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      Determinants of Health Literacy and Its Associations With Health-Related Behaviors, Depression Among the Older People With and Without Suspected COVID-19 Symptoms: A Multi-Institutional Study

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          Abstract

          Purpose: We examined factors associated with health literacy among elders with and without suspected COVID-19 symptoms (S-COVID-19-S).

          Methods: A cross-sectional study was conducted at outpatient departments of nine hospitals and health centers 14 February−2 March 2020. Self-administered questionnaires were used to assess patient characteristics, health literacy, clinical information, health-related behaviors, and depression. A sample of 928 participants aged 60–85 years were analyzed.

          Results: The proportion of people with S-COVID-19-S and depression were 48.3 and 13.4%, respectively. The determinants of health literacy in groups with and without S-COVID-19-S were age, gender, education, ability to pay for medication, and social status. In people with S-COVID-19-S, one-score increment of health literacy was associated with 8% higher healthy eating likelihood (odds ratio, OR, 1.08; 95% confidence interval, 95%CI, 1.04, 1.13; p < 0.001), 4% higher physical activity likelihood (OR, 1.04; 95%CI, 1.01, 1.08, p = 0.023), and 9% lower depression likelihood (OR, 0.90; 95%CI, 0.87, 0.94; p < 0.001). These associations were not found in people without S-COVID-19-S.

          Conclusions: The older people with higher health literacy were less likely to have depression and had healthier behaviors in the group with S-COVD-19-S. Potential health literacy interventions are suggested to promote healthy behaviors and improve mental health outcomes to lessen the pandemic's damage in this age group.

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          Most cited references48

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          Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China

          Background: The 2019 coronavirus disease (COVID-19) epidemic is a public health emergency of international concern and poses a challenge to psychological resilience. Research data are needed to develop evidence-driven strategies to reduce adverse psychological impacts and psychiatric symptoms during the epidemic. The aim of this study was to survey the general public in China to better understand their levels of psychological impact, anxiety, depression, and stress during the initial stage of the COVID-19 outbreak. The data will be used for future reference. Methods: From 31 January to 2 February 2020, we conducted an online survey using snowball sampling techniques. The online survey collected information on demographic data, physical symptoms in the past 14 days, contact history with COVID-19, knowledge and concerns about COVID-19, precautionary measures against COVID-19, and additional information required with respect to COVID-19. Psychological impact was assessed by the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). Results: This study included 1210 respondents from 194 cities in China. In total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels. Most respondents spent 20–24 h per day at home (84.7%); were worried about their family members contracting COVID-19 (75.2%); and were satisfied with the amount of health information available (75.1%). Female gender, student status, specific physical symptoms (e.g., myalgia, dizziness, coryza), and poor self-rated health status were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression (p < 0.05). Specific up-to-date and accurate health information (e.g., treatment, local outbreak situation) and particular precautionary measures (e.g., hand hygiene, wearing a mask) were associated with a lower psychological impact of the outbreak and lower levels of stress, anxiety, and depression (p < 0.05). Conclusions: During the initial phase of the COVID-19 outbreak in China, more than half of the respondents rated the psychological impact as moderate-to-severe, and about one-third reported moderate-to-severe anxiety. Our findings identify factors associated with a lower level of psychological impact and better mental health status that can be used to formulate psychological interventions to improve the mental health of vulnerable groups during the COVID-19 epidemic.
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            International physical activity questionnaire: 12-country reliability and validity.

            Physical inactivity is a global concern, but diverse physical activity measures in use prevent international comparisons. The International Physical Activity Questionnaire (IPAQ) was developed as an instrument for cross-national monitoring of physical activity and inactivity. Between 1997 and 1998, an International Consensus Group developed four long and four short forms of the IPAQ instruments (administered by telephone interview or self-administration, with two alternate reference periods, either the "last 7 d" or a "usual week" of recalled physical activity). During 2000, 14 centers from 12 countries collected reliability and/or validity data on at least two of the eight IPAQ instruments. Test-retest repeatability was assessed within the same week. Concurrent (inter-method) validity was assessed at the same administration, and criterion IPAQ validity was assessed against the CSA (now MTI) accelerometer. Spearman's correlation coefficients are reported, based on the total reported physical activity. Overall, the IPAQ questionnaires produced repeatable data (Spearman's rho clustered around 0.8), with comparable data from short and long forms. Criterion validity had a median rho of about 0.30, which was comparable to most other self-report validation studies. The "usual week" and "last 7 d" reference periods performed similarly, and the reliability of telephone administration was similar to the self-administered mode. The IPAQ instruments have acceptable measurement properties, at least as good as other established self-reports. Considering the diverse samples in this study, IPAQ has reasonable measurement properties for monitoring population levels of physical activity among 18- to 65-yr-old adults in diverse settings. The short IPAQ form "last 7 d recall" is recommended for national monitoring and the long form for research requiring more detailed assessment.
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              Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019

