Search Results (1,070)

Background: Transitional age youth aged 18–25 years are more likely to engage in risky behaviors, displaying significantly higher alcohol and illicit drug use levels than adolescents and older adults. College students are particularly vulnerable at this critical life juncture as transitioning to adulthood may impact emotional health and well-being, contributing to anxiety, depression, and feelings of hopelessness, all of which are linked to increased risk of substance use and disorders. Objective: This study characterizes the design and status of the MAPme Project, a prospective project centered on substance use and emotional wellness during and beyond college. Herein, we describe the 2018–2024 pilot cohort that was followed during the first two years of college, remotely during the COVID-19 pandemic, and upon the return to campus. We also describe our latest 2025+ cohort with ongoing data collection. Participants: The 2018–2024 cohort comprised 301 college freshmen who completed online assessments at baseline (Wave 1). The 2025+ cohort has currently enrolled 618 students and counting. Methods: We provide descriptive information on both cohorts, along with preliminary associations of pre- and early collegiate substance use outcomes, psychopathology, sleep patterns, and personality traits. Results: Approximately 64% of first-year students reported use of a substance in the 90 days leading up to college in 2018. Alcohol and cannabis were the most prevalent substances used in both cohorts with males consuming more alcohol than females. Females reported greater levels of daily stressors and mood symptoms. Other health and personality characteristics and observed associations between psychosocial risk and protective factors are described. Prior studies demonstrate the ability to test research hypotheses in the social, health, and clinical areas of psychology with robust statistical power. Conclusions: Substance use and emotional well-being vary considerably upon entry into college/university and at any particular moment in time. The MAPme Project encourages the engagement of students to address challenges associated with lack of awareness, inclusivity, and acceptance of scientific research. Overcoming barriers of inclusivity and empowering the community is key to the successful adoption and implementation of campus health and community-oriented research programs and systematically enhancing research training. Full article

Background and Objectives: The COVID-19 pandemic and the accompanying containment measures substantially altered everyday life and created conditions that could intensify psychological distress. Physical activity is widely recognized as a factor supporting mental well-being, yet less is known about whether specific forms of outdoor activity were associated with perceived stress during the first pandemic wave. This study aimed to assess the relationship between selected forms of outdoor physical activity and perceived stress during the COVID-19 pandemic among residents of Poland and Italy. Materials and Methods: This cross-sectional analysis was based on data collected within a previously published multinational survey conducted during the first wave of the COVID-19 pandemic. The study included respondents from Poland and Italy and examined PSS scores in relation to three broad self-reported agreement items concerning walking in public places, walking in the neighborhood, and outdoor sports such as running or cycling. Responses were analyzed in their original categories and were additionally dichotomized as agreement versus disagreement. Non-parametric tests were used for unadjusted comparisons, and multivariable logistic regression adjusted for country and sociodemographic and health-related factors. Results: In unadjusted analyses, respondents who agreed that they walked in public places or engaged in outdoor sports had lower mean PSS scores than those who disagreed (20.40 vs. 21.61 and 20.59 vs. 21.70, respectively; both p < 0.001). Respondents who agreed that they walked in their neighborhood had a slightly higher mean PSS score than those who disagreed (21.76 vs. 21.26; p = 0.018). After correction of the dichotomized activity variables, none of the three outdoor activity measures were independently associated with high perceived stress in the adjusted model. Conclusions: Self-reported walking in public places and outdoor sports were associated with lower PSS scores in unadjusted comparisons, whereas neighborhood walking showed a small association in the opposite direction. None of the three broad activity measures were independently associated with high perceived stress after adjustment. Because the study was cross-sectional and outdoor activity was assessed using simple agreement statements rather than frequency, duration, or intensity measures, these findings should be interpreted cautiously and do not support causal conclusions. Full article

