Resident Depression and Burnout During the COVID-19 Pandemic.

CONTEXT.­: Resident physicians face a higher rate of burnout and depression than the general population. Few studies have examined burnout and depression in Canadian laboratory medicine residents, and none during the COVID-19 pandemic. OBJECTIVE.­: To identify the prevalence of burnout and depression, contributing factors, and the impact of COVID-19 in this population. DESIGN.­: An electronic survey was distributed to Canadian laboratory medicine residents. Burnout was assessed using the Oldenburg Burnout Inventory. Depression was assessed using the Patient Health Questionnaire 9. RESULTS.­: Seventy-nine responses were collected. The prevalence of burnout was 67% (50 of 79). The prevalence of depression was 47% (37 of 79). Modifiable factors significantly associated with burnout included career dissatisfaction, below average academic performance, lack of time off for illness, stress related to finances, lack of a peer or staff physician mentor, and a high level of fatigue. Modifiable factors significantly associated with depression further included a lack of access to wellness resources, lack of time off for leisure, and fewer hours of sleep. Fifty-five percent (41 of 74) of participants reported direct impacts to their personal circumstances by the COVID-19 pandemic. CONCLUSIONS.­: Burnout and depression are significant issues affecting Canadian laboratory medicine residents. As the COVID-19 pandemic continues, we recommend the institution of flexible work arrangements, protected time for illness and leisure, ongoing evaluation of career satisfaction, formal and informal wellness programming with trainee input, formal mentorship programming, and a financial literacy curriculum as measures to improve trainee wellness.

Burnout Interventions for Resident Physicians.

CONTEXT.­: Physicians face a high rate of burnout, especially during the residency training period when trainees often experience a rapid increase in professional responsibilities and expectations. Effective burnout prevention programs for resident physicians are needed to address this significant issue. OBJECTIVE.­: To examine the content, format, and effectiveness of resident burnout interventions published in the last 10 years. DESIGN.­: The literature search was conducted on the MEDLINE database with the following keywords: internship, residency, health promotion, wellness, occupational stress, burnout, program evaluation, and program. Only studies published in English between 2010 and 2020 were included. Exclusion criteria were studies on interventions related to the coronavirus disease 2019 (COVID-19) pandemic, studies on duty hour restrictions, and studies without assessment of resident well-being postintervention. RESULTS.­: Thirty studies were included, with 2 randomized controlled trials, 3 case-control studies, 20 pretest and posttest studies, and 5 case reports. Of the 23 studies that used a validated well-being assessment tool, 10 reported improvements postintervention. These effective burnout interventions were longitudinal and included wellness training (7 of 10), physical activities (4 of 10), healthy dietary habits (2 of 10), social activities (1 of 10), formal mentorship programs (1 of 10), and health checkups (1 of 10). Combinations of burnout interventions, low numbers of program participants with high dropout rates, lack of a control group, and lack of standardized well-being assessment are the limitations identified. CONCLUSIONS.­: Longitudinal wellness training and other interventions appear effective in reducing resident burnout. However, the validity and generalizability of the results are limited by the study designs.

CRISPR/Cas systems usher in a new era of disease treatment and diagnosis.

The discovery and development of the CRISPR/Cas system is a milestone in precise medicine. CRISPR/Cas nucleases, base-editing (BE) and prime-editing (PE) are three genome editing technologies derived from CRISPR/Cas. In recent years, CRISPR-based genome editing technologies have created immense therapeutic potential with safe and efficient viral or non-viral delivery systems. Significant progress has been made in applying genome editing strategies to modify T cells and hematopoietic stem cells (HSCs) ex vivo and to treat a wide variety of diseases and disorders in vivo. Nevertheless, the clinical translation of this unique technology still faces many challenges, especially targeting, safety and delivery issues, which require further improvement and optimization. In addition, with the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), CRISPR-based molecular diagnosis has attracted extensive attention. Growing from the specific set of molecular biological discoveries to several active clinical trials, CRISPR/Cas systems offer the opportunity to create a cost-effective, portable and point-of-care diagnosis through nucleic acid screening of diseases. In this review, we describe the development, mechanisms and delivery systems of CRISPR-based genome editing and focus on clinical and preclinical studies of therapeutic CRISPR genome editing in disease treatment as well as its application prospects in therapeutics and molecular detection.

