1.Basic information
2748 participants were investigated in all the four stages. At all stages of the study, we investigated 2748 subjects. In Stage 1, 180 (40.82%) doctors and 261 (59.18%) nurses were investigated. In Stage 3, 264 (24.93%) doctors and 773 (73.0%) nurses were investigated. In Stage 4, 254 (25.43%) doctors and 721 (72.17%) nurses participated in the survey..442 medical staffs working outside Hubei Province were investigated at Stage 1(the beginning of the epidemic), which was the main period of investigation for medical staff working outside Hubei Province. From Stage 3 on, medical staff working in Hubei Province began to be investigated. In Stage 3, 601 (57.46%) medical workers were in Wuhan and 444 (42.45%) medical workers were in other cities of Hubei Province. It should be noted that female medical staff were larger than male, especially in Stage 1, which investigated 362 (81.90%) women and 80 (18.10%) men. In addition, the population we investigated mainly consists of medical workers aged 21–40. In Stage 3, 382 (36.17%) medical workers in their 20s and 432 (40.91%) medical workers in their 30s were investigated, which is the most significant stage (Table 1).
Table 1
Table of research object composition
Variables | Date |
---|
Stage 1 (2.10–2.20) | Stage 2 (3.3–3.5) | Stage 2 (3.15–3.18) | Stage 3 (3.23–3.28) | Stage 4 (4.1–4.7) |
---|
Work Location | | | | | | | | | | |
Wuhan | | | | | | | 601 | (57.46%) | 577 | (58.34%) |
Regions outside Hubei Province | 442 | (100.00%) | | | | | 1 | (0.10%) | 1 | (0.10%) |
Regions of Hubei Province except Wuhan | | | | | | | 444 | (42.45%) | 411 | (41.56%) |
Sex | | | | | | | | | | |
Male | 80 | (18.10%) | 16 | (28.57%) | 70 | (36.65%) | 298 | (28.14%) | 294 | (29.40%) |
Female | 362 | (81.90%) | 40 | (71.43%) | 121 | (63.35%) | 761 | (71.86%) | 706 | (70.60%) |
Occupation | | | | | | | | | | |
Doctor | 180 | (40.82%) | 18 | (32.14%) | 70 | (36.65%) | 264 | (24.93%) | 254 | (25.43%) |
Nurse | 261 | (59.18%) | 38 | (67.86%) | 120 | (62.83%) | 773 | (72.99%) | 721 | (72.17%) |
Other | | | | | 1 | (0.52%) | 22 | (2.08%) | 24 | (2.40%) |
Age | | | | | | | | | | |
21–30 | 185 | (41.86%) | 20 | (35.71%) | 87 | (45.55%) | 382 | (36.17%) | 352 | (35.24%) |
31–40 | 149 | (33.71%) | 15 | (26.79%) | 67 | (35.08%) | 432 | (40.91%) | 410 | (41.04%) |
41–50 | 83 | (18.78%) | 20 | (35.71%) | 35 | (18.32%) | 218 | (20.64%) | 209 | (20.92%) |
51–60 | 20 | (4.52%) | | | 2 | (1.05%) | 23 | (2.18%) | 28 | (2.80%) |
> 60 | 5 | (1.13%) | 1 | (1.79%) | | | 1 | (0.09%) | | |
Marital Status | | | | | | | | | | |
Unmarried | 115 | (26.02%) | 14 | (25.00%) | 65 | (34.03%) | 289 | (27.29%) | 266 | (26.60%) |
Married | 317 | (71.72%) | 39 | (69.64%) | 122 | (63.87%) | 734 | (69.31%) | 700 | (70.00%) |
Other | 10 | (2.26%) | 3 | (5.36%) | 4 | (2.09%) | 36 | (3.40%) | 34 | (3.40%) |
Educational background | | | | | | | | | | |
Undergraduate | 292 | (66.06%) | 46 | (82.14%) | 140 | (73.30%) | 772 | (72.90%) | 730 | (73.00%) |
Graduate | 67 | (15.16%) | 1 | (1.79%) | 14 | (7.33%) | 103 | (9.73%) | 87 | (8.70%) |
Middle school | 83 | (18.78%) | 9 | (16.07%) | 37 | (19.37%) | 184 | (17.37%) | 183 | (18.30%) |
2.Anxiety
