Search Results (1,750)

Previous studies about the COVID-19 pandemic on STEMI patient outcomes have conflicting results. It remains unclear if this may be attributed to regional differences and/or differences during COVID-19 wave periods. Using the American Heart Association Get With The Guidelines–Coronary Artery Disease registry data, we evaluated (1) time metrics related to STEMI system goals and (2) regional variation in STEMI incidence and in-hospital mortality during pandemic wave time periods. The study included all patients 18–100 years old admitted with STEMI (n = 72,516) to 1 of 435 American Heart Association Get With The Guidelines–Coronary Artery Disease hospitals (1 October 2019–31 December 2021). Of these, 70.8% were male and 73.0% non-Hispanic White, with a median age of 63 (IQR 18) years. Compared to pre-pandemic time frames, patients with STEMI had a higher risk profile, delayed time to treatment, were treated with fibrinolytic therapy or primary PCI, and were transferred for primary PCI at similar rates, and had higher adjusted in-hospital mortality (during the second wave in the South and Midwest). Preservation of STEMI systems of care resulted in an overall lower in-hospital mortality rate than predicted, although opportunities exist to improve treatment delays. Regional differences in mortality rates require further study. Full article

Food security is defined as a state in which all people at all times have both physical and economic access to sufficient food to meet their dietary needs for a productive and healthy life. The general objective of this work was to assess the situation of food insecurity and its impact on the quantity and quality of food consumption during lockdown in the first wave of the COVID-19 pandemic and to identify the determinants associated with the different food insecurity (FI) categories on a sample of 2227 people (1168 people from Spain and 1059 people from Morocco). Food insecurity (FI) assessed by the Household Food Insecurity Access Scale (HFIAS) were compared in both countries, controlling for the effect of sociodemographic variables, age, gender, marital status, and education level. The mean HFIAS was 0.53 in the Spanish and 3.55 in the Moroccan samples (p < 0.001). Only 2.1% of the Spanish sample were in a situation of severe insecurity against 15.5% in Morocco (p < 0.001). Moroccans with moderate and severe food insecurity decreased their consumption of meat, fish, eggs, nuts, legumes, and fruits. The risk of food insecurity was higher in men than in women, in separated or divorced people, in people with secondary and middle education, and in younger people. Full article

The COVID-19 pandemic has significantly impacted global health, with pulmonary embolism (PE) emerging as a critical complication due to the hypercoagulable state induced by SARS-CoV-2 infection. Despite advancements in prevention and treatment, PE remains a major cause of morbidity and mortality in COVID-19 patients. This study analyzes the trends, outcomes, and contributing factors of PE across ten pandemic waves in Romania, highlighting the evolving clinical burden and management approaches. This retrospective observational study was conducted on confirmed COVID-19 patients that also developed PE, who were admitted to “Victor Babeș” Hospital and Municipal Emergency Hospital in Timișoara, Romania. Data on demographics, clinical features, inflammatory markers, comorbidities, and treatment were collected from medical records. Statistical analyses, including ANOVA and Kaplan–Meier survival analysis, were conducted to evaluate trends and survival outcomes over time. The study included 166 patients, with a mean age of 67.26 ± 13.57 years. Mortality peaked at 50% in Wave 1, declined to 12% in Wave 7, and increased again to 28% in Wave 10. Intubation rates varied, with a high of 29% in Wave 6 and a low of 12% in Wave 8. Lung involvement was the most severe in Wave 4 (mean 0.54 ± 0.18) but improved in later waves, reaching a mean of 0.24 ± 0.12 in Wave 8. This study highlights the dynamic trends in PE during the COVID-19 pandemic in Romania. Improved clinical management, vaccination, and adaptive healthcare strategies contributed to better outcomes in later waves. Full article

