Impacts of Digital Healthy Diet Literacy and Healthy Eating Behavior on Fear of COVID-19, Changes in Mental Health, and Health-Related Quality of Life among Front-Line Health Care Workers

Nguyen M.H., Pham T.T., Nguyen K.T., Nguyen Y.H., Tran T.V., Do B.N., Dao H.K., Nguyen H.C., Do N.T., Ha T.H., Phan D.T., Pham K.M., Pham L.V., Nguyen P.B., Nguyen H.T., et. al.

Background: The COVID-19 pandemic has been disseminating fear in the community, which has affected people’s quality of life, especially those with health problems. Health literacy (HL), eHealth literacy (eHEAL), and digital healthy diet literacy (DDL) may have potential impacts on containing the pandemic and its consequences. This study aimed to examine the association between the fear of COVID-19 scale (FCoV-19S) and the health-related quality of life (HRQoL), and to examine the effect modification by HL, eHEAL, and DDL on this association. Methods: A cross-sectional study was conducted in 11 hospitals across Vietnam from 7 April to 31 May 2020. Data were collected on 4348 outpatients, including demographic characteristics, HL, eHEAL, DDL, FCoV-19S, and HRQoL. Multiple linear regression and interaction models were used to explore associations. Results: Patients with higher FCoV-19S scores had lower HRQoL scores (unstandardized coefficient, B = −0.78, p < 0.001). HL (B = 0.20, p < 0.001), eHEAL (B = 0.24, p < 0.001), and DDL (B = 0.20, p < 0.001) were positively associated with higher HRQoL scores. The negative impact of FCoV-19S on HRQoL was significantly attenuated by higher eHEAL score groups (from one standard deviation (SD) below the mean, B = −0.93, p < 0.001; to the mean, B = −0.85, p < 0.001; and one SD above the mean, B = −0.77, p < 0.001); and by higher DDL score groups (from one SD below the mean, B = −0.92, p < 0.001; to the mean, B = −0.82, p < 0.001; and one SD above the mean, B = −0.72, p < 0.001). Conclusions: eHealth literacy and digital healthy diet literacy could help to protect patients’ health-related quality of life from the negative impact of the fear of COVID-19 during the pandemic.

Liu S., Yang L., Zhang C., Xu Y., Cai L., Ma S., Wang Y., Cai Z., Du H., Li R., Kang L., Zheng H., Liu Z., Zhang B.

The coronavirus disease 2019 (COVID-19) pandemic has imposed both physical and psychological burdens on healthcare workers (HCWs). What is more, few studies have focused on the gender differences in mental health problems (MHPs) among HCWs during such an outbreak. Thus, the current study investigated the prevalence and gender differences of various MHPs among HCWs in China during the COVID-19 outbreak. This nationwide survey was conducted online from January 29 to February 3, 2020. General information was collected by questions about socio-demographics, work-related factors, and living situations. Depressive, anxiety, stress, and insomnia symptoms were assessed by the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Impact of Event Scale-Revised, and the Insomnia Severity Index, respectively. Among the 2198 contacted HCWs, 1563 (71.1%) responded with valid data, of whom 1293 (82.7%) were females. The prevalences of depressive, anxiety, stress, and insomnia symptoms in participants were 50.7%, 44.7%, 52.5%, and 36.1%, respectively. Female HCWs had significantly higher scores in all four scales ( p < 0.001) and higher prevalences in all MHPs involved (range, odds ratio [OR] 1.55–1.97). After adjusting for potential confounders, female HCWs still had higher risks for all MHPs involved than males (range, adjusted OR 1.36–1.96). HCWs present high prevalences of depressive, anxiety, stress, and insomnia symptoms during the COVID-19 outbreak. Furthermore, female HCWs are more vulnerable to all MHPs involved. These findings highlight the need for timely, special care and support for HCWs during the outbreak, especially for females. • Healthcare workers had high prevalences of mental problems in the COVID-19 pandemic. • Female healthcare workers are more vulnerable to mental health problems. • Timely and special care for healthcare workers, especially for females, is needed.

Hoang T.D., Colebunders R., Fodjo J.N., Nguyen N.P., Tran T.D., Vo T.V.

The COVID-19 pandemic and associated restrictive measures implemented may considerably affect people’s lives. This study aimed to assess the well-being of Vietnamese people after COVID-19 lockdown measures were lifted and life gradually returned to normal. An online survey was organized from 21 to 25 April 2020 among Vietnamese residents aged 18 and over. The survey was launched by the Hue University of Medicine and Pharmacy. The WHO-5 Well-Being Index (scored 0–25) was used to score participants’ well-being. A multivariate logistic regression model was used to determine the predictors of well-being. A total of 1922 responses were analyzed (mean age: 31 years; 30.5% male; 88.2% health professionals or students in the health sector). The mean well-being score was 17.35 ± 4.97. Determinants of a high well-being score (≥13) included older age, eating healthy food, practicing physical exercise, working from home, and adhering to the COVID-19 preventive measures. Female participants, persons worried about their relatives’ health, and smokers were more likely to have a low well-being score. In conclusion, after the lockdown measures were lifted, the Vietnamese have people continued to follow COVID-19 preventive measures, and most of them scored high on the well-being scale. Waiting to achieve large-scale COVID-19 vaccine coverage, promoting preventive COVID-19 measures remains important, together with strategies to guarantee the well-being of the Vietnamese people.

Collantoni E., Saieva A.M., Meregalli V., Girotto C., Carretta G., Boemo D.G., Bordignon G., Capizzi A., Contessa C., Nesoti M.V., Donato D., Flesia L., Favaro A.

