Exploring the Impact of Education Strategies on Individuals' Attitude Towards Telemental Health Service: Findings from a Survey Experiment Study.

While COVID-19 has caused significant mental health consequences, telemental health services have the potential to mitigate this problem. But due to the sensitive nature of mental health issues, such services are seriously underutilized. Based on an integrated variance-process theoretical framework, this study examines the impact of applying different education strategies on individuals' attitude toward telemental health and subsequently their intention to adopt telemental health. Two different education videos on telemental health (peer- or professional-narrated) were developed based on social identity theory. A survey experiment study was conducted at a major historically black university, with 282 student participants randomly assigned to the two education videos. Individual perceptions of the telemental health service (usefulness, ease of use, subjective norms, relative advantage, trust, and stigma) and their attitude and usage intention data were collected. The results show that ease of use, subjective norms, trust, relative advantage, and stigma significantly influence individuals' attitude toward telemental health in the peer-narrated video group. Only trust and relative advantage were found to be significant factors toward attitude in the professional-narrated video group. This study highlights the importance of designing education strategies and builds a theoretical foundation for understanding the nuanced differences in individuals' responsiveness to different educational materials.

Health-Seeking Behavior and Its Associated Technology Use: Interview Study Among Community-Dwelling Older Adults.

BACKGROUND: Understanding older people's health-seeking behavior (HSB) is crucial for uncovering their health needs and priorities and developing appropriate policies to address them and avert their disease progression. Technologies play an active role in our daily lives and have been incorporated into health activities to support the older population and facilitate their HSB. However, previous studies of HSB have mainly focused on behaviors during illness, and there are limited studies on how technologies have been used in older people's health-seeking activities. OBJECTIVE: This study aimed to investigate HSB and the associated technology use among the older population, ultimately proposing implications for practice to address their unmet health needs. METHODS: This paper presents partial data from a large qualitative study, which has been approved by the institutional review board and used a phenomenological approach. Semistructured interviews were conducted between April 2022 and July 2022, either via Zoom (Zoom Video Communications Inc) or face-to-face sessions. Inclusion criteria were being aged ≥50 years, long-term residence in Singapore, and being able to speak English or Mandarin. The interviews were manually transcribed verbatim, and thematic analysis was performed, with the individual as the unit of analysis to understand the patterns of behaviors. RESULTS: In total, 15 interviews were conducted to reach thematic saturation. We identified 5 main consequences of HSB, which were aligned with the original HSB model. Regarding technology use in health seeking, 4 themes were extracted: the most widely used digital technologies are the mobile health apps and wearable devices with the associated wellness programs launched by the government and local companies, and they have the potential to enhance health communication, promote health maintenance, and increase access to health services; information communication technologies and social media, though not primarily designed for health purposes, play a substantial role in easing the process of seeking health information and managing symptoms. Although the outbreak of the COVID-19 pandemic has resulted in some alterations to older adults' well-being, it has catalyzed the adoption of telehealth as a complement to access health care services, and older adults have different considerations when selecting technologies to facilitate their health seeking and fulfill their health needs. Moreover, 4 archetypes were proposed based on our findings and the insights gained from our participants' observations in their social networks. These findings led to several implications for practice regarding health communication and promotion, health education, technology design and improvement, telemonitoring service implementation, and solutions to address the needs of each proposed archetype. CONCLUSIONS: Unlike the commonly held belief that older adults resist technologies and lack technological proficiency, our findings showed that technologies could play a promising role in facilitating older adults' health seeking. Our findings have implications for the design and implementation of health services and policies.