The COVID-19 pandemic exposed the urgent need for scalable, reliable telemedicine tools to manage mild cases remotely and avoid overburdening healthcare systems. This study evaluates StepCare, a remote monitoring medical device, during the first pandemic wave at a single center in Spain. Among 35 patients monitored, StepCare showed high clinical reliability, aligning with physician assessments in 90.4% of cases. Patients and clinicians reported excellent usability and satisfaction. The system improved workflow efficiency, reducing triage time by 25% and associated costs by 84%. These results highlight StepCare’s value as a scalable, patient-centered solution for remote care during health crises. Full article

The objective of this paper is to analyse profitability and risk through the return on equity (ROE) measure of the open economy insurance sector in a non-stable economic period with an economic shock chain, during the years 2018–2022, characterised by an overheating economy, the Covid pandemic, the war in Ukraine, and a high-inflation wave. The ROE pyramid decomposition structure is proposed, along with the detailed CARAMEL version. A static and risk (dynamic) decomposition deviation analysis is used. The yearly non-stable drivers of insurance sector profitability deviation were confirmed. Despite this, the most influential were the earnings ratio deviations in either increasing or decreasing ROE alternatives. Solvency positively influenced the ROE deviation. It turned out that earnings and asset quality enormously increase the risk of the insurance sector. Conversely, risk is decreased mainly by liquidity and management. Simultaneously, significant, influential factors were identified. The results can serve as a background for carrying out operations, strategic analysis, and decision-making. Full article

Background: In just twenty years, three dangerous human coronaviruses—SARS-CoV, MERS-CoV, and SARS-CoV-2 have exposed critical gaps in early detection of emerging viral threats. Current diagnostics remain pathogen-focused, often missing the earliest phase of infection. A virus-agnostic, host-based diagnostic capable of detecting responses to viral intrusion is urgently needed. Methods: We hypothesized that the lungs act as biomechanical instruments, with infection altering tissue tension, wave propagation, and flow dynamics in ways detectable through subaudible vibroacoustic signals. In a matched case–control study, we enrolled 19 RT-PCR-confirmed COVID-19 inpatients and 16 matched controls across two Johns Hopkins hospitals. Multimodal data were collected, including passive vibroacoustic auscultation, lung ultrasound, peak expiratory flow, and laboratory markers. Machine learning models were trained to identify host-response biosignatures from anterior chest recordings. Results: 19 COVID-19 inpatients and 16 matched controls (mean BMI 32.4 kg/m², mean age 48.6 years) were successfully enrolled to the study. The top-performing, unoptimized, vibroacoustic-only model achieved an AUC of 0.84 (95% CI: 0.67–0.92). The host-covariate optimized model achieved an AUC of 1.0 (95% CI: 0.94–1.0), with 100% sensitivity (95% CI: 82–100%) and 99.6% specificity (95% CI: 85–100%). Vibroacoustic data from the anterior chest alone reliably distinguished COVID-19 cases from controls. Conclusions: This proof-of-concept study demonstrates that passive, noninvasive vibroacoustic biosignatures can detect host response to viral infection in a hospitalized population and supports further testing of this modality in broader populations. These findings support the development of scalable, host-based diagnostics to enable early, agnostic detection of future pandemic threats (ClinicalTrials.gov number: NCT04556149). Full article

(1) Background: Patients admitted for gastrointestinal bleeding (GIB) who are diagnosed with COVID-19 at presentation may face significant therapeutic challenges. The delicate balance between the use of anticoagulant and anti-inflammatory therapy to address COVID-19 and hemostasis targets can, in turn, lead to delays in COVID-19 treatment until bleeding is controlled. The published systematic reviews and meta-analyses that were reviewed included patients with both GIB and COVID-19 regardless of GIB presence at admission, and a separate analysis of patients admitted for GIB and tested for COVID-19 infection during hospitalization was not performed. (2) Methods: PubMed, Web of Science, and Scopus databases were used to access articles published from 1 December 2019 to 20 December 2024. Retrospective studies involving human subjects with GIB and COVID-19 were included in the final analysis. The exclusion criteria were as follows: pediatric population studies; the absence of a GIB control group; reviews, conference abstracts, expert opinions, and letters. The risk of bias in the included studies was assessed using the rank correlation test and Begg’s and Egger’s regression tests. We estimated the outcomes using the pooled odds ratio (OR) and the 95% confidence interval (95% CI). (3) Results: Seven studies, which included 3291 patients admitted for GIB who tested positive for COVID-19 infection, were included in our systematic review; four studies with a control group of patients with GIB but without COVID-19 infection were included in our meta-analysis. The odds of mortality among COVID-19-infected patients admitted for GIB were 3.80. There was heterogeneity regarding the site of GIB (some studies included all forms of GIB, others included only UGIB) and the study period (most studies included only patients from the first pandemic wave, and only one study reported cases from the first 2 years of the pandemic, including the delta pandemic wave). (4) Conclusions: COVID-19 infection in patients admitted for GIB was associated with a higher overall mortality rate. Full article

