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Using network analysis, the current study investigated the pathways that underlie selected components of sleep health and their changes over time. Undergraduates ( N  = 1423; 80.60% female) completed a two-wave survey, sleep health (i.e. chronotypologies (CTs), sleep procrastination (SP), sleep quality (SQ)), psychological distress (PD), emotion regulation (ER), self-control (SC), problematic smartphone use (PSU) were measured. CTs, SP, and SQ formed a spatially contiguous pattern that remained unchanged in both waves. ER and PD node increased its strength, betweenness, and closeness in the network, while the link between the two was strengthened at T2. PSU was connected to SP, but not to CTs and SQ during both waves. In the context of the network approach, SP had the highest strength, and its associations with other dimensions of individual sleep may represent key factors in understanding the influence of exposure to the COVID-19 outbreak on sleep health., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: The regularity of epidemic prevention and control measures in China has meant that nursing students have been exposed to more electronic devices, while problematic smartphone use has increased. The purpose of this study is to determine the prospective associations among time management tendency, negative emotions, and problematic smartphone use in nursing students during the COVID-19 pandemic., Methods: A longitudinal study was conducted between November 2021 and May 2022. A total of 989 nursing students participated. The convenience sampling method was adopted and the following tools were used: the Adolescence Time Management Disposition Scale, the Depression Anxiety Stress Scales - 21, and the Mobile Phone Addiction Index. Multiple parallel mediation models were used by Mplus., Results: Time management tendency had a significantly negative effect on problematic smartphone use ( p  < 0.05). Further tests using mediation models showed that stress as a negative emotion mediated the relationship between time management tendency and problematic smartphone use ( p  < 0.05) over time., Conclusion: Nursing educators need to strengthen the stress resistance and time management ability of nursing students., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ding, Shi, Xu, Wang, Liu, Mao, Zhang and Zhang.)

Background: Low temperature is conducive to the survival of COVID-19. Some studies suggest that cold-chain environment may prolong the survival of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and increase the risk of transmission. However, the effect of cold-chain environmental factors and packaging materials on SARS-CoV-2 stability remains unclear., Methods: This study aimed to reveal cold-chain environmental factors that preserve the stability of SARS-CoV-2 and further explore effective disinfection measures for SARS-CoV-2 in the cold-chain environment. The decay rate of SARS-CoV-2 pseudovirus in the cold-chain environment, on various types of packaging material surfaces, i.e., polyethylene plastic, stainless steel, Teflon and cardboard, and in frozen seawater was investigated. The influence of visible light (wavelength 450 nm-780 nm) and airflow on the stability of SARS-CoV-2 pseudovirus at -18°C was subsequently assessed., Results: Experimental data show that SARS-CoV-2 pseudovirus decayed more rapidly on porous cardboard surfaces than on nonporous surfaces, including polyethylene (PE) plastic, stainless steel, and Teflon. Compared with that at 25°C, the decay rate of SARS-CoV-2 pseudovirus was significantly lower at low temperatures. Seawater preserved viral stability both at -18°C and with repeated freeze-thaw cycles compared with that in deionized water. Visible light from light-emitting diode (LED) illumination and airflow at -18°C reduced SARS-CoV-2 pseudovirus stability., Conclusion: Our studies indicate that temperature and seawater in the cold chain are risk factors for SARS-CoV-2 transmission, and LED visible light irradiation and increased airflow may be used as disinfection measures for SARS-CoV-2 in the cold-chain environment., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Peng, Li, Lin, Guo, Xu, Qiu, Zhu, Zheng, Sun, Hu, Zhang, Li, Pathak, Bi and Dai.)

