Search Results (4,341)

Objective: Virtual reality (VR) exercises may offer a comprehensive rehabilitation approach for many conditions. This study primarily aimed to evaluate the effectiveness of VR exercises compared with conventional exercise in reducing pain intensity in individuals with post-COVID-19 condition (PCC). Secondary analyses explored their effects on fatigue, functional capacity, mood, and quality of life. Materials and Methods: A single-center, randomized, assessor-blinded intervention study was conducted with 79 individuals between July 2021 and February 2022. The primary outcome was pain intensity measured using the Visual Analog Scale (VAS). Secondary outcomes included mood (Hospital Anxiety and Depression Scale, HADS), fatigue (Fatigue Severity Scale, FSS), quality of life (SF-12), and functional exercise capacity (6-Minute Walk Test, 6 MWT). Participants completed supervised exercise sessions 3 times weekly for 30–45 min over 8 weeks. The conventional exercise program involved moderate-intensity aerobic, strength, stretching, and neuromuscular exercises. VR exercises were delivered semi-immersively using motion-controlled video games. Time × group interactions were analyzed using linear mixed-effects model. Results: In both groups, 6MWT, SF-12 physical and mental components increased, while VAS, FSS and HADS anxiety and depression scores decreased. Time-group interaction was observed in favor of VRG for VAS [F(1, 59.4) = 56.3, p = 0.001], as well as HADS-D [F(1, 54.6) = 7.40, p = 0.008] and FSS [F(1, 61.4) = 8.96, p = 0.004]. Conclusions: While structured exercise improves the physical and psychological conditions of individuals with PCC, virtual reality exercises stand out in pain, also fatigue, and depression. Full article

Viral zoonoses represent a critical intersection of global health, ecology, and ethical issues. Pathogens that pass from animals to humans. This review examines the complex landscape of viral zoonoses, including their mechanisms, impact, and mitigation strategies. We begin with insights into the historical context and significance of these diseases and then explore spillover mechanisms influenced by genetic, ecological, and anthropogenic factors. This review covers the host range, transmission dynamics, and immunological barriers, including viral detection, adaptation, and immune evasion. Genomic insights have revealed the genetic determinants of host switching and adaptation, illuminating the dynamics of viral spillover events. We emphasize the anticipation and prevention of zoonotic events, highlighting surveillance, early warning systems, and the “One Health” approach. Using case studies of outbreaks such as Ebola, avian influenza, and COVID-19, this review examines the real-world consequences of zoonotic diseases. We then discuss interventions, including mitigation strategies and vaccination, and their ethical and social implications. Drawing on past outbreaks, we provide recommendations for the future, aiming to balance human health, conservation, and animal welfare. This review aims to inform professionals, academics, and policymakers by offering a multidisciplinary perspective on the complex world of viral zoonoses and strategies to protect global health. Full article

Background: The COVID-19 pandemic has imposed significant changes on daily life. It negatively impacts children’s physical activity and lifestyle behaviors, which may cause accelerated weight gain during the COVID-19 pandemic. This study aims to evaluate children’s longitudinal age- and sex-adjusted body mass index (BMI) percentile changes during and after the COVID-19 pandemic. Methods: Height and weight data were obtained from electronic medical records for children (ages 2–18) visiting outpatient clinics during three periods: pre-COVID-19 lockdown, during COVID-19 lockdown, and post-COVID-19 lockdown. According to the availability of anthropometric information, three partially overlapping cohorts were formed: Cohort 1 (N = 934, pre- and during lockdown), Cohort 2 (N = 1129, during and post-lockdown), and Cohort 3 (N = 203, data from all three periods). Results: During the lockdown, the mean changes in percentiles of age- and sex-adjusted BMI were 6% ± 0.23, while after the lockdown, there were smaller mean changes in BMI percentiles (1% ± 0.19). There were significant associations of age and the baseline BMI categories with the change in the means of the adjusted BMI percentile of children during and after the COVID-19 pandemic (p-value < 0.001). In addition, there were significant associations of gender and the baseline BMI categories with the change in the means of the adjusted BMI percentile of children over a three-time series (p-value: <0.04, <0.001, respectively). Conclusions: In conclusion, children experienced increased BMI during and after the COVID-19 lockdown. This result highlights the importance of structured interventions to mitigate the consequences during challenging times on children’s health. Full article

