Pandemics have become more frequent and more complex during the twenty-first century. Posttraumatic stress disorder (PTSD) following pandemics is a significant public health concern. We sought to ...provide a reliable estimate of the worldwide prevalence of PTSD after large-scale pandemics as well as associated risk factors, by a systematic review and meta-analysis. We systematically searched the MedLine, Embase, PsycINFO, Web of Science, CNKI, WanFang, medRxiv, and bioRxiv databases to identify studies that were published from the inception up to August 23, 2020, and reported the prevalence of PTSD after pandemics including sudden acute respiratory syndrome (SARS), H1N1, Poliomyelitis, Ebola, Zika, Nipah, Middle Eastern respiratory syndrome coronavirus (MERS-CoV), H5N1, and coronavirus disease 2019 (COVID-19). A total of 88 studies were included in the analysis, with 77 having prevalence information and 70 having risk factors information. The overall pooled prevalence of post-pandemic PTSD across all populations was 22.6% (95% confidence interval (CI): 19.9-25.4%, I
: 99.7%). Healthcare workers had the highest prevalence of PTSD (26.9%; 95% CI: 20.3-33.6%), followed by infected cases (23.8%: 16.6-31.0%), and the general public (19.3%: 15.3-23.2%). However, the heterogeneity of study findings indicates that results should be interpreted cautiously. Risk factors including individual, family, and societal factors, pandemic-related factors, and specific factors in healthcare workers and patients for post-pandemic PTSD were summarized and discussed in this systematic review. Long-term monitoring and early interventions should be implemented to improve post-pandemic mental health and long-term recovery.
Background and Objectives
COVID‐19‐related quarantine and stress have likely escalated the crisis of Internet addiction. This study aimed to determine the impact of the COVID‐19 pandemic on Internet ...use and related risk factors among the general public in China.
Methods
A large‐sample cross‐sectional online survey was conducted from March 24 to April 30, 2020, in China, and 20,472 participants completed the survey. We investigated the prevalence and severity of Internet addiction based on the Internet Addiction Test (IAT), and explored the risk factors related to increases in time spent on Internet use and severity of Internet addiction, as well as severe Internet addiction.
Results
The overall prevalence of Internet addiction was 36.7% among the general population during the pandemic, and that of severe Internet addiction was 2.8%, according to IAT scores. Time spent on recreational Internet use had significantly increased during the pandemic, and almost half of participants reported increases in the severity of Internet addiction. Risk factors for increases in time spent on Internet use and severity of Internet addiction and severe Internet addiction included having fewer social supporters, perceiving pressure and impact on mental health status due to COVID‐19, and being over‐engaged in playing videogames.
Discussion and Conclusions
The COVID‐19 pandemic adversely impacted Internet use and increased the prevalence and severity of Internet addiction among the general population in China, especially in vulnerable populations.
Scientific Significance
This study provides evidence for policymakers to refine public health policies to control the pandemic and make efforts to provide population‐specific prevention and interventions for people at risk of developing Internet addiction. (Am J Addict 2021;00:00–00)
People exposed to coronavirus disease 2019 (COVID-19) and a series of imperative containment measures could be psychologically stressed, yet the burden of and factors associated with mental health ...symptoms remain unclear.
To investigate the prevalence of and risk factors associated with mental health symptoms in the general population in China during the COVID-19 pandemic.
This large-sample, cross-sectional, population-based, online survey study was conducted from February 28, 2020, to March 11, 2020. It involved all 34 province-level regions in China and included participants aged 18 years and older. Data analysis was performed from March to May 2020.
The prevalence of symptoms of depression, anxiety, insomnia, and acute stress among the general population in China during the COVID-19 pandemic was evaluated using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Insomnia Severity Index, and Acute Stress Disorder Scale. Logistic regression analyses were used to explore demographic and COVID-19-related risk factors.
