Covid-19 Related Generalized Anxiety Disorder Among Health Care Workers In A Hospital In The Greater Accra Region (preprint)

Background The emergence of Coronavirus disease 2019 (COVID-19) an infectious disease caused by the newly discovered severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) has caused a lot of harm to humanity. Healthcare workers who are the leading the charge in the fight against the virus can experience mental health challenges with anxiety being an important illness. Anxiety can become morbid quickly and ultimately affect function, hence the need to study its prevalence among HCWs, since they are a high-risk population. Studies across various regions worldwide reported elevated levels of anxiety amongst HCWs during the SARS, Ebola, and H1N1 pandemics. Nevertheless, Generalized Anxiety Disorder (GAD), an easily measured and ubiquitous member of the family of anxiety disorders has hardly been researched. However, new studies in Togo, China, India and Mexico have reported elevated levels of GAD in HCWs during the COVID-19 pandemic. Given the complexities surrounding mental health care in Ghana, and Africa as a whole it would be expedient to uncover the prevalence of GAD among HCWs during the pandemic. Hence, a study at Family Health Hospital will provide information about the prevalence of COVID-19 related GAD among Health care workers representative of Ghana. Aim The aim of this study was to establish the prevalence of COVID-19 related GAD amongst healthcare workers, in a tertiary hospital in Accra. Methods A descriptive cross-sectional study design using a self-administered questionnaire was employed. Nine-two (92) HCWs in the study area were sampled. A consecutive sampling technique was used to select the respondents for the study. The study was analyzed using SPSS version 25. The results were presented in summary tables and analyzed using frequencies and percentages. Chi square test performed on categorical data to test association between selected variables and their outcome with COVID-19 related GAD. Results The GAD level among nurses was 55.4%, and for doctors it was 30.4%. The GAD level among medical laboratory technicians and pharmacists were 7.6% and 6.5% respectively. Furthermore being age 50-69 years was a significant risk factor for developing GAD during the COVID-19 pandemic in Ghana. Female HCWs were more likely to experience GAD. However, only 13.1% of the HCWs were considered to have Corona phobia. Perception of workplace as being high risk was positively correlated with mild to moderate forms of anxiety. However, perception of organizational support as being guaranteed in case one succumbed to the virus and confidence in PPE availability was not reported to be strong protective factors against GAD among HCWs. Conclusion COVID-19 related GAD is a challenge amongst HCWs especially nurses in FHH. The management of the FHH should set up certain services such as psychological help lines, peer support programs as well as run a sensitization campaign to cater for the wellbeing of doctors as well as encourage mental health seeking behavior.

Impact of Emerging COVID-19 variants on psychosocial health: A Systematic Review (preprint)

Background: The COVID-19 pandemic has had significant psychological effects on individuals and communities around the world. Studies have found that the prevalence of anxiety and depression symptoms increased significantly during the pandemic. The goal of the study is to understand how the emerging new virus variants keep the world in a state of fear and the ways in which mental health measures can be implemented and adopted to alleviate anxiety. Methods: A broad search for observational studies were carried out in Pubmed, Google Scholar, Clinical Key, and World Medical Library. Studies that reported and/or related the existence of anxiety generated by suffering or not from diseases caused by the new emerging Covid-19 viruses and that for which the full text of the article was accessible were included in the study while systematic review and meta-analysis and studies in groups were excluded. Results: 22 studies were included in the review. The deleterious psychosocial effects were the restructuring of life, establishment of unhealthy habits, emergence of "corona phobia", fear and stigma of being afflicted with the disease and spreading it to loved ones, and lack of contact with others. Increased rates of depression and anxiety were also seen. The circulating variants responsible for these main psychosocial repercussions were: Epsilon, Zeta, Eta, Iota, Kappa, Alpha, Beta, Gamma, and Delta. Social support was found to be protective. Conclusion: Hence interventions targeted at promoting mental health should be considered a public health priority.

