COVID

Background: Hypertension is one of the most prevalent comorbidities in patients with COVID-19 and a major contributor to chronic kidney disease (CKD). Traditional kidney injury markers, including creatinine, estimated glomerular filtration rate (eGFR) and microalbuminuria, reflect renal injury only after substantial nephron loss has already occurred. Urinary podocyte proteins, such as nephrin (nephrinuria), have been suggested as early markers of glomerular barrier dysfunction; however, their clinical behavior and diagnostic value in hypertensive patients with previous SARS-CoV-2 infection are unknown. Aim: To assess urinary nephrinuria, microalbuminuria, transforming growth factor β1 (TGF-β1), aldosterone, vascular endothelial growth factor A (VEGF-A) and renal hemodynamics across different stages of hypertension in patients with and without a history of COVID-19 and to assess the response to conventional antihypertensive and nephroprotective treatment. Methods: In a prospective comparative cohort study, 120 patients (aged 30–60 years) with stage I–III essential hypertension were stratified by COVID-19 history into a post-COVID-19 group (n = 60) and a non-COVID-19 group (n = 60); within each group, 20 patients were assigned to each hypertension stage. Comparisons were performed between the post-COVID-19 and non-COVID-19 subgroups at the same hypertension stage. Serum creatinine, cystatin-C, aldosterone, TGF-β1 and VEGF-A, urinary microalbumin and nephrin and intrarenal Doppler hemodynamics were measured at baseline and after six months of guideline-based treatment. Results: Nephrinuria was markedly increased in post-COVID-19 patients in all stages of hypertension, including stage I, where serum creatinine, cystatin-C and eGFR were within the normal range (126.5 ± 9.1 vs. 91.9 ± 8.3 pg/mL, p < 0.01). Nephrinuria was strongly correlated with renal functional reserve (r = −0.824, p < 0.001), eGFR (r = −0.797, p < 0.001), microalbuminuria (r = 0.758, p < 0.001), aldosterone (r = 0.613, p < 0.001) and VEGF-A (r = 0.589, p < 0.001). Antihypertensive and nephroprotective treatment for six months decreased nephrinuria, blood pressure and TGF-β1, with more limited effects in stage III disease. Conclusions: Nephrinuria was found to be an early marker of renal involvement in COVID-19, occurring before microalbuminuria and conventional functional markers and with a greater relative difference than these markers in stage I disease, suggesting podocyte injury as an early and potentially reversible mechanism of post-COVID renal involvement in hypertensive patients. Nephrinuria seems to be a potential biomarker for early renal surveillance in this population and its prognostic role for incident CKD needs to be validated in longitudinal outcome studies. Full article

Understanding COVID-19 transitions towards endemicity is vital by examining center-specific data within provincial and national contexts. This retrospective study aimed to enhance public health management and understanding of COVID-19 dynamics using data from Atma Jaya Catholic University of Indonesia (AJCUI) and open-source databases from Jakarta and Indonesia’s official websites from July 2020 to December 2022. Trends across data sources were compared, and correlations between positivity rates at AJCUI and Jakarta/Indonesia were assessed using linear regression. A total of 8,354,809 positive samples were analyzed nationally, showing similar trends and peaks of positivity rates across databases, with positive correlations between AJCUI–Jakarta (β = 1.154; p < 0.001; 95% CI = 0.86–1.45) alongside AJCUI–Indonesia (β = 1.262; p < 0.001; 95% CI = 0.74–1.79). Mobility restriction policies substantially reduced the positivity rate within the study period. Further analysis of AJCUI showed that higher proportions of low Ct value (≤30) were associated with increased contemporaneous positivity at AJCUI (β = 0.442; p < 0.001) and Jakarta (β = 0.319; p < 0.001), although inadequately reflected in Indonesia (β = 0.039; p = 0.589). This study highlights the potential of incorporating Ct value distributions as epidemiological indicators within surveillance systems. These findings support the importance of comprehensive laboratory data recording to better characterize COVID-19 transmission patterns across different surveillance levels, alerting policymakers to establish efficient policies. Full article