Deriving happiness through extraordinary or ordinary brand experiences in times of COVID-19 threat.

The authors examined how the joint effect of brand experience type (ordinary vs. extraordinary) and COVID-19 threat on consumer happiness changed at different stages of the COVID-19 pandemic. The findings from five studies, with the COVID-19 threat and lockdown status measured as well as manipulated, suggest that COVID-19 threat exerts converse moderating influences on the extraordinariness-happiness relationship under no lockdown and lockdown. Under lockdown, threat attenuates the effect of brand extraordinariness on happiness; extraordinary brand experiences bring more happiness than ordinary brand experiences when the perceived threat of COVID-19 is low, but consumers derive comparable happiness from extraordinary and ordinary experiences when perceived threat is high. Under no lockdown, threat amplifies the positive effect of extraordinariness on happiness. Consumers rarely experience a large-scale lockdown due to a pandemic, and this research advances understanding of how consumer happiness from a brand experience changes with the trajectory of a pandemic.

Factors associated with high compliance behaviour against COVID-19 in the early phase of pandemic: a cross-sectional study in 12 Asian countries

IntroductionRegardless of having effective vaccines against COVID-19, containment measures such as enhanced physical distancing and good practice of personal hygiene remain the mainstay of controlling the COVID-19 pandemic. Countries across Asia have imposed these containment measures to varying extents. However, residents in different countries would have a differing degree of compliance to these containment measures potentially due to differences in the level of awareness and motivation in the early phase of pandemic.ObjectivesIn our study, we aimed to describe and correlate the level of knowledge and attitude with the level of compliance with personal hygiene and physical distancing practices among Asian countries in the early phase of pandemic.MethodsA multinational cross-sectional study was carried out using electronic surveys between May and June 2020 across 14 geographical areas. Subjects aged 21 years and above were invited to participate through social media, word of mouth and electronic mail.ResultsAmong the 2574 responses obtained, 762 (29.6%) participants were from East Asia and 1812 (70.4%) were from Southeast Asia (SEA). A greater proportion of participants from SEA will practise physical distancing as long as it takes (72.8% vs 60.6%). Having safe distancing practices such as standing more than 1 or 2 m apart (AdjOR 5.09 95% CI (1.08 to 24.01)) or more than 3 or 4 m apart (AdjOR 7.05 95% CI (1.32 to 37.67)), wearing a mask when they had influenza-like symptoms before the COVID-19 pandemic, preferring online news channels such as online news websites/applications (AdjOR 1.73 95% CI (1.21 to 2.49)) and social media (AdjOR 1.68 95% CI (1.13 to 2.50) as sources of obtaining information about COVID-19 and high psychological well-being (AdjOR 1.39 95% CI (1.04 to 1.87)) were independent factors associated with high compliance.ConclusionsWe found factors associated with high compliance behaviour against COVID-19 in the early phase of pandemic and it will be useful to consider them in risk assessment, communication and pandemic preparedness.

High recurrence of lymphedema and influencing factors in discharged breast cancer patients during the COVID-19 pandemic: A multicenter, cross-sectional survey.