Mental Health Problems and Coping Strategies of Medical Interns in Clinical Teaching Base During Epidemic Period - Data from China (preprint)

Background The COVID-19 pandemic has dealt a heavy blow to the mental health of tens of millions of people, with nearly 1 billion people living with a mental disorder worldwide and one person dying every 40 seconds from suicide [1]. On 5 May 2023, WHO declared the end of the global health emergency, but globally, more than 2.6 million new cases and more than 17 000 deaths have been reported in the past 28 days (10 April to 7 May 2023) [2]. There are new coronavirus positive cases around us from time to time, and many people are anxious about this. It shows that COVID-19 remains a global health threat. Therefore, we should pay attention to the mental health problems caused by the epidemic, especially the social vulnerable population who are in the front line of fighting the epidemic but have relatively weak self-prevention ability [3] -- medical interns. It's necessary to investigate their mental health status and explore coping strategies.Methods We administered the Symptom Checklist 90 (SCL-90) and Simplified Coping Style Questionnaire (SCSQ) to assess somatization symptoms and coping styles, respectively, and compared results to national norms for Chinese youth.Results The scores of somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, terror, paranoia and psychosis of the interns were higher than those of the national youth group norm. The scores of somatization and phobia in female students were higher than those in male students, and the scores of each factor in undergraduate students were higher than those in college students, and the differences were statistically significant (P < 0.05). The score of negative coping style was positively correlated with the total score of negative factors of mental health (somatization, compulsion, depression, anxiety) (β=-0.569, P < 0.05). Positive coping style was negatively correlated (β = 0.899, P < 0.01).Conclusion During the epidemic period, the mental health level of interns in the base is lower than that of the national youth norm, and female and undergraduate interns are more serious. Positive coping style can reduce their mental health problems.

Developmental Epidemiology of Pediatric Anxiety Disorders.

This review summarizes the developmental epidemiology of childhood and adolescent anxiety disorders. It discusses the coronavirus disease of 2019 (COVID-19) pandemic, sex differences, longitudinal course, and stability of anxiety disorders in addition to recurrence and remission. The trajectory of anxiety disorders-whether homotypic (ie, the same anxiety disorder persists over time) or heterotypic (ie, an anxiety disorder shifts to a different diagnosis over time) is discussed with regard to social, generalized, and separation anxiety disorders as well as specific phobia, and panic disorder. Finally, strategies for early recognition, prevention, and treatment of disorders are discussed.

The Effects of COVID-19 Phobia on Abuse of Children by Parents.

BACKGROUND: This study aims to determine the effect of parents' levels of COVID-19 phobia on the risk of abuse and neglect towards their children. SUBJECTS AND METHODS: A total of 472 parents, who have children between the ages of 0-18, who use social media and volunteer to participate in the research, were included in the study. The sociodemographic information form, Corona Virus 19 Phobia Scale (C19P-S), and Abuse Awareness Scale-Parent Form were used to collect the study's data. RESULTS: 57.9% of the parents participating in the study were female, and the mean age was 42.08±10.33. It was found that 55.9% of the participants continued to go to the workplace during the COVID-19 pandemic. While 12% of the parents were treated for COVID-19, 21.4% were quarantined. The average C19P-S score of the parents was found to be 50.2. The mean score of the sub-dimensions of the scale varies between 8.4 and 18.5. The average score of the parents from the Abuse Awareness Scale-Parent Form was 55.4. A positive correlation was found between the Abuse Awareness Scale-Parent Form and the C19P-S score averages. CONCLUSION: The findings have shown that the family's risk of children being exposed to abuse and neglect increases due to the negativities experienced during the pandemic period.

Assessing the Fear Factor of Coronavirus Disease 2019 (COVID-19) in Korea Using the COVID-19 Phobia Scale: A Cross-Sectional Study.

