Search Results (1,737)

Background and Objectives: COVID-19 has been associated with prolonged inactivity and reduced physical performance, even in mild and moderate cases. This study aimed to evaluate changes in functional mobility and gait speed, assessed with the Timed Up and Go (TUG) and 10-Meter Walk Test (10MWT), in patients with mild to moderate post-COVID-19 conditions undergoing a structured rehabilitation program. Materials and Methods: A controlled observational study was conducted on 193 patients (115 women, 78 men) who had recovered from mild to moderate COVID-19. Participants were divided into a rehabilitation group (n = 160) and a control group (n = 33) who did not undergo structured physical therapy. Functional performance was assessed with TUG and 10MWT at admission and at one-year follow-up. Results: Both tests showed significant improvements following rehabilitation. In the rehabilitation group, the proportion of patients classified as functionally independent increased significantly for both the TUG (Cramér’s V = 0.468, p < 0.001) and 10MWT (Cramér’s V = 0.500, p < 0.001). The McNemar test confirmed a moderate within-group improvement for 10MWT (p = 0.001). Older adults (≥60 years) exhibited functional gains comparable to younger participants. A strong association between final TUG and 10MWT categories (Cramér’s V = 0.40, p < 0.001) confirmed the consistency of outcomes. Conclusions: Structured rehabilitation significantly improves balance, gait speed, and functional independence in mild-to-moderate post-COVID-19 patients. These findings highlight that rehabilitation should be integrated into the continuum of post-COVID care, as meaningful recovery is achievable even outside severe cases. Full article

In COVID-19 (coronavirus disease 2019), multi-organ complications depend on the immune system’s activity. α1-Acid glycoprotein (AGP) is a highly glycosylated positive acute-phase protein having multifaceted immunomodulatory and protective effects. We were interested in changes in serum AGP concentrations, expression of its glycans, and oxidation-reduction potential (ORP) between severe COVID-19 patients, convalescents, and healthy controls, and whether any of the analyzed parameters could serve as an additional diagnostic biomarker of severe COVID-19 and/or help monitor recovery. We were also interested in associations between the examined parameters. AGP concentrations were measured using an immunoturbidimetric method. The profile and degree of AGP glycosylation were analyzed using lectin-ELISA with lectins: sialo-specific from Sambucus nigra (SNA) and Maackia amurensis (MAA), fucose-specific from Lotus tetragonolobus (LTA) and Aleuria aurantia (AAL). The static and capacitive ORP (sORP and cORP, respectively) were measured using MiOXSYS C+^® device (Caerus Biotechnologies, Vilnius, Lithuania). Statistica13.3PL software was used for statistical analysis. AGP concentrations increased in COVID-19 patients, showing high clinical usefulness in distinguishing them from convalescents and controls. AGP α2,6-sialylation (reactivity with SNA) was reduced in COVID-19 vs. other study groups, while α2,3-sialylation (reactivity with MAA) was reduced in convalescents vs. controls. The expression of LTA-reactive fucose (Lewis^x structures, Le^x) was reduced in COVID-19 patients compared to controls and convalescents, but AGP reactivity with AAL did not differ between the study groups. The sORP was reduced, and the cORP was increased in COVID-19. The observed negative correlations between sORP and AGP levels may suggest the antioxidant effect of AGP during severe COVID-19. Higher levels of serum AGP in severe COVID-19, together with low expression of sialic acid α2,6-linked and Le^x structures, accompanied by reduced sORP, constitute a characteristic pattern of biomarker expression during severe COVID-19. The increased expression of SNA-reactive sialic acid and Le^x structures may reflect the recovery process after SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection. The observed negative correlations between AGP and sORP levels may suggest that serum AGP in COVID-19 also plays a role as an antioxidative molecule. 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

Hospital readmission among stroke survivors is frequent, especially in contexts of social vulnerability, compromising recovery and overburdening health services. This study aimed to develop a predictive model of hospital readmission among socially vulnerable stroke survivors, based on the Chronic Conditions Care Model (CCCM). Machine learning algorithms were applied, specifically decision tree and logistic regression, with data split into training (70% and 80%) and testing (30% and 20%) sets. Analyses were conducted using Python, with accuracy evaluated through ROC curves, AUC, and the confusion matrix in Analyse-it^®, adopting a 5% significance level. The decision tree with an 80/20 partition achieved an accuracy of 92.45%. The variables most associated with readmission were falls, time since the first stroke, presence of a caregiver, and difficulty sleeping. In logistic regression, falls increased the risk by 235%, ischemic stroke by 155%, complications by 153.53%, COVID-19 by 132%, and time since stroke by 11.5% per year. The model proved to be feasible and robust, with the decision tree standing out, highlighting its potential to support preventive strategies and enhance care management. Full article

