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The study aims to evaluate global research output (103054 records) on coronavirus disease (COVID-19) based on quantitative and qualitative indicators. It presents a bibliometric profile of most influential countries, organizations, authors and journals and their collaborative linkages, besides identifying broad subject areas of research, most significant keywords and highly-cited papers related to COVID-19. During 2020-21, more than 150 countries participated in COVID-19 research, of which top 10 countries accounted for a 82.93% global share. The USA, China and U.K. produced the most articles (25.86%, 10.77% and 10.7% respectively). The top three organizations, namely Harvard Medical School, USA, Huazhong University of S&T, China and Tongji Medical College, China contributed 1755, 1344 and 1267 papers, respectively. The most cited organizations in COVID-19 research are: Peking Union Medical College, China (97.41 CPP), University of Hong Kong (82.17 CPP) and Renmin Hospital of Wuhan University, China (59.88 CPP). The top three most productive authors are: V. Wanitlit, E. Mahase and G. Lacobucci (with 152, 135 and 108 papers). The top three most cited authors in terms of citations per paper (CPP) are: Y. Hu (319.82), L. Liu (303.91) and J.F.W. Chan (169.55). The most productive organizations originate from most productive countries and they contribute the most collaborative papers. The top three journals, namely International Journal of Environmental Research, BMJ and PLOS One contributed 961, 854 and 781 papers, respectively. The top three journals in terms of citations per paper (CPP) are New England Journal of Medicine (122.78), The Lancet (106.3) and JAMA (75.17). The most ubiquitous topic was COVID-19 clinical studies, with maximum focus on virological aspects (9.58%), respiratory aspects (6.97%), molecular aspects (3.11%), genetic aspects (3.09%) and immunological aspects (1.3%). The results of this study should be of interest to working scientists, clinicians and policy-makers in improving their understanding of COVID-19 disease and in its management. [ABSTRACT FROM AUTHOR]

Objective: This paper used meta-regression to analyze the heterogenous factors contributing to the prevalence rate of mental health symptoms of the general and frontline healthcare workers (HCWs) in China under the COVID-19 crisis. Method: We systematically searched PubMed, Embase, Web of Science, and Medrxiv and pooled data using random-effects meta-analyses to estimate the prevalence rates, and ran meta-regression to tease out the key sources of the heterogeneity. Results: The meta-regression results uncovered several predictors of the heterogeneity in prevalence rates among published studies, including severity (e.g., above severe vs. above moderate, p < 0.01; above moderate vs. above mild, p < 0.01), type of mental symptoms (PTSD vs. anxiety, p = 0.04), population (frontline vs. general HCWs, p < 0.01), sampling location (Wuhan vs. Non-Wuhan, p = 0.04), and study quality (p = 0.04). Conclusion: The meta-regression findings provide evidence on the factors contributing to the prevalence rate of mental health symptoms of the general and frontline healthcare workers (HCWs) to guide future research and evidence-based medicine in several specific directions. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display%5frecord.php?RecordID=220592, identifier: CRD42020220592. [ABSTRACT FROM AUTHOR]

Background: During the course of the COVID-19 pandemic, states were called upon by the World Health Organization to introduce and prioritise the collection of sex-disaggregated data. The collection of sex-disaggregated data on COVID-19 testing, infection rates, hospital admissions, and deaths, when available, has informed our understanding of the biology of the infectious disease. The collection of sex-disaggregated data should also better inform our understanding of the gendered impacts that contribute to risk of exposure to COVID-19. In China, the country with the longest history of fighting the COVID-19 infection, what research was available on the gender-differential impacts of COVID-19 in the first 6 months of the COVID-19 pandemic?Methods: In this scoping review, we examine the first 6 months (January-June 2020) of peer-reviewed publications (n = 451) on sex and gender experiences related to COVID-19 in China. We conducted an exhaustive search of published Chinese and English language research papers on COVID-19 in mainland China. We used a COVID-19 Gender Matrix informed by the JPHIEGO gender analysis toolkit to examine and illuminate research into the gendered impacts of COVID-19 within China.Results: In China, only a small portion of the COVID-19-related research focused on gender experiences and differences. Near the end of the six-month literature review period, a small number of research items emerged on women healthcare workers, women's mental health, and pregnant women's access to care. There was an absence of research on the gendered impact of COVID-19 amongst populations. There was minimal consideration of the economic, social and security factors, including gender stereotypes and expectations, that affected different populations' experiences of infection, treatment, and lockdown during the period of review.Conclusion: At the outset of health emergencies in China, gender research needs to be prioritised during the first stage of an outbreak to assist with evaluation of the most effective public health measures, identifying access to healthcare and social welfare barriers amongst priority communities. Gender stereotypes and gendered differences lead to different patterns of exposure and treatment. The exclusion of this knowledge in real time affects the design of effective prevention and recovery. [ABSTRACT FROM AUTHOR]

Background: Since the coronavirus disease 2019 (COVID-19) pandemic outbreak, the incidence of mental health problems in perinatal women has been high, and particularly prominent in China which was the first country affected by COVID-19. This paper aims to investigate the current situation and the related factors of maternal coping difficulties after discharge during COVID-19. Methods: General information questionnaires (the Perinatal Maternal Health Literacy Scale, Postpartum Social Support Scale and Post-Discharge Coping Difficulty Scale-New Mother Form) were used to investigate 226 puerperal women in the third week of puerperium. The influencing factors were analyzed by single factor analysis, correlation and multiple linear regression. Results: The total score of coping difficulties after discharge was 48.92 ± 12.05. At the third week after delivery, the scores of health literacy and social support were 21.34 ± 5.18 and 47.96 ± 12.71. There were negative correlations among health literacy, social support and coping difficulties after discharge (r = -0.34, r = -0.38, P < 0.001). Primipara, family income, health literacy and social support were the main factors influencing maternal coping difficulties after discharge. Conclusion: During the COVID-19 pandemic, puerperal women in a low- and middle-income city had moderate coping difficulties after discharge and were affected by many factors. To meet the different needs of parturients and improve their psychological coping ability, medical staff should perform adequate assessment of social resources relevant to parturients and their families when they are discharged, so they can smoothly adapt to the role of mothers. [ABSTRACT FROM AUTHOR]

The outbreak of COVID-19 has imposed a great threat both to people's health and to social relations. By following the theoretical constructions of critical genre analysis and critical discourse analysis and drawing on the 35 press conferences on the COVID-19 outbreak in China, this paper explores how the discourse of press conferences is used by the Chinese government as a means of crisis management to (re)construct social relations. The analysis of the data reveals a hybridity of social relations reproduced discursively between such social actors as government institutions, the general public, medical institutions or staff, and COVID-19 patients, and a distinct feature of interdiscursivity of the discourse of press conferences on COVID-19, with descriptive, instructional, strategic, and evaluative discourses being the most frequently employed. It is also found that political, professional, social, and cultural forces are interwoven with each other to contribute to the interdiscursivity of the discourse of press conferences and the hybridity of social relations constructed thereof. [ABSTRACT FROM AUTHOR]

Objective: Lack of information about mental health status among medical staff during the epidemic of COVID-19 in China is one of the major barriers to psychological interventions. This paper aims to evaluate the contributions of perceived psychological feelings to the symptoms of common mental disorders among medical staff during the epidemic of COVID-19 in China. Method: A large sample of medical staff based on a non-probability sampling design was collected from February 17 to 24, 2020. The symptoms of common mental disorders were screened based on self-reported instruments to evaluate psychological distress, anxious symptoms, and depressive symptoms during the past week. Perceived psychological feelings were based on self-report. Logistic regressions and elastic net regularizations were used to evaluate the independent effect of the psychological feelings controlled by hospitals and participants characteristics. Results: Totally 4,677 medical staff completed the survey. The prevalence of psychological distress, anxious symptoms, and depressive symptoms were 15.9% (95% CI 14.8–16.9), 16.0% (95% CI 15.0–17.1), and 34.6% (95% CI 33.2–35.9). Feelings of having adequate personal protective equipment, receiving enough emotional supports from both family members and colleagues were significantly associated with fewer symptoms of common mental disorders, while the feelings of overloaded work and insufficient rest times contributed to more psychological problems. Conclusions: Psychological feelings make important contributions to the symptoms of common mental disorders of medical staff during the epidemic of COVID-19. Strategies of psychological aids or interventions could be developed based on these feelings. [ABSTRACT FROM AUTHOR]

