Search Results (513)

Wildlife–vehicle collisions (WVCs) remain a significant cause of animal mortality worldwide, particularly in regions experiencing rapid road network expansion. During the COVID-19 pandemic, a number of studies reported decreased WVC rates, attributing this trend to reduced traffic volumes. However, the validity of the simplified assumption that “fewer vehicles means fewer collisions” remains underexplored from a mechanistic perspective. This study aims to reevaluate that assumption using two simulation-based models that incorporate both the physics of vehicle movement and behavioral parameters of road-crossing animals. Employing an inverse modeling approach with quasi-realistic traffic scenarios, we quantify how vehicle speed, spacing, and animal hesitation affect collision likelihood. The results indicate that approximately 10% of modeled cases contradict the prevailing assumption, with collision risk peaking at intermediate traffic densities. These findings challenge common interpretations of WVC dynamics and underscore the need for more refined, behaviorally informed mitigation strategies. We suggest that integrating such approaches into road planning and conservation policy—particularly under the European Union’s ‘Vision Zero’ framework—could help reduce wildlife mortality more effectively in future scenarios, including potential pandemics or mobility disruptions. Full article

COVID-19 vaccines have revolutionized prevention and clinical management by reducing disease severity and mortality. However, their long-term impact on hospitalization is unclear. This retrospective study assessed whether vaccination status, timing, and number of vaccine doses influence the risk of hospitalization and COVID-19 pneumonia in a large cohort in Italy, several years after initial vaccine rollout. From 1 October 2023, to 2 February 2024, at Humanitas Research Hospital (Milan) and two affiliates, we recorded age, sex, comorbidities, vaccination status (number of doses and time since last dose), admission type (urgent vs. elective), and pneumonia diagnosis. Baseline health was quantified by the Charlson Comorbidity Index. Among 16,034 admissions (14,874 patients), vaccination data were available for 5743 cases: 40.8% were in the emergency setting and 59.2% were elective. Patients presented with pneumonia in 6.8% of cases. Laboratory results confirmed COVID-19 pneumonia occurred in 43.7% of pneumonia cases, with a 16.9% mortality. Patients with no vaccine dose had a higher proportion of COVID-19 pneumonia, while COVID-19 pneumonia rates were lower in individuals who had received more vaccine doses. There were no significant differences in COVID-19 pneumonia risk by timing of last vaccination. Moreover, hospitalized unvaccinated patients had overall more frequent emergency admissions (57.3%), while patients with three or more doses had about a ~40% emergency admission rate. COVID-19 positivity during hospitalization was highest in unvaccinated patients (90.7%) and declined with vaccination status. Vaccinated patients, especially those with multiple doses, had significantly lower COVID-19 pneumonia rates and emergency admissions. These findings suggest a possible protective effect of vaccination in modifying the clinical presentation and severity of illness among those who are hospitalized and support continued vaccination efforts for high-risk groups to reduce severe adverse outcomes. Full article

Background: Since the pathophysiology of long COVID is not yet fully understood, there are no specific methods for its treatment; however, its individual symptoms can currently be treated. Long COVID is characterized by symptoms that persist at least 2 to 3 months after contracting COVID-19, although it is difficult to predict how long such symptoms may persist. Methods: In the present study, 774 patients who first visited our outpatient clinic during the Omicron period from February 2022 to October 2024 were divided into two groups: the early recovery (ER) group (370 cases; 47.8%), who recovered in less than 180 days (median 33 days), and the persistent-symptom (PS) group (404 cases; 52.2%), who had symptoms that persisted for more than 180 days (median 437 days). The differences in clinical characteristics between these two groups were evaluated. Results: Although the median age of the two groups did not significantly differ (40 and 42 in ER and PS groups, respectively), the ratio of female patients was significantly higher in the PS group than the ER group (59.4% vs. 47.3%). There were no significant differences between the two groups in terms of the period after infection, habits, BMI, severity of COVID-19, and vaccination history. Notably, at the first visit, female patients in the PS group had a significantly higher rate of complaints of fatigue, insomnia, memory disturbance, and paresthesia, while male patients in the PS group showed significantly higher rates of fatigue and headache complaints. Patients with more than three symptoms at the first visit were predominant in the PS groups in both genders. Notably, one to two symptoms were predominant in the male ER group, while two to three symptoms were mostly reported in the female PS group. Moreover, the patients in the PS group had significantly higher scores for physical and mental fatigue and for depressive symptoms. Conclusions: Collectively, these results suggest that long-lasting long COVID is related to the number of symptoms and presents gender-dependent differences. Full article

