Exploring the knowledge, attitudes, behaviors and training needs of obstetric and gynecological nurses regarding COVID-19 during the peak period of the pandemic in middle-risk areas of China: A cross-sectional study.

Background: COVID-19 has become a global pandemic, which necessitates that health workers be capable of protecting themselves and their patients. This article aimed to describe knowledge levels, attitudes, behaviors and training needs regarding COVID-19 among obstetric and gynecological nurses in medium-risk areas during the pandemic. Method: A cross-sectional survey of obstetric and gynecological nurses in medium-risk areas was performed during the peak period of the pandemic in China. The main survey tool was the self-designed COVID-19 Knowledge, Attitude, Behavior and Training Needs Questionnaire. Pearson correlation analysis was conducted to analyze the relationships among knowledge, attitudes, behaviors and training needs. Results: A total of 599 nurses were recruited, of whom 27.7% failed the knowledge part of the questionnaire. Positive correlations were found between knowledge and attitudes (r = 0.100, P = 0.015) and between attitudes and behaviors (r = 0.352, P = 0.000) regarding occupational protection against COVID-19. A total of 88.5% of nurses preferred online training to traditional training, and more than 70% believed that demonstration of and training in operations by their own department were effective ways to learn about how to protect themselves against COVID-19. Conclusion: The higher the level of knowledge about the disease was, the more positive the attitude toward occupational protection, and consequently, the more actively protective behaviors were adopted. Training affected nurses' knowledge of COVID-19 occupational protection and promoted positive attitudes, which further facilitated the effective prevention and control of the disease. Online training with demonstrations are recommended for COVID-19 training of nurses.

Associations between adolescents' empathy and prosocial attributes before and during the COVID-19 pandemic.

BACKGROUND: Adolescence is a formative period of social development. Adolescents have experienced considerable changes in their lives due to the COVID-19 pandemic. We conducted a longitudinal study to examine the effects of the COVID-19 pandemic on adolescents' prosocial attributes and empathy, as well as their longitudinal bilateral relationships. METHODS: A total of 2,510 students from five junior schools in Sichuan Province were recruited via random cluster sampling. Data were collected in December 2019 (Wave 1, before the outbreak of the pandemic) and July 2020 (Wave 2, during the pandemic) in Chengdu, Sichuan, China. Prosocial attributes and empathy were measured with the Positive Youth Development Scale (GPYDS) subscale and Chinese Empathy Scale, respectively. RESULTS: During the pandemic, both empathy and prosocial attributes decreased significantly from 49.89 (9.12) and 49.89 (8.80) before to 48.29 (8.72) and 49.39 (9.26) (p < 0.001), respectively. A higher level of empathy at Wave 1 significantly predicted higher prosocial attributes at Wave 2 (ß = 0.173, SE = 0.021, t = 8.430, p < 0.001). A lower prosocial attributes score predicted a significantly lower empathy score from Wave 1 to Wave 2 (ß = 0.100, SE = 0.021, t = 4,884, p < 0.001). CONCLUSIONS: The COVID-19 pandemic has had detrimental effects on adolescents' empathy and prosocial attributes. Special attention should be given to these two longitudinally associated factors in any social crisis, such as the COVID-19 pandemic, considering their importance for adolescents' physical, mental, and social development.

The psychological impact of the COVID-19 pandemic in the elderly in southwest China: A longitudinal study based on generalized estimating equations.

The objectives of this study were to assess the trends in anxiety and depression levels in older adults nearly 10 months after the outbreak of coronavirus disease 2019 (COVID-19) and explore its determinants. A longitudinal study was performed between October 2019 and December 2020. The Patient Health Questionnaire 9-Item Scale and the Generalized Anxiety Disorder 7-Item Scale were used to assess depression and anxiety. Data were collected before (wave 1), during (wave 2), and 10 months after the COVID-19 outbreak (wave 3). The prevalence of depressive symptoms in the elderly was found to be 18.9%, 28.1%, and 35.9% at wave 1, wave 2, and wave 3 respectively. The prevalence of depressive symptoms at wave 1 was lower than that at wave 2 (χ 2  = 15.544, P < 0.001) and wave 3 (χ 2 = 44.878, P < 0.001). There was no significant change in the prevalence of anxious symptoms (wave 1, 28.5%, wave 2, 30.3%, and wave 3, 30.3%). Older adults who were single/divorced/widowed had higher levels of anxiety compared with those who were married (OR = 2.306 95%CI 1.358-3.914, P = 0.002). The pandemic appeared to be associated with increases in depressive symptoms in older persons. Targeted interventions could be carried out among those with higher risk of maladjustment.

