A systematic review and meta-analysis of long term physical and mental sequelae of COVID-19 pandemic: call for research priority and action

Awe reduces depressive symptoms and improves well-being in a randomized-controlled clinical trial

Emerging evidence suggests that experiences of awe benefit health and well-being. The present investigation examined the efficacy of an awe intervention to improve the psychological health-stress, anxiety, depression, and well-being-of patients living with long COVID. The awe intervention, a Randomized-controlled Clinical Trial, was delivered in synchronous online sessions to patients, across the United States (in April 2023), who met the criteria for long COVID. Results revealed significant improvements in psychological health for those in the awe intervention (N = 30), compared to the control group (N = 38): including decreased stress, decreased depression symptoms, and increased well-being. There were no significant differences between groups in anxiety symptoms. Effect sizes ranged from medium to large (d = 0.78-0.96), demonstrating the robustness of these findings. This work is the first to document that awe can have salutary effects on psychological health, such as reducing symptoms of depression. These findings suggest that a brief awe intervention can improve psychological health in people dealing with chronic stress and physical ailments, as in the case of long COVID.Trial registration. The trial is registered at ClinicalTrials.gov (NCT05676008, 09/01/2023).

A simulation-based network analysis of intervention targets for comorbid symptoms of depression and anxiety in Chinese healthcare workers in the post-dynamic zero-COVID policy era

BACKGROUND

After the official end of the dynamic zero-COVID policy in China, healthcare workers continued to heavy workloads and psychological stress. In this new phase, concerns related to work and family, rather than infection, may have become new sources of psychological issues such as depression and anxiety among healthcare workers, leading to new patterns of comorbidity. However, few studies have addressed these issues. To fill this gap, this study used network analysis to examine new features and mechanisms of comorbidity between depression and anxiety symptoms, and simulated symptom-specific interventions to identify effective targets for intervention.

METHODS

A total of 708 Chinese healthcare workers (71.2% females; Age: M = 37.55, SD = 9.37) were recruited and completed the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). This study first calculated the incidence rates of anxiety, depression, and their comorbidity, and then constructed the comorbid Ising network. Central and bridge symptoms were identified with expected influence (EI) and bridge EI, respectively. The NodeIdentifyR algorithm (NIRA) was then used to simulate interventions within the network, examining the effects of alleviating or aggravating specific symptoms on the network's severity.

RESULTS

48.2% of Chinese healthcare workers reported experiencing depression (19.8%), anxiety (11.7%), or both (16.2%). In the anxiety-depression network, "guilt" and "appetite changes" were identified as the central symptoms, and "guilt" and "excessive worry" were identified as the bridge symptoms. Simulated interventions suggested that alleviating "Anhedonia" can the most reduce the overall severity of the network, while aggravating "guilt" can the most increase the overall severity. These two symptoms were considered the key target for treatment and prevention, respectively.

CONCLUSIONS

Chinese healthcare workers still face high risk of depression, anxiety, and comorbidity in the post-dynamic zero-COVID policy era. Our findings highlight the key roles of guilt, appetite changes, and excessive worry in the network of depression and anxiety symptoms. Future research should apply the results of the simulated interventions, develop intervention strategies targeting anhedonia, and focus on preventing guilt to improve the healthcare workers' mental health.

TRIAL REGISTRATION

Not applicable.

Longitudinal Assessment of Pulmonary Involvement and Prognosis in Different Subtypes of COVID-19 Patients After One Year Using Low-Dose CT: A Prospective Observational Study

RATIONALE AND OBJECTIVES

Severe COVID-19 typically results in pulmonary sequelae. However, current research lacks clarity on the differences in these sequelae among various clinical subtypes. This study aimed to evaluate the changing lung imaging features and predictive factors in patients with COVID-19 pneumonia in northern China over a 12-month follow-up period after the relaxation of COVID-19 restrictions in 2022.

MATERIALS AND METHODS

Imaging and clinically relevant data from three groups (moderate, severe, and critical) of patients with varying severity were prospectively analyzed. Low-dose CT scans were conducted at 3, 6, and 12 months after discharge, with chest CT images evaluated at baseline and each follow-up using qualitative and quantitative analyses. Clinical symptoms and pulmonary function recovery at 12 months were documented. The correlation between lung function and CT results was analyzed. Univariate and multivariable logistic regression analyses were employed to examine factors influencing prognosis, while a post-hoc analysis model was utilized to investigate the relationships among different groups, time points, and chest CT findings.

RESULTS

Among the 103 hospitalized patients with COVID-19 pneumonia, 64 completed the 12-month evaluation. The median age was 63.70 ± 12.15%, and 62.5% (40/64) were men. During the follow-up period, while 67.19% (43/64) showed abnormalities, including fibrotic changes in 9.38% (6/64). Multivariable logistic regression identified age ≥ 65 (OR: 8.66; 95% CI: 1.86, 40.34; P = 0.006), length of hospital stays (OR: 1.23; 95% CI: 1.03, 1.47; P = 0.022), and baseline consolidation volume as a percentage of the whole lung (OR: 56.95; 95% CI: 1.198, 2706.782; P = 0.04) as independent risk factors for persistent CT lung abnormalities at 1 year. After 1 year, 34.38% (22/64) of patients still had abnormal lung function, and 9.38% (6/64) had pulmonary fibrosis and restrictive ventilatory dysfunction. The relationship between lung function and CT findings is weak correlation. The mixed model analysis revealed significant differences between groups, particularly between the moderate and severe groups, and significant changes in CT values over time.

CONCLUSION

One year after infection, more than one third of even moderate patients with mild symptoms had persistent pulmonary abnormalities. In our study, fibrotic changes were seen in severe and critically ill patients and remained stable 6 months after discharge from hospital. Imaging parameters can predict the prognosis. The larger the extent of baseline consolidation, the worse the prognosis of elderly patients.

Neuropsychology practice guidance for the neuropsychiatric aspects of Long COVID

Objective: The coronavirus disease-2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has had a profound global impact on individual health and well-being in adults and children. While most fully recover from COVID-19, a relatively large subgroup continues to experience persistent physical, cognitive, and emotional/behavioral symptoms beyond the initial infection period. The World Health Organization has termed this phenomenon "Post-COVID-19 Condition" (PCC), better known as "Long COVID." Due to the cognitive and psychosocial symptoms, neuropsychologists often assess and recommend treatment for individuals with Long COVID. However, guidance for neuropsychologists' involvement in clinical care, policy-making, and research has not yet been developed. The authors of this manuscript convened to address this critical gap and develop guidance for clinical neuropsychologists working with patients presenting with Long COVID. Method: Authors include pediatric and adult neuropsychologists with expertise in Long COVID and behavioral health. All authors have been engaged in clinical and research efforts examining the impact of COVID-19. Authors summarized the literature-to-date pertinent to the neuropsychiatric sequelae of Long COVID and developed guidance for neuropsychologists working with individuals with Long COVID. Conclusions: Research findings regarding neuropsychiatric symptoms associated with Long COVID are mixed and limited by methodological differences. As they practice and conduct research, neuropsychologists should remain mindful of the evolving and tenuous nature of the literature.

Optimization of the preparation method of inactivated intact virus particle vaccine for COVID-19

It has been recognized that it is difficult to maintain the virus particle structure of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may be associated with lower immunogenicity of inactivated vaccines against coronavirus disease 2019 (COVID-19). We have previously demonstrated that an intact structure of the virus particles is critical for influenza inactivated whole virus particle vaccine (WPV) to be immunogenically potent. Here, we tested 37, 35, 33, and 31 °C for the virus propagation temperatures and the timing of formaldehyde treatment of the virus before and after centrifugation-based purification to obtain virus particles with an intact structure. Virus particles cultured at 33 °C retained spike proteins on the surface the most abundantly. The pretreatment of the virus with formaldehyde prevented the dissociation of the spike proteins from the viral surface during the centrifugation-based purification. The immunogenicity of the prepared vaccines, intact WPV and non-intact WPV that had lost the spike proteins, was evaluated in a mouse model. A single dose of intact WPV effectively induced humoral immunity compared to non-intact WPV, as indicated by higher titers of neutralizing antibodies. After a virus challenge, the mice vaccinated with a single dose of inactivated intact WPV showed less severe weight loss and lower virus titers in the lungs compared to those vaccinated with non-intact WPV. These results demonstrate the importance of the structural integrity of WPV in inducing effective and protective immunity, and provide significant insight into the development of COVID-19 WPV for practical use.

A biopsychosocial analysis of risk factors for persistent physical, cognitive, and psychological symptoms among previously hospitalized post-COVID-19 patients

A significant number of COVID-19 survivors continue to experience persistent physical, cognitive, and psychological symptoms up to one year after discharge. This study aimed to examine the frequency, severity, and progression of and risk factors for these symptoms. This single-centre retrospective cohort study included 126 COVID-19 patients admitted to the VieCuri Medical Centre between 2020 and 2022. Follow-up assessments were conducted at 3 and 12 months postdischarge, including pulmonary function tests, CT scans, bioimpedance analysis, and questionnaires on physical, cognitive, and psychological symptoms. At both follow-up assessments, 31-32% of patients reported moderate to severe physical symptoms, 26-27% reported multiple cognitive symptoms, and 14-18% experienced depressive or posttraumatic stress symptoms (PTSSs). Only anxiety symptoms significantly decreased between the 3-month follow-up and the 12-month follow-up (from 22 to 12%; p = .014). The persistence of symptoms at 12 months was significantly associated with premorbid conditions (chronic respiratory disease, multiple comorbidities), illness severity (infection during the third wave), physical factors (COVID-19-related pulmonary abnormalities, lower total lung capacity, and dyspnoea), and cognitive and psychological factors (cognitive symptoms, anxiety, depression, and PTSS) (p < .05). These findings suggest that a significant proportion of COVID-19 survivors continue to experience persistent symptoms due to biopsychosocial factors, thus emphasizing the need for a biopsychosocial approach in early screening and treatment.

The experience and influence of youth in China in coping with stressful life events during the post-COVID-19 pandemic era: a qualitative study

BACKGROUND

The COVID-19 pandemic has had a profound effect on the mental well-being of individuals, particularly among the youth. The experience of stressful life events has been linked to increased poor mental health. While the immediate effects have been documented, there is evidence to suggest that the pandemic's impact on mental health could persist in the long run. Additionally, the pandemic has influenced coping strategies and forms of social support.

METHODS

A phenomenological descriptive study was conducted to elucidate the changes in strategies adopted by youth to cope with stressful life events during the COVID-19 era. Thirty-three Chinese youths aged 15 to 24 years who have experienced regular COVID-19 pandemic prevention and control were invited to complete a semi-structured interview. Colaizzi's method was used to analyze the data. Triangulation was adopted to ensure the validity.