Introduction: In December 2019, a new coronavirus has emerged out of China, the SARS‐CoV‐2 virus, causing a disease known as COVID‐19, which steadily has progressed into a pandemic. This coronavirus affects many organs, including the skin, whose manifestations are a consequence of the disease itself, as well as the preventative measures taken to avoid the infection. This paper reviews the cutaneous manifestations which currently have been encountered during this pandemic. Methods: A search was conducted on PubMed, and all relevant articles were included. Results: The results show the occurrence of many cutaneous findings, ranging from those related to the infection itself and to various dermatitides related to the use of personal protective equipment (PPE) utilized by healthcare workers while attending to infected patients. Discussion: Recognizing these findings is important for the accurate diagnosis of those infected with COVID‐19 as well as the prompt treatment of the side effects caused by PPE that might further impair the effectiveness of healthcare workers. [ABSTRACT FROM AUTHOR]

Background: Dental and oral health workers have direct contact with respiratory aerosols of patients during procedures. This study aimed to determine the main concerns of dental and oral health workers globally during COVID-19 outbreaks and the coping strategies that help the resilience of dental and oral healthcare system. Methods: This scoping study was conducted in August 2020. After adjusting the search strategy, a systematic search of five databases (PubMed, ISI Web of Science, Scopus, ProQuest and EMBASE) was conducted. Data was extracted using Microsoft Excel and the contents of retrieved articles were analysed through a qualitative thematic analysis applying MAX QDA10. Results: Most articles were either editorial/letters to the editor/commentary formats (34%), or literature reviews (26%). About half of the articles belonged to three countries of Italy, China and the USA (each 16% and totally 48%). Thematic analysis of included papers led to the identification of four main global concerns and 19 sub-concerns. Economic, ethical, social and professional concerns are among dental and oral health concerns. Other results indicate on three main themes and 13 sub-themes as the coping strategies including patient management, infection control and virtual strategies. Conclusion: Dental and oral health care workers have many concerns relating to COVID-19 including economic, ethical, social and professional factors. Resolution of concerns may involve enhancing coping strategies relating to patient management and infection control strategies as well as using new technologies for virtual contact with the patient without any risk of infection. [ABSTRACT FROM AUTHOR]

Background: A novel coronavirus (COVID-19) outbreak has occurred in China, and national medical workers have been thrown into this silent battle. Paediatric medical workers have been an important part of this battle and under enormous pressure. This paper evaluates the depression, anxiety, and stress of paediatric medical staff during the epidemic and examines related impact factors. Methods: We conducted this study using online questionnaires via social networking software during the week of Feb. 17 to Feb. 23, 2020. The 21-item Depression Anxiety Stress Scale (DASS), which is a revised, simplified version of the original DASS developed by Lovibond et al., was used in this study. Results: Among all 2,031 respondents, 14.81%, 18.3%, and 9.98% had depression, anxiety and stress symptoms, respectively. Males, doctors, individuals aged between 31‑60 years, those with senior job titles, those who had contact with patients with confirmed or suspected cases of COVID-19, those who worked on the clinical frontlines fighting the epidemic and those who had experience combating similar outbreaks were more likely to have depression, anxiety or stress symptoms. Respondents in Beijing and Chongqing had lower negative psychological symptom scores than the national average. Conclusion: During the COVID-19 outbreak, depression, anxiety and stress are present to varying degrees among paediatric medical workers across the country. Psychological crisis interventions should be implemented to protect the mental health of paediatric medical workers during and after the epidemic. [ABSTRACT FROM AUTHOR]

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Background: Post-traumatic stress disorder is an important psychological problem affecting the physical mental health of Chinese healthcare workers during the COVID-19 pandemic. Aims: To estimate the prevalence and influencing factors of post-traumatic stress disorder (PTSD) among Chinese healthcare workers during COVID-19. Methods: Search of Chinese and English literature in PubMed, EMbase, Web of Science, Medline, Elsevier, SpringerLink, China Biomedical Literature Database, CNKI, Wan-fang, and CQVIP for the period from December 2019 to August 2023. Stata 14.0 software was used for data analysis. The methodological quality of each study was scored, and data were extracted from the published reports. Pooled prevalence was estimated using the Random-effects model. Publication bias was evaluated using Egger's test and Begg's test. Results: Twenty-one studies included 11841 Chinese healthcare workers in this review. First, the overall prevalence of Post-traumatic stress disorder among Chinese healthcare workers during the COVID-19 epidemic was 29.2% (95% CI: 20.7% to 33.7%). Twelve factors included in the meta-analysis were found to be protective against PTSD among Chinese healthcare workers: female, nurse, married, front-line work, less work experience, family or friend diagnosed with COVID-19, history of chronic disease and fear of COVID-19. Conversely, outside Hubei, higher education, social support and psychological resilience are protective factors Conclusion: These recent findings increase our understanding of the psychological status of Chinese healthcare workers and encourage that longterm monitoring and long-term interventions should be implemented to improve the mental health of Chinese healthcare workers in the aftermath of the COVID-19. [ABSTRACT FROM AUTHOR]

Background: Over the past three years, the COVID-19 pandemic has brought an overwhelming impact on China's hospital system and health care workers, which can lead to post traumatic stress disorder (PTSD) symptoms. Previous research has shown that the COVID-19 pandemic had long-term adverse effects on the mental health of health care workers. Indeed, PTSD symptoms have emerged as one of the significant mental health issues for health care workers arising from the COVID-19 pandemic. Therefore, we conducted this cross-sectional survey to investigate the prevalence of PTSD symptoms in health care workers and its relationship with the fear of COVID-19 and the COVID-19 burden after the full liberalization of COVID-19 prevention and control policy in China. Methods: This study was conducted three years after the global COVID-19 pandemic (January 15 to January 16, 2023). This study was conducted via the Wenjuanxing platform and used the Chinese versions of the scales PC-PTSD-5, COVID-19 Anxiety Scale (FCV-19S), Social Support Scale, COVID-19 Stress Scale, GAD-2, and PHQ-2. Results: The prevalence of PTSD symptoms in health care workers was 24.3% (232/955). depression(P < 0.001), anxiety(P < 0.05), the fear of COVID-19(P < 0.001), and COVID-19 burden(P < 0.001) were highly correlated with PTSD symptoms in health care workers. Social support(P < 0.05) was a protective factor of PTSD symptoms. Conclusions: This survey shows that PTSD symptoms were highly prevalent among Chinese health care workers after the COVID-19 pandemic. Governments and leaders of medical institutions should, through psychological interventions, address the current situation of PTSD symptoms among health care workers and develop targeted programs and strategies to reduce their psychological problems. [ABSTRACT FROM AUTHOR]

Aim: To explore the job demands of healthcare workers (HCWs) working in mobile cabin hospitals in Shanghai and identify the influencing factors. Design: The study had a cross‐sectional design. Methods: Using the convenience sampling method, we selected 1223 HCWs (medical team members) working in these mobile cabin hospitals during April–May 2022. The findings of the general information questionnaire and the hierarchy scale of job demands of HCWs working in mobile cabin hospitals were used for the investigation. Results: The total score of job demands of the included HCWs was 132.26 ± 9.53; the average score of the items was 4.73 ± 0.34. Multivariate linear regression analyses showed that the following HCWs had significantly higher job demands: female HCWs and HCWs who received psychological training or intervention during the COVID‐19 pandemic, were satisfied with the doctor/nurse–patient relationship, received support from family members/friends/colleagues, believed that the risk of working in mobile cabin hospitals was high, had adapted to the working environment of mobile cabin hospitals and had college/undergraduate level of education. They would benefit from increased social support and better training in terms of psychological coping mechanisms(both theoretical knowledge and applicable skills) and COVID‐19 prevention,control and treatment abilities. [ABSTRACT FROM AUTHOR]

