Search Results (2,420)

Lower respiratory tract infections remain a leading cause of morbidity and mortality among Intensive Care Unit patients, with severe cases often progressing to acute respiratory distress syndrome (ARDS). This life-threatening syndrome results from alveolar–capillary membrane injury, causing refractory hypoxemia and respiratory failure. Early detection and management are critical to treat the underlying cause, provide protective lung ventilation, and, eventually, improve patient outcomes. The 2012 Berlin definition standardized ARDS diagnosis but excluded patients on non-invasive ventilation (NIV) or high-flow nasal cannula (HFNC) modalities, which are increasingly used, especially after the COVID-19 pandemic. By excluding these patients, diagnostic delays can occur, risking the progression of lung injury despite ongoing support. Indeed, sustained, vigorous respiratory efforts under non-invasive modalities carry significant potential for patient self-inflicted lung injury (P-SILI), underscoring the need to broaden diagnostic criteria to encompass these increasingly common therapies. Recent proposals expand ARDS criteria to include NIV and HFNCs, lung ultrasound, and the SpO₂/FiO₂ ratio adaptations designed to improve diagnosis in resource-limited settings lacking arterial blood gases or advanced imaging. However, broader criteria risk overdiagnosis and create challenges in distinguishing ARDS from other causes of acute hypoxemic failure. Furthermore, inter-observer variability in imaging interpretation and inconsistencies in oxygenation assessment, particularly when relying on non-invasive measurements, may compromise diagnostic reliability. To overcome these limitations, a more nuanced diagnostic framework is needed—one that incorporates individualized therapeutic strategies, emphasizes lung-protective ventilation, and integrates advanced physiological or biomarker-based indicators like IL-6, IL-8, and IFN-γ, which are associated with worse outcomes. Such an approach has the potential to improve patient stratification, enable more targeted interventions, and ultimately support the design and conduct of more effective interventional studies. Full article

The mental and physical health of college students, especially in urban environments like Shanghai, is crucial given the high academic and urban stressors, which were intensified by the COVID-19 lockdown. Prior research has shown gender differences in health impacts during public health crises, with females often more vulnerable to mental health issues. Objective: This study aimed to comprehensively assess the physical and psychological health of Chinese college students post-lockdown, focusing on the relationship between stress, anxiety, depression, sleep patterns, and physical health, with a particular emphasis on gender differences. Methods: We conducted a cross-sectional study involving 116 students in Shanghai, utilizing psychological scales (HAMA, IPAQ, PSQI, SDS, FS 14, PSS, SF-36) and physical fitness tests (resting heart rate, blood pressure, hand grip, forced vital capacity, standing long jump, sit-and-reach, one-minute sit-up test and the one-minute squat test, single-leg stand test with eyes closed), to analyze health and behavior during the pandemic lockdown. All students have undergone the same life habits during the pandemic. Results: The HAMA scores indicated no significant levels of physical or mental anxiety. The PSS results (42.45 ± 8.93) reflected a high overall stress level. Furthermore, the PSQI scores (5.4 ± 2.91) suggested that the participants experienced mild insomnia. The IPAQ scores indicated higher levels of job-related activity (1261.49 ± 2144.58), transportation activity (1253.65 ± 987.57), walking intensity (1580.78 ± 1412.20), and moderate-intensity activity (1353.03 ± 1675.27) among college students following the lockdown. Hand grip strength (right) (p = 0.001), sit-and-reach test (p = 0.001), standing long jump (p = 0.001), and HAMA total score (p = 0.033) showed significant differences between males and females. Three principal components were identified in males: HAMA, FS14, and PSQI, explaining a total variance of 70.473%. Similarly, three principal components were extracted in females: HAMA, PSQI, and FS14, explaining a total variance of 69.100%. Conclusions: Our study underscores the complex interplay between physical activity (PA), mental health, and quality of life, emphasizing the need for gender-specific interventions. The persistent high stress, poor sleep quality, and reduced PA levels call for a reorganized teaching schedule to enhance student well-being without increasing academic pressure. Full article

