Anxiety and Its Determinants among Undergraduate Students during E-learning in Bangladesh Amid Covid-19

Evaluation of a hybrid model of a Physician Associate Studies programme: students, teachers, and examiner perspectives

BACKGROUND

To date, there is one university offering the Physician Associate (PA) Studies programme in Ireland. Responding to a demand for PAs outside of Dublin, a hybrid model was introduced, allowing students undertake the didactic phase of the programme online for synchronous instruction, attending campus twice a month for anatomy learning, clinical skills, and integration sessions.

AIMS

The aim of this study was to evaluate the hybrid model from the perspectives of students and their teachers, including the external examiner.

METHODS

This was a mixed methods study, using surveys (n = 15), focus groups with students (n = 10), teaching staff (n = 4), and a one-to-one interview with an external examiner. Action points of programme board meetings were also analysed.

RESULTS

While attitudes to online learning were positive, the need for improvements was highlighted. During online teaching sessions, the students expressed the need to feel more a part of the traditional classroom experience. Even though lecturers were aware of students online, some found it difficult to engage with these students. Clinical teachers did not detect any differences between hybrid and on-campus students on their clinical application to practice.

CONCLUSION

Findings suggest that hybrid learning is influenced by previous online learning experiences. Students admitted to a feeling of social isolation at times and the reminder for faculty to support an inclusive environment. Student performance showed that hybrid students did as well or better across both years of the programme, and this translated into clinical practice too.

A systematic review on the relationship between socioeconomic conditions and emotional disorder symptoms during Covid-19: unearthing the potential role of economic concerns and financial strain

BACKGROUND

Covid-19 has disrupted the lives of many and resulted in high prevalence rates of mental disorders. Despite a vast amount of research into the social determinants of mental health during Covid-19, little is known about whether the results are consistent with the social gradient in mental health. Here we report a systematic review of studies that investigated how socioeconomic condition (SEC)-a multifaceted construct that measures a person's socioeconomic standing in society, using indicators such as education and income, predicts emotional health (depression and anxiety) risk during the pandemic. Furthermore, we examined which classes of SEC indicators would best predict symptoms of emotional disorders.

METHODS

Following PRISMA guidelines, we conducted search over six databases, including Scopus, PubMed, etc., between November 4, 2021 and November 11, 2021 for studies that investigated how SEC indicators predict emotional health risks during Covid-19, after obtaining approval from PROSPERO (ID: CRD42021288508). Using Covidence as the platform, 362 articles (324 cross-sectional/repeated cross-sectional and 38 longitudinal) were included in this review according to the eligibility criteria. We categorized SEC indicators into 'actual versus perceived' and 'static versus fluid' classes to explore their differential effects on emotional health.

RESULTS

Out of the 1479 SEC indicators used in these 362 studies, our results showed that 43.68% of the SEC indicators showed 'expected' results (i.e., higher SEC predicting better emotional health outcomes); 51.86% reported non-significant results and 4.46% reported the reverse. Economic concerns (67.16% expected results) and financial strains (64.16%) emerged as the best predictors while education (26.85%) and living conditions (30.14%) were the worst.

CONCLUSIONS

This review summarizes how different SEC indicators influenced emotional health risks across 98 countries, with a total of 5,677,007 participants, ranging from high to low-income countries. Our findings showed that not all SEC indicators were strongly predictive of emotional health risks. In fact, over half of the SEC indicators studied showed a null effect. We found that perceived and fluid SEC indicators, particularly economic concerns and financial strain could best predict depressive and anxiety symptoms. These findings have implications for policymakers to further understand how different SEC classes affect mental health during a pandemic in order to tackle associated social issues effectively.

Understanding the impacts of COVID-19 pandemic on mental health and well-being among university students in Dhaka, Bangladesh: A nested mixed-methods study

Background

University students are more at risk of mental illness compared with the general population. Declaration of a global COVID-19 pandemic led the Bangladesh government in March 2020 to implement a national lockdown, home quarantining, social distancing measures, and closure of educational institutions. We aimed to explore the impact of lockdown on the mental health and well-being of university students in Bangladesh.