This study presents the HISTOESE (History Education for Sustainable Environments) Model, an empirically grounded and practice-based framework for cultural heritage education and sustainability. Developed through a qualitative, design-based research approach, it analyzes a longitudinal corpus of 50 master’s dissertations and supervised teaching reports (2008–2025) from the Polytechnic Institute of Viana do Castelo, Portugal. Although the empirical basis derives from teacher education, the HISTOESE model fosters school–community partnerships that indirectly support cultural tourism and sustainable, place-based recovery. Using inductive thematic analysis, the study traced how project-based learning (PBL) activities mobilised local heritage, community collaboration, and sustainable pedagogical practices. Three key findings emerged: (1) local-context pedagogies strengthened children’s historical consciousness and heritage literacy; (2) inclusive, low-cost and upcycling strategies fostered community participation; and (3) partnerships with museums, tourism offices, and cultural associations generated visible cultural events that reinforced post-COVID resilience. The HISTOESE framework synthesises these insights into four interrelated pillars—Proximity and Contextualization, Inclusive and Sustainable Practices, Recognition and Valorisation and Active Citizenship and Collaboration—providing a transferable model for teacher education and community-based cultural sustainability. Practical implications concern curriculum design, heritage–tourism interfaces, and collaborative strategies for sustainable development. Full article

Most reinforcement learning (RL) methods for portfolio optimization remain limited to single markets and a single algorithmic paradigm, which restricts their adaptability to regime shifts and heterogeneous conditions. This paper introduces a generalized version of the Modular Portfolio Learning System (MPLS), extending beyond its initial PPO backbone to integrate four RL algorithms: Proximal Policy Optimization (PPO), Deep Q-Network (DQN), Deep Deterministic Policy Gradient (DDPG), and Soft Actor-Critic (SAC). Building on its modular design, MPLS leverages specialized components for sentiment analysis, volatility forecasting, and structural dependency modeling, whose signals are fused within an attention-based decision framework. Unlike prior approaches, MPLS is evaluated independently on three major equity indices (S&P 500, DAX 30, and FTSE 100) across diverse regimes including stable, crisis, recovery, and sideways phases. Experimental results show that MPLS consistently achieved higher Sharpe ratios—typically +40–70% over Minimum Variance Portfolio (MVP) and Risk Parity (RP)—while limiting drawdowns and Conditional Value-at-Risk (CVaR) during stress periods such as the COVID-19 crash. Turnover levels remained moderate, confirming cost-awareness. Ablation and variance analyses highlight the distinct contribution of each module and the robustness of the framework. Overall, MPLS represents a modular, resilient, and practically relevant framework for risk-aware portfolio optimization. Full article

The COVID-19 pandemic has profoundly affected global economies, including the electricity sector. Governments implemented strict containment measures to mitigate the health crisis, including lockdowns, social distancing, and event cancelations. These interventions, while essential for public health, also disrupted energy demand and supply patterns. This study supports regulators by quantifying the short- and long-term impacts of the pandemic on local electricity prices (LEPs) in the Nord Pool market (Norway, Sweden, Denmark, Finland, Estonia, Latvia, and Lithuania) during 2020. The findings highlight a crucial link between crisis response strategies and the transition to sustainable energy systems. In times of uncertainty, governments tend to prioritize renewable energy investments, particularly wind power, which offers a clean and resilient alternative to fossil-fuel-based electricity generation. Using the PMG-ARDL estimator, our analysis reveals a significant long-term negative association between government interventions and LEP, as well as between wind energy production (WEP) and LEP. Specifically, an additional gigawatt of wind energy generation reduces local electricity prices by up to EUR 0.09, confirming the merit-order effect. These findings emphasize the environmental and economic benefits of expanding wind energy capacity as a stabilizing force in electricity markets. Moreover, while health-related news influenced LEP fluctuations in the long run, government restrictions had a limited short-term impact, likely due to the inelastic nature of electricity demand and supply. This study reinforces the argument that integrating more renewable energy sources can enhance market resilience, reduce price volatility, and contribute to long-term sustainable development, making the energy transition an essential pillar of post-pandemic recovery strategies. Full article

