Post-COVID-19: Time to Change Our Way of Life for a Better Future (preprint)

Rationale - From the year 1 anno Domini until 1855 with the third Plague, major pandemics occurred on average every 348 years. Since then, they have occurred on average every 33 years, with Coronavirus disease 2019 (COVID-19) now underway.Even though current technologies have greatly improved the way of life of human beings, COVID-19, with more than 700 000 000 cases and 6 950 000 deaths worldwide by the end of 2023, reminds us that much remains to be done. Objective - Given the frequency and duration of recent pandemics, it might be wise to start thinking about preventative methods to minimize the impact of future pandemics. This report looks back at 18 months of COVID-19, from March 2020 to August 2021, with the aim of highlighting potential solutions that could prove practical, or even essential, for the future. Material - COVID-19 data, including case and death reports, were extracted daily from the Worldometer platform to build a database for macroscopic analysis of the spread of the virus around the world. Demographic data were integrated into the COVID-19 database for a better understanding of the spatial spread of the SARS-CoV-2 virus in cities/municipalities. Method - Without loss of generality, we only analyzed data from the top 30 (out of 200 and above) countries ranked by total number of COVID-19 cases. Statistics (regression, t-test (p < 0.05), correlation, mean ± std, etc.) were carried out with Excel software. Spectral analysis, using Matlab software, was also used to try to better understand the temporal spread of COVID-19. Results - A good linear correlation was observed between the number of cases and the respective number of deaths depending on the country, i.e. y = 0.0121x + 19559 with R² = 0.8042. The analysis then focused mainly on the number of cases.This study showed that COVID-19 mainly affects G20 countries. The most interesting result is that cities/municipalities with high population density are a powerful activator of the spread of the virus. The current demographic context seems to be becoming a societal problem that must be addressed adequately.Spectral analysis highlighted that the very first months of spread of COVID-19 were the most notable with a strong expansion of the SARS-CoV-2 virus. On the other hand, the following six months showed a certain stability due mainly to multiple preventive measures such as confinement, closure of non-essential services, wearing of masks, distancing of 2 meters, etc. Discussion - Analysis of case and death data showed that COVID-19 mainly affects G20 countries. Nevertheless, the most interesting result of this study is that cities and municipal areas with population densities of several thousand inhabitants per square kilometer largely favored the spread of the SARS-CoV-2 virus. It is believed that such a demographic context is becoming a societal problem that developed countries around the world will sooner or later face and therefore needs to be adequately addressed. Conclusion - COVID-19 has made us understand that it is time to act both preventatively and curatively. Phenomenological insights suggest that the next pandemic could occur in less than 50 years. It may be time to launch new societal projects aimed at relieving congestion in densely populated regions.

A Critical Analysis of UK Media Characterisations of Long Covid in Children and Young People (preprint)

Long Covid is the continuation or development of symptoms related to a SARSCoV2 infection. Those with Long Covid may face epistemic injustice, where they are unjustifiably viewed as unreliable evaluators of their own illness experiences. Media articles both reflect and influence perception and subsequently how people regard children and young people (CYP) with Long Covid, and may contribute to epistemic injustice.? We aimed to explore how the UK media characterises Long Covid in CYP through examining three key actor groups: parents, healthcare professionals, and CYP with Long Covid, through the lens of epistemic injustice. A systematic search strategy resulted in the inclusion of 103 UK media articles. We used an adapted corpus-assisted Critical Discourse Analysis in tandem with thematic analysis. Specifically, we utilised search terms to locate concordances of key actor groups. In the corpus, parents highlighted minimisation of Long Covid, barriers to care, and experiences of personal attacks. Mothers were presented as also having Long Covid. Fathers were not mentioned once. Healthcare professionals emphasised the rarity of Long Covid in CYP, avoided pathologizing Long Covid, and overemphasised psychological components. CYP rarely were consulted in media articles but were presented as formerly very able. Manifestations of Long Covid in CYP were validated or invalidated in relation to adults. Media characterisations contributed to epistemic injustice. The disempowering portrayal of parents promote stigma and barriers to care. Healthcare professionals' narratives often contributed to negative healthcare experiences and enacted testimonial injustice, where CYP and parents credibility was diminished due to unfair identity prejudice, in their invalidation of Long Covid. Media characterisations reveal and maintain a lack of societal framework for understanding Long Covid in CYP. The findings of this study illustrate the discursive practices employed by journalists that contribute to experiences of epistemic injustice. Based on our findings, we propose recommendations for journalists.

