Individual-Level Heterogeneity in Mask-wearing During the COVID-19 Pandemic in Malaysia

Wearing a face mask has been a key approach to contain or slow down the spread of COVID-19 in the ongoing pandemic. However, there is huge heterogeneity among individuals in their willingness to wear face masks during an epidemic. This research aims to investigate the individual heterogeneity to wear face masks and its associated predictors during the COVID-19 pandemic when mask-wearing was not mandatory but individuals choices. Based on a survey of 708 Malaysian adults and a multivariate least-squares fitting analysis, the results reveal a significant variance among individuals in wearing masks, as 34% of the individual adults did not always wear masks in public places. Female, individuals who wash their hands more frequently, and those who reported more availability of personal protective equipment were more likely to practice mask-wearing. The identification of less compliant groups of mask-wearing has critical implications by enabling more specific health communication campaigns.

Predictors of Depression and Anxiety Symptoms in Brazil during COVID-19

The COVID-19 pandemic in Brazil is extremely severe, and Brazil has the third-highest number of cases in the world. The goal of the study is to identify the prevalence rates and several predictors of depression and anxiety in Brazil during the initial outbreak of COVID-19. We surveyed 482 adults in 23 Brazilian states online on 9-22 May 2020, and found 70.3% of the adults (N=339) had depressive symptoms and 67.2% (N=320) had anxiety symptoms. The results of multi-class logistic regression models revealed that females, younger adults and those with fewer children had a higher likelihood of depression and anxiety symptoms; adults who worked as employees were more likely to have anxiety symptoms than those who were self-employed or unemployed; adults who spent more time browsing COVID-19 information online were more likely to have depression and anxiety symptoms. Our results provide preliminary evidence and early warning for psychiatrists and healthcare organizations to better identify and focus on the more vulnerable sub-populations in Brazil during the ongoing COVID-19 pandemic.

Correlation between serum bilirubin and cystatin C in patients with type 2 diabetes mellitus / 中国医师进修杂志

Objective:To study the correlation between serum bilirubin and cystatin C in patients with type 2 diabetes mellitus.Methods:A retrospective cohort study was conducted on 750 patients who were in the Affiliated Hospital of Jining Medical University from June 2017 to May 2018. The clinical data were collected, and the correlation between serum total bilirubin, direct bilirubin, indirect bilirubin and cystatin C was analyzed.Results:According to the results of single factor analysis, after adjusting the related confounding factors, the smooth curve fitting showed that there was a U-shaped relationship between the total bilirubin, indirect bilirubin and cystatin C. When the total bilirubin was <15.9 μmol/L, for every increase of 1 μmol/L in total bilirubin, cystatin C decreased 0.008 mg/L ( β = - 0.008, 95% CI - 0.014 to - 0.002, P<0.01); when indirect bilirubin was <11.5 μmol/L, for every increase of 1 μmol/L in indirect bilirubin, cystatin C decreased 0.011 mg/L ( β = - 0.011, 95% CI - 0.018 to - 0.003, P<0.01). When cystatin C was grouped according to the normal range (cystatin C<1.25 mg/L), after adjusting the related confounding factors, the smooth curve fitting showed that there was a U-shaped relationship between the total bilirubin and indirect bilirubin with cystatin C; when total bilirubin was <15.5 mol/L, for every increase of 1 μmol/L in total bilirubin, the risk of cystatin C exceeding the normal value was reduced by 17% ( OR = 0.83, 95% CI 0.71 to 0.96, P<0.01); when total bilirubin was ≥15.5 μmol/L, for every increase of 1 μmol/L in total bilirubin, the risk of cystatin C exceeding the normal value was increased by 12% ( OR = 1.12, 95% CI 1.01 to 1.25, P<0.05); when indirect bilirubin was <11.8 μmol/L, every increase of 1 μmol/L in indirect bilirubin, the risk of cystatin C exceeding the normal value was reduced by 20% ( OR = 0.80, 95% CI 0.67 to 0.95, P<0.01). However there was no significant correlation between direct bilirubin and cystatin C. Conclusions:There is a U-shaped relationship between total bilirubin, indirect bilirubin and cystatin C. At physiological concentrations, the increase of total bilirubin and indirect bilirubin can reduce cystatin C.