The uptake of the COVID-19 and seasonal influenza (SI) vaccines have decreased in Europe and especially in Malta. The present study aimed to investigate the attitudes toward COVID-19 and SI vaccines and determine if individuals perceive that these vaccines are relevant to protect their health and identify reasons for their responses. A cross-sectional study using an anonymous questionnaire, informed by the Theory of Planned Behavior, addressing behavior beliefs and attitudes, and targeted at adult residents in Malta, was designed on Google Forms and disseminated using social media between January and March 2024. A total of 555 responses were received. The majority of respondents did not take/intend to take the COVID-19 (75%, n = 417) or SI (64.3%, n = 362) vaccines, with females being less likely to do so (p = 0.033). Perceived lack of safety (31.3%, n = 174) was the primary reason for rejecting the COVID-19 vaccine, and perceived lack of a threat from SI (26%, n = 144) was the reason for rejecting the SI vaccine. Those having chronic conditions were positively associated with uptake of both vaccines. In the post-pandemic era, these vaccines are not envisaged as having a major role in protecting one’s health. A high degree of skepticism especially toward the combined COVID-19 and SI vaccine in terms of safety, mostly in women, is still present. Full article

Background: Insomnia and excessive sleepiness are significant health problems with a complex etiology, increasingly affecting young people, especially students. This study aimed to assess the prevalence of sleep disturbances and patterns of psychoactive drug use among female Polish students. We also explored the potential impact of the COVID-19 pandemic on sleep behaviors. We hypothesized that sleep disorders are common in this group, that medical students are more likely to experience insomnia and excessive sleepiness, and that the pandemic has exacerbated both sleep disturbances and substance use. Methods: This cross-sectional study utilized a custom survey designed using standardized questionnaires—the Athens Insomnia Scale and Epworth Sleepiness Scale—that was distributed online using the Computer-Assisted Web Interviewing method. A total of 11,988 responses were collected from 31 January 2016 to 1 January 2021. Inclusion criteria were being female, having a college student status, and giving informed consent. Results: Among the 11,988 participants, alcohol use declined after the pandemic began (p = 0.001), while sedative use increased (p < 0.001). Insomnia (AIS) was associated with study year, university profile, and field of study (p < 0.001), with the highest rates in first-year and non-medical students. It was more common among users of sedatives, psychostimulants, and multiple substances. No significant change in insomnia was found before and after the pandemic. Excessive sleepiness (ESS) peaked in first-year and medical students. It decreased during the pandemic (p < 0.001) and was linked to the use of alcohol, psychostimulants, cannabinoids, and multiple substances. Conclusions: These findings highlight that female students are particularly vulnerable to sleep disorders. The influence of the COVID-19 pandemic on sleep disturbances remains inconclusive. Given the varied results in the existing literature, further research is needed. Full article

Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus, whose 2020 outbreak was characterized as a pandemic by the World Health Organization. Restriction measures changed healthcare delivery, with telehealth providing a viable alternative throughout the pandemic. This study analyzed a telemedicine platform database with the goal of developing a diagnostic prediction model for COVID-19 patients. This is a longitudinal study of patients seen on the Conexa Saúde telemedicine platform in 2022. A multiple binary logistic regression model of controls (negative confirmation for COVID-19 or confirmation of other influenza-like illness) versus COVID-19 was developed to obtain an odds ratio (OR) and a 95% confidence interval (CI). In the final binary logistic regression model, six factors were considered significant: presence of rhinorrhea, ocular symptoms, abdominal pain, rhinosinusopathy, and wheezing/asthma and bronchospasm were more frequent in controls, thus indicating a greater chance of flu-like illnesses than COVID-19. The presence of tiredness and fatigue was three times more prevalent in COVID-19 cases (OR = 3.631; CI = 1.138–11.581; p-value = 0.029). Our findings suggest potential predictors associated with influenza-like illness and COVID-19 that may distinguish between these infections. Full article

