Anxiety and Depression Among College Students During the COVID-19 Lockdown: A Cross-Sectional Survey in Jiangsu, China.

Background: This study aimed to explore the levels of anxiety and depression in a sample of home-quarantined college students to identify the risk factors for psychological distress during the COVID-19 lockdown. Methods: A total of 1156 college students studying in Jiangsu, China, participated from August 5 to August 14. A structured questionnaire was used to collect data anonymously, including demographic characteristics, the generalized anxiety disorder-7 (GAD-7) questionnaire, the patient health questionnaire-9 (PHQ-9), a physical activity scale, and items related to COVID-19. The chi-square test and Fisher's exact test were employed to establish the differences in levels of anxiety and depression across sociodemographic characteristics. Binary logistic regression was applied to measure the predictors of levels of anxiety and depression, and associations were considered significant at p <0.05. Results: The estimates of anxiety and depression were 48.1% and 57.6%, respectively. The univariate analysis indicated a significant difference in anxiety levels across student grades, whether the student was an only child, the distance from the worst-hit areas, and physical activity/exercise intensity. Physical activity intensity and living in communities with infected people were statistically correlated with the level of depression. Binary logistic regression results indicated that the predictive factors for anxiety were living within a short distance from the worst-hit areas (10~20 km), engaging in higher education (graduate students), and low-intensity daily exercise. Factors statistically predicting depression symptoms were having siblings, a COVID-19 diagnosis in the community and low-intensity daily exercise. Conclusion: During outbreaks, students in an extremely stressful state are more likely to develop anxiety and depression, particularly postgraduates. Psychological interventions to reduce fears and encourage exercise should be available to home-quarantined college students. Students who live in the worst-hit areas and are not the only child in the family should be prioritized.

Impact of coronavirus disease 2019 on food security in early childhood.

PURPOSE OF REVIEW: To summarize the impact of the COVID-19 pandemic on food insecurity during early childhood, with a focus on challenges and strategies to improve access to and consumption of nutritious food in early childcare and education settings. RECENT FINDINGS: The COVID-19 pandemic exacerbated existing gaps and inequities in the early childcare and education system, resulting in closures and decreased access to healthy foods that disproportionately impacted black, indigenous, and people of color, as well as rural and low-income communities. SUMMARY: Closures and changes in operational capacity not only stressed the early childcare and education system and its workforce but also contributed to financial strain and food insecurity among families with young children. Increased public investment and cross-sector partnerships can support and strengthen both early childcare and education and food systems, increasing equitable access to quality care and reducing food insecurity in early childhood.

Hydrogen-oxygen therapy alleviates clinical symptoms in twelve patients hospitalized with COVID-19: A retrospective study of medical records.

ABSTRACT: A global public health crisis caused by the 2019 novel coronavirus disease (COVID-19) leads to considerable morbidity and mortality, which bring great challenge to respiratory medicine. Hydrogen-oxygen therapy contributes to treat severe respiratory diseases and improve lung functions, yet there is no information to support the clinical use of this therapy in the COVID-19 pneumonia.A retrospective study of medical records was carried out in Shishou Hospital of Traditional Chinese Medicine in Hubei, China. COVID-19 patients (aged ≥ 30 years) admitted to the hospital from January 29 to March 20, 2020 were subjected to control group (n = 12) who received routine therapy and case group (n = 12) who received additional hydrogen-oxygen therapy. The clinical characteristics of COVID-19 patients were analyzed. The physiological and biochemical indexes, including immune inflammation indicators, electrolytes, myocardial enzyme profile, and functions of liver and kidney, were examined and investigated before and after hydrogen-oxygen therapy.The results showed significant decreases in the neutrophil percentage and the concentration and abnormal proportion of C-reactive protein in COVID-19 patients received additional hydrogen-oxygen therapy.This novel therapeutic may alleviate clinical symptoms of COVID-19 patients by suppressing inflammation responses.

Water clarity mapping of global lakes using a novel hybrid deep-learning-based recurrent model with Landsat OLI images.