BACKGROUND: A study on coronavirus disease 2019 (COVID-19) phobia among students revealed that fear of contracting COVID-19 was associated with commuting to school and spending time with others at school. Therefore, it is the need-of-the-hour for the Korean government to identify factors affecting COVID-19 phobia among university students and to consider these factors while framing the policy direction for the process of returning to normalcy in university education. Consequently, we aimed to identify the current state of COVID-19 phobia among Korean undergraduate and graduate students and the factors affecting COVID-19 phobia. METHODS: This cross-sectional survey was conducted to identify the factors affecting COVID-19 phobia among Korean undergraduate and graduate students. The survey collected 460 responses from April 5 to April 16, 2022. The questionnaire was developed based on the COVID-19 Phobia Scale (C19P-S). Multiple linear regression was performed on the C19P-S scores using five models with the following dependent variables: Model 1, total C19P-S score; Model 2, psychological subscale score; Model 3, psychosomatic subscale score; Model 4, social subscale score; and Model 5, economic subscale score. The fit of these five models was established, and a P-value of less than 0.05 (F test) was considered statistically significant. RESULTS: An analysis of the factors affecting the total C19P-S score led to the following findings: women significantly outscored men (difference: 4.826 points, P = 0.003); the group that favored the government's COVID-19 mitigation policy scored significantly lower than those who did not favor it (difference: 3.161 points, P = 0.037); the group that avoided crowded places scored significantly higher than the group that did not avoid crowded places (difference: 7.200 points, P < 0.001); and those living with family/friends scored significantly higher than those in other living situations (difference: 4.606 points, P = 0.021). Those in favor of the COVID-19 mitigation policy had significantly lower psychological fear than those who were against it (difference: -1.686 points, P = 0.004). Psychological fear was also significantly higher for those who avoided crowded places compared to those who did not difference: 2.641 points, P < 0.001). Fear was significantly higher in people cohabitating than those living alone (difference: 1.543 points, P = 0.043). CONCLUSION: The Korean government, in their pursuit of a policy that eases COVID-19-related restrictions, will also have to spare no efforts in providing correct information to prevent the escalation of COVID-19 phobia among people with a high fear of contracting the disease. This should be done through trustworthy information sources, such as the media, public agencies, and COVID-19 professionals.

Effects of phase synchronization and frequency specificity in the encoding of conditioned fear-a web-based fear conditioning study.

Oscillatory synchronization in the theta-frequency band was found to play a causal role in binding information of different modalities in declarative memory. Moreover, there is first evidence from a laboratory study that theta-synchronized (vs. asynchronized) multimodal input in a classical fear conditioning paradigm resulted in better discrimination of a threat-associated stimulus when compared to perceptually similar stimuli never associated with the aversive unconditioned stimulus (US). Effects manifested in affective ratings and ratings of contingency knowledge. However, theta-specificity was not addressed so far. Thus, in the present pre-registered web-based fear conditioning study, we compared synchronized (vs. asynchronized) input in a theta-frequency band vs. the same synchronization manipulation in a delta frequency. Based on our previous laboratory design, five visual gratings of different orientations (25°, 35°, 45°, 55°, 65°) served as conditioned stimuli (CS) with only one (CS+) paired with the auditory aversive US. Both CS and US were luminance or amplitude modulated, respectively, in a theta (4 Hz) or delta (1.7 Hz) frequency. In both frequencies, CS-US pairings were presented either in-phase (0° phase lag) or out-of-phase (90°, 180°, 270°), resulting in four independent groups (each group N = 40). Phase synchronization augmented the discrimination of CSs in CS-US contingency knowledge but did not affect valence and arousal ratings. Interestingly, this effect occurred independent of frequency. In sum, the current study proves the ability to successfully conduct complex generalization fear conditioning in an online setting. Based on this prerequisite, our data supports a causal role of phase synchronization in the declarative CS-US associations for low frequencies rather than in the specific theta-frequency band.

Distortions and disjunctions of temporalities in times of pandemic.

Since the Covid pandemic required the implementation of restrictions, my patients have been concerned with their experience of time, which seemed distorted by the state of emergency impacting on our lives, and often elicited the feeling of inhabiting a dystopian world. There appear existential demands for subjective meaning, especially when the fear of death is so intense it appears uncontainable. The state of uncertainty impacts upon the sense of the future, and hence on desire and hope: affect states that emerge primarily from the internal world. Within the framework of Western thought, time is linear (Cronos), cyclical and recursive (Aion) or fugitively punctual (Kairos). These figures of time implicate the interaction between the internal and external world within a first-person account. The paper focuses on Kairos - that critical moment where the subject's sense of reality through attention serves self-protective functions and leads to action. Kairos is also the temporality of trauma. Vignettes from two patients, of different ages and in different phases of analyses, illustrate the subjective vicissitudes of Kairos, depending on the state of the self, ego, and biographical inscriptions in a wider human chronology. Freud's equation: perception=attention=time captures the psychic work and significance of the temporality of Kairos.

