Self-Medication Practices with Antibiotics and Associated Factors among the Public of Malaysia: A Cross-Sectional Study

Background

Self-medication with antibiotics (SMA) is an important public health issue, which can result in the facilitated development of antibiotic resistance, and may increase the risk of inappropriate utilization of antibiotics. So, the objective of the present study was to estimate the prevalence rate of SMA and to also explore SMA practices among the lay population of Kuala Lumpur (Malaysia).

Methods

The current study was cross-sectional population-based and used a convenient sampling technique. Moreover, Lorenz’s formula was used to calculate the sample size and the required sample size was 480. Data were collected through face-to-face interviews with a pre-validated questionnaire and the study was conducted in Kuala Lumpur (Malaysia). Descriptive statistics, cross-tabulation, and logistic regression were executed by using SPSS version 24.

Results

Out of 480 participants, 45.8% were polled male and the prevalence of SMA in this study was found to be 15.1%. The majority of participants 23.1% indicated that they practiced antibiotics at least once in the last six months. The commonly self-medicated antibiotics were amoxicillin-clavulanate 20.6%, ampicillin/cloxacillin 14.2%, and levofloxacin 8.3%. Moreover, 64.8% of participants indicated that they bought their antibiotics from pharmacies. Whereas, most of the participants practice antibiotics to save money 19.2% and time 23.1%. Findings from multivariate logistic regressions showed that predictors of SMA were male gender, (95% CI: 0.300–0.877) occupation (95% CI: 0.122–10.797), health insurance (95% CI: 0.025–0.472), and education (95% CI: 0.084–0.800).

Conclusion

The results of this study indicate that SMA persists among the community and education level has a significant impact on this behavior. Thus, concerning health management authorities should step in with developing legislation to stop this practice, and by implementing such interventions and policies to educate and to raise awareness about the risk of SMA for the future.

Health literacy and knowledge of antenatal care among pregnant women

Health literacy has a direct impact on pregnancy from the perspectives of both the mother and the baby. This study aimed to determine the level of health literacy and assess the knowledge of antenatal care among pregnant women. From among all pregnant women who presented to the hospital's obstetric polyclinic during the study's timeline, the study group consisted of 460 women who agreed to take part (492 women were invited and a response rate of 93.5% was achieved). A questionnaire prepared based on the literature in line with the study's objectives was completed by the participants under supervision. The Turkish Health Literacy Scale (THLS-32) was used to assess health literacy. In order to determine the women's prenatal care knowledge levels, a total of 20 knowledge-testing statements prepared using the literature were applied, 14 of which were true and six of which were false. The internal consistency of antenatal information questions during pregnancy was made and the Cronbach alpha coefficient was calculated as 0.77. It was determined that 33.9% of the participants had a sufficient level of health literacy. Health literacy was sufficient in young married women (19 years and less) in their first pregnancy and those who had regular reading habits, participated in healthcare activities and received postpartum care at a family health clinic (p < 0.05 for each). While the most accurately evaluated statement about antenatal care was 'It is normal to experience nausea/vomiting in the first trimester of pregnancy', the least accurately evaluated statement was 'Over 35% of women incorrectly believed it was normal to gain 20 kg of weight during pregnancy'. It was found that pregnant women with sufficient health literacy had higher levels of knowledge about antenatal care (p < 0.05). In this study, it was determined that approximately two-thirds of the participants had insufficient health literacy and the women with insufficient health literacy had low levels of knowledge about antenatal care.

Preferred Surgical and Anesthesia Techniques for Cataract Surgery in Jordan

Purpose

To study the current practices in Jordan regarding cataract surgical procedures and anesthesia trends for cataract surgery.

Methods

A cross-sectional survey of members of the Jordanian Ophthalmology Society was conducted in October 2020. The questionnaire included questions about participants' demographics, the preferred surgical techniques for cataracts, the preferred anesthesia technique for cataract surgery, the factors which affect the choice of anesthesia technique, the use of sedation, who gives the anesthesia, if there is an anesthesia-trained person who observes the patient during cataract surgery, and the changing trends towards anesthesia between the surgeons.

Results

More than half of the respondents (59.1%) had been in practice for more than 5 years. The preferred method for routine cataract was phacoemulsification for most participants (98.4%). For mature cataract, phacoemulsification was the preferred method for 61.4% of participants. More than half (55.1%) used topical with intracameral anesthesia for phacoemulsification. Two thirds of the participants (66.3%) performed retrobulbar anesthesia for extracapsular cataract surgery. In the majority of cases (86.6%), the respondent themself is the one who administers the anesthesia. No sedation was used before surgery in 62.6% of cases. Two thirds of the respondents (70.1%) reported that they had an anesthesia-trained person monitoring the patient during surgery. Patient cooperation was the most important factor (70.9%) affecting the surgeon's choice of anesthesia technique followed by surgeon skill and experience (57.5%).

