Search Results (128)

Objectives: Telemedicine has rapidly expanded in oral and maxillofacial surgery (OMFS), especially during the COVID-19 pandemic, but its specific roles and limitations across the care pathway remain unclear. This narrative review aimed to map telemedicine modalities and indications in OMFS, summarize reported outcomes, and identify priorities for future research. Methods: A narrative synthesis was undertaken after a systematic search of medical and engineering databases to 10 October 2025. Studies applying telemedicine, telehealth, telepresence or teleradiology to OMFS practice were eligible, including trials, observational cohorts, technical reports and surveys. Data were extracted in duplicate and organized thematically; heterogeneity precluded meta-analysis. Results: Fifty studies met the inclusion criteria. Telemedicine was mainly used for preoperative consultation and triage, postoperative follow-up, trauma teleradiology and tele-expertise, oncologic and oral medicine follow-up, temporomandibular disorders, and education or humanitarian work. In low-risk outpatient and postoperative settings, remote consultations showed high concordance with in-person plans, similar complication or reattendance rates, reduced travel, and high satisfaction. In trauma networks, telemedicine supported timely triage and reduced unnecessary inter-hospital transfers. Evidence in oral oncology and complex mucosal disease was more cautious, favouring hybrid models and escalation to face-to-face assessment. Data on cost-effectiveness and impacts on equity were limited. Conclusions: Telemedicine in OMFS has moved from niche innovation to a pragmatic adjunct across the clinical pathway. Current evidence supports its use for selected pre- and postoperative care and trauma triage within risk-stratified hybrid models, while underscoring the need for stronger comparative and implementation studies, clear governance on equity and data protection, and alignment with wider digital and AI-enabled health systems. Full article

Background: Some patients suffer from persistent symptoms following a COVID-19 infection, referred to as long COVID. The aims of the study were to estimate the prevalence of long COVID and study its determinants in Tunisia. Methods: We conducted a nationwide cross-sectional study among a representative sample of COVID-19 survivors residing in Tunisia between June and August 2022. We selected a random sample, stratified by age and region, among residents registered in the national surveillance database with a SARS-CoV-2 positive test taken from September 2020 to September 2021 (n = 479,743). The expected sample size was 384. We defined a patient with long COVID as having at least one self-reported symptom persisting for more than four weeks after the first confirmation of SARS-CoV-2 infection (RT-PCR or Ag-RDT) and not explained by an alternative diagnosis. Trained healthcare workers interviewed consenting respondents by phone using a structured questionnaire. We described continuous variables using median and interquartile range (IQR). We measured the prevalence of long COVID and its 95% confidence interval (95% CI). We estimated the association between explanatory variables (socio-demographic, lifestyle and comorbidities, SARS-CoV-2 history infection, COVID-19 vaccination status) and long COVID using a log-binomial model, reporting adjusted prevalence ratios (a-PR) and its 95% CI. Results: Of 1094 persons contacted, 416 were enrolled (response rate: 38%). Long-COVID prevalence was 64% (267/416); 95% CI [59–69%]. The sex ratio (M:F) was 0.72. Age ranged from 1 to 101 years, with a median of 41 years (IQR:31–55 years). The most common symptoms were fatigue (63%), myalgia/arthralgia (33%), and cognitive symptoms (52%). Median duration of long-COVID symptoms was 11 months (IQR: 3–14 months). In multivariate analysis, experiencing acute COVID-19 (a-PR = 1.5; 95% CI [1.0–2.1]), being a woman of childbearing age (a-PR = 1.2; 95% CI [1.0–1.4]) and residing in the central region (a-PR = 1.5; 95% CI [1.1–2.0]) were significantly associated with a higher prevalence of long COVID. Conclusions: Long COVID is prevalent in Tunisia affecting patients with multiple symptoms initially, those residing in the central region and young women. We recommend to enhance healthcare access and medical follow-up both during and after the infection, focusing on identified risk groups. We also recommend to conduct further research to optimize management of long-COVID patients. Full article

