Search Results (499)

People living with HIV (PLWH) faced diverse challenges during the COVID-19 pandemic, including disruptions to care, housing instability, emotional distress, and economic hardship. This study used graph-based clustering methods to analyze pandemic-era experiences of PLWH in a national sample from the NIH’s All of Us dataset (n = 242). Across three graph configurations we identified consistent subgroups shaped by social connectedness, housing stability, emotional well-being, and engagement with preventive behaviors. Comparison with an earlier local study of PLWH in Illinois confirmed recurring patterns of vulnerability and resilience while also revealing additional national-level subgroups not observed in the smaller sample. Subgroups with strong social or institutional ties were associated with greater emotional stability and proactive engagement with COVID-19 preventive behaviors, while those facing isolation and structural hardship exhibited elevated distress and limited engagement with COVID-19 preventive measures. These findings underscore the importance of precision public health strategies that reflect the heterogeneity of PLWH and suggest that strengthening social support networks, promoting housing stability, and leveraging institutional connections may enhance pandemic preparedness and HIV care in future public health crises. Full article

Avian influenza viruses (AIVs) pose significant risks to occupational populations engaged in poultry farming, livestock handling, and live poultry market operations due to frequent exposure to infected animals and contaminated environments. This review synthesizes evidence on AIV exposure patterns and risk factors through a comprehensive analysis of viral characteristics, host dynamics, environmental influences, and human behaviors. The main routes of transmission include direct animal contact, respiratory contact during slaughter/milking, and environmental contamination (aerosols, raw milk, shared equipment). Risks increase as the virus adapts between species, survives longer in cold/wet conditions, and spreads through wild bird migration (long-distance transmission) and live bird trade (local transmission). Recommended control measures include integrated animal–human–environment surveillance, stringent biosecurity measures, vaccination, and education. These findings underscore the urgent need for global ‘One Health’ collaboration to assess risk and implement preventive measures against potentially pandemic strains of influenza A viruses, especially in light of undetected mild/asymptomatic cases and incomplete knowledge of viral evolution. Full article

Background/Objective: A growing body of international research continues to show evidence of worsening youth mental health since the beginning of the COVID-19 global pandemic, yet very little research in this area has included young children under 6 years. Given the potential impact of early life stress during this critical period of development, it is crucial to better understand the effects on this age group. The objective of this study was to better understand the impact of the COVID-19 pandemic on the emotional health of very young children. Methods: This study utilized retrospective chart review of primary care records to compare the prevalence of markers of stress in two cohorts of children under the age of 6 years, comparing children presenting for care prior to the pandemic (1 April 2019–31 March 2020; control period) with those presenting for care during the first year of the pandemic (1 April 2020–31 March 2021; study period) in a large pediatric primary care clinic in Washington, DC, USA. Based on power calculations, charts of 200 patients from each cohort were reviewed and prevalence of stress markers were summarized using counts and percentages and compared between groups using chi-squared tests. Multivariable logistic regression models were also conducted for each domain adjusting for age, gender, and insurance type. Results: Overall, sleep difficulties were significantly more prevalent during the pandemic period compared to the control period (14% vs. 6.5%, p = 0.013). In addition, signs of stress presented differently across age groups. For example, during the pandemic period toddlers (13–35 months) were 13 times more likely (OR = 13, 95% CI [2.82, 60.4], p < 0.001) and preschool-aged children (36–71 months) were 18.5 times more likely (OR = 18.5, 95% CI [4.0, 86], p < 0.001) than infants to present with behavior problems, indicating substantially higher risk of externalizing symptoms in older children compared to infants. Toddlers were less likely than infants to present with mood changes (e.g., fussiness or crying) (OR = 0.15, 95% CI [0.03, 0.65], p = 0.011). In addition, toddlers (OR = 0.55, 95% CI [0.31, 0.97], p = 0.038) and preschool-aged children (OR = 0.15, 95% CI [0.06, 0.4], p < 0.001) were also less likely to present with feeding difficulties compared to infants. Conclusions: One of the very few studies of young children under 6 years (including infants) during the COVID-19 pandemic, this study found that even very young children experienced stress during the pandemic. Signs of emotional stress were identified in a primary care office during routine care, highlighting an important opportunity for early intervention and/or prevention, such as counseling and resources for caregivers, in settings where young children are already presenting for routine care. Full article

