Factors associated with health outcomes among the uninsured population

The United States health care system lacks uniform and universal health coverage, causing approximately 10% of the population to be without health insurance, a critical determinant of health care access. Safety net organizations, including free clinics, provide free and/or reduced health care services to sociodemographic disadvantaged individuals. Despite concerns about the uninsured population, free clinic patients have not been sufficiently studied. This dissertation was designed to address this gap by adding to the literature and was designed around three empirical chapters utilizing mixed methodology.The first study used cross-sectional primary data to examine the differences between perceived and physiological stress levels and the effect of a social support network among uninsured free clinic patients. Findings suggest that higher levels of perceived stress are not significantly more prevalent than higher levels of salivary cortisol among these populations. Higher levels of social networking are significantly associated with lower perceived stress levels;having more friends than family members is slightly more associated with lower levels of perceived. However, social support and networking was not significantly associated with patients' salivary morning cortisol levels.The second study utilized a qualitative approach regarding COVID-19 vaccine perception and hesitancy among uninsured free clinic patients. Social networks are found to be important factors in reducing vaccine hesitancy. Hesitant patients had concerns related to vaccines' safety, effectiveness, and side effects. Lack of valid and reliable COVID-19 vaccination information was a challenge among this study's participants.The third study also utilized cross-sectional primary data to examine whether certain factors, including the component of patient-centeredness, are associated with patient autonomy among these populations. Findings conclude that Spanish speaking patients at the free clinic have a stronger belief in a paternalist model of the provider-patient relationship. Better communication between patients and providers results in higher levels of autonomy. Higher levels of educational attainment and better communication partnership were associated with higher levels of a free clinic patient's understanding of treatment risks.In conclusion, this dissertation's focus was to understand characteristics of an uninsured population to help develop strategies and intervention on changing behaviors, providing information that leads to their better health outcome. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Analyzing the Effect of Choice and Availability in Healthcare on Health Outcomes in Canada – A Pre-COVID-19 Environment

This research hypothesizes that greater availability of healthcare services, and greater choice in healthcare facilities results in better health when controlling for a variety of socio-economic factors within the Canadian context. This research will model access to healthcare services using density of general and specialist physicians relative to population size, and the geographic density of healthcare facilities. Choice in healthcare is modeled by the number of healthcare facilities in each health region, when normalized by the population in that health region. Various health outcomes will be used as benchmarks to test this hypothesis, including self-reported general health, self-reported mental health, influenza immunization rates, body mass index (BMI), and incidence of diabetes, cardiovascular disease and hypertension. From the empirical results, choice in the healthcare system does not have an impact on the selected health outcomes. Increased availability of healthcare generally improves health outcomes, but this is dependent on the health outcome in question, and the provincial region being analyzed. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Online teaching, learning, and health outcomes: Impact on medical undergraduate students.

Background: Online education has become a norm since the pandemic and it was a complete change for the medical curriculum. Many students missed patient interaction, which was a crucial part of their learning. Aim: This study was designed to know the perceptions of online teaching of both the non-competency-based medical education (non-CBME) and competency-based medical education (CBME) curriculum during the coronavirus disease 2019 (COVID-19) pandemic, learning outcomes, and health-related problems due to online teaching-learning in medical undergraduates. Materials and Methods: It was an online survey done after ethics approval. The survey questionnaire was sent to all medical undergraduates via email or WhatsApp and responses were recorded after informed consent. The total number of students who completed the survey was 346. Results: 66% of students found that online classes were not as enjoyable as offline. 66% found them time-saving with learning at their own pace. 85% felt they learned no clinical skills, and 80.6% said there was a lack of practical demonstrations. 71% experienced digital fatigue, 62% missed learning in a group, and 73% felt the poor motivation to study. Only 30% and 18.7% were confident enough to take a history or do an examination of the patient, respectively, after online clinics. 33% were confident to appear for university theory and only 11% for practical exams. The health problems faced due to online teaching included somatic complaints, sleep disturbances anxiety, and depressive symptoms in 40% of students. Conclusions: The students were dissatisfied with online teaching. Learning outcomes were affected, as they were not confident to appear for university exams. Hence, though teaching happened during the pandemic, the online education imparted revealed lacunae and health effects.