RESULTS

Four key themes were generated, including (1) negative changes in mental health, (2) positive changes in mental health, (3) changes in the adoption of coping strategies, and (4) the utilization of internet-based coping strategies.

CONCLUSIONS

The results could guide the development of interventions to help the youth cope with stressful life events and further promote mental health among this population.

TRIAL REGISTRATION

This study has prospectively been registered on the Chinese Clinical Trial Registry (ID: ChiCTR2200060894) on 14/06/2022.

Construction of an evaluation index system for hospital resilience to emerging infectious diseases: a Delphi study from China

BACKGROUND

The frequent outbreak of infectious diseases has presented unparalleled challenges to hospitals globally. The pressure exerted on healthcare systems during these crises accentuates the imperative need for enhanced management and resource allocation, further emphasizing the pivotal role of hospital resilience. As the vanguard in combating infectious disease outbreaks, bolstering hospital resilience has become a strategic imperative to fortify healthcare systems against the unpredictable and volatile landscape of global health threats. Consequently, in this study, we aimed to develop an index system for the comprehensive evaluation of hospital resilience in response to emerging infectious diseases.

METHODS

Drawing on the World Health Organization "Action Framework" for responding to infectious disease outbreaks, the Delphi method was implemented to identify the core evaluation index of hospital resilience in the context of emerging infectious diseases. In this method, we assembled a panel of 16 health experts specializing in medical statistics, infectious disease prevention and control, emergency medicine, hospital management, and public health administration. The panel evaluated the importance of the proposed indicators using a five-point Likert scale, supplemented by their qualitative feedback. To ascertain the weights of these indicators, the Analytic Hierarchy Process and the Precedence Chart were integrated.

RESULTS

After two rounds of expert consultation on the evaluation index system, a consensus was reached. The system contained five first-level indicators (hospital command and coordination capacity, hospital monitoring capacity, hospital risk communication capacity, hospital medical response capacity, and hospital health management capacity) affiliated with 13 second-level indicators and 32 third-level indicators. Among the primary indicators, hospital command and coordination capacity had the highest weight, followed by hospital medical response capacity. The expert authority coefficient of consultation was 0.96. The Kendall's concordance coefficients of the total indicators were 0.223 and 0.342, respectively. The differences were statistically significant (P < 0.05).

CONCLUSION

The evaluation index system for hospital resilience to emerging infectious diseases, developed using the Delphi method in this study, is comprehensive and possesses high scientific reliability. The widespread application of this index system can assist hospitals in identifying and ameliorating weaknesses in their resilience capabilities, thereby enhancing their rapid response and adaptability to potential future outbreaks.

A patient-centered view of symptoms, functional impact, and priorities in post-COVID-19 syndrome: cross-sectional results from the Québec Action Post-COVID cohort

BACKGROUND

Health services planning and mechanism-focused research would benefit from a clearer picture of symptoms, impact, and personal priorities in post-COVID-19 syndrome (PCS). This study aimed to provide estimates of the symptom, function, and quality of life (QOL) impact of PCS.

METHODS

People living in Quebec, aged ≥ 18, were eligible for the Québec Action for/pour le Post-COVID (QAPC) study if they had symptoms lasting more than 4 weeks post-acute SARS-CoV-2 infection, with or without a positive COVID-19 test. Recruitment was through conventional and social media between September 2022 and December, 31, 2023. Standardized and individualized questionnaires, in French or English, were accessed through an online portal. We report cross-sectional results from the baseline visit.

RESULTS

Individuals (n=535) spontaneously reported symptoms attributable to an average of 4.5 organ systems. Fatigue was most frequent. Effects on function and quality of life were moderate to severe and had already persisted for a year or more in the majority. Personal intervention priorities included fatigue and post-exercise malaise (PEM), cognitive symptoms, shortness of breath, and impaired taste and smell. Except for PEM, women and men did not differ importantly on measures of PCS impact, while older age was associated with lower impact.

CONCLUSION

Symptom clusters defined a range of severity, with fatigue a pervasive symptom at all levels of severity. Participants in this study are likely to be representative of those seeking health care for post-COVID-19 symptoms in Canada and the results can inform next steps for clinical, research, and health services planning.

Psychotherapies and psychological support for individuals facing psychological distress during the COVID-19 pandemic: A scoping review

In this scoping review, we investigated the psychotherapies and psychological support provided during the coronavirus disease 2019 (COVID-19) pandemic to clarify its recipients and the methods employed, among other characteristics. We used Scopus and PubMed as the two search engines and employed the following search terms: "COVID*" AND ("psychotherap*" OR "psychological support*") AND "psychological distress*." The first search was conducted on October 18, 2022, by reviewing search engines and conducting a manual search. It yielded 154 articles, of which 18 finally met the eligibility criteria after the second round of screening. The distribution of the participants in the intervention studies included in this review was diverse, including the general population, patients with COVID-19, and patients who had recovered from COVID-19. The implementation of psychotherapy was not limited to more advanced countries in psychiatry, indicating the broader reach of these interventions. Psychotherapy includes various methods, including cognitive behavioral therapy, acceptance commitment therapy, mindfulness, supportive care, virtual reality therapy, and online educational content via apps. The rise of new technologies may have increased the replacement rate of human therapists. In addition, the use of remote interventions was more common than that of face-to-face interventions. It is necessary to monitor whether the technologies and methods used for the first time during the pandemic will continue to be used in the future. Therefore, further research is needed to compare the effectiveness of remote randomized controlled trials with conventional face-to-face randomized controlled trials. Finally, most of those providing psychotherapies and psychological support in the studies included in this review were not doctors or psychologists.

COVID-19 Pandemic-Related Exposures and Cognitive Function in Middle-Aged Women

Importance

The COVID-19 pandemic has been associated with risk factors for cognitive decline, such as bereavement and SARS-CoV-2 infection.

Objective

To examine whether the COVID-19 pandemic and pandemic-related exposures are associated with cognitive function among middle-aged women.

Design, Setting, and Participants

This cohort study analyzed data from the Nurses' Health Study II, an ongoing study of registered nurses in the US. The present study focused on women aged 51 to 76 years who completed 2 to 8 objective cognitive assessments both prior to (October 1, 2014, to February 29, 2020) and during the COVID-19 pandemic (March 1, 2020, to September 30, 2022). Statistical analyses were performed from January 2023 to January 2025.

Exposure

COVID-19 pandemic.

Main Outcomes and Measures

Two standardized (ie, z-scored) composite cognitive scores (psychomotor speed and attention, learning and working memory) and a global score constituted the primary outcomes. Higher scores indicated better cognitive function. Cognitive function was assessed using the Cogstate Brief Battery, a computer-administered cognitive test battery. Participants completed cognitive assessments every 6 to 12 months.

Results

A total of 5191 women (mean [SD] age at first cognitive assessment, 63.0 [4.8] years) completed both prepandemic and during-pandemic measures, contributing 23 678 cognitive assessments. After adjustment for age at cognitive assessment, educational level for both participants and their parents, cognitive test practice effects, and comorbidities (eg, diabetes, hypertension), no difference in cognitive function was observed between assessments taken during vs before the pandemic (psychomotor speed and attention: β = -0.01 SD [95% CI, -0.05 to 0.02 SD]; learning and working memory: β = 0.00 SD [95% CI, -0.03 to 0.03 SD]; global score: β = 0.00 SD [95% CI, -0.03 to 0.02 SD]). Among 4456 participants who responded to the COVID-19 substudy (ie, surveys about pandemic-related events), those with a history of SARS-CoV-2 infection (164 [3.7%]) or post-COVID-19 conditions (PCC; 62 [1.4%]), at a median (IQR) 20.0 (18.5-22.1) months after initial infection, had reduced cognitive function compared with women without infection or PCC; however, these differences did not reach statistical significance, and the wide CIs suggested considerable uncertainty.

Conclusions and Relevance

This cohort study of middle-aged women found that the COVID-19 pandemic and pandemic-related events were not associated with cognitive decline up to 2.5 years after the onset of the pandemic. Future studies are needed to examine the long-term implications of SARS-CoV-2 infection and PCC for cognitive function.

Cognitive reserve moderates the effect of COVID-19 on cognition: A systematic review and meta-analysis of individual participant data

Elucidating the factors that mitigate the effects of COVID-19 on cognitive function offers important insights for public health policy and intervention. This systematic review and individual participant data (IPD) meta-analysis assesses cognitive reserve (CR) as a potential moderator of post-COVID-19 cognitive dysfunction (PCCD). Under PRISMA-IPD guidelines, data searches were conducted via PubMed, PsycINFO, Scopus, and Embase, up to January 2023. Eligible studies included at least one cognitive assessment, CR proxy, and disease severity indicator. Of 5604 studies, 87 were eligible (10,950 COVID-19 cases; 78,305 controls), and IPD was obtained for 29 datasets (3919 COVID-19 cases; 8267 controls). Three-level random-effects meta-analyses indicated that CR had a moderate positive association (rsp =.29), and COVID-19 severity had a small negative association (rsp = -.07) with cognitive outcomes. These effects were moderated by a significant within-study interaction. Cognitive deficits following COVID-19 were 33 % smaller among high CR individuals, and 33 % greater among low CR individuals, relative to those with average CR. Population-based initiatives promoting reserve-building behaviors may alleviate the PCCD-related public health burden. REVIEW REGISTRATION: PROSPERO registration number: CRD42022360670.

Socio-demographic environmental and clinical factors influencing asthma control in community pharmacies of Lahore Pakistan

Asthma is a significant non-communicable disease affecting over 300 million people worldwide. This study aimed to evaluate the influence of socio-demographic, environmental, and clinical factors on asthma control among patients visiting community pharmacies in Lahore, Pakistan. A multicenter prospective observational study was conducted with 284 participants using a validated data collection tool. Data included demographics and potential confounders such as smoking, obesity, co-morbidities (e.g., allergic rhinitis, gastroesophageal reflux disease [GERD]), and adherence to treatment. Asthma control was classified into full, partial, and uncontrolled levels based on established guidelines. Statistical analyses, including chi-square tests and logistic regression, were performed to identify significant predictors. The results indicated that 53.5% of participants were female, 74.6% were aged above 40 years, and 42.3% were obese. A family history of asthma was reported in 55.6% of participants, while smoking was prevalent in 77.1%. Clinical co-morbidities, such as allergic rhinitis (49.3%) and GERD (50.7%), were notable. Participants who adhered to treatment (62.3%) and engaged in daily exercise (59.5%) exhibited significantly better asthma control. Multivariate analysis revealed that higher education, rural residence, and the absence of obesity were positively associated with asthma control, whereas passive smoking and prolonged asthma history had a negative impact. This study underscores the multifaceted nature of asthma management and the importance of addressing socio-demographic, environmental, and clinical factors. Improved asthma outcomes require targeted interventions, including promoting adherence to treatment plans, encouraging physical activity, and minimizing exposure to smoking and environmental allergens. The findings highlight the need for community-centered strategies to enhance asthma control and reduce its public health burden, particularly in middle-income countries like Pakistan.