Aim: Post-COVID condition (PCC) is largely considered the biggest public health emergency in recent times. The role of exercise therapy in PCC is currently unknown, and evaluative studies are currently lacking in this area. This study therefore aimed to evaluate the effects of a football club community trust exercise rehabilitation programme on physical function and quality of life in individuals with PCC. Method: A mixed-methods retrospective design was employed, utilising a framework to assess the programme’s reach, effectiveness, adoption, implementation, and maintenance (RE-AIM). Quantitative data (questionnaires and physiological assessments) were collected at baseline, 6 weeks, and 12 weeks during the programme, and at 6 months post-intervention (n = 7). Qualitative data were gathered through semi-structured focus groups at week 12 (n = 7) and 12 months (n = 5) post-intervention. Quantitative data and qualitative data were analysed using repeated measures ANOVAs and thematic analysis, respectively. Results: The programme led to significant improvements in physical function, including increased six-minute walking distance (6MWT, p < 0.001), one-minute sit-to-stand repetitions (1MSST, p < 0.035), and lung function (spirometry; MIP: p = 0.048, MEP: p = 0.024). Participants also reported enhanced QoL (HRQoL-14, p = 0.004), reduced anxiety (GAD-7, p = 0.008) and depression (PHQ-9, p = 0.008), and increased confidence and self-efficacy. The programme was well-received, with participants valuing the supportive environment and personalised approach. Conclusions: Football community trust exercise rehabilitation programmes can effectively improve physical function and quality of life in individuals with PCC, offering a promising model for community-based rehabilitation. Further studies are needed with larger sample sizes to assess the scalability of similar programmes. Full article

Long COVID is frequently accompanied by neurocognitive complaints, yet the combined effects of demographic and clinical factors remain unclear. This study examined individuals six months after their most recent SARS-CoV-2 infection using a Demographic/Infection-History form, a Physical and Neurocognitive Symptom Checklist (binary), and the Post-COVID Cognitive Impairment Scale (memory, attention; 5-point Likert). Participants were recruited through convenience sampling from multiple community and online sources. Inclusion criteria required confirmed prior COVID-19 infection, self-perceived or clinically documented Long COVID symptoms, and no history of neurological or severe psychiatric disorders. The final sample consisted of 212 participants (mean age = 39.7 years, SD = 10.5), of whom 67.9% were female, and most held a master’s (35.4%) or bachelor’s (28.3%) degree. Difficulties with retaining new information (57.8%) and concentrating (52.1%) were the most frequent neurocognitive complaints, while severe fatigue after mild activity (23.2%) and chronic fatigue (22.7%) were the most common physical symptoms. Confusion and decision-making difficulty were more frequent among younger participants; women reported greater difficulty retaining new information, and difficulty concentrating varied by education level. A multivariable regression model explained 7% of the variance in total cognitive complaints, identifying education level (β = −0.18, p < 0.01) and number of physical symptoms (β = 0.19, p < 0.01) as significant predictors. Higher educational attainment was associated with fewer cognitive complaints, whereas a greater burden of physical symptoms predicted higher complaint scores. Persistent cognitive difficulties in Long COVID appear closely related to physical symptom burden and protective factors such as education, rather than to infection frequency or sensory dysfunction duration. Findings highlight the need for routine cognitive screening, fatigue-focused management, and longitudinal multimodal research to elucidate underlying mechanisms and recovery pathways. Full article

