Public Health

BackgroundCoronavirus disease 2019 (COVID-19) is an international emergency that has been addressed in many countries by changes in and restrictions on behaviour. These are often collectively labelled social distancing and lockdown. On the 23rd June 2020, Boris Johnson, the Prime Minister of the United Kingdom announced substantial easings of restrictions. This paper examines some of the data he presented. MethodsGeneralised additive models, with negative binomial errors and cyclic term representing day-of-week effects, were fitted to data on the daily numbers of new confirmed cases of COVID-19. Exponential rates for the epidemic were estimated for different periods, and then used to calculate R, the reproduction number, for the disease in different periods. ResultsAfter an initial stabilisation, the lockdown reduced R to around 0.81 (95% CI: 0.79, 0.82). This value increased to around 0.94 (95% CI 0.89, 0.996) for the fortnight from the 9th June 2020. ConclusionsOfficial UK data, presented as the easing of the lockdown was announced, shows that R was already more than half way back to 1 at that point. That suggests there was little scope for the announced changes to be implemented without restarting the spread of the disease.

ObjectiveWe aimed to determine which aspects of the COVID-19 national response are independent predictors of COVID-19 mortality and case numbers. DesignComparative observational study between nations using publicly available data. SettingWorldwide Participants Covid-19 patients InterventionsStringency of 11 lockdown policies recorded by the Blavatnik School of Government database and earliness of each policy relative to first recorded national cases Main outcome measuresAssociation with log10 National deaths (LogD) and log10 National cases (LogC) on the 29th April 2020 corrected for predictive demographic variables ResultsEarly introduction was associated with reduced mortality (n=137) and case numbers (n=150) for every policy aside from testing policy, contact tracing and workplace closure. Maximum policy stringency was only found to be associated with reduced mortality (p=0{middle dot}003) or case numbers (p=0{middle dot}010) for international travel restrictions. A multivariate model, generated using demographic parameters (r2=0{middle dot}72 for LogD and r2=0{middle dot}74 for LogC), was used to assess the timing of each policy. Early introduction of first measure (significance p=0{middle dot}048, regression coefficient {beta}=-0{middle dot}004, 95% confidence interval 0 to -0{middle dot}008), early international travel restrictions (p=0{middle dot}042, {beta}=-0{middle dot}005, -0{middle dot}001 to - 0{middle dot}009) and early public information (p=0{middle dot}021, {beta}=-0{middle dot}005, -0{middle dot}001 to -0{middle dot}009) were associated with reduced LogC. Early introduction of first measure (p=0{middle dot}003, {beta}=-0{middle dot}007, -0{middle dot}003 to -0{middle dot}011), early international travel restrictions (p=0{middle dot}003, {beta}=-0{middle dot}008, -0{middle dot}004 to-0{middle dot}012), early public information (p=0{middle dot}003, {beta}=-0{middle dot}007, 0{middle dot}003 to -0{middle dot}011), early generalised workplace closure (p=0{middle dot}031, {beta}=-0{middle dot}012, -0{middle dot}002 to -0{middle dot}022) and early generalised school closure (p=0{middle dot}050, {beta}=-0{middle dot}012, 0 to -0{middle dot}024) were associated with reduced LogC. ConclusionsAt this stage in the pandemic, early institution of public information, international travel restrictions, and workplace closure are associated with reduced COVID-19 mortality and maintaining these policies may help control the pandemic. What is already known on this topicThe COVID-19 pandemic has spread rapidly throughout the world and presented vast healthcare, economic and political challenges. Many nations have recently passed the peak of their infection rate, and are weighing up relaxation of lockdown strategies. Though the effect of individual lockdown policies can be estimated by modelling, little is known about the impact of individual policies on population case numbers or mortality through comparison of differing strategies between nations. A PubMed search was carried out on the 14/5/20 using keywords including "novel coronavirus-infected pneumonia", "2019-nCoV", "Sars-Cov-2", "Covid-19", "lockdown"," policy", "social distancing", "isolation", "quarantine" and "contact tracing" returned 258 studies in total. Following scanning of the above results, we found 19 studies that have examined the effect of lockdown within a region, which have demonstrated a reduction in case numbers after the introduction of a lockdown. There are no previous studies that have compared the effectiveness of government lockdowns between nations to determine the effectiveness of specific policies. What this study addsThis study examines the corollary between government policy and COVID-19 case numbers and mortality, correct as of the 29th of April 2020, for every nation that there is available date within the Blavatnik School of Government database on COVID-19 policy. The study demonstrates that early generalised school closure, early generalised workplace closure, early restriction of international travel and early public information campaigns are independently associated with reduced national COVID-19 mortality. The maximum stringency of individual lockdown policies were not associated with reduced case numbers or mortality. Early reintroduction of these policies may be most effective in a relapse of the pandemic, though, school closure, workplace closure and restriction of international travel carry heavy politico-economic implications. There was no measurable effect of maximum stringency of lockdown policy on outcome at this point in time, indicating that early timing of lockdown introduction is of greater importance than its stringency, provided that the resultant viral reproductive rate is less than 1.

