Mental Health Disorders of the Indonesian People in the Early Stages of the COVID-19 Pandemic:Who is Vulnerable to Experiencing it?

The extraordinary situation related to COVID-19 makes people worry about their health,family health,work,finances,and other daily activities.This condition can lead to social unrest,which has consequences for mental health problems.This study aims to determine the mental health consequences at the beginning of the COVID-19 pandemic in Indonesia.This is a cross-sectional study involving a target population aged 18 years and over who had access to electronic communication devices.An online questionnaire was randomly distributed and snowballed throughout 34 provinces in Indonesia.The study was conducted from 2 to 4 May 2020.Non-parametric and multi-variate linear regression analyses were performed to identify factors associated with anxiety and depression.Two thousand seven hundred forty-three participants were involved in this study,with 69.16%female.In sum,6.92%of participants had General Anxiety Disorder-7(GAD-7)scores≥10 for moderate-severe anxiety symptoms,and 8.57%had Patient Health Questionnaire-9(PHQ-9)scores≥10 for moderate-severe depressive symptoms.The multivariate linear regression analyses showed that the strongest factors influencing anxiety and depression were a history of mental illnesses,chronic illnesses,the group affected by layoffs or job seekers,unemployed,students,younger age group,living in a rented house,single,and female.In contrast,the lower and secondary education level seems to reduce the risk of depression compared to those with higher education levels.Anxiety and depression occur during the periods of activity restriction during the COVID-19 pandemic and are influenced by several modifiable and non-modifiable factors.There is an urgent need to emphasize vulnerable groups such as those with a history of illness,those affected by layoffs/looking for work,and the younger age group.

China's unique role in the field of global health

China's participation in global governance,inspired by the 17 United Nations Sustainable Development Goals,is driven by the guiding principle of"Building a Community of Shared Future for Mankind".China has been promoting the Belt and Road Initiative and South-South Cooperation and has made significant contributions to the prosperity of human beings.Along with the opportunities that globalization brought about such as the World Health Organization and the boom in the economy,global health challenges also emerged.This resulted in certain obstacles for China when it sought to advocate the Belt and Road Initiative and when it attempted to carry out its strategy to address global health issues.What are the emerging challenges for global health?What can China do for global health?Why does global health need China?We tried to address these questions as China's global engagement continues to expand in the new era.This article makes the case for Chinese approaches,including getting involved in public health,being consistent in addressing local conditions,and sharing China's experience with handling health services and staying in the lead through government action while being guided by relative policies.China has a lot to offer in the promotion of global health and in overcoming the challenges and risks that this goal currently faces.Thus,China should be considered an inseparable part of global health governance and bilateral health development cooperation.

Prevalence and factors associated with belief in COVID-19 vaccine efficacy in Indonesia:A cross-sectional study

Objective:To investigate the prevalence of belief in COVID-19 vaccine efficacy and its associated factors.Methods:Due to mobility restriction,this study was conducted cross-sectionally via online platforms.The included factors were age,gender,religious identity,marital status,education level,occupation,and living with health workers.Logistic regression was used to assess the association between belief in COVID-19 vaccine with the predictors.Results:A total of 5397 responses were taken into analysis.The prevalence of belief in COVID-19 vaccine efficacy was 62.3%.Whereas factors associated with belief in COVID-19 vaccines were being in the age of 45-54(aOR 1.767;95%CI 1.219-2.562),55-64(aOR 1.703;95%CI 1.219-2.562),and>64(aOR 2.136;95%CI 1.128-4.047),completing education until the secondary level(aOR 1.354;95%CI 1.111-1.650),working as health practitioners(aOR 2,353;95%CI 1.655-3.344),and living with health workers(aOR 1.278,95%CI 1.079-1.514).All religious identities including Muslim(aOR 2.447;95%CI 1.183-5.062),Protestant(aOR 3.615;95%CI 1.703-7.677),Catholic(aOR 4.486;95%CI 2.015-9.987),and Hindu(aOR 3.286;95%CI 1.410-7.655)showed significant association with belief in COVID-19 vaccine efficacy.Conclusions:A high prevalence of belief in COVID-19 vaccine efficacy was evident.Since vaccine compliance is determined by an individual's risk-benefit perception,this study emphasizes the need of raising awareness of the benefits of COVID-19 immunization.