According to our survey data, there was a statistical correlation between anxiety level and the occurrence and development of epidemic diseases (χ2 = 206.394, P < 0.0001). In Stage 1, the prevalence of moderate and severe anxiety was 7.47% and kept decreasing, which gradually decreased to 2.46% in Stage 3 and even to 0.9% in Stage 4. The prevalence of mild anxiety was 41.4% in Stage 1, with the downward trend to 17.28% in Stage 2 and finally to 12.4% in Stage 4. In all subgroups, most of the respondents were those without anxiety symptoms ,and the proportion of respondents with moderate and severe anxiety was the smallest. Further stratified analysis showed that various factors had a certain impact on the anxiety variables of medical staff. Compared with working in Wuhan City, working in regions outside Wuhan especially outside Hubei province was more likely to have a higher level of anxiety (OR,4.566;95%CI,3.603–5.786). Univariate logistic regression analysis showed that gender was associated with anxiety (male medical staff vs female medical staff (OR,0.639;95%CI,0.517–0.79) .Further, compared with 21-30-years-old young medical staff, medical staff over 60 years old were inclined to a greater risk of anxiety (OR,3.967;95%CI,0.955–16.473). And married (OR,1.982;95%CI,1.047,3.750) and unmarried (OR,2.394;95%CI,1.250,4.585) medical workers have more possibilities to suffer from anxiety problems than medical workers with other marital status. In addition, compared to the undergraduate education group,the graduates' educational background group was more likely to suffer anxiety. (OR,1.330;95CI,1.002,1.767) (Table 2).
Table 2
Factors influencing anxiety level
Variables | No anxiety (N = 1924) | Mild anxiety (N = 656) | Moderate and Severe anxiety (N = 168) | | P | OR(95%CI) |
---|
Time | | | | | 206.3935 | < .0001 | |
Stage 1 (2.10–2.20) | 442 | 226(51.13) | 183(41.4) | 33(7.47) | / | / | 1 |
Stage 2 (3.3–3.5) | 56 | 44(78.57) | 12(21.43) | 0(0) | 0.2995 | 0.5842 | 0.276(0.142–0.537) |
Stage 2 (3.15–3.18) | 191 | 154(80.63) | 33(17.28) | 4(2.09) | 2.2291 | 0.1354 | 0.25(0.167–0.374) |
Stage 3(3.23–3.28) | 1059 | 821(77.53) | 212(20.02) | 26(2.46) | 0.3158 | 0.5741 | 0.302(0.239–0.381) |
Stage 4 (4.1–4.7) | 1000 | 867(86.7) | 124(12.4) | 9(0.9) | 41.4921 | < .0001 | 0.159(0.123–0.206) |
Work Location | | | | | 181.0609 | < .0001 | |
Wuhan City | 1178 | 974(82.68) | 186(15.79) | 18(1.53) | / | / | 1 |
Regions outside Hubei Province | 444 | 228(51.35) | 183(41.22) | 33(7.43) | 177.7324 | < .0001 | 4.566(3.603–5.786) |
Regions of Hubei Province except Wuhan | 855 | 693(81.05) | 147(17.19) | 15(1.75) | 37.4884 | < .0001 | 1.117(0.889–1.402) |
Gender | | | | | 17.1784 | < .0001 | |
Male | 758 | 624(82.32) | 118(15.57) | 16(2.11) | 17.1784 | < .0001 | 0.639(0.517–0.79) |
Female | 1990 | 1488(74.77) | 446(22.41) | 56(2.81) | / | / | 1 |
Occupation | | | | | 0.8661 | 0.6485 | |
Doctor | 786 | 614(78.12) | 148(18.83) | 24(3.05) | / | / | 1 |
Nurse | 1913 | 1459(76.27) | 409(21.38) | 45(2.35) | 0.2209 | 0.6384 | 1.097(0.9-1.338) |
Other | 47 | 37(78.72) | 7(14.89) | 3(6.38) | 0.0114 | 0.9151 | 1.009(0.498–2.044) |
Age | | | | | 10.7989 | 0.001 | |
21–30 | 1026 | 750(73.1) | 249(24.27) | 27(2.63) | / | / | 1 |
31–40 | 1073 | 843(78.56) | 199(18.55) | 31(2.89) | 5.4765 | 0.0193 | 0.752(0.615–0.918) |
41–50 | 565 | 458(81.06) | 97(17.17) | 10(1.77) | 9.801 | 0.0017 | 0.637(0.496–0.819) |
51–60 | 73 | 55(75.34) | 16(21.92) | 2(2.74) | 0.6886 | 0.4066 | 0.895(0.517–1.547) |
> 60 | 7 | 3(42.86) | 3(42.86) | 1(14.29) | 4.7798 | 0.0288 | 3.967(0.955–16.473) |
Marital Status | | | | | 8.8586 | 0.0119 | |
