Investigation of the change in the physical activity levels of students when the curfew was applied during the COVID-19 pandemic period

It is important to develop approaches to encourage physical activity so that people can lead a healthy life. This study was conducted to compare the physical activity status of students during the Covid-19 pandemic period when the curfew was applied and the restriction was not applied. The sample group of the study consisted of a total of 254 participants, 108 women and 146 men, studying at Tekirdag Namik Kemal University Faculty of Sport Sciences. In the study, the International Physical Activity-Short Form (IPAQ-SF) was used to determine the physical activity status of individuals. Kolmogorov-Smirnov and Paired Sample T Test were applied to compare the analysis of the variables of individuals by gender, before and during the curfew. In this study, the level of significance was accepted as p<0.05. According to the results obtained, students' vigorous physical activities before and during restraint (p<0.05;2:494), walking (p<0.05;2:354) and total physical activity (p <0.05;2: 541) parameters were found to be significantly different. It was determined that there was a significant difference between the parameters of walking (p<0.05;2:411) and total physical activity (p<0.05;2:377) of female students before and during the restraint. Between the parameters of vigorous physical activities before and during restraint (p<0.05;2:13.499), walking (p <0.05;2:312) and total physical activity (p<0.05;2:669) of male students was found to be a significant difference. As a result, it was determined that the total physical activity levels of the students decreased significantly when the curfew was applied.

Emotions, perceived knowledge and food behaviors during stressful periods

PurposeThis paper aims to examine how emotions affect consumers' food choices and food preparation activities during stressful periods, using the context of the coronavirus disease 2019 (COVID-19) outbreak in China.Design/methodology/approachThis study used an online survey, with a sample of 1,050 individuals from 32 regions in China. Multi-regression and mediation models were used to test the relationships among perceived knowledge, emotions and food behaviors.FindingsThe results show that positive emotions positively affect healthy food consumption and engagement in food preparations. In contrast, negative emotions contribute to an increase in indulgent food consumption and quick-and-easy meal preparations. Increased knowledge of the current situation can enhance positive emotions and thus promote healthy food behaviors. Lacking knowledge may result in unhealthy food behaviors through negative emotions.Originality/valueThis study contributes to the understanding of emotions and food behaviors by examining the effects of both negative and positive emotions in the general population, exploring a wider constellation of food behaviors and identifying perceived knowledge as an important antecedent to emotions' effects on food behaviors. Implications for consumers and public policy are offered.

The experience of family members who have had a loved one in physical restraint in a critical care setting during the COVID-19 pandemic: A qualitative study using a phenomenological design

Limited accounts of family members' experiences with loved ones who have been physically restrained in ICU settings (Ones, 2020;Singer et al., 2020) have left a gap in providing respectful, responsive patient care. One study estimated that physical restraint was being used at the rate of 50 per 1,000 patient days. Currently, it is estimated that approximately 27,000 people are placed in physical restraints each day in U.S. hospitals. ICUs are responsible for 56% of all restraint days, despite accounting for only 16% of all patient days (Mion, 2008). According to Abdeljawad and Mrayyan (2016), patients may experience trauma with the use of these devices. In order to better comprehend the effects following physical restraint use, this dissertation explored the perceptions of family members with loved ones who have been physically restrained, with a focus on their application in critical care settings during the COVID-19 pandemic.While no scientific evidence of physical restraint efficacy is available, there is much evidence of its risk. Another study reported that in hospitals in the United States, the prevalence of using physical restraints is approximately with 53% of all patients. Further, the prevalence of using restraints on patients in critical care units is 75%. With the increased use of physical restraint, the mortality and morbidity rates are expected to increase, due to serious consequences of physical restraint that can result in confusion, deconditioning, pressure injuries, strangulation, death, and adverse psychological effects (Rakhmatullina et al., 2013). In the extant literature, limited studies have explored family members' experiences of loved ones being physically restrained (Ones, 2020). The findings from this study included the following themes: Theme 1: Having to Deal with Complications and Difficulties Encountered Preceding, During, and Post Hospitalization;Theme 2: Experiences That Are Identified as Negative;Theme 3: Understanding of Hospital Staff Intentions;Theme 4: The Need for Physical Restraint Intervention (PRI) May Be Justifiable but Stirs up Negative Emotions;and Theme 5: Feelings of Ambivalence Associated with PRI. The study provides an understanding of family members' perception of these experiences. These insights may help health care clinicians improve the experience of patient care, safety, and quality. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Racial Disparities in Emergency Restraint Use for Agitated Patients