Incidence rates of treated mental disorders before and during the COVID-19 pandemic - a nationwide study comparing trends in the period 2015 to 2021 (preprint)

Background: There is a concern that exposure to psychosocial stressors during the COVID-19 pandemic may have led to a higher incidence of mental disorders. Thus, this study aimed to compare trends in incidence rates of depressive disorder, anxiety disorders, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and eating disorders in primary- and specialist health care before (2015-2019) and during the COVID-19 pandemic (2020-2021). Methods: We used aggregated population registry data to calculate incidence rates of mental disorders from primary (The Norwegian Control and Payment of Health Reimbursement Registry (KUHR)) and specialist (The Norwegian Patient Registry (NPR)) health care. The analyses included all Norwegian residents aged 18-65 during the study period. Incident cases were defined as having no previous registration with the same mental disorder in KUHR (from 2006) or NPR (from 2008). We used linear prediction models and mean models to compare incidence rates and test trends before and during the pandemic. Results: During the pandemic, the incidence rates among women were higher or as predicted for OCD in specialist care and for eating disorders in both primary and specialist care. Incidence rates for depression and phobia/OCD among both genders in primary care and phobic anxiety disorders among both genders in specialist care were lower or as predicted. Conclusion: The COVID-19 pandemic may have led to more women needing treatment for OCD and eating disorders in the Norwegian population. The decreased incidence rates for some disorders might indicate that some individuals either avoided seeking help or had improved mental health during the pandemic.

Phobia of Coronavirus (Covid-19) Pandemic in Turkish Society.

BACKGROUND: The American Psychiatric Association describes phobia as a state of constant, extreme, and high level of fear against an object or situation. This study determines the level of phobia related to the coronavirus (COVID-19) pandemic in Turkish society. SUBJECTS AND METHODS: Data were collected through an online survey between May 26 and June 5, 2020, using an introductory information form, a COVID-19 specification questionnaire, and a COVID-19 Phobia Scale (CP19-S). The data were then analysed through a descriptive statistical analysis, the Kruskal-Wallis and Mann-Whitney U tests in independent groups. RESULTS: Participants' phobia of COVID-19 was close to the moderate level (46.43±14.88). It was found that the scores for the COVID-19 Phobia Scale were higher in female participants, individuals who had to change duties during the pandemic, have a chronic illness, individuals who did not have social security, participants who had a relative/friend die due to COVID-19, those having no idea about preventive studies in Turkey, those stating that preventive studies in the globally are insufficient, those expressing that it is partially possible to be protected by taking personal measures, those expressing that it is partially possible to treat with medicine, those who have no idea about finding the vaccine and preventing its spread. The difference was found to be statistically significant (p<0.05). CONCLUSION: In conclusion, the findings of this study are important for the development of intervention programs and support strategies to protect mental health and increase psychological resilience during the COVID-19 outbreak.

Prevalence of Internet Gaming Addiction and its Association with Social Phobia among Arab Adolescents and Young Adults: A Cross-Sectional Study (preprint)

Background Gaming addiction is a compulsive mental health condition that can have severe negative consequences on a person's life. As online gaming has increased during the COVID-19 pandemic, studies have shown a heightened risk of mental health issues. This study aims to assess the prevalence of severe phobia and addiction to online gaming among Arab adolescents and identify risk factors associated with these disorders.Methods This cross-sectional study was conducted across 11 Arab nations. Participants were recruited using convenience sampling through an online survey distributed on social media platforms in 11 Arab countries. The survey included demographic questions, the Nine-item Internet Gaming Disorder Scale-Short Form (IGDS-SF9) to measure participants' online gaming addiction, the Social Phobia Scale (SPS), and questions assessing the impact of the COVID-19 pandemic on the prevalence of internet gaming addiction. The data were analyzed using SPSS win statistical package version 26.Results Out of 2458 participants, 2237 were included in the sample due to non-response and missing data. The average age of the participants was 19.9 ± 4.8, and the majority were Egyptian and unmarried. 69% of the participants reported playing more than usual since the COVID-19 pandemic, as they were confined to their homes. Higher social phobia scores were associated with being single, male, and Egyptian. Participants from Egypt and those who felt that the pandemic significantly increased their gaming time had higher scores for online gaming addiction. Several major criteria, such as playing hours per day and beginning gaming at an early age, were associated with a higher level of online gaming addiction with social phobia.Conclusion The study's findings suggest that there is a high prevalence of internet gaming addiction among Arab adolescents and young adults who play online games. The results also indicate a significant association between social phobia and several sociodemographic factors, which may inform future interventions and treatments for individuals with gaming addiction and social phobia.

