ABSTRACT
The COVID-19 pandemic changed behaviors, at least temporarily, and possibly more permanently, with implications for both work and leisure activities. Some of those behavioral changes, such as dining in restaurants, have significant ripple effects on businesses and employment. We investigate the response to health risks in China with a study of decisions about eating out during the pandemic. We find that compared to a traditional measure of financial risk attitude, dining out behavior better captures individuals' attitude toward the health risk posed by the pandemic and is more significant in predicting their expected total consumption during the recovery phase of the pandemic. In addition, we find that the effect of domestic in-migration is positive with respect to dining out, a signifier of confidence in the government response to the safety of internal flows. In contrast, international migration and port city of entry status are strongly negative with respect to dining out. The risk from the virus is perceived to be much stronger in such contexts. From a policy perspective establishing border controls was critical in re-creating a robust economy. Additional city and household level characteristics that affect dining-out behavior are also identified. © The Author(s) 2022.
ABSTRACT
Background/Aims Steroids are commonly used for immunosuppression in the majority of rheumatology conditions. Patients on long-term steroids are vulnerable to adrenal insufficiency during acute illness or if steroids are stopped or weaned down abruptly. During the COVID-19 pandemic, this risk has further multiplied due to change in practice with inclusion of telephone consultations and less frequent hospital visits. Although our patients were routinely provided with steroid alert cards by pharmacy, we aim to ascertain the knowledge and understanding of sick day rules in patient who are on steroids for immunosuppression. Methods We designed a novel questionnaire consisting of 10 questions, designed to determine patients' knowledge about steroid sick day rules. All questions were close-ended, either single best answer or yes/ no except question about primary rheumatological condition and type of steroids. A total of 100 patients (including new and follow-ups) attending rheumatology clinics between January and June 2020 were screened and selected randomly. Questionnaires and consent forms were sent by post as agreed with clinical effectiveness team with return envelopes. Results 29 completely filled questionnaires were received back. The majority of patients (96.5%;n=28) were on prednisolone and only 3.44% (n=1) were on hydrocortisone. The majority of the patients (95.6.6%;n=29) were on steroids for duration between 1-6 months. Answering the question on steroid dose during an acute illness,10.3% (n=3) patients had knowledge to take double dose of steroids, 55.1% (n=16) responded to take regular dose, 3.44 (n=1) answered by lowering dose to half, and strikingly 10.3% (n=3) answered to stop steroids. For further question on when to seek medical advice during an acute illness while on steroids, 31.0% (n=9) responded by answering correctly, 37.9% (n=11) were unsure when to take medical attention, and 3.44% (n=1) responded to wrong option. Despite providing steroids alert cards to everyone, only 65.5% (n=19) answered yes on asking about carrying alert card with them. Conclusion Despite providing steroid alert card and verbal information, these data highlight a significant dearth of knowledge and understanding about sick day rules among rheumatology patients on steroids for immunosuppression. This knowledge gap increases the risk of potentially lifethreatening emergency of adrenal crisis among this patient group. To bridge this knowledge gap, we started to provide steroid sick day rules written information leaflet to all new and old rheumatology patients on steroids to reduce risk of future adrenal crisis. We are aiming to re audit this after 1 year to check improvement in patient knowledge and understanding of sick day rules with this change in practice.