Conclusion

Presently, phacoemulsification is the preferred surgical technique for cataract in Jordan. Topical with intracameral anesthesia is the most common anesthesia for phacoemulsification while retrobulbar anesthesia is the most common for extracapsular cataract extraction.

Internet survey on factors associated with care-seeking behaviours of people with chronic musculoskeletal pain in Japan

Purpose: Many people with chronic musculoskeletal pain (CMP) seek healthcare from conventional and complementary and alternative medicine. However, treatment/therapy is not always adequate, patients often change healthcare providers, and some patients are left untreated. This study clarified care-seeking behaviours and explored factors behind the behaviours in people with CMP. Methods: Using a Japanese cross-sectional online survey, participants aged ≥ 20 years with non-cancer/fracture CMP lasting for ≥ 6 months and presenting ≤1 month, interfering with daily living activities and/or work were enrolled. We summarized and analysed the characteristics and factors associated with choice of healthcare providers; information on socio-demographics, including employment; ability to use healthcare, including income; and need for healthcare, including pain intensity, using a logistic regression model. Results: Among the 9105 respondents, 24.5% consulted physicians, 18.3% complementary and alternative medicine practitioners, and 57.2% were untreated. More respondents who had moderate-severe pain visited physician, more regularly employed and with high income visited complementary and alternative medicine, and less respondents who had moderate-severe pain were untreated. These were found to be associated with the respective healthcare use versus untreated. Conclusions: People with severe conditions, higher income and regular employment, and less severe conditions have visited physicians, complementary and alternative medicine practitioners and none, respectively. By applying this result at each type of healthcare provider, it may be possible to treat patients more appropriately.

Reported asthma and dental amalgam exposure among adults in the United States: An assessment of the National Health and Nutrition Examination Survey

Objective: Mercury (Hg)-based amalgam is a dental restorative material in common use. This hypothesis-testing study evaluated the relationship between dental amalgam exposure and the risk of reported asthma diagnoses in American adults. Methods: A total of 97,861,577 weighted-persons with one or more dental amalgam surfaces (exposed group) and 31,716,558 weighted-persons with one or more other dental surfaces (no dental amalgams, unexposed group) were examined in the 2015–2016 National Health and Nutrition Examination Survey. All persons were 20–80 years old and with known reported asthma status (only newly diagnosed asthma cases were examined). Survey logistic regression and survey frequency modeling in SAS were employed to evaluate the relative incidence rate of reported asthma diagnoses among those in the exposed group compared to the unexposed group. Covariates of gender, race, socioeconomic status, educational status, country of birth, and tobacco exposure were considered. Results: Survey logistic modeling revealed a significantly increased incidence rate of reported asthma in the exposed group as compared to the unexposed group in unadjusted (4.46-fold) and adjusted (4.84-fold) models. A dose–response relationship was observed for the risk of reported asthma per dental amalgam filling surface in unadjusted (1.073) and adjusted (1.076) models. Survey frequency modeling revealed that the frequency of reported asthma (per 10,000 weighted-person years) was 3.66-fold significantly increased in the exposed group (2.06) as compared to the unexposed group (0.56). Conclusion: Increased dental amalgam exposure was associated with an increased risk of reported asthma diagnoses in American adults, but future studies should further evaluate this relationship.

The Personal Food Systems of Pre-Season NCAA Division 1 High-Contact, Low-Contact, and Non-Contact College Athletes

Previous research indicates that dietary habits may differ between athletes of different sports. In this cross-sectional study, we hypothesize meal frequency, food choices, and food preferences will significantly differ between contact types. The participants were athletes (n = 92; men: n = 57, body fat percent (BF%): 14.8 ± 8.4%, body mass index (BMI): 25.5 ± 5.5 kg·m^-2; women: n = 36, BF%: 26.7 ± 7.3%, BMI: 22.3 ± 2.7 kg·m^-2) from high-contact (HCS), low-contact (LCS), and non-contact (NCS) sports. Meal frequency, food preference, and food choice questionnaires assessed factors influencing dietary habits. Dual-energy X-ray absorptiometry (DXA) measured lean body mass, fat mass, and body fat. A GLM multivariate analysis was used with significance accepted at p < 0.05. Significant body composition differences were observed between genders (p < 0.001) and among sports (p < 0.001). Dinner (83.7%), lunch (67.4%), and breakfast (55.4%) were the most frequently eaten meals, followed by evening snack (17.8%), afternoon snack (15.2%), and morning snack (8.7%). Greater preferences for starches were observed for HCS (p = 0.04; η² = 0.07) and for a greater preference for vegetables was found for NCS (p = 0.02; η² = 0.09). Significant differences also existed in the importance of health (p = 0.04; η² = 0.07), weight control (p = 0.05; η² = 0.11), natural content (p = 0.04; η² = 0.07), and price (p = 0.04; η² = 0.07). These results support our hypothesis that food choices and food preferences differ between contact types. This may help sports dieticians create more individualized nutrition programs.