BACKGROUND: There has been a delay in the detection and treatment of lymphedema in breast cancer patients during the lockdown owing to quarantine and limited social activity. Moreover, this scenario has caused psychosocial issues in these patients. Given that there is scarce information on the prevalence and influence of lymphedema during the coronavirus disease (COVID-19) pandemic, we aimed to estimate the prevalence of lymphedema recurrence and its influencing factors among discharged breast cancer patients during the COVID-19 pandemic. METHODS: This was a multicenter, cross-sectional, hospital-based survey of discharged breast cancer patients was conducted during the COVID-19 pandemic in eight first-class hospitals in Wuhan, China. The Norman Questionnaire was used to assess lymphedema. Univariable and multivariable binary logistic regression analyses were performed to identify factors influencing moderate or severe lymphedema. Differences in living characteristics, anxiety, and depression were compared between the no/mild lymphedema group and the moderate/severe lymphedema groups. Preferences for lymphedema management during the pandemic were determined. RESULTS: Overall, 202 patients were included in this study, and 191 of them reported recurrent lymphedema (prevalence: 94.6%, 95% confidence interval [CI] 90.5% to 97.3%). Among them, 134 and 57 had mild and moderate/severe lymphedema, respectively. In 191 patients, the main symptoms were swelling (140; 69.3%) and pain (56, 27.7%). Multivariable regression showed that older age (odds ratio [OR], 1.06; 95% CI: 1.02-1.10), radical surgery (OR = 4.35, 95% CI: 1.54-12.50), and fully complete radiotherapy (OR = 2.62, 95% CI: 1.17-5.87, p = 0.019) were associated with an elevated risk of moderate/severe lymphedema. The moderate/severe lymphedema group experienced a higher rate of anxiety and depression than the no/mild lymphedema group did. Patients equally preferred treatment in the hospital and self-care at home. CONCLUSION: During the COVID-19 pandemic, high prevalence of lymphedema was observed in patients Age, radical surgery and fully completed radiotherapy were associated with increased risk of severer lymphedema. Meanwhile, the patients with severe lymphedema experienced psychological distress. While the Covid-19 pandemic was still raging, continuous efforts should be made to identify patient at risk of lymphedema and distribute feasible guidance and education for self-management in lymphedema.

Prevalence and Impact Factors of COVID-19 Vaccination Hesitancy Among Breast Cancer Survivors: A Multicenter Cross-Sectional Study in China.

Cancer patients are at a high risk of being infected with COVID-19 and have a poor prognosis after infection. Breast cancer is one of the most common cancers. Since vaccination is an effective measure to prevent the spread of COVID-19, we studied the vaccination rate among breast cancer survivors and analyzed their characteristics to provide evidence for boosting the vaccination rate. The researchers conducted a multicenter, cross-sectional study on 747 breast cancer survivors from six hospitals in Wuhan city between June 5, 2021, and June 12, 2021. The self-administrated questionnaires based on relevant studies were distributed. The researchers then compared differences in characteristics among vaccinated patients, hesitant patients, and non-vaccinated patients. Moreover, they performed univariable and multivariable logistic regression analyses to identify potential factors associated with vaccination hesitancy. The researchers assessed a total of 744 breast cancer survivors -94 cases in the vaccinated group, 103 in the planning group, 295 in the hesitancy group, and 252 in the refusal group. The vaccination rate was 12.63% (95% CI 10.25-15.02%) and 37.23% (95% CI 27.48-47.82%) patients reported adverse reactions. The vaccination hesitancy/refusal rate was 73.52% (95% CI 70.19-76.66%), which was independently associated with current endocrine or targeted therapy (odds ratio [OR] = 1.52, 95% CI 1.03-2.24), no notification from communities or units (OR = 2.46, 95% CI 1.69-3.59) and self-perceived feel (general vs. good, OR = 1.46, 95% CI 1.01-2.13; bad vs. good, OR = 4.75, 95% CI 1.85-12.16). In the hesitancy/refusal group, the primary reason was "I did not know who to ask whether I can get vaccinated" (46.07%), the person who would most influence decisions of patients was the doctor in charge of treatment (35.83%). Effective interaction between doctors and patients, simple and consistent practical guidelines on vaccination, and timely and positive information from authoritative media could combat misinformation and greatly reduce vaccine hesitancy among breast cancer survivors.

Association between well-being and compliance with COVID-19 preventive measures by healthcare professionals: A cross-sectional study.

