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OBJECTIVE: To explore potential categories of parental social support for young parents under the coronavirus disease 2019 (COVID-19) epidemic, and to examine correlations of different types of parents' social support with parental burnout. METHOD(S): In April 2020, we conducted an online voluntary survey among young parents across China with scales and a self-designed questionnaire. The latent profile analysis method was used to analyze parents' received social support and perceived social support. The social support categories were taken as independent variables and parental burnout as dependent variables, and multiple regression analysis was carried out to explore the relationship between received social support, perceived social support and parental burnout. Finally, the moderating effect of resilience between social support groups and parental burnout was discussed. RESULT(S): The results of latent profile analysis revealed three potential types of received social support, namely isolate, normal, and multi-support and the proportions of the respondents with the three profiles were 14.1%, 78.0%, and 7.9%. Four potential types of perceived social support, namely, indigent, medium, affluent and divergent and the proportions of the respondents with the four profiles were 13.7%, 29.6%, 25.3%, and 31.3%. Among them, the parents with divergent perceived social support had more perception of social support from the couple, family and relatives, but less perception of social support from net-friend, social organizations and the government. Regression analysis showed that there was no statistically significant correlation between different profiles of received social support and parental burnout, and among the groups of perceived social support, there was a statistically significant correlation between indigent and divergent types of social support and parental burnout. The divergent parents had lower levels of parental burnout compared with indigent (beta=-0.120, P=0.003). Also, resilience moderated the effect of divergent perceived social support and parental burnout. Compared with the parents with low resilience, the parents with high resilience perceived divergent social support with lower parenting burnout. CONCLUSION(S): There are prominent latent types of received social support and perceived social support under epidemic. People with divergent perceived social support (more perceived supports from partner, family and friends) are prone to have a relatively lower risk of parental burnout. Parents with higher resilience will be more sensitive to the support of close acquaintances, and can better resist parental burnout.
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The great challenge to prevent transmission makes widespread of respiratory infectious diseases easily occur. Intranasal immunization is considered to be a promising route of vaccination to prevent it. Different from parenteral vaccines, intranasal vaccines can induce mucosal immune in respiratory tracts in addition to systemic immune, which provide the first line of defense against respiratory pathogen infection and further prevent transmission. Safe and effective intranasal spray flu vaccines have been licensed. Since the outbreak of COVID-19, intranasal administration has been applied in different vaccine platforms. This article has reviewed the progress of intranasal vaccines for respiratory infectious diseases that have been licensed or are under evaluation in the clinical trials, meanwhile discusses its unique advantages and challenges faced. © 2023, Publication Centre of Anhui Medical University. All rights reserved.
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Objective To improve the diagnosis and treatment level for tuberculous meningitis (TBM) under the Coronavirus disease 2019 (COVID-19) epidemic. Methods The diagnosis and treatment course of a female patient under the COVID-19 epidemic was analyzed for high fever, vomiting for 23 days, headache, talk nonsense for 10 days, inability to stand, and double vision lasting 5 days. The patient was successively misdiagnosed to suffer from viral pneumonia and acute disseminated encephalomyelitis (ADEM) in other hospitals. The patient had a history of transit at Hankou railway station (wearing a mask without departing the station throughout the process) under the COVID-19 epidemic. The patient had a history of leukopenia and long-term medical therapy. The patient was diagnosed as TBM by applying the diagnostic scheme for the 2019 China Central Nervous System Tuberculosis Diagnosis and Treatment Guidelines after physical examination, cerebrospinal fluid test, magnetic resonance imaging (MRI) plain scan and enhanced examination. The analysis on reasons for extramural hospital misdiagnosis showed it was related to the lack of careful physical examination and lack of scientific analysis of laboratory test results. Results The intracranial pressure reduction, anti-tuberculosis treatment, adrenal cortex hormone treatment and symptomatic treatment were immediately administered according to the 2019 China Central Nervous System Tuberculosis Diagnosis and Treatment Guidelines. Intensive anti-tuberculosis treatment (4 months) was implemented firstly and followed by the anti-tuberculosis treatment (12 months) during the consolidation phase, clinically enabling the patient to be cured. Conclusion Careful inquiry of medical history, careful physical examination, timely cerebrospinal fluid examination and MRI examination and scientific analysis on clinical data are critical to confirmation of TBM. Standard anti-tuberculosis treatment, rational use of adrenal cortex hormones and lowering intracranial pressure are critical factors for curing. © 2023, Editorial Department of Medical Pest Control. All rights reserved.