Background: Since March 2022, the COVID-19 epidemic has rebounded widely and frequently in China. Healthcare workers have faced grand challenges such as soaring COVID-19 patients, being busy with the nucleic acid screening of all the populations in the epidemic areas every day, and testing positive for COVID-19, all of which contributed to anxiety easily according to the Conservation of Resources theory. However, anxiety among healthcare workers is not only associated with personal health but also adversely affects the quality of health services. Therefore, it is crucial to search for suitable tools to monitor the anxiety related to COVID-19 among healthcare workers. The current study aimed to test the Coronavirus Anxiety Scale (CAS) in Chinese healthcare workers. Methods: The current study employed a cross-sectional design. The CAS was translated into Chinese. Then, according to Classical Test Theory (CTT) and Item Response Theory (IRT) models, the psychometric properties of the Chinese version were measured among 811 healthcare workers. Results: The split‐half reliability was 0.855. The Cronbach's α coefficient was 0.895. The retest coefficient was 0.901 with 10 days as the retest interval. The content validity index was 0.920. In exploratory factor analysis, one common factor was extracted and explained 72.559% of the total variance. All item load values on the common factor ranged from 0.790 to 0.885, and the communality of each item ranged from 0.625 to 0.784. With confirmatory factor analysis, the single factor model showed an excellent goodness-of-fit, chi-square/degree of freedom (χ2/df) = 3.339, goodness of fit index (GFI) = 0.992, adjusted goodness of fit index (AGFI) = 0.975, root-mean-square error of approximation (RMSEA) = 0.054, root mean square residual (RMR) = 0.005, incremental fit index (IFI) = 0.967, Tucker-Lewis index (TLI) = 0.932, and comparative fit index (CFI) = 0.966. The multiple-group confirmatory factor analysis revealed the invariance measuring anxiety of COVID-19 was in similar ways across ages, hospital degrees, and professional titles. With convergent validity, the CAS was positively correlated with post-traumatic stress disorder (r = 0.619, P < 0.001), fear of COVID (r = 0.550, P < 0.001), and depression (r = 0.367, P < 0.001). According to IRT models, the results showed that all item discrimination parameters were higher than 1.70 and difficulty parameters ranged from 1.13 to 2.83. Conclusion: The Chinese version of CAS has good psychometric properties in healthcare workers after China adjusted the COVID-19 management measures during the COVID-19 Omicron epidemic, and can be used for assessing the anxiety associated with COVID-19 in Chinese healthcare workers. [ABSTRACT FROM AUTHOR]

Misinformation posted on social media during COVID-19 is one main example of infodemic data. This phenomenon was prominent in China when COVID-19 happened at the beginning. While a lot of data can be collected from various social media platforms, publicly available infodemic detection data remains rare and is not easy to construct manually. Therefore, instead of developing techniques for infodemic detection, this paper aims at constructing a Chinese infodemic dataset, "infodemic 2019", by collecting widely spread Chinese infodemic during the COVID-19 outbreak. Each record is labeled as true, false or questionable. After a four-time adjustment, the original imbalanced dataset is converted into a balanced dataset by exploring the properties of the collected records. The final labels achieve high intercoder reliability with healthcare workers' annotations and the high-frequency words show a strong relationship between the proposed dataset and pandemic diseases. Finally, numerical experiments are carried out with RNN, CNN and fastText. All of them achieve reasonable performance and present baselines for future works. [ABSTRACT FROM AUTHOR]

Aims: To explore the lived experiences of emergency department (ED) healthcare professionals regarding visiting restrictions during the COVID‐19 pandemic. Design: A qualitative phenomenology study. Methods: Semi‐structured interviews were undertaken. Participants consisted of 10 physicians, 20 clinical nurses, and three managers, who were purposefully selected from two EDs in China between April and July 2021. Colaizzi's approach guided data analysis. Results: Four themes arose: (i) burden moral injury, (ii) higher workload to provide and support patient‐ and family‐centered care, (iii) dissatisfied and unsafe healthcare service for patients and families, and (iv) tailoring strategies to provide family‐centered care. Patient or Public Contribution: This study explored the lived experiences of ED health care professionals regarding visiting restrictions during the COVID‐19 pandemic. Noted challenges included communicating with families and ethical decision making. Strategies that support ED clinician welfare, and communication with families are warranted if visiting policy restrictions are continued or re‐introduced. [ABSTRACT FROM AUTHOR]

Background: Telehealth systems can significantly improve the triage, treatment and care of COVID-19 patients. Both patients and health providers are strongly motivated to use telehealth services, due to the quarantine and social distancing policies. Objective: This study aimed to systematically review the characteristics of telehealth-based services developed to support COVID-19 patients and/or healthcare providers. Material and Methods: A comprehensive search for the English language articles had been conducted up to 13 May 2020 using PubMed and Scopus electronic databases. In this review paper, only studies have been included that focus on a telehealth-based service to support COVID-19 patients and/or healthcare providers. Later, the general and detailed characteristics of the included studies were extracted. Results: In this review, fifteen out of the 1,291 retrieved articles met the study eligibility criteria. The studies came from 7 countries, where most of them (9, 56.25%) were conducted in the United States, and 3 (18.75%) of them implemented in China. The majority of studies (n=14, 93.4%) addressed patients as the telehealth recipients. Seven studies (46.6%) introduced a mobile application as the main means of the needed communication, followed by videoconferencing or video calls (6, 40%), and phone calls (5, 33.3%) as the media. 10 studies used a synchronous communication, four used an asynchronous communication, and one addressed both communications. Four studies (26.6%) developed a guideline-based telehealth tool. Of 15 included studies, seven (46.6%) addressed diagnosis, three (20%) prevention, three (20%) treatment, and three (20%) follow-up aspects of COVID-19. Totally, 10 group barriers were identified in literature. Conclusion: This review reveals the usefulness of the telehealth-based services during the COVID-19 outbreak. The existing challenges identified through the literature pointed out the need for clear guidelines, scientific evidence, and innovative policies to implement successful telehealth projects. [ABSTRACT FROM AUTHOR]

Role models are essential in medical education, yet empirical research is relatively insufficient on the influence of prosocial modelling on medical students' career commitment. The prosocial behaviour of medical staff involved in the fight against the novel coronavirus disease 2019 (COVID-19) at the beginning of 2020 presents an opportunity to fill the research gap. We explored and compared the different associations of the two most important role models for medical students – parents and faculty- with medical students' career commitment. The cross-sectional study was conducted with 99,559 undergraduate students majoring in clinical medicine in mainland China. Questions were asked to collect information about participants in the battle against COVID-19, medical students' determination to practice medicine after graduation, as well as students' socio-demographic characteristics. Chi-square tests and hierarchical regressions were performed to examine the associations between parent and faculty involvement and students' career commitment. The results showed statistically significant associations between prosocial modelling during the COVID-19 pandemic in China and students' intention to pursue medical careers. The association of faculty involvement (OR = 1.165, p <.001) with students' career commitment was greater than that of parents (OR = 0.970, p >.05). For faculty involvement, the association was stronger among male students (OR = 1.323, p <.001) and students who were already determined to be doctors (OR = 1.219, p <.001) before the pandemic. Our study provides new evidence on the potential roles of parents and faculty in shaping medical students' career commitment. Encouraging faculty to act as positive role models could help medical students increase their intention to become doctors. Prosocial modelling could enhance students' intention to pursue medical careers. The association of prosocial behaviour of faculty is larger than that of parents on medical students. Those who have prior medical career commitment are much more likely to persist in the medical profession, and prosocial modelling of faculty is positively associated with their medical career commitment. [ABSTRACT FROM AUTHOR]