Unmarried | 749 | 553(73.83) | 179(23.9) | 17(2.27) | 8.455 | 0.0036 | 2.394(1.250,4.585) |
Married | 1912 | 1483(77.56) | 376(19.67) | 53(2.77) | 2.0094 | 0.1563 | 1.982(1.047,3.750) |
Other | 87 | 76(87.36) | 9(10.34) | 2(2.3) | / | / | 1 |
Educational Background | | | | | 3.8925 | 0.1428 | |
Undergraduate | 1980 | 1534(77.47) | 396(20) | 50(2.53) | / | / | 1 |
Graduate | 272 | 197(72.43) | 63(23.16) | 12(4.41) | 3.3847 | 0.0658 | 1.330(1.002,1.767) |
Middle school | 496 | 381(76.81) | 105(21.17) | 10(2.02) | 0.7725 | 0.3795 | 1.030(0.816,1.301) |
Obviously, compared with the medical staff who felt mild anxiety, the medical staff who felt moderate or severe anxiety were only a small part of the respondents. As shown in Fig. 1, the prevalence of mild anxiety in male has been decreasing all the time, but the prevalence of mild anxiety in women has increased slightly from 17.5% (the former period of Stage 2) to 21.81% (Stage 3) (March 4 to March 26). In Stage 1, both the male and female medical staff were found to suffer the highest prevalence of mild anxiety with 42.82% for female medical staff, which was 7.82% higher than that of male. Moreover, the prevalence of moderate and severe anxiety of medical workers of different genders were highest to 5% for male medical works and 8.01% for female medical workers, then decreased to the lowest prevalence in the former period of Stage 2. Although this prevalence slightly increased to 2.63% for female and 2.01% for male, it decreased to 0.57% and 1.7% for female and for male respectively in Stage 4 .
For nurses,the prevalence of mild anxiety increased from 18.33% (the latter period of Stage 2) to 22.38% (Stage 3), although the changing trends of anxiety of doctors and nurses are similarly downward. Moreover, the main difference of moderate and severe anxiety is that the prevalence of doctors decreased from 2.86% (the latter period of Stage 2) to 1.89% (Stage 3), while that of nurses increased from 1.67% (the latter period of Stage 2) to 2.59% (Stage 3) (Fig. 2).
In Fig. 3, from the first sampling (Stage 1) to March 17 (the latter period of Stage 2), the prevalence of mild anxiety in graduate education background group, undergraduate education background group and middle school education background group decreased by 39.13%, 27.04% and 6.09%, respectively. The main difference of the prevalence of moderate and severe anxiety of medical staff with different educational background occured between Stage 3 and Stage 4. The prevalence of moderate and severe anxiety of medical staff with graduate education increased from 0.97–1.15% between Stage 3 and Stage 4, while on the contrary, the prevalence of moderate and severe anxiety of medical staff with undergraduate education background decreased from 2.46–1.1% during the same period.
Although the prevalence of mild anxiety of married and unmarried medical staff increased by 3.23% and 4.57% respectively only between the latter period of Stage 2 and Stage 3, while the prevalence of medical staff with other marital status decreased sharply from 25–8.33%. The prevalence of moderate and severe anxiety of medical staff in different marital status groups was similar, but there was one point that should be paid attention to widely that between the latter period of Stage 2 and Stage 3, the prevalence of moderate and severe anxiety of married medical staff decreased by 0.01%, while that of unmarried medical staff increased by 0.88% (Fig. 4).
