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To date the pathophysiology of COVID-19 remains unclear: this represents a factor determining the current lack of effective treatments. In this paper, we hypothesized a complex host response to SARS-CoV-2, with the Contact System (CS) playing a pivotal role in innate immune response. CS is linked with different proteolytic defense systems operating in human vasculature: the Kallikrein–Kinin (KKS), the Coagulation/Fibrinolysis and the Renin–Angiotensin (RAS) Systems. We investigated the role of the mediators involved. CS consists of Factor XII (FXII) and plasma prekallikrein (complexed to high-molecular-weight kininogen-HK). Autoactivation of FXII by contact with SARS-CoV-2 could lead to activation of intrinsic coagulation, with fibrin formation (microthrombosis), and fibrinolysis, resulting in increased D-dimer levels. Activation of kallikrein by activated FXII leads to production of bradykinin (BK) from HK. BK binds to B2-receptors, mediating vascular permeability, vasodilation and edema. B1-receptors, binding the metabolite [des-Arg9]-BK (DABK), are up-regulated during infections and mediate lung inflammatory responses. BK could play a relevant role in COVID-19 as already described for other viral models. Angiotensin-Converting-Enzyme (ACE) 2 displays lung protective effects: it inactivates DABK and converts Angiotensin II (Ang II) into Angiotensin-(1-7) and Angiotensin I into Angiotensin-(1-9). SARS-CoV-2 binds to ACE2 for cell entry, downregulating it: an impaired DABK inactivation could lead to an enhanced activity of B1-receptors, and the accumulation of Ang II, through a negative feedback loop, may result in decreased ACE activity, with consequent increase of BK. Therapies targeting the CS, the KKS and action of BK could be effective for the treatment of COVID-19. [ABSTRACT FROM AUTHOR]

Introduction: Previous coronavirus, 2019 (COVID-19) research has applied network analysis to examine relationships between psychopathological symptoms but rarely extended to potential risk and protective factors or the influence of COVID-19 infection history. This study examined complex interrelationships between psychopathological symptoms, COVID-19-related stressors, perceived social support, and COVID-19 infection history among Chinese university/college students during the peak of fifth pandemic wave using a network analysis approach. Methods: A Least Absolute Shrinkage and Selection Operator-regularized partial correlation network using Gaussian graphical model was constructed in 1,395 Chinese university/college students in Hong Kong who completed a survey between 15 March and 3 April, 2022. Depressive, anxiety, and acute/traumatic stress symptoms were measured by Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Impact of Event Scale-6, respectively. COVID-19-related stressors and perceived social support were measured. Network differences by COVID-19 infection history (COVID-network vs. no_COVIDnetwork) and network communities were examined. Results: Our results showed that the most influential nodes were depressed mood, uncontrollable worries, and uncontrollable thoughts about COVID-19. The main bridging symptoms were concentration problems and psychomotor problems. The COVID-network, comprising participants with a history of COVID-19 infection only, was significantly stronger than the no_COVIDnetwork. Perceived social support and stress from conflicts with family/friends formed a unique community with negative cognition and suicidal idea in the COVID-network only. Conclusion: Our findings indicate that specific interventions targeting interpersonal conflicts and concentration problems as well as facilitating stress buffering effects of social support may represent effective strategies to reduce psychological distress in university/college students during COVID-19 and should be considered for future pandemic preparedness. [ABSTRACT FROM AUTHOR]

Although the COVID-19 pandemic has caused many problems for university students, there are several research gaps in the study of psychological well-being of Hong Kong university students. First, few studies have examined different ecological correlates of mental health in a single study. Second, few studies have used both psychological morbidity and positive well-being as indicators of mental health. Third, we know little about the relationships between university students’ perceived need satisfaction, difficulties, service utilization, and their mental health. Hence, we conducted a study (N  =  1,020 university students) in the later stage of the COVID-19 pandemic in Hong Kong. For mental health, we included measures of negative mental health (psychological morbidity) and positive mental health. We addressed several research questions in this study: (1) what is the mental health status of Hong Kong university students? (2) what is the relationship between COVID-19 stress and student mental health? (3) what are the intrapersonal correlates of student mental health? (4) are interpersonal factors related to student mental health? (5) are need satisfaction, difficulties encountered, and service utilization related to students’ mental health? (6) are there gender differences in the effects of correlates in different ecological systems? Analyses using structural equation modeling showed several observations. First, the prevalence of mental health symptoms among university students was alarming. Second, COVID-19 related socio-economic stress positively predicted psychological morbidity but negatively predicted well-being. Third, beliefs about adversity, resilience, and emotional competence predicted mental health. Fourth, family functioning was related to psychological morbidity negatively but connected with wellbeing positively. Fifth, while need satisfaction predicted psychological morbidity negatively, difficulties encountered showed the opposite direction. Besides, the perceived usefulness of university services positively predicted mental health. Finally, there were no gender differences in the effects of different predictors. The present findings enable public health researchers to formulate theoretical models on different ecological determinants of university students’ mental health under the pandemic. For public health practitioners, the study highlights the importance of reducing COVID-19 associated stress, strengthening internal and external developmental assets, and meeting the psychosocial needs of university students as strategies to promote their mental health under the pandemic. [ABSTRACT FROM AUTHOR]