Background: The COVID 19 pandemic and the murder of George Floyd have prompted healthcare organizations to reexamine racial inequities in their care, challenging us to produce lasting, fundamental change. Mental health disorders, both diagnosed and undiagnosed, have increased in volume and developed new challenges for acute care practitioners during the pandemic. Additionally previous research has suggested that there are intrinsic and extrinsic biases that affect how care is delivered to patients presenting with mental health crises. Method(s): Through nominal group technique, we identified topics for equitable-care-oriented QI in the emergency department (ED) of our Level-1 Trauma center. Initial review of triage, left-without-being-seen, and fast-track data did not demonstrate significant racial disparities in standard benchmarks. We therefore focused on behavioral codes and restraint use. We prospectively collected data on all behavioral codes over a 3-month period, including demographics, visit characteristics, and certain aspects of restraint use including type of restraint, length of restraints, medication use, and reinitiation of restraints. In addition to tracking these metrics, employee perceptions of the psychiatric mental health emergencies were polled and evaluated. Result(s): Our QI process identified varying levels of disparities in care. Over the study period, white, non-white, and black patients comprised 50.5%, 49.5%, and 28.7% of the ED patient population, respectively, and 50%, 50%, and 44% of the patients who were subject to behavioral codes. Of those patients who had behavioral codes called, restraints were used for 64.8% of white patients, 64.3% of non-white patients, and 67.2% of black patients. Of those arriving by ambulance or police, 20% arrived with pre-hospital restraints or handcuffs, and of those, 90.9% were placed in restraints on arrival to the ED. Of those patients who had restraints placed, 4-points were used for 34.1%, 26.1%, and 25.5% of white, non-white, and black patients, respectively, and the restraint chair was used for 30.7%, 38,6%, and 41.8% of those same groups. Medications were given to 80.7%, 88.7%, and 91.4% of white, non-white, and black patients who were placed in restraints, respectively, and to 77.4%, 80.6%, and 83.3% of those same groups of patients who were not placed in restraints. None of the differences were statistically significant. Of those patients who had restraints placed and then discontinued, 13% were re-restrained at some other point during their visit. Among other responses, nearly half of all ED employees thought that patients should ideally not be restrained during behavioral codes and that, if necessary, the restraint chair provides a better experience than 4-point restraints. Conclusion(s): Continuous QI around a variety of measures can identify disparities and targets for sustained anti-racist improvements in emergency department care. This study will guide further intervention and education around inequities in care in our department and has prompted further consideration of, when restraints are deemed necessary, preferentially using less invasive measures like the restraint chair over 4-point restraints. Although decision-making around chemical and physical restraints for mental health emergencies is complex and difficult to study, EDs should carefully examine their use through continuous QI in order to optimize patient-centered outcomes.

Cultural values and changes in happiness in 78 countries during the COVID-19 pandemic: An analysis of data from the World Happiness Reports.

The concept of happiness is consistent across cultures to a significant extent, and encompasses both internal (subjective) and external (situational) aspects. Cultural values and norms shape emotions and behavior from an early age, and hence play a key role in influencing cross-national variations in happiness. Cross-national variations in culture can thus play a key role in influencing the relationship between adverse circumstances, such as the COVID-19 pandemic, and happiness. The current study examines the relationship between the six dimensions of culture, defined by Hofstede and his colleagues, and subjective ratings of happiness in 78 countries, obtained before (2017-19) and during (2020-21) the COVID-19 pandemic, based on data from the most recent World Happiness reports. The key results were: (a) countries were as likely to experience an increase as a decrease in self-reported happiness during this period; (b) distinct domains of culture were significantly correlated with happiness at each time point, though there was a certain degree of overlap; (c) pre-pandemic levels of happiness were negatively associated with changes in happiness during the pandemic; and (d) among cultural dimensions, long-term orientation was positively associated with changes in subjective happiness, while indulgence was negatively associated with this variable. Certain cultural values may play an important part in fostering a path to well-being in the face of stressful or traumatic circumstances. This path may be similar to the concept of mature happiness, derived from existential philosophy, which is characterized by achieving a balance between the positive and negative aspects of one's life.