IMPORTANCE: Knowledge and attitude influence compliance and individuals' practices. The risk and protective factors associated with high compliance to these preventive measures are critical to enhancing pandemic preparedness. OBJECTIVE: This survey aims to assess differences in mental health, knowledge, attitudes, and practices (KAP) of preventive measures for COVID-19 amongst healthcare professionals (HCP) and non-healthcare professionals. DESIGN: Multi-national cross-sectional study was carried out using electronic surveys between May-June 2020. SETTING: Multi-national survey was distributed across 36 countries through social media, word-of-mouth, and electronic mail. PARTICIPANTS: Participants ≥21 years working in healthcare and non-healthcare related professions. MAIN OUTCOME: Risk factors determining the difference in KAP towards personal hygiene and social distancing measures during COVID-19 amongst HCP and non-HCP. RESULTS: HCP were significantly more knowledgeable on personal hygiene (AdjOR 1.45, 95% CI -1.14 to 1.83) and social distancing (AdjOR 1.31, 95% CI -1.06 to 1.61) compared to non-HCP. They were more likely to have a positive attitude towards personal hygiene and 1.5 times more willing to participate in the contact tracing app. There was high compliance towards personal hygiene and social distancing measures amongst HCP. HCP with high compliance were 1.8 times more likely to flourish and more likely to have a high sense of emotional (AdjOR 1.94, 95% CI (1.44 to 2.61), social (AdjOR 2.07, 95% CI -1.55 to 2.78), and psychological (AdjOR 2.13, 95% CI (1.59-2.85) well-being. CONCLUSION AND RELEVANCE: While healthcare professionals were more knowledgeable, had more positive attitudes, their higher sense of total well-being was seen to be more critical to enhance compliance. Therefore, focusing on the well-being of the general population would help to enhance their compliance towards the preventive measures for COVID-19.

Impact of the coronavirus disease 2019 pandemic on irritable bowel syndrome.

BACKGROUND AND AIM: Gastrointestinal manifestations of the coronavirus disease 2019 (COVID-19) pandemic may mimic irritable bowel syndrome (IBS), and social distancing measures may affect IBS patients negatively. We aimed to study the impact of COVID-19 on respondents with self-reported IBS. METHODS: We conducted an anonymized survey from May to June 2020 in 33 countries. Knowledge, attitudes, and practices on personal hygiene and social distancing as well as psychological impact of COVID-19 were assessed. Statistical analysis was performed to determine differences in well-being and compliance to social distancing measures between respondents with and without self-reported IBS. Factors associated with improvement or worsening of IBS symptoms were evaluated. RESULTS: Out of 2704 respondents, 2024 (74.9%) did not have IBS, 305 (11.3%) had self-reported IBS, and 374 (13.8%) did not know what IBS was. Self-reported IBS respondents reported significantly worse emotional, social, and psychological well-being compared with non-IBS respondents and were less compliant to social distancing measures (28.2% vs 35.3%, P = 0.029); 61.6% reported no change, 26.6% reported improvement, and 11.8% reported worsening IBS symptoms. Higher proportion of respondents with no change in IBS symptoms were willing to practice social distancing indefinitely versus those who deteriorated (74.9% vs 51.4%, P = 0.016). In multivariate analysis, willingness to continue social distancing for another 2-3 weeks (vs longer period) was significantly associated with higher odds of worsening IBS. CONCLUSION: Our study showed that self-reported IBS respondents had worse well-being and compliance to social distancing measures than non-IBS respondents. Future research will focus on occupational stress and dietary changes during COVID-19 that may influence IBS.

Comparison of clinical, laboratory, and radiological characteristics between SARS-CoV-2 infection and community-acquired pneumonia caused by influenza virus: A cross-sectional retrospective study.

Coronavirus disease 2019 (COVID-19) is the most important global public health issue that we currently face. We aimed to explore the clinical features of patients with COVID-19 and compared them with those of hospitalized community-acquired pneumonia (CAP) patients caused by influenza virus during the same period.From Jan 1, to Mar 4, 2020, patients with COVID-19 or CAP caused by influenza virus who were admitted to the First Affiliated Hospital of Xiamen University were consecutively screened for enrollment.A total of 35 COVID-19 patients and 22 CAP patients caused by influenza virus were included in this study. Most of COVID-19 patients had characteristics of familial clustering (63%), however, in the other group, there was no similar finding. The percentages of patients with a high fever (the highest recorded temperature was ≥39.0°C; 11% vs 45% [COVID-19 vs CAP groups, respectively]), dyspnea (9% vs 59%), leukocytosis (3% vs 32%), elevated C-reactive protein concentrations (>10 mg/L, 48% vs 86%), elevated procalcitonin levels (>0.1 ng/ml, 15% vs 73%), PaO2/FiO2 <200 mm Hg (4% vs 22%), and infiltration on imaging (29% vs 68%) in the COVID-19 group were less than those same indices in the hospitalized CAP patients caused by influenza virus. Ground-glass opacity with reticular pattern (63%) and interlobular septal thickening (71%) in chest CT were commonly observed in the COVID-19 group.COVID-19 and CAP caused by influenza virus appear to share some similarities in clinical manifestaions but they definitely have major distinctions. Influenza infection remains a health problem even during COVID-19 pandemic.

