Factors influencing parents' hesitancy to vaccinate their children aged 5-11 years old against COVID-19: results from a cross-sectional study in Malaysia.

Introduction: Vaccination programs have been rolled out across the globe to contain and mitigate the spread of the COVID-19 infection. Until recently, such programs were limited to adults and the older population, thereby limiting children from getting vaccinated. Recently, the Malaysian government rolled out vaccination for children aged 5-11 years. However, there are certain factors that might affect vaccination uptake among children. This study explores factors influencing parents' hesitancy to vaccinate children in Malaysia. Method: A nationwide online cross-sectional convenience sampling survey from April 21, 2022 to June 3, 2022 was conducted. The study used descriptive statistics to inform about vaccine hesitancy among parents. Cross-tabulation was performed to calculate the frequency and percentage of vaccine hesitancy, quality of life, e-health literacy, and the 5C psychological antecedents of vaccination among parents with children 5-11 years in Malaysia. Graphical methods were used to portray the levels of e-health literacy and levels of 5C psychological antecedents of vaccination. The study used both bi-variate and multivariate analysis to understand the relationship between vaccine hesitancy and the socio-demo-economic factors, quality of life, e-health literacy and 5C psychological antecedents. Results: Of 382 participants, almost one-third (33%) of participants reported vaccine hesitancy for their children. For 5C's psychological antecedents of vaccination, around one quarter (26.96%) reported disagreement for confidence in vaccination, almost half (52.36%) reported disagreement for vaccination complacency, three-fifths (60.99%) reported vaccination constraint, one quarter (25.92%) reported calculation antecedent, and almost one-third reported disagreement over collective responsibility antecedent (25.92%). Chi-square test revealed that gender, employment status, and parents' COVID-19 vaccination status were significantly associated (p<0.05) with vaccine hesitancy among parents. Assessing the influence of transactional e-health literacy, only the communication component contained a significant association (p<0.05). Among the 5C psychological antecedents, confidence, calculation, and collective responsibility were significantly associated (p<0.05) with vaccine hesitancy. Parents with secondary [OR: 8.80; CI: 2.44-31.79, (p<0.05)], post-secondary [OR: 5.21; CI: 2.10-13.41, (p<0.05)], and tertiary education [OR: 6.77; CI: 2.25-20.35, (p<0.05)] had significantly higher likelihood of vaccine hesitancy than those with primary education. Conclusion: Highly educated parents are more skeptical and are more likely to perceive the vaccine as unsafe and ineffective for their children. It is critical to disseminate the required information about the vaccine safety to the educated group.

Non-clinical safety evaluation of prophylactic mRNA vaccine:general principles and concerns

Messenger RNA（mRNA） vaccine, with antigen-encoded mRNA packaged in delivery vehicles, performs its functions via antigen translation and specific immune response. mRNA vaccines have proven their protective effects and safety in the ongoing COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2（SARS-CoV-2）. The World Health Organization issued guidelines specifically for prophylactic mRNA vaccines in 2021, which provide important guidance for non-clinical research on mRNA vaccines. Furthermore, some unusual adverse reactions, such as cerebrovascular disease, embolic stroke, transient cerebral ischemia, deep vein thrombosis, myocarditis（pericarditis） and allergic reactions, have been also found in clinical trials and applications of mRNA vaccines, which deserves attention in non-clinical studies.

Demographic and work-related factors associated with burnout, resilience, and quality of life among healthcare workers during the COVID-19 pandemic: A cross sectional study from Malaysia.