Typhoon Eye Effect vs. Ripple Effect: The Role of Family Size on the Mental Health under the COVID-19 Pandemic in Pakistan

BackgroundThe recent outbreak of COVID-19 impacts the mental health of people worldwide. The mental conditions and the associated predictors of adults in Pakistan, the fifth most populous country in the world, during the COVID-19 remains understudied. We aim to investigate distress, anxiety and overall mental health and their associated predictors among Pakistani adults in this pandemic. We specifically examine the mental health issues based on the distance to the epicenter, a predictor that has revealed opposing evidence in other countries based on the theories of typhoon eye effect and ripple effect. The samples consist of 601 adults who were surveyed online about 2.5 months into the outbreak across Pakistan with varying distance to the epicenter of COVID-19 of Karachi in Pakistan. ResultsThe results showed that 9.2% and 19.0% of the participants surpassed the cut-off of distress and anxiety disorders, respectively. Overall, the distance to the epicenter positively predicted the mental health of adults in Pakistan, and family size negatively moderated this effect. The distance to the epicenter negatively predicted distress and anxiety disorders for adults in large families, which are quite common in Pakistan. ConclusionThe evidence of the study interestingly finds the prediction of the mental health of people by their distance to the epicenter depends on the family. The evidence of this study can help to provide the initial indicator for mental health care providers to screen vulnerable groups in Pakistan, a populous country that continues to struggle to cope with the COVID-19 pandemic.

The Mental Health of Healthcare Staff during the COVID-19 Pandemic: It Depends on How Much They Work and Their Age

BackgroundHealthcare staff are the forefront of fight against COVID-19 and they are under enormous pressure due to the fast growth in the number and severity of infected cases. This creates their mental issues such as distress, depression and anxiety. Exploring healthcare staffs mental health during the pandemic contributes to improving their persistence in the growing challenges created by COVID-19 and enabling effective management of their mental health. MethodsAn online survey of 280 healthcare staff in all the 31 provinces of Iran was conducted during April 5-20, 2020. The survey assessed staffs distress, depression and anxiety in the COVID-19 pandemic. ResultsNearly a third of healthcare staff suffered from distress, depression and anxiety. Females and more educated healthcare staff were more likely to experience distress. Compared to personnel who did not have COVID-19, those who were unsure whether they had COVID-19 were more likely to experience distress and depression. The number of COVID-19 cases among the staffs colleagues or friends positively predicted their anxiety. Compared to radio technologists, doctors were less likely to experience distress and anxiety. Technicians and obstetrics experienced less anxiety. Analysis the interaction between weekly working days and age of the staff indicated the chance of experiencing distress and depression varied greatly by working days among younger but not older healthcare staff. ConclusionThe predictors of mental health issues assists healthcare organizations to identify healthcare staff with mental health issues in sever crises such as the COVID-19 pandemic. Our research highlight the need to identify more working characteristics as predictors for healthcare staff at different ages. FundingThis work was supported by Tsinghua University-INDITEX Sustainable Development Fund (No. TISD201904).

Health Condition and Test Availability as Predictors of Adults' Mental Health during the COVID-19 Pandemic

BackgroundResearch identifying adults mental health during the COVID-19 pandemic relies solely on demographic predictors without examining adults health status during the COVID-19 pandemic as a potential predictor. MethodsAn online survey of 669 adults in Malaysia was conducted during May 2-8, 2020, six weeks after a Movement Control Order (MCO) was issued. FindingsAdults health condition had curvilinear relationships (horizontally reversed J-shaped) with insomnia, anxiety, depression and distress. Reported test availability for COVID-19 (from "strongly disagree" to "strongly agree") also had curvilinear relationships (horizontally reversed J-shaped) with anxiety and depression. Younger adults reported worse mental health, but people from various religions and ethnic groups did not differ significantly in reported mental health. InterpretationAdults with worse health conditions had more mental health problems, especially adults at the lower end of the health spectrum. Test availability negatively predicted anxiety and depression, especially for adults experiencing poor COVID-19 test availability. The significant predictions of health condition and COVID-19 test availability suggest a new direction for the literature to identify psychiatric risk factors directly from health related variables during a pandemic. FundingTsinghua University-INDITEX Sustainable Development Fund (Project No. TISD201904).

Who do not wash their hands during the Covid-19 pandemic? Social media use as a potential predictor

This study predicts handwashing behavior during the Covid-19 pandemic. An analysis of 674 adults in Malaysia identifies their time spent on social media per day as a key predictor of handwashing. The association between time spent on social media and handwashing substantially depends on gender and the number of children in the same household. Additional predictors include age and health condition. This study helps identify specific target groups for health communication on hand hygiene via peoples use of social media, which can be a key channel for health communication campaigns during a pandemic.

