Background The COVID-19 pandemic affects the processes of routine care for chronic patients. A better understanding helps to increase resilience of the health system and prepare adequately for next waves of the pandemic. Methods A qualitative study was conducted in 16 primary care practices: 6 solo working, 4 monodisciplinary and 7 multidisciplinary. Twenty-one people (doctors, nurses, dieticians) were interviewed, using semi-structured video interviews. A thematic analysis was done using the domains of the Chronic Care Model (CCM). Results Three themes emerged: changes in health care organization, risk stratification and self-management support. All participating practices reported drastic changes in organization with a collective shift towards COVID-19 care, and reduction of chronic care activities, less consultations, and staff responsible for self-management support put on hold. A transition to digital support did not occur. Few practitioners had a systematic approach to identify and contact high-risk patients for early follow-up. A practice with a pre-established structured team collaboration managed to continue most chronic care elements. Generally, practitioners expected no effects of the temporary disruption for patients, although they expressed concern about patients already poorly regulated. Conclusion Our findings show a disruption of the delivery of chronic care in the Belgium prim care context. In such contexts, the establishment of the CCM can facilitate continuity of care in crisis times. Short term actions should be directed to facilitate identifying high-risk patients and to develop a practice organization plan to organize chronic care and use digital channels for support, especially to vulnerable patients, during next waves of the epidemic.

As a large international consortium of 26 countries and 110 higher-education institutions (HEIs), we successfully developed and executed an online student survey during or directly after the initial peak of the COVID-19 pandemic. The COVID-19 International Student Well-being Study (C19 ISWS) is a cross-sectional multicountry study that collected data on higher-education students during the COVID-19 outbreak in the spring of 2020. The dataset allows description of: (1) living conditions, financial conditions, and academic workload before and during the COVID-19 outbreak; (2) the current level of mental well-being and effects on healthy lifestyles; (3) perceived stressors; (4) resources (e.g., social support and economic capital); (5) knowledge related to COVID-19; and (6) attitudes toward COVID-19 measures implemented by the government and relevant HEI. The dataset additionally includes information about COVID-19 measures taken by the government and HEI that were in place during the period of data collection. The collected data provide a comprehensive and comparative dataset on student well-being. In this article, we present the rationale for this study, the development and content of the survey, the methodology of data collection and sampling, and the limitations of the study. In addition, we highlight the opportunities that the dataset provides for advancing social science research on student well-being during the COVID-19 pandemic in varying policy contexts. Thus far, this is, to our knowledge, the first cross-country student well-being survey during the COVID-19 pandemic, resulting in a unique dataset that enables high-priority socially relevant research.

This study aimed to determine the changes in health behaviors among students of a French university during the COVID-19 lockdown. An online retrospective survey was distributed to Rouen-Normandy University students at the end of the COVID-19 lockdown (13th March–11th May 2020). Voluntary university students were included. Data collected were on socio-demographics, academic environment, COVID19 concerns, tobacco smoking, binge drinking, cannabis use, and physical activity in the periods before and during COVID-19 lockdown. The survey was completed by 3671 university students (mean age 20.9 ± 2.47 years, 72.9% female). Significantly favorable changes between the periods before and during COVID-19 were reported for tobacco smoking (18.5% vs. 14.8%), binge drinking (35.9% vs. 9.3%) and cannabis use (5.6% vs. 3.2%) and unfavorable changes for moderate (79.4% vs. 67.9%) and vigorous physical activity (62.5% vs. 59.1%). After logistic regression, factors associated with unfavorable changes in tobacco smoking and with favorable changes in vigorous physical activity were the worry of not validating the academic year and stress related to changes in the mode of teaching, respectively. For each health behavior, unfavorable changes were associated with higher depression levels, and male gender. Then as a decrease, mainly in binge drinking was observed during the COVID-19 lockdown, care must be taken to prevent university students from resuming binge drinking after the end of the lockdown. Health-promotion strategies directed at adopting or maintaining positive mental health and promoting physical activity should be developed for university students to better manage future lockdown periods.

