Dynamic observation and qualitative analysis of a psychological crisis hotline during the COVID-19 pandemic

Objective The aim of this study was to analyze the chief complaints of psychological crisis hotlines during the coronavirus disease 2019 (COVID-19) pandemic in Jiangsu, China, and to summarize the psychological characteristics of the public during the different stages of COVID-19. Methods The chief complaints of calls to the psychological crisis hotline from 27 January 2020 to 30 June 2020. A total of 578 calls were extracted and grouped using thematic analysis into categories. After statistical analysis, the monthly and three-period trends were observed dynamically to determine whether there were statistical differences in the proportion of specific chief complaints over the phases. Results There were a total of 495 cases of psychological problems or physical discomfort, accounting for 85.64% of the total sample number of hotline calls related to the pandemic. The numbers of callers with anxiety, depression, obsessive-compulsive symptoms, illness anxiety, insomnia, and physical discomfort were 370 (64.01%), 103 (17.99%), 33 (5.71%), 36 (6.23%), 51 (8.82%), and 72 (12.46%), respectively, and 83 (14.36%) callers consulted other problems. The monthly main complaints showed a fluctuating trend, and each main complaint peaked at different stages. The main complaints during the three stages had distinct features, respectively, and the proportions of calls for the specific complaints differed statistically over the phases. Conclusion Dynamic observation and qualitative analysis of psychological crisis hotline data might indicate dynamic changes and accordingly provide guidance for online crisis intervention when other public health crises occur.

Dynamic observation and qualitative analysis of a psychological crisis hotline during the COVID-19 pandemic.

Objective: The aim of this study was to analyze the chief complaints of psychological crisis hotlines during the coronavirus disease 2019 (COVID-19) pandemic in Jiangsu, China, and to summarize the psychological characteristics of the public during the different stages of COVID-19. Methods: The chief complaints of calls to the psychological crisis hotline from 27 January 2020 to 30 June 2020. A total of 578 calls were extracted and grouped using thematic analysis into categories. After statistical analysis, the monthly and three-period trends were observed dynamically to determine whether there were statistical differences in the proportion of specific chief complaints over the phases. Results: There were a total of 495 cases of psychological problems or physical discomfort, accounting for 85.64% of the total sample number of hotline calls related to the pandemic. The numbers of callers with anxiety, depression, obsessive-compulsive symptoms, illness anxiety, insomnia, and physical discomfort were 370 (64.01%), 103 (17.99%), 33 (5.71%), 36 (6.23%), 51 (8.82%), and 72 (12.46%), respectively, and 83 (14.36%) callers consulted other problems. The monthly main complaints showed a fluctuating trend, and each main complaint peaked at different stages. The main complaints during the three stages had distinct features, respectively, and the proportions of calls for the specific complaints differed statistically over the phases. Conclusion: Dynamic observation and qualitative analysis of psychological crisis hotline data might indicate dynamic changes and accordingly provide guidance for online crisis intervention when other public health crises occur.

Adaptor protein MyD88 confers the susceptibility to stress via amplifying immune danger signals.

Increasing evidence supports the pathogenic role of neuroinflammation in psychiatric diseases, including major depressive disorder (MDD) and neuropsychiatric symptoms of Coronavirus disease 2019 (COVID-19); however, the precise mechanism and therapeutic strategy are poorly understood. Here, we report that myeloid differentiation factor 88 (MyD88), a pivotal adaptor that bridges toll-like receptors to their downstream signaling by recruiting the signaling complex called 'myddosome', was up-regulated in the medial prefrontal cortex (mPFC) after exposure to chronic social defeat stress (CSDS) or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein. The inducible expression of MyD88 in the mPFC primed neuroinflammation and conferred stress susceptibility via amplifying immune danger signals, such as high-mobility group box 1 and SARS-CoV-2 spike protein. Overexpression of MyD88 aggravated, whereas knockout or pharmacological inhibition of MyD88 ameliorated CSDS-induced depressive-like behavior. Notably, TJ-M2010-5, a novel synthesized targeting inhibitor of MyD88 dimerization, alleviated both CSDS- and SARS-CoV-2 spike protein-induced depressive-like behavior. Taken together, our findings indicate that inhibiting MyD88 signaling represents a promising therapeutic strategy for stress-related mental disorders, such as MDD and COVID-19-related neuropsychiatric symptoms.