The COVID-19 pandemic caused immense physical disruptions, affecting young adults in the U.S. The Health Belief Model is a social psychological framework that predicts the likelihood of adopting health behavior. The purpose of this research is to investigate COVID-19-related health beliefs and dietary behaviors among undergraduate students during the pandemic. Using convenience sampling, a cross-sectional survey was completed by 304 individuals at a New Jersey state university. Survey data included the frequency of COVID-19 prevention behaviors (e.g., wearing an indoor mask, handwashing), and consumption of fruit and vegetables. The Health Belief Model constructs measured perceived susceptibility to COVID-19, severity, benefits, barriers, and self-efficacy. Frequency distributions, t-tests, and Kruskal–Wallis tests were investigated for racial subgroups (Whites, Blacks, Latinos, and Asians). The mean age of the sample was 21.7, with 27% males, and 46% self-identified as White. Whites adopted fewer COVID-19 prevention behaviors (p < 0.001) than non-Whites. Black students perceived less COVID-19 severity (p < 0.01) and stronger perceived benefits (p < 0.05) than the other subgroups. Latino students perceived greater susceptibility (p < 0.01) and greater barriers than non-Latinos. Asians practiced higher mask wearing frequency (p < 0.05) but less daily fruit intake than their counterparts (p < 0.01). This research highlights the importance of handwashing, wearing indoor masks, and consuming produce among university students. Addressing barriers to health action while promoting the benefits of enacting behaviors to mitigate the risk of COVID-19 is warranted. Full article

Background The COVID-19 epidemic had a deleterious impact on mental health and substance abuse and led to an increase in several forms of violence, including self-harm and interpersonal violence among youth from low- and middle-income countries. Nevertheless, the relationship between the variables and their directionality has not been recognized. This study describes the relationship directionality between these variables among 18- to 20-year-old Mexican youths during the COVID-19 pandemic. Methods The longitudinal cohort study comprises an evolving group of young Mexican adults: 1390 participants aged 18 in 2021, 654 aged 19 in 2022, and 442 aged 20 in 2023. Proportions by sex—50% were matched in every cohort, and the evolution–age sample accomplishment accounted for 47% in 2022 and 32% in 2023. Results According to a structural equation model, which fit the data from 195 iterations with 246 parameters (X²[2722] = 8327.33, p < 0.001), yielding a CFI of 0.946, a TLI of 0.943, and an RMSEA of 0.029 [0.028–0.029]), perpetrating intimate violence, preceded by suffering intimate violence, combined with suffering anxiety symptoms, was associated with self-harm–suicide thoughts and behaviors (ShSTB), marked distress, dysfunction, and somatization symptoms. The relationship was stronger in women and 20-year-old Mexicans. In men, this pathway was exclusively associated with ShSTB. Suffering from intimate violence has been associated with depression, anxiety, and PTSD symptoms, as well as harmful alcohol use. Conclusions During an epidemic, prevention programs should be designed to warn about self-harm–suicide thoughts and behaviors, not only to ensure the safety of the victims of intimate personal-violence but also to prevent the suicidal behavior of perpetrators. Full article

Congenital Rubella Syndrome (CRS) results from maternal infection with the rubella virus during pregnancy, particularly in the first trimester, when the risk of vertical transmission and severe fetal damage is highest. CRS is characterized by a broad spectrum of congenital anomalies, including sensorineural hearing loss, congenital heart defects, cataracts, neurodevelopmental delay, and behavioral disorders. Despite the absence of specific antiviral therapies, active immunization remains the only effective strategy to prevent rubella infection and its congenital consequences. Global immunization efforts, particularly in the Americas, have led to the elimination of rubella and CRS in several countries. However, challenges persist in the post-elimination era, including declining vaccine coverage, vaccine hesitancy, and setbacks caused by the COVID-19 pandemic. Diagnosis relies on maternal serology, fetal imaging, postnatal antibody testing, and molecular techniques. Management requires long-term, multidisciplinary follow-up due to the complex and lifelong sequelae affecting sensory, motor, and cognitive development. This review highlights the clinical, epidemiological, and pathophysiological aspects of CRS, while emphasizing the urgent need to maintain high vaccination coverage and strengthen surveillance systems. Sustained public health commitment is essential to prevent the reemergence of rubella and protect future generations from this preventable syndrome. Full article