Background: The 2019 novel coronavirus (COVID-19)-related depression symptoms of healthcare workers have received worldwide recognition. Although many studies identified risk exposures associated with depression symptoms among healthcare workers, few have focused on a predictive model using machine learning methods. As a society, governments, and organizations are concerned about the need for immediate interventions and alert systems for healthcare workers who are mentally at-risk. This study aims to develop and validate machine learning-based models for predicting depression symptoms using survey data collected during the COVID-19 outbreak in China. Method: Surveys were conducted of 2,574 healthcare workers in hospitals designated to care for COVID-19 patients between 20 January and 11 February 2020. The patient health questionnaire (PHQ)-9 was used to measure the depression symptoms and quantify the severity, a score of ≥5 on the PHQ-9 represented depression symptoms positive, respectively. Four machine learning approaches were trained (75% of data) and tested (25% of data). Cross-validation with 100 repetitions was applied to the training dataset for hyperparameter tuning. Finally, all models were compared to evaluate their predictive performances and screening utility: decision tree, logistics regression with least absolute shrinkage and selection operator (LASSO), random forest, and gradient-boosting tree. Results: Important risk predictors identified and ranked by the machine learning models were highly consistent: self-perceived health status factors always occupied the top five most important predictors, followed by worried about infection, working on the frontline, a very high level of uncertainty, having received any form of psychological support material and having COVID-19-like symptoms. The area under the curve [95% CI] of machine learning models were as follows: LASSO model, 0.824 [0.792–0.856]; random forest, 0.828 [0.797–0.859]; gradient-boosting tree, 0.829 [0.798–0.861]; and decision tree, 0.785 [0.752–0.819]. The calibration plot indicated that the LASSO model, random forest, and gradient-boosting tree fit the data well. Decision curve analysis showed that all models obtained net benefits for predicting depression symptoms. Conclusions: This study shows that machine learning prediction models are suitable for making predictions about mentally at-risk healthcare workers predictions in a public health emergency setting. The application of multidimensional machine learning models could support hospitals' and healthcare workers' decision-making on possible psychological interventions and proper mental health management. [ABSTRACT FROM AUTHOR]

Background: The shortage of healthcare workers is becoming a serious global problem. The underlying reasons may be specific to the healthcare system in each country. Over the past decade, medicine has become an increasingly unpopular profession in China due to the heavy workload, long-term training, and inherent risks. The ongoing COVID-19 pandemic has placed the life-saving roles of healthcare professionals under the spotlight. This public health crisis may have a profound impact on career choices in Chinese population. Methods: We conducted a questionnaire-based online survey among 21,085 senior high school students and 21,009 parents from 24 provinces (or municipalities) of China. We investigated the change of interest in medical study due to the outbreak of COVID-19 and the potential motivational factors based on the expectancy-value theory framework. Pearson correlation analysis was used to assess the correlation of static or dynamic interest in medical career pursuit with the reported number of COVID-19 cases. Logistic regression model was adopted to analyze the main factors associated with students' choices. Results: We observed an increased preference for medical study post the outbreak of COVID-19 in both students (17.5 to 29.6%) and parents (37.1 to 47.3%). Attainment value was found to be the main reason for the choice among students, with the contribution to society rated as the top motivation. On the other hand, the predominant demotivation in high school students was lack of interest, followed by concerns regarding violence against doctors, heavy workload, long-term training and heavy responsibility as a doctor. Additionally, students who were female, in the resit of final year, had highly educated parents and outside of Hubei province were significantly associated with a keen interest in pursuing medical study. Conclusions: This is the first multi-center cross-sectional study exploring the positive change and motivations of students' preferences in medical study due to the outbreak of COVID-19. Our results may help medical educators, researchers and policymakers to restructure medical education to make it more appealing to high school students, particularly, to develop a more supportive social and working environment for medical professionals to maintain the observed enhanced enthusiasm. [ABSTRACT FROM AUTHOR]

Introduction: Limited studies have focused on how the COVID-19 outbreak and thereby lockdown had affected the youth's food ordering patterns, which was associated with their dietary behaviors and could have longer term impacts on their later-life health status if the trend persists. This study aimed to evaluate changes in food ordering patterns among youths in China after the COVID-19 outbreak. Methods: The data were obtained from a national retrospective survey (COINLICS) conducted in early May 2020 via social media platforms in China among more than 10,000 youth participants at 3 educational levels. Participants reported their basic sociodemographic characteristics, weight status, and lifestyles including food ordering patterns. We described and compared their weight status and food ordering patterns before COVID-19 (January) and under lockdown (February). Results: We observed significant changes in youths' weight status and food ordering patterns under lockdown. A significant increase was observed in the prevalence of overweight/obesity (13.5%–17.0%) and obesity (8.7–10.8%), which varied by sex and educational level. Overall, the average weekly frequency of food ordering among the Chinese students had declined, with the largest decrease seen among graduate students, followed by undergraduate and high/vocational school students. Regardless of types of food, the percentage of participating youths who started ordering under lockdown was all lower than that of youths who stopped ordering. Among those who had still ordered foods under lockdown, a larger percentage of female than male high/vocational school students ordered barbecue/grill and cakes/pastries; no significant differences were found across the educational levels. Conclusion: The participating youths' food ordering patterns had significantly changed during the COVID-19 lockdown, with heterogeneities observed to different extents between sexes and across educational levels. Our findings would inform policy makers and health professionals of these changes in time, for better policy making and public health practice. [ABSTRACT FROM AUTHOR]

Aims: The Covid‐19 pandemic has had a substantial impact on the mental health of the general public and high‐risk groups worldwide. Due to its proximity and close links to China, Southeast Asia was one of the first regions to be affected by the outbreak. The aim of this systematic review was to evaluate the prevalence of anxiety, depression and insomnia in the general adult population and healthcare workers (HCWs) in Southeast Asia during the course of the first year of the pandemic. Methods: Several literature databases were systemically searched for articles published up to February 2021 and two reviewers independently evaluated all relevant studies using pre‐determined criteria. The prevalence rates of mental health symptoms were calculated using a random‐effect meta‐analysis model. Results: In total, 32 samples from 25 studies with 20 352 participants were included. Anxiety was assessed in all 25 studies and depression in 15 studies with pooled prevalence rates of 22% and 16%, respectively. Only two studies assessed insomnia, which was estimated at 19%. The prevalence of anxiety and depression was similar among frontline HCWs (18%), general HCWs (17%), and students (20%) while being noticeably higher in the general population (27%). Conclusions: This is the first systematic review to investigate the mental health impact of the Covid‐19 pandemic in Southeast Asia. A considerable proportion of the general population and HCWs reported mild to moderate symptoms of anxiety and depression; the pooled prevalence rater, however, remain significantly lower than those reported in other areas such as China and Europe. [ABSTRACT FROM AUTHOR]

Background: At the end of 2019, news circulated the world that a new, highly contagious coronavirus had emerged in China that caused severe disease in the respiratory tract. Subsequently, SARS-CoV-2 spread rapidly around the world. Healthcare professionals, including midwives, have been on the front lines of the fight against this disease, and their working conditions changed overnight, causing tremendous stress. Aim of the study: The purpose of this study was to analyze stress among midwives in relation to the SARSCoV- 2 pandemic. Material and methods: This study was conducted in 2020/2021 among 500 midwives. The testing method used was a diagnostic survey consisting of a self-compiled questionnaire. 444 midwives properly completed the survey and their results were analyzed. Results: The study confirmed that the work of a midwife is stressful. More than half of those surveyed changed their attitude towards work when SARS-CoV-2 emerged. Midwives were also more likely to experience stress before going to work. Only a small percentage of the respondents had the opportunity to receive psychological help in the workplace. Conclusions: The stress caused by the SARS-CoV-2 pandemic in the midwifery profession has had a negative impact on the psychophysical health of this occupational group. Thus, there is a dire need for workplace interventions for midwives to minimize the accompanying stress. [ABSTRACT FROM AUTHOR]