Antiretroviral regimen change among people infected with HIV:evidence from a crosssectional study in China

Background:The rate of death among people living with HIV/AIDS has decreased significantly as a result of treatment with highly active antiretroviral therapy(HAART).However,the issues of drug induced toxicities and complexity of current HAART regimens has remained of great concern.The aim of this study was to determine factors in uencing antiretroviral regimen changes among people living with HIV/AIDS in China.Methods:This retrospective study collected data through face-to-face interviews with people living with HIV/AIDS who were receiving HAART,and gathered relevant information from infectious disease hospitals.The following information were collected:social-demographic characteristics,antiretroviral therapies,CD4 cell counts,virus loads,reasons for changing medication and other related data.Mean and percentages were used to describe the frequency of regimen change among patients,and binary logistic regression was employed to test the factors in uencing regimen change.Results:1,123 people who had experienced regimen change were included in the analysis.On average,patients remained on HAART for 10.2 months before changing regimen,and the average CD4 cell count and viral load(VL)were 383.1 cells/ l and 28,132.4 copies/mL respectively when changing regimen.The reasons for modi cation were determined as treatment failure(52.5%),adverse reactions(32.3%),and other reasons including pregnancy(15.2%).There are significant differences in regimen change among people with different genders(P<0.001),modes of transmission(P<0.001),duration of HAART(P<0.001)and initial CD4 cell counts(P=0.0024).Males,drug users,people taking long-term medication,and those with lower initial CD4 counts when starting HAART tend to change regimen.Conclusion:Treatment failure was the main reason for the change of HAART regimen.Males,drug users,people on longterm medication and those with lower initial CD4 cell counts when starting HAART were most likely to change regimen.

Changes in clinical indicators among human immunodeficiency virus patients who failed in antiretroviral therapy during 2004–2016 in Yunnan, China: an observational cohort study

Background:This study aimed to investigate the changes in the clinical indicators and influencing factors of treatment duration among human immunodeficiency virus(HIV)patients in whom antiretroviral therapy(ART)was unsuccessful.Methods:In this retrospective study,a total of 9,418 HIV patients who failed in ART during 2004–2016 were included and divided into two treatment groups—Group 1(treatment time≤3 years,n1=5,218)and Group 2(treatment time>3 years,n2=4,200).Patient follow-up data,including age,cluster of differentiation 4(CD4)count,and viral load,glucose,creatinine,and triglyceride levels,were extracted from electronic health record databases.Covariance analysis for repeated measures was used to analyze the biochemical indicators,and multiple logistic regression modeling was used to compare relevant data extracted from the Group 1 and Group 2 HIV patient cohorts with different treatment time.Results:The median initial CD4 count was 175.0 cells/μl(interquartile range,77.0–282.0),while the initial CD4 counts for Group 1 were lower than those for Group 2(P<0.05).A significant interaction between group and time effects was observed(P<0.05)in total cholesterol(TC).Changes in hemoglobin level among HIV patients were also significantly associated with treatment time(P=0.001).The initial CD4 count(odds ratio[OR]=0.756),female sex(OR=0.713),Zerit(d4T)(OR=1.443),TC(OR=1.285),and aspartate aminotransferase level(OR=1.002)were significantly associated with the survival time of dead patients with HIV(P<0.05).Additionally,the initial CD4 count(OR=1.456),age(OR=1.022),time interval(OR=0.903),patient’s living status(OR=0.597),d4T(OR=2.256),and triglyceride(OR=0.930)and hemoglobin levels(OR=0.997)were significantly associated with the treatment time of HIV patients with drug withdrawal(P<0.05).Conclusion:The initial biochemical parameters can affect the survival and treatment time of HIV patients.With a comprehensive understanding of the physiological and biochemical indicators of patients,we can reduce the probability of drug withdrawal and prolong the survival time of HIV patients.

Health related behaviors among HIV-infected people who are successfully linked to care:an institutional-based crosssectional study