Background/Objectives: The COVID-19 pandemic has had a profound impact on the mental health of the general population, particularly older adults. This study aimed to explore the association between loneliness and mental health disorders in this demographic during the pandemic. Methods: A cross-sectional survey was conducted in Portugal using data from the Survey of Health, Ageing and Retirement in Europe (SHARE) database between June and August 2020, during the COVID-19 pandemic (Wave 8 COVID-19 Survey), using computer-assisted telephone interviews. Results: The final sample included 836 participants, with 387 (46.4%) men and a mean age of 74.5 years (SD = 6.7). Mental health indicators revealed that 441 (52.1%) reported feelings of nervousness, 384 (45.3%) experienced sadness or depression, 349 (41.2%) encountered sleeping difficulties, and 280 (33.1%) reported experiencing loneliness often or some of the time. Increased feelings of loneliness were notably associated with women in poorer health, those with heightened fear of falling, dizziness, fatigue, anxiety, depression, and concurrent health and sleep issues. Age and medication use did not significantly impact feelings of loneliness. Conclusions: The findings highlight a potential association between adverse mental health outcomes among older adults during the initial phase of the pandemic. Future research, employing longitudinal research designs, is warranted to explore these relationships more rigorously, in a post-pandemic context, and to inform effective intervention development and strategies to prevent mental health problems within this vulnerable population. Full article

This study examines the relationship between K-Pop and education migration to South Korea in the context of the global internet and the COVID-19 pandemic. It focuses on the phenomenon in which local Asian territories have been widely influenced by the Korean Wave, particularly K-Pop, even during the era of global communication and health risks. This research illuminates some intriguing aspects of the distinctive reception patterns of Korean Wave audiences, as well as their unique characteristics, such as innocence, transgression, and the nuanced dynamics of the fandom during that period. Furthermore, this research engages critically with controversial aspects of cultural politics, such as the transmission of the legacy of K-Pop and the centralisation of femininity more actively. This study concludes that K-Pop has recently been relocated to the conjunctures of mediated and overdetermined influences on students’ education migration to South Korea rather than acting as a direct power and reason for it, particularly in the context of the COVID-19 pandemic and the rapid digitalisation of education. Full article

COVID-19 mortality is a complex phenomenon influenced by multiple factors. This study aimed to identify factors associated with death in COVID-19 patients by considering clinical, demographic, environmental, and socioeconomic conditions, using machine learning models and a national dataset from Mexico covering all pandemic waves. We integrated data from the national COVID-19 dataset, municipal-level socioeconomic indicators, and water quality contaminants (physicochemical and microbiological). Patients were assigned to one of four datasets (groundwater, lentic, lotic, and coastal) based on their municipality of residence. We trained XGBoost models to predict patient death or survival on balanced subsets of each dataset. Hyperparameters were optimized using a grid search and cross-validation, and feature importance was analyzed using SHAP values, point-biserial correlation, and XGBoost metrics. The models achieved strong predictive performance (F1 score > 0.97). Key risk factors included older age (≥50 years), pneumonia, intubation, obesity, diabetes, hypertension, and chronic kidney disease, while outpatient status, younger age (<40 years), contact with a confirmed case, and care in private medical units were associated with survival. Female sex showed a protective trend. Higher socioeconomic levels appeared protective, whereas lower levels increased risk. Water quality contaminants (e.g., manganese, hardness, fluoride, dissolved oxygen, fecal coliforms) ranked among the top 30 features, suggesting an association between environmental factors and COVID-19 mortality. Full article

