Keep Calm and Stay Safe: The Relationship between Anxiety and Other Psychological Factors, Media Exposure and Compliance with COVID-19 Regulations

The COVID-19 pandemic has led many countries to employ public health regulations to achieve behavioral change and stop the transmission of the virus. The factors influencing compliance with these regulations may differ from “classic” predictors for medical compliance. This study attempted to assess the effect of social communication and psychological factors on intention to comply. A cross-sectional online survey was conducted on healthy adults living in Israel (n = 697). The survey assessed the intention to comply with the state COVID-19 regulations and explored possible correlations with demographic and psychosocial factors. Data were collected during May 2020 using a Qualtrics online survey. Data were analyzed to find correlations between anxiety, uncertainty, media exposure and other variables and the level of intention to comply as self-reported. Moderation and mediation effects were studied by an integrative model of influencing factors. We found that media exposure change, trust in responsible agencies and anxiety were positively correlated with compliance, while uncertainty was correlated with noncompliance. The effect of media exposure on compliance had two components. First, media exposure was positively correlated with compliance. On the other hand, media exposure was positively correlated with uncertainty, and uncertainty was negatively correlated with compliance. Interestingly, anxiety, which was positively correlated with media exposure, also moderated the negative correlation between uncertainty and compliance. Our results highlight the important role of uncertainty and anxiety as moderators between media exposure and compliance. To increase public compliance with COVID-19 regulations, efforts should be directed at decreasing uncertainty and anxiety.

eDOTS: a new system applied for improving the treatment of pulmonary tuberculosis patients from Kashgar villages and Urumqi streets in Xinjiang, China

Background: Although the direct observed treatment strategy (DOTS) has been used for the control of pulmonary tuberculosis (PTB) in Xinjiang Uygur Autonomous Region for more than 30 years, the disease is still highly endemic in the region. To increase PTB treatment ability and control efficacy, we developed a new electronic DOTS (eDOTS) system for reminding, monitoring and educating PTB patients taking antibiotics.Methods: A total 167 cases with active PTB from Kashgar villages and Urumqi streets in Xinjiang were involved in the study referring to the criteria published by the National Health and Family Planning Commission of the People's Republic of China. All the participants in Kashgar or Urumqi were randomly assigned into eDOTS group or DOTS group. Among them, 81 patients were from Kashgar villages with 43 patients using eDOTS system and 38 patients with traditional DOTS as control. Eighty six patients were from Urumqi streets with 50 patients using eDOTS and 36 patients using DOTS. T test and ANOVA were used to compare the image scores and treatment compliance rates before and after treatment of these patients between groups.Findings: PTB patients from villages in Kashgar treated with DOTS showed only 27.9% the patients took TB antibiotics regularly. However, with help of village and hospital doctors through the eDOTS system, the medical compliance was increased to 77.2%. The treatment compliance of patients from township (100%) using eDOTS was significantly higher than that of those patients from the rural villages (48.8%) in the first 6 weeks (t=-32.781, p<0.001). The comparison of lung X-ray(DR) scores showed that the patients using eDOTS either from the villages or from township had significantly lower scores than these patients using DOTS by 1.81 points，95% CI (0.72-2.90) and 1.05 points, 95% CI (0.15-1.95) respectively after 25 weeks of treatment. Conclusion: eDOTS is an effective means for treating TB patients through daily reminding and monitoring TB patients taking antibiotics. Easy contact link with doctors and special education programs for encouraging patients finishing their treatment course can increase the treatment compliance, which is more conducive to improving the control efficacy of TB in remote and poor areas.

Medical Compliance of Fibrate and the Decreased Risk of Age-Related Macular Degeneration in Dyslipidemia-Related Diseases: A Population-Based Cohort Study

The purpose of the current study is to evaluate the incidence of age-related macular degeneration (AMD) in dyslipidemia-related diseases with or without the use of fibrate. Patients were defined as dyslipidemia-related diseases according to the diagnostic code and lab exam arrangement, then the population was divided into those with fibrate application and those without via 1:2 ratios of propensity-score matching. The primary outcome is the development of AMD after dyslipidemia-related diseases by the Cox proportional hazard regression. Besides, the relationship between the medical compliance of fibrate, presented as medical possession ratio (MPR), and the AMD development was also analyzed. A total of 22,917 patients and 45,834 individuals were enrolled in the study and control groups. There were 572 and 1181 events of any AMD development in the study and control groups which showed identical risk of AMD (aHR: 0.94, 95% CI: 0.85–1.04). However, a reduced risk of any AMD was found in those patients reached a baseline MPR more than 20% (aHR: 0.729, 95% CI: 0.599–0.887, p = 0.0016) and overall MPR more than 5% three years after the diagnosis of dyslipidemia-related diseases (aHR: 0.712, 95% CI: 0.557–0.909, p = 0.0065). Besides, a lower risk of dry-AMD was also found in those patients with the above conditions (aHR: 0.736, 95% CI: 0.599–0.906, p = 0.0038 and aHR: 0.721, 95% CI: 0.557–0.934, p = 0.0133, respectively). In conclusion, the use of fibrate with fair initial medical compliance will decrease the incidence of AMD in patients with dyslipidemia-related diseases, especially for the development of dry-AMD.