Excitotoxicity is one of the factors that participates in neurodegeneration, impairing neuronal and glial cells’ function, and leading to the development of chronic neurodegenerative diseases. The main mechanism of action lies in the overstimulation of excitatory receptors, especially the NMDA (N-methyl-D-aspartic acid) receptor, by glutamate, which promotes a massive influx of Ca²⁺ that is not sufficiently buffered by the intracellular machinery, or not released by mechanisms such as Ca²⁺ ATPase and plasma membrane Ca²⁺/Na⁺ exchanger promoting, among other toxic effects, mitochondrial damage and an increase in reactive oxygen species (ROS). Notably, many cases reported of long COVID-19 describe significant brain alterations and neuropsychiatric disorders, including delirium, depression, etc., and patients required increased use of antidepressant or anxiolytic drugs, for example. In addition, emerging evidence links neurodegeneration as a potential long-term sequelae associated with an increased number of patients with cognitive disorders. This review analyzes data from the literature regarding brain alterations associated with post-COVID-19 syndrome and explores a potential link to the excitotoxicity pathways, due to its participation in neurodegeneration by homeostatic failure, and it is clearly present in various brain conditions, such as Alzheimer’s and Parkinson’s diseases. Full article

COVID-19-related school closures substantially disrupted students’ daily lives. While prior research has predominantly relied on externally assessed achievement data and proxy indicators of well-being, less is known about students’ own perceptions of their experiences during distance learning. This study addresses this gap, using a qualitatively informed quantitative analysis. First, open-ended responses from N = 698 students from German and Swiss schools were analyzed to identify perceived positive and negative aspects of distance learning, thereby providing experience-based indicators of how the pandemic affected students’ well-being. Quantitative content analysis revealed that students most frequently mentioned advantages such as being at home and experiencing greater independence, while common disadvantages included a lack of social contact and insufficient learning support. Second, random forest models were applied to identify individual, contextual, and background-related predictors of these perceptions. Students with stronger self-regulation skills, lower levels of procrastination, and better-equipped home learning environments were more likely to emphasize positive experiences. Conversely, younger students and those with weaker self-regulation and fewer home learning resources more frequently reported negative experiences. The findings reveal substantial variability in students’ perceptions of distance learning, shaped by learner-related, contextual, and broader background factors. They underscore the importance of fostering self-regulation and ensuring equitable access to learning resources to better prepare schools for future crises. Full article

Traditional and COVID-19-specific severity scores are applied in intensive care units (ICUs) to guide decision-making and predict mortality. Since traditional severity scores (APACHE II, SAPS II, SAPS 3, and SOFA) were not originally designed for SARS-CoV-2, this study compared their performance with COVID-19–specific models (Shang-COVID and SEIMC), including a novel distinction between early (≤7 days) and late (>7 days) ICU mortality. Adult ICU COVID-19 patients from the first two pandemic waves in Portugal were included (n = 286). Six scores were calculated, and four outcomes assessed: hospital, ICU, early ICU, and late ICU mortality. Discrimination was assessed using ROC curves with AUCs, 95% CIs, and p-values. AUCs were compared using the Delong test (early vs. late ICU mortality and across scores within each wave) and the Hanley & McNeil test (between waves for each score). Traditional scores demonstrated robust mortality prediction. SEIMC performed well for hospital (AUC_wave1 = 0.808; AUC_wave2 = 0.724) and ICU mortality (AUC_wave1 = 0.805; AUC_wave2 = 0.706). SEIMC (AUC_wave1 = 0.786; AUC_wave2 = 0.800) and Shang-COVID (AUC_wave1 = 0.617; AUC_wave2 = 0.736) showed potential for early mortality prediction but require further validation and recalibration. Overall performance was superior during the first wave, likely reflecting differences in patient characteristics, viral variants, and health measures. Traditional severity scores demonstrated stable robust prediction of ICU and hospital mortality in COVID-19 cases. Disease-specific scores did not significantly outperform established models, though also showed good predictive ability in some contexts, particularly early ICU mortality. These findings highlight the need for continuous validation and recalibration of predictive tools as clinical contexts evolve. Full article