Background:By the end of October 2019,there were 958 thousand people were reported living with HIV/AIDS in China.Unhealthy lifestyle factors,such as smoking,drinking alcohol,using illicit drugs and no physical activity have been found to mitigate the positive impact of antiretroviral therapy(ART)on viral load and HIV-related quality of life.Moreover,risky sexual behavior among HIV-positive persons places their partners at risk for HIV transmission and other sexually transmitted infections.The aim of the study is to determine the prevalence of unhealthy behavior of people living with HIV/AIDS and related influencing factors,particularly those that are closely connected with HIV infection and ART effects.Methods:An institutional based cross-sectional study design was used to collect data from people living with HIV/AIDS(PLWHA)in Beijing and Yunnan Province.The following information was included in the questionnaire survey:social-demographic characteristics,health behavior information,sexual risk behaviors.Binary logistic regression model was conducted to analyze the influencing factors of unhealthy general health behaviors and risky sexual behaviors.Results:In total,2575 PLWHA were included in the study and 78.3%(2017/2575)were male.For the general health behaviors,34.2%(987/2544)smoke;33.8%(870/2575)drank alcohol and 2.3%(49/2134)reported the use of illicit drugs in the previous 6 months.From the sexual behaviors perspective,59.0%(1519/2575)had sex in the previous 6 months.Among people who had sex,92.0%(1398/1519)had fixed sexual partners.Among those with no fixed sexual partner,38.0%(46/121)had more than three partners.Among men who had sex,34.7%(448/1292)reported having sex with men in the previous 6 months and 167%(75/448)of these had group sexual activity.Among participants,72.2%(1053/1458)used condoms every time they had sex while 6.4%(94/1458)of people never used condom.Male people living with HIV/AIDS were more likely to have sexual risk behaviors(adjusted odds ratio[OR]=2.208,95%confidence interval[CI]:1.147-4.252)and unhealthy general health behaviors(adjusted OR=2.029,95%CI:1.480-2.783).The odds of higher risk sexual behaviors was 1.546 times(95%CI:1.302-1.827,P=0.001)greater among participants who drank alcohol compared with their non-drinking counterparts.Conclusions:PLWHA is a group that is vulnerable to problematic health behaviors,especially for men who were more likely to drink alcohol,have more sexual partners,more sexual risk behaviors including group sexual activity,not using condoms and using drugs.Therefore,interventions focusing on gender-specific risk behaviors reduction for people living with HIV/AIDS are now necessary to control the spread of HIV infection and improve the efficacy of antiviral treatment.

Therapeutic potential of an anti-HER2 single chain antibody-DM1 conjugates for the treatment of HER2-positive cancer

Antibody–drug conjugates(ADCs)take the advantage of monoclonal antibodies to selectively deliver highly potent cytotoxic drugs to tumor cells,which have become a powerful measure for cancer treatment in recent years.To develop a more effective therapy for human epidermal growth factor receptor 2(HER2)-positive cancer,we explored a novel ADCs composed of anti-HER2 scFv–HSA fusion antibodies conjugates with a potent cytotoxic drug DM1.The resulting ADCs,T-SA1–DM1 and T-SA2–DM1(drug-to-antibody ratio in the range of 3.2–3.5)displayed efficient inhibition in the growth of HER2-positive tumor cell lines and the half-maximal inhibitory concentration on SKBR-3 and SKOV3 cells were both at the nanomolar levels in vitro.In HER2-positive human ovarian cancer xenograft models,T-SA1–DM1 and T-SA2–DM1 also showed remarkable antitumor activity.Importantly,three out of six mice exhibited complete remission without regrowth in the high-dose group of T-SA1–DM1.On the basis of the analysis of luminescence imaging,anti-HER2 scFv–HSA fusion antibodies,especially T-SA1,showed strong and rapid tumor tissue penetrability and distribution compared with trastuzumab.Collectively,the novel type of ADCs is effective and selective targeting to HER2-positive cancer,and may be a promising antitumor drug candidate for further studies.

Family support,discrimination,and quality of life among ART-treated HIV-infected patients:a two-year study in China

Background:By September 2016,approximately 653,865 people in China were living with HIV/AIDS(PLWHA)and 492,725 people were receiving antiretroviral therapy(ART).PLWHA frequently experience discrimination in all domains of their personal and social lives.The World Health Organization includes discrimination in its list of social determinants of health factors that have been linked to poor physical and psychological health.This paper identifies the family support enjoyed and discrimination faced by people infected with HIV and examines the effect they have on patients’quality of life(QOL)as they undergo ART in China.Methods:We conducted this observational cohort study of ART-treated patients with HIV in Guangxi Province using a questionnaire survey at baseline,6,12,and 24 months,starting in 2010.Descriptive analysis was used to describe the demographic characteristics(e.g.,age,sex,educational level,marital status,and employment status)of participants.Generalized estimating equations(GEE)were employed to examine the relationships between family support,discrimination,and QOL.Results:In the study,90.4%(n=281)of patients received family support at baseline,here defined as the initiation of ART,91.8%(n=244)received family support 6 months into ART,95.5%(n=220)at 12 months,and 94.3%(n=230)at 24 months.The proportion of patients who did not feel discriminated against by their families was 87.2%(n=274)at baseline,90.4%(n=229)6 months into ART,90.0%(n=210)at 12 months,and 94.5%(n=219)at 24 months.Patients’overall QOL scores were positively associated with having received family support(OR=2.74,P=0.040,95%CI:1.68-4.47),not feeling discriminated against by their families(OR=1.3,P=0.041,95%CI:1.07-1.59)or discrimination from patients themselves,including never experiencing fear of abandonment by family(OR=2.05,P=0.025,95%CI:1.49-2.82).Conclusions:Family support along with no or minimal discrimination was found to contribute to QOL among people infected with HIV.Their overall QOL tended to improve significantly as ART continued.This suggests that strategies meant to improve and strengthen family support,care for PLWHA,and promote HIV screening among high-risk populations should be explored by both policy makers and researchers.