The first case of Coronavirus Disease 2019 (COVID-19) in Tunisia was reported on 2 March 2020. This study aimed to describe the epidemiological evolution of the COVID-19 pandemic in Tunisia from March 2020 to December 2022 and to assess changes in key transmission indicators across the different phases and epidemic waves. We conducted a nationwide longitudinal descriptive study based on prospectively collected surveillance data including all laboratory-confirmed COVID-19 cases reported through the national surveillance system between March 2020 and December 2022. Descriptive analyses were performed to estimate screening rates, test positivity rates, cumulative incidence rates, and the time-varying effective reproduction number (Rt). During the three-year study period, Tunisia reported a cumulative incidence of 9562.05 cases per 100,000 inhabitants. The mean daily screening rate was 38.23 tests per 100,000 inhabitants, while the average positivity rate reached 16.03%. The mean effective reproduction number was estimated at 1.14 (95% CI: 1.11–1.17). The epidemic evolved through two distinct transmission phases. The first phase, extending from 2 March to 17 August 2020, was characterized by limited community transmission mainly associated with imported cases. The second phase was marked by sustained autochthonous community transmission and comprised five epidemic waves. Between March and May 2021, genomic surveillance identified the predominance of the Alpha Variant of Concern (VOC). The fourth wave was dominated by the Delta VOC until December 2021, whereas the fifth wave, occurring in 2022, was associated with the Omicron VOC. Continuous monitoring of transmission indicators through the national surveillance system provided timely evidence to support risk assessment, guide public health decision-making, and adapt prevention and control measures throughout the different phases of the pandemic in Tunisia. Full article

The COVID-19 pandemic caused sudden changes in school routines, creating conditions that may have been relevant to students’ self-efficacy for self-regulated learning (SESRL). This research investigated high-school students’ SESRL during the initial lockdown (Study 1) and across three pandemic stages (Study 2). Using a cross-sectional retrospective design, Study 1 (N = 802, 32.5% males; M_age [Time1 (T1)] = 16.40, SD = 1.52) revealed a significant difference between retrospectively reported SESRL for the pre-pandemic period and SESRL perceived during the first lockdown. Also, higher perceived teacher support and effortful control were associated with higher SESRL during the lockdown. Latent Growth Curve Analyses in Study 2 [N (T1) = 455, 31.9% males; M_age (T1) = 15.37, SD = 1.10; 71% attrition rate] showed a declining trend for perceived SESRL over time, regardless of gender and school grade, whereas COVID-19-related life disruption showed a significant time-varying effect. Specifically, higher levels of COVID-19-related life disruption were associated with lower SESRL at each time point. These findings highlight the potential value of monitoring students’ SESRL and exploring educational initiatives that support self-regulatory skills and positive teacher–student relationships, particularly during periods of widespread educational disruption. However, the longitudinal findings should be interpreted cautiously given the substantial attrition across waves. Full article

The COVID-19 pandemic placed unprecedented pressure on healthcare systems and frontline professionals, particularly nurses, highlighting the importance of understanding their emotional experiences and coping strategies. This study aimed to explore the emotional experiences and coping strategies of nursing professionals during the first wave of the COVID-19 pandemic in a Spanish regional healthcare setting. A qualitative descriptive phenomenological study was conducted in 2020. Data were collected through semi-structured interviews and written narratives from 36 nursing professionals working in the Riojan Health Service. Three main themes emerged: perceived emotions, stressors, and coping strategies. Nurses reported intense feelings of fear, uncertainty, and frustration, which negatively impacted their mental health and hindered emotional regulation and decision-making. Key stressors included high workload, lack of resources, constant exposure to risk, and rapidly changing clinical situations. Despite these challenges, participants described various coping strategies, such as peer support, professional commitment, and adaptive emotional responses, which helped them manage the situation. The findings describe the emotional impact experienced by nursing professionals during the first months of the COVID-19 pandemic and identify coping strategies used in a specific regional healthcare context in Spain. Full article