Methods

A nested mixed-methods survey design was undertaken using a semi structured questionnaire and in-depth interviews conducted by telephone of 73 university students (mean age of 22 years, range 18 to 26-years-old) attending public and private academic institutions in Dhaka. A questionnaire was developed de-novo and pre-tested. Qualitative, open-ended questions were used to understand experiences regarding students' mental health and well-being, their perceptions of COVID-19, and coping strategies.

Results

Fifty nine percent of students reported that lockdown had a significant impact on their mental health and well-being. They described difficulties with social isolation and loneliness, motivation, and interpersonal conflict within families. Students' knowledge of COVID-19 were high with television, newspapers, online, and social media were main sources of information; few relied on government reports. Most pressing concerns were timely graduation and employment (83%), not being able to socialize (46%), being stuck at home (37%), and financial difficulties regarding university fees (29%). Additional underlying stressors included financial insecurity of respondents' households and parental health. Coping strategies included watching television or films, online meetings with friends, social media, as well interactions with family.

Conclusion

As a result of Bangladesh's first national lockdown, university students experienced negative effects on their mental health and well-being. There is an urgent need for greater proactive measures within educational settings, such as mental health literacy programmes and diagnosis management that could mitigate and prevent adverse impacts of future lockdowns.

Association of sugar-sweetened beverage consumption and sleep quality with anxiety symptoms: a cross-sectional study of Tibetan college students at high altitude

Background

Research on the association between sugar-sweetened beverages (SSBs) consumption and sleep quality with anxiety symptoms has been highly emphasized. However, past studies have focused on college students in plains areas, while fewer research studies have been conducted on Tibetan college students at high altitudes. Whether this association changes due to ethnicity or altitude is unclear. The present study will contribute to the prevention and intervention of depressive symptoms among Tibetan college students at high altitude.

Methods

A self-assessment questionnaire was administered to 3,026 university students (1,491 boys students, 49.27%) on SSBs consumption, sleep quality and anxiety symptoms status in the Tibetan Plateau, a high-altitude region of China. Logistic regression analysis and ordered logistic regression analysis in generalized linear model were used to analyze the association between SSBs consumption and sleep quality with anxiety symptoms.

Results

The prevalence of anxiety symptoms among Tibetan college students at high altitude was 26.9%. SSBs consumption of ≤1 times/week, 2-5 times/week, and ≥ 6 times/week were 20.7, 28.1, and 45.7%, respectively, with statistically significant differences (χ2 value of 134.353, p < 0.001). Anxiety detection rates for Sleep quality of Good (PSQI ≤5), Moderate (PSQI 6-7), and Poor (PSQI >7) were 16.8, 19.8, and 32.0%, respectively, and the difference was also statistically significant (χ2 value was 73.761, p < 0.001). The ordered logistic regression analysis in the generalized linear model showed that, overall, the group of college students with SSBs ≤1 times/week and sleep quality of Good served as the reference group, and the group with SSBs ≥6 times/week and sleep quality of Poor (OR: 5.06, 95% CI: 3.75-6.83) had the highest risk of anxiety symptoms.

Conclusion

SSBs consumption and sleep quality were associated with anxiety symptoms, and there was an interaction effect. Effective control of SSBs consumption and improvement of sleep quality may be important factors in preventing and reducing the occurrence of anxiety symptoms.

Good performance in difficult times? Threat and challenge as contributors to achievement emotions and academic performance during the COVID-19 outbreak

Introduction

The COVID-19 pandemic has emerged as one of the most formidable global crises, leading to the disruptions to education systems worldwide and impacting learning attitudes and psychological well-being of various learner groups, including university students. In this context, students' appraisals of adverse learning situations play a key role. It is not just the learning situation, but rather students' appraisal of it which impacts their emotions, attitudes, and behaviors in academic context. The aim of the present study was to investigate how university students' challenge and threat appraisals were related to emotional learning experiences and learning outcomes during the COVID-19 pandemic. Furthermore, the study focuses on the role of personal and external resources for learning in this context.