IDDF2020-ABS-0205 The impact of the COVID-19 pandemic on irritable bowel syndrome

IDDF2020-ABS-0205 Table 1Comparison of demographic variables between respondents with and without IBS Non-IBS (n = 2024) IBS (n = 305) p Age 39.7 ± 12.9 40.1 ± 13.0 1.0 Gender 0.6 Male 727 (35.9) 119 (39.0) Female 1297 (64.1) 186 (61.0) Race 0.2 Bengali 31 (1.5) 2 (0.7) Caucasian 24 (1.2) 6 (2.0) Chinese 1148 (56.7) 188 (61.6) Filipino 45 (2.2) 2 (0.7) Indian 154 (7.6) 20 (6.6) Japanese 5 (0.2) 0 (0.0) Korean 131 (6.5) 28 (9.2) Malay 328 (16.2) 39 (12.8) Others 158 (7.8) 20 (6.6) Economic region 0.3 High 1156 (57.1) 183 (60.0) Upper-middle 457 (22.6) 74 (24.3) Middle/Low 411 (20.3) 48 (15.7) What is your highest education level? 0.8 No formal education/Primary school 9 (0.4) 0 (0.0) Secondary school 164 (8.1) 29 (9.5) Pre-university 258 (12.7) 44 (14.4) Tertiary – undergraduate/postgraduate degree 1593 (78.7) 232 (76.1) Employment 0.4 Full-time 1497 (74.0) 213 (69.8) Part-time 125 (6.2) 18 (5.9) Not working 402 (19.9) 74 (24.3) Housing 1.0 Dormitory 61 (3.0) 13 (4.3) Government housing with 2 or 3 rooms 306 (15.1) 37 (12.1) Government housing with more than 3 rooms 376 (18.6) 62 (20.3) Private apartment or condominium 601 (29.7) 89 (29.2) Private landed property 680 (33.6) 104 (34.1) Annual household Income per capita in USD (total household income/number of people in the household) 1.0 Less than $1000 259 (12.8) 37 (12.1) $1000 - $2000 274 (13.5) 46 (15.1) $2000 - $4000 375 (18.5) 49 (16.1) $4000 - $6000 211 (10.4) 29 (9.5) $6000 - $8000 138 (6.8) 24 (7.9) $8000 - $10000 173 (8.5) 23 (7.5) More than $10000 594 (29.3) 97 (31.8) Have you been diagnosed with COVID-19? 1.0 Yes 32 (1.6) 4 (1.3) No 1992 (98.4) 301 (98.7) Compliance 0.029 Yes 715 (35.3) 86 (28.2) No 1309 (64.7) 219 (71.8) Not flourishing 1025 (50.6) 207 (67.9) <0.01 Flourishing 999 (49.4) 98 (32.1) Well-being total scores 45.8 ± 14.6 40.5 ± 14.8 <0.01 Emotional well-being 10.3 ± 3.5 9.4 ± 3.6 <0.01 Social well-being 15.0 ± 6.1 12.8 ± 6.1 <0.01 Psychological well-being 20.4 ± 6.6 18.3 ± 6.7 <0.01 Abstract IDDF2020-ABS-0205 Table 2Comparison of demographic variables between respondents who reported no change and worsening in severity of IBSQuestion No change (n = 183) Worsen (n = 35) p Age 38.8 ± 12.2 40.1 ± 14.3 1.0 Gender 1.0 Male 71 (38.8) 14 (40.0) Female 112 (61.2) 21 (60.0) Economic region 0.1 High 110 (60.1) 28 (80.0) Upper-middle 44 (24.0) 6 (17.1) Middle/Low 29 (15.8) 1 (2.9) What is your highest education level? 1.0 Secondary school 18 (9.8) 4 (11.4) Pre-university 22 (12.0) 5 (14.3) Tertiary – undergraduate/postgraduate degree 143 (78.1) 26 (74.3) Employment 0.2 Full-time 132 (72.1) 26 (74.3) Part-time 7 (3.8) 4 (11.4) Not working 44 (24.0) 5 (14.3) Work from home 1.0 Yes 45 (32.1) 8 (26.7) No 95 (67.9) 22 (73.3) Compliance 1.0 Yes 54 (29.5) 10 (28.6) No 129 (70.5) 25 (71.4) Which of the following would you consider as main reason for compliance with social distancing measures? 