Introduction: The COVID-19 pandemic highlighted the need for digital tools that support public health decision-making and behavior change. Dashboards became a primary method for communicating infectious disease data. However, their influence on preventive health behaviors (PHBs) is not well understood—especially among young adults. This group is less likely to adhere to PHBs, but highly familiar with online tools. Methods: Two experimental studies were conducted with young adult participants (200 in Study 1, 228 in Study 2) who viewed the same COVID-19 data in dashboards with or without actionable components. Participants were randomly assigned to different dashboard conditions to measure, on seven-point Likert scales, their PHB intentions and perceptions of behavioral control, attitudes, norms, and risk. The actionable dashboard interventions, designed using the theory of planned behavior, included dynamic behavioral guidance and risk level visualizations. Results: Actionable dashboards versus basic dashboards significantly increased PHB intentions (B = 0.84, p < 0.001, Study 1). Dynamic behavioral guidance was the key dashboard component influencing PHB intentions (B = 0.61, p = 0.005, Study 2). Parallel mediation analysis testing norms, attitudes, behavioral control, and perceived risk against one another found that only norms explained the link between the dashboard intervention and PHB intentions (B_boot = 0.18 and 0.19). Conclusions: Findings suggest that actionable dashboards can effectively promote PHB by influencing psychosocial beliefs. These dashboards provide context and guidance, making risky situations more manageable and directing individuals to appropriate preventive actions. Public health professionals should consider incorporating behavioral guidance into community health dashboards to improve their effectiveness. Full article

Background: The COVID-19 pandemic highlighted the crucial role of community preventive behaviors in controlling the virus’ spread. Studies show that people’s risk perceptions and awareness significantly contribute to the containment and prevention of infections by motivating adoption of desired actions and behaviors. This study aimed at assessing the role of risk communication and factors that influenced responses during the COVID-19 pandemic in rural communities in Western Kenya. Methods: A descriptive cross-sectional study was conducted using a quantitative research approach, collecting data from 806 individuals across Kisumu, Vihiga, and Kakamega counties. Descriptive statistics were used to detail the demographic characteristics of the study population, while logistic regression analysis estimated the associations between risk communication and demographic characteristics on COVID-19 vaccine acceptance, compliance with mitigation behaviors, perceived severity, and perceived susceptibility. Results: The results showed that 55% of participants were male and 45% were female, with an average moderate compliance with safety measures (mean = 5.15). A significant portion of participants wore face masks (85.3%), practiced hand hygiene (78.9%), and avoided close contact behaviors (66.6%). Most respondents received information through mass media (86.1%) and health workers (72.9%). Compliance with COVID-19 mitigation measures was highest among those who trusted information from official institutions, health professionals, and mass media, compared to social media, with increased odds of 2.7 times and 2.5 times, respectively. Higher risk perception was significantly associated with older age groups (above 50 years), being male, and working in the private sector. Effective risk communication significantly influenced risk perception, compliance with COVID-19 measures, and vaccination acceptance. Conclusions: The findings suggest that effective risk communication strategies are critical during public health emergencies and hence implications for future public health crises. The results underscore the importance of targeted communication and tailored interventions to improve compliance and vaccine acceptance among different demographic groups, ensuring a more robust public health response during outbreaks and pandemics. Full article

New STI/HIV diagnoses disproportionately impact U.S. Black cisgender women at higher rates compared to other racial/ethnic U.S. cisgender women. Biomedical HIV prevention interventions, such as HIV Pre-Exposure Prophylaxis, have demonstrated lower uptake among Black women. Given the need to further develop prevention interventions that meet the sexual and reproductive health (SRH) needs of U.S. Black women, this study aimed to identify and characterize condom use behaviors, sexual communication efficacy, and SRH healthcare utilization among sexually experienced young Black women (YBW) aged 18–25 (N = 206). Participants completed a self-administered questionnaire assessing sexual and conception vulnerability, sexual/reproductive healthcare utilization, and sexual communication efficacy. Descriptive statistics and univariate analyses were conducted to identify correlations in sexual and reproductive behaviors. The results showed that 32% of YBW used a condom during their last sexual encounter. Five distinct trends in condom use were identified, three of which included condomless vaginal/oral sex. YBW reported high levels of sexual communication with sexual partners and consistent engagement in sexual/reproductive health care, including abortion care. Young Black women have diverse sexual/reproductive health needs and require culturally responsive patient-centered clinical practices aimed at reducing STI/HIV rates and unintended pregnancies. Future research could examine healthcare providers’ understanding of Black women’s SRH priorities and assess how this knowledge aligns with or diverges from established clinical guidelines and best practices. Such inquiries could illuminate potential gaps in provider education and clinical practice, ultimately informing the development of care models that are both evidence-based and responsive to the lived experiences of young Black women. Full article