Serotonergic psychedelics as potential therapeutics for post-COVID-19 syndrome (or Long COVID): A comprehensive review

RATIONALE

In our ongoing battle against the coronavirus 2019 (COVID-19) pandemic, a major challenge is the enduring symptoms that continue after acute infection. Also known as Long COVID, post-COVID-19 syndrome (PCS) often comes with debilitating symptoms like fatigue, disordered sleep, olfactory dysfunction, and cognitive issues ("brain fog"). Currently, there are no approved treatments for PCS. Recent research has uncovered that the severity of PCS is inversely linked to circulating serotonin levels, highlighting the potential of serotonin-modulating therapeutics for PCS. Therefore, we propose that serotonergic psychedelics, acting mainly via the 5-HT2A serotonin receptor, hold promise for treating PCS.

OBJECTIVES

Our review aims to elucidate potential mechanisms by which serotonergic psychedelics may alleviate the symptoms of PCS.

RESULTS

Potential mechanisms through which serotonergic psychedelics may alleviate PCS symptoms are discussed, with emphasis on their effects on inflammation, neuroplasticity, and gastrointestinal function. Additionally, this review explores the potential of serotonergic psychedelics in mitigating endothelial dysfunction, a pivotal aspect of PCS pathophysiology implicated in organ dysfunction. This review also examines the potential role of serotonergic psychedelics in alleviating specific PCS symptoms, which include olfactory dysfunction, cognitive impairment, sleep disturbances, and mental health challenges.

CONCLUSIONS

Emerging evidence suggests that serotonergic psychedelics may alleviate PCS symptoms. However, further high-quality research is needed to thoroughly assess their safety and efficacy in treating patients with PCS.

Neuropsychiatric sequelae in an experimental model of post-COVID syndrome in mice

The global impact of the COVID-19 pandemic has been unprecedented, and presently, the world is facing a new challenge known as post-COVID syndrome (PCS). Current estimates suggest that more than 100 million people are grappling with PCS, encompassing several manifestations, including pulmonary, musculoskeletal, metabolic, and neuropsychiatric sequelae (cognitive and behavioral). The mechanisms underlying PCS remain unclear. The present study aimed to: (i) comprehensively characterize the acute effects of pulmonary inoculation of the betacoronavirus MHV-A59 in immunocompetent mice at clinical, cellular, and molecular levels; (ii) examine potential acute and long-term pulmonary, musculoskeletal, and neuropsychiatric sequelae induced by the betacoronavirus MHV-A59; and to (iii) assess sex-specific differences. Male and female C57Bl/6 mice were initially inoculated with varying viral titers (3x103 to 3x105 PFU/30 μL) of the betacoronavirus MHV-A59 via the intranasal route to define the highest inoculum capable of inducing disease without causing mortality. Further experiments were conducted with the 3x104 PFU inoculum. Mice exhibited an altered neutrophil/lymphocyte ratio in the blood in the 2nd and 5th day post-infection (dpi). Marked lung lesions were characterized by hyperplasia of the alveolar walls, infiltration of polymorphonuclear leukocytes (PMN) and mononuclear leukocytes, hemorrhage, increased concentrations of CCL2, CCL3, CCL5, and CXCL1 chemokines, as well as high viral titers until the 5th dpi. While these lung inflammatory signs resolved, other manifestations were observed up to the 60 dpi, including mild brain lesions with gliosis and hyperemic blood vessels, neuromuscular dysfunctions, anhedonic-like behavior, deficits in spatial working memory, and short-term aversive memory. These musculoskeletal and neuropsychiatric complications were exclusive to female mice and prevented after ovariectomy. In summary, our study describes for the first time a novel sex-dependent model of PCS focused on neuropsychiatric and musculoskeletal disorders. This model provides a unique platform for future investigations regarding the effects of acute therapeutic interventions on the long-term sequelae unleashed by betacoronavirus infection.

Clinical characterization of acute COVID-19 and Post-COVID-19 Conditions 3 months following infection: A cohort study among Indigenous adults and children in the Southwestern United States

Long-term effects of COVID-19 on multiple organ systems have been reported. Indigenous persons experienced disproportionate morbidity and mortality from COVID-19; however, Post-COVID-19 Conditions (PCC) have not been well described in this population. We conducted a longitudinal cohort study among Indigenous persons living in the Navajo Nation or White Mountain Apache Tribal lands in the Southwest United States who tested positive for SARS-CoV-2 between February 1, 2021 and August 31, 2022. Participants were enrolled during their acute illness and followed for three months. PCC was defined as the presence of any self-reported symptom and/or any sequelae or new condition recorded in the electronic health record at the 3-month visit. Risk factors for PCC were evaluated using Poisson regression with robust standard errors. The analysis included 258 adults and 84 children. Most participants (98.4% of adults, 90.5% of children) experienced a mild, symptomatic acute illness. Over half of adults (57.8%) and a third (39.3%) of children experienced six or more symptoms during the acute illness. Three months post-acute COVID-19, 39.8% of adults and 15.9% of children had symptoms consistent with PCC. Commonly reported symptoms were fatigue/tiredness, cough, headache, runny nose, and myalgia. Among adults enrolled during Omicron predominance, older age and hospitalization for COVID-19 were significantly associated with an increased risk of PCC, and COVID-19 vaccination was significantly associated with a decreased risk of PCC in univariable analysis. In a multivariable analysis, COVID-19 vaccination (risk ratio: 0.56; 95% confidence interval: 0.34, 0.90) remained significantly associated with a decreased risk of PCC. In this cohort of Indigenous persons in the Southwest US, PCC at three months post-acute COVID-19 illness were common, including among individuals with mild acute illness. While the absence of a control group is a limitation, these findings highlight the potential ongoing healthcare needs related to PCC in Indigenous populations.

Global prevalence of post-COVID-19 condition: a systematic review and meta-analysis of prospective evidence

INTRODUCTION

We investigated the prevalence of new or persistent manifestations experienced by COVID-19 survivors at 3 or more months after their initial infection, collectively known as post-COVID-19 condition (PCC).

METHODS

We searched four electronic databases and major grey literature resources for prospective studies, systematic reviews, authoritative reports and population surveys. A random-effects meta-analysis pooled the prevalence data of 22 symptoms and outcomes. The GRADE approach was used to assess the certainty of evidence. PROSPERO CRD42021231476.

RESULTS

Of 20 731 identified references, 194 met our inclusion criteria. These studies followed 483 531 individuals with confirmed COVID-19 diagnosis over periods of up to 2 years. Most focused on adults, nearly two-thirds were conducted in Europe and 63% were of high or moderate quality. The supplementary search identified 17 systematic reviews, five authoritative reports and four population surveys that reported on PCC prevalence. Our analysis revealed that more than half of COVID-19 survivors experienced one or more symptoms more than a year after their initial infection. The most common symptoms were fatiguedyspneamemory, sleep or concentration disturbances; depressionand pain. Limitation in returning to work was the most common outcome. Prevalence tended to be higher among females, individuals hospitalized during their initial infection and those who experienced severe COVID-19 illness.

CONCLUSION

PCC presents a significant health burden, affecting some groups more than others. This information will help inform health care system policies and services for people living with PCC and those caring for them.

Psychotherapy in patients with long/post-COVID - A systematic review on the feasibility, acceptability, safety, and efficacy of available and emerging interventions

BACKGROUNDS

There is an urgent need for effective treatments for patients with long/post-COVID. Current recommendations for management favor a multimodal approach including psychotherapy and emphasize that interventions should also consider the mental health impact of living with long/post-COVID. This systematic review synthesizes psychotherapeutic interventions that currently target long/post-COVID complaints and summarizes data on the feasibility, acceptability, safety, and efficacy of psychotherapy for patients with long/post-COVID.

METHODS

This systematic review was conducted according to the PRISMA statement. Studies were retrieved from three databases (PubMed, PsycInfo, Web of Science) and independently assessed by two raters. Studies investigating patients of any age suffering from long/post-COVID were included if the intervention involved psychotherapeutic treatment and changes in long/post-COVID symptoms were reported. The review has been pre-registered on PROSPERO.

RESULTS

A total of 12 studies were included in the analysis. Of these, 10 were multimodal approaches with integrated psychotherapeutic interventions, and two were studies on stand-alone psychotherapy. The majority of studies were uncontrolled and demonstrate pre-post improvements in a range of long/post-COVID symptoms. Only one RCT could be identified, which supports the benefit of CBT for COVID-related fatigue. It was not possible to draw general conclusions regarding the efficacy of psychotherapy for long/post-COVID. However, data on feasibility, acceptability, and safety support the potential of psychotherapy as a treatment approach for long/post-COVID.

CONCLUSION

Future studies investigating the potential of psychotherapy approach for long/post-COVID which go beyond the pilot stage are needed to systematically assess feasibility, acceptability, safety, and efficacy in large-scale confirmatory trials.

Cognitive Sequelae of COVID-19: Mechanistic Insights and Therapeutic Approaches

BACKGROUND

The COVID-19 pandemic has left an indelible mark on the world, with mounting evidence suggesting that it not only posed acute challenges to global healthcare systems but has also unveiled a complex array of long-term consequences, particularly cognitive impairment (CI). As the persistence of post-COVID-19 neurological syndrome could evolve into the next public health crisis, it is imperative to gain a better understanding of the intricate pathophysiology of CI in COVID-19 patients and viable treatment strategies.

METHODS

This comprehensive review explores the pathophysiology and management of cognitive impairment across the phases of COVID-19, from acute infection to Long-COVID, by synthesizing findings from clinical, preclinical, and mechanistic studies to identify key contributors to CI, as well as current therapeutic approaches.

RESULTS

Key mechanisms contributing to CI include persistent neuroinflammation, cerebrovascular complications, direct neuronal injury, activation of the kynurenine pathway, and psychological distress. Both pharmacological interventions, such as anti-inflammatory therapies and agents targeting neuroinflammatory pathways, and non-pharmacological strategies, including cognitive rehabilitation, show promise in addressing these challenges. Although much of the current evidence is derived from preclinical and animal studies, these findings provide foundational insights into potential treatment approaches.