Introduction: Coronavirus disease 2019 (COVID-19) can cause persistent cardiovascular alterations, including autonomic dysfunction. Heart rate (HR) recovery (HRR) after exercise is a simple marker of autonomic modulation associated with functional capacity and clinical prognosis. Evaluating HRR during the six-minute walk test (6MWT) may help identify residual functional limitations in diverse patients. Objective: To compare pulmonary function, maximal inspiratory pressure (MIP), functional capacity, dyspnea, fatigue, and functional status in post-COVID-19 patients. Methods: This cross-sectional study included 75 adults (mean age: 47.6 ± 13.1 years; 54.7% male) who recovered from COVID-19 divided into 2 groups based on HRR 1 min after the 6MWT: delayed (≤12 beats/min); and non-delayed (>12 beats/min). Pulmonary function, MIP, exercise capacity (via 6MWT), dyspnea, muscle fatigue, and functional status were assessed. Results: Based on HRR 1 min after 6MWT, 27 (36%) participants were classified with abnormal HRR and 48 (64%) with normal HRR. There were statistical differences between the groups regarding demographic or clinical characteristics, pulmonary function, MIP, muscle fatigue, or functional status (p > 0.05). The delayed HRR group exhibited a smaller reduction in HR in first minute of recovery (ΔHR = 6 vs. 23 beats/min), higher baseline HR (p = 0.010), and greater dyspnea (p = 0.020). Furthermore, this group exhibited worse functional performance in the 6MWT, with shorter distance walked (437.33 vs. 494.27 m; p = 0.019) and a lower percentage of predicted distance (74.66 ± 12.98% vs. 82.94 ± 15.71%; p = 0.023) compared with the non-delayed HRR group. Conclusion: Delayed HRR post-COVID-19 was associated with poorer functional performance and greater dyspnea, regardless of pulmonary function. The blunted reduction in HRR after exertion suggests impaired cardiovascular autonomic modulation, possibly related to attenuated vagal reactivation, which may contribute to exercise intolerance observed in this population. Full article

Since the introduction of the Post-COVID-19 Functional Status (PCFS) scale early in the COVID-19 pandemic, the scale has been incorporated in research and clinical guidelines to assess and monitor functional status. In this explorative study, we aimed to evaluate characteristics of the PCFS scale based on its use during a 12-month follow-up of COVID-19 survivors to increase understanding of the scale over a longer period of time. Adult COVID-19 patients who were evaluated by multidisciplinary measures at 6 weeks and 12 months post-discharge at the Leiden University Medical Center (The Netherlands) were included. The distribution of PCFS scale grades, as well as descriptive patterns between PCFS grades and patient-reported outcome measures (PROMs), pulmonary function and physical function were evaluated with descriptive analyses; no statistical tests were performed due to data availability. Of the 79 included patients, 62% had a change in PCFS grade between the 6-week and 12-month follow-ups, of whom 63% improved over time. At 12 months, abnormal PROMs regarding psychological symptoms (according to clinical cut-offs), relatively lower quality of life (EQ VAS) scores, and MRC dyspnea grades ≥ 2 were observed in patients scoring PCFS grade ≥ 2. With increasing PCFS grade, a decrease in pulmonary function and physical function outcomes was observed. Higher PCFS grades (worse functional status) seemed related to worse outcomes at 12-month follow-up. Future studies are needed to investigate whether changes in PCFS grade reflect clinically relevant changes in patients’ self-perceived functioning. Full article