Profile of multimorbidity in outpatients attending public healthcare settings: A descriptive cross-sectional study from Odisha, India

Background

Multimorbidity, the co-occurrence of two or more long-term conditions (LTC) in individuals, is associated with greater healthcare utilization, expenditure, and premature mortality, thus positing a challenge for patients and healthcare providers. Given its sparsely available epidemiological evidence, we aimed to describe the profile of multimorbidity in a representative sample of public healthcare outpatients in India.

Methods

A facility-based cross-sectional study was conducted from 1^st July to 31^st December 2015 in Odisha, India. Fifteen public healthcare facilities were selected by stratified random sampling. Data was collected from 1,870 adult outpatients attending these settings using Multimorbidity Assessment Questionnaire for Primary Care (MAQ-PC) tool.

Result

Nearly 3/4^th of both women and men outpatients were either obese or overweight. >1/2 had multimorbidity (≥2 LTC) while 1/3^rd had ≥3 LTC. Most prevalent condition was hypertension (63%), followed by chronic backache and arthritis. Cancer and psychiatric illness were least reported. Multimorbidity increased with age group, socioeconomic status, and education level. Females across all age groups had higher reported multimorbidity than males. Diabetes--hypertension was frequently occurring dyad. Both physical and mental component of quality of life was reduced in multimorbidity.

Conclusion

Multimorbidity is becoming a norm in healthcare practice with high prevalence in females and older adults. Health services for non-communicable diseases need to include commonly occurring dyads along with health promotion. Higher prevalence in females reinforces the need to incorporate gender differences while studying multimorbidity. Analysis of multimorbidity epidemiology through an equity lens could illuminate the underpinning complexities and heterogeneities of this phenomenon.

Red Alert: It Is Time to Strengthen the Medical Knowledge of Noncompressible Torso Hemorrhage Among Health-Care Workers

OBJECTIVE

Noncompressible torso hemorrhage (NCTH) is a major challenge in prehospital bleeding control and is associated with high mortality. This study was performed to estimate medical knowledge and the perceived barriers to information acquisition among health-care workers (HCWs) regarding NCTH in China.

METHODS

A self-administered and validated questionnaire was distributed among 11 WeChat groups consisting of HCWs engaged in trauma, emergency, and disaster rescue.

RESULTS

A total of 575 HCWs participated in this study. In the knowledge section, the majority (87.1%) denied that successful hemostasis could be obtained by external compression. Regarding attitudes, the vast majority of HCWs exhibited positive attitudes toward the important role of NCTH in reducing prehospital preventable death (90.4%) and enthusiasm for continuous learning (99.7%). For practice, fewer than half of HCWs (45.7%) had heard of NCTH beforehand, only a minority (14.3%) confirmed they had attended relevant continuing education, and 16.3% HCWs had no access to updated medical information. The most predominant barrier to information acquisition was the lack of continuing training (79.8%).

CONCLUSIONS

Knowledge and practice deficiencies do exist among HCWs. Obstacles to update medical information warrant further attention. Furthermore, education program redesign is also needed.

Determination of serum 25-hydroxyvitamin D levels in patients with alopecia areata and their comparison with levels in healthy controls: A cross-sectional study

Background

Alopecia areata (AA) has been postulated to be an autoimmune disease affecting the hair follicles. Because vitamin D receptors are present in the immune system and hair follicles, vitamin D has been hypothesized to affect the disease.

Objective

The aim of this study was to determine serum 25-hydroxyvitamin D levels and the percentage of vitamin D deficiency in AA patients and compare them with those in healthy controls in a Philippine tertiary hospital.

Methods

This cross-sectional study included 29 AA patients and 29 healthy controls. The serum 25-hydroxyvitamin D levels were determined using the chemiluminescent immunoassay method.

Results

There was no significant difference in the mean vitamin D levels between AA patients (24.41 ± 6.87 ng/mL) and healthy controls (24.68 ± 6.68 ng/mL) (P = .88). The percentage of patients with vitamin D deficiency, defined as <20 ng/mL, trended to higher among AA patients (34.4%) than among healthy controls (17.2%), with an odds ratio of 2.53 (95% CI 0.73-8.65), though this was not statsitically significant.

Limitations

This study involved a limited number of patients in an urbanized area in the Philippines, and majority of the AA cases seen had mild AA.

Conclusion

The trend toward the increased percentage of vitamin D-deficient individuals among AA patients seen in this study may provide insight into the association of vitamin D with AA.

Triglyceride-Glucose Index as a Novel Biomarker in the Occurrence of Kidney Stones: A Cross-Sectional Population-Based Study

Background

Triglyceride–glucose (TyG) index has been considered as the reliable marker of insulin resistance (IR), which is one risk factor of kidney stone. This study aimed to evaluate the TyG index in the occurrence of kidney stones among the United States (US) population.