Universities worldwide are pausing in an attempt to contain COVID-19's spread. In February 2019, universities in China took the lead, cancelling all in-person classes and switching to virtual classrooms, with a wave of other institutes globally following suit. The shift to online platform poses serious challenges to medical education so that understanding best practices shared by pilot institutes may help medical educators improve teaching. Provide 12 tips to highlight strategies intended to help on-site medical classes moving completely online under the pandemic. We collected 'best practices' reports from 40 medical schools in China that were submitted to the National Centre for Health Professions Education Development. Experts' review-to-summary cycle was used to finalize the best practices in teaching medical students online that can benefit peer institutions most, under the unprecedented circumstances of the COVID-19 outbreak. The 12 tips presented offer-specific strategies to optimize teaching medical students online under COVID-19, specifically highlighting the tech-based pedagogy, counselling, motivation, and ethics, as well as the assessment and modification. Learning experiences shared by pilot medical schools and customized properly are instructive to ensure a successful transition to e-learning. [ABSTRACT FROM AUTHOR]

Aim: Since the 2019 coronavirus disease (COVID-19) outbreak, medical staff have faced greater psychological stress and are prone to psychological problems such as anxiety and depression, as confirmed by several studies. This study further clarifies the psychological status of Chinese medical staff during the stable phase of the pandemic through a cross-sectional investigation in a large population sample in northern China. Methods: Subjects: Clinical frontline medical staff from seven hospitals in Liaoning Province were recruited from November 2020 to February 2021. Research Tools: The research tools used were the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Simplified Coping Style Questionnaire (SCSQ), and General Status Questionnaire. Statistical Analysis: SPSS 22.0, ANOVA variance analysis, and multiple logistics regression were used for statistical analysis. P -values of <0.05 indicated significant statistical differences. Results: A total of 3,144 medical staff completed the survey (599 men [19.1%] and 2,545 women [80.9%]; 1,020 doctors [32.4%] and 2,124 nurses [67.6%]). Among all subjects, the rates of anxiety and depression were 21.1% (663/3, 144) and 43.9% (1,381/3,144), respectively. Multiple logistic comparative analysis revealed that age (OR = 1.272, 95% CI = 1.036–1.561, P = 0.022), the need for psychological counseling (OR = 1.566, 95% CI = 1.339–1.830, P < 0.001), and the coexistence of depression (OR = 0.050, 95% CI = 0.038–0.066, P < 0.001) were significantly associated with anxiety. Coexisting anxiety was also associated with the occurrence of depression (OR = 0.050, 95% CI = 0.038–0.065, P < 0.001). Conclusions: In the later stages of the pandemic in China, the occurrence rates of anxiety and depression among medical staff remain high. In addition to age, there is little correlation between anxiety or depression and general factors such as gender and profession. As a special group, medical staff show different psychological changes at various times during a stressful event. Concerning for the psychological needs of medical staff and different psychologically oriented policy implementation are needed. [ABSTRACT FROM AUTHOR]

Background: Studies showed that healthcare workers (HCWs) and pregnant women bore the burden of mental problems during the coronavirus disease 2019 (COVID-19) pandemic. While, few studies have focused on the psychological impact of COVID-19 pandemic on pregnant women who work at healthcare settings. This study aimed to investigate and compare the prevalence difference of psychological symptoms between pregnant HCWs and pregnant non-HCWs during the early stage of COVID-19 pandemic in China. Methods: A cross-sectional online survey with anonymous structured questionnaires was conducted from February 15 to March 9, 2020. A total of 205 pregnant women in Chongqing, China were recruited. The mental health status was assessed using symptom checklist-90 (SCL-90). Results: Our sample was composed of 83 pregnant HCWs (mean age = 29.8) and 122 pregnant non-HCWs (mean age = 30.8). The results suggested the prevalence of psychological symptoms (the factor score ≥2) among all pregnant women ranged from 6.83% (psychosis symptoms) to 17.56% (obsessive-compulsive symptoms). Compared with pregnant non-HCWs, pregnant HCWs reported higher prevalence of psychological symptoms in 10 factors of SCL-90. After controlling the confounding variables, multiple logistic regression demonstrated that pregnant HCWs experienced higher prevalence of psychological symptoms of somatization (18.07 vs. 5.74%, p = 0.006, aOR = 4.52), anxiety disorders (16.87 vs. 6.56%, p = 0.016, aOR = 3.54), and hostility (24.10 vs. 10.66%, p = 0.027, aOR = 2.70) than those among pregnant non-HCW. Conclusion: Our study indicated that pregnant HCWs were more likely to suffer from mental health distress than pregnant non-HCWs during the early stage of COVID-19 pandemic. It is vital to implement targeted psychological interventions for pregnant women, especially for pregnant HCWs to cope with distress when facing the emerging infectious diseases. [ABSTRACT FROM AUTHOR]

Background: The 2019 coronavirus disease (COVID-19) pandemic is a public health emergency of international concern and poses a challenge to the mental health and sleep quality of front-line medical staff (FMS). The aim of this study was to investigate the sleep quality of FMS during the COVID-19 outbreak in China and analyze the relationship between mental health and sleep quality of FMS. Methods: From February 24, 2020 to March 22, 2020, a cross-sectional study was performed with 543 FMS from a medical center in Western China. A self-reported questionnaire was used to collect data anonymously. The following tests were used: The Self-Rating Anxiety Scale (SAS) for symptoms of anxiety, the Beck Depression Inventory (BDI) for depressive symptoms, and the Pittsburgh Sleep Quality Index (PSQI) for sleep quality assessment. Results: Of the 543 FMS, 216 (39.8%) were classified as subjects with poor sleep quality. Anxiety (P<0.001), depression (P<0.001), and the prevalence of those divorced or widowed (P<0.05) were more common in FMS with poor sleep quality than in participants with good sleep quality. The FMS exhibiting co-occurrence of anxiety and depression were associated with worse scores on sleep quality than those medical staff in the other three groups/categories. The difference in sleep quality between the FMS with only depression and the FMS experiencing co-occurrence of anxiety and depression was statistically significant (P<0.05). However, there was no significant difference in sleep quality between the FMS experiencing only anxiety and the FMS with co-occurrence of anxiety and depression (P > 0.05). Conclusions: During the COVID-19 pandemic, there was a noteworthy increase in the prevalence of negative emotions and sentiments among the medical staff, along with poor overall sleep quality. We anticipate that this study can stimulate more research into the mental state of FMS during outbreaks and other public health emergencies. In addition, particular attention must be paid to enhance the sleep quality of FMS, along with better planning and support for FMS who are continuously exposed to the existing viral epidemic by virtue of the nature of their profession. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to describe the sleep quality and its influencing factors among medical workers of different working statuses and staff types during the coronavirus disease 2019 (COVID-19) epidemic. Methods: Through an online questionnaire survey, all medical staffs in Xiangya Hospital were invited to complete sections on general information, the Self-Rating Scale of Sleep (SRSS), the Depression, Anxiety and Stress Scale (DASS-21), the Social Support Rating Scale (SSRS), and the Simplified Coping Style Questionnaire (CSQ). Results: A total of 4,245 respondents completed the survey. Among them, 38.7% had sleep disturbance. After matching, the SRSS scores in the staffs who were assigned to the intensive care unit (ICU) of Union Hospital in Wuhan and working in the epidemic area of Xiangya Hospital were not significantly different (P > 0.05); the SRSS scores in the battlefront staffs were significantly higher than (P < 0.05) those who were not treating patients infected with COVID-19. The SRSS scores of nurses were significantly higher than those of doctors and hospital administrators (P < 0.01). Anxiety, depression, and coping style were associated with sleep disturbance. Conclusion: The sleep quality of the medical staffs has been impaired during the epidemic period, especially among nurses, doctors, and administrators who are working on the front line. Medical institutions should strengthen psychological services and coping strategies for medical staffs. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has had impact that may contribute to a rise in mental health problems. The present study was aimed to better understand psychological status among medical staff and medical students during the early epidemic and to explore the influence factors of psychological distress. Methods: A cross-sectional survey was conducted online from February 2–14, 2020. We collected general information related to the COVID-19 outbreak. Respondents were assessed using the Kessler-6 Psychological Distress Scale (K6), Social Support Rating Scale (SSRS), Perceived Stress Scale (PSS) and Simplified Coping Style Questionnaire (SCSQ). Stepwise multiple linear regression was performed to identify factors influencing psychological distress. Results: Five hundred and twenty-eight respondents returned valid questionnaires. Medical staff and Medical students scored averages of 6.77 ± 5.04, 15.48 ± 8.66 on the K6, 37.22 ± 11.39, 22.62 ± 11.25 on the SSRS and 18.52 ± 7.54, 28.49 ± 11.17 on the PSS, respectively. Most medical staff (279, 91.77%) and 148 medical students (66.07%) showed a positive coping style. Social support, perceived stress, hours spent watching epidemic-related information per day and frequency of epidemic-related dreams were identified as factors influencing psychological distress among medical staff and medical students. Coping style emerged as a determinant of psychological distress among medical staff. Conclusions: In the early stages of the COVID-19 epidemic in China, medical staff and medical students were at moderate to high risk of psychological distress. Our results suggest that psychological interventions designed to strengthen social support, reduce perceived stress and adopt a positive coping style may be effective at improving the mental health of medical staff and medical students. [ABSTRACT FROM AUTHOR]

