Search Results (28,566)

There is a paucity of evidence informing our understanding of how the COVID-19 pandemic affected pediatric trauma in Manitoba, Canada. The aim of this retrospective cohort study was to analyze the effect of the pandemic on pediatric trauma and its association with patients’ demographic characteristics. Pre-pandemic and pandemic patient cohorts were created, and the rates of these injuries were compared by patients’ sex, age, and area of residence. During the pre-pandemic period, ED presentations with an MSK or head injury were lower in patients from rural communities compared to urban communities (RR: 0.68, p < 0.001, RR: 0.51, p < 0.001). Hospitalizations with an MSK or head injury were higher in patients from rural communities (RR: 1.78, p < 0.001, RR: 1.14, p = 0.62). During the pandemic, MSK injury ED presentations (RR: 1.14, p = 0.037) and hospitalizations (RR: 1.78, p < 0.001) were higher in patients from rural communities. Patients from rural communities had a lower rate of head injury ED presentations (RR: 0.81, p < 0.001), but higher hospitalization rate (RR:1.96, p = 0.001). Differences in the rates of pediatric MSK and head injuries could be attributed to the limited healthcare resources in underserved rural communities. Efforts should be made to rectify these inequities to ensure fair access to healthcare for these patients. Full article

Background: The COVID-19 pandemic substantially altered the epidemiology of respiratory infections. Its impact on the clinical course of influenza in hospitalised children remains insufficiently characterised. Objectives: We aimed to compare the clinical course, complications, and selected laboratory parameters of influenza in children before, during, and after the COVID-19 pandemic. Methods: This single-centre retrospective study included 553 children hospitalised with laboratory-confirmed influenza between September 2017 and August 2025. Patients were divided into three groups: pre-pandemic, pandemic, and post-pandemic. Clinical complications and inflammatory markers (CRP, PCT, neutrophil counts) were analysed. Results: Influenza-related complications occurred in 59.5% of patients and were significantly more frequent after the pandemic compared to the pre-pandemic period (64.3% vs. 52.9%, p = 0.02). Pneumonia was the most common complication across all groups, but its incidence was lowest during the pandemic. Myositis occurred most frequently during the pandemic and appears to coincide with a higher proportion of influenza B infections. No significant differences were observed in CRP, PCT concentrations, or neutropenia rates between groups. Conclusions: The COVID-19 pandemic influenced the clinical presentation of influenza in children, with a post-pandemic increase in complications. These findings may reflect delayed access to healthcare and the phenomenon of immunity debt, highlighting the need for continued surveillance and preventive strategies. Full article

This paper analyzes the impact of COVID-19 on the supply chain and production, investigating countermeasures for industrial recovery. In particular, the study examines how COVID-19 has affected the raw material supply chain, production, and outages on a real case study, that is, Turkey’s Glass-Reinforced Plastic (GRP) pipe industry. Using two- and three-way analysis of variance (ANOVA), significant negative impacts on the raw material supply chain are identified with 95% confidence. To enhance decision-making, the fuzzy q-rung orthopair set (FQROPS) and entropy-based multi-criteria decision-making (MCDM) methods are integrated in the baseline method. Specifically, ANOVA-identified factors, such as cost, supply continuity, production capacity, and risk level, are used as criteria in the MCDM analysis. Entropy determined criteria weights and FQROPS evaluate alternatives based on their proximity to the ideal solution. Findings show that significant disruptions occurred due to the pandemic. In addition, the MCDM analysis reveals that pre-pandemic conditions for key materials, such as fiberglass and resin, were significantly more favorable in terms of cost, supply continuity, production capacity, and risk levels. This integrated approach provides strategic insights for managing supply chains and production in the GRP pipe industry during and after pandemic events. Full article