Purpose: This study aimed to examine the associations between frequent exposure to positive/negative information about vaccine efficacy/safety on social media and intention of COVID-19 vaccination, and to test if media literacy and perceived information quality would moderate such associations., Design: A multi-city cross-sectional survey., Setting: At five universities in different regions of China., Subjects: 6922 university students (a response rate of 72.3%)., Measures: frequency of exposure to social media information about COVID-19 vaccination, media literacy, perceived information quality, intention of COVID-19 vaccination, and sociodemographic characteristics., Analysis: Logistic regression analysis was conducted to test main and interaction effects., Results: Higher exposure to positive information about vaccine efficacy (adjusted odds ratio [AOR] = 1.30, P < .001) and vaccine safety (AOR = 1.27, P < .001) were positively associated with vaccination intention. No significant associations were shown between exposure to negative information about vaccine efficacy/safety and vaccination intention. Higher net exposure to negative vs positive information was negatively associated with vaccination intention (AOR = .82, P < .001). High media literacy was further found to attenuate the effect of negative information exposure and strengthen that of positive information exposure. Perceived information quality was not a significant moderator., Conclusion: The valence of social media information regarding the efficacy and safety of COVID-19 vaccines and individuals' media literacy jointly shaped COVID-19 vaccination intention. The findings can inform the development of effective health promotion strategies for enhancing COVID-19 vaccination.

Smartphone addiction (SPA) is prevalent in college students and harms their healthy development, and perceived stress (PS) has been a well-documented risk factor of SPA. People often experienced boredom during COVID-19; however, its effect on behavioral/mental health during the pandemic has been rarely tested. We investigated the prospective association between SPA and PS before and during COVID-19, as well as the moderation of boredom. A total of 197 college students participated in four-wave surveys from December 2018 to June 2020 in China. The cross-lagged model was developed to investigate the prospective association between SPA and PS from T1 to T4. Boredom was added to the model at T4 as a moderator to explore the moderating role of boredom during COVID-19. The results showed that the pandemic changed PS's prediction on SPA. During COVID-19, boredom significantly affected SPA and PS and moderated the link from PS at T3 to PS at T4. The results suggest that the prospective associations between SPA and PS varied before and during COVID-19. Prevention of SPA should be conducted for new students and should be used to enhance their stress coping capacity. Intervention programs for eliminating boredom may be effective for reducing stress and SPA during COVID-19.

Background: Coronavirus disease 2019 (COVID-19) vaccination is expected to end the pandemic; a high coverage rate is required to meet this end. This study aimed to investigate the prevalence of behavioral intention of free/self-paid COVID-19 vaccination and its associations with prosociality and social responsibility among university students in China., Methods: An anonymous online cross-sectional survey was conducted among 6922 university students in five provinces in China during November 1-28, 2020. With informed consent, participants filled out an online survey link distributed to them via WeChat study groups. The response rate was 72.3%., Results: The prevalence of behavioral intentions of free COVID-19 vaccination was 78.1%, but it dropped to 57.7% if the COVID-19 vaccination involved self-payment (400 RMB; around 42 USD). After adjusting for background factors, prosociality (free vaccination: adjusted odds ratio [ORa] = 1.10, 95% CI: 1.09-1.12; self-paid vaccination: ORa = 1.08, 95% CI: 1.07-1.09) and social responsibility (free vaccination: ORa = 1.17, 95% CI: 1.14-1.19; self-paid vaccination: ORa = 1.13, 95% CI: 1.11-1.14) were positively associated with the two variables of COVID-19 vaccination intention., Conclusion: The present study demonstrated the positive effects of prosociality and social responsibility on the intention of COVID-19 vaccination. Accordingly, modification of prosociality and social responsibility