              Key Points Question What factors are associated with mental health outcomes among health care workers in China who are treating patients with coronavirus disease 2019 (COVID-19)? Findings In this cross-sectional study of 1257 health care workers in 34 hospitals equipped with fever clinics or wards for patients with COVID-19 in multiple regions of China, a considerable proportion of health care workers reported experiencing symptoms of depression, anxiety, insomnia, and distress, especially women, nurses, those in Wuhan, and front-line health care workers directly engaged in diagnosing, treating, or providing nursing care to patients with suspected or confirmed COVID-19. Meaning These findings suggest that, among Chinese health care workers exposed to COVID-19, women, nurses, those in Wuhan, and front-line health care workers have a high risk of developing unfavorable mental health outcomes and may need psychological support or interventions.
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                Author and article information

                Contributors
                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                16 November 2020
                2020
                16 November 2020
                : 8
                : 581746
                Affiliations
                [1] 1Department of Infectious Diseases, Vietnam Military Medical University , Hanoi, Vietnam
                [2] 2Division of Military Science, Military Hospital 103 , Hanoi, Vietnam
                [3] 3International Center for Health Information Technology, Taipei Medical University , Taipei, Taiwan
                [4] 4Department of Healthcare Information and Management, Ming Chuan University , Taoyuan City, Taiwan
                [5] 5Faculty of Public Health, Hai Phong University of Medicine and Pharmacy , Hai Phong, Vietnam
                [6] 6President Office, Hai Phong University of Medicine and Pharmacy , Hai Phong, Vietnam
                [7] 7Director Office, Thai Nguyen National Hospital , Thai Nguyen City, Vietnam
                [8] 8President Office, Thai Nguyen University of Medicine and Pharmacy , Thai Nguyen City, Vietnam
                [9] 9International Master/Ph.D. Program in Medicine, Taipei Medical University , Taipei, Taiwan
                [10] 10Department of Anesthesiology, Thu Duc District Hospital , Ho Chi Minh City, Vietnam
                [11] 11Director Office, Thu Duc District Health Center , Ho Chi Minh City, Vietnam
                [12] 12Health Management Training Institute, Hue University of Medicine and Pharmacy , Hue, Vietnam
                [13] 13Department of Health Economics, Corvinus University of Budapest , Budapest, Hungary
                [14] 14Director Office, Military Hospital 103 , Hanoi, Vietnam
                [15] 15Department of Pulmonary and Cardiovascular Diseases, Hai Phong University of Medicine and Pharmacy Hospital , Hai Phong, Vietnam
                [16] 16Director Office, Hai Phong University of Medicine and Pharmacy Hospital , Hai Phong, Vietnam
                [17] 17Director Office, Hospital District 2 , Ho Chi Minh City, Vietnam
                [18] 18Nursing Office, Tan Phu District Hospital , Ho Chi Minh City, Vietnam
                [19] 19Department of Internal Medicine, Thai Nguyen University of Medicine and Pharmacy , Thai Nguyen City, Vietnam
                [20] 20Department of Health Education, Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health , Hanoi, Vietnam
                [21] 21Graduate Institute of Data Science, Taipei Medical University , Taipei, Taiwan
                [22] 22School of Nutrition and Health Sciences, Taipei Medical University , Taipei, Taiwan
                Author notes

                Edited by: Marcia G. Ory, Texas A&M University, United States

                Reviewed by: Marissa Dickins, Bolton Clarke Research Institute, Australia; Kenneth Chui, Tufts University, United States

                *Correspondence: Tuyen Van Duong duongtuyenvna@ 123456gmail.com

                This article was submitted to Aging and Public Health, a section of the journal Frontiers in Public Health

                †These authors have contributed equally to this work

                Article
                10.3389/fpubh.2020.581746
                7703185
                33313037
                400b9864-5b19-4724-b10b-b3da5d03ef65
                Copyright © 2020 Do, Nguyen, Pham, Nguyen, Nguyen, Tran, Nguyen, Tran, Pham, Tran, Duong, Duong, Nguyen, Pham, Hsu and Duong.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 09 July 2020
                : 05 October 2020
                Page count
                Figures: 0, Tables: 3, Equations: 1, References: 52, Pages: 9, Words: 6128
                Categories
                Public Health
                Original Research

                covid-19,older people,health literacy,health-related behaviors,depression,vietnam

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