Information regarding water clarity at large spatiotemporal scales is critical for understanding comprehensive changes in the water quality and status of ecosystems. Previous studies have suggested that satellite observation is an effective means of obtaining such information. However, a reliable model for accurately mapping the water clarity of global lakes (reservoirs) is still lacking due to the high optical complexity of lake waters. In this study, by using gated recurrent units (GRU) layers instead of full-connected layers from Artificial Neural Networks (ANNs) to capture the efficient sequence information of in-situ datasets, we propose a novel and transferrable hybrid deep-learning-based recurrent model (DGRN) to map the water clarity of global lakes with Landsat 8 Operational Land Imager (OLI) images. We trained and further validated the model using 1260 pairs of in-situ measured water clarity and surface reflectance of Landsat 8 OLI images with Google Earth Engine. The model was subsequently utilized to construct the global pattern of temporal and spatial changes in water clarity (lake area>10 km2) from 2014 to 2020. The results show that the model can estimate water clarity with good performance (R2 = 0.84, MAE = 0.55, RMSE = 0.83, MAPE = 45.13%). The multi-year average of water clarity for global lakes (16,475 lakes) ranged from 0.0004 to 9.51 m, with an average value of 1.88 ± 1.24 m. Compared to the lake area, elevation, discharge, residence time, and the ratio of area to depth, water depth was the most important factor that determined the global spatial distribution pattern of water clarity. Water clarity of 15,840 global lakes between 2014 and 2020 remained stable (P ≥ 0.05); while there was a significant increase in 243 lakes (P < 0.05) and a decrease in 392 lakes (P < 0.05). However, water clarity in 2020 (COVID-19 period) showed a significant increase in most global lakes, especially in China and Canada, suggesting that the worldwide lockdown strategy due to COVID-19 might have improved water quality, espically water clarity, dueto the apparent reduction of anthropogenic activities.

In their own words: Child and adolescent perceptions of caregiver stress during early COVID-19.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has exacerbated multiple stressors for caregivers of children in the United States, raising concern for increased family conflict, harsh parenting, and child maltreatment. Little is known regarding children's perceptions and experiences of caregiver stress during the COVID-19 pandemic. OBJECTIVE: To examine how children and adolescents identify and experience caregiver stress during the early COVID-19 pandemic. METHODS: We analyzed 105 de-identified helpline text and online chat transcripts from children under age 18 who submitted inquiries to the Childhelp National Child Abuse Hotline from March to June of 2020, with COVID-19 as a presenting issue. Inductive, thematic analysis was used to identify how child helpline users: 1) perceived and experienced drivers of caregiver stress and 2) used words to describe manifestations of caregiver stress during the COVID-19 pandemic. RESULTS: Children experienced multiple drivers of caregiver stress during COVID-19, including intrapersonal (e.g. caregiver health concerns), interpersonal (e.g. parental discord, perceived dislike of child), and extrapersonal (e.g. financial insecurity, sheltering in place) stressors. Regardless of the driver, caregivers' stress was internalized by children. "Anger," "control," and "blame" were most commonly used to label manifestations of caregiver stress, which were often externalizing behaviors, including yelling, name calling, and blaming of others. CONCLUSION: In text and online chat inquiries to a national child helpline during the COVID-19 pandemic, children described multiple drivers of caregiver stress, often feeling as though they were to blame. Providers serving children should address household stress spillover effects by including caregivers and directly acknowledging children's concerns using their own words.

Guidelines on the treatment with integrated traditional Chinese medicine and western medicine for severe coronavirus disease 2019.

Severe Coronavirus Disease 2019 (COVID-19) is characterized by numerous complications, complex disease, and high mortality, making its treatment a top priority in the treatment of COVID-19. Integrated traditional Chinese medicine (TCM) and western medicine played an important role in the prevention, treatment, and rehabilitation of COVID-19 during the epidemic. However, currently there are no evidence-based guidelines for the integrated treatment of severe COVID-19 with TCM and western medicine. Therefore, it is important to develop an evidence-based guideline on the treatment of severe COVID-19 with integrated TCM and western medicine, in order to provide clinical guidance and decision basis for healthcare professionals, public health personnel, and scientific researchers involved in the diagnosis, treatment, and care of COVID-19 patients. We developed and completed the guideline by referring to the standardization process of the "WHO handbook for guideline development", the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, and the Reporting Items for Practice Guidelines in Healthcare (RIGHT).

