Barriers and Facilitators to Prevention and Care of COVID-19 Infection in Cincinnati Latinx Families: a Community-Based Convergent Mixed Methods Study.

BACKGROUND: Latinx populations have experienced disproportionately high case rates of COVID-19 across the USA. Latinx communities in non-traditional migration areas may experience greater baseline day-to-day challenges such as a lack of resources for immigrants and insufficient language services. These challenges may be exacerbated by the COVID-19 pandemic. OBJECTIVE: This article describes the results of an initial community health needs assessment to better understand the prevention and care of COVID-19 infection in the Cincinnati Latinx community. METHODS: We used convergent mixed methods to examine barriers and facilitators to COVID-19 prevention and care for those with infection. RESULTS: Latinx adults ≥ 18 years old completed 255 quantitative surveys and 17 qualitative interviews. Overarching mixed methods domains included knowledge, prevention, work, challenges, and treatment. Quantitative results largely reinforced qualitative results (confirmation). Certain quantitative and qualitative results, however, diverged and expanded insights related to caring for COVID-19 infection among Latinx adults (expansion). There were infrequent contradictions between quantitative and qualitative findings (discordance). Primary barriers for the Latinx community during the COVID-19 pandemic included insecurities in food, jobs, housing, and immigration. Key facilitators included having trusted messengers of health-related information. CONCLUSION: Public health interventions should be centered on community partnerships and the use of trusted messengers. Wraparound services (including resources for immigrants) are essential public health services. Close partnership with employers is essential as lack of sick leave and mask supplies were more frequent barriers than knowledge. These findings emerged from experiences during the COVID-19 pandemic but likely generalize to future public health crises.

Seventy-Two-Hour Reutilization After Telemedicine Visits in Academic Pediatric Primary Care.

Telemedicine has expanded due to the COVID-19 pandemic. However, the health care usage after telemedicine visits compared with similar in-person visits is not known. This study compared the 72-hour health care reutilization after telemedicine visits and in-person acute encounters in a pediatric primary care office. A retrospective cohort analysis was performed in a single quaternary pediatric health care system between March 1, 2020, and November 30, 2020. Reutilization information was collected for 72 hours following the index visit and included subsequent encounters within the health care system. The 72-hour reutilization rate for telemedicine encounters was 4.1% compared with 3.9% for in-person acute visits. Of revisits, patients who had a telemedicine visit most often sought additional care at the medical home, and patients with an in-person visit most often sought additional care to the emergency department or urgent care. Telemedicine does not result in higher total health care reutilization.

Effect of outreach messages on adolescent well-child visits and coronavirus disease 2019 vaccine rates: A randomized, controlled trial.

OBJECTIVE: To determine effectiveness of text/telephone outreach messages, with and without coronavirus disease 2019 (COVID-19) vaccine information. STUDY DESIGN: We conducted an intent-to-treat, multiarm, randomized clinical trial with adolescents aged 12-17 years. Eligible patients did not have an adolescent well-care visit in the past year or scheduled in the next 45 days or an active electronic health record portal account. We randomized participants to the standard message, COVID-19 vaccine message, or no message (control) group and delivered 2 text messages or telephone calls (per family preference) to the message groups. The primary outcome was adolescent well-care visit completion within 8 weeks, and secondary outcomes were adolescent well-care visit scheduled within 2 weeks and receiving COVID-19 vaccine within 8 weeks. RESULTS: We randomized 1235 adolescents (mean age, 14 ± 1.5 years; 51.6% male; 76.7% Black; 4.1% Hispanic/Latinx; 88.3% publicly insured). The standard message group had higher odds of scheduling an adolescent well-care visit compared with the control group (OR, 2.07; 95% CI, 1.21-3.52) and COVID-19 vaccine message group (OR, 1.66; 95% CI, 1.00-2.74). The odds of completing an adolescent well-care visit did not differ significantly (standard message group vs control group; OR, 1.35; 95% CI, 0.88-2.06; COVID-19 vaccine message group vs control group, OR, 1.33; 95% CI, 0.87-2.03). In per-protocol analyses, adolescents in the standard message group were twice as likely as the control group to receive the COVID-19 vaccine (OR, 2.48; 95% CI, 1.05-5.86). CONCLUSIONS: Outreach messages were minimally effective. Efforts are needed to address widening disparities. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov: NCT04904744.

The difference of primary school teachers' online teaching satisfaction in subject and educational level.