The COVID-19 pandemic is causing a heavy burden in hospital healthcare workers (HCW) in terms of increased work, organizational changes, risk exposure, and social stigma. The present study aims at evaluating the psychological outcome among HCWs at the final stages of the first wave of the COVID-19 pandemic. This cross-sectional and survey-based study was conducted during June 2020 among 996 HCWs of the University Hospital of Padova. All the subjects completed questionnaires investigating the perception of risk of infecting or being infected by COVID-19, psychopathological variables, and coping abilities. Compared to physicians and healthcare assistants, nurses showed higher levels of depression (p = 0.002), insomnia (p < 0.001), and generalized anxiety (p = 0.001). Females reported increased concerns about the possibility of infecting others (p = 0.046), greater anxiety (p < 0.001), COVID-19 related fears (p < 0.001), depression (p < 0.001), and post-traumatic distress (p < 0.001) than males. Being employed in a COVID-19 unit, being transferred to other units, and living with children and the elderly were factors associated with higher levels of psychological distress. Greater coping abilities were detected in physicians, and in those HCWs employed in COVID units. Our findings evidenced that the psychological consequences of the pandemic were non-homogeneously distributed across HCWs categories and pointed out the presence of specific in-hospital and out-of-hospital risk factors.

Sahebi A., Nejati-Zarnaqi B., Moayedi S., Yousefi K., Torres M., Golitaleb M.

Healthcare workers, who are at the forefront of the fight against COVID-19, are particularly susceptible to physical and mental health consequences such as anxiety and depression. The aim of this umbrella review of meta-analyses is to determine the prevalence of anxiety and depression among healthcare workers during the COVID-19 pandemic.Using relevant keywords, data resources including PubMed, Scopus, Web of Science, Cochrane, ProQuest, Science Direct, Google Scholar and Embase were searched to obtain systematic reviews and meta-analyses reporting the prevalence of anxiety and depression among healthcare workers during the COVID-19 pandemic from the beginning of January to the end of October 2020. The random effects model was used for meta-analysis, and the I2 index was employed to assess heterogeneity among studies. Data was analyzed using STATA 14 software.In the primary search, 103 studies were identified, and ultimately 7 studies were included in the umbrella review. The results showed that the overall prevalence of anxiety and depression among healthcare workers during the COVID-19 pandemic was 24.94% (95% CI: 21.83-28.05, I2 = 0.0%, P = 0.804) and 24.83% (95% CI: 21.41-28.25, I2 = 0.0%, P = 0.897), respectively.This umbrella review shows that the prevalence of anxiety and depression is relatively high among healthcare workers during the COVID-19 pandemic. Healthcare workers should be provided with resources to minimize this risk.

Zaçe D., Hoxhaj I., Orfino A., Viteritti A.M., Janiri L., Di Pietro M.L.

Considering the importance of evidence on interventions to tackle mental health problems in healthcare workers (HCWs) during pandemics, we conducted a systematic review, aiming to identify and summarize the implemented interventions to deal with mental health issues of HCWs during infectious disease outbreaks and report their effectiveness. Web of Science, PubMed, Cochrane, Scopus, CINAHL and PsycInfo electronic databases were searched until October 2nd, 2020. Primary-data articles, describing any implemented interventions and their effectiveness were considered pertinent. Studies were screened according to the inclusion/exclusion criteria and subsequently data extraction was performed. Twenty-four articles, referring to SARS, Ebola, Influenza AH1N1 and COVID-19 were included. Interventions addressing mental health issues in HCWs during pandemics/epidemics were grouped into four categories: 1) informational support (training, guidelines, prevention programs), 2) instrumental support (personal protective equipment, protection protocols); 3) organizational support (manpower allocation, working hours, re-organization of facilities/structures, provision of rest areas); 4) emotional and psychological support (psychoeducation and training, mental health support team, peer-support and counselling, therapy, digital platforms and tele-support). These results might be helpful for researchers, stakeholders, and policymakers to develop evidence-based sustainable interventions and guidelines, aiming to prevent or reduce the immediate and long-term effect of pandemics on mental health status of HCWs.

Nguyen P.T., Nguyen T.B., Pham A.G., Duong K.N., Gloria M.A., Vo T.V., Vo B.V., Phung T.L.

Introduction: Coronavirus disease 2019 (COVID-19) has significantly affected health care workers (HCWs), including their mental health. However, there has been limited evidence on this topic in the Vietnamese context. Therefore, this study aimed to explore COVID-19-related, psychological stress risk factors among HCWs, their concerns and demands for mental health support during the pandemic period.Methods: We employed a cross-sectional study design with convenience sampling. An online, self-administered questionnaire was used and distributed through social media among medical and non-medical HCWs from April 22 to May 12, 2020. HCWs were categorized either as frontline or non-frontline. We measured the prevalence of psychological stress using the Impact of Event Scale-Revised (IES-R) instrument. Multivariate binary logistic regression analysis was performed to identify risk factors associated with psychological stress among HCWs.Results: Among the 774 enrolled participants, 761 (98.3%) eligible subjects were included in the analysis. Most respondents were females (58.2%), between 31 and 40 years of age (37.1%), lived in areas where confirmed COVID-19 cases had been reported (61.9%), medical HCWs (59.9%) and practiced being at the frontline (46.3%). The prevalence of stress was 34.3%. We identified significant risk factors such as being frontline HCWs (odds ratio [OR] = 1.77 [95% confidence interval [CI]: 1.17–2.67]), perceiving worse well-being as compared to those before the COVID-19 outbreak [OR = 4.06 (95% CI: 2.15–7.67)], and experiencing chronic diseases [OR = 1.67 (95% CI: (1.01–2.77)]. Majority (73.9%) were concerned about testing positive for COVID-19 and exposing the infection to their families. Web-based psychological interventions that could provide knowledge on managing mental distress and consulting services were highly demanded among HCWs.Conclusion: The prevalence of psychological stress among HCWs in Vietnam during the COVID-19 pandemic was high. There were also significant risk factors associated with it. Psychological interventions involving web-based consulting services are highly recommended to provide mental health support among HCWs.