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Objective To improve the diagnosis and treatment level for tuberculous meningitis (TBM) under the Coronavirus disease 2019 (COVID-19) epidemic. Methods The diagnosis and treatment course of a female patient under the COVID-19 epidemic was analyzed for high fever, vomiting for 23 days, headache, talk nonsense for 10 days, inability to stand, and double vision lasting 5 days. The patient was successively misdiagnosed to suffer from viral pneumonia and acute disseminated encephalomyelitis (ADEM) in other hospitals. The patient had a history of transit at Hankou railway station (wearing a mask without departing the station throughout the process) under the COVID-19 epidemic. The patient had a history of leukopenia and long-term medical therapy. The patient was diagnosed as TBM by applying the diagnostic scheme for the 2019 China Central Nervous System Tuberculosis Diagnosis and Treatment Guidelines after physical examination, cerebrospinal fluid test, magnetic resonance imaging (MRI) plain scan and enhanced examination. The analysis on reasons for extramural hospital misdiagnosis showed it was related to the lack of careful physical examination and lack of scientific analysis of laboratory test results. Results The intracranial pressure reduction, anti-tuberculosis treatment, adrenal cortex hormone treatment and symptomatic treatment were immediately administered according to the 2019 China Central Nervous System Tuberculosis Diagnosis and Treatment Guidelines. Intensive anti-tuberculosis treatment (4 months) was implemented firstly and followed by the anti-tuberculosis treatment (12 months) during the consolidation phase, clinically enabling the patient to be cured. Conclusion Careful inquiry of medical history, careful physical examination, timely cerebrospinal fluid examination and MRI examination and scientific analysis on clinical data are critical to confirmation of TBM. Standard anti-tuberculosis treatment, rational use of adrenal cortex hormones and lowering intracranial pressure are critical factors for curing. © 2023, Editorial Department of Medical Pest Control. All rights reserved.
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The great challenge to prevent transmission makes widespread of respiratory infectious diseases easily occur. Intranasal immunization is considered to be a promising route of vaccination to prevent it. Different from parenteral vaccines, intranasal vaccines can induce mucosal immune in respiratory tracts in addition to systemic immune, which provide the first line of defense against respiratory pathogen infection and further prevent transmission. Safe and effective intranasal spray flu vaccines have been licensed. Since the outbreak of COVID-19, intranasal administration has been applied in different vaccine platforms. This article has reviewed the progress of intranasal vaccines for respiratory infectious diseases that have been licensed or are under evaluation in the clinical trials, meanwhile discusses its unique advantages and challenges faced.Copyright © 2023, Publication Centre of Anhui Medical University. All rights reserved.
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Many types of microorganisms, including SARS-CoV-2, can spread through aerosols. Indoor medical environments are abundant in bioaerosols, which can cause infections among medical staff members and patients in hospitals. Given the ongoing COVID-19 pandemic, using a steadystate displacement air purification system may reduce the spread of SARS-CoV-2 and other microorganisms. In this study, we analyzed the purification effect of the steady-state displacement air purification system on bioaerosols in the bronchoscopy room of the hospital. In particular, bioaerosols were collected from the bronchoscopy room at different periods from April to May 2021. Among them, the microorganisms contained in the bioaerosol were identified using nextgeneration sequencing (NGS) and culture and strain identification. During the experiment, we took 5 sampling points to collect the bioaerosols. The total purification efficiency was 88.0% (NGS) and 87.5% (microbial culture count and identification). The results were significantly different between the purified and unpurified groups. In an occupant environment in the bronchoscopy room, the steady-state displacement air purification system exerted a favorable removal effect on the bioaerosols. Such purification efficiency may help prevent the in-hospital spread of COVID-19 and various infectious diseases.
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We consider a novel partially linear additive functional regression model in which both a functional predictor and some scalar predictors appear. The functional part has a semiparametric continuously additive form, while the scalar predictors appear in the linear part. The functional part has the optimal convergence rate, and the asymptotic normality of the nonfunctional part is also shown. Simulations and an empirical analysis of a Covid-19 data set demonstrate the performance of the proposed estimator.