The growth of online education requires high-quality online teaching. Teachers' satisfaction with online teaching is of great significance for improving online teaching effectiveness. This study was to explore the primary school teachers' online teaching satisfaction during the spread of COVID-19 from Shanghai, who have experienced online teaching, and explore whether there were differences of teachers' online teaching satisfaction in subject and educational level. 939 teachers from Shanghai participated in the study. The non-parametric Mann-Whitney U test and Kruskal-Wallis test of variance were performed. Results showed that teachers' online teaching satisfaction was at a high level. Moreover, there was a significant difference in teachers' subject and educational level on online teaching satisfaction. In terms of subject differences of teachers, there were significant differences in resource suitability (RS) among teachers of different subjects. Therefore, it is recommended that each subject should develop the online teaching resources to support teachers' online teaching. In terms of the differences in teachers' educational levels, there were no significant differences between the satisfaction of college-level teachers on non-technical variables such as content selectivity (CS) and teachers with undergraduate and graduate degrees, and only on technical variables such as self-efficacy (SE), resource suitability (RS), ease of use (EU), and intention to use (IU). Given the national context in China, the difference in educational levels may be more reflected in the age of the teachers. For teachers with college educational level, due to their older age, rather than simply enhancing motivation and improving learning ability to increase online teaching satisfaction, emphasis should be placed on providing appropriate teaching service support to help improve online teaching effectiveness. The findings provide new empirical evidence, strategies and Chinese experience for promoting teachers' online teaching satisfaction.

Effect of Electronic Outreach Using Patient Portal Messages on Well Child Care Visit Completion: A Randomized Clinical Trial.

Importance: Outreach messages to patients overdue for well child care (WCC) can be delivered different ways (ie, telephone calls and text messages). Use of electronic health record patient portals is increasingly common but their effectiveness is uncertain. Objective: To determine the effectiveness of patient portal outreach messages, with and without the date of the last WCC, on the scheduling and completion of WCC visits and completion of vaccinations. Design, Setting, and Participants: An intention-to-treat, multigroup, randomized clinical trial was conducted at 3 academic primary care practices from July 30 to October 4, 2021. The population included predominantly non-Hispanic Black, low-income children (age, 6-17 years) whose parent had an active portal account. Interventions: Participants were randomized to the standard message, tailored message, or no message (control) group. Two messages were delivered to those in the message groups. Main Outcomes and Measures: Outcomes included WCC visit scheduled within 2 weeks of the first intervention message, WCC visit completed within 8 weeks (primary outcome), and receipt of COVID-19 vaccine within 8 weeks. Results: Nine hundred forty-five patients participated (mean [SD] age, 9.9 [3.3] years, 493 [52.2%] girls, 590 [62.4%] non-Hispanic Black, 807 [85.4%] publicly insured). Scheduling rates were 18.4% in the standard message group (adjusted risk ratio [aRR], 1.97; 95% CI, 1.32-2.84) and 14.9% in the tailored message group (aRR, 1.57; 95% CI, 1.02-2.34) compared with the control group (9.5%). Well child care visit completion rates were 24.1% in the standard message group (aRR, 1.92; 95% CI, 1.38-2.60) and 19.4% in the tailored message group (aRR, 1.52; 95% CI, 1.06-2.13) compared with the control group (12.7%). Among eligible children, rates of receiving the COVID-19 vaccine were 16.7% in the standard message group compared with 4.8% in the tailored message (aRR, 3.41; 95% CI, 1.14-9.58) and 3.7% in the control groups (aRR, 4.84; 95% CI, 1.44-15.12). Conclusions and Relevance: In this randomized clinical trial, outreach messages delivered via electronic health record patient portals increased the rates of scheduling and completing WCC visits and receiving the COVID-19 vaccine, providing a useful tool to help restore WCC in populations whose care was delayed during the pandemic. Trial Registration: ClinicalTrials.gov Identifier: NCT04994691.