Persistence of VRC01-resistant HIV-1 during antiretroviral therapy

VRC01,a broadly neutralizing monoclonal antibody(bnmAb),can neutralize a diverse array of HIV-1 isolates by mimicking CD4 binding to the envelope glycoprotein gp120.We have previously demonstrated the presence of VRC01-resistant strains in an HIV-1 infected patient during antiretroviral therapy.Here,we report follow-up studies of two subsequent samples from the same patient.With genetic and phenotypic analysis of over 70 full-length molecular clones of the HIV-1 envelope,we show that VRC01-resistant HIV-1 continued to exist and change in its proportion of the infecting virus during treatment with a highly active antiretroviral therapy.Consistent with our previous observation,the resistant phenotype was associated with a single asparagine residue at position 460(N460),a potential N-linked glycosylation site in the V5 region.The persistence and continuing evolution of VRC01-resistant HIV-1 in vivo presents a great challenge to our future preventative and therapeutic interventions based on VRC01.

The COVID‐19 vaccine: Attitudes and vaccination in patients with autoimmune inflammatory rheumatic diseases

Background:We examined attitudes toward the COVID‐19 vaccine,potential factors underlying these attitudes,and ways to increase vaccination willingness in autoimmune inflammatory rheumatic diseases(AIIRD)patients.Methods:A multicenter,web‐based,observational survey using an online questionnaire was conducted among AIIRD patients aged≥18 years from May 24,2021,to June 3,2021.Participants were 3104 AIIRD patients(2921 unvaccinated and 183 vaccinated).Results:Of the unvaccinated patients,32.9%were willing to receive the COVID‐19 vaccine,45.0%were uncertain,and 14.8%were unwilling.When vaccination was recommended by physicians,patients'willingness increased to 93.8%.Participants'main concerns were that the vaccine may aggravate AIIRD disease(63.0%)and may cause vaccine‐related adverse events(19.9%).Female patients were less likely to be vaccinated.However,patients who had children aged≤18 years were more willing to be vaccinated.In addition,vaccination willingness was higher in patients with trust in the safety and efficacy of the COVID‐19 vaccine.Notably,183(5.9%)patients were vaccinated.The major vaccination side effects were injection reaction,myalgia,and fatigue.At a median follow‐up of 88(38,131)days,patients'disease activities were stable.Conclusions:The findings show that AIIRD patients were unwilling to receive the COVID‐19 vaccine because of fears of potential disease exacerbation and additional adverse events.Sociodemographic characteristics and concerns about COVID‐19 disease and vaccines had a significant effect on vaccination willingness.

Studyt on the Emergency Medical Service Evaluation and Improvement

The Emergency Medical Service（ EMS） system in China from service supply chain perspective is analyzed. Firstly,it reviews service supply chain researches in emergency medical service,and it is found that waiting time,safety,service integration and communication before the emergency surgery are the four indicators to measure the quality of emergency medical service. Secondly,the information barrier-inconsistent information flow-is prominent,which is between emergency in hospital and pre-hospital,after analyzing three different types of flows on service, information and logistics. Besides, comparing with Joint Commission International accreditation（ JCI） standards for hospitals in USA,the requirements of service integration and communication in Chinese hospital accreditation are much lower. In the end,a Smart First Aid Information Center（ SFAIC） model for first aid service is proposed. This model can be used to enhance information exchanges more effectively between first aid in-and pre-hospital. Moreover,it also shortens pre-surgery time and betters the communication and coordination between service sections. To put it in a nutshell,the improved medical service process can greatly increase emergency medical service quality.