Since the beginning of 2022, the Hong Kong government has imposed strict social distancing measures and changed its stance on various regional policies with the aim to contain the so-called ‘fifth wave’ of COVID-19. In these pandemic and ‘infodemic’ times filled with uncertainty and fear, Hong Kong netizens used local online discussion forums as a resource to establish an innovative form of ‘helping network.’ This study is based on 230 posts from a popular local online discussion forum ‘LIHKG’ in February 2022 when the pandemic was regarded as most critical by the Department of Health. Speech Acts theoretic approach was adopted to explore how forum users employed speech acts to perform various communicative practices such as expressing concerns, asking for information, and engaging with others in a CMC environment amid a global health crisis. Representatives were found to be the most dominant text-based speech acts, followed by directives, expressives and commissives. Speech acts provide forum users a context in which emoji usage occurs. Forum users not only make use of words to ‘do’ things in the online self-help forum, but they also employ emojis to either supplement or complement speech acts. This study also shows that emojis perform multiple functions in the discussion posts and argues that they do not merely function as emotion indicators of their textual company, but also carry significant pragmatic meanings by illustrating how they can also carry illocutionary force and in some cases, even alter the illocutionary force of their preceding texts. The findings of this study enhance our understanding of how forum users communicate via verbal and nonverbal means within the underexplored ‘helping domain’ of online discussion forums. It also suggests that online discussion forum interactions need to be approached differently than other better understood alternatives. [ABSTRACT FROM AUTHOR]

Our study (NCT04800133) aimed to determine the safety and immunogenicity in patients with IEIs receiving a 3-dose primary series of mRNA vaccine BNT162b2 (age 12+) or inactivated whole-virion vaccine CoronaVac (age 3+) in Hong Kong, including Omicron BA.1 neutralization, in a nonrandomized manner. Intradermal vaccination was also studied. Thirty-nine patients were vaccinated, including 16 with homologous intramuscular 0.3ml BNT162b2 and 17 with homologous intramuscular 0.5ml CoronaVac. Two patients received 3 doses of intradermal 0.5ml CoronaVac, and 4 patients received 2 doses of intramuscular BNT162b2 and the third dose with intradermal BNT162b2. No safety concerns were identified. Inadequate S-RBD IgG and surrogate virus neutralization responses were found after 2 doses in patients with humoral immunodeficiencies and especially so against BA.1. Dose 3 of either vaccine increased S-RBD IgG response. T cell responses against SARS-CoV-2 antigens were detected in vaccinated IEI patients by intracellular cytokine staining on flow cytometry. Intradermal third dose vaccine led to high antibody response in 4 patients. The primary vaccination series of BNT162b2 and CoronaVac in adults and children with IEIs should include 3 doses for optimal immunogenicity. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has imposed a profound negative impact on the mental health and wellbeing of societies and individuals worldwide. Older adults may be more vulnerable to the mental health effects of the pandemic, either directly from the infection itself or indirectly through the preventive measures. However, the existing literature on mental health in the older age groups has not been consistent so far. The aim of this study was therefore to assess the prevalence of common mental disorders (CMD; including depression and anxiety disorders) given their association with dementia risk, and to further examine age-related differences between older (≥60 years old) and younger (18-59 years old) adult's psychological status during the COVID-19 pandemic. Method: This was a secondary analysis of a cross-sectional survey-study conducted during the second wave of COVID-19 pandemic in Hong Kong. The survey was disseminated through different social media platforms to the general population and included sociodemographic questions, self-reported physical health, and previous encounter with SARS or COVID-19. CMD was the primary outcome and was assessed using the 6-item Kessler Scale. A total of 1030 adults fulfilled inclusion criteria. Results: The prevalence of CMD during the pandemic was 16.1%. Compared to younger adults, older adults were significantly less likely to have a CMD (unadjusted OR = 0.07, 95% CI = 0.02-0.30, p < 0.001), with 18.1% of younger adults having CMD compared to 1.6% in the older cohort. Age differences remained significant after controlling for sociodemographic factors, physical health, and previous encounter with SARS or COVID-19 (adjusted OR = 0.12, 95% CI = 0.02-0.57, p = 0.008). Conclusion: Common mental disorders are highly prevalent during the COVID-19 pandemic in Hong Kong, though older adults appeared to be less affected mentally. Present findings highlight the urgent need to implement measures and strategies tomitigate themental health problems, with particular Frontiers in attention to the younger cohort. Given their association with higher dementia risk, early detection and treatment of depression and anxiety disorders will be of critical importance in providing some relief to the already pressurized dementia burden in the longer term. [ABSTRACT FROM AUTHOR]