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Methods: The survey was designed by an international team, translated and adapted to simplified Chinese, including 132 kinds of traditional Chinese medicine (TCM) preparation recommended by guidelines. It was distributed and collected from February to May 2021, with data analysed by WPS spreadsheet and wjx.cn. Descriptive statistics were used to describe demographics and clinical characteristics, diagnosis, treatments, preventative behaviours and interventions, and their associated outcomes. Results: The survey was accessed 503 times with 341 (67.8%) completions covering 23 provinces and four municipalities in China. Most (282/341, 82.7%) respondents reported no symptoms during the pandemic and the majority (290/341, 85.0%) reported having a SARS-CoV-2 PCR test at some point. Forty-five (13.2%) reported having a respiratory infection, among which 19 (42.2%) took one or more categories of modern medicine, e.g. painkillers, antibiotics;16 (35.6%) used TCM interventions(s);while seven respondents combined TCM with modern medicine. All respondents reported using at least one behavioural or medical approach to prevention, with 22.3% taking TCM and 5.3% taking modern medicines. No respondents reported having a critical condition related to COVID-19. Background: We aimed to investigate use of infection control behaviours, preventative and therapeutic interventions, and outcomes among respondents to an online survey during the COVID-19 pandemic in China. Conclusion: We found evidence of widespread use of infection control behaviours, modern medicines and TCM for treatment and prevention of COVID-19 and other respiratory symptoms. Larger scale studies are warranted, including a more representative sample exploring TCM preparations recommended in clinical guidelines.
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OBJECTIVE: To explore potential categories of parental social support for young parents under the coronavirus disease 2019 (COVID-19) epidemic, and to examine correlations of different types of parents' social support with parental burnout. METHODS: In April 2020, we conducted an online voluntary survey among young parents across China with scales and a self-designed questionnaire. The latent profile analysis method was used to analyze parents' received social support and perceived social support. The social support categories were taken as independent variables and parental burnout as dependent variables, and multiple regression analysis was carried out to explore the relationship between received social support, perceived social support and parental burnout. Finally, the moderating effect of resilience between social support groups and parental burnout was discussed. RESULTS: The results of latent profile analysis revealed three potential types of received social support, namely isolate, normal, and multi-support and the proportions of the respondents with the three profiles were 14.1%, 78.0%, and 7.9%. Four potential types of perceived social support, namely, indigent, medium, affluent and divergent and the proportions of the respondents with the four profiles were 13.7%, 29.6%, 25.3%, and 31.3%. Among them, the parents with divergent perceived social support had more perception of social support from the couple, family and relatives, but less perception of social support from net-friend, social organizations and the government. Regression analysis showed that there was no statistically significant correlation between different profiles of received social support and parental burnout, and among the groups of perceived social support, there was a statistically significant correlation between indigent and divergent types of social support and parental burnout. The divergent parents had lower levels of parental burnout compared with indigent (β=-0.120, P=0.003). Also, resilience moderated the effect of divergent perceived social support and parental burnout. Compared with the parents with low resilience, the parents with high resilience perceived divergent social support with lower parenting burnout. CONCLUSION: There are prominent latent types of received social support and perceived social support under epidemic. People with divergent perceived social support (more perceived supports from partner, family and friends) are prone to have a relatively lower risk of parental burnout. Parents with higher resilience will be more sensitive to the support of close acquaintances, and can better resist parental burnout.
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Since 2013, the winter mean fine particulate matter (PM2.5) had been decreased significantly due to stringent emission controls in most of China. Nevertheless, we found a seesaw pattern of PM2.5 interannual anomalies between Beijing-Tianjin-Hebei (BTH) and Yangtze River Delta (YRD). Using the multiple linear regression method, meteorology-driven PM2.5 interannual anomalies show that the low (high) PM2.5 relative difference between BTH and YRD (RDB&Y) was associated with the strong (weak) East Asian winter monsoon (EAWM). The strong EAWM transported more air pollutants from BTH to YRD. During the COVID-19 lockdown period, due to the weak EAWM, air pollution still occurred in northern BTH, while the PM2.5 was relatively low in YRD, causing high RDB&Y values. Our results imply that the activity of EAWM and characteristics of regional transport have obvious interannual variations, which is indispensable in evaluating the achievements of PM2.5 quality management between up and downstream regions.
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Objective: To analyze the follow-up changes of subjects of anti-cancer clinical trials in our department under the COVID-19 epidemic situation. Methods: The clinical trials were classified. The follow-up status of subjects in our department from February 3 to April 30 and May 6 to 29, 2020 was collected, and the data were input and analyzed by Excel and SPSS 22.0. Results: There were 32 anti-cancer clinical trials in our department. From February 3 to April 30, 2020, 1 049 person times were planned to be followed up, and 658 person times were actually followed up, accounting for 62.73%. The follow-up rate of oral drugs was 93.33%, that of oral drugs combined with non-oral drugs was 87.73%, and that of non-oral drugs was 70.71%. In May 2020, the actual follow-up rate of subjects on site rose to 88.97%, while the number of delayed drug users, the number of external hospital inspectors and the number of non-drug users decreased. Conclusion: The epidemic situation had a great impact on the follow-up of anti-cancer clinical trials in a short time, but did not cause a sustained impact. The establishment of relevant follow-up measures improved the follow-up rate of subjects to some extent. For the affected subject population, further analysis is needed to better guide the follow-up work of subjects under emergency.