Background: The aim of the study is to determine whether environmental and climatic factors (air quality, precipitation rates, and air temperatures) alongside specific public health measures (social distancing and vaccination) have influenced total number of SARS CoV-2 positive cases (TOTAL CASES) and deaths (TOTAL DEATHS) from COVID-19 infection in the Republic of Serbia (RS). Method: An observational, retrospective study was conducted, covering the following three-year period in the RS: I (1 March 2020–1 March 2021); II (1 March 2021–1 March 2022); and III (1 March 2022–1 March 2023). Air quality was expressed as the values of the air quality index (AQI) and the concentrations of particulate matter 2.5 µm (PM_2.5). Precipitation rates (PREC) were expressed as the average monthly amount of rainfall (mm), while average air temperatures (AIR TEMP) were expressed in °C. Data were collected from relevant official and publicly available national and international resources. Data regarding the COVID-19 pandemic were collected from the World Health Organization. Results: No differences between the periods were observed for the average values of AIR TEMP (11.2–12.2 °C), PREC (56.1–66.8 mm), and AQI (57.2–58.8), while the average values of PM_2.5 significantly decreased in the III period (21.2 compared to 25.2, p = 0.03). Both TOTAL CASES and TOTAL DEATHS from COVID-19 infection showed positive correlation with the AQI and PM_2.5 and a negative correlation with the AIR TEMP. The correlation coefficient was strongest between TOTAL DEATHS and the AIR TEMP in the II period (r = −0.7; p = 0.007). The extent of rainfall and vaccination rates did not affect any of the observed variables. No differences in TOTAL CASES and TOTAL DEATHS were observed between the periods of increased social measures and other months, while both statistically significantly increased during the vaccination period compared to months without the vaccination campaign (p < 0.02, for both). Conclusions: Air quality, more precisely AQI and PM_2.5 and average air temperatures, but no precipitation rates, influenced the number of TOTAL CASES and TOTAL DEATHS from COVID-19 infection. These were the highest during the vaccination period, but vaccination could be considered as a confounding factor since the intensive vaccination campaign was conducted during the most severe phase of the COVID-19 pandemic. Social distancing measures did not reduce the number of TOTAL CASES or TOTAL DEATHS during the COVID-19 pandemic. Full article

This paper presents an enhanced hub location model tailored to port–hinterland logistics planning, grounded in the Capacitated Multiple-Allocation Hub Location Problem (CMAHLP). The formulation incorporates nonlinear cost structures, hub-specific operating costs, adaptive capacity constraints, and a feasibility condition based on the Social Net Present Value (NPVsocial) to support the design of intermodal freight networks under asymmetric spatial and socio-environmental conditions. The empirical case focuses on Spain, leveraging its strategic position between Asia, North Africa, and Europe. The model includes four major ports—Barcelona, Valencia, Málaga, and Algeciras—as intermodal gateways connected to the 47 provinces of peninsular Spain through calibrated cost matrices based on real distances and mode-specific road and rail costs. A Genetic Algorithm is applied to evaluate 120 scenarios, varying the number of active hubs (4, 6, 8, 10, 12), transshipment discounts (α = 0.2 and 1.0), and internal parameters. The most efficient configuration involved 300 generations, 150 individuals, a crossover rate of 0.85, and a mutation rate of 0.40. The algorithm integrates guided mutation, elitist reinsertion, and local search on the top 15% of individuals. Results confirm the central role of Madrid, Valencia, and Barcelona, frequently accompanied by high-performance inland hubs such as Málaga, Córdoba, Jaén, Palencia, León, and Zaragoza. Cities with active ports such as Cartagena, Seville, and Alicante appear in several of the most efficient network configurations. Their recurring presence underscores the strategic role of inland hubs located near seaports in supporting logistical cohesion and operational resilience across the system. The COVID-19 crisis, the Suez Canal incident, and the persistent tensions in the Red Sea have made clear the fragility of traditional freight corridors linking Asia and Europe. These shocks have brought renewed strategic attention to southern Spain—particularly the Mediterranean and Andalusian axes—as viable alternatives that offer both geographic and intermodal advantages. In this evolving context, the contribution of southern hubs gains further support through strong system-wide performance indicators such as entropy, cluster diversity, and Pareto efficiency, which allow for the assessment of spatial balance, structural robustness, and optimal trade-offs in intermodal freight planning. Southern hubs, particularly in coordination with North African partners, are poised to gain prominence in an emerging Euro–Maghreb logistics interface that demands a territorial balance and resilient port–hinterland integration. Full article