Background: Many people have experienced novel coronavirus pneumonia since the beginning of the COVID-19 pandemic in Wuhan, China. The Chinese government has encouraged people to wear face masks in public places; however, due to the large population, there may be a series of problems related to this recommendation, including shortages of masks and lack of an optimal disposal method for used masks. Objective: The purpose of this study is to understand the current status of mask shortages and used masks in China. Methods: A questionnaire survey was designed to assess the current status of mask shortages and used masks. The differences among groups were analyzed with chi-square tests. Results: The constituent ratio of those who reuse masks was 61%. Obtaining masks from the drugstore was reported to be very difficult due to high demand and short supply, and approximately 1/3 of the respondents purchased expensive masks. Most people know how to properly handle used masks, and only 7% of them casually discard masks. However, 50% of respondents have seen others throw away used masks at will. A further subgroup analysis showed that respondents in Central China tended to use masks repeatedly, as did medical personnel. Females, people living in the central region, and medical personnel may find it more difficult to purchase masks in drugstores. Non-medical personnel may be more likely to buy expensive masks. Females, people living in the western region, and medical personnel may be more likely to know how to properly handle used masks and not to discard used masks at will. Medical personnel may be more likely to observe others discarding used masks at will. Conclusion: In response to COVID-19, the public should be encouraged to use face masks and are advised not to reuse or throw away masks at will due to safety concerns. [ABSTRACT FROM AUTHOR]

A sequence of pneumonia-causing diseases from the Novel coronavirus (COVID-19) appeared in Wuhan, Hubei, China in December 2019. The outbreak of COVID-19 spread quite rapidly. Just as we write this report, almost two and a half million verified cases were reported globally, and almost 180,000 people died.1 Experience from China reveals that COVID-19 outbreaks can be brought under control within 3 months, with highly efficient touch tracking and case isolation.2 Healthcare staff are at the forefront of treatment for COVID-19 cases and have a very large chance of exposure to the infection.3 Cuts in disposable gear and COVID-19 awareness are triggering infections in healthcare workers. 4 As of February 11, 2020, China has contaminated more than 1,700 health-care workers. In Italy, 2026 (9 percent) of the COVID-19 incidents happened in healthcare professionals (as of March 15). 5 But, 31 medical teams containing more than 42,000 nurses and doctors sent by the Hubei from other provinces did not have a reported infection. It indicates that sufficient information about the transmission of disease and the use of protective equipment and procedures to manage infections is necessary to avoid the spread of infection among health care staff. [ABSTRACT FROM AUTHOR]

Background: Misdiagnosis, arbitrary charges, annoying queues, and clinic waiting times among others are long-standing phenomena in the medical industry across the world. These factors can contribute to patient anxiety about misdiagnosis by clinicians. However, with the increasing growth in use of big data in biomedical and health care communities, the performance of artificial intelligence (Al) techniques of diagnosis is improving and can help avoid medical practice errors, including under the current circumstance of COVID-19.Objective: This study aims to visualize and measure patients' heterogeneous preferences from various angles of AI diagnosis versus clinicians in the context of the COVID-19 epidemic in China. We also aim to illustrate the different decision-making factors of the latent class of a discrete choice experiment (DCE) and prospects for the application of AI techniques in judgment and management during the pandemic of SARS-CoV-2 and in the future.Methods: A DCE approach was the main analysis method applied in this paper. Attributes from different dimensions were hypothesized: diagnostic method, outpatient waiting time, diagnosis time, accuracy, follow-up after diagnosis, and diagnostic expense. After that, a questionnaire is formed. With collected data from the DCE questionnaire, we apply Sawtooth software to construct a generalized multinomial logit (GMNL) model, mixed logit model, and latent class model with the data sets. Moreover, we calculate the variables' coefficients, standard error, P value, and odds ratio (OR) and form a utility report to present the importance and weighted percentage of attributes.Results: A total of 55.8% of the respondents (428 out of 767) opted for AI diagnosis regardless of the description of the clinicians. In the GMNL model, we found that people prefer the 100% accuracy level the most (OR 4.548, 95% CI 4.048-5.110, P<.001). For the latent class model, the most acceptable model consists of 3 latent classes of respondents. The attributes with the most substantial effects and highest percentage weights are the accuracy (39.29% in general) and expense of diagnosis (21.69% in general), especially the preferences for the diagnosis "accuracy" attribute, which is constant across classes. For class 1 and class 3, people prefer the AI + clinicians method (class 1: OR 1.247, 95% CI 1.036-1.463, P<.001; class 3: OR 1.958, 95% CI 1.769-2.167, P<.001). For class 2, people prefer the AI method (OR 1.546, 95% CI 0.883-2.707, P=.37). The OR of levels of attributes increases with the increase of accuracy across all classes.Conclusions: Latent class analysis was prominent and useful in quantifying preferences for attributes of diagnosis choice. People's preferences for the "accuracy" and "diagnostic expenses" attributes are palpable. AI will have a potential market. However, accuracy and diagnosis expenses need to be taken into consideration. [ABSTRACT FROM AUTHOR]

Background: The outbreak of novel coronavirus disease 2019 (COVID-19) has caused public panic and psychological health problems, especially in medical staff. We aimed to investigate the psychological effect of the COVID-19 outbreak on medical staff. Methods: A cross-sectional study was conducted to examine the psychological impact of medical staff working in COVID-19 designated hospitals from February to March 2020 in China. We assessed psychological health problems using the Symptom Check List 90 (SCL-90). Results: Among 656 medical staff, 244 were frontline medical staff and 412 general medical staff. The prevalence of psychological health problems was 19.7%. The SCL-90 scores in frontline medical staff were significantly higher than that in general medical staff (mean: 141.22 vs. 129.54, P < 0.05). Furthermore, gender [odds ratio (OR) = 1.53, 95% CI = (1.02, 2.30), P = 0.042 for female vs. male] and the burden of current work [OR = 7.55, 95% CI = (3.75, 15.21), P < 0.001 for high burden; OR = 2.76, 95% CI = (1.80, 4.24), P < 0.001 for moderate burden vs. low burden] were associated with increased risk of poor psychological status. Conclusions: Medical staff experienced a high risk of psychological health problems during the outbreak of COVID-19, especially for frontline medical staff. Psychological health services are expected to arrange for medical staff in future unexpected infectious disease outbreaks. [ABSTRACT FROM AUTHOR]