Preventing, reducing, and attenuating restraint: A prospective controlled trial of the implementation of peer support in acute psychiatry.

Introduction: The use of restraint as a means of managing patients is considered a critical factor that interferes with recovery. Strategies to create a less restrictive environment within psychiatric facilities are therefore eagerly sought. Peer support workers (PSWs) are increasingly employed in mental health settings. The prevailing theory is that PSWs have the potential to contribute to conflict and restraint prevention efforts in acute psychiatric wards. However, to date, research in support of this claim remains limited. Objective: The present study aimed at assessing the effectiveness of employing peer support workers with regard to reducing the use of restraint. Methods: This prospective controlled pre-post study sought to evaluate the implementation of peer support in one locked ward compared to treatment as usual (TAU) with no implementation of peer support in a second locked ward of a psychiatry department in Berlin, Germany. The pre-post comparison was planned to consist of two assessment periods of 3 months each, taking place directly before and after peer support implementation or TAU. Both assessments were extended to a period of 6 months, before and after the initially planned 12-month implementation process, in order to balance the effects of disruptions and of the COVID-19 pandemic. Using routine data, the proportion, frequency, and duration of mechanical restraint, forced medication as well as mechanical restraint in combination with forced medication, were evaluated. Results: In the control group, an increase in the proportion of patients subjected to measures of restraint was found between pre- and post-assessment, which was accompanied by a further increase in the mean number of events of restraint per patient within this group. In the intervention group, no significant change in the application of restraint was observed during the study period. Discussion: There is some indication that peer support may be protective with regard to restraint in acute wards. However, our study faced major challenges during the implementation process and the post-assessment period, such as COVID-19 and staff reorganization. This may have led to peer support not reaching its full potential. The relationship between the implementation of peer support and the use of restraint therefore merits further investigation.

Nasogastric tube feeding under restraint: practical guidance for children's nurses.

The number of children and young people admitted to children's wards with an eating disorder has increased significantly since the start of the coronavirus disease 2019 (COVID-19) pandemic. In the most extreme cases, those with severe malnutrition may need to be fed via a nasogastric tube without their consent. Children's nurses working on hospital wards may therefore care for children and young people who need to receive nasogastric tube feeding under physical restraint. This article offers an overview of eating disorders and their detrimental effects as well as practical advice for children's nurses, supporting them to provide safe, compassionate and person-centred care to their patients.

Nasogastric tube feeding under physical restraint on paediatric wards: ethical, legal and practical considerations regarding this lifesaving intervention.

Eating disorders have the highest mortality rate of any psychiatric condition. Since the COVID-19 pandemic, the number of patients who have required medical stabilisation on paediatric wards has increased significantly. Likewise, the number of patients who have required medical stabilisation against their will as a lifesaving intervention has increased. This paper highlights a fictional case study aiming to explore the legal, ethical and practical considerations a trainee should be aware of. By the end of this article, readers will be more aware of this complex issue and how it might be managed, as well as the impact it can have on the patient, their family and ward staff.

COVID-19, stigma, and habituation: evidence from mobility data.

BACKGROUND: The Japanese government has restricted people's going-out behavior by declaring a non-punitive state of emergency several times under COVID-19. This study aims to analyze how multiple policy interventions that impose non-legally binding restrictions on behavior associate with people's going-out. THEORY: This study models the stigma model of self-restraint behavior under the pandemic with habituation effects. The theoretical result indicates that the state of emergency's self-restraint effects weaken with the number of times. METHODS: The empirical analysis examines the impact of emergency declarations on going-out behavior using a prefecture-level daily panel dataset. The dataset includes Google's going-out behavior data, the Japanese government's policy interventions based on emergency declarations, and covariates that affect going-out behavior, such as weather and holidays. RESULTS: First, for multiple emergency declarations from the beginning of the pandemic to 2021, the negative association between emergency declarations and mobility was confirmed in a model that did not distinguish the number of emergency declarations. Second, in the model that considers the number of declarations, the negative association was found to decrease with the number of declarations. CONCLUSION: These empirical analyses are consistent with the results of theoretical analyses, which show that the negative association between people's going-out behavior and emergency declarations decreases in magnitude as the number of declarations increases.

