Exploring the Health Literacy and Health Situation of School Principals and Vice Principals in Punjab, Pakistan: Insights from an Online-Based Survey during the COVID-19 Pandemic (preprint)

Background This study aimed to evaluate health literacy and general health status among school principals and vice principals in Pakistan, 1) to identify work-related factors associated with them, and 2) to determine their association with physical and mental health, particularly in the context of the COVID-19 pandemic.Methods An online-based cross-sectional survey was conducted among 350 school principals and vice principals in Punjab province, Pakistan. The study was conducted under the COVID Global Health Literacy Network. Data related to socio-demographic characteristics, health literacy, general health status, chronic illnesses and impairment, well-being, psychosomatic complaints, and emotional exhaustion were collected. We applied bivariate analyses as well as binary and multivariable logistic regression analyses.Results Over half of the respondents (66.6%) had sufficient levels of health literacy. A good general health status was reported by 80.3%. One of the strongest predictors of health literacy and general health status was school position (principals vs. vice principals). Additionally, those with sufficient health literacy were less likely to have frequent emotional exhaustion; while those having good general health status were less likely to report low well-being, frequent emotional exhaustion, and psychosomatic complaints. The study also found that females were less likely to have a good general health status (OR = 0.45) and were more likely to have frequent emotional exhaustion (OR = 1.75) as well as psychosomatic complaints (OR = 1.94) than males.Conclusions Limited health literacy in school leaders requires interventions for better decision-making on health matters, emphasizing the need for targeted training programs.

Effectiveness Of Pcr Pool Testing For Screening Of Covid-19 Infection In Pakistan.

BACKGROUND: We tested the utility of mini-pool PCR testing for the rational use of PCR consumables in screening for CoViD-19. METHODS: After pilot experiments, 3-samples pool size was selected. One step RT-PCR was performed. The samples in the mini-pool having COVID gene amplification were tested individually. RESULTS: 1548 samples tested in 516 mini-pools resulted 396 mini-pools as negative and 120 as positive. Upon individual testing, 110 samples tested positive and 9 were inconclusive. 876 PCR reactions were performed to test 1548 samples, saving 43% PCR reagents. Centres with low prevalence resulted in most saving on reagents (50%), while centres with high prevalence resulted in more test reactions. Testing of individual samples resulted in delays in reporting. CONCLUSIONS: Pooling can increase lab capacity, however, pooling delays results and cause degradation of samples.

Characteristic Distinctions Between Pre-/Post-COVID-19 Teledermatology Adoptees: A Cross-Sectional United States-based Analysis and the Implications for Dermatologic Healthcare Equity.

BACKGROUND: Studies suggest potential heterogeneity in telemedicine adoption with potential to exacerbate healthcare access inequity. METHODS: A pre-validated survey was electronically sent to a proprietary listserv of practicing US-based dermatologists. Results were stratified by when teledermatology was adopted. Chi-square and odds ratios (OR) with 95% confidence intervals (95%CI) were used to analyze categorical data while single-factor ANOVA with posthoc Tukey-Kramer was used for continuous data. RESULTS: 338 practicing US-based dermatologists completed the questionnaire. Academic/Government dermatologists were 4-times more likely (OR 4.08, 95%CI 2.37-7.03) to adopt teledermatology pre-COVID than private-practice dermatologists. Dermatologists with ≤10 years of experience were 1.8-times (OR 1.8, 95%CI 1.01-3.18) and 2.82-times more likely (OR 2.82, 95%CI 0.78-10.25) to adopt teledermatology pre-COVID-19 or at all, respectively, compared to dermatologists with ≥20 years of experience. Teledermatology adopters practiced more medical-dermatology (P<.0001) than non-adopters, who reported practicing more dermatologic surgery (P=.003; Tukey-Kramer α<.05) and dermatopathology (P<.0001; Tukey-Kramer α<.05). Pre-COVID-19 adopters were 4-times more likely (OR 4.69, 95%CI 1.46-15.07) to switch/incorporate live-interactive-only teledermatology (LI) post-COVID-19. Post-COVID-19 adopters were 6-times more likely (OR 6.09, 95%CI 3.36-11.06) to utilize LI than Pre-COVID-19 adopters. Pre-COVID-19 adopters use teledermatology for a larger proportion of patient visits than Post-COVID-19 adopters (19.6% v 10.4%, P<.0001), but also are 3.43-times more likely (OR 3.43, 95%CI 1.82-6.46) to report future decreases in usage. LIMITATIONS: Cross-sectional retrospective survey and potential response bias. CONCLUSION: Current teledermatology usage may be a suitable tool for medical-dermatology-focused practices. Material hurdles still exist for procedurally-oriented practices and future studies should investigate these barriers to maximize equitable access to dermatological care. J Drugs Dermatol. 2023;21(1):101-104. doi:10.36849/JDD.7169.