Arthroscopic knee surgery represents a cornerstone of modern orthopedic practice, yet nationwide data from Eastern Europe remain scarce. This study provides the first comprehensive assessment of arthroscopic knee procedures in Romania over a seven-year period (2017–2023), focusing on anterior cruciate ligament (ACL) reconstruction trends and related interventions. Using national hospital discharge data, all arthroscopic knee procedures were identified and analyzed by year, sex, age group, region, and hospital type. A total of 76,804 procedures were recorded, including 26,888 reconstructions (O15301/O15303) and 29,979 meniscectomies (O13404). ACL reconstructions increased from 1560 cases in 2017 (7.9/100,000 inhabitants) to 1865 in 2023 (9.8/100 k), with a marked decline in 2020 (5.3/100 k) due to the COVID-19 pandemic and full recovery thereafter. Men predominated in ACL reconstructions (74%; 8226 males vs. 2854 females), whereas meniscectomy peaked in middle-aged adults (50–54 years: 48.7/100 k). Surgical activity was highly centralized, with five counties performing over two-thirds of all ACL reconstructions. Approximately 89% of procedures were conducted in public hospitals. These findings reveal substantial progress but also persistent regional and demographic inequities. Strengthening access, standardizing indications for degenerative meniscal surgery, and establishing a national ACL registry could support equitable, evidence-based advancement of arthroscopic care in Romania. Full article

Background: The COVID-19 pandemic led to an unprecedented global health and economic crisis, and vaccination emerged as a critical intervention to control the spread of the virus and mitigate its impact on health systems and economies. Despite the rapid development and deployment of vaccines, the financial commitments required for these vaccination programs are substantial, necessitating a comprehensive understanding of the associated costs to inform future public health strategies and resource allocation. Method: This analysis estimates the global, regional, and national economic costs of COVID-19 vaccination across 234 countries and regions in the period 2020–2023, consisting of vaccine procurement costs and administration costs. Result: As of 31 December 2023, the global costs of COVID-19 vaccination programs were estimated at USD 246.2 billion, with vaccine procurement accounting for approximately USD 140.2 billion and administration costs totaling USD 96.4 billion. Globally, a cumulative total of 136.9 billion doses of COVID-19 vaccines had been administered. Factoring in an estimated wastage rate of 10%, it is projected that approximately 150.6 billion doses were used. On a global scale, the average number of vaccine doses administered per capita was estimated at 1.73. The mean cost per capita was USD 17.70 (95% CI: USD 15.84–19.56) for vaccine procurement and USD 12.16 (95% CI: USD 10.29–14.02) for administration, resulting in a total average cost of USD 29.85 (95% CI: USD 26.33–33.37) per capita. Significant disparities in costs were observed across income groups and regions. High-income countries incurred a notably higher average cost per capita of USD 76.90 (95% CI: USD 72.38–81.41) in contrast to low-income countries, where the per capita cost was USD 7.20 (95% CI: USD 5.38–9.02). For middle-income countries, the average per capita costs were USD 15.02 (95% CI: USD 10.64–19.40) in lower-middle-income countries and USD 28.21 (95% CI: USD 23.60–32.83) in upper-middle-income countries. Regionally, the Americas (AMR) reported the highest total cost at USD 70.8 billion, with an average per capita cost of USD 65.23 (95% CI: USD 56.18–74.28). The Western Pacific Region (WPR) followed with a total cost of USD 63.9 billion and an average per capita cost of USD 31.93 (95% CI: USD 20.35–43.51). Conversely, the African Region (AFR) had the lowest total spending at USD 10.8 billion and a per capita cost of USD 8.85 (95% CI: USD 5.34–12.37), reflecting both lower vaccine procurement and administration costs. The European Region (EUR) recorded a high average per capita cost of USD 53.36 (95% CI: USD 46.79–59.94), with procurement costs at USD 31.28 (95% CI: USD 27.41–35.14) and administration costs of USD 22.09 (95% CI: USD 19.31–24.87). Conclusions: The global rollout of COVID-19 vaccination revealed substantial variation in cost structures across income groups. Procurement costs imposed greater burdens on low- and lower-middle-income countries, whereas delivery and administration costs dominated in higher-income settings. These disparities highlight persistent fiscal inequities and emphasize the need for stronger international coordination and cost transparency to enhance equity, efficiency, and preparedness in future vaccination efforts. Full article