Background: Greece is among the fastest-aging countries globally, with one of the highest proportions of elderly individuals. As a result, the prevalence of mild cognitive impairment (MCI) and dementia is among the highest in Europe. The distribution of affected individuals varies considerably across different regions of the country. Method: We estimated the number of people living with MCI or dementia in Greece and visualized these estimates using heatmaps by regions for four census years: 1991, 2001, 2011, and 2023 (the 2023 census was delayed due to the COVID-19 pandemic). Age- and sex-specific prevalence rates of MCI and dementia were obtained from the Hellenic Longitudinal Investigation of Aging and Diet. These prevalence rates were then applied to population data from each census to estimate the number of affected individuals per region. Results: There was a consistent increase in the number of people living with MCI, rising from 177,898 in 1991 to 311,189 in 2023. Dementia cases increased from 103,535 in 1991 to 206,939 in 2023. Projections based on future census data for 2035 and 2050 suggest that the number of people with MCI will reach 375,000 and 440,000, respectively, while dementia cases will increase to 250,000 in 2035 and 310,000 in 2050. Conclusion: Given that each person with dementia typically requires care from at least two caregivers over time, these projections highlight the profound impact the dementia epidemic will have on Greece. The heatmaps developed in this study can serve as valuable tools for policymakers in designing and implementing clinical care programs tailored to the needs of each region based on the projected burden of disease. Full article

The COVID-19 pandemic intensified existing structural challenges in Africa, including poverty, weak healthcare systems, and fragile agricultural supply chains. Consequently, examining its effects remains a critical area of study. This research investigates the effect of food prices on the prevalence of malnutrition in the context of the COVID-19 pandemic in sub-Saharan Africa. The findings indicate a significant long-term relationship between the number of COVID-19 cases, food prices, and the prevalence of undernourishment. Specifically, increases in food prices are associated with a rise in undernourishment rates over the long term. These results are corroborated by estimations using Fully Modified Ordinary Least Squares (FMOLS). To mitigate malnutrition in the face of potential future health shocks, governments could create and operationalize food price stabilization funds to cushion against sharp increases in food prices. These funds can be used to subsidize key staples during periods of price volatility, ensuring affordability for vulnerable populations. Full article