Introduction: The COVID-19 pandemic had significant effects on mental health and lifestyle behaviours, especially among university students who experienced academic disruptions, social isolation, and fewer social interactions. Alcohol consumption has long been part of student culture. Still, the influence of post-pandemic academic reintegration on drinking patterns and psychological distress remains relatively unexplored, particularly in countries like Portugal, where student traditions heavily shape consumption habits. This study aimed to describe the prevalence of alcohol consumption, depression, anxiety, and stress in a sample of Portuguese university students during the post-pandemic academic period, and to explore associations with sociodemographic variables. Methods: A cross-sectional study was conducted in November 2021 with 90 students from a private higher education institution in northern Portugal. Data were collected via an online questionnaire including sociodemographic information, the Alcohol Use Disorders Identification Test (AUDIT), and the Depression, Anxiety and Stress Scale (DASS-21). Result: The majority of the participants were not at risk of alcohol addiction (95.3%). In total, 15.1% of students reported anxiety symptoms ranging from severe to extremely severe. A binomial logistic regression was performed to ascertain the effects of being away from home and psychological distress (DASS-42 score), on the likelihood that participants were at risk of alcohol addiction (Level 3 and 4 in the AUDIT scale). The logistic regression model was statistically significant, χ²(2) = 9.20, p = 0.010. Living away from home was associated with a substantially lower likelihood of high-risk status (B = −2.79, p = 0.034), corresponding to an odds ratio of 0.06, indicating a strong protective effect. DASS-42 total score was positively associated with high-risk status (B = 0.04, p = 0.039), such that higher psychological distress increased the odds of being classified as high risk. Conclusions: The findings reveal a low prevalence of alcohol risk but heightened symptoms of anxiety, depression, and stress. Psychological distress notably increases the likelihood of hazardous alcohol use, emphasising the importance of targeted mental health and alcohol-use interventions among university students. Full article

The COVID-19 outbreak has made it evident that the nature and behavior of SARS-CoV-2 requires constant research and surveillance, owing to the high mutation rates that lead to variants. This work focuses on the statistical analysis of energy measures as biomarkers of SARS-CoV-2. The main purpose of this study is to determine which energy measure can differentiate between SARS-CoV-2 variants, human cell receptors (GRP78 and ACE2), and their combinations. The dataset includes energy measures for different biological structures categorized by variants, receptors, and combinations, representing the sequence of variants and receptors. A multiple analysis of variance (ANOVA) test for equality of means and a Bartlett test for equality of variances are applied to energy measures. Results from multiple ANOVA show (a) the presence of significant differences in energy across variants, receptors, and combinations, (b) that average energy is significant only for receptors and combinations, but not for variants, and (c) the absence of significant differences observed for standard deviation across variants or combinations, but that there are significant differences across receptors. The results from the Bartlett tests show that (a) there is a presence of significant differences in the variances in energy across the variants and combinations, but no significant differences across receptors, (b) there is an absence of significant differences in variances across any group (variants, receptors, combinations), and (c) there is an absence of significant differences in variances for standard deviation of energy across variants, receptors, or combinations. In summary, it is concluded that energy and mean energy are the key biomarkers used to differentiate receptors and combinations. In addition, energy is the primary biomarker where variances differ across variants and combinations. These findings can help to implement tailored interventions, address the SARS-CoV-2 issue, and contribute considerably to the global fight against the pandemic. Full article

The COVID-19 pandemic led to an unprecedented slowdown in global economic and transportation activities, offering a unique opportunity to assess the relationship between human activity and atmospheric pollution. This study analyzes global variations in major air pollutants and meteorological conditions during the pandemic period using multi-satellite and reanalysis datasets. Nitrogen dioxide (NO₂) data were obtained from the OMI sensor aboard NASA’s Aura satellite, while carbon monoxide (CO) observations were taken from the MOPITT instrument on Terra. Reanalysis products from MERRA-2 were used to assess CO, sulfur dioxide (SO₂), black carbon (BC), organic carbon (OC), and key meteorological variables, including temperature, precipitation, evaporation, wind speed, and direction. Average concentrations of pollutants for April, May, and June 2020, representing the lockdown phase, were compared with the average values of the same months during 2017–2019, representing pre-pandemic conditions. The difference between these multi-year means was used to quantify spatial changes in pollutant levels. Results reveal widespread reductions in NO₂, CO, SO₂, and BC concentrations across major industrial and urban regions worldwide, consistent with decreased anthropogenic activity during lockdowns. Meteorological analysis indicates that the observed reductions were not primarily driven by short-term weather variability, confirming that the declines are largely attributable to reduced emissions. Unlike most previous studies, which examined local or regional air-quality changes, this work provides a consistent global-scale assessment using harmonized multi-sensor datasets and uniform temporal baselines. These findings highlight the strong influence of human activities on atmospheric composition and demonstrate how large-scale behavioral and economic shifts can rapidly alter air quality on a global scale. The results also provide valuable baseline information for understanding emission–climate interactions and for guiding post-pandemic strategies aimed at sustainable air-quality management. Full article