Effect of Outreach Messages on Adolescent Well Child Visits and COVID-19 Vaccine Rates: An RCT

Objective To determine effectiveness of text/telephone outreach messages, with and without COVID-19 vaccine information. Study design We conducted an intent-to-treat, multi-arm, randomized clinical trial with adolescents aged 12-17 years. Eligible patients did not have an AWC visit in the past year or scheduled in the next 45 days or an active electronic health record portal account. We randomized participants to the Standard Message, COVID-19 Vaccine Message, or No Message (control) group and delivered two text/telephone calls (per family preference) to the message groups. The primary outcome was AWC visit completion within 8 weeks, and secondary outcomes were AWC visit scheduled within 2 weeks and receiving COVID-19 vaccine within 8 weeks. Results We randomized 1235 adolescents (mean [SD] age = 14 [1.5] years, 51.6% male, 76.7% Black, 4.1% Hispanic/Latinx, 88.3% publicly insured). The Standard Message group had higher odds of scheduling an AWC visit compared with the control group (OR, 2.07 [95% CI: 1.21 to 3.52]) and COVID-19 Vaccine Message group (OR, 1.66 [95% CI: 1.00 to 2.74]). The odds of completing an AWC visit did not differ significantly (Standard Message group vs. control group, OR = 1.35 [95% CI: 0.88 to 2.06];COVID-19 Vaccine Message group vs. control group, OR = 1.33 [95% CI: 0.87 to 2.03]. In per-protocol analyses, adolescents in the Standard Message group were twice as likely as the control group to receive the COVID-19 vaccine (OR, 2.48 [95% CI: 1.05 to 5.86]). Conclusion Outreach messages were minimally effective. Efforts are needed to address widening disparities.

Anxiety and sleep quality among front-line nurses treating first wave COVID-19 in China: The mediating role of mindfulness.

AIM: To explore anxiety, sleep quality, and mindfulness of frontline nurses at the initial epicenter of the pandemic, to examine the mediating effects of mindfulness. BACKGROUND: COVID-19 was first identified in Wuhan, China in January 2020. Nurses were at the forefront of care and treatment across hospitals in response to the pandemic. METHODS: Single site cross-sectional survey conducted in Wuhan province (China) between March and April in 2020. Quantitative analysis of survey data from N118 nurses working in the frontline COVID response. Questionnaires included: The general information questionnaire, the Self-Anxiety Scale, the Short Inventory of Mindfulness, and the Pittsburgh Sleep Quality Index. RESULTS: Front-line nurses' anxiety was positively associated with sleep quality and mindfulness was negatively associated with anxiety and sleep quality. Mindfulness had a mediating role on anxiety and sleep quality, with intermediary adjustment effects (ES = 0.136, 95 % CI 0.02 to 0.26), accounting for 21.9 % of the total effect ratio. CONCLUSIONS: Anxiety causes a reduction in sleep quality and mindfulness can help with anxiety. Mindfulness strategies may help during periods of higher anxiety in the workplace; however, other factors must be considered. Further research is required on strategies for assisting nurses during periods of extreme anxiety.

Assessing the Impact of COVID-19 on Price Co-movements in China

The COVID-19 crisis has caused violent fluctuations in prices, and government responses to the pandemic further intensify the uncertainty of price changes. This study evaluates the dynamic price co-movement of main consumption categories within an Additive Bayesian Network (ABN) framework, which shows dramatically fluctuating price risks during the pandemic period. The global fears for COVID-19 affects price co-movements in China negatively with a direct linkage. By contrast, confirmed cases in China, confirmed cases around the world, and fears for the domestic pandemic situation are indirectly related with price co-movements through financial markets. The exchange rate and international hedging assets such as gold play important intermediary roles in such relationships. Meanwhile, volatile international markets including crude oil and Bitcoin are also indirectly linked with price changes in China. Comparing with the situation in China, the global pandemic appears to be a more important factor influencing the price stability in China. Overall, the impacts of COVID-19 on price co-movements are empirically demonstrated, which highlights the importance of prudent policies in response to the pandemic.

The Selectivity and Suitability of Online Learning Resources as Predictor of the Effects of Self-Efficacy on Teacher Satisfaction During the COVID-19 Lockdown.

Online learning resources (OLR) play an important role in teaching and learning in the process of online learning. Teachers will be satisfied with selectable and suitable online learning resources, which can promote their self-efficacy to facilitate online teaching and learning. This study proposed a model to examine the effects of the selectivity of online learning resources (SE-OLR) and the suitability of online learning resources (SU-OLR) on teachers' online teaching satisfaction, and the mediating role of technology self-efficacy (TECHN-SE) and online teaching self-efficacy (OT-SE) between them. The results indicated that SE-OLR and SU-OLR positively affected teachers' online teaching satisfaction; TECHN-SE and OT-SE positively influenced teachers' online teaching satisfaction, while TECHN-SE and OT-SE played mediating roles between SE-OLR and SU-OLR and teachers' online teaching satisfaction. The findings have implications for the design and development of online learning resources to improve teachers' satisfaction and facilitate students' learning effectiveness and teachers' online teaching.

