Since its emergence in Wuhan, China, covid-19 has spread and had a profound effect on the lives and health of people around the globe. As of 4 July 2021, more than 183 million confirmed cases of covid-19 had been recorded worldwide, and 3.97 million deaths. Recent evidence has shown that a range of persistent symptoms can remain long after the acute SARS-CoV-2 infection, and this condition is now coined long covid by recognized research institutes. Studies have shown that long covid can affect the whole spectrum of people with covid-19, from those with very mild acute disease to the most severe forms. Like acute covid-19, long covid can involve multiple organs and can affect many systems including, but not limited to, the respiratory, cardiovascular, neurological, gastrointestinal, and musculoskeletal systems. The symptoms of long covid include fatigue, dyspnea, cardiac abnormalities, cognitive impairment, sleep disturbances, symptoms of post-traumatic stress disorder, muscle pain, concentration problems, and headache. This review summarizes studies of the long term effects of covid-19 in hospitalized and non-hospitalized patients and describes the persistent symptoms they endure. Risk factors for acute covid-19 and long covid and possible therapeutic options are also discussed.

https://www.bmj.com/content/bmj/374/bmj.n1648.full.pdf

Long covid-mechanisms, risk factors, and management.

Background University students are increasingly recognized as a vulnerable population, suffering from higher levels of anxiety, depression, substance abuse, and disordered eating compared to the general population. Therefore, when the nature of their educational experience radically changes—such as sheltering in place during the COVID-19 pandemic—the burden on the mental health of this vulnerable population is amplified. The objectives of this study are to 1) identify the array of psychological impacts COVID-19 has on students, 2) develop profiles to characterize students' anticipated levels of psychological impact during the pandemic, and 3) evaluate potential sociodemographic, lifestyle-related, and awareness of people infected with COVID-19 risk factors that could make students more likely to experience these impacts. Methods Cross-sectional data were collected through web-based questionnaires from seven U.S. universities. Representative and convenience sampling was used to invite students to complete the questionnaires in mid-March to early-May 2020, when most coronavirus-related sheltering in place orders were in effect. We received 2,534 completed responses, of which 61% were from women, 79% from non-Hispanic Whites, and 20% from graduate students. Results Exploratory factor analysis on close-ended responses resulted in two latent constructs, which we used to identify profiles of students with latent profile analysis, including high (45% of sample), moderate (40%), and low (14%) levels of psychological impact. Bivariate associations showed students who were women, were non-Hispanic Asian, in fair/poor health, of below-average relative family income, or who knew someone infected with COVID-19 experienced higher levels of psychological impact. Students who were non-Hispanic White, above-average social class, spent at least two hours outside, or less than eight hours on electronic screens were likely to experience lower levels of psychological impact. Multivariate modeling (mixed-effects logistic regression) showed that being a woman, having fair/poor general health status, being 18 to 24 years old, spending 8 or more hours on screens daily, and knowing someone infected predicted higher levels of psychological impact when risk factors were considered simultaneously. Conclusion Inadequate efforts to recognize and address college students’ mental health challenges, especially during a pandemic, could have long-term consequences on their health and education.

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Psychological impacts from COVID-19 among university students: Risk factors across seven states in the United States.

STUDY OBJECTIVES: No systematic review or meta-analysis has yet been conducted to examine the impact of the pandemic on the prevalence of sleep problems among the general population, healthcare workers, or COVID-19 patients. Therefore, this systematic review was conducted to assess the impact and prevalence of sleep problems among those categories. METHODS: APA PsycINFO; Cochrane; Cumulative Index to Nursing and Allied Health Literature (CINAHL); EBSCOhost; EMBASE; Google Scholar; MEDLINE; ProQuest Medical; ScienceDirect; Scopus; and Web of Science from 01 November 2019 to 05 July 2020. Additionally, four preprints servers (medRxiv.org; Preprints.org; psyarxiv.com; arXiv.org; biorxiv.org) were also searched for papers accepted after peer-review but not yet published and indexed. There was no language restriction. The random-effect models meta-analysis model were used with the DerSimonian and Laird methodology. RESULTS: Forty-four papers, involving a total of 54,231 participants from 13 countries, were judged relevant and contributed to the systematic review and meta-analysis of sleep problems during COVID-19. The global pooled prevalence rate of sleep problems among all populations was 35.7% [95%CI 29.4-42.4%]. COVID-19 patients appeared to be the most affected group, with a pooled rate of 74.8% [95%CI 28.7-95.6%]. Healthcare workers and the general population had comparative rates of sleep problems with rates of 36.0% [95%CI 21.1-54.2%] and 32.3% [95%CI 25.3-40.2%], respectively. CONCLUSIONS: The prevalence of sleep problems during the COVID-19 pandemic is high and approximately affect 40% of people from the general and healthcare populations. COVID-19 active patients appeared to have higher prevalence rates of sleep problems.