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The novel coronavirus SARS-CoV-2 is causing a pandemic worldwide. Several months after the initial outbreak, with the help of tight isolation policy, SARS-CoV-2 transmission in the general population is now under control in China. The number of new cases dramatically decreases compared to the outbreak period. Thus, we name this phase the "post-outbreak" period when China has lived through the pandemic phase while many other countries are still facing fast growing cases. To keep the number of new cases at low level under the consistent pressure of imported cases from other countries and prevent a second outbreak in China are tremendous challenges to all workers in the health care system. Currently available studies of the basic reproduction number (R-0) of SARS-CoV-2 demonstrate that the new virus has a higher transmission capacity than other coronaviruses such as SARS-CoV and MERS-CoV. Besides, longitudinal serological studies illuminate that protective antibodies to SARS-CoV-2 may turn negative at early convalescent phase in certain patients, indicating a relatively short protection time. Recent prediction models of the transmission dynamics suggested a risk of recurrent outbreaks of SARS-CoV-2, even in seasonal or perennial pattern. When autumn and winter are approaching, the number of patients infected with SARS-CoV-2 will be likely to increase if appropriate measures are not taken, which will further challenge the medical system. It has been shown that during the outbreak period, the infection rate of SARS-CoV-2 among medical workers is relatively high. According to the serum specific antibody test, about half of the front-line medical staffs have been infected in some countries. Some cluster cases of SARS-CoV-2 infection in hospital settings have been reported. This indicates that the risk of virus transmission in the hospital environment is high and more intensive infection control is needed. In this article, we particularly focus on several high-risk areas, such as respiratory clinics, eye clinics and obstetrical clinics. We summarize their unique clinical practices and possible risks of virus transmission, and propose some suggestions for the protection of health care workers in daily work during the "postoutbreak" period based on guidelines proposed by international groups and specialists of the fields. The review also discusses some approaches that hospitals can take during the "post-outbreak" period to early detect infected patients and cut nosocomial transmission. We focus on the topics including the prevention of the virus spreading via aerosol between patients and doctors, innovation of fast and reliable diagnostic methods to effectively identify SARS-CoV-2 carriers from large number of suspected patients, implementation of effective remote doctor consultation and establishment of a patient stratification system to reduce cross-infection, etc. This article aims to highlight the awareness of SARS-CoV-2 virus transmission in hospitals and clinics during the "post-outbreak" phase and propose crucial aspects for the research of nosocomial infection control.
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Objective: This study summarizes the practical experience of remote monitoring in clinical trials, preliminarily discusses the advantages and consideration factors, and provides reference for monitoring and management of clinical trials. Methods: In view of the problem that on-site monitor cannot be conducted on time during the COVID-19, our hospital launched the online remote monitoring system in time relying on the DPAP technology for the use of sponsor and CRO. The application of remote monitoring by September 15, 2020 were counted through the system backstage. The effect of application was objectively evaluated by comparing the defect detection rate per subject found by remote monitoring and on-site monitoring with chi-square. The user experience, advantages and disadvantages of remote monitoring system were investigated through homemade questionnaire and in-depth interview. The method of health economics evaluation was used to estimate the cost of simple on-site monitoring mode, remote monitoring and on-site monitoring combined mode. Results: The hospital officially launched the remote monitoring system on February 10, 2020. Until September 15, 2020, 176 CRAs from 76 sponsors/CRO have used the remote monitoring system for totally 10 470 times to conduct remote monitoring, involving 228 projects, 1 318 subjects, 16 departments in our hospital. A total of 3 820 findings have been found during the remote monitoring of 228 trials. Compared with the on-site monitoring of the same project in 2019, the remote monitoring achieved the on-site monitoring effect in terms of checking protocol deviation, case report form (CRF), combined drug use and biological samples;however, it is not as good as the on-site monitoring in terms of original records, informed consent, adverse events and experimental drugs, which involves more paper materials. 72.61% of CRAs believed that remote monitoring system effectively supported the completion of monitoring work, and 62.50% of CRAs thought that it reduced the time of on-site monitoring. The in-depth interviews with 16 CRAs showed that remote monitoring had advantages and was highly praised. The cost of the combination of routine on-site monitoring visit, remote monitoring and on-site monitoring was calculated, resulting that on-site monitoring visit frequency was reduced by 16 times, saving 73 600 RMB of travel expenses and 624 hours of travel time. But remote monitoring should be considered and standardized in system verification, subject informed consent monitoring and privacy protection, data security, implementation and other aspects. Conclusion: The remote monitoring mode made the monitoring free from location and time constraints, timely found the problems in the trials, greatly improved the efficiency of the monitoring, and reduced the risk and cost of clinical trials. In the future, it can be applied and explored in more aspects, but still needs to be further supplemented with data sources and standardized in the aspects of system verification.