Editorial: Automations in Long-Term Neurorehabilitation

Neurological disorders, such as stroke, Parkinson's disease, dementia, etc., are increasing globally mainly because of the rapid growth of the aging population and the trend of these diseases in younger generations. Long-term neurorehabilitation for these disorders has been challenging in traditional rehabilitation services, which heavily rely on manual operations by professional manpower in diagnosis, treatment, and follow-up, when the patient populations are expanding. Furthermore, the COVID-19 pandemic has already lasted for years globally with an unforeseeable end-date, which has triggered the urgent need of more flexible rehabilitation, e.g., remote and self-help modes at home, to augment the traditional, centralized, and face-to-face practices in hospitals/clinics.

Social anxiety and associated factors among graduate students under the normalization of epidemic prevention and control

Objective: To understand social anxiety and relevant factors among graduate students under the normalization stage of COVID-19 epidemic prevention and control.

SARS-CoV-2 triggered oxidative stress and abnormal energy metabolism in gut microbiota.

Specific roles of gut microbes in COVID-19 progression are critical. However, the circumstantial mechanism remains elusive. In this study, shotgun metagenomic or metatranscriptomic sequencing was performed on fecal samples collected from 13 COVID-19 patients and controls. We analyzed the structure of gut microbiota, identified the characteristic bacteria, and selected biomarkers. Further, gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) annotations were employed to correlate the taxon alterations and corresponding functions. The gut microbiota of COVID-19 patients was characterized by the enrichment of opportunistic pathogens and depletion of commensals. The abundance of Bacteroides spp. displayed an inverse relationship with COVID-19 severity, whereas Actinomyces oris, Escherichia coli, and Streptococcus parasanguini were positively correlated with disease severity. The genes encoding oxidoreductase were significantly enriched in gut microbiome of COVID-19 group. KEGG annotation indicated that the expression of ABC transporter was upregulated, while the synthesis pathway of butyrate was aberrantly reduced. Furthermore, increased metabolism of lipopolysaccharide, polyketide sugar, sphingolipids, and neutral amino acids were found. These results suggested the gut microbiome of COVID-19 patients was in a state of oxidative stress. Healthy gut microbiota may enhance antiviral defenses via butyrate metabolism, whereas the accumulation of opportunistic and inflammatory bacteria may exacerbate COVID-19 progression.

Kinetic Characteristics of Neutralizing Antibody Responses Vary among Patients with COVID-19.

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic continues to present a major challenge to public health. Vaccine development requires an understanding of the kinetics of neutralizing antibody (NAb) responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: In total, 605 serum samples from 125 COVID-19 patients (from January 1 to March 14, 2020) varying in age, sex, severity of symptoms, and presence of underlying diseases were collected, and antibody titers were measured using a micro-neutralization assay with wild-type SARS-CoV-2. RESULTS: NAbs were detectable approximately 10 days post-onset (dpo) of symptoms and peaked at approximately 20 dpo. The NAb levels were slightly higher in young males and severe cases, while no significant difference was observed for the other classifications. In follow-up cases, the NAb titer had increased or stabilized in 18 cases, whereas it had decreased in 26 cases, and in one case NAbs were undetectable at the end of our observation. Although a decreasing trend in NAb titer was observed in many cases, the NAb level was generally still protective. CONCLUSION: We demonstrated that NAb levels vary among all categories of COVID-19 patients. Long-term studies are needed to determine the longevity and protective efficiency of NAbs induced by SARS-CoV-2.

SARS-CoV-2 Seroprevalence and Profiles Among Convalescents in Sichuan Province, China.