Influence of Internet Celebrity Medical Experts on COVID-19 Vaccination Intention of Young Adults: An Empirical Study From China.

With the continuous expansion of COVID-19, many medical experts with the characteristics of "Internet Celebrities" are increasingly influencing people's vaccination behavior, which is crucial for overall social welfare. To explore the influence of Internet celebrity medical experts on people's vaccination against COVID-19, this study constructed a conceptual model of COVID-19 vaccination intention based on the professionalism, morality, interaction dimension, and information content of Internet celebrity medical experts, to generate perceived value by establishing a trusting relationship between them and the influenced people. The empirical analysis shows that interactivity and information content are important factors determining the influence of Internet celebrity medical experts. In the context of high demands for COVID-19 vaccines, it is more effective to influence vaccination intention through strong demand than through generating trust. The empirical analysis shows that Internet celebrity medical experts have a significant role in COVID-19 vaccination, and interactivity and information content are two important factors determining the influence. Through the connection of information-demand, Internet celebrity medical experts can greatly influence the perceived value, by coaction with trust to influence the final intention. Therefore, the COVID-19 vaccination persuasion information released by Internet celebrity medical experts should be elaborately organized and demonstrated, especially from the demand aspect, and government could put more resources to support the information to spread.

Business Cycle and Public Health: The Moderating Role of Health Education and Digital Economy.

The cyclicality of public health in the emerging market is underexplored in existing literature. In this study, we used a fixed effect model and provincial data to document how public health varies with the business cycle in China over the period of 2010-2019. The estimated results showed that the business cycle is negatively correlated with the mortality of infectious disease, a proxy variable of public health, thus indicating that public health exhibits a countercyclical pattern in China. Furthermore, we investigated the potential moderating role of public health education and digital economy development in the relationship between business cycle and public health. Our findings suggested that public health education and digital economy development can mitigate the damage of economic conditions on public health in China. Health education helps the public obtain more professional knowledge about diseases and then induces effective preventions. Compared with traditional economic growth, digital economy development can avoid environmental pollution which affects public health. Also, it ensures that state-of-the-art medical services are available for the public through e-health. In addition, digitalization assures that remote working is practicable and reduces close contact during epidemics such as COVID-19. The conclusions stand when subjected to several endogeneity and robustness checks. Therefore, the paper implies that these improvements in public health education and digitalization can help the government in promoting public health.

Release and Demand of Public Health Information in Social Media During the Outbreak of COVID-19 in China.

Information release is a key to the macro-economy during the outbreak of the Coronavirus Diosease-2019 (COVID-19). To explore the relationship between information supply by the government and public information demand in the pandemic, this study collected over 4,000 posts published on the most popular social media platform, i.e., WeChat. Many approaches, such as text mining, are employed to explore the information at different stages during the pandemic. According to the results, the government attached great importance to the information related to the pandemic. The main topics of information released by the government included the latest situation of the pandemic, announcements by the State Council, and prevention policies for COVID-19. Information mismatch between the public and Chinese governments contributed to the economic depression caused by the pandemic. Specifically, the topics of "the latest situation" and "popular scientific knowledge regarding the pandemic" have gained the most attention of the public. The information demand of the public has changed from the pandemic itself to the recovery of social life and industrial activities after the authority announced the control of the pandemic. However, during the recession phase, the information demand has shifted to asymptomatic infections and global pandemic trends. By contrast, some of the main topics provided by the government, such as "How beautiful you are," were excessive because the public demand is insufficient. Therefore, severe mismatches existed between information release of the government and public information demand during the pandemic, which impeded the recovery of the economy. The results in this study provide strategical suggestions of information release and opinion guidance for the authorities.

Efficacy and practice of facemask use in general population: a systematic review and meta-analysis.