The Use of Qualitative Methods to Guide the Development of the Border Resilience Scale in a Participatory Research Study.

U.S.-Mexico border residents experience pervasive social and ecological stressors that contribute to a high burden of chronic disease. However, the border region is primarily composed of high-density Mexican-origin neighborhoods, a characteristic that is most commonly health-promoting. Understanding factors that contribute to border stress and resilience is essential to informing the effective design of community-level health promotion strategies. La Vida en La Frontera is a mixed-methods, participatory study designed to understand factors that may contribute to border resilience in San Luis, Arizona. The study's initial qualitative phase included interviews with 30 Mexican-origin adults exploring community perceptions of the border environment, cross-border ties, and health-related concepts. Border residents described the border as a Mexican enclave characterized by individuals with a common language and shared cultural values and perspectives. Positive characteristics related to living in proximity to Mexico included close extended family relationships, access to Mexican food and products, and access to more affordable health care and other services. Based on these findings, we co-designed the 9-item Border Resilience Scale that measures agreement with the psychosocial benefits of these border attributes. Pilot data with 60 residents suggest there are positive sociocultural attributes associated with living in border communities. Further research should test if they mitigate environmental stressors and contribute to a health-promoting environment for residents.

Reviewing the Literature on the Impact of Gun Violence on Early Childhood Development.

PURPOSE OF REVIEW: To examine the impacts of gun violence on early childhood development including early childhood mental health, cognitive development, and the assessment and treatment of survivors. RECENT FINDINGS: The literature reflects that gun violence exposure is often associated with significant mental health outcomes including anxiety, post-traumatic stress, and depression in older youth. Historically, studies have focused on adolescents and their exposures to gun violence through proximity to gun violence within their communities, neighborhoods, and schools. However, the impacts of gun violence on young children are less known. Gun violence has significant impacts on mental health outcomes of youth aged 0-18. Few studies focus specifically on how gun violence impacts early childhood development. In light of the increase in youth gun violence over the past three decades with a significant uptick since the onset of the COVID-19 pandemic, continued efforts are needed to better understand how gun violence impacts early childhood development.

Longitudinal Associations of Staff Shortages and Staff Levels with Health Outcomes in Nursing Homes.

OBJECTIVES: To examine whether facility-reported staff shortages and total staff levels were independently associated with changes in nursing home (NH) outcomes in 2020. DESIGN: Longitudinal cohort study. SETTING AND PARTICIPANTS: A total of 8466 NHs with staffing and outcome data. METHODS: This study used NH COVID-19 Public File (2020), Nursing Home Compare (2019-2020), and Payroll-Based Journal data (2019-2020). Outcome measures included the percentage of long-stay residents in a facility with declines in activities in daily living (ADLs), decreases in mobility, weight loss, and pressure ulcers in 2020 Q2, 2020 Q3, and 2020 Q4. Independent variables were whether NHs reported any shortage of aides or licensed nurses and total staff hours per resident day (HPRD). Separate 2-level (NH, state) Hierarchical Generalized Linear Mixed models examined the association of facility-reported shortages and staff hours with key NH resident outcomes, controlling for NH characteristics and COVID-19 infections. RESULTS: The weekly percentage of NHs reporting any staff shortage averaged 20%. Total staff HPRD increased slightly from 3.7 in 2019 to 3.8 in 2020. Health outcomes were stable during 2019 and 2020 Q1 but worsened substantially starting in 2020 Q2. For example, the percentage of residents with mobility loss increased from 16.2% in 2020 Q1 to 27.9% in 2020 Q4. Facility-reported staff shortages were associated with an increase in the proportion of residents with an ADL decline (0.54 percentage points), mobility loss (0.80 percentage points), weight loss (0.22 percentage points), and pressure ulcers (0.22 percentage points) (all P < .01). Total staff HPRD was not associated with changes in any outcomes (all P > .05). CONCLUSIONS AND IMPLICATIONS: NHs reported worsened health outcomes among long-stay residents in 2020, with worse outcomes found among facilities that reported staff shortages but not among those with lower total staff levels. Facility-reported shortages provide important quality information during the COVID-19 pandemic.