CONCLUSION

By synthesizing current knowledge, this review highlights the importance of addressing COVID-19-related cognitive impairment and offers actionable insights for mitigation and recovery as the global community continues to grapple with the pandemic's long-term impact.

Unveiling causal relationships between addiction phenotypes and inflammatory cytokines: insights from bidirectional mendelian randomization and bibliometric analysis

Observational studies have suggested associations between multiple inflammatory factors and tobacco and alcohol use, but establishing causation is challenging in epidemiological investigations. We employed genetic association data about the circulating levels of 41 cytokines obtained from the genome-wide association study (GWAS), which contained 8293 Finnish participants. Genetic data on 5 substance use phenotypes were obtained from the GWAS dataset containing 1.2 million European subjects. Then, we conducted a bidirectional mendelian randomization (MR) study. The forward results indicated that smoking cessation was positively correlated with hepatocyte growth factor (HGF), interleukin-10 (IL-10), and stem cell factor (SCF); cigarettes per day was a risk factor associated with high expression in stromal cell-derived factor 1α (SDF-1 A), interferon-γ (IFN-G), IL-4, and granulocyte colony-stimulating factor (G-CSF); drinks per week and smoking initiation were risk factors respectively correlated with reduced HGF and IL-2RA levels. During inverse MR analysis, the findings revealed that both IL-16 and IL-18 increased the risk of cigarettes per day; macrophage inflammatory protein-1β (MIP-1B) and tumor necrosis factor-β (TNF-B) inhibited and promoted smoking cessation, respectively; macrophage colony-stimulating factor (M-CSF) elevated the risk of drinks per week, while interferon inducible protein 10 (IP-10) had a contrary role; IL-7 and M-CSF respectively prolonged and shortened age of initiation of regular smoking. This study provides genetic proof supporting a causal relationship between various inflammatory factors and addiction phenotypes. Further comprehensive investigations are required to uncover underlying biological mechanisms. In addition, bibliometric studies have shown that oxidative stress is one of the most important orientations in alcohol and tobacco addiction research, where an in-depth investigation of its pro-inflammatory mechanisms would facilitate the development of potential therapeutic biological targets and drugs.

Use of wearables to measure the effects of long COVID on activities of daily living and their relationship to perceived exertion, occupational performance, and quality of life

Introduction

This study introduces a novel approach to understanding the impact of long COVID symptoms on daily life by integrating wearable devices to assess their influence on physical and mental quality of life, as well as perceived performance and satisfaction in daily activities.

Methods

By leveraging technology such as accelerometers and pulse oximeters alongside assessment tools like the SF-12 Health Survey, the Canadian Occupational Performance Measure, and the Borg Scale, this research provides a comprehensive analysis that advances the field of occupational therapy.

Results

An analytical observational study with 10 participants with long COVID and 10 healthy controls revealed that individuals with long COVID took significantly longer to complete tasks such as setting the table, sweeping, and climbing stairs, compared to the control group. Participants with long COVID also reported higher perceived exertion during all activities, as well as significantly worse physical health-related quality of life and lower satisfaction and performance in daily activities. Notably, perceived exertion correlated with reduced physical quality of life and diminished satisfaction and accomplishment in occupational tasks.

Discussion

These findings emphasize the critical need for occupational therapy interventions to reduce perceived exertion, which could improve physical quality of life and enhance performance and satisfaction in daily activities for individuals with long COVID.

Examining recovery trajectories of physical function, activity performance, cognitive and psychological functions, and health related quality of life in COVID-19 patients treated in ICU: a Swedish prospective cohort study

PURPOSE

To investigate the recovery trajectories of physical function, activity performance, cognitive and psychological functions, and health related quality of life, as well as potential interaction effects, in individuals with COVID-19 treated in an intensive care unit (ICU).

METHODS

This prospective cohort study included patients with confirmed COVID-19 infection, treated in an ICU. Clinical assessments and self-ratings of functioning, disability and health were performed > 1 month and > 12 months after discharge from hospital.

RESULTS

Among the 65 included individuals (mean age 56.6, SD 11) significant improvements in physical and psychological function were observed over time, although not reaching population norms. Cognition remained unchanged (MoCA median 27, IQR 4). At the 12-month follow-up, physical limitations in activity (RAND-36) were found to be associated with dyspnea (mMRC-Dyspnea), mental and physical fatigue (MFI-20), and walking endurance (6-minute walk test) (r2 0.509 p < 0.001). Role limitations due to physical health (RAND-36) was found to be associated with physical and mental fatigue (MFI-20) and pain (r2 0.530 p < 0.001).

CONCLUSION

Despite improvements in functioning and health in this group of predominantly younger age recovery did not reach population norms. These results highlight persistent impairments and activity limitations that may necessitate long-term healthcare interventions.

Prevalence of cardiovascular symptoms in post-acute COVID-19 syndrome: a meta-analysis

BACKGROUND

Since its emergence in 2019, COVID-19 has continued to pose significant threats to both the physical and mental health of the global population, as well as to healthcare systems worldwide (Raman et al., Eur Heart J 43:1157-1172, 2022). Emerging evidence indicates that COVID-19 may lead to post-acute COVID-19 syndrome (PACS) with cardiovascular implications, potentially driven by factors such as ACE2 interaction with viruses, systemic inflammation, and endothelial dysfunction. However, there remains a limited amount of research on the cardiovascular manifestations of PACS, which may delay the development of optimal treatment strategies for affected patients. Therefore, it is crucial to investigate the prevalence of cardiovascular sequelae in COVID-19 patients and to determine whether COVID-19 infection acts as an independent risk factor for these outcomes.

METHODS

This meta-analysis adhered to PRISMA guidelines and was registered in PROSPERO (CRD42024524290). A systematic search of PubMed, Embase, and the Cochrane Library was conducted up to March 17, 2024. The primary outcomes included hypertension, palpitations, and chest pain, with pooled effect estimate reported as proportions and odds ratios (ORs) with 95% confidence intervals (CIs). Sensitivity and subgroup analysis were performed to assess the robustness of the results and to identify sources of heterogeneity.

RESULTS

A total of 37 studies, encompassing 2,965,467 patients, were included in the analysis. Pooled results from case-control studies revealed that, compared to the control group, the ORs of chest pain in the COVID-19 group was 4.0 (95% CI: 1.6, 10.0). The ORs for palpitation and hypertension were 3.4 (95% CI: 1.1, 10.2) and 1.7 (95% CI: 1.6, 1.8), respectively. The proportions of PACS patients experiencing chest pain, palpitation, and hypertension as sequelae were 22% (95% CI: 14%, 33%), 18% (95% CI: 13%, 24%), and 19% (95% CI: 12%, 31%), respectively.

CONCLUSIONS

Our findings indicate that 15% of COVID-19 patients experience cardiovascular sequelae. Furthermore, COVID-19 infection significantly increases the likelihood of developing these sequelae compared to uninfected individuals. Future research should prioritize investigating the underlying pathological mechanisms and developing targeted preventive and management strategies.

TRIAL REGISTRATION

CRD42024524290.

Neuropsychological functioning after COVID-19: Minor differences between individuals with and without persistent complaints after SARS-CoV-2 infection

Objective: It is unclear how self-reported severe fatigue and difficulty concentrating after SARS-CoV-2 infection relate to objective neuropsychological functioning. The study aimed to compare neuropsychological functioning between individuals with and without these persistent subjective complaints. Method: Individuals with and without persistent severe fatigue (Checklist Individual Strength (CIS) fatigue ≥ 35) and difficulty concentrating (CIS concentration ≥ 18) at least 3 months after SARS-CoV-2 infection were included. Neuropsychological assessment was performed on overall cognitive functioning, attention, processing speed, executive functioning, memory, visuo-construction, and language (18 tests). T-scores -1.5 SD below population normative data (T ≤ 35) were classified as "impaired". Results: 230 participants were included in the study, of whom 22 were excluded from the analysis due to invalid performance. Of the participants included in the analysis, 111 reported persistent complaints of severe fatigue and difficulty concentrating and 97 did not. Median age was 54 years, 59% (n = 126) were female, and participants were assessed a median of 23 months after first infection (IQR: 16-28). With bivariate logistic regression, individuals with persistent complaints had an increased likelihood of slower information processing speed performance on the Stroop word reading (OR = 2.45, 95%CI = 1.02-5.84) compared to those without persistent complaints. Demographic or clinical covariates (e.g. hospitalization) did not influence this association. With linear regression techniques, persistent complaints were associated with lower t-scores on the D2 CP, TMT B, and TMT B|A. There were no differences in performance on the other neuropsychological tests. Conclusions: Individuals with subjective severe fatigue and difficulty concentrating after COVID-19 do not typically demonstrate cognitive impairment on extensive neuropsychological testing.

Prolonged high Myl9 levels are associated with the pathogenesis and respiratory symptom of post-acute COVID-19 syndrome: A 6-month follow-up study

BACKGROUND

Post-acute COVID-19 Syndrome (PACS) occurs in some COVID-19 patients long after acute infection and significantly affects patients' health. However, the mechanism by which PACS develops is unknown. Myosin light chain 9 (Myl9), produced by activated platelets, plays a role in immune dysregulation and microthrombi formation during acute COVID-19. However, in the PACS phase, the association between Myl9 and residual symptoms remains unclear, and further investigation is needed.

METHODS

In this prospective cohort study, serum Myl9 concentrations were measured in 195 COVID-19 patients during hospitalization and at 3- and 6-month follow-up visits. Gaussian mixture modeling was used to identify groups on the basis of Myl9 levels. Relationships between Myl9 levels and residual symptoms were evaluated. Clinical characteristics influencing Myl9 levels were analyzed via logistic regression.

RESULTS

A total of 304 serum samples from 195 patients were collected. Two distinct groups were identified in the Myl9 distribution with a cutoff of 386 ng/mL by Gaussian mixture modeling in this cohort. The high-Myl9 group presented significant residual respiratory symptoms at 6 months post-infection (p < 0.05). Elevated Myl9 levels at 6 months were correlated with increased neutrophil counts (p < 0.01) and respiratory comorbidities at diagnosis (p < 0.05) according to univariate regression analysis. Multivariate regression analysis confirmed the relationship between the neutrophil count and high Myl9 levels.

CONCLUSION

Prolonged high Myl9 levels are associated with respiratory symptoms, suggesting the potential involvement of prolonged inflammation or endothelial damage in PACS.

Treatment of Proximal Humeral Fractures in Older Patients During COVID-19 Pandemic in Germany

Purpose

The COVID-19 pandemic had a severe influence on the entire health sector. Until today, the effect of a SARS-CoV-2 infection on older patients with a proximal humeral fracture (PHF) is unknown. This study examined the following questions: Did the incidence of PHF of older people in Germany vary during the pandemic? Did the treatment change between the lockdown and non-lockdown periods? Was a SARS-CoV-2 infection associated with a worse outcome?