ObjectivesTo examine changes in the occurrence of physical sex with non-steady partners among men who have sex with men (MSM) in Belgium during the first weeks of the COVID-19 lockdown and associations with sociodemographic factors, sexual practices, drug, alcohol and pre-exposure prophylaxis (PrEP) use. A secondary objective was to explore changes in PrEP use and the need for PrEP follow-up.MethodsA cross-sectional online survey. The questionnaire was available in Dutch, French and English, between April 10 and 27 (2020), and disseminated via sexual health and lesbian, gay, bisexual, trans, queer or intersex organisations throughout Belgium. Eligibility criteria included being 18 years or older, not being exclusively heterosexual and living or being born in Belgium.ResultsThe sample included 694 MSM. Physical sex with non-steady partners decreased from 59.1% to 8.9% during the first weeks of the lockdown. Those who had sex with non-steady partners were significantly more likely to be HIV positive, to use PrEP or to have engaged in sexual practices such as group sex, chemsex and sex work before the lockdown, compared with their counterparts. Among those who used PrEP before the lockdown, 47.0% stopped using PrEP, 19.7% used event-driven PrEP and 33.3% used daily PrEP during the lockdown. Almost two-thirds of PrEP users had a PrEP care appointment in the weeks before the lockdown and a minority received follow-up elsewhere or online. Some PrEP users had concerns regarding their follow-up.ConclusionsMSM in our survey substantially reduced sexual contact with non-steady partners during the first weeks of the COVID-19 lockdown, suggesting that the risk for HIV and STI transmission in this period was low. We recommend ensuring access to sexual health services, such as HIV testing and follow-up for PrEP for the small group having multiple sex partners and engaging in sexual practices such as chemsex, or group sex, even in times of a pandemic threat.

Background The surge of COVID-19 infections has prompted many countries to take unprecedented policy measures. In Belgium, the authorities implemented a nation-wide stay-at-home order for several months. Evidence of the mental health effect of such measures is scarce. A recent review by Brooks et al. has compiled a defined list of stressors affecting people’s mental health under quarantine during previous epidemic settings. This study aims to test the association between these stressors and the mental health of students attending higher education during the stay-at-home order in Belgium. Methods In this cross-sectional study, 18,301 students from 13 higher education institutions (HEI) participated in an online survey between 26 April and 11 May 2020. We assessed the association between potential stressors and depressive symptoms severity scores and structural equation modeling was used to assess how stressors may mediate the association between duration of exposure and depressive symptoms severity. Results The stressors proposed by Brooks et al. were found to be associated with depressive symptoms severity. The stressors ‘perceived academic stress’, ‘institutional dissatisfaction’ and ‘fear of being infected’ were associated with substantially higher depressive symptoms severity scores. The association between duration of exposure and depressive symptoms severity was mediated by ‘academic stress’. Being in a steady relationship and living together with others were both associated with a lower depressive symptoms severity. Conclusion Findings underline the need for a student-centered approach and mental health prevention. Authorities and HEIs should consider whether and if so, how a stay-at-home order should be implemented.

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Introduction Cambodia has achieved significant progress in maternal health, yet remains in the group of countries with the highest maternal mortality ratio in South-East Asia. Extra efforts are needed to improve maternal health through assessing the coverage of maternal health services as a continuum of care (CoC) and identifying the gaps. Our study aims to explore the coverage level of the Optimal CoC by (1) measuring the continuity of optimal antenatal care (ANC), skilled birth attendance (SBA) and optimal post-natal care (PNC), (2) identifying the determinants of dropping out from one service to another and (3) of not achieving the complete CoC. Method The study employed data from the Cambodia Demographic Health Survey 2014. We restricted our analysis to married women who had a live birth in the five years preceding the survey (n = 5678). Bi-variate and multivariate logistic regression were performed using STATA version 14. Results Almost 50% of women had achieved the complete optimal CoC, while the remaining have used only one or two of the services. The result shows that the level of women’s education was positively associated with the use of optimal ANC, the continuation to using optimal PNC and achieving the complete CoC. More power of women in household decision making was also positively associated with receiving the complete CoC. The birth order was negatively associated with achieving the complete CoC, while exposure to the mass media and having health insurance increased the odds of achieving the complete CoC. Household wealth consequently emerged as an influential predictor of dropping out and not achieving the complete CoC. Receiving all different elements of ANC care improved the continuity of care from optimal ANC to SBA and from SBA to optimal ANC. Conclusion The findings urge policy makers to approach maternal health care as a continuum of care with different determinants at each step. Household wealth was found to be the most influential factor, yet the study discovered also other barriers to optimal maternal health care which need to be addressed: future intervention should thus not only aim to increase wealth or health insurance coverage but also stimulate the education of women and empower women to claim power in household decision-making.

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