Methods

Participants who received assessment were retrieved from the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2018. The logistic regression analysis was conducted to assess the relationship between the TyG index and kidney stones occurrence. A 1:1 matched-pair analysis was established to optimize the bias in kidney stones by propensity score matching (PSM). The dose–response curve was performed to verify the association between the TyG index and risk of kidney stones.

Results

Of the 14,158 eligible enrolled participants, 1346 (9.5%) self-reported a history of kidney stones. All participants were divided into two groups (high TyG index group and low TyG index group) based on the median TyG index. The dose–response curve exhibited a positive non-linear correlation between the TyG index and kidney stones risk. High TyG index was related to increased kidney stones occurrence in participants, with adjusted odds ratios (AOR) of 1.14 (95% confidence intervals (CI): 1.01–1.30, P = 0.038) compared with the low TyG index subgroup before PSM. After PSM, the risk of kidney stones was 19% higher in the high TyG group compared with the low TyG group (AOR = 1.19, 95% CI: 1.02–1.38, P = 0.026), and the dose–response curve still showed a positive association between TyG index and kidney stone risk.

Conclusion

The TyG index was independently associated with kidney stones and would be a novel biomarker in predicting occurrence for clinical decision.

Adoption of Preventive Measures During the Very Early Phase of the COVID-19 Outbreak in China: National Cross-sectional Survey Study

BACKGROUND

The outbreak of COVID-19 in China occurred around the Chinese New Year (January 25, 2020), and infections decreased continuously afterward. General adoption of preventive measures during the Chinese New Year period was crucial in driving the decline. It is imperative to investigate preventive behaviors among Chinese university students, who could have spread COVID-19 when travelling home during the Chinese New Year break.

OBJECTIVE

In this study, we investigated levels of COVID-19-related personal measures undertaken during the 7-day Chinese New Year holidays by university students in China, and associated COVID-19-related cognitive factors.

METHODS

A cross-sectional anonymous web-based survey was conducted during the period from February 1 to 10, 2020. Data from 23,863 students (from 26 universities, 16 cities, 13 provincial-level regions) about personal measures (frequent face-mask wearing, frequent handwashing, frequent home staying, and an indicator that combined the 3 behaviors) were analyzed (overall response rate 70%). Multilevel multiple logistic regression analysis was performed.

RESULTS

Only 28.0% of respondents (6684/23,863) had left home for >4 hours, and 49.3% (11,757/23,863) had never left home during the 7-day Chinese New Year period; 79.7% (19,026/23,863) always used face-masks in public areas. The frequency of handwashing with soap was relatively low (6424/23,863, 26.9% for >5 times/day); 72.4% (17,282/23,863) had frequently undertaken ≥2 of these 3 measures. COVID-19-related cognitive factors (perceptions on modes of transmission, permanent bodily damage, efficacy of personal or governmental preventive measures, nonavailability of vaccines and treatments) were significantly associated with preventive measures. Associations with frequent face-mask wearing were stronger than those with frequent home staying.

CONCLUSIONS

University students had strong behavioral responses during the very early phase of the COVID-19 outbreak. Levels of personal prevention, especially frequent home staying and face-mask wearing, were high. Health promotion may modify cognitive factors. Some structural factors (eg, social distancing policy) might explain why the frequency of home staying was higher than that of handwashing. Other populations might have behaved similarly; however, such data were not available to us.

A Framework for Using Epidemiology in Animal Welfare Science

The potential advantages of using epidemiology in animal welfare research are substantial and are used with increased frequency. Collaboration between scientists of different fields, with different specific expertise is advantageous in the advancement of science. In this review, a framework to use epidemiology in animal welfare science is established. The different epidemiological study designs and analytical procedures are explored and put in an animal welfare scientific context. It is argued and demonstrated that epidemiology is used with advantage: in the identification of risk factors behind the development of maladaptation and abnormal behaviors; in the introduction of standardized procedures in research allowing comparisons between studies and facilitating the integration for evidence synthesis in systematic reviews and meta-analysis; by allowing animal welfare scientists to analyze complex settings such as farms or zoos. Mathematical modeling can also be used with advantage in risk assessment.

Development of the Hypertension Index Model in General Adult Using the Korea National Health and Nutritional Examination Survey and the Korean Genome and Epidemiology Study

Hypertension, a risk factor for cardiovascular disease and all-cause mortality, has been increasing. Along with emphasizing awareness and control of hypertension, predicting the incidence of hypertension is important. Several studies have previously reported prediction models of hypertension. However, among the previous models for predicting hypertension, few models reflect various risk factors for hypertension. We constructed a sex-specific prediction model using Korean datasets, which included socioeconomic status, medical history, lifestyle-related variables, anthropometric status, and laboratory indices. We utilized the data from the Korea National Health and Nutrition Examination Survey from 2011 to 2015 to derive a hypertension prediction model. Participants aged 40 years or older. We constructed a sex-specific hypertension classification model using logistic regression and features obtained by literature review and statistical analysis. We constructed a sex-specific hypertension classification model including approximately 20 variables. We estimated its performance using the Korea National Health and Nutrition Examination Survey dataset from 2016 to 2018 (AUC = 0.847 in men, AUC = 0.901 in women). The performance of our hypertension model was considered significant based on the cumulative incidence calculated from a longitudinal dataset, the Korean Genome and Epidemiology Study dataset. We developed this hypertension prediction model using features that could be collected in a clinical office without difficulty. Individualized results may alert a person at high risk to modify unhealthy lifestyles.

