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1.
SSM Popul Health ; 17: 101017, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1635395

ABSTRACT

Background: The COVID-19 pandemic and associated policy responses, such as physical distancing interventions, pose risks to mental health that could be mitigated by social support systems. We examine associations between changes in mental health in the population aged 50 years and older in Europe and stringency of pandemic responses and social protection. Methods: We analysed data from the Survey of Health, Ageing and Retirement in Europe: n = 50,278 individuals aged 50 years and older in 26 European countries between June and August 2020. Linear multivariable regression models were used to evaluate potential risk factors for deterioration in self-reported mental health and investigate whether social protection systems mitigate it. Results: Across the European Union, 28.1% (95% CI:27.1-29.2) of participants reported worsening mental health since the beginning of the pandemic, ranging from 16.1% in Slovakia to 54.8% in Portugal. Factors associated with increased risk of deterioration included: being female (12.7 percentage points (ppt), 95%CI:9.2-16.2); experiencing unmet healthcare needs during the pandemic (14.6 ppt, 95%CI:11.2-18.1); job loss during the pandemic (6.2 ppt, 95%CI:1.1-11.8); and financial hardship (5.1 ppt, 95%CI:2.9-7.2). Greater stringency of physical distancing measures in countries was associated with worsening mental health (0.2 ppt per each one point increase on a stringency index, 95% CI:0.09-0.4); however, country-level pre-pandemic expenditures on various social protection packages was associated with decreased probability of worsening mental health (-1.3 ppt, 95%CI: 0.3 to -2.3 per €1,000 increase in health care expenditures per capita and, among the unemployed, -3.8 ppt, 95%CI: 1.6 to -2.4 per €100 increase in unemployment expenditure per capita). Conclusions: The COVID-19 pandemic has been associated with substantial mental health deterioration exhibiting social inequalities. Adverse mental health has been exacerbated by policy responses to the pandemic regulating physical distancing, but social protection expenditure might have helped mitigate the impact. Strengthening social protection systems might render the mental health of the population more resilient to the consequences of crises such as the COVID-19 pandemic.

3.
Health Policy ; 2022.
Article in English | ScienceDirect | ID: covidwho-1620689

ABSTRACT

The COVID-19 pandemic has shone a light on the complex relationship between science and policy. Policymakers have had to make decisions at speed in conditions of uncertainty, implementing policies that have had profound consequences for people's lives. Yet this process has sometimes been characterised by fragmentation, opacity and a disconnect between evidence and policy. In the United Kingdom, concerns about the secrecy that initially surrounded this process led to the creation of Independent SAGE, an unofficial group of scientists from different disciplines that came together to ask policy-relevant questions, review the evolving evidence, and make evidence-based recommendations. The group took a public health approach with a population perspective, worked in a holistic transdisciplinary way, and were committed to public engagement. In this paper, we review the lessons learned during its first year. These include the importance of learning from local expertise, the value of learning from other countries, the role of civil society as a critical friend to government, finding appropriate relationships between science and policy, and recognising the necessity of viewing issues through an equity lens.

4.
Sci Rep ; 12(1): 702, 2022 01 13.
Article in English | MEDLINE | ID: covidwho-1621268

ABSTRACT

Only a few studies investigated changes in electronic cigarette (e-cigarette) and heated tobacco product (HTP) use during pandemic restrictions. We conducted a web-based cross-sectional study of a representative sample of 6,003 Italian adults during the strictest phase of the Covid-19 lockdown (April-May 2020). Participants were asked to report changes in e-cigarette and HTP use compared to before the pandemic. E-cigarette users increased from 8.1% to 9.1% and HTP users from 4.0% to 4.5%. Among e-cigarette non-users before lockdown, 1.8% started using e-cigarettes during lockdown. New users were more frequently younger (p for trend 0.001), men (odds ratio, OR 1.56; 95% confidence interval, CI: 1.03-2.34), cannabis users (OR 2.35; 95% CI: 1.33-4.13), gamblers (OR 3.34; 95% CI: 2.18-5.11) and individuals with anxiety symptoms (OR 1.58; 95% CI: 1.00-2.52). 1.0% of HTP non-users started using it during lockdown. New users were less frequently current than never cigarette smokers (OR 0.19; 95% CI: 0.06-0.61) and more frequently gamblers (OR 2.23; 95% CI: 1.22-4.07). E-cigarettes and HTPs played little role as smoking cessation tools for hardcore smokers but rather provided opportunities for young never smokers to engage in socially acceptable activities, perhaps reflecting the obstacles they faced in obtaining other addictive substances during confinement.