Health disparities among rural individuals with mental health conditions: A systematic literature review

There is growing concern about the availability of health care services for rural patients. This systematic literature review evaluates original research on health disparities among rural and urban populations with mental health (MH) conditions in North America. Using the Preferred Reporting Items for Systematic Reveiws and Meta-Analyses guidelines, we used four electronic databases (Pubmed, Cochrane, APA PsycInfo, Web of Science) and hand searches and included original research conducted in the United States or Canada before July 2021 that compared health outcomes of patients with any mental health disorder in rural versus nonrural areas. Both qualitative and quantitative data were extracted including demographics, mental health condition, health disparity measure, rural definition, health outcome measures/main findings, and delivery method. To evaluate study quality, the modified Newcastle-Ottawa Scale was used. Our initial search returned 491 studies, and 17 studies met final inclusion criteria. Mental health disorders included schizophrenia (4 studies), posttraumatic stress disorder (10), mood disorders (9), and anxiety disorders (6). Total sample size was 5,314,818 with the majority being military veterans. Six studies (35.2%) showed no significant rural-urban disparities, while 11 (64.7%) identified at least one. Of those, nine reported worse outcomes for rural patients. The most common disparities were diagnostic differences, increased suicide rates, and access problems. This review found mixed results regarding outcomes in rural patients with mental health disorders. Disparities were found regarding risk of suicide and access to services. Telehealth in addition to in-person outreach to these rural communities may be alternative to impact these outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement This critical review of the literature highlights that health disparities such as suicide rates/ideation, access to care, and utilization of mental health services are essential factors that put some subsets of rural patients compared to urban patients at a disadvantage. There is still a significant need for more research post COVID-19 on the use of telepsychiatry and rural health populations with mental health conditions. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Fear of coronavirus (COVID-19) and mental health outcomes in Palestine: The mediating role of social support.

The current investigation was conducted to test the correlation between fear due to coronavirus (COVID-19) and mental health outcomes (stress, depression, and anxiety) and the mediating role of social support during the Covid-19 Pandemic in Palestine. Structural equation modeling (SEM) was performed to test the conceptual model, where fear of Covid-19 was considered as a predictor, social support as a mediating variable, and mental health (stress, depression, and anxiety) as outcomes. The participants involved were 370 Palestinians, 266 females, and the remaining were males. Participants were recruited through online methods; Facebook advertising, Network email, and Twitter during the COVID-19 in Palestine. Results of the study showed that fear related to COVID-19 was positively and significantly correlated with mental health outcomes (anxiety; r = .29, p < .01, depression; r = .25, p < .01, and stress; r = .36, p < .01), while negatively correlated to perceived emotional support (r = -.30, p < .01), support seeking (r = -.29, p < .01), and received support (r = -.31, p < .01). Results of SEM indicated a standardized total effect of social support on mental health outcomes (ßX, M = -.57; p < .001), and an indirect but statistically significant effect (via social support, ßX, M, Y = -. 286; p < .01). These results indicate that social support fully mediated the relationship between fear associated with COVID-19 and mental health distress (stress, depression, and anxiety). The current study supported previous findings demonstrating that fear related to COVID-19 positively correlated with mental health distress (depression, anxiety, and stress). In addition, social support mediated the relationship between fear of COVID19 and mental health outcomes. However, further investigations are needed to test the correlation between current study variables and other associated factors and develop intervention programs targeting affected populations during crises to enhance mental health outcomes.