Methods

Altogether, 428 students, who attended a Psychology lecture at one Austrian university, filled in a questionnaire about their challenge and threat appraisals of learning circumstances during the COVID-19 pandemic, achievement emotions they experienced during this time as well as gender, proneness to anxiety, academic self-concept, and learning resources. Additionally, students' performance in the examination was recorded.

Results

The structural equation model emphasizes a crucial role of challenge and threat appraisals for students' achievement emotions in learning and exam preparation during the COVID-19 pandemic. Challenge appraisals were the strongest predictor for pleasant emotions and threat appraisals were strongest predictor for unpleasant emotions. Proneness to anxiety was related to threat appraisal as well as to experience of more unpleasant and, surprisingly, to positive emotions in adverse learning situation. Academic self-concept and learning resources were identified as important resources for learning in adverse learning situation. Unpleasant achievement emotions were directly and negatively related to academic performance and may thus be seen as a critical variable and crucial obstacle to academic performance.

Discussion

The present study provides implications for learning and instructions which could be implemented by universities in order to support learning and learning attitudes among university students in adverse learning situations.

The Effect of a Home-Based Tele-Exercise Training Program on the Quality of Life and Physical Performance in Breast Cancer Survivors

The number of breast cancer (BCa) survivors has been steadily increasing due to advances in anti-cancer treatments, though these individuals suffer from various cancer- and treatment-related long-term side effects. The present study aimed at investigating the effects of a home-based tele-exercise training intervention on physical- and mental health-associated parameters in BCa survivors. A total of 13 female BCa survivors (age: 58.31 ± 3.13 years, BMI: 25.68 ± 0.62 kg/m², waist circumference: 96.54 ± 1.84 cm) participated in a two-month group tele-exercise program twice per week which included aerobic, resistance and flexibility exercises. The results of the study revealed that the tele-exercise intervention improved participants' body mass index (BMI) (p < 0.001), waist circumference (p < 0.001), cardiorespiratory fitness (6 min walk test) (p < 0.001) and muscle function (sit to stand (p < 0.01), sit ups (p < 0.001) and push-ups (p < 0.001)). Beneficial effects were also observed on perceived anxiety (Zung Self-Rating Anxiety Scale) (p < 0.001), post-traumatic stress disorder (PTSD) symptoms (PCL-C) (p < 0.01), self-reported fatigue (p < 0.001), quality of life (QoL) (p < 0.05) and physical (p < 0.05), cognitive (p < 0.01) and emotional (p < 0.05) functioning (EORTQ-QLQ-C30). Our findings suggest that common cancer- and treatment-related adverse effects on physical performance, mental health and the overall QoL can be ameliorated through tele-exercise training programs in BCa survivors.

Anxiety and associated factors among Vietnamese students during COVID-19 pandemic: A cross-sectional study

Mental health care for students in general, particularly anxiety, is a significant problem that needs more attention, especially during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to describe the prevalence of anxiety and examine the associated factors among students during the COVID-19 pandemic in Vietnam. A cross-sectional study was conducted from August to September 2021 among 5730 students. An online survey was used to collect sociodemographic information, and the generalized anxiety disorder questionnaire (GAD-7) was used to assess anxiety symptoms among Vietnamese students. Results showed that the prevalence of anxiety among study participants was 16.2% (95% confidence interval [CI]: 15.3%-17.2%). Factors related to anxiety among students were gender, type of housemate, COVID-19 exposure/infection status, vaccination status, health status, academic performance, and social relationships during the COVID-19 pandemic. A significant number of students experienced anxiety during COVID-19, and this rate was related to several factors. Psychological interventions are required to support students during and after the COVID-19 pandemic and other health crises. Further studies are required to confirm our findings.