Belief in Conspiracy Theory about COVID-19 Predicts Mental Health and Well-being -- A Study of Healthcare Staff in Ecuador

BackgroundSocial media are becoming hotbeds of conspiracy theories, which aim to give resolute explanations on the cause of COVID-19 pandemic. Yet, no research has investigated whether individuals belief in conspiracy theory about COVID-19 is associated with mental health and well-being issues. This association enables an assessable channel to identify and reach people with mental health and well-being issues during the pandemic. ObjectiveWe aim to provide the first evidence of belief in conspiracy theory regarding the COVID-19 virus as a predictor of the mental health and well-being of healthcare workers. MethodsWe conducted a survey of 252 healthcare workers in Ecuador from April 10 to May 2, 2020. We analyzed the data of distress and anxiety caseness with logistic regression and life and job satisfaction with linear regression. ResultsAmong the sampled healthcare workers in Ecuador, 24.2% believed that the virus was developed intentionally in a lab; 32.54% experienced distress disorder, and 28.17% had anxiety disorder. Compared to healthcare workers who were not sure where the virus originated, those who believed the virus was developed intentionally in a lab were more likely to have distress disorder and anxiety disorder and had lower levels of job satisfaction and life satisfaction. ConclusionsThis paper identifies belief in a COVID-19 conspiracy theory as an important predictor of distress, anxiety, and job and life satisfaction of healthcare workers. It enables mental health services to better target and help mentally vulnerable healthcare workers during the ongoing COVID-19 pandemic.

Succumbing to the COVID-19 Pandemic: Healthcare Workers not Satisfied and Intend to Leave Their Jobs

BackgroundHealthcare workers are under such a tremendous amount of pressure during the COVID-19 pandemic that many have become concerned about their jobs and even intend to leave them. It is paramount for healthcare workers to feel satisfied with their jobs and lives during a pandemic. MethodsBetween 10 to 30 April, 2020, 240 healthcare workers in Bolivia completed a cross-sectional online survey, which assessed their job satisfaction, life satisfaction, and turnover intention in the ongoing COVID-19 pandemic. ResultsThe results revealed that their number of office days predicted job satisfaction, life satisfaction, and turnover intention, but the relationships varied by their age. For example, healthcare workers office days negatively predicted job satisfaction for the young (e.g. at 25 years old: b=-0.21; 95% CI: -0.36 to -0.60) but positively predicted job satisfaction for the old (e.g. at 65 years old: b=0.25; 95% CI: 0.06 to 0.44). ConclusionsThese findings provide evidence to enable healthcare organizations to identify staff concerned about job satisfaction, life satisfaction, and turnover intention to enable early actions so that these staff can remain motivated to fight the prolonged COVID-19 pandemic.

When the storm is the strongest: The health conditions and job satisfaction of Healthcare staff and their associated predictors during the epidemic peak of COVID-19

This study reports the physical health, mental health, anxiety, depression, distress, and job satisfaction of healthcare staff in Iran when the country faced its highest number of total active COVID-19 cases. In a sample of 304 healthcare staff (doctors, nurses, radiologists, technicians, etc.), we found a sizable portion reached the cutoff levels of disorders in anxiety (28.0%), depression (30.6%), and distress (20.1%). Age, gender, education, access to PPE (personal protective equipment), healthcare institutions (public vs. private), and individual status of COVID-19 infection each predicted some but not all the outcome variables of SF-12, PHQ-4, K6, and job satisfaction. The healthcare workers varied greatly in their access to PPE and in their status of COVID-19 infection: negative (69.7%), unsure (28.0%), and positive (2.3%). The predictors were also different from those identified in previous studies of healthcare staff during the COVID-19 crisis in China. This study helps to identify the healthcare staff in need to enable more targeted help as healthcare staff in many countries are facing peaks in their COVID-19 cases.

First study on mental distress in Brazil during the COVID-19 crisis

ObjectiveWe aim to provide early evidence of mental distress and its associated predictors among adults one month into the COVID-19 crisis in Brazil. MethodsWe conducted an online survey of 638 adults in Brazil on March 25-28, 2020, about one month (32 days) cross-sectionally after the first COVID-19 case in South America was confirmed in Sao Paulo. The 638 adults were in 25 states out of the 26 Brazilian states, with the only exception being Roraima, the least populated state in the Amazon. Of all the participating adults, 24%, 20%, and 18% of them were located in Rio de Janeiro state, Santa Catarina state, and Sao Paulo state respectively. ResultsIn Brazil, 52% (332) of the sampled adults experienced mild or moderate distress, and 18.8% (120) suffered severe distress. Adults who were female, younger, more educated, and exercised less reported higher levels of distress. Each individuals distance from the Brazilian epicenter of Sao Paulo interacted with age and workplace attendance to predict the level of distress. The "typhoon eye effect" was stronger for people who were older or attended their workplace less. The most vulnerable adults were those who were far from the epicenter and did not go to their workplace in the week before the survey. ConclusionIdentifying the predictors of distress enables mental health services to better target finding and helping the more mentally vulnerable adults during the ongoing COVID-19 crisis.