Methods

Retrospective claims data of the BARMER health insurance were analysed. All in- and outpatient cases of insurance holders ≥65 years from 01/2010 to 09/2022, with coded diagnosis of PHF were analysed. Primary endpoints were the 1-month incidence of PHF per 100,000 insurance holders, number of operative therapies, in-hospital death and in-hospital major adverse events (MAEs).

Results

174,898 inpatient PHF cases were included. During the lockdown periods, the total incidence fell, while the outpatient incidence partially increased during the pandemic-period. Regarding the therapy allocation, there were no relevant persisting changes. In a detailed analysis of 23,979 PHF cases from 01/2020 to 09/2022, 4.1% patients suffered from a SARS-CoV-2 infection and showed a notably higher in-hospital mortality (8.1% vs 2.5%; risk adjusted OR 2.79, 95% CI 2.11-3.70, p < 0.001) and more MAEs (17.0% vs 7.8%; risk adjusted OR 1.43, 95% CI 1.15-1.77, p < 0.001).

Conclusion

During the COVID-19 pandemic, the overall incidence of PHF in older patients was reduced. The treatment allocation did not change between the pre- and intra-pandemic period. An infection with SARS-CoV-2 was associated with higher mortality and more MAEs.

The emotions of Chinese netizens toward the opening-up policies for COVID-19: panic, trust, and acceptance

With the development of social media platforms such as Weibo, they have provided a broad platform for the expression of public sentiments during the pandemic. This study aims to explore the emotional attitudes of Chinese netizens toward the COVID-19 opening-up policies and their related thematic characteristics. Using Python, 145,851 texts were collected from the Weibo platform. Sentiment analysis and topic modeling techniques were employed to reveal the distribution of public emotions and key themes. The study found that the proportions of emotions were as follows: Good (46%), Happy (11%), Anger (17%), Disgust (6%), Sadness (10%), Surprise (2%), and Fear (8%). Through topic analysis, the following main themes were identified: medical resource shortages, healthcare workers, national policies, and COVID-19 sequelae. Based on the results of sentiment and topic analysis, public emotions toward the COVID-19 opening-up policies were categorized into three dimensions: panic, trust, and acceptance. Panic was primarily associated with medical resource shortages, concerns about COVID-19 sequelae, and doubts about policy transparency and fairness. Trust was reflected in public gratitude toward healthcare workers and support for national policies. Acceptance represented the public's optimism about returning to normal life. The findings demonstrate that changes in public emotions not only reflect the social impact of policy implementation but also highlight the critical roles of medical resource allocation, information transparency, and psychological health support in adjusting pandemic policies. This study provides empirical evidence and theoretical support for the government to develop more precise pandemic control strategies.

Early prediction of long COVID-19 syndrome persistence at 12 months after hospitalisation: a prospective observational study from Ukraine

OBJECTIVE

To identify the early predictors of a self-reported persistence of long COVID syndrome (LCS) at 12 months after hospitalisation and to propose the prognostic model of its development.

DESIGN

A combined cross-sectional and prospective observational study.

SETTING

A tertiary care hospital.

PARTICIPANTS

221 patients hospitalised for COVID-19 who have undergone comprehensive clinical, sonographic and survey-based evaluation predischarge and at 1 month with subsequent 12-month follow-up. The final cohort included 166 patients who had completed the final visit at 12 months.

MAIN OUTCOME MEASURE

A self-reported persistence of LCS at 12 months after discharge.

RESULTS

Self-reported LCS was detected in 76% of participants at 3 months and in 43% at 12 months after discharge. Patients who reported incomplete recovery at 1 year were characterised by a higher burden of comorbidities (Charlson index of 0.69±0.96 vs 0.31±0.51, p=0.001) and residual pulmonary consolidations (1.56±1.78 vs 0.98±1.56, p=0.034), worse blood pressure (BP) control (systolic BP of 138.1±16.2 vs 132.2±15.8 mm Hg, p=0.041), renal (estimated glomerular filtration rate of 59.5±14.7 vs 69.8±20.7 mL/min/1.73 m2, p=0.007) and endothelial function (flow-mediated dilation of the brachial artery of 10.4±5.4 vs 12.4±5.6%, p=0.048), higher in-hospital levels of liver enzymes (alanine aminotransferase (ALT) of 76.3±60.8 vs 46.3±25.3 IU/L, p=0.002) and erythrocyte sedimentation rate (ESR) (34.3±12.1 vs 28.3±12.6 mm/h, p=0.008), slightly higher indices of ventricular longitudinal function (left ventricular (LV) global longitudinal strain (GLS) of 18.0±2.4 vs 17.0±2.3%, p=0011) and higher levels of Hospital Anxiety and Depression Scale anxiety (7.3±4.2 vs 5.6±3.8, p=0.011) and depression scores (6.4±3.9 vs 4.9±4.3, p=0.022) and EFTER-COVID study physical symptoms score (12.3±3.8 vs 9.2±4.2, p<0.001). At 1 month postdischarge, the persisting differences included marginally higher LV GLS, mitral E/e' ratio and significantly higher levels of both resting and exertional physical symptoms versus patients who reported complete recovery. Logistic regression and machine learning-based binary classification models have been developed to predict the persistence of LCS symptoms at 12 months after discharge.

CONCLUSIONS

Compared with post-COVID-19 patients who have completely recovered by 12 months after hospital discharge, those who have subsequently developed 'very long' COVID were characterised by a variety of more pronounced residual predischarge abnormalities that had mostly subsided by 1 month, except for steady differences in the physical symptoms levels. A simple artificial neural networks-based binary classification model using peak ESR, creatinine, ALT and weight loss during the acute phase, predischarge 6-minute walk distance and complex survey-based symptoms assessment as inputs has shown a 92% accuracy with an area under receiver-operator characteristic curve 0.931 in prediction of LCS symptoms persistence at 12 months.

A novel analysis of interoceptive underpinnings of anxious psychopathology in COVID-19 survivors

INTRODUCTION

SARS-CoV-2 affects brain, body, and their interchange. We investigated interoceptive mechanisms in COVID-19 survivors focusing on their potential link with psychopathology and inflammatory biomarkers.

METHODS

We assessed interoceptive accuracy (IAc) and time-perceiving (TA) skills of 57 COVID-19 survivors one month after hospital discharge through, respectively, a heartbeats perception task and a time duration task. Each participant was assessed about his interoceptive awareness (IAw) through Multidimensional Assessment of Interoceptive Awareness questionnaire (MAIA) and then, screened for post-traumatic (Impact of Events Scale - IES-R), anxious (State-Trait Anxiety Inventory - STAI-Y1) and depressive (Zung Self-Rating Depression Scale - ZSDS; Beck Depression Inventory - BDI-13) symptoms. Biomarkers of inflammation (platelet count, PC; mean platelet volume, MPV and systemic immune-inflammation index, SII) were obtained in a subsample of 40 survivors by a blood sampling conducted at admission and discharge time from the hospital. Correlational, GLM, GLMZ, and mediation analyses were performed.

RESULTS

IAc did not correlate with TA confirming the reliability of interoceptive measure. IAc positively predicts MAIA's Trusting subscale and negatively predicts anxious psychopathology which fully mediates the effect of IAc on Trusting.PC at hospital admission predicts anxiety at one month after recovery. Again, a higher decrease of SII during hospitalization predicts higher IAc skill and lower anxiety state at one month. The link between SII change and anxiety is fully mediated by IAc.

CONCLUSIONS

Our results unveil a potential key role of interoception and brain-body interchange in the exacerbation and maintenance of anxiety psychopathology in COVID-19 survivors.

COVID-19 and Mental Distress and Well-Being Among Older People: A Gender Analysis in the First and Last Year of the Pandemic and in the Post-Pandemic Period

The Coronavirus disease 2019 (COVID-19) pandemic seriously threatened the health and well-being of the population. This study aims to investigate the relevance of the COVID-19 pandemic on the stress, mental distress, and well-being of older people in Spain. The design was quantitative repeated cross-sectional. The sample was non-probability and consisted of 1436 persons from the general population divided into two groups: (1) the study group, composed of 718 women (61.3%) and men aged 60 to 89; (2) the comparison group, composed of the same number of women and men aged 30 to 45. All were assessed in three phases of the COVID-19 pandemic: the first pandemic year, the last pandemic year, and the post-pandemic period. The results showed that during the first year of the pandemic, the prevalence of mental distress was higher in older women (50%) than in older men (37.2%), while the rates in the comparison group were 57.2% for women and 53.2% for men. In the post-pandemic period, the rates of mental distress were 30.2% for older women and 29.8% for older men while in the comparison group, the rates were 48.5% for women and 26.5% for men. No significant differences in well-being were found between the groups or between the different phases of the pandemic. The most common stressors reported by older people were illness and death of family and/or loved ones, followed by personal illness. In the post-pandemic period, more stressful events and lower stress resilience were found to predict mental distress in older women and men. Greater perceived vulnerability to infection was another important predictor for women. Low self-esteem and younger age were also predictors of mental distress for men. High self-esteem, high social support, greater stress resilience and fewer stressful events were predictors of well-being for both genders. The results of this study are relevant for the design of policies, programs, and strategies to improve the health and well-being of older people.

Sleep disorders among frontline nurses after the COVID-19 outbreak: a large-scale cross-sectional study

This large-scale cross-sectional multicenter study aims to investigate the prevalence of sleep disorders among frontline nurses in China after the COVID-19 pandemic and to identify potential influencing factors contributing to these sleep disturbances. A total of 2065 frontline nurses from 27 provinces in China participated in an online survey conducted through the Wenjuan Xing platform. Data on demographic characteristics, work-related factors, and mental health assessments, including the Pittsburgh Sleep Quality Index (PSQI), Zung Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS), were collected. Statistical analyses, including chi-square tests, t-tests, binary logistic regression, and ROC analysis, were conducted to explore the relationships between various factors and sleep disorders. Over half (52.7%) of the surveyed nurses exhibited sleep disorders, reflecting a considerable post-pandemic impact on sleep quality. Factors such as nursing titles, personality traits, COVID-19 infection status, and exercise frequency showed statistically significant associations with sleep disorders. Extraverted nurses and those who had recovered from COVID-19 displayed a lower risk of sleep disorders, while anxiety was identified as an independent risk factor. The study also identified a nuanced relationship between exercise frequency and sleep quality. The study highlights a high prevalence of sleep disorders among frontline nurses post-COVID-19, emphasizing the need for targeted interventions. Factors such as nursing titles, personality traits, COVID-19 infection status, exercise habits, and anxiety levels were found to influence sleep quality. Comprehensive support strategies addressing these factors are essential for improving the overall well-being of frontline nurses and, subsequently, sustaining a resilient healthcare workforce. Further research is recommended to explore additional influencing factors and consider diverse nurse populations.