Traditional and COVID-19-specific severity scores are applied in intensive care units (ICUs) to guide decision-making and predict mortality. Since traditional severity scores (APACHE II, SAPS II, SAPS 3, and SOFA) were not originally designed for SARS-CoV-2, this study compared their performance with COVID-19–specific models (Shang-COVID and SEIMC), including a novel distinction between early (≤7 days) and late (>7 days) ICU mortality. Adult ICU COVID-19 patients from the first two pandemic waves in Portugal were included (n = 286). Six scores were calculated, and four outcomes assessed: hospital, ICU, early ICU, and late ICU mortality. Discrimination was assessed using ROC curves with AUCs, 95% CIs, and p-values. AUCs were compared using the Delong test (early vs. late ICU mortality and across scores within each wave) and the Hanley & McNeil test (between waves for each score). Traditional scores demonstrated robust mortality prediction. SEIMC performed well for hospital (AUC_wave1 = 0.808; AUC_wave2 = 0.724) and ICU mortality (AUC_wave1 = 0.805; AUC_wave2 = 0.706). SEIMC (AUC_wave1 = 0.786; AUC_wave2 = 0.800) and Shang-COVID (AUC_wave1 = 0.617; AUC_wave2 = 0.736) showed potential for early mortality prediction but require further validation and recalibration. Overall performance was superior during the first wave, likely reflecting differences in patient characteristics, viral variants, and health measures. Traditional severity scores demonstrated stable robust prediction of ICU and hospital mortality in COVID-19 cases. Disease-specific scores did not significantly outperform established models, though also showed good predictive ability in some contexts, particularly early ICU mortality. These findings highlight the need for continuous validation and recalibration of predictive tools as clinical contexts evolve. Full article

Objectives: The association between osteonecrosis (ON) and Coronavirus Disease of 2019 (COVID-19) was reported early during the pandemic. ON of the femoral head (ONFH) is particularly problematic, as it may destroy the joint and lead to arthroplasty, although early diagnosis and treatment might mitigate its progression. The aim of the present study was to quantify the prevalence of symptomatic and asymptomatic ONFH in patients with severe COVID-19 treated with high doses of corticosteroids during the first pandemic wave. Methods: For this prospective, observational, monocentric cohort study, patients were selected according to the risk factors described for severe acute respiratory syndrome coronavirus in 2002–2004 (SARS-1): young males (<61 years old), high cumulative cortisone doses (≥2 g), severe disease, and followed up clinically and with magnetic resonance imaging. ONFH was classified with the ARCO classification. Results: Out of 1944 patients admitted for COVID-19 from 23 February to 21 May 2020, 856 of 1944 were treated in ICU; 30/1944 were selected according to the inclusion criteria and 27 of 30 were enrolled. The mean age at admission was 54 years (range, 42–60). The mean dose of cumulative cortisone was 6.25 g (range, 2–16). A total of 4/27 (15%) patients had ONFH; only 2 of 4 (50%) were symptomatic, including 1 with multiple ON of major joints. Conclusions: A high-risk cohort of patients with COVID-19 and high doses of corticosteroids had a 15% rate of ONFH, and 2 years after the event, 50% of them were asymptomatic. For those patients, relying solely on clinical evaluation would risk underestimating ONFH, potentially influencing treatment and outcomes. Moreover, other joints might develop ON. The data collected in the present study can be considered for the management of long-COVID. The association between severe COVID-19, high doses of corticosteroids and ONFH suggests the need for focused clinical and magnetic resonance imaging, considering the high rate of asymptomatic patients. Full article