Objective: This pilot study assessed the psychological and physical impact of the COVID-19 pandemic on postpartum women that gave birth during the pandemic, and evaluated the feasibility of remote monitoring for maternal mental health. The study also proposes a conceptual framework to strengthen remote maternal care in future public health emergencies. Methods: Conducted between 2020 and 2021 in Reggio Emilia, one of Italy’s ten hardest-hit provinces during the early COVID-19 outbreak, this study enrolled 21 pregnant women (10 COVID-19-positive at delivery, 11 COVID-19-negative controls). Psychological and physical health were assessed using validated instruments: the Beck Depression Inventory (BDI) and Edinburgh Postnatal Depression Scale (EPDS) for depression, the State-Trait Anxiety Inventory (STAI) for anxiety, the Impact of Event Scale–Revised (IES-R) for trauma-related stress, and the SF-36 for physical functioning. Additional measures included breastfeeding experience and resilience. Remote assessments were conducted between 6 and 12 months postpartum to evaluate psychological recovery and satisfaction with perinatal care. C test was used to compare the two groups of women. Results: COVID-19-positive women reported significantly higher depressive symptoms (BDI: 13.50 ± 8.14 vs. 6.73 ± 4.73; U = 27, p = 0.048), and elevated state anxiety levels (STAI-S: 41.60 ± 10.23 vs. 33.64 ± 10.15; U = 27, p = 0.048) compared to controls. Post-traumatic stress symptoms were also higher among COVID-positive participants (IES-R total: 41.10 ± 19.33 vs. 30.64 ± 7.99; U = 24.5, p = 0.029). No significant differences emerged in EPDS or trait anxiety scores. Conclusions: Remote data collection proved feasible for postpartum women during the pandemic and highlighted elevated depressive, anxiety, and trauma-related symptoms in COVID-19-positive mothers. These findings support the development of flexible digital care frameworks for maternal well-being in crises. The introduction of the “10 Gold Rules for Remote Maternal Healthcare in Critical Situations” offers a forward-looking, expert-informed conceptual framework to guide the development of scalable, trust-based digital care models that go beyond monitoring to include proactive, patient-centred support. Full article

Olfactory dysfunction (OD) is an early symptom associated with a variety of diseases, including COVID-19, Alzheimer’s disease, and Parkinson’s disease, where patients commonly experience hyposmia or anosmia. Effective restoration of olfactory function is therefore crucial for disease diagnosis and management, and improving overall quality of life. Traditional treatment approaches have primarily relied on medication and surgical intervention. However, recent advances in bionic sensing and brain–computer interface (BCI) technologies have opened up novel avenues for olfactory rehabilitation, facilitating the reconstruction of neural circuits and the enhancement of connectivity within the central nervous system. This review provides an overview of the current research landscape on OD-related diseases and highlights emerging olfactory restoration strategies, including olfactory training (OT), electrical stimulation, neural regeneration, and BCI-based approaches. These developments lay a theoretical foundation for achieving more rapid and reliable clinical recovery of olfactory function. Full article

Background: Post-COVID-19 condition (‘long COVID’) involves fluctuating symptoms across multiple organ systems and disability or functional loss, which may be episodic, continuous, or permanent. Qualitative research is essential to capture lived experiences and explain how social and health system contexts may influence improvement, recovery, and service use. We synthesised perspectives from people living with long COVID and healthcare professionals to inform service design and policy. Methods: We conducted a systematic review and qualitative meta-synthesis. MEDLINE, Embase, PsycINFO, CINAHL, Scopus, and Web of Science were searched for studies published between 1 January 2020 and 19 August 2025. Eligible studies reported qualitative data from adults with long COVID (≥12 weeks after acute infection) and/or healthcare professionals in any setting. We excluded non-qualitative, non-primary, or non-English reports. Two reviewers independently screened, extracted, and appraised studies using the Critical Appraisal Skills Programme checklist. Data were synthesised thematically. The protocol was registered with the Open Science Framework. Findings: Of 1544 records screened, 49 studies met the inclusion criteria: 41 involving patients, two involving professionals, and six involving both. Eight patient themes (including symptom burden, identity disruption and stigma) and four professional themes (including recognition, care coordination and holistic care models) were identified. Recognition emerged as a cross-cutting mechanism: validation and consistent pacing guidance facilitated engagement and safer activity, whereas invalidation and inconsistent advice were associated with distress, avoidance, and disengagement. Trajectories showed gradual expansion of multidisciplinary care models, but major capacity and equity gaps persisted. Most studies had low methodological concerns, although heterogeneity in populations and settings was substantial. Interpretation: Long COVID is a chronic, biological condition that also intersects with social and psychological dimensions, and may present with episodic, continuous, or progressive trajectories. Healthcare services must prioritise early validation, provide consistent pacing and relapse prevention guidance, expand access to multidisciplinary and peer-supported rehabilitation, integrate mental healthcare, strengthen coordinated pathways, and support graded return to work. Explicit attention to equity is required to avoid widening disparities. Full article