BackgroundThere is a lack of empirical evidence that lockdowns decrease daily cases of COVID-19 and related mortality compared to herd immunity. England implemented a delayed lockdown on March 23, 2020, but Sweden did not. We aim to examine the effect of lockdown on daily COVID-19 cases and related deaths during the first 100 days post-lockdown. MethodsWe compared daily cases of COVID-19 infection and related mortality in England and Sweden before and after lockdown intervention using a comparative-interrupted time series analysis. The period included was from COVID-19 pandemic onset till June 30, 2020. ResultsThe adjusted-rate of daily COVID-19 infections was eight cases/10,000,000 person higher in England than Sweden before lockdown order (95% CI: 2-14, P=0.01). On the day of intervention (lagged lockdown), England had 693 more COVID-19 cases/10,000,000 person compared to Sweden (95% CI: 467-920, P<0.001). Compared to the pre-intervention period, the adjusted daily confirmed cases rate decreased by 19 cases/ 10,000,000 person compared to Sweden (95% CI: 13-26, P<0.001). There was a rate excess of 1.5 daily deaths/ 10,000,000 person in England compared to Sweden pre-intervention (95% CI: 1-2, P<0.001). The increased mortality rate resulted in 50 excess deaths/ 10,000,000 person related to COVID-19 in England compared to Sweden on the day of lockdown (95% CI: 30-71, P<0.001). Post-intervention, the rate of daily deaths in England decreased by two deaths/ 10,000,000 person compared to Sweden (95% CI: 1-3, P<0.001). During phases one and two of lockdown lifting in England, there was no rebound increase in daily cases or deaths compared to Sweden. ConclusionThe lockdown order implemented in England on March 23, 2020, effectively decreased the daily new cases rate and related mortality compared to Sweden. There was no short-term increase in COVID-19 cases and related-deaths after the phases one and two of the lifting of restrictions in England compared to Sweden. This study provides empirical, comparative evidence that lockdowns slow the spread of COVID-19 in communities compared to herd immunity.

BackgroundThe Greek authorities implemented the strong social distancing measures within the first few weeks after the first confirmed case of the virus to curtail the COVID-19 growth rate. ObjectivesTo estimate the effect of the two-stage strong social distancing measures, the closure of all non-essential shopping centers and businesses on March 16 and the shelter in place orders (SIPOs) on March 23 on the COVID-19 growth rate in Greece MethodsWe obtained data on COVID-19 cases in Greece from February 26th through May 4th from publicly available sources. An interrupted time-series regression analysis was used to estimate the effect of the measures on the exponential growth of confirmed COVID-19 cases, controlling for the number of daily testing, and weekly fixed-effects. ResultsThe growth rate of the COVID-19 cases in the pre-policies implementation period was positive as expected (p=0.003). Based on the estimates of the interrupted time-series, our results indicate that the SIPO on March 23 significantly slowed the growth rate of COVID-19 in Greece (p=0.04). However, we did not find evidence on the effectiveness of standalone and partial measures such as the non-essential business closures implemented on March 16 on the COVID-19 spread reduction. DiscussionThe combined social distancing measures implemented by the Greek authorities within the first few weeks after the first confirmed case of the virus reduced the COVID-19 growth rate. These findings provide evidence and highlight the effectiveness of these measures to flatten the curve and to slow the spread of the virus.