American Indian and Alaska Native (AI/AN) communities experienced disproportionate COVID-19 morbidity and mortality, particularly in rural areas with limited public health infrastructure. This study examined primary COVID-19 information sources among AI/AN adults in rural Michigan and evaluated how trust in these sources relates to health knowledge, attitudes, and vaccination behaviors. We conducted a prospective, randomized pre-post interventional study among 273 adults at a tribal health clinic in rural Isabella County, Michigan (2022–2024). Participants were assigned to receive a culturally tailored educational video or infographic, and surveys assessed COVID-19 knowledge, vaccine attitudes, information sources, and perceived reliability. Social media was the most frequently used information source but was rated as less reliable, whereas healthcare workers (HCWs) were considered the most trusted. Reliance on HCWs and personal relationships was associated with higher baseline vaccine knowledge and greater uptake of influenza vaccination. Both educational formats resulted in modest improvements in COVID-19 knowledge and vaccine attitudes. While no consistent differences were observed between formats overall, infographic-based education was associated with greater gains in select vaccine knowledge domains among participants who relied on trusted interpersonal or clinical information sources. These findings highlight a “usage-trust gap” in rural AI/AN health communication, where frequently used information channels are not necessarily the most trusted. Culturally tailored messaging delivered through trusted clinical and interpersonal networks may enhance the effectiveness of public health communication and support vaccine uptake in underserved communities. Full article

Many people experienced difficulties grieving the death of a loved one during the COVID-19 pandemic. The main objective of this research was to examine the psychological manifestations of grief for people who experienced the death of a loved one between March 2020 and March 2022 in Panama. A sample of 110 participants completed an online survey including sociodemographic questions and psychological questionnaires. A subsample of twenty-six participants was interviewed about their experience of loss leading up to death, at the time of death, and after death. Results indicated that 43.6% of participants suffered from complicated grief (CG). Participants who experienced CG had more post-traumatic stress symptoms, somatic symptomatology, anxiety/insomnia, social dysfunction, severe depression, use of avoidant coping mechanisms, and more anxiety about the pandemic than participants who did not experience CG. A logistic regression analysis indicated that anxiety/insomnia symptoms, denial as a coping mechanism, and post-traumatic stress symptoms increased the likelihood of CG. For qualitative analyses, the most relevant themes that emerged were distress associated with contagion and illness, hospitalization and access to healthcare services, communication with medical staff, the impact of the news of death, inability to view the body, emotions following the loss, farewell rituals, and coping mechanisms. Full article

Rapid antigen tests targeting SARS-CoV-2 nucleocapsid protein were essential for decentralised testing during the COVID-19 pandemic. Independent performance evaluations are essential to support regulatory approval and inform clinical implementation, particularly in resource-limited settings. This study presents a retrospective analytical and operational evaluation of two instrument-based fluorescent immunoassays (FIAs): the PCL COVID-19 Ag Rapid FIA and LumiraDx SARS-CoV-2 Ag Test. Analytical sensitivity was determined using recombinant nucleocapsid protein and viral cultures. Clinical performance was assessed using residual clinical specimens (n = 110) with RT-PCR as a reference, stratified by cycle threshold (Ct). Operational characteristics were assessed using a structured Likert framework. Overall sensitivity was 63% (51–73) for PCL and 95% (88–99) for LumiraDx. For Ct ≤ 25, sensitivity increased to 93% and 100%. Specificity was ≥97% for both. LumiraDx maintained sensitivity (83–94%) at Ct 25–30, whereas PCL did not detect any positives in this range. The limit of detection was 39 pM (PCL) and 0.6 pM (LumiraDx). Operational usability was high for both (90% PCL, 87% LumiraDx). LumiraDx showed higher analytical sensitivity across a broader viral load range, supporting primary diagnostic use, whereas PCL was limited to high viral loads. This evaluation provides a reproducible framework for rapid diagnostic assessment during emerging outbreaks. Full article

Background: Post-COVID-19 syndrome (PCS) is associated with impairments in mobility, balance, and physical function, which may reduce quality of life. The 30 s Sit-to-Stand (30STS) and Timed Up and Go (TUG) tests are widely used clinical measures; however, their intra-rater reliability in older adults with PCS has not been established. Reliable outcome measures are essential for clinical assessment and rehabilitation planning. Methods: In this single-center pilot study, nineteen older adults with PCS were recruited as a convenience sample. Participants completed three trials of the 30STS and TUG tests on day one, with the protocol repeated after three days. The 30STS evaluates lower-limb strength and functional performance, while the TUG assesses balance, gait, and fall risk. Intra-class correlation coefficient (ICC), standard error of measurement (SEM), and minimum detectable change (MDC) were calculated. Results: The TUG showed an ICC of 0.995 (95% CI: 0.991–0.998), SEM of 0.48 s, and MDC of 1.33 s. The 30STS showed an ICC of 0.986 (95% CI: 0.973–0.994), SEM of 0.26 repetitions, and MDC of 0.72 repetitions. Conclusions: The TUG and 30STS demonstrate excellent intra-rater reliability and appear to be feasible clinical tools for assessing functional performance in older adults with PCS. However, findings should be interpreted cautiously due to the small, single-center pilot design and single evaluator. Further research is needed to confirm generalizability across broader PCS populations and clinical settings. Full article