In recent decades, respiratory infections, including SARS, HINI and the currently spreading COVID-19, caused by various viruses such as influenza and coronavirus have seriously threatened human health. It has generated inconsistent recommendations on the mandatory use of facemasks across countries on a population level due to insufficient evidence on the efficacy of facemask use among the general population. This meta-analysis aimed to explore (1) the efficacy of facemask use on preventing respiratory infections, and (2) the perceptions, intentions, and practice about facemask use among the general population worldwide. We searched PubMed, MEDLINE, Web of Science, Cochrane, bioRxiv, and medRxiv databases since inception to August 17, 2020. From 21,341 records identified, eight RCTs on facemask in preventing infections and 78 studies on perception, intention, and practice of facemask use among the general population were included in the analysis. The meta-analysis of RCTs found a significant protective effect of facemask intervention (OR = 0.84; 95% CI = 0.71-0.99; I2 = 0%). This protective effect was even more pronounced when the intervention duration was more than two weeks (OR = 0.76; 95% CI = 0.66-0.88; I2 = 0%). The meta-analysis of observational studies on perception, intention, and practice on facemask use showed that 71% of respondents perceived facemasks to be effective for infection prevention, 68% of respondents would wear facemasks, and 54% of respondents wore facemasks for preventing respiratory infections. Differences in perception, intention, and practice behavior of facemask use in different regions may be related to the impact of respiratory infections, regional culture, and policies. The governments and relevant organizations should make effort to reduce the barriers in the use of facemasks.

The impact of quarantine on mental health status among general population in China during the COVID-19 pandemic.

Quarantine and isolation measures urgently adopted to control the COVID-19 pandemic might potentially have negative psychological and social effects. We conducted this cross-sectional, nationwide study to ascertain the psychological effect of quarantine and identify factors associated with mental health outcomes among population quarantined to further inform interventions of mitigating mental health risk especially for vulnerable groups under pandemic conditions. Sociodemographic data, attitudes toward the COVID-19, and mental health measurements of 56,679 participants from 34 provinces in China were collected by an online survey from February 28 to March 11, 2020. Of the 56,679 participants included in the study (mean [SD] age, 36.0 [8.2] years), 27,149 (47.9%) were male and 16,454 (29.0%) ever experienced home confinement or centralized quarantine during COVID-19 outbreak. Compared those without quarantine and adjusted for potential confounders, quarantine measures were associated with increased risk of total psychological outcomes (prevalence, 34.1% vs 27.3%; odds ratio [OR], 1.34; 95% CI, 1.28-1.39; P < 0.001). Multivariable logistic regression analyses showed that vulnerable groups of the quarantined population included those with pre-existing mental disorders or chronic physical diseases, frontline workers, those in the most severely affected areas during outbreak, infected or suspected patients, and those who are less financially well-off. Complying with quarantine, being able to take part in usual work, and having adequate understanding of information related to the outbreak were associated with less mental health issues. These results suggest that quarantine measures during COVID-19 pandemic are associated with increased risk of experiencing mental health burden, especially for vulnerable groups. Further study is needed to establish interventions to reduce mental health consequences of quarantine and empower wellbeing especially in vulnerable groups under pandemic conditions.