Female migraine patients had lower COVID-19 phobia and PCL-5 scores during the lockdown period.

BACKGROUND: To examine the impact of the lockdown period of the pandemic on COVID-19 phobia and post-traumatic stress disorder (PTSD) in migraine patients. METHODS: A total of 73 patients, including 39 migraine and 34 controls, completed the study during the lockdown period. The patients were evaluated using the Structured Headache Questionnaire, PTSD Checklist for DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) (PCL-5) and COVID-19 Phobia Scale via the telephone-based telemedicine method. RESULTS: Migraine patients had significantly lower scores in all subgroups of the COVID-19 Phobia Scale (mean = 42.33 ± 12.67) than those in the healthy control group (mean = 52.88 ± 13.18). PCL-5 scale scores in migraine patients were significantly lower (mean = 27.18 ± 14.34) compared to the healthy controls (Mean = 34.03 ± 14.36). Migraine attack frequency decreased or did not change in 67% of the patients during the lockdown period. CONCLUSION: Acute stress response to an extraordinary situation such as a pandemic may be more controlled in migraine patients, yet specific phobia and post-traumatic stress disorder have been reported more frequently in patients with migraine under normal living conditions. We interpreted that the life-long headache-associated stress may generate a tendency to resilience and resistance to extraordinary traumatic events in migraine patients.

Reliability and validity of the Chinese version of the COVID-19 Phobia Scale.

BACKGROUND: The COVID-19 pandemic has become a source of fear worldwide and has negative mental health effects on the general population. In 2022, the epidemic continues to be characterized by many points, widespread and frequent in China, and the situation is serious and complex. To provide an effective and scientific tool, the study validated the Chinese version of the COVID-19 Phobia Scale (C19P-SC). METHODS: This study selected 1138 Chinese individuals (age ranged 13 to 80). RESULTS: Cronbach's alpha coefficient for the C19P-SC was 0.93 (the coefficients of the four dimensions ranged from 0.75 to 0.85). The results of the confirmatory factor analysis supported the four-factor structure of the C19P-SC. Meanwhile, there was a positive and significant correlation between coronaphobia and state anxiety (r = 0.48, p < 0.001). The metric invariance hypothesis and the scalar invariance hypothesis were valid in the different subgroups. Significant multivariate effects of gender, education level, and identity differences on coronaphobia were found. CONCLUSIONS: The Chinese version of the COVID-19 Phobia Scale has good psychometric properties and is suitable for measuring COVID-19 phobia in Chinese individuals.

Psychometric properties of the Persian version of the COVID-19 Phobia Scale (C19P-S).

BACKGROUND: During various infectious pandemics, phobia or panic has been suggested as one of the most common mental disorders. The current study reports on the psychometric properties of the Persian version of the COVID-19 Phobia Scale (C19P-S) in Iran. METHODS: The forward-backward translation procedure was applied to translate the English version of the C19P-S into Persian. Then, content and face validity, structural validity (exploratory and confirmatory factor analyses), convergent and discriminant validity, concurrent validity, reliability, and stability were performed to evaluate the Persian version. RESULTS: In all, 660 people participated in the study. The mean age of patients was 35.55 (SD = 12.24) years. Exploratory factor analysis confirmed a four-factor structure for the scale. Confirmatory factor analysis showed that almost all fitness indices for the model were satisfactory (RMSEA = 0.06, CFI = 0.96, TLI = 0.96, IFI = 0.97). The Cronbach's alpha coefficient and intraclass correlation coefficient (ICC) for the questionnaire were 0.95 and 0.96, respectively. CONCLUSION: The Persian version of C19P-S showed good psychometric properties and a good fit for the four-factor structure. It can now be used to assess panic disorder in therapeutic settings and identify candidates needing clinical intervention.

Chinese college students COVID-19 phobia and negative moods: Moderating effects of physical exercise behavior.