In Their Own Words: Children's Perceptions of Caregiver Stress during COVID-19

Research Objective To use text and chat transcripts from a national child helpline to examine how children perceive, identify, and describe caregiver stress during the coronavirus disease 2019 (COVID-19) pandemic. Study Design We obtained 105 deidentified text and chat transcripts from March through June of 2020 from the Childhelp National Child Abuse Hotline, which supports the needs of abused, neglected, and at-risk children. The helpline is staffed 24?hours a day, 7?days a week with professional crisis counselors who serve families from all over the United States. Transcripts were analyzed with Atlas TI software using inductive, thematic analysis to identify how child helpline users: 1) perceived drivers of caregiver stress and 2) used words to describe manifestations of caregiver stress. Population Studied Text and chat transcripts were included if they originated from children under age 18 and one of the presenting issues included ?COVID-19,? labeled by a Childhelp counselor. The majority (86%) were from children ages 13 to 17. Principal Findings Children perceived multiple drivers of caregiver stress during COVID-19, including intrapersonal (e.g. caregiver health concerns), interpersonal (parental discord, perceived dislike of child), and extrapersonal (financial insecurity, sheltering in place) stressors. Regardless of the driver, caregivers' stress was internalized by children (Table 1). Children were most likely to use the words ?anger,? ?control,? and ?blame? to label manifestations of caregiver stress, and often cited examples of externalizing behaviors, including yelling, name calling, and blaming of others (Table 2). 1 TABLE Examples of perceived drivers of caregiver stress Driver Representative Quote Financial insecurity ?They say?I'm the [reason] they don't have enough money every week? COVID-19 sheltering in place ??ever since quarantine?there have been more occurrences of him shouting and yelling at us at small things.? 2 TABLE Examples of words children use to describe manifestations of caregiver stress Descriptor Representative Quote ?Blowing up? ?She sort of blew up screaming, slamming things, breaking things?? ?Blaming me for everything? ?She tells me that I am the reason she has lost friends, or that?her and my step dad got a divorce? Conclusions In text and chat inquiries to a national child helpline during the COVID-19 pandemic, children identified, described, and internalized multiple drivers of caregiver stress, often feeling as though they were to blame. Providers serving children should address household stress spillover effects by directly acknowledging children's perceptions and concerns using their own words. Implications for Policy or Practice Child helplines can help make child distress more ?visible? during a time when mandatory reporters such as educational personnel and daycare providers have limited contact with at-risk children. Texts and chats, which are accessible to school-age children and offer privacy from nearby caregivers, are an important mechanism by which children in crisis can sound their own alarms. We illustrate the real-time impacts of caregiver stress on children during the COVID-19 pandemic, in which close proximity and heightened duress likely increase children's sensitivity and vulnerability to caregivers' variations in mood and behavior. Findings can inform policy efforts to expand access to supportive services and highlight the promise of text and chat modalities to address children's needs.

Variation in Obsessive-Compulsive Disorder Symptoms and Treatments: A Side Effect of COVID-19.

The Coronavirus Disease 2019 (COVID-19) exerts variable impact on patients with obsessive compulsive disorders (OCD). There remains a challenge to determine the extent to which OCD is exacerbated due to the pandemic. Therefore, our aim is to explicate the latest researching progress of OCD under COVID-19 based on a review of 15 existing articles. Our review confirms the prevalence of OCD exacerbation in different age groups and particular symptoms. However, it also reveals nonconformity among research, lack of investigation in OCD treatment, and imbalance in OCD symptoms research. Further, we discuss the probable reasons of the exacerbation and current situation of OCD treatments. Finally, based on our discussion, we offer suggestions on how to manage OCD under the new circumstance, including the introduction of new policies, the use of communications technology, the improvement of researching methods, and possible angles for further research.

"The Stay at Home Order is Causing Things to Get Heated Up": Family Conflict Dynamics During COVID-19 From The Perspectives of Youth Calling a National Child Abuse Hotline.

The purpose of this study was to identify changes in family conflict and abuse dynamics during COVID-19 stay-at-home orders from the perspectives of youth calling a national child abuse hotline. We analyzed text and chat transcripts from Childhelp's National Child Abuse Hotline from May-June 2020 that were flagged as coming from a child with a COVID-19-related concern (N = 105). Thematic analysis was used to identify COVID-19 related influences of family conflict as well as how COVID-19 constraints influenced coping and survival for youth reporting distress or maltreatment to the hotline. Family conflict most commonly disclosed stemmed from parental or child mental health concerns, often manifesting in escalated child risk taking behaviors, parental substance use, and violence in the home. Conflict was also mentioned surrounding caregiver issues with child productivity while sheltering-in-place, commonly related to school or chores. Youth often voiced feeling unable to find relief from family conflict, exacerbated from physical distance from alternative social supports, technological isolation, and limited contact with typical safe places or supportive adults. To cope and survive, youth and crisis counselors found creative home-based coping skills and alternative reporting mechanisms. Understanding the unique impact of COVID-19 on youth in homes with family conflict and abuse can point to areas for intervention to ensure we are protecting the most vulnerable as many continue to shelter-in-place. In particular, this study revealed the importance of online hotlines and reporting mechanisms to allow more youth to seek out the help and professional support they need.