Influences of the COVID-19 Pandemic on Obesity and Weight-Related Behaviors among Chinese Children: A Multi-Center Longitudinal Study.

COVID-19-related lockdown measures have been affecting children's weight status and weight-related behaviors, which are often associated with an increase in childhood obesity. However, large-scale longitudinal studies are lacking. Our study aimed to analyze changes in obesity and weight-related behaviors in Chinese children before and during the COVID-19 pandemic and provide references for addressing the high prevalence of childhood obesity. A prospective multi-center longitudinal survey was conducted among Chinese children (n = 5963), collecting data on weight status, COVID-19-related measures, and lifestyle behaviors. Changes were assessed using t-tests and χ2 tests for paired samples, or the Wilcoxon signed-rank test, according to the type and distribution of data. The Generalized Estimating Equations model was used to explore influential factors of obesity. The prevalence of overweight and obesity increased from 9.2% and 8.6% before the pandemic to 10.5% and 10.6% during the pandemic (p < 0.001), respectively. Daily physical activity, sleep duration, and sugar-sweetened beverage consumption decreased while screen time increased. The results of the generalized estimating equations showed that ethnic minority, older age, less daily physical activity, reduced sleep duration, and longer screen time were positively associated with obesity. There is an intensifying trend of obesity in children in the context of the COVID-19 pandemic, to which altered weight-related behaviors might have contributed largely. Maintaining a healthy lifestyle, especially in social crises, should be highlighted to ease the burden of childhood obesity.

Knowledge, attitude and practice regarding occupational protection against COVID-19 among midwives in China: A nationwide cross-sectional study.

Midwives assume the roles in protecting perinatal women and newborns, meanwhile defending their own safety during the epidemic of COVID-19. Since there is currently no specific treatment available that targets the disease, strictly compliance with various infection prevention and control measures appears utmost important to achieve their occupational safety. We then explored the status quo and influencing factors of the knowledge, attitude and practice (KAP) of occupational protection against the COVID-19 among midwives in China. This online cross-sectional survey was conducted on 2663 midwives across the China during the early stages of the pandemic with a self-reported structured questionnaire. 97.4% and 92.9% of them were identified with positive attitude and appropriate practice, respectively, whereas only 6.4% showed good level of knowledge about the occupational protection toward the COVID-19. Midwives with older age, keeping on working during the breakout period, completing the training programs, caring the confirmed COVID-19 cases and having family members with cold-like symptoms were significantly associated with their KAP status. This study could provide valuable information not only for policy makers and administrators to optimize resource allocation and design education programs on targeted midwives, but also serve as a baseline for measuring changes in subsequent, post-intervention KAP studies.

Effect of the COVID-19 Pandemic on Resilience Among Chinese Adolescents and Its Influential Factors: A Longitudinal Study.

The current study assessed the effect of the coronavirus disease 2019 (COVID-19) pandemic on resilience among Chinese adolescents and explored its influential factors. A total of 2,359 students were recruited from three middle schools through cluster randomization in Chengdu. Data were collected before and after home confinement due to the COVID-19 pandemic. Resilience, family function, and effect of the pandemic were measured using subscales of the Chinese Positive Youth Development Scale, Chinese Family Assessment Instrument, and Children's Revised Impact of Event Scale. Paired samples t test showed resilience decreased significantly after confinement. According to stepwise multiple linear regression, basal resilience, family dysfunction, higher frequencies of hyperarousal symptoms of posttraumatic stress, increased electronic device use, and relationship with caregivers were independent influential factors of resilience. COVID-19 negatively affected adolescents' resilience; therefore, stakeholders need to focus on improving resilience in this population to mitigate mental health impacts of acute stressful events. [Journal of Psychosocial Nursing and Mental Health Services, 60(12), 31-37.].

The relationship between family functioning and non-suicidal self-injury in adolescents: A structural equation modeling analysis.