The influence of social media personalities has grown significantly, especially among youth audiences who spend substantial time on platforms like TikTok. The emergence and popularity of different types of social media influencers accelerated during the COVID-19 pandemic in many countries, including South Africa. In turn, this period also saw a surge in youth audiences following these influencers. This rapid growth of influencer followings among young people is largely driven by specific types of content that resonate with them, thus encouraging continued engagement. However, the benefits that these young followers gain from engaging with various influencers and the factors driving their preferences for specific influencers remain underexplored, particularly within the context of South African students within higher education. Therefore, this study explores the types of social media influencers most followed by university students at a South African University and investigates the key factors that drive their preferences. A structured online questionnaire was distributed, gathering both multiple-choice and open-ended responses from students. The data were analyzed using categorical frequency counts and thematic analysis. The data highlight how students actively turn to influencers as emotional anchors, role models, and sources of practical guidance. Their engagement reflects a deep need for connection, inspiration, and identity formation in a challenging academic and social environment. These patterns show that influencer content is not just entertainment but plays a critical developmental role. Understanding these motivations helps educators, policymakers, and brands to align better with youth values. The significance of these results lies in how influencer content is now coming in to fill the emotional, cultural, and educational gaps left by traditional systems among the young South African university students in this modern era. Full article

Objective: To explore the relationship between type of grocery store used (chain vs. independent), transportation access, food insecurity, and fruit and vegetable intake in Detroit, Michigan, USA, during the COVID-19 pandemic. Design: A cross-sectional online survey was conducted from December 2021 to May 2022. Setting: Detroit, Michigan. Participants: 656 Detroit residents aged 18 and older. Results: Bivariate analyses showed that chain grocery store shoppers reported significantly greater fruit and vegetable intake (2.42 vs. 2.14 times/day for independent grocery store shoppers, p < 0.001) and lower rates of food insecurity compared to independent store shoppers (45.9% vs. 65.3% for independent grocery store shoppers, p < 0.001). Fewer independent store shoppers used their own vehicle (52.9% vs. 76.2% for chain store shoppers, p < 0.001). After adjusting for socioeconomic and demographic variables transportation access was strongly associated with increased odds of shopping at chain stores (OR = 1.89, 95% CI [1.21,2.95], p = 0.005) but food insecurity was no longer associated with grocery store type. Shopping at chain grocery stores was associated with higher fruit and vegetable intake after adjusting for covariates (1.18 times more per day, p = 0.042). Qualitative responses highlighted systemic barriers, including poor food quality, high costs, and limited transportation options, exacerbating food access inequities. Conclusions: These disparities underscore the need for targeted interventions to improve transportation options and support food security in vulnerable populations, particularly in urban areas like Detroit. Addressing these structural challenges is essential for reducing food insecurity and promoting equitable access to nutritious foods. Full article