Predicting mask-wearing behavior intention among international students during COVID-19 based on the theory of planned behavior.

BACKGROUND: The global outbreak of the coronavirus disease 2019 (COVID-19) has emerged as a major public health threat. This study aimed to analyze the influencing factors of international students' intention to wear a mask based on the theory of planned behavior (TPB). The findings are important because they provide pertinent information in designing and implementing COVID-19 prevention programs. METHODS: Self-designed questionnaires were distributed to 477 international students. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) was conducted to identify and confirm the factor structure, and the structural equation model (SEM) was applied to determine the predictors of masks wearing. RESULTS: The final structural model was well reflected by fit indices. The research model of international students' intention to wear a mask for protection against COVID-19 was acceptable. All of the hypotheses were supported. Attitude and perceived behavioral control (PBC) were positively related to behavior intention (BI), respectively. Subjective norm (SN) also had a direct effect on attitude, PBC, and BI. CONCLUSIONS: Referring to TPB was useful in identifying determinants of mask-wearing. The strongest predictor was SN, which indicated it was deserving of increased attention. These findings are significant to strengthen international students' awareness regarding self-protection and enhance the effectiveness of COVID-19 prevention programs.

Novel insight from the first lung transplant of a COVID-19 patient.

BACKGROUND: To reveal detailed histopathological changes, virus distributions, immunologic properties and multi-omic features caused by SARS-CoV-2 in the explanted lungs from the world's first successful lung transplantation of a COVID-19 patient. MATERIALS AND METHODS: A total of 36 samples were collected from the lungs. Histopathological features and virus distribution were observed by optical microscope and transmission electron microscope (TEM). Immune cells were detected by flow cytometry and immunohistochemistry. Transcriptome and proteome approaches were used to investigate main biological processes involved in COVID-19-associated pulmonary fibrosis. RESULTS: The histopathological changes of the lung tissues were characterized by extensive pulmonary interstitial fibrosis and haemorrhage. Viral particles were observed in the cytoplasm of macrophages. CD3+ CD4- T cells, neutrophils, NK cells, γ/δ T cells and monocytes, but not B cells, were abundant in the lungs. Higher levels of proinflammatory cytokines iNOS, IL-1ß and IL-6 were in the area of mild fibrosis. Multi-omics analyses revealed a total of 126 out of 20,356 significant different transcription and 114 out of 8,493 protein expression in lung samples with mild and severe fibrosis, most of which were related to fibrosis and inflammation. CONCLUSIONS: Our results provide novel insight that the significant neutrophil/ CD3+ CD4- T cell/ macrophage activation leads to cytokine storm and severe fibrosis in the lungs of COVID-19 patient and may contribute to a better understanding of COVID-19 pathogenesis.

Risk factors for prolonged viral clearance in adult patients with COVID-19 in Beijing, China: A prospective observational study.

Clearance of COVID-19 from the human body has not been established. Our study collected the laboratory test results from patients and analyzed the correlation between early changes in serum indices and the virus clearance by univariable and multivariable COX regression models, with an aim to explore the risk factors for prolonged viral clearance. The study included 61 patients with COVID-19 treated at the Fifth Medical Center of PLA General Hospital in Beijing from 20 January 2020 to 20 February 2020. We set the total observation of the disease course to 20 days and the patients were divided into two groups (prolonged group, > 20d vs. normal group, ≤ 20d). The 48 patients with COVID-19 included in this study, 13 remained positive for viral nucleic acid monitoring 20 days after onset. The median for virus clearance was 16 days (range, 6-35 days). The results showed that hypertension, a lactate dehydrogenase level > 211.5 U/L, an interleukin 6 (IL-6) level > 12.5 pg/ml, and a NK lymphocyte percentage > 0.5% were associated with prolonged viral clearance. Therefore, we showed that a history of hypertension, an elevated IL-6 level, and an elevated percentage of NK cells were risk factors for prolonged viral clearance.