Do hospitals need to establish multiple hospital districts? A hospital-based perspective on the benefits of scale.

Background: During the fight against COVID-19, China's public hospitals played the main role in taking on the most urgent, dangerous and arduous medical treatment and work. Therefore, in order to promote the high-quality development of hospitals, it is necessary to support some potential public hospitals to build and develop a "One Hospital with Multiple Campuses System" (OHMC) based on controlling the size of single hospitals, and to quickly convert their functions in the event of a severe epidemic. Methods: The Cobb-Douglas production function and log-transformed production function were used to measure the appropriate hospital size for 22 public hospitals in a region of China. Results: The eight OHMC hospitals that planned to be build are basically qualified to handle the conditions and potential of multi-districts from the perspective of economy of scale. The OHMC hospitals in operation appear to have weakened incremental scale rewards, because they are in the process of development, but they are still higher than the overall level of single-campus hospitals. Conclusion: The expansion of hospital scale may bring the advantages of group development, but it may also bring about problems including rising hospital cost, increasing management and operation cost, inefficient allocation of medical resources and unbalanced development.

The Association between Post-Traumatic Stress Disorder and Psychological Distress among Primary School and Middle School Teachers during the COVID-19 Epidemic: A Moderated Mediation Analysis

Background: The outbreak of the coronavirus disease (COVID-19) and its rapid spread may have led to individuals developing post-traumatic stress disorder (PTSD) and psychological distress. Under this context, teachers merit more attention as a group with high levels of work stress. The purpose of this study was to verify the relationship between PTSD and psychological distress and to explore sleep problems as a possible mediator in the relationship between PTSD and psychological distress, as well as the moderator of internet gaming disorders (IGD) in the relationship between sleep problems and psychological distress. Methods: A total of 11,014 Chinese primary and middle school teachers participated in this study. The survey was conducted online between 25 May and 30 June 2020. Results: PTSD was shown to have both a direct and indirect effect on teachers' psychological distress. The indirect effect was mediated by sleep problems. IGD played a moderating role between sleep problems and psychological distress. Conclusions: During the COVID-19 pandemic, PTSD has been shown to have had a serious impact on the psychological stress of teachers, which was mediated by sleep problems. In addition, IGD raised the harm brought from sleep problems on teachers' mental health.

Cross-Verification of COVID-19 Information Obtained From Unofficial Social Media Accounts and Associated Changes in Health Behaviors: Web-Based Questionnaire Study Among Chinese Netizens.

BACKGROUND: As social media platforms have become significant sources of information during the pandemic, a significant volume of both factual and inaccurate information related to the prevention of COVID-19 has been disseminated through social media. Thus, disparities in COVID-19 information verification across populations have the potential to promote the dissemination of misinformation among clustered groups of people with similar characteristics. OBJECTIVE: This study aimed to identify the characteristics of social media users who obtained COVID-19 information through unofficial social media accounts and were (1) most likely to change their health behaviors according to web-based information and (2) least likely to actively verify the accuracy of COVID-19 information, as these individuals may be susceptible to inaccurate prevention measures and may exacerbate transmission. METHODS: An online questionnaire consisting of 17 questions was disseminated by West China Hospital via its official online platforms, between May 18, 2020, and May 31, 2020. The questionnaire collected the sociodemographic information of 14,509 adults, and included questions surveying Chinese netizens' knowledge about COVID-19, personal social media use, health behavioral change tendencies, and cross-verification behaviors for web-based information during the pandemic. Multiple stepwise regression models were used to examine the relationships between social media use, behavior changes, and information cross-verification. RESULTS: Respondents who were most likely to change their health behaviors after obtaining web-based COVID-19 information from celebrity sources had the following characteristics: female sex (P=.004), age ≥50 years (P=.009), higher COVID-19 knowledge and health literacy (P=.045 and P=.03, respectively), non-health care professional (P=.02), higher frequency of searching on social media (P<.001), better health conditions (P<.001), and a trust rating score of more than 3 for information released by celebrities on social media (P=.005). Furthermore, among participants who were most likely to change their health behaviors according to social media information released by celebrities, female sex (P<.001), living in a rural residence rather than first-tier city (P<.001), self-reported medium health status and lower health care literacy (P=.007 and P<.001, respectively), less frequent search for COVID-19 information on social media (P<.001), and greater level of trust toward celebrities' social media accounts with a trust rating score greater than 1 (P≤.04) were associated with a lack of cross-verification of information. CONCLUSIONS: The findings suggest that governments, health care agencies, celebrities, and technicians should combine their efforts to decrease the risk in vulnerable groups that are inclined to change health behaviors according to web-based information but do not perform any fact-check verification of the accuracy of the unofficial information. Specifically, it is necessary to correct the false information related to COVID-19 on social media, appropriately apply celebrities' star power, and increase Chinese netizens' awareness of information cross-verification and eHealth literacy for evaluating the veracity of web-based information.

Review of the risk factors for SARS-CoV-2 transmission.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, which has lasted for nearly a year, has made people deeply aware of the strong transmissibility and pathogenicity of SARS-CoV-2 since its outbreak in December 2019. By December 2020, SARS-CoV-2 had infected over 65 million people globally, resulting in more than 1 million deaths. At present, the exact animal origin of SARS-CoV-2 remains unclear and antiviral vaccines are now undergoing clinical trials. Although the social order of human life is gradually returning to normal, new confirmed cases continue to appear worldwide, and the majority of cases are sporadic due to environmental factors and lax self-protective consciousness. This article provides the latest understanding of the epidemiology and risk factors of nosocomial and community transmission of SARS-CoV-2, as well as strategies to diminish the risk of transmission. We believe that our review will help the public correctly understand and cope with SARS-CoV-2.

A Family Cluster of Severe Acute Respiratory Syndrome Coronavirus 2 Infections (preprint)

Background In December 2019, the outbreak of 2019 novel coronavirus disease (COVID-19) began in Wuhan, Hubei Province, China. The disease has rapidly spread from Wuhan to other provinces and other countries. Clinical and epidemiological knowledge is limited. We aimed to describe the clinical and epidemiological characteristics of a family cluster of COVID-19 in Beijing.Methods We reported a family cluster of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases in Beijing, China. We obtained and analyzed clinical and epidemiologic data from these patients. Throat swab samples were tested for SARS-CoV-2 using real-time reverse transcriptase-polymerase chain reaction assays.Results This family comprised three laboratory confirmed cases with clinical symptoms. All three patients had close contact with a relative from Wuhan, Hubei Province. Chest computerized tomography revealed ground-glass opacities and consolidation. Patient 1 was finally intubated and mechanical ventilated. Patient 2 received high-flow oxygen therapy. The clinical condition of Patient 3 has resolved.Conclusion SARS-CoV-2 infections tend to clusters. Advanced age and comorbidities are associated with adverse outcomes. Physicians should be aware of contact history so that infected patients can be identified promptly and further spreading prevented.