Background/Objective: A growing body of international research continues to show evidence of worsening youth mental health since the beginning of the COVID-19 global pandemic, yet very little research in this area has included young children under 6 years. Given the potential impact of early life stress during this critical period of development, it is crucial to better understand the effects on this age group. The objective of this study was to better understand the impact of the COVID-19 pandemic on the emotional health of very young children. Methods: This study utilized retrospective chart review of primary care records to compare the prevalence of markers of stress in two cohorts of children under the age of 6 years, comparing children presenting for care prior to the pandemic (1 April 2019–31 March 2020; control period) with those presenting for care during the first year of the pandemic (1 April 2020–31 March 2021; study period) in a large pediatric primary care clinic in Washington, DC, USA. Based on power calculations, charts of 200 patients from each cohort were reviewed and prevalence of stress markers were summarized using counts and percentages and compared between groups using chi-squared tests. Multivariable logistic regression models were also conducted for each domain adjusting for age, gender, and insurance type. Results: Overall, sleep difficulties were significantly more prevalent during the pandemic period compared to the control period (14% vs. 6.5%, p = 0.013). In addition, signs of stress presented differently across age groups. For example, during the pandemic period toddlers (13–35 months) were 13 times more likely (OR = 13, 95% CI [2.82, 60.4], p < 0.001) and preschool-aged children (36–71 months) were 18.5 times more likely (OR = 18.5, 95% CI [4.0, 86], p < 0.001) than infants to present with behavior problems, indicating substantially higher risk of externalizing symptoms in older children compared to infants. Toddlers were less likely than infants to present with mood changes (e.g., fussiness or crying) (OR = 0.15, 95% CI [0.03, 0.65], p = 0.011). In addition, toddlers (OR = 0.55, 95% CI [0.31, 0.97], p = 0.038) and preschool-aged children (OR = 0.15, 95% CI [0.06, 0.4], p < 0.001) were also less likely to present with feeding difficulties compared to infants. Conclusions: One of the very few studies of young children under 6 years (including infants) during the COVID-19 pandemic, this study found that even very young children experienced stress during the pandemic. Signs of emotional stress were identified in a primary care office during routine care, highlighting an important opportunity for early intervention and/or prevention, such as counseling and resources for caregivers, in settings where young children are already presenting for routine care. Full article

Since the early 21st century, urban shrinkage has become a significant global phenomenon. Dongguan, in Guangdong Province, China, is known as a “world factory”. It experienced notable urban shrinkage following the 2008 financial crisis. However, the city demonstrated remarkable recovery and ongoing development in subsequent years. On that basis, this study focuses on the following three points: (1) identifying the spatiotemporal factors contributing to the growth and shrinkage of manufacturing cities, taking Dongguan as an example; (2) explaining the influencing factors of the growth and shrinkage of Dongguan City during three critical periods, 2008–2014 (post-crisis), 2015–2019 (as machinery replaced human work), and 2020–2023 (the COVID-19 pandemic and recovery); and (3) selecting representative towns and streets for on-site observation and investigation, analyzing the measures they have taken to cope with growth and shrinkage during different periods. The key findings include the following: (1) The spatial dynamics of growth and shrinkage in Dongguan show significant temporal patterns, with traditional manufacturing areas shrinking from 2008 to 2014, central urban areas recovering from 2015 to 2019, and renewed shrinkage from 2020 to 2023. However, some regions maintained stability through strategic innovations. (2) Various factors, particularly industrial upgrading and technological innovation, drove the urban dynamics, enhancing economic resilience. (3) The case study of Houjie Town revealed successful adaptive mechanisms supported by policy while facing challenges like labor mismatches and inadequate R&D investment. This research offers insights for improving urban resilience and promoting sustainable development in Dongguan. Full article

Background/Objectives: The COVID-19 pandemic introduced various stressors for families, including changes to daily routines, work, and schooling. Studies have linked these stressors to increased mental health challenges for parents and children. Sleep difficulties were also common during the pandemic, with some children and parents experiencing poorer sleep quality and shorter sleep duration. However, it remains unclear whether the effects of COVID-19 stress on mental health challenges are explained, at least in part, by effects of COVID-19 stress on child and/or parent sleep challenges. This study examined the impacts of COVID-19 stress on sleep and, in turn, mental health difficulties in school-aged children and their parents in Canada and the United States. Methods: Parents (N = 961) completed validated measures of COVID-19 stress, and of their own and their child’s sleep and mental health. Path analyses tested direct and indirect effects of COVID-19 stress on mental health outcomes with sleep problems as the potential mediator. Results: Child sleep problems partially mediated COVID-19 stress effects on both parent (β = 0.33) and child (β = 0.20) mental health difficulties, while parent sleep problems contributed significantly but to a lesser degree (parent mental health: β = 0.07; child mental health: β = 0.03). There also remained significant direct effects of COVID-19 stress on both child and parent mental health difficulties that were not mediated through sleep difficulties. Conclusions: Our findings underscore the interconnected nature of sleep and mental health, demonstrating that stress-related disruptions in sleep (particularly children’s sleep) can exacerbate mental health difficulties for both parents and children during crises like the COVID-19 pandemic. Full article