Factors Associated With Adherence to First-line Antiviral Therapy Among Commercially Insured Patients With Chronic Hepatitis B.

Background: Nonadherence to antiviral therapy can lead to poor clinical outcomes among patients with chronic hepatitis B (CHB). We used a claims database to evaluate risk factors for nonadherence to antiviral therapy among commercially insured patients with CHB in the United States. Methods: We obtained data for commercially insured adult patients with CHB prescribed entecavir or tenofovir disoproxil fumarate (TDF) in 2019. Primary outcomes were adherence to entecavir and adherence to TDF. Enrollees with a proportion of days covered (PDC) ≥80% were considered adherent. We presented adjusted odds ratios (AORs) from multivariate logistic regressions. Results: Eighty-three percent (n = 640) of entecavir patients were adherent, and 81% (n = 687) of TDF patients were adherent. Ninety-day supply (vs 30-day supply; AOR, 2.21; P < .01), mixed supply (vs 30-day supply; AOR, 2.19; P = .04), and ever using a mail order pharmacy (AOR, 1.92, P = .03) were associated with adherence to entecavir. Ninety-day supply (vs 30-day supply; AOR, 2.51; P < .01), mixed supply (vs 30-day supply; AOR, 1.82; P = .04), and use of a high-deductible health plan (vs no high-deductible health plan; AOR, 2.29; P = .01) were associated with adherence to TDF. Out-of-pocket spending of >$25 per 30-day supply of TDF was associated with reduced odds of adherence to TDF (vs <$5 per 30-day supply of TDF; AOR, 0.34; P < .01). Conclusions: Ninety-day and mixed-duration supplies of entecavir and TDF were associated with higher fill rates as compared with 30-day supplies among commercially insured patients with CHB.

Data-Resource Profile: United Kingdom Optimum Patient Care Research Database.

Introduction: Electronic medical records (EMRs) maintained in primary care in the UK and collected and stored in EMR databases offer a world-leading resource for observational clinical research. We aimed to profile one such database: the Optimum Patient Care Research Database (OPCRD). Methods and Participants: The OPCRD, incepted in 2010, is a growing primary care EMR database collecting data from 992 general practices within the UK. It covers over 16.6 million patients across all four countries within the UK, and is broadly representative of the UK population in terms of age, sex, ethnicity and socio-economic status. Patients have a mean duration of 11.7 years' follow-up (SD 17.50), with a majority having key summary data from birth to last data entry. Data for the OPCRD are collected incrementally monthly and extracted from all of the major clinical software systems used within the UK and across all four coding systems (Read version 2, Read CTV3, SNOMED DM+D and SNOMED CT codes). Via quality-improvement programmes provided to GP surgeries, the OPCRD also includes patient-reported outcomes from a range of disease-specific validated questionnaires, with over 66,000 patient responses on asthma, COPD, and COVID-19. Further, bespoke data collection is possible by working with GPs to collect new research via patient-reported questionnaires. Findings to Date: The OPCRD has contributed to over 96 peer-reviewed research publications since its inception encompassing a broad range of medical conditions, including COVID-19. Conclusion: The OPCRD represents a unique resource with great potential to support epidemiological research, from retrospective observational studies through to embedded cluster-randomised trials. Advantages of the OPCRD over other EMR databases are its large size, UK-wide geographical coverage, the availability of up-to-date patient data from all major GP software systems, and the unique collection of patient-reported information on respiratory health.

Twins early development study (teds): A genetically sensitive investigation of mental health outcomes in the mid-twenties

The Twins Early Development Study (TEDS) is a longitudinal study following a cohort of twins born 1994-1996 in England and Wales. Of the 13,759 families who originally consented to take part, over 10,000 families remain enrolled in the study. The current focus of TEDS is on mental health in the mid-twenties. Making use of over 25 years of genetically sensitive data, TEDS is uniquely placed to explore the longitudinal genetic and environmental influences on common mental health disorders in early adulthood. This paper outlines recent data collection efforts supporting this work, including a cohort-wide mental health assessment at age 26 and a multi-phase Covid-19 study. It will also provide an update on data linkage efforts and the Children of TEDS (CoTEDS) project. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Effects of Gut Microbiome Modulation on Reducing Adverse Health Outcomes among Elderly and Diabetes Patients during the COVID-19 Pandemic: A Randomised, Double-Blind, Placebo-Controlled Trial (IMPACT Study).

Gut microbiota is believed to be a major determinant of health outcomes. We hypothesised that a novel oral microbiome formula (SIM01) can reduce the risk of adverse health outcomes in at-risk subjects during the coronavirus disease 2019 (COVID-19) pandemic. In this single-centre, double-blind, randomised, placebo-controlled trial, we recruited subjects aged ≥65 years or with type two diabetes mellitus. Eligible subjects were randomised in a 1:1 ratio to receive three months of SIM01 or placebo (vitamin C) within one week of the first COVID-19 vaccine dose. Both the researchers and participants were blinded to the groups allocated. The rate of adverse health outcomes was significantly lower in the SIM01 group than the placebo at one month (6 [2.9%] vs. 25 [12.6], p < 0.001) and three months (0 vs. 5 [3.1%], p = 0.025). At three months, more subjects who received SIM01 than the placebo reported better sleep quality (53 [41.4%] vs. 22 [19.3%], p < 0.001), improved skin condition (18 [14.1%] vs. 8 [7.0%], p = 0.043), and better mood (27 [21.2%] vs. 13 [11.4%], p = 0.043). Subjects who received SIM01 showed a significant increase in beneficial Bifidobacteria and butyrate-producing bacteria in faecal samples and strengthened the microbial ecology network. SIM01 reduced adverse health outcomes and restored gut dysbiosis in elderly and diabetes patients during the COVID-19 pandemic.

Indirect positive health outcomes of COVID-19: a systematic review.

OBJECTIVES: The aim of this study was to assess the frequency of indirect positive health outcomes as a result of the COVID-19 pandemic. STUDY DESIGN: This was a systematic review. METHODS: Articles were identified from four online databases (Web of Science, Scopus, PubMed and Google Scholar) using predetermined search terms. After studies were systematically identified, the results were summarised narratively. The indirect positive health outcomes associated with the emergence of COVID-19 and measures taken for its prevention were categorised into four health dimensions (physical, mental, social and digital). RESULTS: After initial screening, 44 articles were assessed for eligibility, and 33 were included in the final sample. Of the included studies, 72.73% noted a benefit from COVID-19 prevention measures in the physical health dimension. In addition, 12.12%, 9.09%, 3.03% and 3.03% of articles reported a positive impact in the digital, mental, social and combined digital and mental health dimensions, respectively. CONCLUSIONS: Despite the catastrophic health, socio-economic and political crises associated with the COVID-19 emergency, it has also resulted in some positive health outcomes. Reduced air pollutants, improved disease prevention practices, increased digital health delivery and improved mental and social health dimensions were reported during the pandemic. Integrated and collaborative activities for the persistence of these health benefits are recommended.

Investigating social support among adolescent and young adult palliative care patients using an online gaming network from the patient perspective