Mental and neurological disorders and risk of COVID-19 susceptibility, illness severity and mortality: A systematic review, meta-analysis and call for action.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has evolved into a worldwide pandemic, and has been found to be closely associated with mental and neurological disorders. We aimed to comprehensively quantify the association between mental and neurological disorders, both pre-existing and subsequent, and the risk of susceptibility, severity and mortality of COVID-19. METHODS: In this systematic review and meta-analysis, we searched PubMed, Web of Science, Embase, PsycINFO, and Cochrane library databases for studies published from the inception up to January 16, 2021 and updated at July 7, 2021. Observational studies including cohort and case-control, cross-sectional studies and case series that reported risk estimates of the association between mental or neurological disorders and COVID-19 susceptibility, illness severity and mortality were included. Two researchers independently extracted data and conducted the quality assessment. Based on I2 heterogeneity, we used a random effects model to calculate pooled odds ratios (OR) and 95% confidence intervals (95% CI). Subgroup analyses and meta-regression analysis were also performed. This study was registered on PROSPERO (registration number: CRD 42021230832). FINDING: A total of 149 studies (227,351,954 participants, 89,235,737 COVID-19 patients) were included in this analysis, in which 27 reported morbidity (132,727,798), 56 reported illness severity (83,097,968) and 115 reported mortality (88,878,662). Overall, mental and neurological disorders were associated with a significant high risk of infection (pre-existing mental: OR 1·67, 95% CI 1·12-2·49; and pre-existing neurological: 2·05, 1·58-2·67), illness severity (mental: pre-existing, 1·40, 1·25-1·57; sequelae, 4·85, 2·53-9·32; neurological: pre-existing, 1·43, 1·09-1·88; sequelae, 2·17, 1·45-3·24), and mortality (mental: pre-existing, 1·47, 1·26-1·72; neurological: pre-existing, 2·08, 1·61-2·69; sequelae, 2·03, 1·66-2·49) from COVID-19. Subgroup analysis revealed that association with illness severity was stronger among younger COVID-19 patients, and those with subsequent mental disorders, living in low- and middle-income regions. Younger patients with mental and neurological disorders were associated with higher mortality than elders. For type-specific mental disorders, susceptibility to contracting COVID-19 was associated with pre-existing mood disorders, anxiety, and attention-deficit hyperactivity disorder (ADHD); illness severity was associated with both pre-existing and subsequent mood disorders as well as sleep disturbance; and mortality was associated with pre-existing schizophrenia. For neurological disorders, susceptibility was associated with pre-existing dementia; both severity and mortality were associated with subsequent delirium and altered mental status; besides, mortality was associated with pre-existing and subsequent dementia and multiple specific neurological diseases. Heterogeneities were substantial across studies in most analysis. INTERPRETATION: The findings show an important role of mental and neurological disorders in the context of COVID-19 and provide clues and directions for identifying and protecting vulnerable populations in the pandemic. Early detection and intervention for neurological and mental disorders are urgently needed to control morbidity and mortality induced by the COVID-19 pandemic. However, there was substantial heterogeneity among the included studies, and the results should be interpreted with caution. More studies are needed to explore long-term mental and neurological sequela, as well as the underlying brain mechanisms for the sake of elucidating the causal pathways for these associations. FUNDING: This study is supported by grants from the National Key Research and Development Program of China, the National Natural Science Foundation of China, Special Research Fund of PKUHSC for Prevention and Control of COVID-19, and the Fundamental Research Funds for the Central Universities.

Has COVID-19 Changed the Hedge Effectiveness of Bitcoin?

The Bitcoin market has become a research hotspot after the outbreak of Covid-19. In this paper, we focus on the relationships between the Bitcoin spot and futures. Specifically, we adopt the vector autoregression-dynamic correlation coefficient-generalized autoregressive conditional heteroskedasticity (VAR-DCC-GARCH) model and vector autoregression-Baba, Engle, Kraft, and Kroner-generalized autoregressive conditional heteroskedasticity (VAR-BEKK-GARCH) models and calculate the hedging effectiveness (HE) value to investigate the dynamic correlation and volatility spillover and assess the risk reduction of the Bitcoin futures to spot. The empirical results show that the Bitcoin spot and futures markets are highly connected; second, there exists a bi-directional volatility spillover between the spot and futures market; third, the HE value is equal to 0.6446, which indicates that Bitcoin futures can indeed hedge the risks in the Bitcoin spot market. Furthermore, we update the data to the post-Covid-19 period to do the robustness checks. The results do not change our conclusion that Bitcoin futures can hedge the risks in the Bitcoin spot market, and besides, the post-Covid-19 results indicate that the hedging ability of Bitcoin futures increased. Finally, we test whether the gold futures can be used as a Bitcoin spot market hedge, and we further control other cryptocurrencies to illustrate the hedging ability of the Bitcoin futures to the Bitcoin spot. Overall, the empirical results in this paper will surely benefit the related investors in the Bitcoin market.

Integration and Impact of Telemedicine in Underserved Pediatric Primary Care.

Telemedicine, more novel in provision of pediatric care, rapidly expanded due to the recent coronavirus disease 2019 pandemic. This study aimed to determine the feasibility of telemedicine for acute and chronic care provision in an underserved pediatric primary care center. Items assessed included patient demographic data, chief complaint, and alternative care locations if telemedicine was not available. In our setting, 62% of telemedicine visits were for acute concerns and 38% for chronic concerns. Of acute telemedicine visits, 16.5% of families would have sought care in the Emergency Department/Urgent Care, and 11.3% would have opted for no care had telemedicine not been offered. The most common chronic issues addressed were attention deficit hyperactivity disorder (80.3%) and asthma (16.9%). Racial disparities existed among our telemedicine visits with Black patients utilizing telemedicine services less frequently than non-Black patients. Telemedicine is feasible for pediatric acute and chronic care, but systems must be designed to mitigate widening racial disparities.