Background: Understanding how demographic and clinical factors influence SARS-CoV-2 infection patterns, vaccination uptake and disease outcomes in community settings is essential for effective primary care-based public health planning. Objectives: This study aimed to investigate the distribution of SARS-CoV-2 infections among adults attending Primary Healthcare (PHC) facilities in Giannitsa, Greece, from 2020 to 2024, and to examine associations between demographic and clinical characteristics, vaccination category and disease outcomes. Methods: A retrospective analysis was conducted using data from the National Registry of Patients with COVID-19. The study included 1144 adults diagnosed with SARS-CoV-2 at PHC facilities from 19 November 2020 to 3 October 2024; all cases included in the present analysis had been confirmed by rapid antigen testing. Variables included age, gender, residence, registry-recorded underlying medical conditions, vaccination category, seasonality and clinical outcome. Results: Significant shifts in case distribution were observed across time, with younger adults predominating in 2020–2022 and older adults (61–90 years) in 2023–2024 (p < 0.001). Winter months showed higher case incidence overall (p < 0.001). Vaccination coverage increased annually, reaching 84.8% in 2024 (p < 0.001). Hospitalization/death occurred in 1.7% of patients and was strongly associated with age ≥61 years (6.0% vs. 0.3%), the presence of at least one registry-recorded underlying medical condition (9.2% vs. 0.9%) and vaccination category; specifically, hospitalization/death occurred in 10.4% of individuals diagnosed during the pre-vaccine period, 2.3% of unvaccinated individuals during the vaccination era and 0.9% of vaccinated individuals (all p < 0.001). Conclusions: Older age, underlying medical conditions and a lack of vaccination were key predictors of worse outcomes. The findings underscore the importance of strengthening vaccination outreach and targeted PHC interventions, particularly for high-risk and rural populations. Full article

Background: COVID-19 is primarily a respiratory disease, but increasing evidence suggests possible oral and maxillofacial complications. This study presents a case series of post-COVID maxillary osteonecrosis (PC-RONJ) cases from western Romania and explores the possible association between SARS-CoV-2 infection, its treatment, and this complication. Methods: We conducted a multicenter retrospective case series of two patients with recent PCR-confirmed SARS-CoV-2 infection who subsequently developed maxillary osteonecrosis (ONC) between 2021 and 2023. Clinical examination, CT imaging (including 3D reconstructions), and ENT assessment were used to assess the severity of the disease. All medical records were reviewed to identify comorbidities, details of COVID-19 treatment, and the appearance of maxillofacial symptoms. Results: Both patients had been hospitalized for severe COVID-19 and treated according to the national protocol with systemic corticosteroids, oxygen therapy, anticoagulation, and antivirals. CT scans revealed marked osteolytic destruction of the maxilla and maxillary sinus walls, with extension toward adjacent facial bones. Microbiological analysis revealed a complex polymicrobial profile, including Gram-positive and Gram-negative bacteria as well as opportunistic fungal species, consistent with a chronic biofilm-associated infectious process. Patients received surgical treatment, followed by local care and, in both cases, prosthetic rehabilitation with maxillary obturators, which improved speech, chewing, and oral function. Conclusions: This case series suggests a possible association between severe COVID-19, its treatment, and subsequent maxillary osteonecrosis in susceptible patients; however, the small number of cases precludes causal inference. To our knowledge, this is the first Romanian report describing such cases in patients without prior antiresorptive therapy. These findings highlight the need for careful use of systemic corticosteroids and vigilant post-recovery monitoring of maxillofacial complications. Further studies are required to clarify the underlying mechanisms and risk factors. Full article