Of 71 227 individuals who clicked on the survey link, 56 932 submitted the questionnaires, for a participation rate of 79.9%. After excluding the invalid questionnaires, 56 679 participants (mean SD age, 35.97 8.22 years; 27 149 men 47.9%) were included in the study; 39 468 respondents (69.6%) were aged 18 to 39 years. During the COVID-19 pandemic, the rates of mental health symptoms among the survey respondents were 27.9% (95% CI, 27.5%-28.2%) for depression, 31.6% (95% CI, 31.2%-32.0%) for anxiety, 29.2% (95% CI, 28.8%-29.6%) for insomnia, and 24.4% (95% CI, 24.0%-24.7%) for acute stress. Participants with confirmed or suspected COVID-19 and their family members or friends had a high risk for symptoms of depression (adjusted odds ratios ORs, 3.27 95% CI, 1.84-5.80 for patients; 1.53 95% CI, 1.26-1.85 for family or friends), anxiety (adjusted ORs, 2.48 95% CI, 1.43-4.31 for patients; 1.53 95% CI, 1.27-1.84 for family or friends), insomnia (adjusted ORs, 3.06 95% CI, 1.73-5.43 for patients; 1.62 95% CI, 1.35-1.96 for family or friends), and acute stress (adjusted ORs, 3.50 95% CI, 2.02-6.07 for patients; 1.77 95% CI, 1.46-2.15 for family or friends). Moreover, people with occupational exposure risks and residents in Hubei province had increased odds of symptoms of depression (adjusted ORs, 1.96 95% CI, 1.77-2.17 for occupational exposure; 1.42 95% CI, 1.19-1.68 for Hubei residence), anxiety (adjusted ORs, 1.93 95% CI, 1.75-2.13 for occupational exposure; 1.54 95% CI, 1.30-1.82 for Hubei residence), insomnia (adjusted ORs, 1.60 95% CI, 1.45-1.77 for occupational exposure; 1.20 95% CI, 1.01-1.42 for Hubei residence), and acute stress (adjusted ORs, 1.98 95% CI, 1.79-2.20 for occupational exposure; 1.49 95% CI, 1.25-1.79 for Hubei residence). Both centralized quarantine (adjusted ORs, 1.33 95% CI, 1.10-1.61 for depression; 1.46 95% CI, 1.22-1.75 for anxiety; 1.63 95% CI, 1.36-1.95 for insomnia; 1.46 95% CI, 1.21-1.77 for acute stress) and home quarantine (adjusted ORs, 1.30 95% CI, 1.25-1.36 for depression; 1.28 95% CI, 1.23-1.34 for anxiety; 1.24 95% CI, 1.19-1.30 for insomnia; 1.29 95% CI, 1.24-1.35 for acute stress) were associated with the 4 negative mental health outcomes. Being at work was associated with lower risks of depression (adjusted OR, 0.85 95% CI, 0.79-0.91), anxiety (adjusted OR, 0.92 95% CI, 0.86-0.99), and insomnia (adjusted OR, 0.87 95% CI, 0.81-0.94).
The results of this survey indicate that mental health symptoms may have been common during the COVID-19 outbreak among the general population in China, especially among infected individuals, people with suspected infection, and people who might have contact with patients with COVID-19. Some measures, such as quarantine and delays in returning to work, were also associated with mental health among the public. These findings identify populations at risk for mental health problems during the COVID-19 pandemic and may help in implementing mental health intervention policies in other countries and regions.
Interstitial lung disease (ILD) is the most important prognostic factor for mortality in patients with polymyositis (PM) and dermatomyositis (DM), but the prevalence of ILD in PM/DM may vary between ...countries. The aim of this study was to determine the overall prevalence of ILD in global patients with PM/DM.
We performed a systematic literature review of studies published from Jan 1, 2000 to April 30, 2020 on ILD and PM/DM. We extracted data and pooled the prevalence by using a random-effect model due to high heterogeneity. Heterogeneity was assessed by subgroup analysis and sensitivity analysis.