can potentially improve COVID-19 vaccination. Future longitudinal and intervention studies are warranted to confirm such associations across populations and countries., (© 2022 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Objectives: Artificial intelligence (AI) has been proved to be a highly efficient tool for COVID-19 diagnosis, but the large data size and heavy label force required for algorithm development and the poor generalizability of AI algorithms, to some extent, limit the application of AI technology in clinical practice. The aim of this study is to develop an AI algorithm with high robustness using limited chest CT data for COVID-19 discrimination., Methods: A three dimensional algorithm that combined multi-instance learning with the LSTM architecture (3DMTM) was developed for differentiating COVID-19 from community acquired pneumonia (CAP) while logistic regression (LR), k-nearest neighbor (KNN), support vector machine (SVM), and a three dimensional convolutional neural network set for comparison. Totally, 515 patients with or without COVID-19 between December 2019 and March 2020 from five different hospitals were recruited and divided into relatively large (150 COVID-19 and 183 CAP cases) and relatively small datasets (17 COVID-19 and 35 CAP cases) for either training or validation and another independent dataset (37 COVID-19 and 93 CAP cases) for external test. Area under the receiver operating characteristic curve (AUC), sensitivity, specificity, precision, accuracy, F1 score, and G-mean were utilized for performance evaluation., Results: In the external test cohort, the relatively large data-based 3DMTM-LD achieved an AUC of 0.956 (95% confidence interval, 95% CI, 0.929∼0.982) with 86.2% and 98.0% for its sensitivity and specificity. 3DMTM-SD got an AUC of 0.937 (95% CI, 0.909∼0.965), while the AUC of 3DCM-SD decreased dramatically to 0.714 (95% CI, 0.649∼0.780) with training data reduction. KNN-MMSD, LR-MMSD, SVM-MMSD, and 3DCM-MMSD benefited significantly from the inclusion of clinical information while models trained with relatively large dataset got slight performance improvement in COVID-19 discrimination. 3DMTM, trained with either CT or multi-modal data, presented comparably excellent performance in COVID-19 discrimination., Conclusions: The 3DMTM algorithm presented excellent robustness for COVID-19 discrimination with limited CT data. 3DMTM based on CT data performed comparably in COVID-19 discrimination with that trained with multi-modal information. Clinical information could improve the performance of KNN, LR, SVM, and 3DCM in COVID-19 discrimination, especially in the scenario with limited data for training., (© 2022 American Association of Physicists in Medicine.)

Background: Previous outbreaks of emerging infectious diseases (e.g., SARS) had increased the uptake of influenza vaccination (IV). It is uncertain whether such was also true for COVID-19. This study hence investigated prevalence of IV behavior/intention prior to and during the COVID-19 pandemic and associated cognitive factors., Methods: A self-administered, online, and anonymous cross-sectional survey was conducted among 6,922 university students of five provinces in China during November 1-28, 2020 (response rate: 72.3%)., Results: Of all the participants, 35.1% self-reported behavioral intention of IV (next 12 months), while 62.9% reported an increased intention of IV due to COVID-19. However, only 4.7% and 2.9% had taken up IV during the 12-month period prior to the outbreak (1/2019-12/2019) and during the COVID-19 outbreak (1-11/2020), respectively. Adjusted for the background factors, the multivariable logistic regression analysis showed that in general the COVID-19 related perceptions (perceived susceptibility, perceived severity, and perceived chance of having another wave of COVID-19 outbreak) were significantly and positively associated the IV behavior (during the COVID-19 outbreak) and intention of IV uptake in the next 12 months., Conclusions: The COVID-19 pandemic may have influenced actual behavior and intention of IV uptake among university students during the pandemic. Efforts are warranted to reduce the intention-behavior gap of IV uptake; modification of perceived susceptibility and perceived severity regarding COVID-19 may help. Future longitudinal and intervention studies are needed to confirm the findings of this study and explore other factors affecting IV uptake during the COVID-19 period., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: The outbreak of COVID-19 in China occurred around the Chinese New Year (January 25, 2020), and infections decreased continuously afterward. General adoption of preventive measures during the Chinese New Year period was crucial in driving the decline. It is imperative to investigate preventive behaviors among Chinese university students, who could have spread COVID-19 when travelling home during the Chinese New Year break., Objective: In this study, we investigated levels of COVID-19-related personal measures undertaken during the 7-day Chinese New Year holidays by university students in China, and associated COVID-19-related cognitive factors., Methods: A cross-sectional anonymous web-based survey was conducted during the period from February 1 to 10, 2020. Data from 23,863 students (from 26 universities, 16 cities, 13 provincial-level regions) about personal measures (frequent face-mask wearing, frequent handwashing, frequent home staying, and an indicator that combined the 3 behaviors) were analyzed (overall response rate 70%). Multilevel multiple logistic regression analysis was performed., Results: Only 28.0% of respondents (6684/23,863) had left home for >4 hours, and 49.3% (11,757/23,863) had never left home during the 7-day Chinese New Year period; 79.7% (19,026/23,863) always used face-masks in public areas. The frequency of handwashing with soap was relatively low (6424/23,863, 26.9% for >5 times/day); 72.4% (17,282/23,863) had frequently undertaken ≥2 of these 3 measures. COVID-19-related cognitive factors (perceptions on modes of transmission, permanent bodily damage, efficacy of personal or governmental preventive measures, nonavailability of vaccines and treatments) were significantly associated with preventive measures. Associations with frequent face-mask wearing were stronger than those with frequent home staying., Conclusions: University students had strong behavioral responses during the very early phase of the COVID-19 outbreak. Levels of personal prevention, especially frequent home staying and face-mask wearing, were high. Health promotion may modify cognitive factors. Some structural factors (eg, social distancing policy) might explain why the frequency of home staying was higher than that of handwashing. Other populations might have behaved similarly; however, such data were not available to us., (©Joseph Lau, Yanqiu Yu, Meiqi Xin, Rui She, Sitong Luo, Lijuan Li, Suhua Wang, Le Ma, Fangbiao Tao, Jianxin Zhang, Junfeng Zhao, Dongsheng Hu, Liping Li, Guohua Zhang, Jing Gu, Danhua Lin, Hongmei Wang, Yong Cai, Zhaofen Wang, Hua You, Guoqing Hu, COVID-19 University Student Research Group. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 07.10.2021.)

Background: The current study aims to track the changes in the levels of smart phone addiction (SPA) and depressive symptoms between pre and during COVID-19 and potential risk factors of among Chinese college students in a four-wave longitudinal study., Methods: The participants were recruited from a Chinese university (n = 195; 58.5% females). The first three-wave surveys were conducted before COVID-19 (during December of Year 1, June of Year 1, and December of Year 2 of their college study; Time 1, Time 2, Time 3), while the fourth survey (Time 4; during June of Year 2 of their college study) was conducted in June 2020 during COVID-19. COVID-19-related factors, including quarantine, lockdown, boredom, emotional loneliness, and social loneliness, were investigated., Results: The results showed a significant increase in the levels of depressive symptoms and prevalence of probable depression during COVID-19 (69.2%) compared to those 18 months, 12 months and 6 months before COVID-19 (41.5, 45.6, 48.2%) but non-significant changes in SPA. Boredom and emotional loneliness were positively associated with both SPA and depressive symptoms during COVID-19. Social loneliness was also positively associated with depressive symptoms during COVID-19. Quarantine and lockdown were not significantly associated with SPA or depressive symptoms., Discussion and Conclusions: The results highlight that the study population may be a high risk group of probable depression. Future studies should continue to track these mental and behavioral status with the progression of the epidemic. The identified emotional factors could be used to reduce depressive symptoms during COVID-19 and prevent the potential risk of SPA.