COVID-19 MORTALITY CASES IN KUBANG PASU DISTRICT

COVID-19 has rapidly impacted on mortality worldwide. Early identification of COVID-19 cases in community at high risk of death can enhance patient treatment and resource allocation. The goal of this study is to identify the characteristics of COVID-19 mortality cases in Kubang Pasu districts in 2021. Data on mortality cases in the year 2021 in Kubang Pasu district were collected, extracted and analyzed. There are 210 (1.9%) mortality cases had been recorded in 2021 due to COVID-19 infection form 11019 COVID-19 cases in Kubang Pasu district. The mortality cases consist of 108(51%) female and 102(49%) male. The highest mortality cases involved the age group of more than 70 years old with 73 (34.8%) cases. The highest race was Malay 193(91.9%), followed by non-Malaysian(2.9%), Chinese 4(1.9%), Siamese 4(1.9%) and Indian 3(1.4%) respectively. Most of the mortality cases are unvaccinated 153 (72.9%). The most coomon cause of death is due to COVID-19 pneumonia with 205 (97.5%) cases. Majority of the cases were screen through symptomatic screening and close contact screening 86 (40.9%) cases and 52 (24.8%) respectively. Among the mortality cases, there are 22(10.5%) brought-in-death cases which 19 (86%) cases are Malay. Most of the brought-in-death cases are unvaccinated, 19 (86%) cases, incomplete vaccine 1 (5%) case and 2 (9%) cases completed vaccine. The highest number of mortality cases occur among those with age more than 70. It involved mostly among Malay race and they were unvaccinated. Lung complication is the main cause of death since most of the mortality cases passed away due to pneumonia. This high number of mortality and BID cases might be attributed to poor health-seeking behaviour among the Kubang Pasu population with COVID-19. Promotion activities about COVID-19 and vaccine should be strengthened further to improve the knowledge and actions towards COVID-19 in community. © 2022, Malaysian Journal of Public Health Medicine. All Rights Reserved.

The effect of fear of COVID-19 on health-seeking behaviors and Pap smear test rates in women.

This study was carried out to determine the effect of fear of COVID-19 on health-seeking behaviors and Pap smear test rates in women. This study was conducted online between June and September 2021. Women aged 21-65 years were invited to participate in the study via social media. A total of 396 women comprised the sample for this study. Data were collected the Fear of COVID-19 Scale, and the Health-seeking Behavior Scale. Data were evaluated using descriptive statistics, parametric tests and regression analysis. As a result of the study, 11.1 percent of women were found to have had a Pap smear test during the pandemic period. Fear of COVID-19 was determined to have a positive and significant effect on online health-seeking behavior (t = 7.915, p < .001), professional health-seeking behavior (t = 4.503, p < .001), traditional health-seeking behavior (t = 6.037, p < .001), and general health-seeking behavior(t = 8.390, p < .001) while it did not have any effect on having a Pap smear test (p > .05). This study showed that although the fear of COVID-19 positively affected health-seeking behaviors in women, the rates of gynecological examination and Pap smear test rates were low during the pandemic.

Changes in Etiology and Clinical Outcomes of Pleural empyema during the COVID-19 Pandemic.

Healthcare-seeking behavior changed during the COVID-19 pandemic and might alter the epidemiology of pleural empyema. In this study, the incidence, etiology and outcomes of patients admitted for pleural empyema in Hong Kong in the pre-COVID-19 (January 2015-December 2019) and post-COVID-19 (January 2020-June 2022) periods were compared. Overall, Streptococcus pneumoniae was the predominant organism in <18-year-old patients, while Streptococcus anginosus, anaerobes and polymicrobial infections were more frequent in adults. In the post-COVID-19 period, a marked decline in the incidence of pleural empyema in children was observed (pre-COVID-19, 18.4 ± 4.8 vs. post-COVID-19, 2.0 ± 2.9 cases per year, p = 0.036), while the incidence in adults remained similar (pre-COVID-19, 189.0 ± 17.2 vs. post-COVID-19, 198.4 ± 5.0 cases per year; p = 0.23). In the post-COVID-19 period, polymicrobial etiology increased (OR 11.37, p < 0.0001), while S. pneumoniae etiology decreased (OR 0.073, p < 0.001). In multivariate analysis, clinical outcomes (length of stay, ICU admission, use of intrapleural fibrinolytic therapy, surgical intervention, death) were not significantly different in pre- and post-COVID-19 periods. In conclusion, an increase in polymicrobial pleural empyema was observed during the pandemic. We postulate that this is related to the delayed presentation of pneumonia to hospitals.

Drivers of medical spending behaviour amid the COVID-19 pandemic: Heuristic or systematic.