A total of 34 studies with 10,130 patients were included in our meta-analysis. Pooled data demonstrated that the global prevalence of ILD in patients with PM/DM was 0.41 (95% confidence interval CI 0.35–0.48). However, this prevalence varied with geographical locations and time trends. The prevalence of ILD in PM/DM was 0.5 (95% CI 0.42–0.57) in Asia, 0.23 (95% CI 0.15–0.31) in America, and 0.26 (95% CI 0.18–0.34) in Europe. A higher prevalence of ILD was reported in studies published in 2011–2015 (0.43, 95% CI 0.34–0.52) and 2016–2020 (0.45, 95% CI 0.35–0.54), compared with those published in 2000–2010 (0.27, 95% CI 0.16–0.39). The pooled prevalence of ILD in patients with DM, PM, and clinically amyopathic dermatomyositis subtype was 0.42 (95% CI 0.35–0.49), 0.35 (95% CI 0.27–0.42), and 0.53 (95% CI 0.32–0.74), respectively. Patients with anti-Jo-1 and anti-melanoma differentiation-associated gene 5 antibodies were more likely to develop ILD than other myositis-specific autoantibodies.
The global prevalence of ILD in patients with PM/DM was approximately 41% and the condition was predominant in Asians. This highlights potential genetic and environmental differences in the pathogenesis of ILD in patients with PM/DM. More studies are required to elucidate the specific associations.
As a result of recent, substantial capacity building, a new landscape for cancer drug trials is emerging in China. However, data on the characteristics of cancer drug trials, and how they have ...changed over time, are scarce. Based on clinical trials published on the China Food and Drug Administration Registration and Information Disclosure Platform for Drug Clinical Studies, we aimed to systematically review changes over time in clinical trials of cancer drugs in mainland China from 2009 to 2018, to provide insight on the effectiveness of the pharmaceutical industry and identify unmet clinical needs of stakeholders. A total of 1493 trials of 751 newly tested cancer drugs were initiated. Increases over time were observed for the annual number of initiated trials, newly tested drugs, and newly added leading clinical trial units, with a sharp increase after 2016. Of the 1385 trials in which cancer types were identified, solid tumours (325 23% trials), non-small-cell lung cancer (232 17%), and lymphoma (126 9%) were the most common. A markedly uneven distribution was also observed in the geography of leading units with the largest number of leading units located in east China (50 41%) and the smallest number located in southwest China (4 3%). The growth trends we observed illustrate the progress in and increasing capability of cancer drug research and development achieved in mainland China over the decade from 2009. The low number of clinical trials on tumours with epidemiological characteristics unique to the Chinese population and the unbalanced geographical distribution of leading clinical trial units will provide potential targets for policy makers and other stakeholders. Further research efforts should address cancers uniquely relevant to Chinese populations, globally rare cancers, and the balance between equitable drug access, efficiency, and sustainability of cancer drug research and development in mainland China.
COVID-19 might have long-term mental health impacts. We aim to investigate the longitudinal changes in mental problems from initial COVID-19 peak to its aftermath among general public in China. ...Depression, anxiety and insomnia were assessed among a large-sample nationwide cohort of 10,492 adults during the initial COVID-19 peak (28 February 2020 to 11 March 2020) and its aftermath (8 July 2020 to 8 August 2020) using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Insomnia Severity Index. We used generalized estimating equations and linear mixed models to explore factors associated with long-term mental health symptoms during COVID-19. During the five months, mental health symptoms remained consistently elevated (baseline 46.4%; follow-up 45.1%). Long-term depression, anxiety and insomnia were associated with several personal and work-related factors including quarantine (adjusted OR for any mental health symptoms 1.31, 95%CI 1.22–1.41, p < 0.001), increases in work burden after resuming work (1.77, 1.65–1.90, p < 0.001), occupational exposure risk to COVID-19 (1.26, 1.14–1.40, p < 0.001) and living in places severely affected by initial COVID-19 peak (1.21, 1.04–1.41, p = 0.01) or by a COVID-19 resurgence (1.38, 1.26–1.50, p < 0.001). Compliance with self-protection measures, such as wearing face masks (0.74, 0.61–0.90, p = 0.003), was associated with lower long-term risk of mental problems. The findings reveal a pronounced and prolonged mental health burden from the initial COVID-19 peak through to its aftermath in China. We should regularly monitor the mental health status of vulnerable populations throughout COVID-19.