The Association of Perceived Vulnerability to Disease with Cognitive Restraint and Compensatory Behaviors.

Individual differences exist in perceived vulnerability to disease (PVD). PVD is associated with negative responses (e.g., disgust) towards individuals with obesity and heightened sensitivity regarding personal appearance. Through increasing fear of fat (FOF), PVD may be associated with cognitive restraint and compensatory behaviors. We utilized an adult sample (n = 247; 53.3% male sex assigned at birth) recruited through Amazon's MTurk prior to the COVID-19 pandemic to investigate associations between PVD, cognitive restraint and compensatory behaviors. Participants completed the Perceived Vulnerability to Disease Scale, Eating Disorder Diagnostic Scale, Dutch Eating Behaviors Questionnaire, and Goldfarb's Fear of Fat Scale. Mediation analyses were used to test our hypotheses. Perceived infectability (PVD-Infection) was associated with cognitive restraint and compensatory behaviors through increased FOF. Perceived germ aversion (PVD-Germ) was associated with cognitive restraint, but FOF did not mediate this association. Sex-stratified analyses revealed no significant sex differences. PVD may be an overlooked factor associated with cognitive restraint and compensatory behaviors in males and females. FOF was an important mediating factor in these associations. Increased engagement in cognitive restraint and compensatory behaviors may reflect attempts to reduce FOF. Future longitudinal research should explore whether PVD is a risk factor for cognitive restraint and compensatory behaviors.

Effect of COVID-19 infection related experiences on social behaviors when a state of emergency is declared: a cohort study.

BACKGROUND: Restricting the movement of the public to gathering places and limiting close physical contact are effective measures against COVID-19 infection. In Japan, states of emergency have been declared in specific prefectures to reduce public movement and control COVID-19 transmission. We investigated how COVID-19 infection related experiences including people with a history of infection, people with a history of close contact, and people whose acquaintances have been infected, affected self-restraint from social behaviors during the second state of emergency in Japan. METHODS: A prospective cohort study was conducted among workers aged 20-65 years using data from an internet survey. The baseline survey was conducted on December 22-25, 2020, and a follow-up survey was on February 18-19, 2021. There were 19,051 participants who completed both surveys and were included in the final analysis. We identified eight social behaviors: (1) eating out (4 people or fewer); (2) eating out (5 people or more); (3) gathering with friends and colleagues; (4) day trip; (5) overnight trip (excluding visiting home); (6) visiting home; (7) shopping for daily necessities; and (8) shopping for other than daily necessities. We set self-restraint regarding each social behavior after the second state of emergency was declared in January 2021 as the dependent variable, and COVID-19 infection related experiences as independent variables. Odds ratios were estimated using multilevel logistic regression analyses nested in the prefecture of residence. RESULTS: Significant differences by COVID-19 infection related experiences were identified: compared to people without COVID-19 related experiences, people with a history of COVID-19 were less likely self-restraint from most social behaviors. People whose acquaintance had been diagnosed with COVID-19 were significantly more likely to refrain from most social behaviors. There was no significant difference in any social behaviors for people with a history of close contact only. CONCLUSION: To maximize the effect of a state of emergency, health authorities should disseminate information for each person in the target population, taking into account potential differences related to the infection related experiences.

COVID-19 Anxiety in Children and Its Relationship with Self-Related Skills of Executive Functions