Background: Post-COVID-19 syndrome (PCS) is defined as the persistence or development of new symptoms 3 months after the initial infection with the SARS-CoV-2 virus, these clinical aspects being most often associated with functional respiratory changes, as well as imagistic modifications. This study aimed to evaluate longitudinal changes in pulmonary function among patients with PCS, in relation to the severity of the acute COVID-19 episode and the time elapsed since infection. Methods: A retrospective, observational study was conducted at the Clinical Hospital of Pulmonary Diseases Iași, Romania, between January 2021 and December 2022, including 97 adult patients with confirmed PCS. Demographic, clinical, and functional data were collected from medical records. Pulmonary function tests (PFTs) were performed according to ATS/ERS standards, assessing Forced Vital Capacity (FVC), Forced Expiratory Volume in the First Second (FEV₁), FEV₁/FVC ratio (Tiffeneau Index), Maximal Expiratory Flow at 50% and 25% of FVC (MEF50, MEF25), Diffusing Capacity of the Lung for Carbon Monoxide (adjusted for haemoglobin) (DLCO), Carbon Monoxide Transfer Coefficient (KCO), Alveolar Volume (AV), Total Lung Capacity (TLC) and Residual Volume (RV). Patients were grouped by time elapsed since infection (1–3, 4–7, 9–12, and up to 22 months). Statistical analyses included the Mann–Whitney U test, Spearman’s correlation, ROC curve analysis, and Principal Component Analysis (PCA). Results: A progressive improvement in FVC was observed up to 9–18 months post-infection (p < 0.05), while FEV₁ remained stable, suggesting a predominantly restrictive ventilatory pattern. Patients with moderate acute COVID-19 presented significantly lower FVC%, FEV₁%, DLCO%, and KCO% values compared with those with mild disease (p < 0.05). Diffusion abnormalities (DLCO and KCO) persisted beyond 12 months, indicating lasting alveolar-capillary impairment. ROC analysis identified TLC (AUC = 0.857), AV (AUC = 0.855), and KCO (AUC = 0.805) as the most discriminative parameters for residual dysfunction. PCA revealed three major functional domains—airflow limitation, diffusion capacity, and lung volume—explaining up to 70% of total variance. Conclusions: We are facing the emergence of a new phenomenon, namely a secondary post-COVID-19 pandemic of patients confronting with persistent post-COVID-19 symptoms who present with functional respiratory changes and who require careful monitoring in dynamics, personalized treatments and a multidisciplinary approach. Full article

Mathematical models for infectious diseases, particularly autonomous ODE models, are generally known to possess simple dynamics, often converging to stable disease-free or endemic equilibria. This paper investigates the dynamic consequences of a crucial, yet often overlooked, component of pandemic response: the saturation of public health testing. We extend the standard SIR model to include compartments for ‘Confirmed’ (C) and ‘Monitored’ (M) individuals, resulting in a new SICMR model. By fitting the model to U.S. COVID-19 pandemic data (specifically the Omicron wave of late 2021), we demonstrate that capacity constraints in testing destabilize the testing-free endemic equilibrium ($E_1$). This equilibrium becomes an unstable saddle-focus. The instability is driven by a sociological feedback loop, where the rise in confirmed cases drive testing effort, modeled by a nonlinear Holling Type II functional response. We explicitly verify that the eigenvalues for the best-fit model satisfy the Shilnikov condition (${\lambda }_u>{\lambda }_s$), demonstrating the system possesses the necessary ingredients for complex, chaotic-like dynamics. Furthermore, we employ Stochastic Differential Equations (SDEs) to show that intrinsic noise interacts with this instability to generate ’noise-induced bursting,’ replicating the complex wave-like patterns observed in empirical data. Our results suggest that public health interventions, such as testing, are not merely passive controls but active dynamical variables that can fundamentally alter the qualitative stability of an epidemic. Full article

Background: Depression and eating disorders (EDs) represent significant and often multiple public health concerns. Healthcare workers, including medical residents, were affected by several stressors that the COVID-19 pandemic has engendered and amplified, potentially exacerbating mental health issues. Despite this, limited evidence is available regarding the association between depressive symptoms and possible EDs among Public Health Residents (PHRs). Methods: A nationwide cross-sectional study, the ‘Public Health Residents Anonymous Survey in Italy (PHRASI),’ was conducted between June and July 2022. A total of 379 PHRs participated in this study, filling in a self-administered questionnaire which included the PHQ-9 for assessing depressive symptoms and the SCOFF (Sick, Control, One, Fat, Food) test as a screening tool for possible EDs. Multivariable logistic regression evaluated associations between sociodemographic and training/work-related factors, depressive symptoms, and EDs. Results: Overall, 40.6% of respondents screened positive for possible EDs. Depressive symptoms had a positive association with possible EDs (aOR = 2.76; 95% CI = 1.55–4.93). Other factors associated with higher ED odds included region of residence (aOR = 1.92; 95% CI = 1.06–3.47), intention to repeat the test for another postgraduate course (aOR = 3.22; 95% CI = 1.25–8.3), and working more than 40 h per week (aOR = 1.91; 95% CI = 1.19–3.07). Conversely, having more than one child (aOR = 0.32; 95% CI = 0.13–0.78) was associated with lower odds. Conclusions: The findings highlight a significant association between depressive symptoms and positive screening for possible EDs, underscoring the need for integrated mental health support and preventive interventions within medical residency programmes, especially in the context of public health crises. Full article