Infectious diseases, including COVID-19, are crucial public health issues and may lead to considerable fear among the general public and stigmatization of, and discrimination against, specific ...populations. This meta-analysis aimed to estimate the pooled prevalence of stigma in infectious disease epidemics. We systematically searched PubMed, PsycINFO, Embase, MEDLINE, Web of Science, and Cochrane databases since inception to June 08, 2021, and reported the prevalence of stigma towards people with infectious diseases including SARS, H1N1, MERS, Zika, Ebola, and COVID-19. A total of 50 eligible articles were included that contributed 51 estimates of prevalence in 92722 participants. The overall pooled prevalence of stigma across all populations was 34% 95% CI: 28-40%, including enacted stigma (36% 95% CI: 28-44%) and perceived stigma (31% 95% CI: 22-40%). The prevalence of stigma in patients, community population, and health care workers, was 38% 95% CI: 12- 65%, 36% 95% CI: 28-45%, and 30% 95% CI: 20-40%, respectively. The prevalence of stigma in participants from low- and middle-income countries was 37% 95% CI: 29-45%, which is higher than that from high-income countries (27% 95% CI: 18-36%) though this difference was not statistically significant. A similar trend of prevalence of stigma was also observed in individuals with lower education (47% 95% CI: 23-71%) compared to higher education level (33% 95% CI: 23-4%). These findings indicate that stigma is a significant public health concern, and effective and comprehensive interventions are needed to counteract the damaging effects of the infodemics during infectious disease epidemics, including COVID-19, and reduce infectious disease-related stigma.
The upsurge in the number of people affected by the COVID-19 is likely to lead to increased rates of emotional trauma and mental illnesses. This article systematically reviewed the available data on ...the benefits of interventions to reduce adverse mental health sequelae of infectious disease outbreaks, and to offer guidance for mental health service responses to infectious disease pandemic. PubMed, Web of Science, Embase, PsycINFO, WHO Global Research Database on infectious disease, and the preprint server medRxiv were searched. Of 4278 reports identified, 32 were included in this review. Most articles of psychological interventions were implemented to address the impact of COVID-19 pandemic, followed by Ebola, SARS, and MERS for multiple vulnerable populations. Increasing mental health literacy of the public is vital to prevent the mental health crisis under the COVID-19 pandemic. Group-based cognitive behavioral therapy, psychological first aid, community-based psychosocial arts program, and other culturally adapted interventions were reported as being effective against the mental health impacts of COVID-19, Ebola, and SARS. Culturally-adapted, cost-effective, and accessible strategies integrated into the public health emergency response and established medical systems at the local and national levels are likely to be an effective option to enhance mental health response capacity for the current and for future infectious disease outbreaks. Tele-mental healthcare services were key central components of stepped care for both infectious disease outbreak management and routine support; however, the usefulness and limitations of remote health delivery should also be recognized.
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•Sandwiched composites can achieve high microwave SE and absorption coefficient.•Sandwiched composites have higher microwave SE than conventional composites.•Thick middle layer ...usually gives high microwave SE for sandwiched composites.•Dielectric/magnetic fillers in middle layer can affect microwave interference effect.•Sandwiched composites have higher microwave SE than gradient composites.
Herein, regulating microwave interference effect is carried in polydimethylsiloxane/carbon nanotube (PDMS/CNT) sandwiched composites via tuning dielectric and magnetic loss in middle layer to develop absorption-type microwave shielding materials. First, the sandwiched samples with different thickness of middle layer are prepared to discuss the thickness-dependent microwave interference effect. The microwave shielding performance is enhanced by thickness of middle layer due to the enhancement of the microwave interference effect. Second, the dielectric fillers or magnetic fillers are added into the middle layer to affect the microwave interference effect via dielectric or magnetic regulation, so as to tune the microwave shielding effectiveness (SE) of the composites. Third, a comparative study on absorption (A) coefficient and microwave SE is carried on the sandwiched and gradient samples. The sandwiched samples show more excellent microwave SE values and A coefficients than that of the gradient samples because of the microwave interference effect.
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