BACKGROUND: The COVID-19 pandemic has been creating unprecedented chaos and it could forever alter the way people live and work. Experiencing multiple waves of pandemic attacks could make people evolve their perceived risks about the health crisis, change their healthcare behaviours and medical spending to deal with the changing threats over time. OBJECTIVES: Even though there has been a great dealt of research on personal healthcare behaviours during the COVID-19 pandemic, the individual decision on medical spending has not been well explored. This study uses the health belief model and heuristic-systematic information processing theory to study the key drivers of medical spending behaviour as the COVID-19 pandemic evolved in Vietnam. METHODS: Two surveys were conducted during the first (April 2020) and second waves (August 2020) of the COVID-19 pandemic resulted in a sample size of 1037 cases. The partial least square structural equation modeling (PLS-SEM) technique was employed to explore the structural relationships between health-seeking behaviours, pandemic perceived risks, panic buying, and demographic factors and how these sets of factors drive medical spending behaviours over time. RESULTS: Comparing the two pandemic waves, this study finds significant distinctions in how people evaluate the risks of the pandemic and process information to make decisions about their medical spending. People were primarily influenced by the heuristic processes of panic buying patterns (ß = 0.313, p < 0.001) and the health-related established habits in the first wave. Only in the second wave of the pandemic, the impact of the COVID-19 pandemic perceived risk has been recognized as a significant factor on medical spending via the comparison between perceived risks of the first and second pandemic waves (ß = 0.262, p < 0.001). CONCLUSIONS: This study explores how individuals formulate their spending decisions in extreme conditions and provide valuable insights to help governments and institutions plan their policies to combat the COVID-19 pandemic more effectively.

Perceptions of travel-related health risks and pre-travel health-seeking behaviour among students: A qualitative analysis.

BACKGROUND: The impact of the COVID-19 pandemic on travel risk perceptions and pre-travel healthcare attendance is unknown. We aimed to explore barriers and enablers to engagement in and uptake of pre-travel advice (PTA) among university students, a recognised at-risk group for travel-related morbidity and poor PTA uptake. Additionally, we aimed to explore whether the COVID-19 pandemic has influenced attitudes towards future PTA. METHODS: Semi-structured interviews were conducted with university students (October-December 2021). Thematic analysis of the data was conducted using the Health Belief Model (HBM) framework. RESULTS: We interviewed 18 students (11 male, median age 24). Students' risk perceptions relating to travel-related illnesses were influenced by past experiences, travel destination, vaccination status and knowledge. Barriers to seeking PTA included a lack of perceived need and concerns about accessibility/availability, whereas potential benefits included reduced health risks, vaccine-induced protection, and knowledge gain. Cues to seeking future PTA were perceived risks of travel-related illness, perceived high-risk destination, itinerary-related vaccine requirements, perceived benefits of advice and concerns about COVID-19 infection. COVID-19 risk perceptions did not consistently align with those of other travel-related illness. We used findings to inform recommendations. CONCLUSION: The current COVID-19 pandemic offers an opportunity to increase students' risk awareness and promote preventive travel health behaviours. Recommendations to improve students' future engagement in PTA include: 1) increasing awareness of risks associated with travel, 2) emphasising PTA benefits, and 3) ensuring PTA is convenient, accessible and affordable.

Understanding of Stigmatization and Death Amid COVID-19 in India: A Sociological Exploration.

The unanticipated outbreak of Coronavirus had proven detrimental to human existence. It had created waves of panic, anxiety, and fear among people hence facilitating stigmatization toward an infected person. This stigmatization further influences patients health-seeking behaviour due to the trust deficit in the public health system. The virus had placed the world in an impotent situation as people helplessly watched their loved ones pass away in the absence of effective treatment. Dead bodies are denied a dignified death due to mandatory guidelines prescribed by countries to control the pandemic. This article attempts to understand the process of stigmatization of Coronavirus and its mechanism of influencing the health-seeking behaviour of people. Moreover, the way this stigmatization, accompanied by fear and anxiety, led to the denial of having a dignified death in India.

Evaluation of health-seeking behaviour among older people during the COVID-19 pandemic in Bali and Yogyakarta, Indonesia