Background: East Asia accounts for the highest number of anxiety disorders cases globally, with China, Japan, and Republic of Korea representing 17.5% of global incidence according to GBD 2021. These nations offer a unique context for examining how different modernization paths impact anxiety disorders patterns. This study examined anxiety disorders incidence trends across these countries from 1992 to 2021 to compare disease burdens and inform public health strategies. Methods: Using GBD 2021 data, we employed age–period–cohort analysis to evaluate factors affecting anxiety disorders incidence, examining age-specific rates, period effects, and birth cohort influences. Results: All three countries experienced sharp increases in anxiety disorders following COVID-19. Age-standardized incidence rates decreased by 4.89% in China and 10.52% in Japan from 1992 to 2019, while remaining stable in Republic of Korea. Net drift was −0.40% for China, −0.50% for Japan, and approximately 0 for Republic of Korea. Local drifts were positive among older adults in China and Japan, and middle-aged adults in Republic of Korea. Longitudinal age curves showed inverted V-shaped patterns, peaking in the 10–14 age group across all three countries. China and Republic of Korea exhibit a second peak during middle age, while Japan shows continuous decline after the 10–14 age group. Period and cohort effects indicating overall decreases in China and Japan, with minimal changes in Republic of Korea. Conclusions: Different modernization trajectories have produced distinct anxiety disorders patterns across these East Asian nations. The elevated risk among adolescents across all countries warrants targeted interventions, while high risks among middle-aged adults in China and Republic of Korea requires age-specific approaches. Countries should utilize their healthcare systems’ strengths to create targeted strategies for reducing anxiety disorders while addressing pandemic-related mental health impacts. Full article

Background: Frequency indicators are used by epidemiologists to facilitate public health professionals in estimating the impact of diseases. As of April 2022, Romania had reported 2.8 million confirmed COVID-19 cases to the World Health Organization, equating to a prevalence rate of 13.94%. A more accurate method for assessing the cumulative number of cases is the use of seroprevalence studies. This study retrospectively evaluates infection trends in Romania to enhance understanding of the virus’s spread and may support future comparative analyses of public health responses and community-level immunity. Methods: We analyzed 51,533 qualitative test results for high-affinity IgG antibodies targeting the SARS-CoV-2 nucleocapsid protein. Results: The largest proportion of tested individuals (59.4%) was aged 18–49 years. Among all serological tests, 18,980 were positive, corresponding to an adjusted seroprevalence rate of 40%. Conclusions: During the second year of the pandemic, seropositivity rates were highest among young adults, particularly in the western regions, and lowest among children and adolescents. These findings point out variations in exposure across age groups and geographic areas. Full article

Measles remains a major public health issue, particularly among paediatric populations who are unvaccinated or lack of maternal antibody transfer. Although the majority of cases manifest with moderate clinical forms, certain patient categories are at risk for severe disease progression. This study aims to describe the clinical and epidemiological characteristics of paediatric measles cases hospitalized in the Paediatric Departments of the “Prof. Dr. Matei Balș” National Institute of Infectious Diseases, Bucharest, Romania during two distinct epidemic waves: 2017–2019 and 2023–2024. A retrospective analysis evaluated mortality rates, distribution by age and sex, as well as clinical disease patterns. The 2023–2024 measles epidemic was marked by a higher number of paediatric cases (3.114 vs. 1.068), a lower mortality rate (0.32% vs. 3.74%), a shift towards older age groups, and a greater frequency of complications—particularly gastrointestinal, haematological, and ophthalmological—compared to the 2017–2019 wave. The findings underscore the urgent need for strengthened vaccination programs and targeted public health interventions, particularly among vulnerable groups and patients at risk of developing severe forms of the disease. Owing to a sustained decline in measles vaccination coverage among the paediatric population, Romania has experienced two major measles outbreaks within the past decade, interrupted by the COVID-19 pandemic. This study draws attention to the increasing incidence of measles in older children, suggesting a cumulative effect of reduced immunization rates over time. Full article

