The Impact of the COVID-19 Pandemic on Physical Activity, Function, and Quality of Life

Changes in Preterm and Low Birthweight Birth Rate During the COVID-19 Lockdown at Two San Francisco Hospitals

OBJECTIVE

The COVID-19 lockdown impacted interactions with the health care system and societal stress levels. Previous US-based studies suggest that pandemic lockdowns may have lowered preterm birth rates although there are mixed findings from different settings. We evaluated the impact of COVID-19 on preterm birth and low birthweight rates at two San Francisco hospitals.

METHODS

We compared rates of preterm birth (< 37 weeks) and low birthweight (< 2500 g) in San Francisco at a safety net hospital and an academic medical center during two time periods early in the COVID-19 pandemic compared with the same months from the prior year: from March to May 2019 and 2020 and August to December 2019 and 2020. We calculated crude rates for preterm birth and low birth weight as well as compared maternal and infant birth demographics and health characteristics during these same time periods using descriptive statistics. Secondly using a cross-sectional study design, we used logistic and linear regression models to evaluate risk for preterm birth, gestational age at birth, and low birthweight adjusting for confounders comparing the lockdown period with the pre-COVID year. All analyses were conducted using Stata 15.0.

RESULTS

From August to December 2019 to 2020, the preterm birth rate decreased from 13.20 to 7.96% in the combined hospital data (p < 0.01), and the low birthweight rate decreased from 11.33 to 9.70% during the same time period (p = 0.13). We did not find a comparable reduction from March to May 2019 to 2020. Maternal age at delivery was significantly younger during the lockdown period, August to December, than in the prior year (36.29 ± 5.69 versus 37.15 ± 5.68 years p < 0.01) and parity was greater (0.83 ± 1.15 versus 0.74 ± 1.04, p = 0.03) but there were no other significant differences in race or ethnicity, infant sex or type of delivery (vaginal versus Cesarean section) from 2019 to 2020. In a logistic and linear regression model adjusting for maternal age and infant sex and other confounders, the lockdown period from August to December was protective against preterm birth (OR 0.65, 95%CI 0.51-0.82) and associated with overall longer gestational duration (Coeff 0.23, 95%CI 0.07-0.39). The August to December lockdown period was also associated with greater birthweight (Coeff 43.76, 95%CI 2.19-85.34).

CONCLUSIONS

In San Francisco, COVID-19 lockdowns lowered the preterm birth and increased gestational duration in infants comparing 2019 with 2020 for August to December. The reduced in preterm birth rates may be related to the overall strict lockdown measures that San Francisco implemented compared with other US cities. WHAT THIS STUDY ADDS TO THE CLINICAL WORK?: This study suggests that COVID-19 lockdowns lowered the preterm birth rate in August -December 2020 compared with the same months in 2019 in two hospitals in San Francisco. San Francisco had strict lockdowns compared with other areas of the country and fewer deaths. The stay-at-home measures could possibly have reduced stress for pregnant women or had other positive benefits that reduced the preterm birth rate.

Long-term effects of the COVID-19 pandemic for patients with cancer

INTRODUCTION

Long COVID is defined as the continuation of symptoms, unexplainable by alternative diagnosis, longer than four weeks after SARS-CoV-2 infection. These symptoms might hinder daily activities and overall well-being, ultimately impacting quality of life (QoL). Several studies have reported fatigue as the most common symptom, followed by dyspnoea, headache and myalgia. Although it is assumed that long COVID affects 10-20% of SARS-CoV-2 infected individuals, recently numbers up to 60% were described for patients with cancer. This study uncovers the impact of the COVID-19 pandemic on QoL of patients with cancer and how long COVID manifests in this cohort.

METHODS

A group of 96 patients with cancer was followed from March 2022 till March 2023. Online questionnaires assessing symptoms associated with long COVID, anxiety and depression (HADS), quality of life (EORTC-QLQ-C30) and cognitive functioning (CFQ) were sent every three months during this period. Furthermore, a semi-structured focus group was organised for qualitative data collection.

RESULTS

Overall, these patients reported a negative impact of the enforced COVID-19 restrictions on the emotional and psychological wellbeing. Forty nine patients with cancer (51.0%) were infected with SARS-CoV-2 over the course of the study, of which 39 (79.6%) reported long COVID symptoms. The most commonly reported symptoms were myalgia (46.2%), fatigue (38.5%) and disturbed sleep (35.9%) and it was observed that male sex is associated with poor long COVID outcomes.

CONCLUSION

While patients with cancer experience similar long COVID symptoms as healthy controls, the prevalence is remarkably higher possibly due to their compromised immune system and weakened physiological reserve.