The distress of Iranian adults during the Covid-19 pandemic - More distressed than the Chinese and with different predictors

Early papers on the mental health of the public during the Covid-19 pandemic surveyed participants from China. Outside of China, Iran has emerged as one of the most affected countries with a high death count and rate. The paper presents the first empirical evidence from Iranian adults during the Covid-19 pandemic on their level of distress and its predictors. On March 25-28, 2020, a dire time for Covid-19 in Iran, we surveyed 1058 adults from all 30 provinces in Iran using the Covid-19 Peritraumatic Distress Index (CPDI). The distress level of Iranian adults (mean: 34.54; s.d.: 14.92) was significantly higher (mean difference: 10.9; t=22.7; p<0.0001; 95% CI: 10.0 to 11.8) than that of Chinese adults (mean: 23.65; s.d.: 5.45) as reported in a prior study with the same measure of Covid-19 Peritraumatic Distress Index (CPDI). We also found the predictors of distress in Iran vary from those in China. Our findings that the predictors of distress in Iran vary from those in China suggest the need to study the predictors of mental health in individual countries during the Covid-19 pandemic to effectively identify and screen for those more susceptible to mental health issues. FundingNone

The imaging manifestations and misdiagnosis analysis of chondroblastoma / 实用放射学杂志

Objective To investigate the X-ray,CT and MRI features of chondroblastoma (CB)and to improve diagnostic skills of this disease.Methods The X-ray,CT and MRI imaging of 27 cases with CB which were verified by histopathological examination and the misdiagnosed cases were analyzed retrospectively.Results Accurate diagnosis of preoperative images was made in 10 cases and all 10 cases were located in the epiphysis of long bone.X-ray and CT showed eccentric round and oval osteolytic bone destruction,with sclerotic rim and internal spotted calcification;MRI showed hypointensity on T1 WI and heterogeneous hypo-and hyperintensity on T2 WI,with peripheral regions of marrow edema and adjacent joint effusion.Seventeen cases were misdiagnosed preoperatively,including 8 cases in long bone epiphysis or apophysis,8 cases in short,flat and irregular bones and 1 case in metaphysis of long bone.Twelve cases showed expansive changes and 10 cases with associated aneurysmal bone cyst(ABC)showed fluid-fluid levels.Conclusion The CB shows sandy or stippled calcification,rim sclerosis,extensive surrounding bone marrow edema.CB in unusual sites usually shows expansive bone destruction,peripheral bone marrow edema,secondary aneurysmal bone cyst.Combined utilization of clinic,pathology and imaging features is helpful for the diagnosis.

Effects of Electroacupuncture plus Oxygenmedicine on the Expression of Bcl-2 and Bax Proteins in the Hippocampal CA 1 Area in Rats with Global Cerebral Ischemia/Reperfusion Injury / 针刺研究

Objective To observe the effect of electroacupuncture (EA) plus oxygenmedicine (OM) on the expression of Bcl-2 and Bax in the hippocampal CA 1 area in cerebral ischemia/reperfusion injury (CI/RI) rats. Methods Thirty SD rats were randomized into sham-operation,model,EA,OM,EA+OM groups (n=6/group). CI/RI model was established by using modified Pulsinelli 4 vessel occlusion and reperfusion. EA (100 Hz,3.5 mA) was applied to "Baihui" (GV 20) and "Zusanli" (ST 36) 30 min,once daily for 4 days. Rats of OM and EA+OM groups were put into a box filled with oxygen and atomized herbal medicines containing Bingpian (Borneolum),Shexiang (Moschus),Huangjing (Rhizoma Polygonati),Shouwu (Radix Polygoni Multiflori),etc. for 30 min,once daily for 4 days. Bcl-2 and Bax expression of the hippocampal CA 1 area was detected by immunohistochemistry. Results Compared with sham group,the numbers of Bcl-2 immunoreaction (IR) and Bax IR positive cells,and the immunoactivity of Bcl-2 IR and Bax IR positive products in the hippocampal CA 1 area were increased significantly in model group (P0.05). Conclusion EA and OM and EA+OM can effectively regulate the expression of Bcl-2 and Bax in the hippocampal CA 1 area in CI/RI rats,and the effects of EA+OM are significantly superior to those of simple EA and simple OM,which may contribute to their effect in improving cerebral ischemia.