Explaining interpersonal differences in COVID-19 disease prevention behavior based on the health belief model and collective resilience theory: a cross-sectional study from Bolivia.

BACKGROUND: Governments have attempted to combat the COVID-19 pandemic by issuing guidelines for disease prevention behavior (e.g., wearing masks, social distancing, etc.) and by enforcing these guidelines. However, while some citizens have complied with these guidelines, others have ignored them or have even participated in large-scale protests. This research aims both to understand the causes of such variation in citizens' adherence to government guidelines on disease prevention behavior and to extend the scientific literature on disease prevention to account for the collective resilience of a society to diseases. Thus, this research draws on the health belief model and collective resilience theory to develop hypotheses about the determinants of a citizen's disease prevention behavior. These hypotheses deal with how citizens' vulnerability, attitudes toward disease prevention, and social orientation are associated with COVID-19 prevention behaviors. METHODS: From March 24 to April 4, 2020, a cross-sectional online survey was conducted in Bolivia. It included questions on demographic characteristics, chronic health problems, emotional burden, attitudes towards preventive behaviors, trust in public institutions, and culture. Among 5265 participants who clicked on the survey, 1857 at least partially filled it out. After removing data with missing responses to any variable, the final sample consists of 1231 respondents. The collected data were analyzed using hierarchical linear modeling. RESULTS: Regarding a citizen's vulnerability, chronic health problems have a U-shaped association with disease prevention behavior. Moreover, age, female gender, and worries have positive associations with disease prevention behavior, whereas depression showed a negative association. Regarding attitudes toward disease prevention, trust in public institutions, and attitudes toward social distancing, a government-imposed lockdown and the enforcement of this lockdown showed positive associations with disease prevention behavior. Regarding social orientation, individualism and collectivism both have positive relationships with disease prevention behavior. CONCLUSIONS: In the COVID-19 pandemic, a citizen's low vulnerability, weak social orientation, and beliefs about low benefits of disease prevention behavior are associated with poor compliance with guidelines on disease prevention behavior. More research on these associations would help generalize these findings to other populations and other public health crises.

Interpreting time series of patient satisfaction: macro vs. micro components.

Recent research discovered that economic processes influence national averages of customer satisfaction. Using time-series data from Japanese and South Korean hospitals, we conducted principal component regression analyses to examine whether these findings are transferable to patient satisfaction. Our results reveal that aggregate income has a positive impact and economic expectations have a negative impact on patient satisfaction. Further analyses demonstrate that these strong economic influences make it difficult for hospital managers to use patient satisfaction scores to assess the performance impact of their customer-oriented actions. In order to improve performance evaluations based on patient surveys, we thus recommend managers to remove economic influences from time-series of patient satisfaction.

Methylphenidate, modafinil, and caffeine for cognitive enhancement in chess: A double-blind, randomised controlled trial.

Stimulants and caffeine have been proposed for cognitive enhancement by healthy subjects. This study investigated whether performance in chess - a competitive mind game requiring highly complex cognitive skills - can be enhanced by methylphenidate, modafinil or caffeine. In a phase IV, randomized, double-blind, placebo-controlled trial, 39 male chess players received 2×200mg modafinil, 2×20mg methylphenidate, and 2×200mg caffeine or placebo in a 4×4 crossover design. They played twenty 15-minute games during two sessions against a chess program (Fritz 12; adapted to players' strength) and completed several neuropsychological tests. Marked substance effects were observed since all three substances significantly increased average reflection time per game compared to placebo resulting in a significantly increased number of games lost on time with all three treatments. Treatment effects on chess performance were not seen if all games (n=3059) were analysed. Only when controlling for game duration as well as when excluding those games lost on time, both modafinil and methylphenidate enhanced chess performance as demonstrated by significantly higher scores in the remaining 2876 games compared to placebo. In conjunction with results from neuropsychological testing we conclude that modifying effects of stimulants on complex cognitive tasks may in particular result from more reflective decision making processes. When not under time pressure, such effects may result in enhanced performance. Yet, under time constraints more reflective decision making may not improve or even have detrimental effects on complex task performance.