Systems thinking on the gendered impacts of COVID-19 in Bangladesh: A systematic review

The COVID-19 pandemic has disproportionately affected women and threatens to overturn four decades of progress in Sustainable Development Goal (SDG) 5: Gender Equality and Women's Empowerment. To better grasp the key areas of concern that gender inequality exists, gender studies and sex-disaggregated evidence are required. Using the PRISMA technique, this review paper is the first attempt to present a comprehensive and current picture of the gendered dimensions of the COVID-19 pandemic in Bangladesh regarding economic well-being, resource endowments, and agency. This study found that women were more likely to face hardship as widows, mothers, or sole breadwinners after the loss of husbands and male household members because of the pandemic. The evidence suggests that the advancement of women during this pandemic was hampered by poor reproductive health outcomes; girls' dropping out of school; job loss; less income; a comparable wage gap; a lack of social security; unpaid work burnout; increased emotional, physical, and sexual abuse; an increase in child marriages; and less participation in leadership and decision-making. Our study found inadequate sex-disaggregated data and gender studies on COVID-19 in Bangladesh. However, our research concludes that policies must account for gender disparities and male and female vulnerability across multiple dimensions to achieve inclusive and effective pandemic prevention and recovery.

COVID-19 related anxiety and its associated factors: a cross-sectional study on older adults in Bangladesh

BACKGROUND

The COVID-19 pandemic has resulted in serious mental health conditions, particularly among older adults. This research explored the prevalence of COVID-19-related anxiety and its associated factors among older adults residing in Bangladesh.

METHODS

This cross-sectional study was conducted among 1,045 older Bangladeshi adults aged ≥ 60 years through telephone interviews in September 2021. A semi-structured interview schedule was used to collect data on participants' characteristics and COVID-19-related anxiety. The anxiety level was measured using the Bengali version of the five-point Coronavirus Anxiety Scale (CAS). A linear regression model explored the factors associated with COVID-19-related anxiety.

RESULTS

Overall, the prevalence of COVID-19-related anxiety was 23.2%. The regression analysis revealed that the average COVID-19-related anxiety score was significantly higher among females (β: 0.43, 95% CI: 0.05 to 0.81), and among those who faced difficulty getting medicine (β: 0.57, 95% CI: 0.16 to 0.97), felt isolated (β: 0.60, 95% CI: 0.24 to 0.95), and felt requiring additional care during the pandemic (β: 0.53, 95% CI: 0.16 to 0.91). Alternatively, the average COVID-19-related anxiety score was significantly lower among those who were widowed (β: -0.46, 95% CI: -0.87 to -0.04) and living distant from the health centre (β: -0.48, 95% CI: -0.79 to -0.17).

CONCLUSION

The findings of the present study suggest providing immediate psychosocial support package to the older adults, particularly females and those who are vulnerable to receive health and social care support during the COVID-19 pandemic in Bangladesh.

COVID-19 Pandemic and Teachers' Classroom Safety Perception, Anxiety and Coping Strategies during Instructional Delivery

Several professionals, including teachers, have been engrossed in fear of the worst happening due to COVID-19 and the rapidly evolving nature of the virus affecting the perception of safety in any working environment. This study examined teachers' perception of classroom safety, anxiety, and coping strategies during instructional delivery in senior high schools in Ghana. Adopting the cross-sectional survey design with a quantitative approach, a convenient sample of 174 senior high school teachers in the Cape Coast Metropolis completed a questionnaire. Data were analyzed using descriptive analysis, analysis of variance, and multiple linear regression. The findings showed that teachers perceived their classroom environment as unsafe during instructional delivery amidst COVID-19 and reported modest to extreme levels of anxiety. Further, teachers with a high level of COVID-19 anxiety were found to utilize active coping strategies to manage stressful situations. The reported unsafe working environment in schools during pandemic times highlights the critical role of supportive working environments for teachers' mental and psychological wellness. School counseling psychologists, school welfare officers, and school health coordinators should collaborate to implement interventions (e.g., social emotional learning; resilience strategies) that promote the wellbeing of teachers and a safe working environment.