BACKGROUND: Previous research has suggested that depressive symptoms, emotional competence, and posttraumatic stress symptoms (PTSS) may mediate the association between family functioning and non-suicidal self-injury (NSSI). Therefore, this study aimed to evaluate the mediation effects of depressive symptoms, emotional competence, and COVID-related PTSS on the relationship between family functioning and NSSI in adolescents. METHOD: A sample of 5854 adolescents was recruited from June 16 to July 8, 2020. The data for family functioning, depressive symptoms, emotional competence, COVID-related PTSS, and NSSI behavior of adolescents were collected via self-reported questionnaires. A structural equation model was constructed to examine the relationship, and a bootstrap analysis was conducted to evaluate the mediation effects. RESULTS: The reporting rate of adolescent NSSI was 30.2%. The poor family functioning was positively associated with adolescent NSSI (ß = 0.130, 95% CI = 0.093-0.182), which was mediated by depression with effect size of 0.231 (95% CI = 0.201-0.257). The pathway coefficients between emotional competence and NSSI, and depression, COVID-related PTSS and NSSI, though statistically significant were unlikely to be clinically meaning with values of 0.057 and 0.015. There was no mediating effect by COVID-related PTSS. The pathways initially constructed between family functioning and COVID-related PTSS, emotional capacity and COVID-related PTSS were not been verified. LIMITATIONS: It was unclear whether this mediational effect would be supported in a longitudinal design. The application and extension of this model toward other regions and countries, and different ages need to be further explored. CONCLUSION: The interventions of adolescent NSSI should focus on both the family level and individual levels. Improving family environment, screening depressive symptoms, enhancing emotional competence and lessening COVID-related PTSS may reduce NSSI.

Exploring lived experiences of informal caregivers for pregnant women seeking scheduled antenatal care during the COVID-19 lockdown in China: A phenomenological study.

OBJECTIVE: We aimed to explore the lived experiences of informal caregivers for pregnant women seeking scheduled antenatal care during the early stage of China's COVID-19 lockdown and potential measures to address the challenges. DESIGN: This is a phenomenological qualitative study. SETTING: The study was carried out in a leading teaching hospital in Southwest China. PARTICIPANTS: We recruited 15 informal caregivers for healthy pregnant women on routine antenatal visits about six months after China launched the city-wide lockdown and other control measures for COVID-19, including 10 males and 5 females with diverse demographic backgrounds. MEASURES AND FINDINGS: The research team developed a demographic form and an interview outline with key questions, conducted semi-structured interviews with the informal caregivers, and analyzed the data using the Colazzie's method. Five themes of lived experiences were revealed, i.e., increased caregiving burdens, disruption of routines in family life, lack of accurate information and knowledge, active role adjustment, and positive attitudes and coping in a difficult time. Some caregivers reacted positively to the lockdown experience and saw it as an opportunity to rethink their lives and improve family relations. KEY CONCLUSIONS: The informal caregivers experienced increased physical and psychological burdens. Strategies such as adoption of a less frequent prenatal visit schedule, use of tele-medicine technologies, and provision of accurate information and knowledge may help to ease the increased informal caregiving burdens. Psychological counseling, community services and disaster response policies specially targeting pregnant women and their informal caregivers may also be valuable resources. IMPLICATIONS FOR PRACTICE: Attention should be drawn to the group of informal caregivers for pregnant women during a COVID-19 lockdown, including professional assistance delivered by nursing and other related professionals. Measures are called for to minimize exposure opportunities such as adoption of a new prenatal care schedule and tele-medicine technologies. Patient education with reliable information should be provided, preferably by nursing staff and physicians. Social support efforts including professional mental counseling may added and work with other resources such as community services and policy makers.

Physical activity and depressive symptoms among community-dwelling older adults in the COVID-19 pandemic era: A three-wave cross-lagged study.

The aim of the study is to determine the trajectories of physical activity and depressive symptoms and their reciprocal relationship among community-dwelling older adults in the COVID-19 pandemic era. The study population consisted of a cohort of 511 participants aged 60 years and over, who were recruited from eight community health centers in Ya'an, China. The Physical Activity Scale for the Elderly and the Patient Health Questionnaire were respectively used to measure physical activity and depressive symptoms at three time points: before the COVID-19 outbreak (T0), during the outbreak period (T1), and after the subsidence of COVID-19 (T2). The results revealed that physical activity and depressive symptoms fluctuated substantially across T0, T1, and T2. In addition, more severe depressive symptoms at T0 and T1 were significantly associated with lower levels of physical activity at T1 and T2, but the obverse direction of physical activity being associated with subsequent depressive symptoms was not observed in the current study. These findings highlight the importance of supporting old people to remain physically active and combat mental distress early in a pandemic, and prevention and management of depressive symptoms may also be beneficial to promote physical activity.