7.
Am J Prev Med ; 2021 Dec 16.
Article in English | MEDLINE | ID: covidwho-1588373

ABSTRACT

INTRODUCTION: Mental health problems increased during the COVID-19 pandemic. The knowledge that one is less at risk after being vaccinated may alleviate distress, but this hypothesis remains unexplored. This study tests whether psychological distress declined in those vaccinated against COVID-19 in the U.S. and whether changes in anticipatory fears mediated any association. METHODS: A nationally representative cohort of U.S. adults (N=8,090) in the Understanding America Study were interviewed regularly from March 2020 to June 2021 (28 waves). Difference-in-differences regression tested whether vaccination reduced distress (Patient Health Questionnaire 4 scores), with mediation analysis used to identify potential mechanisms, including perceived risks of infection, hospitalization, and death. RESULTS: Vaccination was associated with a 0.04-SD decline in distress (95% CI= -0.07, -0.02). Vaccination was associated with a 7.77-percentage point reduction in perceived risk of infection (95% CI= -8.62, -6.92), a 6.91-point reduction in perceived risk of hospitalization (95% CI= -7.72, -6.10), and a 4.68-point reduction in perceived risk of death (95% CI= -5.32, -4.04). Including risk perceptions decreased the vaccination-distress association by 25%. Event study models suggest that vaccinated and never vaccinated respondents followed similar Patient Health Questionnaire 4 trends before vaccination, diverging significantly after vaccination. Analyses were robust to individual and wave fixed effects and time-varying controls. The effect of vaccination on distress varied by race/ethnicity, with the largest declines observed among American Indian and Alaska Native individuals (ß= -0.20, p<0.05, 95% CI= -0.36, -0.03). CONCLUSIONS: COVID-19 vaccination was associated with declines in distress and perceived risks of infection, hospitalization, and death. Vaccination campaigns could promote these additional benefits of receiving the COVID-19 vaccine.

8.
SSM Popul Health ; 17: 101006, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1586469

ABSTRACT

Background: Russia has been portrayed in media as having one of the highest death tolls due to the COVID-19 pandemic in the world. However, the precise scale of excess mortality is still unclear. We provide the first estimates of excess mortality in Russia as a whole and its regions in 2020, placing this in an international context. Methods: We used monthly death rates for Russia and 83 regions plus the equivalent for 36 comparator countries. Expected mortality was derived in two ways using averages in the same months in preceding years and the same averages adjusted for secular trends. Excess death rates were estimated for the whole year and the last 3 quarters. We also estimated the relationships between excess mortality and reported COVID-19 cases and deaths across countries and Russian regions. Results: Estimating excess deaths rates based on the trend-adjusted average, Russia had the highest excess mortality of any of the 37 countries considered. Using the simple average, Russia had the third highest. Most of the excess deaths were recorded in the 4th quarter of 2020 and the level and trajectory of excess mortality in Russia and most of Eastern European countries differed from that in Western countries. While both the cumulative number of COVID-19 cases and deaths showed positive correlations with excess mortality across countries (r=0.65 and r=0.75, p<0.001), the association across the Russian regions was, surprisingly, negative for cases (r=-0.34, p<0.01) and deaths (r=-0.09, p=0.42). When we replaced reported deaths with final data from death certificates the correlation was positive (r=0.38, p<0.001). Conclusion: Russia has one of the largest absolute burden of excess mortality in 2020 but there is a counter-intuitive negative association between excess mortality and cumulative incidence at the regional level. Under-recording of COVID-19 cases seems to be a problem in some regions.

10.
Isr J Health Policy Res ; 10(1): 66, 2021 12 15.
Article in English | MEDLINE | ID: covidwho-1582010

ABSTRACT

For ten years the Israel Journal of Health Policy Research has provided a platform for exchange of knowledge and insights on health policy. It is a unique attempt by scholars and practitioners in one small country to share their knowledge with the world and, in turn to learn from experience elsewhere. Never has this role been as important as during the COVID pandemic, a message that is very clear when we look at failings elsewhere.


Subject(s)
COVID-19 , Health Policy , Humans , Israel , Research , SARS-CoV-2
12.
BMJ ; 375: n3055, 2021 Dec 09.
Article in English | MEDLINE | ID: covidwho-1565121
14.
BMJ ; 375: n3015, 2021 12 07.
Article in English | MEDLINE | ID: covidwho-1560567
16.
Preprint in English | EuropePMC | ID: ppcovidwho-295641