Acute and long-term effects of COVID-19 on brain and mental health: A narrative review

BACKGROUND

COVID infection has been associated with long term sequalae (Long COVID) which include neurological and behavioral effects in thousands of patients, but the etiology and scope of symptoms is not well understood. This paper reviews long term sequelae of COVID on brain and mental health in patients with the Long COVID syndrome.

METHODS

This was a literature review which queried databases for Pubmed, Psychinfo, and Medline for the following topics for January 1, 2020-July 15, 2023: Long COVID, PASC, brain, brain imaging, neurological, neurobiology, mental health, anxiety, depression.

RESULTS

Tens of thousands of patients have developed Long COVID, with the most common neurobehavioral symptoms anosmia (loss of smell) and fatigue. Anxiety and mood disorders are elevated and seen in about 25% of Long COVID patients. Neuropsychological testing studies show a correlation between symptom severity and cognitive dysfunction, while brain imaging studies show global decreases in gray matter and alterations in olfactory and other brain areas.

CONCLUSIONS

Studies to date show an increase in neurobehavioral disturbances in patients with Long COVID. Future research is needed to determine mechanisms.

Neurological, psychological, psychosocial complications of long-COVID and their management

Since it first appeared, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has had a significant and lasting negative impact on the health and economies of millions of individuals all over the globe. At the level of individual health too, many patients are not recovering fully and experiencing a long-term condition now commonly termed 'long-COVID'. Long-COVID is a collection of symptoms which must last more than 12 weeks following initial COVID infection, and which cannot be adequately explained by alternate diagnoses. The neurological and psychosocial impact of long-COVID is itself now a global health crisis and therefore preventing, diagnosing, and managing these patients is of paramount importance. This review focuses primarily on: neurological functioning deficits; mental health impacts; long-term mood problems; and associated psychosocial issues, among patients suffering from long-COVID with an eye towards the neurological basis of these symptoms. A concise account of the clinical relevance of the neurological and psychosocial impacts of long-COVID, the effects on long-term morbidity, and varied approaches in managing patients with significant chronic neurological symptoms and conditions was extracted from the literature, analysed and reported. A comprehensive account of plausible pathophysiological mechanisms involved in the development of long-COVID, its management, and future research needs have been discussed.

Association Between Lifetime Interpersonal Violence and Post-COVID-19 Condition Among Women in Kentucky, 2020-2022

OBJECTIVE

The COVID-19 pandemic increased the risk of interpersonal violence. We investigated the association between lifetime interpersonal violence experience and risk of post-COVID-19 condition (the persistence of symptoms of COVID-19 and severity of health problems associated with COVID-19 that last a few weeks, months, or years) among women with lifetime interpersonal violence experience.

METHODS

Women participants aged ≥18 years in Kentucky's Wellness, Health & You-COVID-19 study completed online quantitative surveys about the impacts of the pandemic, developing COVID-19, and symptoms of post-COVID-19 condition. We conducted cross-sectional analyses estimating rate ratios of developing COVID-19 and symptoms of post-COVID-19 condition during the pandemic (October 13, 2020-February 28, 2022).

RESULTS

Of the analytic sample (N = 938), 342 (36.5%) disclosed a history of lifetime interpersonal violence. Compared with women with no lifetime interpersonal violence experience, women with lifetime interpersonal violence experience had significantly more distress because of the pandemic, defined as family financial challenges (P = .001), symptoms of mental health challenges (P < .001), and negative coping behaviors (P < .001). While experiencing lifetime interpersonal violence was not significantly associated with either receiving COVID-19 vaccinations (adjusted rate ratio [aRR] = 1.10; 95% CI, 0.75-1.61) or developing COVID-19 (aRR = 1.15; 95% CI, 0.92-1.44), experiencing lifetime interpersonal violence was associated with an increased rate of developing symptoms of post-COVID-19 condition (aRR = 2.09; 95% CI, 1.19-3.65).

CONCLUSION

Symptoms of post-COVID-19 condition may be linked to lifetime interpersonal violence experience, possibly through stress or violence-associated trauma. Future research is needed to assess the negative effects of the pandemic, prioritizing people with lifetime interpersonal violence experience.

Self-efficacy and healthy lifestyle behaviors as mediators between COVID-19 care knowledge and health status

The COVID-19 epidemic has affected the psychological well-being and daily life of college students, leading to a decrease in their quality of life. Health status can be influenced by a variety of factors. This study aims to assess the current health status of university students and explore the relationships among COVID-19 care knowledge, self-efficacy, healthy lifestyle behaviors, and health status and how these factors are influenced. Among the 1694 participants, 49.4% were male, 50.6% were female, and 82.2% were freshmen. The results revealed that health status across all dimensions decreased to some extent. COVID-19 care knowledge affected both physical and mental component summaries. The results suggest that improving COVID-19 care knowledge, strengthening self-efficacy, and promoting the development of healthy lifestyle behaviors can positively impact their health status. Here, we explore the health status of college students with COVID-19 infection and the factors and mechanisms that influence it to guide health interventions to better meet the challenges posed by future outbreaks.

Depression in the COVID-19 endemic era: Analysis of online self-disclosures by young South Koreans

Although COVID-19 has been declared endemic in South Korea, there are economic and psychosocial after-effects. One of these is the prevalence of depression. Depressed adolescents and young adults struggle with insecurity, loneliness, and lack of confidence due to the life limitations imposed during the pandemic. Young South Koreans experienced deterioration in mental health because of the recurrence of mass infections. To address professionals' concerns about the lingering effects of COVID-19 on youth mental health, we text-mined young South Koreans' online posts about depression during the pandemic and the endemic phases-from February 2020 to May 2023. We used a total of 1,740 selected posts (raw data publicly available on https://github.com/kimalexis1129/PLOS_endemic_depression.git) to explore the situational triggers, additional factors, and by-products of depression that have persisted during the endemic era. We used Latent Dirichlet allocation and Dirichlet-multinomial regression topic modeling methods in conjunction with sentiment analysis and mean comparison. The results showed that the pandemic and endemic topic models shared similarities, but emerging topics showed extended adversities such as adolescents' vulnerability to eating disorders and young adults' tendency to self-isolate. Comparisons between the levels of positive and negative affect during the pandemic and endemic eras revealed no significant changes in mood. We discussed the results in comparison with SARS and MERS precedents and from general and cultural perspectives.

Clinical risk factors of long-term post-traumatic stress symptoms, anxiety, and depression in COVID-19 survivors

The COVID-19 pandemic has a profound and lasting impact on the mental health of recovered individuals. To investigate the clinical risk factors associated with long-term post-traumatic stress symptoms (PTSS), anxiety, and depression in COVID-19 survivors, demographic information and medical records were collected during February 19 and March 20, 2020. Assessments of PTSS, anxiety, and depressive symptoms were conducted at two months (April to May 2020, Session 1) and two years (April to May 2022, Session 2) post-discharge. Session 1 included 127 survivors who were infected with the early strains of SARS-CoV-2, and 54 of these participants took part in Session 2. PTSS (median: Session 1 = 9, Session 2 = 7; p = 0.522) and depression (median: Session 1 = 5, Session 2 = 4; p = 0.127) remained unchanged over the two years following COVID-19 infection, while anxiety (median: Session 1 = 5, Session 2 = 2; p < 0.001) significantly decreased at the two-year mark. Severe COVID-19 symptoms were consistently identified as significant risk factors for depression at both time points (Session 1: dyspnea [beta = -0.268, p = 0.016], nausea or vomiting [beta = 0.239, p = 0.031]; Session 2: headache [beta = 0.414, p = 0.014]). They also emerged as risk factors for PTSS and anxiety at the two-month mark (PTSS: cough [beta = -0.334, p = 0.002]; anxiety: continued oxygen therapy [beta = 0.343, p = 0.002], cough [beta = -0.267, p = 0.013]). At the two-year mark, blood sample characteristics were identified as risk factors for PTSS (albumin: beta = 0.455, p = 0.010), anxiety (total bilirubin: beta = 0.440, p = 0.013), and depression (total bilirubin: beta = 0.386, p = 0.021). Mann-Whitney U-tests showed that female survivors had higher anxiety (p = 0.012) and depression (p = 0.046) levels than males at the two-month mark. The sample size was relatively small, and further investigation is needed to determine whether our findings can be directly applied to other samples, including those involving different variants of SARS-CoV-2. Our study may highlight the differences between short-term and long-term clinical risk factors for PTSS, anxiety, and depression in COVID-19 survivors. The identified predictors could provide valuable insights for tailoring interventions to improve the PTSS, anxiety, and depression outcomes at different stages of recovery in COVID-19 survivors.

Anxiety and depression among individuals with long COVID: Associations with social vulnerabilities

BACKGROUND

We examined the association between symptoms of anxiety and depression among individuals with long COVID and five social vulnerabilities (expenses, employment, food insufficiency, housing, and insurance).

METHODS

Data from the Census Bureau's Household Pulse Survey (HPS) detailing COVID incidence, duration, and symptoms between June 1st and November 14th, 2022 contained versions of the Generalized Anxiety Disorder (GAD-2) and the Patient Health Questionnaire (PHQ-2) questionnaires. Associations between anxiety, depression, and the five social vulnerabilities among respondents from different racial and ethnic groups experiencing long COVID were evaluated using generalized binomial logistic regression. Structural equation models tested whether social vulnerabilities mediated the pathway between race/ethnicity and anxiety/depression.

RESULTS

Blacks, Asians/others, and Hispanics with long COVID were significantly more likely to report anxiety and depression and various social vulnerabilities than Whites. Anxiety among Blacks was significantly associated with difficulty with expenses [Odds Ratio (OR) = 1.743, 95 % Confidence Interval (CI) = 1.739, 1.747], employment (OR = 1.519, 95 % CI = 1.516, 1.523), and housing (OR = 1.192, 95 % CI = 1.19, 1.194). Anxiety among Hispanics was significantly associated with food insufficiency (OR = 1.048, 95 % CI = 1.044, 1.052). Depression among Blacks was significantly associated with trouble with expenses (OR = 1.201, 95 % CI = 1.198, 1.205) and employment (OR = 1.129, 95 % CI = 1.127, 1.132). Mediation analysis showed that the number of social vulnerabilities partially mediated the association between race and anxiety.

LIMITATIONS

This retrospective study utilized secondary, observational, self-reported data from the HPS. Therefore, results may not be generalizable outside of the context in which they were collected.