Introduction: The healthcare setting is a stressful and demanding work environment, and healthcare workers face a continuous expansion of their job roles and responsibilities. Past studies have shown that factors affecting burnout, resilience, and quality of life among healthcare workers merit further research, as there were inconsistent findings, especially with regards to the influence of demographic and work-related factors. Therefore, this study aims to determine whether demographic and work-related factors are associated with burnout, resilience, and quality of life among healthcare workers. Method: This cross-sectional study was conducted between February 15, 2022 and March 15, 2022, among 394 healthcare workers from Putrajaya and Selangor hospitals, Malaysia. Maslach Burnout Inventory, World Health Organization Quality of Life-BREF 26 inventory, and Brief Resilience Scale were utilized to capture information on burnout, quality of life, and resilience, respectively. Results: The mean score of physical health of participants who work more than 10 h (11.38) is lower than participants who work from 8 to 10 h (13.00) and participants who work 7 h daily (13.03), p-value < 0.001. Similarly, the mean score of psychological health of participants who work more than 10 h (12.35) is lower than participants who work from 8 to 10 h (13.72) and participants who work 7 h daily (13.68), p-value = 0.001. Higher income levels were associated with high resilience and quality of life. Conclusion: It is imperative that healthcare practitioners and policy makers adopt and implement interventions to promote a healthy workplace environment, address ethical concerns, and prevent burnout among healthcare workers during the COVID-19 pandemic. Managing the issue of long working hours could possibly result in improved resilience, burnout, and quality of life among healthcare workers. Despite this study able to tickle out some policy specific areas where interventions are needed, identifying effective solutions and evaluating their efficiency will require larger and interventional studies.

Shugan Jieyu capsule improve sleep and emotional disorder in coronavirus disease 2019 convalescence patients: a randomized, double-blind, placebo-controlled trial.

OBJECTIVE: To evaluate the efficacy of the Shugan Jieyu capsule on improving sleep and emotional disorder during Coronavirus disease 2019 (COVID-19) convalescence. METHODS: We conducted a randomized, double-blind, placebo-controlled trial, and recruit 200 COVID-19 convalescence patients and then divide the subjects into two groups respectively: the experimental group ( 100) and the control group ( 100). Patients in the control group were given doses as a placebo, while those in the experimental group were given Shugan Jieyu capsule. The investigators mainly observed the differences between the two groups before and after treatment in terms of the rate of reduction and the rate of efficiency in Hamilton Depression Scale (HAMD-17) total scores from baseline, and recorded the scores of Hamilton Anxiety Scale (HAMA), Patient Health Questionnaire-15 (PHQ-15), Insomnia Severity Index (ISI) and Treatment Emergent Symptom Scale at 2 week, the 4 week and the 6 week respectively after treatment, and compared the differences between the groups. And the occurrence of adverse events was recorded. RESULTS: After 6-week treatment, there were statistically significant differences in the rate of reduction as well as efficiency in HAMD-17 scores, HAMA Total Scores, PHQ-15 Score, ISI Score from baseline in the experimental group and control group (< 0.05). There were 4 adverse events in the experimental group and 1 in the control group. CONCLUSION: Shugan Jieyu capsule could significantly improve sleep and emotional disorder in patients during COVID-19 convalescence.

Drone Usage for Medicine and Vaccine Delivery during the COVID-19 Pandemic: Attitude of Health Care Workers in Rural Medical Centres

Rural areas are often difficult to access reliably with medicine and vaccines. This study aimed to examine rural health care workers' attitude towards drone delivery for medicine and vaccines and the factors that influenced it. Health care workers from four rural health care facilities were sampled. Participants self-reported their demographic information, attitude towards medicine and vaccine delivery using drones, perception of benefits and risks of using drones, and perceived leadership innovativeness through an online or a pen-and-paper questionnaire. A total of 272 health care workers (mean age = 36.19, SD = 8.10) from all of the sites participated in this study. More than half of the study participants agreed or strongly agreed that using a drone to deliver medicine and vaccines is a good idea (54.2%, 95% CI [47.5, 60.8]), a wise idea (54.6%, 95% CI [47.9, 61.2]), and is desirable (52.5%, 95% CI [45.7, 59.0]). Males (β= 0.223), workers from the Obstetrics and Gynaecology department (β= 0.135), a lower perceived delivery risk (β= −0.237), and higher leadership innovativeness (β= 0.336) predicted positive attitudes towards drone usage. Assistant medical officers (β= −0.172) had a negative attitude. There is a need to further understand the roles of occupation and leadership innovativeness in predicting health care workers' attitude towards drone usage, as these differences could be embedded within their roles in the health care system.