Objectives: To explore and understand the SARS-CoV-2 seroprevalence of convalescents, the association between antibody levels and demographic factors, and the seroepidemiology of convalescents of COVID-19 till March 2021. Methods: We recruited 517 voluntary COVID-19 convalescents in Sichuan Province and collected 1,707 serum samples till March 2021. Then we reported the seroprevalence and analyzed the associated factors. Results: Recent travel history was associated with IgM levels. Convalescents who had recent travel history were less likely to be IgM antibody negative [OR = 0.232, 95% CI: (0.128, 0.420)]. Asymptomatic cases had, approximately, twice the odds of being IgM antibody negative compared with symptomatic cases [OR = 2.583, 95% CI: (1.554, 4.293)]. Participants without symptoms were less likely to be IgG seronegative than those with symptoms [OR = 0.511, 95% CI: (0.293, 0.891)]. Convalescents aged 40-59 were less likely to be IgG seronegative than those aged below 20 [OR = 0.364, 95% CI: (0.138, 0.959)]. The duration of positive IgM antibodies persisted 365 days while the IgG persisted more than 399 days. Conclusions: Our findings suggested that recent travel history might be associated with the antibody levels of IgM, while age could be associated with the antibody levels of IgG. Infection type could be associated with both antibody levels of IgM and IgG that declined quicker in asymptomatic cases.

Initial Public-Health Emergency Response to SARS and COVID-19 Pandemics in Mainland China: A Retrospective Comparative Study.

BACKGROUND: Severe acute respiratory syndrome (SARS) was reported first in China in 2003. The world is currently coping with coronavirus disease-2019 (COVID-19). We conducted a retrospective study to compare the initial public-health emergency response (PHER) to SARS and COVID-19 in mainland China. METHODS: A qualitative comparative study was conducted to compare the PHER timelines to SARS and COVID-19 by selecting six crucial time points. Besides, we explored the speed of spread, peak time and plateau period of SARS and COVID-19, respectively, by comparing the confirmed cases in the same time interval. RESULTS: The government of the People's Republic of China (PRC) accomplished the entire initial PHER to SARS in 127 days and for COVID-19 in 44 days. The speed of PHER for COVID-19 was 83 days faster. The peak time of SARS arose ~80 days later than that of COVID-19. Though the peak number of confirmed daily cases for COVID-19 was fivefold more than that of SARS, the onset of the stabilization period for COVID-19 was >2 months earlier than that of SARS. CONCLUSION: Overall, the speed of the initial PHER to COVID-19 pandemic was faster than that for SARS. Compared with the speed of hospital reporting and government policymaking, the speed of pathogen identification improved the most. The COVID-19 pandemic curve entered a plateau period earlier than the SARS pandemic curve, which suggests that the pandemic was controlled more effectively because of a timely PHER. The PRC government should emphasize improving the ability of hospitals to restrain infectious diseases by enhancing the direct reporting system and cultivating crisis management to empower relevant individuals to make timely scientific decisions.

Can urban prosperity aid in recovery?: The relationship between healthcare workers' mental health status and the city level during the COVID-19 epidemic.

The mental health of healthcare workers during epidemics is a complex topic. The outbreak of coronavirus disease 2019 (COVID-19) that occurred in late 2019 has become a global public health threat and provides an opportunity to investigate this topic. Based on a large-scale investigation of Chinese healthcare workers during the COVID-19 epidemic, the article tests the assumption that the socioeconomic level of a city affects the mental health status of healthcare workers. The result is interesting and important: the mental health status of this population differs based on the city level. Hospital level, hospital type and departments risk level were investigated separately. With regard to the degree of anxiety, depression and post-traumatic stress disorder (PTSD), there were obvious differences based on the city level: the negative mental health impacts increase with increasing city level, such that healthcare workers in first-tier cities have the least negative mental health impacts, while those in third-tier cities have the most. City level reflects the degree of urban development, resource richness, resident satisfaction, and positive social atmosphere. Urban prosperity may affect mental health.