Objectives Concerns about COVID-19 were a key driver of infection-prevention behaviour during the pandemic. The aim of this study was to gain an in-depth longitudinal understanding of the type and frequency of concerns experienced throughout the first two years of the COVID-19 pandemic. Design Content analysis of qualitative descriptions provided in a prospective longitudinal online survey as part of the COVID-19 UK Public Experiences (COPE) Study. Method At baseline (March/April 2020), when the UK entered its first national lockdown, 11,113 adults completed the COPE survey. Follow-up surveys were conducted at 3, 12, 18 and 24 months. Participants were recruited via the HealthWise Wales research registry and social media. Baseline surveys collected demographic and health data, and all waves included an open-ended question about COVID-19 concerns. Content analysis was used to identify the type and frequency of concerns at each time point. Results A total of 41,564 open-text responses were coded into six categories: personal harm (n=16,353), harm to others (n=11,464), social/economic impact (n=6,433), preventing transmission (n=4,843), government/media (n=1,048), and general concerns (n=1,423). The proportion of respondents reporting any concern declined from 75.3% at baseline to 65.8% at 24 months. Over time, concerns about personal harm increased (baseline 41.8% vs. 24-months 52.7%) whereas concerns about harm to others decreased (baseline 48.5% vs. 24-months 28.6%). Concerns about harm were also expressed in relation to clinical vulnerability, lack of trust in government/media, and perceived lack of adherence by others. These were balanced against concerns about wider social and economic impacts of restrictions. Conclusions Public concerns about COVID-19 evolved substantially over the first two years of the pandemic, reflecting changing perceptions of risk and responsibility. Monitoring concerns longitudinally is vital to help guide effective communication and behavioural interventions during future pandemics.

Self-isolation is a public health measure used to prevent the spread of infection, and which can have an impact on the psychological wellbeing of those going through it. It is likely that self-isolation will be used to contain future outbreaks of infectious disease. We synthesised evidence on the impact of home self-isolation on psychological wellbeing of the general public during the COVID-19 pandemic. This systematic review was registered on PROSPERO (CRD42022378140). We searched Medline, PsycINFO, Web of Science, Embase, and grey literature (01 January 2020 to 13 December 2022). Our definition of wellbeing included adverse mental health outcomes and adaptive wellbeing. Studies that investigated isolation in managed facilities, children, and healthcare workers were excluded. We followed PRISMA and synthesis without meta-analysis (SWiM) guidelines. We extracted data on the impact of self-isolation on wellbeing, and factors associated with and interventions targeting wellbeing during self-isolation. We included 36 studies (most were cross sectional, two were longitudinal cohort studies, three assessed interventions, and five were qualitative). The mode quality rating was high-risk. Depressive and anxiety symptoms were most investigated. Evidence for an impact of self-isolation on wellbeing was often inconsistent in quantitative studies, although qualitative studies consistently reported a negative impact on wellbeing. However, people with pre-existing mental and physical health needs consistently reported increased symptoms of mental ill health during self-isolation. Studies reported modifiable stressors that have been reported in previous infectious disease contexts, such as inadequate support, poor coping strategies, inadequate and conflicting information, and the importance of regular contact from trusted healthcare professionals. However, interventions targeting psychological wellbeing were rare and evaluative studies of these had high or very high risk of bias. When implementing self-isolation directives, public health officials should prioritise support for more vulnerable individuals who have pre-existing mental or physical health needs, lack support, or who are facing significant life stressors. Clinicians can play a key role in identifying and supporting those most at risk. Focus should be directed toward interventions that address loneliness, worries, and misinformation, whilst monitoring and identifying individuals in need of additional support.

BackgroundA variant strain of SARS-CoV-2, VOC202012/01, emerged in the UK in September, 2020. Its infectiousness was estimated as higher than that of the original strain. ObjectWe estimated the infectiousness of the variant strain of SARS-CoV-2 in comparison to that of the original strain under conditions prevailing in Japan. MethodsWe estimated infectiousness through a simple susceptible-infected-recovered (SIR) model by strain. The study period was March 1-28, 2020. The information used for the study was available as of April 3, 2020. ResultsThe estimated reproduction number of the SARS-CoV-2 variant strain was 1.799; its 95% CI was [1.642, 1.938]. The onset date of the first case in Japan was estimated as December 4 ([November 16, December 14]), 2020. However, infectiousness of the original strain was estimated as 1.123 ([1.093, 1.166]). Discussion and ConclusionWe demonstrated that infectiousness increased by 0.684 or 60%, increasing from the original to the variant. That finding might be comparable to that of a study conducted in the UK. However, the difference must be monitored continuously and carefully.