Objective: We investigated the effects of COVID-19 fear on negative moods among college students, and assessed the efficacy of physical exercise behavior as a moderator variable. Methods: This was a cross-sectional study. Students from three colleges and universities in Shangqiu City, Henan Province and Yangzhou City, Jiangsu Province were enrolled in this study, which was performed during the COVID-19 pandemic using an online questionnaire. A total of 3,133 college students completed the questionnaire. Measurement tools included the COVID-19 Phobia Scale (C19P-S), Depression-Anxiety-Stress Self-Rating Scale (DASS), and the Physical Activity Behavior Scale (PARS-3). Results: During the COVID-19 pandemic, the rates of depression, anxiety, and stressful negative moods among college students were 35.5, 65.5, and 10.95%, respectively; there was a positive correlation between COVID-19 fear and negative moods among college students (r = 0.479, p < 0.001), which was negatively correlated with physical exercise behavior (r = -0.4, p < 0.001); the regulating effects of physical exercise behavior were significant (ΔR2 = 0.04, p < 0.001). Conclusion: The rate of negative moods among college students is high, and the fear for COVID-19 is one of the key factors that lead to negative moods. Physical exercise can modulate the impact of COVID-19 fear among college students on negative moods. Studies should elucidate on mental health issues among different populations during the COVID-19 pandemic.

Contact with primary care physicians among adults with pre-existing common mental health problems during the COVID-19 pandemic: a registry-based study from Norway (preprint)

Background: During the COVID-19 pandemic, individuals with pre-existing mental health problems may have experienced additional stress, which could worsen symptoms or trigger relapse. Objective: To investigate if the number of consultations with general practitioners (GPs) among individuals with a pre-existing common mental health problem during the pandemic differed from pre-pandemic years. Methods: Data on consultations with GPs among 18-65-year-olds registered with common mental health problems in 2017-2021 were retrieved from the Norwegian Control and Payment of Health Reimbursement register. Based on data from the pre-pandemic years (2017-2019), we predicted the number of consultations per week for depression, anxiety disorder, phobia/obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and eating disorders during the pandemic (March 2020-December 2021) among individuals with pre-existing mental health problems. The forecasted and observed trends in GP consultations per week during the pandemic were stratified by diagnosis, gender, and age groups. Results: The observed number of consultations for anxiety disorder, PTSD, and eating disorders were significantly higher than forecasted during extended periods of the two pandemic years. The differences were largest for PTSD (on average 37% higher in men and 47% higher in women during the pandemic), and for eating disorders among women (on average 87% higher during the pandemic). There were only minor differences between the predicted and observed number of consultations for depression and phobia/OCD. Conclusions: During the pandemic, individuals with a recent history of mental health problems were more likely to seek help for anxiety disorder, PTSD, and eating disorders, as compared to pre-pandemic years.

Exploring the Mental, Social, and Lifestyle Effects of a Positive COVID-19 Infection on Syrian Refugees in Jordan: A Qualitative Study.

Migrants and refugees are among the vulnerable populations that suffered disproportionately from the COVID-19 crisis. However, their experiences with COVID-19 positivity status have not been investigated. This study explored the physical, mental, and psychosocial impacts of a positive COVID-19 diagnosis on Syrian refugees living in Jordan. Using a qualitative approach, twenty phone interviews were conducted with ten adult Syrian refugees living within the camp and ten refugees living in non-camp (host community) settings in Jordan. Follow-up interviews with five health care providers at a refugee camp were conducted to explore the services and support provided to the refugees with COVID-19 infection. The findings were thematically analyzed and grouped into major themes, subthemes, and emerging themes. Refugees living within camp settings had better access to testing, healthcare, and disease management and did not experience fear of being deported. Refugees in both settings suffered mental and psychosocial health impacts, social isolation, fear of death, and disease complications. COVID-19 infection has negatively impacted refugees' well-being with noticeable disparities across the different living conditions. Refugees living within host community settings may need more support for managing their condition, accessibility to free testing, as well as treatment and healthcare services.

Relationships among COVID-19 phobia, health anxiety, and social relations in women living with HIV in Iran: A path analysis.