Adherence to Mediterranean Diet and Cognitive Abilities in the Greek Cohort of Epirus Health Study

The Mediterranean diet is commonly proposed as a major modifiable protective factor that may delay cognitive impairment in the elderly. The aim of the study was to investigate the cross-sectional association of adherence to the Mediterranean diet with cognitive abilities in a younger Greek population. A total of 1201 healthy adults aged 21-77 years (mean: 47.8) from the Epirus Health Study cohort were included in the analysis. Adherence to the Mediterranean diet was measured using the 14-point Mediterranean Diet Adherence Screener (MEDAS) and cognition was measured using the Trail Making Test, the Verbal Fluency test and the Logical Memory test. Statistical analysis was performed using multiple linear regression models adjusted for age, sex, education, body mass index, smoking status, alcohol consumption and physical activity. Overall, no association was found between the MEDAS score and cognitive tests, which could be explained by the young mean age and high level of education of the participants. Future studies should target young and middle-aged individuals to gain further understanding of the association between Mediterranean diet and cognition in this age group.

Associations between empirically derived dietary patterns and cardiovascular risk factors among older adult men

Cardiovascular disease (CVD) remains the leading cause of death globally, and epidemiological studies have suggested a link between diet and cardiometabolic risk. Currently, the prevalence of CVD is rapidly increasing with an aging population and continues to contribute to the growing economic and public health burden. However, there is limited evidence available regarding dietary patterns and cardiometabolic risk factors in older adults. We conducted a cross-sectional study to assess dietary patterns and cardiometabolic risk factors in males ≥60 years. Factor analysis identified a "healthy" diet and an "unhealthy" diet as the two primary dietary patterns. Multivariable logistic regression was used for estimating the associations of identified dietary patterns and cardiometabolic risk factors including anthropometric measures, blood pressure, glycemic biomarkers, lipid profile, and inflammatory biomarkers. A healthy dietary pattern was significantly associated with decreased odds of high serum fasting blood sugar (FBS) (OR: 0.32; 95% CI: 0.15-0.67; P_trend=0.002), but increased odds of high serum low-density lipoprotein cholesterol (LDL-C) (OR: 1.82; 95% CI: 1.02-3.24; P_trend=0.04). In comparison, an unhealthy diet was associated with increased odds of obesity (OR: 2.33; 95% CI: 1.31-4.15; P_trend=0.004) and high LDL-C (OR: 2.00; 95% CI: 1.10-2.61; P_trend=0.02). Thus, in older adults, adherence to an unhealthy dietary pattern has a significant impact on clinically relevant risk factors for cardiometabolic risk.

COVID-19 and dental workers: The Italian Society of Periodontology and Implantology (SIdP) survey

Objectives

To evaluate the proportion of COVID‐19 infections among a population of Italian Dental workers across different geographical area of Italy and to analyze the impact of both the preventive measures/strategies adopted and the psychological influences.

Subjects and Methods

The current cross‐sectional survey was administered with a web‐based form. To be eligible for the study, participants had to be 18 years and being dentists or dental hygienists members of the Italian Society of Periodontology and Implantology (SIdP). A 23‐item questionnaire concerning positiveness to COVID‐19, clinical strategies and psychological attitude within the pandemic was administered. Sub‐group analysis was conducted according to geographical macro‐area.

Results

A total of 790 dentists and dental hygienists were included. A total of 4.7% participants developed a positive diagnosis to COVID‐19. The Northwest of Italy experienced almost double of COVID‐19‐positive participants (p < 0.05). Preoperatory mouthwashes together with natural air change/ventilation were the most frequent approaches used to prevent COVID‐19 outbreak. Positive and proactive attitudes were predominant among participants. Only a reduced proportion feels some concerns for the future.

Conclusions

Prevalence of positive COVID‐19 among dental workers in Italy was double in Northwest area in comparison with the whole country proportion. Preventive strategies comprise mainly ultrasound reduction and preoperative mouthwashes.