BackgroundDuring the pandemic and associated lockdowns, many families from around the world experienced financial and confinement stress and the reorganisation of family caregiving responsibilities. Several studies have been conducted about the impact of the pandemic on family wellbeing. The aim of this systematic review was to identify, synthesize and critique relevant studies in this field. MethodsFollowing Cochrane Collaboration and PRISMA guidelines, a systematic search was performed in databases including MEDLINE, PsycINFO, Embase, SocINDEX and PubMed. Peer-reviewed studies that examined the experiences of families during infectious disease outbreaks were included. Quality assessment was undertaken using the Mixed Methods Appraisal Tool. A narrative synthesis approach was employed. ResultsEighty-four papers were found, all conducted during the Covid-19 pandemic, with the majority from the USA and presented from the perspective of parents/caregivers. Synthesized results focused on how family experiences, the dyad relationship and parenting behaviours were impacted during Covid-19. ConclusionAlthough some families reported positive growth, socially and financially vulnerable families were more negatively impacted than others during the pandemic. The review highlights the important role of families during times of stress and possible intervention targets.

BackgroundTo date, survival data on risk factors for COVID-19 mortality in south- Ethiopia is limited, and none of the published survival studies have used a competing risk approach. This study aims to identify risk factors for in-hospital mortality in COVID-19 patients hospitalized at one of the six hospitals in southeast -Ethiopia, considering recovery as a competing risk. MethodsThis observational multisite study included a medical record of 827 confirmed SARS-CoV-2 cases hospitalized at one of the six hospitals in southeast-Ethiopia from October 1, 2022 to May 31, 2023. We compiled data on the patients socio-demographic characteristics, clinical manifestation, comorbidity, treatment status, treatment outcomes, and length of stay. We performed a Cox regression analysis for competing risks, presenting cause-specific hazard ratios (HRcs) for the effect of preselected factors on the absolute risk of death and recovery. Results827 patients were included (51.9% male; median age 50 years, IQR: 38--65). Patients were hospitalized for a median duration of 5 days (IQR: 1--7); 139 (17%) of them died, while 516 (62%) were recovered and discharged alive, the rest 172 (21%) were censored. Patients with higher age (HRcs 2.62, 95% CI 1.29--5.29), immune- compromised state (HRcs 1.46, 95% CI 1.08--1.98) had increased risk of death, whereas male sex paradoxically (HRcs 0.45, 95% CI 0.22--0.91) associated with decreased risk of death. We found no increased mortality risk in diabetes patients. ConclusionThis competing risk survival analysis allows us to corroborate specific pattern of risk factors about COVID-19 mortality and its progression among different groups of individuals (differentiated by age and immune-compromised state). 62% presenting cases recovered within a median duration of 5 days; where as 17% die within the first 72 hours, most with immune-compromised conditions. This should be considered while planning and allocating the distribution of care services for effective health service delivery

BackgroundAccurate measurement of individuals attitudes toward COVID-19 vaccination and pandemic is critical to understand the way that people respond during a major crisis such as the COVID-19 pandemic. ObjectiveTo develop and validate a questionnaire to assess attitudes toward COVID-19 vaccination and pandemic. MethodsWe performed a reliability and validity study in a sample of the general population in Greece. Data were collected online through social media between 15 August and 7 September 2021. Thus, a convenience sample was obtained. Reliability and validity of the questionnaire were assessed with a Delphi study, an exploratory factor analysis, and a test-retest study. Also, we calculated Cronbachs coefficient alpha for the factors that emerged from the exploratory factor analysis. ResultsThe final study included 1959 adults from the general population in Greece. Our four-factor model explained 73% of the variance and confirmed out initial hypothesis regarding the factors of the questionnaire. In particular, we found the following four factors: (a) fear against the COVID-19 (five items), (b) information regarding the COVID-19 (two items), (c) compliance with hygiene measures (two items), and (d) trust in COVID-19 vaccination (seven items). Cronbachs coefficients alpha for the four factors that emerged from the exploratory factor analysis were greater than 0.82. Pearsons correlation coefficients for the 16 items and the four factors were greater than 0.67 (p-value<0.001 in all cases). ConclusionsWe developed a reliable and valid questionnaire to measure attitudes toward COVID-19 vaccination and pandemic. Further studies should be conducted to expand our knowledge and infer more valid results.

BackgroundNew SARS-CoV-2 variants have emerged and COVID-19 is still a public health issue, especially for vulnerable groups such as people with chronic medical conditions. ObjectiveTo investigate the impact of COVID-19-related burnout on COVID-19 vaccination intention in cardiac patients. Moreover, we investigated other possible demographic and psychological predictors of vaccination intention in cardiac patients. MethodsWe conducted a cross-sectional study in Greece using a convenience sample. Data collection was performed from 20 November 2022 to 10 January 2023. We measured demographic data, COVID-19-related burnout, anxiety, depression, social support, and resilience. We used the following valid tools: COVID-19 burnout scale, Patient Health Questionnaire-4, Multidimensional Scale of Perceived Social Support, and Brief Resilience Scale. ResultsAmong patients, 45.8% were willing to accept a COVID-19 booster dose, 25.3% were hesitant, and 28.9% were unwilling. Patients experienced moderate levels of COVID-19-related burnout. After multivariable linear regression analysis, we found that increased age and decreased emotional exhaustion due to COVID-19 were associated with increased vaccination intention. Moreover, patients who have already received a booster dose had also a greater willingness to accept a new booster dose. ConclusionsIdentification of factors that influence patients decision to accept a COVID-19 booster dose is crucial to maintain a high vaccination coverage rate among them in order to avoid COVID-19-related outcomes. Since a COVID-19 booster dose on an annual basis seems to be necessary policy makers should develop and implement vaccination programmes tailored for patients.

We aimed to assess the relative importance of different settings for SARS-CoV2 transmission in a large community cohort. We demonstrate the importance of home, work and education as venues for transmission. In children, education was most important and in older adults essential shopping was of high importance. Our findings support public health messaging about infection control at home, advice on working from home and restrictions in different venues.

Asymptomatic but infectious people have been reported in many infectious diseases. Asymptomatic and pre-symptomatic carriers would be a hidden reservoir of COVID-19. AimThis review identifies primary empirical evidence about the ability of asymptomatic carriers to infect others with COVID-19 pandemic and reflects on the implications for control measures. MethodsA systematic review is followed by a narrative report and commentary inclusion criteria were: studies reporting primary data on asymptomatic or pre-symptomatic patients, who were considered to have passed on COVID-19 infection; and published in indexed journals or in peer review between January 1 and March 31, 2020. ResultsNine articles reported on 83 asymptomatic or pre-symptomatic persons. ConclusionsThe evidence confirms COVID-19 transmission from people who were asymptomatic at the time. A series of implications for health service response are laid out.

IntroductionNon-pharmaceutical interventions (NPIs) such as lockdown, social distancing and use of face coverings was adopted by the United Kingdom (UK) Armed Forces (AF) during the COVID-19 pandemic. This study assessed the impact of the use of NPIs on influenza activity in the UK AF. MethodsA longitudinal study design was adopted, and secondary data was analysed retrospectively. Clinical Read codes for influenza-like illness (ILI) was used to generate data for flu seasons before and during the COVID-19 pandemic (September 2017 to April 2021). ResultsBefore the COVID-19 pandemic, the rate of reporting ILI was [~] 4% across all flu seasons. The count of ILI was 2.9%, 2.2% and 3.1% during 2017-18, 2018-19 and 2019-20 flu seasons respectively. During the COVID-19 pandemic, both the rate of reporting ILI (0.6%) and the count of ILI (0.5%) were significantly smaller (p < .001). The rate of reporting ILI was positively correlated with the count of ILI (r (2) = .97, p = .014). Influenza vaccination rate increased by 1.3% during the COVID-19 pandemic. vaccination rate was negatively correlated with the rate of reporting ILI (r (2) = -.52, p = 0.24) and the count of ILI (r (2) = -.61, p = 0.19). However, this correlation was not significant. The use of NPIs was negatively correlated with the rate of reporting ILI (r (2) = -.99, p = < .001) and the count of ILI (r (2) = -.95, p = 0.026). The overall multiple regression performed was statistically significant (R2 = 0.94, F (1, 2) = 33.628, p = 0.028). The rate of reporting ILI significantly predicted the count of ILI ({beta} = 0.609, p = 0.028) while vaccination rate did not significantly predict the count of ILI ({beta} = -0.136, p = 0.677). ConclusionsInfluenza activity in the UK AF was significantly reduced during the COVID-19 pandemic. The use of NPIs and the rate of reporting ILI significantly reduced the count of ILI. Being vaccinated for influenza did not significantly reduce the count of ILI.

The present short communication paper describes the methodological approach of applying the Health Belief Model to the use COVID-19 immunity certificates in the UK. We designed an online survey including an adaptation of the following Health Belief Model constructs: perceived COVID-19 susceptibility, perceived COVID-19 severity, perceived benefits of using immunity certificates, perceived barriers from using immunity certificates, perceived severity of not using immunity certificates, and perceived vaccination views. The online cross-sectional survey conducted on the 3rd of August 2021 gathered responses from 534 participants aged 18 and older, representative of the UK population in terms of gender, age, and ethnicity.

Outward medical tourism is when people seek medical treatment in a different country to the one they live in. There are concerns that people travelling abroad for surgery may be at risk of complications when they return home. This review aimed to identify all the studies that describe the impact on the UK NHS of patients who require follow-up care due to outward medical tourism for elective surgery and report on complications, costs and benefits. The review included evidence available until December 2024. 37 studies were included that described patients who were treated in the NHS for complications arising from elective surgery conducted abroad. 35 were case series or case reports, 19 relating to bariatric surgery, 15 to cosmetic surgery and 1 to ophthalmic surgery. 2 were surveys of plastic surgeons practicing in the NHS. 14 studies included a cost analysis. The case series and case reports included a total of 655 patients treated by the NHS between 2006 to 2024 for post-operative complications in specific hospitals. Not all studies reported all outcomes of interest. For the studies that reported demographic data, most patients were female (90%). The most common destination for surgery was Turkey (61%). For bariatric surgery tourism, abdominal pain, vomiting, inability to swallow and malnutrition were cited as presenting symptoms, with gastric leak being the most common diagnosis. Over a third of patients had to have a reversal or revision of the bariatric procedure. For cosmetic surgery tourism, the most common complications were infection and reopening of the surgical wound, with 57% of patients receiving antibiotics. No deaths were reported by any of the studies, although there was evidence that some patients needed complex treatment involving long hospital stays and multiple surgical interventions. Just over a half of patients required at least one investigation or intervention under local or general anaesthetic. Very low certainty of evidence indicates that costs to the NHS from outward medical tourism for elective surgery ranges from {pound}1,058 to {pound}19,549 per patient in 2024 prices. We found no studies that reported on benefits of outward medical tourism. Awareness-raising campaigns and interventions are warranted to inform members of the public considering going abroad for surgery about the potential for complications. There is a need for a systematic approach to collecting information on the impact on the UK NHS of treating complications arising from outward medical tourism for elective surgery and the associated costs. We still do not know how many people resident in the UK go abroad for elective surgery or how many people subsequently have complications. Without this data we cannot fully understand the amount of risk that people seeking surgery abroad are taking. Funding statementThe authors and their Institutions were funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government.

BackgroundThe novel coronavirus disease has led individuals in several medical, psychosocial and economic impacts among the majority of the society such as psychological distress, anxiety, depression, denial, panic, and fear. This pandemic is a disastrous health crisis and becoming a current public health emergency and affects several nations across the world. The widespread of COVID-19 has brought not only the risk of death but also major psychological pressure. The COVID-19 pandemic led individuals to unavoidable psychological distress, anxiety, depression, denial, panic, and fear. The COVID-19 pandemic is a global public health emergency concern, which is severely affected the community and influences the day-to-day life of individuals in Ethiopia. This systematic review used to investigate the pooled estimate on the psychological impact of COVID-19 in Ethiopia. ObjectiveThe main aim of this systematic review and meta-analysis were to provide comprehensive evidence on the psychological impact of COVID-19 in Ethiopia. MethodsThis systematic review and meta-analysis searched through Pub Med, Cochrane Library, Google, Google Scholar, and web of sciences. Data extracted by Microsoft Excel then statistical analyses done using STATA Version 14 software with a random-effects model. The funnel plot checked. The heterogeneity of the studies checked. Subgroup analysis done in relation to the study area and authors names. ResultsA total of 10 studies with 4,215 participants were included in this systematic review and the overall estimated psychological impact of coronavirus disease in Ethiopia was 42.50% (95% CI (31.18%, 53.81%). According to subgroup analysis, the highest estimated status of the psychological impact of coronavirus disease in Ethiopia are 66.40% and 16.20% in Addis Ababa and Amhara regions respectively. ConclusionThis systematic review revealed that the psychological impact of coronavirus disease in Ethiopia is 42.50%. Multiple education and training and adequate personal protective equipment supplies focusing on the psychological impact of COVID-19 should be avail properly for the community in Ethiopia.

IntroductionThe global population has been asked to live under tight restrictions to slow the spread of SARS-CoV-2. Transmission-reducing behaviours (TRBs), (physical distancing, hand washing, wearing a face covering) were introduced by governments in 2020 prior to vaccine availability. People should maintain TRBs throughout the vaccination programme, because there is much uncertainty about the vaccine efficacy, immunity duration, whether there will be the requirement for booster vaccines, and whether vaccinated individuals can be carriers of the virus. This study will explore the effect of the vaccination programme in Scotland on adherence to TRBs. Methods and analysisTelephone interviews will be conducted with participants from the nationally representative CHARIS project that agreed to be contacted for further research. Approximately 200, ten-minute telephone interviews will be conducted. Data will be collected on vaccine uptake or intention and adherence to TRBs. Univariate and multivariate logistic regression analyses and moderation analyses will be used to analyse the data collected. Ethical approval was granted by the Life Sciences and Medicine School Ethics Review Board (SERB) at the University of Aberdeen. DiscussionCHARIS-V will provide an understanding of the effect of the vaccination programme on adherence to TRBs in Scotland. Findings should be useful to governments and public health agencies for the current COVID-19 pandemic and vaccination programme and assist in the management of any future outbreaks.

ObjectiveThe objective of this scoping review is to identify the explanations that have been proposed for higher-than-expected mortality following the first pandemic year, and any evidence to support or refute these explanations. IntroductionMortality rates have remained high compared to previous years, beyond the peak waves of Covid-19 mortality. Several explanations have been suggested for this. Identifying potential hypotheses and empirical studies investigating these is the first step before any further analytical work to investigate these trends can be undertaken. Inclusion criteriaThe scoping review will include papers proposing or investigating hypotheses for raised all cause or cause specific mortality, or reduced life expectancy, from April 2021 onwards compared to pre-pandemic levels. It will include papers on mortality in the whole population or any specific demographic sub-populations, in high income countries only, but exclude studies of mortality or survival following a healthcare intervention. MethodsA systematic search will be undertaken on Medline, Embase and Google Scholar for relevant articles published from 2021 onwards in English, with a similar search for grey literature on relevant government websites. Two reviewers will screen titles and abstracts, then full text articles with disagreements resolved by discussion or involvement of a third reviewer. Data extracted from selected articles will include the setting, population, hypothesis/es proposed, study type and findings if relevant. Included papers will be tabulated against the proposed hypotheses with any empirical evidence and hypotheses summarised narratively.

BackgroundThe issue of migrants health and access to health services is dynamic and complex posing a challenge to health systems worldwide. AimTo investigate migrants access to health services in European countries, the use of health services by migrants and the barriers encountered by migrants in the use of health services. Material and methodsThe search was conducted in January 2022 in five databases; PubMed, Medline, Web of science, Scopus and Cinahl. We used the following keywords: migrants, immigrants, use, access, utilization, healthcare services, services, needs, health, difficulties, barriers. The inclusion criteria were the following: (a) the studies investigated the access of migrants to health services, the use of health services by migrants and the barriers encountered by migrants in using health services. (b) migrants self-assessed access, use and barriers. (c) studies were conducted in European countries. (d) studies included adult migrants. (e) the language of articles was English. ResultsSixty-five studies were met our inclusion criteria. among studies, 89.2% were quantitative and 11.8% were qualitative. All quantitative studies were cross-sectional. for data collection, 58.5% of studies used questionnaires and 30.8% used historical files. Also, personal interviews were performed in 9.2% of studies and focus groups in 1.5% of studies. in our studies, 73.8% of natives stated that they had better access to health services and used health services better than migrants, while 26.2% found that migrants stated that they had better access to health services and used health services better. The most common barriers were the following: inability to understand the language and communicate, lack of insurance, lack of information and knowledge, lack of family support, low educational level, short duration of stay in the country of migration, low income, lack of a family doctor and high costs. ConclusionsMigrants face several barriers both in accessing and using health services in Europe. Intensive efforts are needed to increase migrants knowledge, implement culturally sensitive interventions in migrant communities and better inform healthcare professionals so that they can approach migrants more effectively.