Background and Objectives: Sleep is a vital psychological function for health and well-being in all age groups, from children to adolescents, to adults and the elderly, and impacts quality of life. This study evaluated temporal changes in sleep quality and lifestyle behaviors among medical students in North-Western Romania (Transylvania) between the COVID-19 pandemic and the post-pandemic period. Materials and Methods: A cross-sectional design was employed involving 709 medical students assessed during the first pandemic wave (2020) and the 2023–2024 academic year. Online questionnaires collected data on demographics, body mass index (BMI), substance use, and physical activity. Sleep quality was measured using the validated Athens Insomnia Scale (AIS), and multiple linear regression was performed to identify predictors of sleep outcomes. Results: Post-pandemic data revealed a significant decline in sleep quality, with female gender and lower academic performance identified as significant predictors of insomnia symptoms (R² of 0.258, p < 0.05). While physical activity levels improved significantly in 2024 compared to the confinement period, this was accompanied by increased fast-food consumption and a rise in overweight and obesity rates. Conversely, illicit drug use decreased, and alcohol consumption patterns shifted, characterized by reduced weekly frequency among females but persistent binge drinking episodes. Conclusions: The transition to post-pandemic education yielded mixed health outcomes; while physical activity rebounded, sleep quality and nutritional status deteriorated. These findings highlight the necessity for university-based interventions focusing on sleep hygiene, nutrition, and stress management to support the well-being of medical students. Full article

Background: During the first wave of the COVID-19 pandemic, the importance of the recognition of vulnerable workers was well-established, but the specific impact of the timing of their recognition remains less understood. Objective: This study evaluates the impact of early recognition of vulnerable healthcare workers (VHCWs) and identifies factors associated with SARS-CoV-2 infection. Methods: We performed a retrospective cohort study at the Virgen Macarena University Hospital (HUVM) in Seville and included employees classified as VHCWs between January 2020 and December 2021. All data, including demographic, occupational, and clinical data, were collected from occupational health records and the Andalusian digital health system. The incidence of COVID-19 was analyzed using descriptive, bivariate statistics, and Cox regression. Results: A total of 471 VHCWs were included. Most of the VHCWs were women (79.8%) with a median age of 50 years. The most common vulnerability criteria were pregnancy (32.9%) and age > 60 (28.7%). During the study period, 58 VHCWs (12.3%) were diagnosed with COVID-19, compared to 18.35% of the general workforce. Recognition of VHCW status after the pandemic was declared was strongly associated with higher infection risk (HR = 48.84; 95% CI: 26.21–90.99; p < 0.001). Conclusions: The timing of vulnerability recognition emerged as the most critical protective factor in this cohort. Healthcare workers whose vulnerability was not proactively identified before the pandemic onset faced a substantially higher risk of infection (HR = 44.68; 95% CI: 26.21–90.99; p < 0.001) compared to those recognized early. These findings underscore that pre-pandemic identification facilitated the immediate implementation of task adaptations and workplace restrictions, effectively mitigating high-risk exposure during the most critical early stages of the crisis. Full article

Background/Objectives: Olfactory dysfunction and dysgeusia are common neurosensory manifestations of Coronavirus Disease 2019 (COVID-19), affecting approximately 60% of patients. These symptoms have been mechanistically linked to receptors involved in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) cell entry, including angiotensin-converting enzyme 2 (ACE2), transmembrane protease serine 2 (TMPRSS2), furin, and neuropilin-1 (NRP1), which are highly expressed in the olfactory epithelium. Nevertheless, clinical evidence supporting a direct association between receptor expression and sensory impairment remains inconsistent. Methods: We conducted a multicenter, observational, cross-sectional study including 104 adults with polymerase chain reaction–confirmed SARS-CoV-2 infection during the first and second pandemic waves. Approximately 75 days after diagnosis, nasal and/or pharyngeal samples were obtained to quantify gene expression levels of ACE2, TMPRSS2, furin, and NRP1 using quantitative polymerase chain reaction. Olfactory dysfunction and dysgeusia were recorded as dichotomous variables. Logistic regression analyses were performed with adjustment for age, sex, and race, considering receptor expression as continuous variables and as tertiles. Missing data were addressed using multiple imputation methods. Results: Olfactory dysfunction was reported by 37.5% of participants, and dysgeusia by 36.5%. No statistically significant associations were observed between baseline expression levels of ACE2, TMPRSS2, furin, or NRP1 and the presence of olfactory dysfunction or dysgeusia in either adjusted continuous or categorical models. Although these associations did not reach statistical significance, higher ACE2 and furin expression showed a nonsignificant trend toward an increased probability of sensory alterations, whereas intermediate NRP1 levels were associated with lower disease severity. Conclusions: COVID-19-related olfactory dysfunction and dysgeusia do not appear to be directly determined by isolated baseline expression of SARS-CoV-2 entry receptors. These findings support a multifactorial and dynamic pathophysiological model involving temporal receptor regulation, inflammatory processes, and host-related factors, highlighting the need for longitudinal and interventional studies. Full article