Background: The COVID-19 pandemic has been associated with rising obesity rates. Autistic children have a higher risk of obesity than neurotypical children. Our study aims to describe the changes in overweight/obesity rates in autistic children during the pandemic, and to identify contributing factors. Methods: This is a retrospective case record review of patients with a clinical diagnosis of autism, who were seen at a developmental-behavioral pediatrics clinic in a tertiary academic hospital, between 1 January 2019 and 24 October 2021. We compared the average monthly rates of overweight/obese status pre- and during the pandemic. We collected data on the patients’ and parents’ demographics, duration of screen time per day, degree of difficulties related to autism symptoms and cognition. We analyzed factors associated with being overweight/obese during the pandemic. Results: 1330 patient visits were included. The mean age was 45.4 months; 78% were male; 52% were Chinese. The average monthly rate of overweight/obese status increased by 1.8% during the pandemic (17.9% pre-pandemic; 19.7% during pandemic). Factors associated with being overweight/obese during the pandemic included: Malay ethnicity (OR 2.321, p < 0.01), developmental delay (OR 2.80, p < 0.01), and lower parental education level (father OR 1.73, p = 0.01; mother OR 1.63, p = 0.03). On multivariate analysis, only Malay ethnicity (OR 2.95, p = 0.01) was significant. Conclusions: Our study demonstrates a rising overweight/obesity rate amongst children with autism spectrum disorder during the pandemic. It also identified higher-risk patient profiles (Malay race, developmental delay, lower parental education). We hope this will facilitate the implementation of preventative health measures specifically supporting the high-risk children. Full article

A key goal of inclusive education is to enhance health literacy skills, empowering students with intellectual disabilities (IDs) to access critical information needed to navigate everyday challenges. The COVID-19 pandemic, for example, highlighted unique barriers to preparedness for people with IDs regarding social behavior and decision-making. This study aimed to examine students’ awareness and understanding of pandemic outbreaks. Using an inquiry-based approach supported by Digital Learning Objects (DLOs), the research assessed students’ knowledge and perceptions of viruses, modes of transmission, and preventive measures. An in-depth visual analysis within a single-subject research design demonstrated that interdisciplinary educational scenarios on infectious diseases can be effective for students with ID, especially when DLOs are integrated with targeted instructional techniques. Full article

The phenomenon of suicide has become a significant global concern, claiming over 800,000 lives annually and resulting in millions of suicide attempts worldwide. In the aftermath of the COVID-19 pandemic, these troubling statistics have worsened, with notable increases in suicidal behavior, especially among vulnerable populations such as the youth, the elderly, and those in socioeconomically disadvantaged groups. This paper aims to explore the impact of the COVID-19 pandemic on suicide rates in Spain, using a theoretical ex post facto analysis. Spain has witnessed an alarming rise in suicide rates, particularly among young people, and a disturbing trend of increased suicidal ideation and self-harm behaviors. While some studies report no significant change in suicide rates during the pandemic, others point to the exacerbating effects of social isolation, economic instability, and public health measures. This study provides an in-depth examination of the psychosocial consequences of the pandemic on mental health in Spain, emphasizing the urgency of the need to address pre-existing inequalities and implement effective suicide prevention measures. Furthermore, it highlights the importance of gender-sensitive strategies and the need for systemic reforms to ensure better mental healthcare access for all segments of society. To achieve this goal, this paper uses a narrative literature review combined with a theoretical ex post facto analysis to assess the influence of the COVID-19 pandemic on suicide patterns in Spain. Full article