Effects of the Covid-19 pandemic on the continuity of sexual and reproductive health care in the maternity ward of a health and social promotion centre in Burkina Faso: a qualitative study (preprint)

The COVID-19 pandemic has significantly impacted the continuity of maternity care in Burkina Faso. This study aimed to compare the volumes of in-person visits and explore the experiences of healthcare providers and users regarding the continuity of healthcare in the maternity ward of a Health and Social Promotion Center (HSPC) before, during, and after the lockdown during the COVID-19 pandemic in Ouagadougou, Burkina Faso. Methods We conducted a multimethod, cross-sectional exploratory study with a phenomenological approach. Monthly health administrative data regarding family planning visits, antenatal visits, deliveries, and postnatal care before, during, and after COVID-19 were collected and compared. Qualitative data were collected through semi-structured interviews with family healthcare providers and users and thematically analyzed. Results The study found that the pandemic led to a decline in the demand for healthcare, as people were afraid of contracting COVID-19. This was particularly true for pregnant women who had recently given birth. The study also found that the pandemic disrupted the supply of essential medicines and medical supplies, which made it difficult for healthcare providers to provide quality care. The qualitative analysis allowed us to highlight three themes: the representation of respondents on COVID-19, their perception of the effectiveness of barrier measures and their analysis of the continuity of care in times of COVID-19: the picture of respondents on COVID-19, their perception of the efficacy of barrier measures and their analysis of the continuity of care in times of COVID-19. Despite these challenges, the study found that healthcare providers and users could find ways to maintain continuity of care. Conclusion The study concludes that the COVID-19 pandemic has significantly impacted the continuity of maternity care in Burkina Faso. However, healthcare providers and users have found ways to maintain continuity of care, and the study provides recommendations for improving continuity of care in the future.

Barriers and facilitators for strengthening physiotherapy services in Nepal: perspectives from physiotherapists and health providers (preprint)

Background: Physiotherapy provides non-invasive and non-pharmaceutical intervention for curative, rehabilitation and preventative purposes.  Physiotherapy is also a central provider of health promotion. As the global burden of non-communicable diseases and chronic health conditions is rising, the importance of physiotherapy services increases. Unfortunately, physiotherapy services in low- and middle-income countries (LMICs) are generally unsatisfactory. In Nepal, the earthquake in 2015 and the COVID pandemic have clearly illuminated the importance of physiotherapy. Objective: This qualitative study aimed to identify barriers and facilitators at different system levels for strengthening physiotherapy services in Nepal. Methods: Forty semi-structured individual interviews were performed with different health providers. Transcribed interviews were assessed with thematic analysis. A five-level socioecological framework conceptualised multilevel determinants of barriers and facilitators. Results: The study revealed various factors that were potential barriers and facilitators across five different levels, namely individual (taking the lead, need for advocacy), interpersonal (lack of recognition and autonomy, networking for referrals and coordination), community (lack of knowledge and awareness, social and family support), organisational (accessibility, workplace and clinical practice, educational opportunities, role of organisations and rehabilitation centres), and public policy level (planning and implementation of policies and programs, medical hegemony, priorities). Government officials, local leaders, and clinicians, half of whom were physiotherapists, agreed on many of the same issues, where a lack of awareness of what physiotherapy is and knowledge about what physiotherapists do was central. Conclusions: The results provide information for the development of physiotherapy by pointing out key elements that need attention, which are applicable to the situation in most LMIC countries where special focus needs to be directed towards rural and remote areas.