Background/Objectives: To estimate (a) survival after SARS-CoV-2 infection by COVID-19 vaccination status, and (b) COVID-19 vaccine effectiveness in a middle-income country. Methods: In this retrospective cohort study, secondary analysis of data from the national surveillance and vaccination databases was conducted. The primary outcome was COVID-19 death classified based on the WHO criteria. Data were analysed by vaccination status, age, sex, geographic region, and wave period. Kaplan–Meier curves were plotted; log-rank followed by multiple comparison tests were used to compare survival probabilities. Cox proportional-hazards models with time-varying covariates estimated hazard ratios (HR). Vaccine effectiveness was computed as (1-HR) × 100. Results: A total of 55,299 COVID-19 cases were captured by the national surveillance system between 1 April and 31 December 2021. Of these, 45,774 (1581 vaccinated, 44,193 unvaccinated) were included in the analysis. After a follow-up of 327 days, there were 22 deaths (case fatality rate (CFR) 1.5%) among 1581 COVID-19 vaccinated cases and 1821 deaths (CFR 4.1%) among 44,193 unvaccinated cases. There was one COVID-19 death per 10,000 person days in vaccinated cases compared with 2.7 COVID-19 deaths per 10,000 person days in unvaccinated cases. After adjustment for age, sex, and geographic region, the effectiveness against COVID-19 death across all vaccine types (ChAdOx1 nCoV-19, BNT162b2, Ad26.COV2.S, or BBIBP-CorV) was 68% (95% CI: 51–79). Effectiveness was 75% (95% CI: 59–84) for ChAdOx1 nCoV-19. Vaccine effectiveness across all vaccine types was higher in younger cases, (82% (95% CI: 52–93), 18–64 years vs. 63% (95% CI: 41–77), ≥65 years), females (84% (95% CI: 63–93), females vs. 53% (95% CI: 24–71), males) and those vaccinated in the past 3 months (71% (95% CI: 47–85), past 0–3 months vs. 56% (95% CI: 23–75), 3–6 months). Conclusions: COVID-19 vaccines were effective in preventing COVID-19 death in a population with low vaccination coverage. Limitations of the analysis include the use of surveillance data (under-reporting of cases, missing data), exclusion of partially vaccinated cases, and insufficient data on important confounders (circulating variants and comorbidities). Full article

Background and objectives: This study examines how sociodemographic, clinical, and psychological factors within the patient–caregiver dyad affect caregiver burden and health-related quality of life (HRQoL) in cognitive impairment. By comparing baseline data with a 1-year follow-up, the research aims to identify key predictors of caregiver burden and well-being. Methods: A longitudinal observational study was conducted in an Italian rehabilitation hospital, recruiting 132 outpatients and their caregivers at baseline, categorized as (a) Mild Cognitive Impairment (MCI, n = 33); (b) dementia (DEM, n = 58); (c) healthy subjects (No-CI, n = 41). One year after baseline assessment (T0), patients were contacted and invited for an in-person follow-up re-evaluation (T1). Most attrition was related to the COVID-19 pandemic. Statistical analyses included non-parametric tests for group comparisons and stepwise multiple linear regression to identify predictors of burden, adjusting for confounders (e.g., age, gender, education, employment, co-residence). Results: A total of 51 subjects (age: 80.0 ± 6.1) and 34 caregivers (age: 58.8 ± 15.9) were evaluated. Patients were balanced by gender (53% males); most were retired (96%), married (62.7%), and cared for by sons (47%) or wife–husband (47%). Caregivers (females: 85%) were married (68.3%) and active workers (46.4%). Over one year, 17 No-CI subjects developed MCI or DEM; 15 MCI patients progressed to DEM. Caregiver HRQoL negatively correlated with distress and burden in MCI and DEM groups. Patient cognitive status, functional abilities, neuropsychiatric symptoms, and gender predicted caregiver burden, emphasizing the interplay between clinical and demographic factors. Conclusions: It is essential to monitor psychosocial factors in both the patient and the caregiver to develop effective prevention and support strategies. Full article

