Spatiotemporal Modeling of the Association between Neighborhood Factors and COVID-19 Incidence Rates in Scotland

This study aims to investigate the association between neighborhood-level factors and COVID-19 incidence in Scotland from a spatiotemporal perspective. The outcome variable is the COVID-19 incidence in Scotland. Based on the identification of the wave peaks for COVID-19 cases between 2020 and 2021, confirmed COVID-19 cases in Scotland can be divided into four phases. To model the COVID-19 incidence, sixteen neighborhood factors are chosen as the predictors. Geographical random forest models are used to examine spatiotemporal variation in major determinants of COVID-19 incidence. The spatial analysis indicates that proportion of religious people is the most strongly associated with COVID-19 incidence in southern Scotland, whereas particulate matter is the most strongly associated with COVID-19 incidence in northern Scotland. Also, crowded households, prepandemic emergency admission rates, and health and social workers are the most strongly associated with COVID-19 incidence in eastern and central Scotland, respectively. A possible explanation is that the association between predictors and COVID-19 incidence might be influenced by local context (e.g., people's lifestyles), which is spatially variant across Scotland. The temporal analysis indicates that dominant factors associated with COVID-19 incidence also vary across different phases, suggesting that pandemic-related policy should take spatiotemporal variations into account. © 2023 by American Association of Geographers.

Brexit, COVID-19 and climate change: mapping the impact of the 'triple challenge' on health and well-being in wales

Brexit, COVID-19 and climate change pose challenges of national and global importance. They continue to have impacts across the economy, society, health, and the environment, all of which are determinants of health and well-being. Between 2018 and 2021, Public Health Wales undertook three Health Impact Assessments (HIA) in relation to the impact of the challenges in Wales. Based on these, work has been carried out to map the synergies across the 'Triple Challenge'. This paper highlights the commonalities in the impact of the three challenges for Wales, discusses the process carried out, learns from it and proposes actions that can be taken to mitigate harm. Results indicate the three components of the Triple Challenge must not be viewed as separate silos as they have cumulative multi-faceted impacts. This affects some population groups more negatively than others and present a 'Triple Challenge' to nation states in the UK and Europe. A HIA approach can enable a range of stakeholders to critically view similar challenges not just as single issues but as a holistic whole to mobilise action.

Over-the-counter Medication Use during Pandemic: Lessons Learned from Covid-19 in Lithuania : Rachel Elands

Background Despite the growing awareness about nonprescription misuse of anxiolytics, there is not much evidence about people’s behavior during the covid-19 lockdown when access to healthcare specialists was limited. Over the counter drug use has risen sharply in the past decades among college students and junior health care workers, yet, there are few studies reporting on the use of nonprescription medicine groups during the COVID-19 pandemic. Methods A cross-sectional study among 163 second-year medical students of the Lithuanian University of Health Sciences was conducted in Kaunas, Lithuania with self-reported measures of anxiety and insomnia and comparing nonprescription medicine use for anxiety and insomnia before and during the covid-19 pandemic. Results A near two-fold increase in the prevalence of anxiety and insomnia among Lithuanian medical students was reported during the covid-19 pandemic compared to before the onset of the pandemic (p < 0,001). The use of nonprescription medication increased during the pandemic (p < 0,001), in particular anxiolytics (p < 0,05). Once-weekly anxiolytic medication use increased from 8,0% before the pandemic to 14,7% during the pandemic. Regular nonprescription medicine use (2-3 times weekly) had more than tripled, from 2,4% to 9,2%. During the pandemic, almost a fifth of the respondents were increasingly searching for information on anxiolytic nonprescription medication online during the pandemic compared to before the pandemic. Conclusions During the covid-19 pandemic, the prevalence of anxiety and insomnia increased among Lithuanian medical students, along with the practice of anxiolytic nonprescription medications. Lithuanian medical students increasingly practiced self-medication during the pandemic and found the information on nonprescription medication increasingly online, which offers opportunities for telemedicine. Key messages • During the covid-19 pandemic, the prevalence of anxiety and insomnia increased among Lithuanian medical students, along with the practice of anxiolytic nonprescription medications. • During covid-19, Lithuanian medical students increasingly retrieved information on nonprescription medication online instead of consulting a pharmacist, offering opportunities for telemedicine.