Objective: Some children experience a significant deal of anxiety during the outbreak of COVID-19. Behavioral dimensions of the executive function appear to link to situational anxiety experience. Therefore, the primary aim of the present study is to investigate the relationship between self-related skills of executive functions and the level of anxiety in children (8-12-years-old) during the outbreak of COVID-19. Also, the secondary goal of this study is to predict the level of anxiety based on self-related skills of executive functions. Method: Parents of 300 children filled out the Barkley Deficits in Executive Functioning Scale (BDEFS) and the COVID-19 anxiety scale. Data were analyzed using correlation and path analysis. A significance level of less than 0.05 was set for all tests. Data were analyzed using SPSS 22 software. Results: Results demonstrated that self-related skills of executive functions can predict 28% of COVID-19 anxiety. The subscales of self-management (P < 0.015, t = 5.56), self-regulation (P < 0.011, t = 6.37), self-restraint (P < 0.035, t = 4.29) and emotional self-organization (P < 0.042, P = 0.222) predicted coronavirus anxiety, but self-motivation (P < 0.05, P = 0.894) did not. Conclusion: Given that most subscales of executive function predict anxiety tied to critical situations such as the prevalence of the corona virus, it seems that greater attention should be allocated to the fostering and development of children's executive functions by teaching such skills at home by families.

The Burdens of Self-Restraint: Social Measures and the Containment of Covid-19 in Japan

The essay explores Japan's policies of containing infection without heavy reliance on legally imposed lockdowns or digital surveillance. It examines the 'social measures' that local governments and the Ministry of Health relied on, including consistent public health messaging, contact tracing, education, with a focus on behavior modification. The pandemic worldwide has highlighted the importance of society in addition to the state in controlling infection. This article highlights the benefits of this form of social control as well as its trade-offs, including stress concerning social expectations, informal forms of social control, and inc idences of harassment and discrimination against the diseased.

A two-center pilot study on the effects of clinical ethics support on coercive measures in psychiatry.

BACKGROUND: The use of formal coercion such as seclusion, mechanical restraint, and forced medication is one of the most challenging and complex issues in mental health care, on the clinical, the legal, and the ethical level. Clinical ethics support aims at assisting healthcare practitioners in determining the morally most justifiable course of action in these situations. However, the effectiveness of clinical ethics support has hardly been studied so far. METHODS: Monthly moral case deliberation (MCD) was implemented in two acute wards of two different psychiatric hospitals in Switzerland. Frequency and intensity of coercion was measured on ward level (npatients = 405), and the Moral Attentiveness Scale, Knowledge on Coercion Scale, and Staff Attitudes towards Coercion Scale were applied on healthcare practitioner level (nHP = 46). Pre-post-comparisons were conducted using multi-level modeling where appropriate. RESULTS: After implementation of MCD, formal coercion was less frequent (particularly seclusion, small effect size; 9.6 vs. 16.7%, p = .034, Cramér's V = .105) and less intense (particularly mechanical restraint, large effect size; 86.8 ± 45.3 vs. 14.5 ± 12.1 h, exact p = .019, r = -.74), and approval for coercive measures among healthcare practitioners was lower when controlling for the number of MCD sessions attended. CONCLUSIONS: Clinical ethics support such as MCD may be a hitherto underutilized service for the reduction of coercion, complementing existing strategies and programs. Implementing clinical ethics support may help improve quality of care for persons suffering from severe mental illness.

A Multicenter Network Analysis Examining the Psychological Effects of the COVID-19 Pandemic on Patients with Eating Disorders versus Their Healthy Siblings.

(1) Background: The impact of the COVID-19 pandemic on individuals with eating disorders (EDs) has been recorded all over the world; the traumatic effects of COVID-19 have exacerbated specific and general psychopathologies in those with EDs. Comparing patients' and their healthy siblings' responses might help one evaluate whether there are significant differences between healthy individuals and those struggling with EDs in regard to posttraumatic psychological symptoms. (2) Methods: A sample of 141 ED patients and 99 healthy siblings were enrolled in this study in two different centers specializing in ED treatment. All participants completed the posttraumatic stress disorder (PTSD) checklist and an eating and general psychopathological self-report questionnaire. Network analysis was then applied to evaluate the differences between the populations. (3) Results: No significant differences emerged between the network structures despite the significant differences between patients and their healthy siblings in regard to posttraumatic symptoms, eating, and general psychopathology. (4) Conclusion: The complex nature of the interaction between environmental and personal factors should be evaluated further in individuals with EDs due to how they respond to traumatic events, which exacerbate patients' psychopathology.