Physical activity and depressive symptoms among community-dwelling older adults in the COVID-19 pandemic era: A three-wave cross-lagged study

The aim of the study is to determine the trajectories of physical activity and depressive symptoms and their reciprocal relationship among community-dwelling older adults in the COVID-19 pandemic era. The study population consisted of a cohort of 511 participants aged 60 years and over, who were recruited from eight community health centers in Ya'an, China. The Physical Activity Scale for the Elderly and the Patient Health Questionnaire were respectively used to measure physical activity and depressive symptoms at three time points: before the COVID-19 outbreak (T0), during the outbreak period (T1), and after the subsidence of COVID-19 (T2). The results revealed that physical activity and depressive symptoms fluctuated substantially across T0, T1, and T2. In addition, more severe depressive symptoms at T0 and T1 were significantly associated with lower levels of physical activity at T1 and T2, but the obverse direction of physical activity being associated with subsequent depressive symptoms was not observed in the current study. These findings highlight the importance of supporting old people to remain physically active and combat mental distress early in a pandemic, and prevention and management of depressive symptoms may also be beneficial to promote physical activity.

Women's Psychological Health, Family Function, and Social Support During Their Third Trimester of Pregnancy Within the COVID-19 Epidemic: A Cross-sectional Survey.

OBJECTIVE: This study aims to investigate women's psychological health, family function, and social support during the third trimester within the coronavirus disease 2019 (COVID-19) epidemic. METHOD: From January 30, 2020, to February 26, 2020, a total of 177 pregnant women during their third trimester (mean gestation time was 37.05 ± 4.06 wk) in a maternal and children's hospital were investigated using the Self-Rating Anxiety Scale (SAS), the Edinburgh Postnatal Depression Scale, the Family APGAR Index, and the Perceived Social Support Scale. Nonparametric tests were conducted in the study. The statistical significance was set as P < 0.05. RESULT: The incidence rate of the participants' anxiety and depression during the COVID-19 epidemic was 19.21% and 24.29%, respectively. The participants' greatest concerns in the previous week were the risk of virus transmission (79.66%), and the prenatal examination and fetal growth (70.62%). The SAS ranks were higher in the participants who were concerned about the prenatal examination and fetal growth and work-related affairs. CONCLUSION: The participants' psychological health was indirectly affected by the epidemic through the supply of medical resources and work-related factors. The medical staff should employ family support and social resources to guarantee the accessibility of medical services and living materials to decrease the pregnant women's stress and further improve their psychological health.

Bilateral associations between sleep duration and depressive symptoms among Chinese adolescents before and during the COVID-19 pandemic.

Depression is one of the most prevalent psychiatric disorders and the leading cause of disability among adolescents, with sleep duration as its vital influential factor. Adolescents might be mentally sensitive to the stress caused by the COVID-19 pandemic. Yet, the alteration of adolescents' sleep duration, depression, and their associations within the context of the COVID-19 pandemic have not been well documented. We conducted a longitudinal study, recruiting 2496 adolescents from 3 junior high schools to examine the alteration of their sleep duration and depressive symptoms before and during the pandemic, and to explore their potential association(s). Data were collected before (December 2019) and during the pandemic (July 2020). Paired samples t-test revealed a significant decrease in sleep duration and a significant increase in depressive symptoms during the COVID-19 pandemic. Higher grades, COVID-19 infection history, higher CES-DC score, and the COVID-19 pandemic itself might contribute to decreased sleep duration, while longer exercise duration during the pandemic might be a protective factor. According to the cross-lagged analysis, the existence of depressive symptoms before the pandemic was significantly associated with a shorter sleep duration during the pandemic (ß = -0.106, p < 0.001). Previously shortened sleep duration was significantly associated with a greater likelihood of depressive symptoms during the pandemic (ß = -0.082, p < 0.001). Our findings revealed that the COVID-19 pandemic has a negative influence on adolescents' mental health and sleep. Mental preparedness should be highlighted to mitigate the psychosocial influences of any possible public emergencies in the future. Sleep duration represents a viable home-based intervention for depressive symptoms.

Frontline Health-Care Workers in Combating the COVID-19: Respect and Reflect.

The ongoing coronavirus disease has heightened enormous concern in the global community. China implemented extraordinary public health measures to take the major transmission hotspots under control at great socioeconomic cost. Frontline health-care workers have shown their commitment and accountability in the fight against the epidemic outbreak. This commentary acknowledges their contribution and offers important insights for devising future strategies in enhancing preparedness and response competencies among the health-care workforce to manage future epidemic events.