associated with NDVI in both buffers (objective abundance) and significantly lower anxiety scores with perceived abundance of green space. There was some evidence of lower anxiety scores for people reporting having high quality green spaces near the home (quality). We did not observe significant associations for any green space metric and perceived stress after adjustment for confounding variables. Conclusion Our work provides further evidence of mental health benefits associated with green space exposure during the COVID-19 pandemic even after adjustment for sociodemographic variables and significant pandemic-related stressors.

by X. Hernandez, S. Valentinotti

High quality daily testing for the presence of the SARS-CoV-2 in workplace settings has become part of the standard and mandatory protection measures implemented widely in response to the current pandemic. Such tests are often limited to a small fraction of the attending personnel due to cost considerations, limited availability and processing capabilities and the often cumbersome requirements of the test itself. A maximally efficient use of such an important and frequently scarce resource is clearly required. We here present an optimal testing strategy which minimises the presence of pre-symptomatic and asymptomatic infected members of the population in a workplace setting, derived under a series of simplifying statistical assumptions. These assumptions however, retain many of the generalities of the problem and yield robust results, as verified through a number of numerical simulations. We show that reduction in overall infected-person-days, IPD, by significant percentages can be achieved, for fixed numbers of tests per day of 5% and 10% of the population, of 30% and 50% in the IPD numbers, respectively.

by Nathane C. Mebus-Antunes, Wellington S. Ferreira, Glauce M. Barbosa, Thais C. Neves-Martins, Gilberto Weissmuller, Fabio C. L. Almeida, Andrea T. Da Poian

Dengue virus (DENV) causes a major arthropod-borne viral disease, with 2.5 billion people living in risk areas. DENV consists in a 50 nm-diameter enveloped particle in which the surface proteins are arranged with icosahedral symmetry, while information about nucleocapsid (NC) structural organization is lacking. DENV NC is composed of the viral genome, a positive-sense single-stranded RNA, packaged by the capsid (C) protein. Here, we established the conditions for a reproducible in vitro assembly of DENV nucleocapsid-like particles (NCLPs) using recombinant DENVC. We analyzed NCLP formation in the absence or presence of oligonucleotides in solution using small angle X-ray scattering, Rayleigh light scattering as well as fluorescence anisotropy, and characterized particle structural properties using atomic force and transmission electron microscopy imaging. The experiments in solution comparing 2-, 5- and 25-mer oligonucleotides established that 2-mer is too small and 5-mer is sufficient for the formation of NCLPs. The assembly process was concentration-dependent and showed a saturation profile, with a stoichiometry of 1:1 (DENVC:oligonucleotide) molar ratio, suggesting an equilibrium involving DENVC dimer and an organized structure compatible with NCLPs. Imaging methods proved that the decrease in concentration to sub-nanomolar concentrations of DENVC allows the formation of regular spherical NCLPs after protein deposition on mica or carbon surfaces, in the presence as well as in the absence of oligonucleotides, in this latter case being surface driven. Altogether, the results suggest that in vitro assembly of DENV NCLPs depends on DENVC charge neutralization, which must be a very coordinated process to avoid unspecific aggregation. Our hypothesis is that a specific highly positive spot in DENVC α4-α4’ is the main DENVC-RNA binding site, which is required to be firstly neutralized to allow NC formation.

by Emily Hadley, Sarah Rhea, Kasey Jones, Lei Li, Marie Stoner, Georgiy Bobashev

Agent-based models (ABMs) have become a common tool for estimating demand for hospital beds during the COVID-19 pandemic. A key parameter in these ABMs is the probability of hospitalization for agents with COVID-19. Many published COVID-19 ABMs use either single point or age-specific estimates of the probability of hospitalization for agents with COVID-19, omitting key factors: comorbidities and testing status (i.e., received vs. did not receive COVID-19 test). These omissions can inhibit interpretability, particularly by stakeholders seeking to use an ABM for transparent decision-making. We introduce a straightforward yet novel application of Bayes’ theorem with inputs from aggregated hospital data to better incorporate these factors in an ABM. We update input parameters for a North Carolina COVID-19 ABM using this approach, demonstrate sensitivity to input data selections, and highlight the enhanced interpretability and accuracy of the method and the predictions. We propose that even in tumultuous scenarios with limited information like the early months of the COVID-19 pandemic, straightforward approaches like this one with discrete, attainable inputs can improve ABMs to better support stakeholders.

by János Sándor, Ferenc Vincze, Maya Liza Shrikant, László Kőrösi, László Ulicska, Karolina Kósa, Róza Ádány

The segregated colonies (SCs) in Hungary are populated mainly but not exclusively by Roma. Their health care use is restricted in many respects. It has not been studied yet, whether fair COVID-19 vaccination coverage achieved in Hungary is accompanied with fair effectiveness in SCs. Using census data, the vaccination coverage in SCs and the complementary areas (CAs) in the same settlements of the country was determined. To describe the settlement level differences, the vaccination coverage (until June 30, 2021) in SCs were compared to those in CAs by age, sex, and eligibility for exemption certificate standardized measures. Aggregating settlement level data, the level of geographic discrimination in Hungary was also determined. According to nationwide aggregates, crude vaccination coverage was significantly lower in SCs (40.05%, 95% CI 39.87%-40.23%) than in CAs (65.42%, 95% CI 65.37%-65.46%). The relative standardized vaccination coverage was 0.643 (95% CI 0.639–0.647) in SCs. A total of 437 of the 938 investigated settlements showed significant local vaccination disparities. Hungarian citizens living in SCs, mainly of Roma ethnicity, are a distinct high-risk group. Special intervention adapted to SCs is needed to mitigate inequality in vaccination coverage and further consequences of the pandemic.