Sleep problems during the COVID-19 pandemic by population: a systematic review and meta-analysis.

The present study aimed to identify patterns of dietary changes during the COVID-19 pandemic and their associations with sociodemographics, body mass index (BMI) before pandemic, and lifestyle changes in Polish adults and to examine the effects of lockdowns on dietary-lifestyle changes. This study used a cross-sectional online survey to collect data. The k-means algorithm was used to determine of patterns of dietary changes, and logistic regression analyses were performed. During the study period, 43% of respondents decreased physical activity (PA), 49%-increased screen time, and 34%-increased food consumption. Among the three dietary changes patterns, two opposite patterns were found: Prohealthy (28% participants) and Unhealthy (19% participants).The adherence to the Prohealthy pattern was negatively associated with age, but positively with being overweight (aOR 1.31) or obese before pandemic (aOR 1.64). Residing in a macroeconomic region with GDP > 100% decreased adherence to the Prohealthy (aOR 0.73) but increased adherence to the Unhealthy pattern (aOR 1.47). Adults over 40 years old, those living with children, unemployed, those living in a region with a higher GDP, and those not consuming homemade meals could be more exposed to unhealthy behaviors. From a public health perspective, enhancing the message "to be active" during the compulsory isolation period should be prioritized.

https://www.mdpi.com/2072-6643/12/8/2324/pdf

Dietary and Lifestyle Changes During COVID-19 and the Subsequent Lockdowns among Polish Adults: A Cross-Sectional Online Survey PLifeCOVID-19 Study.

To provide a contemporary global prevalence of mental health issues among the general population amid the coronavirus disease-2019 (COVID-19) pandemic. We searched electronic databases, preprint databases, grey literature, and unpublished studies from January 1, 2020, to June 16, 2020 (updated on July 11, 2020), with no language restrictions. Observational studies using validated measurement tools and reporting data on mental health issues among the general population were screened to identify all relevant studies. We have included information from 32 different countries and 398,771 participants. The pooled prevalence of mental health issues amid the COVID-19 pandemic varied widely across countries and regions and was higher than previous reports before the COVID-19 outbreak began. The global prevalence estimate was 28.0% for depression; 26.9% for anxiety; 24.1% for post-traumatic stress symptoms; 36.5% for stress; 50.0% for psychological distress; and 27.6% for sleep problems. Data are limited for other aspects of mental health issues. Our findings highlight the disparities between countries in terms of the poverty impacts of COVID-19, preparedness of countries to respond, and economic vulnerabilities that impact the prevalence of mental health problems. Research on the social and economic burden is needed to better manage mental health problems during and after epidemics or pandemics. Systematic review registration: PROSPERO CRD 42020177120.

/pdf/global-prevalence-of-mental-health-issues-among-the-general-8lks3vpxrd.pdf

Global prevalence of mental health issues among the general population during the coronavirus disease-2019 pandemic: a systematic review and meta-analysis.

(1) Background: The novel coronavirus disease 2019 (COVID-19) is a global public health emergency that has caused worldwide concern. Vast resources have been allocated to control the pandemic and treat patients. However, little attention has been paid to the adverse impact on mental health or effective mitigation strategies to improve mental health. (2) Purpose: The aim of this study was to assess the adverse impact of the COVID-19 outbreak on Chinese college students’ mental health, understand the underlying mechanisms, and explore feasible mitigation strategies. (3) Methods: During the peak time of the COVID-19 outbreak in China, we conducted longitudinal surveys of sixty-six college students. Structured questionnaires collected information on demographics, physical activity, negative emotions, sleep quality, and aggressiveness level. A mixed-effect model was used to evaluate associations between variables, and the mediating effect of sleep quality was further explored. A generalized additive model was used to determine the dose-response relationships between the COVID-19 death count, physical activity, and negative emotions. (4) Results: The COVID-19 death count showed a direct negative impact on general sleep quality (β = 1.37, 95% confidence interval [95% CI]: 0.55, 2.19) and reduced aggressiveness (β = −6.57, 95% CI: −12.78, −0.36). In contrast, the COVID-19 death count imposed not a direct but an indirect impact on general negative emotions (indirect effect (IE) = 0.81, p = 0.012), stress (IE = 0.40, p < 0.001), and anxiety (IE = 0.27, p = 0.004) with sleep quality as a mediator. Moreover, physical activity directly alleviated general negative emotions (β = −0.12, 95% CI: −0.22, −0.01), and the maximal mitigation effect occurred when weekly physical activity was about 2500 METs. (5) Conclusions: (a) The severity of the COVID-19 outbreak has an indirect effect on negative emotions by affecting sleep quality. (b) A possible mitigation strategy for improving mental health includes taking suitable amounts of daily physical activity and sleeping well. (c) The COVID-19 outbreak has reduced people’s aggressiveness, probably by making people realize the fragility and preciousness of life.