Background: The National Chest Pain Center Accreditation Program (CHANGE) is the first hospital-based, multifaceted, nationwide quality improvement (QI) initiative, to monitor and improve the quality of the ST segment elevation myocardial infarction (STEMI) care in China. The QI initiatives, as implementation strategies, include a bundle of evidence-based interventions adapted for implementation in China. During the pandemic of coronavirus disease 2019 (COVID-19), fear of infection with severe acute respiratory syndrome coronavirus 2, national lockdowns, and altered health care priorities have highlighted the program's importance in improving STEMI care quality. This study aims to minimize the adverse impact of the COVID-19 pandemic on the quality of STEMI care, by developing interventions that optimize the QI initiatives, implementing and evaluating the optimized QI initiatives, and developing scale-up activities of the optimized QI initiatives in response to COVID-19 and other public health emergencies.Methods: A stepped wedge cluster randomized control trial will be conducted in three selected cities of China: Wuhan, Suzhou, and Shenzhen. Two districts have been randomly selected in each city, yielding a total of 24 registered hospitals. This study will conduct a rollout in these hospitals every 3 months. The 24 hospitals will be randomly assigned to four clusters, and each cluster will commence the intervention (optimized QI initiatives) at one of the four steps. We will conduct hospital-based assessments, questionnaire surveys among health care providers, community-based household surveys, and key informant interviews during the trial. All outcome measures will be organized using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework, including implementation outcomes, service outcomes (e.g., treatment time), and patient outcomes (e.g., in-hospital mortality and 1-year complication). The Consolidated Framework for Implementation Research framework will be used to identify factors that influence implementation of the optimized QI interventions.Discussion: The study findings could be translated into a systematic solution to implementing QI initiatives in response to COVID-19 and future potential major public health emergencies. Such actionable knowledge is critical for implementors of scale-up activities in low- and middle-income settings.Trial Registration: ChiCTR 2100043319 . Registered on 10 February 2021. [ABSTRACT FROM AUTHOR]

For years, violence against doctors and healthcare workers has been a growing social issue in China. In a recent series of studies, we provided evidence for a motivated scapegoating account of this violence. Specifically, individuals who feel that the course of their (or their family member's) illness is a threat to their sense of control are more likely to express motivation to aggress against healthcare providers. Drawing on existential theory, we propose that blaming and aggressing against a single individual represents a culturally afforded scapegoating mechanism in China. However, in an era of healthcare crisis (i.e., the global COVID-19 pandemic), it is essential to understand cultural variation in scapegoating in the context of healthcare. We therefore undertook two cross-cultural studies examining how people in the United States and China use different scapegoating responses to re-assert a sense of control during medical uncertainty. One study was conducted prior to the pandemic and allowed us to make an initial validating and exploratory investigation of the constructs of interest. The second study, conducted during the pandemic, was confirmatory and investigated mediation path models. Across the two studies, consistent evidence emerged that, both in response to COVID-related and non-COVID-related illness scenarios, Chinese (relative to U.S.) individuals are more likely to respond by aggressing against an individual doctor, while U.S. (relative to Chinese) individuals are more likely to respond by scapegoating the medical industry/system. Further, Study 2 suggests these culture effects are mediated by differential patterns of primary and secondary control-seeking. [ABSTRACT FROM AUTHOR]

Background: Healthcare workers (HCWs) have been exposed to increased risks of insomnia and fatigue during the COVID-19 pandemic. In this study, we identify important risk factors associated with insomnia symptoms and fatigue among HCWs, and evaluate the effect of organizational support on insomnia and fatigue symptoms. Methods: This is an online cross-sectional survey of HCWs in China administered during the COVID-19 epidemic (from February 27, 2020 to March 12, 2020). We employed the AIS-8 scale for insomnia screening, and a self-reported ten-point scale to evaluate subjects' degrees of fatigue. We also designed a four-point scale to assess the degree of social support provided on an organizational level. Additionally, we conducted logistic regression analysis to identify risk factors. Results: This study included a total of 3,557 participants, 41% of which consisted of non-frontline HCWs and 59% of which was frontline HCWs. Of the non-frontline HCWs, 49% reported insomnia symptoms, and 53.8% reported a moderate to high degree of fatigue. Meanwhile, among the frontline HCWs, the percentages for insomnia and moderate to high fatigue were 63.4% and 72.2%, respectively. Additionally, frontline HCWs and HCWs employed at Centers for Disease Control and Prevention (CDCs) had elevated risks of insomnia and fatigue. However, with increased organizational support, insomnia symptoms decreased among frontline HCWs. Also, organizational support mitigated the positive correlation between daily working hours and degree of fatigue among HCWs. Conclusion: Frontline HCWs and staff in Chinese CDCs have been at a high risk of insomnia symptoms and fatigue during the fight against COVID-19. This study provides evidence for the positive effects of organizational support in relation to insomnia and fatigue among HCWs. This sheds light on government responses to the COVID-19 epidemic for other countries. [ABSTRACT FROM AUTHOR]

Objectives: Healthcare workers (HWs) experienced high levels of work stress during the COVID-19 pandemic, leading to a high risk of sleep disturbances. This meta-analysis aimed to explore the prevalence of sleep disturbances and sleep quality in Chinese HWs during the COVID-19 pandemic. Methods: English (PubMed, EMBASE, PsycINFO, Web of Science, and the Cochrane Library) and Chinese databases (WanFang, Chinese National Knowledge Infrastructure, and SinoMed) were systematically and independently searched for relevant studies published from December 1, 2019, to May 20, 2020. The pooled prevalence of sleep disturbances and sleep quality were calculated using a random-effects model. Results: A total of 17 studies involving 12,682 Chinese HWs were included in the meta-analysis. The pooled prevalence of sleep disturbances in Chinese HWs was 45.1% (95% CI: 37.2–53.1%). We found that the prevalence of sleep disturbances varied among frontline, infected, and non-frontline HWs (Q = 96.96, p < 0.001); females and males (Q = 9.10, p = 0.003); studies using different assessment instruments (Q = 96.05, p < 0.001); and studies with different sample sizes (Q = 5.77, p = 0.016) and cut-off values (Q = 62.28, p < 0.001). The pooled mean total score of the Pittsburgh Sleep Quality Index (PSQI) was 9.83 (95% CI: 8.61–11.04). HWs in Wuhan had a higher total PSQI score than those in other regions (Q = 9.21, p = 0.002). Conclusion: Sleep disturbances were common in Chinese HWs during the COVID-19 pandemic, particularly in frontline and infected HWs. Our results indicate the heavy mental health burden on HWs during the COVID-19 pandemic in China and can provide other countries with valuable information to assist HWs during the crisis. [ABSTRACT FROM AUTHOR]

With the ongoing COVID-19 outbreak, healthcare systems across the world have been pushed to the brink. The approach of traditional healthcare systems to disaster preparedness and prevention has demonstrated intrinsic problems, such as failure to detect early the spread of the virus, public hospitals being overwhelmed, a dire shortage of personal protective equipment, and exhaustion of healthcare workers. Consequently, this situation resulted in manpower and resource costs, leading to the widespread and exponential rise of infected cases at the early stage of the epidemic. To limit the spread of infection, the Chinese government adopted innovative, specialized, and advanced systems, including empowered Fangcang and Internet hospitals, as well as high technologies such as 5G, big data analysis, cloud computing, and artificial intelligence. The efficient use of these new forces helped China win its fight against the virus. As the rampant spread of the virus continues outside China, these new forces need to be integrated into the global healthcare system to combat the disease. Global healthcare system integrated with new forces is essential not only for COVID-19 but also for unknown infections in the future. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic is a major public health issue and challenge to health professionals. In similar epidemics, nurses experienced more distress than other providers. Methods: We surveyed both on-duty nurses caring for infected patients and second-line nurses caring for uninfected patients from Hubei and other provinces throughout China. Results: We received completed surveys from 1,364 nurses from 22 provinces: 658 front-line and 706 second-line nurses. The median (IQR) GHQ-28 score of all nurses was 17 (IQR 11–24). The overall incidence of mild-to-moderate distress (GHQ score > 5) was 28%; that for severe distress (GHQ score > 11) was 6%. The incidence of mild-to-moderate distress in the second-line nurses was higher than that in the front-line nurses (31 vs. 25%; OR, 0.74; 95 CI, 0.58–0.94). Living alone (OR, 0.62; 95% CI, 0.44–0.86) and feeling supported (OR, 0.82, 95% CI, 0.74–0.90) independently predicted lower anxiety. Conclusions: During the COVID-19 pandemic, the psychological problems of all nurses were generally serious. The interviewed second-line nurses face more serious issues than the front-line nurses. [ABSTRACT FROM AUTHOR]