Background/Objectives: Youth-onset type 2 diabetes (Y-T2D) incidence and severity rose during the COVID-19 pandemic, particularly during periods of widespread public health restrictions—including, but not limited to, virtual learning, stay-at-home orders, closure of recreational facilities, and limitations on in-person healthcare access. This study assessed incidence, severity, and remission rates of Y-T2D following the return to in-person education, focusing on cases diagnosed while such restrictions were in place. Methods: A retrospective chart review was conducted at a pediatric tertiary care center (2018–2024) to identify new Y-T2D diagnoses. We compared incidence rates, disease severity at diagnosis, and remission outcomes before and after the period of comprehensive public health restrictions, defined locally as March 2020–August 2021, during which virtual learning was implemented. Results: Incidence declined from 13.2 to 6.3 cases/month after the major restrictions were lifted. Youth diagnosed after the restrictions period had lower rates of diabetic ketoacidosis (7.1% vs. 20.9%, p < 0.001) and severe hyperglycemia (HbA1c 9.1 ± 2.5% vs. 10.1 ± 2.3%, p < 0.001). Among those diagnosed during the restriction period, 11.1% achieved remission within three years. Remission was associated with lower baseline HbA1c (OR = 9.52, 95% CI: 2.2–41.7, p = 0.003), metformin use (OR = 7.0, CI: 1.9–26.3, p = 0.004), GLP-1 receptor agonist use (OR = 5.8, CI: 1.3–24.4, p = 0.018), and lower likelihood of insulin therapy (OR = 19.5, CI: 2.3–166.7, p = 0.007). Conclusions: The reduction in Y-T2D cases after the lifting of pandemic-related restrictions highlights the impact of pandemic-related environmental changes. Low remission rates—especially among underserved youth—underscore the urgency of early screening, prompt intervention, and equitable access to pediatric diabetes care, and highlight the need to consider the metabolic health impacts of future prolonged public health measures. Full article

Background/Objectives: The COVID-19 pandemic profoundly disrupted the daily lives of children with neurodevelopmental disorders, particularly Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD). Lockdowns, therapy interruptions, and reduced access to educational and healthcare services significantly affected developmental progress and family functioning. This pilot study aimed to assess the long-term impact of the pandemic on children with ASD and ADHD in Northern Greece and to explore consequences for their families in the post-pandemic period. Methods: Parents or legal guardians of 72 children (ages 2–17 years) with confirmed diagnoses of ASD (n = 57) or ADHD (n = 15) participated. A structured 25-item questionnaire captured information on developmental, psychological, and social functioning, family well-being, therapy disruption, screen use, and access to online support. Data were collected across urban, semi-urban, and rural areas of Northern Greece over six months. Descriptive and inferential analyses were performed. Results: Most participants were boys (77.8%) and in primary school (73.6%). Common co-occurring conditions included learning difficulties (33.3%), anxiety (8.3%), and epilepsy (6.9%). Nearly half of families (45.8%) reported therapy reductions exceeding 70%, while 29.2% accessed online therapy, often with limited perceived effectiveness. New behavioral symptoms emerged in 45.8% of children, including irritability, anxiety, and emotional instability. Parental psychological distress was reported by 29.2% of caregivers. Screen time increased in over 90% of cases, and 87.5% of parents perceived the pandemic as negatively affecting their child. Financial strain was noted by 37.5% of families. Conclusions: The findings highlight the significant developmental, psychological, and social consequences of the COVID-19 pandemic for children with ASD and ADHD and their families. Service disruptions, unmet therapeutic needs, and increased caregiver burden emphasize the urgency of sustainable, flexible care models. Strengthening telehealth, integrating community-based interventions, and enhancing educational accommodations are essential for resilience in the post-pandemic era. Full article

