Effect of anxiety and depression on self-reported adverse reactions to COVID-19 vaccine: a cross-sectional study in Shanghai, China.

BACKGROUND: The association of anxiety and depression with adverse reactions after receipt of coronavirus disease 2019 (COVID-19) vaccine is not clear among the general population. This study aims to evaluate the effect of anxiety and depression on self-reported adverse reactions to COVID-19 vaccine. METHODS: The cross-sectional study was conducted during April-July 2021. Participants completing the two doses of vaccine were included in this study. Sociodemographic information, anxiety and depression levels and adverse reactions after the first dose of vaccine for all participants were collected. The anxiety and depression levels were assessed by the Seven-item Generalized Anxiety Disorder Scale and the Nine-item Patient Health Questionnaire Scale, respectively. The multivariate logistic regression analysis was used to examine the association between anxiety and depression and adverse reactions. RESULTS: A total of 2161 participants were enrolled in this study. The prevalence of anxiety and depression was 13% (95% confidence interval (CI), 11.3-14.2%) and 15% (95%CI, 13.6-16.7%), respectively. Of the 2161 participants, 1607 (74%; 95% CI, 73-76%) reported at least one adverse reaction after the first dose of the vaccine. Pain at the injection site (55%) and fatigue and headache (53% and 18%, respectively) were the most commonly reported local and systemic adverse reactions, respectively. Participants with anxiety or depression or both were more likely to report local and systemic adverse reactions (P < 0.05). CONCLUSION: The results suggest that anxiety and depression increase the risk of self-reported adverse reactions to COVID-19 vaccine. Consequently, appropriate psychological interventions before vaccination will help to reduce or alleviate symptoms of vaccination.

Burnout syndrome, doctor-patient relationship and family support of pediatric medical staff during a COVID-19 Local outbreak in Shanghai China: A cross-sectional survey study.

Objectives: To explore burnout syndrome (BOS) incidence, doctor-patient relationship, and family support on pediatric medical staff in Shanghai comprehensive hospitals during a COVID-19 local outbreak. Methods: A cross-sectional survey of pediatric medical staff from 7 comprehensive hospitals across Shanghai was conducted from March to July 2022. The survey included BOS, doctor-patient relationships, family support, and the related factors of COVID-19. The T-test, variance, the LSD-t test, Pearson's r correlation coefficient, and multiple regression analyses examined the data. Results: Using Maslach Burnout Inventory-General Survey (MBI-GS), 81.67% of pediatric medical staff had moderate BOS, and 13.75% were severe. The difficult doctor-patient relationship was positively correlated with emotional exhaustion(EE), cynicism(Cy), and negatively with personal accomplishment(PA). When medical staff need help, the greater the support provided by the family, the lower the EE and CY, and the higher the PA. Conclusion: "In our study, the pediatric medical staff in Shanghai comprehensive hospitals had significant BOS during a COVID-19 local outbreak." We provided the potential steps that can be taken to reduce the increasing rate of BOS in pandemics. These measures include increased job satisfaction, psychological support, maintaining good health, increased salary, lower intent to leave the profession, regularly carrying out COVID-19 prevention training, improving doctor-patient relations, and strengthening family support.

Obesity and COVID-19: Mechanistic Insights From Adipose Tissue.

Obesity is associated with an increase in morbidity and mortality from coronavirus disease 2019 (COVID-19). The risk is related to the cytokine storm, a major contributor to multiorgan failure and a pathological character of COVID-19 patients with obesity. While the exact cause of the cytokine storm remains elusive, disorders in energy metabolism has provided insights into the mechanism. Emerging data suggest that adipose tissue in obesity contributes to the disorders in several ways. First, adipose tissue restricts the pulmonary function by generation of mechanical pressures to promote systemic hypoxia. Second, adipose tissue supplies a base for severe acute respiratory syndrome coronavirus 2 entry by overexpression of viral receptors [angiotensin-converting enzyme 2 and dipeptidyl peptidase 4]. Third, impaired antiviral responses of adipocytes and immune cells result in dysfunction of immunologic surveillance as well as the viral clearance systems. Fourth, chronic inflammation in obesity contributes to the cytokine storm by secreting more proinflammatory cytokines. Fifth, abnormal levels of adipokines increase the risk of a hyperimmune response to the virus in the lungs and other organs to enhance the cytokine storm. Mitochondrial dysfunction in adipocytes, immune cells, and other cell types (endothelial cells and platelets, etc) is a common cellular mechanism for the development of cytokine storm, which leads to the progression of mild COVID-19 to severe cases with multiorgan failure and high mortality. Correction of energy surplus through various approaches is recommended in the prevention and treatment of COVID-19 in the obese patients.