Eating Behaviors and Dietary Patterns of Women during Pregnancy: Optimizing the Universal 'Teachable Moment'

Understanding women’s perceptions of eating behaviors and dietary patterns can inform the ‘teachable moment’ model of pregnancy. Our objectives were to describe eating behaviors and dietary patterns in pregnancy. This was a cross-sectional, national electronic survey. Women were ≥18 years of age, living in the United States, currently pregnant or less than two years postpartum, and had internet access. Age, education, race, and marriage were included as covariates in ordinal and binary logistic regressions (significance p < 0.05). Women (n = 587 eligible) made positive or negative changes to their diets, while others maintained pre-existing eating behaviors. The majority of women did not try (84.9 to 95.1% across diets) and were unwilling to try (66.6 to 81%) specific dietary patterns during pregnancy. Concerns included not eating a balanced diet (60.1 to 65.9%), difficulty in implementation without family (63.2 to 64.8%), and expense (58.7 to 60.1%). Helpful strategies included being provided all meals and snacks (88.1 to 90.6%) and periodic consultations with a dietitian or nutritionist (85 to 86.7%). Responses differed across subgroups of parity, body mass index, and trimester, notably in women with obesity who reported healthier changes to their diet (p < 0.05). Our study underscores the importance of tailoring care early to individual needs, characteristics, and circumstances.

Associations Between the Perceived Severity of the COVID-19 Pandemic, Cyberchondria, Depression, Anxiety, Stress, and Lockdown Experience: Cross-sectional Survey Study

Background

The outbreak of the COVID-19 pandemic has caused great panic among the public, with many people suffering from adverse stress reactions. To control the spread of the pandemic, governments in many countries have imposed lockdown policies. In this unique pandemic context, people can obtain information about pandemic dynamics on the internet. However, searching for health-related information on the internet frequently increases the possibility of individuals being troubled by the information that they find, and consequently, experiencing symptoms of cyberchondria.

Objective

We aimed to examine the relationships between people’s perceived severity of the COVID-19 pandemic and their depression, anxiety, and stress to explore the role of cyberchondria, which, in these relationship mechanisms, is closely related to using the internet. In addition, we also examined the moderating role of lockdown experiences.

Methods

In February 2020, a total of 486 participants were recruited through a web-based platform from areas in China with a large number of infections. We used questionnaires to measure participants’ perceived severity of the COVID-19 pandemic, to measure the severity of their cyberchondria, depression, anxiety, and stress symptoms, and to assess their lockdown experiences. Confirmatory factor analysis, exploratory factor analysis, common method bias, descriptive statistical analysis, and correlation analysis were performed, and moderated mediation models were examined.

Results

There was a positive association between perceived severity of the COVID-19 pandemic and depression (β=0.36, t=8.51, P<.001), anxiety (β=0.41, t=9.84, P<.001), and stress (β=0.46, t=11.45, P<.001), which were mediated by cyberchondria (β=0.36, t=8.59, P<.001). The direct effects of perceived severity of the COVID-19 pandemic on anxiety (β=0.07, t=2.01, P=.045) and stress (β=0.09, t=2.75, P=.006) and the indirect effects of cyberchondria on depression (β=0.10, t=2.59, P=.009) and anxiety (β=0.10, t=2.50, P=.01) were moderated by lockdown experience.

Conclusions

The higher the perceived severity of the COVID-19 pandemic, the more serious individuals’ symptoms of depression, anxiety, and stress. In addition, the associations were partially mediated by cyberchondria. Individuals with higher perceived severity of the COVID-19 pandemic were more likely to develop cyberchondria, which aggravated individuals’ depression, anxiety, and stress symptoms. Negative lockdown experiences exacerbated the COVID-19 pandemic’s impact on mental health.

The Roles of Social Comparison Orientation and Regulatory Focus in College Students' Responses to Fitspiration Posts on Social Media: Cross-sectional Study

BACKGROUND

Information shared via social media influences college students' self-perceptions and behavior, particularly, "fitspiration" posts (ie, images of healthy food, people exercising, or fitness quotations). There are mixed findings regarding the mental health implications of fitspiration and its potential to motivate healthy behavior. Individual differences such as social comparison orientation and regulatory focus could aid in determining for whom fitspiration may be helpful versus harmful, though these characteristics have received limited attention in terms of students' fitspiration perceptions.

OBJECTIVE

This cross-sectional study examined associations between students' fitspiration use (ie, intentional versus unintentional exposure while using social media), response tendencies (ie, feelings about the self and motivation to be physically active), social comparison orientation, and regulatory focus.

METHODS

College students (N=344; 239/344, 69.5% women) completed an electronic survey in which they self-reported demographic information, the frequency of their social media use, exposure to fitspiration posts, typical feelings in response to fitspiration posts, and typical motivation for physical activity after viewing fitspiration posts. They also completed validated self-report measures of social comparison orientation and regulatory focus.

RESULTS

College students reported frequent exposure to fitspiration posts on social media and that they experienced negative feelings in response to these posts more often than positive feelings. Average motivation for physical activity was rated as feeling motivated "some of the time." However, students who reported more negative feelings after viewing fitspiration also reported greater motivation to be physically active after exposure. Associations between the frequency of intentional fitspiration use and motivation for physical activity after viewing fitspiration posts were moderated by social comparison orientation (b=-0.01, P=.03) but not by regulatory focus (b=-0.002, P=.67).