Background/Objectives: The COVID-19 pandemic limited access to in-person physiotherapy, raising concerns about post-operative rehabilitation outcomes. This prospective observational study, without a control group, evaluated whether a self-rehabilitation protocol following a mini-open Learjet procedure influenced short-term clinical outcomes in active military personnel. Materials and Methods: We prospectively enrolled 18 patients (19 shoulders) undergoing mini-open Latarjet between May and October 2020. Patients performed a standardized self-rehabilitation protocol starting on the first post-operative day, with progressive range-of-motion (ROM) exercises added at two weeks. Pain was assessed using the Visual Analog Scale (VAS), ROM was recorded at each follow-up, complications were noted, and patient satisfaction was evaluated at 12 weeks. Results: A total of eighteen patients were prospectively enrolled in the study. At 12 weeks, mean VAS decreased from 1.2 ± 0.6 at week 1 to 0 at week 4 onward. The mean drug consumption was 2.5 ± 0.7 tablets/day only for the first week. Mean assisted forward flexion improved from 155° ± 10° at week 1 to 180° in all patients by week 4. External rotation reached 60° ± 5°at 4 weeks, 75° ± 4° at 8 weeks, and 80° ± 3°at 12 weeks, with no deficits compared to the contralateral side. Internal rotation improved to the T7 level by week 8 and remained stable in week 12. No complications, recurrent instability, or graft displacements were reported. Patient satisfaction at 12 weeks was assessed using a 0–10 numeric rating scale, with a mean score of 9.5 ± 0.4. Conclusions: Implementation of a self-rehabilitation protocol after mini-open Latarjet surgery was associated with favorable short-term outcomes in young military patients, including early recovery, high satisfaction, and absence of complications. Further validation of these findings will require larger, rigorously controlled studies. Full article

Background: Telemedicine expanded dramatically during the COVID-19 pandemic, transforming healthcare delivery worldwide. However, implementation faced challenges, and the impact on clinical outcomes, access, and quality remains under investigation. Objective: To systematically review the literature from 2020 to 2025 on telemedicine adoption, identifying key barriers and facilitators, and to evaluate clinical outcomes associated with telehealth use during this period. Methods: We followed PRISMA 2020 guidelines in conducting this review. Multiple databases were searched for studies on the implementation or evaluation of telemedicine/telehealth. Eligible studies included randomized trials and observational studies reporting telehealth-related outcomes, barriers, or facilitators. Two reviewers screened studies and extracted data on study characteristics, telemedicine interventions, barriers/facilitators, and clinical outcomes. Risk of bias was assessed using RoB2 for randomized controlled trials (RCTs) for qualitative or cross-sectional studies. Meta-analyses were performed where data were comparable, and qualitative synthesis was used to summarize barriers and facilitators. Results: Thirty-two studies (17 RCTs and 15 observational) were included. Telemedicine use surged in 2020 and remained elevated compared to baseline through August 2025. Reported barriers included insufficient broadband access, limited digital literacy, uncertain reimbursement policies, and workflow disruptions. Facilitators encompassed supportive policy waivers, the integration of telehealth into established care pathways, and strong acceptance from patients and providers. Clinical outcomes were generally comparable to in-person care. Telehealth enhanced chronic disease management (e.g., hypertension, diabetes) and decreased hospitalizations for heart failure, while ensuring safety in surgical follow-up and prenatal care. However, higher revisit rates were observed in some acute follow-up settings. Patient satisfaction consistently remained high, especially among rural and underserved populations reporting benefits, though disparities in digital access continued to exist. Conclusions: Telemedicine has become a sustainable component of healthcare, delivering clinical outcomes comparable to traditional care while offering convenience and resilience. Overcoming technology gaps, regulatory uncertainties, and equity issues is crucial for ongoing progress. Hybrid care models that combine telemedicine with in-person services, supported by strong policy frameworks, are recommended to maximize benefits and promote fair access in the post-pandemic era. Full article