Background/Objectives: Access to healthcare services was significantly restricted during the COVID-19 pandemic, leading to changes in the management of hepatocellular carcinoma (HCC). However, limited research has examined how these changes evolved post-pandemic. This study evaluated the impact of the pandemic at a tertiary center in Romania, focusing on diagnosis rates, treatments, and survival outcomes. Methods: A retrospective study conducted at Timișoara County Hospital divided patients into three equal cohorts of 23 months each: the pre-pandemic period (PreP: 1 May 2018–31 March 2020), the pandemic period (PandP: 1 April 2020–28 February 2022), and the post-pandemic period (PostP: 1 March 2022–31 January 2024). Newly diagnosed HCC cases were evaluated for the tumor stage, biological markers, and treatment received during each period. A survival census was conducted nine months after the diagnosis. Results: During the PandP and PostP periods, the numbers of newly diagnosed HCC cases decreased to 58 cases (p < 0.001) and 64 cases (p < 0.005), respectively, representing reductions of 38.3% and 31.9% compared to the PreP period, which had 94 cases. The proportion of patients in the BCLC-B stage increased from 31.9% in the PreP period to 50% during the PandP period (p = 0.0401), with fewer BCLC-A-0 cases (17% vs 5.1%; p = 0.059) during PandP. The tumor characteristics, BCLC classification, and TNM staging showed no significant differences between the PreP and PostP periods. Systemic therapy was the most commonly used treatment (39.7–50%). No significant differences were observed across treatment types when comparing all three periods (p > 0.05). The median follow-up times in the PreP, PandP, and PostP periods were 157.5, 159.5, and 183.5 days, respectively, with no statistically significant differences. The survival curve showed no statistically significant differences in survival between the groups at the nine-month follow-up (p > 0.05). Conclusions: The COVID-19 pandemic decreased HCC diagnoses, with only a partial rebound in the PostP period that did not reach PreP levels. While the PandP period showed worsening BCLC staging and an increase in tumor numbers, the tumor stage and treatment in the PostP period were similar to those in the PreP period. Similarly, the nine-month survival rates remained similar across all three periods. Full article

Background/Objectives: COVID-19 has impacted Romania’s healthcare, economy, society, and public health. This study aims to evaluate the financial impact of the COVID-19 pandemic in Romania by analyzing both hospital costs and key elements of economic costs. The assessment was conducted from the perspective of the national payer. Hospital costs were analyzed covering two distinct timeframes: Q4 2020–Q3 2021 and Q1 2022–Q4 2022. The estimation of economic costs covered Q4 2020–Q3 2021. Methods: Hospital care costs were estimated using financial data from eight hospitals. The costs were extrapolated to inpatient data from 60 public hospitals for each of the two study periods. The disease burden was determined based on official data, including the number of confirmed cases, hospital bed occupancy, reported fatalities, and various cost components from an economic perspective. Results: The findings indicate that the average hospital cost per patient episode was EUR 2267 (95% CI: 2137–2396) during the first period and EUR 2003 (95% CI: 1799–2207) in the second. The total national hospitalization expenses amounted to EUR 1.35 billion and EUR 730 million, respectively. When accounting for productivity losses and testing costs, the overall expenditure reached EUR 5.39 billion for Q4 2020–Q3 2021. Conclusions: In conclusion, the total economic burden of the COVID-19 pandemic in Romania by the end of 2021 was estimated at EUR 5.39 billion, encompassing hospitalization, isolation, premature deaths, quarantine, testing, and parental allowances. Despite the emergence of costlier treatment options, overall treatment costs declined, possibly due to increased vaccination rates. The study highlights the significant financial strain on the healthcare system and underscores the importance of evidence-based resource allocation to better manage future public health crises. Full article

Objective: We aimed to analyze the current literature for IORT in gynecological cancers and summarized clinical outcomes regarding patient selection. Methods: A systematic search was conducted utilizing PUBMED, Embase, and CINAHL to identify studies following PRISMA-ScR guidelines. A PICOS structure was utilized: population: patients with epithelial gynecological cancers; intervention: IORT; C: a comparator was not required, as we aimed to analyze patient selection; outcome: clinical outcomes and overall survival; and S: experimental and quasi-experimental analytical observational studies and descriptive observational studies, excluding case series published in English and limited to the last 10 years. Data extraction was conducted for patient selection, IORT, oncological outcomes, and morbidity. Results: A total of 707 results were identified, and 509 studies were uploaded to Covidence for screening after removing duplications. Of the 21 eligible studies, 9 were included in the final review. The total number of patients included was 348. The studies were retrospective single-institution studies, except for one. There was significant heterogeneity in their design and protocols. IORT was exclusively used for recurrent and advanced stage gynecological cancers adjunct to pelvic exenteration or laterally extended endopelvic resections with variable indications across institutions. The mean number of IORT patients per study was 2.8 per year. Survival rates were variable and dependent on the surgical margin. Endometrial cancer had a favorable outcome compared to vulvar and cervical cancers. Conclusions: Current clinical practice, as demonstrated by the research, is consistent with NCCN guidelines that endorse the application of IORT in instances of recurrent cervical, vaginal, and vulvar malignancies; however, there are no established recommendations for primary tumors. The analysis shows that there are gaps in our knowledge, mainly regarding the status of the margins, the criteria used to choose patients, and the outcomes that are specific to each histology. The standardization of protocols and prospectively powered studies are needed to refine patient selection criteria. Full article

