Background: When the contagious COVID-19 spread worldwide, the frontline staff faced unprecedented excessive work pressure and expectations of all of the society. Objective: The aim was to explore healthcare workers’ stress and influencing factors when caring for COVID-19 patients from an altruistic perspective. Methods: A cross-sectional, descriptive study was conducted in a tertiary hospital during the outbreak of COVID-19 between February and March 2020 in Wuhan, the capital city of Hubei province in China. Data were collected from 1208 healthcare workers. Descriptive statistics and multiple linear regression were used to analyze the data. Ethical considerations: Research ethics approval (with the code of TJ-IRB20200379) was obtained from Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology. Written informed consent was also received from participants. Results: Less than 60% of participants chose moderate or severe stress on all stressors, indicating a low stress level among healthcare workers. The main source of stress among frontline healthcare workers caring for COVID-19 patients came from the fear of being infected, the fear of family members being infected, and the discomfort caused by protective equipment. Frontline staff who were nurses, were married, and had worked more than 20 days suffered higher stress, whereas rescue staff showed lower stress. Conclusion: The healthcare workers caring for patients with COVID-19 had low stress level, although they still had the fear of being infected or uncomfortable feeling caused by personal protective equipment. A low stress level among healthcare workers indicated their professional devotion and altruism during COVID-19 epidemic. Medical institutions and the government should continue to strengthen infection prevention measures and provide more comprehensive care involving families of frontline healthcare workers, especially nurses and married staff. It will be a lesson to other countries that awaking healthcare workers’ inside motivation and providing necessary support from government and society were significant.

Aims and objectives To clarify both the potential influencing factors and the current status of front‐line nurses’ work engagement, and thus provide a reference for targeted interventions. Background After coronavirus disease 2019 outbreak, front‐line nurses embraced remarkable potential stress and huge workload when caring for coronavirus disease 2019 patients, which may lead to new challenges to work engagement. Design A large sample survey was conducted at the end of February 2020 in a designated hospital treating coronavirus disease 2019 patients in Wuhan, the capital of Hubei Province, in China. t Test, one‐way ANOVA, chi‐squared test, Pearson's correlation and hierarchical multiple regression were performed among 1,040 nurses using SPSS 24.0. The STROBE checklist was followed for observational studies. Results The final model interpreted 27.3% of the variance, of which each block could explain 11.7%, 10.3% and 7.9% R 2 changes including sociodemographic characteristics, stress and workload, respectively. Work engagement was negatively correlated with stress and workload. The potential influencing factors included sociodemographic characteristics (married, rescue staff, cabin ward), stress (infection control, PPE discomfort) and workload (mental demand, performance, frustration). Conclusions Front‐line nurses perceived low stress and workload, but high work engagement, especially in self‐dedication. However, infection control, PPE discomfort and frustration were negatively associated with nurses’ work engagement, while mental demand and good performance were positively associated with nurses’ work engagement. Future interventions focused on decreasing front‐line staff's infection risk and enhancing their self‐confidence may be recommendable to promote their work engagement.

Background:Overweight and obesity are related to maternal and infant physical health, such as gestational diabetes, preeclampsia, and macrosomia. The purpose of this meta-analysis was to assess the effect of physical exercise on maternal and infant outcomes in overweight and obese pregnant women. Methods: Two researchers independently searched Cochrane Library, Embase, PubMed, Web of Science, and ClinicalTrials.gov. for English-language articles based on randomized controlled trials examining physical exercise in overweight and obese pregnant women and its effect on maternal and infant outcomes. Primary outcomes were gestational weight gain and a relative risk of gestational diabetes. Secondary outcomes were gestational hypertension, preeclampsia, cesarean delivery, birthweight, large for gestational age, small for gestational age, macrosomia, and preterm birth. Risk bias was evaluated by Cochrane Collaboration's tool. The results of integration were reported as relative risks (RR), mean difference, or standard mean difference with 95% confidence intervals (CI). This meta-analysis was registered on PROSPERO on November 18, 2017, with registration number CRD42017081565. Results: Thirteen studies involving 1439 participants were included. Physical exercise reduced gestational weight gain (mean difference = −1.14 kg, 95% CI = [−1.67 to −0.62], P < 0.0001) and the risk of gestational diabetes (RR = 0.71, 95% CI = [0.57-0.89], P = 0.004) in overweight and obese pregnant women. There were no significant differences in other outcomes such as gestational hypertension, preeclampsia, cesarean delivery, birthweight, large for gestational age, small for gestational age, macrosomia, and preterm birth. Conclusions: Prenatal exercise interventions reduced gestational weight gain and the risk of gestational diabetes for overweight and obese pregnant women, which reinforced the benefits of exercise during pregnancy. However, no evidence was found with respect to benefits and/or harm for infants. Consideration should be taken when interpreting these findings as a result of the relative small sample size in this meta-analysis.Further larger well-designed randomized trials may be helpful to assess the short-term and long-term effects of prenatal exercise on maternal and infant outcomes. K E Y W O R D Sexercise, infant health outcomes, maternal health outcomes, meta-analysis, overweight and obesity 212 | DU et al.