The COVID-19 pandemic poses the highest risk to older people with comorbidities, as the rapid spread of the virus reduces the community's access to formal healthcare facilities. This leads to the search for medical alternatives from several informal health sources. Therefore, this study aims to evaluate healthcare-seeking behaviour (HSB) among older people during the COVID-19 pandemic. It also aims to determine the factors influencing this behaviour. Data were obtained from Older People Community-Based Study in Bali and Yogyakarta province, Indonesia, between December 2020 and March 2021, using a phone survey technique. These were analyzed using bivariate (Chi-square test) and multivariate (logistic regression) analyses, to examine the association between the binary outcome of HSB types and explanatory factors. The result showed that 58.3% of the 1241 participants were female, as most were elementary graduates (31.5%) with the average age being 69 years old. During the pandemic period, 49.8% sought medical care at formal health facilities, with a 36% reduction observed in the visitations to formal wellness centres, compared to the pre-pandemic interval. In the multivariate logistic regression, some positive and significant factors were found to influence HSB in visiting formal health facilities. These factors included higher education level/university (AOR=2.04, p<0.05), unemployed status (AOR=1.36, p<0.05), unhealthy lifestyle (AOR=2.53, p<0.001), chronic hypertension disease (AOR=1.78, p<0.001), diabetes (AOR=3.73, p<0.001), and lung disorder (AOR=2.76, p<0.01). In addition, the proportion of inappropriate HSB was relatively high, leading to the necessity to apply the following alternative healthcare techniques, (1) Telephone consultation with professional clinicians, and (2) Provision of village-level care agents, to help monitor older persons' medical conditions during a health crisis. © 2023, Mahidol University - ASEAN Institute for Health Development. All rights reserved.

Behaviour Response among Educated Young Adults Towards COVID-19 Pandemic in Malaysia

Introduction: The new norm of the COVID-19 pandemic may alter the behaviour of an individual either in a positive or negative health-seeking behaviour. The higher education institution may be fully operating someday and students need to practice positive health-seeking behaviour to prevent transmission of the COVID-19 virus. This study aims to identify the behavioural responses of educated young adults towards their health during COVID-19. This study also aims to determine the relationship between health-seeking behaviour and perceived risk towards COVID-19 infection in the future and to determine the association between educational background and health-seeking behaviour during the COVID-19 pandemic. Methods: A cross-sectional study was conducted by distributing the online survey questionnaire adapted from a previous study in 2012 by Masuri et al. that assessed behaviour response towards H1N1 pandemic. 369 participants were included in this study. The data was analysed statistically by using SPSS version 26. Results: The majority of young educated adults (90.8%) showed positive health-seeking behaviour. The result showed no significant differences (p > 0.05) in health-seeking behaviours and perceived risk towards COVID-19 infection. A significant association was found between educational background;educational level (p= 0.015) and courses (p= 0.002) with health-seeking behaviour. Conclusion: This study shows that government and schools/universities/institutions need to provide effective health promotion programs for educated young adults. © 2022 UPM Press. All rights reserved.

Exploring theory-based behavioral interventions promoting COVID-19 prevention and healthcare-seeking for migrant worker men in Singapore: a qualitative study.

BACKGROUND: The first wave of COVID-19 during April to July 2020 in Singapore largely affected the migrant workers living in residential dormitories. A government taskforce working with dormitory operators, employers and non-government agencies came together to deliver behavioral interventions and health care services for migrant worker as dorms were imposed movement restrictions. To fill the research gap in understanding movement restriction experiences of migrant workers, this research seeks to describe dormitory contexts and explore behavior change related to both prevention of transmission as well as healthcare seeking for COVID-19 among male migrant workers. METHODS: With social constructivism as the foundation for this study, 23 telephone interviews were conducted with Bangladeshi and Indian migrant workers. A theory-informed, data-driven conceptual framework, characterized by the "Four Ss": Sensitization, Surveillance, Self-preservation, and Segregation was first generated and later used to frame second-stage, more in-depth, thematic analyses. An effective multipronged approach was documented, persuading migrant workers in our case-study to improve hygiene and follow some safe distancing measures, and adhere to help-seeking when symptomatic. RESULTS: Rapid collective adaptation was demonstrated; it was propped up by effective harnessing of infrastructure and technology. While technology and digital platforms were central to shaping Sensitization for prevention-related behaviors, interpersonal communication, especially peer-sharing, was key to normalizing and accepting healthcare delivery and norms about healthcare seeking. Interpersonal factors particularly supported successful implementation of case-detection Surveillance, stimulating Self-preserving and acceptance of rules, and was found helpful to those Segregated in recovery facilities. In contrast, encouraging prevention-related behaviors relied more heavily on multiple online-platforms, phone-based e-learning/knowledge testing, e-monitoring of behavior, as well as interpersonal exchanges. CONCLUSION: Overall, the findings showed that the conception of the Four Ss helped inform intervention strategies. Anchoring these towards optimal use of technology and harnessing of interpersonal communication for prevention and promotion of healthcare seeking in the planning of future Infectious Disease outbreaks in closed institutional settings is recommended.

Health Services Utilization in China during the COVID-19 Pandemic: Results from a Large-Scale Online Survey.