https://www.mdpi.com/1660-4601/17/10/3722/pdf

Mental Health Problems during the COVID-19 Pandemics and the Mitigation Effects of Exercise: A Longitudinal Study of College Students in China.

This study aimed to assess the effectiveness of an online high-intensity interval training (HIIT) intervention and health education on the behaviors, mental health, and cognitive function of sedentary young females. A single-blinded, six-week, randomized controlled pilot trial involving 70 sedentary young Chinese females, aged 18-30 years, was conducted. An intervention group (IG) (n = 33) underwent a HIIT intervention and health education, while a waitlist group (WG) (n = 37) only received health education. In pre-, mid-, and post-tests, both groups filled out questionnaires about physical activity, sedentary behavior, and mental health. Cognitive functions were assessed at the pre- and post-tests by computer-administered cognitive tests. A mixed-effect model with repeated measures was used to analyze outcomes of interest. The retention rate of the IG and WG was 100% and 78.38%, respectively. The IG were found to have significantly increased rates of moderate-to-vigorous physical activity (MVPA) (Mdiff = 940.61, p < 0.001, 95% confidence interval (95% CI): 576.67, 1304.55) from pre-test to post-test, while the WG demonstrated a more marked reduction in sedentary time (Mdiff = -73.02, p = 0.038, 95% CI: -141.90, -4.14) compared with the IG in the post-test. Moreover, anxiety and stress levels were shown to significantly reduce in the IG over the six-week period (Mdiff = -4.73, p = 0.002, 95% CI: -7.30, -2.15 and Mdiff = -5.09, p = 0.001, 95% CI: -8.29, -1.89, respectively). In addition, we observed a significant improvement in verbal ability (p = 0.008, ηp2 = 0.19) following the HIIT intervention and effects of the interaction with time on processing speed (p = 0.050, ηp2 = 0.10) and episodic memory (p = 0.048, ηp2 = 0.11). Moreover, the IG had better global cognitive performance than the WG in the post-test (Mdiff = 8.28, p = 0.003, 95% CI: 3.06, 13.50). In summary, both an online bodyweight HIIT intervention combined with health education, or health education alone, can effectively improve health-related behaviors, but the behavioral consequences may differ based on the emphasis of different intervention modalities. Furthermore, the "bodyweight HIIT plus health education" modality might be a more promising online intervention strategy to mitigate against negative emotions and improve cognitive function.

https://www.mdpi.com/1660-4601/18/1/302/pdf

Effects of Online Bodyweight High-Intensity Interval Training Intervention and Health Education on the Mental Health and Cognition of Sedentary Young Females.

Purpose: The current study was intended to assess the effect of a facilitated behavioral intervention based on the extended theory of planned behavior (TPB) on psychological constructs and physical activity among adolescents over a period of eight weeks. Methods: Students (n = 51, 12 ± 0.3 years of age) in the seventh grade at a junior middle school in China were randomly assigned to two groups: the intervention group (n = 24) and the control group (n = 27). Both groups were pre- and post-tested with the related psychological constructs of the extended TPB, along with behavioral measures of the Physical Activity Scale and ActiGraph accelerometer (model wGT3X-BT). The intervention group took part in 45 min classes once per week for 8 weeks, including five indoor theoretical courses and three outdoor basketball matches. The control group was not required to make any change to their normal school day. Also, 2 × 2 repeated measures analysis of variance (ANOVA) was conducted to compare the differences between the two groups, and then t-test was employed to compare the independent and paired differences. Results: Significant increases in pre–post subjective norms (SN) (p = 0.041, Cohen’s d = 0.62), perceived behavior control (PBC) (p = 0.023, Cohen’s d = 0.72), exercise intention (EI) (p = 0.043, Cohen’s d = 0.61), and self-efficacy (SE) (p = 0.035, Cohen’s d = 1.36) were observed in the intervention group. In addition, participants in the intervention group increased their exercise frequency (p < 0.001, Cohen’s d = 1.25) and intensity (p = 0.028, Cohen’s d = 0.68), especially their time spent on light intensity physical activity (light-PA%; p = 0.031, Cohen’s d = 0.68), and their percentage of sedentary time (SB%) was also reduced (from 68% ± 10% to 58% ± 7%, p < 0.001, Cohen’s d = 1.17). Furthermore, the intervention group showed significantly better performance in PBC (p = 0.032, Cohen’s d = 0.62), EI (p < 0.001, Cohen’s d = 1.32), SE (p < 0.001, Cohen’s d = 1.15), SB% (p < 0.001, Cohen’s d = 1.22), light-PA% (p < 0.001, Cohen’s d = 1.12), and total physical activity (TPA) (p = 0.015, Cohen’s d = 0.72) compared to the control group at the post-test. No significant pre post differences were observed for any psychological or behavioral variables in the control group, except for exercise frequency, but the values were still lower than those in the intervention group after the 8-week intervention (3.70 ± 0.72 versus 3.92 ± 0.83). Conclusion: The combined theory-based intervention was effective at improving psychological constructs and physical activity among seventh-grade adolescents in 8 weeks.