Background/Objectives: COVID-19 has made a tremendous impact, causing a massive number of deaths worldwide. The inadequacy of health facilities resulted in shortage of resources and exhaustion of frontline workers who had to manage in a short time many patients with no tools to prioritize those at high risk. This study intended to disclose the architecture of such complex disease and enhance the management of hospitalized patients, preventing severe outcomes. Methods: We performed a retrospective multicenter study aimed at refining the best predictive model for COVID-19 mortality, integrating 19 genetic and 13 clinical features. We trained three machine learning (ML) models (GBM, XGB and RF) on a dataset of 532 COVID-19 hospitalized Italian patients, among the 605 recruited during the first wave of the pandemic, when vaccines were not available. Results: All the models achieved great values for accuracy, AUROC, f1, f2 and PR-AUC metrics. XGB f1 optimization resulted in better performance providing fewer false positives (N_f1 = 26 versus N_f2 = 27, N_PR-AUC = 29), and mostly false negatives (N_f1 = 63 versus N_f2 = 69, N_PR-AUC = 69), being the main goal to answer. We next delved into the feature importance to understand which features contribute to the model decision: age was the main driver of mortality prediction, followed by ventilation. The remainder was equally distributed between genetic (HLA-DRA rs3135363, PPARGC1A rs192678, CRP rs2808635, ABO rs657152) and other clinical features, demonstrating that genetic data did not confound, but rather implemented, the power of the model. Conclusions: Our results suggest that integrating genetic and clinical data into ML models is crucial for identifying high-risk cases within the vast disease heterogeneity, enabling the P4-medicine approach to improve patient outcomes and support the healthcare system. Full article

Coronavirus disease 2019 (COVID-19) has caused substantial global health and economic disruption, and identifying factors associated with adverse outcomes remains essential. This study is a first-wave observational study and examined risk factors and outcomes among patients admitted with COVID-19 to a non-acute hospital during the first wave of the pandemic, with particular focus on social deprivation and frailty. We conducted a retrospective review of clinical notes for 205 patients admitted between December 2019 and June 2020. Frailty was assessed using the Clinical Frailty Score and the Charlson Comorbidity Index, and social deprivation was evaluated using the Welsh Index of Multiple Deprivation. Although more women than men were admitted, mortality rates were similar across sexes. Older age was associated with increased mortality, and ischaemic heart disease was the most common comorbidity, occurring more frequently among patients who died. Those who died also demonstrated greater frailty, reflected in higher frailty and comorbidity scores. Most patients, irrespective of survival, were from less deprived areas, and greater social deprivation was not associated with increased admission or mortality. These findings indicate that older age, frailty, and ischaemic heart disease are important predictors of mortality in non-acute hospital settings, while social deprivation did not appear to influence admission risk or outcomes in this cohort. As this cohort predates widespread vaccination and antiviral therapy, these findings provide insight into baseline risk factors for COVID-19 mortality in frail populations during the first pandemic wave. Full article