COVID-19-Related Knowledge and Anxiety Response among Physical Education Teachers during Practical In-Person Lessons: Effects of Potential Moderators

The COVID-19 pandemic has resulted in heightened anxiety levels among teachers, especially regarding PE teachers who are required to engage students in practical in-person or contact teaching lessons. Previous research showed that these levels of anxiety among PE teachers appeared to be explained by the interplay between COVID-19 knowledge, workplace safety perception, and educational qualification. This study assessed the relationship between COVID-19-related knowledge and anxiety response among PE teachers during such practical lessons while moderating the effects of workplace safety perception and educational qualification within the relationship. The study conveniently recruited 160 PE teachers to solicit responses through both online and printed questionnaires. Using correlation and linear regression analyses, the study revealed a significant negative relationship between COVID-19-related knowledge and anxiety response among PE teachers. The educational qualification of PE teachers did not significantly moderate the association between COVID-19-related knowledge and anxiety response. Workplace safety perception significantly moderated the association between COVID-19-related knowledge and anxiety response among PE teachers. The findings remind educational authorities about the essence of creating a positive and safe working environment conducive to academic work. Achieving this goal requires the provision of adequate COVID-19 management logistics (e.g., personal protective equipment, hand sanitizers) by educational authorities for PE teachers to maintain safety practices and optimal learning conditions.

Generalized anxiety disorder among Bangladeshi university students during COVID-19 pandemic: gender specific findings from a cross-sectional study

In the current COVID-19 pandemic there are reports of deteriorating psychological conditions among university students in lower-middle-income countries (LMICs), but very little is known about the gender differences in the mental health conditions on this population. This study aims to assess generalized anxiety disorder (GAD) among university students using a gender lens during the COVID-19 pandemic. A cross-sectional study was conducted using web-based Google forms between May 2020 and August 2020 among 605 current students of two universities in Bangladesh. Within the total 605 study participants, 59.5% (360) were female. The prevalence of mild to severe anxiety disorder was 61.8% among females and 38.2% among males. In the multivariable logistic regression analysis, females were 2.21 times more likely to have anxiety compared to males [AOR: 2.21; CI 95% (1.28-53.70); p-value: 0.004] and participants' age was negatively associated with increased levels of anxiety (AOR = 0.17; 95% CI = 0.05-0.57; p = 0.001). In addition, participants who were worried about academic delays were more anxious than those who were not worried about it (AOR: 2.82; 95% CI 1.50-5.31, p = 0.001). These findings of this study will add value to the existing limited evidence and strongly advocate in designing gender-specific, low-intensity interventions to ensure comprehensive mental health services for the young adult population of Bangladesh.

Influence of Professional Identity on the E-Learning Adaptability Among Chinese Nursing Students During COVID-19

Background

The traditional face-to-face education methods have been altered to E-learning due to the outbreak, and the E-learning adaptability of nursing students will directly affect the effectiveness of online education. The professional identity of nursing students refers to the positive perception, evaluation, and emotional experience of the nursing profession and identity to be undertaken, which may affect the E-learning adaptability of nursing students during the coronavirus disease 2019 (COVID-19). This study aimed to explore the impact of professional identity on the E-learning adaptability of the Chinese nursing students during COVID-19.

Methods

This study was conducted in three medical schools in Yunnan Province, China from August to October 2020. Data collection consisted of three sections: participants' characteristics, learning adaptability, and professional identity.

Results

A total of 585 nursing students had a moderate level of E-learning adaptability. There was a positive correlation between E-learning adaptability and professional identity (r = 0.316~0.505, p &lt; 0.001). In addition, the professional identity was associated with predictors of the E-learning adaptability among nursing students (p &lt; 0.001).

Conclusion

There was a moderate level of E-learning adaptability among the Chinese nursing students during the COVID-19 crisis. Enhancing the professional identity is critical in improving the E-learning adaptability among nursing students.