Exploring the Perspectives of Clients and Clinicians Regarding Digitally Delivered Psychotherapies Utilized for Trauma-Affected Populations. (preprint)

During the COVID-19 pandemic, many clinical sites shifted towards digital delivery of mental health services. However, there is still much to learn regarding tailoring interventions for trauma-affected populations, including military members, Veterans, and public safety personnel. This study examined perceptions of psychotherapies utilized for trauma-affected populations, as reported by Canadian military members, Veterans, and public safety personnel who completed such interventions and mental health clinicians who provided them. Specifically, we explored the shift to digital health use, what changed with this rapid shift, what needs, problems, and solutions arose, and important future considerations associated with delivering trauma-focused and adjunct treatments digitally.   Quantitative survey data were collected from 11 Canadian patients (military members, Veterans, and public safety personnel with post-traumatic stress injury) and 12 Canadian mental health clinicians. Survey questions were adapted from the Alberta Quality Matrix for Health (AQMH) and Unified Theory of Acceptance and Use of Technology (UTAUT) model. As a follow-up, participants were invited to participate in either a semi-structured qualitative interview or focus group to further explore their perspectives on digitally delivered trauma-focused and adjunct therapies. Four clients and 19 clinician participants participated in an interview or focus group.   In survey and interview/focus group results, patient and clinician participants reported that digitally delivered trauma and adjunct therapies offered similar treatment effectiveness as in-person delivery while also improving treatment access. Participants indicated unique advantages of digital delivery, including the increased accessibility of treatment, cost effectiveness, and more efficient use of resources. However, some participants struggled with using digital platforms and felt less comfortable working in a digital environment. Further research with a larger, more diverse population is required to corroborate our results and identify other avenues in which psychotherapies utilized for trauma-affected populations can be engaged with and improved upon.

Impact of COVID-19 on diabetes mellitus outcomes and care in sub-Saharan Africa: A scoping review (preprint)

Background: The COVID-19 pandemic impacted diabetes mellitus clinical outcomes and chronic care globally. However, little is known about its impact in low-resource settings such as sub-Saharan Africa. Hence, to address this, we systematically conducted a scoping review to explore the COVID-19 impact on diabetes outcomes and care in countries of sub-Saharan Africa. Methods We applied our search strategy to PubMed, Web of Science, CINAHL, African Index Medicus, Google Scholar, Cochrane Library, Scopus, Science Direct, ERIC and Embase to obtain relevant articles published from January 2020 to March 2023. Two independent reviewers were involved in the screening of retrieved articles. Data from eligible articles were extracted from quantitative, qualitative and mixed methods studies. Numerical data were summarised using descriptive statistics, while a thematic framework was used to categorise and identify themes for qualitative data. Results We found 42 of the retrieved 360 articles eligible, mainly from South Africa, Ethiopia and Ghana (73.4%). COVID-19 increased the risk of death (OR 1.30,9.0, 95% CI), hospitalisation (OR 3.30,3.73: 95% CI), and severity (OR: 1.30,4.05, 95% CI) in persons with diabetes mellitus. COVID-19 also increased the risk of developing diabetes mellitus in hospitalised cases. The pandemic, on the other hand, was associated with disruptions in patient self-management routine and diabetes mellitus care service delivery. Three major themes emerged, namely, (i) patient-related health management challenges, (ii) diabetes mellitus care service delivery challenges, and (iii) reorganisation of diabetes mellitus care delivery. Conclusion COVID-19 increased mortality and morbidity among people living with diabetes mellitus. In addition, the COVID-19 pandemic worsened diabetes mellitus care management. Sub-Saharan African countries should, therefore, institute appropriate policy considerations for persons with diabetes mellitus during widespread emergencies.

COVID‐19 Vaccine Motivation and Hesitancy among a Sample of African American, Afro‐Caribbean, and African Respondents in the United States (preprint)

Understanding the motivations and decisions behind COVID-19 vaccine acceptance is crucial for designing targeted public health interventions to address vaccine hesitancy. We conducted a qualitative analysis to explore COVID-19 vaccine acceptance among diverse ethnic subgroups of Black Americans in the United States. This study investigates the responses of 79 African American, Afro-Caribbean, and African respondents over the age of 18 in Washington State and Texas between 2021-2022. Qualitative responses were analyzed by content category and ethnic subgroup. Of the 79 responses, 60 expressed favorable perceptions, 16 unfavorable, and 3 neutral. Dominant categories among participants in favor of the vaccine included personal health (26), concern for health of family/or community members (13), and desire to protect others (11). Among the 42 vaccinated African American respondents, the primary motivation was personal health (20). The 12 unvaccinated African American respondents cited fear of side-effects as the dominate motivation. Caribbean respondents cited family or elders as motivation for their decision. African respondents were nearly unanimous in taking the vaccine (13/16), citing trust in healthcare, protecting friends and family, and personal health as reasons. Community and personal relationships were critical decision-making factors in accepting the COVID-19 vaccine with African Americans having the strongest hesitancy.