The COVID-19 pandemic exacerbated structural, social, economic, and racial inequalities affecting immigrant, refugee, and asylum-seeking men—vulnerable populations often overlooked in men’s health research. This study investigated the health conditions of immigrant, refugee, and asylum-seeking men during the COVID-19 pandemic. A scoping review was conducted following Joanna Briggs Institute guidance, and a qualitative lexical analysis (text-mining of standardized study syntheses) was performed in IRaMuTeQ using similarity analysis, descending hierarchical classification, and factorial correspondence analysis. We identified 93 studies published between 2020 and 2023 across 35 countries. The evidence highlighted vaccine hesitancy, high epidemiological risks (infection, hospitalization, and mortality), barriers to accessing services and information, socioeconomic vulnerabilities, psychological distress (e.g., anxiety and depression), and structural inequalities. Findings were synthesized into four integrated thematic categories emphasizing the role of gender constructs in help-seeking and gaps in governmental responses. Most studies focused on immigrants, with limited evidence on refugees and especially asylum seekers; therefore, conclusions should be interpreted cautiously for these groups. Overall, the review underscores the urgency of multisectoral interventions, universal access to healthcare regardless of migration status, culturally and linguistically appropriate outreach, and gender-sensitive primary care strategies to support inclusive and resilient health systems. Full article

Background/Objectives: Public healthcare workers face significant occupational stress during crisis situations, yet research on this particular population remains limited compared to other healthcare workers. The aim of this study was to investigate the impact of the COVID-19 pandemic on distress levels and the sense of coherence among public health workers by integrating psychological assessments with physiological markers of stress to identify protective factors against pandemic-related occupational stress. Methods: This longitudinal study was conducted at the Teaching Public Health Institute of Split and Dalmatia County from July 2021 to February 2022 at two time points: the latency phase (between COVID-19 waves) and hyperarousal phase (during an active wave). Fifty-four public health workers participated in the study. There were three questionnaires assessing psychological distress: Kessler Psychological Distress Scale, Impact of Events Scale—Revised and Sense of Coherence Scale-29. Salivary and blood samples were collected at both time points to measure cortisol levels, cortisol awakening response, and interleukin-6 concentrations. Results: The cortisol area under the curve with respect to ground (AUCg) was significantly elevated during the stress phase compared to the latency phase (234.8 vs. 201.8; p = 0.023), indicating heightened physiological stress responses. Epidemiologists demonstrated significantly lower sense of coherence scores compared to non-epidemiologists (117.9 ± 9.1 vs. 125.6 ± 10.5; p = 0.029). A lower sense of coherence was significantly associated with higher psychological distress and post-traumatic stress symptoms. Multiple linear regression analysis revealed that sense of coherence and interleukin-6 levels were significant independent predictors of cortisol changes. Conclusions: The findings demonstrate that public health workers experience measurable physiological stress responses during pandemic peaks, with sense of coherence emerging as a protective psychological factor. Interventions targeting sense of coherence and organizational support may possibly enhance resilience and reduce mental health morbidity in this vulnerable workforce during crisis situations. Full article