INTRODUCTION: The COVID-19 pandemic and its consequences have caused fear and anxiety worldwide and imposed a significant physical and psychological burden on people, especially women living with HIV (WLHIV). However, WLHIV were not studied as well as others during the pandemic. Hence, this study aimed to determine the relationships between COVID-19 phobia, health anxiety, and social relations in WLHIV. MATERIALS AND METHODS: This cross-sectional study enrolled 300 WLHIV who had records at the Iranian Research Center for HIV/AIDS of Tehran University of Medical Sciences. Data were collected using sociodemographic questionnaire, the fear of COVID-19 scale, the social relations questionnaire, the socioeconomic status scale and the health anxiety inventory. Path-analysis was used to assess the direct and indirct associations between variables. RESULTS: Based on the path analysis, among variables that had significant causal relationships with social relations, socioeconomic status (ß = -0.14) showed the greatest negative relationship, and health anxiety (ß = 0.11) had the strongest positive relationship on the direct path. On the indirect path, fear of COVID-19 (ß = 0.049) displayed the greatest positive relationship. The level of education (ß = 0.29) was the only variable showing a significant positive relationship with social relations on both direct and indirect paths. CONCLUSION: Our result showed that increased fear and health anxiety related to a higher social relations score in WLHIV. Hence, due to their vulnerability, these people require more support and education to adhere to health protocols in future pandemics and similar situations.

Real-world experience of switching from intravenous to subcutaneous vedolizumab maintenance treatment for inflammatory bowel diseases.

BACKGROUND: Subcutaneous (SC) vedolizumab is effective in inflammatory bowel diseases (IBD) when administered after induction with two infusions. AIM: To assess the effectiveness, safety and pharmacokinetics of a switch from intravenous (IV) to SC maintenance vedolizumab in patients with IBD METHODS: In this prospective cohort study, patients with IBD who had ≥4 months IV vedolizumab were switched to SC vedolizumab. We studied the time to discontinuation of SC vedolizumab, adverse events (AEs), changes in clinical and biochemical outcomes and vedolizumab concentrations at baseline, and weeks 12 and 24. RESULTS: We included 82 patients with Crohn's disease (CD) and 53 with ulcerative colitis (UC). Eleven (13.4%) patients with CD and five (9.4%) with UC discontinued SC vedolizumab after a median of 18 (IQR 8-22) and 6 weeks (IQR 5-10), respectively. Four patients with CD switched to a different drug due to loss of response, nine switched back to IV vedolizumab due to adverse events, and three due to needle fear. Common AEs were injection site reactions (n = 15) and headache (n = 6). Median clinical and biochemical disease activity remained stable after the switch. Median serum vedolizumab concentrations increased from 19 µg/ml at the time of the switch to 31 µg/ml 12 weeks after the switch (p < 0.005). CONCLUSIONS: Switching from IV to SC vedolizumab maintenance treatment is effective in patients with CD or UC. However, 9% of patients were switched back to IV vedolizumab due to adverse events or fear of needles.

Evaluation of Phobia, Knowledge, Attitude and Practice about SARS-CoV-2 Infection, a Study on Healthcare Workers and Their 1st Degree Relatives.

Background: Phobia as a psychological disorder seems to be aggravated during health crises like the current COVID-19 outbreak. On the other hand, people's knowledge about a situation can help decrease the resulting fear. Study design: This is a cross-sectional analytical study to evaluate the COVID-19 related phobia and to measure knowledge, attitude, and practice of our target Iranian population about COVID-19. Methods: In this study, DSM-5 specific phobia questionnaire, adapted to SARS-CoV2-19 infection, was used to evaluate the COVID-19 related phobia. Moreover, the knowledge, attitude, and practice (KAP) questionnaire, specific for SARS-CoV-2 infection, was applied. Results: Phobia score was significantly higher in 1st-degree relatives of healthcare staff (20.38±5.82) than healthcare staff (18.36±5.68) (p=0.021). Females showed a significantly more severe phobia (20.27±5.41) than males (17.72±5.35, p=0.001). COVID-19 phobia was significantly more severe in those with past psy-chiatric conditions than in those without psychiatric history (p<0.05). The 1st-degree relatives of healthcare staff had a significantly lower level of knowledge about SARS-CoV-2 infection (8.19±1.65) than healthcare staff (9.08±1.28, p=0.001). Additionally, age had a positive significant correlation with knowledge and practice towards SARS-CoV-2 infection. Conclusion: Both Iranian healthcare staff and 1st-degree relatives of healthcare workers are suffering from moderate COVID-19 phobia. Females are more concerned than males about COVID-19. Phobia is more severe in people with underlying psychiatric conditions than other people. The knowledge level of Iranian healthcare workers and 1st-degree relatives of healthcare staff about COVID-19 is acceptable but it needs improvement in certain areas.