Adolescent and young adult (AYA) patients facing chronic and life-limiting illnesses are a unique population who experience complex health concerns and barriers to accessing psychosocial and palliative care. Research has shown AYAs who receive psychosocial and palliative care can experience numerous benefits from these services;however, there remains a lack of research investigating age-appropriate palliative care programs and interventions targeting the psychosocial needs for AYAs. Streetlight is a peer support palliative care program designed for AYA patients with chronic and life-limiting illnesses. The Streetlight Gaming League (SGL) is an innovative psychosocial intervention aimed at facilitating online social support through an online gaming network. Guided by a phenomenological approach and qualitative methods, the study was developed to investigate AYA patient experiences with an online psychosocial intervention (the SGL) and subsequent experiences of online social support, as well as to add a deeper understanding into how participation style influences online social support among SGL participants. The study utilized questionnaires and semi-structured interviews to examine online social support among SGL patient participants. Findings demonstrate the existence and enactment of online social support among AYA patients using the SGL platform, especially in the form of emotional/esteem, social companionship/belonging, and distraction support. AYA patients reported experiencing positive impacts and psychosocial benefits of online social support through the SGL, such as sense of camaraderie, continuity of relationships, mental health support, and connection during the COVID-19 pandemic. Findings highlight the relevance and meaningfulness of these psychosocial support to AYA patients living with chronic and life-limiting illnesses. They also highlight important implications of participation style. These findings have implications for palliative care programs, as well as future health outcomes research, for the AYA patient population. This study expands the body of knowledge regarding palliative care and psychosocial support interventions for AYAs living with chronic and life-limiting illnesses. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Post-traumatic stress disorder, anxiety, and depression symptoms in healthcare workers during COVID-19 pandemic in Colombia

Background: Mental health outcomes in healthcare workers (HCWs) in low- and middle-income countries (LMICs) have been poorly explored during COVID-19 pandemic. Our aim was to carry out a cross-sectional study of the prevalence of mental health symptoms in HCWs in Colombia. Methods: A cross-sectional web-survey study was performed during the COVID-19 pandemic mid-2021 including HCWs in two hospitals in Colombia. The PCL-5, GAD-7, and PHQ-9 scales were used to assess the prevalence of symptoms and severity of PTSD, anxiety, and depression in Colombia. Results: From 257 surveyed respondents, 44.36% were nurses, 36.58% physicians and 19.07% other health professionals. The prevalence of PTSD, anxiety, and depressive symptoms were 18.68%, 43.19%, and 26.85%, amongst HCWs. The regression model evidence a strong risk of PTSD, anxiety, and depressive symptoms in HCWs in Colombia during the second wave of COVID-19 in the middle of 2021. Conclusions: The prevalence for several mental health symptoms in HCWs in Colombia were higher compared with the general population. HCWs are at-risk population to develop chronic symptoms and mental disorders during and after outbreaks. These results will be helpful to tailor strategies to support the physical and mental health of the HCWs in LMICs. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Autism and COVID-19

This article discusses autism and COVID-19. Autistic individuals in congregate and group settings, with co-occurring medical conditions are at higher risk for contracting COVID-19 and poor health outcomes. Wide variations in state vaccine prioritization plans exist, where high-risk disabled populations are not considered high priority. Access to routine medical visits has been disrupted during surges in cases, leading to potential delays in accessing necessary diagnoses, treatments and services. Emergency preparedness plans often overlook the needs of autistic individuals;for example, the use of the frailty scale to ration care, which unfairly disadvantages autistic individuals. Social isolation has negative effects on the well-being of autistic individuals who have lost their routine social interactions and support. The disruption to learning has been particularly concerning for children with special educational needs. The COVID-19 pandemic has highlighted areas that need urgent attention in the community. Autistic individuals, particularly those at high-risk for COVID-19-related hospitalizations and deaths, should be prioritized to receive the COVID19 vaccine. Autistic individuals must be represented in infection control and emergency preparedness planning at multiple levels: for example, within schools, health care settings, residential facilities, etc. Prolonged and unexpected disruptions to health, educational, and behavioral service deliveries during occurrences such as the COVID-19 pandemic must be met with innovative solutions to maximize individual life-course trajectories. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