Monocytic HLA-DR Expression in Immune Responses of Acute Pancreatitis and COVID-19.

Acute pancreatitis is a common gastrointestinal disease with increasing incidence worldwide. COVID-19 is a potentially life-threatening contagious disease spread throughout the world, caused by severe acute respiratory syndrome coronavirus 2. More severe forms of both diseases exhibit commonalities with dysregulated immune responses resulting in amplified inflammation and susceptibility to infection. Human leucocyte antigen (HLA)-DR, expressed on antigen-presenting cells, acts as an indicator of immune function. Research advances have highlighted the predictive values of monocytic HLA-DR (mHLA-DR) expression for disease severity and infectious complications in both acute pancreatitis and COVID-19 patients. While the regulatory mechanism of altered mHLA-DR expression remains unclear, HLA-DR-/low monocytic myeloid-derived suppressor cells are potent drivers of immunosuppression and poor outcomes in these diseases. Future studies with mHLA-DR-guided enrollment or targeted immunotherapy are warranted in more severe cases of patients with acute pancreatitis and COVID-19.

The Association between Socio-Demographics and Mental Distress Following COVID-19 Vaccination-Mediation of Vaccine Hesitancy.

The COVID-19 vaccine has been administered to over 200 countries and regions. With the unprecedented vaccination scale and speed, vaccination correlated mental health issues should be paid precise attention to. This study aims to assess the association between socio-demographic factors and mental health following vaccination and to analyze the mediation effect of vaccine hesitancy. This study recruited 2112 individuals who took two doses of the COVID-19 vaccine in Shanghai. Structural equation modeling was performed to assess factors associated with anxiety and depression of the vaccinated individuals and the underlying mechanism. The results yielded that vaccine hesitancy partially mediated/suppressed the effect from gender and employment status to anxiety/depression and fully mediated the effects from education to anxiety/depression. This study advanced the understanding of mental health disparity among different socio-demographic groups after vaccination and the impact of vaccine hesitancy on the vaccinated population's mental health. The finding offered insights into the possible mental vulnerability of people holding a hesitant attitude before vaccination and suggested that vaccine hesitancy played a crucial role in people's mental health after vaccination. Health promotion programs can target vaccine hesitancy to prevent unfavorable mental health consequences among specific populations.

COVID-19 Lockdown Stress and the Mental Health of College Students: A Cross-Sectional Survey in China

To prevent the spread of the COVID-19 pandemic, countries around the world adopted varying degrees of lockdown. The lockdowns restricted the freedom of college students, which led to stress and mental health issues. This study constructed a mediating model to explore the relationship between COVID-19 lockdown stress and Chinese college students’ mental health;the mediating role of fear of missing out (FoMO) was also investigated. A 7-item COVID-19 student stress questionnaire (CSSQ), a 6-item mental health scale, and a 10-item FoMO scale were distributed among 695 college students who experienced lockdown in China. The results showed that COVID-19 lockdown stress was significantly and negatively correlated with mental health, significantly and positively correlated with FoMO, and FoMO was significantly and negatively correlated with mental health. COVID-19 lockdown stress significantly and negatively influenced Chinese college students’ mental health directly and indirectly via the complementary partial mediating effect of FoMO. The results intensify our comprehension of the influence of COVID-19 lockdown stress and mental health problems in Chinese college students and also provide practical suggestions for college educators to address such scenarios.

Specific anti-SARS-CoV-2 S1 IgY-scFv is a promising tool for recognition of the virus

As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread globally, a series of vaccines, antibodies and drugs have been developed to combat coronavirus disease 2019 (COVID-19). High specific antibodies are powerful tool for the development of immunoassay and providing passive immunotherapy against SARS-CoV-2 and expected with large scale production. SARS-CoV-2 S1 protein was expressed in E. coli BL21 and purified by immobilized metal affinity chromatography, as antigen used to immunize hens, the specific IgY antibodies were extracted form egg yolk by PEG-6000 precipitation, and the titer of anti-S1 IgY antibody reached 1:10,000. IgY single chain variable fragment antibody (IgY-scFv) was generated by using phage display technology and the IgY-scFv showed high binding sensitivity and capacity to S1 protein of SARS-CoV-2, and the minimum detectable antigen S1 protein concentration was 6 ng/µL. The docking study showed that the multiple epitopes on the IgY-scFv interacted with multiple residues on SARS-CoV-2 S1 RBD to form hydrogen bonds. This preliminary study suggests that IgY and IgY-scFv are suitable candidates for the development of immunoassay and passive immunotherapy for COVID-19 to humans and animals.

Mycoplasma pneumoniae among Chinese Outpatient Children with Mild Respiratory Tract Infections during the Coronavirus Disease 2019 Pandemic.