COVID-19 has emerged as a devastating disease in the last 2 years. Many authors appointed to the importance of kallikrein-kinin system (KKS) in COVID-19 pathophysiology as it is involved in inflammation, vascular homeostasis, and coagulation. We aim to study the bradykinin cascade and its involvement in severity of patients with COVID-19. This is an observational cohort study involving 63 consecutive patients with severe COVID-19 pneumonia and 27 healthy subjects as control group. Clinical laboratory findings and plasma protein concentration of KKS peptides [bradykinin (BK), BK1-8], KKS proteins [high–molecular weight kininogen (HK)], and KKS enzymes [carboxypeptidase N subunit 1 (CPN1), kallikrein B1 (KLKB1), angiotensin converting enzyme 2 (ACE2), and C1 esterase inhibitor (C1INH)] were analyzed. We detected dysregulated KKS in patients with COVID-19, characterized by an accumulation of BK1-8 in combination with decreased levels of BK. Accumulated BK1-8 was related to severity of patients with COVID-19. A multivariate logistic regression model retained BK1-8, BK, and D-dimer as independent predictor factors to intensive care unit (ICU) admission. A Youden's optimal cutoff value of −0.352 was found for the multivariate model score with an accuracy of 92.9%. Multivariate model score-high group presented an odds ratio for ICU admission of 260.0. BK1-8 was related to inflammation, coagulation, and lymphopenia. Our data suggest that BK1-8/BK plasma concentration in combination with D-dimer levels might be retained as independent predictors for ICU admission in patients with COVID-19. Moreover, we reported KKS dysregulation in patients with COVID-19, which was related to disease severity by means of inflammation, hypercoagulation, and lymphopenia. [ABSTRACT FROM AUTHOR]

Post-traumatic growth (PTG) emerges from highly stressful situations. The coronavirus (COVID) pandemic may qualify as one. This study investigated the PTG among Hong Kong citizens during the first outbreak in spring 2020, shortly after a large-scale social movement subsided. A longitudinal online survey was launched during the peak (Time 1) and the palliation (Time 2) of the outbreak. Among the 327 participants who completed both waves, 28.4% exhibited probable post-traumatic stress disorder (PTSD) in Time 1, while 18.0% reported significant PTG in at least one domain in Time 2. The interaction between the sense of coherence (SOC) and post-traumatic stress mediated the relationship between Time 1 perceived outbreak severity and Time 2 PTG, such that PTG was more likely among participants with higher post-traumatic stress and SOC. PTG was also associated with a weaker contingency between Time 1 and Time 2 perceived outbreak severity. Echoing the transformational model, our findings show that both experienced stress and coping resources are essential for PTG to emerge. We also demonstrated how PTG might lead to more flexible risk perceptions according to the development of the outbreak. [ABSTRACT FROM AUTHOR]