Comparing quality of care outcomes between assisted living and nursing homes before and during the COVID-19 pandemic

BACKGROUND

While assisted living (AL) and nursing home (NHs) residents in share vulnerabilities, AL provides fewer staffing resources and services. Research has largely neglected AL, especially during the COVID-19 pandemic. Our study compared trends of practice-sensitive, risk-adjusted quality indicators between AL and NHs, and changes in these trends after the start of the pandemic.

METHODS

This repeated cross-sectional study used population-based resident data in Alberta, Canada. Using Resident Assessment Instrument data (01/2017-12/2021), we created quarterly cohorts, using each resident's latest assessment in each quarter. We applied validated inclusion/exclusion criteria and risk-adjustments to create nine quality indicators and their 95% confidence intervals (CIs): potentially inappropriate antipsychotic use, pain, depressive symptoms, total dependency in late-loss activities of daily living, physical restraint use, pressure ulcers, delirium, weight loss, urinary tract infections. Run charts compared quality indicators between AL and NHs over time and segmented regressions assessed whether these trends changed after the start of the pandemic.

RESULTS

Quarterly samples included 2015-2710 AL residents and 12,881-13,807 NH residents. Antipsychotic use (21%-26%), pain (20%-24%), and depressive symptoms (17%-25%) were most common in AL. In NHs, they were physical dependency (33%-36%), depressive symptoms (26%-32%), and antipsychotic use (17%-22%). Antipsychotic use and pain were consistently higher in AL. Depressive symptoms, physical dependency, physical restraint use, delirium, weight loss were consistently lower in AL. The most notable segmented regression findings were an increase in antipsychotic use during the pandemic in both settings (AL: change in slope = 0.6% [95% CI: 0.1%-1.0%], p = 0.0140; NHs: change in slope = 0.4% [95% CI: 0.3%-0.5%], p < 0.0001), and an increase in physical dependency in AL only (change in slope = 0.5% [95% CI: 0.1%-0.8%], p = 0.0222).

CONCLUSIONS

QIs differed significantly between AL and NHs before and during the pandemic. Any changes implemented to address deficiencies in either setting need to account for these differences and require monitoring to assess their impact.

The seasonal variation of physical activity and quality of life during the first wave of the COVID-19 pandemic in Finnish older golfers: A cross-sectional study

Background and Aims

The COVID-19 pandemic was associated with reduced physical activity and increased sedentary behavior. Golf is a health-enhancing outdoor exercise and is associated with low risk of viral transmission. The purpose of this study was to describe the seasonal differences in physical activity and quality of life during the first wave of COVID-19 pandemic in 2020 in Finnish older golfers.

Methods

Older golfers (n = 325) from eight golf clubs retrospectively responded to a questionnaire in summer 2020 on their physical activity and golf activity in winter 2019/20 (pre-COVID-19 winter season) and summer season 2020. In addition, they reported their quality of life after the first wave of pandemic in summer 2020. To evaluate the seasonal differences in physical activity, life quality and its association with golf activity, the data were analyzed using the Mann-Whitney U test, Wilcoxon signed-rank test, Spearman's correlation test, and linear regression analysis.

Results

Despite COVID-19 restrictions, golfers' physical activity increased by 24% (p < 0.001) during the COVID-19 restrictions in the summer of 2020. Moderate physical activity increased by 37% (p < 0.001), walking activity increased by 26% (p < 0.001), and sitting decreased by 21% (p < 0.001) compared with the pre-COVID-19 winter season. The full 18-hole golf round activity was positively associated with moderate physical activity both in the summer and winter season, and with walking in the summer season. Over 90% of golfers reported good quality of life during the 2020 summer restrictions.

Conclusion

In contrast to physical activity levels generally decreasing during the first wave of pandemic, physical activity levels in Finnish golfers increased, and these golfers reported a good quality of life. Golf can provide health enhancing physical activity and older golfers seems to be physically active throughout the year.

Assessing the Suitability of a Virtual 'Pink Warrior' for Older Breast Cancer Survivors during COVID-19: A Pilot Study

The COVID-19 pandemic impacted the conduct of in-person physical activity (PA) interventions among older survivors of BC, who need such interventions to stay active and prevent functional decline. We tested the feasibility of virtually delivering an exergame-based PA intervention to older BC survivors. We enrolled 20 female BC survivors ≥55 years and randomly assigned them to two groups. The intervention group (Pink Warrior 2) received 12 weekly virtual exergame sessions with behavioral coaching, survivorship navigation support, and a Fitbit for self-monitoring. The control group received 12 weekly phone-based survivorship discussion sessions and wore a Mi Band 3. Feasibility was evaluated by rates of recruitment (≥0.92 participants/center/month), retention (≥80%), and group attendance (≥10 sessions), percentage of completed virtual assessments, and number of technology-related issues and adverse events. Intervention acceptability was measured by participants' ratings on a scale of 1 (strongly disagree) to 5 (strongly agree). The recruitment rate was 1.93. The retention and attendance rates were 90% and 88% (≥10 sessions), respectively. Ninety-six percent completed virtual assessments without an adverse event. Acceptability was high (≥4). The intervention met benchmarks for feasibility. Additional research is needed to further understand the impact of virtually delivered PA interventions on older BC survivors.