Development of a vocational and pedagogic position reflection of a doctor as part of continuing medical education program

The article considers vocational and pedagogic position reflection as an important component of medical vocational continuing education of doctors. According to the general hypothesis of the study, a special program for training vocational and pedagogic position reflection can contribute positively to medical caregivers’ vocational performance in treating patients, who experience troubles with medical compliance and adaptation to the disease. The key methods of the study include a literature survey and theoretical elaboration of the concept of the vocational and pedagogic position of a doctor reflection, meanwhile, the empirical research is based on formative pilot experiment, preceded and followed by testing medical learners’ personal reflexivity readinesses (by using Karpov’s questionnaire). The medical caregiver’s ‘reflective ability’ (Bogin) was considered as a source of doctors’ professionalization. Reflexivity was regarded as a key component of doctors’ preparedness to show empathy and to provide proper pedagogic support for hemodialysis patients, receiving audio-therapy. The results of the study show significant positive dynamics in learners’ cognitive sphere and critical thinking development, a high level of performance in role-played solving educational training healthcare cases, meanwhile personal reflexivity measurements have shown no statistically significant differences after training (according to Student’s t-test). The latter experimentation result testifies the personal nature of the reflexivity feature.

Abstract 15555: Potential Cure for Hypertension? The Effect of Crispr Genome Editing

Hypertension is recognized as one of the largest contributors to the global burden of disease. Unfortunately, for the majority of patients, hypertension is poorly controlled due, in part, to poor medical compliance resulting from the need to take one or more drugs, often several times daily. An ideal therapy would be administered a single time but yield long-term blood pressure control. Under the appropriate condition, we hypothesize that this modality could potentially lead to a cure for hypertension. In this study, we investigated whether that sustained, and possibly life-long, reductions in blood pressure could be achieved via Crispr-Cas9 mediated disruption of a key gene in the RAAS, Angiotensinogen (AGT). In vitro, we demonstrated that expression of Crispr-Cas9 system in the BRL 3A rat liver cell line led to a significant reduction in AGT protein levels (75% reduction, N=3, P<0.01). Delivery of the Crispr-Cas9 system into the liver via systemic delivery of the hepatocyte-targeting AAV8 reduced both AGT mRNA (70% reduction, N=5, P<0.01) and circulating AGT protein (50% reduction, N=5, P<0.01) and Ang II levels (33% reduction, n=5, P<0.01). In the SHR model of hypertension, Crispr-Cas9 mediated loss of AGT expression reduced systolic blood pressure in adult animals with established hypertension (30-35mmHg decrease in both females and males, N=12, P<0.001). Importantly, AGT gene disruption also prevented the spontaneous development of hypertension in young pre-hypertensive SHR (SHR control: 55-60mmHg increase in systolic blood pressure both female and male SHR; SHR plus Crispr-Cas9: 30-33 mmHg increase. N=12. P<0.001). Importantly, in all the models studied, reductions in blood pressure were sustained for at least 4 months. Importantly, the partial disruption of the hepatic AGT gene was sufficient to control hypertension but did not block the renin-angiotensin response to cardiovascular stress such as sodium depletion. In summary, we have demonstrated that targeting the Crispr-Cas9 system to RAAS reduces blood pressure and may be a potential therapy to achieve safe and sustained, possibly life-long, control of hypertension and this approach maybe a cure for hypertension.