Mycoplasma pneumoniae is a common pathogen causing respiratory disease in children. We sought to investigate the epidemiology of M. pneumoniae among outpatient children with mild respiratory tract infections (RTIs) during the coronavirus disease 2019 (COVID-19) pandemic. Eligible patients were prospectively enrolled from January 2020 to June 2021. Throat swabs were tested for M. pneumoniae RNA. M. pneumoniae IgM was tested by a colloidal gold assay. Macrolide resistance and the effect of the COVID-19 countermeasures on M. pneumoniae prevalence were assessed. Symptom scores, treatments, and outcomes were evaluated. Eight hundred sixty-two eligible children at 15 centers in China were enrolled. M. pneumoniae was detected in 78 (9.0%) patients. Seasonally, M. pneumoniae peaked in the first spring and dropped dramatically to extremely low levels over time until the next summer. Decreases in COVID-19 prevalence were significantly associated with decreases in M. pneumoniae prevalence (r = 0.76, P = 0.001). The macrolide resistance rate was 7.7%. The overall sensitivity and specificity of the colloidal gold assay used in determining M. pneumoniae infection were 32.1% and 77.9%, respectively. No more benefits for improving the severity of symptoms and outcomes were observed in M. pneumoniae-infected patients treated with a macrolide than in those not treated with a macrolide during follow-up. The prevalences of M. pneumoniae and macrolide resistance in outpatient children with mild RTIs were at low levels in the early stage of the COVID-19 pandemic but may have rebounded recently. The colloidal gold assay for M. pneumoniae IgM may be not appropriate for diagnosis of M. pneumoniae infection. Macrolides should be used with caution among outpatients with mild RTIs. IMPORTANCE This is the first and largest prospective, multicenter, active, population-based surveillance study of the epidemiology of Mycoplasma pneumoniae among outpatient children with mild respiratory tract infections (RTIs) during the COVID-19 pandemic. Nationwide measures like strict face mask wearing and restrictions on population movement implemented to prevent the spread of COVID-19 might also effectively prevent the spread of M. pneumoniae. The prevalence of M. pneumoniae and the proportion of drug-resistant M. pneumoniae isolates in outpatient children with mild RTIs were at low levels in the early stage of the COVID-19 pandemic but may have rebounded recently. The colloidal gold assay for M. pneumoniae IgM may be not appropriate for screening and diagnosis of M. pneumoniae infection. Macrolides should be used with caution among outpatients with mild RTIs.

Respiratory rehabilitation program (draft) of integrated traditional Chinese and western medicine for novel Coronavirus pneumonia (COVID-19)

Since December 2019, a number of cases of pneumonia with unexplained reasons have been reported in Wuhan, Hubei Province, and a large number of cases have been infected. National Health Commission of the People's Republic of China has named it novel coronavirus pneumonia (COVID-19). With the strengthening of prevention and control forces, the number of mild patients in mobile cabin hospital has increased and a large number of patients have been cured and discharged from the hospital. The rehabilitation program of integrated traditional Chinese and Western medicine needs to be formulated and implemented urgently. Therefore, according to treatment protocols issued by National Health Commission of the People's Republic of China and relevant institutes, and widely discussion of relevant experts of pulmonary rehabilitation, TCM and nutrition, Respiratory Rehabilitation Program (Draft) of Integrated Traditional Chinese and Western Medicine for COVID-19 was compiled, in order to play a positive role in the follow-up epidemic prevention and control.

Resilience Predicts the Trajectories of College Students' Daily Emotions During COVID-19: A Latent Growth Mixture Model.

The objective of this study was to examine the association between resilience and trajectories of college students' negative and positive affect during the COVID-19 pandemic. A total of 391 college students recruited from China completed a daily online negative and positive affect scale for 1 week, and their resilience was also measured. Profiles of brief trajectories of negative and positive affect over time were identified using the latent growth mixture model, and the effect of resilience on these trajectories was further explored. Two latent profiles of negative affect were found: a constant high negative affect profile and a slowly decreasing low negative affect profile, while three latent profiles of positive affect were identified: a slowly increasing high positive affect profile, a rapidly decreasing medium positive affect profile, and a constant medium positive affect profile. The optimism dimension of resilience predicted the membership in the various profiles significantly, whereas the prediction of tenacity and strength dimensions of resilience was not significant. Activities that promote resilience, especially optimism, should be included to improve the daily emotions of college students during COVID-19.

Infection-prevention measures against COVID-19 during anesthesia: a narrative review of current clinical literature.