Background: The COVID-19 pandemic profoundly disrupted healthcare systems worldwide, compelling rapid adaptation of clinical workflows and accelerating the integration of telemedicine. Objective: This study evaluates the implementation of telemedicine in neurosurgical outpatient care at a tertiary referral hospital in Madrid during the first epidemic wave (March–May 2020) and explores its long-term significance five years later. Methods: A retrospective observational analysis including 5175 neurosurgical outpatient consultations was conducted, comparing the first epidemic wave of COVID-19 (2070 teleconsultations) with the equivalent period in 2019 (3105 in-person visits). Demographic, clinical, and procedural data were analyzed, including six-month follow-up outcomes. Univariate and multivariate analyses were performed to identify factors associated with teleconsultation use and follow-up delay. Results: The total number of consultations decreased by 33% compared to the pre-pandemic year. In May 2020, teleconsultations represented more than 70% of all visits. Continuity of care was preserved (follow-up adherence >80%), and missed appointments declined to zero. Cranial and oncological pathologies were prioritized, while degenerative and benign cases were largely deferred. Teleconsultation independently predicted delayed six-month follow-up (aOR 1.9, 95% CI 1.3–2.8, p = 0.002) and a lower likelihood of surgical indication (aOR 0.4, 95% CI 0.2–0.7, p = 0.004). Despite these differences, remote care ensured accessibility, safety, and clinical continuity under extreme healthcare system strain. Five years perspective: In addition to these early outcomes, the study describes the sustained integration of telemedicine during the subsequent five years, illustrating how this model became permanently embedded in routine neurosurgical practice in this center. Conclusions: This study represents one of the earliest structured telemedicine experiences in Spanish neurosurgery. The rapid adaptation of the Hospital General Universitario Gregorio Marañón ensured care continuity during the pandemic and catalyzed the lasting adoption of hybrid models that enhance accessibility, safety, efficiency, and healthcare system resilience. Full article

Background: Dose-sparing approaches can be effective in maintaining immunogenicity and safety while expanding vaccine coverage. We previously demonstrated that a half dose of ChAdOx1 nCoV-19 is as effective and immunogenic for primary vaccination. Methods: This non-inferiority, non-randomized controlled trial evaluated the effectiveness, humoral, and cellular immune responses of a third booster dose—comparing half-dose and full-dose regimens—in individuals aged 18–49 years, with a 1-year follow-up. Results: A total of 2801 participants were enrolled: 2352 received half doses and 449 received full doses. The incidence rate of COVID-19 was 225.0 per 1000 person-years in the half-dose group and 173.8 in the full-dose group, with no significant difference in effectiveness (β = −0.05; 95% CrI: −0.24 to 0.15). No deaths occurred, and hospitalization rates were similar. In a subsample (n = 558), anti-S IgG levels peaked 28 days post-dose and declined by day 180 after the primary series [175 (121–252) vs. 121 (71–208) GMT, p < 0.001], but remained elevated after the booster [192.1 (124–297) vs. 550 (380–797) GMT, p < 0.001]. Booster antibody levels were similar between groups [592.4 (318–1140) vs. 550 (380–797) GMT]. The half-dose group showed high titers against Omicron and robust T/B-cell responses (e.g., EMCD4, EMCD8, IFN⁺CD4⁺, CD19⁺TNF⁺). Conclusions: Fractional half dose of ChAdOx nCov-19 was effective and non-inferior to a full booster dose. Homologous regimen with 3 half doses or 3 full doses induced a similar increase in antibody titers and robust cellular response. ClinicalTrials.gov (NCT05059106). Full article

Background/Objectives: Bitter Taste Receptors (encoded by TAS2R genes) are expressed in mucosal and bronchial epithelia, as well as in immune cells, contributing to defense against airborne pathogens such as SARS-CoV-2. Data on single-nucleotide polymorphisms (SNPs) in TAS2R genes or pseudogenes in COVID-19 are limited. This study examined the association between TAS2R SNPs and COVID-19 infection and seroconversion in European individuals participating in the Canadian Longitudinal Study on Aging. Methods: Data from the Genome-wide Genetic Data, Comprehensive Baseline (version 7.0), Follow-up 2 (version 1.1), COVID-19 Questionnaire Study (4-2020 to 12-2020), and COVID-19 Seroprevalence (Antibody) Study (11-2020 to 7-2021) datasets were accessed. Associations of TAS2R SNPS with COVID-19 infection or seroconversion were determined using logistic regression adjusted for sociodemographics, genetic principal components, smoking, vaccine doses, and chronic medical conditions (diabetes, immune-mediated inflammatory diseases (IMIDs), respiratory disease, and cardiovascular disease). Results: In the COVID-19 Questionnaire Study (N = 14,073), the rs117458236 (C) variant in TAS2R20 showed a trend toward an association with COVID-19 infection (OR = 1.95; 95% Confidence Interval (CI): 0.98, 3.51). In the COVID-19 Antibody Study (N = 8313), the rs2234235(G) variant in TAS2R1 was associated with anti-nucleocapsid (OR = 1.55; CI: 1.06, 2.20) and anti-spike response (OR = 0.74; CI: 0.57, 0.98); the rs2234010(A) variant in TAS2R5 was associated with anti-nucleocapsid (OR = 1.56; CI: 1.08, 2.19); and the rs34039200(A) variant in TAS2R62P was associated with anti-spike (OR = 0.86; CI: 0.77, 0.97). In a subgroup analysis, the rs2234235(G) variant in TAS2R1 was associated with a decreased anti-spike response to infection or vaccination in individuals with IMIDs or respiratory disease and an increased risk of SARS-CoV-2 infection. Conclusions: TAS2R variants are associated with COVID-19 infection and vaccine response. These data may inform personalized management and vaccination strategies. Full article