Vaccination control of an epidemic model with time delay and its application to COVID-19.

This paper studies an SEIR-type epidemic model with time delay and vaccination control. The vaccination control is applied when the basic reproduction number R 0 > 1 . The vaccination strategy is expressed as a state delayed feedback which is related to the current and previous state of the epidemic model, and makes the model become a linear system in new coordinates. For the presence and absence of vaccination control, we investigate the nonnegativity and boundedness of the model, respectively. We obtain some sufficient conditions for the eigenvalues of the linear system such that the nonnegativity of the epidemic model can be guaranteed when the vaccination strategy is applied. In addition, we study the stability of disease-free equilibrium when R 0 < 1 and the persistent of disease when R 0 > 1 . Finally, we use the obtained theoretical results to simulate the vaccination strategy to control the spread of COVID-19.

Geographical distribution and prevalence of mental disorders among healthcare workers in China: A cross-sectional country-wide survey: A cross-sectional study to assess mental disorders of healthcare workers in China.

BACKGROUND: Reliable and detailed nationwide data on the prevalence and distribution of mental disorders among healthcare workers in China during the coronavirus disease 2019 (COVID-19) outbreak are scarce. METHODS: We did a cross-sectional online survey from March 2 to 2 April 2020 and a total of 19,379 healthcare workers from 25 provinces participated. Depression, anxiety and post-traumatic stress disorder (PTSD) were assessed by the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7) and PTSD Checklist for DSM-5 (PCL-5), respectively. RESULTS: The age-standardized prevalence of depression, anxiety and PTSD was 15.5%, 12.7% and 5.2%, respectively. Frontline workers had higher prevalence estimates than non-frontline workers (depression: 18.2% vs. 13.9%; anxiety: 14.7% vs. 11.6%; PTSD: 6.1% vs. 4.6%). Subgroups who were nurses, were married or had dependent children reported higher prevalence of depression, anxiety and PTSD. Despite of the large variations, the prevalence of mental disorders was lowest in East China, followed by Middle China, and highest in West China. CONCLUSION: Healthcare workers faced enormous stress not only from the direct risk presented by the COVID-19 outbreak, but also from the profound changes in their professional practice. Prevalence of adverse psychological outcomes has a significant association with geographically distribution of health resources and regional economic level. Sufficient medical resource may be a protective factor to mental health condition of healthcare personnel when such a public health emergency happened.

Gut, metabolism and nutritional Support for COVID-19: Experiences from China.

There is little research that focuses on the relationship between the gut, metabolism, nutritional support and COVID-19. As a group of Chinese physicians, nutritionists and scientists working on the frontline treating COVID-19 patients, we aim to integrate our experiences and the current clinical evidence to address this pressing issue in this article. Based on our clinical observations and available evidence, we recommend the following practice. Firstly, the Nutritional Risk Screening 2002 tool should be used routinely and periodically; for patients with a score ≥3, oral nutritional supplements should be given immediately. Secondly, for patients receiving the antiviral agents lopinavir/ritonavir, gastrointestinal side effects should be monitored for and timely intervention provided. Thirdly, for feeding, the enteral route should be the first choice. In patients undergoing mechanical ventilation, establishing a jejunal route as early as possible can guarantee the feeding target being achieved if gastric dilatation occurs. Fourthly, we suggest a permissive underfeeding strategy for severe/critical patients admitted to the intensive care unit during the first week of admission, with the energy target no more than 20 kcal/kg/day (for those on mechanical ventilation, this target may be lowered to 10-15 kcal/kg/day) and the protein target around 1.0-1.2 g/kg/day. If the inflammatory condition is significantly alleviated, the energy target may be gradually increased to 25-30 kcal/kg/day and the protein target to 1.2-1.5 g/kg/day. Fifthly, supplemental parenteral nutrition should be used with caution. Lastly, omega-3 fatty acids may be used as immunoregulators, intravenous administration of omega-3 fatty emulsion (10 g/day) at an early stage may help to reduce the inflammatory reaction.