Background: Although digital technology enables people to stay connected during COVID-19, protracted periods of isolation, crisis-induced stress, and technology-based activity may intensify problem technology use (PTU), such as social media addiction (SMA) and Internet gaming disorder (IGD). Objective: This study aimed to characterize the patterns and levels of SMA and IGD during COVID-19 in the general population of Hong Kong. We also tested the associations between prolonged use of social media/Internet games and SMA/IGD and the mediation effects of psychosocial statuses (i.e., loneliness, boredom, and post-traumatic stress) on these associations. Methods: A population-based random telephone survey was conducted in community adults in May 2020; 658 social media users and 177 Internet gamers were identified. A structured questionnaire, including the Bergen Social Media Addiction Scale, the diagnostic and statistical manual of mental disorder IGD Symptoms Checklist, the Post-Traumatic Stress Disorder Scale, Multidimensional State Boredom Scale, and the De Jong Gierveld Loneliness Scale, was used. Time spent on social media and Internet games during and before COVID-19 was also asked. Results: There were 66.2–81.8% increases in time use of social media or Internet games during COVID-19 compared to pre-COVID-19 self-reported information of the participants. The estimated IGD prevalence rate in the gamers based on the sample weighted to the age distribution and gender ratio of the Hong Kong population was 9.7%, higher than that of pre-COVID-19 research. Age, marital status, education levels, time use of social media, COVID-19-related post-traumatic stress, boredom, and emotional loneliness were significantly associated with SMA, while time spent on Internet games, boredom, and emotional loneliness was significantly associated with IGD. Boredom positively mediated the associations between time spent on social media/Internet games and SMA/IGD, whereas social loneliness negatively mediated the association between time spent on social media and SMA. Conclusion: These findings highlight the concern of prolonged use of digital platforms during COVID-19 and its role as a "double-edged sword" for psychosocial wellbeing and behavioral health during COVID-19. It also highlights a need to monitor and prevent PTU in the general public. The observed psychosocial mechanisms are modifiable and can inform the design of evidence-based prevention programs for PTU. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has brought a tremendous impact on the pedagogy and learning experience of students in sub-degree education sector of Hong Kong. Online learning has become the "sole" solution to deal with student learning challenges during this chaotic period. In this study, we explore online learning for sub-degree students by using a community of inquiry (CoI). As such, confirmatory factor analysis (CFA) was conducted on survey data gathered from 287 sub-degree students from the business and engineering disciplines. Results indicated that the network speed for online education determines the perceived cognitive presence, social presence, and teaching presence of students, whereas gender and academic disciplines of students are not moderating factors that create a significant difference in perceived cognitive presence, social presence, and teaching presence of students. Our study findings for creating and sustaining a purposeful online learning community are highlighted. [ABSTRACT FROM AUTHOR]

Background: The mental health of international students studying abroad has been neglected during the COVID-19 pandemic. Objective: This mixed-method study examined perceived public attitudes, personal beliefs, practice and stress toward facemask wearing as a preventive measure against COVID-19 among international University students from Hong Kong studying in the United Kingdom (UK) in the early stage (January–March 2020) of the pandemic. Methods: Our study included 2 parts: (i) an exponential, non-discriminative snowball sampling strategy was used to recruit 91 Chinese students studying in the UK to complete an online questionnaire survey, and (ii) online Zoom focus group interviews were conducted with 16 students who completed the online survey to gain an in-depth understanding of their experiences and coping methods during the pandemic. Results: Of the 91 students, 92.3% reported the UK public did not view facemask wearing as a preventive measure. 98.9% believed facemask wearing was an effective preventive measure, but 56% wore facemasks more than half of the time when out in public. 50.5% had internal conflicts of stress both when wearing and not wearing facemasks, which was more common in females than males [(62.5 vs. 31.5%), P = 0.004, Relative Risk (RR): 1.99 (1.17, 3.38)]. 61.5% reported public prejudiced attitudes against facemask wearing, also more common in females than males (71.4 vs. 45.7%), P = 0.02, RR: 1.56 (1.05, 2.32). The qualitative findings corroborated with the quantitative findings and reported that peer and family support were important for them to face such difficulties, and positive thinking and adaptability were effective methods on stress management. Conclusions: Since the outbreak of COVID-19, Chinese international students have been faced with a difficult, confusing, and sensitive situation. Owing to the ongoing pandemic, rising xenophobia and racist behaviors and the resumption of students' studies studies in the U.K., support from global communities are needed in their pursuit of quality education overseas. Our findings have significant implications on the proactive roles that governments should have, and the need for clear and accurate public health messaging to change public attitudes and mitigate prejudice. Academic institutions and mental health professionals need to proactively provide additional support to Chinese international students. [ABSTRACT FROM AUTHOR]