The outbreak of coronavirus disease 2019 (COVID-19) has increased the risk of infection among medical staff. Anesthetists may have direct or indirect contact with COVID-19 patients' saliva droplets, blood, and other secretions in their daily work. If infection-prevention measures are not appropriate, it will not only cause individual medical staff infection, but also cross-infection among patients and other medical staff. Therefore, it is important to establish infection-control practices for COVID-19 patients during anesthesia. The aim of the present study was to review the infection-prevention measures against COVID-19 during anesthesia. Previously published studies on severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), as well as current studies on COVID-19, specifically in Wuhan, China, were analyzed. In the present study, we discuss the etiology, epidemiology, pathology, clinical manifestations, diagnosis, and treatment of SARS, MERS, and COVID-19 at first. And then we discuss preoperative preparation which include the preparation of operating room, pre-operative assessment, hand hygiene and staffing and psychological counseling. We also discuss the implementation of anesthesia, including anesthesia types, induction of general anesthesia and endotracheal intubation, postoperative recovery and patient transport. Finally, we consider the proper disposal procedure for anesthetic equipment and medical devices. COVID-19 infection can be effectively reduced by infection-prevention measures during the perioperative period.

Highly accurate and sensitive diagnostic detection of SARS-CoV-2 by digital PCR.

The outbreak of COVID-19 caused by a novel Coronavirus (termed SARS-CoV-2) has spread to over 210 countries around the world. Currently, reverse transcription quantitative qPCR (RT-qPCR) is used as the gold standard for diagnosis of SARS-CoV-2. However, the sensitivity of RT-qPCR assays of pharyngeal swab samples are reported to vary from 30% to 60%. More accurate and sensitive methods are urgently needed to support the quality assurance of the RT-qPCR or as an alternative diagnostic approach. A reverse transcription digital PCR (RT-dPCR) method was established and evaluated. To explore the feasibility of RT-dPCR in diagnostic of SARS-CoV-2, a total of 196 clinical pharyngeal swab samples from 103 suspected patients, 77 close contacts and 16 supposed convalescents were analyzed by RT-qPCR and then measured by the proposed RT-dPCR. For the 103 fever suspected patients, 19 (19/25) negative and 42 (42/49) equivocal tested by RT-qPCR were positive according to RT-dPCR. The sensitivity of SARS-CoV-2 detection was significantly improved from 28.2% by RT-qPCR to 87.4% by RT-dPCR. For 29 close contacts (confirmed by additional sample and clinical follow up), 16 (16/17) equivocal and 1 negative tested by RT-qPCR were positive according to RT-dPCR, which is implying that the RT-qPCR is missing a lot of asymptomatic patients. The overall sensitivity, specificity and diagnostic accuracy of RT-dPCR were 91%, 100% and 93%, respectively. RT-dPCR is highly accurate method and suitable for detection of pharyngeal swab samples from COVID-19 suspected patients and patients under isolation and observation who may not be exhibiting clinical symptoms.

Mental distress and influencing factors in nurses caring for patients with COVID-19.

BACKGROUND: Nurses are experiencing tremendous stress during the new coronavirus disease 2019 (COVID-19) pandemic, especially intensive care nurses. The pandemic of the disease is a tragedy, which may leave a catastrophic psychological imprint on nurses. Understanding nurses' mental distress can help when implementing interventions to mitigate psychological injuries to nurses. AIMS AND OBJECTIVES: To quantify the severity of nurses' post-traumatic stress disorder (PTSD) symptoms and stress and explore the influencing factors of their psychological health when caring for patients with COVID-19. DESIGN: A cross-sectional survey. METHODS: The PTSD Checklist-Civilian and the Perceived Stress Scale were administered from 11 to 18 March 2020, to 90 nurses selected from another city to go and help an intensive care unit (ICU) in Wuhan, China. These nurses were selected because of their high levels of clinical performance and resilience status. RESULTS: Nurses' average PTSD score was 24.62 ± 6.68, and five (5.6%) of the nurses reported a clinically significant level of PTSD symptoms (>38 points). Nurses' perceived stress averaged 19.33 ± 7, and 20 nurses (22.22%) scored positively >25 points. Nurses' stress and PTSD symptoms were positively correlated (P < .01). Major stress sources included working in an isolated environment, concerns about personal protective equipment shortage and usage, physical and emotional exhaustion, intensive workload, fear of being infected, and insufficient work experiences with COVID-19. CONCLUSIONS: This study showed that even relatively highly resilient nurses experienced some degree of mental distress, including PTSD symptoms and perceived stress. Our findings highlight the importance of helping nurses cultivate resilience and reduce stress. RELEVANCE TO CLINICAL PRACTICE: Recommendations for practice include providing adequate training and orientation before assigning nurses to ICU to help, offering disaster-emergency-preparedness training to keep nurses prepared, providing caring and authentic nursing leadership, offering ongoing psychological support to frontline nurses.