CONCLUSIONS

Negative feelings about the self may be motivating for students with weak social comparison orientation, as fitspiration may highlight a discrepancy between one's real and ideal self that does not prompt dejection or disengagement. However, negative feelings for prevention-focused students might not be as motivating because there are no salient negative models to avoid. Further research into these associations is warranted and could inform future efforts to promote student health and well-being during college.

Compassion fatigue, burnout and compassion satisfaction among emergency nurses: A path analysis

AIMS

To verify a hypothesized model of the relationships between compassion fatigue, burnout and compassion satisfaction, as well as their influencing factors and consequences, among emergency nurses.

DESIGN

A descriptive, cross-sectional design.

METHODS

A hypothesized model was proposed on the basis of the current literature. A convenience sample was conducted of nurses working in the emergency departments of six hospitals in Shanghai, China, from July to September 2020. A total of 445 valid data points were collected using various self-designed and well-validated instruments. Descriptive statistics and correlations were computed, and a path analysis was used to assess model fitness and to investigate direct and indirect effects.

RESULTS

The final model reported a desirable fit with significant paths. Compassion satisfaction and compassion fatigue directly and inversely affected burnout, and compassion satisfaction positively influenced compassion fatigue. Perceived social support directly improved compassion satisfaction and protected against compassion fatigue. Compassion satisfaction and compassion fatigue directly affected mental health, and burnout directly influenced physical health. Compassion fatigue, burnout and compassion satisfaction had complicated effects on turnover intention.

CONCLUSION

Emergency nurses' compassion satisfaction and compassion fatigue may be two coexisting constructs, and both affect burnout. Perceived social support acts as a protector of the three dimensions, and their effects on health status and turnover intention can be significant and complicated.

IMPACT

Emergency nurses may experience high levels of compassion satisfaction and compassion fatigue simultaneously, which can help to explain why compassion fatigue did not directly increase emergency nurses' turnover intention. The direct effects of compassion fatigue and burnout on emergency nurses' health status and working engagement were significantly different. Support from significant others, professional psychological intervention and emergency nursing system reforms are required to tackle emergency nurses' compassion fatigue and burnout and improve their compassion satisfaction.

Survey of the Impact of COVID-19 on Pediatric Orthopaedic Surgeons Globally

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic required rapid, global health care shifts to prioritize urgent or pandemic-related care and minimize transmission. Little is known about impacts on pediatric orthopaedic surgeons during this time. We aimed to investigate COVID-19-related changes in practice, training, and research among pediatric orthopaedic surgeons globally.

METHODS

An online survey was administered to orthopaedic surgeons with interest in pediatrics in April 2020 and a follow-up was administered in February 2021. The surveys captured demographics and surgeons' self-reported experiences during the pandemic. Participants were recruited from web media and available email lists of orthopaedic societies over a 2-month period. Descriptive statistics were used to analyze results, stratified by the severity of local COVID-19-related measures.

RESULTS

A total of 460 responses from 45 countries were collected for initial survey. Of these, 358 (78.5%) respondents reported lockdown measures in their region at time of survey. Most (n=337, 94.4%) reported pausing all elective procedures. Surgeons reported a reduction in the average number of surgeries per week, from 6.89 (SD=4.61) prepandemic to 1.25 (SD=2.26) at time of survey (mean difference=5.64; 95% confidence interval=5.19, 6.10). Average number of elective outpatient appointments per week decreased from 67.89 (SD=45.78) prepandemic to 11.79 (SD=15.83) at time of survey (mean difference=56.10, 95% confidence interval=5.61, 60.58). In total, 177 (39.4%) surgeons reported using virtual modes of outpatient appointments for the first time. Of 290 surgeons with trainees, 223 (84.5%) reported implementation of systems to continue training such as webinars or virtual rounds. Of 192 respondents with research, 149 (82.8%) reported continuing research activities during the pandemic with most reporting either cessation (n=75, 64.15%), or reduction (n=25, 29.9%) in participant recruitment. A total of 111 responses from 28 countries were collected during follow-up. Surgeons described policy and circumstantial changes that facilitated resumption of clinical work.

CONCLUSIONS

The COVID-19 pandemic and its related counter measures have had significant impacts on pediatric orthopaedic practice and increased uptake of technology to provide care continuity. Rigorous epidemiological studies are needed to assess impacts of delayed and virtual care on patient outcomes.

Assessing the impact of COVID-19 on healthcare staff at a combined elderly care and specialist palliative care facility: A cross-sectional study

BACKGROUND

In the pre-COVID-19 era, healthcare professionals experienced stress and burnout. The international literature confirms that COVID-19 placed significant additional burdens on healthcare workers.

AIM

To describe and characterise the magnitude and variety of ways in which the COVID-19 pandemic affected the personal, social and professional lives of healthcare workers representing several multidisciplinary specialties in a fully-integrated palliative and elderly care service.

DESIGN

All staff were invited to complete an anonymised standardised questionnaire evaluating the impact of COVID-19 across a diverse range of domains. The study was conducted over a 6-week period commencing 11 September 2020.