Psychological Resilience as a Protective Factor for Depression and Anxiety Among the Public During the Outbreak of COVID-19.

BACKGROUND: Psychological resilience may reduce the impact of psychological distress to some extent. We aimed to investigate the mental health status of the public during the outbreak of coronavirus disease 2019 (COVID-19) and explore the level and related factors of anxiety and depression. METHODS: From February 8 to March 9, 2020, 3,180 public completed the Zung's Self-Rating Anxiety Scale (SAS) for anxiety, Zung's Self-Rating Depression Scale (SDS) for depression, the Connor-Davidson resilience scale (CD-RISC) for psychological resilience, and the Simplified Coping Style Questionnaire (SCSQ) for the attitudes and coping styles. RESULTS: The number of people with depressive symptoms (SDS > 53) was 1,303 (the rate was 41.0%). The number of people with anxiety symptoms (SAS > 50) was 1,184 (the rate was 37.2%). The depressed group and anxiety group had less education, more unmarried and younger age, as well as had significant different in SDS total score (P < 0.001), SAS total score (P < 0.001), CD-RISC total score (P < 0.001), and SCSQ score (P < 0.001). The binary logistic regression showed that female (B = -0.261, P = 0.026), strength (B = -0.079, P = 0.000), and the subscales of active coping style in SCSQ (B = -0.983, P = 0.000) remained protective factors and passive coping style (B = 0.293, P = 0.003) and higher SAS score (B = 0.175, P = 0.000) were risk factors for depression. Optimism (B = -0.041, P = 0.015) in CD-RISC was a protective factor, and passive coping styles (B = 0.483, P = 0.000) and higher SDS score (B = 0.134, P = 0.000) were risk factors for anxiety. LIMITATIONS: This study adopted a cross-sectional design and used self-report questionnaires. CONCLUSION: The mental health of the public, especially females, the younger and less educational populations, and unmarried individuals, should be given more attention. Individuals with high level of mental resilience and active coping styles would have lower levels of anxiety and depression during the outbreak of COVID-19.

Rapid Development of SARS-CoV-2 Spike Protein Receptor-Binding Domain Self-Assembled Nanoparticle Vaccine Candidates.

The coronavirus disease pandemic of 2019 (COVID-19) caused by the novel SARS-CoV-2 coronavirus resulted in economic losses and threatened human health worldwide. The pandemic highlights an urgent need for a stable, easily produced, and effective vaccine. SARS-CoV-2 uses the spike protein receptor-binding domain (RBD) to bind its cognate receptor, angiotensin-converting enzyme 2 (ACE2), and initiate membrane fusion. Thus, the RBD is an ideal target for vaccine development. In this study, we designed three different RBD-conjugated nanoparticle vaccine candidates, namely, RBD-Ferritin (24-mer), RBD-mi3 (60-mer), and RBD-I53-50 (120-mer), via covalent conjugation using the SpyTag-SpyCatcher system. When mice were immunized with the RBD-conjugated nanoparticles (NPs) in conjunction with the AddaVax or Sigma Adjuvant System, the resulting antisera exhibited 8- to 120-fold greater neutralizing activity against both a pseudovirus and the authentic virus than those of mice immunized with monomeric RBD. Most importantly, sera from mice immunized with RBD-conjugated NPs more efficiently blocked the binding of RBD to ACE2 in vitro, further corroborating the promising immunization effect. Additionally, the vaccine has distinct advantages in terms of a relatively simple scale-up and flexible assembly. These results illustrate that the SARS-CoV-2 RBD-conjugated nanoparticles developed in this study are a competitive vaccine candidate and that the carrier nanoparticles could be adopted as a universal platform for a future vaccine development.

Association of liver abnormalities with in-hospital mortality in patients with COVID-19.