The COVID 19 pandemic may have influenced smoking behaviours, including decisions to quit smoking. This study aimed to investigate smoking cessation following the first two waves of the COVID-19 pandemic in Switzerland and to assess whether cessation differed according to participants’ SARS-CoV-2–related experiences. Data from SérocoViD, a Swiss repeated cross-sectional study comprising five surveys in the canton of Vaud, was used. A total of 2454 participants aged 15 years and older from the first (May–July 2020) and third (February 2021) surveys were included. Association between SARS-CoV-2 infection experiences and cigarette smoking cessation were analyzed using logistic regression; both factors were unadjusted and adjusted for age and gender. Overall, 21.2% of participants reported being ex-smokers, but only a small proportion of the entire study population (i.e., including both smokers and non-smokers) reported quitting during the pandemic (0.5% in the first sample, 1.5% in the second). Participants who were smokers before the pandemic and had undergone diagnostic testing for SARS-CoV-2 showed a trend toward smoking cessation during the pandemic (non-adjusted odds ratio = 2.15; 95% confidence interval: 0.79–5.87). No such trends were found with a positive diagnostic test or serological result, or with COVID-19-like symptoms. These findings suggest that individuals seeking testing may be more health-conscious, potentially contributing to smoking cessation. For these individuals, the pandemic may represent a critical opportunity to promote smoking cessation, which should be leveraged by healthcare professionals and public health policies. Full article

Background/Objectives: This ecological study aimed to investigate changes in the time-varying reproduction number (Rt) of SARS-CoV-2 across six regions of Massachusetts from 2020 to 2022 and to evaluate the impact of various nonpharmaceutical interventions (NPIs) implemented in 2020 by examining associated changes in the Rt. Methods: COVID-19 incident case data from the Johns Hopkins University database were adjusted for reporting delays using deconvolution and for underreporting via a Poisson-distributed multiplier of 4. Negative and zero counts were corrected using imputation. Rt was estimated using R package EpiEstim (Version 2.2-4) with a 7-day sliding window from 2020 to 2022 and with non-overlapping time windows between policy changes in 2020. Results: From 2020 to 2022, Massachusetts experienced five COVID-19 surges, linked to the wild-type strain and emerging variants, with Rt exceeding 1 during each wave and stabilizing at or dropping below 1 during low-incidence phases. School closure and gathering restrictions, the first major intervention, were associated with a 14.7% statewide reduction in Rt (95% credible interval (CrI): −23.6%, −5.6%), with greater reductions in high-density areas such as Boston (−16.9%; 95% CrI: −26.9%, −7.5%). No statistically significant changes in Rt were found to be associated with other NPIs in 2020, including the mask mandate, reopening phases, travel restrictions and quarantine requirements, and curfews. Conclusions: Our findings highlight the different NPIs’ varying impacts on COVID-19 transmission dynamics across regions in Massachusetts in 2020 and underscore the importance of early interventions for future pandemic preparedness. Full article

During the COVID-19 pandemic, SARS-CoV-2 quickly spread all over the world in a pattern of waves. In Mexico, the first wave was from March 2020 to September 2020, and during this time autopsies were forbidden. After that, the postmortem lung samples allowed us to identify histological alterations because of COVID-19. Moreover, SARS-CoV-2 infections are characterized by the manifestation of cytopathic effects like inclusion bodies, and multinucleated cells in alveolar spaces and alveolar walls. Additionally, atypical, enlarged cells, presence of macrophages in alveolar spaces, and congestion of vascular vessels were the other histopathologic alterations of the lung. Our study covered the analysis of nine postmortem lung samples from patients with severe COVID-19 diagnosed by qRT-PCR. The samples were stained with Hematoxylin-Eosin to identify the histological alterations related to lung architecture and cell populations and were subjected to immunohistochemistry for the SARS-CoV-2 Spike and Nucleocapsid proteins. All samples showed alterations associated with diffuse alveolar damage and 1/9 presented no alveolar space, 5/9 presented different levels of pleural fibrosis, and 4/9 presented distention of the small capillaries. Immunohistochemistry results revealed that 4/9 samples showed Spike-positive cytoplasmic inclusion bodies in type I pneumocytes and 2/9 Spike-positive nuclear inclusion bodies in type I pneumocytes. These inclusion bodies were found to be eosinophilic with H&E stains. The H&E results suggest tissue alterations that may contribute to the signs and symptoms of severe COVID-19, as well as the Spike protein expression, as its distribution suggests its participation in pathophysiology. Full article