The COVID-19 pandemic highlighted substantial variability in public health information environments, yet the relationship between information source, perceived credibility, and behavioral response remains incompletely understood. This study evaluated how information sources influence COVID-19-related knowledge and behaviors and whether targeted educational interventions modify these relationships. We conducted a prospective survey-based study (July–December 2021) among adults recruited from outpatient clinics in Michigan (N = 209). Participants completed pre- and post-intervention surveys assessing information sources, perceived reliability, knowledge, and behaviors, and were randomized to receive either a video or infographic. Social media was the most frequently reported source (n = 95) but had lower perceived reliability (mean 2.97/5), whereas healthcare workers (HCWs) were rated most reliable (mean 4.26/5) despite lower utilization (n = 60). Use of HCWs, print media, and websites was associated with higher baseline knowledge, while television and radio were associated with lower knowledge of vaccine side effects (p = 0.011 and p = 0.003). Educational interventions improved knowledge and attitudes, with differential effects across source groups, while infographic-based interventions were more effective among social media users (p = 0.034). Information sources and perceived credibility significantly shape health knowledge and behavior, highlighting the need for communication strategies that integrate trusted messengers, high-reach platforms, and health literacy to improve public health outcomes. Full article

Background/Objectives: The COVID-19 pandemic imposed logistical challenges on health systems, particularly for mass vaccination campaigns under emergency conditions. In decentralized health systems, the absence of a structured preparedness phase may compromise coordination, allocation, and operational performance. This study analyzes the vaccination campaign in a municipality in southern Brazil, examining how the overlap of the preparedness and response phases affected outcomes and how alternative logistical scenarios could have altered campaign performance. Methods: An empirical analysis was conducted using scenario-based simulation with stock and flow structures. The model represents vaccine procurement, distribution across national, state, regional, and municipal levels, and municipal vaccination capacity. Real data from the 2021 vaccination campaign in the municipality were used to build a Business-as-Usual scenario, compared with alternative scenarios involving changes in procurement predictability, allocation rules, and operational capacity. Results: Vaccination outcomes were strongly conditioned by upstream allocation decisions, particularly at the national state level. Isolated adjustments at intermediate supply chain levels produced limited improvements when upstream constraints persisted. Scenarios combining improved alignment between forecasted and acquired doses with operational capacity showed higher vaccination potential, revealing a gap between observed performance and system capacity. Conclusions: The findings reinforce that preparedness is a critical determinant of vaccination performance and must precede response in emergency contexts. Supply predictability alone is insufficient without coordinated allocation mechanisms and operational readiness across governance levels. This study provides empirical evidence on how preparation-related decisions shape vaccination outcomes in decentralized health systems and inform logistical coordination in future emergencies. Full article

Post-acute sequelae of SARS-CoV-2 infection (PASC), also referred to as Long COVID, affects millions worldwide and is characterized by persistent fatigue, reduced immune fitness, and mood disturbances. The aim of the current study was to identify if immune fitness, mood, fatigue, and quality of life prior to SARS-CoV-2 infection could predict PASC fatigue severity. A retrospective cross-sectional survey was conducted among 299 Dutch PASC patients. Participants completed validated measures of immune fitness, fatigue (assessed with both the Fatigue Severity Scale and a single-item scale), mood (including stress, anxiety, depression, hostility, loneliness, and happiness) and quality of life for the three months prior to SARS-CoV-2 infection. The same assessments were made for the month before survey completion (i.e., during PASC). Correlational and regression analyses were conducted to identify possible predictors of PASC fatigue severity. Participants were predominantly female (90%): mean age 44.1 (SD 11.2) years. Both assessments of PASC fatigue did not correlate significantly with the prior SARS-CoV-2 assessments of immune fitness, fatigue, mood, and quality of life. The regression analyses revealed no significant predictors for PASC fatigue severity. In conclusion, immune fitness, fatigue, mood and quality of life prior to SARS-CoV-2 infection were not identified as independent predictors of PASC fatigue severity. Full article