BACKGROUND & AIMS: The evolution and clinical significance of abnormal liver chemistries and the impact of hepatitis B infection on outcome in patients with COVID-19 is not well characterized. This study aimed to explore these issues. METHODS: This large retrospective cohort study included 2,073 patients with coronavirus disease 2019 (COVID-19) and definite outcomes in Wuhan, China. Longitudinal liver function tests were conducted, with associated factors and risk of death determined by multivariate regression analyses. A prognostic nomogram was formulated to predict the survival of patients with COVID-19. The characteristics of liver abnormalities and outcomes of patients with COVID-19, with and without hepatitis B, were compared after 1:3 propensity score matching. RESULTS: Of the 2,073 patients, 1,282 (61.8%) had abnormal liver chemistries during hospitalization, and 297 (14.3%) had a liver injury. The mean levels of aspartate aminotransferase (AST) and direct bilirubin (D-Bil) increased early after symptom onset in deceased patients and showed disparity compared to levels in discharged patients throughout the clinical course of the disease. Abnormal AST (adjusted hazard ratio [HR] 1.39; 95% CI 1.04-1.86, p = 0.027) and D-Bil (adjusted HR 1.66; 95% CI 1.22-2.26; p = 0.001) levels at admission were independent risk factors for mortality due to COVID-19. A nomogram was established based on the results of multivariate analysis and showed sufficient discriminatory power and good consistency between the prediction and the observation. HBV infection in patients did not increase the risk of poor COVID-19-associated outcomes. CONCLUSIONS: Abnormal AST and D-Bil levels at admission were independent predictors of COVID-19-related mortality. Therefore, monitoring liver chemistries, especially AST and D-Bil levels, is necessary in hospitalized patients with COVID-19. LAY SUMMARY: Liver test abnormalities (in particular elevations in the levels of aspartate aminotransferase [AST] and direct bilirubin [D-Bil]) were observed after symptom onset in patients who went on to die of coronavirus disease 2019 (COVID-19). Abnormal levels of AST and D-Bil at admission were independent predictors of COVID-19-related mortality. HBV infection in patients did not increase the risk of poor COVID-19-associated outcomes.

Characterizing News Report of the Substandard Vaccine Case of Changchun Changsheng in China: A Text Mining Approach.

Background: The substandard vaccine case of that broke out in July 2018 in China triggered an outburst of news reports both domestically and aboard. Distilling the abundant textual information is helpful for a better understanding of the character during this public event. Methods: We collected the texts of 2211 news reports from 83 mainstream media outlets in China between 15 July and 25 August 2018, and used a structural topic model (STM) to identify the major topics and features that emerged. We also used dictionary-based sentiment analysis to uncover the sentiments expressed by the topics as well as their temporal variations. Results: The main topics of the news report fell into six major categories, including: (1) Media Investigation, (2) Response from the Top Authority, (3) Government Action, (4) Knowledge Dissemination, (5) Finance Related and (6) Commentary. The topic prevalence shifted during different stages of the events, illustrating the actions by the government. Sentiments generally spanned from negative to positive, but varied according to different topics. Conclusion: The characteristics of news reports on vaccines are shaped by various topics at different stages. The inner dynamics of the topic and its alterations are driven by the interaction between social sentiment and governmental intervention.

Strategies and recommendations for the management of gastrointestinal surgery during the COVID-19 pandemic: experience shared by Chinese surgeons.

Novel coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an ongoing public-health pandemic worldwide. Although SARS-CoV-2 has been known to spread primarily through respiratory droplets, recent evidence also supports fecal/oral as an additional route of transmission, raising concerns over gastrointestinal (GI) transmission of the infection. Herein, we, as the front-line Chinese GI surgeons, would like to share our experience and lessons in the combat against COVID-19. It is essential to create science-based, rational, and practical strategies during the outbreak of COVID-19. Here, we provide multi-institutional consensus on minimizing disease transmission while continuing to provide care from all aspects for patients in GI surgery, including outpatient clinics, inpatient units, gastrointestinal endoscopy centers, and adjustments in perioperative care. Our experiences and recommendations are worth sharing and may help to establish specific infection-control and outcome measures.