Exploring Key Challenges for Healthcare Providers and Stakeholders in delivering adolescent sexual and Reproductive Health Services and information during the COVID-19 Pandemic in Malawi, Zambia and Zimbabwe: A Qualitative Study (preprint)

Introduction: This study aimed to explore the direct and indirect influences of COVID-19-related restrictions on adolescents and young people's SRHR in Malawi, Zambia, and Zimbabwe, with a focus on teenage pregnancy and access to and utilization of HIV testing and counselling services. Methods: A qualitative case study in a larger mixed-methods study design was used. Thirty-four interviews and four group discussions were conducted with relevant stakeholders in Malawi, Zambia and Zimbabwe. In Zambia, adolescents and young people were included and asked to describe their experience/perceptions of the impact of COVID-19 on their SRHR. Content and thematic analysis were used to analyze the data, Results: Priority shifts resulted in the focus of service provision to the COVID-19 response, shortages of already insufficient human resources due to infection and/or isolation, supply chain disruptions leading to shortages of important SRH-related commodities and supplies, compromised quality of services such as counselling for HIV and overall limited AYP’s access to SRH information. Suggestions for interventions to improve SRH services include the need for a disaster preparedness strategy, increased funding for ASRHR, the use of community health workers and community-based ASRHR strategies, and the use of technology and social media platforms such as mhealth. Conclusion:Disruption of SRH services for AYP due to pandemic related-restrictions, and diversion of resources/funding has had a ripple effect that may have long-term consequences for AYP throughout the East and Southern African region. This calls for further investment in AYP’s access to SRHR services as progress made may have been deterred.

Gender Bias in Emerging New Research Topics: The Impact of COVID-19 on Women in Science (preprint)

We investigate the impact of new research opportunities on the long-standing under-representation of women in medical and academic leadership by assessing the impact of the emergence of COVID-19 as a new research topic in the life sciences on women's authorship. After collecting publication data from 2019 and 2020 on biomedical publications, where the position of first and last author is most important for future career development, we use the major Medical Subject Heading (MeSH) terms to identify the main research area of each publication and measure the relation of each paper to COVID-19. Using a Difference-in-Difference approach, we find that although the general female authorship trend is upwards, papers in areas related to COVID-19 are less likely to have a woman as first or last author compared to research areas not related to COVID-19. Conversely, new publication opportunities in the COVID-19 research field increase the proportion of women in middle, less-relevant, author positions. Stay-at-home mandates, journal importance, and access to new funds do not fully explain the drop in women's outcomes. The decline in female first authorship is related to the increase of teams in which both lead authors have no prior experience in the COVID-related research field. In addition, pre-existing publishing teams show reduced bias in female key authorship with respect to new teams specifically formed for COVID-related research. This suggests that opportunistic teams, transitioning into research areas with emerging interests, possess greater flexibility in choosing the primary and final authors, potentially reducing uncertainties associated with engaging in productions divergent from their past scientific experiences by excluding women scientists from key authorship positions.

Trust and transfer during the covid-19 pandemic: did digital cash transfer save lives? (preprint)

BACKGROUNDIn the first semester of 2020 one in six people in the world (1.36 billion) received cash transfers to tide them over the spreading pandemic that originated in Wuhan. By December 2021 it had claimed up to 18.2 million excess deaths. Compared to no (digital) transfer, did digital cash transfer reduce excess deaths? Serendipitously, two years earlier the world reported levels of trust in science. Did such trust inoculate societies from the pandemic? MATERIALS & METHODSThe growing excess deaths literature distinguishes causal factors (e.g. digital transfer) from risk factors (e.g. trust). During the pandemic period, no randomised trials of digital transfer with excess deaths as primary outcome were registered. This study used reports from 170 countries and applied endogenous treatment models to overcome the endogeneity of digital transfer. RESULTS & DISCUSSIONI found that serendipity matters: countries with high trust in science suffered fewer excess deaths. But creativity matters more. Digital transfers -some creatively scrambled from scratch- reduced excess deaths by many more. Equally marked, North-South inequity in excess deaths persists, consistent with the concentration of vaccine distributions in the North early on. All three are statistically significant. A series of robustness analyses points to the results being reliable to change in outcome estimates, change in trust sources, and change in treatment of omitted countries. Mechanistic analyses show evidence that digital transfer created leg room for governments to expand stringent restrictions to control the spread of SARS-CoV-2, while in the South it weakened the correlation between informal economy and excess deaths. This study of the causal effect of digital cash transfer on a hard outcome (excess deaths) revealed ample global digital dividends across the largest number of countries. This new evidence also suggests that improving and monitoring trust in science can offer considerable benefits for humanity.