Prevalence and Risk Factors of Mental Health Symptoms and Suicidal Behavior Among University Students in Wuhan, China During the COVID-19 Pandemic.

Background: University students who are exposed to coronavirus disease 2019 (COVID-19) could be mentally distressed. We aimed to evaluate the pattern and risk factors of mental health and suicidal behavior among students who experienced long-term school closure due to the COVID-19 pandemic. Methods: This large-sample, cross-sectional, online survey was conducted from June 29, 2020, to July 18, 2020. Eleven thousand two hundred fifty four participants were recruited from 30 universities located in Wuhan, Hubei Province, China. The prevalence of symptoms of depression, anxiety, insomnia, and posttraumatic stress disorder (PTSD) and suicidal behavior was evaluated using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Insomnia Severity Index, Posttraumatic Stress Disorder Checklist for DSM-5, and questions about suicidal ideation and attempts, respectively. Logistic regression was used to explore risk factors for mental health problems and suicidal behavior. Results: The prevalence of mental health problems was 41.5% for depressive symptoms, 32.6% for anxiety symptoms, 35.0% for insomnia symptoms, 8.5% for PTSD symptoms, and 2.0% for suicidal behavior. Participants with high stress during the pandemic were at higher risk of symptoms of depression [adjusted odds ratio (OR) = 1.67, 95% confidence interval (CI) = 1.43-1.95, p < 0.01), anxiety (adjusted OR = 1.90, 95% CI = 1.63-2.23, p < 0.01), insomnia (adjusted OR = 1.64, 95% CI = 1.44-1.87, p < 0.01), PTSD (adjusted OR = 1.71, 95% CI = 1.38-2.11, p < 0.01) and suicidal behavior (adjusted OR = 3.51, 95% CI = 2.28-5.40, p < 0.01). Distant relationship with parents, changes in lifestyle and alcohol use during the pandemic were associated with higher risk of mental health symptoms and suicidal behavior, whereas regular physical exercise reduced the risk of mental health problems. Conclusions: The psychological symptoms and suicidal behavior were relatively high among students who attended university in Wuhan, China after 6 months of the COVID-19 outbreak in China. Comprehensive mental health services and suicide prevention strategies are essential for university students during the COVID-19 pandemic.

Ethical dilemmas faced by frontline support nurses fighting COVID-19.

BACKGROUND: In 2019, an outbreak of COVID-19 broke out in Hubei, China. Medical workers from all over the country rushed to Hubei and participated in the treatment and care of COVID-19 patients. These nurses, dedicated to their professional practice, volunteered to provide compassion and expert clinical care during the pandemic. As with other acts of heroism, the ethical dilemmas associated with working on the front line must be considered for future practice. PURPOSE: To explore the ethical dilemmas of frontline nurses of Jiangsu Province in China during deployment to Wuhan to fight the novel coronavirus pneumonia, and to provide a basis for developing strategies to help nursing staff address personal and practice concerns in order to work more effectively during this pandemic and other disasters in the future. RESEARCH DESIGN AND METHOD: Using the phenomenological research method and the purpose sampling method, semi-structured interviews were conducted with 10 nurses, post-deployment to Wuhan, who had worked on the front line to fight the novel coronavirus. ETHICAL CONSIDERATIONS: The research proposal was approved by the Research Ethic Committee of Yangzhou University, China. FINDINGS: From the analysis of the interviews of the 10 participants, three main themes were identified: ethical dilemmas in clinical nursing, ethical dilemmas in interpersonal relationships, and ethical dilemmas in nursing management. CONCLUSION: During a quick response to public health emergencies, where nurses are deployed immediately as a call to action, the issues surrounding ethical dilemmas from several perspectives must be considered. This research suggests that a team approach to proactive planning and open communication during the emergency is an efficient and productive strategy to improve the nurses' experience and sense of well-being.

COVID-19 and currency dependences: Empirical evidence from BRICS.

The COVID-19 has caused dramatic fluctuations in international financial markets. This paper tests the effect of this pandemic on foreign exchange dependences within the BRICS economies. Upon dividing the COVID-19 episode into four stages, we document negative effects of the COVID-19 on dependences between CNY and other currencies in the BRICS across different stages. In addition, USD flows positively affect the dependencies of BRL-CNY, INR-CNY, and RUB-CNY pairs in response to the transition of the pandemic stages.