COVID-19 Vaccination Acceptance in the Context of the Health Belief Model: Comparative Cross-Sectional Study in Punjab, Pakistan.

One of the models that could be used to understand the adoption of vaccine uptake is the Health Belief Model (HBM). The aim of this study is to assess the role of HBM constructs and Perceived Health Status (PHS) on the vaccination status of individuals and to understand the role of socio-demographic variables on HBM scoring. A comparative cross-sectional telephone survey was conducted among 1325 vaccinated (60.0%) and non-vaccinated (40.0%) individuals aged 40 years and above in July 2021 in Punjab province, Pakistan. A higher level of education was the strongest predictor of positive HBM. All constructs of HBM, PHS and cues-to-action were significant predictors of COVID-19 vaccination uptake, with perceived benefits as the strongest predictor. In order to expand the vaccination coverage, double-pronged interventions utilizing both information and communication technology and human resources should be designed that address each barrier perceived by individuals and understandably communicate the benefits of COVID-19 vaccination to the broader population.

COVID-19 Vaccination Acceptance in the Context of the Health Belief Model: Comparative Cross-Sectional Study in Punjab, Pakistan (preprint)

One of the models that could be used to understand the adoption of vaccine uptake is the Health Belief Model (HBM). The aim of this study is to assess the role of HBM constructs and perceived health status (PHS) on vaccination status of individuals and to understand the role of socio-demographic variables on HBM scoring. A comparative cross-sectional telephone survey was conducted among 1,325 vaccinated (60.0%) and non-vaccinated (40.0%) vaccinated individuals aged 40 years and above in July 2021 in Punjab province, Pakistan. A higher level of education was the strongest predictor of positive HBM. All constructs of HBM, PHS and cues-to-action were significant predictors of COVID-19 vaccination uptake with perceived benefits as the strongest predictor. In order to expand the vaccination coverage, doubled pronged interventions utilizing both ICT and human resources should be designed that address each barrier perceived by individuals and understandably communicate the benefits of COVID-19 vaccine to the broader population.

New Method to Implement and Analysis of Medical System in Real Time.

The use of information technology and technological medical devices has contributed significantly to the transformation of healthcare. Despite that, many problems have arisen in diagnosing or predicting diseases, either as a result of human errors or lack of accuracy of measurements. Therefore, this paper aims to provide an integrated health monitoring system to measure vital parameters and diagnose or predict disease. Through this work, the percentage of various gases in the blood through breathing is determined, vital parameters are measured and their effect on feelings is analyzed. A supervised learning model is configured to predict and diagnose based on biometric measurements. All results were compared with the results of the Omron device as a reference device. The results proved that the proposed design overcame many problems as it contributed to expanding the database of vital parameters and providing analysis on the effect of emotions on vital indicators. The accuracy of the measurements also reached 98.8% and the accuracy of diagnosing COVID-19 was 64%. The work also presents a user interface model for clinicians as well as for smartphones using the Internet of things.

COVID-19 Vaccination Hesitancy or Acceptance and Its Associated Factors: Findings from Post-Vaccination Cross-Sectional Survey from Punjab Pakistan.

COVID-19 has posed massive challenges related to health, economy, and the social fabric of the entire human population. To curb the spread of the virus, the Government of Pakistan initiated a vaccination campaign against COVID-19. The objective of this research was to assess the factors associated with COVID-19 vaccine acceptance or hesitancy. The data were collected telephonically using a cross-sectional survey design through a close-ended structured questionnaire from a sample of 1325 vaccinated and non-vaccinated individuals with a response rate of 38%. SPSS v. 26 was used to analyze the data. The study revealed that 73% of the respondents were male, half in the 40-49 age group, 78% living in urban areas, and 45% had a monthly income between 20,001-50,000 Pakistani rupees. People felt reluctant to get vaccinated because of myths and misinformation related to it. The socio-demographic factors including male, age 60-69, middle or higher level of education, marital status, currently employed, from middle socio-economic status, living in urban areas, high access to mass media, history of influenza vaccination, physical activity, and perceived good health status were significantly associated with COVID-19 vaccination uptake. Concerted efforts are needed to achieve vaccine targets for the broader population through understanding and identifying barriers to vaccination.