The Lancet

Moitra M., Rahman M., Collins P.Y., Gohar F., Weaver M., Kinuthia J., Rössler W., Petersen S., Unutzer J., Saxena S., Huang K.Y., Lai J., Kumar M.

Background: The COVID-19 pandemic has had a significant impact on the mental health of healthcare workers (HCWs) particularly in low and middle-income countries (LMICs). This scoping review provides a summary of current evidence on the mental health consequences of COVID on HCWs.Methods: A scoping review was conducted searching PubMed and Embase for articles relevant to mental health conditions among HCWs during COVID-19. Relevant articles were screened and extracted to summarize key outcomes and findings.Results: A total of fifty-one studies were included in this review. Depressive symptoms, anxiety symptoms, psychological trauma, insomnia and sleep quality, workplace burnout and fatigue, and distress were the main outcomes reviewed. Most studies found a high number of symptoms endorsed for depression, anxiety, and other conditions. We found differences in symptoms by sex, age, and HCW role, with female, younger-aged, frontline workers, and non-physician workers being affected more than other subgroups.Conclusion: This review highlights the existing burden of mental health conditions reported by HCWs during COVID-19. It also demonstrates emerging disparities among affected HCW subgroups. This scoping review emphasizes the importance of generating high quality evidence and developing informed interventions for HCW mental health with a focus on LMICs.

Diver S., Buccheri N., Ohri C.

Cag Y., Erdem H., Gormez A., Ankarali H., Hargreaves S., Ferreira-Coimbra J., Rubulotta F., Belliato M., Berger-Estilita J., Pelosi P., Blot S., Lefrant J.Y., Mardani M., Darazam I.A., Cag Y., et. al.

We aimed to explore anxiety status across a broad range of HCWs supporting patients with COVID-19 in different global regions. This was an international online survey in which participation was on voluntary basis and data were submitted via Google Drive, across a two-week period starting from March 18, 2020. The Beck Anxiety Inventory was used to quantify the level of anxiety. 1416 HCWs (70.8% medical doctors, 26.2% nurses) responded to the survey from 75 countries. The distribution of anxiety levels was: normal/minimal ( n = 503, 35.5%), low ( n = 390, 27.5%); moderate ( n = 287, 20.3%), and severe ( n = 236, 16.7%). According to multiple generalized linear model, female gender ( p = 0.001), occupation (ie, being a nurse dealing directly with patients with COVID-19 [ p = 0.017]), being younger ( p = 0.001), reporting inadequate knowledge on COVID-19 ( p = 0.005), having insufficient personal protective equipment (p = 0.001) and poor access to hand sanitizers or liquid soaps ( p = 0.008), coexisting chronic disorders (p = 0.001) and existing mental health problems (p = 0.001), and higher income of countries where HCWs lived ( p = 0.048) were significantly associated with increased anxiety. Front-line HCWs, regardless of the levels of COVID-19 transmission in their country, are anxious when they do not feel protected. Our findings suggest that anxiety could be mitigated ensuring sufficient levels of protective personal equipment alongside greater education and information .

Salari N., Khazaie H., Hosseinian-Far A., Khaledi-Paveh B., Kazeminia M., Mohammadi M., Shohaimi S., Daneshkhah A., Eskandari S.

Stress, anxiety, and depression are some of the most important research and practice challenges for psychologists, psychiatrists, and behavioral scientists. Due to the importance of issue and the lack of general statistics on these disorders among the Hospital staff treating the COVID-19 patients, this study aims to systematically review and determine the prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients. In this research work, the systematic review, meta-analysis and meta-regression approaches are used to approximate the prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients. The keywords of prevalence, anxiety, stress, depression, psychopathy, mental illness, mental disorder, doctor, physician, nurse, hospital staff, 2019-nCoV, COVID-19, SARS-CoV-2 and Coronaviruses were used for searching the SID, MagIran, IranMedex, IranDoc, ScienceDirect, Embase, Scopus, PubMed, Web of Science (ISI) and Google Scholar databases. The search process was conducted in December 2019 to June 2020. In order to amalgamate and analyze the reported results within the collected studies, the random effects model is used. The heterogeneity of the studies is assessed using the I2 index. Lastly, the data analysis is performed within the Comprehensive Meta-Analysis software. Of the 29 studies with a total sample size of 22,380, 21 papers have reported the prevalence of depression, 23 have reported the prevalence of anxiety, and 9 studies have reported the prevalence of stress. The prevalence of depression is 24.3% (18% CI 18.2–31.6%), the prevalence of anxiety is 25.8% (95% CI 20.5–31.9%), and the prevalence of stress is 45% (95% CI 24.3–67.5%) among the hospitals’ Hospital staff caring for the COVID-19 patients. According to the results of meta-regression analysis, with increasing the sample size, the prevalence of depression and anxiety decreased, and this was statistically significant (P < 0.05), however, the prevalence of stress increased with increasing the sample size, yet this was not statistically significant (P = 0.829). The results of this study clearly demonstrate that the prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients is high. Therefore, the health policy-makers should take measures to control and prevent mental disorders in the Hospital staff.

Duffy C.C., Bass G.A., Fitzpatrick G., Doherty E.M.

Health care workers (HCWs) have been engaged in fighting dangerous epidemics for hundreds of years, more recently in severe acute respiratory syndrome, H1N1, Middle East respiratory syndrome, and now coronavirus disease 2019. A consistent feature of epidemic disease results is that health care systems and HCWs are placed under immense strain.A focused narrative review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to examine the main concerns and anxieties faced by HCWs during recent epidemics and to determine the supports deemed most important to those HCWs to keep them at the frontline. PubMed, Web of Science, and the Cochrane Library were searched in March 2020 using terms "Healthcare" OR "Medical" AND "Staff" OR "Workers" OR "Front line" AND "Concerns" OR "Anxiety" OR "Stress" AND "Pandemic" Or "Epidemic."Twenty-five studies that reported the concerns and expectations of an estimated 13,793 HCWs in 10 countries (Canada, China, Greece, Hong Kong, Japan, Liberia, Netherlands, Saudi Arabia, Singapore and Taiwan) during pandemic situations were identified. Health care workers identified personal and family safety, appreciation, and the provision of personal protective equipment and adequate rest as primary concerns. Informal psychological supports were favored over formal employment-based group interventions.Despite being hailed by the media as heroes, HCWs face social stigmatization and experienced high levels of anxiety and fear regarding personal safety and the health of their colleagues and family. Health care workers are more likely to seek peer-to-peer psychological support but also benefit from knowing that formal psychological supports are available to them.