https://www.mdpi.com/1660-4601/17/9/3026/pdf

Impact of Combined Theory-Based Intervention on Psychological Effects and Physical Activity among Chinese Adolescents.

Short-term PM2.5 exposure and cognitive function: Association and neurophysiological mechanisms.

Introduction The mental health of young adults is a global public health challenge. Numerous studies have demonstrated that exercise benefits mental health. However, it is still unclear which exercise mode is optimal for protecting mental health and its association with the immune system. This study aimed to compare the intervention effect of high-intensity interval training (HIIT) and moderate-to-vigorous intensity continuous training (MVCT) on mental health and assess the underlying mechanism of exercise interventions to improve the immune system, which facilitated the mental health status. Methods This is a double-blinded RCT study conducted from October 13, 2020 to January 25, 2021 (ClinicalTrials.gov identifier: NCT04830059). Ninety-three participants who met the inclusion criteria were randomized into the HIIT (N = 33), MVCT (N = 32), and control groups (N = 28) with a mean age of 25.26 (SD = 2.21), and 43% of males enrolled in the study. Professional coaches guided participants in HIIT and MVCT groups to perform 40 min of exercise training three times a week for 12-week while those in the control group received 1 h of health education twice a week. Questionnaires related to mental health status and blood samples of inflammatory factors, including immunoglobulin A (IgA), immunoglobulin M (IgM), albumin (Alb), globulin (GLO), lymphocytes (LYM), and lymphocyte percentage (LYM) were assessed before and after the intervention. Results We found that blood inflammation factors increased significantly in the control group during 12 weeks (ΔIgA = 0.16 g/L, ΔIgM = 0.092 g/L, ΔAlb = 2.59 g/L, ΔGlo = 3.08 g/L, ΔLYM = 0.36, and ΔLYM% = 3.72%, p < 0.05), and both MVCT and HIIT intervention could effectively defend the increased inflammatory response compared with the control group (IgA: MVCT β = −0.14, p < 0.001, HIIT β = −0.096, p < 0.05; IgM: MVCT β = −0.12, p < 0.001; HIIT β = −0.068, p < 0.05; Alb: MVCT β = −1.64, p < 0.05, HIIT β = −1.14, p > 0.05; Glo: MVCT β = −3.17, p < 0.001, HIIT β = −2.07, p < 0.01; LYM: MVCT β = −0.34, p < 0.05, HIIT β = −0.35, p < 0.05). However, the MVCT intervention modality was more conducive to enhancing positive affect (β = 0.52, p = 0.018) and well-being (β = 1.08, p = 0.035) than HIIT. Furthermore, decreased IgA, Alb, and Glo were associated with improved mental health. Conclusion Both 12-week HIIT and MVCT are beneficial to the immune system. The MVCT intervention mode is recommended to prevent mental health problems and attenuate immune inflammation, and the immune system is a potential mechanism that exercises improving mental health. Clinical trial registration [ClinicalTrials.gov], identifier [NCT04830059].

Yao Zhang

Papers

Mental Health Problems during the COVID-19 Pandemics and the Mitigation Effects of Exercise: A Longitudinal Study of College Students in China.

Effects of Online Bodyweight High-Intensity Interval Training Intervention and Health Education on the Mental Health and Cognition of Sedentary Young Females.

Impact of Combined Theory-Based Intervention on Psychological Effects and Physical Activity among Chinese Adolescents.

Short-term PM2.5 exposure and cognitive function: Association and neurophysiological mechanisms.

Exercise improves mental health status of young adults via attenuating inflammation factors but modalities matter