Digital Literary Creative Practice and COVID-19

The COVID-19 pandemic caused great upheaval to working artists, with performance venues and public exhibitions having to close. Yet despite these new restrictions, digital literature has thrived during this time. Digital literature refers to works that are ‘native to the digital environment’ [Rettberg, S., 2019. Electronic Literature. Cambridge: Polity Press: 6]. In this sense, digital literature is distinguished from works that are simply digitally disseminated (for example, e-books) in that they require a computer/code to exist, and cannot be represented by traditional print. This dependence on a digital environment made digital literature exhibitions and festivals better able to adapt to restrictions imposed by COVID-19. In this article I examine the relationship between digital literary creative practice and COVID-19. From these interrogations, I reveal unique qualities of digital literary creative practice and practice-led research [Smith, H., and Dean, R., 2009. Practice-led Research, Research-led Practice in the Creative Arts. Edinburgh: Edinburgh University Press], with a particular focus on the immediacy and urgency with which these works have been produced and disseminated, as opposed to other artistic practice and media. [ FROM AUTHOR] Copyright of Journal of Intercultural Studies is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

A Case of Cotard Syndrome and Neurosyphilis

BACKGROUND: Cotard syndrome is a rare neuropsychiatric condition in which individuals have delusions of being deceased or losing their organs. It is often seen in patients with severe depression and is associated with catatonia.1 Neurosyphilis is a severe sequelae of untreated treponema pallidum infection in which the paretic form of this disorder commonly has a psychiatric presentation. 2 We present a rare case of Cotard syndrome in a patient with neurosyphilis with successful treatment. OBJECTIVE: To understand Cotard syndrome and underlying neuropsychiatric conditions, and characterize the diagnosis and management of psychiatric symptoms in a patient with neurosyphilis. METHODS: Review of a case using electronic medical records and relevant literature. Key terms searched: 'Cotard syndrome,' 'neurosyphilis,' 'COVID-19 infection' using Medscape and Google Scholar. RESULTS: We present a 49-year-old male with a history of alcohol use disorder in remission, depression, and history of COVID-19 (asymptomatic) 6 months prior. The patient presented to the emergency department for recent changes in behavior. He was agitated, threatening, and required chemical and physical restraint. Evaluation was notable for illogical thought processes with somatic delusions. He repeatedly stated, 'I am already dead, my organs have died,' and had an episode of catatonia. All tests including drug screen and COVID-19 were negative. Rapid plasma regain (RPR) titer was 1:64. Neurology and Infectious Disease were consulted. Lumbar puncture revealed positive venereal disease research laboratory (VDRL) titer of 1:4. The patient was diagnosed with neurosyphilis and major depressive disorder with psychosis with Cotard syndrome. He was treated with intravenous (IV) penicillin G and was discharged on oral mirtazapine 30 mg and olanzapine 20 mg nightly at bedtime, oral donepezil 5 mg daily, thiamine, and folate. CONCLUSIONS: Cotard syndrome is often seen in depression with psychotic features.1 Neurosyphilis can present with depression, anxiety, psychosis, and dementia. Early identification is the key for successful treatment. This is a unique case of neurosyphilis with features of Cotard syndrome in a patient with a history of depression with treatment noncompliance. Studies show that quetiapine and risperidone improve psychosis in neurosyphilis.5 In this case, neurosyphilis was successfully treated with IV penicillin G for 2 weeks. The patient was also tried on antipsychotics and mood stabilizers ' specifically aripiprazole, valproic acid, and haloperidol ' and was eventually stabilized on oral olanzapine 20 mg taken nightly at bedtime. Our differential diagnosis also included COVID-19 delirium with Cotard syndrome, which was ruled out due to a negative COVID test. To our knowledge, there are 2 cases of COVID-19 delirium with Cotard syndrome.6 We present this case to inform clinicians of rare manifestations of neurosyphilis in patients with comorbid psychiatric illness and to advance research into treatment options for psychosis in neurosyphilis.