Workload is an essential factor affecting the performance of health care workers (HCWs). High level of mental workload increased their risks of insomnia, anxiety, and depression. This study committed to investigate frontline HCWs’ mental workload and analyze its influencing factors during the novel coronavirus disease 2019 (COVID-19) pandemic. A total of 802 frontline HCWs completed the online questionnaires. Their total mental workload score was 69.7 ± 16.4. Frontline HCWs were satisfied with their performance (4.0 ± 3.3) and showed a low level of frustration (8.3 ± 5.7). The most important dimensions of mental workload were “effort” (16.4 ± 13.7), “physical demand” (15.7 ± 4.7), and “mental demand” (12.9 ± 5.2). Frontline nurses and HCWs who have higher education level, longer working years, and higher professional title perceived higher mental workload scores ( P < .05). In conclusion, frontline HCWs’ mental workload was not high as seen during the COVID-19 pandemic in China. They have made tremendous efforts and dedication to caring for COVID-19 patients. Job-related factors, some of which can be eliminated by proper management skills, increased frontline HCWs mental workload.

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Background Large-scale emergencies hurt the chronically ill immensely. Improving personal emergency preparedness is an effective means to protect themself. Our objective is to evaluate the emergency preparedness level and its influencing factors among patients with chronic diseases in China. Methods A paper-based self-administrated questionnaire collected data. Descriptive statistics and univariate analysis were used to illustrate the chronically ill's general characteristics and preparedness level. Regression models were constructed to identify influencing factors of preparedness. Results A total of 771 samples were included. Only 23% of respondents prepared three days of water, three days of food, available flashlights, and available radios. 50% were equipped with three-day prescription drugs. Patients with chronic respiratory diseases or cancer were less prepared (p < 0.01). Patients who were never married or married (compared with widowed, divorced, or separated); had junior high school degrees (compared with a college degree and above); had monthly household incomes of more than 10,000 yuan; suffered from two or above chronic diseases, often and rarely discussed emergencies with families (compared with never); perceived learning emergency-related information as essential; participated in emergency drills; believed their families have prepared; and had high levels of mental health are more likely to have the four preparations. Factors related to higher levels of prescription drug reserve include owning junior high school or high school degrees, having two or above chronic diseases, being sick for five to nine years (compared to less than or equal to one year), being interested in gathering information about the emergency response, and perceived learning emergency-related information is crucial.​ Conclusion Patients with chronic diseases have a low level of emergency preparedness. Public health officials should formulate tailored policies, information, and intervention measures that target chronically ill patients to improve their emergency preparedness, particularly those with low income, low mental health, divorce, widowhood, or separation.

Previous studies have investigated influencing factors of early discontinuation of breastfeeding, but few studies have developed an easy‐to‐use tool to identify risk of breastfeeding cessation at 6 months after birth. This research team aimed to develop and validate an exclusive breastfeeding duration risk nomogram in Chinese mothers. A longitudinal cohort survey was conducted. Data were collected from 394 postpartum women in three hospitals in Hubei Province, China from December 2017 to December 2018. The LASSO regression model was used to screen for optimized factors in an exclusive breastfeeding duration model. Multivariable logistic regression was applied to construct a prediction model. Discrimination and calibration were assessed using a C‐index and calibration curve, and internal validity was established using bootstrapping validation. Factors integrated in the prediction risk nomogram were monthly household income (odds ratio [OR] = 1.31, 95% confidence interval [CI]: [0.95, 1.80]), experiences of breastfeeding (OR = 1.23, 95% CI: [0.92, 1.63]), attitude (OR = 1.72, 95% CI: [0.94, 3.16]), self‐efficacy (OR = 2.45, 95% CI: [1.40, 4.29]), perceived insufficient milk supply (OR = 0.12, 95% CI: [0.06, 0.25]) and postpartum depression (OR = 0.06, 95% CI: [0.02, 0.17]). The model displayed good discrimination with a C‐index of 0.87 (95% CI: [0.84, 0.91]) and good calibration. The C‐index interval validation was confirmed to be 0.86. This study resulted in the development of a novel nomogram with good accuracy to aid healthcare professionals in assessing the probability of a mother discontinuing exclusive breastfeeding at the breast before 6 months.

Background: Domperidone and metoclopramide are the most commonly prescribed galactogogues for enhancing milk production, but evidence supporting their efficacy and safety is contradictory. Objectives: To evaluate the efficacy and safety of domperidone and metoclopramide use by breastfeeding women. Search strategy: A systematic literature retrieval of Medline, Embase, Cochrane Library, PubMed, EBSCO, Web of Science, ClinicalTrials.gov and additional bibliography was conducted without time restriction. Selection criteria: Randomised controlled trials exploring the effects of domperidone and metoclopramide in breastfeeding women were included. The primary outcomes were the difference in human milk volume and maternal and neonatal side effects. Data collection and analysis: Two reviewers screened, extracted and assessed the eligible trials independently. Effect size with 95% confidence intervals were presented using random effect model. Main results: Fifteen studies were included. Pooled results demonstrated a low to moderate increase in daily human milk volume of 90.54 mL/day (95%CI 65.69, 115.39), 0.04 mL/day (95%CI 28.85, 28.93) with the use of domperidone and metoclopramide, respectively. No differences were noted in the incidence of maternal side effects with domperidone (RR1.20, 95%CI 0.74, 1.97) or metoclopramide (RR1.23, 95%CI 0.51, 2.94). Additionally, there were no significant differences in the volume of human milk and maternal side effects between the domperidone and metoclopramide group. Conclusions: Domperidone demonstrated a modest increase of 90.54 mL/day in milk production, and had a lower risk of side effects in mothers and infants, which could be considered as a suitable choice for breastfeeding women.