Mental health outcomes among osteopathic physicians during COVID-19.

Objective: SARS-CoV-2 infection responsible for the COVID-19 pandemic has demonstrated a significant burden on the mental health of health care providers. The purpose of the study is to evaluate the mental health symptoms among osteopathic physicians from a single academic institution during the COVID-19 pandemic. Methods: This was a cross-sectional, survey-based study conducted during the COVID-19 pandemic from January 2021 to March 2021. The survey was emailed to 4239 alumni physicians from the single medical school in California, USA. Burnout, anxiety, and depression were assessed by the single-item Mini-Z Burnout Assessment, 7-item Generalized Anxiety Disorder Scale, and 2-item Patient Health Questionnaire, respectively. Results: A total of 104 survey responses were analyzed. Of them, 53 (51.0%) were attending physicians and 51 (49.0%) were residents or fellow physicians. Anxiety, burnout, and depression were reported in 29 (29.9%), 31 (32%), and 11 (11.3%), respectively. Females had increased anxiety (OR 1.66, CI 1.21-2.27; P = 0.002). Resident had higher burnout symptoms (OR 1.28, CI 1.06-1.53; p = 0.009) and depression symptoms (OR 1.15, CI 1.01-1.30; p = 0.032) compared to attending physicians. Physicians who encountered >50 COVID-19 patients had higher depression symptoms (OR 1.17, CI 1.02-1.35; p = 0.027). Conclusion: Our survey study demonstrated that osteopathic physicians graduated from a single academic institution experienced symptoms of anxiety, burnout, and depression during the COVID-19 pandemic based on the validated questionnaires. A higher prevalence was shown in the lesser experienced group of residents and fellow physicians compared to more experienced attending physicians. In addition, adjustments to the pandemic have caused a financial burden among osteopathic physicians. Future studies are warranted to assess the long-term effects of the pandemic on mental health among osteopathic physicians.

Nonprescription Products of Internet Retailers for the Prevention and Management of Herpes Zoster and Postherpetic Neuralgia: Analysis of Consumer Reviews on Amazon.

BACKGROUND: Herpes zoster affects approximately 1 million people annually in the United States, with postherpetic neuralgia as the most common complication. The frequent prescription of opioids as the first-line medication for herpes zoster or postherpetic neuralgia contributes to the increasing health care costs of their treatment. Despite the advent of internet retailers providing alternative products for the prevention and management these conditions, there are limited studies on the availability, ingredients, and consumer preference for the products. OBJECTIVE: This study used the internet retailer Amazon to determine the availability of products for the management of herpes zoster and postherpetic neuralgia, and assessed consumer preference based on listed ingredients. METHODS: The internet retailer Amazon was used to perform a search for products related to "shingles" in September 2020. Top products sorted by reviews and ratings were determined to be either shingles-specific (including "shingles" in either the product title or description) or shingles-nonspecific. Analysis of price, rating, type of vehicle, and ingredients was performed. The types of vehicles, ingredients, and percentages of positive and negative reviews related to "shingles" of the product groups were analyzed with a two-tailed two-sample proportions Z-test to assess the difference between shingles-specific and shingles-nonspecific products. Statistical significance was judged at P<.05. RESULTS: The top 131 products among over 3000 products retrieved were determined based on a rating of 4 or more stars after searching for the term "shingles" on Amazon. Forty-six of the 131 products (35.1%) were shingles-specific. Shingles-nonspecific products were more likely to have positive reviews mentioning "shingles" (P=.005). Vehicles, balms (P=.02), and salves (P=.04) were more likely to be shingles-specific, whereas tablets or capsules (P=.002) were more likely to be shingles-nonspecific. Among the ingredients analyzed, aloe vera was the top-ranked ingredient, included in 29 of the 131 total products (22.1%). Aloe vera (P=.01), lemon balm (P<.001), vitamin E (P=.03), and peppermint oil (P=.008) were more likely to be included in the shingles-specific products, whereas magnesium (P=.01) was more likely to be included in shingles-nonspecific products. CONCLUSIONS: There is an abundance of products and ingredients being used for the management and treatment of shingles with certain ingredients preferred by consumers. There is a discrepancy between approved ingredients and the ingredients preferred by consumers. Furthermore, there are insufficient studies on ingredients used by consumers on internet retailers such as Amazon, and future studies can focus on the effectiveness of popular ingredients to decrease misinformation on the internet.

Green space exposure on mortality and cardiovascular outcomes in older adults: a systematic review and meta-analysis of observational studies.

BACKGROUND: With the launch of the "Global Age-Friendly Cities project", increasing emphasis has been placed on the effects of green spaces on health in the elderly. The previous literature has shown that green spaces are beneficial to a range of health-related outcomes in adults. However, associations of greenness with mortality and cardiovascular outcomes are less certain, which may differ depending on the age class. This review aimed to synthesize current evidence from observational studies to assess relationships of green space exposure with mortality and cardiovascular outcomes in older individuals. METHODS: Five databases were searched. Qualitative evaluation and meta-analyses of included studies were conducted. This review is registered with PROSPERO, CRD42020160366. RESULTS: Of the 8,143 records identified, we finally included 22 studies. In a narrative systematic review, we observed that the majority of studies showed reductions in the risk of all-cause mortality and total cardiovascular disease. Further meta-analyses which included eight cohort studies, indicated that greater greenness exposure (per 0.1 unit increase of normalized difference vegetation index (NDVI)) was associated with a reduced risk of all-cause mortality (pooled hazard ratios (HR) (95% confidence interval (CI) = 0.99 (0.97, 1.00)) and stroke mortality (pooled HR (95% CI) = 0.77 (0.59, 1.00)) in older individuals. CONCLUSIONS: This review supports increasing green space exposure in terms of the prevention of death and cardiovascular outcomes in older individuals. Effective measures to increase or preserve greenspaces should therefore be considered as important public health interventions.