Pediatrics in the Parking Lot-taking Child Passenger Safety to the Community

Background: Motor vehicle crashes (MVCs) remain the leading cause of death for Kentucky children above age 1. The Nest has four separate non-profit programs that provide respite child care, legal/psychological support services to survivors of intimate partner violence, parenting classes, and crisis assistance to families (toiletries/cleaning-supplies/papergoods/diapers/formula/food/rental-assistance since COVID, serving more than 400 clients per month). Community need for car seats was previously demonstrated by the 57 used seats they distributed in a year. Methods: Standard national Child Passenger Safety (CPS) checkup forms were utilized, with an Excel data base of seats provided/notes of special circumstances/problems with seats/cars. Forms from October 1, 2020 to July 1, 2021 were reviewed for quality improvement at least monthly, with immediate adjustments as necessary. All education and seat installation occurred outdoors during fall months and on all but the coldest winter days. Staff and families were masked, items used were sanitized and meticulous hand washing was done between families due to COVID. New convertible seats from grants were supplemented with individually- purchased harnessed booster seats to serve older children and with current (never-in- crash, not -recalled) donated infant seats. CPS services were conducted in 4 languages (English, French, Spanish and Arabic) with fluent staff or consenting family members as translators, and were offered both by appointment/previous consultation/referral from Family Assistance and as walk-ins requesting help or were observed to have car-seat/booster-sized children. Results: A small program that distributed seats as commodities without instruction or assessment of child/car was revised into a formal CPS fitting station, addressing difficult cars, large families, grandparents raising grandchildren, and resettled international refugees. Approximately 90% of families had annual family incomes of < $20,000/year, many below $10,000. Almost every consult for one child revealed multiple children in need of car seat education or new seats. More than 150 seats were checked in nine months. Types of misuse (in >90%) seen include: no seat, child too loose in seat, seat too loose in car, use of infant seats facing forward for too-big toddlers, premature use of no-back boosters (NBB) for small young children when family has no money for harnessed seats or at the mis-direction of a medical professional. Families that live in high crime areas with car theft are bringing in car seats at night so need lighter weight ones, as do grandparents. Conclusion: Taking CPS to the parking lot of an established non-profit has permitted us to reach more families with great need in a place they trust. Types of misuse have provided a real-world window into the potential optimal timing/messages of CPS within pediatric anticipatory guidance, and families have shown how our anticipatory CPS guidance may need to be adapted to work in the environment that people actually live in.

COVID-19 policies and hoteliers' responses in Japan

This study aims to identify the hoteliers' crisis management practices during COVID-19 and analyse the relationship between each practice and government policy. Through in-depth interviews with five hotel chains, common crisis management practice patterns, factors that lead to differences in crisis management practices and the influences of policies on these practices were identified. The findings show strong and complicated relationships between policy and hoteliers' crisis management practices. Although many crisis management practices were encouraged by the government, some practices were not influenced by the policy and others were indirectly impeded. Hoteliers are not only passively affected by government policies, but respond actively to them as well as demonstrate their own initiative in response to the crisis.

Risk factors of hikikomori among office workers during the COVID-19 pandemic: A prospective online survey.

The global pandemic of COVID-19 has forced people to restrict their outings. In Japan, self-restraint behavior (SRB) has been requested by the government, and some of those decreasing their outings may shift to pathological social withdrawal; hikikomori. The purpose of this study was to examine the risk factors of hikikomori conducting an online prospective survey. An online survey was conducted in June 2020 and December 2020; (1) SRB-related indicators (degree of SRB, motivation for SRB, stigma and self-stigma toward COVID-19, anxiety and depressive feelings toward COVID-19) and (2) general mental health (hikikomori tendency, depressive symptoms, modern type depression (MTD) tendency, internet addiction) were collected. A cross-lagged effects model was performed to examine the association between these variables. Lack of emotional support and lack of socialization in June 2020 increased isolation in December 2020. Besides, MTD and hikikomori interacted with each other. Interestingly, although hikikomori tendency increased depressive tendencies, SRB itself did not have a significant path on any mental health-related variables. Poor interpersonal relationships, rather than SRB per se, are suggested to be a risk factor for increased isolation among office workers in the COVID-19 pandemic. Appropriate early interventions such as interpersonal or emotional support may prevent the transition to pathological hikikomori. The association between MTD and hikikomori seems to reveal the interesting possibility that MTD is a gateway to increased risk of hikikomori, and that hikikomori is a gateway to MTD as well. Future research is required to elucidate the relationship between hikikomori and MTD.