Increasing influenza vaccination rates among healthcare workers by focusing on workplace and patient safety

Context: In 2014, the influenza vaccine uptake in Europe was below 35% among healthcare workers (HCWs). Due to a lack of confidence in vaccination as a result of safety concerns, HCWs increasingly do not take the influenza vaccine. Consequently, there is a rising influenza burden which results in increasing mortality of vulnerable patients and absenteeism in hospitals. This policy brief aims to increase the awareness of HCWs regarding the importance of influenza vaccination uptake, which may result in improved patient and workplace safety. Policy Options: To increase vaccination coverage and reduce vaccine hesitancy among HCWs, a change in attitude towards and knowledge about the influenza vaccine is needed. Two potential approaches are presented in this paper. Firstly, a mandatory vaccination policy is discussed. Practical and ethical challenges of implementing a mandatory vaccination policy are considered. Secondly, information campaigns are described, consisting of three pillars: safety, information, and knowledge. Recommendations: It is recommended to initiate information campaigns focussing on patient safety. Furthermore, a structural approach to increase access to vaccination at the workplace must be taken. Higher vaccination rates of HCWs lead to an improved workplace safety. The recommended information campaign can also be used for other vaccine preventable diseases or in other situations, such as HCWs vaccine hesitancy regarding COVID-19 vaccines. Lessons from the COVID-19 pandemic regarding acceptance of vaccines should be considered for the improvement of future influenza vaccine uptake. © 2021 De Bruin et al.;.

Ultraviolet A radiation and COVID-19 deaths in the USA with replication studies in England and Italy.

BACKGROUND: Understanding factors impacting deaths from COVID-19 is of the highest priority. Seasonal variation in environmental meteorological conditions affects the incidence of many infectious diseases and may also affect COVID-19. Ultraviolet (UV) A (UVA) radiation induces release of cutaneous photolabile nitric oxide (NO) impacting the cardiovascular system and metabolic syndrome, both COVID-19 risk factors. NO also inhibits the replication of SARS-CoV2. OBJECTIVES: To investigate the relationship between ambient UVA radiation and COVID-19 deaths. METHODS: COVID-19 deaths at the county level, across the USA, were modelled in a zero-inflated negative-binomial model with a random effect for states adjusting for confounding by demographic, socioeconomic and long-term environmental variables. Only those areas where UVB was too low to induce significant cutaneous vitamin D3 synthesis were modelled. We used satellite-derived estimates of UVA, UVB and temperature and relative humidity. Replication models were undertaken using comparable data for England and Italy. RESULTS: The mortality rate ratio (MRR) in the USA falls by 29% [95% confidence interval (CI) 40% to 15%) per 100 kJ m-2 increase in mean daily UVA. We replicated this in independent studies in Italy and England and estimate a pooled decline in MRR of 32% (95% CI 48% to 12%) per 100 kJ m-2 across the three studies. CONCLUSIONS: Our analysis suggests that higher ambient UVA exposure is associated with lower COVID-19-specific mortality. Further research on the mechanism may indicate novel treatments. Optimized UVA exposure may have population health benefits.

Ultraviolet A correlates inversely with risk of COVID-19 death

Seasonal variation in temperature, humidity and ultraviolet (UV) radiation are related to the incidence of several infectious diseases. COVID-19 arose only 6 months ago, and it is thus not possible to describe seasonal variation. Nonetheless, spatial variation in the levels of environmental UV in the early pandemic allows for an early exploration of its relationship with COVID-19 mortality. We explored whether UVA exposure might be associated with COVID-19 deaths. We used an ecological model across counties (n = 2474) for the contiguous U.S.A. during their 'vitamin D winter' (monthly mean UVvitd < 165 KJ m-2). We derived UVA measures over this period for each area and estimated, in a multilevel zero-inflated negative binomial model, their relationship with COVID-19 mortality with a random effect for states. The 'atrisk' population was the total county population, with the state-level random effect;proportion of population tested positive for COVID-19 at the state level;and measure of infection susceptibility (county population density and urban-rural status) used to incorporate spatial infection into the model. We then replicated this model for excess deaths across 6755 municipalities in Italy, and for COVID-19 deaths in 6274 areas of England. We corrected each model for multiple confounders at the small area level. We generated a pooled overall estimate of risk with a meta-analysis. Daily mean UVA (January-April 2020) varied between 450 and 1000 KJ m-2 across the three countries. Our fully adjusted model showed an inverse correlation between UVA and COVID-19 mortality with a mortality risk ratio (MRR) of 0.73 (0.62-0.87) per 100 KJ m-2 increase in UVA in the U.S.A., 0.81 (0.71-0.93) in Italy and 0.51 (0.39-0.66) in England. The pooled MRR was 0.68 (0.53-0.66). Our analysis, replicated in three independent national datasets, suggests that ambient UVA exposure is associated with lower COVID-19-specific mortality. This effect is independent of vitamin D, as it occurred at irradiances below those likely to induce significant cutaneous vitamin D3 synthesis. Cardiovascular disease worsens prognosis in COVID-19. We have previously described a novel UVA-driven, vitamin D-independent mechanism by which sunlight lowers blood pressure via nitric oxide (NO) release from skin and reduces incident myocardial infarctions. This nonspecific benefit may account for the UV-COVID-19 mortality relationship. Additionally, and more directly, NO inhibits the replication of the closely homologous severe acute respiratory syndrome-coronavirus 1 by post-translational modification of the spike protein blocking ligation of the angiotensin-converting enzyme 2 receptor. Causal interpretations must be made cautiously in observational studies. Nonetheless, this research suggests strategies for a reduction in COVID-19 mortality.