Timely access to essential health services is a concern as COVID-19 continues. This study aimed to investigate health services utilization during the first wave of the pandemic in China. A cross-sectional online survey was conducted using a self-administrated questionnaire in March 2020. Descriptive statistics and logistic regression were used for data analysis. A total of 4744 respondents were included, with 52.00% reporting affected services utilization. Clinical testing (68.14%) and drug purchase (49.61%) were the most affected types. Higher education level, being married, chronic disease, frequently visiting a provincial medical institution, spending more time on pandemic-related information, perception of high-risk of infection, perception of large health impact of the pandemic, and anxiety/depression were significant predictors for reporting affected services utilization. For the 431 chronic disease respondents, 62.18% reported interruption, especially for drug purchase (58.58%). Affected health services utilization was reported during the first wave of the pandemic in China, especially for those with higher education level, chronic diseases, and COVID-19 related concerns. Enhancing primary healthcare, use of telehealth, extended prescription, and public communication were countermeasures undertaken by China during the rapid rise period. As COVID-19 progresses, the changing disease characteristics, adapted health system, along with enhanced public awareness/knowledge should be considered for the evolution of health services utilization, and further investigation is needed.

The need for a holistic approach toward pandemic control: lessons from a cross-sectional study on COVID-19 in Meghalaya, India.

We conducted a community-based cross-sectional survey of 416 participants from Meghalaya, India to assess knowledge, perceptions, and practices toward recommended COVID-19 preventive measures, and to explore health-seeking behavior and stigma during early phase of the pandemic. Most participants had knowledge of the signs and symptoms of COVID-19 (94%) and its spread (96%), and reported positive behavior change such as handwashing ≥ 6 times/day (41% pre-COVID-19 vs. 81% during COVID-19, P < 0.001), sneezing or coughing into sleeves (65% pre-COVID-19 vs. 89% during COVID-19, P < 0.001) and staying home if having flu-like symptoms (44% pre-COVID-19 vs. 94% during COVID-19, P < 0.001). We found delayed healthcare seeking for non-COVID-19 illnesses (16%). Fear of losing life was reported by 26% participants, as was discrimination toward migrant returnees, with 35% blaming returnees for the spread of COVID-19. We highlight the need for a holistic approach toward pandemic control, including social and mental health interventions, in public health strategies.

Predictors and Consequences of Not Seeking Healthcare during the COVID-19 Pandemic: Findings from the HEAF Cohort.

The COVID-19 pandemic resulted in a dramatic reduction of routine healthcare availability in many European countries. Among a cohort of English middle-aged adults, we explored pre-pandemic and pandemic factors associated with not seeking healthcare during lockdown, and their effect on subsequent self-reported health measures. Longitudinal data from the Health and Employment After Fifty (HEAF) cohort were used. Pre-pandemic data came from the 5th annual follow-up (2019), when participants were aged 56-71 years, and pandemic data were collected by e-survey in February 2021 and November 2021. Response rates of the two e-surveys were 53% and 79%, respectively. Pre-pandemic predictors of not seeking healthcare were: female gender, higher BMI, higher comorbidity, poorer self-rated health and depression; non-care seekers were also more likely to report that family or friends were affected by COVID-19 and to have been advised to shield. Not seeking healthcare during lockdown was associated with a higher risk of reporting worsening of physical, but not mental, health during the later phase of the pandemic. In this cohort, those with generally poorer health were disproportionately more likely to not seek healthcare during lockdown, which may potentially exacerbate pre-existing inequalities and lead to longer-term health consequences.

Impact of COVID-19 on Health Seeking Behavior of Patients with Chronic Disease at Public Hospitals in Jimma Zone, South West Ethiopia.