Tran T.V., Nguyen H.C., Pham L.V., Nguyen M.H., Nguyen H.C., Ha T.H., Phan D.T., Dao H.K., Nguyen P.B., Trinh M.V., Do T.V., Nguyen H.Q., Nguyen T.T., Nguyen N.P., Tran C.Q., et. al.

ObjectivesWe examined impacts and interactions of COVID-19 response involvement, health-related behaviours and health literacy (HL) on anxiety, depression, and health-related quality of life (HRQoL) among healthcare workers (HCWs).DesignA cross-sectional study was conducted. Data were collected 6 April to 19 April 2020 using online-based, self-administered questionnaires.Setting19 hospitals and health centres in Vietnam.Participants7 124 HCWs aged 21–60 years.ResultsThe COVID-19 response-involved HCWs had higher anxiety likelihood (OR (95% CI)=4.41 (3.53 to 5.51)), higher depression likelihood (OR(95% CI)=3.31 (2.71 to 4.05)) and lower HRQoL score (coefficient, b(95% CI)=−2.14 (−2.89 to −1.38)), compared with uninvolved HCWs. Overall, HCWs who smoked or drank at unchanged/increased levels had higher likelihood of anxiety, depression and lower HRQoL scores; those with unchanged/healthier eating, unchanged/more physical activity and higher HL scores had lower likelihood of anxiety, depression and higher HRQoL scores. In comparison to uninvolved HCWs who smoked or drank at never/stopped/reduced levels, involved HCWs with unchanged/increased smoking or drinking had lower anxiety likelihood (OR(95% CI)=0.34 (0.14 to 0.83)) or (OR(95% CI)=0.26 (0.11 to 0.60)), and lower depression likelihood (OR(95% CI)=0.33 (0.15 to 0.74)) or (OR(95% CI)=0.24 (0.11 to 0.53)), respectively. In comparison with uninvolved HCWs who exercised at never/stopped/reduced levels, or with those in the lowest HL quartile, involved HCWs with unchanged/increased exercise or with one-quartile HL increment reported lower anxiety likelihood (OR(95% CI)=0.50 (0.31 to 0.81)) or (OR(95% CI)=0.57 (0.45 to 0.71)), lower depression likelihood (OR(95% CI)=0.40 (0.27 to 0.61)) or (OR(95% CI)=0.63 (0.52 to 0.76)), and higher HRQoL scores (b(95% CI)=2.08 (0.58 to 3.58)), or (b(95% CI)=1.10 (0.42 to 1.78)), respectively.ConclusionsPhysical activity and higher HL were found to protect against anxiety and depression and were associated with higher HRQoL. Unexpectedly, smoking and drinking were also found to be coping behaviours. It is important to have strategic approaches that protect HCWs’ mental health and HRQoL.

Amatori S., Donati Zeppa S., Preti A., Gervasi M., Gobbi E., Ferrini F., Rocchi M.B., Baldari C., Perroni F., Piccoli G., Stocchi V., Sestili P., Sisti D.

Social isolation has adverse effects on mental health, physical exercise, and dietary habits. This longitudinal observational study aimed to investigate the effects of mood states and exercise on nutritional choices, on 176 college students (92 males, 84 females; 23 ± 4 years old) during the COVID-19 lockdown. During 21 days, nutrition and exercise were daily monitored, and the mood states assessed. A factor analysis was used to reduce the number of nutritional variables collected. The relationships between exercise, mood and nutrition were investigated using a multivariate general linear model and a mediation model. Seven factors were found, reflecting different nutritional choices. Exercise was positively associated with fruit, vegetables and fish consumption (p = 0.004). Depression and quality of life were, directly and inversely, associated with cereals, legumes (p = 0.005; p = 0.004) and low-fat meat intake (p = 0.040; p = 0.004). Exercise mediated the effect of mood states on fruit, vegetables and fish consumption, respectively, accounting for 4.2% and 1.8% of the total variance. Poorer mood states possibly led to unhealthy dietary habits, which can themselves be linked to negative mood levels. Exercise led to healthier nutritional choices, and mediating the effects of mood states, it might represent a key measure in uncommon situations, such as home-confinement.

Selçuk Tosun A., Duran B., Akgül Gündoğdu N., Lök N.

ABSTRACTObjectiveThis study was conducted to determine the level of health literacy, digital healthy diet literacy, and physical activity of adult individuals to evaluate the relationship of physical activity with health literacy and digital healthy diet literacy and to examine the determinants of physical activity level.Design and MethodIt is a descriptive and correlational study. The sample of the study consists of 404 individuals aged 18–65. Personal Information Form, International Physical Activity Questionnaire—Short Form, Health Literacy Scale—Short Form, and Digital Healthy Diet Literacy Scale were used to collect the study data. Number, percentage, mean and standard deviation, t test in independent groups, one‐way analysis of variance, and multiple regression analysis were used in the analysis of the study data.ResultsParticipants' gender (β = 0.572, p = 0.000), educational status (β = 0.630, p = 0.000), employment status (β = 0.573, p = 0.000), perceived economic situation (β = 0.774, p = 0.000), cohabitants (β = 0.609, p = 0.000), perceived health (β = 0.580, p = 0.000), smoking status (β = 0.639, p = 0.045), health literacy total score (β = 0.603, p = 0.000), and digital health literacy (β = 0.782, p = 0.000) were found to be predictors of physical activity level (p < 0.001). It was determined that these determinants explained 57.3% (adjusted R2 = 0.573) of the change in physical activity level.ConclusionThe mean scores of the participants' physical activity level were at a medium level. Increasing the participants' awareness of health literacy and digital healthy diet literacy may be effective in increasing the level of physical activity.

Mai V.Q., Van Minh H., Lindholm L., Sun S., Kim G.B., Sahlén K.

ObjectiveThis study was conducted with the objective of exploring the usage of health-related quality of life (HRQOL) outcomes and willingness of health technology assessment (HTA) and public health stakeholders to use the EQ-5D-5L instrument in healthcare decision-making processes in Vietnam.MethodIn this qualitative study, 11 interviews were held with key stakeholders involved in healthcare decision-making for HTA between June 2021 and June 2022. The interviewees included members of the Vietnamese pharmacoeconomic council and public-health professionals from a diverse array of regions of Vietnam. The data collection involved obtaining verbal consent, warm-up discussions and interviews conducted via Zoom, with subsequent verification by interviewees. The analysis employed a theoretical thematic approach, adopting a deductive methodology to identify and analyse underlying ideas and meanings within the empirical data.ResultsThis study highlights the general importance and viability of HRQOL measures, and more particularly the EQ-5D-5L instrument, in healthcare decision-making in Vietnam. Challenges have been identified, including insufficient recognition, interpretation, standardisation and educational initiatives relating to HRQOL measurements. This study advocates for official training programmes on HRQOL measurements, guidelines for the application of the EQ-5D-5L and an open HRQOL database in Vietnam. Concerns regarding validity and outcome variation in HRQOL measurements underline the necessity for continuous psychometric properties assessments and regular updates to national HRQOL data in the Vietnamese context.ConclusionHRQOL outcomes are important, and Vietnamese stakeholders express a readiness to employ the EQ-5D-5L in healthcare decision-making, especially HTA. Nevertheless, HRQOL measurements, including the EQ-5D-5L, are currently inadequately used in Vietnam, and further efforts are required to improve utilisation.

Lin L., Liang W., Wang R., Rhodes R.E., Liu H.

BackgroundThe spread of Covid-19 and resultant infection prevention strategies have disturbed the life routine of Chinese young adults, led to reduced physical activity (PA), prolonged screen time (ST) and inadequate sleep duration (SP), and made immense influence on their mental health (MH) and quality of life (QoL). E-Health literacy (EHL) can enable citizens to use available online information to respond to the highly complex information environment and make appropriate health decisions.ObjectiveThis study aims to examine associations between adhering to 24-h movement (24HM) guidelines and MH and QoL among young adults, as well as to identify any mediating or moderating role of EHL in these associations.Methods1742 young adults (20.03 ± 1.54 years old, 68.6% females) from north and south China completed self-report measures of 24HM (PA, ST and SP), health indicators (MH and QoL), EHL and demographic information through an online survey between 4 Apr and 16 Jun 2022. Generalized linear mixed models were applied for data analysis.ResultsResults showed that adhering to PA, ST and SP guidelines were all positively connected with QoL while MH was associated with adhering ST or SP guidelines. Adhering to more of 24HM guidelines was linked to better MH and QoL. EHL significantly mediated the association of guideline adherence and QoL and moderate that of guideline adherence and MH.ConclusionThis is the first study to investigate the role of EHL on the associations between 24HM and MH as well as QoL during the Covid-19. The findings may contribute to further empirical research or intervention that aims to promote MH or QoL among young adults more effectively or provide valuable references for developing relevant strategies or policy of health promotion or public health events in China.

McEvoy M., Caccaviello G., Crombie A., Skinner T., Begg S.J., Faulkner P., McEvoy A., Masman K., Bamforth L., Parker C., Stanyer E., Collings A., Li X.

Background: Coronavirus 19 (COVID-19) has created complex pressures and challenges for healthcare systems worldwide; however, little is known about the impacts COVID-19 has had on regional/rural healthcare workers. The Loddon Mallee Healthcare Worker COVID-19 Study (LMHCWCS) cohort was established to explore and describe the immediate and long-term impacts of the COVID-19 pandemic on regional and rural healthcare workers. Methods: Eligible healthcare workers employed within 23 different healthcare organisations located in the Loddon Mallee region of Victoria, Australia, were included. In this cohort study, a total of 1313 participants were recruited from November 2020–May 2021. Symptoms of depression, anxiety, post-traumatic stress, and burnout were measured using the Patient Health Questionnaire-9 (PHQ-9), Generalised Anxiety Disorder-7 (GAD-7), Impact of Events Scale-6 (IES-6), and Copenhagen Burnout Inventory (CBI), respectively. Resilience and optimism were measured using the Brief Resilience Scale and Life Orientation Test—Revised (LOT-R), respectively. Subjective fear of COVID-19 was measured using the Fear of COVID-19 Scale. Results: These cross-sectional baseline findings demonstrate that regional/rural healthcare workers were experiencing moderate/severe depressive symptoms (n = 211, 16.1%), moderate to severe anxiety symptoms (n = 193, 14.7%), and high personal or patient/client burnout with median total scores of 46.4 (IQR = 28.6) and 25.0 (IQR = 29.2), respectively. There was a moderate degree of COVID-19-related fear. However, most participants demonstrated a normal/high degree of resilience (n = 854, 65.0%). Based on self-reporting, 15.4% had a BMI from 18.5 to 24.9 kgm2 and 37.0% have a BMI of 25 kgm2 or over. Overall, 7.3% of participants reported they were current smokers and 20.6% reported alcohol consumption that is considered moderate/high-risk drinking. Only 21.2% of the sample reported consuming four or more serves of vegetables daily and 37.8% reported consuming two or more serves of fruit daily. There were 48.0% the sample who reported having poor sleep quality measured using the Pittsburgh Sleep Quality Index (PSQI). Conclusion: Regional/rural healthcare workers in Victoria, Australia, were experiencing a moderate to high degree of psychological distress during the early stages of the pandemic. However, most participants demonstrated a normal/high degree of resilience. Findings will be used to inform policy options to support healthcare workers in responding to future pandemics.