3.Depression
According to our survey data, there was a statistical relationship between the level of depression and the occurrence and development of the pandemic (c2 = 181.739, P < 0.0001). The prevalence of moderate and severe anxiety in Stage 1 was 14.48%, which continued to decline to 2.09% in Stage 2 and increased to 6.61% in Stage 3, but finally decline to 3% in Stage 4. The highest prevalence of mild anxiety of depression was 40.72% in Stage 1, and then decreased to 0.39 times of the original in the former period of Stage 2. However, from the latter period of Stage 2 on, it rose to 26.7% in the latter period of Stage 2 temporarily, then continued to decline to 17.4% in Stage 4.
In all subgroups, the proportion of moderate and severe depression was less than that of mild depression. Further stratified analysis showed that all kinds of variables of interest also had a certain impact on the depression variables of medical staff. Compared with working in Wuhan, working outside Wuhan, especially in regions outside Hubei province, is more likely to reach higher depression level (OR,3.846;95%CI,3.079–4.804). Regression analysis showed that gender was associated with depression (male versus female; OR,0.676;95%CI, 0.581–0.786). Moreover, the risk of depression was higher in the medical staff over 60 years old than in the young medical staff aged 21–30 years old (OR,2.032;95%CI,0.494–8.357). Unmarried medical staff were more at risk of depression than married medical staff (OR,1.325;95%CI, 1.109–1.583), while those with other marital status were less at risk of depression than married medical staff (OR,0.858;95%CI,0.526–1.399). In addition, compared with the undergraduate education background group, the graduate education background group is more likely to produce a higher prevalence of anxiety (OR,1.120;95CI,0.857–1.465) (Table 3).
Table 3 Factors influencing depression level
Variables
|
No depression (N=1924)
|
Mild depression (N=656)
|
Moderate and Severe depression (N=168)
|
|
P
|
OR(95%CI)
|
Time
|
|
|
|
|
181.7389
|
<.0001
|
|
Stage 1 (2.10-2.20)
|
442
|
198(44.8)
|
180(40.72)
|
64(14.48)
|
/
|
/
|
1
|
Stage 2 (3.3-3.5)
|
56
|
47(83.93)
|
9(16.07)
|
0(0)
|
6.4561
|
0.0111
|
0.151(0.072-0.317)
|
Stage 2 (3.15-3.18)
|
191
|
136(71.2)
|
51(26.7)
|
4(2.09)
|
0.016
|
0.8993
|
0.315(0.219-0.451)
|
Stage 3 (3.23-3.28)
|
1059
|
747(70.54)
|
242(22.85)
|
70(6.61)
|
0.5384
|
0.4631
|
0.345(0.277-0.43)
|
Stage 4 (4.1-4.7)
|
1000
|
796(79.6)
|
174(17.4)
|
30(3)
|
17.6115
|
<.0001
|
0.207(0.164-0.262)
|
Work Location
|
|
|
|
|
153.0325
|
<.0001
|
|
Wuhan
|
1178
|
896(76.06)
|
235(19.95)
|
47(3.99)
|
/
|
/
|
1
|
Regions outside Hubei Province
|
444
|
200(45.05)
|
180(40.54)
|
64(14.41)
|
148.1195
|
<.0001
|
3.846(3.079-4.804)
|
Regions of Hubei Province except Wuhan
|
855
|
628(73.45)
|
177(20.7)
|
50(5.85)
|
29.5819
|
<.0001
|
1.168(0.955-1.427)
|
Gender
|
|
|
|
|
30.6478
|
<.0001
|
|
Male
|
758
|
592(78.1)
|
128(16.89)
|
38(5.01)
|
30.6478
|
<.0001
|
0.676(0.581-0.786)
|
Female
|
1990
|
1332(66.93)
|
528(26.53)
|
130(6.53)
|
/
|
/
|
1
|
Occupation
|
|
|
|
|
2.3018
|
0.3163
|
|
Doctor
|
786
|
568(72.26)
|
169(21.5)
|
49(6.23)
|
/
|
/
|
1
|
Nurse
|
1913
|
1322(69.11)
|
475(24.83)
|
116(6.06)
|
0.0737
|
0.786
|
1.148(0.957-1.378)
|
Other
|
47
|
32(68.09)
|
12(25.53)
|
3(6.38)
|
0.1399
|
0.7084
|
1.205(0.644-2.252)
|
Age
|
|
|
|
|
20.9162
|
0.0003
|
|
21-30
|
1026
|
673(65.59)
|
276(26.9)
|
77(7.5)
|
/
|
/
|
1
|
31-40
|
1073
|
764(71.2)
|
251(23.39)
|
58(5.41)
|
0.9052
|
0.3414
|
0.765(0.638-0.919)
|
41-50
|
565
|
424(75.04)
|
115(20.35)
|
26(4.6)
|
4.0822
|
0.0433
|
0.631(0.502-0.792)
|
51-60
|
73
|
56(76.71)
|
13(17.81)
|
4(5.48)
|
2.5912
|
0.1075
|
0.585(0.337-1.017)
|
>60
|
7
|
4(57.14)
|
1(14.29)
|
2(28.57)
|
2.0123
|
0.156
|
2.032(0.494-8.357)
|
Marital Status
|
|
|
|
|
10.5116
|
0.0052
|
|
Unmarried
|
749
|
492(65.69)
|
198(26.44)
|
59(7.88)
|
6.0112
|
0.0142
|
1.325(1.109,1.583)
|
Married
|
1912
|