Background: This cross-sectional observational study examined the relationship between caregivers’ adverse childhood experiences (ACEs), their perceived COVID-19-related burden, child psychopathology, and changes in family relationships during the pandemic. Methods: The final sample included 285 children (M = 10.19, SD = 3.36) from clinical settings and their caregivers. Caregivers reported their own ACEs and their children’s psychopathology. Perceived caregiver COVID-19 burden and changes in family relationships were also assessed. Correlational analyses, regressions, and mediation models were conducted to test direct and indirect associations. Results: Caregivers reported an average of 1.63 ACEs, with 18.4% reporting four or more. Children of caregivers who reported four or more ACEs exhibited significantly elevated psychopathology scores. However, caregiver ACEs did not directly predict the perceived COVID-19 burden. A mediation analysis revealed that child psychopathology mediated the association between caregiver ACEs and caregiver COVID-19 burden. Unexpectedly, higher caregiver ACEs were associated with less negative perceived changes in family relationships, particularly in 2023, indicating heterogeneous family adjustment trajectories. Conclusions: These findings highlight that child psychopathology is a key mechanism in the intergenerational transmission of caregiver burden linked to childhood adversity. They also suggest that support systems, resilience, or differing expectations among high-ACE caregivers may help buffer changes in family relationship. Early identification and trauma-informed, family-centered interventions beyond acute crisis are essential. However, limitations include the reliance on caregiver self-report and cross-sectional design. Further, longitudinal, multi-informant research is needed to clarify these dynamics and inform targeted support strategies. Full article

Background/Objectives: Research on the association of adverse social determinants of health (SDOH) with severe pediatric coronavirus disease (COVID-19) is limited. We examined associations between SDOH patterns and COVID-19 severity in children. Methods: We conducted a prospective, observational study of children (<18 years) with symptomatic SARS-CoV-2 infection evaluated in an urban pediatric emergency department (March 2021–April 2022) in Detroit, Michigan. Caregivers completed a 34-item survey based on the Healthy People 2030 framework. Severe disease was defined as the occurrence of respiratory/cardiac failure or death within four weeks of diagnosis. Continuous and categorical variables were described using medians and percentages, respectively. Associations between disease severity and risk factors were determined using chi-square tests. Association rule mining was used for feature selection, followed by multivariate logistic regression. Results: We analyzed data from 354 children [6–12 years: 31.1%, Female: 51.1%, Black: 59%, not Hispanic: 84.7%, public insurance: 77.1%, chronic condition: 27.4%]. Of the total, 113 children had severe disease. Most caregivers were 30–44 years old (53.1%), had less than a college degree (70.4%), and income < USD 50,000 (75.2%). Adverse SDOH reported included food/housing insecurity (24.6%), no support (64.7%), unmet childcare needs (35.9%), and lack of transportation (12.7%). After controlling for age, sex, medical history, income, and obesity, severe disease was associated with caregiver use of drugs/alcohol (OR:5.92, p < 0.001) and social discrimination/lack of support (OR: 1.74, p = 0.030). Conclusions: Two SDOH patterns (caregiver use of drugs/alcohol and social discrimination/lack of support) were associated with severe COVID-19. Further studies are needed to confirm findings and develop interventions. Full article