Background: During an epidemic, both frontline and non-frontline medical staff endure stressful work circumstances that render their mental health a major public health concern. This study aims at investigating and comparing the prevalence and severity of mental health symptoms (i.e., anxiety, depression and insomnia) between frontline medical staff and non-frontline medical staff during the coronavirus disease 2019 (COVID-19) outbreak. It also seeks to evaluate the association of their mental health with occupational stress. Methods: A cross-sectional study was conducted in Wenzhou, China from 2020 February 16th to 2020 March 2th. A total of 524 medical staff responded to the Generalized Anxiety Disorder Scale, the Patient Health Questionnaire, the Insomnia Severity Index, the Occupational stress Questionnaire, and a demographic data form. Data were principally analyzed with logistic regression. Results: Of the 524 participants, 31.3% reported depression, 41.2% reported anxiety, and 39.3% reported insomnia. Compared with the citizens during the COVID-19 epidemic, medical staff experienced higher level of anxiety, depression and insomnia, especially the frontline medical staff. Furthermore, male, married medical staff with poorer physical health reported lower mental health. Frontline medical staff endorsed higher self-reported occupational stress, especially higher occupational hazards, than non-frontline medical staff. In addition, four indicators on occupational stress (working intensity, working time, working difficulty and working risk) were correlated positively with mental health symptoms. Regression analyses found a significant association between occupational stress and mental health symptoms in both frontline and non-frontline medical staff during COVID-19 outbreak. Conclusion: The results indicated that during the COVID-19 epidemic, medical staff experienced higher levels of anxiety, depression and insomnia than citizens, and their occupational stress had positive effects on their psychological distress. These findings emphasize the importance of occupational stress management interventions to decrease the risk of developing mental health problems among the medical staff during a biological disaster. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 epidemic may elevate mental distress and depressive symptoms in various populations in China. Objective: This study investigates the levels of depression and mental distress due to COVID-19, and the associations between cognitive, behavioral, and psychosocial factors, and depression and mental distress due to COVID-19 among university students in China. Methods: A large-scale online cross-sectional study (16 cities in 13 provinces) was conducted among university students from February 1 to 10, 2020, in China; 23,863 valid questionnaires were returned. The Patient Health Questionnaire-9 was used to assess depression. Structural equation modeling was performed to test mediation and suppression effects. Results: Of the 23,863 participants, 47.1% (n=11,235) reported high or very high levels of one or more types of mental distress due to COVID-19; 39.1% (n=9326) showed mild to severe depression. Mental distress due to COVID-19 was positively associated with depression. All but one factor (perceived infection risks, perceived chance of controlling the epidemic, staying at home, contacted people from Wuhan, and perceived discrimination) were significantly associated with mental distress due to COVID-19 and depression. Mental distress due to COVID-19 partially mediated and suppressed the associations between some of the studied factors and depression (effect size of 6.0%-79.5%). Conclusions: Both mental distress due to COVID-19 and depression were prevalent among university students in China; the former may have increased the prevalence of the latter. The studied cognitive, behavioral, and psychosocial factors related to COVID-19 may directly or indirectly (via mental distress due to COVID-19) affect depression. Interventions to modify such factors may reduce mental distress and depressive symptoms during the COVID-19 epidemic. JMIR Ment Health 2021;8(2):e22705 doi:10.2196/22705 [ABSTRACT FROM AUTHOR]

COVID-19 has caused a devastating impact on public health and made the development of the COVID-19 vaccination a top priority. Herd immunity through vaccination requires a sufficient number of the population to be vaccinated. Research on factors that promote intention to receive the COVID-19 vaccination is warranted. Based on Diffusion of Innovations Theory, this study examines the association between the perceived efficacy of the COVID-19 vaccination, use of social media for COVID-19 vaccine-related information, openness to experience and descriptive norm with the intention to receive the COVID-19 vaccination, and the moderating role of openness to experience among 6922 university students in mainland China. The intention to receive the free and self-paid COVID-19 vaccination is 78.9% and 60.2%, respectively. Results from path analyses show that perceived efficacy of the COVID-19 vaccination, use of social media for COVID-19 vaccine-related information, and openness to experience and descriptive norm are all positively associated with the intention to receive COVID-19 free and self-paid vaccination. The association between the perceived efficacy of the COVID-19 vaccination and descriptive norm with the intention to receive the COVID-19 vaccination is stronger among those with a lower level of openness to experience. Our findings support the usefulness of Diffusion of Innovations Theory and the moderating role of openness of experience in explaining intention to receive the COVID-19 vaccination. [ABSTRACT FROM AUTHOR]