CONCLUSIONS

The development of tailored programs for population health should address the differential associations of anxiety and depression with social difficulties among racial and ethnic groups.

Parental experience with childhood COVID-19 vaccines and factors associated with parental hesitancy despite being vaccinated: findings of a cross-sectional analysis from Pakistan and implications for the future

OBJECTIVES

This study examined parental experiences with COVID-19 vaccination and factors contributing to COVID-19 vaccine hesitancy (CVH) among them to help guide future policy initiatives.

DESIGN

Cross-sectional study.

SETTING

Lahore, the second largest metropolis in Pakistan.

PARTICIPANTS

This study was conducted among parents residing in Lahore from March to April 2023. Participants were recruited via convenience sampling.

OUTCOME MEASURES

Data were collected using a prevalidated questionnaire that consisted of four sections: (1) informed consent, (2) demographic details, (3) COVID-19 vaccine uptake in children aged 5-17 years, parents' experience with childhood COVID-19 vaccination and their intention to vaccinate their unvaccinated children and (4) a modified 5C scale tailored to determine parents' confidence, complacency, constraints, calculation and collective responsibility with regard to COVID-19 vaccination.

RESULTS

This study included 414 parents (median age=37 years; mothers=62%). COVID-19 vaccination rates for children in the age groups 12-17 years and 5-11 years were 72.5% and 30.1%, respectively. Transient adverse events following immunisation were reported by 32.7% of parents. Of parents with unvaccinated children aged 12-17 years, only 35% intended to vaccinate them. The majority of parents were not willing to vaccinate their children below 11 years of age. Parents with a self-reported positive history of COVID-19 disease (OR=2.531, p=0.016), and confident in the vaccine's safety and efficacy (OR=1.968, p=0.010), were more inclined to vaccinate their 5-11 years. In terms of vaccination of children below 5 years, confidence in the vaccine (OR=2.942, p=0.003) and a sense of collective responsibility were positive predictors (OR=2.260, p=0.035), while calculation was identified as a negative predictor of parents' intention to vaccinate their under 5 years (OR=0.421, p=0.018).

CONCLUSION

CVH was significantly higher among parents of children aged 5-11 years and children younger than 5 years old. Priority should be given by health authorities to address parental concerns about vaccines and ensure that parents understand the significance of vaccination in protecting their children, to increase vaccination rates. This is because hesitancy towards one specific vaccine can negatively impact hesitancy rates in general.

The impact of nurses' stress situation coping on somatization: a mediated moderation model

Aims

The purpose of this study is to investigate the impact of nurses' stress situation coping levels on somatization symptoms, the mediating effect of depression, and the moderating effect of perceived social support.

Background

As a core part of the global healthcare system, nurses are crucial to patient health and rehabilitation outcomes. However, due to heavy workloads, unreasonable staffing structures, and constant exposure to occupational risks in their workplaces, these factors often place nurses in a high-intensity, high-stress environment, which directly affects their physical and mental health and professional burnout. Coping with stress situations is an important means to help individuals effectively manage stress, reduce negative impacts, and maintain mental health. However, research on the impact of nurses' stress situation coping methods on somatization symptoms is limited.

Methods

This study conducted a cross-sectional survey from December 2022 to April 2023, and finally included 293 nurses working on the front line of tertiary hospitals. Data was collected through questionnaires and analyzed using SPSS 24.0 and the SPSS macro program's Models 7 and 14. This study is an observational study, strictly prepared and presented according to the STROBE checklist.

Results

The somatization symptom scores of the nurses were (27.27 ± 7.33) points, the stress situation coping scores were (59.90 ± 9.64) points, the perceived social support scores were (65.64 ± 12.90) points, and the depression scores were (4.42 ± 4.12) points. The somatization symptom scores of the nurses were positively correlated with the stress situation coping scores and depression scores, and negatively correlated with the perceived social support scores, with correlation coefficients of 0.200, 0.851, and -0.302, respectively. The stress coping level of the nurses had a direct positive impact on somatization symptoms (β = 0.081, p = 0.009), and a direct positive impact on nurse depression (β = 0.202, p = 0.001). Depression had a significant positive impact on somatization symptoms (β = 0.823, p = 0.000), and depression played a mediating role. Perceived social support had a significant negative impact on depression (β = -0.383, p = 0.000). Perceived social support had a significant moderating effect on the relationship between the stress situation coping level and depression (β = -0.121, p = 0.003).

Conclusion

In this study, the stress situation coping methods of nurses had a positive impact on somatization symptoms, had a complete mediating effect on the depression level of nurses, and perceived social support had a significant moderating effect in the pathway from the stress situation coping methods of nurses to depression-mediated somatization symptoms.

The Association Between COVID-19-related Discrimination and Probable Post-traumatic Stress Disorder Among Patients With COVID-19 in Sapporo, Japan

BACKGROUND

Disasters such as earthquakes, terrorism, and pandemics have triggered post-traumatic stress disorder (PTSD), and discrimination against the affected individuals has been linked to the development of PTSD. However, there is limited evidence regarding the association between discrimination against coronavirus disease 2019 (COVID-19) patients and probable PTSD in Japan.

METHODS

We conducted a cross-sectional study utilizing a web-based questionnaire targeting individuals who had contracted the severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) infection in Sapporo City. A total of 4,247 individuals with laboratory-confirmed SARS-CoV-2 infection spanning from February 2020 to February 2022 completed the questionnaire (response rate: 15.9%). Probable PTSD was measured using the three-item Posttraumatic Diagnostic Scale. The stratified exact logistic regression was applied to calculate the odds ratios (ORs) of probable PTSD for COVID-19-related discrimination with adjusted factors.

RESULTS

This study included 3,626 patients who had a history of SARS-CoV-2 infection. Among them, 321 patients (8.9%) experienced COVID-19-related discrimination. The prevalence of probable PTSD was 19.6% (63/321) among the patients who experienced COVID-19-related discrimination, and 4.6% (152/3,305) among those who had not encountered such discrimination. The adjusted OR of COVID-19-related discrimination for probable PTSD was 4.68 (95% confidence interval [CI], 3.36-6.53). The population attributable fraction of probable PTSD attributable to COVID-19-related discrimination among COVID-19 patients was estimated to be 23.4% (95% CI, 21.5-25.3%).

CONCLUSION

The comprehensive epidemiological survey of COVID-19 patients in Japan showed that COVID-19-related discrimination was associated with a higher prevalence of probable PTSD. Mitigating discrimination could be helpful to attenuate PTSD in future pandemics.

A digital intervention for cognitive deficits following COVID-19: a randomized clinical trial

Post-COVID-19 cognitive deficits are common, persistent, and disabling. Evidence on effective treatments is limited. The goal of this study was to investigate the efficacy of a digital intervention to reduce cognitive and functional deficits in adults with persistent post-COVID-19 cognitive dysfunction. We used the remotely-delivered intervention in a randomized clinical trial conducted from July 13, 2021 to April 26, 2023. We hypothesized that participants in the intervention group would improve in measures of cognition and daily functioning. Participants were adults with cognitive deficits persisting >4 weeks following acute COVID-19 illness. Of 183 participants screened, 110 were enrolled; 98 participants (78.6% female; mean age = 48.1) completed at least one study visit. Participants were randomized 1:1 to the intervention (AKL-T01) or waitlist control. AKL-T01 is a digital therapeutic using a videogame interface to target attention and executive control. The intervention was delivered remotely for 6 weeks. The primary outcome was change in performance on a sustained attention measure (Digit Symbol Matching Task). The difference in the primary outcome between the intervention (n = 49) and controls (n = 49) was not statistically significant (F [3,261] = 0.12, p = 0.95). Secondary cognitive outcomes of task-switching (F[3,262] = 2.78, p = 0.04) and processing speed (F[3,267] = 4.57, p = 0.004) improved in the intervention relative to control. Secondary measures of functioning also improved in the intervention relative to control, including disability (F[1,82] = 4.02, p = 0.05) and quality of life (F[3,271] = 2.66, p = 0.05). Exploratory analyses showed a greater reduction in total fatigue (F[1,85] = 4.51, p = 0.04), cognitive fatigue (F[1,85] = 7.20, p = 0.009), and anxiety (F[1,87] = 7.42, p = 0.008) in the intervention relative to control. Despite the lack of improvement in sustained attention, select post-COVID-19 cognitive deficits may be ameliorated by targeted cognitive training with AKL-T01, with associated improvements in quality of life and fatigue. If replicated, the scalable nature of this digital intervention may help address substantial need for accessible, effective treatments among individuals with long COVID.

The efficacy of antivirals, corticosteroids, and monoclonal antibodies as acute COVID-19 treatments in reducing the incidence of long COVID: a systematic review and meta-analysis

BACKGROUND

Whether treatment during acute COVID-19 results in protective efficacy against long COVID incidence remains unclear.

OBJECTIVES

To assess the relationship between acute COVID-19 treatments of antivirals, corticosteroids, and monoclonal antibodies (mAbs) and long COVID incidence, and their effects in different populations and individual symptoms.

METHODS

A systematic review and meta-analysis.

DATA SOURCES

Searches were conducted up to January 29, 2024 in PubMed, Medline, Web of Science, and Embase.

STUDY ELIGIBILITY CRITERIA

Articles that reported long COVID incidence post-acute COVID with a follow-up of at least 30 days with no language restrictions.

PARTICIPANTS

Patients with a COVID-19 diagnosis history.

INTERVENTIONS

Patients treated with antivirals, corticosteroids or mAbs.

ASSESSMENT OF RISK OF BIAS

Quality assessment was based on the Newcastle-Ottawa scale, risk of bias in nonrandomized studies of interventions-I and Cochrane risk of bias tool.

METHODS OF DATA SYNTHESIS

Basic characteristics were documented for each study. Random forest model and meta-regression were used to evaluate the correlation between treatments and long COVID.

RESULTS

Our search identified 2363 records, 32 of which were included in the qualitative synthesis and 25 included into the meta-analysis. Effect size from 14 papers investigating acute COVID-19 antiviral treatment concluded its protective efficacy against long COVID (OR, 0.61; 95% CI, 0.48-0.79; p 0.0002); however, corticosteroid (OR, 1.57; 95% CI, 0.80-3.09; p 0.1913), and mAbs treatments (OR, 0.94; 95% CI, 0.56-1.56; p 0.8012) did not generate such effect. Subsequent subgroup analysis revealed that antivirals provided stronger protection in the aged, male, unvaccinated and nondiabetic populations. Furthermore, antivirals effectively reduced 8 out of the 22 analysed long COVID symptoms.