Scaling the changes in lifestyle, attitude, and behavioral patterns among COVID-19 vaccinated people: insights from Bangladesh

With the advent of COVID-19 vaccines, countries around the globe are anticipating a way out from the pandemic. Despite being an initiative to contain the COVID-19 virus spreading, the mass vaccination program also raised concerns about its consequences on the lifestyle, attitude, and behavioral pattern of vaccinated people in the post-vaccination period. With this in mind, this study investigated changes in lifestyle, attitude, and behavior among vaccinated people in Bangladesh. A cross-sectional survey was conducted incorporating 1227 COVID-19 vaccinated respondents from eight divisions of Bangladesh. The relative importance index (RII) was used to assess the most compelling lifestyle, attitude, and behavior changes, while binary logistic regression was used to identify factors driving the changes. Findings disclosed that respondents increased the physical contact with non-vaccinated ones and amplified consuming nutritious food after vaccination. The inclination of avoiding distance, handshaking, abandoning sanitizer and mask, visiting crowded places, traveling, and staying outside longer was found to be increased among vaccinated individuals. Surprisingly, about seven out of ten surveyed respondents exhibited a sedentary lifestyle, while 67.37% of respondents showed negative behavioral changes following the vaccination period. A positive attitude was observed in encouraging others to be vaccinated against COVID-19. However, 92% of the respondents positively changed their attitude toward the COVID-19 vaccine after vaccination. Furthermore, the participants’ age, residence, economic status, and educational level influenced lifestyle, attitude, and behavioral changes positively. The study recommends informing citizens about the opacity of vaccinations’ ability to contain infections and encouraging them to continue following COVID-19 protective guidelines.

Perceived Safety of Learning Environment and Associated Anxiety Factors during COVID-19 in Ghana: Evidence from Physical Education Practical-Oriented Program

The outbreak of COVID-19 led to the swift migration to alternate instructional delivery models and pedagogical practices in educational institutions. This study examined the perceived safety of the learning environment and associated anxiety factors among physical education students amidst COVID-19. Using a cross-sectional design, a sample of 638 students drawn purposively and conveniently from a public university in Ghana completed a self-developed questionnaire. Frequency counts, percentages, and ordered logistic regression were used to analyze the data. Findings of the study showed that students perceived the practical lesson environment as unsafe, with self-reported moderate to high levels of anxiety during their practical lessons. The ordered logistic regression results revealed that varied factors such as age, COVID-19 information platforms, certainty about personal safety, and adequacy of preparation to manage COVID-19 cases were associated with anxiety. The study concluded that an unsafe practical physical education learning environment increases the anxiety levels of students. Academic departments/units should provide periodic interventions (e.g., positive self-talk, mental rehearsal, cognitive restructuring) and counseling services for students amidst the ongoing pandemic to help moderate situational-specific anxiety. In addition, key to the management of students' anxiety is the provision of a safe and supportive school environment, including the provision of adequate personal protective equipment for practical lessons by school authorities.

Teaching during a pandemic: do university teachers prefer online teaching?

Universities worldwide have been conducting e-learning during the COVID-19 pandemic to continue education irrespective of faculties are familiar with e-education or not. This study assessed perception and preference for e-teaching amongst 438 faculty members. Results revealed that around half of teachers were conducting e-classes without any training, and they also had conducted examinations using online platforms. Teachers perceived e-teaching as effective during the pandemic, time-efficient, easy to share materials, unsuitable for monitoring or conducting practical classes and less effective for evaluation. More than three-fourths of the teachers preferred online teaching during the pandemic, and most preferred both physical and mixed teaching in the post-pandemic era. Their preferences were influenced by their age, teaching experience, academic discipline, current residency, training on online teaching, hours of online classes taught per week, internet connection used, types of classes and whether they had given online examinations. The major challenges in online teaching during COVID-19 were difficulty in practical work, difficulty in monitoring students and insufficient feedback. This study suggests online teaching during the pandemic and mixed teaching after the pandemic. Training faculty members on online teaching, designing e-platforms suitable for examinations and ensuring stable internet connections are also recommended for effective and smooth e-education.