Aims: To analyze the psychological impact of the COVID-19 pandemic on nursing students who had just completed their first period of clinical placement and compare these results with a study previously conducted on the same students during their university education. Design: A pre–post design was used. Methods: Students who had already participated in a previous (February 2021) related study were sent a follow-up questionnaire (response rate = 52.8%) at the end of their clinical placement training period (June 2021). Descriptive analyses of the study variables were conducted, and burnout levels were estimated after the students had completed their clinical placement. Predictive models for the three dimensions of burnout were then obtained using multiple linear regression. Results: The study results suggest that a high proportion (47.2%) of nursing students who performed their first clinical placements during the COVID-19 pandemic experienced high levels of burnout. However, engagement was a protective factor against fear of COVID-19, anxiety, neuroticism, emotional exhaustion and reduced personal accomplishment. Conclusions: Nursing students who completed their first clinical placements during the COVID-19 pandemic were more likely to exhibit high levels of burnout and showed significant changes in their psychological dimensions. A risk profile should be established to identify the nursing students most vulnerable to developing high levels of burnout. Full article

Introduction: The change in environmental and social context during the COVID-19 pandemic affected daily activities of people with spinal cord injury (SCI), their interactions within the community, and, consequently, their social participation during the first wave of the pandemic. However, there is little information about the changes in social participation as the pandemic evolved in Canada. Objective: Our aim was to explore the change in the social participation of adults with SCI after the first two years of the COVID-19 pandemic in Canada. Methods: A follow-up from a previous study exploring the social participation of adults with SCI living during the first wave was conducted eight months later (second wave). Social participation was measured using the Assessment of Life Habits (LIFE-H 4.0) and Measure of Quality of the Environment (MQE) among 18 adults with SCI. Results: Participants reported increases between both waves of COVID-19 in some life habit categories, including mobility, personal care and health, nutrition, and recreation. New environmental factors were identified as facilitators, including the increased availability of businesses in the community. Conclusion: These findings indicate that people with SCI experienced greater realization and satisfaction with certain life habits. Although most barriers and facilitators showed little or no change between the two waves, the reduction in environmental barriers and the increase in facilitators may have contributed to improved social participation as the pandemic progressed. Full article

The COVID-19 pandemic exacerbated mental illness, accelerated cognitive decline, and deepened social inequalities. In low and middle-income countries (LMIC) such as Panama, it is unclear as to whether, and to what extent, the pandemic lockdowns affected cognitive, mental, and physical health of older adults. This study investigated changes in cognitive function, mental health, and physical health in a sample of Panamanian older adults assessed before and during the pandemic, and examined whether sociodemographic variables were associated with cognition and mental health. Participants completed in-person interviews between 2018 and early 2020 and a follow-up telephone interview between February and May 2021. Repeated measures analyses showed no significant changes in cognitive function or depression; however, participants reported fewer chronic illnesses. Linear regression analysis indicated that higher cognitive function during the pandemic was associated with younger age, higher education, and having sufficient income. An attrition analysis compared participants who completed both interviews to those who were lost to follow-up, revealing that participants who dropped out of the study had lower socioeconomic status and greater impairment at baseline. These findings highlight the need for targeted support for vulnerable older adults during public health crises. Full article