Background: The persuasive systems design approach draws together theories around persuasive technology and their psychological foundations to form, alter and/or reinforce compliance, attitudes, and/or behaviors, which have been useful in building health and wellness apps. But with pandemics such as COVID and their ever-changing landscape, there is a need for such design processes to be even more time sensitive, while maintaining the inclusion of empirical evidence and rigorous testing that are the basis for the approach’s successful deployment and uptake. Objective: In response to this need, this study applied a recently developed rapid persuasive systems design (R-PSD) process to the development and testing of a COVID support app. The aim of this effort was to identify concrete steps for when and how to build new persuasion features on top of existing features in existing apps to support the changing landscape of target behaviors from COVID tracing and tracking, to long-term COVID support, information, and prevention. Methods: This study employed a two-fold approach to achieve this objective. First, a rapid persuasive systems design framework was implemented. A technology scan of current COVID apps was conducted to identify apps that had employed PSD principles, in the context of an ongoing analysis of behavioral challenges and needs that were surfacing in public health reports and other sources. Second, a test case of the R-PSD framework was implemented in the context of providing COVID support by building a COVID support app prototype. The COVID support prototype was then evaluated and tested to assess the effectiveness of the integrated approach. Results: The results of the study revealed the potential success that can be obtained from the application of the R-PSD framework to the development of rapid release apps. Importantly, this application provides the first concrete example of how the R-PSD framework can be operationalized to produce a functional, user-informed app under real-world time and resource constraints. Further, the persuasive design categories enabled the identification of essential persuasive features required for app development that are intended to facilitate, support, or precipitate behavior change. The small sample study facilitated the quick iteration of the app design to ensure time sensitivity and empirical evidence-based application improvements. The R-PSD approach can serve as a guided and practical design approach for future rapid release apps particularly in relation to the development of support apps for pandemics or other time-urgent community emergencies. Full article

COVID-19 introduced widespread challenges in healthcare access and was demonstrated to be a significant stressor for patients with pelvic floor dysfunction (PFD). Pelvic Floor Physical Therapy (PFPT) is a first line behavioral modification to address PFD. The impact of COVID-19 on PFPT adherence rates in a urogynecologic population is unknown; therefore, a retrospective chart review was conducted looking at “pre-pandemic” (referring to before 1 March 2020) and “pandemic” (referring to after 1 March 2020) cohorts. A total of 173 women met the inclusion criteria (93 pre-pandemic vs. 80 pandemic). The PFPT adherence rates were similar between the pre-pandemic and pandemic groups (20.0% vs. 18.8%, p = 0.85). Patient-reported barriers to initiation included insurance coverage, transportation, and time commitment. When looking for clinical correlates associated with non-adherence, patients who utilized an internal referral to a hospital-associated PFPT facility were 4.9-fold more likely to adhere to PFPT for PFD (95% confidence interval: 1.31–18.23, p = 0.018). While COVID-19 was not identified as a barrier to PFPT adherence, identifying barriers preventing patients from attending PFPT remains an area for improvement. Increasing the utilization of an internal referral system to a hospital-associated PFPT facility may be an effective solution for increasing patient adherence. Full article

Background/Objectives: The co-morbidity between neurodevelopmental tics and functional tic-like behaviors (FTBs) in patients with Tourette syndrome (TS) is relatively under-investigated. The demographic and clinical characteristics of a large sample of patients with TS who presented with co-morbid FTBs (functional overlay) were assessed to raise awareness of this complex clinical presentation and to shed light on the differential diagnosis between the two conditions. Methods: We analyzed the clinical data of 63 patients (44 females, mean age 24 years, range 13–40) with pre-existing TS who (sub)acutely developed co-morbid FTBs (TS + FTBs) after the onset of the COVID-19 pandemic and compared them with 63 age- and gender-matched controls with TS (neurodevelopmental tics only). The diagnosis of co-morbid FTBs was validated by the European Society for the Study of Tourette Syndrome (ESSTS) criteria. Results: Complex vocal tics (p < 0.001), including coprolalia (p = 0.002), and self-injurious behaviors (p < 0.001), often as part of tic attacks (p < 0.001), were confirmed to be more commonly reported by the group of patients with TS + FTBs, who were also more likely to present with anxiety (p < 0.001) and other functional neurological symptoms (p < 0.001) compared to patients with TS. Conclusions: Patients with TS and co-morbid FTBs can pose significant diagnostic and treatment challenges. By systematically applying ESSTS criteria, we confirmed specific red flags for the diagnosis of functional overlay in patients with TS. The correct identification of this composite clinical phenotype plays a key role in preventing the misdiagnosis of treatment-resistant TS and implementing tailored treatment interventions. Full article