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Background. The course of disease in mild and moderate COVID-19 has many implications for mobile patients, such as the risk of spread of the infection, precautions taken, and investigations targeted at preventing transmission. Methods. Three hundred thirty-one adults were hospitalized from January 21 to February 22, 2020, and classified as severe (10%) or critical (4.8%) cases;1.5% died. Two hundred eighty-two (85.2%) mild or moderate cases were admitted to regular wards. Epidemiological, demographic, clinical, chest computed tomography (CT) scan, laboratory, treatment, and outcome data from patient records were analyzed retrospectively. Results. Patients were symptomatic for 9.82 +/- 5.75 (1-37) days. Pulmonary involvement was demonstrated on a chest CT scan in 97.9% of cases. It took 16.81 +/- 8.54 (3-49) days from the appearance of the first symptom until 274 patients tested virus-negative in naso- and oropharyngeal (NP) swabs, blood, urine, and stool, and 234 (83%) patients were asymptomatic for 9.09 +/- 7.82 (1-44) days. Subsequently, 131 patients were discharged. One hundred sixty-nine remained in the hospital;these patients tested virus-free and were clinically asymptomatic because of widespread persisting or increasing pulmonary infiltrates. Hospitalization took 16.24 +/- 7.57 (2-47) days;the time interval from the first symptom to discharge was 21.37 +/- 7.85 (3-52) days. Conclusions. With an asymptomatic phase, disease courses are unexpectedly long until the stage of virus negativity. NP swabs are not reliable in the later stages of COVID-19. Pneumonia outlasts virus-positive tests if sputum is not acquired. Imminent pulmonary fibrosis in high-risk groups demands follow-up examinations. Investigation of promising antiviral agents should heed the specific needs of mild and moderate COVID-19 patients.
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Objective: To analyze the effects of angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) on coronavirus disease 2019 (COVID-19) patients with hypertension, and to provide an evidence for selecting antihypertensive drugs in those patients. Methods: Clinical data were retrospectively analyzed in 58 COVID-19 patients with hypertension admitted to Shanghai Public Health Clinical Center from January 20 to February 22, 2020, including epidemiological history, clinical manifestations, laboratory findings, chest CT and outcome. Patients were divided into ACEI/ARB group and non-ACEI/ARB group. Results: Twenty-six patients were in ACEI/ARB group and the other 32 patients in non-ACEI/ARB group, with median age 64.0 (49.5, 72.0) years and 64.0 (57.0, 68.8) years respectively. The median time to onset was 5(3, 8) days in ACEI/ARB group and 4 (3, 7) days in non-ACEI/ARB group, the proportion of patients with severe or critical illness was 19.2% and 15.6% respectively. The main clinical symptoms in two groups were fever (80.8% vs. 84.4%) and cough (23.1% vs. 31.3%). The following parameters were comparable including lymphocyte counts, C-reactive protein, lactate dehydrogenase, D-dimer, bilateral involvement in chest CT (76.9% vs. 71.9%), worsening of COVID-19 (15.4% vs. 9.4%), favorable outcome (92.3% vs. 96.9%) between ACEI/ARB group and non-ACEI/ARB group respectively (all P>0.05). However, compared with non-ACEI/ARB group, serum creatinine [80.49 (68.72, 95.30) µmol/L vs. 71.29 (50.98, 76.98) µmol/L, P=0.007] was higher significantly in ACEI/ARB group. Conclusions: ACEI/ARB drugs have no significant effects on baseline clinical parameters (serum creatine and myoglobin excluded) , outcome, and prognosis of COVID-19 patients with hypertension. Antihypertensive drugs are not suggested to adjust in those patients, but the potential impairment of renal function as elevation of serum creatinine should be paid attention in patients administrating ACEI/ARB drugs.