1368(71.55)
|
436(22.8)
|
108(5.65)
|
/
|
/
|
1
|
Other
|
87
|
64(73.56)
|
22(25.29)
|
1(1.15)
|
1.3968
|
0.2373
|
0.858(0.526,1.399)
|
Educational Background
|
|
|
|
|
1.19
|
0.5516
|
|
Undergraduate
|
1980
|
1388(70.1)
|
466(23.54)
|
126(6.36)
|
/
|
/
|
1
|
Graduate
|
272
|
184(67.65)
|
69(25.37)
|
19(6.99)
|
1.0826
|
0.2981
|
1.120(0.857,1.465)
|
Middle school
|
496
|
352(70.97)
|
121(24.4)
|
23(4.64)
|
0.988
|
0.3202
|
0.940(0.758,1.165)
|
The prevalence of mild anxiety of female medical staff decreased by 5.91% and 7.22% respectively between the latter period of Stage 2 and Stage 3 and between Stage 3 and Stage 4, while that of male medical staff decreased by 2.46% and 0.8% respectively. Between Stage 3 and Stage 4, the prevalence of moderate and severe anxiety in male and female medical staff decreased by 1.3% and 4.53% respectively, which indicated that women responded more intensely to the changing variables of interest in this stage (Fig. 5).
We found that nurses' prevalence of mild depression and moderate to severe depression decreased by 7.47% and 4.35% between Stage 3 Stage 4 respectively. In contrast, doctors' prevalence of mild depression and moderate to severe depression decreased by 1.34% and 2.15% between Stage 3 and Stage 4 respectively, which can be seen that the reaction of nurses to the change factors between Stage 3 and Stage 4 is more intense (Fig. 6).
The mild depression of medical staff with different educational background showed great difference between the latter period of Stage 2 and Stage 3. During this period, graduate students' prevalence of mild depression increased from 14.29–19.42%. However, the prevalence of mild depression decreased by 5.06% in undergraduate education background group and 2.03% in middle school education background group. The main difference of moderate and severe depression among medical staff with different educational background exists between Stage 3 and Stage 4. During this period, the prevalence of moderate and severe depression of medical staff with undergraduate education and middle school education decreased, but the prevalence of moderate and severe depression of medical staff with graduate education increased by 3.99% (Fig. 7).
Between Stage 1 and the former period of Stage 2 (March 3 to March 5), only the prevalence of mild depression of medical staff with other marital status increased from 40–66.67%, and the prevalence of mild depression of married and unmarried medical staff was alleviated. However, the prevalence of mild depression in medical staff with other marital status has been declining since then, while the prevalence of mild depression in married and unmarried medical staff increased by 15.15% and 6.26% respectively between two periods of Stage 2 (March 4 to March 17). The difference of moderate and severe depression among medical staff with different marital status should be paid attention to between the latter period of Stage 2 and Stage 3. During this period, the prevalence of moderate and severe depression of married medical staff increased from 2.46–5.86%, while that of unmarried medical staff increased from 1.54–9% (Fig. 8).
4.Analysis of the influencing factors of anxiety and depression
2748 medical staffs were observed, applying multivariate regression model to explore the relevance between time and depression/anxiety of staffs. Variable ‘Time’ was taken as independent variable, depression/anxiety level of medical staffs were taken as dependent variables. Stage 1 (February 10-February 20) was taken as reference in multiple logistic regression, and OR(95%CI) and P value were observed. Different models based on different adjustment were built to control the potential bias of confounder. In Model 1, we did single-factor analysis and any variables was adjusted. In Model 2, staffs' gender, age and occupation were adjusted. In Model 3, staffs' gender, age, occupation, marital status and educational background were adjusted.