Background and Objectives: The COVID-19 pandemic affected children’s lifestyle, due to strict lockdown restrictions. This study evaluated Romanian children’s lifestyle prior to and during the pandemic and their associated factors. Materials and Methods: A longitudinal study was performed in 7 urban schools from Romania. Data were gathered at baseline (T1), from October to November 2019, and follow-up (T2), from December 2020 to February 2021. Results: A total of 880 children were enrolled at baseline, 484 at T2, and 350 in both evaluations. Initially, 66.3% did not perform at least one hour of physical activity per day, two thirds did not sleep at least 9 h per night during the week, and more than one third used the internet more than 2 h daily. Investigating changes before and during COVID-19 among students participating at both evaluations, a statistically significant drop in physical activity and sleep time during the week was recorded, while weekend sleep and internet use increased. Several gender- and age-related differences were noted. Physical activity and sleep patterns as well as internet use behavior at T1 predicted the same behavior at T2. Reduced sleep during the week and internet overuse were positively associated at both waves as well as longitudinally. Conclusions: These findings highlight calls for combined strategies that include parents, schools, and community, aiming to enhance a healthier lifestyle among children. Full article

Background: Dental professionals were thought to have the most significant risk of coronavirus infection during the pandemic. Since the first Coronavirus Disease 2019 (COVID-19) patient was detected in Japan in January 2020, Japan has faced several waves of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections. However, no cluster of SARS-CoV-2 infections associated with dental procedures has been reported in Japan. In this study, we aimed to investigate the actual status of SARS-CoV-2 infection during the pandemic through antibody testing for dental professionals. We further investigated saliva and oral management-related aerosol to estimate the risk of virus transmission during dental procedures. Methods: SARS-CoV-2 antibody titer in the blood of dental professionals and their families was determined during the pre-vaccinated period of the SARS-CoV-2 wave to see the history of infection in Japan. Viral loads in saliva and in the aerosol generated during the oral management of COVID-19 patients were detected by RT-qPCR. Results: The antibody testing of dental healthcare providers during the early phases of the pandemic in Japan revealed low antibody positivity, which supported the low incidence of infection clusters among dental clinics. The aerosol generated during dental procedures may contain trace levels of SARS-CoV-2, indicating the risk of transmission through dental procedures is limited. Therefore, SARS-CoV-2 did not spread through dental clinics. Conclusions: Very few SARS-CoV-2 infections were observed in dental professionals who took appropriate infection control measures in the early period of the pandemic. Performing dental procedures using standard precautions seems to be sufficient to prevent SARS-CoV-2 infections. Full article

Background: Professional knowledge and experience of healthcare organization went through continuous change and development with the progression of COVID-19 pandemic waves. However, carefully developed guidelines for cardiopulmonary resuscitation (CPR) remained largely unchanged regardless of the epidemic situation, with the largest change being a more prominent bioethical approach. It would be possible to further improve the quality of CPR by systematic data collection, the facilitation of prospective studies, and further development of the methodology based on this evidence, as well as by providing information and developing provisions on interventions with expected poor outcomes, and ultimately by refusing resuscitation. Methods: This study involved the critical collection and analysis of literary data originating from the Web of Science and PubMed databases concerning bioethical aspects and the efficacy of CPR during the COVID-19 pandemic. Results: According to the current professional recommendation of the European Resuscitation Council (ERC), CPR should be initiated immediately in case of cardiac arrest in the absence of an exclusionary circumstance. One such circumstance is explicit refusal of CPR by a well-informed patient, which in practice takes the form of a prior declaration. ERC prescribes the following conjunctive conditions for do-not-attempt CPR (DNACPR) declarations: present, real, and applicable. It is recommended to take the declaration as a part of complex end-of-life planning, with the corresponding documentation available in an electronic database. The pandemic has brought significant changes in resuscitation practice at both lay and professional levels as well. Incidence of out-of-hospital resuscitation (OHCA) did not differ compared to the previous period, while cardiac deaths in public places almost halved during the epidemic (p < 0.001) as did the use of AEDs (p = 0.037). The number of resuscitations performed by bystanders and by the emergency medical service (EMS) also showed a significant decrease (p = 0.001), and the most important interventions (defibrillation, first adrenaline time) suffered a significant delay. Secondary survival until hospital discharge thus decreased by 50% during the pandemic period. Conclusions: The COVID-19 pandemic provided a significant impetus to the revision of guidelines. While detailed methodology has changed only slightly compared to the previous procedures, the DNACPR declaration regarding self-determination is mentioned in the context of complex end-of-life planning. The issue of safe environment has come to the fore for both lay and trained resuscitators. Future Directions: Prospective evaluation of standardized methods can further improve the patient’s autonomy and quality of life. Since clinical data are controversial, further prospective controlled studies are needed to evaluate the real hazards of aerosol-generating procedures. Full article