This paper investigates the impact of the transition from manufacturing to tourism on sectoral productivity, output prices, and labor costs. Using panel data econometric models for 15 selected EU countries from 2011 to 2023, the study confirms key dynamics predicted by Baumol’s cost disease (BCD) hypothesis. The findings reveal that higher productivity is positively associated with both implied prices and hourly labor costs across sectors, supporting the wage equalization mechanism central to BCD. However, the relationship between productivity and wages or prices is weaker in labor-intensive sectors like tourism, underscoring their structural vulnerability to wage-driven cost pressures. Additionally, the analysis captures the impact of major external shocks, including the COVID-19 pandemic and the Russo–Ukrainian war, treated as jointly sourced super-shocks. The regression results indicate significant price disruptions following these shocks, whereas no statistically significant trend in labor costs was detected in the post-treatment period. These results highlight the differential effects of external shocks on wages versus prices, emphasizing the challenges faced by low-productivity, labor-intensive sectors in managing cost dynamics. The findings provide valuable insights for policymakers addressing sectoral imbalances in the context of BCD and navigating the economic consequences of global disruptions. Full article

The 100-Day Mission, coordinated by the Coalition for Epidemic Preparedness Innovations (CEPI) and endorsed by significant international stakeholders, aims to shorten the timeframe for developing and implementing vaccines to 100 days after the report of a new pathogen. This ambitious goal is outlined as an essential first step in improving pandemic preparedness worldwide. This review highlights the mission’s implementation potential and challenges by examining it through the lens of low- and middle-income countries (LMICs), which often face barriers to equitable vaccine access. This article explores the scientific, economic, political, and social aspects that could influence the mission’s success, relying on lessons learned from previous pandemics, such as the Spanish flu, H1N1, and COVID-19. We also examined important cornerstones like prototype vaccine libraries, accelerated clinical trial preparedness, early biomarkers identification, scalable manufacturing capabilities, and rapid pathogen characterization. The review also explores the World Health Organization (WHO) Pandemic Agreement and the significance of Phase 4 surveillance in ensuring vaccine safety. We additionally evaluate societal issues that disproportionately impact LMICs, like vaccine reluctance, health literacy gaps, and digital access limitations. Without intentional attempts to incorporate under-resourced regions into global preparedness frameworks, we argue that the 100-Day Mission carries the risk of exacerbating already-existing disparities. Ultimately, our analysis emphasizes that success will not only rely on a scientific innovation but also on sustained international collaboration, transparent governance, and equitable funding that prioritizes inclusion from the beginning. Full article