Naamati-Schneider L., Alt D.

The integration of ChatGPT into educational systems underscores the critical importance of reevaluating the relevance of digital literacy skills. This study empirically tested, for the first time, the theoretical premise that the use of ChatGPT could render certain digital skills obsolete by assuming competencies that students were previously required to master. The study aimed to propose an instructional approach that combines a problem-based learning with ChatGPT activity (AIPBL). Subsequently, it sought to quantitatively measure the impact of AIPBL on students’ digital literacy competencies, comparing it to a similar PBL assignment devoid of AI technology (PBL) and a control group engaged in lecture-based learning (LBL). In addition, students’ experiences with ChatGPT were qualitatively evaluated. The study enrolled 223 healthcare management students, collecting 441 observations through pre-post-tests. Analysis of covariance and thematic analysis of qualitative data were employed. The results revealed that AIPBL led students to utilize fewer digital literacy skills compared to the PBL group, which displayed improvement across all three digital literacy components. Specifically, AIPBL did not significantly enhance participants’ perceptions of access and analysis skills, but it did bolster their evaluation skills between pre- and post-tests. Conversely, the LBL group showed no significant differences between their pre- and post-test results. In conjunction with qualitative findings, this study contributes to existing research by affirming the necessity for updated AI literacy skills in education and highlighting the evolving role of literacy skills in the context of AI integration in higher education.

Wamba A., Laoungang A.M., Soh G.

Résumé : Contexte : Il est connu que les maladies non transmissibles s’originent dans les habitudes et les choix alimentaires, et la littératie en santé est le meilleur déterminant de la santé d’un individu au 21e siècle. Or, cet aspect reste peu exploré en contexte camerounais. Dès lors, cette étude examine la relation entre la littératie en santé, la littératie alimentaire, la littératie alimentaire numérique et le comportement alimentaire des étudiants de l’Université de Yaoundé I. Méthodes : Un total de 240 étudiants âgés de 18 à 48 ans ( M = 21,97 ans, ET = 7,03), dont 149 (62,1 %) femmes, sélectionnés par commodité, ont rempli un questionnaire composite comprenant des échelles de mesure de la littératie en santé (Health Literacy Survey European Union Questionnaire Short Form), de la littératie alimentaire (Short Food Literacy Questionnaire), de la littératie alimentaire numérique (eHealth Literacy Scale) et du comportement alimentaire (General Dietary Behavior Inventory). Les données ont été analysées grâce au logiciel SPSS, v.20, en utilisant des tests de Mann-Whitney, de Kruskal-Wallis, de Spearman et des modèles linéaires généralisés. Résultats : Les résultats ont montré que le comportement alimentaire n’est pas associé aux caractéristiques sociodémographiques des étudiants. L’analyse des modèles linéaires généralisés a démontré que le comportement alimentaire des étudiants est influencé par la littératie alimentaire (β = 1,503, p < 0,001), la littératie en santé (β = 1,191, p < 0,05) et la littératie alimentaire numérique (β = 1,263, p < 0,001). De même, prises ensemble, elles entrainent une variation de 6,929 sur le comportement alimentaire (χ²(3) = 63,070, β = 6,929, p < 0,001). Conclusion : L’étude suggère que plus de recherches sur d’autres sous-groupes de population sont nécessaires afin de fournir des données pour des interventions en faveur d’une alimentation saine.

Cicero A.F., Fogacci F., Borghi C.

Throughout life, most of us eat at least three meals a day for 365 days a year [...]

Sharma L., Sharma D.

Purpose This study aims to conduct a systematic literature review to investigate the mental health problems during COVID-19 and the role of nutrition in minimizing mental and health-related issues during COVID-19. Design/methodology/approach A literature search was done electronically on April–May 2022 in the databases Google Scholar, PubMed and Cochrane Library, reviewing all the articles published in English. There were no limitations for the study (such as study design, region or any time frame). The quality assessment was done. The beginning database search picked out a total of 654 articles, 47 in PubMed, 575 in Google Scholar, 22 in Cochrane Library and 10 records from other sources. A total of 565 (duplicates found 89) were found after removing the duplicated articles, after reading the title and abstracts were further decreased to 88 full-text articles. These 88 studies went for full-text analysis, which excluded 56 studies and generated a final 32 articles for systemic analysis. The quality of the included study for the systematic review was assessed in two ways: one is evidence-based and another one on the JBI checklist. Findings People in social isolation and home quarantine suffer from severe anxiety, stress, depression, loneliness, anger and panic attack. During COVID-19, the vital role of diet and nutrients in mental health has been acknowledged and helps mitigate COVID-19 infection. Many studies showed stress and anxiety due to increased unhealthy eating and lifestyle practices. Originality/value This review will explain the interlink between diet and mental health because what we eat and think is interconnected with the gut–brain axis. The dietary elements and psychobiotic help in improving the immune system and psychological distress during the pandemic. This paper describes the role of different nutrients, psychobiotics and phytochemicals, to minimize mental and health issues during the COVID-19 pandemic. This paper also contains a balanced diet plan to withstand COVID-19.

Kumar J.P., Poovizhi T.

Huang Z., Tan P.T., Kua Z., Ong L.J., Hamzah F.B., Tan B.