Background: The twenty-first century viral respiratory epidemics have taught us valuable lessons. Our systematic review examined the impact of these epidemics, including coronavirus disease 2019 (COVID-19), on mental health among different population groups, drawing on their insights for recommendations for the current COVID-19 pandemic. Methods: Searches were performed on PubMed, Embase, PsycINFO, Web of Science, Scopus, CINAHL, and Cochrane on April 4, 2020. Studies that had undefined mental health outcomes or did not use a validated scale for measure were excluded. Quality assessment was carried out via the Newcastle–Ottawa Scale. Results: We included 95 studies, most of which were conducted in Hong Kong (31.6%) and China (21.4%). A total of 30 (30.9%) studies are on the general public, 41 (42.2%) on healthcare workers, and 26 (26.6%) on patients and quarantined individuals. Furthermore, 36 (37.1%) of the studies are of high quality, 48 (49.5%) are of moderate quality, and 13 (13.4%) are of low quality. The most significant mental health outcomes reported include anxiety, depression, and post-traumatic stress disorder symptoms. The subgroups identified to have a higher risk of psychiatric symptoms among the general public include females, the elderly, individuals with chronic illness, migrant workers, and students. Long-term mental health impact was reported in some healthcare workers and epidemic patients, even up to 3 years in the former. Interestingly, when compared to non-quarantined groups, quarantine was not significantly associated with worse mental health outcomes. Conclusion: Important implications for the COVID-19 pandemic were highlighted. Respiratory epidemics pose a significant psychological morbidity onto many population groups. Psychological support for vulnerable groups, including healthcare workers and patients, should be implemented to prevent them from spiraling into clinical psychiatric conditions. [ABSTRACT FROM AUTHOR]

COVID-19 has brought tremendous and abrupt threats to various aspects of our daily lives, from school and work to interpersonal relationships. Self-compassion is put forth as a salutogenic perspective on oneself that buffers the adverse mental health impacts of these threats. During the peak of a local outbreak in Hong Kong in Spring 2020, 761 participants completed questionnaires on self-compassion, perceived threats, as well as perceived benefits and psychological distress. Controlling for demographic variables, negative indicators of self-compassion (aka self-coldness) was found to intensify the impacts of threats on psychological distress. The positive indicators of self-compassion also moderated the link between threats and perceived benefits, such that perceived benefits tend to be less related to threats in participants with higher self-compassion. Our findings highlight the impacts of both positive and negative indicators of self-compassion on the adjustment to such unprecedented challenges, and point to the possibility of enhancing people's resilience through fostering self-compassion and alleviating self-coldness. [ABSTRACT FROM AUTHOR]

The 2019 novel coronavirus (COVID-19) pandemic is associated with increases in psychiatric morbidity, including depression. It is unclear if people with depressive symptoms understand or apply COVID-19 information differently to the general population. Therefore, this study aimed to examine associations between depression, health beliefs, and face mask use during the COVID-19 pandemic among the general population in Hong Kong. This study gathered data from 11,072 Hong Kong adults via an online survey. Respondents self-reported their demographic characteristics, depressive symptoms (PHQ-9), face mask use, and health beliefs about COVID-19. Hierarchical logistic regression was used to identify independent variables associated with depression. The point-prevalence of probable depression was 46.5% (n = 5,150). Respondents reporting higher mask reuse (OR = 1.24, 95%CI 1.17–1.34), wearing masks for self-protection (OR = 1.03 95%CI 1.01–1.06), perceived high susceptibility (OR = 1.15, 95%CI 1.09–1.23), and high severity (OR = 1.33, 95%CI 1.28–1.37) were more likely to report depression. Depression was less likely in those with higher scores for cues to action (OR = 0.82, 95%CI 0.80–0.84), knowledge of COVID-19 (OR = 0.95, 95%CI 0.91–0.99), and self-efficacy to wear mask properly (OR = 0.90 95%CI 0.83–0.98). We identified a high point-prevalence of probable major depression and suicidal ideation during the COVID-19 outbreak in Hong Kong, but this should be viewed with caution due to the convenience sampling method employed. Future studies should recruit a representative probability sample in order to draw more reliable conclusions. The findings highlight that COVID-19 health information may be a protective factor of probable depression and suicidal ideation during the pandemic. Accurate and up-to-date health information should be disseminated to distressed and vulnerable subpopulations, perhaps using digital health technology, and social media platforms to prompt professional help-seeking behavior. [ABSTRACT FROM AUTHOR]