Background: COVID-19 is a global pandemic with unprecedented medical, economic and social consequences affecting nations across the world. This epidemic arises while chronic diseases are continued to be a public health concern. Though evidence is generated on its impact on the health care system, little is known about the Impact of COVID -19 on the care-seeking behavior of chronic patients. Objective: To assess the Impact of COVID-19 on healthcare-seeking behavior of patients with chronic diseases attending follow-up at public hospitals in Jimma zone, South West Ethiopia. Methods: Facility-based cross-sectional study design was employed. The sample was calculated using the single population proportion formula. Hospitals were selected by using simple random sampling. Then, the final calculated sample size for the study was proportionally allocated to each selected hospital. Data were collected from 400 participants through face-to-face interviews and card reviews. Data were entered into Epi-Data version 3.1 and then exported to SPSS version 23 for analysis. Binary and multivariable logistic regression analyses with 95% CI for odds ratio (OR) were used to identify significant factors. Results: Of the total respondents 156 (39.0%) of them had poor health-seeking behavior. Contact history with COVID -19 patient (AOR = 2.8; 95% CI = 1.1-7.0), perceived moderate depression (AOR = 2.3; 95% CI = 1.2-4.2), perceived extreme depression (AOR = 4.3; 95% CI = 1.8-10.5), shortage of medication (AOR = 2.4; 95% CI = 1.0-6.2) increases the odds of poor health-seeking behavior. In addition, the odds of poor health-seeking in patients with no formal education were higher compared to patients with higher educational status (AOR = 2.7; 95% CI = 1.0-9.0). Conclusion: COVID -19 outbreaks affected the health-seeking behavior of patients with chronic diseases. The impact was found to be more significant among patients who had a contact history with COVID -19 patients. Moreover, perceived depression, shortage of medication, and low educational status were significant predictors of poor health-seeking behavior. Therefore, working on the barriers to the health-seeking behavior of chronic patients may reduce the effect of COVID-19.

Reasons for Knocking at an Empty House: Visualisation, Representation and Dissemination of Health-Related Public Engagement Media.

Stigma and mistrust generate significant barriers to the uptake of biomedical, clinical and public health measures to combat infectious diseases. Many pandemics such as HIV, TB and COVID-19 disproportionately affect poorer communities, and the social and public health impact is connected through socio-political histories and contexts. This chapter describes activities and reflections of a South African public engagement programme, Eh!woza, that aims to bring together the biomedicine of disease with its social context and impact. We describe experiences working on tuberculosis-related public engagement programmes in South Africa, and how these approaches were refocused to address the COVID-19 pandemic. We reflect on the lesson learned and considerations around visualising the social impact of disease and making the visualisation of accurate information relatable to younger audiences. Much of the discussion is situated within description and reflection, touching on both the historical and contemporary cultural and political conditions in which infectious diseases have flourished. Finally, the challenges we faced when effectively disseminating media on large-scale digital platforms are highlighted, raising important questions around representation, mass targets, and impactful dissemination of public engagement outputs.

Coronavirus Disease Pandemic Effect on Medical-Seeking Behaviors Even in One Resource-Competent Community: A Case Controlled Study.

(1) Background: The coronavirus disease 2019 (COVID-19) pandemic had overwhelming impacts on medical services. During its initial surge, Taiwan was unique in maintaining its medical services without imposing travel restrictions, which provided an ideal environment in which to test if the fear of becoming infected with COVID-19 interfered with health-seeking behavior (HSB). We tested this hypothesis among adults with acute complicated appendicitis (ACA). (2) Methods: Adults with acute appendicitis were enrolled between 1 January and 30 June 2020 (COVID-19 period). The first two quarters of the preceding 3 years were defined as a historical control group. Outcome measures included the rate of ACA and the number of hospital stays. (3) Results: The COVID-19 era included 145 patients with acute appendicitis. Compared to the historical control (320 patients), the COVID-19 era was significantly associated with a higher length of symptom duration until presentation to the emergency room within >48 h (17.2% vs. 9.1%, p = 0.011), a higher incidence of ACA (29.7% vs. 19.4%, p = 0.014), and a longer length of hospital stays (5.0 days vs. 4.0 days, p = 0.043). The adjusted models showed that the COVID-19 period had a significant relationship with a higher rate of ACA (odds ratio (OR) = 1.87; 95% confidence interval (CI): 1.23-2.52; p = 0.008) and longer length of hospital stays (OR= 2.10; 95% CI: 0.92 to 3.31; p < 0.001). (4) Conclusions: The fear of COVID-19 may prohibit patients from seeking medical help, worsening their clinical outcomes. The surgical community should take action to provide scientific information to relive mental stress.

ECG Utilization Patterns of Patients With Arrhythmias During COVID-19 Epidemic and Post-SARS-CoV-2 Eras in Shanghai, China.