Our study sought to examine the impact of the pandemic and the Circuit-breaker (CB) measures on dietary behaviours of healthcare workers (HCW). In addition, the association between self-regulatory eating behaviours and psychological stress was explored. Our study employed a cross-sectional anonymous survey that examined the demographics, dietary habits, self-regulatory eating behaviours (SR) and their association to stress levels of healthcare workers (HCWs) before and during the Circuit Breaker (CB) in Singapore. The survey was conducted over four weeks from May 17 to June 18, 2020. Snowball sampling was performed in the final week. A total of 707 participants took part in the survey. Due to the CB measures and modifications of work scope and work areas, there were significant changes in their dietary behaviors before CB versus during the CB period (n = 707), with many reducing the intake of vegetables (p = 0.018) while increasing their intake of unhealthy food choices such as canned drinks (p = 0.002), convenience food (p ≤ 0.001) and alcoholic drinks (p = 0.034). Before the CB period, 91.8% (602/656) of participants who intended to have a healthy diet were classified in medium-to-high SR groups whereas during the CB period, 87.7% (575/656) were in medium-to-high SR groups and the difference was statistically significant (p = 0.011). Nurses, administrative staff, HCWs of Chinese and Indian ethnicities, staff who did not complete university education and those who did not have domestic helpers were more likely to have reduced SR. Importantly, amongst participants who intended to have a healthy diet, 70.9% displayed no change or improved eating habits and showed medium-to-high levels of SR during CB. Participants with no changes in SR were 2.11 times more likely to be stress-free as compared to those who had deteriorated SR (OR 2.11 95% CI 1.27–3.48, p = 0.004). Due to CB measures and work modifications, dietary behaviours of HCWs deteriorated with increased intake of unhealthy food choices. HCWs who maintain their self-regulatory eating behaviour are more likely to be stress-free. Short screening questionnaires based on SR changes should be developed and explored as surveillance tools for assessment of HCWs’ general well-being such that personalized interventions to vulnerable groups of workers could be implemented effectively on the ground.

Nguyen M.H., Do T.X., Nguyen T.T., Pham M.D., Pham T.T., Pham K.M., Kim G.B., Do B.N., Nguyen H.T., Nguyen N., Dam H.T., Nguyen Y.H., Nguyen K.T., Nguyen T.T., Nguyen T.T., et. al.

BackgroundMedical students' health and wellbeing are highly concerned during the COVID-19 pandemic. This study examined the impacts of fear of COVID-19 (FCoV-19S), healthy eating behavior, and health-related behavior changes on anxiety and depression.MethodsWe conducted an online survey at 8 medical universities in Vietnam from 7th April to 31st May 2020. Data of 5,765 medical students were collected regarding demographic characteristics, FCoV-19S, health-related behaviors, healthy eating score (HES), anxiety, and depression. Logistic regression analyses were used to explore associations.ResultsA lower likelihood of anxiety and depression were found in students with a higher HES score (OR = 0.98; 95%CI = 0.96, 0.99; p = 0.042; OR = 0.98; 95%CI = 0.96, 0.99; p = 0.021), and in those unchanged or more physical activities during the pandemic (OR = 0.54; 95%CI = 0.44, 0.66; p &lt; 0.001; OR = 0.44; 95%CI = 0.37, 0.52; p &lt; 0.001) as compared to those with none/less physical activity, respectively. A higher likelihood of anxiety and depression were reported in students with a higher FCoV-19S score (OR = 1.09; 95%CI = 1.07, 1.12; p &lt; 0.001; OR = 1.06; 95%CI = 1.04, 1.08; p &lt; 0.001), and those smoked unchanged/more during the pandemic (OR = 6.67; 95%CI = 4.71, 9.43; p &lt; 0.001; OR = 6.77; 95%CI = 4.89, 9.38; p &lt; 0.001) as compared to those stopped/less smoke, respectively. In addition, male students had a lower likelihood of anxiety (OR = 0.79; 95%CI = 0.65, 0.98; p = 0.029) compared to female ones.ConclusionsDuring the pandemic, FCoV-19S and cigarette smoking had adverse impacts on medical students' psychological health. Conversely, staying physically active and having healthy eating behaviors could potentially prevent medical students from anxiety and depressive symptoms.

Nguyen T.T., Nguyen M.H., Nguyen Y.H., Nguyen T.T., Giap M.H., Tran T.D., Pham T.T., Pham K.M., Nguyen K.T., Le V.T., Su C., Duong T.V.

BackgroundHypertension is a major cause of death and disability worldwide. Enhancing health literacy (HL) may help to alleviate the risk of hypertension and its burden. However, evidence on the association between HL and hypertension and potential mechanisms remain to be explored.ObjectivesThis study examined the association between HL and hypertension; and explored whether body mass index (BMI), body fat percentage (PBF), and visceral fat (VF) were mediators of this association in people who resided in rural and suburban areas in Vietnam.MethodsA cross-sectional survey was conducted from 1st July to 31st December 2019, involving 1655 residents and exploring participants' sociodemographic characteristics, HL, health-related behaviors, comorbidities, body composition, and blood pressure (BP). People with systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg or using antihypertensive medication were classified as having hypertension. Multiple logistic regression and mediation analyses were used to explore associations.ResultsThe hypertension prevalence was 41.9% (694/1,655). In adjusted models, a higher HL score was associated with a lower hypertension likelihood (OR = 0.96; 95%CI = 0.95–0.97; p &lt; 0.001). Factors associated with a higher odd of hypertension were overweight/obese (OR = 1.69; 95%CI = 1.24–2.29; p = 0.001), high PBF (OR = 2.35; 95%CI = 1.85–2.99; p &lt; 0.001), and high VF (OR = 2.27; 95%CI = 1.63–3.16; p &lt; 0.001). Notably, PBF significantly mediated the association between HL and hypertension (indirect effect, OR = 0.99; 95%CI = 0.98–0.99; p = 0.009; percent mediated = 8.56%). The mediating roles of BMI and VF were not found.ConclusionThe prevalence of hypertension was relatively high. People with better HL were less likely to have hypertension. The association between HL and hypertension was partially explained by PBF. Strategic approaches are required to improve people's HL and body fat which further help to manage hypertension in rural and suburban areas.