Role of the Media in Health-Related Awareness Campaigns on Perception of COVID-19: A Pre-post Study in the General Population of Pakistan.

Medical preparedness and community education are the most valuable preventive tools for combatting the COVID-19 pandemic. This study aims to assess the role of media public health awareness campaigns on the knowledge of the general population about COVID-19 in Rawalpindi, Pakistan. A quantitative study using a pre-post design among 384 respondents was conducted. A structured questionnaire was administered to the participants twice: The first response (t 1) from participants was filled in during the 1st week in February 2020 before any confirmed cases were reported in the country, and the second response (t 2) was completed 1 month after the first case detection in Pakistan (March 2020). Media health awareness campaigns were launched just after the detection of the first case in Pakistan. Exposure to the media and knowledge relating to COVID-19 increased over time. Whereas, only a quarter of respondents judged the isolation of suspected cases in quarantine to be important to prevent the spread of infection in society at t 1, more than half did so at t 2. Socio-demographic characteristics were not significantly associated with knowledge (gains). However, more frequent use of electronic media is associated with greater knowledge gains from t 1 to t 2. The findings of this study provide evidence that awareness and knowledge related to COVID-19 symptoms and preventive measures increased significantly over time. The increased frequency of following the media indicates that health awareness campaigns are important for enhancing the knowledge of the general public regarding COVID-19.

Insights into the Mobility Pattern of Australians during COVID-19

Coronavirus disease 2019 (COVID-19) is an infectious disease characterised by symptoms that are like the common cold. The current pandemic situation in anticipation of a vaccine has posed serious threats to the health and economic sectors of countries worldwide. To overcome the quick transmission of the virus, the government of Australia has also taken drastic measures to prevent its spread. These policies include an international and interstate travel ban, social distancing rules, lockdown, shutdown of educational institutes and work-from-home policies. Such rules have affected people on both behavioural and psychological levels. This study aims to analyse the effect of COVID-19 on Australian citizens, and therefore, the changed behaviour of citizens concerning their mobility patterns, transport preferences and shopping methods under the pandemic have been studied. A detailed literature search was adopted for gathering data related to the study theme, along with real-time evidence of changes in the behaviour of people following the pandemic. The socioeconomic impact of the pandemic on social inequality and thereby the effect on the vulnerable people of the population are also studied. Authentic surveys and statistical data are consulted to figure out how the new lifestyle choices of people will linger in the post-pandemic era. It was found that people in Australia have adopted the work-from-home regime, and new habits suiting the nationwide restrictions have become routine for many people.

Sociocultural Challenges in the Implementation of COVID-19 Public Health Measures: Results From a Qualitative Study in Punjab, Pakistan.

Informed public health measures are crucial to curb the COVID-19 pandemic. The sociocultural context is important to understand the success or failure of implementing public health measures. This study explores the social and behavioral response to COVID-19 and unveils challenges in the implementation of related public health measures in Pakistan. Within this qualitative study, we conducted 34 telephonic/online in-depth interviews with youths, adults, elderly people, and healthcare professionals in the Punjab province of Pakistan. Framework analysis was used for data analysis. People's poor understanding about COVID-19 and the need for preventive measures were the major challenge in implementing public health preventive strategies. Study participants reported that the lockdown strategy increased poverty and unemployment. People's poor living conditions and living environment compelled them not to follow social distancing and restricting themselves to home. Additionally, an underdeveloped healthcare system was one of the major challenges for Pakistan. The culture of denial in Pakistan related to the epidemiology of COVID-19 was an important challenge within the implementation of public health preventive measures. It is extremely important that public health experts and social scientists work together to understand the contextual sociocultural factors which shape behaviors associated with the spread of a pandemic.

Psychosocial effects of the COVID-19 pandemic and lockdown on university students: Understanding apprehensions through a phenomenographic approach.