Background: The COVID-19 pandemic has led to concerns around its subsequent impact on global health. Objective: To investigate the health-seeking behavior, reflected by ECG utilization patterns, of patients with non-COVID-19 diseases during and after COVID-19 epidemic. Methods: Taking advantage of the remote ECG system covering 278 medical institutions throughout Shanghai, the numbers of medical visits with ECG examinations during the lockdown (between January 23 and April 7, 2020), post-lockdown (between April 8 and December 31, 2020) and post-SARS-CoV-2 (between January 23 and April 7, 2021) periods were analyzed and compared against those during the same periods of the preceding years (2018 and 2019). Results: Compared with the same period during pre-COVID years, the number of medical visits decreased during the lockdown (a 38% reduction), followed by a rebound post-lockdown (a 17% increase) and a fall to the baseline level in post-SARS-CoV-2 period. The number of new COVID-19 cases announced on a given day significantly correlated negatively with the numbers of medical visits during the following 7 days. Medical visit dynamics differed for various arrhythmias. Whereas medical visits for sinus bradycardia exhibited a typical decrease-rebound-fallback pattern, medical visits for atrial fibrillation did not fall during the lockdown but did exhibit a subsequent increase during the post-lockdown period. By comparison, the volume for ventricular tachycardia remained constant throughout this entire period. Conclusion: The ECG utilization patterns of patients with arrhythmias exhibited a decrease-rebound-fallback pattern following the COVID-19 lockdowns. Medical visits for diseases with more severe symptoms were less influenced by the lockdowns, showing a resilient demand for healthcare.

[Time to initial diagnosis of imported malaria and its influencing factors in Jiangsu Province].

OBJECTIVE: To investigate the health-seeking behaviors of imported malaria cases after returning to China, and to investigate the factors affecting the time to initial diagnosis, so as to provide the scientific evidence for early identification of imported malaria cases and prevention of severe cases development and secondary transmission. METHODS: The individual demographic features, and the disease onset and the time to initial diagnosis of imported malaria cases in Jiangsu Province in 2019 were captured from the National Notifiable Disease Report System and the Information Management System for Parasitic Disease Control in China. The characteristics of health-seeking behaviors and epidemiological features of imported malaria cases were descriptively analyzed, and the factors affecting the time to initial diagnosis of imported malaria cases after returning to China were identified using multivariate logistic regression analysis. RESULTS: A total of 244 imported malaria cases were reported in Jiangsu Province in 2019, and the time to initial diagnosis of the cases were 1-12 days, with mean time of (1.53 ± 1.65) days, with median time of one day. The highest number of malaria cases seeking healthcare services were found on the day of developing primary symptoms (76 cases, 31.1%), followed by on the second day (68 cases, 27.9%), on the third day (46 cases, 18.9%), and 54 cases (22.1%) received initial diagnosis 3 days following presence of primary symptoms, including 3 cases with initial diagnosis at more than one week. High proportions of imported malaria cases with a delay in the time to initial diagnosis were seen in migrant workers who returned to China in January (14 cases, 5.7%) and December (13 cases, 5.3%) and those aged between 41 and 50 years (32 cases, 13.1%). Multivariate logistic regression analysis showed relative short time to initial diagnosis among imported malaria cases returning to China on March [odds ratio (OR) = 0.16, P = 0.03, 95% confidence interval (CI): (0.03, 0.85)] and those with a history of overseas malaria parasite infections [OR = 0.36, P = 0.001, 95% CI: (0.19, 0.67)]. CONCLUSIONS: Timely health-seeking behaviors should be improved among imported malaria cases in Jiangsu Province, patients with a history of overseas malaria infections require faster health-seeking activities.

Healthcare concerns of older adults during the COVID-19 outbreak in low- and middle- income countries: Lessons for health policy and social work

This reprinted chapter originally appeared in Journal of Gerontological Social Work, 2020, 63[6-7], 717-723. (The following of the original article appeared in record 2021-00510-034.) Older people have been identified to be one of the most vulnerable population groups to the 2019 novel coronavirus (COVID-19). At the same time, more health workers in low-and middle-income countries (LMICs) including Ghana are contracting COVID-19. This poses healthcare utilization concerns for older adults. As a result, many older adults are changing their health-seeking behavior by staying at home and resorting to informal healthcare such as the use of traditional therapies and over-the-counter medicines for self-treatment or to boost their immune system. This commentary calls for social workers to collaborate with health authorities and community pharmacists to develop social and health programs to increase older adults' access to healthcare during the COVID-19 crisis. Policies are also required to deal with the pandemic and its impact on health systems in LMICs for both short and long term. We have suggested in this commentary how governments, health institutions, and local authorities in LMICs can address the healthcare concerns of older adults during this and any future pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved)