ABSTRACT
Under heat problem, the combined effects of heatwaves and urban heat island effects, has been one of the deadliest climate-related disasters. Uncovering heat-induced health problems is of significance to inform people about urban heat impacts and improve people's awareness of addressing urban heat problems. Existing studies have primarily done this through panel analysis based on second-hand data from local or national authorities. However, there are limited studies directly concentrating on the heat responses of people. To address this gap, this study aims to investigate public responses to urban heat and heat-related illness on the individual side. The study was conducted through a questionnaire survey in three Chinese cities including Nanchang, Shenyang and Xi'an. Based on 1154 valid responses, this study analysed respondents understanding of urban heat problems, symptoms of physiological illnesses and their behaviours of hospitalisation. The results indicate that the knowledge of heat-related risks (2.29 out of 5) was significantly lower than the perceived urban heat severity (3.24) and the perceived severity of physiological impacts (2.40). The skin heat damage (44.7%), among 873 respondents who underwent physiological impacts, was the most frequent physiological illness, followed by the digestive systems (34.0%) and then respiratory (24.1%) and cardiovascular diseases (18.2%). Among the 873 respondents, only 4.0% and 17.7% of respondents would like or were mostly yes to visit hospitals, while 14.2% and 26.4% of the respondents would not like or were mostly not to visit hospitals. Moreover, perceived urban heat severity, knowledge of heat-related risks, perceived severity of physiological impacts, symptoms of physiological illnesses and behaviours of hospitalisation were city-specific and demography-dependent. Overall, the empirical analysis provides new evidence of urban heat problems and generates theoretical and policy implications for heat-induced impact estimation and prevention.
ABSTRACT
Background: People living with HIV and AIDS (PLWHA) could benefit from COVID-19 vaccination. There is a dearth of evidence on willingness to receive COVID-19 vaccination (WTR) among PLWHA.Methods: The study is a multicenter cross-sectional online survey conducted in eight conveniently selected Chinese metropolitan cities between January and February 2021. Participants were PLWHA aged 18-65 years and living in the study cities. Eight community-based organizations (CBO) providing services to PLWHA, one in each city, facilitated the recruitment through their networks. Eligible PLWHA completed an online survey developed using Golden Data, a widely used encrypted web-based survey platform in China. Logistic regression models and path analysis were used in data analysis.Findings: Out of 10,845 PLWHA approached by the CBO, 2740 completed the survey. This analysis was performed among 2570 participants who had never received COVID-19 vaccination. Over half of the participants reported WTR (57·2%, 1470/2570). After adjusting for potential confounders, all four constructs of the Theory of Planned Behavior (TPB) were significantly associated with WTR, including positive attitudes (adjusted odds ratio, aOR: 1·11, 95%CI: 1·09, 1·12), negative attitudes (aOR: 0·96, 95%CI: 0·94, 0.97), perceived support from significant others (perceived subjective norm) (aOR: 1·53, 95%CI: 1·46, 1·61), and perceived higher behavioral control (aOR: 1·13, 95%CI: 1·11, 1·14). At the interpersonal level, receiving advice supportive of COVID-19 vaccination from doctors (aOR: 1·99, 95%CI: 1·65, 2·40), CBO staff (aOR: 1·89, 95%CI: 1·51, 2·36), friends and/or family members (aOR: 3·22, 95%CI: 1·93, 5·35), and PLWHA peers (aOR: 2.38, 95%CI: 1·85, 3·08) were associated with higher WTR. Overall opinion supporting COVID-19 vaccination for PLWHA on Internet or social media was also positively associated with WTR (aOR: 1·59, 95%CI: 1·31, 1·94). Path analysis indicated that interpersonal-level variables was indirectly associated with WTR through TPB-related perceptions (β=0·43, 95% CI=0·37, 0·51).Interpretation: PLWHA in China reported a relatively low WTR. Interpersonal communication and Internet/social media may be the major sources to convey information and promote COVID-19 vaccination in the population.Funding Statement: This work was supported by the Academic technology leader project of Changzhi Medical College (Grant No. XSQ201902), he Beijing Excellent Talent Plan (2018000021223ZK04) and the National Institute of Mental Health of the National Institutes of Health under Award Numbers R34MH119963.Declaration of Interests: The authors have no conflicts of interest to disclose.Ethics Approval Statement: The Institutional Review Boards of Changzhi Medical College (RT2021003) approved this study.
Subject(s)
COVID-19 , HIV Infections , Acquired Immunodeficiency SyndromeABSTRACT
BackgroundCoronavirus Disease 2019 (COVID-19) has become a global pandemic and caused over one hundred thousand death. Chloroquine (CQ) and hydroxychloroquine (HCQ) were recommended for off-label use in the treatment of COVID-19 in some countries despite their unclear benefit. However, the toxicity of these agents has been ignored, so the investigation of their safety in the treatment of COVID-19 is crucial for providing a reference for the rational use. MethodsThe medical records obtained from the information management system of Guangzhou Eighth People’s Hospital were reviewed to extract data about patients who received chloroquine phosphate tablets for COVID-19 treatment from January 20th to March 5th, 2020. The data were assessed to determine the correlation of adverse reaction with chloroquine phosphate based on Chinese CFDA standards as well as the severity of adverse events based on American CTCAE5.0 standard, and evaluate the safety of this medication.ResultsA total of 42 patients (23 males and 19 females, average 42.19±14.29 years old) with COVID-19 were treated with low-dose chloroquine phosphate (oral, 500 mg, once per day). Totally 18 patients（42.86%）experienced 20 adverse events. The mean duration of CQ administration was 6.57 days (SD, 3.16 days; range: 1 day to 16 days) and 52.4% received CQ for 7 to 9 days. The adverse events occurred within 6–8 days of treatment. For the 20 adverse events, 19 were not higher than grade 2 and only one was grade 3 because of the severely limited self-care ability in one patient. The most common adverse events were related to the digestive, circulatory, hepatic, and nervous systems.ConclusionOral chloroquine phosphate tablets resulted in a high incidence of adverse reactions. In the clinical trial of chloroquine phosphate for COVID-19 treatment, it should be used under pharmaceutical care; timely evaluation of the drug safety during the treatment process is necessary and a randomized controlled clinical trial should be conducted.
Subject(s)
COVID-19 , Hallucinations , Drug-Related Side Effects and Adverse ReactionsABSTRACT
Background Approximately 15-20% of COVID-19 patients will develop severe pneumonia, about 10 % of which will die if not properly managed. Methods 125 COVID-19 patients enrolled in this study were classified into mild (93 cases) and severe (32 cases) groups, basing on their 3 to 7-days clinical outcomes. Patients' gender, age, comorbid with underlying diseases, epidemiological history, clinical manifestations, and laboratory tests on admission were collected and subsequently analyzed with single-factor and multivariate logistic regression methods. Finally, we evaluate their prognostic values with the receiver operating characteristic curve (ROC) analysis. Results Seventeen factors on admission differed significantly between mild and severe groups. Next, only four factors, including the comorbid with underlying diseases, increased respiratory rate (>24/min), elevated C-reactive protein (CRP >10mg/liter), and lactate dehydrogenase (LDH >250U/liter), were found to be independently associated with the later disease development. Prognostic value analysis by ROC indicated that individual factors could not confidently predict the occurrence of severe pneumonia, but that the combination of fast respiratory rate and elevated LDH significantly increase the predictive confidence (AUC= 0.944, sensitivity= 0.941, and specificity= 0.902). Three- or four-factors combinations, including elevated LDH and fast respiratory rate, further increased the prognostic value. Additionally, measurable serum viral RNA post-admission could independently predict the severe illness occurrence. Conclusions General clinical characteristics and laboratory tests, such as combinations consisting of elevated LDH and fast respiratory rate, and detectable viral RNA in serum post-admission could provide high confident prognostic value for identifying potential severe COVID-19 pneumonia patients.
Subject(s)
COVID-19 , PneumoniaABSTRACT
Background: Antiviral therapies against the novel coronavirus SARS-CoV-2, which has caused a global pandemic of respiratory illness called COVID-19, are still lacking. Methods: Our study (NCT04252885, named ELACOI), was an exploratory randomized (2:2:1) controlled trial assessing the efficacy and safety of lopinavir/ritonavir (LPV/r) or arbidol monotherapy for treating patients with mild/moderate COVID-19. Findings: This study successfully enrolled 86 patients with mild/moderate COVID-19 with 34 randomly assigned to receive LPV/r, 35 to arbidol and 17 with no antiviral medication as control. Baseline characteristics of the three groups were comparable. The primary endpoints, the average time of positive-to-negative conversion of SARS-CoV-2 nucleic acid and conversion rates at days 7 and 14, were similar between groups (all P>0.05). There were no differences between groups in the secondary endpoints, the rates of antipyresis, cough alleviation, or improvement of chest CT at days 7 or 14 (all P>0.05). At day 7, eight (23.5%) patients in the LPV/r group, 3 (8.6%) in the arbidol group and 2(11.8%) in the control group showed a deterioration in clinical status from moderate to severe/critical(P =0.206). Overall, 12 (35.3%) patients in the LPV/r group and 5 (14.3%) in the arbidol group experienced adverse events during the follow-up period. No apparent adverse event occurred in the control group. Conclusions: LPV/r or arbidol monotherapy present little benefit for improving the clinical outcome of patients hospitalized with mild/moderate COVID-19 over supportive care.