Pulmonary Function Test as a Diagnostic Tool for Post-COVID-19 Effects

COVID-19-infected survivors are reporting persistent anomalies upon hospital discharge. After one year, a sizable percentage of COVID-19 survivors still have persistent symptoms affecting different bodily systems. Evidence suggests that the lungs are the most affected organs by COVID-19. It may also cause corollary and other medical issues. The literature on preceding COVID-19 infections reviews that patients may also experience chronic impairment in breathing characteristics after discharge. The outcome of COVID-19 may remain for weeks to months after the initial recovery. Our goal is to determine the superiority of the restrictive pattern, obstructive pattern, and adjusted diffusion in patients post-COVID-19 contamination and to explain the distinctive opinions of breathing characteristics used with those patients. Therefore, lung function tests were measured post-discharge for three to 12 months. According to estimates, 80% of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2)-infected patients experienced one or more chronic symptoms. Multidisciplinary teams are required to develop preventive measures, rehabilitation methods, and scientific control plans with a completely patient-centered attitude for long-term COVID-19 care. Clarifying the pathophysiologic mechanisms, creating and testing specific interventions, and treating patients with long-term COVID-19 are urgently needed. The goal of this review is to locate research evaluating COVID-19's long-term effects. A person who has suffered from COVID-19 in the past showed changes in their pulmonary function test. So, we have to notice the changes and recovery from post-COVID-19 effects. COVID-19 survivors were observed in an eventual observational study and continuously examined three, six, and 12 months after having COVID-19 infections. We evaluated the clinical features and concentrations of circulating pulmonary epithelial and endothelial markers in COVID-19 survivors with normal or lower diffusion capacity for carbon monoxide (DLCO) six months after discharge to analyze risk factors and underlying pathophysiology.

Designing for the post-pandemic era: Trends, focuses, and strategies learned from architectural competitions based on a text analysis

The COVID-19 pandemic has made the built environment an important source of prevention and control, architects and scholars have thus been seeking countermeasures since the beginning of the outbreak. As design and construction cycles are long, only a few completed cases and evidence-based studies are available for reference. However, massive architectural competition works have emerged, which always been the soil for discussion and practice of cutting-edge design issues. These contain a vast number of ideas for solutions from various design dimensions-including cities, buildings, and facilities-and provide a great deal of materials worth analyzing and summarizing. Therefore, the exploration of competitions will provide us with public health intervention directions, strategies and a rethinking of the built environment. Using a text-mining approach, we analyzed 558 winning entries in architectural competitions related to the pandemic response, exploring specific issues, populations involved, coping strategies, and trends that emerged as the pandemic evolved. Our results show that the strategies proposed can be grouped into 17 keywords, with modularization being the most frequent strategy and related strategies like rapid assembly, flexible space, etc. are also took a significant percentage of the use. Further, we explored the technical orientation, year, territory, target groups, and target problems of the works which lead to a series of cross-comparison relationships. The results indicate that indirect impacts caused by the pandemic gained more attention and flexible Solutions were used more often highlighted the consensus when adapting to the uncertainties. The focus on the spiritual dimension is increasing year by year reflected the spiritual influences were gaining traction and the indirect impacts gradually showed up over time. The research will provide a strategy reference for the design response to the pandemic, as well as help understand the influence and significance of social factors behind the divergence of issue focuses and strategic tendency in different regions and times.

Has the Pandemic Altered Public Perception of How Local Green Spaces Affect Quality of Life in the United Kingdom?

Green spaces unquestionably improve both physical and mental health, but there is little information on how they affect quality of life. This study investigates whether the public perception of how local green spaces and their impact on quality of life have altered as a result of restrictions imposed by the U.K.’s SARS-CoV-2 pandemic containment strategy. Qualitative data were collected using an online questionnaire distributed via social media platforms and postal flyers. The results clearly demonstrate that 90% of participants believe that green spaces improved their quality of life during the pandemic, with over 85% thinking that green spaces will continue to have a positive impact on their quality of life once the pandemic is over. Whether this is a permanent change in public thinking or a short-term adaptation to the stresses of the pandemic can be assessed in future research studies. More detailed research is required to understand more clearly the aspects and types of green spaces that are the most valuable for improving quality of life so that future ones can be designed to provide maximum benefits.