The negative health effects of anti-Asian stigma in the U.S. during COVID-19

This study provided a systemic review of the content of 50 behavioral and social science studies investigating enactment and outcomes of anti-Asian stigma related to coronavirus disease (COVID-19) published in the final quarter of 2020 and during 2021. Based on a systematic search of several databases in December of 2021, 500 studies describing the impact of COVID-related stigma on Asian Americans were identified. From this group, 50 studies meeting the inclusion criteria were analyzed focusing on health and social consequences of stigma. The studies were described by five stigma themes: the enactment of stigma, health consequences of stigma, stigma in the social media, Asian American stigma in education, and policy and political consequences of anti-Asian stigma. The studies appeared in a wide range of scholarly journals using several methodologies. While some studies exclusively focused on health impacts of stigma, all considered how Asian Americans have been scapegoated for COVID-19. Spread of blame and digital stigma on the social media has been particularly damaging to psychological well-being. Discussion of these studies provided an informative systemic overview for how scholars from various disciplines have investigated the antecedents and possible mechanisms leading to anti-Asian hate. This study serves as a baseline for other scholars who want to build on this body of research in future studies as Omicron and other potential future variants of COVID unfold. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Stress-Coping Tweets Acquisition: A Two-phase Bootstrapping Method on Patterns and Semantic Features

Stress is integral to biological survival. However, without an appropriate coping response, high stress levels and long-term stressful situations may lead to negative mental health outcomes. Since the COVID-19 pandemic, remote assessment of mental health has become imperative. The majority of past studies focused on detecting users' stress levels rather than coping responses using social media. Because of the diversity of human expression and because people do not usually express stress and the corresponding coping response simultaneously, it is challenging to extract users' tweets about their coping responses to stressful events from their daily tweets. Consequently, there are two goals being pursued in this study: to anchor users' stress statuses and to detect their stress responses based on the existing stressful conditions. In order to accomplish these goals, we propose a framework that consists of two phases: the construction of stress dataset and the extraction of coping responses. Since the stressed users' data are lacking, the first phase is to construct a stress dataset based on stress-related hashtags, personal pronouns, and emotion recognition. In addition, to ensure the collection of enough tweets to observe the coping responses of stressed users, we broadened the survey's scope by collecting all tweets from the same user. In the second phase, stress-coping tweets were extracted by utilizing bootstrapping-based patterns and semantic features. The bootstrapping method was used to enrich word patterns for text expression and the semantic feature to assess the meaning of sentences. The collected data included the tweets of the stressed users identified in Phase 1 and the various coping responses from Phase 2 can contribute to developing a tool for the remote assessment of mental health. The experimental results show that our two-phase method outperforms the baseline and can help improve the efficiency of extracting stress-coping tweets. © 2022 IEEE.

Geospatial variations in socioeconomic conditions and health outcomes in COVID-19 era: insights from South Africa (2020–2022)

South Africa also has the highest burden of coronavirus disease 2019 (COVID-19) related comorbidities in Africa. We aimed to quantify the temporal and geospatial changes in unemployment, food insecurity, and their combined impact on depressive symptoms among South Africans who participated into several rounds of national surveys. We estimated the population-attributable risk percent (PAR%) for the combinations of the risk factors after accounting for their correlation structure in multifactorial setting. Our study provided compelling evidence for immediate and severe effect of the pandemic where 60% of South Africans reported household food insecurity or household hunger, shortly after the pandemic emerged in 2020. Despite the grants provided by the government, these factors were also identified as the most influential risk factors (adjusted odds ratios (aORs) ranged from 2.06 to 3.10, p < 0.001) for depressive symptoms and collectively associated with 62% and 53% of the mental health symptoms in men and women, respectively. Similar pattern was observed among pregnant women and 41% of the depressive symptoms were exclusively associated with those who reported household hunger. However, aORs associated with the concerns around pandemic and vaccine were mostly not significant and ranged from 1.12 to 1.26 which resulted substantially lower impacts on depressive symptoms (PAR%:7%-and-14%). Our findings suggest that South Africa still has unacceptably high rates of hunger which is accelerated during the pandemic. These results may have significant clinical and epidemiological implications and may also bring partial explanation for the low vaccine coverage in the country, as priorities and concerns are skewed towards economic concerns and food insecurity. © 2023, The Author(s).