Uptake of COVID-19 vaccination and associated factors among patients attending oncology services in Dar es Salaam, Tanzania: A mixed design methods’ trajectories (preprint)

Background COVID-19 vaccination campaigns have reduced diseases severity and fatalities around the globe. Global data shows 67.7% of the general population are vaccinated, and Tanzania is reported to have over 70% coverage among individuals more than 18 years of age. However, group-specific assessment of the vaccination coverage is needed in sub-Saharan Africa, and cancer patients constitute a special priority group owing to the vulnerability attributable to this group.Methods A cross-sectional study design was conducted in September 2022 at Ocean Road Cancer Institute (ORCI) in Dar Es Salaam, Tanzania. A stratified sampling technique was used for quantitative data collection involving 479 cancer patients, and convenience sampling was applied for qualitative data collection involving 26 patients. Data were analysed using the statistical software ‘R’ by logistic regression analysis to determine association between socio-demographic, clinical and health belief model (HBM) variables against COVID-19 vaccine uptake among cancer patients.Results A total of 384 (80.2%) participants were female with a mean age (± standard deviation) of 48 ± 12.4 years; ranging from 18 to 83 years. Approximately 58.2% (278/479) of the participants reported to be vaccinated against COVID-19, and among them 79.5% were females. Having secondary school education or higher education (OR 2.26, CI 1.20–4.27 p = 0.011), perception on COVID-19 vaccine (OR 8.86, CI 2.84–32.2, p < 0.001) and perceived severity of COVID-19 (OR 0.56, CI 0.36–0.87, p = 0.010) were significantly associated with vaccine uptake. In the qualitative part, the findings suggest that individuals’ beliefs, perceptions, and external factors play a role in their decision to get vaccinated.Conclusions Approximately 6 out of 10 cancer patients at the ORCI reported to be vaccinated; with patients’ higher education status, perception on COVID-19 vaccine, and perceived severity being significantly associated with COVID-19 vaccination uptake. Public health interventions should leverage these identified factors to promote vaccine uptake through tailoring communication efforts to specific characteristics.

Exploring the experiences of COVID-19 survivors with a history of admission to the respiratory intensive care unit (RICU): A phenomenological study in Iran (preprint)

COVID-19 is still spreading around the world. To this end, the present study sought to explore the experiences of COVID-19 survivors with a history of admission to ICUs in southern Iran. This study was conducted using descriptive phenomenology on twelve COVID-19 survivors with a history of admission to the ICU. The patients were selected using purposive sampling. The data were collected through face-to-face semistructured interviews with the patients. The collected data were analyzed using the seven steps of Colaizzi analysis. Data analysis revealed 3 main themes: better resources and facilities, unpleasant physical and psychological experiences, and pain relievers. COVID-19 survivors who were admitted to the RICU reported that they had many positive and negative experiences. Thus, health officials, experts, nurses, and physicians need to pay special attention to the problems faced by COVID-19 patients admitted to ICUs.

How COVID-19 has Impacted the Anti-Vaccine Discourse: A Large-Scale Twitter Study Spanning Pre-COVID and Post-COVID Era (preprint)