Behavioral problems of pediatric patients recovered from COVID-19 in Wuhan, China

Background Coronavirus disease 2019 (COVID-19) is profoundly affecting lives around the globe. Previous studies on COVID-19 mainly focused on epidemiological, clinical, and radiological features of patients with confirmed infection. Little attention has been paid to the follow-up of recovered patients. As a vulnerable population to adverse events, the health status of the COVID-19 recovered pediatric patients is of great concern. We aimed to investigate the prevalence of behavioral problems among pediatric patients recovered from the COVID-19 in Wuhan, China. Methods A total of 122 children who were suspected or confirmed COVID-19 cases and hospitalized for treatment were enrolled in the study between April 2020 and May 2020 in Wuhan, China. We collected related information about hospitalization and discharge of the children and emotional symptoms of their parents through electronic medical records and questionnaire. The behavioral problems of children were examined by applying the parent-reported the Strengths and Difficulties Questionnaire (SDQ). Results The participant children were discharged from hospital after about two months. Among them, 76 (62%) were boys, and the mean age was 6.71 years old. The highest prevalence of behavioral problems among pediatric children with COVID-19 was for prosocial behavior (15%), followed by total difficulties (13%), emotional symptoms (11%), hyperactivity (10%), conduct problems (9%), and peer problems (1%). With regarding to their parents, 26% reported having symptoms of anxiety and 23% as having symptoms of depression. The scores of SDQ were higher in those children whose parents have emotional problems compared to parents without. Conclusion Long-term follow up studies on the psychological and behavioral problems of COVID-19 recovered children and their parents are warranted.

Analysis on medication rules of 361 patients of COVID-19 treated by traditional Chinese medicine

Objective: Analyzed the prescriptions of traditional Chinese medicine (TCM) for patients diagnosed with Novel Coronavirus Pneumonia (COVID-19), and the medication patterns were statistically analyzed to provide reference for the treatment of COVID-19.

Long-Term Outcomes of COVID-19 Survivors and an Exploratory Analysis of Factors Associated with Sequela-Free Survival of Patients Treated at Leishenshan Hospital in Wuhan, China (preprint)

Objective: To determine key factors associated with sequela-free survival of patients with COVID-19.Design: Retrospective–prospective observational study.Setting: Leishenshan Hospital in Wuhan, China.Participants: Patients with COVID-19 admitted at Leishenshan Hospital in Wuhan, China between 15 February 2020 and 1 April 2020 and discharged.Main Outcomes: MeasuresSequela-free survival is defined as having none of the long-term sequelae measured with the Activity of Daily Living (ADL) Scale, Modified Medical Research Council (mMRC) Dyspnoea Scale, New York Heart Association (NYHA) classification, Self-rating Depression Scale (SDS), Carcinologic Handicap Index (CHI) and Modified Telephone Interview for Cognitive Status (TICS-M). Multivariable logistic regression was used to examine the key factors of sequela-free survival.ResultsThe follow-up period for the 464 patients was 10 August to 30 September 2020. Of these, 424 patients completed the assessment of all scales. 30.2% (128 of 424) were categorised as sequela-free at follow-up. The most common sequelae were psychosocial problems (254 [57.7%]), respiratory function abnormality (149 [32.6%]) and cardiac function abnormality (98 [21.5%]). Risk factors associated with COVID-19 sequelae were anaemia on admission, longer duration from the onset of symptoms to admission and advanced age, whereas anti-anaemia treatment was a protective factor against sequelae. A haemoglobin level of <113 g/l for female patients or <92 g/l for male patients at admission discriminated a higher risk of any COVID-19 sequelae.Conclusions: Only one third COVID-19 survivors were sequela-free. Anaemia on admission, longer duration from the onset of symptoms to admission and advanced age were the risk factors of any long-term sequela. Anti-anaemia treatment was associated with beneficial outcomes in COVID-19 survivors.Funding: This study was funded by grants to DSS from the National Natural Science Foundation of China (Nos.81771133, 81970995) (DSD grants), Shanghai Shenkang Hospital Development Center Founding (SHDC12017X11), Renji Hospital Clinical Innovation Foundation (PYMDT-007), Shanghai municipal Education Commission-Gaofeng Clinical Medicine Support (20191903), State Key Laboratory of Neuroscience(SKLN－201803), the National Natural Science Foundation of China (No.81701358) (DH grants), the Shanghai Municipal Commission of Health and Family Planning Funding (20184Y0205) (CYC grants) and Renji Hospital founding (RJZZ18-019) (LLH grants).Declaration of Interest: None to declare. Ethical Approval: This study was approved by the Institutional Research Ethics Committee of Renji Hospital, School of Medicine, Shanghai Jiaotong University (ethics committee approval No. KY2020-34).