Background/Objective: Frontline healthcare staff who contend diseases and mitigate their transmission were repeatedly exposed to high-risk conditions during the COVID-19 pandemic. They were at risk of mental health issues, in particular, psychological stress, depression, anxiety, financial stress, and/or burnout. This study aimed to investigate and evaluate the occupational stress of medical doctors, nurses, pharmacists, physiotherapists, and other hospital support crew during the COVID-19 pandemic in Saudi Arabia. Methods: We collected both qualitative and quantitative data from a survey given to public and private hospitals using methods like correspondence analysis, cluster analysis, and structural equation models to investigate the work-related stress (WRS) and anxiety of the staff. Since health-related factors are unclear and uncertain, a fuzzy association rule mining (FARM) method was created to address these problems and find out the levels of work-related stress (WRS) and anxiety. The statistical results and K-means clustering method were used to find the best number of fuzzy rules and the level of fuzziness in clusters to create the FARM approach and to predict the work-related stress and anxiety of healthcare staff. This innovative approach allows for a more nuanced appraisal of the factors contributing to work-related stress and anxiety, ultimately enabling healthcare organizations to implement targeted interventions. By leveraging these insights, management can foster a healthier work environment that supports staff well-being and enhances overall productivity. This study also aimed to identify the relevant health factors that are the root causes of work-related stress and anxiety to facilitate better preparation and motivation of the staff for reorganizing resources and equipment. Results: The results and findings show that when the financial burden (FIN) of healthcare staff increased, WRS and anxiety increased. Similarly, a rise in psychological stress caused an increase in WRS and anxiety. The psychological impact (PCG) ratio and financial impact (FIN) were the most influential factors for the staff’s anxiety. The FARM results and findings revealed that improving the financial situation of healthcare staff alone was not sufficient during the COVID-19 pandemic. Conclusions: This study found that while the impact of PCG was significant, its combined effect with FIN was more influential on staff’s work-related stress and anxiety. This difference was due to the mutual effects of PCG and FIN on the staff’s motivation. The findings will help healthcare managers make decisions to reduce or eliminate the WRS and anxiety experienced by healthcare staff in the future. Full article

Background: Women with systemic autoimmune rheumatic disease (SARD) are at higher risk of developing infection-related complications, anxiety, and depression. Using the example of the COVID-19 pandemic, we aimed to explore the impact of this external stressor on symptoms of depression, anxiety, and stress in a sample of women with SARD in a cross-sectional study design. Methods: Females aged 18–50 with SARD were enrolled from 04/2021 to 04/2022 at the Medical University of Vienna or through an online self-help group, while snowball sampling was used to recruit an age-matched healthy control group. Participants completed questionnaires including: (1) demographic information, medical history, and access to healthcare; (2) the Depression, Anxiety, and Stress Scale (DASS-21); and (3) the Coronavirus Anxiety Scale (CAS). Parameters were compared between groups using Chi-squared, Fisher’s exact, and Mann–Whitney U tests. Linear regression analysis was used to investigate which individual factors predicted the DASS-21 in women with SARD. Results: The study sample consisted of 226 women (n = 99 with SARD and n = 127 healthy controls). Women with SARD reported lower DASS-21 stress (p = 0.008) and CAS scores (p = 0.057) than the control group. There were no significant differences in DASS-21 anxiety or depression scores. Among women with SARD, a linear regression model identified the most important predictors of DASS-21 as access to rheumatological care (p = 0.002) and recent disease activity (p = 0.028). Conclusions: Despite the pandemic, women with SARD reported mental health outcomes equal to or better than those of the healthy control group. Continued access to rheumatological care may serve as an important protective factor for their mental health during large-scale crises like pandemics. Full article

Enteroviruses (EVs) cause broad clinical manifestations, particularly in children. Certain serotypes have been implicated in respiratory infections; however, epidemiological studies analyzing EV circulation based on clinical respiratory specimens are limited in Korea. This retrospective study evaluates EV detection patterns in respiratory specimens to demonstrate their clinical and epidemiological significance as respiratory pathogens in Korea. Respiratory samples collected from outpatient and hospitalized patients with respiratory symptoms at Dankook University Hospital between 2018 and 2024 were analyzed. EV detection patterns were analyzed by year, season, sex, and age. EVs were detected in 303/6292 respiratory specimens. The highest and lowest positivity rates were in 2018 (8.2%) and 2020 (1.6%), likely due to non-pharmaceutical interventions during the COVID-19 pandemic. The highest positivity rates were in summer and autumn, and in children aged 2–11 years and infants aged 0–1 years. EV positivity did not differ significantly between sexes. Significant differences were identified across years, seasons, and age groups. EVs can be detected in respiratory specimens from symptomatic patients and exhibit a marked seasonal distribution and elevated positivity rates in pediatric populations. Hence, EVs may act as atypical respiratory pathogens, underscoring the need for integrated public health surveillance and seasonal prevention strategies. Full article