This paper introduces a novel fractional Susceptible-Infected-Recovered ($\mathbb{SIR}$) model that incorporates a power Caputo fractional derivative (PCFD) and a density-dependent recovery rate. This enhances the model’s ability to capture memory effects and represent realistic healthcare system dynamics in epidemic modeling. The model’s utility and flexibility are demonstrated through an application using parameters representative of the COVID-19 pandemic. Unlike existing fractional $\mathbb{SIR}$ models often limited in representing diverse memory effects adequately, the proposed PCFD framework encompasses and extends well-known cases, such as those using Caputo–Fabrizio and Atangana–Baleanu derivatives. We prove that our model yields bounded and positive solutions, ensuring biological plausibility. A rigorous analysis is conducted to determine the model’s local stability, including the derivation of the basic reproduction number (${\mathbf{R}}_0$) and sensitivity analysis quantifying the impact of parameters on ${\mathbf{R}}_0$. The uniqueness and existence of solutions are guaranteed via a recursive sequence approach and the Banach fixed-point theorem. Numerical simulations, facilitated by a novel numerical scheme and applied to the COVID-19 parameter set, demonstrate that varying the fractional order significantly alters predicted epidemic peak timing and severity. Comparisons across different fractional approaches highlight the crucial role of memory effects and healthcare capacity in shaping epidemic trajectories. These findings underscore the potential of the generalized PCFD approach to provide more nuanced and potentially accurate predictions for disease outbreaks like COVID-19, thereby informing more effective public health interventions. Full article

Introduction: Respiratory syncytial virus (RSV) is the main etiological agent in pediatric lower respiratory tract infections. The limited availability of therapeutic options for severe clinical cases associated with RSV infection makes prophylactic interventions a priority for containment. The aim of the current study was to evaluate the epidemiology of RSV in the Piedmont population and the consequences of containment measures applied during the pandemic on viral circulation in the immediate and medium-term post-pandemic phase. Methods: This study considered all biological samples analyzed for RSV at the City of Health and Science of Turin collected from 1 January 2016 to 31 December 2023. Evaluation of the positivity rates of samples was performed and differences between pediatric and adult population swabs (nasopharyngeal, pharyngeal, nasal aspirates) and bronchoalveolar samples were reported. Results: This study analyzed 14,085 samples and highlighted a trend in Piedmont RSV infections characterized by a higher pediatric population involvement of 82% compared to the adult population at 17%. A higher number of URT infections (95%) compared to LRT infections (4.6%) was also identified. This study shows a peak in RSV cases from November to April between 2016 and 2020. Our data show no RSV positivity during the 2020/2021 winter season, a result most likely due to the influence of containment measures implemented during the COVID-19 pandemic. Conclusions: Our study provided an epidemiological panorama of RSV and its high prevalence in pediatrics and adults. Pediatrics had a higher prevalence, while adults presented a delayed trend of about one month compared to pediatrics. The effectiveness of infection control measures applied during the SARS-CoV-2 pandemic to limit viral infections were proved. Future studies may further investigate the impact of the SARS pandemic on RSV epidemiology considering patients at a higher risk of severe symptoms. Full article