College students are particularly vulnerable to psychological distress, including anxiety, depression, and chronic stress, often triggered by academic pressure, developmental challenges, and events such as the COVID-19 pandemic. This study examined the effectiveness and feasibility of a structured mindfulness-based program—Mindfulness Laboratory (MLAB)—delivered over three academic years to psychology students in Italy through online, hybrid, and in-person formats. A total of 194 students participated, with 176 completing pre- and post-intervention assessments. Standardized self-report measures evaluated mindfulness (FFMQ, MAAS), perceived stress (PSS), resilience (RS-14), sleep quality (PSQI), depressive symptoms (BDI-II), anxiety (STAI-Y1, STAI-Y2), and self-compassion (SCS). A non-randomized control group of 51 students who did not undergo the intervention was also included. The results showed significant improvements in mindfulness, perceived stress, anxiety, and depression, with a smaller but significant increase in resilience. Sleep quality remained stable, while self-compassion levels slightly declined. Surprisingly, no significant differences were found across the three delivery formats, suggesting comparable effectiveness regardless of modality. These results support the feasibility and benefits of mindfulness-based interventions for university students. Further controlled studies with long-term follow-up are needed to confirm upon these findings. Full article

Background: Food insecurity and social isolation among older adults are pressing public health concerns that significantly impact physical and mental health outcomes. The COVID-19 pandemic exacerbated these challenges while forcing innovative adaptations to traditional congregate meal programs. Objective: This study examined the effectiveness of Kūpuna U, an alternative flexible congregate meal program comprising three models (virtual, hybrid, and traditional), in addressing food insecurity, loneliness, and self-rated health among older adults in Hawaiʻi. Methods: A quasi-experimental study with non-equivalent groups analyzed secondary program evaluation data. Participants (N = 270, follow-up N = 116) self-selected into virtual (grab-and-go meals + online activities), hybrid (grab-and-go meals + virtual and in-person activities), or traditional (in-person congregate meals + in-person activities) models. Food insecurity (6-item scale), loneliness (UCLA 3-item scale), and self-rated health (5-point scale) were measured at the baseline and 6-month follow-up. Results: The Virtual group showed significant improvements in food insecurity (baseline: 1.73 to follow-up: 0.04, p < 0.001) and self-rated health (baseline: 2.92 to follow-up: 3.72, p = 0.005). The Hybrid group demonstrated a significant increase in loneliness (baseline: 4.25 to follow-up: 5.00, p = 0.024). The Traditional group showed no significant changes in any outcome measures. Analysis of variance (ANOVA) revealed significant between-group differences for food insecurity (F = 9.047, p < 0.001) and self-rated health (F = 5.814, p = 0.004) change scores. Conclusions: The Virtual model demonstrated a superior effectiveness in improving food security and self-rated health outcomes. However, self-selection bias limits causal inferences. These findings suggest that flexible, technology-enhanced nutrition programs may effectively serve older adults with mobility or transportation barriers while maintaining program benefits. Full article

Background: Women carry out an array of demanding tasks due to their multiple roles as mothers, workers, spouses, and caregivers. Their responsibilities to the family and society are essential throughout life, but they become even more important at times of crisis and unanticipated events. All these obligations may have a detrimental effect on their mental health and general well-being. According to the social model of health, through personal development groups, women improve their health because they can transform their personalities, enhance their social and personal abilities, and strengthen their resilience to unforeseen occurrences, health crises, and adversity. Aim of the study: This follow-up study examined the viewpoints of women regarding the durability and efficacy of group therapy’s positive impact on their resilience and mental health, especially through unforeseen circumstances and crises. This group of women had taken part in group therapy six years ago to strengthen their resilience and improve their mental health. Methods: Data collection was implemented through semi-structured in-person interviews conducted from December 2020 to March 2021. Five topics emerged from the framework analysis: (a) personal development and mental health; (b) reinforcement of their resilience; (c) group therapy and women’s health during the COVID-19 pandemic; (d) an assessment of group therapy on women’s health through imagery; (e) future recommendations. Results: Most of the women stated that group treatment had a beneficial impact in terms of improving their individual abilities. The group experience was described as a bridge that allowed them to recognize and accept their emotions. Since COVID-19, women have developed helpful coping strategies to deal with daily tension, loneliness, and work-related stress. Conclusions: Our research results indicate that group therapy is a useful tool for women’s empowerment and mental health in times of crises and adversity. Social policy should take it into account in order to meet women’s highly demanding roles and personal needs. Full article