The debate around vaccines has been going on for decades, but the COVID-19 pandemic showed how crucial it is to understand and mitigate anti-vaccine sentiments. While the pandemic may be over, it is still important to understand how the pandemic affected the anti-vaccine discourse, and whether the arguments against non-COVID vaccines (e.g., Flu, MMR, IPV, HPV vaccines) have also changed due to the pandemic. This study attempts to answer these questions through a large-scale study of anti-vaccine posts on Twitter. Almost all prior works that utilized social media to understand anti-vaccine opinions considered only the three broad stances of Anti-Vax, Pro-Vax, and Neutral. There has not been any effort to identify the specific reasons/concerns behind the anti-vax sentiments (e.g., side-effects, conspiracy theories, political reasons) on social media at scale. In this work, we propose two novel methods for classifying tweets into 11 different anti-vax concerns -- a discriminative approach (entailment-based) and a generative approach (based on instruction tuning of LLMs) -- which outperform several strong baselines. We then apply this classifier on anti-vaccine tweets posted over a 5-year period (Jan 2018 - Jan 2023) to understand how the COVID-19 pandemic has impacted the anti-vaccine concerns among the masses. We find that the pandemic has made the anti-vaccine discourse far more complex than in the pre-COVID times, and increased the variety of concerns being voiced. Alarmingly, we find that concerns about COVID vaccines are now being projected onto the non-COVID vaccines, thus making more people hesitant in taking vaccines in the post-COVID era.

Change, Adversity, and Adaptation: Young People’s Experience of the COVID-19 Pandemic Expressed through Artwork and Semi-structured Interviews (preprint)

This study explores how young people’s mental health was affected by the COVID-19 pandemic using artwork and semi-structured interviews. This is important to understand so that policy and practice professionals can support those affected, prepare, and respond to future crises, and support young people who are isolated and restricted in other contexts. Co-designed participatory art workshops and interviews were conducted with 16–18-year-olds (N = 21) from the London-based Longitudinal cohort Study of Cognition, Adolescents and Mobile Phones (SCAMP). Artworks and interview transcripts were qualitatively co-analysed with young people. From interviews, six themes were identified: adaptation, restriction, change, challenges, overcoming adversity, and lockdown life. From artwork, four themes were identified; trapped, negative mental wellbeing, positive emotions, and technology. Everyday factors such as home environment, relationships, hobbies, habits, and education or work were key determinants of how challenged and restricted participants felt, and their capacity to overcome this. This implies that young people’s mental health services should collaborate with other sectors to address wider life determinants in a holistic way, and that clearer guidance and support in these areas could mitigate the negative mental health impacts of major environmental changes on young people.

Community-Based View on Diagnostic Imaging at the End of COVID-19 Pandemic: Online Survey-Assisted Study (preprint)

Background: Online survey-based observational cross-sectional study aimed at elucidating experience and attitudes of unstructured population regarding diagnostic imaging. Methods: Invitations to participate were distributed using mixed-mode design to deidentified residents aged 18 years and older. Main outcome measures included morbidity structure and incidence of diagnostic imaging administrations. Results: Respondents (n = 1069) aged 44.3 ± 14.4 years; 32.8% suffered from cardiovascular diseases (CVD); 9.5% had chronic respiratory pathology; 28.9% considered themselves healthy. Respondents with COVID-19 history (49.7%) reported higher rates of computed tomography (CT) (p < .0001), magnetic resonance imaging (MRI) (p < .001), and ultrasound (p < .05). COVID-19 history in CVD respondents shifted imaging administrations towards CT and MRI (p < .05). Every tenth respondent received MRI, CT, and ultrasound on paid basis; 29.0% could not pay for diagnostic procedures; 13.1% reported unavailable MRI. Professional status significantly affected the pattern of diagnostic modalities (p < .05). MRI and CT availability differed between respondents in urban and rural areas (p < .0001). History of technogenic events predisposed responders to overestimate diagnostic value of fluorography (p < .05). Conclusions: Preparedness to future pandemics requires development of community-based outreach programs focusing on people's awareness regarding medical imaging safety and diagnostic value.

Effect of online peer support on mental health among patients of post-acute sequelae of SARS-CoV-2 infection: A systematic review (preprint)