Jin X., Chen Y., Zhou R., Jiang X., Chen B., Chen H., Li Y., Chen Z., Zhu H., Wang H.

For older adults, self-care begins with daily health behaviors (DHB), which refers to a series of basic behaviors beneficial to health in daily life; it is the foundation for promoting health, preventing disease, and maintaining health with or without the support of a healthcare provider. Thus, this study aimed to observe the changes in DHB among older adults when the COVID-19 pan-demic first erupted in China (at the beginning of 2020) and explore the impact factors on self-care routines in daily life. We applied a cross-sectional study among 1256 (83.7%) valid older Chinese from 19 February 2020 to 19 March 2020, the score of DHB changes (mean ± SD, 14.70 ± 2.140; range, 8–18) presented a significant growth (t1256 = 44.636, p < 0.001) during COVID-19. From 3 hierarchical linear regression models, the older Chinese who received a higher education include high school (β = 0.403, 95% CI [0.009, 0.797], p = 0.045) and college degree and above (β = 0.488, 95% CI [0.034, 0.943], p = 0.035), and lived in the eastern China (β = 0.771, 95% CI [0.392, 1.151], p < 0.001) took DHB more frequently. However, the high-risk infection (β = −0.740, 95% CI [−1.248, −0.231], p = 0.004), overweight/obese character (β = −0.265, 95% CI [−0.526, −0.004], p = 0.047), and alcohol consumption (β = −0.350, 95% CI [−0.634, −0.065], p = 0.016) are significant factors in decreasing a senior’s DHB performance. For China, self-care offers a straightforward strategy among the range of measures required to combat COVID-19 and future health threats. In summary, findings in this study can build a foundation for developing healthcare policy and services for the relevant government and departments on prompting DHB and the importance of self-care among the older population.

Tran H.T., Nguyen M.H., Pham T.T., Kim G.B., Nguyen H.T., Nguyen N., Dam H.T., Duong T.H., Nguyen Y.H., Do T.T., Nguyen T.T., Le T.T., Do H.T., Nguyen T.T., Pham K.M., et. al.

Background: The infodemic has been co-existing with the COVID-19 pandemic with an influx of misinformation and conspiracy theories. These affect people’s psychological health and adherence to preventive measures. eHealth literacy (eHEALS) may help with alleviating the negative effects of the infodemic. As nursing students are future healthcare professionals, having adequate eHEALS skills is critically important in their clinical practice, safety, and health. This study aimed to (1) explore the eHEALS level and its associated factors, and (2) examine the associations of eHEALS with preventive behaviors, fear of COVID-19 (FCV-19S), anxiety, and depression among nursing students. Methods: We surveyed 1851 nursing students from 7 April to 31 May 2020 from eight universities across Vietnam. Data were collected, including demographic characteristics, eHEALS, adherence to preventive behaviors (handwashing, mask-wearing, physical distancing), FCV-19S, anxiety, and depression. Linear and logistic regression analyses were performed appropriately to examine associations. Results: The mean score of eHEALS was 31.4 ± 4.4. The eHEALS score was significantly higher in males (unstandardized regression coefficient, B, 0.94; 95% confidence interval, 95% CI, 0.15 to 1.73; p = 0.019), and students with a better ability to pay for medication (B, 0.79; 95% CI, 0.39 to 1.19; p < 0.001), as compared to their counterparts. Nursing students with a higher eHEALS score had a higher likelihood of adhering to hand-washing (odds ratio, OR, 1.18; 95% CI, 1.15 to 1.22; p < 0.001), mask-wearing (OR, 1.15; 95% CI, 1.12 to 1.19; p < 0.001), keeping a safe physical distance (OR, 1.20; 95% CI, 1.15 to 1.25; p < 0.001), and had a lower anxiety likelihood (OR, 0.95; 95% CI, 0.92 to 0.99; p = 0.011). Conclusions: Nursing students who were men and with better ability to pay for medication had higher eHEALS scores. Those with higher eHEALS scores had better adherence to preventive measures, and better psychological health. The development of strategies to improve eHEALS of nursing students may contribute to COVID-19 containment and improve their psychological health.

Marquez N.M., Saintila J., Castellanos-Vazquez A.J., Dávila-Villavicencio R., Turpo-Chaparro J., Sánchez-Tarrillo J.A., Salinas Arias S.A., Calizaya-Milla Y.E., Morales-García W.C.

Background: The coronavirus disease 2019 pandemic has impacted the health of the population. Technological advances become alternative tools for the promotion of lifestyle and prevention of non-communicable diseases in university personnel. Objective: This study analyzed the effect of an intervention based on a telehealth program and investigated its efficacy in improving lifestyle, body mass index, and glucose concentration in university staff during the coronavirus disease 2019 pandemic. Methods: A pre-experimental study was conducted between August and December 2021 on 100 workers of a private university located in Tarapoto, Peru. Information was collected on lifestyle practices and beliefs, body mass index, and glucose contraction before and after the intervention. After the intervention, 78 participants were analyzed; 22 workers did not respond to the invitation. Results: Comparison between pretest and follow-up showed an increase in lifestyle practices and beliefs (from 93.33 ± 9.44 to 96.23 ± 9.32, p < 0.01), although this value is considered an unhealthy lifestyle. Moreover, a decrease in body mass index (from 25.23 ± 3.08 to 24.98 ± 2.98, p < 0.05) and glucose concentration (from 98.35 ± 6.70 to 97.45 ± 5.61, p < 0.01) was observed. Conclusion: Telehealth-based educational interventions could be effective in university staff during the coronavirus disease 2019 pandemic, which, in turn, would support improved lifestyles and adequate body mass index and glucose levels.