Long-Term Outcomes and Sequelae for 464 COVID-19 Patients Discharged from Leishenshan Hospital in Wuhan, China (preprint)

Background: While coronavirus disease 2019 (COVID-19) has emerged as a global pandemic, millions of COVID-19 patients have recovered and returned to their families and work, although the long-term outcomes remain unknown.Methods: This retrospective–prospective study analysed data for COVID-19 patients discharged from Leishenshan Hospital in Wuhan, China. Long-term outcomes were measured by Activity of Daily Living (ADL) Scale, Modified Medical Research Council (mMRC) Dyspnoea Scale, New York Heart Association (NYHA) classification, Self-rating Depression Scale (SDS), Carcinologic Handicap Index (CHI), and Modified Telephone Interview for Cognitive Status (TICS-M). Multivariable logistic regression was used to examine the risk factors of long-term outcomes.Findings: The follow-up period for the 464 patients was August 10–September 30, 2020. The most common sequelae were psychosocial problems (254 [57·7%]), respiratory function abnormality (149 [32·6%]), and cardiac function abnormality (98 [21·5%]). Rare sequelae were ADL disability (61 [13·3%]); pain (55 [12·5%]); feeding difficulties (54 [12·2%]); dysphonia (46 [10·4%]); and hyposmia (27 [6·1%]), as well as impairment in hearing (40 [9·1%]), vison (37 [8·4%]), swallowing (30 [6·8%]), and gustation (18 [4·1%]). Almost all patients (98·2%) had normal cognitive function. Risk factors associated with ADL disability were advanced age, intensive care unit (ICU) stay, and cancer, which were also associated with respiratory function abnormality. Risk factors associated with cardiac function abnormality were long hospital stay, cancer, and respiratory diseases. Advanced age, ICU stay, and nonischemic heart diseases were associated with psychosocial problems. Compared with female patients, male patients had decreased odds of declined respiratory, cardiac function, depression and anxiety, and pain.Interpretation: Nearly normal ADL, moderate cardiopulmonary function and psychosocial issues, and minor sensory abnormalities were observed in COVID-19 survivors. Advanced age, ICU stay, cancer, and female sex were adverse risk factors in long-term sequelae. These data provide a generalisable estimate of long-term outcomes for COVID-19.Trial Registration: This study was registered in the ClinicalTrial.gov database (NCT04508712).Funding: National Natural Science Foundation of China, Shanghai Shenkang Hospital Development Center, Shanghai municipal Education Commission, State Key Laboratoy of Neuroscience, and Renji Hospital.Declaration of Interests: All authors declare no competing interests.Ethics Approval Statement: This study was approved by the Institutional Research Ethics Committee of Renji Hospital, School of Medicine, Shanghai Jiaotong University (Ethical Committee approval number: KY2020-34). Oral consent was acquired from patients or from their immediate family members in cases of communication disorder or death.