Selfies of nurses and healthcare workers (HCWs) with painful personal protective equipment (PPE) injuries posted to social media provided early warning of the global PPE shortage impact during the COVID-19 pandemic. We aim to describe contextual factors associated with these injuries and describe factors that influenced posting on social media. A social media ethnographic study used purposeful sampling of Instagram posts (selfies/text) from March–October 2020 (170 posts; 26 countries). Posts were coded using focused content analysis to identify contextual factors. Data were reduced to understand and interpret the “essence” of the posts and discern themes. Themes included the following: (1) grueling shifts filled with unimaginable loss; (2) faces forever marked by the physical and emotional scars of COVID-19; (3) the COVID-19 battlefront; (4) dire and unprecedented PPE shortages; (5) pervasive fear (for self, colleagues, and family); (6) extreme emotional and physical consequences; (7) creating a collective voice. Examining injuries within the context of the nurses’/HCWs’ experiences provided new insights into the emotional scars, pervasive fears, and extreme emotional and physical consequences. An urgent need exists to address these harms and facilitate recovery. Before addressing emergency preparedness for the next pandemic event, psychosocial support is needed to address the harms incurred during the COVID-19 pandemic. Moreover, it is critical to understand past experiences to truly prepare for future pandemics. Full article

Background and Objectives: This research aimed to examine the impact of sociodemographic characteristics on mental health during the COVID-19 pandemic, with religiosity as a moderator. Materials and Methods: The cross-sectional study was conducted in family medicine clinics within the Primary Healthcare Center of Virovitica-Podravina County among 1131 participants, divided into 2 groups: RC (Recovered from COVID-19; N = 423) and NRC (Not Recovered from COVID-19; N = 708). To ensure clear differentiation, RC participants were defined as individuals with documented positive PCR results for SARS-CoV-2 (prior infection and clinical recovery), whereas NRC participants exhibited consistently negative PCR results and lacked any clinical history of the disease. Group allocation was rigorously based on the review of medical records and corresponding PCR documentation obtained both at the time of recruitment and retrospectively. All data were collected through a questionnaire from September 2022 to September 2023. Participants completed questionnaires measuring their sociodemographic characteristics (gender, age, education, and marital status), levels of depression, anxiety, stress, and level of religiosity. Results: Older participants were more prone to depression, whereas younger participants showed relatively better mental-health indicators. Sociodemographic characteristics were significantly associated with mental health during the pandemic. Religiosity was found to be a significant moderator in the relationship between sociodemographic characteristics and mental health. Individuals with higher levels of religiosity reported higher levels of depression and anxiety, suggesting that religiosity may act as a negative factor in times of crisis. Conclusions: Sociodemographic characteristics were significant predictors of mental health during the pandemic. Religiosity emerged as an important factor, particularly in moderating the relationship between sociodemographic characteristics and mental health. Further research is recommended to develop targeted interventions for vulnerable groups such as women, younger individuals, and those with lower incomes. Full article

Olfaction is thought to have a role in intimate relationships and sexuality, despite the major roles that other senses, like sight, might have for human beings. Moreover, one of the specific symptoms of the COVID-19 infection, a disease largely impacting human sexuality at various levels, has been the absence of smell. This study aimed to examine the impact of olfaction on partner selection and on different phases of sexual response. Moreover, we evaluated whether the absence of smell could influence aspects of sexual function, such as orgasmic intensity, by comparing subjects with and without COVID-19 olfactory dysfunction. A group of 259 participants has been initially enrolled through social media. Of the 138 sexually active subjects included in the final analysis, 61 (44.2%) reported olfactory dysfunction (anosmia group) and 77 (55.8%) did not (no-anosmia group). Perceived orgasmic intensity was evaluated retrospectively at two time points—during the COVID-19 infection and in the four weeks preceding the evaluation—using the male and female versions of the Orgasmometer. The results revealed a significant interaction between time and olfactory condition, indicating opposite recovery trajectories. Participants without anosmia showed a significant improvement in orgasmic intensity post-COVID-19 infection; in contrast, the anosmia group reported a significant decline over the same period. Although the presence of anosmia was not a direct predictor of orgasmic intensity per se, it critically determined the orgasmic intensity evolution over time. These findings suggest that, beyond its perceived importance, the actual absence of olfaction may have a specific and negative long-term impact on core components of the sexual experience, such as the intensity of orgasm. Full article