There are no other bovine coronavirus (BCoV) infection models except calves, which makes efficacy evaluation of vaccines and pathogenic mechanism research of BCoV inconvenient owing to their high value and inconvenient operation. This study aimed to establish a mouse model of BCoV infection. BCoV was used to infect 4-week-old male BALB/c mice and the optimal infection conditions were screened, including the following infection routes: gavage, intraperitoneal injection, and tail vein injection at doses of 1 × 108 TCID 50 , 2 × 108 TCID 50 and 4 × 108 TCID 50. Using the optimal infection conditions, BALB/c mice were infected with BCoV, and their body weight, blood routine, inflammatory factors, autopsy, virus distribution, and viral load were measured at 1, 3, 5, and 7 days after infection. The results showed that the optimal conditions for infecting BALB/c mice with BCoV HLJ-325 strain were continuous oral gavage for 3 days with a dose of 4 × 108 TCID 50. On the 7th day after infection, there was significant extensive consolidation of the lungs and thinning of the colon wall. Significant inflammation was observed in various organs, especially in the colon and alveoli, where a large number of inflammatory cells infiltrate. Both BCoV Ag and nucleic acid are positive in visceral organs. The viral load in the colon and lungs was significantly higher than that in the other organs (p < 0.001). BCoV-infected mice showed a decreasing trend in body weight starting from day 5, and there was a significant difference compared to the control group on days 6 and 7 (p < 0.001). The total number of white blood cells and lymphocytes began to decrease and was significantly lower than that in the control group 24 h after infection (p < 0.001), and gradually returned to the control level. The cytokine TNF-α, IL-1β, and IL-6 showed an increasing trend, significantly higher than the control group on day 5 and 7 (p < 0.001). These results indicate that the BCoV HLJ-325 strain can infect BALB/c mice and cause inflammatory reactions and tissue lesions. The most significant effect was observed on the seventh day after infection with a dose of 4 × 108 TCID 50 and three consecutive gavages. This study established, for the first time, a BALB/c mouse model of BCoV infection, providing a technical means for evaluating the immune efficacy of BCoV vaccines and studying their pathogenic mechanisms. • This study established for the first time a laboratory animal model of Bovine coronavirus (BCoV) infection. • This study established a BALB/c mouse model infected with BCoV. • Oral gavage was the optimal route, with the most severe histopathological lesions and the highest viral load in the colon and lungs. [ABSTRACT FROM AUTHOR]

Quarantine plays a key role in controlling the pandemic of 2019 coronavirus disease (COVID-19). This study investigated (a) the associations between mandatory quarantine status and negative cognitions (perceived discrimination because of COVID-19 and perceived risk of COVID-19 infection)/mental health status (emotional distress because of COVID-19, probable depression, and self-harm/suicidal ideation), (b) the associations between the negative cognitions and mental health status, and (c) potential mediations between quarantined status and probable depression and self-harm/suicidal ideation via COVID-19-related negative cognitions/emotional distress. An online cross-sectional survey was conducted among 24,378 students of 26 universities in 16 Chinese cities (February 1–10, 2020). Correlation coefficients, odds ratios (OR), structural equation modeling, and other statistics were used for data analysis. Mandatory quarantined status was significantly and positively associated with perceived discrimination (Cohen's d = 0.62), perceived high/very high risk of infection (OR = 1.61), emotional distress (Cohen's d = 0.46), probable depression (OR = 2.54), and self-harm/suicidal ideation (OR = 4.98). Perceived discrimination was moderately and positively associated with emotional distress (Spearman correlation = 0.44). Associations between perceived risk of infection and mental health variables were significant but relatively weak. Cross-sectional mediation models showed good model fit, but the overall indirect paths via COVID-19-related negative cognitions/emotional distress only accounted for 12–15% of the total effects between quarantined status and probable depression and self-harm/suicidal ideation. In conclusion, quarantined participants were more likely than others to perceive discrimination and exhibit mental distress. It is important to integrate mental health care into the planning and implementation of quarantine measures. Future longitudinal studies to explore mechanisms underlying the mental health impact of quarantines are warranted. Public Significant Statement: This study suggests that mandatorily quarantined individuals are more likely to have mental distress and negative cognitions related to COVID-19 than their nonquarantined counterparts. Attention should be paid to the heightened perceived discrimination as it was associated with both mandatory quarantine status and negative mental health status. The findings demonstrate the need to develop interventions to meet the psychological needs of people in quarantine during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]