Limited evidence exists to help understand the experiences of university students in relation to the long-term lockdown due to the COVID-19 pandemic. For that reason, we conducted a study using a phenomenographic approach in order to understand how university students perceive COVID-19 and the associated lockdown. Data were collected from 25 students in Pakistan. They were asked to demonstrate the psychological effects of the COVID-19 pandemic and lockdown in illustrations. In addition, in-depth interviews were conducted with these students, to gain further insights into their perspectives on the psychosocial effects of the COVID-19 pandemic. The analysis revealed four interlinked directions for understanding students' experiences. These themes were: 1) escape into peace, 2) hope for personal freedom, 3) fear of becoming a victim of COVID-19, and 4) concerns regarding education, future career, and opportunities. All four themes were analyzed and condensed into an outcome space, which further gathers the perceptions of students under one theme as "Hope for life while paradoxically living with fear". Studying the psychological impact of the COVID-19 pandemic and lockdown on students not only highlighted their concerns, but also emphasized the importance of starting regular psychological evaluations and stress-releasing sessions, along with online education to overcome growing depression.

Blockchain based Privacy-Preserved Federated Learning for Medical Images: A Case Study of COVID-19 CT Scans (preprint)

Medical health care centers are envisioned as a promising paradigm to handle the massive volume of data of COVID-19 patients using artificial intelligence (AI). Traditionally, AI techniques often require centralized data collection and training the model in a single organization, which is most common weakness due to the privacy and security of raw data communication. To solve this challenging task, we propose a blockchain-based federated learning framework that provides collaborative data training solutions by coordinating multiple hospitals to train and share encrypted federated models without leakage of data privacy. The blockchain ledger technology provides the decentralization of federated learning model without any central server. The proposed homomorphic encryption scheme encrypts and decrypts the gradients of model to preserve the privacy. More precisely, the proposed framework: i) train the local model by a novel capsule network to segmentation and classify COVID-19 images, ii) then use the homomorphic encryption scheme to secure the local model that encrypts and decrypts the gradients, and finally the model is shared over a decentralized platform through proposed blockchain-based federated learning algorithm. The integration of blockchain and federated learning leads to a new paradigm for medical image data sharing in the decentralized network. The conducted experimental resultsdemonstrate the performance of the proposed scheme.

SARS-CoV-2 and immune-microbiome interactions: Lessons from respiratory viral infections.

By the beginning of 2020, infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had rapidly evolved into an emergent worldwide pandemic, an outbreak whose unprecedented consequences highlighted many existing flaws within public healthcare systems across the world. While coronavirus disease 2019 (COVID-19) is bestowed with a broad spectrum of clinical manifestations, involving the vital organs, the respiratory system transpires as the main route of entry for SARS-CoV-2, with the lungs being its primary target. Of those infected, up to 20% require hospitalization on account of severity, while the majority of patients are either asymptomatic or exhibit mild symptoms. Exacerbation in the disease severity and complications of COVID-19 infection have been associated with multiple comorbidities, including hypertension, diabetes mellitus, cardiovascular disorders, cancer, and chronic lung disease. Interestingly, a recent body of evidence indicated the pulmonary and gut microbiomes as potential modulators for altering the course of COVID-19, potentially via the microbiome-immune system axis. While the relative concordance between microbes and immunity has yet to be fully elucidated with regards to COVID-19, we present an overview of our current understanding of COVID-19-microbiome-immune cross talk and discuss the potential contributions of microbiome-related immunity to SARS-CoV-2 pathogenesis and COVID-19 disease progression.

COVID-19 and Health Information Seeking Behavior: Digital Health Literacy Survey Amongst University Students in Pakistan (preprint)

Amid to the COVID-19 pandemic, digital health literacy (DHL) has become a significant public health concern. This research aims to assess information seeking behavior, as well as the ability to find relevant information and deal with DHL among university students in Pakistan. An online-based cross-sectional survey, using a web-based interviewing technique, was conducted to collect data on DHL. Simple bivariate and multivariate linear regression was performed to assess the association of key characteristics with DHL. The results show a high DHL related to COVID-19 in 54.3% of students. Most of the Pakistani students demonstrated ~50% DHL in all dimensions, except of reliability. Multivariate findings showed that gender, sense of coherence and importance of information were found to be significantly associated with DHL. However, a negative association was observed with students’ satisfaction with information. This led to the conclusion that critical operational and navigations skills are essential to achieve COVID-19 DHL and cope with stress, particularly to promote both personal and community health. Focused interventions and strategies should be designed to enhance DHL amongst university students to combat the pandemic.