GPS tracking has made ski injury data abundant, yet few studies have mapped where incidents actually occur or how those patterns differ between skiers and snowboarders. To address this gap, we analyzed 8719 GPS-located incidents (4196 skier; 4523 snowboarder) spanning four seasons (2017–2022, excluding 2019–2020 due to COVID-19) at a large West Coast resort in California. Incidents were aggregated into 45 m hexagons and analyzed using Getis–Ord Gi* hot spot analysis, Local Outlier Analysis (LOA), and a space–time cube with time-series clustering. Hot spot analysis identified both activity-specific and overlapping high-injury concentrations at the 99% confidence level (p < 0.01). The LOA revealed no spatial overlap between skier and snowboarder High-High classifications (areas with high incident counts surrounded by other high-count areas) at the 95% confidence level. Temporal analysis exposed distinct patterns by activity: Time Series Clustering revealed skier incidents concentrated at holiday-sensitive locations versus stable zones, while snowboarder incidents separated into sustained high-activity versus baseline areas. These findings indicate universal safety strategies may be insufficient; targeted, activity-specific interventions may warrant investigation. The methodology provides a reproducible framework for spatial injury surveillance applicable across the ski industry. Full article

The COVID-19 pandemic represents a major challenge for healthcare systems, particularly affecting healthcare workers (HCW) due to their higher occupational risk. A retrospective observational study was conducted using data from 239,188 diagnostic tests performed on HCW from the Castilla y León (Spain) Health Service between March 2020 and March 2022. The objective was to explore associations between categorical variables, such as geographic areas, job categories, and infection status, through Multiple Correspondence Analysis and Hierarchical Clustering. The results revealed higher infection rates among HCW in regions near Madrid and in job categories with a greater care-related workload. These findings help identify risk factors and support the development of more effective occupational hazard prevention and health interventions to reduce infection risk and improve preventive measures. Full article

The COVID-19 pandemic has profoundly amplified burnout and moral injury among nurses, exposing structural vulnerabilities in healthcare systems and accelerating workforce attrition. Beyond the acute crisis, nurses continue to face chronic staff shortages, overwhelming workloads, and unresolved ethical tensions that compromise both well-being and quality of care. Synthesis of recent meta-analyses in this review indicates that nurse burnout during the pandemic ranged between 30% and 50%, illustrating the magnitude of the problem. Particular attention is given to innovative organizational strategies that foster resilience, including workload redistribution, enhanced professional autonomy, supportive leadership, and the integration of digital technologies such as telecare. Comparative perspectives across healthcare systems illustrate how policy reforms, staffing models, and ethical frameworks can mitigate psychological distress and strengthen organizational resilience. By reframing burnout and moral injury not only as individual challenges but as systemic phenomena requiring structural solutions, this review emphasizes the imperative of multilevel interventions. Building resilient nursing workforces through innovation, leadership, and evidence-based policies is essential for sustaining high-quality patient care in the post-pandemic era. Full article

Background: Long COVID—defined as the persistence of symptoms or the development of new symptoms beyond four weeks after acute SARS-CoV-2 infection—affects an estimated 10–30% of individuals recovering from COVID-19, posing a significant public health burden. Emerging evidence suggests that type I interferons (IFNs) (a critical group of cytokines in the antiviral defense) and hematologic alterations, such as lymphopenia and elevated inflammatory markers, are linked to both the severity of acute COVID-19 and the likelihood of developing long-term symptoms. The aim of this study is to explore the association between type I IFN signatures and long COVID. A second aim is to examine the relationship between laboratory findings during acute infection and long COVID. Methods: The study included 61 patients investigated for the presence of long COVID symptoms 16.5 ±1.5 months after acute infection. Patients were divided into two groups of higher symptom burden of long COVID and those with milder symptoms based on demographic, laboratory, and clinical data as well as type I IFN-inducible gene expression (MX-1, IFIT-1, and IFI-44) measured in peripheral blood by real-time PCR. Data collected during acute infection were recorded. Peripheral blood samples were collected during the acute phase of infection, within the first 48 h of hospital admission. IFN-inducible gene expression was measured prospectively at that time, and RNA was extracted immediately for subsequent analysis. Results: History of intubation emerged as a significant associated factor of severe long COVID, with 75% of intubated patients reporting >8 persistent symptoms approximately 16 months post-infection. Higher white blood cell (WBC) and neutrophil counts but lower eosinophil and monocyte counts in acute infection were found to be associated with a high burden of long COVID symptoms. Interestingly, absolute monocyte count was found to independently correlate with higher long COVID symptom burden. Lactate dehydrogenase (LDH) and serum glutamic-oxaloacetic transaminase (SGOT) also differed significantly between groups, with higher levels correlating with a high burden of long COVID symptoms. Notably, MX-1 transcript levels in peripheral blood at the time of acute infection were reduced in patients with a high burden of long COVID symptoms, suggesting that dysregulated immune responses during the acute phase may contribute to persistent symptoms. Conclusions: These findings suggest the potential association of hematological and immune markers with long COVID severity, as well as the importance of monitoring these parameters to identify at-risk patients for early interventions. Full article