COVID-19-related stigma and its' influencing factors: a rapid nationwide study in China (preprint)

Background：COVID-19 poses a significant challenge to global public health. During the pandemic, COVID-19 patients and people in outbreak areas have suffered from stigma associated with the disease. This study aimed to evaluate the prevalence of COVID-19-related stigma toward COVID-19 patients and people from the city of Wuhan in China and assess the association of COVID-19-related stigma, health literacy, and sociodemographic characteristics.Methods：A cross-sectional survey covering 5,039 respondents was conducted in 31 provinces in China using a convenience sampling method. Binary logistic regressions were used to identify the factors associated with COVID-19-related stigma.Results：Among the participants, 122 (2.4%) reported themselves and 254 (5.0%) reported the communities they lived in held a stigmatizing attitude toward COVID-19 patients, respectively. Additionally, 114 (2.5%) and 475 (10.3%) reported that themselves and the communities they lived in, respectively, held a stigma against people from Wuhan, where was the most severely affected area in China. People aged over 40, lived in areas with severe epidemics (aOR=2.15, 95% CI [1.12-4.13]), and who felt it difficult to find and understand information about COVID-19 (aOR=1.91, 95% CI [1.08-3.27]; aOR=1.88, 95% CI [1.08-3.29]) were more likely to stigmatize COVID-19 patients. People who were male, aged 41 to 50, and had difficulty understanding information (aOR=2.08, 95% CI [1.17-3.69]) were more likely to stigmatize people from Wuhan.Conclusions：COVID-19 patients and Wuhan residents suffered stigma at both the individual and community levels, although proportion of those holding a stigma was not very high. Provinces close to Wuhan had relatively high stigma toward COVID-19 patients and people from Wuhan. There was a correlation between better health literacy and lower stigma during the COVID-19 outbreak. Tailored interventions were encouraged to improve health literacy and consequently to reduce stigma toward both COVID-19 patients and Wuhan people from individual and community levels, respectively.

Clinical characteristics and outcomes of hepatitis B virus carriers infected with COVID-19 at the Jinyintan hospital in WuHan, China (preprint)

Background: Coronavirus 2019 (COVID-19) is a novel infectious disease that was earliest reported in Wuhan, China, but has been later discovered everywhere in the world. On the other hand, Hepatitis B virus (HBV) is ubiquitous in China; having millions of HBV carriers, HBV infection has become a major problem of public health in China. In this study, we aim to describe the clinical features of HBV carriers infected with COVID-19 and to assess factors that may affect the progression and outcome of the disease.Methods: 72 patients diagnosed as infected with both COVID-19 and HBV at the Jinyintan Hospital of Wuhan have been involved in this study. Epidemiological characteristics, demographic features, clinical manifestations, laboratory test, treatment, management and final outcomes of these patients were collected and analyzed.Results: Among all 72 patients (40 male and 32 female, with a median age of 58.5 years old), 22 (30.56%) were diagnosed as severe cases and 50 (69.44%) non-severe cases. Fever is the most common symptom, followed by cough, chest tightness and sputum. Significant differences have been observed in the outcomes of laboratory tests including hematologic, biochemical, infection and coagulation parameters, and in indicators like Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), Total Bilirubin (TBil), Direct Bilirubin (DBil), Indirect Bilirubin (IBil) and γ-glutamyl Transferase (GGT) at the admission and discharge of these patients. Especially, levels of Prealbumin (PA) and Serum Amyloid A (SAA) showed an obvious trend of decreasing, which is statistically significant.Conclusions: The clinical features of HBV carriers infected with COVID-19 have obvious systemic symptoms, such as fever, cough, and chest tightness. By comparing their liver functions tested on the dates of admission and discharge, we found that the SARS-CoV-2 virus, which causes COVID-19, does not directly activate the Hepatitis B virus, so that the risk of liver cell damage for HBV carriers infected with COVID-19 does not increase. Both PA and SAA seem to work as sensitive indicators and can be used to evaluate the prognosis and outcome of these patients.