Background: The COVID-19 pandemic increased stress experienced by children through individual-, family-, and community-level factors, with potential sex-specific impacts on behavioural outcomes. Children’s resilience may buffer these effects. This exploratory study investigated associations between COVID-19 stress and children’s internalising, externalising, and overall behavioural symptoms, and whether child resilience and sex assigned at birth moderated these associations. Methods: Data (N = 68) came from the longitudinal COVID-19 Impact Study of the Canadian APrON pregnancy cohort of mothers and their children followed for more than 9 years. COVID-19 stress, combining individual-, family-, and community-level stressors, was reported by mothers (mean age = 42.37, SD = 3.72) and their children (53% female; mean age = 10.21 years, SD = 0.43) across three timepoints (October–December 2020; February–May 2021; June–August 2021). Children’s behavioural problems and self-reported resilience were assessed between April and September 2022. Results: COVID-19 stress was not significantly associated with children’s behavioural problems. Moderated-moderation suggested that the association between COVID-19 stress and children’s internalising (T-score estimate = −2.38, 95% CI [−4.08, −0.68]), externalising (T-score estimate = −3.21, 95% CI [−5.09, −1.33]), and overall (T-score estimate = −2.79, 95% CI [−4.45, −1.12]) symptoms may vary by child resilience and child sex assigned at birth. Among females, COVID-19 stress appeared to be associated with more behavioural problems at lower levels of resilience and fewer problems at higher levels of resilience. Significance: The association between COVID-19 stress and children’s behavioural symptoms across children’s resilience levels may vary based on sex assigned at birth, with effects suggested among females. Null findings may reflect the modest sample size and limited statistical power. Full article

This study evaluates the performance of a semi-dynamic negative binomial model with cubic spline smoothing to characterize the spatiotemporal dynamics of COVID-19 mortality in Peru, a setting marked by significant data inconsistency and reporting delays. Using nationwide weekly mortality data, we compared a Poisson regression against a semi-dynamic NB model with a population offset and cubic splines (df = 6). The models were evaluated using Akaike Information Criterion and log-likelihood to handle overdispersion and temporal non-stationarity. The NB model demonstrated a superior fit, reducing the AIC from 136,596.4 to 75,668.25 and improving log-likelihood by over 30,000 points. Demographic analysis revealed an 81.6% higher risk of death in males (IRR = 1.816; 95% CI: 1.753–1.881) and an exponential gradient with age, peaking at an IRR of 4.717 (95% CI: 4.499–4.945) for individuals ≥80 years. Departmental fixed effects identified significant spatial heterogeneity, with higher diffusion in coastal regions. The semi-dynamic NB model with splines provides a robust, parsimonious, and scalable framework for epidemiological surveillance in resource-limited settings. By effectively correcting for overdispersion and stabilizing weekly reporting fluctuations, this approach offers a reliable tool for public health decision making in environments with fragmented data quality. Full article

Background: Religious affiliation has traditionally served as a coping strategy during stressful events such as the COVID-19 pandemic. Pregnant women faced heightened stress during the pandemic due to concerns about their health as well as that of their fetus. This study examined the prevalence of self-reported religious affiliation among SARS-CoV-2-positive pregnant women and investigated differences in psychiatric diagnoses and pregnancy outcomes based on religious affiliation. Methods: The study included all asymptomatic or mildly symptomatic SARS-CoV-2-positive pregnant women who received care at the Mayo Health System from March 2020 through October 2021 and completed the routine religious affiliation questionnaire. Those selecting “none” were categorized as having no religious affiliation (RA−), whereas those selecting a specific religion were categorized as religiously affiliated (RA+). Results: Among 609 women, 49.6% were RA+ and 50.4% were RA−. RA+ women were more likely to be white, married, college-educated, and have fewer prior abortions. There were no significant differences in rates of depression, anxiety, psychotropic medication use, substance use, or pregnancy and labor complications between RA+ and RA− groups. Conclusions: Half of the women in this cohort reported no religious affiliation. Previously reported protective associations between religiosity and mental health were not observed when religious affiliation alone was examined. Full article