Preliminary Evaluation of a New Initiative to Centralize Colorectal Cancer Care During the COVID-19 Epidemic in Shanghai, China: A Retrospective Study (preprint)

Background: A novel colorectal cancer center (CCC) was developed in the Tenth Hospital of Shanghai during the coronavirus disease 2019 (COVID-19) epidemic. We aimed to evaluate the CCC for the centralized management of colorectal cancer (CRC) on three dimensions during this distinctive period. Methods: This retrospective study used data from the Tenth Hospital’s patient databases. The research hypothesis was that the CCC reduces preoperative waiting time (PWT), length of stay (LOS) during hospitalization, and costs of hospitalization, without reducing the quality of surgery. Thus, we analyzed three dimensions: time, cost, and quality. We compared the expected outcomes between March 1–December 31, 2019, and March 1–December 31, 2020. Descriptive and inferential analyses of patient demographic characteristics, time, postoperative outcomes, and inpatient costs were conducted. Findings: A total of 965 hospitalizations for CRC were identified. In the CCC, PWT declined by 26.2 hours (p<0.01). Patients who entered the CCC express group only needed to wait for 24.5 hours before undergoing surgery, with shorter LOS during hospitalization than the normal group (p<0.01). No patients had any symptoms of COVID-19 or high-risk COVID-19 contacts, and the immediate postoperative complication incidence was low. The mean total inpatient cost (TIC) for all patients with CRC was 78309.824 Chinese yuan in 2020, which was slightly lower than this cost in 2019. Interpretation: This study examined the efficiency of the centralized management model for CRC care during the COVID-19 epidemic in terms of time, cost, and quality. Funding Information: This study was sponsored by the Clinical Research Plan of SHDC (No. SHDC2020CR5006-002), the National Natural Science Foundation of China (No.71804128, 71904145), the Special Funds for Fundamental Research Expenses of Central Universities (No. 22120200407) and the Personnel Development Plan of Shanghai Tenth People's Hospital of Tongji University (No. 2021SYPDRC014).Declaration of Interests: None declared.Ethics Approval Statement: This study has been approved by the Ethics Committee of the Shanghai Tenth People's Hospital of Tongji University (SHSY-IEC-4.1/20-272/01).

A Multinational Study on the Protective and Risk Factors Associated with Mental Health Parameters in the General Population During the COVID-19 Pandemic: A Study in the Asia-Europe-North America Cohort (preprint)

Background: The novel Coronavirus-2019 (COVID-19) was declared a pandemic by the World Health Association (WHO) in March 2020, impacting the lifestyles, economy, physical and mental health of individuals globally. Little is known about the relationship between the impact of COVID-19 and one’s mental health status, and thus research needs to be conducted to identify the factors involved and develop tailored evidence-based strategies in response to reduce the adverse psychological impact. Methods: From February to June 2020, we conducted an online Global Mental Health survey which recruited participants via a respondent-driven sampling country in 8 countries (China, Pakistan, Philippines, Iran, Poland, Spain, USA and Vietnam). The online survey collected information on demographic characteristics, physical symptoms and health service utilisation, contact history, knowledge and concerns regarding COVID-19, precautionary measures taken and additional health information variables among the countries involved. The psychological impact was measured by the Impact of Event Scale-Revised (IES-R) questionnaire and the mental health status was measured by the Depression, Anxiety and Stress Scale (DASS-21). Results: There were 5555 participants involved in the study, 31.4% male and 68.6% female, with an age range of 12-to above 50 years of age. There were significant differences in the mean IES-R and DASS-21 scores between the 8 countries (F(7, 55477) = 71.605, η2=0.085, p<0.001). China had the highest IES-R score (mean=32.98, SD=15.42). Poland and Pakistan were found to be the two countries with the highest levels of anxiety, depression and stress; conversely, Vietnam had the lowest scores in stress (mean = 3.80, SD = 5.81), anxiety (mean = 2.10, SD = 4.91) and depression (mean = 2.28, SD = 5.43). Female gender, age older than 50 years, crowded home environment, unemployment and student status were significant associated with adverse mental health (p<0.05). However, higher education background, greater level of satisfaction with health information, staying with family members, spending less than 2 hours a day monitoring health information, taking suitable precautionary measures, use of face masks and less time spent at home were found to be protective factors for mental health (p<0.05). Interpretation: During the height of the COVID-19 pandemic, the mental health of the global population was significantly affected as shown empirically by the results of our study, and each country faced their own set of unique challenges in their response to COVID-19. Our findings have identified protective and risk factors associated with mental health that can help us to develop targeted psychological interventions for those who are more vulnerable during this pandemic.Funding Statement: This study has the following funding sources: Huaibei Normal University, China, Ministry of Science and Higher Education in Poland under the 2019-2022 program, Regional Initiative of Excellence", project number 012 / RID / 2018/19, National University of Singapore iHeathtech Other Operating Expenses (R-722-000-004-731) and Vingroup Innovation Foundation (VINIF) COVID research grant (VINIF.2020.Covid19.DA07) in Vietnam.Declaration of Interests: None declared.Ethics Approval Statement: The study was approved by the Institutional Review Boards from each country, China (Huaibei Normal University of China, HBU-IRB2020-001/002), Philippines (University of Philippines Manila Research Ethics Board, UPMREB 2020-198-01), Poland (SWPS University, WKEB62/04/2020), Spain (Complutense University of Madrid of Spain, Pr_2019_20_027), Vietnam (Hanoi Medical University, QD 75/QD-YHDP&YHDP) and the US (East Carolina University, UMCIRB 20-000838). Approval was also obtained from the relevant Iranian and Pakistani committees. All respondents provided informed consent. The collected data were anonymous and treated as confidential.