Background/Objectives: Post-COVID-19 pulmonary fibrosis (PCPF) and idiopathic pulmonary fibrosis (IPF) exhibit significant clinical and pathophysiological overlap, suggesting convergent molecular pathways driving fibrosis. This prospective longitudinal study investigates the sustained dysregulation of matrix metalloproteinases (MMP)-2 and MMP-9 and its relationship with evolving systemic inflammation and endothelial dysfunction in convalescent COVID-19 patients, with comparative analysis to IPF. Methods: We conducted a prospective observational study of 86 patients at 6 and 12 months post-SARS-CoV-2 infection, stratified by high-resolution CT evidence of PCPF (FB+ group, n = 32) or absence of fibrosis (FB− group, n = 54). Gene expression of MMP-2 and MMP-9 in peripheral blood leukocytes and circulating levels of MMP-2, MMP-9, pro-inflammatory cytokines (TNF-α, IL-6), and endothelial dysfunction markers (Endothelin-1 [ET-1], adhesion molecules) were quantified via qRT-PCR and ELISA. A pre-pandemic healthy control group (HD, n = 20) and an IPF patient group (n = 10) served as comparators. Results: A significant, sustained elevation of MMP-2 and MMP-9 was observed in all post-COVID-19 patients versus HDs, most pronounced in the FB+ group and qualitatively similar to IPF. A critical divergence emerged: FB− patients showed resolution of systemic inflammation (reduced TNF-α, IL-6), whereas FB+ patients exhibited persistent cytokine elevation. Critically, a delayed, severe endothelial dysfunction, characterized by a profound surge in ET-1 and elevated adhesion molecules, manifested exclusively in the FB+ cohort at 12 months. Positive correlations linked plasma MMP-2/9 levels with ET-1 (r_s = 0.65, p = 0.004; r_s = 0.49, p = 0.009) and ET-1 with sICAM-1 (r_s = 0.68, p = 0.01). Conclusions: The development of PCPF is associated with a distinct pathogenic triad: sustained MMP dysregulation, failure to resolve inflammation, and severe late-phase endothelial dysfunction. The correlative links between these components suggest a self-reinforcing loop. This systemic signature mirrors patterns in IPF, underscoring shared final pathways in fibrotic lung disease and identifying the MMP–inflammation–endothelial axis as a promising target for biomarker development and therapeutic intervention. Full article

Excess commuting reflects the inefficiency of urban land resource allocation, generating additional greenhouse gas emissions and social costs, and has therefore become a central concern in the pursuit of sustainable cities. While exogenous shocks inevitably alter the efficiency of land resource allocation, it remains unclear how such shocks affect overall urban efficiency. To address this gap, this paper proposes a generalized framework for measuring excess commuting that accounts for imbalances between the numbers of jobs and residences. Drawing on mobile signaling big data, we trace the daily commuting patterns of more than 900,000 residents in Beijing, comparing the pre-pandemic period (March–October 2019) with the pandemic period (March–October 2020). The results show that: (1) Excess commuting increased significantly after the outbreak of COVID-19, with the observed average commuting distance (Tact) of the full sample rising from 6267 m to 10,058 m (an increase of 59%), indicating a decline in urban land resource allocation efficiency; (2) A more pronounced center-periphery pattern emerged at the metropolitan scale: the average Jobs–Housing Ratio (JHR) increased from 1.08 to 1.11, and its standard deviation rose from 0.54 to 0.70, with the JHR of central urban areas decreasing by 3% and that of suburban areas increasing by 20%—suggesting a marked increase in commuting distances; (3) Heterogeneous impacts were observed across age groups: the Difference-in-Differences (DID) regression confirmed a significant negative interaction term (Group × COVID-19 = −0.2991 **, p < 0.05), indicating that older adults experienced a greater increase in commuting inefficiency than younger adults. These findings reveal the dynamic mechanisms linking exogenous shocks, jobs–housing mismatch, and urban land resource allocation efficiency and provide policy implications for improving spatial resource allocation in the post-pandemic era. Full article

Vaccination has been a cornerstone of the public health response to the COVID-19 pandemic, particularly in protecting older and frail populations. A detailed characterization of antibody titer dynamics and their determinants represents a crucial step toward optimizing vaccination strategies. However, antibody titers are bounded within assay-specific limited intervals and often display skewness and intra-subject correlation, which limit the suitability of conventional modeling approaches. We analyzed longitudinal antibody titer data from 608 residents and staff members of five nursing homes in Calabria (southern Italy) using beta-generalized linear mixed models (β-GLMMs). This framework enabled simultaneous modeling of the mean humoral response (μ), precision parameter (ϕ), and probability of achieving the maximum immune response (α), thereby providing a comprehensive assessment of factors influencing immune dynamics. Two distinct patterns of antibody titer evolution were identified. Among nursing home residents, stroke was associated with higher antibody concentrations, whereas atrial fibrillation, lower body mass index, non-Alzheimer’s dementia, and chronic obstructive pulmonary disease were linked to reduced responses. The β-GLMM approach allowed for a more accurate identification of demographic and clinical determinants compared with traditional methods. These findings underscore the utility of β-GLMMs for analyzing bounded longitudinal immunological data and highlight key factors shaping vaccine-induced immunity. Such insights may lead to more tailored immunization strategies in vulnerable older populations. Full article