Background Psychosocial burdens of the post-acute sequelae of SARS-CoV-2 infection (PASC) are an emerging public health concern. Online peer support is expected to be effective in improving the mental health of PASC patients. However, the effectiveness of these treatments remains unclear. This study investigated the effectiveness of online peer support for improving the mental health of PASC patients.Methods We searched the MEDLINE, PsycINFO/PsycArticles, and Japan Medical Abstracts Society electronic databases for studies on June 12, 2023. The inclusion criteria for studies were as follows: 1) patients with post-COVID-19 conditions over 18 years of age; 2) conducted online peer support exposure or intervention; 3) measured mental health-related outcomes using quantity scales; and 4) peer-reviewed original articles written in English or Japanese. We excluded qualitative studies that did not use quantitative scales to measure outcomes and original peer-reviewed articles. We conducted risk of bias assessments with the Risk of Bias Assessment instrument designed for non-randomized studies (RoBANS).Results A total of 157 studies were retrieved, and two met the inclusion criteria. The total numbers of participants in the two studies were 239 and 47, respectively. One was a cohort study, and the other was a pre-post study; neither had a control group. Most participants in both studies were middle-aged women or female from high-income European countries. Exposure or intervention included sharing sources of support (e.g., experiences, knowledge, and expertise) and peer support combined with workshops for the self-management of physical and mental health facilitated by trained medical experts. The effectiveness of online peer support on mental health outcomes was also assessed. Two studies reported significant improvements in work productivity, functional status, quality of life, self-efficacy, and well-being. Both studies were rated as high or unclear in most risk-of-bias domains. No meta-analysis was performed because of the small number of included studies.Conclusions Few studies examine online peer support for improving mental health-related outcomes among PASC patients, and evidence of its effectiveness is unclear. Well-designed studies are required to conduct meta-analyses to evaluate the effectiveness of online peer support for PASC patients.

Addressing evidence needs during health crises in the province of Quebec (Canada): a proposed action plan for rapid evidence synthesis (preprint)

Background: The COVID-19 pandemic necessitated the rapid availability of evidence to respond in a timely manner to the needs of practice settings and decision-makers in health and social services. Now that the pandemic is over, it is time to put in place actions to improve the capacity of systems to meet knowledge needs in a situation of crisis. The main objective of this project was thus to develop an action plan for the rapid syntheses of evidence in times of health crisis in Quebec (Canada). Methods: We conducted a three-phase collaborative research project. First, we carried out a survey with producers and users of rapid evidence syntheses (n=40) and a group interview with three patient partners to prioritize courses of action. In parallel, we performed a systematic mapping of the literature to identify rapid evidence synthesis initiatives developed during the pandemic. The results of these two phases were used in a third phase, in which we organized a deliberative workshop with 26 producers and users of rapid evidence syntheses to identifying ways to operationalize priorities. The data collected at each phase were compared to identify common courses of action and integrated to develop an action plan. Results: A total of 14 specific actions structured into four main axes were identified over the three phases. In axis 1, actions on raising awareness of the importance of evidence-informed decision-making among stakeholders in the health and social services network are presented. Axis 2 includes actions to promote optimal collaboration of key stakeholders in the production of rapid evidence synthesis to support decision-making. Actions advocating the use of a variety of rapid evidence synthesis methodologies known to be effective in supporting decision-making are presented in axis 3. Finally, axis 4 is about actions on the use of effective strategies to promote the dissemination, sharing, and use of rapid evidence synthesis products to support decision-making. Conclusions: This project led to the development of a collective action plan aimed at preparing the Quebec ecosystem and other similar jurisdictions to meet knowledge needs more effectively in times of health emergency. The implementation of this plan and its evaluation will enable us to continue to fine-tune it.

Social isolation emanated psychological exhaustion and disconnectedness among physicians during the COVID-19 pandemic: Results of a qualitative study in Pakistan (preprint)

Background: During the COVID-19 pandemic, many healthcare providers remained on call in COVID-19 wards, isolation centres, and emergency departments, caring for both infected and non-infected patients. Physicians have faced various challenges during the pandemic, including the stress of working with limited resources, the physical burden of long work hours and fear of public abuse in terms of stigmatization. Therefore, this study focusses on social-psychological aspects of isolation period of physicians during the COVID-19 pandemic. Methods: It is a qualitative study based on responses from 14 physicians working in two hospitals located in Islamabad, which is the capital city of Pakistan (Pakistan Institute of Medical Sciences [PIMS] and PolyclinicHospital). In-depth interviews were conducted with selected physicians by using an interview guide as a tool of data collection to explore the experiences of those physicians who suffered from COVID-19 and lived in isolation as their quarantine period. The data was analyzed by using thematic analysis technique. Results: The study explored isolation experiences of physicians during the selected period of COVID-19 and significantly found that two major themes emerged, i.e. psychological exhaustion (depression, anxiety and loneliness were subthemes) and disconnectedness (relational detachment and lack of interaction were subthemes). Conclusions: This pandemic crisis has significantly resulted in having adverse impact on the ability of physicians to approach both potential and existing patients. Particularly in times of such a crisis, adequate measures have to be taken to address mental health issues of the health workforce.