CONCLUSIONS

Our meta-analysis determined that antivirals reduced long COVID incidence across populations and should thus be recommended for acute COVID-19 treatment. There was no relationship between mAbs treatment and long COVID, but studies should be conducted to clarify acute COVID-19 corticosteroids' potential harmful effects on the post-acute phase of COVID-19.

Lifestyle, Environment, and Dietary Measures Impacting Cognitive Impairment: The Evidence Base for Cognitive Subtypes

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Cognition includes all phases of valid functions and processes, e.g., sensitivity, judgment, assessment, and decision-making. Thinking is also a cognitive procedure since it involves considering potential opportunities. There are various types of cognition. Hot cognition involves mental procedures where emotion plays a role, while cold cognition includes mental processes that do not include feelings or emotions. Cognitive memories of various types include sensor memory, sensing touch, smell, and sight; short-term memory allows one to recall, e.g., what one had for lunch a few days ago; working memory includes remembering telephone numbers or directions to a destination; and long-term memory comprises of major milestones in life and recalling one’s childhood events. These are further classified as episodic, e.g., the first day in primary school, and semantic memories, such as recalling the capital city of a country and filling out crossword puzzles. Declarative memories include remembering significant past events, such as global information. Cognition is affected by factors, such as nutrition, aging, addiction, environment, mental health, physical activity, smoking, and keeping the brain active. Consumption of plant- based foods plays a prominent role in the prevention of cognitive memory. Playing games and instruments, reading books, and being socially active make life more satisfying, thus assisting in the preservation of mental function and slowing mental decline.

Fear and Impact of COVID-19 Among Post-Infected Adults: Types and Associations with Quality of Life and Post-Traumatic Stress Symptoms

Survivors of COVID-19 are susceptible to diminished health-related quality of life (HRQoL) and adverse psychological health, which may be exacerbated by their experiences of fear and the impact of the pandemic itself. This study aims to identify distinct fear and impact patterns related to the COVID-19 pandemic among survivors through latent profile analysis (LPA) and examine the associations of fear and impact patterns with post-traumatic stress symptoms (PTSS) and HRQoL. A total of 5,890 Vietnamese COVID-19 survivors completed the COVID-19 Impact Battery- Disability Scale (CIB-D), the Fear of COVID-19 Scale (FCoV-19 S), the Impact of Event Scale-Revised for PTSS, and the 36-Item Short Form Survey (SF-36) for HRQoL. Four distinct groups of fear and impact were identified: "Fearful and highly impacted" (26.8%), "moderately impacted yet not fearful" (22.9%), "less impacted and less fearful" (18.6%), and "mildly impacted and neutral" (31.7%). Survivors who were "less impacted and less fearful" exhibited significantly higher HRQoL scores (regression coefficient, B: 10.9; 95% confidence interval (CI): 10.0 - 11.7), both in terms of physical (B: 12.0; 95%CI: 11.1 - 12.9) and mental health (B: 19.4; 95%CI: 9.6 - 11.1), and lower PTSS levels (B: -24.5; 95%CI: -25.8 - -23.3) compared to those who were "highly impacted and fearful". It is imperative to acknowledge the intricate association between fear, impact, and mental health to comprehensively address the diverse needs of this distinct population post-COVID-19. These findings provide insights for designing interventions and support mechanisms for COVID-19 survivors.

The Physical Condition and Mental Health of Chinese College Students 3 Months After COVID-19 Recovery

Purpose: The study was to evaluate the physical condition and mental health of Chinese college student COVID-19 survivors, and to perform severity clustering of physical symptoms. Participants: The study finally included 1912 Chinese college students. Methods: A total of 33 symptoms including general physical symptoms, cardiopulmonary system, digestive system, neurological system, mental health and other symptoms were investigated three months after recovery from COVID-19, and these symptoms are identified using latent class analysis. Results: Three clusters were identified through latent class analysis: 13.2% with severe impairment (cluster 1), 27.2% with mild physical symptoms (cluster 2), and 59.5% with no or mild symptoms (cluster 3). The students who smoked, drank alcohol, did not exercise, or had a history of underlying medical conditions were more likely to have moderate to severe symptoms. Conclusions: Young COVID-19 survivors with a history of underlying diseases and unhealthy habits are more likely to have moderate to severe COVID-19 sequelae. Varying degrees of symptoms should be treated with different rehabilitation plans.

Fatigue and cognitive dysfunction in previously hospitalized patients with COVID-19: A 1-year follow-up

PURPOSE

The aim was to longitudinally explore changes in fatigue- and cognition-related symptoms during the first year after hospital treatment for COVID-19.

METHOD

Patients hospitalized for COVID-19 in Gothenburg, Sweden, were consecutively included from 01-07-2020 to 28-02-2021. Patients were assessed at the hospital (acute) and at 3 and 12 months after hospital discharge. Cognition was assessed with the Montreal Cognitive Assessment (MoCA), the Trail Making Test B (TMTB), and the Cognitive Failure Questionnaire (CFQ). Fatigue was assessed using the Multidimensional Fatigue Inventory-20 (MFI-20) and the Mental Fatigue Scale (MFS). Data was analyzed with demographics and changes over time calculated with univariable mixed-effects models.

RESULT

In total, 122 participants were included. Analyzes of Z-scores for MoCA indicated improvement over the year, however the results were 1 SD below norm at all assessments. Alertness (TMTB scores) improved significantly from the acute assessment to the 12- month follow-up (p = <0.001, 95% CI 34.67-69.67). CFQ scores indicated cognitive impairment, and the sum scores for MFI reflected a relatively high degree of fatigue at follow-up.

CONCLUSION

In the first year after hospitalization for COVID-19, most patients experienced fatigue and cognitive impairment. Alertness improved, but improvements in other domains were limited.

Effects of bottom-up and top-down attentional processes on change blindness for COVID-related stimuli: influence of heart rate variability

Introduction

Top-down mechanisms that regulate attentional control are influenced by task demands and individuals' goals, while bottom-up processes are influenced by salient stimuli. Analogous networks are involved in both processes (e.g., frontostriatal areas). However, they are affected differently by the emotional salience of stimuli, which determines the allocation of attention. This study aims to determine whether the recent pandemic experience continues to exert an influence on cognitive processes. To this end, the study will determine attentional biases toward pandemic-related stimuli compared to negative and neutral stimuli. Furthermore, the study will investigate whether pandemic-related stimuli influence top-down and bottom-up attentional processes and whether the latter affect autonomic control as indexed by Heart Rate Variability (HRV).

Methods

Ninety-six undergraduate students completed a Flicker Task with stimuli categorized by emotional valence (neutral, negative non-COVID, negative COVID-related). This paradigm involves the presentation of two different pictures, which are identical except for a specific detail. The task required to detect the specific detail that has been changed. Given that the task employs images of natural scenes, participants tend to focus more on specific areas of the scene than others. As a result, changes in central interest (CI) areas are detected more rapidly than changes in marginal interest (MI) areas. Participants' response times (RTs) at the task and their HRV data were used to assess attentional performance and the associated autonomic nervous system activity.

Results

The results indicate slower responses to COVID-related stimuli than negative and neutral stimuli for both CI and MI changes, requiring the involvement of bottom-up (CI changes) and top-down (MI changes) processes. The HRV was associated with a slower detection of CI changes in COVID-related scenes.

Discussion

These findings highlight the intricate interplay between emotional salience, attentional mechanisms, and physiological responses to threatening stimuli. Contextual factors, particularly those related to pandemic-related stress, influence attentional processing and its relationship with autonomic activity.

Unraveling the relationships among pandemic fear, cyberchondria, and alexithymia after China's exit from the zero-COVID policy: insights from a multi-center network analysis

Objective

China's abrupt exit from the zero-COVID policy in late 2022 led to a rapid surge in infections, overwhelming healthcare systems and exposing healthcare providers to intensified psychological pressures. This sudden shift exacerbated pandemic-related psychological issues, including fear, health anxiety, and emotional processing difficulties. This study aimed to unravel the relationships among pandemic fear, cyberchondria, and alexithymia following China's exit from the zero-COVID policy.

Methods

A multi-center cross-sectional survey was conducted among 4088 nurses from 43 public hospitals in China. The web-based survey comprised the Fear of COVID-19 Scale, Cyberchondria Severity Scale, and Toronto Alexithymia Scale. Network analysis was employed to explore the interconnections and identify central components within these psychological and behavioral constructs.

Results

The analysis revealed a dense network with predominantly positive connections. Specific aspects of cyberchondria and pandemic fear exhibited the highest strength centrality, indicating their critical influence. The externally oriented thinking dimension of alexithymia emerged as a crucial bridge node, linking pandemic fear and cyberchondria. The network structure demonstrated consistency across diverse educational backgrounds and career stages.

Conclusion

These findings highlight the need for targeted interventions focusing on key network components, particularly externally oriented thinking, to disrupt the detrimental cycle of pandemic fear and cyberchondria. Healthcare organizations should promote balanced objective fact-focused and problem-solving approaches while also fostering skills in emotional awareness and expression, thereby mitigating the risk of maladaptive pandemic fear responses and dysfunctional online health information-seeking behaviors.

Protocol for an ambidirectional cohort study on long COVID and the healthcare needs, use and barriers to access health services in a large city in Southeast Brazil

INTRODUCTION

Post-COVID-19 condition, or syndrome, also known as long COVID, is an infection-associated chronic condition that can develop after a SARS-CoV-2 infection and last at least 3 months to years. Despite representing a high burden for the Unified Health System (SUS), which has affected millions of Brazilians, it has received limited attention in Brazil. Prevalence studies to date have failed to include a broad representation of the population, and there has been insufficient exploration of the impact on people's lives and the burden of and barriers to accessing health services. This article presents the research protocol for the quantitative component of a mixed methods project to produce evidence to inform SUS's provision of care for long COVID. The protocol was designed to study long COVID in SUS patients hospitalised for COVID-19 in a large city in Southeast Brazil to capture symptoms and factors associated with the syndrome, effects on quality of life and employment, health needs, use of health services and barriers to accessing necessary healthcare.

METHODS AND ANALYSIS

An ambidirectional cohort study to capture data retrospectively and prospectively from adults previously discharged from SUS hospitals for COVID-19. The study involves up to two telephone surveys with the patients or proxies selected from a sampling plan for population estimates. Survey questions include baseline and follow-up data on demographic, socioeconomic, comorbidities, work status, health-related quality of life, vaccination status, long COVID symptoms, healthcare needs, use and barriers to access. Descriptive and appropriate multivariable analyses will be employed.

ETHICS AND DISSEMINATION

The project was approved by the Research Ethics Committees of participant institutions and by the Brazilian National Research Ethics Commission. All participants provided verbal consent. We plan to publish articles in scientific journals and multimedia resources for SUS professionals and the general population.