Metacognitive Beliefs, Positive States of Mind, and Emotional Approach Coping as the Predictors of Medical Compliance in Patients with Cancer

Background: Medical compliance plays an essential role in the control of cancer and psychological factors such as metacognitive beliefs, positive psychology, and coping styles which are among the predictors of medical compliance. Objectives: The aim of this study was to determine how much metacognitive beliefs, positive states of mind, and emotional approach coping can predict medical compliance in patients with breast cancer. Methods: This was a descriptive correlational study. By available sampling method, 154 women with breast cancer who were medically treated and had inclusion criteria, responded to the Morisky Medication Adherence scale (MMAS), Metacognitive Beliefs questionnaire (MCBQ), Positive states of mind (PSOM) scale, and emotional approach coping (EAC) scale. Stepwise multiple regression analysis by SPSS statistics version 24 was applied for data analysis. Results: There was a significant correlation between positive states of mind and metacognitive beliefs and between emotional approach coping with medical compliance (P < 0.05). Positive states of mind and metacognitive beliefs were the best predictors of medical compliance (P < 0.001), while the emotional approach coping could not predict medical compliance. Results also showed that positive states of mind (β = 0. 51) have the greatest predictive power to medical compliance, and the variable of emotional approach coping is not effective in predicting. Conclusions: Research findings suggest that positive states of mind and orientation toward metacognitive beliefs can control anxiety among patients and predict medical compliance in patients with breast cancer but research about emotional approach coping needs to more investigation.

Improving the control ability of pulmonary tuberculosis with an internet based eDOTS system in the communities of Kashgar and Urumqi, Xinjiang of China

Background: Although the direct observed treatment strategy (DOTS) has been used for the control of pulmonary tuberculosis (PTB) in Xinjiang Uygur Autonomous Region for more than 30 years, the disease is still highly endemic in the region. To increase ability of PTB treatment and control efficacy, we developed a new eDOTS system for reminding, monitoring and educating PTB patients for regularly taking antibiotics.Methods: A total 167 new cases with active PTB from Kashgar villages and Urumqi City in Xinjiang were involved in the study. Among them, 81 patients were from villages with 43 patients using eDOTS system and 38 patients with traditional DOTS as control. Eighty six patients were from township with 50 patients using eDOTS and 36 patients using DOTS. Findings: PTB patients from villages in Kashgar treated with DOTS showed low compliance of taking antibiotics, only 27.9% the patients took medicine consistently once the network service for eDOTS system was removed. However, with the help of village and hospital doctors through the eDOTS system, the medical compliance were increased to 70-85%. The treatment compliance with eDOTS of patients from township (100%) was significantly higher than that of those patients from the rural villages (49%) in the first 6 weeks ( Χ 2 =33.3, P <0.01). DR X-ray Scores of PTB lesions showed that the patients using eDOTS either from the villages or from township significantly decreased their lesion score points compared to these scores from those patients using DOTS by 1.81 points，95% CI (0.72-2.90) and 1.05 points，95% CI (0.15-1.95) after 25 weeks of treatment, respectively. In the township, those 50 patients were looked after by one community doctor with eDOTS. Conclusion: eDOTS is an effective means of treating PTB patients in terms of reducing doctor’s work and increasing the compliance of taking antibiotics regularly during the treatment course. One doctor can easily look after 50 or more PTB patients through the eDOTS system. The constantly education program online through the system for the patients especially in villages plays an important role in encouraging TB patients taking antibiotics for a long period.

Clinical characteristics of survivors and non-survivors, medical and non-medical staff members with 2019-nCoV pneumonia in Wuhan, China: a descriptive study

Objectives: In December 2019，the 2019 novel coronavirus ( 2019-nCoV ) emerged in Wuhan, China, leading to a cluster of severe pneumonia cases. Medical staff members on the front line were also infected. We compared the epidemiology, clinical characteristics, and treatment measures of survivors and non-survivors and the different clinical outcomes of medical staff members and non-medical members of the community infected with 2019-nCoV. Methods: We included 81 patients with adult 2019-nCoV in Hankou Hospital from mid-January to mid-February 2020 in this single-center retrospective study. Data were compared between survivors and non-survivors and between medical staff members and non-medical individuals. Results: All 38 medical staff members were infected by patients while working. Only 2 (2.5%) non-medical individuals had a clear history of exposure to 2019-nCoV patients. The median age was 49 years (interquartile range [IQR], 35-59; range, 23-89 years), and 42 (51.9%) were women. We found that the median age,comorbidity, and some laboratory outcomes(lymphocyte count, urea nitrogen, aspartate aminotransferase, lactate dehydrogenase, etc.)differed significantly between survivors and non-survivors. There were also significant differences in the time from onset to admission, disease classification, comorbidity, and prognosis between medical staff members and non-medical individuals. All medical staff members were cured, while 13 (30.2%) non-medical individuals died. Conclusions: Older males with comorbidities are more likely to be affected by 2019-nCoV. Significant changes in some laboratory markers may indicate a poor prognosis. Medical staff members may have had better prognoses due to fewer comorbidities and better medical compliance. Key words: 2019-nCoV; Clinical characteristics; Mortality; comorbidity; Survivors; Non-survivors; Medical Staff