SETTING

The setting incorporates two distinct but integrated services operating under a single management structure in Ireland: (i) Specialist palliative care across hospice (44 beds), community and hospitals and (ii) Elderly Care Service (long-term and respite care) delivered in a 63-bed inpatient unit.

RESULTS

250 respondents (69.8%) completed the questionnaire. Nurses and healthcare assistants comprised the majority of respondents (60%) and other disciplines were represented proportionately. 230 participants (92%) agreed that their personal workload had changed significantly in response to COVID-19 and 182 (72.8%) agreed that their responsibilities had increased. 196 (78.4%) reported greater work-related stress. Highest-rated sources of stress included fear of contracting COVID-19 or transmitting it to friends/family, interacting with isolated frail/dying patients, changes to workplace protocols and reduced social interaction with colleagues.

CONCLUSIONS

This study demonstrates the profound impact of COVID-19 on personal and professional wellbeing of staff. The greatest burden was carried by those providing prolonged, direct and intimate patient care.

Associations between health-related skills and young adults' work ability within a structural health literacy model

Young adults have a high societal relevance but are still an under-represented target group in health promotion. Health literacy is widely acknowledged as one of the strongest predictors and key determinant of health, so its influence on work ability is of great interest. The purpose of the study was to examine the associations between health-related skills and work ability within the structural model of health literacy of Lenartz, Soellner and colleagues, which explains health behaviour and health through the indirect and direct influence of six 'advanced skills' ('self-perception', 'proactive approach to health', 'dealing with health information', 'self-control', 'self-regulation' and 'communication and cooperation'). The cross-sectional study was based on baseline data of a health literacy promotion intervention (495 vocational school students, 59.0% female, age span 18-25 years). Structural equation modelling with partial least squares was used to examine the associations between the six constructs of the model and the Work Ability Index (WAI). Mean WAI score was 39.7 ± 4.5 (51.1% categorized 'moderate'/'poor'). Five out of six constructs of the model showed a statistically significant indirect or direct effect, respectively, on work ability. The model explained 24.8% of the WAI score variance. Our findings show associations between the health literacy model and the work ability among young employees. In view of demographic change, it is crucial to develop and analyse target group-specific health literacy interventions. The model offers new facets in the modelling of health literacy.

Analysis of Social Determinants and the Utilization of Pediatric Tele-Urgent Care During the COVID-19 Pandemic: Cross-sectional Study

BACKGROUND

Telehealth is increasingly used to provide specialty consultations to infants and children receiving care. However, there is uncertainty if the COVID-19 pandemic has influenced the use of telehealth among vulnerable populations.

OBJECTIVE

This research aims to compare the overall use of tele-urgent care visits for pediatric patients before and after the pandemic, especially among vulnerable populations.

METHODS

We conducted a cross-sectional analysis of pediatric tele-urgent care visits at a virtual care center at a southeastern health care center. The main outcome of this study was the use of pediatrics tele-urgent visits across geographical regions with different levels of social disparities and between 2019 and 2020.

RESULTS

Of 584 tele-urgent care visits, 388 (66.4%) visits occurred in 2020 during the pandemic compared to 196 (33.6%) visits in 2019. Among 808 North Carolina zip codes, 181 (22%) consisted of a high concentration of vulnerable populations, where 17.7% (56/317) of the tele-urgent care visits originated from. The majority (215/317, 67.8%) of tele-urgent care visits originated from zip codes with a low concentration of vulnerable populations. There was a significant association between the rate of COVID-19 cases and the concentration level of social factors in a given Zip Code Tabulation Area.

CONCLUSIONS

The use of tele-urgent care visits for pediatric care doubled during the COVID-19 pandemic. The majority of the tele-urgent care visits after COVID-19 originated from regions where there is a low presence of vulnerable populations. In addition, our geospatial analysis found that geographic regions with a high concentration of vulnerable populations had a significantly higher rate of COVID-19-confirmed cases and deaths compared to regions with a low concentration of vulnerable populations.

Headache and distress during pregnancy

OBJECTIVE

To determine the prevalence of headache, review variables believed to be associated, and assess distress levels in pregnant women.

METHODS

This is a cross-sectional study conducted on pregnant women who presented to a Training and Research Hospital in Sakarya, Turkey from June 1, 2020 to December 1, 2020. The study group consisted of 600 pregnant women who agreed to take part in the study. Chi-squared test and logistic regression analysis were used to analyze the data. Statistical significance level was accepted as P value of 0.05 or less.

RESULTS

The ages of pregnant women ranged from 19 to 44 years with a mean age of 29.01 ± 5.27 years. Prevalence of headache during pregnancy was found to be 55.7% (n = 334). The number of pregnant women at of distress was found to be 144 (24.0%). There was no difference between women with and without headache and between severity of headache and prevalence of distress (P > 0.05 for each).

CONCLUSION

Headache is an important health issue in pregnant women. There was no relationship between the presence and severity of headache and distress level.