Lessons from the COVID-19 pandemic to strengthen NCD care and policy in humanitarian settings: a mixed methods study exploring humanitarian actors’ experiences. (preprint)

Background The COVID-19 pandemic and response severely impacted people living with non-communicable diseases (PLWNCDs) globally. It exacerbated pre-existing health inequalities, severely disrupted access to care, and worsened clinical outcomes for PLWNCDs, who were at higher risk of morbidity and mortality from the virus. The pandemic’s effects were likely magnified in humanitarian settings, where there were pre-existing gaps in continuity of care for non-communicable diseases (NCDs). We sought to explore factors affecting implementation of NCD care in crises settings during the COVID-19 pandemic and the adaptations made to support implementation.Methods Guided by the Consolidated Framework for Implementation Research, we undertook an online survey of 98 humanitarian actors from multiple regions and organization types (March-July 2021), followed by in-depth interviews with 13 purposively selected survey respondents (October-December, 2021). Survey data were analysed using descriptive statistics, while interview data were analysed both deductively and inductively.Results Initially, humanitarian actors faced challenges influenced by external actors’ priorities, such as deprioritisation of NCD care by governments, travel restrictions and supply chain interruptions. With each infection wave and lockdown, humanitarian actors were better able to adapt and maintain NCD services. The availability of COVID-19 vaccines was a positive turning point, especially for the risk management of people with NCDs and protection of health workers. Key findings include that, despite pre-existing challenges, humanitarian actors largely continued NCD services during the crisis. Enabling factors that supported continuity of NCD services included the ability to quickly pivot to remote means of communication with PLWNCDs, flexibility in medicine dispensing, and successful advocacy to prioritize NCD management within health systems. Key lessons learned included the importance of partnerships and cooperation with other health actors and the mobilisation or repurposing of community health workers/volunteer networks.Conclusions The COVID-19 experience should prompt national and global health stakeholders to strengthen inclusion of NCDs in emergency preparedness, response, and resilience planning, building on lessons learned around remote care provision adapted to PLWNCDs severity, integrating community health workers, providing context-adapted PLWNCDs information and combating misinformation and strengthening cross-sectoral partnerships.

Family member and service provider experiences and perspectives of a digital surveillance and service navigation approach: A qualitative study with a culturally diverse community (preprint)

Background Children and families from priority populations experienced significant psychosocial and mental health issues to the COVID-19 pandemic. Yet they also faced significant barriers to service access, particularly families from culturally and linguistically diverse (CALD) backgrounds. With most child and family health nurse clinics ceasing in-person consultations due to the pandemic, many children missed out on health and developmental checks. The aim of this study was to investigate the perspectives and experiences of family members and service providers from an urban, CALD community regarding the implementation of a digital, developmental surveillance, Watch Me Grow-Electronic (WMG-E) program.Methods Semi-structured interviews were conducted with 17 family members, service navigators, and service providers in a multicultural community in South Western Sydney, Australia. This qualitative study formed part of a larger, two-site, randomised controlled trial of the WMG-E program. A reflexive thematic analysis approach was adopted to analyse the data.Results Participants highlighted the comprehensive and personalised support offered by existing child and family health services. The WMG-E was deemed beneficial because the weblink was easy and quick to use and it enabled access to a service navigator who support family access to relevant services. However, the WMG-E was problematic because of technology or language barriers, and it did not facilitate immediate clinician involvement when families completed the weblink.Conclusions Families and service providers found that using WMG-E empowered parents and caregivers to access developmental screening and learn more about their child’s development and engage with relevant services. This beds down a new and innovative solution to the current service delivery gap and create mechanisms that can engage families currently not accessing services, and develops and increases knowledge around navigating the health and social care services.Trial registration: The study is part of a large randomised controlled trial (Protocol No. 1.0, Version 3.1) was registered with ANZCTR (registration number: ACTRN12621000766819) on July 21st, 2021 and reporting of the trial results will be according to recommendations in the CONSORT Statement.