In logistic regression analysis of depression in staffs, comparing with Stage 1 (February 10-February 20), the proportion of depression in staffs in other time (March 3-March 5、March 15-March 18、March 23-March 28、April 1-April 7) were all observed declined with different decrease. The decrease was observed statistically difference in the former period of Stage 2 (March 3-March 5) and the decrease of Stage 4 (April 1-April 7: after medical support teams got rest) were observed statistically significant difference. According to P for trend, the decline of the proportion of depression in staffs as time goes by were observed statistically significant difference. Same trend was observed both in model 2 and model 3.
Similar trend was found in the result of logistic regression analysis of anxiety in staffs. Comparing with Stage 1 (February 10-February 20), the proportion of anxiety in staffs in other time (March 3-March 5、March 15-March 18、March 23-March 28、April 1-April 7) were all observed declined with different decrease. Decrease of Stage 4 (April 1-April 7: after medical support teams got rest) were observed statistically significant difference. According to P for trend, the decline of the proportion of anxiety in staffs as time goes by were observed statistically significant difference. Same trend was observed both in model 2 and model 3(Table 4, Table 5).
Table 4
Multivariate analysis results of anxiety
Time | Model 1(cRR) | Model 2(aRR) | Model 3(aRR) |
---|
2.10–2.20 | Ref | Ref | Ref |
3.3–3.5 | 0.276(0.142,0.537) | 0.279(0.143,0.545) | 0.278(0.142,0.544) |
3.15–3.18 | 0.25(0.167,0.374) | 0.251(0.167,0.376) | 0.249(0.166,0.374) |
3.23–3.28 | 0.302(0.239,0.381) | 0.293(0.23,0.371) | 0.293(0.231,0.372) |
4.1–4.7 | 0.159(0.123,0.206)*** | 0.155(0.119,0.202)*** | 0.155(0.119,0.202)*** |
P-trend | 0.655(0.617,0.696)*** | 0.650(0.611,0.692)*** | 0.650(0.611,0.692)*** |
Model 1: Single factor analysis. Model 2: Staffs' sex, age and occupation were adjusted. Model 3: Staffs' sex, age, occupation, marital status and educational background were adjusted. cRR:cursory Risk Ratio. aRR:adjusted Risk Ratio. |
*P < 0.05,**P < 0.01,***P < 0.0001。 |
*2.10–2.20 is at the beginning of coronavirus epidemic in China,3.3-3. and 3.1–3.18 is in the period of coronavirus epidemic in China,Medical support teams backed in 3.23–3.28.4.1–4.7:After 14 days rest. |
Table 5
Multivariate analysis results of depression
Time | Model 1(cRR) | Model 2(aRR) | Model 3(aRR) |
---|
2.10–2.20 | Ref | Ref | Ref |
3.3–3.5 | 0.151(0.072,0.317)* | 0.154(0.073,0.325)* | 0.152(0.072,0.32)* |
3.15–3.18 | 0.315(0.219,0.451) | 0.32(0.222,0.461) | 0.315(0.219,0.454) |
3.23–3.28 | 0.345(0.277,0.43) | 0.34(0.271,0.427) | 0.337(0.269,0.423) |
4.1–4.7 | 0.207(0.164,0.262)*** | 0.205(0.161,0.261)*** | 0.204(0.16,0.259)*** |
P-trend | 0.701(0.663,0.742)*** | 0.699(0.659,0.740)*** | 0.698(0.658,0.739)*** |
Model 1: Single factor analysis. Model 2: Staffs' sex, age and occupation were adjusted. Model 3: Staffs' sex, age, occupation, marital status and educational background were adjusted. cRR:cursory Risk Ratio. aRR:adjusted Risk Ratio. |
*P < 0.05,**P < 0.01,***P < 0.0001。 |
*2.10–2.20 is at the beginning of coronavirus epidemic in China,3.3-3. and 3.1–3.18 is in the period of coronavirus epidemic in China,Medical support teams backed in 3.23–3.28.4.1–4.7:After 14 days rest. |