ABSTRACT

Background: There is continuing uncertainty about the effectiveness of testing, tracing, isolation, and quarantine (TTIQ) policies during the pandemic.<br><br>Methods: We developed proxy indicators of the implementation of TTIQ policies at subnational and national (Republic of Korea), and international level (111 countries) from the beginning of 2020 to September 2021. These were: proportion of quarantined population (“Q-proportion”) among newly diagnosed COVID-19 cases/week, ratio of quarantined people to cases, and ratio of negative tests to new cases, with higher values suggesting more complete TTIQ. We used linear regression to analyze the association between TTIQ indicators and 1-week lagged cases and cumulative deaths, separating periods before and after vaccines becoming available.<br><br>Findings: We found consistently inverse associations between TTIQ indicators and COVID-19 outcomes, with gradual attenuation as vaccination coverage rose. Q-proportion overall (β= -0·091;p -value < 0·001) and log-transformed quarantined population per case (β ranges from -0·626;p < 0.001 to -0·288;p = 0·023) in each of 9 provinces were negatively associated with log-transformed 1-week lagged incidence in Korea overall. The strength of association decreased with greater vaccination coverage. The ratio of negative test results/new case was also inversely associated with incidence (β= -1·19;p -value < 0·001) in Korea. Globally, increasing negative test ratio was significantly associated with lower cumulative cases and deaths per capita, more so earlier in the pandemic. Jurisdictions with lower vaccination coverage showed the strongest association.<br><br>Interpretation: A real-world evaluation demonstrates an association between performance of testing, contact tracing, isolation, and quarantine and better disease outcomes.<br><br>Funding Information: Ministry of Foreign Affairs, Republic of Korea. <br><br>Declaration of Interests: None to declare.

17.
Health Policy ; 126(1): 1-6, 2022 01.
Article in English | MEDLINE | ID: covidwho-1549805

ABSTRACT

The COVID-19 pandemic is a catastrophe. It was also preventable. The potential impacts of a novel pathogen were foreseen and for decades scientists and commentators around the world warned of the threat. Most governments and global institutions failed to heed the warnings or to pay enough attention to risks emerging at the interface of human, animal, and environmental health. We were not ready for COVID-19, and people, economies, and governments around the world have suffered as a result. We must learn from these experiences now and implement transformational changes so that we can prevent future crises, and if and when emergencies do emerge, we can respond in more timely, robust and equitable ways, and minimize immediate and longer-term impacts. In 2020-21 the Pan-European Commission on Health and Sustainable Development assessed the challenges posed by COVID-19 in the WHO European region and the lessons from the response. The Commissioners have addressed health in its entirety, analyzing the interactions between health and sustainable development and considering how other policy priorities can contribute to achieving both. The Commission's final report makes a series of policy recommendations that are evidence-informed and above all actionable. Adopting them would achieve seven key objectives and help build truly sustainable health systems and fairer societies.


Subject(s)
COVID-19 , Pandemics , Government , Health Policy , Humans , Pandemics/prevention & control , SARS-CoV-2
18.
European Journal of Risk Regulation : EJRR ; 12(4):739-757, 2021.
Article in English | ProQuest Central | ID: covidwho-1537244

ABSTRACT

In this article, we argue that the design and timing of regulatory responses, as well as the adherence of the population to the relevant rules, have a critical impact on the progression and public health consequences of the COVID-19 pandemic. This hypothesis is empirically tested using the example of Poland, a country that experienced, compared to its Western European neighbours, a relatively mild first phase of the pandemic. In this context, we compare Poland with selected countries, including France, Germany, Spain and the UK, and we supplement them with examples from other Visegrad Four (V4) countries – Czechia, Slovakia and Hungary. On that basis, we conclude that while the observed differences between the countries in the progression of the COVID-19 pandemic are the result of a multitude of complex and interrelated reasons (such as demographic structure, population density and connectivity or cultural factors), well-designed public health measures, which are implemented early as a part of the proactive strategy that anticipates and reacts quickly to changing circumstances, can effectively decrease the number of COVID-19 infections and related deaths, provided that the adherence of the relevant population is high.

20.
Health Econ ; 2021 Nov 12.
Article in English | MEDLINE | ID: covidwho-1508656

ABSTRACT

The COVID-19 pandemic has been associated with worsening mental health but it is unclear whether this is a direct consequence of containment measures, like "Stay at Home" orders, or due to other considerations, such as fear and uncertainty about becoming infected. It is also unclear how responsive mental health is to a changing situation. Exploiting the different policy responses to COVID-19 in England and Scotland and using a difference-in-difference analysis, we show that easing lockdown measures rapidly improves mental health. The results were driven by individuals with lower socioeconomic position, in terms of education or financial situation, who benefited more from the end of the strict lockdown, whereas they suffered a larger decline in mental health where the lockdown was extended. Overall, mental health appears to be more sensitive to the imposition of containment policies than to the evolution of the pandemic itself. As lockdown measures may continue to be necessary in the future, further efforts (both financial and mental health support) are required to minimize the consequences of COVID-19 containment policies for mental health.

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