0.034 Fear of getting COVID 19 90 (49.2) 11 (31.4) Fear of family members getting COVID 19 86 (47.0) 19 (54.3) Fear of fines/punitive measures 7 (3.8) 5 (14.3) Would you willingly participate in the contact tracing app? 1.0 Yes 143 (78.1) 27 (77.1) No 40 (21.9) 8 (22.9) For how long are you willing to practice social distancing behaviour to keep yourself and others safe? 0.016 As long as it takes 137 (74.9) 18 (51.4) For another 2–3 weeks 4 (2.2) 4 (11.4) For another 1 month 12 (6.6) 6 (17.1) For another 3 months 14 (7.7) 5 (14.3) For another 6 months 13 (7.1) 1 (2.9) I want social distancing to stop now 3 (1.6) 1 (2.9) Flourishing <0.01 Yes 64 (35.0) 3 (8.6) No 119 (65.0) 32 (91.4) Well-being total scores 40.5 ± 15.0 35.4 ± 13.3 0.1 Emotional well-being 9.5 ± 3.5 7.7 ± 3.6 0.014 Social well-being 12.7 ± 6.3 11.7 ± 4.7 0.8 Psychological well-being 18.3 ± 6.9 15.9 ± 6.5 0.1 Abstract IDDF2020-ABS-0205 Table 3Univariable and multivariable regression of factors associated with worsening in severity of IBS (with no change in severity of IBS group as reference)Question OR (95% CI) p AdjOR(95%CI) p Do you wash your hands before and after handing food?* Never (ref) 1.00 - - Seldom 0.0 (0.0) 1.0 - - 50% of the time 0.0 (0.0) 1.0 - - Most of the time 0.0 (0.0) 1.0 - - Always 0.0 (0.0) 1.0 - - Do you cover your mouth when you sneeze or cough?* Never (ref) 1.00 - - Seldom 0.0 (0.0) 1.0 - - 50% of the time 0.0 (0.0) 1.0 - - Most of the time 0.0 (0.0) 1.0 - - Always 0.0 (0.0) 1.0 - - Which of the following would you consider as main reason for compliance with social distancing measures? Fear of getting COVID 19 (ref) 1.00 1.00 Fear of family members getting COVID 19 1.8 (0.8 – 4.0) 0.1 2.0 (0.9 – 4.7) 0.1 Fear of fines/punitive measures 5.8 (1.6 – 21.6) <0.01 5.9 (1.4 – 25.6) 0.017 For how long are you willing to practice social distancing behaviour to keep yourself and others safe? As long as it takes (ref) 1.00 1.00 For another 2–3 weeks 7.6 (1.7 – 33.1) <0.01 6.0 (1.2 – 28.8) 0.026 For another 1 month 3.8 (1.3 – 11.4) 0.017 2.9 (0.9 – 9.0) 0.1 For another 3 months 2.7 (0.9 – 8.4) 0.1 3.1 (0.9 – 10.2) 0.1 For another 6 months 0.6 (0.1 – 4.7) 0.6 0.6 (0.1 – 4.7) 0.6 I want social distancing to stop now 2.5 (0.3 – 25.7) 0.4 1.3 (0.1 – 22.3) 0.9 Emotional well-being 0.9 (0.8 – 1.0) <0.01 0.9 (0.8 – 1.0) 0.042 Flourishing was excluded from analysis due to overlap with emotional well-being.*Excluded from multivariable analysis due to 0 respondents in reference categories for respondents with no change in control IBSConclusionsOur study showed differences in well-being and compliance to social distancing between IBS and non-IBS respondents, and these factors influence the worsening in severity of IBS. Further research will focus on how occupational stress and dietary changes may influence IBS symptoms