Background: The outbreak of novel coronavirus disease (COVID-19) has brought serious psychological pressure to people, especially medical health staff. At present, there are few studies on insomnia and related factors of medical health staff in the middle and late stage of the epidemic of COVID-19. Therefore, the purpose of this study was to investigate the prevalence of insomnia and its related risk factors among medical workers in China in the middle and later stage of COVID-19 epidemic, as well as the relationship between insomnia and psychological resilience. Methods: From February 14 to March 29, 2020, a cross-sectional survey was conducted among 606 medical staff in China through Ranxing Technology's "SurveyStar" network platform. All subjects were assessed with the Insomnia Severity Index (ISI) and simplified Chinese version of Connor-Davidson Resilience scale (CD-RISC-10). Results: In the middle and later stages of the COVID-19 outbreak, the incidence of insomnia among medical staff was 32.0%. Compared with non-insomnia group, the insomnia group had younger age, lower education level, longer daily working hours and less psychological resilience. In addition, the prevalence of insomnia was higher in medical staff with a history of somatic diseases. The severity of insomnia of Chinese medical staff was associated with age, education level, daily working hours, psychological resilience and somatic diseases. Conclusions: Our study shows that nearly 1/3 of Chinese medical workers suffer from insomnia nearly a month after the COVID-19 outbreak. Compared with the general population, medical staff who are working with COVID are more prone to insomnia. Risk factors for insomnia include younger age, lower education level, longer working hours per day, and physical illness. The tenacious dimension of psychological resilience is a protective factor for insomnia. [ABSTRACT FROM AUTHOR]

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Virtual reality exposure therapy (VRET) is becoming popular for treating phobia and anxiety disorder. The recent pandemic of COVID-19 not only causes infection per se but also has an impact on mental health. This case series aimed to explore the role of VRET in the intervention of psychiatric illnesses with chief complaints of fear of COVID-19 infection. In vivo exposure therapy for fear of COVID-19 infection is not possible due to the risk of virus infection; in this scenario, the VRET provides an immersive experience and can act as adjunctive therapy for treating phobias and anxiety disorders arising due to novel coronavirus pandemic. Clinical presentation and findings as well as management and procedures of VRET are discussed. Medical record of three patients (two male and one female) at the Shenzhen Mental Health Center (Shenzhen Kangning Hospital), China, was included in the present case series. Patients were assessed with the Hamilton Anxiety Rating Scale and Fear of COVID-19 Scale to measure anxiety and fear, respectively. Throughout VRET sessions, we gradually and systematically exposed the patient to virtual COVID-19 scenarios (for example, touching stained door handle which may have viruses, watching pandemic news, watching frontline health care workers, etc.). In our study, VRET intervention significantly reduced the related symptoms caused by fear of COVID-19 infection. Furthermore, virtual reality can provide relevant theoretical and practical support for exploring the remote psychological counseling of patients in isolation wards. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease-2019 (COVID-19) is a new infectious disease. The COVID-19 outbreak has quickly spread globally and now is having remarkable effects on public health and national economies. Purpose: Effective measures for prevention and control of nosocomial infection are urgently needed to control COVID-19 infection among medical staff. Methods: Herein, we described COVID-19 prevention and control strategies that have been implemented in a tertiary hospital in the middle east of China. Hospital layout was adjusted to prevent and control transmission. Other procedures were then implemented to prevent the spread of the virus, including specialized training and evaluation of medical staff, pre-testing and triage, measures to promote early identification of patients, environmental cleaning and disinfection, new medical waste processing procedures, new patient management procedures, timely disinfection of potential sources of nosocomial infection, and strict protective measures. Results: Since the new measures were implemented, to date there have only been three new confirmed cases of COVID-19 infection, no cases of medical staff infection, and no COVID-19-related deaths at the hospital. Conclusion: The current report provides a protocol that could be implemented in medical departments in similar cities worldwide. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic and its related containment measures—mainly physical distancing and isolation—are having detrimental consequences on the mental health of the general population worldwide. In particular, frustration, loneliness, and worries about the future are common reactions and represent well-known risk factors for several mental disorders, including anxiety, affective, and post-traumatic stress disorders. The vast majority of available studies have been conducted in China, where the pandemic started. Italy has been severely hit by the pandemic, and the socio-cultural context is completely different from Eastern countries. Therefore, there is the need for methodologically rigorous studies aiming to evaluate the impact of COVID-19 and quarantine measures on the mental health of the Italian population. In fact, our results will help us to develop appropriate interventions for managing the psychosocial consequences of pandemic. The "COVID-IT-mental health trial" is a no-profit, not-funded, national, multicentric, cross-sectional population-based trial which has the following aims: a) to evaluate the impact of COVID-19 pandemic and its containment measures on mental health of the Italian population; b) to identify the main areas to be targeted by supportive long-term interventions for the different categories of people exposed to the pandemic. Data will be collected through a web-platform using validated assessment tools. Participants will be subdivided into four groups: a) Group 1—COVID-19 quarantine group. This group includes the general population which are quarantined but not isolated, i.e., those not directly exposed to contagion nor in contact with COVID-19+ individuals; b) Group 2—COVID-19+ group, which includes isolated people directly/indirectly exposed to the virus; c) Group 3—COVID-19 healthcare staff group, which includes first- and second-line healthcare professionals; d) Group 4—COVID-19 mental health, which includes users of mental health services and all those who had already been diagnosed with a mental disorder. Mental health services worldwide are not prepared yet to manage the short- and long-term consequences of the pandemic. It is necessary to have a clear picture of the impact that this new stressor will have on mental health and well-being in order to develop and disseminate appropriate interventions for the general population and for the other at-risk groups. [ABSTRACT FROM AUTHOR]

As was previously known, pediatric medical staff in China faced several hurdles including high occupational risk, multiple contradictions, heavy workload, and long working hours. After the outbreak of 2019 novel coronavirus, facing the overload of work and the potential risk of infection, pediatric medical workers may be under great psychological pressure. The purpose of this article was to call attention to the impact of the epidemic on the mental health of Chinese pediatric workers, and developing psychological intervention program that are tailored to them. The experiences from this public health emergency should inform the efficiency and quality of future crisis intervention of the Chinese government and authorities around the world. [ABSTRACT FROM AUTHOR]

The contactless food supply and delivery system of Raytheon Mountain Hospital is an innovative action to solve the dining problem and balance nutrition for medical staff and patients. The system was established according to five approval criteria, including localization, experience in hospital meal service, sufficient raw materials and supporting facilities, food safety, and high execution in dispatching. From the preparation phase to service optimization and improvement, the service model of the full collection of food and beverage information, point-to-point distribution, contactless food delivery, one-stop ordering, and full coverage of separately eating is established to safeguard the contactless food supply and delivery system operating smoothly. As of April 15, 2020 Raytheon Mountain Hospital had been operating safely for 68 days with no occurrence of food safety accident. [ABSTRACT FROM AUTHOR]