The COVID-19 pandemic has profoundly influenced healthcare systems and infection control worldwide, with important implications for the epidemiology of antimicrobial resistance. This study examined the prevalence and characteristics of carbapenem-resistant Enterobacterales (CRE) isolates in Southeastern Austria from 2018 to 2022 to assess potential pandemic-related effects. A total of 63 isolates were analyzed using phenotypic and molecular methods, including carbapenemase detection, genotyping, and multilocus sequence typing. The number of CRE isolates appeared to decline during the pandemic years (2021–2022) compared to the pre-pandemic period, with Enterobacter cloacae notably detected in both full pandemic years. Carbapenemase-producing CRE accounted for 44 out of the 63 isolates (69.8%), with metallo-beta-lactamases (VIM-1 and NDM-1) and OXA-48-like carbapenemases predominating. Resistance mechanisms not based on carbapenemase production were more common before the pandemic but rarely detected thereafter. To our knowledge, this is the first report of dual-carbapenemase-producing CRE isolates in Austria. Multi-locus-sequence typing indicated limited nosocomial transmission, with most isolates representing independent introductions linked to external sources. The decline in CRE prevalence may reflect reduced international travel and healthcare access during the pandemic, which could have limited the importation of resistant strains. These findings reflect the potential role of global mobility in the spread of CRE and illustrate how public health interventions can shape antimicrobial resistance trends. Full article

Objective: To identify facilitating and hindering factors for implementing a care transition strategy for adult patients undergoing elective colorectal cancer surgery, within a primary health care (PHC) context, addressing gaps in the literature on implementation challenges and contextual factors influencing such strategies. Methods: This complex mixed methods study combined a randomized clinical trial (RCT) and a qualitative component within an Implementation Research framework. The RCT enrolled adult patients with colorectal cancer, while the qualitative phase included a multilevel sample of participants. Iterative data integration occurred throughout the planning, implementation, and evaluation phases. The intervention was assessed using the RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) framework. Statistical analyses were conducted using IBM SPSS Statistics 22.0, applying descriptive and inferential methods. Results: Our findings revealed that the adoption of the intervention was satisfactory; however, Reach, Efficacy, and Implementation were not achieved. Facilitating factors included recognition of the potential of the care transition strategy to improve patient outcomes, and the intervention’s feasibility, replicability, and low cost. The main hindering factors identified included poor communication between care levels, inadequate material resources, and high workload. Integration of qualitative insights helped explain the limited quantitative impact, highlighting contextual challenges during the COVID-19 pandemic. Conclusions: The care transition strategy was well accepted by participants and health care providers, demonstrating potential to strengthen continuity of care between hospital and PHC services. Nonetheless, significant organizational and resource-related barriers hindered its effectiveness. Future studies are required to adapt transitional care models to overcome communication gaps, optimize resource allocation, and enhance implementation in similar settings. Full article