Insight into the Impact of COVID-19 on Australian Transportation Sector: An Economic and Community-Based Perspective

The Coronavirus Disease 2019 (COVID-19) is a major virus outbreak of the 21st century. The Australian government and local authorities introduced some drastic strategies and policies to control the outspread of this virus. The policies related to lockdown, quarantine, social distancing, shut down of educational institute, work from home, and international and interstate travel bans significantly affect the lifestyle of citizens and, thus, influence their activity patterns. The transport system is, thus, severely affected due to the COVID-19 related restrictions. This paper analyses how the transport system is impacted because of the policies adopted by the Australian government for the containment of the COVID-19. Three main components of the transport sector are studied. These are air travel, public transport, and freight transport. Various official sources of data such as the official website of the Australian government, Google mobility trends, Apple Mobility trends, and Moovit were consulted along with recently published research articles on COVID-19 and its impacts. The secondary sources of data include databases, web articles, and interviews that were conducted with the stakeholders of transport sectors in Australia to analyse the relationship between COVID-19 prevention measures and the transport system. The results of this study showed reduced demand for transport with the adoption of COVID-19 prevention measures. Declines in revenues in the air, freight, and public transport sectors of the transport industry are also reported. The survey shows that transport sector in Australia is facing a serious financial downfall as the use of public transport has dropped by 80%, a 31.5% drop in revenues earned by International airlines in Australia has been predicted, and a 9.5% reduction in the freight transport by water is expected. The recovery of the transport sector to the pre-pandemic state is only possible with the relaxation of COVID-19 containment policies and financial support by the government.

Role of the Media in Health-Related Awareness Campaigns on Perceptions of COVID-19: A Pre-Post Study in the General Population of Pakistan (preprint)

Background: In January 2020, the World Health Organization declared the COVID-19 outbreak a global public health emergency. Medical preparedness and community education are the most valuable preventive tools for combatting this pandemic. The objective of this study was to assess the role of media public health awareness campaigns on the knowledge of the general population about COVID-19 in Rawalpindi, Pakistan.Methods: A quantitative study using a pre-post design among 384 respondents was conducted. To recruit study participants, a systematic random sampling technique was used. A structured questionnaire was administered to the participants twice: The first response (t1) from participants was filled in during the first week in February 2020 before any confirmed cases were reported in the country, and the second response (t2) was completed one month after the first case detection in Pakistan (March 2020). Media health awareness campaigns were launched just after the detection of the first case in Pakistan. Data was analysed by computing descriptive statistics and paired t-tests to measure the level of association between variables.Results: Exposure to the media and knowledge relating to COVID-19, particularly its symptoms and frequent handwashing as a preventive measure, increased over time. Whereas only a quarter of respondents judged the isolation of suspected cases in quarantine to be important to prevent the spread of infection in society at t1, more than half did so at t2. The same increase was visible in relation to the statement that a lockdown helps to follow social distancing. Socio-demographic characteristics were not significantly associated with knowledge (gains). However, more frequent use of electronic media is associated with greater knowledge gains from t1 to t2.Conclusions: The findings of this study provide evidence that awareness and knowledge related to COVID-19 symptoms and preventive measures increased significantly over time. The increased frequency of following the media indicates that health awareness campaigns are important for enhancing the knowledge of the general public regarding COVID-19.

Blockchain-Federated-Learning and Deep Learning Models for COVID-19 detection using CT Imaging (preprint)

With the increase of COVID-19 cases worldwide, an effective way is required to diagnose COVID-19 patients. The primary problem in diagnosing COVID-19 patients is the shortage and reliability of testing kits, due to the quick spread of the virus, medical practitioners are facing difficulty identifying the positive cases. The second real-world problem is to share the data among the hospitals globally while keeping in view the privacy concerns of the organizations. Building a collaborative model and preserving privacy are major concerns for training a global deep learning model. This paper proposes a framework that collects a small amount of data from different sources (various hospitals) and trains a global deep learning model using blockchain based federated learning. Blockchain technology authenticates the data and federated learning trains the model globally while preserving the privacy of the organization. First, we propose a data normalization technique that deals with the heterogeneity of data as the data is gathered from different hospitals having different kinds of CT scanners. Secondly, we use Capsule Network-based segmentation and classification to detect COVID-19 patients. Thirdly, we design a method that can collaboratively train a global model using blockchain technology with federated learning while preserving privacy. Additionally, we collected real-life COVID-19 patients data, which is, open to the research community. The proposed framework can utilize up-to-date data which improves the recognition of computed tomography (CT) images. Finally, our results demonstrate a better performance to detect COVID-19 patients.