The COVID-19 pandemic has intensified the challenges of balancing work and personal life for healthcare professionals, particularly nurses. In Spain, during the sixth wave of the pandemic, characterized by a high number of infections and increased healthcare pressure, these challenges became even more pronounced. This study examines how perceived stress, sociodemographic characteristics, and work-related factors influence Work–Life Balance among Spanish nurses in this context. A cross-sectional study was conducted with a sample of 305 Spanish nurses using the online Work-Life Interaction Questionnaire (SWING) and the Perceived Stress Scale (EP-10). The findings revealed that higher levels of perceived stress were associated with increased work-to-family conflict. This conflict was further intensified among nurses working rotating shifts. In the reverse direction, from life to work, perceived stress was again a significant factor, and having children contributed to increased negative life-to-work interference. On the other hand, certain variables were linked to more positive interactions. Having a paid caregiver was associated with lower positive work-to-family interaction, whereas religious beliefs were related to more positive experiences in this domain. Finally, being a woman and having children were both associated with greater positive life-to-work interaction. This study offers a vital perspective on the complex Work–Life interaction in nursing during crises, highlighting the urgent need for structural policies that alleviate stress and conflict while enhancing well-being by recognizing the protective role of family and spirituality. These findings open new avenues for designing more effective, responsive interventions for healthcare personnel. Full article

Background: Human milk (HM) provides critical immunological support to neonates, serving as a key component of passive immunity during early life. Objectives: The main aim of this cohort study was to compare the concentrations of lactoferrin (Lf), secretory immunoglobulin A (SIgA), C-reactive protein (CRP), and their ratios to total protein levels in the colostrum of postpartum women infected with SARS-CoV-2 and healthy controls. Methods: Colostrum samples (3–5 mL) were collected from 40 mothers (20 infected, 20 healthy) during the first wave of the COVID-19 pandemic in Poland. Concentrations of Lf, SIgA, and CRP were analyzed using ELISA, and total protein content was measured using the bicinchoninic acid assay (BCA). Results: The presence of specific anti-SARS-CoV-2 SIgA antibodies was assessed via cassette serological lateral flow detection tests. Significant differences were observed in Lf (p = 0.04) and SIgA (p = 0.03) concentrations, both lower in the COVID-19 group. Lactoferrin medians were 12.30 g/L (infected) and 14.95 g/L (healthy), and for SIgA: 9.15 g/L vs. 15.01 g/L, respectively. No significant difference was found in CRP levels. Interestingly, the Lf/Protein ratio was significantly higher in the infected group (p = 0.03), whereas the SIgA/Protein ratio did not differ. Furthermore, 75% of infected mothers had positive anti-SARS-CoV-2 SIgA results. These mothers also showed a higher Lf/Protein ratio. Among healthy controls, 90% had negative test results. Conclusions: These findings suggest a potential compensatory role of lactoferrin in the nonspecific immune response to SARS-CoV-2, though stress-related reductions in SIgA levels cannot be excluded. Full article