Changes in mental well-being in Hong Kong before and during social unrest and COVID-19 (preprint)

Purpose Understanding the impact of co-occurring population- and individual-level stressful events on mental well-being should inform future intervention design. This study examined the association of two population-level stressful events (social unrest and COVID-19) and personal stressors with life satisfaction in Hong Kong.Methods This study analyzed data on life satisfaction, experience of stressful life events (SLEs), rumination, and resilience, from two representative population telephone surveys conducted in 2018 (n = 1,514) and 2020 (n = 1,258). The association between life satisfaction and personal SLEs was further compared between the two samples using moderation analysis. Using data from the 2020 survey, the effect of different types of SLEs, rumination, and resilience on life satisfaction was investigated using hierarchical regression analysis.Results The study achieved a response rate of 56.2% and 68.9% for surveys 2018 and 2020, respectively. Life satisfaction of the population decreased significantly in 2020, accompanied by an overall increase in SLEs. Moderation analysis revealed that the relationship between personal SLEs and life satisfaction was significantly greater in 2018 than in 2020. Hierarchical regression analysis showed that an increase in all kinds of SLEs and higher levels of rumination were significantly associated with lower life satisfaction in 2020.Conclusion The significant reduction in life satisfaction reported in this study suggests that measures to support the mental health of populations that have experienced multiple simultaneous, large-scale stressors would be crucial. During distinctive phases as such, rumination may be a potential target for improving overall mental health.

The Association between Hypoglycemic Agents and Clinical Outcomes of COVID-19 in Patients with Diabetes: A Systematic Review and Meta-Analysis (preprint)

Background: During the current Coronavirus Disease 2019 (COVID-19) pandemic, diabetic patients face disproportionately more. Anti-inflammatory effects of hypoglycemic agents have been reported, and their effects in patients with diabetes and COVID-19 remain controversial. This study was performed to clarify this association.Methods: Relevant literature was searched on China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, Chinese periodical service platform VIP Database, Sinomed (China Biology Medicine, CBM), MedRxiv, PubMed, ScienceDirect, Web of Science, Ovid Databases (LWW), Springer Link, Wiley Online Library, Oxford Academic, Nature Press Group, Cochrane Library, and BMJ Evidence-Based Medicine up to November 14, 2020. Only observational studies of hypoglycemic agents vs. other drugs or therapy in adult diabetic patients with COVID-19 were included. Data of death and poor composite outcomes were extracted. The pooled effects of hypoglycemic agents on mortality and poor composite outcomes of COVID-19 in diabetic patients, pooled ORs along with 95% CIs, were calculated using the fixed-effects or random-effects models based on heterogeneity assessment. Registration number of PROSPERO is CRD42020221951.Findings: 16 studies were included in the qualitative analysis and 14 studies with 13,371 patients were included in quantitative synthesis. Meta-analysis showed that metformin was associated with a statistically significant lower mortality in diabetic patients with COVID-19 (pooled OR=0·56, 95% CI, 0·39-0·81, p=0·002), especially home use of metformin (pooled OR=0·60, 95%CI, 0·40-0·88, p=0·01). but in-hospital use of metformin was associated with statistically non-significant lower mortality (pooled OR=0·44, 95%CI, 0·15-1·33, p=0·14) or poor composite outcomes (pooled OR=0·93, 95% CI, 0·79-1·11, p=0·44). Dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) were associated with statistically non-significant lower mortality (pooled OR=0·63, 95% CI, 0·26-1·56, p=0·32) or poor composite outcomes of COVID-19 in diabetic patients (pooled OR=0·96, 95% CI, 0·74-1·26, p=0·78).Interpretation: Home use of metformin might be beneficial in decreasing mortality in diabetic patients infected with SARS-CoV-2. There is insufficient evidence to conclude that metformin and other hypoglycemic agents are associated with poor composite outcomes. Limited by retrospective characteristics, with relative weak capability to verify causality, more prospective studies, especially RCTs are needed.Funding Statement: This study is financially supported by Hunan Provincial Key Laboratory of Clinical Epidemiology (grant number: 2020ZNDXLCL002).Declaration of Interests: We declare no competing interests.

The Association Between Hypoglycemic Agents and Clinical Outcomes of COVID-19 in Patients with Diabetes: A Systematic Review and Meta-Analysis (preprint)

Background During the current Coronavirus Disease 2019 (COVID-19) pandemic, diabetic patients face disproportionately more. Anti-inflammatory effects of hypoglycemic agents have been reported, and their beneficial or harmful effects in patients with diabetes and COVID-19 remain controversial. Purpose This study was performed to clarify this association. Data Sources Relevant literature was searched on China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, Chinese periodical service platform VIP Database, Sinomed (China Biology Medicine, CBM), MedRxiv, PubMed, ScienceDirect, Web of Science, Ovid Databases (LWW), Springer Link, Wiley Online Library, Oxford Academic, Nature Press Group, Cochrane Library and BMJ Evidence-Based Medicine up to November 14, 2020. Study Selection Only observational studies of hypoglycemic agents vs. drugs or therapy without hypoglycemic agents in adult diabetic patients with COVID-19 were included. Data Extraction Data of death and poor composite outcomes were extracted. Data Synthesis The pooled effects were calculated using the fixed-effects or random-effects models based on heterogeneity assessment. Limitation Most studies were retrospective cohort studies with relative weak capability to verify causality. Conclusion Home use of metformin might be beneficial in decreasing mortality in diabetic patients infected with SARS-CoV-2. There is insufficient evidence to conclude that metformin and other hypoglycemic agents are associated with poor composite outcomes. More prospective studies, especially RCTs are needed. Registration-PROSPERO CRD42020221951.